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 2.6 1,546 Total 7.0 2.5 9.5 6,927 The proportion of teenagers who have started having children increases rapidly with age. While only 1 percent of women age 15 have started childbearing, 24 percent of women age 19 are either mothers or pregnant with their first child. Rural teenagers are more likely than urban teenagers to have started childbearing (13 percent compared with 6 percent). There is an inverse relationship between early childbearing and education. Sixteen percent of teenagers with no education had begun childbearing compared with 1 percent of those with more than secondary education. By wealth status, the proportion of teenagers who have begun childbearing varies from a high of 17 percent among those living in households in the lowest wealth quintile to a low of 3 percent among those in the highest quintile. Appendix Table-A.5.5 presents the prevalence of teenage pregnancy and motherhood by province. Fertility Preferences • 63 FERTILITY PREFERENCES 6 nformation on fertility preferences is of considerable importance to family planning programs as this allows planners to understand women’s and men’s current childbearing desires and also to assess the extent of unwanted and mistimed pregnancies. This chapter first addresses several basic questions about childbearing preferences among women and men in Indonesia. Does the respondent want more children? If so, how long would she/he prefer to wait before the next child? If she/he could start afresh, how many children in all would she/he want? Two further issues are examined. To what extent do unwanted or mistimed pregnancies occur? What effect would the prevention of such pregnancies have on the fertility rates? Bearing in mind that the underlying rationale of most family planning programs is to give couples the freedom and ability to bear the number of children they want and to achieve the spacing of births they prefer, the importance of this chapter is obvious. The inclusion of women who are currently pregnant and men whose wife (wives) may be expecting an additional child complicates the measurement of views on future childbearing. For these respondents, the question on desire for more children was rephrased to refer to their desire for another child after the one that they are expecting. In addition, the question on preferred waiting time before the next birth was rephrased to clarify that the information wanted was the preferred waiting time after the birth of the child currently expected. To take into account the way in which the preference variable was defined for these respondents, the preference results in the tables in this chapter are classified by number of living children, including any current pregnancy. Women and men who are sterilized also required special analytic treatment. The general strategy in this chapter is to classify sterilized women and men as wanting no additional children. Interpretation of data on fertility preferences has always been the subject of controversy. Survey questions have been criticized on the grounds that answers are misleading because: a) they reflect unformed, ephemeral views, which are held with weak intensity and little conviction; and b) they do not take into account the effect of social pressures or the attitudes of other family members, particularly the husband, who may exert a major influence on reproductive decisions. The first objection has greater force in non-contracepting societies where the idea of conscious reproductive choice may still be strange; in societies such as Indonesia with moderate to high levels of contraceptive use, greater interpretive weight can be attached to the findings. The I Key Findings • Fifty-eight percent of currently married women and 53 percent of currently married men who have two living children do not want to have more children. The percentage wanting no more children increases rapidly with the number of living children. • Urban residents consistently want fewer children than their rural counterparts. • The mean ideal number of children among currently married women age 15-49 is 2.7 children while among currently married men age 15-54, it is 2.8 children. • The total wanted fertility rate is two births per woman, 23 percent lower than the actual fertility (2.6 births per woman). 64 • Fertility Preferences second objection is correct in principle. In practice, however, its importance is doubtful; for instance, the evidence from surveys in which both husbands and wives are interviewed suggests that there is no radical difference between the views of the two sexes. 6.1 DESIRE FOR ADDITIONAL CHILDREN Table 6.1 shows the percent distribution of currently married women age 15-49 and currently married men age 15-54 by desire for more children, according to the number of living children. The table allows the potential need for contraceptive services for spacing as well as limiting births to be examined. Until recently, concern for providing appropriate contraceptive methods to couples who wish to have no further children has overshadowed contraception for child spacing purposes. The interest in spacing has been reinforced by recent evidence that: a) short birth intervals are harmful to the welfare of children and mothers and b) large numbers of couples wish to postpone childbearing by using contraception. Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 and currently married men age 15-54 by desire for children, according to number of living children, Indonesia 2012 Number of living children1 Total Desire for children 0 1 2 3 4 5 6+ CURRENTLY MARRIED WOMEN Have another soon2 83.9 22.8 6.8 3.5 2.2 0.8 0.8 14.6 Have another later3 4.3 53.0 18.6 7.7 5.0 2.7 1.4 23.4 Have another, undecided when 5.7 8.9 5.7 2.8 1.9 1.3 1.5 5.5 Undecided 0.8 3.6 6.7 4.0 5.1 4.6 5.4 4.8 Want no more 2.7 10.6 58.2 73.0 73.3 82.2 80.0 46.8 Sterilized4 0.1 0.1 2.3 7.2 10.0 5.9 8.1 3.4 Declared infecund 2.3 0.7 0.8 1.1 1.9 1.5 1.9 1.1 Missing 0.2 0.3 0.8 0.6 0.5 0.9 0.8 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,989 9,444 11,192 6,173 2,609 1,115 943 33,465 CURRENTLY MARRIED MEN5 Have another soon2 76.8 24.0 8.4 5.2 3.1 2.5 2.8 15.1 Have another later3 8.5 54.6 20.1 10.1 6.7 5.4 3.1 24.9 Have another, undecided when 7.9 8.4 6.6 5.2 4.8 3.1 2.0 6.5 Undecided 1.8 3.7 9.8 8.1 5.9 5.3 6.4 6.7 Want no more 0.7 8.5 53.4 68.8 75.1 80.1 77.9 44.4 Sterilized4 0.0 0.0 0.3 1.2 1.3 1.4 3.2 0.6 Declared infecund 3.8 0.5 0.8 1.1 2.1 1.8 3.4 1.2 Missing 0.1 0.1 0.5 0.2 0.3 0.0 0.7 0.3 Total 99.5 99.9 99.7 99.8 99.4 99.6 99.5 99.7 Number 525 2,579 3,030 1,766 793 337 276 9,306 na = Not applicable 1 The number of living children includes the current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization 5 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Figure 6.1, which illustrates the breakdown of desire for children among women, shows that half of married women in Indonesia prefer to limit childbearing, that is, they want no more children or were sterilized. Around one-quarter of married women want to have another child but later (after two or more years); that is, they are potential spacers. Fifteen percent of currently married women want to have another child soon, 6 percent want a child but are undecided when, and 5 percent are uncertain about their childbearing preference. One percent of married women declare themselves unable to become pregnant (infecund). Fertility Preferences • 65 Figure 6.1 Desire for another child Wants no more children 47% Sterilized 3% Declared infecund 1% Have another child soon 15% Have another child later 24% Have another child, undecided when 5% Undecided 5% IDHS 2012 Table 6.1 also presents information on the fertility preferences of the currently married men interviewed in the 2012 IDHS. Although the results are not strictly comparable to the findings for the women because of the differences in the age composition of the female and male respondents (15-49 years for women and 15-54 years for men), the table confirms that a large majority of married men share with women a desire to control childbearing. Forty-five percent of currently married men (including those who had been sterilized) want no more children, and 25 percent want to have another but later. Fifteen percent of currently married men want to have another child soon; 7 percent want a child but are undecided when, and 7 percent are uncertain about whether or not they want another child. The remaining 1 percent declare themselves to be infecund. Finally, Table 6.1 shows how women’s and men’s childbearing preferences vary according to the number of children (including any current pregnancy) they have. As expected, the desire to have no more children increases rapidly with parity. For example, among currently married women age 15-49, the percentage wanting no more children (including those who are sterilized) increases from 11 percent women with one child to 61 percent among those with two children and peaks at 88 percent among women with five or more children. Among married men age 15-54, there is also a rapid rise in the interest in limiting childbearing; the percentage wanting no more children increases from 9 percent among men with one child to 54 percent among men with two children and peaks at 82 percent among men with five children. Among both childless women and men, there is comparatively little interest in delaying a first birth (4 percent and 9 percent, respectively); however, more than half of married women and men with one child and around one-fifth of those with two children say they would like to have another child but later. This may reflect in part the success of the family planning program in building a mindset about planning or spacing the next birth through contraceptive use. 66 • Fertility Preferences Tables 6.2.1 and 6.2.2 present the percentage of currently married women age 15-49 and currently married men age 15-54 who want no more children (including those who are sterilized) for each parity (including the current pregnancy) by selected background characteristics. The tabulations provide information about subgroup variations in the potential demand for fertility control. Table 6.2.1 Desire to limit childbearing: Women Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Indonesia 2012 Background characteristic Number of living children1 Total 0 1 2 3 4 5 6+ Residence Urban 2.2 10.5 63.1 86.2 88.1 92.0 88.0 52.5 Rural 3.2 10.8 57.8 74.2 79.0 85.6 88.2 47.9 Education No education 4.9 36.9 56.7 79.5 73.6 87.5 79.6 63.7 Some primary 16.9 27.8 60.6 76.9 79.8 82.6 89.8 64.4 Completed primary 1.9 13.4 60.0 78.8 82.4 91.3 89.2 53.7 Some secondary 0.3 7.5 60.8 79.4 84.7 89.5 87.8 44.9 Completed secondary 1.4 7.3 62.6 84.1 89.4 91.4 91.9 44.9 More than secondary 1.1 7.6 58.5 85.5 85.5 92.6 81.7 42.3 Wealth quintile Lowest 5.4 9.7 43.5 66.4 72.2 83.9 86.4 44.6 Second 2.2 11.5 59.6 75.0 85.0 86.3 87.1 48.0 Middle 3.1 10.2 60.3 82.9 85.7 92.4 90.7 49.7 Fourth 1.4 8.9 63.4 85.7 85.7 89.8 92.5 50.0 Highest 1.9 13.4 69.3 88.4 90.8 94.7 86.1 57.6 Total 2.7 10.7 60.6 80.3 83.2 88.1 88.1 50.1 Note: Women who have been sterilized are considered to want no more children. 1 The number of living children includes the current pregnancy. Table 6.2.2 Desire to limit childbearing: Men Percentage of currently married men age 15-54 who want no more children, by number of living children, according to background characteristics, Indonesia 2012 Background characteristic Number of living children1 Total 0 1 2 3 4 5 6+ Residence Urban 0.8 9.8 54.9 76.5 81.3 89.2 88.7 47.3 Rural 0.7 7.2 52.2 63.4 71.6 76.0 77.5 42.7 Education No education 7.2 14.7 61.1 70.5 83.5 77.3 69.7 59.0 Some primary 0.0 22.4 57.1 68.6 74.5 79.2 82.2 57.9 Completed primary 1.5 12.2 56.6 67.9 80.8 89.3 78.7 49.2 Some secondary 0.9 7.4 51.0 67.3 67.5 79.4 84.6 39.2 Completed secondary 0.0 4.5 56.4 75.3 76.9 80.0 84.8 40.5 More than secondary 0.8 4.0 42.1 71.1 77.8 65.2 82.3 38.2 Wealth quintile Lowest 1.5 8.2 41.2 58.0 64.1 68.7 74.0 39.6 Second 0.2 9.4 52.2 67.2 82.2 85.2 79.8 44.5 Middle 0.9 5.3 57.9 72.1 76.2 81.7 87.5 45.4 Fourth 0.0 10.0 57.0 74.4 79.5 86.5 87.2 45.6 Highest 1.0 10.0 54.5 76.6 81.0 94.2 93.3 49.2 Total 0.7 8.5 53.7 70.0 76.4 81.5 81.1 45.0 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. 1 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 67 Overall, among both women and men, the percentage wanting no more children is higher in urban areas than in rural areas and increases with the wealth quintile. To some degree, the wealth differential may reflect the modernized thoughts among parents with higher economic status; for these parents raising children may be more often considered a burden or responsibility rather than an asset, for example, in helping to raise family income (Friedman, 1994; McDonald, 2010). Tables 6.2.1 and 6.2.2 also show an unexpected finding; the desire to limit childbearing does not increase with educational level, as might be expected. To some extent, this pattern is due to differences in the age profile of the educational subgroups. Because educational opportunities have increased over time, more highly educated respondents tend to be younger than less educated respondents. Reflecting their younger average age, more highly educated respondents are more concentrated in the early stages of family building and, thus, they are less likely to be interested in limiting childbearing than less educated respondents who have an older age profile. Finally, care has to be taken in interpreting male-female differences in fertility preferences because of the slightly different age ranges of women and men interviewed in the IDHS. However, a comparison of the results in Tables 6.2.1 and 6.2.2 suggests that women are generally more likely to want no more children than their male counterparts, in every subgroup being assessed. This may due to the fact that the burden of childbearing is predominantly borne by women rather than by men (Tshatsinde, 1993; Parawansa, 2001). Appendix Tables A-6.1.1 and A-6.1.2 present differentials in the desire to limit childbearing by province among currently married women age 15-49 and currently married men age 15-54, respectively. 6.2 IDEAL FAMILY SIZE Thus far in this chapter, interest has focused on the respondents’ wishes for the future, implicitly taking into account the number of sons and daughters they already have. Table 6.3 considers information obtained in the survey on respondents’ ideal family size. In ascertaining the total ideal number of children, respondents were required to perform the more difficult task of considering abstractly, and independently of their actual family size, the number of children they would choose if they could start building their family again. There is usually a correlation between actual and ideal number of children. The reason is twofold. First, to the extent that respondents implement their preferences, those who want larger families will tend to achieve larger families. Second, respondents may adjust upward their ideal size of family as the actual number of children increases. It is also possible that respondents with large families, being on average older than those with small families, have larger ideal sizes because of attitudes they acquired 20 to 30 years ago. Despite the likelihood that some rationalization occurs, however, it is common to find that many respondents state ideal sizes lower than their actual number of surviving children. Table 6.3 presents the distribution of ever-married women age 15-49 and currently married men age 15-54 by the ideal number of children, according to the number of living children (including any current pregnancy). It was decided to show the ever-married distribution for women rather than the distribution of all women or currently married women in order to facilitate comparisons with the ideal family size results presented in the reports on prior IDHS surveys. Table 6.3 does include information from the 2012 IDHS on the mean ideal number of children for all women and currently married women; these means do not differ markedly from those reported for ever-married women, indicating that the fertility preferences of unmarried women are similar to those of ever-married women. 68 • Fertility Preferences Table 6.3 Ideal number of children by number of living children Percent distribution of ever-married women age 15-49, all women age 15-49, and currently married men age 15-54 by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to the number of living children, Indonesia 2012 Number of living children1 Total Ideal number of children 0 1 2 3 4 5 6+ EVER-MARRIED WOMEN 0 0.6 0.3 0.4 0.5 0.5 0.6 1.2 0.4 1 5.1 4.4 2.1 1.4 0.8 1.2 0.2 2.6 2 56.1 64.1 59.8 35.8 29.5 21.4 13.0 51.4 3 18.1 17.2 17.7 30.3 11.6 16.6 15.8 19.3 4 9.1 7.3 11.0 14.4 30.2 12.0 18.4 12.2 5 2.1 1.8 2.0 4.2 5.1 15.0 7.1 3.2 6+ 1.9 0.5 1.0 2.0 5.0 8.4 15.3 2.1 Non-numeric responses 7.0 4.3 6.2 11.4 17.3 24.7 29.0 8.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,241 10,111 11,747 6,557 2,801 1,213 1,019 35,688 Mean ideal number children for:2 Ever-married women 2.5 2.4 2.5 2.9 3.3 3.6 4.1 2.7 Number 2,084 9,674 11,019 5,809 2,315 913 724 32,537 All women 2.4 2.4 2.5 2.9 3.3 3.6 4.1 2.6 Number 11,214 9,683 11,020 5,812 2,317 913 724 41,683 Currently married 2.5 2.4 2.5 2.9 3.3 3.7 4.1 2.7 Number of currently married 1,851 9,055 10,515 5,467 2,171 841 670 30,571 CURRENTLY MARRIED MEN3 0 0.9 0.0 0.3 0.6 0.4 0.9 0.0 0.3 1 3.3 1.8 0.8 0.9 0.5 0.9 0.4 1.3 2 54.8 61.4 53.6 32.4 21.9 16.9 15.8 48.5 3 22.6 20.6 20.7 27.6 15.0 9.0 12.6 21.1 4 8.9 7.3 11.7 15.7 27.8 15.7 10.5 12.1 5 0.9 2.5 3.2 5.0 11.3 21.2 3.7 4.2 6+ 2.0 1.4 1.3 3.0 6.6 13.4 24.1 2.8 Non-numeric responses 6.7 4.9 8.3 14.9 16.5 22.0 32.9 9.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 516 2,485 2,694 1,403 568 219 130 8,014 Mean ideal number children for:2 Currently married men 2.5 2.5 2.6 3.0 3.6 4.1 4.7 2.8 Number 481 2,363 2,469 1,194 474 170 87 7,240 1 The number of living children includes current pregnancy for women. 2 Means are calculated excluding respondents who gave non-numeric responses. 3 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Table 6.3 shows that around half of women and men who expressed a numeric preference wanted a two-child family, and roughly 20 percent considered a three-child family to be ideal. Relatively few wanted five or more children. As expected, higher-parity women and men showed a preference for more children. For example, the mean ideal number of children ranges from 2.4 children among ever-married women with one child to 4.1 children among women with six or more children. Among currently married men, the mean ideal family size varies from 2.5 children among those with one child to 4.7 children among those with six or more children. The results in Table 6.3 also clearly show that many women and men in Indonesia have had more children than they would now prefer. For example, among ever-married women with five or more children, the mean ideal number of children (3.6 children) is smaller than the actual number of children they have, indicating that many of these women had more children than they now prefer. Similar patterns are seen for men. For example, among men with five or more children, 43 percent reported an ideal family size smaller than their current number of children. The results in Table 6.3 also show that the majority women and men Fertility Preferences • 69 who are beginning childbearing prefer to have small families; for example, more than half of women and men with no children said that their ideal number of children is two. Table 6.4 shows the variation in the mean ideal family size among ever-married and all women age 15-49 and currently married men age 15-54, by background characteristics. Table A-6.2 presents provincial differentials in the mean ideal family size. The results in Table 6.4 indicate that the older the age group, the greater the tendency to want a higher ideal number of children among both women and men. The mean ideal number of children among urban women and men is consistently slightly lower than that among their rural counterparts. Table 6.4 Mean ideal number of children Mean ideal number of children for ever-married women age 15-49, all women age 15-49, and currently married men age 15-54 by background characteristics, Indonesia 2012 Background characteristic Ever-married women All women Currently married men Mean Number of women1 Mean Number of women1 Mean Number of men1 Age 15-19 2.3 884 2.3 6,405 (2.5) 26 20-24 2.4 3,710 2.4 5,999 2.5 328 25-29 2.6 5,894 2.6 6,581 2.7 1,069 30-34 2.6 6,109 2.6 6,377 2.8 1,558 35-39 2.7 6,021 2.6 6,206 2.8 1,601 40-44 2.8 5,435 2.7 5,549 2.9 1,496 45-49 2.9 4,485 2.9 4,566 2.9 1,162 50-54 na 0 na 0 3.2 1,010 Residence Urban 2.6 16,174 2.5 21,887 2.7 4,245 Rural 2.8 16,363 2.7 19,797 3.0 4,004 Education No education 3.2 1,146 3.1 1,218 3.4 194 Some primary 3.0 3,867 3.0 4,067 3.2 1,125 Completed primary 2.7 8,695 2.7 9,200 2.8 1,892 Some secondary 2.6 7,807 2.5 11,800 2.8 1,771 Completed secondary 2.5 7,712 2.4 10,103 2.7 2,253 More than secondary 2.6 3,310 2.6 5,295 2.9 1,015 Wealth quintile Lowest 3.0 5,711 2.9 6,845 3.3 1,328 Second 2.7 6,413 2.6 7,937 2.8 1,682 Middle 2.6 6,728 2.5 8,524 2.8 1,776 Fourth 2.5 7,011 2.5 9,056 2.7 1,769 Highest 2.5 6,674 2.4 9,320 2.7 1,695 Total 2.7 32,537 2.6 41,683 2.8 8,250 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Number of women and men who gave a numeric response na = not applicable Generally, those with a higher educational level tend to have a lower ideal number of children. The exception is among women and men with more than a secondary education, where the mean ideal number of children is observed to be the same or somewhat higher than among those with some or completed secondary education. The wealthier the respondents, the lower the number of children they perceived as ideal. 6.3 PLANNED FERTILITY Women were asked a series of questions for each child born in the preceding five years and any current pregnancy to determine whether the particular pregnancy was desired at the time (“planned”), not desired at the time but wanted at a later time, or unwanted at any time. The results of these questions, which 70 • Fertility Preferences are presented in Table 6.5, form a potentially powerful indicator of the degree to which couples successfully control childbearing. In addition, the data can be used to gauge the effect of the prevention of unwanted births on period fertility. The questions are demanding. The respondent is required to recall accurately her wishes at one or more points in the last five years and to report them honestly. The danger of rationalization is present; an unwanted conception may well become a cherished child. Despite the potential problems of comprehension, recall and truthfulness, results from previous surveys have proved surprisingly plausible. Respondents are clearly willing to report unwanted conceptions. Nevertheless, some rationalization undoubtedly still occurs after a child who may have been considered as unwanted at conception is born, resulting in underreporting of unwanted fertility. Table 6.5 Fertility planning status Percent distribution of births to women age 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother’s age at birth, Indonesia 2012 Birth order and mother’s age at birth Planning status of birth Total Number of births Wanted then Wanted later Wanted no more Missing Birth order 1 96.5 2.8 0.2 0.5 100.0 7,286 2 87.1 9.4 2.8 0.7 100.0 5,834 3 75.3 9.3 14.6 0.8 100.0 3,037 4+ 65.5 7.0 26.3 1.2 100.0 2,741 Mother’s age at birth <20 93.4 5.6 0.3 0.6 100.0 1,687 20-24 92.0 6.1 1.3 0.6 100.0 4,829 25-29 87.8 7.8 3.7 0.7 100.0 5,436 30-34 83.8 6.7 8.9 0.6 100.0 3,934 35-39 73.1 5.2 20.6 1.1 100.0 2,325 40-44 59.6 4.1 35.0 1.3 100.0 625 45-49 59.5 1.9 38.6 0.0 100.0 63 Total 85.7 6.5 7.1 0.7 100.0 18,898 Table 6.5 shows the percent distribution of births in the five years preceding the survey (including current pregnancies) by the planning status of the birth, according to birth order and mother’s age at birth. More than 80 percent of births were wanted at the time of conception, 7 percent were wanted but at a later time, and 7 percent were not wanted at all. These figures are generally similar to those reported in the 2007 IDHS (CBS et al., 2008), although the proportion of births wanted then is slightly higher than in 2007 (86 percent versus 80 percent) and the proportion of births wanted later is slightly lower than in 2007 (7 percent versus 12 percent). Table 6.5 shows that the higher the birth order, the more likely it is that births are reported as unwanted. Among fourth and higher-order births, around one-quarter of them were not wanted at all and 7 percent were wanted later. The planning status of births also is associated with the age of the mother. In general, older mothers tend to have a smaller percentage of children who were wanted at conception. Overall, the percentage of unwanted births (including those wanted later and those not wanted) rises from 6 percent of births among women under age 20 to 41 percent of births among women age 45-49. Fertility Preferences • 71 6.4 WANTED FERTILITY RATES Wanted fertility rates are calculated in the same manner as the conventional age-specific fertility rates presented in Chapter 5, except that births classified as unwanted are omitted from the numerator; the remainder are cumulated to form a total wanted fertility rate. Analogous to the conventional total fertility rate (TFR), the total wanted fertility rate provides another indicator of fertility aspirations and may be interpreted as the number of wanted births that a woman would bear by age 50, if she experienced the wanted fertility rates observed for the past three years. The Lightbourne method of calculating a “wanted” birth is used for this table: a birth is considered wanted if the number of living children at the time of conception was less than the ideal number of children reported at the time of the survey (Lightbourne, 1985). Wanted fertility rates express the level of fertility that theoretically would result if all unwanted births were prevented. Comparison of actual rates with wanted rates indicates the potential demographic impact of the elimination of unwanted births. There is a difference between ideal family size and the wanted fertility rate in that the wanted fertility rate takes observed fertility as its starting point and can never be larger than the actual TFR; ideal family size can be and often is larger than the number of children born. This characteristic of the wanted fertility rate has an advantage and a disadvantage. It may be the more realistic measure, because it takes into account the fact that fecundity impairment prevents some women from having wanted births and from achieving their desired family size. But it has the disadvantage of interpretive complexity and, like any period measure, is vulnerable to temporary influences on the level of recent fertility. Table 6.6 shows the wanted fertility and the actual total fertility rates by background characteristics. Overall, the total wanted fertility rate in Indonesia is lower than the actual total fertility rate. The total wanted fertility rate is 2.0 children per woman; thus, if women were to achieve their childbearing goals, the overall TFR could drop to the replacement level in Indonesia. To reach the wanted fertility level, the actual fertility rate (2.6 children per woman) would have to decrease by 23 percent. The gap between the wanted and actual fertility rates is greatest (0.8 births) among women with no education and women in the lowest wealth quintile. Appendix Table A-6.3 shows the wanted and actual fertility rates by province. Table 6.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Indonesia 2012 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 1.9 2.4 Rural 2.2 2.8 Education No education 2.0 2.8 Some primary 2.3 3.0 Completed primary 2.3 2.9 Some secondary 2.1 2.6 Completed secondary 2.2 2.7 More than secondary 2.0 2.4 Wealth quintile Lowest 2.4 3.2 Second 2.1 2.7 Middle 2.0 2.5 Fourth 2.0 2.4 Highest 1.8 2.2 Total 2.0 2.6 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2. Family Planning • 73 FAMILY PLANNING 7 his chapter is divided into three major sections. The first section presents information from the 2012 Indonesia Demographic and Health Survey (IDHS) related to knowledge and attitudes toward family planning. Topics addressed in this section include knowledge of contraceptive methods, awareness of a woman’s fertile period, exposure to family planning messages through mass media and personal contact, and contact of nonusers with family planning providers. The second section focuses on the use of family planning and provides information on the level of current use of contraception, timing of sterilization, the source of modern contraception, and costs of family planning services. The third section on nonuse and intent to use family planning discusses discontinuation rates, reasons for discontinuation, need and demand for family planning, attitudes toward the future use of contraception, and reasons for not intending to use contraception in the future. Even though the main focus of this chapter is on women, results from the male survey are also presented because men play an important role in the realization of reproductive goals. 7.1 KNOWLEDGE OF FAMILY PLANNING 7.1.1 Knowledge of Contraceptive Methods Knowledge about fertility control and family planning is a prerequisite to gaining access to contraceptive methods and using a suitable method in a timely and effective manner. In the 2012 IDHS, the information about knowledge of contraception was obtained by asking respondents to name ways that a couple can delay or avoid a pregnancy. If the respondent did not spontaneously name a method, the interviewer read a description of each method and asked if the respondent recognized it. The information was collected for two types of contraceptive methods: modern and traditional. Modern methods include female sterilization, male sterilization, pill, intrauterine device (IUD), injectables, implants, male condom, diaphragm (intravag), lactational amenorrhea method (LAM), and emergency contraception. Traditional methods include periodic abstinence (rhythm method) and withdrawal. An additional question, which probed for knowledge about other methods, was included to obtain information on knowledge of folk methods. T Key Findings • Virtually all women age 15-49 (98 percent) know about modern contraceptive methods. • Only 18 percent of Indonesian women know that the most fertile time for a woman is halfway between two menstrual periods. • Sixty-two of currently married women age 15-49 are using contraception, and 58 percent are relying on modern contraceptive methods. • Injectables are the most widely used method, followed by the pill (32 percent and 14 percent, respectively). • More than 7 in 10 current users obtain their method from a private sector provider, and 9 in 10 users report paying for their method. • Overall, 27 percent of contraceptive users discontinue using a method within 12 months of starting its use, and 13 percent switch to another method. • The total unmet need for family planning services in Indonesia is 11 percent, of which 7 percent is an unmet need for limiting. 74 • Family Planning Table 7.1 shows knowledge of contraceptive methods for all women age 15-49, currently married women age 15-49, and currently married men age 15-54. Almost all women, currently married women, and currently married men in Indonesia know at least one method of family planning (98 percent, 99 percent, and 97 percent, respectively). Virtually all respondents who recognized at least one method knew about a modern method. Respondents were much less likely to know about a traditional method of family planning (57 percent of all women, 63 percent of currently married women, and 47 percent of currently married men) than a modern method. Table 7.1 Knowledge of contraceptive methods Percentage of all women age 15-49, currently married women age 15-49, and currently married men age 15-54 who know any contraceptive method, by specific method, Indonesia 2012 Method All women Currently married women Currently married men Any method 98.0 99.0 97.3 Any modern method 98.0 98.9 97.2 Female sterilization 61.4 67.0 40.3 Male sterilization 33.7 37.7 30.6 Pill 95.6 97.3 93.0 IUD 75.8 82.3 65.1 Injectables 95.9 98.0 92.5 Implants 81.8 89.0 63.1 Male condom 83.1 84.4 87.0 Diaphragm (Intravag) 10.7 10.5 7.8 Lactational amenorrhea (LAM) 21.6 23.8 7.7 Emergency contraception 11.0 11.3 6.9 Any traditional method 56.8 62.6 46.7 Rhythm 42.8 47.2 33.6 Withdrawal 42.1 48.1 34.6 Other 8.4 9.5 4.1 Mean number of methods known by respondents 6.6 7.1 5.7 Number of respondents 45,607 33,465 9,306 Injectables and the pill are the most widely known modern methods; more than nine in ten IDHS respondents recognized these methods. Among the modern methods, respondents were least likely to know about emergency contraception, the diaphragm, and lactational amenorrhea (LAM). In general, men were less likely to know specific family planning methods than women, with the exception of the male condom, where men had a slight advantage over women. Women recognized an average of seven methods while men recognized fewer than six methods. With the exception of the male condom, there were only minor changes between the 2007 and 2012 IDHS surveys in the percentages of currently married women who knew about specific methods. Knowledge of the male condom increased among married women from 77 percent in 2007 to 84 percent in 2012. Table 7.2 presents differentials in contraceptive knowledge among all women age 15-49 and currently married men age 15-54. More than 90 percent of the IDHS respondents knew at least one method and one modern method in all subgroups, except among the small number of women and men with no education. Family Planning • 75 Table 7.2 Knowledge of contraceptive methods by background characteristics Percentage of women age 15-49 and currently married men age 15-54 who have heard of at least one contraceptive method and who have heard of at least one modern method, by background characteristics, Indonesia 2012 Background characteristic Women Men Heard of any method Heard of any modern method1 Number Heard of any method Heard of any modern method1 Number Age 15-19 94.7 94.6 6,927 100.0 100.0 28 20-24 97.8 97.8 6,305 94.4 94.4 345 25-29 98.8 98.7 6,959 98.3 98.3 1,127 30-34 99.2 99.2 6,876 98.4 98.1 1,674 35-39 98.8 98.8 6,882 98.1 97.8 1,775 40-44 98.8 98.7 6,252 97.9 97.7 1,693 45-49 98.1 98.0 5,407 97.4 97.1 1,371 50-54 na na 0 94.0 94.0 1,292 Residence Urban 98.9 98.8 23,805 98.6 98.6 4,739 Rural 97.1 97.0 21,802 96.0 95.7 4,567 Education No education 83.5 82.7 1,500 77.5 76.6 265 Some primary 97.0 96.9 4,870 92.9 92.4 1,371 Completed primary 98.4 98.3 10,254 97.3 97.1 2,118 Some secondary 97.8 97.8 12,753 98.8 98.8 1,979 Completed secondary 99.5 99.5 10,677 99.6 99.5 2,453 More than secondary 99.6 99.6 5,552 99.9 99.9 1,119 Wealth quintile Lowest 94.1 93.8 7,767 91.9 91.5 1,596 Second 98.0 97.9 8,784 96.4 96.0 1,866 Middle 99.0 99.0 9,243 98.8 98.8 2,008 Fourth 99.2 99.2 9,743 99.0 98.9 1,962 Highest 99.1 99.0 10,071 99.6 99.6 1,875 Total 98.0 98.0 45,607 97.3 97.2 9,306 na = Not applicable 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception Appendix Table A-7.1 presents the variation in knowledge methods by province. 7.1.2 Knowledge of Fertile Period A basic knowledge about reproductive physiology provides a useful background for the successful practice of coitus-associated methods such as condoms, vaginal methods, and withdrawal. Knowledge is especially critical in the case of the rhythm (periodic abstinence) method. In the 2012 IDHS, all women were asked about their knowledge of a woman’s fertile period. Table 7.3 differentiates current users and nonusers of the rhythm method in presenting the 2012 IDHS findings on women’s knowledge of the fertile period. Table 7.3 Knowledge of fertile period Percent distribution of women age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of the rhythm method, Indonesia 2012 Perceived fertile period Users of rhythm method Nonusers of rhythm method All women Just before her menstrual period begins 3.0 3.8 3.8 During her menstrual period 0.4 0.6 0.6 Right after her menstrual period has ended 33.7 32.1 32.1 Halfway between two menstrual periods 50.4 18.0 18.3 Other 2.0 0.6 0.6 No specific time 4.6 16.7 16.6 Don’t know 5.6 27.8 27.6 Missing 0.2 0.3 0.3 Total 100.0 100.0 100.0 Number of women 439 45,168 45,607 76 • Family Planning Only 18 percent of all women age 15-49 know the most fertile time is halfway between two menstrual periods. Among users of rhythm method, however, 50 percent correctly identify that a woman is most likely to become pregnant if she has sexual intercourse halfway between two periods. These results show that there is the need for more education about the physiology of reproduction in order to increase the effective use of rhythm and other coitus-associated methods. 7.1.3 Exposure to Family Planning IEC The family planning mass information, education, and communication (IEC) program in Indonesia focuses on the dissemination of family planning information through a variety of media. Media have an important role in familiarizing men and women with current information about family planning. Both print materials (newspapers/magazines, pamphlets, posters) and electronic media (radio and TV) are used to disseminate family planning messages. IEC activities on television are shown on government-run stations, both on central and regional stations. Family planning information is carried on the radio by both government and private stations throughout Indonesia. Personal contacts with staff of the family planning program and other health workers as well as with village and religious leaders, teachers, and members of women’s groups are other potentially important channels for the dissemination of family planning information. The 2012 IDHS included questions to determine whether or not respondents had been exposed to family planning messages through various media and personal contacts during the six-month period prior to the survey interview. These results will help program managers and planners to effectively target population subgroups for information, education, and communication campaigns. Exposure to family planning messages through mass media Tables 7.4.1-7.4.2 show the percentage of currently married women age 15-49 and currently married men age 15-54 who were exposed to family planning messages through five mass media sources (television, radio, newspapers/magazines, posters, and pamphlets) during the six months before the IDHS interview. The results show that television is the outlet through which IDHS respondents most often receive family planning information; more than 4 in 10 currently married women age 15-49 and men age 15-54 saw family planning messages on television. Posters were the second most important source of family planning information; around one-quarter of married women and more than one-third of married men were exposed to family planning posters. Family planning messages disseminated through other print media (newspapers/magazines and pamphlets) reached about 1 in 7 married women and 1 in 5 married men. Only 1 in 10 married women and 1 in 8 married men said they had heard about family planning on the radio. Overall, 46 percent of currently married women and 38 percent of currently married men were not exposed to family planning messages through any of the five sources. This represents a substantial decrease in the proportions of women and men reporting no exposure to family planning messages compared with the 2007 IDHS results; around two-thirds of ever-married women age 15-49 and 6 in 10 currently married men 15- 54 were not exposed to family planning messages through any of the five media sources during the six months before the 2007 IDHS. The likelihood of having been exposed to family planning messages during the six months prior to the survey varies noticeably with background characteristics among both women and men. Urban residents are less likely than rural residents to have had no exposure to family planning messages. For example, 55 percent of currently married women age 15-49 in rural areas had not seen or heard family planning messages through any of the five media sources compared with 37 percent of married women in urban areas. The proportions of currently married women and men who were not exposed to family planning information through any of the five sources also varied markedly with education and wealth. For example, 62 percent of married men in the lowest wealth quintile had not received family planning information from any of the five sources compared with 20 percent of men in the highest wealth quintile. Family Planning • 77 Table 7.4.1 Exposure to family planning messages through mass media: currently married women Percentage of currently married women age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper in the past few months, according to background characteristics, Indonesia 2012 Background characteristic Radio Television Newspaper/ magazine Poster Pamphlet None of these five media sources Number of women Age 15-19 10.2 46.5 7.3 21.0 8.5 45.3 890 20-24 9.2 48.8 11.5 25.9 12.3 42.1 3,754 25-29 9.0 49.6 14.9 29.1 15.9 41.1 6,000 30-34 9.7 47.2 15.5 28.7 14.8 42.1 6,285 35-39 9.6 47.2 16.4 28.8 15.0 44.3 6,331 40-44 10.6 40.9 12.8 24.3 13.4 49.7 5,572 45-49 8.8 36.5 9.6 18.5 9.5 57.5 4,633 Residence Urban 11.3 52.9 19.6 33.4 18.4 36.6 16,466 Rural 7.8 37.9 7.9 19.2 8.9 54.7 16,999 Education No education 2.1 13.8 0.3 2.0 0.6 84.4 1,209 Some primary 4.9 26.0 1.3 8.0 3.3 69.6 4,185 Completed primary 7.3 38.3 5.0 16.3 6.1 55.1 9,045 Some secondary 9.8 48.6 10.3 25.7 12.1 43.0 7,912 Completed secondary 12.7 57.9 23.3 39.1 21.7 30.2 7,760 More than secondary 15.9 62.5 42.8 55.2 36.3 19.7 3,353 Wealth quintile Lowest 5.7 24.5 3.6 13.1 5.3 67.9 5,966 Second 6.6 38.2 6.3 17.9 7.8 54.6 6,614 Middle 9.8 46.4 10.5 24.1 12.2 45.8 6,864 Fourth 10.4 53.3 16.6 30.2 15.9 36.8 7,218 Highest 14.6 60.7 29.6 43.4 25.5 27.4 6,803 Total 9.5 45.3 13.6 26.2 13.6 45.8 33,465 Table 7.4.2 Exposure to family planning messages through mass media: men Percentage of married men age 15-54 who heard or saw a family planning message on radio, on television, or in a newspaper in the past few months, according to background characteristics, Indonesia 2012 Background characteristic Radio Television Newspaper/ magazine Poster Pamphlet None of these five media sources Number of men Age 15-19 5.6 33.1 9.8 22.8 1.7 43.3 28 20-24 17.6 50.2 15.9 32.2 14.6 33.9 345 25-29 11.3 48.1 21.3 38.1 19.9 36.8 1,127 30-34 14.1 55.7 19.3 41.9 20.0 30.5 1,674 35-39 12.7 49.6 22.7 38.8 21.3 35.1 1,775 40-44 12.8 47.9 21.7 37.1 19.0 36.8 1,693 45-49 10.9 42.7 18.6 31.3 15.0 44.3 1,371 50-54 11.4 39.1 12.4 25.4 12.7 48.6 1,292 Residence Urban 14.7 53.7 26.8 44.7 23.5 28.8 4,739 Rural 10.3 41.4 11.8 26.4 12.4 47.5 4,567 Education No education 6.5 22.8 3.0 9.8 6.8 69.4 265 Some primary 6.6 27.1 3.0 13.2 3.6 63.9 1,371 Completed primary 8.9 39.9 7.9 22.4 8.7 49.8 2,118 Some secondary 11.7 49.6 15.1 36.4 15.1 34.7 1,979 Completed secondary 16.2 58.5 28.8 50.5 27.2 23.2 2,453 More than secondary 21.6 66.6 52.3 60.8 41.2 14.9 1,119 Wealth quintile Lowest 7.6 29.1 7.1 15.2 6.0 61.6 1,596 Second 9.1 37.9 9.2 26.4 11.8 48.9 1,866 Middle 11.5 50.0 16.2 35.6 18.5 36.1 2,008 Fourth 14.1 56.1 23.8 43.4 21.3 28.0 1,962 Highest 19.6 62.0 38.9 54.4 30.6 19.5 1,875 Total 12.5 47.7 19.4 35.7 18.0 38.0 9,306 78 • Family Planning Appendix Table A-7.2.1-7.2.2 show the exposure of IDHS respondents to family planning messages through various media by province. Exposure to family planning messages through personal contact Information on family planning can be exchanged during personal contacts. The 2012 IDHS collected information from women about whether or not they had obtained family planning information during contacts they may have had in the six months before the survey with family planning fieldworkers, teachers, religious leaders, doctors, nurse/midwives, village leaders, women’s groups, and pharmacists. Table 7.5 shows the percentages of currently married women age 15-49 who obtained family planning information through personal contacts with various sources, according to background characteristics. Table 7.5 Exposure to family planning messages through personal contact Percentage of currently married women age 15-49 who heard or saw a family planning message through personal contact in the past 6 months, according to background characteristics, Indonesia 2012 Background characteristic Family planning officer Teacher Religious leader Doctor Nurse/ midwife Village leader Women’s group Pharmacist Number Age 15-19 7.8 0.9 0.7 4.0 24.9 1.1 0.9 0.2 890 20-24 11.1 0.8 0.9 7.3 29.4 1.6 3.2 0.4 3,754 25-29 10.9 0.4 1.6 7.0 27.7 1.8 5.4 0.7 6,000 30-34 10.7 0.6 1.4 6.4 25.7 1.7 6.4 0.8 6,285 35-39 11.0 0.8 2.1 6.6 24.5 2.5 7.7 0.9 6,331 40-44 11.1 0.5 2.5 6.0 20.7 2.2 8.0 0.4 5,572 45-49 7.9 0.4 2.2 4.2 13.5 2.5 5.7 0.2 4,633 Marital status Married 10.4 0.6 1.8 6.2 23.7 2.1 6.2 0.6 33,291 Living together 12.9 0.1 0.9 4.8 22.2 1.5 1.1 0.4 174 Residence Urban 9.5 0.5 1.7 7.3 23.5 1.5 7.0 0.8 16,466 Rural 11.3 0.6 1.8 5.1 23.9 2.6 5.3 0.4 16,999 Education No education 5.7 0.0 0.5 0.5 8.3 0.5 1.6 0.1 1,209 Some primary 6.8 0.2 1.1 2.6 14.5 2.1 3.8 0.2 4,185 Completed primary 9.8 0.3 1.7 3.8 22.4 2.6 5.8 0.4 9,045 Some secondary 11.6 0.3 1.8 5.7 27.3 1.8 6.8 0.4 7,912 Completed secondary 11.9 0.6 1.8 8.0 27.4 1.9 7.3 0.6 7,760 More than secondary 12.3 2.5 3.3 16.4 27.2 2.1 7.4 2.1 3,353 Wealth quintile Lowest 9.5 0.4 1.4 3.0 19.1 2.0 3.0 0.4 5,966 Second 10.0 0.4 1.1 3.9 22.9 2.0 4.9 0.4 6,614 Middle 11.6 0.5 1.9 5.9 25.8 2.2 6.7 0.6 6,864 Fourth 9.9 0.5 2.0 6.5 24.2 2.1 6.7 0.3 7,218 Highest 11.1 1.0 2.4 11.3 25.9 1.8 8.9 1.2 6,803 Total 10.4 0.6 1.8 6.2 23.7 2.0 6.1 0.6 33,465 Currently married women most often obtained family planning information from nurse/midwives (24 percent), followed by family planning fieldworkers (10 percent), medical doctors (6 percent), and women’s groups (6 percent). The variation in the percentages of married women reporting they obtained family planning from specific types of contacts is greatest by educational level. For example, women with some secondary education or higher are more than three times as likely to report obtaining family planning information from a nurse/midwife than women with no education (27 percent versus 8 percent). Appendix Table A-7.3 shows the exposure of IDHS respondents to family planning information through personal contacts by province. Family Planning • 79 7.1.4 Contact of Nonusers with Fieldworkers/Health Providers about Family Planning The 2012 IDHS included several questions designed to obtain information on whether or not nonusers had had any contact with health providers in which family planning was discussed during the six months prior to the survey. Table 7.6 presents the information on nonuser contacts with family planning or health providers by background characteristics for ever-married women age 15-49. The results in the table can be used to assess the extent to which opportunities are being missed to provide nonusers with information about family planning. Table 7.6 Contact of nonusers with fieldworkers/health providers about family planning Among ever-married women age 15-49 who are not using contraception, the percentage who during the past 6 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with a fieldworker or at a health facility, by background characteristics, Indonesia 2012 Percentage of women who were visited by fieldworker who discussed family planning Percentage of women who visited a health facility in the past 6 months and who: Percentage of women who did not discuss family planning either with fieldworker or at a health facility Number of women Background characteristic Discussed family planning Did not discuss family planning Age 15-19 3.4 6.6 45.5 90.4 494 20-24 5.9 14.6 45.9 82.3 1,618 25-29 5.3 10.9 41.6 85.4 2,398 30-34 4.9 9.9 42.0 87.1 2,424 35-39 7.4 9.3 37.4 85.8 2,336 40-44 5.0 5.3 31.8 91.3 2,456 45-49 4.0 3.8 30.8 93.2 3,147 Marital status Married 5.5 9.3 38.8 87.1 12,652 Living together 3.9 8.3 33.6 89.5 110 Divorced/separated 2.1 2.1 33.0 96.1 879 Widowed 4.3 3.2 30.5 93.6 1,233 Residence Urban 4.4 8.3 40.3 88.8 7,388 Rural 6.0 8.4 35.2 87.6 7,486 Education No education 3.3 2.2 22.4 95.0 873 Some primary 4.4 4.1 29.1 93.0 2,383 Completed primary 6.9 7.3 35.6 87.9 3,685 Some secondary 5.4 8.5 41.5 87.6 3,017 Completed secondary 4.7 11.0 42.1 86.3 3,307 More than secondary 4.5 14.5 47.6 83.2 1,609 Wealth quintile Lowest 5.8 7.7 31.5 88.7 3,101 Second 4.3 7.1 34.3 90.2 2,824 Middle 6.1 8.2 36.1 87.3 2,902 Fourth 5.9 8.6 42.5 87.7 3,000 Highest 4.1 10.0 43.9 87.2 3,047 Total 5.2 8.3 37.7 88.2 14,874 The results show that only around one in seven ever-married nonusers had any contacts with health providers in which family planning was discussed. Five percent were visited by a fieldworker in their homes, and 8 percent reported discussing family planning during a visit they made to a health facility. An additional 38 percent of nonusers reported they had visited a health facility at least once during the six-month period but said that no one had discussed family planning during their visit. The percentage of nonusers reporting a health facility visit in which family planning was not discussed was higher among nonusers under age 35 compared with older nonusers. Urban nonusers were also somewhat more likely than rural nonusers to report such visits. 80 • Family Planning The proportion who had visited a health facility but had not discussed family planning increased with both the woman’s education level and the wealth quintile. To sum up, not all visits to health providers present appropriate opportunities for offering family planning information or services. Nevertheless, the results in Table 7.6 suggest that health providers may not be taking full advantage of opportunities for informing and motivating nonusers to adopt family planning. Better coordination is needed to ensure that family planning services are well integrated into the health service delivery system in order to reduce the number of ‘”missed” opportunities in the future. Greater outreach may also be needed to target subgroups of the population, particularly less educated and poorer women, who are less likely to visit health facilities. Appendix Table A-7.4 presents information on the extent to which potential opportunities to counsel nonusers about family planning are being missed by province. 7.2 CURRENT USE OF FAMILY PLANNING Information on the current level of contraceptive use (contraceptive prevalence) is important for measuring the success of the National Family Planning Program. Contraceptive prevalence is defined as the proportion of currently married women age 15-49 using a method of family planning at the time of the survey. This section of the chapter presents information concerning levels, trends, and differentials in current use; sources of family planning methods; informed choice; timing of sterilization; problems with current method of contraception; the quality of use of the pills and injectable; and the costs of contraception. 7.2.1 Current Use of Contraception by Age Table 7.7.1 shows the percent distribution of all women and currently married women age 15-49 who are using specific family planning methods by age. The discussion of the results in the table focuses on the levels and differentials in use among the currently married women since very few unmarried women reported current use of contraception. Table 7.7.1 Current use of contraception by age: Women Percent distribution of all women, currently married women, and sexually active unmarried women age 15-49 by contraceptive method currently used, according to age, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Number of womenAge Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male condom LAM Other Rhythm With- drawal Other ALL WOMEN 15-19 6.3 6.2 0.0 0.0 1.2 0.1 4.9 0.1 0.0 0.0 0.0 0.1 0.0 0.1 0.0 93.7 100.0 6,927 20-24 36.2 35.4 0.0 0.0 6.5 1.2 25.5 1.6 0.6 0.0 0.0 0.8 0.1 0.6 0.1 63.8 100.0 6,305 25-29 55.0 52.2 0.2 0.0 11.2 2.1 34.2 2.8 1.7 0.0 0.0 2.7 0.7 1.9 0.1 45.0 100.0 6,959 30-34 60.2 56.7 1.3 0.1 13.4 3.4 32.7 3.6 2.0 0.1 0.0 3.6 1.1 2.1 0.3 39.8 100.0 6,876 35-39 62.9 57.9 3.8 0.2 14.3 4.2 29.5 3.8 2.0 0.0 0.0 5.0 1.5 3.1 0.4 37.1 100.0 6,882 40-44 58.6 53.5 5.8 0.1 13.7 5.2 23.5 3.6 1.5 0.0 0.0 5.1 2.0 2.4 0.6 41.4 100.0 6,252 45-49 39.8 36.3 7.0 0.5 9.4 5.1 11.6 1.5 1.1 0.0 0.0 3.6 1.3 1.7 0.5 60.2 100.0 5,407 Total 45.7 42.7 2.4 0.1 10.0 3.0 23.5 2.4 1.3 0.0 0.0 3.0 1.0 1.7 0.3 54.3 100.0 45,607 CURRENTLY MARRIED WOMEN 15-19 48.1 47.6 0.0 0.0 8.8 0.9 37.3 0.6 0.0 0.1 0.0 0.4 0.1 0.3 0.1 51.9 100.0 890 20-24 60.5 59.3 0.0 0.0 10.9 2.0 42.7 2.6 0.9 0.1 0.0 1.3 0.2 1.0 0.1 39.5 100.0 3,754 25-29 63.6 60.4 0.3 0.0 12.9 2.4 39.6 3.2 2.0 0.0 0.0 3.1 0.8 2.2 0.1 36.4 100.0 6,000 30-34 65.7 61.8 1.4 0.1 14.7 3.6 35.7 3.9 2.2 0.1 0.0 3.9 1.2 2.3 0.3 34.3 100.0 6,285 35-39 68.1 62.7 4.1 0.2 15.6 4.4 32.0 4.1 2.2 0.0 0.0 5.4 1.7 3.3 0.5 31.9 100.0 6,331 40-44 65.2 59.5 6.3 0.1 15.4 5.5 26.4 4.0 1.7 0.0 0.0 5.7 2.3 2.7 0.7 34.8 100.0 5,572 45-49 45.8 41.6 7.7 0.5 10.9 5.8 13.6 1.7 1.3 0.0 0.0 4.2 1.5 2.0 0.6 54.2 100.0 4,633 Total 61.9 57.9 3.2 0.2 13.6 3.9 31.9 3.3 1.8 0.0 0.0 4.0 1.3 2.3 0.4 38.1 100.0 33,465 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Family Planning • 81 Sixty-two percent of currently married women are using contraception. Traditional methods are not commonly used in Indonesia; 58 percent of currently married women age 15-49 were using modern methods, and 4 percent of currently married women were relying on a traditional method. Injectables are the most commonly used method, followed by the pill (32 percent and 14 percent, respectively). Younger women (age 15-19) and older women (age 45-49) were less likely to be using contraception than women in the mid-childbearing ages (20 to 44 years). Modern methods dominate the method mix among currently married users of all ages. However, preferences for specific methods vary by age. For example, while injectable were the most widely used in every age group, they were most popular among women under age 30. Older women (age 30-44) continued to rely on injectables but were more likely to use the pill and long-term methods such as the intrauterine device (IUD), implants, and female sterilization than younger women. The program encouraging male participation in family planning has been in place for several years; however, the use of coitus-associated methods is still low. Relatively few currently married women age 15-49 reported use of the male condom and withdrawal (2 percent each), and 1 percent were using rhythm. The rate of use of male sterilization is less than 1 percent. The 2012 IDHS also collected information directly from the sample of currently married men on the use of coitus-associated methods of family planning. The results presented in Table 7.7.2 confirm that use of male methods is very limited among Indonesian couples. Among married men age 15-54 who reported use of coitus-associated methods, the condom (3 percent) and withdrawal (1 percent) were the most popular methods. Table 7.7.2 Current use of contraception by age: Men Percent distribution of currently married men age 15-54 by contraceptive method currently used, according to age, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Other Not currently using Total Number of men Age Male sterili- zation Male condom Rhythm With- drawal 15-19 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 28 20-24 0.6 0.4 0.0 0.4 0.3 0.0 0.3 0.0 99.4 100.0 345 25-29 3.9 2.6 0.3 2.3 1.2 0.1 1.1 0.1 96.1 100.0 1,127 30-34 4.6 2.3 0.0 2.3 2.2 0.4 1.7 0.1 95.4 100.0 1,674 35-39 4.9 2.5 0.1 2.4 2.3 0.4 1.9 0.0 95.1 100.0 1,775 40-44 5.5 3.3 0.3 3.0 2.1 1.1 1.0 0.1 94.5 100.0 1,693 45-49 5.2 2.8 0.0 2.8 2.1 0.6 1.4 0.3 94.8 100.0 1,371 50-54 4.6 3.4 1.1 2.3 1.2 0.3 0.9 0.0 95.4 100.0 1,292 Total 4.7 2.7 0.3 2.5 1.9 0.5 1.3 0.1 95.3 100.0 9,306 7.2.2 Current Use of Contraception by Background Characteristics Tables 7.8.1 and 7.8.2 show the prevalence of contraceptive use among all women age 15-49 and currently married women age 15-49, respectively, by background characteristics. Again the discussion in this section will focus on the results for currently married women. Table 7.8.2 shows that the contraceptive prevalence rate was virtually the same in urban and rural areas (62 percent). However, there were differences by residence in the use of specific methods. Injectables were the most widely used method among both urban and rural women, but rural women were noticeably more likely to use the method than urban women (35 percent and 28 percent, respectively). The implant was also somewhat more popular among rural women than urban women. On the other hand, urban women were more likely to use the IUD, female sterilization, and the condom compared with rural women. 82 • Family Planning Table 7.8.1 Current use of contraception by background characteristics: All women Percent distribution of all women age 15-49 by contraceptive method currently used, according to background characteristics, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Number of women Background characteristic Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male condom LAM Rhythm With- drawal Other Residence Urban 43.3 39.7 2.9 0.1 9.6 3.6 19.8 1.6 2.0 0.0 3.5 1.3 1.9 0.2 56.7 100.0 23,805 Rural 48.3 46.0 2.0 0.1 10.3 2.2 27.5 3.4 0.5 0.0 2.3 0.6 1.5 0.3 51.7 100.0 21,802 Marital status Never married 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 99.8 100.0 9,919 Married 62.0 58.0 3.2 0.2 13.6 3.9 32.0 3.3 1.8 0.0 4.0 1.3 2.3 0.4 38.0 100.0 33,291 Living together 36.8 33.6 3.1 0.0 6.6 1.6 17.9 2.5 1.8 0.0 3.2 1.2 1.6 0.5 63.2 100.0 174 Divorced/separated 5.9 5.9 3.2 0.0 0.0 2.4 0.1 0.2 0.0 0.0 0.0 0.0 0.0 0.0 94.1 100.0 935 Widowed 4.2 4.2 1.1 0.0 0.4 1.6 0.8 0.4 0.0 0.0 0.0 0.0 0.0 0.0 95.8 100.0 1,288 Education No education 35.4 34.0 2.1 0.7 9.6 1.6 17.3 2.5 0.1 0.0 1.4 0.1 0.5 0.8 64.6 100.0 1,500 Some primary 46.2 43.9 3.1 0.3 10.4 1.9 25.1 2.7 0.4 0.0 2.3 0.3 1.2 0.7 53.8 100.0 4,870 Completed primary 58.2 56.4 2.4 0.1 14.0 2.4 33.1 3.9 0.5 0.0 1.8 0.3 1.3 0.2 41.8 100.0 10,254 Some secondary 42.1 39.9 1.8 0.0 9.3 1.9 23.7 2.2 0.9 0.0 2.2 0.6 1.5 0.2 57.9 100.0 12,753 Completed secondary 45.2 41.1 3.0 0.1 9.2 3.7 21.1 2.0 2.1 0.0 4.1 1.5 2.3 0.2 54.8 100.0 10,677 More than secondary 33.9 28.3 2.6 0.0 5.2 6.1 9.8 1.1 3.4 0.1 5.6 2.7 2.6 0.2 66.1 100.0 5,552 Number of living children 0 1.5 1.4 0.0 0.0 0.7 0.0 0.6 0.0 0.1 0.0 0.1 0.0 0.1 0.0 98.5 100.0 12,896 1-2 63.5 59.8 1.2 0.1 14.0 4.1 35.4 3.0 2.0 0.1 3.7 1.3 2.2 0.2 36.5 100.0 21,465 3-4 65.7 61.0 7.8 0.3 14.0 4.7 28.6 4.2 1.3 0.0 4.7 1.4 2.7 0.6 34.3 100.0 9,053 5+ 47.9 43.0 6.6 0.1 9.1 2.0 19.5 4.4 1.2 0.0 4.9 1.2 2.8 1.0 52.1 100.0 2,193 Wealth quintile Lowest 43.4 41.0 1.2 0.0 9.6 1.3 24.8 3.8 0.2 0.0 2.4 0.4 1.5 0.5 56.6 100.0 7,767 Second 48.8 46.6 2.1 0.1 10.9 1.9 27.9 3.1 0.6 0.0 2.2 0.4 1.4 0.3 51.2 100.0 8,784 Middle 47.6 44.9 2.3 0.2 10.3 2.0 26.2 2.7 1.1 0.0 2.7 0.8 1.8 0.2 52.4 100.0 9,243 Fourth 46.9 43.7 2.4 0.1 10.9 3.2 23.7 1.7 1.7 0.0 3.2 1.2 1.8 0.2 53.1 100.0 9,743 Highest 41.7 37.7 3.9 0.1 8.3 5.8 15.8 1.3 2.6 0.1 4.0 1.8 2.1 0.2 58.3 100.0 10,071 Total 45.7 42.7 2.4 0.1 10.0 3.0 23.5 2.4 1.3 0.0 3.0 1.0 1.7 0.3 54.3 100.0 45,607 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method. Table 7.8.2 Current use of contraception by background characteristics: Currently married women Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Number of men Background characteristic Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male condom LAM Rhythm With- drawal Other Residence Urban 62.1 57.0 4.0 0.2 13.9 5.1 28.6 2.3 2.9 0.1 5.1 1.9 2.8 0.3 37.9 100.0 16,466 Rural 61.6 58.7 2.4 0.1 13.2 2.8 35.2 4.3 0.6 0.0 3.0 0.7 1.8 0.4 38.4 100.0 16,999 Education No education 43.4 41.8 2.5 0.9 11.9 1.7 21.5 3.2 0.1 0.0 1.7 0.1 0.6 1.0 56.6 100.0 1,209 Some primary 53.4 50.8 3.5 0.3 12.1 2.1 29.1 3.1 0.4 0.0 2.6 0.4 1.4 0.8 46.6 100.0 4,185 Completed primary 65.7 63.7 2.7 0.1 15.8 2.7 37.5 4.3 0.6 0.0 2.0 0.4 1.4 0.2 34.3 100.0 9,045 Some secondary 67.4 63.9 2.7 0.0 15.0 3.0 38.2 3.5 1.5 0.1 3.5 0.9 2.4 0.3 32.6 100.0 7,912 Completed secondary 61.8 56.2 3.9 0.1 12.6 5.0 28.9 2.8 2.8 0.1 5.6 2.1 3.2 0.3 38.2 100.0 7,760 More than secondary 55.8 46.6 4.2 0.1 8.6 10.1 16.2 1.7 5.5 0.2 9.2 4.5 4.3 0.3 44.2 100.0 3,353 Number of living children 0 6.5 6.2 0.0 0.0 3.0 0.0 2.8 0.0 0.3 0.0 0.3 0.1 0.1 0.1 93.5 100.0 2,737 1-2 67.1 63.2 1.2 0.1 14.8 4.2 37.5 3.1 2.1 0.1 3.9 1.4 2.3 0.2 32.9 100.0 20,236 3-4 69.7 64.6 8.0 0.3 14.9 4.9 30.5 4.4 1.4 0.0 5.1 1.5 2.9 0.6 30.3 100.0 8,474 5+ 51.7 46.3 7.0 0.1 9.9 2.2 21.2 4.7 1.3 0.0 5.4 1.3 3.0 1.1 48.3 100.0 2,019 Wealth quintile Lowest 56.2 53.0 1.5 0.1 12.5 1.5 32.3 4.8 0.3 0.0 3.2 0.5 1.9 0.7 43.8 100.0 5,966 Second 64.3 61.4 2.6 0.1 14.4 2.3 36.9 4.2 0.8 0.0 2.9 0.6 1.8 0.5 35.7 100.0 6,614 Middle 63.9 60.2 3.1 0.2 13.9 2.7 35.2 3.7 1.5 0.1 3.6 1.1 2.4 0.2 36.1 100.0 6,864 Fourth 63.0 58.7 3.0 0.2 14.7 4.3 31.9 2.3 2.2 0.0 4.3 1.6 2.4 0.3 37.0 100.0 7,218 Highest 61.3 55.4 5.6 0.1 12.2 8.4 23.3 1.9 3.8 0.1 5.9 2.6 3.1 0.2 38.7 100.0 6,803 Total 61.9 57.9 3.2 0.2 13.6 3.9 31.9 3.3 1.8 0.0 4.0 1.3 2.3 0.4 38.1 100.0 33,465 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method. Family Planning • 83 Table 7.8.2 also shows that contraceptive use generally increased with the respondent’s level of education, peaking at 67 percent among women with some secondary education, after which it declined to 47 percent among women with the more than secondary education. The contraceptive method mix also varied with the level of education. The injectable was again the most popular method across all education categories. The IUD, the condom, and female sterilization were most likely to be used by married women with more than secondary education. Married women with more than a secondary education were also most likely to report use of traditional methods. Pill and implant use was most prevalent among women in the completed primary education category. Contraceptive use increased rapidly with the number of living children. Use of any method ranged from 7 percent among women with no living children to 70 percent among women with three or four children, after which it declined to 52 percent for women with five or more children. The most popular family planning methods among childless women were the injectable and the pill (3 percent for each method). Use of injectables increased substantially after the first child, peaking at 38 percent among women with one or two children. The proportion of women who used female sterilization increased from 1 percent for women with one or two children to 8 percent for women with three or four children. Overall, the differentials in use levels between wealth quintiles were smaller than the differentials between education groups. Fifty-six percent of women in the lowest wealth quintile used family planning compared with 64 percent of women in the second quintile (where the use peaked), and 61 percent in the highest quintile. The injectable was the most popular method in all wealth quintiles. Female sterilization, the IUD, and the condom were likely to be used by the married women in the highest quintile, while the implant was most likely to be used by the women in the lowest quintile. Appendix Table A-7.5.1 and Table A-7.5.2 show the percent distributions of all women and currently married women age 15-49 by contraceptive method used, according to province. 7.2.3 Trends in Contraception by Background Characteristics Table 7.9 and Figure 7.1 show the trends in current use of contraceptive methods among currently married women age 15-49 during the period 1991-2012. The results show that, overall, the contraceptive prevalence rate increased from 50 percent at the time of the 1991 IDHS to 62 percent in the 2012 IDHS. Most of the growth in family planning use occurred prior to the 2002-2003 IDHS. The use rate increased by almost 1 percentage point per year during an 11-year period between the 1991 IDHS and the 2002-2003 survey. During the decade following the 2002-2003 survey, the use rate increased by a total of fewer than two percentage points. 84 • Family Planning Table 7.9 Trends in use of specific contraceptive methods, Indonesia 1991-2012 Percentage of currently married women age 15-49 who are currently using a contraceptive method, by specific method, Indonesia 1991-2012 Method 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Any method 49.7 54.7 57.4 60.3 61.4 61.9 Pill 14.8 17.1 15.4 13.2 13.2 13.6 IUD 13.3 10.3 8.1 6.2 4.9 3.9 Injectables 11.7 15.2 21.1 27.8 31.8 31.9 Condom 0.8 0.9 0.7 0.9 1.3 1.8 Implants 3.1 4.9 6.0 4.3 2.8 3.3 Female sterilization 2.7 3.1 3.0 3.7 3.0 3.2 Male sterilization 0.6 0.7 0.4 0.4 0.2 0.2 Periodic abstinence 1.1 1.1 1.1 1.6 1.5 1.3 Withdrawal 0.7 0.8 0.8 1.5 2.1 2.3 Other 0.9 0.8 0.8 0.5 0.4 0.4 Number of women 21,109 26,186 26,886 27,857 30,931 33,465 Note: The 2002-2003 IDHS did not include Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua Provinces. Previous surveys (the 1991, 1994, and 1997 IDHS) included East Timor. In the 1991, 1994, and 1997 IDHS surveys, West Java includes Banten. In the 2002-2003 IDHS, West Java exludes Banten. The 2007 IDHS and the 2012 IDHS covered all 33 provinces. Source: CBS et al., 1992; CBS et al., 1994; CBS et al., 1998; CBS et al., 2003; CBS et al.,2008 Figure 7.1 Trends in contraceptive use among currently married women, 1991-2012 50 15 13 12 3 55 17 10 15 5 57 15 8 21 6 60 13 6 28 4 61 13 5 32 3 62 14 4 32 3 Any method Pill IUD Injectables Implants Percentage of currently married women 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Table 7.9 and Figure 7.1 also document substantial changes in the popularity of several modern methods. Use of the IUD decreased steadily during the past 20 years, from 13 percent in 1991 to the current rate of 4 percent. On the other hand, use of the injectable increased substantially, from 12 percent in 1991 to 32 percent in 2012. While the pill was the most commonly used modern method at the time of the 1991 and the 1994 IDHS surveys, the injectable has been the most commonly used modern method since the 1997 IDHS. Family Planning • 85 7.2.4 Timing of Sterilization Given the importance of female sterilization as a way of preventing pregnancies among women in high-risk groups, the family planning program supports the dissemination of information about this method. The program also provides services in accordance with a woman’s age and health status. The program considers the optimal target age for sterilization for women to be age 30-35. The 2012 IDHS collected from women using female sterilization the age at which they had the procedure. When considering the data on the age at which female sterilization was adopted, the problem of censoring must be taken into account. Because the survey includes all married women age 15-49, the experience of sterilized women age 50 and over is not included. Table 7.10 shows the percent distribution of sterilized women age 15-49 by the woman’s age at the time of sterilization, according to the number of years since the operation. The median age at the time of sterilization is 33.8 years. The majority (82 percent) of women were sterilized at age 30 and older. Table 7.10 Timing of sterilization Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Indonesia 2012 Years since operation Age at time of sterilization Total Number of women Median age1 <25 25-29 30-34 35-39 40-44 45-49 <2 0.7 7.2 22.6 46.0 20.0 3.4 100.0 204 36.3 2-3 2.9 6.1 20.9 44.6 21.6 3.8 100.0 160 35.7 4-5 0.0 5.7 46.4 31.8 16.1 0.0 100.0 175 34.0 6-7 0.3 10.8 30.6 45.9 12.5 0.0 100.0 113 35.3 8-9 3.0 9.0 41.2 38.3 8.5 0.0 100.0 98 34.5 10+ 15.5 23.5 40.8 20.2 0.0 0.0 100.0 365 a Total 5.9 12.7 34.5 34.5 11.3 1.2 100.0 1,115 33.8 a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring. 7.2.5 Source of Methods Information about sources of contraceptive methods is important because the Indonesian family planning program is currently directed toward self-reliance and greater use of the private sector. Table 7.11 shows the percent distribution of current users of modern contraceptive methods by the most recent source of method. The findings from the 2012 IDHS indicate that contraceptive users are much more likely to rely on private medical sources than government sources. Reliance on private medical providers increased from 69 percent at the time of the 2007 IDHS (CBS et al., 2008) to 73 percent in 2012. In turn, the proportion of users who went to government sources for their method decreased from 26 percent1 in 2007 to 22 percent in 2012. Among private sources, midwives, village midwives, and pharmacy/drug stores are the most commonly reported sources (32 percent, 19 percent, and 12 percent, respectively), while, among public sector sources, government health centers are the primary source for family planning methods (13 percent) followed by government hospitals (4 percent). Four percent of users obtained their method from other sources such as shops and friends/relatives. 1 Includes current users in the 2007 IDHS who reported obtaining their contraceptive method from government hospitals, government health centers, government clinics, family planning fieldworkers, family planning mobile units, delivery posts, health posts, family planning posts, and other public sector sources. Delivery posts, health posts, and family planning posts were classified with other sources in the 2007 IDHS report (CBS et al. 2008). 86 • Family Planning Table 7.11 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Indonesia 2012 Source Female sterilization Pill IUD Injectables Implants Male condom Total Public sector 57.4 18.7 40.0 16.5 59.4 5.1 23.3 Government hospital 54.3 0.2 10.1 0.4 2.8 0.0 4.4 Government health center 1.4 7.9 27.6 11.9 46.1 1.9 13.2 Government clinic 1.3 0.1 0.8 0.2 1.0 0.0 0.3 FP fieldworker 0.0 2.5 0.3 0.1 0.9 0.9 0.7 FP mobile clinic 0.1 0.1 0.1 0.1 0.6 0.0 0.1 Village health post 0.0 0.4 0.1 0.9 1.2 0.0 0.7 Delivery post 0.0 0.8 0.4 2.0 2.1 0.2 1.5 Health post 0.0 4.7 0.3 0.9 1.4 2.1 1.8 FP post 0.0 1.4 0.0 0.0 0.5 0.0 0.4 Other public sector 0.5 0.7 0.3 0.0 2.9 0.0 0.4 Private sector 41.4 68.2 59.4 83.1 37.3 81.1 72.7 Private hospital 28.8 0.1 6.5 0.3 0.8 0.0 2.3 Private clinic 1.2 0.9 3.3 2.3 1.2 0.2 1.9 Private doctor 0.5 0.5 0.4 2.0 0.6 0.2 1.3 Midwife 0.0 14.8 30.0 45.7 16.7 2.4 31.7 Village midwife 0.0 10.3 5.7 26.9 15.4 0.9 18.5 Pharmacy/drug store 0.0 39.4 0.0 0.2 0.0 77.0 11.6 Maternity hospital 7.2 0.1 2.6 0.2 0.3 0.0 0.8 Maternity home 0.9 0.1 0.2 0.2 0.0 0.0 0.2 Obstetrician 1.5 0.1 9.2 0.3 0.2 0.2 0.9 Nurse 0.0 1.7 1.1 4.8 1.5 0.1 3.2 Private mobile unit 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other private sector 1.2 0.4 0.4 0.2 0.5 0.1 0.3 Other source 0.0 10.4 0.2 0.1 0.0 13.0 3.8 Friends/relatives 0.0 0.9 0.2 0.1 0.0 0.4 0.3 Shop 0.0 9.5 0.0 0.0 0.0 12.7 2.6 Other 1.1 2.4 0.2 0.1 2.9 0.6 0.9 Total 100.0 99.7 99.9 99.9 99.6 99.9 99.8 Number of women 1,115 4,546 1,353 10,695 1,115 591 19,468 Note: Total includes other modern methods but excludes lactational amenorrhea method (LAM). Sources of family planning methods vary by method. Around one in two sterilized women had their operation in a government hospital. Fifty-nine percent of all implants took place in the public sector, principally in government health centers (46 percent). Sixty-eight percent of pill users obtained their pills from the private medical sector, 39 percent from pharmacies or drugstores, 15 percent from midwives, and 10 percent from village midwives. Eighty three percent of injectable users obtained the method from private sector providers, mainly from midwives (46 percent) and village midwives (27 percent). The majority of IUD users also obtained the method from private sector sources, with 30 percent relying on midwives. More than 8 in 10 condom users obtained the method from private providers, principally pharmacies or drugstores (77 percent). 7.2.6 Informed Choice Informed choice is an important tool for monitoring the quality of family planning services. Family planning providers should inform all method users of the potential side effects of each method and what they should do if they have side effects. This information assists users in coping with side effects and also decreases unnecessary discontinuation of temporary methods. All providers of sterilization must inform potential users that they may not be able to have any (more) children after their operation, and potential users of this method must be informed of other contraceptive methods that could be used. Users of other methods should also be informed of the choices they have with respect to other methods. Family Planning • 87 Table 7.12 shows, for users of modern contraceptive methods who adopted their current method in the past five years, the percentage who were informed about the potential side effects of their current method, the percentage advised about what to do if they experienced any of these side effects, and the percentage told about other methods according to the method used, the initial source of method, and selected background characteristics. The results indicate that many current users were not provided the information that they needed Table 7.12 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the five years preceding the survey, the percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method, initial source, and background characteristics, Indonesia 2012 Among women who started last episode of modern contraceptive method within five years preceding the survey: Method/source/characteristic Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Method Female sterilization 35.3 29.9 42.3 441 Pill 27.8 23.9 48.4 3,072 IUD 56.1 52.7 56.7 681 Injectables 38.1 29.0 52.7 7,585 Implants 38.1 33.5 49.7 896 Initial source of method1 Public sector 34.3 30.0 51.5 2,770 Government hospital 37.9 32.7 50.3 348 Government health center 35.6 30.9 51.6 1,728 Government clinic (37.5) (37.5) (58.3) 30 FP fieldworker 21.0 20.4 47.2 111 FP mobile clinic * * * 8 Village health post 40.9 32.5 64.2 117 Delivery post 35.1 30.2 51.3 189 Health post 22.9 21.0 53.0 194 FP post (15.2) (22.2) (27.1) 43 Other public sector * * * 2 Private medical sector 38.5 30.5 52.7 9,120 Private hospital 49.5 44.3 49.7 262 Private clinic 43.4 35.1 50.5 247 Private doctor 49.9 42.4 57.5 267 Midwife 41.5 33.2 56.4 4,610 Village midwife 35.5 25.0 50.4 2,562 Pharmacy/drug store 26.4 24.9 43.9 1,113 Maternity hospital (26.3) (24.5) (30.3) 45 Maternity home * * * 2 Obstetrician * * * 5 Other private sector * * * 7 Other private source 11.9 9.4 21.3 256 Friends/relatives (14.8) (16.4) (53.0) 24 Shop 11.6 8.7 17.9 232 Other 24.4 18.0 41.1 447 Background characteristic Residence Urban 41.0 33.5 55.3 6,029 Rural 32.4 25.6 47.7 6,645 Education No education 23.8 18.5 36.2 199 Some primary 23.7 19.2 36.8 1,130 Completed primary 29.5 23.2 46.4 3,574 Some secondary 35.8 28.2 50.7 3,596 Completed secondary 44.7 35.9 59.5 3,161 More than secondary 54.2 48.6 64.5 1,015 Wealth quintile Lowest 25.2 21.1 44.0 2,304 Second 32.0 24.5 46.5 2,669 Middle 36.4 27.4 51.0 2,722 Fourth 39.4 33.2 55.1 2,760 Highest 50.0 41.5 60.3 2,219 Total 36.5 29.4 51.3 12,675 Note: Table includes users of only the methods listed individually. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Source at start of current episode of use 88 • Family Planning to make an informed choice at the time they initiated use of their method. Overall, more than one in three current users (37 percent) were informed about the possible side effects or problems with their current method, and 29 percent of current users were informed of what to do if they experienced side effects. Just over half of current users were informed about other methods that could be used. Pill users were the least likely to be informed about possible side effects and what to do if problems occur while they are using the method (28 percent and 24 percent, respectively). IUD users were the most likely to receive this information (56 percent and 53 percent, respectively). They were also the most likely to have been given information about other methods (57 percent). Female sterilization users were the least likely to have received information about other methods (42 percent). Table 7.12 also allows for an assessment of the extent to which different types of sources performed in providing the information that was needed by a user to make an informed contraceptive choice. Overall, public sector sources and private sector sources did not vary markedly with respect to the three elements of informed choice shown in Table 7.12. A user’s current residence, education, and wealth status were related to the extent to which they had access to information to make an informed contraceptive choice. Urban users were better informed than rural women. The percentages of users who were informed about side effects or problems with their method, told what to do in case problems occurred, and advised about other methods increased with the woman’s education level and the wealth quintile. For example, 25 percent of users in the poorest quintile are informed about side effects or problems with their method, compared with 50 percent of users in the richest quintile. Twenty-one percent of users in the poorest quintile were informed about what to do if they have side effects experienced compared with 42 percent of users in the richest quintile. 7.2.7 Pill Use Compliance Because the pill is one of the most popular modern methods used in Indonesia, it is important for program planners and managers to find out whether it is used properly. The 2012 IDHS included a series of questions asked of pill users on the type of pill used, the availability of pills (pill packet) in the household at the time of the survey, and the last time a pill was taken. This information is presented in Table 7.13. Overall, 99 percent of pills users who said they had the pill package were able to show the package to the interviewer. The majority (92 percent) of pill users take the combined oral contraceptive (combined pill), and 3 percent use the progestin-only oral contraceptive (single pill). Eighty-five percent of pill users took their pills in order and had taken a pill less than two days before the interview. Differences in the type of pill and in the pill use compliance indicators by background characteristics are minor. Appendix Table A-7.6 shows the variation in quality of pill use compliance across provinces. Family Planning • 89 Table 7.13 Pill use compliance Percentage of women age 15-49 who are using the pill; among pill users who have the pill package, percent distribution who can show the pill package by type of pil;, and percentage of pill users who complied with pill use instructions, according to background characteristics, Indonesia 2012 Percent using Currently married women Among pill users who have the pill package Percentage of pill users who: Number of pill users Background characteristic Combi- nation1 Single2 Other Package not seen Missing Total Number of women who have pill package Took pill in order Took pill <2 days ago Age 15-19 9.2 890 91.6 6.8 1.2 0.3 0.0 100.0 74 90.1 85.8 82 20-24 10.9 3,754 92.1 4.0 2.0 1.8 0.1 100.0 377 82.1 81.2 411 25-29 13.0 6,000 92.9 3.2 2.4 0.9 0.5 100.0 740 84.2 88.5 780 30-34 14.7 6,285 91.4 4.5 2.4 1.7 0.0 100.0 877 85.3 84.9 922 35-39 15.6 6,331 94.4 2.2 2.2 0.6 0.6 100.0 937 86.5 88.6 986 40-44 15.4 5,572 90.9 3.0 4.7 1.0 0.4 100.0 820 85.0 83.6 858 45-49 10.9 4,633 91.0 3.5 3.0 1.8 0.8 100.0 485 85.8 77.8 507 Residence Urban 13.9 16,466 92.7 4.0 2.4 0.9 0.1 100.0 2,184 85.9 86.2 2,293 Rural 13.3 16,999 91.8 2.7 3.2 1.5 0.8 100.0 2,127 84.5 83.7 2,253 Education No education 11.9 1,209 92.5 3.7 3.2 0.7 0.0 100.0 136 90.1 86.3 144 Some primary 12.1 4,185 93.3 1.6 2.9 1.4 0.8 100.0 481 84.4 84.8 508 Completed primary 15.8 9,045 92.1 3.3 3.0 0.9 0.6 100.0 1,337 83.9 83.4 1,432 Some secondary 15.1 7,912 91.8 2.9 4.0 1.0 0.3 100.0 1,142 85.9 86.2 1,191 Completed secondary 12.7 7,760 92.5 4.3 1.5 1.6 0.2 100.0 938 86.5 86.6 983 More than secondary 8.6 3,353 91.8 5.2 1.3 1.8 0.0 100.0 277 82.5 81.8 288 Wealth quintile Lowest 12.6 5,966 93.1 2.8 2.1 1.5 0.5 100.0 689 84.7 84.7 749 Second 14.4 6,614 93.6 2.9 2.5 0.6 0.4 100.0 888 82.5 84.9 954 Middle 13.9 6,864 89.9 4.0 3.3 1.8 1.0 100.0 918 84.4 83.4 951 Fourth 14.7 7,218 92.5 3.3 3.8 0.3 0.0 100.0 1,022 88.1 86.8 1,061 Highest 12.2 6,803 92.3 3.7 1.9 2.0 0.1 100.0 794 85.8 84.7 831 Total 13.6 33,465 92.2 3.4 2.8 1.2 0.4 100.0 4,311 85.2 85.0 4,546 Note: Table excludes pill users who do not know the brand name. Total number includes a small number of unmarried women using the pill. 1 Combination brands include: Andalan, Diane, Pilkab, Kimbinasi, Lyndiol, Microdyol, Mycrogynon, Microlut, Planak, Trinordiol 21/ Trinordiol 28, and Yasmin. 2 Excluton 7.2.8 Quality of Use of Injectables In the 2012 IDHS, women who used injectables were asked whether they used the one-month or three- month injectable. Based on their responses, users were further asked how many weeks ago they had received their last injection. The purpose of the questions was to examine the quality of use of this method of contraception. Table 7.14 shows that 96 percent of users of the one-month injectable received an injection in the past four weeks, and 97 percent of users of the three-month injectable had an injection in the past three months. Appendix Table A-7.7 shows the variation in quality of use of injectables across provinces. 90 • Family Planning Table 7.14 Use of injectables Percentage of users of one-month injectables who had an injection in the past four weeks and percentage of users of three-month injectables who had an injection in the past three months, according to background characteristics, Indonesia 2012 Background characteristic Percent of users of one-month injectable contraception who had an injection in the past four weeks Number of users Percent of users of three-month injectable contraception who had an injection in the past three months Number of users Age 15-19 98.5 32 97.5 305 20-24 96.4 249 98.1 1,357 25-29 97.8 387 98.2 1,990 30-34 98.1 297 97.5 1,950 35-39 95.3 236 95.9 1,792 40-44 93.5 162 96.1 1,309 45-49 78.3 50 94.3 579 Residence Urban 96.6 929 96.9 3,776 Rural 95.0 484 97.1 5,506 Education No education 100.0 1 93.0 259 Some primary 96.4 55 94.8 1,170 Completed primary 93.2 202 97.6 3,188 Some secondary 97.1 423 97.1 2,606 Completed secondary 98.1 530 98.1 1,718 More than secondary 91.0 203 96.8 341 Wealth quintile Lowest 96.9 63 96.9 1,866 Second 94.2 172 96.7 2,278 Middle 96.9 262 97.3 2,161 Fourth 96.2 452 97.3 1,854 Highest 95.9 466 96.9 1,122 Total 96.0 1,414 97.0 9,282 7.2.9 Problems with Current Method In the 2012 IDHS, all contraceptive users were asked whether they had experienced any health problems with the method they were using. Table 7.15 shows that the vast majority of users (89 percent or higher) of the most commonly-used modern methods (pill, IUD, injectables, and implants) did not have any health problems as a result of using their method. The most common problem reported by pill users is headache (2 percent). Injectable users most often cited as problems the absence of menstruation (3 percent), weight gain (3 percent), and headache (2 percent). Implant users also cited the absence of menstruation (2 percent), weight gain (2 percent), and headaches (2 percent) as problems in using the method. Table 7.15 Problems with current method of contraception Percent distribution of current users of selected methods by the main health problems with the method, Indonesia 2012 Main problem with current method Pill IUD Injectables Implants None 94.5 94.5 89.3 89.4 Weight gain 0.7 0.6 2.7 1.6 Weight loss 0.0 0.0 0.2 0.2 Bleeding 0.3 0.8 0.3 0.3 Hypertension 0.2 0.0 0.1 0.1 Headache 2.0 0.0 2.3 1.5 Nausea 1.2 0.0 0.2 0.0 No menstruation 0.2 0.0 2.9 2.2 Weak/tired 0.0 0.1 0.2 0.2 Other 0.7 3.8 1.7 4.0 Don’t know 0.0 0.1 0.0 0.4 Missing 0.1 0.0 0.1 0.2 Total 100.0 100.0 100.0 100.0 Number of women 4,546 1,353 10,695 1,115 Family Planning • 91 7.2.10 Cost of Contraceptive Use The national family planning program in Indonesia is implemented by the government with the active involvement and participation of the community and private sectors. One indicator of the extent and desire of women to use contraception is self-reliance, measured here by the proportion of users who pay for the contraceptive methods and services received. In the 2012 IDHS, to assess the extent to which the program is achieving the goal of self-reliance, current users were asked how much they paid for the method and any consultation they had. The results presented in Tables 7.16 and 7.17 include the total cost that the user incurred for the method. Table 7.16 shows that 23 percent of all current users obtained their method from a government service delivery point, and most of them (16 percent) paid for the method and services. Seventy three percent of users obtained their current method from a private facility, and most of them (70 percent) paid for it. Overall, 89 percent of current users paid for their contraceptive method. Self-reliance in contraceptive use in the 2012 IDHS is two percentage points lower than in the 2007 IDHS (91 percent). Users of injectables, the pill, and the condom were more likely to pay for their contraceptive method (96 percent, 95 percent, and 95 percent, respectively) than users of other methods. Two-thirds of IUD users, 62 percent of female sterilization users, and 55 percent of implant users paid for their method. Women relying on male sterilization were the least likely to report paying for their method. Table 7.16 Payment for contraceptive methods and services Percent distribution of current female users of modern contraceptive methods by source of method and whether method is free or respondent pays for it, according to method, Indonesia 2012 Government Private Other Total Number of women Method Free Pay Free Pay Free Pay Female sterilization 27.9 30.9 9.5 30.6 0.6 0.5 100.0 1,081 Male sterilization (84.4) (0.0) (3.0) (12.7) (0.0) (0.0) 100.0 52 Pill 3.7 15.1 1.4 66.8 0.5 12.6 100.0 4,539 IUD 23.4 16.4 9.1 50.5 0.4 0.2 100.0 1,343 Injectables 2.6 13.9 1.3 81.8 0.0 0.4 100.0 10,676 Implants 33.4 26.0 9.1 28.2 2.7 0.6 100.0 1,110 Condom 2.7 2.6 2.0 78.6 0.4 13.8 100.0 575 Total 7.7 15.6 2.8 69.9 0.4 3.6 100.0 19,376 Note: Excludes cases where cost of method was “don’t know” or missing (11 and 85 weighted cases). Figures in parentheses are based on 25-49 unweighted cases. Table 7.17 shows the percentage of current users who received their method free, and for those who paid for their method, the mean cost in rupiah, by source of method. Overall, the 2012 IDHS shows that women who rely on government sources are much more likely to get free services (33 percent) than those who use private sources (4 percent) or other sources (9 percent). The mean cost of contraceptive methods varies substantially by type of method and source of services. Female sterilization is the most expensive method, while the pill is the cheapest. The cost of methods in a government facility is always less than in a private facility. For example, injectables cost Rp.18,000 in a private facility, compared with Rp.17,000 in a government facility. The cost of the pill from a private sector provider is twice what a user paid at a government source (Rp.10,000 versus Rp.5,000). An IUD costs Rp.278,000 in the private sector, compared with Rp.126,000 in the government sector. Users paid Rp.2,859,000 for female sterilization in the private sector compared with Rp.1,560,000 in the government sector. 92 • Family Planning Table 7.17 Mean cost of contraceptive methods and services Percentage of current users of modern contraceptive methods who get their method free and the mean cost (in 1,000 rupiahs) of the method (including services) for those who pay for it, by the type of source and method, Indonesia 2012 Government Private Other Method Free Mean cost (Rp.000) Number of users Free Mean cost (Rp.000) Number of users Free Mean cost (Rp.000) Number of users Female sterilization 47.5 1,506 636 23.6 2,859 433 55.0 279 13 Male sterilization (100.0) - 44 * * 8 na na 0 Pill 19.7 5 850 2.0 10 3,094 3.7 4 594 IUD 58.9 126 534 15.3 278 800 69.6 241 8 Injectables 15.6 17 1,761 1.6 18 8,873 10.1 16 42 Implants 56.2 85 660 24.4 145 414 81.9 50 36 Condom 51.1 6 30 2.5 13 463 2.8 14 81 Total 33.0 193 4,515 3.9 102 14,086 9.2 10 775 Note: Excludes cases where cost of method was “don’t know” or missing (11 and 85 weighted cases). Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 7.3 NONUSE AND INTENTION TO USE FAMILY PLANNING 7.3.1 Discontinuation Rates The number of women who are using a contraceptive method at a particular moment in time and their continuity of use affect the success of a particular method of contraception in preventing unwanted pregnancy. Improvement in the quality of family planning services in Indonesia must focus on maintaining continuity of use of contraceptive methods. Thus, a key indicator measuring the quality of use is the discontinuation rate of using a method of contraception. Table 7.18 presents contraceptive discontinuation rates among women age 15-49. These rates are based on information collected in the calendar section of the IDHS woman’s questionnaire. The analysis takes into account all episodes of contraceptive use from 3 to 62 months prior to the date of interview. The discontinuations that occurred in the two months preceding the interview were excluded to avoid the bias that might be caused by an unrecognized pregnancy. The rates in Table 7.18 represent the proportions of users who discontinue using a method within one year after the start of use. The single-month discontinuation rates are calculated by dividing the number of discontinuations at each duration of use in single months, by the number of months of exposure for that duration. These single-month rates are then cumulated to produce a one-year rate. The reasons for discontinuation are treated as competing risks (net rates). Table 7.18 also shows the switching rate. A woman was considered to have switched to another method if she used a different method in the month following discontinuation or if she gave “wanted a more effective method” as the reasons for discontinuation and started another method within two months of discontinuation. Overall, 27 percent of women who began an episode of contraceptive use within the five years preceding the survey discontinued using contraception within 12 months of starting the method. As expected, discontinuation rates are much higher for temporary methods like the pill (41 percent), male condoms (31 percent), and injectable (25 percent) than long-term methods like the IUD (6 percent) and implants (8 percent). Table 7.18 also shows that the switching rate was 13 percent for all methods. The switching rate is highest in the case of the pill and the male condom (20 percent and 18 percent, respectively). Family Planning • 93 Table 7.18 Twelve-month contraceptive discontinuation rates Among women age 15-49 who started an episode of contraceptive use within the five years preceding the survey, the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Indonesia 2012 Method Method failure Desire to become pregnant Other fertility- related reasons1 Side effects/ health concerns Wanted more effective method Other method- related reasons2 Other reasons Any reason3 Switched to another method4 Number of episodes of use5 Female sterilization 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.8 0.0 454 Pill 3.2 8.3 3.0 13.2 3.7 2.0 7.4 40.7 19.6 9,634 IUD 0.2 1.0 0.3 2.8 0.0 0.5 1.0 5.7 3.1 886 Injectables 0.4 4.4 3.4 9.8 1.0 1.4 4.2 24.7 12.0 16,915 Implants 0.2 0.7 0.6 4.6 0.0 0.4 1.4 7.9 4.3 1,243 Male condom 2.1 8.1 0.5 3.3 7.1 6.3 3.7 31.2 18.3 1,007 Rhythm 4.6 4.2 0.5 1.3 2.6 0.4 6.3 19.9 6.9 538 Withdrawal 5.5 4.8 0.8 2.8 2.6 1.4 4.8 22.8 7.4 1,037 Other1 5.5 0.3 0.0 0.8 3.7 2.7 0.9 13.8 4.8 119 All methods 1.5 5.1 2.7 9.4 1.9 1.6 4.9 27.1 13.0 31,970 Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the survey. 1 Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation 2 Includes lack of access/too far, costs too much, and inconvenient to use 3 Reasons for discontinuation are mutually exclusive and add to the total given in this column. 4 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A woman is considered to have switched to another method if she used a different method in the month following discontinuation or if she gave “wanted a more effective method” as the reason for discontinuation and started another method within two months of discontinuation. 5 Number of episodes of use includes both episodes of use that were discontinued during the period of observation and episodes of use that were not discontinued during the period of observation. 7.3.2 Reason for Discontinuation of Contraceptive Use Another perspective on contraceptive discontinuation is presented in Table 7.19. This table shows the percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason for discontinuation, according to method. The most common reason for discontinuing a method is the desire to become pregnant (29 percent). The next most common reason for discontinuation is fear about side effects or health concerns (18 percent). Table 7.19 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason stated for discontinuation, according to specific method, Indonesia 2012 Reason Pill IUD Injection Implants Male condom Rhythm With- drawal All methods Became pregnant while using 10.9 4.4 3.2 2.5 14.5 28.9 24.6 6.8 Wanted to become pregnant 28.7 29.6 30.3 22.2 30.5 31.2 30.0 29.4 Husband disapproved 0.5 0.5 0.3 0.1 1.9 0.3 0.3 0.4 Wanted a more effective method 7.3 3.9 3.5 4.1 14.4 9.5 11.7 5.3 Side effects/health concerns 14.9 12.7 21.6 22.1 4.4 4.2 3.8 18.1 Lack of access/too far 0.3 0.0 0.4 0.5 0.2 0.0 0.0 0.3 Cost too much 0.5 1.4 1.8 4.5 0.1 0.0 0.2 1.4 Inconvenient to use 2.8 4.8 2.4 3.5 11.4 0.5 3.2 2.8 Up to God/fatalistic 0.6 0.0 0.5 1.5 0.0 0.1 0.2 0.5 Difficult to get pregnant/menopausal 1.3 2.3 1.2 1.2 0.0 0.9 0.8 1.2 Infrequent sex/husband away 4.5 2.0 5.5 1.7 1.5 1.3 1.5 4.7 Marital dissolution/separation 2.2 2.0 2.9 2.7 1.0 0.7 3.2 2.6 IUD expelled 0.1 4.3 0.1 0.3 0.9 0.0 0.6 0.3 Other 12.3 14.7 12.2 17.2 7.6 10.1 12.0 12.4 Don’t know 0.0 0.0 0.1 0.1 0.2 0.4 0.6 0.1 Missing 13.1 17.4 14.0 15.8 11.5 11.9 7.3 13.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 5,423 591 10,883 681 409 316 545 18,972 Note: Total includes other modern methods. 94 • Family Planning It is worth noting that the main reason for discontinuation varies by method. Contraceptive failure (became pregnant while using) is a frequent reason for discontinuations of rhythm (29 percent) and withdrawal (25 percent), the condom (15 percent), and the pill (11 percent), but not of the IUD (4 percent), implants (3 percent) or injectables (3 percent). The percentage of discontinuations due to side effects/health concerns varies from 4 percent in the case of the rhythm, withdrawal, and the condom to 22 percent in the case of injectables and implants. The desire for a more effective method was cited more often as a reason for discontinuing the condom (14 percent), withdrawal (12 percent), and rhythm (10 percent) compared with other methods. 7.3.3 Need for Family Planning Services An estimate of the size and composition of the population of women who have an unmet need for family planning services is useful for planning purposes in reproductive health programs. Women with an unmet need for family planning include fecund women who are not using contraception but who wish to postpone the next birth (spacing) or stop childbearing altogether (limiting). The criteria used within the DHS program to identify women with unmet need for family planning have recently been revised (Bradley et al., 2012). The revised definition was employed for determining the women who have an unmet need for family planning in Table 7.20. Specifically, women are considered to have unmet need for spacing if they are: • At risk of becoming pregnant, not using contraception, and either do not want to become pregnant within the next two years, or are unsure if or when they want to become pregnant. • Pregnant with a mistimed pregnancy. • Postpartum amenorrheic for up to two years following a mistimed birth and not using contraception. Women are considered to have unmet need for limiting if they are: • At risk of becoming pregnant, not using contraception, and want no (more) children. • Pregnant with an unwanted pregnancy. • Postpartum amenorrheic for up to two years following an unwanted birth and not using contraception. Women who are classified as infecund have no unmet need because they are not at risk of becoming pregnant. Women using contraception are considered to have met need. Women using contraception who say they want no (more) children are considered to have met need for limiting, and women who are using contraception and say they want to delay having a child, or are unsure if or when they want a/another child, are considered to have met need for spacing. Finally, the total demand, percentage of demand satisfied, and percentage of demand satisfied by modern methods are defined as follows: • Total demand for family planning: the sum of unmet need (for spacing and limiting ) plus total contraceptive use • Percentage of demand satisfied: total contraceptive use divided by the sum of unmet need plus total contraceptive use • Percentage of demand satisfied by modern methods: use of modern contraceptive methods divided by the sum of unmet need plus total contraceptive use. Family Planning • 95 The change in the definition of unmet need for family planning was intended to make levels of unmet need comparable over time and across DHS surveys. The aspect of the change in the definition that has the largest impact on the level of unmet need is the decision not to use information collected from the contraceptive calendar in defining need. The contraceptive calendar has not been included in all DHS surveys across countries, and, consequently, unmet need had to be defined differently in countries like Indonesia in which the calendar was included than in countries in which the calendar was not included. Previously, in surveys like those in Indonesia that included a calendar, women who were pregnant or postpartum amenorrheic resulting from contraceptive failure were not considered to have unmet need, even if their last pregnancy/birth was unwanted or mistimed. By contrast, if a survey did not collect information on contraceptive failure in the calendar, all pregnant and postpartum amenorrheic women whose last pregnancy/birth was unwanted or mistimed were considered to have unmet need. To make the definition of unmet need comparable in both types of surveys, the new definition does not take information on contraceptive failure into account for any woman when assigning unmet need status. Removing contraceptive failure from the calculation results in a small increase in the estimated level of unmet need over the level that would be obtained using the prior definition in countries like Indonesia in which calendar data are available. Table 7.20 provides estimates of unmet need, met need, and demand for family planning for currently married women age 15-49 based on the new definition. Appendix Table A-7.8 shows the need and demand for family planning services across provinces. Table 7.20 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Indonesia 2012 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Age 15-19 6.3 0.4 6.7 45.0 3.1 48.1 51.2 3.5 54.7 87.8 87.1 890 20-24 7.7 0.6 8.3 54.8 5.7 60.5 62.5 6.4 68.8 88.0 86.1 3,754 25-29 6.8 2.1 8.9 48.0 15.6 63.6 54.8 17.7 72.5 87.7 83.3 6,000 30-34 6.1 3.7 9.7 33.7 31.9 65.7 39.8 35.6 75.4 87.1 81.9 6,285 35-39 3.3 7.9 11.2 16.9 51.2 68.1 20.2 59.1 79.3 85.9 79.0 6,331 40-44 2.1 12.8 14.9 5.6 59.6 65.2 7.6 72.4 80.0 81.4 74.3 5,572 45-49 0.9 15.3 16.2 1.9 43.8 45.8 2.9 59.1 62.0 73.8 67.1 4,633 Residence Urban 4.2 7.6 11.8 24.8 37.3 62.1 29.0 44.9 73.9 84.0 77.2 16,466 Rural 4.8 6.2 10.9 28.4 33.2 61.6 33.2 39.4 72.6 84.9 80.8 16,999 Education No education 5.3 8.1 13.4 10.1 33.4 43.4 15.3 41.5 56.8 76.5 73.5 1,209 Some primary 3.9 10.5 14.4 16.9 36.5 53.4 20.8 47.0 67.8 78.7 74.9 4,185 Completed primary 4.2 7.2 11.4 26.4 39.2 65.7 30.6 46.4 77.1 85.3 82.6 9,045 Some secondary 4.2 5.5 9.7 33.1 34.4 67.4 37.3 39.8 77.1 87.5 82.9 7,912 Completed secondary or higher 5.1 6.2 11.2 27.8 32.2 60.0 32.8 38.4 71.2 84.2 74.8 11,113 Number of living children 0 3.2 0.1 3.3 6.4 0.1 6.5 9.6 0.2 9.8 66.1 63.1 2,737 1-2 5.7 5.0 10.6 38.6 28.5 67.1 44.2 33.5 77.7 86.3 81.3 20,236 3-4 2.5 11.0 13.6 10.1 59.6 69.7 12.6 70.6 83.2 83.7 77.6 8,474 5+ 2.4 18.2 20.6 4.4 47.3 51.7 6.8 65.5 72.3 71.5 64.1 2,019 Wealth quintile Lowest 6.7 6.7 13.5 28.8 27.3 56.2 35.6 34.1 69.7 80.6 76.1 5,966 Second 3.8 6.4 10.2 30.2 34.1 64.3 34.0 40.5 74.5 86.3 82.4 6,614 Middle 3.9 6.4 10.3 28.1 35.7 63.9 32.0 42.1 74.2 86.1 81.2 6,864 Fourth 3.9 6.9 10.9 27.0 36.0 63.0 30.9 42.9 73.8 85.3 79.5 7,218 Highest 4.3 7.9 12.3 19.5 41.8 61.3 23.8 49.8 73.6 83.3 75.3 6,803 Total 4.5 6.9 11.4 26.7 35.2 61.9 31.1 42.1 73.2 84.5 79.0 33,465 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM). 96 • Family Planning The results in Table 7.20 indicate that, in Indonesia, the total unmet need for family planning is 11 percent, of which 7 percent is for limiting. Total unmet need rises with age, peaking at 16 percent among currently married women age 45-49. As expected, virtually all of the unmet need among women under age 25 is for spacing. Unmet need for limiting increases rapidly among women age 35 and older, peaking at 15 percent among women age 45-49 years. Total unmet need increases directly with the number of children to a level of 21 percent among women with five or more children. As expected, most of the unmet need among women at parities three and above is for limiting. Total unmet is only slightly higher among rural than urban women (12 percent versus 11 percent). Unmet need does not vary greatly across educational categories. Table 7.20 also shows that the total demand for family planning among currently married women in Indonesia, which is the sum of the met and unmet need, is 73 percent. Eighty-five percent of that demand is satisfied, primarily through use of modern contraceptive methods. Demand for family planning is lowest among women with no children (10 percent). The level of satisfied demand is lowest among women age 45-49 (74 percent), women with no education (76 percent), and women with five or more children (71 percent). As discussed above, the unmet need estimates included in the reports for prior IDHS surveys are not comparable with estimates in Table 7.20 because of the changes that have occurred in how unmet need is calculated. To provide comparable estimates, the total unmet need and the total demand for family planning have been recalculated using the new definition for the five DHS surveys carried out in Indonesia during the period 1991-2007. The recalculated estimates are shown in Table 7.21 along with the 2012 IDHS estimates. The results indicate that the level of unmet need in Indonesia has been declining over time. Between the 2007 and the 2012 IDHS surveys, total unmet need declined from a level of 13 percent to 11 percent (Figure 7.2). Largely as a result of the decline in unmet need, the total demand decreased slightly between the two surveys and the proportion of the demand that is satisfied also rose slightly. Table 7.21 Unmet need, current use, and demand for family planning, Indonesia 1991-2012 Percentage of currently married women aged 15-49 with unmet need for family planning, the percentage with a met need for family planning (currently using), the total demand for family planning, the percentage of the demand for contraception that is satisfied and the percentage of the demand satisfied by modern methods, Indonesia 1991-2012 Survey year Unmet need Met need (currently using) Total demand1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women 1991 IDHS 17.0 49.7 66.7 74.5 70.5 21,109 1994 IDHS 15.3 54.7 70.1 78.1 74.3 26,186 1997 IDHS 13.6 57.4 71.0 80.9 77.1 26,886 2002-2003 IDHS 13.2 60.3 73.6 82.0 77.1 27,857 2007 IDHS 13.1 61.4 74.5 82.4 77.0 30,931 2012 IDHS 11.4 61.9 73.2 84.5 79.0 33,465 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. The 2002-2003 IDHS did not include Nanggroe Aceh Darussalam, Maluku, North Maluku, and Papua Provinces. Previous surveys (the 1991, 1994, and 1997 IDHS) included East Timor. In the 1991, 1994, and 1997 IDHS surveys, West Java includes Banten. In the 2002-2003 IDHS West Java excludes Banten. The 2007 IDHS and the 2012 IDHS covered all 33 provinces. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM). Family Planning • 97 Figure 7.2 Trends in unmet need, 1991-2012 17 15 14 13 13 11 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Percentage with unmet need for family planning 7.3.4 Intention to Use in the Future Information obtained from nonusers in the 2012 IDHS on the intention to use contraception in the future provides insight into the attitudes of nonusers toward contraception and serves as a forecast of the demand for family planning among this group. Table 7.21 shows the percent distribution of currently married nonusers by intention to use in the future according to number of living children. Overall, 53 percent of nonusers intend to use contraception at some point in the future while 38 percent say that they do not plan to use. Nonusers with no children or only one child are the most likely to say they intend to use contraception (63 percent and 67 percent, respectively) and nonusers with four or more children are least likely to be interested in adopting contraception in the future (29 percent). Table 7.22 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Indonesia 2012 Number of living children1 Total Intention 0 1 2 3 4+ Intends to use 62.8 66.5 52.2 43.1 29.3 53.2 Unsure 11.2 6.8 6.6 7.1 8.9 7.7 Does not intend to use 25.6 25.7 39.1 47.7 60.7 37.7 Missing 0.5 1.1 2.1 2.2 1.1 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,812 3,861 3,196 1,955 1,938 12,761 1 Includes current pregnancy 98 • Family Planning 7.3.5 Reason for Nonuse One way of assessing obstacles to the adoption of family planning is to ask nonusers who say they do not intend to use contraception why they do not plan to use in the future. Table 7.23 shows the distribution of currently married nonusers who do not intend to use contraception by the main reason for not using family planning, according to age. Table 7.23 Reason for not intending to use contraception in the future Percent distribution of currently married women and currently married men who are not using contraception and who do not intend to use in the future by main reason for not intending to use, according to age Indonesia 2012 Women Men Reason 15-29 30-49 Total 15-29 30-54 Total Fertility-related reasons 22.1 43.3 40.2 7.8 12.8 12.0 Not having sex 3.4 8.1 7.4 0.2 1.3 1.1 Menopausal, hysterectomy 0.1 22.2 19.1 0.0 3.8 3.1 Can’t get pregnant 1.6 3.2 3.0 0.0 0.8 0.7 Want as many as children as possible 14.7 8.3 9.2 7.0 5.4 5.7 Fatalistic 2.3 1.5 1.6 0.6 1.5 1.4 Opposition to use 10.8 2.9 4.1 7.8 6.1 6.4 Respondent opposed 2.6 0.9 1.2 5.5 4.5 4.6 Husband opposed 4.0 1.8 2.1 0.9 0.3 0.4 Others opposed 0.3 0.1 0.1 0.4 0.0 0.1 Religious prohibition 4.0 0.2 0.7 1.0 1.2 1.2 Lack of knowledge 4.7 1.6 2.0 10.2 7.8 8.2 Knows no method 4.6 1.5 1.9 8.7 7.3 7.5 Knows no source 0.1 0.1 0.1 1.5 0.5 0.6 Method-related reasons 34.5 21.5 23.4 16.1 13.6 14.1 Health concerns 6.8 7.9 7.8 1.0 1.3 1.3 Side effects 24.7 9.3 11.5 9.5 7.7 8.0 Lack of access, too far 0.1 0.0 0.1 0.3 0.0 0.1 Cost too much 0.3 0.9 0.8 0.1 0.3 0.3 Inconvenient to use 1.3 2.4 2.3 5.2 4.1 4.3 Gain/lose weight 1.3 0.9 1.0 0.1 0.2 0.2 Other reasons 17.2 28.1 26.5 44.4 48.7 48.0 Don’t know 9.3 2.1 3.1 12.7 10.3 10.7 Missing 1.3 0.6 0.7 1.0 0.7 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 847 5,020 5,867 1,179 5,728 6,907 Married women who are not using contraception and do not intend to use a method most often cited fertility-related reasons (40 percent) for nonuse. Fertility-related reasons included factors that prevented the woman from becoming pregnant such as being menopausal or having had a hysterectomy (19 percent) as well as a desire to have as many children as possible (9 percent). More than one-fifth of the women mentioned method-related reasons including health concerns (8 percent) and fears about side effects (12 percent). Among men, 12 percent mentioned fertility-related reasons for nonuse, and 14 percent mentioned method-related reasons. The reasons women and men had for not planning to use varied with their age. For example, women under age 30 were more likely say they did not plan to use because they wanted more children (15 percent) while older women more often cited being menopausal or having had a hysterectomy (22 percent). Younger women were much more likely than older women to express concerns about side effects (25 percent) than older women (9 percent). Infant and Child Mortality • 99 INFANT AND CHILD MORTALITY 8 nfant and child mortality rates reflect a country’s level of health development and quality of life of the people. They are used to monitor and evaluate population and health programs and policies. For some time, Indonesia’s health programs have focused on reducing the high levels of infant and child mortality. The reduction of infant mortality and maternal mortality has become one of the major objectives to reach Goals 4 and 5 of the Millennium Development Goals (MDGs). For that purpose, in 2011, the government of Indonesia launched a JAMPERSAL (Jaminan Persalinan), a program that provides free antenatal, delivery, and postnatal services to pregnant women without health insurance and free childcare for the newborn baby for 28 days (Directorate of Child Health, Ministry of Health, 2012). This chapter covers information on the mortality of infants and children, including neonatal, postneonatal, infant, child, and under-5 mortality. In addition, it presents information on perinatal mortality and patterns of fertility related to mortality. Mortality estimates are disaggregated by socioeconomic characteristics, such as urban- rural residence, mother’s level of education, and household wealth, as well as selected demographic characteristics, such as child sex, mother’s age at birth, birth order, birth interval, and birth size. This chapter also reports on levels, trends, and differentials in infant and child mortality based on the 2012 Indonesia Demographic and Health Survey (IDHS) and selected earlier surveys. The data for mortality estimates were collected in the birth history section of the Woman’s Questionnaire. The 2012 IDHS asked women age 15-49 to provide a complete history of their live births, such as name of the child; sex, month, and year of birth; survival status; and age at death. Age at death was recorded in days for children dying in the first month of life, in months for children dying before their second birthday, and in years for children dying at later ages. I Key Findings • Infant and under-5 mortality rates for the five-year period preceding the survey are 32 and 40 deaths per 1,000 live births, respectively. Thus, one in every 31 babies dies before reaching age 1, and one in every 28 children dies between their first and fifth birthday. • Sixty percent of infant deaths occurred during the first month of life (neonatal period), and eighty percent of child deaths occurred during infancy. • Infant mortality rates for the 10-year period preceding the survey are highest for children living in rural areas, children whose mothers have no education, and children in the lowest wealth quintile. • Infant mortality rates for the 10-year period preceding the survey are highest among children whose mother gave birth at age 40 or older, who had high parity (3 or higher), and became pregnant after a short birth interval (less than 24 months). • Perinatal mortality is highest among children born less than 15 months after the previous pregnancy (45 deaths per 1,000 pregnancies). 100 • Infant and Child Mortality The following rates are used to measure early childhood mortality: Neonatal mortality: the probability of dying within the first month of life Post-neonatal mortality: the probability of dying after the first month of life but before exact age 1 Infant mortality: the probability of dying between birth and exact age 1 Child mortality: the probability of dying between exact age 1 and exact age 5 Under-five mortality: the probability of dying between birth and exact age 5 Perinatal mortality: the sum of stillbirths and early neonatal deaths (deaths in the first seven days of life) divided by the number of pregnancies of seven or more months 8.1 ASSESSMENT OF DATA QUALITY A retrospective birth history, such as that included in the 2012 IDHS, is susceptible to several possible data collection errors. First, only surviving women age 15-49 were interviewed; therefore, no data were available for children of women who had died. The resulting mortality estimates will be biased if the fertility of surviving and nonsurviving women differs substantially. In Indonesia, this bias is likely to be negligible. But if the survivorship of children of surviving and nonsurviving mothers is different, it is likely that the children of non- surviving mothers will fare worse than those of surviving mothers, and the resulting mortality estimates will have a downward bias. Another possible error is underreporting of events; respondents are more likely to forget distant events than recent events. Thus, deaths that occurred in the more distant past are less likely to be reported than recent deaths, resulting in underreporting of deaths. Mortality estimates based on these data are likely to be biased downward as a result of underreporting. The effect of truncation of birth history data, for estimates in the more distant past, is mostly the experience of younger respondents, for whom the relatively lower estimate in the more distant past is more apparent. Misreporting of date of birth and/or age at death can also bias mortality rates. In general, these problems are less serious for time periods in the recent past than for those in the more distant past. The 2012 IDHS data can be examined for evidence of the existence and extent of some of these biases. With respect to the misreporting of children’s birth dates, as shown in Appendix Table D-4, there is a deficit of births in calendar year five (year 2007) and an excess of births in calendar year six (year 2006). This pattern, which has been found in previous IDHS surveys, is thought to result from interviewers’ transference of births out of the period in which the calendar and child health data were collected (i.e., January 2007 through the date of the survey) to reduce their workload. With regard to the reporting of children’s age at death, the most common source of error is the tendency of mothers to report the age in multiples of six months. To reduce this type of error, detailed instructions were given to the IDHS interviewers to record age at death under 1 month in days and age at death under 2 years in months. Interviewers were also instructed to probe for exact age at death in months whenever it was reported as “1 year” or “12 months.” The distribution of deaths among children under age 2 is shown in Appendix Table D.6. The quality of reported data on age at death in months is similar to the previous IDHS. There is evidence of heaping of deaths at age 12 months in the 2012 IDHS (in total 28 deaths, 4 deaths reported as deaths at 12 months and 24 deaths reported at 1 year), a common error that can affect infant mortality estimates. As experienced in the 2007 IDHS, heaping in age at death is more serious for deaths that occurred further in the past than for those that occurred more recently. As can been seen in Figure 8.1 although it is apparent that age at death heaping occurs at 12 months, the distribution of deaths by months reported for the period 0-4 years preceding the survey is smoother than the distributions for the periods 5-9 and 10-14 years before the survey. Infant and Child Mortality • 101 Figure 8.1 Reported age at death in months 0 50 100 150 200 250 300 350 400 <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24+ Number of deaths Age at death (months) 0-4 5-9 10-14 Years preceding the survey: Another problem concerns the fact that the IDHS mortality estimates refer to the survival status of births that occurred in a given period of time (e.g., 0-4 years before survey). However, because only women who were in the reproductive ages at the time of the survey were interviewed, women age 50 and over were not interviewed and, thus, could not report the survival of any births they may have had in the period being considered. As the periods covered extend further into the past, the resulting censoring of information becomes progressively more severe. To minimize the effect of censoring, analysis of infant and child mortality trends from the 2007 IDHS is limited to a period no more than 15 years prior to the survey. In discussing issues affecting IDHS mortality data, it should also be noted that, because fertility levels are low in Indonesia, the IDHS infant and child mortality estimates are based on relatively small numbers of cases. This situation can lead to unstable estimates. To reduce this problem, mortality measures based on the 2012 IDHS are calculated for five- or ten-year periods. Finally, the mortality estimates from the IDHS surveys are computed directly from information on the deaths of children collected in the birth history table. Lacking the necessary information for producing estimates using direct methods, population censuses in Indonesia typically report indirect estimates based on the number of children ever born and children surviving. While there is no conclusive agreement on whether one estimate is better than the other, the underlying assumptions used in the indirect estimates can introduce a potential bias. Studies have found that even when an appropriate mortality model is applied, the results of the indirect estimation techniques are consistently higher than those of direct methods (Sullivan et al., 1994). Thus, in this report, only direct estimates from the IDHS are presented. 8.2 LEVELS AND TRENDS IN INFANT AND CHILD MORTALITY Mortality rates for infant and child are presented in Table 8.1 for the three five-year periods preceding the survey. Data from the 2012 IDHS show that infant mortality during the five years preceding the survey (which roughly corresponds to the years 2008-2012) is 32 deaths per 1,000 live births. This means that one in thirty-one children born in Indonesia die before reaching the first birthday. Sixty percent of infant deaths occurred during the age of 0 months, which gives a neonatal mortality rate of 19 deaths per 1,000 live births. Eighty percent of child deaths occurred during age 1-11 months, which give the postneonatal mortality of 13 deaths per 1,000 live births. 102 • Infant and Child Mortality The under-5 mortality and child mortality rates are 40 and 9 deaths per 1,000 live births, respectively. The level of child mortality rate is around one-third of the infant mortality rate, 9 deaths compared with 32 deaths per 1,000 live births. Table 8.1 Early childhood mortality rates Neonatal, post-neonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Indonesia 2012 Years preceding the survey Approximate calendar year Neonatal mortality (NN) Post-neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 0-4 2008-2012 19 13 32 9 40 5-9 2003-2007 20 15 35 11 45 10-14 1998-2002 23 21 45 14 58 1 Computed as the difference between the infant and neonatal mortality rates Using estimates from prior IDHS surveys, Table 8.2 shows that the infant mortality rate has declined by more than half, from 68 deaths per 1,000 live births in the period 1987-1991 to 32 deaths per 1,000 live births in the period 2008-2012. Even more impressive are the 72 percent decline in child mortality and the 64 percent decline in postneonatal mortality over the same period. The corresponding decline in neonatal mortality was 41 percent. Comparison of six IDHS surveys (1991, 1994, 1997, 2002-2003, 2007, and 2012) shows different patterns in the decline of neonatal, infant, and under-5 mortality (Figure 8.2). Comparison of mortality rates over the last two surveys show that infant and under-5 mortality have declined slightly, while neonatal mortality which remains constant. Based on the IDHS findings, the MDGs goal in reducing the infant mortality from 90 deaths per 1,000 live births in 1990 to 23 deaths per 1,000 live births in 2015 seems hard to achieve. Many factors must be addressed, such as availability of and access to health facilities, as well as improving the quantity and quality of health providers. Table 8.2 Trends in early childhood mortality Neonatal, postneonatal, infant, child, and under-5 mortality rates for five-year periods preceding the IDHS surveys Data source Approximate reference period Neonatal mortality (NN) Post- neonatal mortality1 (PNN) Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 2012 IDHS 2008-2012 19 13 32 9 40 2007 IDHS 2003-2007 19 15 34 10 44 2002-2003 IDHS 1998-2002 20 15 35 11 46 1997 IDHS 1993-1997 22 24 46 13 58 1994 IDHS 1990-1994 30 27 57 26 81 1991 IDHS 1987-1991 32 36 68 32 97 1 Computed as the difference between the infant and neonatal mortality rates Infant and Child Mortality • 103 Figure 8.2 Trend in neonatal, infant, and under-5 mortality, IDHS 1991-2012 32 30 22 20 19 19 68 57 46 35 34 32 97 81 58 46 44 40 1985 1990 1995 2000 2005 2010 2015 Deaths per 1,000 live births Calendar year Neonatal mortality Infant mortality Under-5 mortality Sources: (a) 1991 IDHS; (b) 1994 IDHS; (c) 1997 IDHS; (d) 2002-2003 IDHS; (e) 2007 IDHS; (f) 2012 IDHS (a) (a) (a) (b) (b) (b) (c) (c) (c) (d) (d) (d) (e) (e) (e) (f) (f) (f) Figure 8.3 shows estimates of infant mortality rate from prior surveys and censuses. The infant mortality rate has gradually decreased from 142 deaths per 1,000 live births in 1967 to 32 deaths per 1,000 live births in 2012. Slight fluctuations in the estimates are expected as they were calculated based on different data collection methods and using different estimation techniques. There are also differences in the geographic coverage of the various surveys and censuses. Figure 8.3 shows that the decline in the infant mortality rate has slowed down in recent years. 104 • Infant and Child Mortality Figure 8.3 Trend in infant mortality rate, selected sources, Indonesia 1971-2012 142 112 75 70 68 57 46 47 35 34 26 32 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Deaths per 1,000 live births Calendar year Sources: (a) 1971 Census; (b) 1980 Census; (c) 1987 NICPS; (d) 1990 Census; (e) 1991 IDHS; (f) 1994 IDHS; (g) 1997 IDHS; (h) 2000 Census; (i) 2002-2003 IDHS; (j) 2007 IDHS; (k) 2010 Census; (l) 2012 IDHS (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) 8.3 SOCIOECONOMIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY Differentials in childhood mortality by selected socioeconomic characteristics for the ten years preceding the survey (approximately 2003-2012) are presented in Table 8.3. The socioeconomic determinants include place of residence, mother’s educational attainment, and wealth index quintiles. These findings must be interpreted with caution given the low precision of mortality estimates due to sampling errors. There is a large difference in infant and child mortality levels between urban and rural areas. In general, urban mortality is around two-thirds of the rural mortality at every age. . Mother’s level of education is inversely related to her child’s risk of dying. Higher levels of educational attainment are generally associated with lower mortality risks because education exposes mothers to information about better pregnancy and child health care. For example, infant mortality is 77 percent lower for children whose mothers have more than secondary education than for those with no education (15 and 66 deaths per 1,000 live births, respectively). A child’s risk of dying is also associated with the economic status of the household. All childhood mortality rates are lowest for children in the highest wealth quintile. For all infant and child mortality rates, the level of mortality of children in the highest quintile is about one-third that of children in the lowest quintile. For instance, the risk of dying by age 5 for children in the highest quintile is 23 deaths per 1,000 live births compared with 70 deaths per 1,000 live births for children in the lowest quintile. Infant and Child Mortality • 105 Table 8.3 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by background characteristics, Indonesia 2012 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Residence Urban 15 11 26 8 34 Rural 24 16 40 12 52 Mother’s education No education 31 34 66 33 96 Some primary 37 22 60 17 76 Completed primary 24 18 43 10 52 Some secondary 15 9 24 8 32 Completed secondary 16 11 27 6 32 More than secondary 10 4 15 4 18 Wealth quintile Lowest 29 23 52 19 70 Second 21 13 34 9 43 Middle 23 10 33 7 39 Fourth 15 12 28 7 34 Highest 10 8 17 6 23 1 Computed as the difference between the infant and neonatal mortality rates 8.4 DEMOGRAPHIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY A number of socioeconomic, environmental, and biological factors influence infant and child mortality. In a framework developed for the study of child mortality in developing countries, Mosley and Chen (1984) outlined various proximate and socioeconomic determinants of infant mortality. The proximate determinants, which are factors that affect mortality directly, include maternal characteristics such as age, parity, and birth interval; environmental contamination; nutrition; injury; and personal illness. Socioeconomic factors operate through the proximate determinants. Based on Mosley and Chen’s framework, this section examines differentials in early childhood mortality by demographic characteristics of the child and the mother such as mother’s age at birth, birth order, birth interval, and birth size. It also examines the infant and child mortality by sex (Table 8.4). Neonatal mortality is expected to be higher for males than for females because baby boys are more vulnerable than baby girls from the time of conception. The 2007 and 2012 IDHS found that all infant and child mortality rates are lower for females than for males. For example, the neonatal mortality rate for males is 24 deaths per 1,000 live births compared with 16 deaths per 1,000 live births for females. The infant mortality rate for males is 39 percent higher than the rate for females. The relationship between mother’s age at birth and childhood mortality rates exhibits a U-shaped pattern. Children of the youngest and the oldest mothers experienced the highest mortality risks. The higher rates for younger and older women may be related to biological factors that lead to complications during pregnancy and delivery. The 2012 IDHS results show that there is a clear positive association between birth order and the probability of dying; the risk of dying increases with higher order births. For example, while the infant mortality rate for first-order births is 35 deaths per 1,000 live births, the rate for seventh- or higher-order births is 71 deaths per 1,000 live births. 106 • Infant and Child Mortality Table 8.4 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Indonesia 2012 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Child’s sex Male 24 15 39 10 49 Female 16 12 28 9 37 Mother’s age at birth <20 34 16 50 11 61 20-29 18 13 31 8 39 30-39 17 14 31 11 42 40-49 33 25 58 13 70 Birth order 1 24 11 35 7 41 2-3 15 13 29 9 37 4-6 22 18 40 16 56 7+ 43 28 71 26 95 Previous birth interval2 <2 years 36 28 64 20 82 2 years 24 19 42 16 58 3 years 11 15 27 12 38 4+ years 13 12 24 8 32 Birth size3 Small/very small 66 18 84 na na Average or larger 8 10 18 na na DK/Missing 117 59 176 na na na = Not applicable 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey Short birth intervals are associated with an increased risk of dying. Retherford and others (1989) observe an association between short birth intervals (less than 2 years) and increased mortality, even after controlling for other demographic and socioeconomic variables. As shown in Table 8.4, all childhood mortality rates are lower at longer birth intervals. Child mortality is more than three times higher for children born after an interval of less than two years compared with children who are born after an interval of four years or longer. Neonatal, postneonatal, infant, and under-5 mortality are more than two times higher for children born after an interval of less than two years compared with children who are born after an interval of four years or longer. Studies have shown that children’s birth weight is an important determinant of their survival chances (UNICEF and WHO, 2004). In the 2012 IDHS, mothers were asked whether, according to their perception, their child was very large, larger than average, average, smaller than average, or very small at birth; this perception has been found to be a good proxy for a child’s weight. As expected, the size of the baby at birth and mortality are negatively associated. For example, neonatal mortality of births reported with small or very small size is 66 deaths per 1,000 live births, whereas neonatal mortality of births reported with average or large size is 8 deaths per 1,000 live births. 8.5 PERINATAL MORTALITY The perinatal mortality rate is a useful indicator of the state of delivery services, both in terms of the utilization of these services and their ability to ensure delivery of healthy babies. In the 2012 IDHS, women were asked to report all pregnancy losses that occurred in the five years preceding the survey. For each such pregnancy, the duration was recorded. Perinatal deaths are composed of pregnancy losses occurring after seven completed months of gestation (stillbirths) and deaths within the first seven days of life (early neonatal deaths). The perinatal Infant and Child Mortality • 107 mortality rate is the sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration. The distinction between a stillbirth and an early neonatal death is a delicate one, often depending on the observed presence or absence of some signs of life after delivery. The causes of stillbirths and early neonatal deaths overlap, and examining just one or the other can understate the true level of mortality around delivery. For these reasons, it is suggested that both events be combined and examined together. In the 2012 IDHS, information on stillbirths is available for the five years preceding the survey and is collected using the calendar at the end of the Woman’s Questionnaire, while information on early neonatal deaths is calculated from the birth history. Data in Table 8.5 show that 181 stillbirths and 268 early neonatal deaths were reported in the survey, resulting in a perinatal mortality rate of 26 per 1,000 pregnancies in Indonesia. This figure is almost same as the level observed in the 2007 and 2002-2003 IDHS (25 deaths and 24 deaths per 1,000 pregnancies, respectively). Table 8.5 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Indonesia 2012 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother’s age at birth <20 19 34 34 1,544 20-29 82 133 23 9,341 30-39 74 87 29 5,612 40-49 7 13 32 631 Previous pregnancy interval in months4 First pregnancy 64 119 30 6,132 <15 9 26 45 776 15-26 16 30 28 1,664 27-38 13 29 29 1,457 39+ 79 64 20 7,100 Residence Urban 54 112 20 8,459 Rural 127 156 33 8,670 Mother’s education No education 8 6 36 372 Some primary 22 37 40 1,480 Completed primary 83 83 41 4,059 Some secondary 39 59 22 4,477 Completed secondary 25 66 20 4,619 More than secondary 4 16 9 2,123 Wealth quintile Lowest 66 68 35 3,792 Second 46 51 29 3,301 Middle 39 66 31 3,351 Fourth 16 48 19 3,453 Highest 15 34 15 3,232 Total 181 268 26 17,129 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, expressed per 1,000. 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. 108 • Infant and Child Mortality Perinatal mortality is high among teenage mothers and mothers age 40-49. Perinatal mortality is highest in women who have a birth interval of less than 15 months (45 deaths per 1,000 pregnancies). Rural areas have higher perinatal mortality than urban areas (33 compared with 20 deaths per 1,000 pregnancies). Perinatal mortality has a negative association with a mother’s education and wealth status; it is lowest for women who have more than a secondary education and for women in the highest wealth quintile. 8.6 HIGH-RISK FERTILITY BEHAVIOR Many studies have found a strong relationship between children’s chances of dying and certain fertility behaviors. In general, the probability of dying in early childhood is much greater if children are born to mothers who are too young or too old, if they are born after a short birth interval, or if they are born to mothers with high parity. For this analysis, mothers are classified as too young if they are less than age 18 and too old if they are over age 34 at the time of delivery. A short birth interval is defined as a birth occurring within two years of a previous birth, and a high birth order is defined as a birth occurring after three or more previous births (birth order four or higher). After cross-classification of births by combinations of all three characteristics, a birth may have from zero to three high-risk characteristics. All risk categories are potentially avoidable except for first births to mothers age 18-34. Table 8.6 shows the percent distribution of births in the five-year period preceding the survey and the distribution of all currently married women across various risk categories. It also shows the relative risk of children dying across the various risk categories. The purpose of this table is to identify areas in which changes in reproductive behavior would be likely to reduce infant and child mortality. Mortality risk is represented by the proportion of children born during the five years preceding the survey who had died by the time of the survey. The “risk ratio” is the ratio of the proportion of dead children in a given high-risk category to the proportion of dead children not in any high-risk category. Among children born in the five years preceding the survey, 36 percent are not in any high-risk categories, another 29 percent of births are in one of the avoidable high-risk categories, 20 percent are in a single high-risk category, and 9 percent are in a multiple high-risk category. The remainder (35 percent) fall in the category of unavoidable risk, that is, first order births to women age 18-34. Thus, 64 percent of births in Indonesia are in some high-risk category. The most common risk categories are a mother’s old age (older than 34 years) or young age (younger than 18 years), a birth interval of less than two years, and a birth order of three or higher. Table 8.6 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Indonesia 2012 Risk category Births in the 5 years preceding the survey Percentage of currently married women1 Percentage of births Risk ratio Not in any high risk category 35.5 1.00 30.5a Unavoidable risk category First order births between ages 18 and 34 years 35.4 1.35 5.8 Single high-risk category Mother’s age <18 2.4 2.07 0.3 Mother’s age >34 7.6 1.51 21.7 Birth interval <24 months 4.0 1.73 8.5 Birth order >3 5.6 1.94 4.1 Subtotal 19.6 1.75 34.7 Multiple high-risk category Age <18 and birth interval <24 months2 0.1 (14.68) 0.1 Age >34 and birth interval <24 months 0.2 (0.71) 0.6 Age >34 and birth order >3 7.1 1.85 24.8 Age >34 and birth interval <24 months and birth order >3 0.8 2.57 1.7 Birth interval <24 months and birth order >3 1.3 3.23 1.8 Subtotal 9.5 2.19 29.1 In any avoidable high-risk category 29.1 1.89 63.7 Total 100.0 na 100.0 Number of births/women 16,954 na 33,465 Note: Risk ratio is the ratio of the proportion dead among births in a specific high- risk category to the proportion dead among births not in any high-risk category. Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women Infant and Child Mortality • 109 Risk ratios, which describe the relationship between a particular risk category and a reference category, are used to compare mortality by risk category. The single high-risk category with the largest percentage of births is mother’s age more than 34, which constitutes 8 percent of births. The mortality associated with this category is 1.5 times that of births with no elevated mortality risk. Children born to mothers age less than 18 are more than twice as likely to die as those born to mothers who are not in any high-risk category. Children with birth order three or higher are twice as likely to die as children not in any high-risk category The multiple high-risk category with the largest percentage of births is children with birth order more than three born to mothers age 34 or older (7 percent). The multiple high-risk category with the highest risk ratio is the combination birth interval less than 24 months and birth order higher than 3. The children in this category (1 percent of all children) is more than three times more likely to die than children with no elevated mortality risk. The last column in Table 8.6 shows the distribution of currently married women by the risk category into which a birth would fall if conceived at the time of the survey. This column is based on assumptions that do not take into account family planning, postpartum infecundity, and prolonged abstinence. Among married woman who gave birth in the five years preceding the survey, 31 percent are not at any elevated risk of mortality, and 64 percent are in at least one of the avoidable high-risk categories; 35 percent have a single high-risk factor and 29 percent have multiple high-risk factors. Reproductive Health • 111 REPRODUCTIVE HEALTH 9 his chapter presents findings from the 2012 Indonesia Demographic Health Survey (IDHS) on several areas of importance to reproductive health, i.e., antenatal and delivery care, complications during pregnancy and delivery, postnatal care, and problems in accessing health care. Information on antenatal care (ANC) and postnatal care (PNC) is of great value in identifying subgroups of women who do not utilize such services, and is useful in planning for improvements in services. Antenatal care is defined according to the type of provider, the number of ANC visits made, the stage of pregnancy at the time of the first visit, and the services and information provided during antenatal care, including whether a tetanus toxoid injection was received. Similarly, delivery services are described according to the place of delivery, the person who assisted with the delivery, and some information about preparations for the delivery. Information on postnatal care from the 2012 IDHS is more comprehensive than information from the IDHS 2007. The 2012 IDHS collected information about postnatal checkups not only for the mother but also for the newborn. Combined with details about pregnancy complications and neonatal and infant mortality rates, this information helps identify groups that are underserved. T Key Findings • Ninety-six percent of mothers receive antenatal care from a skilled provider. This proportion has slightly increased from the 2007 IDHS. • Eighty-eight percent of women make four or more antenatal care visits during their pregnancy, and this percentage has increased by 6 percentage points from the level in the 2007 IDHS. • More than half (53 percent) of the mothers were informed of possible complications during pregnancy, an increase from 39 percent from the 2007 IDHS. • Sixty percent of last-born children were fully protected against neonatal tetanus during the five-year period before the survey. • Eighty-three percent of births in the past five years were assisted by a skilled provider, an increase from 73 percent in 2007. • The percentage of births taking place in a health facility has increased from 46 percent in the 2007 IDHS to 63 percent in the 2012 IDHS. • Eighty percent of women receive postnatal care in the first two days after delivery. • For births in the two years preceding the survey, 12 percent received a postnatal checkup within one hour, and 23 percent received a postnatal checkup within 1-3 hours. 112 • Reproductive Health 9.1 ANTENATAL CARE 9.1.1 Antenatal Care Table 9.1 shows the percent distribution of women who had a live birth in the five years preceding the survey according to the provider of antenatal care received during pregnancy and background characteristics. Appendix Table A-9.1 shows provincial differentials in antenatal care coverage. In Indonesia, antenatal care is defined as pregnancy-related health care provided by a skilled provider (i.e., doctor, obstetrician, nurse, midwife, or village midwife). Although mothers of live births may have received antenatal care from more than one type of provider, for early detection of high-risk pregnancies, this report uses the most qualified provider. Among 45,607 women age 15-49 interviewed in the survey, 14,782 were mothers who had a live birth in the five years preceding the survey. Ninety-six percent of these women received antenatal care from a skilled provider: 75 percent received care from a nurse, midwife, or village midwife; 19 percent received care from an obstetrician, and 1percent received care from a doctor. Compared with the 2007 IDHS (BPS and Macro International, 2008), antenatal care coverage has slightly increased (93 and 96 percent, respectively). Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Indonesia 2012 Antenatal care provider No ANC Total Percentage receiving antenatal care from a skilled provider1 Number of women Background characteristic Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Other Missing Mother’s age at birth <20 1.0 8.3 85.4 1.5 0.6 0.1 3.0 100.0 94.7 1,328 20-34 1.5 20.3 74.4 0.7 0.4 0.4 2.4 100.0 96.1 11,045 35-49 1.5 19.1 73.7 0.7 0.2 0.9 4.0 100.0 94.3 2,409 Birth order 1 1.5 20.0 76.3 0.4 0.3 0.1 1.4 100.0 97.7 5,543 2-3 1.4 20.7 73.9 0.7 0.5 0.5 2.3 100.0 96.0 7,115 4-5 1.6 13.0 77.0 1.6 0.5 1.2 5.1 100.0 91.6 1,588 6+ 1.4 4.4 76.8 2.6 0.3 0.4 14.3 100.0 82.5 536 Residence Urban 1.2 27.9 69.1 0.1 0.3 0.5 0.9 100.0 98.2 7,358 Rural 1.7 10.2 81.3 1.4 0.5 0.4 4.5 100.0 93.3 7,424 Education No education 1.2 3.2 59.6 4.9 0.5 0.8 29.8 100.0 64.0 274 Some primary 1.1 4.9 82.5 2.1 0.7 0.3 8.3 100.0 88.5 1,242 Completed primary 1.2 5.5 87.4 1.3 0.7 0.8 3.1 100.0 94.0 3,516 Some secondary 1.6 9.6 86.2 0.5 0.3 0.3 1.6 100.0 97.4 3,965 Completed secondary 1.8 26.8 69.7 0.2 0.3 0.3 0.9 100.0 98.4 4,021 More than secondary 1.1 61.7 36.3 0.1 0.0 0.5 0.3 100.0 99.1 1,765 Wealth quintile Lowest 1.6 3.3 82.1 2.8 0.8 0.7 8.8 100.0 86.9 3,035 Second 1.7 8.5 85.6 0.6 0.7 0.5 2.5 100.0 95.8 2,881 Middle 1.5 13.4 82.8 0.2 0.2 0.4 1.5 100.0 97.7 2,939 Fourth 1.5 23.7 73.8 0.1 0.2 0.4 0.3 100.0 99.0 3,105 Highest 1.1 47.2 51.1 0.0 0.2 0.2 0.2 100.0 99.4 2,822 Total 1.4 19.0 75.3 0.8 0.4 0.4 2.7 100.0 95.7 14,782 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, obstetrician, nurse, midwife, and village midwife. Reproductive Health • 113 Table 9.1 shows that antenatal care coverage is 90 percent or higher in most subgroups. The exceptions include mothers of sixth or higher order births (83 percent), mothers with no or some education (64 and 89 percent, respectively), and mothers in the lowest wealth quintile (87 percent). Considering specific provider categories, there are marked differences, particularly with respect to antenatal care from obstetricians. For example, whereas 28 percent of urban women received ANC from an obstetrician, only 10 percent of rural women did so. There also is a strong relationship between the type of skilled provider and mother’s level of education and economic status. Mothers with the highest education and in the highest wealth quintile are much more likely than other women to receive care from an obstetrician. 9.1.2 Number of Antenatal Care Visits and Timing of First Visit The Indonesian maternal health program recommends that pregnant women have at least four antenatal care visits during pregnancy, according to a 1-1-2 schedule, i.e., at least one visit in the first trimester, at least one visit in the second trimester, and at least two visits in the third trimester (Ministry of Health, 2012). Table 9.2 shows that 74 percent of pregnant women met the government’s recommended schedule of antenatal care visits. This is higher than the antenatal care coverage rate found in the 2007 IDHS (66 percent) (BPS and Macro International, 2008) but still well below the target of 95 percent set by the maternal health program. Pregnant women in urban areas are more likely than those in rural areas to have 1-1-2 antenatal care visits (80 and 68 percent, respectively). The details about the number and timing of visits show 88 percent of pregnant women had four or more antenatal care visits. Women in urban areas were more likely to make four or more visits than women in rural areas (93 and 83 percent, respectively). Overall, 80 percent of pregnant women came for the first antenatal care visit before the fourth month of pregnancy. The median number of months pregnant at the first antenatal care visit is 2.4. Women in urban areas are more likely than those in rural areas to come for the first antenatal care visit before the fourth month (85 and 76 percent, respectively). The median number of months pregnant at first visit is 2.1 and 2.6 months, respectively, among urban and rural mothers. The percentage having the first antenatal care visit before the fourth month of pregnancy was higher in 2012 than in 2007 (75 percent) as seen in Figure 9.1. Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, the percentage who had ANC visits on the recommended schedule, the percent distribution by the timing of the first visit, and, among women with ANC, median months pregnant at first visit, according to residence, Indonesia 2012 Number and timing of ANC visits Residence Total Urban Rural Number of ANC visits None 1.3 4.8 3.1 1 0.9 2.2 1.6 2-3 4.6 9.1 6.9 4+ 92.7 82.9 87.8 Don’t know/missing 0.6 0.9 0.7 Total 100.0 100.0 100.0 At least one visit in the first trimester, at least one in the second, and at least two in the third 79.6 67.5 73.5 Number of months pregnant at time of first ANC visit No antenatal care 1.3 4.8 3.1 <4 84.8 76.2 80.4 4-5 10.7 12.7 11.7 6-7 2.6 4.3 3.5 8+ 0.4 1.3 0.9 Don’t know/missing 0.2 0.6 0.4 Total 179.6 167.5 173.5 Number of women 7,358 7,424 14,782 Median months pregnant at first visit (for those with ANC) 2.1 2.6 2.4 Number of women with ANC 7,260 7,066 14,327 114 • Reproductive Health Figure 9.1 Trend in timing of first ANC visit 9.1.3 Components of Antenatal Care In Indonesia, it is recommended that every pregnant woman receive the following services: height and weight measurements, blood pressure measurement, iron tablets, tetanus toxoid immunization, abdominal examination, and pregnancy consultation/counseling (Ministry of Health, 2012). As part of her antenatal care, a woman also should be informed of the signs of pregnancy complications and give blood and urine samples. Table 9.3 shows the percentage of women who received the services typically provided during antenatal care visits for their most recent birth and the percentage that took iron tablets or syrup during their pregnancy. Appendix Table A-9.2 shows the variation by province in the components of antenatal care services received by pregnant women. More than nine in ten women reported having an abdominal examination (98 percent) and their blood pressure (96 percent) and weight measured (95 percent). Eight in ten women had at least one consultation on the progress of their pregnancy. Only slightly more than half (53 percent) of pregnant women were informed of the signs of pregnancy complications. Seventy-six percent of pregnant women took iron tablets or syrup during pregnancy for their last birth.1 Less than half of women had a urine or blood sample taken (48 and 41 percent, respectively) or their height measured (47 percent). In general, the likelihood that a mother received the various antenatal care services in Table 9.3 decreased with the birth order. For example, 85 percent of mothers receiving antenatal care for a first birth reported that they had a consultation about preparing for the delivery compared with 69 percent of mothers of sixth or higher order births. Urban mothers reported receiving the various antenatal care services more often than rural mothers. The differences are especially notable with respect to the proportions of urban and rural 1 Additional information on the consumption of iron supplements is discussed in Chapter 11. 4 75 15 4 1 3 80 12 4 1 No ANC < 4 months 4-5 months 6-7 months 8+ months Percent 2012 IDHS 2007 IDHS IDHS 2012 Reproductive Health • 115 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, percentage who received antenatal care for the most recent live birth, by content of care received, and the percentage who took iron tablets or syrup for the most recent birth, according to background characteristics, Indonesia 2012 Among women who received antenatal care for their most recent birth in the past five years, the percentage with selected services Among women with a live birth in the past five years, the percentage who during the pregnancy of their last birth: Background characteristic Informed of signs of pregnancy complica- tions Weight measured Height measured Blood pressure measured Urine sample taken Blood sample taken Stomach examined Consulta- tion Number of women Took iron tablets or syrup Number of women Mother’s age at birth <20 49.8 92.7 46.0 93.5 43.9 38.6 98.0 79.7 1,286 74.3 1,328 20-34 54.3 95.3 47.3 96.4 47.9 40.7 98.0 85.1 10,748 76.8 11,045 35-49 48.8 94.1 47.6 95.9 48.7 43.8 98.2 82.3 2,293 70.2 2,409 Birth order 1 56.8 96.1 49.7 96.5 49.8 42.1 97.8 85.3 5,458 78.3 5,543 2-3 52.9 95.1 47.1 96.5 48.1 41.0 98.4 85.4 6,923 76.8 7,115 4-5 42.8 92.0 41.2 94.5 43.2 39.2 98.0 78.5 1,489 64.8 1,588 6+ 41.0 86.4 38.3 88.5 31.3 33.8 95.3 69.0 457 59.8 536 Residence Urban 57.1 98.1 49.1 98.2 52.3 45.4 98.7 87.9 7,260 79.5 7,358 Rural 48.7 91.6 45.3 93.8 42.9 36.5 97.4 80.3 7,066 71.5 7,424 Education No education 27.8 86.1 38.0 79.9 30.2 39.8 93.3 62.3 190 36.7 274 Some primary 35.4 85.7 35.6 89.8 36.9 36.6 95.9 72.2 1,136 61.5 1,242 Completed primary 48.1 92.7 41.7 94.7 43.3 41.7 97.5 77.1 3,380 70.4 3,516 Some secondary 51.3 95.2 48.3 96.4 48.9 39.0 98.2 83.8 3,897 77.6 3,965 Completed secondary 60.3 97.8 49.8 98.0 52.1 41.2 98.8 90.3 3,974 80.0 4,021 More than secondary 63.6 98.8 58.0 99.2 52.6 46.9 98.9 94.5 1,751 86.3 1,765 Wealth quintile Lowest 42.1 86.9 39.3 89.5 35.7 35.0 95.6 72.0 2,746 61.6 3,035 Second 49.9 93.3 46.4 95.6 45.2 41.2 97.9 81.0 2,797 74.8 2,881 Middle 53.7 96.5 45.9 97.6 47.7 41.1 98.9 85.5 2,884 77.5 2,939 Fourth 57.5 97.8 51.0 97.8 53.2 42.1 99.0 88.4 3,089 79.5 3,105 Highest 61.0 99.5 52.9 99.3 55.9 45.4 98.7 93.1 2,809 84.6 2,822 Total 53.0 94.9 47.2 96.0 47.7 41.0 98.0 84.1 14,327 75.5 14,782 mothers who were told about signs of pregnancy complications (57 percent and 49 percent, respectively), and who had urine samples (52 percent and 42 percent, respectively) or blood samples (45 percent and 37 percent, respectively) taken. Urban mothers were also more likely to have taken iron tablets or syrup during pregnancy than rural mothers (80 percent and 72 percent, respectively). A mother’s education level and her economic status are positively related to the receipt of the various components of antenatal care. For example, the proportion informed about signs of pregnancy complications increased from 28 percent among mothers with no education to 64 percent among mothers with more than a secondary education. 9.1.4 Tetanus Toxoid Injections Tetanus toxoid (TT) injections are given to women during pregnancy to prevent deaths from neonatal tetanus. Immunization of pregnant women is a program coordinated by the Expanded Program on Immunization (EPI) and the Maternal and Child Health Care (MCH) units in the Ministry of Health. The program recommends that women receive two tetanus toxoid injections during the first pregnancy. Booster injections are given once during each subsequent pregnancy to maintain full protection. In recent years, TT immunization was also given to women before marriage, so that any pregnancy occurring within three years of their marriage would be protected against tetanus (Ministry of Health, 2005). 116 • Reproductive Health Table 9.4 shows the percentage of women with a live birth in the five years preceding the survey who reported receiving TT injections during pregnancy for the last live birth. The same table shows the percentage of women whose last birth was protected against neonatal tetanus. An infant is considered to be fully protected if any of the following criteria are met:1) the mother had two TT injections during pregnancy:2) the mother had two or more injections, the last within 3 years on the last birth;3) the mother had at least three TT injections, the last within 5 years of the last birth:4) the mother had at least four or more TT injections, the last within 10 years of the last birth; or5) the mother had at least five or more TT injections at any time prior to the last birth. Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections (TTI) during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Indonesia 2012 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother’s age at birth <20 45.3 57.1 1,328 20-34 45.5 61.2 11,045 35-49 45.0 58.6 2,409 Birth order 1 44.2 60.1 5,543 2-3 47.4 62.9 7,115 4-5 43.4 54.7 1,588 6+ 37.9 47.4 536 Residence Urban 45.4 61.4 7,358 Rural 45.5 59.5 7,424 Education No education 25.2 29.7 274 Some primary 38.1 46.9 1,242 Completed primary 47.5 59.2 3,516 Some secondary 47.7 63.4 3,965 Completed secondary 48.2 66.4 4,021 More than secondary 38.3 57.1 1,765 Wealth quintile Lowest 41.5 52.9 3,035 Second 46.3 61.0 2,881 Middle 47.0 61.8 2,939 Fourth 49.4 65.2 3,105 Highest 42.9 61.3 2,822 Total 45.4 60.4 14,782 1 Includes mothers with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth. According to 2012 IDHS results, 45 percent of the mothers received two or more TT injections during their last pregnancy, and 60 percent of last-born children during the five-year period before the survey were protected against neonatal tetanus. There is a little variation in TT coverage by mother’s age at birth or place of residence. TT coverage is higher among mothers of first-order births and second- and third-order births compared with other birth orders. Although the pattern is not uniform, TT coverage also increases with the mother’s education level and the wealth quintile. Appendix Table A-9.3 presents information on tetanus toxoid coverage by province. Reproductive Health • 117 9.1.5 Complications of Pregnancy Complications of pregnancy are health problems that occur during pregnancy. Some women have health problems before they become pregnant that could lead to complications. These complications can involve the mother’s health, the health of the fetus, or both. To identify complications associated with pregnancy, respondents were asked about certain signs and symptoms that they had experienced in association with their last birth. Table 9.5 shows that 87 percent of women reported no complications during pregnancy. Four percent had excessive vaginal bleeding, 2 percent had premature labor, that is, labor before nine months, and less than 1 percent each had fever and convulsions. Eight percent of women reported other signs and symptoms of pregnancy complications that included hypertension, dizziness, the fetus in breech position, and swelling. Table 9.5 Complications during pregnancy Percentage of last births in the five years preceding the survey for which the mother had complications associated with the pregnancy, by type of complications and maternity care indicators, Indonesia 2012 Maternity care indicators Premature labor Excessive vaginal bleeding Fever Convulsions and fainting Other Missing No complica- tions Number of births Number of ANC visits None 1.1 2.4 1.1 0.0 1.9 12.8 81.7 456 1-3 times 2.5 3.2 0.7 0.4 4.8 0.0 89.8 1,243 4+ times 2.2 3.7 0.7 0.3 8.0 0.0 86.7 12,974 Don’t know/ missing 4.4 4.2 0.2 0.0 6.3 0.0 85.4 109 Actions taken to overcome the complications Nothing 3.1 0.9 0.4 0.0 2.8 na na 41 Rest 17.8 12.0 28.0 18.2 11.6 na na 252 Take medication 8.8 8.8 15.3 10.3 10.6 na na 183 Take herbs 0.2 0.6 0.0 0.8 0.4 7 See TBA 8.4 1.6 4.4 3.3 4.0 na na 75 See midwife 55.9 44.1 56.6 46.7 42.8 na na 851 See doctor 20.9 40.0 27.2 35.0 29.5 na na 558 Go to health facility 16.4 27.5 16.7 32.8 22.9 na na 407 Other 3.9 0.8 3.1 0.0 8.4 na na 105 Baby died within one month of birth 6.9 7.4 4.0 2.0 16.1 11.9 60.3 154 Delivery assisted by a health provider 2.3 3.9 0.7 0.3 8.2 0.0 86.2 12,466 Delivery by C-section 3.3 7.0 0.9 0.6 14.5 0.0 76.5 1,878 Total 2.2 3.6 0.7 0.3 7.5 0.4 86.8 14,782 Note: Total includes seven women who took herbs and seven women with information missing on action taken to overcome complications. Women were able to provide more than one response about what they did to overcome pregnancy complications so the percentages taking various actions to deal with a complication add to more than 100 percent. na = Not applicable The percentage reporting complications during pregnancy varies with the number of antenatal care visits although the differences are not large. Table 9.5 shows that mothers who had no antenatal care were only slightly less likely to report having no complications during pregnancy than mothers who had had 1-3 ANC visits or 4 or more ANC visits (82 percent, 90 percent, and 87 percent, respectively). AppendiTable A-9.4 presents information on complications during pregnancy by province. 118 • Reproductive Health Advice or treatment from a skilled provider or a health facility is expected to be sought for births involving complications. Women who reported experiencing pregnancy complications were asked about what they did to overcome the complications. Figure 9.2 shows the percentage of women experiencing complications who reported taking various actions in response to the complications. Women most often sought medical advice, i.e., 44 percent reported seeing a midwife, 29 percent saw a doctor, and 21 percent went to a health facility. Only a few women did nothing when they experienced complications (2 percent). Figure 9.2 Actions taken in response to pregnancy complications Among women who had premature labor, the majority reported seeing a midwife (56 percent), 21 percent saw a doctor, and 16 percent went to a health facility. Women who had excessive vaginal bleeding most often saw a midwife (44 percent), a doctor (40 percent), or went to a health facility (28 percent). Table 9.5 shows that the experience of pregnancy complications was associated with adverse pregnancy outcomes. Women whose babies died within one month of delivery and women who had a caesarean delivery were more likely to have experienced complications during pregnancy than other women. 9.2 DELIVERY CARE Increasing the proportion of babies delivered under the supervision of health professionals is an important step in reducing the health risks of mothers and children. Appropriate medical attention during delivery can reduce the risk of complications that may cause death or serious illness to both mother and the baby. The 2012 IDHS collected information on several aspects of delivery care for all births that occurred in the five years preceding the survey including the place of delivery, assistance at delivery, and preparations for delivery. 9.2.1 Place of Delivery One of the main factors contributing to high maternal death is lack of access of maternity services. In the effort to reduce health risks of mothers and children, it is very important to increase the proportion of babies delivered under the supervision of health professionals. 2 13 9 4 44 29 21 5 Nothing Rest Take medication See TBA See midwife See doctor Go to health facility Other Percent Women with complications IDHS 2012 Reproductive Health • 119 Table 9.6 shows the percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics. Sixty-three percent of births in the five years preceding the survey were delivered in a health facility, 17 percent in a public facility (government hospital or health center) and 46 percent in a private health facility (private hospital, clinic, private doctor/midwife). Figure 9.3 shows that the percentage of deliveries that took place in a health facility (63 percent) is substantially higher than that reported in the 2007 IDHS (46 percent) (BPS and Macro International, 2008). Table 9.6 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health facility, according to background characteristics, Indonesia 2012 Background characteristic Health facility Home Other Missing Total Percentage delivered in a health facility Number of births Public sector Private sector Mother’s age at birth <20 16.8 36.6 46.0 0.2 0.5 100.0 53.4 1,526 20-34 16.4 48.0 34.9 0.1 0.6 100.0 64.4 12,757 35-49 21.9 41.1 35.8 0.2 1.0 100.0 63.0 2,665 Birth order 1 18.4 50.9 30.2 0.1 0.4 100.0 69.3 6,557 2-3 17.0 47.2 34.9 0.2 0.7 100.0 64.2 7,892 4-5 16.0 32.4 50.1 0.1 1.4 100.0 48.4 1,827 6+ 13.1 19.1 67.1 0.0 0.6 100.0 32.3 672 Antenatal care visits1 None 4.7 5.8 77.3 0.4 11.6 100.0 10.6 456 1-3 10.6 22.9 66.3 0.1 0.0 100.0 33.5 1,243 4+ 18.7 50.7 30.5 0.1 0.0 100.0 69.4 12,974 Don’t know/missing 13.5 33.1 53.3 0.0 0.2 100.0 46.6 109 Residence Urban 20.4 59.5 19.3 0.0 0.6 100.0 80.0 8,405 Rural 14.2 32.5 52.4 0.3 0.6 100.0 46.7 8,543 Mother’s education No education 10.7 10.4 76.1 1.2 1.6 100.0 21.1 365 Some primary 15.4 22.6 61.3 0.2 0.5 100.0 38.0 1,457 Completed primary 14.4 32.8 51.5 0.2 1.1 100.0 47.1 3,976 Some secondary 15.6 45.4 38.5 0.1 0.4 100.0 61.0 4,438 Completed secondary 20.8 59.0 19.7 0.1 0.3 100.0 79.8 4,594 More than secondary 20.9 65.5 12.8 0.0 0.8 100.0 86.4 2,119 Wealth quintile Lowest 14.0 15.6 68.9 0.3 1.1 100.0 29.7 3,727 Second 20.5 36.7 41.8 0.3 0.7 100.0 57.2 3,255 Middle 18.5 47.7 33.2 0.1 0.5 100.0 66.2 3,311 Fourth 17.7 61.4 20.5 0.1 0.3 100.0 79.1 3,437 Highest 16.1 72.0 11.5 0.0 0.4 100.0 88.1 3,218 Total 17.3 45.9 36.0 0.2 0.6 100.0 63.2 16,948 1 Includes only the most recent birth in the five years preceding the survey Table 9.6 shows that mothers under age 20 are less likely to deliver in a facility than older mothers. High-order births (6+) are much more likely to take place at home (67 percent) than first-order births (30 percent). There is a negative association between delivery at home and the number of ANC visits. Mothers with no antenatal care are more likely to deliver at home than mothers with four or more ANC visits (77 and 31 percent, respectively). Appendix Table A-9.5 presents information on the variation in place of delivery by province. 120 • Reproductive Health Figure 9.3 Trend in percentage of births delivered in a health facility and at home The utilization of health facilities for delivery is considerably higher in urban areas than in rural areas (80 and 47 percent, respectively). Births to mothers who have no education are much more likely to be delivered at home than births to mothers who have more than secondary education (76 percent and 13 percent, respectively). Births to mothers who are in the lowest wealth quintile are almost six times as likely to be delivered at home as births to mothers in the highest quintile (69 percent and 12 percent, respectively). 9.2.2 Assistance during Delivery The Ministry of Health has set a target of 90 percent of births to be assisted at delivery by medical staff by 2015 (Ministry of Health, 2008). To measure progress toward this goal, respondents were asked about all of the persons who assisted them during delivery. Table 9.7 shows the distribution of births by the most qualified person providing assistance during delivery. The most qualified person is the person to whom the woman may have been referred if she had any problems during delivery. Eighty-three percent of births in the five years preceding the survey were assisted by a skilled provider; 62 percent by a nurse/midwife/village midwife; 20 percent by an obstetrician; and 1 percent by a doctor. The proportion of births assisted at delivery by skilled providers increased from 73 percent in the 2007 IDHS to 83 percent in the 2012 IDHS. While there has been a shift away from TBAs, these persons still have a role to play in delivery assistance, especially in the rural areas (20 percent), for births to mothers with no education (34 percent), for high-order births (30 percent), and for births to mothers in the lowest wealth quintile (32 percent). 10 36 53 17 46 36 Public sector Private sector Home Percent 2012 IDHS 2007 IDHS IDHS 2012 Reproductive Health • 121 Table 9.7 Assistance during delivery: the most qualified person Percent distribution of live births in the five years preceding the survey by the most qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to background characteristics, Indonesia 2012 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Background characteristic Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Relative/ friend Other No one Missing Total Mother’s age at birth <20 0.8 11.4 63.0 21.5 2.4 0.1 0.3 0.4 100.0 75.3 5.8 1,526 20-34 0.9 20.4 62.9 12.7 2.0 0.3 0.3 0.6 100.0 84.2 12.6 12,757 35-49 1.4 23.0 58.0 13.0 2.8 0.2 0.4 1.0 100.0 82.5 14.9 2,665 Birth order 1 1.1 23.1 63.3 10.6 1.2 0.2 0.2 0.3 100.0 87.5 14.4 6,557 2-3 1.0 20.0 63.0 12.9 1.9 0.3 0.1 0.8 100.0 84.0 12.2 7,892 4-5 1.0 12.6 59.3 20.4 3.9 0.5 0.9 1.4 100.0 73.0 8.3 1,827 6+ 0.4 8.5 48.6 30.3 9.9 0.5 1.2 0.7 100.0 57.5 4.5 672 Place of delivery Health facility 1.5 31.5 66.6 0.2 0.1 0.1 0.0 0.1 100.0 99.5 19.5 10,710 Elsewhere 0.1 0.3 55.5 37.0 5.8 0.5 0.8 0.0 100.0 55.9 0.0 6,132 Missing 0.0 1.8 0.5 0.0 0.0 0.8 0.0 96.9 100.0 2.3 2.0 106 Residence Urban 1.3 27.7 62.8 6.7 0.6 0.2 0.1 0.7 100.0 91.8 16.8 8,405 Rural 0.7 12.4 61.5 20.2 3.7 0.4 0.5 0.6 100.0 74.6 7.9 8,543 Mother’s education No education 0.2 5.1 26.5 33.9 28.6 2.1 1.8 1.8 100.0 31.8 2.7 365 Some primary 0.7 8.7 51.7 33.3 4.5 0.2 0.4 0.6 100.0 61.1 6.1 1,457 Completed primary 0.6 10.8 61.4 22.6 2.6 0.3 0.6 1.1 100.0 72.8 6.8 3,976 Some secondary 0.7 13.9 71.1 12.0 1.4 0.1 0.2 0.5 100.0 85.7 7.6 4,438 Completed secondary 1.2 26.6 66.5 4.6 0.5 0.2 0.0 0.3 100.0 94.3 18.5 4,594 More than secondary 2.3 45.8 48.7 1.8 0.4 0.3 0.0 0.7 100.0 96.8 24.9 2,119 Wealth quintile Lowest 0.9 6.2 50.3 32.4 7.6 0.6 0.8 1.1 100.0 57.5 3.7 3,727 Second 0.7 14.6 66.6 15.5 1.5 0.1 0.3 0.7 100.0 81.8 9.0 3,255 Middle 0.7 15.9 73.1 8.7 0.7 0.2 0.2 0.5 100.0 89.7 11.4 3,311 Fourth 1.5 24.4 67.3 5.9 0.1 0.3 0.0 0.5 100.0 93.2 15.5 3,437 Highest 1.1 40.9 54.6 2.5 0.3 0.1 0.0 0.4 100.0 96.6 23.1 3,218 Total 1.0 20.0 62.2 13.5 2.2 0.3 0.3 0.7 100.0 83.1 12.3 16,948 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, obstetrician, nurse, midwife, and village midwife. Delivery assistance by a skilled provider varies according to background characteristics of the mother. The percentage of births delivered by a skilled provider is lower among mothers under age 20 than among older mothers and decreases with increasing birth order. More than 9 in 10 urban births are delivered by a skilled provider compared with 75 percent of rural births. The percentage of births delivered by a skilled provider increases with the mother’s level of education and wealth status. Table 9.7 also shows that 12 percent of births in the five years preceding the survey were delivered by caesarean section. Women most likely to deliver by caesarean section are those age 35-49 (15 percent), those with first-order births (14 percent), women in urban areas (17 percent), women with secondary and higher education (19 and 25 percent, respectively), and women in the highest wealth quintile (23 percent). The rate of caesarean deliveries is substantially higher than the rate at the time of the 2007 IDHS (7 percent). Appendix Table A-9.6.1 shows that there are substantial variations in assistance during delivery by the most qualified person by province. In some cases, the most qualified person assisting a delivery may have been a person to whom the woman was referred because she was experiencing problems. To provide some insight into the extent to which this may have occurred, Table 9.8 shows the distribution of births during the five years prior to the survey by the least qualified person providing assistance during delivery. The table shows that a skilled provider was the 122 • Reproductive Health least qualified person attending 68 percent of births. A comparison of this percentage with the percentage of births in which a skilled provider was the most qualified person attending the delivery (83 percent) indicates that referrals to a more skilled provider may have occurred in the case of 15 percent of births. Table 9.8 Assistance during delivery: the least qualified person Percent distribution of live births in the five years preceding the survey by the least qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to background characteristics, Indonesia 2012 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Background characteristic Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Relative/ friend Other No one Missing Total Mother’s age at birth <20 0.2 5.7 51.8 23.6 17.8 0.1 0.3 0.4 100.0 57.8 5.8 1,526 20-34 0.3 9.8 59.0 17.2 12.5 0.3 0.3 0.6 100.0 69.1 12.6 12,757 35-49 0.3 11.1 58.8 17.1 11.0 0.2 0.4 1.0 100.0 70.3 14.9 2,665 Birth order 1 0.3 11.4 59.6 15.2 12.8 0.2 0.2 0.3 100.0 71.4 14.4 6,557 2-3 0.2 9.5 59.7 17.1 12.3 0.3 0.1 0.8 100.0 69.5 12.2 7,892 4-5 0.3 6.1 53.0 24.7 13.3 0.5 0.9 1.4 100.0 59.3 8.3 1,827 6+ 0.0 4.2 44.5 31.8 17.0 0.5 1.2 0.7 100.0 48.8 4.5 672. Place of delivery Health facility 0.4 15.2 72.7 2.7 8.7 0.1 0.0 0.1 100.0 88.4 19.5 10,710 Elsewhere 0.0 0.1 34.2 44.3 20.1 0.5 0.8 0.0 100.0 34.3 0.0 6,132 Missing 0.0 0.6 1.6 0.0 0.0 0.8 0.0 96.9 100.0 2.3 2.0 106 Residence Urban 0.3 13.8 63.8 8.8 12.4 0.2 0.1 0.7 100.0 77.9 16.8 8,405 Rural 0.3 5.6 53.0 26.5 13.2 0.4 0.5 0.6 100.0 58.8 7.9 8,543 Mother’s education No education 0.0 4.1 22.9 33.1 34.3 2.1 1.8 1.8 100.0 27.0 2.7 365 Some primary 0.2 3.8 41.8 37.1 15.9 0.2 0.4 0.6 100.0 45.8 6.1 1,457 Completed primary 0.1 5.1 50.8 27.7 14.2 0.3 0.6 1.1 100.0 56.1 6.8 3,976 Some secondary 0.4 6.5 61.3 17.4 13.6 0.1 0.2 0.5 100.0 68.2 7.6 4,438 Completed secondary 0.3 12.6 68.6 8.2 9.7 0.2 0.0 0.3 100.0 81.5 18.5 4,594 More than secondary 0.2 23.6 61.6 4.4 9.0 0.3 0.0 0.7 100.0 85.4 24.9 2,119 Wealth quintile Lowest 0.4 2.5 40.8 35.9 17.9 0.6 0.8 1.1 100.0 43.7 3.7 3,727 Second 0.2 6.1 59.9 21.7 10.9 0.1 0.3 0.7 100.0 66.2 9.0 3,255 Middle 0.1 7.9 64.6 14.8 11.7 0.2 0.2 0.5 100.0 72.7 11.4 3,311 Fourth 0.3 12.1 65.7 9.5 11.6 0.3 0.0 0.5 100.0 78.1 15.5 3,437 Highest 0.2 20.7 62.8 4.5 11.2 0.1 0.0 0.4 100.0 83.8 23.1 3,218 Total 0.3 9.7 58.4 17.7 12.8 0.3 0.3 0.7 100.0 68.3 12.3 16,948 Note: If the respondent mentioned more than one person attending during delivery, only the least qualified person is considered in this tabulation. 1 Skilled provider includes doctor, obstetrician, nurse, midwife, and village midwife. Appendix Table A-9.6.2 shows the differentials in assistance during delivery by the least qualified person by province. 9.2.3 Preparation for Delivery To ensure the safety of the mother and infant at the time of delivery, certain preparations are necessary. These include deciding who is going to assist in the delivery, where the delivery is going to take place, how the woman is going to get to the place of delivery, and how much the delivery is going to cost. It is also important to consider who might serve as a blood donor if there is a need at the time of delivery. In the 2012 IDHS, respondents who had given birth during the five years prior to the survey were asked whether or not they had discussed each of these topics with anyone prior to the last birth. Reproductive Health • 123 Table 9.9 shows that 87 percent of women had discussed at least one of the issues related to the baby’s delivery prior to the birth. The subjects discussed most often were place of delivery (80 percent), delivery assistant (80 percent), and payment for services (77 percent). Less often discussed were issues of transportation (60 percent) and potential blood donors (15 percent). Mothers age 20-34 were slightly more likely than younger and older mothers to have talked about delivery preparations. The likelihood that a mother had discussed various aspects of delivery preparations decreased with the child’s birth order. Mothers in urban areas, better educated mothers, and those in the highest wealth quintile were more likely than other mothers to talk about issues related to their baby’s delivery. For example, mothers with more than secondary education were almost twice as likely to have discussed at least one topic related to the delivery as mothers with no education (95 and 50 percent, respectively). Table 9.9 Preparation for delivery Percentage of women who had a live birth in the five years preceding the survey who discussed specific topics during pregnancy for the most recent birth, according to background characteristics, Indonesia 2012 Topics discussed No topics discussed Number of births Background characteristic Place to deliver Transportation Delivery assistance Payment Blood donor Any topic Mother’s age at birth <20 75.3 52.2 75.6 74.4 13.7 84.4 15.6 1,475 20-34 81.8 61.3 81.4 77.5 15.9 88.0 12.0 11,048 35-49 76.0 55.5 76.4 73.8 14.4 84.5 15.5 2,259 Birth order 1 84.1 62.9 82.9 79.7 17.3 89.5 10.5 6,557 2-3 80.4 60.3 80.2 76.7 15.1 87.6 12.4 6,380 4-5 68.6 47.3 71.3 68.8 10.8 79.8 20.2 1,396 6+ 57.4 37.2 61.8 55.2 7.6 68.6 31.4 448 Residence Urban 86.4 67.2 84.7 81.9 17.8 91.1 8.9 7,358 Rural 74.1 51.8 75.4 71.4 13.0 83.2 16.8 7,424 Mother’s education No education 41.9 27.5 45.2 41.1 5.8 49.7 50.3 274 Some primary 62.6 38.1 63.8 61.3 9.1 74.4 25.6 1,242 Completed primary 72.7 50.5 73.4 71.9 11.5 82.6 17.4 3,516 Some secondary 80.8 58.7 80.7 77.7 13.3 88.3 11.7 3,965 Completed secondary 88.6 68.3 87.6 83.1 17.7 93.0 7.0 4,021 More than secondary 93.5 79.3 91.4 85.3 28.8 95.0 5.0 1,765 Wealth quintile Lowest 64.1 40.6 66.8 63.1 10.5 75.6 24.4 3,035 Second 76.5 54.5 75.9 74.6 13.6 85.0 15.0 2,881 Middle 82.9 59.4 82.1 78.8 12.6 88.9 11.1 2,939 Fourth 86.9 68.4 85.8 81.8 17.9 91.7 8.3 3,105 Highest 91.3 75.3 89.9 85.2 22.8 94.8 5.2 2,822 Total 80.3 59.5 80.0 76.6 15.4 87.1 12.9 14,782 9.2.4 Complications during Delivery To identify complications associated with delivery, respondents were asked about certain signs and symptoms that they had experienced during their most recent birth in the five years preceding the survey. Table 9.10 shows that 54 percent of women reported having no complications during delivery. Women experienced prolonged labor in the case of 35 percent of births, the water broke more than six hours before delivery in the case of 15 percent of births, fever/foul smelling vaginal discharge was reported for 8 percent of births, and women had excessive vaginal bleeding in the case of 8 percent of births. Maternal convulsions and other complications occurred less frequently (2 and 5 percent, respectively). 124 • Reproductive Health Women assisted by a health professional during both pregnancy and delivery were the most likely to report delivery complications. As expected, women who give birth by caesarean section were more likely to report complications (55 percent) than other women. Most of the complications for mothers who had a caesarean delivery were related to prolonged labor (35 percent) or to the water breaking more than 6 hours before delivery. For babies who died within one month of birth, 40 percent of the mothers reported complications, including prolonged labor (28 percent), water breaking more than six hours before delivery (14 percent), and excessive vaginal bleeding (9 percent). However, the overall rate of complications among mothers whose child died soon after delivery was not greater than the rate for other mothers. Table 9.10 Complications during delivery Percentage of last births in the five years preceding the survey for which the mother had complications associated with delivery, by type of complications and maternity care indicators, Indonesia 2012 Maternity care indicators Prolonged labor Excessive vaginal bleeding Fever/foul smelling vaginal discharge Convulsions Water broke >6 hours before delivery Other No complications Number of births Antenatal care/ delivery assistance Both ANC and DA 38.2 8.1 8.3 1.7 16.8 5.2 49.6 12,292 ANC only 19.0 6.0 4.0 1.3 5.4 0.7 76.1 1,855 DA only 32.1 5.0 7.6 0.7 15.2 3.6 60.0 173 Neither ANC or DA 6.9 2.6 2.9 0.4 2.7 0.1 90.9 462 Baby died within one month of birth 27.9 9.1 12.4 2.8 14.0 3.7 59.7 154 Delivery by C-section 34.5 7.8 8.1 2.7 22.6 12.6 44.6 1,878 Total 34.7 7.6 7.6 1.6 14.9 4.5 54.4 14,782 Appendix Table A-9.7 shows the differentials in delivery characteristics across provinces. 9.3 POSTNATAL CARE Postnatal care (PNC) is important for the welfare of the mother and the child. It provides an opportunity to treat complications arising from the delivery and provides the mother with important information on how to care for herself and her infant. The postnatal period is defined as the time between delivery of the placenta and 42 days (6 weeks) following delivery. Care very early in the postnatal period is especially important because the first two days after delivery are critical; most maternal and neonatal deaths occur during this period. 9.3.1 Timing of First Postnatal Checkup for the Mother Table 9.11 presents information on the timing of the first postnatal checkup for women who gave birth during the two years prior to the survey. Appendix Table A-9.9 shows the variations in postnatal care coverage by province. Eighty percent of women received postnatal care for their last birth within the critical first two days following delivery. Specifically, 56 percent of women received postnatal care less than four hours of delivery, 13 percent received postnatal care within 4-23 hours, and 11 percent were seen 1-2 days following delivery. One in nine women did not receive any postnatal checkup. Reproductive Health • 125 Table 9.11 Timing of first postnatal checkup Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution of the mother’s first postnatal check-up for the last live birth by time after delivery, and the percentage of women with a live birth in the two years preceding the survey who received a postnatal checkup in the first two days after giving birth, according to background characteristics, Indonesia 2012 Time after delivery of mother’s first postnatal checkup No postnatal checkup1 Total Percentage of women with a postnatal checkup in the first two days after birth Number of women Background characteristic Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don’t know/ missing Mother’s age at birth <20 54.3 10.9 9.6 4.2 6.0 1.6 13.3 100.0 74.9 664 20-34 56.3 13.5 11.2 3.0 3.7 1.4 10.9 100.0 81.0 5,082 35-49 54.8 14.1 10.0 3.8 2.7 2.5 12.1 100.0 78.9 1,084 Birth order 1 57.4 13.7 10.5 3.4 4.1 1.9 9.0 100.0 81.6 2,664 2-3 56.4 13.7 11.4 3.0 3.5 1.4 10.6 100.0 81.6 3,277 4-5 50.4 12.3 9.2 3.8 3.9 1.7 18.5 100.0 72.1 660 6+ 44.6 5.6 13.3 3.8 2.8 1.1 28.9 100.0 63.5 230 Place of delivery Health facility 64.9 15.8 8.5 1.9 2.9 2.0 4.0 100.0 89.2 4,710 Elsewhere 36.0 7.8 16.2 6.2 5.7 0.9 27.2 100.0 60.1 2,109 Residence Urban 60.4 15.1 10.5 2.0 3.6 1.6 6.8 100.0 86.0 3,361 Rural 51.5 11.6 11.3 4.4 3.9 1.6 15.7 100.0 74.3 3,470 Education No education 22.9 3.0 12.9 2.3 6.3 4.6 48.1 100.0 38.8 134 Some primary 46.5 8.0 12.1 6.0 3.4 1.3 22.8 100.0 66.5 498 Completed primary 53.7 10.3 11.8 3.4 3.2 1.2 16.3 100.0 75.9 1,519 Some secondary 54.3 13.7 10.5 4.6 5.3 1.2 10.4 100.0 78.5 1,886 Completed secondary 62.6 14.7 9.6 1.9 3.1 2.2 5.9 100.0 86.9 1,899 More than secondary 58.5 19.2 11.8 1.5 2.6 1.9 4.5 100.0 89.5 894 Wealth quintile Lowest 41.0 6.9 11.2 4.6 5.2 1.5 29.4 100.0 59.3 1,410 Second 58.3 13.2 10.8 4.4 3.2 1.1 8.9 100.0 82.4 1,436 Middle 55.0 17.7 10.8 3.4 3.6 1.2 8.3 100.0 83.5 1,333 Fourth 61.4 14.5 9.4 2.0 3.2 3.2 6.4 100.0 85.3 1,370 Highest 64.1 14.8 12.2 1.6 3.5 1.1 2.7 100.0 91.1 1,282 Total 55.8 13.3 10.9 3.2 3.7 1.6 11.3 100.0 80.1 6,830 Note: Total includes 12 women missing information on place of delivery who are not shown separately. 1 Includes women who received a checkup after 41 days Table 9.11 shows that younger women were less likely to have a checkup after delivery than older women. Women with higher-order births were less likely to receive postnatal care than those with lower-order births. Urban women were more likely to receive postnatal care than rural women. As expected, postnatal care coverage increased with women’s level of education and wealth status. Forty-eight percent of mothers with no education and 29 percent of mothers in the lowest wealth quintile had no postnatal care compared with 9 in 10 mothers with more than secondary education or in the highest wealth quintile. Table A-9.8 presents the information on timing of first postnatal checkup for the mother by province. 9.3.2 Provider of First Postnatal Checkup for the Mother The skill level of the provider who performs the first postnatal checkup has important implications for maternal and neonatal health. Table 9.12 shows that 78 percent of mothers with a birth in the two years preceding the survey received postnatal care from a skilled provider (doctor, obstetrician, nurse, midwife, or village midwife). Only 2 percent of women received postnatal care from a traditional birth attendant. Mothers with no education and mothers delivering outside of a health facility were most likely to receive postnatal care from a traditional birth attendant (7 percent each). 126 • Reproductive Health Table 9.12 Type of provider of first postnatal checkup for the mother Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution by type of provider of the mother’s first postnatal health check in the two days after the last live birth, according to background characteristics, Indonesia 2012 Background characteristic Type of health provider of mother’s first postnatal checkup No postnatal checkup in the first two days after birth1 Total Number of women Doctor Obstetrician Nurse/ midwife/ village midwife Traditional birth attendant Mother’s age at birth <20 2.0 6.9 62.3 3.7 25.1 100.0 664 20-34 1.2 17.0 60.9 1.8 19.0 100.0 5,082 35-49 1.6 20.4 54.2 2.7 21.1 100.0 1,084 Birth order 1 1.4 16.4 62.1 1.7 18.4 100.0 2,664 2-3 1.4 18.2 60.3 1.7 18.4 100.0 3,277 4-5 0.9 12.9 53.3 5.0 27.9 100.0 660 6+ 2.4 6.2 50.7 4.2 36.5 100.0 230 Place of delivery Health facility 1.8 24.0 63.3 0.2 10.8 100.0 4,710 Elsewhere 0.4 0.2 52.9 6.5 39.9 100.0 2,109 Residence Urban 1.3 23.9 59.6 1.1 14.0 100.0 3,361 Rural 1.4 9.5 60.4 3.1 25.7 100.0 3,470 Education No education 0.6 4.8 26.4 6.9 61.2 100.0 134 Some primary 1.6 7.6 51.9 5.5 33.5 100.0 498 Completed primary 1.4 9.5 61.2 3.8 24.1 100.0 1,519 Some secondary 1.1 8.5 67.1 1.7 21.5 100.0 1,886 Completed secondary 1.5 22.3 62.2 0.8 13.1 100.0 1,899 More than secondary 1.3 40.2 47.6 0.3 10.5 100.0 894 Wealth quintile Lowest 1.1 4.9 47.8 5.4 40.7 100.0 1,410 Second 1.9 10.3 67.4 2.7 17.6 100.0 1,436 Middle 1.3 13.1 67.7 1.4 16.5 100.0 1,333 Fourth 1.8 19.8 62.9 0.8 14.7 100.0 1,370 Highest 0.5 36.6 53.9 0.1 8.9 100.0 1,282 Total 1.4 16.6 60.0 2.1 19.9 100.0 6,830 Note: Total includes 12 women missing information on place of delivery who are not shown separately. 1 Includes women who received a checkup more than 2 days after giving birth and women receiving a checkup within 2 days of giving birth from a provider other than a doctor, obstetrician, nurse/midwife/village midwife, or traditional birth attendant. Table A-9.9 presents the information on type of provider of first postnatal checkup for the mother by province. 9.3.3 Timing of First Postnatal Checkup for the Newborn Newborn care is essential to reduce neonatal mortality and to prevent complications soon after delivery. Table 9.13 provides information on the timing of newborn care among children born in the two years preceding the survey. Appendix Table A-9.11 shows variations in delivery characteristics by province. Less than half (48 percent) of newborns received postnatal care within the critical first two days after birth. Specifically, 12 percent of newborns received postnatal care less than 1 hour after birth, 23 percent received postnatal care within 1-3 hours, 6 percent received postnatal care within 4-23 hours, and 7 percent were seen 1-2 days after birth. Reproductive Health • 127 The proportion of postnatal checkups within the first two days of birth is higher among births to mothers age 20-34, first-order births, second- and third-order births, births occurring in a health facility, and births to mothers living in urban areas. Postnatal checkups within the first two days after birth are more than twice as likely among births to mothers with completed primary or higher education (45-58 percent) compared with births to mothers with no education (21 percent). Fifty-eight percent of births in the highest quintile had a checkup within the first two days after birth compared with 35 percent of births in the lowest quintile. Table A-9.10 presents the information on timing of first postnatal checkup for the newborn by province. Table 9.13 Timing of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal checkup in the first two days after birth, according to background characteristics, Indonesia 2012 Time after birth of newborn’s first postnatal checkup No postnatal checkup1 Total Percentage of births with a postnatal checkup in the first two days after birth Number of births Background characteristic Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don’t know/ missing Mother’s age at birth <20 14.2 18.1 4.4 7.0 4.5 3.0 48.8 100.0 43.7 664 20-34 12.0 23.7 5.7 7.6 3.2 1.9 45.9 100.0 48.9 5,082 35-49 8.9 20.9 9.0 6.5 3.5 2.9 48.4 100.0 45.2 1,084 Birth order 1 11.8 24.2 5.4 7.1 3.8 2.4 45.3 100.0 48.4 2,664 2-3 12.6 22.9 6.6 7.7 3.5 2.2 44.6 100.0 49.8 3,277 4-5 8.8 20.0 6.9 7.7 1.9 1.5 53.1 100.0 43.4 660 6+ 6.2 10.0 3.9 5.9 2.1 1.3 70.6 100.0 26.0 230 Place of delivery Health facility 14.2 26.5 6.9 5.8 3.7 2.5 40.5 100.0 53.3 4,710 Elsewhere 6.3 14.2 4.4 11.0 2.9 1.4 59.8 100.0 35.9 2,109 Residence Urban 15.4 26.2 6.5 6.0 2.9 2.3 40.6 100.0 54.2 3,361 Rural 8.1 19.3 5.7 8.7 3.9 2.0 52.4 100.0 41.7 3,470 Mother’s education No education 1.7 11.4 1.7 6.2 3.9 2.2 73.0 100.0 21.0 134 Some primary 7.4 15.6 5.1 5.5 2.8 1.8 61.8 100.0 33.6 498 Completed primary 10.5 20.2 5.2 9.1 3.5 2.0 49.5 100.0 45.0 1,519 Some secondary 13.3 21.5 5.9 8.2 4.6 1.7 44.7 100.0 49.0 1,886 Completed secondary 12.7 25.1 6.4 5.9 3.2 2.5 44.3 100.0 50.1 1,899 More than secondary 12.2 29.9 8.3 7.0 1.5 3.2 37.9 100.0 57.4 894 Wealth quintile Lowest 5.4 15.8 5.0 8.8 2.8 1.6 60.6 100.0 35.0 1,410 Second 12.0 21.7 5.5 8.2 4.4 1.3 46.8 100.0 47.5 1,436 Middle 11.6 23.9 6.7 6.3 3.6 1.7 46.2 100.0 48.5 1,333 Fourth 11.4 25.0 8.4 6.7 3.4 3.0 42.0 100.0 51.6 1,370 Highest 18.7 27.5 4.7 6.7 2.8 3.3 36.2 100.0 57.7 1,282 Total 11.7 22.7 6.1 7.4 3.4 2.2 46.6 100.0 47.8 6,830 Note: Total includes 12 women missing information on place of delivery who are not shown separately. 1 Includes newborns who received a checkup after the first week 9.3.4 Provider of First Postnatal Checkup for the Newborn Table 9.14 presents the percent distribution of last births in the two years preceding the survey by type of provider of newborn care during the first two days after delivery. Appendix Table A-9.11 shows variations on type of provider of first postnatal checkup for the newborn by province. 128 • Reproductive Health Forty-six percent of newborns received postnatal care in the two days following birth from a skilled provider (doctor, obstetrician, pediatrician, or nurse/midwife/village midwife). Only 2 percent of newborns received postnatal care from a traditional birth attendant (TBA). The variation in the percentage of newborns receiving care from a skilled provider by background characteristics is similar to the pattern described with respect to providers of mothers’ postnatal checkups. Table 9.14 Type of provider of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by type of provider of the newborn’s first postnatal health check during the two days after the last live birth, according to background characteristics, Indonesia 2012 Type of health provider of newborn’s first postnatal checkup No postnatal checkup in the first two days after birth1 Total Number of births Background characteristic Doctor Obstetrician Pediatrician Nurse/ midwife/ village midwife Traditional birth attendant Mother’s age at birth <20 0.4 0.8 3.3 34.9 4.2 56.3 100.0 664 20-34 0.5 4.0 6.4 36.4 1.7 51.1 100.0 5,082 35-49 0.5 3.9 6.8 31.2 2.8 54.8 100.0 1,084 Birth order 1 0.4 3.4 6.3 36.5 1.7 51.6 100.0 2,664 2-3 0.6 4.2 6.6 36.3 2.0 50.2 100.0 3,277 4-5 0.4 2.8 4.6 31.7 3.9 56.6 100.0 660 6+ 0.2 0.2 1.0 20.9 3.7 74.0 100.0 230 Place of delivery Health facility 0.6 5.2 8.9 38.2 0.3 46.7 100.0 4,710 Elsewhere 0.2 0.0 0.1 29.4 6.2 64.1 100.0 2,109 Residence Urban 0.6 5.3 9.8 37.5 1.0 45.8 100.0 3,361 Rural 0.4 2.0 2.6 33.4 3.3 58.3 100.0 3,470 Mother’s education No education 0.0 0.6 0.9 10.5 8.9 79.0 100.0 134 Some primary 0.3 0.8 1.2 25.7 5.6 66.4 100.0 498 Completed primary 0.3 1.8 2.0 37.0 3.8 55.0 100.0 1,519 Some secondary 0.4 2.4 3.2 41.1 1.8 51.0 100.0 1,886 Completed secondary 0.8 3.9 9.4 35.3 0.7 49.9 100.0 1,899 More than secondary 0.7 10.6 15.8 30.1 0.2 42.6 100.0 894 Wealth quintile Lowest 0.5 0.9 1.6 27.0 5.0 65.0 100.0 1,410 Second 0.6 2.7 2.4 38.8 3.0 52.5 100.0 1,436 Middle 0.4 2.3 4.9 39.5 1.3 51.5 100.0 1,333 Fourth 0.6 3.7 8.1 38.7 0.6 48.4 100.0 1,370 Highest 0.5 8.9 14.5 33.1 0.6 42.3 100.0 1,282 Total 0.5 3.6 6.1 35.4 2.1 52.2 100.0 6,830 Note: Total includes 12 women missing information on place of delivery who are not shown separately. 1 Includes newborns who received a checkup after more than 2 days after birth and newborns receiving a checkup within 2 days after birth from a provider other than a doctor, obstetrician, pediatrician, nurse/midwife/village midwife, or traditional birth attendant. 9.4 PROBLEMS IN ACCESSING HEALTH CARE Many factors can prevent women from getting medical advice or treatment for themselves when they are sick or need it. Information on those factors is particularly important in understanding and addressing the barriers women may face in seeking care during pregnancy and at the time of delivery. In the 2012 IDHS, all women were asked whether or not each of the following factors would be a significant problem for them in seeking medical care: getting permission to go for treatment, getting money for treatment, distance to a health facility, and not wanting to go alone. Reproductive Health • 129 Table 9.15 shows the percentage of women who reported having serious problems in accessing health care by background characteristics. Thirty-four percent of women reported that at least one of these problems would pose a barrier to seeking health care for themselves when they are sick. The most often cited problem was that the woman did not want to go alone (23 percent). Other concerns included getting money for treatment (15 percent), distance to the health facility (11 percent), and getting permission to go for treatment (5 percent). Table 9.15 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Indonesia 2012 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone At least one problem accessing health care Number of women Age 15-19 9.1 19.7 14.6 40.6 50.7 6,927 20-34 4.8 13.5 10.4 21.6 32.3 20,140 35-49 3.9 15.3 9.1 17.5 30.0 18,541 Number of living children 0 7.2 16.1 12.4 32.9 42.7 12,896 1-2 4.2 13.7 9.0 19.3 30.2 21,465 3-4 4.3 16.0 10.6 17.5 30.8 9,053 5+ 5.8 21.4 13.9 20.0 35.8 2,193 Marital status Never married 7.5 17.1 12.8 34.3 44.2 9,919 Married or living together 4.5 13.9 9.7 20.0 31.1 33,465 Divorced/separated/ widowed 4.0 25.5 12.1 14.3 35.0 2,223 Employed last 12 months Not employed 6.0 16.5 11.2 25.7 36.8 17,725 Employed for cash 4.3 13.6 8.6 19.6 30.8 20,855 Employed not for cash 5.2 16.6 14.5 25.3 37.4 6,984 Missing 0.4 13.1 1.9 16.1 28.8 43 Residence Urban 4.3 12.9 7.3 20.3 30.2 23,805 Rural 6.0 17.8 14.0 25.6 38.4 21,802 Education No education 10.1 30.3 24.1 29.3 47.6 1,500 Some primary 6.1 21.0 13.6 22.8 38.4 4,870 Completed primary 5.3 17.2 11.4 21.7 35.1 10,254 Some secondary 6.0 16.5 11.6 27.5 38.6 12,753 Completed secondary 3.9 11.7 7.3 19.7 29.1 10,677 More than secondary 2.7 6.1 6.0 18.7 24.2 5,552 Wealth quintile Lowest 7.7 27.0 21.8 26.8 46.5 7,767 Second 5.2 18.8 12.0 23.9 37.3 8,784 Middle 4.7 15.2 8.5 23.5 34.5 9,243 Fourth 4.8 10.5 6.9 21.4 30.1 9,743 Highest 3.8 7.5 5.8 19.7 25.4 10,071 Total 5.1 15.2 10.5 22.8 34.1 45,607 Note: Total includes 43 women missing information on employment who are not shown separately. Younger women, women with no children, women who are never married, women who are not employed or employed not for cash, those who live in rural areas, women with no education, and women from the lowest wealth quintile were more likely than other women to say they would face at least one serious problem in accessing health care. Table A-9.12 presents the information on problems in accessing health care by province. Child Health • 131 CHILD HEALTH 10 his chapter presents findings in several areas of importance to child health, including the mother’s perception of baby’s size at birth, the immunization status of children, and the prevalence and treatment of major childhood illnesses. Information on perceived size at birth is important for the design and implementation of programs aimed at reducing neonatal and infant mortality. Information on vaccination coverage focuses on children age 12-23 months. Overall coverage levels at the time of the survey, and at age 12 months, are shown for this group. Additionally, the source of the information—a written vaccination card or the mother’s recall—is displayed. Knowing how vaccination coverage varies among subgroups of the population can aid in program planning. Examining treatment practices and the contact with health services for children with the three major childhood illnesses—diarrhea, acute respiratory infection (ARI), and fever—can help assess national programs aimed at reducing mortality from these illnesses. Information is provided on the prevalence and treatment of ARI and its treatment with antibiotics and the prevalence of fever and its treatment with antimalarial drugs and antibiotics. The treatment of diarrheal disease with oral rehydration therapy (including increased fluids) aids in the assessment of programs that recommend such treatment. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal disease, information is also provided on the manner of disposing of children’s fecal matter. 10.1 CHILD’S SIZE AT BIRTH A child’s birth weight or size at birth is an important indicator of the child’s vulnerability to the risk of illnesses and chances of survival. Children whose birth weight is less than 2.5 kilograms, i.e., low birth weight (LBW), have a higher risk of early childhood death. For births in the five years preceding the survey, birth weight was recorded in the questionnaire based on either a written record or the mother’s recall. Because birth weight was not likely to be known for many babies, particularly for those born at home, the mother’s T Key Findings • The percentage of children age 12-23 months who are fully vaccinated has increased from 59 percent in 2007 to 66 percent in 2012. • Five percent of children under age 5 had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Three in four (75 percent) of children with symptoms of ARI were taken to a health facility or health provider for treatment, an increase from 66 percent in 2007. • Three in 10 children under age 5 had a fever in the two weeks preceding the survey. Of these children, 74 percent received treatment from a health facility or health provider. • Fourteen percent of children under age 5 had diarrhea in the two weeks preceding the survey. Of these children, 65 percent received treatment from a health facility or health provider, an increase from 51 percent in 2007. • Overall, 47 percent of children with diarrhea received oral rehydration therapy (ORT), and 40 percent received increased fluids. A total of 66 percent received either ORT or increased fluids. 132 • Child Health perception of the baby’s size was obtained in the IDHS. A mother’s report of a child being “very small” or “smaller than average,” even though subjective, is considered a useful proxy for LBW. Table 10.1 presents the information on child’s weight and size at birth. The 2012 IDHS recorded 16,948 births, of which 15,135 (89 percent) had a reported birth weight. Records of birth weight vary by the mother’s characteristics. The lowest proportion with a record available is observed among births to mothers who have no education (36 percent). Table 10.1 Child’s weight and size at birth Percentage of live births in the five years preceding the survey with a reported birth weight; among live births in the five years preceding the survey that have a reported birth weight, percent distribution by birth weight; and percent distribution of all live births in the five years preceding the survey by mother’s estimate of baby’s size at birth, according to background characteristics, Indonesia 2012 Percentage of all births that have a reported birth weight1 Percent distribution of births with a reported birth weight1 Number of births Percent distribution of all live births by size of child at birth Number of births Background characteristic Less than 2.5 kg 2.5 kg or more Total Very small Smaller than average Average or larger Don’t know/ missing Total Mother’s age at birth <20 85.0 10.3 89.7 100.0 1,296 2.5 14.9 79.1 3.5 100.0 1,526 20-34 90.0 6.8 93.2 100.0 11,483 1.9 10.7 84.6 2.8 100.0 12,757 35-49 88.4 8.3 91.7 100.0 2,356 1.9 13.1 81.5 3.5 100.0 2,665 Birth order 1 92.3 7.6 92.4 100.0 6,055 1.9 12.1 83.8 2.1 100.0 6,557 2-3 90.6 6.8 93.2 100.0 7,149 1.8 11.0 84.5 2.8 100.0 7,892 4-5 81.3 8.6 91.4 100.0 1,485 2.8 10.7 81.2 5.4 100.0 1,827 6+ 66.3 7.9 92.1 100.0 446 2.3 12.1 78.4 7.2 100.0 672 Mother’s smoking status Smokes cigarettes/ tobacco 73.2 4.4 95.6 100.0 243 1.8 8.7 78.1 11.4 100.0 332 Does not smoke 89.6 7.4 92.6 100.0 14,891 1.9 11.5 83.7 2.8 100.0 16,615 Residence Urban 96.2 6.2 93.8 100.0 8,089 1.7 10.7 86.1 1.6 100.0 8,405 Rural 82.5 8.6 91.4 100.0 7,045 2.2 12.2 81.2 4.3 100.0 8,543 Mother’s education No education 35.9 14.5 85.5 100.0 131 3.4 11.0 72.2 13.3 100.0 365 Some primary 73.2 13.2 86.8 100.0 1,066 4.5 15.1 73.3 7.0 100.0 1,457 Completed primary 85.0 9.7 90.3 100.0 3,381 2.1 13.7 79.7 4.5 100.0 3,976 Some secondary 91.0 6.2 93.8 100.0 4,039 1.7 9.9 86.0 2.4 100.0 4,438 Completed secondary 96.7 6.1 93.9 100.0 4,441 1.5 11.1 86.4 1.1 100.0 4,594 More than secondary 98.0 4.9 95.1 100.0 2,077 1.1 8.9 89.1 0.9 100.0 2,119 Wealth quintile Lowest 69.0 11.2 88.8 100.0 2,572 2.2 13.9 76.2 7.7 100.0 3,727 Second 89.8 7.2 92.8 100.0 2,924 2.1 11.8 82.9 3.2 100.0 3,255 Middle 93.6 7.8 92.2 100.0 3,101 2.3 12.1 83.8 1.9 100.0 3,311 Fourth 97.7 6.3 93.7 100.0 3,358 1.5 10.7 87.0 0.8 100.0 3,437 Highest 98.8 5.0 95.0 100.0 3,180 1.6 8.5 89.2 0.7 100.0 3,218 Total 89.3 7.3 92.7 100.0 15,135 1.9 11.5 83.6 3.0 100.0 16,948 Note: Total includes one child with missing information on mother’s smoking status. 1 Based on either a written record or the mother’s recall Overall, 7 percent of children weighed below 2.5 kg at birth. Children born to younger mothers, to mothers who did not complete primary school, and to mothers in the lowest wealth quintile are more likely to have weighed less than 2.5 kilograms at birth. The prevalence of LBW has a negative association with mother’s education (Figure 10.1). Use of tobacco, especially during pregnancy, is known as one of the causes of lower birth weight. However, data in Table 10.1 show that the prevalence of LBW is higher among births to mothers who do not smoke than among births to mothers who smoke (7 and 4 percent, respectively). The use Child Health • 133 of tobacco refers only to the mother’s status at the time of the survey, so it is possible that mothers who are not currently smoking did so in the past. According to their mother’s perception, 13 percent of children are very small or smaller than average at birth. The likelihood of a child being reported as very small or smaller than average at birth does not vary much by the child’s birth order, mother’s smoking status, or urban-rural residence. There is no uniform pattern in child’s birth size according to mother’s educational level. Children of mothers in the highest wealth quintile are less likely than other children to be reported as having less than average birth size. Figure 10.1 summarizes the birth weight and size by mother’s education. Appendix Table A-10.1 shows the child’s weight and size at birth across provinces. Figure 10.1 Birth weight and birth size by mother’s education 15 13 10 6 6 5 14 20 16 12 13 10 No education Some primary Completed primary Some secondary Completed secondary More than secondary Percent Birth weight <2.5 kg Size of child very small or smaller than average 10.2 IMMUNIZATION OF CHILDREN The Expanded Program on Immunization (EPI) launched by the World Health Organization (WHO) in 1977 was adopted by the Indonesian Ministry of Health (MOH). Universal immunization of children against the six vaccine-preventable diseases—tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles— is crucial in reducing infant and child mortality. Differences in immunization coverage among subgroups of the population are useful for program planning and targeting resources to areas most in need. Additionally, information on immunization coverage is important for monitoring and evaluation of the EPI, which targets universal coverage of children age 12-23 months by year 2014 (MOH, 2010). The 2012 IDHS collected information on immunization coverage for all living children born in the five years preceding the survey. According to WHO guidelines, children are considered fully immunized when they have received one dose of the vaccine against tuberculosis (BCG), three doses each of the DPT and polio vaccines, and one dose of measles vaccine. 134 • Child Health In 1997, the Indonesian MOH expanded the program to include four doses of the hepatitis B (HB) vaccine to be given before a child’s first birthday (MOH, 2003). BCG, Polio 1, and HB 0 are given at birth or at first clinical contact; DPT, HB, and polio require three doses at approximately 6, 10, and 14 weeks of age; and measles vaccine is given soon after 9 months of age. In Indonesia, infants and young children receive basic immunizations from various personnel in several venues, including the integrated service posts (Posyandu) managed by staff from the community (kader desa); the village maternity clinics (Polindes) managed by the village midwife (bidan desa); the community health centers (Puskesmas); and government and/or private hospitals or clinics. In Posyandu, the health services include child growth monitoring, immunizations, management and treatment of diarrhea and other childhood diseases, information, education, and communication on family planning, and treatment of illnesses. During the first visit, each child receives a health card (Kartu Menuju Sehat, KMS). During the mother’s first antenatal care visit, she receives a maternal and child health book (Buku Kesehatan Ibu dan Anak, KIA), which is used to record basic information on the mother and her child. The information on the child includes birth weight, monthly weight, and type and dates of immunizations. Finally, information about the child’s immunizations is recorded in a registration book maintained by the field administrator of vaccines. Even though most mothers are aware of the importance of keeping the health card/book at home to be able to monitor their child’s growth and keep track of immunizations, not all mothers have these documents at home. Furthermore, not all infants receive postnatal care and therefore do not have a health card. In the 2012 IDHS, data on child immunization were collected for all living children age 12-59 months. Information on vaccination coverage was collected in two ways: from the child’s health card or the maternal and child health book shown to the interviewer or, if these cards are not available, from the mother’s report. If the health cards or the health books were available, the interviewer copied the immunization dates directly onto the questionnaire. When there was no health card for the child or maternal and child health book, or if a vaccine had not been recorded on these documents as being administered, the respondent was asked to recall the specific vaccines given to her child. The recording of polio immunizations in the 2002-2003, 2007 (BPS and ORC Macro, 2008), and 2012 IDHS surveys was done differently from the 1994 and 1997 IDHS surveys. The three most recent surveys recorded information on polio vaccines 1 through 4, while the earlier surveys recorded information on polio vaccines 0 to 3. The recording of HB vaccination started in 2002-3 IDHS. In that survey and the 2007 IDHS, HB was recorded differently from that in the 2012 survey. The 2012 survey recorded HB 0, 1, 2, and 3 while the 2002-3 and 2007 surveys only asked about HB 1, 2, and 3. In the 2012 IDHS, two measures of immunization coverage are presented in Table 10.2: the first is BCG, three doses each of DPT and polio vaccine (polio 1 through 3), and measles, and the second covers BCG, three doses each of DPT and polio vaccine (polio 1 through 3), four doses of HB, and measles. 10.2.1 Immunization Coverage for Children age 12-23 Months Table 10.2 shows the percentage of children age 12-23 months who have received various immunizations by three sources of information: health card or health book, mother’s report, or health card or mother’s report. The results are presented for this group because they are the youngest cohort of children who have reached the age by which they should be fully immunized. Overall, 60 percent of children 12-23 months are considered fully immunized excluding HB, while 37 percent are fully immunized when HB is considered. With regard to specific vaccines, 89 percent of children age 12-23 months had received BCG vaccine, 88 percent had received the first dose of DPT vaccine, 91 percent had received the first dose of polio, and 85 percent had received the first dose of HB vaccine (HB 0). Although the coverage of the first doses of DPT and polio vaccines is relatively high (88 and 91 percent, respectively), only 71 and 75 percent, went on to receive Child Health • 135 the third dose of DPT and polio (Figure 10.2). Thus, the dropout rate1 between the first and third doses of vaccines is 19 percent for DPT and 18 percent for polio. For HB immunization, the dropout between the first (HB 0) and fourth dose (HB 3) is 52 percent. Seventy-four percent of children age 12-23 months received immunization against measles. Eight percent of children 12-23 months did not receive any vaccinations at all. Table 10.2 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated, age 12 months, Indonesia 2012 Source of information BCG DPT Polio Hepatitis Measles All basic vaccinations excluding hepatitis B All basic vaccina- tions1 No vaccina- tions Number of children1 2 3 1 2 3 0 1 2 3 Vaccinated at any time before survey Vaccination card 39.7 40.2 38.8 37.0 40.7 39.4 37.5 39.6 37.1 35.5 28.9 35.7 34.1 27.4 0.2 1,370 Mother’s report 49.6 47.9 41.9 35.0 50.5 46.1 38.4 45.7 37.5 30.8 13.6 44.4 31.5 12.9 7.1 1,963 Either source 89.3 88.1 80.7 72.0 91.2 85.5 75.9 85.3 74.5 66.3 42.4 80.1 65.6 40.3 7.3 3,333 Vaccinated by age 12 months3 88.6 87.6 80.5 70.6 90.7 85.1 74.6 84.8 74.0 65.5 40.9 74.2 59.9 36.8 7.5 3,333 Note: For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination. 1 BCG, measles, all four doses of hepatitis B, three doses each of DPT and polio vaccine, excluding polio 4 Figure 10.2 Vaccination by 12 months of age (based on health cards and mother’s reports) 89 88 81 71 91 85 75 85 74 66 41 74 60 37 8 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 HB 0 HB 1 HB 2 HB 3 Measles All basic vaccinations excluding HB All basic vaccinations No vaccinations Percent IDHS 2012 Appendix Table A-10.2 shows the variation in immunization coverage across provinces. 1 Dropout rate = (Dose 1 – Dose 3)/Dose 1 * 100 136 • Child Health Table 10.3 presents by background characteristics the percentage of children age 12-23 months who received specific vaccines at any time before the survey. Information on children’s immunizations collected from health cards is presented in the top panel; information from the mother’s report is in the middle panel; and information from both sources is in the bottom panel. This table shows that health cards were seen at the time of the interview for 41 percent of children 12-23 months, an increase of four percentage points from the 2007 IDHS (37 percent) and of ten percentage points from the 2002-2003 IDHS (31 percent). Immunization coverage based on mothers’ reports is considerably lower than the coverage based on written records. According to mothers’ reports, only 53 percent of children 12-23 months are fully immunized, excluding HB, compared with 83 percent of children with health cards. The highest coverage based on mother’s recall is for polio 1, BCG, and DPT 1 (80 percent or more), while the lowest coverage is for HB 3 (23 percent). Based on the information from health cards and mothers’ reports, 66 percent of children 12-23 months were fully immunized (excluding HB) at the time of the survey. Although there is almost no difference in immunization coverage by the child’s sex, those least likely to have received basic immunizations are sixth- or higher-order births (31 percent) and children whose mothers have had no education (23 percent). Table 10.3 shows that immunization cards were more likely to have been seen for first-order births, children living in urban areas, children of mothers with complete secondary or higher education, and children whose mothers are in the second or highest wealth quintiles. Child Health • 137 Table 10.3 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey, according to a vaccination card, the mother’s report, and vaccination card or the mother’s report, percentage with a vaccination card, by background characteristics, Indonesia 2012 Background characteristic BCG DPT Polio Hepatitis Measles All basic vaccina- tions excluding hepatitis B All basic vaccina- tions1 No vaccina- tions Percent- age with a vaccina- tion card seen Number of children1 2 3 1 2 3 0 1 2 3 HEALTH CARD Sex Male 98.1 99.0 95.7 91.8 99.4 97.0 93.5 97.1 91.0 87.2 72.3 86.8 84.1 67.5 0.3 100.0 720 Female 95.2 96.7 92.9 88.1 98.5 94.6 88.8 95.5 89.4 85.3 67.9 86.9 81.8 65.9 0.6 100.0 650 Birth order 1 95.8 98.5 95.3 90.8 98.6 95.1 90.7 95.9 91.0 86.7 74.8 88.3 82.9 70.5 0.5 100.0 582 2-3 97.4 98.0 94.5 91.0 99.3 97.6 92.8 96.8 90.7 87.6 68.9 87.2 84.4 65.8 0.3 100.0 658 4-5 98.7 97.9 95.0 90.5 100.0 97.1 93.0 95.6 89.2 85.9 61.7 86.1 85.1 58.7 0.0 100.0 107 6+ 88.1 80.9 61.9 42.5 96.1 61.2 56.3 96.4 61.2 44.5 34.8 44.2 37.1 33.0 2.4 100.0 23 Residence Urban 97.5 97.7 95.8 91.2 99.2 96.7 93.1 98.0 92.5 88.6 73.6 85.6 82.9 68.8 0.4 100.0 696 Rural 95.9 98.0 92.9 88.9 98.8 95.0 89.4 94.6 87.9 84.0 66.8 88.2 83.1 64.5 0.5 100.0 674 Mother’s education No education 77.0 92.5 92.5 66.5 92.5 90.3 66.5 90.3 84.7 69.2 19.4 53.4 45.9 19.4 0.0 100.0 7 Some primary 94.6 84.9 77.9 70.9 94.9 86.8 74.1 86.4 76.8 74.7 48.4 61.2 58.2 38.1 2.4 100.0 71 Completed primary 94.2 98.1 93.4 88.5 99.2 95.9 88.9 96.9 90.8 86.9 67.7 87.6 82.2 65.3 0.6 100.0 331 Some secondary 96.0 98.3 94.6 88.2 98.6 95.6 91.7 95.9 91.9 84.9 71.9 88.7 82.5 69.8 0.6 100.0 386 Completed secondary 98.9 99.0 96.5 94.2 99.7 96.5 94.1 97.8 89.3 87.5 73.4 87.7 86.5 69.4 0.0 100.0 442 More than secondary 99.6 99.6 97.7 96.8 99.6 99.4 97.2 96.5 94.6 92.4 75.7 92.3 90.4 70.0 0.0 100.0 133 Wealth quintile Lowest 92.5 96.7 87.0 79.9 96.7 92.1 83.3 92.9 84.2 76.3 50.5 80.0 73.3 48.9 0.9 100.0 211 Second 94.9 97.9 93.9 86.8 99.0 93.7 88.8 97.5 90.2 84.5 70.0 83.9 78.6 66.5 0.7 100.0 335 Middle 97.7 98.1 97.2 95.5 98.7 98.4 95.0 96.1 91.8 89.9 69.8 93.2 89.9 66.6 0.6 100.0 258 Fourth 98.1 98.1 95.7 91.3 99.9 96.9 92.7 96.9 92.5 89.0 79.6 86.2 82.5 73.7 0.0 100.0 287 Highest 99.6 98.3 96.3 95.2 100.0 97.9 95.4 97.0 91.1 90.0 76.3 90.4 89.8 73.3 0.0 100.0 279 Total 96.7 97.9 94.3 90.0 99.0 95.9 91.3 96.3 90.2 86.3 70.2 86.9 83.0 66.7 0.4 100.0 1,370 MOTHER’S REPORT Sex Male 84.8 81.2 72.1 59.5 86.1 79.4 65.6 78.3 65.9 53.8 24.3 77.2 53.1 23.2 11.8 0.0 994 Female 83.5 81.4 70.1 59.4 85.5 77.0 64.7 76.8 61.3 50.7 21.7 73.6 53.7 20.6 12.4 0.0 969 Birth order 1 87.0 84.1 75.2 63.2 87.1 78.6 66.1 78.2 63.8 53.5 23.5 79.7 56.5 22.5 10.5 0.0 663 2-3 86.2 83.9 73.4 62.0 87.8 81.6 67.9 80.5 66.3 55.6 24.7 76.3 56.3 23.4 10.3 0.0 1,008 4-5 74.7 70.9 59.0 45.5 79.7 68.0 54.9 71.2 59.2 40.8 17.1 67.4 39.2 16.4 18.1 0.0 214 6+ 59.2 53.7 40.6 33.5 65.4 58.8 50.0 52.1 40.2 30.2 13.9 50.7 29.8 13.7 33.2 0.0 79 Residence Urban 90.9 87.7 76.3 66.5 91.5 84.3 70.8 84.7 69.1 57.1 23.4 79.8 59.3 22.1 7.2 0.0 928 Rural 78.1 75.6 66.5 53.1 80.7 72.7 60.1 71.2 58.7 48.0 22.7 71.5 48.1 21.8 16.5 0.0 1,035 Mother’s education No education 47.9 35.2 29.9 19.3 46.2 42.0 26.5 34.0 23.3 18.4 7.9 30.2 18.9 7.6 45.7 0.0 45 Some primary 68.0 59.5 48.8 39.1 68.0 59.4 49.4 58.1 48.6 37.0 20.9 58.5 37.4 20.1 27.2 0.0 148 Completed primary 79.4 77.4 62.4 48.2 83.3 73.2 56.6 73.3 51.6 41.6 17.3 71.1 43.3 16.5 14.5 0.0 440 Some secondary 84.9 82.3 70.9 58.4 86.7 78.3 66.9 77.1 64.1 52.6 23.1 76.4 53.1 21.5 11.4 0.0 554 Completed secondary 90.5 87.8 79.2 68.1 91.0 84.3 68.4 84.4 71.7 57.3 24.1 80.5 57.4 22.6 7.8 0.0 490 More than secondary 93.1 92.9 89.2 80.7 94.3 90.6 83.7 90.3 81.4 72.8 33.4 87.7 76.3 33.1 4.0 0.0 286 Wealth quintile Lowest 67.4 62.7 52.0 39.6 71.5 63.6 50.1 58.7 47.6 36.4 14.9 57.7 35.4 14.4 25.5 0.0 462 Second 83.1 79.6 67.3 54.4 85.8 77.3 61.3 74.9 60.0 47.3 21.2 75.8 49.2 18.8 11.0 0.0 404 Middle 89.1 87.4 76.5 61.5 89.0 81.0 70.6 83.1 68.8 60.3 26.7 80.5 55.7 25.9 9.6 0.0 395 Fourth 92.4 89.3 80.7 71.6 92.9 85.8 69.0 85.9 68.4 56.3 25.9 79.6 60.4 24.6 5.3 0.0 355 Highest 93.6 93.0 85.2 77.0 93.8 87.8 79.7 90.9 78.4 66.0 28.9 88.7 72.6 28.3 5.2 0.0 347 Total 84.1 81.3 71.1 59.4 85.8 78.2 65.2 77.6 63.6 52.3 23.0 75.5 53.4 21.9 12.1 0.0 1,963 Continued… 138 • Child Health Table 10.3—Continued Background characteristic BCG DPT Polio Hepatitis Measles All basic vaccina- tions excluding hepatitis B All basic vaccina- tions1 No vaccina- tions Percent- age with a vaccina- tion card seen Number of children1 2 3 1 2 3 0 1 2 3 HEALTH CARD AND MOTHER’S REPORT Sex Male 90.4 88.7 82.0 73.1 91.7 86.8 77.3 86.2 76.4 67.8 44.5 81.2 66.1 41.8 6.9 42.0 1,714 Female 88.2 87.6 79.3 70.9 90.7 84.1 74.4 84.3 72.5 64.6 40.3 79.0 65.0 38.8 7.7 40.2 1,619 Birth order 1 91.1 90.8 84.6 76.1 92.4 86.3 77.6 86.5 76.5 69.0 47.5 83.7 68.8 44.9 5.8 46.7 1,244 2-3 90.6 89.5 81.8 73.5 92.3 87.9 77.7 86.9 75.9 68.2 42.1 80.6 67.4 40.1 6.3 39.5 1,665 4-5 82.7 79.9 71.0 60.5 86.5 77.7 67.6 79.3 69.2 55.8 32.0 73.6 54.5 30.5 12.1 33.3 322 6+ 65.8 59.9 45.5 35.5 72.4 59.4 51.5 62.2 45.0 33.4 18.7 49.2 31.4 18.1 26.2 22.9 102 Residence Urban 93.7 92.0 84.6 77.1 94.8 89.6 80.4 90.4 79.1 70.6 44.9 82.3 69.4 42.1 4.3 42.8 1,624 Rural 85.1 84.5 76.9 67.2 87.8 81.5 71.7 80.4 70.2 62.2 40.1 78.1 61.9 38.6 10.2 39.5 1,709 Mother’s education No education 52.0 43.2 38.7 25.9 52.7 48.8 32.1 41.9 31.9 25.5 9.5 33.4 22.7 9.2 39.3 14.1 53 Some primary 76.6 67.7 58.3 49.4 76.8 68.3 57.5 67.3 57.8 49.2 29.9 59.4 44.2 26.0 19.1 32.5 219 Completed primary 85.8 86.3 75.7 65.5 90.1 83.0 70.5 83.4 68.4 61.0 38.9 78.1 60.0 37.4 8.5 42.9 770 Some secondary 89.4 88.9 80.7 70.7 91.6 85.4 77.1 84.8 75.5 65.9 43.1 81.5 65.2 41.4 7.0 41.1 939 Completed secondary 94.5 93.1 87.4 80.5 95.1 90.1 80.6 90.7 80.0 71.6 47.5 83.9 71.2 44.8 4.1 47.4 932 More than secondary 95.2 95.1 91.9 85.8 96.0 93.4 88.0 92.3 85.6 79.0 46.9 89.2 80.8 44.8 2.8 31.7 420 Wealth quintile Lowest 75.2 73.4 63.0 52.2 79.4 72.5 60.5 69.4 59.0 48.9 26.0 64.7 47.3 25.2 17.8 31.3 673 Second 88.5 87.9 79.4 69.1 91.8 84.7 73.8 85.2 73.6 64.1 43.3 79.5 62.5 40.4 6.3 45.3 739 Middle 92.5 91.6 84.7 74.9 92.8 87.9 80.3 88.2 77.9 72.0 43.7 85.5 69.3 42.0 6.1 39.6 653 Fourth 95.0 93.3 87.4 80.4 96.1 90.7 79.6 90.8 79.2 71.0 49.9 82.5 70.3 46.6 2.9 44.7 642 Highest 96.3 95.4 90.2 85.1 96.6 92.3 86.7 93.6 84.0 76.7 50.1 89.5 80.2 48.4 2.9 44.6 625 Total 89.3 88.1 80.7 72.0 91.2 85.5 75.9 85.3 74.5 66.3 42.4 80.1 65.6 40.3 7.3 41.1 3,333 1 BCG, measles, all four doses of hepatitis B, three doses each of DPT and polio vaccine excluding polio 4 Figure 10.3 shows the trend in immunization coverage from 1991. In the past 20 years, immunization coverage has increased substantially from 48 to 66 percent. Caution should be used when comparing the results of the 2002-2003 IDHS with those of the 2007 and 2012 IDHS surveys because the last two IDHS surveys covered the whole country (33 provinces), while the 2002-2003 IDHS excluded three provinces (Aceh, Maluku, and Papua). Although there seems to be a dip in the 2002-03 IDHS, there has been an increase of 13 percent between 2002-03 and 2007 and 12 percent in the past five years (BPS et al., 2008). Child Health • 139 Figure 10.3 Trends in immunization coverage excluding hepatitis B 48 50 55 52 59 66 1991 IDHS 1994 IDHS 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Percent Source: Information from Health Cards and mothers' reports Note: The 2003-2003 IDHS excluded Aceh, Maluku, and Papua provinces. 10.3 CHILDHOOD ILLNESS AND TREATMENT This section of the chapter presents findings on the prevalence and treatment of childhood illnesses. The 2012 IDHS collected information on several infectious diseases common among children under age 5, such as acute respiratory infection (ARI), fever, and diarrheal diseases. Acute respiratory tract infections, primarily pneumonia, are a common cause of morbidity and death among children under age 5 throughout the world. Pneumonia is characterized by cough with difficult or rapid breathing and chest in-drawing. For severe pneumonia, hospitalization is recommended; otherwise, ambulatory treatment with antibiotics is recommended. Early diagnosis and treatment with antibiotics can reduce the number of deaths caused by ARI, particularly deaths resulting from pneumonia. Various infectious diseases are usually accompanied by fever. In Indonesia, the most common diseases accompanied by fever are malaria, respiratory and intestinal infections, measles, and typhoid. In the 2012 IDHS, information about the prevalence of fever in the preceding two weeks in children less than age 5 was collected through mother’s report, although the causes of fever were not specified. The prevalence of diarrhea among children under age 5 was also collected by asking mothers about the incident of diarrhea in their children in the past two weeks. Treatment practices and contact with health services among children with the three most common childhood illnesses (ARI, fever, and diarrhea) help in assessing national programs aimed at reducing the mortality impact of these illnesses. Information is provided on the prevalence and treatment of ARI and administration of antibiotics, as well as on the prevalence of fever and its treatment with antimalarial drugs and antibiotics. Information on the treatment of diarrheal diseases with oral rehydration therapy (ORT), including increased fluids, aids in the assessment of programs in Indonesia that recommend such treatment. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal diseases, information was also collected in the survey on the disposal of children’s fecal matter. 140 • Child Health 10.3.1 Acute Respiratory Infection (ARI) In the 2012 IDHS, the prevalence of ARI was estimated by asking mothers whether their children under age 5 had been ill with a cough accompanied by short, rapid breathing and difficulty breathing as a result of a problem in the chest, in the two weeks preceding the survey. These symptoms are compatible with ARI. It should be noted that the morbidity data collected are subjective in the sense that they are based on the mother’s perception of illness without validation by medical personnel. Table 10.4 shows that overall, 5 percent of children had symptoms of ARI in the two weeks preceding the survey. There are small variations across subgroups of children. The prevalence of ARI does not vary much by child’s sex, mother’s smoking status, residence, maternal education, or wealth quintile. The lowest prevalence of ARI is seen among children less than age 6 months (2 percent). Table 10.4 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey, and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider, and the percentage who received antibiotics as treatment, according to background characteristics, Indonesia 2012 Among children under age five: Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 2.3 1,614 (82.6) (25.8) 37 6-11 5.9 1,853 88.8 42.1 110 12-23 5.1 3,333 79.1 40.4 171 24-35 6.5 3,218 69.2 35.0 208 36-47 5.4 3,200 75.3 41.1 172 48-59 4.2 3,162 67.0 41.2 134 Sex Male 5.7 8,327 75.9 40.8 474 Female 4.5 8,054 74.6 36.3 359 Mother’s smoking status Smokes cigarettes/tobacco 6.2 316 (62.4) (20.7) 20 Does not smoke 5.1 16,063 75.6 39.3 813 Cooking fuel Electricity or gas (2.3) 22 * * 0 Kerosene 5.3 1,264 74.6 40.3 67 Charcoal 3.2 66 * * 2 Wood/straw3 6.3 5,668 70.3 34.0 356 No food cooked in household (12.6) 39 * * 5 Residence Urban 4.5 8,173 74.6 40.0 366 Rural 5.7 8,207 75.9 38.0 467 Mother’s education No education 5.4 341 (75.3) (7.1) 18 Some primary 7.5 1,374 70.4 40.9 103 Completed primary 5.1 3,812 72.9 44.9 196 Some secondary 5.8 4,315 79.2 38.4 251 Completed secondary 4.4 4,450 76.4 34.4 196 More than secondary 3.3 2,089 72.5 41.8 69 Wealth quintile Lowest 6.7 3,541 60.7 36.1 236 Second 6.0 3,164 83.7 40.8 190 Middle 4.9 3,197 80.3 40.3 158 Fourth 4.1 3,338 86.8 42.7 137 Highest 3.6 3,141 71.0 34.8 112 Total 5.1 16,380 75.3 38.9 833 Note: Total includes 17 children with missing information on cooking fuel. Figures in parentheses are based on 25-49 unweighted cases. An asterisk (*) indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI (cough accompanied by short, rapid breathing that was chest-related and/or by difficult breathing that was chest-related) is considered a proxy for pneumonia. 2 Excludes pharmacy, shop, and traditional practitioner Child Health • 141 Three in four children (75 percent) with symptoms of ARI were taken to a health facility or health provider for treatment, an increase of nine percentage points compared with the rate reported in the 2007 IDHS. This increase may indicate an improvement in the accessibility of basic health services in Indonesia. Among children under age 5 who suffered from ARI and went to health facilities, 39 percent received antibiotic treatment. There is no clear pattern in health-seeking behavior by the child’s background characteristics. Children age 48-59 months are the least likely to be taken for advice or treatment from a health provider. Appendix Table A-10.3 shows the prevalence and treatment of symptoms of ARI by province. 10.3.2 Fever Fever is a major manifestation of malaria and other acute infections in children. Malaria and fever contribute to high levels of malnutrition and morbidity. While fever can occur year-round, malaria is more prevalent following the end of the rainy season, when the climatic conditions are more favorable to malaria transmission. For this reason, temporal factors must be taken into account when interpreting fever as an indicator of malaria prevalence. Because malaria is a major contributory cause of death in infancy and childhood in many developing countries, presumptive treatment of fever with antimalarial medication is advocated in many countries where malaria is endemic. In Indonesia, malaria is mainly found in eastern Indonesia including Papua, West and East Nusa Tenggara, Maluku, and North Maluku provinces. It is also found in Lombok island, and in all rural areas in Sumatera, Kalimantan, and Sulawesi. Table 10.5 shows the percentage of children under age 5 with fever during the two weeks preceding the survey and the percentage receiving various treatments by selected background characteristics. Overall, 31 percent of children under age were reported to have had fever in the two weeks preceding the survey. Fever prevalence varied by age of the child. Children 6-23 months are more prone to have fever (37-39 percent) than other children. Fever prevalence varies only slightly by gender, residence, mother’s education, and wealth quintiles. Three in four children with fever (74 percent) were taken to a health facility or provider for treatment. Children 6-23 months are more likely than younger or older children to be taken to a health facility or provider for treatment of fever (77-78 percent). The percentage of children with fever taken to a health facility or provider increases significantly with wealth quintiles; 66 percent of children from the poorest households are taken for treatment compared with 79 percent of children from the highest wealth quintile. As expected, since malaria is found in only a few areas in Indonesia, few children with fever were given antimalarial drugs. Table 10.5 also shows that 36 percent of children with fever received antibiotics. Children age 6 months and above more likely than very young children to receive antibiotic treatment. There is no clear pattern in the treatment of fever with antibiotics by gender, residence, and wealth quintiles. However, treatment of fever with antibiotics is related to the mother’s education; children whose mothers have no education are the least likely to receive antibiotics (21 percent). 142 • Child Health Table 10.5 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Indonesia 2012 Among children under age 5: Among children under age 5 with fever: Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antimalarial drugs Percentage who took antibiotic drugs Number of children Age in months <6 21.9 1,614 72.9 0.0 25.3 353 6-11 39.3 1,853 78.0 0.9 35.0 728 12-23 37.2 3,333 77.2 0.9 36.6 1,239 24-35 33.3 3,218 73.3 0.9 37.1 1,073 36-47 28.3 3,200 68.0 0.6 35.1 905 48-59 24.9 3,162 70.1 1.0 37.4 788 Sex Male 32.2 8,327 74.6 0.8 37.1 2,682 Female 29.8 8,054 72.2 0.8 33.8 2,404 Residence Urban 29.4 8,173 74.4 0.5 37.2 2,400 Rural 32.7 8,207 72.6 1.1 34.1 2,686 Mother’s education No education 27.6 341 63.1 0.8 20.8 94 Some primary 34.2 1,374 68.8 0.4 37.1 470 Completed primary 32.2 3,812 70.9 1.0 36.2 1,229 Some secondary 33.8 4,315 77.0 0.6 33.4 1,459 Completed secondary 29.4 4,450 75.1 0.6 37.0 1,308 More than secondary 25.2 2,089 71.6 1.8 37.6 526 Wealth quintile Lowest 32.5 3,541 65.6 1.1 33.9 1,150 Second 33.4 3,164 73.9 1.2 36.2 1,057 Middle 32.0 3,197 73.5 0.3 36.1 1,023 Fourth 30.9 3,338 77.1 0.7 36.8 1,033 Highest 26.2 3,141 79.1 0.5 34.6 824 Total 31.0 16,380 73.5 0.8 35.5 5,086 1 Excludes pharmacy, shop, and traditional practitioner 10.3.3 Diarrhea Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young children, although the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. This combination of high cause-specific mortality and the existence of effective treatment make diarrhea and its treatment a priority concern for health services. In interpreting the findings of the 2012 IDHS it should be borne in mind that the prevalence of diarrhea varies seasonally. Prevalence of diarrhea Table 10.6 shows the percentage of children under 5 with diarrhea and diarrhea with blood in the stools in the two weeks preceding the survey, according to selected background characteristics. Diarrhea with blood in the stools is indicative of cholera or other specific disease and needs to be treated somewhat differently than diarrhea without blood. Child Health • 143 Overall, 14 percent of children under age 5 were reported to have diarrhea in the two weeks before the survey. Only 1 per 1,000 children had diarrhea with blood. The prevalence of diarrhea is highest among children age 6-35 months, presumably because babies are usually weaned off breast milk around the age of six months. In general, the source of drinking water makes a difference in the likelihood of children having diarrhea. Eighteen percent of children who use a non-improved source of water had diarrhea compared with 14 percent of children who use an improved source of drinking water. Furthermore, children who have no toilet facility and who live in a household with a private toilet facility without a septic tank are more likely to suffer from diarrhea than children living in households with other types of sanitation facilities. There is no clear pattern for the prevalence of diarrhea according to a mother’s level of education. The prevalence of diarrhea is highest among children from the lowest wealth quintile. Appendix Table A-10.4 shows the variation in the prevalence of diarrhea by province. Knowledge of ORS packets or prepackaged liquids A simple and effective response to dehydration caused by diarrhea is a prompt increase in the child’s fluid intake through some form of oral rehydration therapy (ORT), which may include the use of a solution prepared from packets of oral rehydration salts (ORS). To ascertain how widespread knowledge of ORS is in Indonesia, female respondents in the 2012 IDHS were asked whether they know about Oralit, the most commonly used ORS brand in the country. Table 10.6 Prevalence of diarrhea Percentage of children under age 5 who had diarrhea in the two weeks preceding the survey, by background characteristics, Indonesia 2012 Background characteristic Diarrhea in the two weeks preceding the survey Number of children All diarrhea Diarrhea with blood Age in months <6 11.8 0.0 1,614 6-11 19.2 0.1 1,853 12-23 21.4 0.3 3,333 24-35 16.0 0.0 3,218 36-47 9.7 0.2 3,200 48-59 8.1 0.1 3,162 Sex Male 15.6 0.1 8,327 Female 12.9 0.1 8,054 Source of drinking water1 Improved source 13.7 0.1 12137 Non-improved source 17.8 0.2 3,759 Other/missing 14.5 0.0 72 Toilet facility2,3 Private Private - with septic tank 13.1 0.1 9,919 Private - without septic tank 16.2 0.3 1,262 Shared/public 14.7 0.1 1,463 Other facility Pit latrine 14.8 0.3 871 Yard/bush/forest 18.5 0.0 579 River/stream/creek 17.4 0.2 1,927 Other 15.3 0.2 351 Residence Urban 13.2 0.1 8,173 Rural 15.4 0.2 8,207 Mother’s education No education 11.8 0.0 341 Some primary 17.4 0.3 1,374 Completed primary 14.1 0.0 3,812 Some secondary 15.7 0.2 4,315 Completed secondary 14.1 0.1 4,450 More than secondary 10.6 0.0 2,089 Wealth quintile Lowest 16.9 0.2 3,541 Second 15.5 0.2 3,164 Middle 15.0 0.0 3,197 Fourth 13.4 0.1 3,338 Highest 10.4 0.0 3,141 Total 14.3 0.1 16,380 Note: Total includes 9 households with missing information on sanitation facility. 1 See Table 2.1 for definition of categories. 2 Private toilet is not shared with other households. 3 The septic tank may/may not be located in the household. 144 • Child Health Table 10.7 and Figure 10.4 show that knowledge of ORS is widespread among women in Indonesia with a birth in the five years preceding the survey, similar to the rate that has been reported since 1997 (BPS et al., 2008). Knowledge of ORS is somewhat lower among women age 15-19 when compared with older women. Urban women are somewhat more likely than rural women to know about ORS (97 and 91 percent, respectively). Mother’s education is positively associated with knowledge of ORS packets; only 60 percent of mothers with no education have heard about ORS compared with 98 percent of women with secondary or higher education. A similar pattern is observed for household’s wealth status; 86 percent of mothers in the lowest wealth quintile know about ORS compared with 98 percent of mothers in the highest wealth quintile. Figure 10.4 Trends in knowledge and use of ORS packets for treatment of children with diarrhea, 1997-2012 94 92 93 94 48 36 35 39 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Percent Knowledge of ORS Use of ORS Note: The 2002-2003 IDHS excluded Aceh, Maluku, and Papua provinces. Appendix Table A-10.5 shows mother’s knowledge of ORS packets or pre-packaged liquids by province. Table 10.7 Knowledge of ORS packets or pre-packaged liquids Percentage of women age 15-49 with a live birth in the five years preceding the survey who know about ORS packets or ORS pre- packaged liquids for treatment of diarrhea by background characteristics, Indonesia 2012 Background characteristic Percentage of women who know about ORS packets or ORS pre- packaged liquids Number of women Age 15-19 83.7 478 20-24 90.8 2,877 25-34 94.7 7,626 35-49 95.7 3,804 Residence Urban 96.7 7,359 Rural 91.0 7,427 Education No education 60.2 275 Some primary 84.7 1,243 Completed primary 92.7 3,517 Some secondary 94.5 3,965 Completed secondary 97.2 4,021 More than secondary 98.4 1,765 Wealth quintile Lowest 85.5 3,038 Second 93.5 2,881 Middle 96.7 2,939 Fourth 96.3 3,105 Highest 97.5 2,822 Total 93.8 14,786 ORS = Oral rehydration salts Child Health • 145 Diarrhea treatment In the 2012 IDHS, mothers of children who had diarrhea were asked what they did to treat the illness. Table 10.8 shows the percentage of children with diarrhea who received specific treatments according to background characteristics. Data in Table 10.8 show that 65 percent of children under 5 with diarrhea in the two weeks preceding the survey were taken to a health facility or provider. This is an increase of 14 percentage points over that reported in the 2007 IDHS. Treatment of diarrhea varies by age of child. Infants under 6 months are the least likely to be taken to a health facility or provider compared with older children. Male children are slightly more likely to be taken to a health facility or provider than female children. There are no clear patterns for health- seeking behavior by mother’s education and wealth quintile. Even though more than nine in ten mothers reported knowing about ORS packets (Table 10.7), only 39 percent of children with diarrhea were treated with ORS (or a prepackaged liquid). This percentage is higher than that reported in the 2007 IDHS (35 percent) (BPS et al., 2008). Seventeen percent were given the recommended home fluids (RHF) and 40 percent were given increased fluids. A total of 66 percent were given some form of oral rehydration therapy (either ORS or RHF) or increased fluids. Looking at treatments other than ORT, 13 percent of children with diarrhea received antibiotics, while 45 percent were given a home remedy or other treatment. Fifteen percent of children with diarrhea did not receive any treatment at all. 146 • Child Health Table 10.8 Diarrhea treatment Among children under age 5 who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by background characteristics, Indonesia 2012 Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 Oral rehydration therapy (ORT) In- creased fluids ORT or in- creased fluids Other treatments Missing No treat- ment Number of children with diarrhea Background characteristic Fluid from ORS packets or pre- packaged liquid Recom- mended home fluids (RHF) Either ORS or RHF Antibiotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other Age in months <6 47.3 15.9 2.6 18.5 30.8 45.1 4.6 0.0 0.0 0.0 32.1 0.0 36.6 190 6-11 67.0 36.7 12.5 42.7 32.7 58.0 16.1 2.2 0.9 0.0 36.9 0.3 19.0 356 12-23 69.6 39.7 19.1 49.0 44.1 70.9 14.1 0.9 1.0 0.5 48.1 0.7 12.0 713 24-35 65.8 43.8 19.4 52.7 39.6 70.8 9.9 0.7 1.9 0.0 47.7 0.1 11.0 515 36-47 64.8 45.1 20.4 51.6 47.9 73.1 12.5 0.3 1.4 0.0 50.3 0.3 11.8 309 48-59 57.9 38.3 22.9 49.9 37.6 62.6 13.8 1.4 0.3 0.0 41.6 0.8 12.8 256 Sex Male 66.3 42.3 18.3 50.5 40.2 68.6 11.8 0.6 1.2 0.3 45.1 0.5 14.3 1,300 Female 62.5 34.4 16.3 42.3 40.0 63.2 13.4 1.4 0.8 0.0 43.9 0.3 15.7 1,040 Type of diarrhea Non-bloody 63.5 35.6 18.7 45.8 52.3 73.4 10.5 0.9 3.1 0.0 42.8 0.3 10.5 486 Bloody 83.2 61.6 21.2 63.6 45.9 78.4 19.7 0.0 0.0 0.0 28.7 0.0 16.5 20 Missing 68.9 52.8 13.6 58.7 14.6 67.3 27.4 0.0 3.1 0.0 42.2 11.5 1.6 30 Residence Urban 63.2 40.8 15.9 47.8 43.8 67.8 13.5 1.0 1.5 0.0 46.4 0.3 14.1 1,078 Rural 65.8 37.1 18.7 46.0 36.9 64.9 11.6 0.9 0.6 0.3 43.0 0.5 15.6 1,263 Mother’s education No education 54.6 28.2 14.3 39.0 21.1 49.4 11.6 0.0 1.7 0.0 23.6 0.0 26.1 40 Some primary 65.0 40.9 19.7 47.6 39.1 63.7 11.8 2.8 0.3 0.0 44.5 0.1 15.4 239 Completed primary 66.9 38.7 19.0 47.1 36.6 67.6 13.8 0.9 0.5 0.0 42.9 0.0 13.6 538 Some secondary 66.6 40.1 18.8 50.7 38.0 67.0 10.6 0.9 0.9 0.6 46.4 1.0 14.1 676 Completed secondary 64.0 37.6 16.7 44.6 45.9 66.6 13.3 0.7 2.0 0.0 44.3 0.3 16.6 627 More than secondary 56.4 37.9 9.3 41.2 42.8 65.5 13.6 0.3 1.0 0.0 47.4 0.2 13.3 221 Wealth quintile Lowest 62.8 39.3 21.6 49.2 31.4 63.7 11.1 0.9 0.8 0.0 38.6 0.3 15.9 598 Second 65.9 38.7 16.7 45.2 41.6 66.7 14.0 1.1 2.3 0.8 42.7 0.7 14.7 491 Middle 67.3 39.9 18.5 49.4 45.2 70.6 9.4 1.1 0.7 0.0 53.0 0.4 10.7 479 Fourth 65.0 40.2 12.4 46.7 43.8 67.6 13.6 1.3 0.6 0.0 38.5 0.3 18.0 447 Highest 61.5 34.3 16.2 41.2 41.1 61.8 15.7 0.0 0.9 0.0 54.1 0.4 15.4 325 Total 64.6 38.8 17.4 46.8 40.1 66.2 12.5 1.0 1.1 0.2 44.6 0.4 14.9 2,341 Note: ORT includes fluid prepared from oral rehydration salt (ORS) packets, pre-packaged ORS fluid, and recommended home fluids (RHF). 1 Excludes pharmacy, shop, and traditional practitioner Feeding practices during diarrhea Mothers are encouraged to continue feeding their children with diarrhea normally and to increase the amount of fluids. In particular, consumption of extra fluids is essential to avoid dehydration. Table 10.9 shows the results on feeding practices during diarrhea. Table 10.9 shows that only 40 percent of children with diarrhea were given more fluids than usual, while 43 percent received the same amount. Seventeen percent of children with diarrhea received fewer liquids or no liquids at all. Only 10 percent of children received more food than usual during their diarrhea, 39 percent received the same amount of food as usual, and 46 percent were given less food or no food at all. Child Health • 147 Table 10.9 also shows feeding practices during diarrhea by background characteristics. Sixty-one percent of children with diarrhea continued feeding and were given ORT and/or increased fluids during the diarrheal episode, while 37 percent were given increased fluids and continued feeding. The percentage of children that continued feeding and were correctly given ORT and/or increased fluids is lower among children under 6 months than among older children. Female children and those living in rural areas are somewhat less. likely than male children and those living in urban areas to continue feeding and to receive ORT and/or increased liquids. There is no clear association between mother’s level of education and household wealth quintile and proper feeding practices during diarrhea. Table 10.9 Feeding practices during diarrhea Percent distribution of children under age 5 who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by background characteristics, Indonesia 2012 Amount of liquids given Amount of food given Percent- age given increased fluids and continued feeding1 Percent- age who continued feeding and were given ORT and/or increased fluids1 Number of children with diarrhea Background characteristic More Same as usual Some- what less Much less None Don’t know/ mis- sing Total More Same as usual Some- what less Much less None Never gave food Don’t know/ mis- sing Total Age in months <6 30.8 58.1 7.0 0.5 3.6 0.0 100.0 6.8 24.7 9.2 0.7 8.4 50.2 0.0 100.0 11.5 20.6 190 6-11 32.7 49.8 16.8 0.2 0.3 0.2 100.0 9.3 45.5 37.3 1.3 2.9 3.9 0.0 100.0 31.3 53.1 356 12-23 44.1 40.8 11.5 0.6 2.0 1.1 100.0 9.1 37.5 47.7 3.1 1.3 0.4 0.8 100.0 41.9 67.1 713 24-35 39.6 38.1 19.7 0.8 1.7 0.2 100.0 10.2 42.4 43.6 3.3 0.2 0.2 0.2 100.0 39.0 67.2 515 36-47 47.9 34.4 15.1 0.4 2.1 0.0 100.0 11.7 36.6 44.0 7.3 0.1 0.0 0.3 100.0 45.7 70.7 309 48-59 37.6 43.8 12.5 2.6 3.1 0.4 100.0 9.3 40.7 46.8 1.5 0.0 0.4 1.3 100.0 36.9 61.2 256 Sex Male 40.2 43.4 13.4 0.7 1.9 0.5 100.0 9.0 40.2 42.0 3.5 1.7 2.9 0.8 100.0 37.9 63.9 1,300 Female 40.0 41.3 15.5 0.9 2.0 0.3 100.0 10.2 37.4 40.9 2.5 1.5 7.3 0.1 100.0 36.2 57.5 1,040 Type of diarrhea Non-bloody 52.3 26.4 19.5 0.2 1.6 0.0 100.0 9.7 33.9 42.7 2.3 0.7 10.5 0.2 100.0 44.8 63.7 486 Bloody (45.9) (20.5) (30.4) (3.2) (0.0) (0.0) 100.0 (6.9) (24.2) (60.3) (2.5) (6.1) (0.0) (0.0) 100.0 (37.3) (69.8) 20 Residence Urban 43.8 41.3 12.1 0.3 2.2 0.3 100.0 10.5 41.5 38.8 2.5 1.0 5.6 0.1 100.0 40.8 63.2 1,078 Rural 36.9 43.5 16.2 1.1 1.7 0.5 100.0 8.7 36.8 43.8 3.5 2.1 4.3 0.8 100.0 34.0 59.2 1,263 Mother’s education No education 21.1 41.2 31.2 0.0 6.5 0.0 100.0 2.5 37.0 50.8 1.6 2.2 6.0 0.0 100.0 19.0 45.6 40 Some primary 39.1 39.9 17.2 0.4 3.0 0.3 100.0 7.2 37.2 48.8 2.9 0.6 3.0 0.3 100.0 38.5 61.6 239 Completed primary 36.6 43.4 18.7 0.3 0.8 0.1 100.0 6.1 35.2 47.9 3.9 1.3 4.8 0.7 100.0 33.6 61.1 538 Some secondary 38.0 44.0 13.2 1.6 2.4 0.8 100.0 9.0 38.5 44.2 2.4 1.4 3.8 0.8 100.0 35.6 62.4 676 Completed secondary 45.9 41.5 9.8 0.3 2.3 0.2 100.0 12.7 41.3 34.2 2.2 2.8 6.5 0.1 100.0 42.1 60.7 627 More than secondary 42.8 41.3 13.7 0.9 0.4 0.8 100.0 14.0 45.1 28.6 6.0 0.4 5.7 0.2 100.0 38.2 59.8 221 Wealth quintile Lowest 31.4 44.5 20.7 0.3 2.7 0.3 100.0 9.9 35.8 45.1 2.6 2.7 3.5 0.4 100.0 29.5 59.6 598 Second 41.6 43.3 12.8 0.7 0.9 0.7 100.0 8.1 37.9 43.5 2.2 0.6 6.8 0.9 100.0 38.3 62.1 491 Middle 45.2 42.3 9.5 0.4 2.3 0.3 100.0 8.4 39.2 43.2 2.9 0.9 4.6 0.7 100.0 40.2 63.6 479 Fourth 43.8 40.2 11.7 1.9 1.8 0.6 100.0 10.8 37.5 40.0 2.5 2.8 6.4 0.0 100.0 41.0 62.3 447 Highest 41.1 41.0 15.6 0.5 1.7 0.2 100.0 10.8 48.2 31.2 6.1 0.4 2.8 0.4 100.0 39.7 56.6 325 Total 40.1 42.5 14.3 0.7 1.9 0.4 100.0 9.5 39.0 41.5 3.1 1.6 4.9 0.5 100.0 37.1 61.0 2,341 Note: It is recommended that children should be given more liquids to drink during diarrhea, and food should not be reduced. Total includes 30 children with missing information about type of diarrhea. Figures in parentheses are based on 25-49 unweighted cases. 1 Continued feeding practices include children who were given more, same as usual, or somewhat less food, during the diarrhea episode. Figure 10.5 shows that the proportion of children with diarrhea in Indonesia who were given liquids according to recommendations has decreased since the 1997 IDHS. The feeding practices have changed only slightly since the 2002-2003 IDHS (BPS and ORC Macro, 2008). 148 • Child Health Figure 10.5 Trends in feeding practices during diarrhea, 1997, 2002-2003, 2007, and 2012 IDHS 26 57 15 30 20 4647 28 24 44 10 4445 30 22 43 8 48 43 40 17 39 10 46 Same as usual Increased Decreased/ None Same as usual Increased Decreased/ None Percent 1997 IDHS 2002-2003 IDHS 2007 IDHS 2012 IDHS Amount of liquids Amount of food Note: The 2002-2003 IDHS excluded Aceh, Maluku, and Papua provinces. 10.4 DISPOSAL OF STOOLS The proper disposal of children’s feces is extremely important in preventing the spread of diseases. If feces are left uncontained, diseases may spread by direct contact or through animal contact. Table 10.10 presents information on the disposal of children’s stools by background characteristics. Data show that 65 percent of children under age 5 have their stools disposed of safely (that is, children use a toilet or latrine, the stools are rinsed into the toilet or latrine or the stools are buried. Mothers report that one in three children always use a toilet or latrine, one in four have their stools thrown into a toilet or latrine, and 5 percent report burying their children’s stools in the yard. For 6 percent of children, the stools were thrown outside their dwelling, 8 percent rinsed them away, 7 percent used disposable or washable diapers, and 1 percent had the stools left in the open. The percentage of children whose stools are disposed of safely increases with the child’s age. Access to a private toilet facility improves the likelihood of safe disposal of children’s stool (74-75 percent). The likelihood of safe disposal of stools decreases if the children live in a household with a shared or non-improved toilet facility. Children’s stools are much more likely to be disposed of safely in urban areas than in rural areas (69 and 60 percent, respectively). Disposal of a child’s stools varies substantially by mother’s level of education and socio-economic status. Children whose mothers completed secondary education are much more likely to have their stools disposed of safely (72 percent) than those whose mothers have no education (36 percent). Similarly, mothers in the two highest wealth quintiles are much more likely to dispose of their children’s stools safely (74-76 percent) than mothers in the lowest wealth quintile (43 percent). Comparison of these results with those from the 2007 IDHS (BPS et al., 2008) indicates that the overall the percentage of children whose stools were disposed of safely has decreased from 71 percent in 2007 Child Health • 149 to 65 percent in 2012. However, at the same time, the proportion of children who always use a toilet/latrine increased from 25 percent in 2007 to 35 percent in 2012. At the same time, the percentage of mothers who reported throwing their children’s stools into a toilet/latrine has decreased slightly to 26 percent from 29 percent in the 2007 IDHS (BPS and ORC Macro, 2008). Appendix Table A-10.9 shows the variation in the disposal of children’s stools by province. Table 10.10 Disposal of children’s stools Percent distribution of youngest children under age five living with the mother by the manner of disposal of the child’s last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Indonesia 2012 Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Background characteristic Used toilet/ latrine Put/ rinsed in toilet/ latrine Buried in the yard Throw outside the dwelling Rinse away Use dispos- able diapers Use washable diapers Left in the open/not disposed setting Other Missing Age in months <6 3.2 26.2 3.0 8.5 22.5 7.2 13.8 0.6 14.6 0.3 100.0 32.4 1,593 6-11 7.3 33.6 5.1 10.7 14.8 8.0 5.4 0.8 13.7 0.6 100.0 46.0 1,806 12-23 18.9 33.1 5.2 9.8 7.4 5.3 2.6 1.8 15.6 0.3 100.0 57.2 3,193 24-35 43.1 25.8 5.4 3.9 4.0 2.0 0.9 1.2 13.2 0.4 100.0 74.3 2,831 36-47 58.9 17.7 4.4 1.1 2.5 0.3 0.1 1.5 12.8 0.7 100.0 81.0 2,559 48-59 61.5 17.3 3.5 0.5 2.0 0.1 0.1 1.3 12.7 1.1 100.0 82.2 2,331 Toilet facility2, Private - with septic tank 43.0 30.3 2.1 6.3 7.0 4.5 2.8 0.3 3.2 0.6 100.0 75.3 8,686 Private - without septic tank 38.8 32.3 2.8 5.5 7.0 2.0 1.9 0.5 8.6 0.5 100.0 74.0 1,139 Shared/public 31.5 23.6 7.3 5.1 9.0 2.6 3.1 1.1 16.5 0.3 100.0 62.4 1,269 Pit latrine 18.4 30.1 10.9 3.5 9.0 1.5 4.8 5.1 16.3 0.5 100.0 59.4 738 Yard/bush/forest 4.5 2.9 24.0 6.2 7.5 1.7 4.4 11.9 36.4 0.6 100.0 31.3 472 River/stream/creek 10.4 6.8 8.3 2.8 9.3 1.6 3.7 2.6 53.6 0.9 100.0 25.5 1,698 Other 11.9 6.4 4.1 4.4 7.2 2.0 1.2 1.0 62.0 0.1 100.0 22.3 306 Residence Urban 40.4 27.2 1.6 7.0 7.5 4.4 2.3 0.3 8.6 0.8 100.0 69.2 7,112 Rural 28.8 24.1 7.5 4.1 7.7 2.5 3.7 2.3 18.9 0.4 100.0 60.3 7,202 Mother’s education No education 11.9 13.3 10.7 7.1 5.0 1.5 4.1 9.2 35.8 1.4 100.0 35.9 261 Some primary 23.7 20.9 9.1 3.5 7.9 1.8 3.8 3.0 26.0 0.2 100.0 53.7 1,180 Completed primary 31.4 23.0 6.2 3.0 7.8 1.3 3.1 1.9 21.5 0.7 100.0 60.7 3,405 Some secondary 35.1 26.5 4.6 4.4 8.0 2.2 3.1 1.1 14.5 0.5 100.0 66.2 3,849 Completed secondary 40.4 28.7 3.0 6.9 7.1 4.6 2.6 0.5 5.5 0.7 100.0 72.1 3,894 More than secondary 37.3 26.8 0.7 11.3 7.4 9.5 2.7 0.2 3.9 0.3 100.0 64.8 1,725 Wealth quintile Lowest 17.4 14.2 11.5 3.5 9.0 1.6 4.5 4.8 32.9 0.6 100.0 43.1 2,940 Second 28.4 24.4 5.6 4.7 8.9 2.6 3.4 1.0 20.8 0.3 100.0 58.4 2,817 Middle 37.6 31.3 3.1 4.3 7.2 3.3 2.5 0.4 9.1 1.1 100.0 71.9 2,837 Fourth 45.4 29.9 1.2 6.1 6.8 4.0 2.3 0.2 3.6 0.5 100.0 76.4 3,007 Highest 44.4 28.6 1.2 9.3 5.9 5.8 2.2 0.0 2.1 0.4 100.0 74.3 2,714 Total 34.6 25.6 4.6 5.6 7.6 3.5 3.0 1.3 13.8 0.6 100.0 64.7 14,314 Note: Total includes six households with missing information on sanitation facility. 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine, or if it was buried. 2 See Table 2.2 for definition of categories. Infant Feeding • 151 INFANT FEEDING 11 his chapter reviews the 2012 Indonesia Demographic and Health Survey (IDHS) findings related to the nutritional status of children and women in Indonesia. The specific issues discussed are infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods; diversity of foods and frequency of feeding; and micronutrient intake among children and women. Proper feeding practices are of fundamental importance for the survival, growth, development, and health of infants and young children. The mother’s nutritional well-being before and during pregnancy can influence the health of her child later on. It also influences her ability to have a successful pregnancy and delivery and to successfully breastfeed her baby. The health benefits of breastfeeding for both mother and child are undisputed, and they are influenced by both the duration and intensity of breastfeeding. The age at which a child starts receiving complementary foods also influences the child’s nutritional status. To minimize morbidity and mortality of children, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) recommend that children should be breastfed for at least six months. Solid food should only be given after age 6 months, and breastfeeding should continue well into the second year of life (WHO, 2005). In 2003, the Indonesian government changed the recommended duration of exclusive breastfeeding from four to six months (Ministry of Health, 2002a). 11.1 INITIAL BREASTFEEDING Early initiation of breastfeeding is encouraged for a number of reasons. Mothers benefit from early suckling because it stimulates breast milk production and facilitates the release of oxytocin, which helps the T Key Findings • Breastfeeding is nearly universal in Indonesia; 96 percent of children under age 2 are ever breastfed. • Forty-two percent of children less than age 6 months are exclusively breastfed. • Complementary foods are introduced in a timely fashion for most children. Overall, more than 9 in 10 children age 6-8 months consume solid or semisolid foods. • Only 37 percent of children age 6-23 months are fed appropriately based on WHO recommendations on infant and young child feeding (IYCF) practices. • Consumption of foods rich in vitamin A increases from 52 percent among children age 6-8 months to 94 percent among children age 18-23 months. • Sixty-eight percent of children age 6-35 months consumed foods rich in iron in the 24 hours preceding the interview. • Twenty-three percent of women who gave birth during the five years preceding the survey did not take any iron supplements during the pregnancy for their last birth, and only one-third of women took them for the recommended 90 or more days. 152 • Infant Feeding contraction of the uterus and reduces postpartum blood loss. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also fosters bonding between mother and child. Over the long-term, a breastfeeding mother is likely to extend the length of her birth intervals because of the suppressive effect that breastfeeding has on postpartum amenorrhea. Longer birth intervals allow a mother’s body to recover from the physical depletion associated with pregnancy. The effect of breastfeeding on return of menses is moderated by both duration and intensity of breastfeeding (Ministry of Health, 2002b). For all children born in January 2007 or later, mothers were asked if they had ever breastfed the child. If the child was breastfed, mothers were asked about how long after the birth the child was first put to the breast and if the child was given anything to drink other than breast milk during the first three days after delivery. Table 11.1 uses this information in looking at breastfeeding initiation practices. Table 11.1 Initial breastfeeding Among last-born children who were born in the two years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within one hour and within one day of birth; and among last-born children born in the two years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Indonesia 2012 Among last-born children born in the past two years: Among last-born children born in the past two years who were ever breastfed: Background characteristic Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last- born children Percentage who received a prelacteal feed2 Number of last- born children ever breastfed Sex Male 95.7 48.9 65.7 3,504 60.9 3,355 Female 95.8 49.7 66.8 3,327 59.7 3,189 Assistance at delivery Health professional3 95.8 48.6 65.5 5,887 62.3 5,637 Traditional birth attendant 97.4 52.1 70.0 757 52.2 737 Other 96.5 64.7 81.9 161 28.1 156 No one * * * 14 * 14 Place of delivery Health facility 95.7 49.3 66.2 4,710 61.9 4,507 At home 96.5 49.5 66.7 2,094 56.7 2,022 Other * * * 14 * 14 Residence Urban 95.3 48.6 65.7 3,361 63.0 3,202 Rural 96.3 50.0 66.8 3,470 57.7 3,341 Mother’s education No education 96.4 65.3 80.0 134 26.3 129 Some primary 93.8 50.4 64.2 498 54.0 467 Completed primary 97.0 55.2 71.1 1,519 56.0 1,473 Some secondary 96.1 47.3 65.8 1,886 59.6 1,812 Completed secondary 95.0 46.9 64.1 1,899 64.2 1,804 More than secondary 96.0 45.8 62.9 894 69.5 858 Wealth quintile Lowest 96.5 52.6 68.5 1,410 49.2 1,361 Second 96.4 49.3 66.4 1,436 59.2 1,385 Middle 95.6 47.2 67.3 1,333 61.3 1,274 Fourth 96.2 48.8 65.1 1,370 63.6 1,318 Highest 94.1 48.5 63.9 1,282 69.4 1,206 Total 95.8 49.3 66.3 6,830 60.3 6,543 Note: Table is based on last-born children born in the two years preceding the survey regardless of whether the children are living or dead at the time of interview. The total includes children missing information on the person assisting at delivery and the place of delivery for whom results are not shown separately. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse/midwife, or village midwife Infant Feeding • 153 The table shows that breastfeeding is nearly universal in Indonesia; 94 percent or more of children in all subgroups were breastfed at some time. About half of children (49 percent) were breastfed within one hour of birth, and nearly two-thirds (66 percent) were breastfed within one day of birth. The percentages of children who were breastfed within one hour and within one day of birth decline with the mother’s education, although the pattern is not uniform. Children of mothers who were assisted at delivery by a health professional were somewhat less likely to initiate breastfeeding within one hour or within one day of birth than children assisted by a traditional birth attendant or others (e.g., relatives). Table 11.1 also shows that 60 percent of children born in the two years prior to the survey received a prelacteal feed, that is, something other than breast milk during the first three days of life. Prelacteal feeds were most common among urban children, children delivered with the assistance of a health professional, children born in a health facility, children whose mothers had more than secondary education, and children in the highest wealth quintile. Appendix Table A-11.1 shows the differentials in the initiation of breastfeeding by province. 11.2 AGE PATTERNS OF BREASTFEEDING UNICEF and WHO recommend that children be exclusively breastfed during the first six months of life. Thereafter, children should be given solid or semisolid complementary food in addition to continued breastfeeding. Exclusive breastfeeding is recommended in the first few months of life because breast milk is uncontaminated and contains all the nutrients necessary for children that age. Early introduction of foods that are low in energy and nutrients or prepared under unhygienic conditions may result in under-nutrition and infection with foreign organisms, which may in turn contribute to lower immunity to disease among young children (Ministry of Health, 2002a). Information on supplementation was obtained in the 2012 IDHS for the youngest surviving child born in the two years before the survey and living with the mother. To obtain this information, mothers were asked a series of questions about the types of foods their youngest child had consumed the day before the survey.1 The dietary data are subject to a number of limitations. First the mother may not remember all of the foods given to the child. She may also not know about everything the child consumed if the child had been cared for by other individuals during the reference period. Table 11.2 and Figure 11.1 present by breastfeeding status the percent distribution of the youngest children under age 2 living with the mother. The results show that breastfeeding continues for the majority of Indonesian children well beyond the first year of life; more than half (55 percent) of children age 20-23 months were still being breastfed at the time of the survey. Supplementary foods and liquids were introduced early. Only around half of children under age 2 months were exclusively breastfed. The percentage exclusively breastfed continued to drop after the first two months. More than 7 in 10 children age 4-5 months were receiving complementary foods (44 percent), plain water (8 percent), milk or other liquid supplements (9 percent) in addition to breast milk or had been fully weaned (13 percent). 1 The questions on the types of foods and liquids the child consumed are more detailed in the 2012 IDHS than in the 2007 IDHS. Consequently, caution should be used in comparing indicators based on the dietary information from the two surveys. Comparisons between the two surveys also should take into account that the dietary data presented in the 2007 IDHS report are based on children under age 3 living with the mother, while the 2012 IDHS results are for children under age 2 living with the mother. 154 • Infant Feeding Table 11.2 Breastfeeding status by age Percent distribution of youngest children under age 2 who are living with their mother, by breastfeeding status; the percentage currently breastfeeding; and the percentage of all children under age 2 using a bottle with a nipple, according to age in months, Indonesia 2012 Not breast- feeding Breastfeeding status Total Percentage currently breast- feeding Number of youngest child under age 2 living with the mother Percentage using a bottle with a nipple Number of all children under age 2 Age in months Exclusively breastfed Breast- feeding and consuming plain water only Breast- feeding and consuming non-milk liquids1 Breast- feeding and consuming other milk Breast- feeding and consuming comple- mentary foods 0-1 3.9 50.8 4.2 0.1 31.5 9.6 100.0 96.1 458 30.3 464 2-3 6.4 48.9 9.0 0.9 18.0 16.7 100.0 93.6 552 27.4 557 4-5 12.5 27.1 7.9 0.8 7.9 43.9 100.0 87.5 583 28.7 593 6-8 12.8 3.4 2.5 0.5 2.1 78.8 100.0 87.2 907 30.1 939 9-11 20.4 1.1 1.0 0.5 0.3 76.8 100.0 79.6 899 41.3 914 12-17 25.4 1.0 0.6 0.2 0.1 72.8 100.0 74.6 1,635 39.6 1,681 18-23 40.3 0.7 0.2 0.3 0.0 58.4 100.0 59.7 1,558 42.8 1,652 0-3 5.3 49.8 6.8 0.5 24.1 13.5 100.0 94.7 1,010 28.7 1,021 0-5 7.9 41.5 7.2 0.6 18.2 24.6 100.0 92.1 1,593 28.7 1,614 6-9 13.8 2.7 2.2 0.4 1.6 79.2 100.0 86.2 1,182 32.4 1,216 12-15 22.8 1.2 0.6 0.2 0.0 75.1 100.0 77.2 1,128 37.5 1,151 12-23 32.7 0.9 0.4 0.2 0.0 65.7 100.0 67.3 3,193 41.2 3,333 20-23 44.7 0.9 0.1 0.3 0.0 53.9 100.0 55.3 1,040 45.5 1,113 Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non- milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Non-milk liquids include juice, juice drinks, clear broth, or other liquids. Figure 11.1 Infant feeding practices by age 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age group in months Not breastfeeding Complementary foods Other milk Non-milk liquids/juice Plain water only Exclusively breastfed IDHS 2012 After age 6 months, breast milk alone does not provide sufficient nutrition for the infant; thus, children over that age should not be exclusively breastfed. Table 11.2 shows that 8 in 10 Indonesian children age 6-8 months living with their mothers were consuming solid or semi-solid foods. Most were also still being Infant Feeding • 155 breastfed; however, around 1 in 8 children (13 percent) in this age group had been fully weaned and were not breastfeeding. Table 11.2 also shows the percentage of children under age 2 using a bottle with a nipple. Bottle- feeding is usually associated with increased risk of illness, especially diarrheal diseases, because of the difficulty in sterilizing the nipples properly. Bottle-feeding also shortens the period of postpartum amenorrhea of the mother, and increases the risk of pregnancy. The 2012 IDHS results indicate that bottle-feeding is relatively common in Indonesia, even among very young children. Three in ten children under age 2 months were being fed using a bottle with a nipple. Finally, Figure 11.2 highlights a number of the key indicators from Table 11.2 as well as several other indicators related to breastfeeding status that WHO recommends be monitored.2 Overall, the figure shows that breastfeeding practices were age-appropriate for around six in ten children. Almost half (46 percent) of children age 20-23 months were bottle-fed, which is higher than the proportion of children in the age group reported as bottle-fed (37 percent) in the 2007 IDHS (BPS et al., 2008). Figure 11.2 IYCF indicators on breastfeeding status 41 27 77 91 55 63 49 37 Exclusive breastfeeding under age 6 months Exclusive breastfeeding at age 4-5 months Continued breastfeeding at 1 year Introduction of solid, semi-solid, or soft foods (6-8 months) Continued breastfeeding at 2 years Age-appropriate breastfeeding (0-23 months) Predominant breastfeeding (0-5 months) Bottle feeding (0-23 months) Percentage of children IDHS 2012 11.3 DURATION AND FREQUENCY OF BREASTFEEDING Table 11.3 shows the median duration and frequency of breastfeeding by selected background characteristics. The estimates of median and mean durations of breastfeeding are based on current status data, that is, the proportion of last-born children in the three years preceding the survey who were being breastfed at the time of the survey. The overall median duration of any breastfeeding in Indonesia is 21.4 months, and the mean duration is 20.5 months. The median duration of exclusive breastfeeding is less than one month, while the mean duration is just over three months. The median duration of predominant breastfeeding is 1.8 months, and the mean duration is 3.7 months. 2 Detailed descriptions of all of indicators can be found in two recent WHO publications on the definition and measurement of indicators for assessing infant and child feeding practices (WHO, 2008; WHO, 2010). 156 • Infant Feeding Table 11.3 Median duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, by background characteristics, Indonesia 2012 Median duration (months) of breastfeeding among children born in the past three years1 Background characteristic Any breastfeeding Exclusive breastfeeding Predominant breastfeeding2 Sex Male 21.7 0.7 0.7 Female 21.1 1.5 2.5 Residence Urban 21.0 0.7 0.7 Rural 21.7 1.3 2.2 Mother’s education No education 19.7 0.7 1.4 Some primary 24.8 0.6 0.7 Completed primary 22.4 1.7 2.9 Some secondary 22.2 1.1 2.0 Completed secondary 19.9 0.7 0.7 More than secondary 17.7 0.7 0.7 Wealth quintile Lowest 21.7 1.1 2.7 Second 21.7 0.7 1.1 Middle 22.1 1.9 2.3 Fourth 21.2 0.6 0.7 Highest 19.3 0.7 0.7 Total 21.4 0.7 1.8 Mean for all children 20.5 3.1 3.7 Note: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only Appendix Table A-11.2 shows the median duration of any breastfeeding by province. 11.4 TYPES OF COMPLEMENTARY FOODS WHO recommends the introduction of solid food to infants around the age of 6 months because by that age breast milk by itself is no longer sufficient to maintain a child’s optimal growth. During the transition from breastfeeding to complementary feeding, the prevalence of malnutrition among young children increases substantially in many countries. This phenomenon is attributed primarily to increased infections and poor feeding practices. Appropriate complementary nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. In the transition to eating a healthy diet, children age 6 months or older should be fed small quantities of solid and semisolid foods throughout the day. Table 11.4 provides information on the types of liquids and foods given to the youngest child under age 2 living with the mother on the day and night preceding the survey, according to breastfeeding status. The results show that the introduction of infant formula takes place for many children much earlier than the recommended age of 6 months. For example, more than one-third of breastfed children under 2 months were also receiving infant formula. Overall, 27 percent of breastfed children and 70 percent of nonbreastfed children age 0-23 months received infant formula. Infant Feeding • 157 Table 11.4 also shows that relatively few children under age 6 months received other milk or liquids. The consumption of other liquids increases gradually with age among children 6 months and older. Around two-thirds of breastfed children (67 percent) and nonbreastfed children (69 percent) age 18-23 months were receiving liquid supplements other than milk and infant formula. Consumption of other milk also was highest at age 18-23 months (23 percent among breastfed children and 25 percent of nonbreastfed children). Many very young babies received fortified baby foods. At age 4-5 months, more than one-third of babies were being fed fortified baby foods. At age 6-8 months, breastfed children were more likely to be have been given fortified baby foods (60 percent) than other types of foods. A similar percentage of nonbreastfed children age 6-8 months were receiving fortified baby foods (61 percent). Overall, 32 percent of breastfed children age 6-23 months consumed fortified baby foods, 81 percent consumed food made from grains, 72 percent consumed fruits and vegetables rich in vitamin A, 50 percent had meat, fish, and poultry, and 46 percent consumed eggs. In addition to being breastfed, 26 percent of these children also received infant formula, 11 percent received other milk, and 8 percent received cheese, yogurt, or other milk products. As expected, nonbreastfed children age 6-23 months were generally more likely than breastfed children to consume other types of liquids and foods. Differences between nonbreastfed and breastfed children in the intake of the liquids and foods shown in Table 11.4 are especially marked in the case of infant formula (68 percent versus 26 percent), fruits and vegetables rich in vitamin A (82 percent versus 72 percent), meat, fish and poultry (65 percent versus 50 percent), and eggs (56 percent versus 46 percent). Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under age 2 who are living with the mother by type of foods consumed in the day or night preceding the interview, according to breastfeeding status and age, Indonesia 2012 Liquids Solid or semi-solid foods Any solid or semi- solid food Number of children Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Food made from grains3 Fruits and vege- tables rich in vitamin A4 Other fruits and vege- tables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry5 Eggs Cheese, yogurt, other milk product BREASTFEEDING CHILDREN 0-1 34.5 1.5 1.5 6.9 2.7 3.0 0.8 0.6 0.2 1.7 1.1 0.0 10.0 440 2-3 24.4 0.1 2.6 12.1 3.9 2.9 1.5 0.9 0.4 0.5 0.6 0.5 17.8 517 4-5 22.6 1.2 9.5 35.9 16.7 12.3 4.0 2.6 1.8 1.7 2.9 0.2 50.1 510 6-8 23.5 3.2 34.0 59.5 47.8 44.9 15.7 15.3 13.6 20.9 18.9 2.7 90.3 791 9-11 30.9 5.3 49.7 43.8 83.2 68.4 28.5 36.5 31.4 48.2 41.3 7.6 96.4 716 12-17 24.9 8.7 59.4 23.0 90.1 82.7 29.0 35.7 35.9 56.6 53.4 8.1 97.5 1,220 18-23 27.2 23.0 67.4 11.9 94.8 81.7 35.1 41.5 44.7 68.8 61.0 11.0 97.8 930 6-23 26.3 10.5 54.1 32.1 80.8 71.5 27.6 32.9 32.5 50.3 45.5 7.6 95.8 3,657 Total 26.5 7.8 39.9 28.3 59.9 52.8 20.3 23.9 23.4 36.3 32.9 5.5 76.0 5,124 NONBREASTFEEDING CHILDREN 0-1 75.7 11.5 6.5 16.5 5.1 5.1 5.1 0.0 0.0 5.1 5.1 0.0 16.5 18 2-3 94.4 7.0 8.1 32.7 11.1 3.6 1.9 1.8 1.8 0.5 0.0 0.0 42.3 35 4-5 88.5 17.4 14.9 45.3 16.8 14.2 0.9 9.5 0.7 2.9 2.1 0.0 62.8 73 6-8 81.4 10.4 35.8 61.0 63.6 58.2 26.0 21.5 15.9 29.3 22.1 7.0 96.9 116 9-11 85.1 8.2 56.0 44.1 90.1 81.4 39.2 36.1 24.6 57.2 47.9 10.5 98.8 183 12-17 79.4 15.4 62.7 25.0 95.0 86.5 37.1 44.4 45.7 67.3 58.9 12.6 98.6 415 18-23 52.4 24.7 68.8 11.5 91.5 83.5 33.1 37.2 43.8 71.9 62.4 13.3 96.8 628 6-23 67.7 18.3 62.3 24.4 90.0 82.0 34.6 38.0 39.4 64.8 55.8 12.1 97.6 1,342 Total 69.5 17.9 58.0 25.5 83.4 75.8 31.8 35.2 36.1 59.4 51.2 11.1 93.6 1,468 Note: Breastfeeding status and food consumed refer to a “24-hour” period (yesterday and last night). 1 Other milk includes fresh, tinned, and powdered cow or other animal milk. 2 Doesn’t include plain water 3 Includes fortified baby food 4 Includes yellow squash, carrots, yellow or orange sweet potatoes, dark green leafy vegetables (spinach, kangkung, katuk, cassava leaf, and squash leaf), mangoes, papayas, jackfruit, cempedak, persimmon, yellow melon, and other locally grown fruits and vegetables that are rich in vitamin A 5 Meat includes liver, kidney, heart, or other organ meats. 158 • Infant Feeding 11.5 INFANT AND YOUNG CHILD FEEDING PRACTICES Infant and young child feeding (IYCF) practices include timely initiation of feeding solid/semisolid foods from age 6 months, feeding small amounts, and increasing the amount of foods and frequency of feeding as the child gets older, while maintaining frequent breastfeeding. Guidelines have been established with respect to these practices for children age 6-23 months (PAHO/WHO, 2003; WHO, 2005). For the average, healthy breastfed child, solid/semisolid foods should be provided two to three times per day at age 6-8 months and three to four times per day between ages 9 and 24 months, with an additional snack being offered one to two times per day, as desired. Table 11.5 highlights infant and young child feeding practices among the youngest children age 6-23 months living with the mother, by background characteristics and breastfeeding status. The minimum IYCF practices for breastfed children age 6-23 months are defined as continued breastfeeding; a minimum of two feedings of solid or semi-solid foods per day for infants age 6-8 months and three feedings for children age 9- 23 months; and consumption of solid or semi-solid foods from a minimum of three food groups per day. The ICYF criteria for nonbreastfed children are receiving breast milk substitutes (that is, commercially produced infant formula, tinned, powdered, or fresh animal milk, cheese, yogurt, and other milk products); a minimum of four feedings of solid or semi-solid foods per day; and consumption of solid or semi-solid foods from at least four food group, including breast milk substitutes, per day. Table 11.5 shows that on the day before the survey, 93 percent of all children age 6-23 months were given breast milk, milk, or milk products; 58 percent were fed foods from the recommended number of food groups; and 66 percent were fed the recommended number of times. Figure 11.3 shows that only 37 percent were fed according to all recommended IYCF practices (milk or milk products, with adequate diversity and frequency of meals). This percentage was much lower for breast-fed children (34 percent) than nonbreastfed children (43 percent). Compared with nonbreastfed children, breastfed children were less likely to be given meals with adequate diversity (52 percent and 76 percent respectively) and adequate number of meals (61 percent and 79 percent, respectively). The proportion of children 6-23 months who were fed according to all three IYCF recommendations increased with the child’s age, from 18 percent for children 6-8 months to 45 percent for children 18-23 months. The proportion was slightly lower in boys (35 percent) than girls (38 percent) and among children in rural areas (31 percent) than in urban areas (43 percent). There was a positive relationship between appropriate infant and child feeding practices and mother’s education and household wealth status. However, feeding practices conformed to the IYCF standards for only around half of children, even in the highest education category and wealth quintile. Infant Feeding • 159 Table 11.5 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Indonesia 2012 Among breastfed children 6-23 months, percentage fed: Among non-breastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Background characteristic 4+ food groups1 Minimum meal frequency2 Both 4+ food groups and minimum meal frequency Number of breastfed children 6-23 months Milk or milk products3 4+ food groups1 Minimum meal frequency4 With 3 IYCF practices5 Number of non- breastfed children 6-23 months Breast milk, milk, or milk products6 4+ food groups1 Minimum meal frequency7 With 3 IYCF practices Number of all children 6-23 months Age in months 6-8 20.5 73.3 17.3 791 77.4 41.2 78.2 21.8 116 97.1 23.1 73.9 17.9 907 9-11 49.4 58.0 30.4 716 83.8 69.4 85.4 45.6 183 96.7 53.5 63.6 33.5 899 12-17 58.6 55.6 36.7 1,220 80.3 82.0 85.5 54.0 415 95.0 64.5 63.2 41.1 1,635 18-23 71.6 61.6 48.2 930 63.7 79.3 72.3 39.0 628 85.4 74.7 65.9 44.5 1,558 Sex Male 50.9 60.9 33.0 1,889 73.5 73.3 79.2 40.7 687 92.9 56.9 65.8 35.1 2,576 Female 52.8 62.0 35.4 1,768 72.0 77.8 78.2 45.5 655 92.4 59.6 66.4 38.2 2,423 Residence Urban 58.4 64.2 39.1 1,714 79.7 80.1 85.2 50.7 756 93.8 65.1 70.6 42.6 2,469 Rural 46.1 59.0 29.9 1,943 63.9 69.6 70.3 33.2 586 91.6 51.5 61.6 30.7 2,529 Mother’s education No education 19.6 64.7 11.4 75 27.3 30.5 50.2 6.2 16 87.1 21.6 62.1 10.5 91 Some primary 37.2 55.7 24.6 289 56.4 57.3 63.2 30.0 75 91.0 41.3 57.3 25.7 364 Completed primary 44.0 58.7 29.2 916 59.3 72.8 71.4 30.8 217 92.2 49.5 61.1 29.5 1,133 Some secondary 51.3 59.6 33.3 1,061 65.7 71.5 74.8 39.0 329 91.9 56.1 63.2 34.7 1,390 Completed secondary 60.9 65.6 39.9 904 80.7 80.6 84.0 47.2 451 93.6 67.4 71.7 42.4 1,355 More than secondary 67.1 66.5 45.8 412 87.0 82.3 87.0 57.7 254 95.0 72.9 74.3 50.3 665 Wealth quintile Lowest 36.4 60.4 24.6 786 47.6 55.5 55.8 18.0 214 88.8 40.5 59.4 23.2 1,001 Second 44.8 62.5 30.6 837 65.9 81.1 77.1 38.3 264 91.8 53.5 66.0 32.5 1,100 Middle 54.9 61.0 35.9 735 73.6 74.8 81.2 42.9 239 93.5 59.8 65.9 37.6 974 Fourth 58.9 59.7 37.6 705 78.4 77.9 81.2 43.7 292 93.7 64.4 66.0 39.4 997 Highest 70.1 63.8 45.6 594 88.8 82.3 90.7 62.6 332 96.0 74.5 73.5 51.7 927 Total 51.8 61.4 34.2 3,657 72.7 75.5 78.7 43.1 1,342 92.7 58.2 66.1 36.6 4,999 1 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt, or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts. 2 For breastfed children, minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a day for children 9-23 months. 3 Includes two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt 4 For non-breastfed children age 6-23 months, minimum meal frequency is receiving solid or semi-solid food or milk feeds at least four times a day. 5 Non-breastfed children age 6-23 months are considered to be fed with a minimum standard of three Infant and young child feeding practices if they receive other milk or milk products at least twice a day, receive the minimum meal frequency, and receive solid or semi-solid foods from at least four food groups not including the milk/milk products group. 6 Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned and powdered animal milk, and yogurt 7 Children are fed the minimum recommended number of times per day according to their age and breastfeeding status as described in footnotes 2 and 4. 160 • Infant Feeding Figure 11.3 IYCF indicators on minimum acceptable diet 52 61 34 76 79 43 58 66 37 IYCF 5: Minimum dietary diversity IYCF 6: Minimum meal frequency IYCF 7: Minimum acceptable diet Percent Among breastfed children Among non-breastfed children Among all children 6-23 months IDHS 2012 Appendix Table A-11.3 shows the infant and young child feeding (IYCF) practices by province. 11.6 MICRONUTRIENT INTAKE AMONG CHILDREN Micronutrient deficiency has serious consequences for childhood morbidity and mortality. The 2012 IDHS collected information on the intake of two micronutrients, vitamin A and iron, from foods and supplements. Both vitamin A and iron are important for a child’s healthy development. Vitamin A is an essential micronutrient for the immune system. Vitamin A deficiency (VAD) can increase the severity of infections such as measles and diarrheal diseases in children and slow recovery from illness. In severe cases, VAD can also cause eye damage. Periodic dosing with vitamin A supplements every six months is one method of protecting children from VAD. Low iron intake contributes to anemia and affects cognitive development. Iron requirements are greatest between the ages of 6 and 11 months, when growth is extremely rapid. Table 11.6 presents information from the IDHS on the intake of vitamin A- and iron-rich foods among children age 6-23 months. Overall, eight in ten (83 percent) children consumed foods rich in vitamin A in the 24-hour period before the survey. The likelihood of consuming vitamin A-rich foods increased with the age of the child, the age of the mother at birth, and the wealth quintile. It was higher in urban children than rural children and among nonbreastfed children than breastfed children. About two-thirds (68 percent) of children age 6-23 months consumed foods rich in iron in the 24 hours preceding the interview. Unlike the consumption of foods rich in vitamin A, the consumption of foods rich in iron increases markedly with the mother’s education. Otherwise, the variations in children’s consumption of iron-rich foods by background characteristics are generally similar to those observed for consumption of vitamin A-rich foods. Infant Feeding • 161 Table 11.6 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron- rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were given iron supplements in the past seven days, and who were given deworming medication in the six months preceding the survey, by background characteristics, Indonesia 2012 Among youngest children age 6-23 months living with the mother: Among all children age 6-59 months: Background characteristic Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given iron supplements in last 7 days Percentage given deworm- ing medication in last 6 months3 Number of children Age in months 6-8 51.7 28.9 907 28.3 12.8 2.2 939 9-11 80.1 62.8 899 47.6 14.6 6.3 914 12-17 90.4 75.3 1,635 56.1 13.5 9.3 1,681 18-23 94.1 84.3 1,558 66.9 14.3 19.8 1,652 24-35 na na na 68.3 13.4 33.8 3,218 36-47 na na na 65.1 13.5 33.3 3,200 48-59 na na na 63.2 13.7 35.1 3,162 Sex Male 81.9 65.3 2,576 60.5 14.0 26.9 7,513 Female 83.5 69.8 2,423 61.8 13.2 24.8 7,254 Breastfeeding status Breastfeeding 79.8 63.6 3,657 55.0 12.7 15.0 4,912 Not breastfeeding 90.5 77.9 1,342 64.5 14.1 31.5 9,781 Mother’s age at birth 15-19 70.1 57.6 239 49.9 10.0 19.7 319 20-29 82.6 66.9 2,591 59.3 13.0 26.7 6,835 30-39 83.8 69.2 1,889 63.1 14.3 25.9 6,266 40-49 87.0 69.7 281 64.1 14.4 23.3 1,347 Residence Urban 85.0 69.5 2,469 63.7 16.4 25.7 7,395 Rural 80.4 65.4 2,529 58.6 10.8 26.1 7,371 Mother’s education No education 81.1 50.6 91 28.2 5.9 15.5 303 Some primary 75.7 59.2 364 56.3 11.7 19.4 1,269 Completed primary 80.0 61.5 1,133 59.6 12.3 22.9 3,473 Some secondary 82.9 65.9 1,390 62.5 10.4 28.5 3,867 Completed secondary 86.3 74.0 1,355 64.7 15.8 28.2 3,973 More than secondary 83.6 74.3 665 62.3 20.6 27.2 1,881 Wealth quintile Lowest 79.8 60.8 1,001 53.0 8.3 22.7 3,181 Second 81.5 65.5 1,100 58.3 10.9 24.1 2,847 Middle 81.8 66.5 974 63.6 13.8 27.0 2,890 Fourth 83.9 68.2 997 66.4 14.8 29.1 3,003 Highest 86.9 77.1 927 65.1 20.9 26.9 2,846 Total 82.7 67.5 4,999 61.1 13.6 25.9 14,766 Note: Information on vitamin A is based on both mother’s recall and the immunization card (where available). Information on iron supplements and deworming medication is based on the mother’s recall. Total for children age 6-59 includes children missing information on breastfeeding status for whom results are not shown separately. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, yellow squash, carrots, yellow or orange sweet potatoes, dark green leafy vegetables (spinach, kangkung, katuk, and squash leaf), mangoes, papayas, jackfruit, cempedak, persimmon, yellow melon, and other locally grown fruits and vegetables that are rich in vitamin A, 2 Includes meat (including organ meat), fish, poultry and eggs 3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 162 • Infant Feeding Table 11.6 also shows information on the receipt of vitamin A or iron supplements among children age 6-59 months. Sixty-one percent of children in that age group received a vitamin A supplement in the six months before the survey, compared with 69 percent at the time of the 2007 IDHS (CBS et al., 2008). Children age 6-8 months were markedly less likely to have received vitamin A supplements compared with older children. Children living in urban areas, those born to highly educated mothers, children of mothers age 20 or older at the child’s birth, and children in the highest wealth quintiles were more likely to have received vitamin A supplements than other children. Fourteen percent of children age 6-23 months received an iron supplement in the seven days prior to the survey. The coverage of iron supplementation was higher in urban (16 percent) than rural (11 percent) areas and generally increased with mother’s education level and household wealth quintile. Periodic deworming for organisms such as soil-transmitted helminthes can improve children’s micronutrient status. Table 11.6 shows that 26 percent of children age 6-59 months had received a deworming tablet in the six months prior to the survey. The percentage of children who received deworming medication increased with age, ranging from 2 percent of children age 6-8 months to 35 percent of children age 48-59 months. The likelihood of receiving a deworming tablet was higher among nonbreastfed than among breastfed children, reflecting at least in part the age difference between the two groups. Children whose mothers had at least some secondary education were more likely to have been given a deworming tablet than children whose mothers did not attend school or had only a primary education. The percentage also varied with the wealth quintile, peaking at 29 percent in the fourth wealth quintile. Appendix Table A-11.4 shows the variations in micronutrient intake among children by province. 11.7 MICRONUTRIENT INTAKE AMONG MOTHERS A mother’s nutritional status during pregnancy is crucial both for the child’s intrauterine development and for protection against maternal morbidity and mortality. Vitamin A deficiency can lead to increased risk of mortality and morbidity as well as night blindness. Iron deficiency anemia also puts both the mother and baby at risk. Supplementation is an important strategy for addressing micronutrient deficiencies among women. Table 11.7 presents by background characteristics the data on micronutrient supplementation among women age 15-49 who gave birth in the five years preceding the survey. Around half (48 percent) of women reported that they had received a vitamin A capsule in the two months after delivery of their last-born child, a slight increase since the 2007 IDHS figure (45 percent). Supplementation levels were lowest among women with no education and women in the lowest wealth quintile (23 percent and 38 percent, respectively). The results in Table 11.7 indicate that the majority of women who gave birth during the five years preceding the survey received iron supplements during the pregnancy for their last birth. However, only one- third (33 percent) of women took iron tablets or syrup for the recommended duration (90 days or more). Seven percent took iron supplements for 60-89 days, and 31 percent took them for less than 60 days. The likelihood of having taken iron supplements for 90 or more days increased with the woman’s age and educational level and with the wealth quintile. Urban women were also much more likely than rural women to have taken iron tablets or syrup for at least 90 days. Infant Feeding • 163 Table 11.7 Micronutrient intake among mothers Among women age 15-49 with a child born in the past five years, the percentage who received a vitamin A dose in the first two months after the birth of the last child and the percent distribution by number of days they took iron tablets or syrup during the pregnancy of the last child, by background characteristics, Indonesia 2012 Percentage who received vitamin A dose postpartum1 Number of days women took iron tablets or syrup during pregnancy of last birth Number of women Background characteristic None <60 60-89 90+ Don’t know/ Missing Total Age 15-19 42.5 30.3 37.1 7.5 23.1 2.0 100.0 478 20-29 47.8 21.7 32.9 6.5 32.9 6.1 100.0 6,941 30-39 48.8 22.4 28.9 8.0 34.0 6.6 100.0 6,059 40-49 47.9 28.1 27.1 6.4 29.6 8.9 100.0 1,308 Breastfeeding status Breastfeeding 45.5 23.5 30.9 7.7 32.9 5.1 100.0 6,382 Not breastfeeding 50.0 22.4 30.9 6.7 32.6 7.4 100.0 8,404 Residence Urban 49.4 18.8 28.3 7.4 39.1 6.5 100.0 7,359 Rural 46.8 26.9 33.5 6.9 26.4 6.3 100.0 7,427 Education No education 22.6 53.1 18.6 5.4 9.9 13.0 100.0 275 Some primary 41.7 37.6 31.6 6.3 19.4 5.1 100.0 1,243 Completed primary 46.2 27.6 30.4 7.6 28.5 5.9 100.0 3,517 Some secondary 49.3 21.4 34.2 7.8 31.2 5.4 100.0 3,965 Completed secondary 49.3 18.1 30.2 6.8 37.5 7.4 100.0 4,021 More than secondary 54.4 12.4 27.2 6.5 46.7 7.2 100.0 1,765 Wealth quintile Lowest 38.0 35.9 32.4 5.2 19.8 6.8 100.0 3,038 Second 46.4 24.0 35.2 7.3 28.0 5.6 100.0 2,881 Middle 49.8 20.7 32.9 7.8 32.1 6.5 100.0 2,939 Fourth 54.4 19.6 29.7 8.4 36.8 5.5 100.0 3,105 Highest 51.7 13.5 24.0 7.0 47.7 7.8 100.0 2,822 Total 48.1 22.9 30.9 7.1 32.7 6.4 100.0 14,786 1 In the first two months after delivery of last birth Appendix Table A-11.5 shows the variations in micronutrient intake among mothers of young children by province. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 165 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12 cquired immune deficiency syndrome (AIDS) is caused by a human immunodeficiency virus (HIV) that weakens the immune system, making the body susceptible to and unable to recover from other opportunistic diseases that lead to death. The predominant mode of HIV transmission in Indonesia is through the sharing of needles among injecting drug users, known as unsafe injections, followed by heterosexual contact, followed by prenatal transmission in which the mother passes the virus to her child during pregnancy, delivery, or breastfeeding. Other modes of transmission are through infected blood and other skin-piercing practices. The Minister of Health established a National AIDS Committee (NAC) in 1987 after the detection of the first AIDS case in a foreign tourist in Bali. The NAC structure was reorganized in July 2006 through Presidential Regulation No. 75/2006. The Coordinating Minister for People’s Welfare serves as chair of the NAC with the Minister of Health and the Minister of Home Affairs serving as vice chairs. The membership was expanded to include 18 ministries and agencies and five nongovernmental organizations (NGOs) (NAC, 2012). An impressive expansion of the response to the epidemic has been seen in the past two decades, and a number of sound strategies and interventions are in place to deal with the epidemic. The national commitment to respond effectively to the epidemic is strong and growing. However, major disparities still exist because of geography, health systems capacity, the nature and size of the epidemic, and available resources. The data obtained in the 2012 IDHS provide an opportunity to assess some of the factors contributing to the spread of HIV-AIDS and sexually transmitted infections (STIs). The principal objective of this chapter is to gauge knowledge, perceptions, and behaviors at the national and the provincial levels, and among groups A Key Findings • Eighty-two percent of currently married men age 15-54 and 77 percent of women age 15-49 have heard of AIDS. • Knowledge of ways to prevent HIV transmission among currently married men age 15-54, both by using condoms and limiting sexual intercourse to one partner, is higher among men than women age 15-49. • Comprehensive knowledge of AIDS is not widespread among either women age 15-49 (11 percent) or currently married men age 15-54 (12 percent). • Currently married men age 15-54 are more likely than women age 15-49 to know how HIV is transmitted. Older women and currently married men are less knowledgeable than younger ones about how HIV infection is prevented. • Three of four currently married men age 15-54 and 71 percent of women age 15-49 know that the HIV virus can be transmitted by using an unsterilized needle or syringe. • The majority of women age 15-49 (91 percent) and currently married men 15-54 (94 percent) believe that a woman who has recently given birth is justified in refusing to have sex with her husband. 166 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior with similar background characteristics, such as demographic and socioeconomic subgroups of the population. This information can be used to assist AIDS control programs and develop strategies to target those groups most in need of information and services and most vulnerable to the risk of HIV. Many of the indicators reported in this chapter are included among the United Nations General Assembly Special Session (UNGASS) indicators because the survey collected information from all women age 15-49 years. However, indicators for men do not meet the UNGASS requirement because the 2012 IDHS data are limited to currently married men. This chapter presents findings about current levels of knowledge on AIDS-related issues, such as HIV prevention methods, sources of information about AIDS, misconceptions about AIDS, and knowledge of other issues related to sexually-transmitted infections. The chapter also discusses the social aspects of HIV-AIDS and knowledge of and access to male condoms. Information is presented on attitudes toward negotiating safer sex, the prevalence of higher-risk sex, knowledge of the symptoms of STIs, self-reported prevalence of STIs, and HIV knowledge and sexual behavior among youths. The chapter concludes with information on the proportion of respondents who know a person who is living with HIV or AIDS. All information is also analyzed by background characteristics. 12.1 KNOWLEDGE OF HIV-AIDS AND TRANSMISSION AND PREVENTION METHODS 12.1.1 Knowledge of HIV-AIDS IDHS respondents were asked whether they had ever heard of HIV-AIDS. Those who reported having heard of HIV-AIDS were asked where they obtained their information. The results are presented by background characteristics in Table 12.1, both for women age 15-49 and currently married men age 15-54. Table 12.1 shows that 77 percent of women age 15-49 and 82 percent of currently married men age 15-54 say that they have heard of HIV-AIDS. The percentage of women age 15-49 that has heard of HIV-AIDS decreases with age, from 85 percent of women age 15-24 to 63 percent age 40-49. The differentials across age groups for men are not similar to those for women, in that the highest percentage with knowledge is men age 30-39 (89 percent). Table 12.1 also shows that the percentage of never-married women age 15-49 who have heard of HIV- AIDS is higher than that of ever-married women; 88 percent for never-married women compared with 74 percent for currently married women and 63 percent for widowed, divorced, or separated women. As expected, urban residents are much more likely than rural residents to have heard about AIDS (87 percent and 66 percent, respectively). Similarly, 92 percent of urban men have heard of AIDS compared with 73 percent of rural men. The percentage of women and men who have heard of AIDS increases with their level of education and wealth quintile (Figure 12.1). HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 167 Table 12.1 Knowledge of AIDS Percentage of all women age 15-49 and currently married men age 15-54 who have heard of AIDS, by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic Has heard of AIDS Number of respondents Has heard of AIDS Number of respondents Age 15-24 84.4 13,232 83.8 373 15-19 84.8 6,927 (79.6) 28 20-24 84.0 6,305 84.1 345 25-29 82.2 6,959 85.4 1,127 30-39 78.3 13,757 88.9 3,449 40-49 62.8 11,659 79.6 3,065 50-54 na 0 68.2 1,292 Marital status Never married 88.2 9,919 na 0 Ever had sex 82.7 123 na 0 Never had sex 88.3 9,796 na 0 Married/living together 74.3 33,465 82.3 9,306 Divorced/separated/widowed 62.6 2,223 na 0 Residence Urban 87.0 23,805 91.5 4,739 Rural 65.6 21,802 72.8 4,567 Education No education 15.7 1,500 28.9 265 Some primary 38.0 4,870 51.7 1,371 Completed primary 62.3 10,254 74.9 2,118 Some secondary 84.6 12,753 89.5 1,979 Completed secondary 95.7 10,677 97.8 2,453 More than secondary 99.2 5,552 99.8 1,119 Wealth quintile Lowest 49.0 7,767 59.4 1,596 Second 68.1 8,784 74.0 1,866 Middle 79.9 9,243 85.9 2,008 Fourth 86.4 9,743 90.9 1,962 Highest 93.4 10,071 97.2 1,875 Total 76.7 45,607 82.3 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable Figure 12.1 Knowledge of AIDS by education level, Indonesia 2012 16 29 38 52 62 75 85 90 96 9899 100 Women 15-49 Currently married men 15-54 No education Some primary Completed primary Some secondary Completed secondary More than secondary Percent IDHS 2012 168 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior The differentials in awareness of HIV-AIDS among women age 15-49 and currently married men age 15-54 by province are shown in Appendix Table A-12.1. 12.1.2 Knowledge of HIV Prevention Methods HIV in adults is mainly transmitted through heterosexual contact between an HIV-positive partner and an HIV-negative partner. Consequently, HIV prevention programs focus their messages and efforts on three important aspects of behavior: use of condoms; limiting the number of sexual partners or staying faithful to one uninfected partner; and delaying sexual debut for young persons (abstinence). To ascertain whether the programs have effectively communicated these messages, IDHS respondents were prompted with specific questions about whether it is possible to reduce the chances of getting HIV by using a condom at every sexual encounter and limiting sexual intercourse to one partner. The 2012 IDHS collected information to present these indicators, except the second one was defined as having sexual intercourse with one partner, regardless of the partner’s HIV status. Table 12.2 Knowledge of HIV prevention methods Percentage of women age 15-49 and currently married men age 15-54 who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, having one sex partner and no other partners, and both using condoms and having one partner, by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic Using condoms1 Limiting sexual intercourse to one partner2 Using condoms and limiting sexual intercourse to one partner1,2 Number of women age 15-49 Using condoms1 Limiting sexual intercourse to one partner2 Using condoms and limiting sexual intercourse to one partner1,2 Number of currently married men age 15-54 Age 15-24 44.5 62.5 38.2 13,232 53.2 63.2 44.2 373 15-19 40.5 61.0 34.3 6,927 (61.1) (62.3) (58.4) 28 20-24 49.0 64.0 42.5 6,305 52.6 63.3 43.0 345 25-29 47.6 62.5 41.4 6,959 60.9 63.8 50.4 1,127 30-39 45.9 60.4 40.5 13,757 65.8 69.6 55.8 3,449 40-49 34.6 45.8 30.0 11,659 56.3 60.1 47.3 3,065 50-54 na na na na 43.4 49.8 35.8 1,292 Marital status Never married 46.4 65.9 40.0 9,919 na na na na Ever had sex 52.3 62.7 47.4 123 na na na na Never had sex 46.3 66.0 39.9 9,796 na na na na Married/living together 42.5 56.0 37.1 33,465 58.5 62.8 49.1 9,306 Divorced/separated/widowed 32.5 44.7 27.9 2,223 na na na na Residence Urban 51.5 68.2 45.4 23,805 68.2 72.0 57.2 4,739 Rural 33.5 46.0 28.4 21,802 48.4 53.2 40.6 4,567 Education No education 5.9 8.1 4.1 1,500 15.9 14.5 10.9 265 Some primary 14.0 22.6 10.6 4,870 25.6 31.8 20.6 1,371 Completed primary 28.6 41.2 23.8 10,254 49.3 51.6 38.2 2,118 Some secondary 43.0 60.7 36.1 12,753 62.8 68.1 52.7 1,979 Completed secondary 60.1 77.5 53.5 10,677 75.1 80.6 65.3 2,453 More than secondary 71.2 86.6 65.9 5,552 82.2 84.7 71.7 1,119 Wealth quintile Lowest 22.8 31.2 18.4 7,767 33.8 40.4 27.7 1,596 Second 32.8 47.5 27.8 8,784 49.2 52.3 38.9 1,866 Middle 42.5 59.2 36.5 9,243 58.0 62.6 47.3 2,008 Fourth 50.8 67.6 44.6 9,743 68.6 72.8 59.2 1,962 Highest 59.9 75.6 53.7 10,071 78.6 81.8 68.7 1,875 Total 42.9 57.6 37.3 45,607 58.5 62.8 49.1 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 169 Table 12.2 shows the level of knowledge of the various HIV prevention methods by background characteristics. Overall, 58 percent of women age 15-49 and 63 percent of currently married men age 15-54 know that limiting sexual intercourse to one partner who has no other partners can reduce the chances of contracting HIV. Forty-three percent of women age 15-49 and 59 percent of men age 15-54 say that using condoms at every sexual intercourse can reduce the risk of HIV transmission. Thirty-seven percent of women age 15-49 and 49 percent of men know that both using condoms and limiting sexual intercourse to one partner can reduce the risk of HIV infection. Knowledge of HIV prevention methods—using condoms and limiting sexual intercourse to one partner—decreases with age among women, with the highest percentage found in age group 20-24 (43 percent). Women who have never been married and who have never had sex are more likely to know of HIV prevention methods (40 percent) than married women (37 percent) or women who are divorced, separated, or widowed (28 percent). Knowledge of HIV prevention methods is higher among women in urban than in rural areas (45 percent and 28 percent, respectively). Knowledge of HIV prevention methods increases as the level of education and wealth quintile rise. The age pattern in knowledge of HIV prevention methods—both using condoms and limiting sexual intercourse to one partner—among currently married men age 15-54 differs from that for women age 15-49. Married men age 30-39 are most likely to know of HIV prevention methods (56 percent). Differentials by residence, education, and wealth quintile among currently married men are similar to those among women age 15-49. Knowledge of HIV prevention methods among women age 15-49 and currently married men age 15- 54 by province is shown in Appendix Table A-12.2. 12.1.3 Comprehensive Knowledge about AIDS As part of the effort to assess HIV and AIDS knowledge, the 2012 IDHS collected information on common misconceptions about HIV transmission. Respondents were asked whether they think it is possible for a healthy-looking person to have HIV and whether they believe HIV is transmitted through mosquito bites, supernatural means, or sharing food with a person who has HIV or AIDS. Comprehensive knowledge is defined as knowing that consistent condom use and having just one faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about HIV transmission in Indonesia: that HIV can be transmitted by mosquito bites and that HIV can be transmitted by sharing food with a person who has AIDS. Tables 12.3.1 and 12.3.2 show the knowledge about the ways in which the AIDS virus is transmitted. Sharing an unsterilized needle or syringe was identified by 71 percent of women age 15-49 and 75 percent of currently married men age 15-54 as a way of contracting HIV. Sixty-one percent of women age 15-49 and 63 percent of currently married men age 15-54 know that a healthy-looking person can have HIV. Thirty-five percent of women age 15-49 and 32 percent of currently married men know that HIV cannot be transmitted by mosquitoes. Six in ten women age 15-49 and 67 percent of currently married men age 15-54 know that HIV cannot be transmitted by supernatural means. However, the fact that a majority of men and women still have this misconception indicates that the government needs to increase awareness of HIV transmission modes to reduce these misconceptions. Overall, only 11 percent of women age 15-49 and 12 percent of currently married men age 15-54 have comprehensive knowledge about AIDS. 170 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Table 12.3.1 Comprehensive knowledge about AIDS: Women Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with a comprehensive knowledge about AIDS, by background characteristics, Indonesia 2012 Percentage of respondents who say that: Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local misconcep- tions1 Percentage with a compre- hensive knowledge about AIDS2 Number of women age 15-49 Background characteristic A healthy- looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites The AIDS virus cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has the AIDS virus A person can get infected by sharing unsterilized needle or syringe Age 15-24 69.7 40.6 66.7 35.0 78.1 19.6 11.4 13,232 15-19 68.7 41.6 65.7 33.6 78.9 18.7 9.4 6,927 20-24 70.8 39.5 67.8 36.5 77.2 20.6 13.6 6,305 25-29 67.0 36.7 64.3 36.6 75.6 19.3 12.9 6,959 30-39 63.1 36.5 63.8 36.0 72.6 20.6 13.3 13,757 40-49 46.8 26.4 47.6 24.9 56.2 13.0 8.3 11,659 Marital status Never married 73.3 45.6 71.7 40.6 83.1 23.9 13.9 9,919 Ever had sex 61.8 47.4 68.9 45.5 73.5 27.6 18.6 123 Never had sex 73.4 45.6 71.7 40.5 83.2 23.8 13.8 9,796 Married/living together 58.8 32.7 58.1 31.2 67.7 16.8 10.9 33,465 Divorced/separated/ widowed 47.7 24.9 49.2 26.3 55.1 14.2 7.7 2,223 Residence Urban 72.5 43.7 72.3 41.5 81.6 24.1 15.3 23,805 Rural 49.3 25.8 47.8 23.7 58.3 11.7 7.1 21,802 Education No education 8.5 4.0 8.6 4.2 11.8 1.4 0.6 1,500 Some primary 23.2 12.8 24.2 9.7 30.2 3.6 1.6 4,870 Completed primary 43.7 21.0 42.5 18.7 52.8 7.9 4.0 10,254 Some secondary 67.2 36.7 64.2 31.4 77.1 16.5 8.9 12,753 Completed secondary 81.6 47.6 81.6 47.4 92.1 26.3 17.4 10,677 More than secondary 89.9 61.6 91.3 63.2 97.3 42.7 30.9 5,552 Wealth quintile Lowest 33.5 17.5 32.0 15.4 41.7 6.9 3.8 7,767 Second 51.2 27.0 49.0 23.4 60.1 11.2 6.1 8,784 Middle 63.0 34.4 62.2 32.1 72.3 16.5 9.8 9,243 Fourth 71.0 40.6 71.6 38.5 81.0 21.2 13.5 9,743 Highest 81.2 51.2 80.6 50.3 89.8 31.7 21.3 10,071 Total 61.4 35.1 60.6 33.0 70.5 18.2 11.4 45,607 1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and by sharing food with a person who has AIDS virus. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention: the AIDS virus cannot be transmitted by mosquito bites or by sharing food with a person who has the AIDS virus. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 171 Table 12.3.2 Comprehensive knowledge about AIDS: Currently married men age 15-54 Percentage of currently married men age 15-54 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Indonesia 2012 Percentage of men who say that: Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local misconcep- tions1 Percentage with a compre- hensive knowledge about AIDS2 Number of currently married men age 15-54 Background characteristic A healthy- looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites The AIDS virus cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has the AIDS virus A person can get infected by sharing unsterilized needle or syringe Age 15-24 64.1 31.5 67.1 33.4 77.0 15.3 10.3 373 15-19 (70.3) (38.4) (40.4) (34.4) (65.2) (16.1) (4.0) 28 20-24 63.6 30.9 69.2 33.3 77.9 15.3 10.8 345 25-29 66.7 34.2 69.5 33.4 77.6 16.1 10.7 1,127 30-39 68.7 37.8 73.5 39.7 80.8 20.1 15.9 3,449 40-49 60.8 29.5 64.3 30.6 73.0 15.0 10.7 3,065 50-54 47.3 22.7 52.3 23.2 57.6 11.2 8.2 1,292 Residence Urban 72.2 39.1 78.0 41.3 86.2 21.3 16.0 4,739 Rural 52.8 25.2 55.1 25.2 62.3 11.5 8.3 4,567 Education No education 15.4 8.7 18.8 4.7 20.1 2.3 2.1 265 Some primary 30.0 12.9 33.5 12.9 39.6 5.0 3.4 1,371 Completed primary 51.9 24.4 55.3 21.6 62.8 8.4 4.8 2,118 Some secondary 68.8 31.2 71.3 31.1 81.3 13.8 10.1 1,979 Completed secondary 79.2 42.8 85.4 48.0 94.0 23.4 18.2 2,453 More than secondary 87.5 55.2 91.8 59.9 97.2 38.8 30.5 1,119 Wealth quintile Lowest 38.1 17.1 39.4 17.2 47.2 5.8 3.7 1,596 Second 54.8 23.8 56.5 24.0 64.5 10.1 6.5 1,866 Middle 62.4 30.6 70.2 29.7 76.6 13.7 9.3 2,008 Fourth 73.4 40.1 77.8 41.8 85.6 22.5 17.4 1,962 Highest 80.7 47.2 85.1 51.8 93.6 28.7 23.0 1,875 Total 62.7 32.3 66.8 33.4 74.5 16.5 12.3 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and by sharing food with a person who has AIDS virus. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention; the AIDS virus cannot be transmitted by mosquito bites or by sharing food with a person who has the AIDS virus. Comprehensive knowledge of AIDS is lowest among women age 15-49 and currently married men age 15-54 with no education and those in the lowest wealth quintile. Differentials in comprehensive knowledge about AIDS among women age 15-49 and currently married men age 15-54 by province are shown in Appendix Tables A-12.3.1 and A-12.3.2 12.1.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV Increasing knowledge about prevention of mother-to-child transmission (PMTCT) of HIV to reduce transmission is critical. To assess PMTCT knowledge, respondents were asked whether HIV can be transmitted from a mother to a child during pregnancy, during delivery, and through breastfeeding. Table 12.4 shows that knowledge of HIV transmission from mother to child during pregnancy, delivery, and breastfeeding is similar among women age 15-49 and currently married men age 15-54. Knowledge of PMTCT in the three events tends to be higher for urban residents, respondents with higher education, and respondents in the higher wealth quintiles. 172 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Table 12.4 Knowledge of prevention of mother to child transmission of HIV Percentage of women age 15-49 and currently married men age 15-54 who know that HIV can be transmitted from mother to child during pregnancy, during delivery and by breastfeeding by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic HIV can be transmitted during pregnancy HIV can be transmitted during delivery HIV can be transmitted by breast- feeding Number of women HIV can be transmitted during pregnancy HIV can be transmitted during delivery HIV can be transmitted by breast- feeding Number of currently married men age 15-54 Age 15-24 69.2 59.4 69.0 13,232 63.8 55.0 67.2 373 15-19 69.8 58.7 69.5 6,927 (69.3) (66.6) (70.0) 28 20-24 68.5 60.2 68.6 6,305 63.4 54.0 66.9 345 25-29 69.5 60.0 66.8 6,959 62.7 56.4 63.9 1,127 30-39 67.9 59.2 64.9 13,757 69.3 60.4 65.8 3,449 40-49 52.3 45.7 49.8 11,659 64.8 54.8 60.8 3,065 50-54 na na na 0 50.2 42.6 50.2 1,292 Marital status Never married 74.1 63.7 73.0 9,919 na na na na Ever had sex 69.8 59.1 71.9 123 na na na na Never had sex 74.1 63.7 73.0 9,796 na na na na Married/living together 62.5 54.4 60.3 33,465 64.1 55.4 61.8 9,306 Divorced/separated/widowed 51.8 44.0 49.0 2,223 na na na na Currently pregnant Pregnant 67.5 55.7 65.2 1,950 na na na na Not pregnant or not sure 64.4 55.9 62.4 43,657 na na na na Residence Urban 75.9 66.7 72.9 23,805 75.1 65.4 70.0 4,739 Rural 52.1 44.2 51.2 21,802 52.8 44.9 53.3 4,567 Education No education 10.5 9.5 10.3 1,500 14.9 10.6 15.7 265 Some primary 27.1 23.0 26.7 4,870 33.2 26.9 33.2 1,371 Completed primary 47.0 39.4 46.3 10,254 49.4 43.8 52.7 2,118 Some secondary 69.0 58.2 67.8 12,753 67.5 58.8 66.8 1,979 Completed secondary 85.7 75.2 82.7 10,677 83.7 72.2 78.3 2,453 More than secondary 93.1 85.5 87.3 5,552 92.8 79.6 80.3 1,119 Wealth quintile Lowest 36.3 30.7 35.8 7,767 37.3 32.3 37.9 1,596 Second 53.8 45.7 52.8 8,784 53.7 45.6 53.8 1,866 Middle 65.9 56.4 63.6 9,243 64.5 57.6 67.3 2,008 Fourth 74.6 64.9 72.6 9,743 76.1 65.6 71.4 1,962 Highest 84.6 75.2 80.9 10,071 84.5 71.5 74.3 1,875 Total 64.5 55.9 62.5 45,607 64.1 55.4 61.8 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 12.2 ACCEPTING ATTITUDES TOWARD THOSE LIVING WITH HIV AND AIDS AND ATTITUDES TOWARD NEGOTIATING SAFER SEXUAL RELATIONS WITH HUSBAND 12.2.1 Accepting Attitudes toward Those Living with HIV and AIDS The HIV and AIDS epidemic has generated fear, anxiety, and prejudice against people living with HIV. There is widespread stigma and discrimination against people who are HIV positive. These societal attitudes can adversely affect both people’s willingness to be tested for HIV and their initiation of and adherence to antiretroviral therapy. Reducing stigma and discrimination is therefore an important factor in the prevention, management, and control of the HIV epidemic. In the 2012 IDHS, women age 15-49 and currently married men age 15-54 who have heard of AIDS are asked a number of questions to assess the level of stigma associated with HIV and AIDS. These questions HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 173 ascertain whether they would be willing to care for a relative who was sick with AIDS in their own home, whether they would buy fresh vegetables from a shopkeeper who has the AIDS virus, whether they thought a female teacher who has HIV but is not sick should be allowed to continue teaching, and whether they would keep secret that a family member got infected with the AIDS virus. Tables 12.5.1 and 12.5.2 present results for women age 15-49 and currently married men age 15-54, respectively. Overall, currently married men age 15-54 are more likely than women age 15-49 to express acceptance attitudes on all four indicators (11 percent versus 9 percent). On an individual indicator, 75 percent of currently married men age 15-54 are willing to care for a family member with AIDS in their own home compared with 70 percent of women age 15-49. Accepting attitudes are generally more common among women and men in urban areas than in rural areas and increase with education and wealth. Table 12.5.1 Accepting attitudes toward those living with HIV-AIDS: Women age 15-49 Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV-AIDS, by background characteristics, Indonesia 2012 Percentage of respondents who: Percentage expressing acceptance attitudes on all four indicators Number of respondents who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 71.4 28.3 50.7 36.4 6.1 11,172 15-19 69.1 25.8 48.8 35.5 5.1 5,875 20-24 74.1 31.1 52.8 37.4 7.2 5,297 25-29 71.0 33.8 50.7 43.6 9.6 5,720 30-39 69.5 35.5 49.2 49.3 11.9 10,778 40-49 67.0 29.3 42.0 56.1 9.9 7,327 Marital status Never married 72.0 31.9 53.2 36.7 7.5 8,751 Ever had sex 78.0 42.1 53.1 34.6 12.2 102 Never had sex 71.9 31.8 53.2 36.7 7.5 8,650 Married/living together 69.1 31.5 47.1 48.4 9.9 24,853 Divorced/separated/ widowed 69.5 31.7 42.1 53.2 8.8 1,392 Residence Urban 70.4 35.4 51.9 43.1 10.4 20,700 Rural 68.9 26.1 43.3 49.5 7.6 14,296 Education No education 68.7 16.8 29.0 50.9 3.4 235 Some primary 66.9 18.2 30.6 49.8 4.4 1,852 Completed primary 69.8 23.1 38.1 48.9 6.8 6,388 Some secondary 67.8 27.5 45.9 44.9 8.0 10,788 Completed secondary 70.5 36.5 53.0 45.3 10.7 10,223 More than secondary 73.5 45.7 63.6 42.5 13.8 5,510 Wealth quintile Lowest 66.1 20.9 37.4 51.3 6.3 3,804 Second 67.4 25.0 42.5 48.4 7.5 5,984 Middle 69.8 28.3 46.9 47.2 8.3 7,386 Fourth 70.9 33.4 49.6 43.6 9.7 8,420 Highest 72.0 41.2 56.7 42.3 11.9 9,402 Total 69.8 31.6 48.4 45.7 9.3 34,997 174 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Table 12.5.2 Accepting attitudes toward those living with HIV-AIDS: Currently married men age 15-54 Among currently married men age 15-54 who have heard of HIV-AIDS, percentage expressing specific accepting attitudes toward people with HIV-AIDS, by background characteristics, Indonesia 2012 Percentage of respondents who: Percentage expressing acceptance attitudes on all four indicators Number of respondents who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 77.9 18.3 38.2 46.8 6.0 313 15-19 (89.0) (19.0) (46.8) (52.1) (15.3) 22 20-24 77.1 18.3 37.5 46.4 5.3 290 25-29 77.2 30.2 45.8 49.7 10.5 962 30-39 76.1 31.7 45.3 56.7 11.8 3,065 40-49 72.7 29.5 42.2 63.7 12.2 2,439 50-54 71.8 28.4 37.2 62.0 10.8 881 Residence Urban 77.7 33.9 49.2 57.1 13.0 4,335 Rural 70.9 24.7 35.4 59.7 9.4 3,325 Education No education 68.4 5.1 22.0 30.3 0.0 77 Some primary 71.1 19.2 26.7 58.5 6.0 709 Completed primary 76.0 21.4 34.7 57.2 6.8 1,587 Some secondary 71.2 26.0 38.9 59.8 10.4 1,772 Completed secondary 77.1 38.4 48.6 59.0 15.4 2,399 More than secondary 76.1 38.3 62.3 57.3 15.3 1,117 Wealth quintile Lowest 68.7 20.2 26.5 56.2 5.7 948 Second 71.0 25.6 33.9 61.3 8.5 1,381 Middle 72.2 26.8 39.1 56.2 9.7 1,724 Fourth 80.0 32.3 50.5 59.9 14.1 1,785 Highest 77.9 38.7 55.5 57.3 15.6 1,823 Total 74.7 29.9 43.2 58.3 11.4 7,661 Note: Figures in parentheses are based on 25-49 unweighted cases. 12.2.2 Attitudes toward Negotiating Safer Sexual Relations with Husband Knowledge about HIV transmission and ways to prevent it is of little use if people feel powerless to negotiate safer sex with their partners. To gauge attitudes toward safer sex, respondents in the 2012 IDHS were asked whether a wife is justified in refusing to have sexual intercourse with her husband if she knows he has an STI, whether a wife is justified in refusing to have sexual intercourse with her husband if she knows he has sex with other women, whether a wife is justified in refusing to have sexual intercourse with her husband if she has recently given birth, and whether a wife is justified in refusing to have sexual intercourse with her husband if she is tired or not in the mood. Table 12.6 shows that 91 percent of women age 15-49 and 94 percent of currently married men age 15-54 believe that a woman is justified in refusing to have sexual intercourse with her husband if she has recently given birth. The percentage of women age 15-49 who say that a woman is justified in refusing to have sexual intercourse with her husband if she knows he has sex with other women is higher than that of currently married men (84 and 77 percent, respectively). Differences by background characteristics among women age 15-49 and currently married men age 15-54 are also presented on Table 12.6. In general, support for a wife’s right to negotiate safer sex with her husband increases with increasing level of the respondent’s education level and wealth quintile. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 175 Table 12.6 Attitudes toward negotiating safer sexual relations with husband Percentage of women age 15-49 and currently married men age 15-54 who believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sexual intercourse with other women, and percentage who believe that a woman is justified in asking that they use a condom if she knows that her husband has a sexually transmitted infection (STI), by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic Refusing to have sexual intercourse with her husband if she knows he has an STI Refusing to have sexual intercourse with her husband if she knows he has sex with other women Refusing to have sexual intercourse with her husband if she has recently given birth Refusing to have sexual intercourse with her husband if she is tired or not in the mood Number of women age 15-49 Refusing to have sexual intercourse with her husband if she knows he has an STI Refusing to have sexual intercourse with her husband if she knows he has sex with other women Refusing to have sexual intercourse with her husband if she has recently given birth Refusing to have sexual intercourse with her husband if she is tired or not in the mood Number of currently married men age 15-54 Age 15-24 82.5 83.2 88.0 66.9 13,232 85.4 78.3 92.7 88.4 373 15-19 80.2 80.9 85.1 66.2 6,927 (85.5) (65.4) (91.6) (80.9) 28 20-24 85.1 85.7 91.2 67.6 6,305 85.4 79.3 92.8 89.0 345 25-29 86.6 86.6 93.0 69.7 6,959 89.0 79.8 94.8 82.1 1,127 30-39 85.5 84.8 93.2 67.0 13,757 89.4 78.5 94.4 83.7 3,449 40-49 81.6 81.2 90.6 67.3 11,659 83.9 77.4 93.6 80.8 3,065 50-54 na na na na 0 77.5 70.5 90.8 79.2 1,292 Marital status Never married 81.7 81.0 86.0 65.0 9,919 na na na na na Ever had sex 79.2 75.1 82.0 69.6 123 na na na na na Never had sex 81.8 81.1 86.1 65.0 9,796 na na na na na Married/living together 84.6 84.8 92.5 68.3 33,465 85.7 77.2 93.6 82.1 9,306 Divorced/separated/ widowed 80.5 78.5 90.2 65.3 2,223 na na na na na Residence Urban 87.7 86.1 92.6 67.8 23,805 90.3 81.8 95.8 83.6 4,739 Rural 79.5 81.0 89.2 67.1 21,802 81.0 72.4 91.3 80.6 4,567 Education No education 63.4 69.2 78.9 60.3 1,500 47.7 53.0 66.3 56.3 265 Some primary 72.4 77.9 88.1 68.6 4,870 71.1 68.2 88.8 75.7 1,371 Completed primary 80.7 81.9 90.7 65.7 10,254 83.1 72.8 92.8 81.9 2,118 Some secondary 83.3 83.7 89.3 68.6 12,753 89.3 79.4 94.6 83.2 1,979 Completed secondary 90.6 87.2 94.3 68.2 10,677 92.9 82.3 96.8 85.6 2,453 More than secondary 93.1 89.1 94.9 67.6 5,552 95.5 86.7 98.7 86.8 1,119 Wealth quintile Lowest 74.4 78.2 86.2 67.9 7,767 74.1 70.0 86.4 76.6 1,596 Second 80.2 81.9 89.7 68.1 8,784 83.9 75.2 94.1 83.2 1,866 Middle 84.5 83.6 91.7 68.3 9,243 87.8 76.3 94.1 82.9 2,008 Fourth 87.8 86.4 93.1 67.4 9,743 88.6 80.5 96.0 84.1 1,962 Highest 89.6 86.8 93.2 65.9 10,071 92.2 82.7 96.2 82.8 1,875 Total 83.8 83.7 91.0 67.5 45,607 85.7 77.2 93.6 82.1 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 12.3 PAYMENT FOR SEXUAL INTERCOURSE AND CONDOM USE AT LAST PAID SEXUAL INTERCOURSE Paid sex is considered a special category of higher-risk sex. Currently married men age 15-54 in the 2012 IDHS were asked whether they had ever paid for sexual intercourse and whether they had done so in the past 12 months. Table 12.7 shows that 5 percent of currently married men age 15-54 had ever paid for sexual intercourse and 2 percent did so in the last 12 months. Currently married men age 15-54 in urban areas are more likely than rural men to pay for sexual intercourse. The likelihood of payment for sexual favors seems to increase with education, while wealth does not have much impact on the practice. One in three men who paid for sex in the past 12 months reported that they used a condom at the last paid sex (data not shown). 176 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Variations in the practice of payment for sexual intercourse and condom use at last paid sexual intercourse among currently married men age 15-54, according to province, are presented in Appendix Table A-12.4. Table 12.7 Payment for sexual intercourse and condom use at last paid sexual intercourse Percentage of currently married men age 15-54 who ever paid for sexual intercourse and percentage reporting payment for sexual intercourse in the past 12 months, and among them, the percentage reporting that a condom was used the last time they paid for sexual intercourse, by background characteristics, Indonesia 2012 Among all currently married men age 15-54: Background characteristic Percentage who ever paid for sexual intercourse Percentage who paid for sexual intercourse in the past 12 months Number of currently married men age 15-54 Age 15-24 2.7 0.7 373 15-19 2.1 2.1 28 20-24 2.8 0.6 345 25-29 4.6 2.3 1,127 30-39 5.9 2.1 3,449 40-49 5.0 2.1 3,065 50-54 6.5 1.7 1,292 Residence Urban 6.1 2.2 4,739 Rural 4.6 1.8 4,567 Education No education 4.1 0.6 265 Some primary 5.1 2.4 1,371 Completed primary 4.6 1.9 2,118 Some secondary 6.1 2.1 1,979 Completed secondary 5.4 2.0 2,453 More than secondary 6.2 2.0 1,119 Wealth quintile Lowest 5.3 2.3 1,596 Second 5.8 2.4 1,866 Middle 5.8 2.3 2,008 Fourth 4.8 1.2 1,962 Highest 5.2 2.0 1,875 Total 5.4 2.0 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 12.4 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS (STIS) AND STI SYMPTOMS In the 2012 IDHS, respondents who had ever had sex were asked if they had contracted a disease through sexual contact in the past 12 months, or if they had had either of two symptoms associated with STIs (a bad-smelling, abnormal discharge from the vagina or penis, or a genital sore or ulcer). Table 12.8 shows the self-reported prevalence of STIs and STI symptoms in the population for women age 15-49 and currently married men age 15-54. The results in Table 12.8 indicate that about 12 percent of women age 15-49 and 1 percent of currently married men age 15-54 who have ever been sexually active reported having an STI and/or an STI symptom in the 12 months preceding the survey. The prevalence of an STI or STI symptoms is highest for sexually active never-married women (24 percent) and women age 15-19 (19 percent). Among women age 15-49, the prevalence of self-reported STIs is highest among women with some secondary education and women in the HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 177 lowest wealth quintile (14 percent each). Differentials in reported STIs and STI symptoms among men are small. Appendix Table A-12.5 shows the percentage of the self-reported prevalence of STIs and STI symptoms in women age 15-49 and currently married men age 15-54 by province. Table 12.8 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms Among women age 15-49 and currently married men age 15-54 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic STI Bad smelling/ abnormal genital discharge Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of respondents who ever had sexual intercourse STI Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of respondents who ever had sexual intercourse Age 15-24 0.2 15.4 2.6 16.8 4,885 0.5 2.5 2.7 372 15-19 0.1 18.3 2.5 19.1 959 (0.0) (2.1) (2.1) 28 20-24 0.3 14.7 2.6 16.3 3,927 0.5 2.6 2.8 344 25-29 0.1 13.8 2.1 14.8 6,227 0.0 1.9 1.9 1,119 30-39 0.1 10.0 2.3 11.5 13,215 0.2 1.1 1.2 3,440 40-49 0.1 7.1 1.4 8.0 11,415 0.2 1.4 1.6 3,062 50-54 na na na na 0 0.0 1.1 1.1 1,292 Marital status Never married 0.7 20.9 7.5 24.0 123 na na na na Ever had sex 0.7 20.9 7.5 24.0 123 na na na na Married/living together 0.1 10.5 2.0 11.7 33,418 0.1 1.4 1.4 9,285 Divorced/separated/ widowed 0.0 9.5 1.1 10.1 2,201 na na na na Residence Urban 0.1 9.5 2.0 10.8 17,711 0.1 1.0 1.1 4,725 Rural 0.1 11.4 2.0 12.6 18,030 0.1 1.7 1.8 4,559 Education No education 0.1 8.3 1.6 9.2 1,405 0.0 0.7 0.7 265 Some primary 0.0 9.4 1.6 10.4 4,618 0.0 1.6 1.6 1,367 Completed primary 0.1 9.4 1.9 10.4 9,654 0.1 1.9 1.9 2,116 Some secondary 0.1 12.6 2.3 14.0 8,408 0.2 1.5 1.7 1,975 Completed secondary 0.2 11.1 2.1 12.4 8,149 0.2 0.7 0.8 2,444 More than secondary 0.2 9.1 2.2 10.6 3,508 0.2 1.4 1.5 1,117 Wealth quintile Lowest 0.1 12.6 2.3 13.8 6,473 0.1 2.0 2.1 1,590 Second 0.1 10.3 1.7 11.4 7,126 0.0 1.1 1.1 1,860 Middle 0.1 11.4 2.1 12.5 7,305 0.4 1.9 2.1 2,004 Fourth 0.1 10.4 2.2 11.8 7,568 0.1 0.9 0.9 1,956 Highest 0.2 8.0 1.9 9.1 7,270 0.1 1.0 1.0 1,874 Total 0.1 10.5 2.0 11.7 35,742 0.1 1.4 1.4 9,285 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 12.5 PREVALENCE OF MEDICAL INJECTIONS Use of nonsterile injections in a health care setting can contribute to the transmission of blood-borne pathogens. To measure the potential risk of transmission of HIV associated with medical injections, respondents in the 2012 IDHS were asked whether they had received an injection in the past 12 months; if so, they were asked how many injections they had received and whether their last injection was given with a syringe from a newly opened package. 178 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Table 12.9 shows the reported prevalence of injections. Forty-six percent of women age 15-49 and 28 percent of currently married men age 15-54 reported receiving a medical injection during the 12-month period preceding the survey. Overall, women received an average of 1.8 medical injections and men received 0.9 injections during that period. The vast majority of women and men reported that the last injection was given with a syringe from a newly opened package (94 percent and 86 percent, respectively). Women age 25-29 are the most likely to receive a medical injection in the last 12 months (57 percent). Urban residents are less likely than rural residents to receive a medical injection in the last 12 months. There is no clear pattern in the prevalence of medical injection by education and wealth quintile. Table 12.9 Prevalence of medical injections Percentage of women age 15-49 and currently married men age 15-54 who received at least one medical injection in the last 12 months, the average number of medical injections per person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-54 Background characteristic Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respon- dents For last injection, syringe and needle taken from a new, unopened package Number of respon- dents receiving medical injections in the last 12 months Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respon- dents For last injection, syringe and needle taken from a new, unopened package Number of respon- dents receiving medical injections in the last 12 months Age 15-24 36.6 1.2 13,232 92.6 4,839 23.8 0.6 373 94.4 89 15-19 23.3 0.6 6,927 91.4 1,614 8.6 0.2 28 * 2 20-24 51.2 1.9 6,305 93.3 3,226 25.0 0.6 345 94.3 86 25-29 57.1 2.3 6,959 95.2 3,976 27.1 0.7 1,127 87.4 305 30-39 52.6 2.1 13,757 94.5 7,238 25.4 0.8 3,449 86.8 876 40-49 42.3 1.7 11,659 92.1 4,937 29.5 1.0 3,065 86.0 905 50-54 na na na na na 30.3 1.4 1,292 83.4 391 Marital status Never married 18.3 0.5 9,919 90.8 1,816 na na na na na Ever had sex 28.7 0.8 123 94.7 35 na na na na na Never had sex 18.2 0.5 9,796 90.7 1,781 na na na na na Married/living together 55.4 2.2 33,465 94.1 18,549 27.6 0.9 9,306 86.3 2,567 Divorced/separated/ widowed 28.1 0.9 2,223 88.5 625 na na na na na Residence Urban 41.6 1.6 23,805 94.1 9,895 23.1 0.8 4,739 89.5 1,096 Rural 50.9 1.9 21,802 93.3 11,095 32.2 1.0 4,567 84.0 1,470 Education No education 40.0 1.4 1,500 90.2 599 29.3 1.4 265 64.7 78 Some primary 47.7 1.8 4,870 90.1 2,324 30.2 1.1 1,371 74.9 415 Completed primary 54.4 2.1 10,254 93.3 5,583 27.3 0.9 2,118 83.6 577 Some secondary 44.1 1.7 12,753 93.9 5,628 27.7 0.9 1,979 87.0 549 Completed secondary 45.0 1.8 10,677 95.2 4,799 25.7 0.9 2,453 93.6 630 More than secondary 37.0 1.4 5,552 95.5 2,057 28.4 0.9 1,119 96.0 318 Wealth quintile Lowest 46.3 1.6 7,767 92.0 3,599 29.7 0.9 1,596 83.4 474 Second 49.7 1.8 8,784 93.5 4,370 29.2 1.1 1,866 83.0 545 Middle 48.8 1.9 9,243 93.5 4,513 27.7 0.9 2,008 84.0 556 Fourth 47.1 1.9 9,743 95.0 4,590 23.7 0.7 1,962 88.5 465 Highest 38.9 1.6 10,071 94.0 3,918 28.1 1.0 1,875 92.9 527 Total 46.0 1.8 45,607 93.7 20,990 27.6 0.9 9,306 86.3 2,567 Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or other health worker. Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable Appendix Table A-12.6 shows the percentage of women age 15-49 and currently married men age 15- 54 who received medical injection according to province. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 179 12.6 COMPREHENSIVE KNOWLEDGE ABOUT AIDS AND SOURCE OF CONDOMS AMONG YOUTH This section addresses HIV-related knowledge and sexual behavior among women and currently married men age 15-24. Knowledge of how HIV is transmitted is crucial to enabling young people to avoid contracting it. Young people are often at greater risk because they may have shorter relationships and more partners, or engage in other risky behaviors. Knowledge of HIV among youth is one of the Millennium Development Goals (MDGs) indicators, and should be monitored periodically by all developing countries. As discussed earlier, comprehensive knowledge of HIV is defined as knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the likelihood of getting HIV; knowing that a healthy-looking person can have HIV, the virus that causes AIDS; and rejecting the two most common local misconceptions about HIV transmission or prevention. In the 2012 IDHS however, information on faithfulness to one sexual partner is not limited to one who is HIV-negative. Table 12.10 shows that 11 percent of women age 15-24 and 10 percent of currently married men age 15-24 have a comprehensive knowledge of AIDS. Knowledge increases with age, is higher in urban areas than in rural areas, and increases with education. Table 12.10 Comprehensive knowledge about AIDS and of a source of condoms among youth Percentage of women age 15-24 and currently married men age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge of a source of condoms, by background characteristics, Indonesia 2012 Women age 15-24 Currently married men age 15-24 Background characteristic Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Age 15-19 9.4 42.2 6,927 4.0 (63.3) 28 15-17 8.3 36.9 4,395 0.0 * 2 18-19 11.2 51.4 2,532 4.3 62.9 26 20-24 13.6 58.0 6,305 10.8 68.5 345 20-22 13.2 58.2 3,750 7.4 73.3 136 23-24 14.0 57.7 2,555 13.0 65.4 209 Marital status Never married 12.9 50.5 8,411 na na na Ever had sex 14.0 58.0 79 na na na Never had sex 12.9 50.5 8,332 na na na Ever married 8.7 48.4 4,821 10.3 68.1 373 Residence Urban 13.9 61.1 7,072 11.5 81.0 146 Rural 8.5 36.7 6,160 9.4 59.8 227 Education No education 0.7 5.4 139 0.0 * 6 Some primary 2.5 16.5 465 0.0 (34.2) 37 Completed primary 3.8 27.5 1,530 6.9 51.6 61 Some secondary 8.1 41.0 6,021 5.6 71.4 129 Completed secondary 13.9 64.6 3,280 14.8 84.5 119 More than secondary 27.4 82.9 1,797 45.1 (83.3) 20 Total 11.4 49.8 13,232 10.3 68.1 373 Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or other health worker. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention of the AIDS virus. 2 For this table, the following responses are not considered sources for condoms: friends or relatives. 180 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Condom use plays an important role in preventing the transmission of HIV and other sexually transmitted infections (as well as preventing unwanted pregnancies). Knowledge of a source for condoms is prerequisite to obtaining and using them. Table 12.10 shows that 50 percent of women 15-24 and 68 percent of currently married men 15-24 know a place where they can get a condom. As expected, the proportion of young adults who know where to get condoms increases with the level of education and wealth status. The percentage of youth who have comprehensive knowledge about AIDS and of a source of condoms by province is shown in Appendix Table A-12.7. 12.7 AGE AT FIRST SEXUAL INTERCOURSE AMONG YOUNG PEOPLE Age at first sex among young adults age 15-24 is one of the UNGASS indicators that are reported every other year. Because Indonesia is considered to have a concentrated epidemic—transmission is predominantly through unsafe injection among intravenous drug users and through heterosexual intercourse between HIV-positive and HIV-negative persons—age at first sexual intercourse marks the point in time when most individuals are first exposed to the risk of contracting HIV. Table 12.11 shows the proportion of women age 15-49 and currently married men age 15-19 and 20- 24 who had sexual intercourse before age 15 and before age 18. Two percent of women 15-24 and three percent of married men 15-24 had sexual intercourse before age 15, while 16 percent of women 18-24 and 12 percent of married men 18-24 had sexual intercourse before age 18. Table 12.11 Age at first sexual intercourse among young people Percentage of women age 15-24 and currently married men age 15-24 who had sexual intercourse before age 15 and percentage of young women and currently married young men age 18-24 who had sexual intercourse before age 18, by background characteristics, Indonesia 2012 Women age 15-49 Currently married men age 15-24 Background characteristic Percentage who had sexual intercourse before age 15 Number of respondents (15-24) Percentage who had sexual intercourse before age 18 Number of respondents (18-24) Percentage who had sexual intercourse before age 15 Number of respondents (15-24) Percentage who had sexual intercourse before age 18 Number of respondents (18-24) Age 15-19 1.6 6,927 na na 21.0 28 na na 15-17 1.7 4,395 na na 0.0 2 na na 18-19 1.5 2,532 15.1 2,532 (22.5) 26 (54.1) 26 20-24 2.5 6,305 16.8 6,305 1.7 345 8.6 345 20-22 2.2 3,750 17.0 3,750 3.0 136 10.7 136 23-24 3.0 2,555 16.5 2,555 0.8 209 7.2 209 Marital status Never married 0.1 8,411 0.3 4,306 na na na na Ever married 5.5 4,821 31.5 4,531 3.1 373 11.8 371 Knows condom source1 Yes 1.2 6,583 10.3 4,961 3.2 254 11.6 253 No 2.9 6,649 24.0 3,876 3.0 119 12.4 118 Residence Urban 0.9 7,072 9.5 4,862 3.0 146 12.2 146 Rural 3.3 6,160 24.7 3,975 3.2 227 11.6 225 Education No education 13.2 139 37.7 114 * 6 * 6 Some primary 13.4 465 37.3 349 (2.2) 37 (23.9) 37 Completed primary 6.4 1,530 39.5 1,244 2.0 61 13.2 61 Some secondary 1.4 6,021 25.7 2,429 7.2 129 14.7 128 Completed secondary 0.3 3,280 4.6 2,917 0.3 119 4.7 119 More than secondary 0.1 1,797 1.0 1,784 (0.0) 20 (6.7) 20 Total 2.1 13,232 16.3 8,837 3.1 373 11.8 371 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. na = Not available 1 For this table, the following responses are not considered a source for condoms: friends or relatives. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 181 The proportions of women who had sexual intercourse before age 15 and before age 18 are higher among those who live in rural areas and those with little or no education. For example, 37 to 40 percent of women 18-24 with less than secondary education had sex before age 18 compared with 26 percent or under with secondary or higher education. 12.8 SOURCE OF INFORMATION ON HIV-AIDS The most common source of information about HIV-AIDS for women age 15-49 and currently married men age 15-54 is television (78 and 86 percent, respectively) (Tables 12.12.1 and 12.12.2). Other sources include the newspaper or magazines (28 percent of women and 38 percent of men), family or friends (29 percent of women and 40 percent of men), and radio (14 percent of women and 20 percent of men). Few respondents cited health providers as a source for information about HIV-AIDS (8 percent each). For women and men, the percentage who had heard of AIDS from television and radio is higher in urban areas than in rural areas, and increases with increasing level of education and wealth quintile. The percent distribution of women age 15-49 and currently married men age 15-54 who have heard of AIDS by source of information about HIV-AIDS, according to province, is shown in the Appendix Table A- 12.8.1 and Table A-12.8.2. Table 12.12.1 Source of information on HIV-AIDS: women age 15-49 Percent distribution of women age 15-49 who have heard of AIDS by source of information on HIV-AIDS by background characteristics, Indonesia 2012 Background characteristic Radio Tele- vision News- paper/ maga- zines Poster Health profes- sional Religious institu- tion School/ teacher Com- munity meeting Friend/ relative Work- place Internet Other Number of women age 15-49 who have heard of AIDS Age 15-24 14.5 65.9 26.5 5.8 7.4 0.5 47.7 2.8 25.5 3.3 8.2 2.6 11,172 15-19 11.6 55.3 23.5 5.2 6.4 0.6 68.5 2.4 22.2 1.6 8.6 2.4 5,875 20-24 17.7 77.6 29.8 6.4 8.6 0.4 24.7 3.2 29.2 5.2 7.7 2.9 5,297 25-29 15.1 84.8 30.1 6.1 8.4 0.5 8.0 2.7 28.5 4.3 4.6 1.9 5,720 30-39 14.0 85.8 29.3 5.0 7.7 0.5 3.1 3.4 29.5 4.5 3.5 1.8 10,778 40-49 13.0 80.6 25.2 3.6 6.8 0.8 1.7 5.5 32.7 3.8 1.4 3.1 7,327 Marital status Never married 15.3 63.5 30.1 7.1 7.0 0.6 56.9 3.0 24.2 4.1 11.1 3.2 8,751 Married or living together 13.6 83.2 27.1 4.5 7.7 0.5 4.9 3.7 30.0 3.8 2.6 2.1 24,853 Divorced/separated/ widowed 16.4 80.4 23.4 3.7 7.5 0.3 2.5 3.8 35.5 5.1 1.9 1.4 1,392 Residence Urban 15.2 81.6 32.6 6.4 7.2 0.4 18.7 3.7 27.4 5.2 6.5 2.4 20,700 Rural 12.7 73.3 20.6 3.3 8.1 0.7 16.6 3.2 30.7 2.1 2.2 2.2 14,296 Education No education 6.1 59.4 4.2 1.0 4.9 3.1 0.3 3.5 44.0 1.9 0.3 4.6 235 Some primary 7.3 66.4 4.0 1.3 3.9 0.2 0.4 1.4 41.2 1.6 0.0 2.5 1,852 Completed primary 9.9 77.0 10.3 1.5 6.0 0.3 0.4 2.3 34.1 2.0 0.1 1.8 6,388 Some secondary 11.7 72.7 19.9 3.9 7.1 0.4 26.6 2.6 26.4 2.1 2.7 2.0 10,788 Completed secondary 17.3 83.8 36.0 6.1 7.4 0.6 18.7 4.7 26.1 4.3 4.0 2.2 10,223 More than secondary 20.7 84.6 56.7 11.6 11.7 0.9 26.0 5.6 27.2 10.2 17.2 3.8 5,510 Wealth quintile Lowest 12.0 60.7 14.5 2.2 9.1 1.3 15.3 3.1 37.2 1.9 0.7 2.1 3,804 Second 11.7 74.3 18.9 3.6 7.6 0.5 16.5 2.7 31.7 2.1 1.9 1.7 5,984 Middle 12.9 79.0 22.2 4.2 7.1 0.4 16.3 3.1 29.4 2.8 2.8 2.3 7,386 Fourth 14.1 81.4 29.0 5.4 6.9 0.3 18.2 3.9 26.6 4.7 4.8 2.4 8,420 Highest 17.5 84.1 41.7 7.8 7.9 0.6 20.6 4.2 24.8 6.2 9.6 3.0 9,402 Total 14.1 78.2 27.7 5.1 7.5 0.5 17.8 3.5 28.7 3.9 4.7 2.4 34,997 182 • HIV- and AIDS-Related Knowledge, Attitudes, and Behavior Table 12.12.2 Source of information on HIV-AIDS: Currently married men age 15-54 Percent distribution of currently married men age 15-54 who have heard of AIDS by source of information on HIV-AIDS by background characteristics, Indonesia 2012 Background characteristic Radio Tele- vision News- paper/ maga- zines Poster Health profes- sional Religious institu- tion School/ teacher Com- munity meeting Friend/ relative Work- place Internet Other Number of currently married men age 15-54 who have heard of AIDS Age 15-24 19.9 82.1 27.1 8.9 11.3 0.9 7.9 2.3 51.0 12.7 5.3 3.1 313 15-19 * * * * * * * * * * * * 22 20-24 19.8 83.1 26.8 8.2 10.5 0.9 7.9 2.4 50.6 12.3 4.3 3.4 290 25-29 24.4 84.7 36.9 9.8 10.0 0.5 6.7 2.3 41.8 13.5 5.4 2.0 962 30-39 20.3 87.5 42.0 9.9 8.1 0.9 4.2 3.1 37.0 14.8 4.7 2.6 3,065 40-49 19.1 86.2 38.7 8.1 7.1 1.0 1.9 3.6 40.4 11.8 3.5 3.0 2,439 50-54 15.2 81.9 29.2 5.2 8.8 1.9 0.6 5.1 40.5 9.6 2.2 1.9 881 Residence Urban 20.2 89.0 46.9 10.7 8.0 0.8 4.1 3.2 38.8 15.5 6.1 3.4 4,335 Rural 19.3 81.7 27.0 6.1 8.4 1.3 2.7 3.6 40.9 9.7 1.6 1.6 3,325 Education No education 10.4 65.0 15.8 11.2 10.7 11.4 4.8 8.2 46.2 3.9 0.0 0.0 77 Some primary 12.2 64.6 7.2 2.6 3.8 1.2 0.0 2.2 54.0 8.6 0.0 2.0 709 Completed primary 16.4 80.6 16.9 2.6 5.2 0.5 0.1 1.7 44.1 12.0 0.0 1.0 1,587 Some secondary 16.6 87.1 31.2 6.8 6.5 0.5 1.2 2.1 41.8 9.6 0.5 1.9 1,772 Completed secondary 22.6 91.5 51.7 11.9 9.6 0.8 5.6 4.1 36.0 14.3 4.0 2.6 2,399 More than secondary 29.4 94.3 72.0 17.6 14.7 2.2 9.6 6.5 28.4 20.3 19.0 6.5 1,117 Wealth quintile Lowest 15.6 69.1 18.8 4.4 8.8 2.7 1.9 3.5 45.3 7.4 0.9 1.5 948 Second 16.1 80.9 25.0 4.3 5.7 0.5 2.4 2.4 43.9 10.8 0.5 1.7 1,381 Middle 18.4 86.6 31.0 6.7 7.0 0.4 1.9 3.3 40.4 12.7 1.8 2.0 1,724 Fourth 20.6 91.5 44.2 10.4 9.1 0.8 3.5 3.2 38.9 13.3 3.5 3.4 1,785 Highest 25.5 92.0 59.5 14.6 10.1 1.3 6.7 4.2 33.6 17.6 11.4 3.6 1,823 Total 19.8 85.9 38.2 8.7 8.2 1.0 3.5 3.4 39.7 13.0 4.2 2.6 7,661 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 12.9 WOMEN AND CURRENTLY MARRIED MEN SEEKING TREATMENT FOR STIS IDHS respondents who reported having an STI or symptoms of an STI in the past 12 months were asked if they sought any advice or treatment for their symptoms, and where such advice or treatment was sought. The results are presented in Figure 12.2. Fifty-six percent of women age 15-49 and 45 percent of currently married men age 15-54 sought advice or treatment from a clinic or hospital, private doctor or other health professional. Advice or medicine received from a drug store or pharmacy is an alternative source for advice or treatment of STIs, used by 11 percent of women and 8 percent of men. HIV- and AIDS-Related Knowledge, Attitudes, and Behavior • 183 Figure 12.2 Women and men seeking treatment for STIs 56 45 11 88 6 30 39 Women 15-49 Currently married men 15-54 Percent Clinic/hospital/private doctor/other health professional Advice or medicine from pharmacy/drug store/TBA Advice or treatment from any other source No advice or treatment IDHS 2012 Women’s Empowerment and Demographic and Health Outcomes • 185 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 13 his chapter presents data on the status of women, including information on gender differences in employment, access to and control over cash earnings, asset ownership, participation in household decision-making, and the relative earnings of husbands and wives. The chapter also considers how demographic and health indicators vary by women’s empowerment, as measured by the number of decisions in which the woman participates and the number of reasons for which wife beating is justified. 13.1 EMPLOYMENT AND CASH EARNINGS OF CURRENTLY MARRIED WOMEN AND MEN Employment, particularly employment for cash, and control over how earnings are used are important indicators of empowerment for women. To obtain information on employment, IDHS respondents were asked whether they had done any work for at least one hour continuously in the last seven days, and, if not, whether they were employed at any time during the 12 months preceding the survey. Because they often do not perceive the work they do in family businesses, on the farm, or in jobs in the informal sector as employment, women who said they were not employed in the last seven days were asked a separate question designed to improve reporting of this type of employment. Both women and men were reminded to include any job or business from which they may have been absent for leave, illness, vacation, or other reasons. Table 13.1 shows the percentage of currently married women age 15-49 and men age 15-54 who were employed at any time in the 12 months preceding the survey, and the percent distribution of currently married women and men employed by the type of earnings they received (cash, cash and in-kind, in kind only, and not paid). Sixty-three percent of currently married women age 15-49 and virtually all currently married men age 15-54 (99 percent) reported being employed in the past 12 months. Among currently married women, the percentage employed increased directly with age, from 43 percent among women age 15-19 to 72 percent among women age 45-49. In contrast, employment among currently married men is 98 percent or higher in all age groups. T Key Findings • More than 6 in 10 currently married women and virtually all currently married men were employed in the past 12 months. • The vast majority of currently married women with cash earnings mainly decide alone (65 percent) or jointly (29 percent) with their husbands how the money will be spent, and most currently married women whose husbands have cash earnings say the women mainly decide (41 percent) or decide jointly (46 percent) how his earnings are used. • Just under half of all women age 15-49 own a house and 41 percent of women own land, with the majority sharing ownership with someone else. • More than 8 in 10 currently married women participate in decisions about their own health care, major household decisions, and visits to their family or relatives. • More than 6 in 10 currently married women and more than 8 in 10 men do not agree that a husband is justified in beating his wife for any of five reasons suggested in the IDHS interview. 186 • Women’s Empowerment and Demographic and Health Outcomes Although employment is assumed to go hand in hand with payment for work, not all of the currently married women and men who were employed in the 12 months before the survey received earnings for the work they did. Table 13.1 shows that 69 percent of women were paid in cash, 3 percent received payment in cash and in-kind, 2 percent got only in-kind payment, and 26 percent were not paid. More than nine in ten men were paid in cash or in cash and in-kind earnings for the work they did. Table 13.1 Employment and cash earnings of currently married women and men Percentage of currently married women age 15-49 and men age 15-54 who were employed at any time in the past 12 months and the percent distribution of currently married women and men employed in the past 12 months by type of earnings, according to age, Indonesia 2012 Among currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Total Number Age Percentage employed Number of respondents Cash only Cash and in-kind In-kind only Not paid Missing/don’t know WOMEN 15-19 43.3 890 59.3 0.9 1.3 38.5 0.0 100.0 385 20-24 51.4 3,754 69.5 2.1 0.7 27.6 0.1 100.0 1,930 25-29 58.3 6,000 71.6 2.0 1.4 24.9 0.1 100.0 3,496 30-34 62.0 6,285 71.6 2.5 1.5 24.4 0.1 100.0 3,894 35-39 65.9 6,331 69.9 3.7 1.9 24.4 0.1 100.0 4,171 40-44 71.2 5,572 67.1 3.1 1.5 28.2 0.1 100.0 3,967 45-49 72.0 4,633 64.7 4.6 2.3 28.2 0.2 100.0 3,334 Total 63.3 33,465 68.9 3.0 1.6 26.3 0.1 100.0 21,177 MEN 15-19 (100.0) 28 (85.8) (1.4) (0.0) (12.8) (0.0) (100.0) 28 20-24 98.8 345 90.0 4.1 0.1 5.8 0.0 100.0 341 25-29 99.5 1,127 88.6 4.5 1.0 5.7 0.2 100.0 1,122 30-34 99.9 1,674 88.6 5.0 1.2 5.2 0.0 100.0 1,672 35-39 99.1 1,775 90.0 4.2 1.7 4.1 0.0 100.0 1,759 40-44 99.6 1,693 84.7 7.5 2.1 5.6 0.0 100.0 1,686 45-49 99.4 1,371 84.4 5.3 1.4 8.9 0.0 100.0 1,363 50-54 98.0 1,292 82.3 8.5 2.1 7.0 0.1 100.0 1,266 Total 99.2 9,306 86.7 5.7 1.5 6.0 0.0 100.0 9,236 Note: Figures in parentheses are based on 25-49 unweighted cases. 13.2 CONTROL OVER EARNINGS 13.2.1 Control over and Relative Magnitude of Women’s Earnings Control over cash earnings is another dimension of empowerment. Currently married women who earn cash for their work were asked who the main decision-maker was regarding the use of their earnings. They were also asked about the relative magnitude of their earnings compared with their husband’s earnings. This information provides insight into women’s empowerment within the family and the extent of their control over resources. Table 13.2.1 shows the percent distribution of currently married women 15-49 who received cash earnings in the past 12 months, according to the person who controls their earnings and their perception of the magnitude of their earnings relative to those of their husband. More than nine in ten women who earn cash either decide alone (65 percent) or jointly with their husband (29 percent) how their cash earnings will be spent. Considering the relative magnitude of their earnings, most currently married women earn less, (60 percent), 19 percent earn about the same amount, and only 16 percent earn more than their husbands. Neither the proportion of women who decided alone or jointly with their husband how their earnings were spent, nor the relative magnitude of the woman’s earnings, varies markedly by background characteristics. Women’s Empowerment and Demographic and Health Outcomes • 187 Table 13.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings: Women Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife’s cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Indonesia 2012 Person who decides how the wife’s cash earnings are used: Total Wife’s cash earnings compared with husband’s cash earnings: Total Number of women Background characteristic Mainly wife Wife and husband jointly Mainly husband Other Missing More Less About the same Husband has no earnings Don’t know/ Missing Age 15-19 67.9 22.9 4.5 1.9 2.9 100.0 9.3 59.3 17.3 3.3 10.7 100.0 232 20-24 66.9 27.4 4.7 0.8 0.2 100.0 15.4 63.8 18.1 1.1 1.6 100.0 1,382 25-29 63.1 29.8 5.9 0.1 1.2 100.0 15.1 62.6 18.6 0.9 2.9 100.0 2,571 30-34 65.2 29.1 5.2 0.0 0.5 100.0 15.0 64.2 17.3 1.1 2.5 100.0 2,884 35-39 66.4 28.9 4.0 0.1 0.5 100.0 15.5 61.1 19.8 1.4 2.2 100.0 3,071 40-44 66.8 26.5 6.1 0.0 0.6 100.0 16.7 57.9 21.4 1.7 2.3 100.0 2,783 45-49 63.6 29.1 6.1 0.0 1.2 100.0 20.3 52.3 20.3 3.4 3.7 100.0 2,310 Number of living children 0 62.6 30.2 5.6 0.4 1.1 100.0 20.3 52.0 21.8 1.4 4.5 100.0 1,457 1-2 65.6 28.6 5.0 0.1 0.7 100.0 15.0 62.6 18.6 1.4 2.4 100.0 9,300 3-4 66.0 27.6 5.7 0.1 0.6 100.0 17.0 60.0 18.9 1.8 2.3 100.0 3,679 5+ 64.3 27.5 7.1 0.0 1.1 100.0 18.8 48.9 24.4 3.8 4.0 100.0 798 Residence Urban 68.7 25.8 4.9 0.1 0.4 100.0 17.7 59.2 18.9 2.0 2.3 100.0 8,484 Rural 61.0 31.8 5.8 0.2 1.2 100.0 14.3 61.5 19.8 1.1 3.2 100.0 6,749 Education No education 71.5 19.5 7.6 0.0 1.4 100.0 12.5 55.0 26.4 2.1 4.0 100.0 540 Some primary 65.1 28.4 5.5 0.3 0.7 100.0 15.5 57.4 22.0 2.4 2.6 100.0 1,846 Completed primary 63.8 29.4 5.7 0.1 1.1 100.0 13.0 62.1 19.8 2.0 3.1 100.0 3,734 Some secondary 68.1 26.1 4.9 0.3 0.6 100.0 13.1 63.2 19.0 1.8 2.9 100.0 3,165 Completed secondary 66.6 27.9 4.4 0.2 0.9 100.0 17.3 60.3 18.4 1.3 2.8 100.0 3,403 More than secondary 61.3 32.7 5.9 0.0 0.1 100.0 24.4 57.0 16.7 0.5 1.4 100.0 2,544 Wealth quintile Lowest 61.3 31.1 6.5 0.1 1.0 100.0 11.0 60.1 22.9 2.2 3.7 100.0 2,119 Second 63.6 29.2 6.4 0.1 0.8 100.0 14.5 64.2 16.7 1.8 2.9 100.0 2,830 Middle 64.5 29.6 5.1 0.3 0.5 100.0 16.6 60.2 18.8 1.9 2.4 100.0 3,070 Fourth 67.3 26.5 5.1 0.1 1.0 100.0 17.9 57.5 20.6 1.4 2.6 100.0 3,551 Highest 67.8 27.4 4.1 0.1 0.6 100.0 18.4 60.0 18.4 1.0 2.2 100.0 3,663 Total 65.3 28.5 5.3 0.1 0.8 100.0 16.2 60.2 19.3 1.6 2.7 100.0 15,233 Appendix Table A.13.1.1 presents information on the control over women's cash earnings and relative magnitude of women's cash earnings by province. 13.2.2 Control over Men’s Earnings Table 13.2.2 shows the percentage of currently married men age 15-54 with cash earnings by the person they report as deciding how those earnings are used. Around nine in ten men with cash earnings either say their wives are the main decision makers about the use of their earnings (45 percent) or report they make these decisions jointly with their wives (42 percent). Table 13.2.2 also shows women’s responses to a question about who makes the decisions about how their husband’s earnings are spent. As is the case with men, nearly 90 percent of currently married women age 15-49 whose husbands have earnings say that they either mainly decide (41 percent) or decide jointly with their husbands (46 percent) about the use of his earnings. Only 12 percent say that their husband mainly makes these decisions. Generally, the differences by background characteristics in Table 13.2.2 are not large. 188 • Women’s Empowerment and Demographic and Health Outcomes Table 13.2.2 Control over men’s cash earnings Percent distributions of currently married men age 15-54 who receive cash earnings and of currently married women age 15-49 whose husbands receive cash earnings, by person who decides how husband’s cash earnings are used, according to background characteristics, Indonesia 2012 Background characteristic Men Women Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number Age 15-19 36.3 55.2 8.4 0.0 0.0 100.0 24 40.3 45.8 13.1 0.5 0.3 100.0 878 20-24 40.2 47.9 11.8 0.1 0.0 100.0 320 41.8 46.3 11.7 0.2 0.1 100.0 3,730 25-29 42.1 44.3 13.6 0.0 0.0 100.0 1,045 41.1 46.7 11.7 0.2 0.2 100.0 5,966 30-34 42.6 44.9 12.4 0.0 0.1 100.0 1,565 40.8 48.1 10.9 0.0 0.1 100.0 6,228 35-39 43.7 41.6 14.5 0.0 0.1 100.0 1,657 42.9 45.4 11.5 0.0 0.1 100.0 6,285 40-44 45.0 42.5 12.1 0.0 0.4 100.0 1,555 42.5 44.4 13.0 0.0 0.1 100.0 5,509 45-49 47.5 40.1 11.8 0.2 0.4 100.0 1,222 39.3 47.0 13.4 0.2 0.1 100.0 4,522 50-54 47.7 37.8 13.9 0.4 0.2 100.0 1,149 na na na na na na 0 Number of living children 0 34.8 50.1 14.6 0.0 0.5 100.0 663 39.4 46.9 13.0 0.5 0.2 100.0 2,698 1-2 45.0 42.3 12.4 0.1 0.1 100.0 5,140 41.3 47.0 11.4 0.1 0.1 100.0 20,059 3-4 46.2 40.0 13.6 0.0 0.2 100.0 2,213 42.5 44.7 12.7 0.0 0.1 100.0 8,386 5+ 44.7 41.1 13.9 0.0 0.3 100.0 523 40.8 45.2 13.8 0.1 0.1 100.0 1,975 Residence Urban 45.5 41.0 13.3 0.1 0.0 100.0 4,510 44.7 43.3 11.7 0.1 0.1 100.0 16,250 Rural 43.3 43.6 12.6 0.1 0.4 100.0 4,028 38.3 49.2 12.3 0.1 0.1 100.0 16,868 Education No education 58.3 25.4 15.9 0.0 0.4 100.0 230 47.8 36.6 15.5 0.1 0.1 100.0 1,184 Some primary 48.7 36.7 14.0 0.6 0.1 100.0 1,206 43.1 42.0 14.2 0.4 0.2 100.0 4,133 Completed primary 44.3 42.5 13.0 0.0 0.3 100.0 1,900 40.8 46.1 12.9 0.1 0.1 100.0 8,930 Some secondary 42.5 44.0 13.3 0.0 0.2 100.0 1,818 42.8 46.1 11.0 0.1 0.1 100.0 7,838 Completed secondary 46.0 42.4 11.6 0.0 0.1 100.0 2,304 41.1 47.7 11.1 0.1 0.1 100.0 7,693 More than secondary 37.4 48.5 13.8 0.0 0.4 100.0 1,080 36.7 53.0 10.3 0.0 0.1 100.0 3,338 Wealth quintile Lowest 43.8 42.2 13.8 0.0 0.2 100.0 1,349 39.9 47.6 12.2 0.1 0.1 100.0 5,894 Second 48.2 41.8 9.6 0.2 0.3 100.0 1,701 40.6 46.6 12.5 0.1 0.2 100.0 6,546 Middle 43.8 40.7 15.1 0.2 0.1 100.0 1,857 42.0 45.7 12.1 0.1 0.1 100.0 6,770 Fourth 45.6 40.2 14.0 0.0 0.2 100.0 1,826 43.6 44.1 11.9 0.2 0.2 100.0 7,158 Highest 41.0 46.4 12.4 0.0 0.2 100.0 1,805 40.7 47.8 11.3 0.1 0.1 100.0 6,750 Total 44.5 42.3 13.0 0.1 0.2 100.0 8,538 41.4 46.3 12.0 0.1 0.1 100.0 33,118 na = Not applicable Appendix Table A.13.1.2 shows the results with respect to control over men’s cash earnings by province. 13.2.3 Women’s Control over Their Own Earnings and over Those of Their Husbands Information from the IDHS can be used to look at the question of whether the level of women’s earnings relative to their husbands’ earnings is associated with women’s control over their own and their husbands’ earnings. Table 13.3 shows that regardless of whether they earn more, less, or the same as the husband, around nine in ten currently married women who earn cash say they either decide on their own or jointly with their husband how their earnings are used. Similarly, regardless of the relative magnitude of a woman’s earnings compared with those of her husband, close to 90 percent of currently married women whose husbands have cash earnings say they either usually decide themselves or jointly with their husband how his earnings are used. Women’s Empowerment and Demographic and Health Outcomes • 189 Table 13.3 Women’s control over their own earnings and over those of their husbands Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife’s cash earnings are used and percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband’s cash earnings are used, according to the relation between wife’s and husband’s cash earnings, Indonesia 2012 Women’s earnings relative to husband’s earnings Person who decides how the wife’s cash earnings are used: Total Number Person who decides how husband’s cash earnings are used: Total Number of women Mainly wife Wife and husband jointly Mainly husband Other Missing Mainly wife Wife and husband jointly Mainly husband Other Missing More than husband 67.5 26.0 6.1 0.4 0.0 100.0 2,464 47.6 39.7 12.6 0.0 0.1 100.0 2,464 Less than husband 68.7 26.5 4.7 0.1 0.0 100.0 9,178 40.9 48.0 11.1 0.0 0.0 100.0 9,178 Same as husband 54.4 38.6 6.9 0.0 0.0 100.0 2,940 35.9 53.2 10.8 0.0 0.0 100.0 2,940 Husband has no cash earnings or did not work 78.1 20.0 1.8 0.0 0.0 100.0 243 na na na na na na 0 Woman worked but has no cash earnings na na na na na na 0 36.2 50.0 13.5 0.2 0.1 100.0 5,919 Woman did not work na na na na na na 0 44.9 42.8 12.0 0.1 0.1 100.0 12,209 Don’t know/missing 47.6 19.6 4.5 0.5 27.8 100.0 409 29.1 48.1 16.7 1.9 4.1 100.0 409 Total1 65.3 28.5 5.3 0.1 0.8 100.0 15,233 41.4 46.3 12.0 0.1 0.1 100.0 33,118 na = Not applicable 1 Includes cases where a woman does not know whether she earned more or less than her husband 13.3 WOMEN’S AND MEN’S OWNERSHIP OF ASSETS Ownership of assets, particularly high-value assets, has many beneficial effects for households, including protection against financial ruin. From a woman’s perspective, individual ownership of assets enables their economic empowerment and provides protection in the case of marital dissolution or abandonment. The 2012 IDHS collected information on women’s and men’s ownership (alone, jointly, and alone and jointly) of two high-value assets, namely, land and a house. Table 13.4.1 shows that just under half of all women age 15-49 own a house, with the majority sharing ownership with someone else. The proportion owning land is somewhat lower; 41 percent of women own land, either alone or jointly with someone else. The likelihood that a woman owns a house or land is directly associated with her age. Rural women are more likely than urban women to own both a house and land. The percentage owning both assets is highest among women with no or only some primary education. Women’s ownership of these assets does not vary consistently with the wealth quintile. 190 • Women’s Empowerment and Demographic and Health Outcomes Table 13.4.1 Ownership of assets: Women Percent distribution of women age 15-49 by ownership of housing and land, according to background characteristics, Indonesia 2012 Percentage who own a house: Total Percentage who own land: Total Number Background characteristic Alone Jointly Alone and jointly Percent- age who do not own a house Missing Alone Jointly Alone and jointly Percent- age who do not own land Missing Age 15-19 1.2 4.0 0.4 94.3 0.0 100.0 1.6 2.9 0.3 95.1 0.1 100.0 6,927 20-24 4.2 14.8 1.3 79.7 0.1 100.0 5.0 12.1 1.2 81.5 0.1 100.0 6,305 25-29 10.9 28.7 2.4 57.8 0.2 100.0 11.8 23.0 2.1 62.9 0.1 100.0 6,959 30-34 14.5 41.0 3.3 41.2 0.0 100.0 13.3 32.8 2.6 51.2 0.3 100.0 6,876 35-39 17.4 47.3 3.9 31.2 0.1 100.0 16.4 36.8 3.7 43.0 0.1 100.0 6,882 40-44 23.5 50.0 3.8 22.6 0.1 100.0 20.7 39.1 3.7 36.5 0.1 100.0 6,252 45-49 24.3 51.8 4.8 19.1 0.1 100.0 20.6 40.1 4.6 34.4 0.3 100.0 5,407 Residence Urban 12.9 27.7 2.9 56.4 0.1 100.0 11.4 21.3 2.3 64.9 0.2 100.0 23,805 Rural 13.8 39.4 2.7 44.0 0.1 100.0 13.6 31.6 2.8 51.8 0.1 100.0 21,802 Education No education 21.8 46.1 4.5 27.5 0.0 100.0 16.4 37.1 3.9 42.4 0.2 100.0 1,500 Some primary 20.5 47.1 3.5 28.8 0.1 100.0 16.8 36.8 3.4 43.0 0.1 100.0 4,870 Completed primary 17.1 44.4 2.9 35.5 0.1 100.0 15.9 32.6 2.5 48.8 0.2 100.0 10,254 Some secondary 9.7 26.4 2.3 61.6 0.0 100.0 9.5 21.2 2.2 67.0 0.1 100.0 12,753 Completed secondary 10.8 26.7 2.6 59.8 0.1 100.0 10.5 21.8 2.3 65.2 0.1 100.0 10,677 More than secondary 11.1 26.2 2.8 59.7 0.2 100.0 12.0 22.2 2.8 62.7 0.3 100.0 5,552 Wealth quintile Lowest 13.1 38.1 2.6 46.1 0.1 100.0 11.5 29.6 2.6 56.1 0.2 100.0 7,767 Second 13.3 32.8 2.1 51.8 0.1 100.0 12.6 25.1 2.1 60.1 0.1 100.0 8,784 Middle 12.2 32.0 2.9 52.9 0.0 100.0 12.2 24.5 2.1 61.2 0.0 100.0 9,243 Fourth 13.0 30.6 2.7 53.6 0.1 100.0 11.7 24.0 2.7 61.6 0.1 100.0 9,743 Highest 15.0 34.0 3.5 47.3 0.2 100.0 14.3 28.4 3.1 53.9 0.3 100.0 10,071 Total 13.3 33.3 2.8 50.4 0.1 100.0 12.5 26.2 2.5 58.6 0.1 100.0 45,607 As shown in Table 13.4.2, 68 percent of currently married men age 15-54 own a house, with around half sharing ownership jointly with someone else. As was the situation among all women age 15-49, currently married men are somewhat less likely to own land than a house; 58 percent say they own land, with around half reporting that they own the land jointly with someone else. Again similar to what is observed among all women, currently married men’s ownership of both assets increases markedly with age, is somewhat more common among rural than urban residents, and is much higher among those with less than a primary education than among those with more education. Women’s Empowerment and Demographic and Health Outcomes • 191 Table 13.4.2 Ownership of assets: Men Percent distribution of men age 15-54 by ownership of housing and land, according to background characteristics, Indonesia 2012 Percentage who own a house: Total Percentage who own land: Total Number Background characteristic Alone Jointly Alone and jointly Percent- age who do not own a house Missing Alone Jointly Alone and jointly Percent- age who do not own land Missing Age 15-19 (7.9) (1.7) (5.1) (85.2) 0.0 100.0 (16.4) (3.8) (5.1) (74.7) (0.0) 100.0 28 20-24 11.4 13.7 0.9 73.9 0.0 100.0 11.2 11.4 1.1 76.3 0.0 100.0 345 25-29 19.5 17.2 1.2 62.0 0.1 100.0 18.8 15.2 0.6 65.1 0.2 100.0 1,127 30-34 24.7 24.4 1.7 49.0 0.2 100.0 21.0 21.3 1.3 56.2 0.2 100.0 1,674 35-39 34.9 34.9 1.4 28.7 0.1 100.0 28.5 29.2 1.2 40.4 0.6 100.0 1,775 40-44 37.4 39.6 2.6 20.2 0.1 100.0 31.4 34.3 3.3 31.0 0.0 100.0 1,693 45-49 40.3 43.6 1.7 14.1 0.3 100.0 35.5 34.5 1.3 28.5 0.2 100.0 1,371 50-54 38.8 47.6 3.7 9.6 0.4 100.0 33.3 39.0 3.0 24.2 0.5 100.0 1,292 Residence Urban 26.3 34.5 1.5 37.5 0.2 100.0 21.6 28.7 1.3 48.2 0.2 100.0 4,739 Rural 38.1 33.2 2.5 26.0 0.2 100.0 33.7 28.2 2.3 35.5 0.3 100.0 4,567 Education No education 41.1 39.3 3.3 15.0 1.3 100.0 31.5 30.2 4.9 32.1 1.4 100.0 265 Some primary 39.8 42.8 2.3 14.9 0.2 100.0 34.2 31.1 1.8 32.7 0.2 100.0 1,371 Completed primary 35.6 34.7 2.2 27.3 0.3 100.0 29.0 29.7 1.3 39.9 0.1 100.0 2,118 Some secondary 26.0 31.5 2.0 40.2 0.2 100.0 23.8 26.1 2.0 47.6 0.4 100.0 1,979 Completed secondary 27.1 29.4 1.4 42.0 0.1 100.0 23.6 26.2 1.3 48.7 0.2 100.0 2,453 More than secondary 35.3 34.0 2.4 28.3 0.0 100.0 31.0 31.4 2.6 34.7 0.2 100.0 1,119 Wealth quintile Lowest 40.8 28.9 2.7 27.2 0.3 100.0 36.1 23.8 2.1 37.9 0.1 100.0 1,596 Second 33.0 29.5 2.2 35.1 0.2 100.0 28.8 24.0 1.4 45.6 0.2 100.0 1,866 Middle 30.7 33.6 1.5 34.0 0.2 100.0 26.4 28.7 1.7 43.1 0.1 100.0 2,008 Fourth 26.3 35.4 1.8 36.4 0.1 100.0 21.5 28.7 1.3 48.0 0.4 100.0 1,962 Highest 31.0 41.1 2.0 25.7 0.2 100.0 26.5 36.2 2.6 34.2 0.5 100.0 1,875 Total 32.0 33.9 2.0 31.9 0.2 100.0 27.5 28.4 1.8 42.0 0.3 100.0 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. Appendix Tables A.13.2.1 and A.13.2.2 present information on asset ownership among women and men by province. 13.4 PARTICIPATION IN DECISION MAKING The 2012 IDHS included a number of questions designed to provide an understanding of gender differences in household decision making. Information was collected from women about participation in decisions about their own health care, major household purchases, and visits to their family or relatives. Currently married men were asked about participation in making decisions about their own health care and major household purchases. For women, the ability to make decisions that affect the personal circumstances of their own lives is an essential aspect of empowerment and serves as an important contributor to their overall welfare. Table 13.5 shows that more than 8 in 10 currently married women age 15-49 participate in decisions about their own health care (83 percent), major household purchases (82 percent), and visits to their family or relatives (86 percent). The percentage of women saying they mainly make the decisions is highest in the case of health care (34 percent) and lowest in the case of family visits (14 percent). The total number of decisions in which a woman is involved provides a measure of the degree of control women are able to exercise in areas that affect their lives and environments and is positively related to women’s empowerment. Figure 13.1 shows the distribution of women by the number of decisions in which they participate alone or jointly with their husband. Only a small percentage of women are not involved in 192 • Women’s Empowerment and Demographic and Health Outcomes making any of the decisions for which information was collected in the IDHS. Seven in 10 women were involved in all three of the decisions. Figure 13.1 Number of decisions in which currently married women participate With respect to men’s participation in household decision making, Table 13.5 shows that the majority of currently married men decide about their own health care or about major purchases alone or jointly with their wives (71 percent and 77 percent, respectively). Currently married men are somewhat more likely to say that their wives mainly make decisions with respect to the man’s health care and major household purchases than currently married women were to say their husbands mainly made these types of decisions. For example, 28 percent of men say the wife mainly makes the decisions about the man’s health care while only 16 percent of women said their husbands mainly made decisions about the woman’s health care. Table 13.5 Participation in decision making Percent distribution of currently married women age 15-49 and currently married men age 15-54 by person who usually makes decisions about various issues, Indonesia 2012 Decision Mainly wife Wife and husband jointly Mainly husband Someone else Other Missing Total Number of women WOMEN Own health care 34.0 49.3 16.2 0.2 0.2 0.1 100.0 33,465 Major household purchases 19.4 62.3 17.5 0.3 0.2 0.2 100.0 33,465 Visits to her family or relatives 13.8 72.1 13.7 0.1 0.1 0.2 100.0 33,465 MEN Own health care 28.1 45.3 26.0 0.4 0.1 0.1 100.0 8,014 Major household purchases 23.1 62.7 13.8 0.3 0.0 0.0 100.0 8,014 6 7 16 70 0 1 2 3 Number of decisions Percent of women IDHS 2012 Women’s Empowerment and Demographic and Health Outcomes • 193 Table 13.6.1 considers how women’s participation in decision making varies by background characteristics. The table shows the percentage of currently married women age 15-49 participating in each of the three specific types of decisions, the percentage involved in making all three decisions, and the percentage not involved in making any of the three decisions. The percentages reporting participation in all decisions is highest among women with more than secondary education (77 percent) and women in the highest wealth quintile (75 percent). Women in these categories also are least likely to report that they do not participate in any of the decisions (4 percent each). Table 13.6.1 Women’s participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Indonesia 2012 Specific decisions Percentage who participate in all three decisions Percentage who participate in none of the three decisions Number of women Background characteristic Woman’s own health care Making major household purchases Visits to her family or relatives Age 15-19 75.9 80.0 80.9 62.6 8.7 890 20-24 81.4 80.0 83.9 67.6 7.0 3,754 25-29 83.7 82.8 85.5 71.0 5.4 6,000 30-34 84.8 82.3 85.9 70.4 5.1 6,285 35-39 84.2 83.4 87.3 72.7 5.7 6,331 40-44 83.6 80.4 86.4 70.3 6.0 5,572 45-49 82.2 80.6 86.7 69.8 6.5 4,633 Employment (last 12 months) Not employed 82.3 80.5 85.0 69.2 6.5 12,281 Employed for cash 85.0 83.5 87.0 72.6 5.3 15,233 Employed not for cash 81.1 79.9 85.2 66.8 6.3 5,920 Number of living children 0 80.8 82.6 86.6 70.5 6.5 2,737 1-2 83.6 82.2 86.2 70.7 5.6 20,236 3-4 83.8 80.9 85.6 70.1 6.3 8,474 5+ 82.0 79.5 83.5 67.5 7.2 2,019 Residence Urban 85.4 83.1 87.2 72.4 4.9 16,466 Rural 81.3 80.4 84.8 68.3 6.9 16,999 Education No education 80.6 77.7 83.8 67.2 8.7 1,209 Some primary 79.0 78.2 82.2 65.3 8.7 4,185 Completed primary 82.2 80.3 84.8 68.0 6.3 9,045 Some secondary 83.3 82.3 86.1 70.2 5.4 7,912 Completed secondary 85.2 83.3 87.7 73.3 5.1 7,760 More than secondary 88.4 86.5 90.2 77.4 3.6 3,353 Wealth quintile Lowest 80.0 79.1 82.4 66.5 7.9 5,966 Second 81.4 79.9 84.5 67.8 7.0 6,614 Middle 84.3 82.7 85.6 71.0 5.7 6,864 Fourth 83.4 82.8 86.9 71.2 5.6 7,218 Highest 87.0 83.7 89.8 74.5 3.6 6,803 Total 83.3 81.7 85.9 70.3 5.9 33,465 Note: Total includes 30 women for whom information on employment was missing. 194 • Women’s Empowerment and Demographic and Health Outcomes Table 13.6.2 shows that currently married men’s participation (alone or jointly) in the two specific types of decisions (health care and major household purchases) as well as in both and in neither of the two decisions by background characteristics. The table shows 59 percent of currently married men participate in both of these decisions, and 12 percent do not participate in either decision. Participation in both decisions is highest among men with more than secondary education while men who are not employed and those with no education are most likely not to participate in either decision. Table 13.6.2 Men’s participation in decision making by background characteristics Percentage of currently married men age 15-49 who usually make specific decisions either alone or jointly with their wife, by background characteristics, Indonesia 2012 Background characteristic Specific decision Both decisions Neither of the two decisions Number of men Man’s own health Making major household purchases Age 15-19 76.2 54.5 48.4 17.8 28 20-24 72.7 75.5 59.9 11.7 345 25-29 70.8 76.9 59.7 12.0 1,127 30-34 71.6 77.8 59.8 10.4 1,674 35-39 74.2 75.8 61.0 11.0 1,775 40-44 70.5 78.4 59.2 10.3 1,693 45-49 67.9 74.0 55.8 13.9 1,371 50-54 67.7 74.1 57.8 16.0 1,292 Employment (last 12 months) Not employed 63.8 62.4 50.4 24.1 70 Employed for cash 69.9 76.2 58.2 12.1 8,538 Employed not for cash 82.4 77.2 69.9 10.3 694 Number of living children 0 75.5 79.2 64.4 9.6 738 1-2 70.3 76.7 58.7 11.7 5,517 3-4 71.8 75.4 59.7 12.5 2,453 5+ 65.2 71.5 53.2 16.4 598 Residence Urban 70.6 75.7 58.7 12.3 4,739 Rural 71.0 76.7 59.4 11.7 4,567 Education No education 63.3 67.1 51.4 21.0 265 Some primary 63.5 71.2 51.2 16.4 1,371 Completed primary 68.5 75.8 56.8 12.4 2,118 Some secondary 73.4 77.7 62.4 11.3 1,979 Completed secondary 72.4 76.8 60.1 10.9 2,453 More than secondary 77.6 81.1 66.3 7.5 1,119 Wealth quintile Lowest 69.3 71.8 55.8 14.7 1,596 Second 67.3 73.9 55.4 14.3 1,866 Middle 71.6 75.6 58.9 11.6 2,008 Fourth 72.0 79.2 62.6 11.4 1,962 Highest 73.4 79.7 61.9 8.8 1,875 Total 70.8 76.2 59.0 12.0 9,306 Note: Total includes four men for whom information on employment was missing. Figures in parentheses are based on 25-49 unweighted cases. Appendix Tables A.13.3.1 and A.13.3.2 show women’s and men's participation in decision making by province. Women’s Empowerment and Demographic and Health Outcomes • 195 13.5 ATTITUDE TOWARD WIFE BEATING The 2012 IDHS collected information from women and currently married men on situations in which they considered it acceptable for a husband to beat his wife. Table 13.7.1 shows the percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics. The most widely accepted reason for wife beating is the wife’s neglect of the children (27 percent), followed by the wife going out without telling her husband (24 percent). Less than one- tenth of women (9 percent) agree that a wife’s refusal to have sexual intercourse is a justifiable reason for wife beating. Six percent of women agree that arguing with her husband is an acceptable reason for a man to beat his wife, and 3 percent of women agree that a husband is justified in beating his wife if she burns the food. Overall, one-third of all women age 15-49 agree that a husband is justified in beating his wife for at least one of these reasons. Table 13.7.1 Attitude toward wife beating: Women Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Indonesia 2012 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 3.2 7.3 27.5 36.8 10.6 44.9 6,927 20-24 2.9 6.5 26.3 31.6 9.9 39.3 6,305 25-29 2.0 5.4 25.3 29.5 8.8 36.1 6,959 30-34 2.2 4.8 24.3 25.8 8.7 32.8 6,876 35-39 2.1 5.2 22.0 23.4 8.3 30.3 6,882 40-44 2.7 4.8 21.9 22.4 8.3 29.4 6,252 45-49 2.9 5.7 20.1 19.7 7.7 26.6 5,407 Employment (last 12 months) Not employed 2.4 5.7 24.7 28.9 8.7 36.3 17,715 Employed for cash 2.2 4.8 22.2 25.2 8.5 31.9 20,855 Employed not for cash 4.0 8.4 28.2 29.5 11.0 37.8 6,984 Number of living children 0 2.7 6.1 23.4 30.2 9.1 37.6 12,896 1-2 2.2 4.9 24.1 26.9 8.5 33.8 21,465 3-4 2.8 6.2 24.6 24.8 9.4 31.9 9,053 5+ 4.4 8.2 25.4 24.3 10.3 33.5 2,193 Marital status Never married 2.7 6.2 23.0 31.2 9.0 38.5 9,919 Married or living together 2.5 5.4 24.3 26.4 8.8 33.5 33,465 Divorced/separated/widowed 3.3 7.2 23.9 23.9 11.2 30.9 2,223 Residence Urban 1.3 3.7 19.3 23.8 6.6 29.8 23,805 Rural 4.0 7.8 29.2 31.0 11.4 39.5 21,802 Education No education 3.8 9.2 19.8 19.9 8.4 26.6 1,500 Some primary 4.8 8.0 25.4 25.7 10.5 33.3 4,870 Completed primary 3.5 6.6 27.6 28.1 11.1 36.5 10,254 Some secondary 2.5 6.3 27.5 32.4 9.3 40.1 12,753 Completed secondary 1.5 3.9 21.4 25.3 7.4 32.1 10,677 More than secondary 0.7 2.9 14.7 21.1 5.9 25.5 5,552 Wealth quintile Lowest 5.9 11.1 32.2 33.7 12.7 42.2 7,767 Second 3.2 7.0 28.2 30.0 11.0 38.2 8,784 Middle 2.4 5.5 24.4 28.0 9.6 35.4 9,243 Fourth 1.2 3.4 19.9 24.5 6.7 31.3 9,743 Highest 0.8 2.7 17.8 21.9 5.8 27.5 10,071 Total 2.5 5.7 24.0 27.3 8.9 34.5 45,607 Note: Total includes 53 women for whom information on employment was missing. 196 • Women’s Empowerment and Demographic and Health Outcomes A woman’s age and wealth quintile are the background characteristics most strongly associated with the level of acceptance of wife beating. For example, the proportion of women who believe that a husband is justified in beating his wife for at least one of the reasons shown in Table 13.7.1 decreases as the woman’s age increases, from 45 percent among women age 15-19 to 27 percent among women age 45-49. Similarly, the level of agreement with wife beating in at least one of the situations declines among women as the wealth quintile increases, from 42 percent in the lowest quintile to 28 percent in the highest quintile. Urban women are uniformly less likely than rural women to agree that wife beating is justified in any of the situations. Table 13.7.2 presents information on the level of acceptance of wife beating in the various situations among currently married men. Overall, men seem to be less accepting of wife beating than women. Only 17 percent of currently married men age 15-54 agree that a husband is justified in beating his wife in at least one of the situations shown in the table compared with 34 percent of currently married women age 15-49 (Table 13.7.1). Like women, men are most likely to agree that wife beating is justified if the woman neglects the children or goes out without telling the husband (12 percent each). Also similar to the pattern among women is the percentage agreeing that wife beating is acceptable in various situations that are negatively associated with a man’s age and wealth quintile and are higher among rural than urban men. Table 13.7.2 Attitude toward wife beating: Men Percentage of all men age 15-54 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Indonesia 2012 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 0.0 7.3 26.3 29.1 12.1 48.4 28 20-24 0.8 4.2 11.3 17.5 3.0 22.9 345 25-29 0.2 5.7 14.6 16.5 3.8 22.6 1,127 30-34 1.3 3.3 11.2 13.9 3.2 18.4 1,674 35-39 1.1 3.0 13.5 13.1 3.5 19.5 1,775 40-44 0.6 2.7 12.2 10.4 3.3 16.4 1,693 45-49 0.9 2.7 10.0 8.1 1.9 13.5 1,371 50-54 0.8 3.3 9.0 7.5 2.9 11.3 1,292 Employment (last 12 months) Not employed 0.0 4.6 2.3 3.8 2.6 6.3 70 Employed for cash 0.8 3.2 11.6 11.9 3.0 17.2 8,538 Employed not for cash 1.3 5.6 14.7 11.7 4.6 20.0 694 Number of living children 0 0.4 3.0 10.2 11.3 1.8 16.1 738 1-2 0.8 3.1 11.8 12.3 3.3 17.8 5,517 3-4 1.0 3.6 12.0 11.1 3.3 16.5 2,453 5+ 0.8 5.5 12.7 12.2 3.1 18.0 598 Residence Urban 0.5 2.0 10.2 9.9 1.9 14.7 4,739 Rural 1.3 4.8 13.4 14.0 4.4 20.0 4,567 Education No education 2.1 8.1 11.5 12.8 5.7 17.2 265 Some primary 1.6 5.3 13.2 13.3 5.1 19.4 1,371 Completed primary 1.1 3.2 13.4 11.6 3.3 18.0 2,118 Some secondary 0.5 3.1 13.0 13.6 2.8 19.1 1,979 Completed secondary 0.7 2.6 10.5 11.5 2.8 16.6 2,453 More than secondary 0.2 2.3 7.8 8.2 1.0 11.8 1,119 Wealth quintile Lowest 1.9 7.4 15.4 15.5 5.4 22.8 1,596 Second 0.8 4.0 13.8 14.4 3.7 19.9 1,866 Middle 0.6 2.9 12.5 12.5 3.1 18.2 2,008 Fourth 0.4 1.7 9.4 9.7 1.7 14.4 1,962 Highest 0.7 1.6 8.5 7.8 2.2 12.1 1,875 Total 0.8 3.4 11.8 11.9 3.1 17.3 9,306 Note: Total includes four men for whom information on employment was missing. Figures in parentheses are based on 25-49 unweighted cases. Women’s Empowerment and Demographic and Health Outcomes • 197 Appendix Tables A. 13.4.1 and A.13.4.2 show wife beating attitudes among women and men by province. 13.6 INDICATORS OF WOMEN’S EMPOWERMENT Women’s empowerment has important implications for demographic and health outcomes, including women’s use of family planning and maternal health care services. Two summary indices of women’s empowerment were used to assess the relationship of selected demographic and health outcomes with women’s empowerment. The first index is the number of decisions that currently married women participate in alone or jointly (see Table 13.6.1 for the list of decisions). This index ranges from 0 (participates in none of the three decisions asked about) to 3 (participates in all three decisions). It reflects the degree of control women are able to exercise over their lives and, thus, a higher score is assumed to be related to a greater level of empowerment. The second index is the number of reasons for which wife-beating is justified (see Table 13.7.1 for a list of the reasons). This index ranges from 0 (agree with none of the reason) to 5 (agree with all five reasons). A low score on the index is considered to be associated with a greater sense of empowerment. Table 13.8 shows how these indices relate to each other. The percentage of women who disagree with all reasons justifying wife beating does not increase with the number of household decisions in which a woman participates as expected; instead, the percentage is the same among women who participate in none of the household decisions (69 percent) and in all three household decisions (69 percent) and slightly lower among women who participate in one or two decisions. The percentage of women who participate in all three household decisions does generally follow the expected pattern and decline as the number of reasons for which wife beating is justified increases; however, the differences between the wife beating index scores are not large, and the percentage of women who participate in all household decisions is slightly higher among women who agree that a man is justified in beating his wife for all five of the reasons than among women who agree it is acceptable in three or four of the situations (65 percent and 63 percent, respectively). Table 13.8 Indicators of women’s empowerment Percentage of currently married women age 15-49 who participate in all decision making and the percentage who disagree with all of the reasons justifying wife-beating, by value on each of the indicators of women’s empowerment, Indonesia 2012 Empowerment indicator Percentage who participate in all decision making Percentage who disagree with all the reasons justifying wife- beating Number of women Number of decisions in which women participate1 0 na 68.8 1,982 1-2 na 59.5 7,951 3 na 68.6 23,532 Number of reasons for which wife-beating is justified2 0 72.6 na 22,245 1-2 66.6 na 8,406 3-4 63.2 na 2,449 5 64.6 na 365 na = Not applicable 1 See Table 13.6.1 for the list of decisions. 2 See Table 13.7.1 for the list of reasons. 198 • Women’s Empowerment and Demographic and Health Outcomes 13.7 WOMEN’S EMPOWERMENT AND HEALTH INDICATORS A woman’s desire and ability to control her fertility, her fertility desires, and her use of health services are likely to be affected by her status in the household, her self-image, and her own sense of empowerment. This section of the report explores how the two indicators of women empowerment constructed from the IDHS data on women’s participation in decision making and women’s attitudes toward wife beating relate to a number of demographic and health measures including a woman’s use of contraception, her desired family size, her use of reproductive health services, and the level of child mortality. Table 13.9 shows the percent distribution of currently married women age 15-49 by the contraceptive method currently used according to the two empowerment indicators. Neither the decision making nor the wife beating index are strongly or consistently related to the level of contraceptive use. For example, the percentage currently using any contraceptive method among women who did not participate in decisions in any of the areas for which the IDHS obtained information is almost the same as the percentage using contraception among women participating in all three decisions (61 percent and 62 percent, respectively). Table 13.9 Current use of contraception by women’s empowerment Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women’s status, Indonesia 2012 Any method Any modern method Modern methods Any traditional method Not currently using Total Number of women Empowerment indicator Female steriliza- tion Male steriliza- tion Temporary modern female methods1 Male condom Number of decisions in which women participate1 0 60.9 58.0 3.5 0.4 53.5 0.7 2.9 39.1 100.0 1,982 1-2 61.7 58.2 3.0 0.0 53.5 1.6 3.5 38.3 100.0 7,951 3 62.0 57.7 3.3 0.2 52.4 1.9 4.3 38.0 100.0 23,532 Number of reasons for which wife-beating is justified2 0 61.2 56.9 3.6 0.2 51.1 1.9 4.3 38.8 100.0 22,245 1-2 63.2 59.8 2.2 0.0 56.0 1.6 3.5 36.8 100.0 8,406 3-4 63.2 60.1 2.6 0.0 56.3 1.2 3.1 36.8 100.0 2,449 5 60.4 56.3 3.6 0.2 52.5 0.0 4.0 39.6 100.0 365 Total 61.9 57.9 3.2 0.2 52.8 1.8 4.0 38.1 100.0 33,465 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUD, injectables, implants, female condom, diaphragm, foam/jelly, and lactational amenorrhea method 2 See Table 13.6.1 for the list of decisions. 3 See Table 13.7.1 for the list of reasons. Table 13.10 looks at how two measures of women’s fertility desires, the mean ideal number of children and the unmet need for spacing and limiting, are related to the women’s status indicators. The mean ideal family size declines with the number of reasons for which wife beating is justified, indicating that, as expected, women who are assessed as more empowered on this measure are more likely to want smaller families than women scoring higher on the index. However, the differences between scores on the wife beating indicator are not large, and the relationship between ideal family size and the participation indicator is not direct. Unmet need is not consistently related to either the participation or wife beating indicators. Women’s Empowerment and Demographic and Health Outcomes • 199 Table 13.10 Women’s empowerment and ideal number of children and unmet need for family planning Mean ideal number of children for women 15-49 and the percentage of currently married women age 155 with an unmet need for family planning, by indicators of women’s empowerment, Indonesia 2012 Mean ideal number of children1 Number of women Percentage of currently married women with an unmet need for family planning2 Number of women Empowerment indicator For spacing For limiting Total Number of decisions in which women participate1 0 2.7 1,803 3.7 3.1 6.8 1,982 1-2 2.7 7,221 3.9 4.7 8.6 7,951 3 2.6 21,548 3.8 4.5 8.3 23,532 Number of reasons for which wife-beating is justified2 0 2.5 27,203 3.5 4.6 8.2 22,245 1-2 2.6 10,950 4.5 4.4 8.9 8,406 3-4 2.8 3,101 4.0 3.5 7.5 2,449 5 2.9 429 3.5 3.3 6.7 365 Total 2.6 41,683 3.8 4.5 8.3 33,465 1 Mean excludes respondents who gave non-numeric responses. 2 See table 7.20 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 13.6.1 for the list of decisions. 4 See Table 13.7.1 for the list of reasons. Table 13.11 examines whether empowered women are more likely to access antenatal, delivery, and postnatal care services from medically trained health personnel. In societies where health care is widespread, women’s empowerment may not affect their access to reproductive health services. In other societies, however, increased empowerment of women is likely to increase their ability to seek out and use health services from qualified health providers to better meet their own reproductive health goals, including the goal of safe motherhood. Table 13.11 Reproductive health care by women’s empowerment Percentage of women age 15-49 with a live birth in the five years preceding the survey who received antenatal care, delivery assistance, and postnatal care from health personnel for the most recent birth, by indicators of women’s empowerment, Indonesia 2012 Empowerment indicator Percentage receiving antenatal care from a skilled provider1 Percentage receiving delivery care from a skilled provider1 Received postnatal care from health personnel within the first two days after delivery2 Number of women with a child born in the last five years Number of decisions in which women participate1 0 91.6 81.9 75.8 830 1-2 95.7 82.7 80.1 3,409 3 96.1 85.2 80.5 10,168 Number of reasons for which wife-beating is justified2 0 95.9 85.8 80.7 9,429 1-2 95.6 83.4 79.2 4,014 3-4 95.2 77.0 77.7 1,182 5 94.3 72.4 72.9 156 Total 95.7 84.3 80.0 14,782 1 “Skilled provider” includes doctor, obstetrician, nurse, midwife, and village midwife. 2 Includes women who received a postnatal checkup from a doctor, nurse, midwife, or village midwife in the first two days after the birth. Includes women who gave birth in a health facility and those who did not give birth in a health facility. 3 Restricted to currently married women. See Table 13.6.1 for the list of decisions. 4 See Table 13.7.1 for the list of reasons. 200 • Women’s Empowerment and Demographic and Health Outcomes The results in Table 13.11 show that women’s empowerment, as expected, is positively associated with women’s access to and use of reproductive health services. For example, the proportion of women receiving delivery care from a skilled provider increases from 82 percent among women who participate in no decisions to 85 percent among women who participate in all three decisions. Women’s wife beating attitudes are also related to their use of all three health services. Compared with women who believe that wife beating is not justified for any reason, women who accept all five reasons for wife beating are less likely to receive antenatal care (94 percent compared with 96 percent for women who agree with no reason), delivery assistance (72 percent compared with 86 percent for women who agree with no reason), and postnatal care within the first two days of delivery from health personnel (81 percent compared with 73 percent). Finally, Table 13.12 shows women’s empowerment is generally negatively related to child mortality rates, although the pattern is not always consistent or very strong. The association is greatest between scores on the wife beating indicator and the level of under-5 mortality, with the rate varying from 41 deaths per 1,000 births among women believing none of the reasons justified beating to 53 per 1,000 among women who accept three or four of the reasons as justifying wife beating. Table 13.12 Early childhood mortality rates by women’s status Infant, child, and under-five mortality rates for the 10-year period preceding the survey, by indicators of women’s empowerment, Indonesia 2012 Empowerment indicator Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Number of decisions in which women participate1 0 34 14 48 1-2 38 9 47 3 31 9 40 Number of reasons for which wife-beating is justified2 0 32 9 41 1-2 35 11 46 3-4 45 9 53 5 23 9 32 1 Restricted to currently married women. See Table 15.6.1 for the list of decisions. 2 See Table 15.7.1 for the list of reasons. Father’s Participation in Family Health Care • 201 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 14 n the 2012 Indonesia Demographic and Health Survey (IDHS), all currently married men age 15-54 living in every third household selected in the sample, were eligible to be interviewed using the Man’s Questionnaire. This questionnaire includes many questions also found in the Woman’s Questionnaire, but it is shorter because it does not contain questions on reproductive history and maternal and child health. Instead, men are asked about their knowledge, attitudes, and practices regarding health care for their wives and children. The chapter presents information on men’s involvement in ensuring safe motherhood for their wives and proper health care for their children. 14.1 ANTENATAL CARE Antenatal check-ups are important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery. Information on antenatal check-up coverage was obtained from men whose youngest child was age 2 or younger at the time of the survey. I Key Findings • The majority of married men (94 percent) said that their wife received an antenatal check-up, and 8 in 10 accompanied their wife to the antenatal check-ups. • Fathers age 20-24 are slightly more likely to discuss preparation for their child’s delivery compared with fathers of other ages (91 percent compared with 87 percent or lower). • Fifty-eight percent of married men talked with a health care provider about their wife’s health during pregnancy • When asked about proper treatment of children with diarrhea, 59 percent of fathers correctly said that children with diarrhea should be given more to drink than usual. • According to the father’s report, the percentages of immunization coverage of last-born children in the past two years are BCG (77 percent), polio (78 percent), DPT (69 percent), measles (62 percent), and hepatitis (63 percent). 202 • Father’s Participation in Family Health Care In the 2012 IDHS, a married man with at least one child born in the preceding two years was asked several questions regarding the pregnancy care of the mother of his most recent child. Table 14.1 shows, by paternal background characteristics, the percentage of births in the two years preceding the survey, according to the father’s report, where the mother received an antenatal check-up, the child was born in a hospital or health facility, and where an antenatal check-up occurred, the father was present. For 94 percent of births, fathers reported that the child’s mother received an antenatal check-up. Sixty-eight percent of the mothers gave birth in a hospital or health facility, and 79 percent of the fathers were present during an antenatal check-up. Table 14.1 Care received by mother during pregnancy Among last births in the two years preceding the survey, and according to a report from the child’s father, the percentage of mothers who received an antenatal checkup, the percentage of births taking place in a hospital or health facility, and among births where the mother received antenatal care, the percentage in which the father was present during the antenatal checkup, according to father’s background characteristics, Indonesia 2012 Mother received antenatal checkup Birth in a hospital or health facility Number of fathers Among births where mothers received an antenatal checkup Background characteristic Father was present in at least one antenatal checkup Number of fathers Age 15-19 * * 18 * 18 20-24 96.4 61.5 181 77.2 174 25-29 93.0 66.2 554 82.7 515 30-34 94.3 68.9 699 79.6 659 35-39 92.4 70.3 530 77.9 489 40-44 94.7 69.0 307 76.1 290 45-49 93.4 67.4 114 67.0 106 50-54 (86.2) (62.2) 44 (62.4) 38 Residence Urban 94.7 80.3 1,272 85.3 1,205 Rural 92.5 54.5 1,173 71.0 1,084 Education No education 63.2 30.6 46 (63.1) 29 Some primary 88.8 49.3 223 63.8 198 Completed primary 94.7 57.5 452 64.4 428 Some secondary 94.1 66.2 645 75.6 607 Completed secondary 95.1 77.8 737 87.7 701 More than secondary 95.6 81.0 342 93.0 327 Wealth quintile Lowest 87.0 36.3 479 61.6 417 Second 95.1 65.8 516 71.7 491 Middle 94.7 72.6 459 81.6 435 Fourth 94.4 78.2 519 84.5 490 Highest 97.0 86.5 471 91.9 457 Total 93.7 67.9 2,445 78.5 2,290 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. The likelihood of receiving an antenatal care check-up declines slightly with the mother’s increasing age. For example, 96 percent of mothers whose husbands are age 20-24 received antenatal care compared with 93 percent of mothers whose husbands are age 45-49. Having an antenatal check-up is strongly related to the father’s level of education. Fathers with more than secondary education are much more likely to say that the mother of their last-born child received an antenatal check-up (96 percent) than fathers with some primary education (89 percent). Similarly, while almost all fathers in the highest wealth quintile say that the mother of their last-born child received an antenatal check-up (97 percent), the corresponding percentage for fathers in the lowest wealth quintile is 87 percent. Father’s Participation in Family Health Care • 203 There are large variations in the likelihood that a child is reported to be born in a health facility. According to the father’s report, births in urban areas are much more likely than those in rural areas to be delivered in a health facility (80 versus 55 percent, respectively). The father’s presence during antenatal care is also more common in urban areas, and increases with the father’s education and wealth status. For example, among fathers in the lowest wealth quintile, 62 percent were present during their child’s antenatal checkup compared with 92 percent of fathers in the highest quintile. Appendix Table A-14.1 shows, by province, according to a report from the child’s father, the percentage of last births in the two years preceding the survey for which the mother received an antenatal check-up. 14.2 PREPARATION FOR DELIVERY For the safety and well-being of mothers and their newborn babies, certain steps need to be taken. These include making decisions on various aspects of the delivery, such as deciding where it will take place, how transportation will occur, the person who will assist, the associated cost, and identification of a possible blood donor. In the 2012 IDHS, fathers were asked whether they discussed these aspects of delivery with anyone during their wife’s pregnancy for their last-born child in the two years preceding the survey. The results are presented in Table 14.2. More than half of the fathers (88 percent) discussed with someone at least one of the topics related to the child’s delivery. The most frequently discussed topics were delivery assistance (77 percent) and place of delivery (76 percent), followed by payment for services (72 percent). Over half of the fathers discussed transportation to the place of delivery (54 percent). Identification of a potential blood donor during delivery was discussed by only 24 percent of the fathers. Table 14.2 Preparation for delivery Percentage of last births born in the two years preceding the survey whose father discussed specific topics about delivery, according to father’s background characteristics, Indonesia 2012 Background characteristic Percentage of fathers who discussed topics about delivery No topics discussed Number of fathers Place to deliver Transportation Delivery assistance Payment Blood donor Any topic Age 15-19 * * * * * * * 18 20-24 84.1 61.6 79.6 69.5 13.3 91.4 8.6 95 25-29 75.5 51.5 71.9 74.2 19.5 87.3 12.7 338 30-34 76.2 51.4 77.1 69.5 28.1 87.3 12.7 421 35-39 76.7 59.1 81.5 74.0 26.5 89.4 10.6 320 40-44 71.6 55.8 81.3 70.8 22.7 88.6 11.4 155 45-49 (75.3) (58.7) (78.5) (63.3) (19.2) (82.6) (17.4) 48 50-54 * * * * * * * 16 Residence Urban 81.4 60.0 80.3 74.9 24.4 90.5 9.5 842 Rural 66.9 45.9 72.6 66.6 22.7 83.8 16.2 563 Education No education * * * * * * * 11 Some primary 57.4 44.6 69.0 67.6 17.3 84.4 15.6 72 Completed primary 66.1 44.4 72.0 69.5 16.6 82.5 17.5 188 Some secondary 72.1 51.4 75.5 71.8 20.1 86.3 13.7 363 Completed secondary 78.0 53.7 76.6 69.8 21.8 88.2 11.8 484 More than secondary 87.3 68.2 85.9 77.0 38.4 93.9 6.1 287 Wealth quintile Lowest 67.1 40.4 68.5 64.2 16.2 83.1 16.9 146 Second 69.9 46.0 71.0 67.6 14.3 86.0 14.0 274 Middle 72.7 55.2 78.3 72.9 19.6 85.8 14.2 274 Fourth 77.4 57.0 76.5 73.2 31.6 88.1 11.9 332 Highest 83.6 62.9 84.8 75.0 29.5 92.2 7.8 380 Total 75.6 54.4 77.2 71.6 23.7 87.8 12.2 1,405 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 204 • Father’s Participation in Family Health Care Fathers in age group 20-24 are more likely to discuss any topic of their child’s delivery preparations compared with fathers in other age groups (91 percent compared with 89 percent or lower). Fathers who live in urban areas are more likely to talk about the birth preparation of their child than fathers in rural areas (91 percent versus 84 percent). This may be due to better access to information about birth preparations in urban areas. Fathers with higher education and those in the highest wealth quintile are more likely than other fathers to have discussed with someone else the topics related to the delivery. Appendix Table A-14.2 shows by province the percentage of fathers who discussed delivery topics. 14.3 CONTACT WITH HEALTH PROVIDER In the 2012 IDHS, the father’s involvement in their wife’s pregnancy and care was measured by asking currently-married men whether they talked to a health care provider about pregnancy care or the health of their last-born child’s mother in the two years preceding the survey. Men were also asked specifically about the topics they discussed during such contacts with a doctor or health provider. Table 14.3 Father's contact with health provider about child’s mother’s health Percentage of last births in the two years preceding the survey whose father discussed with a health provider the health of the child’s mother, and among fathers who talked with a health provider, percentage by specific topics discussed, according to father's background characteristics, Indonesia 2012 Background characteristic Talked with health care provider about mother’s health Number of fathers whose youngest child is two years or younger Among those who talked with a health provider, specific topics discussed: Number of fathers who talked to a health provider Type of foods she eats during pregnancy How much rest she should have during pregnancy Type of health problems for which she should get immediate medical attention Age 15-19 * 18 * * * 12 20-24 52.4 181 95.5 90.7 87.1 95 25-29 60.9 554 90.8 89.2 87.9 338 30-34 60.3 699 91.9 87.7 84.6 421 35-39 60.5 530 92.1 91.1 84.5 320 40-44 50.5 307 91.8 87.1 86.5 155 45-49 42.0 114 (92.9) (91.6) (81.6) 48 50-54 * 44 * * * 16 Residence Urban 66.2 1,272 93.6 88.3 86.8 842 Rural 48.0 1,173 89.1 88.8 83.9 563 Education No education * 46 * * * 11 Some primary 32.3 223 80.4 78.1 78.4 72 Completed primary 41.6 452 87.9 89.5 86.7 188 Some secondary 56.3 645 90.1 84.3 82.2 363 Completed secondary 65.8 737 93.5 89.9 88.2 484 More than secondary 83.8 342 96.6 93.2 86.8 287 Wealth quintile Lowest 30.4 479 84.8 85.2 80.0 146 Second 53.1 516 91.8 83.9 81.4 274 Middle 59.6 459 93.4 91.6 88.6 274 Fourth 63.9 519 91.5 90.0 88.8 332 Highest 80.6 471 93.6 89.4 85.9 380 Total 57.5 2,445 91.8 88.5 85.6 1,405 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed Father’s Participation in Family Health Care • 205 The survey results show that 58 percent of men talked with a health care provider about their wife’s health during pregnancy. Among men who had this discussion, 92 percent talked about the types of foods their wife should eat during the pregnancy, 89 percent talked about how much rest she should have, and 86 percent talked about the types of health problems for which she should get immediate medical attention. Fathers in age groups 25-29, 30-34, and 34-39 are the most likely to talk with the health provider about the health of the mother (60-61 percent) compared with other fathers (52 percent or lower). Fathers who live in urban areas are more likely to talk about the health of the mother (66 percent) than fathers in rural areas (48 percent). Fathers with higher education are more likely to talk with a health provider about the health of the child’s mother (84 percent) than fathers with no education (23 percent). Similarly, fathers in the highest wealth quintile are more likely to talk with the health provider about the health of the mother (81 percent) than fathers in the lowest wealth quintile (30 percent). Variations in the discussions about the type of foods to eat during pregnancy, how much rest the mother should have, and the type of health problems for which she needs to receive immediate care are similar to the variations occurring in the talk to a health provider. Appendix Table A-14.3 shows the variation by province in the level of contact between fathers and health providers regarding the woman’s pregnancy and health. 14.4 DIARRHEA TREATMENT Diarrheal diseases remain a public health problem in developing countries such as Indonesia because morbidity and mortality are still high. A morbidity surveillance study undertaken by the Ministry of Health from 2000 to 2010 saw an increasing incidence rate for diarrhea from 301 per 1,000 population in 2000 to 411 per 1,000 population in 2010 (MOH, 2011). In the 2012 IDHS, fathers of last-born children in the two years preceding the survey were asked a question about their knowledge of diarrhea treatment for children. Table 14.4 shows the percent distribution of fathers by their knowledge of the amount of fluid to be given when a child has diarrhea, according to the father’s background characteristics. The table shows that 59 percent of fathers correctly say that children with diarrhea should be given more to drink than usual. Twenty percent of fathers say that a child with diarrhea should be given the same amount to drink as usual. Four percent of fathers think that a child with diarrhea should be given less than usual to drink, and less than 1 percent of fathers say that a child who has diarrhea should be given nothing to drink. There are large differences in the handling of children with diarrhea by father’s education level. Fathers with more than secondary education are more aware that children with diarrhea should be given more than the usual amount of liquids (75 percent) compared with fathers with some primary education (43 percent). This is also true of the father’s wealth status; fathers in the highest wealth quintile are much more likely than fathers in the lowest wealth quintile to give more drink to children with diarrhea (73 percent and 40 percent, respectively). Appendix Table A-14.4 shows by province the percent distribution of fathers by their knowledge about the amount of drink to be given when a child has diarrhea. 206 • Father’s Participation in Family Health Care Table 14.4 Father’s knowledge about amount to drink for children with diarrhea Among last births in the two years preceding the survey, percent distribution by father’s knowledge of the amount of fluid to be given when a child has diarrhea, according to father’s background characteristics, Indonesia 2012 Background characteristic Amount to drink, when that child has diarrhea Number of fathers Nothing to drink Less than usual/much less About the same More Don’t know Missing Total Age 15-19 1.2 6.9 27.0 7.8 57.0 0.0 100.0 18 20-24 0.7 4.8 20.9 56.7 16.7 0.3 100.0 181 25-29 1.1 5.1 26.0 52.4 12.4 3.0 100.0 554 30-34 0.1 5.7 21.6 57.0 12.7 2.9 100.0 699 35-39 0.9 2.8 12.9 68.0 11.3 4.1 100.0 530 40-44 0.2 1.4 18.7 61.8 15.6 2.3 100.0 307 45-49 0.0 3.6 14.0 70.9 9.2 2.4 100.0 114 50-54 (0.0) (10.5) (16.7) (49.5) (12.3) (10.9) (100.0) 44 Residence Urban 0.7 2.2 14.1 69.4 10.3 3.4 100.0 1,272 Rural 0.5 6.6 26.3 47.9 16.1 2.6 100.0 1,173 Education No education 0.0 11.4 26.4 9.1 37.9 15.2 100.0 46 Some primary 0.4 4.5 33.2 43.1 16.6 2.1 100.0 223 Completed primary 0.0 8.2 26.0 46.9 17.1 1.8 100.0 452 Some secondary 0.5 3.2 20.5 58.2 14.4 3.3 100.0 645 Completed secondary 1.2 3.0 15.1 68.1 9.8 2.8 100.0 737 More than secondary 0.2 3.2 11.4 74.7 6.9 3.6 100.0 342 Wealth quintile Lowest 0.7 7.8 27.4 39.7 20.5 3.9 100.0 479 Second 0.6 5.1 24.5 54.1 13.6 2.1 100.0 516 Middle 0.0 2.0 25.3 57.8 12.4 2.5 100.0 459 Fourth 0.7 1.4 12.6 70.1 11.2 4.0 100.0 519 Highest 0.8 5.4 10.1 73.3 7.8 2.5 100.0 471 Total 0.6 4.3 19.9 59.1 13.1 3.0 100.0 2,445 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 14.5 KNOWLEDGE ABOUT CHILDREN’S IMMUNIZATION In the 2012 IDHS currently married men were also asked if their last living child born in the two years preceding the survey had been immunized against tuberculosis (BCG), polio, DPT, measles, and hepatitis B. Table 14.5 presents information on the specific immunizations received by the children, according to father’s report: BCG (77 percent), polio (78 percent), DPT (69 percent), measles (62 percent), and hepatitis (63 percent). The reporting of children’s immunizations varies by father’s background characteristics. In general, children of fathers age 35-39, children who live in urban areas, children of a better-educated father, and children living in households in the highest wealth quintile are more likely than other children to be immunized with each of the vaccines. For example, 82 percent of children whose fathers reside in urban areas have received polio vaccine compared with 72 percent of children whose fathers reside in rural areas. Furthermore, 50 percent of children born to men with no education have received polio vaccine compared with 87 percent of children of men with more than secondary education. While 63 percent of children of men in the lowest wealth quintile have received polio vaccine, the corresponding proportion for children of men in the highest wealth quintile is 88 percent. Appendix Table A-14.5 shows the percentage of children immunized with each vaccine by province in which the father resides. Father’s Participation in Family Health Care • 207 Table 14.5 Father’s report on children’s vaccination Among last births in the two years preceding the survey, percentage receiving vaccination according to father’s report, by type of vaccination, according to father’s background characteristics, Indonesia 2012 Background characteristic Vaccination Number of fathers BCG Polio DPT Measles Hepatitis Age 15-19 * * * * * 18 20-24 74.2 74.8 63.0 56.9 55.0 181 25-29 76.9 77.3 66.9 61.7 60.5 554 30-34 76.8 78.1 68.0 60.2 63.5 699 35-39 80.3 81.3 74.8 67.7 70.1 530 40-44 78.5 79.0 72.2 62.3 61.5 307 45-49 72.8 70.6 61.8 57.7 54.7 114 50-54 (64.7) (64.7) (60.8) (50.8) (67.5) 44 Residence Urban 81.8 82.2 74.0 64.9 70.1 1,272 Rural 72.0 72.3 62.7 58.0 54.7 1,173 Education No education 50.0 50.2 47.5 39.9 42.5 46 Some primary 54.7 53.1 40.4 34.8 41.9 223 Completed primary 69.9 71.4 61.2 53.1 50.8 452 Some secondary 78.6 81.7 70.8 64.5 63.7 645 Completed secondary 83.3 82.2 74.2 66.7 68.3 737 More than secondary 88.4 86.8 82.9 76.3 80.7 342 Wealth quintile Lowest 61.3 62.6 52.9 50.0 48.8 479 Second 76.1 75.2 67.3 56.3 55.6 516 Middle 80.3 81.0 69.4 62.0 63.5 459 Fourth 81.3 80.8 71.1 62.6 66.3 519 Highest 86.4 87.9 82.2 77.6 79.9 471 Total 77.1 77.5 68.5 61.5 62.7 2,445 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. Adult and Maternal Mortality • 209 ADULT AND MATERNAL MORTALITY 15 his chapter discusses the mortality of adults, including deaths among women from maternal causes. Although the level of maternal mortality is generally considered to be one of the most important indicators of a country’s health, reliable data are scarce, and estimates can vary widely. Abou Zahr estimated that maternal mortality occurs in only about 5 percent of child deaths (2011:123). Therefore, interpreting these results should be done cautiously. Data that allow estimation of adult and maternal mortality using a direct estimation procedure have been collected in the Indonesia Demographic and Health Survey (IDHS) since 1994. The surveys collected information on the survivorship of all live births to the respondent’s natural mother (i.e., the respondent’s brothers and sisters). The direct approach to estimating adult and maternal mortality maximizes use of the available data, including information on the age of surviving siblings, the age at death of siblings who died, and the number of years ago the sibling died. This allows the data to be aggregated for determining the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in defined calendar periods. Rates of maternal and adult mortality are obtained by dividing maternal (or all female or male adult) deaths by person-years of exposure (Ruttenberg and Sullivan, 1991). Another simple measure of maternal mortality is the proportion of deaths of all women of reproductive age due to maternal causes (PMDF). It is believed that PMDF is more accurately recorded than maternal deaths per se (Hill, Kenneth, et. al., 2007). PMDF is obtained directly by dividing maternal deaths by deaths of women of reproductive age. 15.1 DATA To obtain data on adult and maternal mortality, the IDHS woman’s questionnaire included a sibling survivorship history, which obtained a detailed account of the survivorship of all of the live-born children of the respondent’s mother (i.e., maternal siblings). Similar to the pre-2007 IDHS, sibling history was collected only from female respondents in the 2012 IDHS. In the 2007 IDHS, male respondents were also asked the same questions with the main objective of expanding the basis for calculating the mortality rates. To obtain the sibling history, each respondent was first asked to give the total number of her/his mother’s live births. The respondent was next asked to provide a list of all of the children born to her/his mother starting with the first-born. Then the respondent was asked whether each of these siblings was still alive at the time of the survey. For living siblings, current age was collected; for deceased siblings, age at death T Key Findings • The maternal mortality ratio is 359 deaths per 100,000 live births for the five-year period before the survey. • The age-adjusted maternal mortality rate for women age 15-49 is 0.27 per 1,000 women-years of exposure. • The number of maternal deaths was 92 for the five years preceding the survey. • The number of maternal deaths was highest in the age groups 25-29, 30-34, and 35-39. • Male adult mortality is consistently higher than female adult mortality in every age group. The probability of dying is also higher among male adults than among female adults. 210 • Adult and Maternal Mortality and years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on age at death or years since death, approximate but quantitative answers were acceptable. For sisters who died at age 10 or older, three questions were used to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died?” or “Did [NAME OF SISTER] die during childbirth?” and if negative, “Did [NAME OF SISTER] die within 2 months after the end of a pregnancy?” The estimation of adult and maternal mortality requires reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number who died, and (for maternal mortality) the number of sisters who died of maternity-related causes. There is no definitive procedure for establishing the completeness or accuracy of retrospective data on sibling survivorship. Table 15.1 examines several indicators of the quality of the sibling survivorship data from the IDHS, including the completeness of the reporting of sibling survivorship, the current age for surviving siblings, and the age at death and years since death for deceased siblings. Of the 195,945 siblings reported in the sibling histories of the IDHS female respondents, survival status was unknown for 106 (about 0.1 percent). Among surviving siblings, current ages (used to estimate exposure to death) were reported for virtually all surviving siblings (99 percent). Among deceased siblings, complete reporting of age at death and years since death was also nearly universal. For 82 percent of deceased siblings, both age at death and years since death (or year of death) were reported. Age at death was missing for only about 1 percent of deceased siblings, while the years since death were missing for 15 percent of deceased siblings. Rather than exclude siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data.1 It is also important to note that 13 percent of the sisters’ deaths out of a total of 846 dead sisters in the sample could not be categorized as a maternal or non-maternal death. This information may affect the maternal mortality ratio calculation. The sibling survivorship data, including cases with imputed values, were used in the direct estimation of adult and maternal mortality. Table 15.1 Completeness of information on siblings Completeness of data reported by interviewed women on (1) survival status of all of their siblings, (2) age of their surviving siblings, and (3) age at death (AD) and years since death (YSD) of their deceased siblings (unweighted), Indonesia 2012. Sisters Brothers All siblings Number Percent Number Percent Number Percent All siblings 94,757 100.0 101,188 100.0 195,945 100.0 Surviving 82,740 87.3 85,835 84.8 168,575 86.0 Deceased 11,975 12.6 15,289 15.1 27,264 13.9 Survival status unknown 42 0.0 64 0.1 106 0.1 Surviving siblings 82,740 100.0 85,835 100.0 168,575 100.0 Age reported 82,011 99.1 85,066 99.1 167,077 99.1 Age missing 729 0.9 769 0.9 1,498 0.9 Deceased siblings 11,975 100.0 15,289 100.0 27,264 100.0 AD and YSD reported 9,801 81.8 12,503 81.8 22,304 81.8 Missing only AD 116 1.0 184 1.2 300 1.1 Missing only YSD 1,823 15.2 2,236 14.6 4,059 14.9 Missing AD and YSD 235 2.0 366 2.4 601 2.2 1 The imputation procedure is based on the assumption that the reported birth order of siblings in the history is correct. The first step is to calculate birth dates. For each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death, the birth date was calculated. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketed siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either the age at death or years since death was reported, that information was combined with the birth date to produce the information missing. If both pieces of information were missing, the distribution of the ages at death for siblings for whom the years since death were unreported, but age at death was reported, was used as a basis for imputing the age at death. Adult and Maternal Mortality • 211 Table 15.2 shows the average sibling size in Indonesia and the sex ratio at birth based on the age of respondents. The information was not present in the 2007 IDHS report, but it is important to show it, because the maternal mortality ratio is calculated based on the sisterhood method. The mean sibling size in Indonesia based on the 2012 IDHS is 5 with a sex ratio of 106. The average number of siblings is largest for the age group 45-49. 15.2 DIRECT ESTIMATES OF ADULT MORTALITY Table 15.3 presents the age-specific female and male mortality rates for the five-year period before the survey, which roughly corresponds to 2008-2012. Longer age-specific death rates are computed by dividing the number of deaths in each age group by the total person-months of exposure in that age group during a specified reference period. Since the number of deaths on which the rates are based is not large (785 female and 1,001 male deaths), the age-specific rates are subject to large sampling variation. The female mortality rate is 2.49 deaths, and the male mortality rate is 3.11 deaths per 1,000 population. As expected, mortality increases with age for both sexes. In general, in all age groups, male mortality rates are slightly higher than female rates. Table 15.3 Adult mortality rates Direct estimates of female and male mortality rates for the five years preceding the survey, by five-year age groups, Indonesia 2012 Age Deaths Exposure years Mortality rates1 FEMALE 15-19 45 34,164 1.32 20-24 50 45,438 1.09 25-29 89 57,051 1.55 30-34 106 60,601 1.75 35-39 136 56,825 2.40 40-44 157 44,343 3.54 45-49 202 30,496 6.63 15-49 785 328,918 2.49 MALE 15-19 62 33,457 1.87 20-24 84 47,099 1.79 25-29 122 59,987 2.03 30-34 141 62,053 2.27 35-39 144 58,722 2.45 40-44 208 44,523 4.67 45-49 240 30,937 7.76 15-49 1,001 336,778 3.11 1 Expressed per 1,000 population a Age-adjusted rate Analysis of the past-to-present IDHS surveys indicates continuous increases in both female and male adult mortality from 1992 to 2012 (Figure 15.1). Adult mortality rates for female adults increased from 1.7 per 1,000 in the 1997 IDHS to 2.5 per 1,000 in the 2012 IDHS, whereas male adult mortality rates increased from 2.1 to 3.1 per thousand in the same period. Table 15.2 Sibship size and sex ratio of siblings Mean sibship size and sex ratio of siblings at birth, Indonesia 2012 Age of respondents Mean sibship size1 Sex ratio of siblings at birth2 15-19 4.0 105.6 20-24 4.4 102.6 25-29 4.8 106.7 30-34 5.2 107.3 35-39 5.7 104.3 40-44 5.9 107.2 45-49 6.1 105.7 Total 5.1 105.7 1 Includes the respondent 2 Excludes the respondent 212 • Adult and Maternal Mortality Figure 15.1 Trend in adult mortality rates age 15-49 (per 1,000 population), by sex, IDHS 1997-2012 15.3 ESTIMATES OF MATERNAL MORTALITY Direct age-specific estimates of maternal mortality from the reported survivorship of sisters are shown in Table 15.4 for the five-year period before the survey. Age-specific mortality rates are calculated by dividing the number of maternal deaths by woman-years of exposure. To remove the effect of truncation bias (the upper boundary for eligibility for women interviewed in the IDHS is 49 years), the overall rate for women age 15-49 is standardized by the age distribution of the survey respondents. Maternal deaths are defined as any deaths that occur during pregnancy, during childbirth, or within two months after the birth or termination of a pregnancy.2 The number of maternal deaths (92) is small, so age-specific rates are subject to very large sampling errors and should be interpreted with caution. The preferred approach is to calculate one estimate for all childbearing ages (15-49). For the period 0-4 years before the survey, the rate of deaths due to causes related to pregnancy and childbearing is 0.27 maternal deaths per 1,000 woman-years of exposure. Maternal deaths or the proportion of deaths of women of reproductive age due to maternal causes (PMDF) represent 11.7 percent of all deaths of women age 15-49. The maternal mortality rate can be converted to a maternal mortality ratio and expressed per 100,000 live births by dividing the rate by the general fertility rate (75) for the same time period. In this way, the obstetrical risk of pregnancy and childbearing is highlighted. By direct estimation procedures, the maternal mortality ratio is estimated to be 359 maternal deaths per 100,000 live births for the period 2008-2012. 2 This definition includes all deaths that occurred during pregnancy and two months after pregnancy, even if the death is due to nonmaternal causes. However, this definition is unlikely to result in overreporting of maternal deaths because most deaths of women in the specified period are due to maternal causes, and maternal deaths are more likely to be underreported than overreported. 2.1 2.2 2.7 3.1 1.7 1.9 2.0 2.5 1997 IDHS 2002-03 IDHS 2007 IDHS 2012 IDHS Deaths per 1,000 population Male Female Adult and Maternal Mortality • 213 Table 15.4 Maternal mortality Direct estimates of maternal mortality rates for the five years preceding the survey, by five-year age groups, Indonesia 2012 Age Percentage of female deaths that are maternal Maternal deaths Exposure years Maternal mortality rate1 15-19 9.9 4 34,164 0.13 20-24 23.2 12 45,438 0.25 25-29 22.4 20 57,051 0.35 30-34 16.2 17 60,601 0.28 35-39 13.1 18 56,825 0.31 40-44 8.9 14 44,343 0.32 45-49 3.4 7 30,496 0.22 15-49 11.7 92 328,918 0.27 General fertility rate (GFR)2 75 Maternal mortality ratio (MMR)3 359 Lifetime risk of maternal death4 0.009 CI: Confidence interval 1 Expressed per 1,000 woman-years of exposure 2 Expressed per 1,000 woman age 15-49 3 Expressed per 100,000 live births; calculated as the age-adjusted maternal mortality rate times 100 divided by the age-adjusted general fertility rate 4 Calculated as 1-(1-MMR)TFR where TFR represents the total fertility rate for the five years preceding the survey 15.4 TRENDS IN MATERNAL MORTALITY The maternal mortality ratio (MMRatio) is one of the Millennium Development Goal (MDG) indicators to be achieved in 2015. Indonesia’s MMRatio target for 2015 is 102 per 100.000 live births. The MMRatio showed the maternal mortality ratios for the five-year period prior to the survey. Quality of reporting may suffer due to memory lapses if the period of time is longer than 5 years. Based on results from other countries, it may be that the low level of reporting for the distant past relative to the recent period is due to recall problems (Stanton et al. 1997:33). Analysis of maternal mortality ratio (MMRatio) trends shows declines in the MMRatio based on the 1994 IDHS to the 2007 IDHS. The MMRatio in the 1997 IDHS was 390 deaths per 100,000 births. Unpublished analysis of data from the 1997 IDHS implied a slight decline to 334 deaths per 100,000 births for the period 1993-1997. The MMRatio estimate decreased to 307 deaths per 100,000 births in the 2002-2003 IDHS and 228 deaths per 100,000 births in the 2007 IDHS. However, the figure increased in the 2012 IDHS to 359. Despite the increase of the MMRatio in the 2012 IDHS, one must be cautious in interpreting the results. It does not necessarily indicate a failure in reducing the role of maternal deaths on overall adult female mortality. One must take into account the sampling error associated with the selected respondents as well as the nonsampling error. Figure 15.2 shows the range of the estimates based on a 95 percent confidence interval. The range of the MMRatio for the 2012 IDHS can be from 239 to 478 maternal deaths per 100,000 live births. In the 2007 IDHS, the range is 132 to 323. Such a wide confidence interval around the estimates also indicates that routine sample surveys, such as the DHS, cannot provide the information needed to monitor progress towards the MDG target (Hill et. al., 2006). 214 • Adult and Maternal Mortality Figure 15.2 Maternal mortality ratio (MMR) with confidence intervals for the five years preceding the 2007 IDHS and the 2012 IDHS Moreover, it is important to note that the 2012 IDHS asked questions of all women age 15-49 about maternal death, whereas the 2007 IDHS asked questions only of ever-married women age 15-49 in the sample. The increase is actually consistent with the increase of female adult mortality in Indonesia. Figure 15.3 shows changes of female adult mortality and PMDF for the last five IDHS surveys. PMDF had declined from 19 percent (1994 IDHS) to 10 percent (2007 IDHS). However, it then increased slightly to 12 percent (2012 IDHS). The trend of the adult female maternal mortality rate shows more telling evidence of increasing mortality. The adult female mortality rate decreased from the 1992 IDHS to the 2002-2003 IDHS. It began to increase, somewhat slowly at first. Then it increased sharply, from 20 deaths to 25 deaths per 10,000 population between the 2007 IDHS and 2012 IDHS. 323 478 228 359 132 239 0 100 200 300 400 500 600 2007 IDHS 2012 IDHS Maternal deaths per 100,000 live births Adult and Maternal Mortality • 215 Figure 15.3 Changes in adult female mortality rates and PMDF, IDHS 1994-2012 The increase of female adult mortality and the MMRatio from the 2007 IDHS to the 2012 IDHS is also reflected in the probability of dying for adults. Table 15.5 shows that the probability of dying for women between the ages of 15 and 50 shows an increase from 69 per 1,000 in the 2007 IDHS to 87 per 1,000 in IDHS2012. 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Rural Women in Developing Issues and Policies. Agenda Empowering Women for Gender Equity: Women and Economy 9: 63-70. http://www.tandfonline.com/toc/ragn20/9/18. United Nations Children’s Fund (UNICEF) and World Health Organization (WHO). 2004. Low Birthweight: Country, Regional and Global Estimates. New York, NY: UNICEF. United Nations General Assembly. 2001. Road Map towards the Implementation of the United Nations Millennium Declaration: Report of the Secretary-General. New York: United Nations General Assembly. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. 2004. Meeting on the MDG Drinking Water and Sanitation Target: A Mid-term Assessment of Progress. New York: World Health Organization and United Nations Children’s Fund. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. 2005. Water for Life: Making It Happen. Geneva: World Health Organization and United Nations Children’s Fund. World Health Organization (WHO). 2005. 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Appendix A • 221 PROVINCIAL TABLES Appendix A CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION Table A-2.1 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, by province, 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 Province 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 Sumatera Aceh 73.8 751 84.7 0.6 10.4 2.4 0.0 1.6 0.4 100.0 554 North Sumatera 74.2 2,162 91.1 0.0 7.9 0.3 0.0 0.6 0.0 100.0 1,605 West Sumatera 76.3 807 87.9 0.3 10.2 1.3 0.0 0.4 0.0 100.0 616 Riau 81.1 936 96.9 0.0 2.7 0.1 0.0 0.0 0.3 100.0 759 Jambi 78.9 542 85.3 0.0 14.1 0.2 0.0 0.5 0.0 100.0 428 South Sumatera 61.3 1,305 95.3 0.1 3.2 0.8 0.0 0.5 0.1 100.0 800 Bengkulu 84.1 304 92.5 0.1 4.5 2.1 0.1 0.5 0.1 100.0 256 Lampung 82.6 1,418 92.1 0.4 5.8 1.2 0.0 0.5 0.0 100.0 1,171 Bangka Belitung 79.1 236 97.3 0.1 2.1 0.3 0.0 0.1 0.1 100.0 187 Riau Islands 75.6 301 90.7 0.0 6.1 1.7 0.0 1.2 0.3 100.0 228 Java DKI Jakarta 83.2 1,630 96.1 0.0 2.7 0.2 0.0 0.5 0.4 100.0 1,357 West Java 85.8 8,125 96.4 0.3 2.2 0.8 0.0 0.1 0.2 100.0 6,968 Central Java 86.4 6,382 91.5 0.8 6.8 0.5 0.0 0.3 0.1 100.0 5,515 DI Yogyakarta 94.7 759 87.0 0.0 9.4 1.1 0.0 2.5 0.0 100.0 719 East Java 78.4 7,581 93.8 0.0 4.3 1.2 0.0 0.6 0.1 100.0 5,942 Banten 87.8 1,842 94.1 0.0 5.1 0.1 0.1 0.4 0.2 100.0 1,617 Bali and Nusa Tenggara Bali 84.8 787 90.5 0.1 8.4 0.4 0.0 0.7 0.0 100.0 667 West Nusa Tenggara 66.6 947 72.7 0.5 25.2 0.5 0.5 0.3 0.2 100.0 630 East Nusa Tenggara 61.6 750 71.6 0.2 19.6 1.8 0.0 6.7 0.2 100.0 462 Kalimantan West Kalimantan 60.6 724 96.3 0.0 2.8 0.4 0.0 0.3 0.2 100.0 439 Central Kalimantan 75.9 399 87.0 1.8 9.0 0.8 0.1 1.3 0.0 100.0 303 South Kalimantan 91.8 739 96.5 0.0 2.0 1.4 0.0 0.2 0.0 100.0 679 East Kalimantan 91.9 581 95.9 0.0 3.3 0.1 0.0 0.5 0.1 100.0 533 Sulawesi North Sulawesi 65.2 419 86.3 0.0 9.8 2.0 0.0 1.4 0.5 100.0 274 Central Sulawesi 71.2 437 84.8 0.2 10.1 1.6 0.0 3.2 0.1 100.0 311 South Sulawesi 73.2 1,316 86.0 0.0 9.1 1.0 0.0 3.7 0.2 100.0 964 Southeast Sulawesi 86.5 355 90.0 0.3 7.6 0.6 0.0 1.2 0.3 100.0 307 Gorontalo 62.9 173 89.3 0.2 9.4 0.2 0.0 0.7 0.2 100.0 109 West Sulawesi 71.9 182 76.0 0.2 18.8 1.1 0.0 3.8 0.2 100.0 131 Maluku and Papua Maluku 53.2 229 86.9 0.2 6.7 3.3 0.0 2.6 0.4 100.0 122 North Maluku 51.2 145 95.6 0.0 3.0 0.2 0.0 1.0 0.2 100.0 74 West Papua 55.0 112 95.4 0.3 2.4 1.2 0.0 0.6 0.1 100.0 62 Papua 34.2 473 89.0 0.0 8.3 0.3 0.0 0.4 2.1 100.0 162 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 and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 222 • Appendix A Table A-2.2.1 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 province, Indonesia 2012 Province No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Sumatera Aceh 6.5 25.9 14.8 24.2 14.3 14.1 0.2 100.0 1,457 6.3 North Sumatera 5.1 23.0 15.3 27.0 21.1 8.0 0.7 100.0 4,022 7.5 West Sumatera 5.2 25.7 15.2 23.5 18.4 11.8 0.1 100.0 1,511 6.8 Riau 6.3 26.0 17.1 24.7 16.6 8.8 0.5 100.0 1,683 5.9 Jambi 9.8 27.8 18.6 23.5 12.9 7.2 0.2 100.0 941 5.6 South Sumatera 6.0 28.5 21.2 21.9 14.6 7.5 0.3 100.0 2,247 5.7 Bengkulu 8.0 26.2 17.4 23.1 16.2 8.9 0.2 100.0 518 5.9 Lampung 7.0 28.1 21.1 24.8 14.2 4.7 0.3 100.0 2,356 5.7 Bangka Belitung 7.0 30.8 21.6 20.3 13.3 6.6 0.3 100.0 403 5.5 Riau Islands 7.2 20.7 14.1 18.1 30.8 8.9 0.1 100.0 477 8.3 Java DKI Jakarta 3.8 13.9 15.1 22.3 28.9 15.5 0.7 100.0 2,923 8.8 West Java 7.3 25.2 24.0 21.4 14.9 7.0 0.2 100.0 14,181 5.7 Central Java 12.3 23.9 22.9 21.5 12.0 7.1 0.4 100.0 10,881 5.6 DI Yogyakarta 10.5 19.1 13.6 20.8 20.8 14.9 0.2 100.0 1,194 8.1 East Java 16.4 22.9 20.8 20.5 12.8 6.4 0.2 100.0 13,233 5.5 Banten 8.8 24.8 19.3 23.3 16.4 7.2 0.3 100.0 3,388 5.8 Bali and Nusa Tenggara Bali 16.4 18.9 18.4 17.7 17.1 11.4 0.2 100.0 1,343 5.8 West Nusa Tenggara 18.3 24.5 17.2 21.2 12.0 6.8 0.0 100.0 1,675 5.4 East Nusa Tenggara 10.4 30.0 21.0 20.4 10.0 7.9 0.3 100.0 1,533 5.4 Kalimantan West Kalimantan 16.7 29.1 18.6 19.8 10.4 4.9 0.5 100.0 1,324 5.2 Central Kalimantan 7.0 27.3 22.1 22.1 12.4 8.6 0.6 100.0 670 5.7 South Kalimantan 7.7 31.3 16.3 24.2 12.0 8.0 0.5 100.0 1,190 5.6 East Kalimantan 6.4 24.7 15.2 24.0 20.4 9.4 0.0 100.0 1,034 6.6 Sulawesi North Sulawesi 1.9 24.0 15.2 27.1 21.3 10.3 0.3 100.0 753 8.0 Central Sulawesi 8.5 25.6 20.3 25.6 11.3 8.6 0.2 100.0 816 5.7 South Sulawesi 10.8 23.1 17.9 23.1 14.6 9.9 0.6 100.0 2,678 5.8 Southeast Sulawesi 9.7 25.5 15.4 24.7 13.6 10.8 0.4 100.0 653 5.8 Gorontalo 4.9 34.2 19.9 19.4 11.4 9.9 0.3 100.0 351 5.5 West Sulawesi 14.3 30.4 20.3 20.1 7.8 6.8 0.4 100.0 338 5.2 Maluku and Papua Maluku 4.9 26.6 15.5 23.4 18.7 10.5 0.6 100.0 480 6.3 North Maluku 7.3 28.3 15.9 23.2 14.4 10.5 0.3 100.0 316 5.8 West Papua 10.0 26.7 13.0 20.9 17.1 11.6 0.9 100.0 209 5.8 Papua 32.5 23.3 11.1 16.4 9.4 5.7 1.5 100.0 803 3.5 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 Appendix A • 223 Table A-2.2.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to province, Indonesia 2012 Province No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Sumatera Aceh 2.9 24.6 14.8 27.3 18.6 11.5 0.2 100.0 1,350 7.6 North Sumatera 3.2 23.4 14.1 28.3 23.7 7.0 0.2 100.0 3,860 8.0 West Sumatera 3.2 27.8 12.8 28.5 19.0 8.7 0.1 100.0 1,451 6.9 Riau 3.8 23.8 18.0 26.3 20.2 7.7 0.3 100.0 1,702 6.8 Jambi 5.4 25.0 21.1 24.0 17.8 6.6 0.1 100.0 974 5.9 South Sumatera 2.8 26.6 21.2 24.2 18.3 6.7 0.2 100.0 2,275 5.9 Bengkulu 3.5 25.9 17.6 26.9 17.3 8.6 0.2 100.0 514 6.5 Lampung 4.0 27.3 22.4 27.0 15.7 3.4 0.1 100.0 2,482 5.8 Bangka Belitung 3.9 32.8 18.0 22.1 17.1 5.8 0.3 100.0 416 5.7 Riau Islands 5.7 21.9 14.8 19.4 29.6 8.3 0.3 100.0 488 8.2 Java DKI Jakarta 2.5 12.4 11.5 22.3 36.1 14.9 0.5 100.0 2,943 11.0 West Java 5.0 22.6 23.1 22.4 18.3 8.4 0.2 100.0 13,900 5.9 Central Java 5.7 24.5 24.5 23.0 15.9 6.3 0.1 100.0 9,597 5.8 DI Yogyakarta 4.5 18.0 12.6 22.6 25.2 17.0 0.1 100.0 1,117 8.7 East Java 8.3 24.5 22.0 21.9 16.8 6.5 0.1 100.0 12,218 5.7 Banten 4.6 24.0 18.0 23.2 21.6 8.3 0.3 100.0 3,426 6.8 Bali and Nusa Tenggara Bali 7.0 18.5 17.2 20.1 22.7 14.2 0.1 100.0 1,391 8.2 West Nusa Tenggara 9.4 27.8 14.2 23.2 15.6 9.8 0.1 100.0 1,481 5.8 East Nusa Tenggara 8.0 36.1 16.7 21.2 10.4 7.4 0.2 100.0 1,539 5.3 Kalimantan West Kalimantan 9.1 32.5 17.4 20.1 15.5 5.1 0.5 100.0 1,315 5.4 Central Kalimantan 3.5 28.0 20.0 23.1 16.7 8.4 0.3 100.0 686 5.8 South Kalimantan 4.7 26.7 17.3 25.0 16.3 9.8 0.2 100.0 1,151 6.0 East Kalimantan 4.5 24.4 14.0 23.4 25.3 8.3 0.1 100.0 1,078 8.0 Sulawesi North Sulawesi 1.5 24.7 15.5 26.8 21.9 8.8 0.9 100.0 745 7.8 Central Sulawesi 6.6 27.2 20.9 23.1 14.1 8.0 0.1 100.0 842 5.7 South Sulawesi 7.1 25.4 17.5 23.6 16.9 8.4 1.0 100.0 2,433 5.9 Southeast Sulawesi 5.6 29.6 13.5 23.1 18.0 10.1 0.1 100.0 646 5.9 Gorontalo 5.5 39.1 17.5 18.4 11.4 7.7 0.4 100.0 320 5.3 West Sulawesi 11.2 33.4 18.4 21.1 9.5 6.0 0.4 100.0 320 5.3 Maluku and Papua Maluku 2.6 27.0 13.3 27.5 21.1 8.0 0.5 100.0 470 6.9 North Maluku 4.9 26.0 14.4 25.4 19.4 9.5 0.3 100.0 307 6.8 West Papua 6.1 27.1 11.4 21.8 20.2 12.7 0.7 100.0 216 7.2 Papua 19.1 21.9 12.0 21.0 17.1 7.2 1.7 100.0 832 5.6 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 224 • Appendix A CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table A-3.1 Background characteristics of respondents Percent distribution of women age 15-49 and married men age 15-54 by selected province, Indonesia 2012 Women Men Province Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Sumatera Aceh 1.9 877 1,433 1.6 153 240 North Sumatera 5.3 2,394 1,830 5.0 470 372 West Sumatera 1.9 852 1,339 1.8 164 239 Riau 2.3 1,040 1,386 2.5 231 305 Jambi 1.3 580 1,112 1.6 145 292 South Sumatera 3.0 1,358 1,335 3.2 295 293 Bengkulu 0.7 306 997 0.7 67 223 Lampung 3.2 1,443 1,354 3.6 334 307 Bangka Belitung 0.5 245 1,095 0.6 52 236 Riau Islands 0.7 323 1,041 0.7 64 224 Java DKI Jakarta 4.3 1,939 2,391 4.0 374 466 West Java 18.1 8,265 2,224 17.8 1,654 439 Central Java 13.7 6,240 1,998 13.1 1,224 405 DI Yogyakarta 1.4 654 1,519 1.5 135 329 East Java 16.2 7,374 1,979 17.4 1,621 449 Banten 4.7 2,148 2,068 4.8 450 435 Bali and Nusa Tenggara Bali 1.7 790 1,601 1.9 173 365 West Nusa Tenggara 2.2 997 1,368 1.8 171 238 East Nusa Tenggara 2.0 892 1,218 1.7 158 217 Kalimantan West Kalimantan 1.7 756 1,267 1.8 165 256 Central Kalimantan 0.9 409 996 1.0 93 211 South Kalimantan 1.6 730 1,273 1.6 152 270 East Kalimantan 1.5 671 1,079 1.5 139 205 Sulawesi North Sulawesi 0.9 427 1,281 0.9 87 241 Central Sulawesi 1.1 486 1,142 1.1 98 234 South Sulawesi 3.4 1,530 1,778 2.8 258 295 Southeast Sulawesi 0.8 382 1,094 0.8 77 221 Gorontalo 0.4 203 1,153 0.4 39 223 West Sulawesi 0.4 191 1,050 0.4 33 187 Maluku and Papua Maluku 0.6 260 1,129 0.5 47 215 North Maluku 0.4 188 1,149 0.4 35 216 West Papua 0.3 130 1,008 0.3 28 239 Papua 1.2 527 920 1.3 120 219 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. Appendix A • 225 Table A-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 province, Indonesia 2012 Highest level of schooling Total Median years completed Number of women Province No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Sumatera Aceh 1.7 11.0 14.5 28.2 22.7 22.0 100.0 9.1 877 North Sumatera 1.0 8.3 13.1 31.9 33.3 12.4 100.0 9.7 2,394 West Sumatera 1.0 8.9 13.0 30.2 28.4 18.4 100.0 9.6 852 Riau 2.5 11.5 18.0 29.4 25.2 13.4 100.0 8.7 1,040 Jambi 4.8 16.3 19.6 29.4 19.1 10.9 100.0 8.2 580 South Sumatera 1.6 15.4 22.0 27.4 22.5 11.1 100.0 8.3 1,358 Bengkulu 2.7 11.5 16.6 29.8 26.2 13.3 100.0 8.8 306 Lampung 1.2 13.3 24.4 31.8 22.2 7.1 100.0 8.3 1,443 Bangka Belitung 3.5 16.4 24.7 24.1 21.0 10.3 100.0 8.1 245 Riau Islands 3.0 7.6 12.8 20.4 43.8 12.5 100.0 11.1 323 Java DKI Jakarta 1.0 4.0 12.2 25.0 38.8 19.0 100.0 11.2 1,939 West Java 1.8 9.8 27.0 27.4 23.4 10.7 100.0 8.4 8,265 Central Java 2.6 10.5 27.9 28.0 19.3 11.5 100.0 8.3 6,240 DI Yogyakarta 0.5 5.0 11.3 26.2 32.5 24.6 100.0 11.2 654 East Java 4.9 10.1 26.7 27.9 20.7 9.6 100.0 8.3 7,374 Banten 3.1 12.4 22.2 28.1 23.8 10.4 100.0 8.4 2,148 Bali and Nusa Tenggara Bali 5.4 8.5 20.2 22.0 26.4 17.4 100.0 8.9 790 West Nusa Tenggara 7.8 13.8 21.4 27.2 19.3 10.4 100.0 8.1 997 East Nusa Tenggara 3.7 13.7 25.2 28.6 15.8 12.9 100.0 7.5 892 Kalimantan West Kalimantan 8.2 16.7 24.6 26.1 16.7 7.7 100.0 6.0 756 Central Kalimantan 2.5 14.3 25.1 26.6 18.8 12.7 100.0 8.1 409 South Kalimantan 3.0 17.8 18.4 30.7 18.2 11.8 100.0 8.2 730 East Kalimantan 1.5 10.6 15.2 28.3 31.1 13.3 100.0 9.1 671 Sulawesi North Sulawesi 0.6 10.6 11.7 31.3 30.2 15.6 100.0 9.8 427 Central Sulawesi 3.8 10.7 22.5 32.3 17.5 13.2 100.0 8.3 486 South Sulawesi 3.2 10.5 19.2 28.8 22.8 15.5 100.0 8.7 1,530 Southeast Sulawesi 4.3 11.0 15.6 29.8 21.6 17.8 100.0 8.7 382 Gorontalo 1.7 22.5 20.5 23.8 16.9 14.7 100.0 7.8 203 West Sulawesi 7.2 15.8 24.9 26.6 14.0 11.4 100.0 6.4 191 Maluku and Papua Maluku 2.3 7.8 13.5 27.3 31.6 17.5 100.0 10.7 260 North Maluku 1.7 12.7 16.8 28.4 22.2 18.2 100.0 9.0 188 West Papua 5.2 12.1 12.9 24.5 26.8 18.6 100.0 9.0 130 Papua 37.0 9.1 11.0 21.1 13.0 8.9 100.0 5.3 527 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 226 • Appendix A Table A-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 province, Indonesia 2012 Highest level of schooling Total Median years completed Number of men Province No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Sumatera Aceh 1.5 15.9 14.3 33.7 20.0 14.6 100.0 8.5 153 North Sumatera 0.6 8.4 17.6 27.2 37.2 9.1 100.0 9.0 470 West Sumatera 0.4 17.2 12.7 29.0 24.3 16.5 100.0 8.6 164 Riau 1.8 12.5 17.3 29.5 29.1 9.7 100.0 8.6 231 Jambi 3.9 18.3 24.8 20.6 23.6 8.9 100.0 7.3 145 South Sumatera 0.7 17.1 27.4 23.6 20.7 10.6 100.0 8.1 295 Bengkulu 0.0 15.0 14.6 30.4 25.9 14.2 100.0 8.7 67 Lampung 1.3 25.5 23.5 25.1 19.5 5.1 100.0 6.0 334 Bangka Belitung 2.0 21.5 21.8 22.1 23.1 9.5 100.0 7.6 52 Riau Islands 1.7 10.4 16.1 15.1 40.1 16.7 100.0 11.2 64 Java DKI Jakarta 0.4 4.7 12.0 20.3 47.3 15.2 100.0 11.3 374 West Java 2.7 11.0 26.2 17.8 25.4 16.8 100.0 8.5 1,654 Central Java 3.1 17.2 31.5 18.9 18.6 10.8 100.0 5.9 1,224 DI Yogyakarta 1.1 9.9 10.0 21.4 38.7 18.9 100.0 11.2 135 East Java 3.3 16.8 25.0 18.5 28.5 8.0 100.0 8.1 1,621 Banten 1.7 16.4 19.0 19.2 31.2 12.6 100.0 8.7 450 Bali and Nusa Tenggara Bali 2.7 8.8 17.4 20.8 32.2 18.1 100.0 11.0 173 West Nusa Tenggara 6.9 18.0 20.6 24.1 19.4 11.1 100.0 8.1 171 East Nusa Tenggara 2.6 20.4 22.7 21.6 18.1 14.7 100.0 6.1 158 Kalimantan West Kalimantan 2.9 21.2 23.7 23.6 21.9 6.7 100.0 7.1 165 Central Kalimantan 1.4 19.0 20.5 24.4 23.4 11.3 100.0 8.1 93 South Kalimantan 2.0 14.9 14.7 32.2 20.8 15.4 100.0 8.5 152 East Kalimantan 2.2 12.7 15.1 22.9 32.6 14.4 100.0 9.0 139 Sulawesi North Sulawesi 0.8 18.6 11.8 28.8 30.1 9.9 100.0 8.8 87 Central Sulawesi 4.5 13.5 27.1 26.2 16.4 12.3 100.0 6.8 98 South Sulawesi 5.8 13.3 21.8 24.3 22.8 12.0 100.0 8.3 258 Southeast Sulawesi 5.5 15.8 15.0 23.1 24.4 16.1 100.0 8.6 77 Gorontalo (1.8) (31.3) (22.3) (18.1) (16.5) 10.0 100.0 (5.7) 39 West Sulawesi (8.1) (28.4) (22.5) (16.4) (17.6) (7.0) 100.0 (5.6) 33 Maluku and Papua Maluku (0.7) (16.7) (12.1) (26.2) (34.8) (9.5) 100.0 (9.0) 47 North Maluku (1.1) (9.6) (15.6) (29.7) (27.5) (16.5) 100.0 (8.9) 35 West Papua (2.9) (12.6) (13.9) (19.5) (31.8) (19.3) 100.0 (11.0) 28 Papua 26.6 7.3 16.3 14.0 22.7 13.2 100.0 6.0 120 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 Appendix A • 227 Table A-3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended, level of literacy, and percentage literate, according to province, Indonesia 2012 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Province Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Sumatera Aceh 72.8 14.5 5.4 6.5 0.4 0.4 100.0 92.7 877 North Sumatera 77.7 14.0 3.2 3.9 0.3 1.0 100.0 94.8 2,394 West Sumatera 77.0 13.9 2.9 4.7 0.7 0.8 100.0 93.9 852 Riau 68.0 21.0 3.9 5.7 0.4 0.9 100.0 93.0 1,040 Jambi 59.4 25.7 5.7 8.8 0.4 0.0 100.0 90.7 580 South Sumatera 61.0 26.6 5.4 6.4 0.2 0.5 100.0 93.0 1,358 Bengkulu 69.3 16.5 7.0 5.9 0.7 0.6 100.0 92.8 306 Lampung 61.1 27.4 4.9 5.4 0.6 0.6 100.0 93.4 1,443 Bangka Belitung 55.4 33.3 4.8 5.4 1.0 0.1 100.0 93.5 245 Riau Islands 76.7 16.2 2.1 4.5 0.2 0.3 100.0 95.0 323 Java DKI Jakarta 82.9 12.3 1.9 1.6 0.2 1.1 100.0 97.1 1,939 West Java 61.4 30.2 3.4 4.3 0.3 0.3 100.0 95.1 8,265 Central Java 58.9 28.9 5.6 6.1 0.2 0.3 100.0 93.4 6,240 DI Yogyakarta 83.2 12.8 1.5 2.1 0.0 0.4 100.0 97.5 654 East Java 58.2 27.0 5.8 7.7 0.3 1.0 100.0 91.0 7,374 Banten 62.3 26.3 4.9 5.8 0.1 0.6 100.0 93.5 2,148 Bali and Nusa Tenggara Bali 65.9 19.7 4.8 9.0 0.4 0.2 100.0 90.4 790 West Nusa Tenggara 56.9 26.0 3.8 12.7 0.5 0.1 100.0 86.8 997 East Nusa Tenggara 57.4 28.3 2.7 10.1 1.0 0.4 100.0 88.5 892 Kalimantan West Kalimantan 50.5 22.1 13.6 12.3 0.0 1.5 100.0 86.2 756 Central Kalimantan 58.1 29.4 6.0 5.8 0.3 0.4 100.0 93.5 409 South Kalimantan 60.8 28.1 4.5 6.1 0.3 0.2 100.0 93.4 730 East Kalimantan 72.7 20.8 1.8 4.6 0.0 0.2 100.0 95.2 671 Sulawesi North Sulawesi 77.1 14.6 2.3 3.5 0.3 2.1 100.0 94.1 427 Central Sulawesi 63.0 22.2 7.1 6.6 0.6 0.5 100.0 92.3 486 South Sulawesi 67.1 19.6 4.3 7.6 0.5 0.9 100.0 91.0 1,530 Southeast Sulawesi 69.1 16.1 4.7 9.5 0.4 0.2 100.0 89.9 382 Gorontalo 55.4 31.1 5.0 7.5 0.6 0.4 100.0 91.4 203 West Sulawesi 52.1 28.4 5.3 11.8 1.2 1.2 100.0 85.8 191 Maluku and Papua Maluku 76.3 11.9 4.3 6.9 0.2 0.4 100.0 92.5 260 North Maluku 68.8 15.2 6.6 8.0 1.2 0.2 100.0 90.6 188 West Papua 69.8 13.2 5.6 9.7 0.1 1.5 100.0 88.7 130 Papua 43.0 10.2 9.4 36.7 0.1 0.6 100.0 62.6 527 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 228 • Appendix A Table A-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 province, Indonesia 2012 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Province Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Sumatera Aceh 68.3 17.8 5.0 8.8 0.0 0.0 100.0 91.2 153 North Sumatera 73.4 22.3 0.7 3.5 0.0 0.0 100.0 96.5 470 West Sumatera 69.7 19.8 2.5 5.6 2.4 2.4 100.0 92.0 164 Riau 68.3 22.0 3.8 4.4 0.0 1.6 100.0 94.1 231 Jambi 53.1 35.3 6.4 5.2 0.0 0.0 100.0 94.8 145 South Sumatera 54.9 32.6 6.6 4.9 0.7 1.0 100.0 94.1 295 Bengkulu 70.4 20.2 4.5 3.4 1.5 1.5 100.0 95.1 67 Lampung 49.7 34.9 7.7 5.0 0.8 2.7 100.0 92.3 334 Bangka Belitung 54.7 32.8 7.1 5.4 0.0 0.0 100.0 94.6 52 Riau Islands 71.9 21.1 4.4 2.6 0.0 0.0 100.0 97.4 64 Java DKI Jakarta 82.8 14.0 1.4 0.9 0.0 0.9 100.0 98.1 374 West Java 60.1 31.9 3.6 3.3 0.5 1.1 100.0 95.5 1,654 Central Java 48.3 35.6 7.1 8.3 0.5 0.8 100.0 90.9 1,224 DI Yogyakarta 79.0 13.4 4.3 3.1 0.2 0.2 100.0 96.7 135 East Java 54.9 31.6 2.8 8.6 1.9 2.1 100.0 89.3 1,621 Banten 63.0 29.3 3.9 3.1 0.2 0.6 100.0 96.3 450 Bali and Nusa Tenggara Bali 71.2 20.6 4.3 3.9 0.0 0.0 100.0 96.1 173 West Nusa Tenggara 54.5 29.0 6.0 10.5 0.0 0.0 100.0 89.5 171 East Nusa Tenggara 54.3 32.5 2.6 9.5 0.0 1.1 100.0 89.4 158 Kalimantan West Kalimantan 52.2 21.6 16.8 8.2 1.3 1.3 100.0 90.5 165 Central Kalimantan 59.2 31.3 5.1 3.8 0.6 0.6 100.0 95.6 93 South Kalimantan 68.4 25.0 2.5 4.1 0.0 0.0 100.0 95.9 152 East Kalimantan 70.0 21.2 3.5 5.4 0.0 0.0 100.0 94.6 139 Sulawesi North Sulawesi 68.8 18.5 5.3 7.0 0.0 0.4 100.0 92.6 87 Central Sulawesi 54.9 30.4 4.6 8.2 1.5 1.9 100.0 89.9 98 South Sulawesi 59.1 24.9 5.7 9.6 0.0 0.7 100.0 89.8 258 Southeast Sulawesi 63.6 21.3 5.3 8.2 0.0 1.6 100.0 90.2 77 Gorontalo (44.6) (39.1) (2.3) (12.7) 0.5 (1.3) 100.0 (86.0) 39 West Sulawesi (41.0) (36.4) (4.6) (17.4) 0.6 (0.6) 100.0 (82.0) 33 Maluku and Papua Maluku (70.6) (23.6) (2.8) (2.8) 0.0 (0.3) 100.0 96.9 47 North Maluku (73.7) (13.6) (6.4) (5.7) 0.0 (0.6) 100.0 (93.7) 35 West Papua (70.6) (16.2) (6.4) (6.0) 0.3 (0.8) 100.0 (93.2) 28 Papua 49.8 15.5 7.6 26.0 0.0 1.0 100.0 73.0 120 Total 59.7 28.6 4.5 6.2 0.7 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 Appendix A • 229 Table A-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 province, Indonesia 2012 Province 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 Sumatera Aceh 15.7 82.3 14.9 4.3 14.2 877 North Sumatera 13.4 85.0 20.7 4.3 12.0 2,394 West Sumatera 14.4 87.1 17.9 4.6 10.0 852 Riau 20.1 89.1 22.7 8.0 8.0 1,040 Jambi 12.4 89.5 13.8 2.6 8.7 580 South Sumatera 13.5 87.4 15.8 5.2 11.1 1,358 Bengkulu 18.7 84.4 19.2 5.2 12.3 306 Lampung 10.3 86.7 17.7 2.7 10.8 1,443 Bangka Belitung 19.9 94.8 25.0 8.5 3.5 245 Riau Islands 24.7 90.0 19.1 7.1 6.6 323 Java DKI Jakarta 20.7 91.3 22.3 7.9 6.8 1,939 West Java 11.8 89.7 17.0 4.4 8.6 8,265 Central Java 11.1 85.4 21.4 4.3 11.6 6,240 DI Yogyakarta 34.1 89.5 35.9 14.6 6.1 654 East Java 13.3 89.0 24.3 5.2 8.5 7,374 Banten 9.6 89.8 14.7 3.4 8.4 2,148 Bali and Nusa Tenggara Bali 12.7 76.7 23.9 6.5 20.5 790 West Nusa Tenggara 5.5 68.1 10.5 1.5 29.9 997 East Nusa Tenggara 14.2 49.2 19.4 5.9 43.7 892 Kalimantan West Kalimantan 6.0 83.7 11.7 1.7 14.5 756 Central Kalimantan 13.6 89.4 15.5 3.8 8.9 409 South Kalimantan 11.6 93.7 18.6 3.2 5.3 730 East Kalimantan 15.5 93.9 13.8 4.3 5.0 671 Sulawesi North Sulawesi 17.8 87.7 15.5 6.0 11.1 427 Central Sulawesi 11.5 79.7 12.1 2.3 18.2 486 South Sulawesi 17.2 88.8 21.2 6.4 9.4 1,530 Southeast Sulawesi 20.6 86.7 19.5 8.2 10.7 382 Gorontalo 13.8 76.1 29.9 7.5 18.7 203 West Sulawesi 8.3 76.4 8.2 1.8 22.2 191 Maluku and Papua Maluku 10.3 69.9 8.1 2.2 28.3 260 North Maluku 15.2 73.0 9.4 4.2 25.5 188 West Papua 9.3 65.5 16.1 3.3 31.2 130 Papua 8.0 42.3 10.8 4.4 56.7 527 Total 13.3 85.9 19.3 4.9 11.7 45,607 230 • Appendix A Table A-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 province, Indonesia 2012 Province 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 Sumatera Aceh 50.0 90.7 22.6 15.9 7.9 153 North Sumatera 24.4 91.6 16.8 6.8 6.8 470 West Sumatera 24.2 92.7 21.0 4.9 4.4 164 Riau 17.8 94.2 17.1 4.9 4.0 231 Jambi 22.0 91.6 16.3 7.0 7.1 145 South Sumatera 13.2 85.9 11.8 2.9 13.3 295 Bengkulu 30.5 89.6 21.6 7.8 6.8 67 Lampung 14.1 92.9 22.0 4.2 5.9 334 Bangka Belitung 28.7 93.6 36.9 14.3 4.7 52 Riau Islands 37.5 92.7 15.4 10.0 6.5 64 Java DKI Jakarta 47.4 96.6 22.2 17.6 2.3 374 West Java 24.4 91.8 18.0 6.6 6.0 1,654 Central Java 21.1 89.4 27.6 8.9 7.7 1,224 DI Yogyakarta 45.1 91.8 45.4 20.9 2.1 135 East Java 17.1 85.5 26.9 7.4 12.5 1,621 Banten 17.0 90.9 24.0 5.9 8.1 450 Bali and Nusa Tenggara Bali 26.3 69.8 24.8 10.2 23.3 173 West Nusa Tenggara 13.5 85.1 13.8 4.0 13.2 171 East Nusa Tenggara 24.9 58.7 25.8 11.8 34.9 158 Kalimantan West Kalimantan 8.6 85.4 13.1 1.7 12.8 165 Central Kalimantan 18.2 89.1 11.2 4.5 9.6 93 South Kalimantan 27.6 90.8 24.5 10.5 8.5 152 East Kalimantan 19.0 93.9 15.5 3.5 5.6 139 Sulawesi North Sulawesi 36.9 84.9 16.2 6.9 12.5 87 Central Sulawesi 13.7 93.9 18.0 3.7 5.8 98 South Sulawesi 19.6 94.6 13.7 5.6 4.6 258 Southeast Sulawesi 21.0 83.5 13.8 4.8 16.5 77 Gorontalo (23.2) (85.1) (35.6) (15.1) (12.7) 39 West Sulawesi (13.4) (77.4) (12.1) (3.8) (22.2) 33 Maluku and Papua Maluku (11.4) (78.0) (13.9) (2.8) (18.4) 47 North Maluku (16.7) (75.6) (11.8) (7.1) (23.4) 35 West Papua (15.3) (71.0) (12.5) (4.8) (25.4) 28 Papua 8.4 34.5 10.4 3.5 63.1 120 Total 22.1 88.2 21.6 7.5 9.7 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. Appendix A • 231 Table A-3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to province, Indonesia 2012 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/don’t know Total Number of women Province Currently employed1 Not currently employed Sumatera Aceh 53.7 4.9 41.4 0.0 100.0 877 North Sumatera 56.7 4.6 38.7 0.0 100.0 2,394 West Sumatera 59.2 4.3 36.5 0.0 100.0 852 Riau 57.4 7.3 35.3 0.0 100.0 1,040 Jambi 59.9 5.3 34.8 0.1 100.0 580 South Sumatera 58.0 5.1 36.9 0.0 100.0 1,358 Bengkulu 62.2 4.3 33.6 0.0 100.0 306 Lampung 55.5 6.6 37.9 0.0 100.0 1,443 Bangka Belitung 50.5 8.8 40.7 0.0 100.0 245 Riau Islands 51.2 6.2 42.6 0.0 100.0 323 Java DKI Jakarta 54.2 4.9 40.9 0.0 100.0 1,939 West Java 48.9 5.9 45.1 0.0 100.0 8,265 Central Java 55.4 7.7 36.9 0.0 100.0 6,240 DI Yogyakarta 67.6 5.3 27.1 0.0 100.0 654 East Java 59.8 5.7 34.5 0.0 100.0 7,374 Banten 49.8 4.7 45.5 0.0 100.0 2,148 Bali and Nusa Tenggara Bali 73.1 3.7 23.2 0.0 100.0 790 West Nusa Tenggara 61.6 7.9 30.5 0.0 100.0 997 East Nusa Tenggara 58.4 7.0 34.6 0.0 100.0 892 Kalimantan West Kalimantan 61.0 3.6 35.3 0.1 100.0 756 Central Kalimantan 54.0 7.7 38.4 0.0 100.0 409 South Kalimantan 57.8 3.8 38.4 0.0 100.0 730 East Kalimantan 53.1 4.2 42.8 0.0 100.0 671 Sulawesi North Sulawesi 44.9 4.4 50.5 0.2 100.0 427 Central Sulawesi 61.8 4.2 33.9 0.1 100.0 486 South Sulawesi 45.6 6.1 48.2 0.0 100.0 1,530 Southeast Sulawesi 59.5 5.9 34.5 0.0 100.0 382 Gorontalo 45.0 5.4 49.4 0.1 100.0 203 West Sulawesi 56.6 5.1 38.3 0.1 100.0 191 Maluku and Papua Maluku 46.3 0.9 52.7 0.0 100.0 260 North Maluku 50.6 3.6 45.8 0.0 100.0 188 West Papua 45.6 3.8 50.4 0.2 100.0 130 Papua 71.8 3.1 25.0 0.1 100.0 527 Total 55.4 5.8 38.8 0.0 100.0 45,607 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. 232 • Appendix A Table A-3.5.2 Employment status: Men Percent distribution of currently married men age 15-54 by employment status, according to province, Indonesia 2012 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Province Currently employed1 Not currently employed Sumatera Aceh 97.7 2.3 0.0 100.0 153 North Sumatera 99.1 0.0 0.9 100.0 470 West Sumatera 99.1 0.4 0.5 100.0 164 Riau 99.4 0.3 0.3 100.0 231 Jambi 99.1 0.2 0.7 100.0 145 South Sumatera 99.4 0.4 0.3 100.0 295 Bengkulu 98.2 1.8 0.0 100.0 67 Lampung 99.8 0.0 0.2 100.0 334 Bangka Belitung 98.8 0.8 0.4 100.0 52 Riau Islands 98.3 1.5 0.2 100.0 64 Java DKI Jakarta 96.9 0.6 2.5 100.0 374 West Java 97.1 1.6 1.3 100.0 1,654 Central Java 98.8 0.8 0.4 100.0 1,224 DI Yogyakarta 98.6 0.3 1.1 100.0 135 East Java 98.6 0.9 0.5 100.0 1,621 Banten 99.0 0.5 0.5 100.0 450 Bali and Nusa Tenggara Bali 99.1 0.3 0.6 100.0 173 West Nusa Tenggara 95.5 4.0 0.5 100.0 171 East Nusa Tenggara 98.4 0.5 1.1 100.0 158 Kalimantan West Kalimantan 99.2 0.2 0.5 100.0 165 Central Kalimantan 98.7 0.8 0.5 100.0 93 South Kalimantan 98.6 1.1 0.3 100.0 152 East Kalimantan 97.3 2.3 0.4 100.0 139 Sulawesi North Sulawesi 98.1 0.9 1.0 100.0 87 Central Sulawesi 100.0 0.0 0.0 100.0 98 South Sulawesi 99.4 0.3 0.3 100.0 258 Southeast Sulawesi 100.0 0.0 0.0 100.0 77 Gorontalo (98.7) (0.9) (0.4) 100.0 39 West Sulawesi (99.6) (0.0) (0.4) 100.0 33 Maluku and Papua Maluku (96.8) (2.3) (0.9) 100.0 47 North Maluku (94.6) (3.9) (1.5) 100.0 35 West Papua (97.9) (1.1) (1.0) 100.0 28 Papua 95.3 0.9 3.9 100.0 120 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. Appendix A • 233 Table A-3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to province, Indonesia 2012 Province Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Sumatera Aceh 17.5 6.8 26.1 19.7 2.5 27.4 0.0 100.0 514 North Sumatera 9.8 3.8 32.8 20.1 7.0 26.4 0.1 100.0 1,468 West Sumatera 16.7 6.9 34.6 21.6 0.4 19.6 0.1 100.0 541 Riau 13.3 5.6 39.8 21.0 3.6 16.5 0.2 100.0 672 Jambi 9.7 4.9 23.2 17.2 0.9 44.1 0.0 100.0 378 South Sumatera 11.8 3.7 26.7 16.5 2.0 39.2 0.0 100.0 857 Bengkulu 11.9 4.7 24.4 17.8 0.8 40.3 0.2 100.0 204 Lampung 8.7 2.8 32.4 24.3 1.1 30.4 0.2 100.0 896 Bangka Belitung 11.1 6.1 40.1 22.0 1.2 19.1 0.4 100.0 145 Riau Islands 13.2 11.2 41.8 29.4 0.8 3.0 0.5 100.0 186 Java DKI Jakarta 16.5 13.9 51.0 15.1 2.7 0.1 0.6 100.0 1,145 West Java 8.9 7.0 45.7 28.2 1.5 8.6 0.0 100.0 4,531 Central Java 8.9 3.5 34.1 27.3 6.0 20.2 0.0 100.0 3,937 DI Yogyakarta 14.6 6.3 41.2 22.9 3.0 12.0 0.0 100.0 477 East Java 10.5 2.7 32.4 33.9 2.6 17.8 0.2 100.0 4,829 Banten 10.0 9.2 37.1 33.0 6.4 4.0 0.2 100.0 1,170 Bali and Nusa Tenggara Bali 11.8 8.3 37.0 26.5 3.1 13.2 0.1 100.0 607 West Nusa Tenggara 8.2 3.3 23.1 24.3 11.7 29.3 0.1 100.0 692 East Nusa Tenggara 10.8 5.1 22.1 19.9 0.7 41.3 0.0 100.0 583 Kalimantan West Kalimantan 6.6 4.6 21.3 14.0 0.9 52.5 0.0 100.0 488 Central Kalimantan 10.1 6.3 29.4 20.6 1.0 32.2 0.4 100.0 252 South Kalimantan 9.7 4.9 40.4 19.4 1.1 24.6 0.0 100.0 449 East Kalimantan 13.4 11.0 46.0 15.2 2.1 12.3 0.0 100.0 384 Sulawesi North Sulawesi 19.6 9.4 43.3 15.7 1.2 10.2 0.6 100.0 210 Central Sulawesi 10.5 6.5 35.1 12.2 4.0 31.6 0.2 100.0 321 South Sulawesi 15.3 6.6 40.6 13.7 1.8 21.8 0.1 100.0 792 Southeast Sulawesi 12.9 7.5 33.8 23.6 0.0 21.9 0.3 100.0 250 Gorontalo 11.8 11.9 39.8 18.2 2.9 15.0 0.4 100.0 102 West Sulawesi 9.3 2.9 27.3 18.7 0.0 39.8 1.9 100.0 118 Maluku and Papua Maluku 19.0 5.9 37.3 11.6 2.3 23.9 0.0 100.0 123 North Maluku 15.0 11.1 34.1 13.8 0.7 25.4 0.0 100.0 102 West Papua 16.2 11.5 38.8 8.8 2.3 22.1 0.3 100.0 64 Papua 4.6 4.3 14.1 19.8 0.0 56.9 0.3 100.0 395 Total 10.7 5.5 35.7 25.0 3.2 19.8 0.1 100.0 27,882 234 • Appendix A Table A-3.6.2 Occupation: Men Percent distribution of currently married men age 15-54 employed in the 12 months preceding the survey by occupation, according to province, Indonesia 2012 Province Professional/ technical/ managerial Clerical Sales and services Skilled manual Agriculture Missing Total Number of men Sumatera Aceh 10.5 4.4 18.8 30.7 31.9 3.6 100.0 153 North Sumatera 7.9 5.0 14.3 28.5 30.0 14.3 100.0 466 West Sumatera 9.4 6.0 17.3 37.9 27.0 2.4 100.0 163 Riau 9.7 7.1 15.0 34.9 29.3 3.9 100.0 230 Jambi 8.6 3.7 8.6 35.7 41.6 1.8 100.0 144 South Sumatera 7.1 2.8 14.1 26.3 48.2 1.5 100.0 294 Bengkulu 9.0 7.5 10.2 25.7 46.5 1.2 100.0 67 Lampung 4.3 1.9 14.4 33.0 42.6 3.8 100.0 334 Bangka Belitung 9.4 3.4 10.8 46.5 25.5 4.4 100.0 51 Riau Islands 17.5 8.8 14.7 45.4 12.0 1.7 100.0 64 Java DKI Jakarta 16.1 9.8 34.1 30.5 0.5 9.0 100.0 364 West Java 12.5 6.0 27.0 42.8 8.7 2.9 100.0 1,632 Central Java 8.2 3.6 18.6 33.5 27.0 9.1 100.0 1,219 DI Yogyakarta 18.2 5.6 24.5 35.1 11.5 5.1 100.0 134 East Java 7.6 2.4 19.6 37.6 28.3 4.5 100.0 1,613 Banten 9.8 4.8 24.1 46.4 6.5 8.3 100.0 447 Bali and Nusa Tenggara Bali 12.9 6.7 25.5 34.8 13.3 6.8 100.0 172 West Nusa Tenggara 7.5 2.4 12.9 33.2 32.6 11.4 100.0 170 East Nusa Tenggara 8.7 9.0 10.4 29.1 40.4 2.4 100.0 156 Kalimantan West Kalimantan 8.4 4.7 8.3 29.7 48.0 0.9 100.0 165 Central Kalimantan 10.1 6.7 13.9 34.8 32.2 2.3 100.0 93 South Kalimantan 12.2 5.1 20.6 31.6 26.9 3.7 100.0 152 East Kalimantan 11.7 5.4 22.1 32.2 20.8 7.8 100.0 138 Sulawesi North Sulawesi 10.6 4.4 18.8 35.7 26.5 4.0 100.0 87 Central Sulawesi 6.2 5.5 15.4 20.5 47.0 5.4 100.0 98 South Sulawesi 10.9 3.5 20.9 28.1 32.2 4.4 100.0 257 Southeast Sulawesi 13.9 2.9 10.6 28.0 43.3 1.4 100.0 77 Gorontalo 7.6 7.1 18.9 24.1 33.8 8.5 100.0 39 West Sulawesi 3.7 3.4 13.8 21.4 57.0 0.8 100.0 33 Maluku and Papua Maluku 7.9 5.8 12.2 30.9 38.1 5.2 100.0 47 North Maluku 11.5 8.8 12.8 30.6 32.5 3.9 100.0 35 West Papua 13.8 10.9 18.9 29.1 23.4 4.0 100.0 28 Papua 10.0 7.8 9.6 16.7 54.6 1.3 100.0 115 Total 9.8 4.7 19.8 35.3 25.0 5.5 100.0 9,236 Appendix A • 235 Table A-3.7.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to province, Indonesia 2012 Province Social security Other employer based insurance Privately purchased commercial insurance Other None Number of women Sumatera Aceh 59.3 1.5 1.5 11.4 26.8 877 North Sumatera 16.8 7.1 1.7 1.7 73.4 2,394 West Sumatera 29.0 5.1 1.5 2.2 63.5 852 Riau 15.0 10.1 4.7 4.4 67.2 1,040 Jambi 17.2 5.2 1.5 1.6 74.9 580 South Sumatera 21.5 3.5 2.5 0.2 72.8 1,358 Bengkulu 29.9 2.2 1.8 0.8 65.9 306 Lampung 32.5 2.2 0.6 1.4 63.9 1,443 Bangka Belitung 16.9 3.2 2.2 17.3 61.0 245 Riau Islands 14.8 25.8 4.8 2.9 52.9 323 Java DKI Jakarta 7.2 13.5 10.0 1.4 69.0 1,939 West Java 24.7 10.1 4.9 1.6 60.4 8,265 Central Java 26.6 4.7 1.8 2.0 65.9 6,240 DI Yogyakarta 36.5 7.7 3.8 8.8 45.5 654 East Java 22.3 5.4 1.8 0.9 70.2 7,374 Banten 17.8 14.3 3.7 1.2 63.8 2,148 Bali and Nusa Tenggara Bali 18.4 9.0 4.9 17.3 56.1 790 West Nusa Tenggara 44.8 2.2 0.8 0.2 52.1 997 East Nusa Tenggara 60.7 0.7 1.1 0.6 37.4 892 Kalimantan West Kalimantan 23.2 4.4 0.8 0.8 71.1 756 Central Kalimantan 26.4 8.3 2.0 1.2 63.0 409 South Kalimantan 23.7 7.2 3.2 1.9 64.7 730 East Kalimantan 23.3 21.9 3.8 21.2 34.2 671 Sulawesi North Sulawesi 27.7 6.0 2.1 1.1 64.2 427 Central Sulawesi 37.5 1.7 1.3 1.0 58.9 486 South Sulawesi 33.3 2.0 0.9 6.4 58.2 1,530 Southeast Sulawesi 45.6 3.0 0.9 0.6 50.4 382 Gorontalo 48.8 1.9 1.5 0.8 48.0 203 West Sulawesi 34.4 0.3 0.2 0.2 64.8 191 Maluku and Papua Maluku 44.4 2.0 0.3 0.3 53.0 260 North Maluku 33.7 2.2 0.5 13.6 50.3 188 West Papua 48.6 3.9 0.3 1.0 46.7 130 Papua 21.2 2.0 1.0 0.5 75.5 527 Total 25.7 6.9 2.9 2.6 63.0 45,607 236 • Appendix A Table A-3.7.2 Health insurance coverage: Men Percentage of currently married men age 15-54 with specific types of health insurance coverage, according to province, Indonesia 2012 Province Social security Other employer based insurance Privately purchased commercial insurance Other None Number of men Sumatera Aceh 43.2 3.0 1.3 5.6 48.6 153 North Sumatera 9.8 12.6 2.1 0.8 76.0 470 West Sumatera 13.5 10.2 3.8 0.9 72.5 164 Riau 14.7 11.7 5.2 0.4 68.2 231 Jambi 7.8 5.8 1.9 2.1 83.4 145 South Sumatera 14.2 6.4 5.6 1.3 74.3 295 Bengkulu 27.4 4.7 1.2 1.2 65.8 67 Lampung 31.0 5.0 2.7 0.7 61.8 334 Bangka Belitung 11.8 5.3 2.9 11.8 68.6 52 Riau Islands 5.7 24.3 7.4 8.4 55.7 64 Java DKI Jakarta 1.2 15.4 11.7 0.6 72.9 374 West Java 16.9 13.2 6.5 0.4 67.1 1,654 Central Java 20.9 7.0 1.7 1.2 70.0 1,224 DI Yogyakarta 26.5 6.0 8.0 5.7 55.5 135 East Java 14.5 3.9 1.9 1.2 79.7 1,621 Banten 14.2 20.9 8.1 0.3 59.9 450 Bali and Nusa Tenggara Bali 9.7 8.3 8.4 17.8 58.3 173 West Nusa Tenggara 44.9 2.1 0.7 0.0 52.3 171 East Nusa Tenggara 46.3 0.9 3.3 1.8 48.6 158 Kalimantan West Kalimantan 13.6 5.2 1.2 1.3 78.7 165 Central Kalimantan 15.2 7.2 1.6 0.8 76.5 93 South Kalimantan 19.2 10.9 2.3 3.2 64.8 152 East Kalimantan 14.7 22.5 9.5 11.7 46.5 139 Sulawesi North Sulawesi 12.0 7.4 2.0 0.0 78.7 87 Central Sulawesi 23.4 2.4 0.4 0.8 73.6 98 South Sulawesi 20.7 6.9 0.0 28.7 47.1 258 Southeast Sulawesi 26.6 3.9 0.2 3.9 65.7 77 Gorontalo (35.7) (2.9) (0.8) (4.2) (57.2) 39 West Sulawesi (24.5) (0.6) (0.7) (0.6) (73.6) 33 Maluku and Papua Maluku (28.4) (2.3) (2.2) (0.4) (66.7) 47 North Maluku (21.7) (7.4) (3.2) (5.5) (62.3) 35 West Papua (29.8) (6.8) (0.0) (0.6) (63.3) 28 Papua 18.1 2.0 3.0 0.5 76.8 120 Total 17.8 8.8 3.9 2.5 68.8 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. Appendix A • 237 Table A-3.8.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to province , Indonesia 2012 Uses tobacco Does not use tobacco Number of women Province Cigarettes Pipe Other tobacco Sumatera Aceh 1.2 0.0 0.4 98.4 877 North Sumatera 4.6 0.0 2.6 93.1 2,394 West Sumatera 2.1 0.0 0.2 97.8 852 Riau 1.9 0.0 0.1 98.0 1,040 Jambi 1.1 0.0 0.0 98.9 580 South Sumatera 1.4 0.0 0.1 98.6 1,358 Bengkulu 2.0 0.0 0.2 97.9 306 Lampung 1.7 0.0 0.1 98.2 1,443 Bangka Belitung 2.5 0.0 0.1 97.5 245 Riau Islands 6.2 0.0 0.4 93.5 323 Java DKI Jakarta 2.8 0.0 0.1 97.1 1,939 West Java 4.1 0.0 0.3 95.8 8,265 Central Java 0.7 0.0 0.2 99.1 6,240 DI Yogyakarta 0.6 0.0 0.0 99.4 654 East Java 0.9 0.1 0.0 99.1 7,374 Banten 2.3 0.0 0.3 97.5 2,148 Bali and Nusa Tenggara Bali 1.1 0.0 0.4 98.5 790 West Nusa Tenggara 0.8 0.1 0.5 98.8 997 East Nusa Tenggara 1.6 0.0 3.4 95.2 892 Kalimantan West Kalimantan 2.8 0.0 1.9 95.3 756 Central Kalimantan 5.0 0.0 2.4 93.3 409 South Kalimantan 0.6 0.1 0.0 99.4 730 East Kalimantan 2.3 0.0 0.0 97.7 671 Sulawesi North Sulawesi 6.9 0.0 0.1 93.0 427 Central Sulawesi 2.8 0.0 0.4 97.1 486 South Sulawesi 1.0 0.0 0.1 99.0 1,530 Southeast Sulawesi 1.5 0.0 1.7 96.9 382 Gorontalo 3.1 0.1 0.2 96.8 203 West Sulawesi 1.9 0.0 0.5 98.0 191 Maluku and Papua Maluku 1.0 0.0 0.7 98.3 260 North Maluku 5.4 0.0 1.2 93.6 188 West Papua 3.1 0.0 0.1 96.8 130 Papua 16.1 0.0 4.9 81.4 527 Total 2.3 0.0 0.5 97.3 45,607 238 • Appendix A Table A-3.8.2 Use of tobacco: Men Percentage of 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 province, Indonesia 2012 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 Province Cigarettes Pipe Other tobacco 0 1-2 3-5 6-9 10+ Don’t know/ missing Sumatera Aceh 84.8 0.0 1.4 13.7 153 0.5 1.9 3.5 9.6 84.6 0.0 100.0 129 North Sumatera 77.5 0.3 1.6 21.4 470 0.0 0.6 4.6 11.7 83.1 0.0 100.0 364 West Sumatera 75.7 0.0 0.5 24.3 164 1.2 3.5 4.1 9.6 81.6 0.0 100.0 124 Riau 73.4 0.0 0.6 26.3 231 0.0 3.0 5.7 7.8 83.5 0.0 100.0 169 Jambi 68.2 0.0 0.4 31.8 145 1.6 3.5 5.6 8.3 81.0 0.0 100.0 99 South Sumatera 76.2 0.0 0.0 23.8 295 1.6 3.6 9.4 11.5 73.9 0.0 100.0 225 Bengkulu 75.7 0.0 0.0 24.3 67 0.5 1.8 6.7 8.5 82.5 0.0 100.0 51 Lampung 82.9 0.0 0.0 17.1 334 0.8 3.9 17.9 15.5 62.0 0.0 100.0 277 Bangka Belitung (66.3 0.0 0.5 33.7 52 (1.4) (3.5) (2.7) (11.7) (80.7) (0.0) 100.0 34 Riau Islands 62.9 0.0 0.2 37.1 64 (0.0) (3.3) (4.0) (7.2) (85.6) (0.0) 100.0 40 Java DKI Jakarta 62.3 0.0 0.4 37.7 374 0.0 5.3 10.2 13.7 70.2 0.5 100.0 233 West Java 76.2 0.5 1.9 23.5 1,654 1.2 3.0 10.1 17.8 67.8 0.0 100.0 1,261 Central Java 69.6 0.0 3.1 30.4 1,224 0.3 7.0 14.0 17.8 60.2 0.7 100.0 852 DI Yogyakarta 59.5 0.0 0.9 40.3 135 1.5 7.7 15.5 17.7 57.6 0.0 100.0 81 East Java 70.1 0.0 0.0 29.9 1,621 1.3 6.8 9.7 15.3 66.6 0.3 100.0 1,136 Banten 77.4 0.0 0.0 22.6 450 0.0 6.5 9.6 24.4 59.2 0.3 100.0 348 Bali and Nusa Tenggara Bali 59.2 0.0 2.1 39.7 173 0.0 3.4 13.2 17.7 65.3 0.5 100.0 102 West Nusa Tenggara 84.8 0.0 13.0 15.2 171 0.0 1.0 10.4 15.6 72.5 0.5 100.0 145 East Nusa Tenggara 69.8 0.0 5.9 27.4 158 2.8 8.8 19.7 18.5 49.5 0.7 100.0 110 Kalimantan West Kalimantan 67.1 0.5 5.1 32.0 165 0.6 0.7 7.1 6.7 84.3 0.6 100.0 111 Central Kalimantan 68.7 0.0 0.4 30.8 93 0.9 2.0 3.5 11.1 82.4 0.0 100.0 64 South Kalimantan 61.9 0.0 1.4 38.1 152 0.6 0.6 6.3 9.0 83.4 0.0 100.0 94 East Kalimantan 61.5 0.0 0.0 38.5 139 1.6 4.0 7.1 8.0 79.4 0.0 100.0 85 Sulawesi North Sulawesi 70.8 0.0 0.4 29.2 87 0.5 4.9 13.6 19.9 59.8 1.3 100.0 62 Central Sulawesi 67.9 0.0 0.0 32.1 98 0.0 3.8 10.2 8.7 77.4 0.0 100.0 67 South Sulawesi 65.7 0.0 0.4 34.3 258 0.0 1.1 6.1 13.2 79.7 0.0 100.0 169 Southeast Sulawesi 77.3 0.0 2.0 22.7 77 2.0 4.3 5.7 14.8 73.3 0.0 100.0 60 Gorontalo (75.6) (0.0) (0.0) (24.4) 39 (2.4) (4.9) (18.2) (23.5) (51.0) (0.0) 100.0 30 West Sulawesi (70.6) (0.0) (1.1) (29.4) 33 (0.0) (3.5) (3.6) (7.7) (85.3) (0.0) 100.0 23 Maluku and Papua Maluku (74.5) (0.0) (18.4) (20.9) 47 (1.2) (9.2) (21.8) (17.7) (50.0) (0.0) 100.0 35 North Maluku (71.0) (0.0) (3.2) (26.3) 35 (0.0) (2.5) (13.4) (20.5) (63.2) (0.5) 100.0 25 West Papua (64.5) (0.0) (8.1) (34.4) 28 (2.2) (7.1) (4.5) (19.7) (65.6) (0.9) 100.0 18 Papua (68.7) (1.0) 3.3 30.9 120 0.0 3.1 12.5 13.7 69.9 0.7 100.0 82 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. Appendix A • 239 CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY Table A-4.1 Number of men’s wives Percent distribution of currently married men age 15-54 by number of wives, according to province, Indonesia 2012 Background characteristic Number of wives Total Number of men 1 2+ Sumatera Aceh 100.0 0.0 100.0 153 North Sumatera 99.7 0.3 100.0 470 West Sumatera 100.0 0.0 100.0 164 Riau 99.6 0.4 100.0 231 Jambi 99.7 0.3 100.0 145 South Sumatera 99.1 0.9 100.0 295 Bengkulu 100.0 0.0 100.0 67 Lampung 99.0 1.0 100.0 334 Bangka Belitung 99.5 0.5 100.0 52 Riau Islands 99.3 0.7 100.0 64 Java DKI Jakarta 99.8 0.2 100.0 374 West Java 99.1 0.9 100.0 1,654 Central Java 99.4 0.6 100.0 1,224 DI Yogyakarta 99.2 0.8 100.0 135 East Java 99.3 0.7 100.0 1,621 Banten 99.8 0.2 100.0 450 Bali and Nusa Tenggara Bali 97.9 2.1 100.0 173 West Nusa Tenggara 99.6 0.4 100.0 171 East Nusa Tenggara 97.9 2.1 100.0 158 Kalimantan West Kalimantan 99.3 0.7 100.0 165 Central Kalimantan 98.5 1.5 100.0 93 South Kalimantan 98.1 1.9 100.0 152 East Kalimantan 100.0 0.0 100.0 139 Sulawesi North Sulawesi 99.6 0.4 100.0 87 Central Sulawesi 99.7 0.3 100.0 98 South Sulawesi 99.2 0.8 100.0 258 Southeast Sulawesi 99.6 0.4 100.0 77 Gorontalo (99.1) (0.9 ) 100.0 39 West Sulawesi (99.5) (0.5 ) 100.0 33 Maluku and Papua Maluku (99.0) (1.0) 100.0 47 North Maluku (99.6) (0.4) 100.0 35 West Papua (98.8) (1.2) 100.0 28 Papua 95.6 4.4 100.0 120 Total 99.3 0.7 100.0 9,306 Note: Figures in parentheses are based on 25-49 unweighted cases. 240 • Appendix A Table A-4.2 Median age at first marriage by province 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 25-54, according to province, Indonesia 2012 Women age Ever-married women age Currently married men age 25-54 Province 20-49 25-49 20-49 25-49 Sumatera Aceh a 21.2 a 20.7 a North Sumatera a 22.0 a 21.6 24.9 West Sumatera a 21.7 a 21.3 a Riau a 20.8 a 20.6 24.3 Jambi 19.4 19.3 19.0 19.1 23.6 South Sumatera a 20.3 19.9 20.0 23.6 Bengkulu 19.9 19.8 19.5 19.6 24.0 Lampung 20.0 19.7 19.7 19.7 24.5 Bangka Belitung a 20.0 19.6 19.8 23.8 Riau Islands a 22.9 a 22.3 a Java DKI Jakarta a 23.1 a 22.3 a West Java 19.9 19.6 19.4 19.4 24.1 Central Java a 20.3 a 20.1 24.5 DI Yogyakarta a 22.9 a 22.5 a East Java 19.9 19.8 19.4 19.5 24.0 Banten 19.9 19.5 19.3 19.3 24.2 Bali and Nusa Tenggara Bali a 21.9 a 21.5 24.6 West Nusa Tenggara a 19.9 19.4 19.5 23.5 East Nusa Tenggara a 22.1 a 21.6 a Kalimantan West Kalimantan 19.6 19.5 19.2 19.3 23.3 Central Kalimantan 19.4 19.2 19.0 19.0 23.1 South Kalimantan 19.5 19.3 18.9 19.0 23.8 East Kalimantan a 20.5 a 20.2 24.9 Sulawesi North Sulawesi a 21.3 a 21.0 23.7 Central Sulawesi 19.8 19.7 19.3 19.5 23.5 South Sulawesi a 21.1 19.9 20.2 24.3 Southeast Sulawesi 19.6 19.3 19.0 19.0 23.5 Gorontalo a 20.3 19.7 20.0 22.9 West Sulawesi 19.9 19.8 18.9 19.1 23.4 Maluku and Papua Maluku a 21.7 a 21.2 24.3 North Maluku a 20.7 a 20.3 23.9 West Papua a 21.0 a 20.7 24.8 Papua 19.8 19.9 19.3 19.6 23.3 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 Appendix A • 241 Table A-4.3 Median age at first sexual intercourse by province 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 25-54, according to province, Indonesia 2012 Women age Ever-married women age Married men age 25-54 Province 20-49 25-49 20-49 25-49 Sumatera Aceh a 21.6 a 21.0 a North Sumatera a 22.1 a 21.8 24.5 West Sumatera a 22.4 a 22.0 a Riau a 21.1 a 20.9 24.1 Jambi 19.7 19.6 19.3 19.4 23.3 South Sumatera a 20.5 a 20.3 23.4 Bengkulu a 20.0 19.6 19.8 24.1 Lampung a 20.0 19.9 19.9 24.4 Bangka Belitung a 20.2 19.8 20.0 23.5 Riau Islands a 23.5 a 22.8 25.0 Java DKI Jakarta a 23.4 a 22.6 a West Java a 20.0 19.7 19.8 23.8 Central Java a 20.5 a 20.3 24.3 DI Yogyakarta a 23.0 a 22.5 a East Java a 20.0 19.7 19.8 23.5 Banten a 19.9 19.6 19.7 24.1 Bali and Nusa Tenggara Bali a 21.0 a 20.7 22.4 West Nusa Tenggara a 20.0 19.5 19.6 22.5 East Nusa Tenggara a 22.2 a 21.6 22.8 Kalimantan West Kalimantan a 20.3 19.7 20.0 22.9 Central Kalimantan 19.5 19.5 19.1 19.3 22.4 South Kalimantan 19.6 19.4 19.0 19.1 23.8 East Kalimantan a 20.6 a 20.3 23.9 Sulawesi North Sulawesi a 21.0 a 20.8 20.0 Central Sulawesi a 20.0 19.5 19.7 21.5 South Sulawesi a 21.5 a 20.6 23.0 Southeast Sulawesi 19.8 19.6 19.2 19.3 21.7 Gorontalo a 20.5 19.8 20.3 21.5 West Sulawesi a 20.2 19.2 19.4 21.6 Maluku and Papua Maluku a 21.1 a 20.6 20.4 North Maluku a 20.8 a 20.4 20.2 West Papua a 20.9 a 20.6 20.8 Papua 19.7 19.8 19.2 19.5 20.8 Total a 20.6 a 20.3 23.8 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 242 • Appendix A Table A-4.4 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to province, Indonesia 2012 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Province Within the past 4 weeks Within 1 year1 One or more years Missing Sumatera Aceh 54.6 7.0 5.8 1.6 31.0 100.0 877 North Sumatera 54.9 9.3 6.0 0.4 29.4 100.0 2,394 West Sumatera 57.9 10.1 4.9 0.6 26.5 100.0 852 Riau 63.2 12.5 3.6 0.4 20.3 100.0 1,040 Jambi 66.5 10.7 5.1 0.1 17.5 100.0 580 South Sumatera 65.4 11.3 3.4 0.1 19.8 100.0 1,358 Bengkulu 61.9 11.6 5.3 0.5 20.7 100.0 306 Lampung 65.8 10.9 4.0 0.4 18.9 100.0 1,443 Bangka Belitung 63.6 10.4 4.9 0.3 20.7 100.0 245 Riau Islands 55.5 12.9 5.1 1.5 25.0 100.0 323 Java DKI Jakarta 54.1 10.3 6.0 0.2 29.5 100.0 1,939 West Java 61.8 12.3 6.2 0.3 19.5 100.0 8,265 Central Java 55.4 16.6 6.3 0.6 21.2 100.0 6,240 DI Yogyakarta 58.0 10.5 5.4 0.1 26.1 100.0 654 East Java 59.9 14.9 7.0 1.1 17.2 100.0 7,374 Banten 62.8 9.2 5.0 0.2 22.8 100.0 2,148 Bali and Nusa Tenggara Bali 63.5 12.0 5.1 0.0 19.4 100.0 790 West Nusa Tenggara 50.4 14.5 13.5 0.1 21.6 100.0 997 East Nusa Tenggara 44.2 16.4 11.4 0.4 27.6 100.0 892 Kalimantan West Kalimantan 62.0 13.7 7.2 0.0 17.1 100.0 756 Central Kalimantan 67.7 10.2 5.3 0.8 15.9 100.0 409 South Kalimantan 64.3 8.9 6.6 0.7 19.6 100.0 730 East Kalimantan 60.9 12.2 4.8 0.8 21.4 100.0 671 Sulawesi North Sulawesi 62.9 11.8 4.5 0.4 20.4 100.0 427 Central Sulawesi 61.1 13.6 5.8 0.0 19.4 100.0 486 South Sulawesi 50.5 12.6 6.8 0.8 29.3 100.0 1,530 Southeast Sulawesi 58.0 13.7 6.8 0.2 21.4 100.0 382 Gorontalo 58.5 14.4 4.3 0.1 22.7 100.0 203 West Sulawesi 55.2 10.3 6.1 2.0 26.3 100.0 191 Maluku and Papua Maluku 52.6 13.9 6.2 0.3 27.0 100.0 260 North Maluku 54.7 14.2 7.5 0.2 23.5 100.0 188 West Papua 50.1 16.5 8.5 3.7 21.2 100.0 130 Papua 54.7 12.3 14.8 1.1 17.1 100.0 527 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 Appendix A • 243 CHAPTER 5 FERTILITY Table A-5.1 Fertility by province Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by province, Indonesia 2012 Province Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Sumatera Aceh 2.8 5.2 3.9 North Sumatera 3.0 5.8 4.0 West Sumatera 2.8 5.7 3.5 Riau 2.9 6.1 4.0 Jambi 2.3 5.3 3.4 South Sumatera 2.8 4.6 3.3 Bengkulu 2.2 6.1 3.5 Lampung 2.7 4.8 3.6 Bangka Belitung 2.6 4.3 3.5 Riau Islands 2.6 4.7 3.2 Java DKI Jakarta 2.3 4.1 2.6 West Java 2.5 4.4 3.4 Central Java 2.5 4.0 2.8 DI Yogyakarta 2.1 3.4 2.3 East Java 2.3 2.9 2.6 Banten 2.5 3.7 3.8 Bali and Nusa Tenggara Bali 2.3 3.1 2.5 West Nusa Tenggara 2.8 4.8 3.7 East Nusa Tenggara 3.3 6.2 4.2 Kalimantan West Kalimantan 3.1 5.3 3.7 Central Kalimantan 2.8 5.5 3.6 South Kalimantan 2.5 3.8 3.2 East Kalimantan 2.8 5.2 3.4 Sulawesi North Sulawesi 2.6 3.6 2.7 Central Sulawesi 3.2 5.3 3.9 South Sulawesi 2.6 3.9 3.3 Southeast Sulawesi 3.0 5.7 4.1 Gorontalo 2.6 4.1 3.4 West Sulawesi 3.6 4.6 4.3 Maluku and Papua Maluku 3.2 4.5 4.2 North Maluku 3.1 5.3 4.0 West Papua 3.7 5.2 3.9 Papua 3.5 2.5 3.9 Total 2.6 4.3 3.2 244 • Appendix A Table A-5.2 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 province, Indonesia 2012 Months since preceding birth Total Number of non-first births Median number of months since preceding birth Province 7-17 18-23 24-35 36-47 48-59 60+ Sumatera Aceh 5.8 8.6 16.6 15.8 16.9 36.5 100.0 235 50.5 North Sumatera 6.1 10.5 25.9 18.5 14.5 24.5 100.0 706 40.2 West Sumatera 4.0 7.4 17.4 16.0 14.8 40.4 100.0 216 51.4 Riau 4.3 8.4 16.8 17.5 10.8 42.2 100.0 311 50.3 Jambi 5.8 4.3 10.3 11.6 13.1 54.9 100.0 128 66.8 South Sumatera 5.3 5.9 12.1 12.6 10.7 53.4 100.0 333 62.7 Bengkulu 3.1 2.4 11.5 18.9 10.5 53.6 100.0 70 63.8 Lampung 2.2 3.3 10.2 9.9 11.0 63.4 100.0 306 - Bangka Belitung 4.7 3.9 10.8 11.4 13.8 55.4 100.0 64 64.2 Riau Islands 6.2 7.6 16.1 18.2 15.1 36.9 100.0 91 48.8 Java DKI Jakarta 5.6 5.8 12.7 14.4 12.4 49.1 100.0 353 59.5 West Java 2.3 4.5 11.4 12.1 11.3 58.3 100.0 1,911 67.5 Central Java 3.3 3.7 10.0 8.7 9.5 65.0 100.0 1,100 - DI Yogyakarta 3.5 5.4 11.6 12.8 7.5 59.2 100.0 102 67.2 East Java 4.3 4.4 8.5 11.3 10.9 60.7 100.0 1,291 69.2 Banten 2.8 3.6 13.1 11.5 9.9 59.0 100.0 500 69.1 Bali and Nusa Tenggara Bali 4.7 7.2 11.8 17.4 13.3 45.5 100.0 143 55.2 West Nusa Tenggara 3.1 4.7 13.8 11.3 16.3 50.9 100.0 223 60.7 East Nusa Tenggara 6.8 8.7 27.1 19.6 14.1 23.7 100.0 319 41.3 Kalimantan West Kalimantan 2.9 3.8 15.5 14.1 13.0 50.7 100.0 203 60.6 Central Kalimantan 6.1 6.8 8.6 11.8 13.0 53.7 100.0 104 63.2 South Kalimantan 4.2 5.7 7.8 12.3 11.6 58.3 100.0 158 67.8 East Kalimantan 3.9 6.3 17.0 16.3 15.5 41.1 100.0 179 53.3 Sulawesi North Sulawesi 2.6 7.0 15.0 13.1 12.5 49.9 100.0 99 58.7 Central Sulawesi 10.1 8.6 19.2 14.2 12.3 35.6 100.0 150 45.1 South Sulawesi 6.0 7.5 19.5 13.5 12.3 41.1 100.0 404 49.7 Southeast Sulawesi 5.8 7.0 15.4 19.6 17.0 35.2 100.0 125 48.9 Gorontalo 5.2 6.5 16.1 15.8 11.2 45.1 100.0 50 51.5 West Sulawesi 7.6 11.9 24.3 15.7 14.6 25.9 100.0 72 38.9 Maluku and Papua Maluku 11.6 15.7 24.6 15.1 10.0 23.1 100.0 95 35.1 North Maluku 6.8 9.8 24.2 14.2 10.3 34.6 100.0 61 44.4 West Papua 11.6 13.6 23.3 15.3 10.7 25.4 100.0 51 36.5 Papua 10.5 17.8 23.8 14.9 8.1 24.8 100.0 204 35.1 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. Appendix A • 245 Table A-5.3 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 province, Indonesia 2012 Province Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Sumatera Aceh 3.8 2.7 4.2 North Sumatera 4.2 2.3 5.0 West Sumatera 2.2 2.4 3.1 Riau 2.9 2.4 3.7 Jambi 3.6 2.5 3.8 South Sumatera 3.1 3.2 4.1 Bengkulu 2.2 1.4 2.3 Lampung 2.2 2.0 2.8 Bangka Belitung 2.4 1.7 2.6 Riau Islands 2.3 1.9 2.3 Java DKI Jakarta 2.4 2.3 3.4 West Java 2.1 2.1 2.4 Central Java 2.3 2.3 3.6 DI Yogyakarta 4.9 3.1 6.1 East Java 2.1 2.9 4.7 Banten 2.1 1.9 3.2 Bali and Nusa Tenggara Bali 3.0 2.4 3.5 West Nusa Tenggara 3.4 2.2 4.2 East Nusa Tenggara 5.3 4.6 11.5 Kalimantan West Kalimantan 2.1 2.4 2.9 Central Kalimantan 2.8 2.6 3.6 South Kalimantan 2.5 2.9 3.5 East Kalimantan 1.8 2.3 3.2 Sulawesi North Sulawesi 1.0 3.2 3.6 Central Sulawesi 3.3 2.2 3.7 South Sulawesi 3.0 2.2 3.8 Southeast Sulawesi 4.4 3.6 6.6 Gorontalo 2.1 2.6 4.1 West Sulawesi 4.0 1.9 4.4 Maluku and Papua Maluku 3.1 2.9 11.2 North Maluku 6.0 2.0 9.6 West Papua 2.3 3.4 4.2 Papua 6.5 8.4 10.3 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 246 • Appendix A Table A-5.5 Median age at first birth Median age at first birth among women age 25-49 years, according to province, Indonesia 2012 Women age 25-49 Province Sumatera Aceh 22.8 North Sumatera 23.2 West Sumatera 23.3 Riau 22.2 Jambi 21.0 South Sumatera 21.9 Bengkulu 21.2 Lampung 21.0 Bangka Belitung 21.3 Riau Islands 24.6 Java DKI Jakarta 24.4 West Java 21.5 Central Java 21.9 DI Yogyakarta 24.3 East Java 21.8 Banten 21.1 Bali and Nusa Tenggara Bali 23.2 West Nusa Tenggara 21.7 East Nusa Tenggara 23.4 Kalimantan West Kalimantan 20.9 Central Kalimantan 20.9 South Kalimantan 21.2 East Kalimantan 21.9 Sulawesi North Sulawesi 22.0 Central Sulawesi 21.3 South Sulawesi 22.9 Southeast Sulawesi 21.1 Gorontalo 21.8 West Sulawesi 21.7 Maluku and Papua Maluku 22.8 North Maluku 21.9 West Papua 22.1 Papua 21.7 Total 22.0 Appendix A • 247 Table A-5.6 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 province, Indonesia 2012 Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Province Have had a live birth Are pregnant with first child Sumatera Aceh 3.0 2.2 5.2 142 North Sumatera 3.1 1.6 4.7 455 West Sumatera 1.4 1.9 3.3 145 Riau 4.4 1.5 5.8 144 Jambi 12.6 3.8 16.4 87 South Sumatera 9.1 2.8 11.9 190 Bengkulu 4.7 4.1 8.8 49 Lampung 8.1 3.8 11.9 220 Bangka Belitung 9.7 1.9 11.6 37 Riau Islands 4.4 0.4 4.8 36 Java DKI Jakarta 2.4 1.6 4.1 278 West Java 7.6 3.6 11.2 1,260 Central Java 4.7 1.1 5.7 943 DI Yogyakarta 4.7 1.4 6.1 96 East Java 8.0 2.1 10.1 931 Banten 6.2 1.3 7.5 358 Bali and Nusa Tenggara Bali 6.8 2.1 8.9 106 West Nusa Tenggara 8.4 3.8 12.3 152 East Nusa Tenggara 4.1 2.2 6.3 159 Kalimantan West Kalimantan 19.8 3.1 22.9 114 Central Kalimantan 16.7 3.8 20.5 59 South Kalimantan 12.7 3.7 16.4 114 East Kalimantan 9.3 3.7 13.0 100 Sulawesi North Sulawesi 10.8 4.2 15.0 71 Central Sulawesi 14.5 5.2 19.7 79 South Sulawesi 6.7 3.9 10.6 274 Southeast Sulawesi 10.7 5.1 15.8 62 Gorontalo 8.8 4.9 13.6 35 West Sulawesi 15.5 1.6 17.1 33 Maluku and Papua Maluku 5.4 2.6 7.9 47 North Maluku 9.2 2.6 11.8 35 West Papua 13.0 4.3 17.3 22 Papua 11.8 2.5 14.3 93 Total 7.0 2.5 9.5 6,927 248 • Appendix A CHAPTER 6 FERTILITY PREFERENCES Table A-6.1.1 Desire to limit childbearing: Women Percentage of currently married women age 15-49 who want no more children, by number of living children, according to province, Indonesia 2012 Number of living children Total Province 0 1 2 3 4 5 6+ Sumatera Aceh 0.0 4.6 21.4 46.9 63.5 72.6 65.6 32.6 North Sumatera 3.1 8.1 45.1 82.6 87.7 92.2 90.5 56.0 West Sumatera 0.0 5.3 41.1 73.4 81.3 (90.4) * 46.6 Riau 1.7 5.5 41.5 68.8 92.1 93.5 92.9 48.2 Jambi 0.0 5.8 55.3 78.9 88.4 (91.7) * 47.8 South Sumatera 0.0 10.0 53.5 86.4 95.4 (92.8) * 49.8 Bengkulu 0.0 5.0 55.6 85.0 93.0 (82.6) * 53.8 Lampung (1.8) 5.9 55.7 81.2 88.7 (88.4) (94.9) 48.7 Bangka Belitung (8.2) 8.2 57.4 75.5 92.7 * * 51.4 Riau Islands 0.0 13.7 45.1 76.7 86.9 (100.0) * 47.3 Java DKI Jakarta 1.7 8.8 62.0 86.9 89.8 * * 48.5 West Java 2.0 9.0 62.5 84.6 81.6 (89.0) 86.6 51.7 Central Java 0.0 13.7 73.0 91.5 94.3 * * 55.5 DI Yogyakarta 1.6 19.9 87.9 97.0 97.3 * * 62.8 East Java 5.0 14.7 73.7 94.1 87.1 (92.5) * 53.4 Banten 3.0 4.9 44.4 70.0 74.0 81.6 (85.8) 40.8 Bali and Nusa Tenggara Bali 7.0 25.1 80.0 87.0 93.4 * * 63.6 West Nusa Tenggara 0.0 6.5 27.9 56.4 79.6 (90.8) * 33.0 East Nusa Tenggara 0.0 6.7 35.7 58.4 79.2 96.6 90.7 50.2 Kalimantan West Kalimantan (8.8) 5.9 45.8 68.1 81.4 (83.4) (85.9) 45.0 Central Kalimantan (5.5) 5.8 53.2 73.5 78.0 (80.6) * 44.2 South Kalimantan 6.0 10.7 53.1 77.0 65.2 * * 43.6 East Kalimantan (8.3) 7.3 56.4 72.5 84.5 (93.5) (93.6) 50.3 Sulawesi North Sulawesi (6.8) 16.6 65.1 84.9 91.1 (89.5) * 57.0 Central Sulawesi 0.0 11.0 47.9 64.3 82.4 (73.5) (82.0) 46.9 South Sulawesi 4.7 8.3 34.8 56.7 67.3 77.5 83.2 40.3 Southeast Sulawesi (4.9) 3.6 34.2 52.9 66.9 (68.8) (88.5) 39.8 Gorontalo 3.6 12.5 55.4 77.1 84.9 (90.7) * 49.3 West Sulawesi 0.0 6.6 23.8 46.4 50.7 70.9 74.6 35.2 Maluku and Papua Maluku (2.0) 11.5 51.6 60.9 78.5 80.4 90.3 51.7 North Maluku (4.6) 9.2 33.0 59.2 76.3 (84.1) (86.5) 43.5 West Papua 5.6 7.5 38.4 58.4 77.8 (71.0) (73.8) 40.1 Papua 0.0 7.6 32.1 37.6 56.4 (64.9) (71.1) 29.7 Total 2.7 10.7 60.6 80.3 83.2 88.1 88.1 50.1 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Appendix A • 249 Table A-6.1.2 Desire to limit childbearing: Men Percentage of currently married men age 15-54 who want no more children, by number of living children, according to province, Indonesia 2012 Number of living children Total Province 0 1 2 3 4 5 6+ Sumatera Aceh * 2.6 15.8 26.8 * * * 23.3 North Sumatera * 3.4 45.2 73.0 82.8 (85.1) (84.5) 54.0 West Sumatera * 5.4 26.3 56.3 * * * 35.0 Riau * 2.5 39.9 48.7 (74.1) * * 37.9 Jambi * 2.8 38.7 65.6 (73.3) * * 38.3 South Sumatera * 4.4 58.7 74.6 (89.3) * * 49.0 Bengkulu * 8.0 49.8 (82.2) (92.5) * * 49.5 Lampung * 2.1 40.4 77.6 (76.2) * * 41.2 Bangka Belitung * 2.9 38.6 51.0 * * * 33.8 Riau Islands * 1.3 24.4 (48.6) * * * 25.0 Java DKI Jakarta 0.0 11.9 50.7 80.3 (77.5) * * 44.2 West Java 0.0 11.3 53.2 72.3 (82.0) * * 46.0 Central Java * 7.9 70.3 86.3 (84.6) * * 52.7 DI Yogyakarta * 24.2 76.9 92.5 * * * 58.9 East Java 0.0 11.0 68.8 81.8 * * * 49.4 Banten * 3.4 42.0 67.6 67.3 * * 38.6 Bali and Nusa Tenggara Bali (8.9) 26.9 75.0 81.4 * * * 61.1 West Nusa Tenggara * 1.7 32.4 (48.9) (55.8) * * 32.1 East Nusa Tenggara * (8.7) 30.9 (43.5) (88.1) * * 43.8 Kalimantan West Kalimantan * 9.9 39.6 (65.9) (79.9) * * 43.4 Central Kalimantan * 4.4 54.3 (74.0) * * * 43.5 South Kalimantan 0.0 4.8 36.5 (56.6) * * * 30.1 East Kalimantan * 2.2 36.6 (71.4) * * * 40.3 Sulawesi North Sulawesi * 18.6 51.4 (80.3) * * * 49.0 Central Sulawesi * 3.5 36.6 43.5 * * * 32.0 South Sulawesi * 0.0 28.4 37.5 (55.6) * * 31.1 Southeast Sulawesi * (2.4) 19.6 (38.6) (47.0) * * 31.8 Gorontalo * 12.6 33.6 (36.0) 82.2 * * 33.2 West Sulawesi * (3.0) (40.3) (27.8) (36.3) * * 28.4 Maluku and Papua Maluku * (10.4) 46.4 (61.7) * * * 49.3 North Maluku * 3.1 28.2 55.4 * * * 36.8 West Papua * (8.5) 33.7 (52.6) (61.9) * * 41.6 Papua (3.1) (9.9) (29.7) (27.6) (55.5) * * 29.0 Total 0.7 8.5 53.7 70.0 76.4 81.5 81.1 45.0 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 250 • Appendix A Table A-6.2 Mean ideal number of children Mean ideal number of children for ever-married women age 15-49, all women age 15-49, and married men age 15-54 by province, Indonesia 2012 Province Ever-married women All women Married men Mean Number of women1 Mean Number of women1 Mean Number of women1 Sumatera Aceh 3.8 479 3.5 701 4.1 114 North Sumatera 3.2 1,604 3.0 2,244 3.3 427 West Sumatera 2.9 568 2.8 783 3.1 130 Riau 2.8 699 2.7 891 3.2 194 Jambi 2.6 405 2.6 495 2.9 133 South Sumatera 2.7 1,026 2.6 1,278 3.0 258 Bengkulu 2.8 224 2.6 283 2.9 63 Lampung 2.6 1,104 2.6 1,374 2.8 302 Bangka Belitung 2.7 181 2.7 230 3.0 46 Riau Islands 2.7 213 2.6 282 2.9 62 Java DKI Jakarta 2.5 1,258 2.4 1,795 2.6 316 West Java 2.6 5,856 2.6 7,358 2.7 1,524 Central Java 2.5 4,712 2.4 5,945 2.6 1,176 DI Yogyakarta 2.2 471 2.2 644 2.3 130 East Java 2.4 5,873 2.3 7,078 2.6 1,428 Banten 3.0 1,346 2.9 1,783 3.1 367 Bali and Nusa Tenggara Bali 2.3 597 2.2 759 2.4 172 West Nusa Tenggara 3.0 680 2.9 875 3.4 131 East Nusa Tenggara 3.4 568 3.1 814 3.5 137 Kalimantan West Kalimantan 2.8 556 2.7 675 3.0 147 Central Kalimantan 2.8 307 2.7 363 3.0 86 South Kalimantan 2.7 473 2.6 601 2.5 126 East Kalimantan 2.6 462 2.5 596 2.9 118 Sulawesi North Sulawesi 2.2 316 2.1 391 2.3 79 Central Sulawesi 2.6 358 2.5 446 3.4 91 South Sulawesi 2.8 913 2.6 1,313 3.1 161 Southeast Sulawesi 3.1 277 3.0 355 3.8 75 Gorontalo 2.5 145 2.4 186 2.5 28 West Sulawesi 3.5 122 3.2 164 4.0 29 Maluku and Papua Maluku 3.1 180 2.9 256 3.5 46 North Maluku 3.0 113 2.8 157 3.3 32 West Papua 2.6 74 2.5 99 4.1 24 Papua 3.3 379 3.1 469 3.8 99 Total 2.7 32,537 2.6 41,683 2.8 8,250 1 Number of women and men who gave a numeric response Appendix A • 251 Table A-6.3 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by province, Indonesia 2012 Province Total wanted fertility rates Total fertility rate Sumatera Aceh 2.1 2.8 North Sumatera 2.3 3.0 West Sumatera 2.2 2.8 Riau 2.1 2.9 Jambi 1.7 2.3 South Sumatera 2.3 2.8 Bengkulu 1.8 2.2 Lampung 2.3 2.7 Bangka Belitung 2.1 2.6 Riau Islands 1.8 2.6 Java DKI Jakarta 1.8 2.3 West Java 1.9 2.5 Central Java 2.1 2.5 DI Yogyakarta 1.8 2.1 East Java 2.0 2.3 Banten 1.9 2.5 Bali and Nusa Tenggara Bali 1.9 2.3 West Nusa Tenggara 2.2 2.8 East Nusa Tenggara 2.5 3.3 Kalimantan West Kalimantan 2.3 3.1 Central Kalimantan 2.2 2.8 South Kalimantan 2.0 2.5 East Kalimantan 2.0 2.8 Sulawesi North Sulawesi 1.8 2.6 Central Sulawesi 2.2 3.2 South Sulawesi 1.8 2.6 Southeast Sulawesi 2.3 3.0 Gorontalo 1.9 2.6 West Sulawesi 2.5 3.6 Maluku and Papua Maluku 2.4 3.2 North Maluku 2.2 3.1 West Papua 1.9 3.7 Papua 2.4 3.5 Total 2.0 2.6 Note: Rates are calculated based on births to women age 15- 49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2. 252 • Appendix A CHAPTER 7 FAMILY PLANNING Table A-7.1 Knowledge of contraceptive methods by province Percentage of women age 15-49 and currently married men age 15-54 who have heard of at least one contraceptive method and who have heard of at least one modern method by province, Indonesia 2012 Women Men Province Heard of any method Heard of any modern method1 Number Heard of any method Heard of any modern method1 Number Sumatera Aceh 96.6 96.6 877 93.8 93.8 153 North Sumatera 95.7 95.5 2,394 95.2 94.9 470 West Sumatera 98.1 98.1 852 100.0 100.0 164 Riau 99.3 99.3 1,040 97.6 97.6 231 Jambi 99.5 99.5 580 98.9 98.6 145 South Sumatera 98.3 98.3 1,358 99.2 99.2 295 Bengkulu 99.7 99.6 306 98.1 98.1 67 Lampung 99.1 99.1 1,443 99.0 99.0 334 Bangka Belitung 99.4 99.2 245 97.5 97.5 52 Riau Islands 99.5 99.5 323 100.0 100.0 64 Java DKI Jakarta 99.3 99.3 1,939 99.7 99.7 374 West Java 99.0 98.9 8,265 98.5 98.5 1,654 Central Java 99.2 99.1 6,240 97.2 96.9 1,224 DI Yogyakarta 99.8 99.8 654 100.0 100.0 135 East Java 98.8 98.8 7,374 97.3 97.3 1,621 Banten 98.9 98.9 2,148 99.3 99.3 450 Bali and Nusa Tenggara Bali 97.5 97.4 790 98.5 98.5 173 West Nusa Tenggara 99.4 99.4 997 97.1 97.1 171 East Nusa Tenggara 94.7 94.3 892 95.7 94.7 158 Kalimantan West Kalimantan 98.0 98.0 756 97.5 97.5 165 Central Kalimantan 99.0 98.9 409 98.6 97.0 93 South Kalimantan 98.9 98.9 730 98.9 98.9 152 East Kalimantan 98.7 98.6 671 97.9 97.9 139 Sulawesi North Sulawesi 99.0 99.0 427 97.9 97.9 87 Central Sulawesi 97.6 97.4 486 95.5 95.0 98 South Sulawesi 97.1 97.0 1,530 95.4 93.8 258 Southeast Sulawesi 97.5 97.5 382 96.7 96.7 77 Gorontalo 98.6 98.6 203 97.3 97.3 39 West Sulawesi 95.1 95.1 191 92.5 91.9 33 Maluku and Papua Maluku 95.6 95.2 260 96.8 95.9 47 North Maluku 97.6 97.4 188 93.1 92.6 35 West Papua 91.6 91.0 130 91.6 88.9 28 Papua 58.8 57.1 527 66.4 65.0 120 Total 98.0 98.0 45,607 97.3 97.2 9,306 na = Not applicable 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception Appendix A • 253 Table A-7.2.1 Exposure to family planning messages through mass media: Currently married women Percentage of currently married women age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper in the past few months, according to province, Indonesia 2012 Province Radio Television Newspaper/ magazine Poster Pamphlet None of these five media sources Number of women Sumatera Aceh 5.4 27.1 9.6 18.6 16.8 62.0 558 North Sumatera 7.4 25.4 6.9 17.0 15.3 63.9 1,564 West Sumatera 12.4 62.2 20.8 33.4 18.2 31.6 588 Riau 8.6 44.2 17.0 34.0 22.8 41.6 791 Jambi 7.7 47.8 11.4 23.1 8.8 45.7 452 South Sumatera 7.0 43.5 9.0 20.3 10.9 51.1 1,051 Bengkulu 9.3 50.6 15.6 24.0 11.6 40.7 230 Lampung 6.0 42.1 8.0 21.1 7.1 50.9 1,118 Bangka Belitung 9.8 37.7 11.8 34.5 6.5 41.1 183 Riau Islands 11.0 40.3 17.5 31.5 14.1 44.1 228 Java DKI Jakarta 11.9 72.9 31.3 46.2 28.6 18.4 1,261 West Java 9.7 58.0 13.9 27.9 14.8 36.9 6,170 Central Java 10.1 38.7 13.3 24.2 13.4 51.0 4,657 DI Yogyakarta 15.5 40.8 23.5 34.8 18.2 39.0 456 East Java 11.0 40.6 13.2 25.5 10.8 47.6 5,765 Banten 8.9 62.2 17.7 31.3 18.0 31.5 1,557 Bali and Nusa Tenggara Bali 12.5 44.8 14.6 22.7 11.7 49.0 589 West Nusa Tenggara 8.1 39.4 5.3 18.0 5.3 56.0 686 East Nusa Tenggara 12.6 29.8 13.7 37.3 18.8 50.3 584 Kalimantan West Kalimantan 3.1 17.7 4.2 9.2 3.4 76.8 591 Central Kalimantan 4.4 28.4 10.5 16.7 7.3 65.3 325 South Kalimantan 4.2 29.1 9.1 30.1 10.1 55.1 536 East Kalimantan 7.3 44.0 15.0 31.0 16.7 43.1 498 Sulawesi North Sulawesi 7.5 49.4 15.9 24.9 13.5 44.6 316 Central Sulawesi 11.2 52.7 13.2 26.2 9.6 40.5 362 South Sulawesi 12.3 59.8 17.1 31.1 13.0 34.5 1,000 Southeast Sulawesi 10.7 47.4 12.6 20.5 9.7 48.3 282 Gorontalo 23.9 49.7 16.7 29.6 19.3 43.2 149 West Sulawesi 3.5 27.6 5.6 16.7 5.1 64.1 131 Maluku and Papua Maluku 5.0 26.7 6.8 7.8 3.2 69.7 175 North Maluku 5.5 30.4 10.5 15.3 7.0 62.9 131 West Papua 12.9 32.4 12.4 29.1 17.2 54.1 94 Papua 5.4 21.3 10.0 16.5 12.0 70.9 384 Total 9.5 45.3 13.6 26.2 13.6 45.8 33,465 254 • Appendix A Table A-7.2.2 Exposure to family planning messages through mass media: Men Percentage of currently married men age 15-54 who heard or saw a family planning message on radio, on television or in a newspaper in the past few months, according to province, Indonesia 2012 Province Radio Television Newspaper/ magazine Poster Pamphlet None of these five media sources Number of men Sumatera Aceh 9.7 31.9 19.7 24.7 30.2 50.3 153 North Sumatera 11.6 59.2 21.6 47.2 29.3 24.4 470 West Sumatera 7.1 38.0 14.5 29.1 31.5 36.5 164 Riau 8.8 49.0 21.2 43.6 31.0 36.8 231 Jambi 7.3 30.3 14.1 19.4 19.7 59.6 145 South Sumatera 8.2 32.0 15.0 17.9 6.7 59.0 295 Bengkulu 7.7 39.3 21.7 29.9 12.8 47.7 67 Lampung 11.6 58.9 15.5 22.6 11.2 35.4 334 Bangka Belitung 12.0 41.7 16.9 13.7 6.2 47.3 52 Riau Islands 5.8 39.9 14.5 20.9 6.5 50.5 64 Java DKI Jakarta 8.2 49.0 22.4 48.6 12.9 28.6 374 West Java 16.2 63.0 25.4 37.5 18.9 25.5 1,654 Central Java 12.8 49.2 21.6 40.2 14.8 36.7 1,224 DI Yogyakarta 19.0 45.3 33.1 42.5 16.8 33.2 135 East Java 14.4 42.5 17.6 45.5 28.3 36.2 1,621 Banten 13.6 47.0 16.3 39.9 14.4 36.7 450 Bali and Nusa Tenggara Bali 16.4 51.2 21.9 20.7 11.6 43.7 173 West Nusa Tenggara 9.7 30.9 9.1 11.6 2.4 61.9 171 East Nusa Tenggara 16.3 20.3 17.8 37.7 16.8 50.7 158 Kalimantan West Kalimantan 6.6 41.1 10.4 24.2 6.8 53.3 165 Central Kalimantan 5.6 47.5 16.0 21.0 5.7 44.5 93 South Kalimantan 13.5 56.7 22.2 49.7 9.0 28.9 152 East Kalimantan 8.3 39.6 14.4 26.9 7.6 49.7 139 Sulawesi North Sulawesi 14.1 48.3 21.1 22.2 11.1 47.0 87 Central Sulawesi 7.1 31.4 9.0 18.5 10.4 61.2 98 South Sulawesi 5.7 38.2 12.2 15.8 5.7 56.8 258 Southeast Sulawesi 7.1 44.8 12.3 20.1 12.6 47.8 77 Gorontalo 18.3 52.9 16.1 22.0 8.7 40.4 39 West Sulawesi 4.8 34.1 10.6 16.5 10.9 57.5 33 Maluku and Papua Maluku 13.5 42.5 16.7 15.3 14.0 54.0 47 North Maluku 11.7 34.4 16.5 23.5 6.1 59.8 35 West Papua 12.8 39.8 17.1 37.0 21.2 41.2 28 Papua 15.7 25.8 15.7 22.7 20.0 63.8 120 Total 12.5 47.7 19.4 35.7 18.0 38.0 9,306 Appendix A • 255 Table A-7.3 Exposure to family planning messages through personal contact: Currently married women Percentage of currently married women age 15-49 who heard or saw a family planning message through personal contact in the past 6 months, according to province, Indonesia 2012 Province Family planning officer Teacher Religious leader Doctor Nurse/ midwife Village leader Women’s group Pharmacist Number Sumatera Aceh 9.1 1.1 2.2 5.9 23.9 0.5 1.4 0.6 558 North Sumatera 5.1 0.2 1.1 2.0 13.3 0.9 2.1 0.7 1,564 West Sumatera 11.1 1.3 3.7 8.2 26.5 2.9 5.0 1.2 588 Riau 6.3 0.5 2.9 7.4 20.1 1.1 4.3 0.7 791 Jambi 4.7 0.3 0.6 3.6 12.6 0.8 1.9 0.2 452 South Sumatera 4.2 0.6 0.2 4.6 19.8 0.4 0.9 0.4 1,051 Bengkulu 11.6 0.8 1.9 5.8 30.6 2.3 5.0 0.8 230 Lampung 7.6 1.1 3.3 5.3 26.5 2.5 3.8 0.8 1,118 Bangka Belitung 7.0 0.5 0.7 2.9 22.1 0.4 1.1 0.1 183 Riau Islands 8.8 0.7 1.1 7.6 18.4 0.6 2.6 0.5 228 Java DKI Jakarta 7.2 1.1 1.9 9.7 21.6 0.4 4.5 0.7 1,261 West Java 7.9 0.5 2.3 7.0 28.0 1.2 4.0 0.6 6,170 Central Java 16.3 0.5 2.6 7.9 30.2 6.1 15.4 0.6 4,657 DI Yogyakarta 13.6 0.8 2.8 9.9 27.9 2.3 13.1 0.7 456 East Java 14.1 0.4 1.2 4.9 21.4 1.8 10.3 0.6 5,765 Banten 4.2 0.6 1.3 3.7 15.9 0.6 1.8 0.5 1,557 Bali and Nusa Tenggara Bali 7.5 0.0 0.5 7.6 23.8 0.7 2.7 0.2 589 West Nusa Tenggara 15.2 0.5 0.5 4.1 23.6 2.0 1.5 0.2 686 East Nusa Tenggara 24.8 0.9 2.4 8.5 41.4 3.9 2.6 0.3 584 Kalimantan West Kalimantan 4.5 0.5 0.9 2.6 17.2 0.1 0.2 0.1 591 Central Kalimantan 8.0 0.3 0.6 3.5 15.3 0.7 0.9 0.0 325 South Kalimantan 7.8 0.0 0.1 1.9 19.7 0.1 1.1 0.0 536 East Kalimantan 8.3 0.5 0.6 7.8 20.7 0.9 3.1 0.3 498 Sulawesi North Sulawesi 13.1 1.0 2.2 11.5 20.5 5.6 7.2 1.9 316 Central Sulawesi 16.7 1.1 1.9 8.0 20.2 1.8 3.4 0.8 362 South Sulawesi 9.5 1.5 1.1 9.9 25.8 1.0 2.8 0.8 1,000 Southeast Sulawesi 13.2 0.9 1.2 6.3 18.3 2.6 3.9 0.4 282 Gorontalo 16.3 2.4 2.9 11.3 22.2 8.3 10.6 1.6 149 West Sulawesi 7.7 0.2 0.4 5.2 22.1 0.2 1.5 0.3 131 Maluku and Papua Maluku 6.4 0.6 0.5 3.2 22.0 0.2 0.8 0.2 175 North Maluku 12.3 1.1 1.8 7.7 18.0 2.9 3.3 1.2 131 West Papua 1.9 0.5 1.8 5.8 20.5 0.5 0.7 0.4 94 Papua 7.3 0.2 2.9 3.7 14.5 1.1 0.4 0.9 384 Total 10.4 0.6 1.8 6.2 23.7 2.0 6.1 0.6 33,465 256 • Appendix A Table A-7.4 Contact of nonusers with fieldworkers/health providers about family planning Among ever-married women age 15-49 who are not using contraception, the percentage who during the past 6 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with a fieldworker or at a health facility, by province, Indonesia 2012 Percentage of women who were visited by fieldworker who discussed family planning Percentage of women who visited a health facility in the past 6 months and who: Percentage of women who did not discuss family planning either with fieldworker or at a health facility Number of women Province Discussed family planning Did not discuss family planning Sumatera Aceh 6.3 8.5 37.5 87.1 343 North Sumatera 2.3 4.5 28.8 93.6 806 West Sumatera 6.9 10.2 43.5 85.0 289 Riau 2.7 5.4 39.4 92.6 344 Jambi 2.8 4.2 39.2 93.5 175 South Sumatera 3.2 5.0 33.6 92.2 376 Bengkulu 6.0 15.2 33.9 81.2 95 Lampung 1.7 10.2 42.9 88.6 380 Bangka Belitung 2.7 7.2 37.8 90.8 65 Riau Islands 5.0 8.8 27.8 87.5 117 Java DKI Jakarta 3.1 7.5 41.3 90.5 635 West Java 3.6 8.7 42.4 89.5 2,799 Central Java 8.5 8.5 38.0 85.2 1,878 DI Yogyakarta 2.2 14.2 51.7 84.6 155 East Java 7.8 9.3 36.3 85.5 2,313 Banten 1.6 4.4 41.7 94.2 657 Bali and Nusa Tenggara Bali 3.7 11.1 33.2 87.5 218 West Nusa Tenggara 6.0 6.3 28.3 89.7 391 East Nusa Tenggara 9.8 21.4 33.5 75.0 353 Kalimantan West Kalimantan 6.6 4.7 31.8 90.0 241 Central Kalimantan 4.0 4.5 32.9 92.1 124 South Kalimantan 3.3 6.6 36.9 91.2 217 East Kalimantan 4.7 6.7 49.9 90.2 225 Sulawesi North Sulawesi 2.8 8.6 25.3 89.4 115 Central Sulawesi 8.3 16.0 36.4 78.0 186 South Sulawesi 6.2 8.5 37.4 87.4 518 Southeast Sulawesi 5.3 10.9 35.8 86.0 154 Gorontalo 6.9 12.1 38.5 85.7 61 West Sulawesi 3.3 4.0 29.9 93.3 72 Maluku and Papua Maluku 4.9 6.6 26.4 90.6 103 North Maluku 13.8 8.4 25.7 81.4 69 West Papua 2.7 5.1 42.7 93.1 60 Papua 3.2 4.8 33.2 92.7 338 Total 5.2 8.3 37.7 88.2 14,874 Appendix A • 257 Table A-7.5.1 Current use of contraception by province: All women Percent distribution of all women age 15-49 by contraceptive method currently used, according to background characteristics, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Number of womenProvince Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male condom LAM Other Rhythm With- drawal Other Sumatera Aceh 29.9 28.4 0.5 0.0 6.1 1.4 19.1 0.4 0.8 0.2 0.0 1.5 0.4 0.7 0.4 70.1 100.0 877 North Sumatera 36.8 28.3 4.4 0.0 7.1 1.3 12.0 2.1 1.3 0.1 0.0 8.5 1.5 6.2 0.8 63.2 100.0 2,394 West Sumatera 39.5 34.8 2.1 0.1 6.6 2.6 19.2 3.0 1.3 0.0 0.0 4.6 0.9 3.6 0.1 60.5 100.0 852 Riau 46.6 41.2 2.8 0.1 10.3 1.5 22.2 2.2 2.1 0.1 0.0 5.4 1.9 3.4 0.1 53.4 100.0 1,040 Jambi 52.2 48.4 0.8 0.0 14.6 2.9 25.6 3.4 1.1 0.0 0.0 3.8 0.7 2.4 0.7 47.8 100.0 580 South Sumatera 52.3 49.9 2.0 0.1 7.3 1.2 33.8 4.3 1.1 0.0 0.0 2.5 0.7 1.7 0.1 47.7 100.0 1,358 Bengkulu 48.4 46.2 2.1 0.0 8.4 2.6 24.7 6.8 1.6 0.0 0.0 2.2 0.5 1.6 0.2 51.6 100.0 306 Lampung 54.6 51.5 0.8 0.2 11.2 2.1 31.9 4.1 1.2 0.0 0.0 3.1 0.9 2.1 0.1 45.4 100.0 1,443 Bangka Belitung 52.6 49.5 1.7 0.0 15.2 0.8 28.1 2.1 1.6 0.0 0.0 3.2 1.0 2.2 0.0 47.4 100.0 245 Riau Islands 37.8 34.2 2.2 0.0 10.0 1.9 16.4 2.0 1.7 0.0 0.0 3.6 1.4 1.8 0.4 62.2 100.0 323 Java DKI Jakarta 37.6 35.1 2.5 0.0 8.4 4.2 17.2 0.9 1.8 0.1 0.0 2.5 1.3 1.2 0.0 62.4 100.0 1,939 West Java 46.7 45.3 2.4 0.0 12.5 3.1 25.0 1.1 1.1 0.0 0.0 1.5 0.6 0.7 0.2 53.3 100.0 8,265 Central Java 48.8 46.1 3.6 0.3 7.5 2.8 25.3 4.3 2.2 0.0 0.0 2.7 0.6 2.1 0.0 51.2 100.0 6,240 DI Yogyakarta 49.6 42.2 2.9 0.0 7.2 9.7 15.8 2.7 3.8 0.0 0.1 7.3 2.6 4.4 0.3 50.4 100.0 654 East Java 51.4 49.2 2.8 0.2 11.5 4.1 27.2 2.4 1.0 0.0 0.0 2.2 1.0 1.0 0.3 48.6 100.0 7,374 Banten 46.5 44.5 1.7 0.0 9.4 2.5 27.7 1.4 1.8 0.0 0.0 2.0 0.9 1.0 0.0 53.5 100.0 2,148 Bali and Nusa Tenggara Bali 50.9 45.7 4.4 0.5 6.7 14.7 16.2 0.5 2.7 0.1 0.0 5.2 2.2 2.9 0.1 49.1 100.0 790 West Nusa Tenggara 38.8 38.1 1.0 0.0 4.9 2.6 25.4 3.8 0.4 0.0 0.0 0.7 0.3 0.1 0.2 61.2 100.0 997 East Nusa Tenggara 31.8 25.2 2.9 0.1 2.9 2.9 13.1 2.9 0.3 0.0 0.0 6.6 3.6 2.1 0.9 68.2 100.0 892 Kalimantan West Kalimantan 50.9 50.0 1.2 0.3 12.2 1.0 33.7 0.8 0.6 0.0 0.0 0.9 0.3 0.4 0.2 49.1 100.0 756 Central Kalimantan 53.5 51.5 0.9 0.0 18.9 0.6 28.4 2.1 0.5 0.2 0.0 2.0 0.6 0.2 1.1 46.5 100.0 409 South Kalimantan 50.4 49.0 0.9 0.1 19.7 1.0 24.7 1.5 1.2 0.0 0.1 1.4 0.2 0.4 0.7 49.6 100.0 730 East Kalimantan 44.9 40.5 2.1 0.0 14.1 2.1 19.1 1.4 1.6 0.1 0.0 4.4 1.6 2.3 0.5 55.1 100.0 671 Sulawesi North Sulawesi 51.8 48.0 2.2 0.0 14.5 3.9 20.2 6.6 0.4 0.0 0.0 3.8 2.9 0.7 0.2 48.2 100.0 427 Central Sulawesi 41.9 39.5 1.6 0.0 15.3 2.4 17.6 2.4 0.1 0.1 0.0 2.4 1.0 0.7 0.8 58.1 100.0 486 South Sulawesi 36.7 31.2 1.1 0.0 9.0 0.8 18.3 1.5 0.6 0.1 0.0 5.5 0.8 4.5 0.2 63.3 100.0 1,530 Southeast Sulawesi 38.2 36.0 1.1 0.0 11.2 1.0 17.8 4.7 0.2 0.0 0.0 2.2 0.3 1.4 0.5 61.8 100.0 382 Gorontalo 46.9 45.7 1.8 0.4 12.4 2.8 18.0 10.2 0.1 0.0 0.0 1.2 0.5 0.4 0.4 53.1 100.0 203 West Sulawesi 35.8 33.0 0.9 0.0 16.8 0.4 12.9 1.6 0.5 0.0 0.0 2.8 0.4 1.9 0.6 64.2 100.0 191 Maluku and Papua Maluku 30.7 27.3 1.2 0.0 4.0 0.3 17.7 3.9 0.0 0.0 0.1 3.4 1.8 0.7 0.9 69.3 100.0 260 North Maluku 37.6 35.7 1.3 0.1 5.8 0.8 20.4 6.2 0.7 0.4 0.0 1.9 1.1 0.2 0.5 62.4 100.0 188 West Papua 30.8 29.7 3.1 0.0 7.3 0.1 16.7 2.1 0.4 0.0 0.0 1.1 0.6 0.2 0.3 69.2 100.0 130 Papua 16.2 14.3 1.4 0.0 2.7 0.4 7.3 2.4 0.0 0.0 0.0 1.9 0.3 0.0 1.6 83.8 100.0 527 Total 45.7 42.7 2.4 0.1 10.0 3.0 23.5 2.4 1.3 0.0 0.0 3.0 1.0 1.7 0.3 54.3 100.0 45,607 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 258 • Appendix A Table A-7.5.2 Current use of contraception by province: Currently married women Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Indonesia 2012 Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Number of menProvince Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male condom LAM Other Rhythm With- drawal Other Sumatera Aceh 46.8 44.4 0.8 0.0 9.6 2.1 30.0 0.6 1.2 0.3 0.0 2.4 0.7 1.1 0.6 53.2 100.0 558 North Sumatera 55.9 42.8 6.4 0.0 10.8 2.1 18.3 3.1 1.9 0.1 0.0 13.1 2.3 9.5 1.2 44.1 100.0 1,564 West Sumatera 56.9 50.2 3.0 0.1 9.6 3.6 27.9 4.2 1.9 0.0 0.0 6.7 1.3 5.2 0.2 43.1 100.0 588 Riau 61.1 54.0 3.6 0.2 13.6 1.9 29.1 2.8 2.7 0.1 0.0 7.1 2.5 4.5 0.1 38.9 100.0 791 Jambi 66.9 62.0 0.9 0.0 18.8 3.7 32.9 4.3 1.4 0.0 0.0 4.8 0.9 3.0 0.9 33.1 100.0 452 South Sumatera 67.6 64.4 2.6 0.1 9.5 1.6 43.7 5.6 1.4 0.0 0.0 3.2 0.9 2.1 0.2 32.4 100.0 1,051 Bengkulu 64.2 61.2 2.6 0.0 11.1 3.4 32.9 9.0 2.2 0.0 0.0 3.0 0.6 2.1 0.3 35.8 100.0 230 Lampung 70.3 66.3 1.0 0.2 14.4 2.7 41.2 5.3 1.5 0.0 0.0 4.0 1.2 2.7 0.1 29.7 100.0 1,118 Bangka Belitung 69.6 65.3 2.0 0.0 20.2 1.1 37.4 2.4 2.2 0.0 0.0 4.2 1.3 3.0 0.0 30.4 100.0 183 Riau Islands 53.1 48.0 3.1 0.1 14.2 2.6 22.8 2.8 2.4 0.0 0.0 5.1 2.0 2.5 0.6 46.9 100.0 228 Java DKI Jakarta 57.3 53.4 3.6 0.0 13.0 6.2 26.4 1.4 2.8 0.1 0.0 3.9 2.0 1.8 0.0 42.7 100.0 1,261 West Java 62.2 60.3 3.1 0.1 16.6 4.1 33.4 1.4 1.5 0.1 0.0 1.9 0.8 0.9 0.3 37.8 100.0 6,170 Central Java 65.2 61.5 4.7 0.4 10.1 3.6 33.9 5.8 2.9 0.1 0.0 3.7 0.9 2.7 0.1 34.8 100.0 4,657 DI Yogyakarta 69.9 59.6 3.7 0.0 10.4 13.6 22.6 3.8 5.4 0.0 0.1 10.3 3.8 6.1 0.5 30.1 100.0 456 East Java 65.3 62.4 3.5 0.3 14.7 5.0 34.7 3.1 1.3 0.0 0.0 2.8 1.3 1.2 0.3 34.7 100.0 5,765 Banten 64.0 61.3 2.3 0.1 13.0 3.5 38.1 1.9 2.4 0.0 0.0 2.7 1.3 1.4 0.1 36.0 100.0 1,557 Bali and Nusa Tenggara Bali 66.2 59.6 5.6 0.7 9.0 19.0 21.6 0.7 2.9 0.1 0.0 6.6 2.9 3.6 0.1 33.8 100.0 589 West Nusa Tenggara 56.0 55.1 1.4 0.0 7.1 3.8 36.8 5.4 0.5 0.0 0.0 1.0 0.5 0.2 0.3 44.0 100.0 686 East Nusa Tenggara 47.9 38.3 4.5 0.1 4.4 4.4 20.0 4.5 0.5 0.0 0.0 9.6 5.5 2.8 1.3 52.1 100.0 584 Kalimantan West Kalimantan 65.1 63.9 1.6 0.4 15.6 1.3 43.2 1.0 0.8 0.0 0.0 1.1 0.4 0.5 0.2 34.9 100.0 591 Central Kalimantan 67.3 64.8 1.1 0.0 23.7 0.8 35.8 2.6 0.6 0.3 0.0 2.5 0.8 0.3 1.4 32.7 100.0 325 South Kalimantan 68.3 66.4 1.1 0.1 26.7 1.3 33.5 2.0 1.6 0.0 0.1 1.9 0.3 0.6 1.0 31.7 100.0 536 East Kalimantan 60.1 54.1 2.7 0.0 19.0 2.6 25.7 1.9 2.2 0.1 0.0 5.9 2.2 3.1 0.6 39.9 100.0 498 Sulawesi North Sulawesi 68.9 63.7 2.4 0.0 19.5 5.1 27.2 8.8 0.6 0.0 0.0 5.2 3.9 1.0 0.2 31.1 100.0 316 Central Sulawesi 55.7 52.5 2.1 0.0 20.5 3.1 23.4 3.1 0.2 0.1 0.0 3.3 1.3 0.9 1.0 44.3 100.0 362 South Sulawesi 55.8 47.5 1.5 0.0 13.8 1.1 27.8 2.3 0.8 0.1 0.0 8.4 1.2 6.8 0.3 44.2 100.0 1,000 Southeast Sulawesi 51.5 48.4 1.5 0.0 15.1 1.3 23.9 6.2 0.3 0.0 0.0 3.0 0.4 1.9 0.7 48.5 100.0 282 Gorontalo 63.2 61.5 2.3 0.6 16.7 3.4 24.6 13.7 0.1 0.0 0.0 1.7 0.7 0.5 0.5 36.8 100.0 149 West Sulawesi 52.2 48.0 1.3 0.0 24.5 0.6 18.8 2.3 0.7 0.0 0.0 4.1 0.6 2.7 0.8 47.8 100.0 131 Maluku and Papua Maluku 45.5 40.4 1.8 0.0 5.9 0.5 26.3 5.8 0.0 0.0 0.1 5.1 2.7 1.1 1.3 54.5 100.0 175 North Maluku 53.7 51.1 1.9 0.1 8.3 1.2 29.2 8.9 1.0 0.6 0.0 2.6 1.6 0.2 0.8 46.3 100.0 131 West Papua 42.5 41.0 4.0 0.0 10.2 0.2 23.2 2.9 0.5 0.0 0.0 1.5 0.8 0.3 0.4 57.5 100.0 94 Papua 21.8 19.1 1.8 0.0 3.6 0.6 10.0 3.2 0.0 0.0 0.0 2.6 0.4 0.0 2.2 78.2 100.0 384 Total 61.9 57.9 3.2 0.2 13.6 3.9 31.9 3.3 1.8 0.0 0.0 4.0 1.3 2.3 0.4 38.1 100.0 33,465 Appendix A • 259 Table A-7.6 Pill use compliance Percentage of women age 15-49 who are using the pill; among pill users who have the pill package, percent distribution who can show the pill package by type of pill, and percentage of pill users who complied with pill use instructions, according to province, Indonesia 2012 Percent using Currently married women Among pill users who have the pill package Percentage of pill users Number of pill users Province Combination1 Single2 Other Package not seen Took pill in order Took pill <2 days ago Sumatera Aceh 9.6 558 84.6 8.9 0.0 0.0 87.1 86.8 53 North Sumatera 10.8 1,564 80.9 5.7 7.9 2.3 91.5 83.8 169 West Sumatera 9.6 588 80.4 2.2 2.1 2.3 73.1 80.5 56 Riau 13.5 791 84.4 3.4 7.9 1.4 81.1 85.6 106 Jambi 18.8 452 85.3 3.9 0.0 1.2 75.8 88.5 85 South Sumatera 9.5 1,051 93.8 0.0 3.3 0.9 83.8 84.2 99 Bengkulu 11.1 230 84.3 3.5 0.0 8.5 79.0 89.6 26 Lampung 14.4 1,118 97.0 0.5 0.0 0.5 88.2 87.5 161 Bangka Belitung 20.3 183 89.6 6.1 1.8 1.3 94.8 90.1 37 Riau Islands 14.2 228 83.0 1.3 0.4 1.9 77.0 83.5 32 Java DKI Jakarta 13.0 1,261 83.1 8.9 0.0 0.5 84.0 84.9 164 West Java 16.6 6,170 90.3 1.8 1.7 0.4 84.8 84.6 1,026 Central Java 10.1 4,657 82.8 2.4 5.9 2.9 76.1 75.1 471 DI Yogyakarta 10.4 456 94.3 0.9 0.0 2.0 90.8 86.5 47 East Java 14.5 5,765 89.1 3.1 3.4 0.0 89.0 86.5 838 Banten 13.0 1,557 88.5 3.7 2.0 1.6 85.4 86.1 203 Bali and Nusa Tenggara Bali 9.0 589 73.2 13.3 7.2 1.5 89.6 87.4 53 West Nusa Tenggara 7.1 686 89.8 4.6 0.0 1.3 91.4 96.1 49 East Nusa Tenggara 4.4 584 (89.7) (5.2) 0.0 (5.1) (86.8) (94.4) 26 Kalimantan West Kalimantan 15.6 591 81.7 9.8 2.1 0.0 89.1 92.8 92 Central Kalimantan 23.7 325 87.4 5.7 1.5 0.6 91.1 88.0 77 South Kalimantan 26.6 536 93.3 1.2 0.3 1.6 88.8 88.6 143 East Kalimantan 19.0 498 93.6 2.5 0.0 1.3 89.7 85.4 95 Sulawesi North Sulawesi 19.6 316 82.9 1.6 6.2 0.8 85.8 87.2 62 Central Sulawesi 20.5 362 83.1 5.0 3.0 2.9 86.1 85.2 74 South Sulawesi 13.7 1,000 90.8 1.4 1.4 1.9 84.9 88.9 137 Southeast Sulawesi 15.1 282 89.6 1.3 0.9 0.0 83.5 80.7 43 Gorontalo 16.8 149 86.2 2.7 0.7 3.2 79.8 83.9 25 West Sulawesi 24.6 131 90.6 1.4 0.0 2.7 79.4 84.6 32 Maluku and Papua Maluku 5.9 175 (82.1) (2.2) (4.7) (2.2) (70.0) (82.5) 10 North Maluku 8.3 131 86.1 6.2 2.2 0.0 89.6 89.3 11 West Papua 10.2 94 73.0 12.8 0.0 0.0 77.0 77.4 10 Papua 3.8 384 (74.2) (6.5) 0.0 (11.8) (64.7) (72.2) 14 Total 13.5 33,465 87.8 3.2 2.7 1.1 85.1 84.9 4,528 Note: Table excludes pill users who do not know the brand name. Total number includes a small number of unmarried women using the pill. 1 Combination brand include: Andalan, Diane, Pilkab, Kimbinasi, Lyndiol, Microdyol, Mycrogynon, Microlut, Planak, Trinordiol 21/Trinordiol 28, Yasmin. 2 Excluton 260 • Appendix A Table A-7.7 Use of injectables Percentage of users of one-month injectables who had an injection in the past four weeks and percentage of users of three-month injectables who had an injection in the past three months, according to province, Indonesia 2012 Province Percent of users of one-month injectable contraception who had an injection in the past four weeks Number of users Percent of users of three-month injectable contraception who had an injection in the past three months Number of users Sumatera Aceh 98.7 36 95.8 132 North Sumatera 100.0 85 95.8 203 West Sumatera 96.4 30 97.8 134 Riau 93.1 57 95.1 174 Jambi 100.0 18 98.1 131 South Sumatera 100.0 47 99.1 412 Bengkulu 96.5 10 96.5 66 Lampung 100.0 33 96.8 428 Bangka Belitung 95.5 19 97.3 50 Riau Islands 97.7 15 94.4 38 Java DKI Jakarta 94.0 93 96.0 239 West Java 96.8 323 97.6 1,741 Central Java 94.7 115 95.6 1,463 DI Yogyakarta 100.0 10 98.7 93 East Java 92.9 264 99.3 1,740 Banten 98.3 64 93.6 530 Bali and Nusa Tenggara Bali 100.0 26 98.0 102 West Nusa Tenggara 100.0 11 97.7 242 East Nusa Tenggara 100.0 3 97.5 114 Kalimantan West Kalimantan 95.2 22 98.9 233 Central Kalimantan 96.2 13 97.7 103 South Kalimantan 94.0 29 96.5 151 East Kalimantan 97.4 27 96.8 101 Sulawesi North Sulawesi 98.3 16 93.3 71 Central Sulawesi 100.0 7 96.8 78 South Sulawesi 95.8 15 94.2 264 Southeast Sulawesi 92.0 8 97.1 59 Gorontalo 100.0 2 92.3 34 West Sulawesi 71.7 2 93.9 22 Maluku and Papua Maluku 80.8 2 92.6 44 North Maluku 100.0 2 95.9 36 West Papua 89.8 4 94.3 18 Papua 100.0 4 86.5 35 Total 96.0 1,414 97.0 9,282 Appendix A • 261 Table A-7.8 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by province, Indonesia 2012 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Province For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Sumatera Aceh 8.2 5.7 14.0 28.2 18.5 46.8 36.5 24.3 60.7 77.0 73.1 558 North Sumatera 4.1 9.2 13.2 19.0 36.8 55.9 23.1 46.0 69.1 80.9 61.9 1,564 West Sumatera 5.7 8.0 13.7 26.2 30.7 56.9 31.9 38.7 70.7 80.6 71.1 588 Riau 4.1 7.7 11.8 28.3 32.8 61.1 32.4 40.4 72.8 83.9 74.1 791 Jambi 3.1 4.8 7.9 32.3 34.5 66.9 35.4 39.4 74.8 89.4 82.9 452 South Sumatera 2.6 5.5 8.1 31.1 36.5 67.6 33.7 42.0 75.7 89.3 85.1 1,051 Bengkulu 4.0 5.1 9.1 25.0 39.2 64.2 29.0 44.4 73.3 87.5 83.5 230 Lampung 3.0 4.9 7.9 32.1 38.2 70.3 35.0 43.1 78.2 89.9 84.8 1,118 Bangka Belitung 3.5 6.3 9.8 30.7 38.9 69.6 34.2 45.2 79.4 87.6 82.3 183 Riau Islands 6.3 8.2 14.5 22.3 30.9 53.1 28.6 39.0 67.6 78.6 71.0 228 Java DKI Jakarta 5.1 8.1 13.2 24.8 32.4 57.3 29.9 40.5 70.5 81.3 75.8 1,261 West Java 3.5 7.5 11.0 26.7 35.6 62.2 30.2 43.1 73.2 85.0 82.3 6,170 Central Java 3.9 6.4 10.4 24.5 40.6 65.2 28.4 47.1 75.5 86.3 81.4 4,657 DI Yogyakarta 3.6 7.9 11.5 21.0 48.9 69.9 24.6 56.8 81.4 85.8 73.2 456 East Java 3.5 6.6 10.1 26.0 39.2 65.3 29.5 45.9 75.4 86.6 82.8 5,765 Banten 4.5 5.7 10.2 36.5 27.5 64.0 41.0 33.1 74.2 86.3 82.6 1,557 Bali and Nusa Tenggara Bali 3.2 6.1 9.3 17.7 48.5 66.2 20.9 54.6 75.5 87.7 78.9 589 West Nusa Tenggara 11.1 5.0 16.1 34.7 21.4 56.0 45.8 26.4 72.2 77.6 76.3 686 East Nusa Tenggara 8.6 8.9 17.5 19.4 28.5 47.9 28.0 37.5 65.5 73.2 58.6 584 Kalimantan West Kalimantan 5.2 4.6 9.8 33.2 31.9 65.1 38.3 36.5 74.8 87.0 85.5 591 Central Kalimantan 3.6 4.0 7.6 34.9 32.4 67.3 38.5 36.4 74.9 89.8 86.5 325 South Kalimantan 3.0 5.4 8.4 35.0 33.3 68.3 38.0 38.7 76.7 89.1 86.6 536 East Kalimantan 5.4 7.6 13.0 24.6 35.4 60.1 30.0 43.0 73.0 82.3 74.1 498 Sulawesi North Sulawesi 3.1 7.7 10.8 27.0 41.8 68.9 30.1 49.5 79.7 86.4 80.0 316 Central Sulawesi 7.0 8.8 15.7 26.3 29.4 55.7 33.3 38.2 71.5 78.0 73.4 362 South Sulawesi 7.1 7.3 14.3 28.5 27.3 55.8 35.6 34.6 70.2 79.6 67.6 1,000 Southeast Sulawesi 8.4 10.0 18.4 28.9 22.6 51.5 37.3 32.6 69.8 73.7 69.4 282 Gorontalo 6.4 7.2 13.6 27.5 35.7 63.2 33.9 42.9 76.8 82.3 80.1 149 West Sulawesi 7.4 6.9 14.2 31.1 21.0 52.2 38.5 27.9 66.4 78.5 72.3 131 Maluku and Papua Maluku 8.1 11.1 19.2 17.9 27.6 45.5 26.0 38.7 64.7 70.3 62.4 175 North Maluku 5.6 8.3 14.0 27.2 26.5 53.7 32.8 34.8 67.7 79.3 75.5 131 West Papua 10.6 10.0 20.6 21.3 21.2 42.5 31.8 31.3 63.1 67.4 64.9 94 Papua 16.2 7.6 23.8 9.9 11.9 21.8 26.0 19.5 45.5 47.8 42.0 384 Total 4.5 6.9 11.4 26.7 35.2 61.9 31.1 42.1 73.2 84.5 79.0 33,465 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. 1 Total demand is the sum of unmet need and met need 2 Percentage of demand satisfied is met need divided by total demand 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM) 262 • Appendix A CHAPTER 8 INFANT AND CHILD MORTALITY Table A-8.1 Early childhood mortality rates by province Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by province, Indonesia 2012 Province Neonatal mortality (NN) Post-neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Sumatera Aceh 28 18 47 6 52 North Sumatera 26 14 40 15 54 West Sumatera 17 10 27 7 34 Riau 15 9 24 4 28 Jambi 16 18 34 3 36 South Sumatera 20 8 29 9 37 Bengkulu 21 8 29 7 35 Lampung 20 10 30 8 38 Bangka Belitung 20 7 27 6 32 Riau Islands 21 13 35 8 42 Java DKI Jakarta 15 7 22 10 31 West Java 17 13 30 9 38 Central Java 22 10 32 7 38 DI Yogyakarta 18 7 25 5 30 East Java 14 15 30 4 34 Banten 23 9 32 7 38 Bali and Nusa Tenggara Bali 18 11 29 4 33 West Nusa Tenggara 33 24 57 18 75 East Nusa Tenggara 26 19 45 14 58 Kalimantan West Kalimantan 18 13 31 6 37 Central Kalimantan 25 24 49 8 56 South Kalimantan 30 14 44 13 57 East Kalimantan 12 9 21 10 31 Sulawesi North Sulawesi 23 9 33 4 37 Central Sulawesi 26 32 58 28 85 South Sulawesi 13 12 25 13 37 Southeast Sulawesi 25 20 45 10 55 Gorontalo 26 41 67 11 78 West Sulawesi 26 34 60 11 70 Maluku and Papua Maluku 24 12 36 24 60 North Maluku 37 24 62 25 85 West Papua 35 39 74 38 109 Papua 27 27 54 64 115 Total 20 14 34 10 43 1 Computed as the difference between the infant and neonatal mortality rates Appendix A • 263 Table A-8.2 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five- year period preceding the survey, by province, Indonesia 2012 Province Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Sumatera Aceh 7 6 35 372 North Sumatera 14 21 32 1,072 West Sumatera 3 8 30 345 Riau 7 7 30 491 Jambi 5 1 28 226 South Sumatera 7 8 25 584 Bengkulu 1 1 19 107 Lampung 10 7 31 548 Bangka Belitung 0 2 27 99 Riau Islands 1 1 16 140 Java DKI Jakarta 1 11 18 642 West Java 34 41 25 3,043 Central Java 11 52 32 1,990 DI Yogyakarta 2 3 24 191 East Java 26 23 20 2,441 Banten 3 13 20 785 Bali and Nusa Tenggara Bali 2 2 16 241 West Nusa Tenggara 4 11 38 401 East Nusa Tenggara 10 8 41 446 Kalimantan West Kalimantan 6 2 22 337 Central Kalimantan 3 3 31 177 South Kalimantan 3 4 26 275 East Kalimantan 1 4 18 272 Sulawesi North Sulawesi 1 3 24 159 Central Sulawesi 4 7 47 224 South Sulawesi 6 7 22 586 Southeast Sulawesi 2 2 22 182 Gorontalo 1 1 20 76 West Sulawesi 1 1 26 101 Maluku and Papua Maluku 1 1 21 131 North Maluku 2 2 46 90 West Papua 2 2 51 74 Papua 2 4 19 279 Total 181 268 26 17,129 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, expressed per 1,000. 264 • Appendix A CHAPTER 9 REPRODUCTIVE HEALTH Table A-9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to province, Indonesia 2012 Province Antenatal care provider No ANC Total Percentage receiving antenatal care from a skilled provider1 Number of women Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Other Missing Sumatera Aceh 0.6 28.1 66.6 1.3 0.5 0.2 2.7 100.0 95.3 294 North Sumatera 1.7 16.2 75.3 1.9 0.4 0.1 4.3 100.0 93.2 833 West Sumatera 2.0 22.3 71.6 1.9 0.3 0.0 1.9 100.0 95.9 286 Riau 3.4 24.6 67.7 0.4 0.0 1.0 2.8 100.0 95.8 413 Jambi 1.6 14.4 76.6 4.4 0.3 0.0 2.7 100.0 92.6 198 South Sumatera 1.4 18.5 77.3 0.9 0.0 0.0 1.9 100.0 97.2 511 Bengkulu 1.0 14.3 81.3 1.8 0.0 0.7 1.0 100.0 96.5 96 Lampung 1.4 9.8 86.1 0.2 1.0 0.2 1.3 100.0 97.3 486 Bangka Belitung 1.7 20.0 74.5 0.5 0.0 0.3 2.9 100.0 96.2 87 Riau Islands 3.4 36.7 56.6 0.4 0.5 0.5 1.9 100.0 96.8 113 Java DKI Jakarta 2.4 31.6 64.6 0.0 0.2 0.7 0.5 100.0 98.6 556 West Java 0.7 19.2 76.3 0.4 0.7 1.1 1.6 100.0 96.2 2,675 Central Java 1.3 17.7 79.6 0.0 0.6 0.3 0.6 100.0 98.6 1,824 DI Yogyakarta 1.3 37.5 60.1 0.0 0.0 0.2 0.9 100.0 98.9 171 East Java 1.0 17.1 80.6 0.3 0.0 0.0 1.0 100.0 98.7 2,213 Banten 0.0 15.1 81.3 1.3 0.8 0.2 1.3 100.0 96.4 706 Bali and Nusa Tenggara Bali 0.8 41.8 56.7 0.0 0.0 0.0 0.7 100.0 99.3 208 West Nusa Tenggara 1.5 10.2 86.7 0.5 0.4 0.0 0.7 100.0 98.4 350 East Nusa Tenggara 4.5 13.5 74.2 0.8 0.3 0.5 6.4 100.0 92.1 338 Kalimantan West Kalimantan 0.9 9.5 77.0 0.9 2.2 0.6 8.8 100.0 87.4 293 Central Kalimantan 2.0 9.9 76.6 3.6 0.6 0.0 7.3 100.0 88.5 154 South Kalimantan 1.1 19.4 72.8 3.5 0.5 0.2 2.5 100.0 93.2 247 East Kalimantan 3.7 37.6 56.0 0.5 0.0 0.0 2.1 100.0 97.4 231 Sulawesi North Sulawesi 3.8 30.4 60.8 0.5 0.5 0.4 3.5 100.0 95.1 137 Central Sulawesi 3.1 11.9 78.1 0.8 0.3 0.0 5.8 100.0 93.2 175 South Sulawesi 1.3 18.5 75.1 0.7 0.0 1.1 3.2 100.0 94.9 474 Southeast Sulawesi 1.2 14.9 77.0 2.6 0.3 0.5 3.5 100.0 93.1 150 Gorontalo 2.2 28.3 63.7 2.0 0.2 0.3 3.3 100.0 94.2 66 West Sulawesi 2.3 7.7 75.1 1.7 0.3 0.6 12.3 100.0 85.0 77 Maluku and Papua Maluku 3.2 17.9 65.3 1.5 0.5 0.2 11.3 100.0 86.5 97 North Maluku 2.7 21.7 65.7 1.8 0.0 0.0 8.1 100.0 90.1 71 West Papua 5.7 32.3 48.1 0.3 0.2 0.7 12.8 100.0 86.1 52 Papua 3.7 13.6 40.5 1.8 0.6 1.8 38.0 100.0 57.8 202 Total 1.4 19.0 75.3 0.8 0.4 0.4 2.7 100.0 95.7 14,782 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, obstetrician, nurse, midwife, and village midwife. Appendix A • 265 Table A-9.2 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, percentage who received antenatal care for the most recent live birth, by content of care received, and the percentage who took iron tablets or syrup for the most recent birth, according to province, Indonesia 2012 Among women who received antenatal care for their most recent birth in the past five years, the percentage with selected services Among women with a live birth in the past five years, the percentage who during the pregnancy of their last birth: Province Informed of signs of pregnancy complications Blood pressure measured Urine sample taken Blood sample taken Stomach examined Consultation Number of women with ANC for their most recent birth Took iron tablets or syrup Number of women with a live birth in the past five years Sumatera Aceh 49.9 94.1 35.4 31.2 97.5 86.7 286 54.9 294 North Sumatera 39.8 90.5 31.8 16.2 97.7 83.6 796 60.0 833 West Sumatera 60.3 95.1 44.5 43.5 97.7 86.9 280 78.9 286 Riau 50.0 95.1 36.5 27.1 98.9 85.6 398 63.1 413 Jambi 43.9 92.6 29.7 42.9 97.9 79.1 192 71.6 198 South Sumatera 39.7 93.8 29.7 31.1 93.6 73.3 501 68.0 511 Bengkulu 59.7 96.1 32.7 36.6 99.4 79.7 95 77.7 96 Lampung 53.7 98.8 52.7 34.3 97.4 89.1 479 79.2 486 Bangka Belitung 56.8 96.0 50.8 43.5 98.4 89.9 84 77.3 87 Riau Islands 47.5 94.7 40.6 25.7 98.9 92.4 111 71.5 113 Java DKI Jakarta 64.8 98.5 71.0 68.1 98.5 93.4 549 81.9 556 West Java 55.5 97.3 50.5 41.8 99.0 85.9 2,605 71.7 2,675 Central Java 57.9 97.2 55.1 46.9 98.8 85.9 1,808 81.5 1,824 DI Yogyakarta 66.5 99.8 70.9 66.7 98.9 95.7 169 96.6 171 East Java 55.1 98.5 52.6 42.9 97.7 85.6 2,191 88.0 2,213 Banten 51.4 96.5 59.1 37.2 98.2 87.3 695 73.7 706 Bali and Nusa Tenggara Bali 56.9 95.9 41.2 30.2 99.1 90.6 207 85.2 208 West Nusa Tenggara 59.6 94.1 65.0 52.8 97.6 63.6 347 90.0 350 East Nusa Tenggara 54.5 92.8 40.8 55.0 98.4 81.4 315 86.9 338 Kalimantan West Kalimantan 34.1 97.0 33.8 26.7 98.9 73.6 266 46.3 293 Central Kalimantan 56.9 91.8 41.3 46.4 97.8 86.4 143 72.2 154 South Kalimantan 52.3 94.8 38.4 39.3 97.2 86.3 240 86.0 247 East Kalimantan 57.1 97.2 46.4 41.3 99.5 82.9 226 84.1 231 Sulawesi North Sulawesi 51.6 95.8 31.1 40.2 98.6 72.4 132 78.5 137 Central Sulawesi 59.1 93.6 29.0 34.0 97.4 81.0 165 67.2 175 South Sulawesi 49.3 94.0 46.0 46.7 95.9 82.7 456 73.4 474 Southeast Sulawesi 39.0 90.2 22.1 31.2 98.5 70.3 143 68.6 150 Gorontalo 51.9 93.5 33.5 37.7 98.2 76.8 63 78.9 66 West Sulawesi 42.4 92.3 38.8 43.2 96.4 77.7 67 54.0 77 Maluku and Papua Maluku 27.9 89.3 16.2 31.4 99.8 69.1 85 64.7 97 North Maluku 37.4 91.4 25.3 44.7 95.1 67.3 65 69.2 71 West Papua 38.2 92.7 29.1 55.9 96.1 66.9 45 65.5 52 Papua 35.9 85.7 33.1 46.7 94.9 75.1 121 31.9 202 Total 53.0 96.0 47.7 41.0 98.0 84.1 14,327 75.5 14,782 266 • Appendix A Table A-9.3 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections (TTI) during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to province, Indonesia 2012 Province Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Sumatera Aceh 47.5 61.7 294 North Sumatera 18.1 23.0 833 West Sumatera 44.4 61.3 286 Riau 28.1 44.1 413 Jambi 48.4 61.7 198 South Sumatera 46.2 54.3 511 Bengkulu 64.5 70.9 96 Lampung 54.8 66.1 486 Bangka Belitung 41.1 60.9 87 Riau Islands 24.9 44.1 113 Java DKI Jakarta 47.0 58.5 556 West Java 58.1 65.8 2,675 Central Java 48.1 68.9 1,824 DI Yogyakarta 46.9 78.0 171 East Java 23.5 49.5 2,213 Banten 53.6 64.9 706 Bali and Nusa Tenggara Bali 54.2 78.8 208 West Nusa Tenggara 64.6 79.5 350 East Nusa Tenggara 61.6 77.8 338 Kalimantan West Kalimantan 37.1 49.6 293 Central Kalimantan 58.8 66.2 154 South Kalimantan 51.9 68.8 247 East Kalimantan 38.1 75.0 231 Sulawesi North Sulawesi 67.9 75.4 137 Central Sulawesi 64.8 71.9 175 South Sulawesi 57.7 70.4 474 Southeast Sulawesi 65.7 73.9 150 Gorontalo 53.0 73.4 66 West Sulawesi 47.7 61.5 77 Maluku and Papua Maluku 52.4 60.9 97 North Maluku 63.2 72.1 71 West Papua 52.2 64.6 52 Papua 26.2 36.4 202 Total 45.4 60.4 14,782 1 Includes mothers with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth. Appendix A • 267 Table A-9.4 Complications during pregnancy Percentage of last births in the five years preceding the survey for which the mother had complications associated with the pregnancy, by type of complications, by province, Indonesia 2012 Province Premature labor Excessive vaginal bleeding Fever Convulsions and fainting Other Missing No complications Number of births Sumatera Aceh 4.5 3.9 1.8 0.7 7.4 0.2 83.9 294 North Sumatera 2.1 4.6 1.0 0.1 7.0 0.1 86.8 833 West Sumatera 3.0 3.3 0.3 0.1 10.6 0.0 84.8 286 Riau 2.1 4.0 0.6 0.2 9.7 0.7 84.1 413 Jambi 3.1 3.2 0.0 0.6 7.1 0.0 87.9 198 South Sumatera 1.6 2.9 1.5 0.2 6.3 0.0 88.0 511 Bengkulu 3.9 4.5 1.3 0.0 5.5 0.7 85.8 96 Lampung 0.9 4.8 0.3 0.8 3.1 0.4 90.5 486 Bangka Belitung 1.5 2.3 1.4 0.0 6.7 0.3 88.9 87 Riau Islands 1.2 2.8 0.1 0.0 9.5 0.5 86.8 113 Java DKI Jakarta 3.3 5.5 1.4 0.4 9.3 0.7 82.2 556 West Java 1.3 3.6 0.1 0.4 7.8 1.0 87.2 2,675 Central Java 2.6 2.9 0.4 0.4 8.5 0.3 86.4 1,824 DI Yogyakarta 1.2 3.6 0.3 0.3 8.7 0.2 87.4 171 East Java 2.2 3.1 0.5 0.2 8.2 0.0 86.7 2,213 Banten 2.3 5.2 1.2 0.0 6.3 0.2 86.6 706 Bali and Nusa Tenggara Bali 2.6 3.8 1.0 0.2 7.8 0.0 87.1 208 West Nusa Tenggara 3.0 5.1 1.0 0.2 5.6 0.0 87.4 350 East Nusa Tenggara 3.1 4.0 1.7 0.1 8.4 0.5 85.2 338 Kalimantan West Kalimantan 2.0 3.3 1.1 0.2 3.8 0.4 90.5 293 Central Kalimantan 1.9 2.9 1.0 0.0 7.5 0.0 88.2 154 South Kalimantan 0.8 1.3 0.9 0.0 9.4 0.2 88.5 247 East Kalimantan 1.1 3.4 0.6 0.0 8.4 0.0 87.4 231 Sulawesi North Sulawesi 1.5 3.6 1.2 0.5 4.0 0.4 90.7 137 Central Sulawesi 3.8 2.2 3.2 0.8 5.4 0.0 88.0 175 South Sulawesi 4.0 3.4 0.2 0.5 10.3 0.7 83.1 474 Southeast Sulawesi 1.6 2.5 1.4 0.2 3.7 0.5 92.0 150 Gorontalo 5.3 3.9 2.2 0.6 6.0 0.3 83.8 66 West Sulawesi 3.1 1.1 0.2 0.3 11.2 0.5 85.2 77 Maluku and Papua Maluku 3.2 2.5 0.4 0.8 1.9 0.5 92.4 97 North Maluku 0.8 3.1 1.0 0.3 2.8 0.0 93.0 71 West Papua 2.9 2.8 1.1 0.6 4.6 0.7 88.6 52 Papua 2.3 3.8 4.6 0.0 1.5 2.1 88.5 202 Total 2.2 3.6 0.7 0.3 7.5 0.4 86.8 14,782 268 • Appendix A Table A-9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health facility, according to province, Indonesia 2012 Health facility Home Other Missing Total Percentage delivered in a health facility Number of births Province Public sector Private sector Sumatera Aceh 18.1 35.2 45.5 0.4 0.8 100.0 53.3 365 North Sumatera 8.5 39.5 51.5 0.1 0.3 100.0 48.0 1,058 West Sumatera 17.8 56.6 24.8 0.2 0.5 100.0 74.5 343 Riau 9.2 42.5 47.4 0.1 0.8 100.0 51.7 484 Jambi 12.3 28.7 58.7 0.2 0.0 100.0 41.1 221 South Sumatera 12.4 43.5 43.5 0.0 0.5 100.0 56.0 577 Bengkulu 16.7 18.4 64.3 0.0 0.6 100.0 35.0 106 Lampung 8.6 52.9 38.0 0.2 0.3 100.0 61.4 538 Bangka Belitung 18.9 46.3 33.7 0.5 0.7 100.0 65.2 99 Riau Islands 16.5 65.2 16.8 0.2 1.2 100.0 81.8 139 Java DKI Jakarta 21.9 74.2 3.2 0.0 0.7 100.0 96.1 642 West Java 15.1 48.3 35.6 0.1 1.0 100.0 63.3 3,009 Central Java 16.7 58.8 24.0 0.0 0.5 100.0 75.5 1,979 DI Yogyakarta 24.6 69.2 5.8 0.0 0.4 100.0 93.8 189 East Java 15.3 69.4 15.0 0.1 0.1 100.0 84.7 2,416 Banten 7.8 52.8 38.8 0.3 0.3 100.0 60.6 782 Bali and Nusa Tenggara Bali 28.0 70.4 1.6 0.0 0.0 100.0 98.4 239 West Nusa Tenggara 59.2 15.2 24.9 0.0 0.6 100.0 74.5 397 East Nusa Tenggara 35.6 5.5 57.4 0.0 1.5 100.0 41.0 436 Kalimantan West Kalimantan 13.4 27.3 57.5 0.2 1.6 100.0 40.8 332 Central Kalimantan 11.1 11.2 77.2 0.0 0.6 100.0 22.3 174 South Kalimantan 17.5 18.1 63.9 0.2 0.2 100.0 35.7 273 East Kalimantan 16.7 46.9 36.3 0.2 0.0 100.0 63.5 271 Sulawesi North Sulawesi 36.6 23.1 39.4 0.2 0.6 100.0 59.8 159 Central Sulawesi 23.1 7.4 68.8 0.2 0.4 100.0 30.5 220 South Sulawesi 28.1 19.6 50.5 0.4 1.5 100.0 47.7 580 Southeast Sulawesi 15.4 6.4 77.3 0.0 1.0 100.0 21.7 180 Gorontalo 31.0 9.7 58.8 0.2 0.3 100.0 40.7 76 West Sulawesi 11.6 5.1 82.4 0.3 0.6 100.0 16.7 100 Maluku and Papua Maluku 14.8 6.8 77.1 0.0 1.3 100.0 21.6 130 North Maluku 14.9 5.7 78.6 0.2 0.6 100.0 20.6 88 West Papua 32.0 6.3 58.9 0.5 2.3 100.0 38.3 72 Papua 21.1 5.9 70.2 1.6 1.3 100.0 27.0 277 Total 17.3 45.9 36.0 0.2 0.6 100.0 63.2 16,948 1 Includes only the most recent birth in the five years preceding the survey Appendix A • 269 Table A-9.6.1 Assistance during delivery: The most qualified person Percent distribution of live births in the five years preceding the survey by the most qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to province, Indonesia 2012 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C- section Number of births Province Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Relative/ friend Other No one Missing Total Sumatera Aceh 0.2 18.5 71.1 9.0 0.2 0.2 0.2 0.6 100.0 89.8 12.0 365 North Sumatera 0.7 18.4 69.2 7.6 3.3 0.1 0.4 0.3 100.0 88.4 14.5 1,058 West Sumatera 0.4 24.0 66.2 8.5 0.2 0.0 0.0 0.7 100.0 90.5 20.3 343 Riau 0.6 20.1 65.7 11.7 1.1 0.0 0.0 0.8 100.0 86.4 14.6 484 Jambi 0.0 14.8 60.8 22.4 1.9 0.0 0.0 0.0 100.0 75.7 9.7 221 South Sumatera 0.7 19.1 65.2 13.6 0.9 0.0 0.0 0.5 100.0 85.1 12.5 577 Bengkulu 2.5 14.8 69.8 11.3 0.9 0.0 0.0 0.6 100.0 87.2 8.9 106 Lampung 0.4 11.7 72.5 13.3 0.7 0.4 0.6 0.3 100.0 84.6 12.0 538 Bangka Belitung 1.5 22.6 65.2 8.3 1.3 0.0 0.5 0.7 100.0 89.3 12.3 99 Riau Islands 1.1 29.4 64.3 3.7 0.4 0.0 0.0 1.2 100.0 94.7 18.6 139 Java DKI Jakarta 2.0 37.1 59.6 0.5 0.1 0.0 0.0 0.7 100.0 98.7 26.5 642 West Java 0.4 19.9 60.0 17.3 0.7 0.3 0.4 1.1 100.0 80.3 10.7 3,009 Central Java 0.6 24.8 68.1 5.2 0.5 0.2 0.2 0.5 100.0 93.6 13.7 1,979 DI Yogyakarta 1.1 42.0 54.9 1.5 0.0 0.0 0.0 0.4 100.0 98.0 15.5 189 East Java 0.7 19.7 69.4 9.2 0.6 0.4 0.0 0.1 100.0 89.8 12.6 2,416 Banten 2.0 16.8 58.5 21.7 0.5 0.0 0.2 0.3 100.0 77.3 12.9 782 Bali and Nusa Tenggara Bali 2.2 44.8 51.6 0.6 0.5 0.0 0.0 0.2 100.0 98.7 22.4 239 West Nusa Tenggara 3.5 15.2 63.1 16.4 0.4 0.2 0.6 0.6 100.0 81.7 9.7 397 East Nusa Tenggara 3.3 7.5 46.0 29.9 10.7 0.8 0.2 1.7 100.0 56.8 5.2 436 Kalimantan West Kalimantan 1.2 10.5 60.6 25.7 0.5 0.1 0.0 1.5 100.0 72.2 7.1 332 Central Kalimantan 0.6 9.2 60.4 27.7 1.2 0.0 0.3 0.6 100.0 70.2 5.8 174 South Kalimantan 0.9 17.6 61.6 19.3 0.4 0.0 0.0 0.2 100.0 80.1 7.7 273 East Kalimantan 2.5 22.5 58.8 14.1 2.2 0.0 0.0 0.0 100.0 83.8 14.5 271 Sulawesi North Sulawesi 3.5 29.4 52.9 12.4 0.2 0.6 0.2 0.8 100.0 85.8 12.0 159 Central Sulawesi 1.2 13.8 47.9 25.6 11.2 0.0 0.0 0.3 100.0 62.9 9.2 220 South Sulawesi 1.3 19.8 54.6 17.8 3.9 0.1 0.9 1.5 100.0 75.8 8.2 580 Southeast Sulawesi 0.3 7.0 58.6 29.6 3.3 0.0 0.2 1.0 100.0 65.9 4.7 180 Gorontalo 2.1 17.4 55.5 23.4 1.2 0.0 0.2 0.3 100.0 74.9 8.4 76 West Sulawesi 0.4 4.5 38.5 43.5 11.2 0.0 1.2 0.8 100.0 43.3 3.6 100 Maluku and Papua Maluku 1.1 8.4 40.3 46.0 2.9 0.0 0.2 1.1 100.0 49.9 5.0 130 North Maluku 1.1 11.3 39.1 40.8 4.3 0.4 2.4 0.6 100.0 51.5 6.7 88 West Papua 2.0 12.6 47.9 12.8 16.0 4.6 1.5 2.5 100.0 62.6 8.4 72 Papua 0.3 11.4 28.2 9.3 42.2 4.0 3.2 1.3 100.0 39.9 3.9 277 Total 1.0 20.0 62.2 13.5 2.2 0.3 0.3 0.7 100.0 83.1 12.3 16,948 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, obstetrician, nurse, midwife, and village midwife. 270 • Appendix A Table A-9.6.2 Assistance during delivery: The least qualified person Percent distribution of live births in the five years preceding the survey by the least qualified person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to province, Indonesia 2012 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C- section Number of births Province Doctor Obste- trician Nurse/ midwife/ village midwife Traditional birth attendant Relative/ friend Other No one Missing Total Sumatera Aceh 0.0 10.3 70.2 14.3 4.1 0.2 0.2 0.6 100.0 80.6 12.0 365.1 North Sumatera 0.3 11.3 69.2 11.7 6.8 0.1 0.4 0.3 100.0 80.8 14.5 1,057.9 West Sumatera 0.2 16.8 66.1 9.9 6.4 0.0 0.0 0.7 100.0 83.1 20.3 342.5 Riau 0.3 8.4 62.1 16.9 11.5 0.0 0.0 0.8 100.0 70.8 14.6 483.6 Jambi 0.0 6.9 50.7 31.7 10.8 0.0 0.0 0.0 100.0 57.5 9.7 220.6 South Sumatera 0.4 11.9 59.0 21.1 7.1 0.0 0.0 0.5 100.0 71.3 12.5 577.3 Bengkulu 0.6 8.4 64.0 21.2 5.1 0.0 0.0 0.6 100.0 73.0 8.9 106.3 Lampung 0.2 6.0 55.5 20.7 16.2 0.4 0.6 0.3 100.0 61.8 12.0 537.6 Bangka Belitung 0.2 8.9 66.3 15.0 8.5 0.0 0.5 0.7 100.0 75.4 12.3 98.7 Riau Islands 0.0 19.8 72.5 4.4 2.0 0.0 0.0 1.2 100.0 92.3 18.6 138.9 Java DKI Jakarta 0.8 23.8 71.1 1.4 2.2 0.0 0.0 0.7 100.0 95.7 26.5 641.5 West Java 0.0 7.6 46.8 20.3 23.6 0.3 0.4 1.1 100.0 54.4 10.7 3,008.8 Central Java 0.5 10.9 67.6 15.6 4.6 0.2 0.2 0.5 100.0 78.9 13.7 1,978.9 DI Yogyakarta 0.0 12.0 80.3 3.4 3.9 0.0 0.0 0.4 100.0 92.3 15.5 189.3 East Java 0.3 10.6 70.3 9.9 8.3 0.4 0.0 0.1 100.0 81.2 12.6 2,415.5 Banten 0.1 8.6 47.9 20.8 22.2 0.0 0.2 0.3 100.0 56.6 12.9 782.1 Bali and Nusa Tenggara Bali 0.2 19.0 75.6 0.6 4.3 0.0 0.0 0.2 100.0 94.9 22.4 239.5 West Nusa Tenggara 0.5 5.1 60.6 27.2 5.1 0.2 0.6 0.6 100.0 66.2 9.7 396.7 East Nusa Tenggara 0.1 1.7 45.8 30.8 19.0 0.8 0.2 1.7 100.0 47.5 5.2 436.1 Kalimantan West Kalimantan 0.8 6.4 53.2 28.4 9.6 0.1 0.0 1.5 100.0 60.4 7.1 331.7 Central Kalimantan 0.0 3.0 45.6 33.2 17.3 0.0 0.3 0.6 100.0 48.7 5.8 174.1 South Kalimantan 0.2 9.0 47.7 29.2 13.6 0.0 0.0 0.2 100.0 57.0 7.7 272.6 East Kalimantan 0.5 6.3 64.6 17.1 11.4 0.0 0.0 0.0 100.0 71.5 14.5 271.1 Sulawesi North Sulawesi 1.2 10.9 61.2 14.2 10.9 0.6 0.2 0.8 100.0 73.2 12.0 158.5 Central Sulawesi 0.2 3.2 37.8 23.6 34.8 0.0 0.0 0.3 100.0 41.3 9.2 220.3 South Sulawesi 0.3 11.4 49.6 21.2 15.0 0.1 0.9 1.5 100.0 61.3 8.2 580.1 Southeast Sulawesi 0.2 2.8 35.9 46.2 13.8 0.0 0.2 1.0 100.0 38.9 4.7 180.1 Gorontalo 0.5 7.2 39.5 45.9 6.5 0.0 0.2 0.3 100.0 47.1 8.4 75.8 West Sulawesi 0.4 3.7 23.0 53.7 17.3 0.0 1.2 0.8 100.0 27.0 3.6 99.8 Maluku and Papua Maluku 0.8 5.6 33.4 50.3 8.6 0.0 0.2 1.1 100.0 39.8 5.0 129.9 North Maluku 0.0 5.2 34.3 47.6 9.5 0.4 2.4 0.6 100.0 39.5 6.7 88.0 West Papua 1.0 6.2 51.9 13.3 19.1 4.6 1.5 2.5 100.0 59.0 8.4 72.0 Papua 0.2 5.6 30.2 8.3 47.3 4.0 3.2 1.3 100.0 35.9 3.9 277.3 Total 0.3 9.7 58.4 17.7 12.8 0.3 0.3 0.7 100.0 68.3 12.3 16,948.3 Appendix A • 271 Table A-9.7 Delivery characteristics Percentage of births in the last five years preceding the survey delivered by caesarean section and percent distribution by birth weight and by mother’s estimate of baby’s size at birth, according to province, Indonesia 2012 Delivery by C- section Birth weight Total Percent distribution of all live births by size of child at birth Total Number of births Province Not weighed Less than 2.5 kg 2.5 kg or more Don’t know/ missing Very small Smaller than average Average or larger Don’t know/ missing Sumatera Aceh 8.9 13.0 6.5 78.7 1.7 100.0 1.3 12.1 81.0 5.6 100.0 365 North Sumatera 12.4 14.9 4.2 79.6 1.3 100.0 1.7 9.9 83.1 5.3 100.0 1,058 West Sumatera 17.4 3.3 4.6 90.2 1.8 100.0 1.4 8.5 88.8 1.3 100.0 343 Riau 11.8 8.3 4.3 85.3 2.1 100.0 1.7 8.8 85.3 4.1 100.0 484 Jambi 6.9 15.5 4.7 79.8 0.0 100.0 2.4 14.3 80.6 2.7 100.0 221 South Sumatera 9.8 6.0 6.3 87.1 0.7 100.0 1.0 11.4 85.8 1.8 100.0 577 Bengkulu 6.0 5.7 5.0 88.0 1.3 100.0 1.9 9.9 84.7 3.4 100.0 106 Lampung 9.8 7.3 6.1 86.3 0.3 100.0 0.9 8.9 87.8 2.3 100.0 538 Bangka Belitung 10.0 2.9 5.4 90.1 1.6 100.0 1.0 12.7 84.6 1.7 100.0 99 Riau Islands 14.3 2.7 5.5 89.8 1.9 100.0 0.6 7.6 89.7 2.1 100.0 139 Java DKI Jakarta 20.1 0.1 4.7 93.8 1.4 100.0 0.6 11.0 87.1 1.3 100.0 642 West Java 8.7 4.0 6.5 87.2 2.4 100.0 2.0 11.8 82.9 3.2 100.0 3,009 Central Java 10.4 0.7 6.9 92.0 0.5 100.0 1.9 10.1 87.4 0.6 100.0 1,979 DI Yogyakarta 13.1 0.2 9.2 90.2 0.4 100.0 2.5 8.8 88.3 0.4 100.0 189 East Java 9.8 6.2 7.8 85.2 0.8 100.0 2.9 12.5 83.7 0.9 100.0 2,416 Banten 9.6 10.6 7.9 80.7 0.8 100.0 1.7 10.4 85.8 2.1 100.0 782 Bali and Nusa Tenggara Bali 17.2 0.8 6.7 92.3 0.2 100.0 2.6 6.5 90.5 0.4 100.0 239 West Nusa Tenggara 7.5 8.8 9.6 80.8 0.8 100.0 3.2 13.1 80.5 3.2 100.0 397 East Nusa Tenggara 3.9 29.6 10.6 57.2 2.6 100.0 3.0 15.1 72.8 9.2 100.0 436 Kalimantan West Kalimantan 4.8 18.2 6.9 73.3 1.6 100.0 0.3 10.2 84.6 4.9 100.0 332 Central Kalimantan 4.1 17.5 4.6 77.1 0.8 100.0 2.3 9.4 85.2 3.1 100.0 174 South Kalimantan 6.5 8.2 6.6 84.6 0.6 100.0 1.5 11.8 83.8 2.9 100.0 273 East Kalimantan 11.7 3.1 5.0 91.5 0.4 100.0 0.7 12.0 87.1 0.2 100.0 271 Sulawesi North Sulawesi 10.5 6.8 7.1 84.9 1.2 100.0 2.8 14.5 80.6 2.1 100.0 159 Central Sulawesi 6.3 23.9 10.7 63.5 2.0 100.0 2.4 13.4 77.1 7.1 100.0 220 South Sulawesi 7.2 14.8 6.9 75.5 2.8 100.0 2.6 18.0 74.8 4.6 100.0 580 Southeast Sulawesi 3.1 28.0 3.3 65.9 2.8 100.0 2.8 16.6 76.9 3.8 100.0 180 Gorontalo 5.8 20.1 9.6 67.7 2.5 100.0 4.3 16.6 73.7 5.4 100.0 76 West Sulawesi 2.7 42.3 5.5 48.6 3.6 100.0 2.1 17.5 72.4 7.9 100.0 100 Maluku and Papua Maluku 4.4 46.1 2.9 48.8 2.2 100.0 1.0 13.1 77.7 8.2 100.0 130 North Maluku 5.9 41.1 4.3 51.3 3.3 100.0 2.5 12.4 75.9 9.2 100.0 88 West Papua 6.6 30.4 5.8 58.1 5.7 100.0 2.7 10.3 71.0 15.9 100.0 72 Papua 3.2 52.1 2.7 34.3 10.9 100.0 0.7 5.2 82.6 11.5 100.0 277 Total 9.7 9.2 6.5 82.8 1.5 100.0 1.9 11.5 83.6 3.0 100.0 16,948 272 • Appendix A Table A-9.8 Timing of first postnatal checkup Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution of the mother’s first postnatal check-up for the last live birth by time after delivery, and the percentage of women with a live birth in the two years preceding the survey who received a postnatal checkup in the first two days after giving birth, according to province, Indonesia 2012 Time after delivery of mother’s first postnatal checkup No postnatal checkup1 Total Percentage of women with a postnatal checkup in the first two days after birth Number of women Province Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don’t know/ missing Sumatera Aceh 44.8 11.4 19.5 6.5 3.9 0.2 13.6 100.0 75.7 144 North Sumatera 36.0 19.2 15.9 1.6 4.3 1.7 21.3 100.0 71.1 388 West Sumatera 54.7 14.9 12.7 0.5 3.9 2.6 10.7 100.0 82.3 138 Riau 46.6 20.1 15.1 2.5 4.1 1.7 9.9 100.0 81.8 176 Jambi 42.8 16.4 14.8 7.5 8.0 0.6 9.9 100.0 74.0 94 South Sumatera 49.2 13.9 15.9 4.0 7.1 0.8 8.9 100.0 79.1 222 Bengkulu 55.5 15.8 19.2 0.9 3.1 1.2 4.2 100.0 90.6 42 Lampung 50.6 19.6 13.9 4.6 2.4 0.5 8.3 100.0 84.1 226 Bangka Belitung 55.8 10.6 16.5 5.7 4.8 0.4 6.2 100.0 82.9 40 Riau Islands 53.6 14.9 13.8 2.4 2.8 3.9 8.6 100.0 82.3 58 Java DKI Jakarta 64.9 12.4 10.2 3.4 4.6 0.9 3.7 100.0 87.4 253 West Java 59.0 10.2 10.8 4.3 4.1 0.6 10.9 100.0 80.1 1,207 Central Java 68.8 12.8 7.6 3.0 3.0 0.3 4.4 100.0 89.2 847 DI Yogyakarta 63.5 23.7 9.2 1.9 0.0 0.6 1.1 100.0 96.4 69 East Java 63.5 17.7 7.2 1.9 2.5 3.6 3.6 100.0 88.4 1,014 Banten 58.0 10.9 6.7 4.7 8.3 1.6 9.8 100.0 75.6 316 Bali and Nusa Tenggara Bali 64.5 19.7 9.1 1.3 2.4 0.0 3.0 100.0 93.3 91 West Nusa Tenggara 68.2 11.4 8.7 1.3 2.6 0.5 7.2 100.0 88.8 158 East Nusa Tenggara 40.6 8.9 7.5 1.6 4.3 0.8 36.2 100.0 57.0 158 Kalimantan West Kalimantan 38.2 3.6 17.7 9.0 3.6 1.2 26.7 100.0 59.4 151 Central Kalimantan 49.1 6.0 19.0 4.5 3.7 0.6 17.0 100.0 74.1 71 South Kalimantan 53.2 11.1 14.9 3.6 3.2 1.3 12.7 100.0 79.1 111 East Kalimantan 59.2 17.9 6.1 1.9 1.0 0.6 13.2 100.0 83.2 109 Sulawesi North Sulawesi 42.3 11.4 15.9 3.8 4.8 6.0 15.7 100.0 69.7 64 Central Sulawesi 46.1 15.1 14.2 1.8 2.2 1.3 19.3 100.0 75.4 90 South Sulawesi 60.8 5.7 9.2 2.2 2.2 5.1 15.0 100.0 75.6 238 Southeast Sulawesi 55.7 7.0 14.4 5.4 1.6 0.0 15.9 100.0 77.1 70 Gorontalo 38.4 29.2 13.4 1.3 4.9 1.5 11.4 100.0 81.0 29 West Sulawesi 32.5 8.6 18.9 1.1 3.8 3.4 31.7 100.0 60.0 40 Maluku and Papua Maluku 33.6 11.5 15.3 3.4 4.1 0.3 31.8 100.0 60.4 49 North Maluku 46.2 4.6 10.0 4.2 3.7 0.5 30.9 100.0 60.7 34 West Papua 34.3 11.1 8.9 2.4 3.3 1.8 38.3 100.0 54.2 29 Papua 15.6 6.3 7.5 2.3 5.1 9.3 53.9 100.0 29.4 106 Total 55.8 13.3 10.9 3.2 3.7 1.6 11.3 100.0 80.1 6,830 1 Includes women who received a checkup after 41 days Appendix A • 273 Table A-9.9 Type of provider of first postnatal checkup for the mother Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution by type of provider of the mother’s first postnatal health check in the two days after the last live birth, according to province, Indonesia 2012 Type of health provider of mother’s first postnatal checkup No postnatal checkup in the first two days after birth Total Number of women Province Doctor Obstetrician Nurse/ midwife/ village midwife Traditional birth attendant Sumatera Aceh 0.5 12.3 60.6 2.3 24.3 100.0 144 North Sumatera 1.7 12.5 55.9 1.0 28.9 100.0 388 West Sumatera 2.3 15.9 62.0 2.2 17.7 100.0 138 Riau 0.4 18.4 60.2 2.9 18.2 100.0 176 Jambi 0.0 13.4 58.4 2.3 26.0 100.0 94 South Sumatera 1.6 16.7 59.3 1.4 20.9 100.0 222 Bengkulu 2.3 9.9 76.0 2.4 9.4 100.0 42 Lampung 0.5 8.8 71.4 3.3 15.9 100.0 226 Bangka Belitung 1.1 19.5 60.9 1.5 17.1 100.0 40 Riau Islands 1.6 29.2 49.6 2.0 17.7 100.0 58 Java DKI Jakarta 2.1 33.9 51.4 0.0 12.6 100.0 253 West Java 0.0 17.0 60.9 2.2 19.9 100.0 1,207 Central Java 2.1 18.6 67.8 0.7 10.8 100.0 847 DI Yogyakarta 2.9 38.1 55.4 0.0 3.6 100.0 69 East Java 1.1 17.1 69.5 0.8 11.6 100.0 1,014 Banten 0.7 11.8 58.0 5.1 24.4 100.0 316 Bali and Nusa Tenggara Bali 2.5 38.0 52.8 0.0 6.7 100.0 91 West Nusa Tenggara 1.7 9.6 72.4 5.2 11.2 100.0 158 East Nusa Tenggara 4.8 7.6 43.5 1.2 43.0 100.0 158 Kalimantan West Kalimantan 0.8 11.1 45.2 2.2 40.6 100.0 151 Central Kalimantan 1.8 8.3 59.8 4.3 25.9 100.0 71 South Kalimantan 0.5 11.7 63.9 2.9 20.9 100.0 111 East Kalimantan 2.9 21.5 56.1 2.7 16.8 100.0 109 Sulawesi North Sulawesi 5.6 26.5 33.5 4.1 30.3 100.0 64 Central Sulawesi 1.4 14.1 57.6 2.3 24.6 100.0 90 South Sulawesi 2.5 17.2 50.7 5.2 24.4 100.0 238 Southeast Sulawesi 0.0 9.9 55.7 11.5 22.9 100.0 70 Gorontalo 1.4 20.1 51.5 8.0 19.0 100.0 29 West Sulawesi 1.2 2.3 52.6 3.9 40.0 100.0 40 Maluku and Papua Maluku 4.2 7.3 40.2 8.7 39.6 100.0 49 North Maluku 2.2 10.6 42.7 5.2 39.3 100.0 34 West Papua 3.0 15.8 34.0 1.4 45.8 100.0 29 Papua 1.5 11.9 16.1 0.0 70.6 100.0 106 Total 1.4 16.6 60.0 2.1 19.9 100.0 6,830 1 Includes women who received a checkup more than 2 days after giving birth and women receiving a checkup within 2 days of giving birth from a provider other than a doctor, obstetrician, nurse/midwife/village midwife, or traditional birth attendant. 274 • Appendix A Table A-9.10 Timing of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal checkup in the first two days after birth, according to province, Indonesia 2012 Time after birth of newborn’s first postnatal checkup No postnatal checkup1 Total Percentage of births with a postnatal checkup in the first two days after birth Number of births Province Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don’t know/ missing Sumatera Aceh 13.0 14.3 8.0 13.6 4.7 0.5 45.8 100.0 48.9 144 North Sumatera 0.6 14.1 9.4 10.3 0.6 2.7 62.2 100.0 34.5 388 West Sumatera 3.1 24.0 8.9 9.4 2.5 3.3 48.7 100.0 45.4 138 Riau 8.6 17.9 8.1 14.6 1.3 1.7 47.8 100.0 49.2 176 Jambi 7.2 17.3 11.1 15.0 7.6 2.1 39.8 100.0 50.5 94 South Sumatera 5.5 22.4 4.4 7.3 3.1 1.8 55.6 100.0 39.5 222 Bengkulu 19.9 37.1 9.1 15.5 0.8 0.9 16.6 100.0 81.7 42 Lampung 4.5 15.1 10.3 8.5 1.7 0.0 59.9 100.0 38.4 226 Bangka Belitung 11.4 18.2 5.1 11.1 2.1 0.0 52.1 100.0 45.8 40 Riau Islands 9.2 23.2 3.1 4.8 2.8 1.6 55.4 100.0 40.3 58 Java DKI Jakarta 11.5 20.6 5.3 3.3 2.6 1.3 55.3 100.0 40.8 253 West Java 25.4 16.4 1.3 6.9 3.8 1.9 44.4 100.0 49.9 1,207 Central Java 15.2 32.8 4.9 5.4 2.6 2.5 36.6 100.0 58.3 847 DI Yogyakarta 15.3 56.1 14.6 4.1 2.2 0.5 7.2 100.0 90.1 69 East Java 9.5 26.8 10.5 5.6 7.2 3.8 36.7 100.0 52.3 1,014 Banten 3.5 27.6 2.8 7.0 2.5 0.7 55.9 100.0 40.9 316 Bali and Nusa Tenggara Bali 2.2 38.0 10.4 7.4 2.4 1.0 38.6 100.0 58.0 91 West Nusa Tenggara 13.6 34.5 8.7 10.8 2.7 0.5 29.1 100.0 67.7 158 East Nusa Tenggara 1.1 22.7 5.7 7.5 1.1 1.4 60.5 100.0 37.0 158 Kalimantan West Kalimantan 2.6 8.6 0.9 10.8 3.2 3.4 70.4 100.0 23.0 151 Central Kalimantan 7.6 14.8 2.2 2.9 3.7 3.3 65.5 100.0 27.5 71 South Kalimantan 20.4 21.5 9.2 10.8 3.6 1.9 32.5 100.0 62.0 111 East Kalimantan 27.8 30.9 10.6 3.2 2.8 2.6 22.1 100.0 72.6 109 Sulawesi North Sulawesi 8.0 15.5 7.9 7.3 5.3 2.6 53.4 100.0 38.7 64 Central Sulawesi 1.3 27.1 10.7 10.7 1.8 2.0 46.5 100.0 49.8 90 South Sulawesi 11.5 20.7 2.3 5.7 0.3 2.1 57.5 100.0 40.1 238 Southeast Sulawesi 8.0 28.3 6.7 9.4 3.7 1.8 42.0 100.0 52.5 70 Gorontalo 3.0 31.9 17.0 10.7 2.6 1.1 33.7 100.0 62.6 29 West Sulawesi 1.2 14.6 3.1 4.2 1.6 3.0 72.3 100.0 23.1 40 Maluku and Papua Maluku 1.9 16.9 6.8 12.8 3.7 1.0 56.9 100.0 38.4 49 North Maluku 2.4 21.4 1.8 12.5 8.4 1.0 52.5 100.0 38.2 34 West Papua 0.0 7.0 2.0 4.6 0.3 1.7 84.5 100.0 13.5 29 Papua 0.0 5.4 1.9 3.4 3.2 3.9 82.2 100.0 10.7 106 Total 11.7 22.7 6.1 7.4 3.4 2.2 46.6 100.0 47.8 6,830 1 Includes newborns who received a checkup after the first week Appendix A • 275 Table A-9.11 Type of provider of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by type of provider of the newborn’s first postnatal health check during the two days after the last live birth, according to province, Indonesia 2012 Type of health provider of newborn’s first postnatal checkup No postnatal checkup in the first two days after birth Total Number of births Province Doctor Obstetrician Pediatrician Nurse/ midwife/ village midwife Traditional birth attendant Sumatera Aceh 0.0 6.4 2.8 39.2 0.5 51.1 100.0 144 North Sumatera 1.0 2.0 5.0 25.8 0.7 65.5 100.0 388 West Sumatera 0.4 4.1 3.3 35.4 2.2 54.6 100.0 138 Riau 0.4 3.8 5.3 37.3 2.3 50.8 100.0 176 Jambi 0.4 3.5 4.7 38.3 3.6 49.5 100.0 94 South Sumatera 0.4 8.3 2.3 28.0 0.5 60.5 100.0 222 Bengkulu 0.0 6.6 2.0 70.7 2.4 18.3 100.0 42 Lampung 0.0 2.5 1.6 30.6 3.8 61.6 100.0 226 Bangka Belitung 0.0 5.9 2.7 35.6 1.6 54.2 100.0 40 Riau Islands 0.0 9.2 5.0 26.1 0.0 59.7 100.0 58 Java DKI Jakarta 0.4 5.6 14.4 20.3 0.0 59.2 100.0 253 West Java 0.0 4.4 5.2 37.5 2.8 50.1 100.0 1,207 Central Java 0.3 3.6 6.2 45.8 2.4 41.7 100.0 847 DI Yogyakarta 0.6 4.2 34.5 49.9 1.0 9.9 100.0 69 East Java 0.4 2.3 9.1 39.2 1.4 47.7 100.0 1,014 Banten 0.3 2.3 5.1 30.3 2.9 59.1 100.0 316 Bali and Nusa Tenggara Bali 0.6 6.7 17.2 33.5 0.0 42.0 100.0 91 West Nusa Tenggara 0.8 2.9 1.2 58.8 4.0 32.3 100.0 158 East Nusa Tenggara 2.3 0.6 3.2 30.4 0.6 63.0 100.0 158 Kalimantan West Kalimantan 0.9 3.2 1.2 15.0 2.7 77.0 100.0 151 Central Kalimantan 1.3 1.3 2.8 21.5 0.5 72.5 100.0 71 South Kalimantan 0.0 6.3 2.8 50.4 2.5 38.0 100.0 111 East Kalimantan 2.2 5.5 16.4 45.2 3.3 27.4 100.0 109 Sulawesi North Sulawesi 3.6 4.0 9.6 19.6 1.9 61.3 100.0 64 Central Sulawesi 0.6 3.1 3.6 39.3 3.2 50.2 100.0 90 South Sulawesi 1.2 3.4 6.9 26.7 1.9 59.9 100.0 238 Southeast Sulawesi 0.6 3.0 1.0 39.2 8.7 47.5 100.0 70 Gorontalo 0.0 3.0 8.7 41.5 9.4 37.4 100.0 29 West Sulawesi 0.3 0.0 0.3 21.1 1.5 76.9 100.0 40 Maluku and Papua Maluku 1.4 3.1 0.0 24.5 9.5 61.6 100.0 49 North Maluku 1.5 2.5 1.5 28.5 4.2 61.8 100.0 34 West Papua 0.0 1.4 2.8 8.8 0.6 86.5 100.0 29 Papua 1.0 0.4 1.9 6.1 1.2 89.3 100.0 106 Total 0.5 3.6 6.1 35.4 2.1 52.2 100.0 6,830 276 • Appendix A Table A-9.12 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to province, Indonesia 2012 Problems in accessing health care Province Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone At least one problem accessing health care Number of women Sumatera Aceh 7.7 12.3 9.2 21.3 29.4 877 North Sumatera 2.7 13.8 10.2 22.9 32.9 2,394 West Sumatera 2.8 13.1 8.4 30.2 40.9 852 Riau 3.2 11.3 9.6 33.9 43.1 1,040 Jambi 6.8 15.1 16.4 22.5 35.9 580 South Sumatera 5.3 14.9 14.6 22.5 35.3 1,358 Bengkulu 2.4 12.7 7.7 22.5 33.1 306 Lampung 7.6 15.7 14.1 26.5 37.0 1,443 Bangka Belitung 2.8 7.5 4.7 28.2 31.9 245 Riau Islands 4.5 11.5 8.1 17.6 25.9 323 Java DKI Jakarta 2.2 9.9 5.0 18.5 25.9 1,939 West Java 5.8 16.2 11.0 20.9 32.9 8,265 Central Java 3.4 19.7 8.7 20.6 36.0 6,240 DI Yogyakarta 3.0 12.4 6.7 23.3 31.5 654 East Java 3.5 9.7 5.5 24.5 31.8 7,374 Banten 14.1 18.9 12.2 25.0 39.0 2,148 Bali and Nusa Tenggara Bali 13.9 20.5 23.6 42.2 49.0 790 West Nusa Tenggara 5.0 16.0 9.0 12.9 25.7 997 East Nusa Tenggara 2.7 16.9 16.5 19.5 34.0 892 Kalimantan West Kalimantan 2.8 5.7 13.6 26.2 30.5 756 Central Kalimantan 2.6 9.3 12.1 21.9 29.3 409 South Kalimantan 2.0 9.4 12.1 29.1 35.2 730 East Kalimantan 1.7 5.9 5.0 21.9 26.2 671 Sulawesi North Sulawesi 2.0 18.0 9.0 14.6 32.5 427 Central Sulawesi 7.1 22.5 18.9 28.9 43.6 486 South Sulawesi 2.3 13.2 9.8 17.1 29.4 1,530 Southeast Sulawesi 5.5 21.3 13.6 20.4 34.8 382 Gorontalo 8.0 17.4 16.2 22.6 33.6 203 West Sulawesi 12.1 37.9 32.9 37.6 54.1 191 Maluku and Papua Maluku 5.6 23.0 12.4 14.4 32.1 260 North Maluku 5.6 19.4 12.1 15.0 29.6 188 West Papua 24.6 39.9 27.3 27.9 53.5 130 Papua 24.9 57.8 50.5 26.8 64.0 527 Total 5.1 15.2 10.5 22.8 34.1 45,607 Appendix A • 277 CHAPTER 10 CHILD HEALTH Table A-10.1 Child’s weight and size at birth Percentage of live births in the five years preceding the survey with a reported birth weight; among live births in the five years preceding the survey that have a reported birth weight, percent distribution by birth weight; and percent distribution of all live births in the five years preceding the survey by mother’s estimate of baby’s size at birth, according to province, Indonesia 2012 Percentage of all births that have a reported birth weight1 Percent distribution of births with a reported birth weight1 Total Number of births Percent distribution of all live births by size of child at birth Total Number of births Province Less than 2.5 kg 2.5 kg or more Very small Smaller than average Average or larger Don’t know/ missing Sumatera Aceh 85.2 7.6 92.4 100.0 311 1.3 12.1 81.0 5.6 100.0 365 North Sumatera 83.8 5.0 95.0 100.0 886 1.7 9.9 83.1 5.3 100.0 1,058 West Sumatera 94.9 4.9 95.1 100.0 325 1.4 8.5 88.8 1.3 100.0 343 Riau 89.6 4.8 95.2 100.0 433 1.7 8.8 85.3 4.1 100.0 484 Jambi 84.5 5.6 94.4 100.0 187 2.4 14.3 80.6 2.7 100.0 221 South Sumatera 93.3 6.7 93.3 100.0 539 1.0 11.4 85.8 1.8 100.0 577 Bengkulu 93.0 5.4 94.6 100.0 99 1.9 9.9 84.7 3.4 100.0 106 Lampung 92.4 6.6 93.4 100.0 497 0.9 8.9 87.8 2.3 100.0 538 Bangka Belitung 95.5 5.7 94.3 100.0 94 1.0 12.7 84.6 1.7 100.0 99 Riau Islands 95.4 5.8 94.2 100.0 132 0.6 7.6 89.7 2.1 100.0 139 Java DKI Jakarta 98.4 4.7 95.3 100.0 632 0.6 11.0 87.1 1.3 100.0 642 West Java 93.7 6.9 93.1 100.0 2,818 2.0 11.8 82.9 3.2 100.0 3,009 Central Java 98.8 7.0 93.0 100.0 1,956 1.9 10.1 87.4 0.6 100.0 1,979 DI Yogyakarta 99.4 9.4 90.6 100.0 188 2.5 8.8 88.3 0.4 100.0 189 East Java 93.0 8.4 91.6 100.0 2,246 2.9 12.5 83.7 0.9 100.0 2,416 Banten 88.6 8.9 91.1 100.0 693 1.7 10.4 85.8 2.1 100.0 782 Bali and Nusa Tenggara Bali 99.0 6.8 93.2 100.0 237 2.6 6.5 90.5 0.4 100.0 239 West Nusa Tenggara 90.4 10.6 89.4 100.0 358 3.2 13.1 80.5 3.2 100.0 397 East Nusa Tenggara 67.8 15.7 84.3 100.0 296 3.0 15.1 72.8 9.2 100.0 436 Kalimantan West Kalimantan 80.2 8.6 91.4 100.0 266 0.3 10.2 84.6 4.9 100.0 332 Central Kalimantan 81.7 5.6 94.4 100.0 142 2.3 9.4 85.2 3.1 100.0 174 South Kalimantan 91.2 7.2 92.8 100.0 249 1.5 11.8 83.8 2.9 100.0 273 East Kalimantan 96.5 5.2 94.8 100.0 262 0.7 12.0 87.1 0.2 100.0 271 Sulawesi North Sulawesi 92.0 7.7 92.3 100.0 146 2.8 14.5 80.6 2.1 100.0 159 Central Sulawesi 74.1 14.4 85.6 100.0 163 2.4 13.4 77.1 7.1 100.0 220 South Sulawesi 82.4 8.4 91.6 100.0 478 2.6 18.0 74.8 4.6 100.0 580 Southeast Sulawesi 69.2 4.8 95.2 100.0 125 2.8 16.6 76.9 3.8 100.0 180 Gorontalo 77.4 12.5 87.5 100.0 59 4.3 16.6 73.7 5.4 100.0 76 West Sulawesi 54.1 10.2 89.8 100.0 54 2.1 17.5 72.4 7.9 100.0 100 Maluku and Papua Maluku 51.7 5.7 94.3 100.0 67 1.0 13.1 77.7 8.2 100.0 130 North Maluku 55.6 7.7 92.3 100.0 49 2.5 12.4 75.9 9.2 100.0 88 West Papua 63.9 9.1 90.9 100.0 46 2.7 10.3 71.0 15.9 100.0 72 Papua 37.0 7.2 92.8 100.0 103 0.7 5.2 82.6 11.5 100.0 277 Total 89.3 7.3 92.7 100.0 15,135 1.9 11.5 83.6 3.0 100.0 16,948 1 Based on either a written record or the mother’s recall 278 • Appendix A Table A-10.2 Vaccinations by province Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card and the mother’s report), by province, Indonesia 2012 Province BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Hepa- titis 0 Hepa- titis 1 Hepa- titis 2 Hepa- titis 3 Measles All basic vacci- nations exclud- ing Hepa- titis B All basic vacci- nations2 No vacci- nations Per- centage with a vacci- nation card seen Number of children Sumatera Aceh 77.6 76.8 67.6 57.6 83.6 75.5 64.5 67.5 59.6 56.1 31.4 59.8 49.7 29.9 11.5 25.5 68 North Sumatera 80.4 76.7 68.4 61.1 87.0 81.5 65.3 67.6 57.3 47.0 18.1 64.2 50.8 16.8 12.4 26.9 194 West Sumatera 89.0 81.8 74.7 62.9 92.2 79.4 73.8 78.8 67.8 62.3 36.8 69.5 59.4 34.9 6.3 26.9 69 Riau 82.4 84.2 78.2 67.0 86.6 81.6 69.0 80.4 71.9 60.4 35.1 70.8 57.6 33.3 12.5 36.7 86 Jambi 79.1 80.7 76.3 69.3 82.3 80.7 69.6 77.5 73.6 68.4 49.6 76.7 65.7 47.3 17.7 28.0 41 South Sumatera 90.1 88.3 77.9 69.5 90.6 79.4 68.6 84.6 71.2 63.2 32.6 80.1 63.3 30.2 7.5 38.1 113 Bengkulu 88.9 92.9 84.8 71.9 91.1 89.7 77.9 87.8 78.2 69.6 18.7 82.1 66.7 13.8 7.1 35.8 18 Lampung 95.3 95.8 86.0 74.1 95.8 91.9 79.4 95.9 86.2 65.6 38.8 89.3 68.9 36.5 2.5 48.1 119 Bangka Belitung 84.7 81.4 78.6 72.8 87.8 79.4 76.4 87.8 77.6 64.2 56.0 74.9 70.2 54.7 12.2 43.9 16 Riau Islands 85.2 85.0 78.3 74.2 87.8 84.8 76.2 79.3 77.1 72.1 36.0 75.7 65.3 34.0 10.3 28.2 32 Java DKI Jakarta 93.3 92.3 84.2 77.5 95.3 88.7 82.8 87.7 78.8 68.3 39.1 86.5 73.2 36.7 4.7 24.3 110 West Java 94.1 91.8 81.8 73.8 95.2 88.7 77.0 89.2 78.0 69.5 41.8 81.1 65.6 38.8 3.5 41.6 608 Central Java 91.8 94.2 89.7 82.7 95.6 92.6 87.3 92.6 85.0 78.9 64.7 92.6 78.7 63.2 4.4 56.5 420 DI Yogyakarta 100.0 100.0 100.0 96.4 100.0 100.0 97.5 98.8 96.1 93.7 77.5 97.1 93.5 76.2 0.0 69.4 30 East Java 96.8 95.7 90.7 83.6 96.5 92.3 86.7 93.1 80.7 75.8 54.4 87.8 77.2 52.0 2.6 53.9 458 Banten 82.0 78.7 68.7 49.1 83.5 73.6 54.9 74.5 53.8 43.1 23.3 61.4 37.9 20.8 13.5 30.3 143 Bali and Nusa Tenggara Bali 98.7 96.3 93.6 89.2 98.7 94.8 89.2 97.2 85.7 80.0 60.3 93.1 87.0 59.5 1.3 57.5 42 West Nusa Tenggara 92.2 92.9 85.1 70.7 92.9 91.8 75.5 90.9 75.7 58.5 33.7 89.9 66.0 32.7 5.4 35.2 78 East Nusa Tenggara 87.6 91.7 83.8 76.4 93.3 89.5 81.6 90.9 81.7 77.6 47.0 82.7 73.1 46.5 6.7 30.7 77 Kalimantan West Kalimantan 79.5 77.4 71.8 62.8 80.2 74.4 66.9 79.8 71.8 62.6 35.8 71.6 57.5 34.3 16.2 43.8 85 Central Kalimantan 72.3 67.2 57.3 52.5 79.7 69.2 57.5 67.6 54.7 49.9 27.5 64.2 45.9 27.5 15.9 32.7 36 South Kalimantan 83.1 79.2 69.1 62.1 84.4 78.1 72.1 74.2 68.1 63.3 36.5 73.6 61.4 34.7 11.4 40.5 57 East Kalimantan 91.6 94.1 86.4 80.4 95.3 90.2 83.0 92.8 81.9 67.5 51.4 89.0 76.6 50.1 4.7 58.0 53 Sulawesi North Sulawesi 97.3 94.0 89.4 84.2 94.1 88.5 84.2 89.8 82.4 74.8 49.6 87.5 77.1 48.6 2.7 41.1 31 Central Sulawesi 86.3 86.0 77.7 71.5 85.3 78.3 76.1 84.0 71.0 61.7 31.2 82.9 67.2 31.2 12.5 39.6 48 South Sulawesi 82.2 79.6 69.4 60.3 85.0 74.7 61.1 76.4 60.7 53.5 39.0 71.9 48.7 33.3 12.0 26.5 122 Southeast Sulawesi 87.8 87.2 84.6 75.7 89.5 86.6 78.3 83.2 76.6 71.0 32.5 81.4 70.5 32.5 9.2 26.7 42 Gorontalo 94.5 90.3 81.1 71.5 93.1 79.8 72.3 93.0 74.7 64.9 47.8 91.6 67.4 47.8 5.5 45.8 14 West Sulawesi 71.7 70.5 58.3 49.8 74.9 68.2 56.4 71.3 52.1 47.0 32.5 60.9 43.4 28.3 18.5 26.3 21 Maluku and Papua Maluku 76.6 71.1 59.9 46.9 78.4 66.5 53.6 69.3 60.3 50.4 20.6 65.1 44.2 19.7 18.8 26.9 25 North Maluku 91.1 92.0 83.4 62.2 91.0 84.4 68.0 85.9 78.7 54.7 21.1 83.4 55.1 21.1 6.0 19.9 16 West Papua 72.3 74.5 69.5 58.1 75.9 69.5 59.6 70.4 66.6 58.2 29.9 62.9 50.7 26.1 23.0 34.6 13 Papua 59.4 51.9 48.0 35.3 51.6 49.0 43.4 50.3 45.4 36.2 14.1 49.0 34.0 14.1 38.4 16.7 47 Total 89.3 88.1 80.7 72.0 91.2 85.5 75.9 85.3 74.5 66.3 42.4 80.1 65.6 40.3 7.3 41.1 3,333 1 BCG, measles, all four doses of Hepatitis B, three doses each of DPT and polio vaccine excluding polio 4 Appendix A • 279 Table A-10.3 Prevalence and treatment of symptoms of ARI Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to province, Indonesia 2012 Among children under age five: Among children under age five with symptoms of ARI: Province Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Sumatera Aceh 7.6 353 88.2 39.3 27 North Sumatera 4.6 1,026 74.4 45.5 47 West Sumatera 8.6 332 74.9 52.4 28 Riau 5.3 472 79.3 45.4 25 Jambi 5.8 217 73.2 68.0 13 South Sumatera 4.5 559 84.3 76.2 25 Bengkulu 7.8 103 94.6 55.5 8 Lampung 3.6 524 54.7 29.7 19 Bangka Belitung 5.0 96 85.1 28.5 5 Riau Islands 4.3 135 82.5 32.5 6 Java DKI Jakarta 7.2 625 83.7 39.0 45 West Java 4.1 2,888 75.7 30.2 120 Central Java 5.0 1,902 77.9 22.2 94 DI Yogyakarta 3.8 183 75.3 7.5 7 East Java 3.9 2,371 76.2 35.8 93 Banten 4.3 756 87.0 68.7 33 Bali and Nusa Tenggara Bali 3.0 232 93.8 80.8 7 West Nusa Tenggara 6.9 375 71.4 47.5 26 East Nusa Tenggara 6.7 415 67.4 25.2 28 Kalimantan West Kalimantan 9.0 322 70.7 39.1 29 Central Kalimantan 5.1 168 71.9 71.6 9 South Kalimantan 4.1 262 57.5 89.6 11 East Kalimantan 7.3 265 80.4 36.0 19 Sulawesi North Sulawesi 4.0 154 68.9 9.9 6 Central Sulawesi 12.0 202 63.2 26.5 24 South Sulawesi 6.0 564 64.0 37.1 34 Southeast Sulawesi 9.3 173 73.7 42.5 16 Gorontalo 8.9 72 62.0 13.2 6 West Sulawesi 8.1 96 60.3 20.8 8 Maluku and Papua Maluku 2.7 126 73.8 60.9 3 North Maluku 5.1 84 55.9 29.7 4 West Papua 2.6 66 100.0 32.9 2 Papua 2.4 260 53.7 29.2 6 Total 5.1 16,380 75.3 38.9 833 1 Symptoms of ARI (cough accompanied by short, rapid breathing which was chest-related and/or by difficult breathing which was chest-related) is considered a proxy for pneumonia 2 Excludes pharmacy, shop, and traditional practitioner 3 Includes grass, shrubs, crop residues 280 • Appendix A Table A-10.4 Prevalence and treatment of fever Among children under age five, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by province, Indonesia 2012 Among children under age five Among children under age five with fever Province Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antimalarial drugs Percentage who took antibiotic drugs Number of children Sumatera Aceh 35.8 353 83.0 4.8 40.4 127 North Sumatera 27.2 1,026 69.4 0.4 46.3 279 West Sumatera 33.6 332 80.4 0.0 52.0 111 Riau 32.4 472 73.0 1.0 30.7 153 Jambi 34.5 217 65.6 0.0 45.7 75 South Sumatera 22.0 559 67.1 0.0 48.0 123 Bengkulu 30.1 103 77.5 0.0 45.4 31 Lampung 28.6 524 75.6 2.4 27.3 150 Bangka Belitung 31.9 96 73.8 0.0 32.1 30 Riau Islands 28.7 135 77.2 0.8 34.3 39 Java DKI Jakarta 28.7 625 76.5 0.5 35.4 180 West Java 27.5 2,888 69.9 0.0 30.6 793 Central Java 29.9 1,902 78.1 0.5 34.3 569 DI Yogyakarta 31.6 183 69.9 0.8 19.0 58 East Java 37.3 2,371 83.5 0.0 34.3 885 Banten 31.7 756 75.3 0.5 42.1 240 Bali and Nusa Tenggara Bali 24.4 232 84.1 2.6 60.6 57 West Nusa Tenggara 35.9 375 71.3 2.2 36.8 135 East Nusa Tenggara 37.6 415 67.2 5.9 30.2 156 Kalimantan West Kalimantan 32.5 322 64.6 0.0 31.9 104 Central Kalimantan 33.3 168 60.5 0.0 36.1 56 South Kalimantan 32.8 262 52.0 0.0 54.8 86 East Kalimantan 33.4 265 75.3 0.0 43.5 89 Sulawesi North Sulawesi 35.0 154 72.5 0.6 29.5 54 Central Sulawesi 42.5 202 59.6 0.6 23.4 86 South Sulawesi 35.0 564 63.5 0.0 34.8 197 Southeast Sulawesi 27.8 173 62.3 4.3 31.9 48 Gorontalo 46.5 72 60.9 0.6 18.2 33 West Sulawesi 37.7 96 60.6 0.0 21.7 36 Maluku and Papua Maluku 19.1 126 63.6 0.0 37.3 24 North Maluku 30.8 84 59.6 1.5 27.3 26 West Papua 24.3 66 76.0 18.1 25.7 16 Papua 15.8 260 65.0 6.8 25.2 41 Total 31.0 16,380 73.5 0.8 35.5 5,086 1 Excludes pharmacy, shop, and traditional practitioner Appendix A • 281 Table A-10.5 Prevalence of diarrhea Percentage of children under age five who had diarrhea in the two weeks preceding the survey, by province, Indonesia 2012 Diarrhea in the two weeks preceding the survey Number of children Province All diarrhea Diarrhea with blood Sumatera Aceh 16.0 0.0 353 North Sumatera 13.7 0.1 1,026 West Sumatera 15.1 0.2 332 Riau 17.4 0.0 472 Jambi 16.7 0.0 217 South Sumatera 11.5 0.2 559 Bengkulu 18.6 0.0 103 Lampung 13.0 0.0 524 Bangka Belitung 9.8 0.0 96 Riau Islands 11.2 0.0 135 Java DKI Jakarta 13.8 0.0 625 West Java 12.6 0.0 2,888 Central Java 13.7 0.0 1,902 DI Yogyakarta 7.4 0.0 183 East Java 14.1 0.1 2,371 Banten 16.0 0.1 756 Bali and Nusa Tenggara Bali 10.1 0.0 232 West Nusa Tenggara 14.0 0.4 375 East Nusa Tenggara 17.6 0.7 415 Kalimantan West Kalimantan 24.0 0.4 322 Central Kalimantan 18.5 0.3 168 South Kalimantan 17.1 0.5 262 East Kalimantan 13.7 0.3 265 Sulawesi North Sulawesi 12.9 0.0 154 Central Sulawesi 17.9 0.5 202 South Sulawesi 19.6 0.3 564 Southeast Sulawesi 15.9 0.2 173 Gorontalo 20.8 0.5 72 West Sulawesi 19.9 0.4 96 Maluku and Papua Maluku 8.7 0.2 126 North Maluku 13.4 0.0 84 West Papua 9.2 0.0 66 Papua 9.9 0.4 260 Total 14.3 0.1 16,380 1 See Table 2.1 for definition of categories 2 See Table 2.2 for definition of categories 3 Facilities that would be considered improved if they were not shared by two or more households 282 • Appendix A Table A-10.6 Diarrhea treatment Among children under age five who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by province, Indonesia 2012 Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 Oral rehydration therapy (ORT) Increased fluids ORT or increased fluids Other treatments Missing No treat- ment Number of children with diarrhea Province Fluid from ORS packets or pre- packaged liquid Recom- mended home fluids (RHF) Either ORS or RHF Anti-biotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other Sumatera Aceh 69.9 25.1 14.6 31.4 45.4 65.9 2.6 2.6 9.7 0.0 52.4 0.0 10.6 56 North Sumatera 59.5 25.0 7.2 32.2 43.1 64.0 13.7 0.0 0.0 0.0 46.2 1.8 15.8 140 West Sumatera 67.0 34.2 20.8 44.5 54.3 73.1 12.2 0.0 0.0 0.0 38.6 0.0 15.6 50 Riau 63.5 37.6 16.7 46.9 48.2 72.6 11.6 0.0 1.1 0.0 52.2 0.0 11.0 82 Jambi 70.0 41.3 18.7 52.2 32.7 63.3 6.4 0.0 0.0 0.0 50.0 0.0 16.5 36 South Sumatera 65.7 40.4 16.3 49.8 37.8 62.0 15.5 1.7 3.2 0.0 35.6 0.0 17.6 64 Bengkulu 81.6 53.6 27.1 54.8 54.2 75.2 13.0 0.0 0.0 0.0 34.1 0.0 9.8 19 Lampung 67.7 32.2 13.4 37.7 42.1 60.9 18.2 5.1 0.0 0.0 53.7 0.0 13.5 68 Bangka Belitung (69.8) (44.0) (21.9) (56.0) (40.7) (73.0) (14.7) (0.0) (5.1) (0.0) (58.2) (0.0) (7.5) (9) Riau Islands (64.0) (67.1) (14.0) (73.3) (37.6) (86.5) (22.5) (0.0) (6.6) (0.0) (40.8) (0.0) (8.8) (15) Java DKI Jakarta 66.2 35.7 12.0 43.1 40.0 66.5 16.4 1.0 3.3 0.0 47.1 0.9 15.7 86 West Java 65.5 35.9 15.4 40.8 47.5 64.5 8.9 0.9 2.3 0.0 50.5 0.0 14.9 363 Central Java 68.4 27.3 16.2 32.1 39.2 55.0 14.5 1.2 0.0 0.0 47.3 1.3 22.7 260 DI Yogyakarta (45.3) (37.1) (18.3) (50.3) (63.0) (77.6) (10.3) (0.0) (0.0) (0.0) (57.6) (3.6) (7.2) (14) East Java 71.9 53.2 23.9 63.7 42.3 75.8 11.1 2.1 0.0 1.2 51.2 0.0 6.9 335 Banten 62.6 43.5 13.1 53.7 41.3 70.4 17.9 0.8 0.0 0.0 26.8 0.8 17.6 121 Bali and Nusa Tenggara Bali (76.0) (50.2) (19.7) (57.9) (35.2) (71.2) (29.2) (0.0) (3.0) (0.0) (26.2) (0.0) (12.3) (24) West Nusa Tenggara 63.8 49.6 14.6 58.0 49.2 81.4 15.1 0.0 3.8 0.0 33.2 0.0 10.2 53 East Nusa Tenggara 60.8 43.4 27.5 61.8 20.1 70.4 2.3 0.0 0.0 0.0 31.4 0.0 12.9 73 Kalimantan West Kalimantan 54.1 31.7 19.9 43.2 26.2 59.4 12.5 0.9 0.0 0.0 36.5 0.0 18.0 77 Central Kalimantan 53.2 34.2 33.1 50.7 24.7 59.1 13.3 0.0 0.0 0.0 59.0 0.0 16.8 31 South Kalimantan 45.8 30.3 7.5 32.7 30.4 56.7 32.2 0.0 1.4 0.0 36.5 0.0 14.0 45 East Kalimantan 68.1 55.4 17.9 61.0 33.2 74.2 25.0 0.0 0.0 0.0 46.9 0.0 10.4 36 Sulawesi North Sulawesi 64.3 45.5 17.9 51.7 54.3 74.7 14.9 0.0 0.0 0.0 46.2 0.0 13.5 20 Central Sulawesi 59.5 46.8 25.4 59.5 36.6 73.0 12.7 0.0 0.0 0.0 31.1 0.0 11.1 36 South Sulawesi 56.8 36.1 14.0 40.9 29.7 55.4 8.9 0.0 0.0 0.0 42.6 0.8 22.0 110 Southeast Sulawesi 55.4 44.3 21.6 57.1 39.3 72.9 8.9 0.0 0.0 0.0 30.2 0.0 13.6 28 Gorontalo 55.5 49.2 27.5 56.7 52.6 76.1 5.1 1.4 1.2 0.0 39.7 0.0 8.8 15 West Sulawesi 56.8 34.8 22.5 48.8 29.8 57.8 1.2 0.0 0.8 0.0 29.5 0.0 28.9 19 Maluku and Papua Maluku 54.0 51.9 21.5 58.5 12.6 62.7 3.9 0.0 0.0 0.0 37.4 2.2 18.6 11 North Maluku (60.6) (49.4) (20.4) (57.3) (28.3) (64.3) (1.6) (0.0) (0.0) (0.0) (40.1) (0.0) (12.7) (11) West Papua (47.6) (38.6) (37.6) (54.5) (22.7) (68.3) (11.5) (2.6) (0.0) (1.3) (33.7) (0.0) (15.4) (6) Papua (65.0) (42.3) (20.5) (51.9) (7.9) (51.9) (13.3) (0.0) (0.0) (0.0) (28.9) (0.0) (33.7) (26) Total 64.6 38.8 17.4 46.8 40.1 66.2 12.5 1.0 1.1 0.2 44.6 0.4 14.9 2,341 Note: ORT includes fluid prepared from oral rehydration salt (ORS) packets, pre-packaged ORS fluid, and recommended home fluids (RHF). 1 Excludes pharmacy, shop and traditional practitioner Appendix A • 283 Table A-10.7 Feeding practices during diarrhea Percent distribution of children under age five who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by province, Indonesia 2012 Amount of liquids given Amount of food given Percent- age given increased fluids and continued feeding1 Percent- age who continued feeding and were given ORT and/or in- creased fluids1 Number of children with diar- rhea Province More Same as usual Some- what less Much less None Don’t know/ miss- ing Total More Same as usual Some- what less Much less None Never gave food Don’t know/ miss- ing Total Sumatera Aceh 45.4 33.3 20.0 1.3 0.0 0.0 100.0 5.2 37.5 44.8 9.9 0.0 2.6 0.0 100.0 40.7 58.6 56 North Sumatera 43.1 37.4 17.6 0.0 0.9 1.0 100.0 8.5 34.3 48.9 2.8 1.9 2.6 1.0 100.0 38.7 58.7 140 West Sumatera 54.3 42.8 1.6 1.4 0.0 0.0 100.0 4.6 46.2 41.4 1.4 1.0 5.3 0.0 100.0 53.1 70.6 50 Riau 48.2 38.0 11.6 0.0 0.8 1.4 100.0 10.6 35.7 44.1 1.7 1.1 6.9 0.0 100.0 41.5 64.9 82 Jambi 32.7 36.9 21.2 1.8 7.4 0.0 100.0 0.0 28.8 56.7 11.8 0.0 2.7 0.0 100.0 29.5 56.6 36 South Sumatera 37.8 44.4 12.9 0.0 3.0 1.8 100.0 10.5 28.6 52.5 0.0 1.9 6.4 0.0 100.0 34.4 58.6 64 Bengkulu 54.2 27.5 16.5 0.0 0.0 1.7 100.0 9.7 24.8 59.4 2.6 1.7 1.8 0.0 100.0 52.9 70.8 19 Lampung 42.1 39.9 16.8 0.0 1.2 0.0 100.0 4.5 31.1 46.3 5.4 3.2 9.6 0.0 100.0 31.2 50.0 68 Bangka Belitung (40.7) (32.2) (22.6) (2.3) (2.3) (0.0) 100.0 (12.6) (29.1) (50.5) (7.9) (0.0) (0.0) (0.0) 100.0 (40.7) (70.7) (9) Riau Islands (37.6) (46.2) (16.2) (0.0) (0.0) (0.0) 100.0 (6.4) (48.0) (40.8) (0.0) (2.5) (2.3) (0.0) 100.0 (35.3) (81.7) (15) Java DKI Jakarta 40.0 41.8 15.6 0.9 1.7 0.0 100.0 6.8 37.2 47.6 1.5 0.9 5.1 0.9 100.0 37.2 61.8 86 West Java 47.5 36.3 12.0 0.0 4.2 0.0 100.0 13.4 39.8 36.5 1.0 1.9 6.5 0.9 100.0 43.3 59.2 363 Central Java 39.2 42.5 14.4 1.3 1.2 1.3 100.0 10.0 30.5 44.0 3.6 4.9 5.5 1.3 100.0 37.9 52.6 260 DI Yogyakarta 63.0 28.6 4.8 0.0 0.0 3.6 100.0 2.7 38.2 45.1 7.3 0.0 3.2 3.6 100.0 59.1 70.3 14 East Java 42.3 48.5 8.0 1.3 0.0 0.0 100.0 12.0 45.0 33.0 5.3 0.0 4.6 0.0 100.0 41.1 68.0 335 Banten 41.3 36.9 20.1 0.0 1.8 0.0 100.0 7.3 39.5 45.2 1.0 0.8 6.2 0.0 100.0 37.8 66.1 121 Bali and Nusa Tenggara Bali (35.2) (48.9) (12.9) (3.0) (0.0) (0.0) 100.0 (11.4) (38.6) (47.9) (0.0) (0.0) (2.1) (0.0) 100.0 (33.1) (69.1) (24) West Nusa Tenggara 49.2 30.5 20.3 0.0 0.0 0.0 100.0 6.9 36.8 46.8 2.7 0.0 6.8 0.0 100.0 44.2 74.9 53 East Nusa Tenggara 20.1 50.6 27.1 0.0 1.2 1.0 100.0 6.4 37.0 46.0 3.2 0.0 7.5 0.0 100.0 16.1 64.0 73 Kalimantan West Kalimantan 26.2 46.8 19.7 3.6 3.6 0.0 100.0 2.7 35.9 51.5 7.3 0.9 0.9 0.9 100.0 23.7 51.1 77 Central Kalimantan 24.7 56.6 17.3 0.0 1.5 0.0 100.0 12.3 35.5 49.4 0.0 0.0 2.8 0.0 100.0 24.7 57.7 31 South Kalimantan 30.4 52.8 15.5 0.0 0.0 1.3 100.0 9.2 57.7 26.3 1.4 1.4 2.7 1.4 100.0 29.0 53.9 45 East Kalimantan 33.2 47.8 15.4 1.4 2.2 0.0 100.0 19.2 38.0 32.2 5.2 2.9 2.5 0.0 100.0 31.5 66.6 36 Sulawesi North Sulawesi 54.3 36.1 9.6 0.0 0.0 0.0 100.0 24.5 47.0 25.2 3.3 0.0 0.0 0.0 100.0 54.3 73.0 20 Central Sulawesi 36.6 50.9 10.9 1.6 0.0 0.0 100.0 7.3 47.8 36.1 3.0 1.4 4.4 0.0 100.0 35.2 68.5 36 South Sulawesi 29.7 47.7 13.7 0.8 8.1 0.0 100.0 7.2 43.0 42.3 0.8 2.1 4.6 0.0 100.0 28.8 54.5 110 Southeast Sulawesi 39.3 40.5 18.7 0.0 0.0 1.5 100.0 14.0 36.9 36.8 1.0 4.6 5.1 1.5 100.0 34.5 64.9 28 Gorontalo 52.6 30.1 12.5 3.6 0.0 1.2 100.0 8.8 40.5 38.9 10.4 0.0 1.3 0.0 100.0 48.4 68.4 15 West Sulawesi 29.8 52.8 17.4 0.0 0.0 0.0 100.0 8.0 54.3 32.1 0.0 1.2 4.5 0.0 100.0 28.6 55.5 19 Maluku and Papua Maluku (12.6) (63.2) (24.2) (0.0) (0.0) (0.0) 100.0 (3.8) (54.8) (37.5) (1.9) (0.0) (2.1) (0.0) 100.0 (12.6) (62.7) (11) North Maluku 28.3 52.9 15.7 0.0 3.1 0.0 100.0 11.0 48.9 38.4 0.0 0.0 1.6 0.0 100.0 28.3 62.6 11 West Papua (22.7) (55.6) (14.0) (0.0) (7.7) (0.0) 100.0 (8.8) (53.0) (32.1) (0.0) (3.7) (0.0) (2.5) 100.0 (22.7) (63.5) (6) Papua (7.9) (66.2) (18.7) (2.4) (4.8) (0.0) 100.0 (4.2) (65.5) (27.8) (0.0) (2.4) (0.0) (0.0) 100.0 (7.9) (51.9) (26) Total 40.1 42.5 14.3 0.7 1.9 0.4 100.0 9.5 39.0 41.5 3.1 1.6 4.9 0.5 100.0 37.1 61.0 2,341 Note: It is recommended that children should be given more liquids to drink during diarrhea and food should not be reduced. 1 Continued feeding practices includes children who were given more, same as usual, or somewhat less food during the diarrhea episode 284 • Appendix A Table A-10.8 Knowledge of ORS packets or pre-packaged liquids Percentage of women age 15-49 with a live birth in the five years preceding the survey who know about ORS packets or ORS pre- packaged liquids for treatment of diarrhea by province, Indonesia 2012 Province Percentage of women who know about ORS packets or ORS pre- packaged liquids Number of women Sumatera Aceh 93.4 294 North Sumatera 90.5 833 West Sumatera 94.6 286 Riau 91.3 413 Jambi 90.0 198 South Sumatera 91.0 511 Bengkulu 96.2 96 Lampung 94.3 486 Bangka Belitung 93.6 87 Riau Islands 94.7 113 Java DKI Jakarta 98.8 556 West Java 97.2 2,675 Central Java 94.2 1,824 DI Yogyakarta 99.8 171 East Java 96.6 2,213 Banten 95.5 706 Bali and Nusa Tenggara Bali 96.4 208 West Nusa Tenggara 96.8 350 East Nusa Tenggara 90.2 338 Kalimantan West Kalimantan 86.7 293 Central Kalimantan 92.1 154 South Kalimantan 95.5 247 East Kalimantan 97.1 231 Sulawesi North Sulawesi 95.6 137 Central Sulawesi 86.7 175 South Sulawesi 91.3 475 Southeast Sulawesi 90.4 150 Gorontalo 89.4 66 West Sulawesi 79.5 77 Maluku and Papua Maluku 83.7 97 North Maluku 83.2 71 West Papua 78.7 52 Papua 55.4 203 Total 93.8 14,786 ORS = Oral rehydration salts Appendix A • 285 Table A-10.9 Disposal of children’s stools Percent distribution of youngest children under age five living with the mother by the manner of disposal of the child’s last fecal matter, and percentage of children whose stools are disposed of safely, according to province, Indonesia 2012 Province Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Used toilet/ latrine Put/ rinsed in toilet/ latrine Throw outside the dwelling Buried in the yard Rinse away Use dispos- able diapers Use washable diapers Left in the open/not disposed of Other Sumatera Aceh 19.5 14.8 8.5 9.6 20.4 7.7 2.8 1.8 14.0 99.1 34.3 291 North Sumatera 32.8 23.8 3.5 8.9 19.6 1.1 0.3 1.9 7.4 99.5 56.6 811 West Sumatera 31.6 22.5 1.8 4.0 2.7 6.5 11.7 0.3 19.0 100.0 54.1 281 Riau 34.3 21.2 6.0 6.3 18.4 3.0 1.0 0.8 9.0 100.0 55.4 399 Jambi 38.2 14.2 3.6 5.0 4.7 4.0 6.7 0.9 22.6 100.0 52.4 195 South Sumatera 36.7 21.6 3.8 3.9 6.3 2.3 12.6 0.5 12.1 99.8 58.2 498 Bengkulu 30.5 36.5 3.3 6.7 10.3 0.0 0.0 0.7 11.3 99.4 67.0 94 Lampung 38.3 34.1 3.4 4.2 10.5 0.0 0.0 0.5 8.6 99.7 72.4 479 Bangka Belitung 43.2 16.7 11.1 7.5 8.0 1.0 2.4 1.9 8.2 100.0 59.9 84 Riau Islands 34.0 32.4 13.1 0.8 5.7 4.8 0.3 0.0 8.8 100.0 66.4 109 Java DKI Jakarta 40.2 26.5 11.5 0.0 8.8 7.8 3.0 0.0 1.6 99.3 66.6 523 West Java 44.1 22.6 7.9 1.3 11.8 0.4 2.1 0.1 8.2 98.5 66.7 2,571 Central Java 27.9 40.2 4.3 3.9 2.3 0.2 0.2 1.1 19.9 99.8 68.1 1,775 DI Yogyakarta 49.0 32.3 2.5 3.8 5.2 1.0 2.2 0.0 4.1 100.0 81.3 168 East Java 35.2 31.0 3.9 4.7 4.3 3.3 1.4 0.0 15.8 99.6 66.2 2,159 Banten 30.9 40.8 5.6 4.1 2.1 0.7 0.6 0.5 14.7 100.0 71.6 676 Bali and Nusa Tenggara Bali 44.2 13.5 6.8 3.3 3.2 11.9 8.1 2.2 6.6 100.0 57.8 202 West Nusa Tenggara 35.3 4.4 2.4 10.8 1.0 12.2 4.2 6.4 23.4 100.0 39.7 335 East Nusa Tenggara 24.0 19.6 2.7 11.2 5.3 2.1 10.4 14.8 9.7 99.8 43.6 322 Kalimantan West Kalimantan 28.2 11.7 1.4 3.3 10.3 10.0 8.7 2.8 22.5 98.9 39.9 288 Central Kalimantan 27.1 18.2 5.4 2.0 11.2 0.4 0.6 1.9 33.0 99.8 45.3 152 South Kalimantan 34.3 18.7 11.1 1.9 7.0 4.1 3.8 0.3 18.6 99.7 52.9 238 East Kalimantan 36.1 27.2 17.0 3.1 2.1 0.3 0.0 0.0 14.3 100.0 63.3 225 Sulawesi North Sulawesi 30.4 21.3 2.8 7.7 3.1 19.1 8.8 0.3 5.5 98.9 51.6 131 Central Sulawesi 18.9 21.3 4.5 10.4 8.4 7.9 5.2 1.5 21.8 100.0 40.3 166 South Sulawesi 41.7 7.2 3.7 5.6 3.6 11.9 8.4 1.7 14.7 98.6 48.9 464 Southeast Sulawesi 26.1 17.6 3.6 7.5 8.4 10.7 2.6 0.8 22.2 99.5 43.7 145 Gorontalo 17.2 11.5 8.0 12.7 1.7 12.5 8.9 5.5 22.0 100.0 28.7 62 West Sulawesi 12.3 16.4 1.8 11.3 13.5 8.7 7.5 6.6 21.9 100.0 28.7 74 Maluku and Papua Maluku 24.8 11.1 4.1 12.7 1.2 16.5 3.6 2.3 23.7 100.0 35.8 93 North Maluku 21.2 17.1 9.8 7.3 4.0 13.3 3.1 3.2 20.2 99.2 38.3 66 West Papua 29.6 5.8 1.9 3.9 15.2 18.4 9.2 0.0 13.8 97.8 35.4 47 Papua 11.9 16.8 9.4 7.1 2.1 4.1 4.2 9.4 33.0 98.0 28.7 189 Total 34.6 25.6 5.6 4.6 7.6 3.5 3.0 1.3 13.8 99.4 60.2 14,314 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine or if it was buried. 2 See Table 2.2 for definition of categories 3 Facilities that would be considered improved if they were not shared by two or more households 286 • Appendix A CHAPTER 11 INFANT FEEDING Table A-11.1 Initial breastfeeding Among last-born children who were born in the two years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within one hour and within one day of birth; and among last-born children born in the two years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by province, Indonesia 2012 Among last-born children born in the past two years: Among last-born children born in the past two years who were ever breastfed: Province Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last- born children Percentage who received a prelacteal feed2 Number of last- born children ever breastfed Sumatera Aceh 95.6 46.4 63.5 144 65.8 138 North Sumatera 94.2 17.1 38.9 388 77.7 366 West Sumatera 96.2 38.6 72.1 138 61.5 133 Riau 91.8 26.2 44.9 176 80.5 162 Jambi 96.5 35.7 53.5 94 81.2 91 South Sumatera 96.3 35.9 58.8 222 69.3 214 Bengkulu 95.0 39.8 61.4 42 63.2 40 Lampung 95.2 43.9 60.9 226 62.2 215 Bangka Belitung 90.1 53.4 60.2 40 60.5 36 Riau Islands 92.2 51.5 70.7 58 63.8 53 Java DKI Jakarta 93.7 60.1 71.8 253 55.1 237 West Java 96.8 56.7 76.0 1,207 58.2 1,168 Central Java 96.8 54.9 74.1 847 54.7 820 DI Yogyakarta 95.8 55.1 75.2 69 49.1 66 East Java 96.9 52.2 66.7 1,014 66.9 983 Banten 95.5 49.5 62.7 316 60.7 302 Bali and Nusa Tenggara Bali 90.5 47.9 59.6 91 64.3 82 West Nusa Tenggara 98.7 73.7 85.3 158 29.0 156 East Nusa Tenggara 98.0 68.2 80.2 158 27.2 155 Kalimantan West Kalimantan 92.9 39.1 48.6 151 64.6 140 Central Kalimantan 95.8 42.6 48.2 71 68.0 68 South Kalimantan 95.3 46.8 59.8 111 69.0 106 East Kalimantan 94.5 46.9 62.0 109 63.2 103 Sulawesi North Sulawesi 93.5 40.9 59.2 64 69.4 60 Central Sulawesi 97.1 38.9 58.3 90 65.2 87 South Sulawesi 95.3 56.9 67.2 238 50.9 227 Southeast Sulawesi 94.2 43.2 55.4 70 56.3 66 Gorontalo 94.7 36.7 63.5 29 71.5 27 West Sulawesi 96.1 56.7 70.9 40 47.0 38 Maluku and Papua Maluku 89.2 35.1 60.2 49 54.2 44 North Maluku 94.5 47.6 62.4 34 44.0 32 West Papua 95.6 32.5 64.9 29 43.3 28 Papua 96.9 64.1 78.4 106 35.5 103 Total 95.8 49.3 66.3 6,830 60.3 6,543 Note: Table is based on last-born children born in the two years preceding the survey regardless of whether the children are living or dead at the time of interview. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse/midwife, or village midwife Appendix A • 287 Table A-11.2 Median duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, by province, Indonesia 2012 Median duration (months) of breastfeeding among children born in the past three years1 Province Any breastfeeding Exclusive breastfeeding Predominant breastfeeding2 Sumatera Aceh 20.4 2.3 2.9 North Sumatera 18.2 0.6 0.7 West Sumatera 21.2 0.7 0.7 Riau 18.2 0.6 0.7 Jambi 19.8 2.0 2.8 South Sumatera 22.2 0.5 0.5 Bengkulu 21.3 2.5 2.5 Lampung 21.8 0.5 0.6 Bangka Belitung 11.4 0.5 0.7 Riau Islands 9.4 0.6 0.6 Java DKI Jakarta 14.5 0.6 0.6 West Java 23.4 1.1 3.1 Central Java 22.9 2.2 2.5 DI Yogyakarta 22.6 3.0 3.0 East Java 19.9 0.7 0.7 Banten 20.6 0.6 0.6 Bali and Nusa Tenggara Bali 16.4 1.0 1.0 West Nusa Tenggara 21.4 4.2 5.0 East Nusa Tenggara 17.4 2.8 3.2 Kalimantan West Kalimantan 29.7 0.5 0.6 Central Kalimantan 18.4 1.6 1.7 South Kalimantan 22.5 0.5 0.6 East Kalimantan 12.4 0.7 1.2 Sulawesi North Sulawesi 16.5 0.5 0.5 Central Sulawesi 18.4 1.7 2.2 South Sulawesi 20.3 3.1 3.6 Southeast Sulawesi 17.9 2.8 2.8 Gorontalo 15.9 0.6 0.6 West Sulawesi 21.4 1.7 2.9 Maluku and Papua Maluku 15.2 1.1 1.9 North Maluku 19.4 1.8 1.8 West Papua 17.9 1.2 1.2 Papua 19.7 0.5 0.7 Total 21.4 0.7 1.8 Note: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only 288 • Appendix A Table A-11.3 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding status, number of food groups, and times they are fed during the day or night preceding the survey, by province, Indonesia 2012 Among breastfed children 6-23 months, percentage fed: Among non-breastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Province 4+ food groups1 Minimum meal fre- quency2 Both 4+ food groups and minimum meal fre- quency Number of breast- fed children 6-23 months Milk or milk products3 4+ food groups1 Minimum meal fre- quency4 With 3 IYCF practices5 Number of non- breast- fed children 6-23 months Breast milk, milk, or milk products6 4+ food groups1 Minimum meal fre- quency7 With 3 IYCF practices Number of all children 6-23 months Sumatera Aceh 41.7 68.7 34.2 75 75.5 70.0 86.1 35.5 29 93.1 49.7 73.6 34.5 104 North Sumatera 48.4 65.8 34.9 186 52.2 68.6 59.7 31.8 98 83.5 55.4 63.7 33.8 285 West Sumatera 63.1 67.0 44.9 76 68.9 81.8 84.3 40.8 27 91.9 68.0 71.5 43.8 102 Riau 53.2 65.4 34.8 81 79.2 79.0 83.8 46.4 41 93.0 61.9 71.6 38.7 122 Jambi 46.7 68.0 37.4 50 97.6 88.0 97.6 53.8 21 99.3 59.1 76.9 42.3 71 South Sumatera 53.0 55.9 29.7 125 84.0 71.8 89.7 45.7 38 96.3 57.3 63.7 33.4 163 Bengkulu 63.9 65.4 41.4 24 58.9 74.1 62.7 29.6 7 90.3 66.3 64.7 38.6 31 Lampung 62.0 69.5 44.1 133 76.5 88.0 78.0 56.0 41 94.4 68.2 71.5 46.9 175 Bangka Belitung 39.7 66.2 33.0 14 81.5 68.6 77.8 38.7 12 91.5 52.9 71.5 35.6 26 Riau Islands 70.6 60.6 41.6 23 87.8 70.1 93.7 40.4 18 94.6 70.4 75.1 41.1 41 Java DKI Jakarta 63.1 61.2 34.6 109 87.7 91.3 93.4 64.0 73 95.1 74.4 74.1 46.5 183 West Java 48.7 47.6 24.7 718 76.5 79.9 80.0 45.3 196 95.0 55.4 54.6 29.1 914 Central Java 58.3 61.1 38.7 489 78.5 68.2 81.5 42.3 113 96.0 60.2 64.9 39.4 602 DI Yogyakarta 66.7 77.1 51.2 42 91.3 90.7 100.0 75.3 9 98.4 71.0 81.2 55.5 51 East Java 56.3 72.4 43.1 536 68.2 82.3 80.8 46.1 207 91.1 63.5 74.7 44.0 742 Banten 55.9 54.9 34.3 168 77.1 85.5 81.6 41.9 62 93.8 63.9 62.1 36.4 229 Bali and Nusa Tenggara Bali 50.1 73.1 40.4 41 72.4 73.5 73.1 42.9 24 89.8 58.8 73.1 41.3 65 West Nusa Tenggara 40.5 61.6 31.3 93 49.0 53.1 56.7 21.3 20 90.9 42.8 60.7 29.5 113 East Nusa Tenggara 40.8 67.0 27.3 76 36.2 52.6 46.6 26.4 32 81.1 44.3 61.0 27.0 108 Kalimantan West Kalimantan 44.8 51.3 27.0 92 75.3 75.6 78.7 48.8 23 95.0 51.0 56.8 31.4 115 Central Kalimantan 45.4 73.0 35.1 38 86.0 79.7 86.7 49.7 15 96.0 55.2 76.9 39.3 53 South Kalimantan 52.9 68.5 41.0 62 85.4 68.2 89.8 34.0 22 96.1 56.9 74.2 39.2 85 East Kalimantan 53.3 72.3 42.0 48 97.1 78.6 98.6 63.5 30 98.9 63.1 82.5 50.4 78 Sulawesi North Sulawesi 42.0 63.6 29.7 31 85.1 62.7 86.6 34.9 20 94.2 50.0 72.5 31.7 51 Central Sulawesi 54.3 69.8 39.5 45 63.3 71.7 70.7 30.0 21 88.2 59.9 70.1 36.4 66 South Sulawesi 45.5 65.4 29.8 115 71.6 65.9 74.1 40.5 57 90.7 52.2 68.3 33.3 172 Southeast Sulawesi 29.0 69.0 22.2 34 61.9 71.1 73.5 41.7 20 85.9 44.6 70.7 29.4 54 Gorontalo 33.9 78.1 32.4 13 85.3 63.6 87.3 34.7 8 94.6 44.8 81.4 33.2 21 West Sulawesi 24.0 69.2 17.9 22 32.4 36.6 53.9 10.9 6 84.7 26.8 65.7 16.3 29 Maluku and Papua Maluku 33.2 53.0 18.6 21 59.7 63.3 62.9 20.5 15 83.3 45.7 57.1 19.4 35 North Maluku 34.2 62.0 24.3 18 45.7 59.6 56.8 25.0 8 84.0 41.7 60.5 24.5 25 West Papua 25.0 48.5 13.5 12 61.2 49.6 51.2 22.7 7 85.6 34.1 49.5 16.9 18 Papua 33.6 42.0 15.7 49 56.0 62.6 58.2 26.6 21 86.8 42.3 46.8 19.0 70 Total 51.8 61.4 34.2 3,657 72.7 75.5 78.7 43.1 1,342 92.7 58.2 66.1 36.6 4,999 1 Food groups: A- infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts. 2 For breastfed children, minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a day for children 9-23 months. 3 Includes two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt 4 For non-breastfed children age 6-23 months, minimum meal frequency is receiving solid or semi-solid food or milk feeds at least four times a day. 5 Non-breastfed children age 6-23 months are considered to be fed with a minimum standard of three Infant and young child feeding practices if they receive other milk or milk products at least twice a day, receive the minimum meal frequency, and receive solid or semi-solid foods from at least four food groups not including the milk/milk products group. 6 Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned and powdered animal milk, and yogurt 7 Children are fed the minimum recommended number of times per day according to their age and breastfeeding status as described in footnotes 2 and 4. Appendix A • 289 Table A-11.4 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were given iron supplements in the past seven days, and who were given deworming medication in the six months preceding the survey, by province, Indonesia 2012 Among youngest children age 6-23 months living with the mother: Among all children age 6-59 months: Province Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given iron supplements in last 7 days Percentage given deworming medication in last 6 months3 Number of children Sumatera Aceh 71.7 60.5 104 48.7 8.7 29.4 316 North Sumatera 82.9 73.1 285 42.1 9.5 30.2 936 West Sumatera 82.9 75.3 102 55.6 8.0 24.1 298 Riau 83.8 70.1 122 49.7 6.8 30.3 424 Jambi 76.4 66.9 71 50.3 8.1 32.5 195 South Sumatera 82.4 72.7 163 49.0 7.8 31.3 506 Bengkulu 95.3 76.8 31 58.9 11.3 30.3 93 Lampung 88.9 76.3 175 60.6 11.7 34.8 475 Bangka Belitung 74.8 62.7 26 48.9 14.6 29.9 84 Riau Islands 88.9 73.9 41 56.2 11.0 20.9 121 Java DKI Jakarta 87.9 78.3 183 61.0 25.9 33.7 563 West Java 82.6 61.8 914 65.7 15.4 28.7 2,640 Central Java 82.1 62.2 602 70.3 11.3 23.0 1,688 DI Yogyakarta 88.3 72.3 51 70.3 15.1 25.7 168 East Java 85.3 72.3 742 68.2 20.0 19.5 2,130 Banten 85.1 66.3 229 62.4 13.4 27.2 684 Bali and Nusa Tenggara Bali 79.3 64.5 65 66.9 22.3 13.7 210 West Nusa Tenggara 82.9 61.4 113 74.7 12.3 18.1 334 East Nusa Tenggara 79.0 60.4 108 59.7 8.9 24.9 371 Kalimantan West Kalimantan 77.2 69.0 115 55.3 12.3 27.8 290 Central Kalimantan 77.8 67.3 53 48.8 8.2 26.0 152 South Kalimantan 79.8 68.8 85 64.3 12.3 15.5 238 East Kalimantan 87.0 74.8 78 68.4 9.9 30.0 238 Sulawesi North Sulawesi 71.3 60.4 51 69.5 13.7 20.1 143 Central Sulawesi 85.0 77.3 66 65.3 11.7 23.5 184 South Sulawesi 80.8 69.2 172 55.9 11.6 32.4 499 Southeast Sulawesi 76.7 68.4 54 63.9 8.1 23.1 159 Gorontalo 77.2 67.5 21 60.5 16.3 6.6 65 West Sulawesi 74.5 50.8 29 32.0 4.6 17.2 86 Maluku and Papua Maluku 79.8 62.6 35 58.1 13.8 24.7 113 North Maluku 64.3 57.9 25 57.5 14.4 28.2 77 West Papua 75.9 52.0 18 38.3 10.5 30.9 58 Papua 84.6 56.8 70 36.1 11.2 15.1 228 Total 82.7 67.5 4,999 61.1 13.6 25.9 14,766 Note: Information on vitamin A is based on both mother’s recall and the immunization card (where available). Information on iron supplements and deworming medication is based on the mother’s recall. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, yellow squash, carrots, yellow or orange sweet potatoes, dark green leafy vegetables (spinach, kangkung, katuk, and squash leaf), mangoes, papayas, jackfruit, cempedak, persimmon, yellow melon, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat (including organ meat), fish, poultry and eggs 3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 290 • Appendix A Table A-11.5 Micronutrient intake among mothers Among women age 15-49 with a child born in the past five years, the percentage who received a vitamin A dose in the first two months after the birth of the last child and the percent distribution by number of days they took iron tablets or syrup during the pregnancy of the last child, by province Indonesia 2012 Percentage who received vitamin A dose postpartum1 Number of days women took iron tablets or syrup during pregnancy of last birth Number of women Province None <60 60-89 90+ Don’t know/ Missing Total Sumatera Aceh 40.6 44.1 25.8 4.8 9.4 15.9 100.0 294 North Sumatera 33.0 37.5 44.0 3.5 8.7 6.3 100.0 833 West Sumatera 43.2 20.2 38.1 6.5 25.6 9.7 100.0 286 Riau 35.4 34.0 36.5 4.6 17.6 7.3 100.0 413 Jambi 44.0 27.7 48.6 7.8 12.4 3.5 100.0 198 South Sumatera 46.0 31.4 46.7 3.2 12.9 5.8 100.0 511 Bengkulu 43.5 20.9 33.3 12.1 24.9 8.8 100.0 96 Lampung 47.4 19.5 57.4 4.2 11.4 7.6 100.0 486 Bangka Belitung 52.5 19.3 44.4 8.6 22.9 4.9 100.0 87 Riau Islands 37.9 24.6 21.0 3.4 19.0 32.0 100.0 113 Java DKI Jakarta 48.5 15.7 28.8 6.2 44.3 5.0 100.0 556 West Java 43.3 25.4 25.1 8.1 31.5 9.8 100.0 2,675 Central Java 56.5 17.6 22.0 6.8 50.7 2.9 100.0 1,824 DI Yogyakarta 54.8 3.2 10.7 8.7 77.2 0.2 100.0 171 East Java 60.7 11.8 24.1 12.0 49.2 2.9 100.0 2,213 Banten 52.7 24.7 23.7 5.7 37.8 8.1 100.0 706 Bali and Nusa Tenggara Bali 55.5 14.8 18.0 3.7 58.6 4.9 100.0 208 West Nusa Tenggara 50.2 10.0 46.2 10.4 32.9 0.6 100.0 350 East Nusa Tenggara 54.9 12.6 16.1 7.3 62.1 2.0 100.0 338 Kalimantan West Kalimantan 34.8 52.8 36.5 1.6 3.6 5.5 100.0 293 Central Kalimantan 39.9 27.6 30.1 10.9 28.5 2.9 100.0 154 South Kalimantan 46.7 12.8 24.4 11.7 44.6 6.5 100.0 247 East Kalimantan 44.3 13.9 49.5 5.4 28.2 3.0 100.0 231 Sulawesi North Sulawesi 47.5 20.0 55.8 7.4 8.7 8.0 100.0 137 Central Sulawesi 44.1 32.8 43.1 4.7 17.5 1.8 100.0 175 South Sulawesi 43.2 24.6 45.3 5.2 16.9 8.0 100.0 475 Southeast Sulawesi 45.8 30.9 56.1 2.0 9.7 1.3 100.0 150 Gorontalo 50.2 20.6 54.8 8.3 11.0 5.3 100.0 66 West Sulawesi 31.3 43.4 35.5 6.9 4.7 9.5 100.0 77 Maluku and Papua Maluku 40.1 35.1 32.3 6.7 24.0 1.9 100.0 97 North Maluku 50.1 30.6 31.3 4.1 30.5 3.5 100.0 71 West Papua 45.7 33.5 44.8 3.9 6.2 11.5 100.0 52 Papua 29.7 47.8 15.7 1.3 4.3 30.9 100.0 203 Total 48.1 22.9 30.9 7.1 32.7 6.4 100.0 14,786 1 In the first two months after delivery of last birth Appendix A • 291 CHAPTER 12 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES AND BEHAVIOR Table A-12.1 Knowledge of AIDS Percentage of women age 15-49 and currently-married men age 15-54 who have heard of AIDS, by province, Indonesia 2012 Women Currently-married men Province Has heard of AIDS Number of respondents Has heard of AIDS Number of respondents Sumatera Aceh 70.8 877 72.7 153 North Sumatera 75.1 2,394 83.3 470 West Sumatera 80.8 852 85.6 164 Riau 79.2 1,040 88.0 231 Jambi 66.9 580 78.2 145 South Sumatera 67.9 1,358 77.2 295 Bengkulu 70.3 306 84.1 67 Lampung 78.8 1,443 82.8 334 Bangka Belitung 82.6 245 86.3 52 Riau Islands 91.1 323 88.9 64 Java DKI Jakarta 96.0 1,939 98.7 374 West Java 79.6 8,265 88.1 1,654 Central Java 79.6 6,240 78.1 1,224 DI Yogyakarta 95.2 654 94.5 135 East Java 75.1 7,374 82.3 1,621 Banten 76.2 2,148 78.9 450 Bali and Nusa Tenggara Bali 83.2 790 94.8 173 West Nusa Tenggara 60.6 997 78.0 171 East Nusa Tenggara 65.5 892 70.3 158 Kalimantan West Kalimantan 62.3 756 68.5 165 Central Kalimantan 71.6 409 79.8 93 South Kalimantan 77.2 730 87.3 152 East Kalimantan 84.3 671 82.0 139 Sulawesi North Sulawesi 84.6 427 88.4 87 Central Sulawesi 69.2 486 71.7 98 South Sulawesi 69.9 1,530 66.7 258 Southeast Sulawesi 71.6 382 69.4 77 Gorontalo 64.5 203 59.4 39 West Sulawesi 49.2 191 53.0 33 Maluku and Papua Maluku 72.1 260 81.0 47 North Maluku 66.0 188 63.3 35 West Papua 80.3 130 92.7 28 Papua 52.2 527 81.1 120 Total 76.7 45,607 82.3 9,306 na = Not applicable 292 • Appendix A Table A-12.2 Knowledge of HIV prevention methods Percentage of women 15-49 and currently-married men age 15-54 who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, and by having one sex partner and has no other partners, by province, Indonesia 2012 Women Currently-married men Province Using condoms1 Limiting sexual intercourse to one partner2 Using condoms and limiting sexual intercourse to one partner1,2 Number of women Using condoms1 Limiting sexual intercourse to one partner2 Using condoms and limiting sexual intercourse to one partner1,2 Number of men Sumatera Aceh 34.3 45.1 27.7 877 37.8 49.7 30.4 153 North Sumatera 45.4 58.7 40.3 2,394 60.3 55.4 42.4 470 West Sumatera 47.1 58.8 40.3 852 60.3 74.0 58.6 164 Riau 41.1 57.1 34.7 1,040 56.1 70.9 49.6 231 Jambi 40.3 51.6 36.5 580 60.5 61.2 52.3 145 South Sumatera 35.3 49.2 31.6 1,358 59.0 62.1 51.5 295 Bengkulu 39.7 50.4 34.1 306 39.7 65.2 36.0 67 Lampung 41.2 57.1 35.9 1,443 61.8 73.3 59.6 334 Bangka Belitung 43.7 55.4 37.0 245 50.9 56.5 43.1 52 Riau Islands 58.0 67.3 46.8 323 50.4 73.7 45.6 64 Java DKI Jakarta 51.0 66.5 41.8 1,939 77.3 90.2 74.3 374 West Java 42.1 61.0 36.1 8,265 63.2 65.7 50.8 1,654 Central Java 45.2 56.8 38.7 6,240 59.9 59.6 48.8 1,224 DI Yogyakarta 74.2 87.2 70.4 654 80.5 86.2 75.2 135 East Java 43.8 61.8 40.2 7,374 58.7 59.9 47.0 1,621 Banten 42.6 55.6 36.2 2,148 58.3 61.0 51.0 450 Bali and Nusa Tenggara Bali 53.9 63.9 47.0 790 81.5 79.8 72.1 173 West Nusa Tenggara 33.0 43.9 28.8 997 40.7 48.7 33.7 171 East Nusa Tenggara 35.0 51.8 31.1 892 46.0 54.0 42.0 158 Kalimantan West Kalimantan 37.5 42.9 28.8 756 34.4 39.9 25.6 165 Central Kalimantan 35.0 51.5 29.9 409 55.8 68.4 52.9 93 South Kalimantan 45.3 61.2 41.7 730 63.1 67.5 52.4 152 East Kalimantan 46.8 62.5 40.0 671 56.3 70.5 51.6 139 Sulawesi North Sulawesi 48.2 63.4 42.1 427 58.8 70.8 52.1 87 Central Sulawesi 34.5 46.4 28.5 486 49.3 59.5 42.4 98 South Sulawesi 35.7 46.8 29.4 1,530 39.5 47.9 35.1 258 Southeast Sulawesi 41.4 56.4 37.7 382 43.3 57.2 38.4 77 Gorontalo 27.3 42.7 22.0 203 34.3 38.2 26.4 39 West Sulawesi 22.9 28.7 18.2 191 33.3 40.1 31.3 33 Maluku and Papua Maluku 45.4 58.2 40.3 260 45.1 43.8 27.7 47 North Maluku 34.6 43.5 30.1 188 36.8 45.7 32.4 35 West Papua 39.4 54.8 31.9 130 54.6 57.8 42.1 28 Papua 27.9 35.6 24.5 527 45.4 50.3 36.5 120 Total 42.9 57.6 37.3 45,607 58.5 62.8 49.1 9,306 na = Not applicable 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners Appendix A • 293 Table A-12.3.1 Comprehensive knowledge about AIDS: Women Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with a comprehensive knowledge about AIDS by province, Indonesia 2012 Percentage of respondents who say that: Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of women Province A healthy- looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites The AIDS virus cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has the AIDS virus A person can get infected by sharing unsterilized needle or syringe Sumatera Aceh 52.9 23.4 53.0 24.6 62.7 12.0 6.7 877 North Sumatera 60.5 33.0 57.8 31.7 68.7 17.8 12.2 2,394 West Sumatera 67.2 32.2 61.3 33.0 75.1 16.9 11.4 852 Riau 59.2 29.8 56.4 31.5 72.1 14.4 8.8 1,040 Jambi 51.0 26.1 47.2 27.7 60.7 13.6 9.7 580 South Sumatera 52.2 30.0 50.4 23.3 61.7 11.9 6.8 1,358 Bengkulu 54.0 25.2 50.9 28.4 65.0 12.5 8.0 306 Lampung 64.9 29.2 56.5 27.8 71.8 13.9 8.7 1,443 Bangka Belitung 62.8 27.3 60.2 27.0 75.8 10.8 7.0 245 Riau Islands 74.9 36.7 70.0 38.6 84.0 21.9 15.1 323 Java DKI Jakarta 78.3 54.2 84.2 54.1 92.6 31.8 15.0 1,939 West Java 66.8 36.0 62.0 33.3 73.3 17.8 10.5 8,265 Central Java 68.2 39.3 63.6 35.0 73.4 20.9 12.6 6,240 DI Yogyakarta 89.8 56.4 86.2 58.7 92.3 40.7 33.4 654 East Java 58.2 35.7 63.7 33.7 68.5 18.5 13.0 7,374 Banten 61.8 34.3 58.8 30.7 69.8 18.0 11.4 2,148 Bali and Nusa Tenggara Bali 65.8 46.5 68.8 45.1 78.8 26.9 17.3 790 West Nusa Tenggara 41.7 30.8 44.3 28.2 56.4 13.8 7.8 997 East Nusa Tenggara 49.5 27.4 44.8 26.9 59.0 16.1 11.0 892 Kalimantan West Kalimantan 47.3 24.2 52.1 26.4 58.8 14.0 9.1 756 Central Kalimantan 53.7 29.6 50.5 25.7 65.9 13.7 7.6 409 South Kalimantan 62.1 33.2 59.2 29.7 69.7 17.8 11.8 730 East Kalimantan 72.5 34.3 65.2 35.0 79.2 18.5 10.7 671 Sulawesi North Sulawesi 52.2 33.8 66.3 32.9 77.1 13.4 9.1 427 Central Sulawesi 50.3 31.3 57.0 26.7 64.1 14.6 6.9 486 South Sulawesi 48.6 26.6 52.3 20.8 61.2 9.5 5.9 1,530 Southeast Sulawesi 50.8 30.9 55.8 26.3 63.6 12.8 9.1 382 Gorontalo 36.4 31.0 53.6 23.7 48.2 10.7 5.7 203 West Sulawesi 30.9 17.8 35.2 18.1 41.1 7.7 4.9 191 Maluku and Papua Maluku 51.3 34.6 56.8 28.8 67.4 13.9 9.0 260 North Maluku 43.5 34.2 49.0 24.7 56.7 15.2 10.0 188 West Papua 54.4 40.6 63.6 47.9 70.7 25.8 13.1 130 Papua 36.6 30.7 37.3 35.9 46.0 22.5 14.9 527 Total 61.4 35.1 60.6 33.0 70.5 18.2 11.4 45,607 1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and by sharing food with a person who has AIDS virus. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention; the AIDS virus cannot be transmitted by mosquito bites or by sharing food with a person who has the AIDS virus. 294 • Appendix A Table A-12.3.2 Comprehensive knowledge about AIDS: Men Percentage of currently-married men age 15-54 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with a comprehensive knowledge about AIDS by province, Indonesia 2012 Percentage of respondents who say that: Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of men Province A healthy- looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites The AIDS virus cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has the AIDS virus A person can get infected by sharing unsterilized needle or syringe Sumatera Aceh 43.8 17.5 48.2 20.8 50.0 6.1 2.8 153 North Sumatera 65.9 32.2 72.3 36.3 79.0 17.7 10.4 470 West Sumatera 61.0 21.1 63.2 24.8 72.2 9.1 8.3 164 Riau 73.3 26.5 68.5 38.6 80.7 15.1 13.0 231 Jambi 58.9 26.0 56.8 30.2 68.5 14.2 11.1 145 South Sumatera 62.9 26.3 57.7 27.5 68.7 13.9 11.2 295 Bengkulu 60.4 17.4 56.1 25.3 73.2 7.2 5.7 67 Lampung 68.3 31.2 69.7 35.5 72.6 17.2 14.6 334 Bangka Belitung 52.4 27.2 52.4 29.6 79.2 9.9 7.4 52 Riau Islands 74.8 56.8 80.4 63.6 84.4 40.8 18.9 64 Java DKI Jakarta 66.5 56.7 86.4 56.5 97.1 32.3 25.9 374 West Java 68.7 34.6 68.0 35.0 81.5 16.4 12.3 1,654 Central Java 68.8 32.1 68.7 34.5 73.6 18.6 12.9 1,224 DI Yogyakarta 86.2 53.7 86.6 52.0 90.8 37.6 32.1 135 East Java 63.8 31.3 72.4 30.2 73.0 14.4 11.0 1,621 Banten 51.7 30.1 59.0 38.1 69.7 17.3 14.0 450 Bali and Nusa Tenggara Bali 82.0 55.9 81.6 43.8 89.8 29.9 26.5 173 West Nusa Tenggara 30.8 26.0 53.8 18.1 56.4 7.9 4.5 171 East Nusa Tenggara 48.4 27.3 52.4 23.8 59.1 9.9 8.4 158 Kalimantan West Kalimantan 48.5 30.4 55.5 28.6 60.6 17.2 8.8 165 Central Kalimantan 51.3 26.7 64.5 21.4 76.8 6.8 5.1 93 South Kalimantan 69.7 34.4 62.1 30.7 79.4 17.2 13.2 152 East Kalimantan 61.1 32.2 68.6 30.8 78.3 16.4 13.3 139 Sulawesi North Sulawesi 66.3 22.0 60.2 23.6 79.5 8.6 7.3 87 Central Sulawesi 57.8 24.0 53.6 22.5 66.1 10.9 7.3 98 South Sulawesi 39.5 23.3 51.6 27.1 57.7 10.1 5.1 258 Southeast Sulawesi 50.9 26.0 54.1 28.4 57.5 15.0 12.1 77 Gorontalo 30.8 19.2 41.8 14.4 50.3 5.2 2.9 39 West Sulawesi 37.1 17.7 39.6 15.9 43.6 7.6 6.0 33 Maluku and Papua Maluku 58.5 35.4 75.7 27.9 75.0 15.0 6.5 47 North Maluku 40.1 18.0 53.4 17.7 52.7 5.7 1.8 35 West Papua 29.1 46.6 73.5 47.4 81.4 18.0 13.2 28 Papua 37.7 22.3 41.3 31.4 60.1 13.4 10.3 120 Total 62.7 32.3 66.8 33.4 74.5 16.5 12.3 9,306 1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and by sharing food with a person who has AIDS virus. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention; the AIDS virus cannot be transmitted by mosquito bites or by sharing food with a person who has the AIDS virus. Appendix A • 295 Table A-12.4 Payment for sexual intercourse and condom use at last paid sexual intercourse Percentage of currently-married men age 15-54 who ever paid for sexual intercourse and percentage reporting payment for sexual intercourse in the past 12 months, by province Indonesia 2012 Among all men: Province Percentage who ever paid for sexual intercourse Percentage who paid for sexual intercourse in the past 12 months Number of men Sumatera Aceh 0.9 0.0 153 North Sumatera 5.8 1.0 470 West Sumatera 7.5 2.2 164 Riau 4.8 1.1 231 Jambi 7.8 1.2 145 South Sumatera 7.4 1.6 295 Bengkulu 1.8 1.3 67 Lampung 6.5 3.5 334 Bangka Belitung 5.4 2.2 52 Riau Islands 4.9 2.9 64 Java DKI Jakarta 0.9 0.7 374 West Java 5.5 2.0 1,654 Central Java 5.2 1.0 1,224 DI Yogyakarta 7.5 2.5 135 East Java 3.7 2.4 1,621 Banten 2.2 1.2 450 Bali and Nusa Tenggara Bali 6.9 3.0 173 West Nusa Tenggara 2.4 1.9 171 East Nusa Tenggara 19.4 7.6 158 Kalimantan West Kalimantan 6.1 2.9 165 Central Kalimantan 4.7 0.0 93 South Kalimantan 9.2 1.2 152 East Kalimantan 12.1 5.7 139 Sulawesi North Sulawesi 3.0 0.8 87 Central Sulawesi 2.1 2.1 98 South Sulawesi 8.6 2.4 258 Southeast Sulawesi 8.8 2.2 77 Gorontalo 9.2 7.3 39 West Sulawesi 8.6 1.1 33 Maluku and Papua Maluku 11.9 4.2 47 North Maluku 7.8 1.4 35 West Papua 12.5 5.6 28 Papua 4.6 4.1 120 Total 5.4 2.0 9,306 296 • Appendix A Table A-12.5 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms Among women age 15-49 and currently-married men age 15-54 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by province, Indonesia 2012 Women Currently-married men Province STI Bad smelling/ abnormal genital discharge Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of respondents who ever had sexual intercourse STI Genital sore/ulcer STI/genital discharge/ sore or ulcer Number of respondents who ever had sexual intercourse Sumatera Aceh 0.1 11.2 1.6 12.2 604 0.0 2.5 2.5 153 North Sumatera 0.0 17.0 1.7 17.9 1,686 0.0 1.1 1.1 470 West Sumatera 0.1 16.1 3.2 18.9 626 0.0 1.3 1.3 163 Riau 0.0 14.8 2.0 16.2 828 0.5 0.3 0.8 229 Jambi 0.1 21.7 2.6 22.5 478 0.0 0.7 0.7 145 South Sumatera 0.0 12.1 3.5 14.3 1,089 0.4 1.0 1.4 295 Bengkulu 0.4 10.6 2.8 12.0 242 0.0 0.5 0.5 67 Lampung 0.1 13.7 1.7 14.9 1,168 0.2 1.3 1.3 334 Bangka Belitung 0.1 13.5 2.2 14.6 194 0.0 1.2 1.2 52 Riau Islands 0.0 15.1 1.2 15.4 242 0.0 0.7 0.7 64 Java DKI Jakarta 0.1 9.5 3.2 11.4 1,363 0.0 0.0 0.0 374 West Java 0.1 8.3 1.1 8.9 6,651 0.0 1.1 1.1 1,651 Central Java 0.1 8.5 1.6 9.2 4,915 0.2 0.9 0.9 1,217 DI Yogyakarta 0.0 7.6 1.3 8.4 484 0.2 1.7 1.9 135 East Java 0.1 9.4 2.9 11.5 6,100 0.2 3.0 3.2 1,617 Banten 0.1 9.0 1.2 9.8 1,656 0.0 0.3 0.3 450 Bali and Nusa Tenggara Bali 0.1 4.4 0.9 5.2 637 0.0 0.0 0.0 173 West Nusa Tenggara 0.1 7.5 1.0 8.0 781 0.5 0.4 0.9 171 East Nusa Tenggara 0.3 19.5 5.2 21.5 644 0.0 2.3 2.3 157 Kalimantan West Kalimantan 0.2 7.2 2.0 8.6 626 0.3 1.2 1.5 165 Central Kalimantan 0.2 9.5 2.1 10.9 343 0.0 0.5 0.5 92 South Kalimantan 0.1 9.5 0.8 9.9 587 0.0 1.4 1.4 152 East Kalimantan 0.2 9.9 1.8 11.0 527 0.0 2.2 2.2 138 Sulawesi North Sulawesi 0.7 10.8 2.6 12.5 338 0.0 2.9 2.9 87 Central Sulawesi 0.5 13.2 2.9 14.7 391 0.0 2.0 2.0 98 South Sulawesi 0.4 14.7 3.2 16.9 1,078 0.0 1.2 1.2 258 Southeast Sulawesi 0.0 14.3 1.7 15.0 300 0.0 1.4 1.4 77 Gorontalo 0.2 7.4 2.4 8.4 157 0.0 1.8 1.8 39 West Sulawesi 0.0 17.4 1.3 18.2 141 0.6 1.8 2.5 33 Maluku and Papua Maluku 0.3 11.6 3.0 13.1 190 0.0 1.3 1.3 47 North Maluku 0.6 16.2 2.1 16.9 144 1.4 3.6 3.6 35 West Papua 0.6 6.8 1.7 8.0 99 0.8 0.0 0.8 28 Papua 0.0 11.4 2.3 11.8 432 0.5 1.0 1.5 119 Total 0.1 10.5 2.0 11.7 35,742 0.1 1.4 1.4 9,285 Appendix A • 297 Table A-12.6 Prevalence of medical injections Percentage of women age 15-49 and currently-married men age 15-54 who received at least one medical injection in the last 12 months, the average number of medical injections per person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by province, Indonesia 2012 Women Currently-married men Province Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respondents For last injection, syringe and needle taken from a new, unopened package Number of respondents receiving medical injections in the last 12 months Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respondents For last injection, syringe and needle taken from a new, unopened package Number of respondents receiving medical injections in the last 12 months Sumatera Aceh 40.7 1.8 877 90.1 357 30.9 1.5 153 83.3 47 North Sumatera 44.9 2.1 2,394 92.2 1,074 40.3 1.5 470 89.6 189 West Sumatera 38.0 1.5 852 94.0 324 15.3 0.5 164 (88.8) 25 Riau 47.4 2.0 1,040 91.4 493 31.8 1.0 231 83.0 73 Jambi 51.3 2.1 580 94.1 298 36.4 1.6 145 85.2 53 South Sumatera 56.2 2.6 1,358 92.2 764 32.9 0.9 295 90.6 97 Bengkulu 57.0 2.3 306 95.5 175 46.1 1.3 67 90.7 31 Lampung 46.7 1.8 1,443 93.7 673 38.4 1.1 334 89.3 129 Bangka Belitung 56.4 2.7 245 95.5 138 39.5 1.0 52 83.0 20 Riau Islands 38.8 1.6 323 92.7 126 19.7 0.6 64 85.9 13 Java DKI Jakarta 33.1 1.2 1,939 95.2 641 16.1 0.6 374 95.0 60 West Java 44.5 1.7 8,265 93.3 3,678 18.7 0.5 1,654 83.3 309 Central Java 46.6 1.6 6,240 93.5 2,911 25.3 0.7 1,224 88.1 310 DI Yogyakarta 37.2 1.5 654 94.7 243 23.8 0.5 135 84.3 32 East Java 54.8 2.2 7,374 94.3 4,041 30.4 1.4 1,621 80.2 492 Banten 43.4 1.6 2,148 93.0 932 20.1 0.6 450 87.4 90 Bali and Nusa Tenggara Bali 46.2 1.7 790 96.5 365 35.6 1.1 173 91.5 61 West Nusa Tenggara 58.8 2.1 997 95.9 586 45.2 1.7 171 85.2 77 East Nusa Tenggara 39.2 1.3 892 97.0 349 31.4 0.9 158 96.6 49 Kalimantan West Kalimantan 53.8 2.0 756 96.4 407 32.1 1.1 165 88.8 53 Central Kalimantan 48.8 2.2 409 91.6 200 33.4 1.3 93 94.8 31 South Kalimantan 49.3 2.1 730 89.8 360 45.0 1.4 152 87.0 69 East Kalimantan 41.0 1.5 671 92.0 275 37.2 1.6 139 93.2 52 Sulawesi North Sulawesi 35.7 1.4 427 89.8 152 17.9 0.7 87 (91.7) 16 Central Sulawesi 44.6 1.6 486 96.3 216 35.4 1.3 98 92.7 35 South Sulawesi 34.5 1.2 1,530 94.7 528 22.0 0.5 258 78.4 57 Southeast Sulawesi 36.5 1.3 382 95.9 139 17.7 0.5 77 (91.6) 14 Gorontalo 58.6 1.8 203 94.5 119 50.3 2.0 39 90.8 20 West Sulawesi 31.6 0.9 191 93.5 60 14.7 0.5 33 (64.5) 5 Maluku and Papua Maluku 38.3 1.3 260 96.1 99 31.6 1.2 47 93.1 15 North Maluku 40.1 1.3 188 93.2 75 27.0 0.9 35 94.2 9 West Papua 36.3 1.2 130 90.6 47 31.7 0.9 28 87.7 9 Papua 27.2 0.7 527 88.0 143 20.5 1.0 120 (92.9) 25 Total 46.0 1.8 45,607 93.7 20,990 27.6 0.9 9,306 86.3 2,567 Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist or other health worker. Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 298 • Appendix A Table A-12.7 Comprehensive knowledge about AIDS and of a source of condoms among youth Percentage of women age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge of a source of condoms, by province, Indonesia 2012 Province Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source1 Number of respondents Sumatera Aceh 7.6 40.8 288 North Sumatera 11.8 48.3 788 West Sumatera 8.7 45.1 258 Riau 8.4 54.3 282 Jambi 10.8 38.1 167 South Sumatera 5.3 40.0 391 Bengkulu 4.2 48.9 91 Lampung 8.4 46.1 429 Bangka Belitung 9.2 44.6 79 Riau Islands 13.3 58.4 82 Java DKI Jakarta 14.3 72.2 550 West Java 9.6 54.2 2,319 Central Java 16.0 61.1 1,773 DI Yogyakarta 30.6 83.2 177 East Java 13.7 45.9 1,919 Banten 8.5 53.5 686 Bali and Nusa Tenggara Bali 21.2 63.6 199 West Nusa Tenggara 7.9 33.0 304 East Nusa Tenggara 10.9 34.9 279 Kalimantan West Kalimantan 8.6 28.6 228 Central Kalimantan 8.9 34.7 126 South Kalimantan 10.2 43.7 230 East Kalimantan 9.6 50.7 198 Sulawesi North Sulawesi 8.8 46.4 125 Central Sulawesi 6.5 40.8 147 South Sulawesi 5.6 36.9 482 Southeast Sulawesi 13.6 41.3 119 Gorontalo 6.4 31.8 66 West Sulawesi 4.2 25.8 66 Maluku and Papua Maluku 10.8 36.6 91 North Maluku 9.9 30.3 65 West Papua 11.6 41.5 45 Papua 14.3 25.9 182 Total 11.4 49.8 13,232 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention of the AIDS virus. The components of comprehensive knowledge are presented in Tables 13.2, 13.3.1 and 13.3.2. 2 For this table, the following responses are not considered sources for condoms: friends or relatives. Appendix A • 299 Table A-12.8.1 Source of information on HIV/AIDS: Women Percent distribution of women age 15-49 who have heard of AIDS by source of information on HIV/AIDS by province, Indonesia 2012 Source of information on HIV/AIDS Province Radio Television News- paper/ maga- zines Poster Health profes- sional Religious institution School/ teacher Commu- nity meeting Friend/ relative Work place Internet Other Number of women who have heard of AIDS Sumatera Aceh 10.9 77.0 32.5 3.4 7.1 0.3 24.3 1.4 32.3 3.1 4.7 2.3 621 North Sumatera 12.5 74.8 28.1 4.3 4.7 0.8 25.2 1.4 36.7 2.3 3.4 0.7 1,799 West Sumatera 17.6 78.0 36.2 8.1 13.8 0.2 20.5 3.3 28.5 2.2 5.1 2.0 688 Riau 15.1 75.7 33.9 7.4 10.2 0.5 17.7 3.3 30.6 2.1 4.1 5.0 823 Jambi 11.7 79.2 28.1 4.1 5.2 0.2 18.4 1.2 32.8 3.3 4.1 2.3 388 South Sumatera 11.3 82.9 21.8 2.9 4.8 0.1 13.9 0.8 26.1 2.2 3.1 1.2 922 Bengkulu 10.6 74.5 27.3 5.0 11.4 0.6 20.4 1.9 30.1 2.0 2.4 2.8 216 Lampung 12.9 76.1 21.0 3.3 5.5 0.1 14.7 1.7 28.4 1.3 2.1 3.1 1,138 Bangka Belitung 16.2 74.6 25.7 4.0 6.0 0.4 16.5 1.3 45.0 4.5 2.9 2.2 203 Riau Islands 12.1 71.5 33.4 4.6 7.3 1.5 17.2 6.1 34.9 4.3 5.0 5.2 295 Java DKI Jakarta 13.4 83.7 36.2 7.0 6.2 0.4 14.5 5.1 27.6 7.4 8.2 2.8 1,861 West Java 15.3 84.9 27.4 5.5 5.8 0.5 17.0 1.5 24.9 5.3 4.8 2.2 6,581 Central Java 16.7 78.1 28.2 5.4 7.1 0.3 19.3 5.7 20.2 2.4 5.1 3.8 4,966 DI Yogyakarta 24.0 80.0 51.0 8.6 10.6 0.8 23.3 9.8 22.1 3.6 8.5 2.0 623 East Java 12.8 78.3 26.6 5.3 6.4 0.1 14.7 3.3 27.9 3.0 5.1 1.0 5,541 Banten 11.3 84.1 25.9 3.3 4.7 0.1 17.5 1.2 22.5 6.7 5.8 1.9 1,638 Bali and Nusa Tenggara Bali 18.6 74.1 31.1 6.5 10.6 0.5 17.6 9.0 44.4 7.8 6.9 1.8 658 West Nusa Tenggara 18.4 80.5 18.8 4.1 7.2 0.3 18.3 2.3 37.7 6.8 2.9 1.5 604 East Nusa Tenggara 17.9 40.4 30.3 3.9 30.8 2.8 27.8 6.4 53.8 4.8 2.2 6.4 584 Kalimantan West Kalimantan 7.7 73.8 13.3 1.6 5.2 0.3 11.1 2.0 34.6 2.6 1.8 2.3 471 Central Kalimantan 6.9 75.5 25.3 4.5 8.1 0.2 14.3 5.8 38.3 4.0 2.7 1.7 293 South Kalimantan 10.1 84.1 21.6 4.1 5.7 0.1 15.1 4.1 27.1 2.6 5.1 1.1 564 East Kalimantan 7.8 77.6 23.3 3.8 9.8 0.9 18.8 3.4 35.7 3.6 4.8 2.4 565 Sulawesi North Sulawesi 12.0 76.2 31.2 3.1 8.3 1.9 17.9 6.8 36.9 5.7 4.8 1.5 361 Central Sulawesi 8.0 71.9 21.0 3.6 12.0 0.4 17.1 4.2 41.3 6.5 3.5 2.8 336 South Sulawesi 14.2 71.6 26.9 5.3 8.8 0.5 20.5 4.9 34.7 3.1 3.1 2.9 1,070 Southeast Sulawesi 11.4 69.3 20.5 3.1 10.5 0.0 20.1 2.1 37.2 3.6 3.3 2.5 274 Gorontalo 30.3 73.4 26.3 6.8 13.0 0.4 19.7 5.4 26.0 4.1 2.9 2.0 131 West Sulawesi 9.1 68.0 22.6 4.3 8.9 0.4 20.4 4.0 27.8 3.3 3.7 2.2 94 Maluku and Papua Maluku 7.3 57.6 20.3 2.9 13.4 1.6 21.7 5.8 56.8 4.9 3.2 0.5 187 North Maluku 7.5 53.4 21.4 4.2 15.7 3.7 22.6 4.3 46.8 4.8 2.6 2.6 124 West Papua 19.7 51.6 23.5 9.7 36.7 5.2 21.7 10.9 37.3 6.3 1.7 4.7 105 Papua 18.7 46.6 18.0 11.3 24.6 13.0 19.1 15.5 44.5 5.0 3.6 5.1 275 Total 14.1 78.2 27.7 5.1 7.5 0.5 17.8 3.5 28.7 3.9 4.7 2.4 34,997 300 • Appendix A Table A-12.8.2 Source of information on HIV/AIDS: Men Percent distribution of currently-married men age 15-54 who have heard of AIDS by source of information on HIV/AIDS by province, Indonesia 2012 Source of information on HIV/AIDS Province Radio Television News- paper/ maga- zines Poster Health profes- sional Religious institution School/ teacher Commu- nity meeting Friend/ relative Work place Internet Other Number of men who have heard of AIDS Sumatera Aceh 12.3 77.2 56.2 4.2 10.4 0.0 2.4 1.7 32.6 2.7 3.6 6.6 111 North Sumatera 6.8 81.4 39.6 2.8 3.4 0.0 2.9 1.3 55.2 12.4 1.9 1.9 391 West Sumatera 19.3 82.4 47.2 8.2 12.7 1.4 1.4 2.8 44.6 3.1 3.1 7.3 140 Riau 12.2 88.7 33.4 8.0 6.2 0.3 1.4 2.6 24.6 11.8 3.1 1.2 203 Jambi 20.1 87.8 40.6 7.2 8.1 0.0 2.4 2.1 28.7 8.9 2.3 2.7 113 South Sumatera 15.5 90.2 37.3 4.9 5.0 0.0 3.4 2.2 35.8 3.5 1.6 3.5 228 Bengkulu 24.1 81.3 39.6 7.9 5.3 0.0 4.6 3.9 31.8 1.7 2.4 1.5 56 Lampung 23.5 88.1 29.2 3.7 6.5 0.4 2.2 0.4 31.4 2.8 1.1 0.3 277 Bangka Belitung 21.9 86.1 34.7 9.9 6.7 0.0 3.3 2.0 49.0 5.9 2.4 3.8 45 Riau Islands 11.8 87.8 43.5 8.3 14.4 0.7 3.3 6.1 52.4 19.9 3.8 1.8 57 Java DKI Jakarta 9.4 87.5 49.4 21.0 6.0 0.2 0.9 1.6 17.0 14.3 6.6 1.3 369 West Java 23.3 92.5 42.6 10.8 8.2 0.8 5.8 3.1 33.6 23.5 7.3 4.0 1,458 Central Java 22.5 89.3 36.3 7.8 7.3 1.3 2.1 5.6 46.9 10.1 4.9 2.6 956 DI Yogyakarta 36.1 83.6 62.6 9.8 16.4 1.1 4.8 5.3 34.5 4.3 7.1 1.6 128 East Java 25.5 85.6 37.6 12.9 7.5 0.5 4.0 2.8 48.2 14.6 3.3 1.3 1,334 Banten 13.1 86.5 38.7 3.6 1.6 0.3 1.6 1.8 32.5 2.8 4.0 4.3 355 Bali and Nusa Tenggara Bali 22.8 80.2 42.1 3.9 9.6 0.9 2.3 5.6 49.7 8.0 2.9 0.8 164 West Nusa Tenggara 17.9 76.2 17.1 0.0 6.6 1.0 0.0 3.4 45.4 19.9 1.4 1.8 133 East Nusa Tenggara 27.3 54.2 38.9 7.8 23.0 1.1 4.5 16.1 54.1 5.9 1.6 3.9 111 Kalimantan West Kalimantan 13.7 82.6 25.9 4.5 9.8 0.6 3.6 0.7 33.7 14.1 3.2 2.9 113 Central Kalimantan 7.6 87.1 25.1 2.7 6.3 1.2 1.6 2.2 35.1 25.0 1.0 3.0 74 South Kalimantan 18.1 87.8 31.0 7.6 12.6 0.0 6.2 1.2 29.7 8.6 7.6 3.3 133 East Kalimantan 18.5 86.3 40.8 8.0 13.5 0.4 5.8 5.6 48.8 7.4 4.7 2.0 114 Sulawesi North Sulawesi 16.3 81.3 36.8 3.8 6.3 2.5 4.4 2.2 48.6 18.5 0.9 2.6 77 Central Sulawesi 10.3 83.6 26.3 6.1 11.4 4.5 6.1 2.5 52.4 3.9 0.5 0.9 70 South Sulawesi 15.6 82.9 28.1 2.5 7.7 1.0 1.0 3.6 29.6 13.5 1.5 2.8 172 Southeast Sulawesi 16.4 83.8 24.9 3.1 11.5 0.0 3.5 2.9 39.8 16.5 1.9 3.5 54 Gorontalo 36.9 82.9 31.8 7.3 8.8 0.0 2.1 3.8 19.9 2.3 4.0 5.2 23 West Sulawesi 14.0 84.8 25.9 1.9 16.8 0.0 0.0 8.3 46.7 8.4 0.0 0.0 18 Maluku and Papua Maluku 13.9 76.3 21.5 3.1 12.6 3.0 6.9 4.2 47.9 15.5 0.7 0.0 38 North Maluku 13.1 71.5 43.8 4.8 12.5 2.8 5.9 4.9 53.7 6.1 3.0 3.9 22 West Papua 18.2 60.7 29.6 24.3 36.2 6.3 17.0 9.5 47.8 19.4 0.6 0.7 26 Papua 17.0 44.5 18.1 12.2 31.1 24.2 4.1 11.8 38.1 8.7 2.0 2.0 97 Total 19.8 85.9 38.2 8.7 8.2 1.0 3.5 3.4 39.7 13.0 4.2 2.6 7,661 Appendix A • 301 CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table A-13.1.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings: Women Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife’s cash earnings are used and by whether she earned more or less than her husband, according to province, Indonesia 2012 Person who decides how the wife’s cash earnings are used: Total Wife’s cash earnings compared with husband’s cash earnings: Total Number of womenProvince Mainly wife Wife and husband jointly Mainly husband Other Missing More Less About the same Husband has no earnings Don’t know/ Missing Sumatera Aceh 34.9 53.2 11.9 0.0 0.0 100.0 18.7 52.1 19.1 1.0 9.0 100.0 235 North Sumatera 60.7 30.5 7.5 0.0 1.2 100.0 17.0 59.7 18.1 1.7 3.5 100.0 630 West Sumatera 50.2 44.2 4.3 0.2 1.0 100.0 18.7 59.6 14.6 1.2 5.9 100.0 285 Riau 60.4 31.3 8.0 0.2 0.1 100.0 14.4 64.0 18.5 1.5 1.6 100.0 367 Jambi 52.4 44.7 1.9 0.0 0.9 100.0 10.4 59.5 23.9 1.4 4.8 100.0 180 South Sumatera 65.2 27.9 6.0 0.0 1.0 100.0 16.4 54.2 27.3 0.6 1.5 100.0 438 Bengkulu 60.9 33.0 5.8 0.3 0.0 100.0 12.8 55.1 24.4 1.4 6.3 100.0 85 Lampung 69.8 25.5 4.5 0.2 0.0 100.0 11.4 59.8 19.5 2.0 7.3 100.0 408 Bangka Belitung 66.4 26.3 6.8 0.0 0.5 100.0 14.2 71.3 12.6 1.5 0.5 100.0 84 Riau Islands 62.7 31.4 5.4 0.0 0.5 100.0 17.3 54.2 20.8 3.7 4.0 100.0 105 Java DKI Jakarta 74.4 17.6 6.6 0.4 1.0 100.0 22.8 47.2 22.0 3.7 4.3 100.0 619 West Java 68.1 27.4 3.6 0.3 0.7 100.0 16.7 58.1 20.8 2.8 1.7 100.0 2,633 Central Java 57.5 36.9 4.8 0.0 0.8 100.0 14.9 60.7 21.3 0.8 2.3 100.0 2,400 DI Yogyakarta 63.9 33.8 1.9 0.0 0.4 100.0 14.6 64.0 17.7 0.9 2.8 100.0 298 East Java 72.1 21.3 5.3 0.3 1.0 100.0 14.5 66.0 16.5 0.7 2.2 100.0 2,944 Banten 77.2 18.0 4.8 0.0 0.0 100.0 22.3 54.3 19.3 1.5 2.6 100.0 693 Bali and Nusa Tenggara Bali 57.2 29.0 13.4 0.1 0.4 100.0 16.7 61.3 18.7 1.3 1.9 100.0 391 West Nusa Tenggara 67.6 26.5 5.8 0.0 0.0 100.0 11.7 67.4 15.8 2.3 2.8 100.0 341 East Nusa Tenggara 63.4 31.7 3.9 0.5 0.5 100.0 18.4 69.8 9.4 0.8 1.5 100.0 203 Kalimantan West Kalimantan 69.7 25.6 3.8 0.0 1.0 100.0 8.6 60.2 29.0 0.8 1.4 100.0 262 Central Kalimantan 53.2 44.0 2.3 0.5 0.0 100.0 12.5 59.9 24.3 2.3 1.1 100.0 157 South Kalimantan 68.8 23.8 6.3 0.0 1.2 100.0 16.9 56.3 22.1 1.8 2.9 100.0 233 East Kalimantan 57.8 38.2 3.1 0.0 0.8 100.0 12.6 63.8 16.9 4.1 2.6 100.0 208 Sulawesi North Sulawesi 59.9 33.9 4.5 0.0 1.7 100.0 21.0 61.0 14.1 0.8 3.0 100.0 130 Central Sulawesi 60.4 37.7 1.4 0.0 0.6 100.0 21.5 61.7 13.5 1.1 2.3 100.0 146 South Sulawesi 75.9 18.1 4.3 0.0 1.6 100.0 22.1 58.3 14.7 2.2 2.7 100.0 326 Southeast Sulawesi 73.2 19.3 5.6 0.0 1.9 100.0 16.5 66.1 12.5 1.9 2.9 100.0 96 Gorontalo 68.8 22.3 8.6 0.0 0.2 100.0 14.9 69.3 11.7 2.1 2.1 100.0 65 West Sulawesi 63.5 33.2 3.0 0.0 0.3 100.0 12.8 58.1 16.2 1.1 11.7 100.0 43 Maluku and Papua Maluku 49.4 38.9 9.6 0.0 2.1 100.0 22.8 60.1 11.2 2.2 3.7 100.0 53 North Maluku 44.6 47.2 8.0 0.0 0.2 100.0 22.6 56.3 19.3 0.8 1.0 100.0 59 West Papua 65.1 29.4 4.3 0.0 1.2 100.0 17.3 47.9 23.7 6.2 5.0 100.0 36 Papua 47.1 21.1 30.4 0.0 1.4 100.0 23.9 42.5 26.9 3.1 3.7 100.0 80 Total 65.3 28.5 5.3 0.1 0.8 100.0 16.2 60.2 19.3 1.6 2.7 100.0 15,233 302 • Appendix A Table A-13.1.2 Control over men’s cash earnings Percent distributions of currently married men age 15-54 who receive cash earnings and of currently married women age 15-49 whose husbands receive cash earnings, by person who decides how husband’s cash earnings are used, according to province, Indonesia 2012 Men Women Province Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number Sumatera Aceh 21.6 64.3 14.2 0.0 0.0 100.0 144 17.4 67.3 15.3 0.0 0.0 100.0 556 North Sumatera 62.6 31.3 5.9 0.0 0.3 100.0 411 41.4 45.9 12.5 0.0 0.2 100.0 1,546 West Sumatera 20.9 66.7 12.4 0.0 0.0 100.0 161 26.0 63.4 10.6 0.1 0.0 100.0 583 Riau 44.7 44.8 10.0 0.0 0.6 100.0 230 39.5 47.0 13.2 0.2 0.2 100.0 783 Jambi 38.6 42.7 18.7 0.0 0.0 100.0 143 22.7 70.0 7.3 0.0 0.0 100.0 449 South Sumatera 42.8 40.1 17.1 0.0 0.0 100.0 294 45.6 38.7 15.4 0.0 0.2 100.0 1,046 Bengkulu 51.3 42.7 5.9 0.0 0.0 100.0 66 34.5 54.8 10.6 0.0 0.1 100.0 229 Lampung 64.1 20.3 15.6 0.0 0.0 100.0 320 48.6 43.5 7.8 0.1 0.0 100.0 1,106 Bangka Belitung 43.7 46.7 9.7 0.0 0.0 100.0 50 43.4 46.5 10.0 0.0 0.1 100.0 181 Riau Islands 52.9 40.0 7.2 0.0 0.0 100.0 63 32.3 57.2 10.4 0.1 0.0 100.0 224 Java DKI Jakarta 43.2 27.8 28.9 0.0 0.0 100.0 348 49.5 34.3 15.6 0.1 0.5 100.0 1,231 West Java 50.6 39.3 9.9 0.3 0.0 100.0 1,498 50.1 40.5 9.2 0.1 0.2 100.0 6,079 Central Java 43.6 46.9 8.8 0.0 0.6 100.0 1,076 31.6 57.6 10.5 0.2 0.0 100.0 4,629 DI Yogyakarta 29.9 56.2 13.9 0.0 0.0 100.0 129 26.4 64.4 9.0 0.2 0.0 100.0 453 East Java 40.5 38.3 21.1 0.2 0.0 100.0 1,536 44.0 41.7 14.1 0.2 0.0 100.0 5,730 Banten 43.8 42.3 13.7 0.0 0.2 100.0 440 47.8 36.0 16.2 0.0 0.0 100.0 1,543 Bali and Nusa Tenggara Bali 12.0 71.4 15.8 0.5 0.3 100.0 168 23.1 41.9 34.7 0.4 0.0 100.0 582 West Nusa Tenggara 16.0 79.7 4.2 0.0 0.0 100.0 164 41.7 51.5 6.8 0.0 0.0 100.0 673 East Nusa Tenggara 46.1 49.3 4.6 0.0 0.0 100.0 89 41.9 44.6 13.1 0.3 0.0 100.0 577 Kalimantan West Kalimantan 39.9 50.5 9.5 0.0 0.0 100.0 137 20.2 71.6 8.0 0.0 0.1 100.0 589 Central Kalimantan 61.2 31.6 7.2 0.0 0.0 100.0 90 26.0 68.5 5.4 0.0 0.0 100.0 321 South Kalimantan 30.5 49.8 19.3 0.0 0.4 100.0 145 33.0 50.8 15.9 0.1 0.1 100.0 532 East Kalimantan 58.9 32.9 7.2 0.0 1.1 100.0 134 31.0 60.9 8.1 0.0 0.0 100.0 489 Sulawesi North Sulawesi 47.7 46.9 5.4 0.0 0.0 100.0 83 45.0 45.3 9.1 0.0 0.6 100.0 314 Central Sulawesi 36.3 54.1 8.2 0.0 1.4 100.0 82 34.9 56.8 8.3 0.0 0.0 100.0 360 South Sulawesi 44.7 51.3 3.2 0.0 0.8 100.0 230 64.4 25.9 8.9 0.4 0.5 100.0 988 Southeast Sulawesi 67.6 29.5 2.4 0.0 0.5 100.0 62 62.0 29.3 7.9 0.3 0.6 100.0 280 Gorontalo 52.8 39.0 8.3 0.0 0.0 100.0 37 43.3 38.8 17.7 0.1 0.1 100.0 147 West Sulawesi 43.5 37.2 19.3 0.0 0.0 100.0 30 39.2 55.1 5.5 0.0 0.1 100.0 130 Maluku and Papua Maluku 64.4 28.5 7.1 0.0 0.0 100.0 41 37.6 49.3 12.9 0.0 0.3 100.0 170 North Maluku 81.1 12.8 5.0 0.6 0.6 100.0 34 31.2 59.0 9.4 0.0 0.5 100.0 130 West Papua 38.5 55.1 5.2 0.0 1.2 100.0 25 38.2 50.2 11.1 0.1 0.3 100.0 88 Papua 45.6 46.6 7.8 0.0 0.0 100.0 76 43.6 30.5 24.8 0.2 1.0 100.0 380 Total 44.5 42.3 13.0 0.1 0.2 100.0 8,538 41.4 46.3 12.0 0.1 0.1 100.0 33,118 na = Not applicable Appendix A • 303 Table A-13.2.1 Ownership of assets: Women Percent distribution of women age 15-49 by ownership of housing and land, according to province, Indonesia 2012 Percentage who own a house: Total Percentage who own land: Total Number Province Alone Jointly Alone and jointly Percent- age who do not own a house Missing Alone Jointly Alone and jointly Percent- age who do not own land Missing Sumatera Aceh 7.8 36.9 2.8 52.4 0.0 100.0 10.3 30.5 2.2 56.9 0.1 100.0 877 North Sumatera 13.4 24.9 0.4 61.2 0.1 100.0 10.5 22.4 0.5 66.4 0.2 100.0 2,394 West Sumatera 11.3 28.3 0.4 60.0 0.0 100.0 16.6 24.7 0.4 58.3 0.0 100.0 852 Riau 12.8 34.2 0.9 52.1 0.0 100.0 14.8 33.5 1.1 50.5 0.1 100.0 1,040 Jambi 5.8 44.2 0.7 49.2 0.1 100.0 7.9 40.7 1.3 50.1 0.1 100.0 580 South Sumatera 6.8 42.8 4.2 46.2 0.0 100.0 8.1 36.1 4.2 51.5 0.1 100.0 1,358 Bengkulu 12.1 44.7 1.1 42.1 0.0 100.0 12.2 45.5 1.3 41.0 0.0 100.0 306 Lampung 10.9 38.8 5.6 44.6 0.1 100.0 10.8 31.9 4.9 52.2 0.1 100.0 1,443 Bangka Belitung 6.9 46.7 7.9 38.4 0.1 100.0 7.8 40.0 7.6 44.5 0.1 100.0 245 Riau Islands 13.1 33.9 4.8 48.1 0.2 100.0 11.5 21.5 3.4 63.2 0.3 100.0 323 Java DKI Jakarta 13.8 14.9 3.4 67.8 0.1 100.0 11.6 11.2 2.1 74.8 0.4 100.0 1,939 West Java 18.8 28.2 3.2 49.8 0.1 100.0 16.0 23.9 2.7 57.3 0.1 100.0 8,265 Central Java 9.3 35.7 5.6 49.4 0.1 100.0 8.3 15.4 4.8 71.3 0.2 100.0 6,240 DI Yogyakarta 6.8 36.7 0.9 55.6 0.1 100.0 11.7 27.4 1.0 59.9 0.0 100.0 654 East Java 19.4 32.9 1.0 46.7 0.1 100.0 17.4 27.3 0.7 54.5 0.1 100.0 7,374 Banten 10.5 39.3 0.9 49.3 0.1 100.0 6.6 33.0 0.9 59.3 0.2 100.0 2,148 Bali and Nusa Tenggara Bali 3.2 32.1 2.3 62.3 0.1 100.0 3.0 18.2 1.2 77.6 0.0 100.0 790 West Nusa Tenggara 9.4 47.2 0.8 42.5 0.1 100.0 7.4 38.4 2.0 52.1 0.1 100.0 997 East Nusa Tenggara 10.1 36.3 0.4 53.3 0.0 100.0 12.8 32.5 0.7 54.0 0.0 100.0 892 Kalimantan West Kalimantan 20.6 40.1 3.6 35.2 0.5 100.0 20.6 38.1 2.9 38.1 0.2 100.0 756 Central Kalimantan 5.7 49.7 0.2 44.3 0.1 100.0 8.2 47.6 0.1 43.8 0.3 100.0 409 South Kalimantan 10.1 37.1 0.6 52.2 0.1 100.0 10.0 35.8 1.2 53.0 0.0 100.0 730 East Kalimantan 7.8 32.2 1.7 58.3 0.0 100.0 10.3 33.5 2.7 53.5 0.1 100.0 671 Sulawesi North Sulawesi 10.5 36.2 8.1 44.7 0.6 100.0 12.5 28.7 7.7 50.6 0.5 100.0 427 Central Sulawesi 7.3 43.6 0.9 48.1 0.2 100.0 9.4 37.8 0.8 51.9 0.1 100.0 486 South Sulawesi 16.3 24.8 4.5 54.4 0.0 100.0 18.4 18.6 5.5 57.6 0.0 100.0 1,530 Southeast Sulawesi 7.1 46.8 3.7 42.4 0.0 100.0 7.6 43.7 6.1 42.5 0.1 100.0 382 Gorontalo 10.5 31.3 4.0 54.1 0.1 100.0 12.4 26.2 4.3 57.0 0.1 100.0 203 West Sulawesi 5.9 57.1 3.3 33.4 0.3 100.0 6.2 49.1 4.5 40.2 0.1 100.0 191 Maluku and Papua Maluku 4.3 35.4 3.4 56.8 0.2 100.0 5.9 29.2 2.7 62.1 0.2 100.0 260 North Maluku 4.4 48.5 3.2 43.9 0.0 100.0 7.4 42.2 2.6 47.6 0.2 100.0 188 West Papua 5.9 28.9 2.3 62.2 0.7 100.0 9.0 20.4 2.0 68.5 0.1 100.0 130 Papua 10.9 41.1 8.1 39.4 0.6 100.0 11.4 34.1 7.9 45.9 0.7 100.0 527 Total 13.3 33.3 2.8 50.4 0.1 100.0 12.5 26.2 2.5 58.6 0.1 100.0 45,607 304 • Appendix A Table A-13.2.2 Ownership of assets: Men Percent distribution of men age 15-54 by ownership of housing and land, according to province, Indonesia 2012 Percentage who own a house: Total Percentage who own land: Total Number Province Alone Jointly Alone and jointly Percent- age who do not own a house Missing Alone Jointly Alone and jointly Percent- age who do not own land Missing Sumatera Aceh 26.1 46.1 0.0 27.8 0.0 100.0 29.7 41.4 1.7 27.2 0.0 100.0 153 North Sumatera 8.4 48.4 2.3 40.8 0.0 100.0 10.2 40.2 1.3 48.0 0.3 100.0 470 West Sumatera 22.6 26.7 1.5 48.8 0.4 100.0 26.8 26.6 1.7 45.0 0.0 100.0 164 Riau 36.2 20.7 0.6 42.0 0.6 100.0 36.6 16.0 0.9 45.4 1.1 100.0 231 Jambi 44.6 22.1 0.0 33.3 0.0 100.0 47.3 22.9 2.2 27.6 0.0 100.0 145 South Sumatera 68.1 3.6 0.0 28.3 0.0 100.0 59.4 3.1 0.0 37.2 0.3 100.0 295 Bengkulu 54.4 14.7 0.0 30.9 0.0 100.0 36.7 26.9 0.5 36.0 0.0 100.0 67 Lampung 16.4 58.5 1.2 23.9 0.0 100.0 17.9 47.4 1.2 33.5 0.0 100.0 334 Bangka Belitung 7.9 50.9 19.2 22.0 0.0 100.0 12.2 42.3 19.7 25.8 0.0 100.0 52 Riau Islands 52.6 17.6 2.5 27.3 0.0 100.0 38.8 16.8 1.6 42.9 0.0 100.0 64 Java DKI Jakarta 10.4 34.5 1.5 53.1 0.5 100.0 9.2 27.2 0.8 62.0 0.7 100.0 374 West Java 20.1 44.6 1.2 33.9 0.2 100.0 13.7 41.0 1.7 43.2 0.4 100.0 1,654 Central Java 44.2 27.2 0.9 27.1 0.6 100.0 31.7 18.6 0.5 48.9 0.3 100.0 1,224 DI Yogyakarta 24.9 39.4 2.0 33.7 0.0 100.0 31.0 24.4 5.4 39.2 0.0 100.0 135 East Java 29.9 37.5 0.6 32.0 0.0 100.0 23.7 30.2 1.1 45.0 0.0 100.0 1,621 Banten 19.7 33.4 13.6 33.1 0.2 100.0 17.3 30.0 5.9 46.2 0.6 100.0 450 Bali and Nusa Tenggara Bali 60.4 13.9 0.0 25.8 0.0 100.0 36.1 11.0 0.3 52.5 0.0 100.0 173 West Nusa Tenggara 51.8 34.5 2.5 10.8 0.4 100.0 47.3 15.5 0.0 35.9 1.3 100.0 171 East Nusa Tenggara 71.6 11.2 1.1 15.8 0.3 100.0 78.3 12.4 2.8 6.4 0.0 100.0 158 Kalimantan West Kalimantan 25.5 45.5 0.3 28.7 0.0 100.0 26.3 38.2 0.0 35.5 0.0 100.0 165 Central Kalimantan 64.0 4.6 0.5 30.9 0.0 100.0 67.1 4.5 1.5 27.0 0.0 100.0 93 South Kalimantan 61.6 9.1 0.4 28.8 0.0 100.0 55.0 8.6 0.4 36.0 0.0 100.0 152 East Kalimantan 43.9 22.4 0.6 32.7 0.4 100.0 44.3 22.2 0.6 32.5 0.4 100.0 139 Sulawesi North Sulawesi 18.9 51.4 0.8 28.5 0.4 100.0 20.6 45.0 0.8 33.1 0.6 100.0 87 Central Sulawesi 59.3 8.7 0.8 31.2 0.0 100.0 68.5 8.2 0.6 22.8 0.0 100.0 98 South Sulawesi 15.5 40.0 11.0 33.6 0.0 100.0 18.9 33.9 11.0 36.2 0.0 100.0 258 Southeast Sulawesi 33.3 37.0 1.0 28.7 0.0 100.0 34.6 39.7 1.4 24.4 0.0 100.0 77 Gorontalo 35.3 29.3 0.5 34.9 0.0 100.0 38.7 25.4 1.4 34.6 0.0 100.0 39 West Sulawesi 55.4 28.2 0.6 15.8 0.0 100.0 45.4 19.9 1.0 33.7 0.0 100.0 33 Maluku and Papua Maluku 57.1 14.0 0.4 28.5 0.0 100.0 56.1 10.1 0.0 33.8 0.0 100.0 47 North Maluku 48.5 14.6 1.3 35.6 0.0 100.0 52.9 16.5 1.9 28.8 0.0 100.0 35 West Papua 65.3 7.7 0.5 26.5 0.0 100.0 60.7 7.3 1.0 30.4 0.5 100.0 28 Papua 59.6 17.5 5.5 17.4 0.0 100.0 49.1 22.0 5.7 23.2 0.0 100.0 120 Total 32.0 33.9 2.0 31.9 0.2 100.0 27.5 28.4 1.8 42.0 0.3 100.0 9,306 na = Not Applicable Appendix A • 305 Table A-13.3.1 Women’s participation in decision making Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by province, Indonesia 2012 Specific decisions Percentage who participate in all three decisions Percentage who participate in none of the three decisions Number of women Province Woman’s own health care Making major household purchases Visits to her family or relatives Sumatera Aceh 77.4 81.1 85.0 68.7 9.4 558 North Sumatera 80.6 79.5 83.6 70.8 10.6 1,564 West Sumatera 78.7 84.5 89.5 67.4 3.9 588 Riau 74.8 76.5 85.2 60.0 6.3 791 Jambi 86.8 88.0 91.4 78.2 2.9 452 South Sumatera 83.4 76.6 75.3 65.9 8.6 1,051 Bengkulu 85.9 86.9 88.5 74.9 3.9 230 Lampung 83.7 83.5 87.3 69.1 3.0 1,118 Bangka Belitung 87.6 83.4 83.4 73.1 6.5 183 Riau Islands 87.2 89.5 91.3 79.1 3.2 228 Java DKI Jakarta 84.8 79.0 83.3 70.2 7.7 1,261 West Java 83.6 83.5 87.4 69.6 3.5 6,170 Central Java 86.8 79.5 87.4 71.2 5.3 4,657 DI Yogyakarta 92.0 84.3 90.9 74.4 0.8 456 East Java 81.8 80.5 86.7 69.9 7.0 5,765 Banten 81.3 77.0 79.9 63.9 7.0 1,557 Bali and Nusa Tenggara Bali 64.5 65.5 74.9 51.9 15.9 589 West Nusa Tenggara 77.9 88.0 89.4 72.2 5.7 686 East Nusa Tenggara 84.6 87.7 90.1 74.4 2.7 584 Kalimantan West Kalimantan 93.7 94.2 93.3 86.5 1.6 591 Central Kalimantan 88.3 92.0 93.7 81.6 1.9 325 South Kalimantan 80.3 84.0 85.1 70.7 8.1 536 East Kalimantan 93.1 88.6 91.4 81.4 2.3 498 Sulawesi North Sulawesi 89.6 87.2 89.1 82.3 6.6 316 Central Sulawesi 85.2 88.6 87.2 74.7 3.4 362 South Sulawesi 87.9 86.9 85.4 75.6 4.8 1,000 Southeast Sulawesi 70.1 75.3 71.4 56.6 15.0 282 Gorontalo 74.9 74.5 73.8 57.0 12.0 149 West Sulawesi 93.5 94.4 92.6 87.0 1.8 131 Maluku and Papua Maluku 86.8 82.8 82.8 73.2 7.1 175 North Maluku 87.7 87.7 89.8 80.2 5.3 131 West Papua 86.8 82.9 81.2 71.8 6.2 94 Papua 79.5 73.9 74.7 67.1 15.8 384 Total 83.3 81.7 85.9 70.3 5.9 33,465 306 • Appendix A Table A-13.3.2 Men’s participation in decision making by provinces Percentage of currently married men age 15-49 who usually make specific decisions either alone or jointly with their wife, by province, Indonesia 2012 Specific decision Both decisions Neither of the two decisions Number of men Province Man’s own health Making major household purchases Sumatera Aceh 79.3 80.4 67.5 7.8 153 North Sumatera 65.2 76.3 53.8 12.3 470 West Sumatera 70.3 80.8 60.6 9.5 164 Riau 68.7 70.0 58.5 19.8 231 Jambi 71.5 90.9 67.2 4.8 145 South Sumatera 82.8 84.5 75.8 8.5 295 Bengkulu 74.7 79.7 63.5 9.1 67 Lampung 56.7 68.6 42.5 17.3 334 Bangka Belitung 83.7 77.4 69.2 8.0 52 Riau Islands 51.8 54.9 43.3 36.7 64 Java DKI Jakarta 69.5 84.6 60.9 6.8 374 West Java 69.8 78.7 58.5 9.9 1,654 Central Java 71.0 74.2 58.3 13.1 1,224 DI Yogyakarta 81.3 80.8 69.2 7.0 135 East Java 65.9 78.3 56.2 12.1 1,621 Banten 70.6 68.3 54.5 15.6 450 Bali and Nusa Tenggara Bali 87.2 93.3 84.8 4.3 173 West Nusa Tenggara 93.6 92.2 89.7 4.0 171 East Nusa Tenggara 77.3 60.2 52.6 15.2 158 Kalimantan West Kalimantan 82.5 82.4 73.9 9.0 165 Central Kalimantan 53.2 51.8 37.0 32.0 93 South Kalimantan 72.0 86.4 62.1 3.7 152 East Kalimantan 69.5 54.6 43.7 19.5 139 Sulawesi North Sulawesi 64.6 70.3 55.0 20.1 87 Central Sulawesi 74.5 70.2 60.3 15.6 98 South Sulawesi 79.2 60.3 53.9 14.4 258 Southeast Sulawesi 91.5 84.5 81.1 5.1 77 Gorontalo 77.2 74.1 60.4 9.1 39 West Sulawesi 85.6 73.9 67.7 8.2 33 Maluku and Papua Maluku 58.4 61.4 36.9 17.1 47 North Maluku 37.5 47.0 30.5 46.0 35 West Papua 83.0 82.1 69.9 4.8 28 Papua 77.9 71.6 65.6 16.0 120 Total 70.8 76.2 59.0 12.0 9,306 Appendix A • 307 Table A-13.4.1 Attitude toward wife beating: Women Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by province, Indonesia 2012 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number Province Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Sumatera Aceh 4.6 11.8 42.7 41.1 14.5 52.2 877 North Sumatera 2.2 4.8 20.6 25.9 9.2 32.4 2,394 West Sumatera 2.4 5.8 25.6 31.2 9.5 37.8 852 Riau 3.6 6.1 29.7 33.3 11.9 43.6 1,040 Jambi 4.2 6.9 29.8 31.3 15.7 40.0 580 South Sumatera 3.3 5.6 20.4 25.7 10.8 30.5 1,358 Bengkulu 5.0 6.7 29.1 29.2 11.1 39.4 306 Lampung 4.7 7.7 29.3 32.7 12.2 41.3 1,443 Bangka Belitung 2.4 7.2 30.7 39.6 12.9 47.4 245 Riau Islands 2.1 4.3 25.1 29.4 7.2 36.6 323 Java DKI Jakarta 0.6 2.2 11.0 13.6 4.4 18.4 1,939 West Java 2.1 3.2 21.5 25.4 9.2 32.7 8,265 Central Java 1.1 3.3 18.4 22.0 5.9 27.9 6,240 DI Yogyakarta 0.3 1.5 10.3 13.6 3.1 18.0 654 East Java 1.2 4.8 26.3 29.7 7.6 36.9 7,374 Banten 1.8 3.6 23.7 26.2 11.2 34.3 2,148 Bali and Nusa Tenggara Bali 3.4 6.3 16.1 19.9 6.7 24.3 790 West Nusa Tenggara 7.0 20.6 52.4 53.3 24.0 62.4 997 East Nusa Tenggara 17.4 23.9 36.3 38.2 14.5 48.1 892 Kalimantan West Kalimantan 2.0 5.7 16.7 18.9 5.5 23.3 756 Central Kalimantan 3.5 9.3 27.4 30.1 8.4 38.7 409 South Kalimantan 0.8 4.2 29.1 28.2 7.8 36.8 730 East Kalimantan 1.4 3.8 20.2 24.0 5.1 30.3 671 Sulawesi North Sulawesi 1.6 4.0 15.3 17.5 3.6 21.7 427 Central Sulawesi 4.5 9.8 42.9 44.0 11.7 55.1 486 South Sulawesi 2.2 6.9 27.1 31.2 8.3 38.8 1,530 Southeast Sulawesi 5.0 6.6 28.3 30.9 7.7 37.2 382 Gorontalo 3.4 10.0 29.7 33.0 6.0 41.0 203 West Sulawesi 3.2 9.2 40.1 37.9 10.8 48.7 191 Maluku and Papua Maluku 10.5 26.3 40.0 42.9 17.8 52.9 260 North Maluku 7.6 17.8 33.9 34.6 14.7 45.3 188 West Papua 9.8 17.3 33.1 37.5 15.3 46.3 130 Papua 3.6 10.4 17.3 16.0 5.9 24.7 527 Total 2.5 5.7 24.0 27.3 8.9 34.5 45,607 308 • Appendix A Table A-13.4.2 Attitude toward wife beating: Men Percentage of all men age 15-54 who agree that a husband is justified in hitting or beating his wife for specific reasons, by province, Indonesia 2012 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number Province Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Sumatera Aceh 2.7 6.0 19.2 15.2 4.5 24.7 153 North Sumatera 0.9 1.9 8.1 9.4 2.2 14.1 470 West Sumatera 0.7 1.8 9.7 11.5 3.4 14.4 164 Riau 1.2 4.8 16.8 18.2 3.8 26.3 231 Jambi 0.4 2.8 11.4 12.2 2.0 17.9 145 South Sumatera 1.1 5.1 12.6 18.7 2.9 21.0 295 Bengkulu 0.0 2.7 9.3 9.8 0.9 14.5 67 Lampung 0.7 5.3 15.7 18.7 5.2 25.3 334 Bangka Belitung 0.7 5.0 18.3 20.6 4.6 27.0 52 Riau Islands 0.5 0.7 3.4 3.2 1.3 3.6 64 Java DKI Jakarta 0.0 0.0 3.2 5.5 1.3 5.5 374 West Java 1.4 1.1 12.5 9.3 2.1 16.1 1,654 Central Java 0.0 2.4 9.1 10.3 2.6 14.9 1,224 DI Yogyakarta 0.0 1.6 7.9 14.2 1.5 18.7 135 East Java 1.1 4.7 16.3 15.1 5.5 21.9 1,621 Banten 0.0 2.0 6.3 6.8 2.0 9.8 450 Bali and Nusa Tenggara Bali 0.6 1.9 2.7 4.0 1.7 4.8 173 West Nusa Tenggara 0.0 2.0 8.3 3.4 1.6 9.5 171 East Nusa Tenggara 3.0 15.3 19.2 21.4 3.8 29.8 158 Kalimantan West Kalimantan 2.0 3.7 8.6 11.9 4.2 16.0 165 Central Kalimantan 1.3 5.2 9.8 15.6 1.8 21.1 93 South Kalimantan 0.4 1.6 8.4 8.7 1.4 13.0 152 East Kalimantan 0.0 3.8 10.6 11.1 1.4 13.4 139 Sulawesi North Sulawesi 1.0 3.4 8.4 11.8 2.7 15.0 87 Central Sulawesi 0.8 6.9 23.5 17.9 2.9 32.4 98 South Sulawesi 0.0 1.0 8.0 7.4 1.1 10.9 258 Southeast Sulawesi 0.5 11.9 16.1 17.8 9.8 27.8 77 Gorontalo 0.8 5.4 12.0 9.5 0.9 16.9 39 West Sulawesi 0.7 2.3 14.5 10.5 2.6 18.9 33 Maluku and Papua Maluku 2.3 13.4 7.0 10.5 2.8 20.7 47 North Maluku 0.4 5.3 9.9 11.3 2.3 15.1 35 West Papua 1.3 4.2 5.5 7.9 1.4 11.7 28 Papua 3.1 19.4 31.7 31.5 9.5 41.4 120 Total 0.8 3.4 11.8 11.9 3.1 17.3 9,306 Appendix A • 309 CHAPTER 14 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Table A-14.1 Care received by mother during pregnancy Among last birth in the two years preceding the survey, according to the report from child’s father, percentage the mother received antenatal checkup, percentage who was born in a hospital or health facility, and among births whose mother received antenatal care, percentage the father was present during the antenatal checkup, according to province, Indonesia 2012 Mother received antenatal checkup Birth born in a hospital or health facility Number of fathers Among births whose mothers were received antenatal checkup Province Father was present during the antenatal checkup Number of fathers Sumatera Aceh 87.9 50.4 48 75.3 42 North Sumatera 93.5 71.2 141 79.6 132 West Sumatera 100.0 61.5 56 72.4 56 Riau 96.3 53.8 72 93.8 69 Jambi 90.8 55.5 40 84.6 36 South Sumatera 94.2 63.4 89 69.2 84 Bengkulu 96.2 42.5 18 89.0 18 Lampung 93.6 67.6 83 89.6 78 Bangka Belitung 95.1 54.1 14 78.6 14 Riau Islands 99.3 78.0 21 88.9 21 Java DKI Jakarta 97.9 95.5 91 96.5 89 West Java 91.8 64.4 410 80.0 377 Central Java 98.7 82.6 286 87.8 283 DI Yogyakarta 98.1 90.2 25 96.7 25 East Java 92.8 87.9 399 76.5 371 Banten 96.9 58.0 111 73.0 107 Bali and Nusa Tenggara Bali 98.7 97.6 34 93.7 34 West Nusa Tenggara 98.9 76.5 57 75.3 56 East Nusa Tenggara 90.9 51.4 55 52.0 50 Kalimantan West Kalimantan 90.1 42.5 43 73.2 39 Central Kalimantan 93.0 37.4 28 70.9 26 South Kalimantan 98.9 38.0 44 96.5 44 East Kalimantan 96.5 65.1 37 82.7 35 Sulawesi North Sulawesi 94.4 59.1 18 62.2 17 Central Sulawesi 92.9 42.1 25 55.8 23 South Sulawesi 95.1 52.6 77 51.4 74 Southeast Sulawesi 90.8 22.7 27 47.0 25 Gorontalo 92.7 58.9 10 62.6 9 West Sulawesi 73.6 22.5 11 47.0 8 Maluku and Papua Maluku 90.1 37.1 16 46.0 14 North Maluku 73.6 22.6 10 51.2 8 West Papua 62.2 35.8 9 80.9 6 Papua 59.4 21.5 38 67.1 23 Total 93.7 67.9 2,445 78.5 2,290 310 • Appendix A Table A-14.2 Preparation for delivery Percentage of last births born in the two years preceding the survey whose father discussed specific topics about delivery, according to province, Indonesia 2012 Percentage of fathers who discussed topics about delivery No topics discussed Number of fathers Province Place to deliver Transportation Delivery assistance Payment Blood donor Any topic Sumatera Aceh 39.0 31.8 41.5 37.2 16.1 44.1 55.9 48 North Sumatera 41.3 14.8 25.1 28.1 5.2 43.2 56.8 141 West Sumatera 47.8 29.4 45.7 40.2 14.4 57.2 42.8 56 Riau 49.1 40.3 50.0 43.5 20.1 52.0 48.0 72 Jambi 31.8 28.1 38.6 32.8 11.5 42.2 57.8 40 South Sumatera 25.3 19.7 23.1 20.0 7.1 26.6 73.4 89 Bengkulu 49.1 34.1 44.3 38.7 24.9 54.2 45.8 18 Lampung 46.1 29.2 47.8 52.1 15.0 57.4 42.6 83 Bangka Belitung 38.1 19.8 34.9 25.2 7.7 42.2 57.8 14 Riau Islands 70.8 45.9 65.2 61.7 3.6 72.7 27.3 21 Java DKI Jakarta 35.1 24.4 33.8 29.5 10.1 40.8 59.2 91 West Java 58.5 52.6 60.2 61.4 24.2 62.3 37.7 410 Central Java 49.8 31.5 55.9 51.2 12.7 67.2 32.8 286 DI Yogyakarta 67.0 34.4 60.3 55.4 12.7 74.7 25.3 25 East Java 43.7 30.9 49.0 39.7 13.3 51.8 48.2 399 Banten 40.6 24.2 41.9 39.6 8.1 50.4 49.6 111 Bali and Nusa Tenggara Bali 61.1 39.7 49.5 59.3 16.2 68.0 32.0 34 West Nusa Tenggara 30.6 24.7 28.1 30.8 18.3 34.5 65.5 57 East Nusa Tenggara 25.4 18.5 21.4 14.6 8.5 25.4 74.6 55 Kalimantan West Kalimantan 23.9 19.6 33.2 28.7 10.6 33.2 66.8 43 Central Kalimantan 47.2 36.7 50.4 44.0 13.8 50.4 49.6 28 South Kalimantan 52.2 43.5 51.0 52.2 28.7 53.5 46.5 44 East Kalimantan 48.8 35.9 55.1 41.2 7.2 57.3 42.7 37 Sulawesi North Sulawesi 28.0 24.3 23.4 21.3 5.6 28.0 72.0 18 Central Sulawesi 36.6 24.4 34.6 33.7 7.2 39.7 60.3 25 South Sulawesi 17.0 8.9 15.4 12.0 1.2 22.3 77.7 77 Southeast Sulawesi 27.6 18.4 28.6 26.3 6.5 33.9 66.1 27 Gorontalo 23.0 12.7 21.4 22.9 10.1 24.6 75.4 10 West Sulawesi 17.8 11.9 24.5 12.9 8.6 25.5 74.5 11 Maluku and Papua Maluku 19.8 8.5 18.0 19.7 5.6 21.1 78.9 16 North Maluku 18.0 14.7 21.7 16.8 11.7 21.7 78.3 10 West Papua 29.0 18.6 31.9 31.1 3.5 39.0 61.0 9 Papua 15.7 14.7 23.9 16.3 4.0 27.9 72.1 38 Total 43.4 31.2 44.4 41.1 13.6 50.5 49.5 2,445 Appendix A • 311 Table A-14.3 Father’s contact with health care provider about wife’s health and pregnancy Percentage of last births in the two years preceding the survey whose father discussed with a health care provider about the health of the mother or the pregnancy, and among these fathers, percentage who discussed specific topics according to province, Indonesia 2012 Talked with health care provider Topics of discussion Number of fathers Province Type of foods she eats during pregnancy How much rest she should have during pregnancy Type of health problems for which she should get immediate medical attention Sumatera Aceh 48.3 39.2 37.7 33.2 48 North Sumatera 54.1 51.3 49.2 48.6 141 West Sumatera 60.1 58.1 51.1 49.5 56 Riau 63.7 59.1 54.8 52.5 72 Jambi 42.2 39.1 40.5 33.3 40 South Sumatera 42.7 27.4 26.0 29.3 89 Bengkulu 66.7 63.1 61.7 61.8 18 Lampung 63.2 60.2 59.3 57.5 83 Bangka Belitung 48.1 38.6 44.0 42.1 14 Riau Islands 77.0 65.1 58.4 71.5 21 Java DKI Jakarta 57.6 55.7 52.5 49.2 91 West Java 64.0 60.3 57.5 57.5 410 Central Java 77.7 70.5 70.4 68.2 286 DI Yogyakarta 79.4 76.3 66.9 58.2 25 East Java 59.3 56.6 51.8 48.3 399 Banten 56.7 52.7 56.2 51.2 111 Bali and Nusa Tenggara Bali 79.1 74.3 74.1 72.8 34 West Nusa Tenggara 42.4 37.4 38.7 36.1 57 East Nusa Tenggara 26.9 24.3 24.4 25.8 55 Kalimantan West Kalimantan 38.8 27.2 26.9 22.2 43 Central Kalimantan 52.0 47.3 42.5 45.8 28 South Kalimantan 59.8 57.1 58.4 58.4 44 East Kalimantan 60.9 52.8 50.4 44.7 37 Sulawesi North Sulawesi 30.1 28.0 30.1 28.0 18 Central Sulawesi 46.2 40.4 32.7 37.8 25 South Sulawesi 28.0 25.7 25.8 26.9 77 Southeast Sulawesi 41.2 29.6 33.5 29.8 27 Gorontalo 27.9 27.9 26.2 24.7 10 West Sulawesi 30.0 24.5 27.2 27.1 11 Maluku and Papua Maluku 30.9 25.4 25.4 25.4 16 North Maluku 23.5 21.8 23.5 21.8 10 West Papua 42.3 31.6 35.0 33.4 9 Papua 34.0 31.0 29.4 27.9 38 Total 57.5 52.8 50.8 49.2 2,445 312 • Appendix A Table A-14.4 Father’s knowledge about amount to drink for children with diarrhea Among last births in the two years preceding the survey, percent distribution of father’s knowledge about the amount of drink to be given when a child has diarrhea, according to province, Indonesia 2012 Amount to drink, when that child has diarrhea Number of fathers Province Nothing to drink Less than usual/much less About the same More Don’t know Missing Total Sumatera Aceh 1.6 9.5 33.8 24.7 20.7 9.8 100.0 48 North Sumatera 0.0 3.8 26.0 63.6 4.6 2.0 100.0 141 West Sumatera 0.0 1.4 32.8 61.2 4.6 0.0 100.0 56 Riau 0.0 5.4 10.7 62.7 19.5 1.7 100.0 72 Jambi 0.0 5.7 29.3 49.6 12.9 2.5 100.0 40 South Sumatera 2.5 3.4 28.8 50.9 12.2 2.2 100.0 89 Bengkulu 1.1 3.3 20.5 59.0 16.2 0.0 100.0 18 Lampung 0.0 4.7 21.1 61.8 8.9 3.5 100.0 83 Bangka Belitung 1.5 1.6 13.5 55.0 19.2 9.2 100.0 14 Riau Islands 0.0 2.5 10.5 73.2 11.3 2.5 100.0 21 Java DKI Jakarta 0.0 0.0 0.8 94.2 4.2 0.7 100.0 91 West Java 1.8 2.9 14.6 61.9 12.4 6.4 100.0 410 Central Java 0.0 3.3 12.7 76.3 6.5 1.3 100.0 286 DI Yogyakarta 0.0 4.6 7.7 83.9 3.8 0.0 100.0 25 East Java 0.0 6.4 22.3 52.3 14.6 4.4 100.0 399 Banten 0.0 3.7 22.0 51.3 23.0 0.0 100.0 111 Bali and Nusa Tenggara Bali 0.0 1.8 7.1 89.9 1.2 0.0 100.0 34 West Nusa Tenggara 0.0 0.0 32.8 53.3 13.9 0.0 100.0 57 East Nusa Tenggara 1.5 14.0 34.6 34.3 15.6 0.0 100.0 55 Kalimantan West Kalimantan 0.0 3.2 38.6 50.0 4.8 3.4 100.0 43 Central Kalimantan 0.0 2.9 27.1 61.4 8.6 0.0 100.0 28 South Kalimantan 0.0 2.5 13.4 79.1 4.9 0.0 100.0 44 East Kalimantan 0.0 3.5 18.4 65.2 12.9 0.0 100.0 37 Sulawesi North Sulawesi 0.0 6.9 10.4 66.9 11.6 4.2 100.0 18 Central Sulawesi 0.0 9.1 30.2 41.2 18.0 1.6 100.0 25 South Sulawesi 0.0 4.5 14.6 39.7 41.2 0.0 100.0 77 Southeast Sulawesi 0.0 7.1 30.4 45.8 16.7 0.0 100.0 27 Gorontalo 1.6 8.1 13.0 54.9 22.4 0.0 100.0 10 West Sulawesi 0.0 1.8 29.1 52.5 14.6 2.0 100.0 11 Maluku and Papua Maluku 1.4 11.3 29.4 35.0 19.9 2.9 100.0 16 North Maluku 3.2 5.4 27.0 20.7 40.3 3.5 100.0 10 West Papua 0.0 3.9 23.6 33.9 25.2 13.5 100.0 9 Papua 4.3 7.3 33.9 8.0 34.5 11.9 100.0 38 Total 0.6 4.3 19.9 59.1 13.1 3.0 100.0 2,445 Appendix A • 313 Table A-14.5 Father’s report on children’s vaccination Among last births in the two years preceding the survey, percentage received vaccination according to father’s report, by type of vaccination, according to province, Indonesia 2012 Vaccination Number of fathers Province BCG Polio DPT Measles Hepatitis Sumatera Aceh 42.9 49.7 39.2 41.5 35.9 48 North Sumatera 80.9 75.8 67.8 57.3 66.1 141 West Sumatera 77.5 76.8 71.6 62.4 68.8 56 Riau 72.6 75.1 64.4 59.9 59.4 72 Jambi 68.6 70.4 65.4 54.7 64.8 40 South Sumatera 79.2 72.5 67.6 68.2 66.9 89 Bengkulu 88.8 93.2 83.8 76.5 82.4 18 Lampung 78.4 72.1 72.8 62.6 67.6 83 Bangka Belitung 79.4 76.8 69.4 61.9 76.3 14 Riau Islands 85.8 93.7 80.7 72.7 75.0 21 Java DKI Jakarta 73.6 81.7 65.3 52.4 74.6 91 West Java 76.1 81.7 66.9 60.9 61.2 410 Central Java 86.6 84.3 74.0 72.8 57.8 286 DI Yogyakarta 85.9 87.2 86.8 73.7 83.3 25 East Java 74.7 76.5 68.6 59.5 62.0 399 Banten 74.9 71.4 67.4 55.6 62.7 111 Bali and Nusa Tenggara Bali 100.0 97.7 90.4 73.8 86.9 34 West Nusa Tenggara 90.9 87.0 81.4 66.0 62.9 57 East Nusa Tenggara 69.9 54.7 46.0 55.2 45.5 55 Kalimantan West Kalimantan 74.1 75.9 63.7 64.4 55.7 43 Central Kalimantan 56.0 64.4 52.8 45.2 45.5 28 South Kalimantan 88.1 86.2 83.2 77.5 70.7 44 East Kalimantan 93.0 93.5 89.9 69.3 77.8 37 Sulawesi North Sulawesi 85.6 87.6 81.9 80.3 80.4 18 Central Sulawesi 78.6 82.2 64.7 63.4 67.5 25 South Sulawesi 74.3 75.4 70.9 54.5 68.3 77 Southeast Sulawesi 79.6 85.5 78.7 72.4 75.6 27 Gorontalo 77.5 72.2 72.5 60.8 74.4 10 West Sulawesi 32.3 32.3 23.4 29.4 20.4 11 Maluku and Papua Maluku 72.9 73.4 62.4 58.8 54.2 16 North Maluku 69.2 68.0 62.1 64.1 65.0 10 West Papua 60.2 51.3 41.8 37.8 36.0 9 Papua 54.5 54.5 48.4 41.1 40.1 38 Total 77.1 77.5 68.5 61.5 62.7 2,445 Appendix B • 315 SURVEY DESIGN Appendix B B.1 INTRODUCTION The primary objective of the 2012 Indonesia Demographic and Health Survey (IDHS) is to provide policymakers and program managers with national- and provincial-level data on representative samples of all women age 15-49 and currently-married men age 15-54. Specifically, the 2012 IDHS was designed to: • estimate demographic rates, particularly fertility and under-5 mortality rates; • measure the level of contraceptive knowledge and practice; • measure key child health indicators including the level of immunizations, the prevalence and treatment of diarrhea and other childhood diseases, and child feeding practices; • assess the coverage of maternity care services; • explore men’s involvement in reproductive health; • provide data on awareness of AIDS/STIs; and • investigate the direct and indirect determinants of maternal and child health. B.2 SAMPLE DESIGN AND IMPLEMENTATION Indonesia is divided into 33 provinces. Each province is subdivided into districts (regency in areas mostly rural and municipality in urban areas). Districts are subdivided into subdistricts, and each subdistrict is divided into villages. The entire village is classified as urban or rural. The 2012 IDHS sample is aimed at providing reliable estimates of key characteristics for women age 15-49 and currently-married men age 15-54 in Indonesia as a whole, in urban and rural areas, and in each of the 33 provinces included in the survey. To achieve this objective, a total of 1,840 census blocks (CBs)—874 in urban areas and 966 in rural areas—were selected from the list of CBs in the selected primary sampling units formed during the 2010 population census. Because the sample was designed to provide reliable indicators for each province, the number of CBs in each province was not allocated in proportion to the population of the province or its urban-rural classification. Therefore, a final weighing adjustment procedure was done to obtain estimates for all domains. A minimum of 43 CBs per province was imposed in the 2012 IDHS design. 316 • Appendix B The 2012 IDHS sample is stratified by province and urban-rural areas. The selected CBs were allocated to each stratum using the square root formula allocations as follows: n m m n k 1h h h h ×=  = Where nh: sample size of census block strata-h mh: sample size of household strata h n: the target sample census block, and k: number of allocated domains The allocation of census blocks and households in each province by urban and rural areas is presented in Table B.1.1. Table B.1.1 Sample allocation by province Province Census blocks Households Urban Rural Total Urban Rural Total Sumatera DI Aceh 21 33 54 525 825 1350 North Sumatera 31 38 69 775 950 1725 West Sumatera 24 30 54 600 750 1350 Riau 23 31 54 575 775 1350 Jambi 16 27 43 400 675 1075 South Sumatera 21 33 54 525 825 1350 Bengkulu 15 28 43 375 700 1075 Lampung 18 36 54 450 900 1350 Bangka Belitung 22 21 43 550 525 1075 Riau Islands 28 15 43 700 375 1075 Java DKI Jakarta 90 0 90 2250 0 2250 West Java 57 37 94 1425 925 2350 Central Java 41 43 84 1025 1075 2100 DI Yogyakarta 45 29 74 1125 725 1850 East Java 41 43 84 1025 1075 2100 Banten 48 27 75 1200 675 1875 Bali and Nusa Tenggara Bali 38 30 68 950 750 1700 West Nusa Tenggara 25 29 54 625 725 1350 East Nusa Tenggara 13 30 43 325 750 1075 Kalimantan West Kalimantan 20 34 54 500 850 1350 Central Kalimantan 17 26 43 425 650 1075 South Kalimantan 24 30 54 600 750 1350 East Kalimantan 24 19 43 600 475 1075 Sulawesi North Sulawesi 23 31 54 575 775 1350 Central Sulawesi 15 28 43 375 700 1075 South Sulawesi 27 42 69 675 1050 1725 Southeast Sulawesi 15 28 43 375 700 1075 Gorontalo 17 26 43 425 650 1075 West Sulawesi 14 29 43 350 725 1075 Maluku and Papua Maluku 17 26 43 425 650 1075 North Maluku 15 28 43 375 700 1075 West Papua 17 27 44 425 675 1100 Papua 12 32 44 300 800 1100 Total 874 966 1840 21850 24150 46000 Appendix B • 317 In each CB, a complete household listing and mapping was conducted in April 2012. The complete list of households in each CB is the basis for the second-stage sampling. An average of 25 households was selected systematically from each CB. All women age 15-49 were eligible for interview in the IDHS, and all never-married men age 15-24 were eligible to be interviewed in the ARH component of the IDHS. Eight households were selected systematically from the 25 households for the men’s survey. In these households, all currently married men age 15-54 were eligible for individual interview. The expected number of women age 15-49 and currently married men age 15-54 are shown in Table B.1.2. Table B.1.2 Expected number of respondents by province Province Women 15-49 Currently married men 15-54 Urban Rural Total Urban Rural Total Sumatera DI Aceh 630 990 1620 151 238 389 North Sumatera 930 1140 2070 223 274 497 West Sumatera 720 900 1620 173 216 389 Riau 690 930 1620 166 223 389 Jambi 480 810 1290 115 194 310 South Sumatera 630 990 1620 151 238 389 Bengkulu 450 840 1290 108 202 310 Lampung 540 1080 1620 130 259 389 Bangka Belitung 660 630 1290 158 151 310 Riau Islands 840 450 1290 202 108 310 Java DKI Jakarta 2700 0 2700 648 0 648 West Java 1710 1110 2820 410 266 677 Central Java 1230 1290 2520 295 310 605 DI Yogyakarta 1350 870 2220 324 209 533 East Java 1230 1290 2520 295 310 605 Banten 1440 810 2250 346 194 540 Bali and Nusa Tenggara Bali 1140 900 2040 274 216 490 West Nusa Tenggara 750 870 1620 180 209 389 East Nusa Tenggara 390 900 1290 94 216 310 Kalimantan West Kalimantan 600 1020 1620 144 245 389 Central Kalimantan 510 780 1290 122 187 310 South Kalimantan 720 900 1620 173 216 389 East Kalimantan 720 570 1290 173 137 310 Sulawesi North Sulawesi 690 930 1620 166 223 389 Central Sulawesi 450 840 1290 108 202 310 South Sulawesi 810 1260 2070 194 302 497 Southeast Sulawesi 450 840 1290 108 202 310 Gorontalo 510 780 1290 122 187 310 West Sulawesi 420 870 1290 101 209 310 Maluku and Papua Maluku 510 780 1290 122 187 310 North Maluku 450 840 1290 108 202 310 West Papua 510 810 1320 122 194 317 Papua 360 960 1320 86 230 317 Total 26220 28980 55200 6293 6955 13248 Results of the household sample implementation by urban-rural residence, by province as well as by male and female subsample, are shown in Tables B.2.1 to B.3.3. As shown in Table B.2.1, 46,024 households were selected for the 2012 IDHS. Of these, 99 percent were successfully interviewed; 2 percent were not interviewed because they were vacant, and 2 percent were away during the survey fieldworkers’ visit. Other reasons for not interviewing households include having no competent respondent in the household, the dwelling was not found, or the dwelling had been destroyed. The level of successful household interviews varies little across provinces (Table B.2.2). 318 • Appendix B Table B.2.3 presents the survey coverage for interviews of women. Of 47,533 women eligible for individual interview, 96 percent were successfully interviewed and 2 percent were not interviewed because they were not at home. Urban women were as likely as rural women to be interviewed in the survey. The response rates varied by province, ranging from 86 percent in West Papua to 99 percent in Bangka Belitung. Table B.2.1 Sample implementation: Women Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall women response rates, according to urban- rural residence (unweighted), Indonesia 2012 Residence Total Result Urban Rural Selected households Completed (C) 94.7 95.8 95.3 Household present but no competent respondent at home (HP) 0.6 0.5 0.6 Refused (R) 0.3 0.1 0.2 Dwelling not found (DNF) 0.3 0.1 0.2 Household absent (HA) 2.2 2.1 2.1 Dwelling vacant/address not a dwelling (DV) 1.3 0.9 1.1 Dwelling destroyed (DD) 0.2 0.2 0.2 Other (O) 0.4 0.3 0.3 Total 100.0 100.0 100.0 Number of sampled households 22,039 23,985 46,024 Household response rate (HRR)1 98.8 99.2 99.0 Eligible women Completed (EWC) 95.6 96.3 95.9 Not at home (EWNH) 2.3 2.1 2.2 Postponed (EWP) 0.1 0.0 0.1 Refused (EWR) 1.0 0.5 0.8 Partly completed (EWPC) 0.2 0.2 0.2 Incapacitated (EWI) 0.5 0.7 0.6 Other (EWO) 0.3 0.2 0.2 Total 100.0 100.0 100.0 Number of women 23,949 23,584 47,533 Eligible women response rate (EWRR)2 95.6 96.3 95.9 Overall women response rate (OWRR)3 94.4 95.5 95.0 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ——————————— C + HP + P + R + DNF 2 The eligible women response rate (EWRR) is equivalent to the percentage of interviews completed (EWC). 3 The overall women response rate (OWRR) is calculated as: OWRR = HRR * EWRR/100 Appendix B • 319 Table B.2.2 Sample implementation: result of household interview: Women Percent distribution of households and eligible women by results of the household interview and household response rate, according to urban-rural residence and province, Indonesia 2012 Selected households Total Number of sampled households Household response rate (HRR)1 Residence and province Completed (C) No competent respondent at home (HP) Postponed (P) Refused (R) Dwelling not found (DNF) Household absent (HA) Dwelling vacant/ address not a dwelling (DV) Dwelling destroyed (DD) Other (O) Residence Urban 94.7 0.6 0.0 0.3 0.3 2.2 1.3 0.2 0.4 100.0 22,039 98.8 Rural 95.8 0.5 0.0 0.1 0.1 2.1 0.9 0.2 0.3 100.0 23,985 99.2 Sumatera Aceh 94.3 1.2 0.1 0.1 0.1 3.0 0.6 0.1 0.4 100.0 1,359 98.4 North Sumatera 97.2 0.1 0.0 0.2 0.0 1.0 1.1 0.1 0.3 100.0 1,743 99.8 West Sumatera 95.7 0.7 0.0 0.3 0.1 1.9 1.0 0.2 0.1 100.0 1,351 98.9 Riau 94.7 0.6 0.0 0.1 0.4 1.3 2.5 0.1 0.2 100.0 1,350 98.9 Jambi 97.1 0.1 0.0 0.0 0.1 2.0 0.2 0.4 0.2 100.0 1,076 99.8 South Sumatera 96.3 0.7 0.0 0.1 0.0 1.5 1.0 0.1 0.2 100.0 1,350 99.1 Bengkulu 94.8 1.4 0.0 0.1 0.0 2.2 0.7 0.3 0.5 100.0 1,076 98.5 Lampung 97.3 0.1 0.0 0.1 0.0 1.6 0.9 0.0 0.0 100.0 1,354 99.8 Bangka Belitung 97.8 0.2 0.0 0.0 0.1 0.8 0.8 0.0 0.3 100.0 1,075 99.7 Riau Islands 93.8 0.6 0.0 0.4 0.2 1.9 2.5 0.4 0.2 100.0 1,083 98.7 Java Jakarta 92.7 1.4 0.0 0.7 0.3 3.0 0.9 0.3 0.7 100.0 2,284 97.5 West Java 95.5 0.2 0.0 0.0 0.0 2.5 1.1 0.3 0.4 100.0 2,371 99.7 Central Java 97.5 0.3 0.0 0.0 0.0 1.1 0.7 0.3 0.0 100.0 2,117 99.7 Yogyakarta 96.5 0.5 0.0 0.1 0.1 1.3 1.0 0.1 0.4 100.0 1,856 99.4 East Java 98.1 0.1 0.0 0.0 0.1 0.7 0.7 0.1 0.1 100.0 2,106 99.8 Banten 96.3 0.2 0.0 0.0 0.6 0.5 2.0 0.3 0.2 100.0 1,881 99.2 Bali and Nusa Tenggara Bali 96.2 0.2 0.0 0.2 0.0 2.1 0.9 0.1 0.3 100.0 1,701 99.6 West Nusa Tenggara 96.4 0.1 0.0 0.0 0.2 1.2 1.4 0.4 0.1 100.0 1,362 99.6 East Nusa Tenggara 96.9 0.5 0.0 0.0 0.3 1.3 0.7 0.2 0.1 100.0 1,080 99.2 Kalimantan West Kalimantan 93.1 0.7 0.0 0.2 0.6 3.7 1.0 0.1 0.7 100.0 1,350 98.4 Central Kalimantan 92.8 1.2 0.0 0.3 0.2 3.5 1.3 0.0 0.7 100.0 1,076 98.2 South Kalimantan 96.3 0.2 0.0 0.1 0.0 2.1 1.2 0.1 0.0 100.0 1,368 99.7 East Kalimantan 90.3 1.0 0.0 0.7 0.9 3.8 2.9 0.3 0.0 100.0 1,076 97.1 Sulawesi North Sulawesi 95.9 0.5 0.0 0.2 0.1 1.5 1.4 0.1 0.4 100.0 1,377 99.2 Central Sulawesi 96.3 0.4 0.0 0.1 0.0 2.1 0.5 0.3 0.4 100.0 1,078 99.5 South Sulawesi 94.7 1.3 0.0 0.2 0.2 1.5 0.8 0.2 1.2 100.0 1,724 98.3 Southeast Sulawesi 95.8 0.3 0.0 0.1 0.2 2.3 1.0 0.1 0.2 100.0 1,075 99.4 Gorontalo 94.6 0.4 0.0 0.2 0.0 3.3 0.5 0.0 0.9 100.0 1,113 99.3 West Sulawesi 94.2 1.7 0.0 0.0 0.0 3.8 0.1 0.2 0.0 100.0 1,072 98.2 Maluku and Papua Maluku 96.2 0.4 0.0 0.1 0.2 2.2 0.7 0.0 0.2 100.0 1,075 99.3 North Maluku 89.9 1.8 0.1 0.0 0.6 4.5 3.1 0.0 0.2 100.0 1,077 97.4 West Papua 89.1 1.0 0.0 1.3 0.9 4.4 1.0 0.8 1.3 100.0 1,063 96.4 Papua 93.5 0.1 0.0 1.3 0.3 3.7 0.9 0.0 0.2 100.0 925 98.2 Total 95.3 0.6 0.0 0.2 0.2 2.1 1.1 0.2 0.3 100.0 46,024 99.0 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C —————————— C + HP + P + R + DNF 320 • Appendix B Table B.2.3 Sample implementation: result of individual interview: Women Percent distribution of eligible women by results of the individual interview, and eligible women and overall response rates, according to urban-rural residence and province , Indonesia 2012 Residence and province Eligible women Total Number of women Eligible women response rate (EWRR)1 Overall women response rate (ORR)2 Completed (EWC) Not at home (EWNH) Postponed (EWP) Refused (EWR) Partly completed (EWPC) Incapaci- tated (EWI) Other (EWO) Residence Urban 95.6 2.3 0.1 1.0 0.2 0.5 0.3 100.0 23,949 95.6 94.4 Rural 96.3 2.1 0.0 0.5 0.2 0.7 0.2 100.0 23,584 96.3 95.5 Sumatera Aceh 94.7 2.0 0.2 1.9 0.3 0.7 0.2 100.0 1,513 94.7 93.2 North Sumatera 97.9 0.7 0.0 0.4 0.3 0.7 0.1 100.0 1,870 97.9 97.6 West Sumatera 96.0 1.7 0.0 1.3 0.0 0.9 0.1 100.0 1,395 96.0 94.9 Riau 96.9 1.4 0.1 0.8 0.0 0.8 0.1 100.0 1,431 96.9 95.8 Jambi 97.9 0.7 0.0 0.5 0.2 0.7 0.0 100.0 1,136 97.9 97.7 South Sumatera 97.5 0.9 0.0 0.9 0.0 0.6 0.1 100.0 1,369 97.5 96.6 Bengkulu 95.7 2.4 0.1 0.9 0.2 0.6 0.2 100.0 1,042 95.7 94.2 Lampung 98.5 0.7 0.0 0.4 0.0 0.3 0.1 100.0 1,375 98.5 98.3 Bangka Belitung 99.0 0.1 0.0 0.3 0.0 0.5 0.1 100.0 1,106 99.0 98.7 Riau Islands 95.3 2.3 0.0 1.3 0.5 0.4 0.3 100.0 1,09