Indonesia - Demographic and Health Survey - 2003

Publication date: 2003

Demographic and Health Survey Indonesia I n d o n e s i a 2 0 0 3 D e m o g r a p h i c a n d H e a l t h S u r v e y 2002-2003 World summit for children indicators, Indonesia 2002-2003 Under-five mortality rate 46 per 1,000 Infant mortality rate 35 per 1,000 Maternal mortality rate 0.24 Use of improved drinking water sources1 61.1 Use of improved sanitary means of excreta disposal 51.6 Contraceptive prevalence – currently married women 60.3 Contraceptive prevalence – ever-married women 57.3 Antenatal care2 91.5 Childbirth care 66.2 Low birth weight3 7.6 Children receiving vitamin A supplements 75.1 Mothers receiving vitamin A supplements 42.5 Night blindness in pregnant women 1.7 Exclusive breastfeeding 39.5 Continued breastfeeding at 12-15 months 82.7 Continue breastfeeding at 20-23 months 55.7 Timely complementary feeding 75.0 Tuberculosis immunization coverage 82.5 DPT immunization coverage 58.3 Polio immunization coverage 65.6 Measles immunization coverage 71.6 Children protected against neonatal tetanus 50.7 Oral rehydration therapy (ORT) 48.4 Home management of diarrhea 26.2 Treatment of ARI 61.3 Birth registration 55.1 Children's living arrangements 4.5 Orphans in households 3.2 Treatment of illness 55.8 Malaria treatment 0.7 Knowledge of preventing HIV/AIDS4 19.3 Knowledge of misconceptions of HIV/AIDS5 2.3 Knowledge of mother-to-child transmission of HIV 30.0 Women who know where to be tested for HIV 13.7 1Piped water or protected well water 2 For the last live birth in the five years preceding the survey 3For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 4Having sex with only one partner who has no other partners and using a condom every time they have sex 5They say that AIDS cannot be transmitted through mosquito bites and that a healthy-looking person can have the AIDS virus. Indonesia Demographic and Health Survey 2002-2003 Statistics Indonesia Jakarta, Indonesia National Family Planning Coordinating Board Jakarta, Indonesia Ministry of Health Jakarta, Indonesia ORC Macro Calverton, Maryland USA December 2003 This report summarizes the findings of the 2002-2003 Indonesia Demographic and Health Survey (IDHS) carried out by Badan Pusat Statistik-Statistics Indonesia (BPS). The IDHS is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The Government of Indonesia provided most of the survey costs through a loan from the World Bank. The United States Agency for International Development (USAID) provided funding for implementation of the survey in three newly established provinces and for technical assistance from ORC Macro. Additional information about the survey may be obtained from the Directorate for Population Statistics, BPS, Jalan Dr. Sutomo No. 6-8, Jakarta 10710, Indonesia (Telephone/fax 345-6285, email: kependudukan@ mailhost.bps.go.id), or the National Family Planning Coordinating Board, BKKBN, Jalan Permata 1, Halim Perdanakusumah, Jakarta 13650, Indonesia (Telephone/fax 800-8535), or the Institute for Research and Development, Ministry of Health, Jalan Percetakan Negara 29, Jakarta 10560, Indonesia (Telephone/fax 4287-1604). Additional information about the DHS program may be obtained by writing to: MEASURE DHS, ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone 301-572-0200; Fax 301- 572-0999; email: reports@orcmacro.com). Recommended citation: Badan Pusat Statistik-Statistics Indonesia (BPS) and ORC Macro. 2003. Indonesia Demographic and Health Survey 2002-2003. Calverton, Maryland, USA: BPS and ORC Macro. CONTENTS TABLES AND FIGURES . vii PREFACES. xvii SUMMARY OF FINDINGS . xxiii MAP OF INDONESIA .xxviii CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy.1 1.2 Population .2 1.3 Population and Family Planning Policies and Programs .3 1.4 Health Priorities and Programs .4 1.5 Objectives of the Survey .5 1.6 Organization of the Survey.5 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND HOUSING CHARACTERISTICS 2.1 Household Population by Age, Sex, and Residence.9 2.2 Household Composition .9 2.3 Children’s Living Arrangements and Parental Survival.11 2.4 Educational Level of Household Population .12 2.5 Housing Characteristics and Household Possessions.17 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3.1 Characteristics of Survey Respondents.21 3.2 Educational Attainment.22 3.3 Literacy.24 3.4 Exposure to Mass Media .25 3.5 Employment .27 3.6 Form of Women’s Earnings .31 3.7 Control Over Women’s Earnings and Women’s Contribution to Household Expenditures .33 3.8 Women’s Empowerment .35 Contents | iii 3.9 Life Style Measures .42 CHAPTER 4 FERTILITY 4.1 Current Fertility Levels and Trends .43 4.2 Children Ever Born and Children Surviving .47 4.3 Birth Intervals.48 4.4 Age at First Birth .49 4.5 Teenage Fertility .51 CHAPTER 5 KNOWLEDGE AND EVER USE OF FAMILY PLANNING 5.1 Knowledge of Family Planning Methods.53 5.2 Exposure to Family Planning Messages .56 5.4 Discussion of Family Planning with Husband.61 5.5 Attitudes of Couples Toward Family Planning.62 5.6 Knowledge of the Fertile Period .63 5.7 Ever Use of Contraception .64 CHAPTER 6 CURRENT USE OF FAMILY PLANNING 6.1 Current Use of Family Planning.67 6.2 Trends In Contraceptive Use.70 6.3 Quality of Use .73 6.4 Informed Choice.75 6.5 Problems with Current Method.77 6.6 Cost and Accessibility of Methods .78 6.7 Source of Methods.79 6.8 Timing of Sterilization .81 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Additional Children .83 7.2 Need for Family Planning Services .85 7.3 Ideal Family Size.87 7.4 Unplanned and Unwanted Fertility .89 iv | Contents 7.5 Fertility Preferences by Women’s Status .90 CHAPTER 8 NONUSE AND INTENTION TO USE FAMILY PLANNING 8.1 Discontinuation Rates .93 8.2 Reasons for Discontinuation of Contraceptive Use .94 8.3 Intention to Use Contraception in the Future .96 8.4 Reasons for Nonuse .97 8.5 Preferred Method .98 CHAPTER 9 OTHER PROXIMATE DETERMINANTS OF FERTILITY 9.1 Current Marital Status .99 9.2 Age at First Marriage . 100 9.3 Recent Sexual Activity. 102 9.4 Postpartum Amenorrhea, Abstinence, and Insusceptibility. 103 9.5 Termination of Exposure . 106 CHAPTER 10 INFANT AND CHILD MORTALITY 10.1 Assessment of Data Quality. 107 10.2 Levels and Trends in Infant and Child Mortality . 109 10.3 Mortality Differentials . 110 10.4 Demographic Characteristics. 112 10.5 Mortality by Women’s Status . 114 10.6 Perinatal Mortality . 115 10.7 High-risk Fertility Behavior . 116 CHAPTER 11 MATERNAL HEALTH 11.1 Antenatal Care. 119 11.2 Delivery. 125 11.3 Postnatal Care. 133 11.4 Maternal Health Care and Women’s Status. 134 11.5 Problems in Accessing Health Care . 135 11.6 Birth Registration . 137 Contents | v CHAPTER 12 IMMUNIZATION OF CHILDREN 12.1 Immunization Coverage. 141 12.2 Immunization by Background Characteristics . 142 12.3 Hepatitis B Immunization . 145 CHAPTER 13 CHILDHOOD DISEASES 13.1 Prevalence and Treatment of Acute Respiratory Infections and Fever . 147 13.2 Disposal of Children’s Stools . 149 13.3 Prevalence of Diarrhea . 150 13.4 Knowledge of Diarrhea Care. 150 13.5 Diarrhea Treatment . 151 13.6 Feeding Practices during Diarrhea. 154 13.7 Children’s Health Care and Women’s Status . 155 13.8 Hand-Washing Practices . 156 CHAPTER 14 INFANT FEEDING 14.1 Initial Breastfeeding . 159 14.2 Age Pattern of Breastfeeding . 161 14.3 Duration and Frequency of Breastfeeding . 163 14.4 Types of Complementary Foods. 165 14.5 Frequency of Foods Consumed by Children. 166 14.6 Micronutrient Intake Among Children. 167 14.7 Micronutrient Intake Among Mothers . 169 CHAPTER 15 KNOWLEDGE OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 15.1 Knowledge of AIDS. 171 15.2 Knowledge of Ways to Avoid Contracting HIV/AIDS . 174 15.3 Knowledge of Programmatically Important Ways to Avoid Contracting HIV/AIDS. 175 15.4 Knowledge of HIV/AIDS-related Issues . 177 15.5 Discussion of HIV/AIDS. 179 vi | Contents 15.6 Social aspects of HIV/AIDS. 181 15.7 Knowledge of Symptoms of Sexually Transmitted Infections (STIs). 182 15.8 Knowledge of a Source for Male Condoms. 184 CHAPTER 16 ADULT AND MATERNAL MORTALITY 16.1 Data . 187 16.2 Direct Estimates of Adult Mortality . 188 16.3 Estimates of Maternal Mortality . 189 16.4 Trends in Maternal Mortality . 190 CHAPTER 17 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 17.1 Advice or Care during Antenatal, Delivery, and Postnatal Periods . 191 17.2 Knowledge about Children’s Immunization. 192 17.3 Contact with Health Care Providers . 193 17.4 Preparation for Delivery. 194 REFERENCES . 197 APPENDIX A PROVINCIAL TABLES. 199 APPENDIX B SAMPLE DESIGN B.1 Introduction. 267 B.2 Sample Design and Implementation. 267 B.3 Pretest . 274 B.4 Training . 274 B.5 Fieldwork. 274 B.6 Data Processing . 274 APPENDIX C ESTIMATES OF SAMPLING ERRORS . 275 APPENDIX D DATA QUALITY TABLES. 309 APPENDIX E SURVEY STAFF. 315 APPENDIX F QUESTIONNAIRES . 319 Contents | vii viii | Contents TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators.3 Table 1.2 Results of the household and individual interviews.7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS 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.12 Table 2.4 Educational attainment of household population .13 Table 2.5.1 School attendance ratios: primary school .15 Table 2.5.2 School attendance ratios: secondary school .16 Table 2.6 Household characteristics .18 Table 2.7 Household durable goods .19 Figure 2.1 Population Pyramid of Indonesia .10 Figure 2.2 Housing Characteristics by Residence .19 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS Table 3.1 Distribution of respondents by background charactristics .22 Table 3.2 Educational attainment by background characteristics .23 Table 3.3 Literacy.24 Table 3.4 Exposure to mass media.26 Table 3.5.1 Employment status: women.28 Table 3.5.2 Employment status: men.29 Table 3.6.1 Occupation: women.30 Table 3.6.2 Occupation: men .31 Table 3.7 Employment characteristics .32 Tables and Figures | vii Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures.34 Table 3.9 Women’s control over earnings.35 Table 3.10 Women’s participation in decisionmaking.36 Table 3.11 Women's participation in decisionmaking .37 Table 3.12 Women's attitude toward wife beating .39 Table 3.13 Women’s attitude toward refusing sex with husband.41 Table 3.14 Use of smoking tobacco.42 Figure 3.1 Employment Status of Women Age 15-49.28 Figure 3.2 Type of Earnings of Employed Women Age 15-49 .32 Figure 3.3 Number of Decisions in Which Women Participate in the Final Say.38 CHAPTER 4 FERTILITY Table 4.1 Current fertility .44 Table 4.2 Fertility by background characteristics .45 Table 4.3 Trends in age-specific fertility rates.47 Table 4.4 Children ever born and living.48 Table 4.5 Birth intervals.49 Table 4.6 Age at first birth .50 Table 4.7 Median age at first birth .51 Table 4.8 Teenage pregnancy and motherhood.52 Figure 4.1 Total Fertility Rate of Southeast Asian Countries .44 Figure 4.2 Total Fertility Rate by Province.46 Figure 4.3 Trends in the Total Fertility Rate, 1991-2003 .46 CHAPTER 5 KNOWLEDGE AND EVER USE OF FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .53 Table 5.2 Knowledge of contraceptive methods by background characteristics .55 Table 5.3 Exposure to family planning messages .57 viii | Tables and Figures Table 5.4 Exposure to family planning messages through personal contact.59 Table 5.5 Contact of nonusers with family planning providers .60 Table 5.6 Discussion of family planning between husband and wife .61 Table 5.7 Attitudes toward family planning.62 Table 5.8 Knowledge of fertile period.63 Table 5.9 Ever use of contraception.64 Table 5.10 Number of children at first use of contraception .65 Figure 5.1 Percentage of Currently Married Women Who Know Specific Modern Contraceptive Methods, Indonesia 1991 and 2003.54 CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table 6.1 Current use of contraception .67 Table 6.2 Current use of contraception by background characteristics .68 Table 6.3 Trends in use of specific contraceptive methods: Indonesia 1991-2003 .70 Table 6.4 Trends in contraceptive use by province in Java 1991-2002-2003.71 Table 6.5 Current use of contraception by women’s status .73 Table 6.6 Pill use compliance .74 Table 6.7 Use of injectables.75 Table 6.8 Informed choice .76 Table 6.9 Problems with curent method of contraception.77 Table 6.10 Payment for contraceptive method and services.78 Table 6.11 Mean cost of contraceptive method and services .79 Table 6.12 Source of contraception.80 Table 6.13 Timing of sterilization.82 Figure 6.1 Percentage of Currently Married Women Age 15-49 Who Are Using a Contraceptive Method .69 Figure 6.2 Percentage of Currently Married Men Age 15-54 Who Are Using a Contraceptive Method .70 Figure 6.3 Percentage of Currently Married Women Age 15-49 Using Specific Contraceptive Methods, Indonesia 1997-2003 .71 Tables and Figures | ix Figure 6.4 Percentage of Currently Married Women Age 15-49 Using a Contraceptive Method by Province in Java, 1994-2003 .72 Figure 6.5 Distribution of Current Users of Modern Contraceptive Methods by Source of Supply, Indonesia 1997-2003 .81 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences .84 Table 7.2 Desire to limit childbearing .85 Table 7.3 Need for family planning .86 Table 7.4 Ideal number of children .88 Table 7.5 Mean ideal number of children by background characteristics .88 Table 7.6 Fertility planning status.89 Table 7.7 Wanted fertility rates.90 Table 7.8 Ideal number of children and unmet need by women’s status.91 Figure 7.1 Fertility Preferences of Currently Married Women Age 15-49 .84 CHAPTER 8 NONUSE AND INTENTION TO USE FAMILY PLANNING Table 8.1 First-year contraceptive discontinuation rates .93 Table 8.2 Reasons for discontinuation of contraceptive methods .95 Table 8.3 Future use of contraception .96 Table 8.4 Reason for not intending to use contraception .97 Table 8.5 Preferred method .98 Figure 8.1 Reasons for Discontinuation of Contraceptive Methods.95 CHAPTER 9 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 9.1 Current marital status . 100 Table 9.2 Age at first marriage . 100 Table 9.3 Median age at first marriage. 101 Table 9.4 Recent sexual activity. 103 Table 9.5 Postpartum amenorrhea, abstinence, and insusceptibility. 104 x | Tables and Figures Table 9.6 Median duration of postpartum insusceptibility by background characteristics . 105 Table 9.7 Menopause. 106 Figure 9.1 Median Age at First Marriage by Province in Java 1994, 1997, and 2002- 2003. 102 Figure 9.2 Percentage of Births in the Past Three Years for Which the Mother is Amenorrheic or Abstaining. 105 CHAPTER 10 INFANT AND CHILD MORTALITY Table 10.1 Early childhood mortality rates . 109 Table 10.2 Early childhood mortality rates by socioeconomic characteristics. 111 Table 10.3 Trends in infant mortality by province. 112 Table 10.4 Early childhood mortality rates by demographic characteristics. 113 Table 10.5 Early childhood mortality rates by women's status . 115 Table 10.6 Perinatal mortality. 116 Table 10.7 High-risk fertility behavior . 117 Figure 10.1 Reporting of Age at Death in Months . 108 Figure 10.2 Infant Mortality Rates, Selected Sources, Indonesia, 1971-2002. 110 CHAPTER 11 MATERNAL HEALTH Table 11.1 Antenatal care. 120 Table 11.2 Number of antenatal care visits and timing of first visit . 121 Table 11.3 Components of antenatal care . 123 Table 11.4 Tetanus toxoid injections . 124 Table 11.5 Complications during pregnancy. 125 Table 11.6 Place of delivery . 126 Table 11.7 Assistance during delivery: most qualified person. 128 Table 11.8 Assistance during delivery: least qualified person . 129 Table 11.9 Delivery characteristics . 130 Table 11.10 Preparation for delivery. 131 Tables and Figures | xi Table 11.11 Complications during delivery. 133 Table 11.12 Postnatal care by background characteristics . 134 Table 11.13 Maternal health care and women's status . 135 Table 11.14 Problems in accessing health care . 136 Table 11.15 Birth registration . 137 Table 11.16 Reason for not registering births . 138 Figure 11.1 Number of Antenatal Care Visits and Number of Months Pregnant at Time of First ANC Visit. 122 Figure 11.2 Place of Delivery and Least Qualified Delivery Assistant . 127 Figure 11.3 Discussion on Preparation for Delivery. 132 CHAPTER 12 IMMUNIZATION OF CHILDREN Table 12.1 Vaccinations by background characteristics . 143 Table 12.2 Hepatitis B vaccination coverage. 144 Figure 12.1 Percentage of Children Age 12-23 Months Vaccinated by 12 Months of Age (Based on Information from Health Cards and Mother’s Reports) . 142 Figure 12.2 Children Age 12-23 Months Who Are Fully Immunized (Based on Information from Health Cards and Mother’s Reports) . 145 CHAPTER 13 CHILDHOOD DISEASES Table 13.1 Prevalence and treatment of acute respiratory infections (ARI) and/or fever. 148 Table 13.2 Drugs taken for fever . 148 Table 13.3 Disposal of children’s stools . 149 Table 13.4 Prevalence of diarrhea . 150 Table 13.5 Knowledge of ORS packets . 151 Table 13.6 Diarrhea treatment . 152 Table 13.7 Feeding practices during diarrhea . 154 Table 13.8 Children’s health care by women’s status . 155 Table 13.9 Hand-washing practices . 157 xii | Tables and Figures Figure 13.1 Knowledge and Use of ORS Packets among Mothers Who Gave Birth in the Past Five Years, by Level of Education . 153 Figure 13.2 Trends in Knowledge and Use of ORS Packets for Treatment of Diarrhea by Mothers who Gave Birth in the Past Five Years . 153 Figure 13.3 Trends in Feeding Practices among Children Under Five with Diarrhea. 155 CHAPTER 14 INFANT FEEDING Table 14.1 Initial breastfeeding. 160 Table 14.2 Breastfeeding status by child’s age. 162 Table 14.3 Median duration of breastfeeding . 164 Table 14.4 Foods consumed by children in the day or night preceding the interview. 166 Table 14.4 Foods consumed by children in the day or night preceding the interview. 162 Table 14.5 Frequency of foods consumed by children in the day or night preceding the interview. 167 Table 14.6 Micronutrient intake among children . 168 Table 14.7 Micronutrient intake among mothers . 170 Figure 14.1 Distribution of Children by Breastfeeding (BF) Status, According to Age . 163 Figure 14.2 Median Duration of Any Breastfeeding (months) . 165 CHAPTER 15 KNOWLEDGE OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Table 15.1 Knowledge of HIV/AIDS. 172 Table 15.2 Knowledge of ways to avoid HIV/AIDS. 175 Table 15.3.1 Knowledge of programmatically important ways to avoid HIV/AIDS: women . 176 Table 15.3.2 Knowledge of programmatically important ways to avoid HIV/AIDS: men. 177 Table 15.4.1 Knowledge of HIV/AIDS-related issues: women . 178 Table 15.4.2 Knowledge of HIV/AIDS-related issues: men. 179 Table 15.5.1 Discussion of HIV/AIDS with husband. 180 Table 15.5.2 Discussion of HIV/AIDS with wife . 180 Table 15.6 Social aspects of HIV/AIDS. 182 Table 15.7.1 Knowledge of symptoms of STIs: women . 183 Tables and Figures | xiii Table 15.7.2 Knowledge of symptoms of STIs: men. 184 Table 15.8 Knowledge of source of male condoms and access to condoms . 185 Figure 15.1 Percentage of Ever-Married Women Who Have Heard of AIDS and Believe There is a Way to Avoid ADIS, Indonesia 1994-2003 . 172 Figure 15.2 Percentage of Ever-Married Women Who Have Heard of AIDS and Believe There is a Way to Avoid AIDS, By Education . 173 Figure 15.3 Percentage of Currently Married Men Who Have Heard of AIDS and Believe There is a Way to Avoid AIDS, By Education . 174 Figure 15.4 Percentage of Currently Married Women and Currently Married Men Who Discussed AIDS Prevention with Their Spouse, by Education . 181 Figure 15.5 Percentage of Ever-Married Women and Currently Married Men Who Do Not Know the Symptoms of STIs, by Level of Education . 183 CHAPTER 16 ADULT AND MATERNAL MORTALITY Table 16.1 Data on siblings . 188 Table 16.2 Adult mortality rates. 189 Table 16.3 Maternal mortality rates . 189 CHAPTER 17 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Table 17.1 Advice or care received by mother during pregnancy and delivery and after delivery. 191 Table 17.2 Specific vaccines received by children under five. 192 Table 17.3 Father’s contact with a health care provider about wife’s health and pregnancy. 194 Table 17.4 Preparation for delivery. 195 APPENDIX A PROVINCIAL TABLES Table A.3.1 Distribution of respondents by province. 199 Table A.3.2.1 Educational attainment by province: ever-married women . 200 Table A.3.2.2 Educational attainment by province: currently married men . 201 Table A.3.3.1 Literacy by province: women. 202 Table A.3.3.2 Literacy by province: men . 203 Table A.3.4.1 Exposure to mass media by province: women. 204 xiv | Tables and Figures Table A.3.4.2 Exposure to mass media by province: men . 205 Table A.3.5.1 Employment status by province: women. 206 Table A.3.5.2 Employment status by province: men. 207 Table A.3.6 Decision on use of earnings and contribution of earnings to household expenditures by province. 208 Table A.3.7 Women's participation in decisionmaking by province . 209 Table A.3.8 Women's attitude toward wife beating by province . 210 Table A.3.9 Women’s attitude toward refusing sex with husband by province. 211 Table A.4.1 Fertility by province . 212 Table A.4.2 Birth intervals by province. 213 Table A.4.3 Median age at first birth by province . 214 Table A.4.4 Teenage pregnancy and motherhood by province. 215 Table A.5.1 Knowledge of contraceptive methods by province . 216 Table A.5.2 Exposure to family planning messages by province . 217 Table A.5.3 Exposure to family planning messages through personal contact by province . 218 Table A.5.4 Contact of nonusers with family planning providers by province . 219 Table A.5.5 Discussion of family planning between husband and wife by province . 220 Table A.6.1 Current use of contraception by province . 221 Table A.6.2 Pill use compliance by province. 222 Table A.6.3 Informed choice by province . 223 Table A.6.4 Payment for contraceptive method and services by province . 224 Table A.7.1 Desire to limit childbearing by province. 225 Table A.7.2 Need for family planning by province . 226 Table A.7.3 Mean ideal number of children by province. 227 Table A.7.4 Wanted fertility rates by province . 228 Tables and Figures | xv Table A.9.1 Current marital status by province. 229 Table A.9.2 Median age at first marriage by province. 230 Table A.9.3 Recent sexual activity by province. 231 Table A.9.4 Median duration of postpartum insusceptibility by province. 232 Table A.10.1 Early childhood mortality rates by province. 233 Table A.11.1 Antenatal care by province . 234 Table A.11.2 Components of antenatal care by province . 235 Table A.11.3 Tetanus toxoid injections by province . 236 Table A.11.4 Place of delivery by province . 237 Table A.11.5 Assistance during delivery by province . 238 Table A.11.6 Delivery characteristics by province . 239 Table A.11.7 Preparation for delivery by province . 240 Table A.11.8 Postnatal care by province . 241 Table A.11.9 Problems in accessing health care by province . 242 Table A.11.10 Birth registration by province . 243 Table A.11.11 Reason for not registering births by province . 244 Table A.12.1 Vaccinations by province . 245 Table A.12.2 Hepatitis B vaccinations by province. 246 Table A.13.1 Prevalence and treatment of acute respiratory infections (ARI) and/or fever by province. 247 Table A.13.2 Disposal of children’s stools by province . 248 Table A.13.3 Prevalence of diarrhea by province . 249 Table A.13.4 Knowledge of ORS packets by province . 250 Table A.14.1 Initial breastfeeding by province. 251 xvi | Tables and Figures Table A.14.2 Median duration and frequency of breastfeeding by province . 252 Table A.14.3 Micronutrient intake among children by province . 253 Table A.14.4 Micronutrient intake among mothers by province . 254 Table A.15.1 Knowledge of HIV/AIDS by province . 255 Table A.15.2 Knowledge of programmatically important ways to avoid HIV/AIDS by province . 256 Table A.15.3 Knowledge of HIV/AIDS-related issues by province . 257 Table A.15.4 Discussion of HIV/AIDS with husband by province. 258 Table A.15.5 Social aspects of HIV/AIDS by province. 259 Table A.15.6 Knowledge of symptoms of STIs by province: women . 260 Table A.15.7 Knowledge of symptoms of STIs by province: men. 261 Table A.15.8 Knowledge of source of male condoms and access to condoms by province . 262 Table A.17.1 Advice or care on antenatal care, delivery, and postnatal care by province . 263 Table A.17.2 Specific vaccines received by children under five by province. 264 Table A.17.3 Father’s contact with a health care provider about wife’s health and pregnancy by province. 265 Table A.17.4 Preparation for delivery by province . 266 APPENDIX B SAMPLE DESIGN Table B.1 Allocation of census blocks by province . 268 Table B.2.1 Sample implementation: results of the household interview: women . 270 Table B.2.2 Sample implementation: results of the household interview: women . 271 Table B.3.1 Sample implementation: results of the household interview: men. 272 Table B.3.2 Sample implementation: results of the household interview: men. 273 APPENDIX C ESTIMATES OF SAMPLING ERRORS Table C.1 List of selected variables for sampling errors, Indonesia 2002-2003. 278 Table C.2 Sampling errors: National sample, Indonesia 2002-2003 . 279 Table C.3 Sampling errors: Urban sample, Indonesia 2002-2003. 280 Tables and Figures | xvii Table C.4 Sampling errors: Rural sample, Indonesia 2002-2003. 281 Table C.5 Sampling errors: North Sumatera sample, Indonesia 2002-2003 . 282 Table C.6 Sampling errors: West Sumatera sample, Indonesia 2002-2003 . 283 Table C.7 Sampling errors: Riau sample, Indonesia 2002-2003. 284 Table C.8 Sampling errors: Jambi sample, Indonesia 2002-2003. 285 Table C.9 Sampling errors: South Sumatera sample, Indonesia 2002-2003 . 286 Table C.10 Sampling errors: Bengkulu sample, Indonesia 2002-2003 . 287 Table C.11 Sampling errors: Lampung sample, Indonesia 2002-2003 . 288 Table C.12 Sampling errors: Bangka Belitung sample, Indonesia 2002-2003. 289 Table C.13 Sampling errors: DKI Jakarta sample, Indonesia 2002-2003 . 290 Table C.14 Sampling errors: West Java sample, Indonesia 2002-2003. 291 Table C.15 Sampling errors: Central Java sample, Indonesia 2002-2003 . 292 Table C.16 Sampling errors: DI Yogyakarta sample, Indonesia 2002-2003 . 293 Table C.17 Sampling errors: East Java sample, Indonesia 2002-2003 . 294 Table C.18 Sampling errors: Banten sample, Indonesia 2002-2003. 295 Table C.19 Sampling errors: Bali sample, Indonesia 2002-2003. 296 Table C.20 Sampling errors: West Nusa Tanggara sample, Indonesia 2002-2003 . 297 Table C.21 Sampling errors: East Nusa Tenggara sample, Indonesia 2002-2003. 298 Table C.22 Sampling errors: West Kalimantan sample, Indonesia 2002-2003 . 299 Table C.23 Sampling errors: Central Kalimantan sample, Indonesia 2002-2003 . 300 Table C.24 Sampling errors: South Kalimantan sample, Indonesia 2002-2003 . 301 Table C.25 Sampling errors: East Kalimantan sample, Indonesia 2002-2003 . 302 Table C.26 Sampling errors: North Sulawesi sample, Indonesia 2002-2003 . 303 Table C.27 Sampling errors: Central Sulawesi sample, Indonesia 2002-2003 . 304 Table C.28 Sampling errors: South Sulawesi sample, Indonesia 2002-2003 . 305 Table C.29 Sampling errors: Southeast Sulawesi sample, Indonesia 2002-2003. 306 Table C.30 Sampling errors: Gorontalo sample, Indonesia 2002-2003 . 307 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . 309 xviii | Tables and Figures Table D.2.1 Age distribution of eligible and interviewed women . 310 Table D.2.2 Age distribution of eligible and interviewed men. 311 Table D.3 Completeness of reporting . 311 Table D.4 Births by calendar years . 312 Table D.5 Reporting of age at death in days . 313 Table D.6 Reporting of age at death in months. 314 Tables and Figures | xix PREFACE The 2002-2003 Indonesia Demographic and Health Survey (IDHS) is the fifth survey on demography and health in Indonesia and was conducted as part of the worldwide Demographic and Health Surveys (DHS) project. The first survey was the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS), the second, third, and the fourth surveys were the 1991 IDHS, 1994 IDHS, and 1997 IDHS. The 2002-2003 IDHS was designed as a collaborative effort of four institutions, i.e., BPS-Statistics Indonesia (BPS), National Family Planning Coordinating Board (NFPCB), the Ministry of Health (MOH), and ORC Macro. The Government of Indonesia provided most of the survey costs through a loan from the World Bank. The U.S. Agency for International Development (USAID) provided funding for implementation of the survey in three newly established provinces and for technical assistance from ORC Macro. The BPS was responsible for conducting the survey, including survey design, fieldwork, and data processing. The 2002-2003 IDHS fieldwork was carried out from October 2002 to April 2003 in selected enumeration areas of the 26 provinces in Indonesia. Due to security reasons, four provinces were excluded: Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua. The sampling frame for this survey is the list of census blocks (CBs) developed for the 2002 National Socioeconomic Household Surveys (Susenas). The 2002-2003 IDHS sample is aimed at providing reliable estimates of key characteristics of ever-married women 15-49 and married men 15-54 in Indonesia as a whole, in urban and rural areas, and in each of the 26 provinces. The main objective of the 2002-2003 IDHS is to provide policymakers and program managers in population and health with detailed information on population, family planning, and health. In particular, the 2002-2003 IDHS collected information on the female respondents’ socioeconomic background, fertility levels, marriage and sexual activity, fertility preferences, knowledge and use of family planning methods, breastfeeding practices, childhood and adult mortality including maternal mortality, maternal and child health, and awareness and behavior regarding AIDS and other sexually transmitted infections in Indonesia. This report supplements the preliminary report released earlier. The success of this very important undertaking would not have been realized without the relentless effort and dedication of all parties concerned. To those who actively contributed to this project, I would like to extend my gratitude and appreciation, especially to World Bank, USAID and MEASURE DHS+ ORC Macro. Dr. Soedarti Surbakti Director General BPS-Statistics Indonesia Preface | xvii PREFACE Until 1997, the Indonesia Demographic and Health Surveys (IDHS) had been conducted every three years. The current survey is conducted more than five years after the last one. In the course of the global rapid development progress, there have been tremendous changes in the country’s political and socioeconomic situation, which have led to changes in the strategic environment of the Indonesian Family Planning Program. BKKBN has adopted a new Family Planning Movement (FPM) paradigm, which has moved from concentrating on demographic objectives to a people- and family-centered approach. This approach emphasizes the importance of human and family development, and strives to change reproductive health and family planning attitudes. The new paradigm also strives to provide high quality information and services, and to improve family welfare and prosperity. The new paradigm is presented in the new vision ”The Quality Family by 2015”. Under this new vision, due to continued fertility decline and widely accepted norm of a small family, the program’s future activities will be focused on the enhancing the quality of services on contraceptive methods and information, education and communication, as well as welfare programs. In addition, we have taken a stock of new knowledge and integrated this into our strategic plan on the provision of services. This is particularly true of recent landmark studies on male participation in family planning. These studies have shed light on these elusive issues and have enabled us to address them strategically. The 2002-2003 IDHS includes new features, in which use of contraception by married men and participation of women in household decision-making are also examined. I consider this report monumental not only because of the breadth of its coverage, but more importantly because it provides us with greater chances for in-depth analysis that goes into formulating it. I therefore congratulate the 2002-2003 IDHS Steering and Technical Committees for spearheading the effort to prepare this report. I would like to express my deepest gratitude to BPS- Statistics Indonesia, the Ministry of Health, and ORC Macro. Our appreciation goes to the World Bank for the funding support, without which this survey could not have been completed. Our appreciation also goes to USAID for the funding support necessary to cover the new three provinces and the technical assistance rendered through ORC Macro in collaboration with BKKBN, BPS, and the Ministry of Health. Dr. Sumarjati Arjoso, SKM Chairperson, National Family Planning Coordinating Board Preface | xix PREFACE The goal of health development is to increase the awareness, willingness, and ability of everyone to live a healthy life. To meet this goal the government of Indonesia, entering the third millennium, has reformed its health policies by the adoption of the new vision of Healthy Indonesia 2010, which provides the basis for determining the goals and strategies for health development. This health development reform will be implemented through evidence-based programming, which requires the availability of reliable health information. Surveys are one of many methods used to generate needed health information. Many health-related surveys have been and are being conducted in Indonesia to provide the health data needed by the Ministry of Health and other sectors. An attempt to integrate national surveys that collect health data to support the need for optimal health information should be carried out. The 2002-2003 Indonesia Demographic and Health Survey (IDHS), which was implemented through collaboration and partnership among many parties including the National Family Planning Coordinating Board, BPS Statistics, and the Ministry of Health, is an example of the efficient provision of survey-based data to many parties. The Ministry of Health has indeed benefited from the IDHS data. The result of the 2002-2003 IDHS together with data from various other sources will be used effectively to support evidence-based programming. I also recommend that the results of the 2002-2003 IDHS should be disseminated to decisionmakers at different administrative levels and to the community at large. Finally, I would like to extend my gratitude and appreciation to BPS Statistics, the National Family Planning Coordinating Board, the World Bank, USAID, ORC Macro in Calverton, Maryland (USA), and all other parties who have contributed to the success of the 2002-2003 IDHS. Special appreciation goes to the Steering Committee and the Technical and Survey Field Teams, without whose relentless effort and dedication the survey could not have been realized. Dr. Achmad Sujudi Minister of Health Republic of Indonesia Preface | xxi SUMMARY OF FINDINGS The 2002-2003 Indonesia Demographic and Health Survey (IDHS) is a nationally representa- tive survey of 29,483 ever-married women age 15-49 and 8,310 currently married men age 15- 54. The main purpose of the 2002-2003 IDHS is to provide policymakers and program managers with detailed information on fertility, family planning, childhood and adult mortality, mater- nal and child health, and knowledge of and atti- tudes related to HIV/AIDS and other sexually transmitted diseases. The 2002-2003 IDHS is the fifth national sample survey of its kind to be un- dertaken in Indonesia. Caution needs to be exer- cised when analyzing trends using the IDHS data sets because of differences in geographic coverage. The current survey excludes Nanggroe Aceh Darussalom, Maluku, North Malaku, and Papua provinces. Past IDHS surveys included East Timor. CURRENT STATUS AND PROGRESS FERTILITY The 2002-2003 IDHS indicates that there has been a steady decline in fertility in Indonesia from 3.0 children per woman in 1988-1991 to 2.6 children per woman in 2000-2002. The de- cline took place in most provinces. Compared with selected southeast Asian countries such as Cambodia, the Philippines, Malaysia, and Myan- mar, the TFR in Indonesia is low, although not as low as that in Singapore and Thailand. Fertility varies enormously across subgroups of women. Urban women have, on average, 0.3 children fewer than rural women (2.4 compared with 2.7, respectively). The relationship between education and fertility takes the form of an in- verted U-shape curve. Women with some pri- mary and completed primary education have the highest TFRs. There are sharp variations in TFRs by level of wealth. Women in the poorest households have significantly higher fertility than those in the richest households (4.4 births and 3.4 births, respectively). Variations across province are notable; Central Java, DI Yogyakarta, East Java, and Bali have reached or surpassed replacement level (2.1 children per woman), while East Nusa Tenggara and South Sulawesi, have the highest TFRs (4.1 and 3.6 chil- dren per woman, respectively). WHY DID FERTILITY DECLINE? The decline in fertility is brought about by, among other things, increased education among women (which delays marriage), increased age at first birth, desire for fewer children, and greater use of contraceptive methods. Better education. Women of reproductive age are increasingly better educated. In 1997, 13 percent of women age 15-49 had no education. In 2002- 2003, this figure had declined to 8 percent. Further- more, the percentage of women who have had some secondary education increased from 28 percent in 1997 to 38 percent in 2002-2003. Later marriage. The 2002-2003 IDHS shows that more Indonesian women remain single. Women who marry, do so at a later age. In 1997 half of women age 25-49 were married by age 18.6 years; in 2002-2003 the median age at marriage was 19.2 years. Later childbearing. Women are also delaying their first births. The median age at first birth for women 25-49 has increased from 20.8 years in 1997 to 21.0 years in 2002-2003. Furthermore, teenage childbearing has declined from 12 percent in the 1997 IDHS to 10 percent in the 2002-2003 IDHS. Longer birth intervals. Fertility decline can also be attributed to longer birth intervals, implying a delay in the second birth. Results of the 2002-2003 IDHS indicate that half of births occur 54 months after the previous birth, which is a much longer in- terval than that reported in the 1997 IDHS and 1994 IDHS (45 months and 42 months, respectively). Summary of Findings | xxiii Increased desire for smaller families. The IDHS data indicate that the desire to limit child- bearing continues to increase. The percentage of married women who say that they want no more children or have been sterilized increased from 50 percent in 1997 to 54 percent in 2002-2003. Gap between wanted fertility and actual fertility. Despite an increasing use of contracep- tion, the survey data show that one in ten preg- nancies were mistimed and one in fourteen were not wanted at all. If unwanted births could be prevented, the total fertility rate in Indonesia would be 2.2 births per woman instead of the actual level of 2.6. This gap remains the same as that recorded in 1997, but the fertility levels in 2002-2003 are lower than in 1997 (2.4 and 2.8 births per woman, respectively). USE OF CONTRACEPTION Contraceptive use among currently married women in Indonesia has increased from 57 per- cent in 1997 to 60 percent in 2002-2003. Most of the increase is due to an increase in the use of injectables from 21 percent to 28 percent (ac- counting for 47 percent of family planning users). Method mix. Other than injectables, popu- lar family planning methods in 2002-2003 in- clude the pill (13 percent), IUD (6 percent), and implants and female sterilization (4 percent each). The gain in the use of injectables is ac- companied by a decrease in the use of the IUD and implants of 2 percentage points each. There has been a shift in the use of specific modern family planning methods. While in 1991, 30 percent of contraceptive users used the pill, in 2002-2003 the proportion had declined to 22 percent. Use of the IUD declined from 27 percent in 1991 to 10 percent in 2002-2003. Male sterilization and condoms continue to have limited numbers of users. Large differentials in use of contracep- tion. There are large differences in the use of modern contraceptive methods across subgroups of married women. Use of modern family plan- ning methods is much higher in urban areas than in rural areas (42 and 15 percent, respectively), among women in the middle of their reproductive years (20-34), better-educated women, and women with a larger number of children. Contraceptive prevalence varies across prov- inces. It is 65 percent or higher in DI Yogyakarta, North Sulawesi, Bengkulu, East Java, Central Java, and Bangka Belitung. On the other hand, East Nusa Tenggara has the lowest level of contraceptive prevalence (35 percent). Source of supply. In Indonesia, contraceptive users are increasingly more likely to rely on private medical sources for their method. Use of govern- ment sources decreased from 43 percent in 1997 to 28 percent in 2002-2003, while use of private medi- cal sources increased from 42 percent to 63 percent, and use of other sources decreased from 15 percent to 8 percent. The substantial increase in use of pri- vate sources is mainly due to the increased use of private midwives (18 percentage points). Quality of use of contraception. In the 2002- 2003 IDHS, 90 percent of pills users were able to show a package to the interviewer and among these women, 83 percent had taken the pills in order. Among users of contraceptive injectables, only 2 to 5 percent may actually be at risk of pregnancy be- cause they did not have an injection in time Unmet need for family planning. Unmet need for family planning services is defined as the per- centage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2002-2003 IDHS data show that the total unmet need for family planning ser- vices in Indonesia is 9 percent, of which 5 percent is for limiting and 4 percent is for spacing. The level of unmet need has not changed since 1997. Overall, the total demand for family planning in Indonesia is 70 percent, of which 88 percent has been satisfied. If all of this need were satisfied, a contraceptive prevalence rate of about 68 percent could, theoretically, be expected. Comparison with the 1997 IDHS indicates that the percentage of de- mand satisfied has increased only slightly. Self-reliance in family planning. Overall, 89 percent of users pay for their contraceptives, while xxiv | Summary of Findings 11 percent receive the method and services free of charge. Injectables and pill users are most likely to pay for their contraceptive method (98 percent and 97 percent, respectively). Self- reliance is much lower for IUDs, with only 57 percent of users paying for their method. Users of contraception were more self-reliant in 2002- 2003 than in 1997. For example, the percentage of users who received family planning services from a government source free of charge has decreased from 11 percent in 1997 to 7 percent in 2002-2003. REPRODUCTIVE HEALTH Antenatal care. Nine in ten mothers re- ceived care from a medical professional during their pregnancy while 4 percent received no an- tenatal care. Coverage of K4—at least one visit in the first trimester, at least one visit in the sec- ond trimester, and at least two visits in the third trimester—is 64 percent. Mothers who live in urban areas more likely to receive antenatal care from a medical professional than those living in rural areas. Delivery care. Four in ten births in the five years preceding the survey were delivered in a health facility, 9 percent in a public facility (government hospital or health center) and 31 percent were delivered in a private health facil- ity. This is a significant change from 1997, when only two in ten births were delivered in a health facility. Medical staff (midwives and doctors) as- sisted 66 percent of births in the five years be- fore the survey while traditional birth attendant (TBA) assisted 32 percent of births. Again, this is a substantial increase from 1997, when 43 percent of deliveries were assisted by medical staff and 54 percent of births were assisted by TBAs. Postnatal care. In the 2002-2003 IDHS, women who had given birth outside a health fa- cility were asked if they had received postnatal care. Overall, eight in ten of these women re- ceived postnatal care; with 62 percent receiving postnatal care within 2 days of delivery, 13 per- cent 3-6 days after delivery, and 8 percent 7-41 days after delivery. CHILD HEALTH Childhood immunization. Information from health cards and mothers’ reports (combined) shows that 52 percent of children 12-23 months are fully immunized. This percentage is lower than the 55 percent reported in the 1997 IDHS, but higher than that reported in the 1994 and 1991 IDHS (50 percent and 48 percent, respectively). Childhood illnesses. Acute respiratory infec- tions (ARI), diarrhea and malaria are common causes of child death. In the two weeks before the survey, 8 percent of children were reported to have symptoms of ARI, of whom 60 percent were taken to a health facility. Eleven percent of children had diarrhea in the two weeks preceding the survey, 45 percent of whom were taken to a health provider. Sixty-one percent of children with diarrhea were given oral rehydration therapy, that is, oral rehydra- tion salts (ORS), a recommended homemade fluid, or increased fluids. Breastfeeding. Breastfeeding is universally practiced in Indonesia, with 98 percent of babies breastfed for at least some period of time. However, only 4 percent of babies are put to the breast within one hour of birth (as recommended), while 27 per- cent initiated breastfeeding in the first day of life. The overall median duration of any breastfeeding is 22.3 months, which is a month and a half less than in 1997 (23.9 months). Exclusive breastfeeding is not widely practiced in Indonesia. Despite the government’s recommen- dation that infants receive breast milk exclusively through the first six months of life, only 64 percent of infants under 2 months are exclusively breastfed. At age 4 to 5 months, only one in seven infants re- ceives breast milk without complementary feeding. Perceived problems in accessing health care. In the 2002-2003 IDHS, women were asked whether they have problems seeking medical advice or treatment for themselves. The main problem cited by women is economic in nature (24 percent). The next big problems are the distance to a health facility (12 Summary of Findings | xxv percent) and having to take transportation (12 percent). FATHER’S PARTICIPATION IN FAMILY HEALTH CARE In the survey, fathers were asked questions about their involvement in ensuring safe moth- erhood for the mother of their last-born child and their involvement in ensuring the health of their last-born child. The questions are in re- sponse to the newly established policies of the Indonesian government to involve men in the health care of their wives and children. The survey shows that for 87 percent of births in the five years preceding the survey the mothers are reported by their husbands to have received advice or care during pregnancy, 77 percent received care during delivery, and 71 percent received care in the six weeks after de- livery (postpartum period). Two in three fathers know their last child has been immunized. However, only four in ten fathers had any contact with a health care pro- vider during their wife’s pregnancy with that child. Most fathers discussed the preparations for their child’s delivery. The most frequently men- tioned topics of discussion were the place of de- livery and the delivery assistant (65 percent and 64 percent, respectively), followed by payment for the services (57 percent). A topic less fre- quently discussed by fathers is transportation to the place of delivery (33 percent), probably be- cause many deliveries take place at home. AWARENESS OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Knowledge of HIV/AIDS. While increas- ing, knowledge of HIV/AIDS in Indonesia is fairly low. The level of knowledge among women increased gradually from 38 percent in 1994 to 51 percent in 1997. In 2002-2003, 59 percent of ever-married women and 73 percent of married men reported having heard of HIV/ AIDS. Knowledge of the three principal ways to reduce HIV transmission—abstinence, use of condoms, and reducing the number of partners—is extremely lim- ited. One percent of women and one percent of men cited abstinence, 6 percent of women and 10 percent of men mentioned limiting the number of sexual partners, and 5 percent of women and 13 percent of men cited the use of condoms. The most common responses on ways to avoid getting AIDS were avoiding having sex with prostitutes (16 percent for women and 41 percent for men) and having sex with only one partner (14 percent for women and 18 per- cent for men). Knowledge of mother-to-child transmission. In the IDHS, respondents were asked if the virus that causes AIDS can be transmitted from a mother to a child. They were then asked if transmission occurs during pregnancy, delivery, or breastfeeding. One in three women said that HIV/AIDS can be transmitted from mother to child during all three. The corre- sponding figures for married men are 45 percent, 48 percent, and 46 percent, respectively. Knowledge of symptoms of sexually trans- mitted infections (STIs). STIs have been identified as co-factors in HIV/AIDS transmission. Knowledge of the symptoms of STIs among women in Indonesia is limited; 73 percent of ever-married women re- ported no knowledge of the symptoms associated with STIs in women and 13 percent have no knowl- edge of the symptoms of STIs in men. Knowledge of the symptoms of STIs among married men is lower than that among ever-married women. MORTALITY Childhood Mortality. The infant mortality rate in Indonesia has declined from 142 deaths per 1,000 live births in 1967 to 35 deaths in 2000. At current mortality levels, 46 of every 1,000 children born in Indonesia die before the fifth birthday. In general, there is a strong inverse relationship between wealth and mortality rates; children living in richer households have lower mortality rates than children in poorer households (17 compared with 61 deaths per 1,000 live births). Childhood mortality rates decline as the birth in- terval increases. For example, the infant mortality xxvi | Summary of Findings rate for children born less than two years after a previous birth is more than three times higher than for children born after an interval of four or more years (102 deaths compared with 31 deaths per 1,000 live births). ADULT MORTALITY The female mortality rate for the period 0-4 years before the 2002-2003 IDHS is two deaths per 1,000 population. For the same period, the male mortality rate is also two deaths per 1,000 population. For both sexes, mortality increases with age. In general, male mortality rates are slightly higher than female rates at most ages. The 2002-2003 data suggest that female adult mortality continues to decline gradually. The maternal mortality ratio estimated using direct procedures, is 307 maternal deaths per 100,000 live births for the period 1998-2002. Because maternal mortality estimates are subject to high sampling errors and wide confidence intervals, it is not possible to conclude that there has been any decline in maternal mortality levels over the past 10 to 15 years. CONTINUING CHALLENGES • Despite the increased use of family planning, increased age at first marriage, and continued decline in fertility, the 2002-2003 IDHS reveals continuing challenges. Ten per- cent of births in the five years preceding the sur- vey were wanted but at a later time and 7 per- cent were not wanted at all. This situation has not changed since 1997. • While use of family planning has been in- creasing over time, there is heavy reliance on supply methods, particularly injectables and the pill. Greater program emphasis needs to be placed on long-term methods such as the IUD, implants and sterilization. • In the maternal health sector, while selected health indicators have shown improvement, others show deterioration. The target of 90 percent of women having at least one antenatal care visit in the first trimester has not been reached. • In the area of child health, the percentage of women who have been immunized against neonatal tetanus has declined from 53 percent in 1997 to 51 percent in 2002-2003. Coverage of childhood im- munizations against the six major diseases also de- clined from 55 percent in 1997 to 52 percent in 2002-2003. • Although childhood mortality continues to decline, one in three births in Indonesia has an ele- vated mortality risk that is avoidable. These include births in which the mother is too young (under age 18) or too old (age 35 or older), the birth interval is too short (less than two years), or the mother has had too many prior births (three or more). Summary of Findings | xxvii Timor Leste Papua New Guinea Malaysia Malaysia Singapore INDONESIA xxviii | M ap o f In d o n esia Philippines 1 Nanggroe Aceh Darussalam 2 North Sumatera 3 West Sumatera 4 Riau 5 Jambi 6 South Sumatera 7 Bengkulu 8 Lampung 9 Bangka Belitung 10 DKI Jakarta 21 South Kalimantan 22 East Kalimantan 23 North Sulawesi 24 Central Sulawesi 25 South Sulawesi 26 Southeast Sulawesi 27 Gorontalo 28 North Maluku 29 Maluku 30 Papua 1 2 4 5 6 9 10 11 14 19 20 22 23 24 25 27 28 29 30 2621 16 17 18 15 13 12 8 7 3 11 West Java 12 Central Java 13 DI Yogyakarta 14 East Java 15 Banten 16 Bali 17 West Nusa Tenggara 18 East Nusa Tenggara 19 West Kalimantan 20 Central Kalimantan Brunei INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY The Republic of Indonesia, which consists of approximately 17,000 islands, is located between 6 degrees north and 11 degrees south latitude, and from 95 to 141 degrees east longitude. The Indonesian archipelago lies between Asia and Australia. It is bounded by the South China Sea in the north, the Pacific Ocean in the north and east, and the Indian Ocean in the south and west. There are five major islands: Sumatera in the west; Java in the south; Kalimantan straddling the equator; Sulawesi, which resembles the letter “K”; and Irian Jaya or Papua bordering Papua New Guinea on the west. Two remaining groups of islands are Maluku and Nusa Tenggara, running from Sulawesi to Papua in the north and from Bali to Timor in the south. Other islands are small and mostly uninhabited. More than 80 percent of Indonesia’s territory is covered with water; the land area is about 1.9 million square kilometers. The large number of islands and their dispersion over a wide area has given rise to a diverse culture and hundreds of ethnic groups, each with its own language. This is the basis of the national motto “Unity in Diversity.” Indonesia’s climate is tropical with two seasons. The dry season extends from May to October, and the rainy season from November to April. Indonesia is administratively divided into provinces. Since 2001, the number of provinces was expanded from 26 to 30. The new provinces are Bangka Belitung, Banten, Gorontalo, and North Maluku. These new provinces formerly were part of South Sumatera, West Java, North Sulawesi, and Maluku province, respectively. Each province is subdivided into regencies and municipalities. Altogether, there are 302 regencies and 89 municipalities in Indonesia. The next lower administrative units are subdistricts and villages. In 2002, there were 4,918 subdistricts and 70,460 villages in Indonesia. The entire village is classified as urban or rural. Since proclaiming its independence in 1945, Indonesia has experienced several political shifts. In 1948, a rebellious movement by the Communist Party took place in Madiun. Up until the end of 1949, when the Dutch gave up control over Indonesia, there were disputes against the ruling democratic republic. Some factions, supported by the Dutch, formed the Federation of Indonesian Republics, which lasted less than one year. From 1950 to 1959, Indonesia faced several political problems including the adoption of a multiparty system (which resulted in political and economic instability) and rebellious uprisings caused by ideological, ethnic, and racial differences. The history of the Republic of Indonesia had a turning point after an aborted coup by the Communist Party in September 1965. In 1966, President Suharto began a new era with the establishment of the New Order Government, which was oriented toward overall development. After more than 30 years under the New Order Government, Indonesia has made substantial progress, particularly in stabilizing political and economic conditions. A period of great economic growth was experienced from 1968 to 1986, when per capita income increased sharply from about US $50 to US $385. This increase was primarily the result of the international oil boom in the early 1980s, from which more than 60 percent of the country’s foreign exchange came. The drop in the price of crude oil and natural gas in 1985 forced the government to look for alternative sources of income, such as manufacturing, international trade, and service industries. This effort has been successful. Per capita income has increased to approximately US $1,124 in 1996, while the economic growth was nearly 5 percent. All of these successes ended in mid-1997 when the Asian economy collapsed. The value of the currency plummeted, prices increased, and unemployment rose dramatically. In addition, parts of the country suffered from relatively long droughts and extensive forest fires. Introduction | 1 In 1998, Indonesia went through its worst economic crisis, when the economic growth rate dropped to negative 13 percent (BPS, 2003). At the same time, the political situation became unstable in several regions. President Suharto was ousted and replaced by his Vice President, B.J. Habibie. This time was known as the reformation era. Since 1998, Indonesia has had three presidents, B.J. Habibie, Abdurrahman Wahid, and Megawati Soekarnoputri. In 1999, Law No. 22 on Regional Development was enacted. The law gives full autonomy to districts (Kota/Kabupaten). With some limited exceptions, the same law also makes the local government responsible for all deconcentrated central government ministries at the province and district levels. Since 2000, the economy has recovered, with a growth rate of 5 percent in 2000 and 4 percent in 2002. However, the political situation remains unstable in several provinces such as Nanggroe Aceh Darussalam (formerly known as Dista Aceh), Maluku, and Papua. An important achievement of the Indonesian government is the improvement of the general welfare of the population by ensuring the availability of adequate food, clothing, and housing, as well as providing adequate education and health services. Data from the 1971 and 2000 Population Censuses and the 2002 National Socio-Economic Survey (Susenas) show that in the past 32 years Indonesia has undergone a major improvement in the area of education. The literacy rate among persons age 10 years and older increased from 61 percent in 1971 to 91 percent in 2002. The improvement in education is most pronounced among females. Whereas in 1971 school attendance among children age 7-12 years was 62 percent for males and 58 percent for females, the corresponding rates in 2002 were 96 percent and 97 percent, respectively. From 1971 to 2002, the proportion of people who never attended school declined, while that of graduates at all levels increased. The proportion of people who finished primary school only increased from 20 percent in 1971 to 33 percent in 2002, while the proportion of those who attended junior high school or higher education increased from 7 percent in 1971 to 35 percent in 2002. At all levels, the increase in education among females has been greater than that of males (CBS, 1972; BPS 2002b). The fact that a larger number of girls are enrolled in education longer has a direct impact on the increase of the average age at first marriage. The mean age at first marriage increased from 20 years in 1971 to 22 and 23 years in 1990 and 2000, respectively (BPS, 2002a). This increase was greater in urban areas than in rural areas. The increasing level of completed education has also provided women with greater opportunity to participate in the labor force. Labor force participation among women age 10 and older increased from 33 percent in 1971 to 45 percent in 2002. Most women work in agriculture, trade, or the service industries, with the employment status mostly as an unpaid family worker and regular employee (BPS, 2002b). 1.2 POPULATION According to the 2000 Population Census, the population of Indonesia was 205.8 million in 2000 and was projected to increase to reach 211.1 million in 2002. This makes Indonesia the fourth most populous country in the world after the People’s Republic of China, India, and the United States of America. An estimated 86.5 million people (42 percent of the population) lived in urban areas in 2000, compared with 92.7 million (44 percent of the population) in 2002. In 2000, more than 88 percent of the Indonesian population was Muslim. Indonesia’s population growth rate has declined in the last two decades. Between 1980 and 1990, the average annual population growth rate was 1.98 percent, compared with 1.49 percent between 1990 and 2000 (see Table 1.1). This figure was projected to decline further to 1.25 percent between 2000 and 2002. Another characteristic of Indonesia is the uneven distribution of the population among the islands and provinces. The 2000 Population Census indicates that the population density varies not only across 2 | Introduction islands, but also among provinces of the same island. Java, which covers only 7 percent of the total area of Indonesia, is inhabited by 59 percent of the country’s population, making the population den- sity of Java (951 persons per square kilometer) higher than that of other islands. By comparison, Kalimantan has a density of 20 persons per square kilometer. Within provinces in Java, the population density ranges from 12,700 persons per square kilometer in DKI Jakarta to 726 persons per square kilometer in East Java. Population den- sity at the national level was 109 persons per square kilometer in 2000 and pro- jected to be 112 persons per square kilometer in 2002. Table 1.1 Basic demographic indicators Demographic indicators from selected souces, Indonesia 1990-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1990 2000 2002 Indicators census census projection1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Population (millions) 179.4 206.3 211.1 Growth rate (GR)2 (percent) 1.98 1.49 1.25 Density (pop/km2) 93.0 109.0 112 Percent urban 31 42 44 Reference period 1986-89 1996-99 2002 Crude birth rate (CBR)3 28 23 22 Crude death rate (CDR)4 9 8 10 Life expectancy6 Male 57.9 63.5 64.3 Female 61.5 67.3 68.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Projected based on the 1990 and 2000 Population Census 2 Calculated using compound interest formula 3 Births per 1,000 population; CBR = 9.48968 + 5.55 TFR 4 Deaths per 1,000 population; CDR = CBR – GR per 1,000 5 Estimated based on own children method 6 Estimated using indirect estimation techniques Source: BPS-Statistics Indonesia 2001 and 2003 Table 1.1 shows that Indonesia’s fertility has declined significantly since the 1980s. The crude birth rate (CBR), which was estimated at 28 births per 1,000 people in the period 1986-1989, declined to 23 per 1,000 people during 1996-1999, resulting in an annual decline of 2.1 percent. These figures suggest a more rapid decline in fertility in more recent years. The CBR in 200 The same data sources also demonst mortality levels, and life expectancy at birth expectancy increased from 57.9 years in 19 females are 61.5 years and 68.2 years, respect 1.3 POPULATION AND FAMILY PLANNING The government of Indonesia has im population-related issues since President Suh the World Leaders in 1967. In this declara l hindrance to economic development. To car several programs. Family planning is one of t Under the auspices of the Internatio Planned Parenthood Association (IPPA) init provided family planning counseling and s government established a National Family Family Planning Coordinating Board (NFPC the chairman reporting directly to the Preside family planning and has been working with promote family planning. 2 was projected to be 22 births per 1,000 people. rate that in Indonesia there has been a significant decline in for both males and females has increased. For males, life 90 to 64.3 years in 2002. The corresponding figures for ively. POLICIES AND PROGRAMS plemented many of its development programs responding to arto joined other heads of state in signing the Declaration of tion, rapid population growth was considered a potentia ry out its population policy, the government has launched he most important of these programs. nal Planned Parenthood Federation (IPPF), the Indonesian iated family planning activities in Indonesia in 1957. IPPA ervices, including maternal and child care. In 1968, the Planning Institute, which was reorganized as the National B) two years later. NFPCB is a nondepartmental body, with nt. The government of Indonesia has a strong commitment to religious and community leaders to develop programs to Introduction | 3 In less than three decades, the population policy has not only contributed to reducing the fertility rate of the country by half, but it has also helped to improve family welfare. One of the factors that contributed to the success of the family planning program in Indonesia has been the empowerment of the community in implementing the programs on the notion that family planning is more than controlling births. In Act No.10, which was passed in 1992, family planning is explicitly defined as efforts to increase the society’s concern and participation in delaying marriage, controlling births, fostering family resilience, and improving family welfare to create small, happy, and prosperous families. A new paradigm was introduced in 1999. During previous years the program’s ultimate objective was to institutionalize the small, happy, and prosperous family norm. The objective for the future is to materialize “Quality Families” by the year 2015. Parallel to this new vision is the enactment of Law number 22 in 2000 on Decentralization, which empowers district-level governments to plan and implement their respective development programs, including family planning and reproductive health. 1.4 HEALTH PRIORITIES AND PROGRAMS Health Law number 23 enacted in 1992 provides a legal basis for the health sector activities. It stipulates that the goal of the health programs and development is to increase the awareness, willingness, and ability of everyone to live a healthy life. The law emphasizes the decentralization of operational responsibility and authority to the local level as a prerequisite for successful and sustainable development. In the second 25-Year Development Plan (1994-2019), economic and human development is identified as the key to national development and self-reliance. Following the National Guidelines on State Policy issued in 1993, the strategy adopted to improve the health and nutritional status of the population is two pronged: to improve the quality of health services and make them affordable to all, and to promote a healthy lifestyle supported by adequate housing and environmental sanitation. In mid-September 1998, a new health paradigm was introduced that focuses health development more on the health promotion and prevention than on curative and rehabilitative services. The new vision is reflected in the motto “Healthy Indonesia 2010.” Year 2010 was used as a target to allow sufficient time for measuring success in achieving the set goals. To achieve Healthy Indonesia 2010, the Ministry of Health (MOH) has the following goals: • To initiate and lead a health orientation of the national development • To maintain and enhance individual, family, and public health, along with improving the environment • To maintain and enhance quality, accessible, and affordable health services • To promote public self-reliance in achieving good health. The government of Indonesia places a great emphasis on intersectoral coordination, joint responsibility of local government and the community, region-specific programs, targeting of vulnerable groups, and building a strong information and communication program. 4 | Introduction 1.5 OBJECTIVES OF THE SURVEY The 2002-2003 Indonesia Demographic and Health Survey (IDHS) follows a sequence of several previous surveys: the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS), the 1991 IDHS, the 1994 IDHS, and the 1997 IDHS.1 The 2002-2003 IDHS is expanded from the 1997 IDHS by including a collection of information on the participation of currently married men and their wives and children in the health care. The 2002-2003 IDHS was specifically designed to meet the following objectives: • Provide data concerning fertility, family planning, maternal and child health, maternal mortality, and awareness of AIDS/STIs to program managers, policymakers, and researchers to help them evaluate and improve existing programs • Measure trends in fertility and contraceptive prevalence rates, analyze factors that affect such changes, such as marital status and patterns, residence, education, breastfeeding habits, and knowledge, use, and availability of contraception • Evaluate achievement of goals previously set by the national health programs, with special focus on maternal and child health • Assess men’s participation and utilization of health services, as well as of their families • Assist in creating an international database that allows cross-country comparisons that can be used by the program managers, policymakers, and researchers in the area of family planning, fertility, and health in general. 1.6 ORGANIZATION OF THE SURVEY The 2002-2003 IDHS was implemented by BPS-Statistics Indonesia (BPS). The government of Indonesia provided most of the local costs for the survey through a loan from the World Bank. Additional funds were obtained from the U.S. Agency for International Development (USAID) through ORC Macro, which provided technical assistance under the auspices of the Demographic and Health Surveys (MEASURE DHS+) program. USAID also supported the implementation of the survey in three newly established provinces, Bangka Belitung, Banten, and Gorontalo. In addition to ORC Macro, other collaborating partners that were involved in questionnaire development, data analysis, and dissemination include the following: BPS, NFPCB, and MOH. A survey Steering Committee was established. This committee consists of senior representatives from BPS, NFPCB, MOH, the State Ministry for Women Empowerment, and the Demographic Institute at the University of Indonesia. A Technical Team, consisting of members of the same organizations, met more frequently than the Steering Committee to discuss and decide on technical issues relating to the implementation of the survey. BPS implemented the survey and processed the data. The directors of the provincial statistical offices were responsible for both the technical and the administrative aspects of the survey in their 1 Central Bureau of Statistics, National Family Planning Coordinating Board, and Institute for Resource Development/Westinghouse, 1989; Central Bureau of Statistics, National Family Planning Coordinating Board, Ministry of Health, and Macro International Inc., 1992; Central Bureau of Statistics, State Ministry of Population/National Family Planning Coordinating Board, Ministry of Health, and Macro International Inc., 1995; Central Bureau of Statistics, State Ministry of Population/National Family Planning Coordinating Board, Ministry of Health, and Macro International Inc., 1998. Introduction | 5 respective areas. They were assisted by field coordinators, most of whom were chiefs of the social statistics divisions in the provincial offices. The 2002-2003 IDHS used three questionnaires: the Household Questionnaire, the Women’s Questionnaire for ever-married women 15-49 years old, and the Men’s Questionnaire for currently married men 15-54 years old. The Household Questionnaire and the Women’s Questionnaire were based on the DHS Model “A” Questionnaire, which is designed for use in countries with high contraceptive prevalence. In consultation with the NFPCB and MOH, BPS modified these questionnaires to reflect relevant issues in family planning and health in Indonesia. Inputs were also solicited from potential data users to optimize the IDHS in meeting the country’s needs for population and health data. The questionnaires were translated from English into the national language, Bahasa Indonesia. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Basic information collected for each person listed includes the following: age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, the Household Questionnaire also identifies unmarried women and men age 15-24 who are eligible for the individual interview in the Indonesia Young Adult Reproductive Health Survey (IYARHS). Information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, construction materials used for the floor and outer walls of the house, and ownership of various durable goods were also recorded in the Household Questionnaire. These items reflect the household’s socioeconomic status. The Women’s Questionnaire was used to collect information from all ever-married women age 15-49. These women were asked questions on the following topics: • Background characteristics, such as age, marital status, education, and media exposure • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Childhood mortality • Awareness and behavior regarding AIDS and other sexually transmitted infections (STIs) • Sibling mortality, including maternal mortality. The Men’s Questionnaire was administered to all currently married men age 15-54 in every third household in the IDHS sample. The Men’s Questionnaire collected much of the same information included in the Women’s Questionnaire, but was shorter because it did not contain questions on reproductive history, maternal and child health, nutrition, and maternal mortality. Instead, men were asked about their knowledge and participation in the health-seeking practices for their children. As in previous surveys, data were collected by teams of interviewers. There were 94 interviewing teams, each of which consists of one team supervisor, one field editor, three female interviewers, and one male interviewer. Altogether, 530 persons, 362 women and 168 men participated in the survey as data collectors. They were trained for 16 days, from September 30 to October 17, 2002. The field supervisors and editors received additional training in supervision and editing techniques. Fieldwork took place over a five-and- a-half-month period, from October 21, 2002 to April 9, 2003. In most provinces, data collection took a break for at least one month during the Muslim fasting month, which fell in early November through early December 2002. In the Riau province, fieldwork began only in December 2002. In three provinces, Bangka Belitung, Banten, and Gorontalo, training of field staff occurred February 15 to March 6 | Introduction 4, 2003, and fieldwork took place March 7 to April 31, 2003. For more information about the fieldwork, see Appendix A. A list of persons involved in the implementation of the survey is found in Appendix D. The survey questionnaires are reproduced in Appendix E. As in previous IDHS surveys, the 2002-2003 IDHS sample was designed to produce estimates at the national, urban-rural, and provincial levels. Table 1.2 is a summary of the results of the fieldwork for the 2002-2003 IDHS from both the household and individual interviews, by urban-rural residence. In general, the response rates for both the household and individual interviews in the 2002-2003 IDHS are high. A total of 34,738 households were selected for the survey, of which 33,419 were found. Of the encountered households, 33,088 (99 percent) were successfully interviewed. In these households, 29,996 ever-married women 15-49 were identified, and complete interviews were obtained from 29,483 of them (98 percent). From the households selected for interviews with men, 8,740 currently married men 15-54 were identified, and complete interviews were obtained from 8,310 men, or 95 percent of all eligible men. The generally high response rates for both household and individual interviews (for eligible women and men) were due mainly to the strict enforcement of the rule to revisit the originally selected household if no one was at home initially. No substitution for the originally selected households was allowed. Interviewers were instructed to make at least three visits in an effort to contact the household, eligible women, and eligible men. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Indonesia 2002-2003 Residence Result Urban Rural Total Household interviews Households selected 14,779 19,959 34,738 Households occupied 14,152 19,267 33,419 Households interviewed 13,961 19,127 33,088 Household response rate 98.7 99.3 99.0 Interviews with women Number of eligible women 12,537 17,459 29,996 Number of eligible women interviewed 12,318 17,165 29,483 Eligible woman response rate 98.3 98.3 98.3 Interviews with men Number of eligible men 3,736 5,004 8,740 Number of eligible men interviewed 3,555 4,755 8,310 Eligible man response rate 95.2 95.0 95.1 Introduction | 7 CHARACTERISTICS OF HOUSEHOLDS AND HOUSING CHARACTERISTICS 2 This chapter presents information on some demographic and socioeconomic characteristics of the population in the sampled households. This chapter also considers the condition of the households in which the survey population lives, including source of drinking water, availability of electricity, sanitation facilities, building materials, and possession of household durable goods. Information on the characteris- tics of the households and the individual women and men interviewed is essential for the interpretation of survey findings and can provide an approximate indication of the representativeness of the Indonesia Demographic and Health Survey. For the purpose of the 2002-2003 IDHS, a household was defined as a person or a group of per- sons, related or unrelated, who live together in the same dwelling unit and share a common source of food. The Household Questionnaire (see Appendix F) was used to collect information on all usual resi- dents and visitors who spent the night preceding the survey in the household. This method of data collec- tion allows the analysis of either de jure (usual residents) or de facto (those who are there at the time of the survey) populations. 2.1 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE Age and sex are important demographic variables and are the primary basis of demographic clas- sification in vital statistics, censuses, and surveys. They are also important variables in the study of mor- tality, fertility, and nuptiality. The distribution of the de facto household population in the 2002-2003 IDHS is shown in Table 2.1 by five-year age groups, according to sex and urban rural residence. The 2002-2003 IDHS households constitute a population of 142,610 persons. The data show that there is an equal proportion of women and men in the population (50 percent each). The sex composition of the population does not show significant variation by urban-rural residence. The table further depicts Indonesia as a young population, with a large proportion of the population being in the younger age groups. The population under age 15 constitutes 32 percent of the total population. The older age groups are small in comparison, as can be seen in the popu- lation pyramid (Figure 2.1). The population pyramid has a narrow top and a wide base reflecting a pattern typical of countries with relatively high fertility in the past. This type of age structure has a built-in mo- mentum for the growth of the country’s population. When the young population eventually reaches repro- ductive age, the result will be a high population growth for several years to come. The slight tapering at the base is likely to have been caused by a decline in fertility in the recent years. 2.2 HOUSEHOLD COMPOSITION Information about the composition of households by sex of the head of the household and size of the household is presented in Table 2.2. These characteristics are important because they are associated with aspects of household welfare. Female-headed households are, for example, typically poorer than male-headed households. Where households are large, there is generally greater crowding, which is usu- ally associated with unfavorable health conditions and economic hardships. The 2002-2003 IDHS data show that 12 percent of households are headed by women. This pro- portion is the same as the level observed in the 1997 IDHS (CBS et al., 1998:12). The proportion of fe- male-headed households is slightly higher in urban areas than in rural areas (12 and 11 percent, respec- tively). Characteristics of Households and Housing Characteristics | 9 Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Indonesia 2002-2003 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.6 9.8 10.2 10.8 10.4 10.6 10.7 10.1 10.4 5-9 10.7 10.0 10.4 11.2 10.9 11.0 11.0 10.5 10.7 10-14 10.3 10.0 10.2 11.3 10.5 10.9 10.8 10.3 10.5 15-19 10.1 10.2 10.2 9.2 8.5 8.9 9.7 9.3 9.5 20-24 9.4 10.0 9.7 7.9 8.6 8.2 8.6 9.2 8.9 25-29 8.5 9.3 8.9 7.4 8.1 7.8 7.9 8.7 8.3 30-34 8.3 8.4 8.4 7.8 7.9 7.8 8.0 8.1 8.1 35-39 7.3 7.7 7.5 6.7 7.2 6.9 7.0 7.4 7.2 40-44 6.8 6.4 6.6 6.4 6.6 6.5 6.6 6.5 6.6 45-49 5.0 5.6 5.3 5.5 5.9 5.7 5.3 5.8 5.5 50-54 4.3 3.5 3.9 4.8 3.6 4.2 4.6 3.5 4.0 55-59 2.4 2.3 2.4 2.8 2.9 2.9 2.6 2.6 2.6 60-64 2.6 2.4 2.5 2.9 3.3 3.1 2.8 2.9 2.8 65-69 1.4 1.7 1.5 2.0 2.1 2.0 1.7 1.9 1.8 70-74 1.0 1.5 1.2 1.7 1.9 1.8 1.4 1.7 1.5 75-79 0.5 0.6 0.6 0.7 0.7 0.7 0.6 0.7 0.6 80 + 0.6 0.7 0.6 0.9 0.9 0.9 0.7 0.8 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 33,543 33,720 67,264 37,629 37,718 75,346 71,172 71,438 142,610 Figure 2.1 Population Pyramid of Indonesia IDHS 2002-2003 80+ 75-79 70-74 65 69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15 -19 10-14 5-9 0-04 Age 0510 0 5 10 Male Female Percent 0-4 10 | Characteristics of Households and Housing Characteristics Table 2.2 Household composition Percent distribution of households by sex of head of house- hold and by household size, according to residence, Indonesia 2002-2003 Residence Characteristic Urban Rural Total Sex of head of household Male 87.7 88.6 88.2 Female 12.3 11.4 11.8 Total 100.0 100.0 100.0 Number of usual members 1 5.8 4.6 5.1 2 9.9 12.2 11.1 3 16.6 21.5 19.2 4 23.9 23.4 23.6 5 18.5 17.4 17.9 6 11.6 10.5 11.0 7 6.4 5.0 5.6 8 3.4 2.5 2.9 9+ 4.0 2.8 3.3 Total 100.0 100.0 100.0 Number of households 15,126 17,962 33,088 Mean size 4.5 4.2 4.3 Note: Table is based on de jure members, i.e., usual residents. Five percent of households have only one member, with urban areas having a slightly higher pro- portion of one-member households than rural areas (6 and 5 percent, respectively). However, very large households (nine persons or more) still exist in Indonesia (4 percent in urban and 3 percent in rural areas). The sex composition of the population does not show significant variations by urban-rural residence. Ta- ble 2.2 shows that the overall mean household size in Indonesia is 4.3 persons. The household size is roughly the same in rural areas (4.2 persons) and in urban areas (4.5 persons). The same pattern was ob- served in the 1997 IDHS (CBS et al., 1998:12). 2.3 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Information on children’s living arrangements, specifically fosterhood and orphanhood, is pre- sented in Table 2.3. Several aspects of the table are of interest, particularly the extent of orphanhood (i.e., the proportion of children who have lost one or both parents). In the 2002-2003 IDHS, information was collected for all persons under age 15 concerning their living arrangements and survival status of their biological parents. A large majority of children under age 15 live with both their parents (88 percent), 7 percent live with one parent, and 4 percent live with neither of their natural parents. Younger children are more likely than older children to live with both parents (for example, 93 percent of children under age 2 compared with 85 percent of those age 10-14). Male children are as likely as female children to live with both parents, while children in urban areas are slightly more likely than in rural areas to live with their parents (89 percent compared with 87 percent). Characteristics of Households and Housing Characteristics | 11 Table 2.3 Children's living arrangements and orphanhood Percent distribution of de jure children under age 15 by children's living arrangements and survival status of parents, according to back- ground characteristics, Indonesia 2002-2003 Not living with either parent Living with mother but not father Living with father but not mother Backgroud characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Total Number of children Age <2 93.2 4.8 0.7 0.1 0.1 0.9 0.1 0.0 0.0 0.1 100.0 5,762 2-4 90.2 4.1 0.6 1.4 0.3 3.0 0.1 0.1 0.1 0.1 100.0 9,010 5-9 88.0 3.7 1.7 1.6 0.4 3.6 0.3 0.2 0.2 0.3 100.0 15,280 10-14 84.5 2.9 3.4 1.6 0.9 4.8 0.5 0.4 0.4 0.7 100.0 14,998 Sex Male 88.1 3.6 1.8 1.3 0.5 3.4 0.3 0.2 0.3 0.3 100.0 23,076 Female 87.7 3.7 2.1 1.4 0.4 3.7 0.3 0.2 0.2 0.4 100.0 21,974 Residence Urban 89.2 3.3 1.8 1.0 0.4 3.2 0.2 0.2 0.2 0.4 100.0 20,614 Rural 86.9 3.9 2.0 1.6 0.6 3.8 0.4 0.2 0.2 0.3 100.0 24,436 Total 87.9 3.6 1.9 1.4 0.5 3.5 0.3 0.2 0.2 0.4 100.0 45,050 2.4 EDUCATIONAL LEVEL OF HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and status an individual enjoys in a society. Stud- ies have consistently shown that educational attainment has strong effects on reproductive behavior, con- traceptive use, fertility, infant and child mortality, morbidity, and attitudes and awareness related to fam- ily health and hygiene. In the 2002-2003 IDHS, information on educational attainment was collected for every member of the household. 2.4.1 EDUCATIONAL ATTAINMENT OF THE HOUSEHOLD POPULATION Table 2.4 shows the percent distribution of the de facto male and female population age six and over by the highest level of education attained, according to age and residence. Table 2.4 indicates that there are significant differences in the level of education by background characteristics. Overall, men are slightly better educated than women: 13 percent of females age six and above have never to school com- pared with only seven percent of males. In all age groups except 10-14, males are more likely to have been educated and more likely to stay in school than females. In 1994, based on President’s Instruction number 1, the government of Indonesia declared “Nine Years Compulsory Education” for children under 15. This campaign resulted in bringing equity in education for males and females. While there are small differences in the educational attainment between males and females in older ages, the gap in educational attainment is no longer visible among the youngest age cohort. These figures imply that in recent years, girls have had as much opportunity as boys to pursue education. The percentage of males and females who have never attended school increases steadily with age. Among females, this proportion increases from one percent among those age 10-14 to 68 percent in the oldest age group (65 years or older). The increase is slightly less drastic among males, from one percent to 34 percent, respectively. 12 | Characteristics of Households and Housing Characteristics Table 2.4 Educational attainment of household population Percent distribution of the de facto male and female household population age six and over by highest level of edu- cation attended or completed, according to background characteristics, Indonesia 2002-2003 Background characteristic No educa- tion Some primary Com- pleted primary1 Some second- ary Com- pleted second- ary2 More than second- ary Don't know/ missing Total Number Median number of years MALE Age 6-9 14.2 84.9 0.0 0.2 0.0 0.0 0.7 100.0 6,530 0.6 10-14 1.3 56.5 10.0 32.1 0.0 0.0 0.0 100.0 7,700 4.6 15-19 0.9 9.4 17.1 60.7 9.7 2.1 0.1 100.0 6,881 8.3 20-24 1.0 7.5 25.1 26.8 28.6 10.9 0.1 100.0 6,129 8.6 25-29 1.6 7.6 30.9 23.0 27.8 9.0 0.2 100.0 5,630 8.4 30-34 2.0 10.9 29.5 21.7 27.6 8.2 0.1 100.0 5,714 8.3 35-39 3.8 16.2 29.3 16.3 24.1 10.2 0.2 100.0 4,979 6.5 40-44 6.2 23.2 31.8 13.0 17.1 8.5 0.2 100.0 4,691 5.6 45-49 6.8 26.9 32.3 13.2 14.9 5.8 0.1 100.0 3,775 5.5 50-54 8.9 27.1 32.5 14.6 11.5 5.4 0.0 100.0 3,257 5.4 55-59 14.4 28.1 30.7 10.5 10.4 5.3 0.6 100.0 1,852 5.2 60-64 22.4 26.9 28.4 9.3 8.0 4.4 0.6 100.0 1,972 5.0 65+ 33.8 31.1 23.9 4.4 5.1 1.0 0.7 100.0 3,134 2.1 Residence Urban 4.0 23.1 17.8 24.9 20.8 9.3 0.2 100.0 29,377 7.2 Rural 9.1 33.7 26.7 19.6 8.9 1.8 0.3 100.0 32,889 5.3 Total 6.7 28.7 22.5 22.1 14.5 5.3 0.2 100.0 62,266 5.6 FEMALE Age 6-9 14.5 84.7 0.0 0.1 0.0 0.0 0.6 100.0 6,231 0.6 10-14 0.9 52.8 10.0 36.2 0.0 0.1 0.0 100.0 7,328 4.8 15-19 1.1 6.9 18.7 59.4 10.2 3.6 0.0 100.0 6,632 8.4 20-24 1.3 8.1 28.8 23.8 25.5 12.4 0.0 100.0 6,608 8.5 25-29 2.5 9.8 34.8 20.9 23.5 8.6 0.0 100.0 6,192 8.0 30-34 4.9 14.9 31.9 18.3 22.3 7.7 0.1 100.0 5,789 5.9 35-39 9.2 24.3 31.7 13.0 14.7 7.0 0.1 100.0 5,298 5.5 40-44 14.9 29.9 30.5 10.7 9.1 5.0 0.1 100.0 4,652 5.2 45-49 17.1 32.8 28.9 9.9 8.0 3.2 0.1 100.0 4,125 5.0 50-54 26.3 28.9 25.1 10.3 6.3 2.2 0.9 100.0 2,518 3.7 55-59 38.1 30.3 17.6 7.7 4.7 1.0 0.7 100.0 1,885 2.1 60-64 53.1 23.4 13.1 4.8 3.2 0.6 1.9 100.0 2,066 0.0 65+ 67.6 17.4 9.8 2.6 1.1 0.4 1.1 100.0 3,593 0.0 Residence Urban 9.0 23.3 18.8 23.9 16.8 8.0 0.1 100.0 29,786 5.9 Rural 17.2 33.5 24.6 16.9 6.0 1.5 0.4 100.0 33,159 4.8 Total 13.3 28.7 21.8 20.2 11.1 4.6 0.3 100.0 62,945 5.3 Note: Total includes 20 unweighted men and 25 unweighted women with missing information on age. 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Characteristics of Households and Housing Characteristics | 13 Table 2.4 also shows that older people have less education. For example, the median duration of schooling among men age 50-54 years is 5.4 years, whereas for men age 20-24 the median is 8.6 years. The difference for women is even more striking; 3.7 years for age 50-54 years and 8.5 years for age 20- 24. Urban residents are much more likely to attend school and stay in school than rural residents. Only 4 percent of men in urban areas have never gone to school, while the proportion in rural areas is 9 percent. For women, the corresponding figures are 9 percent in the urban areas and 17 percent in the rural areas. The urban-rural difference is more pronounced at the level of secondary or higher education. The median years of schooling for urban men is 7.2 years, compared with 5.3 years for rural men. The urban-rural difference among women is less pronounced, 5.9 years and 4.8 years, respectively. 2.4.2 SCHOOL ATTENDANCE RATES The 2002-2003 IDHS collected information on school attendance among the population that al- lows the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary school is the percentage of the primary school-age population (6-13 years) that is attending pri- mary school. The NAR for secondary school is the percentage of the secondary-school-age population (14-17 years) that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students, of any age, expressed as the per- centage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students up to an age limit of 24 years, expressed as the percentage of the official secondary-school-age population. The GARs are almost always higher than the NARS because the GAR includes participation by those who are older or younger than the official range for that level. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. The Gender Parity Index represents the ratio of the GAR for females to the GAR for males. It is presented for both the primary and secondary levels and offers a summary measure of the extent to which there are gender differences in attendance rates. Table 2.5.1 and 2.5.2 indicate that among primary school and secondary school there are signifi- cant differences in rate of school attendance by background characteristics. Table 2.5.1 shows that in pri- mary school, the NAR and GAR are slightly higher in rural than in urban areas (88 percent compared 87 percent, and 104 percent compared 103 percent. The Gender Parity Index is 1.03 in rural areas and 0.98 in urban areas. There are no significant sex differentials in NAR and GAR by residence. Overall, the NAR and GAR for primary school in all provinces are slightly higher than for secondary school. In primary school, the NAR and GAR are lowest in Gorontalo (81.3 for NAR and 96.4 for GAR), while NAR in West Nusa Tenggara is 90.8 and GAR in Central Kalimantan it is 108.8. 14 | Characteristics of Households and Housing Characteristics Table 2.5.1 School attendance ratios: primary school Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population attending primary school by sex, residence, and province, Indonesia 2002-2003 Net attendance ratio1 Gross attendance ratio2 Residence/ province Male Female Total Male Female Total Gender Parity Index3 Residence Urban 88.3 85.0 86.7 103.8 102.1 103.0 0.98 Rural 87.3 88.5 87.9 102.2 105.2 103.7 1.03 Region/province Sumatera North Sumatera 84.1 82.6 83.4 99.4 99.6 99.5 1.00 West Sumatera 87.4 89.9 88.7 104.4 103.7 104.0 0.99 Riau 88.8 86.6 87.8 103.7 103.0 103.3 0.99 Jambi 82.6 84.7 83.6 106.5 105.6 106.0 0.99 South Sumatera 85.0 86.8 85.8 100.4 102.4 101.3 1.02 Bengkulu 89.7 82.9 86.4 111.5 102.7 107.2 0.92 Lampung 91.3 89.4 90.5 107.7 105.8 106.9 0.98 Bangka Belitung 86.1 90.8 88.5 111.7 111.0 111.3 0.99 Java DKI Jakarta 86.0 87.8 86.9 109.7 104.8 107.1 0.96 West Java 86.9 88.4 87.6 99.1 103.2 101.0 1.04 Central Java 89.9 89.9 89.9 105.4 107.5 106.4 1.02 DI Yogyakarta 91.3 85.1 88.1 106.1 97.3 101.6 0.92 East Java 91.7 84.7 88.3 106.8 104.3 105.6 0.98 Banten 88.1 85.2 86.7 99.5 103.2 101.2 1.04 Bali and Nusa Tenggara Bali 84.4 84.5 84.4 104.1 105.3 104.6 1.01 West Nusa Tenggara 88.3 93.2 90.8 99.4 102.5 101.0 1.03 East Nusa Tenggara 85.7 90.2 88.0 106.2 110.2 108.3 1.04 Kalimantan West Kalimantan 82.7 86.1 84.3 105.5 106.9 106.1 1.01 Central Kalimantan 89.1 89.9 89.5 106.0 111.8 108.8 1.05 South Kalimantan 83.2 84.8 84.0 98.3 99.2 98.8 1.01 East Kalimantan 84.1 84.3 84.2 110.5 105.8 108.0 0.96 Sulawesi North Sulawesi 84.2 82.5 83.3 102.1 96.9 99.5 0.95 Central Sulawesi 84.9 89.7 86.9 104.5 111.9 107.7 1.07 South Sulawesi 88.7 81.2 85.1 101.0 97.1 99.1 0.96 Southeast Sulawesi 82.3 90.1 86.1 103.6 108.6 106.1 1.05 Gorontalo 81.0 81.7 81.3 93.8 99.4 96.4 1.06 Total 87.7 86.9 87.4 102.9 103.8 103.4 1.01 1 The NAR for primary school is the percentage of the primary-school age (6-13 years) population that is attending primary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official pri- mary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school GAR for females to the GAR for males. Characteristics of Households and Housing Characteristics | 15 Table 2.5.2 School attendance ratios: secondary school Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population attending secon- dary school by sex, residence, and province, Indonesia 2002-2003 Net attendance ratio1 Gross attendance ratio2 Residence/ province Male Female Total Male Female Total Gender Parity Index3 Residence Urban 65.0 63.0 64.0 77.6 76.4 77.0 0.98 Rural 41.8 45.8 43.7 51.3 53.6 52.4 1.05 Region/province Sumatera North Sumatera 61.7 63.7 62.7 76.0 77.6 76.8 1.02 West Sumatera 60.3 69.7 65.2 70.6 78.1 74.5 1.11 Riau 58.2 61.4 59.7 68.8 73.2 70.9 1.06 Jambi 48.7 45.5 47.0 66.5 56.5 61.2 0.85 South Sumatera 45.3 54.0 49.7 56.8 61.8 59.3 1.09 Bengkulu 57.1 64.9 60.8 65.2 79.3 71.9 1.22 Lampung 48.1 55.9 51.5 55.4 64.1 59.2 1.16 Bangka Belitung 43.5 49.9 46.5 56.2 60.1 58.0 1.07 Java DKI Jakarta 69.1 60.3 64.3 82.7 70.9 76.3 0.86 West Java 48.8 50.6 49.7 61.0 62.4 61.7 1.02 Central Java 54.4 56.8 55.5 66.2 67.7 66.9 1.02 DI Yogyakarta 71.1 69.7 70.4 81.6 84.6 83.1 1.04 East Java 54.5 58.2 56.2 63.8 68.9 66.2 1.08 Banten 52.1 48.6 50.3 59.6 56.7 58.1 0.95 Bali and Nusa Tenggara Bali 64.9 60.2 62.8 80.8 70.0 76.0 0.87 West Nusa Tenggara 55.1 40.1 47.2 62.9 42.7 52.2 0.68 East Nusa Tenggara 35.9 36.3 36.1 45.0 41.2 43.2 0.92 Kalimantan West Kalimantan 46.1 40.7 43.2 60.2 47.2 53.2 0.78 Central Kalimantan 46.2 45.4 45.8 55.2 58.7 56.9 1.06 South Kalimantan 43.2 41.5 42.4 50.6 49.9 50.2 0.99 East Kalimantan 60.8 60.8 60.8 73.6 74.5 74.0 1.01 Sulawesi North Sulawesi 51.2 59.5 55.4 67.6 71.1 69.3 1.05 Central Sulawesi 47.0 51.1 48.9 59.6 60.2 59.9 1.01 South Sulawesi 47.2 43.2 45.3 54.9 56.0 55.4 1.02 Southeast Sulawesi 48.3 52.5 50.4 63.3 59.8 61.6 0.95 Gorontalo 25.6 40.5 33.3 29.3 47.0 38.4 1.60 Total 53.0 54.4 53.7 64.0 65.0 64.5 1.02 1 The NAR for secondary school is the percentage of the secondary-school age (14-17 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secon- dary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. 16 | Characteristics of Households and Housing Characteristics Table 2.5.2 shows that secondary school attendance ratios are much lower and differ substantially by background characteristics. The NAR and the GAR for secondary school are 54 and 65 percent, re- spectively. The secondary school attendance is substantially higher in urban areas (64 percent) than in rural areas (44 percent). There are no significant differences in the overall NAR and GAR between males and females. However, among provinces, the GPI varies from 0.68 in West Nusa Tenggara to 1.22 in Bengkulu. This means the attendance of females in secondary school is lower than of males in West Nusa Tenggara, while in Bengkulu the GPI is higher than that of males. Among provinces, the NAR and GAR are the lowest in East Nusa Tenggara (36 and 43 percent, respectively) and the highest DI Yogyakarta (70 and 83 percent, respectively). 2.5 HOUSING CHARACTERISTICS AND HOUSEHOLD POSSESSIONS In the 2002-2003 IDHS, information was collected about certain characteristics of households, including access to electricity, source of drinking water, time to water source, type of sanitation facilities, construction and flooring materials of housing, possession of various durable goods, and distance between the well and the nearest septic tank. These are important determinants of the health status of household members, particularly children. They can also be used as indicators of household socioeconomic status. Proper hygiene and sanitation practices can help to prevent major childhood diseases, such as diarrhea. The information on housing characteristics is summarized in Tables 2.6 and 2.7. Table 2.6 shows that 91 percent of the households covered in the 2002-2003 IDHS have electric- ity, a large increase from 80 percent found in the 1997 IDHS (CBS et al., 1998:17). There are significant urban-rural differentials, with 98 percent of urban households having electricity, compared with 85 per- cent in rural areas (see Figure 2.2). Table 2.6 shows that protected wells, whether in dwelling, in yard, or public, are the main source of drinking water (42 percent). Seventeen percent of households use water that is either piped into the residence or into the yard or obtained from the public tap, this proportion being significantly higher in urban areas than in rural areas (29 and 7 percent, respectively). Other sources of drinking water include springs (12 percent), other open water such as rivers and ponds (3 percent), and bottled water (3 percent). Rural households are much more likely to use spring water than urban households (19 percent, compared with 3 percent). On the other hand, bottled water is more common in urban areas (6 percent) than in rural areas (1 percent). The urban-rural differences are also reflected in the time taken to draw water. In urban areas, 97 percent of the households are within 15 minutes of a water source, compared with 86 percent of rural households. Households without proper toilet facilities are more exposed to the risk of diseases like dysentery, diarrhea, and typhoid fever. More than half of households in the sample (54 percent) have a private toilet, a slight increase from 50 percent found in the 1997 IDHS (CBS et al., 1998:19). Eight percent of house- holds use a shared facility, and the remaining 28 percent do not have a toilet. This presents a slight de- crease from the 40 percent found in the 1997 IDHS (CBS et al., 1998:19). The urban-rural differences are significant. Seventy-four percent of households in urban areas have a private toilet, compared with 37 percent in rural areas. Table 2.6 also presents the distribution of households by the distance from the well to the nearest septic tank. Forty-one percent of households have no well. For 9 percent of the households, the nearest septic tank is less than 7 meters from their well, and for 38 percent, the nearest septic tank is 7 meters or further from the well. Wells are slightly closer to a septic tank in urban areas than in rural areas. Characteristics of Households and Housing Characteristics | 17 The type of flooring material can be considered as an economic and health indicator of the household. Some floor materials like dirt or earth pose a health problem for the household since they can act as breeding grounds for pests and insects and may be a source of dust. This kind of flooring is also more difficult to keep clean. In Indonesia, 14 percent of households have a dirt floor. More than half of households (52 percent) live in dwellings with a concrete, brick, or tile floor, while 15 percent have a wood floor. There are substantial urban-rural differen- tials by floor materials. Whereas 58 percent of urban households have a concrete, brick, or tile floor, the proportion of such households in rural areas is 47 percent. Conversely, 22 percent of rural households have a dirt floor, compared with 5 percent in urban areas. Table 2.6 Household characteristics Percent distribution of households by household characteristics, accord- ing to residence, Indonesia 2002-2003 Residence Household characteristic Urban Rural Total Electricity Yes 98.1 84.5 90.7 No 1.9 15.4 9.2 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 22.1 4.2 12.4 Piped into yard/plot 2.9 1.4 2.1 Public tap 3.9 1.5 2.6 Open well in dwelling 5.8 3.6 4.6 Open well in yard/plot 5.8 12.4 9.4 Open public well 1.7 4.9 3.5 Protected well in dwelling 24.9 12.8 18.4 Protected well in yard/plot 11.9 18.1 15.3 Protected public well 6.0 9.8 8.0 Spring 3.2 19.1 11.8 River, stream, pond 0.3 6.0 3.4 Rainwater 1.2 3.2 2.3 Tanker truck 3.2 1.6 2.3 Bottled water 6.2 0.8 3.3 Other 0.8 0.4 0.6 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 96.8 86.3 91.1 Sanitation facility Private with septic tank 64.6 26.6 44.0 Private with no septic tank 8.9 10.2 9.6 Shared/public 9.3 6.2 7.6 River/stream/creek 11.3 26.6 19.6 Pit 2.9 16.5 10.3 Bush/forest/yard/field/no facility 0.5 7.1 4.1 Other 2.2 6.7 4.6 Missing 0.3 0.2 0.2 Total 100.0 100.0 100.0 Distance from well to nearest septic tank No well 43.8 38.3 40.8 Less than 7 meters 11.4 7.6 9.4 7 meters or farther 36.5 39.4 38.1 Don't know/missing 8.2 14.7 11.7 Total 100.0 100.0 100.0 Flooring material Dirt/earth 4.6 21.9 14.0 Bamboo 0.5 2.3 1.5 Wood 9.0 20.0 14.9 Brick/concrete 35.0 33.1 34.0 Tile 23.1 13.5 17.9 Ceramic/marble/granite 27.4 8.7 17.2 Other 0.1 0.2 0.1 Missing 0.4 0.3 0.4 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.7 0.2 0.4 LPG, natural gas 18.6 2.8 10.0 Kerosene 63.8 27.7 44.2 Coal, lignite 0.1 0.1 0.1 Charcoal 0.1 0.4 0.3 Firewood, straw 15.9 68.5 44.4 Other 0.8 0.3 0.5 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number of households 15,126 17,962 33,088 The majority of the households use kerosene and firewood or straw for cooking (44 percent each), while 10 percent use liquid pro- pane gas or natural gas. There are substantial urban-rural differentials by type of cooking fuel. Whereas 64 percent of urban households use kerosene for cooking, only 28 percent of house- holds do so in rural areas. Furthermore, 19 per- cent of urban households use gas for cooking compared with 3 percent in rural areas. The presence of durable goods in the household, such as radio, television, telephone, refrigerator, motorcycle, and private car, is an- other indicator of the household's socioeconomic status. Moreover, particular goods have specific benefits. Ownership of a radio or television is a measure of access to mass media and exposure to innovative ideas; telephone ownership meas- ures access to an efficient means of communica- tion; refrigerator ownership prolongs the whole- someness of foods; and ownership of private transport means allows greater access to many services away from the local area. Table 2.7 shows that 56 percent of households have a radio, 62 percent have a tele- vision, 13 percent have a telephone, 18 percent have a refrigerator, 44 percent have a bicycle or boat, and 30 percent have a motorcycle or mo- torboat. Only 6 percent of households have a private car or truck. One in six households has none of the durable goods listed in Table 2.8. The 18 | Characteristics of Households and Housing Characteristics ownership of durable goods, except radio and bicycle or boat, has increased from that recorded in 1997 IDHS (CBS et al., 1998:20). Whereas ownership of radio has decreased since 1997 (62 to 56 percent), ownership of television has increased during the same period (48 to 62 percent). Ownership of specific durable goods varies by urban-rural residence. In general, these goods are more available in urban households than in rural households. For example, four in five urban households have a television set, while that is true for less than half of rural households (48 percent). A telephone is available in 25 percent of urban households but is almost nonexistent in rural areas. Furthermore, urban households are four times more likely to own a private car than rural households. Table 2.7 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Indonesia 2002-2003 Residence Durable consumer goods Urban Rural Total Radio 64.8 48.4 55.9 Television 79.3 47.8 62.2 Telephone 25.1 2.4 12.8 Refrigerator 31.9 6.2 17.9 Bicycle/rowboat 45.6 42.9 44.2 Motorcycle/motorboat 38.7 21.9 29.6 Car/truck 9.7 2.3 5.7 None of the above 8.4 22.8 16.2 Number of households 15,126 17,962 33,088 Figure 2.2 Housing Characteristics by Residence 98 29 74 58 85 7 37 47 91 17 54 52 Electricity Piped Water Private Toilet Brick/Concrete/Tile 0 20 40 60 80 100 Urban Rural Total IDHS 2002-2003 Characteristics of Households and Housing Characteristics | 19 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of the 2002-2003 Indonesia Demographic and Health Surveys (DHS) sample of ever-married women and cur- rently married men. Information on the basic background characteristics of the respondents in the survey is essential for the interpretation of findings presented later in the report. The chapter begins by describing basic background characteristics including age, marital status, educational level, and residential character- istics. More detailed information on education, literacy, and exposure to mass media are then discussed. This is followed by data on the employment and earnings of women, decisionmaking in the household, and attitudes on women’s position in relation to others in the household. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 presents the distributions of ever-married women age 15-49 and currently married men age 15-54 interviewed in the 2002-2003 IDHS by key background characteristics, including age, marital status, urban-rural residence, and educational level. The findings show that approximately one-third of the women and one in five men are under age 30. Table 3.1 also shows that 95 percent of the women are currently married, the remaining 5 percent are split halfway, either divorced or widowed. Forty-six percent of female and 47 percent of male respon- dents live in urban areas. Eight percent of ever-married women and 4 percent of currently married men have never attended any formal schooling. More women than men completed primary school (34 and 30 percent, respec- tively). Men tend to be more highly educated than women, with 28 percent of men having completed sec- ondary or higher education, compared with 21 percent of women. Women are becoming better educated. The percentage of ever-married women with no education declined (13 percent in 1997 compared with 8 percent in 2002-2003), while the percentage of those with some secondary school increased (28 percent in 1997 compared with 38 percent in 2002-2003). Looking at religion, 90 percent of both women and men are Muslim, followed by Chris- tian/Protestant or Catholic (7 to 8 percent). The small remaining percentage are Hindus, Buddhists, or belong to other religions. Differentials of the background characteristics by province are presented in Appendix Table A.3.1. The majority of respondents live in Java (62 percent of each women and men), followed by Su- matera (20 percent of women and 21 percent of men). Kalimantan Bali and Nusa Tenggara island groups have the lowest proportion of the respondents: 6 and 5 percent of women, respectively, and 5 percent each of men. Notable is the large difference between the weighted number of men and women and the un- weighted number in some provinces. The unweighted number represents the number that were actually interviewed in the 2002-2003 IDHS survey; whereas the weighted number represents that province’s pro- portional representation in the population based on the 2002 National Household Survey. For instance, South Sumatera has only 3 percent of the national population of ever-married women age 15-49 (as repre- sented by 809 cases), but 1,242 women were actually interviewed. This is mentioned so that the reader will understand that while weighted numbers are presented throughout the rest of the report, the province estimates may be based on a significantly larger number of unweighted male or female interviews. Characteristics of Respondents and Women’s Status | 21 Table 3.1 Distribution of respondents by background characteristics Percent distribution of ever-married women and currently married men by background characteris- tics, Indonesia 2002-2003 Number of ever-married women Number of currently married men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 3.2 956 924 0.1 11 22 20-24 13.1 3,875 3,892 5.1 426 429 25-29 18.2 5,375 5,528 14.6 1,214 1,220 30-34 18.4 5,428 5,529 17.6 1,462 1,580 35-39 17.6 5,181 5,112 18.9 1,572 1,538 40-44 15.5 4,581 4,403 16.8 1,395 1,366 45-49 13.9 4,086 4,095 14.7 1,224 1,178 50-54 na na na 12.1 1,007 977 Marital status Married 94.5 27,857 27,784 100.0 8,310 8,310 Divorced/separated 2.9 868 850 na na na Widowed 2.6 757 849 na na na Residence Urban 45.8 13,499 12,318 46.5 3,866 3,555 Rural 54.2 15,984 17,165 53.5 4,444 4,755 Education No education 7.9 2,335 2,248 4.1 341 330 Some primary 20.0 5,902 5,896 20.8 1,730 1,557 Completed primary 33.9 9,995 8,958 29.6 2,462 2,205 Some secondary 17.4 5,136 5,499 17.8 1,477 1,584 Secondary + 20.7 6,114 6,882 27.7 2,301 2,634 Religion Islam 89.7 26,447 24,528 90.0 7,480 6,898 Christian/Protestant 5.5 1,630 2,239 5.3 442 637 Catholic 2.2 643 916 1.9 160 237 Hindu 1.6 479 1,377 1.8 146 415 Buddhist 0.7 192 209 0.6 53 57 Confucian 0.1 21 47 0.1 6 14 Other 0.1 34 84 0.1 11 27 Missing 0.1 37 82 0.1 12 25 Total 100.0 29,483 29,483 100.0 8,310 8,310 Note: Education categories refer to the highest level of education attended, whether or not that level was com- pleted. na = Not applicable 3.2 EDUCATIONAL ATTAINMENT Table 3.2 shows the percent distribution of respondents by highest level of schooling attained or completed according to their age and place of residence. Young women and men are more likely to have attended school than the older generation. The distribution of respondents who have never attended school rises with increasing for both men and women. For example, 2 percent of ever-married women and 1 percent of currently married men age 20-24 have no formal education, compared with 17 percent of 22 | Characteristics of Respondents and Women’s Status women and 7 percent of men age 45-49. Similarly, 28 percent of women 20-24 completed some secon- dary school, compared with only 9 percent of women age 45-49. For the male respondents, 34 percent of men age 20-24 attended some secondary school, compared with 15 percent of men age 50-54. The IDHS data indicate that educational opportunities vary among the respondents according to their areas of residence. Urban women and men are more likely to go to school than their rural counter- parts. Five percent of urban women and 2 percent of urban men have not attended school, compared with 10 percent and 6 percent in rural areas, respectively. Comparing the median completed years of education shows a similar pattern, with urban women having a median of eight years of schooling and rural women having five years. Table 3.2 Educational attainment by background characteristics Percent distribution of women and men by highest level of schooling attended or completed, and median number of years of schooling, according to age and residence, Indonesia 2002-2003 Highest level of schooling attended or completed Age/residence No edu- cation Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years of schooling EVER-MARRIED WOMEN Age 15-19 1.5 11.1 40.5 38.3 8.5 0.1 100.0 956 5.9 20-24 1.7 10.2 39.2 27.6 18.9 2.5 100.0 3,875 6.0 25-29 2.4 10.7 37.6 21.8 22.1 5.4 100.0 5,375 6.0 30-34 4.9 15.2 33.2 18.2 21.7 6.7 100.0 5,428 5.9 35-39 9.3 24.2 32.0 12.9 14.7 6.8 100.0 5,181 5.5 40-44 14.7 30.8 30.8 10.3 8.6 4.8 100.0 4,581 5.1 45-49 17.3 32.6 29.3 9.9 7.8 3.2 100.0 4,086 5.0 Residence Urban 5.0 13.5 28.9 20.0 24.2 8.4 100.0 13,499 8.0 Rural 10.4 25.5 38.1 15.2 8.7 2.0 100.0 15,984 5.4 Total 7.9 20.0 33.9 17.4 15.8 4.9 100.0 29,483 5.6 CURRENTLY MARRIED MEN Age 15-19 * * * * * * 100.0 11 * 20-24 0.9 7.6 37.7 33.9 18.1 1.7 100.0 426 7.8 25-29 1.7 8.9 32.6 24.9 26.8 5.2 100.0 1,214 8.2 30-34 1.0 16.3 25.6 22.6 26.7 7.9 100.0 1,462 8.2 35-39 4.3 16.7 30.0 15.9 21.7 11.4 100.0 1,572 6.0 40-44 6.0 28.9 27.1 12.6 17.0 8.3 100.0 1,395 5.6 45-49 7.0 29.5 30.5 10.1 16.5 6.4 100.0 1,224 5.4 50-54 6.5 32.0 30.6 14.7 10.4 5.8 100.0 1,007 5.4 Residence Urban 1.9 14.0 24.0 18.4 29.5 12.3 100.0 3,866 8.5 Rural 6.0 26.7 34.5 17.2 12.2 3.3 100.0 4,444 5.5 Total 4.1 20.8 29.6 17.8 20.2 7.4 100.0 8,310 5.8 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Across provinces, differentials in educational attainment are significant (see Appendix Table A.3.2). The proportion of ever-married women who have never gone to school varies from 2 percent in Gorontalo province to 27 percent in West Nusa Tenggara. Furthermore, there are pronounced variations among provinces in the educational attainment and completion. Characteristics of Respondents and Women’s Status | 23 3.3 LITERACY The ability to read is an important personal asset allowing women and men increased opportuni- ties in life. Information on the distribution of literate population can help health and family planners to better reach their target population with their messages. In the 2002-2003 IDHS, the level of literacy is defined by the respondent’s ability to read none, part, or all of a sentence from a card in a language that the respondent is likely to be able to read. The questions assessing literacy were asked only of women and men who have not attended school or have attended only primary school. Respondents who attended at least secondary are considered literate. Table 3.3 shows that the literacy rate in Indonesia is quite high, with 86 percent of ever-married women and 93 percent of currently married men being literate. The percentage of women who cannot read at all is 13 percent compared with 7 percent of men. Younger respondents are more likely to be liter- ate than older respondents. While 96 percent of women and 98 percent of men age 20-24 are literate, the proportion drops to 72 percent for women and 88 percent for men age 45-49. Table 3.3 Literacy Percent distribution of ever-married women and currently married men by level of schooling attended and by level of literacy, and percent liter- ate, according to age and residence, Indonesia 2002-2003 No schooling or primary school Age/residence Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Missing Total Number Percent literate1 EVER-MARRIED WOMEN Age 15-19 46.9 45.2 4.2 2.4 1.3 100.0 956 96.3 20-24 48.9 43.4 3.9 3.4 0.4 100.0 3,875 96.2 25-29 49.3 40.0 4.9 4.9 0.8 100.0 5,375 94.3 30-34 46.6 38.8 6.4 7.7 0.5 100.0 5,428 91.9 35-39 34.5 39.4 10.0 15.5 0.6 100.0 5,181 83.9 40-44 23.7 39.5 13.2 23.2 0.5 100.0 4,581 76.4 45-49 20.9 37.2 13.5 27.7 0.7 100.0 4,086 71.5 Residence Urban 52.6 33.0 5.9 7.9 0.6 100.0 13,499 91.5 Rural 25.9 45.6 10.5 17.3 0.6 100.0 15,984 82.1 Total 38.2 39.8 8.4 13.0 0.6 100.0 29,483 86.4 CURRENTLY MARRIED MEN Age 15-19 * * * * * 100.0 11 * 20-24 53.8 41.7 2.6 2.0 0.0 100.0 426 98.0 25-29 56.8 37.9 1.8 3.3 0.1 100.0 1,214 96.6 30-34 57.1 35.3 3.4 4.1 0.1 100.0 1,462 95.8 35-39 49.0 39.8 5.7 5.3 0.1 100.0 1,572 94.6 40-44 38.0 42.0 9.9 10.0 0.2 100.0 1,395 89.9 45-49 33.0 46.6 8.8 11.4 0.2 100.0 1,224 88.4 50-54 30.9 45.9 12.5 10.3 0.4 100.0 1,007 89.3 Residence Urban 60.1 32.7 3.9 3.2 0.1 100.0 3,866 96.7 Rural 32.7 48.1 8.9 10.1 0.2 100.0 4,444 89.7 Total 45.5 40.9 6.5 6.9 0.2 100.0 8,310 92.9 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Refers to respondents who attended secondary school or higher and respondents who can read a whole sentence or part of a sentence 24 | Characteristics of Respondents and Women’s Status Urban residents have a higher level of literacy (92 percent of women and 97 percent of men) than their rural counterparts (82 and 90 percent, respectively). The variation in literacy rate by province is pre- sented in Appendix Tables A.3.3.1 and A.3.3.2. In most provinces, women are less literate than men. For women, West Nusa Tenggara has the lowest literacy rate (67 percent), while North Sulawesi has the high- est (96 percent). For men, East Nusa Tenggara has the lowest literacy rate (81 percent), whereas DKI Ja- karta province has the highest (99 percent). 3.4 EXPOSURE TO MASS MEDIA The 2002-2003 IDHS collected information on the exposure of respondents to the various com- mon mass media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television in a week. This information is useful in determining the media channels to use in dis- seminating family planning program and health information to target audiences. Furthermore, it is impor- tant for knowing the likelihood of reaching the respondents by media. Table 3.4 shows that television is the most popular mass media among ever-married women and currently married men (76 and 79 percent, respectively), followed by radio with 38 percent of women and 46 percent of men listening to the radio weekly. A much lower percentage of both women and men read a newspaper at least once a week (15 percent of women and 29 percent of men). Since 1997, there has been a significant decrease in the proportion of women who are exposed to all three media from 16 percent to the current level of 9 percent based on the 2002-2003 IDHS. Women and men living in urban areas and those age 25-39 are more likely to have access to all three types of media than their rural counterparts or those in other age groups. Findings also show that education is strongly associated with mass media exposure. For instance, 26 percent of women and 37 percent of men with secondary or higher education were likely to have access to all three types of me- dia versus 2 percent and 5 percent, respectively, of women and men with some primary education. Men have greater exposure to the mass media than women. This differential applies within every population group. Appendix Tables A.3.4.1 and A.3.4.2 show the variation in media exposure of ever-married women and currently married men according to province. It is important to note that the television expo- sure is extremely important in DKI Jakarta where 91 percent of women and 94 percent of men watch tele- vision programs weekly. DI Yogyakarta has the highest proportion of women who are exposed to all three media (24 percent), while West Nusa Tenggara has the lowest (4 percent). North Sulawesi has the highest proportion of men who are exposed to all three media (45 percent), whereas Bengkulu and Southeast Su- lawesi have the lowest (7 percent). It is interesting to note that 64 percent of women and 56 percent of men in East Nusa Tenggara are not exposed to any of the three mass media. Characteristics of Respondents and Women’s Status | 25 Table 3.4 Exposure to mass media Percentage of ever-married women and currently married men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background char- acteristics, Indonesia 2002-2003 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number EVER-MARRIED WOMEN Age 15-19 8.9 74.9 46.3 5.5 17.9 956 20-24 14.4 79.2 41.5 8.8 15.4 3,875 25-29 17.8 80.1 41.8 11.1 15.1 5,375 30-34 18.6 78.0 40.3 10.8 16.3 5,428 35-39 16.2 75.1 36.1 9.3 19.2 5,181 40-44 12.6 74.7 34.8 7.2 20.0 4,581 45-49 11.2 70.6 31.5 6.3 23.8 4,086 Residence Urban 23.7 87.4 39.0 13.6 9.6 13,499 Rural 8.0 67.1 37.4 5.0 25.3 15,984 Education No education 0.1 51.7 24.8 0.0 40.8 2,335 Some primary 2.9 64.8 30.2 1.5 28.5 5,902 Completed primary 7.2 75.7 38.8 4.4 18.4 9,995 Some secondary 16.9 83.7 41.0 10.5 11.4 5,136 Secondary + 44.5 92.0 47.3 25.7 4.8 6,114 Total 15.2 76.4 38.1 9.0 18.1 29,483 CURRENTLY MARRIED MEN Age 15-19 * * * * * 11 20-24 25.6 85.8 51.6 17.2 10.5 426 25-29 30.7 80.1 49.4 17.5 14.5 1,214 30-34 32.5 80.1 50.5 20.0 12.3 1,462 35-39 31.9 81.8 48.6 21.3 12.6 1,572 40-44 28.6 79.0 44.0 16.5 15.0 1,395 45-49 25.4 79.9 36.3 13.3 14.8 1,224 50-54 24.6 70.5 40.2 12.2 22.2 1,007 Residence Urban 43.1 87.7 47.7 25.5 8.0 3,866 Rural 16.9 72.1 43.8 10.0 20.3 4,444 Education No education 0.9 49.2 26.3 0.7 43.9 341 Some primary 7.1 69.6 37.2 4.5 23.2 1,730 Completed primary 15.6 74.5 44.8 9.6 17.8 2,462 Some secondary 32.5 85.4 50.2 18.3 8.6 1,477 Secondary + 62.0 92.4 52.8 36.7 4.3 2,301 Total 29.1 79.3 45.6 17.2 14.6 8,310 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 26 | Characteristics of Respondents and Women’s Status 3.5 EMPLOYMENT 3.5.1 Employment Status Respondents in the 2002-2003 IDHS were asked a number of questions to elicit their employment status at the time of the survey and the continuity of their employment in 12 months prior to the survey. The measurement of women’s employment, however, is difficult. This difficulty arises largely because some of the work that women do, especially work on family farms, family businesses, or in the informal sector, is often not perceived by women themselves as employment and hence is not reported as such. To avoid underestimating women’s employment, the IDHS asked women several questions to ascertain their employment status. First, women were asked, “Aside from your own housework, are you currently work- ing?” Women who answered “no” to this question were then asked, “As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business, or work on the fam- ily farm or in the family business. Are your currently doing any of these things or any other work?” Women who answered “no” to this question were asked, “Have you done any work in the last 12 months?” Women are currently employed if they answer “yes” to either of the first two questions. Women who answer “yes” to the third question are not currently employed but have worked in the past 12 months. Table 3.5.1 and Figure 3.1 show that 51 percent of ever-married women are currently employed, 2 percent were employed at some time during the past 12 months, and 47 percent of women were not em- ployed at all in the same period. Older women, women in rural areas, and women who have no education are more likely to have been employed. Moreover, women who have more children are more likely to be currently employed. Table 3.5.2 shows that almost all currently married men are currently employed (97 percent), while 1 percent were employed at some time in the past year. Appendix Tables A.3.5.1 and A.3.5.2 present the percent distribution of ever-married women and currently married men by employment status, according to province. The highest proportion of currently employed women is found in Bengkulu province (75 percent) and the lowest in Central Kalimantan (27 percent). For men, the variation in employment status by province is negligible. Characteristics of Respondents and Women’s Status | 27 Table 3.5.1 Employment status: women Percent distribution of ever-married women by employment status, according to background characteristics, Indonesia 2002-2003 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not em- ployed in the 12 months preceding the survey Total Number of women Age 15-19 25.3 3.5 71.2 100.0 956 20-24 33.0 3.4 63.6 100.0 3,875 25-29 41.0 1.6 57.3 100.0 5,375 30-34 52.7 1.5 45.9 100.0 5,428 35-39 56.2 1.7 42.1 100.0 5,181 40-44 62.3 1.5 36.2 100.0 4,581 45-49 63.9 1.1 35.0 100.0 4,086 Marital status Married 49.5 1.8 48.7 100.0 27,857 Divorced/widowed 71.6 2.1 26.3 100.0 1,626 Number of living children 0 44.7 3.8 51.5 100.0 2,422 1-2 47.7 2.0 50.2 100.0 15,344 3-4 55.7 1.3 43.0 100.0 8,418 5+ 56.5 0.9 42.6 100.0 3,299 Residence Urban 44.6 1.8 53.6 100.0 13,499 Rural 55.9 1.8 42.2 100.0 15,984 Education No education 67.0 1.4 31.5 100.0 2,335 Some primary 59.5 2.0 38.5 100.0 5,902 Completed primary 49.4 1.7 48.8 100.0 9,995 Some secondary 39.9 1.7 58.4 100.0 5,136 Secondary + 47.4 2.0 50.6 100.0 6,114 Total 50.7 1.8 47.4 100.0 29,483 IDHS 2002-2003 Figure 3.1 Employment Status of Women Age 15-49 Currently employed 51% Employed in the last 12 months, but not currently employed 2% Did not work in past 12 months 47% 28 | Characteristics of Respondents and Women’s Status Table 3.5.2 Employment status: men Percent distribution of currently married men by employment status, according to back- ground characteristics, Indonesia 2002-2003 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not em- ployed in the 12 months preceding the survey Total Number of men Age 15-19 100.0 0.0 0.0 100.0 11 20-24 93.6 3.7 2.4 100.0 426 25-29 96.5 2.1 1.4 100.0 1,214 30-34 97.7 1.9 0.4 100.0 1,462 35-39 98.0 1.2 0.7 100.0 1,572 40-44 98.7 0.3 1.0 100.0 1,395 45-49 96.9 1.1 2.0 100.0 1,224 50-54 96.5 1.3 2.2 100.0 1,007 Number of living children 0 95.1 2.8 2.1 100.0 705 1-2 97.5 1.3 1.1 100.0 4,244 3-4 97.2 1.7 1.2 100.0 2,437 5+ 98.2 0.3 1.5 100.0 925 Residence Urban 96.3 1.8 1.9 100.0 3,866 Rural 98.1 1.1 0.7 100.0 4,444 Education No education 97.1 0.3 2.6 100.0 341 Some primary 97.9 1.0 1.1 100.0 1,730 Completed primary 97.2 2.1 0.6 100.0 2,462 Some secondary 96.8 1.4 1.9 100.0 1,477 Secondary + 97.3 1.2 1.4 100.0 2,301 Total 97.3 1.4 1.3 100.0 8,310 3.5.2 Occupation Table 3.6.1 presents the percent distribution of ever-married women who were employed in the 12 months preceding the survey by occupation, according to background characteristics. The data show that 45 percent of ever-married women work in agriculture, of whom more than half (24 percent) work on their own land. The majority of women who work in the nonagricultural sector are engaged in sales and services occupations (32 percent). The respondent’s occupation varies by age; younger women who work in agriculture tend to work on family land, while older women tend to work on their own land. In the nonagricultural sector, the en- gagement of women in sales and services increases with age. Rural and less educated women are more likely to work in agriculture than other women. Urban and better educated women are much more likely to work in sales and services professions. Characteristics of Respondents and Women’s Status | 29 Table 3.6.1 Occupation: women Percent distribution of ever-married women employed in the 12 months preceding the survey by occupation, according to background characteristics, Indonesia 2002-2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Agricultural Nonagricultural –––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––– Pro- Someone fessional/ Sales Un- Number Background Own Family else’s Rented technical/ and Skilled skilled Agri- of characteristic land land land land managerial Clerical services manual manual culture Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.4 15.2 16.0 0.6 0.3 0.4 21.9 18.9 0.0 0.9 100.0 276 20-24 21.2 8.1 10.5 1.6 2.9 2.3 28.9 23.5 0.1 0.7 100.0 1,411 25-29 22.3 4.6 12.5 2.1 5.2 3.7 30.6 17.0 0.4 1.3 100.0 2,291 30-34 23.1 4.5 12.6 2.0 7.4 3.8 31.3 14.2 0.0 0.9 100.0 2,939 35-39 25.0 2.7 13.9 2.2 9.3 3.0 31.2 10.6 0.0 1.7 100.0 2,998 40-44 24.7 2.7 16.7 2.2 6.7 1.8 34.1 8.9 0.2 1.8 100.0 2,925 45-49 28.5 2.8 17.2 3.3 4.9 1.9 32.7 6.5 0.0 1.8 100.0 2,656 30 Marital status Married 25.1 4.1 14.0 2.3 6.7 2.8 30.4 12.6 0.1 1.4 100.0 14,297 Divorced/widowed 15.9 3.4 17.0 1.7 2.5 1.5 44.9 11.2 0.0 1.0 100.0 1,198 Number of living children 0 16.4 5.3 12.6 1.2 8.0 6.4 30.2 17.6 0.6 0.9 100.0 1,175 1-2 21.8 4.5 13.7 1.7 6.9 3.4 31.2 15.4 0.0 1.1 100.0 7,628 3-4 27.1 3.2 14.5 2.7 6.6 1.7 32.7 9.2 0.1 2.0 100.0 4,800 5+ 33.0 3.9 16.8 4.1 2.6 0.4 31.2 6.1 0.0 1.2 100.0 1,892 Residence Urban 4.2 0.7 6.7 0.7 10.1 5.8 51.2 18.7 0.3 1.1 100.0 6,267 Rural 38.1 6.4 19.4 3.3 3.8 0.7 18.3 8.3 0.0 1.6 100.0 9,228 Education No education 31.5 3.7 31.2 2.2 0.0 0.0 24.9 4.9 0.1 1.0 100.0 1,599 Some primary 32.3 3.7 23.1 2.8 0.2 0.1 26.0 9.5 0.0 2.1 100.0 3,630 Completed primary 29.6 5.4 13.5 2.8 0.1 0.1 31.2 15.5 0.0 1.3 100.0 5,114 Some secondary 21.1 5.5 6.7 2.0 1.1 0.9 44.1 16.8 0.3 1.2 100.0 2,133 Secondary + 4.6 1.4 1.3 0.7 31.3 13.1 33.5 12.2 0.3 1.0 100.0 3,019 Total 24.4 4.1 14.3 2.2 6.3 2.7 31.6 12.5 0.1 1.4 100.0 15,495 Table 3.6.2 shows the percent distribution of currently married men who were employed in the 12 months preceding the survey by occupation, according to background characteristics. Thirty-eight per- cent of currently married men work in agriculture, with more than half (19 percent) working on their own land. In the nonagricultural sector, similarly to women, men are by far more likely to work in sales and services than in other professions (38 percent). Men show the same variations across subgroups as women. | Characteristics of Respondents and Women’s Status Table 3.6.2 Occupation: men Percent distribution of currently married men employed in the 12 months preceding the survey by occupation, according to background charac- teristics, Indonesia 2002-2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Agricultural Nonagricultural ––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Some- Pro- one fessional/ Sales Un- Number Background Own Family else’s Rented technical/ and Skilled skilled Agri- of characteristic land land land land Missing managerial Clerical services manual manual culture Missing Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 * * * * * * * * * * * * * 11 20-24 12.4 10.8 15.6 0.2 0.4 2.8 0.6 42.8 11.4 0.0 3.0 0.0 100.0 414 25-29 15.3 5.9 10.9 2.0 1.7 4.3 3.1 41.2 13.2 0.4 1.9 0.1 100.0 1,196 30-34 15.0 3.5 10.2 1.6 1.8 7.3 3.9 44.7 9.6 0.0 2.3 0.1 100.0 1,456 35-39 17.7 2.4 12.6 0.9 1.2 9.9 6.0 38.4 8.6 0.1 1.8 0.4 100.0 1,559 40-44 22.3 1.1 12.7 1.2 0.8 9.4 5.3 33.4 10.6 0.3 2.3 0.5 100.0 1,381 45-49 20.5 2.2 14.7 2.3 1.0 7.9 4.8 34.8 9.0 0.0 2.9 0.0 100.0 1,200 50-54 30.8 2.4 12.6 2.2 0.8 7.3 6.3 29.6 5.3 0.0 2.6 0.1 100.0 985 Number of living children 0 13.3 5.8 15.2 0.8 0.8 7.6 2.4 44.6 8.0 0.0 1.5 0.0 100.0 690 1-2 17.4 3.8 10.7 1.3 1.4 7.9 4.6 39.1 11.1 0.2 2.4 0.1 100.0 4,194 3-4 20.8 2.0 13.5 1.7 1.0 8.4 6.1 35.9 8.4 0.0 2.0 0.3 100.0 2,409 5+ 28.8 2.5 15.5 3.0 1.1 3.6 3.2 31.2 6.9 0.1 3.7 0.5 100.0 911 Residence Urban 3.8 0.8 5.9 0.9 1.3 11.9 6.6 52.9 13.4 0.2 2.0 0.2 100.0 3,793 Rural 32.6 5.5 18.0 2.1 1.1 3.9 3.0 24.7 6.3 0.1 2.5 0.2 100.0 4,411 Education No education 34.6 4.1 25.6 3.4 1.3 0.0 0.0 23.3 4.5 0.0 3.1 0.0 100.0 333 Some primary 29.2 3.6 23.1 1.6 0.9 0.4 0.2 30.4 7.2 0.2 3.1 0.0 100.0 1,710 Completed primary 22.8 3.5 16.5 2.2 1.8 0.6 1.6 37.9 10.6 0.0 2.6 0.1 100.0 2,446 Some secondary 18.2 4.1 5.5 1.8 0.3 3.6 3.1 49.3 11.4 0.4 1.7 0.4 100.0 1,449 Secondary + 6.6 2.3 2.4 0.4 1.4 24.2 13.1 37.9 9.8 0.0 1.6 0.4 100.0 2,266 Total 19.3 3.3 12.4 1.6 1.2 7.6 4.7 37.8 9.6 0.1 2.3 0.2 100.0 8,203 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 3.6 FORM OF WOMEN’S EARNINGS Table 3.7 shows the percent distribution of ever-married women who were employed during the 12-month period prior to the survey by type of earnings received, type of employer, and continuity of em- ployment, and how this varies by type of employment (agricultural or nonagricultural). Fifty-six percent of women receive their earnings in cash; 8 percent receive them as cash and in-kind; and 35 percent re- ceive no payment (Figure 3.2). The majority of women who work in agriculture (58 percent) receive no pay, while for those women in nonagricultural professions, only 16 percent reported no pay. Characteristics of Respondents and Women’s Status | 31 Table 3.7 Employment characteristics Percent distribution of ever-married 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 nonagri- cultural), Indonesia 2002-2003 Employment characteristic Agricultural work Non- agricultural work Total Type of earnings Cash only 29.1 79.1 56.1 Cash and in-kind 6.5 4.1 5.2 In-kind only 6.8 0.4 3.3 Not paid 57.5 16.4 35.2 Missing 0.1 0.0 0.2 Total 100.0 100.0 100.0 Type of employer Employed by family member 60.4 14.9 35.7 Employed by nonfamily member 29.4 46.1 38.4 Self-employed 9.8 38.6 25.4 Missing 0.3 0.4 0.4 Total 100.0 100.0 100.0 Continuity of employment All year 55.3 91.4 74.8 Seasonal 40.2 5.3 21.3 Occasional 3.9 3.3 3.5 Missing 0.6 0.1 0.4 Total 100.0 100.0 100.0 Number of women1 7,087 8,390 15,495 1 Total includes women with missing information on type of employment who are not shown separately. IDHS 2002-2003 Figure 3.2 Type of Earnings of Employed Women Age 15-49 Cash only 56% No payment 35% In-kind only 3% Cash and in-kind 5% 32 | Characteristics of Respondents and Women’s Status Six in 10 women who work in agriculture sector are employed by a family member, but women who work in the nonagricultural sector are more likely to be employed by a non-family member (46 per- cent) or self employed (39 percent) or. Nine in 10 women who work in nonagricultural jobs work all year, compared with about half of women in agriculture (55 percent). Forty percent of ever-married women in the agriculture sector work seasonally. 3.7 CONTROL OVER WOMEN’S EARNINGS AND WOMEN’S CONTRIBUTION TO HOUSEHOLD EXPENDITURES Employed women who earn cash for their work were asked about who the main decisionmaker is with regard to the use of their earnings. This information allows the assessment of women’s control over their own earnings. In addition, they were asked about the proportion of household expenditures met by their earnings to assess the relative importance of women’s earnings. This information not only allows an evaluation of the relative importance of women’s earnings in the household economy, but has implica- tions for the empowerment of women. It is expected that employment and earnings are more likely to empower women if they perceive their earnings as important for meeting the needs of their households. Table 3.8 shows how respondent’s degree of control over the use of their earnings and the extent to which the earnings of women meet household expenditures vary by background characteristics. Table 3.8 shows that 68 percent of ever-married women report they alone decide how their earn- ings are to be spent, and 29 percent decide jointly with someone else (mostly husbands). Only 2 percent of women reported that someone else makes the decision on how their earnings are used. The table also shows that the respondent’s degree of control over the use of their earnings varies little by background characteristics, except for marital status. Divorced, separated, or widowed women are significantly more likely to decide alone how their earning are used than women who are married (98 percent versus 65 percent). Thirty-two percent of married women report that this decision is made jointly with someone else, compared with only 1 percent of divorced, separated, or widowed women. When asked about the proportion of household expenditures that are met by their earnings, 43 percent of women reported that their earnings support all of the household expenditures and 42 percent reported that their earnings support half or more. Across subgroups, the data show that older women, those who are widowed, separated, or divorced, rural women, and those who are less educated are more likely to meet all of their household’s expenditures. Appendix Table A.3.6 shows the provincial variations of the decision on use of earnings in the household and women’s contribution to household expenditures. The proportion of women employed for cash in the past year who decide alone on how their earnings are used ranges from 88 percent in South Sulawesi to 26 percent in North Sulawesi. Women in Central Sulawesi and North Sulawesi are the least likely to fully support their households financially (12 and 15 percent, respectively), while women in West Nusa Tenggara and Bangka Belitung are the most likely to do so (62 and 60 percent, respectively). Characteristics of Respondents and Women’s Status | 33 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of ever-married women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Indonesia 2002- 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person who decides how Proportion of household earnings are used expenditures met by earnings –––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––– Someone Almost Less Half Number Background Self else none/ than or of characteristic only Jointly1 only2 Missing Total none half more All Missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 68.8 18.7 7.5 5.1 100.0 4.8 7.8 43.9 43.5 0.0 100.0 142 20-24 67.2 28.5 3.0 1.3 100.0 3.6 12.5 46.2 36.0 1.7 100.0 829 25-29 65.0 32.5 1.9 0.6 100.0 3.3 14.1 44.4 37.4 0.8 100.0 1,425 30-34 67.8 29.6 2.0 0.6 100.0 2.9 12.5 46.2 37.7 0.7 100.0 1,832 35-39 66.4 31.1 0.9 1.6 100.0 2.9 10.6 40.4 45.3 0.8 100.0 1,861 40-44 69.1 28.5 1.2 1.3 100.0 2.3 7.8 39.7 49.1 1.1 100.0 1,803 45-49 72.0 25.4 1.4 1.3 100.0 2.3 8.2 38.9 50.1 0.5 100.0 1,611 Marital status Married 64.6 32.3 1.8 1.3 100.0 2.7 11.4 44.3 40.8 0.9 100.0 8,544 Divorced/widowed 98.2 1.2 0.3 0.2 100.0 4.1 4.2 24.9 66.2 0.6 100.0 959 Number of living children 0 68.7 26.5 3.9 0.9 100.0 5.0 15.9 48.3 29.1 1.8 100.0 799 1-2 68.1 29.5 1.2 1.2 100.0 2.9 10.9 44.3 41.3 0.6 100.0 4,904 3-4 66.4 31.0 1.5 1.1 100.0 2.7 9.8 39.6 46.7 1.1 100.0 2,850 5+ 71.6 23.9 2.6 1.9 100.0 1.0 7.5 34.8 55.9 0.8 100.0 950 Residence Urban 69.4 28.1 1.4 1.1 100.0 3.1 12.1 44.5 39.5 0.7 100.0 5,071 Rural 66.4 30.3 2.0 1.3 100.0 2.5 9.0 39.8 47.7 1.0 100.0 4,432 Education No education 71.1 25.9 1.6 1.3 100.0 1.6 5.3 29.4 62.7 1.0 100.0 946 Some primary 71.3 25.7 1.3 1.7 100.0 2.2 8.6 34.5 53.6 1.2 100.0 2,022 Completed primary 70.0 27.3 1.7 1.0 100.0 2.2 8.8 41.3 46.9 0.8 100.0 2,766 Some secondary 68.0 28.8 2.1 1.1 100.0 3.2 12.8 46.4 37.1 0.5 100.0 1,268 Secondary + 61.9 35.3 1.8 1.0 100.0 4.4 15.4 52.6 27.0 0.8 100.0 2,501 Total 68.0 29.1 1.7 1.2 100.0 2.8 10.7 42.3 43.3 0.9 100.0 9,503 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 With husband or someone else 2 Includes husband Table 3.9 shows the control of currently married working women over their own earnings by the extent to which their earnings meet household expenditures. Sixty-five percent of currently married women make their own decisions on how their earnings are used. Interestingly, women who do not con- tribute any cash in the household expenditures are much more likely to make the decision on cash spend- ing alone (80 percent) compared with those who cover all of their household expenditures (67 percent). Almost all women who are not currently married make decisions on how their cash will be used by themselves (98 percent), regardless of their contribution to the household expenditures (data not shown). 34 | Cha racteristics of Respondents and Women’s Status Table 3.9 Women’s control over earnings Percent distribution of currently married women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to the proportion of household expenditures met by earnings, Indonesia 2002-2003 Contribution to household expenditures Self only Jointly with husband Jointly with someone else Husband only Someone else only Missing Total Number of women Almost none/none 80.1 17.3 0.5 0.9 0.1 1.2 100.0 230 Less than half 61.2 35.9 0.0 1.9 0.1 0.9 100.0 973 Half or more 63.4 33.2 0.1 2.4 0.2 0.8 100.0 3,782 All 66.7 30.9 0.1 0.9 0.1 1.4 100.0 3,484 Total 64.6 32.2 0.1 1.7 0.2 1.3 100.0 8,544 Note: Total includes 75 women with missing information on contribution to household expenditures 3.8 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the 2002-2003 IDHS obtained information from both ever-married women and currently married men on some other measures of women’s status and empowerment. Specifically, questions were asked on women’s participation in specific household decisions, on their degree of acceptance of wife beating, and on their opinions about when a wife should be able to refuse sex with her husband. These data provide insights into women’s control over their lives and their environment and their attitudes toward traditional gender roles, which are important aspects of women’s empowerment relevant for understanding women’s demographic and health behaviors. 3.8.1 Women’s Participation in Decisionmaking To assess women’s decisionmaking autonomy, information was collected on women’s participa- tion in five different types of decisions: on the respondent’s own health care, on making large household purchases, on making household purchases for daily needs, on visits to family or relatives, and on what food should be cooked each day. Table 3.10 shows the percent distribution of ever-married women ac- cording to who in the household usually has the final say on each one of specified decisions. Women are considered to participate in decisionmaking if they make decisions alone or jointly with their husband or someone else. Currently married women are significantly less likely to make the specified household decisions by themselves than women who are currently not married. For instance, about half of currently married women (54 percent) decide by themselves on their own health care versus nine in ten (91 percent) of women who are not married. Characteristics of Respondents and Women’s Status | 35 Table 3.10 Women’s participation in decisionmaking Percent distribution of ever-married women by person who has the final say in making specific decisions, according to current marital status and type of decision, Indonesia 2002-2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married women Women who are not married1 ––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––– Jointly Decision Jointly Decision Jointly with Some not with Some- not with some- Hus- one made/ Number some- one made/ Number Self hus- one band else not of Self one else not of Decision only band else only only applicable Total women only else only applicable Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Own health care 54.0 32.1 0.2 12.7 0.3 0.6 100.0 27,857 90.8 5.6 3.1 0.5 100.0 1,626 Large household purchases 13.9 66.4 0.3 17.8 0.8 0.7 100.0 27,857 76.2 11.6 7.7 4.4 100.0 1,626 Daily household purchases 82.6 13.0 0.8 2.4 0.8 0.3 100.0 27,857 87.0 6.8 5.5 0.7 100.0 1,626 Visits to family or relatives 12.5 74.2 0.2 10.8 0.3 1.9 100.0 27,857 79.4 12.4 4.0 4.1 100.0 1,626 What food to cook each day 89.8 5.9 1.3 1.3 1.1 0.5 100.0 27,857 86.5 7.3 4.8 1.2 100.0 1,626 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Divorced or widowed women Table 3.11 and Figure 3.3 show how women’s participation in decisionmaking varies by back- ground characteristics. The findings show that 68 percent of women have a final say (alone or jointly) in all five specific areas of decisionmaking. It is noteworthy that a large majority of women (above 80 per- cent) have a final say alone or jointly in each of the five specified areas of decisionmaking. Women’s de- cisionmaking autonomy generally increases with age. For example, while 56 percent of women age 15-19 have a final say in all the specified decisions, this is true for 72 percent of women age 45-49. Divorced, separated, or widowed women are more likely to have a final say in all specified decisions than currently married women, 83 versus 68 percent, respectively. Furthermore, women’s decisionmaking autonomy increases with their education level. Seventy-four percent of women with secondary or higher education have a final say in all the specified decisions, compared with 65 percent of women with no education. Appendix Table A.3.7 presents women’s participation in decisionmaking by province. There are significant variations in the proportion of women who have a final say in all five specified areas of deci- sionmaking, ranging from 50 percent in West Kalimantan to 91 percent in North Sulawesi. 36 | Characteristics of Respondents and Women’s Status Table 3.11 Women's participation in decisionmaking Percentage of ever-married women who say that they alone or jointly have the final say in specific decisions, by background char- acteristics, Indonesia 2002-2003 Alone or jointly have final say in: Background characteristic Own health care Making large pur- chases Making daily pur- chases Visits to family or relatives What food to cook each day All speci- fied deci- sions None of the specified decisions Number of women Age 15-19 80.8 71.8 89.3 78.3 89.5 56.0 2.4 956 20-24 85.0 78.0 95.3 85.7 95.2 63.0 0.4 3,875 25-29 86.3 80.5 95.9 87.1 96.5 67.5 0.4 5,375 30-34 87.3 83.5 97.4 87.9 97.4 68.7 0.4 5,428 35-39 87.8 82.0 97.4 88.4 98.1 70.4 0.4 5,181 40-44 87.5 82.6 96.6 86.7 97.7 71.1 0.6 4,581 45-49 88.4 80.8 96.2 88.8 97.6 71.8 0.7 4,086 Marital status Married 86.3 80.7 96.5 86.9 97.1 67.6 0.5 27,857 Divorced/widowed 96.4 87.9 93.7 91.8 93.8 83.1 1.4 1,626 Number of living children 0 85.1 77.7 92.2 84.7 90.8 62.6 1.1 2,422 1-2 87.8 82.5 97.1 87.5 97.2 69.6 0.4 15,344 3-4 86.2 80.7 96.2 87.6 97.6 68.7 0.6 8,418 5+ 85.6 77.9 95.9 86.2 97.9 66.5 0.7 3,299 Residence Urban 87.5 81.9 97.0 87.6 97.1 69.0 0.5 13,499 Rural 86.4 80.3 95.8 86.8 96.7 68.0 0.6 15,984 Education No education 83.5 77.1 95.2 86.2 97.8 64.9 0.9 2,335 Some primary 85.6 78.0 95.6 86.6 97.1 66.2 0.8 5,902 Completed primary 86.5 80.3 96.6 86.0 97.5 67.1 0.5 9,995 Some secondary 86.8 81.7 95.8 86.9 96.1 68.6 0.6 5,136 Secondary + 90.1 86.3 97.3 90.3 96.0 74.0 0.2 6,114 Employment Not employed 85.0 78.6 95.7 84.6 96.5 64.2 0.7 14,482 Employed for cash 90.6 85.1 97.9 90.7 97.3 74.2 0.2 9,105 Employed not for cash 85.7 80.9 95.5 88.2 97.3 69.9 0.6 5,834 Missing 90.1 83.3 86.7 79.0 84.2 64.1 4.7 62 Total 86.9 81.1 96.3 87.2 96.9 68.4 0.5 29,483 Characteristics of Respondents and Women’s Status | 37 Figure 3.3 Number of Decisions in Which Women Participate in the Final Say 87 81 96 87 97 68 0 1 2 3 4 5 Number of Decisions 0 20 40 60 80 100 Pe rc e n t o f W om e n IDHS 2002-2003 3.8.2 Attitude Toward Wife Beating To assess women’s degree of acceptance of wife beating, the IDHS survey asked ever-married women, “Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations?” The five situations presented to women for their opinion were: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses to have sex with him. The first five columns in Table 3.12 show how acceptance of wife beating varies for each reason. The last column gives the per- centages of women who feel that a husband beating his wife is justified for at least one of the specified reasons. Data show that younger women, those who are married, and women who live in rural areas are more likely than other women to agree with at least one of the specified reason. It is worth noting that women who have no final say in household decisions are the least likely to agree with wife-beating when compared to other women. However, women who participate in one or two household decisions are more likely to agree with at least one of the specified reasons for wife-beating than women who participate in more household decisions. According to Appendix Table A.3.8, women in West Nusa Tenggara province are the most likely to agree with at least one specified reason for a husband to beat his wife (64 percent), while women resid- ing in DKI Jakarta are the least likely to do so (13 percent). 38 | Characteristics of Respondents and Women’s Status Table 3.12 Women's attitude toward wife beating Percentage of ever-married women who agree that a husband is justified in hitting or beating his wife for specific rea- sons, by background characterisitics, Indonesia 2002-2003 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the chil- dren Refuses to have sex with him Agrees with at least one specified reason Number of women Age 15-19 3.6 6.8 24.9 24.3 9.2 29.9 956 20-24 3.2 5.4 21.0 22.9 7.6 28.6 3,875 25-29 3.1 5.7 22.0 23.6 7.0 29.3 5,375 30-34 2.6 4.8 17.8 18.9 6.9 24.2 5,428 35-39 3.3 4.5 15.8 17.3 6.7 22.9 5,181 40-44 2.6 5.3 16.0 17.3 7.0 22.2 4,581 45-49 2.8 5.8 15.2 16.3 5.9 20.4 4,086 Marital status Married 2.9 5.2 18.3 19.7 6.9 25.0 27,857 Divorced/widowed 4.3 7.3 16.9 16.5 7.4 21.3 1,626 Number of living children 0 3.5 6.2 21.3 19.7 7.2 26.3 2,422 1-2 2.7 4.7 17.8 19.4 6.4 24.4 15,344 3-4 2.9 5.5 17.8 18.9 7.2 24.4 8,418 5+ 4.2 6.7 19.0 21.7 8.7 26.8 3,299 Residence Urban 2.2 4.1 14.9 16.5 5.8 21.6 13,499 Rural 3.6 6.3 21.1 22.1 7.9 27.6 15,984 Education No education 3.7 8.0 18.1 18.1 8.3 22.6 2,335 Some primary 3.4 6.0 18.9 20.0 7.6 25.6 5,902 Completed primary 3.4 5.7 19.0 20.3 7.6 25.3 9,995 Some secondary 2.5 4.6 20.2 21.6 6.6 27.6 5,136 Secondary + 2.0 3.4 14.6 16.8 4.9 21.7 6,114 Employment Not employed 2.6 4.5 17.8 19.1 6.7 24.1 14,482 Employed for cash 3.0 5.5 17.1 18.2 6.3 23.5 9,105 Employed not for cash 3.8 6.9 21.1 23.0 8.5 28.7 5,834 Number of decisions in which woman has final say1 0 4.8 7.0 15.6 12.7 7.9 18.9 159 1-2 5.4 9.7 25.6 26.1 10.8 33.5 1,280 3-4 2.8 6.3 21.8 21.8 7.7 28.8 7,871 5 2.9 4.6 16.4 18.3 6.4 22.8 20,173 Total 3.0 5.3 18.2 19.6 6.9 24.8 29,483 Note: Total includes 62 women with missing information on employment 1 Either by herself or jointly with others Characteristics of Respondents and Women’s Status | 39 3.8.3 Women’s Attitude Toward Refusing Sex with Husband The extent of control women have over when and with whom they have sex has important impli- cations for demographic and health outcomes. It is also an indicator of women’s empowerment because it measures women’s degree of acceptance of norms that make women believe that they do not have the right to refuse to have sex with their husbands for any reason. In the 2002-2003 IDHS, women were asked whether a wife is justified in refusing to have sex with her husband under four circumstances: she knows her husband has a sexually transmitted disease (STD); she knows her husband has sex with other women; she has recently given birth; and she is tired or not in the mood. These four circumstances for which women’s opinions are sought have been chosen because they are effective in combining issues of women’s rights and consequences for women’s health. Table 3.13 shows the percentage of ever-married women who say that a wife is justified in refus- ing to have sex with her husband for specific reasons by background characteristics. Findings show that 62 percent of women agree that a wife is justified in refusing sex with her husband for all the specified reasons. On the other hand, 7 percent of women agree with none of the specified reasons. Respondents are most likely to agree with a woman’s right to refuse sex if she gave birth recently (91 percent). Women are the least likely to agree that a wife has a right to refuse sex to her husband if she is tired or not in the mood (69 percent). Justification for a wife to refuse sex to her husband does not have a clear pattern with women’s background characteristics, except for women’s education and employment status. Better- educated women and women who are employed for cash are more likely to agree with all of the reasons for a wife to refuse sex to her husband than other women. Appendix Table A.3.9 shows that 76 percent of women in East Java and East Kalimantan agree with all of the specified reasons for a wife to refuse sex with her husband, compared with 32 percent of women in South Sumatera. 40 | Characteristics of Respondents and Women’s Status Table 3.13 Women’s attitude toward refusing sex with husband Percentage of ever-married women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, according to background characteristics, Indonesia 2002-2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife is justified in refusing sex with her husband if she: ––––––––––––––––––––––––––––––––––––––– Percentage Percentage Knows Knows who agree who agree husband has husband Is tired agree with with none a sexually has sex Has or not all of the of the Number Background transmitted with other recently in the specified specified of characteristic disease women given birth mood reasons reasons women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 83.7 84.7 89.6 67.7 61.5 8.0 956 20-24 85.5 85.0 92.3 69.7 61.5 5.7 3,875 25-29 86.5 84.9 90.9 67.3 60.6 6.1 5,375 30-34 86.2 84.2 91.4 70.0 62.6 6.0 5,428 35-39 84.4 83.0 89.9 70.3 62.5 7.2 5,181 40-44 83.0 81.3 90.0 69.2 61.1 7.6 4,581 45-49 81.9 80.4 88.9 68.3 60.8 8.9 4,086 Marital status Married 84.9 83.4 90.9 69.2 61.5 6.6 27,857 Divorced/widowed 80.4 80.1 85.0 66.7 61.7 11.8 1,626 Number of living children 0 84.3 82.3 88.3 68.5 60.8 7.5 2,422 1-2 86.7 85.0 91.8 70.3 63.4 6.1 15,344 3-4 83.2 82.2 90.0 69.2 61.1 7.4 8,418 5+ 79.6 78.6 87.8 63.8 54.8 8.8 3,299 Residence Urban 88.5 86.0 93.1 69.2 62.9 5.0 13,499 Rural 81.4 81.0 88.4 69.0 60.4 8.5 15,984 Education No education 76.1 77.6 85.3 68.1 57.5 11.1 2,335 Some primary 78.4 79.2 87.3 68.7 60.1 9.8 5,902 Completed primary 84.0 83.3 89.8 68.2 60.4 7.2 9,995 Some secondary 89.2 86.1 93.5 70.5 63.5 4.7 5,136 Secondary + 91.3 86.8 94.3 70.1 64.7 3.8 6,114 Employment Not employed 86.0 84.6 90.8 68.2 61.5 6.6 14,482 Employed for cash 85.8 83.9 91.7 71.5 64.3 6.3 9,105 Employed not for cash 79.4 78.8 88.1 67.8 57.8 8.8 5,834 Number of decisions in which woman has final say1 0 57.6 61.1 69.0 49.9 37.6 26.3 159 1-2 71.6 73.5 80.8 58.3 45.9 13.9 1,280 3-4 83.5 81.8 91.2 69.1 60.0 6.3 7,871 5 86.2 84.6 91.1 69.9 63.3 6.5 20,173 Number of reasons wife beating is justified 0 84.9 84.2 90.3 69.7 63.4 7.7 22,166 1-2 83.9 79.6 91.5 67.6 55.8 4.4 5,247 3-4 83.0 81.8 91.1 63.9 53.4 4.8 1,590 5 87.6 83.9 88.5 74.4 68.3 6.8 479 Total 84.7 83.3 90.6 69.1 61.6 6.9 29,483 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 62 women with missing information on employment 1 Either by herself or jointly with others Characteristics of Respondents and Women’s Status | 41 3.9 LIFE STYLE MEASURES The use of tobacco in the household adversely affects the health status of all household members, including individuals who are not smoking. To assess the use of tobacco, the 2002-2003 IDHS included questions on tobacco use. Respondents were asked whether they smoke regularly, the type of tobacco they use and how much they smoked in the past 24 hours. When interpreting the data on tobacco use, it is important to recognize the fact that some respondents may have a tendency to under-report tobacco use 42 | C out of embarrassment. Table 3.14 shows that two percent of ever married women smoke tobacco regularly. Among women who smoke, 30 percent reported smoking 1-2 cigarettes and 26 percent smoked 3-5 cigarettes in the past 24 hours. It is of interest to note that 19 percent of women who smoke reported having smoked 10 or more cigarettes in the past 24 hours. Table 3.14 Use of smoking tobacco Percentage of ever-married women who smoke cigarettes or tobacco and percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics and maternity status, Indonesia 2002-2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cigarettes Uses tobacco Does ––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––– not Number Don't Number Background Other use of know/ of characteristic Cigarettes tobacco tobacco women 0 1-2 3-5 6-9 10+ missing Total smokers –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.2 0.0 98.8 956 * * * * * * 100.0 11 20-34 0.9 0.0 99.0 14,679 6.6 36.9 19.7 15.7 10.9 10.3 100.0 134 35-49 3.0 0.3 96.7 13,848 1.7 26.7 29.3 18.2 22.2 2.0 100.0 418 Residence Urban 2.4 0.0 97.5 13,499 2.7 27.6 24.5 21.7 20.6 2.9 100.0 330 Rural 1.5 0.3 98.2 15,984 3.0 34.4 29.2 11.0 17.1 5.4 100.0 234 Education No education 2.3 0.4 97.3 2,335 1.8 23.5 30.6 20.0 23.7 0.4 100.0 53 Some primary 2.3 0.5 97.2 5,902 2.5 32.4 35.5 18.5 7.6 3.5 100.0 137 Completed primary 1.7 0.1 98.2 9,995 2.3 41.7 22.0 14.8 11.9 7.2 100.0 167 Some secondary 2.1 0.0 97.9 5,136 3.7 16.3 16.8 21.7 39.7 1.9 100.0 109 Secondary + 1.6 0.0 98.3 6,114 3.9 27.6 29.7 13.4 22.4 3.1 100.0 98 Maternity status Pregnant 1.0 0.0 98.9 1,627 * * * * * * 100.0 17 Breastfeeding (not pregnant) 0.6 0.1 99.2 6,017 0.3 31.4 20.6 19.3 12.0 16.5 100.0 38 Neither 2.3 0.2 97.5 21,839 2.8 30.2 27.2 17.2 20.2 2.4 100.0 509 Total 1.9 0.2 97.9 29,483 2.9 30.4 26.4 17.3 19.1 3.9 100.0 564 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. haracteristics of Respondents and Women’s Status FERTILITY 4 The 2002-2003 Indonesia Demographic and Health Survey (IDHS) collected information on cur- rent, past, and cumulative fertility. This chapter presents the results of the survey on levels, trends, and differentials in fertility based on the analysis of the birth histories collected from ever-married women age 15-49 interviewed during the survey. Women were first asked a series of questions to determine the total number of live births that occurred in their lifetime. Second, 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. Information from birth history is used to assess current fertility (age-specific and total fertility) and completed fertility (number of children ever born alive to the woman), as well as to look at other fertility-related factors, such as age at first birth, birth intervals, and teenage childbearing. From population censuses and surveys in Indonesia, fertility and mortality rates have been esti- mated using indirect methods, and are based on the number of children ever born and children surviving. The fertility measures presented here are calculated directly from the birth history. There are some limi- tations with both procedures. Because interviews were conducted only with living women, there was no information on the fertility of women who have died. The fertility rates would be biased if the mortality of women of childbearing age was high and if there were significant differences in fertility between living and dead women. In Indonesia, neither of these appears to be the case. Also, the census and the 2002-2003 IDHS collected data only from ever-married women. Since most births in Indonesia occur within marriage, the number of births to single women is negligible. The accuracy of fertility data is affected primarily by underreporting of births (especially children who died in early infancy) and misreporting of the date of birth. Errors in underreporting of births affect the estimates of fertility levels, while misreporting of dates of births can distort estimates of fertility trends. If these errors vary by socioeconomic characteristics of the women, the differentials in fertility will also be affected. 4.1 CURRENT FERTILITY LEVELS AND TRENDS 4.1.1 Fertility Levels The most widely used measures of current fertility are the total fertility rates (TFRs) and the age- specific fertility rates (ASFRs).1 The TFR is calculated by summing the ASFRs and can be defined as the total number of births a woman would have by the end of her childbearing period if she were to pass through those years bearing children at the currently observed rates of age-specific fertility. To obtain the most recent estimates of fertility—without compromising the statistical precision of estimates and in an attempt to avoid possible displacement of births from five to six years before the survey—the three-year period preceding the survey is used. It corresponds roughly to the calendar period 2000-2002 . 1 Numerators of the ASFRs are calculated by summing the number of live births that occurred in the period 1 to 36 months preceding the survey (determined by the date of interview and the date of birth of the child) and classifying them by the age (in five-year groups) of the mother at the time of birth (determined by the mother’s date of birth). The denominators of the rates are the number of woman-years lived in each of the specified five-year groups during the 1 to 36 months preceding the survey. Since only women who had ever married were interviewed in the IDHS, the numbers of women in the denominators of the rates were inflated by factors calculated from information in the Household Questionnaire on populations ever married in order to produce a count of all women. Never-married women are presumed not to have given birth. Fertility | 43 Table 4.1 presents the current TFRs and ASFRs for In- donesia by urban-rural residence. The results indicate that if fertility were to remain constant at the current age-specific rates measured in the survey (for the 36 months preceding the sur- vey), a woman in Indonesia would, on average, bear 2.6 chil- dren in her lifetime. The TFRs for urban and rural areas are 2.4 and 2.7 children per woman, respectively. The TFR measured in the 2002-2003 IDHS survey is slightly lower than the corre- sponding rate of 2.8 obtained in the 1997 IDHS survey. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the sur- vey, by urban-rural residence, Indonesia 2002-2003 Residence Age group Urban Rural Total 15-19 41 63 51 20-24 119 144 131 25-29 143 144 143 30-34 103 95 99 35-39 64 68 66 40-44 18 21 19 45-49 2 5 4 TFR 2.4 2.7 2.6 GFR 85 93 89 CBR 22.1 21.7 21.9 Note: Rates for age group 45-49 may be slightly biased because of truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population A further examination of the patterns of fertility in urban and rural areas reveals that rural fertility is higher than urban fertility at almost every age. The peak of childbearing among all women is age 25-29 (143 children per 1,000 women). Results from the 2002-2003 IDHS indicate that the age pattern of fertility is the same as that observed in the 1997 IDHS. However, increased childbearing in urban areas is lim- ited to women age 25-29, while in rural areas childbearing has increased for women age 20-29. Thus, urban women tend to start limiting their family size (or spacing births) at an earlier age than do rural women. Table 4.1 also presents the general fertility rate (GFR) and the crude birth rate (CBR) for the three years preceding the survey. The GFR is the number of live births per 1,000 women age 15-44. The CBR is the number of births per 1,000 popula- tion. In Indonesia, the GFR is 89 and the CBR is 22. Figure 4.1 shows that the TFR in Indonesia is lower than that in selected Southeast Asian coun- tries, such as Cambodia, Philippines, Malaysia and Myanmar, although not as low as that in Singapore, Thailand, or Vietnam. 4.7 4.0 3.7 2.9 2.8 2.6 2.5 1.9 1.7 1.4 Laos Cambodia Philippines Malaysia Myanmar Indonesia Brunei Vietnam Thailand Singapore 0.0 1.0 2.0 3.0 4.0 5.0 Children per Woman Figure 4.1 Total Fertility Rate of Southeast Asian Countries Source: 2003 United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) Population Data Sheet, DHS reports for Cambodia, Philippines, Vietnam, and Indonesia 44 | Fertility 4.1.2 Differentials in Current and Completed Fertility Table 4.2 shows fertility differentials by urban-rural residence, education, and wealth index quintile. In the 2002-2003 IDHS, information was collected on household’s ownership of a number of consumer items, such as radio, television, or car, as well as on dwelling characteristics and sanitation facili- ties. The wealth index is constructed by as- signing a weight or factor score to each household asset through principal components analysis. These scores were summed by household, and individuals were ranked ac- cording to the total score of the household in which they resided. The sample was then di- vided into population quintiles—five groups with the same number of individuals in each. Table 4.2 shows that in addition to urban-rural differentials, some variation exists in the TFR by woman’s education and socio- economic status (measured by the wealth in- dex). Results of the 2002-2003 IDHS show an inverted U-shaped relationship between edu- cation and fertility. Women with primary edu- cation have a TFR that is somewhat higher than that of other women. A sharper variation in TFR is seen by wealth index: The TFR for women in the lowest (poorest) quintile is 3.0 births per woman, compared with 2.2 births for women in the highest (richest) quintile. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, per- centage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by back- ground characteristics, Indonesia 2002-2003 Background characteristic Total fertility rate1 Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 2.4 3.8 4.0 Rural 2.7 4.5 4.1 Education No education 2.6 1.7 4.3 Some primary 2.7 3.2 4.4 Completed primary 2.7 4.5 4.0 Some secondary 2.5 4.1 3.7 Secondary+ 2.5 5.1 3.0 Wealth index quintile Lowest 3.0 4.8 4.4 Second 2.6 4.2 4.3 Middle 2.7 3.9 4.1 Fourth 2.5 4.1 4.0 Highest 2.2 3.7 3.4 Total 2.6 4.1 4.0 1 Women age 15-49 Table 4.2 also shows that at the time of the survey, 4 percent of women were pregnant. The pro- portions of pregnant women in urban areas, those with no education, and women in the richest quintile are lower than those for the other population subgroups. The last column of Table 4.2 shows the mean number of children ever born (CEB) to women 40-49. This is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period and thus represents completed fertility. If fertility had re- mained stable over time, the two fertility measures, TFR and CEB, would be equal or similar. The find- ings show that the mean number of children ever born to women age 40-49 (4.0 children per woman) is much higher than the TFR for the three years preceding the survey (2.6 children per woman), suggesting a substantial recent reduction in fertility. Appendix Table A.4.1 and Figure 4.2 show provincial differentials in fertility. Fertility variations across provinces are large, with TFRs ranging from 1.9 children per woman in DI Yogyakarta to 3.6 and 4.1 children per woman in Southeast Sulawesi and East Nusa Tenggara, respectively. Figure 4.2 shows the TFR levels by province in descending order. Fertility | 45 1.9 2.1 2.1 2.1 2.2 2.3 2.4 2.4 2.6 2.6 2.6 2.7 2.7 2.8 2.8 2.8 2.9 3.0 3.0 3.0 3.2 3.2 3.2 3.2 3.6 4.1 DI Yogyakarta Central Java East Java Bali DKI Jakarta South Sumatera Bangka Belitung West Nusa Tenggara Banten North Sulawesi South Sulawesi Jambi Lampung West Java East Kalimantan Gorontalo West Kalimantan North Sumatera Bengkulu South Kalimantan West Sumatera Riau Central Kalimantan Central Sulawesi Southeast Sulawesi East Nusa Tenggara Number of Children per Woman IDHS 2002-2003 Figure 4.2 Total Fertility Rate by Province 4.1.3 Trends in Fertility Besides comparing the current and completed fertility, the trend in fertility can be assessed by comparing the current TFR with estimates from previous DHS surveys. Figure 4.3 shows the TFRs for the 1991, 1994, 1997 and 2002-2003 IDHS surveys. There is a steady decline from 3.0 children per woman in 1988-1991 to 2.6 children per woman in 1999-2001. Figure 4.3 Trends in the Total Fertility Rate, 1991-2003 IDHS 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 0.0 1.0 2.0 3.0 4.0 C hi ld re n pe r W o m an Note: The 2002-2003 IDHS did not include Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua province. Previous surveys included East Timor. 3.0 2.9 2.8 2.6 46 | Fertility Further information on the fertility trends comes from analysis of the fertility of age cohorts of women in the 2002-2003 IDHS survey (i.e., by examining trends within age groups). Table 4.3 shows ASFRs for successive five-year periods preceding the survey. Because women age 50 and older were not interviewed in the survey, the rates for calendar periods preceding the survey will be increasingly trun- cated by the exclusion of the fertility experience of older women. For example, fertility rates cannot be calculated for women age 45-49 for the period five years or more preceding the survey, because women in that age group would have been 50 years or older at the time of the survey. Table 4.3 shows that over time there has been a decline in ASFRs in every age group. For all age groups, the decline is steepest between the periods 15-19 and 10-14 years preceding the survey. The re- duction in TFRs over time is due primarily to signifi- cant declines in fertility in age groups 20-24 and 25- 29. 4.2 CHILDREN EVER BORN AND CHILDREN SUR- VIVING Table 4.4 presents the distribution of ever- married women and currently married women by the number of children ever born (CEB). The table also shows the mean number of children ever born and the mean number of living children for each five-year age group. The distribution of children ever born is the outcome of lifetime fertility. It reflects the accumulation of births over the past 30 years to women inter- viewed in the IDHS. The data may be subject to some recall error, which typically is greater for older than for younger women. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preced- ing the survey, by mother’s age at the time of the birth, Indonesia 2002-2003 Number of years preceding survey Mother’s age at birth 0-4 5-9 10-14 15-19 15-19 54 69 83 100 20-24 135 150 166 200 25-29 139 149 165 200 30-34 101 112 123 [139] 35-39 61 69 [87] a 40-44 19 [27] a a 45-49 [5] a a a Note: Age-specific fertility rates are per 1,000 women. Esti- mates in brackets are truncated. a Less than 125 woman-years of exposure The information on parity is useful for understanding a number of related issues. First, these re- sults show how average family size varies across age groups. They also offer insight into the impact of marital status on women’s fertility. Virtually all women in Indonesia are married by age 30 (see Table 9.1). Thus, differences in the parity between ever-married women and currently married women primarily reflect the effects of widowhood and divorce on fertility. In addition, the percentage of women in their 40s who have never had children provides an indicator of the level of primary infertility,2 or the inability to bear children. Voluntary childlessness is rare in developing countries like Indonesia; that is, married women in their late 40s with no live births are predominantly unable to bear children. Finally, a compari- son of the mean number of children ever born and surviving children among women in their 40s reflects the extent and impact of mortality on the population. Table 4.4 shows that, on average, women have given birth to less than one child by their mid-20s, more than two children by their mid-30s, and about four children by their mid- to-late 40s. Differences in the mean number of children ever born between all women and currently married women are large at the younger age groups, after which they narrow. 2 It should be pointed out here that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more children, or secondary infertility. Fertility | 47 Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Indonesia 2002-2003 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of chil- dren ever born Mean number of living children ALL WOMEN 15-19 91.7 7.5 0.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,531 0.09 0.09 20-24 52.0 35.0 10.7 1.9 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,593 0.63 0.61 25-29 20.0 33.6 30.9 11.6 2.6 1.0 0.2 0.1 0.0 0.0 0.0 100.0 6,234 1.47 1.39 30-34 10.7 17.0 38.5 19.2 8.8 3.4 1.7 0.5 0.2 0.1 0.0 100.0 5,767 2.20 2.05 35-39 6.6 8.4 25.4 28.0 15.3 8.1 4.4 2.0 0.9 0.7 0.2 100.0 5,342 3.01 2.78 40-44 5.5 6.0 16.9 23.5 17.8 11.0 8.2 4.5 2.9 1.7 2.1 100.0 4,679 3.78 3.37 45-49 4.9 6.2 10.2 18.0 18.9 15.5 9.8 6.4 4.9 1.9 3.2 100.0 4,168 4.30 3.74 Total 30.8 17.5 19.0 13.5 8.0 4.7 2.9 1.6 1.0 0.5 0.6 100.0 39,315 1.99 1.81 CURRENTLY MARRIED WOMEN 15-19 43.0 51.0 4.9 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 912 0.64 0.60 20-24 18.4 59.5 18.6 3.2 0.3 0.1 0.0 0.0 0.0 0.0 0.0 100.0 3,761 1.08 1.03 25-29 6.9 38.5 36.3 13.6 3.1 1.2 0.3 0.1 0.0 0.0 0.0 100.0 5,217 1.72 1.62 30-34 4.5 17.2 41.4 20.9 9.5 3.7 1.8 0.6 0.2 0.1 0.0 100.0 5,150 2.37 2.21 35-39 3.5 7.8 26.1 29.2 16.2 8.6 4.6 2.1 1.0 0.8 0.2 100.0 4,953 3.15 2.91 40-44 2.9 5.6 16.8 24.7 18.5 11.4 8.4 4.6 3.1 1.7 2.3 100.0 4,294 3.92 3.49 45-49 2.6 6.2 10.1 18.8 18.5 16.0 10.6 6.4 5.0 2.1 3.7 100.0 3,570 4.44 3.85 Total 7.4 23.1 25.6 18.3 10.5 6.2 3.9 2.0 1.3 0.7 0.9 100.0 27,857 2.66 2.42 4.3 BIRTH INTERVALS Information on the length of birth intervals provides insight into birth spacing patterns. Research shows that children born too soon after a previous birth are at an increased risk of dying, particularly when the interval between births is less than 24 months. Maternal health is also jeopardized when births are closely spaced. Table 4.5 shows the distribution of births in the five years preceding the survey by the number of months since the previous birth, according to background characteristics. First births have been omitted from the table. Results of 2002-2003 IDHS indicate that the overall median birth interval is 54 months, which is much higher than the median birth interval of the 1997 IDHS and 1994 IDHS (45 and 42 months, respectively). Thirteen percent of births in Indonesia occur less than 24 months after the birth of a previous child. About six in ten births (57 percent) take place four or more years after a previous birth. The 2002-2003 IDHS results indicate that birth intervals tend to be shorter for younger mothers. For example, the median number of months since preceding birth for women age 15-19 is 32 months, ver- sus 65 months for women age 40-49. Additionally, the interval between births is much lower for births after the preceding sibling has died. This relationship is largely a result of replacement fertility, whereby a mother will get pregnant again soon after the death of a child. The median birth interval length is short- ened by 25 months when the preceding sibling dies. 48 | Fertility 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, according to background characteristics, Indonesia 2002-2003 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48+ Total Number of non-first births Median number of months since preceding birth Age 15-19 20.4 13.0 33.3 16.2 17.1 100.0 61 31.8 20-29 8.0 9.0 20.9 16.8 45.2 100.0 3,706 44.7 30-39 3.9 5.8 12.8 13.4 64.1 100.0 4,962 61.2 40-49 4.7 6.4 15.7 9.9 63.2 100.0 1,083 64.7 Birth order 2-3 5.5 6.9 15.0 13.6 59.0 100.0 6,691 56.3 4-6 4.4 6.7 17.1 16.8 55.0 100.0 2,451 52.5 7+ 11.4 11.3 25.8 12.8 38.6 100.0 670 36.7 Sex of preceding birth Male 5.1 7.1 15.9 14.2 57.7 100.0 4,898 54.6 Female 6.2 7.1 16.7 14.4 55.5 100.0 4,913 53.3 Survival of preceding birth Living 4.5 6.8 15.9 14.5 58.3 100.0 9,182 55.5 Dead 21.7 12.0 22.3 11.9 32.1 100.0 629 30.9 Residence Urban 6.6 7.4 15.9 14.4 55.7 100.0 4,417 52.5 Rural 4.9 6.9 16.6 14.3 57.4 100.0 5,395 55.1 Education No education 9.0 7.2 13.8 14.2 55.8 100.0 617 54.8 Some primary 5.9 5.4 17.5 13.9 57.2 100.0 1,855 55.7 Completed primary 3.7 6.5 14.0 13.8 62.0 100.0 3,425 58.9 Some secondary 6.0 7.8 17.9 13.2 55.1 100.0 1,710 51.8 Secondary + 7.3 9.1 18.2 16.4 49.0 100.0 2,205 47.6 Total 5.6 7.1 16.3 14.3 56.6 100.0 9,811 54.2 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. Appendix Table A.4.2 shows that median birth intervals vary substantially across provinces, ranging from 38 months in North Sumatera and South Sulawesi to 69 months in East Java. 4.4 AGE AT FIRST BIRTH One of the factors that determine the fertility in a population is the average age at first birth. Women who marry early are typically exposed to pregnancy for a longer period. Thus, early childbearing generally leads to a large family size and is often associated with increased health risks for the mother and child. A rise in the median age at first birth is typically a sign of transition to lower fertility levels. Fertility | 49 Table 4.6 presents the percentage of women who have given birth by specified ages and the me- dian age at first birth, according to current age. The results indicate that women are delaying having their first child. The distribution is similar to that in the 1997 IDHS and shows that the prevalence of early childbearing has declined over time. While 7 percent of women age 45-49 had their first child by age 15, less than 1 percent of women age 15-19 did so. Again, the percentage of women who had their first child by age 18 years is highest among women age 45-49 (30 percent) and lowest among women age 20-24 (12 percent). The increase in the median age at first birth among Indonesian women can also be observed in the last column of Table 4.6—20.1 years for women age 45-49 to 21.9 years for women age 25-29. Table 4.6 Age at first birth Among all women, percentage who gave birth by exact age, and median age at first birth, by current age, Indonesia 2002-2003 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.7 na na na na 91.7 6,531 a 20-24 1.3 11.9 27.5 na na 52.0 6,593 a 25-29 2.5 14.9 32.9 51.1 70.5 20.0 6,234 21.9 30-34 4.2 18.4 35.9 53.6 72.1 10.7 5,767 21.6 35-39 4.9 24.3 43.1 59.5 76.2 6.6 5,342 20.9 40-44 7.0 27.5 47.5 65.4 81.5 5.5 4,679 20.2 45-49 7.0 30.2 49.5 66.1 81.9 4.9 4,168 20.1 na = Not applicable a Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 4.7 presents data on differentials in median age at first birth among women age 25-49 by age, residence, and education. Results of the 2002-2003 IDHS indicate that there are wide differences in the age at which women have their first child. Overall, the median age at first birth is 21.0 years, which is slightly higher than the results of the 1997 IDHS and 1994 IDHS (20.8 and 20.3 years, respectively). Ur- ban women start childbearing two years later than their rural counterparts (22.0 years compared with 20.2 years). A positive relationship exists between educational level and median age at first birth. Women with secondary or higher education start childbearing about six years later (median age 25 years) than do women with no education or some primary education (median ages 19.4 and 19.2 years, respectively). This relationship is true for all age groups. Appendix Table A.4.3 shows the median age at first birth among women age 25-49 by province. The median age at first birth varies substantially by province, ranging from 19.8 years in West Java to 23.2 years in East Nusa Tenggara. West Java is the only province where the median age at first birth is less than 20.0 years. 50 | Fertility Table 4.7 Median age at first birth Median age at first birth among women age 25-49, by current age, residence, and education, Indonesia 2002-2003 Current age Residence/education 25-20 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 23.2 22.9 21.8 20.7 20.7 22.0 Rural 20.7 20.5 20.0 19.8 19.6 20.2 Education No education 19.4 19.3 18.5 19.5 19.9 19.4 Some primary 19.2 18.7 19.4 19.2 19.3 19.2 Completed primary 20.1 20.2 19.7 19.8 19.4 19.9 Some secondary 21.5 21.5 21.2 20.9 20.6 21.2 Secondary + a 25.3 24.8 24.1 23.8 25.0 Total 21.9 21.6 20.9 20.2 20.1 21.0 a Omitted because less than 50 percent of the women had a birth before reaching the be- ginning of the age group 4.5 TEENAGE FERTILITY The issue of adolescent fertility is important for both health and social reasons. Adolescent child- bearing has potentially negative demographic and social consequences. Children born to very young mothers face an increased risk of illness and death. Teenage mothers themselves, especially those under age 18, are more likely to experience adverse pregnancy outcomes and maternity-related mortality than more mature women. In addition, early childbearing limits a teenager’s ability to pursue educational op- portunities and also can limit her access to job opportunities. Table 4.8 shows the percentage of women age 15-19 who are mothers or pregnant with their first child by background characteristics. Teenagers who have never married are assumed to have had no preg- nancies and no births. Findings show that 10 percent of adolescent women have started childbearing: 8 percent are already mothers, and 2 percent are currently pregnant with their first child. Since 1997, there has been a slight decrease in the proportion of adolescents who have begun childbearing—from 12 per- cent in the 1997 IDHS to the current level of 10 percent. The proportion of teenagers already on the family formation pathway rises very rapidly with age. While only 1 percent of 15-year-olds have started childbearing, 25 percent of women have had a baby or are pregnant with their first child by age 19. There is a substantial difference in fertility among teenagers who live in urban and rural areas. In rural areas the proportion of teenagers who have started childbearing is twice the proportion in urban ar- eas (14 and 7 percent, respectively). Women’s educational attainment is inversely related to the initiation of childbearing; women with less education are more likely to have begun childbearing during adolescence than women with higher education. While 14 percent of women with no formal education have become mothers, only 4 percent of women with secondary or higher education have done so. Fertility | 51 Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Indonesia 2002-2003 Percentage who are: Background characteristic Mothers Pregnant with first child Percentage who have begun childbearing Number of women Age 15 0.7 0.5 1.2 1,223 16 1.5 1.0 2.5 1,328 17 4.2 2.4 6.6 1,254 18 13.6 2.4 16.0 1,463 19 20.9 3.8 24.7 1,263 Residence Urban 6.4 0.9 7.3 3,297 Rural 10.5 3.2 13.7 3,191 Education No education 13.5 0.1 13.6 81 Some primary 12.8 3.4 16.2 452 Completed primary 18.5 4.2 22.7 1,240 Some secondary 5.4 1.3 6.7 3,860 Secondary+ 4.0 1.6 5.7 910 Total 8.3 2.0 10.4 6,531 Variation in teenage pregnancy and motherhood also exists among provinces. Appendix Table A.4.4 shows that the highest percentage of teenagers who have begun childbearing is in Central Kaliman- tan (19 percent) and Jambi (18 percent), while the lowest is in North Sumatera (4 percent) and DKI Jakarta (5 percent). 52 | Fertility KNOWLEDGE AND EVER USE OF FAMILY PLANNING 5 5.1 KNOWLEDGE OF FAMILY PLANNING METHODS Acquiring knowledge about fertility control is an important step toward gaining access to contra- ceptive methods and using a suitable method in a timely and effective matter. In the 2002-2003 Indonesia Demographic and Health Survey (IDHS), data on knowledge of family planning methods were obtained by first asking the respondent to name the ways that a couple can use to delay or avoid a pregnancy or birth. If the respondent did not spontaneously mention a particular method, the interviewer described the method and asked the respondent if she recognized it. Descriptions were included in the questionnaire for nine modern family planning methods: female sterilization, male sterilization, the pill, intrauterine device (IUD), injectables, implants, condom, intravag/diaphragm, and lactational amenorrhea method (LAM). Information was also collected on two traditional methods: periodic abstinence and withdrawal. All other traditional or folk methods mentioned by the respondent, such as herbs (jamu) and abdominal massage (pijat), were recorded as well. Table 5.1 presents knowledge of contraceptive methods for ever-married and currently married women, as well as for currently married men. The results show that almost all ever-married and currently married women (99 percent each) know at least one method of family planning. Simi- lar proportions of ever-married women (98 percent) and currently married women (99 percent) have knowledge of at least one modern method. Knowledge of at least one contraceptive method or a modern method is almost universal among currently married men (97 and 96 percent, respectively). About four in ten of both women and men know at least one traditional method. Table 5.1 Knowledge of contraceptive methods Percentage of ever-married women, currently married women, and currently married men who know any contraceptive method, by spe- cific method, Indonesia 2002-2003 Method Ever- married women Currently married women Currently married men Any method 98.5 98.7 96.7 Any mode

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