Indonesia Demographic and Health Survey 2012

Publication date: 2013

Indonesia Demographic and Health Survey 2012 Indonesia 2012 D em ographic and H ealth Survey Indonesia Demographic and Health Survey 2012 Statistics Indonesia National Population and Family Planning Board Ministry of Health MEASURE DHS ICF International August 2013 The 2012 Indonesia Demographic and Health Survey (IDHS) was carried out by Statistics Indonesia (Badan Pusat Statistik—BPS) in collaboration with the National Population and Family Planning Board (BKKBN) and the Ministry of Health (MOH). Funding for the local costs of the survey was provided by the Government of Indonesia. ICF International provided technical assistance under the auspices of the Demographic and Health Surveys (MEASURE DHS) program, which is funded by the U.S. Agency for International Development (USAID). Additional information about the survey may be obtained from the Directorate for Population and Labor Force Statistics, BPS, Jalan Dr. Sutomo No. 6-8, Jakarta 10710, Indonesia (Telephone/fax 345-6285, e-mail: demografi@bps.go.id), or BKKBN, Jalan Permata 1, Halim Perdanakusumah, Jakarta 13650, Indonesia (Telephone/fax 800-8557, email: pusdu@bkkbn.go.id), or the Institute for Research and Development, Ministry of Health, Jalan Percetakan Negara 29, Jakarta 10560, Indonesia (Telephone 426-1088, fax 424-3935, email: sesban@litbang.depkes.go.id). Additional information about the DHS program may be obtained by contacting: MEASURE DHS, ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone 301-572-0200; Fax 301- 572-0999; E-mail: reports@measuredhs.com; Internet: www.measuredhs.com). Recommended citation: Statistics Indonesia (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), and Kementerian Kesehatan (Kemenkes—MOH), and ICF International. 2013. Indonesia Demographic and Health Survey 2012. Jakarta, Indonesia: BPS, BKKBN, Kemenkes, and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . vii PREFACE (BPS) . xv PREFACE (BKKBN) . xvii PREFACE (MOH) . xix MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxi MAP OF INDONESIA . xxii 1 INTRODUCTION . 1 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 . 3 1.5 Objectives of the Survey . 4 1.6 Organization of the Survey . 5 1.7 Questionnaires . 5 1.8 Pretest, Training, and Fieldwork . 6 1.8.1 Pretest . 6 1.8.2 Training . 7 1.8.3 Fieldwork . 7 1.9 Data Processing . 7 1.10 Response rates . 7 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 2.1 Housing Characteristics . 9 2.1.1 Drinking Water . 9 2.1.2 Household Sanitation Facilities . 11 2.1.3 Housing Characteristics . 12 2.2. Household Possessions . 14 2.3 Wealth Index . 15 2.4 Hand Washing . 16 2.5 Household Population by Age and Sex . 17 2.6 Household Composition . 19 2.7 Birth Registration . 19 2.8 Education of Household Population . 20 3 CHARACTERISTICS OF RESPONDENTS . 23 3.1 Characteristic of Survey Respondents . 23 3.2 Educational Attainment . 24 3.3 Literacy . 26 3.4 Exposure to Mass Media . 28 3.5 Employment . 29 3.5.1 Employment status . 29 3.5.2 Occupation . 32 3.5.3 Type of employment . 34 3.6 Health Insurance Coverage . 35 3.7 Lifestyle Measures . 37 iv • Contents 4 MARRIAGE AND SEXUAL ACTIVITY . 41 4.1 Current Marital Status . 41 4.2 Polygyny . 42 4.3 Median Age at First Marriage . 43 4.4 Age at First Sexual Intercourse . 45 4.5 Median Age at First Sexual Intercourse . 46 4.6 Recent Sexual Activity . 47 5 FERTILITY . 49 5.1 Assessment of the 2012 IDHS Fertility Data . 49 5.2 Fertility Levels and Differentials . 50 5.2.1 Fertility Levels . 50 5.2.2 Differentials in Current and Completed Fertility . 51 5.3 Fertility Trends . 53 5.3.1 Evidence from Retrospective Data . 53 5.3.2 Evidence from Comparisons with Previous IDHS Surveys . 53 5.4 Children Ever Born and Living . 54 5.5 Birth Intervals . 55 5.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 57 5.7 Menopause . 59 5.8 Age at First Birth . 59 5.9 Teenage Pregnancy and Motherhood . 60 6 FERTILITY PREFERENCES . 63 6.1 Desire for Additional Children . 64 6.2 Ideal Family Size . 67 6.3 Planned Fertility . 69 6.4 Wanted Fertility Rates . 71 7 FAMILY PLANNING . 73 7.1 Knowledge of Family Planning . 73 7.1.1 Knowledge of Contraceptive Methods . 73 7.1.2 Knowledge of Fertile Period . 75 7.1.3 Exposure to Family Planning IEC . 76 7.1.4 Contact of Nonusers with Fieldworkers/Health Providers about Family Planning . 79 7.2 Current Use of Family Planning . 80 7.2.1 Current Use of Contraception by Age . 80 7.2.2 Current Use of Contraception by Background Characteristics . 81 7.2.3 Trends in Contraception by Background Characteristics . 83 7.2.4 Timing of Sterilization . 85 7.2.5 Source of Methods . 85 7.2.6 Informed Choice . 86 7.2.7 Pill Use Compliance . 88 7.2.8 Quality of Use of Injectables . 89 7.2.9 Problems with Current Method . 90 7.2.10 Cost of Contraceptive Use . 91 7.3 Nonuse and Intention to Use Family Planning . 92 7.3.1 Discontinuation Rates . 92 7.3.2 Reason for Discontinuation of Contraceptive Use . 93 7.3.3 Need for Family Planning Services . 94 7.3.4 Intention to Use in the Future . 97 7.3.5 Reason for Nonuse . 98 Contents • v 8 INFANT AND CHILD MORTALITY . 99 8.1 Assessment of Data Quality . 100 8.2 Levels and Trends in Infant and Child Mortality . 101 8.3 Socioeconomic Differentials in Infant and Child Mortality . 104 8.4 Demographic Differentials in Infant and Child Mortality . 105 8.5 Perinatal Mortality . 106 8.6 High-risk Fertility Behavior . 108 9 REPRODUCTIVE HEALTH . 111 9.1 Antenatal Care . 112 9.1.1 Antenatal Care . 112 9.1.2 Number of Antenatal Care Visits and Timing of First Visit . 113 9.1.3 Components of Antenatal Care . 114 9.1.4 Tetanus Toxoid Injections . 115 9.1.5 Complications of Pregnancy . 117 9.2 Delivery Care . 118 9.2.1 Place of Delivery . 118 9.2.2 Assistance during Delivery . 120 9.2.3 Preparation for Delivery . 122 9.2.4 Complications during Delivery . 123 9.3 Postnatal Care . 124 9.3.1 Timing of First Postnatal Checkup for the Mother . 124 9.3.2 Provider of First Postnatal Checkup for the Mother . 125 9.3.3 Timing of First Postnatal Checkup for the Newborn . 126 9.3.4 Provider of First Postnatal Checkup for the Newborn . 127 9.4 Problems in Accessing Health Care . 128 10 CHILD HEALTH . 131 10.1 Child’s Size at Birth . 131 10.2 Immunization of Children . 133 10.2.1 Immunization Coverage for Children age 12-23 Months . 134 10.3 Childhood Illness and Treatment . 139 10.3.1 Acute Respiratory Infection (ARI) . 140 10.3.2 Fever . 141 10.3.3 Diarrhea . 142 10.4 Disposal of Stools . 148 11 INFANT FEEDING . 151 11.1 Initial Breastfeeding . 151 11.2 Age Patterns of Breastfeeding . 153 11.3 Duration and Frequency of Breastfeeding . 155 11.4 Types of Complementary Foods . 156 11.5 Infant and Young Child Feeding Practices . 158 11.6 Micronutrient Intake Among Children . 160 11.7 Micronutrient Intake Among Mothers . 162 12 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 165 12.1 Knowledge of HIV-AIDS and Transmission and Prevention Methods . 166 12.1.1 Knowledge of HIV-AIDS . 166 12.1.2 Knowledge of HIV Prevention Methods . 168 12.1.3 Comprehensive Knowledge about AIDS . 169 12.1.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 171 vi • Contents 12.2 Accepting Attitudes toward those Living with HIV and AIDS and Attitudes toward Negotiating Safer Sexual Relations with Husband . 172 12.2.1 Accepting Attitudes toward Those Living with HIV and AIDS . 172 12.2.2 Attitudes toward Negotiating Safer Sexual Relations with Husband. 174 12.3 Payment for Sexual Intercourse and Condom Use at Last Paid Sexual Intercourse . 175 12.4 Self-Reporting of Sexually Transmitted Infections (STIs) and STI Symptoms . 176 12.5 Prevalence of Medical Injections . 177 12.6 Comprehensive Knowledge about AIDS and Source of Condoms among Youth . 179 12.7 Age at First Sexual Intercourse among Young People . 180 12.8 Source of Information on HIV-AIDS . 181 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 185 13.1 Employment and Cash Earnings of Currently Married Women And Men . 185 13.2 Control over Earnings . 186 13.2.1 Control over and Relative Magnitude of Women’s Earnings . 186 13.2.2 Control over Men’s Earnings . 187 13.2.3 Women’s Control over Their Own Earnings and over Those of Their Husbands . 188 13.3 Women’s and Men’s Ownership of Assets . 189 13.4 Participation in Decision Making . 191 13.5 Attitude Toward Wife Beating . 195 13.6 Indicators of Women’s Empowerment . 197 13.7 Women’s Empowerment and Health Indicators . 198 14 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE . 201 14.1 Antenatal Care . 201 14.2 Preparation for Delivery . 203 14.3 Contact with Health Provider . 204 14.4 Diarrhea Treatment . 205 14.5 Knowledge about Children’s Immunization . 206 15 ADULT AND MATERNAL MORTALITY . 209 15.1 Data . 209 15.2 Direct Estimates of Adult Mortality . 211 15.3 Estimates of Maternal Mortality . 212 15.4 Trends in Maternal Mortality . 213 REFERENCES . 217 APPENDIX A PROVINCIAL TABLES . 221 APPENDIX B SURVEY DESIGN . 315 APPENDIX C SAMPLING ERRORS . 325 APPENDIX D DATA QUALITY TABLES . 365 APPENDIX E PERSONS INVOLVED IN THE 2012 INDONESIA DEMOGRAPHIC AND HEALTH SURVEY . 371 APPENDIX F QUESTIONNAIRES . 387 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 2 Table 1.2 Results of the household and individual interviews . 8 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 Table 2.1 Household drinking water . 10 Table 2.2 Household sanitation facilities . 12 Table 2.3 Household characteristics . 13 Table 2.4 Household possessions . 14 Table 2.5 Wealth quintiles . 16 Table 2.6 Hand washing . 17 Table 2.7 Household population by age, sex, and residence. 18 Table 2.8 Household composition . 19 Table 2.9 Birth registration of children under age 5 . 20 Table 2.10.1 Educational attainment of the female household population . 21 Table 2.10.2 Educational attainment of the male household population . 21 Figure 2.1 Population pyramid of Indonesia . 18 Figure 2.2 Age-specific attendance rates of the de facto population age 5-24 . 22 3 CHARACTERISTICS OF RESPONDENTS . 23 Table 3.1 Background characteristics of respondents . 24 Table 3.2.1 Educational attainment: Women . 25 Table 3.2.2 Educational attainment: Men . 26 Table 3.3.1 Literacy: Women . 27 Table 3.3.2 Literacy: Men . 27 Table 3.4.1 Exposure to mass media: Women . 28 Table 3.4.2 Exposure to mass media: Men . 29 Table 3.5.1 Employment status: Women . 30 Table 3.5.2 Employment status: Men . 32 Table 3.6.1 Occupation: Women . 33 Table 3.6.2 Occupation: Men . 34 Table 3.7 Type of employment: Women . 35 Table 3.8.1 Health insurance coverage: Women . 36 Table 3.8.2 Health insurance coverage: Men . 37 Table 3.9.1 Use of tobacco: Women . 38 Table 3.9.2 Use of tobacco: Men . 39 Figure 3.1 Women’s employment status in the past 12 months . 31 4 MARRIAGE AND SEXUAL ACTIVITY . 41 Table 4.1 Current marital status . 42 Table 4.2 Number of men's wives . 42 Table 4.3 Median age at first marriage by background characteristics . 43 Table 4.4 Age at first sexual intercourse . 45 Table 4.5 Median age at first sexual intercourse by background characteristics . 46 Table 4.6 Recent sexual activity: Women . 48 Figure 4.1 Trends in median age at first marriage of ever-married women age 25-49 . 44 viii • Tables and Figures 5 FERTILITY . 49 Table 5.1 Current fertility . 50 Table 5.2 Fertility by background characteristics . 52 Table 5.3 Trends in age-specific fertility rates . 53 Table 5.4 Trends in current fertility rates . 54 Table 5.5 Children ever born and living . 55 Table 5.6 Birth intervals . 56 Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility . 57 Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 59 Table 5.9 Menopause . 59 Table 5.10 Age at first birth . 60 Table 5.11 Median age at first birth . 60 Table 5.12 Teenage pregnancy and motherhood . 61 Figure 5.1 Age-specific fertility rates by residence . 51 Figure 5.2 Trend in total fertility rate, 1991-2012 . 54 Figure 5.3 Percentage amenorrheic and abstaining by months since birth . 58 6 FERTILITY PREFERENCES . 63 Table 6.1 Fertility preferences by number of living children . 64 Table 6.2.1 Desire to limit childbearing: Women . 66 Table 6.2.2 Desire to limit childbearing: Men . 66 Table 6.3 Ideal number of children by number of living children . 68 Table 6.4 Mean ideal number of children . 69 Table 6.5 Fertility planning status . 70 Table 6.6 Wanted fertility rates . 71 Figure 6.1 Desire for another child . 65 7 FAMILY PLANNING . 73 Table 7.1 Knowledge of contraceptive methods . 74 Table 7.2 Knowledge of contraceptive methods by background characteristics . 75 Table 7.3 Knowledge of fertile period . 75 Table 7.4.1 Exposure to family planning messages through mass media: currently married women . 77 Table 7.4.2 Exposure to family planning messages through mass media: men . 77 Table 7.5 Exposure to family planning messages through personal contact . 78 Table 7.6 Contact of nonusers with fieldworkers/health providers about family planning . 79 Table 7.7.1 Current use of contraception by age: Women . 80 Table 7.7.2 Current use of contraception by age: Men . 81 Table 7.8.1 Current use of contraception by background characteristics: All women . 82 Table 7.8.2 Current use of contraception by background characteristics: Currently married women . 82 Table 7.9 Trends in use of specific contraceptive methods, Indonesia 1991-2012 . 84 Table 7.10 Timing of sterilization . 85 Table 7.11 Source of modern contraception methods . 86 Table 7.12 Informed choice . 87 Table 7.13 Pill use compliance . 89 Table 7.14 Use of injectables . 90 Table 7.15 Problems with current method of contraception . 90 Tables and Figures • ix Table 7.16 Payment for contraceptive methods and services . 91 Table 7.17 Mean cost of contraceptive methods and services . 92 Table 7.18 Twelve-month contraceptive discontinuation rates . 93 Table 7.19 Reasons for discontinuation . 93 Table 7.20 Need and demand for family planning among currently married women . 95 Table 7.21 Unmet need, current use, and demand for family planning, Indonesia 1991-2012 . 96 Table 7.22 Future use of contraception . 97 Table 7.23 Reason for not intending to use contraception in the future . 98 Figure 7.1 Trends in contraceptive use among currently married women, 1991-2012 . 84 Figure 7.2 Trends in unmet need, 1991-2012 . 97 8 INFANT AND CHILD MORTALITY . 99 Table 8.1 Early childhood mortality rates . 102 Table 8.2 Trends in early childhood mortality . 102 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 105 Table 8.4 Early childhood mortality rates by demographic characteristics . 106 Table 8.5 Perinatal mortality . 107 Table 8.6 High-risk fertility behavior . 108 Figure 8.1 Reported age at death in months . 101 Figure 8.2 Trend in neonatal, infant, and under-5 mortality, IDHS 1991-2012 . 103 Figure 8.3 Trend in infant mortality rate, selected sources, Indonesia 1971-2012 . 104 9 REPRODUCTIVE HEALTH . 111 Table 9.1 Antenatal care . 112 Table 9.2 Number of antenatal care visits and timing of first visit . 113 Table 9.3 Components of antenatal care . 115 Table 9.4 Tetanus toxoid injections . 116 Table 9.5 Complications during pregnancy . 117 Table 9.6 Place of delivery . 119 Table 9.7 Assistance during delivery: the most qualified person . 121 Table 9.8 Assistance during delivery: the least qualified person . 122 Table 9.9 Preparation for delivery . 123 Table 9.10 Complications during delivery . 124 Table 9.11 Timing of first postnatal checkup . 125 Table 9.12 Type of provider of first postnatal checkup for the mother . 126 Table 9.13 Timing of first postnatal checkup for the newborn . 127 Table 9.14 Type of provider of first postnatal checkup for the newborn . 128 Table 9.15 Problems in accessing health care . 129 Figure 9.1 Trend in timing of first ANC visit . 114 Figure 9.2 Actions taken in response to pregnancy complications . 118 Figure 9.3 Trend in percentage of births delivered in a health facility and at home . 120 10 CHILD HEALTH . 131 Table 10.1 Child’s weight and size at birth . 132 Table 10.2 Vaccinations by source of information . 135 Table 10.3 Vaccinations by background characteristics . 137 Table 10.4 Prevalence and treatment of symptoms of ARI . 140 Table 10.5 Prevalence and treatment of fever . 142 x • Tables and Figures Table 10.6 Prevalence of diarrhea . 143 Table 10.7 Knowledge of ORS packets or pre-packaged liquids . 144 Table 10.8 Diarrhea treatment . 146 Table 10.9 Feeding practices during diarrhea . 147 Table 10.10 Disposal of children’s stools . 149 Figure 10.1 Birth weight and birth size by mother’s education . 133 Figure 10.2 Vaccination by 12 months of age (based on health cards and mother’s reports) . 135 Figure 10.3 Trends in immunization coverage excluding hepatitis B . 139 Figure 10.4 Trends in knowledge and use of ORS packets for treatment of children with diarrhea, 1997-2012 . 144 Figure 10.5 Trends in feeding practices during diarrhea, 1997, 2002-2003, 2007, and 2012 IDHS . 148 11 INFANT FEEDING . 151 Table 11.1 Initial breastfeeding . 152 Table 11.2 Breastfeeding status by age . 154 Table 11.3 Median duration of breastfeeding . 156 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview . 157 Table 11.5 Infant and young child feeding (IYCF) practices . 159 Table 11.6 Micronutrient intake among children . 161 Table 11.7 Micronutrient intake among mothers . 163 Figure 11.1 Infant feeding practices by age . 154 Figure 11.2 IYCF indicators on breastfeeding status . 155 Figure 11.3 IYCF indicators on minimum acceptable diet . 160 12 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 165 Table 12.1 Knowledge of AIDS . 167 Table 12.2 Knowledge of HIV prevention methods . 168 Table 12.3.1 Comprehensive knowledge about AIDS: Women . 170 Table 12.3.2 Comprehensive knowledge about AIDS: Currently married men age 15-54. 171 Table 12.4 Knowledge of prevention of mother to child transmission of HIV . 172 Table 12.5.1 Accepting attitudes toward those living with HIV-AIDS: Women age 15-49 . 173 Table 12.5.2 Accepting attitudes toward those living with HIV-AIDS: Currently married men age 15-54. 174 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 175 Table 12.7 Payment for sexual intercourse and condom use at last paid sexual intercourse . 176 Table 12.8 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 177 Table 12.9 Prevalence of medical injections . 178 Table 12.10 Comprehensive knowledge about AIDS and of a source of condoms among youth . 179 Table 12.11 Age at first sexual intercourse among young people . 180 Table 12.12.1 Source of information on HIV-AIDS: women age 15-49 . 181 Table 12.12.2 Source of information on HIV-AIDS: Currently married men age 15-54 . 182 Figure 12.1 Knowledge of AIDS by education level, Indonesia 2012 . 167 Figure 12.2 Women and men seeking treatment for STIs . 183 Tables and Figures • xi 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 185 Table 13.1 Employment and cash earnings of currently married women and men . 186 Table 13.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings: Women . 187 Table 13.2.2 Control over men’s cash earnings . 188 Table 13.3 Women’s control over their own earnings and over those of their husbands . 189 Table 13.4.1 Ownership of assets: Women . 190 Table 13.4.2 Ownership of assets: Men . 191 Table 13.5 Participation in decision making . 192 Table 13.6.1 Women’s participation in decision making by background characteristics . 193 Table 13.6.2 Men’s participation in decision making by background characteristics . 194 Table 13.7.1 Attitude toward wife beating: Women . 195 Table 13.7.2 Attitude toward wife beating: Men . 196 Table 13.8 Indicators of women’s empowerment . 197 Table 13.9 Current use of contraception by women’s empowerment . 198 Table 13.10 Women’s empowerment and ideal number of children and unmet need for family planning . 199 Table 13.11 Reproductive health care by women’s empowerment . 199 Table 13.12 Early childhood mortality rates by women’s status . 200 Figure 13.1 Number of decisions in which currently married women participate . 192 14 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE . 201 Table 14.1 Care received by mother during pregnancy . 202 Table 14.2 Preparation for delivery . 203 Table 14.3 Father's contact with health provider about child’s mother’s health . 204 Table 14.4 Father’s knowledge about amount to drink for children with diarrhea . 206 Table 14.5 Father’s report on children’s vaccination. 207 15 ADULT AND MATERNAL MORTALITY . 209 Table 15.1 Completeness of information on siblings . 210 Table 15.2 Sibship size and sex ratio of siblings . 211 Table 15.3 Adult mortality rates . 211 Table 15.4 Maternal mortality . 213 Table 15.5 Adult mortality probabilities . 215 Figure 15.1 Trend in adult mortality rates age 15-49 (per 1,000 population), by sex, IDHS 1997-2012 . 212 Figure 15.2 Maternal mortality ratio (MMR) with confidence intervals for the five years preceding the 2007 IDHS and the 2012 IDHS . 214 Figure 15.3 Changes in adult female mortality rates and PMDF, IDHS 1994-2012 . 215 APPENDIX A PROVINCIAL TABLES . 221 Table A-2.1 Hand washing . 221 Table A-2.3.1 Educational attainment of the female household population . 222 Table A-2.3.2 Educational attainment of the male household population . 223 Table A-3.1 Background characteristics of respondents . 224 Table A-3.2.1 Educational attainment: Women . 225 Table A-3.2.2 Educational attainment: Men . 226 Table A-3.3.1 Literacy: Women . 227 Table A-3.3.2 Literacy: Men . 228 xii • Tables and Figures Table A-3.4.1 Exposure to mass media: Women . 229 Table A-3.4.2 Exposure to mass media: Men . 230 Table A-3.5.1 Employment status: Women . 231 Table A-3.5.2 Employment status: Men . 232 Table A-3.6.1 Occupation: Women . 233 Table A-3.6.2 Occupation: Men . 234 Table A-3.7.1 Health insurance coverage: Women . 235 Table A-3.7.2 Health insurance coverage: Men . 236 Table A-3.8.1 Use of tobacco: Women . 237 Table A-3.8.2 Use of tobacco: Men . 238 Table A-4.1 Number of men’s wives . 239 Table A-4.2 Median age at first marriage by province . 240 Table A-4.3 Median age at first sexual intercourse by province . 241 Table A-4.4 Recent sexual activity: Women . 242 Table A-5.1 Fertility by province . 243 Table A-5.2 Birth intervals . 244 Table A-5.3 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility . 245 Table A-5.5 Median age at first birth . 246 Table A-5.6 Teenage pregnancy and motherhood . 247 Table A-6.1.1 Desire to limit childbearing: Women . 248 Table A-6.1.2 Desire to limit childbearing: Men . 249 Table A-6.2 Mean ideal number of children . 250 Table A-6.3 Wanted fertility rates . 251 Table A-7.1 Knowledge of contraceptive methods by province . 252 Table A-7.2.1 Exposure to family planning messages through mass media: Currently married women . 253 Table A-7.2.2 Exposure to family planning messages through mass media: Men . 254 Table A-7.3 Exposure to family planning messages through personal contact: Currently married women . 255 Table A-7.4 Contact of nonusers with fieldworkers/health providers about family planning . 256 Table A-7.5.1 Current use of contraception by province: All women . 257 Table A-7.5.2 Current use of contraception by province: Currently married women . 258 Table A-7.6 Pill use compliance . 259 Table A-7.7 Use of injectables . 260 Table A-7.8 Need and demand for family planning among currently married women . 261 Table A-8.1 Early childhood mortality rates by province . 262 Table A-8.2 Perinatal mortality . 263 Table A-9.1 Antenatal care . 264 Table A-9.2 Components of antenatal care . 265 Table A-9.3 Tetanus toxoid injections . 266 Table A-9.4 Place of delivery . 267 Table A-9.5.1 Assistance during delivery: the most qualified person . 268 Table A-9.5.2 Assistance during delivery: The least qualified person . 269 Table A-9.6 Timing of first postnatal checkup . 270 Table A-9.7 Type of provider of first postnatal checkup for the mother . 271 Table A-9.8 Timing of first postnatal checkup for the newborn . 272 Table A-9.9 Type of provider of first postnatal checkup for the newborn . 273 Table A-9.10 Problems in accessing health care . 274 Table A-9.11 Complications during pregnancy . 275 Table A-9.12 Delivery characteristics . 276 Tables and Figures • xiii Table A-10.1 Child’s weight and size at birth . 277 Table A-10.2 Vaccinations by province . 278 Table A-10.3 Prevalence and treatment of symptoms of ARI . 279 Table A-10.4 Prevalence and treatment of fever . 280 Table A-10.5 Prevalence of diarrhea . 281 Table A-10.6 Diarrhea treatment . 282 Table A-10.7 Feeding practices during diarrhea . 283 Table A-10.8 Knowledge of ORS packets or pre-packaged liquids . 284 Table A-10.9 Disposal of children’s stools . 285 Table A-11.1 Initial breastfeeding . 286 Table A-11.2 Median duration of breastfeeding . 287 Table A-11.3 Infant and young child feeding (IYCF) practices . 288 Table A-11.4 Micronutrient intake among children . 289 Table A-11.5 Micronutrient intake among mothers . 290 Table A-12.1 Knowledge of AIDS . 291 Table A-12.2 Knowledge of HIV prevention methods . 292 Table A-12.3.1 Comprehensive knowledge about AIDS: Women . 293 Table A-12.3.2 Comprehensive knowledge about AIDS: Men . 294 Table A-12.4 Payment for sexual intercourse and condom use at last paid sexual intercourse . 295 Table A-12.5 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms . 296 Table A-12.6 Prevalence of medical injections . 297 Table A-12.7 Comprehensive knowledge about AIDS and of a source of condoms among youth . 298 Table A-12.8.1 Source of information on HIV/AIDS: Women . 299 Table A-12.8.2 Source of information on HIV/AIDS: Men . 300 Table A-13.1.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings: Women . 301 Table A-13.1.2 Control over men’s cash earnings . 302 Table A-13.2.1 Ownership of assets: Women . 303 Table A-13.2.2 Ownership of assets: Men . 304 Table A-13.3.1 Women’s participation in decision making . 305 Table A-13.3.2 Men’s participation in decision making by provinces . 306 Table A-13.4.1 Attitude toward wife beating: Women . 307 Table A-13.4.2 Attitude toward wife beating: Men . 308 Table A-14.1 Care received by mother during pregnancy . 309 Table A-14.2 Preparation for delivery . 310 Table A-14.3 Father’s contact with health care provider about wife’s health and pregnancy . 311 Table A-14.4 Father’s knowledge about amount to drink for children with diarrhea . 312 Table A-14.5 Father’s report on children’s vaccination. 313 APPENDIX B SURVEY DESIGN . 315 Table B.1.1 Sample allocation by province . 316 Table B.1.2 Expected number of respondents by province . 317 Table B.2.1 Sample implementation: Women . 318 Table B.2.2 Sample implementation: result of household interview: Women . 319 Table B.2.3 Sample implementation: result of individual interview: Women . 320 Table B.3.1 Sample implementation: Men . 321 Table B.3.2 Sample implementation: result of the household interview: Men . 322 Table B.3.3 Sample implementation: result of the individual interview: men . 323 xiv • Tables and Figures APPENDIX C SAMPLING ERRORS . 325 Table C.1 List of indicators for sampling errors, Indonesia DHS 2012 . 327 Table C.2 Sampling errors: Total sample, Indonesia 2012 . 328 Table C.3 Sampling errors: Urban sample, Indonesia 2012 . 329 Table C.4 Sampling errors: Rural sample, Indonesia 2012 . 330 Table C.5 Sampling errors: Aceh sample, Indonesia 2012 . 331 Table C.6 Sampling errors: North Sumatera sample, Indonesia 2012 . 332 Table C.7 Sampling errors: West Sumatera sample, Indonesia 2012 . 333 Table C.8 Sampling errors: Riau sample, Indonesia 2012 . 334 Table C.9 Sampling errors: Jambi sample, Indonesia 2012 . 335 Table C.10 Sampling errors: South Sumatera sample, Indonesia 2012 . 336 Table C.11 Sampling errors: Bengkulu sample, Indonesia 2012 . 337 Table C.12 Sampling errors: Lampung sample, Indonesia 2012 . 338 Table C.13 Sampling errors: Bangka Belitung sample, Indonesia 2012 . 339 Table C.14 Sampling errors: Riau Islands sample, Indonesia 2012 . 340 Table C.15 Sampling errors: Jakarta sample, Indonesia 2012 . 341 Table C.16 Sampling errors: West Java sample, Indonesia 2012 . 342 Table C.17 Sampling errors: Central Java sample, Indonesia 2012 . 343 Table C.18 Sampling errors: Yogyakarta sample, Indonesia 2012 . 344 Table C.19 Sampling errors: East Java sample, Indonesia 2012 . 345 Table C.20 Sampling errors: Banten sample, Indonesia 2012 . 346 Table C.21 Sampling errors: Bali sample, Indonesia 2012 . 347 Table C.22 Sampling errors: West Nusa Tenggara sample, Indonesia 2012 . 348 Table C.23 Sampling errors: East Nusa Tenggara sample, Indonesia 2012 . 349 Table C.24 Sampling errors: West Kalimantan sample, Indonesia 2012 . 350 Table C.25 Sampling errors: Central Kalimantan sample, Indonesia 2012 . 351 Table C.26 Sampling errors: South Kalimantan sample, Indonesia 2012 . 352 Table C.27 Sampling errors: East Kalimantan sample, Indonesia 2012 . 353 Table C.28 Sampling errors: North Sulawesi sample, Indonesia 2012 . 354 Table C.29 Sampling errors: Central Sulawesi sample, Indonesia 2012 . 355 Table C.30 Sampling errors: South Sulawesi sample, Indonesia 2012 . 356 Table C.31 Sampling errors: Southeast Sulawesi sample, Indonesia 2012 . 357 Table C.32 Sampling errors: Gorontalo sample, Indonesia 2012 . 358 Table C.33 Sampling errors: West Sulawesi sample, Indonesia 2012 . 359 Table C.34 Sampling errors: Maluku sample, Indonesia 2012 . 360 Table C.35 Sampling errors: North Maluku sample, Indonesia 2012 . 361 Table C.36 Sampling errors: West Papua sample, Indonesia 2012 . 362 Table C.37 Sampling errors: Papua sample, Indonesia 2012 . 363 APPENDIX D DATA QUALITY TABLES . 365 Table D.1 Household age distribution . 365 Table D.2.1 Age distribution of eligible and interviewed women . 366 Table D.2.2 Age distribution of eligible and interviewed men . 366 Table D.3 Completeness of reporting . 367 Table D.4 Births by calendar years . 367 Table D.5 Reporting of age at death in days . 368 Table D.6 Reporting of age at death in months . 369 Preface (BPS) • xv Preface (BKKBN) • xvii PREFACE As the world’s fourth most populous country, with 237 million people according to the 2010 Population Census, Indonesia attaches high priority on population issues and focuses on reviving family planning program and empowering women, youth, and the elderly population. The Law Number 52/2009 on Population and Family Development gives BKKBN new responsibility for population management. BKKBN’s name was changed accordingly to the National Population and Family Planning Board, maintaining the same acronym. In 2012 the family planning program in Indonesia took on a new vision statement “Balanced Population Growth by 2015”, while the main mission is to realize population centered- development as well as small, happy and prosperous families. The main strategies include enhancing partnerships with various agencies in different sectors and with regional governments. Targeted strategies have been designed to meet the needs of different provinces, focusing on those with large population and health vulnerabilities with an aim to accelerate the attainment of MDGs in 2015. The publication of the 2012 IDHS is well-timed since 2014 will be the final year of the 2010- 2014 Mid-Term National Development Plan. Results of the 2012 IDHS are useful for the evaluation of the achievements of the current population, family planning, and health programs and serve as basis for developing the plan for the 2015-2019 period. The new development plan will determine Indonesia’s course of development and the welfare of Indonesians in the next 5 years. I would like to express my deepest gratitude to Statistics Indonesia (BPS), the Ministry of Health (Kemenkes), National Development Planning Agency (Bappenas), the University of Indonesia, and ICF International for their close cooperation in the preparation and finalization of the survey report. I would also like to extend my gratitude to the United States Agency for International Development (USAID) for providing technical assistance through ICF International. Jakarta, September 2013 Prof. Fasli Jalal MD, PhD Chairperson, National Population and Family Planning Board Preface (MOH) • xix Millennium Development Goal Indicators • xxi MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators by sex Indonesia 2012 Value Total Goal Female Male 2. Achieve universal primary education 2.3 Literacy rate of 15-24 year olds1 97.8 95.8 96.8 4. Reduce child mortality 4.1 Under-five mortality rate (per 1000 live births)2 37 49 40 4.2 Infant mortality rate (per 1000 live births)2 28 39 32 4.3 Proportion of 1 year-old children immunized against measles 79.0 81.2 80.1 5. Improve maternal health 5.1 Maternal mortality ratio3 359 5.1 Percentage of births attended by skilled health personnel4 na na 83.1 5.2 Contraceptive prevalence rate5 61.9 na na 5.3 Adolescent birth rate6 48.4 na na 5.4a Antenatal care coverage: at least 1 visit by skilled health professional7 21.5 na na 5.4b Antenatal care coverage: at least 4 visits by any provider7 87.8 na na 5.5 Unmet need for family planning 11.4 na na 6. Combat HIV/AIDS, malaria, and other diseases 6.3 Percentage of population 15-24 years with comprehensive knowledge of HIV/AIDS8 11.4 10.3 10.8 6.3 Percentage of children under 5 with fever who are treated with appropriate antimalarial drugs9 0.8 0.8 0.8 na = Not applicable 1 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 2 Expressed in terms of deaths per 1,000 live births and refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 3 Expressed in terms of maternal deaths per 100,000 live births in the 5-year period preceding the survey 4 Among births in the five years preceding the survey 5 Percentage of currently married women age 15-49 using any method of contraception 6 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year preceding the survey, expressed in terms of births per 1,000 women age 15-19 7 Includes doctor, midwives, and nurses 8 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one 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. 9 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received anti-malarial drug xxii • Map of Indonesia Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY he 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 extends from November to April. Indonesia is divided administratively into provinces. Since 2001, the number of provinces has 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 399 districts and 98 municipalities in Indonesia. The next lower administrative units are subdistricts and villages. In 2012, there were 6,793 subdistricts and 79,075 villages in Indonesia. Each entire village is classified as urban or rural (BPS, 2012a). Indonesia has been viewed as one of Southeast Asia's highly performing economies in recent decades. The Indonesian economy grew rapidly during the 1980s and 1990s, but a financial crisis in 1997 slowed economic growth. Indonesia's economy is recovering. The per capita GDP increased steadily in the 2000s to reach its highest level in Indonesian economic history of USD $846.8 billion in 2012. With a total population of 238 million people in 2010, Indonesia’s per capita GDP was around USD $3,000. The increase in GDP will accelerate development in a number of sectors (such as retail, automotive, and property), due to rising consumer demand, and thus will promote economic growth. The Indonesian government has set a target GDP of USD $5,000 for the year 2014 (http://www.indonesia-investments.com/finance/macroeconomic- indicators/gross-domestic-product-of-indonesia/item16). 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. 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 2010 Population Censuses and the 2011 National Socio-Economic Survey (Susenas) show that in the past 40 years Indonesia has undergone a major improvement in the area of education. The literacy rate among persons age 10 and older increased from 61 percent in 1971 to 92 percent in 2011 (BPS, 1972 and BPS, 2012b). T 2 • Introduction The improvement in education is more pronounced among females. Whereas in 1971 school attendance among children age 7-12 was 62 percent for males and 58 percent for females, the corresponding rates in 2011 were 97 percent and 98 percent, respectively. From 1971 to 2011, the proportion of people age 5 and older who never attended school declined, while that of graduates at all levels increased. The proportion of people who finished primary school increased from 20 percent in 1971 to 29 percent in 2011, while the proportion of those who attended junior high school or higher education increased from 7 percent in 1971 to 50 percent in 2011. At all levels, the increase in education among females has been greater than that of males (BPS, 1972 and BPS, 2012b). 1.2 POPULATION According to the 2010 Population Census, the population of Indonesia was 237.6 million. 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 118.3 million people (50 percent of the population) lived in urban areas in 2010. In 2010, more than 87 percent of the Indonesian population was Moslem. Indonesia’s population growth rate has declined in the last three decades. Between 1980 and 1990, the average annual population growth rate was 1.98 percent. Between 1990 and 2000 the rate was 1.49, and then 1.44 percent between 2000 and 2010 (see Table 1.1). Table 1.1 Basic demographic indicators Demographic indicators from selected sources, Indonesia 1990-2010 Indicators 1990 census 2000 census 2010 census Population (millions) 179.4 206.3 237.6 Growth rate (GR)1 (percent) 1.98 1.49 1.44 Density (pop/km2) 93 109 124 Percent urban 31 42 50 Reference period 1986-89 1996-99 2006-09 Crude birth rate (CBR)2 28 23 23 Crude death rate (CDR)3 9 8 9 Life expectancy4 Male 57.9 63.5 68.7 Female 61.5 67.3 72.6 1 Calculated using compound interest formula 2 Births per 1,000 population; CBR = 9.48968 + 5.55 TFR 3 Deaths per 1,000 population; CDR = CBR – GR per 1,000 4 Estimated using indirect estimation techniques Source: BPS-Statistics Indonesia 1992, 2002, and 2012 (unpublished). Another characteristic of Indonesia is the uneven distribution of the population among the islands and provinces. The 2010 Population Census indicates that the population density varies not only across islands, but also among provinces of the same island. Population density at the national level was 109 persons per square kilometer in 2000 and increased to 124 persons per square kilometer in 2010. 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 population in the period 1986-1989, declined to 23 per 1,000 population during 1996-1999, representing an annual decline of one percent. In 2010, the CBR remained at 23 births per 1,000 population. The life expectancy at birth for both males and females has increased. For males, the life expectancy increased from 58 years in 1990 to 69 years in 2010. The corresponding figures for females are 62 and 73 years, respectively. Introduction • 3 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMS The government of Indonesia has implemented many of its development programs in response to population-related issues that occurred after 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. 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 52 of 2009 on Population and Family Development, family planning is explicitly defined as efforts to regulate childbirth, including ideal birth spacing and maternal age at birth, and to regulate pregnancy, by promoting, protecting, and assisting couples in accordance with reproductive rights to achieve quality families. A new paradigm was introduced in 1999. Based on Law Number 22 in 1999 on Regional Government, the system of the country was changed from centralized government to regional autonomy at the district or municipality level. In 2004, this law was revised to transfer planning authorities to the district or municipality government with varying organization. To anticipate the changing strategic era brought about by ongoing decentralization processes, BKKBN has reformulated the vision, mission, and strategies of the national family planning programs in BKKBN’s Strategic Plan for 2010-2014 on Population and National Family Planning Development. The new vision of BKKBN is “Balanced Population Growth in 2015.” This vision sets a goal of a total fertility rate (TFR) of 2.1 births per woman and a net reproduction rate of 1.0 in 2015. To realize the above vision, the mission defined population and family planning development as population-based development to achieve a happy, prosperous small family. The mission is carried out through (1) harmonizing the population control policy, (2) determining the parameters of the population, (3) increasing the supply and quality of data and information, (4) using the concept of population control in population and family planning development, and (5) encouraging stakeholders and partners to implement the family planning program in preparing teens for family life, fulfilling reproductive rights, and increasing resilience and well- being of family planning participants (BKKBN, 2011). 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. 4 • Introduction 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 with adequate and quality housing. In mid-September 1998, a new health paradigm was introduced that focuses more on health development and promotion and prevention than on curative and rehabilitative services. The new vision is reflected in the motto “Healthy Indonesia 2010.” The year 2010 was used as a target to allow sufficient time to achieve the goals. In October 1999, the Ministry of Health introduced the Health Development Plan Towards Healthy Indonesia 2010, with the following objectives: (1) to lead and initiate health-oriented national development; (2) to maintain and enhance individual, family, and public health, along with improving the environment; (3) to maintain and enhance the quality, equitability and affordability of health services; and (4) to promote public self-reliance in achieving good health. In January 2010, the Ministry of Health launched the new Strategic Plan for 2010-2014, emphasizing “Healthy Communities Independent and Just”. The Ministry’s missions to achieve that vision are as follows: (1) improving the community health status through community empowerment (2) protecting the public health by ensuring the availability of health efforts which is plenary, equitable, and justice, (3) ensuring the availability and equitable distribution of health resources, and (4) creating a good governance (MOH, 2011). 1.5 OBJECTIVES OF THE SURVEY The 2012 Indonesia Demographic and Health Survey (IDHS) is the seventh survey conducted in Indonesia under the auspices of the DHS program. Previous IDHS surveys are as follows: the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS), the 1991 IDHS, the 1994 IDHS, the 1997 IDHS, the 2002-03 IDHS, and the 2007 IDHS. Since 2002-03, the survey has expanded to include a survey of currently married men age 15-54 and never-married women and men age 15-24, referred to as adolescents. Findings of the survey of adolescents are presented in a separate report. A departure from past DHS surveys in Indonesia, which covered ever-married women age 15-49, the 2012 IDHS included never-married women age 15-49. In addition to women age 15-49, the 2012 IDHS interviewed currently married men age 15-54 and never-married men age 15-24. The 2012 IDHS was specifically designed to meet the following objectives: • Provide data on fertility, family planning, maternal and child health, adult mortality (including 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, and analyze factors that affect such changes, such as marital status and patterns, residence, education, breastfeeding habits, and knowledge, use, and availability of contraception; • Evaluate the achievement of goals previously set by national health programs, with special focus on maternal and child health; • Assess married men’s knowledge of utilization of health services for their family’s health, as well as participation in the health care of their families; Introduction • 5 • Participate in creating an international database that allows cross-country comparisons that can be used by the program managers, policymakers, and researchers in the areas of family planning, fertility, and health in general. 1.6 ORGANIZATION OF THE SURVEY The 2012 IDHS was carried out by Statistics Indonesia (Badan Pusat Statistik-BPS) in collaboration with the National Population and Family Planning Board (Badan Kependudukan dan Keluarga Berencana Nasional - BKKBN) and the Ministry of Health (MOH). Funding for the local costs of the survey was provided by the government of Indonesia. ICF International provided technical assistance through the U.S. Agency for International Development (USAID)-funded Demographic and Health Surveys (MEASURE DHS) program. A survey steering committee was established. This committee consisted of senior representatives from BPS, BKKBN, MOH, and the Ministry of National Development Planning/National Development Planning Agency. A technical team, consisting of members of the same organizations and the Demographic Institute of the University of Indonesia, 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 2012 IDHS used four questionnaires: the Household Questionnaire, the Woman’s Questionnaire, the Currently Married Man’s Questionnaire, and the Never-Married Man’s Questionnaire. Because of the change in survey coverage from ever-married women age 15-49 in the 2007 IDHS to all women age 15-49 in the 2012 IDHS, the Woman’s Questionnaire now has questions for never-married women age 15-24. These questions were part of the 2007 Indonesia Young Adult Reproductive Survey questionnaire. The Household and Woman’s Questionnaires are largely based on standard DHS phase VI questionnaires (March 2011 version). The model questionnaires were adapted for use in Indonesia. Not all questions in the DHS model were adopted in the IDHS. In addition, the response categories were modified to reflect the local situation. The Household Questionnaire was used to list all the usual members and visitors who spent the previous night in the selected households. Basic information collected on each person listed includes age, sex, education, marital status, education, and relationship to the head of the household. Information on characteristics of the housing unit, such as the source of drinking water, type of toilet facilities, construction materials used for the floor, roof, and outer walls of the house, and ownership of various durable goods were also recorded in the Household Questionnaire. These items reflect the household’s socioeconomic status and are used to calculate the household wealth index. The main purpose of the Household Questionnaire was to identify women and men who were eligible for an individual interview. 6 • Introduction The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: • Background characteristics (marital status, education, media exposure, etc.) • Reproductive history and fertility preferences • Knowledge and use of family planning methods • Antenatal, delivery, and postnatal care • Breastfeeding and infant and young children feeding practices • Childhood mortality • Vaccinations and childhood illnesses • Marriage and sexual activity • Fertility preferences • Woman’s work and husband’s background characteristics • Awareness and behavior regarding HIV-AIDS and other sexually transmitted infections (STIs) • Sibling mortality, including maternal mortality • Other health issues Questions asked to never-married women age 15-24 addressed the following: • Additional background characteristics • Knowledge of the human reproduction system • Attitudes toward marriage and children • Role of family, school, the community, and exposure to mass media • Use of tobacco, alcohol, and drugs • Dating and sexual activity The Man’s Questionnaire was administered to all currently married men age 15-54 living in every third household in the 2012 IDHS sample. This questionnaire includes much of the same information included in the Woman’s Questionnaire, but is shorter because it did not contain questions on reproductive history or maternal and child health. Instead, men were asked about their knowledge of and participation in health-care- seeking practices for their children. The questionnaire for never-married men age 15-24 includes the same questions asked to never- married women age 15-24. 1.8 PRETEST, TRAINING, AND FIELDWORK 1.8.1 Pretest Prior to the start of the fieldwork, the questionnaires were pretested in Riau and East Nusa Tenggara provinces to make sure that the questions were clear and could be understood by the respondents. The pretest is important given the different sample coverage of women from ever-married women age 15-49 to all women age 15-49. In addition, there are new questions and changes in question format from those in the standard DHS questionnaires. Two teams were recruited in each province. The pilot survey was conducted from mid-July to mid- August 2011 in four selected districts, representing four urban and four rural clusters. The areas selected for the pretest were Pekanbaru and Kampar districts (Riau province) and Kupang City and South Central Timor districts (East Nusa Tenggara province). Findings of the pretest were used to refine the questionnaires. Introduction • 7 1.8.2 Training A total of 922 persons, 376 men and of 546 women, participated in the main survey training for interviewers. The training took place for 12 days in May 2012 in nine training centers: Batam, Bukit Tinggi, Banten, Yogyakarta, Denpasar, Banjarmasin, Makasar, Manokwari, and Jayapura. The training included class presentations, mock interviews, and tests. In each training center, the participants were grouped in three separate classes, one each for interviewers of women, married men, and never-married men respectively. All of the participants were trained using the household and individual questionnaires. 1.8.3 Fieldwork The 2012 IDHS employed 119 interviewing teams to collect the data. Each team was comprised of eight interviewers: one male supervisor, one female field editor, four female interviewers, and two male interviewers, one for currently married men and one for never-married men. In Papua and West Papua, each team consisted of five interviewers: one male supervisor, one female field editor, two female interviewers, and one male interviewer for married men and never-married men. Fieldwork took place from May 7 to July 31, 2012. 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. 1.9 DATA PROCESSING All completed questionnaires, along with the control forms, were returned to the BPS central office in Jakarta for data processing. The questionnaires were logged and edited, and all open-ended questions were coded. Responses were entered in the computer twice for verification, and they were corrected for computer- identified errors. Data processing activities were carried out by a team of 58 data entry operators, 42 data editors, 14 secondary data editors, and 14 data entry supervisors. A computer package program called Census and Survey Processing System (CSPro), which was specifically designed to process DHS-type survey data, was used in the processing of the 2012 IDHS. 1.10 RESPONSE RATES Results of the 2012 IDHS are presented in two separate reports. This report presents findings of interviews with all women age 15-49 and all currently married men age 15-54. Results of interviews with never-married women age 15-24 and never-married men age 15-24 are presented in a special report addressing the adolescent reproductive health component of the IDHS. As in previous IDHS surveys, the 2012 IDHS sample was designed to produce estimates at the national, urban-rural, and provincial levels. Table 1.2 summarizes results of the 2012 IDHS fieldwork for both the household and individual interviews, by urban-rural residence. In general, the response rates for both the household and individual interviews in the 2012 IDHS are high. A total of 46,024 households were selected in the sample, of which 44,302 were occupied. Of these households, 43,852 were successfully interviewed, yielding a household response rate of 99 percent. 8 • Introduction In the interviewed households, 47,533 women were identified as eligible for individual interview and of these completed interviews were conducted with 45,607 women, yielding a response rate of 96 percent. In a third of the households, 10,086 married men were identified as eligible for interview, of which 9,306 were successfully interviewed, yielding a response rate of 92 percent. The lower response rate for men was due to the more frequent and longer absence of men from the household. In general, response rates in rural areas were higher than those in urban areas. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Indonesia 2012 Result Residence Total Urban Rural Household interviews Households selected 22,039 23,985 46,024 Households occupied 21,130 23,172 44,302 Households interviewed 20,866 22,986 43,852 Household response rate1 98.8 99.2 99.0 Interviews with women age 15-49 Number of eligible women 23,949 23,584 47,533 Number of eligible women interviewed 22,898 22,709 45,607 Eligible women response rate2 95.6 96.3 95.9 Interviews with married men age 15-54 Number of eligible men 4,836 5,250 10,086 Number of eligible men interviewed 4,417 4,889 9,306 Eligible men response rate2 91.3 93.1 92.3 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter provides an overview of the socioeconomic characteristics of the population, including composition of the households, sources of drinking water, sanitation facilities, housing conditions, possession of household assets, and hand-washing facilities. Information on household assets is used to create an indicator of household economic status, which is presented in the wealth index. In addition, this chapter also describes demographic characteristics of the household population, which include age, sex, educational attainment, and birth registration of children under age 5. A household in the 2012 Indonesia Demographic and Health Survey (IDHS) is defined as a person or a group of related or unrelated persons, who usually live together in the same dwelling unit and have common cooking and eating arrangements, and who acknowledge one adult member as the head of the household. A member of the household is any person who usually lives in the household. Information on the household members was collected using the Household Questionnaire (see Appendix F) in the 2012 IDHS for all usual residents of a selected household (de jure population) as well as persons who stayed in the selected household the night before the interview (de facto population). 2.1 HOUSING CHARACTERISTICS Characteristics of the dwelling in which members of a household live are important factors determining the health status of household members, particularly for vulnerable members such as children and elderly people. Source of drinking water, type of sanitation facility, type of flooring, walls, roof, number of rooms in the dwelling, and type of fuel used for cooking are physical characteristics of a household that are asked about in the 2012 IDHS and used to assess the general wellbeing and socioeconomic status of its members. The results are presented in terms of both the sampled households and the de jure population. 2.1.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals (MDGs) that Indonesia has adopted along with other nations worldwide (United Nations General Assembly, 2001). T Key Findings • Three in four households in Indonesia have access to an improved source of drinking water. • Seventy percent of households use an appropriate water treatment method prior to drinking. • Sixty-eight percent of households have an improved toilet facility that is not shared with other households. • More than half (52 percent) of households use LPG or natural gas fuel for cooking. • Two-thirds of households have a motorcycle or a scooter. • Thirty percent of the population is under age 15. • Fifteen percent of households are headed by a woman. • Two in three children under age 5 are registered, and 57 percent of them have a birth certificate. 10 • Housing Characteristics and Household Population Table 2.1 presents 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 that are likely to provide water suitable for drinking are identified as improved sources in Table 2.1. They include a piped source into the dwelling or plot, public tap, protected well, and bottled or refill water.1 Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Indonesia 2012 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source Piped into dwelling 12.9 5.2 9.0 13.7 5.2 9.5 Piped to yard/plot 2.4 1.4 1.9 2.6 1.3 1.9 Public tap/standpipe 2.1 1.2 1.6 2.1 1.1 1.6 Protected well in dwelling 17.0 14.5 15.7 17.8 14.3 16.0 Protected well in yard/plot 8.8 15.8 12.4 8.8 15.4 12.1 Protected public well 4.1 8.7 6.4 3.7 8.4 6.1 Bottled/refill water 41.8 14.7 28.0 39.9 14.7 27.2 Non-improved source Open well in dwelling 2.3 2.4 2.4 2.5 2.5 2.5 Open well in yard/plot 2.4 5.5 4.0 2.4 5.5 3.9 Open public well 1.1 3.4 2.3 1.0 3.5 2.3 Spring 2.7 17.2 10.1 2.7 17.4 10.1 River/stream 0.2 4.0 2.2 0.2 4.3 2.3 Pond/lake 0.0 0.1 0.0 0.0 0.1 0.0 Dam 0.0 0.1 0.1 0.0 0.1 0.1 Rainwater 1.1 4.3 2.7 1.1 4.4 2.8 Tanker truck 0.8 1.0 0.9 0.9 1.1 1.0 Other 0.3 0.6 0.4 0.3 0.5 0.4 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 Percentage using any improved source of drinking water 89.1 61.2 74.9 88.7 60.5 74.5 Time to obtain drinking water (round trip) Water on premises 51.1 60.2 55.7 53.0 59.6 56.3 Less than 30 minutes 46.5 35.4 40.9 44.6 35.7 40.2 30 minutes or longer 1.0 3.4 2.2 1.0 3.8 2.4 Don’t know/missing 1.4 1.0 1.2 1.4 0.9 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 58.4 80.4 69.6 60.0 80.1 70.1 Bleach/chlorine added 0.3 0.6 0.5 0.3 0.6 0.5 Strained through cloth 1.5 3.7 2.6 1.6 3.9 2.8 Ceramic, sand or other filter 1.8 3.0 2.4 1.8 2.8 2.3 Solar disinfection 0.0 0.0 0.0 0.0 0.0 0.0 Other 20.7 25.0 22.9 21.3 24.8 23.0 No treatment 37.9 17.9 27.7 36.3 18.1 27.1 Percentage using an appropriate treatment method2 59.0 80.7 70.1 60.7 80.5 70.6 Number 21,523 22,329 43,852 87,230 87,747 174,977 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 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 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, 2004). Housing Characteristics and Household Population • 11 from a source that is not readily accessible to the household may be contaminated during transport or storage. Households were further asked if they treat the water before drinking it. Table 2.1 shows that protected wells, either in the dwelling, in the yard, or at a public tap, are the main source of drinking water (35 percent). Twenty-eight percent of households use bottled water, including refill water. This proportion is much higher in the urban than in the rural areas (42 and 15 percent, respectively). Other sources of drinking water include springs (10 percent) and rainwater (3 percent). Rural households are much more likely to use spring water than urban households (17 percent compared with 3 percent). Only 2 percent of households use open water sources such as rivers and ponds. Forty-seven percent of households in urban areas spend less than 30 minutes round trip to reach the water sources, compared with 35 percent of households in rural areas. Nationally, 70 percent of households use an appropriate water treatment method. Urban households are much less likely than rural households to treat their water appropriately (59 percent and 81 percent, respectively) because urban households prefer to use bottled water or refill water for drink. Overall, boiling water prior to drinking is the most common treatment method (70 percent). 2.1.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is another of the MDGs shared 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 sanitation facilities have a greater risk of diseases like diarrhea, dysentery, and typhoid than households with improved sanitation facilities. Table 2.2 shows the distribution of households by type of toilet or latrine facilities and the distance from the well to the nearest septic tank. Sixty- eight percent of households have a private toilet2, an increase from 57 percent found in the 2007 IDHS (BPS and Macro International, 2008). Ten percent of households use a shared facility, and the remaining 23 percent do not have a toilet. This latter percentage is lower than that found in the 2007 IDHS (33 percent). The urban- rural differences are notable; 80 percent of households in urban areas have a private toilet compared with 56 percent in rural areas. For 24 percent of the households, the well is less than seven meters from the nearest septic tank3, and for 63 percent households, the nearest septic tank is seven meters or more from the well. 2 In the Indonesia DHS, a private toilet is defined as a facility that is not shared with other households. 3 In this table, the location of the septic tank is not determined whether in the household or not. 12 • Housing Characteristics and Household Population Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Indonesia 2012 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Private facility Private with septic tank 71.7 47.8 59.6 73.4 48.6 60.9 Private without septic tank 7.8 8.1 8.0 8.2 8.4 8.3 Shared/public 9.9 9.5 9.7 7.8 8.9 8.4 Other facility Pit latrine 1.3 9.2 5.3 1.2 9.1 5.2 Yard/bush/forest 0.8 5.4 3.1 0.8 5.5 3.2 River/stream/creek 7.3 16.7 12.1 7.4 16.4 11.9 Other 1.1 3.2 2.1 1.2 3.0 2.1 Missing 0.0 0.1 0.1 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 21,523 22,329 43,852 87,230 87,747 174,977 Distance between the well and the nearest septic tank1 Less than 7 meters 27.0 21.7 23.9 27.3 21.5 23.9 7 meters or more 61.0 64.7 63.2 61.1 65.1 63.4 Don’t know/missing 12.0 13.5 12.9 11.6 13.4 12.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 7,659 11,235 18,894 31,613 43,563 75,176 1Only for households that use well for source of drinking water. 2.1.3 Housing Characteristics Housing characteristics such as type of flooring material in the dwelling can be considered as both an economic indicator and a health indicator for household. Some flooring materials like earth or sand pose health problems for the household because they are the natural environment of insects or parasites, and may be a source of dust. In addition, this type of flooring is more difficult to keep clean. Table 2.3 shows that 96 percent of the households covered in the 2012 IDHS have electricity, a slight increase from 91 percent reported in the 2007 IDHS (BPS and Macro International, 2008). There are no significant urban-rural differentials; 99 percent of urban households and 93 percent of rural households have electricity. Only 8 percent of households have an earth or a sand floor: 13 percent of rural households and 3 percent of urban. Forty percent of households live in dwellings with a tile, cement, or brick floor. The percentage is similar to households living in a dwelling with a ceramic, marble, or granite floor. There are substantial urban-rural differentials by this type of flooring material; 54 percent in urban areas and 26 percent in rural areas use ceramic, marble, or granite. Eleven percent of households use wood or plank as flooring materials in their dwelling. Most households in Indonesia (87 percent) cook their food in the house. The majority of the households use liquid petroleum gas (LPG) or natural gas and wood for cooking (52 and 38 percent, respectively), while only 7 percent of households still use kerosene. Households using LPG or natural gas for cooking in the 2012 IDHS significantly increased compared with the result of the 2007 IDHS (11 percent) because the government of Indonesia has launched a gradual “kerosene to LPG conversion program” since 2007 in response to the global food and fuel crises. The program’s objective is to reduce dependency on petroleum (http://www.esdm.go.id/berita/migas/40-migas/6284-beralih-ke-gas-pemerintah-laksanakan- berbagai-program.html). There are substantial urban-rural differentials by type of cooking fuel. Whereas 70 percent of urban households use LPG or natural gas for cooking, only 34 percent of rural households do so. Furthermore, 16 percent of urban households use wood for cooking compared with 59 percent of households in rural areas. Housing Characteristics and Household Population • 13 Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Indonesia 2012 Residence Total Housing characteristic Urban Rural Electricity Yes 99.1 92.9 96.0 No 0.7 7.0 3.9 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Flooring material Earth/sand 3.2 13.1 8.2 Wood/plank 5.7 16.0 10.9 Bamboo 0.2 1.8 1.0 Parquet 0.1 0.0 0.1 Ceramic/marble/granite 54.0 25.6 39.5 Tiles/terrazzo 11.1 7.4 9.2 Cement/brick 25.5 35.8 30.7 Other 0.0 0.4 0.2 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping One 22.9 21.2 22.0 Two 36.2 39.6 37.9 Three or more 38.1 36.1 37.1 Missing 2.8 3.1 3.0 Total 100.0 100.0 100.0 Place for cooking In the house 88.1 85.3 86.7 In a separate building 4.8 10.3 7.6 Outdoors 3.3 3.5 3.4 No food cooked at home 3.6 0.8 2.2 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.5 0.2 0.3 Biogas 0.2 0.1 0.2 Kerosene 9.5 5.3 7.4 Charcoal 0.2 0.6 0.4 Wood 15.5 58.9 37.6 Straw/shrubs/grass 0.0 0.1 0.0 LPG/Natural Gas 70.3 34.0 51.8 No food cooked in house 3.6 0.8 2.2 Other 0.1 0.0 0.0 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 15.8 59.5 38.1 Frequency of smoking in the home Daily 60.1 67.5 63.8 Weekly 6.1 6.7 6.4 Monthly 3.0 3.1 3.0 Less than monthly 2.4 2.1 2.2 Never 28.4 20.6 24.4 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number 21,523 22,329 43,852 LPG = Liquid petroleum gas 1 Includes charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung 14 • Housing Characteristics and Household Population Information on smoking was collected in the 2012 IDHS to assess the percentage of household members who are exposed to secondhand smoke (SHS), which is a risk factor for those who do not smoke. The frequency of smoking in the home presented in Table 2.3 shows that 64 percent of households are exposed daily to SHS; rural households are more likely than urban households to be exposed to SHS (68 percent and 60 percent, respectively). 2.2. HOUSEHOLD POSSESSIONS The presence of durable goods in the households, such as a radio, television, telephone, refrigerator, motorcycle, and private car, is another useful indicator of the household socioeconomic status. Moreover, the possession and use of household durable goods have multiple effects and implications. For instance, ownership of a radio or television is a measure of access to mass media and exposure to innovative ideas. Similarly, telephone ownership measures access to an efficient means of communication; refrigerator ownerships prolong the wholesomeness of foods; and ownership of private transport allows greater access to many services away from the local area. Table 2.4 shows that 34 percent of households have a radio, 83 percent have a television, 83 percent have a mobile telephone, and 40 percent have a refrigerator. Ownership of radios has declined from 49 percent in 2007 to 34 percent in 2012, while ownership of televisions has increased from 69 to 83 percent. In terms of means of transportation, 42 percent of households have a bicycle, 67 percent have a motorcycle or scooter, and 9 percent of households have a private car or truck. Meanwhile, 36 percent of households own agricultural land; 54 percent of rural households and 17 percent of urban households do. Furthermore, 43 percent of households have farm animals, such as cattle, cows, horses, goats, sheep, or chickens. Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Indonesia 2012 Residence Possession Urban Rural Total Household effects Radio 39.6 27.8 33.6 Television 91.9 74.8 83.2 Mobile telephone 90.7 75.5 82.9 Non-mobile telephone 11.5 1.0 6.2 Refrigerator 55.5 24.7 39.8 Means of transport Bicycle 45.2 38.9 42.0 Motorcycle/scooter 73.2 60.7 66.8 Rowboat 0.6 2.4 1.5 Boat with a motor 0.7 1.6 1.1 Animal drawn cart 0.2 0.1 0.1 Car/truck 12.3 5.1 8.6 Ship 0.1 0.1 0.1 Ownership of agricultural land 17.4 54.3 36.2 Ownership of farm animals1 27.8 58.3 43.3 Number 21,523 22,329 43,852 1 Cattle, cows, water buffaloes, horses, donkeys, mules, goats, sheep, pigs or poultry Housing Characteristics and Household Population • 15 2.3 WEALTH INDEX In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. Categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally-applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. This three- step procedure permits greater adaptability of the wealth index in both urban and rural areas. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning the household score to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Table 2.5 shows the distribution of the de jure household population into the five wealth quintiles by residence and region. The distribution indicates the degree to which wealth is evenly (or unevenly) distributed by urban-rural residence. Data in Table 2.5 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. More than half (60 percent) of the rural population is in the two lowest quintiles, while one-third (33 percent) of the urban population is in the highest quintiles. Among provinces, almost half (47 percent) of people living in DKI Jakarta province fall in the highest wealth quintile. In contrast, Papua, East Nusa Tenggara and West Sulawesi provinces have the highest proportion of the population in the lowest wealth quintile (70, 66, and 64 percent, respectively). Table 2.5 also includes information on the Gini coefficient, which indicates the level of concentration of wealth. This ratio is expressed as a proportion between 0 and 1; 0 being an equal distribution and 1 being a totally unequal distribution. Wealth inequality, as measured by the Gini coefficient, is higher in rural than in urban areas (17 percent compared with 8 percent). Inequality in wealth is highest in Papua province (35 percent) and lowest in DKI Jakarta province (4 percent). 16 • Housing Characteristics and Household Population Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Indonesia 2012 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 6.4 13.6 21.0 26.4 32.7 100.0 87,230 0.08 Rural 33.5 26.4 19.0 13.7 7.4 100.0 87,747 0.17 Province Sumatera Aceh 29.4 25.4 18.8 14.5 11.9 100.0 3,369 0.19 North Sumatera 27.1 22.6 20.1 19.2 11.0 100.0 9,228 0.19 West Sumatera 22.7 24.7 22.4 17.0 13.3 100.0 3,435 0.16 Riau 20.6 23.1 22.2 17.5 16.6 100.0 4,017 0.17 Jambi 31.6 21.5 18.3 17.4 11.2 100.0 2,183 0.20 South Sumatera 24.7 21.5 20.5 16.8 16.4 100.0 5,242 0.19 Bengkulu 28.5 22.8 19.2 15.8 13.7 100.0 1,197 0.19 Lampung 23.9 25.9 23.5 14.1 12.5 100.0 5,560 0.16 Bangka Belitung 10.4 20.4 22.8 24.8 21.6 100.0 943 0.15 Riau Islands 12.0 14.7 21.7 29.3 22.1 100.0 1,131 0.13 Java DKI Jakarta 2.5 7.6 14.8 27.8 47.2 100.0 6,647 0.04 West Java 10.7 15.8 20.4 26.2 26.9 100.0 32,102 0.12 Central Java 13.7 22.6 22.9 21.0 19.8 100.0 23,256 0.16 DI Yogyakarta 7.1 19.4 19.5 20.3 33.7 100.0 2,559 0.09 East Java 11.8 20.9 23.8 23.2 20.4 100.0 28,791 0.14 Banten 13.6 14.3 15.7 23.4 33.1 100.0 7,779 0.13 Bali and Nusa Tenggara Bali 8.8 17.0 20.6 19.7 33.8 100.0 3,025 0.10 West Nusa Tenggara 38.1 27.2 15.2 11.1 8.3 100.0 3,644 0.20 East Nusa Tenggara 65.9 15.6 7.5 5.9 5.0 100.0 3,741 0.31 Kalimantan West Kalimantan 38.2 24.5 14.6 12.9 9.9 100.0 3,109 0.25 Central Kalimantan 49.5 23.3 14.6 6.9 5.7 100.0 1,604 0.27 South Kalimantan 37.6 26.4 15.3 10.3 10.4 100.0 2,667 0.21 East Kalimantan 16.3 28.4 23.2 15.8 16.3 100.0 2,484 0.17 Sulawesi North Sulawesi 30.9 25.7 17.6 14.7 11.1 100.0 1,710 0.22 Central Sulawesi 43.3 19.2 16.8 14.0 6.8 100.0 1,938 0.24 South Sulawesi 28.8 20.8 20.3 13.9 16.2 100.0 6,003 0.17 Southeast Sulawesi 43.4 21.9 15.9 10.3 8.6 100.0 1,580 0.24 Gorontalo 43.4 22.6 12.0 13.0 9.0 100.0 776 0.22 West Sulawesi 64.4 13.4 8.8 6.8 6.6 100.0 825 0.33 Maluku and Papua Maluku 47.6 22.1 16.8 10.1 3.4 100.0 1,158 0.23 North Maluku 40.4 25.1 15.8 12.5 6.2 100.0 742 0.22 West Papua 37.5 16.7 19.8 17.9 8.0 100.0 517 0.21 Papua 69.9 13.2 7.9 5.8 3.3 100.0 2,015 0.35 Total 20.0 20.0 20.0 20.0 20.0 100.0 174,977 0.13 2.4 HAND WASHING Hand washing, which protects against communicable diseases, is promoted by the government of Indonesia and its development partners, such as UNICEF. Table 2.6 provides information on designated places for hand washing in households and on the use of water and cleansing agents for washing hands, according to place of residence (urban or rural) and wealth quintile. In the 2012 IDHS, interviewers were instructed to observe the place where household members usually wash their hands. They looked for regularity of water supply and observed whether the household had cleansing agents near the place of hand washing. In 80 percent of households, the interviewers observed designated places for hand washing; the proportion observed in urban areas was higher than in rural areas (87 Housing Characteristics and Household Population • 17 percent and 72 percent, respectively). Households in the highest wealth quintile are more likely to have this facility observed than those in the lowest wealth quintile; the highest is 96 percent of households in the highest wealth quintile and the lowest is 54 percent of households in the lowest quintile. Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Indonesia 2012 Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed Number of households with place for hand washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 87.2 21,523 95.5 0.2 3.3 0.5 0.0 0.4 0.2 100.0 18,775 Rural 72.4 22,329 88.6 0.4 8.6 1.2 0.0 1.0 0.1 100.0 16,174 Wealth quintile Lowest 54.4 9,550 77.2 0.6 17.8 1.7 0.1 2.6 0.2 100.0 5,192 Second 74.0 9,106 90.0 0.4 7.5 1.1 0.0 0.9 0.1 100.0 6,736 Middle 85.8 8,836 94.0 0.2 4.5 0.8 0.0 0.3 0.2 100.0 7,584 Fourth 92.8 8,425 96.7 0.1 2.4 0.5 0.0 0.2 0.2 100.0 7,815 Highest 96.1 7,936 98.5 0.1 1.0 0.3 0.0 0.0 0.2 100.0 7,623 Total 79.7 43,852 92.3 0.3 5.8 0.8 0.0 0.7 0.2 100.0 34,950 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water as well as another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent Most households (92 percent) have soap and water in the place where household members wash their hands, and 6 percent of households have water only. Overall, less than 1 percent of households do not have water, soap, or any cleansing agent. Appendix Table A-2.1 shows the differentials in hand washing practices by province. 2.5 HOUSEHOLD POPULATION BY AGE AND SEX 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 and fertility. The distribution of the de facto household population in the 2012 IDHS is shown by five-year age groups in Table 2.7, according to sex and urban-rural residence. The 2012 IDHS households constitute a population of 172,322 persons. The data show that there is an almost equal proportion of women and men in the population (49 and 51 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 percent of the population is under age 15; 64 percent are age 15-64, and 6 percent are age 65 or older. 18 • Housing Characteristics and Household Population Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Indonesia 2012 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 9.6 9.5 9.6 10.5 9.4 9.9 10.1 9.4 9.8 5-9 9.8 9.4 9.6 11.1 10.4 10.7 10.5 9.9 10.2 10-14 10.0 8.8 9.4 10.8 10.2 10.5 10.4 9.5 9.9 15-19 8.8 8.6 8.7 8.3 7.6 7.9 8.5 8.1 8.3 20-24 7.8 8.0 7.9 5.8 6.7 6.2 6.8 7.3 7.1 25-29 7.9 8.2 8.0 7.0 7.8 7.4 7.5 8.0 7.7 30-34 8.4 8.3 8.3 7.6 7.4 7.5 8.0 7.8 7.9 35-39 8.1 8.1 8.1 7.0 7.6 7.3 7.6 7.9 7.7 40-44 7.4 7.6 7.5 6.7 6.7 6.7 7.1 7.1 7.1 45-49 5.8 6.2 6.0 5.7 6.0 5.9 5.8 6.1 6.0 50-54 5.1 5.3 5.2 5.5 5.5 5.5 5.3 5.4 5.4 55-59 4.1 4.0 4.0 4.4 4.1 4.2 4.2 4.1 4.1 60-64 2.8 2.7 2.8 3.2 3.4 3.3 3.0 3.0 3.0 65-69 1.6 1.9 1.8 2.2 2.3 2.3 1.9 2.1 2.0 70-74 1.4 1.6 1.5 1.8 2.1 2.0 1.6 1.8 1.7 75-79 0.7 0.8 0.7 1.0 1.1 1.0 0.8 1.0 0.9 80 + 0.7 1.0 0.9 1.3 1.6 1.5 1.0 1.3 1.2 Don’t know/missing 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 42,472 43,579 86,052 42,234 44,032 86,270 84,706 87,611 172,322 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. Figure 2.1 Population pyramid of Indonesia Housing Characteristics and Household Population • 19 2.6 HOUSEHOLD COMPOSITION Information about the composition of households by the sex of the head of the household and size of the household are important because they are associated with aspects of household welfare. Female-headed households are, for example, typically poorer than male-headed households. Where households are large, there is generally greater crowding, which is usually associated with less favorable health conditions and economic hardship. Table 2.8 presents information on household composition. The 2012 IDHS data show that 15 percent of households are headed by women. This proportion is slightly higher than the level observed in the 2007 IDHS (13 percent). The proportion of female-headed households is almost similar in urban and rural areas (15 and 14 percent, respectively). Seven percent of households have only one member, with urban and rural areas having the same proportion of one-member households (7 percent, each). However, very large households (nine persons or more) still exist in Indonesia (3 percent in urban and 2 percent in rural areas). Table 2.8 also shows that the overall mean household size in Indonesia is four persons. The household size in rural and urban areas is similar (four persons, each). The same pattern was observed in the 2007 IDHS (BPS and Macro International, 2008). 2.7 BIRTH REGISTRATION In the 2012 IDHS, information on birth registration was solicited for children under age 5. Table 2.9 presents the percentage of the de jure population under age 5 whose births are registered with the civil authorities, according to background characteristics. About two in three children (67 percent) have their births registered, and 57 percent of children under age 5 have a birth certificate. Although the vital registration system requires that a newborn be registered within the shortest possible time, Table 2.9 indicates that children under age 2 are less likely to be registered than children age 2-4 (63 and 69 percent, respectively). The registration of older children is primarily driven by the practice of asking parents to produce a child’s birth certificate for school admission. Table 2.9 also shows that birth registration is higher in urban (76 percent) than in rural (58 percent) areas. There is no difference regarding the extent of birth registration between male and female children. Children from the highest wealth quintile are more likely to have their births registered (88 percent) than children from the lowest wealth quintile (41 percent). Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; and mean size of household, according to residence, Indonesia 2012 Residence Total Characteristic Urban Rural Household headship Male 84.8 85.6 85.2 Female 15.2 14.4 14.8 Total 100.0 100.0 100.0 Number of usual members 1 7.2 6.5 6.8 2 11.7 14.2 13.0 3 20.8 23.0 21.9 4 25.6 23.8 24.7 5 17.2 15.8 16.5 6 8.7 8.7 8.7 7 4.1 4.5 4.3 8 2.1 1.8 1.9 9+ 2.5 1.6 2.1 Total 100.0 100.0 100.0 Mean size of households 4.1 3.9 4.0 Number of households 21,523 22,329 43,852 20 • Housing Characteristics and Household Population Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Indonesia 2012 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Age <2 48.5 14.1 62.6 6,834 2-4 63.1 6.3 69.4 9,950 Sex Male 56.8 9.5 66.3 8,559 Female 57.5 9.5 67.0 8,226 Residence Urban 67.1 8.6 75.7 8,246 Rural 47.5 10.4 57.9 8,538 Wealth quintile Lowest 29.6 10.9 40.5 3,681 Second 48.2 11.2 59.5 3,328 Middle 60.4 9.8 70.2 3,266 Fourth 70.1 9.0 79.0 3,380 Highest 81.6 6.4 87.9 3,130 Total 57.1 9.5 66.6 16,785 2.8 EDUCATION 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 2012 IDHS, information on educational attainment was collected for every member of the household. The 2012 IDHS results can be used to show the educational attainment of household members as well as school attendance among youth. Tables 2.10.1 and 2.10.2 show the distribution of the female and male household population age 6 and older by the highest level of education completed and the median number of years of education completed, according to background characteristics. The majority of Indonesians age 6 and older have attended school. Only 10 percent of women and about 6 percent men have never attended school. There is no gender difference in primary education. However, women are less likely to have completed secondary school or to have attained a higher education compared with men (23 percent versus 27 percent). Overall, levels of educational attainment are higher in urban than in rural areas (Tables 2.10.1 and 2.10.2). The proportions of women and men with no education are lower in urban areas (7 percent of women and 4 percent of men) than in rural areas (14 percent of women and 8 percent of men), while the proportion who have more than secondary education are greater in urban areas (12 percent of women and men, respectively) than in rural areas (4 percent of women and men, respectively). On average, men and women living in urban areas have completed almost three more years of schooling than those living in rural areas. The percent distribution of educational attainment by province is shown in Appendix Table A-2.2.1 for the female household population and in Appendix Table A-2.2.2 for the male household population. Housing Characteristics and Household Population • 21 Table 2.10.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Indonesia 2012 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 17.8 81.3 0.0 0.2 0.1 0.0 0.7 100.0 6,879 0.7 10-14 0.7 45.3 16.6 37.0 0.1 0.0 0.3 100.0 8,313 5.1 15-19 0.9 2.9 7.6 62.3 20.2 6.0 0.1 100.0 7,078 8.9 20-24 1.5 4.6 16.0 25.9 29.8 22.0 0.0 100.0 6,420 11.1 25-29 1.9 5.9 20.9 26.5 29.5 15.3 0.0 100.0 7,008 8.8 30-34 2.1 8.7 26.7 23.5 25.0 13.9 0.0 100.0 6,857 8.5 35-39 2.8 11.6 30.7 21.3 22.5 11.1 0.1 100.0 6,885 8.1 40-44 5.7 16.6 30.8 16.8 21.0 9.1 0.0 100.0 6,263 5.9 45-49 10.9 27.6 26.5 13.2 13.4 8.4 0.0 100.0 5,382 5.4 50-54 16.6 31.0 28.2 9.5 7.2 7.0 0.5 100.0 4,767 5.1 55-59 19.1 30.7 29.1 9.5 7.6 3.3 0.6 100.0 3,552 5.0 60-64 30.0 30.4 22.6 7.5 5.5 2.4 1.6 100.0 2,661 2.8 65+ 51.8 24.1 14.5 4.5 3.0 0.8 1.4 100.0 5,474 0.0 Don’t know/ missing 78.1 5.4 1.6 0.5 0.0 0.0 14.4 100.0 42 0.0 Residence Urban 7.0 20.2 16.5 22.8 21.0 12.3 0.3 100.0 38,557 8.1 Rural 13.6 28.5 23.4 21.3 9.1 3.8 0.3 100.0 39,024 5.3 Wealth quintile Lowest 19.9 33.9 22.9 16.9 4.9 1.0 0.5 100.0 15,294 4.2 Second 13.0 28.9 23.4 22.5 9.6 2.2 0.3 100.0 15,536 5.3 Middle 8.8 24.5 22.6 25.0 14.2 4.6 0.3 100.0 15,289 5.7 Fourth 6.4 20.3 19.4 24.6 20.5 8.6 0.2 100.0 15,545 7.2 Highest 3.7 14.6 11.8 21.2 25.4 23.1 0.3 100.0 15,917 10.0 Total 10.3 24.4 20.0 22.0 15.0 8.0 0.3 100.0 77,581 5.7 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Table 2.10.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Indonesia 2012 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 18.3 80.4 0.1 0.3 0.0 0.0 0.8 100.0 7,186 0.6 10-14 0.9 49.5 16.9 32.4 0.1 0.0 0.2 100.0 8,831 5.0 15-19 0.8 4.5 8.3 65.0 17.2 4.1 0.0 100.0 7,225 8.8 20-24 1.1 6.1 14.5 25.7 33.9 18.7 0.0 100.0 5,750 11.1 25-29 1.4 6.2 19.3 25.9 33.2 13.6 0.3 100.0 6,312 8.9 30-34 1.2 7.6 23.4 25.1 30.8 11.7 0.2 100.0 6,767 8.7 35-39 1.4 8.1 26.6 21.6 30.8 11.3 0.2 100.0 6,408 8.6 40-44 2.5 10.2 25.8 21.5 28.8 11.1 0.0 100.0 5,990 8.5 45-49 4.2 19.9 27.7 13.4 23.2 11.6 0.1 100.0 4,887 5.9 50-54 7.3 26.6 28.1 12.6 16.1 9.1 0.2 100.0 4,492 5.6 55-59 9.4 28.0 29.7 12.9 12.5 7.1 0.5 100.0 3,569 5.4 60-64 11.9 28.0 32.2 11.5 10.6 5.8 0.1 100.0 2,556 5.3 65+ 24.3 30.7 25.4 7.9 7.2 3.9 0.7 100.0 4,489 3.5 Don’t know/ missing 61.4 10.4 6.6 0.0 17.3 2.0 2.3 100.0 20 0.0 Residence Urban 3.8 19.1 15.6 23.6 25.3 12.4 0.2 100.0 37,583 8.4 Rural 7.5 29.7 23.8 23.1 12.1 3.5 0.3 100.0 36,901 5.5 Wealth quintile Lowest 10.9 36.1 24.6 20.2 6.9 1.0 0.3 100.0 14,394 5.1 Second 6.6 29.4 24.8 24.9 11.7 2.1 0.4 100.0 14,870 5.5 Middle 5.1 22.6 22.0 26.9 18.9 4.3 0.2 100.0 15,099 5.9 Fourth 3.7 18.7 18.2 25.1 26.3 7.9 0.1 100.0 15,112 8.2 Highest 2.3 15.5 8.8 19.5 29.4 24.4 0.2 100.0 15,009 11.1 Total 5.7 24.3 19.6 23.3 18.8 8.0 0.2 100.0 74,484 5.9 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 22 • Housing Characteristics and Household Population Figure 2.2 shows the age-specific attendance rates of the de facto population age 5-24. For ages 5-15, girls have a higher school attendance than boys. The pattern reverses at age 16 and older. Attendance rates are highest at age 10 for boys and at age 9 for girls. Figure 2.2 Age-specific attendance rates of the de facto population age 5-24 Characteristics of Respondents • 23 CHARACTERISTICS OF RESPONDENTS 3 he purpose of this chapter is to provide a demographic and socioeconomic profile of the 2012 Indonesia Demographic and Health Survey (IDHS) sample of women age 15-49 and currently married men age 15-54. 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 that include age, marital status, educational level, and residential characteristics. The chapter also explores exposure to mass media, employment status, and occupation. Additional information was collected on health insurance coverage and use of tobacco. In 2012, the IDHS gathered information from all women age 15-49 irrespective of their marital status. Earlier IDHS surveys interviewed only ever-married women age 15-49. The discussion in this report refers to all women age 15-49 and currently-married men age 15-54. 3.1 CHARACTERISTIC OF SURVEY RESPONDENTS Table 3.1 shows the distribution by background characteristics of women age 15-49 and currently married men age 15-54 interviewed in the 2012 IDHS. These characteristics included age, marital status, urban-rural residence, educational level, and wealth status. The findings show that less than half of women and one in six currently married men are under the age of 30. The results also show that 73 percent of women are currently married or living together, 22 percent have never married, and the remaining 5 percent are primarily divorced and widowed women. Fifty-two percent of women and 51 percent of men live in urban areas. T Key Findings • Three percent of women age 15-49 and 3 percent of currently married men age 15-54 have no education. The percentage of women and men with no education has decreased since 2007. At the same time, the percentage of women and men who attended secondary or higher education has increased from 46 to 64 percent for women and from 51 to 60 percent for men). • Twelve percent of women and 10 percent of men are not regularly exposed to any media source. • Sixty-one percent of women and 99 percent of men were employed in the 12 months preceding the survey. • Sixty-three percent of women and 69 percent of men have no health insurance. The majority of those who are covered by health insurance receive it through social security. • Three percent of women and 72 percent of men smoke cigarettes or other tobacco products. 24 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 and currently married men age 15-54 by selected background characteristics, Indonesia 2012 Background characteristic Women Currently married men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 15.2 6,927 7,207 0.3 28 37 20-24 13.8 6,305 6,589 3.7 345 398 25-29 15.3 6,959 7,160 12.1 1,127 1,195 30-34 15.1 6,876 6,965 18.0 1,674 1,685 35-39 15.1 6,882 6,780 19.1 1,775 1,745 40-44 13.7 6,252 5,881 18.2 1,693 1,712 45-49 11.9 5,407 5,025 14.7 1,371 1,322 50-54 na na na 13.9 1,292 1,212 Marital status Never married 21.7 9,919 10,742 na na na Married 73.0 33,291 32,361 99.8 9,286 9,260 Living together 0.4 174 345 0.2 20 46 Divorced/separated 2.8 1,288 1,238 na na na Widowed 2.1 935 921 na na na Residence Urban 52.2 23,805 22,898 50.9 4,739 4,417 Rural 47.8 21,802 22,709 49.1 4,567 4,889 Education No education 3.3 1,500 1,622 2.9 265 270 Some primary 10.7 4,870 5,090 14.7 1,371 1,394 Completed primary 22.5 10,254 8,642 22.8 2,118 1,791 Some secondary 28.0 12,753 12,554 21.3 1,979 2,123 Completed secondary 23.4 10,677 11,205 26.4 2,453 2,542 More than secondary 12.2 5,552 6,494 12.0 1,119 1,186 Wealth quintile Lowest 17.0 7,767 10,642 17.1 1,596 2,319 Second 19.3 8,784 9,187 20.0 1,866 1,920 Middle 20.3 9,243 8,678 21.6 2,008 1,786 Fourth 21.4 9,743 8,478 21.1 1,962 1,700 Highest 22.1 10,071 8,622 20.1 1,875 1,581 Total 100.0 45,607 45,607 100.0 9,306 9,306 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Three percent of women age 15-49 have never attended formal schooling. The proportion of women who completed primary school is 23 percent and 36 percent have completed secondary or higher education. Three percent of men are uneducated. The proportion of married men who completed primary school is 23 percent and 38 percent have completed secondary or higher education. Looking at the distribution of respondents by wealth status, 64 percent of women and 63 percent of men were in the middle to highest upper quintiles. Differentials in background characteristics by province are presented in Appendix Table A-3.1. 3.2 EDUCATIONAL ATTAINMENT Education is one of the most influential determinants of an individual’s knowledge, attitudes, and behaviors. The educational attainment of a population is an important indicator of the society’s stock of human capital and level of socioeconomic development. Tables 3.2.1 and 3.2.2 present differentials in the educational attainment of women and men by highest level of schooling attained or completed, according to age, residence, and wealth status. Characteristics of Respondents • 25 Table 3.2.1 shows that 3 percent of women age 15-49 have never been to school, 11 percent have some primary education, 23 percent have completed primary education, 28 percent have some secondary education, 23 percent have completed some secondary education, and 12 percent have more than secondary education or continued on to higher education. Older women, women in rural areas, and those in the lowest wealth quintile are most likely than other women to have no education. Urban-rural differences in education are pronounced at the secondary and higher levels. For example, urban women are two times more likely than rural women to have completed secondary education (31 percent and 15 percent, respectively) and urban women are three times more likely than rural women to have more than secondary education (18 percent and 6 percent, respectively). Women age 15-49 have completed a median of 8.5 years of schooling. The differentials across subgroups of women are reflected in the medians. For example, the median number of years of schooling for women in the highest wealth quintile is 11.4 years compared with 5.6 years of schooling for women in the lowest quintile. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Indonesia 2012 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 1.0 3.5 11.6 45.5 24.8 13.6 100.0 9.1 13,232 15-19 0.7 2.6 7.6 62.8 20.3 6.0 100.0 9.0 6,927 20-24 1.4 4.5 16.0 26.5 29.7 21.9 100.0 11.1 6,305 25-29 1.6 5.8 20.9 26.8 29.6 15.2 100.0 8.8 6,959 30-34 2.0 8.9 26.6 23.7 25.2 13.6 100.0 8.5 6,876 35-39 2.6 11.5 30.8 21.4 22.6 11.1 100.0 8.1 6,882 40-44 5.5 16.9 30.7 16.8 21.1 9.0 100.0 5.9 6,252 45-49 11.0 28.4 25.9 13.1 13.5 8.2 100.0 5.4 5,407 Residence Urban 1.6 7.1 16.2 26.9 30.7 17.6 100.0 10.1 23,805 Rural 5.2 14.6 29.4 29.2 15.4 6.2 100.0 6.2 21,802 Wealth quintile Lowest 9.8 21.5 31.6 25.9 9.4 2.0 100.0 5.6 7,767 Second 4.1 15.3 29.5 30.8 16.3 4.0 100.0 6.4 8,784 Middle 2.1 10.3 25.4 32.2 22.6 7.3 100.0 8.4 9,243 Fourth 1.4 6.4 19.7 29.5 30.4 12.7 100.0 8.9 9,743 Highest 0.6 2.8 9.4 21.8 34.4 31.1 100.0 11.4 10,071 Total 3.3 10.7 22.5 28.0 23.4 12.2 100.0 8.5 45,607 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Table 3.2.2 shows that 3 percent of currently married men age 15-54 have never been to school, 15 percent have some primary education, 23 percent have completed primary education, 21 percent have some secondary education, 26 percent have completed some secondary education, and 12 percent have more than secondary education or continued on to higher education. Differentials in educational attainment across groups of currently married men are similar to those of women. Older men, those in urban areas, and men in the higher wealth quintiles are more likely to be educated than other men. Urban-rural differences in education are pronounced at the secondary and higher levels. 26 • Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of currently married men age 15-54 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Indonesia 2012 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 1.7 9.9 16.4 34.6 31.9 5.5 100.0 8.5 373 15-19 (0.0) (31.5) (15.3) (43.1) (7.6) (2.6) 100.0 (5.9) 28 20-24 1.8 8.1 16.5 33.9 33.9 5.7 100.0 8.6 345 25-29 1.5 6.5 21.0 28.6 33.3 9.1 100.0 8.8 1,127 30-34 1.2 8.5 21.5 25.8 29.3 13.7 100.0 8.8 1,674 35-39 1.8 10.2 24.1 20.9 30.6 12.5 100.0 8.7 1,775 40-44 2.0 11.3 22.6 23.3 27.5 13.3 100.0 8.6 1,693 45-49 4.8 24.7 21.8 12.9 22.2 13.5 100.0 5.9 1,371 50-54 7.1 31.6 27.1 11.8 12.0 10.3 100.0 5.4 1,292 Residence Urban 1.4 9.2 16.3 20.2 34.9 18.0 100.0 11.1 4,739 Rural 4.4 20.4 29.4 22.4 17.5 5.8 100.0 5.8 4,567 Wealth quintile Lowest 7.8 24.9 32.2 23.0 10.4 1.7 100.0 5.5 1,596 Second 2.6 22.3 32.0 24.9 15.8 2.4 100.0 5.8 1,866 Middle 2.3 14.5 27.5 26.5 24.1 5.1 100.0 8.1 2,008 Fourth 1.7 10.4 15.8 21.3 38.8 11.9 100.0 11.0 1,962 Highest 0.7 3.3 7.7 10.5 39.8 37.9 100.0 11.7 1,875 Total 2.9 14.7 22.8 21.3 26.4 12.0 100.0 8.4 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level There are significant differentials in educational attainment across provinces (see Appendix Tables A- 3.2.1 and A-3.2.2). 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 planning professionals reach their target populations with messages. In the 2012 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. Tables 3.3.1 and 3.3.2 show that the majority of respondents are literate. The percentages of women who are literate is the same as that of men (93 percent). Younger respondents are more likely than older respondents to be literate. 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 (99 percent each). The variation in literacy rates by province is presented in Appendix Tables A-3.3.1 and A-3.3.2. Characteristics of Respondents • 27 Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Indonesia 2012 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/visually impaired Missing Age 15-24 83.9 12.7 1.2 1.9 0.0 0.3 100.0 97.8 13,232 15-19 89.1 8.4 0.9 1.3 0.0 0.2 100.0 98.4 6,927 20-24 78.1 17.4 1.5 2.5 0.0 0.4 100.0 97.1 6,305 25-29 71.6 22.0 2.5 3.4 0.0 0.5 100.0 96.1 6,959 30-34 62.5 29.0 3.9 4.0 0.0 0.6 100.0 95.3 6,876 35-39 55.1 32.2 5.8 5.9 0.2 0.9 100.0 93.1 6,882 40-44 47.0 33.8 7.4 10.5 0.6 0.7 100.0 88.2 6,252 45-49 34.8 29.6 12.2 20.7 1.7 1.0 100.0 76.6 5,407 Residence Urban 75.2 18.2 2.5 3.4 0.2 0.5 100.0 95.9 23,805 Rural 50.9 31.2 6.9 9.8 0.4 0.8 100.0 89.0 21,802 Wealth quintile Lowest 37.2 35.5 9.1 17.0 0.5 0.7 100.0 81.8 7,767 Second 51.1 32.0 6.4 9.3 0.5 0.7 100.0 89.5 8,784 Middle 62.2 27.7 4.4 4.8 0.3 0.7 100.0 94.3 9,243 Fourth 72.5 20.8 3.0 2.7 0.3 0.7 100.0 96.3 9,743 Highest 87.3 9.9 1.4 1.0 0.1 0.3 100.0 98.6 10,071 Total 63.5 24.4 4.6 6.5 0.3 0.6 100.0 92.6 45,607 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Table 3.3.2 Literacy: Men Percent distribution of currently married men age 15-54 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Indonesia 2012 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Missing Age 15-24 72.0 19.9 3.9 4.0 0.1 100.0 95.8 373 15-19 (53.3) (29.6) (16.5) (0.6) (0.0) 100.0 (99.4) 28 20-24 73.5 19.1 2.9 4.3 0.2 100.0 95.5 345 25-29 71.0 23.9 2.2 2.6 0.3 100.0 97.1 1,127 30-34 68.8 25.1 2.7 2.9 0.5 100.0 96.6 1,674 35-39 64.0 28.3 3.6 3.5 0.6 100.0 95.9 1,775 40-44 64.1 27.4 3.6 4.0 0.9 100.0 95.1 1,693 45-49 48.7 31.5 6.3 11.7 1.8 100.0 86.5 1,371 50-54 34.2 38.6 9.3 14.8 3.1 100.0 82.1 1,292 Residence Urban 73.1 20.1 2.6 3.6 0.6 100.0 95.8 4,739 Rural 45.7 37.4 6.4 8.8 1.7 100.0 89.5 4,567 Wealth quintile Lowest 35.1 40.1 8.7 14.1 2.0 100.0 83.9 1,596 Second 43.1 40.1 6.5 9.2 1.1 100.0 89.7 1,866 Middle 55.7 33.1 4.7 5.2 1.3 100.0 93.5 2,008 Fourth 72.0 21.5 2.6 3.0 0.8 100.0 96.2 1,962 Highest 88.3 10.1 0.5 0.8 0.3 100.0 98.9 1,875 Total 59.7 28.6 4.5 6.2 1.1 100.0 92.7 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 28 • Characteristics of Respondents 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 2012 IDHS, exposure to media was assessed by asking how often a respondent reads a newspaper, watched television, or listened to the radio. Table 3.4.1 shows that television is the most popular mass media for women (86 percent). Exposure to radio and print media is much lower (19 percent and 13 percent, respectively). Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Indonesia 2012 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 16.6 86.8 26.9 6.8 9.4 6,927 20-24 14.9 86.4 22.9 6.0 10.9 6,305 25-29 12.1 86.5 18.6 4.1 11.5 6,959 30-34 13.4 87.7 17.6 4.6 10.3 6,876 35-39 13.4 85.8 17.3 4.9 12.1 6,882 40-44 11.8 84.5 16.0 3.9 13.5 6,252 45-49 10.0 82.6 15.2 3.2 15.5 5,407 Residence Urban 18.7 89.8 22.0 6.9 7.6 23,805 Rural 7.3 81.6 16.5 2.6 16.2 21,802 Education No education 0.3 57.8 8.2 0.2 41.2 1,500 Some primary 1.8 78.0 11.1 0.7 20.3 4,870 Completed primary 4.1 83.1 15.9 1.6 14.8 10,254 Some secondary 10.4 88.2 20.9 4.0 9.4 12,753 Completed secondary 17.8 90.9 23.1 7.1 6.6 10,677 More than secondary 41.6 90.6 25.1 13.2 5.7 5,552 Wealth quintile Lowest 3.9 64.6 13.6 1.4 31.6 7,767 Second 6.9 85.5 17.0 2.3 12.2 8,784 Middle 9.2 89.9 19.7 3.3 7.9 9,243 Fourth 15.4 92.1 20.6 5.6 6.2 9,743 Highest 27.7 93.0 24.3 10.4 4.9 10,071 Total 13.3 85.9 19.3 4.9 11.7 45,607 Table 3.4.2 shows that television is the most popular mass media for men (88 percent). Similar percentages of men are exposed to radio and print media. Characteristics of Respondents • 29 Table 3.4.2 Exposure to mass media: Men Percentage of currently married men age 15-54 who are exposed to specific media on a weekly basis, by background characteristics, Indonesia 2012 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 (25.7) (84.8) (14.2) (3.0) (12.0) 28 20-24 18.7 86.8 28.4 7.2 10.0 345 25-29 19.6 87.3 22.3 6.6 9.9 1,127 30-34 23.5 89.1 21.2 8.0 8.7 1,674 35-39 24.1 88.8 22.1 8.1 8.8 1,775 40-44 24.8 89.6 18.5 7.2 8.3 1,693 45-49 20.8 85.8 23.4 7.9 12.4 1,371 50-54 18.7 88.0 21.1 7.1 11.0 1,292 Residence Urban 31.5 92.5 23.8 10.7 5.3 4,739 Rural 12.4 83.7 19.2 4.3 14.4 4,567 Education No education 3.0 61.6 13.0 1.6 36.5 265 Some primary 3.2 79.9 15.6 1.4 19.0 1,371 Completed primary 8.9 85.9 20.6 3.7 11.5 2,118 Some secondary 14.5 90.5 22.6 5.6 7.7 1,979 Completed secondary 32.6 93.0 22.7 10.6 5.0 2,453 More than secondary 65.6 94.1 28.2 20.3 2.8 1,119 Wealth quintile Lowest 7.0 68.8 15.8 2.5 27.7 1,596 Second 9.3 86.9 16.7 2.1 11.0 1,866 Middle 17.1 92.7 21.7 6.2 6.3 2,008 Fourth 25.7 94.7 24.3 9.3 3.6 1,962 Highest 49.5 94.3 28.3 16.8 3.4 1,875 Total 22.1 88.2 21.6 7.5 9.7 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. Women and men living in urban areas are more likely to have access to all three media than their rural counterparts. The findings also show that education and wealth status are strongly associated with exposure to mass media. For instance, 13 percent of women and 20 percent of men with secondary or higher education are likely to have access to all three types of media, compared with 1 percent and 1 percent with some primary education. In general, men have greater exposure to mass media than women. This differential applies to all population groups. Appendix Tables A-3.4.1 and A-3.4.2 show the variation in media exposure among women and currently married men by province. 3.5 EMPLOYMENT 3.5.1 Employment status Respondents in the 2012 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, have you done any work in the last seven days?” 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 30 • Characteristics of Respondents things, have a small business, or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?” A further probe identified women who usually were working but had been absent from work during the week before the IDHS interview because of illness or other reasons. Women who answered “no” to these questions were asked, “Although you did not work in the last seven days, do you have any job or bussiness from which you were absent for leave, illness, vacation, maternity leave, or any other such reason? 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 55 percent of women are currently employed, 6 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. Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Indonesia 2012 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 29.0 5.7 65.3 100.0 6,927 20-24 48.6 10.1 41.3 100.0 6,305 25-29 54.2 7.6 38.2 100.0 6,959 30-34 58.7 5.0 36.2 100.0 6,876 35-39 62.1 4.9 33.0 100.0 6,882 40-44 69.2 3.3 27.4 100.0 6,252 45-49 69.8 3.2 27.0 100.0 5,407 Marital status Never married 44.0 5.5 50.5 100.0 9,919 Married or living together 57.4 5.9 36.7 100.0 33,465 Divorced/separated/ widowed 75.5 5.2 19.3 100.0 2,223 Number of living children 0 46.8 7.4 45.8 100.0 12,896 1-2 57.0 5.6 37.4 100.0 21,465 3-4 61.3 4.4 34.3 100.0 9,053 5+ 65.9 3.2 30.8 100.0 2,193 Residence Urban 54.5 5.4 40.1 100.0 23,805 Rural 56.4 6.1 37.5 100.0 21,802 Education No education 74.9 4.4 20.6 100.0 1,500 Some primary 63.9 5.8 30.3 100.0 4,870 Completed primary 58.0 5.7 36.2 100.0 10,254 Some secondary 44.0 5.9 50.1 100.0 12,753 Completed secondary 53.7 6.2 40.1 100.0 10,677 More than secondary 67.2 4.9 27.9 100.0 5,552 Wealth quintile Lowest 59.1 6.2 34.6 100.0 7,767 Second 52.9 6.7 40.3 100.0 8,784 Middle 51.8 6.7 41.5 100.0 9,243 Fourth 54.7 5.5 39.8 100.0 9,743 Highest 58.6 3.9 37.5 100.0 10,071 Total 55.4 5.8 38.8 100.0 45,607 Note: Total may not sum to 100 percent because a very small percentage of women have missing information on employment. 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. Characteristics of Respondents • 31 Figure 3.1 Women’s employment status in the past 12 months Table 3.5.2 shows that almost all currently married men are currently employed (98 percent), 1 percent each was employed at some time in the past 12 months or was not employed at all during the past 12 months. There are small variations across subgroups of men. Appendix Tables A-3.5.1 and A-3.5.2 show the percent distribution of women and currently married men by employment status and by province. Currently employed 55% Not currently employed, but worked in last 12 months 6% Did not work in last 12 months 39% IDHS 2012 32 • Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of currently married men age 15-54 by employment status, according to background characteristics, Indonesia 2012 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 (97.0) (3.0) (0.0) 100.0 28 20-24 97.0 1.8 1.2 100.0 345 25-29 98.0 1.5 0.5 100.0 1,127 30-34 99.5 0.4 0.1 100.0 1,674 35-39 98.1 1.0 0.9 100.0 1,775 40-44 98.9 0.7 0.4 100.0 1,693 45-49 98.8 0.6 0.6 100.0 1,371 50-54 96.7 1.3 2.0 100.0 1,292 Number of living children 0 98.0 0.9 1.1 100.0 738 1-2 98.4 1.0 0.6 100.0 5,517 3-4 98.3 0.7 1.0 100.0 2,453 5+ 98.0 1.0 1.0 100.0 598 Residence Urban 98.2 0.9 0.9 100.0 4,739 Rural 98.5 0.9 0.6 100.0 4,567 Education No education 97.2 0.0 2.8 100.0 265 Some primary 99.0 0.7 0.3 100.0 1,371 Completed primary 97.7 1.3 1.0 100.0 2,118 Some secondary 97.8 1.3 1.0 100.0 1,979 Completed secondary 98.6 0.8 0.6 100.0 2,453 More than secondary 99.4 0.4 0.2 100.0 1,119 Wealth quintile Lowest 97.4 1.4 1.2 100.0 1,596 Second 98.5 1.1 0.5 100.0 1,866 Middle 98.2 0.9 0.9 100.0 2,008 Fourth 98.5 0.8 0.7 100.0 1,962 Highest 99.0 0.6 0.5 100.0 1,875 Total 98.3 0.9 0.8 100.0 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 3.5.2 Occupation Table 3.6.1 shows by occupation and background characteristics the percent distribution of women who were employed during the 12 months preceding the survey. The data indicate that 20 percent of women work in agriculture. More than one-third of women (36 percent) are engaged in sales and services and one- quarter are employed in the industrial sector. Respondents’ occupations vary by age. For example, the percentage of women who work in agriculture is lower among younger than older women. 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 clerical, and professional, technical and managerial jobs. Characteristics of Respondents • 33 Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Indonesia 2012 Background characteristic Professional/ technical/ managerial Clerical Sales and services Agriculture Industrial worker Missing Total Number of women Age 15-19 4.4 4.3 49.5 14.9 23.7 3.1 100.0 2,404 20-24 14.1 10.7 33.3 12.7 26.4 2.9 100.0 3,700 25-29 14.5 7.6 32.2 17.1 25.5 3.1 100.0 4,300 30-34 11.7 5.8 35.3 18.7 25.4 3.1 100.0 4,382 35-39 10.0 4.6 35.4 20.9 25.9 3.2 100.0 4,610 40-44 9.5 2.5 36.0 24.3 23.8 3.9 100.0 4,537 45-49 8.5 3.4 33.8 26.8 23.7 3.8 100.0 3,948 Marital status Never married 15.5 11.5 39.7 8.7 21.2 3.4 100.0 4,912 Married or living together 10.0 4.4 34.2 22.5 25.8 3.1 100.0 21,177 Divorced/separated/ widowed 6.9 2.8 42.1 17.1 26.0 5.2 100.0 1,794 Number of living children 0 15.0 10.6 38.5 10.6 22.4 3.0 100.0 6,989 1-2 10.7 4.9 34.7 19.7 26.7 3.3 100.0 13,429 3-4 7.4 2.4 35.9 25.9 24.8 3.6 100.0 5,947 5+ 4.4 0.5 30.3 38.7 22.7 3.4 100.0 1,516 Residence Urban 13.8 8.7 45.5 4.5 23.6 3.9 100.0 14,256 Rural 7.5 2.2 25.4 35.7 26.5 2.7 100.0 13,626 Education No education 0.6 0.1 16.5 47.9 29.9 5.0 100.0 1,190 Some primary 0.6 0.1 28.9 37.6 29.5 3.4 100.0 3,394 Completed primary 0.8 0.3 34.6 28.4 31.5 4.5 100.0 6,540 Some secondary 2.1 1.3 44.9 19.6 28.9 3.2 100.0 6,363 Completed secondary 9.1 10.1 45.4 7.9 24.1 3.3 100.0 6,392 More than secondary 55.1 19.8 18.7 1.4 4.1 1.0 100.0 4,003 Wealth quintile Lowest 2.4 0.7 17.3 46.7 29.6 3.3 100.0 5,075 Second 4.4 2.0 32.3 28.8 28.9 3.6 100.0 5,240 Middle 7.0 3.7 38.3 17.0 30.0 4.0 100.0 5,407 Fourth 13.1 6.6 44.0 8.7 24.4 3.1 100.0 5,864 Highest 23.8 12.9 43.3 3.2 14.2 2.6 100.0 6,296 Total 10.7 5.5 35.7 19.8 25.0 3.3 100.0 27,882 Table 3.6.2 shows that one in four currently-married men who were employed in the 12 months preceding the survey work in agriculture. Like women, men were also frequently employed in sales and services (20 percent) and industrial work (35 percent). The variations across subgroups in men’s occupations are similar to those observed for women. Provincial differentials in occupation are shown in Appendix Tables A-3.6.1 and A-3.6.2. 34 • Characteristics of Respondents Table 3.6.2 Occupation: Men Percent distribution of currently arried men age 15-54 employed in the 12 months preceding the survey by occupation, according to background characteristics, Indonesia 2012 Background characteristic Professional/ technical/ managerial Clerical Sales and services Agriculture Industrial worker Missing Total Number of men Age 15-19 (0.0) (0.0) (6.9) (41.9) (51.2) (0.0) 100.0 28 20-24 3.0 1.3 28.3 24.5 37.5 5.5 100.0 341 25-29 9.4 3.8 18.6 20.3 42.5 5.4 100.0 1,122 30-34 9.5 6.3 21.6 21.6 35.2 5.8 100.0 1,672 35-39 8.4 5.6 20.9 23.6 35.2 6.3 100.0 1,759 40-44 11.6 4.6 18.6 23.3 36.4 5.6 100.0 1,686 45-49 11.4 4.5 18.3 29.0 31.8 5.0 100.0 1,363 50-54 10.1 3.7 18.3 33.0 30.5 4.4 100.0 1,266 Number of living children 0 10.1 3.5 25.8 23.6 31.1 6.0 100.0 730 1-2 10.0 5.5 19.5 22.5 36.9 5.6 100.0 5,485 3-4 10.3 3.9 20.1 27.2 33.4 5.0 100.0 2,429 5+ 5.1 2.4 14.1 40.1 32.9 5.4 100.0 592 Residence Urban 13.6 6.8 27.5 7.8 37.0 7.3 100.0 4,696 Rural 5.8 2.5 12.0 42.7 33.5 3.5 100.0 4,540 Education No education 0.8 3.2 8.4 51.6 31.9 4.2 100.0 258 Some primary 0.4 0.0 12.1 42.6 39.9 5.0 100.0 1,366 Completed primary 1.4 0.6 17.3 33.9 41.7 5.1 100.0 2,097 Some secondary 3.0 1.4 24.0 25.9 39.4 6.3 100.0 1,960 Completed secondary 9.6 8.5 26.1 13.2 35.3 7.3 100.0 2,438 More than secondary 51.1 16.2 15.6 4.4 11.1 1.6 100.0 1,117 Wealth quintile Lowest 1.6 0.7 7.9 52.0 34.0 3.9 100.0 1,576 Second 2.8 2.1 16.5 34.8 37.4 6.4 100.0 1,857 Middle 4.8 2.8 22.9 21.0 44.3 4.2 100.0 1,989 Fourth 10.8 6.9 25.4 14.9 34.8 7.1 100.0 1,948 Highest 27.8 10.5 24.1 7.0 25.1 5.6 100.0 1,866 Total 9.8 4.7 19.8 25.0 35.3 5.5 100.0 9,236 Note: Figures in parentheses are based on 25-49 unweighted cases. 3.5.3 Type of employment Table 3.7 shows the percent distribution of 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). Seventy-two percent of women received their earnings in cash; 3 percent received payment in cash and in kind; and 24 percent received no payment. The majority of women who work in agriculture (61 percent) receive no payment, while 85 percent of women engaged in nonagricultural professions reported receiving cash payment. Two in three women who work in the agricultural sector are employed by a family member, while 57 percent of women who work in the nonagricultural sector are employed by a non-family member and 26 percent are self-employed. Six in 10 women who work in agricultural jobs work all year, compared with 88 percent of women in nonagricultural jobs. Thirty-two percent of women in the agricultural sector work seasonally. Characteristics of Respondents • 35 Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Indonesia 2012 Employment characteristic Agricultural work Nonagricultural work Missing Total Type of earnings Cash only 30.7 81.9 81.6 71.8 Cash and in-kind 3.7 2.8 5.2 3.0 In-kind only 4.2 0.7 1.5 1.4 Not paid 61.3 14.5 11.3 23.6 Missing 0.1 0.2 0.4 0.2 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 67.2 16.7 12.0 26.5 Employed by nonfamily member 18.4 57.3 68.9 50.0 Self-employed 14.4 25.9 18.7 23.4 Missing 0.1 0.1 0.4 0.1 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 62.5 88.0 78.7 82.7 Seasonal 31.7 7.4 14.5 12.5 Occasional 5.5 4.3 6.5 4.6 Missing 0.3 0.2 0.4 0.2 Total 100.0 100.0 100.0 100.0 Number of women employed during the last 12 months 5,508 21,451 923 27,882 Note: Total includes women with missing information on type of employment who are not shown separately. 3.6 HEALTH INSURANCE COVERAGE Access to health care improves when individuals are covered by health insurance. The 2012 IDHS collected information on health insurance. Tables 3.8.1 and 3.8.2 show the information on health insurance coverage by selected background characteristics. Respondents may have reported having more than one type of health insurance, so the percentages reporting specific types of coverage and the percentage with no coverage may sum to more than 100 percent. Table 3.8.1 shows that more than six in ten women do not have any health insurance (63 percent). Twenty-six percent of women have insurance through social security (local government), while 7 percent have group insurance through their employer; 3 percent are covered by privately-purchased insurance, and 3 percent are covered by other insurance. There are variations in health insurance coverage. As expected, women in rural areas are more likely not to have health insurance coverage than urban women (68 percent and 59 percent, respectively). Women’s education is associated with the likelihood of having health insurance coverage. Women with no education are much less likely to have no health insurance (69 percent) than those with more than secondary education (41 percent). The findings also show that the wealth quintile is strongly associated with the proportions covered in employer-based insurance other than social security and privately-purchased commercial insurance. For instance, 13 percent of women in the highest wealth quintile are covered by other employer-based insurance compared with 1 percent of women in the lowest wealth quintile. Nine percent of women in the highest quintile are covered by privately-purchased commercial insurance compared with less than 1 percent of women in the lowest quintile. 36 • Characteristics of Respondents Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Indonesia 2012 Background characteristic Social security Other employer- based insurance Privately- purchased commercial insurance Other None Number of women Age 15-19 25.8 3.5 1.7 2.2 67.3 6,927 20-24 21.0 9.5 2.7 2.3 65.6 6,305 25-29 21.2 7.9 2.9 2.7 66.2 6,959 30-34 21.9 9.2 4.1 2.8 63.4 6,876 35-39 28.5 8.3 3.6 3.2 58.0 6,882 40-44 29.3 5.4 2.9 2.5 60.8 6,252 45-49 34.1 4.1 1.9 2.4 58.6 5,407 Residence Urban 24.6 10.7 4.9 2.9 58.6 23,805 Rural 26.9 2.8 0.6 2.3 67.8 21,802 Education No education 29.2 0.6 0.1 1.7 68.7 1,500 Some primary 30.1 1.4 0.3 1.9 66.6 4,870 Completed primary 26.3 2.5 0.5 1.8 69.2 10,254 Some secondary 23.6 5.3 1.4 2.5 67.6 12,753 Completed secondary 20.1 13.7 3.8 3.1 60.5 10,677 More than secondary 35.6 12.3 11.7 4.1 41.0 5,552 Wealth quintile Lowest 35.1 1.1 0.3 2.1 61.8 7,767 Second 29.1 2.9 0.4 2.3 65.5 8,784 Middle 23.5 5.3 0.9 2.4 68.3 9,243 Fourth 19.5 10.1 2.6 2.6 66.1 9,743 Highest 23.5 13.3 9.0 3.3 53.9 10,071 Total 25.7 6.9 2.9 2.6 63.0 45,607 Provincial differentials in health insurance coverage are shown in Appendix Tables A-3.7.1 and A-3.7.2. Table 3.8.2 shows that seven in ten men do not have any health insurance (69 percent). Eighteen percent of men have insurance through social security, 9 percent have employer-based commercial insurance, 4 percent are covered by privately-purchased commercial insurance, and 3 percent are covered by other types of insurance. Men’s education is strongly associated with the likelihood of having health insurance coverage. Urban men are less likely than rural men to have no health insurance (66 percent and 72 percent, respectively). As in the case of women, men’s wealth status is strongly associated with having employer-based insurance or privately-purchased commercial insurance. Provincial differentials in health insurance coverage are shown in Appendix Tables A-3.7.1 and A-3.7.2. Characteristics of Respondents • 37 Table 3.8.2 Health insurance coverage: Men Percentage of currently married men age 15-54 with specific types of health insurance coverage, according to background characteristics, Indonesia 2012 Background characteristic Social security Other employer- based insurance Privately- purchased commercial insurance Other None Number of men Age 15-19 (18.1) (0.0) (0.0) (8.8) (73.0) 28 20-24 16.3 6.8 3.8 3.0 72.9 345 25-29 14.3 9.4 2.1 2.2 74.3 1,127 30-34 15.3 10.1 4.2 2.4 69.0 1,674 35-39 17.5 10.4 5.7 2.7 65.6 1,775 40-44 20.2 11.4 4.5 2.4 64.4 1,693 45-49 20.1 6.8 3.3 3.0 68.4 1,371 50-54 19.7 3.9 2.8 1.6 72.8 1,292 Residence Urban 14.6 13.5 6.7 2.4 65.5 4,739 Rural 21.2 3.9 1.0 2.5 72.1 4,567 Education No education 24.0 0.2 0.1 2.5 73.2 265 Some primary 25.2 2.4 0.1 1.9 70.7 1,371 Completed primary 25.5 2.4 0.7 2.2 69.5 2,118 Some secondary 20.9 5.0 2.1 2.7 70.2 1,979 Completed secondary 10.7 18.3 5.4 2.5 66.2 2,453 More than secondary 2.9 16.7 15.6 3.0 66.9 1,119 Wealth quintile Lowest 34.3 1.3 0.2 3.1 61.5 1,596 Second 26.5 3.9 0.8 2.1 67.3 1,866 Middle 17.5 7.2 1.0 2.5 73.2 2,008 Fourth 11.1 12.2 3.7 2.1 72.4 1,962 Highest 2.7 18.2 13.6 2.7 67.7 1,875 Total 17.8 8.8 3.9 2.5 68.8 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 3.7 USE OF TOBACCO 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 2012 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 have smoked in the past 24 hours. Tables 3.9.1 and 3.9.2 show the percentage of women who smoke cigarettes or use other tobacco products and the percent distribution of cigarette smokers by the number of cigarettes smoked in the preceding 24 hours, according to background characteristics and maternity status. When interpreting the data on tobacco use, it is important to recognize that some respondents may, out of embarrassment, under-report tobacco use. 38 • Characteristics of Respondents Table 3.9.1 shows that 3 percent of women smoke tobacco. Older women are more likely than younger women to smoke, especially cigarettes. Two percent of breastfeeding women smoke, as do 1 percent of pregnant women. Women with less education are more likely to use tobacco than women with more education. Among women who smoke cigarettes, 18 percent say that they smoked 10 or more cigarettes in the past 24 hours, 15 percent had 6 to 9 cigarettes, 22 percent smoked 3 to 5 cigarettes in the past 24 hours, and 26 percent had 1 or 2 cigarettes (data not shown). Table 3.9.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Indonesia 2012 Background characteristic Uses tobacco Does not use tobacco Number of women Cigarettes Other tobacco Age 15-19 0.9 0.2 98.9 6,927 20-24 1.5 0.3 98.3 6,305 25-29 2.0 0.4 97.6 6,959 30-34 2.2 0.4 97.5 6,876 35-39 2.7 0.6 96.8 6,882 40-44 3.2 0.6 96.4 6,252 45-49 4.5 0.9 94.9 5,407 Maternity status Pregnant 0.7 0.3 99.0 1,950 Breastfeeding (not pregnant) 1.5 0.4 98.2 6,340 Neither 2.6 0.5 97.0 37,317 Residence Urban 2.5 0.2 97.4 23,805 Rural 2.2 0.8 97.1 21,802 Education No education 8.0 2.5 90.3 1,500 Some primary 3.3 0.9 96.0 4,870 Completed primary 2.1 0.5 97.5 10,254 Some secondary 2.2 0.4 97.5 12,753 Completed secondary 2.0 0.3 97.8 10,677 More than secondary 1.5 0.1 98.4 5,552 Wealth quintile Lowest 3.7 1.5 95.1 7,767 Second 2.4 0.5 97.2 8,784 Middle 1.9 0.4 97.9 9,243 Fourth 2.3 0.1 97.6 9,743 Highest 1.7 0.1 98.2 10,071 Total 2.3 0.5 97.3 45,607 Characteristics of Respondents • 39 Table 3.9.2 shows that 72 percent of currently married men smoke tobacco. Young men are more likely than older men to smoke. Use of tobacco is inversely related to the man’s education and wealth. Men with less education are more likely to use tobacco than those with more education. Among men who smoke cigarettes, 69 percent smoked 10 or more cigarettes in the past 24 hours, 15 percent smoked 6 to 9 cigarettes, and 10 percent smoked 3 to5 cigarettes. Appendix Tables A.3.8.1 and Table A.3.8.2 present the differential in the years of tobacco use by women and men, according to province. Table 3.9.2 Use of tobacco: Men Percentage of currently married men age 15-54 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Indonesia 2012 Background characteristic Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Total Number of cigarette smokers Cigarettes Pipe Other tobacco 0 1-2 3-5 6-9 10+ Don't know/ missing Age 15-19 (89.7) (0.0) (0.6) (9.6) 28 (1.8) (0.0) (6.3) (37.9) (54.0) (0.0) 100.0 25 20-24 79.0 0.0 1.9 20.6 345 0.1 3.5 13.0 18.3 65.2 0.0 100.0 272 25-29 76.8 0.1 1.3 23.1 1,127 1.2 4.3 8.3 19.2 66.9 0.1 100.0 866 30-34 72.9 0.3 1.7 26.8 1,674 0.3 2.7 11.5 15.9 68.9 0.6 100.0 1,221 35-39 72.6 0.2 1.2 27.3 1,775 0.5 3.7 10.2 14.5 71.0 0.1 100.0 1,288 40-44 68.5 0.0 0.9 31.4 1,693 1.2 6.6 11.5 11.5 69.2 0.1 100.0 1,159 45-49 69.1 0.0 2.8 30.6 1,371 1.0 5.2 8.4 17.2 67.7 0.6 100.0 948 50-54 71.9 0.1 2.0 27.6 1,292 1.1 4.6 8.7 13.1 72.3 0.1 100.0 928 Residence Urban 68.8 0.2 1.0 31.2 4,739 0.6 4.6 10.0 16.9 67.6 0.3 100.0 3,261 Rural 75.5 0.1 2.3 24.0 4,567 1.0 4.3 10.1 13.8 70.7 0.2 100.0 3,447 Education No education 72.3 0.2 3.4 27.1 265 0.1 5.9 12.2 9.8 71.6 0.3 100.0 192 Some primary 78.1 0.0 3.2 21.3 1,371 0.2 4.0 8.6 15.7 70.7 0.8 100.0 1,070 Completed primary 78.4 0.1 2.1 21.2 2,118 0.9 4.6 9.2 16.1 69.0 0.2 100.0 1,660 Some secondary 77.8 0.0 0.9 22.1 1,979 1.0 3.7 10.6 15.0 69.6 0.0 100.0 1,539 Completed secondary 68.6 0.3 1.4 31.3 2,453 0.7 5.3 10.6 16.4 66.8 0.2 100.0 1,684 More than secondary 50.3 0.0 0.1 49.7 1,119 1.4 3.7 11.5 11.3 72.0 0.1 100.0 563 Wealth quintile Lowest 80.5 0.2 4.1 18.6 1,596 0.8 4.7 12.2 12.6 69.6 0.2 100.0 1,285 Second 78.8 0.0 2.0 21.0 1,866 0.5 4.1 10.4 16.7 68.2 0.0 100.0 1,469 Middle 76.5 0.0 1.5 23.3 2,008 1.3 4.6 7.7 16.9 69.3 0.3 100.0 1,535 Fourth 68.0 0.4 0.5 32.0 1,962 0.4 4.4 9.4 16.2 69.1 0.5 100.0 1,335 Highest 57.8 0.0 0.4 42.1 1,875 1.0 4.3 11.4 13.1 70.1 0.1 100.0 1,084 Total 72.1 0.1 1.6 27.7 9,306 0.8 4.4 10.1 15.3 69.2 0.2 100.0 6,708 Note: Figures in parentheses are based on 25-49 unweighted cases. Marriage and Sexual Activity • 41 MARRIAGE AND SEXUAL ACTIVITY 4 his chapter discusses key factors other than contraception that affect a woman’s risk of becoming pregnant. These factors include marriage, sexual activity, and polygyny. Marriage is a primary indicator of women’s exposure to the risk of pregnancy. Populations in which age at marriage is low tend to be those with early childbearing and high fertility. In addition, this chapter includes information on more direct measures of the beginning of exposure to pregnancy and level of exposure, for example, age at first sexual intercourse and frequency of recent sexual intercourse. All women age 15-49 in the selected households were interviewed with the 2012 Indonesia Demographic and Health Survey (IDHS) Woman’s Questionnaire. This is different from previous IDHS surveys, which interviewed only ever-married women age 15-49. In the 2012 IDHS, two new categories were also added to the question on marital status: living together and separated. 4.1 CURRENT MARITAL STATUS The percent distribution of women age 15-49 by current marital status and age is shown in Table 4.1. Twenty-two percent of women have never married, 73 percent are currently married, 3 percent are divorced, and 2 percent are widowed. Overall, the two new categories (living together and separated) include very few women, each less than 1 percent of women age 15-49. The percentage of women never married decreases substantially from 87 percent among women age 15-19 to 38 percent among women age 20-24. Thirteen percent of women under 20 are currently in a union (currently married or living together), compared with 60 percent of women age 20-24 and 86 percent of women age 25-29. The highest proportion of women currently in a union is observed in the age group 35-39 (92 percent). T Key Findings • The percentage of currently married increases rapidly among young women; only 13 percent of women under 20 are currently married compared with 60 percent of women age 20-24. • Less than 1 percent of women age 15-49 live together (0.4 percent) or are separated (0.2 percent). • The median age at first marriage increases with level of education: 22.9 years among women age 25-49 who have completed secondary education compared with 17.2 years among women who have no education. • The median age at first sexual intercourse has increased from 19.0 years among women age 45-49 to 21.3 years among women age 25-29. • Fifty-nine percent of women age 15-49 were sexually active within the past four weeks, and 13 percent were sexually active within the past year. • Less than 1 percent of currently married men age 15-54 are in a polygynous union. 42 • Marriage and Sexual Activity The proportion of women who are widowed increases steadily with age, from less than 1 percent of women under age 35 to 4 percent of women age 40-44, and to 8 percent of women age 45-49. The proportion of women who are divorced increases with age, reaching 4 percent for women age 40-44 and age 45-49. Table 4.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Indonesia 2012 Age Never married Married Living together Divorced Separated Widowed Total Percentage of women currently in union Number of women 15-19 86.6 12.6 0.2 0.4 0.1 0.0 100.0 12.8 6,927 20-24 38.2 58.8 0.7 1.8 0.1 0.3 100.0 59.5 6,305 25-29 10.6 85.6 0.6 2.4 0.2 0.6 100.0 86.2 6,959 30-34 4.5 91.1 0.3 3.1 0.2 0.8 100.0 91.4 6,876 35-39 3.2 91.8 0.2 2.9 0.2 1.7 100.0 92.0 6,882 40-44 2.1 88.8 0.3 4.1 0.2 4.4 100.0 89.1 6,252 45-49 2.0 85.5 0.2 4.2 0.3 7.9 100.0 85.7 5,407 Total 21.7 73.0 0.4 2.7 0.2 2.1 100.0 73.4 45,607 4.2 POLYGYNY There are two types of marital unions: monogamous and polygynous. The distinction has social significance and probable fertility implications, although the association between union type and fertility is complex and not well understood. Polygyny, the practice of having more than one wife at the same time, has potential implications for the frequency of sexual intercourse and thus may have an effect on fertility. The extent of polygyny was measured in the 2012 IDHS by asking currently married male respondents whether they had one or more wives or partners with whom they were living. Table 4.2 Number of men's wives Percent distribution of currently married men age 15-54 by number of wives, according to background characteristics, Indonesia 2012 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 (100.0) (0.0) 100.0 28 20-24 98.9 1.1 100.0 345 25-29 99.8 0.2 100.0 1,127 30-34 99.8 0.2 100.0 1,674 35-39 99.3 0.7 100.0 1,775 40-44 98.6 1.4 100.0 1,693 45-49 99.3 0.7 100.0 1,371 50-54 99.0 1.0 100.0 1,292 Residence Urban 99.4 0.6 100.0 4,739 Rural 99.2 0.8 100.0 4,567 Education No education 94.3 5.7 100.0 265 Some primary 99.2 0.8 100.0 1,371 Completed primary 99.4 0.6 100.0 2,118 Some secondary 99.0 1.0 100.0 1,979 Completed secondary 99.7 0.3 100.0 2,453 More than secondary 99.8 0.2 100.0 1,119 Wealth quintile Lowest 98.9 1.1 100.0 1,596 Second 98.6 1.4 100.0 1,866 Middle 99.7 0.3 100.0 2,008 Fourth 99.6 0.4 100.0 1,962 Highest 99.4 0.6 100.0 1,875 Total 99.3 0.7 100.0 9,306 Marriage and Sexual Activity • 43 Table 4.2 shows the percentage distribution of currently married men age 15-54 by the number of wives according to background characteristics. Overall, less than 1 percent of married men in Indonesia are in a polygynous union, i.e., they have two or more wives. There is no variation in the extent of polygyny by background characteristics except by education. The proportion of currently married men in a polygynous union for men with no education is 6 percent compared with less than 1 percent for men with more than secondary education. The distribution of currently married men age 15-54 by number of wives by province is shown in Appendix Table A-4.1. 4.3 MEDIAN AGE AT FIRST MARRIAGE Whether or not marriage coincides with the 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 4.3 shows the median age at first marriage for all women age 20-49, all women age 25-49, ever- married women age 20-49, ever-married women age 25-49, and currently married men age 25-54, according to background characteristics. 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. Table 4.3 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, median age at first marriage among ever-married women age 20-49 and age 25-49, and median age at first marriage among currently married men age 20-54 and 25-54, according to background characteristics, Indonesia 2012 Background characteristic Women age Ever-married women age Married men age 25-54 20-49 25-49 20-49 25-49 Residence Urban a 21.5 a 21.2 a Rural 19.3 19.1 19.0 19.0 23.4 Education No education 17.3 17.2 17.1 17.0 21.8 Some primary 17.5 17.4 17.4 17.3 21.9 Completed primary 18.4 18.4 18.3 18.3 23.0 Some secondary 19.7 19.7 19.4 19.6 23.8 Completed secondary a 22.9 a 22.6 a Wealth quintile Lowest 19.1 19.1 18.9 18.9 23.4 Second 19.6 19.4 19.2 19.2 23.7 Middle 20.0 19.7 19.5 19.5 23.7 Fourth a 20.6 a 20.4 24.6 Highest a 22.6 a 22.2 a Total a 20.4 19.9 20.1 24.3 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. a = Omitted because less than 50 percent of the respondents began living with their spouse/partners for the first time before reaching the beginning of the age group 44 • Marriage and Sexual Activity The median age at first marriage among all women age 25-49 is 20.4 years, while among ever-married women age 25-49 it is 20.1 years. The median age at first marriage among currently married men age 25-54 is 24.3 years. In general, urban women age 25-49 marry more than two years later than rural women (21.5 years compared with 19.1 years). A positive association is seen between median age at first marriage and level of education. For example, the median age at first marriage among women age 25-49 with completed secondary education is 22.9 years, more than five years later than among women with no education (17.2 years). Also, women in wealthier households marry later than women in poorer households; the median age at first marriage for women age 25-49 in the highest wealth quintile is 22.6 years, compared with 19.1 years for women in the lowest wealth quintile. This pattern is also seen among ever-married women age 25-49. The median age at first marriage for currently married men age 25-54 displays patterns and associations by educational attainment and household wealth similar to those observed for women. Currently married men with some secondary education marry two years later than men with no education (23.8 years compared to 21.8 years). The median age at first marriage for currently married men age 25-54 in the fourth wealth quintile is 24.6 years, compared with 23.4 years for men in the lowest wealth quintile. Variations in median age at first marriage for all women age 20-49, all women age 25-49, ever- married women age 20-49, ever-married women age 25-49, and currently married men age 25-54, according to province, are presented in Appendix Table A-4.2. Figure 4.1 Trends in median age at first marriage of ever-married women age 25-49 17.7 18.1 18.6 19.2 19.8 20.1 1991 IDHS 1994 IDHS 1997 IDHS 2003-2003 IDHS 2007 IDHS 2012 IDHS Median age at first marriage (years) Figure 4.1 shows trends in median age at first marriage among ever-married women age 25-49. The median age at first marriage has increased gradually over time, from 17.7 years in 1991 to 20.1 years in 2012. Marriage and Sexual Activity • 45 4.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is often used as a proxy for first exposure to sexual intercourse and used as a proxy measure for the beginning of exposure to the risk of pregnancy. But these two events may not occur at the same time because some women and men engage in sexual activity before marriage. The 2012 IDHS collected information on the timing of first sexual intercourse for all women and currently married men. Table 4.4 shows the proportion of women age 15-49 and currently married men age 15-54 who had first sexual intercourse by specific ages and the median age at first sexual intercourse for successive age groups. Older women are more likely than younger women to have had their first sexual encounter at an earlier age. Eight percent of women age 25-49 had first sexual intercourse by age 15, while 45 percent had first sexual intercourse by age 20. There has been a substantial change in the age at which women have first sexual intercourse. Fifteen percent of women age 45-49 had first sexual intercourse by age 15, compared with 6 percent of women age 30-34 and 3 percent of women age 20-24. The median age at first sexual intercourse among women age 25-49 (20.6 years) is only marginally higher than the median age at first marriage (20.4 years), suggesting that Indonesian women in general initiate sexual intercourse at the time of their first marriage. Overall, the median age at first sexual intercourse has increased from 19.0 years among women age 45-49 to 21.3 years among women age 25-29. Table 4.4 Age at first sexual intercourse Percentage of women age 15-49 and currently married men age 15-54 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Indonesia 2012 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had sexual intercourse Number Median age at first sexual intercourse 15 18 20 22 25 WOMEN 15-19 1.6 na na na na 86.2 6,927 na 20-24 2.5 16.8 37.4 na na 37.6 6,305 na 25-29 4.3 20.4 38.0 55.0 75.3 10.4 6,959 21.3 30-34 6.3 24.5 41.2 56.9 72.0 4.5 6,876 21.0 35-39 7.1 26.8 43.3 58.8 74.1 3.1 6,882 20.8 40-44 11.1 32.5 48.3 62.2 75.2 2.1 6,252 20.2 45-49 14.9 41.5 57.0 68.7 79.6 1.9 5,407 19.0 20-49 7.4 26.6 43.7 na na 10.0 38,680 na 25-49 8.4 28.5 45.0 59.9 75.1 4.6 32,375 20.6 15-24 2.1 na na na na 63.0 13,232 na CURRENTLY MARRIED MEN 15-19 (21.0) na na na na 0.0 28 na 20-24 1.7 8.6 35.0 na na 0.2 345 na 25-29 1.6 6.6 18.2 36.0 71.4 0.4 1,127 23.3 30-34 0.9 6.7 17.1 32.8 54.9 0.2 1,674 24.4 35-39 1.7 7.4 17.6 32.7 53.0 0.0 1,775 24.4 40-44 1.4 7.5 17.1 33.9 57.9 0.0 1,693 24.0 45-49 1.6 11.1 22.3 37.4 58.2 0.0 1,371 23.5 50-54 1.5 10.7 23.0 42.8 65.2 0.0 1,292 23.1 20-49 1.4 7.8 19.0 na na 0.1 7,986 na 25-49 1.4 7.8 18.3 34.3 58.1 0.1 7,641 23.9 15-24 3.1 na na na na 0.2 373 na 20-54 1.4 8.2 19.6 na na 0.1 9,278 na 25-54 1.4 8.2 19.0 35.5 59.2 0.1 8,933 23.8 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 46 • Marriage and Sexual Activity The data for currently married men are not comparable with data for women, because of the difference in the base population; married men age 15-54 and all women age 15-49. The median age at first sexual intercourse among currently married men age 25-54 is 23.8 years. One percent of currently married men age 25-54 had their first sexual intercourse by age 15 and 19 percent had first sexual intercourse by age 20. As in the case of women, there has been a substantial increase in the age at first sexual intercourse among men. Twenty-three percent of currently-married men age 50-54 had first sexual intercourse by age 20, compared with 18 percent of currently-married men age 25-29. The median age at first sexual intercourse among currently married men age 25-54 (23.8 years) is only marginally lower than the median age at first marriage (24.3 years), suggesting that Indonesian men in general initiate sexual intercourse at the time of their first marriage. 4.5 MEDIAN AGE AT FIRST SEXUAL INTERCOURSE Table 4.5 shows the variation in the median age at first sexual intercourse for all women age 20-49, women age 25-49, ever-married women age 20-49, ever-married women age 25-49, and currently-married men age 25-54 across background characteristics. The variation in the median age at first sexual intercourse among women according to background characteristics is nearly identical to the variation in the median age at first marriage (Table 4.3). Urban woman age 25-49 had first sexual intercourse more than two years later than rural women age 25-49 (21.8 years compared with 19.4 years). The median age at first sexual intercourse for women age 25-49 with completed secondary education is 23.1 years, five years later than the median age for women with no education (17.5 years). The median age at first sexual intercourse increases with wealth status; the median age at first sexual intercourse for women age 25-49 in the highest wealth quintile is three and a half years later than the median age for women in the lowest wealth quantile (22.8 years compared with 19.3 years). This pattern is also seen among ever-married women age 25-49. Table 4.5 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, median age at first sexual intercourse among ever-married women age 20-49 and age 25-49, and median age at first sexual intercourse among currently married men age 20-54 and age 25-54, according to background characteristics, Indonesia 2012 Background characteristic Women age Ever-married women age Currently married men age 25-54 20-49 25-49 20-49 25-49 Residence Urban a 21.8 a 21.4 24.6 Rural 19.5 19.4 19.2 19.2 23.1 Education No education 17.6 17.5 17.3 17.3 21.4 Some primary 17.9 17.8 17.7 17.7 21.5 Completed primary 18.6 18.5 18.4 18.4 22.8 Some secondary 19.8 19.9 19.5 19.7 23.2 Completed secondary a 23.1 a 22.8 a Wealth quintile Lowest 19.3 19.3 19.0 19.1 22.6 Second 19.7 19.6 19.4 19.4 23.2 Middle a 20.0 19.7 19.8 23.3 Fourth a 20.9 a 20.6 24.1 Highest a 22.8 a 22.4 a Total a 20.6 a 20.3 23.8 a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 47 The median age at first sexual intercourse for urban currently married men age 25-54 is 24.6 years, two years later than that for rural men (23.1 years). The median age at first sexual intercourse for currently- married men increases with education. For example, the median age at first intercourse of currently married men with some secondary education is 23.2 years, two years later than among men with no education (21.4 years). Wealth is also related to age at first sexual among married men. The median age at first intercourse for men age 25-54 in the fourth wealth quintile is 24.1 years, one and a half years later than that for men in the lowest wealth quintile (22.6 years). The median age at first sexual intercourse by province is shown in Appendix Table A-4.3. 4.6 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 2012 IDHS, women age 15-49 were asked how long ago their last sexual intercourse occurred. Table 4.6 shows the percent distribution of women age 15-49 by the timing of their last sexual intercourse, according to background characteristics. Overall, 59 percent of women age 15-49 were sexually active in the four weeks preceding the survey. Thirteen percent of women age 15-49 had been sexually active in the 12 months preceding the survey, but not in the past month. Six percent of women age 15- 49 had their most recent sexual intercourse one or more years before the survey. One in every five women (22 percent) had never had sexual intercourse. It is not surprising that the majority of women age 15-19 (86 percent) have never had sexual intercourse. Ten percent of the women age 15-19 had their last sexual intercourse in the past four weeks. This proportion increases sharply by age to 72 percent for women age 25-29 and 77 percent for women age 30-34. Practically all never-married women never had sexual intercourse (99 percent). Eighty percent of women currently in a union were sexually active in the four weeks preceding the survey. Small variations are found in recent sexual activity by marital duration; women who have married for 0-19 years are more likely to be sexually active in the four weeks preceding the survey than women who married for longer periods. Women in rural areas were only slightly more likely to have been sexually active in the past four weeks (61 percent) compared with women in urban areas (57 percent). They were also more likely than urban women to have ever had sexual intercourse. Women with no education were more likely to have been sexually active than educated women; only 5 to 6 percent of women with primary or less education never had sexual intercourse, compared with 24 percent or more women with secondary or higher education. Women using a contraceptive method were more likely to be sexually active than women not using a method. Four in ten women not using contraception had never had sexual intercourse, whereas 36 percent of women using contraception had been sexually active in the four weeks preceding the survey. The 2012 IDHS data suggest that the timing of sexual activity varies somewhat by the type of contraceptive method used. For example, 85 percent of women using injectables and 76 percent of women using female sterilization had had sex in the four weeks prior to the survey, compared with 90 percent and 94 percent of women who use the pill and male condom, respectively. There is no noticeable variation in recent sexual activity by wealth quintile. Appendix Table A-4.4 shows percent distribution of women age 15-49 by timing of last sexual intercourse, according to province. 48 • Marriage and Sexual Activity Table 4.6 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Indonesia 2012 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 10.2 2.6 0.8 0.2 86.2 100.0 6,927 20-24 49.0 10.6 2.4 0.3 37.6 100.0 6,305 25-29 72.0 12.6 4.5 0.5 10.4 100.0 6,959 30-34 76.7 12.7 5.6 0.6 4.5 100.0 6,876 35-39 75.5 14.8 6.1 0.4 3.1 100.0 6,882 40-44 70.3 16.2 10.5 0.9 2.1 100.0 6,252 45-49 58.8 22.0 16.4 0.9 1.9 100.0 5,407 Marital status Never married 0.2 0.5 0.5 0.1 98.7 100.0 9,919 Married or living together 80.1 16.6 2.6 0.7 0.0 100.0 33,465 Divorced/separated/widowed 0.4 9.8 88.2 0.7 0.9 100.0 2,223 Marital duration2 0-4 years 80.7 16.7 1.9 0.5 0.2 100.0 6,362 5-9 years 84.7 12.9 1.8 0.6 0.0 100.0 5,654 10-14 years 85.0 12.3 2.2 0.5 0.0 100.0 5,432 15-19 years 82.2 14.9 2.1 0.8 0.0 100.0 4,731 20-24 years 79.3 17.6 2.2 0.9 0.0 100.0 3,904 25+ years 67.3 26.3 5.3 1.0 0.0 100.0 4,269 Married more than once 77.4 18.8 3.4 0.3 0.0 100.0 3,112 Residence Urban 57.3 10.8 6.0 0.4 25.5 100.0 23,805 Rural 60.6 14.9 6.6 0.6 17.2 100.0 21,802 Education No education 54.5 19.9 18.7 0.8 6.2 100.0 1,500 Some primary 61.1 20.8 12.3 0.8 4.9 100.0 4,870 Completed primary 69.1 16.8 7.8 0.5 5.8 100.0 10,254 Some secondary 51.1 9.8 4.6 0.5 34.0 100.0 12,753 Completed secondary 61.5 10.3 4.2 0.4 23.6 100.0 10,677 More than secondary 51.9 7.9 3.0 0.4 36.8 100.0 5,552 Current contraceptive method3 Female sterilization 76.0 18.3 5.4 0.2 0.0 100.0 1,115 Male sterilization 70.3 24.0 5.7 0.0 0.0 100.0 52 Pill 89.7 9.6 0.3 0.3 0.0 100.0 4,546 IUD 83.4 12.4 3.4 0.8 0.0 100.0 1,353 Injection 85.2 13.2 0.8 0.7 0.0 100.0 10,695 Male condom 93.6 4.9 0.1 1.5 0.0 100.0 591 Withdrawal 87.4 11.9 0.7 0.0 0.0 100.0 782 Not using 36.2 13.0 10.6 0.5 39.6 100.0 24,777 Wealth quintile Lowest 59.5 14.3 9.2 0.6 16.4 100.0 7,767 Second 58.3 15.1 7.2 0.5 18.8 100.0 8,784 Middle 58.9 13.5 6.1 0.6 20.9 100.0 9,243 Fourth 60.8 11.6 4.9 0.4 22.3 100.0 9,743 Highest 57.0 9.9 4.8 0.5 27.7 100.0 10,071 Total 58.9 12.8 6.3 0.5 21.5 100.0 45,607 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 3 Excludes women who use methods not listed Fertility • 49 FERTILITY 5 his chapter begins with a description of the current levels and differentials in fertility and then explores trends in fertility in Indonesia. These topics are of great importance because of their direct relevance to population policies and programs in the country. The chapter also considers cumulative fertility patterns and presents data from the 2012 IDHS on birth intervals, the age at first birth, and the prevalence of teenage pregnancy and motherhood. Information on the age at which women initiate childbearing and the length of the interval between births is important as both may pose increased health risks for a mother and her child. 5.1 ASSESSMENT OF THE 2012 IDHS FERTILITY DATA The fertility measures presented in the chapter are based on the analysis of the birth histories collected from all women age 15-49 interviewed during the survey. To obtain these data, women were first asked a series of questions to determine the total number of live births that occurred in their lifetime. For each live birth, information was collected on the age, sex, and survival status of the child. For dead children, age at death was recorded. The accuracy of fertility data is affected by factors that result in either an undercount of births or a misreporting of birth dates. Underreporting of births affects the estimates of fertility levels, while misreporting of dates of births can distort estimates of fertility trends. If these errors vary with the socioeconomic characteristics of the women, the differentials in fertility will also be affected. Both respondents and interviewers are potential sources of omission and displacement. Interviewed women may underreport births, especially of a child who later died, because they find it painful to talk about the death of a child. Recall errors may be a source of underreporting of births, especially among older mothers, and recall errors also contribute to errors in birth dates. Because certain sections of the questionnaire (e.g., the child health questions) are administered for children born after a certain date, interviewers may fail to record births during that period or displace a child’s birth outside the period to lighten their workload. T Key Findings • The total fertility rate for the three years preceding the survey is 2.6 children per woman. The rate has been stable at this level since the 2002-2003 IDHS. • The total fertility rate in urban areas is slightly lower than in rural areas (2.4 children and 2.8 children respectively). • The peak childbearing years have shifted from the 20-24 to the 25-29 age group. • Younger women are having their first birth much later than older women; the median age at first birth has increased from 20.6 years among women age 45-49 to 22.8 years among women age 25-29. • Ten percent of adolescent women age 15-19 are already mothers or pregnant with their first child. 50 • Fertility Tables D.3 and D.4 include several measures that are useful in assessing the extent to which the birth history data obtained in the 2012 IDHS are subject to omission and displacement. Omission is more difficult than displacement to detect, but one sign of potential omission is a pattern of abnormal sex ratios at birth. The sex ratio, typically expressed as the number of males per 100 females, is expected to be around 103 to 106 at birth. Although there is some fluctuation, the sex ratios at birth for successive calendar-year periods prior to the 2012 IDHS generally fall within or close to the expected range (Table D.4). With respect to the quality of the reporting of birth dates, complete birth dates were obtained for almost all births (98 percent) in the 15 years preceding the survey (Table D.3). Although there is some evidence of displacement of births out of the three- year and five-year periods used in calculating the various fertility measures presented in the chapter (Table D.4), the displacement is not large enough to produce noticeable bias in the fertility measures. Fertility estimates also are affected by the accuracy of the reporting of the women of reproductive ages. Comparison of the age distribution of women in the 2012 IDHS with the distribution reported in the 2010 Indonesia census indicates that the survey may have missed interviewing some unmarried women, especially in the 20-24 and 25-29 age groups. Additional investigation will be needed to confirm the extent of the potential omission of young unmarried women and to assess its effect on the IDHS fertility estimates. However, since young unmarried women are very unlikely to have had many births, the impact of their omission, if significant, will be an overestimate of the fertility rates for these age groups and, thus, of the total fertility rate. 5.2 FERTILITY LEVELS AND DIFFERENTIALS 5.2.1 Fertility Levels Table 5.1 presents age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR) by residence. The rates are calculated for the three-year period preceding the survey, which corresponds to the approximate calendar period June 2009-May 2012. A three- year period was chosen in order to balance the goal of obtaining an estimate of the current fertility situation in Indonesia against the interest in having a sufficient number of births to reduce sampling error. The ASFRs provide the age pattern of fertility, while the TFR refers to the number of live births that a woman would have had if she were subject to the current age-specific rates throughout the reproductive ages (15-49 years). The general fertility rate (GFR) is expressed as the annual number of live births per 1,000 women age 15-44, and the crude birth rate (CBR) provides a measure of the annual number of live births per 1,000 population. The total fertility rate is 2.6 births per woman. The rural fertility rate is 2.8 births per woman, around 17 percent higher than the rate in urban areas (2.4 births). An examination of the urban-rural ASFRs in Figure 5.1 suggests that most of the overall difference in the urban and rural TFRs is because young rural women are bearing children at much higher rates than their urban counterparts. Using the ASFRs in Table 5.3, it is possible to calculate cumulative fertility rates separately for the 15-24 and 25-49 age groups. The results show that rural women are having an average of 1.1 Table 5.1 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 2012 Residence Total Age group Urban Rural 15-19 32 69 48 20-24 121 156 138 25-29 145 141 143 30-34 108 98 103 35-39 59 64 62 40-44 22 20 21 45-49 3 6 4 TFR(15-49) 2.4 2.8 2.6 GFR 82.0 94.0 88.0 CBR 20.1 20.7 20.4 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 preceding the interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Fertility • 51 births before their 25th birthday, substantially above the 0.7 births urban women are having at the same ages. On the other hand, fertility at older ages is virtually identical among urban and rural women. Table 5.1 also shows a GFR of 88 live births per 1,000 women age 15-49 and a crude birth rate of 20 live births per 1,000 population. Figure 5.1 Age-specific fertility rates by residence 0 50 100 150 200 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group Urban Rural Total Births per 1,000 women IDHS 2012 5.2.2 Differentials in Current and Completed Fertility Table 5.2 presents the variation in several fertility measures—the TFR, the percentage of women age 15-49 who are currently pregnant, and the mean number of children ever born to women age 40-49—according to selected background characteristics. The mean number of births to women age 40-49 is an indicator of cumulative fertility, reflecting the fertility performance of older women approaching the end of their reproductive span. If fertility remains stable over time, the TFR and the number of children ever born tend to be very similar. When fertility levels have been falling, the TFR will be substantially lower than the mean number of children ever born. The percentage of pregnant women provides a useful additional measure of current fertility, although it may not capture all early stage pregnancies. Looking at the differences by residence, Table 5.2 shows that the mean number of children ever born among women age 40-49 is higher among rural women (3.4 children) than urban women (3.0). This suggests that the pattern of higher rural than urban fertility described above in the discussion of the TFR has persisted for several decades. 52 • Fertility Table 5.2 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 2012 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 2.4 4.1 3.0 Rural 2.8 4.4 3.4 Education No education 2.8 1.3 3.7 Some primary 3.0 2.9 3.7 Completed primary 2.9 3.9 3.3 Some secondary 2.6 4.0 3.2 Completed secondary 2.7 5.6 2.7 More than secondary 2.4 5.0 2.3 Wealth quintile Lowest 3.2 5.2 3.9 Second 2.7 4.0 3.3 Middle 2.5 4.6 3.3 Fourth 2.4 4.1 3.0 Highest 2.2 3.6 2.7 Total 2.6 4.3 3.2 Note: Total fertility rates are for the period 1-36 months preceding the interview. Although the pattern is not uniform, the TFR generally declines with the woman’s educational level; the TFR among women who have more than secondary education (2.4 births per woman) is around half a birth lower than the rate among women with completed primary or lower education. The woman’s educational level is also negatively related to the completed fertility level; the mean number of children ever born is 3.7 among women age 40-49 with no or only some primary education compared with 2.3 among those with more than secondary education. Similar to education, women’s wealth status is negatively related to both fertility measures. The TFR decreases from 3.2 children among women in the lowest wealth quintile to 2.2 children among women in the highest wealth quintile, and the mean number of children ever born declines from 3.9 among women age 40-49 in the lowest quintile to 2.7 among women in the highest quintile. A comparison of the TFR and the mean number of children ever born among women age 40-49 provides an indication of the magnitude and direction of fertility change in Indonesia over the past several decades. Overall, the comparison suggests that fertility declined modestly; women age 40-49 have had an average of 3.2 children during their lifetime, 0.6 births more than the current TFR. Completed fertility is higher than the TFR in both urban and rural areas as well as in all wealth quintiles. Completed fertility is also higher than the TFR in most education groups, except in the completed secondary and more than secondary categories; the mean number of children ever born among women 40-49 is the same or lower than the current TFR in these categories. This pattern suggests that the fertility level among highly educated women has remained stable for some time. Table 5.2 also presents information on respondents who were pregnant at the time of the survey. Overall, 4 percent of women were pregnant. The proportion pregnant was virtually identical among urban and rural women and declined with the wealth quintile, although the decrease was neither large nor uniform. Surprisingly, the percentage pregnant was slightly higher among women who had completed secondary school or more than among less educated women. In part, this is due to age differences between highly educated and Fertility • 53 less educated women; highly educated women tend to be younger than women in other educational categories and, thus, they are more likely to still be in the family-building stage than other women. Appendix Table A-5.1 and Figure A-5.1 show provincial differentials in fertility. 5.3 FERTILITY TRENDS 5.3.1 Evidence from Retrospective Data Table 5.3 uses information from the birth histories obtained from IDHS respondents to examine trends in age- specific fertility rates for successive five-year periods before the survey. To calculate the rates shown in the table, 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 and, thus, not eligible for interview. Overall, Table 5.3 documents only a fairly modest decline in ASFRs over the 20-year period. Moreover, much of the change in the ASFRs was concentrated during the periods 10-14 years and 15-19 years preceding the survey. For example, cumulative fertility among women age 15-29 remained essentially stable at 1.6 births per woman during the periods 0-4 and 5-9 years before the survey, after falling from a high of 1.8 births in the period 15-19 years before the survey. 5.3.2 Evidence from Comparisons with Previous IDHS Surveys Another way to examine fertility trends is to compare the current TFR with estimates from previous DHS surveys. Table 5.4 and Figure 5.2 shows the TFRs for the six IDHS surveys carried out during the more than 20-year period between 1991 and 2012. The survey results reinforce the conclusion that fertility has declined only relatively modestly over the past two decades in Indonesia, with most of the change occurring between the 1991 and 2002-2003 IDHS surveys. The TFR has remained stationary at 2.6 births per woman since the 2002-2003 IDHS. Table 5.3 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 2012 Mother’s age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 47 51 58 65 20-24 134 130 139 152 25-29 137 139 143 152 30-34 104 114 110 [119] 35-39 62 67 [82] - 40-44 20 [28] - - 45-49 [4] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 54 • Fertility Table 5.4 Trends in current fertility rates Age-specific and total fertility rates (TFRs) among women age 15-49 for the three-year period preceding the survey, IDHS surveys, Indonesia 1991-2012 Mother’s age at birth 1991 IDHS 1994 IDHS 1997 IDHS 2002- 2003 IDHS1 2007 IDHS 2012 IDHS 15-19 67 61 62 51 51 48 20-24 162 147 143 131 135 138 25-29 157 150 149 143 134 143 30-34 117 109 108 99 108 103 35-39 73 68 66 66 65 62 40-44 23 31 24 19 19 21 45-49 7 4 6 4 6 4 TFR 15-49 3.0 2.9 2.8 2.6 2.6 2.6 Note: Total fertility rates are for the period 1-36 months preceding the interview. Age-specific rates are per 1,000 women. 1 The 2002-2003 IDHS did not include Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua provinces. The 1991 IDHS, 1994 IDHS, and 1997 IDHS included East Timor. Source: CBS et al., 1992; CBS et al., 1994; CBS et al., 1998; CBS et al., 2003; CBS et al., 2008 Figure 5.2 Trend in total fertility rate, 1991-2012 3.0 2.9 2.8 2.6 2.6 2.6 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Total Fertility Rate An examination of the changes in the age-specific fertility rates shown in Table 5.4 indicates that the peak childbearing age has shifted over time from the 20-24 to the 25-29 age group. The results in Table 5.4 also indicate that the largest absolute change in fertility occurred in the 20-24 age group; fertility levels in this age group have declined from a high of 162 births per 1,000 at the time of the 1991 IDHS to 138 births per 1,000 in the 2012 IDHS. 5.4 CHILDREN EVER BORN AND LIVING Table 5.5 presents the distribution of all women and currently married women age 15-49 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 Fertility • 55 outcome of lifetime fertility. It reflects the cumulative 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. Table 5.5 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born, and mean number of living children, according to age group, Indonesia 2012 Number of children ever born Total Number of women Mean number of children ever born Mean number of living children Age 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 93.0 6.6 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,927 0.07 0.07 20-24 50.8 40.9 7.2 0.9 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,305 0.59 0.56 25-29 20.0 42.0 28.8 7.1 1.6 0.4 0.1 0.0 0.0 0.0 0.0 100.0 6,959 1.30 1.24 30-34 9.2 24.2 42.3 16.1 5.6 1.9 0.4 0.1 0.1 0.1 0.0 100.0 6,876 1.94 1.84 35-39 6.9 12.4 35.6 26.0 11.2 4.5 1.8 0.9 0.4 0.1 0.1 100.0 6,882 2.51 2.38 40-44 5.0 9.2 29.4 25.5 15.5 7.4 3.9 1.9 1.3 0.4 0.5 100.0 6,252 3.00 2.76 45-49 4.7 7.2 22.0 26.3 16.6 9.0 5.8 3.9 2.0 1.3 1.2 100.0 5,407 3.44 3.08 Total 27.9 20.7 23.8 14.2 6.9 3.1 1.6 0.9 0.5 0.2 0.2 100.0 45,607 1.78 1.66 CURRENTLY MARRIED WOMEN 15-19 48.2 49.4 1.8 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 890 0.55 0.53 20-24 20.3 66.1 11.9 1.4 0.1 0.1 0.0 0.0 0.0 0.0 0.0 100.0 3,754 0.95 0.92 25-29 10.2 46.8 32.6 8.1 1.8 0.4 0.2 0.0 0.0 0.0 0.0 100.0 6,000 1.46 1.40 30-34 4.6 24.5 45.0 17.1 5.9 2.1 0.4 0.1 0.1 0.1 0.0 100.0 6,285 2.05 1.95 35-39 3.6 12.4 37.1 27.1 11.6 4.7 1.8 1.0 0.4 0.1 0.1 100.0 6,331 2.62 2.47 40-44 2.7 8.2 30.5 26.5 16.1 7.7 4.1 2.1 1.4 0.4 0.5 100.0 5,572 3.10 2.85 45-49 2.4 6.7 22.5 27.2 17.3 9.1 5.9 4.2 2.1 1.2 1.3 100.0 4,633 3.55 3.18 Total 7.7 26.4 30.9 18.1 8.7 3.9 2.0 1.1 0.6 0.3 0.3 100.0 33,465 2.27 2.12 Table 5.5 shows that the average woman has given birth to 1.78 children. Out of that number, 1.66 are still alive, indicating that around 7 percent of children ever born to IDHS respondents have died. Reflecting the natural family-building process, the number of children ever born rises directly with age. On average, women in their early twenties have given birth to less than one child, women in their early thirties have around two children, and women in their late forties have more than three children. As expected, the likelihood that at least one of a woman’s children has died increases with the woman’s age. Of the lifetime average 3.4 births to women age 45-49, 10 percent are no longer alive. The mean number of children ever born is higher for currently married women (2.27 children) than for all women (1.78 children). The difference in the mean number of children ever born between all women and currently married women is due the presence of substantial numbers of unmarried women with negligible fertility in the former group, especially at the younger ages. Finally, the parity distribution at older ages provides an indication of the level of primary infertility since voluntary childlessness among married women is not common in Indonesia. Two percent of women age 45-49 have never given birth. 5.5 BIRTH INTERVALS Research has shown that birth intervals of less than 36 months are associated with higher morbidity and mortality risks for the child, with the risks being especially pronounced for intervals of less than 24 months (Rutstein, 2005). Longer birth intervals not only benefit the child but also have been shown to contribute to improved health status of the mother. They allow the mother to recover physically and emotionally before she becomes pregnant again and must face the demands of another pregnancy and birth, 56 • Fertility with the added stressors of breastfeeding and child care. Table 5.6 presents the distribution of second and higher order births in the five years preceding the survey by the number of months since the previous birth, according to background characteristics. The table also presents the median number of months since the last birth. Birth intervals during the period were relatively long, with 75 percent of non-first births taking place at least 36 months after the previous birth. Although the majority of births were appropriately spaced, around one in ten births occurred within 24 months of a prior birth, the period where mortality risks have been shown to be highest. The overall median birth interval is 60.2 months, a substantial increase from the 2007 IDHS, where the median interval was 54.6 months (CBS et al., 2008). The median birth interval increases with age, from 18.9 months for women age 15-19 to 75.4 months for women age 40-49. Table 5.6 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 2012 Background characteristic Months since preceding birth Total Number of non-first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 (34.5) (31.0) (13.0) (19.3) (2.3) (0.0) 100.0 27 18.9 20-29 8.0 8.5 19.2 16.5 14.9 32.9 100.0 3,073 46.2 30-39 2.9 5.2 12.0 11.9 11.3 56.6 100.0 5,874 67.0 40-49 2.1 3.9 12.5 11.3 7.4 62.8 100.0 1,382 75.4 Sex of preceding birth Male 4.4 5.7 14.1 13.6 12.5 49.7 100.0 5,346 59.8 Female 4.4 6.4 14.2 12.9 11.2 50.9 100.0 5,010 60.6 Survival of preceding birth Living 3.4 5.7 13.7 13.3 12.1 51.9 100.0 9,785 61.5 Dead 21.2 13.2 21.8 12.6 8.4 22.8 100.0 570 31.4 Birth order 2-3 4.1 5.2 12.5 12.3 12.0 54.0 100.0 7,854 63.6 4-6 4.8 8.0 17.8 15.0 11.8 42.6 100.0 2,124 52.1 7+ 8.0 13.4 29.1 22.6 10.0 16.9 100.0 377 35.8 Residence Urban 3.8 5.9 13.8 13.8 12.6 50.2 100.0 5,061 60.1 Rural 5.0 6.3 14.6 12.7 11.2 50.4 100.0 5,294 60.3 Education No education 8.6 12.3 19.5 12.7 8.6 38.5 100.0 292 44.6 Some primary 3.7 6.2 13.7 12.8 11.9 51.8 100.0 1,137 61.5 Completed primary 3.1 4.5 11.5 11.0 9.5 60.4 100.0 2,812 72.5 Some secondary 4.4 5.3 13.8 12.2 11.9 52.3 100.0 2,511 61.8 Completed secondary 4.8 6.5 14.0 16.4 14.1 44.2 100.0 2,530 55.2 More than secondary 6.2 9.0 21.6 14.8 13.6 34.8 100.0 1,073 46.7 Wealth quintile Lowest 5.9 9.0 19.8 15.6 11.7 37.9 100.0 2,535 47.5 Second 4.7 5.3 12.1 14.1 11.8 52.0 100.0 1,914 61.3 Middle 4.1 4.5 11.9 12.3 10.6 56.5 100.0 1,967 66.1 Fourth 3.4 4.2 11.4 11.3 12.4 57.4 100.0 1,976 68.4 Highest 3.3 6.5 14.0 12.2 12.8 51.1 100.0 1,963 60.8 Total 4.4 6.1 14.2 13.2 11.9 50.3 100.0 10,355 60.2 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parentheses are based on 25-49 unweighted cases. Fertility • 57 Studies have shown that the death of a preceding child leads to a shorter birth interval than when the preceding child survived. This pattern is evident in the 2012 IDHS results. 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 (61.5 months and 31.4 months, respectively). As expected, the median birth interval also declines with the child’s birth order. Appendix Table A-5.2 shows the variation in median birth intervals across provinces. 5.6 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY Among women who are not using contraception, exposure to the risk of pregnancy in the period after a birth is influenced primarily by two factors: breastfeeding and sexual abstinence. Breastfeeding affects the length of the period of postpartum amenorrhea, i.e., the period between the birth of a child and the resumption of menstruation during which the risk of pregnancy is much reduced. The extent of postpartum protection from conception depends upon the intensity and duration of breastfeeding. Delaying the resumption of sexual relations after a birth also prolongs the period of postpartum protection. A woman is considered insusceptible if she is not exposed to the risk of pregnancy, either because she is amenorrheic or because she is abstaining from sexual intercourse following a birth. Table 5.7 and Figure 5.3 show the percentage of births in the three years preceding the survey for which the mother is postpartum amenorrheic, abstaining, and insusceptible, by the number of months since the birth. The estimates shown in Table 5.7 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 proportions. Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Indonesia 2012 Months since birth Percentage of births for which the mother is: Number of births Amenorrheic Abstaining Insusceptible1 < 2 87.3 90.5 96.5 465 2-3 39.1 40.1 55.6 569 4-5 26.3 19.5 36.9 600 6-7 29.1 19.5 40.3 636 8-9 21.4 9.4 27.4 607 10-11 21.4 14.0 30.9 646 12-13 22.0 11.3 28.2 621 14-15 19.1 10.9 24.5 555 16-17 19.7 11.9 26.9 546 18-19 18.0 9.1 25.0 554 20-21 12.9 7.6 18.3 583 22-23 15.9 8.4 21.3 543 24-25 10.9 8.7 17.7 607 26-27 15.9 7.6 19.3 547 28-29 7.8 7.2 14.5 569 30-31 12.4 4.0 14.8 535 32-33 13.0 6.2 16.3 588 34-35 9.7 4.7 13.8 495 Total 21.8 15.5 28.9 10,265 Median 2.4 2.4 3.8 na Mean 8.4 6.1 10.8 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 58 • Fertility Figure 5.3 Percentage amenorrheic and abstaining by months since birth 0 20 40 60 80 100 Percent Months since birth Amenorrheic Abstaining IDHS 2012 Table 5.7 shows that almost all women (97 percent) are insusceptible to pregnancy during the first two months following childbirth. In general, the proportion of women who are amenorrheic or abstaining decreases as the number of months after delivery increases. The proportion of women who are amenorrheic drops from 87 percent in the first two months after birth to a low of less than 8 percent at 28-29 months. The majority (91 percent) of Indonesia women abstain from sex during the first two months following a birth. The proportion abstaining drops sharply to 40 percent at 2-3 months and then drops to 20 percent at 4-5 months. The period of postpartum amenorrhea is longer than the period of postpartum abstinence and is the major determinant of the length of postpartum insusceptibility to pregnancy. Table 5.7 shows that Indonesian women are amenorrheic for a median of 2.4 months, abstain for a median of 2.4 months, and are insusceptible to pregnancy for a median of 3.8 months. Table 5.8 shows the median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics. In general, the differences in the median duration of postpartum insusceptibility are small. Urban nomen are insusceptible to the risk of pregnancy for one month less than rural women (3.3 and 4.3 months, respectively). Women with less education are insusceptible for a longer period than more educated women; the median duration of insusceptibility is 5.9 months for women with no education, compared with 4.3 months or less among more educated women. Women in the lowest wealth quintile are insusceptible for a longer period (4.9 months) than women in the highest wealth quintile (3.7 months). Fertility • 59 Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility 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 2012 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother’s age 15-29 2.3 2.4 3.6 30-49 2.6 2.3 4.2 Residence Urban 2.3 2.3 3.3 Rural 2.7 2.4 4.3 Education No education 2.4 3.4 5.9 Some primary 3.1 2.9 4.2 Completed primary 2.3 2.3 4.1 Some secondary 2.4 2.4 3.3 Completed secondary 2.3 2.3 3.7 More than secondary 3.3 2.3 4.3 Wealth quintile Lowest 3.4 2.5 4.9 Second 2.5 2.7 3.9 Middle 2.1 2.2 3.5 Fourth 2.2 2.4 3.0 Highest 2.4 2.2 3.7 Total 2.4 2.4 3.8 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 Table A-5.3 shows the differentials in postpartum amenorrhea, abstinence, and insusceptibility by province. 5.7 MENOPAUSE Another factor influencing the risk of pregnancy among women is menopause. Menopause marks the end of a woman’s fertile period. 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 5.9 presents the proportion of women age 30-49 who are identified as menopausal using this definition. As expected, the percentage increases with age, from 11 percent among women age 30-34 to 44 percent among women age 48-49. 5.8 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. Table 5.9 Menopause Percentage of women age 30-49 who are menopausal, by age, Indonesia 2012 Age Percentage menopausal1 Number of women 30-34 11.4 6,876 35-39 13.6 6,882 40-41 14.8 2,580 42-43 17.8 2,610 44-45 22.6 2,190 46-47 32.6 2,187 48-49 44.0 2,092 Total 18.5 25,417 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey 60 • Fertility Table 5.10 shows the percentage of women who have given birth by specific ages and the median age at first birth, by the woman’s current age. The results indicate that women in younger cohorts are much less likely than older women to have given birth for the first time while they were still in their teens. For example, among women age 45-49, 7 percent had their first child by age 15 compared with less than 1 percent of women age 15-19. The proportion having the first birth by age 20 has also fallen sharply from 45 percent among women age 45-49 to 22 percent among women age 20-24. Overall, Table 5.10 shows that the median age at first birth was 20.6 years among women age 45-49 compared with 22.8 years for women age 25-29. Table 5.10 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Indonesia 2012 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.3 na na na na 93.0 6,927 a 20-24 0.6 6.5 22.2 na na 50.8 6,305 a 25-29 1.1 9.8 25.1 43.9 66.9 20.0 6,959 22.8 30-34 2.2 12.6 28.2 47.1 67.6 9.2 6,876 22.3 35-39 2.4 14.0 29.9 47.6 69.1 6.9 6,882 22.3 40-44 5.5 19.5 36.2 52.9 72.0 5.0 6,252 21.6 45-49 7.1 26.2 44.7 61.1 77.9 4.7 5,407 20.6 20-49 3.0 14.4 30.6 na na 16.2 38,680 a 25-49 3.5 15.9 32.2 50.0 70.4 9.5 32,375 22.0 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 5.11 presents differentials in the median age at first birth among women age 25-49. The median age at first birth for all women in the age group is 22.0 years, which is slightly higher than the median age at the time of the 2007 IDHS (21.5 years) and more than one year higher than the median age at first birth at the time of the 1991 IDHS (20.8 years). Urban women start childbearing two years later than their rural counterparts (23 years compared with 21 years). Better-educated women start childbearing at a later age than women with less education. The median age at first birth increases from 19 years for women with no education to 24 for women with completed secondary education. Women in wealthier households tend to begin childbearing at a later age than women in poorer households. The median age for women in the highest wealth quintile is 24.1 years compared with 21 years for women in the lowest wealth quintile. Appendix Table A-5.4 shows the median age at first birth among women age 25-49 by province. 5.9 TEENAGE PREGNANCY AND MOTHERHOOD The issue of adolescent fertility is important for both health and social reasons because of its association with higher morbidity and mortality for both the mother and child. 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 5.11 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Indonesia 2012 Background characteristic Women age 25-49 Residence Urban 23.0 Rural 21.0 Education No education 19.4 Some primary 19.3 Completed primary 20.3 Some secondary 21.3 Completed secondary 24.2 Wealth quintile Lowest 21.0 Second 21.2 Middle 21.4 Fourth 22.2 Highest 24.1 Total 22.0 Fertility • 61 Table 5.12 shows by background characteristics the percentage of women age 15-19 who are mothers or are pregnant with their first child. The 2012 IDHS findings show that 10 percent of adolescents have started childbearing: 7 percent have had a live birth, and 3 percent are currently pregnant with their first child. Since 2007 IDHS, there has been a small increase in the proportion of adolescents who have begun childbearing, from 9 percent to the current level of 10 percent. Table 5.12 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 childbearing, by background characteristics, Indonesia 2012 Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Background characteristic Have had a live birth Are pregnant with first child Age in years 15 0.5 0.7 1.2 1,428 16 2.3 1.8 4.1 1,508 17 5.3 2.0 7.3 1,459 18 10.0 3.1 13.1 1,253 19 18.6 5.5 24.1 1,279 Residence Urban 4.5 1.8 6.3 3,698 Rural 9.8 3.3 13.1 3,229 Education No education 15.6 0.0 15.6 48 Some primary 23.9 5.6 29.5 183 Completed primary 22.3 8.0 30.3 524 Some secondary 6.0 2.1 8.2 4,349 Completed secondary 3.6 2.0 5.6 1,404 More than secondary 0.6 0.3 0.9 419 Wealth quintile Lowest 13.2 3.6 16.7 1,187 Second 10.4 3.3 13.7 1,372 Middle 6.7 3.0 9.8 1,407 Fourth 4.2 2.3 6.6 1,415 Highest 1.9 0.7

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