Guyana - Demographic and Health Survey - 2010

Publication date: 2010

Guyana Demographic and Health Survey 2009 G uyana 2009 D em ographic and H ealth Survey Guyana Demographic and Health Survey 2009 Ministry of Health Georgetown, Guyana Bureau of Statistics Georgetown, Guyana ICF Macro (Technical Assistance) October 2010 Ministry of Health This report summarizes the results of the 2009 Guyana Demographic and Health Survey (2009 GDHS), implemented by the Ministry of Health (MOH) and the Bureau of Statistics (BOS), with technical assistance from ICF Macro. Funds for the survey were provided in their entirety by the local mission of the United States Agency for International Development (USAID/Guyana) under the MEASURE DHS program. The 2009 GDHS is part of the worldwide MEASURE DHS program, which is designed to assist developing countries to collect, analyze, and disseminate data on fertility, family planning, and maternal and child health. Additional information about the 2009 GDHS may be obtained from Bureau of Statistics (BOS) Avenue of the Republic and Brickdam, Stabroek Georgetown, Guyana Telephone: 592 225 6150 Fax: 592 226 2036 Web site: www.statisticsguyana.gov.gy Additional information about the Demographic and Health Surveys program may be obtained from MEASURE DHS, ICF Macro 11785 Beltsville Drive, Suite 300 Calverton, MD 20705 USA Telephone: 301-572-0200; fax: 301-572-0999 Email: reports@measuredhs.com Web site: www.measuredhs.com Suggested citation: Ministry of Health (MOH), Bureau of Statistics (BOS), and ICF Macro. 2010. Guyana Demographic and Health Survey 2009. Georgetown, Guyana: MOH, BOS, and ICF Macro. Contents | iii CONTENTS Páge TABLES AND FIGURES . ix FOREWORD .xvii SUMMARY OF FINDINGS . xix BASIC INDICATORS . xxix MAP OF GUYANA . xxx CHAPTER 1 INTRODUCTION 1.1 Overview . 1 1.2 Objectives. 1 1.3 Sample Design. 1 1.4 Questionnaires . 2 1.5 Pretest Activities, Training, and Fieldwork. 3 1.6 Data Processing . 3 1.7 Response Rates. 3 1.8 Contents of the Report. 5 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Population. 9 2.1.1 Age-Sex Structure . 9 2.1.2 Household Composition . 11 2.1.3 Children’s Living Arrangements and Orphanhood . 12 2.1.4 Educational Attainment. 14 2.1.5 School Attendance. 17 2.2 Housing Characteristics. 20 2.2.1 Drinking Water and Housing Characteristics. 20 2.2.2 Sanitation Facilities . 24 2.2.3 Household Possessions. 25 2.3 Wealth Quintiles. 26 2.4 Birth Registration . 27 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Survey Respondents. 29 3.2 Educational Attainment of Respondents . 31 3.3 Literacy. 33 3.4 Exposure and Access to Mass Media . 36 3.5 Employment Status and Type of Occupation. 38 3.6 Health Insurance Coverage . 44 iv │ Contents 3.7 Knowledge and Attitudes Concerning Tuberculosis . 47 3.8 Smoking . 50 CHAPTER 4 FERTILITY 4.1 Current Fertility. 53 4.2 Fertility Differentials. 55 4.3 Fertility Trends. 56 4.4 Children Ever Born and Living . 57 4.5 Birth Intervals. 58 4.6 Age at First Birth. 60 4.7 Teenage Pregnancy and Motherhood . 62 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods. 65 5.2 Knowledge of Contraception by Background Characteristics . 67 5.3 Ever Use of Contraceptive Methods . 67 5.4 Current Use of Contraception. 69 5.5 Differentials in Current Use . 71 5.6 Number of Children at First Use of Contraception . 73 5.7 Use of Social Marketing of Brands of Pills and Condoms. 74 5.8 Sources for Family Planning Methods and Informed Choice . 75 5.9 Contraceptive Discontinuation . 78 5.10 Intention to Use Family Planning Among Non-users . 78 5.11 Exposure to Family Planning in the Mass Media. 81 5.12 Contact of Non-users with Family Planning Providers . 83 5.13 Husband/Partner's Knowledge of Women's Use of Contraception . 84 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status . 85 6.2 Age at First Union . 87 6.3 Age at First Sexual Intercourse . 90 6.4 Recent Sexual Activity. 93 6.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility. 96 6.6 Termination of Exposure to Pregnancy. 98 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children . 101 7.2 Desire to Limit Childbearing by Background Characteristics. 104 7.3 Need and Demand for Family Planning Services. 106 7.4 Ideal Family Size. 110 7.5 Fertility Planning Status . 111 7.6 Wanted Fertility Rates. 112 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definition, Data Quality, and Methodology. 115 8.2 Current Estimates of Infant and Child Mortality. 116 Contents | v 8.3 Differentials in Infant and Child Mortality . 117 8.4 Perinatal Mortality. 120 8.5 High-Risk Fertility Behavior. 122 CHAPTER 9 REPRODUCTIVE HEALTH 9.1 Antenatal Care. 125 9.1.1 Content of Antenatal Care. 128 9.1.2 Tetanus Toxoid Injections . 129 9.2 Delivery Care . 131 9.3 Postnatal Care. 135 9.4 Problems in Accessing Health Care . 139 CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth . 141 10.2 Vaccination of Children . 143 10.2.1 Vaccination at Any Time before the Survey . 143 10.2.2 Trends in Vaccination Coverage . 146 10.3 Acute Respiratory Infection . 147 10.4 Fever. 149 10.5 Diarrhea: Prevalence and Treatment . 151 10.5.1 Prevalence of Diarrhea . 151 10.5.2 Treatment of Diarrhea . 153 10.5.3 Feeding Practices during Diarrhea . 154 10.5.4 Knowledge of ORS Packets . 155 10.5.5 Disposal of Stools. 156 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Nutritional Status of Young Children . 159 11.2 Breastfeeding. 165 11.2.1 Initial Breastfeeding . 165 11.2.2 Breastfeeding Status by Age . 167 11.2.3 Duration and Frequency of Breastfeeding. 169 11.3 Complementary Foods . 170 11.4 Appropriate Infant and Young Child Feeding (IYCF) . 172 11.5 Anemia in Children . 175 11.6 Micronutrient Intake among Children . 177 11.7 Presence of Iodized Salt in Households . 180 11.8 Nutritional Status of Women and Men. 181 11.9 Foods Consumed by Mothers. 184 11.10 Anemia in Women and Men . 186 11.11 Micronutrient Intake among Mothers. 189 vi │ Contents CHAPTER 12 MALARIA 12.1 Ownership of Mosquito Nets . 191 12.2 Use of Mosquito Nets by Children. 193 12.3 Use of Mosquito Nets by Women . 195 12.4 Malaria during Pregnancy . 197 12.5 Prevalence and Management of Childhood Malaria . 199 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Knowledge of AIDS. 201 13.2 Knowledge of HIV Prevention Methods. 203 13.3 Beliefs about AIDS . 206 13.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 210 13.5 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS. 212 13.6 Attitudes toward Negotiating Safer Sex . 215 13.7 Attitudes toward Condom Education for Youth. 217 13.8 Higher-Risk Sex . 218 13.8.1 Multiple Partners and Condom Use . 218 13.8.2 Transactional Sex . 222 13.9 Coverage of Prior HIV Testing . 222 13.9.1 HIV Testing during Antenatal Care . 226 13.10 Male Circumcision . 228 13.11 Self-Reporting of Sexually Transmitted Infections. 229 13.12 Prevalence of Medical Injections . 231 13.13 HIV/AIDS-Related Knowledge and Sexual Behavior among Young Adults . 234 13.13.1 HIV/AIDS-Related Knowledge among Young Adults . 234 13.13.2 Age at First Sex . 236 13.13.3 Condom Use at First Sex. 238 13.13.4 Abstinence and Premarital Sex. 240 13.13.5 Higher-Risk Sex and Condom Use among Young Adults . 242 13.13.6 Age Mixing in Sexual Relationships among Women . 244 13.13.7 Drunkenness during Sex among Young Adults . 246 13.13.8 Recent HIV Testing among Youth. 248 CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14.1 Employment and Forms of Earnings. 251 14.2 Control over Women’s and Men’s Earnings . 252 14.3 Women’s Participation in Household Decision-Making. 257 14.4 Attitudes toward Wife Beating. 262 14.5 Attitudes toward Refusing Sex with Husband. 266 14.6 Women’s Empowerment Indicators . 271 14.7 Current Use of Contraception by Women’s Status . 272 14.8 Ideal Family Size and Unmet Need by Women’s Status . 273 14.9 Reproductive Health Care and Women’s Empowerment Status. 274 Contents | vii REFERENCES . 277 APPENDIX A SAMPLE DESIGN. 279 A.1 Sample Frame . 279 A.2 Sample Selection . 279 A.3 Sample Allocation . 280 A.4 Response Rates. 281 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 285 APPENDIX C DATA QUALITY TABLES. 309 APPENDIX D SURVEY PERSONNEL . 315 APPENDIX E QUESTIONNAIRES . 317 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews .4 Table 1.2 Number of women and men interviewed by residence and region.5 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence .10 Table 2.2 Household composition .11 Table 2.3 Children’s living arrangements and orphanhood.13 Table 2.4.1 Educational attainment of the female household population.15 Table 2.4.2 Educational attainment of the male household population.16 Table 2.5 School attendance ratios .18 Table 2.6 Household drinking water.21 Table 2.7 Housing characteristics.23 Table 2.8 Sanitation facilities .24 Table 2.9 Durable goods.25 Table 2.10 Wealth quintiles .27 Table 2.11 Birth registration of children under age 5.28 Figure 2.1 Population Pyramid .10 Figure 2.2 Percentage of Female-Headed Households by Residence.12 Figure 2.3 Age-Specific School Attendance Rates, by Sex .19 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents.29 Table 3.2.1 Educational attainment of respondents: Women .30 Table 3.2.2 Educational attainment of respondents: Men.32 Table 3.3.1 Literacy: Women .34 Table 3.3.2 Literacy: Men .35 Table 3.4.1 Exposure to mass media: Women.36 Table 3.4.2 Exposure to mass media: Men.37 Table 3.5 Employment status .39 Table 3.6.1 Occupation: Women .42 Table 3.6.2 Occupation: Men .43 Table 3.7 Type of employment.44 Table 3.8.1 Health insurance coverage: Women .45 Table 3.8.2 Health insurance coverage: Men .46 Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women.48 Table 3.9.2 Knowledge and attitudes concerning tuberculosis: Men .49 Table 3.10.1 Use of tobacco: Women .51 Table 3.10.2 Use of tobacco: Men.52 x | Tables and Figures Figure 3.1 Respondents Completing Secondary or Higher Education, by Residence and Wealth Quintile.33 Figure 3.2 Respondents Currently Employed, by Residence and Education.41 CHAPTER 4 FERTILITY Table 4.1 Current fertility .54 Table 4.2 Fertility by background characteristics.55 Table 4.3 Trends in age-specific fertility rates .56 Table 4.4 Children ever born and living .57 Table 4.5 Birth intervals .59 Table 4.6 Age at first birth.61 Table 4.7 Median age at first birth by background characteristics .62 Table 4.8 Teenage pregnancy and motherhood .63 Figure 4.1 Total Fertility Rates for the Three Years Preceding the Survey, by Residence.54 Figure 4.2 Births with a Birth Interval of Less than 24 Months, by Residence and Wealth Quintile.60 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .66 Table 5.2 Knowledge of contraceptive methods by selected background characteristics .67 Table 5.3 Ever use of contraception by age: Women .68 Table 5.4 Ever use of contraception by age: Men .69 Table 5.5 Current use of contraception by age .70 Table 5.6 Current use of contraception by background characteristics .72 Table 5.7 Number of children at first use of contraception .74 Table 5.8.1 Brand of pills .74 Table 5.8.2 Brand of condoms.75 Table 5.9 Source of modern contraception methods .76 Table 5.10 Informed choice.77 Table 5.11 First-year contraceptive discontinuation rates .78 Table 5.12 Future use of contraception among non-users .79 Table 5.13.1 Reasons for not intending to use contraception .80 Table 5.13.2 Preferred method of contraception for future use.81 Table 5.14 Exposure to family planning messages.82 Table 5.15 Contact of non-users with family planning providers .83 Figure 5.1 Contraceptive Use among Currently Married Women, by Region.73 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status by age and sex .86 Table 6.2 Current marital status by background characteristics .87 Table 6.3 Age at first union .88 Table 6.4 Median age at first union by background characteristics .89 Table 6.5.1 Age at first sexual intercourse: Women.91 Table 6.5.2 Age at first sexual intercourse: Men.91 Table 6.6.1 Median age at first sexual intercourse, by background characteristics: Women .92 Table 6.6.2 Median age at first sexual intercourse, by background characteristics: Men .93 Table 6.7.1 Recent sexual activity: Women .94 Tables and Figures | xi Table 6.7.2 Recent sexual activity: Men.94 Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility .97 Table 6.9 Median duration of postpartum insusceptibility by background characteristics.98 Table 6.10 Menopause.99 Figure 6.1 Median Age at First Sexual Intercourse by Region.92 CHAPTER 7 FERTILITY PREFERENCES Table 7.1.1 Fertility preferences by number of living children .102 Table 7.1.2 Fertility preferences by background characteristics .103 Table 7.2 Desire to limit childbearing by background characteristics.105 Table 7.3 Need and demand for family planning .108 Table 7.4 Ideal number of children.111 Table 7.5 Fertility planning status .112 Table 7.6 Wanted fertility rates .113 Figure 7.1 Fertility Practices of Women in Union.104 Firuge 7.2 Desire for No More Children by Region .106 Figure 7.3 Components of the Unmet Need for Family Planning .109 Figure 7.4 Women with Unmet Need and Demand Satisfied, by Region.109 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates .117 Table 8.2 Early childhood mortality rates by socioeconomic characteristics.118 Table 8.3 Early childhood mortality rates by demographic characteristics.119 Table 8.4 Perinatal mortality .121 Table 8.5 High-risk fertility behavior .123 Figure 8.1 Infant Mortality Rates for the 10-Year Period Preceding the Survey, by Residence and Wealth Quintile .119 Figure 8.2 Births in the Last Five Years and Women in Categories of High-risk Fertility Behavior.124 CHAPTER 9 REPRODUCTIVE HEALTH Table 9.1 Antenatal care .126 Table 9.2 Number of antenatal care visits and timing of first visit.127 Table 9.3 Components of antenatal care.129 Table 9.4 Tetanus toxoid injections.130 Table 9.5 Place of delivery .133 Table 9.6 Assistance during delivery.134 Table 9.7 Timing of postnatal care .137 Table 9.8 Type of provider of first postnatal checkup.138 Table 9.9 Problems in accessing health care .140 Figure 9.1 Two Tetanus Vaccinations during Last Pregnancy and Births Protected against Neonatal Tetanus, by Residence .131 xii | Tables and Figures CHAPTER 10 CHILD HEALTH Table 10.1 Child’s weight and size at birth .142 Table 10.2 Vaccinations by source of information.143 Table 10.3 Vaccinations by background characteristics.144 Table 10.4 Vaccinations in the first 18 months of life.147 Table 10.5 Prevalence and treatment of symptoms of acute respiratory infection (ARI).148 Table 10.6 Prevalence and treatment of fever .150 Table 10.7 Prevalence of diarrhea .152 Table 10.8 Diarrhea treatment .154 Table 10.9 Feeding practices during diarrhea.155 Table 10.10 Knowledge of ORS packets or pre-packaged ORS liquid.156 Table 10.11 Disposal of children's stools .157 Figure 10.1 Vaccination Coverage at Any Time before the Survey among Children 18-29 Months.145 Figure 10.2 Children Age 18-29 Months with All Vaccines at Any Time before the Survey, by Residence .145 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1.1 Nutritional status of children by demographic characteristics.162 Table 11.1.2 Nutritional status of children by socioeconomic characteristics .164 Table 11.2 Initial breastfeeding .166 Table 11.3 Breastfeeding status by child’s age.168 Table 11.4 Median duration and frequency of breastfeeding .170 Table 11.5 Foods consumed by children in the day or night preceding the interview .171 Table 11.6 Infant and young child feeding (IYCF) practices .174 Table 11.7 Prevalence of anemia in children.176 Table 11.8 Micronutrient intake among children .179 Table 11.9 Presence of iodized salt in the household .180 Table 11.10.1 Nutritional status by background characteristics: Women .182 Table 11.10.2 Nutritional status by background characteristics: Men.183 Table 11.11 Foods consumed by mothers in the day or night preceding the interview.185 Table 11.12.1 Prevalence of anemia: Women .187 Table 11.12.2 Prevalence of anemia: Men .188 Table 11.13 Micronutrient intake among mothers.190 Figure 11.1 Nutritional Status of Children under Age 5 .153 Figure 11.2 Children under Five Stunted and Underweight, by Residence .165 Figure 11.3 Infant Feeding Practices by Age.169 CHAPTER 12 MALARIA Table 12.1 Household possession of mosquito nets .192 Table 12.2 Use of mosquito nets by children .194 Table 12.3.1 Use of mosquito nets by women.196 Table 12.3.2 Use of mosquito nets by pregnant women.198 Table 12.4 Prevalence and prompt treatment of children with fever.200 Tables and Figures | xiii CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 13.1 Knowledge of AIDS .202 Table 13.2 Knowledge of HIV prevention methods.204 Table 13.3.1 Comprehensive knowledge about AIDS: Women.208 Table 13,3,2 Comprehensive knowledge about AIDS: Men .209 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV.211 Table 13.5.1 Accepting attitudes toward those living with HIV: Women.213 Table 13.5.2 Accepting attitudes toward those living with HIV: Men.214 Table 13.6 Attitudes toward negotiating safer sex with husband .216 Table 13.7 Adult support of education about condom use to prevent AIDS.217 Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women.220 Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men .221 Table 13.9.1 Coverage of prior HIV testing: Women .224 Table 13.9.2 Coverage of prior HIV testing: Men.225 Table 13.10 Pregnant women counseled and tested for HIV.227 Table 13.11 Male circumcision .228 Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms.230 Table 13.13 Prevalence of medical injections .232 Table 13.14 Comprehensive knowledge about AIDS and of a source for condoms among youth .235 Table 13.15 Age at first sexual intercourse among youth .237 Table 13.16 Condom use at first sexual intercourse among youth .239 Table 13.17 Premarital sexual intercourse in the past year and condom use during premarital sexual intercourse among youth .241 Table 13.18 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months .243 Table 13.19 Age mixing in sexual relationships among women age 15-19 .245 Table 13.20 Drunkenness during sexual intercourse among youth .247 Table 13.21 Recent HIV tests among youth .249 Figure 13.1 Knowledge of Two HIV Prevention Methods (Using Condoms and Limiting Sexual Intercourse to One Uninfected Faithful Partner), by Residence and Education .206 Figure 13.2 Comprehensive Knowledge about AIDS, by Residence and Education .210 Figure 13.3 Women and Men Seeking Treatment for STIs .231 Figure 13.4 Type of Facility Where Last Medical Injection Was Received.233 Figure 13.5 Abstinence, Being Faithful, and Condom Use (ABC) among Young Women and Men Age 15-24 .244 CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 14.1 Employment and cash earnings of currently married women and men.252 Table 14.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women.253 Table 14.2.2 Control over men's cash earnings .255 Table 14.3 Women's control over her own earnings and over those of her husband.256 xiv | Tables and Figures Table 14.4.1 Women's participation in decision making.257 Table 14.4.2 Women's participation in decision making according to men .258 Table 14.5.1 Women's participation in decision-making by background characteristics.259 Table 14.5.2 Men's attitude toward wives' participation in decision making .261 Table 14.6.1 Attitude toward wife beating: Women .264 Table 14.6.2 Attitude toward wife beating: Men.265 Table 14.7.1 Attitude toward refusing sexual intercourse with husband: Women .267 Table 14.7.2 Attitude toward refusing sexual intercourse with husband: Men .268 Table 14.7.3 Men's attitude toward a husband's rights when his wife refuses to have sexual intercourse .270 Table 14.8 Indicators of women's empowerment .272 Table 14.9 Current use of contraception by women's status.273 Table 14.10 Women's empowerment and ideal number of children and unmet need for family planning.274 Table 14.11 Reproductive health care by women's empowerment.275 Figure 14.1 Number of Decisions in Which Currently Married Women Participate.262 APPENDIX A SAMPLE DESIGN Table A.1 Sample allocation .281 Table A.2.1 Sample implementation by residence .282 Table A.2.2 Sample implementation by region .283 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors.287 Table B.2.1 Sampling errors for the total sample.288 Table B.2.2 Sampling errors for the Urban sample.289 Table B.2.3 Sampling errors for the Georgetown urban sample .290 Table B.2.4 Sampling errors for the rest of urban sample (other than Georgetown urban) .291 Table B.2.5 Sampling errors for the Rural sample .292 Table B.2.6 Sampling errors for the Coastal total sample.293 Table B.2.7 Sampling errors for the Coastal urban sample.294 Table B.2.8 Sampling errors for the Coastal rural sample .295 Table B.2.9 Sampling errors for the Interior sample.296 Table B.2.10 Sampling errors for the Region 1 sample .297 Table B.2.11 Sampling errors for the Region 2 sample .298 Table B.2.12 Sampling errors for the Region 3 sample .299 Table B.2.13 Sampling errors for the Region 4 sample .300 Table B.2.14 Sampling errors for the Region 5 sample .301 Table B.2.15 Sampling errors for the Region 6 sample .302 Table B.2.16 Sampling errors for the Region 7 sample .303 Table B.2.17 Sampling errors for the Region 8 sample .304 Table B.2.18 Sampling errors for the Region 9 sample .305 Table B.2.19 Sampling errors for the Region 10 sample .306 Table B.3 Sampling errors for fertility rates for the three-year period before the survey.307 Table B.4.1 Sampling errors for mortality rates for the five-year period preceding the survey and for the infant mortality rates by five-year periods.307 Table B.4.2 Sampling errors for mortality for the ten-year period preceding the survey .308 Tables and Figures | xv APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution .310 Table C.2.1 Age distribution of eligible and interviewed women.311 Table C.2.2 Age distribution of eligible and interviewed men .311 Table C.3 Completeness of reporting.311 Table C.4 Births by calendar years.312 Table C.5 Reporting of age at death in days .312 Table C.6 Reporting of age at death in months .312 Table C.7.1 Nutritional status of children by NCHS/CDC/WHO International Reference Population according to demographic characteristics .313 Table C.7.2 Nutritional status of children by NCHS/CDC/WHO International Reference Population according to socioeconomic characteristics .314 Foreword | xvii FOREWORD Guyana is increasing efforts to put together a comprehensive set of tools for the monitoring and evaluation of health and the social determinants of health under a new paradigm. The Ministry of Health (MoH) is demonstrating that information and statistics are important ingredients for the strengthening of health systems and the improvement of services. I am therefore happy to introduce Guyana’s first Demographic and Health Survey (GDHS), conducted in 2009 by the Ministry in collaboration with the Bureau of Statistics of Guyana and with technical assistance from ICF MACRO. The GDHS was designed to provide nationally representative data on housing and household characteristics in areas of education; maternal and child health; nutrition; family planning; gender; and knowledge, attitudes, and behaviors concerning HIV and other risk factors. The survey has provided valuable and timely data to go along with other indicators for the Government of Guyana (GoG) and its many partners in health care−the Pan American Health Organization/World Health Organization (PAHO/WHO), the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the President’s Emergency Plan for AIDS Relief (PEPFAR), among others. The 2009 GDHS sampled about 6,000 households and completed interviews with 4,996 womenand 3,522 men, age 15-49. Information was also collected on all children of the women in the sample. All households successfully enrolled in the study were asked questions regarding the physical dwelling, ownership of various durable goods, and characteristics of usual residents of the household. In-depth individual interviews were used to collect information from women and men age 15- 49 on smoking, diet, and sexual activity and practices, as well as knowledge of HIV/AIDS, experience with HIV testing, and attitudes regarding people living with HIV/AIDS. It is hoped that the data collected through the GDHS will inform our efforts to develop the policies and programs to respond to the health needs of all Guyanese. The survey information can complement other survey data and national data in informing us of the health of the people. I would like to express my gratitude to the GDHS technical and managerial staff at the Ministry of Health, whose efforts made this report possible. I would also like to thank the Guyana Bureau of Statistics, the agency asked to conduct this survey. Finally, I would like to thank ICF Macro for their technical assistance to the project under the MEASURE DHS program and the U.S. Agency for International Development (USAID) for their financial support. Dr. Leslie Ramsammy Minister of Health Summary of Findings | xix SUMMARY OF FINDINGS This document contains the main results of the 2009 Guyana Demographic and Health Survey (2009 GDHS). The 2009 GDHS is the first household-based, comprehensive survey on demographics and health (especially maternal and child health) to be carried out in Guyana. The survey was conducted by the Bureau of Statistics (BOS) and the Ministry of Health (MOH) of Guyana. ICF Macro of Calverton, Maryland, provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding to cover technical assistance by ICF Macro and local costs was provided in its entirety by the USAID Mission in Georgetown, Guyana. The primary objective of the 2009 GDHS was to collect information on characteristics of the households and their members, including exposure to malaria and tuberculosis; infant and child mortality; fertility and family planning; pregnancy and postnatal care; childhood immunization, health, and nutrition; marriage and sexual activity; and HIV/AIDS indicators. Other objectives of the 2009 GDHS included (1) supporting the dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country and (2) enhancing the survey capabilities of the institutions involved to facilitate surveys of this type in the future. The 2009 GDHS sampled 5,632 households and completed interviews with 4,996 women age 15-49 and 3,522 men age 15-49. Three questionnaires were used for the 2009 GDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content of these questionnaires was based on the model questionnaires developed by the MEASURE DHS program of ICF Macro. FERTILITY Fertility Levels and Differentials If fertility were to remain constant in Guyana, women would bear, on average, 2.8 children by the end of their reproductive lifespan. The total fertility rate (TFR) is close to replacement level in urban areas (2.1 children per woman), and higher in the rural areas (3.0 children per woman). The TFR in the Interior area (6.0 children) is more than twice as high as the TFR in the Coastal area (2.4 children per woman) and is three times the fertility in the Georgetown (urban) area (2.0 children). The TFRs for women in the Interior area are significantly higher for all age groups. The TFR is extremely high in some regions of Guyana: 6.9 children per woman in Region 1, 6.1 children per woman in Region 8, and 5.7 children per woman in Region 9. Region 1 also has the highest percentage of women currently pregnant (15 percent), which is several times the national average of 4 percent. Fertility decreases rapidly with increasing education of women and increasing socioeconomic status of the household. The TFR for women with more than secondary education (1.7 children per woman) clearly indicates very low fertility among highly educated women. On the other hand, the TFR for women with primary education (3.8 children) exceeds the fertility rate of women with higher xx | Summary of Findings education by over two children. Fertility decreases with wealth; the TFR for women in the poorest quintile is very high (4.9 children), 2.5 times the level of fertility for women in the highest quintile (1.9 children). Fertility Preferences Fifty-six percent of currently married women reported that they don’t want to have a/another child, and five percent are already sterilized. The figures for men are 51 and 1 percent, respectively. The desire to stop childbearing increases rapidly as the number of children increases. Among respondents with one child, around one in five wants no more children. Among those with three children, about eight in ten women and seven in ten men want no more children. Among women who want to have a child or another child (32 percent), half (16 percent) want to delay the birth for two or more years. Thirty-five percent of men want to have a/another child, but less than half of them (14 percent) want to wait two or more years. Currently married women in urban areas are somewhat less likely than those in rural areas to want to limit childbearing (58 percent versus 62 percent). Additionally, currently married women in the Coastal area (61 percent) are less likely than women in the Interior area (67 percent) to want no more children. Close to seven in ten currently married women in Regions 1, 2, 6, and 9 are either sterilized or want no more children compared with 55 percent in Region 3 and 57 percent in Region 4. The largest differences in the desire for no more children among currently married women are observed by educational level. Seventy-six percent of women with no education or primary education want no more children compared with 48 percent of women with more than secondary education. The percentage of women who want to limit childbearing decreases as the wealth quintile increases, from 68 percent of women in the lowest quintile to 58 percent of women in the highest two wealth quintiles. FAMILY PLANNING Use of Contraception Forty-three percent of women who are currently married or in union are currently using a contraceptive method, mainly a modern method (40 percent). The methods most commonly used by currently married women are the male condom (13 percent), the pill (9 percent), and the IUD (7 percent). Female sterilization and injectables are each used by 5 percent of women. The 2009 GDHS prevalence rate of 43 percent represents an increase of 8 percentage points since the 2005 GAIS (35 percent). Most of the increase was in condom use, injectables, and female sterilization. The level of contraceptive use increases with the level of education, from 22 percent among women with no education to 46 percent among women with more than secondary education. The level of contraceptive use increases with the number of living children (up to 4 children), from 16 percent of women with no children to 51 percent of those with 3 to 4 children, after which it decreases to 46 percent for women with 5 or more children. Similarly, the percentage of women currently using contraception increases with women’s age, from 30 percent among women age 15-19 to 50 percent among women age 30-34, after which it decreases to reach 33 percent among women age 45-49. The current use of contraception is similar for women in Urban, Rural, and Coastal areas (42-44 percent), but it is much lower among women in the Interior area (31 percent). The method mix among women in the Urban and Rural areas is slightly different: Rural area women are more likely to use the condom, the pill, and the IUD, while Urban area women are more likely to use the condom, the IUD, and female sterilization. Summary of Findings | xxi Unmet Need for Family Planning Twenty-nine percent of currently married women have an unmet need for family planning, mostly for limiting births (19 percent) compared with spacing (10 percent). Because 43 percent of married women are currently using a contraceptive method (met need), the total demand for family planning is estimated at 71 percent of married women (22 percent for spacing, 49 percent for limiting). As a result, only 60 percent of the total demand for family planning is met. The unmet need for family planning is highest among youngest women age 15-19 (35 percent, mostly for spacing) and declines with age to 26 to 28 percent among women age 40-49 (mostly for limiting). In Urban, Rural, and Coastal areas, 27 to 29 percent of women have an unmet need, compared with 37 percent in the Interior area. By region, unmet need ranges from 26 percent in Regions 3 and 10 to 46 percent in Region 1. Unmet need for spacing increases steadily with education while unmet need for limiting declines with education. As a result, unmet need remains relatively constant among educational groups (28 to 31 percent), with the exception of women with no education who have a much higher percentage of unmet need (41 percent). Both unmet need for spacing and unmet need for limiting are highest for women in the lowest wealth quintile, and they tend to decline with increasing socioeconomic status of the household. Overall, 38 percent of women in the lowest wealth quintile have unmet need for family planning compared with 24 percent of women in the highest quintile. MATERNAL HEALTH Antenatal Care Among women who had a birth in the five years preceding the survey, 92 percent received antenatal care (ANC) from a skilled health provider for their most recent birth (51 percent from a nurse/midwife and 35 percent from a doctor). Older mothers (35-49 years) are less likely to receive antenatal care by a skilled health provider than younger mothers. Eighty-six percent of women with no education received ANC from a skilled health provider compared with 95 percent of women with more than secondary education. Urban women are more likely than Rural area women to have received antenatal care from a skilled health provider (98 and 90 percent, respectively). The lowest percentage of women who received antenatal care from a skilled health provider is in the Interior area (78 percent). Antenatal care from a skilled health provider is almost universal in Regions 3, 4, 5, 6, and 10, compared with only 35 percent of women in Region 9. Forty-two percent of women in Region 9 received ANC by a community health worker for their most recent birth. Nurses/midwives provide antenatal care for a large proportion of women in Region 6 (79 percent) and in Region 1 (70 percent). On the other hand, a large percentage, more than half (53 percent) of women in Region 4 receive ANC from a doctor. Antenatal care is more beneficial in preventing adverse outcomes when it is sought early in the pregnancy and is continued through to delivery. Under normal circumstances, the World Health Organization (WHO) recommends that a woman without complications have at least four antenatal care visits, the first of which should take place during the first trimester. Almost eight in ten women (79 percent) with a live birth in the five years preceding the survey had four or more antenatal care visits, as recommended. Almost half of the visits (49 percent) took place during the first trimester, ranging from a low of 42 percent in the Interior area to 67 percent in the Georgetown (urban) area. The median number of months pregnant at the first visit for women who received ANC was 4 months. xxii | Summary of Findings Delivery Care Overall, 92 percent of births in the five years preceding the survey were assisted by a skilled birth provider, mainly by a nurse or midwife (56 percent), followed by a doctor (31 percent). Births to mothers under age 35 and lower order births are more likely to have assistance at delivery by a skilled provider than births to older mothers and higher order births. By residence, births in Urban areas are more likely than those in Rural areas, and births in the Coastal area are more likely than births in the Interior area, to be assisted by a skilled health provider. The percentage of births assisted by a skilled provider ranges from a low of 57 percent in Region 9 to a high of 98 percent in Region 4. Births to mothers who have more education and births in the higher wealth quintiles are more likely to be assisted by a skilled provider than other births. Almost all births to mothers with more than secondary education (98 percent) are assisted by a skilled provider compared with 71 percent of births to mothers with no education. Caesarean section One in eight births (13 percent) in the five years preceding the survey was delivered by caesarean section. The prevalence of C-section delivery increases steadily with mother’s age and decreases with birth order. Regions 1, 6, 7, and 9 have the lowest levels of deliveries by C-section (2-5 percent) and Region 3 has the highest level (23 percent). The percentage of births delivered by C-section increases with a mother’s education and generally increases with her wealth. CHILD HEALTH Infant and Child Mortality Childhood mortality rates in Guyana are relatively low. For every 1,000 live births, 38 children die during the first year of life (infant mortality), and 40 children die during the first five years (under-age 5 mortality). Almost two-thirds of deaths in the first five years (25 deaths per 1,000 live births) take place during the neonatal period (the first month of life). The mortality rate after the first year of life up to age 5 (child mortality) is also very low at 3 deaths per 1,000 live births. The 2009 GDHS mortality data do not show any clear trends over time. However, mortality data have to be interpreted with caution because sampling errors associated with mortality estimates are large. All indicators of childhood mortality are higher in Urban than in Rural areas. For example, infant mortality is 45 deaths per 1,000 live births in Urban areas and 32 deaths per 1,000 live births in Rural areas. Childhood mortality is higher in the Coastal than in the Interior area for most indicators. The infant mortality rate is 37 deaths per 1,000 live births in the Coastal area compared with 27 deaths per 1,000 live births in the Interior area. Early childhood mortality is generally lower among children in the poorer quintiles and higher among children in the wealthiest quintiles. For example, children in the wealthiest quintile are more likely to die during the first year of life (44 deaths per 1,000 live births) than children in poor households (25 deaths per 1,000 live births). The patterns in childhood mortality by mother’s education are not clear due to the small number of cases under each education category. Mortality rates among children born to the oldest mothers (age 30-39) are almost twice as high as mortality rates among children born to the youngest mothers. Furthermore, higher-parity children (parity 7 or higher) have higher childhood mortality rates than children of birth orders 2 through 6. Short birth intervals (i.e., less than two years) are clearly associated with higher mortality both during and after infancy, supporting the importance of child spacing for child survival. Almost half the children in Guyana (48 percent) are in so-called avoidable high-risk categories, although mostly in single high-risk categories, because they were born of birth order 4 or higher (13 percent); born after a short birth interval of less than 24 months (9 percent); or born to mothers less than 18 years old and, thus, considered very young (9 percent) or to mothers age 35 or older (4 percent). Summary of Findings | xxiii Fourteen percent of children in an avoidable high-risk category are classified in the multiple high- risk category, mostly because the mother is 35 years or older and the birth order is high (6 percent); and also because of a short birth interval and a high birth order (5 percent). The latter group of children is of particular concern because they are almost five times more likely to die than children who are not in any high-risk category (the risk ratio is 4.5). Vaccination Coverage Overall, 63 percent of Guyanese children age 18-29 months are fully immunized, and only 5 percent of the children received no vaccinations at all. Looking at coverage for specific vaccines, 94 percent of children received the BCG vaccination, 92 percent received the first dose of pentavalent vaccine, and 78 percent received the first polio dose (Polio 1). Coverage for the pentavalent and polio vaccinations declines with subsequent doses; 85 percent of children received the recommended three doses of pentavalent vaccine, and 70 percent received three doses of polio. These figures reflect dropout rates of 8 percent for the pentavalent vaccine and 11 percent for polio; the dropout rate represents the proportion of children who received the first dose of a vaccine but who did not get the third dose. Eighty-two percent of children are vaccinated against measles, and 79 percent of children have been vaccinated against yellow fever. Full vaccination coverage is lower for first- and sixth- or higher-order births (56 and 50 percent, respectively). Full vaccination coverage decreases with an increase in mother’s education, and it is lowest for children in the lowest and highest wealth quintiles. There are no major variations in vaccination coverage by residence. However, children in the Interior area are somewhat less likely to be vaccinated than other children. This is especially true when looking at specific vaccines, indicating a need for scaling up efforts in the Interior area to reach more children and to improve the quality of vaccination services, including recording and monitoring systems. Illnesses and Treatment Acute Respiratory Infections (ARI) Five percent of children under age 5 had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Among children with symptoms of ARI, advice or treatment was sought from a health facility or provider for 65 percent, and antibiotics were prescribed as treatment for 18 percent (data not shown). Fever Fever was found to be moderately frequent in children under age 5 in Guyana (20 percent), ranging from 17 percent in children under 6 months to about 26 percent in children 12–17 months. Most of the children under age 5 with fever (59 percent) were taken to a health facility or a health provider for their most recent episode of fever. Overall, about one in five children with fever (21 percent) received antibiotics, and 6 percent received antimalarial drugs. Diarrhea Overall, about 10 percent of children were reported to have diarrhea in the two weeks immediately before the survey, with just 1 percent reporting bloody diarrhea. Overall, about six in ten children under age 5 with diarrhea (59 percent) were taken to a health facility or health provider for advice or treatment. Male children (55 percent) are less likely than female children (63 percent) to be taken for treatment or advice to a health facility or provider. Additionally, children living in the Coastal area are much less likely to be taken for treatment or advice (50 percent) than children in the Interior area (79 percent). Oral rehydration therapy (ORT) was given to almost six in ten children (59 percent), half of the children (50 percent) received ORS packets or pre-packaged liquid, and one in six (16 percent) received xxiv | Summary of Findings recommended home fluid (RHF). In total, 64 percent of children with diarrhea received ORT or increased fluids. Antibiotics are generally not recommended to treat non-bloody diarrhea in young children. Twelve percent of children with diarrhea received antibiotics, even though only 1 percent of children under age 5 had a bloody diarrhea. Four percent of children received antimotility drugs, and 1 percent received zinc supplements. One in four children (25 percent) received home or other remedies for their diarrhea. About one in five children with diarrhea (18 percent) did not receive any treatment at all. Urban children are more than twice as likely as rural children (36 versus 15 percent) and children living in the Coastal area are almost five times as likely as children in the Interior area (24 percent versus 5 percent) to receive no treatment at all for their diarrhea. NUTRITION OF CHILDREN Height and Weight Almost one in five children (18 percent) under age 5 is short for age or stunted, and one in twenty (5 percent) is severely stunted. As expected, stunting, which reflects chronic malnutrition, rises with age during the first year. Stunting is lower among children whose mothers have more than secondary education (16 percent). Children in Rural areas are almost twice as likely to be stunted as children in Urban areas (20 and 11 percent, respectively). The highest levels of stunting are found among children in the Interior area (35 percent). Based on the weight-for-age index, 11 percent of children (over one in ten) in Guyana are underweight, and about 2 percent are severely underweight. Boys are somewhat more likely to be underweight than girls (12 and 9 percent, respectively), and children in Rural areas are more likely to be underweight than children in Urban areas (12 and 7 percent, respectively). Based on the weight-for-height index, 5 percent of children under age 5 are considered wasted, and just 1 percent are severely wasted. Anemia Overall, about four in ten (39 percent) children age 6-59 months have some level of anemia, in- cluding 23 percent of children who are mildly anemic, 15 percent who are moderately anemic, and less than 1 percent with severe anemia. Prevalence of any anemia is highest for children 9-11 months (74 percent) and lowest for those 36-59 months (25 to 28 percent). More than half of children in Region 1 are anemic (51 percent) compared with three in ten (30 percent) in Region 8. The percentage of children with anemia is lowest among children of mothers with secondary or higher education (38-40 percent) and among children of mothers in the highest wealth quintile (32 percent). Malaria Eighty-nine percent of households own a mosquito net, whether treated or untreated, and 66 percent of households own more than one net. Rural households are more likely to own at least one net than urban households (90 percent versus 85 percent). About nine in ten households (89 percent) in the malaria-endemic regions (Regions 1, 7, 8, and 9) have at least one mosquito net. About three in ten households (29 percent) own at least one ever-treated net, and more than one in four (26 percent) households owns an insecticide-treated net. Rural area households are more than twice Summary of Findings | xxv as likely as Urban area households to own an ITN (31 percent versus 13 percent), and households in the Interior area are more likely than those in the Coastal area to own at least one ITN (34 percent versus 25 percent). About four in ten households in the malaria-endemic regions (38 percent) have at least one ITN. The percentage of households with at least one ITN is lowest for households in the highest wealth quintile (17 percent) compared with other households (25 to 29 percent). The average number of mosquito nets per household is two. Eight in ten children under age 5 in all households in Guyana slept under a mosquito net (treated or untreated) the night before the survey; about three in ten (29 percent) slept under an ever-treated net; and about one in four (24 percent) slept under an ITN. In households that own at least one ITN, a substantially larger proportion of children under age 5 slept under an ITN the night before the survey (81 percent). HIV/AIDS Knowledge of HIV Prevention Methods Knowledge of AIDS is almost universal in Guyana—97 percent of women and men have heard of AIDS. There are minor variations in knowledge of AIDS by age, marital status, or residence. The only exception is the level of knowledge in the Interior area, which is the lowest for both women (89 percent) and men (95 percent). More than eight in ten respondents age 15-49 know that consistent use of condoms is a means of preventing the spread of HIV (81 percent of women and 84 percent of men) and that limiting sexual intercourse to one HIV-negative and faithful partner can reduce the chances of contracting HIV (82 percent of women and 85 percent of men). A smaller proportion of respondents (73 percent of women and 77 percent of men) reported that both methods—using condoms and limiting sexual intercourse to one HIV-negative partner who has no other partners—are ways of avoiding HIV transmission. Thus, knowledge is higher among men than women for each of the three specified prevention methods. An equal proportion of women and men age 15-49 (78 percent, each) know that abstinence is a way to reduce risk of getting HIV. Beliefs about AIDS About nine in ten Guyanese adults know that a healthy-looking person can have the AIDS virus (87 percent of women and men) or that AIDS cannot be transmitted by supernatural means (87 percent of women and 88 percent of men). About three-quarters of women (73 percent) and two-thirds of men (65 percent) are aware that the AIDS virus cannot be transmitted through mosquito bites. Furthermore, 84 percent of women and 79 percent of men know that the AIDS virus cannot be contracted by sharing food with a person who has AIDS. These findings show that the two most common local misconceptions are that the HIV virus can be transmitted (1) by mosquito bites and (2) by sharing food with someone with AIDS. Overall, more than half of women (53 percent) and more than four in ten men (46 percent) in Guyana have a comprehensive knowledge of HIV/AIDS transmission and prevention methods, i.e., they know that condom use and limiting sex to one uninfected partner are HIV prevention methods; they are aware that a healthy looking person can have the AIDS virus; and they reject the two most common local xxvi | Summary of Findings misconceptions (that AIDS can be transmitted by mosquito bites and by sharing food with someone with AIDS). Younger women are somewhat more likely to have a comprehensive knowledge about AIDS than older women, while among men there is no major difference by age. Respondents who have ever had sex have a much higher level of comprehensive knowledge than those who have never had sex. Currently married women (48 percent) are less likely than never married women (61 percent) or formerly married women (60 percent) to have a comprehensive knowledge of AIDS, while among men the variation is not pronounced. Urban respondents and those living in the Coastal area are much more likely to have comprehensive knowledge about AIDS than respondents in the Rural and Interior areas. For example, 70 percent of women in Urban areas have comprehensive knowledge about AIDS compared with 46 percent of women in Rural areas; and 54 percent in the Coastal area have such knowledge compared with 41 percent of women in the Interior area. For women, the lowest percentage of comprehensive knowledge about AIDS is in Region 9 (31 percent) and the highest is in Region 10 (63 percent), while for men it ranges from 26 percent in Region 5 to 64 percent in Region 10. Education and wealth status have a strong positive correlation with the likelihood of having a comprehensive knowledge of AIDS. The percentage with comprehensive knowledge increases from 20 percent among women and 11 percent among men with no education to 78 and 75 percent, respectively, among women and men with secondary or higher education. Similar patterns are observed in the variation of this indicator by wealth. Thirty-two percent of women and 28 percent of men in the lowest wealth quintile have a comprehensive knowledge of AIDS compared with 68 percent of women and 65 percent of men in the highest wealth quintile. Mother-to-Child Transmission About eight in ten women (79 percent) and seven in ten men (67 percent) know that HIV can be transmitted by breastfeeding. Sixty-eight percent of women and 54 percent of men are aware that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking drugs during pregnancy. Overall, 60 percent of women and 43 percent of men know both facts: (1) HIV can be transmitted through breastfeeding and (2) the risk of MTCT can be reduced by the mother taking special drugs during pregnancy. Both individual indicators, as well as the combination indicator (knowledge that HIV can be transmitted by breastfeeding and knowledge that the risk of MTCT can be reduced by the mother taking special drungs during pregnancy), have shown significant improvement over the same period. For women, knowledge of the combination indicator has increased from 39 percent in 2005 to 60 percent in 2009, and for men it has increased from 28 percent in 2005 to 43 percent in 2009. Attitudes toward Negotiating Safer Sex Almost nine in ten respondents (89 percent of women and 88 percent of men) feel that a wife is justified in refusing to have sexual intercourse with her husband if she knows that he has a sexually transmitted disease. Ninety-six percent of women and men agree that a woman is justified in either refusing sexual intercourse with her husband or in asking him to use a condom if she knows that he has an STI. Attitudes toward Educating Children on Condom Use Overall, more than eight in ten women (81 percent) and men (86 percent) age 18-49 agree that children age 12-14 should be taught to use condoms to avoid AIDS. Older respondents age 40-49 are Summary of Findings | xxvii slightly less likely than younger respondents to support education of children age 12-14 about condom use to prevent AIDS. Women and men living in the Coastal area (82 and 86 percent, respectively) are more likely than women and men living in the Interior area (73 and 82 percent, respectively) to agree about education on condom use of children age 12-14. Fifty-eight percent of women and 61 percent of men with no education agree on instructing children age 12-14 about condoms, compared with 85 percent of women and 86 percent of men with more than secondary education. For women, the percentage who agree that children age 12-14 should be taught about condoms increases from 72 percent among those in the lowest wealth quintile to 85 percent among women in the highest wealth quintile. Among men, there is no clear pattern in the variation of this indicator by wealth. Higher-risk Sex A larger proportion of men (10 percent) than women (1 percent) reported having had more than one sexual partner in the 12 months preceding the survey. Additionally, a higher percentage of men (30 percent) than women (17 percent) reported having had sex with a person who was neither their spouse nor their cohabiting partner (higher-risk sex) in the year before the survey. Among respondents who reported having had higher-risk intercourse (with a person who was neither their husband nor who lived with them) in the past 12 months, about half of women (52 percent) and seven in ten men (72 percent) used a condom at the last higher-risk sex. The smaller proportions of women with multiple partners, higher-risk sexual intercourse, and condom use, compared with men, may accurately reflect the context, but it may also reflect a bias from some women being hesitant to report behavior that may not be widely accepted. Condom use in the past 12 months by respondents who had higher-risk sexual intercourse is more likely among young people age 15-19, never married respondents, respondents living in an Urban area, women living in the Coastal area, and respondents in Region 10. Condom use during last higher-risk sexual intercourse is higher among men with more than secondary education. For both women and men, it is highest among those in the highest wealth quintile. HIV/AIDS-Related Knowledge and Sexual Behavior among Young Adults About half of respondents age 15-24 (54 percent of women and 47 percent of men) have a comprehensive knowledge of AIDS (i.e., they know that people can reduce their chances of getting the AIDS virus by having sex with only one uninfected, faithful partner and by using condoms consistently; know that a healthy-looking person can have the AIDS virus; and know that HIV cannot be transmitted by mosquito bites or by supernatural means). Overall, about four in ten women age 15-24 (41 percent) and men age 15-24 (39 percent) in Guyana have never had sex, and an additional 6 percent of women and 9 percent of men have had sex but not in the 12 months before the survey. Furthermore, the proportion of young people who had multiple sexual partners in the past 12 months is not large—1 percent of women and 12 percent of men. Less than 1 percent of young women and 3 percent of young men who had sex with more than one partner in the past 12 months did not use a condom the last time they had sex. One in ten women (10 percent) age 15-24 and one in five men (19 percent) age 15-24 had sex by age 15, up from 9 and 13 percent, respectively, in the 2005 GAIS. The percentage of respondents age 18- 24 who had sex before exact age 18 increases rapidly to 46 percent for women and 60 percent for men, a decrease from 59 percent for women and 68 percent for men in the 2005 GAIS. xxviii | Summary of Findings Condom use at first sex is not very common in Guyana. Among young adults age 15-24 who have ever had sexual intercourse, only 46 percent of females and 54 percent of males used a condom the first time they had sex. Never-married women and men (63 and 59 percent, respectively) are much more likely to use a condom at first sex than those who have been married (34 and 35 percent, respectively). Use is also markedly higher among respondents who know where to obtain a condom (49 percent of women and 55 percent of men) than among those who do not have such knowledge (27 percent of women and 25 percent of men). Young women and men who live in Urban areas and in the Coastal area, and those who live in Region 10, are more likely to use a condom at first sex than other young adults. As expected, young women and men with more than secondary education (68 and 58 percent, respectively) and in the highest wealth quintiles (64 and 58 percent, respectively) are the most likely to use a condom at first sex compared with those who have less or no education or are in the lowest wealth quintiles. Among youth who had sexual intercourse in the past 12 months, higher-risk sex is more common among young men (80 percent) than among young women (42 percent). Condom use at last higher-risk sexual intercourse is also higher among young men (78 percent) than young women (56 percent). Higher- risk sex is more prevalent among younger respondents and among those who have never married. Urban respondents age 15-24 and those living in the Coastal area are more likely to have higher-risk sexual intercourse than rural respondents and those living in the Interior area. The variation is more pronounced among women than men. The proportion of youth age 15-24 who reported higher-risk sexual intercourse in the 12 months preceding the survey increases with level of education and wealth quintile. Condom use at the last higher-risk sex generally follows the same patterns. Basic Indicators | xxix BASIC INDICATORS Fertility Levels and Preferences Total fertility rate for three years preceding the survey (average number of children at end of reproductive life) . 2.8 Percentage of women who want no more children (includes sterilized women).61.2 Percentage of women who want more children soon.14.0 Percentage of women who want more children later .15.5 Mortality in the Five-Year Period Preceding the Survey (deaths per 1,000 births) Infant mortality rate (deaths in the first year per 1,000 births). 38 Under-5 mortality rate (deaths in the first five years of life per 1,000 births). 40 Contraceptive Knowledge and Use among All Women and Currently Married Women Percentage of currently married women using any method .42.5 Percentage of currently married women using modern methods .40.0 Antenatal and Delivery Care for Women with Births in the Five Years Preceding the Survey Percentage of women who received an antenatal checkup from a health professional .92.1 Percentage of women whose last birth was protected against neonatal tetanus1 .34.5 Percentage of live births in the five years preceding the survey delivered by a skilled provider .91.9 Percentage of live births in the five years preceding the survey delivered in a health facility .89.0 Vaccinations at Any Time (from health card and mother’s report) Percentage of children age 18-29 months who received BCG vaccine at any time.94.1 Percentage of children age 18-29 months who received pentavalent 3 vaccine at any time.84.7 Percentage of children age 12-29 months who received polio 3 vaccine at any time.70.0 Percentage of children age 12-29 months who received MMR vaccine at any time .66.6 Percentage of children age 12-29 months who received yellow fever vaccine at any time.79.0 Percentage of children age12-29 months who received all basic vaccines at any time2.63.4 Treatment for Children under Age 5 with Symptoms of Acute Respiratory Infection (ARI) and Diarrhea in Two Weeks Preceding the Survey Percentage of children with symptoms of ARI for whom treatment was sought from a health facility or provider.65.3 Percentage of children with fever for whom treatment was sought from a health facility or provider.59.0 Percentage of children with diarrhea for whom treatment was sought from a health facility or provider .58.8 Percentage of children with diarrhea who were given a solution made from packets of oral rehydration salts (ORS) .49.8 Children with diarrhea who received oral rehydration therapy (ORT)3 .59.0 Infant Feeding and Nutritional Status Percentage of children under age 4 months exclusively breastfeeding .42.4 Percentage of children under age 4 months breastfeeding and consuming plain water only. 1.5 Percentage of children under age 4 months using a bottle with a nipple.33.7 Percentage of children under age 5 years stunted (short for their age).18.2 Percentage of children under age 5 years severely stunted . 5.3 Percentage of children under age 5 years underweight .10.5 Percentage of children under age 5 years severely underweight . 1.6 Percentage of children age 6-59 months with anemia.39.3 Percentage of households with adequately iodized salt4 .10.5 Malaria Indicators Percentage of households with at least one Insecticide Treated Net (ITN) .25.6 Percentage of children under 5 who slept under an ITN the night before the interview.24.4 Percentage of pregnant women age 15-49 who slept under an ITN the night before the interview .30.1 Among children under age 5 with fever in the two weeks preceding the survey, percentage who took antimalarial drugs .6.4 Among children under age 5 with fever in the two weeks preceding the survey, percentage who took antimalarial drugs the same day/next day after developing fever . 4.3 AIDS-Related Knowledge and Attitudes Women Men Total Percentage of respondents age 15-49: Who have heard of AIDS . 97.0 .97.4. 97.2 With knowledge of using condoms as a specific way to avoid AIDS. 81.3 .83.9. 82.4 With knowledge of limiting sexual intercourse to one uninfected partner who has no other partners . 82.3 .84.7. 83.3 With knowledge of abstaining from sexual intercourse as a specific way to avoid AIDS . 78.2 .77.8. 78.0 Who had higher-risk sexual intercourse in the last 12 months4. 16.7 .29.2. 21.9 Using condoms at high-risk sexual intercourse in the last 12 months (among married respondents)5 . 52.2 .71.5. 62.9 __________________________________ 1 Includes mothers with two injections during the pregnancy of her last birth (19 percent), or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within five years of the last birth), or four or more injections (the last within ten years of the last live birth), or five or more injections prior to the last birth 2 Measles and three doses each of pentavalent and polio vaccines 3 ORS packets, pre-packaged liquid, or recommended home fluids 4 Salt containing 15 part per million (ppm) of iodine or more. Excludes households where salt was not tested. 5 Sexual intercourse with a partner who was neither a spouse nor who lived with the respondent, among those who had sexual intercourse xxx | Map of Guyana GUYANA Introduction | 1 INTRODUCTION 1 1.1 OVERVIEW The 2009 Guyana Demographic and Health Survey (2009 GDHS) is a nationally representative sample survey of women, men, and children. The survey is designed to obtain information on fertility and family planning, sexual activity and awareness of HIV and other infections, infant and child mortality, and the health and nutritional status of mothers and children. The survey was conducted in Guyana by the Bureau of Statistics (BOS) and the Ministry of Health (MOH). ICF Macro of Calverton, Maryland, provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding to cover technical assistance by ICF Macro and local costs was provided entirely by the USAID mission in Georgetown, Guyana. 1.2 OBJECTIVES The primary objective of the 2009 GDHS was to collect information on the following topics: • Characteristics of households and household members • Fertility and reproductive preferences, infant and child mortality, and family planning • Health-related matters, such as breastfeeding, antenatal care, children’s immunizations, and childhood diseases • Marriage, sexual activity, and awareness and behavior regarding HIV and other sexually transmitted infections (STIs) • The nutritional status of mothers and children, including anthropometry measurements and anemia testing Other complementary objectives of the 2009 GDHS were: • To support dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country • To enhance the survey capabilities of the institutions involved to facilitate their use of surveys of this type in the future 1.3 SAMPLE DESIGN The 2009 GDHS utilized a two-stage sample design. The 2002 Population and Housing Census served as the master sample for the GDHS survey. In 2000, the Guyana BOS, in collaboration with the U.S. Census Bureau, designed a sampling frame from the census master sample. In the same year, BOS updated the geographical location and household listing of each primary sampling unit included in the master sample; this work was supported in part by USAID. In the first stage, 330 clusters, or enumeration districts (EDs), were selected from the master sample. In the second stage, 25 households were selected by systematic random sampling from the updated household listing of the selected EDs. Administratively, Guyana is divided into 10 regions, with 71 percent of the population dispersed in rural areas. The rural areas of Regions 3, 4, and 6 are the most densely populated. Regions 1, 7, 8, and 9 each account for less than 4 percent of the rural population, and Region 5 accounts for 10 percent. 2 | Introduction Region 4 includes almost two-thirds (64 percent) of the urban population. Because of these variations in population density, the sample was not allocated by region according to the actual distribution of the population. A minimum of 400 households were allocated to each region. The largest numbers of households were allocated to Regions 4 (1,600 households) and 6 (1,000 households). Around 600 to 650 households were allocated to each of Regions 2, 3, and 10. Table 1.1 shows the number of households and clusters allocated by region and by the main sample domains—Coastal (urban), Coastal (rural), and Interior. Additional details on how the sample was allocated by domains and procedures are included in Appendix A. All women and men age 15-49 who were either permanent residents or visitors present in the selected households the night before the interview were eligible to be interviewed in the survey. 1.4 QUESTIONNAIRES Three questionnaires were used for the 2009 GDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The contents of these questionnaires were based on the model questionnaires developed by the MEASURE DHS program. In consultation with USAID/Guyana, technical institutions, and local and international organizations, the contents of the model questionnaires were modified to reflect relevant issues in population, family planning, and other health issues in Guyana. The Household Questionnaire was used to list all the usual members and visitors in the selected households. The following basic information was collected: • Characteristics of each person listed, including age, sex, education, and relationship to the head of the household. As a result, women and men who would be eligible for a subsequent individual interview could be identified. • Characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito nets. • Height and weight measurements of women age 15-49 and children under age 6, as well as the results of anemia testing. The Women’s Questionnaire was used to collect information from all women age 15-49. Eligible women were asked questions on the following topics: • Background characteristics (e.g., education, residential history, media exposure) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care for children born after January 2004 • Breastfeeding and infant feeding practices • Vaccinations and illnesses for children born after January 2004 • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Awareness and behavior regarding AIDS and other STIs The Men’s Questionnaire was administered to all men age 15-49 living in households included in the 2009 GDHS sample. The Men’s Questionnaire collected information similar to that of the Women’s Questionnaire but was shorter because it did not include a reproductive history or questions on maternal and child health and nutrition. The following topics were addressed: • Background characteristics (e.g., education, residential history, media exposure) Introduction | 3 • Reproductive history and basic health questions about last birth • Knowledge and use of family planning methods • Fertility preferences • Marriage and sexual activity • Employment and gender roles • Awareness and behavior regarding AIDS and other sexually transmitted infections (STIs) 1.5 PRETEST ACTIVITIES, TRAINING, AND FIELDWORK A training of trainers took place in early December 2008. One hundred and twelve candidates (50 men and 62 women) participated in the main survey training of interviewers, supervisors, and field editors, which took place on December 9-19, 2008, and January 12-22, 2009. Special parallel training sessions for supervisors and editors were conducted on January 19-21. All participants received training in interviewing techniques and became acquainted with the contents of the survey questionnaires. The training was conducted following standard DHS procedures and included class presentations, mock interviews, and tests in which the actual 2009 GDHS questionnaires were used. During the last week of January 2009, the editors of each team received training and instruction on how to use measuring boards and scales to conduct anthropometric measurements (height and weight) of women and young children and on how to conduct anemia testing. Because the beginning of fieldwork was delayed, a refresher training course was conducted on February 24-26, 2009. Data collection for the 2009 GDHS took place over a five-month period from March 1 through late July 2009 and was carried out by 16 interviewing teams. Each team consisted of one team supervisor, one field editor, two female and two male interviewers, and one driver. In total, 96 fieldworkers completed work first in the Coastal enumeration districts (Regions 2, 3, 4, 5, and 10). At a later stage, 60 fieldworkers were selected to work in the Interior districts (Regions 1, 7, 8, 9, and 10). Staff from the Bureau of Statistics was responsible for coordinating and supervising fieldwork activities. Two nurses supervised the anthropometry and anemia testing. ICF Macro staff participated in the survey, assisting with questionnaire design, training for data collection, data processing and tabulation, field supervision of interviews, and training in anthropometry and anemia testing. 1.6 DATA PROCESSING The processing of the 2009 GDHS questionnaires began on March 16, 2009, shortly after fieldwork commenced. Completed questionnaires were submitted periodically to BOS offices in Georgetown, where they were edited by data processing personnel who had been trained specifically for this task by ICF Macro staff. Data processing was done concurrently with fieldwork using CSPro, a program specially developed for use in complex surveys. The concurrent processing of the data was an advantage because field check tables were produced periodically to advise field teams of any problems that were detected during data processing. Data processing was completed in late August 2009. 1.7 RESPONSE RATES Table 1.1 shows the number of households selected and interviewed, numbers of women and men eligible for individual interviews, and their response rates (percentage of interviews), according to residence and region. • Of the 6,376 selected households, 6,042 households were occupied, and a total of 5,632 households were interviewed, yielding a household response rate of 93 percent. By residence, the household response rate is lowest in urban areas (91 percent), especially in Georgetown (86 percent), and highest in Interior areas of the country (96 percent). By region, the household response rate ranges from 89 percent in Region 4 to 99 percent in Region 8. 4 | Introduction • In the households interviewed, a total of 5,547 eligible women were identified. Interviews were completed with 4,996 of these women, yielding a response rate for women of 90 percent. The women’s response rates were lowest in the Interior areas (86 percent) and in Region 1 (83 percent) and highest in the Coastal areas (92 percent) and Region 2 (95 percent). • Of the 4,553 eligible men identified in the same interviewed households, a total of 4,553 men were identified. Interviews were conducted with only 3,522 men, yielding a response rate for men of 77 percent. Men from the Interior area (70 percent) and from Region 1 (62 percent) have the lowest response rates, while men in Urban and Coastal (urban) areas (82 percent, each) have the highest response rates. • The primary reason for non-response among eligible women and men was the failure to find individuals at home despite repeated visits to the household. The substantially lower response rate for men reflects the more frequent and longer absences of men from the household, principally related to employment and lifestyle activities (data not shown). Table 1.1 Results of the household and individual interviews Number of households and individual interviews, and response rates (percentage of interviews), according to residence and region, Guyana 2009 Households Women Men Residence and region Number of households selected Number of households occupied Number of households interviewed Household response rate Number of eligible women Number of eligible women interviewed Women response rate Number of eligible men Number of eligible men interviewed Men response rate Residence Total Urban 1,779 1,670 1,518 90.9 1,558 1,420 91.1 1,230 1,013 82.4 Georgetown (urban) 760 694 598 86.2 614 554 90.2 485 394 81.2 Other (urban) 1,019 976 920 94.3 944 866 91.7 745 619 83.1 Total Rural 4,597 4,372 4,114 94.1 3,989 3,576 89.6 3,323 2,509 75.5 Total Coastal 4,714 4,477 4,123 92.1 4,078 3,738 91.7 3,378 2,697 79.8 Coastal(urban) 1,779 1,670 1,518 90.9 1,558 1,420 91.1 1,230 1,013 82.4 Coastal (rural) 2,935 2,807 2,605 92.8 2,520 2,318 92.0 2,148 1,684 78.4 Total Interior 1,662 1,565 1,509 96.4 1,469 1,258 85.6 1,175 825 70.2 Region 1 387 383 370 96.6 345 287 83.2 288 179 62.2 2 623 605 574 94.9 534 505 94.6 438 386 88.1 3 645 609 565 92.8 564 520 92.2 423 326 77.1 4 1,600 1,491 1,319 88.5 1,314 1,179 89.7 1,111 861 77.5 5 489 479 452 94.4 431 404 93.7 393 319 81.2 6 977 937 881 94.0 881 817 92.7 771 614 79.6 7 367 351 334 95.2 330 290 87.9 221 165 74.7 8 308 304 302 99.3 302 256 84.8 248 169 68.1 9 382 335 322 96.1 317 280 88.3 261 195 74.7 10 598 548 513 93.6 529 458 86.6 399 308 77.2 Total 6,376 6,042 5,632 93.2 5,547 4,996 90.1 4,553 3,522 77.4 The weighted and unweighted numbers of women and men in the 2009 GDHS are shown in Table 1.2. The weighted numbers are shown because weighting is necessary for the calculation of most indicators—percent distributions, percentages, and rates. This is because the sample was not allocated by region according to the actual distribution of the population. Instead, the sample was allocated to provide a sufficient number of respondents for each region to allow calculation of most survey variables at the regional level. The unweighted numbers are the actual numbers of interviews. Some subgroups shown may include comparatively small numbers of respondents (e.g., respondents with no education and those in some religious and ethnic groups). In some tables in this report, estimates for these subgroups are not shown if the unweighted number of cases is fewer than 25. Also, estimates based on 25 to 49 unweighted cases are shown enclosed in parentheses. • Although only 1,179 women were interviewed in Region 4 (24 percent of the total unweighted number of all women), the weighted number is 2,168 women (43 percent of the total weighted Introduction | 5 number of women). On the other hand, 280 women were interviewed in Region 9 (6 percent of the total unweighted number of all women), and the weighted number is 78 women (2 percent of the total weighted number of women). • The regional distribution of the population shows no marked differences by sex, with around three in ten women (30 percent) and men (27 percent) living in Urban areas, with two-thirds of these living in Georgetown. Approximately nine in ten respondents of both sexes (90 percent of women and 89 percent of men) live in the Coastal areas, with the majority (60 percent of women and 62 percent of men) living in the Coastal (rural) areas. Only one-tenth of the respondents (10 percent of women and 11 percent of men) live in the Interior areas of the country. Table 1.2 Number of women and men interviewed by residence and region Percent distribution of women age 15-49 and men age 15-49, by residence and region, Guyana 2009 Women Men Residence and region Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Residence Total Urban 29.5 1,475 1,420 27.0 949 1,013 Georgetown (urban) 19.4 967 554 17.6 619 394 Other (urban) 10.2 508 866 9.4 330 619 Total Rural 70.5 3,521 3,576 73.0 2,573 2,509 Total Coastal 90.0 4,495 3,738 88.7 3,126 2,697 Coastal (urban) 29.5 1,475 1,420 27.0 949 1,013 Coastal (rural) 60.4 3,019 2,318 61.8 2,176 1,684 Total Interior 10.0 501 1,258 11.3 396 825 Region Region 1 3.2 162 287 4.5 160 179 Region 2 5.9 293 505 5.1 179 386 Region 3 13.8 687 520 11.9 420 326 Region 4 43.4 2,168 1,179 43.7 1,540 861 Region 5 7.1 353 404 7.7 271 319 Region 6 15.6 780 817 16.7 587 614 Region 7 2.1 104 290 1.7 61 165 Region 8 1.9 95 256 1.9 68 169 Region 9 1.6 78 280 1.6 57 195 Region 10 5.6 277 458 5.1 178 308 Total 100.0 4,996 4,996 100.0 3,522 3,522 1.8 CONTENTS OF THE REPORT Chapter 1, which is introductory, includes a description of the country and its population history, selected health and demographic characteristics, and an overview of the health care system. It also includes the 2009 GDHS objectives, a brief summary of the survey design and implementation, the sample design, and data on the numbers of households and individuals selected for interview and corresponding response rates. Chapter 2 describes the background characteristics of the household population and its dwelling conditions. Chapter 3 contains information on the basic characteristics of the eligible respondents, including their educational level, work status, and occupation. Chapter 4 describes the current and past fertility of the population. The chapter also presents information on the beginning of a woman's childbearing years, including the age when she first gives birth, as well as her current level of fertility. 6 | Introduction Chapter 5 includes information on one of the main determinants of fertility, use of family planning. Information on the current and ever use of specific methods by age and background characteristics is included here. Chapter 6 includes factors other than contraception that regulate the level of fertility, such as marriage patterns and sexual activity. Chapter 7 discusses fertility preferences, the desire to limit childbearing, the ideal number of children, and the unmet need for contraception. Chapter 8 describes the current and past levels of infant and child mortality, as well as differentials in childhood mortality, by demographic and background characteristics. Also included is information on the extra risk in infant and child mortality incurred by certain reproductive behaviors. Chapter 9 presents findings from areas important to reproductive and women’s health (i.e., antenatal, delivery, and postnatal care), as well as general access to health services. Chapter 10 presents the impact on child health indicators of children being born in the five years preceding the survey, including weight and size at birth, vaccination status as children, and history of childhood illnesses (acute respiratory infection, fever, and diarrhea, for example) and their treatment. Chapter 11 presents data on the nutritional status of children and adults. The section on childhood nutrition covers anthropometric assessment of the nutritional status of children under age 5; infant and young child feeding practices, including breastfeeding and feeding with solid/semi-solid foods; diversity of foods being fed; frequency of feeding; micronutrient status; supplementation and fortification; and anemia. The section on adult nutrition covers the nutritional status of women and men age 15-49; the diversity of foods eaten by mothers of children under age 3; micronutrient status, supplementation and fortification; and presence of anemia. Chapter 12 describes the availability and use of preventive measures for malaria among women and children, as well as access to early diagnosis and prompt treatment. This chapter also describes knowledge about tuberculosis (TB) and its mode of transmission, diagnosis, and treatment among men and women. Chapter 13 presents information collected from the HIV/AIDS module, including knowledge of HIV/AIDS, attitudes about HIV/AIDS, and behavior among adults and youth at risk for HIV/AIDS. Chapter 14 presents indicators of women’s empowerment, such as receipt of cash earnings, the magnitude of a woman’s earnings relative to those of her husband, and control over the use of woman’s earnings and the earnings of her husband. Three separate indices of empowerment are developed that are based on the number of household decisions in which the respondent participates, her opinion on the number of reasons that justify wife beating, and her opinion on the number of circumstances for which a woman is justified in refusing to have sexual intercourse with her husband. The sample design is described in Appendix A, and the estimates of sampling errors are covered in Appendix B. Appendix C contains several tables that may be of use in examining the quality of some data collected in the 2009 GDHS: single-year age distribution of the de facto household population by sex; age distribution of the eligible respondents; completeness of reporting of basic indicators; distribution of births by calendar years; reporting of age at death in days, and reporting of age at death in months. Appendix C also includes tables showing the percentage of children under age 5 who are classified as malnourished according to three anthropometric indices of nutritional status―height-for-age, weight-for-height, and weight-for-age―based on the former NCHS/CDC/WHO International Reference Introduction | 7 Population. Shown for comparative purposes, is the vaccination coverage for children following the DHS program schedule, which includes neither yellow fever nor measles, mumps, rubella (MMR) vaccine (only measles). Full immunization in Guyana includes BCG, MMR, yellow fever, and three doses each of pentavalent and polio vaccines. Finally, the survey personnel are listed in Appendix D, and the questionnaires are included in Appendix E. Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter summarizes demographic and socioeconomic characteristics of the household popu- lation, including age, sex, place of residence, educational status, and household characteristics. Informa- tion collected on the characteristics of the households and individual respondents in the survey helps one to understand and interpret the findings of the survey and also provides some indication of the repre- sentativeness of the survey. A household is defined as a person or group of related and unrelated persons who (1) live together in the same dwelling unit(s) or in connected premises, (2) acknowledge one adult member as head of the household, and (3) have common arrangements for cooking and eating their food. The questionnaire for the 2009 GDHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed the night before the interview in the household). According to the 2009 GDHS data, the differences between these populations are small. Tabulations for the household data presented in this chapter are primarily based on the de facto population. The number of cases in some regions may appear small. This is because they have been weighted to make the regional distribution appear nationally representative. Throughout this report, numbers in the tables reflect weighted numbers. To ensure statistical reliability, percentages based on 25 to 49 un- weighted cases are shown within parentheses, and percentages based on fewer than 25 unweighted cases are suppressed. 2.1 CHARACTERISTICS OF THE POPULATION 2.1.1 Age-Sex Structure Age and sex are important demographic variables. They serve as the primary basis for demographic classification in vital statistics, censuses, and surveys. Age and sex are also important variables in the study of mortality, fertility, and nuptiality. Table 2.1 presents the percent distribution of the de facto population by five-year age groups, according to Urban-Rural residence and sex. The data are used to construct the population pyramid shown in Figure 2.1. • Guyana has a larger proportion of its population in younger age groups than in older age groups (65+). One third (34 percent) of the population is under age 15 (36 percent male and 31 percent female) compared with only 5 percent of males and 6 percent of females age 65 and older. • Sixty-one percent of the household population (59 percent of males and 62 percent of females), however, are in the economically productive age range (age 15-64). 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age group, according to sex and residence, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Rural Total –––––––––––––––––––––– –––––––––––––––––––––– –––––––––––––––––––––– Age Male Female Total Male Female Total Male Female Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <5 8.7 7.6 8.1 11.0 10.2 10.6 10.4 9.4 9.9 5-9 10.7 9.1 9.8 13.0 11.2 12.0 12.4 10.6 11.4 10-14 13.6 9.8 11.6 13.2 12.1 12.6 13.3 11.4 12.3 15-19 10.5 10.7 10.6 8.8 10.1 9.4 9.2 10.3 9.8 20-24 7.7 7.8 7.7 6.6 8.1 7.4 6.9 8.0 7.5 25-29 7.3 6.2 6.7 6.0 6.9 6.5 6.3 6.7 6.5 30-34 5.9 6.6 6.3 6.7 6.5 6.6 6.5 6.5 6.5 35-39 5.4 7.7 6.7 6.5 6.6 6.6 6.2 6.9 6.6 40-44 6.0 6.4 6.2 6.2 5.9 6.0 6.1 6.0 6.1 45-49 4.6 6.6 5.7 5.3 5.7 5.5 5.1 6.0 5.6 50-54 5.6 5.6 5.6 5.1 5.2 5.1 5.2 5.3 5.3 55-59 4.7 4.3 4.5 4.0 3.9 4.0 4.2 4.0 4.1 60-64 3.0 3.0 3.0 2.8 2.3 2.5 2.8 2.5 2.7 65-69 2.4 2.7 2.6 2.1 1.9 2.0 2.2 2.1 2.2 70-74 1.8 1.9 1.8 1.4 1.4 1.4 1.5 1.6 1.5 75-79 1.1 1.8 1.5 0.6 1.0 0.8 0.8 1.2 1.0 80 + 1.0 2.0 1.5 0.6 1.0 0.8 0.7 1.3 1.0 Don't know/missing 0.2 0.2 0.2 0.2 0.1 0.2 0.2 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,647 3,143 5,790 7,277 7,849 15,126 9,924 10,992 20,916 Figure 2.1 Population Pyramid 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ A ge Percentage of population Male Female Household Population and Housing Characteristics | 11 2.1.2 Household Composition The size and composition of the household usually affect the allocation of financial and other resources available to its members. In cases where women are heads of household, financial resources are typically limited. Similarly, the size and composition of the household affect the well-being of its members. If the household is large, crowding can lead to health problems. Table 2.2 presents the percent distribution of households by sex of head of the household and by number of residents, according to Urban-Rural residence. The percentage of households with a female as head is presented in Figure 2.2 by residence. Table 2.2 also presents the mean number of members of the households and the percentage of households with orphans and foster children under age 18. Table 2.2 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, according to residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Characteristic Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total Household headship Male 55.9 53.2 61.2 70.6 65.3 55.9 69.7 76.3 66.5 Female 44.1 46.8 38.8 29.4 34.7 44.1 30.3 23.7 33.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of usual members 0 0.3 0.4 0.1 0.3 0.3 0.3 0.3 0.0 0.3 1 13.5 13.4 13.8 12.6 13.0 13.5 12.8 11.3 12.8 2 21.0 23.4 16.5 17.0 18.9 21.0 17.9 11.6 18.2 3 18.8 18.3 19.9 18.3 18.9 18.8 19.0 14.1 18.4 4 16.8 16.6 17.2 18.1 17.9 16.8 18.4 16.3 17.7 5 12.4 11.4 14.4 15.0 14.4 12.4 15.4 12.9 14.3 6 7.3 7.3 7.2 8.5 7.7 7.3 7.9 11.7 8.1 7 4.8 4.9 4.5 4.8 4.3 4.8 4.1 9.2 4.8 8 2.3 2.0 2.8 2.6 2.2 2.3 2.2 5.3 2.5 9+ 2.8 2.4 3.6 2.9 2.3 2.8 2.1 7.5 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Mean size of households 3.7 3.6 3.8 3.8 3.7 3.7 3.7 4.6 3.8 Percentage of households with orphans and foster children under 18 Foster children1 12.6 10.9 15.8 12.0 12.1 12.6 11.8 13.0 12.2 Double orphans 0.3 0.3 0.4 0.5 0.5 0.3 0.6 0.3 0.5 Single orphans 6.7 7.0 6.0 5.2 5.5 6.7 4.9 7.2 5.7 Foster and/or orphan children 16.3 14.8 19.2 14.6 14.9 16.3 14.2 17.3 15.1 Number of households 1,603 1,053 550 4,029 5,052 1,603 3,449 580 5,632 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 years of age living in households where neither their mother nor their father is a de jure resident. . • Women head one-third of Guyanese households (34 percent). Households with a female head are more common in the urban areas, with 44 percent in Total Urban, consisting of 47 percent in Georgetown (urban), and 39 percent in Other (urban). The average household size is 3.8 persons, with little difference attributable to Urban or Rural area residence or residence within the Coastal area. The average household in the Interior area is larger in comparison, however, with 4.6 members. 12 | Household Population and Housing Characteristics • More than four in five households (82 percent) have five or fewer members, and one in eight (13 percent) is a single-person household. Generally, there are no significant urban- rural differences in the household composition. The only urban-rural difference is the percentage of households with two members: 21 percent in Urban areas compared with 17 percent in Rural areas. More than one-third (34 percent) of households in the Interior area have 6 or more members compared with fewer than one in five in other areas. As a result, the mean size of a household in the Interior area is 4.6. 2.1.3 Children’s Living Arrangements and Orphanhood Table 2.3 shows information relevant to living arrangements and orphanhood for children less than 18 years of age. The table also includes the percentage of children living in a household where neither parent is present (foster children) and the percentage of children who are orphans (children with the father dead, the mother dead, both parents dead, or one parent dead but with missing information on survival status of the other parent). No distinction is made between long-term and short-term fostering. 34 44 47 39 29 Total Guyana Total Urban Georgetown (Urban) Other Urban Total Rural 0 10 20 30 40 50 Percentage of households GDHS 2009 Figure 2.2 Percentage of Female-Headed Households, by Residence Household Population and Housing Characteristics | 13 • Twelve percent of Guyanese children under age 18 live in households with neither their mother nor their father (they are foster children), and 7 percent have lost at least one biological parent (they are orphan children). These percentages are similar to those reported in the 2005 Guyana AIS (11 percent and 7 percent, respectively). • The percentages of both foster children and orphans increase steadily with the children’s age, and they are higher in urban areas (15 percent and 9 percent, respectively) than in rural Table 2.3 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Living Living with mother with father Not living with but not father but not mother either parent Missing Living –––––––––––– ––––––––––––––– ––––––––––––––––––––––––– informa- with Only Only tion on Percent- Percent- Number Background both Father Father Mother Mother Both father mother Both father/ age age of characteristic parents alive dead alive dead alive alive alive dead mother Total foster1 orphan2 children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 0-4 65.9 25.4 0.6 1.6 0.1 4.3 0.3 0.2 0.0 1.6 100.0 4.8 1.2 2,053 <2 68.2 26.2 0.5 0.9 0.0 2.0 0.2 0.1 0.0 1.9 100.0 2.3 0.9 825 2-4 64.3 25.0 0.7 2.0 0.1 5.8 0.4 0.2 0.0 1.5 100.0 6.4 1.4 1,228 5-9 56.1 24.6 3.0 2.5 0.5 8.6 1.5 1.0 0.2 1.9 100.0 11.3 6.3 2,403 10-14 52.1 22.4 4.3 2.4 1.4 12.4 1.4 0.9 0.6 2.0 100.0 15.3 8.8 2,603 15-17 45.5 22.6 6.7 3.0 0.5 12.2 3.1 1.1 0.9 4.4 100.0 17.2 12.4 1,292 Sex Male 56.0 23.4 3.2 2.8 0.5 9.2 1.4 0.7 0.3 2.4 100.0 11.6 6.3 4,217 Female 55.3 24.3 3.6 1.8 0.8 9.4 1.5 0.9 0.4 2.0 100.0 12.2 7.3 4,134 Residence Total Urban 40.1 34.2 5.0 3.5 0.6 11.7 1.8 0.7 0.3 2.1 100.0 14.5 8.5 2,097 Urban (Georgetown) 36.7 37.6 6.1 4.2 0.8 10.3 2.3 0.5 0.2 1.3 100.0 13.3 10.1 1,257 Urban (other) 45.4 29.0 3.2 2.5 0.3 13.8 1.1 1.0 0.3 3.4 100.0 16.2 6.0 839 Total Rural 60.8 20.4 2.9 2.0 0.7 8.5 1.3 0.8 0.4 2.3 100.0 11.0 6.2 6,254 Total Coastal 54.4 24.4 3.4 2.4 0.7 9.8 1.5 0.8 0.4 2.3 100.0 12.5 6.8 6,986 Coastal (urban) 40.1 34.2 5.0 3.5 0.6 11.7 1.8 0.7 0.3 2.1 100.0 14.5 8.5 2,097 Coastal (rural) 60.5 20.2 2.7 1.9 0.7 9.1 1.3 0.8 0.5 2.4 100.0 11.7 6.1 4,889 Total Interior 62.2 21.1 3.7 2.1 0.5 6.5 1.0 0.9 0.2 1.9 100.0 8.6 6.3 1,365 Region Region 1 58.6 25.6 2.3 3.0 0.6 5.8 0.9 0.8 0.4 2.2 100.0 7.8 5.0 488 Region 2 64.6 16.2 3.0 1.5 0.4 9.4 0.5 0.3 0.8 3.2 100.0 11.0 5.1 541 Region 3 59.5 21.4 3.1 2.0 0.0 9.5 1.5 0.9 0.3 1.8 100.0 12.2 6.0 1,078 Region 4 47.4 28.8 3.9 3.2 1.3 9.6 2.2 0.6 0.4 2.6 100.0 12.8 8.5 3,037 Region 5 56.8 23.1 2.7 1.4 0.4 12.2 1.0 1.0 0.6 0.8 100.0 14.8 5.8 616 Region 6 65.7 16.5 2.8 2.0 0.3 8.9 0.6 1.0 0.3 1.8 100.0 10.9 5.0 1,325 Region 7 56.8 25.5 3.2 1.6 0.1 6.3 2.7 1.5 0.1 2.1 100.0 10.6 7.6 249 Region 8 65.9 16.5 5.0 0.2 0.8 8.6 0.6 0.4 0.1 2.0 100.0 9.7 6.8 230 Region 9 76.9 9.7 2.1 2.8 0.5 6.1 0.2 0.0 0.0 1.7 100.0 6.3 2.8 236 Region 10 42.6 33.7 5.0 1.6 0.2 10.9 1.2 1.4 0.2 3.3 100.0 13.6 8.1 550 Wealth quintile Lowest 62.0 20.1 4.0 1.8 0.3 7.6 0.8 0.8 0.4 2.2 100.0 9.6 6.3 2,036 Second 54.7 25.9 3.3 2.1 0.2 8.6 1.6 0.9 0.3 2.3 100.0 11.4 6.6 1,806 Middle 52.7 24.9 3.2 2.7 2.1 10.4 1.0 0.6 0.3 2.2 100.0 12.2 7.2 1,609 Fourth 52.8 23.3 3.2 2.7 0.5 11.3 2.7 0.8 0.4 2.5 100.0 15.2 7.6 1,522 Highest 54.0 26.1 3.2 2.8 0.2 9.2 1.2 0.9 0.6 1.9 100.0 11.9 6.2 1,378 Total <15 57.5 24.1 2.8 2.2 0.7 8.8 1.1 0.7 0.3 1.8 100.0 10.9 5.7 7,059 Total <18 2009 55.6 23.8 3.4 2.3 0.7 9.3 1.4 0.8 0.4 2.2 100.0 11.9 6.8 8,351 2005 59.7 21.1 4.0 2.4 0.4 7.7 1.0 0.9 1.0 1.8 100.0 10.6 7.3 4,324 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure 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 father dead, mother dead, both dead, and one parent dead but information missing on survival status of the other parent. 14 | Household Population and Housing Characteristics areas (11 percent and 6 percent, respectively). The percentage of foster children ranges from 6 percent in Region 9 to 15 percent in Region 5, while the percentage of orphan children ranges from 3 percent in Region 9 to 9 percent in Region 4. • Fifty-six percent of children under age 18 live with both parents, 27 percent live with their mothers but not with their fathers; 3 percent live with their fathers but not with their mothers; and 12 percent live with neither of their natural parents. There has been a slight decrease since the 2005 Guyana AIS (GAIS) in the percentage of children under age 18 who live with both their parents, which has dropped from 60 percent in 2005 to 56 percent to 2009. • The proportion of children living with both parents decreases with age; younger children are more likely than older children to live with both natural parents. More than six in ten children under age 18 in Rural areas (61 percent in Coastal [rural] and 62 percent in the Interior area) live with both parents compared with four in ten children in the Urban areas. • Region 9 has the highest percentage of children living with both parents (77 percent), and Region 10 has the lowest percentage (43 percent), mostly due to the high percentage of children (34 percent) who live with the mother despite the fact that the father is alive. 2.1.4 Educational Attainment The educational level of household members is perhaps their most important demographic characteristic. Many phenomena—reproductive behavior, use of contraception, health of children, and proper hygienic habits— are affected by the education of the household members. Tables 2.4.1 and 2.4.2, respectively, show the percent distribution of the de facto female and male household populations, age 6 and over, by highest level of schooling attended or completed, and median number of years completed. Schooling in Guyana starts at the nursery school level, which is available to children for two years, beginning at age four. Children begin primary school at age 6. Primary school has six grades: Preparatory A and B and Standards I through IV. Entry into secondary education is based on students' performance in a placement examination, the Secondary School Entrance Examination (SSEE) administered to 11-year-old students. For students who score poorly on the SSEE, a continuation of primary education for three to four years is also available in the senior department of the primary school, also known as the all-age school (or the primary-top). Thus, students who complete primary school and pass the SSEE placement test or students who complete all-age school are eligible to continue in secondary school. There are three different kinds of secondary school in Guyana for students who have passed the SSEE: the general secondary school, the multilateral school, and the community high school. The general secondary school consists of Forms I-VI (Form VI being the equivalent of the senior year of high school in the United States). At the end of their secondary education, students can take the Secondary School Proficiency Examination to be admitted into the trade school. Or they can take the General Certificate of Education (GCE) Advanced Level examination or the Caribbean Examination Council examination to be admitted into the university. The multilateral school, established in 1974, consists of Forms I-V for students age 10-18 years. The community high school provides on-the-job training to students over age 12. Students who complete a full secondary education may enroll in the university. Household Population and Housing Characteristics | 15 Table 2.4.1 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 number of years completed, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling ––––––––––––––––––––––––––––––––––––––––––––––––––– Median More number Some than Don’t Number of years Background No Some Completed secon- Completed secon- know/ of of characteristic education primary primary1 dary secondary2 dary missing Total women schooling3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 11.8 86.6 0.2 0.5 0.2 0.0 0.8 100.0 985 1.2 10-14 0.9 39.8 12.2 46.2 0.3 0.2 0.5 100.0 1,258 5.5 15-19 1.4 4.6 2.7 60.6 26.7 3.4 0.6 100.0 1,127 9.1 20-24 1.1 6.3 4.8 28.9 45.9 11.7 1.2 100.0 879 10.2 25-29 1.6 10.0 6.8 34.0 35.2 11.6 0.9 100.0 736 9.8 30-34 1.9 12.0 7.4 38.3 26.7 11.2 2.6 100.0 720 9.3 35-39 1.7 9.4 11.9 41.0 26.0 7.7 2.2 100.0 761 9.1 40-44 1.7 20.0 11.5 35.6 22.8 4.8 3.8 100.0 663 8.3 45-49 2.2 18.4 12.4 33.9 20.8 7.1 5.2 100.0 658 8.0 50-54 2.6 21.6 19.4 28.0 17.0 6.0 5.4 100.0 582 6.5 55-59 2.0 31.3 18.6 20.6 15.8 6.4 5.3 100.0 440 5.7 60-64 2.8 29.7 32.0 13.0 11.5 4.5 6.6 100.0 275 5.5 65+ 7.3 30.7 28.8 11.4 6.8 4.4 10.6 100.0 678 5.3 Residence Total Urban 1.8 17.7 9.1 31.8 24.6 10.8 4.3 100.0 2,861 8.9 Georgetown (urban) 1.3 15.8 8.7 30.3 27.1 11.7 5.2 100.0 1,874 9.3 Other (urban) 2.8 21.2 9.7 34.6 20.0 9.1 2.5 100.0 987 8.1 Total Rural 3.5 28.8 11.6 32.9 17.2 3.5 2.4 100.0 6,918 6.7 Total Coastal 2.6 24.7 10.9 32.6 20.3 6.1 2.9 100.0 8,718 7.6 Coastal (urban) 1.8 17.7 9.1 31.8 24.6 10.8 4.3 100.0 2,861 8.9 Coastal (rural) 3.0 28.1 11.8 32.9 18.2 3.8 2.3 100.0 5,857 6.9 Total Interior 6.8 32.9 10.1 33.0 11.6 2.1 3.4 100.0 1,061 5.7 Region Region 1 11.7 42.9 10.2 24.8 5.3 1.7 3.4 100.0 367 4.3 Region 2 4.9 30.2 16.3 29.0 13.5 3.7 2.4 100.0 608 5.7 Region 3 3.5 27.6 8.1 35.9 19.5 3.6 1.8 100.0 1,327 7.3 Region 4 2.0 21.7 9.8 31.6 23.0 7.7 4.2 100.0 4,139 8.3 Region 5 2.0 28.6 15.1 28.7 18.2 5.5 1.9 100.0 698 6.5 Region 6 2.9 28.2 13.8 33.0 17.9 3.3 1.1 100.0 1,537 6.6 Region 7 4.2 26.4 10.7 35.2 17.3 3.1 3.0 100.0 228 7.0 Region 8 2.8 22.8 10.9 41.9 14.6 2.1 4.9 100.0 166 7.5 Region 9 5.5 35.7 10.1 31.9 12.6 0.8 3.4 100.0 170 5.6 Region 10 2.8 18.9 5.6 41.9 17.6 10.5 2.6 100.0 537 8.4 Wealth quintile Lowest 7.2 38.2 12.8 29.2 7.7 1.0 3.9 100.0 1,726 5.2 Second 3.7 29.4 13.2 35.6 13.7 2.0 2.5 100.0 1,955 6.3 Middle 1.6 24.6 10.9 36.8 20.3 3.0 2.8 100.0 1,926 7.7 Fourth 1.8 22.7 10.5 33.4 22.7 6.2 2.9 100.0 2,086 8.0 Highest 1.6 15.3 7.2 27.9 30.3 14.8 2.8 100.0 2,086 9.6 Total 2009 3.0 25.6 10.8 32.6 19.4 5.6 3.0 100.0 9,778 7.4 Total 2005 3.5 27.1 13.3 35.1 12.8 6.2 2.1 100.0 4,446 8.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 15 females with information missing on age who are not shown separately. 1 Completed 6th grade at the primary level 2 Completed 5th grade at the secondary level 3 The median number of years is the midpoint of the distribution of the population by number of years of education. 16 | Household Population and Housing Characteristics Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age 6 and over by highest level of education attended or completed and median number of years completed, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling ––––––––––––––––––––––––––––––––––––––––––––––––––– Median More number Some than Don’t Number of years Background No Some Completed secon- Completed secon- know/ of of characteristic education primary primary1 dary secondary2 dary missing Total men schooling3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 16.9 82.1 0.0 0.2 0.0 0.0 0.8 100.0 1,013 0.8 10-14 0.5 37.8 10.7 50.5 0.0 0.0 0.5 100.0 1,322 5.5 15-19 0.6 4.8 3.7 67.7 17.1 5.1 1.0 100.0 915 8.7 20-24 0.9 8.7 4.6 38.1 31.3 13.6 2.7 100.0 682 9.8 25-29 2.1 9.1 8.0 38.3 26.9 9.6 6.1 100.0 628 9.3 30-34 1.8 15.7 10.2 37.3 20.4 9.4 5.3 100.0 643 8.7 35-39 1.5 18.9 10.0 39.0 20.7 5.8 4.1 100.0 618 8.6 40-44 1.3 20.3 12.5 36.0 18.8 5.6 5.5 100.0 607 8.2 45-49 1.6 21.5 13.3 35.7 13.8 7.0 7.1 100.0 506 7.6 50-54 1.3 21.1 17.3 26.6 16.6 6.9 10.2 100.0 518 7.4 55-59 2.6 26.1 10.9 24.6 16.8 7.9 11.1 100.0 418 7.1 60-64 1.0 23.7 32.0 14.7 15.6 7.6 5.5 100.0 281 5.8 65+ 4.1 27.2 29.8 12.2 10.6 7.4 8.6 100.0 510 5.5 Residence Total Urban 1.9 19.1 8.6 35.7 19.4 10.8 4.4 100.0 2,379 8.2 Georgetown (urban) 1.3 16.9 8.9 33.9 22.1 12.0 4.9 100.0 1,537 8.7 Other (urban) 2.9 23.2 8.1 39.1 14.3 8.7 3.5 100.0 842 7.4 Total Rural 3.8 30.3 11.1 34.3 12.4 3.7 4.4 100.0 6,301 6.2 Total Coastal 2.8 26.2 10.4 35.4 15.0 6.2 4.1 100.0 7,670 7.0 Coastal (urban) 1.9 19.1 8.6 35.7 19.4 10.8 4.4 100.0 2,379 8.2 Coastal (rural) 3.3 29.3 11.1 35.2 13.1 4.0 3.9 100.0 5,290 6.4 Total Interior 6.3 35.7 11.0 29.9 8.5 2.0 6.7 100.0 1,010 5.4 Region Region 1 10.4 39.6 11.3 25.0 5.6 0.7 7.5 100.0 367 4.5 Region 2 3.6 34.4 14.0 31.6 11.3 2.8 2.4 100.0 522 5.8 Region 3 4.3 31.4 7.9 36.0 11.8 3.8 4.7 100.0 1,076 6.5 Region 4 1.9 22.8 8.5 35.8 18.2 7.6 5.2 100.0 3,607 7.8 Region 5 2.4 30.8 14.1 34.1 11.6 4.8 2.2 100.0 663 6.0 Region 6 4.1 26.3 15.2 33.5 14.1 4.5 2.2 100.0 1,471 6.3 Region 7 4.1 31.1 13.7 32.4 11.8 3.5 3.4 100.0 170 6.0 Region 8 3.3 31.9 12.0 32.1 8.2 0.4 12.1 100.0 183 5.7 Region 9 5.7 37.5 7.7 33.3 9.1 2.6 4.0 100.0 165 5.5 Region 10 2.6 25.6 5.1 41.5 9.3 11.3 4.5 100.0 456 7.4 Wealth quintile Lowest 6.5 40.2 11.4 29.3 5.9 1.1 5.7 100.0 1,693 5.1 Second 4.1 32.3 11.9 36.9 9.4 1.9 3.5 100.0 1,708 5.8 Middle 2.1 26.0 10.9 40.4 13.3 3.6 3.7 100.0 1,784 7.1 Fourth 2.3 21.9 10.2 36.6 16.8 7.1 5.1 100.0 1,734 7.8 Highest 1.4 16.5 7.8 30.3 25.5 14.5 4.0 100.0 1,762 9.2 Total 2009 3.2 27.3 10.4 34.7 14.3 5.7 4.4 100.0 8,680 6.8 Total 2005 3.2 24.7 13.2 35.7 16.0 5.6 1.5 100.0 4,814 9.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 19 males with information missing on age who are not shown separately. 1 Completed 6th grade at the primary level 2 Completed 5th grade at the secondary level 3 The median number of years is the midpoint of the distribution of the population by number of years of education. Household Population and Housing Characteristics | 17 • Over two-thirds of the household population (68 percent of females and 65 percent of males) have completed primary school or higher. Only 3 percent of the population age 6 and over have never attended school, and about one in four people (26 to 27 percent) have attended only some primary school. • There is no significant gap in educational attainment between females and males except for the percentages who have completed secondary school (19 and 14 percent, respectively). • The median number of years of schooling is slightly higher for females than for males: 7.4 years versus 6.8 years. The median number of years of schooling are two years higher among both Urban area females and males (8.9 years and 8.2 years, respectively) compared with their Rural area counterparts (6.7 and 6.2 years, respectively). • The most substantial variation in educational attainment among household members is evident across wealth quintiles and regions for both females and males. Seventeen percent of females and 18 percent of males from the wealthiest households have never been to school or have just attended some primary school, compared with 45 percent of females and 47 percent of males from the poorest households. • Regarding regions, 55 percent of females and 50 percent of males in Region 1 have never been to school or have just attended some primary school, compared with 22 percent of females in Region 10 and 25 percent of males in Region 4. 2.1.5 School Attendance Table 2.5 provides net and gross attendance ratios by school level, sex, and residence. The net attendance ratio (NAR) is an indicator of participation in schooling among the population of official school age, while the gross attendance ratio (GAR) is an indicator of participation in schooling among those of any age between 5 and 24 years. The difference between the ratios indicates the incidence of over-age and under-age attendance. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.1 A NAR of 100 percent would indicate that all children in the official age range for the level are attending education at that level. The GAR can exceed 100 percent if there is significant over- age or under-age participation at a given level of schooling. Children are considered to be attending school currently if they attended at any point during the current school year. Figure 2.3 presents the age-specific attendance ratios (ASAR) for the population age 5-24 by sex. The ASAR indicates participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100 percent, the higher is the proportion of a given age attending school. The Gender Parity Index (GPI), or the ratio of the female to the male GAR at the general basic and general secondary levels, is also included in Table 2.5. The GPI indicates the magnitude of the gender gap in attendance ratios. If there is no gender difference, the GPI will be equal to 1. The GPI will be closer to 0 if the disparity is in favor of males. If the gender gap favors females, the GPI will exceed 1. 1 Students who are over-age for a given level of schooling may have started school over-age, may have repeated one or more grades in school, or may have dropped out of school and later returned. 18 | Household Population and Housing Characteristics Table 2.5 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by sex and grade; and the Gender Parity Index (GPI), according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Net attendance ratio1 Gross attendance ratio2 Background –––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––– characteristic Male Female Total GPI3 Male Female Total GPI3 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– PRIMARY SCHOOL ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 94.9 92.8 93.9 0.98 97.7 95.3 96.5 0.98 Georgetown (urban) 96.2 95.5 95.8 0.99 99.5 97.8 98.6 0.98 Other (urban) 93.1 88.7 90.9 0.95 95.1 91.6 93.3 0.96 Total Rural 91.3 93.3 92.3 1.02 96.9 98.4 97.6 1.01 Total Coastal 93.1 93.8 93.4 1.01 96.9 96.8 96.8 1.00 Coastal (urban) 94.9 92.8 93.9 0.98 97.7 95.3 96.5 0.98 Coastal (rural) 92.3 94.2 93.2 1.02 96.5 97.4 96.9 1.01 Total Interior 88.2 90.0 89.1 1.02 98.3 101.9 100.0 1.04 Wealth quintile Lowest 88.3 90.4 89.3 1.02 97.2 98.7 97.9 1.02 Second 94.6 92.4 93.5 0.98 100.6 97.0 98.8 0.96 Middle 92.5 95.2 93.9 1.03 95.5 98.4 97.0 1.03 Fourth 89.8 95.6 92.9 1.07 93.1 97.3 95.3 1.05 Highest 97.6 93.3 95.5 0.96 98.3 96.3 97.3 0.98 Total 2009 92.2 93.2 92.7 1.01 97.1 97.6 97.4 1.01 Total 2005 90.1 91.2 90.6 na 100.3 101.0 100.6 1.01 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SECONDARY SCHOOL –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 87.1 91.5 89.2 1.05 96.6 111.1 103.5 1.15 Georgetown urban 88.4 92.8 90.4 1.05 98.6 113.9 105.7 1.16 Other urban 85.2 89.7 87.4 1.05 93.5 107.0 100.2 1.14 Total Rural 76.4 77.8 77.1 1.02 86.1 87.0 86.5 1.01 Total Coastal 80.8 83.5 82.1 1.03 90.5 95.9 93.1 1.06 Coastal urban 87.1 91.5 89.2 1.05 96.6 111.1 103.5 1.15 Coastal rural 77.7 79.9 78.8 1.03 87.5 89.0 88.2 1.02 Total Interior 69.5 67.9 68.7 0.98 78.4 77.3 77.8 0.99 Wealth quintile Lowest 64.6 61.5 63.0 0.95 68.8 69.6 69.2 1.01 Second 72.5 77.6 75.1 1.07 82.3 88.7 85.5 1.08 Middle 77.3 86.2 81.3 1.12 85.5 96.5 90.4 1.13 Fourth 87.5 91.3 89.4 1.04 102.2 105.4 103.7 1.03 Highest 97.5 92.3 94.8 0.95 108.8 109.1 109.0 1.00 Total 2009 79.5 81.6 80.5 1.03 89.2 93.6 91.3 1.05 Total 2005 69.9 78.1 74.0 na 87.1 95.5 91.3 1.10 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not available 1 The net attendance ratio (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 gross attendance ratio (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 (GPI) for primary school is the ratio of the primary school GAR for females to the GAR for males. The GPI for secondary school is the ratio of the secondary school GAR for females to the GAR for males. Household Population and Housing Characteristics | 19 • More than nine in ten of the primary school-age children (age 6-11) in Guyana attend primary school; males (92 percent) are about as likely as females (93 percent) to attend primary school. • About eight in ten secondary school-age children (age 12-17) attend secondary school (80 percent of males and 82 percent of females). • Although the urban-rural difference in primary school NAR is negligible (94 and 92 percent, respectively), there is a 12 percentage point difference in the NAR for secondary school (89 and 77 percent, respectively). The gap in the secondary school NAR between the Coastal and the Interior areas is slightly larger: 82 and 69 percent, respectively. • Although there is little variation in the primary school NAR, according to the wealth index, secondary school-age children from the wealthiest households are significantly more likely to attend school than those in the least wealthy households (95 and 63 percent, respectively). 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 0 20 40 60 80 100 Percentage of the population Female Male GDHS 2009 Figure 2.3 Age-Specific School Attendance Rates, by Sex A ge 3 8 2 6 6 8 5 9 12 17 9 19 21 17 42 68 58 88 47 92 85 81 96 9590 82 95 96 96 97 99 98 98 98 98 99 97 98 20 | Household Population and Housing Characteristics • An important proportion of primary school students fall outside the official age range for primary schooling: whereas the primary school NAR is 93, the GAR is 97, indicating that for every 93 students age 6-11, there are four primary school students who are either younger than age 6 or older than age 11. In secondary school, the NAR is 81, while the GAR is 91, indicating that for every 81 students age 12-17, there are 10 who are either younger than age 12 or older than age 17. • The gross atendance ratios at the primary and secondary levels are slightly higher for females than for males, resulting in a Gender Parity Index of 1.01 for primary school and 1.05 for secondary school. • As shown on Figure 2.3, similar proportions of female and male youth attend school between 7 and 14 years. Attendance rates peak around age 7-13 (close to 100 percent) and decrease rapidly after age 15. At age 15 and age 16, greater proportions of female than male youth attend school, while between age 17 and age 24 male youths are generally more likely to attend school. 2.2 HOUSING CHARACTERISTICS To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their household environment. Type of water source, sanitation facilities, and floor material are characteristics that affect the health status of household members and, in particular, children. They also indicate the socioeconomic status of households. Table 2.6 shows the percentage of households with drinking water by Urban-Rural and Coastal-Interior residence. Major housing characteristics are presented in Table 2.7, and sanitation facilities are described in Table 2.8. 2.2.1 Drinking Water and Housing Characteristics Table 2.6 presents several indicators relating to household access to improved drinking water. The source of drinking water is an indicator of whether or not it is suitable for drinking. Sources that are considered likely to be of suitable quality are listed under “Improved source,” and sources that may not be of suitable quality are listed under “Non-improved source.” The categorization by improved and non- improved sources is proposed by WHO, UNICEF, and the Joint Monitoring Program for Water and Sanitation (WHO, UNICEF, and JMP, 2004). Information is also provided on the time to obtain drinking water, the age and sex of the person who usually collects the drinking water, and the treatment given to water used for drinking. Water may be treated in several ways by a household, so water treatment is given as the percentage of households using the treatment rather than as a distribution. The results for the de jure population are also included.2 2 The information for the de jure population is shown, given that UNICEF tabulates statistics by population rather than by household. Household Population and Housing Characteristics | 21 Table 2.6 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage by treatment of drinking water, according to residence, Guyana 2009 Urban-rural residence Coastal-Interior residence Urban Coastal Characteristic Total urban Georgetown urban Other urban Total rural Total Coastal Coastal urban Coastal rural Total Interior Total percentage of households Total percentage of population Source of drinking water Improved source 44.7 25.8 80.8 69.5 61.7 44.7 69.6 69.4 62.5 62.8 Piped into dwelling/yard/plot 28.5 14.5 55.4 33.9 34.9 28.5 37.9 10.5 32.4 32.5 Public tap/standpipe 0.4 0.0 1.3 1.3 0.9 0.4 1.1 2.3 1.1 1.1 Tube well or borehole 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 Protected dug well 0.0 0.0 0.1 2.0 0.7 0.0 0.9 8.6 1.5 1.7 Protected spring 0.7 0.0 2.1 0.3 0.3 0.7 0.1 1.3 0.4 0.5 Rainwater 14.9 11.3 21.9 31.9 24.9 14.9 29.5 46.5 27.1 27.0 Non-improved source 0.6 0.0 1.8 6.3 2.3 0.6 3.1 25.5 4.7 5.9 Unprotected dug well 0.0 0.0 0.0 0.7 0.0 0.0 0.0 4.3 0.5 0.7 Unprotected spring 0.4 0.0 1.3 0.6 0.3 0.4 0.2 2.8 0.5 0.6 Tanker truck/cart with small tank 0.0 0.0 0.1 0.2 0.1 0.0 0.2 0.4 0.2 0.2 Surface water 0.1 0.0 0.4 4.9 1.9 0.1 2.7 17.9 3.5 4.3 Bottled water1 54.2 73.6 17.1 23.4 35.3 54.2 26.6 4.7 32.1 30.6 Improved source 53.8 73.3 16.4 22.8 34.7 53.8 25.9 4.7 31.6 30.1 Non-improved source 0.4 0.3 0.7 0.6 0.6 0.4 0.7 0.0 0.5 0.5 Other sources 0.5 0.5 0.3 0.7 0.7 0.5 0.8 0.3 0.6 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 98.5 99.1 97.1 92.3 96.4 98.5 95.4 74.0 94.1 93.0 Time to obtain drinking water (round trip) Water on premises 97.4 99.3 93.9 90.7 94.8 97.4 93.6 73.3 92.6 91.7 Less than 30 minutes 2.1 0.6 5.1 7.1 3.5 2.1 4.2 24.5 5.7 6.7 30 minutes or longer 0.3 0.0 0.9 1.6 1.3 0.3 1.7 0.8 1.2 1.2 Don't know/missing 0.1 0.1 0.2 0.6 0.3 0.1 0.4 1.3 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 0.2 0.0 0.6 2.6 1.3 0.2 1.9 7.0 1.9 2.3 Adult male 15+ 1.8 0.6 4.2 5.3 3.2 1.8 3.8 13.9 4.3 4.4 Female child under age 15 0.1 0.0 0.4 0.1 0.1 0.1 0.0 0.5 0.1 0.1 Male child under age 15 0.3 0.0 0.8 0.5 0.3 0.3 0.3 1.6 0.4 0.7 Other 0.0 0.0 0.1 0.7 0.2 0.0 0.2 3.3 0.5 0.7 Water on premises 97.4 99.3 93.9 90.7 94.8 97.4 93.6 73.3 92.6 91.7 Missing 0.1 0.1 0.1 0.2 0.1 0.1 0.1 0.4 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 14.3 10.9 20.9 8.0 9.9 14.3 7.8 8.7 9.8 9.8 Bleach/chlorine 32.6 27.0 43.4 39.0 38.8 32.6 41.6 23.4 37.2 38.9 Strained through cloth 0.1 0.0 0.4 0.8 0.5 0.1 0.7 1.6 0.6 0.6 Ceramic, sand or other filter 0.6 0.6 0.7 0.8 0.8 0.6 0.8 0.5 0.7 0.7 Other 1.6 0.9 2.7 1.9 1.7 1.6 1.8 2.5 1.8 1.7 No treatment 56.3 64.9 39.6 52.1 52.0 56.3 50.0 65.1 53.3 51.9 Percentage using an appro- priate treatment method3 42.1 34.0 57.7 46.5 46.7 42.1 48.9 32.4 45.3 46.7 Number 1,603 1,053 550 4,029 5,052 1,603 3,449 580 5,632 21,317 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non- improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining through cloth, filtering, and solar disinfecting. 22 | Household Population and Housing Characteristics • Although the majority of Guyanese households (94 percent) have access to clean water sources, 27 percent rely on rainwater and 32 percent rely on bottled water. For 33 percent of households, the water is piped into the dwelling, yard, or plot. • Access to an improved source of drinking water is similar for Urban, Rural, and Coastal area residences (92 to 99 percent). However, for residences in the Interior area, only 74 percent of households have access to an improved source of drinking water, where the main sources of drinking water are rainwater and surface water (47 and 18 percent, respectively). The drinking water is piped into the dwelling, yard, or plot for only 11 percent of house- holds in the Interior area. • Overall, 93 percent of Guyanese households have drinking water on their premises. In the Interior area, however, only 73 percent of households have drinking water on their premi- ses, with the majority of the remaining households (25 percent) reporting that it takes less than 30 minutes to obtain the water. In the Interior area, men over age 15 usually collect the water (14 percent) followed by women over age 15 (7 percent). • More than half of the households (53 percent) reported no water treatment prior to drinking, including almost two-thirds (65 percent) in the Interior and in the Urban (Georgetown) areas. Only 45 percent of households use an appropriate treatment method (i.e., boiling, bleaching, straining through cloth, filtering, or solar disinfecting). The principal water treatment is bleach or chlorine (37 percent) followed by boiling (10 percent). Table 2.7 shows information on basic housing characteristics by residence, including access to electricity, type of flooring material, number of rooms used for sleeping, place for cooking, and type of cooking fuel. • As many as 78 percent of Guyanese households have electricity, 91 percent in Urban areas compared with 72 percent in Rural areas. In the Interior area, only 40 percent of households have electricity. • Many households (38 percent) have wood or planks as flooring material, and 16 percent each have vinyl/asphalt strips or cement. • The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding increases the risk of infectious diseases, including acute respiratory infections and skin diseases, which particularly affect children. About one-third of households in rural areas (32 percent) use only one room for sleeping, and about one-fourth (24 percent) use three or more rooms for sleeping, compared with 21 percent and 36 percent, respectively, in urban areas. • Overall, in 86 percent of the households in Guyana cooking is done in the house. The only exception is the Interior area where 31 percent of households cook outdoors or in a separate building. • More than half of the households (56 percent) use LPG/natural gas/biogas as cooking fuel, and more than one-third (34 percent) use kerosene. In the Urban (Georgetown) area, however, the corresponding figures are 84 and 15 percent, respectively. • Solid fuel (coal/lignite, charcoal, wood, and straw/shrubs/grass) is used in only 8 percent of households for cooking. In the Interior area, however, more than one-third of households (35 percent) use solid fuel, compared with virtually 0 percent in the Urban (Georgetown) area. These Interior-area households use either fire-side (65 percent) or “open fire/stove without chimney or hood” (31 percent), with little difference by residence (data not shown). Household Population and Housing Characteristics | 23 Table 2.7 Housing characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Characteristic Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total percentage of households Total percentage of population Electricity 90.9 91.8 89.3 72.3 81.9 90.9 77.7 40.3 77.6 75.9 Flooring material Earth, sand 0.1 0.2 0.0 3.1 0.8 0.1 1.1 14.9 2.3 2.9 Dung 0.0 0.0 0.0 0.4 0.1 0.0 0.2 1.4 0.3 0.3 Wood/planks 25.3 22.7 30.3 43.1 37.1 25.3 42.6 45.6 38.0 38.2 Palm/bamboo 0.0 0.0 0.1 0.4 0.2 0.0 0.3 0.8 0.3 0.2 Parquet or polished wood 16.6 19.1 11.9 9.3 11.2 16.6 8.7 13.2 11.4 10.7 Vinyl or asphalt strips 21.5 22.5 19.5 13.5 16.1 21.5 13.7 12.3 15.7 15.9 Ceramic tiles 7.7 9.1 5.1 4.1 5.6 7.7 4.6 1.3 5.2 4.9 Cement 13.1 9.2 20.5 16.9 16.7 13.1 18.4 8.1 15.8 16.2 Carpet 14.9 16.4 11.9 8.8 11.4 14.9 9.9 2.3 10.5 10.1 Other 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.1 Missing 0.7 0.7 0.5 0.4 0.5 0.7 0.4 0.3 0.5 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 21.0 20.1 22.7 31.7 27.4 21.0 30.3 39.6 28.6 20.9 Two 40.6 41.8 38.1 39.7 40.5 40.6 40.5 34.9 40.0 41.1 Three or more 35.9 35.6 36.3 23.9 28.8 35.9 25.5 14.4 27.3 33.8 Missing 2.6 2.4 2.9 4.7 3.3 2.6 3.6 11.2 4.1 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 95.9 98.3 91.2 82.7 88.5 95.9 85.1 67.9 86.4 85.5 In a separate building 1.0 0.3 2.1 7.3 4.4 1.0 6.1 14.5 5.5 6.3 Outdoors 2.2 0.7 5.2 8.9 5.9 2.2 7.5 16.7 7.0 7.6 Missing 0.9 0.6 1.5 1.2 1.1 0.9 1.2 0.8 1.1 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 3.8 0.1 11.0 0.6 1.4 3.8 0.3 2.3 1.5 1.5 LPG/natural gas/biogas 71.6 84.0 47.7 49.1 57.9 71.6 51.5 34.5 55.5 54.9 Kerosene 22.2 15.2 35.6 38.6 34.7 22.2 40.6 27.2 34.0 33.5 Coal/lignite 0.3 0.0 0.9 0.2 0.2 0.3 0.2 0.2 0.2 0.2 Charcoal 0.1 0.0 0.3 0.2 0.1 0.1 0.2 0.6 0.2 0.2 Wood 1.2 0.0 3.4 10.2 4.6 1.2 6.2 34.1 7.7 9.1 Straw/shrubs/grass 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 No food cooked in household 0.7 0.6 0.9 0.9 0.9 0.7 1.0 0.3 0.8 0.3 Other 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.2 0.0 0.1 Missing 0.1 0.0 0.3 0.1 0.1 0.1 0.1 0.3 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 1.6 0.0 4.5 10.7 5.0 1.6 6.5 35.1 8.1 9.5 Number of households 1,603 1,053 550 4,029 5,052 1,603 3,449 580 5,632 21,317 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood, and straw/shrubs/grass. 24 | Household Population and Housing Characteristics 2.2.2 Sanitation Facilities Table 2.8 shows the proportions of households and of the de jure population that have access to hygienic sanitation facilities. Hygienic status is determined on the basis of type of facility used and whether or not it is a shared facility. A household’s toilet/latrine facility is classified as hygienic if it is used only by household members (i.e., not shared) and if the type of facility effectively separates human waste from human contact. The types of facilities that are most likely to accomplish this are flush or pour flush into a piped sewer system, septic tank, or pit latrine; a ventilated, improved pit (VIP) latrine; and a pit latrine with a slab. A household’s sanitation facility is classified as unhygienic if it is shared with other households or if it does not effectively separate human waste from human contact. • With regard to sanitation facilities, 48 percent of households use septic tank toilets, 24 percent use a pit latrine with slab, and 7 percent use a ventilated improved pit latrine. Only 1 percent of households have no sanitation facilities. • In urban areas, the most common type of toilet facility is a septic tank (69 percent), while only 11 percent of households are connected to a piped sewer system. In Rural areas, 40 percent of households have septic tanks, and 31 percent have pit latrines with a slab. Sharing a toilet facility with other households is also more common in Rural areas (10 percent of households) compared with Urban areas (6 percent of households). Table 2.8 Sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Type of toilet/latrine facility Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total percentage of households Total percentage of population Improved, not shared facility Flush/pour flush to piped sewer system 11.3 16.4 1.5 1.1 4.3 11.3 1.1 1.4 4.0 4.0 Flush/pour flush to septic tank 68.6 72.1 61.7 39.8 51.9 68.6 44.2 13.3 48.0 45.9 Flush/pour flush to pit latrine 0.1 0.2 0.0 0.3 0.2 0.1 0.2 1.0 0.2 0.4 Ventilated improved pit (VIP) latrine 3.5 2.5 5.5 9.0 6.9 3.5 8.5 11.5 7.4 8.3 Pit latrine with slab 6.6 1.6 16.2 31.2 23.1 6.6 30.8 33.8 24.2 25.4 Non-improved facility Any facility shared with other households 5.9 4.7 8.3 10.4 8.7 5.9 10.0 13.0 9.1 8.3 Flush/pour flush not to sewer/septic tank/pit latrine 0.1 0.2 0.0 0.3 0.2 0.1 0.3 0.3 0.2 0.2 Pit latrine without slab/open pit 3.3 1.8 6.1 5.5 3.5 3.3 3.5 17.3 4.9 5.5 Hanging toilet/hanging latrine 0.0 0.0 0.1 0.9 0.7 0.0 1.0 0.7 0.7 0.7 No facility/bush/field 0.3 0.2 0.5 1.3 0.3 0.3 0.3 7.1 1.0 1.0 Missing 0.3 0.3 0.1 0.1 0.1 0.3 0.1 0.4 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,603 1,053 550 4,029 5,052 1,603 3,449 580 5,632 21,317 Household Population and Housing Characteristics | 25 2.2.3 Household Possessions The availability of durable goods is a proximate measure of household socioeconomic status. Moreover, goods have specific benefits. Having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport, such as a bicycle, motorcycle, or car, allows access to many services available outside the local area. In the 2009 GDHS, respondents were asked about ownership of particular household goods. Table 2.9 provides information on household ownership of durable goods (radios, televisions, telephones, refrigerators, and other items) and modes of transportation (bicycles, motorcycles, and automobiles). • Nationally, the most commonly owned items among those investigated are the television (81 percent of households) and the mobile telephone (80 percent). The ownership of these two items is high in all areas, except for households in the Interior area, where ownership of television and mobile telephones is relatively low (45 and 55 percent, respectively). • Refrigerators and radios are the next most popular household items (62 and 59 percent, respectively). Over half of Guyanese households own a land-line telephone (54 percent) and a bicycle (52 percent), but only 17 percent own a car or a truck. • As expected, for most items ownership is much higher in Urban than in Rural areas, especially for non-mobile telephones (78 percent compared with 45 percent) and refrigerators (80 percent compared with 55 percent). Table 2.9 Durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land, and livestock/farm animals, by residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Characteristic Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total percentage of households Total percentage of population Radio 70.8 75.9 61.2 54.4 62.0 70.8 57.9 33.7 59.1 58.7 Television 90.4 91.2 89.1 76.5 84.6 90.4 81.8 44.8 80.5 81.8 Mobile telephone 87.2 87.3 87.0 76.8 82.6 87.2 80.5 54.9 79.7 82.9 Non-mobile telephone 77.9 86.9 60.9 44.7 59.6 77.9 51.1 6.8 54.2 53.2 Refrigerator 79.5 83.6 71.5 54.9 66.4 79.5 60.3 22.8 61.9 61.7 Bicycle 47.8 39.2 64.2 53.8 54.7 47.8 57.9 29.3 52.1 57.2 Animal-drawn cart 0.9 0.7 1.2 1.2 1.1 0.9 1.3 0.8 1.1 1.2 Motorcycle/scooter 14.6 16.0 11.7 6.6 9.4 14.6 7.0 4.6 8.9 9.8 Car/truck 22.8 26.3 16.2 15.0 18.5 22.8 16.5 5.9 17.2 17.6 Boat with a motor 0.6 0.0 1.8 5.0 3.2 0.6 4.4 8.8 3.7 4.4 Ownership of agricultural land 5.9 2.5 12.3 18.5 11.8 5.9 14.6 42.1 14.9 16.4 Ownership of farm animals1 11.7 6.4 21.7 27.8 22.4 11.7 27.4 30.5 23.2 26.4 Number 1,603 1,053 550 4,029 5,052 1,603 3,449 580 5,632 21,317 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, or chickens 26 | Household Population and Housing Characteristics 2.3 WEALTH QUINTILES In addition to standard background characteristics, most of the results in this report are shown by wealth quintiles, an indicator of the economic status of households. Although surveys under the DHS program do not collect data on consumption or income, they do collect detailed information on dwelling and household characteristics and access to a variety of consumer goods, services, and assets. The wealth index is a measure that has been tested in a number of countries in relation to inequities in household income, use of health services, and health outcomes. The wealth index is constructed by assigning a weight or factor score to each household asset through principal components analysis. The resulting asset scores are standardized in relation to a standard normal distribution with a mean of zero and standard deviation of one. These scores are summed by household, and individuals are ranked according to the total score of the household in which they reside. The sample is then divided into population quintiles— five groups with the same number of individuals in each. At the national level, approximately 20 percent of the population is in each wealth quintile (Gwatkin et al, 2000). Asset information was collected in the 2009 GDHS Household Questionnaire and covers information on household ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, type of sanitation facilities, and type of material used in flooring (see Tables 2.7.1 through 2.9). Table 2.10 shows the distribution of the population across the five wealth quintiles, by areas of residence (Urban or Rural; Coastal or Interior) and by region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. Also included in Table 2.10 is the Gini coefficient, which indicates the level of concentration of wealth, with 0 being an equal distribution and 1 a totally unequal distribution, although the coefficient is expressed as a percentage in the table. • Around two-thirds of households in Urban areas are in the two highest wealth quintiles compared with about one-third in Rural areas. In contrast, households in Rural areas are five times as likely as those in Urban areas to be in the poorest wealth quintile (26 percent versus 5 percent). • Fifty percent of the Urban (Georgetown) households are in the wealthiest quintile, com- pared with only 24 percent in Urban (other) areas in the country and 12 percent in Rural areas. • Two-thirds of households (66 percent) in the Interior area are in the lowest quintile, and 83 percent are in the two poorest quintiles. Regions 1, 8, and 9 have most of their households in the lowest quintile (72, 74, and 84 percent, respectively), while Regions 4 and 10 have a significant percentage of households in the wealthiest quintile (32 and 24 percent, respectively). Household Population and Housing Characteristics | 27 2.4 BIRTH REGISTRATION The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. In the 2009 GDHS, for all children born since January 2004, mothers were asked if their child’s birth had been registered. Table 2.11 shows the percentage of children under age 5 whose births were officially registered and the percentage that had a birth certificate at the time of the survey. Not all children who are registered may have a birth certificate since some certificates may have been lost or were never issued. However, all children with a certificate have been registered. • A total of 88 percent of Guyanese children under age 5 have been registered with the civil authority. There are no substantial variations by background characteristics in the per- centage of chidlren whose births are registered, except for regions. The total percentage of registered births ranges from 83 percent in Region 1 to 96 percent in Region 5. • More variation is observed in the proportion of children with a birth certificate available at the time of the survey. Overall, 73 percent of children under age 5 had a birth certificate at the time of the survey. Children in Urban areas are slightly more likely than those in Rural areas to have a birth certificate available (81 and 70 percent, respectively). Only 61 percent of children under age 5 in the Interior area had a birth certificate at the time of the survey. • The likelihood of having a birth certificate at the time of the survey is 21 percentage points lower for children in the poorest wealth quintile compared with those in the highest wealth quintile (63 percent versus 84 percent). Table 2.10 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, according to residence and region, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wealth quintile Number of –––––––––––––––––––––––––––––––––––––––––––– de jure Gini Residence/region Lowest Second Middle Fourth Highest Total population coefficient ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 5.1 12.2 17.4 24.8 40.5 100.0 5,870 7.8 Urban (Georgetown) 3.4 9.7 12.9 24.3 49.7 100.0 3,774 5.6 Urban (other) 8.2 16.7 25.5 25.7 24.0 100.0 2,096 9.0 Total Rural 25.7 23.0 21.0 18.1 12.2 100.0 15,448 18.8 Total Coastal 13.5 20.4 21.7 22.0 22.4 100.0 18,649 12.1 Coastal (urban) 5.1 12.2 17.4 24.8 40.5 100.0 5,870 7.8 Coastal (rural) 17.3 24.1 23.7 20.8 14.1 100.0 12,780 12.6 Total Interior 65.6 17.4 8.1 5.6 3.4 100.0 2,668 40.1 Region Region 1 72.0 20.1 4.2 2.1 1.6 100.0 934 33.8 Region 2 38.0 21.6 17.7 14.2 8.5 100.0 1,312 21.5 Region 3 15.5 22.9 28.2 18.9 14.5 100.0 2,842 10.5 Region 4 9.4 17.6 18.7 22.7 31.6 100.0 8,678 10.2 Region 5 15.8 30.4 22.0 20.1 11.5 100.0 1,567 9.7 Region 6 13.9 22.5 23.6 26.0 14.0 100.0 3,357 12.5 Region 7 53.8 14.6 11.8 12.4 7.3 100.0 508 39.7 Region 8 74.0 12.9 9.6 2.6 0.9 100.0 465 43.5 Region 9 84.4 6.8 3.7 3.0 2.1 100.0 439 51.3 Region 10 10.8 17.9 25.2 22.4 23.8 100.0 1,215 12.8 Total 20.0 20.0 20.0 20.0 20.0 100.0 21,317 16.9 28 | Household Population and Housing Characteristics Table 2.11 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, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children whose births are registered: –––––––––––––––––––––––––––––– Had Didn’t have Number Background a birth a birth Total of characteristic certificate certificate registered children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age <2 58.8 28.4 87.2 825 2-4 82.1 6.3 88.4 1,228 Sex Male 71.6 16.7 88.2 1,023 Female 73.9 13.8 87.6 1,030 Residence Total Urban 81.2 9.9 91.1 464 Urban (Georgetown) 83.9 7.6 91.5 286 Urban (other) 77.0 13.5 90.4 178 Total Rural 70.2 16.8 87.0 1,589 Total Coastal 75.9 12.5 88.3 1,623 Coastal (urban) 81.2 9.9 91.1 464 Coastal (rural) 73.7 13.5 87.2 1,158 Total Interior 60.8 25.5 86.3 430 Region Region 1 56.1 26.8 83.0 162 Region 2 70.0 16.7 86.6 123 Region 3 73.9 15.0 88.9 269 Region 4 78.8 9.2 87.9 727 Region 5 81.2 14.6 95.8 144 Region 6 69.3 15.9 85.2 272 Region 7 73.6 15.5 89.2 73 Region 8 56.4 34.0 90.4 76 Region 9 59.4 24.5 83.9 72 Region 10 73.9 16.2 90.1 133 Wealth quintile Lowest 63.3 20.9 84.3 595 Second 74.5 15.4 89.8 438 Middle 72.6 15.5 88.2 374 Fourth 76.7 11.2 87.9 339 Highest 84.1 7.9 92.0 307 Total 2009 72.7 15.2 87.9 2,053 Total 2005 77.5 17.3 94.8 1,006 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure household members, i.e., usual household members. Characteristics of Survey Respondents | 29 CHARACTERISTICS OF SURVEY RESPONDENTS 3 This chapter provides a brief description of demographic and socioeconomic characteristics of the survey respondents, specifically their age, sex, residence, education, economic status, employment, and marital status. Examination of these characteristics not only helps one to gauge the accuracy of the survey data but also provides a look at trends in these characteristics over time. Most important, they provide a basis for the analysis of how these characteristics relate to the other issues investigated in the survey. 3.1 BACKGROUND CHARACTERISTICS OF SURVEY RESPONDENTS A description of the basic characteristics of the 4,996 women and 3,522 men interviewed in the 2009 GDHS is essential as background for interpreting findings presented later in the report. Table 3.1 provides the percent distribution of respondents by age, marital status, level of education, wealth quintile, religion, and ethnicity. Information on both the weighted and unweighted numbers is included. To determine their age, respondents were asked two questions in the individual interview: “In what month and year were you born?” and “How old were you at your last birthday?” The interviewers were trained to use probing techniques for situations in which respondents did not know their age or date of birth, and as a last resort, they were instructed to record their best estimate of the respondent's age. Highlights of basic background characteristics of the respondents are the following: • The percentage of each age group decreases with age for both women and men, reflecting the predominantly youthful age structure of the population of Guyana. Respondents age 15-19 represent the highest percentage—20 percent— or one-fifth of the total population age 15-49. • About one-third of women (34 percent) and men (31 percent) are currently married. An additional one in four women (25 percent) and one in five men (22 percent) are in “informal” unions. All together, 59 percent of women and 52 percent of men are currently in a union. Eleven percent of women and 9 percent of men are divorced, separated, or widowed. The proportion that has never married is higher for men (39 percent) than for women (31 percent). • About one-fifth of women (19 percent) and men (20 percent) attended or completed primary school. Seven in ten respondents have attended or completed secondary school, and 8 percent each of women and men have more than a secondary education. • The male population is more evenly distributed among wealth quintiles (19-21 percent each) than the female population (which increases steadily from 16 percent in the lowest quintile to 23 percent in the highest quintile). • The majority of respondents (66 percent of women and 56 percent of men) are Christian, followed by Hindu (26 percent of women and 31 percent of men). Another 6 percent of women and 8 percent of men are Muslim. • The largest ethnic group in Guyana is Indian: 43 percent of women and 50 percent of men are of Indian descent. More than one-quarter of respondents are in the African ethnic group (30 percent of women and 27 percent of men), and slightly less than one-tenth of respondents (9 percent of women and 8 percent of men) report that they are Amerindian. • Eighteen percent of women and 14 percent of men say they are of mixed ethnic background. 30 | Characteristics of Survey Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––– Background Weighted Weighted Unweighted Weighted Weighted Unweighted characteristic percent number number percent number number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 20.3 1,016 1,016 19.6 689 720 20-24 15.4 767 775 14.5 511 497 25-29 13.2 658 658 13.1 462 460 30-34 12.9 643 661 14.8 521 487 35-39 14.0 699 697 13.3 470 482 40-44 12.5 624 624 13.0 457 463 45-49 11.8 589 565 11.7 413 413 Marital status Never married 30.8 1,540 1,512 39.2 1,382 1,377 Married 33.8 1,687 1,803 30.6 1,078 1,159 Living together 24.7 1,233 1,203 21.5 757 725 Divorced/separated 9.1 454 398 8.3 291 247 Widowed 1.6 82 80 0.4 14 14 Education No education 1.4 68 81 1.7 60 56 Primary 19.1 952 1,042 20.2 711 741 Secondary 71.4 3,568 3,500 69.8 2,459 2,451 More than secondary 8.2 409 373 8.3 292 274 Wealth quintile Lowest 15.6 779 1,254 18.8 663 900 Second 19.2 957 899 19.3 679 675 Middle 20.5 1,025 936 20.5 723 667 Fourth 21.7 1,084 984 21.3 751 695 Highest 23.0 1,151 923 20.0 705 585 Religion Christian 66.2 3,306 3,520 55.5 1,956 2,095 Hindu 26.2 1,307 1,137 31.4 1,106 981 Muslim 6.1 306 271 8.0 282 262 Rastafarian 0.2 12 7 1.2 42 38 Not religious 1.1 53 48 3.5 123 131 Other 0.1 4 6 0.3 11 12 Missing 0.1 6 7 0.1 3 3 Ethnic group African 29.5 1,475 1,242 26.5 933 848 Indian 43.4 2,168 1,847 49.6 1,748 1,557 Amerindian 9.0 449 932 8.2 291 561 Portuguese 0.1 5 7 1.1 38 26 Chinese 0.0 2 3 0.1 2 3 Mixed 17.9 892 959 14.3 504 520 Other 0.1 3 2 0.1 4 6 Missing 0.0 2 4 0.0 2 1 Total 100.0 4,996 4,996 100.0 3,522 3,522 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Unweighted numbers refer to the number of interviews actually completed. Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Survey Respondents | 31 3.2 EDUCATIONAL ATTAINMENT OF RESPONDENTS Tables 3.2.1 and 3.2.2 show the percent distribution of women and men age 15-49, respectively, by highest level of schooling attended or completed and median number of years completed, according to background characteristics. Furthermore, Figure 3.1 shows the gender differentials in educational attain- ment, by place of residence and by wealth index. Table 3.2.1 Educational attainment of respondents: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed and median number of years completed, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median Some More than years Number Background No Some Completed secon- Completed secon- of of characteristic education primary primary1 dary secondary2 dary Total schooling3 women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 0.8 6.2 3.5 47.8 34.3 7.5 100.0 9.6 1,783 15-19 0.8 5.5 2.4 61.5 26.4 3.5 100.0 9.1 1,016 20-24 0.8 7.0 4.9 29.7 44.8 12.8 100.0 10.2 767 25-29 1.8 9.8 8.1 35.8 32.6 11.9 100.0 9.6 658 30-34 1.9 11.8 6.9 41.8 26.4 11.2 100.0 9.2 643 35-39 1.9 11.7 10.7 46.2 22.5 7.0 100.0 8.9 699 40-44 1.1 17.9 13.1 39.6 23.3 4.9 100.0 8.4 624 45-49 1.6 20.7 12.0 37.7 20.3 7.7 100.0 8.1 589 Residence Total Urban 0.6 4.8 2.5 43.8 32.7 15.6 100.0 9.9 1,475 Georgetown (urban) 0.6 3.0 1.2 44.5 34.3 16.4 100.0 10.0 967 Other (urban) 0.6 8.2 4.9 42.5 29.6 14.2 100.0 9.6 508 Total Rural 1.7 14.1 9.9 42.7 26.6 5.1 100.0 8.8 3,521 Total Coastal 1.0 10.6 7.5 42.9 29.2 8.7 100.0 9.3 4,495 Coastal (urban) 0.6 4.8 2.5 43.8 32.7 15.6 100.0 9.9 1,475 Coastal (rural) 1.2 13.5 9.9 42.5 27.5 5.4 100.0 8.8 3,019 Total Interior 4.5 17.5 9.9 44.0 21.1 3.1 100.0 8.3 501 Region Region 1 10.8 36.7 8.7 31.0 9.9 2.8 100.0 5.4 162 Region 2 2.8 11.8 13.3 45.4 21.1 5.6 100.0 8.3 293 Region 3 1.2 15.3 7.0 40.2 29.7 6.5 100.0 8.9 687 Region 4 0.9 7.8 4.4 45.3 31.0 10.6 100.0 9.6 2,168 Region 5 1.6 12.5 16.6 34.6 29.0 5.6 100.0 9.1 353 Region 6 0.5 15.2 11.6 39.9 27.5 5.3 100.0 8.6 780 Region 7 1.3 6.5 9.1 44.7 33.7 4.6 100.0 9.5 104 Region 8 0.4 8.3 9.5 61.0 19.1 1.7 100.0 9.0 95 Region 9 2.3 11.5 15.1 41.0 28.4 1.7 100.0 8.7 78 Region 10 0.5 4.5 3.1 49.8 25.8 16.3 100.0 9.6 277 Wealth quintile Lowest 6.0 23.9 13.9 40.9 14.4 1.0 100.0 7.0 779 Second 0.9 13.9 9.3 52.0 21.3 2.5 100.0 8.5 957 Middle 0.5 10.2 8.1 47.7 28.7 4.8 100.0 9.2 1,025 Fourth 0.4 8.1 7.0 43.0 32.3 9.2 100.0 9.5 1,084 Highest 0.3 4.7 2.6 32.7 39.8 19.9 100.0 10.2 1,151 Total 2009 1.4 11.3 7.7 43.0 28.4 8.2 100.0 9.2 4,996 Total 2005 1.0 12.1 8.0 47.9 23.1 7.9 100.0 12.1 2,425 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed 6 grades at the primary level 2 Completed 5 grades at the secondary level 3 The median is the midpoint of the distribution of the population by number of years of education. 32 | Characteristics of Survey Respondents • Only 1 percent of women and 2 percent of men have never attended school. Respondents in the Interior area (5 percent of women and 6 percent of men) and in Region 1 (11 percent of women and 12 percent of men) are more likely than other respondents to have no education. • Eighty percent of women and 78 percent of men have attended secondary school or higher, the percentage being significantly higher for younger age groups. An Urban-Rural differential exists, with Urban respondents being much more likely to have attended secondary or higher education than Rural respondents. Ninety-two percent of Urban Table 3.2.2 Educational attainment of respondents: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed and median number of years completed, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median Some More than years Number Background No Some Completed secon- Completed secon- of of characteristic education primary primary1 dary secondary2 dary Total schooling3 men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 1.1 6.0 2.9 57.7 23.0 9.2 100.0 9.1 1,200 15-19 0.3 4.7 2.2 69.6 17.9 5.1 100.0 8.8 689 20-24 2.2 7.7 3.8 41.7 29.9 14.7 100.0 9.7 511 25-29 2.1 7.7 6.1 45.5 28.1 10.5 100.0 9.4 462 30-34 1.4 15.6 8.8 46.9 18.1 9.2 100.0 8.5 521 35-39 1.9 18.1 9.3 44.4 19.8 6.5 100.0 8.6 470 40-44 1.3 20.0 11.9 44.5 17.2 5.0 100.0 8.1 457 45-49 3.5 22.5 11.3 43.8 11.2 7.8 100.0 8.1 413 Residence Total Urban 0.4 4.7 4.1 47.0 28.8 15.1 100.0 9.6 949 Georgetown (urban) 0.3 4.0 4.2 42.4 33.0 16.2 100.0 10.0 619 Other (urban) 0.5 5.9 3.9 55.7 21.1 12.9 100.0 9.1 330 Total Rural 2.2 16.0 8.4 50.3 17.3 5.8 100.0 8.5 2,573 Total Coastal 1.2 12.9 6.7 49.2 21.1 8.8 100.0 8.9 3,126 Coastal (urban) 0.4 4.7 4.1 47.0 28.8 15.1 100.0 9.6 949 Coastal (rural) 1.6 16.5 7.9 50.2 17.8 6.1 100.0 8.6 2,176 Total Interior 5.6 13.8 11.0 50.8 14.8 4.0 100.0 8.0 396 Region Region 1 12.1 16.2 10.7 46.6 11.8 2.6 100.0 6.5 160 Region 2 1.3 16.4 15.5 44.6 18.5 3.8 100.0 8.1 179 Region 3 1.7 12.8 4.5 58.8 15.8 6.4 100.0 8.8 420 Region 4 0.9 13.1 4.1 46.1 25.7 10.1 100.0 9.2 1,540 Region 5 1.4 16.5 9.0 51.0 14.5 7.5 100.0 8.3 271 Region 6 1.7 12.0 12.9 47.6 18.8 7.0 100.0 8.5 587 Region 7 0.4 9.9 18.4 45.8 20.3 5.2 100.0 8.8 61 Region 8 2.7 7.0 16.0 55.8 17.7 0.8 100.0 8.5 68 Region 9 0.5 21.8 4.5 56.3 13.3 3.6 100.0 8.4 57 Region 10 0.3 4.4 1.8 62.9 12.5 18.0 100.0 9.0 178 Wealth quintile Lowest 4.2 23.4 12.9 49.6 7.7 2.2 100.0 6.7 663 Second 2.6 18.0 7.2 54.4 14.2 3.5 100.0 8.2 679 Middle 1.1 12.7 6.9 55.5 17.4 6.3 100.0 8.8 723 Fourth 0.7 8.5 6.2 50.7 25.4 8.6 100.0 9.2 751 Highest 0.2 3.3 3.3 36.7 36.1 20.4 100.0 10.2 705 Total 2009 1.7 13.0 7.2 49.4 20.4 8.3 100.0 8.8 3,522 Total 2005 1.6 11.6 10.1 49.2 19.1 8.5 100.0 11.8 1,875 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed 6 grades at the primary level 2 Completed 5 grades at the secondary level 3 The median is the midpoint of the distribution of the population by number of years of education. Characteristics of Survey Respondents | 33 women and 91 percent of Urban men have secondary or higher education compared with 74 percent of Rural women and 73 percent of Rural men. Only 68 percent of women and 70 percent of men in the Interior area have secondary or higher education. • Respondents in the higher wealth quintiles are much more likely to be educated than respondents in the lower wealth quintiles. The percentage of respondents who have secondary or higher education increases rapidly with wealth. For women, it increases from 56 percent in the lowest wealth quintile to 92 percent in the highest quintile, while for men it increases from 60 percent to 93 percent. • The median years of schooling, indicating the number of years spent in school by half the population, is 9.2 years for women and 8.8 years for men. The median is about one year higher for young respondents, those age 15-24, than for those age 45-49. Respondents in the highest wealth quintile have at least three more years of schooling than those in the lowest wealth quintile (3.2 more years for women and 3.5 more years for men). 3.3 LITERACY The ability to read and write is an important personal asset, offering individuals increased opportunities in life. Knowing the distribution of the literate population can help program managers— especially those concerned with health and family planning—reach women and men with their messages. The 2009 GDHS assessed respondents’ ability to read by asking them to read a simple sentence. Only women and men who had never attended school and who had attended only primary school were asked to read the sentence; it was assumed that everyone with secondary or higher education was literate. Literacy was measured by whether the respondent could read none, part, or all of the sentence. Individuals who were blind or visually impaired were excluded. Figure 3.1 Respondents Completing Secondary or Higher Education, by Residence and Wealth Quintile 37 48 51 44 32 15 24 34 42 60 29 44 49 34 23 10 18 24 34 57 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural WEALTH QUINTILE Lowest Second Middle Fourth Highest 0 20 40 60 80 Percentage of respondents Women Men GDHS 2009 34 | Characteristics of Survey Respondents The following sentences were included in the 2009 GDHS: • The child is reading a book. • The rains came late this year. • Parents must care for their children. • Farming is hard work. Tables 3.3.1 and 3.3.2 show the percent distributions of women and men, respectively, by level of schooling attended, by level of literacy, and by percentage literate, according to background character- istics. Table 3.3.1 Literacy: Women Percent distribution of women by level of schooling attended, by level of literacy, and by percentage literate, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No schooling or primary school –––––––––––––––––––––––––––––––––––––– Secondary Can Can No card school read read Cannot with Blind/ Don't Number Background or whole part of read required visually know/ Percentage of characteristic higher sentence sentence at all language impaired missing Total literate1 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 91.3 4.3 1.6 2.4 0.0 0.0 0.3 100.0 97.3 1,016 20-24 87.4 4.9 3.6 4.1 0.1 0.0 0.0 100.0 95.9 767 25-29 80.4 9.2 3.9 6.6 0.0 0.0 0.0 100.0 93.4 658 30-34 79.4 8.9 4.4 6.9 0.3 0.0 0.1 100.0 92.7 643 35-39 75.6 12.1 5.3 5.9 0.0 0.0 1.0 100.0 93.1 699 40-44 67.8 19.7 5.6 6.3 0.0 0.1 0.5 100.0 93.1 624 45-49 65.8 21.3 6.2 5.8 0.0 0.6 0.3 100.0 93.3 589 Residence Total Urban 92.2 4.6 1.2 1.7 0.1 0.0 0.2 100.0 97.9 1,475 Georgetown (urban) 95.2 2.9 0.7 0.8 0.2 0.0 0.2 100.0 98.8 967 Other (urban) 86.3 7.9 2.0 3.4 0.0 0.0 0.3 100.0 96.2 508 Total Rural 74.3 13.2 5.4 6.6 0.0 0.1 0.4 100.0 92.9 3,521 Total Coastal 80.9 10.1 3.8 4.7 0.0 0.1 0.3 100.0 94.8 4,495 Coastal (urban) 92.2 4.6 1.2 1.7 0.1 0.0 0.2 100.0 97.9 1,475 Coastal(rural) 75.4 12.8 5.1 6.2 0.0 0.1 0.3 100.0 93.3 3,019 Total Interior 68.2 15.2 7.0 9.0 0.1 0.0 0.6 100.0 90.4 501 Region Region 1 43.7 20.7 13.8 21.3 0.2 0.0 0.2 100.0 78.2 162 Region 2 72.1 12.6 4.2 10.0 0.0 0.3 0.8 100.0 88.9 293 Region 3 76.4 14.8 3.7 4.7 0.0 0.0 0.4 100.0 94.9 687 Region 4 86.9 6.9 2.6 3.2 0.1 0.1 0.3 100.0 96.4 2,168 Region 5 69.3 17.6 6.4 6.3 0.0 0.4 0.0 100.0 93.2 353 Region 6 72.7 12.4 6.8 7.7 0.0 0.0 0.4 100.0 91.9 780 Region 7 83.0 9.7 4.1 2.0 0.0 0.0 1.1 100.0 96.9 104 Region 8 81.8 10.7 4.5 1.6 0.0 0.0 1.4 100.0 97.0 95 Region 9 71.1 20.1 3.7 5.1 0.0 0.0 0.0 100.0 94.9 78 Region 10 91.9 5.8 0.9 1.4 0.0 0.0 0.0 100.0 98.6 277 Wealth quintile Lowest 56.2 18.6 8.5 16.4 0.0 0.0 0.3 100.0 83.2 779 Second 75.9 11.2 5.7 6.6 0.0 0.2 0.4 100.0 92.8 957 Middle 81.2 10.1 5.5 3.0 0.0 0.3 0.1 100.0 96.7 1,025 Fourth 84.6 10.6 2.0 2.4 0.0 0.0 0.4 100.0 97.2 1,084 Highest 92.4 5.4 0.7 0.9 0.2 0.0 0.4 100.0 98.5 1,151 Total 79.6 10.6 4.1 5.2 0.0 0.1 0.3 100.0 94.4 4,996 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Refers to respondents who attended secondary school or higher level and respondents who can read a whole sentence or part of a sentence. The calculation excludes from the denominator respondents for whom no card in the required language was available and respondents who were blind/visually impaired (their literacy could not be gauged). Characteristics of Survey Respondents | 35 • Overall, 94 percent of women and 91 percent of men age 15-49 are literate. Only 5 percent of women and 8 percent of men age 15-49 cannot read at all. The figures for respondents in Region 1 are much higher, 21 percent for women and 19 percent for men. • Literacy levels among men have increased over the years, from 88 percent for men age 45- 49 to 96 percent for those age 15-19. This pattern is less pronounced among women as literacy in all age groups is 93 percent or higher. • As expected, literacy levels in urban areas are higher than in rural areas (98 percent versus 93 percent for women; 97 percent versus 89 percent for men). The lowest literacy levels occur in Region 1 (78 percent for women and 80 percent for men). Table 3.3.2 Literacy: Men Percent distribution of men by level of schooling attended, by level of literacy, and by percentage literate, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No schooling or primary school –––––––––––––––––––––––––––––––––––––– Secondary Can Can No card school read read Cannot with Blind/ Don't Number Background or whole part of read required visually know/ Percentage of characteristic higher sentence sentence at all language impaired missing Total literate1 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 92.7 1.8 1.3 4.0 0.0 0.0 0.2 100.0 95.8 689 20-24 86.3 3.9 3.5 6.0 0.0 0.0 0.3 100.0 93.6 511 25-29 84.2 4.4 3.2 8.0 0.1 0.0 0.2 100.0 91.7 462 30-34 74.2 11.6 3.5 10.1 0.0 0.0 0.6 100.0 89.3 521 35-39 70.8 9.0 7.9 10.4 0.2 0.4 1.4 100.0 87.6 470 40-44 66.7 14.7 9.1 8.2 0.0 0.0 1.2 100.0 90.5 457 45-49 62.8 19.2 6.4 10.2 0.2 0.6 0.6 100.0 88.3 413 Residence Total Urban 90.9 4.0 1.9 2.4 0.0 0.2 0.7 100.0 96.7 949 Georgetown (urban) 91.5 4.1 2.2 1.3 0.0 0.2 0.7 100.0 97.8 619 Other (urban) 89.7 3.7 1.3 4.4 0.0 0.2 0.7 100.0 94.7 330 Total Rural 73.4 10.3 5.7 9.9 0.1 0.1 0.6 100.0 89.3 2,573 Total Coastal 79.2 8.1 4.4 7.6 0.0 0.1 0.6 100.0 91.7 3,126 Coastal (urban) 90.9 4.0 1.9 2.4 0.0 0.2 0.7 100.0 96.7 949 Coastal (rural) 74.1 9.9 5.5 9.8 0.0 0.1 0.6 100.0 89.5 2,176 Total Interior 69.6 12.1 6.9 10.2 0.6 0.1 0.4 100.0 88.7 396 Region Region 1 61.1 11.8 6.9 18.6 1.3 0.0 0.3 100.0 79.8 160 Region 2 66.8 17.3 8.7 7.1 0.0 0.0 0.0 100.0 92.9 179 Region 3 81.0 8.1 4.8 5.3 0.0 0.3 0.5 100.0 94.0 420 Region 4 81.9 7.1 4.6 5.6 0.0 0.1 0.6 100.0 93.7 1,540 Region 5 73.0 11.4 1.9 13.2 0.0 0.4 0.0 100.0 86.4 271 Region 6 73.4 7.9 4.0 13.5 0.0 0.0 1.2 100.0 85.3 587 Region 7 71.3 17.8 5.5 4.0 0.0 0.0 1.2 100.0 94.7 61 Region 8 74.3 11.3 8.6 5.6 0.3 0.0 0.0 100.0 94.1 68 Region 9 73.2 16.1 4.5 5.1 0.4 0.6 0.0 100.0 93.8 57 Region 10 93.4 1.2 3.1 0.8 0.0 0.4 1.0 100.0 97.8 178 Wealth quintile Lowest 59.5 13.1 10.2 15.8 0.3 0.1 0.9 100.0 82.8 663 Second 72.2 9.4 6.9 10.8 0.1 0.3 0.3 100.0 88.5 679 Middle 79.2 8.9 4.0 7.2 0.0 0.0 0.8 100.0 92.0 723 Fourth 84.6 7.7 1.7 5.1 0.0 0.2 0.7 100.0 94.0 751 Highest 93.2 4.1 1.1 1.2 0.0 0.0 0.4 100.0 98.4 705 Total 15-49 78.1 8.6 4.7 7.9 0.1 0.1 0.6 100.0 91.3 3,522 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Refers to respondents who attended secondary school or higher and respondents who can read a whole sentence or part of a sentence. The calculation excludes from the denominator respondents for whom no card with the required language is avail- able and respondents who are blind/visually impaired, since their literacy cannot be gauged. 36 | Characteristics of Survey Respondents • Literacy among respondents in the highest wealth quintile is almost universal (99 percent for women and 98 percent for men), but only 83 percent of women and men in the lowest wealth quintile are literate. 3.4 EXPOSURE AND ACCESS TO MASS MEDIA Respondents were asked in the 2009 GDHS how frequently they read a newspaper or watch television and how frequently they listen to a radio. This information is important to program planners seeking to reach women and men through the media with family planning and health messages. The percentages of women and men who were exposed to specific mass media on a weekly basis are presented in Tables 3.4.1 (for women) and 3.4.2 (for men), by background characteristics. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure –––––––––––––––––––––––––––––––– Reads a Watches Listens to newspaper television the radio at least at least at least All No Number Background once once once three mass of characteristic a week a week a week media media women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 70.6 85.4 52.4 38.3 6.1 1,016 20-24 71.0 83.6 47.0 35.9 8.2 767 25-29 66.7 83.3 43.9 32.0 8.6 658 30-34 69.8 85.4 51.2 38.5 5.3 643 35-39 67.4 84.5 47.5 35.8 8.2 699 40-44 65.4 82.5 46.1 33.7 7.6 624 45-49 62.4 83.4 44.2 28.1 8.7 589 Residence Total Urban 79.9 90.6 61.9 50.1 2.4 1,475 Georgetown (urban) 82.9 92.2 69.3 57.1 2.0 967 Other (urban) 74.3 87.5 47.8 36.7 3.2 508 Total Rural 63.0 81.4 42.0 28.7 9.5 3,521 Total Coastal 70.9 88.1 50.7 37.8 4.4 4,495 Coastal (urban) 79.9 90.6 61.9 50.1 2.4 1,475 Coastal (rural) 66.5 86.9 45.2 31.9 5.4 3,019 Total Interior 41.4 48.5 22.4 9.6 34.6 501 Region Region 1 35.3 42.9 18.2 6.4 40.7 162 Region 2 60.0 75.0 47.0 28.3 9.9 293 Region 3 70.7 90.4 46.0 34.2 4.3 687 Region 4 76.5 89.7 57.7 45.1 3.2 2,168 Region 5 58.2 82.2 40.4 25.7 6.2 353 Region 6 63.9 90.2 41.9 30.3 5.3 780 Region 7 50.0 57.1 34.0 21.8 29.5 104 Region 8 40.5 45.2 13.3 3.9 36.3 95 Region 9 31.5 30.6 20.8 3.0 45.2 78 Region 10 72.4 82.7 44.3 31.4 5.2 277 Education No education 5.4 37.6 16.3 0.3 50.6 68 Primary 42.7 74.0 35.4 16.5 15.7 952 Secondary 73.6 87.0 50.2 38.4 4.9 3,568 More than secondary 87.8 90.5 62.2 53.8 3.2 409 Wealth quintile Lowest 37.6 37.0 32.2 9.0 35.3 779 Second 59.5 86.0 41.9 25.8 5.3 957 Middle 70.9 92.6 46.5 34.2 2.2 1,025 Fourth 75.7 96.0 49.9 40.2 1.6 1,084 Highest 85.7 95.7 62.8 56.1 0.7 1,151 Total 2009 68.0 84.1 47.9 35.0 7.4 4,996 Total 2005 69.6 82.9 60.3 41.2 5.5 2,425 Characteristics of Survey Respondents | 37 • Only 7 percent of women and 9 percent of men are not exposed to any of the specified media. • More than eight in ten respondents (84 percent of women and 83 percent of men) watch television, the most common type of mass media in Guyana, at least once a week. More than two-thirds of women (68 percent) and six in ten men (62 percent) read a newspaper. About half (48 percent of women and 55 percent of men) listen to the radio at least once a Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure –––––––––––––––––––––––––––––––– Reads a Watches Listens to newspaper television the radio at least at least at least All No Number Background once once once three mass of characteristic a week a week a week media media men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 62.9 88.2 50.9 33.6 6.2 689 20-24 60.4 82.5 54.5 36.1 10.6 511 25-29 65.7 86.5 58.9 44.9 8.4 462 30-34 58.9 83.7 55.5 37.2 9.2 521 35-39 58.4 80.9 53.1 33.7 7.7 470 40-44 66.2 79.1 54.0 39.5 11.6 457 45-49 58.1 77.3 57.9 35.2 11.3 413 Residence Total Urban 75.6 92.4 63.4 49.6 2.5 949 Georgetown (urban) 78.6 93.0 68.9 56.1 2.4 619 Other (urban) 69.8 91.3 53.0 37.5 2.5 330 Total Rural 56.4 79.6 51.4 32.3 11.5 2,573 Total Coastal 65.0 87.5 57.5 40.0 5.6 3,126 Coastal (urban) 75.6 92.4 63.4 49.6 2.5 949 Coastal (rural) 60.3 85.3 54.9 35.8 7.0 2,176 Total Interior 34.8 48.3 32.4 12.8 36.3 396 Region Region 1 27.7 47.8 31.6 11.6 41.2 160 Region 2 60.1 84.5 64.6 38.4 6.5 179 Region 3 60.8 89.2 46.4 28.9 5.0 420 Region 4 70.7 88.2 62.4 48.0 5.5 1,540 Region 5 51.8 77.5 47.7 26.6 8.7 271 Region 6 58.4 89.0 56.2 34.1 5.1 587 Region 7 52.5 61.1 47.5 32.0 29.0 61 Region 8 34.4 37.7 18.1 2.1 40.8 68 Region 9 35.4 34.0 36.8 9.5 36.8 57 Region 10 63.5 83.3 45.4 30.4 8.5 178 Education No education 3.2 64.4 29.2 1.4 32.1 60 Primary 33.3 72.0 47.6 19.0 18.6 711 Secondary 67.9 85.6 56.7 41.3 6.6 2,459 More than secondary 88.6 92.0 59.7 51.1 1.6 292 Wealth quintile Lowest 34.9 43.1 42.3 13.6 33.4 663 Second 48.7 84.1 50.2 25.6 6.3 679 Middle 64.3 93.3 56.1 39.1 3.9 723 Fourth 73.0 95.6 59.4 48.6 1.9 751 Highest 84.0 95.8 64.0 55.3 1.7 705 Total 2009 61.6 83.0 54.7 36.9 9.1 3,522 Total 2005 64.1 85.5 67.0 44.0 4.8 1,875 38 | Characteristics of Survey Respondents week. Slightly over one-third of women and men (35 and 37 percent, respectively) have exposure to all three media on a weekly basis. • As expected, women and men living in urban areas are more likely than those living in rural areas to be exposed to mass media. Half of urban women and men are exposed to all three forms of media. On the other hand, only 29 percent of rural women and 32 percent of rural men are exposed to all three media weekly. • The exposure to all three forms of mass media is relatively low in Region 8 (4 percent of women and 2 percent of men), Region 9 (3 percent of women and 10 percent of men), and Region 1 (6 percent of women and 12 percent of men). Additionally, the likelihood of having exposure to any mass media strongly correlates with the person’s education and wealth status. 3.5 EMPLOYMENT STATUS AND TYPE OF OCCUPATION Male and female respondents age 15 and older were asked if they were employed at the time of the survey and, if not, if they were employed in the 12 months preceding the survey. The measurement of employment, however, is difficult because some work, especially work on family farms, in family businesses, or in the informal sector, is often not perceived as employment and hence not reported as such. To avoid underestimating respondent’s employment, the DHS questionnaire asks respondents several questions to probe for their employment status and to ensure complete coverage of employment in both the formal and informal sectors. Respondents are considered “employed” if they are currently working (i.e., worked in the past seven days) or if they worked at any time during the 12 months preceding the survey. Table 3.5 shows the percent distribution of respondents by employment status, according to background characteristics, while Figure 3.2 presents the percentage of currently employed respondents by residence and education. Tables 3.6.1 and 3.6.2 present the distribution of currently employed women and men, respectively, by type of occupation, according to background characteristics. Table 3.7 shows the percentage distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural). Characteristics of Survey Respondents | 39 Table 3.5 Employment status Percent distribution of women and men by employment status, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––– Employed Employed in the 12 months in the 12 months preceding the survey Not preceding the survey Not ––––––––––––––––––– employed ––––––––––––––––––– employed Not in the Number Not in the Number Background Currently currently last 12 of Currently currently last 12 of characteristic employed1 employed months Total women employed1 employed months Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 13.9 3.9 82.2 100.0 1,016 44.7 6.1 49.0 100.0 689 20-24 38.6 3.8 57.6 100.0 767 85.2 6.9 7.9 100.0 511 25-29 41.4 5.1 53.1 100.0 658 93.6 3.9 2.5 100.0 462 30-34 40.2 3.3 56.3 100.0 643 96.1 2.4 1.4 100.0 521 35-39 43.3 2.9 53.6 100.0 699 92.7 4.9 2.2 100.0 470 40-44 45.5 3.3 50.9 100.0 624 93.9 3.5 2.5 100.0 457 45-49 43.6 2.6 52.9 100.0 589 89.4 4.7 5.7 100.0 413 Marital status Never married 35.4 4.6 59.7 100.0 1,540 64.0 6.8 29.0 100.0 1,382 Married or living together 32.5 3.0 64.2 100.0 2,920 95.3 3.1 1.6 100.0 1,835 Formerly married 59.2 3.9 36.9 100.0 536 90.7 5.0 4.2 100.0 305 Number of living children 0 31.1 4.3 64.6 100.0 1,598 68.9 5.9 25.1 100.0 1,621 1-2 40.6 2.6 56.4 100.0 1,773 93.1 4.8 2.1 100.0 978 3-4 34.8 3.9 61.2 100.0 1,147 95.8 2.6 1.5 100.0 662 5+ 41.2 4.5 54.0 100.0 478 95.5 2.6 1.9 100.0 260 Residence Total Urban 48.0 4.1 47.7 100.0 1,475 77.1 5.9 17.1 100.0 949 Georgetown (urban) 50.5 4.1 45.4 100.0 967 77.8 4.3 17.8 100.0 619 Other (urban) 43.3 4.1 52.0 100.0 508 75.7 8.7 15.6 100.0 330 Total Rural 31.4 3.4 65.0 100.0 3,521 84.7 4.3 10.9 100.0 2,573 Total Coastal 36.6 3.5 59.6 100.0 4,495 82.3 4.8 12.8 100.0 3,126 Coastal (urban) 48.0 4.1 47.7 100.0 1,475 77.1 5.9 17.1 100.0 949 Coastal (rural) 31.0 3.3 65.4 100.0 3,019 84.6 4.4 11.0 100.0 2,176 Total Interior 33.4 4.1 62.4 100.0 501 85.3 4.0 10.6 100.0 396 Region Region 1 23.9 6.9 69.2 100.0 162 84.4 3.1 12.5 100.0 160 Region 2 28.5 2.0 69.3 100.0 293 88.0 3.2 8.8 100.0 179 Region 3 36.7 1.5 61.8 100.0 687 85.9 4.7 9.3 100.0 420 Region 4 41.5 5.1 53.1 100.0 2,168 82.6 3.5 13.9 100.0 1,540 Region 5 31.4 2.0 66.6 100.0 353 82.9 7.4 9.4 100.0 271 Region 6 24.0 1.3 74.2 100.0 780 80.6 5.9 13.6 100.0 587 Region 7 37.5 1.3 61.3 100.0 104 90.5 3.4 6.0 100.0 61 Region 8 38.5 3.0 58.3 100.0 95 85.0 4.9 10.0 100.0 68 Region 9 37.4 1.1 60.7 100.0 78 79.9 6.2 13.4 100.0 57 Region 10 49.1 6.7 44.1 100.0 277 72.0 10.8 17.2 100.0 178 Education No education 23.8 0.0 76.2 100.0 68 77.9 3.7 18.4 100.0 60 Primary 26.9 2.3 70.5 100.0 952 90.1 5.4 4.5 100.0 711 Secondary 34.4 4.0 61.3 100.0 3,568 80.7 4.5 14.7 100.0 2,459 More than secondary 76.3 3.5 20.0 100.0 409 81.4 5.2 12.9 100.0 292 Wealth quintile Lowest 27.9 3.6 68.0 100.0 779 86.0 4.9 9.0 100.0 663 Second 31.4 4.3 64.2 100.0 957 83.4 5.9 10.5 100.0 679 Middle 34.8 3.9 61.0 100.0 1,025 81.7 4.3 14.0 100.0 723 Fourth 35.3 3.5 60.9 100.0 1,084 80.9 5.0 13.9 100.0 751 Highest 48.2 2.9 48.9 100.0 1,151 81.5 3.6 14.9 100.0 705 Total 36.3 3.6 59.9 100.0 4,996 82.6 4.7 12.6 100.0 3,522 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The total includes cases with missing data on employment (0.1 percent for women and 0.2 percent for men), which are not shown separately. 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. 40 | Characteristics of Survey Respondents • The level of current employment for women stands at 36 percent, with an additional 4 percent who worked in the 12 months preceding the survey. As a result, a total of four in ten women were employed in the 12 months preceding the survey. The corresponding proportions for men are twice as high: 83 percent of men are currently employed and 5 percent were employed in the last 12 months, putting the total level of employment for men in the last 12 months at 88 percent. • The proportion of women and men who are currently employed is lowest in the age 15-19 group (14 percent for women and 45 percent for men), compared with 39-46 percent of women and 85-96 percent of men age 20 or older. • There are some variations in employment by residence. Current employment for women in urban areas is higher than in rural areas (48 and 31 percent, respectively), while for men the reverse is true: 77 percent of men are currently employed in urban areas compared with 85 percent in rural areas. By region, currently employment for women varies from 24 percent in Regions 1 and 6 to 49 percent in Region 10. Among men, the lowest level of current employment is in Region 10 (72 percent), and the highest is in Region 7 (91 percent). • Women with the most education and in the highest wealth quintile are most likely to be currently employed, while there is little variation among men. • Among women, the two most common occupations are sales and services (36 percent) and professional/technical/managerial occupations (22 percent). Among men, the most common occupations are skilled/manual jobs (42 percent), agriculture (17 percent), and unskilled manual jobs (14 percent). • Analysis by age does not suggest an important variation by occupational categories, with few exceptions. For both men and women, the proportions working in most occupations decrease with age, except for agricultural employment for both women and men, domestic services for women, and professional, technical, or managerial jobs for women. • Region 9 has the highest percentage of both women and men working in agriculture: 39 percent of women and 47 percent of men. • As expected, women and men with higher education are most likely to be employed in a professional, technical, or managerial job. • Ninety-two percent of women receive cash only for their work. As expected, women working in nonagricultural jobs are much more likely to be paid in cash (95 percent) than women who do agricultural work (60 percent). It is noteworthy that about three in ten women who work in agriculture (29 percent) are not paid at all. • Sixty-three percent of women are employed by a nonfamily member, 25 percent are self- employed, and 12 percent work for a family member. Characteristics of Survey Respondents | 41 Figure 3.2 Respondents Currently Employed, by Residence and Education 36 48 51 43 31 24 27 34 76 83 77 78 76 85 78 90 81 81 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural EDUCATION No education Primary Secondary Higher 0 20 40 60 80 100 Percentage of respondents currently employed Women Men GDHS 2009 42 | Characteristics of Survey Respondents Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number Background technical/ and Skilled skilled Domestic know/ of characteristic managerial Clerical services manual manual service Agriculture missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 13.2 26.2 44.1 3.8 0.4 3.9 5.3 3.1 100.0 181 20-24 27.1 25.3 34.3 3.6 0.5 1.3 3.2 4.6 100.0 325 25-29 27.8 16.4 31.3 6.0 2.4 6.3 6.7 3.1 100.0 306 30-34 24.2 11.9 35.2 3.6 2.7 9.1 6.7 6.6 100.0 280 35-39 21.1 11.8 37.3 5.9 2.1 9.5 7.6 4.7 100.0 323 40-44 14.7 4.5 39.4 8.2 4.4 18.0 6.9 4.0 100.0 304 45-49 21.3 6.5 30.7 5.7 4.1 17.9 10.3 3.5 100.0 272 Marital status Never married 27.9 24.2 33.3 4.5 0.7 5.1 1.6 2.8 100.0 616 Currently in union 18.8 10.6 33.9 6.6 2.7 11.5 11.0 4.9 100.0 1,038 Formerly in union 20.4 7.2 45.2 3.3 4.7 11.8 2.5 5.0 100.0 338 Number of living children 0 29.7 25.7 31.9 4.0 0.4 3.7 1.0 3.5 100.0 565 1-2 23.9 14.7 33.7 6.0 1.8 9.2 6.0 4.6 100.0 765 3-4 14.2 4.1 45.5 4.0 4.0 12.8 9.5 5.9 100.0 444 5+ 10.1 3.0 31.7 9.2 6.6 19.2 18.1 2.1 100.0 219 Residence Total Urban 25.9 16.9 38.0 5.2 1.5 8.4 0.4 3.7 100.0 769 Georgetown (urban) 26.0 19.6 35.3 4.6 1.8 9.2 0.0 3.5 100.0 528 Other (urban) 25.6 10.8 43.9 6.5 0.7 6.8 1.2 4.3 100.0 241 Rural 19.3 12.5 34.1 5.5 3.0 10.3 10.6 4.6 100.0 1,223 Total Coastal 22.0 15.3 35.2 5.6 2.5 9.8 5.1 4.4 100.0 1,804 Coastal (urban) 25.9 16.9 38.0 5.2 1.5 8.4 0.4 3.7 100.0 769 Coastal (rural) 19.2 14.1 33.1 5.9 3.3 10.8 8.7 4.9 100.0 1,036 Total Interior 20.2 3.9 39.5 3.3 1.3 7.5 21.3 3.0 100.0 188 Region Region 1 18.6 0.7 43.9 0.1 0.5 8.7 24.4 3.1 100.0 50 Region 2 20.1 10.6 23.6 8.4 4.3 11.1 20.9 1.0 100.0 89 Region 3 24.2 13.0 32.6 5.9 3.6 10.9 5.2 4.6 100.0 263 Region 4 21.7 19.5 34.2 5.2 2.9 10.6 2.7 3.2 100.0 1,011 Region 5 19.3 7.2 30.9 4.4 0.9 5.4 18.0 13.9 100.0 118 Region 6 19.9 5.2 45.5 7.5 0.6 9.4 6.1 5.8 100.0 197 Region 7 20.3 7.1 52.5 1.5 0.5 7.4 9.3 1.3 100.0 40 Region 8 21.7 5.5 30.7 8.9 1.0 6.1 21.5 4.5 100.0 39 Region 9 24.4 4.4 16.0 5.7 0.0 6.1 38.5 4.9 100.0 30 Region 10 25.5 10.7 45.7 3.3 1.9 5.5 2.7 4.6 100.0 155 Education No education * * * * * * * * * 16 Primary 2.4 2.1 42.6 6.4 4.0 19.0 17.9 5.6 100.0 278 Secondary 16.8 16.1 40.4 5.5 2.6 9.5 5.3 3.7 100.0 1,372 More than secondary 61.1 17.0 10.1 4.4 0.0 1.4 0.4 5.7 100.0 326 Wealth quintile Lowest 12.1 3.7 30.0 4.0 6.4 13.6 27.2 3.0 100.0 245 Second 9.7 8.7 41.8 8.9 3.3 14.4 9.4 3.9 100.0 343 Middle 15.2 14.7 38.3 6.4 2.7 13.0 3.7 6.1 100.0 396 Fourth 23.2 17.1 39.1 3.9 2.2 7.1 3.6 3.7 100.0 421 Highest 36.6 19.3 30.0 4.3 0.3 4.5 0.7 4.3 100.0 588 Total 21.9 14.2 35.6 5.4 2.4 9.6 6.7 4.3 100.0 1,992 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently in union includes respondents in consensual union (living together). Formerly in union includes divorced/separated/widowed. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Characteristics of Survey Respondents | 43 Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number Background technical/ and Skilled skilled Domestic know/ of characteristic managerial Clerical services manual manual service Agriculture missing Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 6.9 4.4 10.9 43.5 17.8 0.7 11.2 4.6 100.0 350 20-24 11.0 6.0 11.8 43.4 14.0 0.0 11.1 2.8 100.0 471 25-29 10.3 4.3 12.0 47.1 9.9 0.0 14.6 1.7 100.0 450 30-34 10.1 0.9 9.3 45.4 13.6 0.2 17.3 3.2 100.0 513 35-39 8.3 1.3 9.4 41.5 15.4 0.2 20.4 3.5 100.0 458 40-44 8.7 0.8 12.9 37.7 15.3 0.6 21.9 2.2 100.0 446 45-49 6.7 0.2 16.1 35.5 11.7 0.9 25.3 3.6 100.0 389 Marital status Never married 10.0 5.7 13.8 41.0 15.2 0.3 10.3 3.8 100.0 979 Currently in union 9.0 1.1 10.1 42.4 12.4 0.4 22.0 2.5 100.0 1,806 Formerly in union 5.4 0.9 14.3 44.5 18.9 0.0 12.5 3.5 100.0 292 Number of living children 0 9.1 4.8 12.8 42.7 14.6 0.3 12.3 3.3 100.0 1,212 1-2 10.5 1.2 12.1 42.6 13.1 0.1 17.5 2.8 100.0 958 3-4 7.2 1.2 8.6 42.0 12.7 0.2 24.5 3.5 100.0 652 5+ 7.0 0.1 12.2 38.4 16.3 2.0 22.6 1.3 100.0 255 Residence Total Urban 14.0 6.2 15.9 46.0 9.5 0.3 3.9 4.3 100.0 787 Georgetown (urban) 16.1 8.2 16.9 45.5 8.4 0.2 0.6 4.2 100.0 508 Other (urban) 10.2 2.7 14.2 47.0 11.4 0.4 9.9 4.3 100.0 279 Total Rural 7.3 1.3 10.2 40.9 15.4 0.4 22.0 2.6 100.0 2,290 Total Coastal 9.5 2.8 12.0 43.2 12.8 0.4 16.0 3.3 100.0 2,723 Coastal (urban) 14.0 6.2 15.9 46.0 9.5 0.3 3.9 4.3 100.0 787 Coastal (rural) 7.6 1.4 10.4 42.1 14.2 0.4 21.0 2.9 100.0 1,936 Total Interior 5.3 0.4 8.7 34.3 22.0 0.1 28.0 1.2 100.0 354 Region Region 1 5.5 0.2 11.2 33.0 21.1 0.0 28.2 0.8 100.0 140 Region 2 8.7 0.6 10.2 36.9 24.7 0.0 15.9 3.1 100.0 163 Region 3 6.8 2.0 10.2 41.8 16.5 0.0 19.2 3.4 100.0 381 Region 4 13.0 4.5 13.9 47.9 9.0 0.6 8.1 2.9 100.0 1,325 Region 5 3.6 0.3 6.5 32.6 16.2 0.3 35.0 5.4 100.0 245 Region 6 4.9 0.6 12.0 36.9 14.8 0.0 27.9 2.9 100.0 508 Region 7 4.3 0.0 11.0 38.5 24.9 0.0 19.3 2.0 100.0 57 Region 8 2.5 0.0 5.3 30.5 31.8 0.0 29.9 0.0 100.0 61 Region 9 7.9 0.8 4.5 25.7 9.9 0.0 47.4 3.8 100.0 49 Region 10 10.0 3.6 10.0 52.0 14.2 0.9 6.2 3.2 100.0 148 Education No education 0.0 0.0 4.5 13.7 27.2 0.0 54.5 0.0 100.0 49 Primary 2.5 0.0 8.4 39.7 19.3 0.0 27.9 2.2 100.0 679 Secondary 7.9 3.1 12.9 44.5 13.2 0.5 14.8 3.0 100.0 2,096 More than secondary 37.0 4.8 11.3 35.1 2.1 0.0 3.5 6.2 100.0 253 Wealth quintile Lowest 2.9 0.1 7.1 34.6 25.1 0.1 28.7 1.5 100.0 603 Second 5.0 0.8 8.2 43.1 18.6 1.0 21.6 1.8 100.0 607 Middle 6.5 2.7 12.0 43.6 12.6 0.2 19.1 3.4 100.0 622 Fourth 9.5 2.9 14.3 45.9 9.3 0.0 14.2 3.9 100.0 644 Highest 21.2 6.2 16.6 43.4 4.0 0.6 3.5 4.5 100.0 600 Total 9.0 2.5 11.7 42.2 13.9 0.3 17.4 3.0 100.0 3,077 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently in union includes respondents in consensual union (living together). Formerly in union includes divorced/separated/widowed. 44 | Characteristics of Survey Respondents Table 3.7 Type of employment Percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Non Agri- agri- cultural cultural Employment characteristic work work Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 59.9 95.2 92.2 Cash and in-kind 10.0 2.2 2.7 In-kind only 0.8 0.5 0.5 Not paid 29.2 1.8 4.1 Missing 0.0 0.4 0.4 Total 100.0 100.0 100.0 Type of employer Employed by family member 20.4 11.0 11.6 Employed by nonfamily member 13.4 67.6 63.0 Self-employed 66.3 21.3 25.2 Missing 0.0 0.2 0.2 Total 100.0 100.0 100.0 Continuity of employment All year 62.6 84.3 82.8 Seasonal 29.2 9.5 10.7 Occasional 8.2 6.2 6.4 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 133 1,774 1,992 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women with missing information on type of employ- ment who are not shown separately. 3.6 HEALTH INSURANCE COVERAGE Tables 3.8.1 and 3.8.2 show the percentages of women and men age 15-49, respectively, with specific types of health insurance coverage, according to background characteristics. The main types of health insurance coverage in Guyana are national insurance, privately purchased insurance, employer- purchased insurance, and foreign insurance. • Eighty-two percent of women and 68 percent of men in Guyana do not have any health insurance coverage. Most of those with insurance are covered by national insurance plan (14 percent of women and 28 percent of men). Only 4 percent of women and 5 percent of men are covered by privately purchased insurance. • The levels of insurance coverage vary greatly by respondents’ background characteristics. Eighty-six percent of rural women have no health insurance coverage compared with 71 percent of urban women. Among men, the difference is not as prounounced (69 percent of men in rural areas have no coverage versus 67 percent in urban areas). • As many as 94 percent of the women in Region 1 have no health insurance coverage compared with 71 percent in Region 10. Characteristics of Survey Respondents | 45 • Among men, the highest percentage with no health insurance coverage is in Region 8 (96 percent), and the lowest percentages are in Regions 3 and 6 (61 percent each). • High levels of privately purchased insurance result in a much higher level of coverage for women and men with more than secondary education and also for those in the highest wealth quintile. Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Guyana 2009 Type of health insurance Background characteristic National insurance plan Privately purchased insurance Employer purchased insurance Foreign insurance Other Missing None Number of women Age 15-19 4.6 2.0 0.3 0.1 0.3 0.2 92.5 1,016 20-24 19.0 2.3 1.1 0.4 0.3 0.1 78.7 767 25-29 16.1 4.7 1.3 0.5 0.6 0.8 79.3 658 30-34 16.4 4.1 1.9 0.8 0.2 0.0 78.7 643 35-39 17.7 3.5 2.1 0.6 0.6 0.8 77.5 699 40-44 15.2 3.8 1.6 0.4 0.3 0.0 81.5 624 45-49 16.1 5.1 0.7 0.0 0.0 0.2 80.1 589 Residence Total Urban 23.9 5.5 2.1 0.2 0.3 0.2 71.3 1,475 Georgetown (urban) 26.1 6.3 2.2 0.2 0.3 0.0 69.1 967 Other (urban) 19.8 4.2 1.9 0.2 0.2 0.7 75.5 508 Total Rural 10.3 2.6 0.9 0.5 0.3 0.3 86.4 3,521 Total Coastal 14.9 3.6 1.3 0.4 0.3 0.3 81.2 4,495 Coastal (urban) 23.9 5.5 2.1 0.2 0.3 0.2 71.3 1,475 Coastal (rural) 10.5 2.7 0.9 0.5 0.4 0.3 86.1 3,019 Total Interior 9.5 2.0 0.4 0.0 0.2 0.1 88.2 501 Region Region 1 5.8 0.4 0.0 0.0 0.0 0.0 93.8 162 Region 2 10.2 0.9 0.1 0.5 0.4 0.2 88.0 293 Region 3 13.9 2.7 0.8 1.8 0.6 0.2 81.9 687 Region 4 18.2 4.8 1.9 0.2 0.4 0.3 77.4 2,168 Region 5 6.5 2.5 0.5 0.0 0.2 0.0 90.4 353 Region 6 9.3 2.3 0.3 0.2 0.1 0.5 87.9 780 Region 7 12.6 1.1 0.0 0.0 0.8 0.1 86.0 104 Region 8 12.3 2.5 0.0 0.0 0.0 0.4 85.9 95 Region 9 6.3 1.6 0.6 0.0 0.2 0.3 90.9 78 Region 10 23.0 5.9 3.4 0.0 0.2 0.2 70.9 277 Education No education 0.6 0.0 0.0 0.0 0.9 0.0 98.6 68 Primary 5.0 1.0 0.0 0.1 0.1 0.2 93.9 952 Secondary 13.4 3.2 1.1 0.3 0.3 0.3 82.9 3,568 More than secondary 46.6 12.4 5.4 1.5 0.8 0.2 43.1 409 Wealth quintile Lowest 5.3 0.4 0.1 0.1 0.1 0.5 93.6 779 Second 9.9 1.1 0.5 0.0 0.3 0.2 88.6 957 Middle 12.9 1.6 1.5 0.7 0.6 0.1 84.0 1,025 Fourth 14.5 5.5 0.6 0.6 0.1 0.5 80.0 1,084 Highest 25.3 7.4 2.9 0.4 0.5 0.1 68.4 1,151 Total 14.4 3.5 1.2 0.4 0.3 0.3 81.9 4,996 46 | Characteristics of Survey Respondents Table 3.8.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, Guyana 2009 Type of health insurance Background characteristic National insurance plan Privately purchased insurance Employer purchased insurance Foreign insurance Other Missing None Number of men Age 15-19 12.4 1.9 1.0 0.1 0.2 0.2 85.1 689 20-24 29.1 3.3 2.3 1.1 0.4 0.1 66.2 511 25-29 33.2 6.9 2.3 0.4 0.5 0.2 60.9 462 30-34 31.3 7.0 1.8 0.0 0.4 0.4 64.4 521 35-39 31.3 4.7 1.8 0.0 0.6 0.4 64.2 470 40-44 30.0 5.3 2.4 0.7 0.7 0.4 64.1 457 45-49 32.5 4.7 2.8 0.1 1.6 0.3 63.0 413 Residence Total Urban 24.9 9.9 5.2 0.6 0.2 0.1 66.8 949 Georgetown (urban) 22.7 12.6 6.5 0.8 0.0 0.0 67.0 619 Other (urban) 28.9 4.8 2.7 0.1 0.7 0.3 66.5 330 Total Rural 28.5 2.7 0.8 0.2 0.7 0.3 68.5 2,573 Total Coastal 29.4 5.0 2.2 0.4 0.6 0.3 65.7 3,126 Coastal (urban) 24.9 9.9 5.2 0.6 0.2 0.1 66.8 949 Coastal (rural) 31.4 2.9 0.9 0.3 0.8 0.4 65.2 2,176 Total Interior 12.5 1.8 0.2 0.0 0.4 0.2 86.6 396 Region Region 1 10.9 1.0 0.0 0.0 0.2 0.2 88.4 160 Region 2 23.9 2.4 0.6 0.2 0.5 0.0 74.7 179 Region 3 35.9 3.1 0.3 0.3 0.3 0.0 61.4 420 Region 4 27.8 7.7 3.4 0.5 0.6 0.4 65.4 1,540 Region 5 22.2 1.9 0.5 1.2 0.6 0.6 74.4 271 Region 6 36.7 1.3 0.9 0.0 1.0 0.2 61.2 587 Region 7 16.4 2.5 0.0 0.0 0.0 0.0 82.5 61 Region 8 3.5 0.0 0.0 0.0 0.3 0.0 96.2 68 Region 9 7.4 1.2 0.4 0.0 0.5 0.5 91.3 57 Region 10 21.5 7.0 4.4 0.0 0.8 0.5 71.2 178 Education No education 16.8 2.5 0.0 0.0 0.3 0.0 80.4 60 Primary 24.2 1.5 0.5 0.0 0.5 0.3 73.9 711 Secondary 27.5 3.9 2.1 0.3 0.6 0.3 68.1 2,459 More than secondary 38.2 19.6 4.4 1.2 0.9 0.5 50.5 292 Wealth quintile Lowest 16.3 0.6 0.3 0.0 1.6 0.4 81.9 663 Second 30.3 0.9 0.1 0.3 0.3 0.2 68.4 679 Middle 30.0 2.5 0.9 0.5 0.3 0.1 66.7 723 Fourth 31.2 7.2 2.6 0.0 0.7 0.6 62.9 751 Highest 28.8 11.6 5.7 0.9 0.1 0.1 61.4 705 Total 15-49 27.5 4.7 2.0 0.3 0.6 0.3 68.0 3,522 Characteristics of Survey Respondents | 47 3.7 KNOWLEDGE AND ATTITUDES CONCERNING TUBERCULOSIS Over the last ten years tuberculosis (TB) rates have increased almost three-fold in Guyana. This increase is observed mainly among young adults in the most populated regions of the country and mirrors closely the patterns seen for HIV and AIDS. The current incidence of TB is 80 cases per 100,000 persons. WHO estimates that about 800 new cases occur annually in Guyana. Diagnostic and treatment services are available through the MoH TB Control Program, which is now implementing the WHO-recommended, directly observed treatment, short-course (DOTS) strategy in all 10 administrative regions at 15 treatment centers. The rate of positive diagnosis of TB using sputum smear microscopy is about 56 percent, with diagnoses being made by x-ray and clinical features less frequently. Cure rates are between 70 and 80 percent—the WHO target—in the regions where DOTS is implemented, but the rates fall to about 50 percent in other regions (MOH, GRPA, and ORC Macro, 2006). Knowledge among the general public about TB and its clinical manifestations delays the seeking of early treatment for the disease. Attitudes and common beliefs, especially about treatment and cure, lead to stigmatization. Even when a correct diagnosis is made, a cure may not be achieved. Tables 3.9.1 and 3.9.2 present the attitudes and knowledge of TB among women and men, respectively, by background characteristics. Knowledge and attitudes among women • Nearly nine in ten women (87 percent) have heard of tuberculosis. Their knowledge of TB increases with age, and ranges from 81 percent of women age 15-19 to 93 percent of those age 45-49. Knowledge also increases steadily with education, from 53 percent of women with no education to as many as 98 percent of those with more than secondary education, and with wealth, from 76 percent of women in the lowest wealth quintile to 95 percent of women in the highest wealth quintile. Knowledge of TB among women living in urban areas is higher than among women living in rural areas (94 and 84 percent respectively). • Among women with knowledge of TB, 55 percent correctly believe that TB is spread through the air (by coughing). This knowledge is less common among younger women age 15-19 (45 percent), those in rural areas (46 percent), women in Regions 2 and 5 (41 percent each), women with no education or primary education (43-44 percent), and women in the lower three wealth quintiles (48-49 percent). • More than half of the women (51 percent) believe that TB can be cured. This knowledge increases slightly with age but more rapidly with education. There is little variation by wealth quintile. Knowledge that TB can be cured varies greatly by region, from a low of 41 percent of women in Region 6 to a high of 72 percent of women in Region 9. • Twenty-two percent of women would want a family member’s TB to be kept a secret, an indicator that reveals the degree of stigma attached to TB. Some variations are observed in this indicator by background characteristics: younger women age 15-19 are more likely to want to keep secret a family member’s TB (29 percent) than older women (18-22 percent). Although in most regions the percentage of women who would want to keep secret a family member’s TB is similar to the national average (22 percent), in Region 9 only 6 percent of women would want to keep secret a family member’s TB status. There is no clear pattern by education or wealth in the variation of this indicator. Knowledge and attitudes among men • Patterns among men are similar to those among women, with almost nine out of ten men (87 percent) having heard of TB. Knowledge about TB among men increases markedly with age (from 71 percent in the age 15–19 group to 96 percent in the age 45–49 group. It also increases with education (from 63 percent of men with no education to 98 percent of 48 | Characteristics of Survey Respondents those with more than secondary education). Knowledge increases moderately with an increase in wealth, from 84 percent of men in the lowest wealth quintile to 93 percent of those in the highest quintile. Knowledge of TB among men living in urban areas (93 percent) is higher than among men living in rural areas (85 percent). • Among men with knowledge of TB, 53 percent correctly believe that TB is spread through the air by coughing, 54 percent believe that TB can be cured, and 18 percent would want a family member’s TB to be kept a secret. There are variations in these indicators by age, education, residence, and wealth that are similar to those observed for women. Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women Percentage of women age 15-49 who have heard of tuberculosis (TB); and among women who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Guyana 2009 All women Among women who have heard of TB: Background characteristic Percentage who have heard of TB Number of women Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number of women Age 15-19 80.8 1,016 45.0 47.4 28.7 821 20-24 86.9 767 51.1 49.8 21.8 667 25-29 85.1 658 57.2 47.6 18.4 560 30-34 88.4 643 63.3 49.1 18.1 569 35-39 89.3 699 58.2 52.4 21.7 624 40-44 89.9 624 56.7 51.3 19.5 561 45-49 92.8 589 59.0 57.3 19.3 547 Residence Total Urban 93.8 1,475 74.5 60.0 23.4 1,384 Georgetown (urban) 95.4 967 81.1 62.4 23.8 923 Other (urban) 90.9 508 61.4 55.2 22.6 461 Total Rural 84.2 3,521 46.0 46.1 20.7 2,963 Total Coastal 87.2 4,495 54.5 49.2 22.0 3,919 Coastal (urban) 93.8 1,475 74.5 60.0 23.4 1,384 Coastal (rural) 83.9 3,019 43.5 43.3 21.3 2,535 Total Interior 85.4 501 60.9 62.7 17.4 428 Region Region 1 84.3 162 58.0 61.6 17.6 137 Region 2 85.1 293 40.9 46.4 19.1 249 Region 3 90.7 687 44.0 48.2 22.9 623 Region 4 89.5 2,168 61.7 50.5 20.9 1,940 Region 5 79.5 353 41.1 48.4 23.7 281 Region 6 79.1 780 47.3 41.1 25.4 617 Region 7 92.7 104 60.0 59.1 19.2 96 Region 8 83.2 95 72.7 63.3 20.9 79 Region 9 72.2 78 57.3 71.6 5.9 56 Region 10 97.1 277 69.9 66.3 20.6 269 Education No education 53.3 68 (43.2) (30.9) (11.8) 36 Primary 79.6 952 43.5 42.2 21.9 758 Secondary 88.4 3,568 54.5 51.3 22.3 3,155 More than secondary 97.5 409 83.1 62.0 16.0 398 Wealth quintile Lowest 75.5 779 49.3 51.7 21.2 588 Second 84.1 957 47.6 46.2 22.3 805 Middle 87.1 1,025 48.3 49.5 22.6 893 Fourth 89.4 1,084 57.1 50.1 21.1 969 Highest 94.9 1,151 67.6 54.1 20.7 1,092 Total 2009 87.0 4,996 55.1 50.5 21.6 4,347 Total 2005 78.7 2,425 41.4 43.3 12.5 1,908 Note: Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Survey Respondents | 49 Table 3.9.2 Knowledge and attitudes concerning tuberculosis: Men Percentage of men age 15-49 who have heard of tuberculosis (TB); and among men who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Guyana 2009 All men Among men who have heard of TB: Background characteristic Percentage who have heard of TB Number of men Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number of men Age 15-19 71.2 689 46.3 44.7 35.6 490 20-24 89.9 511 51.0 49.0 20.5 459 25-29 89.5 462 54.7 52.1 15.6 413 30-34 87.2 521 47.9 53.2 13.7 454 35-39 91.9 470 58.4 55.7 13.7 432 40-44 95.1 457 56.7 59.6 12.5 435 45-49 95.6 413 59.2 63.5 13.0 395 Residence Total Urban 93.0 949 65.3 54.7 17.4 883 Georgetown (urban) 94.6 619 67.8 56.1 14.6 586 Other (urban) 90.0 330 60.5 51.9 23.1 297 Total Rural 85.3 2,573 48.3 53.3 18.5 2,195 Total Coastal 86.8 3,126 53.2 52.8 18.9 2,713 Coastal (urban) 93.0 949 65.3 54.7 17.4 883 Coastal (rural) 84.1 2,176 47.4 51.9 19.6 1,830 Total Interior 92.1 396 52.8 60.0 13.0 365 Region Region 1 97.5 160 44.1 52.2 11.1 156 Region 2 86.1 179 60.8 55.5 11.4 154 Region 3 84.0 420 49.3 56.7 22.9 353 Region 4 89.9 1,540 58.9 54.8 16.6 1,384 Region 5 77.6 271 32.8 43.1 22.3 210 Region 6 83.3 587 44.9 48.2 21.7 489 Region 7 91.4 61 67.1 63.3 10.7 56 Region 8 86.7 68 65.1 61.6 15.1 59 Region 9 81.3 57 56.6 80.2 10.9 46 Region 10 95.3 178 56.2 53.5 24.3 170 Education No education 62.6 60 (26.1) (39.3) (4.2) 38 Primary 84.1 711 48.7 51.5 15.1 598 Secondary 87.6 2,459 52.2 53.2 20.1 2,155 More than secondary 98.4 292 73.8 63.6 12.0 288 Wealth quintile Lowest 84.3 663 49.2 52.2 16.7 559 Second 83.9 679 47.3 48.2 15.9 570 Middle 85.6 723 49.7 53.8 25.2 619 Fourth 89.7 751 54.6 54.6 19.3 673 Highest 93.1 705 63.5 58.6 13.8 657 Total 2009 87.4 3,522 53.2 53.7 18.2 3,078 Total 2005 74.1 1,875 43.8 40.4 13.2 1,389 Note: Figures in parentheses are based on 25-49 unweighted cases. 50 | Characteristics of Survey Respondents 3.8 SMOKING Smoking is a known risk factor for cardiovascular disease. It also causes lung and other forms of cancer, and it contributes to the severity of pneumonia, emphysema, and chronic bronchitis. Smoking may also have an impact on individuals who are exposed to the smoke second-hand. For example, inhaling second-hand smoke may adversely affect children’s growth and cause childhood illness, especially respiratory diseases. Because smoking is an acquired behavior that is chosen by individuals, all morbidity and mortality caused by smoking is preventable. To measure the extent of smoking among Guyanese, women and men who were interviewed in the 2009 GDHS were asked if they currently smoke cigarettes or use other forms of tobacco. The distribution of respondents who smoke cigarettes, or a pipe, or use other tobacco products is shown in Tables 3.10.1 and 3.10.2 for women and men, respectively. Table 3.10.2, which shows use among men, includes the percent distribution of cigarette smokers by number of cigarettes smoked in the preceding 24 hours (not shown for women because of the small number of smokers). • Three percent of women age 15-49 reported that they used cigarettes, and less than 1 percent said that they smoke other tobacco products. By contrast, around one-third of men age 15-49 use tobacco products: 29 percent smoke cigarettes, 3 percent use other tobacco products, and less than 1 percent use a pipe. • Among women, consumption of cigarettes increases somewhat with age, from 1 percent among women age 15-19 to 7 percent among women age 40-44. Looking at residence, smoking among women is higher in urban areas (5 percent), particularly in Georgetown (6 percent), than in rural areas (2 percent). By region, it ranges from 2 percent in Regions 1, 2, and 5, to 7 percent in Region 8. There is little very little variation by education and wealth quintile in the percentage of women who smoke cigarettes. • Forty-five percent of men age 40-44 smoke cigarettes, compared with 8 percent of men age 15-19. Men in rural areas are more likely to smoke than men in urban areas (32 percent versus 23 percent); this percentage is as high as 43 percent among men in the Interior area. Smoking cigarettes among men is lowest in Region 10 (16 percent) and highest in Region 1 (52 percent). Men with secondary (27 percent) and higher education (13 percent) and those in the highest wealth quintile (17 percent) are the least likely to smoke cigarettes when compared with other subgroups. • Among male smokers, 38 percent reportedly smoked 10 or more cigarettes in the 24 hours preceding the survey. The percentage of men who smoked 10 or more cigarettes in the pre- ceding 24 hours increases with age, from 7 percent of men age 15-19 to 50 percent among those age 35-44. Although there are no Urban-Rural area differences, men in the Interior area (22 percent) are much less likely to have smoked 10 or more cigarettes in the pre- ceding 24 hours than other men. There are large differences among regions in the per- centages of heavy smokers, ranging from 12 percent in Region 9 to 50 percent in Region 6. Characteristics of Survey Respondents | 51 Table 3.10.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or use other tobacco products, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Uses tobacco ––––––––––––––––––– Does not Number Background Other use of characteristic Cigarettes tobacco tobacco women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.0 0.1 98.8 1,016 20-24 2.2 0.6 97.6 767 25-29 2.2 0.0 96.9 658 30-34 2.0 0.2 98.0 643 35-39 4.8 0.2 94.4 699 40-44 6.6 0.4 93.4 624 45-49 5.4 0.2 94.2 589 Residence Total Urban 5.4 0.1 94.3 1,475 Georgetown (urban) 6.4 0.2 93.4 967 Other (urban) 3.4 0.0 95.9 508 Total Rural 2.3 0.3 97.3 3,521 Total Coastal 3.1 0.2 96.5 4,495 Coastal (urban) 5.4 0.1 94.3 1,475 Coastal (rural) 2.1 0.2 97.6 3,019 Total Interior 3.8 0.7 95.5 501 Region Region 1 1.7 0.0 98.3 162 Region 2 1.7 0.2 97.8 293 Region 3 2.5 0.5 97.1 687 Region 4 4.2 0.1 95.4 2,168 Region 5 1.9 0.2 98.1 353 Region 6 1.8 0.1 97.8 780 Region 7 4.5 0.0 95.4 104 Region 8 7.3 3.4 89.9 95 Region 9 3.4 0.0 96.3 78 Region 10 3.3 0.1 96.4 277 Education No education 2.6 0.0 97.4 68 Primary 3.1 0.3 96.6 952 Secondary 3.3 0.3 96.3 3,568 More than secondary 2.6 0.0 96.7 409 Wealth quintile Lowest 3.5 0.5 96.0 779 Second 4.2 0.5 95.5 957 Middle 2.4 0.1 97.4 1,025 Fourth 2.4 0.3 97.0 1,084 Highest 3.6 0.0 96.1 1,151 Total 3.2 0.2 96.4 4,996 52 | Characteristics of Survey Respondents Table 3.10.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Guyana 2009 Uses tobacco Number of cigarettes in the last 24 hours Background characteristic Cigarettes Pipe Other tobacco Does not use tobacco Number of men 0 1-2 3-5 6-9 10+ Don't know/ missing Total Number of smokers Age 15-19 7.5 0.0 1.2 91.9 689 29.8 31.8 24.3 0.0 7.3 6.8 100.0 51 20-24 29.1 0.0 4.9 70.1 511 14.6 24.8 27.6 11.6 19.9 1.5 100.0 149 25-29 25.1 0.3 4.8 72.2 462 23.9 13.6 18.4 13.0 29.7 1.4 100.0 116 30-34 33.2 0.0 2.9 64.8 521 7.7 14.4 25.8 15.3 35.5 1.2 100.0 173 35-39 38.1 0.1 4.0 61.1 470 3.5 15.3 15.1 14.5 49.5 2.1 100.0 179 40-44 44.6 0.0 1.5 54.4 457 5.2 11.7 17.8 12.5 49.8 3.0 100.0 204 45-49 39.8 0.2 2.1 58.8 413 10.0 11.6 20.5 14.4 43.1 0.3 100.0 164 Residence Total Urban 22.6 0.0 3.8 75.7 949 8.4 12.3 20.5 19.6 37.8 1.4 100.0 214 Georgetown(urban) 24.3 0.0 3.5 74.3 619 8.3 9.8 19.4 24.3 38.3 0.0 100.0 150 Other (urban) 19.3 0.1 4.3 78.3 330 8.8 18.0 23.3 8.7 36.6 4.6 100.0 64 Total Rural 32.0 0.1 2.7 66.9 2,573 11.4 16.8 21.0 11.2 37.6 2.1 100.0 822 Total Coastal 27.7 0.1 2.7 70.9 3,126 10.3 12.9 20.2 14.0 40.7 1.9 100.0 867 Coastal (urban) 22.6 0.0 3.8 75.7 949 8.4 12.3 20.5 19.6 37.8 1.4 100.0 214 Coastal ( rural) 30.0 0.1 2.3 68.9 2,176 10.9 13.0 20.1 12.2 41.7 2.1 100.0 653 Total Interior 42.8 0.3 4.8 56.3 396 13.0 31.0 24.4 7.6 21.8 2.1 100.0 170 Region Region 1 51.8 0.0 4.0 48.2 160 12.9 33.0 29.0 3.3 21.2 0.6 100.0 83 Region 2 21.8 0.2 0.9 78.2 179 9.8 22.2 28.3 11.0 28.2 0.5 100.0 39 Region 3 28.9 0.0 1.0 71.1 420 10.7 9.6 22.5 13.2 40.0 4.0 100.0 121 Region 4 28.6 0.1 3.1 69.7 1,540 9.7 12.9 18.4 17.6 40.7 0.7 100.0 440 Region 5 30.1 0.0 3.6 68.8 271 16.5 15.6 22.1 8.4 33.6 3.8 100.0 82 Region 6 28.7 0.0 2.7 70.1 587 8.5 10.1 18.6 9.8 50.3 2.6 100.0 169 Region 7 30.3 0.0 4.7 68.0 61 15.5 42.8 11.2 8.9 21.5 0.0 100.0 18 Region 8 46.9 0.0 7.9 50.0 68 5.8 21.5 19.4 20.1 29.4 3.8 100.0 32 Region 9 40.0 2.1 4.6 59.5 57 14.0 37.6 23.5 4.8 11.7 8.3 100.0 23 Region 10 16.4 0.0 5.1 80.5 178 19.4 22.2 34.4 3.1 18.9 2.1 100.0 29 Education No education 49.1 0.1 1.6 50.9 60 (20.2) (3.0) (22.2) (9.3) (45.3) (0.0) (100.0) 29 Primary 42.5 0.1 2.7 56.3 711 6.2 18.4 20.4 10.9 43.1 1.1 100.0 302 Secondary 27.2 0.1 3.2 71.5 2,459 11.9 15.8 20.6 14.0 35.3 2.4 100.0 668 More than secondary 12.6 0.0 2.4 86.1 292 (20.9) (5.2) (29.4) (13.4) (30.2) (0.9) (100.0) 37 Wealth quintile Lowest 51.0 0.1 5.8 47.1 663 12.7 23.2 22.5 10.8 29.3 1.6 100.0 339 Second 33.1 0.0 3.1 65.8 679 7.8 16.1 16.8 13.0 45.1 1.2 100.0 225 Middle 24.6 0.0 3.0 73.7 723 11.8 12.4 20.5 7.7 43.1 4.4 100.0 178 Fourth 23.5 0.3 2.6 75.1 751 9.9 9.6 19.0 18.4 41.6 1.6 100.0 176 Highest 16.9 0.0 0.6 83.0 705 10.9 8.8 27.1 18.8 33.3 1.1 100.0 119 Total men 29.4 0.1 3.0 69.3 3,522 10.8 15.8 20.9 12.9 37.6 1.9 100.0 1,036 Total women 3.2 0.0 0.2 96.4 4,996 17.6 18.3 27.9 13.7 18.4 4.1 100.0 160 Fertility | 53 FERTILITY 4 This chapter looks at a number of fertility indicators, including current fertility levels, trends, and differentials; age at first birth; and teenage pregnancy and motherhood. The analysis is based on the birth histories collected from women age 15-49 who were interviewed during the survey. As part of the birth history, women were first asked a series of questions to determine the total number of live births they had in their lifetime. Then, for each live birth, information was collected on the age, sex, and survival status of the child. For dead children, age at death was recorded. The following measures of current fertility are derived from birth history data: • Age-specific fertility rate (ASFR) is the number of births per thousand women in a specified age group and represents a valuable measure for assessing the current age pattern of childbearing. ASFRs are calculated by dividing the number of live births to women in a specific age group by the number of woman-years lived in that age group. • Total fertility rate (TFR) is defined as the total number of births a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific fertility rates. The TFR is obtained by summing the age- specific fertility rates and multiplying by five, which is the number of years for each age- group. • General fertility rate (GFR) is the number of live births during a specified period per 1,000 women. • Crude birth rate (CBR) is the number of live births during a specified period per 1,000 population. The various measures of current fertility are calculated for the three-year period preceding the survey, which roughly corresponds to the calendar period 2007-2009. A three-year period was chosen because it reflects the current fertility level in Guyana and also provides a sufficient number of cases for statistical precision. Tables included in the report show all children born by the current ages of the women and by the ages of the women at marriage as well as the distribution of birth intervals. The chapter concludes with the analysis of information on the ages of the women at the time of their first birth (as an indicator of the beginning of the women's reproductive life) and on teenage pregnancy and motherhood. 4.1 CURRENT FERTILITY Table 4.1 and Figure 4.1 show the age-specific fertility rates, total fertility rates, general fertility rates, and crude birth rates for Guyana as a whole by residence (Urban or Rural and Coastal or Interior). • According to Table 4.1, if fertility were to remain constant in Guyana, women would bear, on average, 2.8 children by the end of their reproductive years. • Fertility is close to replacement level in urban areas (2.1 children per woman), higher in the rural areas (3.0 children per woman), and substantially higher in the Interior area (6.0 children per woman). Fertility rates for women in the Interior area are higher for all age groups. 54 | Fertility • The general fertility rate (GFR) for Guyana is 94 live births per 1,000 women. The crude birth rate (CBR) is 23 live births per 1,000 population for the period under review. Both measures are based on the birth history for the three-year period preceding the survey. Table 4.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Age group/rate Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total 15-19 50 53 41 123 83 50 99 238 101 20-24 119 106 147 180 149 119 162 282 163 25-29 94 67 133 125 102 94 105 228 116 30-34 96 105 78 104 87 96 83 246 102 35-39 60 62 56 53 48 60 42 129 55 40-44 7 9 4 16 9 7 10 58 13 45-49 0 0 0 6 3 0 5 18 4 Total fertility rate1 2.1 2.0 2.3 3.0 2.4 2.1 2.5 6.0 2.8 General fertility rate2 69 66 74 105 81 69 87 210 94 Crude birth rate3 17 17 18 24 20 17 21 42 23 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. 1 Total fertility rate for ages 15-49, expressed per woman 2 General fertility rate for ages 15-44, expressed per 1,000 women 3 Crude birth rate, expressed per 1,000 population Figure 4.1 Total Fertility Rates for the Three Years Preceding the Survey, by Residence 6.0 2.5 2.1 2.4 3.0 2.3 2.0 2.1 2.8 0 1 2 3 4 5 6 7 Total Interior Coastal (rural) Coastal (urban) Total Coastal Total Rural Other (urban) Georgetown (urban) Total Urban Total Total fertility rate (Children per woman) Fertility | 55 Table 4.2 Fertility by background characteristics Total fertility rate for the five years preceding the survey, mean number of children ever born to women age 40-49, and percentage currently pregnant, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mean number Percentage Total of children currently fertility rate ever born pregnant Background women to women women characteristic age 15-49 age 40-49 age 15-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 2.1 2.8 3.0 Georgetown (urban) 2.0 2.6 2.4 Other (urban) 2.3 3.3 4.1 Total Rural 3.0 3.7 4.8 Total Coastal 2.4 3.2 3.7 Coastal (urban) 2.1 2.8 3.0 Coastal (rural) 2.5 3.5 4.0 Total Interior 6.0 5.6 10.0 Region Region 1 6.9 5.7 15.2 Region 2 2.7 3.7 3.7 Region 3 2.4 3.7 2.8 Region 4 2.3 3.0 3.8 Region 5 3.0 3.4 5.1 Region 6 2.3 3.2 3.0 Region 7 4.9 5.4 8.9 Region 8 6.1 (6.4) 8.8 Region 9 5.7 5.3 6.0 Region 10 3.0 4.0 4.6 Education No education (5.9) * 12.3 Primary 3.8 3.7 5.2 Secondary 2.7 3.4 3.9 More than secondary 1.7 2.7 4.0 Wealth quintile Lowest 4.9 5.0 7.7 Second 2.8 4.1 4.3 Middle 2.7 3.4 4.3 Fourth 2.1 2.8 3.6 Highest 1.9 2.7 2.6 Total 2009 2.8 3.4 4.3 Total 2005 2.6 3.4 4.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total fertility rates are for the period 1-36 months preceding the interview. Fertility rates in parentheses are based on 125-249 unweighted person-years of exposure. Mean number of children 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. 4.2 FERTILITY DIFFERENTIALS Table 4.2 presents differentials in the total fertility rate and the percentage of women who are currently pregnant by background characteristics. The percentage currently pregnant provides a useful measure of current fertility. However, it may not capture all pregnant women because some women may be unaware of their pregnancy or reluctant to disclose a pregnancy in its early stages. The table also shows differentials in the mean number of children ever born to women age 40-49, that is, to women who are at the end of their childbearing years, which is a measure of completed or past fertility. The total fertility rate and the mean number of children ever born can be compared to assess the extent of fertility change over the past two decades in Guyana. 56 | Fertility Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Mother’s age ––––––––––––––––––––––––––– at birth 0-4 5-9 10-14 15-19 –––––––––––––––––––––––––––––––––––––––––––––––– 15-19 97 102 128 115 20-24 160 192 209 196 25-29 112 159 161 166 30-34 91 102 113 [122] 35-39 53 61 [91] 40-44 11 [29] 45-49 [4] TFR 15-30 1.8 2.3 2.5 2.4 –––––––––––––––––––––––––––––––––––––––––––––––– Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of the interview. • The TFR among women in the rural areas (3.0 children) exceeds the fertility rate of women in urban areas (2.1 children) by almost one child. On the other hand, the TFR in the Interior area (6.0 children) is twice as high as the TFR in rural areas and three times the TFR in Georgetown (urban) (2.0 children). • The TFR is still extremely high in some regions of Guyana: 6.9 children in Region 1, 6.1 children in Region 8, and 5.7 children in Region 9. • Fertility decreases rapidly with an increase in women’s education and household wealth. The TFR for women with more than secondary education is 1.7 children compared with 5.9 children for women with no education and 3.8 children for women with primary education. The TFR for women in the poorest households is more than two and a half times as high as the TFR for women in the richest households (4.9 children versus 1.9 children). • The observed gap between the TFR (2.8 children) and the mean number of children ever born to women age 40-49 (3.4) indicates that fertility in Guyana has decreased over time. • Only 4 percent of women are currently pregnant. Region 1 has the highest percentage of women currently pregnant (15 percent), which is several times the national average. Uneducated women (12 percent) and those in the poorest households (8 percent) are also much more likely than other groups to be currently pregnant. 4.3 FERTILITY TRENDS Fertility trends can be analyzed in two ways. One is to compare the 2009 GDHS data with previous surveys. Fertility trends can be also estimated based on the 2009 GDHS birth histories alone. Table 4.3 uses information from the retrospective birth histories obtained from GDHS respondents to examine the trends in age-specific fertility rates for successive five-year periods preceding the survey. To calculate these rates, births were classified according to the period of time in which the birth oc- curred and the mother’s age at the time of birth. The age- specific rates are progressively truncated with increasing time before the survey. Because women over age 50 were not interviewed in the 2009 GDHS, the rates for older age groups become progressively more truncated for periods increasingly distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and earlier prior to the survey, because women in that age group would have been 50 years or older at the time of the survey. Partially truncated rates are enclosed in brackets in the table. • Over time, a significant reduction in age-specific fertility rates is observed for all age groups. • The reduction in ASFR seems particularly pronounced in the last five years, but additional analysis and evaluation of the birth histories is required for a better assessment. Fertility | 57 4.4 CHILDREN EVER BORN AND LIVING Table 4.4 presents the distribution of all women and currently married women by the mean number of children ever born and the mean number of children surviving, according to five-year age groups. Lifetime fertility reflects the accumulation of births over the past 30 years, so its relevance to the current situation is limited; nevertheless, information on the mean number of children ever born is useful in examining the variation among different age groups. Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born, and mean number of living children, according to age group, Guyana 2009 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 83.9 11.0 4.1 0.6 0.4 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,016 0.23 0.22 20-24 47.6 30.1 13.8 6.9 1.3 0.2 0.1 0.0 0.0 0.0 0.0 100.0 767 0.85 0.83 25-29 20.6 26.4 22.1 18.0 8.4 3.1 0.8 0.5 0.1 0.0 0.0 100.0 658 1.83 1.77 30-34 11.9 14.0 29.3 21.7 10.3 6.8 3.0 1.9 0.4 0.0 0.6 100.0 643 2.54 2.45 35-39 8.1 13.3 23.1 23.1 12.7 9.4 4.8 2.8 1.4 0.4 0.8 100.0 699 3.00 2.86 40-44 8.6 10.1 17.8 23.3 14.8 11.4 5.4 4.4 1.4 0.8 2.1 100.0 624 3.35 3.15 45-49 5.6 7.4 21.2 25.1 16.3 8.4 5.3 3.2 4.3 1.1 2.1 100.0 589 3.53 3.23 Total 31.5 16.1 17.6 15.4 8.3 5.0 2.5 1.6 0.9 0.3 0.7 100.0 4,996 2.00 1.89 CURRENTLY MARRIED WOMEN 15-19 34.1 39.5 20.4 3.8 2.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 166 1.00 0.96 20-24 24.3 36.6 23.1 12.8 2.5 0.4 0.2 0.0 0.0 0.0 0.0 100.0 398 1.35 1.31 25-29 11.3 24.9 25.3 21.7 10.5 4.2 1.1 0.7 0.1 0.0 0.0 100.0 458 2.17 2.10 30-34 7.1 11.5 30.5 24.1 10.7 8.5 3.8 2.4 0.5 0.0 0.8 100.0 492 2.83 2.71 35-39 3.8 11.0 23.6 24.2 14.8 10.3 5.6 3.3 1.9 0.5 1.1 100.0 517 3.31 3.17 40-44 4.9 9.6 16.7 24.4 16.0 12.0 6.4 5.0 1.6 0.9 2.5 100.0 460 3.61 3.42 45-49 3.2 6.6 19.8 24.6 18.8 8.4 6.0 4.1 4.5 1.4 2.6 100.0 429 3.79 3.43 Total 10.1 17.5 23.1 21.2 11.8 7.1 3.7 2.5 1.4 0.4 1.1 100.0 2,920 2.77 2.62 • The distribution of children ever born by age shows that early childbearing is not common in Guyana; 84 percent of all women age 15-19 have never given birth. This proportion declines to 21 percent for women age 25-29, and to 9 percent or less among women age 35 and older. • The pattern for currently married women is similar to that for all women, with the proportion childless declining rapidly with age. Just over one-third (34 percent) of currently married women age 15-19 have not borne a child. This is less than half the level observed among all women. The difference in the proportion childless between all women and currently married women is attributable to the sizeable proportion of young, unmarried women in the former category who exhibit lower fertility. • Currently married women reported slightly higher fertility at all ages; they have had an average of 2.8 children compared with 2.0 children among all women. • Voluntary childlessness is uncommon, and currently married women with no live births are likely to be those who either themselves or whose partner is unable to bear children. The level of childlessness among married women at the end of their reproductive lives (age 45-49) can be used as an indicator of the level of primary sterility. In Guyana, primary sterility among older, currently married women is 3 percent. 58 | Fertility 4.5 BIRTH INTERVALS A birth interval is defined as the length of time between two live births. The study of birth intervals is important in understanding the health status of young children. Research has shown that short birth intervals are closely associated with poor health of children, especially during infancy. Children born too close to a previous birth, especially if the interval between the births is less than two years, are at increased risk of health problems and dying at an early age. Longer birth intervals, on the other hand, contribute to the improved health status of both mother and child. The study of birth intervals is done using two measures: median birth interval and proportion of non-first births that occur 24 months or more after the previous birth. Table 4.5 presents the distribution of second and higher-order births in the five years preceding the survey by the number of months since the previous birth, according to background characteristics. First births are omitted from the table because there is no prior birth with which to measure an interval. The table also shows the median number of months since the preceding birth. The prevalence of birth intervals of 24 months or fewer is presented in Figure 4.2 by residence and wealth quintile. • In Guyana, the median length of time between two successive live births is three years (36 months). The median birth interval increases rapidly with the age of the mother, reaching four years among women age 30 years and older (49 months). The median number of months between births is shorter when the preceding birth is dead (23 months) than alive (37 months), and it is longer for births in urban than in rural areas (45 months versus 34 months). The longest birth interval is observed in Region 4 (43 months, and the shortest is in Region 1 (29 months). • A significant proportion of births (25 percent) occur within short intervals from preceding births (24 months or less). The proportion of births with a short interval from the preceding birth is greater in rural (27 percent) than in urban areas (18 percent) and it is highest for births in Region 8 (32 percent) and Region 1 (35 percent). • The proportion of births with a birth interval of 24 months or less is also significantly higher for births to women with no education (36 percent) compared with births to other women, especially those with more than secondary education (17 percent). . Fertility | 59 Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and by median number of months since preceding birth, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median number of Number Number of months since preceding birth months since of Background –––––––––––––––––––––––––––––––––––––––––––––––––––––––– preceding non-first characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total birth1 births –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 24.8 42.7 30.1 2.5 0.0 0.0 100.0 22.5 66 20-29 11.9 18.6 31.5 15.5 9.3 13.1 100.0 31.0 573 30-39 5.4 9.8 18.9 14.5 12.4 39.1 100.0 49.3 530 40-49 4.0 10.2 20.0 13.0 6.6 46.2 100.0 48.9 93 Birth order 2-3 9.2 16.1 25.2 13.0 9.5 27.0 100.0 35.4 790 4-6 9.6 12.1 25.4 15.7 9.8 27.5 100.0 38.3 370 7+ 8.8 23.6 25.9 18.5 13.3 10.0 100.0 31.7 102 Sex of preceding birth Male 7.8 18.2 23.8 14.3 9.3 26.6 100.0 36.2 632 Female 10.8 12.9 26.8 14.1 10.5 25.0 100.0 35.5 630 Survival of preceding birth Living 8.5 14.9 25.5 14.7 9.7 26.7 100.0 37.0 1,206 Dead 25.1 29.7 20.9 4.3 13.5 6.4 100.0 22.8 56 Residence Total Urban 8.4 9.6 21.0 17.3 8.3 35.4 100.0 44.5 271 Georgetown (urban) 8.9 7.9 18.6 20.2 6.9 37.5 100.0 45.7 166 Other (urban) 7.6 12.2 24.8 12.8 10.5 32.1 100.0 41.9 105 Total Rural 9.5 17.2 26.5 13.4 10.3 23.1 100.0 33.7 990 Total Coastal 9.2 13.7 24.1 13.8 9.9 29.3 100.0 39.0 957 Coastal (urban) 8.4 9.6 21.0 17.3 8.3 35.4 100.0 44.5 271 Coastal (rural) 9.6 15.3 25.3 12.4 10.5 26.9 100.0 35.7 686 Total Interior 9.4 21.3 29.0 15.7 9.9 14.8 100.0 31.2 305 Region Region 1 7.7 27.6 27.9 17.3 8.9 10.7 100.0 29.1 122 Region 2 8.3 16.4 37.9 11.3 9.7 16.4 100.0 29.6 71 Region 3 8.1 12.8 29.2 15.2 7.7 27.1 100.0 35.0 143 Region 4 8.6 12.2 21.4 16.2 10.2 31.4 100.0 43.3 419 Region 5 11.9 14.4 26.5 9.6 11.2 26.3 100.0 34.4 93 Region 6 11.4 17.5 18.3 10.4 11.0 31.3 100.0 40.1 178 Region 7 6.5 11.9 29.6 17.1 12.8 22.2 100.0 37.5 45 Region 8 17.2 14.6 23.2 12.1 13.5 19.4 100.0 31.2 54 Region 9 6.0 20.0 40.1 16.3 7.6 10.0 100.0 30.2 49 Region 10 8.9 15.5 27.3 12.6 7.5 28.2 100.0 35.3 87 Education No education 16.1 19.6 32.8 11.7 10.8 9.0 100.0 27.0 48 Primary 6.8 17.8 33.3 12.4 10.0 19.7 100.0 33.0 332 Secondary 10.1 14.9 22.8 14.9 8.9 28.4 100.0 37.7 805 More than secondary 6.6 9.9 13.0 16.5 19.2 34.8 100.0 49.4 78 Wealth quintile Lowest 10.3 21.5 33.5 12.5 7.8 14.3 100.0 28.9 415 Second 8.4 14.6 30.9 15.4 9.2 21.6 100.0 33.2 260 Middle 10.3 14.3 14.9 11.2 13.7 35.5 100.0 47.5 218 Fourth 8.7 14.6 16.6 17.2 11.1 31.8 100.0 43.8 171 Highest 7.5 6.3 19.7 17.1 9.9 39.5 100.0 47.8 197 Total 2009 9.3 15.5 25.3 14.2 9.9 25.8 100.0 35.9 1,262 Total 2005 14.2 15.0 23.2 15.5 [.32.2.] 100.0 33.8 659 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 1 The median is the midpoint of the distribution of births by number of months since preceding birth. 60 | Fertility 4.6 AGE AT FIRST BIRTH The age at which childbearing begins has important demographic implications as well as important consequences for the mother and child. In many countries, postponement of first births, reflecting an increase in the age of a woman at marriage, has contributed greatly to overall fertility declines. Table 4.6 shows the percentage of women who have given birth by exact ages, according to age at the time of the survey. Table 4.7 summarizes the median age at first birth for different age cohorts and compares the entry age into motherhood for different subgroups of the population. Medians for cohorts 15-19 and 20-24 could not be determined because half the women had not yet had a birth. In interpreting these results and other results in this chapter, possible distortions caused by data peculiarities should be borne in mind. Findings for older women should be regarded critically. For instance, unexpectedly high ages at first birth for older cohorts may well indicate omission or misdating of early births, rather than a genuine trend. • Twenty-one percent of women age 25-49 have given birth by exact age 18, and 75 percent have given birth by exact age 25. Data across age groups indicate that these percentages have changed very little over time. • The findings indicate that childbearing begins relatively late in Guyana. The median age at first birth for women in Guyana is almost 21 years, and it seems to have changed little in the last two decades. Figure 4.2 Births with a Birth Interval of Less than 24 Months, by Residence and Wealth Quintile 25 18 17 20 27 32 23 25 23 14 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural WEALTH QUINTILE Lowest Second Middle Fourth Highest 0 5 10 15 20 25 30 35 Percentage of non-first births in the five years preceding the survey GDHS 2009 Fertility | 61 • The median age at first birth for women age 25-49 is 21.8 years in urban areas compared with 20.4 years in rural areas and 19.4 years in the Interior area. Among regions, it is lowest in Region 8 (18.9 years) and highest in Region 4 (21.2 years). • The median age at first birth increases with education, from 19.6 years for women with no education to 24.3 years for women with more than secondary education. • There are also important differences depending on the wealth of the household. The median age at first birth is 19.6 years for women in the poorest households and increases steadily to 22.7 years for women in the wealthiest households. Table 4.6 Age at first birth Percentage of women who have given birth by specific exact ages, percentage who have never given birth, and median age at first birth, according to current age, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who have Percentage Median given birth by exact age: who have Number age at –––––––––––––––––––––––––––––––––––––– never of first Current age 15 18 20 22 25 given birth women birth1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 1.9 na na na na 83.9 1,016 a 20-24 1.9 15.9 34.7 na na 47.6 767 a 25-29 2.1 22.6 41.8 59.1 74.7 20.6 658 20.8 30-34 1.6 22.6 43.5 60.9 74.9 11.9 643 20.7 35-39 1.1 20.1 42.5 58.5 74.5 8.1 699 20.9 40-44 2.3 17.4 40.7 61.1 74.3 8.6 624 20.9 45-49 1.6 24.6 46.2 64.0 78.8 5.6 589 20.4 2009 20-49 1.8 20.3 41.3 na na 18.1 3,980 a 25-49 1.7 21.4 42.9 60.6 75.4 11.1 3,213 20.7 2005 20-49 1.7 21.4 42.3 na na 17.7 1,969 20.8 25-49 1.6 21.3 43.2 62.3 77.4 11.2 1,583 20.7 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable because of censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 1 The median is the midpoint of the distribution of women by exact age at first birth. 62 | Fertility 4.7 TEENAGE PREGNANCY AND MOTHERHOOD Table 4.8 shows the percentage of women age 15-19 who have begun childbearing, either because they are already mothers or because they are pregnant with their first child, by background characteristics. Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic, and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which results in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of educational attainment and accessibility to job opportunities may be curtailed. • At the time of the survey, 18 percent of women age 15-19 had begun childbearing; 16 percent were already mothers, and 2 percent were pregnant with their first child. • Among women age 18-19, about one-third had already begun childbearing (i.e., were mothers or were pregnant with their first child). Table 4.7 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Background –––––––––––––––––––––––––––––––––––––––––––––– age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 22.8 22.1 21.2 22.4 20.9 21.8 Georgetown (urban) 23.2 22.1 21.2 23.0 21.2 22.2 Other (urban) 21.6 22.2 21.3 21.1 20.6 21.3 Total Rural 20.3 20.1 20.8 20.4 20.2 20.4 Total Coastal 21.0 20.8 21.1 21.1 20.5 20.9 Coastal (urban) 22.8 22.1 21.2 22.4 20.9 21.8 Coastal (rural) 20.4 20.2 21.0 20.6 20.4 20.5 Total Interior 19.4 19.7 19.3 19.1 19.4 19.4 Region Region 1 (20.0) (18.6) (21.2) (19.4) (19.3) 19.3 Region 2 20.0 20.6 20.9 20.5 20.8 20.6 Region 3 20.8 20.7 21.9 20.4 20.3 20.8 Region 4 21.9 21.4 20.4 21.6 20.5 21.2 Region 5 (20.5) 19.9 22.6 20.4 21.2 20.8 Region 6 19.7 19.9 21.3 21.2 20.4 20.4 Region 7 (20.5) (20.1) (19.2) (19.7) (19.5) 19.8 Region 8 (18.0) (21.9) (18.8) * (17.7) 18.9 Region 9 19.1 (19.9) (19.0) (19.2) (20.5) 19.6 Region 10 20.2 22.4 20.4 20.7 (20.5) 20.9 Education No education * * * * * 19.6 Primary 18.7 19.3 20.9 20.5 20.1 20.1 Secondary 20.9 20.7 20.6 21.1 20.2 20.7 More than secondary a 25.1 23.2 21.4 24.9 24.3 Wealth quintile Lowest 18.7 19.5 19.6 19.7 20.7 19.6 Second 19.7 19.5 19.7 20.4 19.5 19.8 Middle 19.9 19.7 21.2 20.0 20.2 20.2 Fourth 21.5 21.6 20.9 22.1 20.7 21.4 Highest 23.9 23.2 23.3 22.2 20.5 22.7 Total 20.8 20.7 20.9 20.9 20.4 20.7 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The median is the midpoint of the distribution of women by exact age at first birth. 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. a = Omitted because less than 50 percent of the women had a birth before the beginning of the age group Fertility | 63 Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child and percentage who have begun childbearing, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who are: Percentage ––––––––––––––––––– who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15 1.1 0.8 1.9 210 16 5.3 2.0 7.3 206 17 11.3 1.3 12.6 180 18 29.1 3.4 32.5 179 19 32.3 2.3 34.6 240 Residence Total Urban 8.3 1.4 9.7 307 Georgetown (urban) 9.1 0.7 9.8 199 Other (urban) 6.8 2.6 9.4 108 Total Rural 19.5 2.2 21.6 709 Total Coastal 13.3 1.8 15.1 912 Coastal (urban) 8.3 1.4 9.7 307 Coastal (rural) 15.9 2.0 17.9 605 Total Interior 40.2 3.1 43.3 104 Region Region 1 58.9 3.9 62.7 39 Region 2 20.2 2.8 23.0 70 Region 3 11.4 1.8 13.2 141 Region 4 13.7 1.6 15.3 443 Region 5 10.7 4.4 15.1 66 Region 6 14.7 1.4 16.1 144 Region 7 20.1 2.2 22.3 23 Region 8 43.2 4.7 47.9 19 Region 9 26.8 2.7 29.5 12 Region 10 9.5 0.0 9.5 59 Education No education * * * 8 Primary 32.1 6.0 38.1 80 Secondary 14.6 1.6 16.2 893 More than secondary (2.1) (1.4) (3.6) 35 Wealth quintile Lowest 34.0 4.3 38.3 184 Second 20.6 0.7 21.4 209 Middle 17.3 2.6 19.9 203 Fourth 7.8 0.9 8.6 211 Highest 2.9 1.4 4.4 209 Total 2009 16.1 1.9 18.0 1,016 Total 2005 11.3 2.5 13.8 456 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. • There are important differences by place of residence. Teenagers in rural areas are more than twice as likely (22 percent) and those in the Interior area are four times as likely (43 percent) as teenagers in urban areas (10 percent) to have begun childbearing. • The differences by region are also striking. Only 10 percent of teenagers in Region 10 have begun childbearing compared with 63 percent in Region 1. • The percentage of teenagers who have begun childbearing decreases steadily with education and wealth. Family Planning | 65 FAMILY PLANNING 5 This chapter appraises current knowledge of contraceptive methods and then considers past and current practices of contraceptive use. Special attention is given to those who do not use contraception now but who intend to use it sometime in the future. The chapter concludes with an analysis of how family planning programs use the media to convey information about contraception and to what extent women and men are exposed to this media coverage. Information about family planning is of practical use to policymakers and program managers. The early sections of this chapter concern conditions that precede the adoption of contraception, such as knowledge of methods and supply sources. The levels of use of contraceptives provide the most obvious and widely accepted criterion of success of the program, especially when results from earlier surveys are available so that progress can be charted. Examination of contraceptive use in relation to need pinpoints segments of the population for whom intensified efforts at service provision are most needed. An analytical framework is used to assist in data interpretation. The framework divides the determinants of contraceptive use into two types: those that promote use and those that prevent use. Use- promoting factors include the desire of couples to postpone or terminate childbearing. Obstacles to use, as perceived by potential users, include lack of knowledge of methods; disapproval of contraception; ignorance of sources of advice and supply; and the belief that at least some methods present major barriers to use. Also likely to influence whether initial, and often tentative, adoption of a method is sustained or discontinued is an unsatisfactory experience with the method or source of supply and an inability to use the method effectively. The relative importance of use-promoting and use-discouraging factors in determining actual use has long been the subject of dispute. In reality, the two may not be independent of each other. The reduction or elimination of perceived obstacles may well strengthen use-promoting attitudes and vice versa. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Acquiring knowledge about contraceptive methods is an important step towards access and then adoption of a suitable contraceptive method. Information on knowledge of contraception was collected in two ways. Respondents were asked to mention all ways or methods that couples can use to avoid or delay pregnancy. When a respondent failed to mention a particular method spontaneously, the interviewer described the method and asked whether the respondent knew of it. Using this approach, information was collected for 12 modern family planning methods: female and male sterilization, the pill, the IUD/coil, injectables, implants, male and female condoms, diaphragm, foam tablets and jelly, the lactational amenorrhea method (LAM), and emergency contraception. Information was also collected on two traditional methods: rhythm, or periodic abstinence, and withdrawal. Provision was made in the questionnaire to record any other methods named spontaneously by respondents, and these were coded as ”folk methods.” This report combines both prompted and unprompted knowledge. Thus, knowledge of a family planning method in the 2009 GDHS is defined simply as having heard of a method. Table 5.1 shows the percentage of all women and men, currently married women and men, and sexually active unmarried women and men, age 15-49, who have heard of specific contraceptive methods. The mean number of methods known is also shown. Knowledge of any modern method of contraception 66 | Family Planning should be chosen as a summary indicator of knowledge in preference to knowledge of any method, because of its greater relevance for program promotion, which is usually confined to modern methods. • Knowledge of any contraceptive method is almost universal in Guyana, with 98 percent of all women and 99 percent of all men knowing at least one method of contraception. • Modern methods are more widely known than traditional methods. Ninety-eight percent of all women and men know of a modern method, compared with 54 percent of all women and 65 percent of all men who know of a traditional method. • Among women, the male condom is the most commonly known method (96 percent), followed by the pill (89 percent), injectables (81 percent), and the female condom (78 percent). The lactational amenorrhea method (LAM) is the least known method (14 percent). • Among the traditional methods, withdrawal is known by 49 percent and rhythm by 30 percent of women. Only 5 percent of women mentioned folk methods. • Knowledge of contraceptive methods among currently married women is similar to that among all women. Among sexually active, unmarried women, knowledge of male sterilization, the female condom and vaginal methods, as well as traditional methods, tends to be higher than among other women. • Knowledge of any modern method is as high among men as among women, with knowledge of certain “female-oriented” methods, such as female sterilization, IUD, and injectables, being substantially lower among men than among women. Of the traditional methods, knowledge of rhythm is somewhat less common among men than women, but knowledge of withdrawal is significantly more common among men than among women. Table 5.1 Knowledge of contraceptive methods Percentage of all respondents, currently married respondents, and sexually active unmarried respondents age 15-49 who know any contraceptive method, by specific method, Guyana 2009 Women Men Method All women Currently married women Sexually active unmarried women1 All men Currently married men Sexually active unmarried men1 Any method 98.3 98.8 99.4 98.5 99.2 99.8 Any modern method 98.3 98.8 99.4 98.4 98.9 99.8 Female sterilization 65.8 69.4 71.6 47.2 55.1 47.7 Male sterilization 31.6 29.9 35.6 29.7 30.7 36.4 Pill 89.3 91.3 94.7 74.3 80.1 76.5 IUD 71.1 77.5 74.6 37.3 45.0 40.4 Injectables 81.4 87.3 87.4 49.4 57.9 50.5 Implants 25.0 23.2 28.9 22.1 23.8 26.8 Male condom 96.2 96.3 98.5 98.1 98.7 99.5 Female condom 78.4 75.2 89.0 69.9 70.4 77.8 Diaphragm 24.8 20.8 32.8 18.7 20.2 24.2 Foam/jelly 33.0 32.1 41.1 26.9 28.4 32.3 Lactational amenorrhea method (LAM) 13.9 13.4 18.2 5.7 7.2 4.5 Emergency contraception 29.7 26.6 40.1 26.6 28.5 33.5 Any traditional method 54.4 54.8 63.7 64.8 69.3 75.3 Rhythm 30.2 28.2 35.9 24.0 28.3 25.4 Withdrawal 49.1 49.7 59.7 62.3 66.5 73.7 Folk method 5.4 4.9 6.0 3.8 3.6 6.0 Mean number of methods known by respondents 15-49 7.2 7.3 8.1 6.0 6.4 6.6 Number of respondents 4,996 2,920 408 3,522 1,835 540 1 Had last sexual intercourse within 30 days preceding the survey Family Planning | 67 5.2 KNOWLEDGE OF CONTRACEPTION BY BACKGROUND CHARACTERISTICS Because knowledge of methods of contraception and of modern methods of contraception is almost universal in Guyana for most of the population groups used in this report, a detailed table by background characteristics is not shown. Table 5.2 presents information on knowledge of contraception methods among currently married women and men for only a few selected background characteristics for which knowledge is not universal: the Interior area, Regions 8 and 9, and the lowest wealth quintile. • The lowest levels of knowledge of contraceptive methods in Guyana are found in Region 9, where three-quarters of currently married women know of a method or a modern method of contraception. About nine in ten men in Region 9 know of a method and of a modern method of contraception. • In the Interior area, 94 percent of currently married women know a method or a modern method of contraception. The corresponding figures for men are 97 percent (any method) and 96 percent (modern methods). • Even in the lowest quintile, the level of knowledge is high. Ninety-five percent of currently married women and 97 percent of currently married men know a method or a modern method. 5.3 EVER USE OF CONTRACEPTIVE METHODS All women interviewed in the survey who said they had heard of a method of family planning were asked whether they had ever used that method. Men were asked if they had ever used “male- oriented” methods, i.e., male sterilization, condoms, rhythm, and withdrawal. Table 5.3 shows the percentages of all women, currently married women, and sexually active unmarried women who have ever used specific methods of family planning, by age, and Table 5.4 shows comparable information for men. • Ever use of contraception is significantly higher among sexually active unmarried women (91 percent) than either currently married women (75 percent) or all women (64 percent). The condom is the most common ever used method (83 percent of sexually active unmarried women and 42 percent, each, of married women and all women), followed by the pill (30-39 percent) and injectables (15-21 percent). Table 5.2 Knowledge of contraceptive methods by selected background characteristics Percentage of currently married women and currently married men age 15-49 who know at least one contraceptive method and percentage who know at least one modern method, by selected background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––– Knows Knows any Number Knows Knows any Number Background any modern of any modern of characteristic method method1 women method method1 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Interior 93.7 93.6 357 96.8 95.9 232 Region 8 90.6 90.6 71 93.0 92.4 40 Region 9 75.6 74.9 57 89.0 88.7 40 Lowest wealth quintile 95.1 94.8 554 97.4 96.8 372 Total 98.8 98.8 2,920 99.2 98.9 1,835 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception 68 | Family Planning • Ever use of contraception is also higher among sexually active unmarried men (95 percent) than either currently married men (81 percent) or all men (72 percent). The male condom has been used by 68 percent of all men, 74 percent of currently married men, and 93 percent of sexually active unmarried men. Among the traditional methods, withdrawal has been used by 35 percent of all men, 41 percent of married men and 52 percent of sexually active unmarried men. Table 5.3 Ever use of contraception by age: Women Percentage of all women, currently married women, and sexually active unmarried women age 15-49 who have ever used any contraceptive method by method, according to age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––– Female Emer- Any Never Any sterili- In- gency tradi- Periodic Folk used Number Any modern za- ject- Im- Con- Dia- Foam/ contra- tional absti- With- meth- a of Age method method tion Pill IUD ables plants dom phragm jelly LAM ception method nence drawal od method women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 26.4 25.2 0.4 3.2 0.6 1.9 0.3 22.8 0.8 0.0 0.0 0.0 0.6 4.4 0.6 2.4 1.5 1,016 20-24 66.4 65.1 0.3 18.2 3.9 10.9 0.2 52.2 2.1 0.0 0.0 0.7 1.3 16.1 3.6 13.5 2.7 767 25-29 75.5 74.5 1.9 36.7 11.2 17.6 0.5 54.8 1.3 0.0 2.0 1.8 1.5 16.5 3.2 13.9 2.2 658 30-34 79.3 78.1 2.2 38.5 18.7 21.2 0.2 51.1 2.0 0.0 1.6 0.5 1.3 15.1 3.4 13.1 1.8 643 35-39 79.0 77.5 5.0 44.8 19.4 24.1 0.6 48.8 2.3 0.8 2.8 1.7 2.3 14.0 3.7 11.2 2.4 699 40-44 73.7 72.6 9.0 44.6 24.1 21.5 0.5 37.3 0.8 0.4 6.6 1.3 2.8 13.6 5.1 9.9 1.6 624 45-49 69.8 67.8 10.1 38.9 26.0 18.2 0.6 30.7 1.1 0.9 7.1 0.4 2.3 11.9 4.5 8.3 2.2 589 Total 64.2 62.9 3.7 29.7 13.4 15.3 0.4 41.6 1.5 0.3 2.5 0.9 1.6 12.5 3.2 9.8 2.0 4,996 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 47.8 47.8 2.8 14.2 1.8 7.7 0.1 34.9 0.9 0.0 0.0 0.0 0.0 4.1 0.0 4.1 0.0 166 20-24 71.4 70.0 0.6 25.7 6.9 18.0 0.3 48.3 1.2 0.0 0.0 1.4 0.7 16.0 3.0 13.8 2.1 398 25-29 76.1 74.7 2.6 40.1 14.1 19.4 0.8 51.0 1.0 0.0 1.9 2.1 1.5 16.4 3.7 13.4 2.1 458 30-34 81.0 79.8 2.3 42.2 21.2 24.3 0.3 47.6 2.2 0.0 1.6 0.3 1.6 15.7 3.6 13.8 1.8 492 35-39 80.2 78.2 5.8 46.3 23.1 24.1 0.5 44.4 1.9 0.4 2.7 2.1 2.6 13.2 2.7 10.9 1.7 517 40-44 76.9 75.5 10.4 47.6 26.3 21.9 0.7 36.9 0.7 0.3 7.1 0.9 3.3 15.2 5.7 11.0 1.8 460 45-49 71.8 69.4 10.8 40.6 28.6 19.2 0.5 26.9 1.5 0.4 8.7 0.5 2.6 10.5 3.8 7.4 1.6 429 Total 74.9 73.4 5.3 39.4 19.3 20.6 0.5 42.2 1.4 0.2 3.4 1.2 1.9 13.9 3.5 11.3 1.8 2,920 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED WOMEN2 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 90.6 90.6 0.0 5.5 1.8 7.6 1.7 90.6 3.8 0.0 0.0 0.0 1.9 7.6 2.5 6.2 0.0 76 20-24 84.5 83.3 0.0 15.8 2.1 6.0 0.0 79.9 6.3 0.0 0.0 0.0 1.1 24.2 6.3 21.3 2.8 109 25-29 92.5 92.0 1.0 41.1 2.8 22.5 0.0 82.5 0.6 0.0 4.0 1.4 0.0 26.3 0.7 25.8 0.6 79 30-34 84.7 84.7 1.9 32.7 5.0 15.2 0.0 76.5 3.0 0.0 1.3 0.0 1.3 11.4 5.6 6.0 2.9 39 35-39 100.0 100.0 4.8 58.4 8.9 30.7 0.0 91.1 1.4 0.0 3.9 0.0 1.1 23.9 9.3 15.8 6.8 50 40-49 53.9 53.9 6.6 37.5 12.6 20.6 1.1 43.0 0.8 0.0 5.6 0.0 1.4 11.0 6.4 7.2 2.0 56 Total 90.7 90.3 2.6 32.5 6.0 17.6 0.6 83.0 3.1 0.0 2.8 0.3 1.2 19.6 5.5 16.1 2.5 408 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: For all women and sexually active unmarried women, the use of any method and any modern method includes male sterilization, which is not shown separately. LAM = Lactational amenorrhea method 1 ”Currently married” includes respondents in consensual union (living together). 2 Unmarried women who last had sexual intercourse less than one month preceding the survey. The information for sexually active women age 30-34 and age 35-39 is based on 25 to 49 unweighted cases each. Family Planning | 69 5.4 CURRENT USE OF CONTRACEPTION This section presents information on the prevalence of contraceptive use among all women, currently married women, and sexually active unmarried women age 15-49. The level of current use is the most widely used and valuable measure of the success of a family planning program. Furthermore, it can be used to estimate the reduction in fertility attributable to contraception. The contraceptive prevalence rate (CPR) is usually defined as the percentage of currently married women who are currently using a method of contraception. Table 5.4 Ever use of contraception by age: Men Percentage of all men, currently married men, and sexually active unmarried men who have ever used any contraceptive method, by specific method and age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––– –––––––––––––––––––––––––– Any Male Any Number Any modern sterili- Male traditional With- of Age method method zation condom method Rhythm drawal men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 38.6 37.8 0.4 37.7 11.7 1.0 11.5 689 20-24 82.1 79.6 0.8 79.6 40.0 4.4 38.5 511 25-29 83.7 79.9 0.4 79.7 47.9 9.2 46.7 462 30-34 88.3 84.9 1.2 84.6 43.4 7.2 41.3 521 35-39 78.1 72.1 0.1 72.0 40.8 8.3 38.4 470 40-44 76.2 69.0 0.0 69.0 46.6 8.1 44.9 457 45-49 72.6 64.7 0.1 64.6 40.7 10.5 37.0 413 Total 72.3 68.1 0.4 68.0 37.0 6.5 35.3 3,522 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 * * * * * * * 8 20-24 83.9 81.8 1.3 81.8 34.6 2.1 34.4 143 25-29 84.9 80.4 0.7 80.1 48.2 9.0 46.8 269 30-34 87.4 83.3 1.2 83.3 45.4 7.5 44.0 366 35-39 77.9 72.0 0.1 71.9 40.0 9.0 37.3 354 40-44 76.3 68.5 0.0 68.5 46.2 9.4 44.5 352 45-49 74.9 65.7 0.1 65.6 41.1 12.0 36.6 343 Total 80.5 74.4 0.5 74.3 43.2 8.8 41.0 1,835 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED MEN1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 95.0 93.1 1.6 93.1 41.6 3.0 41.6 101 20-24 96.9 94.9 1.4 94.9 55.5 4.8 54.8 168 25-29 96.8 94.6 0.0 94.6 60.1 17.8 59.0 87 30-34 98.7 97.4 0.0 97.4 61.1 7.8 56.9 71 35-39 88.7 87.5 0.0 87.5 46.3 8.0 43.1 50 40-49 88.4 87.1 0.0 87.1 54.8 4.0 54.3 63 Total 95.0 93.3 0.7 93.3 53.4 7.1 52.1 540 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Male respondents were not asked about methods that are female controlled, such as the pill or the IUD. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. The information for sexually active men age 35-39 is based on 49 unweighted cases. 1 Men who had sexual intercourse in the month preceding the survey 70 | Family Planning Table 5.5 presents the percentage of all women, currently married women, and sexually active unmarried women by contraceptive method currently used, according to age. However, the data interpretation will focus on the findings for currently married women because they are the more meaningful and telling data on current contraceptive use. An inverted-U pattern of contraceptive prevalence rate by age is expected for the currently married women. Current use is usually lower among younger women (because they are in the stage of family building) and among older women (some of whom are no longer fecund) than among those at intermediate ages. • Forty-three percent of married women are currently using a contraceptive method; most of them (40 percent) are using a modern method. The most commonly used methods are the male condom (13 percent), the pill (9 percent), and the IUD (7 percent). Female sterilization and injectables are each used by 5 percent of women. Table 5.5 Current use of contraception by age Percentage of all women, currently married women, and sexually active unmarried women age 15-49 by contraceptive method currently used, according to age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––– Using Female Any Not any Any sterili- In- Male Female tradi- Folk using Number meth- modern za- ject- Im- con- con- tional With- meth- a of Age od method tion Pill IUD ables plants dom dom LAM method Rhythm drawal od method women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 14.2 13.9 0.4 1.3 0.1 0.9 0.1 10.9 0.1 0.0 0.3 0.0 0.2 0.1 85.8 1,016 20-24 36.6 33.4 0.3 5.2 2.0 4.2 0.0 21.0 0.0 0.7 3.2 0.8 1.7 0.7 63.4 767 25-29 41.2 39.1 1.9 9.0 6.1 5.4 0.2 16.3 0.0 0.0 2.2 0.4 1.4 0.4 58.8 658 30-34 47.7 45.6 2.2 9.6 8.0 5.9 0.0 19.8 0.1 0.1 2.1 0.4 1.0 0.6 52.3 643 35-39 43.0 40.2 5.0 8.5 7.9 4.0 0.2 14.6 0.0 0.0 2.8 0.3 1.3 1.2 57.0 699 40-44 40.6 37.6 9.0 7.9 5.9 2.8 0.3 11.4 0.0 0.0 3.0 1.2 0.8 1.1 59.4 624 45-49 29.4 27.4 10.1 2.2 6.8 0.7 0.2 7.4 0.0 0.0 1.9 1.1 0.7 0.1 70.6 589 Total 34.6 32.5 3.7 5.9 4.8 3.3 0.1 14.5 0.0 0.1 2.1 0.5 1.0 0.6 65.4 4,996 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 29.8 29.8 2.8 6.1 0.6 3.5 0.0 16.6 0.2 0.0 0.0 0.0 0.0 0.0 70.2 166 20-24 38.7 36.2 0.6 8.9 3.3 6.9 0.0 15.2 0.0 1.4 2.5 0.8 1.6 0.1 61.3 398 25-29 42.8 40.3 2.6 10.8 8.1 6.8 0.2 11.7 0.0 0.0 2.5 0.5 2.0 0.0 57.2 458 30-34 50.4 48.3 2.3 11.7 9.1 7.2 0.0 17.8 0.1 0.1 2.1 0.3 1.3 0.5 49.6 492 35-39 46.9 44.3 5.8 10.9 9.9 4.9 0.3 12.5 0.0 0.0 2.6 0.2 1.7 0.7 53.1 517 40-44 45.7 41.9 10.4 9.9 7.1 2.2 0.4 11.5 0.0 0.0 3.8 1.6 1.1 1.1 54.3 460 45-49 32.7 30.0 10.8 3.1 8.0 0.9 0.3 7.0 0.0 0.0 2.7 1.5 1.0 0.2 67.3 429 Total 42.5 40.0 5.3 9.2 7.3 4.8 0.2 12.9 0.0 0.2 2.5 0.7 1.4 0.4 57.5 2,920 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED WOMEN2 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 60.9 60.9 0.0 2.7 0.0 3.8 0.0 53.5 0.8 0.0 0.0 0.0 0.0 0.0 39.1 76 20-24 70.7 64.8 0.0 3.1 2.1 2.6 0.0 57.0 0.0 0.0 5.9 2.9 3.0 0.0 29.3 109 25-29 61.3 60.8 1.0 12.0 0.0 1.5 0.0 46.2 0.0 0.0 0.5 0.0 0.5 0.0 38.7 79 30-39 68.2 63.0 3.5 2.5 4.3 1.5 0.0 51.2 0.0 0.0 5.2 1.7 0.0 3.5 31.8 89 40-49 49.4 49.4 11.7 4.4 4.3 3.8 0.0 25.2 0.0 0.0 0.0 0.0 0.0 0.0 50.6 56 Total 63.6 60.8 2.6 4.8 2.1 2.5 0.0 48.7 0.1 0.0 2.8 1.1 0.9 0.8 36.4 408 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM= Lactational amenorrhea method 1 ‘Currently married” includes respondents in consensual union (living together). 2 Unmarried women who last had sexual intercourse less than one month preceding the survey. Family Planning | 71 • Overall, the percentage of currently married women using any contraceptive method increases steadily with women’s age, from 30 percent among women age 15-19 to 50 percent among those age 30-34, after which it drops to 33 percent among women 45-49. • The use of condoms tends to drop for women age 35 and older, reaching a low of 7 percent for women age 45-49. As expected, the use of the IUD is relatively low (1 to 3 percent) among younger women age 15-24, after which its use increases and stays at 7 to 10 percent for older women. The highest percentage of current users of the pill is observed among women age 25-39 (11 to 12 percent). • Table 5.5 also shows that current use of any method is higher among currently married women than among all women. However, use is far higher among sexually active unmarried women (64 percent) than among married women (43 percent) or all women (35 percent). 5.5 DIFFERENTIALS IN CURRENT USE Table 5.6 shows the percentage of currently married women by current use of family planning methods, according to background characteristics. Figure 5.1 shows use of contraception among currently married women by region. Current use of contraception varies with number of living children, urban-rural residence, region, education, and wealth. • As mentioned previously, 43 percent of currently married women are using a contraceptive method, and 40 percent are using a modern method. The CPR has increased from 35 percent as reported in the 2005 GAIS to 43 percent as reported in the 2009 GDHS. Most of the increase is observed in condom use, injectables, and female sterilization. Pill use, on the other hand, has declined over the same period, from 12 to 9 percent. • The percentage of currently married women using contraception increases with the level of education, from 22 percent among women with no education to 46 percent among women with more than secondary education. The level of use increases with the number of living children up to 4 children, after which it drops somewhat. • The prevalence of contraceptive use is similar in urban and rural populations in the Coastal area (43 and 44 percent, respectively), but it is much lower in the Interior area (31 percent). The method mix among urban and rural women is slightly different. Rural women are more likely to use the male condom, the pill (11 percent each), and the IUD (7 percent), while urban women are more likely to use the male condom (18 percent), IUD (8 percent), and female sterilization (7 percent). • Condoms are the contraceptive method preferred by the most educated women (18 percent), while women with five or more children prefer sterilization (13 percent). 72 | Family Planning Table 5.6 Current use of contraception by background characteristics Percentage of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––– Female Any Not Using Any sterili- In- Male Female tradi- Folk using Number Background any modern za- ject- Im- con- con- tional With- meth- a of characteristic method method tion Pill IUD ables plants dom dom LAM method Rhythm drawal od method women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 43.0 40.4 7.0 4.5 7.9 2.7 0.0 18.0 0.1 0.0 2.6 0.8 1.8 0.1 57.0 649 Georgetown (urban) 43.5 40.8 5.5 2.6 9.8 2.7 0.0 20.3 0.0 0.0 2.7 0.8 1.9 0.0 56.5 392 Other (urban) 42.2 39.6 9.3 7.4 5.1 2.7 0.0 14.6 0.3 0.0 2.6 0.8 1.6 0.2 57.8 257 Total Rural 42.3 39.8 4.8 10.5 7.2 5.4 0.3 11.4 0.0 0.3 2.5 0.7 1.3 0.5 57.7 2,271 Total Coastal 44.0 41.4 5.5 9.7 8.1 3.7 0.2 13.9 0.0 0.2 2.6 0.7 1.5 0.4 56.0 2,562 Coastal (urban) 43.0 40.4 7.0 4.5 7.9 2.7 0.0 18.0 0.1 0.0 2.6 0.8 1.8 0.1 57.0 649 Coastal (rural) 44.4 41.8 5.0 11.5 8.2 4.0 0.3 12.5 0.0 0.3 2.6 0.7 1.3 0.5 55.6 1,913 Total Interior 31.4 29.3 3.6 5.0 1.8 12.8 0.1 5.8 0.0 0.1 2.1 0.8 0.8 0.5 68.6 357 Region Region 1 22.2 20.7 2.2 8.0 1.1 5.5 0.3 3.4 0.0 0.3 1.6 0.3 0.9 0.4 77.8 128 Region 2 40.8 38.2 8.6 5.7 9.6 5.6 0.0 8.7 0.0 0.0 2.6 0.7 1.7 0.2 59.2 192 Region 3 49.6 46.3 3.5 13.4 9.9 3.5 0.8 14.8 0.0 0.0 3.3 1.8 0.7 0.9 50.4 424 Region 4 41.1 38.7 4.6 6.8 7.5 2.8 0.2 16.5 0.0 0.3 2.4 0.5 1.7 0.2 58.9 1,121 Region 5 48.4 46.4 5.0 13.8 10.9 5.8 0.0 10.9 0.0 0.0 2.0 0.0 2.0 0.0 51.6 218 Region 6 44.3 41.7 7.0 13.5 7.1 3.7 0.0 9.8 0.2 0.3 2.7 0.5 1.3 0.8 55.7 523 Region 7 34.6 29.8 1.6 2.2 5.2 12.1 0.0 8.7 0.0 0.0 4.8 3.2 1.1 0.5 65.4 65 Region 8 43.8 43.8 6.8 3.1 1.5 26.0 0.0 6.4 0.0 0.0 0.0 0.0 0.0 0.0 56.2 71 Region 9 18.6 15.0 1.6 2.3 0.5 5.6 0.3 4.6 0.0 0.0 3.6 0.6 1.1 1.9 81.4 57 Region 10 50.4 48.2 11.9 6.4 2.3 11.1 0.0 16.4 0.0 0.0 2.2 1.2 1.1 0.0 49.6 121 Education No education 21.9 20.5 1.7 1.2 2.8 4.9 0.0 9.9 0.0 0.0 1.4 0.0 0.0 1.4 78.1 62 Primary 40.4 38.3 7.0 8.3 6.5 4.5 0.3 11.3 0.0 0.3 2.2 0.3 1.5 0.4 59.6 746 Secondary 43.6 41.2 4.9 10.3 7.5 4.9 0.2 13.1 0.0 0.2 2.4 0.8 1.2 0.4 56.4 1,938 More than secondary 46.3 39.9 3.5 2.6 10.8 4.7 0.0 18.3 0.0 0.0 6.4 2.5 3.9 0.0 53.7 173 Number of living children 0 15.9 12.4 0.0 2.6 0.0 0.7 0.0 9.1 0.0 0.0 3.5 1.0 2.4 0.0 84.1 311 1-2 42.1 39.9 1.7 9.6 7.0 4.4 0.0 16.8 0.0 0.3 2.2 0.5 1.2 0.5 57.9 1,260 3-4 50.5 47.6 8.7 11.3 10.5 5.2 0.5 11.0 0.0 0.2 2.9 1.0 1.4 0.5 49.5 935 5+ 45.5 43.6 12.6 7.9 6.6 8.1 0.3 8.0 0.1 0.0 1.9 0.7 0.9 0.3 54.5 414 Wealth quintile Lowest 32.8 31.2 4.9 7.1 2.5 8.3 0.1 8.2 0.0 0.1 1.6 0.6 0.7 0.3 67.2 554 Second 41.2 39.0 5.2 8.7 6.3 7.5 0.4 10.8 0.1 0.0 2.2 0.4 1.4 0.4 58.8 576 Middle 45.0 43.1 5.3 10.8 9.1 3.6 0.2 13.9 0.0 0.3 1.8 0.4 1.0 0.4 55.0 592 Fourth 43.7 40.6 5.6 11.1 7.7 2.7 0.3 12.5 0.1 0.6 3.1 1.1 2.0 0.1 56.3 610 Highest 49.1 45.3 5.4 7.8 10.8 2.1 0.0 18.8 0.0 0.0 3.9 1.2 1.7 1.0 50.9 589 Total 2009 42.5 40.0 5.3 9.2 7.3 4.8 0.2 12.9 0.0 0.2 2.5 0.7 1.4 0.4 57.5 2,920 Total 2005 34.6 33.6 3.0 12.2 7.6 3.8 0.1 6.1 0.0 0.1 1.0 0.7 0.1 0.1 65.4 1,414 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. ”Currently married” includes respondents in consensual union (living together). LAM = Lactational amenorrhea method. Family Planning | 73 5.6 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION Couples use family planning methods to either limit their family size or delay the next birth. The decision to initiate family planning differs according to the circumstances of the couples and the individuals concerned. Couples who use family planning to control family size (i.e., to stop having children) adopt contraception when they have had the number of children they want. When contraception is used to space births, couples may start to use family planning earlier, with the intention of delaying a possible pregnancy. Using contraception for birth spacing may also be done before a couple has had their desired number of children. In the 2009 GDHS, women were asked how many children they had at the time they first used a method of family planning. The number of living children at the time of first use of contraception is both a measure of the willingness to postpone the first birth (i.e., women who have no children) and of the desire of women with children to space subsequent births. Thus, differences in fertility-control behavior among cohorts of women can be observed by examining the parity and number of living children at first use of contraception. Table 5.7 shows the percent distribution of women by number of living children at the time of first use of contraception, according to current age. • Overall, 23 percent of women started using contraception before they had any children. Only 10 percent of women currently age 45-49 adopted contraception before having any children compared with 40 percent of women age 20-24, an indication of a trend towards early adoption of contraception. • A relatively high percentage (18 to 25 percent), of women age 20-49 started using contraception after their first child. 50 19 44 35 44 48 41 50 41 22 43 0 10 20 30 40 50 60 Region 10 Region 9 Region 8 Region 7 Region 6 Region 5 Region 4 Region 3 Region 2 Region 1 Total Percentage of currently married women using contraception Figure 5.1 Contraceptive Use among Currently Married Women, by Region 74 | Family Planning Table 5.7 Number of children at first use of contraception Percent distribution of women age 15-49 by number of living children at the time of first use of contraception, according to current age, Guyana 2009 Number of living children at time of first use of contraception Current age Never used 0 1 2 3 4+ Missing Total Number of women 15-19 73.6 21.4 3.7 0.8 0.3 0.0 0.2 100.0 1,016 20-24 33.6 40.1 18.4 4.7 2.2 0.4 0.8 100.0 767 25-29 24.5 30.9 23.5 13.5 4.2 2.6 0.8 100.0 658 30-34 20.7 23.9 24.5 14.0 9.3 7.5 0.2 100.0 643 35-39 21.0 18.4 23.9 15.1 12.3 9.0 0.4 100.0 699 40-44 26.3 14.4 22.0 15.0 10.3 11.1 0.9 100.0 624 45-49 30.2 9.8 18.4 16.3 13.9 10.7 0.7 100.0 589 Total 35.8 23.2 18.1 10.3 6.8 5.3 0.6 100.0 4,996 5.7 USE OF SOCIAL MARKETING OF BRANDS OF PILLS AND CONDOMS The proportion of clients using socially marketed brands of contraceptives and private commercial sector contraceptives provides information on market segmentation and guidance on preferred brands and sources of contraceptives. This is critical to ensure sustainable supplies of contraceptives for clients, according to their preferences. Information on the use of social marketing of brands is also important for tracking the success of social marketing programs and the private commercial sector. Social marketing has been an important strategy in Guyana. New programs and partners are continually being engaged. The pill and condom are the most commonly used methods of contraception available through social marketing programs. To assess the use of socially marketed brands, pill and condom users in Guyana were asked for the brand name and the cost of their method. Tables 5.8.1 and 5.8.2 present the percentages of pill users and condom users, respectively, by brand names. Table 5.8.1 Brand of pills Percentage of pill users age 15-49 by brand of pills, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Brand of pill Background characteristic Lo-Fomenol Microgymon Nordette Yasmin Other Don't know/ missing Total Number of women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 0.0 35.1 15.0 17.7 16.3 15.9 100.0 41 Total Rural 3.0 26.4 6.9 1.8 23.2 38.8 100.0 255 Total Coastal 2.8 27.1 8.3 4.2 22.6 35.1 100.0 275 Coastal (urban) 0.0 35.1 15.0 17.7 16.3 15.9 100.0 41 Coastal (rural) 3.3 25.7 7.1 1.8 23.7 38.4 100.0 233 Total Interior 0.0 33.1 4.7 1.4 18.2 42.6 100.0 21 Education No education * * * * * * * 1 Primary 0.0 20.9 4.6 1.5 30.1 42.9 100.0 63 Secondary 3.5 28.8 8.5 3.5 21.3 34.4 100.0 220 More than secondary * * * * * * * 12 Wealth quintile Lowest (0.0) (16.2) (0.0) (2.3) (22.8) (58.7) (100.0) 41 Second 3.0 28.8 6.7 0.6 27.8 33.1 100.0 53 Middle 0.0 51.7 6.2 0.0 18.6 23.5 100.0 68 Fourth 5.9 16.8 8.6 4.1 26.2 38.3 100.0 75 Highest 2.8 20.4 16.0 12.6 16.0 32.2 100.0 59 Total 2.6 27.6 8.0 4.0 22.2 35.6 100.0 296 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Family Planning | 75 • More than one-third of pill users (36 percent) were not able to identify the brand name. Twenty-eight percent of users reported using the pill brand Microgymon. • Eight percent of users reported using Nordette and 4 percent reported using Yasmin; in both cases the highest percentages of users were from the Coastal (urban) areas and from the highest wealth quintile. • A large proportion of male condom users (57 percent) did not identify a brand name. The most commonly used condom brand was Rough Rider, reported by 19 percent of all male condom users, the highest percentages being from urban areas (23 percent), among women with higher education (22 percent), and living in the wealthiest households (24 percent). 5.8 SOURCES FOR FAMILY PLANNING METHODS AND INFORMED CHOICE Information on sources of modern contraceptive methods is important to family planning program management. In the 2009 GDHS, all current users of modern contraceptive methods were asked the most recent source of their methods. Interviewers were instructed to record the name of the source or facility, because respondents may not always be able to accurately categorize a source as public or private. Supervisors and editors then verified and coded this information to improve its accuracy. Results are presented in Table 5.9. Table 5.8.2 Brand of condoms Percentages of condom users age 15-49 by brand of condoms, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Brand of condom Background characteristic IDA INNO Rough Rider Other Don't know/ missing Total Number of women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 1.7 3.8 23.2 22.4 49.0 100.0 314 Georgetown (urban) 1.7 4.1 24.8 23.3 46.1 100.0 236 Other (urban) 1.5 2.7 18.5 19.6 57.7 100.0 78 Total Rural 2.3 4.0 15.7 15.2 62.7 100.0 410 Total Coastal 2.1 3.9 19.4 18.1 56.5 100.0 682 Coastal (urban) 1.7 3.8 23.2 22.4 49.0 100.0 314 Coastal (rural) 2.4 4.0 16.2 14.5 62.9 100.0 368 Total Interior 1.7 3.9 11.9 21.9 60.6 100.0 42 Region Region 2 12.5 7.1 19.5 8.2 52.6 100.0 29 Region 3 0.0 2.7 9.5 16.1 71.7 100.0 96 Region 4 1.0 3.8 24.7 19.7 50.9 100.0 414 Region 6 4.3 6.4 11.3 13.8 64.3 100.0 67 Region 10 0.6 2.6 15.9 24.4 56.5 100.0 53 Education No education * * * * * * 8 Primary 3.9 1.5 15.5 11.8 67.2 100.0 105 Secondary 1.4 4.6 19.4 18.2 56.4 100.0 522 More than secondary 2.9 2.8 21.7 28.4 44.2 100.0 89 Wealth quintile Lowest 2.4 2.9 9.2 18.4 67.0 100.0 72 Second 4.2 11.1 8.1 5.0 71.7 100.0 120 Middle 1.6 3.3 12.5 22.2 60.4 100.0 147 Fourth 2.0 3.2 31.5 12.0 51.3 100.0 145 Highest 1.2 1.5 23.7 26.3 47.3 100.0 240 Total 2.0 3.9 19.0 18.3 56.8 100.0 724 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 76 | Family Planning • Almost half (49 percent) of users obtain their contraceptive methods from the public sector. Government health centers (23 percent) are the most common public source, followed by government hospitals (18 percent). In addition, 5 percent of current users obtain their methods from family planning clinics. • The type of source differs by method. Whereas the majority of users of female sterilization (78 percent) and injectables (93 percent) obtain their methods from a public sector source, pill and IUD users are more likely to use private medical sector sources (53 percent, each) than public sector sources (41 and 46 percent, respectively). • One-third (33 percent) of users obtain their methods from the private medical sector, mostly pharmacies (21 percent), followed by private hospitals or clinics (8 percent). • About one in six users (16 percent) obtain their method from other sources, such as a friend or relative (10 percent) or a shop, market, or gas station (6 percent). A friend or a relative is the source for more than one-fifth (21 percent) of male condom users. Table 5.9 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Guyana 2009 Source Female sterilization Pill IUD Injectables Male condom Total Public sector 78.3 41.0 45.5 92.5 35.2 48.6 Government hospital 77.6 5.9 20.9 16.4 7.6 18.2 Government health center 0.7 30.5 13.3 66.3 20.0 23.4 Government health post 0.0 0.7 0.4 4.9 1.2 1.2 Family planning clinic 0.0 3.9 10.2 4.8 4.2 4.6 Public mobile clinic 0.0 0.0 0.7 0.0 0.7 0.4 Community health worker 0.0 0.0 0.0 0.1 0.8 0.5 Other public source 0.0 0.0 0.0 0.0 0.7 0.3 Private medical sector 20.9 53.4 52.8 6.8 27.3 33.1 Private hospital or clinic 20.5 3.0 31.7 1.4 1.2 8.4 Pharmacy 0.0 50.0 0.4 1.4 25.3 20.7 Private doctor 0.4 0.3 20.1 4.0 0.0 3.5 Private mobile clinic 0.0 0.0 0.0 0.0 0.4 0.2 Maternity home 0.0 0.0 0.5 0.0 0.0 0.1 Other private source 0.0 0.0 0.0 0.0 0.4 0.2 Other source 0.0 4.1 0.3 0.5 33.7 16.0 Shop, market or gas station 0.0 3.6 0.0 0.0 10.8 5.5 Church 0.0 0.0 0.0 0.0 0.1 0.1 Friend or relative 0.0 0.5 0.0 0.5 21.1 9.6 NGO 0.0 0.0 0.3 0.0 1.5 0.7 Vending machine 0.0 0.0 0.0 0.0 0.2 0.1 Other 0.0 0.5 0.3 0.1 1.7 1.0 Missing 0.7 1.1 1.0 0.0 2.2 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 184 296 240 164 724 1,619 Note: Users of implants, the female condom, male sterilization, and LAM are included in the total but not listed separately. Family Planning | 77 Informed choice is an important aspect of the delivery of family planning services. Family planning clients have a right to information about their contraceptive method. Providers are required to inform all users of contraceptive methods about (1) the potential side effects of their method, (2) what they should do if they encounter side effects or signs of a problem, and (3) alternate methods of family planning they can use. Current users of modern methods who are well informed about the side effects and problems associated with methods and know of a range of method options are better placed to make an informed choice about the method they would like to use. This information improves the quality of care and compliance by helping users cope with side effects, thereby decreasing unnecessary discontinuation of temporary methods. Current users of selected modern contraceptive methods were asked whether, at the time they adopted the particular method, they were informed about the possible side effects or problems that might be encountered with the method. Table 5.10 shows the percentages of current users of modern methods who were either informed about possible side effects or problems with the method used or informed of other methods they could use; these are broken down by method type and source of the method. • Fifty percent of users of modern contraceptive methods were informed about possible side effects or problems of the method they selected. However, a smaller proportion, 39 percent, was informed about what to do if they experienced side effects or problems. Sixty-two percent of current users were informed of other methods they could use. • Among women who were sterilized in the five years preceding the survey, 85 percent were informed that sterilization is permanent (data not shown separately due to the small number Table 5.10 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the five years preceding the survey, percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods that they could use, by method and source, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of information ––––––––––––––––––––––––––––––––––––––––––– Informed Informed Informed of about side effects what to do other methods Number or problems of if experienced that could of Method and source method used1 side effects1 be used2 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Method Female sterilization 40.7 35.0 56.6 62 Pill 42.5 32.7 56.4 204 IUD 54.6 46.0 57.6 119 Injectables 62.2 43.7 75.7 138 Implants * * * 2 Initial source of method1 Public sector 53.3 39.0 69.1 320 Government hospital 52.5 39.9 64.2 109 Government health center 55.6 38.9 74.3 189 Government health post * * * 6 Family planning clinic * * * 15 Private medical sector 46.7 39.3 53.1 188 Private hospital or clinic 52.3 41.3 65.3 59 Pharmacy 43.0 35.2 45.1 96 Private doctor (49.4) (49.8) (57.1) 31 Maternity home * * * 1 Other private sector * * * 6 Total 50.2 39.0 61.7 525 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table excludes users who obtained the method from friends/relatives. Figures in parentheses are based on 25 to 49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Source at start of current episode of use 78 | Family Planning of cases). Additionally, the small number of sterilized women does not allow for a breakdown by source. • Users of injectables are more likely to be informed about side effects or problems with their method (62 percent) than users of the IUD (55 percent), the pill (43 percent), and female sterilization (41 percent). They are also more likely to be informed of other methods (76 percent) than users of the other methods (56 to 58 percent). • Users whose initial source for their method was the public sector (53 percent) were more likely to have been informed about side effects or problems of the method used than users whose source was the private medical sector (47 percent). They were also more likely to have been informed about other methods that could be used (69 and 53 percent, respectively). 5.9 CONTRACEPTIVE DISCONTINUATION Table 5.11 shows one-year discontinuation rates represent- ing the proportion of users discontinuing a method within 12 months after the start of use. The rates are calculated from information col- lected in the calendar portion of the questionnaire. For each re- spondent, all episodes of contraceptive use between January 2004 and the date of interview are recorded in the calendar. Specifically, the rates presented in Table 5.11 refer to the period 3-59 months prior to the survey⎯the month of interview and the 2 months prior are ignored in order to avoid the bias that may be introduced by unrecognized pregnancies. Table 5.11 shows, by type of method, the percentage of epi- sodes discontinued within 12 months among women age 15-49 who started an episode of contraceptive use in the last five years. • Twenty-eight percent of users of family planning in Guyana discontinue using a contraceptive method within 12 months of starting its use. • Discontinuation rates are higher for injectables (36 percent) and the pill (32 percent) and lower for users of the male condom (29 percent) and the IUD (15 percent). 5.10 INTENTION TO USE FAMILY PLANNING AMONG NON-USERS Intention to use family planning is an important indicator of the potential demand for services. Currently married women who were not using contraceptives at the time of the survey were asked about their intention to use family planning in the future. Table 5.12 shows the percent distribution of currently married women who are not using a contraceptive method by intention to use in the future and according to number of living children, residence, and education. • Thirty-nine percent of currently married women who are not using a contraceptive method intend to use in the future, while almost half (48 percent) do not intend to do so. More than one-tenth of women (12 percent) are unsure about their intention to use or not use in the future. • Intention to use contraception in the future is higher among women with lower parities: 46 percent of women with one child and 43 percent of women with two children intend to use compared with 34 percent among women with 3 children. Intention to use is also higher among women with higher education: 56 percent among women with more than secondary versus 39 percent among women with no education and 32 percent of those with primary education. There is little variation by place of residence. Table 5.11 First-year contraceptive discontinuation rates Among women age 15-49 who started an episode of contraceptive use in the last five years, the percentage of episodes discontinued within 12 months, by type of method, Guyana 2009 Method Total Pill 31.5 IUD 14.5 Injectables 35.5 Male condom 29.2 All methods 28.4 Number of episodes of use 454 Note: Table is based on episodes of contraceptive use that began 3-59 months prior to the survey. Family Planning | 79 • Women with no education (34 percent) are three times more likely to be unsure about their intention to use contraception in the future than women with any education (9 to 12 percent). Furthermore, women in the Rural (13 percent) and in the Interior (22 percent) areas are more likely than other women to be unsure about their intention to use. • The percentage of women who do not intend to use contraception in the future is higher among women with no children (55 percent) and those with 3 or more children (52 to 53 percent) than women with one or two children (41 to 44 percent). Urban women (57 percent) are more likely than rural women (46 percent) to not intend to use in the future. The lowest percentage of non-users who do not intend to use in the future is in the Interior area (40 percent) and the highest is in the Coastal (urban) area (57 percent). There is no clear pattern by education. An understanding of the reasons non-users of contraception have for intending not to use a contraceptive method in the future is crucial to identifying strategies to improve the access, acceptability, and quality of care of family planning services. Table 5.13.1 presents the main reasons for not intending to use contraception reported by currently married women who are not using a contraceptive method and who do not intend to use contraception in the future, according to age and urban-rural residence. Of particular interest to program managers are the preferred methods of non-users who report that they intend to use a family planning method in the future. This information is useful in assessing the potential demand for specific methods of family planning. Non-users who said that they did intend to use family planning in the future were asked which method they preferred to use. Table 5.13.2 shows the results by age and urban-rural residence. Table 5.12 Future use of contraception among non-users Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to selected characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Does not Number Intend intend of Characteristic to use Unsure to use Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 0 30.0 15.0 54.9 0.1 100.0 216 1 45.6 12.3 40.5 1.6 100.0 339 2 43.2 11.4 44.0 1.3 100.0 401 3 33.6 13.2 51.6 1.6 100.0 327 4+ 38.5 8.0 53.4 0.2 100.0 397 Residence Total Urban 37.0 5.1 57.1 0.9 100.0 370 Georgetown (urban) 34.6 5.1 59.7 0.6 100.0 221 Other (urban) 40.5 5.1 53.1 1.3 100.0 148 Total Rural 39.6 13.4 45.9 1.0 100.0 1,309 Total Coastal 39.2 9.9 49.8 1.1 100.0 1,434 Coastal (urban) 37.0 5.1 57.1 0.9 100.0 370 Coastal (rural) 40.0 11.6 47.2 1.2 100.0 1,064 Total Interior 37.8 21.6 40.1 0.5 100.0 245 Education No education 38.5 34.3 27.2 0.0 100.0 48 Primary 32.3 8.9 58.5 0.3 100.0 445 Secondary 40.3 11.9 46.3 1.4 100.0 1,094 More than secondary 56.1 9.3 34.5 0.0 100.0 93 Total 39.0 11.6 48.4 1.0 100.0 1,679 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Includes current pregnancy 80 | Family Planning • Thirty-six percent of currently married women who are not using contraception and who do not intend to use cited method-related reasons—especially health concerns (14 percent) and fear of side effects (12 percent)—as the main reason for not intending to use in the future. Fear of side effects is more common among younger women and urban women. Another method-related reason frequently mentioned (7 percent) was the interference of contra- ception with the body’s normal processes. • For one-third of women (33 percent), fertility-related reasons were the main cause for not intending to use in the future. One in three of these women (10 percent) said that the main reason for non-use was that they wanted as many children as possible, with 21 percent of women 15-29 reporting this reason. • For 10 percent of non-users, the main reason for not intending to use contraception was opposition to use, especially among younger women (14 percent). • Three in ten women (30 percent) said that the pill was the preferred method of future contraception use, but about one in six preferred condoms and injectables (18 percent each) or the IUD (16 percent). Table 5.13.1 Reasons for not intending to use contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not intending to use, according to age and residence, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age Residence –––––––––––––––– ––––––––––––––– Reason 15-29 30-49 Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Fertility-related reasons 22.8 35.4 28.7 34.3 32.8 Infrequent sex/no sex 1.4 9.0 7.6 7.4 7.4 Menopausal/had hysterectomy 0.0 11.4 7.7 9.6 9.1 Subfecund/infecund 0.1 7.5 6.5 5.8 6.0 Wants as many children as possible 21.3 7.5 6.9 11.5 10.3 Opposition to use 14.0 8.6 6.8 10.8 9.7 Respondent opposed 8.7 5.4 4.3 6.7 6.1 Husband/partner opposed 2.7 1.7 1.0 2.3 1.9 Others opposed 0.0 0.1 0.4 0.0 0.1 Religious prohibition 2.6 1.4 1.1 1.8 1.6 Lack of knowledge 1.6 1.3 0.0 1.9 1.5 Knows no method 1.2 0.6 0.0 1.0 0.8 Knows no source 0.4 0.7 0.0 0.9 0.7 Method-related reasons 39.2 35.5 44.9 33.4 36.4 Health concerns 13.1 14.4 16.2 13.4 14.1 Fear of side effects 16.7 10.6 14.7 10.9 11.9 Lack of access/too far 0.1 0.8 0.0 0.9 0.7 Cost too much 0.6 0.9 0.4 1.0 0.9 Inconvenient to use 1.5 2.5 1.0 2.8 2.3 Interfere with body's normal process 7.2 6.3 12.6 4.4 6.5 Other 9.1 10.0 15.1 7.9 9.8 Don't know 13.2 8.8 4.5 11.5 9.7 Missing 0.0 0.2 0.0 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 Number of women 165 647 211 601 812 Family Planning | 81 Table 5.13.2 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to age and residence, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age Residence ––––––––––––––– ––––––––––––––– Preferred method 15-29 30-49 Rural Urban Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Female sterilization 5.9 8.3 7.2 6.9 7.0 Pill 32.4 26.6 32.7 29.0 29.8 IUD 14.2 18.7 12.7 17.2 16.2 Injectables 18.2 16.7 17.1 17.6 17.5 Implants 0.9 0.5 1.3 0.5 0.7 Condom 16.2 20.7 22.0 17.3 18.3 Foam/jelly 0.5 0.3 0.0 0.5 0.4 Periodic abstinence 0.0 0.6 0.0 0.4 0.3 Withdrawal 0.0 0.8 0.7 0.3 0.4 Other 1.4 1.2 0.4 1.6 1.3 Unsure 10.3 5.7 5.9 8.8 8.2 Total 100.0 100.0 100.0 100.0 100.0 Number of women 358 298 137 519 655 5.11 EXPOSURE TO FAMILY PLANNING IN THE MASS MEDIA All respondents in the 2009 GDHS were asked if they had heard or seen a message about family planning on the radio, on television, in newspapers, or in magazines in the few months preceding the survey. The results are presented for women and men by selected background characteristics, in Table 5.14. The purpose of the table is to assess exposure to family planning messages among women and men through various media. • Exposure to family planning messages on the radio in the past few months is similar among women (30 percent) and men (28 percent). Exposure to family planning messages on television and in the print media (newspapers and magazines) is higher for women (51 and 36 percent, respectively) than for men (44 and 29 percent, respectively). • Exposure to family planning messages is similar across all age groups for women but increases with age for men. Women and men in the Interior area are much less likely to have been exposed to family planning messages through the media than other respondents. For example, only 19 and 23 percent of women in the Interior area saw a family planning message on television and in a newspaper or magazine, respectively, compared with 54 and 37 percent, respectively, of women in the Coastal area. • Exposure to family planning messages on the radio is relatively low in Regions 1, 8, and 9 (8 to11 percent for women; 11 to 17 percent for men). Respondents in Regions 1, 8, and 9 also have the lowest level of exposure to family planning messages on television (7 to 16 percent for women; 8 to 12 percent for men). Women in Regions 1 and 9 and men in Regions 1 and 8 have the lowest exposure to such messages through newspapers or magazines (16 and 14 percent, respectively, for women; 17 percent, each, for men). • Exposure to family planning messages increases steadily with education and socioeconomic status, especially for women. For example, only 8 percent of women with no education were exposed to family planning messages on television in the past few months compared with 66 percent of women with more than secondary education. • Exposure to family planning messages also increases with the socioeconomic status of the household but not as sharply as with education. 82 | Family Planning Table 5.14 Exposure to family planning messages Percentages of women and men age 15-49 who heard or saw a family planning message on the radio, on the television, or in a newspaper/magazine in the past few months, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––– Exposed to family planning None Exposed to family planning None messages on or in: of messages on or in: of –––––––––––––––––––––––––– these Number ––––––––––––––––––––––––– these Number Background Tele- Newspaper/ three of Tele- Newspaper/ three of characteristic Radio vision magazine sources women Radio vision magazine sources men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.2 44.5 31.4 45.1 1,016 18.1 34.9 22.4 56.7 689 20-24 30.0 52.4 35.6 37.9 767 23.3 41.7 28.3 50.8 511 25-29 33.1 53.1 38.5 34.6 658 25.5 45.0 25.5 45.7 462 30-34 32.2 52.8 39.3 36.5 643 29.6 46.3 27.5 45.1 521 35-39 29.5 53.9 37.7 38.3 699 29.7 44.9 28.9 44.9 470 40-44 29.6 47.0 33.5 42.8 624 32.8 47.4 34.8 43.0 457 45-49 35.7 52.7 38.1 37.3 589 39.3 55.2 39.5 36.5 413 Residence Total Urban 33.1 56.9 40.5 32.2 1,475 25.5 46.5 27.3 45.0 949 Georgetown (urban) 36.3 57.1 39.6 31.2 967 24.3 41.2 20.1 51.3 619 Other (urban) 27.2 56.6 42.2 34.2 508 27.6 56.4 40.8 33.2 330 Total Rural 28.5 47.8 34.0 42.3 3,521 28.2 43.4 29.5 47.7 2,573 Total Coastal 31.9 54.1 37.3 36.3 4,495 28.8 47.9 29.9 44.1 3,126 Coastal (urban) 33.1 56.9 40.5 32.2 1,475 25.5 46.5 27.3 45.0 949 Coastal (rural) 31.3 52.7 35.8 38.3 3,019 30.2 48.5 31.0 43.7 2,176 Total Interior 11.4 18.8 23.2 66.6 501 17.3 15.6 21.2 69.6 396 Region Region 1 7.7 15.5 16.2 73.8 162 12.2 7.5 17.2 75.8 160 Region 2 20.7 38.6 28.9 50.3 293 25.9 42.2 28.9 49.6 179 Region 3 30.3 55.8 38.7 35.0 687 25.6 48.5 28.9 41.5 420 Region 4 35.9 56.3 39.3 34.1 2,168 30.8 47.2 28.9 46.0 1,540 Region 5 36.3 51.9 35.4 37.3 353 22.2 37.1 22.6 52.9 271 Region 6 24.9 51.2 33.3 40.3 780 29.0 53.0 34.4 38.6 587 Region 7 15.8 27.7 25.8 60.5 104 23.4 30.0 22.6 60.4 61 Region 8 9.7 15.4 30.3 63.2 95 10.5 10.9 17.0 80.3 68 Region 9 11.2 7.2 13.8 78.7 78 16.5 11.6 23.7 68.5 57 Region 10 27.0 54.3 41.6 32.5 277 33.4 53.3 39.5 34.2 178 Education No education 6.6 8.4 3.3 84.5 68 14.1 19.1 4.2 72.7 60 Primary 24.1 39.0 23.4 51.9 952 24.5 37.4 20.4 55.5 711 Secondary 30.6 52.6 37.9 37.2 3,568 28.1 45.4 30.8 45.2 2,459 More than secondary 40.5 65.7 52.9 21.4 409 32.3 55.9 39.0 35.7 292 Wealth quintile Lowest 16.6 16.9 18.1 67.3 779 23.1 20.4 17.2 63.5 663 Second 27.4 43.9 27.3 46.2 957 24.7 41.8 23.6 48.3 679 Middle 31.2 57.5 37.8 35.3 1,025 30.5 51.6 33.7 42.8 723 Fourth 32.7 60.8 42.6 30.1 1,084 29.5 54.5 34.3 40.1 751 Highest 36.9 62.8 47.2 27.1 1,151 28.9 50.5 34.4 41.7 705 Total 29.8 50.5 35.9 39.3 4,996 27.5 44.2 28.9 47.0 3,522 Family Planning | 83 5.12 CONTACT OF NON-USERS WITH FAMILY PLANNING PROVIDERS To determine whether non-users of family planning in Guyana have had an opportunity to receive information about family planning from providers, women who were not using contraception were asked whether they had attended a health facility in the past year for any reason and, if so, whether a staff person at that facility spoke to them about family planning methods. They were also asked whether they had been visited by a fieldworker who discussed family planning. The results are shown in Table 5.15. Table 5.15 Contact of non-users with family planning providers Percentage of women who are not using contraception who were visited by a fieldworker who discussed family planning, who visited a health facility and discussed family planning, and who visited a health facility but did not discuss family planning, in the 12 months preceding the survey, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of Percentage of women Percentage women who who visited a health facility in of women who were visited by the past 12 months and who: did not discuss a fieldworker –––––––––––––––––––––––––– family planning who discussed Discussed Did not with a fieldworker Number Background family family discuss family or at a of characteristic planning planning planning health facility women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 8.6 7.1 22.7 86.7 872 20-24 7.7 20.6 32.6 76.4 487 25-29 7.5 19.9 35.9 78.1 387 30-34 10.8 18.6 31.0 75.2 336 35-39 5.0 12.3 37.0 85.2 398 40-44 8.6 6.3 32.0 88.0 370 45-49 3.3 3.4 30.2 93.7 416 Residence Total Urban 4.6 7.0 32.1 89.7 929 Georgetown (urban) 2.9 7.0 30.2 91.2 598 Other (urban) 7.6 6.9 35.4 87.0 331 Total Rural 8.6 13.8 29.7 81.5 2,337 Total Coastal 6.7 10.3 31.0 85.8 2,912 Coastal (urban) 4.6 7.0 32.1 89.7 929 Coastal (rural) 7.6 11.8 30.5 83.9 1,983 Total Interior 13.8 25.3 24.9 68.0 354 Region Region 1 11.9 27.4 16.1 65.6 129 Region 2 6.9 10.6 33.2 84.5 199 Region 3 6.0 10.8 39.7 85.0 427 Region 4 6.6 10.6 29.7 86.0 1,406 Region 5 9.3 10.3 32.2 83.1 234 Region 6 5.2 8.6 22.5 88.4 522 Region 7 14.8 20.7 25.6 71.6 72 Region 8 23.6 36.2 18.8 56.0 56 Region 9 9.6 19.5 36.8 76.9 64 Region 10 10.4 13.0 45.4 79.0 159 Education No education 15.0 23.8 33.9 67.4 52 Primary 8.2 13.7 29.0 82.2 607 Secondary 7.1 11.4 28.9 84.5 2,364 More than secondary 7.1 8.9 47.0 85.3 243 Wealth quintile Lowest 10.5 19.3 26.9 75.2 555 Second 8.7 15.1 26.4 80.4 639 Middle 6.7 11.5 32.1 84.5 672 Fourth 5.3 8.2 30.9 88.9 712 Highest 6.7 7.2 34.5 88.1 689 Total 7.4 11.9 30.4 83.8 3,266 84 | Family Planning • Only 7 percent of women who were not using contraception were visited by a family planning worker who discussed family planning with them during the 12 months prior to the interview. While 12 percent of women who are not using contraception and who visited a health facility discussed family planning with a health worker, 30 percent did not discuss family planning, thus missing the opportunity. • Overall, 84 percent of women non-users did not discuss family planning with a fieldworker or at a health facility. • Rural women are more likely than urban women to have been visited by a fieldworker who discussed family planning with them (9 percent versus 5 percent) or to have visited a health facility and discussed family planning with a staff member (14 percent versus 7 percent) in the preceding year. Looking at areas, women in the Interior area were more likely to have been visited by a health worker (14 percent) or to have visited a health facility and discussed family planning (25 percent) than those in the Coastal area (7 and 10 percent, respectively). • The highest percentages of non-users who discussed family planning with health providers are in Region 8, where 24 percent of women were visited by a health worker and discussed family planning and 36 percent visited a health facility and discussed family planning. 5.13 HUSBAND/PARTNER'S KNOWLEDGE OF WOMEN'S USE OF CONTRACEPTION The husband or partner’s knowledge about a woman’s use of family planning is an indication of their prior discussion of, interest in, and continued practice of family planning. Inter-spousal/partner communication is an important intermediate step along the path to adopting a contraceptive method, as well as continuing to use that method or other contraceptive methods in the future. Lack of knowledge or discussion of family planning may relate to a number of factors, including lack of interest in family planning, hostility to the subject of family planning, or customary reticence to talk about sex-related matters. To assess the extent to which women use contraception without informing their husbands or partners, the 2009 GDHS asked married women whether their husbands or partners know they are using a method of family planning. Since the husband/partner’s knowledge of women's use of contraception is universal in Guyana, the results are not shown in a separate table. • Ninety-six percent of currently married women age 15-49 who are using a method report that their husbands or partners know about their use of family planning. • The highest level of husband/partner’s knowledge about women’s contraceptive use is observed in the Georgetown (urban) area (99 percent). Among regions, the lowest level of a husband/partner’s knowledge is observed in Region 9 (80 percent; the number of cases is relatively small) and in Region 1 (88 percent). Other Proximate Determinants of Fertility | 85 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6 This chapter addresses the principal factors, other than contraception, which affect a woman's risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhea and abstinence from sexual relations, and infecundity. Although by no means exact, marriage is one indicator of exposure of women to the risk of pregnancy, and it is therefore important for the understanding of fertility. Populations in which age at marriage is low also tend to experience early childbearing and high fertility; hence, there is motivation to examine trends in age at marriage. This chapter includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhea and postpartum absti- nence and the level of infecundity. 6.1 CURRENT MARITAL STATUS Tables 6.1 and 6.2 show the percent distribution of women and men interviewed in the 2009 GDHS by current marital status, according to age (Table 6.1) and background characteristics (Table 6.2). In this report, the term “married” refers to legal or formal marriage, and “living together” refers to an informal union in which a man and a woman live together, even if a formal civil or religious ceremony has not occurred. In later tables that do not list “living together” as a separate category, these women and men are included in the “currently married” group. Respondents who are currently married, widowed, divorced, or separated are referred to as “ever-married.” • About three-tenths of women age 15-49 (31 percent) have never married, about one-third (34 percent) are formally married, one in four (25 percent) are living together, and about one in ten (11 percent) are divorced, separated, or widowed. • Marriage occurs relatively early in Guyana: one in every four women age 20-24 (24 percent) are currently married, and 28 percent are living with a man as if married. Only 9 percent of women age 40 and above have never married. The proportion of women who are separated or divorced generally increases with age and is highest among women age 40-49 (18 percent). • A greater proportion of men (39 percent) than women (31 percent) have never married. About three-tenths of men (31 percent) are currently married, 22 percent are living together, and 9 percent are divorced, separated, or widowed. • Men tend to marry at older ages than women. Although about one-fourth of women age 20-24 (24 percent) are formally married, only 11 percent of men in the same age group are formally married. Only 1 percent of men age 15-19 are married or cohabiting with a woman compared with 16 percent of women. 86 | Other Proximate Determinants of Fertility • There are significant differences in the marital status of respondents by residence. For both women and men, urban residents are much less likely to be currently in a union—married or living together—(44 percent of women and 41 percent of men) than rural residents (65 and 56 percent, respectively). Respondents in the Interior area (71 percent of women and 59 percent of men) are much more likely to be currently in union than those in the Coastal area (57 percent of women and 51 percent of men). The percentage of respondents currently in union decreases steadily with the level of education, especially for women. Ninety-two percent of women and 70 percent of men with no education are currently married or cohabiting with a partner compared with 42 percent of women and 46 percent of men with more than secondary education. Table 6.1 Current marital status by age and sex Percent distribution of women and men age 15-49 by current marital status, according to age, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Marital status Percentage of ––––––––––––––––––––––––––––––––––––––––––––––––––––– respondents Number Never Living currently of Age married Married together Divorced Separated Widowed Total in union1 respondents ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 81.4 4.7 11.5 0.0 2.3 0.0 100.0 16.3 1,016 20-24 42.7 23.9 28.0 0.1 5.2 0.1 100.0 51.9 767 25-29 20.7 34.9 34.6 0.8 8.9 0.1 100.0 69.6 658 30-34 10.9 43.5 33.0 1.5 10.4 0.6 100.0 76.5 643 35-39 9.9 46.9 27.1 2.9 10.8 2.4 100.0 74.0 699 40-44 8.7 49.4 24.3 2.3 12.3 3.0 100.0 73.8 624 45-49 9.4 52.4 20.3 3.2 7.5 7.1 100.0 72.7 589 Total 2009 30.8 33.8 24.7 1.4 7.7 1.6 100.0 58.4 4,996 Total 2005 31.1 39.4 18.9 1.3 7.2 2.1 100.0 58.3 2,425 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 98.5 0.2 1.0 0.0 0.3 0.0 100.0 1.2 689 20-24 67.9 10.7 17.4 0.0 4.0 0.0 100.0 28.0 511 25-29 35.1 29.3 29.0 0.6 6.1 0.0 100.0 58.3 462 30-34 13.7 37.3 32.9 1.7 14.4 0.0 100.0 70.2 521 35-39 11.4 48.0 27.3 1.6 11.6 0.1 100.0 75.3 470 40-44 8.8 51.0 26.1 0.7 12.1 1.4 100.0 77.1 457 45-49 7.1 56.7 26.4 2.8 5.2 1.9 100.0 83.0 413 Total 2009 39.2 30.6 21.5 1.0 7.3 0.4 100.0 52.1 3,522 Total 2005 41.6 34.2 17.4 0.5 6.0 0.4 100.0 51.6 1,875 Other Proximate Determinants of Fertility | 87 6.2 AGE AT FIRST UNION Marriage marks the point in a woman’s life when childbearing becomes socially acceptable in Guyana. Marriage is closely associated with fertility because women who marry early will, on average, have more births than women who marry later. Early age at first marriage is an important fertility indicator not only because it increases the length of time a woman is exposed to the risk of pregnancy, but it also tends to lead to early childbearing and higher fertility. Information on age at first marriage was obtained by asking respondents the month and year, or age, at which they started living with their first husband/partner. Older respondents are less likely to recall with accuracy marriage dates and ages; therefore, the data for older respondents should be interpreted with caution. Table 6.2 Current marital status by background characteristics Percent distribution of women and men by current marital status, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Marital status Percentage of –––––––––––––––––––––––––––––––––––––––––––––––––––– respondents Number Background Never Living currently of characteristic married Married together Divorced Separated Widowed Total in union1 respondents ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 41.5 27.5 16.5 2.6 10.6 1.4 100.0 44.0 1,475 Georgetown (urban) 42.6 23.9 16.6 3.1 12.4 1.4 100.0 40.5 967 Other (urban) 39.3 34.2 16.4 1.5 7.1 1.6 100.0 50.6 508 Total Rural 26.4 36.4 28.1 0.9 6.5 1.7 100.0 64.5 3,521 Total Coastal 31.9 33.7 23.3 1.5 7.9 1.7 100.0 57.0 4,495 Coastal (urban) 41.5 27.5 16.5 2.6 10.6 1.4 100.0 44.0 1,475 Coastal (rural) 27.2 36.7 26.7 1.0 6.6 1.8 100.0 63.4 3,019 Total Interior 21.5 34.6 36.7 0.4 5.8 1.1 100.0 71.3 501 Education No education 4.9 38.0 53.6 0.0 3.6 0.0 100.0 91.5 68 Primary 10.9 42.3 36.1 0.6 6.8 3.3 100.0 78.4 952 Secondary 34.9 31.8 22.5 1.5 8.0 1.3 100.0 54.3 3,568 More than secondary 45.7 30.1 12.2 2.7 7.9 1.4 100.0 42.4 409 Total 30.8 33.8 24.7 1.4 7.7 1.6 100.0 58.4 4,996 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 51.1 23.8 16.9 1.1 6.6 0.5 100.0 40.7 949 Georgetown (urban) 53.1 21.3 16.1 1.1 7.6 0.8 100.0 37.4 619 Other (urban) 47.4 28.6 18.4 1.1 4.6 0.0 100.0 46.9 330 Total Rural 34.9 33.1 23.2 0.9 7.6 0.4 100.0 56.3 2,573 Total Coastal 40.2 31.1 20.1 1.0 7.1 0.4 100.0 51.3 3,126 Coastal (urban) 51.1 23.8 16.9 1.1 6.6 0.5 100.0 40.7 949 Coastal (rural) 35.4 34.3 21.5 1.0 7.4 0.3 100.0 55.9 2,176 Total Interior 31.8 26.5 32.1 0.4 8.7 0.5 100.0 58.7 396 Education No education 25.0 29.3 40.6 0.0 3.8 1.3 100.0 69.9 60 Primary 19.6 39.1 29.4 0.9 9.8 1.2 100.0 68.5 711 Secondary 43.9 27.8 19.9 1.0 7.3 0.2 100.0 47.6 2,459 More than secondary 50.4 34.2 11.9 1.1 2.3 0.1 100.0 46.0 292 Total 39.2 30.6 21.5 1.0 7.3 0.4 100.0 52.1 3,522 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Currently in union includes currently married and living together. 88 | Other Proximate Determinants of Fertility Table 6.3 shows the percentage of women and men who were first married by specific exact ages, and by the median age at first marriage, according to current age. In drawing conclusions concerning trends, the data for the oldest cohorts should be interpreted cautiously because respondents may not recall marriage dates or ages with accuracy, particularly where informal unions are common.1 Table 6.3 presents the median age at first union, which is defined as the age by which half of the cohort of women or men has married. The median is preferred over the mean as a measure of central tendency, because, unlike the mean, it can be estimated for all cohorts where at least half of the respondents are ever married at the time of survey. 1 Another, often more reliable, way of estimating trends is by comparison of percentages for ever-married five-year age groups with similar data from earlier censuses and surveys. The singulate mean age at marriage (SMAM) can also be calculated from various sources and compared over time. However, possible definitional inconsistencies between data sets should be considered when making such comparisons. Table 6.3 Age at first union Percentage of women and men who were first in union, by specified exact ages, and median age at first union, according to current age, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of respondents who were Median first in union by exact age: Percentage Number age ––––––––––––––––––––––––––––––––––––––––––––– never of at first Current age 15 18 20 22 25 in union respondents union1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 4.6 na na na na 81.4 1,016 a 20-24 5.5 23.0 41.8 na na 42.7 767 a 25-29 5.9 25.2 42.5 55.0 71.3 20.7 658 21.1 30-34 7.3 30.8 50.1 63.1 75.5 10.9 643 20.0 35-39 5.3 24.1 37.8 52.3 67.1 9.9 699 21.6 40-44 5.7 25.1 46.6 60.3 71.9 8.7 624 20.4 45-49 5.0 26.9 45.8 58.1 70.9 9.4 589 20.6 2009 20-49 5.8 25.7 43.9 na na 17.9 3,980 a 25-49 5.8 26.4 44.4 57.6 71.3 12.0 3,213 20.7 2005 20-49 5.3 27.2 45.9 na na 18.6 1,969 20.6 25-49 5.0 26.9 46.1 59.9 70.4 13.1 1,583 20.5 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 0.2 na na na na 98.5 689 a 20-24 1.3 5.1 13.3 na na 67.9 511 a 25-29 0.3 5.2 15.8 26.2 49.3 35.1 462 a 30-34 1.2 8.0 18.4 31.1 53.2 13.7 521 24.5 35-39 1.9 7.3 20.7 32.2 49.1 11.4 470 25.1 40-44 1.8 7.1 16.4 30.7 52.0 8.8 457 24.7 45-49 1.4 6.0 14.9 31.4 51.6 7.1 413 24.8 2009 20-49 1.3 6.5 16.6 na na 24.8 2,833 a 25-49 1.3 6.8 17.3 30.3 51.1 15.3 2,322 24.8 2005 20-49 0.8 6.3 15.4 na na 26.7 1,484 25.4 25-49 0.9 6.5 16.2 31.5 52.5 16.5 1,217 24.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The age at first union is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable a = Omitted because less than 50 percent of the respondents were in union for the first time before reaching the beginning of the age group. 1 The median is the midpoint of the distribution of respondents by exact age at first union. Other Proximate Determinants of Fertility | 89 Table 6.4 shows the median age at first marriage among women and men age 25-49, by current age and background characteristics. Table 6.4 Median age at first union by background characteristics Median age at first union among women and men 25-49 by current age and background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Background –––––––––––––––––––––––––––––––––––––––––––– age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 24.8 21.6 24.7 23.4 23.8 23.6 Georgetown (urban) a 20.9 25.8 23.7 24.8 24.1 Other (urban) 23.1 23.0 23.6 23.1 20.9 22.9 Total Rural 20.1 19.4 20.5 19.6 19.6 19.9 Total Coastal 21.5 20.1 21.9 20.6 20.8 20.9 Coastal (urban) 24.8 21.6 24.7 23.4 23.8 23.6 Coastal (rural) 20.3 19.5 20.7 19.7 19.6 20.0 Total Interior 19.4 18.7 18.1 19.0 19.6 19.0 Region Region 1 (18.7) (18.3) (16.8) (18.6) (20.3) 18.4 Region 2 19.7 18.7 19.7 18.8 19.7 19.4 Region 3 20.8 20.3 20.6 19.8 18.9 20.2 Region 4 23.0 20.5 22.7 21.3 22.3 22.1 Region 5 (20.3) 19.4 22.2 19.3 (21.5) 20.6 Region 6 18.6 19.1 20.3 20.2 19.5 19.6 Region 7 (20.6) (20.0) (19.4) (19.7) (18.8) 19.8 Region 8 (19.5) (17.5) (18.1) (19.5) (17.8) 19.0 Region 9 19.2 (19.0) (18.2) (18.5) (19.8) 19.0 Region 10 22.5 23.1 23.1 23.3 (22.8) 22.9 Education No education * * * * * 17.3 Primary 18.1 18.0 20.0 18.9 19.8 19.1 Secondary 21.4 20.1 22.1 21.0 20.6 21.0 More than secondary a 25.8 23.7 24.4 28.2 a Wealth quintile Lowest 18.3 18.2 19.6 18.9 20.2 18.9 Second 20.5 19.1 20.0 19.3 20.1 19.7 Middle 20.7 20.1 20.9 19.9 19.8 20.3 Fourth 21.9 20.9 21.9 21.7 21.0 21.6 Highest 24.3 21.3 23.4 22.3 21.6 22.7 Total 2009 21.1 20.0 21.6 20.4 20.6 20.7 Total 2005 20.0 20.1 20.3 21.2 20.9 20.5 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Rural 24.4 24.3 24.2 24.5 24.7 24.4 Total Coastal a 24.3 25.3 24.6 24.7 24.9 Coastal (urban) a 25.3 27.6 26.0 25.1 a Coastal (rural) 24.7 24.1 24.3 24.4 24.6 24.4 Total Interior 22.6 25.4 23.4 26.0 24.9 24.4 Education No education * * * * a 22.5 Primary 24.3 23.7 25.0 23.6 23.9 24.0 Secondary 24.9 24.7 25.1 26.0 24.6 25.0 More than secondary a (26.3) (28.8) (24.2) (29.7) a Wealth quintile Lowest 23.4 25.0 24.2 26.3 26.1 24.7 Second a 23.5 25.8 24.2 24.2 24.6 Middle 24.3 25.6 23.8 22.8 23.6 23.9 Fourth 24.6 24.0 25.1 24.6 24.8 24.6 Highest a 25.2 26.4 25.6 24.7 a Total 2009 a 24.5 25.1 24.7 24.8 24.8 Total 2005 a 24.1 24.9 24.6 24.0 na –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The age at first union is defined as the age at which the respondent began living with her/his first spouse/partner. 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. na = Not applicable a = Omitted because less than 50 percent of the respondents were in union for the first time before reaching the beginning of the age group 1 Some results for men are not presented due to the small number of cases. 90 | Other Proximate Determinants of Fertility • The median age at marriage among women age 25-49 is 20.7 years. By age 20, 44 percent of women age 25-49 were married, and by age 25, this percentage increases to 71 percent. • Data show that men tend to marry at a later age than women. The median age at marriage among men age 25-49 is 24.8 years, four years later than women. About half of men age 25-49 (51 percent) are married by age 25 compared with seven in ten women (71 percent). • Rural women marry almost four years earlier than urban women (19.9 and 23.6 years, respectively). Differences in the median age at first union by residence among men are minor. • Education has a marked impact on the age at marriage for women. Women age 25-49 with no education marry almost four years earlier than women with secondary education (17.3 and 21.0 years, respectively). Among men, those with no education have a median age at first union of 22.5 years compared with 25.0 years for men with secondary education. • Similarly, women in the highest wealth quintile tend to marry almost four years later than women in the lowest wealth quintile (22.7 and 18.9 years, respectively); for men, there are no differences by quintiles. 6.3 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is sometimes seen as a proxy for a woman’s first exposure to intercourse, but the two events need not occur at the same time. Because women and men may engage in sexual relations prior to marriage, age at first sexual intercourse is a more reliable indicator of a woman’s exposure to the risk of pregnancy than the age at first marriage. In the 2009 GDHS, women and men were asked how old they were when they first had sexual intercourse. Tables 6.5.1 and 6.5.2 show the median age at first sexual intercourse, by specific exact ages for women and men, respectively. Furthermore, Tables 6.6.1 and 6.6.2 show the median age at first sexual intercourse, by background characteristics, for women and men, respectively. Figure 6.1 shows median age at first sexual intercourse by region. • The median age at first sexual intercourse is 18.5 years for women and 17.8 years for men. • Among young adults, age 15-19, about six in ten (62 percent of women and 59 percent of men) have never had intercourse. • Eight percent of women age 20-49 had sex before age 15, while almost half (43 percent) had first sexual intercourse by their 18th birthday. Although there is no clear trend by age cohorts, younger women are generally more likely to have their first sexual encounter at an earlier age than older women. • Twice as many men as women age 20-49 (16 percent versus 8 percent) had sexual inter- course before age 15. Additionally, a higher percentage of men (52 percent) than women (43 percent) had sexual intercourse before age 18. As with women, younger men are generally more likely to have their first sexual encounter at an earlier age than older men. • There are no major variations in the median age at first sexual intercourse by urban-rural residence. Women and men in the Interior area (16.9 and 16.5 years, respectively) start sexual activity earlier than women and men in the Coastal area (18.6 and 18.0 years, respectively). With regard to education, women with more than secondary education begin sexual activity three and a half years later than those with no education (19.3 and 15.7 years, respectively). Poor women initiate sexual activity about two years earlier than those who live in the wealthiest households (17.1 and 19 years, respectively). • There are no major differences in the median age at first sexual intercourse among men by education and wealth. Other Proximate Determinants of Fertility | 91 Table 6.5.2 Age at first sexual intercourse: Men Percentage of men who had first sexual intercourse, by specified exact ages and median age at first intercourse, according to current age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who had first Percentage Median sexual intercourse by exact age: who never Number age at ––––––––––––––––––––––––––––––––––––––––––––– had of first Current age 15 18 20 22 25 intercourse men intercourse1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-24 18.9 a a a a 38.6 1,200 a 15-19 15.7 a a a a 58.9 689 a 20-24 23.2 62.6 80.7 a a 11.2 511 17.1 25-29 17.6 49.5 73.1 82.7 90.2 4.7 462 18.0 30-34 14.5 53.6 72.9 84.3 91.3 2.3 521 17.7 35-39 17.1 52.1 75.6 81.2 86.8 1.7 470 17.8 40-44 12.4 50.4 72.9 82.9 88.5 1.4 457 18.0 45-49 13.0 43.2 64.1 78.6 87.0 2.1 413 18.5 2009 20-49 16.4 52.3 73.5 na na 4.0 2,833 17.8 25-49 15.0 50.0 71.9 82.1 88.8 2.4 2,322 18.0 2005 20-49 14.7 50.6 70.9 na na 5.5 1,484 18.0 25-49 14.5 50.3 70.1 81.3 89.3 3.5 1,217 18.0 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a = Omitted because less than 50 percent of the men had intercourse for the first time before reaching the beginning of the age group 1 The median is the midpoint of the distribution of respondents by exact age at first union. Table 6.5.1 Age at first sexual intercourse: Women Percentage of women who had first sexual intercourse, by specified exact ages and median age at first intercourse, according to current age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who had first Percentage Median sexual intercourse by exact age: who never Number age at ––––––––––––––––––––––––––––––––––––––––––––– had of first Current age 15 18 20 22 25 intercourse women intercourse1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-24 10.1 a a a a 41.0 1,783 a 15-19 10.3 a a a a 61.6 1,016 a 20-24 9.8 46.1 72.3 a a 13.6 767 18.3 25-29 8.6 44.2 72.5 82.7 90.2 2.6 658 18.3 30-34 7.7 47.2 71.9 82.6 88.7 1.5 643 18.2 35-39 6.6 39.6 67.2 79.0 86.7 0.9 699 18.8 40-44 7.3 40.5 67.4 78.6 86.5 1.6 624 18.6 45-49 7.8 40.7 64.6 77.1 85.3 1.2 589 18.8 2009 20-49 8.0 43.1 69.4 na na 3.9 3,980 18.5 25-49 7.6 42.4 68.8 80.1 87.5 1.6 3,213 18.5 2005 20-49 8.9 43.5 67.6 na na 5.4 1,969 18.4 25-49 8.6 43.5 67.9 79.8 87.3 2.3 1,583 18.4 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching the beginning of the age group 1 The median is the midpoint of the distribution of respondents by exact age at first union. 92 | Other Proximate Determinants of Fertility Table 6.6.1 Median age at first sexual intercourse, by background characteristics: Women Median age at first sexual intercourse among women 20-49, by current age and background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Background ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 18.4 18.4 18.4 18.9 19.0 19.2 18.7 Georgetown (urban) 18.5 18.4 18.1 18.7 18.9 19.1 18.6 Other (urban) 18.3 18.5 18.8 19.6 19.2 19.2 18.8 Total Rural 18.2 18.3 18.1 18.8 18.4 18.6 18.4 Total Coastal 18.4 18.4 18.3 19.0 18.8 18.9 18.6 Coastal urban 18.4 18.4 18.4 18.9 19.0 19.2 18.7 Coastal rural 18.4 18.4 18.3 19.1 18.6 18.8 18.6 Total Interior 16.9 17.0 17.0 16.3 17.0 17.5 16.9 Education No education * * * * * * 15.7 Primary 16.9 17.7 17.7 18.7 18.2 18.1 17.9 Secondary 18.5 18.3 18.2 18.7 18.7 19.0 18.5 More than secondary 18.6 19.2 19.4 (19.5) (20.4) (19.8) 19.3 Wealth quintile Lowest 16.8 17.4 16.9 17.0 17.0 18.5 17.1 Second 17.7 17.8 17.5 18.5 18.2 18.1 18.0 Middle 18.7 18.1 18.3 18.7 18.7 18.7 18.5 Fourth 18.4 18.5 19.0 19.3 19.3 19.2 18.9 Highest 19.2 18.9 18.5 19.4 18.9 19.0 19.0 Total 2009 18.3 18.3 18.2 18.8 18.6 18.8 18.5 Total 2005 18.4 17.9 18.5 18.5 18.7 18.6 18.4 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figure 6.1 Median Age at First Sexual Intercourse by Region 18.2 17.5 17.4 17.3 18.7 18.7 18.5 19.1 18.3 16.5 18.5 17.5 16.7 16.4 17.1 18.7 18 17.6 18.4 18.4 15.9 17.8 0 2 4 6 8 10 12 14 16 18 20 22 Region 10 Region 9 Region 8 Region 7 Region 6 Region 5 Region 4 Region 3 Region 2 Region 1 Total Median age in years Men Women Other Proximate Determinants of Fertility | 93 6.4 RECENT SEXUAL ACTIVITY In the absence of contraception, the risk of pregnancy is related to the frequency of intercourse. Information on sexual activity, therefore, can be used to refine measures of exposure to pregnancy. Women and men were asked how long ago their last sexual activity occurred to assess whether they had sexual intercourse in the past four weeks. The results are shown in Tables 6.7.1 and 6.7.2 for women and men, respectively. Table 6.6.2 Median age at first sexual intercourse, by background characteristics: Men Median age at first sexual intercourse among men 20-49, by current age and background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Men Background ––––––––––––––––––––––––––––––––––––––––––––––––––––– age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 16.9 17.5 17.5 17.6 18.1 17.8 17.5 Georgetown (urban) 16.7 17.4 (17.5) (17.4) 18.1 (17.0) 17.3 Other (urban) 18.0 18.4 17.2 17.9 18.1 18.9 18.1 Total Rural 17.2 18.3 17.8 18.0 17.9 18.8 18.0 Total Coastal 17.3 18.3 17.8 18.0 18.1 18.6 18.0 Coastal (urban) 16.9 17.5 17.5 17.6 18.1 17.8 17.5 Coastal (rural) 17.5 18.9 17.9 18.2 18.0 18.9 18.2 Total Interior 15.5 15.7 17.1 16.3 16.8 17.7 16.5 Education No education * * * * * a 18.5 Primary 17.2 17.7 17.7 18.1 17.9 18.9 18.0 Secondary 17.0 18.1 17.8 17.6 18.0 18.2 17.8 More than secondary 17.3 (19.1) (18.0) (18.0) (17.3) (18.3) 17.8 Wealth quintile Lowest 15.7 17.4 17.3 16.4 17.9 18.0 17.2 Second 16.9 17.4 17.8 17.8 18.9 18.4 17.8 Middle 17.3 18.7 17.8 18.3 18.1 19.0 18.2 Fourth 17.9 18.4 17.7 18.5 17.7 18.9 18.2 Highest 17.1 17.7 18.1 17.7 17.5 18.4 17.7 Total 2009 17.1 18.0 17.7 17.8 18.0 18.5 17.8 Total 2005 17.8 18.3 17.9 17.4 18.2 17.9 18.0 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. a = Omitted because less than 50 percent of the men had intercourse for the first time before reaching the beginning of the age group 94 | Other Proximate Determinants of Fertility Table 6.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Time since last sexual intercourse –––––––––––––––––––––––––––––––––––––– Never Within One or had Number Background the past Within more sexual of characteristic 4 weeks 1 year1 years ago Missing intercourse Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 20.2 13.0 4.6 0.6 61.6 100.0 1,016 20-24 55.3 23.2 6.5 1.5 13.6 100.0 767 25-29 67.5 19.0 6.6 4.3 2.6 100.0 658 30-34 68.5 16.5 10.9 2.6 1.5 100.0 643 35-39 64.1 16.3 12.3 6.3 0.9 100.0 699 40-44 62.7 17.5 14.2 3.9 1.6 100.0 624 45-49 56.6 17.9 19.2 5.1 1.2 100.0 589 Marital status Never married 16.6 17.5 12.9 2.4 50.6 100.0 1,540 Married 78.0 15.3 3.2 3.4 0.1 100.0 2,920 Formerly married 28.4 28.7 38.7 4.3 0.0 100.0 536 Marital duration2 Married only once 78.2 14.8 3.2 3.7 0.1 100.0 2,363 0-4 years 75.7 18.5 2.3 3.3 0.3 100.0 588 5-9 years 81.6 12.9 1.4 4.2 0.0 100.0 450 10-14 years 84.3 9.1 3.8 2.8 0.0 100.0 424 15-19 years 75.9 15.7 5.1 3.4 0.0 100.0 357 20-24 years 78.2 15.2 2.8 3.9 0.0 100.0 263 25+ years 72.1 17.4 5.1 5.4 0.0 100.0 281 Married more than once 77.2 17.3 3.2 2.3 0.0 100.0 555 Residence Total Urban 48.2 19.2 12.3 3.4 17.0 100.0 1,475 Georgetown (urban) 49.1 19.7 12.7 2.3 16.2 100.0 967 Other (urban) 46.4 18.2 11.5 5.5 18.3 100.0 508 Total Rural 56.1 16.7 9.0 3.1 15.1 100.0 3,521 Total Coastal 53.1 16.8 10.5 3.2 16.4 100.0 4,495 Coastal (urban) 48.2 19.2 12.3 3.4 17.0 100.0 1,475 Coastal (rural) 55.4 15.7 9.6 3.1 16.2 100.0 3,019 Total Interior 60.3 22.4 5.5 3.3 8.5 100.0 501 Region Region 1 65.2 22.7 3.4 2.1 6.5 100.0 162 Region 2 56.1 16.0 7.6 3.0 17.4 100.0 293 Region 3 54.3 15.9 8.9 2.6 18.3 100.0 687 Region 4 52.4 18.3 10.9 3.2 15.1 100.0 2,168 Region 5 51.9 16.6 13.5 0.8 17.2 100.0 353 Region 6 56.8 11.7 10.1 3.4 18.0 100.0 780 Region 7 53.9 25.4 6.1 2.1 12.6 100.0 104 Region 8 64.0 20.2 5.5 4.5 5.9 100.0 95 Region 9 57.0 19.2 6.6 7.5 9.7 100.0 78 Region 10 43.8 25.0 11.0 6.4 13.8 100.0 277 Education No education 73.4 20.4 0.0 3.6 2.7 100.0 68 Primary 65.4 17.2 8.5 2.7 6.2 100.0 952 Secondary 50.9 17.0 10.1 3.2 18.9 100.0 3,568 More than secondary 49.2 21.2 14.1 4.0 11.6 100.0 409 Wealth quintile Lowest 58.0 21.5 6.7 3.1 10.7 100.0 779 Second 55.8 17.0 8.8 3.1 15.3 100.0 957 Middle 51.4 17.3 11.9 2.9 16.5 100.0 1,025 Fourth 51.9 16.3 11.2 2.9 17.6 100.0 1,084 Highest 53.1 16.0 10.3 3.9 16.6 100.0 1,151 Total 2009 53.8 17.4 10.0 3.2 15.6 100.0 4,996 Total 2005 56.1 16.0 10.2 1.5 16.3 100.0 2,425 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Married includes women in consensual union (living together). Formerly married includes divorced, separated, or widowed. 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married Other Proximate Determinants of Fertility | 95 Table 6.7.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Time since last sexual intercourse –––––––––––––––––––––––––––– Never Within One or had Number Background the last Within more sexual of characteristic 4 weeks 1 year1 years ago Missing intercourse Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 15.6 15.7 8.7 1.2 58.9 100.0 689 20-24 58.0 23.4 6.6 0.7 11.2 100.0 511 25-29 71.0 16.0 6.1 2.1 4.7 100.0 462 30-34 77.7 12.1 5.4 2.5 2.3 100.0 521 35-39 79.3 11.2 6.4 1.5 1.7 100.0 470 40-44 79.5 11.4 4.8 3.0 1.4 100.0 457 45-49 79.9 11.4 5.8 0.8 2.1 100.0 413 Marital status Never married 28.2 21.9 11.3 1.0 37.5 100.0 1,382 Married 90.5 6.5 0.7 2.2 0.1 100.0 1,835 Formerly married 49.2 30.7 18.7 1.4 0.0 100.0 305 Marital duration2 Married only once 90.0 7.0 0.7 2.2 0.1 100.0 1,479 0-4 years 85.1 11.0 1.3 2.3 0.3 100.0 385 5-9 years 92.8 5.0 0.4 1.8 0.0 100.0 305 10-14 years 95.7 3.1 0.0 1.2 0.0 100.0 256 15-19 years 88.1 7.5 1.7 2.7 0.0 100.0 258 20-24 years 91.0 6.1 0.0 3.0 0.0 100.0 177 25+ years 88.7 7.8 0.0 3.4 0.0 100.0 98 Married more than once 92.8 4.7 0.4 2.0 0.0 100.0 354 Residence Total Urban 59.0 18.3 5.5 2.3 14.8 100.0 949 Georgetown (urban) 59.5 19.2 4.9 2.7 13.8 100.0 619 Other (urban) 58.1 16.8 6.8 1.5 16.8 100.0 330 Total Rural 63.8 13.3 6.7 1.4 14.7 100.0 2,573 Total Coastal 61.4 15.0 6.5 1.7 15.4 100.0 3,126 Coastal (urban) 59.0 18.3 5.5 2.3 14.8 100.0 949 Coastal (rural) 62.4 13.6 7.0 1.4 15.7 100.0 2,176 Total Interior 71.4 11.9 5.4 1.6 9.6 100.0 396 Region Region 1 78.2 8.5 4.0 0.3 9.0 100.0 160 Region 2 64.6 12.4 5.6 1.0 16.5 100.0 179 Region 3 65.1 11.6 5.5 0.4 17.3 100.0 420 Region 4 59.5 17.5 6.7 2.4 14.0 100.0 1,540 Region 5 56.1 12.9 10.3 1.9 18.8 100.0 271 Region 6 67.0 10.7 5.6 0.7 16.1 100.0 587 Region 7 72.1 10.6 6.4 1.5 9.5 100.0 61 Region 8 68.3 14.9 2.3 3.5 10.9 100.0 68 Region 9 63.4 15.4 6.5 4.3 10.5 100.0 57 Region 10 55.6 22.4 7.6 1.5 12.8 100.0 178 Education No education 69.8 5.7 5.6 0.0 18.9 100.0 60 Primary 73.7 12.4 5.3 1.3 7.3 100.0 711 Secondary 59.0 15.0 6.9 1.5 17.6 100.0 2,459 More than secondary 63.4 19.6 5.0 4.5 7.6 100.0 292 Wealth quintile Lowest 64.0 15.1 8.5 1.5 11.0 100.0 663 Second 59.2 15.9 8.2 1.1 15.6 100.0 679 Middle 60.1 14.4 7.4 1.1 17.0 100.0 723 Fourth 64.3 12.5 4.5 2.6 16.1 100.0 751 Highest 64.8 15.8 3.7 1.9 13.8 100.0 705 Total 2009 62.5 14.7 6.4 1.7 14.8 100.0 3,522 Total 2005 61.3 12.4 7.6 1.6 17.1 100.0 1,875 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes women in consensual union (living together). Formerly married includes divorced, separated, or widowed. 1 Excludes men who had sexual intercourse within the past 4 weeks 2 Excludes men who are not currently married 96 | Other Proximate Determinants of Fertility Respondents are considered to be sexually active if they had intercourse at least once in the four weeks prior to the survey. • A similar proportion of women and men age 15-49 (16 and 15 percent, respectively) had never had sex. • Fifty-four percent of women and 63 percent of men reported that they had sex within the last four weeks preceding the survey, while 17 percent of women and 15 percent of men had sexual intercourse in the year preceding the survey (but not within the past 4 weeks). • Both young women and men age 15-19 were less likely than respondents in other age groups to be sexually active in the last four weeks, because a large proportion in this age group has never had sexual intercourse (62 percent of women and 59 percent of men). • A large proportion of respondents currently in union (78 percent of women and 91 percent of men) report being sexually active in the last four weeks. • There is little difference in recent sexual activity by marital duration although respondents married 10-14 years ago are somewhat more likely to be sexually active recently. • For both women and men, recent sexual activity is higher in rural areas when compared with urban areas. There are significant variations in the percentage of respondents with recent sexual activity by region, particularly for men. Among women, this percentage ranges from 44 percent in Region 10 to 65 percent in Region 1, while for men recent sexual activity ranges from 56 percent, each, in Regions 5 and 10 to 78 percent in Region 1. • Recent sexual activity is highest for women with no education (73 percent), and it decreases to 49 percent among women with more than secondary education. For men, recent sexual activity tends to decline with increasing education. • There is little variation in recent sexual activity by wealth for either women or men. 6.5 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY Post-partum amenorrhea is the interval between the birth of a child and the return of the menstrual cycle. It is the period during which the woman becomes temporarily and involuntarily infecund following childbirth. Post-partum protection from conception can be prolonged by breastfeeding, which can lengthen the duration of amenorrhea. Delaying the resumption of post-partum sexual relations can also prolong protection. The period of voluntary sexual inactivity after childbirth is referred to as post- partum abstinence. A woman is said to be insusceptible to the risk of pregnancy if she is either amenorrheic or abstaining from sexual intercourse following childbirth. Women who gave birth during the three years prior to the survey were asked about their breastfeeding practices, the duration of amenorrhea, and post-partum sexual abstinence. Table 6.8 shows the percentage of births in the three years preceding the survey for which mothers were post-partum amenorrheic, abstaining, and insusceptible, by number of months since the birth. Mean and median durations are also shown. • In Guyana, the median duration of amenorrhea is 3 months; the median duration of post- partum abstinence is slightly lower at 2 months. Women are insusceptible to pregnancy for about 4 months after a birth (median of 4 months and a mean of 9 months). • Overall, for about one in four births (24 percent) in the last three years, the mothers were insusceptible at the time of the survey, i.e. either still amenorrheic or still abstaining or both (18 percent amenorrheic and 14 percent abstaining). Other Proximate Determinants of Fertility | 97 Table 6.8 Postpartum amenorrhea, abstinence, and insuscep- tibility Percentage of births in the three years preceding the survey for which the mother is postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of births for which the mother is: –––––––––––––––––––––––––––– Number Months Amenor- Insuscep- of since birth rheic Abstaining tible1 births ––––––––––––––––––––––––––––––––––––––––––––––––––––––– < 2 91.8 90.0 94.9 61 2-3 48.5 40.3 61.8 58 4-5 37.7 19.0 44.4 105 6-7 40.0 15.3 44.0 69 8-9 25.3 7.2 26.9 61 10-11 31.4 18.3 45.0 66 12-13 15.7 13.9 27.9 52 14-15 8.9 7.9 16.2 56 16-17 1.2 2.3 3.4 73 18-19 10.9 9.9 20.8 70 20-21 1.6 8.4 9.9 50 22-23 1.4 4.1 5.0 56 24-25 1.5 3.5 5.0 65 26-27 1.0 6.2 7.2 73 28-29 0.3 2.8 3.1 88 30-31 0.0 2.8 2.8 91 32-33 5.4 6.0 11.5 50 34-35 1.6 2.7 4.4 49 Total 18.1 14.1 24.1 1,193 Median 3.2 2.3 4.3 na Mean 6.8 5.5 9.0 na ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Estimates are based on the status at the time of the survey (current status). na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth • Ninety-five percent of women are insusceptible to pregnancy within the first two months following childbirth. At 4-7 months after birth, 44 percent of mothers are still insusceptible mostly as a result of the drastic reduction of in abstinence (only 15-19 percent of mothers abstaining). By 12 to 13 months, about three in ten women (28 percent) are insusceptible, with 16 percent still amenorrheic and 14 percent still abstaining. By 34 to 35 months, the effect of post-partum amenorrhea is almost completely gone (2 percent) and insuscepti- bility to pregnancy is very low (4 percent). In the absence of contraception, variations in postpartum amenorrhea and abstinence are the most important determinants of the interval between births and hence, ultimately, of completed fertility. In some populations differentials across subgroups in the duration of postpartum amenorrhea and abstinence also may indicate incipient changes in traditional postpartum practices. A shortening of the period of postpartum insusceptibility has implications for the provision of family planning services to recent mothers. As will be seen in Chapter 11, duration of breastfeeding (which is linked to amenorrhea) decreases as the education level of the mother increases. As a result, the duration of amenorrhea for educated women is shorter too. Table 6.9 shows the median duration of amenorrhea, post-partum abstinence, and post-partum insusceptibility by selected background characteristics (results are presented only for selected sub-groups due to the small number of cases). 98 | Other Proximate Determinants of Fertility • Women age 30-49 have a longer median duration of insusceptibility (5.3 months) than younger women (4.0 months) as a result of a longer duration of postpartum amenorrhea (4.5 and 3.0 months, respectively). • By residence, there is no major variation in the median duration of insusceptibility, although women in the Interior area have a somewhat longer duration of postpartum insusceptibility (4.9 months) than women in the rural and Coastal areas (4.1 months) mostly due to a longer duration of postpartum amenorrhea. 6.6 TERMINATION OF EXPOSURE TO PREGNANCY Menopause marks the onset of infecundity and is another factor influencing the risk of pregnancy. In this report, women are considered menopausal if they are neither pregnant nor post-partum amenor- rheic and have not had a menstrual period in the past six months. Another facet of loss of exposure not shown in Table 6.10 is terminal separation, divorce, and widowhood where the woman does not remarry before the end of her childbearing years. The 2009 GDHS did not collect enough information on marriage history to define a reasonably precise indicator, but some information may be inferred from the findings already presented in Table 6.1. A third factor affecting the end of fertility is the lack of exposure due to long-term abstinence among currently married women. This information was presented in Table 6.8. Table 6.9 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Postpartum Postpartum Background amenor- Postpartum insuscep- characteristic rhea abstinence tibility1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age 15-29 3.0 2.3 4.0 30-49 4.5 2.3 5.3 Residence Rural 3.4 2.1 4.1 Coastal 2.7 2.2 4.1 Interior 4.3 2.8 4.9 Education Primary 3.8 2.2 4.4 Secondary 3.1 2.2 4.2 Total 3.2 2.3 4.3 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Medians are based on status at the time of the survey (current status). 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Other Proximate Determinants of Fertility | 99 Table 6.10 shows the percentage of women age 30-49 who are menopausal, by age. • Above age 30, the risk of pregnancy begins to decline with age as the prevalence of menopause increases with age. While only 1 percent of women age 30-34 are menopausal, at the end of the reproductive period (age 48-49), about one in four women (23 percent) is menopausal. • Overall, 6 percent of women age 30-49 are menopausal. Table 6.10 Menopause Percentage of women age 30-49 who are menopausal, by age, Guyana 2009 ––––––––––––––––––––––––––––––––––– Number Percentage of Age menopausal1 women ––––––––––––––––––––––––––––––––––– 30-34 1.2 643 35-39 2.6 699 40-41 4.6 259 42-43 5.8 240 44-45 11.8 261 46-47 13.3 236 48-49 23.0 217 Total 6.4 2,554 ––––––––––––––––––––––––––––––––––– 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey. Fertility Preferences | 101 FERTILITY PREFERENCES 7 In the 2009 GDHS, several questions were asked to ascertain the respondent’s fertility preferences. Did they desire to have another child? How long did they want to wait before having that child? How many children did they consider to be ideal for their family? The first two questions were asked of non-sterilized, currently married respondents. The final question was asked of all respondents. In combination with information on contraceptive use, the data from the responses allow estimation of the demand for family planning, with the goal being either to space or to limit births. 7.1 DESIRE FOR MORE CHILDREN Respondents were asked: “Would you like to have another child, or would you prefer not to have any more children?” If they responded that they wanted another child, they were asked: “How long would you like to wait from now before the birth of another child?” These questions were appropriately phrased if the respondent had not yet had any children, and if the woman/wife was pregnant, she/he was asked about the desire for more children after the baby she was expecting. Respondents who had been sterilized for contraceptive purposes also required special analytic treatment; generally they were classified as wanting no more children. Table 7.1.1 shows the percent distribution of currently married women and men by desire for children, according to number of living children. Table 7.1.2 presents the same information for currently married women by background characteristics. Figure 7.1 shows the overall fertility preferences for women in union in Guyana. The summary indicators for women are shown in Figure 7.1. The fertility preferences are classified as follows: wants another child soon (within two years), wants another child later (two or more years later), wants no more children, and sterilized (female and male sterilization). ƒ Fifty-six percent of currently married women reported that they don’t want to have a/another child, and 5 percent are already sterilized. The corresponding figures for men are 51 and 1 percent, respectively. As might be expected, the desire to stop childbearing increases rapidly with the number of children. Among respondents with one child, about one in five (22 percent of women and 20 percent of men) wants no more children or is sterilized; this compares with 81 percent of women and 70 percent of men with three children. ƒ Among women who want to have a/another child at some point (32 percent), half (16 percent) want to delay the (next) birth for two or more years. Among men, 35 percent of men want to have a/another child at some point, and less than half (14 percent), want to wait for the (next) birth later. 102 | Fertility Preferences Table 7.1.1 Fertility preferences by number of living children Percent distribution of currently married women and men 15-49 by desire for children, according to number of living children, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Desire for children 0 1 2 3 4 5 6+ Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Have another soon2 66.1 23.8 7.9 3.8 3.6 2.8 1.9 14.0 Have another later3 16.3 42.9 15.3 7.0 4.2 1.8 0.3 15.5 Have another, undecided when 6.9 4.5 3.4 1.2 1.0 1.1 0.3 2.8 Undecided 2.9 5.4 6.6 4.4 3.2 1.1 0.7 4.3 Want no more 3.8 20.6 62.7 72.5 77.0 83.7 80.7 55.9 Sterilized4 0.0 0.9 2.2 8.6 8.6 8.8 15.2 5.3 Declared infecund 4.1 1.5 1.1 1.9 2.3 0.4 0.8 1.7 Missing 0.0 0.5 0.7 0.6 0.1 0.2 0.1 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 265 552 719 625 336 190 232 2,920 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN5 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Have another soon2 64.0 24.9 11.0 5.4 5.1 4.2 6.1 17.1 Have another later3 13.1 31.4 12.9 11.2 5.5 4.7 3.7 14.1 Have another, undecided when 6.3 9.0 4.3 1.2 1.0 0.5 0.4 3.9 Undecided 4.8 10.9 10.9 6.6 7.7 6.1 10.9 8.7 Want no more 4.1 18.5 55.2 69.0 78.8 79.5 74.9 50.8 Sterilized4 1.9 1.2 0.5 1.4 1.3 0.0 0.3 1.0 Declared infecund 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Missing 5.4 4.1 5.3 5.3 0.5 5.1 3.7 4.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 213 343 448 392 198 109 132 1,835 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: “Currently married” includes respondents in consensual union (living together). 1 Includes current pregnancy 2 Wants next birth within two years 3 Wants to delay next birth for two or more years 4 Includes both female and male sterilization 5 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences | 103 Table 7.1.2 Fertility preferences by background characteristics Percent distribution of currently married women 15-49 by desire for children, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Want no more/ Want more children sterilized ––––––––––––––––––––––––––––– –––––––––––––––– Have Have Have another, Want Number Background another another undecided Un- no Declared of characteristic soon1 later2 when decided more Sterilized3 infecund Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 17.1 14.2 3.6 4.1 51.0 7.0 2.1 0.9 100.0 649 Georgetown (urban) 17.8 14.0 4.5 5.2 49.5 5.5 2.9 0.5 100.0 392 Other (urban) 15.9 14.4 2.3 2.4 53.2 9.3 0.9 1.6 100.0 257 Total Rural 13.1 15.9 2.6 4.4 57.4 4.8 1.6 0.3 100.0 2,271 Total Coastal 14.7 16.0 2.7 3.9 54.9 5.6 1.7 0.5 100.0 2,562 Coastal (urban) 17.1 14.2 3.6 4.1 51.0 7.0 2.1 0.9 100.0 649 Coastal (rural) 14.0 16.6 2.4 3.8 56.3 5.1 1.6 0.3 100.0 1,913 Total Interior 8.8 11.9 3.1 7.6 63.3 3.6 1.4 0.3 100.0 357 Region Region 1 5.7 9.8 3.5 11.8 66.1 2.2 0.7 0.3 100.0 128 Region 2 10.3 10.2 1.8 5.9 61.3 8.6 1.3 0.6 100.0 192 Region 3 12.9 23.2 2.8 4.3 51.5 3.9 1.4 0.0 100.0 424 Region 4 17.3 15.7 2.9 4.6 52.1 4.6 2.4 0.3 100.0 1,121 Region 5 11.0 15.2 2.5 5.2 58.2 5.0 2.1 0.7 100.0 218 Region 6 13.4 13.0 2.8 0.6 61.8 7.0 0.6 0.9 100.0 523 Region 7 12.1 15.0 3.0 5.8 60.3 1.6 2.2 0.0 100.0 65 Region 8 12.8 13.8 4.3 6.8 54.0 6.8 1.5 0.0 100.0 71 Region 9 6.8 11.8 2.8 5.4 67.5 1.6 3.1 1.1 100.0 57 Region 10 14.9 14.8 2.6 3.0 51.9 11.9 0.4 0.6 100.0 121 Education No education 9.5 3.5 6.7 3.1 73.9 1.7 1.6 0.0 100.0 62 Primary 8.4 7.3 1.4 5.0 68.4 7.0 2.1 0.3 100.0 746 Secondary 16.0 18.7 3.1 3.8 51.6 5.0 1.4 0.5 100.0 1,938 More than secondary 17.6 18.9 4.5 7.3 44.7 3.5 3.0 0.5 100.0 173 Wealth quintile Lowest 8.8 12.8 3.2 6.2 63.1 4.9 0.9 0.1 100.0 554 Second 14.0 15.1 2.0 4.3 58.0 5.2 1.1 0.2 100.0 576 Middle 14.3 18.4 2.1 4.3 54.3 5.3 1.1 0.2 100.0 592 Fourth 17.5 16.0 3.1 2.4 52.8 5.6 2.0 0.7 100.0 610 Highest 15.1 14.9 3.6 4.6 52.1 5.6 3.2 0.9 100.0 589 Total 14.0 15.5 2.8 4.3 55.9 5.3 1.7 0.4 100.0 2,920 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: “Currently married” includes respondents in consensual union (living together). 1 Wants next birth within two years 2 Wants to delay next birth for two or more years 3 Includes both female and male sterilization 104 | Fertility Preferences 7.2 DESIRE TO LIMIT CHILDBEARING BY BACKGROUND CHARACTERISTICS Table 7.2 shows the percentage of currently married women who want no more children, by number of living children and background characteristics, and the percentage of currently married men who want no more children, by background characteristics. Regions are not presented in this table because the number of unweighted cases (25-49 for most cells) is small. However, the desire for no children by region is shown in Figure 7.2. ƒ Overall, over six in ten of currently married women (61 percent) and half of currently married men (52 percent) want no more children. ƒ By residence, women in rural areas (62 percent) are more likely to report that they want no more children than women in urban areas (58 percent). Furthermore, women in the Interior area (67 percent) are more likely than those in the Coastal area (61 percent) to want no more children. ƒ Similar to women, men in rural areas are more likely than those in urban areas (54 and 43 percent, respectively) to want no more children. However, unlike women, men in the Coastal area are more likely than those in the Interior area (52 and 50 percent, respectively) to want no more children. ƒ Close to seven in ten currently married women in Regions 1, 2, 6, and 9 want no more children or are sterilized compared with just above half (55 percent) of women in Region 3. Regions 2, 6, and 9 have the highest percentages of men who are either sterilized or want no more children (60 to 66 percent). ƒ The largest differences in the desire for no more children are found by educational level, especially among women. For example, 76 percent of women with no education want no more children compared with 48 percent of women with more than secondary education. The same pattern is observed for men but is less pronounced. In general, the desire to limit childbearing tends to decrease with an increase in the wealth quintile of the household. Figure 7.1 Fertility Preferences of Women in Union 33 14 16 3 61 56 5 WANTS MORE CHILDREN Have another soon Have another later Undecided when WANT NO MORE CHILDREN Wants no more Sterilized 0 20 40 60 80 Percentage of women GDHS 2009 Fertility Preferences | 105 Table 7.2 Desire to limit childbearing by background characteristics Percentage of currently married women age 15-49 who want no more children, by number of living children and background characteristics, and percentage of currently married men age15-49 who want no more children, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 Total Total Background ––––––––––––––––––––––––––––––––––––––––––––––––––– women men characteristic 0 1 2 3 4 5 6+ 15-49 15-49 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 1.5 26.9 61.8 80.4 88.3 (89.8) (90.5) 58.0 43.3 Georgetown (urban) (0.0) (22.0) 64.4 (79.8) * * * 55.1 42.2 Other (urban) (4.6) 35.3 57.8 81.3 92.4 (93.9) (95.6) 62.5 44.9 Total Rural 4.6 19.8 65.9 81.3 84.9 93.2 96.7 62.2 54.1 Total Coastal 3.6 21.5 65.5 82.7 86.7 93.5 96.4 60.5 52.1 Coastal (urban) 1.5 26.9 61.8 80.4 88.3 (89.8) (90.5) 58.0 43.3 Coastal (rural) 4.4 19.6 66.9 83.4 86.2 94.8 97.8 61.3 54.9 Total Interior (6.1) 21.3 58.1 67.9 77.2 89.1 95.0 66.9 49.8 Education No education * * * * * * (100.0) 75.6 52.4 Primary (13.0) 35.7 77.9 82.7 88.0 93.4 96.6 75.5 59.7 Secondary 1.6 18.7 60.7 80.8 85.9 92.0 94.9 56.5 50.3 More than secondary 2.6 20.5 54.0 74.5 * * * 48.2 36.2 Wealth quintile Lowest (6.3) 24.8 66.5 67.3 76.7 89.7 96.8 68.0 55.9 Second (3.2) 18.2 66.0 86.6 87.0 95.8 91.4 63.2 53.8 Middle (2.5) 11.3 67.7 82.3 90.4 (99.3) (100.0) 59.6 55.9 Fourth 6.2 28.2 59.2 84.0 91.8 (80.6) * 58.4 49.0 Highest 1.5 26.4 66.3 83.4 84.3 * * 57.7 44.2 Total 3.8 21.5 64.9 81.1 85.6 92.5 95.9 61.3 51.8 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: “Currently married” includes women/men in consensual union (living together). Women who have been sterilized or who have stated their current method is male sterilization are considered to want no more children. Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. Figures preceded by a bracket 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 Includes current pregnancy 106 | Fertility Preferences 7.3 NEED AND DEMAND FOR FAMILY PLANNING SERVICES In general, women have an unmet need for family planning if (1) they are currently married, (2) they declare either that they do not want to have any more children (they want to limit their childbearing) or that they want to wait two or more years before having another child (they want to space their births), and (3) they are not currently using contraception. Women who have an unmet need for spacing are pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but say they want to wait two or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but want no more children. Excluded from the unmet need category are menopausal or infecund women and unmarried women who have not had sexual intercourse in the four weeks prior to the interview. The category of using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. The using for limiting category includes women who are using family planning and who want no more children. Women with unmet need and those currently using contraception constitute the total demand for family planning. Figure 7.2 Desire for No More Children by Region 52 47 66 58 45 57 60 43 46 63 34 61 68 70 55 57 63 69 62 61 69 64 Total Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Percentage wanting no more children Men Women GDHS 2009 Fertility Preferences | 107 The calculation of unmet need, being a current status measure, is further refined by excluding women who are currently amenorrheic and, therefore, not in need of family planning at this point in time. A more detailed description of the way these indicators are calculated is included in Footnote 1 of Table 7.3, while the components of the unmet need for family planning are illustrated in Figure 7.3. Table 7.3 shows the need and demand for family planning among currently married women, by background characteristics, while Figure 7.4 compares unmet need with demand satisfied, by region. ƒ Twenty-nine percent of married women have an unmet need for family planning, more for limiting (19 percent) than for spacing births (10 percent). Forty-three percent of married women are currently using a contraceptive method (met need), 12 percent for spacing and 30 percent for limiting. As a result, the total demand for family planning is estimated at 71 percent of currently married women, 22 percent for spacing and 49 percent for limiting. These findings indicate that only 60 percent of the total demand for family planning is met (the portion of met need subtracted from the total demand). ƒ Unmet need generally decreases with age and is highest among the youngest age group—age 15-19 (35 percent). The findings show clearly that younger women have a greater unmet need for spacing, while older women have a greater unmet need for limiting. ƒ There are no major differences in the unmet need among women in Urban, Rural, and Coastal areas (27 to 30 percent). However, the unmet need in the Interior area is relatively higher (37 percent). Among regions, the percentage of women with an unmet need for family planning ranges from 26 percent each, in Regions 3 and 10, to as high as 46 percent, in Region 1. ƒ Unmet need for spacing increases steadily with education, while unmet need for limiting declines with education. As a result, unmet need remains relatively constant among educational groups (28 to 31 per cent) except among women with no education (41 percent). Both unmet need for spacing and for limiting decline with increasing socioeconomic status of the household. Overall, 38 of women in the lowest quintile have an unmet need for family planning compared with 24 percent in the highest quintile. ƒ Total demand for family planning increases with age, from 65 percent among women age 15 to 19 to 77 percent among women age 30-34, after which it declines. ƒ Demand for family planning varies slightly by place of residence, from 68 percent among women in the Interior area to 73 percent in the Georgetown (urban) area. Among regions, total demand for family planning is lowest in Region 9 (52 percent) and highest in Region 10 (77 percent). ƒ Total demand for family planning increases steadily with education, from 62 percent among women with no education to 77 percent among those with more than secondary education. The total demand for family planning does not vary much by wealth quintile, mostly as a result of decreasing unmet need and increasing contraceptive use with increasing wealth of the household. 108 | Fertility Preferences Table 7.3 Need and demand for family planning Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Met need for Unmet need for family planning Total demand for Percentage family planning1 (currently using)2 family planning3 of ––––––––––––––––––––– –––––––––––––––––––– –––––––––––––––––––– demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fied women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.3 11.6 34.9 21.5 8.3 29.8 44.8 19.9 64.7 46.0 166 20-24 22.0 8.1 30.1 24.5 14.1 38.7 46.5 22.3 68.8 56.2 398 25-29 16.9 12.1 29.0 21.1 21.7 42.8 38.0 33.8 71.8 59.7 458 30-34 8.0 18.3 26.2 16.4 34.0 50.4 24.4 52.3 76.7 65.8 492 35-39 3.9 25.6 29.5 6.4 40.5 46.9 10.3 66.0 76.4 61.4 517 40-44 2.4 23.9 26.3 2.4 43.3 45.7 4.8 67.2 72.0 63.4 460 45-49 0.5 27.0 27.6 0.9 31.8 32.7 1.4 58.8 60.3 54.3 429 Residence Total Urban 9.3 19.4 28.7 14.5 28.5 43.0 23.8 47.9 71.7 60.0 649 Georgetown (urban) 10.0 19.5 29.5 16.3 27.2 43.5 26.3 46.7 73.0 59.6 392 Other (urban) 8.4 19.2 27.5 11.6 30.6 42.2 20.0 49.8 69.8 60.5 257 Total Rural 9.5 18.9 28.4 11.7 30.7 42.3 21.2 49.6 70.7 59.9 2,271 Total Coastal 9.4 17.9 27.3 13.0 31.0 44.0 22.4 49.0 71.3 61.7 2,562 Coastal (urban) 9.3 19.4 28.7 14.5 28.5 43.0 23.8 47.9 71.7 60.0 649 Coastal (rural) 9.4 17.4 26.8 12.5 31.9 44.4 21.9 49.3 71.2 62.3 1,913 Total Interior 9.9 26.8 36.7 7.2 24.2 31.4 17.1 51.0 68.1 46.1 357 Region Region 1 9.5 36.0 45.5 3.1 19.2 22.2 12.6 55.2 67.8 32.8 128 Region 2 7.8 26.1 33.9 9.0 31.8 40.8 16.8 58.0 74.7 54.6 192 Region 3 9.5 16.0 25.5 18.7 30.9 49.6 28.2 46.9 75.1 66.0 424 Region 4 9.6 17.5 27.1 13.6 27.5 41.1 23.2 45.0 68.2 60.3 1,121 Region 5 10.6 17.8 28.4 10.5 37.9 48.4 21.1 55.7 76.8 63.0 218 Region 6 8.0 18.6 26.6 9.7 34.6 44.3 17.7 53.2 70.9 62.5 523 Region 7 11.3 23.9 35.2 10.8 23.8 34.6 22.1 47.7 69.8 49.6 65 Region 8 10.3 19.2 29.5 12.8 31.0 43.8 23.1 50.2 73.3 59.7 71 Region 9 11.7 21.9 33.6 4.2 14.4 18.6 15.8 36.3 52.2 35.6 57 Region 10 11.9 14.4 26.3 11.7 38.7 50.4 23.6 53.1 76.7 65.7 121 Education No education 9.8 30.7 40.5 0.4 21.5 21.9 10.2 52.2 62.4 35.1 62 Primary 5.6 23.9 29.4 5.1 35.3 40.4 10.7 59.2 69.9 57.9 746 Secondary 10.3 17.2 27.5 14.5 29.1 43.6 24.8 46.3 71.1 61.3 1,938 More than secondary 17.0 13.8 30.7 22.4 23.9 46.3 39.3 37.7 77.0 60.1 173 Wealth quintile Lowest 12.2 26.3 38.4 6.3 26.5 32.8 18.4 52.8 71.2 46.0 554 Second 7.8 20.4 28.2 11.0 30.2 41.2 18.8 50.6 69.4 59.4 576 Middle 10.0 15.6 25.6 13.3 31.7 45.0 23.3 47.3 70.6 63.7 592 Fourth 9.3 17.5 26.8 14.4 29.3 43.7 23.8 46.7 70.5 62.0 610 Highest 8.2 15.8 24.0 16.0 33.2 49.1 24.1 49.0 73.1 67.2 589 Total 9.5 19.0 28.5 12.3 30.2 42.5 21.8 49.2 71.0 59.9 2,920 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: “Currently married” includes women in consensual union (living together). 1 Unmet need for spacing: Includes women who are fecund and not using family planning and who say they want to wait two or more years for their next birth, or who say they are unsure whether they want another child, or who want another child but are unsure when to have the child. In addition, unmet need for spacing includes pregnant women whose current pregnancy was mistimed, or whose current pregnancy was unwanted but who now say they want more children. Unmet need for spacing also includes amenorrheic women whose last birth was mistimed or whose last birth was unwanted but who now say they want more children. Unmet need for limiting: Includes women who are fecund and not using family planning and who say they do not want another child. In addition, unmet need for limiting includes pregnant women whose current pregnancy was unwanted but who now say they do not want more children or who are undecided whether they want another child. Unmet need for limiting also includes amenorrheic women whose last birth was unwanted but who now say they do not want more children or who are undecided whether they want another child. 2 Using for spacing is defined as women who are using some method of family planning and who say they want to have another child or who are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. Fertility Preferences | 109 Figure 7.3 Components of the Unmet Need for Family Planning WOMEN IN UNION WHO ARE NOT USING CONTRACEPTION: 57.6 percent ▼ Currently pregnant or amenorrheic: 10.5 percent Neither pregnant nor amenorrheic: 47.1 percent ▼ Fecund: 31.5 percent Infecund ▼ ▼ ▼ Planned pregnancy or method failure 5.8 percent Mistimed pregnancy 2.4 percent (spacing) Unwanted pregnancy 2.3 percent (limiting) Want no more children 16.7 percent Want to wait two or more years 7.1 percent (spacing) Want soon 7.7 percent Infecund 15.6 percent ▼ ▼ ▼ ▼ UNMET NEED FOR FAMILY PLANNING: 28.5 percent For spacing: 9.5 percent ║ For limiting: 19.0 percent Figure 7.4 Women with Unmet Need and Demand Satisfied, by Region 66 36 60 50 63 63 60 66 55 33 60 26 34 30 35 27 28 27 26 34 46 29 0 10 20 30 40 50 60 70 80 90 100 Region 10 Region 9 Region 8 Region 7 Region 6 Region 5 Region 4 Region 3 Region 2 Region 1 Total Percentage of women Unmet need Demand satisfied 110 | Fertility Preferences 7.4 IDEAL FAMILY SIZE Respondents were asked to consider a hypothetical situation independent of their current family size and to report the number of children they would choose to have. Information on what women and men believe to be the ideal family size was elicited through two questions. Respondents who had no living children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” Respondents who had children were asked, “If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Nevertheless, even though these questions are based on hypothetical situations, they give an idea of the total number of children women who have not started childbearing will have in the future, while among older women and high parity women this information provides a measure of the level of unwanted fertility. Table 7.4 presents the percent distribution of all women and all men age 15-49 by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to number of living children. There is usually a correlation between actual and ideal number of children. The reason is twofold. First, to the extent that women implement their preferences, those who want larger families will tend to achieve larger families. Second, women may adjust upwards their ideal size of family as the actual number of children increases (i.e., rationalization). It is also possible that women with large families, being on average older than women with small families, have larger ideal sizes because of attitudes that they developed 20 to 30 years ago. ƒ The mean ideal number of children for all women age 15-49 is 2.9, while for men age 15-49 it is 3.3, indicating that men’s ideal number of children is slightly higher than women’s ideal number of children. Currently married women and currently married men prefer larger ideal family sizes (3.1 and 3.5, respectively) than all women and all men. There are two likely reasons for this pattern. First, to the extent that women and men are able to implement their fertility preferences, those who want smaller families will tend to achieve smaller families. At the same time, however, some women and men who already have children may find it difficult to say that they would have preferred to have had fewer children than they have. These women and men are likely to report the number of children they have as their preferred number of children. ƒ In general, women and men have similar patterns regarding ideal number of children. The preferences converge around three children. For example, 24 percent of all women and 26 percent of all men consider three children to be ideal, and 15 percent each of women and men consider four children to be ideal. There are no major gender differences as the ideal number of children increases. However, the percentage of respondents who want five or more children is quite low (3 to 8 percent). ƒ The preference for a larger family size is higher for men than women, irrespective of the number of living children. The mean ideal number of children generally increases with the number of living children. Among all women, the ideal number of children ranges from 2.5 for those with no children to 4.2 for those with six or more children. As with women, the mean ideal number of children among all men also tends to increase with the number of children (with some slight fluctuations), from 2.8 for men with no children to 5.7 for men with six or more children. Fertility Preferences | 111 7.5 FERTILITY PLANNING STATUS Women were asked a series of questions about all their children born in the five years preceding the survey, as well as questions about any current pregnancy, to determine whether the pregnancy was planned, mistimed, or unwanted. The answers to these questions provide insight into the degree to which couples are able to control their fertility. Table 7.5 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and background characteristics; and for all men by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age of woman All Number Background ––––––––––––––––––––––––––––––––––––––––––––––––––––––– women of characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-49 women1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 2.6 2.5 2.5 3.0 2.9 2.9 3.0 2.8 1,440 Georgetown urban 2.7 2.5 2.4 2.8 2.9 2.8 2.8 2.7 948 Other urban 2.5 2.4 2.7 3.3 2.9 3.1 3.6 2.9 492 Rural 2.5 2.6 2.8 3.0 3.3 3.2 3.5 2.9 3,415 Coastal 2.5 2.5 2.6 3.0 3.0 3.1 3.2 2.8 4,375 Coastal urban 2.6 2.5 2.5 3.0 2.9 2.9 3.0 2.8 1,440 Coastal rural 2.4 2.6 2.7 3.0 3.1 3.1 3.3 2.8 2,934 Interior 2.8 2.9 3.5 3.2 4.7 3.7 5.0 3.5 481 Region Region 1 3.2 3.1 (3.6) (2.8) (5.7) (4.3) * 3.7 156 Region 2 2.3 2.5 (2.5) 3.4 3.2 3.4 3.6 2.9 275 Region 3 2.5 2.7 2.9 3.0 3.0 3.7 3.3 3.0 665 Region 4 2.6 2.5 2.5 2.9 3.0 2.9 3.0 2.8 2,115 Region 5 2.4 2.6 (2.7) 3.1 3.3 3.2 (3.8) 3.0 350 Region 6 2.2 2.4 2.6 2.8 2.6 2.8 3.1 2.6 761 Region 7 2.3 2.4 (3.2) (3.4) (3.8) (3.4) (4.2) 3.0 100 Region 8 2.7 (2.7) (3.4) (3.3) (4.0) * * 3.7 88 Region 9 (2.7) (3.4) (3.3) (3.7) (4.7) (4.4) (4.0) 3.7 74 Region 10 2.6 2.6 3.2 3.5 3.3 3.6 (3.7) 3.1 270 Education No education * * * * * * * 3.9 64 Primary 2.4 2.7 2.9 2.9 3.0 3.2 3.5 3.0 915 Secondary 2.5 2.6 2.7 3.0 3.2 3.1 3.2 2.8 3,476 More than secondary (2.4) 2.5 2.6 2.8 (2.9) (2.8) (3.6) 2.8 400 Wealth quintile Lowest 2.6 2.7 3.2 3.4 3.9 3.7 4.1 3.2 747 Second 2.4 2.6 2.8 3.2 3.3 3.0 3.3 2.9 928 Middle 2.5 2.6 2.7 3.0 3.1 3.1 3.6 2.9 997 Fourth 2.6 2.5 2.6 2.8 3.1 2.9 3.1 2.8 1,057 Highest 2.6 2.5 2.5 2.8 2.8 3.0 2.9 2.7 1,127 Total 2.5 2.6 2.7 3.0 3.2 3.1 3.3 2.9 4,855 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures preceded by a bracket 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 Number of women who gave a numeric response Table 7.4 Ideal number of children Percent distribution of all women and all men age 15-49 by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to number of living children, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Ideal number of children 0 1 2 3 4 5 6+ Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 3.4 2.0 1.7 0.8 2.3 2.9 7.6 2.5 1 6.2 9.5 4.3 4.2 3.4 1.1 2.1 5.4 2 50.3 43.0 46.5 26.2 32.3 22.4 17.1 40.2 3 24.9 27.8 25.1 33.4 9.6 13.6 13.1 24.4 4 8.7 10.7 14.9 22.7 31.5 15.3 17.7 15.0 5 2.2 3.3 2.1 4.6 7.8 22.0 5.3 4.3 6+ 1.6 1.9 3.6 5.6 9.1 16.5 29.2 5.4 Non-numeric responses 2.6 1.8 1.7 2.5 3.9 6.1 7.9 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,532 865 937 766 408 228 261 4,996 Mean ideal number children2 All women 2.5 2.6 2.8 3.2 3.4 4.1 4.2 2.9 Number of women 1,492 850 921 746 392 214 240 4,855 Currently married women 2.5 2.6 2.7 3.1 3.4 4.4 4.2 3.1 Number of women 257 544 706 608 325 177 218 2,834 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN3 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 5.8 3.4 3.6 3.6 4.6 3.3 1.4 4.6 1 2.3 5.1 1.9 2.2 1.7 1.1 1.0 2.5 2 40.4 37.6 46.5 11.2 18.9 16.4 11.7 33.9 3 29.7 28.4 19.9 36.3 8.1 15.8 11.4 26.3 4 12.4 11.5 15.3 18.6 38.6 15.0 13.1 15.3 5 3.1 3.7 6.3 12.4 10.6 22.9 8.5 6.2 6+ 4.0 6.6 5.8 11.4 13.6 15.1 43.2 8.1 Non-numeric responses 2.1 3.7 0.7 4.3 3.8 10.4 9.8 3.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 1,594 472 520 439 232 125 140 3,522 Mean ideal number children2 All men 2.8 3.3 2.9 4.1 3.9 4.3 5.7 3.3 Number of men 1,560 455 516 421 223 112 126 3,413 Currently married men 2.6 3.2 2.9 4.0 3.8 4.1 5.6 3.5 Number of men 208 328 445 374 189 98 119 1,761 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: “Currently married” includes respondents in consensual union (living together). 1 Number of living children includes current pregnancy 2 Means are calculated excluding respondents giving non-numeric responses. 3 The number of living children includes one additional child if respondent's wife/partner is pregnant (or if any wife/partner is pregnant for men with more than one current wife/partner). 112 | Fertility Preferences Table 7.5 shows the percent distribution of births (including current pregnancy) in the five years preceding the survey by fertility planning status, according to birth order and mother’s age at birth. ƒ Eighteen percent of births in the five years preceding the surveys (and current pregnancies) were unwanted, and 22 percent were wanted later. ƒ The proportion of births that are unwanted increases with age of the mother at the time of the child’s birth and with the birth order. For example, 10 percent of births to mothers age 15-24 are unwanted compared with 54 percent for mothers age 40-44. Only 5 percent of first births are unwanted compared with 40 percent of births of fourth parity or higher. 7.6 WANTED FERTILITY RATES The potential demographic impact of avoiding unwanted births can be estimated by calculating the wanted fertility rate. Unwanted births are defined as births that exceed the number considered ideal. Women who did not report a numeric ideal family size were assumed to want all their births. The total wanted fertility rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births were prevented. A comparison of the total wanted fertility and total fertility rate suggests the potential demographic impact of the elimination of unwanted births. Table 7.6 provides information on total “wanted” fertility rates and total fertility rates for the three years preceding the survey, by background characteristics. ƒ The total wanted fertility rate in Guyana is 2.1 children, 25 percent lower than the observed fertility rate (2.8 children). ƒ The gap between the observed and the wanted fertility rates is the largest in the Interior area, and is almost two children in difference (wanted fertility rate of 4.1 children; total fertility rate of 6.0 children). Table 7.5 Fertility planning status Percent distribution of births in the five years preceding the survey (including current pregnancies), by fertility planning status, according to birth order and mother’s age at birth, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Planning status of birth ––––––––––––––––––––––––––––––––––––– Number Birth order and Wanted Wanted Wanted of mother’s age at birth then later no more Missing Total births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth order 1 68.0 25.5 5.4 1.0 100.0 686 2 65.1 24.4 9.1 1.4 100.0 522 3 58.2 18.8 20.2 2.7 100.0 357 4+ 41.1 16.1 39.7 3.2 100.0 535 Mother's age at birth <20 56.5 31.8 10.4 1.3 100.0 489 20-24 64.1 23.8 9.5 2.5 100.0 627 25-29 58.7 21.3 19.4 0.6 100.0 423 30-34 56.5 14.3 28.0 1.2 100.0 334 35-39 56.3 6.1 34.0 3.6 100.0 186 40-44 35.1 5.1 54.3 5.5 100.0 34 45-49 * * * * * 7 Total 58.8 21.7 17.6 1.9 100.0 2,101 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility Preferences | 113 ƒ Among regions, the difference between wanted and observed fertility is highest in Region 1 (2.5 children) and lowest in Region 3 (0.3 children). ƒ The largest gap is observed among women with no education: 2.6 children (wanted fertility rate of 3.3 children; total fertility rate of 5.9 children). The gap between wanted and observed fertility declines with increasing education. ƒ The gap among women in the poorest quintile is 2.6 children (wanted fertility rate of 3.3 children; total fertility rate of 5.9 children). The gap also decreases with increasing wealth of the household. Table 7.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––– Total wanted Total Background fertility fertility characteristic rate rate ––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 1.7 2.1 Georgetown (urban) 1.5 2.0 Other (urban) 1.9 2.3 Total Rural 2.3 3.0 Total Coastal 1.9 2.4 Coastal (urban) 1.7 2.1 Coastal (rural) 2.0 2.5 Total Interior 4.1 6.0 Region Region 1 4.4 6.9 Region 2 2.0 2.7 Region 3 2.1 2.4 Region 4 1.8 2.3 Region 5 2.2 3.0 Region 6 1.7 2.3 Region 7 3.5 4.9 Region 8 4.3 6.1 Region 9 4.2 5.7 Region 10 2.3 3.0 Education No education (3.3) (5.9) Primary 2.6 3.8 Secondary 2.2 2.7 More than secondary 1.4 1.7 Wealth quintile Lowest 3.3 4.9 Second 2.0 2.8 Middle 2.1 2.7 Fourth 1.8 2.1 Highest 1.5 1.9 Total 2.1 2.8 ––––––––––––––––––––––––––––––––––––––––– Note: Rates are calculated based on births to women age 15-49 in the period 1 to 36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. Figures in parentheses are based on 125 to 249 unweighted person-years of exposure. Infant and Child Mortality | 115 INFANT AND CHILD MORTALITY 8 This chapter presents estimates on levels, trends, and differentials in neonatal, post-neonatal, infant, child, and under-age 5 mortality in Guyana. The information used to measure these childhood mortality rates was collected from the birth history section of the Women’s Questionnaire. Women of reproductive age (15-49) were asked a series of questions including the number of biological sons and daughters living with them, the number living elsewhere, and the number who have died. In addition, for each live birth, women were asked to provide information on the sex, date of birth, whether the birth was single or multiple, and whether the child survived. Current age was collected for living children, and age at death was collected for dead children. Infant and child mortality rates are basic indicators of a country’s socioeconomic situation and quality of life, as well as specific measures of health status. Measures of childhood mortality are also useful in population projections and monitoring and evaluating population and health programs and policies. Characteristics of childhood mortality such as age patterns and socioeconomic and demographic differentials are used to highlight factors that have positive or negative impacts on child survival. Analysis of mortality measures is useful in identifying promising directions for health programs and improving child survival efforts in Guyana. 8.1 DEFINITION, DATA QUALITY, AND METHODOLOGY Childhood mortality estimates in DHS surveys measure the risk of dying from birth through age five. The rates of childhood mortality presented in this chapter are defined as follows: Neonatal mortality (NN): the probability of dying between birth and the first month of life Post-neonatal mortality (PNN): the difference between infant and neonatal mortality Infant mortality (1q0): the probability of dying between birth and exact age 1 Child mortality (4q1): the probability of dying between exact age 1 and exact age 5 Under-age 5 mortality (5q0): the probability of dying between birth and exact age 5. All rates are expressed per 1,000 live births, except child mortality, which is expressed per 1,000 children surviving to age 12 months. A detailed description of the method for calculating the probabilities of dying presented in this chapter is given in Rutstein et al (Rutstein et al, 1984). The reliability of mortality estimates depends on the sampling variability of the estimates and on non-sampling errors. Sampling errors for the 2009 GDHS are presented in Appendix B. Non-sampling errors arise from problems associated with the quality of data collection and include the completeness with which births and deaths are reported and recorded. The most common problems are misreporting of age at death, misreporting of date of birth, and event underreporting (of both the birth and death of a child). The possible occurrence of these data problems in the 2009 GDHS is discussed with reference to the data quality tables in Appendix C. The reliability of the mortality estimates is affected by the completeness of the reporting of deaths, the degree of displacement of birth dates of surviving and dead children, and the extent to which age at death is accurately reported. Heaping of age at death at 12 months in the 2009 GDHS was not 116 | Infant and Child Mortality common (see Appendix C, Table C.6). Also, sometimes interviewers recorded deaths at “1 year,” even though instructions required them to record deaths under 2 years of age in months. An unknown fraction of these deaths may have actually occurred before the first birthday. Thus, the infant mortality rate may be biased downward somewhat, and child mortality may be biased upward; under-age 5 mortality would be unaffected. Yet, earlier simulation studies using DHS data from other countries indicate that while age at death misreporting is troublesome, the type and magnitude of that observed in the 2009 GDHS is unlikely to result in biases of more than 5 percent (Sullivan et al, 1990). The rates presented here are thus unadjusted; that is, all deaths reported at 12 months or “1 year” are assigned to the post-infant age period. Event underreporting is usually more severe for deaths that occur early in infancy. Omission of deaths may also be more common among women who have had several children or in cases where the death took place a long time ago. To assess the impact of omission on measures of child mortality, two indicators are used: (1) the percentage of deaths that occurred under seven days compared with the number that occurred under one month, and (2) the percentage of neonatal deaths compared with the percentage of infant deaths. It is hypothesized that omission will be more prevalent for children who died immediately after birth than for those who lived longer and that omission will be more serious for events that took place in the distant past than for those occurring in the recent past. Table C.5 shows that the percentage of early neonatal deaths ranges from 82 percent (for the period 10 to 14 years preceding the survey) to 91 percent (for the period 0 to 4 years before the survey). Similarly, Table C.6 shows that neonatal deaths comprise 62 to 75 percent of all infant deaths. These figures are considered plausible.1 Over time, the figures vary within a narrow range for the 20 years preceding the survey, suggesting that there has not been selective omission of early infant deaths. In addition to recall errors for the more distant retrospective periods, there are structural reasons for limiting mortality estimation to recent periods, preferably to the periods 0-4, 5-9, and 10-14 years before the survey. In fact, except for the first period (0-4 years), the others are slightly biased estimates because they are based on the child mortality experiences of women age 15-44 and age 15-39, respectively, instead of women age 15-49 as in the period 0-4 years preceding the survey. Therefore, estimating mortality for periods more than 10 to 15 years before the survey is not advisable. 8.2 CURRENT ESTIMATES OF INFANT AND CHILD MORTALITY Table 8.1 presents mortality rates for cohorts of children born in three five-year periods preceding the survey. ƒ Childhood mortality rates in Guyana are relatively low. For every 1,000 live births, 38 children die during the first year of life (infant mortality) and 40 children die during the first five years (under-age 5 mortality). ƒ Almost two-thirds of deaths in the first five years (25 deaths per 1,000 live births) take place during the neonatal period (first month of life). ƒ The mortality rate after the first year of life up to age 5 (child mortality) is also very low, 3 deaths per 1,000 live births. ƒ Trends in mortality can be examined in two ways: by comparing mortality rates for three five-year periods preceding a single survey and by comparing mortality estimates obtained from various surveys. However, mortality data have to be interpreted with caution because sampling errors associated with mortality estimates are large. The 2009 GDHS mortality data do not show any clear trends over time. 1 There are no model mortality patterns for the neonatal period. However, one review of data from several developing countries concluded that at levels of neonatal mortality of 20 per 1,000 or higher, approximately 70 percent of neonatal deaths occur within the first six days of life (Boerma, 1988). Infant and Child Mortality | 117 8.3 DIFFERENTIALS IN INFANT AND CHILD MORTALITY Child survival is closely related to socioeconomic and demographic characteristics of mothers and children. Table 8.2 shows differentials in childhood mortality by four socioeconomic variables: residence, region, mother’s education, and household wealth status (quintile). Additionally, Figure 8.1 displays infant mortality rates by place of residence and wealth quintile. Studies have also shown that a number of demographic factors are strongly associated with the survival chances of young children. These factors include sex of child, age of mother at birth, birth order, length of preceding birth interval, and size of child at birth. Table 8.3 shows the relationship between childhood mortality and these demographic variables. For all variables except birth size, mortality estimates are calculated for the 10-year period preceding the survey to reduce sampling variability. Mortality rates by birth size are for the five-year period preceding the survey because information on birth size was collected only for children born in the past five years. The 10-year period was selected to include a sufficient number of cases to study differentials across population groups and to lower sampling errors. However, it is useful to keep in mind that even for the 10-year period, sampling errors remain quite large. For example, the infant mortality estimate for rural areas is 32 deaths per 1,000 live births, with a 95 percent confidence interval of 25 and 38 deaths per 1,000 live births. This indicates that, given the sample size of the 2009 GDHS, the true value of the infant mortality rate may be 7 points higher or lower than the estimated rate of 32 deaths per 1,000 (see Table B.4.2). ƒ Surprisingly, all indicators of childhood mortality are higher in the Urban than in the Rural areas. For example, infant mortality is 45 deaths per 1,000 live births in Urban areas and 32 deaths per 1,000 live births in Rural areas. Childhood mortality is higher in the Coastal than in the Interior area for most indicators. The infant mortality rate is 37 deaths per 1,000 live births in the Coastal area compared with 27 deaths per 1,000 live births in the Interior area. Early childhood mortality is generally lower among children in the poorer quintiles and higher among children in the wealthier quintiles. For example, children in the wealthiest quintile are more likely to die during the first year of life (44 deaths per 1,000 live births) than children in poor households (25 deaths per 1,000 live births). The patterns in childhood mortality by mother’s education are not clear due to the small number of cases under each education category. ƒ Mortality rates among children born to the oldest mothers (age 30-39) are almost twice as high as mortality rates among children born to youngest mothers. Furthermore, higher-parity children (parity 7 or higher) have higher childhood mortality rates than children of birth orders 2 through 6. Short birth intervals (i.e., less than two years) are clearly associated with higher mortality both during and after infancy, supporting the importance of child spacing for child survival. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child and under age 5 mortality rates for five-year periods preceding the survey, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Years Approximate Neonatal Postneonatal Infant Child Under-five preceding calendar mortality mortality2 mortality mortality mortality the survey years1 (NN) (PNN) (1q0) (4q1) (5q0) –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0-4 2004-2009 25 12 38 3 40 5-9 1999-2004 19 13 32 6 38 10-14 1994-1999 28 11 38 3 42 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Because survey fieldwork was conducted from February through late July 2009, the rates for the five- year period 2004-2009 actually apply to the calendar period from mid-2004 to mid-2009; the same mid- year cutoff applies to the other rates. 2 Computed as the difference between the infant and the neonatal mortality rates 118 | Infant and Child Mortality Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-age 5 mortality rates for the 10-year period preceding the survey, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Neonatal Postneonatal Infant Child Under-5 Background mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0) –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 26 19 45 1 46 Georgetown (urban) (22) (19) (40) (0) (40) Other (urban) 32 20 52 1 54 Total Rural 21 11 32 6 37 Total Coastal 24 13 37 5 41 Coastal (urban) 26 19 45 1 46 Coastal (rural) 24 10 33 6 39 Total Interior 13 13 27 5 31 Mother's education No education * * * * * Primary 22 19 41 7 48 Secondary 22 10 32 4 36 More than secondary * * * * * Wealth quintile Lowest 14 11 25 7 32 Second 28 9 36 11 47 Middle 27 6 34 0 34 Fourth 20 22 42 1 43 Highest (25) (19) (44) (0) (44) –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Rates in parentheses are based on 250 to 499 unweighted exposed persons. An asterisk indicates that a rate is based on fewer than 250 unweighted exposed persons and has been suppressed. 1 Postneonatal mortality is computed as the difference between the infant and the neonatal mortality rates. Infant and Child Mortality | 119 Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Neonatal Postneonatal Infant Child Under-5 Demographic mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0) ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Child's sex Male 24 12 36 4 40 Female 20 13 34 5 38 Mother's age at birth <20 21 7 28 5 33 20-29 16 10 26 4 29 30-39 33 20 53 5 58 40-49 * * * * * Birth order 1 26 8 33 3 37 2-3 18 13 31 4 35 4-6 23 16 39 6 45 7+ (28) (23) (51) (12) (62) Previous birth interval2 <2 years 21 15 36 6 42 2 years 17 10 27 8 35 3 years (7) (28) (35) (1) (35) 4+ years 29 13 41 4 45 Birth size3 Small/very small 38 9 47 na na Average or larger 14 7 21 na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Rates in parentheses are based on 250 to 499 unweighted exposed persons. An asterisk indicates that a rate is based on fewer than 250 unweighted exposed persons and has been suppressed. na = Not applicable 1 Postneonatal mortality is computed as the difference between the infant and the neonatal mortality rates. 2 Excludes first-order births 3 Rates for the five-year period before the survey Figure 8.1 Infant Mortality Rates for the 10-Year Period Preceding the Survey, by Residence and Wealth Quintile 45 40 52 32 25 36 34 42 44 RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural WEALTH QUINTILE Lowest Second Middle Fourth Highest 0 10 20 30 40 50 60 Infant mortality rate per 1,000 births 120 | Infant and Child Mortality 8.4 PERINATAL MORTALITY The perinatal mortality rate serves as a good indicator of the state of health of a population generally, and at delivery in particular. It reflects the level of utilization of health services and the ability of women to cope with the demands of childbirth to deliver a healthy baby. Women in the 2009 GDHS were asked to report on any pregnancy loss that occurred in the five years preceding the survey. For each pregnancy that did not end in a live birth, the duration of pregnancy was recorded. In this report, perinatal deaths include pregnancy losses of at least seven months’ gestation (stillbirths) and deaths among live births that occurred within the first seven days of life (early neonatal deaths). The perinatal mortality rate is the sum of stillbirths and early neonatal deaths divided by the sum of all stillbirths and live births. Information on stillbirths and infant deaths that occurred within the first week of life is highly susceptible to omission and misreporting. However, retrospective surveys such as the 2009 GDHS generally provide more representative and accurate perinatal death rates than the vital registration system. Table 8.4 presents the level of perinatal mortality for Guyana by various background character- istics. ƒ A total of 1,908 neonatal pregnancies of seven or more months’ duration were reported for the five years preceding the survey. Of these, 28 ended in stillbirths and 38 in neonatal deaths, thus giving a perinatal mortality rate of 34 deaths per 1,000 pregnancies. ƒ The highest perinatal mortality risk is observed among mothers age 30-49 years (51 deaths per 1,000 pregnancies) when compared with mothers under age 30 (27 to 32 deaths per 1,000 pregnancies). ƒ Perinatal mortality is higher in urban areas (40 deaths per 1,000 pregnancies) compared with rural areas (33 deaths per 1,000 pregnancies) and in the Coastal area (39 deaths per 1,000 pregnancies) compared with the Interior area (17 deaths per 1,000 pregnancies). The number of cases for each region was too small for meaningful analysis. ƒ Perinatal mortality is relatively low for pregnancies in the lowest quintile (24 deaths per 1,000 pregnancies), after which it increases sharply in the second quintile (59 deaths per 1,000 pregnancies), and it declines thereafter with increasing wealth. Infant and Child Mortality | 121 Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of Number pregnancies Number of early Perinatal of seven or Background of neonatal mortality more months characteristic stillbirths1 deaths2 rate3 duration ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 (3) (11) (32) 460 20-29 13 12 27 935 30-49 11 15 51 513 Previous pregnancy interval in months4 First pregnancy 9 13 39 586 <15 * * * 131 15-26 (1) (5) (15) 367 27-38 (0) (5) (17) 274 39+ 16 14 53 549 Residence Total Urban (7) (10) (40) 431 Georgetown (urban) (3) (6) (33) 268 Other (urban) * * * 163 Total Rural 21 27 33 1,476 Total Coastal 26 33 39 1,497 Coastal (urban) (7) (10) (40) 431 Coastal (rural) 19 23 39 1,066 Total Interior (2) (5) (17) 410 Mother's education No education * * * 58 Primary (5) (6) (27) 421 Secondary 19 31 38 1,296 More than secondary * * * 132 Wealth quintile Lowest 6 7 24 551 Second (11) (13) (59) 407 Middle (6) (7) (36) 354 Fourth (5) (5) (34) 297 Highest (0) (5) (18) 298 Total 28 38 34 1,908 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 250 to 499 unweighted pregnancies of seven or more months in duration. An asterisk indicates that a figure is based on fewer than 250 unweighted pregnancies of seven or more months in duration and has been suppressed. 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months in duration, expressed per 1,000 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months 122 | Infant and Child Mortality 8.5 HIGH-RISK FERTILITY BEHAVIOR The survival of infants and children depends in part on the demographic and biological characteristics of their mothers. These characteristics are of particular importance because many health problems are easily avoidable at a relatively low cost. Infants and children have an elevated risk of dying if their mothers are too young (under 18 years of age) or too old (35 years or older), if they are born after too short a birth interval (less than 24 months), and if they are of high birth order (mother has three or more children). Although first births are commonly associated with higher mortality risk, they are not included in the high-risk category because the risks associated with first births are unavoidable. Table 8.5 shows the percent distribution of children born in the five years preceding the survey and the percent distribution of currently married women, by risk factors. The table also shows the risk ratio (of dying) for children, by comparing the proportion of dead children in each risk category with the proportion of dead children not in any high-risk category. Table 8.5 and Figure 8.2 show the percentage of births in the five years preceding the survey that fall into the various risk categories. • Twenty-eight percent of all children in Guyana are not in a high-risk category, and 24 percent are in an unavoidable risk category. As a result, almost half the children in Guyana (48 percent) are in the so-called avoidable high-risk categories. • Most of the births in the avoidable high-risk category are in the single high-risk category (34 percent): 13 percent are due to high birth orders (birth order of four or higher); for 9 percent, the mother was too young (less than 18 years of age); for another 9 percent, the birth was too soon after a previous birth (less than 24 months), and for 4 percent, the mother was too old (35 years of age or older). • Fourteen percent of children in an avoidable high-risk category are classified in the multiple high-risk category, mostly because the mother is 35 years or older and the birth order is high (6 percent), but also because of a short birth interval and a high birth order (5 percent). The latter group of children is of particular concern because they are almost five times more likely to die than children who are not in any high-risk category (the risk ratio is 4.5). • The births in high-risk categories are associated with 68 percent of the mothers, divided similarly in single high-risk and multiple high-risk categories (33 and 35 percent, respectively). The majority of mothers in the single-risk category (16 percent) are too old or have more than three births (11 percent). The majority of mothers in the multiple high-risk category are 35 years or older and have more than three births (28 percent). Infant and Child Mortality | 123 Table 8.5 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of dying and the risk ratio, and the percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Births in the 5 years Percentage preceding the survey of –––––––––––––––––––– currently Percentage Risk married Risk category of births ratio women1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Not in any high-risk category 27.8 1.00 24.9a Unavoidable risk category First order births between ages 18 and 34 years 24.1 0.42 7.6 In any avoidable high-risk category 48.1 1.01 67.5 Single high-risk category 34.0 0.70 32.8 Mother's age <18 8.8 1.20 0.5 Mother's age >34 3.6 0.22 16.0 Birth interval <24 months 8.5 0.51 5.9 Birth order >3 13.0 0.63 10.5 Multiple high-risk category 14.1 1.76 34.6 Age <18 and birth interval <24 months 1.9 0.49 0.2 Age >34 and birth interval <24 months 0.2 0.00 0.4 Age >34 and birth order >3 6.0 2.39 27.6 Age >34 and birth interval <24 months and birth order >3 1.2 4.53 1.9 Birth interval <24 months and birth order >3 4.7 0.83 4.5 Total 100.0 na 100.0 Number of births/women 1,886 na 2,920 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk category to the proportion dead of births not in any high-risk category. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth occurred less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the combined categories age <18 and birth order >3 a Includes sterilized women 124 | Infant and Child Mortality Reproductive Health | 125 REPRODUCTIVE HEALTH 9 The health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her child. This chapter presents findings on several areas related to maternal health—antenatal, delivery, and postnatal care—and also highlights problems in accessing care. These findings are important for designing appropriate strategies and interventions to improve maternal and newborn health care services. 9.1 ANTENATAL CARE The major objective of antenatal care (ANC) is to identify and treat problems during pregnancy such as anemia and infection. It is during an antenatal care visit that screening for complications and advice on a range of issues, including birth preparedness, place of delivery, and referral of mothers with complications, occurs. Collecting information on antenatal care can be of great value in identifying subgroups of women who do not use such services and is useful in planning improvements in the services. The antenatal care findings from the 2009 Guyana Demographic and Health Survey (GDHS) provide information on the type of service provider, the number of antenatal care visits, the stage of pregnancy at the time of the first visit, and the services and information provided during antenatal care, including whether tetanus toxoid was received. Table 9.1 presents the percent distribution of women age 15-49 who had a live birth in the five years preceding the survey. The women are categorized by the type of antenatal care provider consulted during the pregnancy for the most recent birth and according to their background characteristics. If a woman received antenatal care from more than one provider, the provider with the highest qualifications was recorded. • Among women who had a birth in the five years preceding the survey, 92 percent received antenatal care from a health professional for their most recent birth, 51 percent from a nurse/midwife and 35 percent from a doctor. • Older mothers age 35-49 (87 percent) are somewhat less likely to receive antenatal care than younger mothers (92 to 93 percent). Women who had six or more births (77 percent) are significantly less likely to receive antenatal care from a skilled provider than women with fewer births (91 to 94 percent). • Urban women are more likely than rural women to have received antenatal care from a health professional (98 and 90 percent, respectively). Antenatal care was received by only 78 percent of women in the Interior area compared with 95 percent of women in the Coastal area. While antenatal care from a skilled provider is almost universal among women in Regions 3, 4, 5, 6 and 10, only 35 percent of women in Region 9 had antenatal care from a skilled provider (with 42 percent of women in Region 9 having received ANC by a community health worker). • Eighty-six percent of women with no education received antenatal care from a health professional compared with 95 percent of women with more than secondary education. Similarly, the percentage of women who received ANC from a health professional increased steadily from 79 percent of women in the poorest wealth quintile to 98 percent of those in the highest wealth quintile. • Doctors provide ANC for 53 percent of women in Region 4 compared with only 6 percent of women in Region 1. Nurses/midwives provide antenatal care for a large proportion of women in Region 6 (79 percent) and Region 1 (70 percent) compared with 15 percent of women in Region 9. 126 | Reproductive Health Table 9.1 Antenatal care Percent distribution of women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Guyana 2009 Antenatal care provider Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Medex Community health worker Other No one Missing Total Percentage receiving antenatal care from a skilled provider1 Number of women Mother's age at birth <20 27.2 56.2 0.1 8.9 4.0 0.4 3.1 0.3 100.0 92.3 302 20-34 35.0 51.9 0.4 5.7 4.1 1.3 1.5 0.1 100.0 93.0 944 35-49 44.2 39.1 0.0 3.3 7.8 1.4 2.9 1.2 100.0 86.7 179 Birth order 1 37.2 50.7 0.4 5.8 2.9 0.0 3.1 0.0 100.0 94.0 454 2-3 36.0 51.7 0.3 6.2 3.5 1.3 0.8 0.3 100.0 94.1 614 4-5 32.3 52.7 0.0 5.8 6.2 1.7 1.3 0.0 100.0 90.8 231 6+ 21.4 48.2 0.2 7.4 12.3 3.1 5.7 1.7 100.0 77.2 126 Residence Total Urban 50.9 45.4 0.0 1.7 0.3 0.2 1.5 0.0 100.0 98.0 346 Georgetown (urban) 57.2 41.6 0.0 0.0 0.0 0.0 1.2 0.0 100.0 98.8 223 Other (urban) 39.5 52.4 0.0 4.8 0.7 0.5 2.1 0.0 100.0 96.6 123 Total Rural 29.2 53.1 0.4 7.5 5.9 1.4 2.2 0.4 100.0 90.1 1,080 Total Coastal 39.3 51.7 0.2 4.0 2.2 0.5 1.7 0.3 100.0 95.2 1,160 Coastal (urban) 50.9 45.4 0.0 1.7 0.3 0.2 1.5 0.0 100.0 98.0 346 Coastal (rural) 34.4 54.4 0.3 5.0 3.1 0.6 1.8 0.4 100.0 94.0 815 Total Interior 13.4 49.1 0.4 15.4 14.5 3.9 3.3 0.1 100.0 78.2 265 Region Region 1 5.5 70.1 0.0 16.0 4.1 0.9 3.4 0.0 100.0 91.6 103 Region 2 16.6 32.3 0.0 22.2 24.1 0.0 4.0 0.8 100.0 71.1 80 Region 3 31.2 51.9 0.8 10.7 1.2 0.6 3.2 0.6 100.0 94.5 189 Region 4 52.7 44.8 0.0 0.5 0.6 0.0 1.4 0.0 100.0 98.1 534 Region 5 36.5 58.1 0.0 0.0 0.0 1.8 1.9 1.8 100.0 94.5 105 Region 6 16.5 78.6 0.6 1.5 0.5 1.4 0.9 0.0 100.0 97.2 194 Region 7 14.4 39.0 0.4 20.6 23.0 1.7 0.4 0.5 100.0 74.4 48 Region 8 26.0 32.7 1.4 21.9 8.6 3.7 5.7 0.0 100.0 82.0 47 Region 9 14.1 14.5 0.7 6.0 42.3 17.9 4.5 0.0 100.0 35.3 38 Region 10 42.2 47.9 0.0 5.0 4.1 0.0 0.8 0.0 100.0 95.1 88 Mother's education No education (18.6) (62.0) (0.0) (5.3) (5.1) (1.1) (5.4) (2.5) (100.0) (85.9) 40 Primary 24.6 56.1 0.1 9.4 5.6 1.4 2.5 0.3 100.0 90.2 290 Secondary 36.9 50.0 0.4 5.4 4.5 1.0 1.7 0.2 100.0 92.6 989 More than secondary 44.9 45.6 0.0 4.2 1.2 1.1 3.0 0.0 100.0 94.7 106 Wealth quintile Lowest 19.2 48.0 0.3 11.7 14.0 3.1 3.7 0.0 100.0 79.2 361 Second 27.1 63.7 0.1 4.1 2.3 0.6 1.7 0.4 100.0 95.0 297 Middle 34.2 55.1 0.0 6.3 1.2 0.2 2.4 0.5 100.0 95.7 278 Fourth 40.4 50.8 1.1 5.0 0.8 0.5 1.5 0.0 100.0 97.2 241 Highest 60.2 36.9 0.0 1.1 0.8 0.5 0.1 0.5 100.0 98.1 247 Total 34.5 51.2 0.3 6.1 4.5 1.1 2.0 0.3 100.0 92.1 1,425 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Figures in parentheses are based on 25-49 unweighted cases. 1 Skilled provider includes doctor, nurse, midwife, auxiliary nurse/midwife, and medex. Reproductive Health | 127 Antenatal care is more beneficial in preventing adverse outcomes when it is sought early in the pregnancy and is continued through to delivery. Under normal circumstances, the World Health Organization (WHO) recommends that a woman without complications have at least four antenatal care visits, the first of which should take place during the first trimester. Table 9.2 presents information on antenatal care visits, including the number of visits and the timing of the first visit, according to residence. • Almost eight in ten (79 percent) women with a live birth in the five years preceding the survey had four or more antenatal care visits, as recommended, without significant differences by place of residence. • Almost half of the visits (49 percent) took place during the first trimester, as recommended, ranging from a low of 42 percent in the Interior area to 67 percent in the Georgetown (urban) area. • The median number of months pregnant at the first visit among women who received ANC was 4 months; 3.7 months in Total Urban areas compared with 4.1 months in Total Rural areas, and 3.9 months in the Total Coastal areas compared with 4.3 months in the Total Interior areas. Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, by the timing of the first visit, and by median months pregnant at first visit among women with ANC, according to residence, Guyana 2009 Urban-Rural residence Coastal-Interior residence Urban Coastal Age group/rate Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior Total Number of ANC visits None 1.5 1.2 2.1 2.2 1.7 1.5 1.8 3.3 2.0 1 0.3 0.0 0.8 1.0 0.8 0.3 1.0 0.7 0.8 2-3 2.3 0.0 6.4 5.4 3.8 2.3 4.5 8.4 4.7 4+ 82.1 83.3 79.9 77.3 79.7 82.1 78.7 73.1 78.5 Don't know/missing 13.8 15.5 10.8 14.1 13.9 13.8 14.0 14.5 14.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 1.5 1.2 2.1 2.2 1.7 1.5 1.8 3.3 2.0 <4 58.9 66.9 44.4 45.5 50.4 58.9 46.8 41.7 48.8 4-5 28.8 23.6 38.3 34.2 34.2 28.8 36.5 27.1 32.9 6-7 9.4 7.7 12.4 12.5 10.5 9.4 11.0 17.1 11.7 8+ 0.9 0.5 1.6 2.0 0.8 0.9 0.7 5.7 1.7 Don't know/missing 0.4 0.0 1.2 3.6 2.3 0.4 3.1 5.1 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 346 223 123 1,080 1,160 346 815 265 1,425 Median months pregnant at first visit (for those with ANC) 3.7 3.6 4.2 4.1 3.9 3.7 4.0 4.3 4.0 Number of women with ANC 341 220 120 1,052 1,137 341 796 256 1,392 128 | Reproductive Health 9.1.1 Content of Antenatal Care The quality of antenatal care is measured to a large extent by the essential service package provided to pregnant women. The components of this package include prevention and management of anemia and malaria, which are achieved through screening and appropriate management. Micronutrient supplementation, tetanus immunization, and monitoring of certain vital signs to help in the early detection and management of complications that may arise are also included in this important care package. Pregnancy complications are a primary source of maternal and newborn morbidity and mortality. Therefore, ensuring that pregnant women receive information on the signs of complications is an important component of antenatal care. To help assess antenatal care services, respondents were asked whether they had been advised of possible pregnancy complications and whether they had received certain screening tests during at least one of their antenatal care visits. Caution should be used in considering this information on the components of antenatal care because it depends on pregnant women’s recall of events during antenatal care that may have taken place a number of years before the interview. Nevertheless, the results are useful in providing insights into the content of antenatal care. Table 9.3 presents information on the percentage of pregnant women who took iron tablets or syrup, took drugs for intestinal parasites, were informed of the signs of pregnancy complications, and re- ceived other selected services during antenatal care visits for their most recent birth in the past five years. Information on pregnant women who took preventive treatment for malaria is covered in Chapter 12. • More than four in five women with a live birth in the last five years (83 percent) took iron tablets or syrup during the pregnancy of their most recent birth, but only 17 percent took drugs for intestinal parasites. • Consumption of iron tablets decreases with age and birth order. • Women residing in urban areas (93 percent), those in Regions 4 and 10 (88 percent), women with more than secondary education (90 percent), and those living in the wealthiest households (90 percent) are more likely to take iron supplements than other women. • Consumption of drugs for intestinal parasites increases with age and birth order and is slightly higher in urban than in rural areas. The regional differences are quite pronounced: 8 percent of women in Region 7 received intestinal drugs during their most recent pregnancy compared with 34 percent in Region 1. Consumption of drugs tends to decrease with an increase in education and wealth. • Two-thirds (66 percent) of women who received antenatal care for their most recent birth in the five years before the survey reported that they had been informed of the signs of pregnancy complications. Urban area women (79 percent) are more likely to be informed of signs of pregnancy complications than are Rural area women (62 percent), and women in the Coastal area (68 percent) are more likely than women in the Interior area (59 percent) to receive this information. Among regions, the percentage of women who were informed of signs of pregnancy complications ranges from 51 percent in Region 2 to 81 percent in Region 10. The likelihood of receiving this information increases steadily with education and the wealth quintile. • Among women receiving antenatal care, 97 percent said they were weighed, 98 percent had their blood pressure measured, 95 percent had a urine sample taken, and 93 percent had a blood sample taken. Being weighed and having the blood pressure measured during an antenatal care visit is almost universal in all regions except for Region 9 (74 and 75 percent, respectively). Urine and blood samples during antenatal care are also almost universal in all regions but three: Regions 1, 8, and 9. Reproductive Health | 129 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Guyana 2009 Among women with a live birth in the last five years, the percentage who during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the last five years, the percentage with selected services: Number of women Background characteristic Took iron tablets or syrup Took intestinal parasite drugs Number of women with a live birth in the past five years Informed of signs of pregnancy complications Weighed Blood pressure measured Urine sample taken Blood sample taken with ANC for their most recent birth Mother's age at birth <20 82.9 13.4 302 63.2 97.4 97.7 94.2 92.0 292 20-34 83.7 18.0 944 67.6 97.0 97.6 94.7 93.1 929 35-49 78.1 19.4 179 65.5 95.7 96.8 94.0 90.7 172 Birth order 1 84.2 9.9 454 68.4 99.0 99.2 95.4 96.5 440 2-3 86.1 17.5 614 66.8 96.4 97.6 95.7 93.1 608 4-5 83.1 24.6 231 64.0 96.0 96.6 92.9 91.3 228 6+ 61.3 28.7 126 61.9 93.8 93.0 87.7 77.5 117 Residence Total Urban 92.6 18.5 346 79.1 99.7 99.7 98.6 99.7 341 Georgetown (urban) 94.7 14.8 223 81.3 100.0 100.0 99.2 100.0 220 Other (urban) 89.0 25.2 123 75.0 99.2 99.2 97.7 99.2 120 Total Rural 79.6 16.8 1,080 62.3 96.0 96.8 93.1 90.3 1,052 Total Coastal 85.2 15.6 1,160 68.1 98.1 98.6 97.0 97.5 1,137 Coastal (urban) 92.6 18.5 346 79.1 99.7 99.7 98.6 99.7 341 Coastal (rural) 82.0 14.4 815 63.4 97.4 98.2 96.3 96.5 796 Total Interior 72.3 24.2 265 59.0 91.9 92.7 83.2 70.8 256 Region Region 1 70.4 34.3 103 51.8 95.3 95.7 87.1 58.9 99 Region 2 80.8 19.2 80 51.3 99.4 98.7 98.9 96.5 77 Region 3 83.5 11.0 189 60.6 98.6 98.6 98.2 98.7 182 Region 4 87.7 12.7 534 72.8 97.9 98.6 96.2 97.3 527 Region 5 79.6 22.5 105 68.9 97.2 98.1 98.1 95.9 101 Region 6 81.9 20.8 194 64.2 97.4 98.6 95.9 97.2 192 Region 7 82.8 8.4 48 63.8 99.2 99.2 95.1 88.2 47 Region 8 77.5 20.3 47 61.3 86.1 91.0 76.2 75.3 45 Region 9 57.0 25.0 38 56.0 73.8 75.0 54.6 56.5 36 Region 10 87.6 21.3 88 80.6 100.0 98.9 98.9 98.1 87 Mother's education No education (70.2) (15.6) 40 (58.5) (94.3) (95.4) (97.0) (93.5) 37 Primary 71.9 21.8 290 59.3 95.9 95.9 90.7 84.8 282 Secondary 85.7 16.6 989 67.9 97.2 98.0 95.6 94.7 971 More than secondary 89.9 10.8 106 75.0 98.8 98.8 93.9 93.8 103 Wealth quintile Lowest 75.0 23.6 361 53.5 92.4 93.1 87.6 80.1 348 Second 82.2 13.7 297 65.2 98.4 98.1 96.0 94.9 291 Middle 83.2 15.9 278 70.4 98.9 99.6 96.6 97.5 270 Fourth 87.1 17.3 241 74.1 97.5 98.8 95.2 95.3 238 Highest 90.3 13.5 247 74.5 99.0 99.5 99.5 99.5 246 Total 82.8 17.2 1,425 66.4 96.9 97.5 94.5 92.6 1,392 Note: Figures in parentheses are based on 25-49 unweighted cases. 9.1.2 Tetanus Toxoid Injections Neonatal tetanus is a leading cause of neonatal death in developing countries where a high proportion of deliveries are conducted at home or in places where hygienic conditions may be poor. Tetanus toxoid (TT) immunization is given to pregnant women to prevent neonatal tetanus. If a woman has received no previous TT injections, for full protection a pregnant woman needs two doses of TT during pregnancy. However, if a woman was immunized before she became pregnant, she may require 130 | Reproductive Health one or no TT injections during pregnancy, depending on the number of injections she has previously received and the timing of the last injection. For a woman to have lifetime protection, a total of five doses is required. The 2009 GDHS collected information on whether women received at least two TT injections and whether the pregnancy for the most recent live birth in the five years preceding the survey was protected against neonatal tetanus. Table 9.4 shows the percentage of women who received two or more tetanus toxoid injections and the percentage whose last birth was protected against neonatal tetanus, by background characteristics, and Figure 9.1 shows the same indicators by residence. Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections (TTI) during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Guyana 2009 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother's age at birth <20 18.1 29.9 302 20-34 18.7 34.8 944 35-49 22.1 40.6 179 Birth order 1 23.5 31.3 454 2-3 14.1 32.5 614 4-5 23.2 41.1 231 6+ 18.9 43.6 126 Residence Total Urban 31.9 49.6 346 Georgetown (urban) 44.9 60.1 223 Other (urban) 8.3 30.8 123 Total Rural 14.9 29.7 1,080 Total Coastal 18.9 33.4 1,160 Coastal (urban) 31.9 49.6 346 Coastal (rural) 13.3 26.5 815 Total Interior 19.6 39.4 265 Region Region 1 13.0 38.2 103 Region 2 21.3 39.8 80 Region 3 5.5 17.7 189 Region 4 29.4 43.0 534 Region 5 7.0 26.5 105 Region 6 12.2 23.1 194 Region 7 24.4 44.5 48 Region 8 39.9 55.3 47 Region 9 19.2 35.2 38 Region 10 4.3 27.5 88 Mother's education No education (19.4) (34.9) 40 Primary 14.9 34.3 290 Secondary 19.8 34.1 989 More than secondary 22.3 38.4 106 Wealth quintile Lowest 18.9 37.6 361 Second 17.3 30.2 297 Middle 11.4 27.8 278 Fourth 29.8 41.1 241 Highest 19.3 36.4 247 Total 19.0 34.5 1,425 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes mothers with two injections during the pregnancy of her last birth (19 percent), or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within five years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections prior to the last birth Reproductive Health | 131 • Only one in five mothers (19 percent) received two or more doses of tetanus toxoid during their last pregnancy. Mothers residing in urban areas are more than twice as likely to receive two TT injections as those residing in rural areas (32 and 15 percent, respectively). Coverage with at least two doses ranges from 7 percent or less in Regions 3, 5, and 10 to 40 percent in Region 8. There are no clear patterns in the relationship between the percentage of women who received two or more TT injections during their last pregnancy and education or wealth. • Taking vaccinations given during previous pregnancies into account, a total of 35 percent of recent births were protected against neonatal tetanus. Thirty percent of births to mothers under age 20 were protected, compared with 41 percent of births to women age 35 or older. • Protection against neonatal tetanus is much higher in urban areas than in rural areas (50 and 30 percent, respectively). However, in urban areas outside of Georgetown, only 31 percent of births are protected against neonatal tetanus. Protection ranges from 18 percent in Region 3 to 55 percent in Region 8. Although protection against neonatal tetanus increases steadily with the mother’s age at birth and birth order, the effect of education and wealth quintile is not clear. 9.2 DELIVERY CARE Labor and delivery is the shortest and most critical period of the pregnancy-childbirth continuum because most maternal deaths arise from complications during delivery. Even with the best possible antenatal care, any delivery can become a complicated one and, therefore, skilled assistance is essential to safe delivery care. For numerous reasons, many women do not seek skilled care even when they understand the safety reasons for doing so. Some reasons include cost of service, the distance to the health facility, and quality of care. Figure 9.1 Two Tetanus Vaccinations during Last Pregnancy and Births Protected against Neonatal Tetanus, by Residence 19 32 45 8 15 19 32 13 20 35 50 60 31 30 33 50 27 39 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior 0 10 20 30 40 50 60 70 Percentage of women Two vaccines Last birth protected GDHS 2009 132 | Reproductive Health Respondents in the 2009 GDHS were asked to report the place of birth for all their children born in the five years preceding the survey and to also report those who assisted during the delivery. Table 9.5 shows the percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics. Table 9.6 shows the percent distribution of live births in the five years preceding the survey by person providing assistance, according to background characteristics. If the respondent mentioned more than one person attending during delivery, only the most qualified person is reported. Place of delivery • Overall, 89 percent of births in the five years preceding the survey in Guyana were delivered in a health facility, mostly from public sector facilities (78 percent). • The percentage of deliveries that take place in a health facility decreases with an increase in the birth order, and the percentage is higher for births to women who received antenatal care during pregnancy than for births to women who received none. Births in urban areas are more likely to be delivered in a health facility than births in rural areas (97 percent versus 87 percent), and births in the Coastal area are much more likely to be delivered in a health facility than births in the Interior area (94 percent versus 71 percent). • There are large variations by region. The percentage of births delivered in a health facility ranges from 46 percent in Region 9 to 96 percent in Region 4. • As might be expected, the percentage of births delivered in a health facility increases with the mother’s education and ranges from 72 percent of births to uneducated mothers to 96 percent of births to mothers with more than secondary education. Additionally, the percentage is lowest (74 percent) for births to mothers in the lowest wealth quintile compared with other births (94 to 96 percent). • One in eleven births (9 percent) take place at home. Only 2 percent of births in the Urban areas take place at home compared with 11 percent in Rural areas. One in four births (25 percent) in the Interior area take place at home. The proportion of births that takes place at home ranges from 2 percent in Region 4 to 52 percent in Region 9. • Births of 6th or higher order (17 percent), those to mothers with no education (20 percent), and births in the lowest wealth quintile (23 percent) are more likely to occur at home than other births. Reproductive Health | 133 Table 9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Health facility Percentage –––––––––––––––––––––––––––– delivered Hospital/ Don’t in a Number Background Public Private clinic know/ health of characteristic sector sector abroad Home Other missing Total facility births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 86.4 3.3 0.2 8.5 0.5 1.2 100.0 89.8 456 20-34 75.9 13.0 0.6 8.4 0.3 1.9 100.0 89.5 1,221 35-49 73.2 11.3 0.0 9.5 0.0 6.0 100.0 84.5 209 Birth order 1 81.0 12.2 0.5 5.2 0.4 0.7 100.0 93.7 622 2-3 76.7 12.6 0.5 8.0 0.1 2.2 100.0 89.8 792 4-5 79.3 5.6 0.0 12.1 0.1 2.8 100.0 85.0 296 6+ 72.8 2.6 0.6 16.8 1.1 6.1 100.0 75.9 176 Antenatal care visits1 None (65.3) (6.2) (0.0) (25.3) (3.2) (0.0) (100.0) (71.5) 29 1-3 85.4 5.9 2.4 6.3 0.0 0.0 100.0 93.7 78 4+ 78.7 13.7 0.3 7.0 0.2 0.2 100.0 92.7 1,119 Don't know/missing 75.7 9.2 0.5 9.2 0.5 5.0 100.0 85.3 200 Residence Total Urban 78.2 18.6 0.4 1.5 0.0 1.3 100.0 97.2 425 Georgetown (urban) 68.8 27.8 0.7 1.3 0.0 1.4 100.0 97.2 265 Other (urban) 93.8 3.3 0.0 1.8 0.0 1.1 100.0 97.1 159 Total Rural 78.2 8.1 0.4 10.6 0.4 2.4 100.0 86.7 1,462 Total Coastal 80.6 13.0 0.4 3.9 0.3 1.8 100.0 94.0 1,477 Coastal (urban) 78.2 18.6 0.4 1.5 0.0 1.3 100.0 97.2 425 Coastal (rural) 81.6 10.8 0.3 4.9 0.4 2.0 100.0 92.7 1,053 Total Interior 69.4 1.1 0.6 25.1 0.2 3.6 100.0 71.1 409 Region Region 1 73.8 0.4 0.0 19.9 0.0 5.9 100.0 74.2 164 Region 2 84.9 0.7 0.0 11.5 0.0 2.9 100.0 85.6 108 Region 3 83.5 10.8 0.0 4.4 0.4 0.9 100.0 94.3 234 Region 4 73.0 22.8 0.6 2.0 0.2 1.4 100.0 96.3 666 Region 5 83.8 6.3 1.2 4.1 0.5 4.0 100.0 91.4 139 Region 6 90.0 1.1 0.0 6.1 0.5 2.3 100.0 91.1 253 Region 7 83.8 1.9 0.0 13.0 0.0 1.3 100.0 85.7 65 Region 8 63.6 0.0 0.9 31.6 1.3 2.6 100.0 64.5 72 Region 9 43.2 0.0 2.8 52.0 0.0 2.0 100.0 46.0 62 Region 10 88.3 5.1 0.0 5.9 0.0 0.8 100.0 93.4 124 Mother's education No education 72.3 0.0 0.0 19.6 0.0 8.2 100.0 72.3 60 Primary 79.4 4.2 0.1 13.5 0.1 2.7 100.0 83.7 416 Secondary 79.5 10.9 0.4 6.9 0.4 1.8 100.0 90.9 1,282 More than secondary 63.3 30.8 1.4 3.4 0.0 1.0 100.0 95.6 129 Wealth quintile Lowest 73.3 0.7 0.4 22.6 0.2 2.9 100.0 74.4 545 Second 90.1 2.8 0.7 4.7 0.3 1.4 100.0 93.6 399 Middle 90.4 5.3 0.1 2.1 0.4 1.7 100.0 95.8 349 Fourth 74.8 20.1 0.9 2.0 0.6 1.5 100.0 95.8 293 Highest 60.1 34.9 0.0 2.0 0.0 3.1 100.0 95.0 301 Total 78.2 10.5 0.4 8.5 0.3 2.2 100.0 89.0 1,886 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Information on antenatal care visits includes only the most recent birth in the five years preceding the survey 134 | Reproductive Health Table 9.6 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, the percentage of births assisted by a skilled provider, and the percentage delivered by caesarean section, according to background characteristics, Guyana 2009 Person providing assistance during delivery Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ auxiliary midwife Medex Traditional birth attendant Relative/ other No one Don't know/ missing Total Percentage delivered by a skilled provider1 Percentage delivered by C- section Number of births Mother's age at birth <20 30.3 56.5 1.4 5.4 1.0 5.1 0.0 0.2 100.0 93.6 10.0 456 20-34 31.5 57.0 1.2 2.3 0.6 6.1 0.6 0.7 100.0 92.0 14.1 1,221 35-49 32.0 49.4 3.1 3.1 0.8 7.3 1.4 2.8 100.0 87.6 15.6 209 Birth order 1 39.0 52.0 1.1 3.6 0.7 3.0 0.1 0.5 100.0 95.7 17.8 622 2-3 29.3 59.8 1.5 2.5 0.4 5.3 0.5 0.7 100.0 93.1 13.3 792 4-5 28.0 56.5 1.2 2.9 1.1 7.8 1.4 1.1 100.0 88.6 8.7 296 6+ 18.2 52.7 3.0 4.7 1.5 16.6 0.8 2.4 100.0 78.7 5.2 176 Place of delivery Health facility 35.0 59.6 1.5 3.0 0.1 0.5 0.1 0.2 100.0 99.1 14.9 1,679 Elsewhere 1.6 31.6 1.2 5.4 6.9 48.2 5.1 0.0 100.0 39.8 0.0 166 Missing 0.0 7.7 0.0 0.0 0.0 60.2 0.0 32.1 100.0 7.7 0.0 41 Residence Total Urban 38.1 59.9 0.1 0.1 0.0 1.0 0.2 0.6 100.0 98.2 18.5 425 Georgetown (urban) 43.3 55.3 0.0 0.0 0.0 0.8 0.0 0.7 100.0 98.5 18.9 265 Other (urban) 29.5 67.5 0.4 0.3 0.0 1.4 0.4 0.5 100.0 97.7 17.9 159 Total Rural 29.3 54.9 1.8 4.0 0.9 7.4 0.7 0.9 100.0 90.1 11.8 1,462 Total Coastal 36.4 58.1 1.1 0.6 0.4 2.0 0.4 1.0 100.0 96.2 15.5 1,477 Coastal (urban) 38.1 59.9 0.1 0.1 0.0 1.0 0.2 0.6 100.0 98.2 18.5 425 Coastal (rural) 35.7 57.5 1.4 0.8 0.5 2.4 0.6 1.2 100.0 95.4 14.3 1,053 Total Interior 12.8 48.5 2.9 12.2 1.9 20.5 0.9 0.1 100.0 76.5 5.1 409 Region Region 1 6.1 52.1 1.3 17.7 1.6 20.7 0.5 0.0 100.0 77.2 2.4 164 Region 2 22.2 57.3 5.0 3.4 4.0 6.9 0.0 1.2 100.0 87.9 10.2 108 Region 3 39.0 51.4 4.1 0.0 0.6 2.3 1.7 0.9 100.0 94.6 22.6 234 Region 4 42.7 55.5 0.0 0.2 0.0 0.9 0.0 0.8 100.0 98.3 16.9 666 Region 5 42.4 52.4 0.0 0.0 0.0 2.0 0.6 2.7 100.0 94.8 14.8 139 Region 6 21.8 72.3 0.0 1.5 0.0 2.7 0.4 1.2 100.0 95.7 5.3 253 Region 7 14.1 52.1 8.9 15.5 0.6 8.1 0.0 0.7 100.0 90.6 3.5 65 Region 8 24.9 38.8 0.0 8.5 0.4 26.9 0.5 0.0 100.0 72.1 12.2 72 Region 9 13.9 32.1 6.3 4.8 6.6 34.5 1.9 0.0 100.0 57.0 2.7 62 Region 10 24.9 67.1 0.5 1.6 0.4 3.7 1.7 0.0 100.0 94.2 18.8 124 Mother's education No education 17.1 48.5 1.0 4.6 0.0 24.1 1.4 3.4 100.0 71.1 5.9 60 Primary 21.4 61.3 0.3 5.0 1.4 9.4 0.6 0.6 100.0 88.0 12.5 416 Secondary 33.8 55.1 2.0 2.7 0.6 4.5 0.5 0.9 100.0 93.5 12.9 1,282 More than secondary 44.5 52.7 0.2 0.6 0.5 1.5 0.0 0.0 100.0 98.0 22.8 129 Wealth quintile Lowest 21.5 49.1 2.3 8.1 2.2 15.5 1.1 0.1 100.0 81.0 5.6 545 Second 28.4 64.0 0.4 3.1 0.3 2.7 0.0 1.0 100.0 96.0 11.9 399 Middle 32.6 60.1 1.8 0.6 0.0 3.2 0.9 0.7 100.0 95.2 16.9 349 Fourth 40.0 56.5 1.8 0.0 0.0 0.9 0.4 0.5 100.0 98.2 20.7 293 Highest 42.8 53.0 0.5 0.0 0.0 1.3 0.0 2.3 100.0 96.3 17.7 301 Total 31.3 56.1 1.5 3.1 0.7 6.0 0.5 0.8 100.0 91.9 13.3 1,886 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse/midwife, and auxiliary nurse or auxiliary midwife. Reproductive Health | 135 Assistance at delivery • Overall, 92 percent of births in the five years preceding the survey were assisted by a skilled birth provider, mostly by a nurse or midwife (56 percent), followed by a doctor (31 percent). Friends and relatives assist at 6 percent of the deliveries. • Births to mothers under age 35 and low order births are more likely to have assistance at delivery by a skilled provider than births to older mothers and high order births. Furthermore, as expected, births in the Urban areas are more likely to receive assistance than births in the Rural areas, and births in the Coastal area are more likely than births in the Interior area to be assisted by a skilled health provider. The percentage of births assisted by a skilled provider is 57 percent in Region 9 compared with 98 percent in Region 4. • Births to mothers who have more education and births in the higher wealth quintiles are more likely to be assisted by a skilled provider than other births. For example, almost all births to mothers with more than secondary education (98 percent) are assisted by a skilled provider compared with 71 percent of births to mothers with no education. Cesarean section • One in eight births (13 percent) in the five years preceding the survey was delivered by caesarean section. The prevalence of C-section deliveries increases steadily with mother’s age and decreases with birth order. Regions 1, 6, 7, and 9 have the lowest levels of deliveries by C-section (2 to 5 percent), and Region 3 has the highest level (23 percent). The percentage of births delivered by C-section increases with a mother’s education and generally increases with wealth. 9.3 POSTNATAL CARE Skilled care for mothers is critical in the days after they give birth. Up to 45 percent of all maternal deaths occur within one day of delivery, and 65 percent occur within the first week. This period is also critical to newborn survival because 50 to 70 percent of life-threatening newborn illnesses occur within the first week of life (Manoff Group, 2005). A postnatal checkup within the first week of delivery is therefore an important strategy for ensuring optimal maternal and newborn health. To assess the extent of postnatal care utilization, women who were interviewed in the GDHS were asked about their most recent birth in the five years preceding the survey, specifically, whether they received a health checkup after the delivery, the timing of the first postnatal checkup, and the type of health provider performing the postnatal checkup. This information is shown in Tables 9.7 and 9.8, according to background characteristics. Timing of first postnatal checkup • Postnatal care data show that about two-thirds of women with a birth in the last five years (63 percent) receive a postnatal checkup within 24 hours of delivery, and about eight in ten (79 percent) are checked within the first two days. Two percent of women receive postnatal care 3 to 41 days after delivery, and 15 percent receive no postnatal care at all. • Births to older mothers and births of higher order are somewhat less likely to receive a postnatal checkup than births to young mothers and births of low order. Having a postnatal checkup within the most crucial period (first two days) is primarily associated with how many children a woman has; women with fewer children are more likely to have an early postnatal checkup than women with more children. • Women in the Urban area are more likely than women in the Rural area, and women in the Coastal area are more likely than women in the Interior area, to receive postnatal care overall, as well as in a timely manner. The regional differences are quite pronounced. 136 | Reproductive Health Although 90 percent of women in Region 4 received postnatal care within two days, only 58 percent of women in Region 4 received postnatal care within four hours of delivery. • Women in the highest wealth quintile (87 percent) are much more likely to have an early postnatal checkup than women in the lowest wealth quintile (65 percent), and a similar pattern is seen by level of education. Type of provider of first postnatal checkup • In Guyana, eight in ten women with a birth in the five years preceding the survey received their first postnatal checkup by a doctor, nurse, or midwife. Two percent, each, received their first postnatal care by a Medex or a community health worker. • Similar to the findings on the timing of postnatal care, older mothers age 35-49, and those with six or more children are less likely to receive a postnatal checkup by a skilled health provider than other women. • Women in the Urban area (94 percent) are more likely than women in the Rural area (81 percent) to receive postnatal care from a skilled health provider, as are women in the Coastal area (87 percent) when compared with women in the Interior area (71 percent). Looking at regions, the lowest percentage of women who had the first postnatal checkup done by a doctor, nurse, or midwife is in Region 9 (30 percent) and Region 1 (49 percent). The percentage of women who received their first postnatal checkup by a Medex is unusually high in Region 8 (20 percent) and the percentage who received it by a community health worker is relatively high in Region 9 (23 percent) when compared with the national averages of 2 percent, each. • The percentage of women who received their first postnatal checkup by a skilled health provider increases with education and wealth quintile. About six in ten women with no edu- cation (62 percent) and in the lowest wealth quintile (58 percent) had their first postnatal checkup by a doctor, nurse, or midwife compared with around nine of ten women with more than secondary education (89 percent) and in the highest wealth quintile (92 percent). Reproductive Health | 137 Table 9.7 Timing of postnatal care Among women age 15-49 with a birth in the five years preceding the survey, the percent distribution of mother’s first postnatal checkup for the last live birth by time after delivery, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Timing of first postnatal checkup ––––––––––––––––––––––––––––––––––––––––––––– Did not Less Don't receive Number Background than 4-23 1-2 3-41 know/ postnatal of characteristic 4 hours hours days days missing checkup1 Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 49.3 13.5 16.2 2.2 3.8 15.0 100.0 302 20-34 47.1 16.3 16.1 2.3 4.0 14.1 100.0 944 35-49 49.1 8.1 17.9 2.4 2.3 20.2 100.0 179 Birth order 1 45.6 16.1 19.6 2.1 3.9 12.7 100.0 454 2-3 50.7 16.5 13.7 2.4 3.6 13.0 100.0 614 4-5 46.3 10.6 17.1 1.6 4.0 20.4 100.0 231 6+ 44.9 8.1 16.5 3.5 3.3 23.7 100.0 126 Residence Total Urban 60.8 13.2 15.7 1.1 3.2 6.0 100.0 346 Georgetown (urban) 69.8 11.5 15.0 0.6 1.7 1.3 100.0 223 Other (urban) 44.5 16.3 16.8 2.0 5.9 14.5 100.0 123 Total Rural 43.7 15.2 16.6 2.7 3.9 18.0 100.0 1,080 Total Coastal 49.8 15.7 16.8 1.8 3.5 12.4 100.0 1,160 Coastal (urban) 60.8 13.2 15.7 1.1 3.2 6.0 100.0 346 Coastal (rural) 45.1 16.8 17.2 2.1 3.6 15.1 100.0 815 Total Interior 39.3 10.2 14.7 4.2 4.8 26.8 100.0 265 Region Region 1 37.1 9.8 8.6 2.7 2.3 39.6 100.0 103 Region 2 61.3 8.6 7.1 0.6 4.0 18.4 100.0 80 Region 3 28.7 24.9 20.8 4.0 2.9 18.7 100.0 189 Region 4 58.2 15.2 16.8 1.3 3.7 4.9 100.0 534 Region 5 33.5 9.8 9.8 2.1 3.2 41.5 100.0 105 Region 6 55.3 13.4 19.3 1.8 2.9 7.3 100.0 194 Region 7 37.8 14.5 21.6 1.2 8.5 16.3 100.0 48 Region 8 55.0 5.0 20.7 4.4 1.6 13.3 100.0 47 Region 9 27.2 8.5 11.2 15.0 10.7 27.5 100.0 38 Region 10 37.0 17.9 20.3 1.2 5.5 18.0 100.0 88 Education No education (41.4) (3.8) (18.1) (0.0) (6.1) (30.6) (100.0) 40 Primary 46.6 12.1 10.5 3.4 4.9 22.5 100.0 290 Secondary 48.6 14.9 18.2 1.9 3.4 12.9 100.0 989 More than secondary 47.0 23.5 14.2 3.3 2.6 9.4 100.0 106 Wealth quintile Lowest 38.4 12.2 14.6 4.0 4.8 25.9 100.0 361 Second 48.7 16.4 17.6 1.1 2.6 13.6 100.0 297 Middle 44.9 14.5 19.6 1.9 4.4 14.7 100.0 278 Fourth 54.5 17.2 14.6 1.2 3.4 9.0 100.0 241 Highest 57.4 14.1 15.5 2.6 3.1 7.3 100.0 247 Total 47.8 14.7 16.4 2.3 3.7 15.1 100.0 1,425 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes women who received the first postnatal checkup after 41 days 138 | Reproductive Health Table 9.8 Type of provider of first postnatal checkup Among women age 15-49 with a birth in the five years preceding the survey, the percent distribution by type of provider of the mother's first postnatal health check for the last live birth, according to background characteristics, Guyana 2009 Type of health provider of mother's first postnatal checkup Background characteristic Doctor/ nurse/ midwife Auxiliary nurse/ midwife Medex Community health worker Traditional birth attendant Other Don't know/ missing No postnatal checkup Total Number of women Mother's age at birth <20 78.3 0.1 3.4 2.4 0.3 0.0 0.6 15.0 100.0 302 20-34 81.2 0.2 1.8 1.6 0.3 0.2 0.4 14.1 100.0 944 35-49 72.1 1.2 2.5 3.8 0.1 0.0 0.2 20.2 100.0 179 Birth order 1 83.6 0.0 2.4 0.9 0.3 0.0 0.1 12.7 100.0 454 2-3 81.8 0.2 1.6 2.1 0.2 0.3 0.7 13.0 100.0 614 4-5 75.1 0.0 2.5 1.1 0.5 0.1 0.3 20.4 100.0 231 6+ 61.3 2.1 4.4 7.6 0.1 0.4 0.4 23.7 100.0 126 Residence Total Urban 93.5 0.0 0.1 0.0 0.2 0.0 0.2 6.0 100.0 346 Georgetown (urban) 98.7 0.0 0.0 0.0 0.0 0.0 0.0 1.3 100.0 223 Other (urban) 84.0 0.0 0.4 0.0 0.6 0.0 0.5 14.5 100.0 123 Total Rural 75.0 0.4 2.9 2.7 0.3 0.2 0.5 18.0 100.0 1,080 Total Coastal 85.5 0.1 0.7 0.8 0.1 0.1 0.2 12.4 100.0 1,160 Coastal (urban) 93.5 0.0 0.1 0.0 0.2 0.0 0.2 6.0 100.0 346 Coastal (rural) 82.1 0.1 0.9 1.2 0.1 0.2 0.2 15.1 100.0 815 Total Interior 53.0 1.2 9.1 7.5 0.9 0.2 1.2 26.8 100.0 265 Region Region 1 48.6 0.7 7.2 2.3 1.1 0.4 0.0 39.6 100.0 103 Region 2 64.7 1.5 1.9 11.9 0.7 0.8 0.0 18.4 100.0 80 Region 3 80.7 0.0 0.0 0.0 0.0 0.0 0.6 18.7 100.0 189 Region 4 94.6 0.0 0.5 0.0 0.0 0.0 0.0 4.9 100.0 534 Region 5 57.6 0.0 0.0 0.0 0.0 0.0 0.8 41.5 100.0 105 Region 6 89.5 0.0 2.0 0.0 0.4 0.5 0.3 7.3 100.0 194 Region 7 61.3 2.2 6.8 13.4 0.0 0.0 0.0 16.3 100.0 48 Region 8 59.9 0.9 19.8 4.7 1.0 0.4 0.0 13.3 100.0 47 Region 9 29.5 2.7 6.6 23.4 1.8 0.0 8.6 27.5 100.0 38 Region 10 79.8 0.0 1.8 0.2 0.2 0.0 0.0 18.0 100.0 88 Education No education (61.8) (1.5) (1.5) (1.7) (0.0) (2.8) (0.0) (30.6) (100.0) 40 Primary 70.6 0.3 2.2 3.1 0.4 0.0 0.8 22.5 100.0 290 Secondary 81.7 0.3 2.5 1.9 0.2 0.1 0.4 12.9 100.0 989 More than secondary 89.2 0.0 0.2 1.2 0.0 0.0 0.0 9.4 100.0 106 Wealth quintile Lowest 58.0 0.8 5.4 7.7 0.8 0.4 0.9 25.9 100.0 361 Second 82.5 0.3 2.8 0.6 0.0 0.0 0.2 13.6 100.0 297 Middle 83.2 0.0 1.5 0.0 0.0 0.2 0.3 14.7 100.0 278 Fourth 90.3 0.2 0.0 0.0 0.0 0.0 0.5 9.0 100.0 241 Highest 92.4 0.0 0.0 0.0 0.3 0.0 0.0 7.3 100.0 247 Total 79.5 0.3 2.3 2.1 0.3 0.2 0.4 15.1 100.0 1,425 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Reproductive Health | 139 9.4 PROBLEMS IN ACCESSING HEALTH CARE Where health services are present, there are many factors—social, cultural, and economic—that may cause women not to use the services, particularly when the health concern is related to sexual or reproductive matters. Information on such factors is particularly important in understanding and addressing the barriers women face in seeking care during pregnancy and at the time of delivery. In the 2009 GDHS, women were asked whether each of the following factors would be a big problem or not a big problem in seeking health care for themselves: getting permission to go for treatment, getting money for treatment, distance to a health facility, having to take transportation, not wanting to go alone to the health facility, concern that there may not be a health provider, and concern that there may be no drugs available. Table 9.9 provides women’s perceived problems in accessing health care for these seven specific reasons, according to background characteristics, including employment. • The main problems in accessing health care among women are the concern that no drugs may be available at the health facility (reported by 49 percent of women) and that a provider may not be available (reported by 44 percent of women). Furthermore, getting money for treatment was reported by 19 percent of women, not wanting to go alone by 17 percent of women, having to take transport and concern that no female provider may be available by 16 percent, each, and distance to the health facility was reported by 14 percent of women. Only 4 percent of women reported getting permission to go for treatment as a problem in accessing health care. • Overall, 62 percent of women reported at least one of the specified problems in accessing health care. This percentage declines somewhat with women’s age. There are important differences in the percentage of women reporting at least one problem by place of residence. Seventy percent of women in Rural areas report having at least one problem accessing health care compared with 45 percent in Urban areas (34 percent in Georgetown [urban]). Eighty-four percent of women in Region 3 and 82 in Region 5 report at least one problem in accessing health care compared with 53 percent in Region 4 and 55 percent in Region 2. • There are significant differences in the type of problem in accessing health care by region. For example, getting permission to go for care is reported by 12 percent of women in Region 8 and only 2 percent in Region 4. Thirty-nine percent of women in Region 5 report that getting money for treatment is a problem compared with 14 to 16 percent in Regions 2, 3, and 4. Thirty-eight percent of women in Region 7 say that distance to a health facility is a big problem in accessing care, compared with only 8 percent of women in Region 6. Concern that a female provider may not be available is most common in Region 5 (29 percent) and the lowest in Region 10 (9 percent). • The percentage of women who have at least one big problem in accessing health care for themselves decreases with education and wealth status. For example, about seven in ten women with no education or with primary education and women in the lowest quintile (67 and 72 percent, respectively) have at least one problem when accessing health care com- pared with less than half of women with more than secondary education and in the highest wealth quintile (47 and 49 percent, respectively). 140 | Reproductive Health Table 9.9 Problems in accessing health care Percentage of women who reported they have big problems in accessing health care for themselves when they are sick, by type of problem and background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Problems in accessing health care ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Getting Concern At least permission Getting Distance Not no Concern Concern one to go money to Having to wanting female no no problem Number Background for for health take to go provider provider drugs accessing of characteristic treatment treatment facility transport alone available available available health care women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 8.6 22.4 14.3 15.8 30.7 25.9 48.8 54.1 69.7 1,016 20-34 2.6 17.3 14.2 16.2 14.1 14.4 44.4 49.3 62.4 2,068 35-49 2.7 20.1 12.8 15.4 12.4 11.3 41.5 46.2 58.1 1,912 Number of living children 0 6.2 17.9 12.4 14.7 25.7 22.1 47.6 50.6 65.7 1,598 1-2 2.2 17.3 11.6 14.1 12.7 12.4 42.2 48.3 59.7 1,773 3-4 2.3 20.5 13.4 16.3 11.6 12.9 42.8 47.6 59.5 1,147 5+ 6.0 29.7 26.2 24.8 15.2 11.6 43.6 50.5 66.9 478 Marital status Never married 6.4 19.9 12.5 15.8 24.2 20.7 44.7 49.2 63.1 1,540 Married or living together 3.0 18.6 14.0 16.1 13.6 13.5 44.6 49.6 62.4 2,920 Divorced/separated/widowed 1.5 22.5 15.1 14.6 13.6 11.7 40.4 46.2 59.2 536 Employed last 12 months Not employed 4.5 21.6 14.2 17.0 18.3 17.3 44.9 50.9 65.1 3,004 Employed for cash 2.4 15.5 12.0 12.8 14.2 12.5 42.6 45.8 57.0 1,891 Employed not for cash 10.9 28.9 32.6 37.3 21.9 21.3 51.6 56.1 75.9 93 Missing 18.5 18.5 0.0 15.6 20.6 16.9 59.0 59.0 72.4 8 Residence Total Urban 3.3 15.4 8.1 11.7 12.9 11.0 29.7 34.5 44.9 1,475 Georgetown (urban) 2.9 15.6 6.7 10.9 11.2 11.3 20.8 25.9 34.4 967 Other (urban) 3.9 14.8 10.8 13.2 16.1 10.4 46.6 51.1 65.0 508 Rural 4.1 21.1 16.0 17.6 18.5 17.4 50.2 55.2 69.5 3,521 Total Coastal 3.4 17.9 11.6 14.0 16.5 15.6 44.8 49.6 62.1 4,495 Coastal (urban) 3.3 15.4 8.1 11.7 12.9 11.0 29.7 34.5 44.9 1,475 Coastal (rural) 3.4 19.1 13.2 15.1 18.3 17.9 52.1 57.0 70.5 3,019 Total Interior 8.5 33.0 32.7 32.2 19.9 14.7 38.9 44.3 63.8 501 Region Region 1 9.5 31.5 34.7 34.8 15.7 14.8 32.2 35.5 59.9 162 Region 2 3.3 13.9 11.2 11.9 14.7 13.9 39.7 40.5 54.7 293 Region 3 3.7 15.0 14.9 15.7 19.8 20.7 69.4 74.0 83.6 687 Region 4 2.2 15.6 9.6 11.7 14.8 14.6 35.5 41.3 53.4 2,168 Region 5 6.9 38.7 23.1 31.2 22.5 28.9 61.1 65.8 82.3 353 Region 6 4.8 18.4 8.4 11.2 17.3 11.0 41.2 46.0 57.6 780 Region 7 8.1 32.8 38.0 33.5 16.7 11.0 36.1 39.0 59.7 104 Region 8 11.5 35.5 27.9 27.4 26.1 17.9 52.8 63.2 70.6 95 Region 9 8.6 31.4 25.8 25.9 24.4 17.2 39.0 44.1 63.5 78 Region 10 2.9 23.5 18.0 22.0 14.8 8.6 49.3 53.2 73.5 277 Education No education 8.9 40.0 25.4 25.9 21.9 15.7 29.7 42.6 66.5 68 Primary 4.4 27.4 18.8 21.1 16.1 15.6 47.1 51.8 66.5 952 Secondary 3.9 18.1 13.0 14.9 17.7 16.2 44.6 49.6 62.7 3,568 More than secondary 1.5 8.7 6.0 9.6 10.2 9.6 36.1 39.4 47.4 409 Wealth quintile Lowest 7.9 36.5 29.0 31.7 22.6 18.4 45.4 51.1 71.9 779 Second 4.6 24.5 17.1 18.5 16.2 16.0 49.7 55.6 70.5 957 Middle 2.9 17.1 13.3 13.8 17.7 18.0 49.7 56.1 67.2 1,025 Fourth 3.5 15.9 9.7 14.3 15.7 13.8 41.1 44.2 57.8 1,084 Highest 1.8 9.0 4.5 6.2 13.8 12.6 36.7 40.8 48.7 1,151 Total 3.9 19.4 13.7 15.8 16.8 15.5 44.2 49.1 62.3 4,996 Child Health | 141 CHILD HEALTH 10 Reducing child mortality and morbidity, as well as improving the overall health and wellbeing of children are top priorities for the Government of Guyana and the Ministry of Health as part of their efforts to meet Millennium Development Goals (MDG) for the country. Child health services in Guyana are provided free of charge to all children and are integrated into the primary health care services through the Package of Guaranteed Public Health Services. These services are delivered through the five levels of care: health posts (Level 1), health centers (Level 2), district hospitals (Level 3), regional hospitals (Level 4), and national referral hospitals (Level 5). They are supported by a national referral system that allows for efficient movement of individuals from one level to another. In the rural communities, health services are provided in the health posts, health centers, and district hospitals, and these facilities are staffed with community health workers (CHW), midwives, nurses, and district medical officers. This chapter presents the findings on child health from the 2009 GDHS. It focuses particularly on neonatal conditions (birth weight and size at birth), children’s vaccination status, and treatment practices that are commonly used for children experiencing the three major childhood illnesses: acute respiratory infection (ARI), fever, and diarrhea. The information on children’s birth weight and size, treatment practices, and contact with health facilities when children are sick paves the way to strategic planning and implementation of programs to reduce neonatal and infant mortality. Combined with information on childhood mortality, this information can be used to identify subgroups of women and children who face increased risk because of non-use of maternal and child health (MCH) services, and to assist with planning effective improvements for these services. 10.1 CHILD’S SIZE AT BIRTH A child’s birth weight or size at birth is an important indicator of the child’s vulnerability to the risk of childhood illnesses and the chances of survival. Children whose birth weight is less than 2.5 kilograms, or children reported to be very small or smaller than average are considered to have a higher than average risk of early childhood illness and death. For births in the five years preceding the survey, birth weight was recorded in the questionnaire if available from written records or the mother’s recall. Because birth weight may not be known for many babies, the mother’s estimate of the baby’s size at birth was also obtained. Even though it is subjective, it can be a useful proxy for the weight of the child. Table 10.1 presents information on child’s weight and size at birth, according to background characteristics. • Birth weight was reported for 84 percent of live births in the five years preceding the survey. Of these births, 13 percent were reported (based on either a written record or the mother’s report) to be less than 2.5 kg. The percentage of births less than 2.5 kg is higher for births of mothers younger than 20 years (20 percent) and for first-order births (18 percent). The percentage of low-weight births tends to be higher for mothers with no primary education. Wealth and area of residence of mothers did not significantly influence birth weights. • All mothers were asked about their estimate of the baby’s size at birth. Seven percent of the births were estimated as very small and 14 percent as smaller than average by the mother. Three-quarters of the births (75 percent) were reported to be average or larger than average at birth. • Births of sixth or higher order (32 percent), those from the Interior area (27 percent), births to mothers with no education (28 percent) and births from the lowest wealth quintile (26 percent) are the most likely to be reported as very small or smaller than average by the mother when compared with other births. 142 | Child Health Table 10.1 Child’s weight and size at birth Percent distribution of live births in the five years preceding the survey, by birth weight; percent distribution of all live births in the five years preceding the survey, by mother’s estimate of baby’s size at birth; and percentage of all births with a reported birth weight, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Reported birth weight1 Percentage Size of child at birth –––––––––––––––––––––––––––––––– of all births ––––––––––––––––––––––––––––––––––––––––––––––––– Less 2.5 kg Number with a Smaller Average Don't Number Background than or of reported Very than or know/ of characteristic 2.5 kg. more Total births birth weight small average larger missing Total births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 19.8 80.2 100.0 389 85.3 7.3 16.9 73.2 2.6 100.0 456 20-34 11.1 88.9 100.0 1,024 83.9 7.3 12.5 76.8 3.4 100.0 1,221 35-49 10.5 89.5 100.0 167 80.1 5.9 17.4 69.8 6.9 100.0 209 Birth order 1 17.5 82.5 100.0 544 87.5 7.5 14.5 75.9 2.1 100.0 622 2-3 11.1 88.9 100.0 669 84.5 5.4 12.6 78.5 3.5 100.0 792 4-5 9.7 90.3 100.0 234 79.2 7.2 14.6 73.7 4.5 100.0 296 6+ 12.2 87.8 100.0 133 75.4 13.3 18.5 60.3 7.9 100.0 176 Mother's smoking status Smokes cigarettes/ tobacco (8.3) (91.7) (100.0) 37 68.9 4.1 22.4 71.4 2.1 100.0 54 Does not smoke 13.3 86.7 100.0 1,543 84.5 7.2 13.8 75.4 3.6 100.0 1,827 Residence Total Urban 12.9 87.1 100.0 382 89.9 5.4 11.6 80.9 2.1 100.0 425 Georgetown (urban) 12.0 88.0 100.0 242 91.2 3.8 8.7 85.4 2.1 100.0 265 Other (urban) 14.5 85.5 100.0 140 87.8 8.0 16.6 73.4 2.0 100.0 159 Total Rural 13.2 86.8 100.0 1,199 82.0 7.6 14.8 73.5 4.1 100.0 1,462 Total Coastal 13.6 86.4 100.0 1,277 86.4 5.8 13.8 77.4 2.9 100.0 1,477 Coastal (urban) 12.9 87.1 100.0 382 89.9 5.4 11.6 80.9 2.1 100.0 425 Coastal (rural) 13.8 86.2 100.0 895 85.0 6.0 14.7 76.1 3.3 100.0 1,053 Total Interior 11.5 88.5 100.0 304 74.3 11.9 15.0 67.0 6.1 100.0 409 Region Region 1 9.3 90.7 100.0 114 69.6 16.7 17.0 59.6 6.8 100.0 164 Region 2 11.1 88.9 100.0 92 84.6 6.1 10.8 78.7 4.3 100.0 108 Region 3 15.4 84.6 100.0 217 92.8 8.4 14.6 75.0 2.0 100.0 234 Region 4 11.4 88.6 100.0 576 86.6 4.1 12.0 81.6 2.4 100.0 666 Region 5 16.3 83.7 100.0 99 71.3 7.1 17.2 70.4 5.3 100.0 139 Region 6 17.6 82.4 100.0 219 86.7 6.2 17.3 72.3 4.2 100.0 253 Region 7 16.1 83.9 100.0 60 93.3 10.3 14.6 71.5 3.5 100.0 65 Region 8 13.8 86.2 100.0 54 75.0 5.7 16.3 71.7 6.3 100.0 72 Region 9 12.5 87.5 100.0 37 59.4 14.2 11.5 64.5 9.8 100.0 62 Region 10 10.6 89.4 100.0 112 90.1 6.9 13.3 79.1 0.8 100.0 124 Mother's education No education (21.5) (78.5) (100.0) 37 61.8 13.6 14.5 59.4 12.5 100.0 60 Primary 16.2 83.8 100.0 330 79.3 9.4 20.1 66.6 4.0 100.0 416 Secondary 11.7 88.3 100.0 1,096 85.5 6.3 13.2 77.1 3.3 100.0 1,282 More than secondary 15.8 84.2 100.0 118 91.0 4.8 3.7 90.5 1.0 100.0 129 Wealth quintile Lowest 11.7 88.3 100.0 400 73.3 10.7 15.3 68.3 5.8 100.0 545 Second 13.9 86.1 100.0 348 87.3 6.0 19.3 72.5 2.2 100.0 399 Middle 17.1 82.9 100.0 309 88.7 6.0 14.2 76.0 3.8 100.0 349 Fourth 10.2 89.8 100.0 265 90.5 5.7 10.9 82.2 1.2 100.0 293 Highest 12.9 87.1 100.0 258 85.9 4.8 8.1 83.4 3.7 100.0 301 Total 13.2 86.8 100.0 1,580 83.8 7.1 14.1 75.2 3.6 100.0 1,886 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Based on either a written record or the mother’s report Child Health | 143 10.2 VACCINATION OF CHILDREN The 2009 GDHS collected information on immunization coverage for all children born in the five years before the survey (since January 2004). The government of Guyana has adopted the World Health Organization (WHO) and UNICEF guidelines for vaccinating children. According to these guidelines, to be considered fully vaccinated, a child should receive the following vaccinations: one dose each of BCG and measles, three doses of polio vaccine, and three doses of diphtheria, pertussis (whooping cough), and tetanus (DPT) vaccine. In addition, even though no cases of yellow fever have been reported for the past three decades, a vaccine against yellow fever is also recommended for children in Guyana because the country is situated in the region of South America where the threat of yellow fever still exists. BCG, which protects against tuberculosis, should be given at birth or at first clinical contact. DPT and polio vaccine guidelines require three vaccinations at approximately 6, 10, and 14 weeks of age. The measles and yellow fever vaccines should be given between 9 and 18 months of age. In Guyana, vaccines against measles and rubella are given as part of the MMR vaccine. Currently, the pentavalent vaccine (DPT/HepB/HiB), has replaced the DPT vaccine. This vaccine contains, in addition to DPT, the hepatitis B vaccine and a vaccine against Haemophilus influenza type B. It is recommended that children receive the complete schedule of vaccinations before 12 months of age. In the GDHS, information on vaccination coverage was obtained in two ways—from health cards and from mothers’ verbal reports. All mothers were asked to show the interviewer the health cards on which the child’s immunizations are recorded. If the card was available, the interviewer copied the dates of each vaccination received. If a vaccination was not recorded on the card, the mother was asked to recall whether that particular vaccination had been given. If the mother was not able to present a card for a child, she was asked to recall whether the child had received BCG, polio, pentavalent, MMR/measles, and yellow fever vaccinations. If she recalled that the child had received the polio or pentavalent vaccines, she was asked about the number of doses that the child received. The data presented here are for children age 18-29 months, the youngest cohort of children who have reached the age by which they should be fully vaccinated, and are restricted to children who were alive at the time of the survey. 10.2.1 Vaccination at Any Time before the Survey Table 10.2 shows the percentage of children age 18-29 months who received specific vaccines at any time before the survey by source of information. These children are the youngest who have reached the age by which they should be fully vaccinated. The results are restricted to children who were alive at the time of the survey. Table 10.2 Vaccinations by source of information Percentage of children 18-29 months who received specific vaccines at any time before the survey, by source of information (vaccination card or the mother's report), and percentage vaccinated by 18 months of age, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Pentavalent1 Polio All Number ––––––––––––––– ––––––––––––––– Yellow basic of Source of information BCG 1 2 3 1 2 3 MMR Measles fever vaccines2 None children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Vaccination at any time before the survey Vaccination card 86.5 85.8 84.9 82.2 72.0 70.7 68.9 61.2 76.2 73.7 62.9 0.2 336 Mother's report 7.7 6.1 4.1 2.5 6.4 5.0 1.2 5.5 5.5 5.3 0.5 4.5 47 Either source 94.1 91.9 89.0 84.7 78.4 75.8 70.0 66.6 81.7 79.0 63.4 4.6 384 Vaccinated by 18 months of age3 94.1 91.9 89.0 83.0 77.5 75.8 68.3 59.4 77.2 75.1 58.4 4.6 384 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Pentavalent vaccine is also known as DPT+Hib+HepB 2 BCG, measles, and three doses each of pentavalent and polio vaccines 3 For children whose information was based on the mother’s report, the proportion of vaccinations given during the first 18 months of life was assumed to be the same as for children with a written record of vaccination. 144 | Child Health Table 10.3 shows the percentage of children age 18-29 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and the percentage with a vaccination card by background characteristics. Given the small number of cases, results are not shown by region. Figure 10.1 shows the vaccination coverage by type of vaccine, and Figure 10.2 shows the vaccination coverage by residence. Table 10.3 Vaccinations by background characteristics Percentage of children age 18-29 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and percentage with a vaccination card, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Pentavalent1 Polio All with Number Background ––––––––––––––– ––––––––––––––––– Yellow basic health of characteristic BCG 1 2 3 1 2 3 MMR Measles fever vaccines2 None card children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 92.4 90.4 88.8 82.1 76.9 74.4 68.5 63.9 81.4 77.5 62.4 6.2 87.0 190 Female 95.9 93.4 89.3 87.2 79.9 77.1 71.5 69.3 82.0 80.5 64.4 3.1 88.3 194 Birth order 1 91.9 86.0 83.7 75.8 76.2 73.5 61.9 65.1 79.8 73.1 55.9 5.9 79.0 117 2-3 95.3 94.6 92.3 90.8 78.7 76.5 74.5 65.5 83.5 84.3 68.5 4.4 92.1 181 4-5 94.3 92.0 87.8 86.7 80.5 76.3 75.7 76.2 87.4 80.6 70.5 4.3 88.3 55 6+ 94.9 98.4 92.5 78.6 80.9 78.8 64.8 62.0 67.9 67.3 49.7 1.6 93.2 31 Residence Total Urban 96.1 97.5 94.3 87.8 77.1 75.7 67.2 78.6 88.1 87.1 60.2 2.5 84.9 85 Total Rural 93.6 90.3 87.5 83.8 78.8 75.8 70.9 63.2 79.8 76.7 64.3 5.2 88.4 299 Total Coastal 95.2 93.5 90.5 87.3 78.5 75.8 70.3 67.5 84.8 81.9 63.8 3.8 86.9 287 Coastal (urban) 96.1 97.5 94.3 87.8 77.1 75.7 67.2 78.6 88.1 87.1 60.2 2.5 84.9 85 Coastal (rural) 94.8 91.7 88.8 87.1 79.1 75.8 71.6 62.9 83.4 79.7 65.4 4.4 87.7 202 Total Interior 91.0 87.4 84.7 76.8 78.1 75.6 69.3 63.9 72.4 70.4 62.1 7.0 90.0 97 Mother’s education No education * * * * * * * * * * * * * 7 Primary 93.2 93.7 87.4 81.8 88.4 85.8 78.2 61.9 79.0 78.8 67.3 4.7 90.0 88 Secondary 95.0 91.9 90.4 87.6 76.1 73.2 69.6 67.5 82.7 79.4 64.3 4.1 89.4 263 More than secondary (95.1) (92.2) (86.1) (68.4) (76.8) (76.8) (54.5) (85.3) (90.0) (82.6) 52.8 (3.2) (66.3) 26 Wealth quintile Lowest 89.1 84.8 82.2 76.5 79.6 76.4 68.8 56.2 69.4 70.4 59.9 9.0 84.1 134 Second 98.6 97.6 91.2 91.2 84.3 83.5 76.9 70.8 92.7 86.2 71.6 0.7 90.5 60 Middle 94.6 92.4 92.4 90.7 72.2 69.8 69.5 70.4 85.0 79.5 64.6 4.2 92.2 67 Fourth 94.8 94.2 92.1 88.4 82.3 78.0 72.0 72.4 89.2 85.2 68.8 3.5 88.2 52 Highest 99.0 98.4 94.6 86.2 74.0 71.9 65.6 75.0 87.0 84.0 57.9 1.0 87.3 71 Total 94.1 91.9 89.0 84.7 78.4 75.8 70.0 66.6 81.7 79.0 63.4 4.6 87.7 384 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Pentavalent vaccine is also known as DPT+Hib+HepB 2 BCG, measles, and three doses each of Pentavalent and polio vaccines Child Health | 145 Figure 10.1 Vaccination Coverage at Any Time before the Survey among Children 18-29 Months 63 94 92 89 85 78 76 70 67 82 79 All BCG PENTAVALENT 1 2 3 POLIO 1 2 3 MMR Measles Yellow fever 0 20 40 60 80 100 Percentage of children age 18-29 months who received specific vaccines GDHS 2009 Figure 10.2 Children Age 18-29 Months with All Vaccines at Any Time before the Survey, by Residence 63 60 64 64 60 65 62 Total Total Urban Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior 0 10 20 30 40 50 60 70 Percentage of children age 18-29 months fully vaccinated GDHS 2009 146 | Child Health ƒ The vaccination cards were seen for 88 percent of the children in the survey. ƒ Overall, 63 percent of Guyanese children age 18-29 months are fully immunized, and only 5 percent of the children have received no vaccinations at all. Fifty-eight percent of children age 18-29 months are fully vaccinated by 18 months of age. ƒ Looking at coverage for specific vaccines, 94 percent of children have received the BCG vaccination, 92 percent have received the first dose of pentavalent vaccine, and 78 percent have received the first polio dose (Polio 1). Coverage for the Pentavalent and polio vaccinations declines with subsequent doses; 85 percent of children received the recom- mended three doses of pentavalent vaccine, and 70 percent received three doses of polio vaccine. These figures reflect dropout rates of 8 percent for the pentavalent vaccine and 11 percent for polio; the dropout rate represents the proportion of children who received the first dose of a vaccine but who did not get the third dose. Eighty-two percent of children are vaccinated against measles, and 79 percent have been vaccinated against yellow fever. ƒ Full vaccination coverage is lower for first- and sixth- or higher-order births (56 and 50 percent, respectively). Full vaccination coverage decreases with an increase in mother’s education, and it is lowest for children in the lowest and highest wealth quintiles. ƒ There are no major variations in vaccination coverage by residence. However, children in the Interior area are somewhat less likely to be vaccinated than other children. This is especially true when looking at specific vaccines. For example, the percentages of children who received the third dose of the pentavalent vaccine (77 percent) and polio (69 percent), and who are vaccinated against measles (72 percent) and yellow fever (70 percent) are below the national average, indicating a need for scaling up efforts in the Interior area to reach more children and to improve the quality of vaccination services, including recording and monitoring systems. 10.2.2 Trends in Vaccination Coverage Table 10.4 shows the percentage of children age 18-59 months (at the time of the survey) who received specific vaccines by 18 months of age, and the percentage with a vaccination card. This table helps estimate changes in vaccination coverage over time. ƒ Children in the oldest cohort (42-59 months) were less likely to have received all their vaccinations (44 percent) than children age 30-41 months (52 percent) and those 18-29 months (58 percent). This pattern is seen with each vaccine but is more marked when all the vaccines are considered together. The findings support a trend towards increased vaccination coverage in Guyana over time. ƒ Vaccination cards were shown to interviewers for 88 percent of children age 18-29 months, compared with 82 percent of children age 42-59 months. The difference may partly result from the cards for older children having been lost or misplaced over the longer period of time. Child Health | 147 Data on vaccination coverage for children in the first 12 months of life are also available from the Guyana Ministry of Health. A direct comparison between the GDHS and the MOH vaccination coverage data is not possible because of the different age range (12 months by the MOH versus 18 months in the GDHS) and different reporting methodologies. The GDHS data are collected at the household level based on the vaccination card or, if there is no written record, based on mother’s reporting, which may cause under-reporting due to recall bias. Furthermore, children’s vaccination cards may have been lost or misplaced in the household. Finally, other issues that could cause under-reporting of the vaccination coverage in the GDHS may be due to data collection issues such as insufficient probing or incorrect recording by the interviewers. The Guyana MOH 2009 vaccination coverage rates for children in the first 12 months of age are generally higher than those reported in the 2009 GDHS. ƒ The 2009 vaccination coverage rates by 12 months of age as reported by the MOH are 98 percent for BCG; 97-98 percent for the three doses of the pentavalent vaccine; 97-98 percent for polio, 97 percent for measles, and 97 percent for yellow fever. 10.3 ACUTE RESPIRATORY INFECTION Acute lower respiratory tract infection (ARI), primarily pneumonia, is a common cause of illness and death during infancy and childhood. In the case of pneumonia, early diagnosis and treatment with antibiotics can prevent a large proportion of deaths due to acute respiratory infections (ARI). The prevalence of ARI in the 2009 GDHS was estimated by asking mothers whether their children under age five had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. These symptoms, though compatible with pneumonia, are subjective (i.e., mother’s perception of illness) and were not validated by a medical examination. Table 10.4 Vaccinations in the first 18 months of life Percentage of children age 18-59 months at the time of the survey who received specific vaccines by 18 months of age, and percentage with a vaccination card, by current age of the child, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Pentavalent1 Polio All with Number Age in ––––––––––––––– ––––––––––––––––– Yellow basic health of months BCG 1 2 3 1 2 3 MMR Measles fever vaccines2 None card children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 18-29 94.1 91.9 89.0 83.0 77.5 75.8 68.3 59.4 77.2 75.1 58.4 4.6 87.7 384 30-41 88.5 87.6 85.5 79.0 75.7 70.3 62.0 51.5 73.6 67.9 51.6 9.2 84.1 336 42-59 86.9 87.3 83.6 74.7 71.0 66.1 59.0 55.9 67.1 65.5 44.4 10.7 82.1 502 Total 89.6 88.8 85.8 78.5 74.3 70.3 62.8 55.8 72.1 69.2 50.8 8.4 84.4 1,222 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Information was obtained from the vaccination card, or if there was no written record, from the mother. For children whose information was based on the mother’s report, the proportion of vaccinations given during the first 18 months of life was assumed to be the same as for children with a written record of vaccinations. 1 Pentavalent vaccine is also known as DPT+Hib+HepB. 2 BCG, measles, and three doses each of pentavalent and polio vaccines 148 | Child Health Table 10.5 shows the percentage of children under age 5 who had a cough accompanied by short, rapid breathing (symptoms of ARI). ƒ Nationally, 5 percent of children under age 5 had symptoms of an ARI in the two weeks preceding the survey. For 65 percent of these children, advice or treatment was sought from a health facility or provider, and 18 percent received antibiotics for the ARI symptoms (data not shown separately due to small number of cases). ƒ The prevalence of acute respiratory infection among children increases with age from 1 percent for those under 6 months to 7 percent for children age 12 to 17 months, after which it drops slightly to 4 to 6 percent. ƒ There are no major variations in the prevalence of ARI symptoms among children under age 5 by gender or mother’s smoking status. ƒ Twice as many children in households that use wood or straw for cooking (7 percent) have ARI symptoms as children in households that use kerosene (3 percent). ƒ Children in the Rural areas (5 percent) and in the Interior area (7 percent) are more likely to have ARI symptoms that children residing in the Urban areas (3 percent) or in the Coastal area (4 percent). Among regions, 12 percent of all children in Region 8 reported ARI symptoms compared with just 2 percent in Regions 5 and 9. ƒ There is no clear relationship between prevalence of ARI symptoms among young children and mother’s education and household wealth. Child Health | 149 Table 10.5 Prevalence and treatment of symptoms of acute respiratory infection (ARI) Among children under age 5, the percentage who had symptoms of acute respiratory infection, (ARI) in the two weeks preceding the survey, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children with Number Background symptoms of characteristic of ARI1 children ––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 1.0 221 6-11 6.0 194 12-17 7.3 178 18-29 4.1 384 30-41 5.8 336 42-59 4.5 502 Sex Male 4.9 895 Female 4.5 920 Mother's smoking status Smokes cigarettes/tobacco 5.6 51 Does not smoke 4.7 1,760 Cooking fuel Electricity or gas 5.4 899 Kerosene 3.0 668 Wood/straw2 6.9 236 Residence Total Urban 3.4 405 Georgetown (urban) 2.3 252 Other (urban) 5.1 154 Total Rural 5.1 1,410 Total Coastal 4.1 1,421 Coastal (urban) 3.4 405 Coastal (rural) 4.4 1,015 Total Interior 6.8 395 Region Region 1 7.1 157 Region 2 4.9 106 Region 3 6.9 229 Region 4 3.0 637 Region 5 2.4 129 Region 6 3.9 245 Region 7 6.1 62 Region 8 12.2 71 Region 9 1.7 61 Region 10 6.5 118 Mother's education No education 4.9 56 Primary 5.2 397 Secondary 4.3 1,234 More than secondary 6.2 128 Wealth quintile Lowest 6.5 527 Second 3.8 380 Middle 2.9 335 Fourth 5.4 288 Highest 3.8 285 Total 4.7 1,815 ––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Symptoms of ARI (cough accompanied by short, rapid breathing, which was chest-related) are considered a proxy for pneumonia. 2 Includes grass, shrubs, crop residues 150 | Child Health 10.4 FEVER Fever is a symptom of malaria and other acute infections in children. Malaria and other illnesses that cause fever contribute to high levels of malnutrition and mortality. Although fever can occur year- round, malaria is more prevalent after the end of the rainy season. For this reason, temporal factors must be taken into account when interpreting fever as an indicator of malaria prevalence. Because malaria is a major cause contributing to mortality during infancy and childhood in many developing countries, the so- called presumptive treatment of fever with antimalarial medication is advocated in many countries where malaria is endemic. Malaria in Guyana is discussed in greater detail in Chapter 12. Table 10.6 shows the percentage of children under age 5 with fever during the two weeks preceding the survey and the percentage receiving various treatments, by selected background characteristics. ƒ One in five children under age 5 in Guyana (20 percent) had fever in the two-week period preceding the survey. Fever is most common among children age 6-29 months (24-26 percent) and then decreases with age. The prevalence of fever is similar for both sexes. ƒ Children in urban areas are less likely than those in rural areas to have fever (15 percent versus 22 percent). Regions 7 and 8 have the highest prevalence rates for fever among children under age 5 (26 percent each), while Region 9 has the lowest prevalence (14 percent). ƒ About six in ten children under age 5 with fever (59 percent) were taken to the health facility or provider for the most recent episode of fever. Furthermore, 21 percent received antibiotics, and 6 percent received antimalarial drugs for the fever. Child Health | 151 Table 10.6 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage of children for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs and the percentage who took antibiotic drugs, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Children under age 5 Children under age 5 with fever ––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage for with fever whom advice in the or treatment Percentage Percentage two weeks Number was sought from who took who took Number Background preceding of a health facility antimalarial antibiotic of characteristic the survey children or provider1 drugs drugs children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 17.2 221 (57.0) (0.0) (12.6) 38 6-11 25.2 194 66.2 4.5 19.3 49 12-17 26.2 178 74.3 6.9 23.7 47 18-29 24.1 384 55.6 6.4 20.9 93 30-41 18.2 336 52.5 13.7 22.9 61 42-59 15.5 502 55.7 4.8 24.2 78 Sex Male 21.2 895 58.4 7.8 21.2 190 Female 19.1 920 59.8 4.9 21.3 176 Residence Total Urban 15.2 405 61.2 13.1 12.6 62 Georgetown (urban) 10.7 252 * * * 27 Other (urban) 22.6 154 61.8 13.5 15.3 35 Total Rural 21.5 1,410 58.6 5.1 23.0 304 Coastal 19.8 1,421 56.4 7.3 24.8 282 Coastal (urban) 15.2 405 61.2 13.1 12.6 62 Coastal (rural) 21.7 1,015 55.1 5.7 28.2 220 Total Interior 21.2 395 67.8 3.4 9.2 84 Region Region 1 20.2 157 (71.1) (7.0) (8.7) 32 Region 2 16.7 106 (87.3) (6.5) (19.3) 18 Region 3 19.5 229 (48.8) (11.9) (14.8) 45 Region 4 19.0 637 3.3 7.3 25.5 121 Region 5 21.8 129 (64.3) (0.0) (29.4) 28 Region 6 21.5 245 53.3 2.5 34.8 53 Region 7 26.0 62 (63.4) (2.3) (11.2) 16 Region 8 25.7 71 (75.0) (1.4) (13.3) 18 Region 9 13.7 61 (62.3) (0.7) (6.8) 8 Region 10 22.8 118 (60.6) (14.9) (9.5) 27 Mother's education No education 11.8 56 * * * 7 Primary 22.5 397 65.0 0.5 22.4 89 Secondary 19.9 1,234 57.3 7.1 21.2 246 More than secondary 18.5 128 * * * 24 Wealth quintile Lowest 20.2 527 68.2 2.1 14.8 107 Second 20.3 380 52.0 3.4 23.7 77 Middle 25.1 335 58.2 6.6 29.8 84 Fourth 20.1 288 55.4 11.6 13.1 58 Highest 14.1 285 (55.2) (15.9) (27.3) 40 Total 20.1 1,815 59.0 6.4 21.2 366 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1Excludes pharmacy, shop, and traditional practitioner 152 | Child Health 10.5 DIARRHEA: PREVALENCE AND TREATMENT Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young children in Guyana, although the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. In the 2009 GDHS, mothers were asked whether any of their children under age 5 had diarrhea during the two weeks preceding the survey. If a child had diarrhea, the mother was asked about feeding practices during the diarrheal episode and about actions taken to treat the diarrhea. 10.5.1 Prevalence of Diarrhea The questions included in the 2009 GDHS can be used to obtain a period prevalence measure of diarrhea, the percentage of children under age 5 whose mothers reported that they had been ill with diarrhea in a two-week period before the interview. Table 10.7 shows the percentage of children under age 5 with diarrhea in the two weeks preceding the survey, by selected background characteristics. The estimate is affected by the reliability of the mother's recall as to when the diarrheal episode occurred. Because the number of cases of diarrhea varies seasonally, in interpreting the findings it should be taken into account that fieldwork for 2009 GDHS took place between early February and late July. ƒ Overall, about 10 percent of children were reported to have diarrhea in the two weeks before the survey, with just 1 percent having bloody diarrhea. Not surprisingly, very young children are least likely to have had diarrhea, presumably because most of them are ex- clusively breastfed and hence less exposed to contaminated food. Diarrhea prevalence increases sharply, from 7 percent among children less than 6 months to 18 percent for children 6-11 months and 13 percent for children 12-29 months, and then declines at older ages. The introduction of other liquids and foods at the time of weaning can facilitate the spread of disease-causing microbes. Additionally, at around 12 months, children start to walk and are at increased risk of contamination from the environment. Male children are only slightly more likely to have diarrhea (11 percent) than female children (9 percent). ƒ Prevalence of diarrhea is higher in households where the drinking water source is not improved (15 percent) than when it is improved (9 percent). Similarly, it is higher in households with non-improved or shared toilet facilities (15 percent) compared with households with an improved, not shared facility (8 percent), clearly indicating the need to address the issues of safe drinking water and improved sanitation. ƒ Prevalence of diarrhea in Rural areas (11 percent) and the Interior area (14 percent) is significantly higher than the prevalence in Urban areas (6 percent) and in the Coastal areas (9 percent). The prevalence of diarrhea among children under age 5 ranges from 6 percent in Region 10 to 20 percent in Region 1. ƒ There is no clear pattern in the relationship between prevalence of diarrhea and mother’s education. The prevalence of diarrhea decreases steadily from 16 percent for children in the poorest households to 5 percent for children in the wealthiest. Child Health | 153 Table 10.7 Prevalence of diarrhea Percentage of children under age 5 who had diarrhea in the two weeks preceding the survey, by background character- istics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––– Number Background All Diarrhea of characteristic diarrhea with blood children –––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 7.1 2.0 221 6-11 17.5 1.3 194 12-17 13.2 2.1 178 18-29 12.6 0.4 384 30-41 8.0 0.4 336 42-59 6.2 0.1 502 Sex Male 10.8 0.7 895 Female 9.0 0.8 920 Source of drinking water1 Improved 9.4 0.7 1,609 Not improved 13.3 0.8 206 Toilet facility2 Improved, not shared 8.1 0.4 1,394 Non-improved or shared 15.4 1.8 417 Residence Total Urban 6.1 0.1 405 Georgetown (urban) 5.1 0.0 252 Other (urban) 7.7 0.3 154 Total Rural 11.0 0.9 1,410 Total Coastal 8.7 0.3 1,421 Coastal (urban) 6.1 0.1 405 Coastal (rural) 9.8 0.4 1,015 Total Interior 14.1 2.2 395 Region Region 1 19.7 3.4 157 Region 2 7.5 0.4 106 Region 3 9.5 0.0 229 Region 4 7.0 0.3 637 Region 5 13.6 1.2 129 Region 6 10.8 0.5 245 Region 7 8.9 1.0 62 Region 8 15.5 3.0 71 Region 9 9.3 1.4 61 Region 10 6.4 0.0 118 Mother's education No education 7.6 0.2 56 Primary 18.2 1.5 397 Secondary 7.8 0.6 1,234 More than secondary 4.8 0.0 128 Wealth quintile Lowest 15.7 1.6 527 Second 10.5 0.7 380 Middle 8.3 0.6 335 Fourth 5.2 0.0 288 Highest 4.9 0.3 285 Total 9.9 0.8 1,815 –––––––––––––––––––––––––––––––––––––––––––––––––––– 1 See Table 2.6 for definition of categories. 2 See Table 2.8 for definition of categories. 154 | Child Health 10.5.2 Treatment of Diarrhea Oral rehydration therapy (ORT), which involves giving children with diarrhea a solution prepared from oral rehydration salts (ORS) or recommended home fluids (RHF)—usually a homemade sugar-salt- water solution—is a simple and effective response to diarrheal illness. Commercially prepared ORS packets and pre-packaged oral rehydration liquids are available free of charge at public health facilities across Guyana. However, in Rural and Interior areas, they are often difficult to access. On the other hand, preparation of RHF at home is simple, and mothers are shown how to prepare RHF at child health clinics. Mothers of children with diarrhea in the two weeks preceding the survey were asked what was done to manage or treat the illness. Table 10.8 shows the percentage of children with diarrhea who were taken to a health provider for treatment, the percentage who received ORT, and the percentage who were given other treatments, by sex and residence. The breakdown by other background characteristics such as child’s age, mother’s education, and the wealth quintiles is not shown due to the small number of cases. ƒ Overall, about six in ten children under age 5 with diarrhea (59 percent) were taken to a health facility or health provider for advice or treatment. Male children (55 percent) are less likely to be taken for treatment or advice to a health facility or provider for their diarrhea than female children (63 percent). Additionally, children living in the Coastal area are much less likely to be taken for treatment or advice (50 percent) than children in the Interior area (79 percent). ƒ Oral rehydration therapy (ORT) was given to almost six in ten children (59 percent), and 50 percent received ORS packets or pre-packaged liquid and 16 percent received RHF. In total, 64 percent of children with diarrhea received ORT or increased fluids. Female children and children residing in the Interior area are more likely than male children or those in the Coastal area to be treated with ORT and/or increased fluids for their diarrhea. ƒ Antibiotics are generally not recommended to treat non-bloody diarrhea in young children. Twelve percent of children with diarrhea received antibiotics, even though only 1 percent of children under age 5 had a bloody diarrhea. Four percent of children received anti- motility drugs, and 1 percent received zinc supplements. One in four children (25 percent) received home or other remedies for their diarrhea. ƒ About one in five children with diarrhea (18 percent) did not receive any treatment at all. Urban children are more than twice as likely as rural children (36 versus 15 percent), and children living in the Coastal area are almost five times as likely as children in the Interior area (24 percent versus 5 percent) to receive no treatment at all for their diarrhea. Child Health | 155 Table 10.8 Diarrhea treatment Among children under age 5 who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by selected background characteristics, Guyana 2009 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 ORS packets or pre- packaged liquid Recom- mended home fluids (RHF) Either ORS or RHF Increased fluids ORT or increased fluids Anti- biotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other Missing No treat- ment Number of children Sex Male 55.3 47.6 15.1 55.9 11.8 62.2 13.2 1.1 1.2 1.4 23.3 0.9 19.8 96 Female 62.9 52.4 18.0 62.5 16.1 65.5 11.0 6.7 1.4 0.0 26.2 0.3 16.3 83 Residence Urban (31.5) (12.2) (25.4) (37.6) (18.8) (52.4) (16.0) (0.0) (0.0) (0.0) (11.5) (0.0) (35.6) 25 Rural 63.2 55.8 15.0 62.4 13.0 65.5 11.6 4.3 1.5 0.9 26.7 0.7 15.4 155 Coastal/Interior Total Coastal 49.9 41.0 18.0 51.6 15.9 57.4 15.6 4.9 1.9 1.1 19.3 0.7 24.1 124 Total Interior 78.5 69.5 13.1 75.4 9.2 77.9 4.5 1.1 0.0 0.0 36.6 0.4 4.9 55 Total 58.8 49.8 16.4 59.0 13.8 63.7 12.2 3.7 1.3 0.7 24.6 0.6 18.2 179 Note: Oral rehydration therapy (ORT) includes solution prepared from oral rehydration salts (ORS), pre-packaged ORS packets, and recommended home fluids (RHF). For 1 percent of children with diarrhea there is no information on the type of treatment. Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes pharmacy, shop, and traditional practitioner 10.5.3 Feeding Practices during Diarrhea Mothers are encouraged to continue normal feeding of children with diarrhea and to increase the amount of fluids given. These practices help to reduce dehydration and minimize the adverse conse- quences of diarrhea on the child’s nutritional status. Mothers interviewed in the 2009 GDHS were asked whether they gave the child less, the same amount, or more fluids and food than usual when their child had diarrhea. Table 10.9 shows the percent distribution of children under age 5 who had diarrhea in the two weeks preceding the survey by feeding practices, according to child’s sex and residence. Other background characteristics are not shown due to the small number of cases. ƒ Only 14 percent of children with diarrhea were given more to drink than usual, 43 percent were given the same as usual, and 43 percent were given less to drink than usual or nothing at all. It is particularly unfortunate that 20 percent of children with diarrhea were given much less or nothing to drink. ƒ Food intake is curtailed even more than fluid intake during episodes of diarrhea. Only 2 percent of children with diarrhea were given more to eat than usual, 31 percent were given the same amount of food as usual, and 59 percent were given less food to eat than usual or none at all. These patterns reflect a gap in practical knowledge among some mothers regarding the nutritional requirements of children during diarrheal episodes. The 2009 GDHS findings indicate a need for further health education efforts to reduce the number of children who become dehydrated or malnourished because of improper feeding practices during diarrhea. ƒ Only a small proportion of children with diarrhea (9 percent) were given increased fluids and continued feeding, and 39 percent were given continued feeding and received ORT and/or increased fluids. Differentials in these indicators by sex and residence are not large. Girls are slightly more likely than boys to score better on both these indicators. Children in the Coastal area are more likely to be fed according to the recommended feeding practices during diarrhea than children in the Interior area. 156 | Child Health Table 10.9 Feeding practices during diarrhea Percent distribution of children under age 5 who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by sex and residence, Guyana 2009 Amount of liquids given Amount of food given Background characteristic More Same as usual Some- what less Much less None Total More Same as usual Some- what less Much less None Never gave food Total Percentage given increased fluids and continued feeding1 Percentage who continued feeding and were given ORT and/or increased fluids Number of children with diarrhea Sex Male 11.8 49.3 18.3 20.6 0.0 100.0 2.6 30.5 28.0 32.0 0.6 4.6 100.0 8.4 36.3 96 Female 16.1 35.3 29.3 17.9 1.3 100.0 1.3 32.4 31.0 24.0 2.4 9.0 100.0 9.5 41.9 83 Residence Total Rural 13.0 39.9 26.4 20.3 0.4 100.0 0.9 28.3 31.0 29.7 1.4 7.7 100.0 7.3 38.2 155 Total Coastal 15.9 46.0 20.3 17.4 0.4 100.0 1.7 38.5 29.6 24.1 0.7 4.1 100.0 10.8 40.4 124 Coastal (rural) 15.1 42.2 24.3 18.4 0.0 100.0 0.0 35.5 32.1 25.2 0.5 5.2 100.0 8.8 39.8 99 Total Interior 9.2 35.8 30.2 23.7 1.1 100.0 2.6 15.4 29.0 37.7 3.0 12.2 100.0 4.8 35.4 55 Total 13.8 42.9 23.4 19.3 0.6 100.0 2.0 31.3 29.4 28.3 1.4 6.6 100.0 8.9 38.9 179 1 Continued feeding includes children who were given more, same as usual, or somewhat less food during the diarrhea episode. 10.5.4 Knowledge of ORS Packets As mentioned earlier, a simple and effective response to dehydration caused by diarrhea is a prompt increase in the child’s fluid intake through some form of ORT, which may include the use of a solution prepared from packets of oral rehydration salts (ORS). To ascertain how widespread knowledge of ORS is in Guyana, mothers were asked whether they knew about ORS packets and/or pre-packaged ORS liquid. Table 10.10 shows the percentage of mothers with a birth in the five years preceding the survey who knew about ORS packets and/or pre-packaged ORS liquid for treatment of diarrhea, by background characteristics. ƒ Knowledge of ORS packets or pre-packaged ORS liquid is widespread in Guyana, with 67 percent of mothers having heard of it. Mothers age 25-49 (74-75 percent), mothers from urban areas (78 percent), those with more than secondary education (77 percent), and mothers from the highest wealth quintile (76 percent) have the highest level of knowledge of the ORS packets or pre-packaged ORS liquid. ƒ Women in Region 5 (57 percent) are the least knowledgeable about ORS packets and pre- packaged ORS liquid, while mothers in Region 8 (76 percent) are the most knowledgeable. Child Health | 157 10.5.5 Disposal of Stools If human feces are left uncontained, disease can spread by direct contact or by animal contact with the feces. Hence, the proper disposal of children’s stools is important in preventing the spread of disease. Table 10.11 shows the percent distribution of mothers who have their youngest child under age 5 living with them, by the way in which the child’s stools are disposed of, according to background characteristics and type of toilet facilities in the household. Table 10.10 Knowledge of ORS packets or pre-packaged ORS liquid Percentage of mothers age 15-49 who gave birth in the five years preceding the survey who know about ORS packets or pre-packaged ORS liquid for treatment of diarrhea, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––– Percentage of mothers who know about ORS packets or Number Background pre-packaged of characteristic ORS liquid mothers –––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 55.6 162 20-24 53.4 374 25-34 74.2 622 35-49 75.3 267 Residence Total Urban 77.6 346 Georgetown (urban) 82.9 223 Other (urban) 67.9 123 Total Rural 63.4 1,080 Total Coastal 65.9 1,160 Coastal (urban) 77.6 346 Coastal (rural) 60.9 815 Total Interior 70.8 265 Region Region 1 73.1 103 Region 2 73.5 80 Region 3 66.1 189 Region 4 69.0 534 Region 5 56.7 105 Region 6 58.6 194 Region 7 73.5 48 Region 8 75.5 47 Region 9 57.8 38 Region 10 67.4 88 Education No education 44.8 40 Primary 63.4 290 Secondary 67.6 989 More than secondary 77.2 106 Wealth quintile Lowest 68.8 361 Second 63.9 297 Middle 66.3 278 Fourth 58.4 241 Highest 76.2 247 Total 66.8 1,425 –––––––––––––––––––––––––––––––––––––––––––––– ORS = Oral rehydration salts 158 | Child Health Table 10.11 Disposal of children's stools Percent distribution of youngest children under age five living with the mother by the manner of disposal of the child's last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Guyana 2009 Manner of disposal of children's stools Background characteristic Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Left in the open Other Missing Total Percentage of children whose stools are disposed of safely Number of mothers Age in months <6 5.2 53.3 1.4 13.5 21.1 0.3 1.8 3.4 100.0 59.9 217 6-11 3.8 55.3 2.5 14.7 20.7 0.7 1.6 0.7 100.0 61.5 189 12-17 7.7 55.3 1.1 10.3 22.0 1.0 1.5 1.2 100.0 64.1 172 18-29 13.1 65.2 1.5 3.8 13.0 1.1 0.9 1.4 100.0 79.8 314 30-41 35.7 54.8 0.6 1.0 5.8 0.6 0.2 1.4 100.0 91.0 218 42-59 60.7 37.3 0.0 0.0 1.2 0.4 0.0 0.4 100.0 97.9 263 Toilet facility Improved, not shared1 24.0 52.8 1.1 5.1 14.3 0.3 0.6 1.7 100.0 78.0 1,078 Non-improved or shared 17.5 56.9 1.0 11.4 8.7 2.1 2.0 0.3 100.0 75.4 293 Residence Total Urban 32.3 40.9 0.4 1.5 23.4 0.0 0.9 0.5 100.0 73.6 326 Georgetown (urban) 33.1 40.7 0.0 1.0 25.3 0.0 0.0 0.0 100.0 73.7 212 Other (urban) 31.0 41.3 1.1 2.4 20.1 0.0 2.6 1.4 100.0 73.4 115 Total Rural 19.6 57.7 1.3 8.0 9.8 0.9 0.9 1.7 100.0 78.6 1,047 Coastal/Interior Total Coastal 25.0 52.9 1.0 5.1 13.8 0.2 0.7 1.3 100.0 78.9 1,116 Coastal (urban) 32.3 40.9 0.4 1.5 23.4 0.0 0.9 0.5 100.0 73.6 326 Coastal (rural) 22.0 57.8 1.3 6.5 9.9 0.3 0.6 1.7 100.0 81.1 789 Total Interior 12.2 57.3 1.5 12.6 9.7 2.9 2.0 1.8 100.0 70.9 258 Region Region 1 6.2 61.7 0.0 17.2 10.8 2.3 0.0 1.8 100.0 67.9 100 Region 2 17.4 63.3 1.9 8.4 5.1 1.3 0.9 1.8 100.0 82.6 78 Region 3 23.9 62.1 0.6 5.3 8.0 0.0 0.0 0.0 100.0 86.7 182 Region 4 25.4 48.0 0.6 4.6 20.4 0.0 0.4 0.7 100.0 73.9 514 Region 5 27.1 55.0 4.7 2.2 7.5 0.0 1.6 1.9 100.0 86.8 101 Region 6 23.7 54.8 0.3 7.8 7.9 0.5 1.2 3.7 100.0 78.9 187 Region 7 15.7 47.1 2.2 14.8 11.5 2.8 2.6 3.3 100.0 65.0 46 Region 8 17.6 46.4 1.8 9.9 10.5 6.6 6.9 0.4 100.0 65.8 46 Region 9 20.6 62.6 5.3 0.2 6.7 1.4 0.0 3.3 100.0 88.5 37 Region 10 26.4 51.8 0.8 4.7 12.5 0.5 2.0 1.3 100.0 79.0 82 Education No education (6.8) (47.5) (0.0) (16.7) (23.7) (3.3) (0.0) (1.9) 100.0 54.3 39 Primary 20.7 58.3 1.8 10.3 4.4 1.5 0.8 2.2 100.0 80.8 284 Secondary 23.0 53.2 1.0 5.4 14.7 0.4 0.8 1.3 100.0 77.2 951 More than secondary 30.2 47.5 0.7 1.5 17.6 0.0 2.4 0.0 100.0 78.4 100 Wealth quintile Lowest 15.6 59.7 1.3 11.4 6.7 2.4 1.7 1.2 100.0 76.6 358 Second 21.5 62.4 1.1 4.4 8.5 0.3 0.6 1.1 100.0 85.0 278 Middle 20.3 52.8 0.4 8.6 14.5 0.0 0.8 2.7 100.0 73.5 265 Fourth 26.3 50.0 1.7 3.6 15.9 0.0 0.8 1.7 100.0 78.0 236 Highest 33.3 39.1 1.1 2.0 23.5 0.0 0.4 0.6 100.0 73.5 237 Total 22.6 53.7 1.1 6.5 13.1 0.7 0.9 1.4 100.0 77.4 1,374 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Non-shared facilities that are of the types: flush or pour flush into a piped sewer system/septic tank/pit latrine; ventilated, improved pit (VIP) latrine; pit latrine with a slab; and a composting toilet Child Health | 159 ƒ The most common method of disposing of young children’s stools is rinsing the stools into a toilet or latrine (54 percent), followed by 23 percent of children who are using a toilet or latrine. The stools of 13 percent of children are thrown into the garbage, and those of 7 percent of children are put or rinsed into a drain or ditch. ƒ Overall, 77 percent of children in Guyana have their stools disposed of safely. The percentage of children whose stools are disposed of safely increases sharply with the child’s age, especially around 18 months of age. There is no significant difference by type of toilet facility. Rural children and those living in the Coastal area (79 percent, each) are somewhat more likely to have their stools disposed of safely than Urban area children and those living in the Interior area (74 and 71 percent, respectively). Sixty-five percent of children in Region 7 have their stools disposed of safely compared with 87 percent, each, in Regions 3 and 5. The stools of children of mothers with no education (54 percent) are much less likely to be disposed of safely than children of mothers with any education 77-81 percent). There is no clear relationship between the percentage of children whose stools are disposed of safely and household wealth. Nutrition of Children and Adults | 159 NUTRITION OF CHILDREN AND ADULTS 11 This chapter covers nutritional concerns for children and women. The 2009 GDHS collected information from respondents to evaluate the nutritional status of women and young children. For infants and young children, this included information on breastfeeding and complementary feeding. For the micronutrients of iron, vitamin A, and iodine, information was collected on intake levels from supple- mentation and food. Anthropometric measurements (height and weight) were taken for women age 15-49 and children under age 5 to determine their nutritional status. The 2009 GDHS also included testing of household salt for iodine and testing of children age 6–59 months and women age 15-49 for anemia using HemoCue equipment. Adequate nutrition is critical to child development. The period from birth to age 2 is important for optimal growth, health, and development. Unfortunately, this period is often marked by growth faltering, micronutrient deficiencies, and common childhood illnesses such as diarrhea and acute respiratory infections (ARI). Optimal feeding practices reported in this chapter include early initiation of breast- feeding, exclusive breastfeeding during the first 6 months of life, continued breastfeeding up to age 2 and beyond, and timely introduction of complementary feeding at age 6 months. In addition to timely initiation of feeding solid/semi-solid foods from age 6 months onwards, optimal feeding practices reported here also include increasing the amount and variety of foods and frequency of feeding as the child gets older, while maintaining frequent breastfeeding. A summary indicator that describes the quality of infant and young child (age 6-23 months) feeding practices (IYCF) is included A woman’s nutritional status has important implications for her health as well as for the health of her children. Malnutrition in women results in reduced productivity, increased susceptibility to infections, slow recovery from illness, and heightened risks of adverse pregnancy outcomes. For example, a woman who has a poor nutritional status—as indicated by a low body mass index (BMI), short stature, or other micronutrient deficiencies—has a greater risk of obstructed labor, of having a baby with low birth weight, of producing lower quality breast milk, of dying from postpartum hemorrhage, and of contracting diseases along with her baby. 11.1 NUTRITIONAL STATUS OF YOUNG CHILDREN The 2009 GDHS collected information on the nutritional status of children by measuring the height and weight of all children under age 6. The measurements were collected with the aim of calculating three indices—weight-for-age, height-for-age, and weight-for-height—all of which take age and sex into consideration. Weight measurements were obtained using lightweight, electronic Seca scales with a digital screen, designed and manufactured under the guidance of the United Nations Children’s Fund (UNICEF). Height measurements were carried out using a measuring board produced by Shorr Productions. Children younger than 24 months were measured lying down (recumbent length) on the board, and standing height was measured for older children. For the 2009 GDHS, the nutritional status of children is calculated using new growth standards published by the World Health Organization (WHO) in 2006. These new growth standards were generated using data collected in the WHO Multimember Growth Reference Study (WHO, 2006). Each of the three nutritional status indicators described below is expressed in standard deviation units from the median of the WHO Child Growth Standards. The indices are not comparable with those based on the previously used NCHS/CDC/WHO reference. 160 | Nutrition of Children and Adults For the purposes of comparison with previous surveys, Appendix Tables C.7.1 and C.7.2 include indices expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO inter- national reference population, which was in use prior to the new WHO Child Growth Standards. Each of these indices—height-for-age, weight-for-height, and weight-for-age—provides different information about growth and body composition that is used to assess nutritional status. The height-for- age index is an indicator of linear growth retardation and cumulative growth deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) are considered short for their age (stunted) and are chronically malnourished. Children who are below minus three standard deviations (-3 SD) are considered severely stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents the long-term effects of malnutrition in a population and is not sensitive to recent, short-term changes in dietary intake. The weight-for-height index measures body mass in relation to body height or length and describes current nutritional status. Children with Z-scores below -2 SD are considered thin (wasted) and are acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or a recent episode of illness causing loss of weight and the onset of malnutrition. Children whose weight-for-height is below -3 SD are considered severely wasted. Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic malnutrition. Children whose weight-for-age is below -2 SD are classified as underweight. Children whose weight-for-age is below -3 SD are considered severely underweight. As mentioned above, height and weight measurements were obtained for all children under age 6 living in the sampled households, including children who were not biological offspring of the women interviewed in the survey. Although data were collected for all children under age 6, for purposes of comparability, the analysis is limited to children under age 5. Valid height and weight measurements were obtained for 74 percent of a total of 2,059 de-facto children under age 5 in the GDHS households. Measurements were missing for 19 percent of the children for several reasons: the name and line number of some of the eligible children were not copied into the Anthropometry Section of the questionnaire from the Household Listing and, hence, not measured; also some of the children were not present, their parents refused, or the children were sick. In addition to the children for whom measurements were missing, there were some children for whom the height or weight measures were implausible and some children for whom information on age in months was not available. The following analysis focuses on the children for whom complete and plausible anthropometric and age data were collected. Table 11.1.1, Figure 11.1, and Table 11.1.2 show the percentage of children under age 5 classified as malnourished according to height-for-age, weight-for-height, and weight-for age indices. Table 11.1.1 shows these percentages by demographic characteristics; Figure 11.1 shows them by age, and Table 11.1.2 shows them by socioeconomic characteristics. The percentage of children under age 5 who are stunted and underweight, by residence, is presented in Figure 11.2. Figure 11.1 shows that the level of stunting increases drastically in the second year of life when children are weaned, indicating chronic malnutrition over a long period of time. The level of wasting peaks at about 7 months of age at the time when complementary food in addition to breast milk is introduced. The level of undernutrition increases steadily and peaks at about 11 months of age and then levels off to the second year of life until the age of about 27 months when it starts to decline. Nutrition of Children and Adults | 161 • Stunting. As shown in Table 11.1.1. (columns 1-3), almost one in five children (18 percent) under age 5 is short for their age or stunted, and 1 in 20 (5 percent) is severely stunted. As expected, the level of stunting increases somewhat in the second year of life when children are weaned, indicating chronic malnutrition over a long period of time. There are no major differences in stunting by age. Stunting is higher for children born less than four years apart from a previous birth (21-23 percent), those born very small (38 percent), and children of mothers classified as thin based on their BMI (28 percent). The same columns in Table 11.1.2 show that children in Rural areas are almost twice as likely to be stunted as children in Urban areas (20 and 11 percent, respectively), and children in the Interior area (35 percent) are two a half times as likely as those in the Coastal area (14 percent) to be stunted. Stunting is lowest in Region 3 (9 percent) and highest in Region 8 (50 percent). Looking at education and wealth, the percentage of children who are stunted is lowest among children of mothers with more than secondary education (4 percent) and those in the highest wealth quintile (10 percent) and is highest among children of mothers with primary education and those in the lowest wealth quintile (29 and 30 percent, respectively). • Wasting. In Table 11.1.1, the weight-for-height index (columns 4-7) gives information about children’s recent experience with food intake. Wasting represents failure to receive adequate nutrition in the period immediately preceding the survey and may result from recent illness or seasonal variations of food. Overall, 5 percent of children under age 5 are wasted, with 1 percent severely wasted. Wasting is highest among children less than 6 months and 9-11 months (10 percent, each), male children (7 percent), children who are born very small (12 percent), children of thin mothers (12 percent), and those of mothers with no education (16 percent). • Tables 11.1.1 and 11.1.2 (column 6) highlight another problem among young children in Guyana: 6 percent are overweight [Z-scores for wasting are above two standard deviations (+2 SD)]. The highest proportion of overweight children is in age group 9-11 months (12 percent), children of overweight or obese mothers (8 percent), those living in Regions 4 and 7 (9 percent), children of mothers with secondary or more education (6 to 7 percent) and children in the fourth wealth quintile (9 percent). • Children whose weight-for-age (column 8-11) is below minus two standard deviations (-2 SD) from the median of the reference population are considered underweight. The measure reflects the effects of both acute and chronic malnutrition. Overall, 11 percent of Guyanese children are underweight, with 2 percent classified as severely underweight. Peak levels of low weight-for-age are found among children age 6-8 months (15 percent), followed by those age 12-17 months (14 percent). Boys are slightly more likely to be underweight than girls (12 and 9 percent, respectively). The percentage of children who are underweight decreases with birth interval, and is highest among children born very small and children of thin mothers. Children living in Rural areas are more likely to be underweight than Urban area children (12 and 7 percent, respectively). There is no difference in the percentage of underweight children in Coastal and Interior areas. The proportion of underweight children ranges from 3 percent in Region 7 to 16 percent in Region 1. Children born to mothers with little or no education and those in the lowest wealth quintile are substantially more likely to be underweight than children in the other sub-groups. For example, the proportion of underweight children of mothers with no education is 22 percent, compared with 4 percent of children of mothers with more than secondary education. Similarly, children in the poorest households are almost four times as likely to be underweight as children in the wealthiest (16 percent versus 4 percent). 162 | Nutrition of Children and Adults Table 11.1.1 Nutritional status of children by demographic characteristics Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by demographic characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Height-for-age Weight-for-height Weight-for-age (Stunted) (Wasted) (Underweight) ––––––––––––––––––––––– –––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––– Percent- Percent- Percent- Percent- Percent- Percent- Percent- Percent- age age Mean age age age Mean age age age Mean Number Background below below Z-score below below above Z-score below below above Z-score of characteristic -3 SD -2 SD1 (SD) -3 SD -2 SD1 +2 SD (SD) -3 SD -2 SD1 +2 SD (SD) children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 5.5 16.3 -0.6 5.4 10.3 9.8 -0.2 3.1 13.1 1.4 -0.6 100 6-8 5.4 16.5 -0.5 1.2 6.7 9.3 0.0 3.5 15.3 3.1 -0.4 80 9-11 9.4 20.1 -1.0 1.0 10.4 12.0 0.1 5.3 9.9 6.6 -0.5 73 12-17 5.0 19.1 -0.9 0.2 3.3 3.4 -0.1 1.7 14.3 0.3 -0.5 151 18-23 5.9 19.1 -1.0 1.8 6.7 6.2 0.1 2.7 9.6 2.9 -0.4 149 24-35 6.1 20.0 -1.0 0.6 3.4 7.2 0.1 0.9 8.4 2.3 -0.5 345 36-47 3.2 18.8 -0.8 0.7 4.0 4.9 0.0 0.2 10.0 2.4 -0.5 296 48-59 4.2 15.5 -0.8 0.7 5.8 4.4 -0.2 1.2 9.8 1.7 -0.6 329 Sex Male 5.2 19.2 -0.9 1.5 7.1 4.7 -0.1 1.8 12.1 2.1 -0.6 750 Female 4.9 17.2 -0.8 0.7 3.6 7.7 0.0 1.4 8.8 2.5 -0.4 772 Birth interval in months2 First birth3 4.8 16.6 -0.9 0.5 5.4 7.7 -0.1 1.4 10.5 2.3 -0.5 417 <24 3.9 22.7 -1.0 0.4 7.1 5.0 -0.2 1.9 13.4 2.4 -0.7 251 24-47 7.0 20.7 -1.0 2.0 5.4 5.9 -0.1 2.3 11.5 1.1 -0.6 381 48+ 4.4 13.2 -0.6 1.3 4.1 7.1 0.2 0.9 6.7 3.4 -0.2 317 Size at birth2 Very small 7.6 37.6 -1.4 0.5 12.2 2.4 -0.6 6.7 31.7 0.7 -1.2 89 Small 7.3 22.4 -1.1 1.5 6.0 3.2 -0.4 1.6 16.0 0.6 -0.9 209 Average or larger 4.6 15.5 -0.8 1.1 4.6 7.6 0.1 1.2 7.3 2.6 -0.4 1,039 Missing (2.6) (21.0) (-0.9) (1.0) (11.7) (5.0) (-0.2) (1.1) (18.5) (5.0) (-0.6) 29 Mother's interview status Interviewed 5.2 18.1 -0.9 1.1 5.4 6.6 -0.0 1.6 10.4 2.3 -0.5 1,366 Not interviewed In household 6.5 21.9 -0.6 0.0 5.8 5.4 0.2 0.0 7.5 1.5 -0.2 53 Not in the household4 3.4 17.6 -0.9 1.7 3.4 1.7 -0.2 1.9 12.3 2.8 -0.6 102 Mother's nutritional status5 Thin (BMI<18.5) 3.8 27.6 -1.2 1.7 11.9 5.2 -0.5 3.8 22.7 2.2 -1.0 103 Normal (BMI 18.5-24.9) 5.9 21.9 -1.0 1.7 6.7 5.2 -0.2 1.9 12.3 1.1 -0.7 620 Overweight/obese (BMI > 25) 4.7 12.9 -0.7 0.4 3.1 8.2 0.2 1.1 6.6 3.4 -0.2 653 Missing 4.4 21.6 -0.8 0.0 7.5 3.1 0.1 0.0 7.7 1.8 -0.4 42 Total 5.1 18.2 -0.9 1.1 5.3 6.2 -0.0 1.6 10.5 2.3 -0.5 1,522 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on children who slept in the household the night before the interview. Each of the indices is expressed in standard deviation units -SD from the median of the WHO Child Growth Standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO standards. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes children who are below –3 standard deviations (SD) from the International Reference Population median 2 Excludes children whose mothers were not interviewed 3 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 4 Includes children whose mothers are dead 5 Excludes children whose mothers were not weighed and measured. Mother’s nutritional status in terms of BMI (Body Mass Index) is presented in Table 11.10. Nutrition of Children and Adults | 163 1 Figure 11.1 Nutritional Status of Children Under Age 5 Note: Stunting reflects chronic malnutrition; wasting reflects acute malnutrition; underweight reflects chronic or acute malnutrition or a combination of both. # # # # ## # # ### ## # #### #### # # # ## # ##### ## ## # ### ## #### ### # # ## ### ### ) ) ) ) ) )) ) )))))) ))))))) )))))))))))))) )) ))) ))) ))))) ))))))) )) )) ) 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 Age in months 0 5 10 15 20 25 30 P er ce nt ag e of c h i ld re n Stunted Wasted Underweight) # GDHS 2009 164 | Nutrition of Children and Adults Table 11.1.2 Nutritional status of children by socioeconomic characteristics Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by socioeconomic characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Height-for-age Weight-for-height Weight-for-age (Stunted) (Wasted) (Underweight) ––––––––––––––––––––––– –––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––– Percent- Percent- Percent- Percent- Percent- Percent- Percent- Percent- age age Mean age age age Mean age age age Mean Number below below Z-score below below above Z-score below below above Z-score of Characteristic -3 SD -2 SD1 (SD) -3 SD -2 SD1 +2 SD (SD) -3 SD -2 SD1 +2 SD (SD) children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 4.0 11.0 -0.6 0.9 5.8 6.3 -0.0 2.0 6.8 3.3 -0.4 341 Georgetown (urban) 5.6 10.9 -0.7 0.7 5.5 6.5 0.0 3.0 7.5 2.4 -0.3 203 Other (urban) 1.5 11.1 -0.5 1.2 6.2 6.0 -0.1 0.6 5.7 4.6 -0.4 138 Total Rural 5.4 20.3 -0.9 1.2 5.2 6.2 -0.0 1.5 11.5 2.0 -0.5 1,180 Total Coastal 3.3 14.2 -0.7 1.0 5.8 6.5 -0.1 1.6 10.2 2.5 -0.5 1,233 Coastal (urban) 4.0 11.0 -0.6 0.9 5.8 6.3 -0.0 2.0 6.8 3.3 -0.4 341 Coastal (rural) 3.0 15.4 -0.8 1.1 5.8 6.6 -0.1 1.5 11.5 2.2 -0.5 892 Total Interior 12.7 35.3 -1.4 1.3 3.1 4.9 0.3 1.5 11.7 1.4 -0.6 289 Region Region 1 15.0 39.3 -1.5 2.0 3.0 3.8 0.2 2.2 15.5 0.4 -0.7 116 Region 2 5.7 18.4 -0.9 3.0 9.9 5.5 -0.1 2.4 11.6 2.0 -0.6 96 Region 3 2.0 8.9 -0.6 1.2 6.1 4.2 -0.1 0.6 7.2 1.7 -0.4 217 Region 4 3.9 16.4 -0.8 1.3 5.5 9.3 0.0 2.1 11.3 2.2 -0.4 548 Region 5 2.4 9.9 -0.6 0.0 3.5 3.1 -0.3 0.0 8.4 1.7 -0.5 101 Region 6 3.3 14.8 -0.7 0.0 6.3 4.4 -0.2 2.5 12.1 4.7 -0.6 208 Region 7 6.6 25.0 -1.0 0.2 0.2 8.9 0.6 0.9 3.4 2.7 -0.2 47 Region 8 18.2 49.6 -1.9 0.0 3.2 1.4 0.1 1.0 14.5 1.3 -0.9 46 Region 9 11.1 33.1 -1.5 2.2 4.5 8.4 0.4 1.7 11.5 2.8 -0.6 47 Region 10 3.3 13.8 -0.6 0.4 4.1 3.3 0.0 0.0 5.4 1.9 -0.3 96 Mother's education2 No education 12.0 20.8 -1.1 4.6 16.2 2.4 -0.5 6.8 22.1 1.4 -1.0 46 Primary 8.4 28.6 -1.2 0.9 4.7 4.3 -0.1 2.6 15.2 1.8 -0.7 305 Secondary 4.2 16.2 -0.8 0.9 5.0 7.4 0.0 1.1 8.9 2.5 -0.4 970 More than secondary 2.4 4.4 -0.3 1.3 6.9 6.3 0.1 0.0 3.7 1.8 -0.1 95 Wealth quintile Lowest 9.8 29.6 -1.4 2.4 4.8 4.2 -0.0 3.0 15.7 0.6 -0.8 413 Second 4.8 18.3 -1.0 0.5 6.2 5.8 -0.1 1.8 12.8 1.5 -0.7 345 Middle 3.1 13.4 -0.6 1.2 6.2 7.1 -0.0 0.4 7.6 3.2 -0.4 292 Fourth 0.9 12.2 -0.4 0.2 4.1 9.1 0.0 0.1 7.7 5.2 -0.2 251 Highest 4.2 9.8 -0.5 0.5 5.1 6.1 0.0 1.9 4.1 1.9 -0.2 221 Total 5.1 18.2 -0.9 1.1 5.3 6.2 -0.0 1.6 10.5 2.3 -0.5 1,522 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on children who slept in the household the night before the interview. Each of the indices is expressed in standard deviation units -SD from the median of the WHO Child Growth Standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO standards. Table is based on children with valid dates of birth -month and year and valid measurement of both height and weight. 1 Includes children who are below –3 standard deviations (SD) from the International Reference Population median 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire Nutrition of Children and Adults | 165 11.2 BREASTFEEDING Infant feeding practices have an impact on the health of both the child and the mother. Feeding practices are an important determinant of children’s nutritional status, which is directly related to the risk of becoming sick and of dying. Early initiation of breastfeeding is encouraged for a number of reasons. Mothers benefit from early suckling because it stimulates breast milk production and facilitates the release of oxytocin, which helps the contraction of the uterus and reduces postpartum blood loss. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also fosters bonding between mother and child. 11.2.1 INITIAL BREASTFEEDING Table 11.2 shows the percentage of children born in the five years preceding the survey ever breastfed, and for last-born children ever breastfed, the timing of initial breastfeeding. Figure 11.2 Children under Five Stunted and Underweight, by Residence 18 11 11 11 20 14 11 15 35 11 7 8 6 12 10 7 12 12 Total Total Urban Georgetown (urban) Other (urban) Total Rural Total Coastal Coastal (urban) Coastal (rural) Total Interior 0 5 10 15 20 25 30 35 40 Stunted Underweight GDHS 2009 166 | Nutrition of Children and Adults Table 11.2 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and for the last children born in the five years preceding the survey ever breast, the percentage who started breastfeeding within one hour and within one day of birth, and the percentage who received a prelacteal feed, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– All children under five Last-born children ever breastfed –––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage Percentage Percentage of who started who started who children Number breastfeeding breastfeeding received a Number Background ever of within 1 hour within 1 day prelacteal of characteristic breastfed children of birth of birth1 feed 2 children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 92.2 940 62.7 88.8 17.9 669 Female 93.6 946 65.2 88.4 17.5 670 Assistance at delivery Health professional 3 92.5 1,733 64.6 89.4 17.8 1,260 Traditional birth attendant (98.0) 14 * * * 8 Other 98.7 113 53.0 74.2 14.8 60 No one * 10 59.0 100.0 19.2 7 Missing * 16 * * * 4 Place of delivery Health facility 92.5 1,679 64.7 89.7 17.8 1,218 At home 95.6 161 61.9 85.7 17.4 107 Other * 5 * * * 3 Missing 100.0 41 * * * 12 Residence Total Urban 93.2 425 64.1 88.9 13.9 323 Georgetown (urban) 92.9 265 60.4 87.2 15.7 209 Other (urban) 93.7 159 70.9 92.1 10.7 114 Total Rural 92.8 1,462 63.9 88.5 18.9 1,016 Total Coastal 91.8 1,477 61.4 87.7 19.5 1,081 Coastal (urban) 93.2 425 64.1 88.9 13.9 323 Coastal (rural) 91.2 1,053 60.3 87.2 21.9 758 Total Interior 96.9 409 74.4 92.3 10.1 258 Region Region 1 98.1 164 83.1 95.7 12.2 100 Region 2 96.3 108 63.4 93.7 5.5 77 Region 3 95.2 234 50.2 88.1 26.2 178 Region 4 92.2 666 56.8 85.7 23.3 503 Region 5 84.5 139 76.0 87.0 8.4 91 Region 6 88.6 253 74.1 89.2 17.4 176 Region 7 97.3 65 64.9 91.5 4.2 47 Region 8 93.9 72 69.4 92.1 13.3 45 Region 9 98.6 62 71.2 80.7 10.1 38 Region 10 94.7 124 72.3 94.5 8.3 84 Mother's education No education 100.0 60 (66.0) (83.5) (8.1) 40 Primary 93.0 416 67.4 89.8 14.3 272 Secondary 92.6 1,282 63.2 88.5 19.0 928 More than secondary 92.0 129 60.7 88.5 19.4 99 Wealth quintile Lowest 94.7 545 67.0 90.8 11.4 347 Second 92.2 399 64.1 91.3 17.4 283 Middle 90.5 349 62.2 87.5 17.3 252 Fourth 93.2 293 64.4 87.3 20.8 225 Highest 93.0 301 60.8 84.5 25.0 231 Total 92.9 1,886 63.9 88.6 17.7 1,339 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on children born in the five years preceding the survey regardless of whether the children are living or dead at the time of interview. An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse/midwife, or auxiliary midwife Nutrition of Children and Adults | 167 • Overall, 93 percent of children born in the five years preceding the survey have been breastfed at some time. Children living in the Interior area (97 percent), in Region 1 (98 percent) and Region 9 (99 percent), children of uneducated mothers (100 percent), and children in the poorest households (95 percent) are somewhat more likely than other children to have ever been breastfed. However, there are no major differentials in the percentage of children ever breastfed by various background characteristics. • For last-born children ever breastfed, 64 percent started breastfeeding within one hour of birth, and 89 percent started breastfeeding within the first 24 hours after delivery. The proportion of children who receive early breastfeeding varies by type of assistance at delivery. Children of women who gave birth in a health facility (65 percent) are slightly more likely than women who deliver at home (62 percent) to initiate breastfeeding early. The proportion of women initiating breastfeeding within an hour of birth is highest in the Interior area (74 percent) and Region 1 (83 percent). Early initiation of breastfeeding tends to decrease with mother’s education and household wealth. • The survey results indicate that about one in five (18 percent) of last-born babies ever breastfed received a prelacteal feed, i.e., received something other than breast milk during the first three days of life. Children living in rural areas (19 percent), in the Coastal area (20 percent), in Region 3 (26 percent) and Region 4 (23 percent) are more likely than other children to receive a prelacteal feed. Additionally, the percentage of children who receive a prelacteal feed increases with mother’s education and household wealth, and it is highest for children of mothers with more than secondary education (19 percent) and those in the highest wealth quintile (25 percent). 11.2.2 BREASTFEEDING STATUS BY AGE UNICEF and WHO recommend that children be exclusively breastfed during the first 6 months of life and that children be given solid or semi-solid complementary foods in addition to continued breastfeeding from 6 months until age 24 months or more when the child is fully weaned (PAHO and WHO, 2003b; and WHO, Division of Nutrition, 1998). Exclusive breastfeeding is recommended because breast milk is uncontaminated and contains all the nutrients necessary for children in the first few months of life. In addition, the mother’s antibodies in breast milk provide immunity to disease. Early supplem- entation is discouraged for several reasons. First, it exposes infants to pathogens and increases their risk of infection, especially diarrheal diseases. Second, it decreases infants’ intake of breast milk and therefore suckling, which reduces breast milk production. Third, in low-resource settings, supplementary food is often nutritionally inferior. Information on complementary feeding was obtained by asking mothers about the current breastfeeding status of all children under five years of age and—for the youngest child born in the three- year period before the survey and living with the mother—foods and liquids given to the child the day and night before the survey. Table 11.3 shows the percent distribution of children under age 3 living with their mother by breastfeeding status, and the percentage of all children under age 3 using a bottle with a nipple, according to age in months. Figure 11.3 shows infant feeding practices by age. 168 | Nutrition of Children and Adults • Data show that breastfeeding duration (column 8) is relatively long in Guyana. More than nine in ten children (91 percent) under age 6 months are breastfed, and at age 12-15 months, more than six in ten children (62 percent) are still breastfeeding. By age 20-23 months, about half (49 percent) of children are still breastfeeding. • While breastfeeding extends for a relatively long time in Guyana, exclusive breastfeeding (column 2) has short duration; only 58 percent of children under 2 months of age are exclusively breastfed; by age 4-5 months, only one in five (22 percent) are still being exclusively breastfed. Overall, only one-third (33 percent) of children under 6 months are exclusively breastfed, which is far less than the 100 percent recommended. • In addition to breast milk, 15 percent of children under age 6 months are given other (non- breast) milk, 6 percent are given non-milk liquids or juice, 4 percent are given water, and 33 percent are given complementary food in the form of solid or mushy food. At age 6-9 months, about three-fourths (74 percent) of Guyanese children are still being breastfed but about six in ten (59 percent) are receiving complementary foods in addition to breast milk. Similar patterns are observed for older children; 67 percent of children age 9-11 months are still breastfeeding, while 65 percent are receiving complementary foods. • Bottle-feeding is relatively common. About one in five (19 percent) of the youngest infants (under 2 months) and almost half (49 percent) of infants age 2-3 months use a bottle with a nipple (column 10). This proportion peaks at 67 percent among children age 9-11 months before declining. Table 11.3 Breastfeeding status by child’s age Percent distribution of youngest children under age 3 who are living with their mother, by breastfeeding status; the percentage currently breastfeeding; and the percentage of children under age 3 using a bottle with a nipple, according to age in months, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percent distribution of youngest children under age 3 living with their mother by breastfeeding status Number ––––––––––––––––––––––––––––––––––––––––––––––––––––––– of Breastfeeding and consuming: Percent- youngest Number Exclu- ––––––––––––––––––––––––––––––––– age children Using of all Not sively Plain Non-milk Comple- currently under a bottle children breast- breast- water liquids/ Other mentary breast- age 3 with a under Age in months feeding fed only juice milk foods Total feeding years nipple1 age 3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <2 3.2 57.5 1.7 12.1 17.9 7.6 100.0 96.8 60 19.3 60 2-3 6.7 26.5 1.4 3.4 23.6 38.4 100.0 93.3 57 48.8 58 4-5 14.3 22.4 6.2 3.8 7.7 45.6 100.0 85.7 99 62.8 103 6-8 22.2 4.0 3.8 8.4 1.8 59.8 100.0 77.8 104 57.7 107 9-11 32.8 0.6 0.5 1.2 0.3 64.6 100.0 67.2 85 67.3 87 12-17 40.0 1.5 1.4 0.0 0.6 56.5 100.0 60.0 172 61.0 178 18-23 43.5 1.3 0.0 1.7 0.3 53.3 100.0 56.5 143 48.7 165 24-35 58.0 0.8 0.1 0.0 0.2 41.0 100.0 42.0 306 49.1 404 0-3 4.9 42.4 1.5 7.9 20.7 22.6 100.0 95.1 117 33.7 118 0-5 9.2 33.2 3.7 6.0 14.7 33.2 100.0 90.8 217 47.2 221 6-9 25.6 3.3 3.2 7.0 1.7 59.2 100.0 74.4 125 60.4 128 12-15 38.4 0.8 2.3 0.0 0.3 58.2 100.0 61.6 103 58.0 105 12-23 41.6 1.4 0.8 0.8 0.4 55.1 100.0 58.4 315 55.1 343 20-23 50.7 2.2 0.0 0.0 0.5 46.6 100.0 49.3 82 49.6 100 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus children who receive breast milk and non-milk liquids and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under age 3 Nutrition of Children and Adults | 169 11.2.3 DURATION AND FREQUENCY OF BREASTFEEDING Table 11.4 shows the median duration of breastfeeding by selected background characteristics. The estimates of median and mean durations of breastfeeding are based on current status data, that is, the proportion of children born in the three years preceding the survey who were being breastfed at the time of the survey. • The median duration of any breastfeeding in Guyana is long—slightly more than 19 months, although the median duration of exclusive breastfeeding is short—only 3 months. Differences in both these durations by background characteristics are small. The median duration of any breastfeeding is somewhat longer for female children (21 months) and children residing in the Rural areas (21 months) and in the Interior area (25 months). • Ninety-one percent of all children under age 6 months are breastfed at least six times a day (column 4). On average, children are fed somewhat more frequently during the day (about 7 times) than during the night (about 5 times). The frequency of breastfeeding varies only slightly by background characteristics. Figure 11.3 Infant Feeding Practices by Age 0-1 2-3 4-5 6-8 9-11 12-17 18-23 24-35 Age in months 0 20 40 60 80 100 Exclusively breastfed Plain water only Non-milk liquids/juice Other milk Complementary foods Not breastfeeding GDHS 2009 Percent 170 | Nutrition of Children and Adults 11.3 COMPLEMENTARY FOODS UNICEF and WHO recommend the introduction of solid foods to infants around age 6 months because by that age breast milk alone is no longer sufficient to maintain a child’s optimal growth. In the transition to eating the same food as the rest of the family, children from age 6 months should be fed small quantities of solid and semi-solid foods throughout the day. During this transition period (age 6-23 months), the prevalence of malnutrition increases substantially in many countries because of increased infections and poor feeding practices. Table 11.5 provides information on the types of foods given to the youngest children under three years of age, living with their mother, on the day and night preceding the interview, according to breast- feeding status. Table 11.4 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under age 6 months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day)(night), by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median duration (months) of breastfeeding Frequency of breastfeeding among children born in the past three years1 among children under age 6 months2 ––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––– Percentage Mean Mean Number Predomi- breastfed number number of Any Exclusive nant 6+ times of of children Background breast- breast- breast- in past day night under characteristic feeding feeding feeding3 24 hours feeds feeds 6 months ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 17.6 1.1 1.4 91.9 6.6 5.3 102 Female 20.5 1.3 2.4 89.5 6.6 5.4 91 Residence Total Urban (14.2) (1.9) (2.4) (91.6) (8.7) (6.5) 40 Total Rural 20.5 1.1 1.8 90.6 6.0 5.1 154 Total Coastal 18.1 1.0 1.5 89.3 6.5 5.2 152 Coastal (urban) (14.2) (1.9) (2.4) (91.6) (8.7) (6.5) 40 Coastal (rural) 18.8 0.7 1.1 88.5 5.7 4.8 112 Total Interior 24.5 2.4 3.6 96.1 6.9 5.9 42 Mother's education No education * * * * * * 3 Primary 22.9 1.8 2.0 90.4 6.9 5.9 47 Secondary 18.4 0.7 1.9 91.5 6.4 5.1 132 More than secondary * * * * * * 12 Wealth quintile Lowest 22.0 2.5 3.4 92.9 7.2 6.0 50 Second (10.1) (0.5) (1.8) (94.4) (6.9) (5.5) 50 Middle 15.6 (0.7) (1.3) (90.4) (6.6) (5.6) 37 Fourth * (1.6) (1.6) (85.1) (5.7) (4.1) 42 Highest * * * * * * 14 Total 19.1 1.2 2.0 90.8 6.6 5.3 194 Mean for all children 19.6 3.0 4.1 na na na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Medians and means are based on current status. 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. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2 Excludes children without a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water and/or non-milk liquids only Nutrition of Children and Adults | 171 • Overall, 62 percent of breastfeeding children under age 3 drink milk other than breast milk, 73 percent drink liquids other than water, and 27 percent drink infant formula. Three-fourths (75 percent) of breastfeeding children received solid or semi-solid foods. The most common complementary foods were made from grain (68 percent); meat, fish, poultry, and eggs (51 percent); fruits and vegetables rich in vitamin A (44 percent); and foods made from roots and tubers (31 percent). Twenty-seven percent of breastfeeding children consume cheese, yogurt, or other milk products, and 23 percent consume fruits and vegetables other than those rich in vitamin A. Consumption of anything cooked with butter, fat, or oil generally begins at 2-3 months (4 percent), increasing to 69 percent at 24-35 months. More than four in ten breastfeeding children (42 percent) consumed sugary foods. • Almost all (96 percent) non-breastfeeding children under age 3 received solid or semi-solid foods in the day and night preceding the interview, indicating that consumption of complementary foods is generally higher among non-breastfeeding children than breast- feeding children. More than nine in ten (96 percent) of non-breastfeeding children received foods made from grains; around eight in ten (81 percent) were given meat, fish, poultry, or eggs; more than three-quarters (76 percent) ate fruits and vegetables rich in vitamin A; and Table 11.5 Foods consumed by children in the day or night preceding the interview Percentage of children under age 3 living with the mother who consumed specific foods in the day or night preceding the interview, by breastfeeding status and age, Guyana 2009 Liquids Solid or semi-solid foods Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Foods made from grains3 Fruits and vege- tables rich in vitamin A4 Other fruits and vege- tables Foods made from roots and tubers Foods made from legumes and nuts Meat, fish, poultry, and eggs Cheese, yogurt, other milk product Any solid or semi- solid food Foods made with oil, fat, or butter Sugary foods Number of children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– BREASTFEEDING CHILDREN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0-1 15.9 19.9 22.7 0.8 0.8 1.9 0.8 2.8 0.0 2.8 7.1 7.9 0.0 2.8 58 2-3 38.3 47.1 49.5 7.6 39.6 0.0 1.5 0.0 1.9 3.9 6.9 41.2 3.9 8.9 53 4-5 23.9 42.6 50.8 23.7 44.6 10.0 1.5 6.0 0.8 8.6 12.1 53.2 6.8 9.4 85 6-8 33.6 56.7 76.7 22.8 54.9 35.6 9.1 30.5 7.7 38.4 23.2 76.9 32.3 48.4 81 9-11 35.0 74.7 81.6 28.2 85.8 66.6 34.7 49.1 18.7 70.3 26.7 96.1 51.1 52.9 57 12-17 35.7 72.9 89.3 22.2 87.2 53.0 37.3 44.8 32.1 75.0 32.9 94.2 54.6 48.2 103 18-23 25.8 75.8 89.1 21.0 87.1 60.4 34.5 38.8 20.0 80.6 25.2 92.4 49.9 62.4 81 24-35 16.9 79.0 91.9 25.5 96.0 79.2 41.1 49.5 35.8 83.3 51.0 97.6 69.4 68.7 128 6-23 32.6 69.9 84.7 23.1 78.8 52.9 29.1 40.5 20.6 66.4 27.4 89.7 47.2 52.6 322 Total 27.3 61.7 73.2 20.4 67.5 43.5 23.0 31.0 17.6 51.2 26.6 75.1 38.5 42.0 647 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– NON-BREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0-11 52.7 75.7 78.4 41.9 82.4 52.7 32.4 32.4 12.2 45.9 27.0 83.8 27.0 45.9 74 12-17 46.7 85.7 91.7 31.0 97.1 70.6 42.2 36.6 27.6 70.7 52.1 97.1 58.2 70.1 69 18-23 45.3 87.6 96.7 40.5 98.7 80.8 38.2 44.9 27.8 91.2 32.3 98.9 69.7 71.4 62 24-35 34.3 88.2 96.1 25.1 96.7 83.3 40.1 51.3 29.0 90.5 46.5 97.8 75.3 77.5 177 6-23 49.8 87.0 93.9 37.8 97.8 74.4 43.2 40.0 24.9 77.2 42.3 98.0 58.3 69.7 182 Total 43.0 86.9 93.6 32.1 95.5 76.0 40.1 44.3 26.1 80.5 42.3 96.1 63.8 70.3 379 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). 1 Other milk includes fresh, tinned, and powdered animal milk 2 Does not include plain water 3 Includes fortified baby food 4 Includes pumpkins, carrots, squash, or sweet potatoes that are yellow or orange inside, dark green leafy vegetables, mangoes, papayas, oranges, and pomegranates 172 | Nutrition of Children and Adults about four in ten consumed foods made from roots and tubers (44 percent), cheese, yogurt or other milk products (42 percent), and fruits and vegetables other than those rich in vitamin A (40 percent). More than six in ten (64 percent) of non-breastfeeding children under three years consumed food made with oil, fat, or butter, while seven in ten (70 percent) ate sugary foods. 11.4 APPROPRIATE INFANT AND YOUNG CHILD FEEDING (IYCF) Infant and young child feeding (IYCF) practices include timely initiation of feeding solid/semi- solid foods from age 6 months and increasing the amount and variety of foods and frequency of feeding as the child gets older, while maintaining frequent breastfeeding. Guidelines have been established with respect to IYCF practices for children age 6-23 months (PAHO/WHO, 2003b.; WHO, 2005). Table 11.6 presents the results of the 2009 GDHS according to IYCF practices for breastfed and non-breastfed children living with their mother. The indicators focus on the percentage of children for whom feeding practices meet minimum standards with respect to: • Food diversity (i.e., the number of food groups consumed), • Feeding frequency (i.e., the number of times a child is fed), and • Consumption of breast milk or other milks or milk products. Breastfed children are considered fed in accordance with the minimum IYCF standards if they consume at least three food groups1 and receive foods other than breast milk at least twice per day in the case of children age 6-8 months and at least three times per day in the case of children age 9-23 months. Non-breastfed children are considered to be fed in accordance with the minimum IYCF standards if they consume milk or milk products, are fed four food groups (including milk products), and are fed at least four times per day. • Among breastfed children age 6-23 months, about eight in ten (77 percent) were given foods from three or more food groups in the 24 hours preceding the survey, and 45 percent were fed the minimum number of times in the past 24 hours. About four in ten breastfed children (38 percent) fall into both categories, i.e., their feeding practices meet minimum standards with respect to food diversity and feeding frequency. • The proportion of breastfed children age 6-23 months who receive the recommended variety of foods the minimum number of times a day increases with children’s age from 32 percent among children age 6-8 months to 49 percent among those age 9-11 months, and it drops thereafter. There are slight variations in the proportion of breastfed children who meet both criteria by sex of child. • Urban area children are much more likely than Rural area children (64 percent versus 33 percent), and children living in the Coastal area are more likely than those living in the Interior area (41 percent versus 31 percent) to be fed from three or more food groups the minimum number of times a day. By region, the lowest percentage of breastfed children who are fed the recommended variety of foods the minimum number of times a day ranges from 19 percent in Region 3 to 54 percent in Region 2. The proportion of breastfed children who eat from three or more food groups the minimum number of times a day tends to increase with education and wealth. 1 Food groups used in the assessment of minimum standard of feeding practices include: infant formula, milk other than breast milk, cheese or yogurt or other milk products; foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; fruits and vegetables rich in vitamin A; other fruits and vegetables; eggs; meat, poultry, fish, and shellfish (and organ meats); beans, peas, and nuts; and foods made with oil, fat, or butter. Nutrition of Children and Adults | 173 • Among non-breastfed children age 6-23 months, 91 percent are given milk or milk products, 81 percent are given food from at least four food groups, and 20 percent are fed four or more times per day. However, only about one in six (17 percent) of non-breastfeeding children are fed in accordance with all three IYCF practices (data not shown). • A large majority of young children in Guyana are not being fed appropriately. Overall, feeding practices meet the minimum standards for only 31 percent of children age 6-23 months. More than nine in ten children age 6-23 months (97 percent) received breast milk or milk products and about eight in ten (79 percent) received foods from the recommended number of food groups for their age. However, only 36 percent were fed the minimum number of times. Children age 9-11 months (36 percent) are the most likely to be fed according to all three IYCF practices, while those age 6-8 months (25 percent) are the least likely to be fed according to IYCF practices. • There is very little difference in feeding practices between girls and boys or by Coastal- Interior area. On the other hand, urban children are much more likely than rural children (43 percent versus 27 percent) to be fed in accordance with all three IYCF practices. Among regions, the percentage of children who are fed appropriately is highest in Region 2 (50 per- cent) and lowest in Region 3 (18 percent). The proportion of children who are fed appro- priately increases with mother’s level of education, while its relationship with the household wealth quintile does not show a clear pattern. 174 | Nutrition of Children and Adults Table 11.6 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF practices based on breastfeeding status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Guyana 2009 Among breastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Background characteristic 3+ food groups1 Mini- mum times or more2 Both 3+ food groups and mini- mum times or more Number of breast- fed children 6-23 months Breast milk, or milk products3 3+ or 4+ food groups5 Minimum times or more6 With all 3 IYCF practices Number of all children 6-23 months Age 6-8 50.6 52.6 31.5 81 97.2 51.8 41.8 25.3 104 9-11 81.4 51.5 48.8 57 98.6 83.8 38.9 36.3 85 12-17 88.0 43.0 41.9 103 95.9 86.1 33.4 32.3 172 18-23 85.8 33.5 32.9 81 95.7 85.7 32.0 28.6 143 Sex Male 72.3 48.7 37.8 156 95.0 76.1 37.3 29.0 248 Female 81.2 40.7 38.7 166 98.1 80.9 34.0 31.9 256 Residence Total Urban 81.2 70.0 64.1 59 98.0 83.7 48.3 43.4 103 Georgetown (urban) (83.5) (72.4) (67.3) 41 (98.2 (87.4) (48.9) (45.9) 69 Other (urban) (75.8) (64.4) (56.6) 18 97.6 76.2 46.9 38.4 34 Total Rural 75.9 38.9 32.5 263 96.2 77.2 32.4 27.1 401 Total Coastal 79.9 46.7 41.3 224 96.8 81.1 35.5 31.2 384 Coastal (urban) 81.2 70.0 64.1 59 98.0 83.7 48.3 43.4 103 Coastal (rural) 79.5 38.4 33.2 165 96.3 80.1 30.8 26.6 281 Total Interior 70.0 39.6 31.4 99 96.0 70.3 36.1 28.3 120 Region Region 1 69.7 35.5 22.1 45 99.1 69.9 33.8 21.4 48 Region 2 84.2 56.3 53.9 24 94.8 83.0 53.5 49.7 35 Region 3 81.7 22.9 18.7 33 96.5 82.4 20.5 18.2 58 Region 4 82.5 52.1 47.7 108 97.9 83.5 35.5 32.9 182 Region 5 * * * 22 88.3 78.4 37.5 24.3 37 Region 6 66.6 58.4 46.5 31 99.2 73.5 39.0 31.8 61 Region 7 62.5 51.8 44.0 14 100.0 65.3 49.7 41.2 16 Region 8 68.6 37.3 32.5 16 93.6 68.2 25.6 21.9 23 Region 9 71.8 33.3 33.3 13 84.0 67.6 32.4 28.3 18 Region 10 77.1 48.4 46.5 18 100.0 82.2 41.7 40.3 25 Mother's education No education 66.4 19.2 17.6 16 * * * * 19 Primary 72.3 42.3 32.4 72 98.0 75.0 33.1 26.1 106 Secondary 78.2 46.2 40.6 220 96.4 80.7 36.6 31.9 349 More than secondary * * * 14 (100.0) (73.0) (44.3) (39.4) 29 Wealth quintile Lowest 77.2 39.8 34.5 123 94.2 77.6 33.7 28.6 160 Second 71.6 44.8 41.4 62 99.0 77.7 36.4 33.3 103 Middle 68.5 35.4 22.8 53 95.4 74.2 28.6 18.1 89 Fourth (85.4) (57.1) (52.9) 42 97.4 83.8 36.3 33.2 82 Highest (86.4) (57.5) (50.3) 41 98.8 81.1 47.4 43.2 70 Total 76.9 44.5 38.3 322 96.6 78.5 35.7 30.5 504 Note: An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 1 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts; h. foods made with oil, fat, or butter 2 At least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Non-breastfed children ages 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding practices if they receive other milk or milk products and are fed at least the minimum number of times per day with at least the minimum number of food groups. 5 3+ food groups for breastfed children and 4+ food groups for non-breastfed children 6 Fed solid or semi-solid food at least twice a day for infants 6-8 months, 3+ times for other breastfed children, and 4+ times for non-breastfed children Nutrition of Children and Adults | 175 11.5 ANEMIA IN CHILDREN Anemia is a condition characterized by low levels of hemoglobin in the blood. This results in a reduced amount of oxygen being transported in the body and reduces its capacity to function. Anemia is associated with impaired cognitive and motor development in children. Iron is a main component of hemoglobin, and iron deficiency is estimated to be responsible for half of the global prevalence of anemia. Young children and pregnant and postpartum women are the most severely affected because of the high iron demands of fetal infant growth during pregnancy. Other causes of anemia include malaria, hookworm, and other helminthes infection, nutritional deficiencies, chronic infections, genetic conditions (such as sickle cell and thalassemia), HIV/AIDS, and high fertility. Anemia is a serious concern for children because it can impair cognitive development, stunt growth, and increase morbidity from infectious diseases. Information on the prevalence of anemia can be useful for the development of health- intervention programs designed to prevent anemia, such as promoting consumption of iron-rich foods, iron supplementation, food fortification, and de-worming programs as appropriate (CDC, 1998). The 2009 GDHS included anemia testing of women age 15-49 and children age 6-59 months. Values of hemoglobin were obtained using the HemoCue instrument. Children under 6 months were not tested because they have higher levels of hemoglobin at birth and just after birth, and including them may distort prevalence of anemia. Anemia levels were determined by measuring the level of hemoglobin in the blood. A drop of capillary blood was taken with a finger prick (using sterile, disposable instruments) and the hemoglobin concentration was measured using the HemoCue photometer system. Trained personnel on each of the 2009 GDHS interviewing teams performed the testing procedures, following informed consent. Table 11.7 presents the anemia prevalence for children age 6-59 months based on tests of children who were present at the time of testing, whose parents consented to their being tested, and whose hemoglobin results represented plausible data. Children are classified into three groups according to the level of hemoglobin in their blood: - Mild: hemoglobin concentration 10.0-10.9 g/dl - Moderate: hemoglobin concentration 7.0-9.9 g/dl - Severe: hemoglobin concentration less than 7.0 g/dl • Thirty-nine percent of all children age 6-59 months in Guyana have some level of anemia, in- cluding 23 percent of children who are mildly anemic, 15 percent who are moderately anemic, and less than 1 percent with severe anemia. Prevalence of any anemia is highest for children 9-11 months and lowest for those 36-59 months (25-28 percent). Male children are slightly more anemic (41 percent) than female children (37 percent). • There is little variation in the prevalence of anemia in children by Urban area-Rural area or Coastal area-Interior area residence. • There are important differentials by region in the prevalence of anemia. More than half of children in Region 1 are anemic (51 percent) compared with 30 percent in Region 8. • The percentage of children with anemia is lowest among children of mothers with secondary or higher education (38-40 percent) and children in the highest wealth quintile (32 percent). 176 | Nutrition of Children and Adults Table 11.7 Prevalence of anemia in children Percentage of children age 6-59 months classified as having anemia, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Anemia status by hemoglobin level Background characteristic Mild (10.0-10.9 g/dl ) Moderate (7.0-9.9 g/dl ) Severe ( < 7.0 g/dl ) Any anemia (<12.0 g/dl) Number of children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months 6-8 33.8 23.2 0.0 57.0 71 9-11 44.5 29.3 0.3 74.1 72 12-17 21.2 35.9 0.5 57.7 151 18-23 34.7 19.0 0.3 54.1 141 24-35 21.4 14.2 0.9 36.4 327 36-47 19.0 8.5 0.2 27.7 281 48-59 18.3 6.3 0.0 24.6 306 Sex Male 24.9 16.1 0.4 41.3 664 Female 22.0 14.8 0.4 37.2 685 Mother's interview status Interviewed 23.6 15.5 0.4 39.5 1,188 Not interviewed In household 23.3 14.1 1.0 38.5 52 Not in the household 21.5 15.2 0.0 36.7 109 Residence Total Urban 22.3 16.9 0.6 39.9 297 Georgetown (urban) 23.8 16.5 0.0 40.3 170 Other (urban) 20.4 17.4 1.5 39.2 127 Total Rural 23.8 15.0 0.3 39.1 1,052 Total Coastal 23.0 15.1 0.4 38.5 1,060 Coastal (urban) 22.3 16.9 0.6 39.9 297 Coastal (rural) 23.3 14.4 0.3 38.0 763 Total Interior 25.0 16.5 0.4 41.9 289 Region Region 1 32.8 18.0 0.0 50.8 121 Region 2 28.6 21.0 0.5 50.1 97 Region 3 21.5 12.4 0.0 33.9 168 Region 4 23.1 11.2 0.4 34.7 452 Region 5 24.6 24.8 0.0 49.4 87 Region 6 22.0 18.5 0.7 41.1 199 Region 7 23.7 11.0 0.2 34.9 44 Region 8 10.8 19.2 0.0 30.0 43 Region 9 21.3 10.5 0.6 32.4 49 Region 10 19.8 20.0 1.3 41.1 88 Mother's education No education 15.4 30.6 0.2 46.2 47 Primary 27.4 15.2 0.5 43.2 281 Secondary 23.0 14.5 0.4 37.9 833 More than secondary 22.7 17.1 0.0 39.8 76 Wealth quintile Lowest 24.5 17.0 0.2 41.6 410 Second 24.2 16.5 0.2 40.9 306 Middle 22.8 19.1 0.2 42.1 245 Fourth 21.8 11.6 1.5 34.9 208 Highest 22.7 9.5 0.0 32.1 179 Total 23.4 15.4 0.4 39.3 1,349 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on children who slept in the household the night before the interview. Prevalence of anemia, based on hemoglobin levels, is adjusted for altitude using formulas in CDC, 1998. Hemoglobin in grams per deciliter (g/dl). 1 Includes children whose mothers are deceased 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire Nutrition of Children and Adults | 177 11.6 MICRONUTRIENT INTAKE AMONG CHILDREN Micronutrient deficiency is a serious contributor to childhood morbidity and mortality. Children can receive micronutrients from foods, food fortification, and direct supplementation. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency can cause eye damage. Vitamin A deficiency can also increase the severity of infections such as measles and diarrheal diseases in children and slow recovery from illness. Vitamin A is found in breast milk, other milks, liver, eggs, fish, butter, mangoes, papayas, carrots, pumpkins, yellow-orange sweet potatoes, and dark green leafy vegetables. The liver can store an adequate amount of the vitamin for 4-6 months. Therefore, periodic dosing (every 6 months) with vitamin A supplements is a rapid, low-cost method of ensuring that children at risk do not develop vitamin A deficiency. Since 2004, young children and pregnant mothers are offered a micronutrient Sprinkles Packet that contains vitamin A. Iron is essential for cognitive development. Low iron intake can also contribute to anemia. Iron requirements are greatest between the ages of 6 and 12 months, when growth is extremely rapid. The 2009 GDHS collected information on the consumption of foods rich in vitamin A and foods rich in iron. Dietary deficiency of iodine constitutes a major, global public health concern. A lack of sufficient iodine is known to cause goiter, cretinism (a severe form of neurological defect), spontaneous abortion, premature birth, infertility, stillbirth, and increased child mortality. Iodine deficiency disorders (IDD) are the single most common cause of preventable mental retardation and brain damage (WHO, 2007). Since iodine cannot be stored for long periods by the body, small amounts are needed regularly. Where soil and therefore crops and grazing animals do not provide sufficient dietary iodine to the population, and where seafood is not regularly consumed, food fortification has proven to be a highly successful and sustainable intervention. The fortification of salt with iodine is the most common method of preventing IDD. When vulnerable populations do not have access to fortified foods such as iodized salt, a short-term solution is supplementation with capsules containing iodized oil. Table 11.8 shows indicators used to measure children’s intake of several key micronutrients, as well as the percentage receiving anti-worming medication and living in households with adequately iodized salt. • More than eight in ten (86 percent) children age 6-35 months living with the mother consumed foods rich in vitamin A in the 24 hours preceding the survey, and less than eight in ten (77 percent) consumed foods rich in iron. There is a steady increase with age in the proportion of children who eat foods rich in vitamin A and iron, from 58 percent of children 6-8 months to 94 percent of those age 24-35 months for foods rich in vitamin A and from 46 percent of children 6-8 months to 88 percent of those 24-35 months for foods rich in iron. Female children are slightly more likely to have consumed foods rich in iron than male children. Children who are not breastfeeding are more likely to consume foods rich in vitamin A and iron (94 and 85 percent, respectively) compared with their breastfeeding counterparts (81 and 71 percent, respectively), presumably because they are older than breastfeeding children. Children born to the youngest mothers (15-19) are somewhat less likely to consume vitamin A-rich foods or iron-rich foods (81 and 74 percent, respectively) compared with those born to older women. • Consumption of foods rich in vitamin A or iron is higher among children in Urban areas and Coastal areas than children in Rural and Interior areas. Consumption of vitamin A foods is highest among children in Region 5 (91 percent) and lowest in Region 1 (76 percent). Con- sumption of iron-rich foods ranges from 68 percent in Region 8 to 80 percent in Region 6. 178 | Nutrition of Children and Adults Consumption of vitamin A or iron-rich foods among children age 6-35 months generally increases with mother’s level of education and increasing wealth quintile. • The 2009 GDHS also collected information on iron supplementation. One in five children (25 percent) age 6-59 months received iron supplements in the past seven days. Supplementation is higher among children age 12-23 months (34-35 percent) than younger and older children. Children of the oldest mothers age 40-49 are less likely to receive iron supplements (18 percent) than children of younger mothers (21-29 percent). • Children in the Urban and the Coastal areas (32 and 27 percent, respectively) are more likely to receive an iron supplement than children in the Rural and the Interior areas (22 and 17 percent, respectively). The proportion of children receiving iron supplements in the past seven days is lowest in Region 1 (5 percent) and highest in Region 8 (41 percent). The proportion of children receiving an iron supplement is lowest for children of uneducated mothers (9 percent) and children in households in the lowest two wealth quintiles (18-20 percent). • Because intestinal worms can contribute to both anemia and vitamin A deficiency, the 2009 GDHS collected information on whether children age 6-59 months had been given de- worming medication. More than half of children (55 percent) age 6-59 months received de- worming medication in the six months preceding the survey. Older children age 48-59 months, females, non-breastfeeding children, and children of oldest mothers age 40-49 are more likely than other subgroups to be given de-worming medication in the past six months. Children living in the Urban and the Coastal areas are more likely than children in the Rural and the Interior areas to receive de-worming medication. Among regions, this proportion ranges from 31 percent in Region 7 to 70 percent in Region 10. Children whose mothers have more than secondary education (71 percent) and are in the highest wealth quintile (66 percent) are more likely to receive de-worming medication than other children. • Only 14 percent of children 6-59 months old live in households with adequately iodized salt, with the highest percentage being in the Interior area (28 percent), Region 9 (87 percent), and in households belonging to the lowest wealth quintile (18 percent). However, these data should be interpreted with caution due to a relatively small number of cases in some of the categories. Nutrition of Children and Adults | 179 Table 11.8 Micronutrient intake among children Among youngest children age 6-35 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were given iron supplements in the past seven days, and who were given de-worming medication in the six months preceding the survey, and among all children age 6-59 months who live in households that were tested for iodized salt, the percentage who live in households with adequately iodized salt, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among youngest children age 6-35 months living with the mother: Among all children age 6-59 months: Among children age 6-59 months living in households tested for iodized salt –––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––– –––––––––––––––––––– Background characteristic Percentage who consumed foods rich in vitamin A in past 24 hours1 Percentage who consumed foods rich in iron in past 24 hours2 Number of children Percentage given iron supplements in past 7 days Percentage given de- worming medication in past 6 months3 Number of children Percentage living in households with adequately iodized salt4 Number of children Age in months 6-8 57.5 46.4 104 15.5 3.9 107 13.3 101 9-11 85.8 68.5 85 23.0 17.8 87 13.1 85 12-17 84.6 73.3 172 33.8 36.1 178 13.7 170 18-23 92.1 85.2 143 34.5 46.1 165 11.3 156 24-35 94.2 87.5 306 24.9 66.6 404 14.3 386 36-47 na na na 20.8 64.5 311 11.8 297 48-59 na na na 21.0 71.9 343 15.1 320 Sex Male 85.1 74.6 395 25.4 52.9 777 12.9 737 Female 87.2 78.8 415 23.6 56.9 817 14.0 778 Breastfeeding status Breastfeeding 80.8 71.2 450 24.9 38.7 499 14.1 473 Not breastfeeding 94.0 85.3 330 25.5 63.5 966 12.8 921 Missing (81.9) (66.9) 29 15.2 53.3 130 16.1 121 Mother's age at birth 15-19 80.9 73.8 101 21.0 41.6 161 11.7 159 20-29 86.0 76.8 415 23.0 55.1 843 12.0 793 30-39 88.9 77.6 250 29.3 57.4 502 17.1 481 40-49 84.7 79.1 45 18.4 63.2 88 9.5 82 Residence Total Urban 88.7 81.0 180 31.6 62.8 358 13.4 345 Georgetown (urban) 88.1 79.8 118 33.7 61.6 223 13.8 220 Other (urban) 90.0 83.1 62 28.2 64.7 135 12.6 125 Total Rural 85.5 75.6 630 22.4 52.6 1,236 13.5 1,170 Total Coastal 88.2 78.0 637 26.7 57.0 1,245 9.5 1,185 Coastal (urban) 88.7 81.0 180 31.6 62.8 358 13.4 345 Coastal (rural) 88.0 76.8 457 24.7 54.6 887 7.9 840 Total Interior 78.8 72.4 173 16.8 47.7 349 27.8 330 Region Region 1 76.0 73.6 65 4.8 41.2 136 10.7 131 Region 2 88.8 78.5 47 30.2 51.4 96 12.8 88 Region 3 89.4 74.9 105 20.1 55.3 199 11.2 195 Region 4 87.1 78.3 294 29.0 56.2 554 11.0 535 Region 5 90.5 76.6 61 31.8 60.8 115 1.5 105 Region 6 87.8 79.6 101 23.2 55.3 215 2.8 201 Region 7 79.9 73.5 31 17.2 30.8 55 12.8 50 Region 8 78.0 68.2 32 41.2 56.2 64 23.2 57 Region 9 78.4 73.5 25 19.8 59.5 55 86.7 52 Region 10 89.5 78.1 49 20.2 70.2 106 25.7 100 Mother's education No education (79.1) (65.3) 24 8.6 30.9 54 9.5 52 Primary 85.6 76.8 161 17.4 53.3 341 12.2 318 Secondary 86.1 76.9 572 25.8 54.9 1,086 14.1 1,033 More than secondary 92.6 80.2 53 40.8 70.9 114 13.0 112 Wealth quintile Lowest 86.6 76.9 229 20.3 49.6 471 18.1 441 Second 84.0 73.3 151 18.2 52.5 329 9.9 311 Middle 79.2 72.8 157 24.2 54.1 285 11.6 277 Fourth 91.9 81.6 129 26.5 57.8 244 12.8 234 Highest 90.4 80.4 143 38.1 65.7 266 12.6 251 Total 86.2 76.8 810 24.5 54.9 1,595 13.5 1,515 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Information on vitamin A and iron supplements and de-worming medication is based on the mother’s recall. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A. 2 Includes meat (including organ meat), fish, poultry, and eggs 3 De-worming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 4 Salt containing 15 parts per million (ppm) of iodine or more; excludes children in households in which salt was not tested 180 | Nutrition of Children and Adults 11.7 PRESENCE OF IODIZED SALT IN HOUSEHOLDS The fortification of household salt with iodine is the most common method of preventing iodine deficiency disorders (IDDs). Fortified salt that contains at least 15 parts per million (ppm) of iodine is considered adequate for the prevention of IDD. The 2009 GDHS asked for and tested the salt in the selected households. Results are shown in Table 11.9 by residence. • The household salt was tested in 93 percent of households. • Among households with tested salt, the majority (80 percent) have no iodine at all in their salt, 10 percent have salt with inadequate iodine content (<15 ppm), and only 11 percent have salt with adequate iodine content (15+ ppm). • Households in Urban areas (13 percent) are slightly more likely than Rural area households (10 percent) to have salt with adequate salt content. Households in the Interior area are almost three times as likely as those in the Coastal area to have salt with an adequate salt content (25 percent versus 9 percent). Eighty-one percent of households in Region 9 have salt with adequate iodine content compared with 4 percent in Region 6. Table 11.9 Presence of iodized salt in the household Among all households, percentage of households tested for iodine content and percentage of households with no salt; and among households with salt tested, the percent distribution by level of iodine in salt (parts per million or ppm), according to residence and wealth quintile, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among households with tested salt, the percent distribution by iodine content of salt: Background characteristic Among all households, percentage with salt tested Number of households None (0 ppm) Inadequate (<15 ppm) Adequate (15+ ppm) Total Number of households ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 95.5 1,603 74.0 12.9 13.0 100.0 1,530 Georgetown (urban) 97.0 1,053 72.8 13.6 13.6 100.0 1,022 Other (urban) 92.5 550 76.4 11.7 11.9 100.0 508 Total Rural 92.0 4,029 82.2 8.3 9.5 100.0 3,709 Total Coastal 93.3 5,052 81.9 9.2 8.9 100.0 4,712 Coastal (urban) 95.5 1,603 74.0 12.9 13.0 100.0 1,530 Coastal (rural) 92.2 3,449 85.6 7.5 6.9 100.0 3,182 Total Interior 90.8 580 61.6 13.6 24.9 100.0 527 Region Region 1 93.0 199 74.2 16.3 9.5 100.0 185 Region 2 93.9 348 80.4 7.6 12.0 100.0 327 Region 3 95.3 763 82.3 6.4 11.3 100.0 727 Region 4 93.6 2,420 80.4 10.9 8.7 100.0 2,266 Region 5 90.1 417 87.3 6.9 5.7 100.0 376 Region 6 92.7 879 85.8 10.0 4.2 100.0 815 Region 7 93.0 116 74.4 14.1 11.5 100.0 108 Region 8 84.7 104 73.5 10.6 15.8 100.0 88 Region 9 88.3 88 4.4 14.7 80.9 100.0 78 Region 10 91.0 297 69.2 5.6 25.2 100.0 270 Wealth quintile Lowest 89.0 1,110 80.8 8.2 11.1 100.0 988 Second 92.7 1,151 82.2 8.6 9.3 100.0 1,068 Middle 93.7 1,122 83.0 8.0 9.0 100.0 1,051 Fourth 94.2 1,126 81.7 8.5 9.8 100.0 1,060 Highest 95.4 1,123 71.6 15.0 13.3 100.0 1,072 Total 93.0 5,632 79.8 9.7 10.5 100.0 5,239 Nutrition of Children and Adults | 181 11.8 NUTRITIONAL STATUS OF WOMEN AND MEN The 2009 GDHS collected anthropometric data on height and weight for interviewed women and men age 15-49. Two indicators of nutritional status based on these data are presented in this report for women: the percentage with very short stature (less than 145 cm) and body mass index (BMI). One indicator (BMI) is presented for men. BMI or the Quetelet index, is used to measure thinness or obesity. BMI is defined as weight in kilograms divided by height squared in meters (kg/m2). A cut-off point of 18.5 is used to define thinness or acute undernutrition and a BMI of 25.0 or above usually indicates overweight or obesity. The prevalence of overweight women and men is a growing concern in developing countries, predisposing them to a wide range of health problems such as diabetes and heart disease as well as poor birth outcomes for women. In many countries, however, chronic energy deficiency is still a problem among adults, which leads to low work productivity and reduced resistance to illness. The height of a woman is associated with past socioeconomic status and nutrition during child- hood and adolescence. Low pre-pregnancy BMI and short stature are risk factors for poor birth outcomes and obstetric complications. In developing countries, maternal underweight is a leading risk factor for preventable death and diseases. Tables 11.10.1 and 11.10.2 present data on the nutritional status of women and men age 15-49, respectively, according to background characteristics. Respondents for whom there was no information on anthropometry are excluded from this analysis. The analysis of height is based on 4,758 women, and the analysis of BMI is based on 4,459 women and 3,246 men age 15-49 years. Women • Overall, just 3 percent of women 15-49 in Guyana are less than 145 cm in height, with 42 percent of all women falling within the normal BMI range of 18.5-24.9. Rural area women (4 percent) and those in the Interior area (14.8 percent) are slightly more likely than Urban area women and those in the Coastal area (2 percent, each) to have a height below 145 cm. Women in Region 5 (1 percent) are the least likely and women in Region 8 (20 percent) are the most likely to be less than 145 cm in height. The percentage of women with a height less than 145 cm—most vulnerable to health risks especially during pregnancy—were mostly not educated (13 percent) and in the lowest wealth quintile (11 percent). • The mean BMI for all women 15–49 years old in the sample was 25.6, just above the cut-off point of 25.0 for overweight and obesity. At the national level, 11 percent of women were considered thin (BMI <18.5), and 4 percent were moderately and severely thin (BMI <17.0). The percentage of women who are thin is highest among youngest women 15-19 (26 percent), women in the Rural and Coastal areas (11 percent, each), and those in Regions 3, 4, 5, and 6 (11 to 12 percent). There is no clear relationship between the percentage of women who are thin and education and household wealth. However, women with secondary education (12 percent) and in the second and third wealth quintiles (13-14 percent) are more likely than other women to be thin. • Overweight and obesity (BMI ≥25.0) are quite common in Guyana, with 48 percent of all women being overweight or obese, and 22 percent being obese (BMI ≥30.0). The proportion of women who are overweight or obese is especially high among women age 30-49 years (61-66 percent are overweight or obese, and 27-34 percent are obese). The Interior area (56 percent) and Region 7 (57 percent) have the highest percentages of women who are overweight or obese. The percentages of women who are overweight or obese decreases with education and increases with wealth. 182 | Nutrition of Children and Adults Table 11.10.1 Nutritional status by background characteristics: Women Among women age 15-49, the percentage with height under 145 cm, mean Body Mass Index (BMI), and percentage with specific BMI levels, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Height Body Mass Index BMI 1 (kg/m2) ––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Normal Thin Overweight/obese (OO) ––––––––– –––––––––––––––––––––––––––– –––––––––––––––––––––– Percent- Mean ≥25.0 age of Body <17.0 (total women Number Mass 18.5-24.9 <18.5 17.0-18.4 (moderately over- 25.0-29.9 Number Background below of Index (total (total (mildly and severely weight/ (over- ≥30.0 of characteristic 145 cm women (BMI) normal) thin) thin) thin) obese) weight) (obese) women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 3.5 973 21.7 56.5 25.9 14.5 11.5 17.6 10.9 6.7 917 20-29 3.5 1,362 24.6 47.3 12.2 6.7 5.5 40.5 24.1 16.4 1,217 30-39 3.6 1,283 27.3 35.1 3.7 2.7 1.0 61.2 34.0 27.2 1,218 40-49 2.7 1,161 28.1 30.2 3.4 2.3 1.1 66.3 32.8 33.6 1,150 Residence Total Urban 1.7 1,428 25.9 39.9 9.7 5.4 4.3 50.4 27.0 23.4 1,369 Georgetown (urban) 1.5 934 25.8 40.1 9.3 5.3 4.0 50.5 28.5 22.1 901 Other (urban) 2.2 494 26.1 39.5 10.3 5.6 4.7 50.2 24.3 25.9 469 Total Rural 4.0 3,352 25.5 42.2 10.8 6.4 4.5 47.0 26.0 21.0 3,133 Total Coastal 2.1 4,303 25.5 41.4 11.3 6.5 4.8 47.3 25.5 21.7 4,091 Coastal (urban) 1.7 1,428 25.9 39.9 9.7 5.4 4.3 50.4 27.0 23.4 1,369 Coastal (rural) 2.2 2,875 25.3 42.2 12.1 7.1 5.0 45.7 24.8 20.9 2,722 Total Interior 14.8 476 26.7 42.1 2.2 1.6 0.6 55.7 33.8 21.9 411 Region Region 1 17.8 160 27.4 41.7 2.3 1.3 1.0 56.0 33.8 22.2 125 Region 2 3.4 288 25.2 43.4 9.8 6.3 3.5 46.8 29.4 17.4 273 Region 3 1.5 656 24.8 45.7 11.9 6.9 4.9 42.4 24.4 18.0 629 Region 4 2.0 2,099 25.6 40.7 11.3 6.6 4.7 48.0 25.6 22.4 1,998 Region 5 1.4 321 25.6 41.2 12.4 7.4 5.0 46.5 22.4 24.1 291 Region 6 2.8 730 25.5 39.3 12.0 6.1 5.8 48.7 26.9 21.8 701 Region 7 12.5 95 26.6 42.1 1.3 0.7 0.6 56.6 33.6 23.0 85 Region 8 20.3 87 25.8 48.0 1.7 1.4 0.3 50.2 31.5 18.7 78 Region 9 12.3 73 25.6 48.4 2.5 1.9 0.6 49.1 33.9 15.2 68 Region 10 2.0 269 27.0 37.4 6.8 4.8 2.0 55.7 25.9 29.9 253 Education No education 12.5 65 29.0 33.7 4.4 1.2 3.3 61.8 25.0 36.8 55 Primary 6.2 905 26.4 35.8 7.0 3.8 3.2 57.2 31.8 25.4 843 Secondary 2.7 3,430 25.3 43.2 11.6 6.9 4.7 45.2 24.9 20.3 3,245 More than secondary 0.3 380 25.8 40.4 9.7 4.9 4.8 49.9 26.4 23.5 360 Wealth quintile Lowest 10.7 748 25.5 46.0 7.2 4.5 2.7 46.7 29.2 17.5 674 Second 2.7 923 25.3 42.0 13.6 7.5 6.1 44.4 21.7 22.7 863 Middle 2.0 984 25.0 43.1 13.0 7.3 5.7 43.9 23.4 20.5 917 Fourth 2.4 1,033 26.1 38.3 10.6 6.7 3.9 51.1 27.3 23.8 989 Highest 0.9 1,092 26.0 39.8 7.6 4.2 3.4 52.5 29.7 22.8 1,059 Total 3.3 4,780 25.6 41.5 10.5 6.1 4.4 48.0 26.3 21.7 4,502 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 1 Excludes pregnant women and women with a birth in the preceding 2 months Nutrition of Children and Adults | 183 Men • The mean body mass index for men age 15-49 was 23.6, with 56 percent of all men falling within the normal BMI range of 18.5-24.9. About one in nine of all men (12 percent) is underweight (BMI <18.5), and 8 percent are mildly thin (BMI 17.0-18.4), while 4 percent are moderately and severely thin (BMI <17.0). Similar to women, the percentage of men who are thin is highest among the youngest age group 15-19 (29 percent), men in the Coastal area (13 percent), and those in Region 3 (17 percent). The percentage of men who are thin is lowest among men in the Interior area (3 percent), men in Regions 1,2,7, and 8 (less than 1 to 6 percent), men with more than secondary education (9 percent), and men in the lowest and highest wealth quintiles (9-10 percent). Table 11.10.2 Nutritional status by background characteristics: Men Among men age 15-49, mean Body Mass Index (BMI) and percentages with specific BMI levels, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Normal Thin Overweight/obese (OO) –––––––– –––––––––––––––––––––––––– ––––––––––––––––––––––––– Mean ≥25.0 Body <17.0 (total Mass 18.5-24.9 <18.5 17.0-18.4 (moderately over- 25.0-29.9 Number Background Index (total (total (mildly and severely weight/ (over- ≥30.0 of characteristic (BMI) normal thin) thin) thin) obese) weight) (obese) men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 20.8 60.7 28.9 16.1 12.8 10.4 7.5 2.9 640 20-29 23.7 62.7 8.2 6.3 2.0 29.1 21.2 7.9 904 30-39 24.4 53.8 7.7 5.6 2.1 38.5 27.9 10.6 903 40-49 24.8 46.9 8.0 5.3 2.6 45.1 33.7 11.4 802 Residence Total Urban 23.8 55.9 11.6 7.9 3.7 32.5 21.2 11.3 882 Georgetown (urban) 23.9 56.6 10.8 7.3 3.5 32.6 20.9 11.8 575 Other (urban) 23.7 54.6 13.1 9.0 4.0 32.3 21.8 10.5 307 Total Rural 23.5 55.9 12.3 7.8 4.5 31.8 24.3 7.5 2,368 Total Coastal 23.4 55.1 13.2 8.5 4.7 31.7 23.2 8.5 2,897 Coastal (urban) 23.8 55.9 11.6 7.9 3.7 32.5 21.2 11.3 882 Coastal (rural) 23.2 54.7 13.9 8.7 5.2 31.3 24.1 7.2 2,015 Total Interior 25.0 62.7 3.0 2.4 0.6 34.2 25.2 9.0 353 Region Region 1 25.5 63.3 5.6 4.3 1.3 31.1 18.9 12.2 141 Region 2 24.4 54.0 6.4 4.2 2.3 39.6 28.3 11.3 169 Region 3 22.9 54.7 17.0 12.1 5.0 28.3 21.0 7.3 390 Region 4 23.3 56.1 12.8 7.6 5.2 31.1 23.0 8.2 1,456 Region 5 23.4 56.8 13.5 9.7 3.9 29.7 21.7 8.0 241 Region 6 23.8 51.4 13.2 8.4 4.8 35.4 26.4 9.1 526 Region 7 24.7 57.5 1.4 0.5 0.9 41.1 35.0 6.2 57 Region 8 23.5 74.9 2.8 2.8 0.0 22.3 22.0 0.3 59 Region 9 25.1 56.5 0.0 0.0 0.0 43.5 37.0 6.5 50 Region 10 24.0 59.2 10.5 8.4 2.1 30.3 18.1 12.1 161 Education No education 26.1 61.7 11.1 11.1 0.0 27.2 14.2 13.1 53 Primary 23.7 53.9 10.4 7.8 2.7 35.7 28.0 7.7 643 Secondary 23.3 57.3 12.9 8.0 4.9 29.7 21.7 8.0 2,284 More than secondary 25.1 48.0 9.0 5.4 3.7 42.9 29.1 13.8 270 Wealth quintile Lowest 23.2 66.3 9.5 6.6 2.9 24.1 20.3 3.8 604 Second 22.9 58.1 16.1 11.6 4.5 25.8 18.8 7.0 617 Middle 22.8 57.1 14.9 9.6 5.4 28.0 20.5 7.5 663 Fourth 24.0 52.6 11.1 7.1 3.9 36.3 26.7 9.6 708 Highest 24.8 46.7 9.0 4.3 4.6 44.3 30.3 14.1 658 Total 23.6 55.9 12.1 7.8 4.3 32.0 23.5 8.5 3,250 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 184 | Nutrition of Children and Adults • Overweight and obesity (BMI ≥25.0) is also common among men, although less common than among women (32 and 48 percent, respectively). One in eleven men (9 percent) were classified as obese (BMI ≥30.0). The proportion of men who are overweight or obese is highest among men age 30-49 years (39-45 percent), men in Region 9 (44 percent), those with more than secondary education (43 percent) and men in the highest wealth quintile (44 percent). 11.9 FOODS CONSUMED BY MOTHERS The quality and quantity of foods consumed by mothers has a direct impact on their health and that of their children, especially the health of breastfeeding children. The 2009 GDHS included questions on the types of foods consumed by mothers of children under age 3 during the day and night preceding the interview. Table 11.11 shows the foods most commonly consumed by mothers who have a child younger than age 3 living with them. This information can have policy and programmatic implications because it provides a proxy for the quality of mother's diet. • The foods consumed by women age 15-49 in the day or night preceding the interview include grains, mainly rice (92 percent); meat, fish, shellfish, poultry, or eggs (88 percent); milk (80 percent); vitamin A-rich fruits and vegetables (77 percent), and foods made with oil, butter, or fat (69 percent). A smaller percentage consumed foods made from roots and tubers (46 percent); cheese or yogurt (42 percent); fruits and vegetables other than vitamin-A rich ones (40 percent); and foods made from legumes (31 percent). Consumption of tea/coffee (79 percent), other liquids (88 percent), and sugary foods (60 percent) is also common. • Consumption of milk, a major source of calcium for women, was lowest for women from the Interior area (74 percent), from Rural areas (78 percent), with no education (41 percent), and from the lowest wealth quintile (70 percent). Similar patterns are observed for consumption of vitamin A-rich fruits and vegetables. Foods containing iron such as meat, fish, shellfish, poultry, or eggs were consumed less frequently among women in rural areas. Nutrition of Children and Adults | 185 Table 11.11 Foods consumed by mothers in the day or night preceding the interview Among mothers age 15-49 with a child under age 3 living with them, the percentage who consumed specific types of foods in the day or night preceding the interview, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Liquids Solid or semi-solid foods Background characteristic Milk Tea/coffee Other liquids Foods made from grains Foods made from roots/ tubers Foods made from legumes Meat/ fish/ shellfish/ poultry/ eggs Cheese/ yogurt Vitamin A-rich fruits/ vege- tables1 Other fruits/ vege- tables Other solid or semi- solid food Foods made with oil/ fat/ butter Sugary foods Number of women Age 15-19 78.7 69.0 93.8 87.7 48.0 26.4 86.6 34.0 70.2 38.0 43.0 72.3 57.0 150 20-29 78.2 81.4 87.4 92.8 44.6 31.7 88.5 44.5 76.8 39.2 46.8 67.7 60.8 524 30-39 83.6 78.8 86.7 91.3 46.1 32.3 87.7 41.1 80.8 41.6 42.4 69.0 58.1 305 40-49 87.4 74.4 89.1 92.9 57.7 34.2 88.6 45.1 81.9 38.2 67.5 67.1 66.7 48 Residence Total Urban 89.0 77.1 92.2 95.5 49.7 43.9 94.6 59.7 87.2 43.9 53.7 78.9 70.6 226 Georgetown (urban) 91.2 74.2 95.0 94.3 53.8 44.2 94.2 64.9 89.6 42.1 54.6 81.5 68.9 147 Other (urban) 84.9 82.4 87.2 97.8 42.1 43.3 95.4 50.1 82.8 47.2 52.1 73.9 73.7 80 Total Rural 77.9 78.9 87.1 90.5 45.2 27.6 86.1 37.0 74.4 38.5 43.7 65.8 56.7 800 Total Coastal 82.1 81.4 91.1 93.9 43.5 34.0 87.6 47.8 79.4 40.7 48.6 72.7 64.2 808 Coastal (urban) 89.0 77.1 92.2 95.5 49.7 43.9 94.6 59.7 87.2 43.9 53.7 78.9 70.6 226 Coastal (rural) 79.4 83.0 90.6 93.3 41.1 30.2 84.9 43.2 76.3 39.5 46.7 70.3 61.7 582 Total Interior 73.8 67.7 77.6 83.1 56.0 20.8 89.5 20.4 69.3 36.0 35.8 53.9 43.2 218 Region Region 1 80.9 66.1 71.8 89.5 59.3 18.1 89.4 19.1 68.5 44.5 39.8 47.5 43.6 86 Region 2 78.9 81.3 83.1 83.7 32.0 19.2 84.9 30.5 72.4 32.1 36.2 62.9 57.4 56 Region 3 82.0 80.6 91.9 96.2 43.5 33.0 80.9 47.2 74.0 37.0 45.4 82.9 70.4 135 Region 4 85.0 80.2 93.6 95.6 44.5 37.4 91.5 55.6 82.1 37.2 52.4 74.5 63.5 375 Region 5 85.1 84.3 92.5 91.2 48.9 32.6 79.7 38.1 78.9 47.0 48.9 64.4 61.5 75 Region 6 70.7 84.0 85.7 91.9 43.1 30.2 86.6 38.5 77.8 54.1 42.3 63.0 59.2 131 Region 7 67.9 60.5 84.1 78.3 43.2 11.4 90.6 19.0 66.8 25.9 32.5 56.3 33.7 38 Region 8 60.3 62.2 78.8 69.1 58.5 17.3 80.7 15.1 64.4 36.2 32.3 41.7 43.3 38 Region 9 61.5 71.6 81.0 76.2 71.2 35.3 95.9 24.2 81.6 25.2 40.8 64.7 46.4 32 Region 10 93.6 83.6 87.1 97.9 41.2 38.5 95.2 42.5 80.3 39.6 48.3 81.0 70.3 60 Education No education (41.2) (63.9) (76.8) (77.0) (60.4) (25.0) (88.5) (24.1) (54.8) (39.7) (38.1) (59.7) (48.1) 27 Primary 80.8 77.0 83.5 94.0 47.3 26.7 85.3 32.5 73.3 41.0 44.1 62.2 58.3 214 Secondary 81.9 78.9 90.3 91.3 46.3 32.4 88.4 46.0 78.3 38.0 47.4 71.0 61.0 719 More than secondary 78.2 84.1 85.1 93.9 35.5 35.6 92.4 36.6 87.3 53.1 39.3 69.0 55.8 67 Wealth quintile Lowest 69.9 69.8 81.6 86.4 49.4 22.9 87.6 26.5 70.8 34.3 43.6 55.6 47.7 285 Second 87.3 83.7 94.2 94.4 42.5 27.5 91.7 38.1 77.9 38.7 44.0 77.2 62.6 202 Middle 81.5 82.4 88.7 90.7 42.6 32.1 83.1 45.8 68.3 38.6 47.9 70.3 66.8 204 Fourth 80.6 79.9 89.0 94.9 50.3 36.9 87.0 50.3 83.2 38.1 50.6 75.8 63.3 173 Highest 88.1 80.7 91.0 95.1 45.2 43.3 91.3 60.5 92.5 53.5 44.7 71.5 64.6 162 Total 80.3 78.5 88.2 91.6 46.2 31.2 88.0 42.0 77.2 39.7 45.9 68.7 59.7 1,027 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Foods consumed in the past 24-hour period (yesterday and last night). Figures in parentheses are based on 25-49 unweighted cases. 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A. 186 | Nutrition of Children and Adults 11.10 ANEMIA IN WOMEN AND MEN The same equipment and procedures used to measure anemia in children were employed to measure anemia in women and men. Three levels of severity of anemia are distinguished: mild anemia (10.0-10.9 g/dl for pregnant women, 10.0-11.9 g/dl for non-pregnant women, and 12.0-12.9 g/dl for men); moderate anemia (7.0-9.9 g/dl for women and 9.0-11.9 g/dl for men); and severe anemia (less than 7.0 g/dl for women and less than 9.0 g/dl for men). Appropriate adjustments in these cut-off points should be made for respondents living at altitudes above 1,000 meters and for respondents who smoke because both of these groups require more hemoglobin in their blood (Centers for Disease Control and Prevention, 1998). These adjustments were made for respondents who smoke; however adjustments for altitude were not made because none of the respondents were living at altitudes above 1,000 meters. Tables 11.12.1 and 11.12.2 show the prevalence of anemia in women and men, respectively, by background characteristics. Women • Thirty-seven percent of women 15-49 in Guyana have some form of anemia, with the majority (29 percent) having mild anemia and 8 percent having moderate anemia. • There is some variation in the prevalence of anemia among women by background characteristics. The prevalence of anemia is highest among older women age 40-49 (43 percent), those with six or more children (47 percent), women using an IUD (44 percent), and women living in the Coastal area (38 percent). • There are important differentials by region in the prevalence of anemia among women. Region 5 has the highest percentage of women with anemia (49 percent), while Regions 8 and 9 (24 and 21 percent, respectively) have the lowest percentage of women with anemia. • The prevalence of anemia is lowest among women with no education (28 percent compared with 37-40 percent of women with any education) and women in the highest wealth quintile (33 percent compared with 38-40 percent of women in the other wealth quintiles). Men • Only 6 percent of men 15-49 are classified as anemic, with 4 percent being mildly anemic and only 1 percent being moderately anemic. • There are no major variations in the prevalence of anemia among men by various background characteristics. The highest anemia prevalence is recorded among men in Region 5 (10 percent), men with no education (13 percent), and men in the lowest wealth quintile (8 percent). Nutrition of Children and Adults | 187 Table 11.12.1 Prevalence of anemia: Women Percentage of women age 15-49 with anemia, by background characteristics, Guyana 2008 Anemia status by hemoglobin level Mild Moderate Severe Any Not pregnant 10.0-11.9 g/dl 7.0-9.9 g/dl <7.0 g/dl <12.0 g/dl Background characteristic Pregnant 10.0-10.9 g/dl 7.0-9.9 g/dl < 7.0 g/dl <11.0 g/dl Number of women Age 15-19 26.2 7.4 0.5 34.1 935 20-29 28.8 6.6 0.0 35.5 1,304 30-39 28.1 7.8 0.7 36.7 1,241 40-49 30.7 11.4 1.1 43.1 1,115 Number of children ever born 0 25.4 6.0 0.3 31.8 1,423 1 29.1 8.3 0.5 37.9 725 2-3 29.0 9.6 0.5 39.1 1,543 4-5 31.2 8.8 1.0 41.1 622 6+ 35.0 10.9 1.3 47.2 281 Maternity status Pregnant 18.9 18.7 0.0 37.5 201 Breastfeeding 28.5 8.0 0.1 36.6 622 Neither 29.1 7.7 0.7 37.5 3,772 Using IUD Yes 37.1 6.5 0.0 43.5 226 No 28.1 8.4 0.6 37.1 4,369 Smoking status Smokes cigarettes/tobacco 28.6 7.1 0.2 35.9 148 Does not smoke 28.6 8.3 0.6 37.4 4,438 Residence Total Urban 29.9 7.2 0.4 37.5 1,336 Georgetown (urban) 28.1 7.4 0.3 35.9 860 Other (urban) 33.1 6.7 0.5 40.3 476 Total Rural 28.0 8.7 0.7 37.4 3,259 Total Coastal 29.1 8.5 0.6 38.2 4,127 Coastal (urban) 29.9 7.2 0.4 37.5 1,336 Coastal (rural) 28.7 9.1 0.7 38.6 2,791 Total Interior 23.7 6.1 0.1 30.0 468 Region Region 1 25.8 9.2 0.0 35.0 158 Region 2 31.6 8.3 0.7 40.5 287 Region 3 32.9 5.9 0.4 39.2 605 Region 4 26.6 8.2 0.7 35.5 2,013 Region 5 33.9 14.0 1.3 49.2 316 Region 6 28.6 10.0 0.4 39.0 711 Region 7 19.7 7.1 0.4 27.2 92 Region 8 23.2 1.2 0.0 24.4 88 Region 9 16.5 4.8 0.0 21.3 73 Region 10 33.9 5.1 0.7 39.7 254 Education No education 21.1 7.4 0.0 28.4 63 Primary 27.9 10.5 1.2 39.5 894 Secondary 28.5 8.1 0.5 37.1 3,277 More than secondary 31.7 4.8 0.3 36.7 362 Wealth quintile Lowest 26.4 10.6 1.1 38.1 737 Second 30.6 8.8 0.3 39.7 884 Middle 28.0 9.2 0.9 38.1 950 Fourth 28.6 9.2 0.6 38.4 984 Highest 28.9 4.4 0.2 33.4 1,040 Total 28.6 8.3 0.6 37.4 4,595 Note: Prevalence of anemia is adjusted for altitude and for smoking status, if known, using formulas in CDC, 1998. 188 | Nutrition of Children and Adults Table 11.12.2 Prevalence of anemia: Men Percentage of men age 15-49 with anemia, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Anemia status by hemoglobin level Background characteristic Mild (12.0-12.9 g/dl ) Moderate (9.0-11.9 g/dl ) Severe ( < 9.0 g/dl ) Any anemia (<13.0 g/dl) Number of men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 5.2 1.0 0.0 6.2 625 20-29 4.3 1.8 0.0 6.2 863 30-39 3.5 1.1 0.1 4.7 875 40-49 5.2 1.5 0.2 6.8 770 Smoking status Smokes cigarettes/tobacco 4.7 1.2 0.0 5.8 959 Does not smoke 4.4 1.5 0.1 6.0 2,172 Residence Total Urban 3.8 0.9 0.1 4.9 832 Georgetown (urban) 3.2 0.8 0.2 4.3 536 Other (urban) 4.8 1.2 0.0 5.9 295 Total Rural 4.7 1.5 0.1 6.3 2,302 Total Coastal 4.6 1.3 0.1 6.0 2,781 Coastal (urban) 3.8 0.9 0.1 4.9 832 Coastal (rural) 5.0 1.4 0.1 6.5 1,949 Total Interior 3.3 2.0 0.1 5.4 353 Region Region 1 2.2 3.9 0.3 6.4 149 Region 2 6.2 1.6 0.0 7.9 164 Region 3 7.4 1.0 0.4 8.8 356 Region 4 3.9 0.6 0.1 4.6 1,394 Region 5 4.2 6.2 0.0 10.4 235 Region 6 4.3 0.9 0.0 5.2 524 Region 7 3.3 0.2 0.0 3.5 55 Region 8 3.4 0.5 0.0 3.9 56 Region 9 5.3 2.0 0.0 7.3 49 Region 10 4.6 1.0 0.0 5.5 151 Education No education 6.2 6.8 0.0 13.0 58 Primary 5.0 3.0 0.1 8.0 639 Secondary 4.4 0.8 0.1 5.3 2,186 More than secondary 2.8 1.3 0.0 4.1 251 Wealth quintile Lowest 5.5 2.6 0.1 8.2 605 Second 4.1 2.3 0.2 6.7 599 Middle 4.4 1.1 0.2 5.8 639 Fourth 5.3 0.8 0.0 6.1 671 Highest 2.8 0.1 0.0 2.9 620 Total 4.4 1.4 0.1 5.9 3,133 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Prevalence of anemia is adjusted for altitude and for smoking status, if known, using formulas in CDC, 1998. Nutrition of Children and Adults | 189 11.11 MICRONUTRIENT INTAKE AMONG MOTHERS Adequate micronutrient intake by women has important benefits for them and their children. Breastfeeding children benefit from micronutrient supplementation that mothers receive, especially vitamin A. Iron supplementation of women during pregnancy protects the mother and infant against anemia. It is estimated that one-fifth of perinatal mortality and one-tenth of maternal mortality are attributable to iron deficiency anemia. Anemia also results in an increased risk of premature delivery and low birth weight. Finally, iodine deficiency is related to a number of adverse pregnancy outcomes. Table 11.13 presents indicators of micronutrient intake among mothers, particularly (1) the percentage of women with a birth in the past three years who consume vitamin A- and iron-rich foods; (2) the percentage of women with a birth in the five years preceding the survey who suffered from night blindness during pregnancy, who took iron tablets or syrup for specific numbers of days during their last pregnancy, and who took de-worming medication during their last pregnancy; and (3) the percentage with a live birth in the past five years who live in households that were tested for salt and that have adequately iodized salt, by background characteristics. • Ninety-five percent of women age 15-49 with a child under age 3 living with her consumed foods rich in vitamin A, and 88 percent consumed foods rich in iron in the 24 hours preceding the survey. There are no major variations in the consumption of these foods by various background characteristics. • Night blindness was reported in 5 percent of women 15-49 with a child born in the past five years. However, when adjusted (by excluding women who reported night blindness but did not report difficulty with vision during the day), the prevalence of night blindness was just over 1 percent. Mothers from the Interior area (3 percent), those in Region 1 (7 percent) and Region 2 (5 percent), mothers with primary education and those from the lowest wealth quintile (3 percent, each) have the highest prevalence of night blindness when compared with other women. • With regard to iron supplementation during pregnancy, 16 percent of women did not take iron tablets or syrup during pregnancy. Although six in ten women said they took iron tablets, 20 percent took iron for fewer than 60 days. More than one-third of women (34 percent) took the iron tablets or syrup for the recommended 90 or more days. Iron intake varies by background characteristics. Older women, women living in the Rural and the Interior areas, and those living in Region 9 are more likely than other women not to have taken any iron supplements during pregnancy. The percentage of women who did not take any iron during pregnancy decreases as level of education and wealth quintile increase. • One in eight women (12 percent) with a child born in the past five years lives in households with adequately iodized salt. This percentage is relatively high for women in the Interior area (25 percent) and significantly high for women living in Region 9 (88 percent). There are no major variations by other background characteristics. 190 | Nutrition of Children and Adults Table 11.13 Micronutrient intake among mothers Among women age 15-49 with a child under age three years living with her, the percentages who consumed vitamin A-rich and iron-rich foods in the 24 hours preceding the survey; among mothers age 15-49 who during the pregnancy of the last child born in the five years prior to the survey, the percentage who suffered from night blindness, the percentage who took iron tablets or syrup for specific numbers of days, and the percentage who took deworming medication; and among women age 15-49 with a child born in the past five years, who live in households that were tested for iodized salt, the percentage who live in households with adequately iodized salt, by background characteristics, Guyana 2009 Among women with a child born in the past five years: Among women with a child under three years living with them: Among women with a child born in the past five years, who live in households that were tested for iodized salt: Number of days women took iron tablets or syrup during pregnancy for last birth Percentage with night blindness during pregnancy for last birth Background characteristic Per- centage who consumed vitamin A- rich foods1 Per- centage who con- sumed iron-rich foods2 Number of women Reported Adjusted3 None <60 60-89 90+ Don’t know/ missing Percentage of women who took deworming medication during pregnancy of last birth Number of women Percentage living in households with adequately iodized salt4 Number of women Age 15-19 92.0 86.6 150 8.7 1.9 12.5 26.6 6.0 30.7 24.2 12.1 162 11.2 154 20-29 95.5 88.5 524 3.3 0.7 16.6 19.3 6.0 30.7 27.5 16.1 723 10.2 658 30-39 95.6 87.7 305 5.5 2.0 14.8 20.1 4.2 41.6 19.3 20.1 456 14.6 426 40-49 96.3 88.6 48 10.2 1.9 17.4 16.1 2.6 31.2 32.7 20.8 84 9.3 73 Residence Total Urban 96.9 94.6 226 3.9 1.4 7.2 21.5 5.2 38.5 27.6 18.5 346 12.4 315 Georgetown (urban) 96.1 94.2 147 3.3 1.5 5.3 16.8 2.8 45.6 29.6 14.8 223 13.2 207 Other (urban) 98.4 95.4 80 4.9 1.0 10.6 30.1 9.5 25.6 24.2 25.2 123 10.9 108 Total Rural 94.5 86.1 800 5.4 1.3 18.3 19.8 5.2 32.9 23.9 16.8 1,080 11.5 996 Total Coastal 95.0 87.6 808 3.1 0.9 13.9 18.4 5.1 37.9 24.8 15.6 1,160 8.7 1,069 Coastal (urban) 96.9 94.6 226 3.9 1.4 7.2 21.5 5.2 38.5 27.6 18.5 346 12.4 315 Coastal (rural) 94.2 84.9 582 2.8 0.7 16.7 17.0 5.0 37.6 23.7 14.4 815 7.1 754 Total Interior 95.4 89.5 218 13.7 3.4 23.1 28.3 5.8 18.3 24.6 24.2 265 25.1 242 Region Region 1 97.1 89.4 86 21.3 6.5 24.7 28.4 8.8 12.8 25.3 34.3 103 9.0 97 Region 2 92.4 84.9 56 7.1 4.9 17.6 12.1 5.2 28.6 36.5 19.2 80 10.1 73 Region 3 94.7 80.9 135 4.3 0.4 15.3 7.8 2.7 37.0 37.3 11.0 189 9.9 179 Region 4 94.8 91.5 375 2.4 0.8 12.3 15.1 5.6 48.5 18.6 12.7 534 10.2 497 Region 5 97.7 79.7 75 3.8 0.0 16.0 14.5 5.3 28.8 35.5 22.5 105 1.7 93 Region 6 93.9 86.6 131 0.8 0.0 16.7 38.4 2.8 21.5 20.5 20.8 194 2.6 178 Region 7 97.0 90.6 38 12.9 0.5 15.8 34.3 0.9 30.2 18.7 8.4 48 14.2 43 Region 8 87.6 80.7 38 4.1 1.9 21.9 21.0 4.9 25.5 26.7 20.3 47 16.5 40 Region 9 96.9 95.9 32 11.3 2.1 26.5 25.6 2.7 10.6 34.6 25.0 38 87.6 35 Region 10 98.9 95.2 60 6.4 1.4 12.4 32.0 12.7 23.5 19.4 21.3 88 25.0 78 Education No education (97.3) (88.5) 27 (14.1) (0.0) (24.5) (18.4) (16.6) (15.6) (24.8) (15.6) 40 (8.5) 38 Primary 94.8 85.3 214 9.4 2.6 25.1 18.9 2.1 26.1 27.8 21.8 290 10.5 268 Secondary 94.6 88.4 719 3.8 1.2 13.1 21.0 5.5 36.7 23.6 16.6 989 12.2 906 More than secondary 100.0 92.4 67 1.8 0.0 8.9 16.9 6.4 40.3 27.4 10.8 106 11.8 99 Wealth quintile Lowest 95.8 87.6 285 10.8 3.2 21.4 20.6 4.7 26.6 26.8 23.6 361 15.7 333 Second 95.4 91.7 202 3.6 0.7 16.8 21.4 6.5 27.7 27.6 13.7 297 7.6 263 Middle 89.7 83.1 204 3.3 0.3 15.8 22.2 4.6 37.4 20.0 15.9 278 11.6 258 Fourth 97.6 87.0 173 3.1 1.3 12.1 20.0 6.5 38.1 23.3 17.3 241 11.0 228 Highest 97.2 91.3 162 2.4 0.6 8.7 16.1 3.8 46.0 25.4 13.5 247 11.4 228 Total 95.1 88.0 1,027 5.1 1.3 15.6 20.2 5.2 34.2 24.8 17.2 1,425 11.7 1,311 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat (and organ meat), fish, poultry, and eggs 3 Women who reported night blindness but who did not report difficulty with vision during the day 4 Salt containing 15 ppm of iodine or more; excludes women in households where salt was not tested Malaria | 191 MALARIA 12 Malaria is endemic in the interior regions of Guyana and constitutes one of the leading causes of morbidity and mortality in these regions, especially among pregnant women and children under age 5. Even though interior Regions 1, 7, 8, and 9 constitute about 60 percent of Guyana’s overall surface area, only about 10 percent of the indigenous population lives there. Another 4 to 5 percent of the population seeks work in these regions, especially in mining, logging, and natural resource exploration. Annually, about 12,000 malaria cases were reported nationally in 2008, representing a downward trend from about 60,000 cases reported in 2003. Of the total malaria cases, almost all (98 percent) occurred in Regions 1, 7, 8, and 9, and they accounted for one in twelve (8 percent) of all outpatient visits. Slightly more than 2 percent of hospital admissions result from complications of malaria, and these cases are considered serious, accounting for about 1 percent of all deaths in Guyana (MOH Statistical Unit). Vector Control Services of the Guyana Ministry of Health is in the process of implementing the national malaria strategy for the period 2008-2012. This strategy is guided by WHO criteria, recom- mendations in the Global Malaria Action Plan for a Malaria-Free World, and activities outlined in the Regional Strategic Plan for Malaria in the Americas 2006–2010 (PAHO, 2006). The objectives of this initiative are to ensure that, by 2012, at least 80 percent of individuals at risk for malaria have access to the most suitable and affordable combination of personal and community protective measures, such as insecticide-treated mosquito nets (ITNs), and prompt, effective diagnosis and treatment for malaria. One focus of this initiative is pregnant women, and the related objective is to ensure that at least 90 percent of pregnant women who are at risk of malaria, especially those in their first pregnancies, have access to preventive measures, early diagnosis, and prompt treatment. This chapter presents information that helps assess how well malaria control strategies are implemented. These strategies include making mosquito nets available by category in the selected households, use of mosquito nets by women and children, and use of antimalarial drugs as prophylaxis for pregnant women and as treatment for children under age 5 with fever. Information is also presented on the specific antimalarial drugs received as well as the timing of the treatment. 12.1 OWNERSHIP OF MOSQUITO NETS One of the most important means for controlling vector-borne diseases, such as malaria or dengue fever, is to break the host-vector link. The use of bed nets in malaria control does just that by creating a physical barrier between humans and the female Anopheles mosquito, which feeds primarily at night. Treating the bed nets with an insecticide that leaves a residual effect has the added advantage of repelling and/or killing the mosquitoes. This reduces the mosquito population and, eventually, terminates their ability to transmit malaria. There are various types of insecticide-treated mosquito nets (ITNs) on the market. They include the long-lasting, insecticide-treated nets that require re-treatment only after about four years or 20 washes, and the standard insecticide-treated nets that need to be re-treated every six months or after three washes. Since around 2002, the Guyanese government has purchased and distributed long-lasting ITNs to people living in malaria-endemic regions. There is also an active program, implemented by the Ministry of Health, which educates household members on use and home treatment of ITNs to prevent vector-borne diseases. 192 | Malaria Table 12.1 shows the percentages of households with at least one net, more than one net (treated or untreated), one or more ever-treated nets, one or more insecticide-treated nets, and the average number of nets per household, by background characteristics. • Eighty-nine percent of households in Guyana own a mosquito net, whether treated or untreated, and 66 percent of households own more than one net. Rural area households are more likely to own at least one net than Urban area households (90 percent versus 85 percent). About nine in ten households in the malaria-endemic regions (1, 7, 8, and 9) have at least one mosquito net. The percentage of households with at least one net is lowest for households in the lowest wealth quintile (81 percent) compared with other households (89-93 percent). Table 12.1 Household possession of mosquito nets Percentage of households with at least one and more than one net (treated or untreated), one and more than one ever-treated nets, and one and more insecticide-treated nets1 (ITN), and the average number of nets per household, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Insecticide-treated Any type of mosquito net Ever-treated mosquito net2 mosquito net (ITN)1 ––––––––––––––––––––––––––––– –––––––––––––––––––––––––––– ––––––––––––––––––––––––––– Background characteristic Percentage of households with at least one net Percentage of households with more than one net Average number of nets per household Percentage of households with at least one net Percentage of households with more than one net Average number of ever- treated nets per household Percentage of households with at least one ITN Percentage of households with more than one ITN Average number of ITNs per household Number of households –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 84.6 63.7 1.9 14.1 10.6 0.3 12.6 9.3 0.3 1,603 Georgetown (urban) 86.1 65.2 2.0 5.5 4.4 0.1 4.1 3.1 0.1 1,053 Other (urban) 81.6 60.9 1.9 30.6 22.4 0.7 28.8 21.2 0.6 550 Total Rural 90.2 67.0 2.0 35.2 25.0 0.8 30.7 22.0 0.7 4,029 Total Coastal 88.6 66.1 2.0 26.4 19.1 0.6 24.6 18.1 0.5 5,052 Coastal (urban) 84.6 63.7 1.9 14.1 10.6 0.3 12.6 9.3 0.3 1,603 Coastal (rural) 90.5 67.2 2.0 32.1 23.1 0.7 30.2 22.2 0.7 3,449 Total Interior 88.0 65.8 2.0 53.9 36.5 1.1 34.0 21.1 0.7 580 Region Region 1 94.5 71.5 2.2 55.7 36.6 1.2 38.0 24.0 0.8 199 Region 2 97.5 78.0 2.3 67.2 51.9 1.5 62.0 48.0 1.4 348 Region 3 92.2 67.1 2.0 24.2 16.7 0.5 22.8 16.2 0.5 763 Region 4 88.5 62.9 1.9 15.7 9.5 0.3 14.3 8.8 0.3 2,420 Region 5 87.6 69.5 2.1 26.6 21.7 0.6 24.7 20.9 0.6 417 Region 6 86.8 71.2 2.0 46.4 37.2 1.1 45.1 36.3 1.1 879 Region 7 91.0 64.9 1.9 69.6 45.8 1.4 47.7 30.5 0.9 116 Region 8 89.1 65.3 2.0 70.6 50.5 1.6 40.2 23.2 0.8 104 Region 9 76.0 64.8 2.1 44.2 35.3 1.1 22.7 15.9 0.5 88 Region 10 74.9 52.0 1.6 8.3 3.5 0.1 4.5 1.7 0.1 297 Malaria-endemic regions3 89.4 67.6 2.1 60.0 41.3 1.3 38.0 23.9 0.8 507 Wealth quintile Lowest 80.8 47.2 1.5 39.2 23.5 0.7 28.8 15.5 0.5 1,110 Second 88.9 60.6 1.8 31.1 21.7 0.6 28.1 20.0 0.6 1,151 Middle 92.7 69.4 2.0 30.3 22.3 0.6 28.8 21.4 0.6 1,122 Fourth 90.9 75.2 2.2 27.6 22.2 0.7 25.0 20.8 0.6 1,126 Highest 89.5 77.5 2.3 18.0 14.8 0.5 17.2 14.3 0.4 1,123 Total 88.6 66.0 2.0 29.2 20.9 0.6 25.6 18.4 0.5 5,632 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment, (2) a pre-treated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months 2 An ever-treated net is a pre-treated net or a non-pre-treated net, which has subsequently been soaked with insecticide at any time 3 Regions 1, 7, 8, and 9 Malaria | 193 • The average number of mosquito nets per household is 2. • About three in ten (29 percent) of households own at least one ever-treated net, and more than one in four (26 percent) own an insecticide-treated net. Rural area households are more than twice as likely to own an ITN as Urban area households (31 percent versus 13 percent), and households in the Interior area are more likely than those in the Coastal area to own at least one ITN (34 percent versus 25 percent). About four in ten households in the malaria-endemic regions (38 percent) have at least one ITN. It is noteworthy that only 23 percent of households in Region 9 (a malaria-endemic region) own an ITN. The percentage of households with at least one ITN is lowest for households in the highest wealth quintile (17 percent) compared with other households (25 to 29 percent). 12.2 USE OF MOSQUITO NETS BY CHILDREN Age is an important factor in determining levels of acquired immunity to malaria. For about six months following birth, antibodies acquired from the mother during pregnancy protect children born in areas of endemic malaria. This immunity is gradually lost, and children start to develop their own immunity to malaria. The pace at which immunity is developed depends on the type of exposure to malaria infection, and in malaria-endemic areas, children are thought to have attained a high level of immunity by their fifth birthday. Such children may experience episodes of malaria illness but usually do not suffer from severe, life-threatening malaria. Immunity in areas of low malaria transmission is acquired more slowly, and illness affects all age groups of the population. In the 2009 GDHS, respondents to the Household Questionnaire were asked about the use of mosquito nets by all members of the household on the night before the interview. Table 12.2 presents information on the use of mosquito nets by children under age 5 in all households and in households with an ITN, by background characteristics. • Eight in ten children under age 5 in all households slept under a mosquito net (treated or untreated) the night before the survey; about three in ten (29 percent) slept under an ever- treated net; and about one in four (24 percent) slept under an ITN. In households that own at least one ITN, a substantially larger proportion of children under age 5 slept under an ITN the night before the survey (81 percent). • Among children under age 5, those age 1-2 are somewhat more likely than other children to have slept under any net (82 to 84 percent), an ever-treated net (31 to 32 percent), or an ITN (27 to 28 percent) the night before the survey. Children in Urban areas (82 percent) are slightly more likely than those in Rural areas (80 percent) and children in the Coastal area (83 percent) are more likely than those in the Interior area (70 percent) to have slept under any net. The opposite is true for the other ever-treated and insecticide-treated nets. Children living in the Rural and Interior areas are significantly more likely to have slept under an ever-treated net or an ITN the previous night than children in Urban and Coastal areas. Seventy-five percent of children under age 5 from the malaria-endemic regions had slept under any net, 46 percent had slept under an ever-treated net, and 30 percent had slept under an ITN. Among the malaria- endemic regions, Region 9 has the lowest percentage of children under age 5 who slept under any net (44 percent), under an ever-treated net (18 percent), or an ITN (8 percent) the night before. The proportion of children who slept under an ever-treated net or an ITN generally decreases with increasing wealth quintile, while the percentage sleeping under any net tends to increase with wealth. • In households that own at least one ITN, the percentage of children who slept under an ITN decreases with child’s age. It is higher among children living in Urban areas (90 percent) and in the Coastal area (85 percent) when compared with children living in Rural areas (80 percent) 194 | Malaria Table 12.2 Use of mosquito nets by children Among children under age 5 in all households, the percentage who, on the night preceding the interview, slept under a mosquito net (treated or untreated), under an ever-treated mosquito net, and under an insecticide-treated net (ITN), and among children under age 5 in households with at least one ITN, the percentage who slept under an ITN the past night, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Children under age 5 in all households –––––––––––––––––––––––––––––––––––––––––––––––––– Children under age 5 in households with an ITN ––––––––––––––––––––– Background characteristic Percentage who slept under any net last night Percentage who slept under an ever-treated net last night1 Percentage who slept under an ITN last night2 Number of children Percentage who slept under an ITN last night2 Number of children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age (in years) <1 82.7 27.8 23.8 424 85.7 118 1 84.0 31.4 27.0 400 83.7 129 2 81.9 31.9 28.3 447 81.2 156 3 76.9 26.6 21.6 375 77.9 104 4 76.0 25.8 20.5 411 77.6 109 Sex Male 80.0 29.5 25.4 1,022 81.9 317 Female 80.7 28.0 23.3 1,036 80.8 299 Residence Total Urban 81.8 14.5 12.6 464 90.4 65 Georgetown (urban) 86.7 7.3 5.1 283 * 15 Other (urban) 74.1 25.8 24.3 181 87.7 50 Total Rural 80.0 32.9 27.8 1,594 80.3 551 Total Coastal 83.0 25.6 23.6 1,639 84.6 458 Coastal (urban) 81.8 14.5 12.6 464 90.4 65 Coastal (rural) 83.4 30.0 28.0 1,175 83.7 393 Total Interior 70.3 41.0 27.1 419 72.0 158 Region Region 1 80.9 49.4 36.4 155 78.2 72 Region 2 93.3 68.4 61.5 125 91.5 84 Region 3 88.8 22.8 22.8 272 (92.2) 67 Region 4 81.9 15.0 12.9 733 76.1 125 Region 5 75.2 19.4 17.1 145 (83.6) 30 Region 6 83.9 46.9 45.6 277 85.7 148 Region 7 77.5 56.3 32.4 71 76.3 30 Region 8 70.4 54.7 36.7 75 76.3 36 Region 9 43.9 17.9 7.7 72 (37.3) 15 Region 10 67.2 4.1 2.5 133 * 9 Malaria-endemic regions3 75.3 45.8 30.3 373 73.4 153 Wealth quintile Lowest 72.6 38.0 28.0 582 78.8 207 Second 82.7 29.2 25.8 447 90.3 128 Middle 85.3 30.9 29.7 370 84.4 130 Fourth 79.1 21.5 19.0 347 68.6 96 Highest 87.3 16.4 14.9 311 85.6 54 Total 80.4 28.8 24.4 2,058 81.4 616 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not available 1 An ever-treated net is a pretreated net, or a non-pretreated net, which has subsequently been soaked with insecticide at any time. 2 An insecticide-treated net (ITN) is a factory-treated net that does not require any further treatment; or a pretreated net obtained within the past 12 months; or a net that has been soaked with insecticide within the past 12 months. 3 Regions 1, 7, 8, and 9 and the Interior area (72 percent). About three quarters (73 percent) of children living in house- holds with an ITN in Regions 1, 7, 8, and 9—the malaria-endemic regions—had slept under an ITN the previous night. The relationship between the proportion of children in households with ITNs who slept under an ITN the night before and wealth does not follow a clear pattern. Malaria | 195 12.3 USE OF MOSQUITO NETS BY WOMEN In malaria-endemic areas adults usually have acquired some degree of immunity to severe, life- threatening malaria. However, pregnancy depresses the immune system, so pregnant women, especially those in their first pregnancy, have a higher risk of malaria. Moreover, some malaria episodes may be asymptomatic but can lead to malaria-induced anemia and may interfere with the mother-fetus exchange of nutrients, resulting in low birth-weight births. During pregnancy, women can reduce the risk of the adverse effects of malaria by sleeping under insecticide-treated mosquito nets. Table 12.3.1 shows the percentage of all women age 15-49 in all households who slept under a mosquito net (treated or untreated) the night before the survey, and in households that own at least one ITN, the proportion who slept under an ITN the night before the survey, by background characteristics. • More than three-quarters (76 percent) of women age 15-49 in all households slept under a mosquito net (treated or untreated) the night before the survey; and more than one in five slept under an ever-treated net (24 percent) or under an ITN (22 percent). In households that own at least one ITN, almost four times as many women slept under an ITN the night before the survey when compared with women from all households (82 percent versus 22 percent). • Among all women, those living in Rural areas are much more likely than Urban women to have slept under any net (78 percent versus 71 percent), under an ever-treated net (30 percent versus 11 percent), and under an ITN (27 percent versus 10 percent). Women in the Coastal area are more likely than those in the Interior area to have slept under any net (77 and 70 percent, respectively). On the other hand, women in the Interior area are more likely than those in the Coastal area to have slept under an ever-treated net (41 percent versus 22 percent) or an ITN (27 percent versus 21 percent). • The percentage of women who slept under any net ranges from 43 percent in Region 9 to 90 percent, each, in Regions 1 and 2. Looking at ever-treated nets and ITNs, only 3 percent and 2 percent, respectively, slept under an ever-treated net and an ITN in Region 10 compared with 58 and 53 percent, respectively, of women in Region 2. The proportion of women who slept under any net the previous night tends to increase with education, while the proportion who slept under an ever-treated net or an ITN decreases with education. The lowest percentage of all women who slept under an ever-treated net or under an ITN (15 percent, each) is among women in the highest wealth quintile. The percentage of women who slept under any net does not have a clear relationship with wealth. • In households that own at least one ITN, the percentage of women who slept under an ITN is higher among those living in the Rural areas and the Coastal area (83 percent, each) when compared with women living in the Urban areas (75 percent) and the Interior area (75 percent). Only 28 percent of women living in households with an ITN in Region 10 and 35 percent in Region 9 had slept under an ITN the previous night compared with 90 percent, each, in Regions 2 and 3. The relationship between the proportion of women in households with ITNs who slept under an ITN the night before and education or wealth does not follow a clear pattern. 196 | Malaria Table 12.3.1 Use of mosquito nets by women Among women age 15-49 in all households, the percentages who slept the night before the survey under a mosquito net (treated or untreated), under an ever-treated mosquito net, and under an insecticide-treated net (ITN); and among women age 15-49 in households with at least one ITN, the percentage who slept the night before the survey under an ITN, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-49 in all households –––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-49 in households with an ITN ––––––––––––––––––––– Background characteristic Percentage who slept under any net last night Percentage who slept under an ever-treated net last night1 Percentage who slept under an ITN last night2 Number of women Percentage who slept under an ITN last night2 Number of women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Total Urban 71.1 10.8 9.8 1,638 74.9 215 Georgetown (urban) 72.9 4.5 3.5 1,073 (64.6) 58 Other (urban) 67.7 22.6 21.9 564 78.7 157 Total Rural 78.3 29.8 26.8 3,907 83.2 1,261 Total Coastal 76.9 22.4 21.3 4,986 83.1 1,276 Coastal (urban) 71.1 10.8 9.8 1,638 74.9 215 Coastal (rural) 79.7 28.1 26.9 3,348 84.7 1,061 Total Interior 70.2 40.5 26.7 559 74.7 200 Region Region 1 90.4 48.0 34.1 181 87.6 70 Region 2 89.8 57.5 53.2 324 89.5 192 Region 3 83.7 21.2 20.2 759 89.7 171 Region 4 75.6 12.8 12.1 2,411 78.0 373 Region 5 73.3 23.3 22.0 390 77.1 111 Region 6 77.5 41.9 41.1 864 84.7 419 Region 7 73.0 54.5 36.0 116 79.2 53 Region 8 69.1 54.6 35.2 104 78.4 47 Region 9 43.0 19.7 9.4 86 35.2 23 Region 10 53.1 2.9 1.5 309 (27.8) 17 Malaria-endemic regions3 73.3 45.9 30.4 487 76.8 193 Education No education 70.9 37.3 22.2 92 (86.7) 24 Primary 76.5 28.2 25.1 1,024 82.2 312 Secondary 76.1 23.6 21.6 3,910 82.2 1,027 More than secondary 79.4 19.7 18.0 465 83.2 100 Wealth quintile Lowest 67.2 32.1 24.0 868 75.4 276 Second 76.3 26.7 24.2 1,070 85.5 303 Middle 80.0 25.8 24.6 1,112 86.0 319 Fourth 77.5 24.1 22.6 1,219 79.7 345 Highest 77.6 15.4 15.2 1,276 82.8 233 Total 76.2 24.2 21.8 5,545 81.9 1,476 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 An ever-treated net is a pretreated net, or a non-pretreated net, which has subsequently been soaked with insecticide at any time. 2 An insecticide-treated net (ITN) is a factory-treated net that does not require any further treatment; or a pretreated net obtained within the past 12 months; or a net that has been soaked with insecticide within the past 12 months. 3 Regions 1, 7, 8, and 9 Malaria | 197 12.4 MALARIA DURING PREGNANCY In malaria-endemic areas, it is common health policy that pregnant women receive prophylactic Intermittent Preventive Treatment (IPT) with antimalarial drugs. However, in Guyana and the rest of the Americas where unstable malaria exists, IPT is not commonly promoted and the policy has been to promote the use of preventive measures such as sleeping under an ITN and ensuring early diagnosis and prompt treatment of malaria cases. Questions on IPT with antimalarial drugs during the last pregnancy in the last five years were included in the 2009 GDHS. However, due to the small number of cases of mothers with malaria, the results are described in the text but not included in malaria tables. Additionally, it is likely that, when asked about the drug(s) taken during pregnancy, some women are not sure which specific drug(s) they took, affecting the quality of the data. Table 12.3.2 shows the percentage of pregnant women 15-49 in all households who slept under a mosquito net (treated or untreated) the night before the survey, by background characteristics. The percentage of women age 15-49 in households that own at least one ITN who slept under an ITN the night before the survey is not shown due to the small number of cases. • Around eight in ten women age 15-49 in all households (78 percent), slept under a mosquito net (treated or untreated) the night before the survey; one-third slept under an ever-treated net (33 percent), and three in ten slept under an ITN (30 percent). In households that own at least one ITN, 88 percent of women slept under an ITN the night before the survey (data not shown due to small number of cases). • Among all women, those living in Rural areas are more likely than those from Urban areas to have slept under any net (79 percent versus 76 percent), under an ever-treated net (38 percent versus 15 percent), and under an ITN (35 percent versus 13 percent). • Eighty-six percent of women in the malaria-endemic regions (Regions 1, 7, 8, and 9) slept under any net the previous night, 54 percent slept under an ever-treated net, and 44 percent slept under an ITN. • The number of cases for each education category is relatively small for a meaningful analysis. The percentage of women who slept under any net, under an ever-treated net, and under an ITN the night before decreases with an increase in wealth. • As mentioned above, the Intermittent Preventive Treatment (IPT) is not a recommended strategy to control malaria in Guyana. Data show that only 1 percent of women received SP/Fansidar during an antenatal care visit for their most recent pregnancy in the two preceding years (data not shown). 198 | Malaria Table 12.3.2 Use of mosquito nets by pregnant women Percentage of pregnant women age 15-49 in all households who slept the night before the survey under a mosquito net (treated or untreated), under an ever-treated mosquito net, and under an insecticide-treated net (ITN), by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Pregnant women age 15-49 in all households ––––––––––––––––––––––––––––––––––––––––––––– Background characteristic Percentage who slept under any net last night Percentage who slept under an ever- treated net last night1 Percentage who slept under an ITN last night2 Number of women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 75.6 14.8 12.6 46 Rural 79.2 38.3 34.9 168 Coastal 76.9 28.3 27.0 168 Interior 83.8 50.5 41.1 47 Malaria-endemic regions3 85.9 53.9 43.9 44 Education No education * * * 8 Primary 87.0 37.2 32.9 48 Secondary 79.3 35.1 32.6 142 More than secondary * * * 16 Wealth quintile Lowest 80.5 45.1 38.5 58 Second (83.4) (41.3) (36.9) 41 Middle (77.8) (25.3) (25.3) 44 Fourth (75.5) (26.7) (24.3) 41 Highest (72.5) (19.6) (19.6) 30 Total 78.4 33.2 30.1 215 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk (*) indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 An ever-treated net is a pretreated net or a non-pretreated net that has subsequently been soaked with insecticide at any time. 2 An insecticide-treated net (ITN) is a factory-treated net that does not require any further treatment; or a pretreated net obtained within the past 12 months; or a net that has been soaked with insecticide within the past 12 months. 3 Regions 1, 7, 8, and 9 Malaria | 199 12.5 PREVALENCE AND MANAGEMENT OF CHILDHOOD MALARIA Since the major manifestation of malaria is fever, in the 2009 GDHS mothers were asked whether their children under age 5 had a fever in the two weeks preceding the survey. Although fever can occur all year round, malaria is more prevalent during the rainy season, and such temporal factors must be taken into account when interpreting the occurrence of fever as an indicator of malaria prevalence. If a fever was reported, the mother was asked whether treatment was sought at a health facility and whether the child was given any medication and, if so, how soon the medication was taken after the episode of illness started. Table 12.4 shows the percentage of children under age 5 with fever in the two weeks preceding the survey, and among children with fever, the percentage who received antimalarial drugs and the percentage who took antimalarial drugs the same day or next day, by background characteristics. • One in five children under age five (20 percent) had a fever in the two weeks preceding the survey (also see Table 10.6). Of these, only 6 percent of children received an antimalarial drug, and just 4 percent received the antimalarial drug on the same or the next day after the onset of the fever. Almost all of the children with fever who took antimalarial drugs took Chloroquine (6 percent). • Children age 36-47 months are more likely to be given antimalarial drugs for the treatment of fever and more likely to receive the drugs the same or the next day than other children. Children living in the Urban and the Coastal areas are more likely to be given antimalarial drugs than children in the Rural and the Interior areas. Children of more educated mothers and children of mothers in the higher wealth quintiles are more likely than other children to be given antimalarial drugs and to receive these drugs the same or next day as the onset of the fever. The prevalence of children with fever is high in Region 7 and Region 8 (26 percent each) and low in Region 9 (14 percent). • Four percent of all children with fever in the malaria-endemic regions received antimalarial drugs, and 3 percent received the drugs the same or next day. • The percentage of children with fever who took an antimalarial drug and who took the drug the same or next day tends to increase with wealth, while the pattern of variation by education is not clear because of the small number of cases. 200 | Malaria Table 12.4 Prevalence and prompt treatment of children with fever Percentage of children under age 5 with fever in the two weeks preceding the survey, and among children with fever, the percentage who took antimalarial drugs, and the percentage who took the drugs the same or next day following the onset of fever, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Children under age 5 Children under age 5 with fever –––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Background characteristic Percentage with fever in the two weeks preceding the survey Number of children Percentage who took antimalarial drugs Percentage who took antimalarial drugs same day or next day Percentage who took Chloroquine Percentage who took Chloroquine same day or next day Number of children with fever ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age (in months) <12 21.0 415 2.6 1.8 2.1 1.8 87 12-23 26.0 343 6.9 4.7 4.8 2.6 89 24-35 20.5 404 7.3 5.6 7.3 5.6 83 36-47 18.9 311 11.9 8.4 11.9 8.4 59 48-59 14.0 343 4.5 1.0 4.5 1.0 48 Residence Total Urban 15.2 405 13.1 4.4 13.1 4.4 62 Total Rural 21.5 1,410 5.1 4.3 4.3 3.7 304 Total Coastal 19.8 1,421 7.3 4.9 6.7 4.3 282 Coastal (urban) 15.2 405 13.1 4.4 13.1 4.4 62 Coastal (rural) 21.7 1,015 5.7 5.1 4.9 4.2 220 Total Interior 21.2 395 3.4 2.2 3.0 2.2 84 Region Region 1 20.2 157 (7.0) (5.8) (5.8) (5.8) 32 Region 2 16.7 106 (6.5) (2.6) (6.5) (2.6) 18 Region 3 19.5 229 (11.9) (8.8) (11.9) (8.8) 45 Region 4 19.0 637 7.3 6.2 5.8 4.7 121 Region 5 21.8 129 (0.0) (0.0) (0.0) (0.0) 28 Region 6 21.5 245 2.5 2.5 2.5 2.5 53 Region 7 26.0 62 (2.3) (0.2) (2.0) (0.0) 16 Region 8 25.7 71 (1.4) (0.0) (1.4) (0.0) 18 Region 9 13.7 61 (0.7) (0.0) (0.7) (0.0) 8 Region 10 22.8 118 (14.9) (2.5) (14.9) (2.5) 27 Malaria-endemic regions1 21.2 351 3.9 2.5 2.5 0.0 74 Mother's education No education 11.8 56 * * * * 7 Primary 22.5 397 0.5 0.5 0.5 0.4 89 Secondary 19.9 1,234 7.1 4.8 7.1 4.8 246 More than secondary 18.5 128 * * * * 24 Wealth quintile Lowest 20.2 527 2.1 0.8 1.7 0.8 107 Second 20.3 380 3.4 3.4 3.4 3.4 77 Middle 25.1 335 6.6 6.1 6.6 6.1 84 Fourth 20.1 288 11.6 5.3 8.4 2.1 58 Highest 14.1 285 (15.9) (10.1) (15.9) (10.1) 40 Total 20.1 1,815 6.4 4.3 5.8 3.8 366 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Regions 1, 7, 8, and 9 HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 201 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13 Acquired Immune Deficiency Syndrome (AIDS), first recognized internationally in 1981, is caused by the human immunodeficiency virus (HIV). The virus compromises the immune system and makes the body prone to opportunistic infections. The predominant mode of HIV transmission is through heterosexual contact, which usually accounts for more than 90 percent of new HIV cases, followed in magnitude by perinatal transmission, whereby the mother passes HIV to the child during pregnancy, at the time of birth, or after birth through breastfeeding. Other modes of HIV transmission can be through transfusion of infected blood and blood products and from transplant of donated organs or bone and tissue grafts. The future direction of this pandemic depends in large part on the level of knowledge of how the virus is spread and consequent changes in sexual behavior. The 2009 Guyana DHS collected information on HIV/AIDS-related knowledge in Guyana including social stigmatization, risk behavior modification, access to high-quality services for sexually transmitted infections (STI), provision and uptake of HIV counseling and testing, and the prevalence of male circumcision. The principal objective of this chapter is to establish the level of relevant knowledge, perceptions, and behaviors at the national level, and within geographic and socioeconomic sub- populations. Such information should go a long way toward better targeting of interventions for effective prevention, treatment, care, and support for those groups most in need of information and most at risk of HIV infection. The data presented in this chapter are useful for programs in Guyana that are aimed at controlling the spread of HIV/AIDS, especially by helping to identify individuals and sub-groups most in need of information and behavior change and modification. 13.1 KNOWLEDGE OF AIDS Respondents in the 2009 GDHS were asked whether they had heard of AIDS. Those who reported having heard of AIDS were asked a series of questions about whether AIDS can be avoided and how. Table 13.1 shows the percent distribution of women and men age 15-49 who have heard of AIDS, by background characteristics. • Knowledge of AIDS is almost universal in Guyana—97 percent of women and men have heard of AIDS. There are minor variations in knowledge of AIDS by age, marital status, or residence. The only exception is the level of knowledge in the Interior area, which is lower for both women (89 percent) and men (95 percent). • Among regions, the lowest percentage with knowledge about AIDS is in Region 9 for women (78 percent) and Regions 7 and 9 for men (92 percent, each). • The level of AIDS knowledge generally increases with education and wealth for both women and men. 202 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.1 Knowledge of AIDS Percentage of women and men 15-49 who have heard of AIDS, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––– –––––––––––––––––––– Percentage Percentage who have Number who have Number Background heard of of heard of of characteristic AIDS women AIDS men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 97.3 1,783 98.1 1,200 15-19 97.4 1,016 97.4 689 20-24 97.3 767 99.1 511 25-29 95.6 658 97.4 462 30-39 97.2 1,342 97.3 990 40-49 97.1 1,213 96.5 870 Marital status Never married 97.9 1,540 97.4 1,382 Ever had sex 98.5 761 98.6 863 Never had sex 97.4 779 95.4 518 Currently married 96.2 2,920 97.4 1,835 Formerly married 99.2 536 97.5 305 Residence Total Urban 99.0 1,475 99.3 949 Georgetown (urban) 99.8 967 99.7 619 Other (urban) 97.4 508 98.5 330 Total Rural 96.2 3,521 96.7 2,573 Total Coastal 98.0 4,495 97.7 3,126 Coastal (urban) 99.0 1,475 99.3 949 Coastal (rural) 97.5 3,019 97.0 2,176 Total Interior 88.7 501 94.6 396 Region Region 1 87.9 162 95.8 160 Region 2 96.7 293 98.9 179 Region 3 99.3 687 94.8 420 Region 4 99.4 2,168 99.1 1,540 Region 5 92.3 353 93.9 271 Region 6 95.6 780 97.4 587 Region 7 94.9 104 91.6 61 Region 8 85.3 95 93.5 68 Region 9 77.6 78 92.3 57 Region 10 99.5 277 98.7 178 Education No education 81.3 68 76.3 60 Primary 93.5 952 95.8 711 Secondary 98.0 3,568 98.1 2,459 More than secondary 99.4 409 99.2 292 Wealth quintile Lowest 89.5 779 95.9 663 Second 98.1 957 95.7 679 Middle 98.6 1,025 97.7 723 Fourth 97.7 1,084 98.1 751 Highest 99.3 1,151 99.3 705 Total 2009 97.0 4,996 97.4 3,522 Total 2005 98.2 2,425 98.2 1,875 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced/separated/ widowed. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 203 13.2 KNOWLEDGE OF HIV PREVENTION METHODS In Guyana, as in many other countries, HIV in adults is mainly transmitted by heterosexual contact between a partner who is HIV positive and a partner who is HIV negative. Consequently, HIV prevention programs focus their messages and efforts on three important aspects of behavior: using condoms, limiting the number of sexual partners or staying faithful to one partner, and delaying sexual debut for young persons (abstinence). To ascertain whether programs have effectively communicated these messages, the 2009 GDHS respondents were specifically asked if people can reduce their chances of getting the AIDS virus by using a condom every time they have sex, by having just one HIV-negative sexual partner who has no other sexual partners, and by not having sexual intercourse at all. The information obtained from the answer to these questions is crucial in understanding which population groups have lower levels of knowledge about HIV prevention methods and thus, is helpful in properly tailoring and directing the education programs to the right target groups. Table 13.2 shows the percentage of respondents age 15-49 who, in response to prompted ques- tions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having just one sex partner who is not infected and has no other partners, and by abstaining from sexual intercourse, by background characteristics. Additionally, Figure 13.1 shows knowledge of two HIV prevention methods—condom use and limiting sexual intercourse to one uninfected partner—by residence and education. 204 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.2 Knowledge of HIV prevention methods Percentage of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having just one sex partner who is not infected and has no other partners, and by abstaining from sexual intercourse, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––– Using Using Limiting condoms Limiting condoms sexual and limiting sexual and limiting intercourse sexual inter- Abstaining intercourse sexual inter- Abstaining to one course to one from Number to one course to one from Number Background Using uninfected uninfected sexual of Using uninfected uninfected sexual of characteristic condoms1 partner2 partner intercourse women condoms1 partner2 partner intercourse men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 83.2 79.6 72.4 78.5 1,783 83.5 83.8 75.3 76.9 1,200 15-19 81.8 78.8 71.1 77.4 1,016 84.4 81.4 75.2 76.0 689 20-24 85.0 80.6 74.0 80.0 767 82.4 86.9 75.4 78.2 511 25-29 81.8 84.2 75.6 77.5 658 87.8 86.4 79.5 80.0 462 30-39 81.3 84.3 74.3 79.5 1,342 82.2 83.8 75.8 76.3 990 40-49 78.4 83.0 72.2 76.5 1,213 84.2 86.2 77.5 79.6 870 Marital status Never married 84.9 84.0 76.8 82.1 1,540 84.9 82.7 76.1 78.9 1,382 Ever had sex 89.0 87.2 81.5 84.8 761 87.1 85.6 78.8 82.5 863 Never had sex 81.0 80.9 72.2 79.5 779 81.3 77.9 71.6 72.9 518 Currently married 79.0 80.5 70.8 75.7 2,920 82.6 86.3 76.4 77.3 1,835 Formerly married 83.5 87.1 76.5 80.7 536 87.3 83.9 79.6 76.0 305 Residence Total Urban 90.4 90.9 85.2 89.2 1,475 92.6 91.2 86.9 90.6 949 Georgetown (urban) 93.7 93.1 89.7 94.3 967 96.5 93.8 91.5 92.7 619 Other (urban) 84.0 86.7 76.8 79.5 508 85.5 86.3 78.4 86.6 330 Total Rural 77.5 78.7 68.2 73.6 3,521 80.7 82.3 72.7 73.1 2,573 Total Coastal 83.1 83.6 75.0 79.6 4,495 85.6 86.0 78.1 78.8 3,126 Coastal (urban) 90.4 90.9 85.2 89.2 1,475 92.6 91.2 86.9 90.6 949 Coastal (rural) 79.5 80.0 70.0 74.9 3,019 82.6 83.8 74.3 73.7 2,176 Total Interior 65.5 70.8 57.8 65.3 501 70.4 74.4 64.2 70.2 396 Region Region 1 60.4 63.9 50.5 61.6 162 61.8 64.6 54.1 63.4 160 Region 2 79.5 84.9 73.5 76.6 293 86.2 88.9 79.8 84.5 179 Region 3 83.3 83.0 75.0 77.8 687 75.2 76.0 65.5 64.7 420 Region 4 85.4 84.9 77.8 84.2 2,168 93.4 93.1 89.0 86.5 1,540 Region 5 76.1 75.2 65.5 70.8 353 77.5 74.7 64.8 67.3 271 Region 6 79.6 81.1 70.0 71.5 780 75.5 77.8 62.7 69.9 587 Region 7 79.9 81.2 73.9 75.2 104 75.9 78.7 72.0 71.8 61 Region 8 61.5 74.7 58.3 61.9 95 67.5 71.4 60.6 63.8 68 Region 9 54.7 60.5 47.9 55.4 78 76.2 83.6 71.3 80.4 57 Region 10 84.7 89.0 77.8 84.3 277 88.8 92.0 85.0 88.9 178 Education No education 40.8 50.8 34.8 46.6 68 46.2 54.3 41.2 48.1 60 Primary 68.2 68.7 56.8 65.2 952 77.5 80.4 69.5 69.3 711 Secondary 84.2 85.6 76.9 80.6 3,568 85.8 85.7 78.2 79.7 2,459 More than secondary 93.7 89.8 85.9 92.1 409 91.1 93.1 86.9 89.1 292 Wealth quintile Lowest 62.5 66.6 52.0 62.8 779 74.1 74.5 63.9 69.5 663 Second 78.6 79.1 69.2 73.8 957 80.9 82.2 72.8 77.3 679 Middle 82.9 85.2 75.6 78.6 1,025 83.5 85.6 76.5 73.9 723 Fourth 86.2 86.1 79.2 82.3 1,084 88.8 89.1 82.7 79.9 751 Highest 90.3 89.3 83.3 88.0 1,151 91.2 91.1 85.6 87.9 705 Total 2009 81.3 82.3 73.3 78.2 4,996 83.9 84.7 76.5 77.8 3,522 Total 2005 81.9 86.9 76.2 87.7 2,425 85.0 89.3 80.5 86.2 1,875 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced, separated, and widowed. 1 Every time they have sexual intercourse 2 Who has no other partners HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 205 • More than eight in ten respondents age 15-49 know that consistent use of condoms is a means of preventing the spread of HIV(81 percent of women and 84 percent of men) and that limiting sexual intercourse to one HIV-negative, faithful partner can reduce the chances of contracting HIV (82 percent of women and 85 percent of men). • The proportion of men who said that people can reduce the chances of getting the AIDS virus by using condoms and limiting sex to one HIV-negative partner is slightly higher (77 percent) than that of women (73 percent). Thus, knowledge is higher among men than women for each of the three specified prevention methods. • An equal proportion of women and men age 15-49 (78 percent, each) know that abstinence is a way to reduce the chance of HIV infection. • Differentials in knowledge of HIV prevention by age and marital status are not large. As expected, the level of knowledge of methods of HIV prevention is lower among respondents who have never had sexual intercourse. • For both women and men, knowledge of HIV prevention methods is higher in Urban areas than in Rural areas and higher in the Coastal area than in Interior area. For example, 85 percent of women in Urban areas have knowledge of both prevention methods (using condoms and limiting sexual intercourse to one uninfected faithful partner) compared with 68 percent of women in rural areas. Similarly, 75 percent of women in the Coastal area have knowledge of these two HIV prevention methods compared with 58 percent in the Interior area. For women, the lowest percentages who have knowledge about HIV prevention methods are in Regions 1, 8, and 9, while for men the lowest percentage is in Region 1. For instance, less than half of women in Region 9 (48 percent) know that proper use of condoms and limiting sexual intercourse to one uninfected faithful partner can prevent the spread of HIV infection. In some of these areas, the majority of the indigenous population speak traditional tribal languages, and therefore educational messages in English may not be comphrensible and may not reach them. • For both genders, the percentage with knowledge for any of the HIV prevention methods increases significantly with education and wealth. For example, 86 percent of women and 87 percent of men with more than secondary education know that using condoms and limiting sexual intercourse to one uninfected faithful partner can reduce the risks of getting the AIDS virus, compared with only 35 percent of women and 41 percent of men with no education. 206 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior 13.3 BELIEFS ABOUT AIDS In addition to knowing effective ways to avoid contracting HIV/AIDS, people also find it useful to be able to identify incorrect beliefs about AIDS, thus enabling them to eliminate misconceptions. Common misconceptions about AIDS include the idea that HIV-infected people appear ill and the belief that the virus can be transmitted through mosquito or other insect bites, by sharing food with someone who is infected, or by witchcraft or other supernatural means. Respondents in the 2009 GDHS were asked about these four misconceptions. Table 13.3.1 details the results for women and Table 13.3.2 for men. Figure 13.2 shows comprehensive knowledge about AIDS among women and men, by residence and education. • About nine in ten Guyanese adults know that a healthy-looking person can have the AIDS virus (87 percent of women and men) or that AIDS cannot be transmitted by supernatural means (87 percent of women and 88 percent of men). About three-quarters of women (73 percent) and two-thirds of men (65 percent) are aware that the AIDS virus cannot be transmitted through mosquito bites. Furthermore, 84 percent of women and 79 percent of men know that the AIDS virus cannot be contracted by sharing food with a person who has AIDS. • Overall, more than half of women (53 percent) and more than four in ten men (46 percent) in Guyana have a comprehensive knowledge of HIV/AIDS transmission and prevention methods, that is, they know that condom use and limiting sex to one uninfected partner are HIV prevention methods; are aware that a healthy looking person can have the AIDS virus; and reject the two most common local misconceptions (that AIDS can be transmitted by mosquito bites and by sharing food with someone with AIDS). The percentage of women and men with a comprehensive knowledge has increased only slightly since the 2005 Guyana AIDS Indicator Survey (GAIS). Figure 13.1 Knowledge of Two HIV Prevention Methods (Using Condoms and Limiting Sexual Intercourse to One Uninfected Faithful Partner), by Residence and Education 73 85 90 77 68 35 57 77 86 77 87 92 78 73 41 70 78 87 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural EDUCATION No education Primarfy Secondary More than secondary 0 20 40 60 80 100 Percentage of respondents Women 15-49 Men 15-49 GDHS 2009 HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 207 • Younger women are somewhat more likely to have a comprehensive knowledge about AIDS than older women, while among men there is no major difference by age. Respondents who ever had sex have a much higher level of comprehensive knowledge than those who never had sex. Among women, marital status has an impact on comprehensive knowledge about AIDS; currently married women (48 percent) are less likely than never married (61 percent) or formerly married women (60 percent) to have a comprehensive knowledge about AIDS, while among men the variation is not pronounced. • Urban respondents and those in the Coastal area are much more likely to have comprehensive knowledge about AIDS than respondents in the Rural and Interior areas. For example, 70 percent of women in Urban areas have comprehensive knowledge about AIDS compared with 46 percent of women in Rural areas; and 54 percent in the Coastal area have such knowledge compared with 41 percent of women in the Interior area. • For women, the lowest percentage of comprehensive knowledge about AIDS is in Region 9 (31 percent) and the highest in Region 10 (63 percent), while for men it ranges from 26 percent in Region 5 to 64 percent in Region 10. • Education and wealth status have a strong positive correlation with the likelihood of having a comprehensive knowledge about AIDS. The percentage with comprehensive knowledge increases from 20 percent among women and 11 percent among men with no education to 78 and 75 percent, respectively, among women and men with secondary or higher education. Similar patterns are observed in the variation of this indicator by wealth. Thirty-two percent of women and 28 percent of men in the lowest wealth quintile have a comprehensive knowledge about AIDS compared with 68 percent of women and 65 percent of men in the highest wealth quintile. 208 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.3.1 Comprehensive knowledge about AIDS: Women Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission, and the percentage with a comprehensive knowledge about AIDS, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who say that: Percentage ––––––––––––––––––––––––––––––––––––––––– who say that a Percentage AIDS A person healthy-looking of cannot be cannot become person can have women A healthy- AIDS transmitted infected by the AIDS virus with a looking person cannot be by sharing food and who reject the comprehensive Number Background can have the transmitted by supernatural with someone two most common knowledge of characteristic AIDS virus mosquito bites means with AIDS misconceptions about AIDS1 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 86.3 74.7 88.3 86.8 65.1 54.1 1,783 15-19 84.9 76.0 87.3 86.9 65.6 53.1 1,016 20-24 88.1 73.0 89.5 86.8 64.5 55.4 767 25-29 89.7 74.4 88.2 86.4 69.2 57.0 658 30-39 87.3 74.5 86.5 83.6 64.6 53.7 1,342 40-49 84.9 69.8 85.3 78.4 58.8 48.1 1,213 Marital status Never married 88.6 81.3 89.0 89.2 72.0 60.5 1,540 Ever had sex 92.7 85.7 89.7 92.9 78.8 68.1 761 Never had sex 84.6 76.9 88.2 85.6 65.4 53.0 779 Currently married 85.0 68.1 85.4 80.6 58.4 47.6 2,920 Formerly married 90.6 79.7 90.4 86.2 71.2 60.2 536 Residence Total Urban 93.1 83.9 91.1 91.9 77.5 70.4 1,475 Georgetown (urban) 95.7 87.9 92.8 94.1 81.9 76.6 967 Other (urban) 88.2 76.2 87.9 87.6 69.1 58.5 508 Total Rural 84.0 69.0 85.4 80.5 58.3 45.6 3,521 Total Coastal 88.2 74.5 88.1 85.2 65.2 54.2 4,495 Coastal (urban) 93.1 83.9 91.1 91.9 77.5 70.4 1,475 Coastal (rural) 85.7 69.9 86.7 81.9 59.3 46.3 3,019 Total Interior 73.5 63.9 77.2 71.9 52.7 41.4 501 Region Region 1 67.8 47.9 74.8 61.3 38.6 33.4 162 Region 2 83.6 63.6 87.0 80.2 54.2 46.1 293 Region 3 87.8 75.7 89.1 84.8 63.8 52.9 687 Region 4 91.0 79.3 90.3 89.7 71.0 59.8 2,168 Region 5 83.8 64.4 84.6 76.4 56.2 44.2 353 Region 6 82.5 65.9 83.2 76.2 54.9 43.3 780 Region 7 84.3 76.2 86.5 81.0 64.9 53.6 104 Region 8 74.3 74.7 73.6 77.7 66.6 51.1 95 Region 9 55.6 62.2 68.3 64.8 40.0 30.7 78 Region 10 93.4 81.5 87.5 92.2 75.9 62.8 277 Education No education 65.5 37.3 56.0 48.8 32.0 19.7 68 Primary 74.0 58.3 78.5 70.8 44.6 32.1 952 Secondary 89.2 76.0 88.9 86.5 67.0 56.2 3,568 More than secondary 97.5 92.4 96.0 97.0 88.5 78.0 409 Wealth quintile Lowest 71.9 56.3 75.5 67.6 44.8 32.3 779 Second 85.4 71.4 86.5 80.7 59.6 46.6 957 Middle 87.4 74.2 87.9 87.2 64.7 53.9 1,025 Fourth 90.2 74.4 87.6 85.4 65.8 56.0 1,084 Highest 93.9 85.1 94.1 93.1 78.3 68.2 1,151 Total 2009 86.7 73.4 87.1 83.9 64.0 52.9 4,996 Total 2005 88.4 69.6 86.1 78.3 58.2 50.2 2,425 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes women in consensual union (living together). Formerly married includes divorced, separated, and widowed. 1 Comprehensive knowledge means knowing that use of condom during every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus; knowing that a healthy-looking person can have the AIDS virus; and rejecting the two most common local misconceptions (that AIDS can be transmitted by mosquito bites and by sharing food with someone with AIDS). HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 209 Table 13.3.2 Comprehensive knowledge about AIDS: Men Percentage of men age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission, and the percentage with comprehensive knowledge about AIDS, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who say that: Percentage ––––––––––––––––––––––––––––––––––––––––– who say that a Percentage AIDS A person healthy-looking of cannot be cannot become person can have men A healthy- AIDS transmitted infected by the AIDS virus with looking person cannot be by sharing food and who reject the comprehensive Number Background can have the transmitted by supernatural with someone two most common knowledge of characteristic AIDS virus mosquito bites means with AIDS misconceptions about AIDS1 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 86.3 67.5 88.5 82.0 55.2 46.6 1,200 15-19 83.8 63.9 85.2 80.7 52.0 44.5 689 20-24 89.6 72.4 93.1 83.8 59.5 49.4 511 25-29 90.3 68.3 88.0 78.1 57.3 49.7 462 30-39 85.1 63.1 87.0 77.3 51.8 44.4 990 40-49 88.1 61.6 89.3 77.5 52.6 45.2 870 Marital status Never married 86.1 66.3 86.9 81.4 56.3 48.2 1,382 Ever had sex 92.4 71.2 89.0 84.8 63.0 54.1 863 Never had sex 75.7 58.1 83.3 75.8 45.3 38.4 518 Currently married 87.1 64.4 89.4 78.2 52.6 44.8 1,835 Formerly married 89.3 61.7 87.5 73.4 50.7 43.9 305 Residence Total Urban 92.9 78.0 93.0 88.0 69.2 63.3 949 Georgetown (urban) 93.0 82.6 96.7 90.8 73.8 69.4 619 Other (urban) 92.7 69.5 86.0 82.7 60.6 51.8 330 Total Rural 84.7 60.1 86.5 75.8 48.2 39.7 2,573 Total Coastal 87.9 65.5 89.1 79.9 54.6 46.9 3,126 Coastal (urban) 92.9 78.0 93.0 88.0 69.2 63.3 949 Coastal (rural) 85.7 60.0 87.4 76.4 48.2 39.7 2,176 Total Interior 79.3 60.5 81.5 72.2 48.6 39.5 396 Region Region 1 75.5 48.7 80.2 66.3 38.7 26.9 160 Region 2 91.7 71.8 89.7 80.5 60.2 52.6 179 Region 3 81.6 60.9 84.4 76.7 45.8 34.9 420 Region 4 91.0 71.8 92.9 86.2 62.6 57.8 1,540 Region 5 81.4 45.0 78.9 63.3 35.9 26.1 271 Region 6 84.2 57.6 87.5 70.5 43.0 30.9 587 Region 7 82.1 69.1 84.3 76.0 58.6 50.5 61 Region 8 78.2 61.8 82.8 68.4 46.2 39.5 68 Region 9 73.9 72.2 78.1 76.2 51.3 42.4 57 Region 10 95.8 73.6 85.5 91.1 70.1 63.9 178 Education No education 43.7 28.3 62.5 48.2 15.5 11.0 60 Primary 83.2 56.2 83.8 69.3 43.5 34.8 711 Secondary 87.8 65.4 89.4 81.0 54.2 46.7 2,459 More than secondary 97.5 89.0 94.5 92.6 84.3 75.3 292 Wealth quintile Lowest 79.5 50.5 82.2 63.9 36.1 28.4 663 Second 84.4 61.0 84.7 73.0 48.5 40.6 679 Middle 87.0 64.8 87.7 80.9 52.6 43.8 723 Fourth 90.2 68.1 92.4 84.7 59.7 51.2 751 Highest 92.8 79.0 93.4 91.3 70.9 64.7 705 Total 2009 86.9 64.9 88.2 79.1 53.9 46.0 3,522 Total 2005 89.8 61.1 85.5 74.2 50.9 45.2 1,875 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes men in consensual union (living together). Formerly married includes divorced/separated/ widowed. 1 Comprehensive knowledge means knowing that use of a condom during every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus; knowing that a healthy-looking person can have the AIDS virus; and rejecting the two most common local misconceptions (transmission by mosquito bites and by sharing food with someone with AIDS). 210 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior 13.4 KNOWLEDGE OF PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV Increasing the level of general knowledge of transmission of the virus from mother to child and reducing the risk of transmission by use of antiretroviral drugs are critical to improving the health of HIV- infected mothers and reducing the transmission of the virus to their children during and after pregnancy, labor, and delivery. All women and men interviewed in the 2009 GDHS were asked if the virus that causes AIDS can be transmitted from the mother to her child. If the answer was yes, they were further asked whether the virus could be transmitted during pregnancy, during delivery, or during breastfeeding. Respondents were also asked if a mother who is infected with the AIDS virus could reduce the risk of giving the virus to the baby by taking certain drugs during pregnancy. The results are presented in Table 13.4 by background characteristics. Figure 13.2 Comprehensive Knowledge about AIDS, by Residence and Education 53 70 77 59 46 20 32 56 78 46 63 69 52 40 11 35 47 75 Total RESIDENCE Total Urban Georgetown (urban) Other (urban) Total Rural EDUCATION No education Primary Secondary Higher than secondary 0 20 40 60 80 100 Percentage of respondents Women 15-49 Men 15-49 GDHS 2009 HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 211 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV Percentage of women and men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding, and that the risk of mother-to- child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––– Risk of HIV can be Risk of HIV can be MTCT transmitted by MTCT transmitted by can be breastfeeding and can be breastfeeding and reduced by risk of MTCT reduced by risk of MTCT mother can be reduced by mother can be reduced by HIV taking mother taking HIV taking mother taking can be special drugs special drugs Number can be special drugs special drugs Number Background transmitted by during during of transmitted by during during of characteristic breastfeeding pregnancy pregnancy women breastfeeding pregnancy pregnancy men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 82.0 70.2 63.1 1,783 65.0 55.2 42.5 1,200 15-19 81.6 68.5 61.8 1,016 62.2 54.6 40.5 689 20-24 82.5 72.3 64.8 767 68.7 55.9 45.2 511 25-29 76.8 70.5 62.6 658 69.5 59.5 47.9 462 30-39 75.9 66.3 57.4 1,342 66.0 50.6 39.1 990 40-49 77.2 65.3 57.5 1,213 68.3 54.3 43.7 870 Marital status Never married 82.2 73.7 66.3 1,540 61.8 54.7 40.9 1,382 Ever had sex 86.0 82.0 75.0 761 62.9 59.0 43.4 863 Never had sex 78.5 65.7 57.7 779 59.8 47.5 36.8 518 Currently married 76.1 63.9 55.9 2,920 70.0 54.5 43.7 1,835 Formerly married 80.9 73.5 65.8 536 69.1 50.6 42.8 305 Pregnancy status Pregnant 82.7 63.5 60.9 214 na na na na Not pregnant/not sure 78.3 68.2 60.1 4,782 na na na na Residence Total Urban 86.8 83.4 77.4 1,475 70.3 69.5 53.2 949 Georgetown (urban) 89.0 85.8 81.4 967 69.0 74.1 55.7 619 Other (urban) 82.4 78.7 69.7 508 72.8 61.0 48.4 330 Total Rural 75.1 61.5 52.9 3,521 65.4 48.6 38.6 2,573 Total Coastal 78.7 69.9 61.5 4,495 67.4 55.8 43.6 3,126 Coastal (urban) 86.8 83.4 77.4 1,475 70.3 69.5 53.2 949 Coastal (rural) 74.8 63.3 53.7 3,019 66.2 49.8 39.5 2,176 Total Interior 76.8 50.9 48.1 501 60.8 42.0 34.0 396 Region Region 1 75.9 36.0 33.3 162 57.9 39.2 32.9 160 Region 2 75.8 66.4 59.4 293 68.9 56.9 42.9 179 Region 3 73.7 67.7 54.2 687 57.8 54.6 39.2 420 Region 4 81.9 75.3 68.2 2,168 68.7 62.3 48.8 1,540 Region 5 73.1 55.0 48.3 353 63.4 41.0 31.7 271 Region 6 75.5 59.0 50.8 780 70.9 41.2 34.4 587 Region 7 82.5 67.5 64.5 104 60.2 52.4 40.6 61 Region 8 74.0 46.4 44.5 95 56.7 25.2 19.7 68 Region 9 66.8 47.8 46.1 78 64.9 39.6 31.2 57 Region 10 87.5 86.7 77.4 277 74.0 73.6 61.0 178 Education No education 51.3 24.9 22.1 68 34.0 20.4 17.0 60 Primary 70.7 50.3 43.0 952 63.9 42.6 35.4 711 Secondary 80.2 70.9 63.0 3,568 67.8 55.3 43.1 2,459 More than secondary 86.9 91.0 81.7 409 70.5 80.2 60.7 292 Wealth quintile Lowest 72.4 47.9 43.7 779 62.8 37.2 30.9 663 Second 78.9 63.2 56.0 957 67.9 47.8 39.9 679 Middle 79.3 68.8 60.4 1,025 68.3 52.4 42.2 723 Fourth 78.7 74.2 64.9 1,084 66.5 61.3 46.6 751 Highest 81.5 79.0 70.0 1,151 67.7 70.9 52.0 705 Total 2009 78.5 68.0 60.1 4,996 66.7 54.2 42.5 3,522 Total 2005 71.8 47.6 38.5 2,425 65.2 36.2 27.9 1,875 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The category Currently married includes respondents in consensual union (living together). Formerly married includes divorced/separated/ widowed. na = Not applicable 212 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior • About eight in ten women (79 percent) and seven in ten men (67 percent) know that HIV can be transmitted by breastfeeding. Sixty-eight percent of women and 54 percent of men are aware that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking drugs during pregnancy. • Overall, 60 percent of women and 43 percent of men know that HIV can be transmitted through breastfeeding and that the risk of MTCT can be reduced by the mother taking special drugs during pregnancy. Among women, knowledge is lowest among those who are married or living together. • Older women age 30-49 are somewhat less likely than younger women to know about MTCT and the use of special drugs to reduce the risk of MTCT. As expected, women who ever had sex have a much higher level of knowledge about MTCT and the use of special drugs than those who never had sex. Currently married women (56 percent) are less likely than never married or formerly married women (66 percent, each) to know about MTCT and the use of special drugs to reduce the risk of MTCT, while among men there is no significant variation by marital status. • Similar to their comprehensive knowledge about AIDS, Urban area respondents and those in the Coastal area are much more likely to know about MTCT and the use of special drugs to reduce the risk of MTCT than respondents in the Rural and Interior areas. Among women, 77 percent living in Urban areas have this knowledge compared with 53 percent of women in Rural areas; and 62 percent in the Coastal area have this knowledge compared with 48 percent of women in the Interior area. • For both women and men, the highest percentage with knowledge about MTCT and the use of special drugs to reduce the risk of MTCT is in Region 10 (77 and 61 percent, respectively), while the lowest percentage for women is in Region 1 (33 percent) and for men is in Region 8 (20 percent). • The percentage of respondents with knowledge about MTCT and the use of special drugs to reduce the risk of transmission increases steadily with education and wealth. Twenty-two percent of women and 17 percent of men with no education have such knowledge compared with 82 percent of women and 61 percent of men with secondary or higher education. Similar patterns are observed by wealth. • All the above indicators have improved since the 2005 GAIS for both women and men. The combined indicator, knowledge that HIV can be transmitted by breastfeeding and that the risk of MTCT can be reduced by the mother taking special drugs during pregnancy has also shown significant improvement over the same period. For women, it has increased from 39 percent in 2005 to 60 percent in 2009, and for men it has increased from 28 percent in 2005 to 43 percent in 2009. 13.5 STIGMA ASSOCIATED WITH AIDS AND ATTITUDES RELATED TO HIV/AIDS Widespread stigma and discrimination in a population can adversely affect people’s willingness to be tested for HIV as well as their adherence to antiretroviral therapy. Reduction of stigma and discrimi- nation in a population is, thus, an important impetus to the success of programs targeting HIV/AIDS pre- vention and control. To assess the level of stigma, the 2009 GDHS respondents who had heard of AIDS were asked if they would be willing to care for a family member with the AIDS virus in their home, if they would buy fresh vegetables from a shopkeeper who has the AIDS virus, if they thought a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching, and if they would not want to keep secret that a family member has the AIDS virus. Tables 13.5.1 and 13.5.2 show the results for women and men, respectively. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 213 Table 13.5.1 Accepting attitudes toward those living with HIV: Women Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Would buy Say that a Are willing fresh female teacher Would not Percentage Number to care for a vegetables with the AIDS virus want to keep expressing of family member from a and who is not sick secret that accepting women with the AIDS shopkeeper should be a family member attitudes on who have Background virus in the who has the allowed to got infected with all four heard of characteristic respondent’s home AIDS virus keep teaching the AIDS virus indicators AIDS –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 87.0 58.2 77.3 36.4 17.3 1,736 15-19 87.6 57.0 75.7 35.1 15.2 989 20-24 86.3 59.9 79.5 38.2 20.1 746 25-29 85.2 65.1 75.3 44.1 22.6 629 30-39 82.8 54.1 73.0 45.3 20.6 1,305 40-49 81.5 47.7 69.8 50.5 22.5 1,178 Marital status Never married 88.4 64.1 82.8 33.8 19.1 1,509 Ever had sex 87.5 69.9 88.9 33.1 21.4 750 Never had sex 89.4 58.4 76.7 34.5 16.8 759 Currently married 82.0 50.7 68.3 48.5 20.2 2,808 Formerly married 84.8 55.8 80.0 42.1 23.1 532 Residence Total Urban 86.1 62.4 88.2 30.3 18.8 1,460 Georgetown (urban) 83.6 60.1 92.1 24.7 15.7 965 Other (urban) 90.8 67.0 80.5 41.3 24.8 494 Total Rural 83.6 52.4 68.0 48.8 20.7 3,388 Total Coastal 84.9 55.9 76.1 42.3 20.2 4,403 Coastal (urban) 86.1 62.4 88.2 30.3 18.8 1,460 Coastal (rural) 84.3 52.6 70.0 48.3 20.9 2,943 Total Interior 78.4 51.4 54.3 52.2 19.7 445 Region Region 1 66.1 31.7 39.8 53.8 11.7 142 Region 2 83.2 55.1 66.0 47.9 25.4 283 Region 3 86.6 59.2 74.6 44.6 20.6 682 Region 4 85.4 56.1 82.5 37.3 19.2 2,154 Region 5 84.5 47.8 69.1 50.2 21.2 326 Region 6 80.0 49.0 61.7 49.0 17.4 746 Region 7 81.1 67.5 62.8 46.5 22.3 98 Region 8 85.7 60.3 56.7 46.5 19.3 81 Region 9 80.1 54.4 52.2 57.9 24.1 60 Region 10 94.0 74.5 86.2 46.4 30.3 276 Education No education 59.6 39.1 44.8 39.3 9.0 55 Primary 76.1 37.0 53.8 53.3 14.7 890 Secondary 86.3 57.9 77.3 41.8 20.9 3,497 More than secondary 88.3 77.2 94.8 34.5 26.8 406 Wealth quintile Lowest 77.2 41.7 49.6 48.3 14.1 697 Second 81.3 50.2 68.6 50.7 20.7 939 Middle 86.7 56.9 75.3 41.8 18.7 1,010 Fourth 84.6 57.8 79.1 43.7 23.3 1,059 Highest 88.7 64.7 87.8 34.8 21.8 1,143 Total 2009 84.3 55.5 74.1 43.2 20.1 4,848 Total 2005 77.9 44.7 59.9 58.9 19.4 2,382 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes women in consensual union (living together). Formerly married includes divorced, separated, or widowed. 214 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.5.2 Accepting attitudes toward those living with HIV: Men Among men age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes toward people with HIV, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Would buy Say that a Are willing fresh female teacher Would not Percentage Number to care for a vegetables with the AIDS virus want to keep expressing of family member from a and who is not sick secret that accepting men with the AIDS shopkeeper should be a family member attitudes on who have Background virus in the who has the allowed to got infected with all four heard of characteristic respondent’s home AIDS virus keep teaching the AIDS virus indicators AIDS –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 91.5 67.6 74.2 35.4 18.7 1,177 15-19 92.2 65.2 73.1 32.7 18.1 671 20-24 90.5 70.9 75.6 39.0 19.6 506 25-29 86.7 61.7 74.6 44.7 24.8 449 30-39 82.7 57.0 66.9 54.8 25.6 964 40-49 83.0 61.2 70.0 59.0 28.7 840 Marital status Never married 91.6 66.7 74.9 37.2 21.1 1,346 Ever had sex 93.0 71.1 77.5 38.2 23.4 851 Never had sex 89.2 59.1 70.4 35.4 17.1 494 Currently married 83.0 59.4 68.9 56.0 26.7 1,787 Formerly married 82.2 59.7 68.0 47.1 20.2 298 Residence Total Urban 90.9 74.6 84.5 38.4 25.3 943 Georgetown (urban) 91.8 77.6 89.3 33.8 24.9 617 Other (urban) 89.2 68.9 75.3 47.1 26.1 326 Total Rural 84.6 57.7 66.1 51.5 23.4 2,487 Total Coastal 87.0 62.7 72.5 47.3 24.4 3,055 Coastal (urban) 90.9 74.6 84.5 38.4 25.3 943 Coastal (rural) 85.3 57.4 67.2 51.3 24.0 2,112 Total Interior 80.3 59.2 60.2 52.1 19.7 375 Region Region 1 74.4 49.0 45.9 60.2 17.8 153 Region 2 85.8 58.5 63.9 54.6 27.6 177 Region 3 89.1 58.6 60.8 48.6 24.3 399 Region 4 90.8 68.8 83.6 43.6 27.4 1,526 Region 5 82.9 54.5 58.0 51.4 18.5 255 Region 6 75.8 51.1 57.9 53.1 17.0 572 Region 7 84.9 68.0 76.2 47.5 25.1 56 Region 8 79.6 57.8 58.7 34.6 11.8 64 Region 9 83.9 61.2 68.2 71.0 31.8 53 Region 10 94.3 77.8 82.0 41.8 25.9 176 Education No education (63.4) (30.9) (36.9) (86.7) (19.7) 46 Primary 76.0 53.3 58.7 57.1 24.6 681 Secondary 88.6 62.6 72.7 45.5 22.7 2,413 More than secondary 95.2 85.8 93.5 39.7 32.8 290 Wealth quintile Lowest 77.4 46.2 47.9 53.9 15.8 636 Second 84.3 58.5 67.8 51.5 23.0 650 Middle 86.6 63.0 71.7 47.6 23.8 707 Fourth 89.1 65.9 80.0 46.6 25.7 736 Highest 93.1 76.1 85.6 40.6 30.2 700 Total 2009 86.3 62.3 71.2 47.9 23.9 3,430 Total 2005 77.8 41.9 51.9 59.5 19.5 1,841 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes women in consensual union (living together). Formerly married includes divorced, separated, or widowed. Figures in parentheses are based on 25-49 unweighted cases. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 215 • More than eight in ten women (84 percent) and men (86 percent) in Guyana would be willing to care for a relative who is sick with AIDS in their own household, an increase from 78 percent of both women and men in 2005. More than half of women (56 percent) and six in ten men (62 percent) say that they would buy fresh vegetables from a shopkeeper who is infected with HIV, an increase from 45 percent of women and 42 percent of men in 2005. More thans even in ten respondents (74 percent of women and 71 percent of men) believe that an HIV- positive female teacher who is not sick should be allowed to continue teaching, an increase from 60 percent of women and 52 percent of men in 2005. Finally, 43 percent of Guyanese women and 48 percent of Guyanase men would not want an HIV positive status of their family member to remain a secret, a decrease from 59 percent of women and 60 percent of men in 2005. • A composite indicator showing the percenatge with an accepting attitude on all four indicators shows that only 20 percent of women and 24 percent of men express accepting attitudes on all four indicators, almost the same as in 2005 (19 percent of women and 20 percent of men). • Various background characteristics are correlated with positive attitudes toward people living with HIV. Older women and men age 25 or more are more likely to have accepting attitudes on all four indicators than those 15-24. Respodents who never had sex have the lowest percentage with accepting attitudes on all four indicators (17 percent of both women and men) than other respondents. There are no major variations by urban-rural residence or Coastal-Interior area. By region, the percentage of women withh accepting attitudes on all four indicators ranges from 12 percent in Region 1 to 30 percent in Region 10, while the percentage of men ranges from 12 percent in Region 8 to 32 percent in Region 9. • The percentage of respondents with accepting attitudes on all four measures increases steadily with education. Nine percent of women and 20 percent of men with no education have such accepting attitudes compared with 27 percent of women and 33 percent of men with secondary or higher education. For men, the percentage with accepting attitudes on all four measures incerases by wealth from 16 percent of those in the lowest quintile to 30 percent in the highest quintile, while for women the relationship does not follow a clear pattern. 13.6 ATTITUDES TOWARD NEGOTIATING SAFER SEX In an effort to assess the ability of women to negotiate safer sex with a spouse who has a sexually transmitted infection (STI), all respondents were asked two attitudinal questions. They were asked whether a wife is justified in refusing to have sex with her husband if she knows her husband has an STI and whether a woman in the same circumstances is justified in asking that her husband use a condom. Table 13.6 shows the results for both women and men. • Almost nine in ten respondents (89 percent of women and 88 percent of men) feel that a wife is justified in refusing to have sexual intercourse with her husband if she knows he has a sexually transmitted disease. More than nine in ten believe that a wife is justified in asking that they use a condom if she knows that her husband has an STI (93 percent of women and 94 percent of men). These findings are similar to those reported in the 2005 GAIS. • Ninety-six percent of women and men agree that a woman is justified in either refusing sexual intercourse with her husband or in asking him to use a condom if she knows he has an STI. • Respondents living in the Coastal area and in Region 10, those with more than secondary education, and those in the highest two wealth quintiles are more likely to agree on both indicators than other respondents. 216 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.6 Attitudes toward negotiating safer sex with husband Percentage of women and men age 15-49 who believe that, if a husband has a sexually transmitted disease, his wife is justified in refusing to have sexual intercourse with him or asking that they use a condom, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Woman is justified in: Woman is justified in: –––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––– Either refusing Either refusing Refusing sexual Refusing sexual to have Asking intercourse to have Asking intercourse sexual that or asking Number sexual that or asking Number Background inter- they use to use of inter- they use to use of characteristic course a condom a condom women course a condom a condom men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 85.7 92.2 94.2 1,783 85.2 94.2 95.6 1,200 15-19 83.2 91.2 92.7 1,016 83.5 93.4 95.3 689 20-24 88.9 93.6 96.2 767 87.7 95.1 96.0 511 25-29 88.4 93.9 95.9 658 89.6 95.7 97.2 462 30-39 91.2 95.0 97.0 1,342 90.5 94.4 96.4 990 40-49 90.0 93.3 95.9 1,213 89.7 94.0 94.8 870 Marital status Never married 87.3 92.1 94.5 1,540 85.2 93.8 95.2 1,382 Ever had sex 89.4 94.1 96.3 761 89.5 95.8 97.4 863 Never had sex 85.3 90.1 92.7 779 78.1 90.3 91.6 518 Currently married 89.0 93.9 96.0 2,920 90.0 94.4 96.0 1,835 Formerly married 89.9 95.0 96.5 536 93.2 96.9 97.8 305 Residence Total Urban 91.7 95.6 97.0 1,475 93.9 97.1 98.6 949 Georgetown (urban) 92.8 96.1 97.3 967 95.8 97.7 98.8 619 Other (urban) 89.6 94.5 96.5 508 90.4 96.0 98.2 330 Total Rural 87.3 92.6 95.0 3,521 86.4 93.4 94.8 2,573 Total Coastal 89.6 94.5 96.4 4,495 88.7 94.7 96.2 3,126 Coastal (urban) 91.7 95.6 97.0 1,475 93.9 97.1 98.6 949 Coastal (rural) 88.6 93.9 96.1 3,019 86.4 93.7 95.1 2,176 Total Interior 79.5 84.4 88.3 501 86.1 91.7 93.0 396 Region Region 1 77.9 83.0 85.8 162 87.2 96.1 97.3 160 Region 2 87.8 92.2 94.1 293 86.1 94.8 95.0 179 Region 3 88.4 95.5 97.2 687 80.3 88.6 91.4 420 Region 4 91.5 95.2 96.7 2,168 93.0 97.0 97.8 1,540 Region 5 89.7 95.5 96.8 353 82.2 92.2 94.9 271 Region 6 85.5 90.8 95.0 780 86.9 94.0 95.8 587 Region 7 89.7 90.4 94.7 104 86.5 88.8 90.9 61 Region 8 77.4 82.3 87.1 95 76.5 81.6 83.7 68 Region 9 63.6 73.1 79.2 78 83.4 87.9 88.4 57 Region 10 91.3 97.2 98.3 277 92.2 97.5 99.0 178 Education No education 75.3 67.0 79.3 68 70.2 84.5 88.6 60 Primary 85.1 89.4 92.8 952 85.7 92.9 94.2 711 Secondary 89.1 94.5 96.3 3,568 89.1 94.6 96.2 2,459 More than secondary 94.4 98.0 98.4 409 92.8 97.8 98.3 292 Wealth quintile Lowest 78.5 84.8 88.5 779 85.9 92.0 94.1 663 Second 88.7 92.6 95.2 957 84.9 94.3 95.2 679 Middle 88.6 95.3 96.8 1,025 89.4 94.2 96.2 723 Fourth 92.0 95.9 97.8 1,084 89.4 95.0 96.8 751 Highest 92.1 95.9 97.5 1,151 92.0 96.2 96.7 705 Total 2009 88.6 93.4 95.6 4,996 88.4 94.4 95.8 3,522 Total 2005 93.1 93.8 97.5 2,425 89.4 91.9 95.9 1,875 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced/separated/ widowed. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 217 Table 13.7 Adult support of education about condom use to prevent AIDS Percentage of women and men age 18-49 who agree that children age 12-14 years should be taught about using a condom to avoid AIDS, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women 18-49 Men 18-49 ––––––––––––––––––– –––––––––––––––––– Percentage Number Percentage Number Background who of who of characteristic agree women agree men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 18-24 83.6 1,187 86.4 749 18-19 83.7 420 83.7 238 20-24 83.5 767 87.6 511 25-29 81.1 658 88.1 462 30-39 83.7 1,342 85.9 990 40-49 76.5 1,213 83.4 870 Marital status Never married 80.1 994 84.0 931 Currently married 80.6 2,878 85.9 1,834 Formerly married 87.3 528 89.1 305 Residence Total Urban 84.0 1,284 85.8 800 Georgetown (urban) 83.4 853 86.3 526 Other (urban) 85.2 432 85.0 273 Total Rural 80.2 3,115 85.6 2,271 Total Coastal 82.2 3,958 86.1 2,713 Coastal (urban) 84.0 1,284 85.8 800 Coastal (rural) 81.3 2,674 86.2 1,914 Total Interior 73.3 442 82.2 357 Region Region 1 80.4 141 81.6 147 Region 2 80.1 250 88.7 152 Region 3 81.6 609 83.1 362 Region 4 84.2 1,924 87.6 1,341 Region 5 81.9 310 82.3 239 Region 6 76.4 685 85.7 520 Region 7 67.3 89 71.5 53 Region 8 73.2 86 81.0 62 Region 9 58.8 70 84.5 50 Region 10 87.1 236 87.8 145 Education No education 58.3 60 60.5 58 Primary 74.4 919 84.2 681 Secondary 83.4 3,019 86.8 2,045 More than secondary 85.0 402 85.9 287 Wealth quintile Lowest 72.0 672 85.3 600 Second 79.8 836 81.9 586 Middle 84.5 918 87.0 607 Fourth 81.8 950 88.5 650 Highest 85.3 1,023 85.4 628 Total 2009 81.3 4,399 85.7 3,071 Total 2005 81.1 2,121 83.6 1,619 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced, separated, or widowed. 13.7 ATTITUDES TOWARD CONDOM EDUCATION FOR YOUTH Condom use is one of the main strategies for combating the spread of HIV. Social acceptance of condom use among young people is a key factor determining use of condoms to prevent the sexual transmission of HIV and other STIs, as well as to prevent early pregnancy. However, educating youth about condoms is sometimes controversial, with some saying it promotes early sexual experimentation. Others are in favor of teaching youth to abstain from sexual intercourse until they are married. To measure attitudes toward education about condoms, the 2009 GDHS respondents were asked if they thought that children age 12-14 should be taught about using a condom to avoid HIV. The results are shown in Table 13.7. Because the table focuses on adult opinion, results are tabulated for respondents age 18-49. 218 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior • Overall, more than eight in ten women (81 percent) and men (86 percent) agree that children age 12-14 years should be taught about the use of condoms to avoid AIDS. Older respondents age 40-49 are slightly less likely than younger respondents to support education of children age 12-14 about condom use to prevent AIDS. Formerly married women and men are somewhat more likely than those who are currently married or who never married to agree on safe sex education for children age 12-14. Urban women (84 percent) are more likely than their rural counterparts (80 percent) to agree on teaching children age 12-14 about condom use to avoid AIDS, while there is no urban-rural difference among men. Women and men living in the Coastal area (82 and 86 percent, respectively) are more likely than women and men living in the Interior area (73 and 82 percent, respectively) to agree about education of children age 12-14 on condom use. By region, agreement on teaching children age 12-14 about the use of condoms ranges for women from 59 percent in Region 9 to 87 percent in Region 10 and for men from 72 percent in Region 7 to 89 percent Region 2. • The proportion of both women and men who support teaching children age 12-14 about condoms increases with level of education and, for women, it also tends to increase with wealth. For example, 58 percent of women with no education agree on instructing children 12-14 years about condoms, compared with 85 percent of women with more than secondary education. The comparable figures for men are 61percent and 86 percent, respectively. For women, the percentage who agree that children age 12-14 should be taught about condoms increases from 72 percent among those in the lowest wealth quintile to 85 percent among women in the highest wealth quintile. Among men, there is no clear pattern in the variation of this indicator by wealth. 13.8 HIGHER-RISK SEX Given that most HIV cases in Guyana are contracted through heterosexual contact, information on sexual behavior is important in designing and monitoring intervention programs to control the spread of HIV. The 2009 GDHS included questions on respondents’ sexual partners during their lifetime and in the 12 months preceding the survey. For male respondents, an additional question was asked on whether they paid anyone in exchange for sex during the 12 months preceding the interview. Information on the use of condoms at the last sexual intercourse with each type of partner was collected for women and men. These questions are sensitive, and it is recognized that some respondents may have been reluctant to provide information on recent sexual behavior. 13.8.1 Multiple Partners and Condom Use Tables 13.8.1 and 13.8.2 show the percentage of all women and all men, respectively, age 15-49 years who had sexual intercourse with more than one partner in the past 12 months and the percentage who engaged in higher-risk sexual intercourse in the past 12 months. • A larger proportion of men 15-49 (10 percent) than women (1 percent) reported having had more than one sexual partner in the 12 months preceding the survey. Additionally, a higher percentage of men (30 percent) than women (17 percent) reported having had sex with a person who was neither their spouse nor their cohabiting partner (higher-risk sex) in the year before the survey. • Among respondents who had sexual intercourse in the 12 months before the survey, only 2 percent of women reported having more than one sexual partner in that period. This is considerably lower than the 13 percent reported by men. Similarly, 23 percent of women, compared with 38 percent of men, reported that they had sexual intercourse in the past 12 months with someone who was not their spouse or marital partner. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 219 • Among both women and men who had sexual intercourse in the past 12 months, the proportion having higher-risk sexual intercourse generally decreases as age increases. By definition, sexual intercourse with a person who is not a spouse or a cohabiting partner (higher-risk sex) is more common among women and men who have never married and those who are currently divorced, separated, or widowed. For this reason, almost all (close to 100 percent) never-married women and never-married men who had sexual intercourse in the past 12 months had higher-risk sexual intercourse. On the other hand, only 1 percent of currently married women and 7 percent of currently married men had sexual intercourse with someone other than their spouse. Respondents who live in Urban areas, in the Coastal area, and those living in Region 10 are more likely than other respondents to have had higher-risk sexual intercourse in the past 12 months. Similarly, higher-risk sexual intercourse generally increases with increasing level of education and wealth quintile. • Women and men in the 2009 GDHS were also asked about condom use with multiple partners or higher-risk sexual intercourse in the 12 months preceding the survey. Although truly effective protection requires condom use at every sexual contact, the sexual contacts covered here are those considered to pose the greatest risk of HIV transmission. Among women and men who had more than one partner in the 12 months before the survey, 48 percent of women (data not shown due to the small number of cases) and 65 percent of men said they used a condom during the most recent sexual intercourse. • Among respondents who reported having had higher-risk intercourse (with a person who was neither their husband nor who lived with them) in the past 12 months, about half of women (52 percent) and seven in ten men (72 percent) used a condom at the last higher-risk sex. The smaller proportions of women with multiple partners, higher-risk sexual intercourse, and condom use, compared with men, may accurately reflect the context, but it may also reflect a bias from some women being hesitant to report behavior that may not be widely accepted. • Condom use by respondents who had higher-risk sexual intercourse in the past 12 months is more likely among young people age 15-19, never married respondents, respondents living in Urban areas, women living in the Coastal area, and women in Regions 2 and 10 and men in Regions 9 and 10. Condom use during last higher-risk sexual intercourse is higher among men with more than secondary education, and for both women and men, it is highest among those in the highest wealth quintile. • Overall, the mean number of lifetime sexual partners is four times as high for men as for women (8 partners versus 2 partners). There are no significant variations in the number of lifetime partners for women by background characteristics. For men, those age 40-49 (10 partners) and men who were formerly married (15 partners) have the highest number of lifetime sexual partners when compared with other men. 220 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women Among all women age 15-49, the percentage who had sexual intercourse with more than one sexual partner (column 1) and the percentage who had intercourse in the past 12 months with a person who was neither their husband nor who lived with them (column 2); among women age 15-49 who had sexual intercourse in the past 12 months, the percentage who had sexual intercourse with more than one sexual partner (column 4) and the percentage who had intercourse in the past 12 months with a person who was neither their husband nor who lived with them (column 5); among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse (column 7); and the mean number of sexual partners during her lifetime for women who ever had sexual intercourse (column 9), by background characteristics, Guyana 2009 All women Among women who had sexual intercourse in the past 12 months Among women who had intercourse in the past 12 months with a person who was neither their husband nor who lived with them: Among women who ever had sexual intercourse: Background characteristic Percentage who had 2+ partners in the past 12 months Percentage who had inter- course in the past 12 months with a person who was neither their husband nor who lived with them Number of women Percentage who had 2+ partners in the past 12 months Percentage who had inter- course in the past 12 months with a person who was neither their husband nor who lived with them Number of women Percentage who reported using a condom at last inter- course with that person Number of women Mean number of sexual partners in lifetime Number of women Age 15-24 1.3 22.4 1,783 2.4 42.4 939 55.8 399 1.8 1,028 15-19 1.1 17.3 1,016 3.2 52.1 337 58.9 176 1.6 382 20-24 1.5 29.1 767 1.9 36.9 602 53.4 223 2.0 646 25-29 2.2 22.5 658 2.5 26.0 569 46.7 148 2.1 601 30-39 1.6 13.1 1,342 1.9 15.7 1,108 54.6 175 2.1 1,252 40-49 0.4 9.1 1,213 0.6 11.7 940 42.4 111 2.5 1,127 Marital status Never married 2.0 34.2 1,540 6.0 99.8 526 57.2 527 2.3 728 Currently married 0.4 1.3 2,920 0.5 1.4 2,725 49.6 38 1.9 2,783 Formerly married 3.6 49.9 536 6.2 87.1 306 42.7 268 3.5 498 Residence Total Urban 2.2 26.7 1,475 3.2 39.5 994 61.3 394 2.5 1,156 Georgetown (urban) 2.3 30.4 967 3.3 43.9 666 62.0 294 2.6 778 Other (urban) 1.9 19.7 508 3.0 30.4 328 59.1 100 2.2 378 Total Rural 0.9 12.5 3,521 1.2 17.1 2,562 44.1 439 2.0 2,852 Total Coastal 1.2 16.9 4,495 1.7 24.1 3,141 53.1 758 2.1 3,578 Coastal (urban) 2.2 26.7 1,475 3.2 39.5 994 61.3 394 2.5 1,156 Coastal (rural) 0.7 12.1 3,019 1.1 16.9 2,148 44.2 365 1.9 2,422 Total Interior 1.7 14.9 501 2.1 17.8 415 43.3 75 2.6 430 Region Region 1 0.6 10.4 162 0.7 11.8 142 (42.0) 17 2.6 142 Region 2 0.5 9.1 293 0.7 12.6 211 (62.3) 27 1.6 233 Region 3 1.4 12.8 687 2.0 18.2 482 48.5 88 1.7 541 Region 4 1.5 22.2 2,168 2.1 31.4 1,533 56.3 482 2.5 1,745 Region 5 0.7 10.7 353 1.0 15.6 242 (29.0) 38 1.5 289 Region 6 0.5 7.5 780 0.8 10.8 534 35.6 59 1.5 608 Region 7 2.5 18.8 104 3.2 22.7 82 44.0 19 3.0 87 Region 8 2.4 14.5 95 2.9 17.2 80 (38.6) 14 2.9 82 Region 9 2.8 12.3 78 3.7 16.1 59 48.7 10 1.7 63 Region 10 1.9 29.0 277 2.8 42.2 191 57.9 81 2.8 218 Education No education 0.6 5.8 68 0.7 6.2 63 * 4 2.2 62 Primary 0.8 7.2 952 1.0 8.7 786 47.0 68 1.9 858 Secondary 1.3 17.6 3,568 1.9 25.8 2,419 53.7 628 2.2 2,742 More than secondary 2.2 32.3 409 3.1 46.0 288 47.9 132 2.5 346 Wealth quintile Lowest 1.2 11.6 779 1.5 14.2 619 49.6 90 2.2 646 Second 1.8 15.9 957 2.5 21.9 696 53.2 153 2.0 773 Middle 0.8 15.0 1,025 1.2 21.8 704 48.1 153 2.4 821 Fourth 0.8 15.7 1,084 1.2 23.0 740 47.9 170 2.0 857 Highest 1.7 23.2 1,151 2.5 33.3 796 57.6 267 2.1 911 Total 1.3 16.7 4,996 1.8 23.3 3,556 52.2 833 2.1 4,008 Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced/separated/widowed. 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. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 221 Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men Among all men age 15-49, the percentage who had sexual intercourse with more than one sexual partner (column 1) and the percentage who had intercourse in the past 12 months with a person who was neither their wife nor who lived with them (column 2); among men age 15-49 who had sexual intercourse in the past 12 months, the percentage who had sexual intercourse with more than one sexual partner (column 4) and the percentage who had intercourse in the past 12 months with a person who was neither their wife nor who lived with them (column 5); among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse (column 7); and among those having sexual intercourse in the past 12 months with a person who was neither their wife nor who lived with them, the percentage reporting that a condom was used at last intercourse with that person (column 9); and the mean number of sexual partners during her lifetime for men who ever had sexual intercourse (column 11), by background characteristics, Guyana 2009 All men Among men who had sexual intercourse in the past 12 months Among men who had 2+ partners in the past 12 months: Among men who had intercourse in the past 12 months with a person who was neither their husband nor who lived with them: Among men who ever had sexual intercourse: Background characteristic Percentage who had 2+ partners in the past 12 months Percentage who had intercourse in the past 12 months with a person who was neither their wife nor who lived with them Number of men Percentage who had 2+ partners in the past 12 months Percentage who had intercourse in the past 12 months with a person who was neither their wife nor who lived with them Number of men Percentage who reported using a condom at last sexual inter- course Number of men Percentage who reported using a condom at last inter- course with that person Number of men Mean number of sexual partners in lifetime Numbe r of men Age 15-24 12.4 41.6 1,200 23.6 79.1 632 76.1 149 78.1 500 6.1 659 15-19 8.0 30.2 689 25.6 96.4 216 85.8 55 85.1 208 5.2 264 20-24 18.4 57.1 511 22.6 70.1 416 70.4 94 73.1 292 6.7 395 25-29 9.5 34.0 462 10.9 39.1 402 (76.7) 44 70.8 157 6.8 358 30-39 10.1 23.2 990 11.2 25.7 893 56.6 100 66.5 230 7.5 820 40-49 6.4 16.5 870 7.0 18.2 792 43.4 55 57.6 144 10.2 714 Marital status Never married 13.0 50.0 1,382 25.9 99.7 693 83.8 180 78.3 691 7.1 734 Currently married 5.6 6.6 1,835 5.8 6.8 1,781 27.4 103 59.1 121 7.0 1,569 Formerly married 21.3 71.4 305 26.6 89.4 244 75.0 65 57.2 218 14.9 249 Residence Total Urban 14.8 41.9 949 19.2 54.1 734 70.8 141 77.3 397 8.5 630 Georgetown (urban) 16.2 46.9 619 20.6 59.6 487 73.3 100 76.5 290 9.6 384 Other (urban) 12.3 32.4 330 16.5 43.3 247 64.9 41 79.4 107 6.8 246 Total Rural 8.1 24.6 2,573 10.4 31.9 1,984 61.7 207 68.0 633 7.6 1,921 Total Coastal 9.6 29.1 3,126 12.6 38.0 2,388 64.6 300 71.3 908 7.7 2,257 Coastal (urban) 14.8 41.9 949 19.2 54.1 734 70.8 141 77.3 397 8.5 630 Coastal (rural) 7.3 23.5 2,176 9.6 30.9 1,653 59.0 159 66.7 511 7.4 1,628 Total Interior 12.2 30.7 396 14.7 36.8 330 70.4 48 73.4 122 8.2 294 Region Region 1 10.4 33.7 160 12.0 38.8 138 78.1 * 75.7 54 8.6 129 Region 2 7.3 21.9 179 9.5 28.4 138 (66.3) 13 75.0 39 6.2 143 Region 3 8.7 27.2 420 11.3 35.4 323 (56.8) 36 55.0 114 7.8 313 Region 4 10.3 33.9 1,540 13.4 44.1 1,185 69.4 159 74.6 523 9.2 1,065 Region 5 8.2 22.8 271 11.9 33.1 187 (67.3) 22 74.0 62 5.8 183 Region 6 8.2 19.2 587 10.6 24.7 456 48.9 48 61.6 113 5.5 459 Region 7 8.3 24.5 61 10.0 29.6 50 45.7 * (57.1) 15 9.4 50 Region 8 22.6 39.1 68 27.1 47.0 57 66.5 * (73.9) 27 8.5 35 Region 9 8.3 14.8 57 10.5 18.8 45 78.9 * (84.6) 8 6.2 42 Region 10 15.5 42.2 178 19.9 54.1 139 (73.1) 28 83.8 75 7.6 132 Education No education 0.0 6.3 60 0.0 (8.3) 45 * 0 * 4 (7.1) 44 Primary 7.1 21.0 711 8.3 24.4 612 (51.0) 51 54.1 149 6.0 581 Secondary 10.6 30.7 2,459 14.4 41.5 1,818 68.4 261 73.6 754 8.3 1,712 More than secondary 12.4 42.0 292 14.9 50.7 242 (63.6) 36 80.0 123 8.6 213 Wealth quintile Lowest 8.3 27.1 663 10.5 34.3 524 59.5 55 66.4 180 7.8 511 Second 8.3 25.4 679 11.0 33.8 510 66.2 56 73.0 172 8.1 500 Middle 9.4 29.3 723 12.7 39.3 539 60.0 68 70.9 212 6.5 525 Fourth 9.9 29.9 751 12.9 38.9 576 63.8 75 71.5 224 8.6 545 Highest 13.4 35.7 705 16.6 44.3 568 73.5 94 75.5 252 7.9 470 Total 9.9 29.5 3,522 12.8 38.3 2,718 65.4 348 71.7 1,040 7.8 2,551 Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced/separated/widowed. 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. 222 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior 13.8.2 Transactional Sex As described earlier in the chapter, higher-risk sex is defined as having sex with a non-marital, non-cohabiting partner. This includes sex with commercial sex workers (i.e., prostitutes). Sex with prosti- tutes is particularly risky because they have many partners and are thus more likely to have sexually transmitted infections. Only 1 percent of men reported having paid someone in exchange for sex in the past 12 months, with no major variations by background characteristics (data not shown due to the small number of cases). 13.9 COVERAGE OF PRIOR HIV TESTING Knowledge of one’s HIV status can empower individuals to take precautions to protect against either acquiring or transmitting the disease. Deliberate efforts need to be made to educate people about the importance of getting tested for HIV so as to know one’s status. Consequently, Guyana has estab- lished a number of voluntary counseling and testing (VCT) sites across the country and encourages their access and use by the general population. Through the Ministry of Health, the government has designated a National Day of HIV Testing to improve access of all persons to VCT services. The percentage of women who have ever been tested may increase over time because women who become pregnant do have an additional opportunity to receive counseling on HIV testing when they attend antenatal clinics during pregnancy, and after being counseled, they can also undergo HIV testing as part of their antenatal care. • Data in Tables 13.9.1 and 13.9.2 show that almost nine in ten women (89 percent) and men (87 percent) know where to get an HIV test. However, the proportions ever tested are much smaller; only 53 percent of women and 38 percent of men age 15-49 have ever been tested for HIV. Most of those tested received the results of their test; 50 percent of women and 35 percent of men were ever tested and received the results of their test. The proportions who had a recent test are smaller; only 27 percent of women and 22 percent of men received the results of the last HIV test taken in the past 12 months. • The proportion of respondents ever tested for HIV is lowest for the age group 15-19 (32 percent of women and 18 percent of men) and highest among respondents 25-29 (71 percent of women and 52 percent of men). Formerly married and never married respondents who have had sex are more likely to go for an HIV test than other sub groups. • Urban women (62 percent) and men (49 percent) are more likely than their rural counterparts (48 and 34 percent, respectively) to have ever been tested for HIV. These findings are to be expected given that most NGOs and stand-alone VCT sites in Guyana are in urban areas. Women living in the Interior area are slightly more likely than those living in the Coastal area to have ever been tested for HIV (56 percent versus 52 percent). For men, the opposite is true; those living in the Coastal area are somewhat more likely than men in the Interior area to have ever been tested for HIV (38 and 33 percent, respectively). There are regional variations in HIV testing. The percentage of women ever tested for HIV ranges from 39 percent in Region 5 to 66 percent in Region 7, while for men it ranges from 23 percent in Region 1 to 46 percent in Region 10. • The level of education and wealth is positively related to HIV testing. HIV testing is much more common among the most educated and wealthy individuals when compared with those with no education and in the lowest wealth quntiles; the difference is more pronounced for men than for women. • The differentials in the percentage of individuals ever tested for HIV and who received their results, by residence, education, and socioeconomic status, provide important information that should be considered in the design and implementaton of programs targeting HIV/AIDS in Guyana. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 223 Table 13.9.1 Coverage of prior HIV testing: Women Percentage of women age 15-49 who know where to get an HIV test, percent distribution of women age 15-49 by testing status and by whether they received the results of the test; the percentage of women ever tested, and the percentage of women age 15-49 who received their test results the last time they were tested for HIV in the past 12 months, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percent distribution of women by testing status and by whether they received the results of the last test Background Characteristic Percentage who know where to get an HIV test Ever tested and received results Ever tested, did not receive results Never tested Total Percentage ever tested Percentage who received results from last HIV test taken in the past 12 months Number of women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 88.5 43.7 3.7 52.5 100.0 47.5 29.4 1,783 15-19 86.0 28.9 3.1 68.0 100.0 32.0 21.9 1,016 20-24 91.8 63.4 4.5 32.1 100.0 67.9 39.3 767 25-29 90.2 67.7 3.4 28.9 100.0 71.1 36.4 658 30-39 90.3 57.5 3.1 39.4 100.0 60.6 27.7 1,342 40-49 88.7 39.3 1.6 59.1 100.0 40.9 17.6 1,213 Marital status Never married 89.8 39.3 2.4 58.4 100.0 41.6 25.8 1,540 Ever had sex 95.5 67.0 2.7 30.3 100.0 69.7 43.8 761 Never had sex 84.3 12.1 2.1 85.8 100.0 14.2 8.3 779 Currently married 88.2 52.4 3.5 44.1 100.0 55.9 25.9 2,920 Formerly married 93.2 63.2 2.0 34.8 100.0 65.2 36.5 536 Residence Total Urban 95.2 59.6 2.6 37.7 100.0 62.3 32.5 1,475 Georgetown (urban) 95.9 64.9 2.1 33.0 100.0 67.0 35.5 967 Other (urban) 94.0 49.7 3.6 46.7 100.0 53.3 26.6 508 Total Rural 86.8 45.3 3.1 51.6 100.0 48.4 24.7 3,521 Total Coastal 90.8 49.2 2.9 47.9 100.0 52.1 26.5 4,495 Coastal (urban) 95.2 59.6 2.6 37.7 100.0 62.3 32.5 1,475 Coastal (rural) 88.6 44.1 3.0 52.9 100.0 47.1 23.7 3,019 Total Interior 75.9 52.3 3.7 44.0 100.0 56.0 31.2 501 Region Region 1 67.4 45.6 3.2 51.2 100.0 48.8 28.1 162 Region 2 87.2 43.0 1.7 55.4 100.0 44.6 24.4 293 Region 3 91.5 46.4 3.2 50.4 100.0 49.6 23.9 687 Region 4 93.5 56.2 2.5 41.2 100.0 58.8 31.9 2,168 Region 5 79.7 34.9 4.2 60.9 100.0 39.1 17.6 353 Region 6 86.8 37.2 4.0 58.8 100.0 41.2 17.3 780 Region 7 86.7 63.5 2.8 33.7 100.0 66.3 38.1 104 Region 8 77.3 56.1 4.3 39.6 100.0 60.4 30.9 95 Region 9 67.0 39.3 4.5 56.3 100.0 43.7 20.2 78 Region 10 95.9 62.4 2.1 35.5 100.0 64.5 34.5 277 Education No education 69.1 43.9 1.7 54.4 100.0 45.6 17.2 68 Primary 78.6 38.0 4.4 57.7 100.0 42.3 20.5 952 Secondary 91.6 49.8 2.8 47.4 100.0 52.6 27.1 3,568 More than secondary 97.2 74.6 1.7 23.6 100.0 76.4 42.8 409 Wealth quintile Lowest 75.3 46.9 3.3 49.8 100.0 50.2 26.7 779 Second 88.0 45.8 3.5 50.7 100.0 49.3 27.3 957 Middle 91.2 47.8 4.2 48.0 100.0 52.0 25.8 1,025 Fourth 92.6 46.2 2.3 51.5 100.0 48.5 24.4 1,084 Highest 95.0 59.0 1.9 39.1 100.0 60.9 30.5 1,151 Total 89.3 49.5 3.0 47.5 100.0 52.5 27.0 4,996 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced, separated, or widowed. 224 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.9.2 Coverage of prior HIV testing: Men Percentage of men age 15-49 who know where to get an HIV test, percent distribution of men age 15-49 by testing status and by whether they received the results of the test; the percentage of men ever tested, and the percentage of men age 15-49 who received their test results the last time they were tested for HIV in the past 12 months, according to background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percent distribution of men by testing status and by whether they received the results of the last test Background characteristic Percentage who know where to get an HIV test Ever tested and received results Ever tested, did not receive results Never tested Total Percentage ever tested Percentage who received results from last HIV test taken in the past 12 months Number of men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 83.2 25.1 1.9 73.0 100.0 27.0 17.8 1,200 15-19 80.7 16.4 1.3 82.2 100.0 17.8 13.5 689 20-24 86.6 36.9 2.6 60.5 100.0 39.5 23.6 511 25-29 89.2 49.3 2.7 48.0 100.0 52.0 29.2 462 30-39 89.0 39.2 2.3 58.5 100.0 41.5 22.6 990 40-49 88.6 38.0 2.8 59.3 100.0 40.7 21.6 870 Marital status Never married 83.2 28.4 1.9 69.7 100.0 30.3 20.3 1,382 Ever had sex 88.4 41.3 2.6 56.1 100.0 43.9 29.6 863 Never had sex 74.6 7.0 0.7 92.4 100.0 7.6 4.9 518 Currently married 89.6 38.9 2.9 58.2 100.0 41.8 22.1 1,835 Formerly married 87.4 46.2 1.1 52.7 100.0 47.3 24.5 305 Residence Total Urban 95.0 46.8 2.2 51.0 100.0 49.0 29.3 949 Georgetown (urban) 95.9 52.2 1.8 46.0 100.0 54.0 32.6 619 Other (urban) 93.4 36.6 2.9 60.5 100.0 39.5 23.0 330 Total Rural 84.0 31.2 2.4 66.4 100.0 33.6 18.8 2,573 Total Coastal 88.3 35.9 2.5 61.7 100.0 38.3 21.8 3,126 Coastal (urban) 95.0 46.8 2.2 51.0 100.0 49.0 29.3 949 Coastal (rural) 85.4 31.1 2.6 66.3 100.0 33.7 18.6 2,176 Interior 76.3 32.0 1.2 66.8 100.0 33.2 19.8 396 Region Region 1 70.4 22.9 0.0 77.1 100.0 22.9 17.2 160 Region 2 90.2 28.7 2.6 68.6 100.0 31.4 15.7 179 Region 3 80.4 27.3 3.2 69.6 100.0 30.4 16.8 420 Region 4 91.5 43.6 1.3 55.0 100.0 45.0 26.6 1,540 Region 5 84.5 21.9 4.1 74.0 100.0 26.0 11.3 271 Region 6 85.2 28.5 4.4 67.1 100.0 32.9 18.3 587 Region 7 85.7 38.9 0.9 60.2 100.0 39.8 21.6 61 Region 8 76.7 40.0 1.8 58.2 100.0 41.8 16.8 68 Region 9 71.7 32.0 1.9 66.2 100.0 33.8 21.2 57 Region 10 93.0 43.5 2.3 54.2 100.0 45.8 27.7 178 Education No education 46.3 7.4 0.9 91.8 100.0 8.2 2.0 60 Primary 83.8 30.8 2.6 66.6 100.0 33.4 18.6 711 Secondary 87.5 34.9 2.3 62.7 100.0 37.3 21.1 2,459 More than secondary 98.3 56.4 2.2 41.4 100.0 58.6 37.2 292 Wealth quintile Lowest 76.1 28.0 1.4 70.6 100.0 29.4 17.2 663 Second 84.9 31.4 2.1 66.5 100.0 33.5 17.9 679 Middle 87.8 35.8 2.6 61.6 100.0 38.4 23.0 723 Fourth 91.1 37.6 3.5 58.9 100.0 41.1 23.1 751 Highest 93.9 43.6 1.9 54.5 100.0 45.5 26.2 705 Total 86.9 35.4 2.3 62.2 100.0 37.8 21.6 3,522 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced, separated, or widowed. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 225 13.9.1 HIV Testing during Antenatal Care One of the tragic consequences of HIV in women is the transmission of the virus from mother-to- child. This can occur during pregnancy, at the time of delivery, or through breastfeeding. Worldwide, the effects of mother-to-child transmission (MTCT) of HIV are staggering. As part of the strategy for the prevention of mother-to-child transmission of HIV, women are counseled about HIV/AIDS during antenatal care (ANC) visits and offered an HIV test. In the 2009 GDHS, women age 15-49 who gave birth in the two years preceding the survey were asked whether they received counseling during ANC visits for their most recent birth, whether they were offered and accepted a test for HIV as part of their antenatal care, and if tested, whether they received the test results. Table 13.10 shows, for women who gave birth in the two years preceding the survey, the percentage who received HIV counseling during antenatal care for their most recent birth, and the percentage who accepted an offer of HIV testing, whether or not they received their test results, by background characteristics. • Among women who gave birth in the two years preceding the survey, two-thirds (66 percent) were counseled about HIV/AIDS during antenatal care for their most recent birth. The likelihood of receiving HIV/AIDS counseling during a visit is higher in Urban than in Rrural areas (82 and 61 percent, respectively) and in the Coastal than in the Interior area (69 and 55 percent, respectively). It generally increases with education and wealth. • Almost eight in ten (79 percent) women were offered and accepted an HIV test during antenatal care, and most of them (75 percent) received their test results. These findings show a remarkable improvement from the 2005 GAIS findings when half of the mothers were tested for HIV during ANC, and only 6 percent received their results. • When counselling, testing, and receipt of the results are combined into one indicator, only 60 percent of women received counseling, were offered and accepted an HIV test, and received the results during ANC for their most recent birth. Seventy-seven percent of urban women and 65 percent of women in the Coastal area were being counseled, tested, and given their HIV test result during ANC compared with only 55 percent of rural women and 44 percent of women in the Interior area. The lowest percentages of women who underwent all components of VCT during ANC are in Regions 1 and 9 (34 and 37 percent, respectively) and the highest are in Region 2 (72 percent). • The likelihood of receiving all components of VCT during ANC among women who gave birth in the past two years generally increases with education and wealth. 226 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.10 Pregnant women counseled and tested for HIV Among all women 15-49 who gave birth in the two years preceding the survey, (1) the percentage who received HIV counseling during antenatal care for their most recent birth, (2) the percentage who accepted an offer of HIV testing, by whether they received their test results, and (3) the percentage who were counseled, were offered and accepted testing, and received results, according to background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who were offered and accepted an HIV test during antenatal care and who:2 Background characteristic Percentage who received HIV counseling during antenatal care1 Received results Did not receive results Percentage who were counseled, were offered and who accepted an HIV test, and who received results,2 Number of women who gave birth in the past two years3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 67.4 73.9 4.3 61.2 342 15-19 66.1 69.5 5.9 58.3 133 20-24 68.2 76.7 3.3 63.0 209 25-29 64.1 75.6 4.9 59.2 162 30-39 65.2 76.6 3.3 58.6 222 40-49 (57.0) (57.0) (1.4) (57.0) 24 Residence Total Urban 81.9 85.7 4.3 76.7 158 Georgetown (urban) 84.4 91.0 4.2 79.1 101 Other (urban) 77.4 76.4 4.3 72.5 57 Total Rural 61.4 71.5 4.0 55.4 592 Total Coastal 68.9 81.3 3.7 64.5 581 Coastal (urban) 81.9 85.7 4.3 76.7 158 Coastal (rural) 64.0 79.6 3.4 59.9 423 Total Interior 54.8 51.2 5.4 44.1 168 Region Region 1 47.9 42.0 7.9 33.9 70 Region 2 77.2 78.4 1.3 72.4 46 Region 3 66.9 88.2 1.6 66.9 91 Region 4 71.9 89.4 1.9 69.6 272 Region 5 57.2 63.6 5.0 49.5 55 Region 6 62.2 61.5 10.9 48.7 95 Region 7 72.2 69.0 2.5 66.1 24 Region 8 62.3 54.5 5.0 51.0 30 Region 9 48.9 45.0 5.7 37.1 25 Region 10 67.7 77.3 2.4 66.6 41 Education No education * * * * 23 Primary 50.7 63.6 4.8 43.1 163 Secondary 70.7 78.4 4.1 65.2 518 More than secondary (74.7) (84.5) (0.0) (71.2) 46 Wealth quintile Lowest 57.2 59.8 2.6 51.2 218 Second 71.2 73.8 7.5 62.3 163 Middle 68.2 84.1 3.0 63.3 144 Fourth 69.0 80.5 4.7 64.3 128 Highest 67.6 86.8 2.5 64.4 97 Total 65.7 74.5 4.1 59.9 750 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes women in consensual union (living together). Formerly married includes divorced, separated, or widowed. 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. 1In this context, counseled means that someone talked with the respondent about all three of the following topics: (1) babies getting the AIDS virus from their mother, (2) preventing the virus, and (3) getting tested for the virus 2 Only women who were offered the test are included here. Women who were either required or asked for the test are excluded from the numerator of this measure. 3 Denominator for percentages includes women who did not receive antenatal care for their last birth in the past two years. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 227 13.10 MALE CIRCUMCISION Recently, male circumcision has been shown to be associated with lower transmission of STIs, including HIV (WHO and UNAIDS, 2007). To examine this relationship, men age 15-49 interviewed in the 2009 GDHS were asked if they were circumcised. Table 13.11 shows the percentage of men who report that they have been circumcised, by background characteristics, including ethnicity. Men who declared that they were unsure whether they had been circumcised are considered as not having been circumcised. Table 13.11 Male circumcision Percentage of men age 15-49 who report having been circumcised, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––– Number Background Percentage of characteristic circumcised men –––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 12.7 1,200 15-19 11.4 689 20-24 14.6 511 25-29 10.1 462 30-39 10.8 990 40-49 13.5 870 Residence Total Urban 13.8 949 Georgetown (urban) 12.4 619 Other (urban) 16.3 330 Total Rural 11.4 2,573 Total Coastal 12.7 3,126 Coastal (urban) 13.8 949 Coastal (rural) 12.3 2,176 Total Interior 6.5 396 Region Region 1 7.8 160 Region 2 10.1 179 Region 3 12.7 420 Region 4 11.2 1,540 Region 5 19.0 271 Region 6 14.0 587 Region 7 5.5 61 Region 8 5.8 68 Region 9 5.8 57 Region 10 12.7 178 Ethnicity African 12.7 933 Indian 13.2 1,748 Amerindian 6.2 291 Portuguese (17.4) 38 Chinese * 2 Mixed 9.3 504 Education No education 6.6 60 Primary 10.8 711 Secondary 12.1 2,459 More than secondary 15.3 292 Wealth quintile Lowest 8.2 663 Second 10.1 679 Middle 13.6 723 Fourth 13.8 751 Highest 14.0 705 Total 12.0 3,522 –––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 228 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior • Twelve percent of Guyanese men age 15-49 are circumcised, with little difference by age. Men in the Coastal area are almost twice as likely to be circumcised as men in the Interior area (13 and 7 percent, respectively). Six percent of men in Regions 7, 8, and 9 are circumsized compared with 19 percent of men in Region 5. • The percentage of circumcised men is lowest among those of Amerindian ethnicity (6 percent), half the national prevalence of 12 percent. • The prevalence of circumcision increases with the level of education and the socioeconomic status of the household. Men with more than secondary education are more than twice as likely to be circumcised as men with no education (15 and 7 percent, respectively). 13.11 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections are closely associated with HIV because they increase the likelihood of contracting HIV and share similar risk factors. In the 2009 GDHS, all respondents who ever had sexual intercourse were asked if they had had a sexually transmitted infection (STI) or symptoms of an STI (including bad-smelling/abnormal genital discharge and genital sore or ulcer) in the 12 months preceding the survey. Table 13.12 shows the self-reported prevalence of STIs and STI symptoms among women and men age 15-49 who have ever had sexual intercourse. • Only 1 percent of Guyanese women and men who have ever had sexual intercourse reported having an STI in the past 12 months. Four percent of women and 2 percent of men reported having had an abnormal genital discharge, and 1 percent, each, reported having had a genital sore or ulcer in the 12 months preceding the survey. In total, 5 percent of women and 3 percent of men reported having either an STI, an abnormal discharge, or a genital sore. • The highest rates of STIs and STI symptoms are found in the 15-19 age group (7 percent among women and 4 percent among men), in urban areas for women (6 percent) and in the Interior area for women (5 percent) and men (6 percent). There are no marked differences by marital status for women or men or circumcision status for men. Looking at regional variations, the highest percentage with an STI and/or an STI symptom is in Region 10 for women (7 percent) and Region 1 for men (9 percent). • The prevalence of STIs and STI symptoms is not strongly associated with the level of education or wealth of the household. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 229 Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms Among women and men age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage Number Percentage Percentage Number Percent- with bad Percentage with STI/ of women Percent- with bad Percentage with STI/ of men age smelling/ with discharge/ who age smelling/ with discharge/ who with abnormal genital genital ever had with abnormal genital genital ever had Background an genital sore/ sore/ sexual an genital sore/ sore/ sexual characteristic STI discharge ulcer ulcer intercourse STI discharge ulcer ulcer intercourse ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 1.1 5.0 0.7 5.5 1,053 0.7 2.0 0.5 3.1 737 15-19 1.4 6.2 1.0 6.8 390 1.0 2.5 0.8 4.2 284 20-24 0.9 4.2 0.5 4.8 663 0.5 1.8 0.2 2.5 454 25-29 1.6 5.2 1.1 6.2 641 1.5 1.9 0.5 3.2 440 30-39 0.6 3.8 1.0 4.6 1,326 1.0 1.7 0.8 2.5 970 40-49 0.6 3.2 0.8 3.8 1,196 0.5 1.0 0.8 2.2 855 Marital status Never married 1.6 3.8 0.9 4.9 761 0.6 1.9 0.4 2.6 863 Currently married 0.8 4.2 0.9 4.8 2,918 1.1 1.5 0.7 2.7 1,833 Formerly married 0.4 4.1 0.8 4.8 536 0.1 1.4 1.1 2.6 305 Male circumcision Circumcised na na na na na 0.8 1.9 0.3 2.9 361 Not circumcised na na na na na 0.9 1.6 0.7 2.7 2,563 Residence Total Urban 1.4 4.9 1.3 5.7 1,225 0.4 2.0 0.3 2.6 808 Georgetown (urban) 1.7 4.4 1.1 4.9 810 0.3 1.6 0.3 2.3 534 Other (urban) 0.9 5.8 1.6 7.3 415 0.5 2.8 0.3 3.3 275 Total Rural 0.7 3.8 0.7 4.5 2,990 1.0 1.5 0.8 2.7 2,194 Total Coastal 0.8 4.1 0.8 4.8 3,756 0.6 1.5 0.5 2.3 2,644 Coastal (urban) 1.4 4.9 1.3 5.7 1,225 0.4 2.0 0.3 2.6 808 Coastal (rural) 0.5 3.8 0.6 4.3 2,531 0.7 1.2 0.6 2.1 1,836 Total Interior 1.5 4.2 1.4 5.4 459 2.4 2.8 1.8 5.5 358 Region Region 1 0.9 4.1 1.2 5.3 151 3.5 4.5 4.0 8.5 145 Region 2 0.5 2.2 1.6 3.3 242 0.6 3.1 0.7 4.0 150 Region 3 0.4 4.7 0.4 5.1 561 1.1 2.3 1.2 3.5 347 Region 4 1.0 3.8 0.8 4.4 1,839 0.7 0.9 0.4 1.9 1,324 Region 5 1.0 2.3 0.8 3.0 293 0.0 2.1 0.3 2.4 220 Region 6 0.5 5.8 0.7 6.1 640 0.4 1.4 0.4 1.9 493 Region 7 2.1 5.1 2.1 6.4 91 0.0 1.5 0.7 2.2 55 Region 8 1.7 3.3 1.9 5.2 89 2.0 0.9 0.6 3.0 61 Region 9 1.4 3.6 1.7 4.4 70 1.9 0.8 0.0 2.7 51 Region 10 1.5 5.7 1.6 7.4 239 1.3 2.4 0.0 3.6 155 Education No education 0.0 4.2 0.0 4.2 66 0.0 2.1 1.2 3.3 49 Primary 0.6 2.7 0.5 3.2 893 0.5 1.5 0.5 2.4 659 Secondary 0.9 4.6 1.0 5.4 2,895 1.1 1.7 0.8 2.9 2,025 More than secondary 1.2 3.8 1.4 4.8 362 0.1 1.1 0.2 1.3 270 Wealth quintile Lowest 0.9 3.2 0.9 4.2 695 1.6 2.6 1.4 4.2 590 Second 0.5 3.8 0.7 4.6 811 0.5 1.5 0.5 2.3 573 Middle 0.9 4.6 1.6 5.4 856 0.7 1.4 0.3 2.1 601 Fourth 1.3 4.1 0.3 4.7 893 0.8 1.3 0.7 2.7 630 Highest 0.7 4.7 1.1 5.1 960 0.7 1.3 0.4 2.0 608 Total 2009 0.9 4.1 0.9 4.8 4,215 0.8 1.6 0.7 2.7 3,002 Total 2005 1.4 2.3 0.8 3.7 2,031 1.2 2.5 0.7 3.7 1,555 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not available Note: Currently married includes respondents in consensual union (living together). Formerly married includes divorced, separated, or widowed. 230 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Figure 13.3 shows the proportion of women and men who had an STI or symptoms of an STI who sought advice or treatment from various sources. • About six in ten women (57 percent) and one in six men (17 percent) who had an STI or symptoms of an STI sought treatment from a health facility or health professional. • About one in 13 women (6 percent) or men (7 percent) seeks treatment for their STIs or STI- related symptoms from a shop or a pharmacy. • About one in four women (23 percent) and half of men (50 percent) did not seek any advice or treatment. • It must be noted that there is a relatively high percentage of women (14 percent) and men (26 percent) with missing data on the source of advice or treatment for their STIs or STI-related symptoms (data not shown separately). 13.12 PREVALENCE OF MEDICAL INJECTIONS Injection overuse in a health care setting can contribute to the transmission of blood-borne pathogens because it amplifies the effect of unsafe practices, such as reuse of injection equipment. To measure the potential risk of transmission of HIV associated with medical injections, respondents in the 2009 GDHS were asked if they had received an injection in the past 12 months, and if so, whether their last injection was given with a syringe from a new, unopened package. It should be noted that medical injections can be self-administered (e.g., insulin for diabetes). These injections were not included in the calculation. Results are shown in Table 13.13. Figure 13.3 Women and Men Seeking Treatment for STIs 57 6 1 23 17 7 1 50 Clinic/hospital/ private doctor/ other health prof Advice or medicine from shop/pharmacy Advice or treatment from any other source No advice or treatment 0 20 40 60 80 Percent Women Men Clinic/hospital/ private doctor/ other health professional GDHS 2009 HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 231 Table 13.13 Prevalence of medical injections Percentage of women and men age 15-49 who received at least one medical injection in the past 12 months, the average number of medical injections per person in the past 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––– Background Characteristic Percentage who received a medical injection in the past 12 months Average number of medical injections per person in the past 12 months Number of women For last injection, syringe and needle taken from a new, unopened package Number of women who received a medical injection in the past 12 months Percentage who received a medical injection in the past 12 months Average number of medical injections per person in the past 12 months Number of men For last injection, syringe and needle taken from a new, unopened package Number of men who received a medical injection in the past 12 months ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-24 23.8 0.7 1,783 95.1 425 21.7 0.5 1,200 95.9 260 15-19 20.4 0.6 1,016 93.7 208 22.3 0.5 689 95.7 153 20-24 28.3 0.8 767 96.5 217 20.9 0.6 511 96.3 107 25-29 29.6 1.1 658 97.2 195 22.7 1.1 462 98.4 105 30-39 25.4 1.0 1,342 96.4 341 24.2 1.1 990 94.4 240 40-49 27.3 1.3 1,213 93.8 331 26.2 1.3 870 95.0 228 Residence Total Urban 25.6 1.1 1,475 95.5 378 22.6 0.8 949 95.0 215 Georgetown (urban) 23.1 1.1 967 94.6 223 20.8 0.7 619 96.6 129 Other (urban) 30.4 1.2 508 96.8 154 26.0 1.1 330 92.6 86 Total Rural 26.0 0.9 3,521 95.4 914 24.1 1.0 2,573 95.7 619 Total Coastal 24.9 0.9 4,495 95.5 1,119 23.2 1.0 3,126 95.6 724 Coastal (urban) 25.6 1.1 1,475 95.5 378 22.6 0.8 949 95.0 215 Coastal (rural) 24.5 0.9 3,019 95.5 741 23.4 1.1 2,176 95.8 509 Interior 34.5 1.0 501 95.0 173 27.6 0.7 396 95.4 109 Region Region 1 33.9 0.5 162 94.2 55 21.6 0.7 160 (100.0) 34 Region 2 20.6 1.0 293 94.0 60 18.7 1.2 179 85.1 33 Region 3 24.9 0.8 687 97.6 171 21.6 1.3 420 96.1 91 Region 4 25.3 1.0 2,168 95.9 548 21.1 0.9 1,540 96.9 325 Region 5 21.3 0.9 353 92.3 75 27.6 0.9 271 96.1 75 Region 6 23.0 0.8 780 93.3 179 28.7 1.0 587 93.6 168 Region 7 38.9 1.3 104 96.4 40 31.0 0.9 61 90.7 19 Region 8 37.8 2.2 95 94.6 36 36.1 0.8 68 94.8 25 Region 9 28.1 0.5 78 90.6 22 38.5 0.9 57 94.4 22 Region 10 37.9 1.4 277 97.6 105 23.2 1.0 178 98.3 41 Education No education 18.7 0.4 68 * 13 26.3 3.0 60 * 16 Primary 26.5 1.2 952 94.2 252 23.6 1.4 711 93.1 168 Secondary 25.3 0.9 3,568 95.6 903 24.2 0.8 2,459 96.0 595 More than secondary 30.4 1.0 409 96.3 124 18.6 0.4 292 97.0 54 Wealth quintile Lowest 25.8 0.8 779 94.7 201 26.1 1.4 663 93.7 173 Second 24.5 0.9 957 93.8 234 24.3 1.2 679 94.5 165 Middle 26.8 0.9 1,025 94.9 275 22.7 0.7 723 98.9 165 Fourth 27.7 1.1 1,084 96.1 300 21.8 0.8 751 97.0 164 Highest 24.4 1.0 1,151 97.1 281 23.7 0.8 705 93.8 167 Total 2009 25.9 1.0 4,996 95.4 1,292 23.7 1.0 3,522 95.5 833 Total 2005 24.2 0.9 2,425 91.8 588 26.1 1.0 1,875 90.0 490 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or any other health worker. 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. 232 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior • Overall, about one in four women (26 percent) of women and men age 15-49 (24 percent) received a medical injection in the past 12 months. The average number of injections was about 1 among both women and men. • The potential risk of transmission of HIV associated with such injections is very low because the vast majority of respondents—95 percent of women and 96 percent of men who received medical injections—reported that the syringe and needle were taken from a new, unopened package, with minor variations by background characteristics. These figures are encouraging for the Guyanese population and for the Ministry of Health because contaminated needles can be one means by which HIV is transmitted. • The likelihood of receiving an injection in the past 12 months is highest among respondents in the Interior area (35 percent of women and 28 percent of men), women in Region 7 and men in Region 9 (39 percent, each), and women with more than secondary education (30 percent) and men with no education (26 percent). Respondents who had received an injection in the past 12 months were asked where they obtained their last injection. Figure 13.4 shows the type of facility where the last medical injection was received. • Overall, about three-fourths of women (77 percent) and men (73 percent) age 15-49 received their last medical injection from a public sector facility, the majority (55 percent of women and 49 percent of men) received it from a government hospital, followed by a government health center (19 percent of women and 17 percent of men). • A total of 22 percent of women and 24 percent of men received their last injection from a private medical facility, mainly from a private hospital, clinic, or doctor (20 percent of women and 22 percent of men). Figure 13.4 Type of Facility Where Last Medical Injection Was Received 77 55 19 2 1 1 22 20 2 73 49 17 2 3 1 24 22 2 TOTAL PUBLIC SECTOR Govern- ment hospital Govern- ment health center Govern- ment health post Mobile/ outreach clinic Com- munity health worker TOTAL PRIVATE MEDICAL Other private 0 20 40 60 80 100 Percent Women Men GDHS 2009 Private hos- pital/ clinic/ doctor HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 233 13.13 HIV/AIDS-RELATED KNOWLEDGE AND SEXUAL BEHAVIOR AMONG YOUNG ADULTS This section addresses knowledge of HIV/AIDS issues and related sexual behavior among youth age 15-24. Special attention is paid to this group because it accounts for half of all new HIV cases worldwide (Ross et al., 2006). In addition to knowledge of HIV transmission, results are presented on age at first sex, condom use, age differences between sexual partners, sex related to alcohol use, and voluntary counseling and testing for HIV. 13.13.1 HIV/AIDS-Related Knowledge among Young Adults Young respondents were asked the same set of questions on beliefs about HIV transmission as other respondents. Information on the overall level of knowledge of major methods of avoiding HIV and the level of rejection of major misconceptions is shown in Tables 13.2, 13.3.1, and 13.3.2. These results indicate the general level of awareness of HIV prevention methods among young people. Table 13.14 shows the level of the composite indicator, comprehensive knowledge about AIDS,1 and knowledge of a source of condoms among young people, by background characteristics. • About half of respondents age 15-24 (54 percent of women and 47 percent of men) have a comprehensive knowledge of AIDS, (i.e., know that people can reduce their chances of getting the AIDS virus by having sex with only one uninfected, faithful partner and by using condoms consistently; know that a healthy-looking person can have the AIDS virus; and know that HIV cannot be transmitted by mosquito bites or by supernatural means). • The level of comprehensive knowledge substantially increases with age, education, and wealth status; knowledge is much higher among youth in Urban than in Rural areas and among youth living in the Coastal rather than in the Interior area. For example, 72 percent of young urban women have comprehensive knowledge about AIDS compared with 47 percent of young rural women. Further, comprehensive knowledge among young female respondents with more than secondary education is more than twice as high as among those with primary education (72 and 29 percent, respectively). The gap is even wider among male respondents (75 and 21 percent, respectively). • General knowledge of formal condom sources is higher among young men than young women (87 and 79 percent, respectively). Consistent with trends in other indicators, knowledge of condom sources is higher among more educated, urban youth and among those in the highest wealth quintile. The difference in knowledge of source by education is the most dramatic, especially for young women. Sixty-three percent of women with primary education know a source, compared with 97 percent of women with more than secondary education. The comparable figures for men are 81 and 99 percent, respectively. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one HIV-negative, faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy- looking person can have the AIDS virus, and rejecting the two most common local misconceptions about HIV/AIDS transmission or prevention. The components of comprehensive knowledge are presented in Tables 13.2, 13.3.1, and 13.3.2. 234 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.14 Comprehensive knowledge about AIDS and of a source for condoms among youth Percentage of young women and young men age 15-24 with comprehensive knowledge about AIDS and the percentage with knowledge of a source of condoms, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-24 Men age 15-24 ––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––– Percentage Percentage with Percentage with Percentage comprehensive who know Number comprehensive who know Number Background knowledge a condom of knowledge a condom of characteristic of AIDS1 source2 women of AIDS1 source2 men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 53.1 74.6 1,016 44.5 82.4 689 15-17 51.2 71.9 597 42.1 77.9 451 18-19 55.7 78.5 420 49.1 90.9 238 20-24 55.4 85.7 767 49.4 92.5 511 20-22 56.6 84.7 496 49.0 91.8 312 23-24 53.2 87.6 271 50.2 93.4 199 Marital status Never married 57.7 79.1 1,155 47.6 86.1 1,026 Ever had sex 65.3 90.4 426 53.4 97.2 563 Never had sex 53.3 72.4 729 40.6 72.7 463 Ever married 47.4 80.0 628 40.9 90.1 174 Residence Total Urban 71.7 88.9 513 61.6 92.5 374 Georgetown (urban) 76.1 90.8 339 67.1 91.7 236 Other (urban) 63.1 85.2 174 52.3 94.0 138 Total Rural 47.0 75.6 1,270 39.8 84.0 826 Total Coastal 55.2 80.3 1,586 47.4 86.2 1,075 Coastal (urban) 71.7 88.9 513 61.6 92.5 374 Coastal (rural) 47.3 76.2 1,072 39.8 82.7 701 Total Interior 45.1 72.3 198 39.8 91.2 125 Region Region 1 33.3 56.9 75 30.7 94.9 58 Region 2 49.9 72.6 107 50.1 90.7 61 Region 3 55.9 76.2 256 34.3 74.9 149 Region 4 58.9 82.7 770 57.6 90.3 532 Region 5 43.1 76.8 121 21.8 81.2 93 Region 6 47.5 78.3 253 33.4 79.8 177 Region 7 62.5 85.3 42 54.1 88.7 19 Region 8 55.0 79.3 33 25.4 82.4 17 Region 9 32.4 71.2 24 (43.7) (81.3) 14 Region 10 63.9 91.2 103 66.8 98.6 80 Education No education * * 14 * * 14 Primary 28.9 62.8 171 20.8 81.2 107 Secondary 55.8 80.1 1,465 46.8 85.9 969 More than secondary 71.9 96.7 134 75.0 98.9 110 Wealth quintile Lowest 36.9 65.4 304 25.3 77.6 181 Second 46.8 76.0 371 42.4 82.2 229 Middle 55.2 79.7 367 39.8 87.8 289 Fourth 56.6 83.8 380 56.4 89.2 266 Highest 72.3 89.7 363 64.6 93.8 235 Total 2009 54.1 79.4 1,783 46.6 86.7 1,200 Total 2005 52.6 80.3 842 47.3 91.4 658 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Ever married includes respondents in consensual union (living together). 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 Comprehensive knowledge means knowing that use of a condom and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus; knowing that a healthy-looking person can have the AIDS virus; and rejecting the two most common local misconceptions (transmission by mosquito bites and by sharing food with someone with AIDS). The components of comprehensive knowledge are presented in Tables 13.2, 13.3.1 and 13.3.2. 2 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 235 13.13.2 Age at First Sex Age at first sexual intercourse is of particular interest given the fact that HIV is mainly transmitted through heterosexual contact. The 2009 GDHS gathered information on the timing of the first sexual intercourse for both men and women. Table 13.15 shows the percentage of young women and men who had sexual intercourse before age 15 and before age 18, by background characteristics. • One in ten (10 percent) of women 15-24 and one in five (19 percent) of men age 15-24 had sex by age 15, up from 9 and 13 percent, respectively in the 2005 GAIS. The percentage of respondents 18-24 who had sex before exact age 18 increases rapidly to 46 percent for women and 60 percent for men, a decrease from 59 percent of women and 68 percent of men in the 2005 GAIS. • As might be expected, the proportion of young women who had sex before exact ages of 15 and 18 is much higher among those who have ever been married than among those who have never been married. The relationship is similar for young men, but the gap is not as wide. Among women, those who know of a condom source are as likely to have sex by age 15 as those who do not have such knowledge (10 percent, each) but they are more likely to have sex by age 18 than those who do not know of a condom source (48 and 37 percent, respectively). Among men, those who know of a condom source are much more likely to have sexual intercourse by age 15 (21 percent) or by age 18 (64 percent) than those who do not know of a condom source (7 and 23 percent, respectively). • Urban women are less likely to have sexual intercourse by age 15 (6 percent) or by age 18 (45 percent) than their Rural area counterparts (12 and 47 percent, respectively), and women in Coastal areas are less likely to have sexual intercourse by age 15 (9 percent) or by age 18 (44 percent) than those living in the Interior area (22 and 64 percent, respectively). Among men, however, those living in Urban areas are more likely to have sex by age 15 or by age 18 than men in Rural areas, while the Coastal area-Interior area pattern is similar to that for women, with men in the Coastal area being more likely to have sex by age 15 or 18 than those in the Interior area. • Across regions, young women and men in Region 1 (30 and 44 percent, respectively) are the most likely to have had their sexual debut by age 15. Young women in Region 8 (72 percent) and young men in Region 1 (80 percent) are the most likely to have had sex by age 18. Young women in Regions 3 and 5 (6 percent, each) and young men in Region 2 (9 percent) are the least likely to have had sex by age 15. Finally, young women in Region 3 (36 percent) and young men in Region 6 (42 percent) are the least likely to have had sexual intercourse by age 15. • For young women, higher educational attainment is associated with a lower likelihood of initiating sexual intercourse at an early age. For example, whereas 28 percent of women age 15-24 with primary education had sex by age 15, only 8 percent of women with more than secondary education had sex by age 15. The proportion of young women initiating sex by age 15 and 18 is lowest among women in the highest wealth quintile. The relationship between early initiation of sex and level of education or wealth quintile seen among young women is less apparent among young men, and the percentages do not follow a clear pattern. 236 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.15 Age at first sexual intercourse among youth Percentage of young women and men age 15-24 who had sexual intercourse by exact ages 15 and 18, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-24 Women age 18-24 Men age 15-24 Men age 18-24 ––––––––––––––––––– ––––––––––––––––––– ––––––––––––––––––– –––––––––––––––––– Background characteristic Percentage who had sexual intercourse before exact age 15 Number of women Percentage who had sexual intercourse before exact age 18 Number of women Percentage who had sexual intercourse before exact age 15 Number of men Percentage who had sexual intercourse before exact age 18 Number of men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 10.3 1,016 na na 15.7 689 na na 15-17 8.4 597 na na 14.8 451 na na 18-19 13.0 420 46.0 420 17.6 238 55.7 238 20-24 9.8 767 46.1 767 23.2 511 62.6 511 20-22 9.4 496 47.1 496 20.7 312 56.4 312 23-24 10.6 271 44.1 271 27.0 199 72.2 199 Marital status Never married 4.9 1,155 28.7 608 17.4 1,026 57.5 575 Ever married 19.7 628 64.3 578 27.9 174 69.9 174 Knows condom source1 Yes 10.1 1,416 47.9 987 20.7 1,040 63.7 688 No 10.1 367 37.2 200 7.2 160 22.6 60 Residence Total Urban 5.5 513 44.8 323 20.3 374 65.3 225 Georgetown (urban) 4.8 339 45.4 225 19.3 236 72.0 144 Other (urban) 6.8 174 43.3 98 22.1 138 53.4 81 Total Rural 12.0 1,270 46.5 864 18.2 826 58.3 524 Total Coastal 8.6 1,586 43.7 1,049 17.2 1,075 58.6 663 Coastal (urban) 5.5 513 44.8 323 20.3 374 65.3 225 Coastal (rural) 10.0 1,072 43.3 726 15.6 701 55.2 438 Total Interior 22.4 198 63.6 138 33.2 125 73.9 86 Region Region 1 30.1 75 66.5 55 44.0 58 79.8 45 Region 2 16.7 107 48.5 63 9.4 61 47.1 34 Region 3 5.5 256 35.9 178 16.2 149 57.7 91 Region 4 9.0 770 45.7 526 19.0 532 65.5 333 Region 5 5.9 121 44.2 78 18.6 93 54.6 61 Region 6 8.9 253 42.8 159 9.5 177 41.6 110 Region 7 13.0 42 46.3 28 17.1 19 (65.5) 11 Region 8 27.1 33 72.2 24 21.9 17 (62.1) 11 Region 9 16.3 24 57.1 17 (26.5) 14 * 7 Region 10 8.1 103 55.2 61 31.8 80 68.1 47 Education No education * 14 * 6 * 14 * 11 Primary 27.7 171 65.6 138 25.0 107 56.2 77 Secondary 8.0 1,465 44.2 916 18.3 969 61.3 556 More than secondary 7.6 134 36.2 127 17.5 110 60.0 105 Wealth quintile Lowest 24.4 304 66.0 197 27.2 181 65.9 118 Second 10.7 371 53.4 250 22.5 229 63.3 136 Middle 6.9 367 43.9 261 22.7 289 54.3 173 Fourth 6.2 380 38.7 246 12.7 266 53.5 165 Highest 4.9 363 31.7 234 11.4 235 67.6 157 Total 2009 10.1 1,783 46.1 1,187 18.9 1,200 60.4 749 Total 2005 8.6 842 58.6 538 12.9 658 68.0 403 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Ever married includes respondents in consensual union (living together). na = Not applicable 1 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 237 13.13.3 Condom Use at First Sex Consistent condom use is advocated by HIV control programs to reduce the risk of sexual transmission of HIV among sexually active young adults. Young adults who use condoms the first time they have sexual intercourse are more likely to sustain condom use later in life. Condom use at first sex serves as an indicator of reduced risk of exposure at the beginning of sexual activity. To assess the extent of condom use from the beginning of sexual exposure, respondents age 15-24 were asked whether they used condoms the first time they had sex. Results are shown in Table 13.16 by background character- istics. • Condom use at first sex is not very common in Guyana. Among young adults age 15-24 who have ever had sexual intercourse, only 46 percent of females and 54 percent of males used a condom the first time they had sex. Never-married women and men (63 and 59 percent, respectively) are much more likely to use a condom at first sex than those who have been married (34 and 35 percent, respectively). It is also markedly more common among respondents who know where to obtain a condom (49 percent of women and 55 percent of men) than those who do not have such knowledge (27 percent of women and 25 percent of men). • Young women and men who live in Urban areas (62 and 59 percent, respectively), in the Coastal area (47 and 56 percent, respectively) and in Region 10 (73 and 66 percent, respectively) are more likely to use a condom at first sex than other young adults. • As expected, young women and men with more than secondary education (68 and 58 percent, respectively) and in the highest quintiles (64 and 58 percent, respectively) are the most likely to use a condom at first sex than those with less or no education or in the lowest wealth quintiles. 238 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.16 Condom use at first sexual intercourse among youth Among young women and young men age 15-24 who have ever had sexual intercourse, the percentage who used a condom the first time they had sexual intercourse, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-24 Men age 15-24 ––––––––––––––––––– ––––––––––––––––––––– Percentage Number of Percentage Number of who women who men used a who used a who condom at have ever condom at have ever Background first sexual had sexual first sexual had sexual characteristic intercourse intercourse intercourse intercourse –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 46.3 390 59.7 284 15-17 46.1 139 57.0 131 18-19 46.5 251 62.0 152 20-24 45.5 663 49.6 454 20-22 47.2 409 54.9 261 23-24 42.6 254 42.4 193 Marital status Never married 63.3 426 59.2 563 Ever married 33.9 627 34.9 174 Knows condom source1 Yes 49.4 888 54.8 704 No 26.6 165 (24.7) 33 Residence Total Urban 61.5 283 58.5 240 Georgetown (urban) 60.2 193 51.6 154 Other (urban) 64.4 90 70.8 86 Total Rural 40.0 769 51.1 497 Total Coastal 47.1 897 56.3 643 Coastal (urban) 61.5 283 58.5 240 Coastal (rural) 40.5 614 55.0 403 Total Interior 38.1 156 34.1 94 Region Region 1 23.2 64 31.1 49 Region 2 29.1 62 43.5 33 Region 3 48.4 138 50.2 83 Region 4 50.7 458 59.4 338 Region 5 43.5 65 47.3 54 Region 6 31.1 126 52.4 89 Region 7 43.5 30 (44.3) 13 Region 8 58.5 28 (17.4) 10 Region 9 38.9 17 (38.3) 9 Region 10 72.7 64 66.1 59 Education No education * 12 * 11 Primary 18.1 127 34.8 71 Secondary 48.2 821 55.6 565 More than secondary 67.8 93 58.4 90 Wealth quintile Lowest 31.3 224 34.9 119 Second 39.0 234 52.7 145 Middle 40.9 206 59.1 173 Fourth 57.7 207 57.8 155 Highest 64.2 182 58.1 145 Total 2009 45.8 1,053 53.5 737 Total 2005 43.2 484 54.8 381 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Ever married includes respondents in consensual union (living together). 1 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 239 13.13.4 Abstinence and Premarital Sex The period between age at first sex and age at marriage is often a time of sexual experi- mentation. Premarital sex and the length of the interval between sexual initiation and marriage are among the factors contributing to the spread of HIV. Table 13.17 shows, for never-married women and men age 15-24, the percentage who have never had sexual intercourse, the percentage who had sex in the past 12 months, and among those who had sex in the past 12 months, the percentage who used a condom at last sexual intercourse. • In Guyana, never-married young adults age 15-24 show a relatively high level of abstinence: 63 percent of women and 45 percent of men in this age group have never had sexual intercourse. About three in ten (29 percent) of all never-married women age 15-24 and more than four in ten men (45 percent) of never-married men age 15-24 had sexual intercourse in the 12 months preceding the survey. • Abstinence among unmarried youth decreases with age and is significantly higher among those who do not know of a condom source. Abstinence is much higher among women age 15-24 in rural areas than in urban areas (66 percent versus 57 percent) and those in the Interior area compared with women in the Coastal area (65 percent versus 47 percent). Similar patterns are observed among men. Abstinence is significantly more common among youth with less education. There is no strong relationship between premarital abstinence and wealth among youth. • About six in ten never-married women (59 percent) reported using a condom at last sexual intercourse in the past 12 months (a decrease from 64 percent in the 2005 GAIS), as did eight in ten (80 percent) of the young men (an increase from 70 percent in the 2005 GAIS). Condom use at last sexual intercourse is highest among the 18-19 year-olds; it is higher among women who know where to obtain a condom (number of cases is too small for men to make meaningful comparisons), and it is higher among youth in urban than in rural areas. There is no clear pattern in the relationship between condom use at last sexual intercourse and education or wealth. 240 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.17 Premarital sexual intercourse in the past year and condom use during premarital sexual intercourse among youth Among never-married women and men age 15-24, percentage who have never had sexual intercourse and percentage who have had sexual intercourse in the past 12 months; and among those who have had premarital sexual intercourse in the past 12 months, percentage who used a condom at last sexual intercourse, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Never-married women age 15-24 Never-married men age 15-24 ––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––– Number Number Percentage Percentage of women Percentage Percentage of men Percentage who had Number who who Percentage who Number who who who have sexual of used had sexual who have had sexual of used had sexual never had intercourse never- a condom intercourse never had intercourse never- a condom intercourse Background sexual in the past married at last sexual in the past sexual in the past married at last sexual in the past characteristic intercourse 12 months women intercourse 12 months intercourse 12 months men intercourse 12 months –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 75.5 18.8 827 62.4 156 59.8 30.4 679 85.5 206 15-17 83.8 11.6 547 54.5 63 71.0 20.6 451 79.3 93 18-19 59.4 32.8 281 67.9 92 37.4 49.8 228 90.7 114 20-24 31.8 55.3 328 55.5 181 16.5 73.7 347 75.2 256 20-22 36.2 50.5 242 57.0 122 20.8 70.8 245 74.0 173 23-24 19.5 68.8 86 52.5 59 6.3 80.6 102 77.7 82 Knows condom source1 Yes 57.8 33.9 913 59.6 310 38.1 50.8 883 80.6 449 No 83.1 11.2 242 (48.4) 27 88.8 9.2 143 * 13 Residence Total Urban 57.2 33.8 402 69.1 136 39.6 53.3 339 83.8 181 Georgetown (urban) 54.6 36.4 267 67.8 97 38.2 55.8 215 81.2 120 Other (urban) 62.3 28.5 135 72.5 38 42.1 49.0 124 89.1 61 Rural 66.3 26.7 753 51.7 201 47.8 41.0 686 77.3 281 Total Coastal 64.5 28.2 1,066 58.7 301 46.4 43.8 932 81.3 408 Coastal (urban) 57.2 33.8 402 69.1 136 39.6 53.3 339 83.8 181 Coastal (rural) 68.9 24.8 664 50.1 165 50.3 38.4 592 79.3 227 Total Interior 46.8 40.7 90 58.8 36 32.5 57.0 94 68.5 54 Region Region 1 49.7 39.2 21 * 8 22.3 70.2 40 (64.2) 28 Region 2 71.9 22.4 62 * 14 52.1 35.1 54 (75.9) 19 Region 3 72.5 22.9 162 (61.8) 37 52.2 41.7 126 (63.1) 52 Region 4 58.6 34.5 533 60.6 184 41.4 49.1 467 85.4 230 Region 5 63.9 20.1 86 * 17 49.1 33.0 81 (91.1) 27 Region 6 80.4 14.6 156 (46.7) 23 60.8 31.4 145 68.3 46 Region 7 46.4 41.5 28 (51.3) 11 (33.3) 55.1 17 (64.3) 9 Region 8 (39.2) (44.2) 14 * 6 (62.0) 31.5 11 * 4 Region 9 53.0 36.9 14 * 5 (44.8) 38.1 12 * 5 Region 10 48.1 39.2 80 77.1 31 29.0 59.5 74 90.9 44 Education No education * * 3 * 1 * * 5 * 2 Primary 72.4 20.3 61 * 12 49.2 40.4 72 (55.2) 29 Secondary 65.4 27.3 982 61.0 268 47.5 43.0 851 81.7 366 More than secondary 37.7 50.7 109 (45.8) 55 21.0 67.0 97 79.7 65 Wealth quintile Lowest 59.9 28.8 133 57.8 38 47.1 43.4 133 73.0 58 Second 63.3 31.1 215 66.2 67 43.7 44.5 192 83.0 86 Middle 66.1 26.0 241 59.2 63 46.3 41.0 250 77.2 103 Fourth 63.5 29.2 272 56.9 79 46.7 44.9 237 78.8 107 Highest 61.5 30.6 294 54.7 90 42.1 51.4 213 84.4 110 Total 2009 63.1 29.2 1,155 58.7 337 45.1 45.0 1,026 79.8 462 Total 2005 65.2 27.4 548 63.9 150 48.0 40.4 579 69.9 234 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 241 13.13.5 Higher-Risk Sex and Condom Use among Young Adults The most common means of transmission of HIV in Guyana is through unprotected sex with a person who is HIV positive. To prevent HIV/AIDS transmission, it is important that young people practice the recommended ABC methods regarding safe sex (abstinence, being faithful to one HIV- negative partner, and condom use). Table 13.18 shows for young women and men age 15-24 who were sexually active in the 12 months preceding the survey, the proportion who engaged in higher-risk sex2 during this period. The table also shows, for those who engaged in higher-risk sex, the proportion who used a condom at last higher- risk sex. • The results indicate that higher-risk sex is more common among young men (80 percent) than among young women (42 percent) who had sexual intercourse in the past 12 months. Condom use at last higher-risk sexual intercourse is also higher among young men (78 percent) than young women (56 percent). • Higher-risk sex is more prevalent among younger respondents and among those who have never married. This is expected because higher-risk sex is, by definition, sexual intercourse with a non-marital partner, and older respondents are more likely to be married. It is also higher among youth who know of a condom source. Urban women age 15-24 are more likely to have higher-risk sexual intercourse than rural women (67 and 34 percent, respectively), and young women living in the Coastal area are more likely than those living in the Interior area to have higher-risk sexual intercourse (44 and 32 percent, respectively). The same pattern is seen for men, but the differences are less pronounced. Higher-risk sexual intercourse is most prevalent among young women and men in Region 10 (66 percent of women and 92 percent of men). The proportion of young people age 15-24 who reported higher-risk sexual intercourse in the 12 months preceding the survey increases with level of education and wealth quintile. Condom use at the last higher-risk sex generally follows the same patterns. 2 Sexual intercourse with a non-marital, non-cohabiting partner 242 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.18 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months Among young women and men age 15-24 who had sexual intercourse in the past 12 months, the percentage who had higher-risk sexual intercourse in the past 12 months, and among those having higher-risk intercourse in the past 12 months, the percentage reporting that a condom was used at last higher-risk intercourse, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-24 Men age 15-24 ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Number Percentage Number Number Percentage Number Percentage of women who reported of women Percentage of men who reported of men who had who had using a who had who had who had using a who had higher-risk sexual condom higher-risk higher-risk sexual condom higher-risk intercourse intercourse at last intercourse intercourse intercourse at last intercourse Background in the past in the past higher-risk in the past in the past in the past higher-risk in the past characteristic 12 months 12 months intercourse 12 months 12 months 12 months intercourse 12 months ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 52.1 337 58.9 176 96.7 216 85.2 208 15-17 62.9 113 53.1 71 99.4 93 79.3 93 18-19 46.7 224 62.9 104 94.6 122 89.9 116 20-24 36.9 602 53.3 222 70.6 416 73.3 294 20-22 40.0 369 56.6 148 75.9 239 75.4 181 23-24 32.0 233 46.7 75 63.5 177 69.9 113 Marital status Never married 100.0 337 58.7 337 100.0 462 80.3 462 Ever married 10.1 602 39.4 61 23.7 170 (54.7) 40 Knows condom source1 Yes 46.0 796 56.5 366 81.0 601 79.1 487 No 22.4 143 (47.0) 32 (49.6) 30 * 15 Residence Total Urban 67.0 241 66.9 162 89.6 214 81.9 192 Georgetown (urban) 72.4 166 65.3 120 92.4 140 78.8 129 Other (urban) 55.0 75 71.6 41 84.4 75 88.3 63 Total Rural 33.9 698 48.1 236 74.3 417 75.9 310 Total Coastal 44.3 797 56.0 353 80.5 548 79.6 441 Coastal (urban) 67.0 241 66.9 162 89.6 214 81.9 192 Coastal (rural) 34.4 556 46.7 191 74.7 334 77.7 249 Total Interior 31.8 142 54.0 45 73.0 83 68.5 61 Region Region 1 16.9 61 * 10 69.9 45 (66.1) 32 Region 2 26.6 58 * 15 72.2 26 (75.9) 19 Region 3 35.3 126 (57.7) 44 78.5 76 (60.9) 59 Region 4 53.6 414 57.1) 222 85.1 293 83.1 249 Region 5 37.2 49 * 18 (75.8) 39 (89.7) 30 Region 6 22.4 113 (42.0) 25 62.9) 75 69.5 47 Region 7 50.8 26 (50.7) 13 (80.1 11 (64.3) 9 Region 8 35.5 25 * 9 (70.0) 9 * 6 Region 9 39.0 14 * 6 * 6 * 5 Region 10 65.6 53 74.5 35 91.5 50 89.7 46 Education No education * 12 * 1 * 10 * 4 Primary 13.7 121 * 17 57.7 64 (59.6) 37 Secondary 43.7 727 57.8 318 81.5 480 80.1 391 More than secondary 78.7 79 46.5 62 90.4 77 79.9 70 Wealth quintile Lowest 26.2 204 44.5 53 61.8 105 72.5 65 Second 38.1 217 63.9 83 74.7 122 83.3 91 Middle 36.5 182 59.2 66 82.7 141 74.3 116 Fourth 49.1 185 53.3 91 84.2 134 78.5 113 Highest 69.2 151 55.1 104 90.1 130 81.1 117 Total 2009 42.4 939 55.8 398 79.5 632 78.2 502 Total 2005 40.4 436 61.6 176 80.5 312 67.6 251 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Ever married includes respondents in consensual union (living together). 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 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 243 Figure 13.5 presents the findings on the extent of both risky and safe sex practices among young people in Guyana. • About four in ten women (41 percent) and men age 15-24 (39 percent) have never had sex, and an additional 6 percent of women and 9 percent of men have had sex but not in the 12 months before the survey. • Although 16 percent of women and 23 percent of men age 15-24 say they had sex with only one partner in the past 12 months and that they used a condom the last time, a significant proportion of young women (35 percent) and men (17 percent) had only one partner in the past year but did not use a condom the last time they had sexual intercourse. • The proportion of young people who had multiple sexual partners in the past 12 months is not large—1 percent of women and 12 percent of men. Overall, less than 1 percent of young women and 3 percent of young men who had sex with more than one partner in the past 12 months did not use a condom the last time they had sex. 13.13.6 Age Mixing in Sexual Relationships among Women In many societies, young women have sexual relationships with men who are considerably older than they are. This practice can contribute to the spread of HIV and other STIs because if a younger, HIV-negative partner has sexual intercourse with an older, HIV-positive partner, the virus can be introduced into a younger, HIV-negative cohort. To examine age differences between sexual partners, women age 15-19 who had sex in the 12 months preceding the survey with someone other than their husband or live-in partner were asked the age of such partners. In the event they did not know a partner’s exact age, they were asked if the partner was older or younger than they were and, if older, whether the partner was 10 or more years older. Figure 13.5 Abstinence, Being Faithful, and Condom Use (ABC) among Young Women and Men Age 15-24 15-19 20-24 15-24 15-19 20-24 15-24 0 20 40 60 80 100 Percent Never had sex No partners in past year One partner, used condom at last sex One partner, no condom use at last sex Multiple partners, used condom at last sex Multiple partners, no condom use at last sex Note: Number of partners refers to the 12 months preceding the survey. WOMEN MEN GDHS 2009 244 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.19 shows the percentage of women age 15-19 who had higher-risk sexual intercourse in the past 12 months with a man who was 10 or more years older, by background characteristics. Table 13.19 Age mixing in sexual relationships among women age 15-19 Percentage of women age 15-19 who had higher-risk sexual intercourse in the past 12 months with a man who was 10 or more years older, by background characteristics, Guyana 2009 –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Number of of women women who had who had higher-risk higher-risk intercourse intercourse Background with a man in the past characteristic 10+ years older1 12 months –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-17 3.5 71 18-19 9.8 104 Marital status Never married 3.6 156 Ever married * 20 Knows condom source2 Yes 8.2 155 No (0.0) 21 Residence Total Urban 3.8 63 Georgetown (urban) (3.7) 41 Other (urban) (4.0) 21 Total Rural 9.1 113 Total Coastal 7.3 150 Coastal (urban) 3.8 63 Coastal (rural) 9.8 87 Total Interior 6.9 26 Education Primary * 11 Secondary 5.6 159 More than secondary * 6 Wealth quintile Lowest 14.4 39 Second (8.7) 34 Middle (2.7) 32 Fourth (6.6) 32 Highest (2.9) 38 Total 15-19 2009 7.2 176 2005 8.3 87 Total 15-243 2009 9.8 398 2005 4.6 436 –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Ever married includes respondents in consensual union (living together). 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 Sexual intercourse with a partner who neither was a spouse nor who lived with the respondent 2 The following categories are not considered sources for condoms: friends, family members, and home. 3 This indicator is calculated for women 15-24 and includes all partners (higher-risk and non higher-risk partners) who are older by 10 or more years. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 245 • One in ten women age 15-19 (10 percent) reported higher-risk sex with a man 10 or more years older than themselves in the past 12 months. • A larger proportion of women age 18-19 (10 percent) than those age 15-17 (4 percent) reported having sexual intercourse with a man 10 or more years older in the past 12 months. • Young rural women are more likely than urban women to have sexual intercourse with a man 10 or more years their senior over the past 12 months (9 percent versus 4 percent). • There is no clear relationship between wealth index with the likelihood of engaging in age- mixing in sexual partnerships. Differences by education cannot be analyzed due to the small number of cases. 13.13.7 Drunkenness during Sex among Young Adults Engaging in sexual intercourse while under the influence of alcohol can impair judgment, compromise power relations, and increase risky sexual behavior. Respondents who had sex in the 12 months preceding the survey were asked (for each partner) if they or their partner drank alcohol the last time they had sexual intercourse with that partner, and whether they or their partner was drunk. Table 13.20 shows the results by background characteristics. • The data show that very few young people (less than 1 percent of women and 3 percent of men) reported being drunk during their last sexual intercourse, and only 1 percent of young women and 3 percent of young men said that either they or their partners were drunk. • There is little variation by background characteristics of respondents. 246 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.20 Drunkenness during sexual intercourse among youth Percentage of young women and young men age 15-24 who had sexual intercourse in the past 12 months while being drunk, and percentage who had sexual intercourse in the past 12 months when drunk or with a partner who was drunk, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women 15-24 Men 15-24 ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Background characteristic Percentage who had sexual intercourse in the past 12 months when drunk Percentage who had sexual intercourse in the past 12 months when drunk or with a partner who was drunk Number of women Percentage who had sexual intercourse in the past 12 months when drunk Percentage who had sexual intercourse in the past 12 months when drunk or with partner who was drunk Number of men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.2 1.0 1,016 2.3 2.3 689 15-17 0.0 0.7 597 1.7 1.7 451 18-19 0.4 1.5 420 3.4 3.4 238 20-24 0.3 1.2 767 4.3 4.9 511 20-22 0.4 1.6 496 4.9 5.6 312 23-24 0.1 0.7 271 3.3 3.6 199 Marital status Never married 0.0 0.7 1,155 3.1 3.3 1,026 Ever married 0.5 1.9 628 3.7 4.1 174 Knows condom source1 Yes 0.3 1.2 1,416 3.6 3.9 1,040 No 0.0 0.7 367 0.0 0.0 160 Residence Total Urban 0.0 0.2 513 3.5 3.7 374 Georgetown (urban) 0.0 0.0 339 3.2 3.2 236 Other (urban) 0.0 0.5 174 3.9 4.5 138 Total Rural 0.3 1.5 1,270 3.0 3.3 826 Total Coastal 0.2 1.0 1,586 3.3 3.5 1,075 Coastal (urban) 0.0 0.2 513 3.5 3.7 374 Coastal (rural) 0.2 1.5 1,072 3.1 3.5 701 Total Interior 0.7 1.6 198 2.2 2.2 125 Region Region 1 0.4 1.3 75 0.7 0.7 58 Region 2 0.0 2.4 107 1.3 1.3 61 Region 3 0.0 2.3 256 6.3 6.3 149 Region 4 0.0 0.5 770 2.3 2.6 532 Region 5 0.0 0.0 121 4.6 5.2 93 Region 6 1.0 1.9 253 3.3 3.3 177 Region 7 1.4 2.1 42 0.0 0.0 19 Region 8 0.0 0.5 33 8.6 8.6 17 Region 9 1.9 4.8 24 (6.0) (6.0) 14 Region 10 0.0 0.0 103 2.8 3.8 80 Education No education * * 14 * * 14 Primary 0.2 2.3 171 3.2 3.2 107 Secondary 0.2 0.8 1,465 3.4 3.6 969 More than secondary 0.0 1.6 134 1.5 2.2 110 Wealth quintile Lowest 0.3 2.6 304 2.5 2.5 181 Second 0.0 0.6 371 3.6 3.6 229 Middle 0.4 0.8 367 3.0 3.0 289 Fourth 0.0 1.2 380 2.4 2.6 266 Highest 0.4 0.7 363 4.2 5.2 235 Total 2009 0.2 1.1 1,783 3.1 3.4 1,200 Total 2005 0.1 1.4 842 0.7 1.2 658 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Ever married includes respondents in consensual union (living together). 1 The following categories are not considered sources for condoms: friends, family members, and home. HIV/AIDS-Related Knowledge, Attitudes, and Behavior | 247 13.13.8 Recent HIV Testing among Youth Young people may feel that there are barriers to accessing and using many services and facilities, particularly for sensitive concerns relating to sexual health, including sexually transmitted infections, such as HIV/AIDS. Table 13.21 shows the percentage who had an HIV test in the past 12 months and received the results of the test, among young women and young men age 15-24 who had sexual intercourse in the past 12 months, by background characteristics. • Overall, a larger proportion of sexually active young women (43 percent) than young men (28 percent) reported having an HIV test with test results in the 12 months preceding the survey. • Recent HIV testing is less common among youth age 15-17 than among older youth, those who are ever married than those who are never married, and those living in Rural areas compared with those living in Urban areas. It is also much more common among young people who say they know a source for condoms than for those who do not know of a condom source. • For young women, recent HIV testing ranges from 26 percent in Region 9 to 57 percent in Region 8, while for men the number of cases is relatively small and does not allow meaningful comparisons. • Recent HIV testing among youth is lowest among youth with no or little education and those in the lowest wealth quintile. 248 | HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 13.21 Recent HIV tests among youth Among young women and young men age 15-24 who had sexual intercourse in the past 12 months, the percentage who had an HIV test in the past 12 months and received the results of the test, by background characteristics, Guyana 2009 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women age 15-24 Men age 15-24 who have had sex who have had sex in the past 12 months in the past 12 months ––––––––––––––––––––––––– –––––––––––––––––––––– Background characteristic Percentage who had been tested and received results in the past 12 months Number of women Percentage who had been tested and received results in the past 12 months Number of men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 42.7 337 30.2 216 15-17 36.9 113 23.3 93 18-19 45.7 224 35.5 122 20-24 43.7 602 26.7 416 20-22 45.7 369 23.5 239 23-24 40.6 233 31.1 177 Marital status Never married 47.4 337 30.4 462 Ever married 41.1 602 21.3 170 Knows condom source1 Yes 45.6 796 28.7 601 No 31.0 143 12.6 30 Residence Total Urban 51.2 241 35.0 214 Georgetown (urban) 56.4 166 38.1 140 Other (urban) 39.7 75 29.1 75 Total Rural 40.7 698 24.3 417 Total Coastal 43.2 797 28.9 548 Coastal (urban) 51.2 241 35.0 214 Coastal (rural) 39.7 556 25.0 334 Total Interior 44.3 142 21.7 83 Region Region 1 36.7 61 12.7 45 Region 2 44.0 58 28.4 26 Region 3 38.5 126 15.3 76 Region 4 50.6 414 35.4 293 Region 5 34.2 49 (16.7) 39 Region 6 27.0 113 24.4 75 Region 7 52.0 26 (31.0) 11 Region 8 56.9 25 (25.1) 9 Region 9 26.3 14 * 6 Region 10 43.1 53 30.5 50 Education No education * 12 * 10 Primary 37.5 121 12.9 64 Secondary 44.1 727 27.6 480 More than secondary 47.3 79 44.8 77 Wealth quintile Lowest 39.6 204 19.2 105 Second 45.6 217 26.8 122 Middle 41.0 182 25.2 141 Fourth 42.7 185 34.9 134 Highest 48.8 151 31.8 130 Total 2009 43.4 939 27.9 632 Total 2005 21.9 436 15.4 312 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Ever married includes respondents in consensual union (living together). 1 The following categories are not considered sources for condoms: friends, family members, and home. Women’s Empowerment and Demographic and Health Outcomes | 251 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14 The 2009 Guyana Demographic and Health Survey (2009 GDHS) collected information specific to women’s empowerment. Questions about employment, a key indicator of empowerment, assessed the percentage of women who are employed, how much they earn and how much of their own and their spouse’s incomes they control. The 2009 GDHS also collected information about empowerment through questions on women’s participation in household decision making, the circumstances under which the respondent thinks that a woman is justified in refusing to have sexual intercourse with her husband, and her/his attitude toward wife beating. This report uses the three indices of women’s empowerment developed by DHS to measure women’s and men’s responses to survey questions. The first index is based on the number of household decisions in which the woman participates, the second is based on the respondent’s opinion regarding the number of reasons that justify wife beating, and the third is based on the respondent’s opinion of the number of circumstances under which a wife is justified in refusing to have sexual intercourse with her husband. The ranking of women on these three indices is then related to selected demographic and health outcomes, including use of contraception, ideal family size, and the use of reproductive health care services during pregnancy, childbirth, and the postnatal period. 14.1 EMPLOYMENT AND FORMS OF EARNINGS Employment can be a source of empowerment for both women and men. It is particularly so for women if it puts them in control of the household income. In the 2009 GDHS, respondents were asked whether they were employed at the time of the survey and, if not, whether they were employed in the 12 months preceding the survey. Table 14.1 shows the percentage of currently married women and men age 15-49 who were employed preceding the survey and the percent distribution by type of earnings they received (cash, in- kind, or both), according to age. • Data show that just over one-third (36 percent) of currently married women age 15-49 were employed at the time of the survey or within the 12 months preceding the survey, compared with men who were employed (98 percent). Older married women are more likely to be employed than younger women; however, there are no differences by age for men. • Among currently married respondents employed in the past 12 months, a slightly smaller proportion of women (90 percent) than men (95 percent) received earnings in cash, while similar proportions (4 percent of women and 3 percent of men) received cash and in-kind earnings. Six percent of currently married women and 1 percent of currently married men employed in the past 12 months were not paid. The proportion not paid is highest among women age 25-29 and among men age 20-24. 252 | Women’s Empowerment and Demographic and Health Outcomes Table 14.1 Employment and cash earnings of currently married women and men Percentage of currently married women and men age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently married women and men employed in the past 12 months by type of earnings, according to age, Guyana 2009 Currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Age Percentage employed Number of respondents Cash only Cash and in-kind In-kind only Not paid Missing Total Number of respondents WOMEN 15-19 17.0 166 (79.5) (4.9) (14.8) (0.9) (0.0) 100.0 28 20-24 26.8 398 89.5 2.7 0.3 7.2 0.2 100.0 107 25-29 37.2 458 91.1 0.7 0.0 8.2 0.0 100.0 170 30-34 35.9 492 91.0 3.1 0.0 5.6 0.2 100.0 176 35-39 37.2 517 88.8 6.2 0.9 4.2 0.0 100.0 193 40-44 43.6 460 90.3 3.8 0.1 5.3 0.6 100.0 201 45-49 38.1 429 89.5 4.5 0.0 5.1 1.0 100.0 163 Total 35.6 2,920 89.8 3.6 0.6 5.6 0.3 100.0 1,038 MEN 15-19 * 8 * * * * * * 8 20-24 99.0 143 92.8 2.1 0.3 4.0 0.8 100.0 142 25-29 99.0 269 95.3 3.1 0.6 1.0 0.0 100.0 266 30-34 99.2 366 95.1 3.5 0.2 1.3 0.0 100.0 363 35-39 99.6 354 94.6 3.7 0.7 1.0 0.0 100.0 352 40-44 97.9 352 95.7 2.8 0.8 0.7 0.0 100.0 345 45-49 96.5 343 92.9 3.4 2.2 1.4 0.1 100.0 331 Total 98.4 1,835 94.5 3.3 0.8 1.3 0.1 100.0 1,806 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25 to 49 unweighted cases. Currently married includes respondents in consensual union (living together). 14.2 CONTROL OVER WOMEN’S AND MEN’S EARNINGS Currently married women who were employed and received cash for their work were asked who the main decision-maker is in the family regarding use of their earnings. They were also asked the relative magnitude of their earnings compared with those of their husband/partner. Women whose husbands were employed for cash were asked who usually decides how his earnings are used. Men were also asked who mainly decides how their earnings are used. These pieces of information provide insight into women’s level of empowerment within the family and the extent of their control over decision making regarding the use of household income. It is expected that employment and cash earnings are more likely to empower women if they control their own earnings and perceive their earnings as important to the household relative to those of their husband/partner. Table 14.2.1 shows the women’s control over their cash earnings and the relative magnitude of their earnings relative to those of their husband/partner, for currently married women who had cash earnings in the 12 months preceding the survey. Women’s Empowerment and Demographic and Health Outcomes | 253 Table 14.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey, by person who decides how wife's cash earnings are used and by whether she earns more or less than her husband, according to background characteristics, Guyana 2009 Person who decides how the wife's cash earnings are used: Women's cash earnings compared with husband's cash earnings: Background characteristic Mainly wife Wife and husband jointly Mainly husband Other Missing Total More Less About the same Husband/ partner has no earnings Don't know/ missing Total Number of women Age 15-19 (74.4) (21.1) (2.5) (2.1) (0.0) (100.0) (4.0) (88.6) (7.4) (0.0) (0.0) (100.0) 24 20-24 64.0 35.3 0.7 0.0 0.0 100.0 14.8 67.6 13.5 1.5 2.7 100.0 98 25-29 51.2 44.6 2.7 0.2 1.3 100.0 14.0 60.5 21.7 0.2 3.7 100.0 157 30-34 54.0 43.2 2.5 0.0 0.3 100.0 6.0 68.3 23.3 0.9 1.5 100.0 166 35-39 56.9 41.2 0.3 0.0 1.6 100.0 17.8 58.7 20.4 1.5 1.6 100.0 183 40-44 53.8 42.4 3.6 0.0 0.2 100.0 9.1 65.0 19.2 2.8 3.9 100.0 189 45-49 55.5 42.4 2.2 0.0 0.0 100.0 19.4 52.0 22.6 1.0 5.1 100.0 153 Number of living children 0 60.5 35.9 1.2 0.0 2.5 100.0 15.9 64.3 14.4 1.4 3.9 100.0 102 1-2 60.0 38.2 1.3 0.1 0.4 100.0 12.8 60.9 21.5 0.9 3.9 100.0 426 3-4 52.7 44.9 2.0 0.0 0.4 100.0 13.2 64.5 17.8 2.6 2.0 100.0 278 5+ 47.3 47.5 4.8 0.2 0.2 100.0 11.9 61.6 24.5 0.3 1.8 100.0 164 Residence Total Urban 66.0 32.3 1.4 0.0 0.4 100.0 11.2 70.9 14.7 1.3 2.0 100.0 321 Georgetown (urban) 67.6 30.9 1.5 0.0 0.0 100.0 10.2 71.8 14.7 0.8 2.5 100.0 211 Other (urban) 62.8 34.9 1.2 0.0 1.1 100.0 13.0 69.2 14.6 2.1 1.1 100.0 111 Total Rural 50.8 46.0 2.5 0.1 0.7 100.0 14.0 58.2 22.9 1.3 3.5 100.0 648 Total Coastal 57.8 40.4 1.2 0.0 0.6 100.0 13.3 62.3 20.0 1.4 3.0 100.0 849 Coastal (urban) 66.0 32.3 1.4 0.0 0.4 100.0 11.2 70.9 14.7 1.3 2.0 100.0 321 Coastal (rural)l 52.8 45.4 1.1 0.0 0.7 100.0 14.6 57.1 23.2 1.4 3.6 100.0 527 Total Interior 41.8 48.6 8.4 0.7 0.6 100.0 11.5 63.3 21.6 0.9 2.8 100.0 121 Region Region 1 44.7 41.0 13.0 1.4 0.0 100.0 6.8 67.6 19.2 1.1 5.4 100.0 35 Region 2 54.1 44.5 1.4 0.0 0.0 100.0 2.5 75.0 18.9 3.6 0.0 100.0 44 Region 3 57.7 41.6 0.7 0.0 0.0 100.0 7.0 66.9 23.6 1.8 0.8 100.0 141 Region 4 59.4 39.4 0.7 0.0 0.4 100.0 16.5 59.4 20.2 0.9 3.0 100.0 458 Region 5 57.0 39.6 0.0 0.0 3.5 100.0 6.1 65.6 21.7 1.7 4.8 100.0 48 Region 6 50.6 44.3 5.1 0.0 0.0 100.0 15.0 56.6 19.5 2.6 6.4 100.0 107 Region 7 47.5 50.0 0.0 0.0 2.5 100.0 14.3 63.2 18.4 1.6 2.5 100.0 28 Region 8 32.1 60.0 7.9 0.0 0.0 100.0 24.6 57.5 16.1 1.0 0.9 100.0 26 Region 9 17.2 63.7 17.1 2.0 0.0 100.0 5.9 45.5 45.5 0.0 3.1 100.0 17 Region 10 63.7 33.3 1.1 0.0 1.8 100.0 11.5 76.1 10.6 0.0 1.8 100.0 66 Education No education * * * * * * * * * * * * 14 Primary 52.4 43.5 3.6 0.3 0.2 100.0 10.9 59.7 24.5 2.8 2.2 100.0 166 Secondary 58.2 39.8 1.5 0.1 0.5 100.0 13.8 63.3 19.0 0.9 2.9 100.0 651 More than secondary 52.7 43.5 2.3 0.0 1.5 100.0 13.1 60.9 19.6 1.6 4.7 100.0 138 Wealth quintile Lowest 52.1 41.2 5.1 0.5 1.1 100.0 12.1 59.8 24.8 0.4 2.9 100.0 153 Second 50.0 48.4 1.3 0.0 0.2 100.0 12.0 65.2 20.6 0.8 1.5 100.0 163 Middle 59.4 38.8 1.8 0.0 0.0 100.0 13.4 66.5 16.5 1.7 1.9 100.0 159 Fourth 55.4 43.6 0.6 0.0 0.4 100.0 19.9 56.2 19.9 1.3 2.7 100.0 206 Highest 59.4 37.5 2.2 0.0 1.0 100.0 9.1 64.5 19.8 1.9 4.6 100.0 288 Total 55.8 41.4 2.1 0.1 0.6 100.0 13.1 62.4 20.2 1.3 3.0 100.0 970 Note: Currently married includes respondents in consensual union (living together). An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25 to 49 unweighted cases. 254 | Women’s Empowerment and Demographic and Health Outcomes • More than half (56 percent) of married women who are employed say that they mainly control their cash earnings; about four in ten (41 percent) say that they and their husband jointly decide how her earnings are used; and just 2 percent say that their husband mainly controls their cash earnings. Younger women are slightly more likely than older women to control their own cash earnings. Currently married women with no children or with 1 to 2 living children are also more likely to decide themselves how their cash earnings are used than women with three or more living children. • Overall, Urban area women (66 percent) and those living in the Coastal area (58 percent) are more likely than, respectively, Rural area women (51 percent) and women from the Interior area (42 percent) to have the main control over their own cash income. Women’s control over their cash earnings is highest among women in Region 4 (59 percent) and lowest among women in Region 9 (17 percent). Differentials by education and household wealth status do not show a consistent pattern. • More than six in ten (62 percent) currently married, employed women in Guyana say they earn less than their husband, 20 percent say they earn about the same amount, 13 percent say that they earn more than their husband, and 1 percent say that their husband has no earnings. Thus, one in three currently married, employed women earns at least as much as her husband. • Employed women with no children (16 percent), those living in Rural areas (14 percent) and in Region 8 (25 percent), and those in the fourth wealth quintile (20 percent) are more likely than other women to earn more than their husbands. Currently married men age 15-49 who receive cash earnings and currently married women age 15-49 whose husbands/partners receive cash earnings were asked who decides how the husband’s/ partner’s cash earnings are spent. Table 14.2.2 shows the percent distribution of currently married men age 15-49 who receive cash earnings and the percent distribution of currently married women 15-49 and whose husbands receive cash earnings, by person who decides how men's cash earnings are used, according to background characteristics. • Data show that 12 percent of men and 20 percent of women say that the wife mainly decides how the husband’s earnings are used. The majority of men (74 percent) and women (61 percent) say the husband and wife decide jointly how the man’s cash earnings are used. Rural women and men (77 and 63 percent, respectively) are more likely than those in urban areas (66 and 54 percent, respectively) to say that decisions about how the husband’s cash earnings are spent are made jointly by the husband and wife. Men in Region 5 (87 percent) and women in Region 7 (76 percent) are the most likely to say this decision is made jointly, while men and women in Region 1 (65 and 48 percent, respectively) are the least likely to say so. • Younger men and women and men with no children and women with no children or 1 to 2 living children are more likely to say that the husband mainly decides on how the man’s cash earnings are spent. Urban men and women (13 and 31 percent, respectively) are more likely than rural men and women (9 and 15 percent, respectively) to say that the husband is the main decision maker on how the man’s earnings are to be used. Men and women in Region 1 (23 and 38 percent, respectively) and those with no education (32 and 38 percent, respectively) are the most likely to say that the husband mainly decides how the man’s earnings are used when compared with other respondents. There is no clear pattern in the variation of this indicator by wealth quintile. Women’s Empowerment and Demographic and Health Outcomes | 255 Table 14.2.2 Control over men's cash earnings Percent distributions of currently married men age 15-49 who receive cash earnings and of currently married women 15-49 whose husbands receive cash earnings, by person who decides how men's cash earnings are used, according to background characteristics, Guyana 2009 Men with cash earnings Women with husbands with cash earnings Background characteristic Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number of men Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number of women Age 15-19 * * * * * * 8 20.0 55.6 24.4 0.0 0.0 100.0 165 20-24 9.3 72.0 17.9 0.0 0.7 100.0 134 20.1 62.2 17.0 0.2 0.5 100.0 397 25-29 5.3 78.4 11.7 0.1 4.4 100.0 262 16.7 61.4 19.7 0.0 2.2 100.0 457 30-34 10.5 76.3 8.3 0.1 4.8 100.0 358 19.7 63.4 15.9 0.2 0.7 100.0 490 35-39 12.7 74.8 9.7 0.0 2.9 100.0 346 20.4 59.9 17.9 0.1 1.8 100.0 510 40-44 15.7 72.2 8.4 0.3 3.4 100.0 339 20.7 57.1 20.7 0.6 1.0 100.0 451 45-49 16.1 71.6 7.2 0.1 5.1 100.0 318 21.4 62.0 15.2 0.3 1.2 100.0 418 Number of living children 0 11.6 68.9 14.7 0.0 4.9 100.0 233 18.6 60.5 19.1 0.0 1.9 100.0 306 1-2 9.9 76.8 8.9 0.1 4.3 100.0 751 17.3 60.5 20.6 0.3 1.3 100.0 1,247 3-4 14.6 73.8 8.1 0.3 3.3 100.0 561 22.2 61.9 15.1 0.2 0.6 100.0 923 5+ 13.6 73.4 10.2 0.1 2.6 100.0 221 22.9 58.6 16.8 0.0 1.7 100.0 412 Residence Total Urban 9.1 66.3 13.4 0.1 11.0 100.0 378 14.0 54.1 31.0 0.1 0.8 100.0 642 Georgetown (urban) 6.7 64.5 10.8 0.0 18.0 100.0 228 10.4 50.1 39.2 0.0 0.3 100.0 388 Other (urban) 12.8 69.2 17.3 0.3 0.4 100.0 150 19.5 60.3 18.4 0.2 1.6 100.0 253 Total Rural 12.9 76.6 8.5 0.1 1.9 100.0 1,387 21.5 62.5 14.5 0.2 1.3 100.0 2,247 Total Coastal 12.7 74.8 8.8 0.1 3.6 100.0 1,555 20.7 60.2 17.7 0.2 1.2 100.0 2,533 Coastal (urban) 9.1 66.3 13.4 0.1 11.0 100.0 378 14.0 54.1 31.0 0.1 0.8 100.0 642 Coastal (rural) 13.9 77.5 7.3 0.1 1.3 100.0 1,177 23.0 62.3 13.2 0.2 1.3 100.0 1,891 Total Interior 7.1 71.4 15.8 0.3 5.4 100.0 210 13.5 63.7 21.4 0.2 1.2 100.0 355 Region Region 1 2.2 65.1 22.9 0.4 9.3 100.0 89 14.4 47.9 37.7 0.0 0.0 100.0 127 Region 2 10.2 82.1 7.7 0.0 0.0 100.0 99 14.7 68.4 14.9 0.6 1.4 100.0 189 Region 3 10.7 78.2 10.6 0.5 0.0 100.0 232 22.5 62.9 13.8 0.3 0.6 100.0 418 Region 4 13.5 69.2 9.7 0.0 7.7 100.0 706 19.3 55.6 23.4 0.2 1.5 100.0 1,108 Region 5 8.9 87.1 3.4 0.0 0.6 100.0 126 16.4 73.0 9.4 0.4 0.8 100.0 217 Region 6 16.0 77.6 5.8 0.1 0.4 100.0 346 26.4 59.3 13.3 0.0 1.0 100.0 516 Region 7 6.9 77.3 14.7 0.0 1.1 100.0 36 15.9 76.1 4.7 0.4 2.9 100.0 64 Region 8 11.5 70.9 15.2 0.9 1.6 100.0 32 8.5 72.1 17.5 0.0 1.9 100.0 70 Region 9 14.5 75.5 3.0 0.0 7.0 100.0 30 9.6 73.1 15.7 0.7 0.9 100.0 57 Region 10 5.4 75.9 18.7 0.0 0.0 100.0 71 20.9 63.5 14.2 0.0 1.4 100.0 120 Education No education 24.4 43.0 31.8 0.7 0.2 100.0 41 11.6 47.7 38.3 0.4 1.9 100.0 60 Primary 16.2 75.5 6.0 0.0 2.3 100.0 468 25.1 59.7 14.2 0.0 1.0 100.0 734 Secondary 10.4 75.5 10.1 0.2 3.8 100.0 1,127 18.6 61.5 18.6 0.3 1.1 100.0 1,924 More than secondary 7.6 70.2 10.9 0.0 11.3 100.0 129 14.2 60.2 23.2 0.0 2.4 100.0 170 Wealth quintile Lowest 13.4 69.8 13.5 0.1 3.2 100.0 340 21.0 61.3 16.4 0.0 1.3 100.0 552 Second 14.9 76.4 6.4 0.1 2.1 100.0 351 21.7 59.9 16.9 0.2 1.3 100.0 566 Middle 14.0 73.1 9.1 0.0 3.9 100.0 353 24.8 58.6 15.3 0.1 1.2 100.0 587 Fourth 10.2 76.4 9.6 0.4 3.4 100.0 384 17.0 61.4 20.5 0.5 0.6 100.0 599 Highest 7.9 75.9 9.4 0.0 6.8 100.0 336 14.8 62.1 21.4 0.2 1.5 100.0 583 Total 12.1 74.4 9.6 0.1 3.8 100.0 1,765 19.8 60.7 18.1 0.2 1.2 100.0 2,888 Note: Currently married includes respondents in consensual union (living together). An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 256 | Women’s Empowerment and Demographic and Health Outcomes Table 14.3 shows, for currently married women who earned cash in the past 12 months, the person who decides how their cash earnings are used; and for currently married women whose husbands earn cash, the person who decides how their husband’s cash earnings are used, according to the relative magnitude of the earnings of women and their husband. In particular, it shows whether the person who decides how women’s own earnings are used and the person who decides how her husband’s earnings are used are each affected and vary by whether the woman works and by the magnitude of women’s earnings relative to those of her husband. • Women who earn more than their husband or less than their husband (59 and 63 percent, respectively) are more likely to decide how their cash earnings are used than women whose cash earnings are the same as their husband’s (30 percent). • On the other hand, women who say they earn about the same amount as their husband are more likely to make joint decisions with their husband about how their cash earnings and those of their husband are used (68 and 69 percent, respectively) than women who make more than their husband (40 and 58 percent, respectively) and those who make less than their husband (35 and 59 percent, respectively). Table 14.3 Women's control over her own earnings and over those of her husband Percent distributions of currently married women age 15-49 with cash earnings in the past 12 months by person who decides how the wife's cash earnings are used and of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband's cash earnings are used, according to the relation between woman's and husband's cash earnings, Guyana 2009 Person who decides how wife's cash earnings are used: Person who decides how husband's cash earnings are used: Women's earnings relative to husband's earnings Mainly wife Wife and husband jointly Mainly husband Other Missing Total Number of women with cash earnings Mainly wife Wife and husband jointly Mainly husband Other Missing Total Number of women whose husbands have cash earnings More than husband/ partner 58.9 40.2 0.8 0.0 0.0 100.0 127 19.8 57.8 20.8 1.6 0.0 100.0 124 Less than husband/ partner 62.9 35.0 2.0 0.1 0.0 100.0 605 16.7 59.3 24.0 0.0 0.1 100.0 605 Same as husband/ partner 29.6 67.7 2.6 0.0 0.0 100.0 196 15.2 69.0 15.1 0.0 0.7 100.0 196 Husband/partner has no cash earnings or did not work * * * * * * 13 na na na na na na na Woman worked but has no cash earnings na na na na na na na 11.2 71.8 13.1 0.0 4.0 100.0 68 Woman did not work na na na na na na na 21.9 60.4 16.3 0.2 1.2 100.0 1,866 Don't know/missing (58.9) (14.8) (6.7) (0.0) (19.6) (100.0) 29 (5.2) (37.6) (35.0) (0.0) (22.2) (100.0) 29 Total1 55.8 41.4 2.1 0.1 0.6 100.0 970 19.8 60.7 18.1 0.2 1.2 100.0 2,888 Note: Currently married includes respondents in consensual union (living together). An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25 to 49 unweighted cases. na = Not applicable 1 Excludes cases where a woman or her husband/partner has no earnings and includes cases where a woman does not