Indonesia -Demographic and Health Survey - 2008

Publication date: 2008

Indonesia Demographic and Health Survey 2007 Indonesia Demographic and Health Survey 2007 Statistics Indonesia Jakarta, Indonesia National Family Planning Coordinating Board Jakarta, Indonesia Ministry of Health Jakarta, Indonesia Macro International Calverton, Maryland USA December 2008 This report summarizes the findings of the 2007 Indonesia Demographic and Health Survey (IDHS) carried out by Statistics Indonesia (Badan Pusat Statistik—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 supported the local costs of the survey. The United Nations Population Fund (UNFPA) provided funds for questionnaire printing and shipping. Macro International provided limited technical assistance under the auspices of the Demographic and Health Surveys (MEASURE DHS) program, which is supported by the U.S. Agency for International Development (USAID). The Ford Foundation provided funds for the expansion of the sample in 15 districts in Java, to allow estimates at the individual district level. UNICEF provided funds to allow estimates at the individual district level in Nanggroe Aceh Darussalam Province and for two districts in North Sumatera Province, Nias and South Nias. 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, Macro International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone 301-572-0200; Fax 301-572-0999; Email: reports@macrointernational.com; Internet: www.measuredhs.com). Recommended citation: Statistics Indonesia (Badan Pusat Statistik—BPS) and Macro International. 2008. Indonesia Demographic and Health Survey 2007. Calverton, Maryland, USA: BPS and Macro International. Contents | iii CONTENTS Page TABLES AND FIGURES . ix PREFACE - BPS. xix PREFACE - BKKBN. xxi SUMMARY OF FINDINGS . xxiii MAP OF INDONESIA . xxx 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 1.7 Questionnaires. 6 1.8 Data Collection. 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND HOUSING CHARACTERISTICS 2.1 Household Population by Age, Sex, and Residence. 9 2.2 Household Composition . 10 2.3 Children’s Living Arrangements and Parental Survival . 11 2.4 Educational Level of Household Population . 12 2.4.1 Educational Attainment of the Household Population . 12 2.4.2 School Attendance Rates . 14 2.5 Housing Characteristics and Household Possessions . 15 2.5.1 Household Environment . 15 2.5.2 Drinking Water. 15 2.5.3 Household Sanitation Facilities and Other Characteristics . 17 2.6 Household Possessions. 19 2.7 Wealth Index . 20 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3.1 Characteristics of Survey Respondents. 23 3.2 Educational Attainment . 24 3.3 Literacy . 25 3.4 Exposure to Mass Media . 27 3.5 Employment . 28 3.5.1 Employment status. 28 3.5.2 Occupation . 31 3.6 Form of Women’s Earnings . 32 iv │ Contents 3.7 Control Over Women’s Earnings and Women’s Contribution to Household Expenditures . 34 3.8 Women’s Empowerment . 36 3.8.1 Women’s Participation in Decision Making. 36 3.8.2 Attitudes toward Wife Beating . 40 3.8.3 Women’s Attitudes toward Refusing Sexual Intercourse with Husband. 42 3.9 Lifestyle Measures . 44 CHAPTER 4 FERTILITY 4.1 Current Fertility Levels and Trends . 48 4.1.1 Fertility Levels. 48 4.1.2 Differentials in Current and Completed Fertility . 50 4.1.3 Trends in Fertility. 52 4.2 Children Ever Born and Children Surviving. 53 4.3 Birth Intervals. 54 4.4 Age at First Birth. 55 4.5 Teenage Fertility. 57 CHAPTER 5 KNOWLEDGE AND EVER USE OF FAMILY PLANNING 5.1 Knowledge of Family Planning Methods . 59 5.2 Exposure to Family Planning Messages . 62 5.2.1 Exposure to Mass Media . 62 5.2.2 Dissemination of Family Planning Information . 65 5.3 Discussion of Family Planning with Husband. 66 5.4 Attitudes of Couples Toward Family Planning. 67 5.5 Knowledge of the Fertile Period . 68 5.6 Ever Use of Contraception . 69 CHAPTER 6 CURRENT USE OF FAMILY PLANNING 6.1 Current Use of Family Planning . 73 6.2 Differentials in Contraceptive Use by Background Characteristics. 74 6.3 Trends in Contraceptive Use . 77 6.4 Contraceptive Use by Women’s Status . 78 6.5 Quality of Use. 79 6.5.1 Pill Use Compliance . 79 6.5.2 Quality of Use of Injectables . 80 6.6 Informed Choice. 81 6.7 Problems with Current Method . 83 6.8 Cost and Accessibility of Methods . 83 6.9 Source of Methods. 85 6.10 Timing of Sterilization . 87 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Additional Children. 89 7.2 Need for Family Planning Services. 92 Contents | v 7.3 Ideal Family Size . 94 7.4 Unplanned And Unwanted Fertility. 96 7.5 Fertility Preferences by Women’s Status . 97 CHAPTER 8 NONUSE AND INTENTION TO USE FAMILY PLANNING 8.1 Discontinuation Rates . 99 8.2 Reasons for Discontinuation of Contraceptive Use . 100 8.3 Intention to Use Contraception in the Future . 102 8.4 Reasons for Nonuse . 103 8.5 Preferred Method . 104 CHAPTER 9 OTHER PROXIMATE DETERMINANTS OF FERTILITY 9.1 Current Marital Status . 105 9.2 Age at First Marriage . 106 9.3 Age at First Sexual Intercourse. 108 9.4 Recent Sexual Activity . 110 9.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility. 112 9.6 Termination of Exposure . 114 CHAPTER 10 INFANT AND CHILD MORTALITY 10.1 Assessment of Data Quality . 115 10.2 Levels and Trends in Infant and Child Mortality. 117 10.3 Mortality Differentials. 119 10.4 Demographic Characteristics. 122 10.5 Mortality by Women’s Status. 123 10.6 Perinatal Mortality. 124 10.7 High-risk Fertility Behavior . 126 CHAPTER 11 MATERNAL HEALTH 11.1 Antenatal Care . 129 11.1.1 Antenatal Care . 129 11.1.2 Number of Antenatal Care Visits and Timing of First Visit . 130 11.1.3 Components of Antenatal Care . 132 11.1.4 Tetanus Toxoid Injections . 133 11.1.5 Complications of Pregnancy . 134 11.2 Delivery . 135 11.2.1 Place of Delivery. 135 11.2.2 Assistance during Delivery. 136 11.2.3 Delivery Characteristics . 139 11.2.4 Preparation for Delivery . 140 11.2.5 Complications during Delivery . 141 11.3 Postnatal Care. 142 11.4 Maternal Health Care and Women’s Status . 143 11.5 Problems in Accessing Health Care . 144 11.6 Birth Registration. 145 vi │ Contents CHAPTER 12 IMMUNIZATION OF CHILDREN 12.1 Immunization Coverage for Children Age 12-23 Months . 150 12.2 Immunization Coverage for Children Age 12-59 Months . 154 12.3 Hepatitis B Immunization. 154 CHAPTER 13 CHILDHOOD DISEASES 13.1 Prevalence and Treatment of Acute Respiratory Infections and Fever . 157 13.2 Disposal of Children’s Stools . 159 13.3 Prevalence of Diarrhea. 161 13.4 Knowledge of ORS. 162 13.5 Diarrhea Treatment. 162 13.6 Feeding Practices during Diarrhea. 164 13.7 Children’s Health Care and Women’s Status . 166 13.8 Hand-Washing Practices . 167 CHAPTER 14 INFANT FEEDING 14.1 Initial Breastfeeding. 169 14.2 Age Patterns of Breastfeeding . 170 14.3 Duration and Frequency of Breastfeeding . 172 14.4 Types of Complementary Foods . 174 14.5 Infant and Young Child Feeding Practices. 175 14.6 Foods Consumed by Mothers. 177 14.7 Micronutrient Intake . 178 14.7.1 Micronutrient Intake among Children . 178 14.7.2 Micronutrient Intake among Mothers. 180 CHAPTER 15 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 15.1 Knowledge of AIDS . 184 15.2 Knowledge of HIV Prevention Methods. 187 15.3 Rejection of Misconceptions about HIV/AIDS. 189 15.4 Knowledge of HIV/AIDS-Related Issues . 192 15.5 Discussion of HIV/AIDS. 193 15.6 Social Aspect of HIV/AIDS. 195 15.7 Knowledge of A Source for Male Condoms . 196 15.8 Attitudes toward Negotiating Safer Sex . 197 15.9 Higher-Risk Sex. 198 15.10 Knowledge of Sexually Transmitted Infections and Their Symptoms . 199 15.11 Sources of Information on STIs . 202 15.12 Self-Reporting of Sexually Transmitted Infections. 204 15.13 HIV and AIDS Knowledge and Sexual Behavior among Youth . 206 15.13.1 HIV-Related Knowledge among Young Adults. 206 15.13.2 Knowledge of Condom Sources among Young Women . 207 15.13.3 Age at First Sex . 207 15.14 Knowledge of Voluntary Counseling and Testing for HIV . 209 Contents | vii CHAPTER 16 ADULT AND MATERNAL MORTALITY 16.1 Data. 213 16.2 Direct Estimates of Adult Mortality . 214 16.3 Estimates of Maternal Mortality . 216 16.4 Trends in Maternal Mortality . 217 CHAPTER 17 MALARIA AND OTHER HEALTH ISSUES 17.1 Introduction . 219 17.2 Ownership and Use of Mosquito Nets. 219 CHAPTER 18 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 18.1 Advice and Care during Antenatal Period, Delivery, and Postnatal Period . 223 18.2 Knowledge about Children’s Immunization . 224 18.3 Contact with Health Care Providers. 225 18.4 Preparations for Delivery. 226 APPENDIX A PROVINCIAL TABLES . 229 APPENDIX B SURVEY DESIGN.339 APPENDIX C ESTIMATES OF SAMPLING ERRORS .351 APPENDIX D DATA QUALITY TABLES .391 APPENDIX E PERSONS INVOLVED IN THE 2007 INDONESIA DEMOGRAPHIC AND HEALTH SURVEY.397 APPENDIX F QUESTIONNAIRES .409 Tables and Figures | ix TABLES AND FIGURES Page 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. 9 Table 2.2 Household composition. 10 Table 2.3 Children’s living arrangements and orphanhood . 11 Table 2.4 Educational attainment of household population . 13 Table 2.5.1 School attendance ratios: primary school . 14 Table 2.5.2 School attendance ratios: secondary school . 15 Table 2.6 Household drinking water. 16 Table 2.7 Housing characteristics. 18 Table 2.8 Household durable goods . 20 Table 2.9 Wealth quintiles. 21 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 characteristics . 24 Table 3.2 Educational attainment by background characteristics . 25 Table 3.3 Literacy. 26 Table 3.4 Exposure to mass media: Women. 27 Table 3.5.1 Employment status: Women . 29 Table 3.5.2 Employment status: Men. 30 Table 3.6.1 Occupation: Women. 31 Table 3.6.2 Occupation: Men . 32 Table 3.7 Type of employment: Women. 33 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures. 35 Table 3.9 Women’s control over earnings. 36 Table 3.10.1 Women’s participation in decision making. 37 Table 3.10.2 Women’s participation in decision making according to men. 37 Table 3.11.1 Women’s participation in decision making by background characteristics . 38 Table 3.11.2 Men’s attitudes toward wives’ participation in decision making. 40 Table 3.12.1 Women’s attitudes toward wife beating . 41 Table 3.12.2 Men’s attitudes toward wife beating. 42 Table 3.13 Women’s attitudes toward refusing sex with husband . 43 x | Tables and Figures Table 3.14.1 Use of tobacco: Women. 44 Table 3.14.2 Use of tobacco: Men . 45 Figure 3.1 Employment Status of Women Age 15-49. 30 Figure 3.2 Type of Earnings of Employed Women Age 15-49 . 33 Figure 3.3 Number of Decisions in Which Women Participate in the Final Say. 39 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 48 Table 4.2 Fertility by background characteristics . 51 Table 4.3 Trends in age-specific fertility rates. 52 Table 4.4 Children ever born and living. 53 Table 4.5 Birth intervals. 55 Table 4.6 Age at first birth . 56 Table 4.7 Median age at first birth . 56 Table 4.8 Teenage pregnancy and motherhood. 57 Figure 4.1 Total Fertility Rates in Southeast Asian Countries. 49 Figure 4.2 Total Fertility Rate by Province. 50 Figure 4.3 Trends in Total Fertility Rates, IDHS Surveys 1991-2007. 52 CHAPTER 5 KNOWLEDGE AND EVER USE OF FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 59 Table 5.2 Knowledge of contraceptive methods by background characteristics . 61 Table 5.3 Exposure to family planning messages . 63 Table 5.4 Exposure to family planning messages through personal contact. 64 Table 5.5 Contact of nonusers with family planning providers . 66 Table 5.6 Discussion of family planning between husband and wife . 67 Table 5.7 Attitudes toward family planning. 68 Table 5.8 Knowledge of fertile period. 69 Table 5.9.1 Ever use of contraception: Women. 70 Table 5.9.2 Ever use of contraception: Men . 71 Table 5.10 Number of children at first use of contraception . 71 Figure 5.1 Percentage of Currently Married Women Who Know Specific Modern Contraceptive Methods, Indonesia 1991 and 2007 . 60 CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table 6.1 Current use of contraception by age . 74 Table 6.2 Current use of contraception by background characteristics . 75 Table 6.3 Trends in use of specific contraceptive methods, Indonesia 1991-2007 . 77 Table 6.4 Trends in contraceptive use by province in Java 1991-2007. 77 Table 6.5 Current use of contraception by woman's status . 79 Table 6.6 Pill use compliance . 80 Table 6.7 Use of injectables. 81 Table 6.8 Informed choice . 82 Table 6.9 Problems with current method of contraception . 83 Tables and Figures | xi Table 6.10 Payment for contraceptive method and services. 84 Table 6.11 Mean cost of contraceptive method and services . 85 Table 6.12 Source of modern contraception methods . 86 Table 6.13 Timing of sterilization. 88 Figure 6.1 Contraceptive Use among Currently Married Women Age 15-49 by Background Characteristics . 76 Figure 6.2 Contraceptive Use among Currently Married Men Age 15-54, I DHS 2002-2003 and IDHS 2007. 76 Figure 6.3 Trends in Use of Contraceptive Methods by Province in Java, 1997-2007 . 78 Figure 6.4 Trends in Source of Supply of Modern Contraceptive Methods, Indonesia 2002-03 and 2007. 86 Figure 6.5 Distribution of Current Users of Modern Contraceptive Methods by Source of Supply. 87 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 90 Table 7.2.1 Desire to limit childbearing: Women . 91 Table 7.2.2 Desire to limit childbearing: Men. 92 Table 7.3 Need and demand for family planning among currently married women . 93 Table 7.4 Ideal number of children . 94 Table 7.5 Mean ideal number of children. 95 Table 7.6 Fertility planning status. 96 Table 7.7 Wanted fertility rates. 97 Table 7.8 Ideal number of children and unmet need by women's status . 98 Figure 7.1 Fertility Preferences of Currently Married Women 15-49 . 91 CHAPTER 8 NONUSE AND INTENTION TO USE FAMILY PLANNING Table 8.1 First-year contraceptive discontinuation rates . 99 Table 8.2 Reasons for discontinuation of contraceptive methods . 101 Table 8.3 Future use of contraception . 102 Table 8.4 Reason for not intending to use contraception in the future . 103 Table 8.5 Preferred method of contraception for future use. 104 Figure 8.1 Reasons for Discontinuation of Contraceptive Methods . 101 CHAPTER 9 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 9.1 Current marital status. 105 Table 9.2 Age at first marriage . 106 Table 9.3 Median age at first marriage. 107 Table 9.4 Age at first sexual intercourse . 108 Table 9.5.1 Median age at first intercourse: Ever-married women. 109 Table 9.5.2 Median age at first intercourse: Currently married men. 110 Table 9.6 Recent sexual activity. 111 Table 9.7 Postpartum amenorrhea, abstinence, and insusceptibility. 112 xii | Tables and Figures Table 9.8 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility by background characteristics . 114 Table 9.9 Menopause. 114 Figure 9.1 Median Age at First Marriage by Province in Java 1994, 1997, and 2002-2003 . 107 Figure 9.2 Percentage of Births in the Past Three Years for Which the Mother is Amenorrheic or Abstaining . 113 CHAPTER 10 INFANT AND CHILD MORTALITY Table 10.1 Early childhood mortality rates . 117 Table 10.2 Trends in early childhood mortality rates. 119 Table 10.3 Early childhood mortality rates by socioeconomic characteristics. 120 Table 10.4 Trends in infant mortality by province. 121 Table 10.5 Early childhood mortality rates by demographic characteristics. 123 Table 10.6 Early childhood mortality rates by women's status . 124 Table 10.7 Perinatal mortality. 125 Table 10.8 High-risk fertility behavior . 126 Figure 10.1 Reported Age at Death in Months. 116 Figure 10.2 Infant Mortality Rates, Selected Sources, Indonesia, 1971-2007. 118 Figure 10.3 Trends in Infant and Under-five Mortality Rates for Five-year Periods Preceding the 1997 IDHS, the 2002-2003 IDHS, and the 2007 IDHS . 119 CHAPTER 11 MATERNAL HEALTH Table 11.1 Antenatal care. 130 Table 11.2 Number of antenatal care visits and timing of first visit . 131 Table 11.3 Components of antenatal care . 132 Table 11.4 Tetanus toxoid injections . 133 Table 11.5 Complications during pregnancy. 134 Table 11.6 Place of delivery . 135 Table 11.7 Assistance during delivery: most qualified person. 137 Table 11.8 Assistance during delivery: least qualified person . 138 Table 11.9 Delivery characteristics . 139 Table 11.10 Preparation for delivery. 140 Table 11.11 Complications during delivery. 142 Table 11.12 Postnatal care by background characteristics . 143 Table 11.13 Maternal health care and women's status . 144 Table 11.14 Problems in accessing health care . 145 Table 11.15 Birth registration . 146 Table 11.16 Reason for not registering birth . 147 Figure 11.1 Number of Antenatal Care Visits and Number of Months Pregnant at Time of First ANC Visit . 131 Figure 11.2 Place of Delivery and Least Qualified Delivery Assistant . 136 Figure 11.3 Topics Discussed Regarding Preparation for Delivery . 141 Tables and Figures | xiii CHAPTER 12 IMMUNIZATION OF CHILDREN Table 12.1 Vaccinations by source of information. 150 Table 12.2 Vaccinations by background characteristics . 151 Table 12.3 Vaccinations in first year of life. 154 Table 12.4 Hepatitis B vaccination coverage. 155 Figure 12.1 Percentage of Children Age 12-23 Months Vaccinated by 12 Months of Age (Information from Health Cards and Mothers’ Reports) . 150 Figure 12.2 Percentage of Children Age 12-23 Months Who Are Fully Immunized (Information from Health Cards and Mothers’ Reports) . 153 CHAPTER 13 CHILDHOOD DISEASES Table 13.1 Prevalence and treatment of acute respiratory infection and/or fever . 158 Table 13.2 Drugs taken for fever . 159 Table 13.3 Disposal of children's stools. 160 Table 13.4 Prevalence of diarrhea . 161 Table 13.5 Knowledge of ORS packets . 162 Table 13.6 Diarrhea treatment . 163 Table 13.7 Feeding practices during diarrhea . 164 Table 13.8 Feeding pratices during diarrhea by background characteristics. 166 Table 13.9 Children's health care by women's status. 167 Table 13.10 Hand-washing practices . 168 Figure 13.1 Knowledge and Use of ORS Packets among Mothers Who Gave Birth in the Past Five Years, by Level of Education. 163 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. 164 Figure 13.3 Trends in Feeding Practices among Children Under Five With Diarrhea. 165 CHAPTER 14 INFANT FEEDING Table 14.1 Initial breastfeeding. 170 Table 14.2 Breastfeeding status by age . 171 Table 14.3 Median duration and frequency of breastfeeding . 173 Table 14.4 Foods and liquids consumed by children in the day and night preceding the interview . 175 Table 14.5 Infant and young child feeding (IYCF) practices . 176 Table 14.6 Foods consumed by mothers in the day and night preceding the interview 178 Table 14.7 Micronutrient intake among children . 179 Table 14.8 Micronutrient intake among mothers . 181 Figure 14.1 Percentage of Children under 6 Months of Age Who Are Exclusively Breastfed and Bottlefed, IDHS 2002-2003 and 2007 . 172 Figure 14.2 Median Duration of Any Breastfeeding (in Months) among Children Born in the Past Three Years, IDHS 1997, 2002-2003, and 2007. 173 Figure 14.3 Infant and Young Child Feeding (IYCF) Practices . 177 xiv | Tables and Figures CHAPTER 15 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 15.1 Knowledge of HIV/AIDS. 184 Table 15.2.1 Source of information on HIV/AIDS: women . 186 Table 15.2.2 Source of information on HIV/AIDS: men . 187 Table 15.3 Knowledge of HIV prevention methods. 188 Table 15.4.1 Comprehensive knowledge about AIDS: Women . 190 Table 15.4.2 Comprehensive knowledge about AIDS: Men. 191 Table 15.5 Knowledge of HIV-related issues . 192 Table 15.6.1 Discussion of HIV/AIDS with husband. 193 Table 15.6.2 Discussion of HIV/AIDS with wife . 194 Table 15.7.1 Accepting attitudes toward persons living with HIV/AIDS: Women. 195 Table 15.7.2 Accepting attitudes toward persons living with HIV/AIDS: Men. 196 Table 15.8 Knowledge of source of male condoms and access to condoms . 197 Table 15.9 Attitudes toward refusing sexual intercourse with husband. 198 Table 15.10 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among men. 199 Table 15.11.1 Knowledge of symptoms of STIs: women . 200 Table 15.11.2 Knowledge of symptoms of STIs: men. 201 Table 15.12.1 Sources of information on STIs: Women . 203 Table 15.12.2 Sources of information on STIs: Men. 204 Table 15.13 Self-reporting of sexually transmitted infections (STIs) and STI symptoms . 205 Table 15.14 Comprehensive knowledge about AIDS and of a source of condoms among young people . 207 Table 15.15 Age at first sexual intercourse among young people . 208 Table 15.16.1 Knowledge of where to get voluntary counseling and testing services for HIV: Women. 210 Table 15.16.2 Knowledge of where to get voluntary counseling and testing services for HIV: Men . 211 Figure 15.1 Percentge of Ever-married Women and Currently Married Men Who Have Heard of AIDS by Level of Education . 185 Figure 15.2 Percentge of Ever-married Women and Currently Married Men Who Have Heard of AIDS, Indonesia 1994-2007. 185 Figure 15.3 Trends in Knowledge of HIV Prevention Methods among Ever-married Women Who Have Heard of AIDS,Indonesia 1994-2007. 189 Figure 15.4 Percentage of Currently Married Women and Currently Married Men Who Have Discussed AIDS Prevention with Their Spouse by Level of Education . 194 Figure 15.5 Percentage of Ever-married Women and Currently Married Men Who Do Not Know the Symptoms of STIs, by Level of Education. 202 Figure 15.6 Percentage of Ever-married Women and Currently Married Men Reporting an STI or Symptoms of an STI In the Past 12 Months Who Sought Advice or Treatment. 206 CHAPTER 16 ADULT AND MATERNAL MORTALITY Table 16.1 Completeness of information on siblings . 214 Table 16.2 Adult mortality rates. 215 Tables and Figures | xv Table 16.3 Maternal mortality . 216 Figure 16.1 Trends in Adult Mortality Rates (per 1,000), Women and Men Age 15-49, IDHS 1997-2007. 215 Figure 16.2 Changes in Adult Female Mortality Rates and PMDFs, IDHS 1994-2007. 217 CHAPTER 17 MALARIA AND OTHER HEALTH ISSUES Table 17.1 Ownership of mosquito nets . 220 Table 17.2 Use of mosquito nets by children. 221 Table 17.3 Use of mosquito nets by pregnant women . 222 CHAPTER 18 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Table 18.1 Advice and care received by mother during pregnancy, delivery, and after delivery. 223 Table 18.2 Specific vaccines received by children under five. 224 Table 18.3 Fathers’ contact with health care providers about wife's health and pregnancy. 225 Table 18.4 Preparation for delivery. 226 APPENDIX A PROVINCIAL TABLES Table A-2.1 Children's living arrangements and orphanhood by province. 229 Table A-2.2 Educational attainment of household population by province . 230 Table A-3.1 Distribution of respondents by province. 232 Table A-3.2 Educational attainment by province . 233 Table A-3.3 Literacy by province. 235 Table A-3.4 Exposure to mass media by province. 237 Table A-3.5.1 Employment status by province: Women . 239 Table A-3.5.2 Employment status by province: Men . 240 Table A-3.6.1 Occupation by province: Women. 241 Table A-3.6.2 Occupation by province: Men . 242 Table A-3.7 Decision on use of earnings and contribution of earnings to household expenditures by province. 243 Table A-3.8 Women's participation in decisionmaking by province . 244 Table A-3.9 Men's attitude toward wives' participation in decisionmaking by province. 245 Table A-3.10 Women's attitude toward wife beating by province. 246 Table A-3.11 Men's attitude toward wife beating by province . 247 Table A-3.12 Women's attitude toward refusing sex with husband by province . 248 Table A-3.13.1 Use of tobacco by province: Women. 249 Table A-3.13.2 Use of tobacco by province: Men . 250 Table A-4.1 Fertility by province . 251 Table A-4.2 Birth intervals by province. 252 Table A-4.3 Median age at first birth by province . 253 Table A-4.4 Teenage pregnancy and motherhood by province. 254 Table A-5.1 Knowledge of contraceptive methods by province . 255 Table A-5.2 Exposure to family planning messages by province. 256 Table A-5.3 Exposure to family planning messages through personal contact by province. 258 Table A-5.4 Contact of nonusers with family planning providers by province . 259 xvi | Tables and Figures Table A-5.5 Discussion of family planning between husband and wife by province . 260 Table A-5.6 Attitudes toward family planning by province. 261 Table A-5.7 Ever use of contraception by province: Women. 262 Table A-5.8 Ever use of contraception by province: Men . 264 Table A-5.9 Number of children at first use of contraception by province . 265 Table A-6.1 Current use of contraception by province . 266 Table A-6.2 Pill use compliance by province. 267 Table A-6.3 Use of injectables by province . 268 Table A-6.4 Informed choice by province . 269 Table A.6.5 Payment for contraceptive method and services. 270 Table A-7.1.1 Desire to limit childbearing by province: Women . 271 Table A-7.1.2 Desire to limit childbearing by province: Men. 272 Table A-7.2 Need and demand for family planning among currently married women by province . 273 Table A-7.3 Mean ideal number of children by province. 274 Table A-7.4 Fertility planning status by province . 275 Table A-7.5 Wanted fertility rates by province . 276 Table A-9.1 Current marital status by province. 277 Table A-9.2 Median age at first marriage by province. 278 Table A-9.3 Recent sexual activity by province. 279 Table A-9.4 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility by province . 280 Table A-9.5.1 Median age at first intercourse by province: Ever-married women . 281 Table A-9.5.2 Median age at first intercourse by province: Currently married men. 282 Table A-10.1 Early childhood mortality rates by province by province. 283 Table A-11.1 Antenatal care by province . 284 Table A-11.2 Components of antenatal care by province . 285 Table A-11.3 Tetanus toxoid injections by province . 286 Table A-11.4 Place of delivery by province . 287 Table A-11.5 Assistance during delivery by province: Most qualified person. 288 Table A-11.6 Assistance during delivery by province: Least qualified person . 289 Table A-11.7 Delivery characteristics by province . 290 Table A-11.8 Preparation for delivery by province . 291 Table A-11.9 Postnatal care by province . 292 Table A-11.10 Problems in accessing health care by province . 293 Table A-11.11 Birth registration by province . 294 Table A-11.12 Reason for not registering birth by province . 295 Table A.12.1 Vaccinations by province . 296 Table A-12.2 Hepatitis B vaccination coverage by province . 299 Table A.12.3 Child's weight and size at birth by province. 300 Table A-13.1 Prevalence and treatment of acute respiratory infections (ARI) and/or fever by province . 301 Table A-13.2 Disposal of children's stools by province. 302 Table A-13.3 Prevalence of diarrhea by province . 303 Table A-13.4 Knowledge of ORS packets by province . 304 Table A-13.5 Diarrhea treatment by province . 305 Table A-13.6 Feeding practices during diarrhea by province . 306 Table A-13.7 Hand-washing practices by province. 307 Table A-14.1 Initial breastfeeding by province. 308 Table A-14.2 Median duration and frequency of breastfeeding by province . 309 Table A-14.3 Micronutrient intake among children by province . 310 Tables and Figures | xvii Table A-14.4 Micronutrient intake among mothers by province . 311 Table A-14.5 Infant and young child feeding (IYCF) practices by province. 312 Table A-14.6 Foods consumed by mothers in the day or night preceding the interview by province . 313 Table A-15.1 Knowledge of HIV/AIDS by province . 314 Table A-15.2 Knowledge of HIV prevention methods by province . 315 Table A-15.3.1 Comprehensive knowledge about AIDS by province: Women . 316 Table A-15.3.2 Comprehensive knowledge about AIDS by province: Men. 317 Table A-15.4 Knowledge of HIV/AIDS-related issues by province. 318 Table A-15.5 Discussion of HIV/AIDS with husband by province. 319 Table A-15.6 Discussion of HIV/AIDS with wife by province . 320 Table A-15.7.1 Accepting attitudes toward those living with HIV/AIDS by province: Women. 321 Table A-15.7.2 Accepting attitudes toward those living with HIV/AIDS by province: Men . 322 Table A-15.8 Knowledge of source of male condoms and access to condoms by province. 323 Table A-15.9 Attitudes toward negotiating safer sexual relations with husband by province. 324 Table A-15.10 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months by province . 325 Table A-15.11.1 Knowledge of symptoms of STIs by province: Women . 326 Table A-15.11.2 Knowledge of symptoms of STIs by province: Men. 327 Table A-15.12 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms by province . 328 Table A-15.13 Comprehensive knowledge about AIDS and of a source of condoms among young women by province . 329 Table A-15.14 Age at first sexual intercourse among youth by province. 330 Table A-17.1 Ownership of mosquito nets by province. 331 Table A-17.2 Use of mosquito nets by children by province. 332 Table A-17.3 Use of mosquito nets by pregnant women by province . 333 Table A-18.1 Advice or care received by mother during pregnancy and delivery and after delivery by province. 334 Table A-18.2 Specific vaccines received by children under five by province. 335 Table A-18.3 Father's contact with health care provider about wife's health and pregnancy by province. 336 Table A-18.4 Preparation for delivery by province . 337 APPENDIX B SURVEY DESIGN Table B-1.1 Sample allocation by province . 341 Table B-1.2 Expected number of respondents by province. 342 Table B-2.1 Sample implementation: Women . 343 Table B-2.2 Sample implementation: results of the household interview: women . 344 Table B-2.3 Sample implementation: results of individual interview: women . 345 Table B-3.1 Sample implementation: Men. 346 Table B-3.2 Sample implementation: results of the household interview: men. 347 Table B-3.3 Sample implementation: results of individual interview: men. 349 xviii | Tables and Figures APPENDIX C ESTIMATES OF SAMPLING ERRORS Table C.1 List of selected variables for sampling errors for ever-married women sample . 351 Table C.2 Sampling errors for national sample . 352 Table C.3 Sampling errors for urban sample. 353 Table C.4 Sampling errors for rural sample. 354 Table C.5 Sampling errors for NAD sample . 355 Table C.6 Sampling errors for North Sumatera sample . 356 Table C.7 Sampling errors for West Sumatera sample . 357 Table C.8 Sampling errors for Riau sample. 358 Table C.9 Sampling errors for Jambi sample . 359 Table C.10 Sampling errors for South Sumatera sample . 360 Table C.11 Sampling errors for Bengkulu sample . 361 Table C.12 Sampling errors for Lampung sample . 362 Table C.13 Sampling errors for Bangka Belitung sample . 363 Table C.14 Sampling errors for Sampling errors for Riau Islands sample. 364 Table C.15 Sampling errors for DKI Jakarta sample. 365 Table C.16 Sampling errors for West Java sample. 366 Table C.17 Sampling errors for Central Java sample . 367 Table C.18 Sampling errors for DI Yogyakarta sample . 368 Table C.19 Sampling errors for East Java sample. 369 Table C.20 Sampling errors for Banten sample. 370 Table C.21 Sampling errors for Bali sample . 371 Table C.22 Sampling errors for West Nusa Tenggara sample . 372 Table C.23 Sampling errors for East Nusa Tenggara sample . 373 Table C.24 Sampling errors for West Kalimantan sample. 374 Table C.25 Sampling errors for Central Kalimantan sample . 375 Table C.26 Sampling errors for South Kalimantan sample. 376 Table C.27 Sampling errors for East Kalimantan sample. 377 Table C.28 Sampling errors for North Sulawesi sample. 378 Table C.29 Sampling errors for Central Sulawesi sample . 379 Table C.30 Sampling errors for South Sulawesi sample. 380 Table C.31 Sampling errors for Southeast Sulawesi sample. 381 Table C.32 Sampling errors for Gorontalo sample . 382 Table C.33 Sampling errors for West Sulawesi sample. 383 Table C.34 Sampling errors for Maluku sample . 384 Table C.35 Sampling errors for North Maluku sample . 385 Table C.36 Sampling errors for Papua sample . 386 Table C.37 Sampling errors for West Papua sample . 387 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . 389 Table D.2.1 Age distribution of eligible and interviewed women . 390 Table D.2.2 Age distribution of eligible and interviewed men. 390 Table D.3 Completeness of reporting . 391 Table D.4 Births by calendar years . 391 Table D.5 Reporting of age at death in days . 392 Table D.6 Reporting of age at death in months. 393 Preface | xix PREFACE The 2007 Indonesia Demographic and Health Survey (IDHS) is the sixth in a series of surveys undertaken as part of the international Demographic and Health Surveys project. The first survey was the National Indonesia Contraceptive Prevalence Survey carried out in 1987. Subsequent surveys were con- ducted in 1991, 1994, 1997, and 2002-2003. The 2007 IDHS was designed together with Badan Pusat Statistik (BPS)-Statistics Indonesia, the National Family Planning Coordinating Board (NFPCB), and the Ministry of Health (MOH). BPS-Statistics Indonesia is responsible for the survey design, implementation, and data processing. The main objective of 2007 IDHS was to provide detailed information on population, family planning, and health for policymakers and program managers. The 2007 IDHS was conducted in all 33 provinces in Indonesia. The survey collected information on 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 HIV/AIDS and other sexually-transmitted infec- tions. The Government of Indonesia supported the local costs of the survey. The United Nations Popu- lation Fund (UNFPA) provided funds for printing and shipping the questionnaires. Macro International provided limited technical assistance under the auspices of the Demographic and Health Surveys (MEASURE DHS) program, which is supported by the U.S. Agency for International Development (USAID). The Ford Foundation provided funds for expansion of the sample in 15 districts in Java, to al- low district-level estimates. UNICEF also provided funds to generate district-level estimates in Nanggroe Aceh Darussalam Province and two districts, Nias and South Nias, in North Sumatera Province. Training of the 2007 IDHS field staff was conducted in June and July 2007, followed by field- work from 25 June to 31 December, 2007. Fieldwork in several provinces including Riau Islands, Papua, and West Papua had to be extended because of flooding and other problems. Data collection was com- pleted in all areas in February 2008. Processing of the data took place between September 2007 and March 2008. I would like to extend my gratitute and appreciation to the report-writing team from BPS, NFPCB, MOH, and Macro International for providing assistance in the preparation of the report. DR. Rusman Heriawan, APU Chief Statistician BPS-Statistics Indonesia Preface | xxi PREFACE In line with the change in paradigm from highly centralized to decentralized government, since 2004 Family Planning affairs have been handed over to district governments. This fundamental change needed different strategic management so that the National Family Planning Coordinating Board (BKKBN) reformulated the vision, missions, and grand strategies of the national family planning pro- grams. The new vision of BKKBN is aimed at mobilizing the community participation so that ”All Fami- lies Participate in Family Planning”. In this vision, all families in the country are expected to actively im- prove their family welfare by participating in various programs that are developed by BKKBN. To achieve the mission of achieving the norm ”Small, Happy and Prosperous Family,” BKKBN has devel- oped five grand strategies with regards to 1) mobilizing and empowering the community, 2) readjustment of family planning management, 3) strengthening human resources of the programs, 4) enhancing resil- ience and welfare of families, and 5) increasing financial sources of family planning program at all levels. On the other hand, family planning programs face challenges brought about by the paradigm shift. For the purpose of strategic planning and decision making, accurate and comprehensive data and information with regards to family planning and fertility are needed. One of the most important sources of such data and information is the Indonesia Demographic and Health Survey (IDHS). The 2007 IDHS is the sixth of a series of surveys carried out since 1987. When family planning programs were thought to be weakening since the last decade, the 2007 IDHS is of more importance since the survey provides chances for further in-depth analysis on relationship among various factors with regards to population, Family Planning, fertility, as well as maternal and child health. The data and information provided by the survey will undoubtedly be very beneficial for program improvements in the future. I congratulate the 2007 IDHS Steering and Technical Committees for spearheading and finishing the final report. I would like to express my deepest gratitude to Badan Pusat Statistik-Statistics Indonesia (BPS), the Ministry of Health, and Macro International, Inc. for their close cooperation in the preparation and finalization of the survey report. My thanks also go to the United States Agency for International De- velopment (USAID) for providing technical assistance through Macro International Inc. I also would like to extend my gratitude to the United Nations Population Fund (UNFPA) which provides funds for print- ing and shipping the survey questionnaires, the Ford Foundation for the expansion of the sample in 15 districts in Java, and to UNICEF for taking part in supporting the implementation of the 2007 IDHS. Jakarta, December 2008 Dr. Sugiri Syarief, MPA Chairperson, National Family Planning Coordinating Board Summary of Findings | xxiii SUMMARY OF FINDINGS The 2007 Indonesia Demographic and Health Survey (IDHS) is a nationally representa- tive survey of 40,701 households, 32,895 ever- married women age 15-49, and 8,758 currently married men age 15-54. The 2007 IDHS is the sixth national sample survey of its kind to be undertaken in Indonesia. When analyzing trends in the various IDHS data sets, caution should be used because of differences in geographic cov- erage. The current survey includes 33 provinces in Indonesia. The main purpose of the 2007 IDHS is to provide policymakers and program managers with detailed information on fertility, family planning, maternal and child health, childhood and adult mortality, and knowledge of and atti- tudes related to HIV/AIDS and other sexually transmitted infections. FERTILITY The results of the 2007 IDHS show that the total fertility rate (TFR) in Indonesia has re- mained at 2.6. This figure represents the average number of children an Indonesian woman would have by the end of her reproductive years if she were to bear children at the age-specific rates observed for the three years preceding the sur- vey. At this level, the TFR for Indonesia is lower than rates in some other countries in Southeast Asia, such as Cambodia, Lao PDR, Philippines, and Timor-Leste, but not as low as rates in Sin- gapore, Thailand, or Vietnam; the TFR in Ma- laysia is the same as the Indonesian rate. While the TFR in the 2007 IDHS is the same as that in the 2002-2003 IDHS, there are small differences in the pattern of age-specific fertility rates (ASFRs). The age-specific fertility rate for women age 25-29 declined and for the ASFR for women age 30-34 increased. There are large variations in the total fertility rate amongst provinces in Indonesia, ranging from 1.8 in DI Yogyakarta to 4.2 in East Nusa Teng- gara. The TFR in East Nusa Tenggara is twice that in DKI Jakarta, East Java, and Bali. The differen- tials by province in the TFR in the 2007 IDHS show the same pattern as those in the 2002-2003 IDHS. Fertility varies across subgroups of women. Women in urban areas have an average of 0.5 fewer children than women in rural areas. By level of edu- cation, the results of the 2007 IDHS show an inverted U-shaped relationship between education and fertil- ity; women with some primary and completed pri- mary education have slightly higher fertility than other women. The relationship between fertility and household wealth status (wealth index) does not show the expected pattern. While the highest fertility rate is for women in the lowest quintile (TFR=3.0), it is fol- lowed by the middle quintile (TFR=2.8) and then the highest quintile (TFR=2.7). The second and Fourth quintiles each have a TFR of 2.5 children per woman. FACTORS AFFECTING FERTILITY The number of children a woman has is affected by a number of factor including, level of education (which delays marriage), age at marriage, age at first birth, desired number of children, and use of contra- ceptive methods. Education. Women of reproductive age are in- creasingly better educated. The percentage of women who have had some secondary education increased from 38 percent in 2002-2003 to 46 percent in 2007. Age at marriage. The 2007 IDHS shows that In- donesian women are remaining single for a longer period of time; women who marry, do so at a later age. In the 2002-2003 IDHS, the median age at mar- riage for women age 25-49 was 19.2 years; in the 2007 IDHS that figure has increased to 19.8 years. Age at first birth. Indonesian women are wait- ing longer to have their first birth. The median age at first birth for women age 25-49 increased from 21.0 years in the 2002-2003 IDHS to 21.5 years in the 2007 IDHS. xxiv | Summary of Findings Birth intervals. Fertility is affected by the length of birth intervals. Results from the 2007 IDHS indicate that half of births occurred 54.6 months after the previous birth, and 57 percent of births were occurred 48 months or more after the previous birth. Desire for smaller families. The 2007 IDHS data indicate that the desire to limit child- bearing remains at the same level as in the 2002- 2003 IDHS (54 percent). Gap between actual fertility and wanted fertility. The results of the 2007 IDHS show that one in ten pregnancies in the five years preced- ing the survey was mistimed and 7 percent were not wanted at all. If all unwanted births were avoided, the total (wanted) fertility rate for In- donesia would be 2.2 births per woman instead of the actual rate of 2.6 births per woman. The same gap between actual and wanted fertility was seen in the 2002-2003 IDHS. USE OF CONTRACEPTION Use of any method of contraception among currently married women in Indonesia has in- creased from 57 percent in 1997 to 61 percent in 2007. Between the 2002-2003 IDHS and the 2007 IDHS, use of any modern method re- mained virtually unchanged at 54 percent for ever-married women and 57 percent for cur- rently married women. Method mix. The most commonly used modern methods for both ever-married and cur- rently married women are injectables (30 and 32 percent, respectively). Contraceptive pills are also popular (13 percent for both ever-married and currently married women). Compared with the 2002-2003 IDHS data, use of injectables in- creased four percentage points, from 28 to 32 percent, whereas use of the IUD and implants decreased by one percentage points each, from 6 to 5 percent for the IUD, and from 4 to 3 percent for implants. Differentials in contraceptive use. While women in urban areas are slightly more likely than women in rural areas to use family planning (63 and 61 percent, respectively), use of modern methods in urban and rural areas is almost the same (57 and 58 percent, respectively). There are differ- ences in the method mix in urban and rural areas, with urban women relying more on the IUD, con- doms, and female sterilization, whereas rural women are more likely to use injectables and implants. In general, contraceptive use increases with respon- dents’ level of education and wealth status, and in- creases rapidly with the number of living children a woman has, from (for modern methods) 8 percent among women with no children to 64 percent among women with one or two children, after which contra- ceptive use declines to 42 percent for women with five or more children. In Java, contraceptive use varies across prov- inces, from 61 percent in West Java to 67 percent in DI Yogyakarta. There was a steady increase in use in all provinces until 2002-2003. Use rates decreased between the 2002-2003 IDHS and the 2007 IDHS, except in West Java Province. The most significant decrease was in DI Yogyakarta (from 76 to 67 per- cent) followed by DKI Jakarta (from 63 to 60 per- cent). Source of supply. Contraceptive users are rely- ing increasingly on private medical sources for their methods. Use of government sources decreased from 28 percent in 2002-2003 to the current level of 22 percent, while use of private medical sources in- creased from 63 percent to 69 percent, and use of other sources remained at 8 percent. The substantial increase in the use of private sources is mainly due to the increased use of private midwives—29 percent of current use of modern methods (an increase of three percentage points)—pharmacy/drug stores—9 per- cent of current use of modern methods (an increase of three percentage points), and other private medical sources—7 percent of current use of modern methods (an increase of six percentage points). Quality of use of contraception. In the 2007 IDHS, 92 percent of pill users were able to show the pill package to the interviewer, and among these women, eight in ten took the pill in correct order and reported taking a pill less than two days before the interview. Among users of injectables, only 4 to 9 percent were not current with their injections. Unmet need for family planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any Summary of Findings | xxv more children or want to wait before having their next birth, but are not using any method of family planning. The 2007 IDHS data show that total unmet need for family planning in Indone- sia is 9 percent, of which 4 percent is unmet need for spacing and 5 percent is for unmet need for limiting. The level of unmet need has re- mained at about the same level since 1997. Overall, the total demand for family planning is 71 percent, of which 87 percent has been satis- fied. If all of this demand were satisfied, the contraceptive prevalence rate in Indonesia could be expected to reach 71 percent. The percentage of demand satisfied in 2007 is one percentage point lower than the percentage reported in the 2002-2003 IDHS (87 and 88 percent, respec- tively). Self-reliance in family planning. Almost all family planning users (91 percent) pay for their methods and services. Injectables and pill users are more likely to pay for their contracep- tive method (97 and 96 percent, respectively) than users of other methods. Self-reliance is much lower for IUD users, with only 69 percent of users paying for their method. Self-reliance in the use of contraceptive methods is higher in the 2007 IDHS than in the 2002-2003 IDHS (91 and 88 percent, respectively). REPRODUCTIVE HEALTH Antenatal care. Ninety-three percent of women received antenatal care from a medical professional during pregnancy for the most re- cent birth in the past five years, while 4 percent received no antenatal care. Sixty-six percent of pregnant women had four or more antenatal care visits, as recommended by the government; however, this level of coverage is below the tar- get of 90 percent in the maternal health program. Overall, three in four pregnant women received antenatal care services in the first trimester. Half of these women made the first antenatal care visit when they were 2.7 months pregnant. As expected, mothers in urban areas are more likely to receive antenatal care from a medical profes- sional than mothers in rural areas. Delivery care. Forty-six percent of births in the five years preceding the survey were deliv- ered in a health facility; 10 percent were deliv- ered in a public facility (government hospital or health center) and 36 percent were delivered in a pri- vate facility. There has been an increase of six per- centage points in the proportion of deliveries occur- ring in health facilities since the 2002-2003 IDHS (from 40 to 46 percent). Overall, 79 percent of births in the five years before the survey were assisted at delivery by a skilled provider; 12 percent were deliv- ered by a doctor/OB/GYN and 68 percent were de- livered by a nurse/midwife/village midwife. There has been an increase of 13 percentage points in assis- tance at delivery by a medical professional since the 2002-2003 IDHS (from 66 to 79 percent). Postnatal care. In the 2007 IDHS, women who had given birth outside a health facility were asked if they had received postnatal care. Overall, 83 percent of these women received postnatal care; 70 percent received care during the 2 days following delivery, 6 percent received care 3 to 6 days after delivery, and 7 percent received care 7 to 41 days after delivery. CHILD HEALTH Childhood immunization. Information from health cards combined with mothers’ reports shows that 59 percent of children age 12-23 months are fully immunized. This is seven percentage points higher than the immunization level reported in the 2002- 2003 IDHS (52 percent). Childhood illnesses. Acute respiratory infection (ARI), diarrhea, and malaria are common causes of childhood death. In the two weeks before the survey, 8 percent of children were reported to have symp- toms of ARI, of whom 60 percent were taken to a health facility. Eleven percent of children had diar- rhea in the two weeks preceding the survey, 45 per- cent of whom were taken to a health provider. Sixty- one percent of children with diarrhea were given oral rehydration therapy, that is, solution prepared from oral rehydration salts (ORS), recommended home fluids (RHF), or increased fluids. Breastfeeding. Breastfeeding is practiced almost universally in Indonesia, with 95 percent of children under five having been breastfed for some period of time. However, only 44 percent of babies are put to the breast within one hour of birth (as recommended), and a total of 62 percent of babies have begun breast- feeding within the first day after birth. The overall xxvi | Summary of Findings median duration of any breastfeeding is 22.3 months, which is similar to the duration in the 2002-2003 (22.1 months). Exclusive breastfeed- ing is not widely practiced in Indonesia. Despite the government’s recommendation that infants receive breast milk exclusively through the first six months of life, only 48 percent of infants under 2 months of age are exclusively breastfed. At age 4 to 5 months, just 18 percent of infants are receiving breast milk only, without comple- mentary foods. Overall, less than one in three infants under age six months (32 percent) are breastfed exclusively. This is lower than the level of exclusive breastfeeding reported in the 2002-2003 IDHS (40 percent). Perceived problems in accessing health care. In the 2007 IDHS, women were asked whether they have problems seeking medical advice or treatment for themselves. The most often cited problem is getting money for treat- ment (25 percent). Other concerns include dis- tance to health facility (15 percent), having to take transport (13 percent), and concern that no female worker is available (11 percent). AWARENESS OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Knowledge of HIV/AIDS. According to the results of this survey, 61 percent of ever-married women and 71 percent of currently married men say that they have heard of AIDS. The level of knowledge among women has increased from 59 percent and in 2002-2003, while the level of knowledge for men has decreases from 73 per- cent in 2002-2003. Women and men in urban areas are more likely than those in rural areas to have heard of AIDS. Knowledge of HIV/AIDS Prevention. Knowledge of the three principal ways to reduce the transmission of HIV (abstinence, reducing the number of sexual partners, and use of con- doms) is limited in Indonesia. Thirty-seven per- cent of women and 43 percent of men cited ab- stinence; 42 percent of women and 52 percent of men mentioned limiting the number of sexual partners; and 36 percent of women and 49 per- cent of men cited the use of condoms. Knowledge of mother-to-child transmission of HIV. In the 2007 IDHS, respondents were asked if the virus that causes AIDS can be transmitted from a mother to a child. They were then asked if transmis- sion occurs during pregnancy, delivery, or breast- feeding. Overall, between 36 and 42 percent of women said that HIV can be transmitted from mother to child during any of the three situations. Men are more knowledgeable than women; the corresponding proportions for men are 45 to 51 percent. Knowledge of the symptoms of sexually trans- mitted infections (STIs). STIs have been identified as co-factors in the transmission of HIV. Knowledge of the symptoms of STIs among women in Indonesia is limited; overall, 75 percent of ever-married women reported having no knowledge of STIs. Only 8 per- cent reported knowledge of the symptoms of STIs in a woman, and 9 percent reported knowledge of the symptoms of STIs in a man. Knowledge of the symp- toms of STIs among currently married men is higher than that among ever-married women. MALARIA Ownership of mosquito nets. Overall, 32 per- cent of households own some type of mosquito net and 16 percent own more than one net. Ownership of treated mosquito nets is very low; only 4 percent of households have at least one ever-treated net—a pre- treated net or a non-pretreated net that has subse- quently been soaked in insecticide at least once. Household ownership of insecticide-treated nets (ITNs) is 3 percent; these include 1) factory-treated nets that do not require any further treatment; 2) pre- treated nets obtained within the past 12 months; and 3) nets that have been soaked with insecticide in the past 12 months. Because so few households in Indo- nesia have ITNs, statistically, the average number of ITNs per household is zero. Use of mosquito nets by children under five. Less than one in three children under age five (31 percent) slept under any type of net on the night be- fore the survey. Usage of nets does not vary much by the child’s age or sex. Rural children are much more likely than urban children to sleep under a net (40 and 19 percent, respectively). The highest level of net usage is among children in the lowest wealth quintile (46 percent), while children in the highest wealth Summary of Findings | xxvii quintile have the lowest level of net usage (12 percent). Use of mosquito nets by pregnant women. Overall, 23 percent of women age 15-49 slept under a mosquito net the night before interview. Because treated nets are uncommon in Indone- sia, only 2 percent of these women used an ever- treated net or an ITN. Use of mosquito nets is slightly higher among pregnant women than among all women (24 and 23 percent, respec- tively). Pregnant women are also more likely to use a treated net or an ITN. As with children, net usage is higher in rural areas and among women in the lower wealth quintiles. The use of mos- quito net has a negative relationship with women’s level of education; women with no education are the most likely to sleep under a net, while women with the highest level of edu- cation are the least likely to use a mosquito net (28 and 11 percent, respectively). FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Antenatal care. The survey shows that for 87 percent of births in the five years preceding the survey the mothers are reported by their hus- bands to have received advice or care during pregnancy, 78 percent received care during de- livery, and 68 percent received care in the six weeks after delivery (postpartum period). Children’s immunization. At least two in three fathers reported that their last child had been immunized. However, only four in ten fa- thers had any contact with a health care provider during their wife’s pregnancy for that child. Most of these fathers discussed the preparations for their child’s delivery. The most frequently mentioned topics of discussion were the place of delivery (60 percent) and the person providing delivery assistance (62 percent), followed by payment for the services (52 percent). A topic less frequently discussed by fathers is transpor- tation to the place of delivery (32 percent), probably because many deliveries take place at home. MORTALITY Childhood mortality. The infant mortality rate in Indonesia has declined from 142 deaths per 1,000 live births in 1967 to 34 deaths in 2005. At current mortality levels, 44 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 house- holds have lower mortality rates (26 deaths per 1,000 live births) than children in poorer households (56 deaths per 1,000 live births). Childhood mortality rates decline as the length of the birth interval in- creases. For example, the infant mortality rate for children born less than two years after a previous birth (77 deaths per 1,000 live births) is more than three times higher than the rate for children born after an interval of four or more years (28 deaths per 1,000 live births). Adult mortality. The adult mortality rate for the period 0-4 years preceding the survey is 2 deaths per 1,000 population for both women and men. While the mortality rate increases with age for both sexes, male mortality rates are slightly higher than female rates at most ages. Analysis of the past IDHS surveys indi- cates that there has been a slight increase in both fe- male and male adult mortality from 1992 to 2007. Maternal mortality. Using direct procedures, the maternal mortality ratio for Indonesia is estimated at 228 maternal deaths per 100,000 live births for the period 2004-2007. Analysis of maternal mortality ratios estimated for the 1994 IDHS and the 2007 IDHS seems to confirm the continuing downward trend of maternal mortality in Indonesia, and indicate that the decline is greater in recent years. CONTINUING CHALLENGES Although eight in ten births were wanted at the time of conception, 12 percent of births were wanted but at a later time, and 7 percent were not wanted at all. The proportion of mistimed and unwanted births (19 percent) is about the same as reported in the 2002-2003 IDHS, except for a slightly lower propor- tion of births wanted then and a higher proportion of births wanted later. xxviii | Summary of Findings 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, the target of 90 percent of women having at least one antenatal care visit in the first trimester has not been reached. Whereas the proportion of home deliveries has declined over the years, in 2007 more than half (54 percent) of deliveries took place outside of a health facility. While coverage of childhood immunization has increased, the dropout rate between the first and third doses of DPT and polio remains high; 23 percent for DPT and 18 percent for polio. Furthermore, a high proportion of children age 12-23 months are not fully immunized. Given the higher morbidity and mortality risks to newborns and mothers after delivery, it is important to see that all new mothers receive postnatal care. In the 2007 IDHS, 16 percent of women did not receive postnatal care. Although childhood mortality continues to de- cline slowly, or has leveled off in some groups, one in three births in Indonesia has an elevated 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) xxx | Map of Indonesia Introduction | 1 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 Papua bordering Papua New Guinea on the east. 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 33. The new provinces are Riau Islands, Bangka Belitung, Banten, West Sulawesi, Gorontalo, North Maluku and West Papua. These new provinces formerly were part of Riau, South Sumatera, West Java, South Sulawesi, North Sulawesi, Maluku province and Papua, respectively. Each province is subdivided into districts and municipalities. Altogether, there are 370 districts and 96 municipalities in Indonesia. The next lower administrative units are subdistricts and villages. In 2007, there were 6,131 subdistricts and 73,405 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 Soeharto 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 2 | Introduction 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. 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 Soeharto was ousted and replaced by his Vice President, B.J. Habibie. This time was known as the reform era. Since 1998, Indonesia has had four presidents, B.J. Habibie, Abdurrahman Wahid, Megawati Soekarnoputri and Susilo Bambang Yudhoyono who, for the first time in Indonesia’s history, was elected directly in the 2004 general election. In 1999, Law No. 22 on Regional Government (Pemerintahan Daerah) 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 6 percent in 2007. 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 2007 National Socio-Economic Survey (Susenas) show that in the past 35 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 93 percent in 2007. 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 2007 were 93 percent and 98 percent, respectively. From 1971 to 2007, 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 31 percent in 2007, while the proportion of those who attended junior high school or higher education increased from 7 percent in 1971 to 41 percent in 2007. At all levels, the increase in education among females has been greater than that of males (CBS, 1972; BPS 2008). The fact that a larger number of girls are enrolled in education, and for a longer period, 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 50 percent in 2007. Most women work in agriculture, trade, or the service industries, with the employment status being mostly an unpaid family worker and regular employee (BPS, 2008). 1.2 POPULATION According to the 2000 Population Census, the population of Indonesia was 205.8 million in 2000 and was projected to reach 225.6 million in 2007. 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 86.6 million people (42 percent of the population) lived in urban areas in 2000, compared with 118 million (52 percent of the population) in 2007. In 2000, more than 88 percent of the Indonesian population was Muslim. Introduction | 3 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 1.28 percent between 2000 and 2007. 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 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 density of Java (951 persons per square kilometer) higher than that of other islands. By comparison, Kali- mantan 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 density at the national level was 109 persons per square kilometer in 2000 and projected to be 119 persons per square kilometer in 2007. 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 two percent. These figures suggest a more rapid decline in fertility in more recent years. The CBR in 2007 was projected to be 19 births per 1,000 population. The same data sources also demonstrate that in Indonesia there has been a significant decline in mortality levels, and life expectancy at birth for both males and females has increased. For males, life expectancy increased from 58 years in 1990 to 68 years in 2007. The corresponding figures for females are 62 and 72 years, respectively. 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMS The government of Indonesia has implemented many of its development programs responding to population-related issues since President Soeharto joined other heads of state in signing the Declaration of the World Leaders in 1967. In this declaration, rapid population growth was considered a potential hindrance to economic development. To carry out its population policy, the government has launched several programs. Family planning is one of the most important of these programs. Under the auspices of the International Planned Parenthood Federation (IPPF), the Indonesian Planned Parenthood Association (IPPA) initiated family planning activities in Indonesia in 1957. IPPA provided family planning counseling and services, including maternal and child care. In 1968, the government established a National Family Planning Institute, which was reorganized as the National Family Planning Coordinating Board (NFPCB, also known by its Indonesian acronym as BKKBN) two years later. BKKBN is a nondepartmental body, with the chairman reporting directly to the President. The government of Indonesia has a strong commitment to family planning and has been working with religious and community leaders to develop programs to promote family planning. Table 1.1 Basic demographic indicators Demographic indicators from selected sources, Indonesia 1990- 2007 Indicators 1990 census 2000 census 2007 projection1 Population (millions) 179.4 206.3 225.6 Growth rate (GR)2 (percent) 1.98 1.49 1.28 Density (pop/km2) 93.0 109.0 119.0 Percent urban 31 42 48 Reference period 1986-89 1996-99 2007 Crude birth rate (CBR)3 28 23 19 Crude death rate (CDR)4 9 8 6 Life expectancy5 Male 57.9 63.5 68.4 Female 61.5 67.3 72.4 1 Projected based on the 1990 and 2000 Population Censuses and 2005 Population Intercensal Survey 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 using indirect estimation techniques 4 | Introduction 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 Number 10 of 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. Based on Law Number 22 in 1999 on Regional Government (which was later revised through Law Number 32 in 2004), the system of the country was changed from strongly centralized government to regional autonomy at the district or municipality level. In line with the new era, since 2004 family planning authorities have also been transferred to the district or municipality government. To anticipate the changing strategic environments brought about by decentralization processes that are going through the country, since 2007 BKKBN has reformulated its vision, mission and grand strategies of the national family planning programs (BKKBN, 2008). The new vision of BKKBN is to mobilize the community to participate in family planning programs as “All Families Participate in Family Planning” is articulated. By this vision, all families in the country are expected to actively improve their family welfare through BKKBN’s programs. To bring the mission of making the norm of “small, happy and prosperous family” into reality, BKKBN has formulated five grand strategies, i.e., (1) to push and empower the whole community in family planning programs, (2) to refine the management of family planning programs in accordance with the new era, (3) to strengthen human resources of family planning programs, (4) to improve the resilience and welfare of families through family planning programs, and (5) to increase financial sources of family planning programs at all levels. Through these strategies it is expected that the family planning programs, considered by many as weakened during the new era of decentralization, can be improved. 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, making 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 goals set. In mid-September 1998, a new health paradigm was introduced that focused more on health promotion and prevention rather than on curative and rehabilitative services. The new vision was reflected in the motto Healthy Indonesia 2010. In October 1999, the Ministry of Health presented the Health Development Plan Towards Healthy Indonesia 2010, which outlined the following goals: (a) to lead and initiate health-oriented national development; (b) to maintain and enhance individual, family, Introduction | 5 and public health, along with improving the environment; (c) to maintain and enhance the quality, equitability and affordability of health services; and (d) to promote public self-reliance in achieving good health. In March 2006, the Ministry of Health issued a new Strategic plan 2005-2009 emphasizing the new vision “self reliant communities to pursue healthy living” and its mission “to make people healthy”. The values underlying the vision and mission include: people-oriented approach, rapid and appropriate response, teamwork, high integrity, and transparency and accountability. The four pillars or priorities that form the basis of the new health approach are: (i) social mobilization and community empowerment; (ii) improvement of community access to quality care services; (iii) improvement of surveillance, monitoring and health information system; and (iv) increase in health financing” (MOH, 2006). 1.5 OBJECTIVES OF THE SURVEY The 2007 IDHS is the sixth survey conducted in Indonesia under the auspices of the DHS program. Previous IDHS surveys were: the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS), the 1991 IDHS, the 1994 IDHS, the 1997 IDHS, and the 2002-03 IDHS. Since 2002-03, the survey was expanded to include a survey of currently married men age 15-54 and unmarried women and men age 15-24 (Indonesia Young Adult Reproductive Health Survey–IYARHS). Findings from this survey are presented in a separate report. The 2007 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 2007 Indonesia Demographic and Health Survey (IDHS) was implemented by Statistics Indonesia (Badan Pusat Statistik—BPS). The Government of Indonesia supported the local costs of the survey. United Nations Population Fund (UNFPA) provided funds for questionnaire printing and shipment. Macro International Inc. (Macro) provided limited technical assistance under the auspices of the Demographic and Health Surveys (MEASURE DHS) program, which is supported by the U.S. Agency for International Development (USAID). The Ford Foundation provided funds for the expansion of the sample in 15 districts in Java, to allow estimates at the individual district level. UNICEF also provided funds to allow estimates at the individual district level in Nanggroe Aceh Darussalam Province and for two districts in North Sumatera Province, Nias and South Nias. 6 | Introduction A survey Steering Committee was established. This committee consisted of senior representatives from BPS, BKKBN, 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. The directors of the provincial statistical offices were responsible for both the technical and the administrative aspects of the survey in their respective areas. They were assisted by field coordinators, most of whom were chiefs of the social statistics divisions in the provincial offices. 1.7 QUESTIONNAIRES The 2007 IDHS used three questionnaires: the Household Questionnaire (HQ), the Ever-Married Women’s Questionnaire (EMWQ) and the Married Men’s Questionnaire (MMQ). In consultation with BKKBN and MOH, BPS made a decision to base the 2007 IDHS survey instruments largely on the questionnaires used in the 2002-03 IDHS to facilitate trend analysis. Input was solicited from other potential data users, and several modifications were made to optimize the draft 2007 IDHS instruments to collect the needs for population and health data. The draft IDHS questionnaires were also compared with the most recent version of the standard questionnaires used in the DHS program and minor modifications incorporated to facilitate international comparison. The HQ was used to list all the usual members and visitors in the selected households. Basic information collected on each person listed includes: age, sex, education, and relationship to the head of the household. The main purpose of the HQ was to identify women and men who were eligible for the individual interview. 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 HQ. These items reflect the household’s socioeconomic status. The EMWQ was used to collect information from all ever-married women age 15-49. These women were asked questions on the following topics: • Background characteristics (marital status, education, media exposure, etc.) • Knowledge and use of family planning methods • Reproductive history and fertility preferences • Antenatal, delivery and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Practices related to the malaria prevention • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Infant’s and children’s feeding practices • Childhood mortality • Awareness and behavior regarding AIDS and other sexually transmitted infections (STIs) • Sibling mortality, including maternal mortality. The MMQ was administered to all currently married men age 15-54 living in every third household in the IDHS sample. The MMQ collected much of the same information included in the EMWQ, 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 health-care-seeking practices for their children. Introduction | 7 1.8 DATA COLLECTION As in previous surveys, data were collected by teams of interviewers. The 2007 IDHS employed 104 interviewing teams to collect the data. Each team consisted of one team supervisor, one field editor, three female interviewers, and one male interviewer. A total of 832 persons, 468 women and of 364 men, participated in the main survey training for interviewers. Training took place in June 2007 in seven training centers (Medan, Padang, Banten, Yogyakarta, Denpasar, Banjarmasin, and Makasar), and in July 2007 in two training centers (Jayapura and Manokwari). The training included class presentations, mock interviews, and tests. All of the participants were trained using the EMWQ. Once the materials for the women’s interview were completed, the male participants were trained in conducting an interview using the MMQ. The training included practice interviews in Bahasa Indonesia and the participant’s local language. Data collection principally took place from 25 June to 31 December, 2007. However, fieldwork had to be extended in several provinces including Riau Islands, Papua, and West Papua because of flooding and other problems. Fieldwork was completed in all areas in February 2008. For more information about the fieldwork, see Appendix B. A list of persons involved in the implementation of the survey is found in Appendix E. The survey questionnaires are reproduced in Appendix F. As in previous IDHS surveys, the 2007 IDHS sample was designed to pro- duce estimates at the national, urban-rural, and provincial levels. Table 1.2 is a sum- mary of the results of the fieldwork for the 2007 IDHS from both the household and individual interviews, by urban-rural resi- dence. In general, the response rates for both the household and individual inter- views in the 2007 IDHS are high. A total of 42,341 households were selected in the sample, of which 41,131 were occupied. Of these households, 40,701 were success- fully interviewed, yielding a household response rate of 99 percent. In the interviewed households, 34,227 women were identified for indi- vidual interview and of these completed interviews were conducted with 32,895 women, yielding a response rate of 96 percent. In a third of the households, 9,716 eligible men were identified, of which 8,758 were successfully interviewed, yielding a response rate of 90 percent. The lower response rate for men was due to the more frequent and longer absence of men from the household. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Indonesia 2007 Residence Result Urban Rural Total Household interviews Households selected 16,920 25,421 42,341 Households occupied 16,429 24,702 41,131 Households interviewed 16,224 24,477 40,701 Household response rate1 98.8 99.1 99.0 Individual interviews: women Number of eligible women 13,608 20,619 34,227 Number of eligible women interviewed 13,087 19,808 32,895 Eligible women response rate2 96.2 96.1 96.1 Individual interviews: men Number of eligible men 3,927 5,789 9,716 Number of eligible men interviewed 3,510 5,248 8,758 Eligible men response rate2 89.4 90.7 90.1 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Characteristics of Households and Housing Characteristics | 9 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 physical conditions in the households, including source of drinking water, availability of electricity, sanitation facilities, building materials, and possession of household durable goods. Information on the characteristics 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 2007 IDHS, a household is defined as a person or a group of persons, 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 residents and visitors who spent the night preceding the survey in the household. This method of data collection 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 classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. The distribution of the de facto household population in the 2007 IDHS is shown in Table 2.1 by five-year age groups, according to sex and urban-rural residence. The 2007 IDHS households constitute a population of 164,052 persons. The data show that there are 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 country with a young population. Thirty-one percent of the population is under age 15; only 6 percent are age 65 or over, as can be seen in the population pyramid (Figure 2.1). 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 2007 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.2 9.3 9.7 10.9 10.0 10.4 10.6 9.7 10.1 5-9 10.4 9.1 9.8 11.1 10.2 10.7 10.8 9.8 10.3 10-14 9.4 9.4 9.4 11.3 10.3 10.8 10.5 9.9 10.2 15-19 9.2 8.8 9.0 8.5 7.3 7.9 8.8 7.9 8.4 20-24 8.5 9.1 8.8 6.7 7.5 7.1 7.5 8.2 7.9 25-29 9.0 9.1 9.1 7.2 7.9 7.5 8.0 8.4 8.2 30-34 8.1 8.4 8.2 6.8 7.7 7.2 7.3 8.0 7.7 35-39 8.0 8.1 8.0 7.3 7.3 7.3 7.6 7.6 7.6 40-44 6.8 6.9 6.9 6.3 6.6 6.5 6.5 6.8 6.6 45-49 5.4 5.8 5.6 6.0 6.2 6.1 5.7 6.0 5.9 50-54 4.9 4.8 4.8 4.9 5.1 5.0 4.9 4.9 4.9 55-59 3.3 3.3 3.3 3.6 3.5 3.5 3.5 3.4 3.4 60-64 2.2 2.4 2.3 2.8 3.3 3.1 2.6 2.9 2.7 65-69 1.9 2.1 2.0 2.4 2.5 2.4 2.2 2.3 2.3 70-74 1.4 1.5 1.5 1.9 2.2 2.1 1.7 1.9 1.8 75-79 0.7 0.9 0.8 1.1 1.1 1.1 0.9 1.0 1.0 80 + 0.8 1.0 0.9 1.1 1.3 1.2 1.0 1.2 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 35,024 35,381 70,406 46,355 47,291 93,646 81,379 82,672 164,052 10 | Characteristics of Huseholds and Housing Characteristics Figure 2.1 illustrates the age structure of the household population in a population pyramid. The population pyramid has a narrow top and a wide base reflecting a pattern typical of countries with high fertility in the past. This type of age structure has a built-in momentum for the growth of the country’s population. When the young population eventually reaches reproductive 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 wel- fare. Female-headed households are, for example, typically poorer than male-headed households. Where households are large, there is generally greater crowding, which is usually associated with less favorable health conditions and economic hardship. The 2007 IDHS data show that 13 percent of households are headed by women. This propor- tion is slightly higher than the level observed in the 2002-03 IDHS (BPS and ORC Macro, 2003). Moreover, the proportion of female-headed house- holds is slightly higher in urban areas than in rural areas (14 and 12 percent, respectively). Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Indonesia 2007 Residence Characteristic Urban Rural Total Household headship Male 86.4 87.7 87.1 Female 13.6 12.3 12.9 Total 100.0 100.0 100.0 Number of usual members 1 6.2 5.7 5.9 2 11.1 13.8 12.7 3 19.9 22.3 21.3 4 24.1 23.7 23.9 5 16.9 16.6 16.7 6 11.1 9.4 10.1 7 4.9 4.6 4.7 8 2.9 2.0 2.4 9+ 3.0 1.9 2.3 Total 100.0 100.0 100.0 Mean size of households 4.2 4.0 4.1 Number of households 16,883 23,818 40,701 Note: Table is based on de jure household members, i.e., usual residents. Figure 2.1 Population Pyramid of Indonesia 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 <5 0123456 0 1 2 3 4 5 6 Female Male Percent Characteristics of Households and Housing Characteristics | 11 Six percent of households have only one member, with urban and rural areas having the same proportion of one-member households (6 percent, respectively). However, very large households (nine persons or more) still exist in Indonesia (3 percent in urban and 2 percent in rural areas). The sex composition of the population does not show much variation by urban-rural residence. Table 2.2 shows that the overall mean household size in Indonesia is 4.1 persons. The household size in rural and urban areas is similar (4.0 and 4.2, respectively). The same pattern was observed in the 2002-2003 IDHS (BPS and ORC Macro, 2003). 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). Provincial differences are shown in Appendix Table A-2.1. In the 2007 IDHS, information was collected on all persons under age 15 regarding their living arrangements and the survival status of their biological parents. A large majority of children under age 15 live with both of their parents (85 percent); this percentage is slightly lower than that reported for the 2002-2003 IDHS (88 percent). The level of orphanhood in Indonesia is relatively low, 97 percent of children under age 15 have either their father or mother alive. Six percent of children under age 15 are not living with a biological parent, but only 4 percent are orphans (one or both parents dead). Younger children are more likely than older children to live with both parents. For example, 90 percent of children under age 2 compared with 80 percent of that age 10-14 live with both parents. Male children are as likely as female children to live with both parents, while children in urban areas are slightly more likely than children in rural areas to live with their parents (87 percent compared with 84 percent). 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 background characteristics, Indonesia 2007 Living with mother but not with father Living with father but not with mother Not living with either parent Background 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 Percent- age not living with a biological parent Percent- age with one or both parents dead Number of children Age 0-4 89.0 6.1 1.1 0.8 0.2 2.2 0.2 0.0 0.2 0.2 100.0 2.6 1.7 16,625 <2 90.1 7.0 0.8 0.2 0.1 1.4 0.1 0.0 0.1 0.2 100.0 1.6 1.1 6,673 2-4 88.3 5.5 1.2 1.2 0.3 2.7 0.3 0.1 0.3 0.2 100.0 3.3 2.1 9,952 5-9 85.5 4.6 2.0 1.5 0.6 4.5 0.3 0.3 0.4 0.3 100.0 5.5 3.6 16,941 10-14 80.0 4.2 3.6 2.2 1.0 6.7 0.5 0.5 0.7 0.7 100.0 8.5 6.3 16,854 Sex Male 84.6 5.3 2.1 1.6 0.5 4.3 0.3 0.4 0.5 0.4 100.0 5.5 3.9 26,085 Female 85.0 4.7 2.3 1.4 0.6 4.7 0.3 0.2 0.4 0.4 100.0 5.6 3.9 24,335 Residence Urban 86.5 4.6 2.0 1.4 0.5 3.8 0.2 0.2 0.4 0.4 100.0 4.7 3.4 20,383 Rural 83.7 5.2 2.3 1.6 0.6 4.9 0.4 0.3 0.5 0.4 100.0 6.1 4.2 30,037 Wealth quintile Lowest 83.8 5.2 3.0 1.2 0.9 4.1 0.4 0.4 0.6 0.4 100.0 5.5 5.4 11,371 Second 83.3 5.1 2.6 1.7 0.4 5.0 0.5 0.4 0.5 0.5 100.0 6.4 4.6 10,112 Middle 83.5 5.5 2.0 1.7 0.4 5.3 0.4 0.2 0.5 0.4 100.0 6.4 3.5 10,130 Fourth 85.8 4.8 1.7 1.6 0.4 4.5 0.2 0.2 0.3 0.4 100.0 5.3 2.9 9,531 Highest 88.0 4.3 1.5 1.2 0.7 3.5 0.1 0.1 0.2 0.4 100.0 3.9 2.6 9,276 Total <15 84.8 5.0 2.2 1.5 0.6 4.5 0.3 0.3 0.5 0.4 100.0 5.5 3.9 50,420 Note: Table is based on de jure members, i.e., usual residents. 12 | Characteristics of Huseholds and Housing Characteristics 2.4 EDUCATIONAL LEVEL OF HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and status an individual enjoys in a society. Studies have consistently shown that educational attainment has a strong effect on reproductive behavior, contraceptive use, fertility, infant and child mortality, morbidity, and attitudes and awareness related to family health and hygiene. In the 2007 IDHS, information on educational attainment was collected for every member of the household. The 2007 IDHS results can be used to show the educational attainment of household members as well as school attendance, repetition, and drop-out rates among youth. 2.4.1 Educational Attainment of the Household Population For the purposes of the analysis presented below, the official age for entry into the primary school is six. The official primary school ages are 6-13, while the ages for secondary school are 14-17. 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 substantial differences in the level of education by background characteristics. Overall, men are slightly better educated than women; 12 percent of females age six and above have never attended school compared with only 6 percent of males. In all age groups except 6-19 males are more likely to have been educated and more likely to stay in school than females. In 1994, based on the President’s Instruction Number 1, the Government of Indonesia declared “Nine Years Compulsory Education” for children under age of 15. This campaign resulted in achieving equity in education for males and females. While there are small differences in educational attainment between males and females in older age groups, the gap in educational attainment is no longer visible by gender in 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 1 percent among those age 10-14 years to 57 percent in the oldest age group (65 years or older). The increase is less dramatic among males, from 1 percent to 28 percent, respectively. Table 2.4 shows that older people have less education. For example, the median number of years of schooling among men age 50-54 years is 5.4 years, whereas for men age 20-24 the median is 8.9 years. The difference for women is even greater: a median of 4.5 years for age 50-54 and 8.7 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, compared with 8 percent in the rural areas. For women, the corresponding figures are 7 percent in the urban areas and 15 percent in the rural areas. The urban-rural differential is also evident from the median years of schooling: for men the median is 8.2 years and 5.4 years, respectively. For women the difference is less pronounced, 6.9 years and 5.2 years, respectively. Provincial differences are shown in Appendix Table A-2.2. Characteristics of Households and Housing Characteristics | 13 Table 2.4 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of schooling attended or completed and median number of years completed, according to background characteristics, Indonesia 2007 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed FEMALE Age 6-9 7.4 91.8 0.1 0.3 0.1 0.0 0.3 100.0 6,615 1.1 10-14 0.7 42.3 11.0 45.8 0.1 0.0 0.1 100.0 8,207 5.3 15-19 1.0 5.0 15.2 57.4 15.9 5.5 0.1 100.0 6,560 8.8 20-24 1.6 7.3 21.1 28.1 28.2 13.7 0.1 100.0 6,785 8.7 25-29 2.1 9.4 28.3 22.9 24.3 12.9 0.1 100.0 6,928 8.4 30-34 3.1 10.8 34.4 20.4 21.6 9.6 0.0 100.0 6,588 7.4 35-39 6.1 14.6 31.4 17.9 22.1 7.8 0.0 100.0 6,310 5.9 40-44 12.2 26.1 27.2 12.6 14.2 7.6 0.1 100.0 5,598 5.4 45-49 17.9 32.0 26.3 11.0 7.2 5.5 0.2 100.0 4,976 5.0 50-54 22.1 29.7 27.5 10.9 5.9 3.5 0.6 100.0 4,088 4.5 55-59 24.3 28.0 27.1 9.2 8.3 2.7 0.5 100.0 2,817 4.4 60-64 38.9 26.9 21.3 5.8 4.5 1.7 1.0 100.0 2,421 1.9 65+ 57.1 21.7 14.4 3.0 2.8 0.2 0.8 100.0 5,310 0.0 Residence Urban 7.3 21.1 17.8 23.9 19.8 9.9 0.2 100.0 31,502 6.9 Rural 15.1 30.8 23.8 19.8 7.5 2.7 0.3 100.0 41,714 5.2 Wealth quintile Lowest 21.6 37.9 22.0 14.2 3.5 0.4 0.4 100.0 14,383 3.5 Second 16.3 31.2 25.3 19.7 6.3 0.9 0.3 100.0 14,390 5.1 Middle 11.6 26.8 24.8 23.2 10.9 2.7 0.1 100.0 14,657 5.4 Fourth 6.8 22.8 21.0 26.1 17.0 6.1 0.2 100.0 14,633 5.9 Highest 3.0 15.3 13.4 24.2 25.5 18.5 0.2 100.0 15,153 8.9 Total 11.7 26.6 21.2 21.5 12.8 5.8 0.2 100.0 73,216 5.5 MALE Age 6-9 9.1 90.2 0.1 0.2 0.0 0.0 0.4 100.0 7,248 0.9 10-14 1.0 48.8 10.9 39.2 0.1 0.0 0.1 100.0 8,541 5.0 15-19 1.1 7.0 13.9 60.3 14.9 2.9 0.0 100.0 7,158 8.6 20-24 1.4 7.9 18.5 26.4 33.5 12.2 0.1 100.0 6,095 8.9 25-29 1.8 8.7 25.4 23.3 29.9 10.7 0.2 100.0 6,486 8.6 30-34 1.5 9.8 26.3 23.2 29.8 9.3 0.2 100.0 5,966 8.5 35-39 2.7 11.2 28.6 19.1 28.1 10.2 0.1 100.0 6,169 8.3 40-44 4.7 18.6 26.4 15.4 24.4 10.4 0.2 100.0 5,306 6.0 45-49 6.9 26.4 29.3 13.4 14.7 9.1 0.1 100.0 4,676 5.6 50-54 9.5 28.6 28.8 13.2 12.7 7.1 0.1 100.0 3,985 5.4 55-59 10.8 22.8 33.2 12.9 14.5 5.4 0.4 100.0 2,822 5.5 60-64 18.7 25.3 29.4 9.3 10.6 5.5 1.2 100.0 2,078 5.2 65+ 28.0 30.8 26.1 6.1 6.9 1.5 0.6 100.0 4,666 2.7 Residence Urban 3.5 21.6 15.5 23.6 25.2 10.5 0.2 100.0 30,740 8.2 Rural 7.8 31.8 24.6 22.0 10.5 3.0 0.2 100.0 40,461 5.4 Wealth quintile Lowest 12.3 39.4 24.7 17.3 5.2 0.6 0.5 100.0 13,741 4.7 Second 8.0 33.0 26.5 22.7 8.5 1.2 0.2 100.0 14,515 5.3 Middle 5.2 27.1 24.1 25.9 14.9 2.6 0.2 100.0 14,303 5.7 Fourth 3.1 22.0 19.0 25.8 23.7 6.3 0.1 100.0 14,384 7.6 Highest 1.4 15.8 9.1 21.6 31.6 20.3 0.1 100.0 14,259 11.1 Total 5.9 27.4 20.7 22.7 16.8 6.2 0.2 100.0 71,201 5.7 Note: Total includes 10 unweighted women and 12 unweighted men with information missing on age 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 14 | Characteristics of Huseholds and Housing Characteristics 2.4.2 School Attendance Rates The 2007 IDHS collected information on school attendance that allows the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary school is the percentage of the primary-school-age population (6-13 years) that is attending primary 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 percentage 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 age 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. Youth are considered to be attending school currently if they attended formal academic school at any point during the given school year. The gender parity index (GPI) assesses sex-related differences in school attendance rates and is calculated by dividing the GAR for females by the GAR for males. A GPI less than one indicate a gender disparity in favour of males, i.e., a higher proportion of males than females attends that level of schooling. A GPI greater than one indicates a gender disparity in favour of females. A GPI of one indicates parity or equality between the rates of participation for males and females. Table 2.5.1 indicates that at primary school and secondary school levels there are large differences in NAR and GAR across background characteristics. Table 2.5.1 shows that in primary school, the NAR and GAR are slightly higher in rural than in urban areas (85 percent compared with 84 percent, and 103 percent compared with 101 percent, respectively). The gender parity index is 0.97 in rural areas and 0.94 in urban areas. Moreover, the NAR and GAR are slightly higher for men than for women (86 percent compared with 84 percent and 104 percent compared with 100 percent, respectively). 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 and the gender parity index (GPI), according to residence and wealth index, Indonesia 2007 Net attendance ratio1 Gross attendance ratio2 Residence/ wealth index Male Female Total Male Female Total Gender Parity Index3 Residence Urban 85.7 82.5 84.1 103.7 97.9 100.9 0.94 Rural 85.6 84.4 85.0 104.3 100.8 102.6 0.97 Wealth quintile Lowest 85.2 86.2 85.7 104.8 105.4 105.1 1.01 Second 87.4 85.4 86.5 107.1 101.1 104.2 0.94 Middle 85.5 83.8 84.7 104.5 98.6 101.5 0.94 Fourth 86.2 83.1 84.7 103.8 97.8 100.9 0.94 Highest 83.9 78.8 81.4 99.6 94.2 97.0 0.94 Total 85.7 83.6 84.7 104.1 99.7 101.9 0.96 1 The NAR for primary school is the percentage of the primary-school-age (7-12 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 primary-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 is the ratio of the GAR for females to the GAR for males. Characteristics of Households and Housing Characteristics | 15 Table 2.5.2 shows that secondary school attendance ratios are much lower and differ substantially by background characteristics. The NAR and GAR for secondary school are 58 and 72 percent, respectively. The NAR for secondary school is substantially higher in urban areas (65 percent) than in rural areas (53 percent). The GAR for secondary school is also substantially higher in urban areas (80 percent) than in rural areas (66 percent). In addition, the NAR and GAR for secondary school differ substantially between males and females. In general, the NAR and GAR are lower for males than for females. For the NAR, it is 57 for males compared with 59 for females, and for the GAR, it is 70 for males compared with 75 for females. 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 secondary school by sex and the gender parity index (GPI), residence, province and wealth index, Indonesia 2007 Net attendance ratio1 Gross attendance ratio2 Residence/ wealth index Male Female Total Male Female Total Gender Parity Index3 Residence Urban 65.0 64.6 64.8 79.4 81.4 80.4 1.02 Rural 51.4 54.5 52.9 63.8 69.2 66.3 1.08 Wealth quintile Lowest 35.5 37.7 36.5 44.4 47.4 45.8 1.07 Second 47.9 54.2 50.8 58.8 67.5 62.7 1.15 Middle 57.0 59.7 58.3 69.5 74.5 71.9 1.07 Fourth 67.0 72.2 69.5 83.1 89.7 86.3 1.08 Highest 80.4 69.3 74.7 98.9 91.1 94.9 0.92 Total 57.2 59.0 58.1 70.4 74.6 72.4 1.06 1 The NAR for secondary school is the percentage of the secondary-school age (13-18 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 secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index is the ratio of the GAR for females to the GAR for males. 2.5 HOUSING CHARACTERISTICS AND HOUSEHOLD POSSESSIONS 2.5.1 Household Environment The physical characteristics of the dwelling in which a household lives are important determinants of the health status of household members, especially children. They can also be used as indicators of the socioeconomic status of households. In the 2007 IDHS respondents were asked a number of questions about the physical characteristics of the household environment. These included questions on source of drinking water, type of sanitation facility, type of flooring, walls and roof, and number of rooms in the dwelling. The results are presented both in terms of sampled households and the de jure population. 2.5.2 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals that Indonesia along with other nations worldwide has adopted (United Nations General Assembly, 2001). Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2005). The source of drinking water is an indicator of whether it is suitable for drinking. Sources which are likely to provide water suitable for drinking include a piped source within the dwelling or plot, public tap, tube well or borehole, protected well, or spring and rainwater.1 1 The categorization of drinking water sources into improved and nonimproved follows the guidelines proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO and UNICEF, 2005). 16 | Characteristics of Huseholds and Housing Characteristics Table 2.6 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage of households and the de jure by treatment of drinking water, according to residence, Indonesia 2007 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Piped into dwelling 20.6 5.0 11.5 22.0 5.1 12.3 Piped to yard/plot 2.5 1.6 1.9 2.6 1.6 2.1 Public tap/standpipe 4.0 2.3 3.0 3.8 2.3 2.9 Open well - in dwelling 3.6 3.1 3.3 3.8 3.2 3.5 Open well - in yard/plot 3.3 8.3 6.2 3.4 8.4 6.2 Open well - public 1.3 4.0 2.9 1.2 4.0 2.8 Protected well - in dwelling 19.6 12.9 15.7 20.7 13.4 16.5 Protected well - in yard/plot 12.3 17.6 15.4 12.1 17.5 15.2 Protected well - public 5.4 10.8 8.6 5.0 10.4 8.1 Spring 3.3 22.8 14.7 3.4 22.5 14.3 River/stream 0.8 4.8 3.1 0.9 5.2 3.3 Pond/lake/dam 0.1 0.3 0.2 0.1 0.3 0.2 Rainwater 1.8 2.4 2.1 1.9 2.5 2.2 Tanker truck 4.0 1.1 2.3 4.1 1.0 2.3 Bottled water1 17.3 2.6 8.7 14.9 2.3 7.7 Other 0.2 0.3 0.2 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 80.4 54.5 65.2 80.6 54.4 65.6 Time to obtain drinking water (round trip) Water on premises 87.5 70.3 77.4 88.1 70.2 77.9 Less than 30 minutes 10.8 24.0 18.5 10.1 23.7 17.9 30 minutes or longer 1.0 4.7 3.2 1.0 5.1 3.4 Don't know/missing 0.8 1.0 0.9 0.7 1.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 5.8 18.6 13.3 5.2 18.5 12.8 Adult male 15+ 5.3 8.6 7.2 5.1 8.3 6.9 Female child under age 15 0.3 1.2 0.8 0.3 1.5 1.0 Male child under age 15 0.7 0.8 0.7 0.7 1.0 0.9 Water on premises 87.5 70.3 77.4 88.1 70.2 77.9 Missing 0.5 0.6 0.5 0.5 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 86.4 93.5 90.6 88.3 93.6 91.4 Bleach/chlorine 1.0 1.2 1.1 1.0 1.3 1.2 Ceramic, sand or other filter 3.9 4.5 4.2 4.0 4.6 4.3 Solar disinfection 0.1 0.1 0.1 0.1 0.1 0.1 Other 21.0 27.4 24.8 21.9 28.2 25.5 No treatment 10.7 4.7 7.2 8.9 4.4 6.3 Percentage using an appropriate treatment method3 86.9 93.6 90.8 88.9 93.8 91.7 Number 16,883 23,818 40,701 71,433 95,569 167,002 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, water that must be fetched from a source that is not readily accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is the fact that burden of fetching water often falls disproportionately on female members of the household. Households were further asked if they treat the water before drinking it. Characteristics of Households and Housing Characteristics | 17 Table 2.6 shows that protected wells, whether in the dwelling, in the yard, or at a public tap, are the main source of drinking water (40 percent). Sixteen percent of households use water that is either piped into the residence or into the yard or obtained from the public tap. This proportion is much higher in the urban than in the rural areas (27 and 9 percent, respectively). Other sources of drinking water include springs (15 percent), other open water such as rivers and ponds (3 percent), and bottled water (9 percent). Rural households are much more likely to use spring water than urban households (23 percent compared with 3 percent). On the other hand, bottled water is more common in urban areas (17 percent) than in rural areas (3 percent). The urban-rural differences are also reflected in the time taken to draw water. In urban areas, 98 percent of households have water in the house or yard, compared with 70 percent of rural households. Additionally, 11 percent of urban households are within 15 minutes of a water source, compared with 24 percent of rural households. 2.5.3 Household Sanitation Facilities and Other Characteristics Ensuring adequate sanitation facilities is another of the Millennium Development Goals that Indonesia shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2005). 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 (57 percent) have a private toilet, a slight increase from 54 percent found in the 2002-2003 IDHS (BPS and ORC Macro, 2003). Ten percent of households use a shared facility, and the remaining 33 percent do not have a toilet. This latter percentage is slightly higher than that found in the 2002-2003 IDHS (28 percent). The urban-rural differences are notable; 75 percent of households in urban areas have a private toilet, compared with 43 percent in rural areas. Table 2.7 shows the distribution of households by the distance from the well to the nearest septic tank. Forty-eight percent of households have no well. For 10 percent of the households, the nearest septic tank is less than seven meters from their well, and for 33 percent, the nearest septic tank is seven meters from the well. 18 | Characteristics of Huseholds and Housing Characteristics Table 2.7 Housing characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of chimney/stove, according to residence, Indonesia 2007 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 98.2 86.1 91.1 98.2 85.8 91.1 No 1.8 13.9 8.9 1.8 14.1 8.8 Missing 0.0 0.1 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Sanitation facility Private with septic tank 65.7 32.7 46.4 66.8 33.6 47.8 Private with no septic tank 9.7 10.4 10.1 10.5 10.7 10.6 Shared/public 10.9 8.9 9.8 9.0 8.1 8.5 River/stream/creek 8.6 19.9 15.2 8.4 19.7 14.9 Pit 2.3 15.2 9.9 2.2 14.5 9.3 Bush/forest/yard/field/ no facility 2.2 11.9 7.9 2.4 12.4 8.1 Other 0.5 0.9 0.7 0.6 0.9 0.8 Missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Distance from well to nearest septic tank No well 54.5 43.2 47.9 53.8 43.1 47.7 Less than 7 meters 10.4 9.3 9.7 10.6 9.1 9.7 7 meters or more 28.6 36.2 33.1 29.1 36.6 33.4 Don’t know/missing 6.5 11.3 9.3 6.5 11.2 9.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Dirt/ earth 5.2 18.2 12.8 4.6 16.4 11.4 Bamboo 0.3 1.7 1.1 0.4 1.7 1.2 Wood 5.9 18.3 13.1 5.9 19.1 13.4 Brick/concrete 30.8 34.7 33.1 30.9 35.8 33.7 Tile 19.5 11.0 14.6 19.5 10.8 14.5 Ceramic/marble/granite 37.9 15.8 25.0 38.4 15.8 25.4 Other 0.0 0.1 0.1 0.1 0.1 0.1 Missing 0.3 0.2 0.2 0.3 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 0.5 0.1 0.3 0.4 0.1 0.2 LPG/natural gas/biogas 20.4 3.8 10.7 21.0 3.9 11.2 Kerosene 54.6 18.7 33.6 55.2 18.5 34.2 Coal/lignite 0.0 0.0 0.0 0.0 0.0 0.0 Charcoal 0.3 0.5 0.4 0.2 0.5 0.4 Wood 21.7 76.3 53.6 22.3 76.6 53.4 Straw/shrubs/grass 0.0 0.0 0.0 0.0 0.0 0.0 No food cooked in household 2.5 0.4 1.3 0.8 0.1 0.4 Other 0.0 0.1 0.0 0.0 0.1 0.0 Missing 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 22.0 76.8 54.0 22.6 77.2 53.8 Number of households 16,883 23,818 40,701 71,433 95,569 167,002 Number of households/ population using solid fuel 3,707 18,290 21,997 16,119 73,767 89,885 LPG=Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood, and straw/shrubs/grass Characteristics of Households and Housing Characteristics | 19 The type of flooring material in the dwelling can be considered as both an economic indicator and a health indicator for household. Some floor materials like dirt or earth pose health problems for the household because they are the natural environment of pests such as insects and parasites, and may be a source of dust. This kind of flooring is also more difficult to keep clean. In Indonesia, 13 percent of households have a dirt floor. Almost half of households (48 percent) live in dwellings with a concrete, brick, or tile floor, while 13 percent have a wooden floor. There are substantial urban-rural differentials by type of floor material. Whereas 50 percent of urban households have a concrete, brick, or tile floor, the proportion in rural areas is 46 percent. Conversely, 18 percent of rural households have a dirt floor, compared with 5 percent in urban areas. The majority of the households uses kerosene and firewood or straw for cooking (34 and 54 percent, respectively); while 11 percent use liquid propane gas (LPG) or natural gas. There are substantial urban-rural differentials by type of cooking fuel. Whereas 55 percent of urban households use kerosene for cooking, only 19 percent of rural households do so. Furthermore, 20 percent of urban households use gas for cooking compared with 4 percent of households in rural areas. Table 2.7 shows that 91 percent of the households covered in the 2007 IDHS have electricity, a large increase from the 80 percent reported in the 1997 IDHS (BPS and MI, 1998). There are significant urban-rural differentials, with 98 percent of urban households having electricity, compared with 86 percent of rural households (see Figure 2.2). 2.6 HOUSEHOLD POSSESSIONS The presence of durable goods in the households, such as a radio, television, telephone, refrigerator, motorcycle, and private car, is another 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 measures access to an efficient means of communication; refrigerator ownerships prolongs the wholesomeness of foods; and ownership of private transport allows greater access to many services away from the local area. 98 27 75 50 86 9 43 46 91 16 57 48 Electricity Piped water Private toilet Floor concrete, brick, or tile 0 20 40 60 80 100 Percent Urban Rural Total Figure 2.2 Housing Characteristics by Residence IDHS 2007 20 | Characteristics of Huseholds and Housing Characteristics Table 2.8 shows that 49 percent of households have a radio, 69 percent have a television, 42 percent have telephone or mobile phone, 25 percent have a refrigerator, 47 percent have a bicycle, 45 percent have a motorcycle or scooter, and 7 percent of households have a private car or truck. Thirteen percent of households have none of the durable goods listed in Table 2.8. Ownership of durable goods (except for the radio) has increased since the 2002-2003 IDHS (BPS and ORC Macro, 2003). Ownership of radios has decreased from 62 percent in 1997 to 49 percent in 2007, while ownership of televisions increased from 48 to 69 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, 85 percent of urban households have a television set, compared with 57 percent of rural households. A telephone is available in 61 percent of urban households compared with 29 percent of rural households. Furthermore, urban households are three times as likely to own a private car or truck as rural households (11 and 3 percent, respectively). Table 2.8 Household durable goods Percentage of households and de jure population possessing various durable goods by residence, Indonesia 2007 Households Population Durable goods Urban Rural Total Urban Rural Total Radio 58.3 42.3 49.0 59.8 42.9 50.1 Television 84.9 57.2 68.7 87.6 60.3 72.0 Telephone/mobile phone 61.3 28.5 42.1 63.4 31.0 44.9 Refrigerator 43.1 12.6 25.2 46.0 13.7 27.5 Bicycle 52.5 43.4 47.2 57.1 46.5 51.0 Motorcycle/scooter 55.7 37.3 45.0 59.3 40.1 48.3 Car/truck 10.8 3.4 6.5 12.0 3.8 7.3 None of the above 5.3 19.1 13.4 4.1 16.7 11.3 Number 16,883 23,818 40,701 71,433 95,569 167,002 2.7 WEALTH INDEX The wealth index is a background characteristic that is used throughout the report as a proxy for long-term standard of living of the household. It is based on the data for household ownership of consumer goods; dwelling characteristics; source of drinking water source; toilet facilities; and other characteristics related to the socioeconomic status of households. To construct the index, each of these assets was assigned a weight (factor score) generated through principal component analysis, and the resulting asset scores were standardized in relation to a standard normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household. Individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed on the basis of data from the entire country sample and this index is used in all the tabulations presented in the report. Table 2.9 shows the distribution of the de jure household population into the five wealth quintiles by residence. The distribution indicates the degree to which wealth is evenly (or unevenly) distributed by urban-rural residence. Data in Table 2.9 indicate that the population in urban areas is more likely to be in the highest wealth quintiles, while rural populations are more likely to be in the lowest wealth quintiles. For example, more than half of the rural population is in the two lowest quintiles, while two-thirds of the urban population is in the two highest quintiles. Characteristics of Households and Housing Characteristics | 21 Table 2.9 Wealth quintiles Percent distribution of the jure population by wealth quintiles, according to residence and province, Indonesia 2007 Wealth quintile Residence/province Lowest Second Middle Fourth Highest Total Number of population Residence Urban 4.4 10.1 18.9 28.1 38.5 100.0 71,433 Rural 31.7 27.4 20.8 13.9 6.2 100.0 95,569 Sumatera DI Aceh 36.1 26.8 17.1 14.0 6.0 100.0 2,820 North Sumatera 26.9 19.2 21.5 16.4 15.9 100.0 9,131 West Sumatera 22.6 30.8 20.2 14.0 12.4 100.0 3,237 Riau 21.9 22.1 14.4 21.7 19.9 100.0 2,582 Jambi 23.6 25.0 20.9 18.6 11.9 100.0 1,651 South Sumatera 32.2 21.9 22.2 13.4 10.2 100.0 4,706 Bengkulu 29.9 22.0 18.5 16.4 13.2 100.0 1,089 Lampung 21.1 27.0 24.8 15.7 11.5 100.0 5,147 Bangka Belitung 15.0 19.3 20.9 25.0 19.7 100.0 989 Kep Bangka Belitung 13.6 12.8 18.1 26.2 29.2 100.0 707 Java DKI Jakarta 0.3 3.4 8.0 25.1 63.2 100.0 7,342 West Java 9.7 14.3 20.7 27.8 27.5 100.0 27,052 Central Java 15.0 21.3 25.1 22.6 15.9 100.0 27,012 DI Yogyakarta 5.4 16.4 25.7 24.3 28.3 100.0 2,946 East Java 13.3 24.5 21.0 21.2 20.0 100.0 28,017 Banten 13.5 15.1 20.2 17.6 33.6 100.0 6,752 Bali and Nusa Tenggara Bali 5.3 13.9 18.4 26.7 35.7 100.0 2,713 West Nusa Tenggara 28.4 27.8 15.9 14.8 13.1 100.0 3,506 East Nusa Tenggara 65.8 14.9 10.1 6.8 2.3 100.0 3,617 Kalimantan West Kalimantan 42.6 20.8 13.5 14.3 8.8 100.0 3,365 Central Kalimantan 51.8 22.7 11.7 7.5 6.4 100.0 1,411 South Kalimantan 35.5 27.5 18.7 11.6 6.8 100.0 2,601 East Kalimantan 24.6 22.7 20.0 15.7 17.0 100.0 2,257 Sulawesi North Sulawesi 18.1 28.3 24.0 23.2 6.4 100.0 1,973 Central Sulawesi 45.0 21.9 15.6 8.1 9.4 100.0 1,838 South Sulawesi 37.3 23.0 16.8 11.4 11.5 100.0 5,882 Southeast Sulawesi 49.0 17.8 12.3 11.3 9.7 100.0 1,476 Gorontalo 42.9 22.4 11.3 13.2 10.2 100.0 773 West Sulawesi 51.9 19.1 14.9 9.5 4.6 100.0 779 Maluku and Papua Maluku 42.2 22.3 13.9 14.8 6.9 100.0 1,091 North Maluku 29.8 27.5 20.8 16.4 5.6 100.0 745 Papua 27.7 22.5 17.2 19.9 12.7 100.0 472 West Papua 58.9 12.7 15.8 8.2 4.4 100.0 1,321 Total 20.0 20.0 20.0 20.0 20.0 100.0 167,002 Characteristics of Respondents and Women’s Status | 23 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of the 2007 Indonesia Demographic and Health Survey (IDHS) sample of ever-married women and currently married men. Information on the 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 characteristics. More de- tailed information on education, literacy, and exposure to mass media are then discussed. This is followed by data on the employment and earnings of women, decision making 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 shows the distribution of ever-married women age 15-49 and currently married men age 15-54 interviewed in the 2007 IDHS by background characteristics including age, marital status, urban-rural residence, educational level, wealth index, and religion. The findings show that approximately one-third of women and one in five men are under age 30. Table 3.1 also shows that 94 percent of women are currently married, and the remaining 6 percent is split between divorced and widowed women. Forty-two percent of women and 43 percent of men live in urban areas. Seven percent of ever-married women and 4 percent of currently married men have never attended formal schooling. More women than men completed primary school (31 and 27 percent, respectively), but more men than women have secondary education (31 and 25 percent, respectively). Overall, the data indicate that women are becoming better educated. While the percentage of ever-married women with no education is similar to that in the 2002-2003 IDHS, the percentage of those with some secondary education increased from 38 percent in 2002-2003 to 46 percent in 2007. Looking at the distribution of respondents by religion, 89 percent of women and 88 percent of men are Muslim and 9 percent are Christian (Protestant or Catholic). The small remaining percentages are Hindus, Buddhists, or other religions. Differentials in background characteristics by province are pre- sented in Appendix Table A-3.1. 24 | Characteristics of Respondents and Women’s Status Table 3.1 Distribution of respondents by background characteristics Percent distribution of ever-married women and currently married men by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 2.6 845 914 0.3 29 19 20-24 12.4 4,094 4,156 4.9 432 442 25-29 17.5 5,771 6,170 12.7 1,116 1,190 30-34 18.3 6,020 6,317 16.2 1,418 1,587 35-39 18.3 6,004 5,898 19.2 1,679 1,708 40-44 16.3 5,365 5,034 17.9 1,570 1,500 45-49 14.6 4,795 4,406 15.5 1,359 1,268 50-54 na na na 13.2 1,155 1,044 Marital status Married 94.0 30,931 30,869 100.0 8,758 8,758 Divorced/separated 3.1 1,012 1,035 na na na Widowed 2.9 952 991 na na na Residence Urban 41.8 13,745 13,087 42.6 3,728 3,510 Rural 58.2 19,150 19,808 57.4 5,030 5,248 Education No education 6.9 2,271 2,237 4.2 365 346 Some primary 16.9 5,572 5,503 18.3 1,605 1,444 Complete primary 30.6 10,077 8,834 26.7 2,339 2,084 Some secondary 20.6 6,781 7,048 19.7 1,721 1,868 Secondary + 24.9 8,193 9,273 31.1 2,727 3,016 Wealth quintile Lowest 18.9 6,219 8,453 19.1 1,676 2,226 Second 20.1 6,606 6,578 19.4 1,698 1,750 Middle 20.4 6,710 5,965 20.4 1,788 1,594 Fourth 20.4 6,713 5,918 19.6 1,713 1,527 Highest 20.2 6,647 5,981 21.5 1,882 1,661 Religion Islam 88.5 29,104 26,185 88.2 7,724 6,881 Protestant 6.0 1,989 3,598 6.1 531 990 Catholic 2.9 958 1,406 3.0 263 368 Hindu 1.8 592 1,286 2.0 174 408 Buddhist 0.4 139 253 0.4 33 62 Confucian 0.0 0 0 0.1 7 12 Other 0.2 74 120 0.2 18 26 Missing 0.1 38 47 0.1 8 11 Total 100.0 32,895 32,895 100.0 8,758 8,758 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 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 age, residence, and household wealth status. Young women and men are more likely to have attended school than older respondents. The percentage of respondents who have never attended school increases with age 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 18 percent of women and 7 percent of men age 45-49. Similarly, 35 percent of women age 20-24 had some secondary education, compared with only 11 percent of women age 45-49. The corresponding figures for men are 31 and 14 percent, respectively. Characteristics of Respondents and Women’s Status | 25 Table 3.2 Educational attainment by background characteristics Percent distribution of ever-married women and currently married men by highest level of schooling attended or completed, and median grade completed, according to background characteristics, Indonesia 2007 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed EVER-MARRIED WOMEN Age 15-19 2.2 10.6 38.6 39.2 9.1 0.3 100.0 845 5.9 20-24 1.5 9.4 28.5 34.9 21.7 4.0 100.0 4,094 8.2 25-29 2.1 10.1 31.3 25.1 22.9 8.5 100.0 5,771 8.2 30-34 3.0 11.0 35.4 21.2 21.1 8.2 100.0 6,020 6.3 35-39 5.9 15.0 31.7 18.4 21.8 7.3 100.0 6,004 5.9 40-44 12.5 26.4 27.4 12.5 14.1 7.1 100.0 5,365 5.4 45-49 18.0 32.0 26.5 10.9 7.0 5.6 100.0 4,795 5.0 Residence Urban 3.7 11.2 23.5 22.4 27.7 11.5 100.0 13,745 8.5 Rural 9.2 21.1 35.7 19.3 11.2 3.4 100.0 19,150 5.5 Wealth quintile Lowest 14.7 30.1 34.8 14.7 5.2 0.5 100.0 6,219 5.1 Second 9.9 22.5 38.5 19.3 9.0 0.9 100.0 6,606 5.5 Middle 6.5 16.3 35.7 23.7 14.9 2.9 100.0 6,710 5.8 Fourth 2.7 12.2 29.1 26.3 23.6 6.0 100.0 6,713 8.2 Highest 1.2 4.5 15.3 18.6 36.9 23.3 100.0 6,647 11.3 Total 6.9 16.9 30.6 20.6 18.1 6.8 100.0 32,895 5.8 CURRENTLY MARRIED MEN Age 15-19 * * * * * * 100.0 29 5.9 20-24 1.2 13.0 26.9 31.2 23.7 4.0 100.0 432 8.2 25-29 1.3 8.8 29.2 26.0 28.7 5.9 100.0 1,116 8.4 30-34 1.5 9.2 27.6 23.5 29.0 9.2 100.0 1,418 8.4 35-39 3.2 12.5 27.8 21.0 26.2 9.3 100.0 1,679 8.2 40-44 3.3 22.0 22.5 14.7 24.8 12.7 100.0 1,570 8.0 45-49 7.3 27.2 28.8 14.1 11.7 11.0 100.0 1,359 5.5 50-54 10.0 34.0 24.2 15.3 9.1 7.0 100.0 1,155 5.2 Residence Urban 2.4 11.4 19.5 20.3 32.3 14.0 100.0 3,728 8.9 Rural 5.4 23.5 32.0 19.2 14.4 5.5 100.0 5,030 5.7 Wealth quintile Lowest 9.8 28.9 35.2 16.9 8.4 0.8 100.0 1,676 5.3 Second 5.1 29.1 32.9 21.1 10.4 1.3 100.0 1,698 5.5 Middle 3.3 20.2 31.9 22.2 18.5 4.0 100.0 1,788 5.8 Fourth 1.9 11.3 23.3 22.2 32.0 9.3 100.0 1,713 8.6 Highest 1.0 3.9 11.7 16.0 38.9 28.2 100.0 1,882 11.4 Total 4.1 18.3 26.7 19.7 22.0 9.1 100.0 8,758 6.6 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Completed 6 grade at the primary level 2 Completed 6 grade at the secondary level The IDHS data indicate that educational opportunities vary by urban-rural residence. Urban women and men are more likely to go to school than their rural counterparts. Four percent of urban women and 2 percent of urban men have not attended school, compared with 9 percent of women and 5 percent of men in rural areas. Comparison of the median number of years of education completed shows a similar pattern, with urban women having a median of 8.5 years of schooling and rural women having 5.5 years. For men, the corresponding figures are 8.9 and 5.7 years, respectively. There are significant differentials in educational attainment across provinces (see Appendix Table A-3.2). 3.3 LITERACY The ability to read is an important personal asset that gives women and men increased opportunities in life. Information on the distribution of the literate population can help health and family 26 | Characteristics of Respondents and Women’s Status planning professionals reach their target populations with messages. In the 2007 IDHS, literacy was measured by the respondent’s ability to read a sentence in Indonesian from a card. The questions assessing literacy were asked only of women and men who had not attended school or had attended only primary school. Respondents who attended at least secondary school are considered literate. Table 3.3 shows that the majority of respondents are literate, 87 percent of ever-married women and 91 percent of currently married men cannot read at all. The percentage of women who cannot read at all is 12 percent; 9 percent of men cannot read at all. Younger respondents are more likely to be literate than older respondents. Whereas 96 percent of women and men age 20-24 are literate, the proportion among respondents age 45-49 is 70 percent for women and 85 percent for men. There are variations by urban-rural residence and wealth status, with urban respondents and those in the higher wealth quintiles being more likely to be literate. Almost all women and men in the highest wealth quintile are literate (98 percent each). The variation in literacy rates by province is presented in Appendix Table A-3.3. Table 3.3 Literacy Percent distribution of ever-married women and currently married men by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Indonesia 2007 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Missing Total Percentage literate1 Number EVER-MARRIED WOMEN Age 15-19 48.6 40.0 6.1 4.5 0.9 100.0 94.6 845 20-24 60.6 31.5 3.6 3.8 0.5 100.0 95.7 4,094 25-29 56.4 33.1 5.4 4.5 0.6 100.0 95.0 5,771 30-34 50.6 36.9 5.7 6.0 0.8 100.0 93.2 6,020 35-39 47.4 34.6 7.0 10.6 0.3 100.0 89.0 6,004 40-44 33.7 33.0 11.8 21.0 0.5 100.0 78.5 5,365 45-49 23.5 33.2 13.6 29.2 0.5 100.0 70.3 4,795 Residence Urban 61.6 26.7 5.4 5.8 0.5 100.0 93.7 13,745 Rural 34.0 39.3 9.5 16.7 0.6 100.0 82.8 19,150 Wealth quintile Lowest 20.4 39.9 13.5 25.6 0.7 100.0 73.8 6,219 Second 29.1 42.8 10.0 17.5 0.6 100.0 81.9 6,606 Middle 41.5 39.4 7.7 11.0 0.5 100.0 88.5 6,710 Fourth 55.9 32.0 5.9 5.7 0.6 100.0 93.8 6,713 Highest 78.9 16.6 2.4 1.8 0.3 100.0 97.8 6,647 Total 45.5 34.1 7.8 12.1 0.5 100.0 87.4 32,895 CURRENTLY MARRIED MEN Age 15-19 * * * * * 100.0 * 29 20-24 58.9 30.2 7.2 3.6 0.0 100.0 96.4 432 25-29 60.7 30.7 4.3 3.7 0.6 100.0 95.7 1,116 30-34 61.7 30.8 3.9 3.3 0.3 100.0 96.4 1,418 35-39 56.4 34.1 3.7 5.5 0.3 100.0 94.3 1,679 40-44 52.1 32.3 7.1 8.1 0.4 100.0 91.5 1,570 45-49 36.8 40.2 8.2 14.2 0.5 100.0 85.2 1,359 50-54 31.4 35.2 9.9 22.8 0.6 100.0 76.6 1,155 Residence Urban 66.6 24.6 3.8 4.5 0.5 100.0 95.0 3,728 Rural 39.1 40.5 7.8 12.2 0.4 100.0 87.4 5,030 Wealth quintile Lowest 26.1 43.9 11.6 18.0 0.4 100.0 81.6 1,676 Second 32.9 42.6 9.4 14.6 0.5 100.0 84.9 1,698 Middle 44.6 40.4 6.8 7.6 0.6 100.0 91.8 1,788 Fourth 63.6 30.1 2.5 3.6 0.2 100.0 96.3 1,713 Highest 83.1 13.9 0.8 1.8 0.4 100.0 97.8 1,882 Total 50.8 33.8 6.1 8.9 0.4 100.0 90.7 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Refers to respondents who attended secondary school or higher and those who can read a whole sentence or part of a sentence Characteristics of Respondents and Women’s Status | 27 3.4 EXPOSURE TO MASS MEDIA Information access is essential to increasing people’s knowledge and awareness of what is taking place around them that may eventually affect their perceptions and behavior. It is important to know which groups are likely to be reached by the media for purposes of planning programs intended to disseminate information about health and family planning. In the 2007 IDHS, exposure to media was assessed by asking how often a respondent reads a newspaper, watches television, or listens to the radio. Tables 3.4 shows the percentage of ever-married women and currently married men who were exposed to different types of media by age, urban-rural residence, level of education, and wealth quintile. Table 3.4 shows that television is the most popular mass media among ever-married women and currently married men (78 and 80 percent, respectively), followed by radio with 27 percent of women and 32 percent of men. Readership of print media is much lower for both women and men (12 and 24 percent, respectively). Since 2002-2003, there has been a decrease in the proportion of women exposed to all three media, from 9 percent to 6 percent in the 2007 IDHS. Women and men living in urban areas and those age 30-44 are more likely to have access to all three media than their rural counterparts or those in other age groups. The findings also show that education is strongly associated with exposure to mass media. For instance, 14 percent of women and 22 percent of men with secondary or higher education are likely to have access to all three types of media, compared with 2 and 5 percent, respectively, of women and men with some primary education. In general, men have greater exposure to mass media than women. This differential applies to all population groups. Appendix Table A-3.4 shows the variation in media exposure among ever-married women and currently married men by province. Table 3.4 Exposure to mass media: Women Percentage of ever-married women and currently married men who are exposed to specific media on a weekly basis, by background characteristics, Indonesia 2007 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 at least once a week None of the specified media at least once a week Number EVER-MARRIED WOMEN Age 15-19 6.0 72.0 32.3 2.3 21.3 845 20-24 8.7 79.2 32.2 4.8 15.9 4,094 25-29 12.8 81.3 28.9 5.5 14.9 5,771 30-34 13.2 80.7 27.6 5.7 15.8 6,020 35-39 14.2 78.7 27.8 6.7 17.6 6,004 40-44 13.4 74.7 25.1 6.3 21.7 5,365 45-49 9.2 72.4 22.0 3.4 24.2 4,795 Residence Urban 20.0 86.7 29.7 8.8 10.4 13,745 Rural 6.2 71.5 25.7 2.9 24.0 19,150 Education No education 0.3 50.3 12.4 0.1 46.2 2,271 Some primary 2.1 66.0 19.8 1.0 30.2 5,572 Complete primary 4.8 76.7 26.4 2.5 19.0 10,077 Some secondary 9.4 83.4 30.6 4.4 12.7 6,781 Secondary + 33.0 90.3 35.1 14.3 6.4 8,193 Wealth quintile Lowest 2.8 45.4 19.0 1.1 46.8 6,219 Second 4.6 72.9 25.4 1.9 22.1 6,606 Middle 7.1 84.9 27.6 3.3 12.3 6,710 Fourth 12.6 90.6 30.9 6.1 7.5 6,713 Highest 32.3 93.0 33.3 14.3 4.9 6,647 Total 12.0 77.8 27.3 5.4 18.3 32,895 Continued… 28 | Characteristics of Respondents and Women’s Status Table 3.4—Continued 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 at least once a week None of the specified media at least once a week Number CURRENTLY MARRIED MEN Age 15-19 * * * * * 29 20-24 14.0 82.6 32.5 6.3 13.4 432 25-29 22.9 81.9 31.8 7.4 13.9 1,116 30-34 27.2 81.7 33.6 11.4 12.7 1,418 35-39 25.5 81.2 36.2 11.6 13.7 1,679 40-44 25.7 82.1 31.1 11.5 12.3 1,570 45-49 23.5 78.7 28.1 8.0 17.5 1,359 50-54 19.9 75.5 30.3 8.8 19.8 1,155 Residence Urban 36.0 88.4 33.0 13.7 7.4 3,728 Rural 14.7 74.4 31.3 6.9 20.3 5,030 Education No education 2.2 46.9 20.0 0.4 49.3 365 Some primary 4.7 70.2 24.9 2.1 25.3 1,605 Complete primary 10.2 76.7 31.8 4.5 18.2 2,339 Some secondary 19.1 84.5 33.2 7.5 10.3 1,721 Secondary + 52.6 91.4 37.1 21.7 3.9 2,727 Wealth quintile Lowest 6.3 51.1 25.5 3.0 40.5 1,676 Second 11.1 75.8 30.3 5.6 19.0 1,698 Middle 17.9 87.5 34.0 8.1 8.5 1,788 Fourth 28.2 92.7 33.5 10.6 4.6 1,713 Highest 52.4 92.6 36.0 20.7 3.5 1,882 Total 23.8 80.4 32.0 9.8 14.8 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 3.5 EMPLOYMENT 3.5.1 Employment status Respondents in the 2007 IDHS were asked a number of questions about their employment status at the time of the survey and the continuity of employment in the past 12 months. The measurement of women’s employment, however, is difficult because some of the work they do, especially on family farms, in family businesses, or in the informal sector, is often not perceived as employment by the women themselves 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 working?” 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 family farm or in the family business. Are you 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 past 12 months?” Women are considered currently employed if they answer “yes” to either of the first two questions. Women who answer “yes” to the third question are considered not currently employed, but worked in the past 12 months. Table 3.5.1 and Figure 3.1 show that 57 percent of ever-married women are currently employed, 3 percent are not currently employed but were employed at some time during the past 12 months, and 39 percent of women were not employed at all in the past 12 months. Older women, women in rural areas, and women who have no education are more likely to have been employed during the past year. Women with more children are more likely to be currently employed than those with fewer children. Characteristics of Respondents and Women’s Status | 29 Table 3.5.1 shows that, in general, there is a negative relationship between current employment and household wealth status. The likelihood of a woman being employed goes down as the household wealth quintile increases. Table 3.5.1 Employment status: Women Percent distribution of ever-married women by employment status, according to background characteristics, Indonesia 2007 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the past 12 months Total Number of women Age 15-19 29.7 9.3 61.0 100.0 845 20-24 38.7 5.7 55.6 100.0 4,094 25-29 49.5 4.1 46.3 100.0 5,771 30-34 57.0 3.4 39.7 100.0 6,020 35-39 63.8 2.4 33.8 100.0 6,004 40-44 67.6 2.1 30.3 100.0 5,365 45-49 68.0 2.2 29.9 100.0 4,795 Marital status Married 56.2 3.4 40.4 100.0 30,931 Divorced/separated/ widowed 74.3 3.5 22.3 100.0 1,964 Number of living children 0 54.3 7.2 38.5 100.0 2,687 1-2 55.2 3.3 41.4 100.0 18,545 3-4 60.9 2.7 36.4 100.0 8,908 5+ 62.2 2.0 35.8 100.0 2,754 Residence Urban 53.1 3.0 43.8 100.0 13,745 Rural 60.2 3.6 36.2 100.0 19,150 Education No education 75.9 2.3 21.8 100.0 2,271 Some primary 63.9 3.0 33.0 100.0 5,572 Complete primary 56.9 3.4 39.7 100.0 10,077 Some secondary 47.0 4.4 48.5 100.0 6,781 Secondary + 56.6 3.0 40.4 100.0 8,193 Wealth quintile Lowest 61.8 4.2 33.9 100.0 6,219 Second 59.2 3.5 37.3 100.0 6,606 Middle 56.9 3.8 39.3 100.0 6,710 Fourth 52.6 3.2 44.2 100.0 6,713 Highest 56.2 2.2 41.6 100.0 6,647 Total 57.3 3.4 39.3 100.0 32,895 1 “Currently employed” is defined as having done work in the past seven days; includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Table 3.5.2 shows that almost all currently married men are currently employed (98 percent), another 1 percent were employed at some time in the past year, and 1 percent were not employed at all during the past year. There are small variations across subgroups of men. Appendix Tables A-3.5.1 and A-3.5.2 show the percent distribution of ever-married women and currently married men by employment status, according to province. 30 | 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 background characteristics, Indonesia 2007 Employed in the past 12 months Background characteristic Currently employed Not currently employed Not employed in the past 12 months Total Number of men Age 15-19 * * * 100.0 29 20-24 96.4 3.3 0.3 100.0 432 25-29 97.3 2.1 0.6 100.0 1,116 30-34 98.5 1.3 0.2 100.0 1,418 35-39 98.5 0.9 0.6 100.0 1,679 40-44 98.6 0.5 0.9 100.0 1,570 45-49 98.3 1.3 0.4 100.0 1,359 50-54 96.9 0.7 2.4 100.0 1,155 Number of living children 0 97.4 2.2 0.4 100.0 723 1-2 98.1 1.2 0.6 100.0 4,855 3-4 97.8 0.8 1.4 100.0 2,411 5+ 98.2 1.3 0.5 100.0 769 Residence Urban 97.6 1.3 1.1 100.0 3,728 Rural 98.3 1.1 0.6 100.0 5,030 Education No education 96.7 1.5 1.7 100.0 365 Some primary 98.8 0.6 0.5 100.0 1,605 Complete primary 97.9 1.3 0.8 100.0 2,339 Some secondary 97.1 1.8 1.1 100.0 1,721 Secondary + 98.3 1.0 0.7 100.0 2,727 Wealth quintile Lowest 98.3 1.4 0.3 100.0 1,676 Second 97.5 1.5 1.0 100.0 1,698 Middle 98.0 0.9 1.0 100.0 1,788 Fourth 97.7 1.5 0.8 100.0 1,713 Highest 98.4 0.7 0.9 100.0 1,882 Total 98.0 1.2 0.8 100.0 8,758 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed 1 “Currently employed” is defined as having done work in the past seven days; includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. IDHS 2007 Figure 3.1 Employment Status of Women Age 15-49 Currently employed 57% Not employed in past 12 months 39% Not currently employed 3% Characteristics of Respondents and Women’s Status | 31 3.5.2 Occupation Table 3.6.1 shows the percent distribution of ever-married women who were employed during the 12 months preceding the survey by occupation, according to background characteristics. The data indicate that 40 percent of ever-married women work in agriculture; about half (20 percent) of these women work on their own land. The majority of women who work in the nonagricultural sector are engaged in sales and services occupations (37 percent). Respondents’ occupations vary 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 engagement 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 more likely to work in sales and services professions. 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 2007 Agriculture Nonagriculture Background characteristic Own land Family land Someone else’s land Rented land Don’t know/ missing Professional/ technical/ managerial Clerical Sales and services Skilled manual Un- skilled manual Other/ missing Total Number of women Age 15-19 19.6 14.2 22.0 1.8 0.2 1.4 0.4 26.1 14.2 0.0 0.0 100.0 330 20-24 16.8 8.2 11.1 0.7 1.1 3.7 2.9 35.9 19.1 0.1 0.5 100.0 1,816 25-29 16.3 4.8 10.1 1.4 0.7 8.1 3.7 37.0 17.6 0.0 0.3 100.0 3,093 30-34 16.9 4.3 13.2 1.5 0.6 5.9 3.1 38.4 15.6 0.1 0.3 100.0 3,631 35-39 20.5 3.7 14.4 1.5 0.3 7.3 2.5 38.7 11.0 0.0 0.0 100.0 3,974 40-44 21.9 3.2 13.6 2.0 0.6 8.8 3.0 38.1 8.7 0.1 0.0 100.0 3,740 45-49 28.0 3.0 15.9 1.2 1.1 6.8 1.8 33.5 8.4 0.2 0.1 100.0 3,362 Marital status Married 20.8 4.3 13.5 1.4 0.7 7.1 2.9 36.2 12.8 0.1 0.2 100.0 18,420 Divorced/separated/ widowed 15.2 4.4 12.9 1.5 0.6 4.9 1.9 45.4 13.1 0.0 0.1 100.0 1,526 Number of living children 0 13.6 5.3 8.0 1.3 0.3 9.9 4.6 39.0 17.8 0.1 0.1 100.0 1,653 1-2 18.1 4.4 13.7 1.0 0.6 7.2 3.4 36.5 14.8 0.0 0.2 100.0 10,855 3-4 22.9 3.9 13.9 1.5 0.9 7.0 1.8 39.0 9.0 0.0 0.1 100.0 5,669 5+ 32.4 4.5 15.7 4.0 0.6 2.7 0.7 31.0 8.1 0.3 0.1 100.0 1,769 Residence Urban 2.2 0.7 4.9 0.5 0.4 10.7 5.6 56.9 17.7 0.1 0.2 100.0 7,720 Rural 31.9 6.7 18.8 2.0 0.8 4.6 1.0 24.3 9.7 0.0 0.1 100.0 12,225 Education No education 35.0 5.1 27.8 2.3 0.8 0.0 0.0 20.2 8.9 0.0 0.0 100.0 1,776 Some primary 30.6 5.4 23.4 1.9 1.0 0.0 0.0 28.7 9.0 0.0 0.0 100.0 3,731 Complete primary 25.0 5.5 16.4 1.3 0.5 0.5 0.1 36.2 14.3 0.0 0.2 100.0 6,074 Some secondary 16.4 4.8 6.9 2.0 0.7 1.9 0.4 47.6 18.9 0.1 0.3 100.0 3,489 Secondary + 4.4 1.6 1.5 0.6 0.6 26.5 11.0 42.5 10.9 0.1 0.2 100.0 4,876 Wealth quintile Lowest 41.2 8.8 22.9 2.9 0.9 1.1 0.2 13.8 8.1 0.0 0.1 100.0 4,108 Second 29.2 5.6 22.8 1.9 0.9 1.7 0.5 26.5 10.6 0.0 0.3 100.0 4,143 Middle 18.6 4.2 14.0 1.3 0.6 4.6 1.3 39.2 16.0 0.1 0.0 100.0 4,070 Fourth 8.8 2.2 5.6 0.6 0.2 8.4 1.8 52.7 19.4 0.1 0.1 100.0 3,744 Highest 1.9 0.5 0.4 0.4 0.7 19.8 10.5 54.9 10.4 0.1 0.3 100.0 3,879 Total 20.4 4.4 13.4 1.5 0.7 7.0 2.8 36.9 12.8 0.1 0.2 100.0 19,946 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-nine percent of currently married men work in agriculture, with around half (20 percent) working on their own land. Men in the nonagricultural sector, like women, are far more likely to work in sales and services than in other professions (29 percent). They also show the same variations across subgroups as women. Provincial differentials in occupation are shown in Appendix Tables A-3.6.1 and A-3.6.2 32 | 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 characteristics, Indonesia 2007 Agriculture Nonagriculture Background characteristic Own land Family land Someone else’s land Rented land Don’t know/ missing Professional/ technical/ managerial Clerical Sales and services Skilled manual Agri- culture Other/ missing Total Number of men Age 15-19 * * * * * * * * * * * 100.0 29 20-24 14.3 11.3 14.7 3.4 0.7 1.8 0.7 25.9 25.2 1.7 0.3 100.0 430 25-29 14.3 6.0 10.3 0.9 0.4 3.4 3.4 32.2 26.3 1.6 1.2 100.0 1,109 30-34 16.0 6.1 11.2 1.9 0.4 5.6 3.1 33.9 19.4 1.1 1.3 100.0 1,415 35-39 18.6 3.5 12.4 1.5 0.8 6.9 3.5 31.1 19.1 1.7 0.9 100.0 1,668 40-44 21.3 2.2 11.5 1.1 0.5 8.7 4.6 28.9 18.3 1.7 1.2 100.0 1,555 45-49 24.7 2.5 16.4 1.2 1.0 9.6 4.4 24.5 12.2 1.7 1.8 100.0 1,353 50-54 27.1 2.2 17.0 1.0 0.5 5.2 5.5 26.2 12.0 2.1 1.3 100.0 1,127 Number of living children 0 15.6 6.6 9.6 1.3 0.9 3.9 4.1 36.1 19.3 1.8 0.8 100.0 720 1-2 18.4 4.4 12.8 1.6 0.4 6.4 3.8 29.1 20.2 1.7 1.0 100.0 4,823 3-4 20.8 2.6 14.1 0.8 0.7 8.3 4.0 30.2 16.1 1.1 1.4 100.0 2,378 5+ 30.3 4.5 14.7 2.1 0.9 3.9 3.6 23.0 12.1 2.8 2.1 100.0 765 Residence Urban 4.1 0.7 5.2 0.8 0.7 9.2 6.5 44.4 25.8 0.7 1.9 100.0 3,686 Rural 31.6 6.6 18.9 1.8 0.5 4.5 1.9 18.4 12.7 2.3 0.7 100.0 5,000 Education No education 37.2 3.1 28.9 0.3 1.2 1.4 0.1 13.4 11.5 3.0 0.0 100.0 359 Some primary 27.9 4.0 27.4 2.1 0.7 0.1 0.0 21.2 14.4 1.7 0.4 100.0 1,596 Complete primary 27.8 5.9 13.3 1.2 0.6 0.7 0.2 30.6 16.6 2.6 0.6 100.0 2,322 Some secondary 16.7 5.9 12.1 2.3 0.5 1.6 2.6 30.1 25.8 1.2 1.2 100.0 1,703 Secondary + 8.2 1.7 3.1 0.7 0.5 19.0 10.5 34.9 18.3 0.9 2.3 100.0 2,707 Wealth quintile Lowest 36.6 8.8 25.8 2.4 0.9 0.9 0.5 11.0 10.3 2.7 0.1 100.0 1,672 Second 28.3 4.9 20.4 1.6 0.5 1.2 1.2 20.9 18.0 2.2 0.7 100.0 1,680 Middle 20.5 4.9 13.2 1.9 0.5 4.9 2.7 29.1 19.8 1.6 0.9 100.0 1,770 Fourth 11.9 2.0 6.3 0.6 0.5 7.8 4.0 41.2 24.2 0.7 0.9 100.0 1,700 Highest 4.1 0.5 1.2 0.5 0.6 16.6 10.2 43.2 19.0 1.0 3.1 100.0 1,865 Total 19.9 4.1 13.1 1.4 0.6 6.5 3.9 29.4 18.3 1.6 1.2 100.0 8,686 Note: An asterisk indicates that an estimate 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 months preceding the survey by type of earnings received, type of employer, continuity of employment, and variations by type of employment (agricultural or nonagricultural). Sixty-one percent of women received their earnings in cash; 6 percent receive payment in cash and in kind; and 29 percent receive no payment (Figure 3.2). The majority of women who work in agriculture (53 percent) receive no payment, while among women engaged in nonagricultural professions, only 13 percent reported receiving no payment. Characteristics of Respondents and Women’s Status | 33 Table 3.7 Type of employment: Women 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 nonagricultural), Indonesia 2007 Employment characteristic Agricultural work Non- agricultural work Total Type of earnings Cash only 31.3 81.7 61.4 Cash and in-kind 8.3 4.6 6.1 In-kind only 7.4 0.2 3.1 Not paid 52.9 13.2 29.2 Missing 0.2 0.3 0.2 Total 100.0 100.0 100.0 Type of employer Employed by family member 60.3 12.8 32.0 Employed by nonfamily member 27.8 46.2 38.8 Self-employed 11.7 40.6 28.9 Missing 0.2 0.4 0.3 Total 100.0 100.0 100.0 Continuity of employment All year 58.1 90.6 77.5 Seasonal 36.9 4.9 17.8 Occasional 4.5 4.1 4.3 Missing 0.4 0.4 0.5 Total 100.0 100.0 100.0 Number of women employed during past 12 months 8,038 11,902 19,946 Note: Total includes 15 women with information missing on type of employment who are not shown separately. IDHS 2007 Figure 3.2 Type of Earnings of Employed Women Age 15-49 Cash only 61% No payment 29% Cash and in-kind 6% In-kind only 3% 34 | Characteristics of Respondents and Women’s Status Six in 10 women who work in the agricultural sector are employed by a family member, while women who work in the nonagricultural sector are more likely to be employed by a non-family member (46 percent) or are self-employed (41 percent). Nine in 10 women who work in nonagricultural jobs work all year, compared with 58 percent of women in agriculture. Thirty-seven 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, to assess the relative importance of women’s earnings, respondents were asked about the proportion of household expenditures met by their earnings. This information not only allows an evaluation of the relative importance of women’s earnings in the household economy, but has implications 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 household. Table 3.8 shows the distribution of ever-married women by person who decides how earnings are used and by proportion of household expenditures met by earnings, according to background characteristics. Table 3.8 shows that 69 percent of ever-married women reported that they alone decide how their earnings are to be spent, and 28 percent reported that they decide jointly with someone else (mostly husbands). Only 3 percent of women reported that someone else makes the decision on how their earnings are used. Table 3.8 also shows that respondents’ control over the use of their earnings varies little by background characteristics, except for marital status. Divorced, separated, or widowed women are substantially more likely to decide alone how their earnings are used than women who are married (95 and 66 percent, respectively). While 30 percent of married women report that this decision is made jointly with someone else, only 4 percent of divorced, separated, or widowed women shared the decision making with someone else. When asked about the proportion of household expenditures that are met by their earnings, 47 percent of women reported that their earnings support all of the household expenditures and 39 percent reported that their earnings support half or more. Across subgroups, the data show that older women, those who are widowed, separated, or divorced, women with a larger number of children, rural women, and those who are less educated are more likely to meet all of their household’s expenditures. Appendix Table A-3.7 shows provincial variations regarding the decision on use of earnings in the household and women’s contribution to household expenditures. Characteristics of Respondents and Women’s Status | 35 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 used and by proportion of household expenditures met by earnings, according to background characteristics, Indonesia 2007 Person who decides how the woman’s earnings are used: Proportion of household expenditures met by earnings Background characteristic Self only Jointly1 Someone else only2 Missing Total Almost none/ none Less than half Half or more All Don’t know/ missing Total Number of women Age 15-19 74.1 18.3 3.6 3.9 100.0 7.2 9.0 44.8 33.9 5.0 100.0 208 20-24 66.7 30.0 2.7 0.6 100.0 6.5 12.1 44.0 36.0 1.5 100.0 1,206 25-29 64.4 29.8 3.6 2.1 100.0 5.4 12.8 41.5 39.8 0.5 100.0 2,121 30-34 67.1 29.4 3.0 0.5 100.0 3.2 10.2 37.6 48.4 0.6 100.0 2,534 35-39 68.0 28.1 2.6 1.3 100.0 2.7 9.2 39.3 47.9 0.9 100.0 2,699 40-44 72.2 24.8 2.2 0.8 100.0 1.7 9.2 39.9 48.2 1.1 100.0 2,527 45-49 72.1 24.6 2.3 0.9 100.0 1.7 7.1 33.9 56.7 0.5 100.0 2,158 Marital status Married 65.9 29.9 3.0 1.1 100.0 3.3 10.4 40.7 44.7 0.9 100.0 12,170 Divorced/separated/ widowed 95.0 4.1 0.2 0.7 100.0 2.9 5.2 23.3 68.3 0.4 100.0 1,283 Number of living children 0 70.3 27.0 1.7 1.0 100.0 10.5 15.1 46.8 26.0 1.5 100.0 1,203 1-2 68.4 27.6 3.0 1.1 100.0 3.0 10.1 40.4 45.8 0.7 100.0 7,538 3-4 69.0 27.6 2.3 1.0 100.0 2.2 8.4 36.2 52.3 0.8 100.0 3,702 5+ 68.0 26.9 3.9 1.3 100.0 1.1 7.0 30.2 60.3 1.3 100.0 1,010 Residence Urban 72.0 24.9 2.4 0.6 100.0 4.3 9.8 41.2 44.3 0.4 100.0 6,529 Rural 65.5 29.9 3.1 1.5 100.0 2.3 9.9 37.0 49.4 1.3 100.0 6,924 Education No education 75.6 21.3 2.1 1.0 100.0 1.3 5.5 26.8 64.9 1.5 100.0 960 Some primary 71.9 24.7 2.3 1.2 100.0 1.6 7.7 29.6 60.3 0.8 100.0 2,192 Complete primary 69.1 26.7 3.3 1.0 100.0 1.9 8.8 33.1 55.4 0.8 100.0 3,829 Some secondary 66.6 29.6 2.4 1.3 100.0 3.1 11.9 42.4 41.3 1.4 100.0 2,375 Secondary + 66.2 29.9 2.8 1.0 100.0 6.1 11.9 50.6 30.8 0.6 100.0 4,097 Wealth quintile Lowest 61.9 33.0 3.2 1.9 100.0 1.5 7.0 32.7 57.0 1.8 100.0 2,024 Second 69.2 27.3 2.4 1.1 100.0 2.1 9.6 31.4 55.9 1.0 100.0 2,405 Middle 71.2 24.7 3.0 1.1 100.0 2.2 8.3 36.0 52.7 0.8 100.0 2,851 Fourth 70.6 26.7 2.1 0.6 100.0 2.8 11.6 43.5 41.6 0.5 100.0 2,937 Highest 68.6 27.3 3.1 1.0 100.0 6.8 11.6 47.4 33.6 0.6 100.0 3,236 Total 68.7 27.5 2.7 1.1 100.0 3.3 9.9 39.1 46.9 0.9 100.0 13,453 1 With husband or someone else 2 Includes husband Table 3.9 shows the distribution of currently married working women by person who decides how cash earning are used and the extent to which their earnings meet household expenditures. Sixty-six percent of currently married women make their own decisions on how their earnings are used. Interestingly, women who do not contribute any cash to the household expenditures are much more likely to make the decision on cash spending alone (78 percent) than those who cover all of their household expenditures (67 percent). Almost all women who are not currently married (98 percent) make their own decisions on how their cash will be used, regardless of their contribution to the household expenditures (data not shown). 36 | Characteristics of Respondents and Women’s Status Table 3.9 Women’s control over earnings Percent distributions 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 proportion of household expenditures met by earnings, Indonesia 2007 Person who decides how woman’s cash earnings are used 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 78.0 13.1 1.0 2.8 4.3 0.8 100.0 406 Less than half 67.2 27.9 0.1 3.0 0.2 1.7 100.0 1,261 Half or more 63.8 31.8 0.1 3.3 0.0 0.9 100.0 4,956 All 66.8 29.6 0.0 2.3 0.1 1.2 100.0 5,434 Don’t know/missing 60.6 34.2 0.0 2.3 0.0 2.9 100.0 113 Total1 65.9 29.8 0.1 2.8 0.2 1.1 100.0 12,170 1 Excludes cases where a woman or her husband/partner has no earnings, and includes cases where a woman does not know whether she earned more or less than her husband/partner 3.8 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the 2007 IDHS obtained information from both ever-married women and currently married men on other measures of women’s status and empowerment. Specifically, questions were asked about 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 environment, and their attitudes toward traditional gender roles. These are important aspects of women’s empowerment and are relevant for understanding women’s demographic and health behaviors. 3.8.1 Women’s Participation in Decision Making To assess women’s decision making autonomy, information was collected on women’s partici- pation in five different decisions: respondent’s own health care, large household purchases, household purchases for daily needs, visits to family or relatives, and what food to cook each day. Table 3.10.1 shows the percent distribution of ever-married women by who in the household usually has the final say in making each of the specified decisions. Table 3.10.2 shows the distribution of currently married men by person they think should have the final say in making specific decisions. Women are considered to participate in decision making if they make decisions alone or jointly with their husband or someone else. The data show that for two of the four decisions (what food should be cooked each day and household purchases for daily needs), women are the main decisionmakers. Half of women say that they are responsible for their own health care. Decisions on large household purchases and visits the woman’s family or relatives are more likely to be made by the respondent jointly with her husband. Comparing participation in decision making by marital status, currently married women are substantially less likely to make specific decisions by themselves than women who are not currently married. For instance, about half of currently married women (51 percent) decide themselves about their own health care, compared with 89 percent of women who are not married. Characteristics of Respondents and Women’s Status | 37 Table 3.10.1 Women’s participation in decision making Percent distribution of ever-married women by person who has the final say in making five specific decisions by current marital status, according to type of decision, Indonesia 2007 Currently married women Women who are not married1 Decision Self only Jointly with hus- band Jointly with some- one else Hus- band only Some- one else only No deci- sion/ missing Total Number of women Self only Jointly with hus- band Jointly with some- one else Hus- band only Some- one else only No deci- sion/ missing Total Number of women Own health care 50.9 33.2 0.3 14.4 0.6 0.6 100.0 30,931 88.7 1.5 3.3 0.4 5.2 1.0 100.0 1,964 Large household purchases 16.6 62.5 0.5 17.9 1.2 1.2 100.0 30,931 72.8 3.9 8.4 1.2 9.6 4.2 100.0 1,964 Daily household purchases 81.5 12.7 0.9 3.1 1.4 0.4 100.0 30,931 82.6 1.4 5.6 0.4 8.8 1.2 100.0 1,964 Visits to family or relatives 15.7 71.1 0.7 10.3 0.5 1.6 100.0 30,931 74.6 4.1 10.1 0.6 7.3 3.2 100.0 1,964 What food to cook each day 87.9 6.5 1.7 1.1 2.0 0.8 100.0 30,931 81.0 0.9 5.8 0.3 10.1 1.9 100.0 1,964 1 Divorced or widowed women Table 3.10.2 shows that most men think that women should make decisions about household purchases for daily needs, while decisions about large household purchases and visiting family or relatives should be made together by the wife and husband. Table 3.10.2 Women’s participation in decision making according to men Percent distribution of currently married men by person who they think should have the final say in making three specific decisions, Indonesia 2007 Person who should have final say Decision Wife only Wife and husband equally Husband Husband and someone else Someone else No decision/ missing Total Number of men Large household purchases 12.3 70.0 16.2 0.2 0.5 0.8 100.0 8,758 Daily household purchases 64.3 27.3 7.3 0.2 0.4 0.5 100.0 8,758 Visits to family or relatives 5.8 80.2 12.3 0.1 0.3 1.3 100.0 8,758 Table 3.11.1 shows the percentage of ever-married women who reported that they decide alone or jointly about specific household decisions, according to background characteristics. The results indicate that the majority of women participate in all household decisions including purchases for daily household needs and what food to cook each day (94 percent each), visits to her family or relatives (86 percent), and her own health care (85 percent). It is in decisions regarding major household purchases that women are less likely to have a say (79 percent). Overall, two in three ever-married women participate in all five of the specified decisions and very few (1 percent) say that they do not participate in any of the decisions. The degree of independence in making household decisions increases with age and number of children. The most educated women and women who earn cash are more likely to have a final say in all the specified decisions. 38 | Characteristics of Respondents and Women’s Status Table 3.11.1 Women’s participation in decision making by background characteristics Percentage of ever-married women who say that they alone or jointly have the final say in five specific decisions, by background characteristics, Indonesia 2007 Percentage of women who say that they alone or jointly have final say in the following decisions: Background characteristic Own health care Major household purchases Purchases for daily household needs Visits to her family or relatives What food to cook each day Percentage who participate in all decisions Percentage who participate in none of the decisions Number of women Age 15-19 74.8 65.5 83.9 79.9 81.8 49.3 2.3 845 20-24 81.2 73.7 87.0 83.4 86.8 57.4 2.1 4,094 25-29 84.6 80.5 93.7 85.8 93.2 65.2 0.8 5,771 30-34 85.0 79.6 95.1 87.1 95.4 67.3 1.0 6,020 35-39 86.9 81.5 95.8 87.6 95.6 69.4 0.7 6,004 40-44 83.8 79.5 95.2 87.8 95.3 67.0 0.9 5,365 45-49 85.8 79.5 94.5 86.6 95.6 68.2 1.6 4,795 Marital status Married 84.1 79.1 94.2 86.8 94.4 65.6 0.9 30,931 Divorced/separated/ widowed 90.2 76.7 84.0 78.7 81.9 67.1 4.9 1,964 Number of living children 0 77.8 74.3 86.7 82.3 82.8 54.4 2.6 2,687 1-2 85.2 79.6 93.5 87.0 93.6 66.1 1.0 18,545 3-4 85.3 80.0 95.6 86.5 96.4 68.3 1.0 8,908 5+ 83.6 76.4 94.6 85.4 95.8 65.5 1.5 2,754 Residence Urban 85.6 80.1 93.4 87.4 92.6 66.2 1.1 13,745 Rural 83.6 78.2 93.8 85.6 94.4 65.4 1.2 19,150 Education No education 80.7 73.9 91.9 80.8 94.6 60.1 2.3 2,271 Some primary 81.4 75.2 93.0 83.6 94.8 62.2 1.6 5,572 Complete primary 83.9 77.4 94.0 86.3 94.7 65.4 1.1 10,077 Some secondary 84.0 79.5 93.2 87.1 93.4 65.2 1.1 6,781 Secondary + 88.7 84.5 94.4 89.2 91.6 70.4 0.7 8,193 Wealth quintile Lowest 82.5 76.4 92.5 83.2 95.3 64.3 1.5 6,219 Second 83.2 76.9 93.5 85.0 94.2 63.4 1.2 6,606 Middle 84.8 79.8 93.8 87.2 93.8 66.5 1.4 6,710 Fourth 85.5 80.5 94.1 88.2 93.5 67.1 0.9 6,713 Highest 86.2 81.2 94.1 87.9 91.5 67.0 0.8 6,647 Employment (past 12 months) Not employed 83.6 77.6 92.8 86.6 94.1 64.7 1.2 12,944 Employed for cash 87.2 82.3 94.7 87.7 92.7 69.0 0.9 13,453 Employed not for cash 80.5 75.0 93.1 83.1 94.7 60.8 1.7 6,446 Missing 69.5 70.8 86.2 77.1 86.4 61.9 12.2 52 Total 84.5 79.0 93.6 86.3 93.6 65.7 1.2 32,895 Characteristics of Respondents and Women’s Status | 39 Table 3.11.2 shows the attitudes of men regarding their wife’s participation in three specific household decisions, by background characteristics. It is interesting to note that men are more likely to report that women have the final say in decisions about major household purchases than women (82 and 79 percent, respectively). Appendix Table A-3.8 shows women’s participation in decision making by province and Appendix Table A-3.9 shows men’s attitude toward wives’ participation in decision making by province. 85 79 94 86 94 66 0 1 2 3 4 5 Number of decisions 0 20 40 60 80 100 Percent Figure 3.3 Number of Decisions in Which Women Participate in the Final Say IDHS 2007 40 | Characteristics of Respondents and Women’s Status Table 3.11.2 Men’s attitudes toward wives’ participation in decision making Percentage of currently married men who say a wife should have the greater say alone or equal say with her husband on three specific decisions, by background characteristics, Indonesia 2007 Percentage of men who say that a wife should have the greater say alone or equal say with her husband in the following decisions Background characteristic Major household purchases Purchases for daily household needs Visits to her family or relatives Percentage who participate in all three decisions Percentage who participate in none of the decisions Number of men Age 15-19 97.9 98.3 95.1 94.3 0.9 29 20-24 74.8 89.2 78.8 62.7 4.7 432 25-29 81.8 91.6 84.3 72.9 3.5 1,116 30-34 83.5 92.4 88.1 75.5 2.6 1,418 35-39 81.6 90.8 86.8 72.5 3.5 1,679 40-44 83.3 90.8 85.9 72.3 3.6 1,570 45-49 84.2 91.6 87.0 74.6 3.3 1,359 50-54 80.9 93.6 85.3 74.7 3.1 1,155 Number of living children 0 82.0 90.5 88.1 76.1 5.1 723 1-2 83.4 91.9 86.6 74.4 2.8 4,855 3-4 82.2 92.1 86.6 73.0 3.5 2,411 5+ 75.7 89.6 78.0 63.3 4.6 769 Residence Urban 84.3 92.9 87.8 75.2 2.6 3,728 Rural 80.8 90.7 84.7 71.7 3.9 5,030 Education No education 72.3 88.2 83.1 63.9 7.3 365 Some primary 77.8 89.5 83.1 67.4 3.5 1,605 Complete primary 82.8 89.2 84.2 72.8 4.9 2,339 Some secondary 83.0 93.5 87.3 75.4 2.6 1,721 Secondary + 85.3 94.2 88.8 76.8 1.9 2,727 Wealth quintile Lowest 77.6 88.4 81.0 65.7 5.0 1,676 Second 79.4 87.5 83.8 69.4 4.7 1,698 Middle 82.3 92.5 87.4 75.1 2.8 1,788 Fourth 85.5 93.9 87.6 77.6 3.1 1,713 Highest 86.0 95.3 89.6 77.6 1.4 1,882 Employment (past 12 months) Not employed 74.8 89.1 86.5 71.5 7.4 70 Employed not for cash 82.3 91.6 86.0 73.2 3.3 8,686 Missing 100.0 84.5 100.0 84.5 0.0 1 Total 82.3 91.6 86.0 73.2 3.3 8,758 3.8.2 Attitudes toward Wife Beating To assess women’s degree of acceptance of wife beating, the 2007 IDHS 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: she burns the food, she argues with him, she goes out without telling him, she neglects the children, and she refuses to have sex with him. The first five columns in Table 3.12.1 and Table 3.12.2 show how acceptance of wife beating varies in each situation. The last column shows the percentage of ever-married women and currently married men who feel that a husband is justified in beating his wife for at least one of the specified reasons. Characteristics of Respondents and Women’s Status | 41 It is worth noting that women who have no final say in household decisions are the least likely to agree that wife beating is justified (25 percent), while women who participate in one or two household decisions are most likely to agree with at least one of the specified reasons for wife beating (41 percent). Women who participate in three or four decisions and those who participate in five decisions are less likely to agree (37 to 27 percent, respectively). Appendix Table A-3.10 shows women’s attitudes toward wife beating by province and Appendix Table A-3.11 shows men’s attitudes toward wife beating by province. Table 3.12.1 Women’s attitudes toward wife beating Percentage of ever-married women who agree that a husband is justified in hitting or beating his wife for five specific reasons, by background characteristics, Indonesia 2007 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 children Refuses to have sexual intercourse with him Percentage who agree with at least one specified reason Number of women Age 15-19 5.4 11.0 32.0 33.1 9.5 40.8 845 20-24 3.1 8.0 29.7 31.8 7.5 38.8 4,094 25-29 3.4 6.5 24.8 27.3 7.1 33.0 5,771 30-34 3.0 6.2 23.3 24.4 6.7 30.4 6,020 35-39 3.1 6.8 23.8 24.7 7.2 31.1 6,004 40-44 3.0 6.2 20.1 20.1 6.0 25.9 5,365 45-49 2.8 6.4 20.2 19.7 5.5 25.5 4,795 Marital status Married 3.1 6.8 24.0 25.0 6.8 31.2 30,931 Divorced/separated/widowed 3.2 6.3 19.3 19.9 6.0 25.2 1,964 Number of living children 0 3.8 6.8 24.4 26.5 6.6 31.9 2,687 1-2 2.8 6.4 23.6 24.8 6.4 30.8 18,545 3-4 2.9 6.6 23.1 23.7 6.8 30.2 8,908 5+ 5.2 9.9 25.5 25.7 9.2 32.2 2,754 Residence Urban 1.9 4.5 20.1 20.6 4.8 26.1 13,745 Rural 4.0 8.4 26.3 27.7 8.1 34.2 19,150 Education No education 5.1 12.3 23.9 22.3 8.8 29.7 2,271 Some primary 4.1 8.1 24.9 25.1 8.0 31.4 5,572 Complete primary 3.2 6.6 23.9 25.2 7.0 31.8 10,077 Some secondary 2.6 6.6 26.9 27.8 6.9 34.3 6,781 Secondary + 2.3 4.6 20.0 22.0 4.9 26.7 8,193 Wealth quintile Lowest 6.2 12.0 28.4 30.8 9.6 37.8 6,219 Second 3.5 7.9 26.5 27.2 8.3 34.2 6,606 Middle 3.0 6.6 24.2 25.4 6.5 31.4 6,710 Fourth 1.9 4.1 21.5 23.0 5.6 28.4 6,713 Highest 1.3 3.5 18.2 17.5 3.9 23.0 6,647 Employment (past 12 months) Not employed 2.6 6.3 24.0 24.7 6.2 30.4 12,944 Employed for cash 3.2 6.5 21.9 22.7 6.4 28.8 13,453 Employed not for cash 4.3 8.3 26.9 28.9 8.5 36.1 6,446 Missing 1.7 8.4 10.2 16.3 5.6 19.1 52 Number of decisions in which woman has final say1 0 4.1 6.0 21.7 17.3 6.7 24.9 383 1-2 4.6 11.5 31.6 32.9 9.5 41.3 2,113 3-4 3.4 7.8 28.2 29.2 8.0 37.1 8,786 5 2.9 5.9 21.1 22.2 6.0 27.4 21,613 Total 3.1 6.8 23.7 24.7 6.7 30.8 32,895 1 Either by herself or jointly with others 42 | Characteristics of Respondents and Women’s Status Table 3.12.2 Men’s attitudes toward wife beating Percentage of currently married men who agree that a husband is justified in hitting or beating his wife for five specific reasons, by background characteristics, Indonesia 2007 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 children Refuses to have sexual intercourse with him Percentage who agree with at least one specified reason Number of men Age 15-19 * * * * * * 29 20-24 1.5 6.6 16.7 14.8 2.2 23.6 432 25-29 1.5 5.3 11.5 13.1 2.7 18.8 1,116 30-34 1.4 5.1 12.1 13.1 3.4 17.4 1,418 35-39 1.5 5.2 11.8 11.6 2.3 16.2 1,679 40-44 0.9 4.6 11.4 11.0 2.2 16.6 1,570 45-49 1.6 4.1 10.0 9.4 2.4 13.8 1,359 50-54 1.5 3.2 9.5 9.5 2.7 12.3 1,155 Number of living children 0 1.7 5.4 11.8 11.3 2.3 17.0 723 1-2 0.9 4.3 10.7 10.9 2.4 15.5 4,855 3-4 2.1 5.0 12.0 11.3 2.9 16.7 2,411 5+ 1.8 6.0 13.8 15.0 3.1 19.5 769 Residence Urban 0.6 3.4 9.9 8.7 1.5 13.6 3,728 Rural 1.9 5.7 12.6 13.4 3.4 18.2 5,030 Education No education 4.9 9.4 16.3 16.1 4.2 22.7 365 Some primary 1.2 4.0 12.2 11.4 3.2 16.3 1,605 Complete primary 1.4 4.8 11.6 12.3 2.7 16.3 2,339 Some secondary 1.2 4.4 12.1 12.6 2.6 18.5 1,721 Secondary + 1.1 4.7 9.7 9.3 1.9 14.1 2,727 Wealth quintile Lowest 3.0 7.8 15.6 16.7 4.3 22.6 1,676 Second 1.6 5.0 12.9 12.5 3.0 17.3 1,698 Middle 0.9 3.3 10.3 11.8 2.6 15.9 1,788 Fourth 0.4 3.4 10.1 10.2 2.0 14.6 1,713 Highest 1.0 4.3 8.7 6.5 1.3 11.6 1,882 Employment (past 12 months) Not employed 0.2 4.0 7.4 8.5 1.7 10.7 70 Employed 1.4 4.7 11.5 11.5 2.6 16.3 8,686 Total 1.4 4.7 11.4 11.4 2.6 16.3 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 3.8.3 Women’s Attitudes toward Refusing Sexual Intercourse with Husband The extent of control women have over when and with whom they have sexual intercourse is an indicator of women’s empowerment and has implications for demographic and health outcomes. In the 2007 IDHS, women were asked whether a wife is justified in refusing to have sexual intercourse 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 refusing to have sex with her husband for specific reasons by background characteristics. Findings show that 57 percent of women agree that a wife is justified in refusing sex with her husband for all four of the specified reasons. On the other hand, 6 percent of women agree with none of the specified reasons. Characteristics of Respondents and Women’s Status | 43 Respondents are most likely to agree with a woman’s right to refuse sex with her husband if she gave birth recently (92 percent). Women are the least likely to agree that a wife has a right to refuse sex if she is tired or not in the mood (67 percent). Justification for a wife refusing to have sex with her husband does not show a clear pattern by background characteristics, except for education and employment status. Better-educated women and women who are employed for cash are more likely than other women to agree with all four reasons for a wife to refuse sex with her husband. Appendix Table A-3.12 shows the differentials across provinces in women’s attitudes toward a wife refusing to have sex with her husband. Table 3.13 Women’s attitudes 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 four specific reasons, by background characteristics, Indonesia 2007 Wife is justified in refusing intercourse with her husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has intercourse with other women Has recently given birth Is tired or not in the mood Percentage who agree with all four specified reasons Percentage who agree with none of the specified reasons Number of women Age 15-19 76.6 83.8 89.2 62.5 52.2 7.3 845 20-24 83.3 86.1 92.8 67.9 58.1 4.6 4,094 25-29 85.9 85.5 93.8 70.0 60.6 4.1 5,771 30-34 84.1 84.6 93.4 66.7 58.3 4.9 6,020 35-39 84.3 82.4 92.3 66.1 57.1 5.4 6,004 40-44 81.8 80.3 92.0 64.6 54.7 6.3 5,365 45-49 78.9 79.0 89.7 65.0 54.7 7.6 4,795 Marital status Married 83.2 83.3 92.5 66.9 57.3 5.3 30,931 Divorced/separated/widowed 79.7 78.8 89.4 63.0 55.7 9.0 1,964 Number of living children 0 82.3 82.9 91.0 65.1 56.1 6.1 2,687 1-2 84.9 84.9 93.5 68.4 59.3 4.4 18,545 3-4 81.9 81.2 91.8 64.7 54.8 6.2 8,908 5+ 75.1 76.5 87.5 62.8 51.1 9.9 2,754 Residence Urban 86.9 85.1 93.8 68.1 59.7 4.3 13,745 Rural 80.2 81.5 91.2 65.6 55.4 6.3 19,150 Education No education 67.1 71.7 85.0 61.6 46.3 11.8 2,271 Some primary 76.8 78.9 89.6 65.6 53.9 7.7 5,572 Complete primary 81.7 82.6 92.4 66.8 56.4 5.7 10,077 Some secondary 86.9 85.2 93.8 68.1 60.2 4.0 6,781 Secondary + 90.1 87.5 94.9 67.4 60.9 3.3 8,193 Wealth quintile Lowest 74.2 76.9 87.3 64.5 52.0 9.8 6,219 Second 81.3 82.8 92.0 66.8 56.5 5.6 6,606 Middle 83.5 84.1 93.2 66.6 58.0 5.1 6,710 Fourth 84.7 83.9 94.1 68.0 58.1 3.8 6,713 Highest 90.8 86.9 94.6 67.2 61.0 3.5 6,647 Employment (past 12 months) Not employed 84.4 83.4 92.3 64.7 56.2 5.7 12,944 Employed for cash 83.4 83.7 93.1 68.3 58.7 4.7 13,453 Employed not for cash 79.4 80.7 90.9 67.1 56.0 6.6 6,446 Missing 83.4 82.3 75.1 58.6 50.1 16.3 52 Number of decisions in which woman has final say1 0 64.9 70.8 78.3 60.1 48.0 18.9 383 1-2 81.5 82.3 93.8 67.2 57.1 4.7 2,113 3-4 81.8 82.5 93.8 68.2 56.6 4.2 8,786 5 84.0 83.5 91.8 66.1 57.6 5.9 21,613 Number of reasons for which wife beating is justified 0 82.8 83.1 91.7 66.8 58.1 6.1 22,749 1-2 84.2 82.8 94.3 66.0 54.9 3.8 7,451 3-4 81.8 82.1 91.8 63.8 51.9 4.5 2,139 5 82.5 85.3 90.0 80.1 68.8 5.8 555 Total 83.0 83.0 92.3 66.6 57.2 5.5 32,895 1 Either by herself or jointly with others 44 | Characteristics of Respondents and Women’s Status 3.9 LIFESTYLE 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 2007 IDHS included questions on tobacco use. Respondents were asked whether they smoke regularly, the type of tobacco they use and, if they smoke cigarettes, how many they smoked in the past 24 hours. When interpreting the data on tobacco use, it is important to recognize that some respondents may, out of embarrassment, under- report tobacco use. Table 3.14.1 shows that 3 percent of ever-married women smoke tobacco regularly. Among women who smoke cigarettes, 34 percent reported smoking 1-2 cigarettes and 29 percent smoked 3-5 cigarettes in the past 24 hours. It is of interest to note that 14 percent of women who smoke cigarettes reported smoking 10 or more cigarettes in the past 24 hours. Table 3.14.1 Use of tobacco: Women 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 2007 Use of tobacco by women Number of cigarettes in past 24 hours Background characteristic Cigarettes Other tobacco Does not use tobacco Number of women 0 1-2 3-5 6-9 10+ Don’t know/ missing Total Number of cigarette smokers Age 15-19 1.3 0.0 98.7 845 * * * * * * 100.0 11 20-24 1.6 0.1 98.3 4,094 4.0 29.7 23.9 23.9 5.5 13.0 100.0 65 25-29 1.3 0.3 98.4 5,771 2.5 56.3 17.4 10.2 12.0 1.6 100.0 76 30-34 1.7 0.2 98.1 6,020 6.4 25.4 18.6 19.9 19.0 10.8 100.0 102 35-39 2.7 0.3 96.9 6,004 1.2 35.5 26.7 17.3 18.5 0.8 100.0 164 40-44 3.6 0.5 95.9 5,365 2.5 38.6 35.0 14.3 6.7 2.9 100.0 195 45-49 5.4 0.6 94.1 4,795 1.4 29.3 34.9 13.6 17.8 2.9 100.0 257 Residence Urban 3.2 0.1 96.6 13,745 1.8 35.3 24.1 22.2 12.8 3.8 100.0 446 Rural 2.2 0.5 97.3 19,150 3.3 33.0 34.6 8.5 16.1 4.5 100.0 424 Education No education 3.4 2.0 94.6 2,271 0.0 13.6 42.7 11.6 32.2 0.0 100.0 77 Some primary 3.8 0.6 95.6 5,572 1.4 36.5 34.2 13.4 9.2 5.4 100.0 210 Complete primary 2.1 0.2 97.7 10,077 2.9 39.6 23.1 20.7 8.3 5.5 100.0 215 Some secondary 2.5 0.0 97.5 6,781 4.0 37.2 34.5 7.4 13.0 3.8 100.0 166 Secondary + 2.5 0.1 97.4 8,193 3.1 31.5 21.2 20.4 20.6 3.2 100.0 203 Maternity status Pregnant 0.6 0.5 98.9 1,664 * * * * * * 100.0 10 Breastfeeding (not pregnant) 1.0 0.2 98.8 6,236 0.7 31.9 31.3 6.4 14.7 15.1 100.0 63 Neither 3.2 0.3 96.5 24,996 2.5 34.3 29.3 16.1 14.6 3.2 100.0 797 Wealth quintile Lowest 2.3 1.0 96.7 6,219 4.3 28.8 28.7 11.3 23.3 3.7 100.0 145 Second 2.5 0.3 97.1 6,606 1.8 24.5 41.8 12.2 13.4 6.3 100.0 168 Middle 2.4 0.2 97.3 6,710 4.0 35.9 43.5 7.8 6.4 2.3 100.0 164 Fourth 2.8 0.1 97.1 6,713 1.4 47.6 17.6 15.2 12.8 5.4 100.0 190 Highest 3.1 0.1 96.9 6,647 1.7 32.2 18.6 27.8 16.7 3.0 100.0 205 Total 2.6 0.3 97.0 32,895 2.5 34.2 29.2 15.5 14.4 4.1 100.0 871 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. Characteristics of Respondents and Women’s Status | 45 Table 3.14.2 shows that among currently married men who smoked cigarettes in the past 24 hours, 5 percent reported smoking 1-2 cigarettes, 12 percent smoked 3-5 cigarettes, and 62 percent smoked 10 or more cigarettes. Appendix Tables A-3.13.1 and A-3.13.2 present the differentials in the use of tobacco by women and men by province. Table 3.14.2 Use of tobacco: Men Percentage of currently married men who smoke cigarettes or tobacco and percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Indonesia 2007 Use of tobacco by men Number of cigarettes in past 24 hours Background characteristic Cigarettes Other tobacco Does not use tobacco Number of men 0 1-2 3-5 6-9 10+ Don’t know/ missing Total Number of cigarette smokers Age 15-19 * * * 29 * * * * * * 100.0 5 20-24 50.7 1.3 9.6 432 0.2 4.6 12.3 27.7 55.2 0.0 100.0 219 25-29 52.7 3.5 16.8 1,116 0.2 4.9 13.6 24.1 55.7 1.6 100.0 588 30-34 47.4 3.3 17.8 1,418 0.7 6.0 16.3 19.5 56.4 1.0 100.0 672 35-39 33.2 2.3 17.0 1,679 0.8 6.6 9.6 14.4 68.2 0.4 100.0 558 40-44 29.2 2.1 12.3 1,570 0.3 4.0 10.3 16.7 67.6 1.2 100.0 458 45-49 13.3 1.4 5.9 1,359 0.0 2.6 10.2 18.1 68.6 0.5 100.0 180 50-54 6.6 0.9 2.9 1,155 0.0 0.6 9.9 4.5 85.0 0.0 100.0 76 Residence Urban 32.1 0.8 15.2 3,728 0.5 6.2 13.0 22.5 56.3 1.5 100.0 1,195 Rural 31.1 3.2 10.1 5,030 0.4 4.2 12.0 16.7 66.2 0.4 100.0 1,562 Education No education 18.2 4.2 7.2 365 0.0 5.1 3.7 10.9 80.2 0.0 100.0 66 Some primary 22.5 3.8 5.7 1,605 0.6 2.9 11.0 16.7 68.7 0.0 100.0 360 Complete primary 32.1 3.1 8.9 2,339 0.1 4.5 16.1 19.2 59.4 0.7 100.0 751 Some secondary 35.7 1.5 12.7 1,721 0.8 6.2 9.9 22.7 59.7 0.7 100.0 615 Secondary + 35.4 0.6 19.3 2,727 0.5 5.5 12.4 18.5 61.6 1.6 100.0 965 Wealth quintile Lowest 34.4 6.8 9.2 1,676 0.4 4.1 11.9 17.1 66.4 0.1 100.0 576 Second 33.4 2.6 7.7 1,698 0.5 5.7 12.7 16.8 63.3 0.9 100.0 567 Middle 31.7 1.4 13.6 1,788 0.3 4.7 11.5 19.4 64.1 0.0 100.0 566 Fourth 31.7 0.1 12.4 1,713 0.6 3.3 13.5 21.1 60.8 0.7 100.0 543 Highest 26.8 0.5 17.6 1,882 0.4 7.6 12.7 22.2 54.2 3.0 100.0 505 Total 31.5 2.2 12.2 8,758 0.4 5.1 12.4 19.2 61.9 0.9 100.0 2,758 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility | 47 FERTILITY 4 The 2007 Indonesia Demographic and Health Survey (IDHS) collected information on current, 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. Birth history information is used to assess current fertility (age-specific and total fertility) and completed fertility (number of children ever born [alive] to women), 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 data. There are some limitations 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 or if there were significant differences in fertility between living and dead women. In Indonesia, neither of these situations appears to be the case. The 2007 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. Fertility estimates are affected by the reporting accuracy of women of reproductive age (15-49) in the Household Questionnaire.1 1 Comparison of the age distribution of women age 15-49 in the 2007 IDHS, in the Population Census, and in previous national surveys indicates that the IDHS may have missed reporting some women, especially those who have never been married. For example, the percentage of single women age 15-29 in the 2007 IDHS is lower than that in the 2005 Inter-censal Population Survey (SUPAS). On the other hand, the percentage of ever-married women age 15-29 in the 2007 IDHS is higher than in the SUPAS. The discrepancy resulted in overestimation of age-specific fertility rates, especially for women age 20-29, when the fertility rates are highest. The reestimated TFR after adjusting for the missing never-married women is 2.4 births per woman, 0.2 births fewer than the unadjusted estimate. 48 | Fertility 4.1 CURRENT FERTILITY LEVELS AND TRENDS 4.1.1 Fertility Levels The most widely used measures of current fertility are the total fertility rate (TFR) and the age- specific fertility rate (ASFR).2 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 2005-2007. Table 4.1 shows total fertility, age specific fertility, general fertility, and the crude birth rate by residence for the three years preceding the survey. The 2007 IDHS data indicate that the TFR remains constant at 2.6, which means that, on average, a woman in Indonesia would have 2.6 children in her lifetime. Although the level of fertility remains the same as that in the 2002-2003 IDHS, there is a slight change in the pattern of ASFR. ASFR decreased for age group 25-29 and increased for age group 30-34 (Figure 4.1). Table 4.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Indonesia 2007 Residence Age group Urban Rural Total 15-19 26 74 51 20-24 116 153 135 25-29 138 131 134 30-34 104 110 108 35-39 59 70 65 40-44 17 21 19 45-49 4 7 6 TFR 2.3 2.8 2.6 GFR 80 97 89 CBR 20.2 21.5 20.9 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 2 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 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 to produce a count of all women. Never-married women are presumed not to have given birth. Fertility | 49 As expected, ASFRs are lower in urban areas than in rural areas for almost every age group. However, there are differences in patterns. For women in the youngest age group, ASFRs are much higher in rural than in urban areas. For women in the next two age groups, the reverse is seen. ASFR is higher in urban areas than in rural areas. Peak childbearing for urban women is at age 25-29 (138 children per 1,000 women), whereas for rural women the peak is at age 20-24 (153 children per 1,000 women). The general fertility rate (GFR) is the number of live births per 1,000 women age 15-49. The GFR for rural women is much higher than for urban women (97 compared with 80 live births per 1,000 women). The crude birth rate (CBR) is the number of live births per 1,000 population, which in 2007 is 20.9. All of these rates are lower than those reported in the 2002-2003 IDHS. Comparing the results of the 2002-2003 IDHS with those of the 2007 IDHS shows that the TFR in urban areas was lower in 2007 than in 2002-2003 (2.3 compared with 2.4 births per woman), however the TFR in rural areas was higher in 2007 than in 2002-2003 (2.8 compared with 2.7 births per woman). Figure 4.2 compares the TFR in Indonesia with rates in neighboring South-East Asian countries. The TFR in Indonesia is higher than rates in Singapore, Thailand, Vietnam, Myanmar, and Brunei. It is the same as the rate in Malaysia, and lower than rates in the four remaining countries: Lao PDR, Cambodia, Philippines, and Timor-Leste. 1.3 1.6 1.9 2.1 2.3 2.6 2.6 3.3 3.4 3.5 6.6 Singapore Thailand Viet Nam Myanmar Brunei Darussalam Indonesia Malaysia Lao People's Democratic Republic Cambodia Philippines Timor-Leste 0.0 2.0 4.0 6.0 8.0 Percent Figure 4.1 Total Fertility Rates in Southeast Asian Countries Source: UNESCAP. 2007. Population and Development Indicators for Asia and the Pacific, 2007, DHS reports for Cambodia, Indonesia Philippines, and Vietnam 50 | Fertility 4.1.2 Differentials in Current and Completed Fertility Fertility is known to vary by place of residence, education, and other background characteristics of women. Table 4.2 shows several indicators of fertility including the total fertility rate, mean number of children ever born to women age 40-49, and the percentage currently pregnant. The mean number of children ever born to women age 40-49 is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period. If fertility remains stable over time, the two fertility measures, total fertility rate (TFR) and children ever born (CEB), tend to be very similar. The percentage of pregnant women provides a useful additional measure of current fertility, although it is recognized that it may not capture all early stage pregnancies. Table 4.2 indicates that there are variations in the TFR by residence, region, education, and wealth quintile. Results of the 2007 IDHS show that education has an inverted U-shaped relationship with Figure 4.2 Total Fertility Rate by Province 4.2 3.9 3.8 3.5 3.4 3.4 3.3 3.3 3.2 3.1 3.1 3 2.9 2.8 2.8 2.8 2.8 2.8 2.7 2.7 2.7 2.6 2.6 2.6 2.6 2.5 2.5 2.4 2.3 2.1 2.1 2.1 1.8 East Nusa Tenggara Maluku North Sumatera West Sulawesi West Sumatera Papua Central Sulawesi Southeast Sulawesi North Maluku Riau Islands NAD Central Kalimantan West Papua Jambi West Nusa Tenggara West Kalimantan North Sulawesi South Sulawesi Riau South Sumatera East Kalimantan West Java Banten South Kalimantan Gorontalo Lampung Bangka Belitung Bengkulu Central Java DKI Jakarta East Java Bali DI Yogyakarta 0 1 2 3 4 5 TFR IDHS 2007 Fertility | 51 fertility. Women with no education and women with the highest education have the lowest fertility rates, while women with some primary, completed primary, and some secondary education have higher fertility rates. There is no clear pattern in fertility levels by wealth quintile except that the TFR is highest among women in the lowest (poorest) quintile (3.0). Table 4.2 also presents information on respondents who were pregnant. Four percent of women reported that they were pregnant at the time of the survey. The proportion is slightly higher in rural areas than in urban areas, and generally increases with education. There is no clear pattern in the proportion pregnant by wealth quintile. Table 4.2 presents a crude assessment of trends in fertility by comparing current fertility with a mea- sure of completed fertility: the mean number of chil- dren ever born to women age 40-49. The mean number of children ever born to older women who are nearing the end of their reproductive period is an indicator of average completed fertility among women who began childbearing during the three decades preceding the survey. If fertility remained constant over time and the reported data on both children ever born and births during the three years preceding the survey are reasonably accurate, the TFR and the mean number of children ever born for women 40-49 are expected to be similar. When fertility levels have been falling, the TFR will be substantially lower than the mean number of children ever born. The 2007 IDHS data show that the mean number of children ever born for women age 40-49 is much higher than the TFR for the three years preceding the survey (3.5 compared with 2.6 children per woman), indicating a recent substantial reduction in fertility. Fertility has declined in both urban and rural areas, at all educational levels, and for all wealth quin- tiles. The difference between current and completed fertility is highest in urban areas (1.1 births), among women who have no education (1.7 births), and among women in the lower wealth quintiles (1.2 and 1.3 births). Appendix Table A-4.1 and Figure 4.3 show provincial differentials in fertility. There are large variations in the TFR among provinces in Indonesia, ranging from 1.8 births per woman in DI Yogyakarta to 4.2 births per woman in East Nusa Tenggara. The TFR in East Nusa Tenggara is twice that of DKI Jakarta, East Java, and Bali. In the 2002-2003 IDHS, DI Yogyakarta and East Nusa Tenggara also have the lowest and the highest TFRs. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Indonesia 2007 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 2.3 3.8 3.4 Rural 2.8 4.0 3.7 Education No education 2.4 1.9 4.1 Some primary 2.8 2.7 3.9 Complete primary 2.8 4.2 3.5 Some secondary 2.7 3.8 3.4 Secondary + 2.5 4.6 2.7 Wealth quintile Lowest 3.0 4.0 4.2 Second 2.5 3.4 3.8 Middle 2.8 3.6 3.6 Fourth 2.5 4.5 3.3 Highest 2.7 4.1 3.0 Total 2.6 3.9 3.5 Note: Total fertility rates are for the period 1-36 months preceding the survey. 52 | Fertility 4.1.3 Trends in Fertility Table 4.3 uses information from the retrospective birth histories (obtained from IDHS respon- dents) to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because birth histories were not collected for women over age 50, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years or more prior to 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. The declines are steeper between the periods 10-14 and 15-19 years preceding the survey. Although there has been a de- cline in all age groups for the periods 5-9 and 0-4 years preceding the survey, the declines for age groups 20- 24, 30-34 and 35-39 are not significant. The largest decline occurs in age group 25-29. Besides comparing current and completed fertility using data from the 2007 IDHS, trends in fertility can be assessed by comparing the current TFR with estimates from previous DHS surveys. Figure 4.3 shows the TFRs for IDHS surveys carried out in 1991, 1994, 1997, 2002-2003, and 2007. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Indonesia 2007 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 52 61 67 77 20-24 133 134 153 169 25-29 133 148 153 163 30-34 111 114 111 [136] 35-39 61 63 [83] 40-44 19 [32] 45-49 [6] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 3 2.9 2.8 2.6 2.6 IDHS 1991 IDHS 1994 IDHS 1997 IDHS 2002- 2003 IDHS 2007 0 1 2 3 4 TF R Figure 4.3 Trends in Total Fertility Rates, IDHS Surveys 1991-2007 3.0 Fertility | 53 4.2 CHILDREN EVER BORN AND CHILDREN SURVIVING 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 cumulated number of births over the past 30 years among women interviewed in the IDHS. The data may be subject to some recall error, which typically is greater for older women than for younger women. The information on parity is useful for understanding a number of related issues. First, the results show how average family size varies across age groups. They also offer insight into the impact of marital status on women’s fertility. Almost all women in Indonesia are married by age 30 (see Table 9.1). Thus, differences in 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,3 or the inability to bear children. Voluntary childlessness is rare in developing countries like Indonesia; married women in their late 40s with no live births are generally thought to be unable to bear children. Finally, a comparison 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 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Indonesia 2007 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 93.4 5.8 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,341 0.07 0.07 20-24 51.0 37.7 9.4 1.6 0.2 0.1 0.0 0.0 0.0 0.0 0.0 100.0 6,681 0.62 0.60 25-29 23.1 37.5 27.7 8.8 2.1 0.7 0.1 0.0 0.0 0.0 0.0 100.0 6,842 1.32 1.25 30-34 11.3 19.7 37.1 20.1 7.5 2.7 1.1 0.3 0.1 0.0 0.0 100.0 6,472 2.08 1.96 35-39 6.3 10.4 32.5 25.5 13.8 6.0 3.2 1.4 0.6 0.2 0.2 100.0 6,213 2.74 2.56 40-44 5.4 7.8 24.8 23.2 17.0 9.8 5.2 3.7 1.9 0.7 0.7 100.0 5,518 3.29 2.97 45-49 4.9 7.4 18.3 21.4 16.5 11.3 8.0 4.6 3.1 1.6 3.0 100.0 4,884 3.82 3.35 Total 29.3 19.0 21.6 13.8 7.5 3.9 2.2 1.2 0.7 0.3 0.5 100.0 42,951 1.88 1.73 CURRENTLY MARRIED WOMEN 15-19 50.3 43.4 6.1 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 814 0.56 0.53 20-24 20.0 61.5 15.4 2.7 0.3 0.1 0.0 0.0 0.0 0.0 0.0 100.0 3,952 1.02 0.97 25-29 8.6 44.0 33.4 10.6 2.5 0.8 0.1 0.1 0.0 0.0 0.0 100.0 5,585 1.57 1.49 30-34 4.5 20.4 39.9 22.1 8.3 3.0 1.2 0.3 0.1 0.0 0.0 100.0 5,765 2.26 2.14 35-39 2.8 10.0 33.4 27.0 14.6 6.3 3.4 1.4 0.7 0.2 0.2 100.0 5,704 2.87 2.69 40-44 2.5 7.5 25.0 23.8 17.8 10.2 5.5 4.0 2.0 0.7 0.8 100.0 4,899 3.44 3.10 45-49 3.0 6.3 18.5 22.3 16.6 12.0 8.4 4.7 3.3 1.8 3.2 100.0 4,211 3.97 3.49 Total 7.6 24.6 28.2 18.2 9.8 5.1 2.9 1.6 0.9 0.4 0.6 100.0 30,931 2.47 2.27 3 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 (i.e., secondary infertility). 54 | Fertility Table 4.4 shows that, on average, women give birth to less than one child before their mids-20s, two children by their mid-30s, and about four children by their mid- to late 40s. This pattern is similar to that seen in the 2002-2003 IDHS, with a lower mean number of children ever born to women age 15-49 (1.88 compared with 1.99 in 2002-2003). The same pattern is found among currently married women, except that the mean number of children ever born is higher for currently married women (2.47 children) than for all women (1.88 children). The difference in the mean number of children ever born between all women and currently married women is due to a substantial proportion of young and unmarried women in the former (all women) category who exhibit lower fertility. 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 second- and higher-order births in the five years preceding the survey by the number of months since the preceding birth, according to background characteristics. About 6 percent of births are less than 18 months apart and 13 percent have an interval of less than two years. Seventeen percent of births are born 24-35 months after the previous birth, and 70 percent are at least three years apart. The overall median birth interval is 54.6 months, a slight increase from the 2002-2003 IDHS, which was 54.2 months. The median number of months since the preceding birth increases substantially with age, from 24.4 months for women age 15-19 to 69.4 months for women age 40-49. There are no marked differences in the length of the median birth interval by sex of the preceding birth or by urban- rural residence. Studies have shown that the death of a preceding child leads to a shorter birth interval than when the preceding child survived. Data from the 2007 IDHS indicate that the median birth interval is more than two years longer for births whose previous sibling is alive than for births whose previous sibling is dead (56.4 months and 31.6 months, respectively). Appendix Table A-4.2 shows the variation in median birth intervals across provinces. Fertility | 55 Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Indonesia 2007 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Number of non-first births Median number of months since preceding birth Age 15-19 41.9 6.5 49.5 2.2 0.0 0.0 100.0 52 24.4 20-29 9.6 10.3 20.6 15.0 14.0 30.5 100.0 3,472 43.3 30-39 4.4 5.2 14.6 12.4 12.7 50.7 100.0 5,851 60.5 40-49 3.3 2.9 14.6 10.8 9.2 59.2 100.0 1,240 69.4 Birth order 2-3 6.2 6.4 14.4 11.8 13.1 48.1 100.0 7,495 57.9 4-6 5.8 7.0 20.3 15.8 11.6 39.6 100.0 2,653 48.9 7+ 7.1 8.2 33.6 17.3 12.0 21.9 100.0 467 36.6 Sex of preceding birth Male 6.3 7.4 16.7 13.1 13.1 43.4 100.0 5,508 53.5 Female 6.1 5.8 16.8 12.9 12.1 46.4 100.0 5,107 56.1 Survival of preceding birth Living 5.0 6.2 16.4 13.0 12.7 46.7 100.0 9,909 56.4 Dead 22.7 12.5 22.0 12.8 11.2 18.9 100.0 706 31.6 Residence Urban 6.5 6.3 14.4 13.9 13.1 45.8 100.0 4,209 55.7 Rural 6.0 6.8 18.3 12.4 12.3 44.2 100.0 6,406 54.1 Education No education 9.7 5.8 23.5 11.1 7.2 42.6 100.0 500 47.8 Some primary 5.8 5.3 18.3 13.8 12.3 44.5 100.0 1,561 54.4 Complete primary 4.8 5.5 15.3 10.7 12.1 51.5 100.0 3,314 61.4 Some secondary 6.5 6.2 15.3 13.8 12.1 46.1 100.0 2,429 56.5 Secondary + 7.1 9.2 17.6 14.9 14.9 36.4 100.0 2,810 48.7 Wealth quintile Lowest 7.2 8.9 24.9 15.1 11.5 32.4 100.0 2,688 42.8 Second 5.5 7.0 16.3 11.6 12.3 47.3 100.0 2,107 57.3 Middle 6.1 5.5 14.0 11.2 12.3 50.8 100.0 2,063 60.4 Fourth 4.9 5.0 12.6 12.6 13.6 51.2 100.0 1,897 61.0 Highest 6.8 5.8 12.6 14.0 14.1 46.7 100.0 1,859 56.5 Total 6.2 6.6 16.7 13.0 12.6 44.8 100.0 10,615 54.6 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. 4.4 AGE AT FIRST BIRTH One of the factors that determines fertility levels 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. The age at which childbearing commences is an important determinant of the overall level of fertility as well as the health and welfare of the mother and child. Postponement of first births as a result of an increase in age at marriage has been found to contribute to overall fertility decline. Table 4.6 shows the percentage of women who have given birth by specific ages and the median age at first birth, by current age. The data indicate that women are gradually having children at an older age. The median age at first birth has increased from 20.4 years for women age 45-49 to 22.5 years for women age 25-29. The increase in age at first birth can also be seen from the increase over time in the proportion of women who have given birth at age 15. Seven percent of women age 45-49 had their first child by age 15 compared with less than 1 percent of women age 15-19. 56 | Fertility Table 4.6 Age at first birth Among all women, percentage who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Indonesia 2007 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 0.4 na na na na 93.4 6,341 a 20-24 1.3 10.1 26.2 na na 51.0 6,681 a 25-29 1.4 12.1 28.6 46.3 66.0 23.1 6,842 22.5 30-34 3.1 15.6 31.6 49.8 69.4 11.3 6,472 22.0 35-39 3.0 17.9 34.7 51.3 70.7 6.3 6,213 21.8 40-44 5.7 24.8 43.8 60.3 77.2 5.4 5,518 20.8 45-49 6.7 26.9 45.9 64.6 80.5 4.9 4,884 20.4 20-49 3.3 17.2 34.3 na na 18.2 36,610 a 25-49 3.8 18.8 36.1 53.7 72.1 10.8 29,929 21.5 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 differentials in the median age at first birth among women age 25-49 by age, residence, and education. Results of the 2007 IDHS indicate that the median age at first birth is 21.5 years, which is slightly higher than the results of the 2002-2003 IDHS and the 1997 IDHS (21.0 and 20.8 years, respectively). As seen in the 2002-2003 IDHS, urban women in the 2007 IDHS start childbearing more than two years later than their rural counterparts (22.9 years compared with 20.6 years). A positive relationship exists between level of education and median age at first birth; better-educated women start childbearing at a later age than women with less education. Table 4.7 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Indonesia 2007 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 24.3 23.7 23.2 21.4 21.0 22.9 Rural 21.2 20.8 20.7 20.2 20.0 20.6 Education No education 21.1 19.7 19.6 19.1 19.7 19.6 Some primary 19.9 19.4 19.3 19.3 19.3 19.4 Complete primary 20.5 20.4 20.2 19.7 20.1 20.2 Some secondary 21.4 21.6 21.3 20.8 20.6 21.2 Secondary + a 25.6 25.3 24.9 24.4 a Wealth quintile Lowest 20.8 20.7 20.5 21.1 20.1 20.7 Second 21.0 20.6 20.5 19.8 19.8 20.4 Middle 21.8 21.1 21.3 19.9 19.7 20.9 Fourth 22.7 22.4 21.9 20.6 20.3 21.7 Highest 24.4 24.1 23.6 22.7 21.6 23.3 Total 22.5 22.0 21.8 20.8 20.4 21.5 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group The median age at first birth increases with the woman’s level of education and wealth status. The median age at first birth increases from 19.6 years for women with no education to 21.2 for women with some secondary education. Women in wealthier households tend to marry at a later age than women in poorer households. The median age for women in the highest wealth quintile is 2.6 years higher than Fertility | 57 that for women in the lowest wealth quintile (23.3 and 20.7 years, respectively). Appendix Table A-4.3 shows the median age at first birth among women age 25-49 by province. 4.5 TEENAGE FERTILITY The issue of adolescent fertility is important for both health and social reasons. Adolescent childbearing has potentially negative demographic and social consequences. Children born to very young mothers face an increased risk of illness and death. Teenage mothers, 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 opportunities and can limit access to job opportunities. Table 4.8 shows the percentage of women age 15-19 who are mothers or are pregnant with their first child by background characteristics. Teen- agers who have never married are assumed to have had no pregnancies and no births. The 2007 IDHS findings show that 9 percent of adolescents have started childbearing: 7 percent have had a live birth, and 2 percent are currently pregnant with their first child. Since 2002-2003, there has been a small decline in the proportion of adolescents who have begun childbearing, from 10 percent to the current level of 9 percent. The proportion of teenagers who have started having children increases rapidly with age. While less than 1 percent of women age 15 have started childbearing, one in five women age 19 is either a mother or is pregnant with her first child. Rural teenagers are more likely than urban teen- agers to have started childbearing (13 percent com- pared with 4 percent). There is an inverse relationship between early childbearing and education. Teenagers with less education are more likely to start childbearing earlier than better-educated women; 19 percent of teenagers with no education had begun childbearing compared with 4 percent of those with secondary or higher education. By wealth status, the proportion of teenagers who have begun childbearing increases from 6 percent among those living in households in the lowest wealth quintile to 17 percent among those in the fourth wealth quintile, then drops to 10 percent among those in the highest quintile. Overall, however, because of variations in sample size, three-fourths of teenagers who have begun childbearing live in households in the three lowest wealth quintiles. Variation in the prevalence of teenage pregnancy and motherhood by province is presented in Appendix Table A-4.4. Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child and percentage who have begun childearing, by background characteristics, Indonesia 2007 Percentage who: Background characteristic Have had a live birth Are pregnant with first child Percentage who have begun child- bearing Number of women Age 15 0.6 0.1 0.7 1,410 16 1.9 0.6 2.5 1,136 17 4.7 2.2 6.9 1,404 18 10.7 3.3 14.0 1,238 19 16.4 3.7 20.1 1,154 Residence Urban 2.9 1.0 3.9 3,082 Rural 9.9 2.8 12.7 3,316 Education No education 16.0 2.7 18.7 70 Some primary 19.2 2.0 21.2 315 Complete primary 16.4 5.0 21.4 974 Some secondary 4.2 1.3 5.5 3,707 Secondary + 2.4 1.4 3.8 1,253 Wealth quintile Lowest 4.8 1.1 5.9 2,835 Second 5.0 1.4 6.4 2,317 Middle 8.0 1.8 9.8 1,034 Fourth 11.2 5.6 16.8 499 Highest 6.4 3.1 9.6 425 Total 6.6 1.9 8.5 6,341 Knowledge and Ever Use of Family Planning | 59 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 contraceptive methods and using a suitable method in a timely and effective manner. In the 2007 Indonesia Demographic and Health Survey (IDHS), data on knowledge of family planning methods were obtained by first asking the respondent to name ways that a couple can 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 shows knowledge of contracep- tive methods for ever-married women and currently married women as well as for currently married men. The results indicate that knowledge of contra- ceptive methods is widespread among women and men. Almost all ever-married women and currently married women (98 and 99 percent, respectively) know at least one method of family planning. Knowledge of modern methods for ever-married women and currently married women is as high as knowledge of any method. Knowledge of contra- ceptive methods or modern methods is almost uni- versal among currently married men. Almost half of women and men know at least one traditional method. Knowledge of modern contraceptive meth- ods among women and men has remained un- changed since 2003, while knowledge of traditional methods has increased from 41 to 48 percent for both ever-married women and currently married women. For currently married men, knowledge of traditional methods increased from 37 percent in 2002-2003 to 44 percent in 2007. The most widely known methods for both ever-married women and currently married women are injectables and the pill (96 and 97 percent, respectively). Implants and the IUD are known to 86 percent of ever-married women and 84 percent of currently married women. Knowledge of the lactational amenorrhea method (LAM) and diaphragm among women is relatively low (23 and 14 percent, respectively). Emergency contraception (6 percent) is the least known method among both ever-married 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 specific method, Indonesia 2007 Women Method Ever- married women Currently married women Currently married men Any method 98.4 98.6 94.5 Any modern method 98.1 98.3 94.1 Female sterilization 65.5 66.1 39.2 Male sterilization 39.0 39.4 30.0 Pill 94.9 95.1 86.1 IUD 83.4 83.9 67.2 Injectables 96.3 96.5 87.8 Implants 85.9 86.4 60.0 Male condom 76.2 76.8 80.9 Diaphragm 13.6 13.7 10.5 Lactational amenorrhea (LAM) 23.0 23.3 11.3 Emergency contraception 6.3 6.4 4.5 Any traditional method 47.7 48.4 44.1 Periodic abstinence 38.0 38.5 31.1 Withdrawal 32.8 33.3 33.3 Folk method 6.0 6.0 3.7 Mean number of methods known by respondents 6.6 6.7 5.5 Number of respondents 32,895 30,931 8,758 60 | Knowledge and Ever Use of Family Planning and currently married women. There is limited knowledge of the emergency contraceptive method because this method is relatively new and has not been included in the national family planning program. Knowledge of contraceptive methods among men is similar to that among women. Injectables and the pill are the most well known methods (88 and 86 percent, respectively), followed by the male condom (81 percent). Knowledge of LAM, the diaphragm, and emergency contraception is limited (11, 11, and 5 percent, respectively). In general, women are more knowledgeable about contraceptive methods than men. The average number of methods known for currently married women is 6.7, compared with 5.5 methods among currently married men. Figure 5.1 shows that knowledge of contraceptive methods among married women has continued to increase since 1991. Knowledge of implants increased significantly during the last decade, from 68 percent to the current level of 86 percent. Knowledge of the male condom and female sterilization has also increased since 1991. Knowledge of injectables and male sterilization increased by 9 percentage points each. Table 5.2 shows the percentage of currently married women and currently married men who know of at least one contraceptive method by several background characteristics. Almost all currently married women and 94 percent of currently married men know at least one modern method of family planning methods. Among married women, knowledge of any contraceptive methods is slightly lower among younger and older women than among women in their 20s and 30s. Knowledge of modern methods is similar to knowledge of any method. 88 91 68 83 64 55 30 97 95 86 84 77 66 39 Injectables Pill Implants IUD Male condom Female sterilization Male sterilization 0 20 40 60 80 100 Percent IDHS 1991 IDHS 2007 Figure 5.1 Percentage of Currently Married Women Who Know Specific Modern Contraceptive Methods, Indonesia 1991 and 2007 Knowledge and Ever Use of Family Planning | 61 Almost all women in the urban areas know at least one contraceptive method and at least one modern method, while the figures for rural areas is 98 percent. Knowledge of contraceptive methods increases with the level of education. Almost all currently married women with secondary or higher education know at least one modern method, compared with 90 percent of women with no education. A similar pattern is seen for the relationship between the wealth index and knowledge of a contraceptive method. Knowledge of modern contraceptive methods increases with increasing wealth index quintile, from 94 percent for women in the lowest quintile to all women in the highest quintile. For currently married men, knowledge of at least one contraceptive method and at least one modern method is slightly lower among younger and older men than among men age 25 to 49. Urban men, those with more education, and men in the highest wealth quintile have higher levels of knowledge about family planning methods than other men. Variation in knowledge of contraceptive methods by province is presented in Appendix Table A-5.1. Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men who know of at least one contraceptive method and who know of at least one modern method by background characteristics, Indonesia 2007 Women Men Background characteristic Know of any method Know of any modern method1 Number Know of any method Know of any modern method1 Number Age 15-19 97.2 97.0 814 * * 29 20-24 98.9 98.7 3,952 93.9 92.6 432 25-29 99.1 98.8 5,585 96.1 95.7 1,116 30-34 99.3 99.0 5,765 95.9 95.3 1,418 35-39 99.1 98.9 5,704 95.8 95.5 1,679 40-44 98.1 97.8 4,899 95.5 95.2 1,570 45-49 96.7 96.3 4,211 95.1 94.7 1,359 50-54 na na na 88.1 87.8 1,155 Residence Urban 99.5 99.5 12,842 97.8 97.7 3,728 Rural 97.9 97.5 18,089 92.1 91.5 5,030 Education No education 91.9 89.5 2,004 63.7 62.3 365 Some primary 97.3 97.0 5,112 89.2 88.3 1,605 Complete primary 98.9 98.8 9,511 94.9 94.5 2,339 Some secondary 99.5 99.5 6,494 98.1 97.9 1,721 Secondary + 99.9 99.8 7,810 99.2 99.1 2,727 Wealth quintile Lowest 95.4 94.3 5,773 87.2 85.9 1,676 Second 98.4 98.2 6,233 92.1 91.4 1,698 Middle 99.2 99.2 6,342 95.7 95.7 1,788 Fourth 99.6 99.6 6,358 97.4 97.4 1,713 Highest 99.9 99.9 6,225 99.5 99.5 1,882 Total 98.6 98.3 30,931 94.5 94.1 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception na = Not applicable 62 | Knowledge and Ever Use of Family Planning 5.2 EXPOSURE TO FAMILY PLANNING MESSAGES The objectives of the information, education, and communication (IEC) component of the Indonesia’s family planning program is to increase the knowledge, awareness, and practice of family planning in order to institutionalize the norm of the “small, happy, and prosperous family.” Family planning IEC activities are carried out through face-to-face and group interaction and mass IEC. Face-to-face and group IEC activities are conducted by teams or individuals, such as the Family Planning Fieldworker (PLKB), Family Planning Fieldworker Supervisor (PPLKB/Family Planning Coordinator/Chief of “UPT”), medical staff (dokter, bidan), community worker in the village (Village Family Planning Management Assistant/PPKBD, and Sub-Village Family Planning Management Assistant/Sub PPKBD, cadre). These persons’ activities are focused on providing family planning information and promoting the use of family planning. They operate at the grassroots level and work with community organizations such as religious groups, family planning acceptors groups, and women’s organizations (PKK). Mass IEC in family planning is the dissemination of family planning program information, managed by a program administrator. Mass IEC uses various media, including print (newspaper/ magazine), electronic (radio, TV, family planning information mobile unit), and traditional media. IEC activities for television are shown on government-run stations, both at the central and regional stations. Family planning information is carried on the radio by government and private stations throughout the country. Family planning programs are also inserted in traditional art performances, such as ‘ketoprak’ and ‘wayang orang’. In an effort to investigate which sources of family planning information are reaching the target populations, ever-married women and currently married men in the 2007 IDHS were asked a series of questions on their exposure to such information. Respondents were asked whether they heard or saw a message on family planning on the radio or television, or if they read it in a newspaper or magazine, poster or pamphlet in the six months preceding the survey. Ever-married women and currently married men were also asked whether they had received any family planning messages through personal contact. 5.2.1 Exposure to Mass Media Information on the sources of family planning messages is presented in Table 5.3. In general, men are more likely than women to obtain family planning messages through a variety of mass media. The most often cited media for family planning messages is television; 26 percent of ever-married women and 31 percent of currently married men saw family planning messages on television in the past six months. Print media is also popular; 14 percent of ever-married women and 21 percent of currently married men read family planning messages on a poster, followed by 11 percent of women and 18 percent of men who read those messages in newspapers or magazines. Radio was mentioned by 10 percent of women and 14 percent of men. More than two in three ever-married women (67 percent) and 59 percent of currently married men were not exposed to any media sources with family planning messages in the past six months. The proportion of ever-married women who have heard family planning messages varies somewhat by age. Women age 25-39 are slightly more likely to receive family planning messages through at least one media than women in other age groups. Furthermore, as expected, women who live in urban areas are more exposed to family planning messages (all media sources) than rural women. For instance, 34 percent of women in urban areas watched a family planning message on television in the past six months versus 20 percent in rural areas. Knowledge and Ever Use of Family Planning | 63 Table 5.3 Exposure to family planning messages Percentage of ever-married women and currently married men who heard or saw a family planning message on the radio or television or in a newspaper or on a poster or a pamphlet in the past six months, according to background characteristics, Indonesia 2007 Background characteristic Radio Television Newspaper/ magazine Poster Pamphlet None of the specified media sources Number EVER-MARRIED WOMEN Age 15-19 6.7 22.2 6.3 11.2 4.1 70.4 845 20-24 8.8 25.5 9.5 13.4 6.6 66.6 4,094 25-29 10.4 28.5 13.6 17.1 9.2 62.3 5,771 30-34 11.4 29.4 13.2 16.3 9.0 62.2 6,020 35-39 10.7 28.6 13.6 14.7 8.3 64.2 6,004 40-44 10.0 23.1 10.6 12.0 7.5 70.3 5,365 45-49 7.7 18.6 6.6 9.0 5.6 76.0 4,795 Residence Urban 12.5 34.0 18.6 20.6 12.5 56.3 13,745 Rural 8.0 20.0 6.1 9.1 4.3 74.1 19,150 Education No education 3.3 7.4 0.2 1.8 0.4 90.3 2,271 Some primary 4.8 14.0 1.5 4.8 2.6 82.1 5,572 Complete primary 7.2 19.5 4.3 7.9 3.7 75.1 10,077 Some secondary 11.9 29.9 10.8 15.4 7.5 62.0 6,781 Secondary + 16.8 43.4 30.1 29.6 18.5 43.1 8,193 Wealth quintile Lowest 5.4 10.5 2.4 4.7 2.0 84.5 6,219 Second 7.5 19.5 4.3 8.1 3.8 75.2 6,606 Middle 8.7 24.3 7.4 10.9 5.7 69.7 6,710 Fourth 10.8 31.1 13.0 16.4 8.4 60.2 6,713 Highest 16.6 42.6 28.9 28.6 18.5 45.0 6,647 Total 9.9 25.8 11.3 13.9 7.8 66.7 32,895 CURRENTLY MARRIED MEN Age 15-19 * * * * * * 29 20-24 10.9 28.6 10.8 16.5 11.2 64.3 432 25-29 11.0 35.8 17.1 22.5 14.3 54.9 1,116 30-34 16.8 36.1 23.5 25.9 16.8 51.8 1,418 35-39 14.6 31.6 17.9 21.8 11.9 56.5 1,679 40-44 14.0 31.9 20.4 23.4 15.1 57.8 1,570 45-49 13.0 27.4 16.7 17.5 11.7 63.5 1,359 50-54 11.9 22.3 12.8 13.2 9.3 70.1 1,155 Residence Urban 15.7 39.0 26.8 29.4 19.1 47.6 3,728 Rural 12.0 24.7 11.3 14.3 8.8 67.6 5,030 Education No education 2.0 4.7 1.4 2.8 1.2 93.4 365 Some primary 7.0 14.1 2.9 5.3 2.4 80.6 1,605 Complete primary 10.2 24.6 7.7 12.1 5.2 68.2 2,339 Some secondary 13.9 30.9 15.9 20.1 13.1 58.7 1,721 Secondary + 21.6 49.4 39.0 40.0 28.0 34.3 2,727 Wealth quintile Lowest 9.1 14.9 5.8 7.4 3.1 79.5 1,676 Second 11.6 26.3 9.1 12.0 6.6 67.2 1,698 Middle 11.0 28.2 13.3 17.0 9.6 62.7 1,788 Fourth 15.3 37.2 21.4 26.3 16.2 50.9 1,713 Highest 20.2 45.7 37.8 39.0 28.6 37.7 1,882 Total 13.6 30.8 17.9 20.7 13.2 59.1 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 64 | Knowledge and Ever Use of Family Planning Women with lower education have less access to family planning information through any mass media than those with higher education. For example, 43 percent women with secondary or higher education saw a family planning message on television, compared with 7 percent of women with no formal education. Thirty percent women with secondary or higher education level read family planning messages in a newspaper or magazine in the past six months compared with only 2 percent of women with some primary education. Exposure to family planning messages is positively associated with a person’s wealth status; those in the higher wealth quintiles are more likely to be exposed to family planning messages than those in the lower wealth quintiles. For example, 5 percent of women in the lowest wealth quintile listen to family planning messages on radio, compared with 17 percent of women in the highest wealth quintile. The pattern of exposure to family planning messages for men is similar to that of women. Urban men have better access to family planning information through mass media than rural men. Additionally, education and household wealth status have a positive association with access to family planning messages in a variety of media. For instance, 49 percent of men with secondary or higher education saw family planning messages on TV, compared with only 5 percent of men with no education. Thirty-eight percent of men in the highest wealth quintile read a newspaper or magazine, compared with only 6 percent of men in the lowest wealth quintile. Appendix Table A-5.2 shows the exposure of women and men to family planning messages through variety of media by province. In the survey, women were asked whether they receive family planning information from specific types of persons, including family planning fieldworkers, teachers, health providers, religious leaders, and community leaders. Table 5.4 presents data on exposure to family planning messages through personal contacts by background characteristics. Table 5.4 Exposure to family planning messages through personal contact Percentage of ever-married women who received (heard or saw) a family planning message as a result of contact with specific persons in the past six months, by background characteristics, Indonesia 2007 Background characteristic Family planning officer Teacher Religious leader Doctor Nurse/ midwife Village leader Women's group Pharmacist Number of women Age 15-19 3.9 0.6 0.5 3.9 12.4 0.6 1.0 0.1 845 20-24 5.9 0.6 1.1 4.2 16.5 1.3 2.4 0.5 4,094 25-29 8.1 0.7 1.3 5.5 17.2 1.1 3.8 0.5 5,771 30-34 9.2 0.4 1.2 4.9 16.4 1.9 4.7 0.5 6,020 35-39 8.9 0.5 1.6 5.1 16.2 2.3 6.0 0.5 6,004 40-44 7.1 0.5 1.7 4.1 11.5 1.9 5.8 0.3 5,365 45-49 5.4 0.7 1.6 3.0 8.2 2.5 5.9 0.5 4,795 Residence Urban 7.2 0.6 1.6 6.1 15.4 1.6 5.5 0.5 13,745 Rural 7.7 0.5 1.3 3.4 13.7 2.0 4.2 0.4 19,150 Education No education 4.1 0.5 0.7 1.3 4.8 1.7 2.2 0.1 2,271 Some primary 4.3 0.5 0.8 2.2 9.1 1.4 2.9 0.1 5,572 Complete primary 6.4 0.2 1.2 2.8 13.2 1.7 4.0 0.3 10,077 Some secondary 9.6 0.5 1.8 4.9 17.9 2.2 5.6 0.5 6,781 Secondary + 10.2 1.1 1.9 8.8 19.3 2.1 6.9 0.9 8,193 Wealth quintile Lowest 6.3 0.3 1.0 2.4 11.7 1.6 2.3 0.2 6,219 Second 7.3 0.5 1.4 2.8 13.3 1.8 3.5 0.2 6,606 Middle 7.4 0.4 1.2 3.9 13.1 1.9 4.8 0.3 6,710 Fourth 7.8 0.7 1.5 5.0 17.0 1.9 5.8 0.6 6,713 Highest 8.5 0.7 1.9 8.4 16.8 1.9 7.2 0.8 6,647 Total 7.5 0.6 1.4 4.5 14.4 1.8 4.8 0.4 32,895 Knowledge and Ever Use of Family Planning | 65 In general, the proportion of ever-married women who reported receiving family planning messages through personal contact is relatively low. The persons mentioned most often are nurses and midwives (14 percent), followed by family planning officers (8 percent), and women’s groups and medical doctors (5 percent each). Few women (less than 2 percent) mentioned a religious leader, community leader, teacher, or pharmacist as sources of family planning information. This may be due to more frequent interaction of women with midwives and nurses regarding health-related matters than family planning matters. Contacts with family planning workers are mainly focused on issues of contraception. The levels of exposure to family planning messages, especially through family planning personnel and midwives or nurses, are higher than those reported in the 2002-2003 IDHS, while contact with other persons remains unchanged. In general, the pattern of dissemination of family planning information through personal contact does not vary by age, except for contact by a nurse or midwife. Women age 20-39 are more likely to have received a family planning message from a midwife or nurse than women in other age groups. Similarly, there is no variation in dissemination of family planning information through personal contacts by urban- rural residence. Overall, women with higher education are more likely to have received a family planning message from a family planning officer, a medical doctor, a midwife or a nurse in the past six months than less educated women. There is positive association between household wealth status and exposure to family planning messages through personal contacts. The percentage of women who were exposed to family planning officers ranges from 6 percent among women in the lowest wealth quintile to 9 percent among women in the highest wealth quintile. Provincial differentials in the proportion of women who heard family planning messages through specific persons are shown in Appendix Table A-5.3. 5.2.2 Dissemination of Family Planning Information IEC activities are also carried out through community groups that are formed at the village or neighborhood level. IEC activities at periodic community group meetings are generally handled by a family planning fieldworker or by the group leader. Family planning information is also disseminated through word of mouth among neighbors and friends (gethok tular). In the 2007 IDHS, currently married women who were not using contraception were asked whether they were visited by a family planning worker who discussed family planning in the 12 months prior to the survey. Women were also asked whether they had visited a health facility in the past year and, if so, whether a staff person at that facility spoke to them about family planning. This information is useful in determining if nonusers of family planning are being reached by family planning programs and initiatives in Indonesia. Table 5.5 shows the data on nonusers of family planning who were visited by family planning worker or staff in a health facility. Overall, only 4 percent of nonusers of family planning were visited by a family planning worker who discussed family planning, and 6 percent visited a health facility and discussed family planning with a staff person at that facility. Twenty-five percent of nonusers of family planning visited a health facility but did not discuss family planning with any staff member. This indicates a missed opportunity and demonstrates that family planning services have not been fully integrated into the health service delivery system for women. Nine in ten nonusers reported that they neither discussed family planning with a fieldworker nor with staff at a health facility in the past 12 months. 66 | Knowledge and Ever Use of Family Planning Table 5.5 Contact of nonusers with family planning providers Among women who are not using contraception, the percentage who during the last 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who neither discussed family planning with a fieldworker nor at a health facility, by background characteristics, Indonesia 2007 Percentage of women who visited a health facility in the past 12 months and who: Background characteristic Percentage of women who were visited by fieldworker who discussed family planning Discussed family planning Did not discuss family planning Percentage of women who neither discussed family planning with fieldworker nor at a health facility Number of women Age 15-19 2.9 5.2 24.2 93.3 461 20-24 2.9 6.4 35.8 91.4 1,659 25-29 4.6 9.2 33.0 88.0 2,193 30-34 4.8 9.4 28.0 87.9 2,028 35-39 4.5 5.6 24.6 91.4 2,077 40-44 4.6 4.4 18.4 92.5 2,421 45-49 4.4 3.0 16.2 93.6 2,995 Residence Urban 3.8 7.3 29.4 90.1 5,679 Rural 4.7 5.2 21.7 91.8 8,154 Education No education 3.9 2.4 11.4 94.5 1,417 Some primary 4.3 3.6 19.3 93.0 2,799 Complete primary 4.8 6.0 21.6 90.6 3,957 Some secondary 4.6 6.8 28.4 90.3 2,515 Secondary + 3.5 9.3 37.2 89.0 3,145 Wealth quintile Lowest 4.8 4.5 17.9 92.4 3,153 Second 3.6 4.8 21.7 92.7 2,646 Middle 5.2 5.9 27.0 90.3 2,729 Fourth 4.6 7.3 29.5 89.4 2,627 Highest 3.3 8.1 29.4 90.3 2,678 Total 4.3 6.0 24.9 91.1 13,834 Missed opportunity to discuss family planning issues with nonusers who visited a health facility is higher among urban women, better educated women, and women in the higher wealth quintiles. For example, 11 percent of nonusers with no education visited a health facility but did not discuss family planning compared with 37 percent of nonusers with secondary or higher education. Variation in the proportion of nonusers who had contact with family planning providers in the past 12 months by province is presented in Appendix Table A-5.4. 5.3 DISCUSSION OF FAMILY PLANNING WITH HUSBAND Although discussion between husband and wife about contraceptive use is not a precondition for adoption of contraception, its absence may be an impediment to use. Interpersonal communication is thus an important intermediate step along the path to eventual adoption and especially continuation of contraceptive use. Lack of discussion may reflect a lack of personal interest, hostility to the subject, or customary reticence in talking about sex-related matters. To explore this subject, currently married women and currently married men in the 2007 IDHS were asked whether they discussed family planning with their spouse in the past 12 months. The results are shown in Table 5.6. Knowledge and Ever Use of Family Planning | 67 Table 5.6 Discussion of family planning between husband and wife Percent distribution of currently married women who know a contraception method by the number of times they discussed family planning with their husband in the past year, and percentage of currently married men who know a contraceptive method who discussed family planning with their wife in the past six months, according to current age, Indonesia 2007 Number of times woman discussed family planning with husband Age Never One or two times Three or more times Missing Total Number of women Men who discussed family planning with wife Number of men 15-19 41.7 42.5 15.3 0.5 100.0 791 * 23 20-24 33.9 46.4 19.4 0.3 100.0 3,907 23.2 405 25-29 30.8 49.8 19.1 0.3 100.0 5,534 27.8 1,073 30-34 35.1 48.5 16.0 0.3 100.0 5,728 29.8 1,360 35-39 38.9 45.3 15.5 0.3 100.0 5,654 23.5 1,609 40-44 52.7 35.3 11.5 0.5 100.0 4,808 20.1 1,499 45-49 65.3 27.2 7.2 0.2 100.0 4,071 17.5 1,293 50-54 na na na na na na 9.7 1,017 Total 41.8 42.8 15.0 0.3 100.0 30,492 21.8 8,279 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable The finding indicates that 58 percent of women discussed family planning with their spouse at least once in the past year. Women 20-34 discussed family planning more frequently with their husbands than women in other age groups. Forty-two percent of currently married women never discussed family planning with their spouse in the past year. It is important to note that women were more likely than men to say that they had discussed family planning with their spouse. For example, 58 percent of currently married women said that they discussed family planning with their husband in the past 12 months, compared with 22 percent of currently married men. Variation by province in the proportion of currently married women and currently married men who discussed family planning at least once with their spouse is shown in Appendix Table A-5.5. 5.4 ATTITUDES OF COUPLES TOWARD FAMILY PLANNING When couples have a positive attitude toward family planning, they are more likely to adopt a family planning method. In the 2007 IDHS survey, currently married women were asked whether they approved of couples using family planning and what they perceived as their husband’s attitude toward family planning. This information is important in the formulation of family planning policies because it indicates the extent to which further education and publicity are needed to increase acceptance of family planning. The findings indicate that 95 percent of currently married women who know at least one contraceptive method approve of a couple using contraception; only 5 percent disapprove. Nine in ten (88 percent) currently married women reported that both they and their husband approve of the use of family planning by couples. Disagreement between women and their husbands is low. Only 3 percent of currently married women who said they approve of family planning, think that their husbands also approves; 2 percent of women disapprove of family planning while their husbands approve. 68 | Knowledge and Ever Use of Family Planning Acceptance of family planning by couples is higher among women age 20-39 than women in other age groups. Education level and household wealth status have a positive association with acceptance of the use of family planning by couples. The percentage of couples who approve of family planning ranges from 74 percent among couples in which the woman has no formal education to 91 percent among couples in which the wife has secondary or higher education. Eighty percent of couples in the lowest wealth quintile approve of family planning compared with 91 percent of couples in the highest wealth quintile. Variation by province in attitudes toward the use of family planning by couples is presented in Appendix Table A-5.6. Table 5.7 Attitudes toward family planning Percent distribution of currently married women who know a method of family planning and their perceptions of their husband's attitude toward family planning, according to background characteristics, Indonesia 2007 Respondent approves of family planning Respondent disapproves of family planning Background characteristic Husband approves Husband disapproves Husband's attitude unknown, missing Husband approves Husband disapproves Husband's attitude unknown, missing Respondent unsure1 Total Number of women Age 15-19 84.2 2.1 4.4 1.8 4.5 0.7 2.3 100.0 791 20-24 90.0 2.2 2.5 2.0 1.6 0.3 1.4 100.0 3,907 25-29 90.8 1.9 2.3 2.0 1.4 0.3 1.3 100.0 5,534 30-34 90.2 2.3 2.0 1.8 2.0 0.4 1.3 100.0 5,728 35-39 88.5 2.6 2.6 1.8 2.4 0.3 1.7 100.0 5,654 40-44 84.8 3.0 3.3 1.9 3.2 0.4 3.4 100.0 4,808 45-49 80.9 3.8 4.0 2.3 3.9 0.7 4.3 100.0 4,071 Residence Urban 90.0 2.6 2.1 1.8 1.9 0.4 1.2 100.0 12,784 Rural 86.1 2.6 3.2 2.1 2.8 0.4 2.9 100.0 17,708 Education No education 73.6 4.3 5.0 2.4 4.8 1.0 8.9 100.0 1,842 Some primary 82.0 3.0 4.2 2.6 3.7 0.8 3.7 100.0 4,975 Complete primary 88.6 2.4 2.7 2.1 2.3 0.3 1.5 100.0 9,411 Some secondary 90.7 2.4 2.0 1.5 1.9 0.2 1.3 100.0 6,463 Secondary + 91.3 2.3 2.0 1.6 1.6 0.2 1.0 100.0 7,801 Wealth quintile Lowest 80.3 3.3 4.6 2.0 3.9 0.7 5.2 100.0 5,509 Second 87.3 2.2 3.5 1.6 2.8 0.4 2.3 100.0 6,134 Middle 88.4 2.6 2.3 2.4 2.1 0.3 1.9 100.0 6,294 Fourth 90.9 2.2 2.3 1.8 1.5 0.4 0.9 100.0 6,334 Highest 90.8 2.8 1.3 2.0 2.0 0.2 0.9 100.0 6,222 Total 87.7 2.6 2.8 1.9 2.4 0.4 2.2 100.0 30,492 1 Includes missing 5.5 KNOWLEDGE OF THE FERTILE PERIOD A basic knowledge of female reproductive physiology and the fertile period is useful for the successful practice of periodic abstinence. The success of periodic abstinence as a family planning method depends on women’s and men’s understanding of the monthly cycle and the days when a woman is most likely to conceive. In the 2007 IDHS, ever-married women were asked about their knowledge of a woman’s fertile period. Table 5.8 shows the percent distribution of ever-married women and currently married men by knowledge of the fertile period during the ovulatory cycle, according to current use or nonuse of periodic abstinence. Knowledge and Ever Use of Family Planning | 69 The findings show that accurate knowledge of the reproductive cycle is generally limited, which indicates that there is still a significant need for educating women and men about the mechanism of reproduction and the fertile period. Only 19 percent of ever-married women and 16 percent of currently married men gave the ‘correct’ response, that a woman has the greatest chance of becoming pregnant in the middle of her ovulatory cycle. As expected, women and men who use periodic abstinence are considerably more knowledgeable about the ovulatory cycle than women and men in general. Fifty-nine percent of women who are using periodic abstinence have correct knowledge of the fertile period, compared with 18 percent of women who are not using this method. The corresponding figures for men are 39 and 16 percent, respectively. Overall, 29 percent of ever-married women and 54 percent of currently married men do not know when a woman is most likely to conceive during the menstrual cycle. Knowledge of the fertile period of women has increased slightly since 2003. The proportion of women who have correct knowledge of the fertile period has increased from 16 percent in 2002-2003 to 19 percent in the 2007 IDHS. Table 5.8 Knowledge of fertile period Percent distribution of ever-married women and currently married men by knowledge of the fertile period during the ovulatory cycle, according to current use of periodic abstinence, Indonesia 2007 Ever-married women Currently married men Perceived fertile period Users of rhythm method Nonusers of rhythm method All Users of rhythm method Nonusers of rhythm method All Just before her menstrual period begins 4.8 3.1 3.2 0.8 2.0 2.0 During her menstrual period 0.4 0.5 0.5 0.5 0.3 0.3 Right after her menstrual period has ended 21.0 21.7 21.6 36.3 17.5 17.7 Halfway between two menstrual periods 59.3 18.2 18.8 39.2 15.8 16.0 Other 0.0 0.1 0.1 0.0 0.0 0.0 No specific time 5.9 27.3 27.0 2.6 10.1 10.0 Don't know 8.6 28.9 28.6 20.1 54.0 53.7 Missing 0.0 0.2 0.2 0.5 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 466 32,429 32,895 88 8,670 8,758 5.6 EVER USE OF CONTRACEPTION All women interviewed in the 2007 IDHS survey who reported that they had heard of a method of family planning were asked whether they had ever used that method. Ever use refers to use of a method at any time, with no distinction between past and present use. Table 5.9.1 shows the percentage of ever- married women and currently married women who have ever used any contraceptive method, by specific method and age. The findings indicate that 83 percent of ever-married women and 84 percent of currently married women have used a contraceptive method at some time. The percentage of women who have ever used a modern contraceptive method is 80 percent among ever-married women, and 82 percent among currently married women. The proportion of women who have ever used a modern contraceptive method is slightly higher in the 2007 IDHS compared with the 2002-2003 IDHS. The corresponding figures from the 2002- 2003 IDHS are 78 percent for ever-married women and 79 percent for currently married women. 70 | Knowledge and Ever Use of Family Planning Table 5.9.1 Ever use of contraception: Women Percentage of ever-married women and currently married women who have ever used any contraceptive method by method, according to age, Indonesia 2007 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom Dia- phragm LAM Emer- gency contra- ception Any tradi- tional method Periodic absti- nence With- drawal Folk method Number of women EVER-MARRIED WOMEN 15-19 57.5 55.6 0.0 0.0 19.2 0.4 43.3 1.3 1.8 0.0 1.1 0.0 4.1 0.5 2.2 1.8 845 20-24 76.7 74.9 0.0 0.1 30.8 2.1 64.4 3.0 3.0 0.1 1.8 0.2 7.5 1.5 5.8 1.0 4,094 25-29 84.8 82.3 0.2 0.1 38.7 5.2 70.6 6.8 5.8 0.1 3.1 0.3 11.1 3.5 8.0 1.1 5,771 30-34 88.6 86.1 1.3 0.1 45.6 10.4 71.9 10.6 6.6 0.1 3.6 0.3 13.2 5.6 8.3 1.6 6,020 35-39 87.6 85.2 3.6 0.3 47.3 15.9 66.5 13.8 7.7 0.3 2.9 0.2 15.0 7.0 9.1 2.3 6,004 40-44 83.4 80.8 6.3 0.5 45.2 24.2 55.9 10.5 6.5 0.3 3.1 0.4 11.8 5.1 7.0 2.0 5,365 45-49 76.0 73.8 6.9 0.5 39.7 27.1 41.4 9.2 5.4 0.4 3.0 0.1 10.1 3.9 5.8 1.7 4,795 Total 82.8 80.4 3.0 0.3 41.3 13.9 62.0 9.1 5.9 0.2 2.9 0.3 11.6 4.5 7.3 1.7 32,895 CURRENTLY MARRIED WOMEN 15-19 57.9 56.0 0.0 0.0 19.4 0.2 43.9 1.2 1.9 0.0 0.9 0.0 4.2 0.5 2.1 1.8 814 20-24 77.6 75.7 0.0 0.1 31.3 2.0 65.2 3.1 3.0 0.1 1.9 0.2 7.5 1.6 5.9 0.9 3,952 25-29 85.6 83.2 0.2 0.1 39.3 5.3 71.2 6.9 5.8 0.1 3.2 0.3 11.1 3.5 7.9 1.2 5,585 30-34 89.6 87.0 1.3 0.1 46.4 10.5 72.7 10.6 6.8 0.1 3.6 0.3 13.6 5.8 8.6 1.6 5,765 35-39 88.6 86.1 3.8 0.3 47.8 15.9 67.8 14.0 7.9 0.3 2.6 0.2 15.6 7.3 9.4 2.4 5,704 40-44 85.2 82.6 6.6 0.6 46.5 25.0 57.4 11.0 6.7 0.4 3.1 0.4 12.4 5.3 7.4 2.0 4,899 45-49 78.7 76.4 7.4 0.5 41.1 28.5 43.4 9.7 5.9 0.3 3.0 0.2 10.7 4.1 6.3 1.7 4,211 Total 84.2 81.7 3.0 0.3 42.1 14.0 63.4 9.3 6.1 0.2 2.9 0.3 11.9 4.7 7.6 1.7 30,931 LAM = Lactational amenorrhea method Injectables and the pill are the most commonly used methods of contraception. Injectables have been used by 62 percent of ever-married women and 63 percent of currently married women. The pill has been used by four in ten women. The IUD and implants have been used by 14 percent and 9 percent, respectively, of both ever-married women and currently married women. Use of male sterilization, female sterilization and the male condom is relatively low (less than 1 percent, 3 percent and 6 percent, respectively). Traditional methods have been used by 12 percent of women, 5 percent have used periodic abstinence, and 7 percent have used withdrawal. There has been a noticeable increase in the level of ever use of injectables, the male condom, and traditional methods since 2002-2003. In the 2002-2003 IDHS, 54 percent of currently married had used injectables, 4 percent had used condoms, and 9 percent had used traditional methods. In the 2007 IDHS, the corresponding proportions are 62 percent, 6 percent, and 12 percent, respectively. Ever use of other contraceptive methods was unchanged between the two surveys. Ever use of contraceptive methods reported by men is much lower than that reported by women. Only 23 percent of currently married men have ever used a contraceptive method, while the corresponding figure for currently married women is 84 percent. As expected, use of male contraceptive methods by men is higher than that reported by women. For instance, 13 percent of men reported having ever used a condom compared with 6 percent of women. Variation by province on ever use of contraception for women and men is presented in Appendix Tables A-5.7 and A-5.8. Knowledge and Ever Use of Family Planning | 71 Table 5.9.2 Ever use of contraception: Men Percentage of currently married men who have ever used any contraceptive method by method, according to age, Indonesia 2007 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Male condom Any tradi- tional method Periodic abstinence With- drawal Number of men 15-19 12.2 1.5 0.0 0.0 1.5 12.2 0.8 11.4 29 20-24 17.3 10.8 0.0 0.0 10.6 9.2 3.5 7.2 432 25-29 17.6 10.6 0.1 0.0 10.6 11.6 4.4 9.5 1,116 30-34 25.8 16.2 1.4 0.1 15.7 14.8 6.6 11.3 1,418 35-39 22.1 15.9 2.3 0.5 13.5 11.8 6.2 7.9 1,679 40-44 23.3 16.5 2.5 0.6 14.2 13.5 7.4 9.2 1,570 45-49 27.3 19.6 3.8 0.7 15.6 14.5 9.3 8.7 1,359 50-54 21.6 16.4 7.9 0.9 9.1 9.1 4.9 6.3 1,155 Total 22.8 15.7 2.8 0.4 13.2 12.5 6.4 8.8 8,758 Table 5.10 presents the distribution of ever-married women who have ever used a contraceptive method by the number of living children they had when they first used family planning. The table is used primarily to identify the acceptance of the small family norm and the use of family planning as a method for spacing births. Seven of 10 women started using family planning before they had two children, 14 percent of women used family planning for the first time when they had two children, and 12 percent used it after they had three or more children. There is a trend toward younger women starting to use family planning when they have fewer children. For example, 40 percent of women age 15-19 and 19 percent of those age 20-24 started using family planning before they had any children, compared with 2 percent of women age 45-49. Comparison with data from the 2002-2003 IDHS shows that the proportion of women who started using a contraceptive method when they had one child increased by 9 percentage points (57 percent compared with 66 percent). The increase in contraceptive use occurred mainly among young women (age 15-29). These finding indicates that young women are starting to use family planning at an earlier age and at lower parity. Variation on proportion of women who have ever used contraception by number of living children at the time of first use by province is shown in Appendix Table A-5.9. Table 5.10 Number of children at first use of contraception Percent distribution of women who had ever used contraception by number of living children at the time of first use of contraception, according to current age, Indonesia 2007 Number of living children at time of first use of contraception Current age 0 1 2 3 4+ Missing Total Number of women 15-19 39.8 56.8 3.0 0.1 0.0 0.3 100.0 486 20-24 19.1 74.6 5.5 0.5 0.1 0.1 100.0 3,142 25-29 10.4 77.4 9.1 2.3 0.6 0.1 100.0 4,892 30-34 6.4 72.3 13.9 5.0 2.2 0.1 100.0 5,335 35-39 5.0 66.4 16.0 6.8 5.6 0.1 100.0 5,262 40-44 2.9 56.7 20.3 9.6 10.5 0.1 100.0 4,473 45-49 1.6 44.7 21.5 13.8 18.3 0.2 100.0 3,646 Total 7.7 65.8 14.4 6.2 5.8 0.1 100.0 27,234 Current Use of Family Planning | 73 CURRENT USE OF FAMILY PLANNING 6 Information on the current level of contraceptive use (contraceptive prevalence) is important for measuring the success of the National Family Planning Program. Contraceptive prevalence is defined here as the proportion of currently married women age 15-49 that were using a method of family planning at the time of the survey. This chapter presents data concerning levels, trends, and differentials in current use; sources of family planning methods; age at time of first use of contraception; accessibility; reasons for using a particular method; and some indicators on the quality of use of the pill, injectables, and condoms. 6.1 CURRENT USE OF FAMILY PLANNING This section presents information on the prevalence of contraceptive use among ever-married women and currently married women age 15-49. Level of contraceptive use is the most widely used indicator for measuring the success of family planning programs. Furthermore, it can be used to estimate the reduction in fertility attributable to contraception. Table 6.1 shows the percent distribution of ever-married and currently married women who are using specific family planning methods by age. The results indicate that 58 percent of ever-married women and 61 percent of currently married women are using contraception. Furthermore, 54 percent of ever-married women and 57 percent of currently married women are using modern methods. Traditional methods are not commonly used in Indonesia; only 4 percent of ever-married and 4 percent of currently married women use a traditional method. Among modern methods, injectables are the most commonly used method for both ever-married and currently married women (30 and 32 percent, respectively), followed by the pill (13 percent for both ever-married and currently married women). Modern methods are popular among women of all ages. However, younger women (age 15-19) and older women (age 45-49) are less likely to be using contraception than women in the mid- childbearing ages (20 to 39 years). Injectables, the pill, and implants are more popular among women age 20-34, whereas older women (age 35-44) tend to use long-term methods such as the intrauterine device (IUD), female sterilization, and male sterilization. Compared with the 2002-2003 Indonesia Demographic and Health Survey (IDHS) data, use of injectables has increased by four percentage points from 28 percent in the 2002-2003 IDHS to 32 percent in the 2007 IDHS, whereas use of the IUD and implants has decreased by one percentage point each. Use of the IUD declined from 6 percent in the 2002-2003 IDHS to 5 percent in the 2007 IDHS, and use of implants declined from 4 percent in the 2002-2003 IDHS to 3` percent in the 2007 IDHS. Data from the 2007 IDHS at the national level and for selected provinces cannot be directly compared with data collected in the 2002-2003 IDHS because of differences in geographical coverage. The 2002-2003 IDHS did not include the following provinces: Nanggroe Aceh Darussalam, Riau Islands, West Sulawesi, Maluku, North Maluku, West Papua, and Papua. The prevalence of use of modern contraceptive methods in the 2007 IDHS is virtually the same as that in the 2002-2003 IDHS, for both ever-married women and currently married women (54 and 57 percent, respectively). 74 | Current Use of Family Planning Table 6.1 Current use of contraception by age Percent distribution of ever-married women and of currently married women by contraceptive method currently used, according to age, Indonesia 2007 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom LAM Any tradi- tional method Periodic absti- memce With- drawal Folk method Not currently using Total Number of women EVER-MARRIED WOMEN 15-19 45.4 44.8 0.0 0.0 9.6 0.2 33.5 1.0 0.2 0.2 0.7 0.1 0.5 0.1 54.6 100.0 845 20-24 59.5 57.9 0.0 0.0 11.6 1.2 42.4 2.0 0.5 0.1 1.6 0.3 1.0 0.2 40.5 100.0 4,094 25-29 62.0 58.8 0.2 0.0 13.6 2.5 39.0 2.4 1.0 0.0 3.2 0.9 2.1 0.3 38.0 100.0 5,771 30-34 66.3 62.1 1.3 0.1 14.3 4.1 37.7 3.0 1.6 0.1 4.2 1.7 2.1 0.4 33.7 100.0 6,020 35-39 65.4 60.1 3.6 0.2 15.6 6.0 29.2 4.0 1.5 0.0 5.3 2.5 2.3 0.5 34.6 100.0 6,004 40-44 54.9 50.3 6.3 0.5 11.7 7.2 20.0 2.7 1.8 0.0 4.6 1.9 2.3 0.4 45.1 100.0 5,365 45-49 37.5 34.1 6.9 0.5 6.9 7.3 10.4 1.3 0.8 0.0 3.4 1.0 2.0 0.4 62.5 100.0 4,795 Total 57.9 54.2 3.0 0.2 12.5 4.7 30.0 2.6 1.2 0.0 3.8 1.4 2.0 0.4 42.1 100.0 32,895 CURRENTLY MARRIED WOMEN 15-19 46.8 46.2 0.0 0.0 10.0 0.0 34.8 1.0 0.2 0.2 0.7 0.1 0.5 0.1 53.2 100.0 814 20-24 61.5 59.9 0.0 0.0 12.0 1.3 43.9 2.1 0.6 0.1 1.6 0.3 1.1 0.2 38.5 100.0 3,952 25-29 64.1 60.7 0.2 0.0 14.1 2.6 40.3 2.5 1.0 0.0 3.3 0.9 2.1 0.3 35.9 100.0 5,585 30-34 69.1 64.7 1.3 0.1 14.9 4.2 39.3 3.1 1.7 0.1 4.4 1.7 2.2 0.5 30.9 100.0 5,765 35-39 68.6 63.0 3.8 0.2 16.3 6.2 30.7 4.1 1.6 0.0 5.5 2.7 2.4 0.5 31.4 100.0 5,704 40-44 59.6 54.6 6.6 0.5 12.9 7.9 21.7 3.0 2.0 0.0 5.0 2.1 2.5 0.5 40.4 100.0 4,899 45-49 42.1 38.2 7.4 0.5 7.9 8.1 11.8 1.5 1.0 0.0 3.9 1.2 2.2 0.5 57.9 100.0 4,211 Total 61.4 57.4 3.0 0.2 13.2 4.9 31.8 2.8 1.3 0.0 4.0 1.5 2.1 0.4 38.6 100.0 30,931 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 6.2 DIFFERENTIALS IN CONTRACEPTIVE USE BY BACKGROUND CHARACTERISTICS Table 6.2 shows the prevalence of contraceptive use among currently married women by background characteristics. From these results, it is possible to examine differences in the method mix among current users in various subgroups. Table 6.2 and Figure 6.1 show that use of family planning in urban areas is slightly higher than in the rural areas (63 and 61 percent, respectively). However, use of modern methods is virtually the same in the two areas (57 and 58 percent, respectively). There are differences in the method mix by residence, with urban women relying more on IUDs, condoms, and female sterilization, while rural women rely more on injectables and implants. Table 6.2 also shows that contraceptive use in general increases with the respondent’s level of education. Forty percent of currently married women with no education are using a modern method compared with 61 percent of women who completed primary education or who had some secondary education, after which it declines to 58 percent for women with the highest level of education. The contraceptive method used also varies by level of education. The use of modern methods increases with women’s level of education, except for implants, which are more likely to be used by women with no education. Current Use of Family Planning | 75 Table 6.2 Current use of contraception by background characteristics Percent distribution of all women age 15-49 by contraceptive method currently used, according to background characteristics, Indonesia 2007 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom LAM Any tradi- tional method Periodic absti- nence With- drawal Folk method Not currently using Total Number of women Residence Urban 62.5 57.1 4.0 0.2 13.9 6.7 28.0 1.8 2.4 0.0 5.3 2.3 2.6 0.4 37.5 100.0 12,842 Rural 60.6 57.5 2.3 0.2 12.8 3.6 34.5 3.5 0.5 0.0 3.0 0.9 1.7 0.4 39.4 100.0 18,089 Education No education 42.3 40.1 2.5 0.8 7.1 3.5 21.7 4.2 0.3 0.0 2.2 0.1 0.9 1.2 57.7 100.0 2,004 Some primary 54.0 51.5 4.1 0.2 11.7 3.8 27.9 3.3 0.4 0.0 2.6 0.5 1.6 0.5 46.0 100.0 5,112 Completed primary 64.0 61.1 2.2 0.2 14.7 3.7 36.9 2.9 0.4 0.0 2.9 0.7 1.9 0.3 36.0 100.0 9,511 Some secondary 65.5 61.4 2.8 0.1 13.9 3.3 37.8 2.4 1.1 0.0 4.1 1.6 2.3 0.3 34.5 100.0 6,494 Secondary + 64.4 57.8 3.6 0.2 13.6 8.8 26.0 2.1 3.4 0.1 6.6 3.4 2.8 0.3 35.6 100.0 7,810 Number of living children 0 8.3 7.9 0.0 0.0 3.5 0.0 4.1 0.0 0.1 0.0 0.4 0.1 0.3 0.0 91.7 100.0 2,488 1-2 68.1 64.3 1.1 0.1 14.5 5.4 38.7 3.0 1.4 0.0 3.7 1.5 1.9 0.3 31.9 100.0 17,447 3-4 67.7 62.5 6.7 0.3 15.1 5.9 29.6 3.2 1.6 0.0 5.2 1.9 2.6 0.7 32.3 100.0 8,396 5+ 46.7 41.5 7.1 0.5 8.0 2.7 19.3 2.7 1.0 0.0 5.2 1.4 3.3 0.5 53.3 100.0 2,600 Wealth quintile Lowest 53.0 49.9 1.6 0.1 12.5 1.5 30.5 3.5 0.1 0.0 3.1 0.6 1.8 0.8 47.0 100.0 5,773 Second 63.3 60.3 2.1 0.1 14.1 4.0 35.7 4.0 0.3 0.0 3.0 0.9 1.8 0.3 36.7 100.0 6,233 Middle 62.4 59.0 3.5 0.3 12.9 3.4 35.4 2.7 0.7 0.0 3.5 1.1 2.2 0.2 37.6 100.0 6,342 Fourth 63.8 59.1 3.2 0.2 14.0 5.6 32.6 1.9 1.6 0.0 4.7 2.0 2.3 0.4 36.2 100.0 6,358 Highest 63.5 57.9 4.7 0.3 12.5 9.8 24.9 1.8 3.8 0.0 5.6 2.9 2.3 0.3 36.5 100.0 6,225 Total 61.4 57.4 3.0 0.2 13.2 4.9 31.8 2.8 1.3 0.0 4.0 1.5 2.1 0.4 38.6 100.0 30,931 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Contraceptive use increases rapidly with the number of living children a woman has. Use of any modern method ranges from 8 percent among women with no living children to 64 percent among women with one or two children, after which it declines to 42 percent for women with five or more children. The most popular family planning methods among childless women are injectables and the pill. Use of injectables increases substantially after the first child, from 4 percent among childless women to 39 percent among those with one or two children. The proportion of women who use female sterilization increases from 1 percent for women with one or two children to 7 percent for women with three or more children. Overall, use of any method of family planning increases with increasing wealth quintile, but the gap is narrowing. In the 2007 IDHS, 53 percent of women in the lowest wealth quintile use family planning compared with 64 percent of women in the highest quintile. In the 2002-2003 IDHS, the corresponding proportions are 52 and 64 percent, respectively. Appendix Table A-6.1 shows the percent distribution of currently married women by contraceptive method used, according to province. 76 | Current Use of Family Planning The 2007 IDHS collected information on the use of male methods of family planning from currently married men. Figure 6.2 shows that use of male methods of family planning in Indonesia is limited. The most popular methods are periodic abstinence (2 percent) and withdrawal (2 percent). Only 1 percent of married men use condoms. The figures have not changed since the 2002-2003 IDHS. 61 63 61 42 54 64 66 64 8 68 68 47 53 63 62 64 64 INDONESIA RESIDENCE Urban Rural EDUCATION No education Some primary Completed primary Some secondary Secondary + NUMBER OF LIVING CHILDREN 0 1-2 3-4 5 + WEALTH QUINTILE Lowest Lower middle Middle Upper middle Highest 0 20 40 60 80 Percent IDHS 2007 Figure 6.1 Contraceptive Use among Currently Married Women Age 15-49 by Background Characteristics 1 2 2 1 2 2 Condom Periodic abstinence Withdrawal 0 1 1 2 2 3 Percent IDHS 2002-03 IDHS 2007 Figure 6.2 Contraceptive Use among Currently Married Men Age 15-54, IDHS 2002-2003 and IDHS 2007 Current Use of Family Planning | 77 6.3 TRENDS IN CONTRACEPTIVE USE Table 6.3 shows trends in current use of contraceptive methods among currently married women during the period 1991-2007. Findings show that use of any method by currently married women has increased from 50 percent in the 1991 IDHS to 61 percent in the 2007 IDHS. There has been a shift in the use of some modern methods. In 1991, the pill was used by 15 percent of currently married women; this rate increased slightly between 1991 and 1994, but has declined steadily since, with 13 percent of currently married women using the pill in the 2007 IDHS. Use of the IUD has also decreased steadily during the past 20 years, from 13 percent in 1991 to the current rate of 5 percent. On the other hand, use of injectables has increased sub- stantially, from 12 percent in 1991 to 32 percent in 2007. While the pill was the most commonly used modern method in the 1991 and 1994 IDHS surveys, injectables have been the most commonly used modern method since the 1997 IDHS. The marked changes in levels and patterns of contraceptive use in Java during the past 20 years are shown in Table 6.4 and Figure 6.3. This analysis focuses on the island of Java because 57 percent of Indonesia’s population (approximately 131 million) lives there. The 2007 IDHS results indicate that contraceptive prevalence in Java ranges from 61 percent in West Java to 67 percent in DI Yogyakarta. Contraceptive use increased steadily in all provinces in Java until the 2002-2003 IDHS. Use rates decreased thereafter, except in West Java Province. The largest decrease (nine percentage points) was in DI Yogyakarta, where contraceptive use declined from 76 to 67 percent. In DKI Jakarta, the decline was three percentage points, from 63 to 60 percent. Table 6.4 Trends in contraceptive use by province in Java 1991-2007 Percentage of currently married women who are currently using a method of contraception, by province, Java 1991-2007 Province IDHS 1991 IDHS 1994 IDHS 1997 IDHS 2003 IDHS 2007 DKI Jakarta 56 60 59 63 60 West Java 51 57 58 59 61 Central Java 50 61 62 65 64 D I Yogyakarta 71 70 73 76 67 East Java 55 56 61 67 66 Banten - - - 59 57 Note: In the 1991, 1994, and 1997 IDHS, West Java includes Banten. In the 2002-2003 IDHS West Java exludes Banten. Table 6.3 Trends in use of specific contraceptive methods, Indonesia 1991-2007 Percentage of currently married women who are currently using a contraceptive method, by specific method, Indonesia 1991-2007 Method IDHS 1991 IDHS 1994 IDHS 1997 IDHS 2003 IDHS 2007 Any method 49.7 54.7 57.4 60.3 61.4 Pill 14.8 17.1 15.4 13.2 13.2 IUD 13.3 10.3 8.1 6.2 4.9 Injectables 11.7 15.2 21.1 27.8 31.8 Condom 0.8 0.9 0.7 0.9 1.3 Implants 3.1 4.9 6.0 4.3 2.8 Female sterilization 2.7 3.1 3.0 3.7 3.0 Male sterilization 0.6 0.7 0.4 0.4 0.2 Periodic abstinence 1.1 1.1 1.1 1.6 1.5 Withdrawal 0.7 0.8 0.8 1.5 2.1 Other 0.9 0.8 0.8 0.5 0.4 Number of women 21,109 26,186 26,886 27,857 30,931 Note: The 2002-2003 IDHS did not include Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua Provinces. Previous surveys (the 1991, 1994, and 1997 IDHS) included East Timor. In the 1991, 1994, and 1997 IDHS West Java includes Banten. In the 2002- 2003 IDHS West Java exludes Banten. The 2007 IDHS covers all 33 provinces. 78 | Current Use of Family Planning 6.4 CONTRACEPTIVE USE BY WOMEN’S STATUS A woman’s desire and ability to manage her fertility and her choice of contraceptive methods are in part affected by her status, self-image, and sense of empowerment. A woman who feels that she does not have much control over basic aspects of her life may be less likely to feel that she can make and carry out decisions about her fertility. She may also feel the need to choose methods that are less obvious or that do not depend on her husband’s cooperation. Table 6.5 shows the percent distribution of currently married women by contraceptive method currently used, according to three indicators of women’s status. Use of any method of contraception and use of any modern method increase substantially with increasing number of decisions in which a woman has a final say. For example, 48 percent of women who have no say in any of the five specified decisions are using a contraceptive method, compared with 62 percent of women who themselves or jointly have a final say in all five decisions. Use of contraception among currently married women also increases with increasing number of reasons that justify refusing sexual relations with their husband. Fifty-two percent of women who reported that there is no justifiable reason to refuse sex with their husband reported using a contraceptive method, compared with 62 percent of those who reported more than two reasons that justify refusing sex with their husband. Contraceptive use is inversely related to the number of reasons that justify wife beating. For example, 61 percent of women who believe that a man is not justified in beating his wife for any reason are using a contraceptive method, compared with 54 percent of women who believe that wife beating is justified for all five specified reasons. 59 58 62 73 6163 59 65 76 67 5960 61 64 67 57 57 DKI Jakarta West Java Central Java DI Yogyakarta East Java Banten 0 20 40 60 80 100 Percent IDHS 1997 IDHS 2002-03 IDHS 2007 Figure 6.3 Trends in Use of Contraceptive Methods by Province in Java, 1997-2007 1 In the 1997 IDHS, West Java includes Banten. Since 2002-2003 West Java exludes Banten. 1 Current Use of Family Planning | 79 Table 6.5 Current use of contraception by woman's status Percent distribution of currently married women by contraceptive method currently used, according to selected indicators of women's status, Indonesia 2007 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom LAM Any tradi- tional method Periodic absti- nence With- drawal Folk method Not currently using Total Number of women Number of decisions in which woman has final say 1 0 47.5 45.4 0.1 0.0 3.6 6.2 33.8 1.1 0.6 0.0 2.1 0.5 1.5 0.1 52.5 100.0 287 1-2 57.3 54.5 2.7 0.1 13.0 4.1 31.8 1.9 0.8 0.1 2.8 0.8 1.7 0.3 42.7 100.0 1,903 3-4 60.5 56.7 2.6 0.3 13.5 4.3 32.2 2.7 1.0 0.0 3.9 1.5 1.7 0.7 39.5 100.0 8,446 5 62.3 58.1 3.3 0.2 13.3 5.2 31.7 2.9 1.5 0.0 4.2 1.6 2.3 0.3 37.7 100.0 20,295 Number of reasons given for refusing to have sexual intercourse with husband 0 51.5 48.0 4.1 0.1 9.9 3.4 26.6 3.4 0.3 0.0 3.5 1.6 0.9 1.0 48.5 100.0 1,635 1-2 58.6 54.7 2.6 0.5 11.9 3.6 32.2 3.1 0.6 0.0 3.9 1.0 2.4 0.5 41.4 100.0 3,704 3-4 62.4 58.4 3.0 0.2 13.7 5.2 32.1 2.7 1.5 0.0 4.0 1.6 2.1 0.4 37.6 100.0 25,592 Number of reasons for which wife beating is justified 0 61.2 57.2 3.3 0.2 12.9 5.5 31.0 2.7 1.5 0.0 4.0 1.6 2.1 0.3 38.8 100.0 21,279 1-2 63.8 59.6 2.6 0.2 14.8 3.5 34.6 2.9 1.0 0.0 4.2 1.4 2.1 0.7 36.2 100.0 7,100 3-4 56.5 53.2 2.0 0.0 12.1 3.3 32.3 2.8 0.6 0.1 3.3 0.9 2.0 0.4 43.5 100.0 2,028 5 54.4 50.5 3.8 0.8 10.2 4.8 25.7 4.3 1.0 0.0 3.8 0.8 2.7 0.4 45.6 100.0 524 Total 61.4 57.4 3.0 0.2 13.2 4.9 31.8 2.8 1.3 0.0 4.0 1.5 2.1 0.4 38.6 100.0 30,931 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 1 Either by herself or jointly with others 6.5 QUALITY OF USE 6.5.1 Pill Use Compliance Since the pill is one of the most popular modern methods used in Indonesia, it is important for program planners and managers to find out whether it is used properly. The 2007 IDHS included a series of questions asked of pill users on the type of pill used, the availability of pills (pill packet) in the household at the time of the survey, and the last time a pill was taken. This information is presented in Table 6.6. The findings indicate that the majority (63 percent) of pill users take the combined oral contraceptive (combined pill) and 12 percent use the progestin-only oral contraceptive (single pill). Overall, 92 percent of pills users were able to show the pill package to the interviewer. About eight in ten pill users took their pills in order and had taken a pill less than two days before the interview. Table 6.6 also shows that urban women are more likely than rural women to use the combined pill (67 and 60 percent, respectively). No differences were seen between urban and rural women in pill compliance—at least 81 percent took the pills in order and the last pill was taken less than two days preceding the survey. There is no clear pattern in pill compliance by age group or level of education. Women in the lowest wealth quintile have a lower level of pill compliance than women in the higher wealth quintiles. Appendix Table A-6.2 shows the variation in pill compliance across provinces. 80 | Current Use of Family Planning Table 6.6 Pill use compliance Percentage of currently married women using the pill, percent distribution of pill users by type of pill, and by whether pill users could show a pill packet, and percent pill users who took a pill less than two days ago, according to background characteristics, Indonesia 2007 Percentage of pill users who: Pill packet seen by type of pill Background characteristic Percent using Currently married women Combi- nation Single Other Packet not seen/ missing Took pill in order Took pill <2 days ago Number of pill users Age 15-19 10.0 814 45.4 15.0 32.7 6.9 89.0 90.3 81 20-24 12.0 3,952 66.8 8.1 17.2 7.9 86.5 84.3 476 25-29 14.1 5,585 66.1 12.0 15.9 6.1 82.8 85.3 787 30-34 14.9 5,765 63.2 12.3 15.5 9.0 84.0 81.2 859 35-39 16.3 5,704 63.5 10.2 17.4 8.9 81.9 85.0 930 40-44 12.9 4,899 58.5 17.0 15.0 9.6 84.0 81.2 630 45-49 7.9 4,211 65.5 10.3 14.9 9.3 83.9 74.3 333 Residence Urban 13.9 12,842 67.3 9.9 14.6 8.2 83.3 80.6 1,786 Rural 12.8 18,089 60.3 13.4 17.8 8.5 83.9 84.5 2,310 Education No education 7.1 2,004 69.7 5.1 18.3 6.8 84.6 84.5 143 Some primary 11.7 5,112 57.8 16.2 17.3 8.7 82.9 85.1 598 Completed primary 14.7 9,511 61.3 11.2 18.8 8.6 84.6 82.5 1,394 Some secondary 13.9 6,494 65.5 10.3 15.5 8.7 83.6 82.9 901 Secondary + 13.6 7,810 66.4 12.5 13.3 7.8 82.9 81.8 1,059 Wealth quintile Lowest 12.5 5,773 56.0 14.0 20.6 9.4 79.6 81.7 724 Second 14.1 6,233 65.8 10.9 16.0 7.3 86.1 83.9 880 Middle 12.9 6,342 62.7 13.0 16.6 7.6 83.3 83.2 820 Fourth 14.0 6,358 61.9 12.9 16.9 8.3 85.9 83.1 890 Highest 12.5 6,225 69.7 8.6 12.2 9.5 82.6 82.0 781 Total 13.2 30,931 63.4 11.9 16.4 8.4 83.7 82.8 4,096 6.5.2 Quality of Use of Injectables In the 2007 IDHS, women who use injectables were asked whether they use one-month or three- month injectables. Based on their responses, users were further asked how many weeks ago they had received their last injection. The purpose of the questions was to examine the quality of use of this method of contraception. Table 6.7 shows that 81 percent of users of one-month injectables received an injection in the past four weeks and 96 percent of users of three-month injectables had an injection in the past three months. These findings suggest that users of three-month injectables are more compliant than users of one-month injectables. Compliance in the use of one-month injectables and three-month injectables does not vary by urban-rural residence or level of education. On the other hand, older women are more compliant in the use of injectables than younger women. Overall, there is little variation in compliance between users of the three-month and one-month injectables. Appendix Table A-6.3 shows the variation in quality of use of injectables across provinces. Current Use of Family Planning | 81 Table 6.7 Use of injectables Percentage of users of one-month injectables who had an injection in the past four weeks and percentage of users of three-month injectables who had an injection in the past three months, according to background characteristics, Indonesia 2007 Users of one-month injections Users of three-month injections Background characteristic Percent who had an injection in the past 4 weeks Number of users Percent who had an injection in the past 3 months Number of users Age 15-19 * 18 98.4 265 20-24 87.8 150 96.8 1,599 25-29 81.0 226 96.7 2,032 30-34 84.8 202 96.1 2,086 35-39 69.9 139 96.0 1,627 40-44 72.9 83 93.8 993 45-49 * 35 95.4 469 Residence Urban 79.9 542 96.4 3,090 Rural 81.4 311 96.0 5,982 Education No education * 7 94.9 428 Some primary (68.5) 33 97.6 1,397 Completed primary 80.3 163 96.1 3,378 Some secondary 84.5 208 95.8 2,260 Secondary + 80.0 442 95.7 1,609 Wealth quintile Lowest (82.4) 29 96.3 1,740 Second 78.6 77 95.9 2,164 Middle 86.7 99 96.9 2,161 Fourth 80.5 253 95.5 1,825 Highest 79.1 396 95.6 1,182 Total 80.5 853 96.1 9,072 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 6.6 INFORMED CHOICE Informed choice is an important tool for monitoring the quality of family planning services. All providers of sterilization must inform potential users that they will not be able to have any (more) children after their operation and potential users of this method must be informed of other contraceptive methods that could be used. Family planning providers should also inform all method users of the potential side effects of each method and what they should do if they experience side effects. This information assists users in coping with side effects and decreases unnecessary discontinuation of temporary methods. Users of temporary methods should also be informed of the choices they have with respect to other methods. Table 6.8 shows for users of modern contraceptive methods who adopted their current method in the past five years, the percentage who were informed about the potential side effects of their current method and what to do if they experienced any of these side effects, by specific method, initial source of method, and background characteristics. The data show that about one in three (35 percent) current users were informed about the possible side effects or problems with their current method, and one in three current users were informed what to do if they experienced side effects. Forty-three percent of current users were informed of other methods that could be used. A large majority of women (84 percent) who were sterilized were informed that they would not have any (more) children if they underwent the operation (data not shown). 82 | Current Use of Family Planning Table 6.8 Informed choice Among current users of specific modern contraceptive methods who adopted the method in the five years preceding the survey, percentage who were informed about the side effects of the current method used, percentage who were informed what to do if side effects were experienced, percentage who were informed of other methods that could be used for contraception, by background characteristics, Indonesia 2007 Type of information Method/initial source and background characteristics Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if side effects experienced1 Percentage who were informed by a health or family planning worker of other methods that could be used2 Number of women Method Female sterilization 43.8 38.2 35.7 293 Pill 30.3 32.1 42.5 2,864 IUD 66.3 68.9 61.1 543 Injectables 34.7 36.4 42.5 7,248 Implants 34.6 38.3 35.2 669 Initial source of method Public sector 35.5 38.8 40.6 2,470 Government hospital 44.5 39.7 34.8 248 Government health center 34.7 38.6 41.1 2,043 Government clinic (41.6) (46.8) (41.6) 44 Family planning fieldworker 32.4 44.9 47.3 71 Family planning mobile unit 25.5 28.3 41.7 65 Private medical sector 36.7 37.9 44.5 8,185 Private hospital 39.5 39.7 44.8 236 Private clinic 50.2 50.5 53.4 172 Private doctor 50.4 56.7 53.0 351 Private midwife 39.1 40.6 46.0 3,967 Private village midwife 34.3 33.9 43.0 2,693 Pharmacy/drugstore 21.5 24.9 36.3 725 Other private medical * * * 40 Other source 22.0 22.7 32.8 790 Delivery post 32.1 31.1 40.9 199 Health post 24.9 26.9 30.6 237 Family planning post 22.8 17.8 28.6 75 Friends/relatives 27.2 19.8 32.0 57 Shop 8.3 13.1 29.3 222 Other 29.9 34.3 34.4 173 Residence Urban 40.8 42.1 49.2 4,748 Rural 31.6 33.5 38.3 6,870 Education No education 24.1 23.0 26.1 310 Some primary 26.0 25.9 30.1 1,423 Completed primary 27.3 30.0 34.8 3,658 Some secondary 37.3 38.6 47.0 3,053 Secondary + 48.0 50.0 55.2 3,175 Wealth quintile Lowest 25.3 26.1 33.2 2,112 Second 28.3 31.0 37.3 2,486 Middle 34.6 36.8 42.1 2,432 Fourth 39.7 41.4 46.0 2,407 Highest 49.1 49.9 55.3 2,181 Total 35.3 37.0 42.8 11,618 Note: Table excludes users who obtained their method from friends/relatives. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Among users of female sterilization, pill, IUD, injectables, and implants 2 Among users of female sterilization, pill, IUD, injectables, implants, diaphragm, and lactational amenorrhea method (LAM) Current Use of Family Planning | 83 Among current users of various methods, pill users are the least likely to be informed about possible side effects and what to do if problems occur while they are using the pill. There are small differences in the provision of information about the side effects of methods and the action to be taken in the event that side effects occur across the three main sectors providing contraceptive methods. However, the private sector (medical or otherwise) is more likely than the public sector to inform women of other methods they can use. There are differences by urban-rural residence in the level of informed choice among current users of modern contraceptive methods; urban women are better informed than rural women. Current users of modern methods who have a higher level of education are more likely than those who have a lower level of education to be informed about side effects or problems with their method, what to do in case problems occur, and other methods they can use. A similar pattern is seen by wealth quintile. For example, 25 percent of women in the poorest quintile are informed about side effects or problems with their method, compared with 49 percent of women in the richest quintile. Variations across provinces in the provision of information to potential contraceptive users are presented in Appendix Table A-6.4. 6.7 PROBLEMS WITH CURRENT METHOD In the 2007 IDHS, all contraceptive users were asked whether they had experienced any health problems with the method they were using. Table 6.9 shows that the vast majority of users (78 percent or higher) of the most commonly-used modern methods (pill, IUD, injectables, and implants) do not have any health problems as a result of using their method. The most common problem reported by pill users is headache (6 percent). Six percent of users of injectables cited the absence of menstruation as a problem in using the method. Table 6.9 Problems with current method of contraception Percent distribution of current users of selected methods by the main health problem with the method, according to method characteristics, Indonesia 2007 Main problem with current method Pill IUD Injectables Implants None 85.9 95.2 78.1 86.5 Weight gain 1.6 0.3 2.6 1.1 Weight loss 0.5 0.1 0.9 0.1 Bleeding 0.5 0.5 0.8 0.4 Hypertension 0.2 0.0 0.3 0.3 Headache 5.8 0.7 6.1 2.9 Nausea 2.7 0.2 0.4 0.1 No menstruation 0.2 0.1 6.2 2.1 Weak/tired 0.3 0.7 0.7 0.7 Other/don't know 2.1 2.0 3.8 5.9 Missing 0.1 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 Number of women 4,100 1,537 9,860 863 6.8 COST AND ACCESSIBILITY OF METHODS The national family planning program in Indonesia is implemented by the government with the active involvement and participation of the community and private sectors. One indicator of the extent and desire of women to use contraception is self-reliance, measured here by the proportion of users who pay for the contraceptive methods and services received. In the 2007 IDHS, current users were asked 84 | Current Use of Family Planning where they obtained their current contraceptive method the last time, and how much they paid for the method and for the services. The results are presented in Table 6.10. Table 6.10 shows that 22 percent of all current users obtained their method from a government service delivery point, and most of them (17 percent) paid for the method and services. Sixty-nine percent of users obtained their current method from a private facility, and most of them (67 percent) paid for it. One in ten current users obtained their method from sources other than the government or the private sector, such as a village birth delivery post (polindes), integrated health post (posyandu), family planning post, village contraceptive distribution center, friends, or a shop. Almost all of these users paid for the methods and services. Overall, 91 percent of current users pay for their contraceptive method. Injectables users and pill users are more likely to pay for their contraceptive method (97 and 96 percent, respectively) than users of other methods. Self-reliance is much lower for IUD users, with only 69 percent of IUD users paying for their method. Table 6.10 Payment for contraceptive method and services Percent distribution of current users of modern contraceptive methods by source of method and whether method is free or respondent pays for it, according to method, Indonesia 2007 Government Private Other Method Free Pay Free Pay Free Pay Total Number of women Female sterilization 23.4 44.7 5.7 26.0 0.1 0.2 100.0 978 Male sterilization (42.8) (22.1) (6.5) (13.1) (15.4) (0.0) 100.0 66 Pill 1.8 11.6 1.0 61.9 0.9 22.9 100.0 4,094 IUD 21.7 20.9 7.9 47.5 1.3 0.7 100.0 1,531 Injectables 1.4 14.6 1.2 78.7 0.4 3.7 100.0 9,853 Implants 18.9 31.5 4.4 37.1 5.1 3.1 100.0 859 Condom 3.6 3.6 2.0 78.0 2.8 9.9 100.0 406 Total 5.5 16.7 2.2 66.9 0.9 7.8 100.0 17,788 Note: Excludes cases where cost of method was “don't know” or missing (3 and 39 weighted cases). Figures in parentheses are based on 25-49 unweighted cases. Self-reliance in contraceptive use in the 2007 IDHS is three percentage points higher than in the 2002-2003 IDHS (91 and 88 percent, respectively). The proportion of current users who received their method from a government source decreased between the two surveys, from 28 percent in the 2002-2003 IDHS to the current level of 22 percent. Appendix Table A-6.5 shows that the level of self-reliance varies markedly by source of contraceptive method and province. Table 6.11 shows the percentage of current users who received their method free, and for those who paid for their method, the mean cost (in rupiah), by source of method. Overall, the 2007 IDHS shows that women who rely on government sources are much more likely to get free services (25 percent) than those who use private sources (3 percent) or other sources (11 percent). The cost of methods in a government facility is less than in a private facility. For example, injectables cost Rp.15.000 in a private facility, compared with Rp.14.000 in a government facility. An IUD costs Rp.146.000 in the private sector, compared with Rp.45.000 in the government sector. This pattern is slightly different from that observed in the 2002-2003 IDHS, however the average price of an IUD in the private sector has increased one and a half times. Current Use of Family Planning | 85 Table 6.11 Mean cost of contraceptive method and services Percentage of current users of modern contraceptive methods who get their method free and the mean cost (in 1,000 rupiahs) of the method (including services) for those who pay for it, by the type of source and method, Indonesia 2007 Source of last method Government Private Other Method Free Mean cost (Rp. 000) Number of users Free Mean cost (Rp. 000) Number of users Free Mean cost (Rp. 000) Number of users Female sterilization 34.4 767 666 18.1 2,389 310 * * 3 Male sterilization (65.9) (563) 43 * * 13 * * 10 Pill 13.3 6 547 1.6 7 2,572 4.0 4 975 IUD 50.9 45 652 14.3 146 849 (66.9) (139) 30 Injectables 9.0 14 1,579 1.5 15 7,869 9.1 13 405 Implants 37.5 52 433 10.5 130 356 62.1 98 70 Condom (50.2) (9) 29 2.5 12 325 (22.2) (9) 52 Total 24.8 133 3,949 3.1 75 12,294 10.5 13 1,545 Note: Excludes cases where cost of method was “don't know” or missing (3 and 39 weighted cases). Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. The difference in the mean cost of contraceptive methods varies substantially by type of method and source of services. Female sterilization is the most expensive method, while the pill is the cheapest. The cost of female sterilization and IUD insertion in the private sector is more than three times that in the government sector. Similarly, the cost of implants at a private source is almost three times that at a government source (Rp.130.000 compared with Rp. 52.000). 6.9 SOURCE OF METHODS Information about sources of contraceptive methods is important for family planning program administrators because the family planning movement is currently directed toward self-sustainability and greater use of the private sector. Table 6.12 shows the percent distribution of current users of modern contraceptive methods by the most recent source of method. The findings from the 2007 IDHS indicate that contraceptive users are much more likely to rely on private medical sources than government sources (69 and 22 percent, respectively). Eight percent of users obtained their method from other sources such as posyandu, polindes, family planning posts, and friends or relatives. Among private sources, nurse/ midwives or village midwives are the most commonly reported sources (48 percent), while among other sources, health posts and shops are the primary choices for obtaining family planning methods (2 and 3 percent, respectively). Figure 6.4 shows the distribution of current users of modern methods by source of supply. Use of government sources decreased from 28 to 22 percent between the 2002-2003 IDHS and the 2007 IDHS. During the same period, use of private medical sources increased from 63 to 69 percent, while use of other sources remained at 8 percent. The substantial increase in the use of private sources is mainly due to the increased use of private midwives (3 percentage points), pharmacy/drugstores (3 percentage points), and other private medical sources (6 percentage points). Figure 6.5 shows that most women who obtain their family planning method from a government sector do so at a health center (16 percent). 86 | Current Use of Family Planning Table 6.12 Source of modern contraception methods Percent distribution of current users of modern contraceptive methods by most recent source of method, according to specific method, Indonesia 2007 Source Female sterilization Pill IUD Injectables Implants Male condom Total1 Public sector 68.1 13.4 42.5 16.0 50.5 7.2 22.2 Government hospital 64.3 0.2 7.0 0.5 3.7 0.6 4.9 Government health center 2.3 11.3 33.6 14.8 44.0 4.0 16.0 Government clinic 1.0 0.3 1.2 0.1 0.2 0.2 0.3 Family planning fieldworker 0.0 1.4 0.5 0.1 1.1 1.1 0.5 Family planning mobile unit 0.0 0.1 0.1 0.4 1.0 0.0 0.3 Other 0.6 0.1 0.2 0.0 0.5 1.3 0.1 Private medical sector 31.6 62.8 55.3 79.8 41.3 79.9 69.1 Private hospital 23.4 0.2 5.9 0.4 1.3 0.1 2.2 Private clinic 0.9 1.1 2.3 1.5 0.4 0.5 1.3 Private doctor 0.6 1.0 1.5 2.2 1.0 0.3 1.7 Private midwife 0.0 14.6 24.2 40.2 20.5 5.0 28.8 Private village midwife 0.0 12.2 5.6 28.2 14.7 1.5 19.6 Pharmacy / drugstore 0.0 30.4 0.1 0.1 0.0 71.4 8.7 Other private medical 6.8 3.4 15.8 7.3 3.5 1.2 6.8 Other source 0.0 21.4 1.4 3.8 4.1 10.2 7.6 Delivery post 0.0 1.1 0.5 2.1 0.8 0.2 1.5 Health post 0.0 4.9 0.7 1.3 2.6 0.4 2.1 Family planning post 0.0 2.5 0.2 0.1 0.5 0.0 0.6 Friends/relatives 0.0 1.5 0.0 0.2 0.2 0.9 0.5 Shop 0.0 11.4 0.0 0.0 0.0 8.7 2.8 Other 0.1 2.4 0.5 0.3 3.9 1.1 1.0 Don't know 0.2 0.0 0.0 0.0 0.0 0.0 0.0 Missing 0.0 0.1 0.2 0.1 0.1 1.5 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 981 4,100 1,537 9,860 863 407 17,815 1 Total includes other modern methods but excludes lactational amenorrhea method (LAM). 28 63 9 22 69 9 Government Private Other 0 10 20 30 40 50 60 70 80 Percent IDHS 2002-03 IDHS 2007 Figure 6.4 Trends in Source of Supply of Modern Contraceptive Methods, Indonesia 2002-03 and 2007 Current Use of Family Planning | 87 Sources of family planning methods vary by method. Two in three sterilized women had their operation in a government hospital and one-third in a private medical facility. Forty-four percent of all implants and 34 percent of all IUD insertions took place in a government health center. Sixty-three percent of pill users obtained their pills from the private medical sector, specifically 30 percent from pharmacies or drugstores, 15 percent from midwives or nurses, and 12 percent from village midwives. 6.10 TIMING OF STERILIZATION Given the importance of female sterilization as a way of preventing pregnancies among women in high-risk groups, the family planning movement supports the dissemination of information about this method. The program also provides services in accordance with a woman’s age and health status. Trends in the use of sterilization as a family planning method are of interest, especially the age of women at the time of the operation. When using these data, however, the problem of censoring must be taken into account. Because the survey includes only ever-married women age 15-49, sterilized women age 50 and over are not covered. Figure 6.5 Distribution of Current Users of Modern Contraceptive Methods by Source of Supply Private pharmacy/ drug store 9% Other private 7% Nurse/midwife 29% Village midwife 19% Other source 8% Government hospital 5% Government health center 16% Private hospital/ clinic 4% Private doctor 2% Other government 1% IDHS 2007 88 | Current Use of Family Planning Table 6.13 shows the percent distribution of sterilized women by age at the time of sterilization according to the number of years since the operation. As expected, the vast majority (73 percent) of women were sterilized at age 30 or over. The median age at the time of sterilization is 32.8 years, which is 0.9 years later than the median reported in the 2002-2003 IDHS (31.9 years). Table 6.13 Timing of sterilization Percent distribution of sterilized women by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Indonesia 2007 Age at time of sterilization Years since operation <25 25-29 30-34 35-39 40-44 45-49 Total Number of women Median age1 <2 0.0 4.6 38.9 48.3 8.2 0.0 100.0 142 35.3 2-3 0.6 11.1 32.4 47.0 4.6 4.4 100.0 86 35.1 4-5 0.0 8.3 31.4 47.6 12.6 0.0 100.0 132 35.6 6-7 5.0 15.2 23.8 46.2 9.8 0.0 100.0 121 35.1 8-9 0.8 16.8 37.7 38.3 6.4 0.0 100.0 88 33.9 10+ 13.6 34.5 37.9 14.0 0.0 0.0 100.0 412 a Total 6.5 20.6 34.9 32.5 5.1 0.4 100.0 981 32.8 a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring Fertility Preferences | 89 FERTILITY PREFERENCES 7 This chapter addresses issues of fertility preferences including the extent of unwanted fertility in Indonesia, the degree of acceptance of the two-child family norm, and the level of need for contraceptive services. Respondents in the 2007 Indonesia Demographic and Health Survey (IDHS) were asked questions concerning the following: whether they wanted more children; if so, how long they would prefer to wait before the next child; and if they could start afresh, how many children in all they would want. In addition, the survey included two important questions relating to the status of women and conformity of husbands’ and wives’ opinions on the ideal number of children. The concept of the small family (“Two Children is Better”) promotes regulation of birth intervals through the use of contraceptive methods and has long been an objective of the Indonesian Family Planning Program. A new vision of the family planning program—“All Families Participate in Family Planning”—was launched in 2007 with a mission to create small, happy, and wealthy families. Interpretation of data on fertility preferences has always been the subject of controversy. Survey questions have been criticized on the grounds that 1) answers are misleading because they may reflect unformed, ephemeral views that are held with weak intensity and little conviction and 2) they do not take into account the effect of social pressures or the attitude of other family members, particularly the husband, who may exert a major influence on reproductive decisions. The first objection has greater force in societies where the idea of conscious reproductive choice may still be alien; preference data from these settings should be interpreted with caution. This objection may be irrelevant in Indonesia, where widespread public exposure to the family planning program has no doubt caused most people to establish opinions regarding fertility regulation. The second objection is correct in principle. In practice, however, its importance is doubtful; for instance, the evidence from surveys in which both husbands and wives are interviewed separately suggests that there is little difference in their views. The inclusion of women who are currently pregnant complicates the measurement of views on future childbearing. For these women, the question on desire for more children was rephrased to refer to their desire for another child after the one that they are expecting. To take into account the way in which the preference variable is defined for pregnant women, the results were classified by number of living children, including current pregnancy. In addition, the question on preferred waiting time before the next birth was rephrased for pregnant women to clarify that the information wanted was the preferred waiting time after the birth of the child currently expected. Data for women who have been sterilized require special analytic treatment. The general strategy in some tables in this chapter is to classify these married women and men as wanting no more additional children. 7.1 DESIRE FOR ADDITIONAL CHILDREN Table 7.1 shows the distribution of currently married women and men by desire for more children, according to the number of living children. Forty-one percent of married women said that they wanted to have additional children; 14 percent want a child within two years, 24 percent want a child after two years or more, and 3 percent were unsure about the timing of another birth. Fifty percent of married women said that they wanted no more children, while 3 percent had been sterilized. Four percent of women were not sure whether they wanted another child. 90 | Fertility Preferences Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women and currently married men by desire for children, according to number of living children, Indonesia 2007 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total WOMEN Have another soon2 83.2 20.4 7.7 3.5 2.4 1.3 0.8 13.8 Have another later3 6.3 54.8 21.0 9.6 6.0 3.6 1.9 24.1 Have another, undecided when 2.4 5.4 3.7 2.1 1.1 0.9 0.5 3.3 Undecided 1.1 3.2 5.0 4.5 3.7 3.4 5.0 4.0 Want no more 3.9 14.9 59.8 72.5 76.7 80.4 81.2 50.2 Sterilized4 0.1 0.3 2.0 6.4 7.8 8.8 6.1 3.3 Declared infecund 3.0 0.9 0.8 1.1 1.8 1.3 4.0 1.2 Missing 0.0 0.1 0.1 0.2 0.5 0.2 0.5 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,859 8,239 9,566 5,789 2,823 1,315 1,340 30,931 MEN5 Have another soon2 77.1 21.7 8.8 6.0 3.8 3.2 3.7 15.0 Have another later3 10.9 55.8 25.9 12.9 8.2 5.1 4.4 26.8 Have another, undecided when 4.8 7.4 6.8 4.6 4.2 2.5 2.9 5.8 Undecided 1.4 2.3 6.2 7.1 7.1 12.1 10.5 5.6 Want no more 2.9 11.0 49.0 64.3 68.2 69.7 65.8 42.5 Sterilized4 0.0 0.2 0.5 0.2 1.0 0.8 1.0 0.4 Declared infecund 2.5 1.3 2.6 4.7 7.3 6.6 11.4 3.7 Missing 0.3 0.1 0.1 0.1 0.2 0.1 0.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 550 2,296 2,670 1,610 842 409 381 8,758 na = Not applicable 1 The number of living children includes current pregnancy for women 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization 5 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one wife). The desire to stop childbearing increases substantially after a woman has had two or more children. More than six in ten of currently married women with two children want no more children or have been sterilized. Eight in ten women with three children either have been sterilized or want no more children, and nine in ten women with larger families want no more children. Findings from the 2002-2003 IDHS show the same patterns. The desire to have children is slightly higher among men than among women. Forty-eight percent of married men reported that they wanted to have more children; 15 percent want to have another child in two years; 27 percent want to have another child after two years, and 6 percent want to have another child but have not decided when. Forty-two percent of men do not want to have any more children; less than 1 percent are sterilized. Six percent of married men have not decided whether they want another child (Figure 7.1). Fertility Preferences | 91 Table 7.2.1 shows the percentage of currently married women who want no more children by number of living children and background characteristics. Data for men are shown in Table 7.2.2. Looking at differentials by background characteristics, Table 7.2.1 shows that, in general, urban women are slightly more likely to want to stop childbearing than rural women. The same differentials were seen in the 2002-2003 IDHS. In general, the desire to stop childbearing declines with increasing education and wealth quintile. However, at parities three and above, the woman’s education and wealth quintile no longer have a bearing on her desire to stop childbearing. Table 7.2.1 Desire to limit childbearing: Women Percentage of currently married women who want no more children, by number of living children, according to background characteristics, Indonesia 2007 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 3.9 13.1 65.7 83.3 89.5 94.9 91.8 55.5 Rural 4.0 16.7 58.9 75.6 81.4 86.0 84.8 52.0 Education No education 0.7 45.9 76.8 80.2 77.1 91.1 86.5 72.0 Some primary 6.3 30.4 62.7 74.5 83.3 89.3 85.8 64.6 Complete primary 4.9 15.5 61.1 79.8 83.7 87.7 87.2 54.4 Some secondary 3.9 10.4 57.7 77.4 86.5 90.4 90.9 45.5 Secondary + 2.9 10.4 62.8 82.0 90.9 88.9 94.0 46.9 Wealth quintile Lowest 3.5 15.5 47.4 64.7 75.9 81.6 84.0 48.2 Second 1.8 17.2 60.8 78.4 83.8 88.3 87.4 53.0 Middle 5.4 14.6 64.3 81.3 85.1 93.5 86.9 54.4 Fourth 5.0 13.9 64.1 81.5 85.6 95.8 92.3 53.6 Highest 3.8 14.9 67.7 86.2 95.1 93.6 94.4 57.7 Total 4.0 15.2 61.8 78.9 84.6 89.3 87.3 53.5 Note: Women who have been sterilized are considered to want no more children. 1 The number of living children includes the current pregnancy. Figure 7.1 Fertility Preferences of Currently Married Women 15-49 Want no more children 50% Undecided 4% Have another child, undecided when 3% Have another child later 24% Have another child soon 14% Sterilized 3% Declared infecund 1% 92 | Fertility Preferences The desire to stop having children is slightly lower among men than among woman; 43 percent of men desire to limit childbearing compared with 54 percent of women. As with women, men in urban areas and those with higher education are more likely than other men to want to stop childbearing. Desire to stop childbearing is also correlated with household wealth quintile. The percentage of men who want to stop having children is 37 percent among men in the lowest wealth quintile and 46 percent among men in the highest wealth quintile. Appendix Table A-7.1.1 shows the differentials in the desire for no more children for women by province and Appendix Table A-7.1.2 shows the differentials in the desire for no more children for men by province. Table 7.2.2 Desire to limit childbearing: Men Percentage of currently married men age who want no more children, by number of living children, according to background characteristics, Indonesia 2007 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 3.3 8.9 49.5 69.8 80.7 78.1 74.6 44.9 Rural 2.7 12.9 49.6 60.1 61.7 65.8 62.7 41.5 Education No education 17.7 17.9 48.3 73.3 68.6 86.4 68.7 58.8 Some primary 6.0 28.0 59.9 63.1 63.9 63.0 68.5 54.2 Complete primary 0.9 13.3 52.8 63.5 67.0 64.2 72.0 43.0 Some secondary 3.6 6.7 41.8 67.5 75.4 76.4 56.8 37.9 Secondary + 0.8 6.0 46.2 62.9 74.2 75.0 57.5 37.4 Wealth quintile Lowest 5.7 10.4 38.6 52.0 53.9 65.0 59.5 36.8 Second 3.1 13.2 53.5 62.5 63.9 62.4 66.6 44.2 Middle 0.6 13.6 51.3 65.3 73.4 73.7 72.1 44.6 Fourth 3.2 8.7 52.2 68.0 80.8 73.4 66.1 42.8 Highest 1.3 10.0 49.5 72.2 76.4 85.0 88.0 45.8 Total 2.9 11.2 49.6 64.5 69.2 70.4 66.8 42.9 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. 1 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one wife). 7.2 NEED FOR FAMILY PLANNING SERVICES Unmet need is defined here as the percentage 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. Women with an unmet need for “spacing” include pregnant women whose pregnancy was mistimed; amenorrheic women whose last birth was mistimed; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for “limiting” refers to pregnant women whose pregnancy was unwanted; amenorrheic women whose last child was unwanted; and women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want no more children. Measures of unmet need for family planning are used to evaluate the extent to which programs are meeting the demand for services. Women who have been sterilized are considered to want no more children. According to these criteria, the total unmet need for family planning services in Indonesia is 9 percent, of which 4 percent is for spacing and 5 percent is for limiting (Table 7.3). The level of unmet need has remained at about the same level since 1997. Fertility Preferences | 93 Demand for family planning is defined as the sum of contraceptive prevalence (including currently pregnant or amenorrheic women whose pregnancy or last birth was the result of a contraceptive failure) and unmet need (BPS and ORC Macro, 2003). Overall, the total demand for family planning is 71 percent, of which 87 percent has been satisfied. If all of this need were satisfied, a contraceptive prevalence rate of about 71 percent could, theoretically, be expected. The percentage of demand satisfied is similar to that in the 2002-2003 IDHS (88 percent). Table 7.3 Need and demand for family planning among currently married women Percentage of currently married women with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage for the demand for contraception that is satisfied, by background characteristics, Indonesia 2007 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 7.3 2.5 9.8 41.8 5.1 46.8 49.1 7.6 56.6 82.7 814 20-24 7.9 1.9 9.8 51.3 10.2 61.5 59.4 12.1 71.5 86.3 3,952 25-29 7.7 1.9 9.6 44.5 19.5 64.1 52.5 21.5 74.0 87.1 5,585 30-34 5.3 3.9 9.2 31.5 37.6 69.1 36.9 41.6 78.5 88.3 5,765 35-39 2.7 6.8 9.5 14.6 54.0 68.6 17.4 61.0 78.4 87.9 5,704 40-44 1.0 8.6 9.6 4.1 55.5 59.6 5.1 64.1 69.2 86.1 4,899 45-49 0.5 5.5 6.0 1.4 40.7 42.1 1.9 46.3 48.2 87.5 4,211 Residence Urban 4.0 4.7 8.8 23.7 38.8 62.5 27.9 43.6 71.5 87.7 12,842 Rural 4.5 4.7 9.2 26.1 34.5 60.6 30.7 39.3 70.0 86.8 18,089 Education No education 3.0 7.7 10.6 8.7 33.6 42.3 11.7 41.3 53.0 79.9 2,004 Some primary 3.2 6.2 9.4 16.5 37.6 54.0 19.8 43.8 63.6 85.2 5,112 Complete primary 4.1 4.9 9.0 25.6 38.4 64.0 29.8 43.4 73.2 87.7 9,511 Some secondary 5.2 4.0 9.2 32.2 33.3 65.5 37.6 37.4 74.9 87.8 6,494 Secondary + 4.9 3.4 8.4 28.4 36.0 64.4 33.5 39.5 72.9 88.5 7,810 Wealth quintile Lowest 6.5 6.2 12.7 25.7 27.3 53.0 32.4 33.6 66.0 80.7 5,773 Second 4.3 4.3 8.5 27.4 35.9 63.3 31.8 40.4 72.2 88.2 6,233 Middle 4.1 4.7 8.9 25.0 37.5 62.4 29.2 42.3 71.6 87.6 6,342 Fourth 3.3 3.9 7.3 25.6 38.2 63.8 29.0 42.2 71.2 89.8 6,358 Highest 3.6 4.6 8.2 21.9 41.7 63.5 25.5 46.3 71.8 88.6 6,225 Total 4.3 4.7 9.1 25.1 36.3 61.4 29.5 41.1 70.6 87.2 30,931 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed; amenorrheic women who are not using family planning and whose last birth was mistimed, or whose last birth was unwanted but now say they want more children; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and say they want to wait 2 or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted; amenorrheic women who are not using family planning, whose last child was unwanted and who do not want any more children; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want no more children 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here Unmet need for family planning services varies by age. Younger women are more likely to express a need for spacing birth, while older women more often want to limit births. There are no notable differences in the need for family planning between urban and rural women. Unmet need generally declines with increasing education; the more educated the women, the lower the percentage with unmet need. Unmet need for family planning tends to decrease with increasing wealth quintile; from 13 percent for women in the lowest quintile to 8 percent for women in the highest quintile. 94 | Fertility Preferences The age pattern of total demand for family planning takes the shape of an inverted U; it is low among women age 15-19 (57 percent) and women age 45-49 (48 percent), and peaks among women age 30-34 (79 percent). There are small differences in total demand for family planning between urban and rural women. The percentage of demand for family planning that is satisfied is positively related to level of education, ranging from 80 percent for women no education and 85 percent for women with some primary education, to 88 percent for women with some secondary education and higher. Appendix Table A-7.2 shows the total unmet need for family planning by province. 7.3 IDEAL FAMILY SIZE In the 2007 IDHS, each respondent was asked to perform the difficult task of considering, abstractly and independently of her actual family size, the number of children she would choose if she could start again. Since most ever-married women in the sample are currently married, the ideal number of children for both groups is the same. Table 7.4 Ideal number of children Percent distribution of women and men by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to number of living children, Indonesia 2007 Number of living children1 Ideal number of children 0 1 2 3 4 5 6+ Total EVER-MARRIED WOMEN 0 0.2 0.0 0.0 0.2 0.0 0.0 0.1 0.1 1 5.1 4.3 1.9 0.6 0.7 0.5 0.3 2.2 2 57.2 61.0 57.0 30.9 23.7 17.7 9.7 46.5 3 17.0 17.2 17.8 32.8 11.1 15.0 11.0 19.4 4 6.6 8.0 11.0 16.1 34.9 18.9 20.8 13.8 5 2.3 1.9 2.9 4.0 6.0 16.4 6.3 3.8 6+ 1.2 1.2 1.1 2.1 5.5 9.2 19.6 2.8 Non-numeric responses 10.3 6.5 8.2 13.4 18.2 22.3 32.2 11.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,057 8,817 10,087 6,101 3,024 1,405 1,404 32,895 Mean ideal number of children for:2 Ever-married 2.4 2.4 2.6 3.0 3.5 3.9 4.5 2.8 Number 1,844 8,246 9,260 5,283 2,474 1,093 951 29,152 Currently married women 2.5 2.4 2.6 3.0 3.5 3.9 4.5 2.8 Number 1,685 7,762 8,808 5,043 2,347 1,026 907 27,578 CURRENTLY MARRIED MEN3 0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 1 2.5 3.5 0.7 1.0 0.2 0.1 0.4 1.5 2 52.7 57.1 50.5 25.4 17.8 7.8 11.8 40.9 3 22.2 21.3 24.3 34.3 19.0 18.8 14.3 24.0 4 10.2 7.6 11.4 16.8 30.3 18.9 18.3 13.8 5 4.0 2.2 2.9 5.9 7.4 20.6 5.4 4.7 6+ 1.5 2.0 1.9 5.1 8.5 13.9 33.2 5.1 Non-numeric responses 6.8 6.4 8.4 11.5 16.9 19.8 16.5 10.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 550 2,296 2,670 1,610 842 409 381 8,758 Mean ideal number of children for:2 Currently married men 2.6 2.5 2.7 3.2 3.7 4.3 4.9 3.0 Number 512 2,150 2,446 1,425 701 328 318 7,880 1 The number of living children includes current pregnancy for women. 2 Means are calculated excluding respondents who gave non-numeric responses. 3 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences | 95 There is a correlation between actual and ideal family size; women who have a small number of children are more likely to want a small number of children. As parity increases, the ideal number of children also increases. Two reasons have been suggested for this divergence. First, to the extent that women want to achieve their fertility desires, those who want large families tend to have large families. Second, women may rationalize their actual family size to be their ideal family size. As the actual number of children increases, the preferred family size increases. Further, women with large families, being on average older than women with small families, may have larger ideal family sizes because of attitudes they acquired 20 to 30 years ago. Despite the likelihood of some rationalization, respondents frequently state ideal family sizes that are lower than their actual number of living children. The difference can be taken as an indicator of surplus or unwanted fertility. For example, among women with five or more children, the ideal number of children they want to have is smaller than the actual number of children they have. Among women with six or more children, 48 percent reported an ideal family size smaller than their current number of children; a similar pattern is seen for men. More than half of women and men with no children said that their ideal number of children is two. Table 7.5 shows the mean ideal number of children for all ever-married women by age and selected background characteristics. The ideal number of children varies by age; older women tend to want larger families than younger women. Urban women want smaller families than rural women (2.7 compared with 2.9 children). More educated women tend to want smaller families than women with less education. For example, the mean ideal number of children for women with no education is 3.3 children, while for women with secondary or higher education, it is 2.6 children. Women’s ideal number of children decreases with increasing wealth status; the mean ideal number of children for women in the lowest quintile is 3.2 children compared with 2.6 children for women in the highest quintile. Appendix Table A-7.3 shows the variation in the ideal number of children by province. Table 7.5 Mean ideal number of children Mean ideal number of children for all ever-married women by age and background characteristics, Indonesia 2007 Age Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 2.5 2.4 2.5 2.6 2.7 2.8 2.9 2.7 Rural 2.5 2.6 2.8 2.9 2.9 3.0 3.2 2.9 Education No education * 3.2 3.1 3.5 3.3 3.4 3.3 3.3 Some primary 2.7 2.8 3.1 3.2 3.0 3.1 3.2 3.1 Complete primary 2.5 2.6 2.8 2.7 2.8 2.9 3.1 2.8 Some secondary 2.4 2.5 2.6 2.7 2.8 2.9 3.0 2.7 Secondary + 2.6 2.4 2.5 2.6 2.7 2.7 2.8 2.6 Wealth quintile Lowest 2.7 2.9 3.0 3.3 3.3 3.5 3.7 3.2 Second 2.4 2.4 2.7 2.8 2.8 3.0 3.2 2.8 Middle 2.2 2.5 2.7 2.7 2.7 3.0 3.0 2.7 Fourth 2.6 2.4 2.5 2.6 2.7 2.8 2.9 2.7 Highest 2.4 2.5 2.5 2.5 2.6 2.6 2.8 2.6 Total 2.5 2.5 2.7 2.8 2.8 2.9 3.1 2.8 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 96 | Fertility Preferences 7.4 UNPLANNED AND UNWANTED FERTILITY In the 2007 IDHS, women were asked a series of questions about each child born in the preceding five years and any current pregnancy, to determine whether the pregnancy was wanted then, wanted at a later time, or not wanted. These questions form a particularly powerful indicator of the degree to which couples successfully control childbearing. In addition, the data can be used to gauge the effect of the prevention of unwanted births on fertility. The IDHS questions on fertility planning are extremely demanding. The respondent is required to recall accurately her wishes at one or more points in time during the past five years and to report them honestly. The danger of rationalization is present; an unwanted conception may well have become a cherished child. Despite these potential problems of comprehension, recall, and truthfulness, results from previous surveys have proved surprisingly plausible. Respondents are willing to report unwanted conceptions, although some postpartum rationalization probably occurs. The result is probably an underestimate of unwanted fertility. Table 7.6 shows the percent distribution of births in the five years preceding the survey and current pregnancies by fertility planning status, according to birth order and mother’s age at birth. Eight in ten births were wanted at the time of conception, 12 percent were wanted but at a later time, and 7 percent were not wanted at all. These figures are similar to those reported in the 2002-2003 IDHS, with a slightly lower proportion of births wanted then and a slightly higher proportion of births wanted later. Birth order is strongly associated with the planning status of births. In the 2007 IDHS, the proportion of births wanted at the time of conception decreases as birth order increases, while the proportion of births that were not wanted increases. Almost all first births (93 percent) were wanted at the time of conception, while one in four births of order four or higher were not wanted. Table 7.6 Fertility planning status Percent distribution of births to women in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother's age at birth, Indonesia 2007 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 93.3 5.4 0.4 0.9 100.0 6,462 2 81.3 15.8 2.5 0.5 100.0 5,166 3 72.1 16.7 10.8 0.4 100.0 3,136 4+ 58.1 15.9 25.1 0.8 100.0 3,403 Mother's age at birth <20 89.3 8.6 0.9 1.2 100.0 1,831 20-24 85.9 11.5 1.8 0.8 100.0 5,014 25-29 81.8 14.2 3.7 0.4 100.0 4,847 30-34 75.8 14.1 9.3 0.8 100.0 3,888 35-39 66.1 10.8 22.5 0.6 100.0 1,954 40-44 53.0 6.8 39.8 0.5 100.0 557 45-49 33.1 15.5 49.5 1.9 100.0 76 Total 79.6 12.3 7.4 0.7 100.0 18,168 Fertility Preferences | 97 The planning status of births is associated with the age of the mother. In general, older mothers tend to have a smaller percentage of children who were wanted at conception. The percentage of unwanted births increases with mother’s age; it is less than 1 percent among women under age 20, compared with 40 percent among women age 40-44. The patterns seen for unwanted births by age and by birth order are similar to those reported in the 2002-2003 IDHS, except for the higher proportion of non-first births wanted later. Appendix Table A-7.4 shows the differentials in the fer- tility planning status by province. Table 7.7 shows wanted fertility rates for women; wanted fertility rates are calculated in the same way as conventional age- specific fertility rates, except that only births classified as “wanted” are included in the numerator. A birth is considered wanted if the number of living children at the time of conception was less than or equal to the current ideal number of children reported by the respondent. Wanted fertility rates express the level of fertility that would theoretically result if all unwanted births were prevented. Comparison of actual fertility rates and wanted fertility rates suggests the potential demographic impact of the elimination of unwanted births. The smaller the gap is between the actual fertility rate and the wanted fertility rate, the more successful the woman is in achieving her fertility desires. Overall, the total wanted fertility rate in Indonesia is lower than actual the total fertility rate. Thus, if unwanted births could be eliminated, total fertility in Indonesia would be 2.2 children per women, instead of 2.6. The total wanted fertility rate is similar to that reported in the 2002-2003 IDHS. Table 7.7 shows the differences between the wanted fertility rate and the actual fertility rate by background characteristics. There are small differences in the gap between wanted and actual fertility by urban-rural residence and by women’s education. The gap between wanted fertility and actual fertility decreases with increasing wealth status, ranging from a difference of 0.6 children for women in the poorest quintile to 0.2 among women in the wealthiest quintile. Appendix Table A-7.5 shows the wanted and actual fertility rates by province. 7.5 FERTILITY PREFERENCES BY WOMEN’S STATUS An increase in women’s status and empowerment is recognized as an important factor in reducing fertility; higher status is associated with smaller desired family size and the ability to meet family-size goals through the effective use of contraception. Table 7.8 shows the mean ideal number of children and the unmet need for spacing and limiting by three indicators of women’s status: women’s participation in decisionmaking, women’s attitude toward wives refusing sex with their husband, and women’s attitude toward wife beating. In the 2007 IDHS, women were asked about their participation in the following decisions: their own health care, making large household purchases, making daily household purchases, visiting family or relatives, and deciding what food to cook each day. The data show that women’s participation in household decisionmaking is not associated with their ideal number of children. However, the unmet need for family planning decreases with increasing number of decisions in which a woman participates; unmet need for women who do not participate in Table 7.7 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Indonesia 2007 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 2.0 2.3 Rural 2.4 2.8 Education No education 2.0 2.4 Some primary 2.3 2.8 Complete primary 2.4 2.8 Some secondary 2.3 2.7 Secondary + 2.1 2.5 Wealth quintile Lowest 2.4 3.0 Second 2.0 2.5 Middle 2.4 2.8 Fourth 2.2 2.5 Highest 2.5 2.7 Total 2.2 2.6 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. 98 | Fertility Preferences making household decisions is 16 percent, compared with 9 percent for women who participate in all the specified decisions. The number of reasons for which wives are justified in refusing to have sexual intercourse with their husbands are negatively associated with the mean ideal number of children, but the number of reasons justifying wife beating is positively associated with the mean ideal number of children. On the other hand, the number of reasons justifying wife beating is positively associated with unmet need for family planning. Table 7.8 Ideal number of children and unmet need by women's status Mean ideal number of children and unmet need for spacing and limiting by women's indicators, Indonesia 2007 Unmet need for family planning2 Women's status indicator Mean ideal number of children1 Number of women For spacing For limiting Total Number of women Number of decisions in which woman has final say3 0 2.8 237 5.7 9.8 15.5 287 1-2 2.8 1,717 6.8 3.4 10.2 1,903 3-4 2.8 7,435 4.2 5.0 9.2 8,446 5 2.8 18,188 4.1 4.7 8.8 20,295 Number of reasons given for refusing to have sexual intercourse with husband 0 3.1 1,332 4.0 6.3 10.4 1,635 1-2 3.0 3,116 4.6 4.3 8.9 3,704 3-4 2.8 23,129 4.3 4.7 9.0 25,592 Number of reasons for which wife beating is justified 0 2.7 19,015 4.1 4.7 8.8 21,279 1-2 2.8 6,299 4.2 4.6 8.9 7,100 3-4 3.1 1,796 6.5 4.6 11.1 2,028 5 3.2 468 6.1 6.4 12.4 524 Total 2.8 27,578 4.3 4.7 9.1 30,931 1 Excludes women who gave non-numeric responses 2 See Table 7.3 for definition of unmet need for family planning 3 Alone or jointly with others Nonuse and Intention to Use Family Planning | 99 NONUSE AND INTENTION TO USE FAMILY PLANNING 8 This chapter focuses on women who are not using family planning and the reasons women and men stop using contraceptive methods. Five topics are discussed: contraceptive discontinuation rates, reasons for discontinuing use, reasons for nonuse, intention to use contraception in the future, and methods potential users intend to use. 8.1 DISCONTINUATION RATES Improvement in the quality of contraceptive use is one of the goals of Indonesia’s family plan- ning program. One measure of the quality of use is the rate at which users discontinue using a method of contraception. Reasons for discontinuation may include contraceptive failure, dissatisfaction with the method, side effects, and lack of availability. High rates of discontinuation, method failure, and method switching may indicate that improvements are needed in counseling in the selection of methods, follow- up care, and accessibility of services. Life-table contraceptive discontinuation rates derived from the survey are presented in Table 8.1. These are cumulative first-year discontinuation rates and represent the proportion of users discontinuing a method within 12 months after the start of use. Rates are calculated by dividing the number of discon- tinuations for each reason at each duration of use in single months by the number of months of exposure at that duration. The single-month rates are then totaled to produce a one-year rate. The reasons for discontinuation are treated as competing risks (net rates). Several reasons for discontinuation are tabu- lated, including method failure (woman became pregnant while using contraception), desire to become pregnant, side effects or health concerns, and other reasons. Table 8.1 First-year contraceptive discontinuation rates Percentage of contraceptive users who discontinued use of a method within 12 months after beginning its use, by reason for discontinuation and specific method, Indonesia 2007 Method Method failure Desire to become pregnant Other fertility- related reasons Side effects/ health concerns Other method- related reasons Other reason Total Switched to another method Pill 3.1 8.5 1.6 12.1 8.7 4.8 38.8 19.0 IUD 0.6 0.6 1.2 5.6 0.7 1.1 9.9 5.5 Injectables 0.7 4.3 2.1 10.3 2.8 2.8 23.0 11.7 Implants 0.1 0.4 0.0 3.5 1.1 0.6 5.7 2.6 Male condom 4.8 8.6 4.3 3.9 10.3 6.5 38.3 16.1 Periodic abstinence 5.4 7.8 2.2 1.9 5.6 2.0 24.9 6.8 Withdrawal 3.0 8.2 0.4 1.2 6.7 4.7 24.2 9.2 Other 0.3 1.4 0.0 0.2 0.7 1.7 4.4 1.3 All methods 1.6 5.4 1.8 9.5 4.6 3.4 26.3 12.9 Number of episodes of use 303 1,002 346 1,783 886 638 4,959 2,438 Note: Table is based on episodes of contraceptive use that began 3-59 months prior to the survey 100 | Nonuse and Intention to Use Family Planning The discontinuation rates were calculated from information collected in the calendar portion of the Women’s Questionnaire. All episodes of contraceptive use between January 2002 and the date of the interview were recorded in the calendar, along with the reason for any discontinuation of use during this period. The discontinuation rates presented here refer to all episodes of contraceptive use that began during the period covered by the calendar. Specifically, the first-year contraceptive discontinuation rates shown in Table 8.1 refer to the period 3-59 months preceding the survey; the month of the interview and the preceding two months are ignored to avoid bias that may be introduced by unrecognized pregnancies. Overall, 26 percent of contraceptive users discontinued using a method within 12 months of starting use; 10 percent stopped using because of their fear of side effects or health concerns, 5 percent stopped use to become pregnant, 5 percent stopped using because of method-related reasons, 3 percent stopped for other reasons (including cost, inconvenience, marital dissolution/separation, and infrequent sex), and 2 percent stopped using because they became pregnant while using the contraceptive method (method failure). The discontinuation rate in the 2007 IDHS is higher than that in the 2002-2003 IDHS (26 and 20 percent, respectively). During the same period, the proportion of users who switched to another method increased from 9 percent in 2002-2003 to 13 percent in 2007. The discontinuation rates vary by method. Among modern contraceptive methods, the pill and male condoms have the highest rates (38 to 39 percent), followed by injectables (23 percent). Traditional methods also have high rates of discontinuation; one in four users of periodic abstinence and withdrawal stopped using within 12 months of starting use. The one-year discontinuation rate for the pill has increased from 32 percent in the 2002-2003 IDHS to 39 percent in the 2007 IDHS. The discontinuation rate for injectables increased from 18 percent in the 2002-2003 IDHS to 23 percent in the 2007 IDHS. Contraceptive discontinuation rates according to specific reasons vary by method. For example, the proportion of users who stopped using because they became pregnant (method failure) is highest for users of periodic abstinence and male condoms (5 percent each) and lowest for implants and the IUD (less than 1 percent). Most of pill users and male condom users discontinued use because they switched to another method (19 and 16 percent, respectively). Side effects and health concerns were cited by 12 percent of pill users and 10 percent of women who used injectables. 8.2 REASONS FOR DISCONTINUATION OF CONTRACEPTIVE USE Another perspective on contraceptive discontinuation is provided in Table 8.2, which shows the percent distribution of discontinuations in the five years preceding the survey by reasons for discontinu- ation, according to method. The most common reason for discontinuing a method remains the same as in the 2002-2003 IDHS—that is, the desire to become pregnant (31 percent). This applies to all methods, except LAM, for which the common reason given for discontinuing is the desire for a more effective method (33 percent). Other reasons for discontinuing a method include side effects (18 percent), health concerns (11 percent), and method failure (7 percent) (see Figure 8.1). Side effects and health concerns are mentioned frequently by users of injectables, the IUD, the pill and implants (14 to 23 percent), while method failure and desire for a pregnancy are commonly cited reasons for discontinuing traditional methods. The reasons for discontinuing contraceptive methods have not changed substantially since the 2002-2003 IDHS. Discontinuation because of method failure decreased from 10 to 7 percent, and discontinuation because of side effects increased from 14 to 18 percent. Nonuse and Intention to Use Family Planning | 101 Table 8.2 Reasons for discontinuation of contraceptive methods Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason given by women for discontinuation, according to specific method, Indonesia 2007 Reason Pill IUD Injection Implants Condom LAM Periodic absti- nence With- drawal Other All methods Became pregnant while using 12.1 5.1 3.4 0.4 11.6 9.3 28.8 16.4 10.8 6.9 Wanted to become pregnant 29.8 29.7 31.8 27.3 28.7 12.8 35.0 41.6 47.7 31.2 Husband disapproved 0.6 0.8 0.5 0.3 1.8 0.0 0.5 0.8 0.4 0.6 Side effects 14.7 17.1 22.5 13.8 6.3 0.0 5.8 2.5 0.9 18.1 Health concerns 9.6 14.1 11.9 12.5 2.1 2.2 2.6 3.4 2.8 10.6 Access/availability 0.4 0.0 0.4 1.2 0.3 0.0 0.0 0.0 2.5 0.4 Wanted a more effective method 10.9 2.0 5.1 6.2 13.8 32.5 14.1 13.9 6.7 7.4 Inconvenient to use 2.8 5.1 2.3 3.3 11.4 1.4 1.3 4.6 6.2 2.9 Infrequent sex/husband away 3.7 1.3 4.8 1.9 8.5 3.2 3.1 0.7 0.0 4.1 Costs too much 1.3 1.1 2.7 13.0 1.4 0.0 0.1 0.5 0.2 2.6 Fatalistic 0.3 0.8 0.3 0.1 0.5 0.0 0.6 1.5 0.0 0.4 Difficult to get pregnant/menopausal 1.0 4.4 1.0 1.9 0.2 0.0 0.9 1.4 0.4 1.1 Marital dissolution/separation 2.0 3.9 2.4 1.7 0.1 0.0 0.9 1.1 4.0 2.2 Other 9.4 10.4 9.5 14.1 9.4 18.5 4.3 7.1 9.1 9.6 Don't know 0.3 2.4 0.2 0.9 0.2 3.0 0.0 0.2 0.5 0.3 Missing 1.3 1.7 1.1 1.6 3.6 17.2 2.0 4.3 7.7 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 4,690 653 8,646 862 307 36 333 475 94 16,096 LAM = Lactational amenorrhea method Figure 8.1 Reasons for Discontinuation of Contraceptive Methods Costs too much 3% Method failure 7% Wanted to become pregnant 31% Side effects 18% Health concerns 11% Want more effective method 7%Infrequent sex 4% Other reasons 16% Inconvenient to use 3% 102 | Nonuse and Intention to Use Family Planning 8.3 INTENTION TO USE CONTRACEPTION IN THE FUTURE Intention to use contraception in the future provides a forecast of potential demand for family planning services and represents a summary indicator of attitudes toward contraception among current nonusers. The distinction between intention to use in the next 12 months and intention to use later is useful in assessing the extent of demand in the near future. In Indonesia, where the contraceptive prevalence rate is high, nonusers are the group most targeted by family planning programs and providers. Respondents who were not using any method of contraception at the time of the interview were asked if they intended to use a method at any time in the future. Table 8.3 shows the distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children. The results of the 2007 IDHS indicate that 46 percent of nonusers intend to use family planning sometime in the future, 45 percent do not intend to use family planning, and 8 percent are unsure. Table 8.3 Future use of contraception Percent distribution of currently married women and currently married men who are not using a contraceptive method by intention to use in the future, according to number of living children, Indonesia 2007 Number of living children1 Intention 0 1 2 3 4+ Total CURRENTLY MARRIED WOMEN Intends to use 56.5 59.9 50.4 38.2 23.2 46.2 Unsure 11.8 7.3 6.2 7.4 7.9 7.8 Does not intend to use 31.4 32.2 42.7 52.9 67.7 45.1 Missing 0.3 0.7 0.7 1.5 1.1 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,653 3,254 2,673 1,837 2,533 11,951 CURRENTLY MARRIED MEN Intends to use 13.0 14.1 11.0 9.2 6.6 10.9 Unsure 12.4 8.1 7.4 7.8 11.3 8.9 Does not intend to use 74.3 77.3 80.4 82.1 81.1 79.4 Missing 0.3 0.5 1.2 1.0 1.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 601 1,603 1,716 1,068 1,166 6,154 Note: For men, excludes cases in which man says he is not using method but reports that wife is. 1 Includes current pregnancy The intention to use a contraceptive method in the future decreases with increasing number of children (i.e., women with one child are more likely to use a method of contraception than women with more than one child). Fifty-seven percent of women with no children intend to use a family planning method in the future, compared with 46 percent in the 2002-2003 IDHS. Among male respondents who were not using any contraceptive method, only 11 percent said that they intend to use a method in the future, 9 percent were unsure, and 79 percent had no intention to use in the future (Table 8.3). For men, the correlation between the desire not to use a contraceptive method in the future and the number of living children is not as strong as for women. Nonuse and Intention to Use Family Planning | 103 8.4 REASONS FOR NONUSE One of the best ways of assessing obstacles to family planning programs is to ask women and men why they are not using a contraceptive method; this was done in the 2007 IDHS. Table 8.4 shows the distribution of currently married nonusers who do not intend to use family planning by reason for not using contraception, according to age. The majority of women who are not using a contraceptive method and do not intend to use a method cited fertility-related reasons for nonuse (51 percent). This includes being menopausal or having had a hysterectomy (15 percent), being subfecund or infecund (14 percent), or wanting as many children as possible (12 percent). The next most often cited reasons are method-related (36 percent), including fear of side effects of method (12 percent), concern that method will affect their health (10 percent), concern that method source is inconvenient to use (2 percent), and concern that the method costs too much (3 percent). For men, the major reasons for not using a contraceptive method are method-related (25 percent), followed by fertility-related reasons (22 percent), such as wanting as many children as possible (10 percent) or that wife is menopausal (7 percent). Table 8.4 Reason for not intending to use contraception in the future Percent distribution of currently married women and currently married men who are not using contraception and who do not intend to use in the future by main reason for not intending to use, according to age, Indonesia 2007 Women Men Reason 15-29 30-49 Total 15-29 30-54 Total Fertility-related reasons 39.3 52.2 50.8 16.7 23.7 22.4 Infrequent sex/no sex 4.9 8.6 8.2 0.4 2.7 2.2 Menopausal/had hysterectomy 0.1 16.9 15.1 0.5 8.7 7.2 Subfecund/infecund 5.3 15.0 13.9 0.6 1.9 1.7 Faith 1.9 1.2 1.3 0.9 1.1 1.1 Wants as many children as possible 27.2 10.5 12.3 14.3 9.2 10.2 Opposition to use 9.9 4.1 4.8 9.7 10.4 10.3 Respondent opposed 1.5 1.1 1.2 6.0 7.1 6.9 Husband/partner opposed 7.2 2.6 3.1 2.2 1.5 1.6 Others opposed 0.7 0.1 0.1 0.0 0.0 0.0 Religious prohibition 0.5 0.3 0.4 1.5 1.8 1.7 Lack of knowledge 1.7 1.2 1.3 10.2 8.6 8.9 Knows no method 1.7 0.7 0.8 9.6 7.4 7.8 Knows no source 0.0 0.5 0.5 0.6 1.2 1.1 Method-related reasons 39.0 35.1 35.5 28.1 23.7 24.5 Health concerns 9.2 10.2 10.1 3.1 3.1 3.1 Fear of side effects 24.6 10.8 12.3 13.0 10.2 10.7 Lack of access/too far 1.0 0.3 0.4 0.6 0.6 0.6 Costs too much 1.6 2.6 2.5 0.7 1.1 1.0 Inconvenient to use 2.0 1.4 1.5 10.7 8.5 8.9 Interferes with body's normal process 0.6 0.6 0.6 0.1 0.3 0.3 Too old 0.0 9.1 8.1 0.0 0.0 0.0 Other 3.1 4.2 4.1 16.6 11.8 12.7 Don't know 6.3 2.8 3.1 18.0 13.5 14.3 Missing 0.7 0.4 0.4 0.6 8.2 6.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 586 4,808 5,394 877 4,011 4,888 Note: For men, excludes cases where man says he is not using but says his wife is using 104 | Nonuse and Intention to Use Family Planning As expected, older women are more likely to cite being menopausal or having had a hyster- ectomy, or are subfecund or infecund, while younger women are more likely to want to have more children. The large proportion of women who mentioned health concerns and fear of side effects as reasons for not using contraception suggests that family planning program managers need to expand family plan- ning counselling to eliminate misunderstandings women may have about contraceptive methods and the possible side effects, especially young women. Comprehensive information on available methods includ- ing their advantages and disadvantages would enable nonusers to make informed choices before deciding on a contraceptive method to use. The reasons for not using contraception cited by men also vary by age; younger men tend to report method-related reasons (28 percent) such as fear of side effects (13 percent) more often than fertility-related reasons (17 percent), although 14 percent mentioned the fertility-related reason, “want as many children as possible.” Older men are equally likely to report fertility-related reasons (24 percent) as method-related reasons (24 percent); 10 percent of older men mentioned fear of side effects, 9 percent mentioned “wants as many children as possible,” and 9 percent mentioned wife was menopausal or had a hysterectomy. One-fourth of both younger and older men cited method-related reasons for not using contraception, including health concerns and fear of side effects. 8.5 PREFERRED METHOD Table 8.5 presents data on currently married women and currently married men who are not using a family planning meth- od but intend to use a method in the future. The 2007 IDHS findings indicate that most of these women intend to use inject- ables (61 percent), while 17 percent say that they intend to use the pill. Comparison of the results of this survey with those of the 2002-2003 IDHS shows that injectables have become the pre- ferred method among women, increasing from 56 percent in 2002- 2003 to 61 percent in 2007. Use of the pill has declined in popu- larity from 19 percent in 2002-2003 to 17 percent in 2007. Table 8.5 shows that the majority of men who intend to use a method of contraception in the future prefer condoms (59 percent). Interestingly, 9 percent of men said that they would pre- fer to use male sterilization, whereas very few currently married women mentioned this method as a preferred choice. Six percent of currently married men who intend to use a method in the future reported that they will use “other” methods, including female methods. Table 8.5 Preferred method of contraception for future use Percent distribution of currently married women and currently married men who are not using a contraceptive method but who intend to use in the future by preferred method, Indonesia 2007 Preferred method Women Men Female sterilization 1.9 0.0 Male sterilization 0.0 9.2 Pill 17.2 0.0 IUD 6.1 0.0 Injectables 61.2 0.0 Implants 4.9 0.0 Condom 0.7 59.3 Diaphragm 0.0 0.0 Lactation amenorrhea 0.0 0.0 Periodic abstinence 1.2 6.6 Withdrawal 0.4 4.1 Other 1.8 6.3 Unsure 4.5 13.3 Missing 0.1 1.2 Total 100.0 100.0 Number 5,520 668 Note: For men, excludes cases where man says he is not using but says his wife is using Other Proximate Determinants of Fertility | 105 OTHER PROXIMATE DETERMINANTS OF FERTILITY 9 The principal factors other than contraception that affect a woman’s risk of becoming pregnant— marriage, sexual intercourse, postpartum amenorrhea, postpartum abstinence, and secondary infertility— are discussed in this chapter. Marriage is a primary indicator of the exposure of women to the risk of pregnancy and, therefore, is important for understanding fertility patterns. Populations in which age at marriage is low tend to be those with early childbearing and high fertility. In the 2007 Indonesia Demographic and Health Survey (IDHS), questions relating to the proxi- mate determinants of fertility were included in the individual questionnaire, which was administered only to ever-married women. However, a number of the tables in this chapter are based on all women, that is, on ever-married women and never-married women. In constructing these tables, the denominators have been expanded to represent all women by multiplying the number of ever-married women by an inflation factor equal to the ratio of all women to ever-married women reported in the Household Questionnaire. The inflation factors are calculated by single years of age, either for the population as a whole or, in cases where the results are presented by background characteristics, separately for each category. 9.1 CURRENT MARITAL STATUS The percent distribution of all women age 15-49 by current marital status and age is shown in Table 9.1. The data indicate that 23 percent of women have never married, 72 percent are currently married, 2 percent are divorced, and 2 percent are widowed. The percentage never married decreases rapidly from 87 percent among teenagers (age 15-19) to 39 percent among women age 20-24. The virtual universality of marriage is evidenced by the fact that 93 percent of woman age 30-34 are married, divorced, or widowed. The proportion of women who are widowed increases steadily with age, from less than 1 percent of women under age 30 to 5 percent of women age 40-44, and then to 8 percent of women age 45-49, while the proportion divorced is highest (4 percent) among two age groups, women 40-44 and women 45-49. The distribution of women by marital status and province is shown in Appendix Table A-9.1. Table 9.1 Current marital status Percent distribution of women by current marital status, according to age, Indonesia 2007 Marital status Age Never married Married Divorced Widowed Total Number of women 15-19 86.7 12.8 0.4 0.0 100.0 6,341 20-24 38.7 59.2 2.0 0.1 100.0 6,681 25-29 15.6 81.6 2.1 0.6 100.0 6,842 30-34 7.0 89.1 2.5 1.4 100.0 6,472 35-39 3.4 91.8 2.4 2.4 100.0 6,213 40-44 2.8 88.8 3.7 4.7 100.0 5,518 45-49 1.8 86.2 3.8 8.2 100.0 4,884 Total 23.4 72.0 2.4 2.2 100.0 42,951 106 | Other Proximate Determinants of Fertility 9.2 AGE AT FIRST MARRIAGE Whether or not marriage coincides with initiation of sexual intercourse—and thus, the beginning of exposure to the risk of pregnancy—age at first marriage is an important social and demographic indicator. Women who marry early will have, on average, longer exposure to the risk of becoming pregnant. Therefore, early age at first marriage usually implies higher fertility for a society. In Indonesia, marriage is closely associated with fertility because most births occur within marriage. Thus, an understanding of trends in age at first marriage can be important in interpreting changes in fertility patterns in Indonesia. Table 9.2 shows the proportion of women married by specific ages and the median age at first marriage for successive age groups. The median is defined as the age by which 50 percent of all women in the age group were married. It is preferred over the mean as a measure of central tendency because, unlike the mean, it can be estimated for all cohorts in which at least half of the women are ever married at the time of survey. In drawing conclusions about trends, the data for the oldest cohorts in Table 9.2 should be interpreted with caution because these women may not recall marriage date or age at marriage with accuracy. Table 9.2 Age at first marriage Percentage of women who were first married by specific exact age and median age at first marriage, according to current age, Indonesia 2007 Percentage first married by exact age: Current age 15 18 20 22 25 Percentage never married Number Median age at first marriage 15-19 1.7 na na na na 86.7 6,341 a 20-24 4.3 22.0 40.7 na na 38.7 6,681 a 25-29 5.1 24.0 43.4 58.6 75.7 15.6 6,842 20.8 30-34 8.6 28.0 46.4 63.3 78.6 7.0 6,472 20.4 35-39 9.1 31.7 49.6 64.7 80.2 3.4 6,213 20.0 40-44 15.1 43.4 59.4 71.9 84.4 2.8 5,518 18.9 45-49 16.8 46.6 65.0 77.4 88.2 1.8 4,884 18.3 20-49 9.3 31.6 49.8 na na 12.5 36,610 a 25-49 10.4 33.7 51.8 66.4 80.9 6.6 29,929 19.8 Note: Age at first marriage is the age at which the respondent began living with her first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group There has been a substantial change in the age at which women first marry. For example, 17 percent of women age 45-49 were married by age 15, compared with 9 percent of women age 30-34 and less than 5 percent of women age 20-24. Similarly, two in three women age 45-49 were married by age 20, whereas four in ten women age 20-24 were married by that age. Overall, the median age at first marriage has increased from 18.3 years among women in the oldest age group to 20.8 years among women age 25-29. Comparing the results of the 2007 IDHS with those of the 2002-2003 IDHS confirms the trend toward increasing age at marriage; at the time of the 2002-2003 survey, the median age at first marriage among woman age 25-49 was 19.2 years (BPS and ORC Macro, 2003), compared with 19.8 years in the 2007 survey. Figure 9.1 shows the increase in age at first marriage in the provinces in Java between 1994 and 2007. Other Proximate Determinants of Fertility | 107 Table 9.3 shows the median age at first marriage according to residence, level of education, and wealth index quintile. In general, urban women marry more than two years later than rural women (21.3 years compared with 18.7 years). Also, age at first marriage increases with level of education and wealth status. For example, the median age at first marriage among women with some secondary education is 21.3 years, more than three years later than among women with no education (17.8 years). Women in wealthier households marry later than women in households in poorer households; the median age at first marriage for women in the highest wealth quintile is 21.9 years, compared with 18.7 years for women in the lowest wealth quintile. Variations in age at first marriage according to province are presented in Appendix Table A-9.2. Table 9.3 Median age at first marriage Median age at first marriage among women age 25-49, according to background characteristics, Indonesia 2007 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 22.6 22.2 21.6 19.7 19.2 21.3 Rural 19.5 19.2 18.8 18.1 17.8 18.7 Education No education a 19.2 18.0 17.1 17.5 17.8 Some primary 22.8 18.7 17.9 17.7 17.5 18.2 Complete primary 22.0 19.7 18.9 18.5 18.3 19.5 Some secondary 24.0 21.4 20.4 19.7 19.6 21.3 Secondary + a 25.7 24.7 24.3 23.5 a Wealth index quintile Lowest 19.2 19.0 18.5 18.6 17.9 18.7 Second 19.4 19.0 18.6 17.7 17.7 18.5 Middle 20.4 19.6 19.6 17.7 17.6 19.1 Fourth 21.1 20.8 20.1 18.9 17.9 19.9 Highest 22.7 22.8 22.2 21.4 20.2 21.9 Total 20.8 20.4 20.0 18.9 18.3 19.8 Note: Age at first marriage is the age at which the respondent began living with her first spouse/partner. a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group 20.1 17.0 17.9 20.3 16.7 20.6 17.4 18.5 20.7 17.8 21.4 17.8 18.8 21.1 18.8 22.5 18.8 19.6 22.0 18.8 18.8 DKI Jakarta West Java Central Java DI Yogyakarta East Java Banten 0.0 5.0 10.0 15.0 20.0 25.0 Age at Marriage 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS Figure 9.1 Median Age at First Marriage by Province in Java 1994, 1997, and 2002-2003 a a Includes Banten b Excludes Banten a b 108 | Other Proximate Determinants of Fertility 9.3 AGE AT FIRST SEXUAL INTERCOURSE Although age at marriage is often used as a proxy measure for the beginning of exposure to the risk of pregnancy, some women and men engage in sexual activity before marriage. The 2007 IDHS collected information on the timing of first sexual intercourse for women and men. Table 9.4 shows the proportion of women and men who had first sexual intercourse by specific ages and the median age at first sexual intercourse for successive age groups. The median is defined as the age by which 50 percent of all women and men in the age group had had sexual intercourse. It is preferred over the mean as a measure of central tendency because, unlike the mean, it can be estimated for all cohorts in which at least half of the women and men had experienced sexual intercourse by the time of survey. Ten percent of women age 25-49 had first sex by age 15, while 52 percent had first sex by age 20. Older women are more likely than younger women to have had their first sexual encounter at an earlier age. There has been a substantial change in the age at which women have first sexual intercourse. For example, 15 percent of women age 45-49 had first sexual intercourse by age 15, compared with 8 percent women age 30-34 and 7 percent of women age 20-24. Overall, the median age at first sexual intercourse has increased from 18.5 years among women age 45-49 to 20.0 years among women age 25-29. Table 9.4 Age at first sexual intercourse Percentage of ever-married women and currently married men who had first sexual intercourse by specific exact ages, percentage who never had intercourse, and median age at first intercourse, according to current age, Indonesia 2007 Percentage who had first sexual intercourse by exact age: Current age 15 18 20 22 25 Percentage who never had intercourse Number Median age at first intercourse EVER-MARRIED WOMEN 15-19 13.5 na na na na 0.0 845 a 20-24 6.7 34.6 65.1 na na 0.3 4,094 19.0 25-29 6.0 27.4 49.8 67.0 86.2 0.1 5,771 20.0 30-34 8.2 28.8 47.5 64.5 79.7 0.0 6,020 20.3 35-39 8.8 31.7 49.0 63.3 78.6 0.0 6,004 20.1 40-44 14.5 43.1 58.4 70.6 82.1 0.0 5,365 19.0 45-49 15.4 44.6 61.7 73.8 83.7 0.0 4,795 18.5 15-24 7.9 na na na na 0.2 4,939 a 20-49 9.8 34.6 54.4 na na 0.1 32,050 19.5 25-49 10.3 34.6 52.8 67.5 82.0 0.0 27,956 19.7 CURRENTLY MARRIED MEN 15-19 0.0 na na na na 0.0 29 a 20-24 0.2 10.2 30.8 na na 0.0 432 a 25-29 0.2 6.6 19.6 36.5 72.5 0.0 1,116 23.1 30-34 0.5 5.7 14.1 26.1 53.8 0.0 1,418 24.5 35-39 0.4 4.8 16.2 33.3 57.2 0.0 1,679 24.1 40-44 0.3 8.1 18.1 35.1 58.5 0.0 1,570 23.7 45-49 0.4 10.2 24.5 44.9 67.2 0.0 1,359 22.6 50-54 0.0 8.9 23.8 43.1 69.5 0.0 1,155 22.7 20-49 0.4 7.2 19.0 na na 0.0 7,574 a 25-49 0.4 7.0 18.3 35.0 61.1 0.0 7,143 23.6 15-24 0.2 na na na na 0.0 460 a 20-54 0.3 7.4 19.7 na na 0.0 8,729 a 25-54 0.3 7.3 19.1 36.1 62.3 0.0 8,298 23.5 na = Not applicable because of censoring a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reaching the beginning of the age group Other Proximate Determinants of Fertility | 109 The data for married men show a later age at first sex for all age groups, compared with women. Very few men had had sex by age 15, and only 7 percent of men age 20-49 had had sex by age 18. Sixty- one percent of men age 25-49 had had sex by age 25. As in the case of women, there has been a substantial increase in the age at first sexual intercourse among men. For example, 9 percent of men age 50-54 had first sexual intercourse by age 18, compared with 6 percent of men age 30-34, and with less than 11 percent of men age 20-24. Similarly, two in ten men age 50-54 had first sexual intercourse by age 20, compared with three in ten men age 20- 24. Overall, the median age at first sexual intercourse increased from 22.7 years among men age 50-54 to 24.5 years among men age 30-34. Table 9.5.1 shows the median age at first sexual intercourse for women by residence, level of education, and wealth quintile. Urban woman had first sexual intercourse later than rural women (21.0 years compared with 18.7 years). More educated women had first sexual intercourse at a later age than less educated women. The median age at first sexual intercourse for women with secondary and higher education is 23.5 years, six years later than the median age for women with no education (17.2 years). The median age at first sexual intercourse increases with wealth status; the median for women in the highest wealth quintile is three years later than the median age for women in the lowest wealth quantile (22.0 years compared with 18.7 years). Table 9.5.1 Median age at first intercourse: Ever-married women Median age at first sexual intercourse among ever-married women by five-year age groups, age 25-49, according to background characteristics, Indonesia 2007 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 21.3 21.8 21.6 19.8 19.4 21.0 Rural 19.0 19.2 18.9 18.2 18.0 18.7 Education No education 18.3 17.0 17.3 16.7 17.4 17.2 Some primary 18.1 17.6 17.7 17.3 17.5 17.6 Complete primary 18.7 18.6 18.5 17.9 18.3 18.5 Some secondary 19.3 20.1 19.8 19.3 19.7 19.7 Secondary + 22.8 23.8 23.7 23.6 23.5 23.5 Wealth quintile Lowest 18.8 19.0 18.7 18.6 18.2 18.7 Second 19.1 19.2 18.7 17.7 18.0 18.6 Middle 19.9 19.5 19.9 17.7 18.0 19.0 Fourth 20.6 20.7 20.6 18.8 18.3 19.9 Highest 22.2 22.9 22.5 21.4 20.7 22.0 Total 20.0 20.3 20.1 19.0 18.5 19.7 Table 9.5.2 shows the median age at first sexual intercourse among men by background characteristics. For men age 25-54, the median age at first sexual intercourse is higher in urban areas (24.4 years) than in rural areas (22.8 years). More educated men began having sexual intercourse at a later age than less educated men. Among men with some secondary education, the median age at first sexual intercourse is 23.3 years, almost three years later than among men with no education (20.5 years). Men in the highest wealth quintile had first sexual intercourse at a later age than men in the lowest wealth quintile. For example, the median age at first sexual intercourse for men in the fourth wealth quintile is 23.6 years, two years later than the median for men in the lowest wealth quintile (21.9 years). Appendix Tables A-9.3.1 and A-9.3.2 show the variation in median age at first sexual intercourse for women and men by province. 110 | Other Proximate Determinants of Fertility Table 9.5.2 Median age at first intercourse: Currently married men Median age at first sexual intercourse among currently married men by five-year age groups, age 25-54, according to background characteristics, Indonesia 2007 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 50-54 Men age 25-54 Residence Urban 23.8 25.2 25.0 25.1 23.2 23.4 24.4 Rural 22.6 23.7 23.2 22.8 22.2 22.1 22.8 Education No education 20.5 19.9 21.6 18.9 20.7 20.6 20.5 Some primary 22.2 22.5 22.9 21.3 20.9 21.8 21.7 Complete primary 22.9 23.7 22.7 22.8 22.2 22.6 22.8 Some secondary 22.9 23.9 23.4 22.9 23.0 23.5 23.3 Secondary + 23.6 25.7 25.7 26.4 25.7 25.8 a Wealth quintile Lowest 21.9 23.1 22.1 21.1 20.8 21.8 21.9 Second 22.5 23.5 23.1 22.6 21.6 22.4 22.5 Middle 23.5 23.7 24.4 23.0 22.7 22.6 23.5 Fourth 23.3 25.1 25.0 23.3 23.0 21.7 23.6 Highest a 25.5 25.2 26.4 24.4 23.9 a Total 23.1 24.5 24.1 23.7 22.6 22.7 23.5 a = Omitted because less than 50 percent of the men had intercourse for the first time before reaching the beginning of the age group 9.4 RECENT SEXUAL ACTIVITY In the absence of contraception, the probability of pregnancy is related to the frequency of sexual intercourse. Thus, information on the frequency of intercourse is important for refining the measurement of exposure to pregnancy. In the 2007 IDHS, currently married women were asked how long ago their last sexual intercourse occurred. Table 9.6 provides information on the timing of last sexual intercourse by background characteristics. Overall, 80 percent of married women were sexually active in the four weeks preceding the survey and almost all married women reported having had intercourse in the year preceding the survey. Three percent of married women had their most recent sexual intercourse one or more years before the survey. There is a negative relationship between recent sexual activity and age. Older women tend to be less likely to report recent sexual activity than younger women; 80 percent or more of married women under age 35 were sexually active in the four weeks preceding the survey, compared with 65 percent of women age 45-49. There are no substantial differences in recent sexual activity among women who have been married for 0-15 years. However, women married for longer durations are less likely to have engaged in recent sexual activity. Women in rural areas are slightly less likely to have been sexually active in the past four weeks (78 percent), compared with women in urban areas (83 percent). There is a positive relationship between education and recent sexual activity. Women with no education are less likely to be sexually active than educated women; 63 percent of women with no education were sexually active, compared with 87 percent of women with secondary or higher education. This relationship may be due in part to the fact that less educated women tend to be older than more educated women, and recent sexual activity is closely associated with age. Other Proximate Determinants of Fertility | 111 Table 9.6 Recent sexual activity Percent distribution of currently married women by timing of last sexual intercourse, according to background characteristics, Indonesia 2007 Timing of last sexual intercourse Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Total Number of women Age 15-19 83.4 14.4 2.0 0.2 100.0 814 20-24 82.4 15.1 2.0 0.4 100.0 3,952 25-29 83.9 13.8 1.8 0.5 100.0 5,585 30-34 85.0 12.6 2.0 0.5 100.0 5,765 35-39 83.5 14.3 1.8 0.4 100.0 5,704 40-44 76.7 19.5 3.1 0.7 100.0 4,899 45-49 65.1 27.1 7.2 0.5 100.0 4,211 Marital duration, married only once2 0-4 years 82.4 15.2 2.0 0.4 100.0 5,580 5-9 years 84.0 13.8 1.8 0.4 100.0 5,371 10-14 years 85.3 12.1 2.1 0.5 100.0 5,110 15-19 years 84.2 13.0 2.2 0.6 100.0 4,263 20-24 years 78.7 18.8 1.9 0.5 100.0 3,499 25+ years 67.0 26.6 5.9 0.5 100.0 4,455 Married more than once 75.0 19.4 4.9 0.7 100.0 2,653 Residence Urban 83.1 14.2 2.3 0.4 100.0 12,842 Rural 78.0 18.2 3.2 0.6 100.0 18,089 Education No education 62.7 27.6 8.3 1.4 100.0 2,004 Some primary 71.5 23.2 4.7 0.6 100.0 5,112 Completed primary 80.5 16.5 2.5 0.5 100.0 9,511 Some secondary 83.5 14.6 1.6 0.3 100.0 6,494 Secondary + 87.0 11.0 1.6 0.4 100.0 7,810 Wealth index quintile Lowest 75.8 18.6 4.5 1.1 100.0 5,773 Second 75.8 20.0 3.8 0.5 100.0 6,233 Middle 79.7 17.8 2.2 0.3 100.0 6,342 Fourth 82.4 14.9 2.1 0.5 100.0 6,358 Highest 86.5 11.6 1.6 0.2 100.0 6,225 Current contraceptive method Female sterilization 79.5 17.4 3.1 0.1 100.0 941 Male sterilization 70.5 23.7 5.7 0.0 100.0 67 Pill 91.2 8.3 0.4 0.1 100.0 4,096 IUD 84.1 13.5 1.9 0.4 100.0 1,518 Injectables 85.8 13.3 0.6 0.2 100.0 9,849 Implants 81.5 14.8 3.2 0.5 100.0 857 Condom 94.8 5.0 0.2 0.0 100.0 407 Lactational amenorrhea 93.3 6.7 0.0 0.0 100.0 10 Periodic abstinence 91.4 7.7 0.4 0.5 100.0 466 Withdrawal 87.7 11.5 0.3 0.5 100.0 646 Other 74.2 7.9 13.2 4.7 100.0 123 No method 69.8 23.6 5.7 0.9 100.0 11,951 Total 80.1 16.6 2.8 0.5 100.0 30,931 1 Excludes women who had sexual intercourse within the past 4 weeks 2 Excludes women who are not currently married 112 | Other Proximate Determinants of Fertility Women in the lowest wealth quantile are less likely to be sexually active than those in the highest wealth quantile; 76 percent of women in households in the lowest wealth quintile are sexually active, compared with 87 percent of women in households in the highest wealth quintile. As expected, women who are using a contraceptive method are more likely to be sexually active than women who are not using a method. Also, the 2007 IDHS data suggest that type of contraceptive method used is related to the timing of sexual activity; for example, 86 percent of women using injectables and 80 percent of sterilized women had had sex in the past four weeks, compared with 91 percent of women using the pill. Age differences between women using permanent methods (sterilized women) and women using temporary methods (for spacing) may partly explain variations in the patterns of sexual activity. Appendix Table A-9.4 shows currently married women by timing of last sexual intercourse, according to province. 9.5 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY Among women who are not using contraception, exposure to the risk of preg- nancy in the period following a birth is influenced primarily by two factors: breast- feeding and sexual abstinence. Breastfeeding prolongs postpartum protection from concep- tion (insusceptibility) through its effect on the length of the period of amenorrhea (the period prior to the return of menses) follow- ing a birth. More frequent breastfeeding and breastfeeding for longer durations, as well as delays in the age at which supplementary foods are introduced, are associated with longer periods of postpartum amenorrhea. Delaying the resumption of sexual relations following a birth also prolongs the period of postpartum protection. For purposes of the following discussion, women are defined as insusceptible to pregnancy if they are not at risk of conception, either because they are amenorrheic or because they are abstaining following a birth. Table 9.7 shows the percentage of births in the three years preceding the survey for which the mother is postpartum ameno- rrheic, abstaining, and insusceptible, by the number of months since the birth. The estimates shown in Table 9.7 are based on current status data; that is, they refer to the woman’s situation at the time of the survey. The data are grouped in two-month intervals to minimize fluctuations in the estimates. Table 9.7 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which the mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Indonesia 2007 Percentage of births for which the mother is: Months since birth Amenorrheic Abstaining Insusceptible1 Number of births < 2 90.7 90.8 96.0 485 2-3 49.8 42.6 64.4 609 4-5 33.6 17.9 40.5 609 6-7 30.5 8.6 33.7 608 8-9 28.9 6.9 32.6 611 10-11 21.3 8.0 26.4 518 12-13 21.5 4.9 25.1 584 14-15 20.4 4.6 23.3 568 16-17 18.9 3.3 21.0 442 18-19 18.5 2.5 20.7 569 20-21 12.3 3.4 15.3 488 22-23 18.3 2.5 20.4 542 24-25 16.4 4.2 19.3 581 26-27 12.7 3.9 15.3 548 28-29 15.9 3.4 18.9 539 30-31 12.4 2.4 14.4 539 32-33 8.6 2.7 10.2 521 34-35 9.2 2.2 10.6 520 Total 24.5 11.7 28.4 9,882 Median 3.1 2.4 4.1 na Mean 9.1 4.6 10.4 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Other Proximate Determinants of Fertility | 113 Table 9.7 shows that almost all women are insusceptible to pregnancy in the first two months following a birth, and both amenorrhea and abstinence contribute to their insusceptibility. However, the contribution of abstinence to the period of insusceptibility becomes increasingly less important from the fourth month after birth because most women have resumed sexual relations by that time. The decrease in the protective effect of amenorrhea is less rapid; 50 percent of women are still amenorrheic at 2 to 3 months after birth, 22 percent are still amenorrheic at 12 to 13 months, and 16 percent are still amenorreic at 24 to 25 months (Figure 9.2). The median durations of postpartum amenorrhea, abstinence, and insusceptibility among women are shown in Table 9.8 by background characteristics. Women under 30 years of age are insusceptible to the risk of pregnancy for one month less than women age 30 years and over (3.8 and 4.9 months, respectively). The corresponding periods for urban and rural women are 3.4 and 4.8 months, respectively. Women with less education are insusceptible for a longer period than more educated women; the median duration of insusceptibility is 8.5 months for women with no education, compared with 3.6 months for women with a secondary or higher education. Women in the lowest wealth quintile are insusceptible for a longer period (6 months) than women in the highest wealth quintile (3.2 months). The contribution of amenorrhea to the period of insusceptibility is greater than the contribution of abstinence for all groups. Appendix Table A-9.5 shows the differentials in postpartum amenorrhea, abstinence, and insusceptibility, by province. & & & & & & & & & & & & & & & & & & + + + + + + + + + + + + + + + + + + 2-3 6-7 10-11 14-15 18-19 22-23 26-27 30-31 34-35 Months since birth 0 20 40 60 80 100 Percent Amenorrheic Abstaining+ & IDHS 2007 Figure 9.2 Percentage of Births in the Past Three Years for Which the Mother is Amenorrheic or Abstaining 114 | Other Proximate Determinants of Fertility Table 9.8 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Indonesia 2007 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Number of births Mother's age 15-29 2.7 2.4 3.8 5,588 30-49 4.1 2.4 4.9 4,294 Residence Urban 2.5 2.3 3.4 4,088 Rural 3.7 2.5 4.8 5,794 Education No education 6.8 3.8 8.5 312 Some primary 4.1 2.3 5.0 1,116 Complete primary 4.1 2.6 6.0 2,831 Some secondary 2.8 2.3 3.5 2,510 Secondary + 2.5 2.3 3.6 3,113 Wealth quintile Lowest 4.7 2.3 6.0 2,222 Second 3.8 3.2 6.2 1,906 Middle 3.3 2.4 3.8 2,020 Fourth 2.4 2.4 3.2 1,845 Highest 2.3 2.2 3.2 1,889 Total 3.1 2.4 4.1 9,882 Note: Medians are based on the status at the time of the survey (current status) 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth 9.6 TERMINATION OF EXPOSURE Another factor influencing the risk of pregnancy among women is menopause. Among women age 30 and over, the lack of a menstrual period in the preceding six months among women who are neither pregnant nor postpartum amenorrheic is taken as evidence of menopause and, therefore, infecundity. Table 9.9 shows that, as expected, the proportion of women who are menopousal increases with age from 11 percent among women age 30-34 to 22 percent among those age 44-45, and 45 percent among women age 48-49. Table 9.9 Menopause Percentage of women age 30-49 who are menopausal, by age, Indonesia 2007 Age Percentage menopausal Number of women 30-34 11.1 6,020 35-39 14.4 6,004 40-41 13.9 2,206 42-43 18.4 2,165 44-45 21.6 2,135 46-47 32.0 1,941 48-49 44.8 1,713 Total 18.4 22,184 1 Percentage of all women who are not pregnant and not postpartum amenor- rheic whose last menstrual period occurred six or more months preceding the survey Infant and Child Mortality | 115 INFANT AND CHILD MORTALITY 10 For some time, Indonesia’s health programs have focused on reducing the high levels of infant and child mortality. Infant and child mortality rates are relevant not only in evaluating the progress of health programs, but also in monitoring the current demographic situation and providing input for population projections. In addition, they can be used to identify subgroups of the population that have high mortality risks. This chapter reports on levels, trends, and differentials in infant and child mortality based on the 2007 Indonesia Demographic and Health Survey (IDHS) and selected earlier surveys. The following rates are used to measure early childhood mortality: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the probability of dying after the first month of life but before exact age one year Infant mortality: the probability of dying between birth and exact age one year Child mortality: the probability of dying between exact age one and exact age five Under-five mortality: the probability of dying between birth and exact age five Perinatal mortality: the sum of stillbirths and early neonatal deaths (deaths in the first seven days of life) divided by the number of pregnancies of seven or more months. Data on infant and child mortality in the 2007 IDHS are derived from the birth history section of the individual questionnaire. The section begins with questions about the respondent’s childbearing experience, including the number of sons and daughters who live in the household, the number who live elsewhere, and the number who have died. For each live birth, information was collected on name, date of birth, sex, whether the birth was single or multiple, and survivorship status of birth. For living children, information was also collected on age at last birthday and whether the child resided with the mother. For children who had died, the respondent was asked to provide the age at death. 10.1 ASSESSMENT OF DATA QUALITY A retrospective birth history, such as that included in the 2007 IDHS, is susceptible to several possible data collection errors. First, only surviving women age 15-49 were interviewed; therefore, no data were available for children of women who had died. The resulting mortality estimates will be biased if the fertility of surviving and nonsurviving women differs substantially. In Indonesia, this bias is likely to be negligible. But if the survivorship of children of surviving and nonsurviving mothers is different, it is likely that the children of nonsurviving mothers will fare worse than those of surviving mothers, and the resulting mortality estimates will have a downward biased. Another possible error is underreporting of events; respondents are more likely to forget events that occurred further in the past than recent events. Thus, deaths that occurred in the more distant past are less likely to be reported than recent deaths, resulting in underreporting of deaths. Mortality estimates based on these data are likely to be biased downward as a result of underreporting. The effect of truncation of birth history data, for estimates in the more distant past, is mostly the experience of younger respondents, for whom the relatively lower estimate in the more distant past is 116 | Infant and Child Mortality more apparent. Misreporting of date of birth and/or age at death can also bias mortality rates. In general, these problems are less serious for time periods in the recent past than for those in the more distant past. The 2007 IDHS data can be examined for evidence of the existence and extent of some of these biases. With respect to the misreporting of children’s birth dates, as shown in Appendix Table D-4, there is a deficit of births in calendar year five (year 2002) and an excess of births in calendar year seven (year 2000). This pattern, which has been found in previous IDHS surveys, is thought to result from interviewers’ transference of births out of the period in which the calendar and child health data were collected (i.e., January 2002 through the date of the survey) to reduce their workload. To reduce the effect of birth transference out of the reference period, an analysis was conducted by separating births in the year of the survey (approximate calendar year 2007) and calculating infant and childhood mortality for the period 1-5 years preceding the survey (approximate calendar years 2002- 2006). The differences between these rates and the rates referring to the period 0-4 years preceding the survey are insignificant. However, the analysis does show that childhood mortality in the recent past may have been underestimated. With regard to the reporting of children’s age at death, the most common source of error is the tendency of mothers to report the age in multiples of six months. To reduce this type of error, detailed instructions were given to the IDHS interviewers to record age at death under one month in days and age at death under two years in months. Interviewers were also instructed to probe for exact age at death in months whenever it was reported as “one year” or “12 months.” The distribution of deaths among children under two years is shown in Appendix Table D-6. There is evidence of heaping of deaths at age 12 months, a common error that can affect infant mortality estimates. As expected, heaping in age at death is more serious for deaths that occurred further in the past than for those that occurred more recently. As can been seen in Figure 10.1, although it is apparent that age at death heaping occurs at 12 months, the distribution of deaths by months reported for the period 0-4 years preceding the survey is smoother than the distributions for the periods 5-9 and 10-14 years before the survey. # # # # # # # # # # # # # # # # # # # # # # # # ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( & & & & & & & & & & & & & & & & & & & & & & & & <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 24+ Age at death (months) 0 100 200 300 400 500 Number of deaths Years preceding survey 0-4 5-9 10-14& ( # IDHS 2007 Figure 10.1 Reported Age at Death in Months Infant and Child Mortality | 117 Another problem concerns the fact that the IDHS mortality estimates refer to the survival status of births that occurred in a given period of time (e.g., 0-4 years before survey). However, because only women who were in the reproductive ages at the time of the survey were interviewed, women over age 49 were not interviewed and, thus, could not report the survival of any births they may have had in the period being considered. As the periods covered extend further into the past, the resulting censoring of information becomes progressively more severe. To minimize the effect of censoring, analysis of infant and child mortality trends from the 2007 IDHS is limited to a period no more than 15 years prior to the survey. In discussing issues affecting IDHS mortality data, it should also be noted that, because fertility levels are low in Indonesia, the IDHS infant and child mortality estimates are based on relatively small numbers of cases. This situation can lead to unstable estimates. To reduce this problem, mortality measures based on the 2007 IDHS are calculated for five- or ten-year periods. Finally, the mortality estimates from the IDHS surveys are computed directly from information on the deaths of children collected in the birth history table. Lacking the necessary information for producing estimates using direct methods, population censuses in Indonesia typically report indirect estimates based on the number of children ever born and children surviving. While there is no conclusive agreement on whether one estimate is better than the other, the underlying assumptions used in the indirect estimates can introduce a potential bias. Studies have found that even when an appropriate mortality model is applied, the results of the indirect estimation techniques are consistently higher than those of direct methods (Sullivan et al., 1994). Thus, in this report, only direct estimates from the IDHS are presented. 10.2 LEVELS AND TRENDS IN INFANT AND CHILD MORTALITY Table 10.1 presents estimates of childhood mortality for three five-year periods preceding the survey. The data indicate that under-five mortality has declined 36 percent over the 10-year period, from 69 deaths per 1,000 live births in the period 1993-1997 to 44 per 1,000 in the period 2003-2007. Infant deaths comprise the majority of under-five deaths. During the 10-year period, postneonatal mortality declined at a faster rate (40 percent) than neonatal mortality rate (32 percent). As a result, the majority of infant deaths now take place during the first month of life. Table 10.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Indonesia 2007 Years preceding the survey Approximate calendar year Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 2003-2007 19 15 34 10 44 5-9 1998-2002 23 20 44 15 58 10-14 1993-1997 28 25 53 16 69 1 Computed as the difference between the infant and neonatal mortality rates Using estimates from prior surveys and censuses, Figure 10.2 shows that the infant mortality rate has declined from 142 deaths per 1,000 live births in 1967 to 34 deaths per 1000 live births in 2005. Slight fluctuations in the estimates are expected as they were calculated using different estimation techniques. There are also differences in the geographic coverage of the various surveys and censuses. Figure 10.2 shows that the decline in the infant mortality rate has slowed in recent years. 118 | Infant and Child Mortality The decline in childhood mortality indicated by the IDHS 2007 and described in Table 10.1 may be exaggerated. Comparison of the last three IDHS surveys (1997, 2002-2003, and 2007) shows a different pattern of mortality decline. Infant mortality declined from 46 deaths per 1,000 live births in 1993-1997 to 34 per 1,000 in 2003-2007, with an annual reduction rate (ARR) of 3 percent. The ARR between 1998-2002 and 2003- 2007 is less than 1 percent (from 35 deaths per 1,000 live births to 34 per 1,000). In the same period, under-five mortality declined from 58 deaths per 1,000 live births in 1993-1997 to 44 per 1,000 in 2003- 2007, with an annual reduction rate (ARR) of 3 percent. The ARR in under-five mortality between 1998- 2002 and 2003-2007 is also less than 1 percent (46 deaths per 1,000 live births in 1998-2002 to 44 per 1,000 in 2003-2007). The ARRs for other five-year estimates as well as the 10-year period between 1993- 1997 and 2003-2007 are shown in Table 10.2. Table 10.2 and Figure 10.3 show that the three most recent IDHS surveys tend to give lower 0-4 year period mortality estimates and higher 5-9 year period mortality estimates. The infant mortality estimate for the 0-4 year period preceding the survey for the 2007 IDHS therefore should be higher than 34 deaths per 1,000 live births, and for the 2002-2003 IDHS it should be higher than 35 deaths per 1,000 live births. Using estimates for infant mortality rates in the 5-9 year period preceding the survey, the ARR for the last two IDHS surveys is 3 percent. Assuming this ARR is correct, the 0-4 year period estimate for the 2002-2003 IDHS is 41 deaths per 1,000 live births, and for the 2007 IDHS it is 37 deaths per 1,000 live births. This means that in the 2002-2003 IDHS, the IMR estimate 35 per thousand for the period 0-4 years preceding the survey should be inflated by 17 percent, giving an estimated infant mortality rate of 41 deaths per 1,000 live births; for the 2007 IDHS, the IMR should be inflated by at least 10 percent, giving an estimated infant mortality rate of 37 deaths per 1000 live births (Figure 10.3). # # # # # # # ## # 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Calendar year 0 25 50 75 100 125 150 D ea th s pe r 1 ,0 00 li ve b irt hs Figure 10.2 Infant Mortality Rates, Selected Sources, Indonesia, 1971-2007 142(a) 112(b) 75(c) 70(d) 68(e) 57(h) 46(g) 47(h) 35(i) 34(j) Source: (a) 1971 Census, (b) 1980 Census, (c) 1987 NICPS, (d) 1990 Census, (e) 1991 IDHS, (f) 1994 IDHS, (g) 1997 IDHS, (h) 2000 Census, (i) 2002-2003 IDHS (j) IDHS 2007 Infant and Child Mortality | 119 Table 10.2 Trends in early childhood mortality rates Infant and under-five mortality rates for five-year periods preceding the survey, IDHS 1997, 2002-2003, and 2007 Infant mortality Under-five mortality Survey Years preceding survey Approximate calendar year Infant mortality rate (1q0) ARR five-year period (percent) ARR 1997-2007 (percent) Under-five mortality (5q0) ARR five-year period (percent) ARR 1997-2007 (percent) IDHS 2007 0-4 2003-2007 34 0.58 3.02 44 0.89 2.76 5-9 1998-2002 44 2.95 2.93 58 1.65 3.58 10-14 1993-1997 53 2.14 2.04 69 2.71 3.20 IDHS 2002-2003 0-4 1998-2002 35 5.47 na 46 4.64 na 5-9 1993-1997 51 2.91 na 63 5.51 na 10-14 1988-1992 59 1.94 na 79 3.69 na IDHS 1997 0-4 1993-1997 46 na na 58 na na 5-9 1988-1992 59 na na 83 na na 10-14 1983-1987 65 na na 95 na na ARR = Annual Reduction Rate. Five-year ARR is derived from comparing two successive IDHS surveys. Ten-year ARR is based on comparing the 1997 IDHS and 2007 IDHS. ARR is assumed to decline exponentially. na = Not applicable 10.3 MORTALITY DIFFERENTIALS A number of socioeconomic, environmental, and biological factors influence infant and child mortality. In a framework developed for the study of child mortality in developing countries, Mosley and Chen (1984) outlined various proximate and socioeconomic determinants of infant mortality. The proximate determinants which are factors that affect mortality directly include: maternal characteristics Figure 10.3 Trends in Infant and Under-five Mortality Rates for Five-year Periods Preceding the 1997 IDHS, the 2002-2003 IDHS, and the 2007 IDHS & & &, , , + ++ ) ) )( ( ( ' '' 1980 1985 1990 1995 2000 2005 2010 Year 0 20 40 60 80 100 Ra te (p er 1 , 0 00 ) IMR 0-4 IMR 5-9 IMR 10-14 U5MR 0-4 U5MR 5-9 U5MR 10-14' ( ) + , & 95 79 69 83 63 58 58 46 44 65 59 5359 51 4446 35 34 Under-five mortality rate Infant mortality rate 120 | Infant and Child Mortality such as age, parity, and birth interval; environmental contamination; nutrition; injury; and personal illness. Socioeconomic factors operate through the proximate determinants. This section discusses the socioeconomic and biodemographic differentials for which data were collected in the 2007 IDHS. The socioeconomic determinants include place of residence, mother’s educational attainment, and wealth index quintile. The biodemographic determinants include sex of child, age of mother, parity, and birth interval. Several other variables shown to be related to child health and mortality, such as birth weight, antenatal care, and delivery assistance are also discussed. Table 10.3 presents early childhood mortality rates for the 10-year period preceding the survey (approximately 1998-2007) by socioeconomic characteristics of the mother. In general, children born to mothers living in urban areas have lower mortality rates than those born to women in rural areas. For example, the postneonatal mortality rate in urban areas is about half that in rural areas (12 per 1,000 live births compared with 21 per 1,000 live births). The same pattern was found in previous IDHS surveys, for all ages at death and in all areas of the country. The lower mortality rates in urban areas may be related to the greater availability of health facilities and better health-seeking practices of urban dwellers. Table 10.3 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background characteristic, Indonesia 2007 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Residence Urban 18 12 31 7 38 Rural 24 21 45 16 60 Mother's education No education 39 34 73 22 94 Some primary 26 25 51 19 69 Complete primary 23 21 44 12 56 Some secondary 22 13 35 10 45 Secondary + 14 10 24 8 32 Wealth quintile Lowest 27 28 56 23 77 Second 25 22 47 12 59 Middle 19 13 33 12 44 Fourth 17 12 29 8 36 Highest 17 9 26 6 32 1 Computed as the difference between the infant and neonatal mortality rates The 2007 IDHS data show that mother’s educational attainment is inversely related to childhood mortality levels; children of less educated mothers generally have higher mortality rates than those born to more educated mothers. For instance, the infant mortality rate for children whose mothers had no education is 73 deaths per 1,000 live births, compared with 24 deaths per 1,000 live births for children whose mothers have secondary or higher education. Past IDHS surveys also showed a wide gap in infant and childhood mortality rates between children whose mothers have the lowest and highest education levels. There is an inverse relationship between household wealth status and childhood mortality, with children in richer households having lower mortality than those in poorer households. For example, the infant mortality rate for children in the lowest wealth quintile is 56 deaths per 1,000 live births, compared to 26 deaths per 1,000 live births for children in the highest wealth quintile. Comparing the 2007 IDHS Infant and Child Mortality | 121 with the 2002-2003 IDHS, there is a slight reduction in the childhood mortality gap between children in the lowest and highest wealth quintiles. Appendix Table A-10.1 shows childhood mortality rates for the 10-year period preceding the survey by province. Infant mortality varies widely by province, ranging from 19 deaths per 1,000 live births in DI Yogyakarta to 74 per 1,000 in West Sulawesi. The under-five mortality is also lowest in DI Yogyakarta (22 deaths per 1,000 live births) and highest in West Sulawesi (96 per 1,000 live births). Table 10.4 shows the trends in infant mortality by province from approximately 1985 to 2007. Infant mortality in many provinces declined from the late 1980s to 1999-2003, but the decline has slowed in the past five years. West Nusa Tenggara, which had the highest infant mortality rate until 1999-2003 was replaced by West Sulawesi in 2007. Table 10.4 Trends in infant mortality by province Infant mortality rates (per 1000) for the 10-year period preceding the survey, by province, 1994-2007 Province IDHS 1994 (1985-1994) IDHS 1997 (1988-1997) IDHS 2002-2003 (1994-2003) IDHS 2007 (1998-2007) Sumatera DI Aceh na na na 25 North Sumatera 61 45 42 46 West Sumatera 68 66 48 47 Riau 72 60 43 37 Jambi 60 68 41 39 South Sumatera 60 53 30 42 Bengkulu 74 72 53 46 Lampung 38 48 55 43 Bangka Belitung1 na na 43 39 Riau Islands1 na na na 43 Java DKI Jakarta 30 26 35 28 West Java 89 61 44 39 Central Java 51 45 36 26 DI Yogyakarta 30 23 20 19 East Java 62 36 43 35 Banten1 na na 38 46 Bali and Nusa Tenggara Bali 58 40 14 34 West Nusa Tenggara 110 111 74 72 East Nusa Tenggara 71 60 59 57 Kalimantan West Kalimantan 97 70 47 46 Central Kalimantan 16 55 40 30 South Kalimantan 83 71 45 58 East Kalimantan 61 51 42 26 Sulawesi North Sulawesi 66 48 25 35 Central Sulawesi 87 95 52 60 South Sulawesi 64 63 47 41 Southeast Sulawesi 79 78 67 41 Gorontalo1 na na 77 52 West Sulawesi1 na na na 74 Maluku and Papua Maluku na na na 59 North Maluku na na na 51 Papua na na na 36 West Papua na na na 41 Total 66 52 43 39 Note: The 2002-2003 IDHS did not include Nangroe Aceh Darussalam, Maluku, North Maluku, and Papua province. IDHS before 2002-2003 included East Timor. na = not applicable 1 Provinces that were split off from South Sumatera, Riau, West Java, North Sulawesi and South Sulawesi provinces, respectively 122 | Infant and Child Mortality 10.4 DEMOGRAPHIC CHARACTERISTICS Table 10.5 shows early childhood mortality rates by demographic characteristics. The rates for males are consistently higher than those for females. For example, the infant mortality rate for males is 23 percent higher than the rate for females, and the under-five mortality rate for males is 22 percent higher than for females. Mother’s age at birth can affect a child’s chances of survival. Table 10.5 shows that neonatal mortality rates and infant mortality rates exhibit the expected U-shaped relationship with mother’s age— high for women in the young age groups, low for women in the middle age groups, and high for women in the older age groups. For example, the infant mortality rate for women under age 20 when they gave birth is 56 deaths per 1,000 live births. The rate decreases for women who gave birth at age 20-29 years and 30-39 (32 and 42 deaths per 1,000 live births, respectively), and then rises to 59 deaths per 1,000 live births for women who gave birth at age 40-49 years. The higher rates for younger and older women may be related to biological factors that lead to complications during pregnancy and delivery. The 2007 IDHS results show that there is a clear positive association between birth order and the probability of dying—the risk of dying increases with higher order births. For example, while the infant mortality rate for first-order births is 40 deaths per 1,000 live births, the rate for seventh-order births or higher is 86 deaths per 1,000 live births. As expected, childhood mortality rates decline as the birth interval increases. For example, the infant mortality rate for children born less than two years after a previous birth is almost three times higher than the rate for children born after an interval of four or more years (77 deaths per 1,000 live births compared with 28 deaths per 1,000 live births). A child’s size at birth has been shown to be strongly associated with the risk of dying during infancy, particularly during the first months of life. In the 2007 IDHS, for all children born in the five years preceding the survey, mothers were asked whether the child was very small, small, average size, large, or very large at birth. Although subjective, the mother’s judgment has been shown to correlate closely with the actual birth weight. The 2007 IDHS results show that mortality levels are higher among children perceived by their mother to have been small or very small at birth than among other children. Neonatal mortality rates for infants who were judged by their mothers to be small or very small at birth are, for example, more than four times higher than for infants who were reported by their mothers to be average or large at birth (49 deaths per 1,000 live births compared with 11 deaths per 1,000 live births). Table 10.5 also shows the relationship between infant and child mortality and antenatal care and delivery assistance. As expected, childhood mortality is generally lowest for children of mothers who received antenatal care and were assisted at delivery by a medical professional; childhood mortality is highest for children of mothers who received neither antenatal care nor assistance at delivery from a trained professional. For example, the infant mortality rate for children whose mothers received antenatal care and were assisted at delivery by a medical professional is 17 deaths per 1,000 live births, compared with 85 deaths per 1,000 live births for children whose mothers received neither antenatal care nor assistance at delivery from a trained provider. Infant and Child Mortality | 123 Table 10.5 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic characteristics, Indonesia 2007 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 24 19 43 13 56 Female 19 16 35 12 46 Mother's age at birth <20 30 26 56 17 72 20-29 16 16 32 10 42 30-39 26 17 43 13 55 40-49 33 26 59 33 90 Birth order 1 21 19 40 9 49 2-3 16 14 30 11 41 4-6 29 21 50 19 68 7+ 56 30 86 29 112 Previous birth interval2 <2 years 44 33 77 27 101 2 years 19 21 40 20 59 3 years 20 15 35 12 46 4+ years 16 12 28 9 37 Birth size3 Small/very small 49 18 67 na na Average or larger 11 10 21 na na Don’t know/missing 64 75 139 na na Antenatal care/delivery assistance Both ANC and DA 10 7 17 na na ANC only 9 9 18 na na DA only 35 23 58 na na Neither ANC or DA 54 32 85 na na Note: For ANC and DA, providers included only doctor, nurse, midwife, and/or village midwife. ANC = Antenatal care DA = Delivery assistance na = Not applicable 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey 10.5 MORTALITY BY WOMEN’S STATUS Although there is no direct association, women’s status has been found to influence infant and child mortality levels through women’s ability to control resources and make decisions. In the 2007 IDHS, women were asked about their attitudes toward certain aspects of their autonomy including the number of household decisions in which the woman participates in the final say, the number of reasons with which she agrees that a wife is justified in refusing sexual relations with her husband, and the number of reasons in which she agrees that justify wife beating. A woman is considered more independent if she participates in a larger number of household decisions and agrees with a greater number of reasons for a woman to refuse sexual intercourse with her husband. On the other hand, the more reasons she agrees justify wife beating, the less independent she is. Table 10.6 presents childhood mortality rates by women’s status indicators. The relationship between mother’s participation in decisionmaking and levels of child mortality does not show a clear pattern. It is expected that children whose mothers have greater say in household decisionmaking will 124 | Infant and Child Mortality have lower mortality; however, Table 10.5 shows that this pattern occurs only regarding postneonatal mortality. The number of reasons that justify a woman’s refusal to have sexual relations with her husband operates in the same way as decisionmaking. The more reasons a woman agrees with, the more likely she is to have greater independence. Thus, children of mothers who agree with no reasons would be expected to have the highest mortality rates. Table 10.6 shows that the expected result is seen only for postneonatal and under-five mortality. Attitudes toward wife beating are another reflection of women’s status. Women who do not approve of any reasons that justify wife beating are assumed to enjoy higher status, which in turn, translates into a more favorable mortality profile for their children. Table 10.6 generally shows the expected results; and conversely, children of mothers who agree with 3-5 reasons that justify wife beating have the least favorable mortality profile. Table 10.6 Early childhood mortality rates by women's status Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by indicators of women's status, Indonesia 2007 Empowerment indicator Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Number of decisions in which women participate1 0 13 28 42 12 53 1-2 20 22 42 11 52 3-4 24 20 45 15 59 5 20 16 36 11 47 Number of reasons given for refusing to have sexual intercourse with husband2 0 17 24 41 16 56 1-2 19 18 37 16 53 3-4 22 17 39 12 50 Number of reasons for which wife beating is justified3 0 20 14 34 11 44 1-2 20 21 41 15 55 3-4 36 30 66 16 81 5 26 42 68 20 87 1 Restricted to currently married women. See Table 15.5.1 for the list of decisions. 3 See Table 15.6.1 for the list of reasons 2 See Table 15.7.1 for the list of reasons 10.6 PERINATAL MORTALITY In the 2007 IDHS, women were asked to report all pregnancy losses that occurred in the five years preceding the survey. For each such pregnancy, the duration was recorded. In this report, perinatal deaths include pregnancy losses that occurred after seven completed months of gestation (stillbirths), and deaths among live births that occurred within the first seven days of life (early neonatal deaths). The perinatal mortality rate is the sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration. The distinction between a stillbirth and an early neonatal death may be a fine one, depending often on the observed presence or absence of some faint signs of life after delivery. The causes of stillbirths and early neonatal deaths overlap, and examining Infant and Child Mortality | 125 just one or the other can understate the actual level of mortality around the time of delivery. For this reason, in this report, both event types are combined and examined together. The perinatal mortality rate is a useful indicator of the state of delivery services, both in terms of the use of these services and their ability to ensure delivery of healthy babies. Data in Table 10.7 show that overall, 174 stillbirths and 241 early neonatal deaths were reported in the survey, resulting in a perinatal mortality rate of 25 per 1,000 pregnancies in Indonesia. The 2002-2003 IDHS results were almost the same, showing a perinatal mortality rate of 24 per 1,000 pregnancies. Perinatal mortality is highest among births to women who gave birth after age 40, and lowest among births to women age 20-29. Table 10.7 shows that the duration of the previous pregnancy interval has a strong effect on the outcome of the index pregnancy. Pregnancies occurring within 15 months of a previous birth have the highest risk of pregnancy loss or early death (51 pregnancy losses or early deaths per 1,000 pregnancies), while the safest interval is above 15 months (19-21 pregnancy losses or early deaths per 1,000 pregnancies). Table 10.7 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Indonesia 2007 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother's age at birth <20 41 46 50 1,757 20-29 84 94 20 8,997 30-39 38 90 24 5,351 40-49 11 10 36 572 Previous pregnancy interval in months4 First pregnancy 87 87 31 5,609 <15 12 30 51 828 15-26 13 24 21 1,815 27-38 15 16 20 1,600 39+ 47 83 19 6,825 Residence Urban 78 90 24 6,913 Rural 95 151 25 9,765 Mother's education No education 5 16 36 585 Some primary 15 31 23 2,012 Complete primary 63 83 30 4,821 Some secondary 37 67 25 4,169 Secondary + 53 43 19 5,091 Wealth quintile Lowest 42 63 27 3,848 Second 36 75 34 3,281 Middle 34 45 24 3,279 Fourth 41 27 21 3,163 Highest 20 31 16 3,107 Total 174 241 25 16,678 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months' duration, expressed per 1000. 4 Categories correspond to birth intervals of <24 mos., 24-35 mos., 36-47 mos., and 48+ mos. 126 | Infant and Child Mortality Perinatal mortality rates are similar in urban and rural areas (24 and 25 per 1,000 pregnancies, respectively). Perinatal mortality is highest among births to women with no education (36 pregnancy losses or early deaths per 1,000 pregnancies), almost double that of births to the most educated women (19 pregnancy losses or early deaths per 1,000 pregnancies). In general, there is an inverse relationship between wealth and perinatal mortality rate; children living in richer households have lower mortality. For example, the perinatal mortality rate for children in households in the lowest wealth quintile is 27 pregnancy losses or early deaths per 1,000 pregnancies, while the rate for children in households in the highest wealth quintile is 16 pregnancy losses or early deaths per 1,000 pregnancies. 10.7 HIGH-RISK FERTILITY BEHAVIOR There is a strong relationship be- tween maternal fertility patterns and chil- dren’s survival risks. Generally, infants and children have been shown to have a greater probability of dying if they are born to mothers who are too young or too old, if they are born after a short birth interval, or if they are of high birth order. These factors are of particular interest because they are easily avoidable at low cost. For purposes of the analysis of high- risk fertility presented in Table 10.8, a mother is classified as too young if she is less than 18 years of age and too old if she is over 34 years of age at the time of delivery. A short birth interval is defined as a birth occurring less than 24 months after the previous birth, and a child is of high birth order if the mother had previously given birth to three or more children (i.e., if the child is of birth order four or higher). Al- though first births are commonly associated with high mortality risk, even if they occur when the mother is age 18 to 34 years, they are not included in the high-risk category (unless they occur too early or late), because they are considered unavoidable. The first column in Table 10.8 shows the percentage of births in the five years preceding the survey that fall into these various risk categories. Thirty-two percent of births in Indonesia have an elevated risk of death that is avoidable, another 32 percent are first births for which risk is considered unavoidable, and 36 percent of births are not in any high-risk category. Among those who are at risk, 21 percent of births are in only one of the high-risk categories, while 11 percent are in multiple high-risk categories (due to combinations of mother’s age, birth order, and birth interval). Table 10.8 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Indonesia 2007 Births in the 5 years preceding the survey Risk category Percentage of births Risk ratio Percentage of currently married women1 Not in any high-risk category 35.5 1.00 29.5a Unavoidable risk category First order births between ages 18 and 34 years 32.1 1.38 6.0 Single high-risk category Mother's age <18 3.0 3.62 0.3 Mother's age >34 4.7 2.29 18.3 Birth interval <24 months 5.5 2.51 8.3 Birth order >3 8.1 2.26 5.6 Subtotal 21.4 2.53 32.5 Multiple high-risk category Age <18 and birth interval <24 months2 0.1 0.00 0.1 Age >34 and birth interval <24 months 0.2 0.47 0.5 Age >34 and birth order >3 8.3 2.01 26.8 Age >34 and birth interval <24 months and birth order >3 0.8 5.95 2.2 Birth interval <24 months and birth order >3 1.7 3.41 2.4 Subtotal 11.0 2.46 32.0 In any avoidable high-risk category 32.4 2.50 64.5 Total 100.0 na 100.0 Number of births/women 16,504 na 30,931 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women Infant and Child Mortality | 127 The single high-risk category with the largest percentage of births is birth order three or higher, which constitutes 8 percent of births. The mortality associated with this category is 2.26 times that of births with no elevated mortality risk. Single mortality risks are highest for births to mothers who are too young and births with intervals that are too short; 3 and 6 percent of births fall in these categories, respectively. The multiple high-risk category with the largest percentage of births is children with birth order three or higher born to mothers age 34 or older (8 percent). Compared with births with no elevated risk, these births have a 100 percent greater risk of dying in early childhood. The multiple high-risk category with the highest risk ratio is the combination age more than 34 years, birth interval less than 24 months, and birth order three or higher. The 1 percent of children in this category are almost six times more likely to die than children with no elevated mortality risk. Maternal Health | 129 MATERNAL HEALTH 11 This chapter presents findings from several areas of importance to maternal health, i.e., antenatal and delivery care, complications during pregnancy and delivery, postnatal care, women’s status, and problems in accessing health care. Information on birth registration is also presented. Information on antenatal care (ANC) and postnatal care (PNC) is of great value in identifying subgroups of women who do not utilize such services, and is useful in planning for improvements in services. Antenatal care is defined according to type of provider, the number of ANC visits made, the stage of pregnancy at the time of the first visit, and the services and information provided during antenatal care, including whether a tetanus toxoid injection was received. Similarly, delivery services are described according to the person who assisted with the delivery, the place of delivery, and the rate of caesarean section. Information on postnatal care is collected for women who did not give birth in a health facility; it includes the time since delivery that PNC was received, and the provider of the PNC. Combined with information about pregnancy complications and neonatal and infant mortality rates, this information helps identify groups that are underserved. The questions about birth weight and size provide useful information to countries seeking to reduce infant mortality through a reduction in low-birth-weight infants. Women’s use of antenatal, delivery, and postnatal care services from health professionals is examined in relation to their level of empowerment as measured by three indicators of women’s status. In societies where health care is widespread, women’s status may not affect access to maternal health services; in other societies, however, increased empowerment of women is likely to be associated with an increase in their ability to seek out and use health services to better meet their own health goals, including the goal of safe motherhood. 11.1 ANTENATAL CARE 11.1.1 Antenatal Care Table 11.1 shows the percent distribution of women who had a live birth in the five years prior the survey according to the provider of antenatal care received during pregnancy and background characteristics. In Indonesia, antenatal care is defined as pregnancy-related health care provided by a medical professional (i.e., general practitioner, obstetrician, gynecologist, nurse, midwife, or village midwife). Although mothers of live births may have received antenatal care from more than one type of provider, for early detection of high-risk pregnancies, this report uses the highest qualified provider. Among 32,895 ever-married women age 15-49 interviewed in the survey, 14,043 were mothers who had a live birth in the five years preceding the survey. Ninety-three percent of women received antenatal care from a medical professional: 79 percent received care from a nurse, midwife, or village midwife; 12 percent received care from an obstetrician or gynecologist, and 2 percent received care from a general practitioner. Compared with the 2002-2003 IDHS, ANC coverage has remained at about the same level (92 and 93 percent, respectively) (BPS and ORC Macro, 2003). 130 | Maternal Health Table 11.1 Antenatal care Percent distribution of women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Indonesia 2007 Background characteristic Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Total Percentage receiving antenatal care from a skilled provider1 Number of women Mother's age at birth <20 1.7 4.3 84.8 4.3 0.4 4.4 100.0 90.8 1,385 20-34 2.0 13.1 79.2 1.9 0.3 3.6 100.0 94.2 10,552 35-49 1.9 11.9 76.3 2.7 0.2 7.0 100.0 90.1 2,106 Birth order 1 2.1 13.8 79.3 1.9 0.4 2.5 100.0 95.2 4,856 2-3 1.8 13.1 79.5 2.0 0.3 3.4 100.0 94.4 6,568 4-5 2.0 7.3 81.1 2.8 0.3 6.5 100.0 90.4 1,860 6+ 2.3 2.9 72.9 5.6 0.5 15.8 100.0 78.1 759 Residence Urban 2.0 20.8 74.9 0.6 0.2 1.5 100.0 97.7 5,897 Rural 1.9 5.7 82.5 3.4 0.4 6.1 100.0 90.1 8,145 Education No education 1.5 0.7 60.5 10.6 0.8 26.0 100.0 62.6 458 Some primary 1.7 2.4 78.0 7.7 0.2 9.9 100.0 82.2 1,677 Complete primary 1.8 3.1 87.5 2.0 0.6 5.0 100.0 92.4 4,106 Some secondary 1.9 6.4 88.2 1.3 0.1 2.1 100.0 96.4 3,543 Secondary + 2.3 30.3 66.5 0.2 0.2 0.5 100.0 99.1 4,260 Wealth quintile Lowest 2.1 1.5 78.6 6.0 0.3 11.5 100.0 82.2 3,010 Second 2.4 3.2 86.5 2.7 0.5 4.7 100.0 92.1 2,791 Middle 1.9 6.5 87.1 1.6 0.2 2.7 100.0 95.5 2,812 Fourth 1.6 11.7 85.2 0.3 0.4 0.7 100.0 98.5 2,742 Highest 1.7 39.1 58.5 0.2 0.1 0.4 100.0 99.2 2,688 Total 1.9 12.0 79.3 2.2 0.3 4.2 100.0 93.3 14,043 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. Antenatal coverage is slightly higher among mothers who were age 20-34 at the birth of the child. Mothers of third- or lower-order births are more likely to receive antenatal care from a medical professional. Women in urban areas are more likely than those in rural areas to receive antenatal care from a medical professional (98 and 90 percent, respectively). Whereas 21 percent of urban women received ANC from an obstetrician or a gynecologist, only 6 percent of rural women did so. On the other hand, women in rural areas are much more likely than those in urban areas to receive antenatal care from a traditional birth attendant (TBA) or to receive no antenatal care (11 and 2 percent, respectively). There is a strong relationship between antenatal care coverage and mother’s level of education and economic status. Mothers with the highest education and in the highest wealth quintile are much more likely than other women to receive care from an obstetrician or a gynecologist (31 and 39 percent, respectively). Appendix Table A-11.1 shows the provincial differentials in antenatal care coverage. 11.1.2 Number of Antenatal Care Visits and Timing of First Visit The Indonesian maternal health program recommends that pregnant women have at least four antenatal care visits during pregnancy, according to the following schedule: at least one visit in the first trimester, at least one visit in the second trimester, and at least two visits in the third trimester (Ministry of Health, 2001a). Maternal Health | 131 Table 11.2 shows that 66 percent of pregnant women met the government’s recommended schedule of ANC visits, However, this proportion is still below the target of 90 percent set by the maternal health program, and is only slightly higher than that reported in the 2002-2003 IDHS (64 percent) (BPS and ORC Macro, 2003). More than eight in ten pregnant women had four or more ANC visits. Women in urban areas were more likely to make four or more ANC visits than women in rural areas (90 and 76 percent, respec- tively). Overall, three in four pregnant women received the first antenatal care in the first trimester. Half of these women started antenatal care at 2.7 months of pregnancy. Urban women started ANC earlier than rural women; the median number of months pregnant at first visit is 2.4 and 3.0 months, respectively. The number of antenatal care visits and the number of months pregnant at time of the first ANC visit is shown in Figure 11.1. Table 11.2 Number of antenatal care visits and timing of first visit Percent distribution of women who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, by the timing of the first visit, and whether there was at least one ANC visit in each trimester, and among women with ANC, median months pregnant at first visit, according to residence, Indonesia 2007 Residence Number and timing of ANC visits Urban Rural Total Number of ANC visits None 1.5 6.1 4.2 1 1.5 3.3 2.6 2-3 6.7 14.3 11.1 4+ 89.9 75.5 81.5 Don't know/missing 0.4 0.8 0.7 Total 100.0 100.0 100.0 At least one visit in the first trimester, at least one in the second, and at least two in the third 76.5 57.5 65.5 Number of months pregnant at time of first ANC visit No antenatal care 1.5 6.1 4.2 <4 83.2 69.6 75.3 4-5 11.5 17.1 14.7 6-7 3.1 5.1 4.3 8+ 0.5 1.4 1.0 Don't know/missing 0.2 0.7 0.5 Total 100.0 100.0 100.0 Number of women 5,897 8,145 14,043 Median months pregnant at first visit (for those with ANC) 2.4 3.0 2.7 Number of women with ANC 5,812 7,646 13,457 Figure 11.1 Number of Antenatal Care Visits and Number of Months Pregnant at Time of First ANC Visit Number of Antenatal Care Visits IDHS 2007 Number of Months Pregnant at Time of First Visit No visit 4% 1 visit 3% 2-3 visits 11% 4+ visits 82% No ANC visit 4% <4 months 75% 4-5 months 15% 6-8 months 4%Don’t know/ missing 1% 8+ months 1% Don’t know/ missing 1% 132 | Maternal Health 11.1.3 Components of Antenatal Care In Indonesia, it is recommended that every pregnant woman receive the following services: height and weight measurements, blood pressure measurement, iron tablets, tetanus toxoid immunization, and abdominal examination (Ministry of Health, 2001a). In any antenatal care visit, a woman should be informed of the signs of pregnancy complications, have her weight measured, and give blood and urine samples. Table 11.3 shows the services typically received during antenatal care visits; abdominal exami- nation (96 percent), blood pressure measured (92 percent), weight measured (91 percent), urine sample taken (40 percent) and height measured (33 percent). Overall, almost 40 percent of pregnant women were informed of the signs of pregnancy complications. The percentages were highest for women age 20-34 (40 percent), urban women (43 percent), women with first births (43 percent), women with secondary or higher education (50 percent), and women in the two highest wealth quintiles (47 and 51 percent). Table 11.3 also shows the positive relationship between women’s level of education or wealth status and the components of antenatal care; the higher the level of education or household wealth quintile, the more likely it is that women will receive antenatal care. There is a negative relationship between birth order and mother’s receipt of iron tablets or syrup during pregnancy for the last birth, while mother’s level education and wealth status show a positive relationship. Women in urban areas are more likely to take iron tablets or syrup than those in rural areas. Table 11.3 Components of antenatal care Among women with a live birth in the five years preceding the survey, percentage who received antenatal care (ANC) for the most recent live birth, by content of care received and the percentage who took iron tablets or syrup during the pregnancy for the most recent birth, according to background characteristics, Indonesia 2007 Content of care among women who received antenatal care Background characteristic Informed of signs of pregnancy complications Weight measured Height measured Blood pressure measured Urine sample taken Blood sample taken Abdominal examination Number of women Percentage who received iron tablets Number of women Age at birth <20 31.7 84.2 28.4 89.2 32.0 20.5 94.3 1,324 74.6 1,385 20-34 40.1 91.8 34.4 92.5 42.4 30.3 96.6 10,175 78.9 10,552 35-49 37.0 89.7 31.3 90.9 33.9 29.8 94.1 1,959 71.2 2,106 Birth order 1 42.9 91.8 36.0 93.1 45.4 30.4 96.5 4,733 80.6 4,856 2-3 38.7 92.2 34.0 92.9 40.3 29.4 96.6 6,347 80.0 6,568 4-5 33.8 87.0 28.9 89.3 32.4 27.7 93.9 1,739 68.8 1,860 6+ 24.2 77.9 18.9 80.2 20.4 23.5 92.6 638 54.9 759 Residence Urban 43.3 96.6 38.1 96.4 49.2 33.9 97.6 5,812 84.0 5,897 Rural 35.4 86.2 29.8 88.5 33.2 25.7 94.8 7,646 72.5 8,145 Education No education 16.8 75.3 17.6 71.7 16.0 17.0 89.8 339 42.3 458 Some primary 19.6 77.7 22.5 79.6 23.9 23.4 91.7 1,510 60.6 1,677 Complete primary 33.7 89.2 26.9 90.5 33.4 25.9 95.9 3,900 73.3 4,106 Some secondary 41.7 92.3 33.3 94.2 42.6 28.5 96.7 3,468 81.9 3,543 Secondary + 49.8 96.7 44.4 97.4 51.9 36.0 97.7 4,240 87.9 4,260 Wealth quintile Lowest 25.7 76.9 24.1 81.5 22.0 22.6 92.9 2,665 61.9 3,010 Second 32.0 87.9 29.4 88.8 32.9 26.8 95.1 2,658 72.9 2,791 Middle 38.5 93.2 31.9 94.5 40.7 28.9 97.3 2,737 81.7 2,812 Fourth 47.3 96.5 38.0 96.6 48.1 30.6 97.1 2,722 85.8 2,742 Highest 50.5 98.9 43.3 98.0 56.6 37.2 97.7 2,676 86.1 2,688 Total 38.8 90.7 33.3 91.9 40.1 29.2 96.0 13,457 77.3 14,043 Maternal Health | 133 The maternal health program of the Indonesian Ministry of Health recommends that pregnant women take at least 90 iron tablets during pregnancy (Ministry of Health, 2001a). The consumption of iron supplements is discussed in Chapter 14. Appendix Table A-11.2 shows that there are small variations by province in the components of antenatal care received by pregnant women. 11.1.4 Tetanus Toxoid Injections Immunization of pregnant women is a program coordinated by the Expanded Program on Immunization (EPI) and the Maternal and Child Health Care (MCH) units in the Ministry of Health. The program recommends that women receive two tetanus toxoid (TT) injections during the first pregnancy. Booster injections are given once during each subsequent pregnancy to maintain full protection. In recent years, TT immunization was also given to women before marriage, so that any pregnancy occurring within three years of their marriage would be protected against tetanus (Ministry of Health, 2000). Table 11.4 shows that the coverage of TT immunization varies by age and parity. Overall, half of women received two or more TT injections during pregnancy, 22 percent received one injection, and 26 percent received no TT injection. The table shows that the likelihood that a mother receives two more TT injections has a positive relationship with her level of education and wealth status. For instance, 19 percent of women with no education received two or more TT injections compared with 55 percent of women with secondary or higher education. Appendix Table A-11.3 shows the percent distribution of women who received tetanus toxoid injections by province. Table 11.4 Tetanus toxoid injections Percent distribution of mothers who had a live birth in the five years preceding the survey by number of tetanus toxoid injections received during pregnancy for the most recent birth, according to background characteristics, Indonesia 2007 Background characteristic None One injection Two or more injections Don't know/ missing Total Number of mothers Mother's age at birth <20 32.5 19.3 45.6 2.5 100.0 1,385 20-34 24.3 22.4 50.7 2.6 100.0 10,552 35-49 29.4 20.3 47.4 2.9 100.0 2,106 Birth order 1 23.7 23.1 50.4 2.7 100.0 4,856 2-3 23.7 22.2 51.3 2.8 100.0 6,568 4-5 30.6 19.1 47.7 2.5 100.0 1,860 6+ 46.8 16.2 35.7 1.2 100.0 759 Residence Urban 21.4 23.7 52.3 2.6 100.0 5,897 Rural 29.2 20.4 47.8 2.6 100.0 8,145 Education No education 66.5 12.1 18.5 2.9 100.0 458 Some primary 43.7 17.5 36.5 2.3 100.0 1,677 Complete primary 27.5 20.7 49.1 2.7 100.0 4,106 Some secondary 20.3 22.8 54.4 2.5 100.0 3,543 Secondary + 17.6 24.8 54.8 2.8 100.0 4,260 Wealth quintile Lowest 41.6 16.4 39.8 2.2 100.0 3,010 Second 25.9 22.0 49.6 2.6 100.0 2,791 Middle 22.8 22.4 52.1 2.6 100.0 2,812 Fourth 17.1 24.5 56.0 2.5 100.0 2,742 Highest 20.5 24.4 51.8 3.4 100.0 2,688 Total 25.9 21.8 49.7 2.6 100.0 14,043 134 | Maternal Health 11.1.5 Complications of Pregnancy To identify complications associated with pregnancy, respondents were asked about certain signs and symptoms that they had experienced in association with their last birth. Table 11.5 shows that 89 percent of women reported no complications during pregnancy. Among those who reported complica- tions, 3 percent had excessive vaginal bleeding, 2 percent had labor before nine months, and 1 percent each had fever and the fetus in breech position. Less than 1 percent of women each had convulsions and fainting, swelling, hypertension, and dizziness. The last three complications were added in the 2007 IDHS. While some problems that may lead to complications may have been detected during an ANC visit, the data show that reports of complications during pregnancy vary little by whether the woman received antenatal care. In fact, births to women who had four or more ANC visits are more likely to be associated with complications than births to women with fewer ANC visits. Advice or treatment from a medical professional or a health facility is expected to be sought for births involving complications. Among women who had premature labor, 42 percent took rest and 35 percent went to see a traditional birth attendant. Medical professionals were contacted by 25 percent or less of women who had premature labor. Sixty percent of women who had excessive vaginal bleeding saw a medical professional (midwife and doctor), 29 percent went to a health facility, and 22 percent took medication. No complications were reported for seven in ten births in which the infant died within one month, 88 percent of births that were delivered by a health professional, and 78 percent of births that were delivered by caesarean section. Table 11.5 Complications during pregnancy Percentage of last births in the five years preceding the survey for which the mother had complications associated with the pregnancy, by type of complication and maternity care indicators, Indonesia 2007 Maternity care indicators Premature labor Excessive vaginal bleeding Fever Convulsions and fainting Fetus in breech position Swelling Hyper- tension Dizziness Other No compli- cations Number of births Number of ANC visits None 1.8 0.6 0.7 0.2 0.9 0.9 0.0 0.4 1.9 93.7 585 1-3 times 2.0 1.8 1.1 0.4 0.3 0.2 0.2 0.2 2.7 93.0 1,917 4+ times 2.4 2.7 1.0 0.4 1.3 0.3 0.4 0.4 4.0 88.6 11,448 Don't know/missing 1.2 4.0 0.0 0.0 0.0 0.4 0.0 0.0 1.4 92.9 92 Actions taken to resolve complications Nothing 24.3 4.3 13.9 5.9 2.9 9.3 0.0 6.0 46.0 na 67 Rest 41.6 17.3 13.4 7.5 1.3 4.7 2.0 12.5 34.0 na 205 Take medication 26.6 22.0 15.3 8.3 2.5 2.7 4.7 8.9 35.1 na 174 See TBA 34.5 19.3 12.3 2.6 19.9 0.5 0.0 0.0 38.4 na 90 See midwife 25.0 25.2 12.0 4.0 7.9 3.2 5.1 2.8 29.5 na 641 See doctor 16.9 34.7 8.6 4.4 13.9 1.0 5.4 1.9 32.4 na 425 Go to health facility 20.4 29.1 13.8 4.8 10.9 2.2 4.2 2.9 34.9 na 258 Other 23.9 14.9 2.7 2.3 27.4 8.9 1.7 3.6 28.4 na 124 Baby died within one month of birth 8.4 10.2 1.6 3.0 3.4 4.3 0.0 0.2 4.9 70.0 148 Delivery assisted by a health provider 2.4 3.0 1.1 0.4 1.4 0.3 0.4 0.4 4.0 88.1 10,419 Delivery by C-section 3.6 4.7 2.1 0.5 4.7 0.4 1.1 0.0 8.3 77.9 1,020 Total 2.3 2.5 1.0 0.4 1.1 0.3 0.4 0.4 3.7 89.4 14,043 Note: Total includes 15 women who took herbs and 13 women with information missing on action taken to overcome the complications na = Not applicable Maternal Health | 135 11.2 DELIVERY 11.2.1 Place of Delivery Forty-six percent of births in the five years preceding the survey were delivered in a health facility, 10 percent were delivered in a public facility (government hospital or health center), and 36 percent were delivered in a private health facility (private hospital, clinic, private doctor/midwife) (Table 11.6 and Figure 11.2). Table 11.6 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivering in a health facility, according to background characteristics, Indonesia 2007 Health facility Background characteristic Public sector Private sector Home Other Missing Total Percentage delivered in a health facility Number of births Mother's age at birth <20 8.8 27.0 62.1 0.7 1.4 100.0 35.8 1,716 20-34 9.5 37.9 51.3 0.7 0.6 100.0 47.4 12,482 35-49 11.2 35.0 52.7 0.6 0.5 100.0 46.2 2,306 Birth order 1 11.7 42.7 44.2 0.7 0.7 100.0 54.4 5,855 2-3 8.8 36.8 53.1 0.8 0.6 100.0 45.6 7,529 4-5 7.7 26.8 64.3 0.4 0.8 100.0 34.5 2,207 6+ 8.7 15.4 75.4 0.3 0.3 100.0 24.1 913 Residence Urban 12.9 57.4 28.6 0.7 0.4 100.0 70.3 6,835 Rural 7.4 21.5 69.6 0.6 0.8 100.0 28.9 9,669 Mother's education No education 5.9 9.5 81.4 1.4 1.8 100.0 15.4 579 Some primary 5.8 16.1 76.6 1.0 0.5 100.0 22.0 1,996 Complete primary 7.1 23.8 67.2 0.9 0.9 100.0 31.0 4,759 Some secondary 9.6 39.1 50.2 0.5 0.7 100.0 48.7 4,132 Secondary + 14.2 57.1 28.2 0.3 0.3 100.0 71.2 5,038 Antenatal care visits1 None 2.4 8.7 86.7 0.5 1.7 100.0 11.1 585 1-3 6.6 13.4 79.1 0.8 0.1 100.0 20.0 1,917 4+ 10.9 43.1 45.2 0.7 0.1 100.0 54.0 11,448 Don't know/missing 10.2 24.4 39.2 0.4 25.7 100.0 34.6 92 Wealth quintile Lowest 5.2 8.4 84.8 0.9 0.7 100.0 13.6 3,806 Second 8.3 23.4 66.8 0.5 1.0 100.0 31.7 3,245 Middle 11.4 36.5 51.1 0.6 0.4 100.0 47.9 3,245 Fourth 12.2 49.5 37.1 0.7 0.5 100.0 61.7 3,122 Highest 12.4 71.0 15.5 0.6 0.6 100.0 83.3 3,086 Total 9.7 36.4 52.7 0.7 0.6 100.0 46.1 16,504 1 Includes only the most recent birth in the five years preceding the survey 136 | Maternal Health Caution should be exercised when comparing data from the 2007 IDHS with previous IDHS data because responses to the “place of delivery” question are classified differently in the current survey. The 2007 IDHS includes new categories under private medical: private hospital, clinic, doctors, obstetricians and gynecologists, private midwives, private nurse, and village midwives. These are health professionals who provide delivery services at their practice site. On the other hand, delivery in the home of midwives and village midwives, which in 1997 was classified as home delivery, is currently classified under medical facility. Furthermore, health post, delivery post, and other similar facilities are classified separately in the 2007 IDHS. The percentage of deliveries in a health facility (46 percent) is substantially higher than that reported in the 1997 IDHS (21 percent) (Central Bureau of Statistics et al., 1998) and in the 2002-2003 IDHS (40 percent) (BPS and ORC Macro, 2003). Births to women in high-risk age groups (younger than 20 and 35 and older) are more likely to take place at a home (62 and 53 percent, respectively) than births to women age 20-34 (51 percent). High- order births (6+) are much more likely to take place at home (75 percent) than first-order births (44 percent). The utilization of health facilities for delivery is considerably higher in urban areas than in rural areas (70 and 29 percent, respectively). Births to mothers who have no education are much more likely to be delivered at home than births to mothers who have secondary and higher education (81 and 28 percent, respectively). There is a negative association between delivery at home and the number of ANC visits. Mothers with no antenatal care are more likely to deliver at home than mothers with four or more ANC visits (87 and 45 percent, respectively). Births to mothers who are in the lowest wealth quintile are almost five times as likely to deliver at home as births to mothers in the highest wealth quintile (85 and 16 percent, respectively). Appendix Table A-11.4 shows that there are substantial variations in the place of delivery by province. 11.2.2 Assistance during Delivery The Ministry of Health set 2010 as the target for 90 percent of births to be assisted at delivery by medical staff (Ministry of Health, 2001b). To measure progress toward this goal, respondents were asked Figure11.2 Place of Delivery and Least Qualified Delivery Assistant Place of Delivery IDHS 2007 Least Qualified Delivery Assistant Public sector 10% Private sector 36% Home 53% Other 1% Missing 1% Nurse/midwife 58% Traditional birth attendant 35% Other/Don't know 2% No one 1% OB/GYN/ Doctor 4% Maternal Health | 137 about all of the persons who assisted them during delivery. Table 11.7 shows the distribution of births by the most qualified person providing assistance during delivery. This is the person to whom the woman may have been referred if she had any problems in her pregnancy. Seventy-three percent of births in the five years preceding the survey were assisted by a medical professional; 59 percent by a nurse/midwife /village midwife; 13 percent by an obstetrician/gynecologist; and 1 percent by a doctor. Comparison with data from past IDHS surveys indicates that there has been an increase in the proportion of births assisted at delivery by medical professionals, from 66 percent in the 2002-2003 IDHS to 73 percent in the 2007 IDHS). While there has been a shift away from TBAs, these persons still have a role to play in delivery assistance, especially in rural areas (33 percent), for births to mothers with no education (50 percent), and for high-order births (47 percent). Table 11.7 Assistance during delivery: most qualified person Percent distribution of live births in the five years preceding the survey by the most qualified person providing assistance during delivery, percentage of births assisted by skilled provider, and percentage delivered by caesarean section, according to background characteristics, Indonesia 2007 Person providing assistance during delivery Background characteristic Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Total Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Mother's age at birth <20 1.0 5.7 56.0 33.6 3.2 0.6 100.0 62.6 4.2 1,716 20-34 1.1 13.3 60.4 22.5 2.1 0.6 100.0 74.8 6.9 12,482 35-49 0.7 13.9 56.5 25.1 2.7 1.1 100.0 71.1 8.4 2,306 Birth order 1 1.1 16.7 61.8 18.7 1.5 0.3 100.0 79.6 9.0 5,855 2-3 1.2 11.5 60.7 24.0 2.2 0.4 100.0 73.4 6.0 7,529 4-5 0.5 8.1 56.8 29.3 3.8 1.5 100.0 65.4 4.7 2,207 6+ 0.5 6.7 39.0 46.5 4.6 2.7 100.0 46.2 4.5 913 Place of delivery Health facility 1.7 27.2 70.9 0.1 0.1 0.0 100.0 99.8 14.8 7,601 Elsewhere2 0.4 0.1 50.0 45.0 3.7 0.8 100.0 50.5 0.1 8,798 Missing 0.0 6.0 12.5 2.9 48.3 30.2 100.0 18.5 0.0 106 Residence Urban 1.0 20.8 65.7 11.3 0.8 0.3 100.0 87.6 11.0 6,835 Rural 1.0 6.8 54.9 33.1 3.3 0.9 100.0 62.7 3.9 9,669 Mother's education No education 0.1 3.1 28.3 50.2 10.8 7.5 100.0 31.5 2.6 579 Some primary 0.4 3.5 40.7 49.6 4.7 1.1 100.0 44.7 2.3 1,996 Complete primary 0.9 5.1 56.3 34.7 2.4 0.6 100.0 62.3 2.9 4,759 Some secondary 0.9 10.0 68.4 19.0 1.6 0.2 100.0 79.3 6.5 4,132 Secondary + 1.6 26.6 65.8 5.0 0.8 0.1 100.0 94.0 13.1 5,038 Wealth quintile Lowest 0.9 2.3 40.7 48.4 6.3 1.5 100.0 43.8 1.8 3,806 Second 0.6 5.7 60.1 30.9 2.0 0.8 100.0 66.4 4.5 3,245 Middle 1.1 10.0 67.7 20.1 0.8 0.2 100.0 78.8 5.1 3,245 Fourth 0.6 15.1 71.5 11.7 0.8 0.2 100.0 87.3 7.3 3,122 Highest 1.9 33.0 60.6 3.5 0.7 0.4 100.0 95.4 16.8 3,086 Total 1.0 12.6 59.4 24.0 2.3 0.7 100.0 73.0 6.8 16,504 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. 2 Includes health post and delivery post Delivery assistance by a skilled provider varies according to background characteristics of the mother. The percentage of births delivered by a skilled provider increases with age of the mother, mother’s level of education, and wealth status. The percentage of births delivered by a skilled provider 138 | Maternal Health decreases with increasing birth order, and is higher in urban areas than in rural areas. Appendix Table A-11.5 shows the differentials across provinces in assistance during delivery by the most qualified person. Table 11.7 also shows that 7 percent of births in the five years preceding the survey were delivered by caesarean section. Women most likely to have delivery by caesarean section are those age 35-49 (8 percent), those with first-order births (9 percent), women in urban areas (11 percent), women with secondary and higher education (13 percent), and women in the highest wealth quintile (17 percent). Table 11.8 shows the distribution of births by the least qualified person providing assistance during delivery. While the assistant identified in Table 11.7 may be the person to whom the woman was referred if she had any problems with her pregnancy, Table 11.8 shows the point person in the delivery. While a medical professional was the least qualified person attending 62 percent of births, a medical professional was the most qualified person attending 73 percent of births. The difference (11 percent) suggests that some births are referred by less qualified persons to more qualified persons. The differentials in delivery assistance for the least qualified assistant by mother’s background characteristics show the same pattern as that for the most qualified assistant. Table 11.8 Assistance during delivery: least qualified person Percent distribution of live births in the five years preceding the survey by the least qualified person providing assistance during delivery, percentage of births assisted by skilled provider, and percentage delivered by caesarean section, according to background characteristics, Indonesia 2007 Person providing assistance during delivery Background characteristic Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Total Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Mother's age at birth <20 0.1 2.1 48.9 45.1 3.2 0.6 100.0 51.1 4.2 1,716 20-34 0.3 4.3 59.0 33.6 2.1 0.6 100.0 63.7 6.9 12,482 35-49 0.2 4.6 57.6 33.8 2.7 1.1 100.0 62.3 8.4 2,306 Birth order 1 0.2 5.9 62.4 29.7 1.5 0.3 100.0 68.5 9.0 5,855 2-3 0.3 3.5 58.4 35.2 2.2 0.4 100.0 62.1 6.0 7,529 4-5 0.2 2.3 52.3 39.9 3.8 1.5 100.0 54.8 4.7 2,207 6+ 0.2 2.7 37.0 52.8 4.6 2.7 100.0 39.9 4.5 913 Place of delivery Health facility 0.4 9.0 87.6 3.0 0.1 0.0 100.0 96.9 14.8 7,601 Elsewhere2 0.1 0.0 32.5 62.8 3.7 0.8 100.0 32.7 0.1 8,798 Missing 0.0 0.0 17.9 3.6 48.3 30.2 100.0 17.9 0.0 106 Residence Urban 0.1 6.3 74.0 18.4 0.8 0.3 100.0 80.5 11.0 6,835 Rural 0.3 2.6 46.3 46.5 3.3 0.9 100.0 49.3 3.9 9,669 Mother's education No education 0.0 1.8 22.8 57.1 10.8 7.5 100.0 24.6 2.6 579 Some primary 0.2 0.9 35.1 58.1 4.7 1.1 100.0 36.1 2.3 1,996 Complete primary 0.3 1.6 45.2 49.9 2.4 0.6 100.0 47.1 2.9 4,759 Some secondary 0.4 3.4 63.5 30.9 1.6 0.2 100.0 67.3 6.5 4,132 Secondary + 0.2 8.7 78.0 12.1 0.8 0.1 100.0 86.9 13.1 5,038 Wealth quintile Lowest 0.5 0.7 32.2 58.8 6.3 1.5 100.0 33.4 1.8 3,806 Second 0.2 2.3 48.5 46.2 2.0 0.8 100.0 51.0 4.5 3,245 Middle 0.1 3.2 63.2 32.4 0.8 0.2 100.0 66.5 5.1 3,245 Fourth 0.1 5.3 70.7 22.9 0.8 0.2 100.0 76.0 7.3 3,122 Highest 0.4 10.1 80.4 8.1 0.7 0.4 100.0 90.9 16.8 3,086 Total 0.3 4.1 57.8 34.9 2.3 0.7 100.0 62.2 6.8 16,504 Note: If the respondent mentioned more than one person attending during delivery, only the least qualified person is considered in this tabulation. Figures in parentheses are based on 25-49 unweighted cases. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. 2 Includes health post and delivery post Maternal Health | 139 11.2.3 Delivery Characteristics In Indonesia, caesarean sections are generally performed only for certain medical indications and for complicated deliveries (Ministry of Health, 2001c). According to the 2007 IDHS, 7 percent of births were reported as delivered by caesarean section (Table 11.9). This rate has not changed since the 1997 IDHS (Central Bureau of Statistics et al., 1998). Caesarean section is more likely to be performed for first births (9 percent), for births to mothers with secondary or higher education (13 percent), and births to mothers in the highest wealth quintile (17 percent). Caesarean section is also more common in urban areas (11 percent) than in rural areas (4 percent). Because a large proportion of deliveries take place at home, 17 percent of babies were not weighed at birth. Babies are more likely to be weighed at birth if they are born to women age 20-34, they are first-order births, the mother lives in an urban area, the mother is educated, or the mother is in the highest wealth quintile. For example, while 56 percent of births to women with no education were not weighed at birth, only 5 percent of babies born to mothers with completed secondary education were not weighed at birth. Table 11.9 shows that 6 percent of babies were reported to weigh less than 2.5 kilograms at birth. The birth weight of babies is related to the characteristics of the mother; babies are more likely to have been weighed and to have an average birth weight of 2.5 kilograms or more if they were born to mothers age 20-34, they are first births, the mother lives in an urban area, the mother is educated, and the mother is in the highest wealth quintile. Table 11.9 Delivery characteristics Percentage of births in the five years preceding the survey delivered by caesarean section and percent distribution by birth weight and by mother's estimate of baby's size at birth, according to background characteristics, Indonesia 2007 Birth weight Percent distribution of all live births by size of child at birth Background characteristic Delivery by C-section Not weighed Less than 2.5 kg 2.5 kg or more Don't know/ missing Total Very small Smaller than average Average or larger Don't know/ missing Total Number of births Mother's age at birth <20 4.2 24.3 6.4 67.2 2.1 100.0 3.1 16.5 74.7 5.7 100.0 1,716 20-34 6.9 15.6 5.4 77.7 1.3 100.0 1.9 12.2 82.3 3.6 100.0 12,482 35-49 8.4 18.4 5.5 74.8 1.3 100.0 2.9 10.8 82.1 4.3 100.0 2,306 Birth order 1 9.0 12.3 6.1 80.2 1.4 100.0 2.6 13.8 80.2 3.4 100.0 5,855 2-3 6.0 15.5 5.4 78.1 1.1 100.0 1.7 12.0 83.0 3.3 100.0 7,529 4-5 4.7 24.1 5.0 69.2 1.7 100.0 2.1 10.7 81.9 5.3 100.0 2,207 6+ 4.5 41.4 3.8 52.9 2.0 100.0 3.5 10.6 77.1 8.8 100.0 913 Residence Urban 11.0 4.5 5.4 89.3 0.8 100.0 1.9 10.9 85.8 1.4 100.0 6,835 Rural 3.9 25.7 5.6 67.0 1.7 100.0 2.3 13.5 78.5 5.7 100.0 9,669 Mother's education No education 2.6 55.7 2.7 37.6 3.9 100.0 4.4 11.8 71.9 11.9 100.0 579 Some primary 2.3 39.7 5.4 53.5 1.4 100.0 2.9 14.7 74.4 8.0 100.0 1,996 Complete primary 2.9 19.3 6.2 72.8 1.6 100.0 1.8 14.3 78.9 5.0 100.0 4,759 Some secondary 6.5 12.6 4.9 81.1 1.4 100.0 2.2 12.0 82.9 2.8 100.0 4,132 Secondary + 13.1 4.7 5.6 89.0 0.7 100.0 1.9 10.1 86.7 1.2 100.0 5,038 Wealth quintile Lowest 1.8 43.7 6.1 47.9 2.3 100.0 2.9 15.1 72.8 9.2 100.0 3,806 Second 4.5 20.3 5.6 72.4 1.6 100.0 2.0 13.1 80.2 4.7 100.0 3,245 Middle 5.1 9.1 4.2 85.8 0.9 100.0 2.0 11.4 84.8 1.8 100.0 3,245 Fourth 7.3 4.4 5.8 89.0 0.8 100.0 2.0 12.5 84.0 1.5 100.0 3,122 Highest 16.8 1.1 5.8 92.2 0.9 100.0 1.7 9.3 87.8 1.2 100.0 3,086 Total 6.8 16.9 5.5 76.2 1.3 100.0 2.2 12.4 81.5 3.9 100.0 16,504 140 | Maternal Health In the 2007 IDHS, respondents were asked about their perception of the size of their newborn. Fifteen percent of births were perceived by their mothers as being either very small or smaller than average. Differentials in the perceived size of the baby at birth across subgoups are the same as differences found in the actual weight of babies at birth. Babies that are more likely to be perceived as average in size or larger are those born to mothers age 20-34, lower-order births, births to mothers living in an urban area, babies whose mothers are educated, and babies who mothers are in the higher wealth quintiles (Table 11.9). Differentials in delivery characteristics by province are shown in Appendix Table A-11.6. 11.2.4 Preparation for Delivery To ensure the safety of the mother and infant at the time of delivery, certain preparations need to be made. These include deciding who is going to assist in the delivery, where the delivery is going to take place, how the woman is going to get to the place of delivery, and how much the delivery is going to cost. In the 2007 IDHS, respondents were asked whether they had discussed at least one topic related to preparation for delivery. Table 11.10 shows that 78 percent of women reported that issues related to the baby’s delivery were discussed with their spouse. The subjects discussed most often were place of delivery, delivery assistant, and payment for services (64 to 69 percent). Less often discussed were issues of transportation (43 percent) and potential blood donors (8 percent). Table 11.10 Preparation for delivery Percentage of women who had a live birth in the five years preceding the survey who discussed specific topics during pregnancy for the most recent birth, according to background characteristics, Indonesia 2007 Topics discussed Background characteristic Place to deliver Trans- portation Delivery assistance Payment Blood donor Any topic No topics discussed Number of births Age 15-19 56.4 33.3 57.9 51.4 6.6 68.0 32.0 418 20-24 68.7 42.2 69.6 65.5 7.2 80.1 19.9 2,954 25-29 72.3 45.6 72.5 66.8 8.5 80.9 19.1 3,885 30-34 70.0 45.1 68.8 64.5 9.7 77.7 22.3 3,305 35-39 66.8 42.8 67.6 66.0 8.5 76.8 23.2 2,331 40-44 60.3 36.2 62.4 56.9 7.9 69.8 30.2 909 45-49 53.1 32.6 56.1 47.3 5.6 64.0 36.0 241 Marital status Married 68.6 43.2 68.9 64.6 8.3 78.1 21.9 13,691 Divorced/separated/ widowed 63.1 37.8 64.9 56.0 9.4 72.2 27.8 351 Residence Urban 77.4 51.2 74.2 71.5 11.3 84.4 15.6 5,897 Rural 62.0 37.3 65.0 59.3 6.2 73.2 26.8 8,145 Education No education 34.3 17.3 37.7 30.0 3.4 42.9 57.1 458 Some primary 53.4 26.9 56.3 50.1 3.7 65.5 34.5 1,677 Complete primary 58.7 33.7 60.8 58.3 5.3 71.1 28.9 4,106 Some secondary 72.3 45.0 72.1 68.0 7.5 82.3 17.7 3,543 Secondary + 84.3 59.8 82.1 76.6 14.4 89.4 10.6 4,260 Wealth quintile Lowest 54.8 29.3 58.3 52.9 5.2 66.7 33.3 3,010 Second 61.9 38.2 65.2 61.2 6.3 74.9 25.1 2,791 Middle 67.2 40.8 68.2 63.7 8.0 77.8 22.2 2,812 Fourth 75.5 48.5 72.9 69.9 8.7 83.6 16.4 2,742 Highest 85.0 60.6 81.0 75.9 14.0 87.9 12.1 2,688 Total 68.5 43.1 68.8 64.4 8.3 77.9 22.1 14,043 Maternal Health | 141 Mothers in urban areas, better educated mothers, and those in the highest wealth quintile are more likely than other mothers to discuss issues related to their baby’s delivery. For example, mothers with secondary or higher education are almost twice as likely to discuss topics related to the delivery as mothers with no education (89 and 43 percent, respectively). Currently married men who had a child in the five years preceding the survey were asked whether they had discussed preparations for their child’s delivery. (The findings are presented in Chapter 18.) Figure 11.3 compares the responses of the mothers and fathers. It is interesting to note that fathers are as likely as mothers to report having had discussions on aspects of their child’s birth. Appendix Table A-11.7 shows the variations across provinces in preparations for delivery. 11.2.5 Complications during Delivery To identify complications associated with delivery, respondents were asked about certain signs and symptoms that they had experienced during their most recent birth in the five years preceding the survey. Table 11.11 shows that 53 percent of women reported having no complications during delivery. Prolonged labor was reported for 37 percent of births, water broke more than six hours before delivery was reported for 17 percent of births, and excessive vaginal bleeding was reported for 9 percent of births. Two other complications, fever/foul smelling vaginal discharge and maternal convulsions occurred less frequently (7 and 2 percent, respectively). Women assisted by a health professional during delivery—regardless of whether they received antenatal care or not—are the most likely to report delivery complications. As expected, women who give birth by caesarean section were more likely to report complications (64 percent). Most of the complications are related to prolonged labor (39 percent). For babies who died within one month of birth, 59 percent of the mothers reported complications, including prolonged labor (38 percent), water broke more than six hours before delivery (21 percent), and excessive vaginal bleeding (19 percent). There are negligible differences in the prevalence of delivery complications by urban-rural residence (data not shown). 69 46 43 25 69 48 64 40 8 7 78 56 22 44 Mothers Fathers 0 20 40 60 80 100 Percent Place of delivery Transportation Delivery assistance Payment Blood donor Any topic No topics discussed Figure 11.3 Topics Discussed Regarding Preparation for Delivery IDHS 2007 142 | Maternal Health Table 11.11 Complications during delivery Percentage of last births in the five years preceding the survey for which the mother had complications associated with delivery, by type of complication and maternity care indicators, Indonesia 2007 Maternity care indicators Prolonged labor Excessive vaginal bleeding Fever/foul- smelling vaginal discharge Convul- sions Water broke >6 hours before delivery Other No compli- cations Number of births Antenatal care/delivery assistance Both ANC and DA 39.8 9.4 7.2 1.9 18.1 4.6 49.7 8,836 ANC only 29.8 8.4 6.3 2.2 13.7 2.2 61.5 3,099 DA only 37.0 8.9 6.9 1.2 17.7 4.2 50.4 1,002 Neither ANC or DA 29.8 6.6 4.6 3.0 11.4 3.8 62.0 1,105 Baby died within one month of birth 38.1 19.2 9.5 9.3 21.1 7.7 40.7 148 Delivery by C-section 38.5 11.8 8.8 3.6 22.4 15.7 35.8 1,020 Total 36.6 8.9 6.8 2.0 16.5 4.0 53.3 14,043 Note: For ANC and DA, providers included only doctor, nurse, midwife, and/or village midwife. ANC = Antenatal care DA = Delivery assistance 11.3 POSTNATAL CARE Postnatal care (PNC) is important for the welfare of the mother and the child. It provides an opportunity to treat complications arising from the delivery, and provides the mother with important information on how to care for herself and her infant. The postnatal period is defined as the time between delivery of the placenta and 42 days (6 weeks) following delivery. The timing of postnatal care is important because the first two days after delivery are critical; most maternal and neonatal deaths occur during this period. In the 2007 IDHS, respondents were asked if they had received postnatal care for the last delivery. Overall, eight in ten women received postnatal care; 70 percent receiving PNC within 2 days of delivery, 6 percent within 3-6 days after delivery, and 7 percent between 7 and 41 days after delivery. One in six women did not receive any postnatal care. Table 11.12 shows that mother’s age is associated with the likelihood of receiving postnatal care; younger women are slightly more likely to have a checkup after delivery than older women. Women with higher-order births are less likely to receive PNC than those with lower-order births. There are slight differences in postnatal care coverage between women in rural and urban areas. As expected, PNC coverage increases with women’s level of education and wealth status. Forty percent of mothers with no education and 77 percent of mothers in the lowest wealth quintile had no postnatal care. Appendix Table A-11.8 shows the variations in postnatal care coverage by province. Maternal Health | 143 Table 11.12 Postnatal care by background characteristics Percent distribution of women who had a noninstitutional live birth in the five years preceding the survey by timing of postnatal care for the most recent noninstitutional birth, according to background characteristics, Indonesia 2007 Time after delivery of mother's first postnatal checkup Background characteristic Within 2 days of delivery 3-6 days after delivery 7-41 days after delivery Don't know/ missing No postnatal checkup1 Total Number of women Mother's age at birth <20 71.8 6.5 6.8 0.5 14.4 100.0 861 20-34 70.6 6.2 7.2 0.2 15.8 100.0 5,415 35-49 67.5 5.1 6.6 0.1 20.8 100.0 1,104 Birth order 1 69.5 7.4 9.5 0.3 13.3 100.0 2,139 2-3 72.5 6.1 6.2 0.1 15.0 100.0 3,496 4-5 71.1 5.3 4.8 0.1 18.8 100.0 1,186 6+ 57.7 2.6 7.7 0.4 31.6 100.0 560 Residence Urban 69.1 6.5 9.7 0.1 14.5 100.0 1,713 Rural 70.6 5.9 6.3 0.2 17.0 100.0 5,667 Mother's education No education 53.9 1.8 2.9 1.4 39.9 100.0 386 Some primary 63.2 6.5 6.4 0.3 23.6 100.0 1,272 Complete primary 71.3 7.0 7.3 0.2 14.3 100.0 2,782 Some secondary 75.6 5.1 5.8 0.1 13.4 100.0 1,777 Secondary + 72.8 6.4 10.4 0.1 10.4 100.0 1,164 Wealth quintile Lowest 66.6 5.4 5.0 0.4 22.7 100.0 2,585 Second 70.4 6.2 6.2 0.1 17.1 100.0 1,885 Middle 74.3 6.2 8.6 0.1 10.8 100.0 1,447 Fourth 74.7 5.5 10.0 0.1 9.8 100.0 1,023 Highest 67.8 10.5 10.9 0.1 10.7 100.0 440 Total 70.3 6.1 7.0 0.2 16.4 100.0 7,380 Note: Noninstitutional includes respondent’s home, other home, health post, delivery post and other places of delivery. 1 Includes women who received a checkup after 41 days 11.4 MATERNAL HEALTH CARE AND WOMEN’S STATUS Since the 2002-2003 IDHS, data have been collected on indicators of women’s status. These indicators are: number of decisions in which women participate, number of reasons given for refusing to have sexual intercourse with husband, and number of reasons for which wife beating is justified. Table 11.13 shows the relationship between women’s status indicators and receipt of maternal health services (antenatal care, postnatal care, and delivery care) from a medical professional. Of the three indicators, the number of reasons for a woman to refuse to have sexual intercourse with her husband shows the strongest positive association with receipt of maternal health care. Women who agree with more reasons to refuse sexual intercourse with their husband are more likely to receive antenatal care, postnatal care, and delivery care from a medical professional than women who agree with fewer reasons. For example, 94 percent of women who feel it justifiable to refuse to have sexual intercourse with their husband for 5 reasons received antenatal care, compared with only 83 percent of women who said there was no justifiable reason to refuse sexual intercourse with their husband. 144 | Maternal Health Table 11.13 Maternal health care and women's status Percentage of women with a live birth in the five years preceding the survey who received antenatal and postnatal care from health personnel for the most recent birth, and percentage of births in the five years preceding the survey for which mother's received professional delivery care, by women's status indicators, Indonesia 2007 Woman's status indicator Received antenatal care from doctor/ nurse/midwife/ village midwife Received postnatal care within the first two days of delivery1 Number of women Births for which mothers received delivery care from doctor/ nurse/midwife/ village midwife Number of births Number of decisions in which women participate2 0 88.4 59.1 123 72.4 152 1-2 90.7 70.0 927 68.5 1,089 3-4 92.5 75.6 3,780 71.7 4,435 5 94.4 73.2 8,861 74.2 10,441 Number of reasons given for refusing to have sexual intercourse with husband 0 82.8 58.1 703 58.5 877 1-2 90.5 69.5 1,521 68.4 1,774 3-4 94.3 74.9 11,819 74.5 13,852 Number of reasons for which wife beating is justified 0 94.0 73.1 9,230 75.7 10,722 1-2 93.4 74.8 3,530 71.9 4,182 3-4 87.7 71.6 1,042 58.0 1,310 5 87.4 73.5 241 56.5 290 Total 93.3 73.4 14,043 73.0 16,504 1 Includes mothers who delivered in a health facility 2 Either by herself or jointly with others 11.5 PROBLEMS IN ACCESSING HEALTH CARE Many factors can prevent women from getting medical advice or treatment for themselves when they need it. In this survey, all women were asked if getting medical advice or treatment for themselves was a big problem or not, with respect to the following: knowing where to go, getting permission to go, getting money needed for treatment, distance to the health facility, having to take transport, not wanting to go alone, and concern that there may not be a female health provider. Table 11.14 shows the percentage of ever-married women who reported having big problems in accessing health care by background characteristics. Forty-one percent of women reported having at least one problem in accessing health care. The most often cited problem was getting money for treatment (25 percent). Other concerns included distance to the health facility (15 percent), having to take transport (13 percent), and concern that no female provider would be available (11 percent). Younger women, women with many children, women who are no longer married, those who live in rural areas, women with no education, and women from the poorest households are more likely to report problems in accessing health care than other women. The 2002-2003 IDHS shows the same general pattern in accessing health care; the main problems are economic (24 percent) and the distance to the health facility and transportation (12 percent each). Appendix Table A-11.9 shows the differentials in problems women have in accessing health care by province. Maternal Health | 145 Table 11.14 Problems in accessing health care Percentage of ever-married women who reported that they have big problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Indonesia 2007 Problems in accessing health care Background characteristic Knowing where to go for treatment Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern no female provider available At least one problem accessing health care Number of women Age 15-19 8.1 6.6 31.8 21.1 18.5 25.1 17.3 55.2 845 20-29 5.7 4.3 24.8 16.6 14.2 14.6 13.6 43.9 9,866 30-39 5.3 4.0 25.8 15.3 13.4 10.1 9.9 40.3 12,024 40-49 4.9 4.0 24.1 13.6 11.9 10.9 8.0 37.5 10,160 Number of living children 0 6.4 5.1 24.3 15.9 14.8 18.6 19.1 46.6 2,687 1-2 5.1 3.6 23.3 14.6 12.5 12.6 10.7 39.9 18,545 3-4 4.9 4.3 26.1 14.7 12.9 9.1 8.1 38.7 8,908 5+ 7.8 6.7 35.0 21.6 18.7 12.4 10.2 48.8 2,754 Marital status Married 5.3 4.2 24.4 15.2 13.2 12.3 10.7 40.5 30,931 Divorced/separated/ widowed 6.5 3.4 35.9 16.6 14.8 9.4 9.3 47.0 1,964 Residence Urban 3.5 2.5 19.9 7.1 5.5 8.2 9.6 33.1 13,745 Rural 6.7 5.4 28.9 21.2 18.9 14.9 11.4 46.5 19,150 Education No education 11.3 8.6 40.8 31.7 28.2 20.3 10.0 57.4 2,271 Some primary 6.8 6.0 32.4 20.8 18.4 15.3 11.3 47.9 5,572 Complete primary 4.9 3.5 27.5 16.3 14.6 12.0 10.7 43.7 10,077 Some secondary 4.9 3.7 23.9 13.2 11.1 11.8 11.0 40.7 6,781 Secondary + 3.8 2.9 13.9 7.6 5.9 8.0 10.0 28.3 8,193 Wealth quintile Lowest 11.0 9.4 45.9 34.8 32.5 19.5 12.1 61.7 6,219 Second 5.4 4.6 30.3 19.0 16.5 12.7 10.8 46.5 6,606 Middle 4.8 3.1 23.0 11.8 9.4 10.8 10.5 40.2 6,710 Fourth 3.4 2.2 17.7 7.8 5.8 10.1 9.8 33.1 6,713 Highest 2.6 2.0 10.1 4.6 3.7 7.8 10.2 24.5 6,647 Employed in past 12 months Not employed 5.3 4.3 25.4 14.9 12.9 11.5 10.0 40.2 12,949 Employed for cash 4.5 3.3 22.8 12.5 10.7 11.0 10.2 38.0 13,453 Employed not for cash 7.2 5.6 29.3 22.0 19.4 15.7 12.8 48.5 6,446 Missing 11.4 10.7 36.5 20.0 21.6 13.3 8.9 47.7 47 Total 5.4 4.2 25.1 15.3 13.3 12.1 10.6 40.9 32,895 11.6 BIRTH REGISTRATION Birth registration is recognized as one of children’s rights in Indonesia. While registration is compulsory, Indonesia has never had a comprehensive registration system for either statistical or legal purposes. The Government of Indonesia has carried out initiatives on a pilot basis to revive the civil registration system in the country with no apparent success. In the 2007 IDHS, mothers were asked—for their children born since January 2002—if the births had been registered. Mothers who gave a positive response to this question were asked to show any records they had for their children; these could be one 146 | Maternal Health or more of the following documents: a hospital record, a record issued by the village office, a proof of birth issued by the regency or municipality office as substitute for the birth certificate, and a birth certificate (legal document issued by the civil registrar). Table 11.15 shows the distribution of births in the five years preceding the survey by whether the births were registered and the type of certificate obtained. Overall, 53 percent of these births were reported as registered. However, for 10 percent of births the document was not shown to the interviewer. Three percent of births have a village record and 2 percent have proof of birth issued by the regency or municipality office. Among registered births, 63 percent have a birth certificate and 22 percent have a hospital record. Coverage of birth certificates is highest for births to mothers age 30-34 (57 percent), mothers who live in urban areas (71 percent), mothers who have completed secondary or higher education (74 percent), and mothers in the highest wealth quintile (84 percent). Table 11.15 Birth registration Percent distribution of births in the five years preceding the survey that were registered, and of those registered, percent distributed by type of certificate, according to background characteristics, Indonesia 2007 Registration document Background characteristic Percent of births registered Number of births Not seen Hospital record Village record Proof of birth Birth certificate Missing Total Number of registered births Age 15-19 38.9 471 10.7 24.3 6.2 1.3 57.5 0.0 100.0 183 20-24 51.7 3,448 12.6 20.4 3.5 2.1 61.3 0.2 100.0 1,784 25-29 54.4 4,642 10.6 20.9 1.9 2.8 63.3 0.4 100.0 2,524 30-34 57.4 3,879 7.3 22.9 2.1 1.3 66.1 0.3 100.0 2,227 35-39 53.5 2,784 9.1 21.9 2.3 3.0 63.5 0.2 100.0 1,489 40-44 47.5 1,023 11.5 19.9 2.5 2.8 63.1 0.2 100.0 486 45-49 48.5 257 19.6 29.5 7.7 2.2 41.0 0.0 100.0 125 Residence Urban 70.5 6,835 7.5 18.6 1.7 2.1 70.0 0.2 100.0 4,818 Rural 41.4 9,669 13.3 25.2 3.6 2.5 55.0 0.4 100.0 3,999 Education No education 17.5 579 12.3 31.0 0.8 5.8 50.0 0.0 100.0 101 Some primary 30.3 1,996 13.5 36.3 5.7 5.3 39.1 0.1 100.0 606 Complete primary 44.2 4,759 9.9 26.8 5.4 1.3 56.4 0.2 100.0 2,104 Some secondary 55.2 4,132 11.6 22.3 2.3 2.1 61.5 0.2 100.0 2,279 Secondary + 74.0 5,038 8.7 15.5 0.6 2.3 72.4 0.4 100.0 3,727 Wealth quintile Lowest 22.9 3,806 15.0 32.5 3.7 3.4 44.8 0.5 100.0 871 Second 44.1 3,245 15.5 25.5 4.0 2.9 52.0 0.2 100.0 1,432 Middle 56.2 3,245 10.2 23.6 4.2 2.3 59.2 0.5 100.0 1,825 Fourth 67.3 3,122 8.7 22.9 2.0 2.4 63.8 0.2 100.0 2,102 Highest 83.8 3,086 6.5 13.3 0.6 1.4 78.0 0.1 100.0 2,588 Total 53.4 16,504 10.1 21.6 2.6 2.3 63.2 0.3 100.0 8,817 The 2007 IDHS reported higher coverage of birth certificates than the 2005 Intercensal Population Survey (SUPAS) (63 percent, compared with 43 percent). The coverage of birth certificates among children under five in the 2005 SUPAS was also higher in urban areas than in rural areas (59 and 31 percent, respectively) (BPS, 2006). Appendix Table A-11.10 shows that there are large differentials in birth registration coverage by province. Maternal Health | 147 Table 11.16 shows the distribution of births that were not registered by reason for not registering the birth, according to background characteristics. The reasons cited most often have to do with cost; either the respondent said that registering the birth cost too much (26 percent), or the respondent did not want to pay the late fee (3 percent). Mothers’ knowledge about birth registration is limited; 12 percent of women who gave birth in the five years preceding the survey did not know that a child has to be registered, and 8 percent of women did not know where to register the birth. While 8 percent of women said that the place for registration of births is too far away, 41 percent of women did not give any reason for not registering their children’s births. It is interesting to note that women with the highest education and women in the highest wealth quintile are the most likely to fail to give specific reasons for not registering the births. Appendix Table A-11.11 shows reasons for not registering births by province. Table 11.16 Reason for not registering birth Percent distribution of births in the five years preceding the survey that were not registered by reason for not registering birth, according to background characteristics, Indonesia 2007 Reason for not registering birth Background characteristic Costs too much Too far Did not know child has to be registered Late, did not want to pay fine Did not know where to register Other Missing Total Number of births not registered Age 15-19 19.1 6.7 15.2 1.2 15.2 40.4 2.2 100.0 288 20-24 24.3 8.8 12.7 2.7 9.3 40.5 1.7 100.0 1,665 25-29 23.9 9.7 10.9 2.6 8.1 43.1 1.7 100.0 2,118 30-34 26.4 8.7 12.5 3.4 7.3 40.0 1.8 100.0 1,652 35-39 28.8 6.3 12.3 1.5 7.5 42.2 1.4 100.0 1,295 40-44 34.5 5.0 11.7 2.7 8.9 34.5 2.8 100.0 537 45-49 24.5 5.9 21.0 2.2 10.6 33.8 2.0 100.0 133 Residence Urban 27.4 4.6 5.9 3.4 3.9 52.9 1.8 100.0 2,017 Rural 25.4 9.5 14.5 2.2 10.1 36.6 1.8 100.0 5,670 Education No education 23.3 6.4 24.3 0.3 18.5 25.0 2.2 100.0 478 Some primary 31.2 8.1 13.9 1.7 14.1 29.6 1.4 100.0 1,391 Complete primary 30.2 9.0 12.0 2.1 7.6 36.9 2.2 100.0 2,654 Some secondary 23.6 8.1 11.2 3.1 6.0 46.7 1.3 100.0 1,852 Secondary + 16.0 7.6 8.0 4.3 3.9 58.4 1.8 100.0 1,312 Wealth quintile Lowest 26.4 11.2 17.8 1.7 12.6 28.9 1.4 100.0 2,935 Second 30.1 8.1 12.7 2.3 7.2 37.5 2.1 100.0 1,813 Middle 25.8 5.6 7.3 3.4 6.6 49.9 1.4 100.0 1,420 Fourth 23.9 5.8 6.2 3.1 4.0 54.6 2.4 100.0 1,020 Highest 12.0 4.0 4.6 4.8 2.8 69.3 2.5 100.0 499 Total 25.9 8.2 12.2 2.5 8.4 40.9 1.8 100.0 7,687 Immunization of Children | 149 IMMUNIZATION OF CHILDREN 12 The Expanded Program on Immunization (EPI) launched by the World Health Organization (WHO) in 1977 was adopted by the Indonesian Ministry of Health (MOH). Universal immunization of children against the six vaccine-preventable diseases—tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles—is crucial in reducing infant and child mortality. Differences in immunization coverage among subgroups of the population are useful for program planning and targeting resources to areas most in need. Additionally, information on immunization coverage is important for monitoring and evaluation of the EPI. The 2007 IDHS collected information on immunization coverage for all living children born in the five years preceding the survey. According to WHO guidelines, children are considered fully immunized when they have received one dose of the vaccine against tuberculosis (BCG), three doses each of the DPT and polio vaccines, and one dose of measles vaccine. BCG is given at birth or at first clinical contact; DPT and polio require three doses at approximately 6, 10, and 14 weeks of age; and measles vaccine is given soon after 9 months of age. In 1997, the Indonesian MOH expanded the program to include three doses of the Hepatitis B (HB) vaccine, to be given before a child’s first birthday (MOH, 2003). In Indonesia, infants and young children receive basic immunizations from various personnel in several venues, including the Integrated Service Posts (Posyandu) managed by staff from the community (kader desa); the Village Maternity Clinics (Polindes) managed by the village midwife (bidan desa); the Community Health Centers (Puskesmas); and government and/or private hospitals or clinics. In Posyandu, the health services include child growth monitoring, immunizations, management and treatment of diarrhea and other childhood diseases, information, education and communication on family planning, and treatment of illnesses. During the first visit, each child receives a health card (Kartu Menuju Sehat, KMS). During the mother’s first antenatal care visit, she receives a maternal and child health book (Buku Kesehatan Ibu dan Anak or KIA), which is used to record basic information on the mother and her child. The information on the child includes birth weight, monthly weight, and type and dates of immunizations. Finally, information about the child’s immunizations is recorded in a registration book maintained by the field administrator of vaccines. Even though most mothers are aware of the importance of keeping the health card/book at home for their records, to be able to monitor their child’s growth and keep track of immunizations, not all keep these documents for their records. Furthermore, not all infants receive postnatal care and therefore not all have a health card. In the 2007 IDHS, data on child immunization were collected for all living children age 12-59 months. Information on vaccination coverage was collected in two ways: from the child’s health card or the maternal and child health book shown to the interviewer, and from the mother’s report. If the health cards or the health books were available, the interviewer copied the immunization dates directly onto the questionnaire. When there was no health card for the child or maternal and child health book, or if a vaccine had not been recorded on these documents as being administered, the respondent was asked to recall the specific vaccines given to her child. The recording of polio immunizations in the 2002-2003 and 2007 IDHS surveys was done differently from the 1994 and 1997 IDHS surveys. The two most recent surveys recorded information on polio vaccines 1 through 4, while the earlier surveys recorded information on polio vaccines 0 to 3. In the most recent IDHS surveys, a child is considered fully immunized if she/he has received BCG, measles and three doses each of DPT and polio vaccine (polio 1 through 3, except for polio 4). 150 | Immunization of Children 12.1 IMMUNIZATION COVERAGE FOR CHILDREN AGE 12-23 MONTHS Table 12.1 and Figure 12.1 show the percentage of children age 12-23 months who have received various immunizations by source of information (health card or health book or mother’s report). This is the youngest cohort of children who have reached the age by which they should be fully immunized. Overall, 51 percent of children age 12-23 months were fully immunized by the time of the survey. With regard to specific vaccines, 87 percent of children age 12-23 months had received the first dose of polio, 83 percent had received the first dose of DPT vaccine, and 84 percent had received BCG vaccine. Although coverage for the first doses of DPT and polio is relatively high (83 and 87 percent, respectively), only 64 and 71 percent, respectively, went on to receive the third dose of DPT and polio. The dropout between the first and third doses of polio is noticeable, 23 percent for DPT and 18 percent for polio. Sixty-seven percent of children age 12-23 months received immunization against measles. Data show that about one in ten children 12-23 months (11 percent) did not receive any vaccinations at all. Table 12.1 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (health card or mother's report), and percentage vaccinated by 12 months of age, Indonesia 2007 DPT Polio Source of information BCG 1 2 3 1 2 3 Measles All basic vaccina- tions1 No vaccina- tions Number of children Vaccinated at any time before survey Health card 34.6 35.8 33.3 31.2 35.9 33.9 32.3 30.9 27.0 0.0 1,139 Mother's report 50.8 48.7 42.4 35.4 53.3 48.6 41.2 45.5 31.6 8.5 1,955 Either source 85.4 84.4 75.7 66.7 89.2 82.6 73.5 76.4 58.6 8.6 3,094 Vaccinated by 12 months of age 84.4 82.9 73.7 64.3 87.2 81.0 71.1 67.0 50.7 10.7 3,094 Note: For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. 1 BCG, measles and three doses each of DPT and polio vaccine (except polio 4) 84 83 74 64 87 81 71 67 51 11 BCG DPT 1 2 3 POLIO 1 2 3 Measles All No vaccinations 0 20 40 60 80 100 Percent Figure 12.1 Percentage of Children Age 12-23 Months Vaccinated by 12 Months of Age (Information from Health Cards and Mothers’ Reports) IDHS 2007 Immunization of Children | 151 When compared with the data from the 2002-2003 IDHS, immunization coverage among children has increased for all vaccines. The overall basic coverage increased by 7 percentage points, from 44 percent in 2002-2003 to 51 percent in 2007. On the other hand, the percentage of children who did not receive any vaccinations remained the same (11 percent) between the two surveys (BPS and ORC Macro, 2003). Appendix Table A-12.1 shows the variation in immunization coverage across provinces. Table 12.2 shows the percentage of children age 12-23 months who received specific vaccines at any time before the survey, by background characteristics. Information on children’s immunizations collected from health cards is presented in the top panel; information from mother’s recall is in the middle panel; and information from both sources is in the bottom panel. The data show that health cards were seen at the time of the interview for 37 percent of children age 12-23 months, an increase of six percentage points from the 2002-2003 IDHS (31 percent). Among children with health cards, 73 percent had received all the recommended vaccines, which is a slight increase from the coverage reported in the 2002-2003 IDHS. According to the information on the health cards, the highest coverage is for BCG, DPT 1 and DPT 2, and polio 1 (90 percent or higher), while the lowest coverage is for polio 4 (77 percent). Immunization coverage according to the health cards varies by background characteristics. Girls are more likely than boys to have been fully immunized, and urban children are more likely than rural children to have been fully immunized. A positive correlation is seen between the likelihood of a child being fully immunized and mother’s level of education and wealth status; there is a negative correlation between vaccination coverage and children’s birth order. Table 12.2 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to health card or mother's report), and percentage with a vaccination card, by background characteristics, Indonesia 2007 DPT Polio Background characteristic BCG 1 2 3 1 2 3 4 Measles All1 No vaccina- tions Percentage with health card seen Number of children HEALTH CARD Sex Male 93.5 96.8 89.1 83.3 97.0 90.7 86.9 76.2 83.6 70.1 0.0 100.0 614 Female 94.4 97.6 92.3 86.5 98.4 93.9 88.7 76.9 84.2 77.1 0.3 100.0 525 Birth order 1 94.1 97.8 91.6 87.4 96.1 91.7 88.4 78.4 84.5 76.0 0.0 100.0 478 2-3 93.9 97.5 91.1 84.8 99.2 93.9 88.7 76.0 83.0 72.4 0.1 100.0 509 4-5 93.3 93.6 88.3 80.2 97.4 89.4 85.3 75.2 86.0 70.8 0.7 100.0 126 6+ (95.6) (95.1) (73.2) (59.5) (95.7) (81.1) (67.2) (58.4) (80.2) (53.1) (0.0) 100.0 26 Residence Urban 95.7 98.2 93.0 87.4 99.4 94.5 90.7 80.3 83.2 76.5 0.1 100.0 486 Rural 92.7 96.3 88.8 82.8 96.3 90.4 85.5 73.7 84.5 70.9 0.1 100.0 653 Mother's education No education * * * * * * * * * * * 100.0 13 Some primary 95.3 88.1 81.3 73.4 99.1 92.7 84.3 77.1 83.7 66.5 0.0 100.0 84 Complete primary 91.0 97.6 87.1 79.0 97.0 88.8 82.4 66.7 82.0 69.0 0.2 100.0 344 Some secondary 93.4 97.7 92.0 87.6 98.4 93.4 90.4 83.2 83.0 77.3 0.0 100.0 308 Secondary + 97.4 99.2 95.6 91.6 97.5 95.0 91.9 80.7 87.2 77.0 0.0 100.0 391 Wealth quintile Lowest 87.4 93.6 80.7 71.9 98.1 87.8 78.5 70.6 81.0 62.2 0.4 100.0 164 Second 93.4 97.9 92.2 84.3 95.7 90.9 87.1 72.1 85.9 72.8 0.1 100.0 209 Middle 91.3 95.0 90.0 86.0 98.0 93.6 88.8 77.2 88.1 75.7 0.0 100.0 239 Fourth 97.7 98.8 93.6 87.9 97.1 93.4 88.5 76.0 80.5 73.2 0.0 100.0 296 Highest 97.0 99.0 92.8 89.2 99.5 93.3 92.7 84.6 84.3 79.2 0.3 100.0 232 Total 93.9 97.1 90.6 84.8 97.6 92.2 87.7 76.5 83.9 73.3 0.1 100.0 1,139 Continued… 152 | Immunization of Children Table 12.2—Continued DPT Polio Background characteristic BCG 1 2 3 1 2 3 4 Measles All1 No vaccina- tions Percentage with health card seen Number of children MOTHER’S REPORT Sex Male 81.6 77.1 66.0 54.7 83.9 76.6 63.2 41.0 69.9 48.0 14.3 0.0 1,008 Female 79.2 76.9 68.1 57.5 84.7 77.3 67.2 45.6 74.4 52.1 12.7 0.0 948 Birth order 1 85.5 82.6 71.7 62.1 87.3 80.1 69.5 47.1 74.6 53.9 10.3 0.0 661 2-3 80.4 77.4 68.4 55.4 84.6 78.6 66.1 43.6 73.2 50.5 13.5 0.0 874 4-5 73.1 69.1 60.2 50.9 79.6 71.0 59.9 38.6 66.8 45.7 17.9 0.0 289 6+ 71.7 63.4 49.3 41.8 77.4 63.5 48.6 31.9 63.1 36.2 20.6 0.0 131 Residence Urban 89.8 87.1 77.8 67.0 91.6 86.4 77.0 53.9 81.3 61.9 7.6 0.0 788 Rural 74.2 70.2 59.8 48.8 79.4 70.6 57.1 36.0 65.8 41.9 17.5 0.0 1,167 Mother's education No education 56.0 43.9 38.3 26.0 62.6 41.6 25.7 11.1 47.4 17.2 37.4 0.0 56 Some primary 63.5 53.7 43.8 34.2 69.6 60.9 49.1 23.4 57.1 28.1 26.6 0.0 268 Complete primary 73.7 71.1 59.6 48.1 79.3 70.0 54.9 34.9 64.1 41.6 18.2 0.0 554 Some secondary 83.6 80.6 68.1 56.5 86.7 79.2 65.7 47.8 71.2 49.0 10.3 0.0 447 Secondary + 93.6 92.4 85.2 74.8 95.1 91.5 84.0 58.6 88.2 70.2 4.0 0.0 631 Wealth quintile Lowest 64.9 57.8 46.2 35.5 70.3 61.6 46.7 25.9 57.1 31.4 26.9 0.0 471 Second 78.2 73.4 62.0 50.6 82.4 72.1 56.3 34.0 68.1 42.0 12.8 0.0 379 Middle 80.9 81.1 71.5 55.0 86.8 79.8 67.3 46.4 72.2 47.6 11.3 0.0 396 Fourth 91.3 89.0 79.1 70.1 94.2 86.9 79.4 60.6 82.6 63.6 5.4 0.0 350 Highest 92.1 89.8 82.9 76.3 92.2 89.5 82.4 55.3 85.3 72.2 7.2 0.0 360 Total 80.5 77.0 67.0 56.1 84.3 77.0 65.2 43.2 72.0 50.0 13.5 0.0 1,955 HEALTH CARD AND MOTHER’S REPORT Sex Male 86.1 84.5 74.7 65.6 88.9 82.0 72.2 54.4 75.1 56.4 8.9 37.9 1,622 Female 84.7 84.3 76.8 67.9 89.6 83.2 74.8 56.7 77.9 61.0 8.2 35.6 1,472 Birth order 1 89.1 89.0 80.0 72.7 91.0 85.0 77.4 60.2 78.8 63.2 6.0 41.9 1,139 2-3 85.4 84.8 76.8 66.3 90.0 84.2 74.4 55.5 76.8 58.6 8.6 36.8 1,382 4-5 79.2 76.5 68.7 59.8 85.0 76.6 67.6 49.7 72.6 53.3 12.6 30.4 416 6+ 75.7 68.7 53.3 44.8 80.5 66.4 51.7 36.3 66.0 39.0 17.1 16.7 158 Residence Urban 92.0 91.3 83.6 74.8 94.6 89.5 82.2 64.0 82.0 67.5 4.7 38.1 1,274 Rural 80.8 79.5 70.2 61.0 85.4 77.7 67.3 49.5 72.5 52.3 11.3 35.9 1,820 Mother's education No education 59.2 48.2 42.1 28.7 67.7 45.9 32.0 17.7 49.4 18.6 31.5 18.5 69 Some primary 71.1 61.9 52.7 43.5 76.6 68.5 57.5 36.2 63.5 37.3 20.3 23.8 352 Complete primary 80.3 81.3 70.1 59.9 86.1 77.2 65.4 47.1 71.0 52.1 11.3 38.3 898 Some secondary 87.6 87.6 77.9 69.2 91.5 85.0 75.8 62.3 76.0 60.6 6.1 40.8 754 Secondary + 95.0 95.0 89.1 81.2 96.0 92.8 87.1 67.1 87.8 72.8 2.5 38.2 1,022 Wealth quintile Lowest 70.7 67.1 55.1 44.9 77.5 68.4 54.9 37.5 63.3 39.4 20.0 25.8 635 Second 83.6 82.1 72.8 62.6 87.1 78.8 67.2 47.5 74.4 53.0 8.3 35.5 587 Middle 84.8 86.3 78.5 66.7 91.0 85.0 75.4 58.0 78.2 58.1 7.0 37.6 634 Fourth 94.3 93.5 85.7 78.2 95.5 89.9 83.6 67.6 81.6 68.0 2.9 45.8 646 Highest 94.0 93.4 86.8 81.4 95.0 91.0 86.4 66.8 84.9 74.9 4.5 39.2 592 Total 85.4 84.4 75.7 66.7 89.2 82.6 73.5 55.5 76.4 58.6 8.6 36.8 3,094 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 BCG, measles and three doses each of DPT and polio vaccine (except polio 4) Immunization coverage based on mothers’ reports is considerably lower than the coverage based on written records. According to mothers’ reports, only 50 percent of children age 12-23 months are fully immunized, compared with 73 percent of children with health cards. The highest coverage based on mother’s recall is for polio 1 and BCG (80 percent or more), while the lowest coverage is for polio 4 (43 percent). The correlation between immunization coverage and background characteristics, based on mothers’ reports, is similar to that seem for health card. Full immunization coverage for girls is higher than for boys (52 and 48 percent, respectively). There is an inverse relationship between immunization Immunization of Children | 153 coverage and birth order; i.e., first-order births have the highest full vaccination coverage (54 percent), while sixth- or higher-order births have the lowest full vaccination coverage (36 percent). A substantially higher proportion of children in urban areas are fully immunized compared with rural areas (62 and 42 percent, respectively). Variations in immunization coverage by mother’s level of education are also marked. Only 17 percent of children whose mothers have no education are fully vaccinated compared with 70 percent of children whose mothers have secondary or higher education. Similarly, immunization coverage for children in the lowest wealth quintile (31 percent) is less than half that for children in the highest wealth quintile (72 percent). Based on the information from both health cards and mothers’ reports, 59 percent of children age 12-23 months were fully immunized at the time of the survey. The results from these two combined sources of information show correlations between immunization coverage and background characteristics similar to those observed for the two sources individually. Sixth- or higher-order births (17 percent), children in rural areas (11 percent), children whose mothers have had no education (32 percent), and children living in households in the lowest wealth quintile (20 percent) are the least likely to have received any immunizations at all. Finally, Table 12.2 shows that immunization cards were seen for only 37 percent of children age 12-23 months. Cards were more likely to have been seen for boys, first-order births, children living in urban areas, children of mothers with complete primary or higher education, and children of mothers in the highest two wealth quintiles. Figure 12.2 shows that the percentage of children 12-23 months who are fully immunized based on information from health cards and mothers’ reports has increased since the 1991 IDHS, from 48 percent to the current level of 59 percent. Caution should be used when comparing the results of the 2002- 2003 IDHS with those of the 2007 IDHS surveys because the 2007 IDHS covered the whole country (33 provinces), while the 2002-2003 IDHS excluded three provinces (Nanggroe Aceh Darussalam, Maluku, and Papua). 48 50 55 52 59 IDHS 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 0 20 40 60 Percent Figure 12.2 Percentage of Children Age 12-23 Months Who Are Fully Immunized (Information from Health Cards and Mothers’ Reports) 154 | Immunization of Children 12.2 IMMUNIZATION COVERAGE FOR CHILDREN AGE 12-59 MONTHS While the previous tables in this chapter refer to children age 12-23 months, Table 12.3 is based on children age 12 to 59 months, and shows the percentage of children age 12-59 months who received specific vaccines against the six major preventable childhood diseases during the first year of life (accord- ing to health card or mother’s report) and the percentage of children with a vaccination card. Table 12.3 shows that more than one in two children (51 percent) age 12-23 months received all basic vaccination, and 37 percent had a vaccination card seen at the time of the interview. Differentials across provinces in immunization coverage in the first year of life are shown in Appendix Table A-12.2. Table 12.3 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by 12 months of age, and percentage with a health card by current age of child, Indonesia 2007 BCG Polio Age in months BCG 1 2 3 1 2 3 Measles All basic vaccine- tions1 No vaccine- tions Percentage with health card seen Number of children 12-23 84.4 82.9 73.7 64.3 87.2 81.0 71.1 67.0 50.7 10.7 36.8 3,094 24-35 80.8 78.8 69.0 56.2 87.1 81.5 69.1 66.4 46.7 11.4 23.5 3,162 36-47 78.4 76.7 70.2 57.8 83.5 79.3 70.1 65.3 48.1 14.6 16.9 3,098 48-59 79.2 77.7 68.1 58.1 83.9 79.9 71.7 66.7 48.7 14.2 12.0 3,166 Total 81.2 79.2 70.4 59.4 85.7 80.8 70.8 66.7 48.7 12.4 22.2 12,520 Note: Information was obtained from the vaccination card or if there was no written record, from the mother. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccinations. 1 BCG, measles and three doses each of DPT and polio vaccine (excluding polio 4) 12.3 HEPATITIS B IMMUNIZATION As mentioned earlier, the Government of Indonesia expanded the national immunization program in 1997 to include three doses of Hepatitis B (HB) vaccine. The government also recommends that all Hepatitis B vaccinations be given before the child reaches the age of one year (MOH, 2003). Immunization coverage for Hepatitis B based on both health cards and mothers’ reports is presented in Table 12.4 and Appendix Table A-12.2. Table 12.4 shows that 60 percent of children age 12-23 months have received three doses of Hepatitis B immunization. The coverage varies according to demographic and socioeconomic character- istics, except for child’s sex. Sixth- and higher- order children are less likely to receive all three doses of HB (39 percent) compared with lower-order births (66 percent for first births). Urban children, children whose mothers have secondary or higher education, and children in the highest wealth quintile are more likely than other children to have received three doses of Hepatitis B vaccine. Coverage of hepatitis immunization by province is presented in Appendix Table A-12.2. Immunization of Children | 155 Table 12.4 Hepatitis B vaccination coverage Percentage of children age 12-23 months who received hepatitis B vaccinations at any time before the survey (according to health card or mother's report), by background characteristics, Indonesia 2007 Hepatitis B vaccination Background characteristic HB1 HB2 HB3 Number of children Sex Male 80.5 71.5 59.4 1,622 Female 80.4 72.0 61.2 1,472 Birth order 1 84.0 75.1 65.8 1,139 2-3 82.3 73.3 59.6 1,382 4-5 71.8 64.9 55.6 416 6+ 61.5 51.3 39.1 158 Residence Urban 88.8 81.0 70.0 1,274 Rural 74.6 65.2 53.5 1,820 Mother's education No education 45.0 39.4 21.7 69 Some primary 60.6 47.5 36.6 352 Complete primary 75.5 64.1 51.5 898 Some secondary 82.4 75.3 65.1 754 Secondary + 92.6 86.3 75.3 1,022 Wealth quintile Lowest 61.7 51.3 41.1 635 Second 76.5 64.8 51.0 587 Middle 83.6 73.7 58.7 634 Fourth 89.1 83.4 74.2 646 Highest 91.7 85.7 76.8 592 Total 80.5 71.7 60.3 3,094 Childhood Diseases | 157 CHILDHOOD DISEASES 13 This chapter presents findings on the prevalence and treatment of childhood illnesses. The 2007 IDHS survey collected information on several infectious diseases common among children under five years, such as acute respiratory infection (ARI), fever, and diarrheal diseases. Acute respiratory tract infections, primarily pneumonia, are a common cause of morbidity and death among children under five throughout the world. Pneumonia is characterized by cough with difficult or rapid breathing and chest in-drawing. For severe pneumonia, hospitalization is recommended; otherwise, ambulatory treatment with antibiotics is recommended. Early diagnosis and treatment with antibiotics can reduce the number of deaths caused by ARI, particularly deaths resulting from pneumonia. Various infectious diseases are usually accompanied by fever. In Indonesia, the most common diseases accompanied with fever are malaria, respiratory and intestinal infections, measles, and typhoid. In the 2007 IDHS, information about the prevalence of fever in the preceding two weeks in children less than five years of age was collected, although the causes of fever were not specified. The prevalence of diarrhea among children under five is also collected by asking mothers about the incidents of diarrhea in their children in the past two weeks. Treatment practices and contact with health services among children with the three most common childhood illnesses (ARI, fever, and diarrhea) help in assessing national programs aimed at reducing the mortality impact of these illnesses. Information is provided on the prevalence and treatment of ARI and administration of antibiotics, as well as on the prevalence of fever and its treatment with antimalarial drugs and antibiotics. Information on the treatment of diarrheal diseases with oral rehydration therapy (ORT), including increased fluids, aids in the assessment of programs in Indonesia that recommend such treatment. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal diseases, information was also collected in the survey on the disposal of children’s fecal matter. 13.1 PREVALENCE AND TREATMENT OF ACUTE RESPIRATORY INFECTIONS AND FEVER In the 2007 IDHS, the prevalence of ARI was estimated by asking mothers whether their children under age five had been ill with a cough accompanied by short, rapid breathing and difficulty breathing as a result of a problem in the chest, in the two weeks preceding the survey. These symptoms are compatible with ARI. It should be noted that the morbidity data collected are subjective in the sense that they are based on the mother’s perception of illness without validation by medical personnel. Table 13.1 shows that overall, 11 percent of children had symptoms of ARI in the two weeks preceding the survey. The lowest prevalence of ARI is seen among children less than age 6 months (6 percent) and the highest prevalence is among children age 24-35 months (14 percent). The prevalence of ARI does not vary much by child’s sex and residence. Children of mothers who smoke are more likely to suffer from symptoms of ARI (16 percent) compared with children of mothers who are nonsmokers (11 percent). There is a strong association between ARI prevalence in children and mother’s level of education and wealth quintile. The lower the education of the mother, the higher is the prevalence of ARI among their children. ARI prevalence is highest for children in the lowest wealth quintile (14 percent) and lowest for children in the highest wealth quintile (9 percent). As expected, children living in households that use electricity or gas for cooking are less likely to suffer from ARI symptoms than children living in households that use kerosene or wood, straw or grass for cooking. 158 | Childhood Diseases Table 13.1 Prevalence and treatment of acute respiratory infection and/or fever Percentage of children under five years of age who had a cough accompanied by short, rapid breathing (symptoms of acute respiratory infection [ARI]), percentage of children who had fever in the two weeks preceding the survey, and percentage of children with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by background characteristics, Indonesia 2007 Treatment among children under five with symptoms of ARI and/or fever Prevalence of ARI and/or fever among children under five Background characteristic Percentage of children with symptoms of ARI1 Percentage of children with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Number of children Age in months <6 6.4 21.3 1,686 60.1 402 6-11 12.2 39.9 1,719 73.2 739 12-23 13.0 39.8 3,094 70.3 1,325 24-35 14.0 34.1 3,162 63.5 1,181 36-47 9.9 28.8 3,098 63.1 991 48-59 10.1 24.9 3,166 62.5 900 Sex Male 11.8 32.2 8,249 64.6 2,904 Female 10.6 30.9 7,676 67.4 2,634 Mother's smoking status Smokes cigarettes/tobacco 15.6 37.2 317 42.2 130 Does not smoke 11.1 31.5 15,608 66.5 5,408 Cooking fuel Electricity or gas 8.1 22.3 1790 76.7 449 Kerosene 11.1 31.0 5,728 72.5 1,984 Wood/ straw/ grass 12.0 34.0 8,399 60.3 3,103 Residence Urban 10.3 29.1 6,649 70.5 2,166 Rural 11.9 33.4 9,275 63.0 3,372 Mother's education No education 15.5 38.1 539 37.4 217 Some primary 14.4 33.5 1,920 55.7 713 Complete primary 11.4 34.0 4,562 62.2 1,683 Some secondary 10.6 34.3 3,989 70.6 1,479 Secondary + 9.9 25.8 4,915 74.9 1,446 Wealth quintile Lowest 13.9 34.8 3,627 50.6 1,391 Second 12.5 33.4 3,100 64.5 1,140 Middle 10.8 35.1 3,136 72.0 1,186 Fourth 9.9 30.4 3,051 75.3 1,031 Highest 8.5 23.4 3,010 73.6 791 Total 11.2 31.6 15,925 65.9 5,539 Note: Total includes children with information missing on cooking fuel. The category electricity or gas includes no food cooked in household and the category wood/straw/grass includes coal/lignite/charcoal. 1 Symptoms of ARI (cough accompanied by short, rapid breathing which was chest-related) is considered a proxy for pneumonia 2 Excludes pharmacy, shop, traditional practitioner, delivery post, health post, and health cadre Childhood Diseases | 159 Since the 2002-2003 IDHS, there has been an increase of three percentage points in the prevalence of ARI in children under five years. Table 13.1 also shows that 32 percent of children had fever in the two weeks preceding the survey, an increase of six percentage points compared with the prevalence reported in the 2002-2003 IDHS. The highest percentage of children with fever is observed among those age 6-23 months (40 percent). Looking at residence, the prevalence of fever is slightly higher among children in rural areas (33 percent) than among those in urban areas (29 percent). Similar to ARI, children of smoking mothers are more likely to suffer from fever than children of nonsmoking mothers (37 and 32 percent, respectively). Gender does not make much difference in the prevalence of fever. On the other hand, mother’s education and socio-economic status do have an impact on the prevalence of fever in children—the lower the level of education of the mother, the higher the prevalence of fever in children under five. Furthermore, the prevalence of fever is highest for children in the lowest wealth quintile (35 percent); it is lowest for children in the highest wealth quintile (23 percent). Children living in households that cook with electricity or gas are less likely to experience fever than children living in the households that cook with kerosene or wood, straw or grass. More than six in ten (66 percent) of children with symptoms of ARI and/or fever were taken to a health facility or health provider for treatment, an increase of nine percentage points compared with the rate reported in the 2002-2003 IDHS. This increase may indicate an improvement in the accessibility of basic health services in Indonesia. There is no clear pattern for health-seeking behavior by age of child. Children living in urban areas, those with nonsmoking mothers, and children living in households that use electricity or gas for cooking are more likely to be taken to a health facility or provider for advice or treatment for ARI and/or fever than other children. The expected positive association is observed between seeking treatment for ARI and/or fever and mothers’ level of education and wealth quintile. Appendix Table A-13.1 shows the prevalence of ARI and fever by province. Table 13.2 presents information on the types of drugs given to children with fever by urban-rural residence. One in two children with fever during the two weeks prior to the survey was given acetaminophen or paracetamol, similar to the rate reported in the 2002-2003 IDHS (47 per- cent). Six percent of children were given aspirin, while less than 1 percent were given antimalarial drugs. Thirty percent of the children were given other drugs that respondents were not able to specify. It must be noted that 16 percent of chil- dren did not get any medication at all, an increase of 6 percentage points since the 2002-2003 IDHS. The percentage of children that did not take any drug for fever is higher among rural children (19 percent) than among their urban counterparts (13 percent). 13.2 DISPOSAL OF CHILDREN’S STOOLS The proper disposal of children’s feces is extremely important in preventing the spread of diseases. If feces are left uncontained, diseases may spread by direct contact or through animal contact. Table 13.2 Drugs taken for fever Percentage of children under five years who were ill with fever during the two weeks preceding the survey, by type of drug taken, according to residence, Indonesia 2007 Residence Result Urban Rural Total Fansidar 0.0 0.1 0.1 Chloroquine/Nivaquine 0.3 1.0 0.7 Aspirin 5.0 6.8 6.1 Acetaminophen/paracetamol 50.9 48.9 49.7 Ibuprofen 1.2 0.7 0.9 Other 33.6 27.1 29.6 Missing 0.5 1.2 0.9 No drug 12.7 18.5 16.3 Number of children 1,937 3,096 5,033 160 | Childhood Diseases Table 13.3 presents information on the disposal of children’s stools, by background characteristics. Data show that 71 percent of mothers of children under age five dispose of their youngest child’s stools safely (that is, children use a toilet or latrine, the stools are rinsed into the toilet or latrine, the stools are buried, or disposable or washable diapers are used). Mothers report that one in four children always use a toilet or latrine, three in ten have their stools thrown into a toilet or latrine, and 8 percent report throwing or burying their children’s stools in the yard. Twelve percent of mothers throw their children’s stools outside their dwelling, 4 percent rinse them away, and 11 percent of mothers leave the stools in the open. Comparing these results with those from the 2002-2003 IDHS indicates there has been an increase of four percentage points in the percentage of children that always use a toilet/latrine. On the other hand, the percentage of mothers who reported throwing their children’s stools into a toilet/latrine (29 percent) has decreased slightly from 31 percent in the 2002-2003 IDHS. Table 13.3 Disposal of children's stools Percent distribution of mothers who are living with their youngest child under five years, by way in which child's fecal matter is disposed of, according to background characteristics and type of toilet, Indonesia 2007 Stools contained Stools uncontained Use diapers Background characteristic Child uses toilet/ latrine Thrown into toilet/ latrine Thrown/ buried in yard Thrown outside dwelling Rinsed away Dis- posed in open setting Do nothing Dispos- able Wash- able Other Missing Total Percentage of children whose stools are disposed of safely Number of mothers Age in months <6 4.7 28.4 4.7 9.4 9.3 6.4 0.2 3.3 31.6 1.6 0.3 100.0 72.8 1,664 6-11 8.5 34.8 8.4 14.1 6.3 10.3 0.4 2.6 12.8 1.6 0.1 100.0 67.1 1,684 12-23 17.5 34.8 8.9 14.9 4.5 9.3 0.4 2.4 5.4 1.5 0.3 100.0 69.0 2,929 24-35 29.1 27.1 10.9 12.2 3.0 12.7 0.7 0.8 1.9 1.3 0.3 100.0 69.8 2,748 36-47 36.6 26.5 8.6 10.9 1.4 12.6 0.6 0.3 0.8 1.1 0.5 100.0 72.9 2,471 48-59 44.0 23.9 6.8 9.9 1.5 11.8 0.3 0.2 0.6 0.9 0.1 100.0 75.5 2,164 Residence Urban 35.1 33.5 3.5 6.1 2.9 8.0 0.1 2.7 6.7 1.0 0.3 100.0 81.5 5,733 Rural 17.4 26.2 11.8 16.4 4.7 12.8 0.7 0.6 7.6 1.5 0.3 100.0 63.6 7,927 Education No education 9.2 12.5 20.8 20.7 5.4 20.7 1.8 1.0 4.1 3.0 0.7 100.0 47.7 436 Some primary 15.9 19.2 14.1 18.6 4.2 18.6 1.4 0.2 5.9 1.6 0.1 100.0 55.4 1,638 Complete primary 20.0 26.2 10.9 16.3 3.7 13.1 0.5 0.4 7.2 1.2 0.4 100.0 64.7 3,978 Some secondary 24.0 30.9 6.9 11.4 4.8 11.2 0.2 1.0 8.2 1.1 0.3 100.0 71.0 3,444 Secondary + 35.3 36.5 3.5 5.1 3.3 4.0 0.1 3.5 7.3 1.2 0.2 100.0 86.0 4,163 Wealth quintile Lowest 7.8 14.0 17.6 23.8 5.7 19.4 1.4 0.4 7.4 2.2 0.5 100.0 47.2 2,927 Second 16.1 27.1 10.9 18.1 4.2 13.9 0.5 0.4 6.8 1.7 0.3 100.0 61.3 2,698 Middle 23.4 32.6 7.2 9.6 5.1 12.2 0.3 1.1 7.4 0.9 0.2 100.0 71.8 2,751 Fourth 35.5 36.1 4.0 5.5 2.4 5.3 0.1 2.2 8.0 0.8 0.2 100.0 85.7 2,675 Highest 43.6 38.1 0.9 2.0 2.3 2.0 0.0 3.5 6.4 0.9 0.3 100.0 92.5 2,608 Toilet facility Private, with septic tank 37.4 38.0 3.2 4.8 2.7 2.7 0.2 2.4 7.6 0.7 0.3 100.0 88.5 6,238 Private, without septic tank 28.1 41.4 3.9 7.5 3.3 5.5 0.2 2.1 6.7 0.9 0.4 100.0 82.2 1,506 Shared/public 24.3 30.0 8.6 12.6 4.5 10.2 0.4 0.6 7.4 1.1 0.2 100.0 70.9 1,348 Pit latrine 14.5 38.9 12.6 13.3 7.2 5.2 1.6 0.1 5.0 1.3 0.5 100.0 71.0 1,121 Yard/bush/forest 1.8 2.8 34.9 32.3 6.3 10.1 2.2 0.9 6.4 2.1 0.3 100.0 46.7 760 River/stream/creek 4.6 5.7 13.8 25.2 4.7 34.6 0.5 0.3 8.1 2.3 0.1 100.0 32.6 2,091 Other 5.9 3.7 11.4 24.5 5.9 37.5 0.2 0.3 6.3 3.9 0.5 100.0 27.5 589 Total 24.8 29.3 8.3 12.1 4.0 10.8 0.5 1.5 7.2 1.3 0.3 100.0 71.1 13,659 Childhood Diseases | 161 Safe disposal of children’s stools varies little by child’s age. However, children’s stools are much more likely to be disposed of safely in urban areas than in rural areas (82 and 64 percent, respectively). Disposal of a child’s stools varies substantially by mother’s level of education and socio-economic status. Mothers with secondary or higher education are much more likely to dispose of their children’s stools safely (86 percent) than mothers with no education (48 percent). Similarly, mothers in the highest wealth quintile are much more likely to dispose of their children’s stools safely (93 percent) than mothers in the lowest wealth quintile (47 percent). Access to a private toilet facility increases the likelihood that a child’s stools are disposed of safely; about nine in ten children living in households with a private toilet facility with a septic tank have their stools disposed of safely compared with only about three in ten children in a household without a toilet facility. Appendix Table A-13.2 shows the variation in the disposal of children’s stools by province. 13.3 PREVALENCE OF DIARRHEA Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young children, although the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. In interpreting the findings of the 2007 IDHS survey, it should be borne in mind that the prevalence of diarrhea varies seasonally. Table 13.4 shows the percentage of children under five with diarrhea in the two weeks preceding the survey according to selected background characteristics. Overall, 14 percent of children under age five years had diarrhea in the two weeks before the survey, slightly higher than the 11 percent reported in the 2002-2003 IDHS survey. The prevalence of diarrhea is highest among children age 6-35 months, presumably because babies are usually weaned off breast milk around the age of six months. The prevalence of diarrhea is slightly higher among male children and those living in the rural areas than among female children and those living in urban areas. There is a negative correlation between the prevalence of diarrhea and mother’s level of education and wealth status. The prevalence of diarrhea decreases as mother’s education attainment and the household wealth quintile increase. In general, it is lower among children living in households that use piped water or water from a protected well than among children living in households that use an open well or surface water for drinking. Furthermore, fewer children living in households with a private toilet facility with a septic tank suffer from diarrhea than children living in households with other types of toilet facilities. Appendix Table A-13.3 shows the variation in the prevalence of diarrhea by province. Table 13.4 Prevalence of diarrhea Percentage of children under five years with diarrhea in the two weeks preceding the survey, by background characteristics, Indonesia 2007 Background characteristic Diarrhea in the two weeks preceding the survey Number of children Age in months <6 11.1 1,686 6-11 17.6 1,719 12-23 20.7 3,094 24-35 15.3 3,162 36-47 9.9 3,098 48-59 8.3 3,166 Sex Male 14.8 8,249 Female 12.5 7,676 Residence Urban 12.0 6,649 Rural 14.9 9,275 Mother's education No education 18.1 539 Some primary 16.6 1,920 Complete primary 15.0 4,562 Some secondary 14.0 3,989 Secondary + 10.6 4,915 Wealth quintile Lowest 17.7 3,627 Second 14.7 3,100 Middle 12.5 3,136 Fourth 13.1 3,051 Highest 9.7 3,010 Source of drinking water Piped 12.0 3,053 Protected well 12.7 5,906 Open well 16.1 4,578 Surface 17.1 1043 Other/missing 10.9 1,342 Toilet facility Private, with septic tank 11.1 7,203 Private, without septic tank 14.2 1,747 Shared/public 15.9 1,547 Pit latrine 15.2 1,294 Yard/bush/forest 14.7 988 River/stream/creek 18.4 2,432 Other 14.0 705 Total 13.7 15,925 162 | Childhood Diseases 13.4 KNOWLEDGE OF ORS A simple and effective response to dehydration caused by diarrhea is prompt increase in the child’s fluid intake through some form of oral rehydration therapy (ORT), which may include the use of a solution prepared from packets of oral rehydration salts (ORS). To ascertain how widespread knowledge of ORS is in Indonesia, female respondents were asked whether they know about Oralit, the most commonly used ORS brand in the country. Table 13.5 shows that knowledge of ORS is almost universal among women in Indonesia with a birth in the five years preceding the survey, similar to the rate reported in the 2002-2003 IDHS. Knowledge of ORS is somewhat lower among women age 15-19 when compared with older women. Furthermore, urban women are somewhat more likely than rural women to know about ORS (97 and 90 percent, respectively). Mother’s education is positively associated with knowledge of ORS packets; only 61 percent of mothers with no education have heard about ORS compared with 98 percent of women with secondary or higher education. The same pattern is observed for household wealth status; 83 percent of mothers in the lowest wealth quintile know about ORS compared with 98 percent of mothers in the highest wealth quintile. Appendix Table A-13.4 shows mother’s knowledge of ORS by province. 13.5 DIARRHEA TREATMENT In the 2007 IDHS, mothers of children who had diarrhea were asked about what was done to treat the illness. Table 13.6 shows the percentage of children with diarrhea who received specific treatments according to background characteristics. Data in the table show that 51 percent of children under five with diarrhea in the two weeks preceding the survey were taken to a health facility or provider, similar to the percentage reported in the 2002-2003 IDHS. Treatment of diarrhea varies by age of child. Infants under 6 months are the least likely to be taken to a health facility or provider compared with other age groups. Male children are slightly more likely to be taken to a health facility or provider than female children. Mother’s level of education and the socioeconomic status of the household are related to whether young children receive treatment for diarrhea. The higher the mother’s level of education and the higher the household wealth quintile, the more likely it is that children with diarrhea are to be taken for treatment to a health facility or provider. Even though more than nine in ten mothers reported knowing about ORS packets, only about one-third (35 percent) of children with diarrhea were treated with ORS (or a prepackaged liquid); these results are similar to those reported in the 2002-2003 IDHS. Thirty percent of children with diarrhea were given increased fluids, 22 percent were given recommended home fluids (RHF), and 61 percent were given oral rehydration therapy (either ORS, RHF or increased fluids). Looking at treatments other than ORT, 48 percent of children with diarrhea received syrup or pills, while 14 percent were given a home remedy or other treatment. Seventeen percent of children with diarrhea did not receive any treatment at all. Table 13.5 Knowledge of ORS packets Percentage of mothers with births in the five years preceding the survey who know about ORS packets for treatment of diarrhea, by background characteristics, Indonesia 2007 Background characteristic Percentage of mothers who know about ORS packets Number of women Age 15-19 79.6 418 20-24 91.7 2,954 25-29 93.9 3,885 30-34 95.4 3,305 35-49 92.2 3,481 Residence Urban 96.7 5,897 Rural 90.2 8,145 Education No education 61.2 458 Some primary 83.4 1,677 Complete primary 92.2 4,106 Some secondary 96.0 3,543 Secondary + 98.2 4,260 Wealth quintile Lowest 83.1 3,010 Second 92.0 2,791 Middle 95.5 2,812 Fourth 96.9 2,742 Highest 98.3 2,688 Total 92.9 14,043 ORS = Oral rehydration salts Childhood Diseases | 163 Table 13.6 Diarrhea treatment Among children under age five who had diarrhea in the two weeks preceding the survey, percentage taken for treatment to a health provider, percentage who received oral rehydration therapy (ORT), and percentage given other treatments, by background characteristics, Indonesia 2007 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage taken to a health facility or provider1 Oral rehydra- tion salts (ORS) packets Recom- mended home fluids (RHF) Either ORS or RHF In- creased fluids ORT, RHF or in- creased fluids Pills/ syrup Injec- tion Intra- venous solution Home remedy/ other Missing No treat- ment Number of children with diarrhea Age in months <6 31.3 6.6 7.3 11.8 22.8 33.4 27.9 0.0 0.0 10.1 0.0 50.1 187 6-11 59.1 28.0 15.4 37.2 23.0 51.7 45.5 0.6 0.0 14.0 0.5 23.0 302 12-23 57.1 40.2 25.2 52.7 33.8 67.9 49.8 0.7 0.3 17.3 0.2 9.2 640 24-35 52.0 37.7 25.1 50.8 33.9 65.1 50.8 0.1 0.0 10.8 0.6 14.0 482 36-47 39.7 35.1 29.3 50.2 26.0 59.7 44.3 0.6 0.1 16.6 0.4 16.3 306 48-59 52.3 42.7 21.4 51.5 34.3 68.0 58.1 0.9 0.1 11.7 0.4 11.3 261 Sex Male 52.1 35.4 25.7 49.0 31.1 63.7 50.6 0.7 0.0 13.3 0.5 14.2 1,217 Female 49.7 33.7 18.3 42.4 29.4 57.5 44.2 0.3 0.2 14.9 0.2 20.4 963 Residence Urban 54.4 33.4 21.0 43.9 29.0 58.7 52.9 0.9 0.3 14.4 0.3 16.1 799 Rural 49.1 35.4 23.2 47.4 31.1 62.2 44.8 0.3 0.0 13.8 0.4 17.4 1,381 Mother's education No education 27.7 23.3 11.1 30.2 25.5 49.8 39.2 1.3 0.0 16.0 0.9 24.3 97 Some primary 40.7 31.6 24.8 46.4 28.0 60.9 39.2 0.1 0.0 10.0 0.4 20.8 318 Complete primary 45.2 32.5 20.0 44.7 31.0 59.6 44.2 0.7 0.0 17.0 0.4 16.3 683 Some secondary 59.1 40.3 26.1 51.3 31.8 64.8 53.6 0.3 0.0 12.1 0.3 14.5 558 Secondary + 60.7 35.3 22.2 45.2 30.2 60.7 53.0 0.6 0.5 14.2 0.2 16.6 522 Wealth quintile Lowest 37.7 31.6 26.0 47.0 27.2 60.1 37.9 0.2 0.1 12.3 0.6 20.2 642 Second 46.2 36.1 23.1 47.4 28.8 63.4 46.5 0.8 0.0 17.0 0.5 14.3 454 Middle 61.3 38.4 20.5 48.4 34.6 64.8 51.7 0.6 0.0 16.5 0.3 13.5 393 Fourth 58.3 39.6 21.1 46.4 31.4 58.5 49.3 0.5 0.6 11.3 0.0 18.8 399 Highest 64.3 27.4 17.9 38.7 32.4 56.9 64.3 0.7 0.0 13.2 0.2 16.1 291 Total 51.0 34.7 22.4 46.1 30.3 60.9 47.8 0.5 0.1 14.0 0.4 16.9 2,180 Note: ORT includes solution prepared from oral rehydration salt (ORS), pre-packaged ORS packet, and recommended home fluids (RHF). 1 Excludes pharmacy, shop, traditional practitioner, delivery post, health post, and health cadre Figure 13.1 shows knowledge and use of ORS by mother’s education. There is a positive associ- tion between knowledge and use of ORS and mother’s education. 61 83 92 96 98 23 32 33 40 35 No education Some primary Complete primary Some secondary Secondary+ 0 20 40 60 80 100 Percent Knowledge of ORS Use of ORS Figure 13.1 Knowledge and Use of ORS Packets among Mothers Who Gave Birth in the Past Five Years, by Level of Education IDHS 2007 164 | Childhood Diseases Figure 13.2 shows the trends in knowledge and use of ORS packets for treatment of diarrhea over the past decade. There were no significant changes in knowledge and use of ORS between the 2002-2003 IDHS and the 2007 IDHS. However, use of ORS decreased by eight percentage points between the 1997 IDHS and the 2002-2003 IDHS, and continued to decrease slightly over the past five years (from 36 to 35 percent). 13.6 FEEDING PRACTICES DURING DIARRHEA Mothers are encouraged to continue feeding their children with diarrhea normally and to increase the amount of fluids. In particular, consumption of extra fluids is essential to avoid dehydration. Table 13.7 shows the results on feeding practices during diarrhea. Only 30 percent of children with diarrhea were given more fluids than usual, while 45 percent received the same amount. It must be noted that 22 percent of children with diarrhea received less liquids or no liquids at all. Table 13.7 also shows that only 8 percent of children received more food than usual during their diarrhea, 43 percent received the same amount of food as usual, while 44 percent were given less food or no food at all. Figure 13.3 compares feeding practices during diarrhea for children under five, according to the 1997, 2002-2003, and 2007 IDHS surveys. Overall, the proportion of children with diarrhea in Indonesia who were given the recommended liquids and fed according to recom- mendations, decreased between the 1997 IDHS and the 2002-2003 IDHS, and practices have changed only slightly since the 2002-2003 IDHS. Table 13.7 Feeding practices during diarrhea Percent distribution of children under five years who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, Indonesia 2007 Feeding practices Percent Amount of liquids offered Same as usual 45.4 More 30.3 Somewhat less 15.2 Much less 2.3 None 4.6 Don't know/missing 2.1 Total 100.0 Amount of food offered Same as usual 42.8 More 8.1 Somewhat less 37.4 Much less 5.6 None 1.1 Never gave food 4.1 Don't know/missing 0.8 Total 100.0 Number of children 2,180 94 92 93 48 36 35 1997 IDHS 2002-03 IDHS 2007 IDHS 0 20 40 60 80 100 Percent Knowledge of ORS Use of ORS 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 Childhood Diseases | 165 Table 13.8 shows feeding practices during diarrhea by background characteristics. Fifty-four percent of children with diarrhea continued feeding and were given ORT and/or increased fluids during the diarrhea episode, while 27 percent were given increased fluids and continued feeding. The percentage of children that continued feeding and were correctly given ORT and/or increased fluids is lower among children under six months of age. Male children and those living in rural areas are somewhat more likely than female children and those living in urban areas to continue feeding and receive ORT and/or increased liquids; however, there is no clear association between mother’s level of education and household wealth quintile and proper feeding practices during diarrhea. 26 57 15 30 30 4647 28 24 44 10 4445 30 22 43 8 48 Same as usual Increased Decreased/ None Same as usual Increased Decreased/ None 0 20 40 60 80 Percent 1997 IDHS 2002-2003 IDHS 2007 IDHS Figure 13.3 Trends in Feeding Practices among Children Under Five With Diarrhea AMOUNT OF LIQUIDS AMOUNT OF FOOD 166 | Childhood Diseases Table 13.8 Feeding pratices during diarrhea by background characteristics Percent distribution of children under age five who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by background characteristics, Indonesia 2007 Amount of liquids offered Amount of food offered Background characteristic More Same as usual Some- what less Much less None Don't know/ missing Total More Same as usual Some- what less Much less None Never gave food Don't know/ missing Total Percentage given increased fluids and continued feeding1 Percentage who continued feeding and were given ORT and/or increased fluids Number of children with diarrhea Age in months <6 22.8 48.1 12.8 0.7 15.5 0.1 100.0 3.0 38.7 18.9 1.4 4.7 33.1 0.2 100.0 12.2 19.2 187 6-11 23.0 58.2 12.3 1.7 3.7 1.0 100.0 5.4 50.5 29.9 5.4 1.4 6.7 0.6 100.0 19.3 44.3 302 12-23 33.8 44.0 15.0 2.2 4.6 0.4 100.0 8.9 38.4 42.1 8.0 1.1 0.7 0.7 100.0 29.8 60.2 640 24-35 33.9 42.5 16.9 2.2 1.7 2.9 100.0 10.9 42.0 40.6 4.9 0.3 0.2 1.1 100.0 32.0 61.6 482 36-47 26.0 47.1 15.8 3.2 3.0 5.0 100.0 6.6 50.3 35.3 6.6 0.2 0.4 0.6 100.0 22.1 53.5 306 48-59 34.3 35.2 17.3 3.9 4.6 4.7 100.0 9.9 40.5 44.2 3.2 0.4 0.1 1.7 100.0 32.7 63.9 261 Sex Male 31.1 44.1 15.3 2.6 4.6 2.2 100.0 7.0 41.9 38.3 7.2 1.0 3.9 0.6 100.0 26.9 56.2 1,217 Female 29.4 46.9 15.2 2.0 4.6 2.0 100.0 9.5 44.0 36.2 3.6 1.2 4.3 1.2 100.0 26.1 51.9 963 Residence Urban 29.0 43.2 16.6 2.4 6.5 2.3 100.0 9.4 43.7 34.2 6.5 1.1 4.6 0.6 100.0 24.8 51.7 799 Rural 31.1 46.6 14.5 2.3 3.5 2.1 100.0 7.4 42.3 39.3 5.1 1.1 3.8 1.0 100.0 27.6 55.8 1,381 Mother's education No education 25.5 41.1 20.3 4.2 1.7 7.2 100.0 7.1 50.7 35.2 1.7 0.1 3.7 1.6 100.0 22.4 44.7 97 Some primary 28.0 51.1 13.7 1.6 4.0 1.5 100.0 6.0 41.4 41.1 7.1 0.8 3.1 0.5 100.0 23.2 54.1 318 Complete primary 31.0 46.0 14.7 2.1 3.9 2.3 100.0 6.8 41.8 40.3 5.0 1.6 3.4 1.1 100.0 27.7 52.8 683 Some secondary 31.8 46.2 13.8 2.6 3.4 2.3 100.0 7.9 43.7 34.6 7.7 0.4 4.9 0.8 100.0 26.6 56.8 558 Secondary + 30.2 41.0 17.4 2.4 7.7 1.2 100.0 11.7 42.6 34.8 4.0 1.4 4.7 0.7 100.0 27.9 55.5 522 Wealth quintile Lowest 27.2 49.8 14.6 2.5 3.5 2.4 100.0 6.1 43.5 39.1 3.6 1.5 5.0 1.2 100.0 24.9 54.5 642 Second 28.8 47.3 14.5 2.9 3.0 3.5 100.0 7.4 43.6 37.5 5.9 1.1 3.1 1.3 100.0 23.6 56.0 454 Middle 34.6 41.0 16.6 2.6 2.8 2.4 100.0 7.8 46.1 34.2 8.3 0.5 2.7 0.4 100.0 29.2 57.8 393 Fourth 31.4 41.7 17.7 2.0 6.7 0.5 100.0 11.3 40.6 39.0 6.3 0.9 1.6 0.4 100.0 29.4 52.9 399 Highest 32.4 43.5 12.6 1.2 8.8 1.5 100.0 10.0 38.6 35.8 5.0 1.2 8.9 0.6 100.0 27.4 48.4 291 Total 30.3 45.4 15.2 2.3 4.6 2.1 100.0 8.1 42.8 37.4 5.6 1.1 4.1 0.8 100.0 26.6 54.3 2,180 1 Continued feeding includes children who were given more, same as usual, or somewhat less food during the diarrhea episode. 13.7 CHILDREN’S HEALTH CARE AND WOMEN’S STATUS The 2007 IDHS used three indicators of women’s status to examine the relationship between children’s health care and women’s status: the number of household decisions in which women participate, the number of reasons given for a woman to refuse having sexual intercourse with her husband, and the number of reasons for which wife beating is justified. Table 13.9 shows that there is a positive relationship between children’s health care and women’s status. The greater the number of household decisions in which women participate, the higher the proportion of children who have been fully vaccinated and taken for treatment of fever, ARI, and diarrhea. Furthermore, the greater the number of reasons women give for refusing sexual intercourse with their husband, the higher the proportion of children who have been fully vaccinated. Finally, the lower the number of reasons given by women that justify wife beating, the higher the proportion of children who have been fully vaccinated and received treatment for fever and/or ARI from a health provider. Childhood Diseases | 167 Table 13.9 Children's health care by women's status Percentage of children age 12-23 months who were fully vaccinated and percentage of children under five years who were ill with a fever and/or symptoms of ARI and diarrhea in the two weeks preceding the survey who were taken to a health provider for treatment, by women's status indicators, Indonesia 2007 Children age 12-23 months fully vaccinated1 Children with fever and/or symptoms of ARI taken to a health provider2 Children with diarrhea taken to a health provider Women's status indicator Percentage Number Percentage Number Percentage Number Number of decisions in which women participate3 0 35.1 31 59.5 45 (48.1) 17 1-2 47.9 196 69.4 412 45.4 162 3-4 57.9 855 66.0 1,575 51.4 631 5 60.8 1,946 66.2 3,359 52.0 1,307 Number of reasons given for refusing to have sexual intercourse with husband 0 38.2 162 66.5 247 53.4 136 1-2 52.5 320 61.6 643 48.7 234 3-4 60.6 2,612 66.5 4,648 51.1 1,810 Number of reasons for which wife beating is justified 0 61.3 2,035 67.2 3,298 51.4 1,250 1-2 56.0 781 65.0 1,568 49.8 662 3-4 49.4 227 61.8 550 52.8 225 5 31.5 51 61.3 122 48.8 43 Total 58.6 3,094 65.9 5,539 51.0 2,180 Note: The figure in parentheses is based on 25-49 unweighted cases. 1 Those who have received BCG, measles, and three doses each of DPT and polio vaccine 2 Excludes pharmacy, shop, traditional practitioner, delivery post, health post, and health cadre 3 Either alone or jointly with others 13.8 HAND-WASHING PRACTICES Many diseases are easily transmitted through contaminated foods or from hand to mouth. Hand washing minimizes the transmission of both enteric (fecal) and respiratory pathogens. In the 2007 IDHS, respondents were asked whether they washed their hands before preparing meals for their family. Table 13.10 shows that practically all women reported that they washed their hands before preparing the meal for their family the last time (97 percent). There are almost no variations in hand- washing practices by background characteristics. 168 | Childhood Diseases Table 13.10 Hand-washing practices Percent distribution of women by whether they washed their hands before preparing a meal for their family the last time, according to background characteristics, Indonesia 2007 Background characteristic Washed hands Did not wash hands Never prepared meals Missing Total Number of women Age 15-19 95.3 2.5 2.2 0.0 100.0 845 20-24 94.3 3.3 2.4 0.0 100.0 4,094 25-29 96.3 2.4 1.2 0.1 100.0 5,771 30-34 97.4 2.0 0.6 0.1 100.0 6,020 35+ 96.9 2.1 0.8 0.1 100.0 16,164 Residence Urban 96.9 1.6 1.4 0.2 100.0 13,745 Rural 96.3 2.9 0.9 0.0 100.0 19,150 Wealth quintile Lowest 94.0 5.1 0.8 0.1 100.0 6,219 Second 97.1 2.2 0.7 0.0 100.0 6,606 Middle 96.2 2.5 1.3 0.0 100.0 6,710 Fourth 97.8 1.1 0.9 0.1 100.0 6,713 Highest 97.3 0.9 1.6 0.2 100.0 6,647 Source of drinking water Piped 97.1 1.8 1.0 0.1 100.0 5,340 Protected well 96.9 1.8 1.3 0.0 100.0 13,338 Open well 97.1 2.0 0.6 0.3 100.0 4,139 Surface 94.5 4.5 0.9 0.0 100.0 5,898 Other/missing 97.0 1.8 1.2 0.1 100.0 4,180 Time to obtain drinking water (round trip) Water on premises 97.1 1.7 1.1 0.1 100.0 25,745 Less than 2 minutes 95.2 4.8 0.0 0.0 100.0 210 2-4 minutes 94.4 4.2 1.4 0.0 100.0 926 5-9 minutes 95.3 3.7 1.0 0.0 100.0 2,132 10+ minutes 94.1 5.2 0.6 0.1 100.0 3,592 Don't know/missing 94.9 4.2 0.9 0.0 100.0 290 Total 96.5 2.3 1.1 0.1 100.0 32,895 Infant Feeding | 169 INFANT FEEDING 14 This chapter reviews the nutritional status of children and women in Indonesia. The specific issues discussed are infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods; diversity of foods fed and frequency of feeding; and micronutrient intake among children and women. Proper feeding practices are of fundamental importance for the survival, growth, development, and health of infants and young children. The mother’s nutritional well being before and during pregnancy can influence the health of her child later on. Mother’s nutritional status also influences her ability to have a successful pregnancy and delivery, and to successfully breastfeed her baby after he/she is born. The health benefits of breastfeeding for both mother and child are undisputed and they are influenced by both the duration and intensity of breastfeeding. The age at which a child starts receiving complementary foods also influences their nutritional status. To minimize morbidity and mortality of children, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) recommend that children should be breastfed for at least six months. Solid food should only be given after six months of age, and breastfeeding should continue well into the second year of life (WHO, 2005). In 2003, the Indonesian government changed the recommended duration of exclusive breastfeeding from four to six months (Ministry of Health, 2002c). 14.1 INITIAL BREASTFEEDING Early initiation of breastfeeding is encouraged for a number of reasons. Mothers benefit from early suckling because it stimulates breast milk production and facilitates the release of oxytocin, which helps the contraction of the uterus and reduces postpartum blood loss. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also fosters bonding between mother and child. Over the long-term, a breast- feeding mother is likely to extend the length of her birth intervals because of the suppressive effect that breastfeeding has on postpartum amenorrhea. Longer birth intervals allow a mother’s body to recover from the physical depletions associated with pregnancy The effect of breastfeeding on return of menses is moderated by both duration and intensity of breastfeeding (Ministry of Health, 2002b). Table 14.1 shows the percentage of children born in the five years before the survey by breastfeeding status and the timing of initial breastfeeding, by background characteristics. Breastfeeding is nearly universal in Indonesia, with 95 percent of children born in the five years preceding the survey having been breastfed at some time. This is true for all subgroups of children, except for children of women who did not get any assistance during delivery in the past five years (85 percent were breastfed at some point). More than four in ten children (44 percent) were breastfed within one hour of birth, and more than six in ten (62 percent) were breastfed within one day of birth. The percentage of children who were breastfed within one hour and within one day of birth is inversely associated with mother’s education and wealth quintile, i.e., generally, the lower the mother’s level of education and household wealth quintile, the higher the percentage of children who were breastfed early. Children of mothers who delivered without any assistance are also more likely to initiate breastfeeding within one hour or within one day of birth. Table 14.1 shows that the percentage of born children who receive a prelacteal feed—that is, 170 | Infant Feeding something other than breast milk during the first three days of life—is quite high in Indonesia (65 percent). Children in urban areas, those born to mothers with secondary or higher education, children of mothers who were assisted by a health professional during delivery and born in a health facility, and children in the highest wealth quintile are more likely to receive a prelacteal feed than other children. Appendix Table A-14.1 shows the differentials in the initiation of breastfeeding by province. Table 14.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and for last-born children ever breastfed, the percentage who started breastfeeding within one hour and within one day of birth and the percentage who received a prelacteal feed, by background characteristics, Indonesia 2007 Last-born children ever breastfed Breastfeeding among children born in past five years Background characteristic Percentage ever breastfed Number of children Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 95.0 8,614 43.1 59.9 64.6 7,008 Female 95.4 7,890 44.7 63.2 64.5 6,463 Residence Urban 93.7 6,835 41.6 60.0 68.8 5,571 Rural 96.2 9,669 45.5 62.5 61.6 7,899 Mother's education No education 94.3 579 56.6 72.1 48.7 439 Some primary 96.4 1,996 47.8 63.4 59.2 1,629 Complete primary 96.1 4,759 44.8 62.7 60.9 3,966 Some secondary 95.3 4,132 43.7 61.1 64.9 3,411 Secondary + 93.9 5,038 40.2 58.8 71.8 4,026 Assistance at delivery Health professional 3 94.7 12,048 42.7 61.1 67.1 9,939 Traditional birth attendant 96.7 3,969 47.5 63.0 58.8 3,207 Other 98.1 380 43.0 60.0 48.6 272 No one 85.1 108 54.4 65.0 24.6 52 Place of delivery Health facility 94.1 7,600 43.0 62.4 70.1 6,326 At home 96.1 8,690 45.0 60.9 60.0 7,012 Other 95.5 215 33.0 51.6 43.0 88 Wealth quintile Lowest 96.4 3,806 46.8 64.4 57.6 2,926 Second 96.3 3,245 47.0 63.4 62.3 2,710 Middle 94.5 3,245 42.0 59.2 66.3 2,683 Fourth 95.1 3,122 43.2 60.5 65.6 2,620 Highest 93.3 3,086 40.0 59.7 72.3 2,533 Total 95.2 16,504 43.9 61.5 64.6 13,471 Note: Table is based on births in the past five years whether the children are living or dead at the time of interview. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse, midwife, or village midwife 14.2 AGE PATTERNS OF BREASTFEEDING UNICEF and WHO recommend that children be exclusively breastfed during the first six months of life. Thereafter, children should be given solid or semisolid complementary food in addition to continued breastfeeding. Exclusive breastfeeding is recommended in the first few months of life because breast milk is uncontaminated and contains all the nutrients necessary for children that age. Information on breastfeeding and supplementation was obtained in the 2007 IDHS by asking mothers about the Infant Feeding | 171 current breastfeeding status of all children under five years of age and, for the youngest child born in the three years before the survey and living with the mother, food (liquids or solids) given to the child the day before the survey. Table 14.2 shows the percent distribution of youngest children under three years living with the mother by breastfeeding status and the percentage of children under three years using a bottle with a nipple, according to age in months. Early introduction of foods that are low in energy and nutrients or prepared under unhygienic conditions may result in undernutrition and infection with foreign organisms, which may result in a lower immunity to disease among young children (Ministry of Health, 2002a). Contrary to WHO recommendations, only about one-third (32 percent) of children under six months are exclusively breastfed in Indonesia. Among children under four months, only about four in ten (41 percent) are exclusively breastfed. Since the 2002-2003 IDHS, the proportion of children who are exclusively breastfed until six months of age has declined by 8 percentage points. Furthermore, in the 2002-2003 IDHS, 64 percent of infants less than two months of age were exclusively breastfed, compared with 48 percent in the 2007 IDHS. After six months of age, breast milk alone does not provide sufficient nutrition for the infant; thus, children over the age of six months should not be exclusively breastfed. Table 14.2 shows that 75 percent of children age 6-9 months living with their mothers receive some kind of complementary food, as per the recommended guidelines. The percentage of introduction of complementary feeding after 6 months of age remains unchanged since the 2002-2003 IDHS. Table 14.2 Breastfeeding status by age Percent distribution of youngest children under three years living with their mother by breastfeeding status, the percentage currently breastfeeding; and the percentage of all children under three years using a bottle with a nipple, according to age in months, Indonesia 2007 Breastfeeding and consuming: Age in months Not breast- feeding Exclusively breastfed Plain water only Non- milk liquids juice Other milk Comple- mentary foods Total Percentage currently breast- feeding Number of youngest children under three years living with mother Percentage using a bottle with a nipple1 Number of children <2 4.6 48.3 5.8 0.6 28.6 12.2 100.0 95.4 479 25.1 486 2-3 10.5 34.4 9.6 1.7 16.5 27.2 100.0 89.5 590 30.2 599 4-5 9.7 17.8 10.6 2.6 11.2 48.1 100.0 90.3 595 27.8 601 6-8 13.3 5.5 4.4 0.5 3.1 73.2 100.0 86.7 904 26.2 921 9-11 16.5 0.8 1.6 1.1 0.8 79.1 100.0 83.5 779 28.5 798 12-17 20.9 0.5 1.7 0.3 0.1 76.4 100.0 79.1 1,499 33.4 1,562 18-23 43.0 0.0 0.7 0.4 0.3 55.5 100.0 57.0 1,430 36.7 1,533 24-35 69.8 0.1 0.1 0.4 0.0 29.5 100.0 30.2 2,748 32.4 3,162 <4 7.9 40.6 7.9 1.2 21.9 20.5 100.0 92.1 1,069 27.9 1,085 <6 8.5 32.4 8.9 1.7 18.1 30.4 100.0 91.5 1,664 27.9 1,686 6-9 13.7 4.5 3.8 0.6 2.5 75.0 100.0 86.3 1,188 26.9 1,215 12-15 20.1 0.6 2.2 0.4 0.1 76.5 100.0 79.9 1,090 33.4 1,119 12-23 31.7 0.3 1.2 0.3 0.2 66.2 100.0 68.3 2,929 35.1 3,094 20-23 49.7 0.0 0.0 0.5 0.0 49.7 100.0 50.3 915 37.3 995 Note: Breastfeeding status refers to a 24-hour period (yesterday and the past night). Children classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids/juice, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and non-milk liquids and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years 172 | Infant Feeding Bottle-feeding is usually associated with increased risk of illness, especially diarrheal diseases, because of the difficulty in sterilizing the nipples properly. Bottle-feeding also shortens the period of postpartum amenorrhea of the mother, and increases the risk of pregnancy. However, this practice has become common in Indonesia. Table 14.2 shows that about three in ten children (28 percent) were given a bottle with a nipple as early as two months of age. The results also show that 28 percent of children less than six months of age are bottle-fed. This is an 11 percentage points increase from the level in the 2002- 2003 IDHS (17 percent). 14.3 DURATION AND FREQUENCY OF BREASTFEEDING Table 14.3 shows the median duration and frequency of breastfeeding by selected background characteristics. The estimates of median and mean durations of breastfeeding are based on current status data, that is, the proportion of last-born children in the three years preceding the survey who were being breastfed at the time of the survey. The overall median duration of any breastfeeding in Indonesia is about 21 months, and the mean duration is about the same. The median duration of exclusive breastfeeding is about one month, while the mean duration is about three months. Figure 14.2 shows that the median duration of any breastfeeding in Indonesia has been steadily decreasing from about 23.9 months in 1997 and about 22 months in 2002-2003 to about 20.7 months in 2007. There are only small variations in the median duration of any breastfeeding by selected background characteristics. Male children, children of uneducated mothers and of mothers with secondary or higher education, and children in the highest wealth quintile have the lowest median duration of any breastfeeding, compared with other children. For mothers to enhance their supply of breast milk and delay the return of menstruation, frequent breastfeeding must be practiced throughout the day and night (Ministry of Health, 2002d). Data presented in Table 14.3 indicate that almost all (95 percent) of breastfeeding children under six months of age were breastfed six or more times in the preceding 24 hours. Children are breastfed more frequently during the day than at night. Appendix Table A-14.2 shows the median duration of any breastfeeding by province. 40 32 17 28 IDHS 2002-2003 IDHS 2007 0 10 20 30 40 50 Percent Breastfed Bottlefed Figure 14.1 Percentage of Children under 6 Months of Age Who Are Exclusively Breastfed and Bottlefed, IDHS 2002-2003 and 2007 Infant Feeding | 173 Table 14.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by background characteristics, Indonesia 2007 Median duration (months) of breastfeeding among children born in the past three years1 Frequency of breastfeeding among children under six months2 Background characteristic Any breast- feeding Exclusive breast- feeding Predominant breast- feeding3 Number of children Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children Sex Male 20.2 0.7 0.8 5,235 94.7 7.4 5.8 827 Female 21.1 1.0 1.6 4,725 96.4 7.4 5.6 654 Residence Urban 19.6 0.7 0.7 4,115 94.4 7.0 5.5 611 Rural 21.4 0.7 1.7 5,844 96.2 7.6 5.8 870 Mother's education No education 19.8 1.1 2.0 314 98.9 7.9 6.3 38 Some primary 23.1 0.7 1.3 1,126 95.4 7.5 5.2 149 Complete primary 23.2 0.7 1.5 2,860 97.9 8.3 6.1 405 Some secondary 20.8 0.7 1.6 2,528 96.5 7.4 5.5 432 Secondary + 18.2 0.7 0.8 3,131 92.0 6.5 5.6 457 Wealth quintile Lowest 21.7 1.0 2.3 2,253 95.3 7.4 5.2 326 Second 21.7 0.7 0.7 1,920 98.5 8.4 6.4 301 Middle 21.3 1.3 1.9 2,032 96.0 7.7 6.1 317 Fourth 20.8 0.7 1.5 1,861 98.4 7.1 5.6 258 Highest 17.6 0.5 0.6 1,894 89.0 6.1 5.3 280 Total 20.7 0.7 1.2 9,960 95.4 7.4 5.7 1,481 Mean for all children 21.0 2.7 3.7 na na na na na Note: Median and mean durations are based on current status. Includes children living and deceased at the time of the survey. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding 2 Excludes children without a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only 23.9 22.3 20.7 IDHS 1997 IDHS 2002-2003 IDHS 2007 0 10 20 30 Months Figure 14.2 Median Duration of Any Breastfeeding (in Months) among Children Born in the Past Three Years, IDHS 1997, 2002-2003, and 2007 174 | Infant Feeding 14.4 TYPES OF COMPLEMENTARY FOODS The World Health Organization recommends the introduction of solid food to infants around the age of six months because by that age breast milk by itself is no longer sufficient to maintain a child's optimal growth. Appropriate complementary nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. In the transition to eating a healthy diet, children age six months or older should be fed small quantities of solid and semisolid foods throughout the day. During this transition from breastfeeding to complementary feeding at ages 6-23 months, the prevalence of malnutrition among young children increases substantially in many countries. This phenomenon is attributed primarily to increased infections and poor feeding practices. Table 14.4 provides information on the types of food given to the youngest child under three years living with the mother on the day and night preceding the survey, according to breastfeeding status. The percentage of children receiving solid or semisolid food increases gradually by age. It is encouraging to note that at 6-8 months of age more than eight in ten children are consuming solid or semisolid food. However, the introduction of other liquids such as water, juice, and infant formula takes place earlier than the recommended age of six months. Even among the youngest group of breastfeeding children (<2 months), 33 percent receive infant formula in addition to breast milk. More than half (53 percent) of children age 4-5 months have started consuming solid or semisolid food. The early introduction of water and foods increases the risk of infections, and thus contributes to malnutrition. Consumption of liquids other than milk increases gradually with age and by age 12-17 months about six in ten breastfeeding children (59 percent) and nonbreastfeeding children (66 percent) receive liquid supplements other than milk. Consumption of milk other than breast milk peaks at age 24-35 months (21 percent among breastfeeding children and 33 percent of nonbreastfeeding children). Supplementing with infant formula at any age is relatively common in Indonesia, with breastfeeding children age 6-17 months being the most likely to consume it (29-30 percent). At age 6-8 months, children are more likely to consume foods made from grains—80 percent of breastfeeding children and 79 percent of nonbreastfeeding children—than other types of solid or semisolid foods. About half of children age 6-8 months consumed vitamin A-rich fruits and vegetables in the day and night preceding the survey. Meat, fish, poultry, and eggs have bodybuilding substances essential to good health, and they are important for balanced physical and mental development. At age 6-8 months, about three in ten breastfeeding children and four in ten nonbreastfeeding children consumed meat, fish, shellfish, poultry or eggs. As expected, more nonbreastfeeding children consumed supple- ments at an earlier age than breastfeeding children. Infant Feeding | 175 Table 14.4 Foods and liquids consumed by children in the day and night preceding the interview Percentage of youngest children under three years of age who are living with the mother by type of foods consumed in the day and night preceding the interview, according to breastfeeding status and age, Indonesia 2007 Solid or semisolid foods Age in months Infant formula Other milk/ cheese/ yogurt1 Other liquids2 Food made from grains3 Fruits and vegetables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry, and eggs Food made with oil/ fat/ butter Fruits and vegetables rich in vitamin A4 Any solid or semisolid food Number of children BREASTFEEDING CHILDREN <2 33.4 1.7 3.8 8.0 8.1 1.0 0.8 1.6 1.7 2.5 12.7 457 2-3 30.2 2.2 8.5 23.8 10.3 1.8 2.3 2.7 3.7 7.2 30.4 528 4-5 28.1 1.5 16.1 46.1 18.6 4.2 7.3 8.5 5.0 17.0 52.9 537 6-8 30.1 4.6 34.1 80.1 31.0 15.7 20.9 30.7 19.0 47.6 84.3 784 9-11 28.5 6.9 46.6 88.5 45.1 29.8 37.2 57.3 40.3 76.7 94.8 651 12-17 29.5 9.1 59.1 94.2 51.4 37.9 51.8 71.2 49.1 82.9 96.5 1,185 18-23 27.7 18.3 69.7 94.4 51.0 41.4 54.7 74.0 53.1 83.7 97.2 814 24-35 23.6 20.8 70.5 95.7 49.3 38.0 57.7 78.6 63.0 77.3 97.8 829 <6 30.4 1.8 9.8 26.9 12.6 2.4 3.6 4.4 3.5 9.3 33.1 1,522 6-9 29.5 5.5 35.5 83.1 33.5 18.8 24.2 35.2 23.4 54.2 86.8 1,026 6-23 29.0 9.8 53.5 90.0 45.5 32.1 42.7 60.0 41.5 73.9 93.6 3,434 Total 28.6 9.3 44.5 74.2 37.3 25.1 34.5 48.0 34.6 57.4 78.2 5,785 NONBREASTFEEDING CHILDREN 6-8 84.6 10.0 38.1 79.2 38.7 23.4 17.4 42.1 14.1 51.0 84.6 121 9-11 88.3 9.2 62.4 94.0 54.1 40.9 48.4 71.9 40.5 82.2 97.4 129 12-17 72.6 14.7 66.4 96.5 61.2 42.4 54.3 72.8 48.9 84.9 99.3 314 18-23 52.9 30.5 78.3 99.0 56.7 40.3 61.6 82.1 60.6 88.3 99.3 615 24-35 42.5 33.0 75.6 98.8 58.0 44.6 63.2 80.3 62.7 86.6 99.4 1,918 <6 82.2 4.5 17.2 48.7 25.9 5.3 2.3 8.0 6.1 12.9 55.0 142 6-9 86.8 8.7 42.0 82.2 41.2 26.1 24.0 47.1 20.1 58.4 87.5 162 6-23 65.3 21.9 69.3 95.7 55.8 39.2 53.7 74.4 50.5 82.9 97.6 1,178 Total 52.5 27.7 70.7 95.5 55.8 40.9 57.1 75.0 55.8 82.0 96.8 3,239 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and the past night). 1 Other milk includes fresh, tinned and powdered cow or other animal milk 2 Doesn't include plain water 3 Includes fortified baby food 4 Includes fruits and vegetables included such as pumpkin, carrots, red sweet potatoes, dark green leafy vegetables, mangoes, papayas, jackfruit, and other locally grown fruits and vegetables that are rich in vitamin A 14.5 INFANT AND YOUNG CHILD FEEDING PRACTICES Infant and young child feeding (IYCF) practices include timely initiation of feeding solid/semisolid foods from age six months, feeding small amounts, and increasing the amount of foods and frequency of feeding as the child gets older, while maintaining frequent breastfeeding. Guidelines have been established with respect to these practices for children age 6-23 months (PAHO/WHO, 2003; WHO, 2005). For the average, healthy breastfed child, solid/semisolid foods should be provided two to three times per day at age 6-8 months and three to four times per day between ages 9 and 24 months, with an additional snack being offered one to two times per day, as desired. The minimum IYCF practices for children age 6-23 months are defined as follows: continued breastfeeding, feeding at least the minimum number of times per day (according to age), and feeding from the minimum number of food groups per day. However, not all infants and young children are breastfed. Therefore, for nonbreastfeeding children, the criteria reflected under “feeding practices” are as follows: receiving breast milk substitutes (that is, commercially produced infant formula, tinned, powdered, or fresh animal milk, cheese, yogurt, and other milk products), being fed at least the minimum number of times per day, and eating from the minimum number of food groups for nonbreastfed infants and young children. 176 | Infant Feeding Table 14.5 highlights infant and young child feeding practices among youngest children age 6-23 months living with the mother, by background characteristics and breastfeeding status. As shown in Table 14.5 and Figure 14.3, more than four in ten children age 6-23 months (41 percent) are fed according to recommended IYCF practices; that is, they are given milk or milk products and foods from recommended food groups and are fed at least the recommended minimum number of times per day. Nearly all children age 6-23 months (93 percent) are breastfed or given milk products, three-quarters are given the recommended number of foods (foods from three or more groups for breastfed children), and more than half (53 percent) are fed at least as often as is recommended. Table 14.5 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who were fed according to three IYCF feeding practices based on the number of food groups and number of times fed during the day and night preceding the survey, by breastfeeding status and background characteristics, Indonesia 2007 Among breastfed children 6-23 months, percentage fed: Among nonbreastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Background characteristic 3+ food groups1 Mini- mum times or more2 Both 3+ food groups and minimum times or more Number of breastfed children 6-23 months Milk or milk products3 4+ food groups 4+ times or more With 3 IYCF practices4 Number of non- breastfed children 6-23 months Breast- milk or milk products 3+ or 4+ food groups5 Mini- mum times or more6 With all 3 IYCF practices Number of all children 6-23 months Age 6-8 47.6 80.2 44.4 784 88.0 41.7 3.4 1.9 121 98.4 46.8 70.0 38.7 904 9-11 73.0 62.0 48.7 651 88.3 80.6 7.7 6.2 129 98.1 74.3 53.0 41.7 779 12-17 85.3 62.6 55.2 1,185 76.1 81.3 13.8 10.4 314 95.0 84.5 52.4 45.8 1,499 18-23 87.8 64.8 59.3 814 64.4 87.2 13.5 9.0 615 84.7 87.5 42.7 37.6 1,430 Sex Male 76.1 69.7 55.4 1,773 71.5 82.1 14.5 11.2 644 92.4 77.7 55.0 43.6 2,417 Female 73.8 64.2 49.4 1,661 73.8 78.1 8.8 4.8 534 93.6 74.8 50.7 38.6 2,196 Residence Urban 82.2 72.1 61.3 1,296 84.8 83.2 12.0 9.5 610 95.1 82.5 52.9 44.7 1,906 Rural 70.6 63.9 47.2 2,138 59.4 77.2 11.8 7.1 569 91.5 72.0 53.0 38.7 2,707 Mother's education No education 53.0 49.1 37.6 83 23.3 74.3 5.1 0.0 19 85.7 57.0 40.9 30.6 102 Some primary 70.3 64.1 45.4 392 43.9 64.2 4.9 2.8 92 89.3 69.1 52.8 37.3 484 Complete primary 72.0 62.8 46.7 1,085 61.6 82.0 17.7 11.3 257 92.6 73.9 54.2 39.9 1,342 Some secondary 75.1 67.5 52.8 922 68.3 79.8 13.0 6.6 271 92.8 76.2 55.1 42.3 1,193 Secondary + 82.1 74.1 63.0 952 86.5 82.7 10.1 9.0 539 95.1 82.3 50.9 43.5 1,491 Wealth quintile Lowest 62.9 63.0 43.8 791 45.0 67.9 10.1 6.8 194 89.2 63.9 52.5 36.5 985 Second 76.0 63.8 50.0 661 49.6 75.7 11.5 5.6 176 89.4 75.9 52.8 40.7 837 Middle 76.0 66.8 53.3 727 76.6 82.7 13.0 6.8 230 94.4 77.6 53.8 42.1 957 Fourth 77.8 70.3 54.8 702 81.5 82.9 9.9 9.1 257 95.0 79.2 54.1 42.5 958 Highest 86.0 72.8 63.7 554 91.7 86.4 14.1 11.2 321 97.0 86.2 51.2 44.4 875 Total 75.0 67.0 52.5 3,434 72.5 80.3 11.9 8.3 1,178 93.0 76.3 52.9 41.2 4,612 1 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge, fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts; h. foods made with oil, fat, butter. 2 At least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Nonbreastfed children ages 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding (IYCF) practices if they receive other milk or milk products and are fed at least the minimum number of times per day with at least the minimum number of food groups. 5 3+ food groups for breastfed children and 4+ food groups for nonbreastfed children 6 Fed solid or semisolid food at least twice a day for infants 6-8 months, 3+ times for other breastfed children, and 4+ times for nonbreastfed children. Infant Feeding | 177 These feeding practices are better among children age 12-17 months. For example, 46 percent of children 12-17 months are fed according to IYCF recommendations, compared with 39 percent of children 6-8 months. The findings indicate that male children, children in urban areas, children of mothers with some secondary or higher education, and children in the highest wealth quintile are more likely than other children to be fed according to recommendations. Breastfed children are more than five times as likely to be fed the minimum number of times per day as nonbreastfed children (67 and 12 percent, respectively) but are less likely to receive the recom- mended number of food groups (75 and 80 percent, respectively). Appendix Table A-14.3 shows the variation in infant and young children feeding practices across provinces. 14.6 FOODS CONSUMED BY MOTHERS The quality and quantity of foods that mothers consume influences their health and that of their children, especially the health of breastfeeding children. The 2007 IDHS included questions on the type of foods consumed by mothers of children under age three during the day and night preceding the interview. The results in Table 14.6 indicate that the staple diet of mothers of young children in Indonesia consists of foods made from grains (consumed by 99 percent of mothers), vitamin A-rich fruits and vegetables (consumed by 88 percent of mothers), and meat, fish, poultry and eggs (consumed by 79 percent of mothers). More than six in ten women (65 percent) consume foods made from legumes, more than half (54 percent) consume other fruits and vegetables, and less than half the women (46 percent) consume foods made from roots and tubers. Overall, 66 percent of women consume foods made with oil, fat, or butter. Smaller proportions of mothers consume milk (16 percent) or milk products (4 percent). Appendix Table A-14.4 shows micronutrient intake among mothers according to province. 47 92 59 53 8 41 Breastfed children Nonbreastfed children All children age 6-23 months 0 20 40 60 80 100 Percent Not fed according to all three IYCF practices Fed according to all three IYCF practices Figure 14.3 Infant and Young Child Feeding (IYCF) Practices IDHS 2007 178 | Infant Feeding Table 14.6 Foods consumed by mothers in the day and night preceding the interview Among mothers age 15-49 with a child under age three years living with them, the percentage who consumed specific types of foods in the day and night preceding the interview, by background characteristics, Indonesia 2007 Solid or semisolid foods Liquids Background characteristic Milk Other liquids Foods made from grains Foods made from roots/ tubers Foods made from legumes Meat/ fish/ shellfish/ poultry/ eggs Cheese/ yogurt Vitamin A- rich fruits/ vegetables Other fruits/ vegetables Foods made with oil/ fat/ butter Number of women Age 15-19 9.8 99.7 98.6 39.5 60.9 73.1 2.2 83.1 46.3 60.0 391 20-29 15.4 99.4 98.6 44.3 65.3 80.3 3.2 88.2 52.9 66.2 4,704 30-39 18.7 99.5 99.1 48.8 66.2 79.6 4.4 89.1 57.4 67.0 3,360 40-49 11.7 98.9 98.6 44.5 63.7 73.4 2.8 88.4 54.7 64.3 569 Residence Urban 23.2 99.6 99.2 44.9 72.5 84.9 5.4 91.1 58.1 68.6 3,738 Rural 11.2 99.3 98.4 46.4 60.3 75.3 2.2 86.3 51.8 64.4 5,286 Education No education 6.1 96.1 91.4 45.8 43.4 55.2 4.3 77.3 41.1 51.7 276 Some primary 6.2 99.2 98.3 43.6 57.8 72.1 0.8 82.0 47.0 63.2 1,017 Complete primary 9.7 99.3 98.7 43.2 64.8 74.3 1.8 86.5 49.4 63.0 2,607 Some secondary 13.3 99.9 99.3 45.8 66.5 78.5 2.0 88.7 53.1 68.5 2,307 Secondary + 29.0 99.6 99.2 48.8 69.9 89.5 7.4 93.0 64.1 69.5 2,818 Wealth quintile Lowest 7.0 98.9 97.3 45.3 44.6 70.6 1.9 82.4 45.7 56.1 1,976 Second 10.3 99.1 98.5 44.4 63.7 75.6 1.6 86.1 51.6 65.2 1,730 Middle 13.2 99.6 99.3 45.5 74.4 76.2 1.8 89.8 54.7 71.0 1,874 Fourth 19.1 99.9 99.4 44.1 71.4 84.8 3.5 91.3 55.3 68.5 1,717 Highest 32.7 99.8 99.5 49.6 75.0 90.9 9.4 92.6 65.9 70.9 1,727 Total 16.1 99.4 98.8 45.7 65.4 79.3 3.6 88.3 54.4 66.1 9,024 Note: Foods consumed in the past 24-hour period (yesterday and the past night). 1 Includes fruits and vegetables included in the questionnaire such as pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, jackfruit, and other locally grown fruits and vegetables that are rich in vitamin A 14.7 MICRONUTRIENT INTAKE Micronutrient deficiencies are a result of inadequate intake of micronutrient-rich foods and the inadequate utilization of available micronutrients in the diet as a result of infections, parasitic infestations, and other factors. Measures of micronutrient fortification, micronutrient supplementation with iron and vitamin A, consumption of vitamin A-rich and iron-rich foods, and micronutrient status in terms of night blindness are discussed in this section for both women and children. 14.7.1 Micronutrient Intake among Children Micronutrient deficiency has serious consequences for childhood morbidity and mortality. Chil- dren can receive micronutrients from foods, fortified foods, and direct supplementation. The 2007 IDHS collected information on the consumption of vitamin A-rich and iron-rich foods and vitamin A supplements. Table 14.7 shows the intake of these key micronutrients among children. Both vitamin A and iron are important to a child’s healthy development. Vitamin A is an essential micronutrient for the immune system. Severe vitamin A deficiency (VAD) can cause eye damage. VAD can also increase the severity of infections such as measles and diarrheal diseases in children and can slow recovery from illness. Vitamin A is found in breast milk, other milks, liver, eggs, fish, butter, red palm oil, mangoes, papayas, carrots, pumpkins, and dark green leafy vegetables. The liver can store enough vitamin A for four to six months. Periodic dosing (usually every six months) of vitamin A supplements is one method of ensuring that children at risk do not develop VAD. Iron is essential for cognitive development. Low iron intake also contributes to anemia. Iron requirements are greatest between the ages of 6 and 11 months, when growth is extremely rapid. Infant Feeding | 179 Table 14.7 Micronutrient intake among children Among youngest children age 6-35 months who are living with their mother, the percentage who consumed vitamin A-rich and iron-rich foods in the day and night preceding the survey, and among all children age 6-59 months, the percentage who were given vitamin A supple- ments in the six months preceding the survey, by background characteristics, Indonesia 2007 Youngest children age 6-35 months living with the mother All children age 6-59 months Background characteristic Percentage who consumed foods rich in vitamin A in past 24 hours1 Percentage who consumed foods rich in iron in past 24 hours2 Number of children Percentage given vitamin A supplements in past 6 months Number of children Age in months 6-8 55.0 32.2 904 41.4 921 9-11 83.9 59.7 779 62.3 798 12-17 90.5 71.5 1,499 70.0 1,562 18-23 93.7 77.5 1,430 74.6 1,533 24-35 94.2 79.8 2,748 72.1 3,162 36-47 na na 0 69.6 3,098 48-59 na na 0 69.7 3,166 Sex Male 87.8 70.1 3,797 68.2 7,326 Female 87.0 69.2 3,564 68.8 6,913 Birth order 1 86.0 69.4 2,564 69.1 4,999 2-3 88.3 70.2 3,395 70.8 6,550 4-5 88.0 71.9 997 65.5 1,894 6+ 87.8 61.5 404 52.6 796 Breastfeeding status Breastfeeding 83.1 63.6 4,263 65.6 4,739 Not breastfeeding 93.7 78.3 3,041 70.4 9,312 Residence Urban 90.3 75.0 3,025 74.0 5,927 Rural 85.4 66.0 4,335 64.6 8,312 Mother's education No education 88.0 54.2 232 43.0 495 Some primary 84.6 65.4 852 54.5 1,747 Complete primary 85.4 64.6 2,176 66.4 4,120 Some secondary 87.9 69.8 1,828 73.1 3,509 Secondary + 90.0 77.6 2,273 75.3 4,368 Mother's age at birth 15-19 80.5 60.2 239 52.1 294 20-24 84.0 65.5 1,738 67.7 2,866 25-29 88.2 73.8 2,028 68.5 4,006 30-34 88.9 71.0 1,682 70.7 3,443 35-49 89.5 69.1 1,674 68.4 3,630 Wealth quintile Lowest 82.4 60.8 1,626 54.5 3,266 Second 87.2 66.7 1,409 68.9 2,771 Middle 86.9 69.2 1,530 72.0 2,791 Fourth 88.9 73.4 1,404 75.6 2,737 Highest 92.6 79.8 1,393 74.2 2,673 Total 87.4 69.7 7,360 68.5 14,239 Note: Information on vitamin A and iron supplements medication is based on the mother's recall. There are 56 children age 6-35 months and 188 children age 6-59 months with information missing on breastfeeding status. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, jackfruit, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat, (including organ meat) 180 | Infant Feeding Table 14.7 shows that 87 percent of youngest children age 6-35 months living with their mothers consumed foods rich in vitamin A in the 24-hour period before the survey. Consumption of foods rich in vitamin A increases from 55 percent among children age 6-8 months to 94 percent among children age 24-35 months. There is no variation by sex of child in the consumption of vitamin A-rich foods. Not surprisingly, breastfeeding children are significantly less likely to consume foods rich in vitamin A than non-breastfeeding children. Children living in urban areas and children in the highest wealth quintile are more likely to consume vitamin A-rich foods than other children. Seven in ten children age 6-35 months consumed foods rich in iron in the 24 hours preceding the interview. Variations in children’s consumption of foods rich in iron by background characteristics are similar to those observed for consumption of vitamin A-rich foods. Sixty-nine percent of children age 6-59 months received a vitamin A supplement in the six months before the survey. Children age 6-8 months are the least likely to receive the vitamin A supplements when compared with older children. Children living in urban areas, those born to highly educated mothers, children of mothers age 20 or older, and children in the highest wealth quintiles are more likely to have received vitamin A supplements in past 6 months than other children. Sixty-six percent of breastfeeding children received vitamin A supplements compared with 70 percent of non- breastfeeding children. Appendix Table A-14.5 shows the variations in vitamin A consumption and supplementation by province. 14.7.2 Micronutrient Intake among Mothers A mother's nutritional status during pregnancy is important both for the child’s intrauterine development and for protection against maternal morbidity and mortality. Night blindness is an indicator of severe vitamin A deficiency, and pregnant women are especially prone to suffer from it. This section discusses women’s micronutrient intake status, both in terms of food intake and supplementation. Adequate micronutrient intake by women has important benefits for both women and their children. Breastfeeding children benefit from micronutrient supplementation that mothers receive, especially vitamin A. Iron supplementation of women during pregnancy protects mother and infant against anemia. It is estimated that one-fifth of perinatal mortality and one-tenth of maternal mortality are attributable to iron deficiency anemia. Anemia also results in an increased risk of premature delivery and low birth weight. Finally, iodine deficiency is also related to a number of adverse pregnancy outcomes. Table 14.8 presents the data on micronutrient intake for mothers of young children by background characteristics. The results indicate the 96 percent of mothers of young children consumed vitamin A-rich foods and 79 percent consumed iron-rich foods in the 24 hours preceding the survey. In general, the consumption of vitamin A-rich foods by women with young children does not vary much by background characteristics. Consumption of iron-rich foods by mothers of young children is higher in urban areas (85 percent), mothers with secondary or higher education (90 percent), and mothers in households in the highest wealth quintile (91 percent). Consumption of both vitamin A and iron-rich foods does not vary much by the age of the mothers and number of children ever born. In addition to improving food intake, supplementation is an important strategy for addressing micronutrient deficiencies. Postpartum supplementation with vitamin A is important in reducing the proportion of women experiencing night blindness. Vitamin A deficiency can lead to increased risk of mortality and morbidity as well as night blindness. Table 14.8 shows that only 45 percent of women reported that they had received a vitamin A capsule in the two months after delivery of their last-born child. Women with 1-3 children, those living in urban areas, women with higher education, and women living in households in the two highest wealth quintiles are the more likely to have received a vitamin A dose postpartum than other women. Infant Feeding | 181 Table 14.8 Micronutrient intake among mothers Among women age 15-49 with a child under age three years living with her, the percentage who consumed vitamin A-rich and iron-rich foods in the 24 hours preceding the survey; among women age 15-49 with a child born in the past five years, the percentage who received a vitamin A dose in the two months after the birth of the last child; the percentage who during the pregnancy for the last child suffered from night blindness, and the percentage who took iron tablets or syrup for specific numbers of days, during pregnancy for the last birth, by background characteristics, Indonesia 2007 Women with a child under three years living with her Number of days women took iron tablets or syrup during pregnancy for last birth Percentage who suffered night blindness during pregnancy for last child Background characteristic Percentage consumed vitamin A- rich foods1 Percentage consumed iron-rich foods2 Number of women Percentage who received vitamin A dose postpartum3 Reported Adjusted4 None <60 60-89 90+ Don't know/ missing Number of women Age 15-19 94.7 73.1 391 34.3 0.8 0.1 25.4 33.4 4.5 29.8 6.8 418 20-24 94.4 77.3 2,189 41.7 2.4 0.7 20.0 35.6 8.7 28.9 6.8 2,954 25-29 96.0 82.9 2,515 45.3 1.5 0.2 18.7 35.1 8.4 30.4 7.4 3,885 30-34 96.3 80.7 2,012 47.6 1.9 0.3 18.6 33.8 8.5 30.2 8.9 3,305 35-49 95.4 76.5 1,917 44.6 3.2 0.4 24.8 31.2 7.6 27.0 9.3 3,481 Number of children ever born 1 95.2 79.9 3,198 45.7 1.5 0.3 17.5 33.1 8.7 33.3 7.4 4,856 2-3 95.8 80.0 4,152 46.1 2.0 0.3 18.1 34.3 8.6 30.4 8.5 6,568 4-5 95.6 78.7 1,191 41.3 3.2 0.4 28.6 35.5 6.8 20.3 8.7 1,860 6+ 94.7 70.9 483 32.0 5.8 0.7 43.4 30.7 4.8 14.1 7.0 759 Residence Urban 97.7 84.9 3,738 51.0 1.9 0.2 14.2 33.6 8.8 35.4 8.0 5,897 Rural 93.9 75.3 5,286 39.9 2.4 0.5 25.3 34.1 7.8 24.7 8.1 8,145 Education No education 87.0 55.2 276 25.0 7.2 0.3 54.2 21.4 6.2 10.4 7.8 458 Some primary 94.2 72.1 1,017 31.1 3.4 0.3 37.3 32.6 6.2 17.1 6.8 1,677 Complete primary 94.0 74.3 2,607 40.5 1.7 0.4 24.2 34.6 8.3 24.5 8.4 4,106 Some secondary 95.4 78.5 2,307 47.0 2.3 0.5 16.6 36.3 9.0 31.1 7.0 3,543 Secondary + 98.3 89.5 2,818 54.0 1.5 0.2 10.5 32.9 8.4 38.9 9.3 4,260 Wealth quintile Lowest 91.8 70.6 1,976 34.3 4.0 0.8 36.3 34.0 7.0 15.4 7.3 3,010 Second 93.7 75.6 1,730 40.0 2.5 0.2 24.6 34.6 6.9 25.8 8.2 2,791 Middle 95.7 76.2 1,874 46.0 1.8 0.5 17.2 34.7 10.6 30.6 6.9 2,812 Fourth 98.6 84.8 1,717 50.8 1.4 0.2 12.3 38.4 8.3 32.8 8.2 2,742 Highest 98.2 90.9 1,727 53.1 1.0 0.1 11.2 27.6 8.3 43.0 9.9 2,688 Total 95.5 79.3 9,024 44.6 2.2 0.4 20.7 33.9 8.2 29.2 8.1 14,043 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, carrots, red sweet potatoes, mango, papaya, jackfruit, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat (and organ meat), fish, poultry, eggs 3 In the first two months after delivery 4 Women who reported night blindness but did not report difficulty with vision during the day Two percent of mothers reported having difficulty seeing at night but, when this figure is adjusted to include only those mothers who had no difficulty seeing in the daytime, less than 1 percent of mothers suffered from night blindness during their most recent pregnancy in the past five years. Iron supplementation during pregnancy is important to avoid problems iron deficiency for both the woman and her fetus. The results in Table 14.8 indicate that 21 percent women who gave birth during the five years preceding the survey did not receive any iron supplementation during the pregnancy for their last birth. Among women who reported that they took iron supplements, the majority took the supplements for less than 60 days (34 percent), 8 percent took the iron supplements for 60-89 days, and 29 percent took the supplements as per the recommendations, i.e., for 90 or more days. Variations in the intake of iron supplementation during pregnancy by background characteristics is similar to those observed for vitamin A supplementation. Appendix Table A-14.6 shows the variations in micronutrient intake among mothers of young children by province. HIV and AIDS-related Knowledge, Attitudes and Behavior | 183 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 15 Acquired immune deficiency syndrome (AIDS) is caused by a human immunodeficiency virus (HIV) that weakens the immune system, making the body susceptible to and unable to recover from other opportunistic diseases that lead to death. The predominant mode of HIV transmission in Indonesia is through the sharing of needles among injecting drug users (IDUs), known as unsafe injections, followed by heterosexual contact, followed by perinatal transmission in which the mother passes the virus to her child during pregnancy, delivery, or breastfeeding. Other modes of transmission are through infected blood and other skin-piercing practices. Indonesia has one of the fastest growing HIV epidemics in Asia. Although HIV prevalence among adults is still generally low, it has reached a high level in specific populations such as injecting drug users and sex workers. In Papua, the prevalence in the general population is more than 20 times the national average. A recent survey in Papua found that 1 percent of the general population is HIV positive (European Union, WHO, UNICEF, and UNAIDS, 2006). The HIV/AIDS epidemic in Indonesia is spreading rapidly across almost all 33 provinces. An impressive expansion of the response to the epidemic has been seen in the past two to three years, and a number of sound strategies and interventions are in place to deal with the epidemic. The national commitment to respond effectively to the epidemic is strong and growing. However, major disparities still exist because of geographical, health systems capacity, the nature and size of the epidemic and available resources. The Minister of Health established a National AIDS Committee (NAC) in 1987 after the detection of the first AIDS case in a foreign tourist in Bali. The NAC structure was reorganized in July 2006 through Presidential Regulation No. 75/2006. The Coordinating Minister for People’s Welfare serves as Chair of the NAC with the Minister of Health and the Minister of Home Affairs serving as Vice Chairs. The membership was expanded to include 18 ministries and agencies and five nongovernmental organizations (NGOs). The Commission promotes the National AIDS Strategy known as the “AIDS National Action Plan 2007-2010” (NAC, 2007) with targets to achieve the following: scale up harm reduction activities to reach 80 percent of IDUs; promote 100 percent condom use at hotspots to reach 80 percent of female and male sex workers; provide comprehensive HIV prevention services to 80 percent of IDUs in prisons; provide antiretroviral therapy (ART) to all people living with HIV and AIDS (PLHA) who need ART; and provide HIV prevention messages to all youth/adolescents. The data obtained in the 2007 IDHS provide an opportunity to assess some of the factors related to HIV/AIDS and sexually transmitted infections (STIs). The principal objective of this chapter is to establish the prevalence of relevant knowledge, perceptions, and behaviors at the national and provincial level, and within socioeconomic subgroups of the population. In this way, AIDS control programs and strategies can target those groups most in need of information and services and most vulnerable to the risk of HIV. The indicators reported in this chapter do not include the United Nations General Assembly Special Session (UNGASS) indicators because the survey sample was limited to ever-married women and currently married men; UNGASS indicators measure all women and men. This chapter presents findings about current levels of knowledge (general and specific) on AIDS- related issues, such as the proportion who have ever heard about AIDS, sources of information about AIDS, methods of preventing AIDS, misconceptions about AIDS, and knowledge of other AIDS-related 184 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior issues. The chapter discusses the topics AIDS and spouses, social aspects of HIV/AIDS, and knowledge of and access to male condoms. Information is presented on attitudes toward negotiating safer sex, the prevalence of higher-risk sex, knowledge of the symptoms of STIs, self-reported prevalence of STIs, and HIV knowledge and sexual behavior among young adults. The chapter concludes with information on the proportion of respondents who know a person who is living with HIV or AIDS, knowledge of voluntary counseling and testing (VCT), and where to access VCT. 15.1 KNOWLEDGE OF AIDS IDHS respondents were asked wheth- er they had heard of HIV/AIDS. Those who reported having heard of HIV or AIDS were asked where they obtained the information. Table 15.1 shows the percentage of ever- married women and currently married men who have ever heard of AIDS, by back- ground characteristics. Overall, 61 percent of ever-married women and 71 percent of currently married men said that they had heard of AIDS. The percentage of ever- married women who have heard of AIDS varies by age in an inverted U-shaped pattern, i.e., it increases from 52 percent for age group 15-19 to a peak of 72 percent for age group 25-29, after which it decreases to 47 percent for age group 40-49. The pattern for men is similar to that for women. The percentage of women who have heard of AIDS is higher among currently married women than widowed or divorced women (62 and 49 percent, respectively). Women and men in urban areas are much more likely to have heard about AIDS than those in rural areas. For example, 77 percent of urban women have heard of AIDS, com- pared with 49 percent of rural women. Sim- ilarly, 86 percent of urban men have heard of AIDS, compared with 61 percent of rural men. The percentage of women and men who have heard of AIDS increases with level of education (Figure 15.1) and increasing wealth quintile. Table 15.1 Knowledge of HIV/AIDS Percentage of ever-married women and currently married men who have heard of AIDS by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Has heard of AIDS Number of women Has heard of AIDS Number of men Age 15-24 66.0 4,939 67.3 460 15-19 52.4 845 * 29 20-24 68.8 4,094 68.7 432 25-29 71.8 5,771 77.4 1,116 30-39 65.4 12,024 79.4 3,097 40-49 47.3 10,160 68.3 2,930 50-54 na 0 53.7 1,155 Marital status Married/living together 61.8 30,931 71.4 8,758 Divorced/separated/ widowed 49.3 1,964 na 0 Residence Urban 77.3 13,745 85.5 3,728 Rural 49.3 19,150 61.0 5,030 Education No education 9.4 2,271 18.7 365 Some primary 27.8 5,572 39.6 1,605 Complete primary 52.8 10,077 63.7 2,339 Some secondary 77.6 6,781 84.6 1,721 Secondary + 94.3 8,193 95.5 2,727 Wealth quintile Lowest 29.9 6,219 43.8 1,676 Second 47.1 6,606 60.9 1,698 Middle 61.1 6,710 71.3 1,788 Fourth 74.9 6,713 83.9 1,713 Highest 89.9 6,647 94.2 1,882 Total 61.0 32,895 71.4 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed na = Not applicable HIV and AIDS-related Knowledge, Attitudes and Behavior | 185 Figure 15.2 shows that the percentage of ever-married women who have heard of AIDS increased from 38 percent in 1994 to 61 percent in 2007. In 2007, knowledge of AIDS among currently married men was higher than among ever-married women (71 and 61 percent, respectively). Knowledge of AIDS among ever-married women and currently married men by province is presented in Appendix Table A-15.1. 9 19 28 40 53 64 78 85 94 96 Ever-married women Currently married men 0 20 40 60 80 100 Percent No education Some primary Complete primary Some secondary Secondary+ Figure 15.1 Percentge of Ever-married Women and Currently Married Men Who Have Heard of AIDS by Level of Education IDHS 2007 18 51 59 61 71 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 0 20 40 60 80 Percent Ever-married women Currently married men Figure 15.2 Percentge of Ever-married Women and Currently Married Men Who Have Heard of AIDS, Indonesia 1994-2007 186 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior The most common source of information about AIDS for both women and men is television (89 and 87 percent, respectively) (Tables 15.2.1 and 15.2.2). Other sources include newspaper/magazine (29 percent of women and 41 percent of men), family/friends (23 percent of women and 36 percent of men), and radio (20 percent of women and 26 percent of men). Few respondents cited health providers as a source for information about HIV/AIDS (7 percent of women and 9 percent of men). For both women and men, the percentage who had heard of AIDS from television and radio was higher in urban areas than in rural areas, and increased with increasing level of education and wealth quintile. Table 15.2.1 Source of information on HIV/AIDS: women Percent distribution of ever-married women who have heard of AIDS by source of information on HIV/AIDS, by background characteristics, Indonesia 2007 Source of information on HIV/AIDS Background characteristic Radio Tele- vision News- paper/ maga- zines Poster Health profes- sional Religious insti- tution School/ teacher Com- munity meeting Friend / relative Work- place Internet Other Number of women who have heard of AIDS Age 15-24 21.6 88.4 26.9 4.5 5.9 0.7 4.8 2.4 20.7 2.7 0.1 0.5 3,260 15-19 18.9 86.8 24.3 2.4 4.8 2.6 8.2 3.5 16.9 0.1 0.0 1.8 443 20-24 22.0 88.6 27.3 4.9 6.1 0.4 4.3 2.2 21.3 3.1 0.1 0.3 2,816 25-29 19.7 90.7 30.5 4.3 6.8 0.4 2.7 2.5 22.8 3.3 0.6 0.6 4,146 30-39 20.9 89.6 32.0 4.8 6.8 0.6 1.1 4.0 22.7 3.2 0.2 0.9 7,860 40-49 18.2 85.2 25.8 3.2 6.6 1.3 1.1 5.7 24.7 4.9 0.1 0.8 4,808 Marital status Married/living together 20.1 88.8 29.4 4.3 6.6 0.7 2.1 3.8 22.5 3.5 0.3 0.7 19,105 Divorced/separated/ widowed 19.4 83.3 29.2 3.3 5.9 0.6 1.3 4.3 29.5 4.6 0.0 1.0 968 Residence Urban 21.5 91.4 37.4 5.8 6.6 0.7 2.2 3.9 23.3 4.6 0.4 0.7 10,626 Rural 18.6 85.3 20.3 2.6 6.7 0.7 1.8 3.7 22.4 2.4 0.1 0.7 9,447 Education No education 10.3 65.7 3.6 0.5 5.2 6.0 0.0 5.2 34.9 0.3 0.0 0.6 214 Some primary 10.9 77.2 4.8 0.9 4.3 0.7 0.0 3.8 28.8 1.4 0.0 0.6 1,550 Complete primary 14.3 83.9 11.3 1.1 4.9 0.4 0.0 2.8 23.5 1.8 0.0 0.5 5,317 Some secondary 19.7 90.0 23.3 3.5 6.5 0.5 1.1 3.2 21.7 2.5 0.0 0.5 5,265 Secondary + 26.5 93.7 51.6 7.8 8.4 1.0 4.6 4.9 21.7 5.9 0.7 1.1 7,727 Wealth quintile Lowest 20.4 72.8 15.2 2.2 6.9 1.5 2.0 3.6 26.8 2.3 0.0 0.8 1,857 Second 16.7 84.6 16.5 1.9 6.6 0.5 1.3 3.4 23.9 1.3 0.0 0.4 3,110 Middle 18.0 88.6 20.6 2.8 5.6 0.8 1.6 3.0 22.0 2.6 0.0 0.8 4,101 Fourth 20.6 91.0 29.1 4.6 6.6 0.4 2.1 4.2 22.5 3.7 0.1 0.5 5,026 Highest 22.8 93.3 46.7 6.9 7.2 0.9 2.7 4.4 21.9 5.6 0.8 1.0 5,978 Total 20.1 88.5 29.4 4.3 6.6 0.7 2.1 3.8 22.9 3.5 0.3 0.7 20,073 HIV and AIDS-related Knowledge, Attitudes and Behavior | 187 Table 15.2.2 Source of information on HIV/AIDS: men Percent distribution of currently married men who have heard of AIDS by source of information on HIV/AIDS, by background characteristics, Indonesia 2007 Source of information on HIV/AIDS Background characteristic Radio Tele- vision News- paper/ maga- zines Poster Health profes- sional Religious insti- tution School / teacher Com- munity meeting Friend / relative Work- place Internet Other Number of men who have heard of AIDS Age 15-24 20.8 81.3 37.1 8.7 6.5 0.4 6.9 1.5 46.1 8.2 2.2 3.2 310 15-19 * * * * * * * * * * * * 13 20-24 21.7 81.9 38.4 9.1 6.6 0.4 7.2 1.6 45.4 8.4 2.3 3.1 296 25-29 24.1 88.5 41.2 12.0 8.1 0.5 5.2 2.1 39.8 12.7 0.2 0.4 863 30-39 28.0 87.2 43.8 10.6 8.3 0.9 2.9 2.8 35.5 12.2 0.9 1.8 2,461 40-49 25.1 86.5 41.0 7.5 9.4 1.2 1.4 3.8 34.8 10.8 0.2 2.2 2,000 50-54 27.8 83.0 35.7 6.7 9.1 1.6 1.0 3.6 31.8 10.8 0.1 0.9 621 Residence Urban 25.5 90.2 51.3 13.0 7.9 0.6 2.8 3.1 36.3 13.6 0.7 1.7 3,186 Rural 26.8 82.5 31.2 5.5 9.4 1.4 2.7 3.0 35.7 9.3 0.4 1.7 3,068 Education No education 8.8 61.3 9.3 6.8 1.5 5.8 0.5 2.2 33.9 19.4 0.0 2.4 68 Some primary 14.5 71.7 6.6 0.8 5.4 0.3 0.1 2.1 41.9 7.6 0.0 2.5 635 Complete primary 22.0 81.0 20.8 2.9 4.0 0.9 0.1 3.0 34.6 10.7 0.0 0.5 1,490 Some secondary 25.5 85.9 35.7 5.4 6.8 0.5 0.9 1.4 39.6 9.2 0.0 2.0 1,456 Secondary + 32.1 94.2 65.7 17.3 13.3 1.3 5.9 4.3 33.4 14.0 1.3 2.0 2,605 Wealth quintile Lowest 28.2 71.4 23.1 2.4 9.4 2.7 2.1 4.1 35.1 7.7 0.1 1.2 734 Second 23.9 79.7 24.5 3.1 7.5 0.8 1.8 2.0 35.6 8.1 0.0 2.2 1,035 Middle 23.2 84.2 30.8 5.8 8.8 0.5 2.1 3.4 40.6 9.2 0.1 2.3 1,276 Fourth 26.7 91.8 45.8 10.0 7.2 0.7 3.1 1.7 36.3 11.9 0.1 0.8 1,437 Highest 28.3 93.9 63.0 17.9 9.9 0.9 3.6 4.0 33.1 16.3 1.7 1.8 1,772 Total 26.1 86.5 41.4 9.3 8.6 1.0 2.7 3.1 36.0 11.5 0.6 1.7 6,254 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 15.2 KNOWLEDGE OF HIV PREVENTION METHODS HIV in adults is mainly transmitted through heterosexual contact between an HIV-positive partner and an HIV-negative partner. Consequently, HIV prevention programs focus their messages and efforts on three important aspects of behavior: use of condoms, limiting the number of sexual partners or staying faithful to one partner, and delaying sexual debut for young persons (abstinence). To ascertain whether the programs have effectively communicated these messages, IDHS respondents were prompted with specific questions about whether it is possible to reduce the chances of getting HIV by using a condom at every sexual encounter, limiting sexual intercourse to one uninfected partner, and abstaining from sex. Table 15.3 shows levels of knowledge of the various HIV prevention methods by background characteristics. Thirty-six percent of ever-married women and 49 percent of currently married men know that using condoms can reduce transmission of HIV. Knowledge of condom use is similar across age groups. The percentage of respondents who know that use of condoms can reduce the risk of HIV transmission is higher for urban residents, men, respondents with higher education, and respondents in the higher wealth quintiles. 188 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.3 Knowledge of HIV prevention methods Percentage of ever-married women and currently married men who, in response to prompted questions, say that people can reduce the risk of getting HIV by using condoms every time they have sexual intercourse, by having one sex partner who is HIV negative and has no other partners, and by abstaining from sexual intercourse, by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Using condoms1 Limiting sexual intercourse to one HIV- negative partner2 Using condoms and limiting sexual intercourse to one HIV- negative partner1,2 Abstaining from sexual intercourse Number of women Using condoms1 Limiting sexual intercourse to one HIV- negative partner2 Using condoms and limiting sexual intercourse to one HIV- negative partner1,2 Abstaining from sexual intercourse Number of men Age 15-24 38.1 44.7 31.2 39.9 4,939 49.5 49.2 42.7 39.8 460 15-19 27.5 32.4 21.0 27.2 845 44.4 41.8 41.8 42.9 29 20-24 40.3 47.2 33.4 42.6 4,094 49.8 49.7 42.8 39.6 432 25-29 40.8 49.2 34.0 42.4 5,771 52.6 56.7 45.4 44.4 1,116 30-39 39.3 46.0 33.6 40.3 12,024 56.0 59.3 47.5 49.1 3,097 40-49 26.6 32.4 22.5 27.3 10,160 46.5 49.5 38.2 40.9 2,930 50-54 na na na na 0 32.3 38.0 28.2 30.9 1,155 Marital status Married/living together 35.9 42.8 30.3 37.1 30,931 48.9 52.4 41.3 42.9 8,758 Divorced/separated/ widowed 28.4 32.7 23.8 29.3 1,964 na na na na 0 Residence Urban 48.9 56.4 42.4 49.3 13,745 62.2 66.6 53.7 52.7 3,728 Rural 25.8 32.0 20.9 27.5 19,150 39.1 41.8 32.2 35.6 5,030 Education No education 4.3 5.2 3.1 4.7 2,271 3.2 5.7 2.7 4.8 365 Some primary 11.2 15.0 8.7 12.3 5,572 21.6 22.9 16.8 18.5 1,605 Complete primary 26.0 32.2 20.6 27.7 10,077 36.8 41.1 29.0 35.0 2,339 Some secondary 44.9 53.8 37.5 47.3 6,781 59.6 62.1 49.3 51.4 1,721 Secondary + 64.5 73.6 56.8 64.0 8,193 74.9 79.5 66.5 63.7 2,727 Wealth quintile Lowest 12.6 17.2 9.5 14.1 6,219 23.4 24.6 17.4 21.8 1,676 Second 23.8 29.1 18.6 26.1 6,606 37.2 40.2 31.0 32.6 1,698 Middle 33.3 40.7 28.1 35.1 6,710 47.1 50.6 38.3 41.0 1,788 Fourth 44.5 53.5 38.1 46.1 6,713 61.2 64.6 52.5 52.4 1,713 Highest 61.3 68.5 53.8 60.0 6,647 72.9 78.5 64.8 64.0 1,882 Total 35.5 42.2 29.9 36.6 32,895 48.9 52.4 41.3 42.9 8,758 na = Not applicable 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners The result shows that 42 percent of ever-married women and 52 percent of currently married men know the HIV prevention method: limiting sexual intercourse to one faithful, HIV-negative partner. The proportion with knowledge about limiting sexual intercourse to one faithful partner is similar across age groups. Knowledge about limiting sexual intercourse to one faithful, HIV-negative partner is higher for urban residents, men, respondents with higher education, and respondents in the higher wealth quintiles. Table 15.8 also shows that 37 percent of ever-married women and 43 percent of currently married men know that abstinence is a way to prevent HIV. At the national level, the percentage with this knowledge is highest among women age 20-39 and men age 25-39. Knowledge of abstinence as a way to prevent HIV is also higher for urban residents, men, respondents with higher education, and respondents in the higher wealth quintiles. HIV and AIDS-related Knowledge, Attitudes and Behavior | 189 Figure 15.3 shows levels of knowledge about prevention of HIV/AIDS among ever-married women since 1994. Data are presented for three methods: condom use, limiting sexual intercourse to one HIV-negative partner, and delaying sexual debut (abstinence). The results show that knowledge of condom use to prevent HIV/AIDS increased slowly, from 3 percent in 1994 to 36 percent in 2007. Knowledge of limiting sexual intercourse to one HIV-negative partner as a means of reducing the likelihood of HIV transmission increased from 20 percent in 1994 to 47 percent in 2002-2003; then it decreased to 42 percent in 2007. On the other hand, knowledge of delaying sexual debut (abstinence) decreased from 90 percent in 1994 to 45 percent in 2002-2003; then it decreased further to 37 percent in 2007. 15.3 REJECTION OF MISCONCEPTIONS ABOUT HIV/AIDS Stigma and discrimination are two of the constraints in the prevention of HIV/AIDS. Stigma and discrimination usually arise from misconceptions about HIV/AIDS. For program efforts to succeed, therefore, it is important that common misconceptions about HIV/AIDS are corrected. Common misconceptions about HIV and AIDS include the idea that all HIV-positive persons appear ill, the belief that the virus can be transmitted through mosquito or other insect bites, and the belief that a person can get AIDS by sharing food with someone who has HIV, or by witchcraft, or other supernatural means. Respondents were asked about these misconceptions and the findings are presented in Tables 15.4.1 and 15.4.2. 3 20 0 4 29 1 22 30 36 42 37 Using condom Limiting sexual intercourse to one sexual partner Abstaining from sexual intercourse 0 20 40 60 80 100 Percent 1994 1997 2002-2003 2007 Figure 15.3 Trends in Knowledge of HIV Prevention Methods among Ever-married Women Who Have Heard of AIDS, Indonesia 1994-2007 na na = Not applicable 190 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.4.1 Comprehensive knowledge about AIDS: Women Percentage of ever-married women who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Indonesia 2007 Percentage of respondents who say that: Background characteristic A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by supernatural means A person cannot get HIV by sharing food with a person who has AIDS Percentage who say that a healthy- looking person can have the AIDS virus and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of women Age 15-24 48.6 30.4 49.6 30.6 15.2 9.5 4,939 15-19 37.7 22.2 36.3 18.8 9.8 5.7 845 20-24 50.8 32.1 52.4 33.1 16.3 10.3 4,094 25-29 52.2 35.5 56.9 35.4 18.3 11.1 5,771 30-39 47.7 31.9 51.7 32.0 16.8 10.8 12,024 40-49 31.5 19.8 35.2 19.2 9.3 5.8 10,160 Marital status Married/living together 44.1 28.9 47.9 28.8 14.7 9.3 30,931 Divorced/separated/ widowed 34.9 22.9 36.6 22.6 11.5 7.3 1,964 Residence Urban 59.3 40.2 63.8 40.9 22.7 14.9 13,745 Rural 32.3 20.2 35.4 19.5 8.6 5.0 19,150 Education No education 4.9 1.7 4.0 1.7 0.3 0.2 2,271 Some primary 14.4 8.4 15.7 6.4 2.1 1.1 5,572 Complete primary 33.1 20.1 35.7 18.3 7.7 3.9 10,077 Some secondary 55.4 34.8 60.3 35.1 16.0 10.2 6,781 Secondary + 77.4 55.0 84.1 57.8 34.0 22.7 8,193 Wealth quintile Lowest 17.1 10.5 18.8 8.8 3.3 1.9 6,219 Second 29.3 18.3 32.5 17.9 6.8 3.8 6,606 Middle 41.1 26.1 44.3 24.9 11.1 7.1 6,710 Fourth 55.7 35.2 59.6 36.2 18.1 10.7 6,713 Highest 72.8 51.4 78.9 53.1 32.3 21.7 6,647 Total 15-49 43.6 28.6 47.2 28.4 14.5 9.1 32,895 1 Two most common local misconceptions: AIDS can be transmitted by mosquito bites, and by sharing food with an HIV-positive person 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one HIV- negative faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. It is worth noting that among the misconceptions presented, knowledge was highest for witchcraft or other supernatural means (i.e., 47 percent of women and 60 percent of men said that HIV cannot be transmitted by witchcraft or other supernatural means). Similarly, 44 percent of women and 51 percent of men correctly reported that a healthy-looking person can have HIV. Level of education and household wealth quintile both appear to be strongly related to accurate knowledge about the ways in which HIV can and cannot be transmitted; the lower the level of education and wealth quintile, the lower the level of accurate knowledge about HIV transmission. The percentage of respondents who said that a healthy- looking person can have HIV and rejected the two most common local misconceptions is 15 percent for ever-married women and 17 percent for currently married men. HIV and AIDS-related Knowledge, Attitudes and Behavior | 191 Tables 15.4.1 and 15.4.2 provide an assessment of the level of comprehensive knowledge of HIV prevention and transmission. Comprehensive knowledge is defined as knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or prevention: HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV or AIDS. The results show that the percentage of respondents with comprehensive knowledge of AIDS is very low: 9 percent among ever- married women and 13 percent among currently married men. These low levels of comprehensive knowledge of HIV are of particular concern regarding women age 15-19 and 40-49, and men age 15-19 and 50-54, for whom comprehensive knowledge is 6 percent or less. Table 15.4.2 Comprehensive knowledge about AIDS: Men Percentage of currently married men who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Indonesia 2007 Percentage of respondents who say that: Background characteristic A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by supernatural means A person cannot get HIV by sharing food with a person who has AIDS Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of men Age 15-24 51.8 38.8 58.2 30.3 18.6 14.7 460 15-19 42.7 3.9 44.4 7.8 2.1 2.1 29 20-24 52.4 41.1 59.1 31.8 19.7 15.5 432 25-29 52.9 41.0 67.1 38.0 21.3 16.2 1,116 30-39 59.2 40.6 68.9 36.3 20.3 14.9 3,097 40-49 47.6 32.3 55.8 27.7 15.2 11.4 2,930 50-54 36.2 25.7 41.9 20.1 10.6 5.7 1,155 Residence Urban 64.1 46.1 75.3 42.9 24.6 18.5 3,728 Rural 41.4 28.2 48.9 22.5 12.0 8.4 5,030 Education No education 4.4 3.3 8.5 3.4 1.6 0.1 365 Some primary 20.2 16.5 27.0 10.7 3.3 2.2 1,605 Complete primary 39.8 28.0 49.1 17.6 7.9 4.9 2,339 Some secondary 60.6 38.7 73.3 34.1 15.8 10.2 1,721 Secondary + 79.2 56.4 87.7 56.8 36.8 28.8 2,727 Wealth quintile Lowest 25.1 17.5 31.8 12.9 5.4 3.1 1,676 Second 36.8 24.7 47.6 19.6 9.2 6.3 1,698 Middle 50.8 35.2 59.2 25.7 13.6 9.7 1,788 Fourth 60.5 43.8 73.7 37.7 20.7 15.2 1,713 Highest 78.8 55.4 85.3 57.3 35.8 27.5 1,882 Total 51.1 35.8 60.2 31.2 17.3 12.7 8,758 1 Two most common local misconceptions: AIDS can be transmitted by mosquito bites, and by sharing food with an HIV- positive person 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one HIV-negative faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. 192 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior 15.4 KNOWLEDGE OF HIV/AIDS-RELATED ISSUES Increasing the general knowledge about the transmission of HIV from mother to child and reducing the risk of transmission through the use of antiretroviral drugs is critical to reducing mother-to- child transmission of HIV (MTCT). To assess MTCT knowledge, respondents were asked if HIV can be transmitted from mother to child during pregnancy, during delivery, and through breastfeeding. Table 15.5 shows the percentage of ever-married women and currently married men who know that HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding, and the percentage who know someone personally who has the virus that causes AIDS or has died of AIDS, by background characteristics. According to the 2007 IDHS, 42 percent of ever-married women know that HIV can be transmitted from mother to child during pregnancy, 36 percent know that HIV can be transmitted during delivery, and 40 percent know that HIV can be transmitted through breastfeeding. Only 3 percent know someone personally who has the virus that causes AIDS or has died of AIDS. Table 15.5 Knowledge of HIV-related issues Percentage of ever-married women and currently married men age 15-49 who know that HIV can be transmitted from mother to child during delivery, pregnancy, and through breastfeeding and percentage who know someone personally who has the virus that causes AIDS or has died of AIDS, by background characteristics, Indonesia 2006-07 Ever-married women Currently married men Percentage who say HIV/AIDS can be transmitted from mother to child Percentage who say HIV/AIDS can be transmitted from mother to child Background characteristic During pregnancy During delivery Through breast- feeding Percentage who know someone personally who has the virus that causes AIDS or has died of AIDS Number of women During pregnancy During delivery Through breast- feeding Percentage who know someone personally who has the virus that causes AIDS or has died of AIDS Number of men Age 15-24 42.3 35.1 42.8 2.5 4,939 42.2 39.2 38.3 7.0 460 15-19 29.8 24.0 32.1 2.2 845 * * * * 29 20-24 44.8 37.4 45.0 2.6 4,094 42.3 39.1 37.9 6.8 432 25-29 50.8 43.8 49.2 3.2 5,771 53.9 47.2 49.7 4.3 1,116 30-39 46.2 38.2 43.0 3.6 12,024 58.8 51.2 56.1 5.6 3,097 40-49 32.4 28.9 30.7 3.0 10,160 47.5 41.8 44.6 4.9 2,930 Marital status Married/Living together 42.7 36.4 40.8 3.1 30,931 na na na na 0 Divorced/Separated/ Widowed 33.0 27.7 32.5 3.3 1,964 na na na na 0 Residence Urban 58.9 50.4 55.1 4.3 13,745 67.9 59.6 63.0 5.7 3,728 Rural 30.1 25.4 29.6 2.4 19,150 38.6 34.2 36.8 4.3 5,030 Education No education 4.2 4.0 4.9 0.5 2,271 6.3 5.9 4.6 1.0 365 Some primary 14.4 12.5 14.5 1.3 5,572 22.5 19.0 22.3 2.1 1,605 Complete primary 30.3 25.4 29.9 2.1 10,077 36.2 31.7 35.0 3.3 2,339 Some secondary 52.4 43.6 50.4 3.3 6,781 59.5 51.5 57.1 5.7 1,721 Secondary + 77.7 67.0 71.9 6.4 8,193 81.3 72.8 74.2 7.8 2,727 Wealth quintile Lowest 15.7 13.4 16.3 1.5 6,219 23.0 20.2 23.0 3.0 1,676 Second 27.0 23.0 27.0 2.3 6,606 36.0 30.6 35.1 4.1 1,698 Middle 39.1 32.1 37.3 2.9 6,710 48.0 41.2 45.3 4.4 1,788 Fourth 53.9 44.8 51.2 3.6 6,713 64.8 58.1 61.7 5.3 1,713 Highest 73.2 64.4 67.8 5.4 6,647 80.0 71.5 71.7 7.4 1,882 Total 42.2 35.9 40.3 3.2 32,895 51.0 45.0 47.9 4.9 8,758 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable HIV and AIDS-related Knowledge, Attitudes and Behavior | 193 Table 15.5 shows that 51 percent of currently married men know that HIV can be transmitted from mother to child during pregnancy, 45 percent know that HIV can be transmitted during delivery, and 48 percent know that HIV can be transmitted through breastfeeding. Five percent of currently married men know someone personally who has the virus that causes AIDS or has died of AIDS. Knowledge of all four HIV/AIDS-related issues tends to be higher for urban residents, respondents with higher education, and respondents in the higher wealth quintiles. 15.5 DISCUSSION OF HIV/AIDS In the 2007 IDHS, currently married women and men who had heard of AIDS were asked whether they had ever discussed HIV/AIDS prevention with their spouse. Tables 15.6.1 and 15.6.2 show the percentage of currently women and men who ever discussed HIV/AIDS with their spouses, by background characteristic. Discussion about HIV/AIDS prevention among spouses is limited, only 17 percent among women and 19 percent among men. Inter-spousal discussion about HIV/AIDS is more common among couples in urban areas, those with higher education, and those in the higher wealth quintiles (Figure 15.4). Appendix Table A-15.2 shows the percent distribution of currently married women by whether they ever discussed HIV/AIDS prevention with their husband, according to province. Table 15.6.1 Discussion of HIV/AIDS with husband Percent distribution of currently married women by whether they ever discussed HIV/AIDS prevention with their husband, according to background characteristics, Indonesia 2007 Background characteristic Ever discussed HIV/AIDS prevention Never discussed HIV/AIDS prevention Don't know/ missing Has not heard of AIDS Total Number of women Age 15-24 14.9 48.8 2.3 34.0 100.0 4,939 15-19 10.2 40.2 2.0 47.6 100.0 845 20-24 15.9 50.6 2.4 31.2 100.0 4,094 25-29 19.8 49.9 2.1 28.2 100.0 5,771 30-39 20.5 42.2 2.7 34.6 100.0 12,024 40-49 13.6 29.3 4.4 52.7 100.0 10,160 Residence Urban 24.8 48.1 4.4 22.7 100.0 13,745 Rural 12.1 35.2 2.1 50.7 100.0 19,150 Education No education 1.3 7.4 0.7 90.6 100.0 2,271 Some primary 4.5 21.2 2.1 72.2 100.0 5,572 Complete primary 10.4 39.7 2.7 47.2 100.0 10,077 Some secondary 19.6 54.4 3.6 22.3 100.0 6,781 Secondary + 37.5 52.5 4.3 5.7 100.0 8,193 Wealth quintile Lowest 6.3 22.1 1.5 70.1 100.0 6,219 Second 10.4 34.7 2.0 52.9 100.0 6,606 Middle 14.8 43.3 3.0 38.9 100.0 6,710 Fourth 21.6 49.7 3.6 25.1 100.0 6,713 Highest 33.3 51.6 5.0 10.1 100.0 6,647 Total 17.4 40.6 3.1 39.0 100.0 32,895 194 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.6.2 Discussion of HIV/AIDS with wife Percent distribution of currently married men by whether they ever discussed HIV/AIDS prevention with their wife, according to background characteristics, Indonesia 2007 Background characteristic Ever discussed HIV/AIDS prevention Never discussed HIV/AIDS prevention Don't know/ missing Has not heard of AIDS Total Number of men Age 15-24 14.2 52.8 0.2 32.7 100.0 460 15-19 0.0 45.9 0.0 54.1 100.0 29 20-24 15.2 53.3 0.2 31.3 100.0 432 25-29 17.5 59.9 0.1 22.5 100.0 1,116 30-39 22.1 57.3 0.1 20.5 100.0 3,097 40-49 19.2 49.1 0.0 31.7 100.0 2,930 50-54 12.8 40.6 0.3 46.3 100.0 1,155 Residence Urban 25.6 59.7 0.2 14.5 100.0 3,728 Rural 13.9 47.0 0.1 39.0 100.0 5,030 Education No education 2.5 16.2 0.2 81.1 100.0 365 Some primary 4.9 34.6 0.1 60.4 100.0 1,605 Complete primary 9.1 54.6 0.1 36.2 100.0 2,339 Some secondary 17.8 66.6 0.2 15.4 100.0 1,721 Secondary + 38.4 57.0 0.1 4.5 100.0 2,727 Wealth quintile Lowest 7.9 35.8 0.1 56.2 100.0 1,676 Second 12.6 48.3 0.0 39.1 100.0 1,698 Middle 14.5 56.7 0.3 28.5 100.0 1,788 Fourth 22.9 61.0 0.0 16.1 100.0 1,713 Highest 34.9 59.2 0.1 5.8 100.0 1,882 Total 18.9 52.4 0.1 28.5 100.0 8,758 1 3 5 5 10 9 20 18 38 38 Currently married women Currently married men 0 10 20 30 40 50 Percent No education Some primary Complete primary Some secondary Secondary+ Figure 15.4 Percentage of Currently Married Women and Currently Married Men Who Have Discussed AIDS Prevention with Their Spouse by Level of Education IDHS 2007 HIV and AIDS-related Knowledge, Attitudes and Behavior | 195 15.6 SOCIAL ASPECT OF HIV/AIDS Widespread stigma and discrimination in a population can adversely affect both people’s willingness to be tested and adherence to antiretroviral therapy. Reduction of stigma and discrimination in a population is, thus, an important indicator of the success of programs targeting HIV and AIDS prevention and control. In the IDHS 2007, to assess the level of stigma, survey respondents who had heard of AIDS were asked if they would be willing to care for a relative who was sick with AIDS in their own household, if they would be willing to buy fresh vegetables from a market vendor who had HIV, if they thought a female teacher who has HIV but is not sick should be allowed to continue teaching, and if they would want to keep secret a family member’s HIV-positive status. Tables 15.7.1 and 15.7.2 show the results for ever-married women and currently married men. Table 15.7.1 Accepting attitudes toward persons living with HIV/AIDS: Women Among ever-married women who have heard of AIDS, percentage expressing specific accepting attitudes toward people with AIDS, by background characteristics, Indonesia 2007 Percentage of respondents who: Background characteristic Are willing to care for a family member with the AIDS virus in the respondent's home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member has HIV Percentage expressing accepting attitudes on all four indicators Number of women who have heard of AIDS Age 15-24 70.0 34.4 51.2 52.1 12.8 3,260 15-19 69.4 28.2 44.3 46.3 7.1 443 20-24 70.1 35.4 52.2 53.0 13.6 2,816 25-29 67.6 34.3 51.0 57.0 14.0 4,146 30-39 67.4 34.9 46.1 61.1 15.1 7,860 40-49 65.1 27.4 36.4 63.3 11.2 4,808 Marital status Married/living together 67.4 33.0 45.6 59.2 13.6 19,105 Divorced/separated/ widowed 65.7 31.5 44.6 60.7 11.7 968 Residence Urban 67.8 36.1 49.5 57.8 15.2 10,626 Rural 66.8 29.3 41.2 61.1 11.7 9,447 Education No education 66.4 16.3 23.1 55.8 5.9 214 Some primary 67.4 19.0 27.5 60.2 7.1 1,550 Complete primary 63.7 25.2 38.6 60.0 9.2 5,317 Some secondary 69.2 33.5 46.4 59.6 14.2 5,265 Secondary + 68.6 41.1 54.1 58.6 17.6 7,727 Wealth quintile Lowest 64.1 21.8 34.9 63.2 8.9 1,857 Second 65.0 28.3 39.7 59.7 9.4 3,110 Middle 67.8 29.7 43.7 59.5 12.7 4,101 Fourth 69.2 33.8 47.2 58.7 14.5 5,026 Highest 67.7 40.2 51.9 58.3 16.9 5,978 Total 15-49 67.3 32.9 45.6 59.3 13.6 20,073 196 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Overall, 67 percent of women and men reported that they are willing to care for a family member with HIV in their own household. Among issues related to stigma, the lowest acceptance is willingness to buy fresh vegetables from a person with HIV (33 percent of women and 39 percent of men). The second lowest acceptance is for a female teacher to continue teaching in spite of being HIV positive (46 percent of women and 41 percent of men). Higher acceptance is seen for not wanting to keep secret the HIV- positive status of a family member (59 percent of women and 63 percent of men). Looking at all the stigma indicators together, the percentage of women and men expressing accepting attitudes is fairly low, with 14 percent of ever-married women and 16 percent of currently married men expressing accepting attitudes on all four indicators. Table 15.7.2 Accepting attitudes toward persons living with HIV/AIDS: Men Among currently married men who have heard of HIV/AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Indonesia 2007 Percentage of respondents who: Background characteristic Are willing to care for a family member with the AIDS virus in the respondent's home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member has HIV Percentage expressing accepting attitudes on all four indicators Number of men who have heard of AIDS Age 15-24 74.4 42.2 44.7 48.2 10.8 310 15-19 93.4 36.4 35.7 52.5 4.7 13 20-24 73.6 42.5 45.1 48.0 11.1 296 25-29 71.7 40.0 51.0 55.1 16.1 863 30-39 66.4 40.1 41.4 64.0 16.5 2,461 40-49 66.9 38.5 37.3 67.7 16.5 2,000 50-54 59.5 29.2 32.6 66.6 11.0 621 Residence Urban 69.8 44.5 46.1 64.3 18.9 3,186 Rural 64.1 32.5 35.1 62.5 12.2 3,068 Education No education 54.4 14.0 16.0 37.5 0.3 68 Some primary 61.7 24.0 25.9 61.1 7.8 635 Complete primary 61.4 26.1 27.9 61.5 7.8 1,490 Some secondary 68.8 36.2 38.3 62.7 13.5 1,456 Secondary + 70.8 51.4 53.6 66.2 23.6 2,605 Wealth quintile Lowest 56.6 25.1 26.3 63.7 7.6 734 Second 64.6 30.0 32.1 61.9 8.6 1,035 Middle 66.2 34.1 37.9 63.2 15.2 1,276 Fourth 69.9 39.1 39.8 62.0 14.7 1,437 Highest 70.9 52.1 54.5 65.6 24.1 1,772 Total 67.0 38.6 40.7 63.4 15.6 6,254 15.7 KNOWLEDGE OF A SOURCE FOR MALE CONDOMS Condom use among the sexually active population plays an important role in preventing the transmission of HIV and other sexually transmitted infections. In the 2007 IDHS, ever-married women age 15-49 were asked whether they knew a source where they could obtain condoms if they wanted them. HIV and AIDS-related Knowledge, Attitudes and Behavior | 197 Table 15.8 shows the percentage of ever-married women who know where someone can obtain condoms and where they themselves can access condoms whenever they need them. The results indicate that 43 percent of women know where they can obtain condoms and 28 percent said they could get male condoms if they need them. Table 15.8 Knowledge of source of male condoms and access to condoms Percentage of ever-married women who know a source for male condoms, and percentage who think they themselves could get a male condom, by background characteristics, Indonesia 2007 Background characteristic Knows a source for male condoms Could get a male condom Number of women Age 15-24 39.4 24.0 4,939 15-19 29.3 15.1 845 20-24 41.5 25.8 4,094 25-29 48.2 31.2 5,771 30-39 47.3 31.4 12,024 40-49 38.0 24.4 10,160 Marital status Married/living together 43.7 28.6 30,931 Divorced/separated/ widowed 38.8 19.3 1,964 Residence Urban 60.9 39.7 13,745 Rural 30.9 19.8 19,150 Education No education 8.0 4.2 2,271 Some primary 19.3 10.1 5,572 Complete primary 31.6 19.1 10,077 Some secondary 51.5 32.7 6,781 Secondary + 77.3 54.2 8,193 Wealth quintile Lowest 17.6 10.4 6,219 Second 30.0 19.1 6,606 Middle 39.0 24.8 6,710 Fourth 54.4 34.5 6,713 Highest 74.2 50.4 6,647 Total 43.4 28.1 32,895 Knowledge of a source for male condoms and being able to obtain condoms increases sub- stantially with level of education and wealth quintile. Also, the percentage who know a source for condoms and are able to obtain condoms is twice as high in urban areas as in rural areas. 15.8 ATTITUDES TOWARD NEGOTIATING SAFER SEX The high levels of sexual transmission of HIV make negotiating for safer sex indispensable, especially in marital unions where women’s status is limited by societal expectations, thereby increasing their vulnerability to HIV transmission. Table 15.9 shows that 83 percent of ever-married women believe a wife is justified in refusing to have sex with her husband if she knows her husband has sex with other women. This attitude increases with increasing level of education. 198 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.9 Attitudes toward refusing sexual intercourse with husband Percentage of ever-married women who believe that a wife is justified in refusing to have sexual intercourse with her husband when she knows he has a sexually transmitted disease, she knows her husband has been with other women, she has recently given birth or is menstruating, and she is tired or not in the mood, by background characteristics, Indonesia 2007 A wife is justified in refusing to have sex with her husband when: Background characteristic She knows her husband has a sexually transmitted disease She knows her husband has been with other women She has recently given birth or is menstruating She is tired or not in the mood Number of women Age 15-24 82.2 85.7 92.2 67.0 4,939 15-19 76.6 83.8 89.2 62.5 845 20-24 83.3 86.1 92.8 67.9 4,094 25-29 85.9 85.5 93.8 70.0 5,771 30-39 84.2 83.5 92.9 66.4 12,024 40-49 80.4 79.7 90.9 64.8 10,160 Marital status Married/living together 83.2 83.3 92.5 66.9 30,931 Divorced/separated/ widowed 79.7 78.8 89.4 63.0 1,964 Residence Urban 86.9 85.1 93.8 68.1 13,745 Rural 80.2 81.5 91.2 65.6 19,150 Education No education 67.1 71.7 85.0 61.6 2,271 Some primary 76.8 78.9 89.6 65.6 5,572 Complete primary 81.7 82.6 92.4 66.8 10,077 Some secondary 86.9 85.2 93.8 68.1 6,781 Secondary + 90.1 87.5 94.9 67.4 8,193 Total 83.0 83.0 92.3 66.6 32,895 15.9 HIGHER-RISK SEX 15.9.1 Multiple Sexual Partners Information on sexual behavior is important in designing and monitoring intervention programs to control the spread of HIV. The 2007 IDHS included questions on respondents’ sexual partners over their lifetime and during the 12 months preceding the survey. Information on the use of condoms at last sexual intercourse with each type of partner was collected for women and men. These questions are sensitive, and it is recognized that some respondents may have been reluctant to provide information on recent sexual behavior. Table 15.10 shows the percentage of currently married men age 15-49 who had sex in the 12 months preceding the survey with a person who was neither their wife nor lived with them (nonmarital, noncohabiting partner), by background characteristics. The results show that 3 in 1,000 currently married men engaged in sexual intercourse with a nonmarital, noncohabiting partner in the past 12 months. HIV and AIDS-related Knowledge, Attitudes and Behavior | 199 Table 15.10 Multiple sexual partners and higher- risk sexual intercourse in the past 12 months among men Percentage of currently married men who had sexual intercourse in the past 12 months with a nonmarital, noncohabiting partner, by back- ground characteristics, Indonesia 2007 Background characteristic Percentage who had intercourse in the past 12 months with a nonmarital, noncohabiting partner Number of men Age 15-24 0.1 460 15-19 * 29 20-24 0.2 432 25-29 0.3 1,116 30-39 0.2 3,097 40-49 0.5 2,930 50-54 0.1 1,155 Residence Urban 0.5 3,728 Rural 0.1 5,030 Education No education 0.1 365 Some primary 0.3 1,605 Complete primary 0.1 2,339 Some secondary 0.4 1,721 Secondary + 0.5 2,727 Wealth quintile Lowest 0.0 1,676 Second 0.4 1,698 Middle 0.4 1,788 Fourth 0.1 1,713 Highest 0.5 1,882 Total 0.3 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 15.10 KNOWLEDGE OF SEXUALLY TRANSMITTED INFECTIONS AND THEIR SYMPTOMS Sexually transmitted infections (STIs) are an important predisposing factor that increases the likelihood of HIV transmission. Without appropriate intervention to combat STIs in Indonesia, it will be difficult to reduce the transmission of HIV in the population. The main strategy for controlling STIs is increasing public knowledge of the symptoms of STIs, informing people how to avoid contracting an STI, and informing them where to seek help/information on STIs when they need it. Knowing the symptoms of STIs is one of the most important factors leading people to seek medical care at a health facility. Knowledge of the symptoms of STIs increases the likelihood of early detection and prompt treatment, two key components used to measure program success. 200 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior In the 2007 IDHS, respondents were asked whether they had ever heard of STIs and the symptoms of STIs. Table 15.11.1 shows the percentage of ever-married women who ever heard of STIs and the symptoms of STIs, by background characteristics. Overall, only 25 percent of ever-married women reported that they had heard of STIs; the percentage is higher in urban areas than rural areas, and increases with respondent’s level of education and wealth quintile. Table 15.11.1 Knowledge of symptoms of STIs: women Percentage of ever-married women by knowledge of symptoms associated with sexually transmitted infections (STIs), in a man and in a woman, according to background characteristics, Indonesia 2007 - 12 Dec 2008 Knowledge of symptoms of STI in a man Knowledge of symptoms of STI in a woman Background characteristic No knowledge of STIs No symptoms mentioned Mentioned one symptom Mentioned two or more symptoms No symptoms mentioned Mentioned one symptom Mentioned two or more symptoms Number of women Age 15-24 80.0 8.9 5.5 5.5 10.7 3.8 5.5 4,939 15-19 86.5 6.8 4.1 2.6 7.6 3.7 2.2 845 20-24 78.7 9.4 5.8 6.1 11.3 3.8 6.2 4,094 25-29 72.2 9.9 8.0 9.9 13.0 6.8 8.0 5,771 30-39 71.3 10.2 8.3 10.1 13.0 7.0 8.6 12,024 40-49 77.2 8.2 6.8 7.8 9.7 6.3 6.8 10,160 Marital status Married/living together 74.4 9.5 7.3 8.8 11.8 6.3 7.5 30,931 Divorced/separated/ widowed 78.7 6.5 8.6 6.3 8.4 5.9 7.1 1,964 Residence Urban 62.5 13.2 10.9 13.4 16.2 9.4 11.9 13,745 Rural 83.4 6.5 4.8 5.3 8.4 4.0 4.3 19,150 Education No education 96.6 2.3 0.9 0.3 2.6 0.6 0.2 2,271 Some primary 92.0 3.9 2.2 1.9 4.7 1.8 1.5 5,572 Complete primary 86.7 6.1 3.6 3.6 7.5 3.2 2.6 10,077 Some secondary 72.1 11.6 7.9 8.4 14.1 7.0 6.8 6,781 Secondary + 43.9 17.0 17.0 22.1 22.0 14.1 20.1 8,193 Wealth quintile Lowest 91.1 3.9 2.5 2.4 4.9 1.9 2.0 6,219 Second 86.1 5.7 4.1 4.0 7.4 3.4 3.1 6,606 Middle 79.3 8.7 5.9 6.0 10.6 5.1 4.9 6,710 Fourth 68.4 12.3 9.4 9.9 15.6 7.3 8.7 6,713 Highest 49.3 15.5 14.6 20.6 19.1 13.2 18.3 6,647 Total 74.6 9.3 7.4 8.7 11.6 6.3 7.5 32,895 Table 15.11.2 shows the differentials in knowledge of STIs and STI symptoms among currently married men by background characteristics. Overall, only 51 percent of currently married men reported that they had heard of STIs; the percentage is higher in urban areas than in rural areas, and increases with level of education and wealth quintile. HIV and AIDS-related Knowledge, Attitudes and Behavior | 201 Table 15.11.2 Knowledge of symptoms of STIs: men Percentage of currently married men by knowledge of symptoms associated with sexually transmitted infections (STIs), in a man and in a woman, according to background characteristics, Indonesia 2007 Knowledge of symptoms of STI in a man Knowledge of symptoms of STI in a woman Background characteristic No knowledge of STIs No symptoms mentioned Mentioned one symptom Mentioned two or more symptoms No symptoms mentioned Mentioned one symptom Mentioned two or more symptoms Number of men Age 15-24 56.4 7.6 17.6 18.5 35.2 2.8 5.6 460 15-19 * * * * * * * 29 20-24 56.4 8.0 16.3 19.3 34.8 2.9 6.0 432 25-29 47.7 10.5 20.8 20.9 41.7 5.8 4.8 1,116 30-39 45.0 11.0 18.3 25.6 40.1 7.6 7.3 3,097 40-49 49.0 12.0 15.0 24.0 36.4 7.5 7.0 2,930 50-54 59.0 11.1 14.3 15.7 31.4 4.6 5.0 1,155 Residence Urban 34.2 11.1 22.2 32.6 46.4 9.2 10.2 3,728 Rural 60.3 11.1 13.1 15.6 31.2 4.9 3.7 5,030 Education No education 87.7 3.9 6.3 2.1 9.8 1.0 1.5 365 Some primary 72.1 8.6 11.2 8.1 23.8 2.8 1.4 1,605 Complete primary 63.6 11.9 11.4 13.1 31.0 3.3 2.2 2,339 Some secondary 44.7 11.1 21.6 22.7 44.0 6.3 5.0 1,721 Secondary + 20.9 12.9 23.5 42.6 51.4 13.0 14.8 2,727 Wealth quintile Lowest 74.9 8.8 7.9 8.4 21.1 2.3 1.7 1,676 Second 62.3 11.1 12.9 13.7 30.6 3.9 3.1 1,698 Middle 50.7 10.9 18.8 19.7 38.8 5.7 4.9 1,788 Fourth 41.1 11.5 20.6 26.7 43.7 9.1 6.1 1,713 Highest 20.2 13.0 23.6 43.2 52.3 11.9 15.6 1,882 Total 49.2 11.1 16.9 22.8 37.7 6.7 6.5 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. Figure 15.5 shows the percentage of currently married women and men who do not know any symptoms of STIs by level of education. Most women with no education and 9 in 10 men with no education do not know any STI symptoms. The percentage of those who do not know any symptoms of STIs decreases in the higher level of education. However, at all levels of education, the percentage of women who do not know any STI symptoms is higher than it is for men. Appendix Table A-15.3 shows knowledge of symptoms of STIs among ever-married women by province. 202 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior 15.11 SOURCES OF INFORMATION ON STIS Tables 15.12.1 and 15.12.2 indicate that the most common source of information on STIs for both women and men is television (11 percent for women and 17 percent for men); next is friend/family (7 percent for women and 20 percent for men), radio (2 percent for women and 5 percent for men) and health provider (1 percent for women and 2 percent for men). The percentage of women and men who have heard of STIs from television is higher in urban areas than in rural areas, and increases with level of education and wealth quintile. 97 88 92 72 87 64 72 4544 21 Ever-married women Currently married men 0 20 40 60 80 100 Percent No education Some primary Complete primary Some secondary Secondary+ Figure 15.5 Percentage of Ever-married Women and Currently Married Men Who Do Not Know the Symptoms of STIs, by Level of Education IDHS 2007 HIV and AIDS-related Knowledge, Attitudes and Behavior | 203 Table 15.12.1 Sources of information on STIs: Women Percentage of ever-married women who reported specific sources of information on STIs, by background characteristics, Indonesia 2007 Sources of information on STIs Background characteristic Radio Tele- vision News- paper/ maga- zines Flyers/ poster Health provider FBO School/ teacher Com- munity gathering Friend/ family Work- place Missing Number of women Age 15-24 2.0 8.7 1.5 0.1 0.7 0.0 1.5 0.4 4.5 0.3 80.2 4,939 15-19 1.1 4.6 0.8 0.0 0.8 0.1 0.8 1.2 4.0 0.0 86.6 845 20-24 2.2 9.5 1.6 0.1 0.7 0.0 1.7 0.2 4.7 0.4 78.9 4,094 25-29 2.9 12.1 2.6 0.0 1.0 0.0 0.9 0.4 7.2 0.4 72.5 5,771 30-39 3.0 12.1 2.8 0.1 1.2 0.0 0.7 0.7 7.6 0.3 71.5 12,024 40-49 1.7 9.3 1.9 0.1 1.2 0.0 0.1 0.6 7.2 0.5 77.4 10,160 Marital status Married/living together 2.4 10.9 2.3 0.1 1.1 0.0 0.7 0.6 7.0 0.3 74.5 30,931 Divorced/separated/ Widowed 2.4 7.9 1.4 0.0 1.6 0.0 0.3 0.3 6.7 0.6 78.7 1,964 Residence Urban 3.6 17.0 3.6 0.2 1.4 0.0 1.3 0.7 8.9 0.6 62.7 13,745 Rural 1.6 6.2 1.3 0.0 1.0 0.0 0.3 0.4 5.6 0.1 83.5 19,150 Education No education 0.3 1.2 0.0 0.0 0.0 0.0 0.0 0.2 1.5 0.1 96.6 2,271 Some primary 0.5 2.5 0.2 0.0 0.4 0.0 0.0 0.2 4.1 0.0 92.1 5,572 Complete primary 0.8 5.0 0.4 0.0 0.8 0.0 0.0 0.3 5.6 0.1 86.9 10,077 Some secondary 2.7 11.2 1.4 0.1 1.3 0.0 0.3 0.7 9.5 0.6 72.2 6,781 Secondary + 6.1 25.6 7.3 0.3 2.1 0.1 2.5 1.1 9.9 0.8 44.3 8,193 Wealth quintile Lowest 0.9 2.2 0.6 0.0 0.7 0.0 0.1 0.2 4.0 0.0 91.2 6,219 Second 1.4 5.0 0.5 0.0 0.9 0.0 0.3 0.2 5.4 0.0 86.2 6,606 Middle 2.1 8.3 1.4 0.0 1.0 0.0 0.4 0.7 6.2 0.3 79.5 6,710 Fourth 2.8 13.1 2.7 0.2 1.2 0.0 1.1 0.7 9.0 0.6 68.6 6,713 Highest 4.9 24.3 6.0 0.2 1.8 0.1 1.6 0.9 10.0 0.7 49.6 6,647 Total 2.4 10.7 2.3 0.1 1.1 0.0 0.7 0.5 6.9 0.4 74.8 32,895 204 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.12.2 Sources of information on STIs: Men Percentage of currently married men who reported specific sources of information on STIs, by background characteristics, Indonesia 2007 Source of information on STIs Background characteristic Radio Tele- vision News- paper/ maga- zines Flyers/ poster Health provider FBO School/ teacher Com- munity gathering Friend/ family Work- place Missing Number of men Age 15-24 3.8 11.6 4.5 0.0 4.1 0.0 0.1 0.2 17.9 0.8 57.2 460 15-19 0.0 16.7 5.4 0.0 0.0 0.0 0.0 0.0 21.2 0.0 56.8 29 20-24 4.0 11.2 4.4 0.0 4.3 0.0 0.1 0.2 17.7 0.8 57.2 432 25-29 4.5 19.0 4.7 0.9 1.3 0.0 0.7 1.1 19.0 0.6 48.2 1,116 30-39 5.7 17.1 5.3 0.5 2.4 0.1 0.8 0.8 20.4 1.5 45.5 3,097 40-49 4.1 16.6 4.3 0.2 2.7 0.1 0.5 0.5 20.5 1.2 49.3 2,930 50-54 4.6 12.1 3.2 0.2 2.1 0.0 0.0 0.1 17.8 0.6 59.4 1,155 Marital status Married/living together 4.8 16.2 4.6 0.4 2.4 0.1 0.6 0.6 19.8 1.1 49.6 8,758 Residence Urban 6.1 24.2 7.2 0.7 2.5 0.0 0.9 0.4 22.0 1.4 34.5 3,728 Rural 3.8 10.3 2.6 0.1 2.3 0.1 0.3 0.7 18.1 0.9 60.7 5,030 Education No education 0.4 1.8 0.0 0.0 0.1 0.2 0.0 0.1 9.4 0.0 87.8 365 Some primary 0.7 5.5 0.6 0.0 1.0 0.0 0.0 0.3 18.6 0.8 72.5 1,605 Complete primary 2.6 7.2 1.9 0.2 1.7 0.0 0.0 0.8 20.1 1.5 63.9 2,339 Some secondary 4.8 14.9 2.8 0.5 2.7 0.0 0.1 0.9 26.3 1.4 45.5 1,721 Secondary + 9.7 33.0 10.8 0.7 4.0 0.1 1.7 0.4 17.4 1.0 21.2 2,727 Wealth quintile Lowest 2.4 4.6 1.5 0.0 1.3 0.1 0.2 0.5 12.9 1.3 75.2 1,676 Second 3.1 8.2 1.6 0.1 1.3 0.1 0.1 0.9 20.7 0.8 63.0 1,698 Middle 4.2 14.0 3.9 0.4 2.9 0.0 0.2 0.4 22.0 1.0 51.1 1,788 Fourth 5.8 19.3 5.6 0.6 3.3 0.0 0.6 0.5 21.8 1.0 41.5 1,713 Highest 8.0 33.2 9.7 0.7 3.2 0.0 1.6 0.7 21.0 1.5 20.4 1,882 Total 4.8 16.2 4.6 0.4 2.4 0.1 0.6 0.6 19.8 1.1 49.6 8,758 15.12 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS In the 2007 IDHS, respondents who had ever had sex were asked if they had contracted a disease through sexual contact in the past 12 months, or if they had had either of two symptoms associated with STIs (a bad-smelling, abnormal discharge from the vagina or penis, or a genital sore or ulcer). Table 15.13 shows the self-reported prevalence of STIs and STI symptoms in the population for women and men. The results in Table 15.13 indicate that about 2 percent of women and 1 percent of men who have ever been sexually active had an STI and/or an STI symptom in the 12 months preceding the survey. The prevalence of an STI or STI symptom is higher for younger women (3 percent) and men (1 percent). Among women, the prevalence of self-reported STI is higher in urban areas (3 percent) than in rural area (2 percent), and higher among women with secondary or higher education (4 percent) than those with little or no education (less than 1 percent). HIV and AIDS-related Knowledge, Attitudes and Behavior | 205 Table 15.13 Self-reporting of sexually transmitted infections (STIs) and STIs symptoms Among ever-married women and currently married men who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Bad- smelling/ abnormal genital discharge Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of women who ever had sexual intercourse Bad- smelling/ abnormal genital discharge Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of men who ever had sexual intercourse Age 15-24 2.5 0.4 2.7 4,927 0.9 0.2 1.0 460 15-19 1.4 0.1 1.5 845 * * * 29 20-24 2.7 0.5 3.0 4,082 0.9 0.2 1.0 432 25-29 1.9 0.4 2.0 5,768 0.4 0.3 0.5 1,116 30-39 2.0 0.3 2.2 12,022 0.7 0.4 0.8 3,097 40-49 1.2 0.2 1.3 10,158 0.5 0.2 0.7 2,930 50-54 na na na 0 0.0 0.2 0.2 1,155 Marital status Married 1.8 0.3 2.0 30,922 0.5 0.3 0.7 8,758 Divorced/separated/ widowed 1.1 0.1 1.2 1,953 na na na 0 Residence Urban 2.3 0.5 2.6 13,729 0.5 0.3 0.7 3,728 Rural 1.4 0.2 1.5 19,146 0.5 0.3 0.7 5,030 Education No education 0.3 0.0 0.3 2,270 0.0 0.1 0.1 365 Some primary 0.7 0.1 0.7 5,565 0.7 0.2 0.8 1,605 Complete primary 1.0 0.2 1.1 10,071 0.6 0.5 0.9 2,339 Some secondary 2.4 0.6 2.7 6,780 0.4 0.3 0.6 1,721 Secondary + 3.4 0.5 3.8 8,188 0.4 0.1 0.6 2,727 Total 1.8 0.3 2.0 32,875 0.5 0.3 0.7 8,758 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable The 2007 IDHS respondents who reported having an STI or symptoms of an STI in the past 12 months were asked if they sought any advice or treatment for their symptoms, and where such advice or treatment was sought. The results in Figure 15.6 indicate that 46 percent of women and 61 percent of men sought advice or treatment from a clinic/hospital/private doctor/other health facility or health professional. Advice or medicine received from a shop/pharmacy is considered an alternative way to treat STI symptoms by 16 percent of men. 206 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior 15.13 HIV AND AIDS KNOWLEDGE AND SEXUAL BEHAVIOR AMONG YOUTH This section addresses HIV-related knowledge and sexual behavior among youth age 15-24. Special attention is paid to this group because it accounts for half of all new HIV cases worldwide. The 2007 IDHS also reports on comprehensive knowledge of HIV transmission by age at first sex and knowledge of a source of condoms. 15.13.1 HIV-Related Knowledge among Young Adults Knowledge of how HIV is transmitted is crucial to enabling young people to avoid contracting it. Young people are often at greater risk because they may have shorter relationships and more partners, or engage in other risky behaviors. Knowledge of HIV among youth is part of the Millennium Development Goals (MDGs) indicators, and should be monitored periodically by all developing countries. As discussed earlier, comprehensive knowledge of HIV is defined as 1) knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the likelihood of getting HIV, 2) knowing that a healthy-looking person can have HIV, the virus that causes AIDS, and 3) rejecting the two most common local misconceptions about HIV transmission or prevention. Table 15.14 shows that the proportion of young women and men with comprehensive knowledge of AIDS is very low (10 percent for women and 15 percent for men). It is higher in urban areas than in rural areas, with urban women twice as likely to have knowledge about HIV as rural women. For both women and men, increase in comprehensive knowledge is associated with increased level of education and wealth quintile. 46 6 38 61 16 27 Clinic/hospital/ private doctor/ other health prof Advice or medicine from shop/pharmacy Advice or treatment from any other source 0 20 40 60 80 Percent Ever-married women Currently married men Figure 15.6 Percentage of Ever-married Women and Currently Married Men Reporting an STI or Symptoms of an STI In the Past 12 Months Who Sought Advice or Treatment IDHS 2007 Clinic/hospital/ private doctor/ other health professional HIV and AIDS-related Knowledge, Attitudes and Behavior | 207 Table 15.14 Comprehensive knowledge about AIDS and of a source of condoms among young people Percentage of ever-married women and currently married men age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge of a source of condoms, by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of women Percentage with comprehensive knowledge of AIDS1 Number of men Age 15-19 5.7 29.0 845 * 29 15-17 3.1 21.2 271 * 0 18-19 7.0 32.7 575 * 28 20-24 10.3 41.2 4,094 15.5 432 20-22 8.7 37.2 2,185 9.7 146 23-24 12.1 45.7 1,909 18.5 286 Residence Urban 15.6 59.0 1,708 18.8 151 Rural 6.3 28.5 3,232 12.7 309 Education No education 1.8 7.9 79 * 5 Some primary 2.5 11.6 472 3.5 56 Complete primary 3.6 21.4 1,495 6.4 131 Some secondary 9.6 43.7 1,762 12.5 147 Secondary + 20.6 68.8 1,131 32.1 121 Wealth quintile Lowest 3.0 17.1 1,218 2.2 121 Second 5.7 31.8 1,185 14.7 122 Middle 10.2 41.7 987 11.9 66 Fourth 13.7 52.8 936 25.5 98 Highest 22.5 71.7 614 26.8 53 Total 9.5 39.1 4,939 14.7 460 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Comprehensive knowledge means knowing that consistent use of condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. The components of comprehensive knowledge are presented in Tables 15.4.1, and 15.4.2. 2 Friends, family members, and home are not considered sources for condoms. 15.13.2 Knowledge of Condom Sources among Young Women Condom use among young adults plays an important role in preventing the transmission of HIV and other sexually transmitted infections (as well as preventing unwanted pregnancies). Knowledge of a source for condoms is prerequisite to young adults obtaining and using them. Table 15.14 shows that 39 percent of young women know a source where they can get a condom. As expected, the proportion of young women who know where to get condoms increases with level of education and wealth quintile. 15.13.3 Age at First Sex Age at first sex among young adults age 15-24 is one of the UNGASS indicators that is reported every other year. Because Indonesia is considered to have a concentrated epidemic—transmission is predominantly through unsafe injection among intravenous drug users (IDUs) and through heterosexual 208 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior intercourse between HIV-positive and HIV-negative persons—age at first sexual intercourse marks the point in time when most individuals are first exposed to the risk of contracting HIV. Table 15.15 shows the proportion of women and men in the 15-19 and 20-24 age cohorts who had sexual intercourse before age 15 and before age 18. Eight percent of young women and less than 1 percent of young men had sexual intercourse by age 15, while 38 percent of young women and 12 percent of young men had sexual intercourse by age 18. It should be noted that the highest proportion of young people who had sexual intercourse before the age of 15 is women age 15-17 (26 percent) and the highest proportion to have sexual intercourse by age 18 is women age 18-19 (63 percent). The proportion of young people who had sexual intercourse before age 15 and before age 18 tends to be higher among those with little or no education and those in the lower wealth quintiles. Table 15.15 Age at first sexual intercourse among young people Percentage of ever-married women and currently married men age 15-24 who had sexual intercourse before age 15 and percentage of ever-married women and currently married men age 18-24 who had sexual intercourse before age 18, by background characteristics, Indonesia 2007 Ever-married women Currently married men Background characteristic Percentage who had sexual intercourse before age 15 Number of women age 15-24 Percentage who had sexual intercourse before age 18 Number of women age 18-24 Percentage who had sexual intercourse before age 15 Number of men age 15-24 Percentage who had sexual intercourse before age 18 Number of men age 18-24 Age 15-19 13.5 845 * * * 29 * * 15-17 26.2 271 * * * 0 * * 18-19 7.5 575 63.1 575 * 28 * 28 20-24 6.7 4,094 34.6 4,094 0.2 432 10.2 432 20-22 8.1 2,185 41.5 2,185 0.4 146 10.3 146 23-24 5.1 1,909 26.7 1,909 0.1 286 10.1 286 Knows condom source Yes 3.6 1,930 26.7 1,873 na 0 na 0 No 10.6 3,009 45.7 2,796 na 0 na 0 Residence Urban 3.9 1,708 28.2 1,667 0.2 151 15.3 151 Rural 10.0 3,232 43.6 3,002 0.2 309 9.7 309 Education No education 19.1 79 50.9 70 * 5 * 5 Some primary 20.2 472 60.8 435 0.0 56 14.0 56 Complete primary 14.3 1,495 57.2 1,390 0.0 131 17.6 131 Some secondary 3.6 1,762 36.5 1,646 0.4 147 10.5 146 Secondary + 0.1 1,131 7.4 1,129 0.3 121 5.3 121 Wealth quintile Lowest 11.9 1,218 50.4 1,114 0.0 121 12.3 121 Second 10.1 1,185 47.5 1,096 0.5 122 7.0 122 Middle 5.5 987 33.8 950 0.0 66 7.1 66 Fourth 4.8 936 27.5 910 0.4 98 12.0 98 Highest 4.2 614 21.0 598 0.0 53 25.0 53 Total 7.9 4,939 38.1 4,669 0.2 460 11.6 460 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not available 2 Friends, family members, and home are not considered sources for condoms. HIV and AIDS-related Knowledge, Attitudes and Behavior | 209 15.14 KNOWLEDGE OF VOLUNTARY COUNSELING AND TESTING FOR HIV Knowledge of a person’s HIV status helps the HIV-negative person make decisions about reducing the risk of contracting HIV and increasing the use of safer sex practices. For those who are HIV- positive, knowledge of their HIV status allows them to take action to protect their sexual partners, access treatment, and plan for the future. Knowledge of HIV status is one of the most important components of HIV/AIDS prevention and control. Knowing one’s HIV status can open access to prevention services as well as care and support services and treatment services. The Ministry of Health estimated in 2006 that there were 193,000 PLHAs in Indonesia (MOH, 2006). However, only 17 percent had contacted or enrolled in HIV care by 2008. Faced with this large gap in coverage, the Government of Indonesia has accelerated the expansion of voluntary counseling and testing (VCT) sites to increase national coverage. Regarding knowledge of the counseling procedure prior to having an HIV test, only a few respondents said they had heard of it (6 percent of women and 7 percent of men). Likewise, very few respondents reported knowing a place where they can receive VCT services (Tables 15.16.1 and 15.16.2). Among these persons, 7 percent of women and 6 percent of men said that they can receive testing and counseling in government hospitals/PHC/clinics/VCT; only 1 percent of both women and men said they can receive HIV testing and counseling services in private hospitals, PHCs, clinics, or VCT clinic. Table 15.16.1 Knowledge of where to get voluntary counseling and testing services for HIV: Women Percentage of ever-married women who know where to get VCT services for HIV, by background characteristics, Indonesia 2007 Government Private Background characteristic Hospital Health center VCT clinic Other Hospital Clinic VCT clinic Doctor Nurse/ midwife Other Missing Number of women Age 15-24 3.5 0.4 0.2 0.0 0.5 0.1 0.2 0.7 0.2 0.1 94.1 4,939 15-19 1.5 0.9 0.0 0.0 0.2 0.0 0.0 0.1 0.1 0.0 97.2 845 20-24 3.9 0.2 0.3 0.0 0.5 0.1 0.2 0.8 0.3 0.2 93.4 4,094 25-29 5.8 0.7 0.6 0.0 0.4 0.1 0.1 0.3 0.1 0.2 91.5 5,771 30-39 6.4 0.7 0.3 0.1 0.3 0.0 0.1 0.2 0.1 0.1 91.7 12,024 40-49 4.6 0.3 0.3 0.1 0.1 0.0 0.1 0.2 0.0 0.0 94.2 10,160 Marital status Married/living together 5.3 0.5 0.3 0.1 0.3 0.1 0.1 0.3 0.1 0.1 92.8 30,931 Divorced/separated/ Widowed 5.1 0.8 0.4 0.0 0.2 0.0 0.3 0.3 0.0 0.0 93.0 1,964 Residence Urban 9.0 0.7 0.6 0.1 0.5 0.0 0.2 0.4 0.1 0.2 88.1 13,745 Rural 2.7 0.4 0.2 0.0 0.1 0.1 0.0 0.2 0.1 0.1 96.1 19,150 Education No education 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 99.7 2,271 Some primary 1.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 98.8 5,572 Complete primary 1.9 0.3 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 97.5 10,077 Some secondary 4.4 0.6 0.2 0.0 0.2 0.1 0.2 0.4 0.1 0.1 93.7 6,781 Secondary + 14.5 1.2 1.2 0.2 0.9 0.1 0.3 0.7 0.1 0.4 80.2 8,193 Wealth quintile Lowest 0.9 0.2 0.1 0.0 0.0 0.0 0.0 0.2 0.1 0.0 98.6 6,219 Second 2.2 0.2 0.1 0.1 0.1 0.0 0.0 0.3 0.1 0.0 97.0 6,606 Middle 3.7 0.6 0.2 0.0 0.2 0.0 0.1 0.1 0.0 0.0 95.1 6,710 Fourth 6.7 0.8 0.4 0.1 0.2 0.1 0.1 0.4 0.2 0.2 90.8 6,713 Highest 12.8 0.7 1.1 0.2 0.8 0.1 0.4 0.6 0.0 0.3 82.8 6,647 Total 5.3 0.5 0.3 0.1 0.3 0.1 0.1 0.3 0.1 0.1 92.8 32,895 210 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 15.16.2 Knowledge of where to get voluntary counseling and testing services for HIV: Men Percentage of currently married men who know where to get VCT services for HIV, by background characteristics, Indonesia 2007 Government Private Background characteristic Hospital Health center VCT clinic Other Hospital VCT clinic Doctor Other Missing Number of men Age 15-24 3.8 0.1 0.8 0.1 0.1 0.1 0.0 0.0 94.8 460 15-19 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 29 20-24 4.0 0.1 0.9 0.1 0.2 0.1 0.0 0.0 94.4 432 25-29 4.2 0.2 1.1 0.2 0.2 0.0 0.0 0.6 93.5 1,116 30-39 4.7 0.9 0.1 0.4 0.0 0.2 0.0 0.6 93.2 3,097 40-49 4.5 0.3 0.1 0.3 0.2 0.0 0.2 0.6 93.8 2,930 50-54 3.5 0.4 0.1 0.0 0.1 0.0 0.1 0.1 95.8 1,155 Residence Urban 6.8 0.6 0.6 0.5 0.2 0.2 0.1 0.4 90.6 3,728 Rural 2.6 0.4 0.0 0.1 0.0 0.0 0.1 0.5 96.3 5,030 Education No education 1.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 98.7 365 Some primary 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 99.5 1,605 Complete primary 1.4 0.1 0.0 0.0 0.0 0.2 0.2 0.1 98.0 2,339 Some secondary 2.7 0.2 0.5 0.2 0.1 0.0 0.1 0.8 95.4 1,721 Secondary + 10.7 1.3 0.5 0.7 0.3 0.1 0.1 1.0 85.3 2,727 Wealth quintile Lowest 0.8 0.1 0.0 0.1 0.0 0.0 0.2 0.0 98.7 1,676 Second 2.3 0.5 0.1 0.1 0.1 0.2 0.0 0.3 96.4 1,698 Middle 3.1 0.7 0.0 0.1 0.0 0.0 0.1 0.4 95.6 1,788 Fourth 5.2 0.6 0.6 0.1 0.1 0.0 0.0 0.8 92.5 1,713 Highest 9.9 0.6 0.6 0.8 0.3 0.1 0.1 0.8 86.8 1,882 Total 4.4 0.5 0.3 0.3 0.1 0.1 0.1 0.5 93.9 8,758 Adult and Maternal Mortality | 213 ADULT AND MATERNAL MORTALITY 16 Chapter 10 provides an assessment of mortality during the first few years of life. This chapter discusses adult mortality, particularly deaths among women due to maternal causes. Although the level of maternal mortality is generally considered to be one of the most important indicators of a country’s health status, reliable data are scarce and estimates can vary substantially. Data that allow estimation of adult and maternal mortality using a direct estimation procedure have been collected in the Indonesia Demographic and Health Survey (IDHS) since 1994. The surveys collected information on the survivorship of all live births of the respondent’s natural mother (i.e., the respondent’s brothers and sisters). The direct approach to estimating adult and maternal mortality maximizes use of the available data, including information on the age of surviving siblings, the age at death of siblings who died, and the number of years ago the sibling died. This allows the data to be aggregated for determining the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in specific calendar periods. Rates of maternal and adult mortality are obtained by dividing maternal (or all female or male adult) deaths by person-years of exposure (Rutenberg and Sullivan, 1991). Another simple measure of maternal mortality is the proportion maternal of deaths of females of reproductive age (PMDF), or the proportion of deaths among all women of reproductive age due to maternal causes. It is believed that the PMDF is more accurate than the maternal mortality rate (Hill et al., 2007). The PMDF is obtained directly by dividing maternal deaths by deaths among females of reproductive age. 16.1 DATA To obtain data on adult mortality and maternal mortality, the IDHS questionnaire included a sibling survivorship history that obtained a detailed account of the survivorship of all of the live-born children of the respondent’s mother (i.e., maternal siblings). Before the 2007 IDHS, sibling history was collected only from female respondents. In the 2007 IDHS, male respondents were also asked these questions, the objective being to expand the basis for calculating mortality rates. Estimates based on responses of male respondents are presented elsewhere. To obtain the sibling history, each respondent was first asked to give the total number of live births to her/his mother. The respondent was next asked to list all of the children born to her/his mother starting with the first child born. Then the respondent was asked whether each of these siblings was still alive at the time of the survey. For living siblings, current age was collected; for deceased siblings, age at death and years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on age at death or years since death, approximate but quantitative answers were acceptable. For sisters who died at age 10 years or above, three questions were used to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died or did [NAME OF SISTER] die during childbirth?” and if negative, “Did [NAME OF SISTER] die within 42 hours after the end of a pregnancy?” and if negative,” “Did [NAME OF SISTER] die due to complications of pregnancy or childbirth?” For surviving and dead siblings, an additional question was asked to determine whether the sibling had ever been married. The estimation of adult mortality and maternal mortality requires reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number who died, and (for maternal mortality) the number of sisters who died of maternity-related causes. There is no definitive procedure for 214 | Adult and Maternal Mortality establishing the completeness or accuracy of retrospective data on sibling survivorship. Table 16.1 examines several indicators of the quality of the sibling survivorship data from the IDHS, including the completeness of the reporting of sibling survivorship, the current age of surviving siblings, and the age at death and years since death for deceased siblings. Of the 181,095 siblings reported in the sibling histories of IDHS female respondents, survival status was not reported for 67 (less than 0.1 percent). Among surviving siblings, current age (used to estimate exposure to death) was reported for virtually all surviving siblings (99.6 percent). Among deceased siblings, complete reporting of age at death and years since death was also nearly universal; for 88 percent of deceased siblings, both age at death and years since the death (or year of death) were reported. Age at death was missing for less than 2 percent of deceased siblings, while years since death was missing for 9 percent of deceased siblings. Rather than exclude siblings with missing data from the analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data.1 The sibling survivorship data, including cases with imputed values, were used in the direct estimation of adult and maternal mortality. Table 16.1 Completeness of information on siblings Number of siblings reported by female survey respondents age 15-49 and completeness of reported data on age, age at death (AD), and years since death (YSD), Indonesia 2007 Females Males Total Number Percentage Number Percentage Number Percentage All siblings 88,576 100.0 92,519 100.0 181,095 100.0 Surviving 79,159 89.4 80,644 87.2 159,803 88.2 Deceased 9,397 10.6 11,827 12.8 21,224 11.7 Information missing 20 0.0 47 0.1 68 0.0 Surviving siblings 79,159 100.0 80,644 100.0 159,803 100.0 Age reported 78,806 99.6 80,286 99.6 159,092 99.6 Age missing 352 0.4 359 0.4 711 0.4 Deceased siblings 9,397 100.0 11,827 100.0 21,224 100.0 AD and YSD reported 8,298 88.3 10,437 88.2 18,735 88.3 Missing only AD 170 1.8 136 1.1 306 1.4 Missing only YSD 788 8.4 1,069 9.0 1,857 8.8 Missing both 140 1.5 186 1.6 326 1.5 16.2 DIRECT ESTIMATES OF ADULT MORTALITY Table 16.2 presents the age-specific male and female mortality rates for the five-year period before the survey, which corresponds roughly to 2003-2007. Age-specific death rates are computed by dividing the number of deaths in each age group by the total person-months of exposure in that age group during a specified reference period. Since the number of deaths on which the rates are based is not large (619 female and 835 male deaths), the age-specific rates are subject to large sampling variation. 1 The imputation procedure is based on the assumption that the reported birth ordering of siblings in the history is correct. The first step is to calculate birth dates. For each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death, the birth date was calculated. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either the age at death or years since death was reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of age at death for siblings for whom the years since death was unreported, but age at death was reported, was used as a basis for imputing the age at death. Adult and Maternal Mortality | 215 Table 16.2 Adult mortality rates Direct estimates of age-specific mortality rates for women and men age 15-49 based on the survivorship of sisters and brothers of survey respondents for the period 0-4 years preceding the survey, Indonesia 2007 Females Males Current age Deaths Exposure years Mortality rates Deaths Exposure years Mortality rates 15-19 28 36,631 0.76 84 36,466 2.31 20-24 63 52,378 1.21 97 52,686 1.85 25-29 69 58,635 1.18 105 60,435 1.74 30-34 103 59,058 1.74 87 61,240 1.45 35-39 111 54,252 2.05 159 55,234 2.87 40-44 147 40,489 3.63 131 40,346 3.26 45-49 98 25,726 3.80 170 26,722 6.35 Total 619 327,170 1.95a 835 333,129 2.68a a Age adjusted The female mortality rate is 1.95 deaths per 1,000 and the male mortality rate is 2.68 deaths per 1,000. As expected, mortality increases with age for both sexes. In general, at most ages, male mortality rates are slightly higher than female rates. Analysis of past IDHS surveys shows that there has been a slight increase in both female and male adult mortality from 1992 to 2007 (Figure 16.1). 2.1 2.16 2.68 1.72 1.89 1.95 1997 IDHS 2002-2003 IDHS 2007 IDHS 0 1 2 3 4 Deaths per 1,000 Males Females Figure 16.1 Trends in Adult Mortality Rates (per 1,000), Women and Men Age 15-49, IDHS 1997-2007 2.10 216 | Adult and Maternal Mortality 16.3 ESTIMATES OF MATERNAL MORTALITY Direct age-specific estimates of maternal mortality from the reported survivorship of sisters are shown in Table 16.3 for the five-year period preceding the survey. Age-specific mortality rates are calculated by dividing the number of maternal deaths by woman-years of exposure. To remove the effect of truncation bias—the upper boundary for eligibility for women interviewed in the IDHS is 49 years— the overall rate for women age 15-49 is standardized by the age distribution of the survey respondents. A maternal death is defined as any death that occurs during pregnancy, during childbirth, or within two months after the birth or the termination of the pregnancy.2 The number of maternal deaths (62) is small, so age-specific rates are subject to very large sampling errors and should be interpreted with caution. The preferred approach is to calculate one estimate for all childbearing ages (15-49 years). For the period 0-4 years before the survey, the rate for deaths due to causes related to pregnancy and childbearing is 0.18 maternal deaths per 1,000 woman-years of exposure. Maternal deaths, or the proportion of deaths of women of reproductive age due to maternal causes (PMDF), represent 10 percent of all deaths among women age 15-49. The maternal mortality rate can be converted to a maternal mortality ratio and expressed per 100,000 live births by dividing the rate by the general fertility rate (0.078) for the same period. In this way, the obstetrical risk of pregnancy and childbearing is highlighted. By direct estimation procedures, the maternal mortality ratio is estimated as 228 maternal deaths per 100,000 live births for the period 2004-2007. Table 16.3 Maternal mortality Maternal mortality rates for the period 0-6 years pre- ceding the survey, based on the survivorship of sisters of survey respondents, Indonesia 2007 Age Maternal deaths Exposure (years) Mortality rates (1,000) 15-19 4 36,631 0.10 20-24 6 52,378 0.12 25-29 22 58,635 0.38 30-34 16 59,058 0.27 35-39 5 54,252 0.10 40-44 7 40,489 0.18 45-49 2 25,726 0.07 Total 15-49 62 327,170 0.18a General fertility rate1 0.078 Maternal mortality ratio2 228 1 Expressed per 1,000 woman-years of exposure 2 Expressed per 100,000 live births; calculated as maternal mortality rate divided by the general fertility rate a Age adjusted 2 This definition includes all deaths that occurred during pregnancy and in the two months following the birth, even if the death was due to nonmaternal causes. This definition is unlikely to result in overreporting of maternal deaths, however, because most deaths among women in the specified period are due to maternal causes, and maternal deaths are more likely to be underreported than overreported. Adult and Maternal Mortality | 217 16.4 TRENDS IN MATERNAL MORTALITY Analysis of the maternal mortality ratio (MMRatio) estimated from the 1994 IDHS showed that for the five-year period (1990-1994) the maternal mortality ratio was 390 deaths per 100,000 births. An unpublished analysis of data from the 1997 IDHS implied a slight decline in the ratio to 334 deaths per 100,000 births for the period 1993-1997. The MMRatio estimates of 307 deaths per 100,000 births in the 2002-2003 IDHS and 228 deaths per 100,000 births in the 2007 IDHS appear to confirm the downward trend in maternal mortality in Indonesia. The trend is clearly seen in the annual reduction (ARR) of the MMRatio between the 2002-2003 IDHS and the 2007 IDHS of about 5 percent, compared with about 2 percent between the 1997 IDHS and the 2002-2003 IDHS.3 Despite the slight increase in female adult mortality in Indonesia, the decline in maternal mortality indicates success in reducing the role of maternal deaths in overall female adult mortality. Figure 16.2 shows the changes in female adult mortality and the PMDF for the past four IDHS surveys. The PMDF has declined continuously from 19 percent (1994 IDHS) to 10 percent (2007 IDHS). 3 Note that the figures for the MMRatios from all four surveys are subject to high sampling errors and the 95 percent confidence intervals surrounding the figures overlap. Even at a somewhat more relaxed level of confidence (67 percent), the intervals around the 1994 and 2007 figures still overlap, making it difficult to conclude with confidence that there has been any decline in the level of maternal mortality in Indonesia over the past 10 to 15 years. + + + + ) ) ) ) 1990 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2010 0 5 10 15 20 25 Per 1,000/Percent Female adult mortality rate PMDF (%)) + Figure 16.2 Changes in Adult Female Mortality Rates and PMDFs, IDHS 1994-2007 22 18 19 20 19 17 14 10 Malaria and Other Health Issues | 219 MALARIA AND OTHER HEALTH ISSUES 17 17.1 INTRODUCTION Malaria is a communicable disease that is prevalent in the tropical and subtropical regions. More than one million deaths each year can be attributed to malaria. In Indonesia, deaths due to malaria are high; about 70 million people—or 35 percent of the population in malaria endemic areas—are malaria positive. Among the more than 576 districts and municipalities in Indonesia, 424 are malaria endemic (China Review, 2009). The eastern part of the country has the highest number of reported malaria cases. This includes Papua, East Nusa Tenggara, West Nusa Tenggara, Maluku, North Maluku, and Southeast Sulawesi Provinces. Provinces in other parts of Indonesia that have a high prevalence of malaria cases include West Kalimantan, Bangka-Belitung, South Sumatera, Bengkulu and Riau Provinces (Lie Birchall, 2008). The National Malaria Control Program (NMCP) has set up elimination targets by island as follows: in Java-Bali and Batam by 2010 in Java and Nangroe Aceh Darusalam by 2015, in Sumatera, Kalimantan, Sulawesi, and NTB by 2020, and in Papua, West Papua, Maluku, North Maluku, and East Nusa Tenggara by 2030. Malaria control measures prioritizes early diagnosis and prompt treatment (EDPT) and vector control using bed nets, especially long lasting insecticide nets (LLIN), indoor residual spraying (IRS), and environmental methods. All of these are carried out with increased community participation, involving Malaria Village Post and Village Malaria Post Cadres, and inter-sectoral collaboration. In 2001, the Government of Indonesia initiated a strategic plan in roll back malaria program (Gerakan Berantas Kembali Malaria, abbreviated as Gebrak Malaria), which involves various segments of the community, including the private sector, business community, non-profit organizations, and other development agents (MOH, 2001). To collect information on the impact of these malaria interventions at the community level, the 2007 IDHS included questions on ownership of bednets, use of bednets by pregnant women and young children, and prompt treatment of fever in children under age five. 17.2 OWNERSHIP AND USE OF MOSQUITO NETS The Government of Indonesia is committed to meeting Millennium Development Goals for malaria indicators by 2015, including reducing malaria morbidity and mortality by 50 percent, 80 percent of children under five in malaria endemic areas sleeping under insecticide-treated net), 80 percent of pregnant woman in malaria endemic areas sleeping under insecticide-treated net, 80 percent of uncomplicated P. falciparum malaria treated with artemicin combination therapy/ACT, 80 percent of severe malaria cases treated with artemicin derivatives, and 80 percent of households have at least one insecticide-treated net. The Ministry of Health conducts periodic surveys to determine bed net coverage and usage in communities in the sentinel regions targeted through the Global Fund activities where nets were distributed in many endemic areas of Indonesia. Table 17.1 shows the percentage of households owning various types of mosquito nets (treated or untreated) and the average number of nets per household by background characteristics. Overall, 32 220 | Malaria and Other Health Issues percent of households own some type of mosquito net. Sixteen percent of households own more than one net. Ownership of treated mosquito nets—i.e., a net that had been pretreated with insecticide or a non- pretreated net has subsequently been soaked with insecticide at least once—is limited (4 percent). A somewhat smaller proportion of households (3 percent) own an insecticide-treated net (ITN), which is 1) a factory-treated net that does not require any further treatment; 2) a pretreated net obtained within the past 12 months; or 3) a net that has been soaked with insecticide within the past 12 months. The last column in Table 17.1 indicates that, on average, ITNs are nonexistent in Indonesia. Rural households are more likely to own some type of mosquito net than urban households. Ownership of mosquito nets has a negative relationship with wealth status; households in the lowest wealth quintile are more likely to own a net than households in the highest wealth quintile. Table 17.1 Ownership of mosquito nets Percentage of households with at least one and with more than one mosquito net (treated or untreated), ever-treated mosquito net, and insecticide-treated net (ITN), and the average number of nets per household, by background characteristics, Indonesia 2007 Any type of mosquito net Ever-treated mosquito net1 Insecticide-treated mosquito net (ITN)2 Background characteristic Percentage with at least one Percentage with more than one Average number of nets per household Percentage with at least one Percentage with more than one Average number of ever- treated nets per household Percentage with at least one Percentage with more than one Average number of ITNs per household Number of households Residence Urban 18.2 8.4 0.3 1.9 0.7 0.0 1.4 0.4 0.0 16,883 Rural 41.6 21.9 0.7 4.8 1.8 0.1 3.8 1.4 0.1 23,818 Wealth quintile Lowest 47.2 22.8 0.8 6.0 2.0 0.1 5.0 1.7 0.1 8,529 Second 42.0 22.4 0.7 4.5 1.8 0.1 3.5 1.4 0.1 8,465 Middle 32.8 17.9 0.6 3.7 1.3 0.1 2.7 0.8 0.0 7,993 Fourth 22.6 12.0 0.4 2.2 0.9 0.0 1.5 0.4 0.0 8,119 Highest 12.2 5.1 0.2 1.4 0.6 0.0 1.0 0.5 0.0 7,594 Total 31.9 16.3 0.5 3.6 1.4 0.1 2.8 1.0 0.0 40,701 1 An ever-treated net is a pretreated net or a non-pretreated net that has subsequently been soaked with insecticide at least once. 2 An insecticide-treated net (ITN) is 1) a factory-treated net that does not require any further treatment, or 2) a pretreated net obtained within the past 12 months, or 3) a net that has been soaked with insecticide within the past 12 months. Table 17.2 provides information on the percentage of children under five years who slept under a mosquito net (treated or untreated) on the night before the survey, by background characteristics. Overall, 31 percent of children under five slept under a net on the night before the survey. Usage of nets does not vary much by child’s age, although infants are more likely to sleep under a net than older children. There is no difference in mosquito net usage by sex of the child. Rural children are more likely than urban children to sleep under a net (40 and 19 percent, respectively). Children in the lowest wealth quintile have the highest level of net usage (46 percent), while children in the highest wealth quintile have the lowest level of net usage (12 percent). Malaria and Other Health Issues | 221 Table 17.2 Use of mosquito nets by children Percentage of children under five years of age who slept under a mosquito net (treated or untreated), an ever-treated mosquito net, or an insecticide-treated net (ITN) the night before the survey, by background characteristics, Indonesia 2007 Percentage of children who slept under: Background characteristic Any net the night before the survey An ever- treated net the night before the survey1 An ITN the night before the survey2 Number of children Age (months) <12 36.8 4.5 3.6 3,465 12-23 31.2 4.8 3.7 3,177 24-35 31.5 4.1 3.1 3,284 36-47 27.2 3.7 2.9 3,300 48-59 29.6 4.1 3.1 3,339 Sex Male 31.0 4.4 3.4 8,594 Female 31.6 4.1 3.2 7,972 Residence Urban 18.7 2.3 1.6 6,847 Rural 40.2 5.6 4.5 9,719 Wealth quintile Lowest 46.2 7.0 5.9 3,740 Second 42.2 5.5 4.3 3,249 Middle 32.9 4.4 2.9 3,305 Fourth 20.1 2.3 1.5 3,180 Highest 11.6 1.5 1.3 3,092 Total 31.3 4.3 3.3 16,566 1 An ever-treated net is 1) a pretreated net or a non-pretreated net that has subsequently been soaked with insecticide at least once. 2 An insecticide-treated net (ITN) is 1) a factory-treated net that does not require any further treatment, or 2) a pretreated net obtained within the past 12 months, or 3) a net that has been soaked with insecticide within the past 12 months. Table 17.3 shows the percentage of all women and pregnant women who slept under a mosquito net (treated or untreated) on the night before the survey, by background characteristics. Overall, 23 percent of women age 15-49 slept under a mosquito net the night before interview. Because treated nets are uncommon in Indonesia, only 2 percent of these women used an ever-treated net or an ITN. Usage of mosquito nets is slightly higher among pregnant women than among all women (24 and 23 percent, respectively). Pregnant women are also more likely than women generally to use a treated net or an ITN. As in the case of children, net usage is higher in rural areas and among women in the lower wealth quintiles. The data in Table 17.3 indicate there is a negative association between women’s level of education and use of a mosquito net; women with no education are most likely to sleep under a net, while women in the highest education level are the least likely to use a mosquito net (28 and 11 percent, respectively). 222 | Malaria and Other Health Issues Table 17.3 Use of mosquito nets by pregnant women Percentage of all women age 15-49 and pregnant women age 15-49 who slept under a mosquito net (treated or untreated), an ever-treated mosquito net, or an insecticide-treated net (ITN) the night before the survey, by background characteristics, Indonesia 2007 Percentage of all women age 15-49 who slept under: Percentage of pregnant women age 15-49 who slept under: Background characteristic Any net the night before the survey An ever- treated net the night before the survey1 An ITN the night before the survey2 Number of women Any net the night before the survey An ever- treated net the night before the survey1 An ITN the night before the survey2 Number of women Residence Urban 11.0 1.1 0.7 19,884 9.9 1.1 1.0 726 Rural 33.2 3.5 2.7 23,862 35.0 4.1 3.4 918 Education No education 28.0 2.7 2.0 2,557 41.3 3.7 3.7 47 Primary 28.7 3.0 2.3 17,609 29.6 3.5 2.8 631 Secondary 20.0 2.2 1.6 19,563 21.2 2.7 2.3 796 More than secondary 10.7 1.1 0.8 3,991 10.7 0.1 0.1 169 Missing 19.1 0.0 0.0 23 na na na 0 Wealth quintile Lowest 41.2 4.9 4.0 7,741 45.9 5.5 4.5 378 Second 35.5 3.5 2.7 8,166 31.4 2.1 1.8 317 Middle 24.3 2.3 1.6 8,715 22.7 4.5 3.9 295 Fourth 14.8 1.4 0.9 9,127 11.2 0.7 0.6 347 Highest 5.6 0.6 0.4 9,998 4.7 0.8 0.6 307 Total 23.1 2.4 1.8 43,746 23.9 2.8 2.3 1,644 1 An ever-treated net is 1) a pretreated net or a non-pretreated net that has subsequently been soaked with insecticide at least once. 2 An insecticide-treated net (ITN) is 1) a factory-treated net that does not require any further treatment, or 2) a pretreated net obtained within the past 12 months, or 3) a net that has been soaked with insecticide within the past 12 months. Adult and Maternal Mortality | 223 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 18 One of the established policies of the Indonesian government is to involve men in the health care of their wives and children. Men are expected to be involved in making decisions and taking actions regarding family planning, antenatal care, preparation for delivery, and children’s immunization and nutrition (Ministry of Health, 2001d). The participation and responsibility of men in reproductive health is to promote women’s health status. Important decisions such as who will provide assistance during delivery and what contraceptive method will be used are usually made by the husband. The new approach to increasing men’s participation in reproductive health is to provide them with the right information and involve them in each effort to improve the reproductive health status of their wife. Some activities that involve men’s par- ticipation are family planning, utilization of con- traceptive methods, ensuring safe delivery by a medical professional, assisting in newborn infant care, being a good father, not abusing women, and avoiding the transmission of STDs and HIV (Ministry of Health, 2001a). The next section pre- sents information on men’s involvement in en- suring safe motherhood for their wives and proper health care for their children. 18.1 ADVICE AND CARE DURING ANTENATAL PERIOD, DELIVERY, AND POSTNATAL PERIOD In the 2007 IDHS, currently married men who had had at least one child since January 1997 were asked several questions regarding the preg- nancy care of the mother of their last-born child, and the health care received by the child. Table 18.1 shows the percentage of last births in the five years preceding the survey for which mothers re- ceived advice or care from a doctor or a health provider during the pregnancy, delivery, and dur- ing the six-week period after delivery. For 87 per- cent of births, men reported that the child’s mother received advice or care during the preg- nancy, 78 percent received care during delivery, and 68 percent received care in the six weeks after delivery. The percentages vary somewhat by men’s age; fathers in their thirties are the most likely to say that the mother of their last-born child received advice or care during the preg- nancy, during delivery, and during the six-week Table 18.1 Advice and care received by mother during pregnancy, delivery, and after delivery Among last births in the five years preceding the survey, percentage for which mothers received advice or care from a health care provider (according to fathers’ reports), by type of advice or care and father's background characteristics, Indonesia 2007 Percentage of mothers who received advice or care (fathers’ reports): Background characteristic During pregnancy During delivery During the six weeks after delivery Number of fathers Age 15-19 * * * 6 20-24 87.6 77.7 65.4 264 25-29 86.4 77.1 66.0 791 30-34 89.4 81.8 70.2 902 35-39 85.7 73.6 68.2 825 40-44 89.2 79.9 68.7 633 45-49 79.9 71.6 63.1 243 50-54 71.8 72.7 58.5 104 Residence Urban 94.0 90.0 76.1 1,651 Rural 81.0 67.8 60.8 2,118 Father's education No education 48.6 39.1 26.0 98 Some primary 75.2 63.3 45.5 482 Complete primary 83.2 68.2 60.1 975 Some secondary 87.7 77.8 70.7 816 Secondary + 95.3 91.3 81.3 1,398 Wealth quintile Lowest 69.5 53.5 43.3 804 Second 83.5 67.9 62.0 712 Middle 89.6 80.8 70.7 768 Fourth 94.8 91.1 77.2 712 Highest 97.4 95.3 85.7 774 Total 86.7 77.5 67.5 3,769 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 224 | Adult and Maternal Mortality period after delivery. As expected, fathers in urban areas, those who are better-educated, and those in the higher wealth quintiles are more likely to report that the mother received advice or care during the pregnancy, delivery, and during the six-week period after delivery than other fathers. Appendix Table A-18.1 shows the percentage of last births in the five years preceding the survey for which mothers received advice or care during the pregnancy by province. 18.2 KNOWLEDGE ABOUT CHILDREN’S IMMUNIZATION Currently married men were also asked if their last living child born in the five years preceding the survey had been immunized against tuberculosis (BCG), polio, DPT, measles, and hepatitis B. Table 18.2 presents information on the specific immunizations received by the children, according to fathers’ reports: BCG (77 percent), polio (83 percent), DPT (71 percent), measles (67 percent), and hepatitis B vaccine 68 percent. Reporting of children’s immunizations varies by fathers’ background characteristics. In general, children of fathers age 40-44, children who live in urban areas, children of better-educated fathers, and children living in households in the highest wealth quintile are more likely than other children to be immunized with each of the vaccines. For example, 85 percent of children whose fathers reside in urban areas have received BCG vaccine, compared with 70 percent of children whose fathers reside in rural areas. Furthermore, 40 percent of children born to men with no education have received BCG vaccine, compared with 86 percent of children of men with secondary or higher education; 62 percent of children of men in the lowest wealth quintile have received BCG vaccine, compared with 90 percent of children of men in the highest wealth quintile. Appendix Table A-18.2 shows the percentage of children immunized with each vaccine by the province in which the father resides. Table 18.2 Specific vaccines received by children under five Among children born in the past five years, percentage of last-born children who received specific vaccines (according to fathers’ reports), by father's background characteristics, Indonesia 2007 Percentage of last-born children who received specific vaccines (fathers’ reports) Background characteristic BCG Polio DPT Measles Hepatitis B Number of fathers Age 15-19 * * * * * 5 20-24 61.5 66.6 48.8 37.8 45.3 262 25-29 75.7 82.1 70.8 65.8 65.3 781 30-34 79.2 86.1 75.2 70.1 72.0 887 35-39 75.9 82.6 69.4 67.8 66.0 798 40-44 82.4 88.6 78.7 74.3 77.2 623 45-49 78.7 87.8 72.2 69.7 71.3 235 50-54 73.0 77.9 66.4 66.3 62.4 94 Residence Urban 84.9 87.4 79.6 72.3 76.8 1,637 Rural 70.4 80.2 64.6 62.6 60.9 2,048 Father's education No education 40.3 55.2 30.5 27.7 29.9 94 Some primary 69.4 79.5 62.1 64.1 59.6 459 Complete primary 70.2 79.0 64.5 61.9 61.7 951 Some secondary 78.0 84.8 73.9 65.8 68.2 796 Secondary + 85.6 88.9 80.3 74.6 77.5 1,385 Wealth quintile Lowest 62.3 69.9 53.6 52.3 49.8 778 Second 72.4 85.0 66.5 66.6 63.1 684 Middle 77.8 86.2 74.7 67.6 68.2 755 Fourth 82.2 86.2 76.2 67.3 75.4 698 Highest 89.6 90.3 85.7 80.9 83.6 770 Total 76.8 83.4 71.3 66.9 68.0 3,685 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Adult and Maternal Mortality | 225 18.3 CONTACT WITH HEALTH CARE PROVIDERS In the 2007 IDHS, men’s involvement in their wives’ pregnancy and care was measured by asking male respondents whether they talked to a health care provider about the pregnancy care or the health of the mother of their last-born child in the five years preceding the survey. Men were also asked specifically about the topics they discussed during such contacts with a doctor or health provider. This information is presented in Table 18.3. The findings show that during their wife’s last pregnancy, only 32 percent of fathers talked to a health care provider about the pregnancy care and the health of their wife. Of these men, 26 percent talked with a health care provider about the types of foods their wife should eat during the pregnancy, 25 percent talked about how much rest she should have during the pregnancy, and 27 percent talked about the types of health problems for which she should get immediate medical attention. Fathers in urban areas, those who are better educated, and those in the higher wealth quintiles are more likely than other fathers to talk with a health care provider about their wife’s health and care during the pregnancy. Appendix Table A-18.3 shows the variation by province in the level of contact between fathers and health care providers regarding their wife’s pregnancy and health. Table 18.3 Fathers’ contact with health care providers about wife's health and pregnancy Among children born in the past five years, percentage of last-born children whose fathers discussed with a health care provider the health of the mother or her pregnancy, and among these fathers, percentage who discussed specific topics, according to father's background characteristics, Indonesia 2007 Topics of discussion with health care providers Background characteristic Percentage who talked with health care provider Types of foods wife eats during pregnancy How much rest wife should have during pregnancy Types of health problems for which wife should get immediate medical attention Number of fathers Age 15-19 * * * * 6 20-24 29.0 23.8 19.9 20.9 264 25-29 44.5 37.4 35.5 37.7 791 30-34 44.2 37.5 38.7 39.2 902 35-39 41.4 31.9 30.2 35.2 825 40-44 39.3 30.0 31.6 33.6 633 45-49 38.1 28.2 30.0 31.4 243 50-54 19.7 16.7 17.8 13.0 104 Residence Urban 51.4 43.2 43.0 45.8 1,651 Rural 32.3 24.7 24.3 25.7 2,118 Father's education No education 7.9 3.2 3.8 7.7 98 Some primary 24.3 11.7 12.2 16.1 482 Complete primary 25.9 18.3 18.4 20.6 975 Some secondary 35.7 27.9 27.0 28.9 816 Secondary + 61.8 55.2 54.6 55.7 1,398 Wealth quintile Lowest 20.4 13.7 13.8 17.3 804 Second 32.3 23.1 21.6 23.6 712 Middle 41.1 31.6 31.7 32.8 768 Fourth 46.8 39.1 39.7 40.8 712 Highest 63.3 57.2 56.1 58.3 774 Total 40.7 32.8 32.5 34.5 3,769 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 226 | Adult and Maternal Mortality 18.4 PREPARATIONS FOR DELIVERY For the safety and well-being of mothers and their newborn babies, certain steps need to be taken. These include making decisions on various aspects of the delivery, such as deciding the place of delivery, the person to assist with the delivery, transportation to the place of delivery, the cost associated with the delivery, and identification of a possible blood donor, if needed. In the 2007 IDHS, fathers were asked whether they discussed these aspects of delivery with anyone during their wife’s pregnancy for their last-born child in the five years preceding the survey. This information is presented in Table 18.4. The results show that, overall, 72 percent of fathers discussed with someone at least one of the topics related to the delivery. The most frequently discussed topics are delivery assistance (62 percent) and the place of delivery (60 percent), followed by payment for the services (52 percent). A topic less frequently discussed by fathers is transportation to the place of delivery (32 percent), probably because the majority of deliveries in Indonesia take place at home. Identification of a potential blood donor during delivery was discussed by only 10 percent of the fathers. Table 18.4 Preparation for delivery Among children born in the past five years, percentage of last-born children whose fathers discussed specific topics about delivery, according to father's background characteristics, Indonesia 2007 Percentage of fathers who discussed topics about delivery Background characteristic Place of delivery Transportation Delivery assistance Payment Blood donor Any topic No topics discussed Number of fathers Age 15-19 * * * * * * * 6 20-24 58.0 31.6 55.7 54.5 4.8 71.4 28.6 264 25-29 60.9 29.2 59.1 51.3 9.5 72.1 27.9 791 30-34 60.9 35.5 65.9 54.7 12.3 72.8 27.2 902 35-39 57.8 32.0 61.8 52.2 8.4 72.5 27.5 825 40-44 60.2 30.9 65.2 49.4 9.9 74.9 25.1 633 45-49 59.6 27.6 57.5 42.5 7.2 69.2 30.8 243 50-54 46.2 32.1 45.4 51.2 9.5 61.2 38.8 104 Residence Urban 68.5 37.1 66.8 55.8 11.8 77.8 22.2 1,651 Rural 52.4 27.6 57.7 48.5 7.7 68.0 32.0 2,118 Father's education No education 23.8 13.4 39.2 26.2 3.6 43.6 56.4 98 Some primary 51.1 23.5 49.5 38.5 4.7 64.3 35.7 482 Complete primary 48.0 21.9 52.1 48.2 4.1 65.6 34.4 975 Some secondary 56.1 29.0 62.9 51.5 10.7 70.8 29.2 816 Secondary + 74.8 44.3 73.4 60.6 14.7 82.7 17.3 1,398 Wealth quintile Lowest 43.3 19.9 50.2 41.5 4.8 60.3 39.7 804 Second 45.2 25.6 50.9 44.3 6.9 63.0 37.0 712 Middle 66.1 32.2 68.9 57.7 9.4 77.9 22.1 768 Fourth 66.6 36.4 62.0 56.9 12.1 76.8 23.2 712 Highest 76.2 44.9 76.0 58.5 14.5 83.8 16.2 774 Total 59.5 31.7 61.7 51.7 9.5 72.3 27.7 3,769 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 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Appendix A | 229 PROVINCIAL TABLES Appendix A CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND HOUSING CHARACTERISTICS Table A-2.1 Children's living arrangements and orphanhood by province Percent distribution of de jure children under age 15 by children's living arrangements and survival status of parents, according to province, Indonesia 2007 Not living with either parent Living with mother but not with father Living with father but not with mother Province 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 Percent- age not living with a bio- logical parent Percent- age with one or both parents dead Number of children Sumatera Nanggroe Aceh Darussalam 88.0 2.9 5.4 0.4 0.5 1.3 0.2 0.3 0.3 0.6 100.0 2.2 6.9 962 North Sumatera 89.1 2.3 3.2 1.1 1.1 2.1 0.1 0.3 0.4 0.4 100.0 2.9 5.0 3,396 West Sumatera 86.4 3.9 4.6 0.3 0.6 2.8 0.6 0.2 0.5 0.1 100.0 4.0 6.4 1,087 Riau 90.5 3.0 1.8 0.5 0.8 2.4 0.5 0.0 0.3 0.2 100.0 3.2 3.4 857 Jambi 87.3 4.6 2.6 0.5 0.4 3.3 0.1 0.6 0.3 0.3 100.0 4.3 4.0 540 South Sumatera 89.9 2.9 2.8 0.4 1.0 1.8 0.2 0.3 0.2 0.6 100.0 2.5 4.5 1,474 Bengkulu 90.2 3.5 1.2 0.6 0.4 3.0 0.2 0.4 0.4 0.1 100.0 4.1 2.6 362 Lampung 84.4 3.2 1.1 2.7 0.7 6.3 0.5 0.4 0.2 0.6 100.0 7.4 2.8 1,576 Bangka Belitung 90.0 3.3 2.2 0.5 0.6 2.8 0.2 0.0 0.3 0.1 100.0 3.4 3.3 292 Riau Islands 87.9 2.6 1.9 1.1 0.7 4.2 0.5 0.1 0.7 0.3 100.0 5.5 3.9 221 Java DKI Jakarta 88.9 4.2 2.0 0.4 0.7 2.6 0.0 0.1 0.6 0.5 100.0 3.3 3.5 1,907 West Java 83.5 6.5 1.0 2.8 0.7 4.3 0.3 0.2 0.2 0.4 100.0 5.1 2.4 7,952 Central Java 84.6 5.3 1.8 1.6 0.1 5.3 0.3 0.3 0.4 0.4 100.0 6.2 2.9 7,718 DI Yogyakarta 84.1 7.1 1.8 1.2 0.7 4.4 0.3 0.1 0.0 0.4 100.0 4.7 2.9 674 East Java 81.3 6.1 2.8 2.0 0.3 5.7 0.3 0.2 0.9 0.4 100.0 7.1 4.6 7,150 Banten 88.5 3.6 2.3 0.7 0.4 3.4 0.4 0.1 0.4 0.2 100.0 4.3 3.6 2,243 Bali and Nusa Tenggara Bali 91.7 1.9 1.4 1.5 0.7 1.9 0.1 0.3 0.5 0.1 100.0 2.8 3.0 727 West Nusa Tenggara 73.9 11.0 3.0 3.5 0.7 6.1 0.3 0.6 0.5 0.4 100.0 7.6 5.4 1,165 East Nusa Tenggara 80.1 4.9 2.8 0.6 1.7 7.0 1.2 0.7 0.3 0.8 100.0 9.1 6.6 1,417 Kalimantan West Kalimantan 88.7 3.2 2.2 0.5 1.0 2.7 0.2 0.2 0.6 0.6 100.0 3.8 4.3 1,052 Central Kalimantan 91.5 2.5 1.6 0.6 0.1 2.5 0.3 0.2 0.1 0.5 100.0 3.1 2.4 477 South Kalimantan 85.2 5.2 2.9 0.8 0.5 3.8 0.2 0.3 0.6 0.5 100.0 4.8 4.5 780 East Kalimantan 89.3 4.0 1.1 0.4 0.3 3.3 0.5 0.1 0.3 0.7 100.0 4.3 2.5 738 Sulawesi North Sulawesi 82.0 4.7 1.6 0.9 0.3 8.4 0.6 0.7 0.1 0.6 100.0 9.8 3.4 576 Central Sulawesi 86.4 3.1 2.4 0.7 0.2 5.3 0.4 0.3 0.5 0.8 100.0 6.5 3.8 618 South Sulawesi 80.6 6.5 2.3 0.6 1.0 6.8 0.8 0.7 0.6 0.1 100.0 8.9 5.4 1,966 Southeast Sulawesi 79.9 7.3 2.4 2.1 0.3 6.0 0.4 0.9 0.6 0.1 100.0 7.9 4.6 554 Gorontalo 84.4 4.3 2.5 1.1 0.6 5.3 0.4 0.9 0.2 0.2 100.0 6.8 4.6 266 West Sulawesi 83.9 4.0 2.4 1.4 0.5 5.7 0.9 0.3 0.4 0.4 100.0 7.3 4.6 283 Maluku and Papua Maluku 82.8 4.5 1.4 0.8 0.9 8.3 0.7 0.1 0.2 0.3 100.0 9.4 3.3 423 North Maluku 82.0 5.2 1.2 1.3 1.4 6.8 0.5 0.3 0.8 0.5 100.0 8.3 4.2 277 Papua 83.2 3.5 4.4 1.0 1.6 3.4 0.2 0.4 1.2 1.1 100.0 5.2 7.8 180 West Papua 88.1 2.3 2.6 1.2 0.9 3.1 0.2 0.3 0.8 0.5 100.0 4.4 5.0 511 Total <15 84.8 5.0 2.2 1.5 0.6 4.5 0.3 0.3 0.5 0.4 100.0 5.5 3.9 50,420 Note: Table is based on de jure members, i.e., usual residents. 230 | Appendix A Table A-2.2 Educational attainment of household population by province Percent distribution of the de facto male and female household populations age six and over by highest level of schooling attended or completed and median number of years completed, according to province, Indonesia 2007 Province No education Some primary Completed primary Some secondary Completed secondary More than secondary Don't know/ missing Total Number Median years completed MALE Sumatera Nanggroe Aceh Darussalam 3.9 25.1 19.7 27.9 16.9 6.0 0.4 100.0 1,138 6.0 North Sumatera 3.4 25.6 12.5 30.3 21.4 6.1 0.5 100.0 3,740 7.4 West Sumatera 3.8 32.0 16.0 26.8 14.5 6.6 0.4 100.0 1,326 5.8 Riau 4.9 24.9 18.5 24.3 19.4 7.5 0.4 100.0 1,129 6.0 Jambi 4.5 27.4 23.5 25.4 15.0 4.1 0.0 100.0 722 5.7 South Sumatera 2.4 29.1 23.8 25.6 15.5 3.5 0.2 100.0 2,033 5.7 Bengkulu 4.1 31.0 16.3 25.1 17.1 6.4 0.1 100.0 461 5.8 Lampung 4.0 31.8 21.2 24.4 14.5 3.9 0.2 100.0 2,291 5.6 Bangka Belitung 6.6 30.4 25.2 19.9 13.1 4.8 0.0 100.0 431 5.5 Riau Islands 5.9 24.9 16.9 20.8 24.9 6.1 0.5 100.0 294 6.7 Java DKI Jakarta 1.6 13.9 12.5 23.5 34.2 14.1 0.1 100.0 3,173 10.1 West Java 3.8 25.6 26.0 21.1 17.7 5.9 0.1 100.0 11,524 5.8 Central Java 6.6 30.5 22.9 21.6 12.9 5.3 0.1 100.0 11,640 5.5 DI Yogyakarta 5.8 19.8 13.7 24.2 21.4 15.1 0.1 100.0 1,324 8.3 East Java 9.4 28.1 22.5 20.4 14.2 5.3 0.1 100.0 12,068 5.5 Banten 6.2 25.6 22.6 21.9 17.6 6.0 0.2 100.0 2,919 5.8 Bali and Nusa Tenggara Bali 6.5 21.2 16.8 22.7 22.9 9.7 0.2 100.0 1,288 7.7 West Nusa Tenggara 9.4 27.0 16.4 24.3 16.3 6.3 0.2 100.0 1,453 5.7 East Nusa Tenggara 7.0 37.8 18.2 19.7 11.9 4.6 0.8 100.0 1,422 5.2 Kalimantan West Kalimantan 9.4 32.2 18.0 21.7 13.8 4.2 0.6 100.0 1,409 5.4 Central Kalimantan 2.6 25.9 24.5 25.1 15.0 6.5 0.5 100.0 613 5.8 South Kalimantan 3.8 31.3 18.8 24.1 14.7 7.0 0.2 100.0 1,062 5.7 East Kalimantan 4.0 25.4 15.9 24.3 22.2 7.8 0.4 100.0 973 7.4 Sulawesi North Sulawesi 1.5 26.8 16.6 27.7 21.2 5.8 0.4 100.0 858 7.0 Central Sulawesi 3.8 26.3 23.5 24.2 15.0 6.7 0.5 100.0 739 5.8 South Sulawesi 10.3 30.1 15.7 21.4 15.7 6.5 0.4 100.0 2,426 5.5 Southeast Sulawesi 5.4 28.3 12.6 29.0 15.9 8.5 0.3 100.0 571 6.3 Gorontalo 4.8 39.7 18.8 19.8 12.5 3.9 0.5 100.0 337 5.3 West Sulawesi 8.3 29.2 23.7 21.4 12.9 4.3 0.1 100.0 311 5.5 Maluku and Papua Maluku 2.7 30.6 17.0 24.7 18.6 6.1 0.2 100.0 451 5.9 North Maluku 4.0 27.7 16.8 26.0 20.5 4.8 0.3 100.0 302 5.9 Papua 8.3 21.6 15.4 24.4 22.4 6.3 1.6 100.0 201 7.3 West Papua 20.1 25.2 14.2 19.3 14.4 5.2 1.5 100.0 574 5.3 Total 5.9 27.4 20.7 22.7 16.8 6.2 0.2 100.0 71,201 5.7 Continued… Appendix A | 231 Table A-2.2—Continued Province No education Some primary Completed primary Some secondary Completed secondary More than secondary Don't know/ missing Total Number Median years completed FEMALE Sumatera Nanggroe Aceh Darussalam 9.9 25.6 20.4 25.2 11.3 7.2 0.4 100.0 1,240 5.7 North Sumatera 6.4 25.6 15.4 26.2 19.2 6.6 0.5 100.0 3,880 6.0 West Sumatera 7.2 32.3 14.6 22.6 14.6 8.5 0.2 100.0 1,414 5.7 Riau 8.3 25.2 18.1 23.5 17.0 7.4 0.6 100.0 1,094 5.8 Jambi 9.0 28.7 21.0 23.1 13.8 4.2 0.2 100.0 697 5.6 South Sumatera 6.7 31.2 23.4 22.1 13.1 3.2 0.2 100.0 2,024 5.5 Bengkulu 8.1 30.8 17.3 23.3 13.6 6.7 0.3 100.0 459 5.6 Lampung 9.3 31.2 21.0 22.4 11.7 4.1 0.2 100.0 2,170 5.4 Bangka Belitung 11.3 30.6 23.8 17.3 13.1 3.8 0.1 100.0 423 5.3 Riau Islands 9.9 23.6 16.6 22.4 20.3 6.7 0.3 100.0 298 5.9 Java DKI Jakarta 3.5 16.2 17.3 25.0 25.8 12.1 0.0 100.0 3,281 8.5 West Java 7.4 26.1 27.5 21.4 12.2 5.3 0.1 100.0 11,805 5.6 Central Java 14.8 26.6 23.2 20.6 9.6 5.1 0.1 100.0 12,066 5.4 DI Yogyakarta 15.5 19.7 13.5 22.3 16.1 12.9 0.0 100.0 1,367 6.0 East Java 17.8 26.8 21.1 18.9 10.2 4.9 0.2 100.0 12,714 5.2 Banten 10.7 29.4 20.2 21.2 12.3 6.2 0.1 100.0 2,948 5.5 Bali and Nusa Tenggara Bali 16.5 19.9 21.0 19.8 15.5 6.9 0.4 100.0 1,260 5.6 West Nusa Tenggara 17.4 26.5 17.1 23.2 11.1 4.4 0.3 100.0 1,540 5.3 East Nusa Tenggara 11.7 34.7 22.5 18.8 8.0 3.5 0.8 100.0 1,533 5.1 Kalimantan West Kalimantan 19.7 29.1 15.8 20.2 10.5 4.2 0.4 100.0 1,397 5.1 Central Kalimantan 6.0 25.4 24.6 25.3 12.6 5.5 0.6 100.0 568 5.7 South Kalimantan 9.9 32.9 18.0 22.0 11.4 5.6 0.2 100.0 1,170 5.4 East Kalimantan 7.8 27.3 16.9 23.1 17.7 7.1 0.1 100.0 935 5.8 Sulawesi North Sulawesi 1.5 24.1 17.3 27.3 23.2 6.3 0.5 100.0 835 7.5 Central Sulawesi 5.8 26.7 26.4 21.8 11.8 7.0 0.5 100.0 751 5.6 South Sulawesi 14.7 26.4 18.4 21.0 12.3 6.5 0.6 100.0 2,604 5.4 Southeast Sulawesi 10.9 27.3 13.8 28.0 12.9 6.7 0.3 100.0 626 5.7 Gorontalo 5.3 33.0 20.7 21.9 13.1 5.4 0.6 100.0 330 5.5 West Sulawesi 12.2 29.6 22.0 22.4 9.2 4.1 0.6 100.0 321 5.3 Maluku and Papua Maluku 3.9 27.7 23.5 22.8 15.9 6.0 0.3 100.0 447 5.7 North Maluku 5.8 31.2 17.3 27.2 12.5 5.7 0.3 100.0 311 5.6 Papua 10.7 25.9 18.5 22.3 16.9 4.6 1.1 100.0 188 5.7 West Papua 33.6 24.0 13.7 15.1 8.8 4.1 0.7 100.0 518 2.8 Total 11.7 26.6 21.2 21.5 12.8 5.8 0.2 100.0 73,216 5.5 Total includes 10 unweighted women and 12 unweighted men with missing information on age 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 232 | Appendix A CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS Table A-3.1 Distribution of respondents by province Percent distribution of ever-married women and currently married men by province, Indonesia 2007 Ever-married women Currently married men Province Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Sumatera Nanggroe Aceh Darussalam 1.6 514 929 1.6 137 245 North Sumatera 4.5 1,487 1,126 4.2 370 277 West Sumatera 1.7 570 905 1.6 137 217 Riau 1.5 494 991 1.5 130 243 Jambi 1.1 367 874 1.1 95 231 South Sumatera 2.8 928 1,055 2.8 241 289 Bengkulu 0.6 211 753 0.6 53 197 Lampung 2.9 963 920 3.1 271 265 Bangka Belitung 0.6 194 815 0.6 52 222 Riau Islands 0.4 140 731 0.4 36 184 Java DKI Jakarta 4.5 1,471 1,722 4.7 408 497 West Java 16.9 5,545 1,693 16.5 1,444 432 Central Java 16.4 5,383 1,450 17.3 1,517 425 DI Yogyakarta 1.7 551 1,110 1.7 146 305 East Java 18.0 5,924 1,485 17.8 1,561 387 Banten 4.0 1,310 1,413 3.9 344 357 Bali and Nusa Tenggara Bali 1.8 587 1,302 2.0 174 409 West Nusa Tenggara 2.1 705 964 2.2 194 272 East Nusa Tenggara 1.9 627 821 2.0 172 236 Kalimantan West Kalimantan 1.9 628 933 1.8 162 236 Central Kalimantan 0.9 294 792 0.9 82 223 South Kalimantan 1.7 550 953 1.5 128 237 East Kalimantan 1.4 475 837 1.5 132 218 Sulawesi North Sulawesi 1.1 373 894 1.2 102 229 Central Sulawesi 1.0 339 818 1.0 89 210 South Sulawesi 3.2 1,067 1,217 3.0 259 280 Southeast Sulawesi 0.8 259 767 0.7 60 172 Gorontalo 0.5 163 884 0.5 46 224 West Sulawesi 0.4 139 757 0.5 41 226 Maluku and Papua Maluku 0.5 168 805 0.5 44 222 North Maluku 0.4 129 754 0.4 36 194 Papua 0.8 251 723 0.8 70 209 West Papua 0.3 89 702 0.3 24 188 Total 100.0 32,895 32,895 100.0 8,758 8,758 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Appendix A | 233 Table A-3.2 Educational attainment by province Percent distribution of ever-married women and currently married men by highest level of schooling attended or completed, and median grade completed, according to province, Indonesia 2007 Highest level of schooling Province No education Some primary Completed primary Some secondary Completed secondary More than secondary Missing Total Number Median years completed EVER-MARRIED WOMEN Sumatera Nanggroe Aceh Darussalam 5.9 13.6 29.3 24.7 17.7 8.9 0.0 100.0 514 7.3 North Sumatera 6.2 10.8 19.6 22.4 32.2 8.7 0.0 100.0 1,487 8.6 West Sumatera 2.9 22.8 17.0 23.8 23.6 10.0 0.0 100.0 570 8.1 Riau 5.5 14.3 27.0 21.7 23.9 7.7 0.0 100.0 494 8.0 Jambi 5.4 20.3 28.8 20.9 19.5 4.9 0.3 100.0 367 5.8 South Sumatera 2.8 24.0 32.5 20.0 17.5 3.2 0.0 100.0 928 5.7 Bengkulu 5.1 18.4 25.2 22.9 21.5 6.9 0.0 100.0 211 6.3 Lampung 3.4 20.0 31.6 23.2 17.8 4.1 0.0 100.0 963 5.8 Bangka Belitung 6.8 22.7 32.8 15.4 17.9 4.5 0.0 100.0 194 5.6 Riau Islands 8.3 15.8 20.4 20.2 28.0 7.4 0.0 100.0 140 8.2 Java DKI Jakarta 1.9 8.7 21.8 22.4 32.6 12.7 0.0 100.0 1,471 8.8 West Java 4.2 15.5 37.2 19.8 17.0 6.3 0.0 100.0 5,545 5.8 Central Java 7.4 16.9 35.7 21.0 12.9 6.2 0.0 100.0 5,383 5.7 DI Yogyakarta 4.7 10.5 18.8 23.7 27.5 14.8 0.0 100.0 551 8.7 East Java 10.0 18.7 33.2 18.7 13.9 5.5 0.0 100.0 5,924 5.6 Banten 8.9 21.0 28.4 16.8 16.0 8.9 0.0 100.0 1,310 5.7 Bali and Nusa Tenggara Bali 8.8 12.7 28.5 17.1 23.2 9.6 0.0 100.0 587 6.0 West Nusa Tenggara 15.8 18.6 24.0 19.6 17.7 4.4 0.0 100.0 705 5.6 East Nusa Tenggara 8.3 19.0 36.8 17.4 13.4 5.0 0.0 100.0 627 5.6 Kalimantan West Kalimantan 13.8 22.3 23.5 22.3 13.6 4.3 0.1 100.0 628 5.6 Central Kalimantan 3.9 14.2 30.7 24.6 18.9 7.8 0.0 100.0 294 6.6 South Kalimantan 4.5 22.8 26.0 21.9 18.7 6.2 0.0 100.0 550 5.8 East Kalimantan 5.4 14.9 21.3 26.0 24.2 8.3 0.0 100.0 475 8.2 Sulawesi North Sulawesi 0.3 13.1 19.4 26.7 33.7 6.8 0.0 100.0 373 8.7 Central Sulawesi 3.2 15.3 36.8 21.7 16.3 6.7 0.0 100.0 339 5.8 South Sulawesi 7.2 18.7 25.9 21.5 18.9 7.8 0.0 100.0 1,067 5.9 Southeast Sulawesi 5.9 16.9 20.9 28.8 19.9 7.7 0.0 100.0 259 7.8 Gorontalo 2.7 25.2 27.7 20.6 17.3 6.5 0.0 100.0 163 5.8 West Sulawesi 7.2 19.7 29.5 23.6 15.2 4.8 0.0 100.0 139 5.8 Maluku and Papua Maluku 2.3 14.0 29.8 20.8 26.1 7.0 0.0 100.0 168 8.1 North Maluku 2.5 20.1 24.4 26.2 20.0 6.8 0.0 100.0 129 6.5 Papua 38.9 13.7 15.1 14.9 13.4 4.0 0.0 100.0 251 4.0 West Papua 8.0 13.2 23.7 22.1 27.5 5.5 0.0 100.0 89 8.2 Total 6.9 16.9 30.6 20.6 18.1 6.8 0.0 100.0 32,895 5.8 Continued… 234 | Appendix A Table A-3.2—Continued Highest level of schooling Province No education Some primary Completed primary Some secondary Completed secondary More than secondary Missing Total Number Median years completed CURRENTLY MARRIED MEN Sumatera Nanggroe Aceh Darussalam 5.2 13.0 23.8 24.5 24.5 9.1 0.0 100.0 137 8.2 North Sumatera 2.3 11.5 15.0 26.3 34.3 10.6 0.0 100.0 370 8.8 West Sumatera 3.8 26.9 13.0 28.1 17.9 10.4 0.0 100.0 137 7.5 Riau 3.2 12.5 18.3 22.4 32.3 11.0 0.2 100.0 130 8.8 Jambi 2.1 21.6 28.4 21.1 19.9 7.0 0.0 100.0 95 5.9 South Sumatera 1.3 22.7 33.1 19.8 19.6 3.5 0.0 100.0 241 5.8 Bengkulu 1.2 15.1 21.5 23.8 23.2 15.2 0.0 100.0 53 8.4 Lampung 1.1 22.6 26.2 22.7 23.2 4.2 0.0 100.0 271 6.2 Bangka Belitung 3.7 26.3 34.3 14.9 16.1 4.8 0.0 100.0 52 5.6 Riau Islands 7.8 19.1 15.9 17.1 33.7 6.4 0.0 100.0 36 8.4 Java DKI Jakarta 0.0 5.5 12.2 20.9 46.0 15.5 0.0 100.0 408 11.2 West Java 2.0 16.2 36.2 16.7 18.1 10.6 0.3 100.0 1,444 5.9 Central Java 5.2 22.8 30.6 15.9 16.9 8.6 0.0 100.0 1,517 5.7 DI Yogyakarta 1.7 9.8 17.1 23.6 29.9 17.9 0.0 100.0 146 9.2 East Java 6.8 22.0 27.1 20.3 16.6 7.2 0.0 100.0 1,561 5.8 Banten 5.0 12.6 28.6 16.9 29.4 7.5 0.0 100.0 344 8.1 Bali and Nusa Tenggara Bali 2.2 12.2 21.3 18.2 32.1 14.1 0.0 100.0 174 8.9 West Nusa Tenggara 7.3 19.0 24.5 21.2 21.0 6.9 0.0 100.0 194 5.9 East Nusa Tenggara 3.6 20.6 29.8 21.0 19.0 6.0 0.0 100.0 172 5.9 Kalimantan West Kalimantan 7.5 20.1 22.4 25.4 19.3 5.2 0.0 100.0 162 6.0 Central Kalimantan 2.7 10.6 31.7 21.4 22.9 10.7 0.0 100.0 82 8.2 South Kalimantan 0.9 29.9 20.7 23.2 16.7 8.5 0.0 100.0 128 5.8 East Kalimantan 3.2 13.3 15.0 21.7 34.5 12.3 0.0 100.0 132 9.9 Sulawesi North Sulawesi 0.1 16.1 23.0 25.9 26.9 7.9 0.0 100.0 102 8.3 Central Sulawesi 0.5 12.8 31.6 25.2 23.7 6.3 0.0 100.0 89 6.7 South Sulawesi 7.7 21.9 16.7 18.1 23.7 11.9 0.0 100.0 259 7.0 Southeast Sulawesi 3.7 16.5 14.0 22.6 27.4 15.9 0.0 100.0 60 8.8 Gorontalo 3.7 33.9 24.1 12.9 16.2 9.3 0.0 100.0 46 5.5 West Sulawesi 6.4 11.5 43.2 19.6 13.6 5.7 0.0 100.0 41 5.7 Maluku and Papua Maluku 1.0 7.8 23.9 25.5 28.4 13.4 0.0 100.0 44 8.7 North Maluku 0.9 12.4 22.4 25.6 29.8 8.9 0.0 100.0 36 8.6 Papua 25.0 9.9 20.3 18.3 20.5 6.0 0.0 100.0 70 5.7 West Papua 3.5 10.0 21.1 26.9 29.5 9.0 0.0 100.0 24 8.5 Total 4.1 18.3 26.7 19.7 22.0 9.1 0.1 100.0 8,758 6.6 1 Completed grade 6 at the primary level 2 Completed grade 6 at the secondary level Appendix A | 235 Table A-3.3 Literacy by province Percent distribution of ever-married women and currently married men by level of schooling attended and level of literacy, and percentage literate, according to province, Indonesia 2007 No schooling or primary school Province Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Missing Total Percentage literate Number EVER-MARRIED WOMEN Sumatera Nanggroe Aceh Darussalam 51.3 23.8 13.7 10.8 0.4 100.0 88.8 514 North Sumatera 63.4 20.1 6.6 9.9 0.0 100.0 90.1 1,487 West Sumatera 57.4 27.6 4.4 9.9 0.7 100.0 89.4 570 Riau 53.2 28.8 6.3 10.4 1.2 100.0 88.3 494 Jambi 45.2 33.5 10.5 10.9 0.0 100.0 89.1 367 South Sumatera 40.7 34.8 15.3 8.7 0.5 100.0 90.8 928 Bengkulu 51.3 29.7 6.8 11.4 0.9 100.0 87.7 211 Lampung 45.0 38.1 5.6 11.0 0.3 100.0 88.7 963 Bangka Belitung 37.7 46.3 5.3 9.9 0.7 100.0 89.3 194 Riau Islands 55.6 24.1 9.6 9.6 1.2 100.0 89.2 140 Java DKI Jakarta 67.7 22.7 5.3 2.9 1.4 100.0 95.7 1,471 West Java 43.1 43.1 6.3 7.1 0.5 100.0 92.4 5,545 Central Java 40.1 37.6 8.2 14.0 0.1 100.0 85.8 5,383 DI Yogyakarta 66.0 23.4 3.3 7.2 0.1 100.0 92.7 551 East Java 38.1 35.6 8.5 17.4 0.5 100.0 82.2 5,924 Banten 41.7 36.6 9.6 11.6 0.5 100.0 87.8 1,310 Bali and Nusa Tenggara Bali 49.9 26.2 9.3 13.9 0.7 100.0 85.5 587 West Nusa Tenggara 41.6 28.2 5.9 23.6 0.8 100.0 75.7 705 East Nusa Tenggara 35.9 36.6 8.0 17.0 2.5 100.0 80.5 627 Kalimantan West Kalimantan 40.2 31.5 8.4 19.3 0.5 100.0 80.2 628 Central Kalimantan 51.3 33.4 6.2 7.8 1.4 100.0 90.8 294 South Kalimantan 46.7 32.9 11.4 8.6 0.3 100.0 91.0 550 East Kalimantan 58.4 28.0 5.4 8.0 0.1 100.0 91.9 475 Sulawesi North Sulawesi 67.3 25.5 3.6 2.4 1.2 100.0 96.4 373 Central Sulawesi 44.7 38.7 6.6 9.2 0.8 100.0 90.0 339 South Sulawesi 48.2 27.8 10.3 12.7 1.0 100.0 86.3 1,067 Southeast Sulawesi 56.3 25.2 5.6 12.1 0.8 100.0 87.1 259 Gorontalo 44.4 35.5 11.2 8.5 0.4 100.0 91.1 163 West Sulawesi 43.6 31.0 9.3 15.6 0.5 100.0 83.9 139 Maluku and Papua Maluku 53.9 32.9 4.3 7.4 1.5 100.0 91.1 168 North Maluku 52.9 19.0 13.7 13.7 0.7 100.0 85.6 129 Papua 32.3 16.0 9.0 42.2 0.6 100.0 57.2 251 West Papua 55.1 20.1 9.4 13.2 2.3 100.0 84.5 89 Total 45.5 34.1 7.8 12.1 0.5 100.0 87.4 32,895 Continued… 236 | Appendix A Table A-3.3—Continued No schooling or primary school Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Missing Total Percentage literate Number CURRENTLY MARRIED MEN Sumatera Nanggroe Aceh Darussalam 58.0 20.6 14.6 5.5 1.3 100.0 93.1 137 North Sumatera 71.2 20.1 3.1 5.0 0.7 100.0 94.3 370 West Sumatera 56.4 27.4 4.9 11.1 0.3 100.0 88.6 137 Riau 65.7 22.4 3.3 8.3 0.2 100.0 91.5 130 Jambi 47.9 36.8 11.0 4.3 0.0 100.0 95.7 95 South Sumatera 42.9 34.5 14.8 7.8 0.0 100.0 92.2 241 Bengkulu 62.3 27.8 5.4 4.2 0.4 100.0 95.5 53 Lampung 50.1 39.1 8.1 2.6 0.0 100.0 97.4 271 Bangka Belitung 35.8 55.0 3.2 6.0 0.0 100.0 94.0 52 Riau Islands 57.2 28.4 5.5 8.9 0.0 100.0 91.1 36 Java DKI Jakarta 82.3 15.1 0.1 1.1 1.3 100.0 97.6 408 West Java 45.4 45.5 3.3 4.8 1.0 100.0 94.2 1,444 Central Java 41.4 37.2 10.9 10.5 0.0 100.0 89.5 1,517 DI Yogyakarta 71.5 21.8 3.1 3.6 0.0 100.0 96.4 146 East Java 44.1 37.2 4.0 14.7 0.0 100.0 85.3 1,561 Banten 53.8 30.3 10.7 5.0 0.1 100.0 94.8 344 Bali and Nusa Tenggara Bali 64.4 25.1 4.2 6.1 0.2 100.0 93.7 174 West Nusa Tenggara 49.2 29.8 4.5 15.4 1.1 100.0 83.5 194 East Nusa Tenggara 46.0 34.0 4.1 15.2 0.6 100.0 84.2 172 Kalimantan West Kalimantan 50.0 31.8 5.9 10.9 1.5 100.0 87.7 162 Central Kalimantan 55.0 35.5 3.9 5.6 0.0 100.0 94.4 82 South Kalimantan 48.4 42.9 1.9 6.3 0.4 100.0 93.3 128 East Kalimantan 68.5 23.2 3.5 4.8 0.0 100.0 95.2 132 Sulawesi North Sulawesi 60.8 30.0 3.2 6.0 0.0 100.0 94.0 102 Central Sulawesi 55.1 24.7 8.7 9.4 2.1 100.0 88.5 89 South Sulawesi 53.7 19.6 7.1 19.6 0.0 100.0 80.4 259 Southeast Sulawesi 65.8 15.5 11.2 7.4 0.0 100.0 92.6 60 Gorontalo 38.4 36.2 13.3 10.6 1.4 100.0 88.0 46 West Sulawesi 38.9 34.3 18.4 8.4 0.0 100.0 91.6 41 Maluku and Papua Maluku 67.3 27.3 1.5 3.4 0.5 100.0 96.1 44 North Maluku 64.3 25.9 3.3 6.5 0.0 100.0 93.5 36 Papua 44.8 20.6 6.3 26.6 1.7 100.0 71.7 70 West Papua 65.4 24.0 5.6 4.8 0.2 100.0 95.0 24 Total 50.8 33.8 6.1 8.9 0.4 100.0 90.7 8,758 1 Refers to respondents who attended secondary school or higher and women who can read a whole sentence or part of a sentence Appendix A | 237 Table A-3.4 Exposure to mass media by province Percentage of ever-married women and currently married men who are exposed to specific media on a weekly basis, by province, Indonesia 2007 Province Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number EVER-MARRIED WOMEN Sumatera Nanggroe Aceh Darussalam 10.1 61.3 17.4 4.9 35.4 514 North Sumatera 17.9 74.2 29.5 9.5 20.8 1,487 West Sumatera 17.9 78.6 33.6 9.4 15.7 570 Riau 19.4 80.0 31.6 7.3 14.9 494 Jambi 14.5 83.3 20.9 5.5 13.5 367 South Sumatera 8.7 65.0 26.2 3.6 29.7 928 Bengkulu 20.5 80.2 34.2 8.6 13.5 211 Lampung 8.3 81.5 29.7 3.6 13.2 963 Bangka Belitung 15.7 85.1 21.8 5.4 11.6 194 Riau Islands 28.6 88.1 29.2 11.9 8.4 140 Java DKI Jakarta 28.5 91.7 24.0 9.8 5.2 1,471 West Java 11.9 82.7 27.3 5.5 14.0 5,545 Central Java 9.3 79.9 25.8 3.9 16.1 5,383 DI Yogyakarta 24.6 85.9 52.8 15.0 8.9 551 East Java 7.6 81.3 30.3 4.0 16.3 5,924 Banten 10.1 77.8 22.4 3.8 19.6 1,310 Bali and Nusa Tenggara Bali 13.4 77.3 39.5 8.5 19.6 587 West Nusa Tenggara 8.1 73.1 24.8 3.7 22.8 705 East Nusa Tenggara 8.7 30.8 16.0 2.1 59.5 627 Kalimantan West Kalimantan 6.5 63.1 17.0 1.8 33.6 628 Central Kalimantan 12.6 71.1 21.5 4.2 24.1 294 South Kalimantan 12.2 82.2 23.5 4.9 13.9 550 East Kalimantan 18.8 77.1 20.9 5.7 18.1 475 Sulawesi North Sulawesi 19.4 78.6 27.8 11.3 17.5 373 Central Sulawesi 11.0 76.3 28.0 5.5 19.3 339 South Sulawesi 12.2 73.5 31.2 6.9 22.2 1,067 Southeast Sulawesi 15.2 70.7 26.5 7.7 24.4 259 Gorontalo 10.6 64.2 33.8 7.2 30.8 163 West Sulawesi 12.9 75.8 38.6 6.4 17.4 139 Maluku and Papua Maluku 9.4 52.4 17.9 2.6 40.2 168 North Maluku 21.4 70.7 20.3 6.1 23.6 129 Papua 5.3 40.3 12.2 1.8 55.6 251 West Papua 10.7 60.8 25.3 6.7 35.3 89 Total 12.0 77.8 27.3 5.4 18.3 32,895 Continued… 238 | Appendix A Table A-3.4 —Continued Province Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number CURRENTLY MARRIED MEN Sumatera Nanggroe Aceh Darussalam 29.0 78.3 15.6 5.2 18.3 137 North Sumatera 40.1 85.2 23.9 12.7 12.6 370 West Sumatera 25.2 81.7 36.5 11.2 14.1 137 Riau 31.9 91.6 36.3 15.2 4.2 130 Jambi 16.6 83.9 31.7 4.6 9.0 95 South Sumatera 14.9 81.8 21.2 4.4 14.7 241 Bengkulu 26.9 75.2 34.6 12.5 15.8 53 Lampung 13.6 78.3 32.8 4.9 14.5 271 Bangka Belitung 21.5 75.1 21.7 8.5 20.4 52 Riau Islands 34.3 85.1 30.0 9.7 10.9 36 Java DKI Jakarta 54.9 88.3 37.1 22.0 5.4 408 West Java 21.7 84.9 22.7 6.1 13.0 1,444 Central Java 19.9 81.3 37.8 9.3 12.4 1,517 DI Yogyakarta 52.4 92.0 62.5 32.6 2.2 146 East Java 16.0 78.6 31.6 7.3 17.5 1,561 Banten 26.3 65.3 29.3 11.9 23.6 344 Bali and Nusa Tenggara Bali 26.8 92.0 58.9 15.9 5.8 174 West Nusa Tenggara 14.0 83.6 32.9 4.5 12.8 194 East Nusa Tenggara 20.4 45.1 29.8 8.0 42.2 172 Kalimantan West Kalimantan 15.6 70.4 26.5 8.7 24.8 162 Central Kalimantan 24.5 84.2 26.7 13.5 12.4 82 South Kalimantan 27.1 88.1 44.4 12.0 5.3 128 East Kalimantan 31.1 80.8 19.4 9.5 14.7 132 Sulawesi North Sulawesi 37.1 77.8 26.2 15.0 19.0 102 Central Sulawesi 14.4 75.9 27.1 8.6 19.9 89 South Sulawesi 33.6 81.6 47.3 17.4 12.8 259 Southeast Sulawesi 30.5 94.9 42.7 18.3 3.5 60 Gorontalo 18.9 62.4 29.9 11.5 34.8 46 West Sulawesi 22.9 86.0 50.8 17.5 10.0 41 Maluku and Papua Maluku 15.8 53.5 19.4 4.3 39.0 44 North Maluku 34.0 88.9 37.6 13.8 9.3 36 Papua 13.7 41.2 23.2 5.2 48.6 70 West Papua 10.6 57.5 36.2 6.6 29.1 24 Total 23.8 80.4 32.0 9.8 14.8 8,758 Appendix A | 239 Table A-3.5.1 Employment status by province: Women Percent distribution of ever-married women by employment status, according to province, Indonesia 2007 Employed in the 12 months preceding the survey Province Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Sumatera Nanggroe Aceh Darussalam 52.7 1.5 45.8 0.0 100.0 514 North Sumatera 62.9 2.6 34.4 0.0 100.0 1,487 West Sumatera 66.9 3.6 29.4 0.0 100.0 570 Riau 48.2 3.8 47.9 0.1 100.0 494 Jambi 60.1 3.5 36.5 0.0 100.0 367 South Sumatera 68.7 2.7 28.6 0.0 100.0 928 Bengkulu 80.7 4.4 14.9 0.0 100.0 211 Lampung 69.7 4.2 26.1 0.0 100.0 963 Bangka Belitung 45.9 2.3 51.9 0.0 100.0 194 Riau Islands 36.9 3.5 59.6 0.0 100.0 140 Java DKI Jakarta 49.2 2.1 48.7 0.0 100.0 1,471 West Java 40.1 4.8 55.1 0.0 100.0 5,545 Central Java 63.4 3.8 32.7 0.1 100.0 5,383 DI Yogyakarta 71.9 3.8 24.3 0.0 100.0 551 East Java 66.3 2.9 30.9 0.0 100.0 5,924 Banten 43.9 2.6 53.6 0.0 100.0 1,310 Bali and Nusa Tenggara Bali 75.5 2.2 22.3 0.0 100.0 587 West Nusa Tenggara 57.4 4.2 38.5 0.0 100.0 705 East Nusa Tenggara 68.8 2.3 28.9 0.0 100.0 627 Kalimantan West Kalimantan 64.0 0.8 35.3 0.0 100.0 628 Central Kalimantan 57.2 6.3 36.4 0.0 100.0 294 South Kalimantan 61.7 3.8 34.5 0.0 100.0 550 East Kalimantan 50.8 2.1 47.1 0.0 100.0 475 Sulawesi North Sulawesi 40.0 1.9 58.0 0.1 100.0 373 Central Sulawesi 60.8 1.6 37.6 0.0 100.0 339 South Sulawesi 44.4 3.6 51.9 0.0 100.0 1,067 Southeast Sulawesi 57.2 2.6 40.2 0.0 100.0 259 Gorontalo 42.7 4.7 52.6 0.0 100.0 163 West Sulawesi 58.1 2.7 39.1 0.2 100.0 139 Maluku and Papua Maluku 45.3 2.8 51.7 0.1 100.0 168 North Maluku 51.4 2.0 46.7 0.0 100.0 129 Papua 71.9 3.1 24.9 0.1 100.0 251 West Papua 42.5 1.4 55.9 0.2 100.0 89 Total 57.3 3.4 39.3 0.0 100.0 32,895 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 240 | Appendix A Table A-3.5.2 Employment status by province: Men Percent distribution of currently married men by employment status, according to province, Indonesia 2007 Employed in the 12 months preceding the survey Province Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Sumatera Nanggroe Aceh Darussalam 99.5 0.2 0.3 0.0 100.0 137 North Sumatera 98.8 1.2 0.0 0.0 100.0 370 West Sumatera 98.6 0.5 0.8 0.0 100.0 137 Riau 98.9 0.2 0.9 0.0 100.0 130 Jambi 99.3 0.7 0.0 0.0 100.0 95 South Sumatera 99.4 0.2 0.4 0.0 100.0 241 Bengkulu 99.2 0.8 0.0 0.0 100.0 53 Lampung 98.6 0.0 1.4 0.0 100.0 271 Bangka Belitung 99.6 0.4 0.0 0.0 100.0 52 Riau Islands 96.3 2.5 1.2 0.0 100.0 36 Java DKI Jakarta 96.7 2.0 1.3 0.0 100.0 408 West Java 97.6 1.7 0.7 0.0 100.0 1,444 Central Java 98.6 1.0 0.5 0.0 100.0 1,517 DI Yogyakarta 98.3 1.7 0.0 0.0 100.0 146 East Java 96.5 1.7 1.8 0.0 100.0 1,561 Banten 99.9 0.0 0.1 0.0 100.0 344 Bali and Nusa Tenggara Bali 98.3 0.7 1.0 0.0 100.0 174 West Nusa Tenggara 98.6 0.8 0.7 0.0 100.0 194 East Nusa Tenggara 98.7 0.8 0.5 0.0 100.0 172 Kalimantan West Kalimantan 98.5 1.1 0.4 0.0 100.0 162 Central Kalimantan 98.7 1.3 0.0 0.0 100.0 82 South Kalimantan 99.2 0.8 0.0 0.0 100.0 128 East Kalimantan 97.2 1.5 1.3 0.0 100.0 132 Sulawesi North Sulawesi 97.8 1.5 0.6 0.0 100.0 102 Central Sulawesi 99.6 0.4 0.0 0.0 100.0 89 South Sulawesi 97.9 1.0 0.8 0.4 100.0 259 Southeast Sulawesi 99.0 0.7 0.3 0.0 100.0 60 Gorontalo 98.6 0.6 0.7 0.0 100.0 46 West Sulawesi 98.8 0.8 0.4 0.0 100.0 41 Maluku and Papua Maluku 98.8 1.2 0.0 0.0 100.0 44 North Maluku 99.6 0.4 0.0 0.0 100.0 36 Papua 95.5 3.1 1.2 0.3 100.0 70 West Papua 95.8 1.0 3.2 0.0 100.0 24 Total 98.0 1.2 0.8 0.0 100.0 8,758 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Appendix A | 241 Table A-3.6.1 Occupation by province: Women Percent distribution of ever-married women employed in the 12 months preceding the survey by occupation, according to province, Indonesia 2007 Agriculture Nonagriculture Province Own land Family land Some- one else's land Rented land Don't know/ missing Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agri- culture Other/ missing Total Number of women Sumatera Nanggroe Aceh Darussalam 32.1 6.3 8.1 7.4 0.6 11.7 3.8 24.5 5.2 0.3 0.0 0.1 100.0 278 North Sumatera 24.5 5.7 8.7 8.5 0.8 11.0 3.8 29.8 7.1 0.0 0.0 0.1 100.0 974 West Sumatera 25.5 5.8 12.7 4.2 0.8 10.2 2.8 28.7 9.2 0.0 0.0 0.2 100.0 403 Riau 20.4 1.8 14.8 0.5 1.6 11.1 4.0 40.4 4.9 0.2 0.1 0.2 100.0 257 Jambi 38.0 7.0 15.6 0.6 0.2 6.3 2.4 27.0 2.6 0.3 0.0 0.0 100.0 233 South Sumatera 28.4 11.3 19.5 2.0 0.5 4.5 1.3 22.9 9.4 0.1 0.0 0.0 100.0 662 Bengkulu 45.1 6.8 11.8 2.7 0.5 7.2 2.2 21.8 1.8 0.0 0.0 0.1 100.0 180 Lampung 31.9 7.3 17.4 1.7 0.1 4.4 0.9 30.1 6.0 0.0 0.0 0.1 100.0 711 Bangka Belitung 25.8 10.8 7.8 0.0 0.0 5.5 5.2 34.5 9.6 0.0 0.0 1.0 100.0 93 Riau Islands 4.5 3.1 1.7 1.2 0.0 11.4 6.1 58.9 12.1 0.0 0.0 1.0 100.0 56 Java DKI Jakarta 0.0 0.0 0.0 0.0 0.4 9.4 9.1 67.3 13.6 0.2 0.0 0.0 100.0 755 West Java 7.8 3.8 13.5 0.4 1.2 7.3 3.1 47.1 15.4 0.0 0.0 0.3 100.0 2,489 Central Java 15.5 1.6 14.9 1.0 0.7 4.7 1.7 40.0 19.6 0.1 0.0 0.2 100.0 3,617 DI Yogyakarta 14.9 2.2 7.1 0.4 0.3 9.4 4.3 44.9 16.5 0.0 0.0 0.0 100.0 417 East Java 18.3 3.9 20.1 1.4 0.3 5.8 1.6 32.8 15.6 0.0 0.0 0.2 100.0 4,096 Banten 6.6 4.3 13.2 0.3 0.8 8.8 3.7 46.6 15.4 0.1 0.0 0.2 100.0 608 Bali and Nusa Tenggara Bali 19.2 2.5 9.3 0.3 0.2 5.9 5.5 40.9 15.9 0.2 0.0 0.1 100.0 456 West Nusa Tenggara 20.4 1.4 26.5 0.8 0.7 4.1 2.6 37.3 6.2 0.0 0.0 0.1 100.0 434 East Nusa Tenggara 49.8 5.4 3.4 0.0 0.7 7.4 1.6 22.4 8.8 0.2 0.2 0.1 100.0 445 Kalimantan West Kalimantan 52.6 12.4 4.5 2.9 0.7 4.4 0.7 20.0 1.7 0.2 0.0 0.0 100.0 406 Central Kalimantan 32.9 7.5 16.4 0.1 0.3 9.3 2.6 25.9 4.9 0.0 0.0 0.0 100.0 187 South Kalimantan 20.3 7.1 13.7 1.3 0.8 7.6 2.5 37.6 8.9 0.0 0.0 0.2 100.0 360 East Kalimantan 24.7 2.2 4.7 0.6 0.9 11.9 6.9 41.0 7.1 0.0 0.0 0.0 100.0 251 Sulawesi North Sulawesi 16.7 2.8 6.1 0.7 0.8 13.9 8.1 47.8 2.3 0.2 0.0 0.6 100.0 156 Central Sulawesi 43.1 5.5 4.4 0.6 0.7 9.3 3.6 29.5 3.0 0.0 0.0 0.2 100.0 211 South Sulawesi 33.3 5.0 6.2 0.4 1.2 11.9 3.2 29.1 9.4 0.2 0.0 0.2 100.0 513 Southeast Sulawesi 38.3 8.0 3.9 0.1 0.1 8.1 6.2 31.3 3.8 0.0 0.0 0.2 100.0 155 Gorontalo 25.2 4.3 9.2 0.5 1.8 9.9 4.9 37.9 6.3 0.0 0.0 0.0 100.0 77 West Sulawesi 42.4 4.2 5.9 0.3 0.6 5.6 2.1 31.6 7.1 0.0 0.2 0.0 100.0 85 Maluku and Papua Maluku 22.1 11.5 3.4 0.0 0.8 10.3 6.9 39.1 5.3 0.2 0.0 0.3 100.0 81 North Maluku 39.0 2.6 1.1 0.1 0.3 12.2 3.3 40.3 1.3 0.0 0.0 0.0 100.0 69 Papua 52.0 20.3 2.1 0.0 2.4 4.0 1.2 14.2 3.8 0.0 0.0 0.0 100.0 188 West Papua 31.3 12.8 0.0 0.0 1.8 7.7 2.3 39.2 3.0 0.7 0.0 1.1 100.0 39 Total 20.4 4.4 13.4 1.5 0.7 7.0 2.8 36.9 12.8 0.1 0.0 0.2 100.0 19,946 242 | Appendix A Table A-3.6.2 Occupation by province: Men Percent distribution of currently married men employed in the 12 months preceding the survey by occupation, according to province, Indonesia 2007 Agriculture Nonagriculture Province Own land Family land Some- one else's land Rented land Don't know/ missing Professional/ technical/ managerial Clerical Sales and services Skilled manual Agri- culture Other/ missing Total Number of men Sumatera Nanggroe Aceh Darussalam 24.3 4.2 9.6 3.4 0.6 8.5 5.6 28.6 10.3 3.3 1.6 100.0 137 North Sumatera 19.1 7.1 7.4 4.5 0.5 6.7 6.0 22.4 20.9 1.3 4.1 100.0 370 West Sumatera 22.0 8.3 21.6 4.3 0.6 4.6 5.4 19.7 12.2 0.7 0.5 100.0 136 Riau 20.7 5.1 14.3 0.0 0.2 7.4 6.5 23.9 20.1 0.7 1.0 100.0 129 Jambi 29.0 10.7 17.0 0.8 2.6 8.6 2.4 17.8 10.2 0.8 0.0 100.0 95 South Sumatera 23.9 4.8 18.4 4.1 0.4 4.1 2.2 19.5 18.4 3.9 0.3 100.0 240 Bengkulu 34.0 5.2 18.0 0.5 0.6 7.8 9.2 17.9 6.2 0.7 0.0 100.0 53 Lampung 35.7 10.5 18.8 1.6 0.5 5.8 1.3 15.7 8.7 1.5 0.0 100.0 267 Bangka Belitung 22.9 3.6 11.6 0.0 0.0 3.9 2.2 30.4 23.6 1.6 0.3 100.0 52 Riau Islands 10.0 1.0 4.2 0.3 2.0 11.9 4.0 37.9 21.2 5.7 1.7 100.0 35 Java DKI Jakarta 2.0 0.6 0.8 0.3 0.7 14.4 6.7 43.5 29.3 0.1 1.4 100.0 403 West Java 7.3 3.6 9.6 1.6 0.6 6.6 3.7 40.8 23.6 1.0 1.5 100.0 1,434 Central Java 13.4 2.9 19.5 0.2 0.2 5.7 3.2 36.4 17.7 0.3 0.5 100.0 1,509 DI Yogyakarta 9.9 2.0 6.1 0.7 0.0 10.2 6.0 33.4 29.6 1.7 0.3 100.0 146 East Java 28.3 3.1 18.0 1.6 0.5 4.1 2.5 28.1 11.0 1.9 1.1 100.0 1,533 Banten 5.4 1.8 10.1 0.3 0.6 6.7 2.7 32.3 34.5 4.0 1.4 100.0 343 Bali and Nusa Tenggara Bali 9.9 5.1 12.6 0.0 0.0 9.2 5.6 36.1 17.3 2.4 1.8 100.0 172 West Nusa Tenggara 20.2 3.9 11.5 3.2 1.8 4.3 6.1 17.8 24.2 6.5 0.6 100.0 193 East Nusa Tenggara 53.3 1.8 5.5 1.0 0.3 4.5 5.7 13.7 9.5 2.7 1.9 100.0 171 Kalimantan West Kalimantan 44.6 8.4 5.5 2.2 0.0 4.4 0.9 19.7 10.4 3.6 0.3 100.0 161 Central Kalimantan 39.9 10.3 8.2 0.0 0.9 7.0 6.4 11.9 12.9 0.6 1.7 100.0 82 South Kalimantan 18.7 5.5 9.6 2.3 1.3 7.7 1.2 23.0 28.3 1.5 0.8 100.0 128 East Kalimantan 28.0 1.4 3.1 0.9 0.4 8.6 6.1 17.1 30.0 1.8 2.6 100.0 130 Sulawesi North Sulawesi 28.6 5.2 13.4 4.9 1.6 10.0 4.8 16.2 14.9 0.0 0.4 100.0 102 Central Sulawesi 45.9 4.8 7.4 1.7 1.4 5.1 3.9 11.1 10.9 4.7 3.1 100.0 89 South Sulawesi 25.4 8.3 16.3 0.0 1.3 9.9 5.0 18.0 14.1 0.4 1.2 100.0 256 Southeast Sulawesi 39.5 2.0 5.1 0.0 2.4 7.6 10.2 16.4 12.7 2.0 1.9 100.0 59 Gorontalo 32.9 4.3 8.5 0.5 0.8 6.8 6.0 13.4 18.2 6.6 2.0 100.0 46 West Sulawesi 47.9 7.6 9.3 0.8 2.2 4.1 2.3 14.9 9.6 1.3 0.0 100.0 41 Maluku and Papua Maluku 41.8 5.7 8.4 0.0 1.0 8.8 8.1 9.0 12.2 4.1 0.8 100.0 44 North Maluku 32.5 8.8 5.1 0.0 0.4 4.9 3.9 21.0 22.1 1.3 0.0 100.0 36 Papua 41.5 8.5 2.1 0.0 2.5 9.5 4.3 9.0 10.7 7.0 4.8 100.0 69 West Papua 35.1 1.7 2.5 0.5 1.9 5.8 7.5 24.1 13.7 3.9 3.3 100.0 23 Total 19.9 4.1 13.1 1.4 0.6 6.5 3.9 29.4 18.3 1.6 1.2 100.0 8,686 Appendix A | 243 Table A-3.7 Decision on use of earnings and contribution of earnings to household expenditures by province Percent distribution of ever-married women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are used and by proportion of household expenditures met by earnings, according to province, Indonesia 2007 Person who decides how the woman's earnings are used: Proportion of household expenditures met by earnings Province Self only Jointly1 Someone else only Missing Total Almost none/ none Less than half Half or more All Don't know/ missing Total Number of women Sumatera Nanggroe Aceh Darussalam 42.4 48.8 4.8 4.1 100.0 7.1 13.1 46.2 30.0 3.6 100.0 156 North Sumatera 62.7 31.1 3.6 2.7 100.0 7.0 9.2 45.2 36.7 1.9 100.0 586 West Sumatera 68.1 25.9 5.3 0.7 100.0 5.0 8.4 45.5 41.1 0.0 100.0 243 Riau 54.7 40.5 4.4 0.4 100.0 6.1 12.0 38.7 42.1 1.1 100.0 179 Jambi 45.5 48.0 4.1 2.5 100.0 4.6 17.4 37.3 39.6 1.2 100.0 131 South Sumatera 52.7 39.8 5.3 2.1 100.0 2.1 15.2 32.6 49.9 0.1 100.0 399 Bengkulu 67.2 29.4 3.0 0.4 100.0 4.1 19.5 52.6 23.8 0.0 100.0 72 Lampung 66.9 30.7 1.9 0.5 100.0 3.5 10.0 33.9 51.6 1.0 100.0 385 Bangka Belitung 47.5 47.5 2.6 2.4 100.0 8.9 17.5 49.4 23.7 0.5 100.0 71 Riau Islands 66.1 27.4 4.6 2.0 100.0 9.5 9.9 41.6 38.1 0.9 100.0 48 Java DKI Jakarta 88.2 9.5 1.9 0.4 100.0 5.6 10.7 40.7 42.7 0.3 100.0 681 West Java 78.3 17.1 3.8 0.7 100.0 4.3 8.7 32.4 53.0 1.7 100.0 1,759 Central Java 65.2 32.6 1.6 0.6 100.0 1.8 11.4 34.6 52.2 0.0 100.0 2,763 DI Yogyakarta 71.7 26.4 1.2 0.7 100.0 1.8 6.9 50.3 40.9 0.0 100.0 319 East Java 78.0 18.8 2.3 1.0 100.0 2.9 7.0 40.1 49.7 0.4 100.0 2,734 Banten 70.5 27.4 1.2 0.9 100.0 1.0 5.4 26.5 59.1 8.0 100.0 428 Bali and Nusa Tenggara Bali 58.0 36.9 3.8 1.4 100.0 2.8 18.1 38.4 40.6 0.0 100.0 344 West Nusa Tenggara 68.6 24.6 4.7 2.1 100.0 1.4 5.1 40.6 52.0 0.9 100.0 301 East Nusa Tenggara 35.2 57.2 5.0 2.6 100.0 0.4 8.8 48.9 40.5 1.3 100.0 249 Kalimantan West Kalimantan 31.5 64.9 2.9 0.6 100.0 1.0 6.2 66.9 25.5 0.3 100.0 236 Central Kalimantan 48.5 47.6 0.1 3.8 100.0 2.5 10.2 43.8 42.3 1.3 100.0 147 South Kalimantan 69.5 27.0 3.0 0.5 100.0 5.3 13.2 30.3 51.0 0.3 100.0 231 East Kalimantan 66.9 29.5 2.5 1.1 100.0 8.1 14.9 50.2 26.4 0.4 100.0 175 Sulawesi North Sulawesi 52.9 40.6 4.3 2.2 100.0 2.6 10.0 55.2 31.1 1.2 100.0 112 Central Sulawesi 51.0 41.0 6.9 1.1 100.0 3.6 11.8 54.1 29.9 0.6 100.0 103 South Sulawesi 83.6 13.4 1.9 1.1 100.0 1.8 9.4 47.6 41.2 0.0 100.0 256 Southeast Sulawesi 75.9 20.6 1.6 1.9 100.0 3.5 16.5 38.5 41.0 0.5 100.0 65 Gorontalo 71.6 23.1 3.2 2.2 100.0 8.0 18.8 46.9 26.4 0.0 100.0 44 West Sulawesi 79.4 16.2 2.3 2.1 100.0 4.0 20.1 31.1 38.9 5.9 100.0 48 Maluku and Papua Maluku 60.1 33.0 2.9 3.9 100.0 2.0 3.3 66.9 27.8 0.0 100.0 57 North Maluku 55.1 40.2 3.7 1.0 100.0 4.5 17.4 57.3 20.5 0.3 100.0 62 Papua 42.8 52.4 4.7 0.0 100.0 5.8 15.0 42.0 33.9 3.2 100.0 52 West Papua 52.3 41.8 3.4 2.6 100.0 2.2 6.0 59.8 32.0 0.0 100.0 19 Total 68.7 27.5 2.7 1.1 100.0 3.3 9.9 39.1 46.9 0.9 100.0 13,453 1 With husband or someone else 2 Includes husband 244 | Appendix A Table A-3.8 Women's participation in decisionmaking by province Percentage of ever-married women who say that they alone or jointly have the final say in specific decisions, by province, Indonesia 2007 Province Own health care Making major household purchases Making purchases for daily household needs Visits to her family or relatives Deciding what food to cook each day Percentage who participate in all decisions Percentage who participate in none of the decisions Number of women Sumatera Nanggroe Aceh Darussalam 83.5 81.0 86.4 83.7 91.0 67.6 3.0 514 North Sumatera 87.7 85.2 95.1 89.5 95.7 73.8 1.7 1,487 West Sumatera 76.8 77.0 89.8 85.9 92.4 58.8 2.3 570 Riau 79.1 80.4 94.4 90.0 95.7 67.0 1.4 494 Jambi 84.1 84.7 94.2 91.2 98.1 74.6 0.5 367 South Sumatera 82.7 73.4 90.9 73.2 91.3 55.9 3.3 928 Bengkulu 78.9 78.5 95.4 89.8 96.2 62.1 0.9 211 Lampung 74.8 76.4 96.2 83.5 95.8 60.6 1.0 963 Bangka Belitung 91.1 86.5 95.9 92.6 98.3 79.1 0.6 194 Riau Islands 68.5 68.3 84.5 82.1 88.0 50.0 5.6 140 Java DKI Jakarta 89.4 82.5 95.6 88.3 93.2 70.3 0.4 1,471 West Java 83.0 77.1 93.8 84.9 93.7 62.9 0.8 5,545 Central Java 88.3 83.1 95.4 91.6 93.8 72.3 0.4 5,383 DI Yogyakarta 90.1 76.0 91.8 85.3 90.3 62.4 0.8 551 East Java 81.5 72.1 91.8 83.9 91.1 55.7 1.3 5,924 Banten 84.4 79.0 93.6 83.3 94.9 66.3 1.1 1,310 Bali and Nusa Tenggara Bali 68.0 62.0 87.7 76.0 92.1 51.4 5.3 587 West Nusa Tenggara 78.3 82.8 97.1 88.2 97.3 63.8 0.4 705 East Nusa Tenggara 95.3 91.4 96.5 92.9 95.7 84.7 1.0 627 Kalimantan West Kalimantan 86.7 83.3 93.1 89.3 96.7 74.9 1.5 628 Central Kalimantan 83.8 83.4 94.9 89.2 96.3 69.7 0.8 294 South Kalimantan 83.2 76.5 90.0 84.2 92.4 60.3 1.7 550 East Kalimantan 89.4 82.7 95.5 86.9 95.3 71.8 1.1 475 Sulawesi North Sulawesi 93.0 89.4 95.8 91.2 97.2 81.4 0.7 373 Central Sulawesi 82.2 81.6 95.4 85.1 96.1 66.5 0.6 339 South Sulawesi 94.4 92.2 95.8 94.5 95.9 86.9 1.2 1,067 Southeast Sulawesi 84.5 82.4 95.4 82.5 94.7 70.8 0.9 259 Gorontalo 90.0 78.9 91.9 80.1 94.6 63.6 1.3 163 West Sulawesi 86.0 84.6 94.2 87.8 94.8 72.9 1.9 139 Maluku and Papua Maluku 83.8 69.7 91.7 76.7 95.4 58.5 1.2 168 North Maluku 78.9 70.3 89.7 73.0 91.8 46.4 1.5 129 Papua 89.0 74.6 91.8 72.6 93.0 63.6 3.5 251 West Papua 86.2 73.8 88.8 84.8 90.0 61.2 3.6 89 Total 84.5 79.0 93.6 86.3 93.6 65.7 1.2 32,895 Appendix A | 245 Table A-3.9 Men's attitude toward wives' participation in decisionmaking by province Percentage of currently married men who think a wife should have the greater say alone or equal say with her husband on specific decisions, by province, Indonesia 2007 Province Making major household purchases Making purchases for daily household needs Visits to her family or relatives All decisions None of the decisions Number of men Sumatera Nanggroe Aceh Darussalam 86.5 84.1 92.9 71.4 0.4 137 North Sumatera 69.5 93.1 77.1 56.9 3.7 370 West Sumatera 57.5 88.7 71.1 46.7 5.6 137 Riau 87.1 89.7 88.5 78.8 2.6 130 Jambi 88.7 95.7 97.7 85.2 0.0 95 South Sumatera 85.1 97.2 85.8 78.2 1.6 241 Bengkulu 72.6 91.5 67.2 55.6 4.2 53 Lampung 80.6 92.7 85.9 73.0 3.7 271 Bangka Belitung 77.9 90.4 79.8 63.0 1.6 52 Riau Islands 80.8 94.8 80.9 68.0 1.9 36 Java DKI Jakarta 93.9 97.1 90.1 84.5 0.7 408 West Java 75.4 92.6 83.0 66.7 4.6 1,444 Central Java 86.7 89.7 90.6 75.8 1.2 1,517 DI Yogyakarta 83.5 93.0 84.0 72.6 3.5 146 East Java 84.3 90.8 87.9 80.4 5.3 1,561 Banten 85.7 92.9 86.9 75.5 2.5 344 Bali and Nusa Tenggara Bali 86.3 95.2 91.7 82.8 3.5 174 West Nusa Tenggara 89.7 94.7 88.6 81.5 2.6 194 East Nusa Tenggara 86.5 93.9 86.2 75.4 3.8 172 Kalimantan West Kalimantan 83.9 81.2 74.0 61.8 7.0 162 Central Kalimantan 78.7 93.6 78.9 68.1 1.8 82 South Kalimantan 76.4 90.4 80.7 65.4 4.8 128 East Kalimantan 88.2 84.5 90.2 71.7 2.3 132 Sulawesi North Sulawesi 77.5 86.8 82.9 66.1 2.6 102 Central Sulawesi 84.3 89.1 80.2 71.2 4.3 89 South Sulawesi 82.9 94.3 90.7 77.2 2.0 259 Southeast Sulawesi 79.4 96.9 67.7 56.8 0.4 60 Gorontalo 65.2 97.8 94.2 62.4 1.3 46 West Sulawesi 79.3 93.9 76.3 69.9 4.5 41 Maluku and Papua Maluku 66.5 91.4 78.0 54.9 3.2 44 North Maluku 94.7 96.6 93.3 89.3 1.0 36 Papua 73.7 80.0 72.2 58.4 10.1 70 West Papua 82.4 89.8 86.7 74.4 6.5 24 Total 82.3 91.6 86.0 73.2 3.3 8,758 246 | Appendix A Table A-3.10 Women's attitude toward wife beating by province Percentage of ever-married women who agree that a husband is justified in hitting or beating his wife for specific reasons, by province, Indonesia 2007 Husband is justified in hitting or beating his wife if she: Province Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercours e with him Percentage who agree with at least one specified reason Number Sumatera Nanggroe Aceh Darussalam 9.5 12.4 36.1 34.8 12.1 42.2 514 North Sumatera 7.4 12.8 32.1 34.2 11.4 42.6 1,487 West Sumatera 1.5 4.2 24.0 27.7 5.0 33.7 570 Riau 3.6 5.4 34.7 35.0 9.5 44.9 494 Jambi 1.5 3.6 12.3 11.6 6.2 16.8 367 South Sumatera 4.3 9.2 29.8 36.8 10.4 41.1 928 Bengkulu 8.6 13.7 39.7 46.0 16.3 53.4 211 Lampung 4.4 6.9 31.8 38.7 9.5 45.5 963 Bangka Belitung 6.3 7.1 29.1 30.9 8.4 37.8 194 Riau Islands 5.1 6.6 33.8 33.9 7.6 43.7 140 Java DKI Jakarta 0.6 1.1 6.3 7.3 0.9 9.3 1,471 West Java 2.0 3.8 25.6 26.0 5.1 32.0 5,545 Central Java 2.3 4.9 15.9 17.2 4.5 21.4 5,383 DI Yogyakarta 1.0 1.7 8.0 9.1 1.6 11.1 551 East Java 1.3 5.1 22.6 22.9 5.2 30.0 5,924 Banten 3.5 5.9 24.6 18.8 10.6 28.9 1,310 Bali and Nusa Tenggara Bali 2.3 6.9 16.0 17.4 4.2 20.6 587 West Nusa Tenggara 9.2 37.3 68.7 69.0 31.5 77.3 705 East Nusa Tenggara 3.6 11.4 21.4 24.8 5.1 29.9 627 Kalimantan West Kalimantan 7.7 10.9 16.8 19.1 8.6 22.1 628 Central Kalimantan 5.3 7.0 26.7 38.0 7.7 42.6 294 South Kalimantan 3.3 6.4 34.9 34.0 8.3 43.2 550 East Kalimantan 2.7 5.7 16.9 23.0 4.8 27.5 475 Sulawesi North Sulawesi 3.3 6.2 12.8 12.6 4.3 16.0 373 Central Sulawesi 6.5 11.4 46.4 38.7 10.4 55.1 339 South Sulawesi 3.6 6.7 18.6 20.1 5.9 23.4 1,067 Southeast Sulawesi 6.3 9.0 34.4 29.6 8.7 44.0 259 Gorontalo 0.8 2.4 9.6 10.0 2.0 13.6 163 West Sulawesi 12.5 13.7 35.3 35.7 12.8 42.9 139 Maluku and Papua Maluku 8.1 20.9 32.8 33.5 11.3 43.4 168 North Maluku 4.5 21.0 41.3 34.8 8.8 50.7 129 Papua 7.1 17.9 36.0 38.8 10.3 50.1 251 West Papua 11.3 11.6 14.4 23.5 5.0 35.1 89 Total 3.1 6.8 23.7 24.7 6.7 30.8 32,895 1 Either by herself or jointly with others Appendix A | 247 Table A-3.11 Men's attitude toward wife beating by province Percentage of currently married men who agree that a husband is justified in hitting or beating his wife for specific reasons, by province, Indonesia 2007 Husband is justified in hitting or beating his wife if she: Province Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercours e with him Percentage who agree with at least one specified reason Number Sumatera Nanggroe Aceh Darussalam 4.3 5.7 17.5 19.8 4.3 23.3 137 North Sumatera 2.8 4.9 11.6 15.1 2.4 19.6 370 West Sumatera 2.9 3.5 12.1 13.6 4.4 17.6 137 Riau 1.2 5.4 15.1 16.1 4.7 18.3 130 Jambi 0.0 2.1 12.6 11.6 0.8 16.5 95 South Sumatera 0.0 4.5 6.6 7.5 1.2 12.4 241 Bengkulu 2.0 3.8 21.1 19.6 7.8 27.1 53 Lampung 1.3 3.1 14.0 12.0 4.2 19.6 271 Bangka Belitung 2.7 3.0 17.6 24.8 4.8 30.6 52 Riau Islands 0.9 5.5 14.0 16.0 5.2 21.3 36 Java DKI Jakarta 0.0 0.2 2.0 1.8 0.8 2.6 408 West Java 1.3 4.6 10.8 10.5 1.2 15.5 1,444 Central Java 0.4 0.9 5.5 6.8 1.7 9.1 1,517 DI Yogyakarta 0.6 2.5 6.9 7.8 5.3 13.8 146 East Java 0.5 3.5 9.6 8.9 1.3 12.6 1,561 Banten 1.4 1.7 14.7 6.4 4.7 18.9 344 Bali and Nusa Tenggara Bali 0.3 29.1 28.9 29.7 1.5 30.4 174 West Nusa Tenggara 1.7 7.9 18.6 16.2 6.6 25.0 194 East Nusa Tenggara 4.2 16.3 26.5 21.4 3.9 32.9 172 Kalimantan West Kalimantan 1.6 5.9 8.3 16.3 4.7 20.0 162 Central Kalimantan 0.0 6.5 2.4 4.6 3.5 13.3 82 South Kalimantan 3.9 7.3 12.8 10.9 7.5 16.0 128 East Kalimantan 1.9 4.5 38.4 39.2 3.2 43.5 132 Sulawesi North Sulawesi 0.4 7.3 5.7 8.0 2.1 14.0 102 Central Sulawesi 3.6 9.7 26.6 27.7 3.3 33.4 89 South Sulawesi 0.8 4.0 8.7 7.8 4.7 14.8 259 Southeast Sulawesi 4.4 15.3 31.7 31.6 2.8 44.2 60 Gorontalo 0.9 2.3 2.0 3.8 1.4 7.2 46 West Sulawesi 2.5 17.4 18.5 19.2 2.2 28.3 41 Maluku and Papua Maluku 11.6 23.2 23.0 27.0 3.7 36.3 44 North Maluku 1.0 8.1 19.3 6.2 2.0 22.4 36 Papua 18.4 24.3 42.2 50.4 17.1 63.7 70 West Papua 18.9 21.5 32.1 27.9 14.5 43.0 24 Total 1.4 4.7 11.4 11.4 2.6 16.3 8,758 248 | Appendix A Table A-3.12 Women's attitude toward refusing sex with husband by province Percentage of ever-married women who believe that a wife is justified in refusing to have sex with her husband in specific reasons by province, Indonesia 2007 Wife is justified in refusing intercourse with her husband if she: Province Knows husband has a sexually transmitted disease Knows husband has intercourse with other women Has recently given birth Is tired or not in the mood Percentage who agree with all of the specified reasons Percentage who agree with none of the specified reasons Number Sumatera Nanggroe Aceh Darussalam 69.9 73.6 79.4 48.1 38.8 12.5 514 North Sumatera 83.0 79.9 91.2 76.2 64.8 7.2 1,487 West Sumatera 85.3 86.7 97.4 67.5 57.9 1.1 570 Riau 73.0 72.5 83.2 52.8 41.8 14.0 494 Jambi 85.3 88.1 91.5 77.1 70.4 7.2 367 South Sumatera 77.5 82.0 91.9 59.1 46.9 5.5 928 Bengkulu 86.8 88.7 93.8 68.8 60.1 3.2 211 Lampung 77.7 81.1 92.7 58.5 48.4 5.6 963 Bangka Belitung 80.2 77.0 85.7 56.9 49.5 10.4 194 Riau Islands 90.5 84.5 95.5 69.3 60.2 1.9 140 Java DKI Jakarta 93.7 91.8 94.6 71.1 68.0 2.6 1,471 West Java 87.7 85.3 94.6 62.6 56.3 4.6 5,545 Central Java 81.0 85.4 93.3 62.5 53.0 3.7 5,383 DI Yogyakarta 95.7 95.1 98.5 85.3 81.9 1.0 551 East Java 83.2 82.4 95.8 73.1 58.7 2.5 5,924 Banten 84.1 81.2 92.5 65.7 57.2 5.5 1,310 Bali and Nusa Tenggara Bali 82.7 80.9 84.7 76.9 70.6 12.6 587 West Nusa Tenggara 73.3 71.5 82.8 54.3 41.5 11.6 705 East Nusa Tenggara 71.7 78.4 80.0 70.4 63.0 18.1 627 Kalimantan West Kalimantan 88.1 91.6 94.0 85.5 79.1 5.5 628 Central Kalimantan 85.7 78.7 98.3 69.4 54.2 0.8 294 South Kalimantan 86.7 81.0 96.7 54.5 45.1 1.4 550 East Kalimantan 83.3 82.6 90.7 59.8 49.6 6.9 475 Sulawesi North Sulawesi 88.0 86.8 89.0 82.9 80.7 9.9 373 Central Sulawesi 88.7 90.0 94.2 74.5 68.2 3.2 339 South Sulawesi 79.4 78.8 90.6 64.2 56.5 8.0 1,067 Southeast Sulawesi 70.1 67.4 76.4 75.0 58.4 16.4 259 Gorontalo 69.8 76.7 83.6 64.6 51.9 14.6 163 West Sulawesi 76.3 79.9 81.9 76.8 68.3 15.8 139 Maluku and Papua Maluku 80.3 80.8 88.3 77.8 67.0 9.5 168 North Maluku 76.7 78.3 78.3 59.2 52.8 15.7 129 Papua 64.8 54.4 62.2 43.7 31.1 28.1 251 West Papua 73.7 58.1 74.2 43.5 29.4 13.7 89 Total 83.0 83.0 92.3 66.6 57.2 5.5 32,895 1 Either by herself or jointly with others Appendix A | 249 Table A-3.13.1 Use of tobacco by province: Women Percentage of ever-married women who smoke cigarettes or tobacco , according to province, Indonesia 2007 Uses tobacco Province Cigarettes Other tobacco Does not use tobacco Number of women Sumatera Nanggroe Aceh Darussalam 0.5 0.1 99.4 514 North Sumatera 4.3 0.1 95.6 1,487 West Sumatera 4.3 0.2 95.5 570 Riau 3.1 0.2 96.7 494 Jambi 2.7 0.0 97.2 367 South Sumatera 1.0 0.1 99.0 928 Bengkulu 2.1 0.2 97.7 211 Lampung 2.6 0.2 97.2 963 Bangka Belitung 2.1 0.1 97.8 194 Riau Islands 4.3 0.3 95.4 140 Java DKI Jakarta 3.5 0.0 96.5 1,471 West Java 7.2 0.6 92.2 5,545 Central Java 1.3 0.1 98.6 5,383 DI Yogyakarta 0.5 0.0 99.5 551 East Java 0.4 0.0 99.6 5,924 Banten 4.2 0.2 95.6 1,310 Bali and Nusa Tenggara Bali 0.7 0.5 98.8 587 West Nusa Tenggara 0.2 0.0 99.8 705 East Nusa Tenggara 0.3 0.3 99.4 627 Kalimantan West Kalimantan 1.7 2.3 96.0 628 Central Kalimantan 1.7 0.1 98.1 294 South Kalimantan 1.1 0.0 98.9 550 East Kalimantan 2.6 0.1 97.3 475 Sulawesi North Sulawesi 4.9 0.1 95.0 373 Central Sulawesi 1.4 0.5 98.1 339 South Sulawesi 0.6 0.2 99.2 1,067 Southeast Sulawesi 2.9 0.0 97.1 259 Gorontalo 1.8 0.2 97.9 163 West Sulawesi 1.0 0.1 98.9 139 Maluku and Papua Maluku 0.6 0.3 99.1 168 North Maluku 4.5 0.2 95.3 129 Papua 5.6 10.8 83.6 251 West Papua 1.3 2.0 96.8 89 Total 2.6 0.3 97.0 32,895 250 | Appendix A Table A-3.13.2 Use of tobacco by province: Men Percentage of currently married men who smoke cigarettes or tobacco and percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to province, Indonesia 2007 Uses tobacco Number of cigarettes in the past 24 hours Province Cigarettes Other tobacco Does not use tobacco Number of men 0 1-2 3-5 6-9 10+ Don't know/ missing Total Number of cigarette smokers Sumatera Nanggroe Aceh Darussalam 46.2 0.8 12.6 137 0.0 0.5 1.7 6.0 44.7 47.1 100.0 119 North Sumatera 40.2 0.4 12.0 370 0.0 1.7 3.6 3.5 37.1 54.1 100.0 324 West Sumatera 50.4 0.0 5.5 137 0.0 1.7 4.4 4.7 42.5 46.7 100.0 130 Riau 35.9 0.3 13.7 130 0.0 0.7 2.6 4.6 33.3 58.8 100.0 112 Jambi 36.4 0.0 8.7 95 0.6 1.9 0.0 4.9 32.5 60.1 100.0 87 South Sumatera 40.2 2.0 6.7 241 0.3 0.6 1.2 5.2 36.7 56.0 100.0 220 Bengkulu 39.3 1.6 10.2 53 0.0 0.9 3.0 3.6 37.0 55.5 100.0 47 Lampung 34.4 5.3 8.3 271 0.0 2.0 5.7 9.3 22.9 60.2 100.0 234 Bangka Belitung 37.6 0.0 17.1 52 0.0 0.6 2.3 5.9 36.6 54.6 100.0 43 Riau Islands 36.8 0.2 20.1 36 0.0 2.0 8.2 4.2 31.8 53.8 100.0 28 Java DKI Jakarta 36.6 0.0 15.4 408 0.4 1.2 3.5 11.2 26.9 56.8 100.0 345 West Java 33.3 2.3 9.2 1,444 0.0 3.1 7.9 10.0 16.6 62.4 100.0 1,278 Central Java 25.7 2.4 16.2 1,517 0.0 1.3 4.8 6.8 18.3 68.8 100.0 1,234 DI Yogyakarta 19.3 1.3 12.8 146 0.4 2.0 3.2 6.0 10.9 77.5 100.0 126 East Java 24.2 1.6 9.9 1,561 0.0 2.5 3.6 4.8 15.3 73.7 100.0 1,381 Banten 38.7 0.0 11.8 344 0.0 0.2 3.4 4.4 35.6 56.4 100.0 303 Bali and Nusa Tenggara Bali 20.7 1.4 20.6 174 0.0 0.3 8.2 7.3 10.7 73.4 100.0 136 West Nusa Tenggara 34.3 6.5 7.1 194 0.0 0.3 2.6 10.3 26.5 60.3 100.0 168 East Nusa Tenggara 35.7 12.6 13.8 172 0.6 5.1 8.0 10.3 24.5 51.5 100.0 126 Kalimantan West Kalimantan 30.3 6.1 12.2 162 1.1 2.8 2.2 5.3 25.6 63.0 100.0 132 Central Kalimantan 32.7 0.0 15.8 82 0.0 1.2 0.0 3.4 34.2 61.2 100.0 69 South Kalimantan 25.5 0.0 20.0 128 2.0 3.1 1.1 2.1 23.0 68.6 100.0 103 East Kalimantan 34.6 1.3 13.9 132 0.0 0.0 1.0 10.4 28.7 59.9 100.0 112 Sulawesi North Sulawesi 31.6 1.7 9.8 102 0.0 2.0 6.3 7.5 19.9 64.3 100.0 91 Central Sulawesi 39.0 4.2 17.1 89 1.3 1.1 4.7 13.8 28.7 50.4 100.0 70 South Sulawesi 31.3 2.5 17.3 259 1.4 1.4 4.1 7.9 23.8 61.4 100.0 208 Southeast Sulawesi 45.8 1.3 15.2 60 0.7 1.6 3.9 13.3 35.3 45.2 100.0 50 Gorontalo 33.7 2.0 7.9 46 0.0 0.4 3.0 8.1 25.8 62.6 100.0 41 West Sulawesi 43.9 0.8 10.2 41 0.0 1.5 3.1 5.5 38.9 51.0 100.0 37 Maluku and Papua Maluku 42.9 0.8 11.2 44 0.0 1.7 10.9 6.3 29.8 51.2 100.0 39 North Maluku 47.0 1.9 9.3 36 0.0 0.8 6.8 11.3 34.1 47.1 100.0 32 Papua 26.5 12.2 13.6 70 1.6 0.7 5.5 9.3 18.7 64.3 100.0 52 West Papua 35.4 2.4 22.2 24 0.0 1.6 4.1 4.4 36.6 53.3 100.0 18 Total 31.5 2.2 12.2 8,758 0.2 1.9 4.6 7.1 22.8 63.6 100.0 7,494 Appendix A | 251 CHAPTER 4 FERTILITY Table A-4.1 Fertility by province Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by Province, Indonesia 2007 Province Total fertility rate Percentage women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Sumatera Nanggroe Aceh Darussalam 3.1 6.1 4.2 North Sumatera 3.8 3.6 4.7 West Sumatera 3.4 3.8 4.3 Riau 2.7 4.6 4.0 Jambi 2.8 5.3 3.6 South Sumatera 2.7 3.1 4.2 Bengkulu 2.4 3.9 4.0 Lampung 2.5 4.0 4.3 Bangka Belitung Islands 2.5 5.5 4.2 Riau Islands 3.1 4.7 3.3 Java DKI Jakarta 2.1 3.8 3.2 West Java 2.6 4.1 3.7 Central Java 2.3 3.5 3.3 DI Yogyakarta 1.8 4.4 2.5 East Java 2.1 2.6 2.8 Banten 2.6 3.4 4.6 Bali and Nusa Tenggara Bali 2.1 3.5 2.5 West Nusa Tenggara 2.8 4.9 4.1 East Nusa Tenggara 4.2 6.2 4.2 Kalimantan West Kalimantan 2.8 5.1 4.0 Central Kalimantan 3.0 7.1 3.6 South Kalimantan 2.6 5.7 3.7 East Kalimantan 2.7 5.7 3.7 Sulawesi North Sulawesi 2.8 4.1 2.8 Central Sulawesi 3.3 4.0 3.9 South Sulawesi 2.8 4.1 3.7 Southeast Sulawesi 3.3 5.6 4.3 Gorontalo 2.6 3.8 3.2 West Sulawesi 3.5 6.3 4.4 Maluku and Papua Maluku 3.9 5.1 4.4 North Maluku 3.2 6.5 4.3 Papua 3.4 4.7 4.3 West Papua 2.9 4.2 3.8 Total 2.6 3.9 3.5 Note: Total fertility rates are for the period 1-36 months prior to interview. 252 | Appendix A Table A-4.2 Birth intervals by province Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to province, Indonesia 2007 Months since preceding birth Province 7-17 18-23 24-35 36-47 48-59 60+ Total Number of non-first births Median number of months since preceding birth Sumatera Nanggroe Aceh Darussalam 3.8 8.3 18.3 18.2 14.7 36.6 100.0 218 49.0 North Sumatera 14.1 14.9 29.2 16.7 9.0 16.1 100.0 908 31.7 West Sumatera 5.0 5.9 22.6 16.0 12.7 37.8 100.0 275 48.3 Riau 6.3 5.3 17.8 15.7 17.7 37.2 100.0 190 50.8 Jambi 1.4 1.5 14.3 14.1 11.5 57.2 100.0 115 68.9 South Sumatera 3.9 5.3 20.8 16.2 12.6 41.1 100.0 324 51.5 Bengkulu 3.6 3.4 11.7 13.5 13.9 53.8 100.0 78 62.3 Lampung 3.8 3.7 13.0 11.9 10.7 56.8 100.0 310 66.1 Bangka Belitung 8.2 6.7 12.1 11.9 14.7 46.5 100.0 55 56.5 Riau Islands 10.4 8.2 15.3 13.7 10.0 42.5 100.0 60 52.1 Java DKI Jakarta 6.2 4.9 14.8 14.0 15.4 44.6 100.0 433 56.3 West Java 4.9 4.6 8.7 11.3 14.2 56.3 100.0 1,622 66.3 Central Java 3.4 3.1 12.0 11.7 13.6 56.2 100.0 1,401 66.0 DI Yogyakarta 2.2 3.7 13.0 17.8 10.8 52.5 100.0 113 61.5 East Java 5.7 5.7 12.9 6.7 9.8 59.1 100.0 1,211 70.3 Banten 6.9 6.4 13.4 10.2 14.5 48.6 100.0 481 58.8 Bali and Nusa Tenggara Bali 2.5 4.3 16.7 15.8 14.6 46.1 100.0 162 57.1 West Nusa Tenggara 6.4 7.4 15.1 13.4 12.3 45.3 100.0 276 55.3 East Nusa Tenggara 6.8 8.3 33.5 15.5 13.4 22.5 100.0 370 36.8 Kalimantan West Kalimantan 8.0 9.7 19.1 9.9 13.7 39.6 100.0 224 50.8 Central Kalimantan 4.8 5.9 17.0 15.3 8.9 48.0 100.0 101 57.5 South Kalimantan 4.3 7.6 13.2 13.6 13.0 48.3 100.0 188 58.7 East Kalimantan 8.1 7.1 16.4 16.4 11.6 40.5 100.0 169 49.7 Sulawesi North Sulawesi 5.5 4.9 12.4 15.5 13.0 48.7 100.0 126 58.3 Central Sulawesi 7.1 7.9 20.5 16.9 15.0 32.7 100.0 173 46.8 South Sulawesi 7.4 9.0 25.6 15.4 12.0 30.6 100.0 431 42.6 Southeast Sulawesi 7.7 15.2 24.7 14.6 11.2 26.6 100.0 141 37.3 Gorontalo 6.9 7.2 18.0 16.1 12.4 39.4 100.0 52 49.7 West Sulawesi 9.4 10.2 27.1 14.8 12.5 26.0 100.0 75 37.7 Maluku and Papua Maluku 9.9 13.4 31.4 15.4 14.0 15.9 100.0 110 34.2 North Maluku 11.1 8.6 21.0 16.1 11.2 32.0 100.0 65 42.7 Papua 5.9 8.8 21.4 23.8 13.3 26.8 100.0 115 42.6 West Papua 12.2 10.9 33.0 12.7 9.9 21.3 100.0 44 32.4 Total 6.2 6.6 16.7 13.0 12.6 44.8 100.0 10,615 54.6 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 A | 253 Table A-4.3 Median age at first birth by province Median age at first birth among women age 25-49 years, according to province, Indonesia 2007 Age Province 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Sumatera Nanggroe Aceh Darussalam 23.1 21.6 21.7 20.7 21.1 21.8 North Sumatera 24.4 24.1 24.0 23.3 21.8 23.6 West Sumatera 23.0 22.4 21.9 21.7 21.5 22.2 Riau 22.6 22.7 22.4 21.5 21.3 22.2 Jambi 21.2 20.9 21.0 21.4 20.2 21.0 South Sumatera 21.6 21.0 21.3 20.3 20.0 20.9 Bengkulu 20.9 21.1 20.4 19.5 20.5 20.6 Lampung 21.9 21.4 20.3 19.5 19.1 20.6 Bangka Belitung 22.6 21.5 22.3 20.5 21.1 21.8 Riau Islands 24.1 23.5 23.7 22.7 22.8 23.5 Java DKI Jakarta a 25.1 23.8 22.6 21.5 24.0 West Java 22.4 21.5 20.9 19.6 19.4 20.8 Central Java 22.7 22.0 22.1 20.6 20.3 21.5 DI Yogyakarta 24.6 24.8 24.1 23.3 21.5 23.7 East Java 22.0 21.1 21.2 20.1 20.2 20.9 Banten 21.6 21.3 20.5 20.3 19.0 20.7 Bali and Nusa Tenggara Bali 22.8 22.7 23.3 22.3 21.3 22.5 West Nusa Tenggara 21.4 21.9 21.4 20.9 20.7 21.3 East Nusa Tenggara 22.7 22.6 23.3 23.6 22.8 23.0 Kalimantan West Kalimantan 22.0 21.7 21.0 20.9 20.4 21.4 Central Kalimantan 20.3 21.6 21.8 21.5 20.1 21.1 South Kalimantan 21.2 21.6 21.3 20.0 19.5 20.7 East Kalimantan 22.6 22.1 22.8 20.7 19.8 21.8 Sulawesi North Sulawesi 22.1 22.3 23.3 22.0 21.2 22.2 Central Sulawesi 21.5 21.6 21.5 21.7 20.1 21.4 South Sulawesi 22.5 22.9 23.2 21.7 21.7 22.4 Southeast Sulawesi 21.4 20.8 21.4 21.5 20.3 21.1 Gorontalo 20.7 21.8 22.0 22.8 22.0 21.8 West Sulawesi 21.7 22.1 21.4 20.6 20.3 21.4 Maluku and Papua Maluku 23.3 22.8 23.1 22.9 24.0 23.2 North Maluku 21.8 21.8 21.2 20.9 21.7 21.5 Papua 21.1 21.5 21.0 21.3 22.0 21.4 West Papua 21.4 21.5 21.9 21.8 21.1 21.5 Total 22.5 22.0 21.8 20.8 20.4 21.5 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 254 | Appendix A Table A-4.4 Teenage pregnancy and motherhood by province Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child and percentage who have begun childearing, by province, Indonesia 2007 Percentage who: Province Have had a live birth Are pregnant with first child Percentage who have begun childbearing Number of women Sumatera Nanggroe Aceh Darussalam 4.1 2.6 6.7 106 North Sumatera 3.2 0.7 3.9 392 West Sumatera 9.3 1.9 11.2 103 Riau 6.9 2.6 9.5 115 Jambi 16.4 3.5 19.8 60 South Sumatera 12.5 1.5 14.1 211 Bengkulu 7.4 1.1 8.6 48 Lampung 4.1 3.7 7.8 179 Bangka Belitung 9.4 2.2 11.6 43 Riau Islands 5.7 1.4 7.2 21 Java DKI Jakarta 1.2 0.9 2.2 333 West Java 5.8 3.1 8.9 1,006 Central Java 7.8 1.5 9.3 819 DI Yogyakarta 3.3 1.8 5.1 104 East Java 7.1 1.2 8.3 876 Banten 3.6 2.2 5.8 352 Bali and Nusa Tenggara Bali 0.8 0.2 1.0 116 West Nusa Tenggara 7.9 3.2 11.1 159 East Nusa Tenggara 4.6 1.7 6.3 175 Kalimantan West Kalimantan 10.1 1.5 11.6 130 Central Kalimantan 21.2 4.5 25.7 60 South Kalimantan 10.6 3.6 14.1 105 East Kalimantan 5.4 6.0 11.4 82 Sulawesi North Sulawesi 6.7 1.4 8.0 72 Central Sulawesi 6.2 1.3 7.5 78 South Sulawesi 10.6 1.1 11.7 244 Southeast Sulawesi 11.1 1.8 12.9 79 Gorontalo 12.7 2.9 15.6 34 West Sulawesi 13.8 3.1 16.8 30 Maluku and Papua Maluku 7.1 0.5 7.6 26 North Maluku 3.9 3.2 7.2 34 Papua 13.8 2.2 16.0 46 West Papua 10.9 2.3 13.2 21 Total 6.6 1.9 8.5 6,341 Appendix A | 255 CHAPTER 5 KNOWLEDGE AND EVER USE OF FAMILY PLANNING Table A-5.1 Knowledge of contraceptive methods by province Percentage of currently married women and currently married men who know of at least one contraceptive method and who know of at least one modern method by province, Indonesia 2007 Women Men Province Know of any method Know of any modern method1 Number Know of any method Know of any modern method1 Number Sumatera Nanggroe Aceh Darussalam 96.0 95.7 472 90.2 90.2 137 North Sumatera 95.7 95.6 1,389 96.9 96.5 370 West Sumatera 99.3 99.3 532 96.7 96.7 137 Riau 97.2 96.5 474 96.0 96.0 130 Jambi 99.2 99.1 346 99.2 99.2 95 South Sumatera 99.0 99.0 871 98.8 98.8 241 Bengkulu 99.6 99.6 200 93.2 93.2 53 Lampung 99.6 99.6 925 98.4 98.4 271 Bangka Belitung 99.2 99.2 182 95.0 95.0 52 Riau Islands 98.8 98.8 134 97.0 97.0 36 Java DKI Jakarta 99.9 99.9 1,352 100.0 100.0 408 West Java 99.9 99.9 5,243 97.9 97.9 1,444 Central Java 99.4 99.4 5,158 97.5 97.5 1,517 DI Yogyakarta 100.0 100.0 517 99.7 99.3 146 East Java 98.5 98.4 5,525 88.5 88.3 1,561 Banten 99.4 99.3 1,231 92.7 92.7 344 Bali and Nusa Tenggara Bali 99.5 99.5 564 98.9 98.5 174 West Nusa Tenggara 98.1 97.8 636 95.7 95.3 194 East Nusa Tenggara 90.0 89.9 577 86.9 81.3 172 Kalimantan West Kalimantan 97.1 97.0 590 93.9 93.9 162 Central Kalimantan 100.0 99.8 280 96.2 96.2 82 South Kalimantan 99.3 99.2 507 100.0 100.0 128 East Kalimantan 99.2 99.1 455 91.1 91.1 132 Sulawesi North Sulawesi 99.7 99.7 360 96.4 95.9 102 Central Sulawesi 99.7 99.7 319 96.1 94.7 89 South Sulawesi 97.1 96.4 967 84.2 81.0 259 Southeast Sulawesi 97.5 97.2 242 94.6 94.4 60 Gorontalo 99.7 99.7 152 80.1 80.1 46 West Sulawesi 97.3 97.3 131 79.2 78.7 41 Maluku and Papua Maluku 93.1 91.2 157 78.8 75.9 44 North Maluku 97.2 96.5 120 92.4 91.8 36 Papua 85.1 61.9 242 77.1 66.6 70 West Papua 93.2 92.8 83 91.3 91.2 24 Total 98.6 98.3 30,931 94.5 94.1 8,758 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception 256 | Appendix A Table A-5.2 Exposure to family planning messages by province Percentage of ever-married women and currently married men who heard or saw a family planning message on the radio or television or in a newspaper or on a poster or a pamphlet in the past few months, according to province, Indonesia 2007 Province Radio Television Newspaper/ magazine Poster Pamphlet None of the specified media sources Number EVER-MARRIED WOMEN Sumatera Nanggroe Aceh Darussalam 8.9 22.7 10.6 5.7 6.3 72.2 514 North Sumatera 9.3 19.8 11.9 16.2 14.9 63.4 1,487 West Sumatera 16.3 30.6 16.1 23.2 8.3 56.0 570 Riau 11.5 25.4 13.7 10.7 7.3 66.2 494 Jambi 9.1 26.8 11.4 10.6 6.6 68.6 367 South Sumatera 7.8 18.8 7.1 9.5 5.7 75.7 928 Bengkulu 12.0 29.4 13.4 15.7 6.0 59.8 211 Lampung 6.8 17.1 6.0 7.3 4.3 78.3 963 Bangka Belitung 6.8 23.9 9.7 11.7 5.8 70.8 194 Riau Islands 8.5 25.8 18.8 16.7 11.9 61.7 140 Java DKI Jakarta 17.0 46.9 29.9 25.8 16.8 46.9 1,471 West Java 11.4 30.7 13.6 18.6 11.4 61.2 5,545 Central Java 7.5 24.5 9.3 10.9 3.6 70.8 5,383 DI Yogyakarta 11.9 25.4 16.0 16.1 6.0 61.5 551 East Java 7.4 20.7 7.7 12.1 6.8 71.1 5,924 Banten 9.8 30.9 10.0 20.3 14.3 62.0 1,310 Bali and Nusa Tenggara Bali 15.1 33.6 14.7 9.8 3.6 62.1 587 West Nusa Tenggara 17.0 30.6 10.0 9.1 5.6 65.4 705 East Nusa Tenggara 8.5 13.5 7.6 12.3 3.0 73.5 627 Kalimantan West Kalimantan 6.9 19.7 7.4 3.3 2.0 78.0 628 Central Kalimantan 9.6 33.1 14.9 25.2 13.8 52.1 294 South Kalimantan 8.0 26.5 8.6 11.5 5.7 67.6 550 East Kalimantan 5.7 26.7 14.3 16.1 7.5 64.8 475 Sulawesi North Sulawesi 16.5 29.5 17.6 18.3 9.7 63.1 373 Central Sulawesi 14.8 31.0 10.3 13.0 8.4 59.4 339 South Sulawesi 7.1 20.4 8.1 8.3 3.5 75.4 1,067 Southeast Sulawesi 18.5 30.9 12.2 13.6 5.2 64.0 259 Gorontalo 19.8 29.3 12.7 7.7 3.4 65.5 163 West Sulawesi 20.5 29.3 12.5 10.0 7.4 64.1 139 Maluku and Papua Maluku 7.9 22.3 8.3 6.0 3.0 72.4 168 North Maluku 14.7 25.7 14.8 13.6 3.2 67.2 129 Papua 10.9 15.5 7.1 12.3 3.9 73.2 251 West Papua 19.0 28.1 9.8 10.6 6.6 59.3 89 Total 9.9 25.8 11.3 13.9 7.8 66.7 32,895 Continued… Appendix A | 257 Table A-5.2—Continued Province Radio Television Newspaper/ magazine Poster Pamphlet None of the specified media sources CURRENTLY MARRIED MEN Sumatera Nanggroe Aceh Darussalam 9.2 27.4 21.2 14.6 15.3 61.8 137 North Sumatera 11.1 33.8 19.8 20.2 19.7 59.0 370 West Sumatera 14.4 32.0 14.7 17.1 16.5 61.2 137 Riau 12.4 27.2 16.3 22.1 19.7 62.1 130 Jambi 13.0 27.2 15.1 18.9 17.1 63.0 95 South Sumatera 5.3 14.1 8.7 4.4 1.2 82.0 241 Bengkulu 13.7 34.0 18.0 22.1 12.3 56.8 53 Lampung 11.5 36.4 13.6 8.5 5.1 61.3 271 Bangka Belitung 6.1 17.3 12.0 10.5 5.6 73.9 52 Riau Islands 25.1 49.4 37.0 43.2 28.5 34.3 36 Java DKI Jakarta 11.7 42.4 26.9 39.9 15.8 36.5 408 West Java 14.3 39.6 22.6 30.4 20.1 47.6 1,444 Central Java 13.8 28.8 18.8 22.6 13.3 59.2 1,517 DI Yogyakarta 25.4 33.1 29.9 33.8 28.2 39.0 146 East Java 10.2 17.0 6.9 8.9 6.9 77.2 1,561 Banten 15.9 42.7 27.2 31.1 17.4 46.9 344 Bali and Nusa Tenggara Bali 14.4 32.8 13.2 8.1 4.6 65.7 174 West Nusa Tenggara 9.2 27.7 10.6 8.1 6.6 67.4 194 East Nusa Tenggara 11.6 15.3 13.5 11.1 9.5 78.8 172 Kalimantan West Kalimantan 13.1 24.7 15.3 14.0 4.9 65.0 162 Central Kalimantan 11.7 35.1 27.2 10.4 6.4 58.5 82 South Kalimantan 18.4 34.0 20.9 33.0 9.3 49.0 128 East Kalimantan 6.6 44.1 20.9 9.9 8.0 50.6 132 Sulawesi North Sulawesi 28.1 54.6 40.3 37.5 23.7 35.1 102 Central Sulawesi 28.7 39.6 24.9 32.2 18.3 44.9 89 South Sulawesi 21.5 38.4 22.0 29.3 14.8 50.7 259 Southeast Sulawesi 22.6 35.4 18.9 14.7 9.0 56.0 60 Gorontalo 30.7 47.0 31.7 26.7 10.8 44.8 46 West Sulawesi 22.2 46.2 20.7 23.8 18.9 44.7 41 Maluku and Papua Maluku 12.2 29.7 15.6 17.9 14.6 63.0 44 North Maluku 24.7 42.5 27.9 37.3 26.9 43.0 36 Papua 19.6 19.8 15.7 12.1 6.3 69.4 70 West Papua 28.4 33.0 20.7 15.5 5.8 54.2 24 Total 13.6 30.8 17.9 20.7 13.2 59.1 8,758 na = Not applicable 258 | Appendix A Table A-5.3 Exposure to family planning messages through personal contact by province Percentage of ever-married women who received (heard or saw) a family planning message as a result of contact with specific persons in the past six months according to province, Indonesia 2007 Province Family planning officer Teacher Religious leader Doctor Nurse/ midwife Village leader Women's group Pharmacist Number of women Sumatera Nanggroe Aceh Darussalam 8.9 0.9 2.1 6.0 18.6 1.0 1.5 0.8 514 North Sumatera 5.6 0.6 1.8 4.4 12.4 1.6 3.0 0.8 1,487 West Sumatera 11.5 1.7 1.9 7.1 21.7 2.6 5.8 0.5 570 Riau 7.6 0.6 2.0 5.8 11.6 1.1 3.1 0.4 494 Jambi 7.9 1.6 2.6 6.6 27.5 4.0 8.1 1.4 367 South Sumatera 6.5 0.5 1.7 3.0 15.3 1.5 3.1 0.2 928 Bengkulu 13.9 0.7 2.5 6.2 15.3 4.4 5.7 0.9 211 Lampung 4.7 0.1 0.8 3.3 9.2 1.6 3.0 0.2 963 Bangka Belitung 3.9 0.0 0.3 2.4 8.2 0.0 0.6 0.1 194 Riau Islands 3.9 0.4 1.6 5.9 13.1 0.8 2.4 0.2 140 Java DKI Jakarta 6.4 0.4 0.7 7.2 20.0 0.4 1.6 0.4 1,471 West Java 8.5 0.7 2.3 5.1 16.7 2.1 6.7 0.7 5,545 Central Java 8.1 0.5 0.8 4.0 14.0 1.9 7.4 0.2 5,383 DI Yogyakarta 8.3 0.2 2.4 5.1 11.5 3.9 11.1 0.1 551 East Java 5.6 0.3 1.0 3.7 10.9 1.4 4.2 0.4 5,924 Banten 7.7 0.2 0.4 2.5 8.2 0.4 1.2 0.1 1,310 Bali and Nusa Tenggara Bali 5.3 0.4 0.4 3.4 13.9 0.2 2.1 0.2 587 West Nusa Tenggara 10.8 1.2 3.4 7.3 14.7 7.0 8.2 0.5 705 East Nusa Tenggara 12.5 0.6 1.4 4.6 25.5 1.9 1.4 0.4 627 Kalimantan West Kalimantan 3.2 0.4 0.4 2.1 10.9 0.3 0.9 0.2 628 Central Kalimantan 17.4 0.8 1.4 4.7 29.0 0.8 1.1 1.3 294 South Kalimantan 6.3 0.4 0.6 2.2 12.1 0.8 2.3 0.1 550 East Kalimantan 6.1 0.8 2.2 7.5 19.8 0.8 3.1 0.4 475 Sulawesi North Sulawesi 11.4 1.5 4.0 8.7 15.2 8.5 8.4 1.2 373 Central Sulawesi 8.1 0.4 1.5 4.9 16.6 2.2 4.0 1.0 339 South Sulawesi 6.2 0.2 0.2 2.5 8.3 0.7 1.5 0.1 1,067 Southeast Sulawesi 12.0 0.8 2.7 7.9 19.9 2.2 6.4 1.1 259 Gorontalo 19.7 0.6 1.6 6.1 21.1 6.2 12.3 0.2 163 West Sulawesi 9.6 2.3 2.4 9.6 22.5 3.4 5.0 1.9 139 Maluku and Papua Maluku 4.1 0.3 1.7 2.5 9.5 0.7 2.6 0.7 168 North Maluku 13.4 1.0 2.8 10.8 20.3 6.6 3.9 1.6 129 Papua 4.6 0.9 1.5 4.7 20.0 4.8 2.1 0.2 251 West Papua 10.1 1.1 4.9 8.2 15.0 0.5 5.6 1.0 89 Total 7.5 0.6 1.4 4.5 14.4 1.8 4.8 0.4 32,895 Appendix A | 259 Table A-5.4 Contact of nonusers with family planning providers by province Percentage of women who are not using contraception, the percentage who during the last 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who neither discussed family planning with a fieldworker nor at a health facility, by province, Indonesia 2007 Percentage of women who visited a health facility in the past 12 months and who: Province Percentage of women who were visited by fieldworker who discussed family planning Discussed family planning Did not discuss family planning Percentage of women who neither discussed family planning with fieldworker nor at a health facility Number of women Sumatera Nanggroe Aceh Darussalam 2.7 3.0 13.4 95.8 290 North Sumatera 3.4 3.9 14.4 93.3 733 West Sumatera 6.6 12.4 31.8 83.4 248 Riau 5.1 7.8 26.6 90.0 225 Jambi 3.5 5.9 26.4 91.8 141 South Sumatera 4.6 3.4 15.9 92.6 364 Bengkulu 6.9 10.2 28.6 87.7 63 Lampung 2.9 4.1 40.1 94.1 305 Bangka Belitung 3.7 3.1 24.3 93.9 70 Riau Islands 1.1 7.0 26.2 92.2 62 Java DKI Jakarta 1.1 5.6 31.2 93.6 654 West Java 4.4 7.9 21.8 89.5 2,330 Central Java 5.3 5.1 22.8 90.8 2,072 DI Yogyakarta 2.4 5.9 49.6 92.9 204 East Java 3.3 4.8 31.5 92.3 2,255 Banten 4.5 6.2 19.5 90.3 604 Bali and Nusa Tenggara Bali 6.2 6.3 23.0 90.2 192 West Nusa Tenggara 6.4 4.8 21.7 91.5 355 East Nusa Tenggara 10.1 12.4 27.9 82.6 383 Kalimantan West Kalimantan 5.2 4.1 21.7 92.3 257 Central Kalimantan 4.1 8.3 27.2 89.7 108 South Kalimantan 1.3 5.5 26.3 93.7 223 East Kalimantan 5.7 13.1 32.3 84.7 205 Sulawesi North Sulawesi 3.9 6.9 17.8 91.1 122 Central Sulawesi 5.5 8.3 27.9 88.4 135 South Sulawesi 3.1 4.3 18.7 94.4 549 Southeast Sulawesi 4.3 9.6 27.0 88.5 135 Gorontalo 10.1 7.9 21.3 85.8 71 West Sulawesi 5.3 7.8 29.8 88.8 80 Maluku and Papua Maluku 4.3 5.2 20.6 92.2 115 North Maluku 6.3 3.1 20.6 91.8 70 Papua 4.4 5.2 28.9 91.2 157 West Papua 1.2 6.8 19.8 92.5 56 Total 4.3 6.0 24.9 91.1 13,834 260 | Appendix A Table A-5.5 Discussion of family planning between husband and wife by province Percent distribution of currently married women who know a contraception method by the number of times they discussed family planning with their husband in the past year, and percentage of currently married men who know a contraceptive method who discussed family planning with their wife in the past six months, according to current age, Indonesia 2007 Number of times woman discussed family planning with husband1 Province Never Once or twice Three or more times Missing Total Number of women Men who discussed family planning with wife Number of men Sumatera Nanggroe Aceh Darussalam 32.5 58.6 7.6 1.3 100.0 452 18.9 124 North Sumatera 38.5 45.0 15.5 1.0 100.0 1,326 21.5 359 West Sumatera 34.7 43.4 21.4 0.4 100.0 529 21.2 133 Riau 36.2 39.1 24.5 0.2 100.0 461 16.2 125 Jambi 42.4 44.7 12.8 0.1 100.0 344 6.9 94 South Sumatera 33.4 41.2 25.1 0.3 100.0 862 3.8 238 Bengkulu 25.2 45.7 29.0 0.1 100.0 199 28.3 50 Lampung 31.6 50.4 17.8 0.3 100.0 922 19.2 266 Bangka Belitung 35.1 49.9 14.7 0.2 100.0 181 10.8 49 Riau Islands 33.2 48.6 16.7 1.5 100.0 132 14.4 35 Java DKI Jakarta 42.3 41.6 15.8 0.3 100.0 1,350 51.2 408 West Java 35.4 45.4 19.2 0.1 100.0 5,238 28.7 1,414 Central Java 45.6 42.2 12.2 0.1 100.0 5,126 14.3 1,479 DI Yogyakarta 46.6 44.0 9.3 0.1 100.0 517 33.2 146 East Java 56.6 33.4 10.0 0.0 100.0 5,444 11.8 1,382 Banten 35.2 47.4 16.4 1.0 100.0 1,224 21.7 318 Bali and Nusa Tenggara Bali 36.0 57.1 6.2 0.6 100.0 560 23.6 172 West Nusa Tenggara 38.4 40.8 20.2 0.6 100.0 624 16.1 186 East Nusa Tenggara 33.4 45.1 19.4 2.2 100.0 518 44.3 149 Kalimantan West Kalimantan 37.7 51.3 10.5 0.4 100.0 573 27.8 152 Central Kalimantan 19.1 58.2 22.2 0.5 100.0 280 34.2 79 South Kalimantan 45.6 38.3 15.7 0.3 100.0 503 32.9 128 East Kalimantan 34.0 43.9 21.6 0.5 100.0 451 45.2 120 Sulawesi North Sulawesi 32.0 46.3 20.6 1.1 100.0 358 11.9 99 Central Sulawesi 32.3 46.6 19.5 1.5 100.0 318 22.8 85 South Sulawesi 46.7 48.4 4.4 0.5 100.0 939 26.1 218 Southeast Sulawesi 36.3 34.6 28.5 0.5 100.0 236 25.3 56 Gorontalo 32.3 47.8 18.6 1.3 100.0 152 29.5 37 West Sulawesi 35.6 45.2 19.1 0.1 100.0 127 45.1 33 Maluku and Papua Maluku 48.8 33.4 16.8 0.9 100.0 146 14.2 35 North Maluku 34.2 46.6 19.0 0.3 100.0 117 30.0 33 Papua 48.7 34.4 15.4 1.5 100.0 206 20.2 54 West Papua 52.2 31.3 14.3 2.2 100.0 78 13.2 22 Total 41.8 42.8 15.0 0.3 100.0 30,492 21.8 8,279 1 Includes women who report use of male sterilization, male condoms or withdrawal Appendix A | 261 Table A-5.6 Attitudes toward family planning by province Percent distribution of currently married women who know a method of family planning and their perceptions of their husband's attitude toward family planning, according to province, Indonesia 2007 Respondent approves of family planning Respondent disapproves of family planning Province Husband approves Husband disapproves Husband's attitude unknown, missing Husband approves Husband disapproves Husband's attitude unknown, missing Respondent unsure1 Total Number of women Sumatera Nanggroe Aceh Darussalam 76.3 4.6 4.8 0.2 6.0 1.2 6.9 100.0 452 North Sumatera 80.0 4.7 4.8 1.7 4.2 0.9 3.7 100.0 1,326 West Sumatera 87.9 3.3 2.6 0.7 2.8 0.3 2.4 100.0 529 Riau 83.5 5.6 2.4 2.9 2.6 0.5 2.5 100.0 461 Jambi 85.8 2.0 1.8 4.9 3.2 0.4 1.9 100.0 344 South Sumatera 90.9 1.7 3.2 0.2 0.8 0.5 2.7 100.0 862 Bengkulu 92.7 2.5 1.2 1.9 1.1 0.3 0.3 100.0 199 Lampung 92.1 1.7 1.4 1.5 2.0 0.1 1.3 100.0 922 Bangka Belitung 87.8 3.8 2.3 2.4 2.3 0.3 1.1 100.0 181 Riau Islands 84.8 4.5 2.7 1.9 3.8 0.1 2.2 100.0 132 Java DKI Jakarta 92.9 2.1 2.5 1.1 0.7 0.4 0.4 100.0 1,350 West Java 87.3 2.4 1.5 4.3 2.7 0.1 1.6 100.0 5,238 Central Java 90.5 2.8 1.4 1.4 2.4 0.2 1.3 100.0 5,126 DI Yogyakarta 96.8 1.1 0.5 0.3 0.7 0.3 0.3 100.0 517 East Java 89.2 2.2 2.8 1.3 2.3 0.7 1.4 100.0 5,444 Banten 85.6 2.1 2.8 4.7 1.9 0.2 2.7 100.0 1,224 Bali and Nusa Tenggara Bali 94.5 1.3 2.8 0.3 0.5 0.0 0.6 100.0 560 West Nusa Tenggara 88.2 3.3 4.1 1.1 1.7 0.0 1.7 100.0 624 East Nusa Tenggara 75.2 2.2 6.8 1.5 3.1 0.7 10.5 100.0 518 Kalimantan West Kalimantan 91.3 1.9 1.1 0.8 2.6 0.3 2.0 100.0 573 Central Kalimantan 85.7 1.4 5.6 2.0 0.6 0.1 4.5 100.0 280 South Kalimantan 91.8 2.6 2.2 0.9 2.0 0.0 0.5 100.0 503 East Kalimantan 90.5 2.0 4.0 0.7 1.2 0.6 1.0 100.0 451 Sulawesi North Sulawesi 94.0 1.0 2.5 1.4 0.4 0.1 0.6 100.0 358 Central Sulawesi 93.6 1.8 2.0 0.5 1.2 0.0 0.9 100.0 318 South Sulawesi 78.3 3.4 9.9 0.3 2.8 0.6 4.6 100.0 939 Southeast Sulawesi 80.9 4.2 3.7 1.9 6.2 0.8 2.4 100.0 236 Gorontalo 88.4 1.1 4.0 0.8 1.7 0.8 3.1 100.0 152 West Sulawesi 79.3 4.4 5.7 2.1 4.8 0.7 2.9 100.0 127 Maluku and Papua Maluku 69.3 3.5 8.7 1.7 7.8 1.2 7.9 100.0 146 North Maluku 71.2 5.8 8.2 1.6 4.5 0.6 8.1 100.0 117 Papua 53.8 3.0 6.6 3.2 9.5 1.2 22.8 100.0 206 West Papua 61.2 8.4 11.0 1.5 4.7 1.6 11.7 100.0 78 Total 87.7 2.6 2.8 1.9 2.4 0.4 2.2 100.0 30,492 1 Includes missing T ab le A -5 .7 E ve r u se o f c on tra ce pt io n by p ro vi nc e: W om en P er ce nt ag e of e ve r- m ar rie d w om en a nd c ur re nt ly m ar rie d w om en w ho h av e ev er u se d an y co nt ra ce pt iv e m et ho d by m et ho d, a cc or di ng to p ro vi nc e, In do ne sia 2 00 7 M od er n m et ho d Tr ad iti on al m et ho d P ro vi nc e An y m et ho d An y m od er n m et ho d Fe m al e st er ili - za tio n M al e st er ili - za tio n Pi ll IU D In je ct - ab le s Im -p la nt s M al e co n- do m D ia - ph ra gm LA M Em er ge nc y co nt ra - ce pt io n An y tra di - tio na l m et ho d Pe rio di c ab st i- ne nc e W ith - dr aw al Fo lk m et ho d N um be r o f w om en EV ER -M AR RI ED W O M EN S um at er a N an gg ro e A ce h D ar us sa la m 64 .1 62 .4 0. 6 0. 0 22 .4 3. 3 51 .7 1. 5 2. 2 0. 0 1. 2 0. 0 3. 6 1. 0 1. 1 1. 7 51 4 N or th S um at er a 73 .1 64 .3 6. 9 0. 0 29 .5 8. 3 43 .7 5. 5 5. 3 0. 2 2. 5 0. 5 23 .8 8. 7 17 .9 2. 4 1, 48 7 W es t S um at er a 84 .0 80 .1 2. 6 0. 0 36 .0 15 .7 65 .3 13 .6 7. 3 0. 2 3. 6 0. 2 22 .6 6. 6 18 .7 1. 6 57 0 Ri au 79 .5 77 .1 2. 4 0. 0 45 .6 8. 1 61 .2 8. 3 6. 1 0. 2 3. 2 0. 2 15 .8 5. 2 12 .5 0. 6 49 4 Ja m bi 84 .5 82 .5 2. 3 0. 1 49 .2 6. 9 64 .0 14 .1 4. 7 0. 0 1. 5 0. 0 8. 6 3. 1 2. 1 3. 8 36 7 So ut h Su m at er a 84 .4 83 .5 2. 2 0. 0 41 .4 4. 9 70 .1 21 .4 3. 2 0. 2 0. 7 0. 2 7. 0 4. 0 3. 0 0. 7 92 8 Be ng ku lu 90 .5 89 .1 1. 4 0. 1 55 .7 11 .0 79 .3 19 .8 8. 7 0. 4 1. 4 0. 3 9. 9 3. 8 7. 0 1. 0 21 1 La m pu ng 90 .4 88 .6 1. 2 0. 1 54 .5 11 .5 75 .5 12 .2 5. 6 0. 3 1. 4 0. 7 16 .5 6. 1 12 .4 1. 1 96 3 Ba ng ka B el itu ng 82 .4 80 .6 1. 7 0. 0 48 .0 3. 4 58 .1 5. 7 4. 3 0. 2 0. 4 0. 0 5. 4 1. 9 3. 8 0. 4 19 4 Ri au Is la nd s 80 .8 78 .6 2. 4 0. 0 48 .8 8. 4 55 .5 4. 2 7. 7 0. 3 4. 3 0. 5 11 .0 5. 2 6. 3 1. 3 14 0 J av a D KI Ja ka rta 82 .1 80 .7 2. 5 0. 3 42 .2 15 .6 60 .3 4. 5 11 .0 0. 1 1. 5 0. 1 10 .1 5. 5 5. 2 1. 2 1, 47 1 W es t J av a 88 .4 88 .1 1. 5 0. 5 57 .6 14 .6 70 .3 6. 8 5. 8 0. 3 0. 9 0. 3 7. 2 3. 1 4. 7 1. 0 5, 54 5 C en tra l J av a 83 .2 81 .8 5. 0 0. 5 31 .4 14 .1 66 .0 11 .5 6. 9 0. 3 0. 6 0. 0 8. 2 4. 2 4. 6 0. 6 5, 38 3 D I Y og ya ka rta 85 .6 79 .9 3. 3 0. 2 28 .4 29 .8 53 .1 6. 0 19 .3 0. 2 0. 6 0. 1 28 .0 13 .8 18 .9 1. 1 55 1 Ea st Ja va 84 .7 82 .6 3. 8 0. 1 39 .8 20 .1 59 .0 8. 9 6. 6 0. 2 10 .2 0. 5 13 .8 4. 8 9. 7 1. 9 5, 92 4 Ba nt en 82 .7 82 .3 2. 7 0. 7 37 .0 10 .9 70 .0 8. 6 5. 2 0. 0 2. 6 0. 8 5. 9 2. 5 4. 2 0. 4 1, 31 0 B al i a nd N us a Te ng ga ra Ba li 89 .3 86 .3 2. 8 0. 2 27 .1 49 .9 54 .2 2. 4 9. 1 0. 1 3. 2 0. 1 14 .9 7. 4 10 .0 0. 7 58 7 W es t N us a Te ng ga ra 82 .6 81 .1 2. 0 0. 1 23 .0 11 .8 64 .9 18 .5 1. 7 0. 1 0. 6 0. 0 5. 1 1. 7 1. 5 2. 8 70 5 Ea st N us a Te ng ga ra 65 .6 57 .0 2. 2 0. 0 18 .4 9. 4 43 .6 7. 4 1. 2 0. 0 0. 8 0. 3 24 .4 12 .2 14 .2 2. 1 62 7 K al im an ta n W es t K al im an ta n 81 .6 80 .1 2. 3 0. 3 45 .5 6. 2 64 .3 6. 2 2. 2 0. 0 0. 9 0. 0 4. 5 1. 7 1. 5 1. 4 62 8 C en tra l K al im an ta n 87 .4 86 .4 0. 8 0. 3 54 .5 3. 3 66 .1 5. 1 3. 2 0. 1 2. 3 0. 4 8. 4 2. 7 3. 9 3. 1 29 4 So ut h Ka lim an ta n 86 .5 85 .4 1. 3 0. 0 68 .8 3. 6 60 .8 8. 2 7. 2 0. 4 1. 1 0. 0 13 .2 2. 3 6. 1 6. 6 55 0 Ea st K al im an ta n 81 .8 80 .5 2. 3 0. 1 56 .4 9. 2 61 .1 7. 8 7. 9 0. 2 3. 7 0. 2 12 .3 4. 6 6. 1 2. 7 47 5 S ul aw es i N or th S ul aw es i 89 .4 88 .4 1. 8 0. 1 55 .4 18 .7 68 .4 16 .4 3. 4 0. 3 1. 7 0. 2 7. 8 6. 0 2. 3 0. 7 37 3 C en tra l S ul aw es i 83 .8 80 .9 2. 5 0. 2 54 .9 7. 5 59 .2 12 .7 0. 7 0. 0 1. 3 0. 0 9. 3 3. 1 4. 6 2. 5 33 9 So ut h Su la w es i 73 .0 66 .4 1. 1 0. 0 38 .1 4. 7 50 .8 6. 2 2. 4 0. 1 0. 9 0. 2 17 .6 3. 0 14 .8 1. 5 1, 06 7 So ut he as t S ul aw es i 72 .4 68 .8 1. 8 0. 0 42 .4 4. 5 47 .5 15 .0 1. 2 0. 2 1. 6 0. 0 12 .7 4. 9 7. 5 1. 4 25 9 G or on ta lo 78 .2 78 .0 1. 4 0. 0 50 .2 18 .5 47 .6 18 .1 0. 2 0. 0 0. 8 0. 0 3. 6 2. 3 1. 3 0. 2 16 3 W es t S ul aw es i 66 .9 65 .3 1. 2 0. 2 43 .6 3. 0 42 .3 8. 6 0. 9 0. 0 0. 8 0. 1 6. 6 3. 2 3. 4 1. 1 13 9 M al uk u an d Pa pu a M al uk u 54 .6 48 .9 2. 6 0. 1 17 .7 5. 5 40 .3 6. 2 1. 3 0. 2 0. 4 0. 0 12 .7 4. 1 6. 2 3. 8 16 8 N or th M al uk u 76 .3 74 .0 1. 8 0. 1 30 .3 5. 4 60 .9 15 .3 2. 0 0. 0 1. 4 0. 0 8. 9 2. 3 3. 6 3. 7 12 9 Pa pu a 63 .4 36 .6 2. 7 0. 2 17 .2 5. 4 27 .5 5. 2 1. 2 0. 0 0. 4 0. 0 30 .7 1. 7 2. 9 33 .2 25 1 W es t P ap ua 57 .9 54 .6 2. 6 0. 5 24 .4 5. 1 42 .4 4. 8 3. 6 0. 2 3. 4 0. 0 8. 4 4. 9 4. 1 1. 8 89 T ot al 82 .8 80 .4 3. 0 0. 3 41 .3 13 .9 62 .0 9. 1 5. 9 0. 2 2. 9 0. 3 11 .6 4. 5 7. 3 1. 7 32 ,8 95 C on tin ue d… 262 | Appendix A T ab le A -5 .7 — C on tin ue d M od er n m et ho d Tr ad iti on al m et ho d P ro vi nc e An y m et ho d An y m od er n m et ho d Fe m al e st er ili - za tio n M al e st er ili - za tio n Pi ll IU D In je ct - ab le s Im -p la nt s M al e co n- do m D ia - ph ra gm LA M Em er - ge nc y co nt ra - ce pt io n An y tra di - tio na l m et ho d Pe rio di c ab st i- ne nc e W ith - dr aw al Fo lk m et ho d N um be r o f w om en C U RR EN TL Y M AR RI ED W O M EN S um at er a N an gg ro e A ce h D ar us sa la m 66 .8 64 .9 0. 6 0. 0 22 .8 3. 6 53 .9 1. 5 2. 3 0. 0 1. 3 0. 0 3. 9 1. 1 1. 2 1. 9 47 2 N or th S um at er a 74 .7 65 .6 7. 4 0. 0 30 .3 8. 5 44 .2 5. 7 5. 5 0. 2 2. 6 0. 5 24 .7 8. 9 18 .7 2. 3 1, 38 9 W es t S um at er a 85 .0 80 .9 2. 6 0. 0 36 .8 15 .9 66 .8 13 .8 7. 7 0. 2 3. 6 0. 2 23 .6 7. 0 19 .4 1. 7 53 2 Ri au 80 .7 78 .4 2. 5 0. 0 46 .3 8. 2 62 .3 8. 6 6. 1 0. 2 3. 1 0. 2 16 .2 5. 3 12 .8 0. 5 47 4 Ja m bi 85 .6 83 .5 2. 4 0. 1 50 .1 6. 9 64 .5 14 .9 4. 8 0. 0 1. 6 0. 0 8. 6 3. 3 2. 3 3. 5 34 6 So ut h Su m at er a 86 .1 85 .3 2. 3 0. 0 42 .4 5. 1 72 .3 22 .2 3. 1 0. 2 0. 7 0. 2 7. 0 4. 1 3. 1 0. 6 87 1 Be ng ku lu 91 .6 90 .1 1. 5 0. 1 57 .0 11 .5 80 .5 20 .2 8. 9 0. 4 1. 5 0. 2 9. 9 3. 5 7. 0 1. 1 20 0 La m pu ng 91 .1 89 .2 1. 3 0. 1 55 .1 11 .2 76 .7 12 .3 5. 8 0. 3 1. 3 0. 7 17 .0 6. 4 12 .7 1. 1 92 5 Ba ng ka B el itu ng 83 .6 82 .1 1. 6 0. 0 48 .5 3. 4 59 .7 5. 9 4. 5 0. 2 0. 4 0. 0 5. 3 1. 8 3. 8 0. 3 18 2 Ri au Is la nd s 81 .9 79 .6 2. 2 0. 0 49 .7 8. 0 56 .1 4. 4 8. 0 0. 3 3. 9 0. 6 11 .1 5. 1 6. 6 1. 3 13 4 J av a D KI Ja ka rta 83 .2 81 .8 2. 7 0. 4 43 .0 15 .3 62 .5 4. 5 11 .6 0. 1 1. 6 0. 1 10 .6 5. 8 5. 4 1. 1 1, 35 2 W es t J av a 89 .1 88 .7 1. 5 0. 6 58 .5 14 .2 71 .2 6. 7 6. 1 0. 3 0. 9 0. 3 7. 3 3. 3 4. 7 1. 0 5, 24 3 C en tra l J av a 84 .0 82 .6 4. 9 0. 6 31 .7 14 .1 66 .8 11 .6 6. 8 0. 3 0. 6 0. 0 8. 4 4. 3 4. 8 0. 7 5, 15 8 D I Y og ya ka rta 87 .3 81 .6 3. 5 0. 2 29 .1 30 .7 54 .2 6. 1 20 .4 0. 2 0. 6 0. 1 29 .0 14 .3 19 .6 1. 2 51 7 Ea st Ja va 86 .4 84 .2 3. 9 0. 1 40 .8 20 .6 60 .7 9. 3 6. 6 0. 2 10 .1 0. 5 14 .4 4. 9 10 .1 2. 0 5, 52 5 Ba nt en 84 .4 84 .0 2. 9 0. 5 38 .0 11 .3 71 .7 8. 9 5. 4 0. 0 2. 8 0. 8 6. 1 2. 5 4. 5 0. 4 1, 23 1 B al i a nd N us a Te ng ga ra Ba li 89 .8 86 .7 2. 9 0. 2 27 .4 49 .6 55 .1 2. 5 9. 3 0. 1 3. 1 0. 1 15 .1 7. 6 10 .1 0. 7 56 4 W es t N us a Te ng ga ra 84 .2 82 .7 2. 3 0. 2 23 .1 11 .5 67 .7 19 .0 1. 9 0. 1 0. 3 0. 0 5. 2 1. 8 1. 6 2. 7 63 6 Ea st N us a Te ng ga ra 68 .5 59 .8 2. 3 0. 0 19 .3 9. 8 46 .0 7. 7 1. 3 0. 0 0. 8 0. 3 25 .6 12 .7 15 .2 2. 1 57 7 K al im an ta n W es t K al im an ta n 83 .3 81 .6 2. 4 0. 3 45 .6 6. 4 65 .4 6. 5 2. 4 0. 0 0. 9 0. 0 4. 8 1. 8 1. 5 1. 5 59 0 C en tra l K al im an ta n 88 .9 87 .9 0. 8 0. 2 54 .7 3. 3 67 .7 5. 0 3. 2 0. 1 2. 4 0. 4 8. 9 2. 8 4. 1 3. 3 28 0 So ut h Ka lim an ta n 87 .6 86 .5 1. 3 0. 0 69 .8 3. 7 62 .2 8. 4 7. 6 0. 5 1. 1 0. 0 13 .5 2. 2 6. 5 6. 7 50 7 Ea st K al im an ta n 82 .7 81 .4 2. 4 0. 1 56 .9 8. 7 62 .2 7. 5 8. 3 0. 2 3. 7 0. 2 12 .9 4. 8 6. 4 2. 8 45 5 S ul aw es i N or th S ul aw es i 90 .6 89 .5 1. 6 0. 1 56 .5 18 .8 69 .6 16 .6 3. 4 0. 3 1. 7 0. 2 7. 9 6. 1 2. 4 0. 8 36 0 C en tra l S ul aw es i 85 .2 82 .1 2. 4 0. 1 56 .2 7. 7 60 .8 13 .1 0. 7 0. 0 1. 4 0. 0 9. 6 3. 2 4. 7 2. 5 31 9 So ut h Su la w es i 76 .7 69 .6 1. 3 0. 0 39 .5 5. 1 53 .7 6. 5 2. 6 0. 1 0. 9 0. 3 18 .9 3. 3 15 .8 1. 6 96 7 So ut he as t S ul aw es i 74 .3 70 .4 1. 7 0. 0 43 .0 4. 2 49 .3 15 .0 1. 3 0. 2 1. 7 0. 0 13 .4 5. 3 7. 9 1. 4 24 2 G or on ta lo 80 .8 80 .6 1. 5 0. 0 52 .2 19 .0 49 .9 18 .4 0. 2 0. 0 0. 9 0. 1 3. 8 2. 5 1. 4 0. 3 15 2 W es t S ul aw es i 69 .3 67 .6 1. 2 0. 2 45 .2 3. 1 44 .2 8. 8 1. 0 0. 0 0. 9 0. 1 6. 9 3. 3 3. 6 1. 2 13 1 M al uk u an d Pa pu a M al uk u 56 .8 51 .1 2. 8 0. 2 18 .1 5. 5 42 .0 6. 6 1. 3 0. 2 0. 3 0. 0 12 .8 4. 1 6. 5 3. 7 15 7 N or th M al uk u 78 .7 76 .4 1. 9 0. 2 31 .1 5. 3 63 .5 15 .7 2. 1 0. 0 1. 1 0. 0 9. 1 2. 4 3. 5 4. 0 12 0 Pa pu a 64 .0 37 .1 2. 5 0. 2 17 .3 5. 6 27 .8 5. 4 1. 2 0. 0 0. 4 0. 0 30 .9 1. 8 3. 1 33 .5 24 2 W es t P ap ua 59 .2 56 .2 2. 8 0. 5 24 .7 5. 5 44 .1 5. 0 3. 9 0. 2 3. 0 0. 1 8. 1 4. 8 3. 8 1. 9 83 T ot al 84 .2 81 .7 3. 0 0. 3 42 .1 14 .0 63 .4 9. 3 6. 1 0. 2 2. 9 0. 3 11 .9 4. 7 7. 6 1. 7 30 ,9 31 L AM = L ac ta tio na l a m en or rh ea m et ho d Appendix A | 263 264 | Appendix A Table A-5.8 Ever use of contraception by province: Men Percentage of currently married men who have ever used any contraceptive method by method, according to province, Indonesia 2007 Modern method Traditional method Province Any method Any modern method Female sterili- zation Male sterili- zation Male condom Any tradi- tional method Periodic absti- nence With- drawal Number of men Sumatera Nanggroe Aceh Darussalam 6.5 2.4 0.7 0.0 2.2 4.3 1.0 3.7 137 North Sumatera 30.1 19.9 6.1 0.0 15.8 16.0 6.7 12.3 370 West Sumatera 34.6 15.4 2.3 0.0 13.4 26.3 13.2 19.6 137 Riau 25.7 18.5 0.8 0.0 17.9 12.5 6.8 9.2 130 Jambi 13.6 10.7 2.4 0.0 9.4 5.7 3.0 4.0 95 South Sumatera 10.3 7.4 2.3 0.0 5.5 5.1 2.5 2.8 241 Bengkulu 17.1 13.7 1.8 0.2 13.3 4.1 2.0 2.6 53 Lampung 14.0 10.0 1.1 0.0 9.0 5.7 3.9 3.0 271 Bangka Belitung 11.7 10.9 1.9 0.0 9.7 3.6 1.7 3.2 52 Riau Islands 40.6 29.7 0.4 0.0 29.3 18.2 10.5 11.3 36 Java DKI Jakarta 28.7 23.6 1.4 0.3 21.9 10.1 5.9 6.7 408 West Java 25.7 20.3 2.5 1.1 18.0 12.4 5.0 9.8 1,444 Central Java 23.9 17.6 4.3 0.8 13.3 11.6 5.7 7.9 1,517 DI Yogyakarta 67.8 47.2 2.2 0.0 45.3 50.7 29.4 42.9 146 East Java 17.7 13.7 3.5 0.0 10.7 8.6 4.8 5.4 1,561 Banten 20.7 11.6 0.0 1.4 10.6 14.2 7.7 11.4 344 Bali and Nusa Tenggara Bali 39.9 27.9 2.6 1.3 24.3 26.8 12.2 20.5 174 West Nusa Tenggara 7.4 5.7 1.7 0.0 4.1 2.5 0.9 2.1 194 East Nusa Tenggara 29.4 6.7 3.1 0.0 4.0 25.6 19.3 10.3 172 Kalimantan West Kalimantan 16.7 10.6 2.4 0.2 7.5 10.9 4.7 8.4 162 Central Kalimantan 16.7 6.0 0.0 0.5 6.0 11.8 7.3 9.7 82 South Kalimantan 21.1 15.5 0.7 0.0 14.8 12.4 6.9 6.7 128 East Kalimantan 17.3 11.5 2.7 0.6 8.7 9.4 8.9 2.2 132 Sulawesi North Sulawesi 26.6 10.7 0.9 0.0 9.9 21.5 11.8 13.1 102 Central Sulawesi 15.6 6.0 1.6 0.0 5.0 12.3 9.9 5.7 89 South Sulawesi 29.7 10.8 1.3 0.0 10.0 23.5 9.2 17.1 259 Southeast Sulawesi 23.3 8.7 2.6 1.2 4.8 16.6 11.0 11.6 60 Gorontalo 5.4 2.3 0.0 0.0 2.3 3.7 2.8 1.3 46 West Sulawesi 7.5 4.0 0.8 0.0 3.3 3.9 1.2 2.7 41 Maluku and Papua Maluku 27.9 10.7 2.4 0.0 8.6 24.5 11.2 21.3 44 North Maluku 9.7 4.3 1.3 0.0 4.3 5.3 3.0 2.3 36 Papua 17.8 11.5 4.8 0.5 6.7 11.0 7.4 6.6 70 West Papua 10.3 7.2 1.2 0.0 7.2 7.2 5.3 4.3 24 Total 22.8 15.7 2.8 0.4 13.2 12.5 6.4 8.8 8,758 Appendix A | 265 Table A-5.9 Number of children at first use of contraception by province Percent distribution of women who had ever used contraception by number of living children at the time of first use of contraception, according to province, Indonesia 2007 Number of living children at time of first use of contraception Province 0 1 2 3 4+ Missing Total Number of women Sumatera Nanggroe Aceh Darussalam 1.2 57.7 15.7 12.2 12.4 0.8 100.0 329 North Sumatera 1.2 48.0 17.2 13.4 20.2 0.0 100.0 1,088 West Sumatera 2.4 68.8 12.8 8.3 7.3 0.4 100.0 479 Riau 1.0 68.2 14.3 6.8 9.5 0.1 100.0 393 Jambi 3.3 69.8 13.1 6.5 7.2 0.1 100.0 310 South Sumatera 3.5 66.6 12.9 7.6 9.3 0.0 100.0 783 Bengkulu 1.7 72.2 14.6 5.0 6.4 0.0 100.0 191 Lampung 10.3 65.9 11.2 6.6 6.0 0.0 100.0 871 Bangka Belitung 4.7 72.7 12.1 3.6 6.9 0.0 100.0 160 Riau Islands 2.9 69.8 13.5 8.7 5.0 0.0 100.0 113 Java DKI Jakarta 2.9 79.3 9.4 4.4 3.5 0.5 100.0 1,207 West Java 12.8 66.5 12.8 4.2 3.7 0.0 100.0 4,901 Central Java 3.6 68.3 15.9 7.5 4.8 0.0 100.0 4,478 DI Yogyakarta 3.3 78.6 14.5 2.5 1.1 0.0 100.0 472 East Java 13.5 66.2 14.4 3.6 2.3 0.0 100.0 5,019 Banten 9.3 62.9 10.1 6.8 10.8 0.1 100.0 1,083 Bali and Nusa Tenggara Bali 3.0 81.9 10.5 2.5 1.9 0.3 100.0 525 West Nusa Tenggara 3.5 64.1 16.8 7.1 7.7 0.7 100.0 582 East Nusa Tenggara 0.9 57.3 18.9 12.3 10.2 0.4 100.0 411 Kalimantan West Kalimantan 2.4 68.1 14.0 6.5 8.5 0.6 100.0 512 Central Kalimantan 7.5 68.8 14.7 5.0 4.0 0.0 100.0 257 South Kalimantan 30.0 50.0 9.8 4.1 5.9 0.2 100.0 476 East Kalimantan 6.4 68.6 13.8 6.3 4.6 0.3 100.0 388 Sulawesi North Sulawesi 1.9 78.4 13.2 5.2 1.4 0.0 100.0 334 Central Sulawesi 2.1 54.1 22.9 11.4 9.4 0.0 100.0 284 South Sulawesi 4.0 49.9 25.9 10.4 9.6 0.1 100.0 779 Southeast Sulawesi 2.5 45.9 23.3 12.3 15.7 0.2 100.0 188 Gorontalo 2.3 68.9 15.0 8.0 5.8 0.0 100.0 128 West Sulawesi 2.6 50.1 22.8 12.6 11.8 0.0 100.0 93 Maluku and Papua Maluku 3.3 47.5 16.9 12.3 19.6 0.4 100.0 92 North Maluku 1.8 49.1 24.2 12.4 12.3 0.2 100.0 99 Papua 3.8 68.3 14.3 6.4 7.0 0.2 100.0 159 West Papua 2.7 59.9 11.9 12.6 12.5 0.4 100.0 52 Total 7.7 65.8 14.4 6.2 5.8 0.1 100.0 27,234 266 | Appendix A CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table A-6.1 Current use of contraception by province Percent distribution of currently married women by contraceptive method currently used, according to province, Indonesia 2007 Modern method Traditional method Proovince Any method Any modern method Female sterili- zation Male sterili- aation Pill IUD Inject- ables Im- plants Male con- dom LAM Any tradi- tional method Periodic absti- nence With- drawal Folk method Not currently using Total Number of women Sumatera Nanggroe Aceh Darussalam 47.4 45.4 0.6 0.0 9.3 1.3 33.2 0.4 0.5 0.1 2.0 0.6 0.8 0.6 52.6 100.0 472 North Sumatera 54.2 42.6 7.4 0.0 11.7 2.1 17.4 1.9 2.1 0.1 11.5 2.8 7.9 0.9 45.8 100.0 1,389 West Sumatera 59.9 52.8 2.6 0.0 8.7 5.8 29.9 3.9 1.9 0.0 7.2 1.8 5.1 0.2 40.1 100.0 532 Riau 56.7 52.8 2.5 0.0 14.7 1.6 31.3 1.7 1.0 0.0 4.0 1.6 2.2 0.2 43.3 100.0 474 Jambi 65.2 62.5 2.4 0.0 18.4 1.5 34.3 4.7 1.2 0.0 2.7 2.0 0.4 0.3 34.8 100.0 346 South Sumatera 64.8 62.6 2.3 0.0 10.1 0.9 44.1 4.8 0.5 0.0 2.1 1.3 0.7 0.2 35.2 100.0 871 Bengkulu 74.0 70.4 1.5 0.1 13.0 1.7 46.9 5.4 1.8 0.0 3.6 1.2 1.8 0.5 26.0 100.0 200 Lampung 71.1 66.0 1.3 0.1 14.6 2.5 42.3 3.9 1.4 0.0 5.0 1.8 3.1 0.2 28.9 100.0 925 Bangka Belitung 67.8 64.7 1.6 0.0 26.2 1.6 31.6 1.8 1.9 0.0 3.1 1.4 1.7 0.1 32.2 100.0 182 Riau Islands 57.6 54.0 2.2 0.0 17.6 3.0 27.3 1.1 2.8 0.1 3.5 2.3 1.0 0.1 42.4 100.0 134 Java DKI Jakarta 60.1 56.4 2.7 0.4 13.8 6.5 27.2 2.1 3.6 0.3 3.7 2.2 1.4 0.1 39.9 100.0 1,352 West Java 61.1 60.3 1.5 0.4 19.4 5.1 31.0 1.3 1.6 0.0 0.8 0.6 0.2 0.0 38.9 100.0 5,243 Central Java 63.7 60.0 4.9 0.6 8.7 4.0 37.6 2.6 1.6 0.0 3.8 1.9 1.8 0.1 36.3 100.0 5,158 DI Yogyakarta 66.9 54.8 3.5 0.2 6.8 13.9 21.7 2.0 6.6 0.1 12.0 4.1 7.7 0.3 33.1 100.0 517 East Java 66.1 62.3 3.9 0.0 12.1 7.9 33.7 4.2 0.5 0.0 3.8 1.3 2.0 0.5 33.9 100.0 5,525 Banten 57.4 55.4 2.9 0.3 9.9 4.4 35.7 1.5 0.7 0.0 2.0 0.8 1.2 0.0 42.6 100.0 1,231 Bali and Nusa Tenggara Bali 69.4 65.4 2.9 0.1 7.7 23.8 26.7 1.2 2.9 0.0 4.0 2.4 1.5 0.1 30.6 100.0 564 West Nusa Tenggara 54.8 52.2 2.3 0.2 7.0 4.6 33.5 4.3 0.4 0.0 2.7 0.6 0.6 1.4 45.2 100.0 636 East Nusa Tenggara 42.1 30.1 2.3 0.0 4.3 2.2 19.4 1.6 0.2 0.0 12.0 5.2 6.1 0.7 57.9 100.0 577 Kalimantan West Kalimantan 62.7 61.2 2.4 0.0 15.5 2.2 38.5 1.7 0.9 0.0 1.5 0.4 0.3 0.8 37.3 100.0 590 Central Kalimantan 66.5 65.2 0.8 0.1 23.2 1.0 37.9 1.7 0.3 0.3 1.3 0.9 0.2 0.2 33.5 100.0 280 South Kalimantan 64.4 63.2 1.3 0.0 29.9 1.1 26.8 3.4 0.7 0.0 1.2 0.5 0.5 0.2 35.6 100.0 507 East Kalimantan 59.2 55.4 2.4 0.1 20.9 2.4 24.6 2.9 2.1 0.0 3.9 1.0 1.5 1.3 40.8 100.0 455 Sulawesi North Sulawesi 69.3 66.7 1.6 0.0 23.1 5.9 29.2 6.6 0.3 0.0 2.6 2.2 0.3 0.1 30.7 100.0 360 Central Sulawesi 63.6 59.8 2.4 0.0 21.8 2.7 28.6 3.9 0.3 0.0 3.8 1.7 1.3 0.8 36.4 100.0 319 South Sulawesi 53.4 42.9 1.3 0.0 12.1 1.2 25.2 2.8 0.2 0.1 10.5 1.5 8.4 0.6 46.6 100.0 967 Southeast Sulawesi 50.7 44.4 1.7 0.0 16.3 0.9 19.7 5.1 0.6 0.1 6.2 3.0 3.1 0.2 49.3 100.0 242 Gorontalo 60.1 58.8 1.5 0.0 17.8 9.1 19.1 10.9 0.0 0.2 1.4 1.1 0.1 0.1 39.9 100.0 152 West Sulawesi 45.4 44.5 1.2 0.0 19.4 1.4 19.6 2.5 0.4 0.0 0.9 0.5 0.3 0.1 54.6 100.0 131 Maluku and Papua Maluku 34.1 29.4 2.8 0.0 4.2 1.3 18.5 2.0 0.6 0.0 4.8 1.3 1.5 2.0 65.9 100.0 157 North Maluku 48.8 46.2 1.9 0.0 7.3 1.0 31.0 5.0 0.1 0.0 2.5 1.0 0.2 1.3 51.2 100.0 120 Papua 38.3 24.5 2.5 0.2 5.9 1.3 11.5 3.2 0.0 0.0 13.8 0.9 2.1 10.8 61.7 100.0 242 West Papua 39.6 37.5 2.8 0.4 6.8 1.3 23.9 2.3 0.0 0.0 2.1 0.7 0.2 1.1 60.4 100.0 83 Total 61.4 57.4 3.0 0.2 13.2 4.9 31.8 2.8 1.3 0.0 4.0 1.5 2.1 0.4 38.6 100.0 30,931 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Appendix A | 267 Table A-6.2 Pill use compliance by province Percentage of currently married women using the pill, percent distribution of pill users by type of pill, and by whether pill users could show a pill packet, and percent pill users who took a pill less than two days ago, according to province, Indonesia 2007 Could show packet by type of pill Percentage of pill users who: Province Percent using Currently married women Combi- nation Single Other Package not seen/ missing Took pill in order Took pill <2 days ago Number of pill users Sumatera Nanggroe Aceh Darussalam 9.3 472 53.2 15.0 15.7 16.2 81.0 88.6 44 North Sumatera 11.7 1,389 53.7 15.9 14.7 15.6 70.6 73.8 162 West Sumatera 8.7 532 68.8 0.0 18.1 13.1 75.4 79.5 46 Riau 14.7 474 61.3 14.4 14.5 9.8 75.5 79.0 70 Jambi 18.4 346 50.7 36.3 9.1 3.9 93.8 92.3 64 South Sumatera 10.1 871 58.1 12.7 21.5 7.8 86.3 91.0 88 Bengkulu 13.0 200 68.9 7.4 12.0 11.7 82.9 76.1 26 Lampung 14.6 925 73.0 5.7 16.5 4.8 85.2 77.5 135 Bangka Belitung 26.2 182 80.2 13.2 3.5 3.1 93.8 92.8 48 Riau Islands 17.6 134 69.2 5.1 7.7 18.0 78.8 76.3 24 Java DKI Jakarta 13.8 1,352 72.6 11.9 9.3 6.2 84.1 77.6 187 West Java 19.4 5,243 66.8 13.2 12.0 8.1 87.2 86.7 1,018 Central Java 8.7 5,158 51.2 9.5 29.7 9.6 75.3 72.4 449 DI Yogyakarta 6.8 517 73.0 4.8 16.8 5.4 86.0 89.0 35 East Java 12.1 5,525 58.4 10.6 25.0 6.1 85.4 85.3 669 Banten 9.9 1,231 55.8 20.2 11.2 12.8 76.7 71.8 121 Bali and Nusa Tenggara Bali 7.7 564 47.5 29.8 13.7 9.0 90.6 81.9 43 West Nusa Tenggara 7.0 636 69.0 10.6 10.7 9.7 86.3 86.1 44 East Nusa Tenggara 4.3 577 (39.7) (18.4) (34.6) (7.3) (91.6) 79.9 25 Kalimantan West Kalimantan 15.5 590 67.6 6.2 20.5 5.7 93.7 91.9 91 Central Kalimantan 23.2 280 78.5 2.2 14.5 4.7 88.9 86.8 65 South Kalimantan 29.9 507 93.3 0.5 0.6 5.5 85.6 89.2 152 East Kalimantan 20.9 455 90.0 5.2 0.2 4.6 88.7 82.5 95 Sulawesi North Sulawesi 23.1 360 59.2 23.7 5.2 12.0 83.8 84.7 83 Central Sulawesi 21.8 319 35.8 32.2 17.5 14.5 78.8 82.0 69 South Sulawesi 12.1 967 66.8 1.9 23.8 7.5 84.3 86.8 117 Southeast Sulawesi 16.3 242 68.8 6.4 5.7 19.1 73.5 75.3 39 Gorontalo 17.8 152 56.2 9.1 27.8 7.0 88.3 80.4 27 West Sulawesi 19.4 131 59.2 16.6 16.5 7.6 75.1 86.4 25 Maluku and Papua Maluku 4.2 157 (40.5) (21.4) (13.4) (24.7) (61.5) (67.5) 7 North Maluku 7.3 120 50.8 12.3 12.6 24.2 73.9 81.0 9 Papua 5.9 242 (49.7) (20.5) (12.5) (17.3) (67.8) (80.2) 14 West Papua 6.8 83 (46.8) (39.5) (5.7) (8.0) (86.5) (67.4) 6 Total 13.2 30,931 63.4 11.9 16.4 8.4 83.7 82.8 4,096 Note: Figures in parentheses are based on 25-49 unweighted cases. 268 | Appendix A Table A-6.3 Use of injectables by province Percentage of users of one-month injectables who had an injection in the past four weeks and percentage of users of three month injectables who had an injection in the past three months, according to province, Indonesia 2007 Users of one-month injections Users of three-month injections Province Percent who had an injection in the past 4 weeks Number of users Percent who had an injection in the past 3 months Number of users Sumatera Nanggroe Aceh Darussalam (82.6) 24 94.2 133 North Sumatera (89.4) 52 95.6 190 West Sumatera (82.2) 18 98.0 141 Riau (81.1) 23 96.0 125 Jambi * 9 99.4 110 South Sumatera * 16 97.8 369 Bengkulu * 5 97.2 89 Lampung * 17 95.5 374 Bangka Belitung (92.4) 12 98.8 46 Riau Islands 76.4 11 95.6 26 Java DKI Jakarta 74.5 74 97.4 294 West Java 82.5 160 96.6 1,483 Central Java (69.1) 79 94.1 1,887 DI Yogyakarta * 4 99.1 109 East Java (89.9) 177 98.2 1,691 Banten (57.9) 23 95.6 418 Bali and Nusa Tenggara Bali (76.2) 19 98.4 132 West Nusa Tenggara * 7 95.0 214 East Nusa Tenggara * 2 92.4 110 Kalimantan West Kalimantan (75.9) 23 95.0 205 Central Kalimantan (81.7) 13 95.0 94 South Kalimantan (87.4) 26 96.1 111 East Kalimantan (85.4) 28 93.4 90 Sulawesi North Sulawesi (61.4) 8 93.4 97 Central Sulawesi * 3 98.0 90 South Sulawesi * 9 96.2 236 Southeast Sulawesi * 1 94.5 47 Gorontalo * 0 93.6 30 West Sulawesi * 1 97.5 25 Maluku and Papua Maluku * 2 96.4 28 North Maluku * 1 86.3 36 Papua * 3 87.2 27 West Papua * 3 88.8 17 Total 80.5 853 96.1 9,072 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Appendix A | 269 Table A-6.4 Informed choice by province Among current users of modern methods who adopted the method in the five years preceding the survey, percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods that could use, by method and source, Indonesia 2007 Among women who started last episode of modern contraceptive method within five years preceding the survey: Province Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if side effects experienced Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Sumatera Nanggroe Aceh Darussalam 34.5 35.5 38.9 165 North Sumatera 24.9 33.1 30.7 386 West Sumatera 38.5 35.8 53.9 209 Riau 33.8 37.9 35.7 179 Jambi 27.2 32.2 37.1 155 South Sumatera 33.1 31.6 46.9 391 Bengkulu 30.8 36.7 40.1 101 Lampung 29.0 32.2 34.7 419 Bangka Belitung 25.2 28.5 31.9 78 Riau Islands 33.4 35.6 38.7 53 Java DKI Jakarta 52.4 45.8 56.6 507 West Java 39.8 41.7 45.8 2,199 Central Java 31.7 32.9 36.1 1,958 DI Yogyakarta 54.7 57.1 56.6 131 East Java 34.1 38.7 45.9 1,850 Banten 33.2 32.4 36.6 502 Bali and Nusa Tenggara Bali 53.0 48.6 55.9 186 West Nusa Tenggara 34.5 33.8 40.1 251 East Nusa Tenggara 56.7 60.7 58.5 144 Kalimantan West Kalimantan 24.4 20.5 33.8 263 Central Kalimantan 38.5 45.5 62.6 125 South Kalimantan 30.7 32.2 35.1 244 East Kalimantan 42.5 46.8 53.6 180 Sulawesi North Sulawesi 30.9 29.2 40.3 163 Central Sulawesi 32.4 36.9 48.2 150 South Sulawesi 26.3 27.7 36.1 304 Southeast Sulawesi 33.5 38.8 40.6 85 Gorontalo 28.0 26.8 35.7 55 West Sulawesi 25.1 24.2 35.1 45 Maluku and Papua Maluku 23.8 30.0 36.5 34 North Maluku 24.5 17.0 38.0 44 Papua 47.1 53.8 64.4 42 West Papua 61.1 57.1 66.0 24 Total 35.3 37.0 42.7 11,623 Note: Table excludes users who obtained their method from friends/relatives. na = Not applicable 1 Among women who were sterilized in the five years preceding the survey 2 Source at start of current episode of use 270 | Appendix A Table A-6.5 Payment for contraceptive method and services Percent distribution of current users of modern contraceptive methods by source of method and whether method is free or respondent pays for it, according to province, Indonesia 2007 Government Private Other Province Free Pay Free Pay Free Pay Total Number of women Sumatera Nanggroe Aceh Darussalam 1.9 25.9 0.9 69.2 0.4 1.8 100.0 213 North Sumatera 6.0 13.9 2.5 72.6 0.7 4.3 100.0 589 West Sumatera 12.6 20.4 3.9 58.4 0.9 3.9 100.0 283 Riau 3.5 21.5 2.7 66.9 0.4 5.0 100.0 248 Jambi 5.3 17.7 4.3 68.2 0.4 4.0 100.0 215 South Sumatera 3.5 8.0 2.1 83.7 0.0 2.8 100.0 545 Bengkulu 4.4 13.4 1.7 74.3 0.7 5.5 100.0 140 Lampung 1.7 12.2 1.6 77.7 0.4 6.4 100.0 611 Bangka Belitung 2.8 14.8 1.0 71.0 0.5 10.0 100.0 118 Riau Islands 3.1 8.6 3.7 81.9 0.7 2.0 100.0 72 Java DKI Jakarta 3.5 15.2 1.2 76.6 0.5 3.0 100.0 759 West Java 3.6 9.1 1.9 72.3 0.2 12.9 100.0 3,174 Central Java 4.7 14.0 2.9 71.7 1.0 5.7 100.0 3,112 DI Yogyakarta 14.5 15.9 2.6 61.2 2.4 3.4 100.0 285 East Java 7.7 19.3 1.6 62.0 1.1 8.2 100.0 3,457 Banten 3.3 13.8 2.1 73.3 0.5 7.0 100.0 677 Bali and Nusa Tenggara Bali 9.2 20.7 4.8 64.8 0.1 0.3 100.0 372 West Nusa Tenggara 8.1 34.3 0.9 37.3 1.7 17.8 100.0 331 East Nusa Tenggara 16.2 40.7 3.0 17.7 10.4 12.1 100.0 174 Kalimantan West Kalimantan 1.2 20.3 1.2 72.3 0.1 5.0 100.0 361 Central Kalimantan 2.2 31.0 1.1 56.9 0.6 8.1 100.0 182 South Kalimantan 5.4 12.6 2.2 62.7 2.1 15.0 100.0 321 East Kalimantan 5.3 23.0 2.2 62.8 1.0 5.7 100.0 252 Sulawesi North Sulawesi 4.5 26.4 1.7 58.3 2.1 7.1 100.0 241 Central Sulawesi 7.7 24.1 3.0 48.8 0.4 16.0 100.0 191 South Sulawesi 9.6 31.4 1.8 51.2 1.4 4.7 100.0 415 Southeast Sulawesi 6.8 20.8 3.8 46.8 2.9 19.0 100.0 109 Gorontalo 6.5 34.0 2.0 36.7 2.3 18.6 100.0 90 West Sulawesi 5.2 28.1 3.7 52.3 0.8 9.9 100.0 58 Maluku and Papua Maluku 5.5 33.8 0.7 48.8 1.8 9.4 100.0 46 North Maluku 7.3 29.6 4.4 54.8 0.0 3.9 100.0 56 Papua 17.3 51.3 3.6 18.1 2.9 6.7 100.0 59 West Papua 8.9 51.8 0.6 36.5 0.2 2.0 100.0 31 Total 5.5 16.7 2.2 66.9 0.9 7.8 100.0 17,788 Note: Excludes cases where cost of method was 'Don't know' or missing (3 and 39 unweighted cases) Appendix A | 271 CHAPTER 7 FERTILITY PREFERENCES Table A-7.1.1 Desire to limit childbearing by province: Women Percentage of currently married women who want no more children, by number of living children by province, Indonesia 2007 Number of living children Province 0 1 2 3 4 5 6+ Total Sumatera Nanggroe Aceh Darussalam 1.9 9.5 18.5 45.2 58.7 62.8 65.8 32.7 North Sumatera 0.0 8.7 46.3 70.5 81.8 91.5 91.2 58.7 West Sumatera 0.0 8.6 45.0 68.2 86.6 88.1 90.6 52.7 Riau 0.4 6.3 44.0 68.1 86.9 82.0 89.2 46.4 Jambi 0.0 6.9 50.3 77.3 86.2 75.7 85.7 46.0 South Sumatera 0.0 7.6 49.4 82.5 93.7 93.1 86.8 54.1 Bengkulu 0.0 2.5 52.0 79.5 90.0 95.7 94.2 53.9 Lampung 12.8 9.3 53.1 82.1 92.6 93.2 95.0 53.4 Bangka Belitung 0.0 9.2 53.6 75.7 91.7 96.2 96.0 46.0 Riau Islands 14.3 20.5 54.5 79.6 84.0 89.0 91.5 53.2 Java DKI Jakarta 2.1 12.1 65.5 87.7 91.5 97.5 95.3 52.9 West Java 3.3 15.8 64.2 78.7 86.4 96.0 85.6 54.2 Central Java 3.4 16.1 66.8 91.9 94.5 97.9 96.0 58.9 DI Yogyakarta 3.4 13.3 84.0 94.3 92.3 100.0 100.0 59.0 East Java 7.7 22.7 78.1 94.0 93.1 94.1 97.4 58.6 Banten 1.4 8.8 40.0 50.8 56.5 83.1 79.2 39.7 Bali and Nusa Tenggara Bali 2.4 34.8 81.2 87.9 91.4 93.7 100.0 68.3 West Nusa Tenggara 0.0 11.5 45.3 67.7 81.8 90.7 91.7 45.7 East Nusa Tenggara 0.0 9.1 35.5 48.4 74.7 76.3 76.0 44.1 Kalimantan West Kalimantan 4.2 11.8 46.6 73.5 82.6 77.0 75.5 46.7 Central Kalimantan 4.9 10.2 51.2 68.0 88.1 98.1 91.1 45.4 South Kalimantan 5.6 9.6 40.6 69.0 85.4 87.4 89.4 42.3 East Kalimantan 2.0 16.2 50.8 72.8 82.6 85.6 81.1 48.9 Sulawesi North Sulawesi 5.0 14.8 72.8 86.0 95.1 100.0 100.0 59.2 Central Sulawesi 0.0 14.7 48.4 70.6 86.0 85.1 97.4 53.3 South Sulawesi 2.9 4.8 42.7 59.5 72.2 78.1 76.1 43.8 Southeast Sulawesi 0.0 4.1 28.0 48.6 67.0 69.0 87.9 40.2 Gorontalo 8.9 18.6 62.4 74.8 84.9 86.9 92.4 55.7 West Sulawesi 6.6 8.1 27.5 43.8 66.2 63.5 68.1 36.4 Maluku and Papua Maluku 5.3 10.1 38.9 54.6 75.8 89.1 90.1 51.3 North Maluku 0.0 9.6 27.1 60.0 71.5 77.2 86.1 42.5 Papua 1.8 8.9 44.2 41.6 52.4 60.4 74.4 36.9 West Papua 1.0 8.6 30.1 49.0 68.6 59.0 66.1 38.2 Total 4.0 15.2 61.8 78.9 84.6 89.3 87.3 53.5 Note: Women who have been sterilized are considered to want no more children. 1 The number of living children includes the current pregnancy. 272 | Appendix A Table A-7.1.2 Desire to limit childbearing by province: Men Percentage of currently married men age who want no more children, by number of living children by province, Indonesia 2007 Number of living children Province 0 1 2 3 4 5 6+ Total Sumatera Nanggroe Aceh Darussalam 0.0 1.7 9.9 16.5 50.4 52.1 58.2 20.7 North Sumatera 0.0 4.6 13.7 59.4 65.0 60.6 43.7 39.8 West Sumatera 4.7 5.9 25.2 49.4 66.6 61.9 72.4 38.0 Riau 0.0 4.0 31.9 76.1 63.4 63.7 80.6 38.0 Jambi 0.0 6.0 49.1 63.1 68.5 90.0 91.2 42.1 South Sumatera 0.0 1.7 29.7 52.0 64.0 52.2 46.6 31.0 Bengkulu 9.0 4.9 46.4 75.9 93.5 98.5 78.3 52.7 Lampung 10.9 12.2 44.0 63.2 68.2 66.7 66.9 42.7 Bangka Belitung 0.0 2.5 42.6 55.3 81.7 69.3 60.7 35.7 Riau Islands 0.0 10.4 49.0 60.9 81.8 76.9 87.5 44.9 Java DKI Jakarta 1.9 6.6 38.3 61.0 75.4 63.5 88.8 35.0 West Java 0.0 10.6 52.9 65.9 66.1 62.2 83.2 43.1 Central Java 0.0 11.4 57.2 78.5 90.4 93.9 82.5 52.3 DI Yogyakarta 4.5 8.6 71.8 86.4 100.0 100.0 72.0 52.7 East Java 6.8 20.0 62.1 81.0 81.0 82.8 74.7 48.5 Banten 0.0 3.8 26.8 30.7 42.4 51.7 45.4 23.4 Bali and Nusa Tenggara Bali 4.7 21.9 72.4 75.3 75.7 88.7 82.9 59.7 West Nusa Tenggara 6.2 15.2 66.0 73.6 76.0 90.4 74.0 53.2 East Nusa Tenggara 0.0 4.2 27.9 47.4 66.6 64.6 67.6 40.7 Kalimantan West Kalimantan 5.3 4.0 42.6 42.7 57.6 81.0 49.6 36.4 Central Kalimantan 5.8 2.4 45.5 54.2 64.5 20.5 63.7 33.7 South Kalimantan 0.0 2.2 34.2 65.9 47.4 100.0 85.2 36.1 East Kalimantan 5.6 24.8 46.2 70.2 70.6 77.4 64.1 49.3 Sulawesi North Sulawesi 0.0 19.9 47.2 69.3 47.1 53.2 0.0 43.3 Central Sulawesi 19.3 2.9 19.5 55.5 43.8 76.8 53.8 30.8 South Sulawesi 0.0 1.7 27.3 27.2 49.6 65.1 42.2 27.2 Southeast Sulawesi 0.0 0.0 17.2 44.9 36.9 70.0 83.6 32.4 Gorontalo 0.0 10.0 43.7 45.5 32.9 23.0 58.6 32.7 West Sulawesi 0.0 2.9 18.8 31.4 26.6 26.6 34.4 19.7 Maluku and Papua Maluku 0.0 5.9 23.3 28.2 53.9 66.1 52.4 31.8 North Maluku 0.0 2.2 32.0 31.7 60.8 62.7 51.7 33.8 Papua 0.0 10.8 38.0 35.7 48.6 41.6 48.1 33.0 West Papua 5.6 0.9 37.4 42.4 49.0 78.3 65.2 38.3 Total 2.9 11.2 49.6 64.5 69.2 70.4 66.8 42.9 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. 1 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). Appendix A | 273 Table A-7.2 Need and demand for family planning among currently married women by province Percentage of currently married women with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage for the demand for contraception that is satisfied, by province, Indonesia 2007 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning Province For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Sumatera Nanggroe Aceh Darussalam 8.9 3.0 12.0 29.3 18.1 47.4 38.3 21.1 59.4 79.8 472 North Sumatera 5.1 7.2 12.3 15.2 38.9 54.2 20.8 46.3 67.1 81.6 1,389 West Sumatera 6.3 5.0 11.2 24.1 35.9 59.9 30.4 40.9 71.3 84.2 532 Riau 5.5 3.6 9.1 25.6 31.1 56.7 31.3 34.7 66.1 86.2 474 Jambi 3.5 3.6 7.0 30.0 35.2 65.2 33.7 38.7 72.5 90.3 346 South Sumatera 3.4 4.0 7.4 27.1 37.7 64.8 30.5 41.7 72.2 89.8 871 Bengkulu 2.7 3.4 6.1 31.0 43.0 74.0 33.9 46.5 80.4 92.4 200 Lampung 2.4 3.1 5.5 31.3 39.8 71.1 33.9 43.0 76.8 92.8 925 Bangka Belitung 1.9 1.3 3.2 33.6 34.2 67.8 35.5 35.5 71.0 95.5 182 Riau Islands 5.3 7.1 12.3 22.6 34.9 57.6 28.1 42.0 70.1 82.4 134 Java DKI Jakarta 3.2 3.7 6.9 23.3 36.9 60.1 26.5 40.6 67.1 89.7 1,352 West Java 4.6 5.4 10.0 26.1 35.0 61.1 30.8 40.5 71.3 85.9 5,243 Central Java 2.7 4.7 7.4 24.0 39.8 63.7 26.8 44.5 71.3 89.7 5,158 DI Yogyakarta 2.9 3.9 6.8 21.1 45.7 66.9 24.5 50.0 74.4 90.8 517 East Java 3.2 5.1 8.2 24.3 41.8 66.1 27.5 47.1 74.6 88.9 5,525 Banten 5.6 3.4 9.0 33.1 24.3 57.4 38.8 27.6 66.5 86.4 1,231 Bali and Nusa Tenggara Bali 2.2 3.6 5.8 13.9 55.5 69.4 16.1 59.1 75.2 92.3 564 West Nusa Tenggara 8.6 4.3 12.9 26.4 28.4 54.8 35.2 32.7 67.8 81.0 636 East Nusa Tenggara 9.8 7.7 17.4 20.9 21.2 42.1 31.0 29.1 60.2 71.0 577 Kalimantan West Kalimantan 4.7 3.0 7.7 30.9 31.8 62.7 35.6 34.8 70.4 89.1 590 Central Kalimantan 3.7 2.1 5.7 31.8 34.8 66.5 35.5 36.9 72.4 92.1 280 South Kalimantan 3.3 2.9 6.2 36.6 27.8 64.4 39.9 30.7 70.6 91.2 507 East Kalimantan 3.4 4.3 7.7 25.0 34.3 59.2 28.5 38.6 67.0 88.6 455 Sulawesi North Sulawesi 2.2 3.9 6.1 24.1 45.1 69.3 26.3 49.1 75.5 91.9 360 Central Sulawesi 4.0 4.3 8.3 27.9 35.7 63.6 32.5 40.1 72.6 88.6 319 South Sulawesi 9.2 4.6 13.9 24.8 28.6 53.4 34.1 33.3 67.4 79.4 967 Southeast Sulawesi 8.5 4.4 12.9 27.6 23.0 50.7 36.4 27.6 64.0 79.9 242 Gorontalo 4.9 1.8 6.6 23.2 36.9 60.1 28.2 38.7 66.9 90.1 152 West Sulawesi 12.3 5.0 17.4 26.7 18.7 45.4 39.1 23.7 62.8 72.4 131 Maluku and Papua Maluku 8.9 13.5 22.4 13.2 21.0 34.1 22.1 34.5 56.6 60.3 157 North Maluku 6.7 6.3 13.0 25.3 23.5 48.8 32.0 29.8 61.8 78.9 120 Papua 7.7 8.1 15.8 19.5 18.8 38.3 27.2 26.9 54.1 70.8 242 West Papua 12.2 4.3 16.6 18.4 21.2 39.6 30.6 25.5 56.2 70.5 83 Total 4.3 4.7 9.1 25.1 36.3 61.4 29.5 41.1 70.6 87.2 30,931 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed; amenorrheic women who are not using family planning and whose last birth was mistimed, or whose last birth was unwanted but now say they want more children; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and say they want to wait 2 or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted; amenorrheic women who are not using family planning, whose last child was unwanted and who do not want any more children; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want no more children 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here 274 | Appendix A Table A-7.3 Mean ideal number of children by province Mean ideal number of children for all ever-married women by age and province, Indonesia 2007 Age Province 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Sumatera Nanggroe Aceh Darussalam 4.1 3.8 3.8 4.2 4.2 4.4 4.5 4.1 North Sumatera 3.2 3.2 3.0 3.7 3.6 3.9 4.7 3.7 West Sumatera 2.3 2.6 2.8 3.1 3.2 3.1 3.6 3.0 Riau 2.9 2.7 3.0 2.9 3.1 3.4 3.5 3.1 Jambi 2.3 2.3 2.4 2.7 2.9 2.7 3.0 2.6 South Sumatera 2.7 2.6 2.6 2.9 3.3 3.4 3.8 3.1 Bengkulu 2.6 2.5 2.6 2.6 2.8 3.2 3.4 2.8 Lampung 2.1 2.5 2.8 2.8 3.0 3.1 3.6 2.9 Bangka Belitung 3.2 2.6 2.6 2.9 3.2 3.4 3.9 3.0 Riau Islands 2.7 2.3 2.5 2.8 2.6 3.0 3.4 2.7 Java DKI Jakarta 2.0 2.4 2.5 2.5 2.7 2.8 2.9 2.6 West Java 2.4 2.5 2.9 2.7 2.8 3.0 3.0 2.8 Central Java 2.3 2.5 2.4 2.5 2.7 2.7 3.0 2.6 DI Yogyakarta 2.4 2.2 2.1 2.2 2.2 2.3 2.5 2.3 East Java 2.2 2.1 2.2 2.4 2.4 2.4 2.4 2.3 Banten 4.0 3.2 3.3 3.2 3.2 3.3 3.3 3.3 Bali and Nusa Tenggara Bali 1.6 2.1 2.2 2.2 2.3 2.2 2.4 2.2 West Nusa Tenggara 2.0 2.5 3.0 3.2 3.1 3.3 3.7 3.1 East Nusa Tenggara 3.4 3.3 3.5 3.4 3.4 3.7 3.9 3.5 Kalimantan West Kalimantan 2.5 2.5 2.7 2.9 3.3 3.8 4.0 3.1 Central Kalimantan 2.3 2.5 2.7 2.8 2.8 2.9 3.1 2.7 South Kalimantan 2.5 2.7 2.8 2.9 2.8 3.1 3.5 2.9 East Kalimantan 2.4 2.8 2.5 2.7 2.9 3.0 3.6 2.8 Sulawesi North Sulawesi 2.0 2.0 2.3 2.3 2.4 2.4 2.5 2.3 Central Sulawesi 2.3 2.5 2.7 2.9 3.1 2.9 3.9 2.9 South Sulawesi 2.6 2.6 2.9 3.0 3.1 3.5 3.6 3.1 Southeast Sulawesi 2.9 3.1 3.3 3.7 3.8 3.9 4.2 3.6 Gorontalo 2.1 2.1 2.5 2.6 2.9 2.7 3.2 2.7 West Sulawesi 3.3 3.5 3.3 3.6 4.4 4.8 5.3 4.0 Maluku and Papua Maluku 2.7 2.9 3.3 3.4 3.4 3.6 3.7 3.4 North Maluku 2.4 2.4 2.9 3.1 3.3 3.6 3.5 3.0 Papua 4.0 3.2 3.6 3.7 3.9 3.8 3.6 3.7 West Papua 2.9 3.2 3.0 3.2 3.7 3.4 3.8 3.3 Total 2.5 2.5 2.7 2.8 2.8 2.9 3.1 2.8 1 Means are calculated excluding respondents who gave non-numeric responses. Appendix A | 275 Table A-7.4 Fertility planning status by province Percent distribution of births to women in the five years preceding the survey (including current pregnancies), by planning status of the birth, by province, Indonesia 2007 Planning status of birth Province Wanted then Wanted later Wanted no more Missing Total Number of births Sumatera Nanggroe Aceh Darussalam 84.8 12.3 2.2 0.7 100.0 368 North Sumatera 80.5 11.0 7.9 0.6 100.0 1,274 West Sumatera 77.8 10.9 11.1 0.2 100.0 412 Riau 76.3 18.6 4.3 0.8 100.0 321 Jambi 82.7 6.4 10.0 0.8 100.0 210 South Sumatera 80.5 12.7 5.3 1.6 100.0 528 Bengkulu 77.7 12.7 9.6 0.0 100.0 121 Lampung 79.0 12.6 7.8 0.5 100.0 502 Bangka Belitung 88.5 5.8 4.8 0.9 100.0 117 Riau Islands 72.1 19.4 7.8 0.7 100.0 101 Java DKI Jakarta 83.4 10.8 5.3 0.4 100.0 825 West Java 76.1 15.2 7.7 1.0 100.0 2,885 Central Java 80.6 10.6 8.5 0.3 100.0 2,545 DI Yogyakarta 78.2 12.8 8.7 0.2 100.0 235 East Java 78.0 10.4 10.9 0.7 100.0 2,363 Banten 75.9 16.7 7.3 0.1 100.0 756 Bali and Nusa Tenggara Bali 86.8 8.9 3.9 0.4 100.0 281 West Nusa Tenggara 83.1 13.3 3.1 0.6 100.0 457 East Nusa Tenggara 79.5 12.4 6.8 1.3 100.0 562 Kalimantan West Kalimantan 85.3 10.5 3.2 1.0 100.0 416 Central Kalimantan 86.5 8.2 4.7 0.6 100.0 186 South Kalimantan 81.8 9.9 7.5 0.7 100.0 330 East Kalimantan 80.8 12.6 6.2 0.5 100.0 296 Sulawesi North Sulawesi 71.3 13.5 13.4 1.7 100.0 211 Central Sulawesi 78.5 12.6 8.1 0.9 100.0 261 South Sulawesi 84.1 12.1 2.8 0.9 100.0 692 Southeast Sulawesi 82.5 12.0 4.6 0.9 100.0 213 Gorontalo 84.1 8.8 6.1 0.9 100.0 90 West Sulawesi 69.2 26.0 4.5 0.3 100.0 115 Maluku and Papua Maluku 84.1 6.9 8.3 0.7 100.0 155 North Maluku 79.6 14.0 5.6 0.7 100.0 105 Papua 78.1 16.5 4.0 1.4 100.0 165 West Papua 74.5 16.2 6.1 3.2 100.0 68 Total 79.6 12.3 7.4 0.7 100.0 18,168 276 | Appendix A Table A-7.5 Wanted fertility rates by province Total wanted fertility rates and total fertility rates for the three years preceding the survey, by province, Indonesia 2007 Province Total wanted fertility rates Total fertility rate Sumatera Nanggroe Aceh Darussalam 2.8 3.1 North Sumatera 3.2 3.8 West Sumatera 2.7 3.4 Riau 2.2 2.7 Jambi 2.3 2.8 South Sumatera 2.3 2.7 Bengkulu 2.1 2.4 Lampung 2.1 2.5 Bangka Belitung 2.2 2.5 Riau Islands 2.4 3.1 Java DKI Jakarta 1.8 2.1 West Java 2.2 2.6 Central Java 2.0 2.3 DI Yogyakarta 1.5 1.8 East Java 1.8 2.1 Banten 2.2 2.6 Bali and Nusa Tenggara Bali 1.7 2.1 West Nusa Tenggara 2.4 2.8 East Nusa Tenggara 3.6 4.2 Kalimantan West Kalimantan 2.4 2.8 Central Kalimantan 2.5 3.0 South Kalimantan 2.3 2.6 East Kalimantan 2.3 2.7 Sulawesi North Sulawesi 2.1 2.8 Central Sulawesi 2.5 3.3 South Sulawesi 2.4 2.8 Southeast Sulawesi 2.8 3.3 Gorontalo 2.1 2.6 West Sulawesi 3.2 3.5 Maluku and Papua Maluku 3.0 3.9 North Maluku 2.7 3.2 Papua 2.6 2.9 West Papua 2.7 3.4 Total 2.2 2.6 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. Appendix A | 277 CHAPTER 9 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table A-9.1 Current marital status by province Percent distribution of women by current marital status, according to province, Indonesia 2007 Marital status Province Never married Married Divorced Widowed Total Number of women Sumatera Nanggroe Aceh Darussalam 21.3 72.3 1.2 5.1 100.0 653 North Sumatera 16.8 77.7 1.9 3.6 100.0 1,787 West Sumatera 23.2 71.6 3.0 2.2 100.0 743 Riau 19.7 77.1 1.5 1.7 100.0 615 Jambi 28.1 67.8 2.0 2.1 100.0 510 South Sumatera 31.6 64.2 1.5 2.7 100.0 1,356 Bengkulu 21.3 74.4 2.5 1.8 100.0 268 Lampung 20.1 76.8 1.6 1.5 100.0 1,206 Bangka Belitung 23.4 72.1 1.8 2.7 100.0 253 Riau Islands 18.8 77.8 1.4 2.0 100.0 172 Java DKI Jakarta 16.4 76.9 3.4 3.4 100.0 1,758 West Java 25.0 71.0 2.8 1.3 100.0 7,390 Central Java 17.9 78.7 1.4 2.0 100.0 6,555 DI Yogyakarta 15.0 79.8 2.5 2.8 100.0 648 East Java 25.8 69.2 2.6 2.4 100.0 7,989 Banten 25.1 70.4 2.3 2.3 100.0 1,749 Bali and Nusa Tenggara Bali 15.5 81.0 1.5 2.0 100.0 695 West Nusa Tenggara 25.5 67.2 4.3 3.1 100.0 946 East Nusa Tenggara 18.1 75.4 3.2 3.3 100.0 765 Kalimantan West Kalimantan 30.7 65.2 2.2 1.9 100.0 905 Central Kalimantan 37.0 59.8 1.6 1.5 100.0 467 South Kalimantan 27.8 66.6 3.3 2.4 100.0 762 East Kalimantan 26.0 70.9 1.7 1.4 100.0 641 Sulawesi North Sulawesi 18.6 78.5 1.7 1.2 100.0 458 Central Sulawesi 24.3 71.2 2.1 2.3 100.0 447 South Sulawesi 30.5 63.0 3.6 2.9 100.0 1,536 Southeast Sulawesi 35.1 60.7 1.7 2.5 100.0 399 Gorontalo 34.0 61.5 2.3 2.3 100.0 247 West Sulawesi 30.4 65.1 2.8 1.7 100.0 200 Maluku and Papua Maluku 18.6 76.0 3.2 2.2 100.0 207 North Maluku 22.2 72.5 4.2 1.1 100.0 166 Papua 24.7 72.7 1.0 1.6 100.0 333 West Papua 27.5 67.6 2.3 2.6 100.0 123 Total 23.4 72.0 2.4 2.2 100.0 42,951 278 | Appendix A Table A-9.2 Median age at first marriage by province Median age at first marriage among women by five-year age groups, age 25-49, according to province, Indonesia 2007 Age Province 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Sumatera Nanggroe Aceh Darussalam 21.6 20.4 19.9 19.1 18.6 20.2 North Sumatera 22.9 23.1 22.5 21.6 20.1 22.1 West Sumatera 21.1 20.9 20.3 20.4 20.1 20.6 Riau 21.3 21.4 20.3 20.4 19.5 20.7 Jambi 19.6 19.3 19.5 18.7 17.7 19.1 South Sumatera 20.4 19.4 19.8 18.2 17.9 19.3 Bengkulu 19.2 20.1 19.3 18.5 18.9 19.3 Lampung 20.3 19.9 18.6 17.9 16.7 19.0 Bangka Belitung 21.4 20.3 20.4 19.6 19.7 20.4 Riau Islands 22.4 22.2 22.0 21.3 20.2 21.8 Java DKI Jakarta 23.5 23.6 22.7 20.7 19.8 22.5 West Java 20.3 19.8 19.1 17.5 17.3 18.8 Central Java 21.1 20.2 20.2 18.6 18.5 19.6 DI Yogyakarta 23.0 23.1 22.5 21.5 20.0 22.0 East Java 19.8 19.5 19.0 18.1 17.6 18.8 Banten 20.2 19.9 18.6 17.1 17.3 18.8 Bali and Nusa Tenggara Bali 21.7 21.6 21.9 21.0 19.7 21.3 West Nusa Tenggara 19.8 20.8 19.7 19.5 19.3 19.9 East Nusa Tenggara 20.9 21.5 22.1 22.4 21.2 21.7 Kalimantan West Kalimantan 20.9 20.4 20.1 19.5 19.2 20.1 Central Kalimantan 18.8 20.3 19.8 19.7 18.2 19.4 South Kalimantan 19.2 19.2 19.7 17.8 17.5 18.7 East Kalimantan 21.2 20.6 20.7 18.0 18.4 20.4 Sulawesi North Sulawesi 20.9 21.4 21.7 21.0 20.2 21.0 Central Sulawesi 20.2 20.1 19.9 20.2 19.0 20.0 South Sulawesi 20.5 21.1 21.2 19.7 19.4 20.5 Southeast Sulawesi 19.8 19.2 20.3 19.5 18.8 19.6 Gorontalo 19.7 21.1 20.9 21.2 20.0 20.6 West Sulawesi 20.1 20.3 19.3 18.1 18.3 19.4 Maluku and Papua Maluku 22.4 22.3 21.8 21.2 22.5 22.2 North Maluku 20.3 20.4 19.6 19.0 19.6 20.0 Papua 19.9 20.0 19.1 19.7 19.7 19.6 West Papua 20.6 20.7 20.6 20.7 19.8 20.5 Total 20.8 20.4 20.0 18.9 18.3 19.8 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group Appendix A | 279 Table A-9.3 Recent sexual activity by province Percent distribution of currently married women by timing of last sexual intercourse, according to province, Indonesia 2007 Timing of last sexual intercourse Province Within the last 4 weeks Within 1 year1 One or more years Missing Total Number of women Sumatera Nanggroe Aceh Darussalam 88.6 9.6 1.2 0.6 100.0 472 North Sumatera 84.1 13.7 1.7 0.5 100.0 1,389 West Sumatera 83.5 14.7 1.0 0.8 100.0 532 Riau 85.3 12.5 2.0 0.1 100.0 474 Jambi 82.6 14.6 2.7 0.1 100.0 346 South Sumatera 79.6 18.2 2.0 0.3 100.0 871 Bengkulu 87.3 11.0 1.2 0.5 100.0 200 Lampung 82.7 15.8 1.3 0.1 100.0 925 Bangka Belitung 88.4 9.6 1.5 0.4 100.0 182 Riau Islands 80.9 16.7 1.5 0.9 100.0 134 Java DKI Jakarta 86.8 11.8 1.2 0.2 100.0 1,352 West Java 83.8 14.7 1.4 0.1 100.0 5,243 Central Java 74.8 22.2 2.9 0.1 100.0 5,158 DI Yogyakarta 79.9 16.9 3.2 0.0 100.0 517 East Java 74.5 20.0 5.3 0.2 100.0 5,525 Banten 86.2 11.4 1.2 1.2 100.0 1,231 Bali and Nusa Tenggara Bali 91.0 7.2 1.4 0.4 100.0 564 West Nusa Tenggara 78.6 14.3 6.9 0.2 100.0 636 East Nusa Tenggara 73.0 16.3 8.1 2.7 100.0 577 Kalimantan West Kalimantan 82.3 13.7 2.1 1.8 100.0 590 Central Kalimantan 87.2 11.7 1.1 0.0 100.0 280 South Kalimantan 86.4 11.4 1.7 0.5 100.0 507 East Kalimantan 82.2 15.6 1.2 1.0 100.0 455 Sulawesi North Sulawesi 82.3 14.4 2.4 0.9 100.0 360 Central Sulawesi 85.4 12.7 1.0 0.8 100.0 319 South Sulawesi 79.7 17.0 2.9 0.5 100.0 967 Southeast Sulawesi 74.4 20.8 3.3 1.5 100.0 242 Gorontalo 78.9 18.9 1.2 1.0 100.0 152 West Sulawesi 82.2 13.9 3.4 0.6 100.0 131 Maluku and Papua Maluku 77.3 18.5 3.6 0.7 100.0 157 North Maluku 76.0 19.9 3.7 0.4 100.0 120 Papua 59.8 16.7 7.9 15.6 100.0 242 West Papua 80.0 11.7 3.5 4.7 100.0 83 Total 80.1 16.6 2.8 0.5 100.0 30,931 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 280 | Appendix A Table A-9.4 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility by province Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by province, Indonesia 2007 Province Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility Number of births Sumatera Nanggroe Aceh Darussalam 4.3 1.9 5.2 203 North Sumatera 5.1 2.0 5.8 716 West Sumatera 3.1 2.0 3.3 234 Riau 2.4 1.9 3.4 171 Jambi 3.5 2.1 3.5 110 South Sumatera 2.4 2.3 2.8 298 Bengkulu 4.2 2.3 4.8 63 Lampung 3.1 2.3 4.0 286 Bangka Belitung 3.1 2.6 3.4 63 Riau Islands 2.2 1.9 2.2 58 Java DKI Jakarta 2.4 2.1 2.8 438 West Java 2.6 2.2 3.4 1,560 Central Java 2.7 2.7 4.0 1,374 DI Yogyakarta 3.9 2.7 4.3 122 East Java 2.8 4.2 4.8 1,317 Banten 3.3 2.4 3.6 404 Bali and Nusa Tenggara Bali 2.1 1.4 2.1 143 West Nusa Tenggara 4.6 2.4 5.5 243 East Nusa Tenggara 5.6 4.1 7.5 313 Kalimantan West Kalimantan 3.4 2.2 3.6 222 Central Kalimantan 2.7 2.0 3.4 101 South Kalimantan 2.2 2.1 2.5 171 East Kalimantan 2.8 1.9 3.3 157 Sulawesi North Sulawesi 2.2 1.5 2.5 116 Central Sulawesi 4.6 2.5 5.0 139 South Sulawesi 3.8 2.1 4.9 381 Southeast Sulawesi 5.3 2.3 6.3 107 Gorontalo 3.6 2.8 4.0 48 West Sulawesi 4.3 2.1 6.7 61 Maluku and Papua Maluku 4.3 2.9 6.0 89 North Maluku 5.0 2.8 5.7 53 Papua 3.1 2.8 4.9 82 West Papua 2.2 1.7 3.1 36 Total 3.1 2.4 4.1 9,882 Note: Medians are based on the status at the time of the survey (current status) 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Appendix A | 281 Table A-9.5.1 Median age at first intercourse by province: Ever-married women Median age at first sexual intercourse among ever-married women by five-year age groups, age 25-49, according to province, Indonesia 2007 Age Province 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Sumatera Nanggroe Aceh Darussalam 20.3 20.3 20.2 19.1 18.6 19.8 North Sumatera 21.6 22.5 23.1 21.7 20.5 21.9 West Sumatera 20.7 20.9 20.5 20.4 20.4 20.6 Riau 20.8 21.6 20.6 20.9 19.8 20.9 Jambi 19.4 19.4 19.7 18.9 17.9 19.2 South Sumatera 20.2 19.5 20.1 18.3 18.3 19.4 Bengkulu 19.4 19.9 19.2 18.3 18.9 19.3 Lampung 19.4 20.0 18.5 18.0 16.8 18.7 Bangka Belitung 21.0 20.7 20.3 19.7 20.1 20.4 Riau Islands 21.2 22.7 22.2 21.9 20.8 21.8 Java DKI Jakarta 21.7 22.5 22.2 20.3 19.7 21.5 West Java 19.9 19.7 19.3 17.6 17.8 18.9 Central Java 19.9 20.1 20.5 18.8 18.8 19.6 DI Yogyakarta 21.8 22.5 22.2 21.1 19.8 21.4 East Java 18.9 19.3 19.2 18.1 17.7 18.7 Banten 19.5 20.2 18.8 17.2 17.5 18.8 Bali and Nusa Tenggara Bali 20.7 20.7 21.0 20.7 20.1 20.7 West Nusa Tenggara 19.7 20.8 20.0 19.8 19.3 19.9 East Nusa Tenggara 20.4 21.7 21.6 22.7 21.0 21.5 Kalimantan West Kalimantan 20.9 21.0 20.6 20.6 19.8 20.7 Central Kalimantan 19.0 20.4 20.3 19.9 18.1 19.6 South Kalimantan 18.8 18.9 20.0 17.7 17.5 18.6 East Kalimantan 20.6 20.5 21.1 18.6 18.7 20.3 Sulawesi North Sulawesi 20.2 21.1 21.4 20.5 20.4 20.7 Central Sulawesi 19.3 20.1 19.8 20.6 19.0 19.8 South Sulawesi 19.5 20.7 20.6 19.6 19.1 20.0 Southeast Sulawesi 19.2 19.1 20.6 19.9 19.0 19.6 Gorontalo 19.5 21.1 21.6 21.1 20.3 20.7 West Sulawesi 19.6 20.0 18.7 18.3 19.3 19.3 Maluku and Papua Maluku 20.1 19.9 20.3 20.7 22.2 20.4 North Maluku 20.0 19.9 20.3 20.4 20.4 20.1 Papua 19.3 19.1 19.0 19.0 19.2 19.1 West Papua 20.1 20.7 20.4 20.7 20.0 20.4 Total 20.0 20.3 20.1 19.0 18.5 19.7 a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching the beginning of the age group 282 | Appendix A Table A-9.5.2 Median age at first intercourse by province: Currently married men Median age at first sexual intercourse among currently married men by five-year age groups, age 25-54, according to province, Indonesia 2007 Age Province 25-29 30-34 35-39 40-44 45-49 50-54 Men age 25-54 Sumatera Nanggroe Aceh Darussalam 24.5 25.5 26.8 27.0 25.1 24.2 a North Sumatera 23.9 25.1 25.4 25.1 23.2 22.7 24.2 West Sumatera 22.5 24.0 27.6 23.9 24.1 23.8 24.1 Riau 24.5 25.0 25.5 25.1 23.1 23.3 24.8 Jambi 23.2 25.4 24.6 21.6 22.8 23.1 23.6 South Sumatera 22.9 24.8 23.9 22.7 21.7 21.9 23.2 Bengkulu 23.7 25.0 23.3 25.9 24.6 23.6 24.3 Lampung 23.3 25.0 24.7 24.3 22.8 22.6 24.1 Bangka Belitung 23.0 24.3 23.0 23.7 24.3 22.7 23.6 Riau Islands 23.4 24.1 24.1 23.7 22.7 24.2 23.6 Java DKI Jakarta 23.2 25.5 26.1 25.6 24.1 24.7 a West Java 23.5 25.2 22.3 23.7 22.5 22.0 23.3 Central Java 23.5 25.2 25.4 23.3 22.1 23.4 23.7 DI Yogyakarta 23.4 25.2 25.1 26.6 24.4 23.6 24.8 East Java 22.8 24.6 24.2 23.0 22.3 22.3 23.3 Banten 23.9 24.0 25.4 25.3 23.2 22.0 24.3 Bali and Nusa Tenggara Bali 21.5 23.1 20.8 22.4 21.0 23.4 22.3 West Nusa Tenggara 22.9 22.5 23.7 24.0 21.9 23.0 23.0 East Nusa Tenggara 20.1 20.6 22.5 22.7 23.5 22.1 21.7 Kalimantan West Kalimantan 22.0 25.0 24.4 22.2 23.7 22.3 23.2 Central Kalimantan 21.4 24.1 23.5 25.3 23.7 25.9 24.0 South Kalimantan 22.5 23.7 21.9 24.2 19.9 20.4 22.4 East Kalimantan 24.1 23.0 23.7 24.3 24.7 23.9 23.8 Sulawesi North Sulawesi 19.7 19.6 21.0 20.8 22.9 21.2 20.8 Central Sulawesi 21.3 20.7 21.8 21.6 21.6 24.0 21.7 South Sulawesi 22.8 22.3 21.2 25.3 23.6 22.5 22.7 Southeast Sulawesi 20.5 21.2 21.5 24.7 24.4 23.7 22.6 Gorontalo 21.2 21.1 22.8 23.0 23.4 23.0 22.3 West Sulawesi 19.5 21.3 22.3 22.5 21.2 20.4 21.1 Maluku and Papua Maluku 19.5 20.1 19.6 19.6 20.4 20.3 20.0 North Maluku 18.4 19.5 19.6 19.8 18.9 20.9 19.5 Papua 20.4 21.1 18.7 22.5 21.1 23.6 20.8 West Papua 19.2 20.9 20.2 20.0 25.6 27.4 20.6 Total 23.1 24.5 24.1 23.7 22.6 22.7 23.5 a = Omitted because less than 50 percent of the men had intercourse for the first time before reaching the beginning of the age group Appendix A | 283 CHAPTER 10 INFANT AND CHILD MORTALITY Table A-10.1 Early childhood mortality rates by province by province Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by province, Indonesia 2007 Province Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Sumatera Nanggroe Aceh Darussalam 14 11 25 21 45 North Sumatera 24 22 46 22 67 West Sumatera 34 13 47 16 62 Riau 28 8 37 11 47 Jambi 23 15 39 9 47 South Sumatera 25 17 42 11 52 Bengkulu 17 29 46 20 65 Lampung 27 16 43 13 55 Bangka Belitung 20 19 39 8 46 Riau Islands 18 25 43 16 58 Java DKI Jakarta 15 13 28 9 36 West Java 19 19 39 10 49 Central Java 14 12 26 6 32 DI Yogyakarta 15 3 19 3 22 East Java 21 14 35 10 45 Banten 25 21 46 13 58 Bali and Nusa Tenggara Bali 14 19 34 4 38 West Nusa Tenggara 34 38 72 21 92 East Nusa Tenggara 31 26 57 24 80 Kalimantan West Kalimantan 23 23 46 14 59 Central Kalimantan 13 17 30 4 34 South Kalimantan 39 19 58 19 75 East Kalimantan 16 11 26 12 38 Sulawesi North Sulawesi 24 11 35 9 43 Central Sulawesi 28 31 60 10 69 South Sulawesi 22 19 41 12 53 Southeast Sulawesi 16 25 41 21 62 Gorontalo 22 31 52 18 69 West Sulawesi 46 27 74 25 96 Maluku and Papua Maluku 25 34 59 37 93 North Maluku 32 19 51 24 74 Papua 24 17 41 25 64 West Papua 21 16 36 26 62 1 Computed as the difference between the infant and neonatal mortality rates 284 | Appendix A CHAPTER 11 MATERNAL HEALTH Table A-11.1 Antenatal care by province Percent distribution of women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to province, Indonesia 2007 Province Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Total Percentage receiving antenatal care from a skilled provider Number of women Sumatera Nanggroe Aceh Darussalam 1.8 10.2 77.3 4.2 0.4 6.2 100.0 89.2 269 North Sumatera 2.8 11.9 74.7 1.7 0.5 8.5 100.0 89.3 803 West Sumatera 2.2 10.4 83.4 3.0 0.1 0.8 100.0 96.0 304 Riau 6.2 18.3 68.7 1.3 0.4 5.1 100.0 93.2 243 Jambi 2.9 7.0 74.8 10.3 0.9 4.2 100.0 84.6 169 South Sumatera 1.9 8.3 81.0 1.5 0.3 6.9 100.0 91.3 424 Bengkulu 4.3 8.1 81.3 2.1 0.0 4.2 100.0 93.7 100 Lampung 2.5 9.3 83.6 1.4 0.3 2.9 100.0 95.4 409 Bangka Belitung 0.0 13.5 80.4 1.4 0.2 4.4 100.0 94.0 93 Riau Islands 2.6 28.3 62.9 0.7 1.4 4.1 100.0 93.8 76 Java DKI Jakarta 0.6 24.5 74.3 0.0 0.1 0.4 100.0 99.5 649 West Java 1.5 11.4 82.3 1.2 0.4 3.1 100.0 95.3 2,328 Central Java 1.2 10.5 85.6 0.4 0.4 1.9 100.0 97.3 2,109 DI Yogyakarta 1.0 25.5 72.8 0.0 0.3 0.5 100.0 99.3 179 East Java 2.1 11.5 79.6 3.4 0.0 3.4 100.0 93.2 1,947 Banten 1.7 14.4 70.3 8.7 0.6 4.4 100.0 86.3 599 Bali and Nusa Tenggara Bali 1.6 30.5 66.6 0.1 0.5 0.7 100.0 98.8 225 West Nusa Tenggara 1.2 5.3 88.8 0.7 0.0 4.0 100.0 95.3 347 East Nusa Tenggara 3.3 6.0 77.8 2.4 0.4 10.0 100.0 87.1 375 Kalimantan West Kalimantan 2.4 5.2 82.9 1.4 0.4 7.6 100.0 90.6 312 Central Kalimantan 1.9 5.7 83.3 5.1 0.0 3.9 100.0 91.0 138 South Kalimantan 1.9 9.7 81.5 2.4 0.0 4.6 100.0 93.0 249 East Kalimantan 3.9 19.9 70.1 2.7 0.0 3.4 100.0 93.9 218 Sulawesi North Sulawesi 4.6 19.1 72.2 0.8 0.6 2.7 100.0 95.9 166 Central Sulawesi 2.4 9.2 79.1 4.5 0.3 4.5 100.0 90.7 192 South Sulawesi 1.0 9.6 81.5 2.3 0.4 5.1 100.0 92.2 500 Southeast Sulawesi 3.2 6.4 81.7 4.3 0.0 4.3 100.0 91.3 144 Gorontalo 4.6 11.4 72.5 4.7 0.5 6.2 100.0 88.5 68 West Sulawesi 1.2 4.1 81.3 1.6 0.0 11.8 100.0 86.6 75 Maluku and Papua Maluku 3.3 9.8 57.1 15.6 0.0 14.1 100.0 70.3 99 North Maluku 3.7 11.4 72.9 5.9 0.7 5.4 100.0 88.0 71 Papua 2.1 11.7 55.2 0.4 1.8 28.8 100.0 69.0 117 West Papua 2.9 18.6 59.0 1.9 1.7 15.9 100.0 80.4 45 Total 1.9 12.0 79.3 2.2 0.3 4.2 100.0 93.3 14,043 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife Appendix A | 285 Table A-11.2 Components of antenatal care by province Among women with a live birth in the five years preceding the survey, among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, and the percentage who took iron tablets or syrup during the pregnancy of the most recent birth, according to province, Indonesia 2007 Among women who received antenatal care for their most recent birth in the last five years, the percentage with selected services: Among women with a live birth in the last five years, the percentage who during the pregnancy of their last birth: Province Informed of signs of pregnancy complications Weight measured Height measured Blood pressure measured Urine sample taken Blood sample taken Abdominal examination Number of women Took iron tablets or syrup Number of women Sumatera Nanggroe Aceh Darussalam 29.8 77.9 21.6 83.1 31.0 35.7 94.7 252 57.0 269 North Sumatera 27.7 66.6 12.1 79.8 36.1 20.7 89.3 735 62.7 803 West Sumatera 40.5 88.6 34.6 88.8 27.9 28.0 98.3 301 77.3 304 Riau 36.8 82.7 17.4 89.3 36.6 27.9 92.9 231 65.9 243 Jambi 31.0 76.5 22.8 85.2 20.9 23.6 95.7 162 70.9 169 South Sumatera 30.6 87.8 19.7 92.7 25.6 25.1 94.1 395 69.6 424 Bengkulu 38.3 83.4 22.1 91.9 21.5 19.0 97.3 96 78.8 100 Lampung 33.8 93.5 22.3 96.3 36.8 22.8 95.6 397 81.3 409 Bangka Belitung 31.0 94.8 25.4 94.8 33.0 30.6 96.1 89 78.5 93 Riau Islands 45.1 93.1 38.9 90.9 55.0 42.7 97.2 73 77.5 76 Java DKI Jakarta 39.9 99.6 37.6 98.9 69.6 58.0 98.9 646 80.3 649 West Java 50.8 95.7 34.6 94.9 38.8 27.8 96.2 2,255 82.1 2,328 Central Java 40.9 97.9 22.2 96.6 45.9 27.4 97.9 2,068 83.5 2,109 DI Yogyakarta 52.5 99.1 38.8 98.5 57.0 53.4 98.8 178 94.1 179 East Java 39.8 91.0 49.7 91.2 45.5 21.7 97.4 1,881 80.7 1,947 Banten 27.1 86.0 21.9 84.2 34.0 26.8 96.0 573 70.1 599 Bali and Nusa Tenggara Bali 40.0 98.4 52.9 94.8 55.7 44.5 98.8 223 92.8 225 West Nusa Tenggara 37.9 94.4 39.3 93.9 29.1 26.4 99.4 334 87.4 347 East Nusa Tenggara 37.4 91.3 45.4 85.2 23.0 36.3 96.7 338 83.4 375 Kalimantan West Kalimantan 25.6 90.9 39.4 92.5 42.2 39.3 87.5 288 54.4 312 Central Kalimantan 48.0 84.8 33.4 87.8 40.3 26.6 95.0 133 72.8 138 South Kalimantan 42.6 87.4 29.2 90.6 28.0 22.1 94.4 238 75.7 249 East Kalimantan 44.6 95.7 49.6 96.1 45.8 29.3 96.0 210 81.3 218 Sulawesi North Sulawesi 35.5 92.6 60.2 92.9 39.3 42.7 95.2 161 88.5 166 Central Sulawesi 36.0 82.4 35.1 86.8 27.8 30.1 96.6 184 75.7 192 South Sulawesi 28.1 90.4 45.5 94.9 42.8 26.5 96.8 474 71.9 500 Southeast Sulawesi 32.1 69.6 18.9 85.1 16.0 33.5 94.3 138 58.9 144 Gorontalo 25.2 82.3 46.3 87.4 22.1 37.0 92.9 64 67.3 68 West Sulawesi 21.5 85.6 57.6 86.9 43.2 48.3 90.3 66 59.1 75 Maluku and Papua Maluku 16.1 61.7 28.3 69.1 12.8 17.6 89.8 85 57.0 99 North Maluku 26.3 81.9 39.7 83.9 28.0 31.9 91.2 68 84.1 71 Papua 44.7 94.0 44.1 87.5 28.6 40.0 88.0 84 56.3 117 West Papua 46.1 93.4 48.3 89.4 40.2 52.5 94.9 38 65.1 45 Total 38.8 90.7 33.3 91.9 40.1 29.2 96.0 13,457 77.3 14,043 286 | Appendix A Table A-11.3 Tetanus toxoid injections by province Percent distribution of mothers who had a live birth in the five years preceding the survey by number of tetanus toxoid injections recieved during pregnancy for the most recent birth, according to province, Indonesia 2007 Province None One injection Two or more injections Don't know/ missing Total Number of mothers Sumatera Nanggroe Aceh Darussalam 43.4 12.3 42.7 1.6 100.0 269 North Sumatera 64.9 12.8 19.3 3.1 100.0 803 West Sumatera 17.6 19.2 61.9 1.3 100.0 304 Riau 33.6 21.0 41.5 3.9 100.0 243 Jambi 29.9 21.8 46.7 1.6 100.0 169 South Sumatera 33.4 16.1 47.3 3.3 100.0 424 Bengkulu 23.1 17.1 59.5 0.3 100.0 100 Lampung 21.0 22.4 53.6 3.0 100.0 409 Bangka Belitung 21.9 14.8 58.8 4.5 100.0 93 Riau Islands 42.7 19.1 30.4 7.8 100.0 76 Java DKI Jakarta 21.8 24.8 51.6 1.8 100.0 649 West Java 17.9 19.0 60.6 2.5 100.0 2,328 Central Java 16.1 26.4 53.1 4.5 100.0 2,109 DI Yogyakarta 13.7 28.4 56.1 1.8 100.0 179 East Java 31.5 28.1 39.0 1.3 100.0 1,947 Banten 35.0 16.2 45.1 3.7 100.0 599 Bali and Nusa Tenggara Bali 11.3 28.8 58.6 1.2 100.0 225 West Nusa Tenggara 28.4 21.0 48.8 1.8 100.0 347 East Nusa Tenggara 22.7 21.5 54.8 0.9 100.0 375 Kalimantan West Kalimantan 30.9 17.3 49.5 2.3 100.0 312 Central Kalimantan 22.6 30.4 43.1 3.9 100.0 138 South Kalimantan 29.8 14.0 55.0 1.2 100.0 249 East Kalimantan 16.0 29.1 53.5 1.4 100.0 218 Sulawesi North Sulawesi 11.4 23.1 63.5 2.0 100.0 166 Central Sulawesi 18.4 19.5 59.3 2.9 100.0 192 South Sulawesi 17.1 22.7 59.2 1.0 100.0 500 Southeast Sulawesi 19.1 18.1 59.4 3.4 100.0 144 Gorontalo 25.5 36.9 33.0 4.7 100.0 68 West Sulawesi 21.6 19.8 56.6 2.0 100.0 75 Maluku and Papua Maluku 42.3 13.9 42.6 1.2 100.0 99 North Maluku 13.6 14.8 68.0 3.6 100.0 71 Papua 43.4 17.1 31.6 7.9 100.0 117 West Papua 29.9 18.3 42.0 9.9 100.0 45 Total 25.9 21.8 49.7 2.6 100.0 14,043 Appendix A | 287 Table A-11.4 Place of delivery by province Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health facility, according to province, Indonesia 2007 Health facility Province Public sector Private sector Home Other Missing Total Percentage delivered in a health facility Number of births Sumatera Nanggroe Aceh Darussalam 7.7 17.1 74.5 0.0 0.6 100.0 24.8 324 North Sumatera 5.1 29.9 64.4 0.4 0.2 100.0 35.0 1,197 West Sumatera 18.5 45.0 34.7 1.5 0.4 100.0 63.5 383 Riau 4.9 38.7 55.4 0.2 0.8 100.0 43.6 290 Jambi 5.6 20.5 72.9 0.0 1.0 100.0 26.1 186 South Sumatera 7.6 25.8 64.9 0.2 1.5 100.0 33.4 491 Bengkulu 6.3 5.8 87.9 0.0 0.0 100.0 12.1 111 Lampung 2.5 42.2 54.9 0.0 0.5 100.0 44.7 452 Bangka Belitung 10.1 33.1 54.4 1.5 0.9 100.0 43.2 103 Riau Islands 11.0 65.3 23.1 0.0 0.6 100.0 76.3 93 Java DKI Jakarta 14.8 73.7 11.2 0.2 0.2 100.0 88.4 741 West Java 6.0 38.6 54.5 0.1 0.8 100.0 44.6 2,600 Central Java 7.6 45.5 46.4 0.2 0.3 100.0 53.1 2,308 DI Yogyakarta 16.9 69.9 12.7 0.3 0.2 100.0 86.8 201 East Java 8.5 57.0 32.0 1.6 0.9 100.0 65.5 2,178 Banten 3.7 34.4 61.6 0.1 0.2 100.0 38.1 695 Bali and Nusa Tenggara Bali 24.6 66.2 8.5 0.0 0.7 100.0 90.8 253 West Nusa Tenggara 25.9 6.3 58.4 8.9 0.6 100.0 32.2 412 East Nusa Tenggara 16.1 4.5 77.5 0.5 1.4 100.0 20.7 507 Kalimantan West Kalimantan 8.8 24.9 65.2 0.4 0.7 100.0 33.7 374 Central Kalimantan 5.2 8.9 84.9 0.4 0.6 100.0 14.1 160 South Kalimantan 8.8 10.5 79.8 0.0 0.8 100.0 19.4 289 East Kalimantan 21.2 24.6 53.5 0.4 0.2 100.0 45.8 262 Sulawesi North Sulawesi 26.6 28.4 43.0 0.5 1.5 100.0 55.0 191 Central Sulawesi 11.7 7.3 80.2 0.4 0.4 100.0 19.0 243 South Sulawesi 16.0 14.6 68.9 0.0 0.5 100.0 30.6 631 Southeast Sulawesi 6.3 2.0 90.5 0.6 0.5 100.0 8.4 192 Gorontalo 13.7 8.0 74.8 2.6 0.9 100.0 21.7 82 West Sulawesi 8.9 3.7 87.0 0.0 0.4 100.0 12.6 103 Maluku and Papua Maluku 8.4 4.0 87.1 0.2 0.2 100.0 12.4 143 North Maluku 10.7 7.3 80.5 0.4 1.0 100.0 18.0 93 Papua 18.9 7.4 70.8 1.2 1.7 100.0 26.2 152 West Papua 32.5 6.5 55.7 1.4 3.9 100.0 39.0 62 Total 9.7 36.4 52.7 0.7 0.6 100.0 46.1 16,504 1 Includes only the most recent birth in the five years preceding the survey 288 | Appendix A Table A-11.5 Assistance during delivery by province: Most qualified person Percent distribution of live births in the five years preceding the survey by the most qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to province, Indonesia 2007 Person providing assistance during delivery Province Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Missing Total Percentage delivered by a skilled provider Percentage delivered by C-section Number of births Sumatera Nanggroe Aceh Darussalam 0.5 8.8 63.2 25.9 0.4 0.3 1.0 100.0 72.5 4.9 324 North Sumatera 1.0 12.4 71.0 10.7 0.1 0.9 3.9 100.0 84.5 7.0 1,197 West Sumatera 1.9 12.8 65.8 18.7 0.0 0.3 0.6 100.0 80.5 8.7 383 Riau 1.4 13.3 70.2 13.1 0.6 0.1 1.2 100.0 84.9 11.4 290 Jambi 0.7 7.4 61.8 28.5 0.6 0.4 0.7 100.0 69.8 3.9 186 South Sumatera 0.5 10.6 56.5 28.6 0.4 1.6 1.9 100.0 67.5 3.8 491 Bengkulu 1.6 6.1 64.5 25.5 0.0 0.0 2.2 100.0 72.3 2.7 111 Lampung 0.5 6.5 62.8 28.9 0.2 0.6 0.5 100.0 69.8 3.8 452 Bangka Belitung 2.7 9.3 69.5 17.0 0.6 0.8 0.0 100.0 81.5 3.0 103 Riau Islands 1.6 21.8 68.3 5.3 0.5 1.4 1.2 100.0 91.6 13.1 93 Java DKI Jakarta 1.5 30.3 65.5 2.6 0.0 0.1 0.0 100.0 97.3 13.8 741 West Java 0.8 11.1 56.3 29.8 0.6 0.8 0.6 100.0 68.2 6.3 2,600 Central Java 1.0 12.0 70.0 16.7 0.3 0.0 0.0 100.0 83.0 5.4 2,308 DI Yogyakarta 3.2 35.1 57.4 4.0 0.2 0.0 0.0 100.0 95.8 10.3 201 East Java 0.6 13.9 63.0 21.6 0.0 0.5 0.4 100.0 77.5 9.0 2,178 Banten 0.4 14.6 37.2 46.8 0.3 0.3 0.5 100.0 52.1 9.4 695 Bali and Nusa Tenggara Bali 3.2 30.4 59.0 5.3 0.3 0.0 1.8 100.0 92.6 12.2 253 West Nusa Tenggara 1.3 8.5 54.5 33.8 0.4 0.0 1.5 100.0 64.3 6.7 412 East Nusa Tenggara 1.8 4.6 39.8 42.9 0.7 1.5 8.6 100.0 46.2 4.2 507 Kalimantan West Kalimantan 0.6 8.2 53.4 34.9 0.2 0.8 1.9 100.0 62.2 7.9 374 Central Kalimantan 1.0 4.6 62.6 25.9 0.0 0.6 5.4 100.0 68.1 1.4 160 South Kalimantan 1.1 10.3 64.1 21.8 0.4 0.8 1.4 100.0 75.6 4.6 289 East Kalimantan 1.3 16.6 57.6 19.0 0.0 1.2 4.3 100.0 75.5 8.7 262 Sulawesi North Sulawesi 2.0 24.5 60.8 10.5 0.8 0.7 0.7 100.0 87.3 11.2 191 Central Sulawesi 1.2 9.8 48.6 36.6 0.4 0.0 3.4 100.0 59.6 4.3 243 South Sulawesi 0.3 9.0 49.5 32.4 0.6 0.7 7.6 100.0 58.8 3.2 631 Southeast Sulawesi 0.4 3.1 53.1 40.6 0.2 0.4 2.1 100.0 56.6 2.1 192 Gorontalo 0.6 12.9 40.1 45.0 0.1 0.5 0.7 100.0 53.6 3.3 82 West Sulawesi 1.1 3.8 38.9 44.8 0.0 0.7 10.7 100.0 43.8 3.0 103 Maluku and Papua Maluku 0.5 3.9 28.4 63.5 0.2 0.4 3.1 100.0 32.8 1.8 143 North Maluku 1.7 9.8 34.3 43.7 3.1 2.2 5.2 100.0 45.9 4.2 93 Papua 2.7 5.5 38.2 7.4 2.0 12.0 32.3 100.0 46.3 4.9 152 West Papua 0.8 9.7 47.2 27.1 1.1 4.8 9.3 100.0 57.7 4.8 62 Total 1.0 12.6 59.4 24.0 0.3 0.7 2.0 100.0 73.0 6.8 16,504 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife and auxiliary nurse/midwife. 2 Includes Health Post and Delivery Post. Appendix A | 289 Table A-11.6 Assistance during delivery by province: Least qualified person Percent distribution of live births in the five years preceding the survey by the least qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to province, Indonesia 2007 Person providing assistance during delivery Province Doctor OB/GYN Nurse/ midwife/ village midwife Traditional birth attendant Other/ don't know No one Missing Total Percentage delivered by a skilled provider Percentage delivered by C-section Number of births Sumatera Nanggroe Aceh Darussalam 0.0 3.3 58.6 36.6 0.4 0.3 1.0 100.0 61.8 4.9 324 North Sumatera 0.6 5.3 74.6 14.6 0.1 0.9 3.9 100.0 80.5 7.0 1,197 West Sumatera 0.2 1.4 75.3 22.3 0.0 0.3 0.6 100.0 76.9 8.7 383 Riau 0.9 10.1 67.0 20.1 0.6 0.1 1.2 100.0 77.9 11.4 290 Jambi 0.0 2.9 42.4 53.1 0.6 0.4 0.7 100.0 45.2 3.9 186 South Sumatera 0.0 5.9 53.9 36.3 0.4 1.6 1.9 100.0 59.8 3.8 491 Bengkulu 0.0 0.2 47.0 50.6 0.0 0.0 2.2 100.0 47.1 2.7 111 Lampung 0.0 2.7 50.6 45.4 0.2 0.6 0.5 100.0 53.3 3.8 452 Bangka Belitung 1.1 1.9 69.0 26.5 0.6 0.8 0.0 100.0 72.0 3.0 103 Riau Islands 0.9 7.2 78.7 10.1 0.5 1.4 1.2 100.0 86.9 13.1 93 Java DKI Jakarta 0.0 7.6 85.4 6.9 0.0 0.1 0.0 100.0 93.0 13.8 741 West Java 0.1 4.7 49.9 43.4 0.6 0.8 0.6 100.0 54.6 6.3 2,600 Central Java 0.1 2.8 58.0 38.7 0.3 0.0 0.0 100.0 60.9 5.4 2,308 DI Yogyakarta 0.0 1.9 90.7 7.1 0.2 0.0 0.0 100.0 92.6 10.3 201 East Java 0.4 4.9 67.1 26.6 0.0 0.5 0.4 100.0 72.4 9.0 2,178 Banten 0.2 3.3 43.4 52.1 0.3 0.3 0.5 100.0 46.8 9.4 695 Bali and Nusa Tenggara Bali 0.4 6.7 85.4 5.5 0.3 0.0 1.8 100.0 92.5 12.2 253 West Nusa Tenggara 0.5 3.1 45.9 48.5 0.4 0.0 1.5 100.0 49.6 6.7 412 East Nusa Tenggara 1.0 1.8 38.0 48.3 0.7 1.5 8.6 100.0 40.8 4.2 507 Kalimantan West Kalimantan 0.2 3.9 50.4 42.6 0.2 0.8 1.9 100.0 54.5 7.9 374 Central Kalimantan 0.1 1.5 48.1 44.4 0.0 0.6 5.4 100.0 49.7 1.4 160 South Kalimantan 0.3 2.1 58.7 36.3 0.4 0.8 1.4 100.0 61.1 4.6 289 East Kalimantan 0.5 6.9 61.8 25.3 0.0 1.2 4.3 100.0 69.2 8.7 262 Sulawesi North Sulawesi 0.4 9.5 73.5 14.4 0.8 0.7 0.7 100.0 83.4 11.2 191 Central Sulawesi 0.2 3.9 37.0 55.0 0.4 0.0 3.4 100.0 41.2 4.3 243 South Sulawesi 0.0 3.2 47.9 40.0 0.6 0.7 7.6 100.0 51.1 3.2 631 Southeast Sulawesi 0.2 1.0 28.8 67.3 0.2 0.4 2.1 100.0 30.0 2.1 192 Gorontalo 0.3 4.1 24.6 69.6 0.1 0.5 0.7 100.0 29.0 3.3 82 West Sulawesi 0.2 1.4 23.7 63.3 0.0 0.7 10.7 100.0 25.3 3.0 103 Maluku and Papua Maluku 0.0 2.4 26.5 67.5 0.2 0.4 3.1 100.0 28.8 1.8 143 North Maluku 0.5 2.0 31.7 55.4 3.1 2.2 5.2 100.0 34.2 4.2 93 Papua 0.2 1.1 41.4 10.9 2.0 12.0 32.3 100.0 42.7 4.9 152 West Papua 0.5 4.8 48.1 31.5 1.1 4.8 9.3 100.0 53.4 4.8 62 Total 0.3 4.1 57.8 34.9 0.3 0.7 2.0 100.0 62.2 6.8 16,504 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife and auxiliary nurse/midwife. 2 Includes Health Post and Delivery Post. 290 | Appendix A Table A-11.7 Delivery characteristics by province Percentage of births in the last five years preceding the survey delivered by caesarean section and percent distribution by birth weight and by mother's estimate of baby's size at birth, according to province, Indonesia 2007 Birth weight Percent distribution of all live births by size of child at birth Province Delivery by C-section Not weighed Less than 2.5 kg 2.5 kg or more Don't know/ missing Total Very small Smaller than average Average or larger Don't know/ missing Total Number of births Sumatera Nanggroe Aceh Darussalam 4.9 34.9 3.5 59.8 1.9 100.0 2.6 11.6 80.3 5.6 100.0 324 North Sumatera 7.0 25.7 3.8 68.8 1.7 100.0 2.3 7.3 87.2 3.2 100.0 1,197 West Sumatera 8.7 9.9 5.7 83.6 0.9 100.0 3.1 13.4 81.2 2.4 100.0 383 Riau 11.4 16.1 3.9 79.2 0.8 100.0 0.8 11.0 82.0 6.2 100.0 290 Jambi 3.9 21.6 3.9 72.4 2.0 100.0 1.8 9.4 82.9 5.9 100.0 186 South Sumatera 3.8 21.6 5.2 71.7 1.4 100.0 2.3 11.5 83.2 3.1 100.0 491 Bengkulu 2.7 16.1 4.4 79.5 0.0 100.0 2.1 10.1 86.5 1.3 100.0 111 Lampung 3.8 16.9 3.4 79.3 0.5 100.0 1.8 12.3 83.3 2.6 100.0 452 Bangka Belitung 3.0 9.0 4.8 85.3 0.9 100.0 1.6 8.7 88.0 1.7 100.0 103 Riau Islands 13.1 7.1 3.3 88.8 0.9 100.0 0.5 7.9 88.9 2.6 100.0 93 Java DKI Jakarta 13.8 0.4 6.0 93.2 0.4 100.0 2.5 14.1 83.0 0.5 100.0 741 West Java 6.3 8.4 5.7 85.0 0.9 100.0 1.5 14.1 82.2 2.2 100.0 2,600 Central Java 5.4 2.8 5.7 91.0 0.5 100.0 1.4 10.9 86.9 0.8 100.0 2,308 DI Yogyakarta 10.3 1.2 7.0 91.6 0.2 100.0 2.7 8.9 88.1 0.2 100.0 201 East Java 9.0 15.9 5.2 78.0 0.9 100.0 1.2 13.4 82.1 3.3 100.0 2,178 Banten 9.4 34.8 3.0 59.4 2.8 100.0 5.0 5.1 87.0 2.9 100.0 695 Bali and Nusa Tenggara Bali 12.2 4.4 6.5 88.4 0.8 100.0 1.1 10.5 85.7 2.7 100.0 253 West Nusa Tenggara 6.7 19.2 10.0 68.5 2.3 100.0 1.4 12.5 76.1 10.0 100.0 412 East Nusa Tenggara 4.2 36.1 8.3 51.8 3.8 100.0 1.3 11.2 71.2 16.4 100.0 507 Kalimantan West Kalimantan 7.9 26.1 7.6 64.0 2.2 100.0 1.7 20.2 66.9 11.3 100.0 374 Central Kalimantan 1.4 20.1 3.2 74.9 1.8 100.0 3.1 4.6 88.5 3.8 100.0 160 South Kalimantan 4.6 15.8 7.9 75.5 0.8 100.0 4.3 16.5 74.7 4.5 100.0 289 East Kalimantan 8.7 8.1 9.4 82.2 0.2 100.0 3.1 13.6 80.9 2.3 100.0 262 Sulawesi North Sulawesi 11.2 7.1 6.7 83.0 3.2 100.0 2.5 11.6 80.7 5.2 100.0 191 Central Sulawesi 4.3 25.6 6.0 67.4 1.0 100.0 5.4 18.1 74.8 1.7 100.0 243 South Sulawesi 3.2 33.8 6.2 58.5 1.4 100.0 2.9 21.1 70.4 5.6 100.0 631 Southeast Sulawesi 2.1 38.5 3.5 56.1 1.9 100.0 2.2 13.5 81.7 2.6 100.0 192 Gorontalo 3.3 39.4 4.9 51.0 4.7 100.0 4.7 19.3 66.0 10.0 100.0 82 West Sulawesi 3.0 42.8 5.0 48.9 3.3 100.0 11.5 15.7 67.5 5.3 100.0 103 Maluku and Papua Maluku 1.8 69.3 1.7 27.3 1.7 100.0 4.0 11.3 66.5 18.2 100.0 143 North Maluku 4.2 44.6 7.8 43.3 4.3 100.0 11.0 14.1 61.3 13.5 100.0 93 Papua 4.9 52.1 5.1 36.0 6.7 100.0 1.4 16.3 67.2 15.1 100.0 152 West Papua 4.8 39.2 3.8 44.4 12.5 100.0 1.5 6.1 62.0 30.4 100.0 62 Total 6.8 16.9 5.5 76.2 1.3 100.0 2.2 12.4 81.5 3.9 100.0 16,504 Appendix A | 291 Table A-11.8 Preparation for delivery by province Percentage of women who had a live birth in the five years preceding the survey who discussed specific topics during pregnancy for the most recent birth, according to province, Indonesia 2007 Topics discussed Province Place to deliver Trans- portation Delivery assistance Payment Blood donor Any topic No topics discussed Number of births Sumatera Nanggroe Aceh Darussalam 63.1 43.5 66.8 65.1 12.2 77.6 22.4 269 North Sumatera 57.4 31.4 67.4 60.5 5.1 78.0 22.0 803 West Sumatera 79.4 63.7 73.9 70.1 12.3 85.3 14.7 304 Riau 66.4 48.3 69.7 69.2 10.2 78.1 21.9 243 Jambi 58.4 36.7 60.9 51.3 8.2 69.5 30.5 169 South Sumatera 77.4 40.7 79.0 68.5 5.9 84.5 15.5 424 Bengkulu 67.3 36.4 73.3 67.2 11.5 78.4 21.6 100 Lampung 75.5 45.4 79.4 70.6 5.1 85.1 14.9 409 Bangka Belitung 66.8 43.6 66.9 64.7 9.1 71.4 28.6 93 Riau Islands 73.4 55.4 67.6 65.6 14.7 77.5 22.5 76 Java DKI Jakarta 81.4 63.0 76.9 79.3 15.6 85.8 14.2 649 West Java 68.7 39.6 67.6 64.0 8.3 74.4 25.6 2,328 Central Java 65.7 34.9 65.2 55.6 4.7 76.3 23.7 2,109 DI Yogyakarta 89.5 69.3 86.5 76.8 10.9 90.8 9.2 179 East Java 72.3 52.2 70.7 71.6 5.8 82.2 17.8 1,947 Banten 63.7 42.6 68.6 63.4 2.9 72.2 27.8 599 Bali and Nusa Tenggara Bali 77.7 59.6 69.3 71.8 10.0 82.1 17.9 225 West Nusa Tenggara 69.4 53.7 68.6 68.4 11.1 76.8 23.2 347 East Nusa Tenggara 63.9 41.7 68.2 63.4 18.0 71.9 28.1 375 Kalimantan West Kalimantan 68.1 51.9 71.6 69.8 20.6 78.2 21.8 312 Central Kalimantan 68.1 36.4 79.5 65.3 11.4 89.0 11.0 138 South Kalimantan 60.2 27.9 62.0 48.2 1.5 70.8 29.2 249 East Kalimantan 82.7 64.0 85.9 81.7 17.1 92.3 7.7 218 Sulawesi North Sulawesi 60.2 49.7 58.3 59.2 30.8 67.2 32.8 166 Central Sulawesi 64.6 31.1 72.7 74.1 11.6 83.3 16.7 192 South Sulawesi 64.0 29.4 55.9 54.7 6.2 75.0 25.0 500 Southeast Sulawesi 66.1 32.1 61.4 57.8 4.8 77.2 22.8 144 Gorontalo 63.1 36.9 68.8 68.0 10.5 76.3 23.7 68 West Sulawesi 43.8 24.9 45.6 37.9 6.6 51.4 48.6 75 Maluku and Papua Maluku 61.0 25.1 67.7 55.6 1.9 73.1 26.9 99 North Maluku 54.2 28.6 58.2 51.4 10.7 65.2 34.8 71 Papua 58.0 33.3 58.0 33.5 11.8 63.2 36.8 117 West Papua 60.2 27.1 58.0 52.7 9.1 65.6 34.4 45 Total 68.5 43.1 68.8 64.4 8.3 77.9 22.1 14,043 292 | Appendix A Table A-11.9 Postnatal care by province Percent distribution of women who had non-institutional live birth in the five years preceding the survey by timing of postnatal care for the most recent non-institutional birth, according to province, Indonesia 2007 Time after delivery of mother's first postnatal checkup Province Within 2 days of delivery 3-6 days after delivery 7-41 days after delivery Don't know/ missing No postnatal checkup1 Total Number of women Sumatera Nanggroe Aceh Darussalam 65.6 10.1 2.2 0.3 21.8 100.0 201 North Sumatera 51.4 3.9 5.8 0.2 38.7 100.0 515 West Sumatera 70.6 2.1 4.0 0.0 23.3 100.0 110 Riau 55.1 9.2 8.0 0.0 27.7 100.0 140 Jambi 75.9 8.9 5.8 0.0 9.4 100.0 126 South Sumatera 69.0 5.8 7.0 0.0 18.2 100.0 284 Bengkulu 88.8 1.6 1.8 0.0 7.9 100.0 87 Lampung 87.0 3.4 4.3 0.0 5.4 100.0 222 Bangka Belitung 61.1 15.6 6.3 0.0 16.9 100.0 52 Riau Islands 54.1 6.5 21.1 0.0 18.3 100.0 17 Java DKI Jakarta 64.6 9.7 9.7 0.0 16.0 100.0 77 West Java 65.2 12.1 16.0 0.1 6.6 100.0 1,276 Central Java 84.8 4.7 3.7 0.0 6.9 100.0 971 DI Yogyakarta 93.5 2.4 2.2 0.0 2.0 100.0 25 East Java 82.6 2.8 5.4 0.7 8.5 100.0 660 Banten 58.1 4.6 10.5 0.1 26.6 100.0 371 Bali and Nusa Tenggara Bali 56.1 5.9 8.4 0.8 28.8 100.0 19 West Nusa Tenggara 62.9 6.3 8.7 0.0 22.1 100.0 231 East Nusa Tenggara 67.6 3.7 4.3 0.5 23.9 100.0 292 Kalimantan West Kalimantan 75.3 2.8 1.7 0.0 20.2 100.0 207 Central Kalimantan 69.8 10.7 9.6 0.5 9.4 100.0 118 South Kalimantan 70.3 13.6 7.3 0.3 8.6 100.0 198 East Kalimantan 62.9 2.5 3.5 0.2 30.9 100.0 114 Sulawesi North Sulawesi 54.7 3.6 11.7 1.5 28.5 100.0 73 Central Sulawesi 85.5 2.4 5.8 0.0 6.4 100.0 155 South Sulawesi 73.4 2.4 1.0 0.0 23.1 100.0 338 Southeast Sulawesi 84.7 2.2 2.6 0.0 10.5 100.0 132 Gorontalo 77.3 2.2 3.8 0.0 16.7 100.0 53 West Sulawesi 70.1 4.1 3.5 0.7 21.7 100.0 64 Maluku and Papua Maluku 67.4 3.0 2.6 0.9 26.1 100.0 86 North Maluku 59.2 1.4 1.3 0.1 38.0 100.0 57 Papua 26.9 2.7 2.9 1.4 66.0 100.0 83 West Papua 27.4 7.8 6.6 2.6 55.5 100.0 25 Total 70.3 6.1 7.0 0.2 16.4 100.0 7,380 Note: Non-institutional includes respondent’s home, other home, health post, delivery post, and other places of delivery. 1 Includes women who received a checkup after 41 days Appendix A | 293 Table A-11.10 Problems in accessing health care by province Percentage of ever-married women who reported that they have big problems in accessing health care for themselves when they are sick, by type of problem, according to province, Indonesia 2007 Problems in accessing health care Province Knowing where to go for treatment Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern no female provider available At least one problem accessing health care Number of women Sumatera Nanggroe Aceh Darussalam 12.2 15.1 43.7 33.3 32.9 16.7 7.7 55.5 514 North Sumatera 8.7 7.0 28.5 12.9 11.8 8.0 8.9 40.6 1,487 West Sumatera 9.3 10.5 33.1 18.0 15.5 15.4 12.1 45.7 570 Riau 6.9 5.8 22.4 15.3 10.4 19.6 17.9 49.1 494 Jambi 7.8 3.7 19.6 10.3 7.6 14.9 8.3 35.9 367 South Sumatera 10.3 7.5 35.9 18.6 16.3 15.0 14.8 52.3 928 Bengkulu 5.4 5.2 20.2 13.2 12.2 13.0 10.3 39.6 211 Lampung 5.9 6.2 19.1 11.3 9.4 11.3 8.0 32.9 963 Bangka Belitung 2.7 2.2 16.0 10.7 8.6 10.5 8.4 29.7 194 Riau Islands 5.5 3.3 22.4 14.2 11.5 10.9 9.8 36.3 140 Java DKI Jakarta 2.1 1.7 21.1 4.2 2.7 4.2 6.3 28.8 1,471 West Java 3.1 1.8 21.6 12.7 8.8 9.0 10.6 35.6 5,545 Central Java 4.9 3.0 27.5 13.3 11.2 10.0 8.1 42.5 5,383 DI Yogyakarta 1.1 0.5 15.0 5.4 5.2 6.8 3.0 22.5 551 East Java 3.1 1.9 16.4 11.3 10.5 15.8 16.4 40.0 5,924 Banten 4.1 2.9 25.5 14.7 11.9 9.4 12.7 41.1 1,310 Bali and Nusa Tenggara Bali 7.5 5.1 24.8 18.2 17.1 14.9 10.9 35.3 587 West Nusa Tenggara 6.7 10.9 32.5 18.0 14.7 10.8 7.6 40.9 705 East Nusa Tenggara 15.2 12.4 42.0 33.0 34.6 12.9 11.5 52.0 627 Kalimantan West Kalimantan 6.5 5.1 28.8 35.4 30.9 17.9 8.0 47.2 628 Central Kalimantan 5.3 4.4 45.1 33.4 32.0 16.0 11.6 62.7 294 South Kalimantan 4.7 3.6 15.8 15.2 11.0 15.7 10.1 33.9 550 East Kalimantan 4.9 2.4 24.6 28.9 28.0 21.7 15.4 53.0 475 Sulawesi North Sulawesi 4.8 3.9 24.5 10.4 11.4 5.9 6.9 33.4 373 Central Sulawesi 13.5 19.2 45.3 28.9 26.1 21.8 9.1 64.7 339 South Sulawesi 7.8 4.8 30.6 22.8 20.6 13.2 3.3 43.3 1,067 Southeast Sulawesi 9.0 4.5 45.6 25.3 25.0 15.8 7.4 58.9 259 Gorontalo 10.1 9.1 48.4 23.8 22.4 12.6 7.0 56.3 163 West Sulawesi 17.6 13.1 33.0 32.5 29.9 23.5 11.9 50.6 139 Maluku and Papua Maluku 13.2 8.4 50.1 41.1 37.6 22.0 16.5 62.3 168 North Maluku 15.9 14.1 31.1 29.5 30.0 18.3 13.8 52.3 129 Papua 4.6 3.2 43.6 35.3 36.9 8.7 4.7 54.8 251 West Papua 11.8 16.8 49.2 40.6 40.0 21.5 7.5 59.1 89 Total 5.4 4.2 25.1 15.3 13.3 12.1 10.6 40.9 32,895 294 | Appendix A Table A-11.11 Birth registration by province Percentage of births in the five years before the survey that were registered, and of those registered, percent distributed by type of certificate, according to province, Indonesia 2007 Registration document Province Percent of births registered Number of births Not seen Hospital record Village record Proof of birth Birth certificate Missing Total Number of registered births Sumatera Nanggroe Aceh Darussalam 24.5 324 23.4 13.4 2.0 1.5 59.7 0.0 100.0 80 North Sumatera 28.8 1,197 18.1 36.3 1.7 3.2 39.7 0.9 100.0 345 West Sumatera 57.4 383 12.9 45.9 0.0 11.1 29.7 0.5 100.0 219 Riau 46.8 290 11.7 28.9 0.0 7.0 52.3 0.1 100.0 136 Jambi 49.5 186 4.8 11.2 1.5 1.6 80.9 0.0 100.0 92 South Sumatera 52.7 491 7.1 32.2 1.0 2.3 56.3 1.1 100.0 259 Bengkulu 49.8 111 15.0 15.5 0.0 1.1 67.5 0.8 100.0 55 Lampung 57.2 452 8.1 29.0 0.4 2.9 59.5 0.0 100.0 259 Bangka Belitung 77.4 103 3.5 17.9 1.3 2.5 74.9 0.0 100.0 80 Riau Islands 75.4 93 11.5 24.7 1.5 4.6 56.9 0.7 100.0 70 Java DKI Jakarta 82.9 741 4.6 17.7 0.2 0.2 77.1 0.1 100.0 614 West Java 52.4 2,600 8.1 14.9 0.9 2.4 73.7 0.1 100.0 1,362 Central Java 79.7 2,308 11.6 23.1 7.1 1.3 56.9 0.0 100.0 1,839 DI Yogyakarta 93.8 201 2.7 20.0 0.0 1.1 76.3 0.0 100.0 189 East Java 64.4 2,178 9.7 15.7 2.4 2.4 69.8 0.0 100.0 1,402 Banten 42.3 695 4.5 24.0 2.2 0.1 68.8 0.5 100.0 294 Bali and Nusa Tenggara Bali 53.0 253 5.5 26.9 2.1 0.3 65.0 0.2 100.0 134 West Nusa Tenggara 28.7 412 13.0 28.2 1.6 3.6 52.2 1.3 100.0 118 East Nusa Tenggara 28.0 507 19.3 37.4 0.8 12.0 29.9 0.6 100.0 142 Kalimantan West Kalimantan 37.1 374 12.6 15.3 0.0 0.7 71.1 0.3 100.0 139 Central Kalimantan 46.5 160 15.5 27.4 0.5 0.0 56.6 0.0 100.0 75 South Kalimantan 49.4 289 7.7 10.8 1.3 0.6 78.1 1.5 100.0 143 East Kalimantan 64.8 262 10.8 31.6 1.0 1.2 55.3 0.0 100.0 170 Sulawesi North Sulawesi 45.1 191 16.6 26.0 0.0 0.4 54.5 2.5 100.0 86 Central Sulawesi 23.4 243 41.1 19.1 1.0 2.1 36.7 0.0 100.0 57 South Sulawesi 38.2 631 6.8 21.6 4.4 2.0 63.8 1.4 100.0 241 Southeast Sulawesi 22.8 192 15.8 15.1 0.4 1.8 65.1 1.7 100.0 44 Gorontalo 30.2 82 6.2 34.0 2.3 6.3 49.9 1.3 100.0 25 West Sulawesi 27.1 103 22.1 12.5 0.0 2.0 63.4 0.0 100.0 28 Maluku and Papua Maluku 18.7 143 18.0 9.2 3.5 2.3 66.2 0.8 100.0 27 North Maluku 20.8 93 12.4 11.0 0.0 15.8 60.2 0.6 100.0 19 Papua 31.3 152 18.6 11.3 3.5 0.6 64.9 1.0 100.0 48 West Papua 42.7 62 15.3 27.0 6.7 3.1 47.8 0.0 100.0 27 Total 53.4 16,504 10.1 21.6 2.6 2.3 63.2 0.3 100.0 8,817 Appendix A | 295 Table A-11.12 Reason for not registering birth by province Percentage of births in the five years before the survey that were not registered by reason for not registering the birth, according to province, Indonesia 2007 Reason not registering birth Province Costs too much Too far Did not know child has to be registered Late, did not want to pay fine Did not know where to register Other Missing Total Number of births not registered Sumatera Nanggroe Aceh Darussalam 12.1 10.4 29.4 4.3 19.4 23.4 1.0 100.0 244 North Sumatera 20.2 5.6 22.2 2.5 8.0 41.2 0.3 100.0 852 West Sumatera 20.1 7.6 7.3 0.7 4.6 54.5 5.2 100.0 163 Riau 23.7 13.6 5.0 1.6 5.2 48.7 2.2 100.0 154 Jambi 22.0 18.1 7.3 1.8 7.6 41.3 1.9 100.0 94 South Sumatera 32.9 8.1 8.7 1.8 9.5 35.7 3.3 100.0 232 Bengkulu 29.5 2.1 2.2 0.0 3.2 62.9 0.0 100.0 55 Lampung 44.0 5.0 4.6 1.2 3.2 40.9 1.1 100.0 194 Bangka Belitung 22.6 11.6 9.1 4.1 5.4 43.5 3.7 100.0 23 Riau Islands 22.5 5.7 7.3 3.4 4.3 49.7 7.1 100.0 23 Java DKI Jakarta 35.9 6.1 0.9 3.1 6.3 46.6 1.0 100.0 126 West Java 43.2 2.0 9.6 0.8 3.0 39.9 1.5 100.0 1,238 Central Java 30.0 3.9 6.6 7.4 3.2 46.1 2.8 100.0 468 DI Yogyakarta 30.1 8.3 0.0 0.0 0.0 57.5 4.0 100.0 12 East Java 17.5 8.5 10.5 1.6 12.7 46.3 2.9 100.0 776 Banten 44.9 2.7 2.3 2.4 8.3 39.1 0.3 100.0 401 Bali and Nusa Tenggara Bali 29.7 6.1 9.8 6.8 5.0 41.2 1.5 100.0 119 West Nusa Tenggara 19.4 7.6 11.7 0.9 9.2 50.7 0.5 100.0 294 East Nusa Tenggara 13.2 11.8 22.3 0.0 14.0 36.5 2.3 100.0 365 Kalimantan West Kalimantan 39.9 16.3 5.2 1.7 6.7 27.5 2.7 100.0 235 Central Kalimantan 15.9 15.4 20.1 5.9 10.3 31.2 1.1 100.0 86 South Kalimantan 19.9 10.8 11.6 2.3 12.1 41.6 1.7 100.0 147 East Kalimantan 14.5 33.5 6.7 0.0 9.3 34.2 1.8 100.0 92 Sulawesi North Sulawesi 26.8 8.6 2.4 16.6 6.6 35.3 3.6 100.0 105 Central Sulawesi 17.7 10.3 22.3 1.0 5.7 41.6 1.4 100.0 186 South Sulawesi 13.6 11.9 15.5 2.6 17.1 37.9 1.5 100.0 390 Southeast Sulawesi 14.1 13.3 18.1 13.3 11.7 28.5 1.0 100.0 149 Gorontalo 24.0 6.5 2.0 0.7 1.6 63.7 1.5 100.0 57 West Sulawesi 8.6 15.0 18.8 0.5 12.9 43.6 0.5 100.0 75 Maluku and Papua Maluku 8.4 33.7 3.5 1.6 12.5 39.9 0.5 100.0 116 North Maluku 8.1 6.2 9.4 2.2 7.1 64.8 2.2 100.0 74 Papua 8.2 16.9 33.3 1.1 15.9 20.8 3.7 100.0 105 West Papua 7.0 15.7 16.7 2.7 9.8 40.3 7.7 100.0 36 Total 25.9 8.2 12.2 2.5 8.4 40.9 1.8 100.0 7,687 296 | Appendix A CHAPTER 12 IMMUNIZATION OF CHILDREN Table A-12.1 Vaccinations by province Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to health card or mother's report), and percentage with a vaccination card, by province, Indonesia 2007 DPT Polio Province BCG 1 2 3 1 2 3 4 Measles All1 No vaccina- tions Percentage with health card seen Number of children HEALTH CARD Sumatera Nanggroe Aceh Darussalam 78.7 94.2 71.7 60.4 87.5 66.5 66.5 50.6 66.7 39.6 0.0 100.0 10 North Sumatera 89.0 95.4 79.7 68.9 97.9 83.3 78.3 48.7 64.8 50.6 0.0 100.0 65 West Sumatera 96.7 97.5 87.0 81.8 100.0 95.8 87.5 77.4 77.7 69.3 0.0 100.0 26 Riau 85.7 94.0 85.2 74.9 87.3 84.2 76.9 67.6 78.1 61.6 0.0 100.0 16 Jambi 100.0 100.0 93.2 88.9 100.0 100.0 95.5 88.3 74.7 70.5 0.0 100.0 12 South Sumatera 100.0 96.3 91.5 76.0 100.0 98.2 90.6 67.4 66.7 60.1 0.0 100.0 26 Bengkulu 100.0 100.0 95.2 85.5 100.0 100.0 100.0 94.3 86.3 71.8 0.0 100.0 7 Lampung 97.4 97.6 89.3 85.2 97.4 94.8 86.1 66.2 83.2 65.3 0.0 100.0 46 Bangka Belitung 100.0 100.0 96.3 91.0 94.0 94.0 89.0 55.7 88.0 75.4 0.0 100.0 8 Riau Islands 92.8 96.3 91.7 84.5 96.3 96.3 89.1 80.6 92.3 80.6 0.0 100.0 5 Java DKI Jakarta 94.6 94.6 86.1 83.8 98.5 89.6 86.1 75.7 86.6 76.9 0.0 100.0 37 West Java 93.2 96.2 87.5 80.9 96.3 88.0 83.8 70.2 85.7 70.8 0.0 100.0 248 Central Java 97.2 100.0 100.0 100.0 100.0 100.0 100.0 93.1 87.8 85.0 0.0 100.0 211 DI Yogyakarta 100.0 100.0 100.0 97.6 100.0 100.0 100.0 100.0 92.0 92.0 0.0 100.0 20 East Java 88.0 98.5 90.8 84.8 95.8 86.7 80.3 76.7 84.6 74.8 0.0 100.0 139 Banten 76.4 89.7 63.8 58.7 95.6 86.2 76.0 62.6 75.0 51.8 0.0 100.0 22 Bali and Nusa Tenggara Bali 98.4 98.4 96.2 85.3 100.0 98.4 96.2 89.6 84.9 83.0 0.0 100.0 23 West Nusa Tenggara 97.0 93.2 93.2 80.8 97.0 88.7 85.1 68.8 89.4 72.4 3.0 100.0 21 East Nusa Tenggara 95.8 92.0 88.5 76.2 100.0 100.0 86.9 76.3 94.7 72.3 0.0 100.0 24 Kalimantan West Kalimantan 95.6 97.5 93.1 90.0 97.5 97.5 93.1 83.2 81.8 78.7 0.0 100.0 23 Central Kalimantan 85.8 91.6 84.2 78.5 100.0 91.6 79.8 56.0 84.2 72.5 0.0 100.0 4 South Kalimantan 100.0 98.2 94.4 90.3 100.0 96.0 90.6 86.5 84.8 77.2 0.0 100.0 15 East Kalimantan 92.8 96.4 95.1 95.1 96.4 96.4 96.4 93.2 91.4 86.5 3.6 100.0 25 Sulawesi North Sulawesi 100.0 97.7 97.7 92.5 100.0 100.0 97.7 92.5 92.8 87.9 0.0 100.0 15 Central Sulawesi 96.2 100.0 97.1 80.4 100.0 100.0 96.2 86.3 84.1 71.4 0.0 100.0 16 South Sulawesi 100.0 96.6 87.7 87.7 97.0 90.3 83.9 75.2 87.7 75.2 0.0 100.0 31 Southeast Sulawesi 94.0 88.6 73.2 62.0 95.1 85.0 71.3 62.0 81.4 62.0 0.0 100.0 14 Gorontalo 100.0 100.0 100.0 83.4 100.0 100.0 95.4 85.3 82.8 77.0 0.0 100.0 5 West Sulawesi 93.5 97.0 90.2 80.8 100.0 90.5 80.8 71.0 90.5 71.7 0.0 100.0 6 Maluku and Papua Maluku 100.0 95.3 95.3 74.4 100.0 90.1 72.0 55.2 77.1 72.0 0.0 100.0 4 North Maluku 89.9 95.5 85.5 71.4 100.0 87.6 78.3 63.5 79.7 63.6 0.0 100.0 6 Papua 100.0 100.0 95.5 84.3 100.0 95.5 90.1 84.3 84.3 84.3 0.0 100.0 7 West Papua 77.8 100.0 92.8 56.9 100.0 92.8 88.2 38.9 88.9 45.8 0.0 100.0 3 Total 93.9 97.1 90.6 84.8 97.6 92.2 87.7 76.5 83.9 73.3 0.1 100.0 1,139 Continued… Appendix A | 297 Table A-12.1—Continued DPT Polio Province BCG 1 2 3 1 2 3 4 Measles All1 No vaccina- tions Percentage with health card seen Number of children MOTHER'S REPORT Sumatera Nanggroe Aceh Darussalam 60.5 51.5 42.0 28.6 66.1 52.0 43.1 16.5 46.9 24.3 31.0 0.0 53 North Sumatera 57.2 53.4 42.2 27.5 74.4 68.0 53.7 24.9 47.5 25.9 21.5 0.0 166 West Sumatera 81.5 78.0 65.8 61.6 87.6 77.9 68.0 58.7 69.9 55.0 8.0 0.0 45 Riau 68.7 67.4 64.0 43.8 69.8 60.5 49.4 28.9 65.5 34.0 28.1 0.0 44 Jambi 56.9 62.1 50.9 37.7 62.1 58.0 48.0 21.0 54.8 31.5 37.9 0.0 23 South Sumatera 86.7 83.9 74.8 63.8 89.7 77.6 61.2 32.1 76.1 51.9 8.6 0.0 53 Bengkulu 84.3 79.5 70.4 49.4 97.8 84.4 68.3 45.9 78.3 46.3 2.2 0.0 14 Lampung 90.4 91.5 79.7 73.6 96.4 93.5 86.6 69.6 83.7 68.3 1.6 0.0 63 Bangka Belitung 63.8 60.9 58.5 57.3 74.1 67.1 60.0 51.7 58.4 50.5 25.0 0.0 14 Riau Islands 79.8 78.8 67.4 63.7 89.3 81.2 71.2 56.3 79.4 57.0 10.7 0.0 15 Java DKI Jakarta 86.0 84.1 78.8 74.9 87.9 84.5 81.2 42.2 77.0 69.3 12.1 0.0 96 West Java 86.7 83.1 70.7 60.9 87.7 81.8 67.5 49.7 77.4 58.0 10.6 0.0 295 Central Java 94.2 93.1 86.7 76.9 98.2 87.9 83.2 60.9 86.4 64.7 1.8 0.0 219 DI Yogyakarta 100.0 100.0 99.5 96.3 100.0 100.0 100.0 89.9 99.5 96.3 0.0 0.0 15 East Java 86.5 79.8 72.5 61.5 85.0 81.2 71.1 53.1 77.6 58.2 10.4 0.0 214 Banten 81.3 71.5 63.0 46.7 92.3 77.8 60.3 29.9 77.0 34.4 6.7 0.0 101 Bali and Nusa Tenggara Bali 90.6 93.6 80.7 70.3 87.9 81.5 78.5 56.1 86.0 62.8 6.4 0.0 26 West Nusa Tenggara 82.2 82.3 72.1 54.9 85.4 82.7 61.4 42.4 76.8 49.4 14.6 0.0 56 East Nusa Tenggara 83.3 77.0 60.0 44.6 85.3 77.3 48.3 22.3 71.3 36.7 13.5 0.0 71 Kalimantan West Kalimantan 74.6 73.6 56.9 51.5 69.6 58.0 50.2 36.2 62.1 37.2 25.0 0.0 50 Central Kalimantan 79.8 75.3 53.4 45.1 89.4 83.8 51.7 35.2 83.1 36.8 5.5 0.0 24 South Kalimantan 72.5 65.8 47.5 38.4 74.2 68.5 48.9 40.5 51.4 38.4 24.1 0.0 33 East Kalimantan 79.9 79.1 72.9 57.7 82.9 78.5 67.1 56.1 74.6 54.4 17.1 0.0 29 Sulawesi North Sulawesi 93.9 91.7 84.8 75.2 91.0 89.6 82.6 39.6 82.0 68.7 6.1 0.0 23 Central Sulawesi 71.5 70.3 62.6 44.1 77.3 67.9 58.2 22.3 65.5 38.1 19.2 0.0 27 South Sulawesi 72.1 69.1 62.1 52.0 72.2 70.6 61.6 45.4 61.9 47.4 24.5 0.0 81 Southeast Sulawesi 80.3 80.7 72.1 68.3 84.7 73.9 70.2 39.1 78.4 66.1 15.3 0.0 23 Gorontalo 76.2 73.8 55.2 48.2 74.2 64.6 59.8 35.9 63.7 46.1 19.1 0.0 11 West Sulawesi 73.1 64.0 58.7 46.5 76.3 72.4 55.2 31.5 65.8 42.1 22.9 0.0 10 Maluku and Papua Maluku 60.8 61.5 47.4 37.7 62.7 48.9 39.4 28.4 54.4 32.8 33.1 0.0 20 North Maluku 62.7 41.8 34.5 20.8 65.6 44.5 29.1 14.0 63.7 18.7 34.4 0.0 8 Papua 62.4 59.9 37.3 26.0 62.4 42.2 20.1 14.9 55.8 14.9 35.8 0.0 22 West Papua 56.4 52.1 41.4 29.2 65.2 59.0 46.9 20.0 46.0 17.6 34.1 0.0 10 Total 80.5 77.0 67.0 56.1 84.3 77.0 65.2 43.2 72.0 50.0 13.5 0.0 1,955 Continued… 298 | Appendix A Table A-12.1—Continued DPT Polio Province BCG 1 2 3 1 2 3 4 Measles All1 No vaccina- tions Percentage with health card seen Number of children HEALTH CARD AND MOTHER'S REPORT Sumatera Nanggroe Aceh Darussalam 63.5 58.4 46.8 33.7 69.6 54.3 46.9 22.0 50.1 26.8 26.0 16.2 63 North Sumatera 66.2 65.3 52.8 39.2 81.0 72.3 60.7 31.6 52.4 32.8 15.5 28.2 231 West Sumatera 87.1 85.2 73.6 69.0 92.1 84.5 75.2 65.5 72.7 60.2 5.1 36.6 71 Riau 73.3 74.5 69.7 52.1 74.5 66.9 56.8 39.3 68.9 41.4 20.6 26.8 60 Jambi 71.7 75.1 65.4 55.2 75.1 72.4 64.3 44.1 61.7 44.8 24.9 34.3 35 South Sumatera 91.0 88.0 80.3 67.8 93.1 84.3 70.9 43.6 73.0 54.6 5.8 32.8 80 Bengkulu 89.6 86.4 78.8 61.6 98.6 89.6 79.0 62.3 81.0 54.9 1.4 33.8 21 Lampung 93.4 94.1 83.8 78.5 96.8 94.0 86.4 68.1 83.5 67.0 0.9 42.4 110 Bangka Belitung 76.7 74.8 71.9 69.3 81.2 76.7 70.3 53.1 68.9 59.3 16.1 35.5 21 Riau Islands 82.8 82.8 73.0 68.6 90.9 84.7 75.3 62.0 82.4 62.5 8.2 23.2 20 Java DKI Jakarta 88.4 87.0 80.8 77.4 90.9 85.9 82.6 51.5 79.7 71.5 8.7 27.8 133 West Java 89.6 89.1 78.4 70.0 91.6 84.6 74.9 59.1 81.2 63.9 5.7 45.7 543 Central Java 95.7 96.5 93.2 88.3 99.1 93.8 91.5 76.7 87.1 74.7 0.9 49.1 430 DI Yogyakarta 100.0 100.0 99.8 97.0 100.0 100.0 100.0 95.6 95.2 93.8 0.0 56.7 35 East Java 87.1 87.2 79.7 70.7 89.3 83.3 74.7 62.4 80.3 64.8 6.3 39.4 353 Banten 80.4 74.7 63.1 48.8 92.9 79.3 63.1 35.7 76.6 37.4 5.5 17.5 123 Bali and Nusa Tenggara Bali 94.3 95.9 87.9 77.3 93.5 89.4 86.7 71.6 85.5 72.2 3.4 46.5 49 West Nusa Tenggara 86.3 85.3 77.9 62.0 88.6 84.4 67.9 49.6 80.3 55.7 11.4 27.4 78 East Nusa Tenggara 86.5 80.8 67.3 52.6 89.0 83.0 58.1 36.0 77.2 45.7 10.0 25.4 95 Kalimantan West Kalimantan 81.2 81.1 68.1 63.5 78.3 70.3 63.6 50.9 68.2 50.1 17.2 31.1 73 Central Kalimantan 80.7 77.7 58.1 50.1 91.0 85.0 56.0 38.3 83.3 42.2 4.7 15.1 28 South Kalimantan 81.3 76.2 62.5 55.0 82.4 77.3 62.3 55.2 62.1 50.8 16.4 32.0 48 East Kalimantan 85.9 87.1 83.2 75.0 89.1 86.8 80.6 73.3 82.4 69.2 10.9 46.2 53 Sulawesi North Sulawesi 96.2 94.0 89.7 81.8 94.5 93.6 88.4 59.9 86.2 76.1 3.8 38.4 38 Central Sulawesi 80.5 81.2 75.2 57.3 85.6 79.6 72.1 45.6 72.3 50.3 12.2 36.5 43 South Sulawesi 79.8 76.7 69.2 61.8 79.1 76.0 67.8 53.6 69.0 55.1 17.8 27.5 112 Southeast Sulawesi 85.4 83.6 72.5 65.9 88.6 78.0 70.6 47.6 79.5 64.6 9.6 37.1 37 Gorontalo 83.2 81.5 68.4 58.6 81.8 75.0 70.3 50.5 69.3 55.2 13.4 29.5 16 West Sulawesi 80.6 76.2 70.3 59.2 85.1 79.1 64.7 46.1 74.9 53.0 14.5 37.0 15 Maluku and Papua Maluku 67.7 67.4 55.8 44.2 69.3 56.2 45.2 33.1 58.4 39.7 27.3 17.6 24 North Maluku 73.9 63.8 55.4 41.5 79.7 62.1 49.3 34.3 70.2 37.1 20.3 41.0 14 Papua 72.0 70.2 52.1 40.9 72.0 55.8 38.0 32.6 63.0 32.6 26.7 25.5 29 West Papua 61.0 62.4 52.5 35.2 72.7 66.2 55.8 24.1 55.3 23.7 26.7 21.6 12 Total 85.4 84.4 75.7 66.7 89.2 82.6 73.5 55.5 76.4 58.6 8.6 36.8 3,094 Note: Polio 0 is the polio vaccination given at birth. 2 BCG, measles and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) Appendix A | 299 Table A-12.2 Hepatitis B vaccination coverage by province Percentage of children age 12-23 months who received hepatitis B vaccinations at any time before the survey (according to health card or mother's report), by province, Indonesia 2007 Hepatitis B vaccination Province HB1 HB2 HB3 Number of children Sumatera Nanggroe Aceh Darussalam 50.3 38.3 27.4 63 North Sumatera 58.4 48.6 38.1 231 West Sumatera 81.3 76.5 71.9 71 Riau 73.7 58.7 49.3 60 Jambi 66.3 54.9 41.5 35 South Sumatera 84.5 73.4 57.5 80 Bengkulu 79.0 72.4 61.6 21 Lampung 90.9 81.9 72.5 110 Bangka Belitung 71.1 66.1 64.3 21 Riau Islands 79.5 72.6 64.3 20 Java DKI Jakarta 87.1 81.1 67.3 133 West Java 85.6 77.6 66.0 543 Central Java 94.9 90.1 77.2 430 DI Yogyakarta 100.0 94.5 88.1 35 East Java 82.9 71.2 63.3 353 Banten 72.0 61.4 48.3 123 Bali and Nusa Tenggara Bali 92.3 86.1 78.2 49 West Nusa Tenggara 82.6 74.4 59.4 78 East Nusa Tenggara 69.1 53.8 36.9 95 Kalimantan West Kalimantan 70.4 65.6 58.5 73 Central Kalimantan 80.3 63.3 47.6 28 South Kalimantan 69.8 60.8 52.9 48 East Kalimantan 83.7 76.1 67.3 53 Sulawesi North Sulawesi 87.9 78.4 58.6 38 Central Sulawesi 75.4 63.9 46.3 43 South Sulawesi 73.8 66.9 54.1 112 Southeast Sulawesi 80.0 73.1 60.5 37 Gorontalo 75.7 67.5 54.7 16 West Sulawesi 74.8 66.0 50.6 15 Maluku and Papua Maluku 58.6 50.3 39.2 24 North Maluku 72.2 59.0 35.2 14 Papua 65.4 44.1 35.4 29 West Papua 52.6 40.2 31.4 12 Total 80.5 71.7 60.3 3,094 300 | Appendix A Table A-12.3 Child's weight and size at birth by province Percent distribution of live births in the five years preceding the survey with a reported birth weight by birth weight; percent distribution of all live births in the five years preceding the survey by mother's estimate of baby's size at birth and percentage of all births with a reported birth weight, according to province, Indonesia 2007 Percent distribution of births with a reported birth weight Percent distribution of all live births by size of child at birth Province Less than 2.5 kg 2.5 kg or more Total Number of births Percentage of all births with a reported birth weight Very small Smaller than average Average or larger Don’t know/ missing Total Number of births Sumatera Nanggroe Aceh Darussalam 5.5 94.5 100.0 205 63.2 2.6 11.6 80.3 5.6 100.0 324 North Sumatera 5.2 94.8 100.0 869 72.5 2.3 7.3 87.2 3.2 100.0 1,197 West Sumatera 6.3 93.7 100.0 341 89.2 3.1 13.4 81.2 2.4 100.0 383 Riau 4.7 95.3 100.0 241 83.0 0.8 11.0 82.0 6.2 100.0 290 Jambi 5.2 94.8 100.0 142 76.3 1.8 9.4 82.9 5.9 100.0 186 South Sumatera 6.8 93.2 100.0 378 77.0 2.3 11.5 83.2 3.1 100.0 491 Bengkulu 5.2 94.8 100.0 93 83.9 2.1 10.1 86.5 1.3 100.0 111 Lampung 4.1 95.9 100.0 374 82.7 1.8 12.3 83.3 2.6 100.0 452 Bangka Belitung 5.3 94.7 100.0 93 90.1 1.6 8.7 88.0 1.7 100.0 103 Riau Islands 3.6 96.4 100.0 85 92.1 0.5 7.9 88.9 2.6 100.0 93 Java DKI Jakarta 6.1 93.9 100.0 735 99.2 2.5 14.1 83.0 0.5 100.0 741 West Java 6.3 93.7 100.0 2,360 90.8 1.5 14.1 82.2 2.2 100.0 2,600 Central Java 5.9 94.1 100.0 2,231 96.7 1.4 10.9 86.9 0.8 100.0 2,308 DI Yogyakarta 7.1 92.9 100.0 198 98.6 2.7 8.9 88.1 0.2 100.0 201 East Java 6.3 93.7 100.0 1,812 83.2 1.2 13.4 82.1 3.3 100.0 2,178 Banten 4.7 95.3 100.0 433 62.3 5.0 5.1 87.0 2.9 100.0 695 Bali and Nusa Tenggara Bali 6.8 93.2 100.0 240 94.9 1.1 10.5 85.7 2.7 100.0 253 West Nusa Tenggara 12.8 87.2 100.0 323 78.5 1.4 12.5 76.1 10.0 100.0 412 East Nusa Tenggara 13.9 86.1 100.0 305 60.2 1.3 11.2 71.2 16.4 100.0 507 Kalimantan West Kalimantan 10.6 89.4 100.0 268 71.6 1.7 20.2 66.9 11.3 100.0 374 Central Kalimantan 4.1 95.9 100.0 125 78.1 3.1 4.6 88.5 3.8 100.0 160 South Kalimantan 9.5 90.5 100.0 241 83.4 4.3 16.5 74.7 4.5 100.0 289 East Kalimantan 10.3 89.7 100.0 240 91.7 3.1 13.6 80.9 2.3 100.0 262 Sulawesi North Sulawesi 7.5 92.5 100.0 171 89.7 2.5 11.6 80.7 5.2 100.0 191 Central Sulawesi 8.2 91.8 100.0 178 73.5 5.4 18.1 74.8 1.7 100.0 243 South Sulawesi 9.6 90.4 100.0 409 64.8 2.9 21.1 70.4 5.6 100.0 631 Southeast Sulawesi 5.8 94.2 100.0 115 59.6 2.2 13.5 81.7 2.6 100.0 192 Gorontalo 8.7 91.3 100.0 46 55.9 4.7 19.3 66.0 10.0 100.0 82 West Sulawesi 9.2 90.8 100.0 56 53.9 11.5 15.7 67.5 5.3 100.0 103 Maluku and Papua Maluku 5.7 94.3 100.0 41 28.9 4.0 11.3 66.5 18.2 100.0 143 North Maluku 15.3 84.7 100.0 48 51.1 11.0 14.1 61.3 13.5 100.0 93 Papua 12.5 87.5 100.0 63 41.2 1.4 16.3 67.2 15.1 100.0 152 West Papua 7.9 92.1 100.0 30 48.3 1.5 6.1 62.0 30.4 100.0 62 Total 6.7 93.3 100.0 13,490 81.7 2.2 12.4 81.5 3.9 100.0 16,504 1 Based on either a written record or the mother's recall Appendix A | 301 CHAPTER 13 CHILDHOOD DISEASES Table A-13.1 Prevalence and treatment of acute respiratory infections (ARI) and/or fever by province Percentage of children under five years of age who had a cough accompanied by short, rapid breathing (symptoms of ARI), percentage of children who had fever in the two weeks preceding the survey, and percentage of children with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by province, Indonesia 2007 Treatment among children under five with symptoms of ARI and/or fever Prevalence of ARI and/or fever among children under five Province Percentage of children with symptoms of ARI Percentage of children with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Number of children Sumatera Nanggroe Aceh Darussalam 16.4 38.7 313 74.5 129 North Sumatera 13.5 31.1 1,146 64.8 420 West Sumatera 15.5 38.3 366 69.1 158 Riau 13.5 31.3 282 75.1 102 Jambi 9.9 24.5 179 69.8 50 South Sumatera 8.9 22.6 473 70.0 123 Bengkulu 18.9 37.8 106 73.0 45 Lampung 5.3 26.2 443 68.3 126 Bangka Belitung 10.3 31.6 99 76.6 34 Riau Islands 16.9 29.4 89 78.7 32 Java DKI Jakarta 8.1 22.4 723 81.2 178 West Java 11.3 33.3 2,504 58.1 939 Central Java 8.3 25.7 2,263 72.4 665 DI Yogyakarta 5.3 24.4 197 73.2 53 East Java 12.0 34.3 2,106 71.4 755 Banten 9.2 34.8 672 63.6 238 Bali and Nusa Tenggara Bali 10.0 20.9 248 83.2 56 West Nusa Tenggara 12.6 42.6 380 61.7 174 East Nusa Tenggara 16.5 36.7 478 62.0 199 Kalimantan West Kalimantan 17.2 31.4 361 55.0 128 Central Kalimantan 9.2 32.9 156 61.6 58 South Kalimantan 13.5 39.1 272 48.6 111 East Kalimantan 12.2 31.4 256 63.0 86 Sulawesi North Sulawesi 14.6 29.7 185 77.3 64 Central Sulawesi 14.7 44.0 235 56.0 108 South Sulawesi 6.7 34.6 607 64.9 213 Southeast Sulawesi 16.2 36.5 185 45.3 74 Gorontalo 20.9 44.2 77 55.7 37 West Sulawesi 23.5 43.7 96 52.5 46 Maluku and Papua Maluku 8.2 27.2 134 42.6 40 North Maluku 13.7 37.8 88 66.9 36 Papua 7.6 31.0 144 74.7 47 West Papua 4.5 21.9 59 78.8 13 Total 11.2 31.6 15,925 65.9 5,539 1 Excludes pharmacy, shop, traditional practitioner, delivery post, health post, and health cadre 302 | Appendix A Table A-13.2 Disposal of children's stools by province Percent distribution of mothers who are living with their youngest child under five years, by way in which child's fecal matter is disposed of, according to province, Indonesia 2007 Stools contained Stools uncontained Use diapers Province Child uses toilet/ latrine Thrown into toilet/ latrine Thrown/ buried in yard Thrown outside dwelling Rinsed away Dis- posed in open setting Do nothing Dispos- able Wash- able Other Missing Total Percentage of children whose stools are disposed of safely Number of mothers Sumatera Nanggroe Aceh Darussalam 7.5 19.7 17.7 22.4 9.8 7.0 0.2 3.2 12.0 0.3 0.2 100.0 60.1 264 North Sumatera 17.8 32.9 5.2 16.6 9.2 8.5 0.0 1.4 6.0 1.9 0.5 100.0 63.3 782 West Sumatera 11.2 19.3 6.7 10.0 10.3 28.0 0.0 1.0 11.8 1.3 0.3 100.0 50.0 296 Riau 17.5 39.0 10.1 14.1 5.4 5.2 0.1 1.6 6.2 0.4 0.5 100.0 74.3 240 Jambi 21.1 28.4 10.5 3.3 1.8 24.1 0.0 0.7 8.2 1.6 0.4 100.0 68.9 164 South Sumatera 19.8 23.4 5.4 11.5 12.8 20.6 0.4 0.0 5.5 0.6 0.0 100.0 54.2 420 Bengkulu 27.9 19.6 11.7 11.5 5.4 15.6 0.0 0.0 3.4 4.8 0.2 100.0 62.6 98 Lampung 25.6 36.8 9.8 9.5 4.2 3.6 0.0 0.9 8.9 0.6 0.0 100.0 82.0 404 Bangka Belitung 22.1 19.3 20.5 17.2 2.3 1.4 1.2 3.1 10.6 2.3 0.0 100.0 75.6 90 Riau Islands 8.2 42.6 5.5 10.7 1.2 0.4 0.0 12.2 14.5 4.2 0.5 100.0 83.0 72 Java DKI Jakarta 42.5 40.1 0.5 2.7 1.6 5.1 0.0 3.0 4.1 0.5 0.0 100.0 90.2 622 West Java 37.5 35.6 2.1 6.6 0.6 5.5 0.0 1.8 9.8 0.4 0.1 100.0 86.8 2,251 Central Java 31.7 24.1 8.9 10.5 2.1 12.7 0.0 0.6 7.6 1.4 0.4 100.0 72.9 2,077 DI Yogyakarta 35.2 37.4 13.2 1.2 1.9 5.6 0.0 1.5 3.8 0.3 0.0 100.0 91.1 175 East Java 19.7 36.2 7.9 9.8 2.3 17.1 0.8 0.9 4.3 0.8 0.2 100.0 69.0 1,895 Banten 19.0 18.9 10.6 12.9 11.1 13.8 0.7 2.1 7.6 2.6 0.8 100.0 58.1 587 Bali and Nusa Tenggara Bali 29.8 26.4 10.6 13.0 0.8 1.5 4.5 0.2 12.1 1.2 0.1 100.0 79.0 216 West Nusa Tenggara 17.0 20.1 20.3 24.2 1.2 5.5 1.8 2.4 6.6 0.9 0.0 100.0 66.4 330 East Nusa Tenggara 6.6 25.6 28.4 18.2 1.5 6.2 2.8 1.1 7.4 0.9 1.3 100.0 69.1 360 Kalimantan West Kalimantan 19.1 22.9 3.3 32.9 5.9 8.9 2.3 0.4 2.2 1.9 0.2 100.0 48.0 305 Central Kalimantan 29.8 17.1 1.9 20.8 8.6 6.0 0.0 2.6 12.3 0.3 0.7 100.0 63.6 134 South Kalimantan 24.4 20.7 4.6 11.5 1.5 25.1 0.3 5.4 3.9 2.6 0.0 100.0 59.0 238 East Kalimantan 25.4 37.4 2.3 14.8 4.2 7.3 0.0 3.2 5.0 0.5 0.0 100.0 73.2 209 Sulawesi North Sulawesi 19.3 39.7 18.4 7.9 1.5 4.3 0.0 2.0 6.3 0.6 0.0 100.0 85.6 161 Central Sulawesi 12.1 21.9 18.8 19.6 2.4 16.2 0.0 1.5 5.8 1.1 0.5 100.0 60.2 188 South Sulawesi 18.4 19.4 11.6 20.2 10.9 3.3 1.4 1.2 9.3 3.5 0.8 100.0 59.9 487 Southeast Sulawesi 7.2 28.6 14.1 24.3 9.8 10.0 0.0 0.3 4.7 0.6 0.4 100.0 54.9 141 Gorontalo 11.4 19.9 12.7 23.1 1.8 11.3 0.2 1.4 16.6 1.2 0.4 100.0 62.0 65 West Sulawesi 10.3 19.4 11.3 39.1 6.3 4.5 0.0 1.9 5.8 1.4 0.0 100.0 48.7 72 Maluku and Papua Maluku 18.5 13.7 10.6 2.8 2.1 31.4 0.3 2.1 10.7 7.5 0.2 100.0 55.7 96 North Maluku 16.5 16.6 23.3 14.1 5.9 13.2 0.0 3.8 3.9 2.5 0.2 100.0 64.1 68 Papua 12.1 18.6 16.7 14.3 0.9 20.0 1.2 1.0 2.2 11.0 1.9 100.0 50.6 111 West Papua 13.1 34.6 7.1 20.1 3.5 9.6 2.4 1.7 4.4 2.5 1.2 100.0 60.8 43 Total 24.8 29.3 8.3 12.1 4.0 10.8 0.5 1.5 7.2 1.3 0.3 100.0 71.1 13,659 Appendix A | 303 Table A-13.3 Prevalence of diarrhea by province Percentage of children under five years with diarrhea in the two weeks preceding the survey, by province, Indonesia 2007 Province Diarrhea in the two weeks preceding the survey Number of children Sumatera Nanggroe Aceh Darussalam 19.1 313 North Sumatera 15.8 1,146 West Sumatera 14.5 366 Riau 16.7 282 Jambi 15.3 179 South Sumatera 14.7 473 Bengkulu 20.5 106 Lampung 10.6 443 Bangka Belitung 6.4 99 Riau Islands 14.3 89 Java DKI Jakarta 6.9 723 West Java 18.2 2,504 Central Java 9.3 2,263 DI Yogyakarta 5.4 197 East Java 13.3 2,106 Banten 10.1 672 Bali and Nusa Tenggara Bali 9.1 248 West Nusa Tenggara 18.5 380 East Nusa Tenggara 15.2 478 Kalimantan West Kalimantan 15.2 361 Central Kalimantan 20.8 156 South Kalimantan 15.7 272 East Kalimantan 13.7 256 Sulawesi North Sulawesi 14.1 185 Central Sulawesi 15.8 235 South Sulawesi 11.7 607 Southeast Sulawesi 14.2 185 Gorontalo 16.7 77 West Sulawesi 22.2 96 Maluku and Papua Maluku 9.7 134 North Maluku 14.1 88 Papua 15.3 144 West Papua 13.0 59 Total 13.7 15,925 1 See Table 2.7 for definition of categories. 2 See Table 2.8 for definition of categories. 304 | Appendix A Table A-13.4 Knowledge of ORS packets by province Percentage of mothers with births in the five years preceding the survey who know about ORS packets for treatment of diarrhea, by province, Indonesia 2007 Province Percentage of mothers who know about ORS packets Number of women Sumatera Nanggroe Aceh Darussalam 94.7 269 North Sumatera 87.0 803 West Sumatera 93.9 304 Riau 90.6 243 Jambi 94.9 169 South Sumatera 91.8 424 Bengkulu 93.9 100 Lampung 93.9 409 Bangka Belitung 94.8 93 Riau Islands 84.7 76 Java DKI Jakarta 97.3 649 West Java 97.8 2,328 Central Java 95.1 2,109 DI Yogyakarta 99.8 179 East Java 90.3 1,947 Banten 96.1 599 Bali and Nusa Tenggara Bali 96.2 225 West Nusa Tenggara 93.3 347 East Nusa Tenggara 84.5 375 Kalimantan West Kalimantan 87.7 312 Central Kalimantan 91.9 138 South Kalimantan 95.0 249 East Kalimantan 95.3 218 Sulawesi North Sulawesi 94.8 166 Central Sulawesi 89.2 192 South Sulawesi 89.4 500 Southeast Sulawesi 89.8 144 Gorontalo 87.7 68 West Sulawesi 83.7 75 Maluku and Papua Maluku 79.8 99 North Maluku 89.1 71 Papua 67.7 117 West Papua 80.4 45 Total 92.9 14,043 ORS = Oral rehydration salts Appendix A | 305 Table A-13.5 Diarrhea treatment by province Among children under age five who had diarrhea in the two weeks preceding the survey, percentage taken for treatment to a health provider, percentage who recieved oral rehydration therapy (ORT), and percentage given other treatments, by province, Indonesia 2007 Oral rehydration therapy (ORT) Other treatments Province Percentage taken to a health facility or provider1 Oral rehydra- tion salts (ORS) packets Recom- mended home fluids (RHF) Either ORS or RHF In- creased fluids ORT, RHF or in- creased fluids Pills/ syrup Injec- tion Intra- venous solution Home remedy/ other Missing No treat- ment Number of children with diarrhea Sumatera Nanggroe Aceh Darussalam 68.9 36.2 34.9 51.3 34.8 67.8 57.0 1.6 0.0 12.4 0.0 14.5 60 North Sumatera 45.5 25.0 15.5 31.8 24.7 46.8 43.0 0.0 0.0 21.4 1.2 21.5 181 West Sumatera 51.3 37.1 39.4 56.8 48.3 81.0 38.8 1.3 0.0 17.0 0.0 8.7 53 Riau 49.7 45.9 14.6 49.6 21.9 56.8 45.0 0.0 0.0 11.4 0.0 19.7 47 Jambi 67.2 55.3 37.6 73.4 20.3 80.4 56.3 1.8 0.0 7.7 0.0 5.5 27 South Sumatera 53.6 49.9 21.2 56.7 30.4 66.5 36.1 1.1 0.0 8.6 0.0 18.5 69 Bengkulu 47.8 33.8 33.7 48.7 35.7 67.3 38.0 0.0 0.0 23.2 0.0 10.3 22 Lampung 60.6 34.0 20.0 51.2 20.4 59.5 50.4 2.6 0.0 15.5 0.9 16.7 47 Bangka Belitung 73.7 53.9 16.6 63.0 32.5 71.2 66.0 0.0 0.0 3.4 2.3 8.7 6 Riau Islands 59.4 45.7 22.4 56.4 15.2 58.9 43.1 0.0 0.0 17.7 1.2 18.8 13 Java DKI Jakarta 59.5 48.2 27.0 58.5 26.4 71.0 63.5 0.0 0.0 9.0 0.0 10.7 50 West Java 47.9 30.1 14.7 36.2 33.9 56.8 60.2 0.4 0.0 10.2 0.4 13.6 455 Central Java 51.7 23.2 17.7 35.2 34.6 52.2 52.9 0.0 0.0 12.5 0.0 26.0 211 DI Yogyakarta 69.6 49.6 42.4 78.9 54.8 89.7 61.2 0.0 0.0 20.4 0.0 0.0 11 East Java 50.2 32.0 27.2 47.5 30.4 62.5 42.1 0.7 0.7 12.3 0.0 22.0 279 Banten 57.5 27.3 16.5 36.2 18.2 46.0 54.6 1.4 0.0 13.8 1.3 14.5 68 Bali and Nusa Tenggara Bali 84.3 54.3 30.5 61.6 26.8 67.8 54.3 0.0 0.0 12.1 0.0 11.6 23 West Nusa Tenggara 42.2 43.2 33.6 63.0 16.9 68.8 26.7 1.2 0.0 20.4 0.0 15.9 70 East Nusa Tenggara 51.6 57.5 47.9 79.5 26.6 83.0 30.9 0.0 0.0 4.9 2.4 10.8 73 Kalimantan West Kalimantan 47.3 41.4 25.0 55.3 25.7 62.3 49.8 0.0 0.0 11.7 0.0 17.9 55 Central Kalimantan 63.3 48.5 28.1 60.6 28.6 66.5 52.6 0.0 0.5 13.5 0.0 10.1 33 South Kalimantan 42.5 34.4 15.5 40.2 30.5 58.9 47.6 0.0 0.0 15.1 0.0 18.9 43 East Kalimantan 35.4 39.6 17.7 46.1 36.9 61.4 41.4 0.0 0.0 10.6 0.0 23.2 35 Sulawesi North Sulawesi 58.4 33.0 13.8 39.7 45.1 67.2 57.2 0.0 1.5 8.2 0.0 11.0 26 Central Sulawesi 42.9 34.2 25.0 53.2 33.3 68.4 45.3 0.0 0.0 29.3 0.0 5.9 37 South Sulawesi 48.3 32.8 10.1 38.9 34.7 60.0 42.5 0.0 0.0 18.0 0.0 18.0 71 Southeast Sulawesi 41.4 33.9 24.7 48.7 27.2 64.1 29.7 0.0 1.5 18.6 0.0 18.2 26 Gorontalo 52.2 38.7 47.1 64.5 56.1 75.6 43.3 7.2 0.0 33.7 0.7 6.9 13 West Sulawesi 51.7 35.2 30.3 55.0 33.3 64.3 28.9 0.0 0.0 23.5 0.9 18.9 21 Maluku and Papua Maluku 21.8 20.9 40.3 56.2 17.9 65.1 31.5 0.8 0.0 30.1 0.0 13.1 13 North Maluku 49.5 35.5 20.6 49.4 38.0 64.4 20.8 0.0 0.0 31.6 0.0 18.2 12 Papua 70.6 57.7 31.8 72.9 11.1 73.6 15.8 0.0 0.0 33.8 1.1 17.3 22 West Papua 75.9 56.7 22.2 65.7 22.6 69.6 38.3 3.8 0.0 20.2 0.0 11.8 8 Total 51.0 34.7 22.4 46.1 30.3 60.9 47.8 0.5 0.1 14.0 0.4 16.9 2,180 Note: ORT includes solution prepared from oral rehydration salt (ORS), pre-packaged ORS packet, and recommended home fluids (RHF). 1 Excludes pharmacy, shop, traditional practitioner, delivery post, health post, and health cadre 306 | Appendix A Table A-13.6 Feeding practices during diarrhea by province Percent distribution of children under age five who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by province, Indonesia 2007 Amount of liquids offered Amount of food offered Province More Same as usual Some- what less Much less None Don't know/ missing Total More Same as usual Some- what less Much less None Never gave food Don't know/ missing Total Per- centage given increased fluids and continued feeding1 Percentage who continued feeding and were given ORT and/or increased fluids Number of children with diarrhea Sumatera Nanggroe Aceh Darussalam 34.8 39.7 18.7 2.3 2.5 2.0 100.0 7.8 45.9 38.2 6.0 0.0 2.1 0.0 100.0 33.0 64.5 60 North Sumatera 24.7 42.2 20.8 2.2 8.1 2.0 100.0 5.4 44.6 37.3 1.4 1.5 6.9 2.9 100.0 21.8 42.2 181 West Sumatera 48.3 29.6 18.3 1.2 0.5 2.2 100.0 10.5 35.4 46.0 3.2 0.6 4.3 0.0 100.0 44.8 76.1 53 Riau 21.9 49.9 8.0 1.1 9.7 9.5 100.0 6.7 49.8 27.7 4.0 5.0 1.9 4.9 100.0 21.9 48.4 47 Jambi 20.3 44.5 26.0 0.7 5.9 2.8 100.0 0.0 47.0 40.1 5.2 1.0 5.3 1.5 100.0 14.6 70.6 27 South Sumatera 30.4 38.2 26.9 1.0 3.5 0.0 100.0 12.4 29.8 48.7 3.4 2.1 3.5 0.0 100.0 28.0 61.2 69 Bengkulu 35.7 42.8 14.6 0.0 5.2 1.7 100.0 6.0 42.2 40.6 2.5 1.9 6.8 0.0 100.0 35.2 64.9 22 Lampung 20.4 49.0 24.3 0.0 3.8 2.5 100.0 0.0 39.2 45.2 13.1 0.0 2.5 0.0 100.0 18.3 46.4 47 Bangka Belitung 32.5 56.9 3.8 0.0 4.4 2.3 100.0 5.6 64.7 23.0 0.0 4.4 0.0 2.3 100.0 32.5 66.8 6 Riau Islands 15.2 41.6 31.2 1.3 4.0 6.6 100.0 0.0 37.0 38.7 9.4 1.1 4.8 9.0 100.0 11.8 43.6 13 Java DKI Jakarta 26.4 34.7 24.5 3.7 10.8 0.0 100.0 12.8 36.5 38.0 6.0 1.3 5.4 0.0 100.0 21.4 63.8 50 West Java 33.9 44.8 11.7 1.5 6.1 1.9 100.0 10.7 42.7 36.7 5.4 0.6 3.9 0.0 100.0 30.8 51.2 455 Central Java 34.6 39.1 15.6 5.6 5.1 0.0 100.0 3.8 25.9 53.1 13.3 0.0 3.9 0.0 100.0 25.6 42.2 211 DI Yogyakarta 54.8 19.8 25.4 0.0 0.0 0.0 100.0 13.2 51.5 35.3 0.0 0.0 0.0 0.0 100.0 54.8 89.7 11 East Java 30.4 58.6 7.0 0.7 0.0 3.4 100.0 4.7 52.6 33.4 4.5 0.0 4.8 0.0 100.0 26.5 56.3 279 Banten 18.2 39.9 30.7 9.1 2.2 0.0 100.0 1.5 37.7 39.6 16.4 3.5 0.0 1.3 100.0 15.4 33.0 68 Bali and Nusa Tenggara Bali 26.8 58.9 5.9 4.3 4.1 0.0 100.0 11.4 63.3 18.7 4.0 2.6 0.0 0.0 100.0 25.1 63.9 23 West Nusa Tenggara 16.9 64.7 8.2 1.1 2.4 6.8 100.0 3.3 58.0 24.9 1.6 3.3 4.3 4.5 100.0 12.1 58.9 70 East Nusa Tenggara 26.6 42.3 19.8 4.4 3.4 3.5 100.0 14.1 30.8 41.0 4.6 2.6 3.5 3.5 100.0 21.7 75.4 73 Kalimantan West Kalimantan 25.7 42.3 22.2 3.9 4.0 1.9 100.0 5.5 39.5 45.9 5.6 1.1 2.3 0.0 100.0 24.4 55.7 55 Central Kalimantan 28.6 45.6 17.1 2.4 5.3 1.0 100.0 19.8 39.8 29.9 5.4 0.0 5.0 0.0 100.0 26.5 63.5 33 South Kalimantan 30.5 36.4 18.6 7.5 5.1 1.9 100.0 14.7 30.0 44.3 7.2 2.0 1.8 0.0 100.0 25.6 52.5 43 East Kalimantan 36.9 44.5 10.9 0.6 4.7 2.5 100.0 14.6 48.7 29.6 0.6 1.9 4.6 0.0 100.0 33.4 57.3 35 Sulawesi North Sulawesi 45.1 38.5 14.8 0.0 0.0 1.6 100.0 20.5 40.4 32.3 4.4 1.4 1.1 0.0 100.0 40.7 61.4 26 Central Sulawesi 33.3 52.5 9.9 1.4 1.2 1.6 100.0 11.8 53.8 25.8 5.1 1.3 2.3 0.0 100.0 29.8 63.5 37 South Sulawesi 34.7 45.2 9.6 1.1 8.1 1.3 100.0 8.3 55.0 21.0 2.6 1.3 10.3 1.5 100.0 30.9 53.5 71 Southeast Sulawesi 27.2 46.6 16.3 2.1 7.8 0.0 100.0 6.4 49.7 34.6 3.4 0.8 4.9 0.0 100.0 25.9 59.1 26 Gorontalo 56.1 26.3 13.8 0.0 3.8 0.0 100.0 14.6 28.5 47.6 5.5 0.0 2.4 1.3 100.0 50.0 69.5 13 West Sulawesi 33.3 46.6 12.3 0.8 5.7 1.2 100.0 8.6 48.4 30.7 6.4 2.1 2.9 0.9 100.0 28.1 57.6 21 Maluku and Papua Maluku 17.9 61.7 12.2 3.4 4.9 0.0 100.0 12.2 64.7 16.1 2.3 0.0 2.8 1.8 100.0 15.6 61.0 13 North Maluku 38.0 31.2 23.0 1.3 6.5 0.0 100.0 11.0 31.5 46.6 2.9 0.0 8.0 0.0 100.0 37.5 62.5 12 Papua 11.1 55.1 22.4 3.0 3.8 4.5 100.0 17.3 60.8 18.6 0.0 0.0 0.0 3.3 100.0 7.8 70.3 22 West Papua 22.6 46.3 7.9 1.7 5.9 15.6 100.0 24.2 44.7 26.9 0.0 1.9 0.0 2.3 100.0 22.6 67.0 8 Total 30.3 45.4 15.2 2.3 4.6 2.1 100.0 8.1 42.8 37.4 5.6 1.1 4.1 0.8 100.0 26.6 54.3 2,180 1 Continued feeding includes children who were given more, same as usual, or somewhat less food during the diarrhea episode. Appendix A | 307 Table A-13.7 Hand-washing practices by province Percentage of women who washed their hands before preparing a meal for their family the last time, according to province, Indonesia 2007 Province Washed hands Did not wash hands Never prepared meals Missing Total Number of women Sumatera Nanggroe Aceh Darussalam 98.4 1.1 0.5 0.0 100.0 514 North Sumatera 95.1 3.5 1.3 0.2 100.0 1,487 West Sumatera 86.4 13.2 0.4 0.0 100.0 570 Riau 97.6 1.7 0.6 0.0 100.0 494 Jambi 97.6 0.7 1.7 0.0 100.0 367 South Sumatera 96.3 1.3 2.4 0.0 100.0 928 Bengkulu 96.7 2.4 0.9 0.0 100.0 211 Lampung 91.0 7.5 1.5 0.0 100.0 963 Bangka Belitung 98.0 1.6 0.4 0.1 100.0 194 Riau Islands 98.8 0.9 0.2 0.1 100.0 140 Java DKI Jakarta 97.1 1.1 1.8 0.0 100.0 1,471 West Java 97.3 1.8 0.8 0.0 100.0 5,545 Central Java 97.9 1.0 1.1 0.0 100.0 5,383 DI Yogyakarta 98.7 0.6 0.8 0.0 100.0 551 East Java 98.0 1.0 1.0 0.0 100.0 5,924 Banten 93.5 2.4 2.6 1.5 100.0 1,310 Bali and Nusa Tenggara Bali 93.8 5.2 1.0 0.0 100.0 587 West Nusa Tenggara 98.9 0.5 0.6 0.0 100.0 705 East Nusa Tenggara 86.5 13.0 0.5 0.0 100.0 627 Kalimantan West Kalimantan 97.1 2.6 0.3 0.0 100.0 628 Central Kalimantan 98.2 1.0 0.8 0.0 100.0 294 South Kalimantan 98.2 0.2 1.4 0.1 100.0 550 East Kalimantan 98.3 1.1 0.6 0.0 100.0 475 Sulawesi North Sulawesi 98.3 1.2 0.4 0.1 100.0 373 Central Sulawesi 98.2 1.5 0.3 0.0 100.0 339 South Sulawesi 96.6 2.3 1.1 0.0 100.0 1,067 Southeast Sulawesi 98.9 0.5 0.3 0.3 100.0 259 Gorontalo 98.8 0.7 0.5 0.0 100.0 163 West Sulawesi 97.4 2.0 0.4 0.1 100.0 139 Maluku and Papua Maluku 98.0 1.6 0.4 0.0 100.0 168 North Maluku 99.5 0.2 0.3 0.0 100.0 129 Papua 73.4 25.0 1.3 0.4 100.0 251 West Papua 80.8 17.8 0.9 0.4 100.0 89 Total 96.5 2.3 1.1 0.1 100.0 32,895 308 | Appendix A CHAPTER 14 INFANT FEEDING Table A-14.1 Initial breastfeeding by province Percentage of children born in the five years preceding the survey who were ever breastfed, and for the last children born in the five years preceding the survey ever breastfed, the percentage who started breastfeeding within one hour and within one day of birth and the percentage who received a prelacteal feed, by province, Indonesia 2007 Breastfeeding among children born in past five years Among last-born children ever breastfed: Province Percentage ever breastfed Number of children born in past five years Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth Percentage who received a prelacteal feed Number of last-born children ever breastfed Sumatera Nanggroe Aceh Darussalam 94.8 324 41.6 65.5 57.5 258 North Sumatera 94.7 1,197 23.4 38.1 82.9 766 West Sumatera 96.0 383 31.1 68.9 67.5 295 Riau 92.2 290 36.6 51.5 65.3 228 Jambi 96.0 186 26.4 46.8 71.2 163 South Sumatera 94.2 491 40.2 51.7 67.6 406 Bengkulu 96.2 111 33.4 48.5 76.9 97 Lampung 95.0 452 49.0 61.8 64.8 391 Bangka Belitung 88.3 103 28.7 64.3 48.9 82 Riau Islands 83.7 93 36.1 55.2 75.6 65 Java DKI Jakarta 94.1 741 28.3 50.3 75.0 614 West Java 95.2 2,600 46.9 60.2 53.1 2,228 Central Java 96.0 2,308 45.2 61.8 68.7 2,039 DI Yogyakarta 96.4 201 42.8 73.2 54.5 173 East Java 95.5 2,178 51.5 74.5 69.5 1,881 Banten 94.5 695 46.6 56.0 72.6 573 Bali and Nusa Tenggara Bali 94.8 253 54.3 78.8 47.1 214 West Nusa Tenggara 96.2 412 58.0 77.2 47.8 336 East Nusa Tenggara 97.3 507 48.8 73.3 33.4 369 Kalimantan West Kalimantan 95.2 374 50.0 54.4 59.6 298 Central Kalimantan 96.8 160 42.9 57.0 72.8 133 South Kalimantan 92.6 289 46.9 56.2 70.7 233 East Kalimantan 95.2 262 51.0 68.3 69.3 210 Sulawesi North Sulawesi 93.4 191 60.8 78.2 40.7 154 Central Sulawesi 96.7 243 44.0 48.9 69.7 187 South Sulawesi 97.6 631 43.8 62.4 85.0 486 Southeast Sulawesi 95.3 192 31.6 48.8 68.3 139 Gorontalo 95.1 82 26.2 59.3 73.2 65 West Sulawesi 93.5 103 40.0 53.5 49.0 72 Maluku and Papua Maluku 96.2 143 32.5 52.2 55.2 96 North Maluku 93.7 93 37.1 54.7 48.7 67 Papua 92.6 152 56.3 81.3 36.7 109 West Papua 94.2 62 41.0 78.2 48.8 43 Total 95.2 16,504 43.9 61.5 64.6 13,471 Note: Table is based on births in the past five years whether the children are living or dead at the time of interview. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse/midwife, or auxiliary midwife Appendix A | 309 Table A-14.2 Median duration and frequency of breastfeeding by province Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by province, Indonesia 2007 Median duration (months) of breastfeeding among children born in the past three years Frequency of breastfeeding among children under six months Province Any breast- feeding Exclusive breast- feeding Predomi- nant breast- feeding Number of children Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children Sumatera Nanggroe Aceh Darussalam 19.7 0.6 0.6 205 93.1 6.2 4.8 31 North Sumatera 18.6 0.6 1.1 724 92.1 7.7 6.2 101 West Sumatera 20.1 1.8 3.1 237 100.0 7.8 5.3 36 Riau 19.3 0.6 0.6 173 (98.2) (6.8) (7.0) 29 Jambi 24.2 0.7 2.1 112 (96.0) (6.4) (4.6) 16 South Sumatera 22.3 1.7 3.1 299 98.8 7.3 5.1 44 Bengkulu 19.5 2.8 3.9 64 (97.7) (7.1) (7.3) 8 Lampung 19.1 1.4 2.6 287 (98.7) (7.6) (6.1) 41 Bangka Belitung 4.2 0.5 0.7 63 * * * 4 Riau Islands 3.9 0.5 0.5 58 (89.2) (5.2) (4.5) 6 Java DKI Jakarta 19.7 0.6 0.7 441 93.4 6.9 5.5 52 West Java 21.0 1.2 2.2 1,571 94.0 6.9 5.9 248 Central Java 23.6 0.7 0.7 1,377 94.1 6.8 5.0 212 DI Yogyakarta 22.6 0.7 0.7 123 (95.0) (7.5) (6.4) 19 East Java 17.9 0.7 0.7 1,336 98.9 10.2 7.5 208 Banten 21.9 0.5 0.5 408 95.4 6.9 4.6 83 Bali and Nusa Tenggara Bali 22.8 0.4 0.4 144 (96.3) (7.4) (5.7) 22 West Nusa Tenggara 19.3 1.3 2.4 245 93.3 6.6 4.5 38 East Nusa Tenggara 18.8 2.0 3.2 317 98.7 7.8 5.3 45 Kalimantan West Kalimantan 31.0 0.7 1.4 223 (97.5) (6.6) (4.9) 26 Central Kalimantan 16.0 0.7 0.7 101 (98.4) (6.0) (5.7) 13 South Kalimantan 23.4 1.9 2.2 173 (96.6) (6.6) (4.9) 17 East Kalimantan 18.6 1.8 2.4 157 (98.2) (7.5) (6.3) 27 Sulawesi North Sulawesi 18.1 0.5 0.5 119 * * * 11 Central Sulawesi 22.6 0.7 0.7 140 (94.0) (6.6) (5.7) 20 South Sulawesi 22.1 3.2 4.4 382 95.1 6.5 4.6 59 Southeast Sulawesi 21.5 0.7 1.9 108 (88.2) (6.6) (4.8) 15 Gorontalo 22.9 0.4 0.6 48 (94.2) (5.7) (4.8) 7 West Sulawesi 18.4 3.2 3.5 61 (90.5) (6.0) (4.1) 8 Maluku and Papua Maluku 23.0 3.2 3.6 89 92.0 5.0 5.1 15 North Maluku 13.0 0.7 2.6 55 (90.5) (5.4) (4.9) 8 Papua 20.7 0.5 0.6 84 (82.8) (5.8) (4.5) 10 West Papua 14.5 0.5 0.6 37 (98.9) (4.9) (5.0) 4 Total 20.7 0.7 1.2 9,960 95.4 7.4 5.7 1,481 Note: Includes children living and deceased at the time of the survey.Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding 2 Excludes children without a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only 310 | Appendix A Table A-14.3 Micronutrient intake among children by province Among youngest children age 6-35 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, by province, Indonesia 2007 Among youngest children age 6-35 months living with the mother: Among all children age 6-59 months: Province Percentage who consumed foods rich in vitamin A in past 24 hours Percentage who consumed foods rich in iron in past 24 hours Number of children Percentage given vitamin A supplements in past 6 months Number of children Sumatera Nanggroe Aceh Darussalam 82.6 62.6 155 71.3 279 North Sumatera 84.9 71.4 461 34.3 1,024 West Sumatera 85.4 72.7 176 65.6 328 Riau 85.9 77.1 126 57.9 250 Jambi 89.2 78.6 85 71.2 161 South Sumatera 90.5 76.1 233 63.6 424 Bengkulu 90.6 74.2 51 66.5 99 Lampung 88.5 65.5 227 72.3 395 Bangka Belitung 88.9 80.1 54 70.1 94 Riau Islands 93.2 88.9 42 66.5 81 Java DKI Jakarta 93.2 84.3 339 73.7 655 West Java 91.0 72.5 1,200 74.5 2,233 Central Java 83.5 58.2 1,071 73.0 2,025 DI Yogyakarta 89.1 76.9 95 84.1 178 East Java 83.7 62.6 959 72.8 1,860 Banten 90.1 68.5 290 62.6 582 Bali and Nusa Tenggara Bali 87.5 75.8 114 78.6 224 West Nusa Tenggara 88.4 72.1 174 77.9 339 East Nusa Tenggara 92.8 58.4 222 76.3 429 Kalimantan West Kalimantan 89.0 74.2 172 67.2 331 Central Kalimantan 92.2 82.2 76 71.4 142 South Kalimantan 87.7 78.5 134 70.1 252 East Kalimantan 87.0 75.3 112 75.9 226 Sulawesi North Sulawesi 89.8 76.5 94 77.0 172 Central Sulawesi 83.7 71.5 103 77.6 211 South Sulawesi 89.0 80.7 273 65.1 544 Southeast Sulawesi 87.6 75.2 74 68.0 167 Gorontalo 85.6 70.5 33 60.0 69 West Sulawesi 86.3 74.9 43 60.7 86 Maluku and Papua Maluku 81.4 76.3 56 45.7 117 North Maluku 86.1 83.2 35 54.1 78 Papua 84.7 50.4 59 57.2 131 West Papua 81.7 65.7 26 57.8 53 Total 87.4 69.7 7,360 68.5 14,239 Note: Information on vitamin A and iron supplements is based on the mother's recall. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A, and red palm oil [if data are collected.] 2 Includes meat, (including organ meat) Appendix A | 311 Table A-14.4 Micronutrient intake among mothers by province Among women age 15-49 with a child under age three years living with her, the percentages who consumed vitamin A-rich and iron-rich foods in the 24 hours preceding the survey; among women age 15-49 with a child born in the past five years, the percentage who received a vitamin A dose in the first two months after the birth of the last child; among mothers age 15-49 who during the pregnancy of the last child born in the five years prior to the survey, the percentage who suffered from night blindness, the percentage who took iron tablets or syrup for specific numbers of days, by province, Indonesia 2007 Among women with a child under three years living with her Number of days women took iron tablets or syrup during pregnancy of last birth Province Percentage consumed vitamin A- rich foods1 Percentage consumed iron-rich foods Number of women Percentage who received vitamin A dose postpartum Night blindness reported Night blindness adjusted2 None <60 60-89 90+ Don't know/ missing Number of women Sumatera Nanggroe Aceh Darussalam 96.5 78.1 189 43.8 2.8 0.3 41.1 34.6 4.5 4.8 15.1 269 North Sumatera 96.0 85.7 582 32.9 5.5 1.2 34.8 37.3 3.8 13.4 10.7 803 West Sumatera 97.0 84.9 213 47.3 1.5 0.0 19.7 28.4 6.9 40.0 5.0 304 Riau 97.8 91.1 159 34.6 3.9 0.1 28.3 40.3 4.6 10.4 16.5 243 Jambi 99.0 87.8 104 45.2 1.9 0.0 26.8 38.9 7.0 19.2 8.0 169 South Sumatera 97.1 88.5 282 31.2 2.4 0.7 28.4 34.4 6.6 22.1 8.4 424 Bengkulu 96.3 83.7 59 35.6 3.1 1.0 20.3 33.7 11.4 31.7 2.9 100 Lampung 97.3 74.9 275 41.9 1.0 0.1 17.5 46.7 4.2 11.4 20.2 409 Bangka Belitung 99.6 97.6 59 40.9 3.2 0.7 20.5 30.2 10.5 34.5 4.3 93 Riau Islands 98.0 95.3 50 61.3 2.3 1.1 18.4 34.8 4.3 28.3 14.2 76 Java DKI Jakarta 98.9 93.8 406 54.7 0.5 0.0 15.1 32.8 12.1 28.8 11.3 649 West Java 94.3 80.6 1,465 45.0 1.5 0.5 15.7 39.5 9.2 28.0 7.5 2,328 Central Java 94.1 66.7 1,306 47.6 2.3 0.0 15.2 28.1 11.7 40.0 5.0 2,109 DI Yogyakarta 98.7 87.7 114 54.8 0.6 0.3 5.3 7.3 9.3 75.2 3.0 179 East Java 90.4 67.6 1,199 43.7 0.4 0.0 18.7 23.1 10.9 45.7 1.6 1,947 Banten 99.0 83.9 380 40.0 4.4 0.2 27.2 36.1 3.6 16.2 16.8 599 Bali and Nusa Tenggara Bali 96.9 85.6 136 64.5 1.6 0.3 6.2 17.3 8.5 63.6 4.4 225 West Nusa Tenggara 96.1 78.0 215 51.5 5.1 1.7 12.1 33.6 6.6 45.5 2.2 347 East Nusa Tenggara 96.5 62.6 271 58.3 2.7 0.8 16.0 19.6 11.8 37.9 14.8 375 Kalimantan West Kalimantan 95.6 82.1 201 40.4 5.0 1.4 44.1 42.4 1.0 4.1 8.4 312 Central Kalimantan 99.4 89.5 90 45.2 2.5 1.0 26.3 37.8 4.8 19.3 11.7 138 South Kalimantan 98.7 95.7 154 33.1 1.3 0.2 23.8 31.3 12.1 30.2 2.6 249 East Kalimantan 99.1 90.1 142 35.9 4.6 0.0 17.4 33.5 5.2 37.0 6.9 218 Sulawesi North Sulawesi 97.9 85.4 106 63.0 2.3 1.0 9.7 54.3 6.0 13.4 16.7 166 Central Sulawesi 94.9 80.9 127 46.6 0.7 0.2 23.6 50.0 6.3 12.5 7.7 192 South Sulawesi 98.8 94.0 336 41.7 1.3 0.0 23.2 62.7 2.1 3.2 8.9 500 Southeast Sulawesi 99.3 90.8 92 46.2 4.6 1.0 36.1 37.4 2.5 6.0 18.0 144 Gorontalo 95.6 81.1 41 51.3 3.5 0.3 30.8 46.7 3.3 5.4 13.9 68 West Sulawesi 97.3 90.5 52 43.0 4.0 0.8 37.8 48.3 5.6 3.6 4.7 75 Maluku and Papua Maluku 98.3 92.3 72 32.5 1.5 0.0 42.2 28.4 7.5 15.0 6.8 99 North Maluku 97.5 94.0 45 51.0 3.3 0.9 15.2 38.1 8.8 23.2 14.7 71 Papua 94.8 54.2 72 33.2 3.2 0.6 33.6 28.8 5.0 11.0 21.5 117 West Papua 90.6 76.7 31 42.2 1.1 0.3 30.4 23.3 8.1 16.3 21.8 45 Total 95.5 79.3 9,024 44.6 2.2 0.4 20.7 33.9 8.2 29.2 8.1 14,043 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A, 2 Women who reported night blindness but did not report difficulty with vision during the day 312 | Appendix A Table A-14.5 Infant and young child feeding (IYCF) practices by province Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based upon number of food groups and times they are fed during the day or night preceding the survey by province, Indonesia 2007 Among breastfed children 6-23 months, percentage fed: Among nonbreastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Province 3+ food groups1 Mini- mum times or more2 Both 3+ food groups and minimum times or more Number of breastfed children 6-23 months Milk or milk products3 4+ food groups 4+ times or more With 3 IYCF practices4 Number of non- breastfed children 6-23 months Breast- milk or milk products 3+ or 4+ food groups5 Mini- mum times or more6 With all 3 IYCF practices Number of all children 6-23 months Sumatera Nanggroe Aceh Darussalam 64.3 65.7 47.3 69 73.2 73.4 9.6 0.5 28 92.3 66.9 49.5 33.8 98 North Sumatera 71.3 67.7 51.9 212 69.5 83.8 3.6 2.3 106 89.8 75.5 46.3 35.4 318 West Sumatera 73.9 52.1 45.1 89 53.1 79.9 2.7 0.0 28 88.8 75.3 40.3 34.3 117 Riau 75.3 57.2 45.8 58 70.8 85.0 3.9 3.3 29 90.3 78.5 39.4 31.7 87 Jambi 83.2 61.6 52.1 45 73.9 85.8 11.1 6.1 11 94.9 83.7 51.7 43.1 56 South Sumatera 76.7 66.1 48.5 107 62.9 68.9 11.0 3.2 29 92.1 75.1 54.5 38.9 136 Bengkulu 84.0 62.6 56.2 24 60.6 86.8 9.7 4.9 8 89.7 84.7 48.8 42.8 32 Lampung 81.1 58.5 47.8 112 74.6 82.8 8.5 0.9 47 92.5 81.6 43.7 33.9 159 Bangka Belitung 73.2 60.5 41.0 17 91.4 77.0 1.5 0.0 13 96.3 74.8 35.2 23.4 31 Riau Islands 88.3 73.5 68.5 13 95.4 91.1 0.0 0.0 15 97.5 89.8 33.8 31.5 28 Java DKI Jakarta 83.2 67.5 56.7 138 96.2 91.2 12.0 12.0 76 98.7 86.0 47.8 40.9 214 West Java 76.6 71.4 51.9 619 84.6 85.7 29.0 24.1 171 96.7 78.5 62.2 45.9 790 Central Java 73.8 68.1 53.4 551 67.9 81.0 15.2 11.8 127 94.0 75.1 58.2 45.6 678 DI Yogyakarta 85.3 83.7 70.2 43 96.7 84.0 13.5 10.2 15 99.1 85.0 65.5 54.7 58 East Java 74.4 68.3 56.3 383 58.5 73.1 4.8 1.7 127 89.7 74.0 52.5 42.7 511 Banten 78.4 40.0 32.8 133 78.7 82.8 2.2 0.0 43 94.8 79.4 30.8 24.7 177 Bali and Nusa Tenggara Bali 77.9 87.8 71.3 57 72.3 96.4 21.8 15.6 15 94.2 81.8 74.1 59.7 72 West Nusa Tenggara 77.6 60.0 50.6 79 49.1 80.6 19.2 6.5 28 86.6 78.4 49.3 39.0 107 East Nusa Tenggara 64.8 80.2 58.1 100 52.5 65.3 2.9 0.7 39 86.8 64.9 58.7 42.1 139 Kalimantan West Kalimantan 72.3 69.8 54.5 67 70.2 76.0 17.1 16.0 33 90.2 73.5 52.5 41.8 100 Central Kalimantan 75.4 73.2 56.7 35 82.1 85.6 1.6 1.6 13 95.0 78.2 53.4 41.5 48 South Kalimantan 75.4 57.5 48.3 63 87.2 64.4 0.0 0.0 18 97.2 73.0 44.8 37.7 81 East Kalimantan 76.1 72.3 56.6 48 91.7 69.3 11.6 7.5 26 97.1 73.7 51.1 39.5 73 Sulawesi North Sulawesi 76.0 76.5 63.3 35 74.3 85.6 16.6 10.5 22 90.3 79.6 53.8 43.3 57 Central Sulawesi 72.1 81.4 62.8 52 76.1 73.6 23.8 16.2 13 95.1 72.4 69.5 53.2 65 South Sulawesi 75.8 66.2 55.8 129 68.2 86.1 8.5 7.2 41 92.4 78.3 52.4 44.2 170 Southeast Sulawesi 65.7 64.0 46.2 39 69.4 67.5 10.5 3.3 11 93.4 66.1 52.4 36.9 49 Gorontalo 70.5 72.7 49.6 16 52.4 60.1 16.0 4.0 6 86.4 67.5 56.5 36.6 23 West Sulawesi 67.1 62.5 49.1 21 59.0 78.9 20.9 14.7 7 90.0 70.0 52.3 40.7 27 Maluku and Papua Maluku 63.1 67.7 52.3 29 40.3 80.7 0.0 0.0 7 88.2 66.6 54.4 42.0 36 North Maluku 69.0 58.4 39.7 12 50.5 64.4 9.5 5.5 9 79.0 67.0 37.6 25.1 22 Papua 60.9 48.5 36.2 28 65.9 64.5 19.5 13.3 10 91.0 61.9 40.8 30.1 39 West Papua 74.6 68.8 57.5 10 63.9 61.3 4.9 3.3 7 84.3 68.9 41.1 34.0 17 Total 75.0 67.0 52.5 3,434 72.5 80.3 11.9 8.3 1,178 93.0 76.3 52.9 41.2 4,612 1 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge, fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts; h. foods made with oil, fat, butter. 2 At least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Nonbreastfed children ages 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding (IYCF) practices if they receive other milk or milk products and are fed at least the minimum number of times per day with at least the minimum number of food groups. 5 3+ food groups for breastfed children and 4+ food groups for nonbreastfed children 6 Fed solid or semisolid food at least twice a day for infants 6-8 months, 3+ times for other breastfed children, and 4+ times for nonbreastfed children. Appendix A |