Jordan - Demographic and Health Survey - 2003

Publication date: 2003

2002Population andFamily Health Survey J o r d a n 2 0 0 2 P o p u l a t i o n a n d F a m i l y H e a l t h S u r v e y Jordan World Summit for Children Indicators, Jordan 2002 Childhood mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Family planning Antenatal care Delivery care Low birth weight Exclusive breastfeeding Continued breastfeeding Timely complementary feeding Vaccinations Oral rehydration therapy (ORT) Home management of diarrhea Treatment of ARI Children in especially difficult situations HIV/AIDS Infant mortality rate Under-five mortality rate Percent stunted (children under 5 years) Percent wasted (children under 5 years) Percent underweight (children under 5 years) Percent of households with safe water supply1 Percent of households with flush toilets, pit toilet/latrine Contraceptive prevalence rate (any method, currently married women) Percent of women who received antenatal care from a health professional2 Percent of births in the 5 years preceding the survey attended by a health professional Percent of births in the 5 years preceding the survey at low birth weight3 Percent of youngest children under 6 months who are exclusively breastfed Percent of children age 12-15 months still breastfeeding Percent of children age 20-23 months still breastfeeding Percent of youngest children age 6-9 months receiving breast milk and complementary foods Percent of children age 12-23 months with BCG vaccination Percent of children age 12-23 months with at least 3 DPT vaccinations Percent of children age 12-23 months with at least 3 polio vaccinations Percent of children age 12-23 months with measles vaccination Percent of mothers who received at least 2 tetanus toxoid vaccinations during pregnancy2 Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the survey who received oral rehydration therapy (ORT) Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the interview who took more fluids than usual and continued eating somewhat less, the same or more food Percent of children age 0-59 months with acute respiratory infection (ARI) in the 2 weeks preceding the survey who were taken to a health provider Percent of children with at least one parent dead4 Percent of children who do not live with either biological parent4 Percent of ever-married women age 15-49 who correctly stated 2 ways of avoiding HIV infection5 Percent of ever-married women age 15-49 who correctly identified 2 misconceptions about HIV/AIDS6 Percent of ever-married women age 15-49 who believe that AIDS can be transmitted from mother to child during pregnancy, delivery and breastfeeding 22 per 1,000 27 per 1,000 8.5 2.0 4.4 95.1 99.9 55.8 98.6 99.5 10.6 26.7 51.1 12.4 70.3 28.8 98.2 97.6 95.2 9.0 22.0 38.4 71.7 2.7 0.5 29.7 13.6 33.8 1 Piped water, tanker truck, or bottled water 2 For the last live birth in the five years preceding the survey 3 For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 4 Based on de jure children 5 Having sex with only one partner who has no other partners and using a condom every time they have sex 6They say that AIDS cannot be transmitted through mosquito bites and that a healthy-looking person can have the AIDS virus. THE HASHEMITE KINGDOM OF JORDAN Jordan Population and Family Health Survey 2002 Department of Statistics Amman, Jordan ORC Macro Calverton, Maryland, USA June 2003 Department of Statistics ORC Macro This report summarizes the findings of the 2002 Jordan Population and Family Health Survey (JPFHS) carried out by the Department of Statistics (DOS). ORC Macro provided technical assistance and the U.S. Agency for International Development (USAID) provided financial support. The JPFHS is part of the worldwide Demographic and Health Surveys Program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Jordan survey may be obtained from the Department of Statistics, P.O. Box 2015, Amman 11181, Jordan (telephone: (962) 6-5-300-700; fax: (962) 6-5-300-710; e-mail: stat@dos.gov.jo; internet: www.dos.gov.jo). Additional information about the MEASURE DHS+ program may be obtained from ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@orcmacro.com; internet: www.measuredhs.com). Suggested citation: Department of Statistics [Jordan] and ORC Macro. 2003. Jordan Population and Family Health Survey 2002. Calverton, Maryland, USA: Department of Statistics and ORC Macro. CONTRIBUTORS DEPARTMENT OF STATISTICS Fathi Nsour Fahad Hiyari Ikhlas Aranki Wajdi Akeel Mohamed Arabiat UNIVERSITY OF JORDAN Issa Masarwah ORC MACRO Kiersten Johnson Jasbir Saggu Bernard Barrère CONTENTS Page Tables and Figures .ix Preface .xv Summary and Recommendations . xvii Map of Jordan . xxii CHAPTER 1 INTRODUCTION 1.1 History, Geography, 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 Methodology and Organization of the Survey . 4 1.6.1 Sample Design. 5 1.6.2 Updating of Sampling Frame . 5 1.6.3 Questionnaires . 5 1.6.4 Recruitment of Staff . 6 1.6.5 Training and Pretest . 6 1.6.6 Main Fieldwork . 6 1.6.7 Data Processing . 7 1.7 Results of the Household and Individual Interviews. 7 CHAPTER 2 HOUSEHOLD CHARACTERISTICS 2.1 Population by Age and Sex . 9 2.2 Population by Age from Other Sources . 11 2.3 Household Size. 12 2.4 Level of Education of the Household Population. 13 2.5 School Attendance. 15 2.6 Housing Characteristics . 16 2.7 Presence of Durable Goods in the Household. 17 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3.1 General Characteristics . 19 3.2 Respondents’ Level of Education. 20 3.3 Exposure to Jordanian Mass Media. 21 Contents | v Page 3.4 Respondents’ Employment Characteristics . 23 3.4.1 Employment Status . 23 3.4.2 Occupation . 24 3.4.3 Decision on Use of Women’s Earnings. 26 3.5 Women’s Participation in Household Decisionmaking . 27 3.6 Domestic Violence: Women’s Attitudes toward Wife Beating. . 29 3.7 Women’s Agreement with Reasons for Refusing Sexual Relations. 32 CHAPTER 4 FERTILITY 4.1 Fertility Levels and Trends. 35 4.2 Children Ever Born . 40 4.3 Birth Intervals. 41 4.4 Age at First Birth . 42 4.5 Teenage Fertility . 44 CHAPTER 5 FERTILITY REGULATION 5.1 Knowledge of Family Planning Methods. 45 5.2 Ever Use of Contraception . 46 5.3 Current Use of Contraception . 47 5.4 Current use by Women’s Status . 50 5.5 Number of Children at First Use of Contraception . 51 5.6 Knowledge of the Fertile Period . 52 5.7 Timing of Sterilization . 53 5.8 Source of Supply for Modern Methods. 54 5.9 Informed Choice. 55 5.10 Contraceptive Discontinuation. 57 5.11 Reasons for Not Using and Future Use of Family Planning. 59 5.12 Exposure to Family Planning Messages . 62 5.13 Contact of Nonusers with Family Planning Providers . 63 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY 6.1 Current Marital Status . 65 6.2 Polygyny . 67 6.3 Consanguinity . 68 6.4 Age at First Marriage . 69 6.5 Recent Sexual Activity. 70 6.6 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility . 72 6.7 Menopause. 74 vi | Contents Page CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Children . 75 7.2 Need for Family Planning Services . 78 7.3 Ideal Number of Children . 80 7.4 Planning Status of Births. 82 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends . 86 8.2 Differentials in Infant and Child Mortality. 88 8.3 Perinatal Mortality . 90 8.4 High-risk Fertility Behavior . 92 CHAPTER 9 MATERNAL AND CHILD HEALTH 9.1 Maternal Health. 95 9.2 Delivery . 99 9.3 Postnatal Care and Practices . 105 9.4 Problems in Accessing Health Care . 107 9.5 Smoking Tobacco . 108 9.6 Premarital Medical Examinations . 109 9.7 Breast Cancer Examinations . 109 9.8 Vaccination Coverage . 110 9.9 Acute Respiratory Infection and Fever. 116 9.10 Prevalence of Diarrhea . 118 CHAPTER 10 NUTRITIONAL STATUS, PREVALENCE OF ANEMIA, AND MICRONUTRIENT SUPPLEMENTATION 10.1 Breastfeeding and Supplementation. 123 10.2 Nutritional Status of Children. 131 10.3 Micronutrient Status. 136 CHAPTER 11 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS 11.1 Knowledge of HIV/AIDS and Methods of HIV Prevention. 143 11.2 Social Aspects of HIV/AIDS . 149 11.3 Knowledge of Symptoms of Sexually Transmitted Infections. 150 11.4 Knowledge and Use of Condoms . 151 Contents | vii viii | Contents Page References . 153 APPENDIX A SAMPLE DESIGN A.1 Objectives of the Sample Design. 155 A.2 Sample Frame. 155 A.3 Stratification. 155 A.4 Sample Allocation . 156 A.5 Sample Implementation. 157 A.6 Sample Selection . 159 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 161 APPENDIX C DATA QUALITY TABLES. 171 APPENDIX D QUESTIONNAIRES . 177 TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 7 CHAPTER 2 HOUSEHOLD CHARACTERISTICS Table 2.1 Household population by age, residence, and sex . 10 Table 2.2 Household composition. 12 Table 2.3 Children’s living arrangements and orphanhood . 13 Table 2.4 Educational attainment of household population . 14 Table 2.5 Age-specific attendance rates. 16 Table 2.6 Housing characteristics . 17 Table 2.7 Household durable goods. 18 Figure 2.1 Male and female population by single year of age. 9 Figure 2.2 Population pyramid of Jordan . 11 Figure 2.3 Population by broad age groups, various surveys, 1976-2002 . 11 Figure 2.4 Age-specific attendance rates. 15 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS Table 3.1 Background characteristics of respondents . 20 Table 3.2 Educational attainment of women by background characteristics . 21 Table 3.3 Exposure to Jordanian mass media. 22 Table 3.4 Employment status. 24 Table 3.5 Occupation . 25 Table 3.6 Decision on use of earnings and contribution of earnings to household expenditures. 26 Table 3.7 Women’s participation in decisionmaking . 27 Table 3.8 Women’s participation in decisionmaking by background characteristics . 28 Table 3.9 Women’s attitude toward wife beating . 31 Table 3.10 Women’s attitude toward refusing sex with husband . 33 Figure 3.1 Distribution of women according to the number of decisions in which they participate in the final say . 29 Figure 3.2 Percentage of women who agree with at least one reason justifying a husband beating his wife. 32 Tables and Figures | ix Page CHAPTER 4 FERTILITY Table 4.1 Trends in fertility. 36 Table 4.2 Current fertility . 37 Table 4.3 Fertility by background characteristics. 38 Table 4.4 Trends in age-specific fertility rates . 40 Table 4.5 Children ever born and living. 41 Table 4.6 Birth intervals. 42 Table 4.7 Age at first birth . 43 Table 4.9 Median age at first birth by background characteristics. 43 Table 4.9 Teenage fertility . 44 Figure 4.1 Trends in age-specific fertility rates, various sources, 1976-2002. 37 Figure 4.2 Age-specific fertility rates by urban-rural residence. 38 Figure 4.3 Total fertility rates and percentage of women currently pregnant by educational level attended. 39 CHAPTER 5 FERTILITY REGULATION Table 5.1 Knowledge of contraceptive methods . 45 Table 5.2 Ever use of contraception . 46 Table 5.3 Current use of contraception . 47 Table 5.4 Current use of contraception by background characteristics . 49 Table 5.5 Current use of contraception by women’s status . 51 Table 5.6 Number of children at first use of contraception . 52 Table 5.7 Knowledge of fertile period. 52 Table 5.8 Timing of sterilization . 53 Table 5.9 Approval of sterilization . 54 Table 5.10 Source of contraception. 55 Table 5.11 Informed choice . 56 Table 5.12 First-year contraceptive discontinuation rates. 58 Table 5.13 Reasons for discontinuation . 59 Table 5.14 Reasons for not using contraception. 60 Table 5.15 Future use of contraception . 61 Table 5.16 Reasons for not intending to use contraception. 61 Table 5.17 Preferred method of contraception for future use . 62 Table 5.18 Exposure to family planning messages. 63 Table 5.19 Contact of nonusers with family planning providers . 64 Figure 5.1 Current use of contraception among currently married women, 1990-2002 .48 Figure 5.2 Current use of contraception among currently married women by background characteristics .50 Figure 5.3 Sources of family planning methods among current users of modern methods .55 Figure 5.4 Contraceptive discontinuation rates by reason and method .58 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY Table 6.1 Trends in the proportion of ever-married women by age group . 65 Table 6.2 Current marital status. 66 x | Tables and figures Page Table 6.3 Number of cowives . 67 Table 6.4 Consanguinity. 68 Table 6.5 Age at first marriage . 69 Table 6.6 Median age at first marriage. 70 Table 6.7 Recent sexual activity. 71 Table 6.8 Postpartum amenorrhea, abstinence, and insusceptibility . 72 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 73 Table 6.10 Menopause . 74 Figure 6.1 Distribution of never-married women 15-39 by age group, various surveys, 1976-2002 . 66 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children. 76 Table 7.2 Desire to limit childbearing. 77 Table 7.3 Preferred sex of future child. 78 Table 7.4 Need for family planning . 79 Table 7.5 Ideal number of children . 81 Table 7.6 Mean ideal number of children by background characteristics . 82 Table 7.7 Fertility planning status . 83 Table 7.8 Wanted fertility rates . 84 Figure 7.1 Fertility preferences of currently married women 15-49. 76 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates. 86 Table 8.2 Early childhood mortality by background characteristics. 88 Table 8.3 Early childhood mortality by demographic characteristics. 89 Table 8.4 Perinatal mortality . 91 Table 8.5 High-risk fertility behavior. 93 Figure 8.1 Trends in infant and child mortality by five-year periods . 87 Figure 8.2 Trends in infant and child mortality, 1978-2002 . 87 Figure 8.3 Infant mortality by demographic characteristics. 90 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care . 96 Table 9.2 Number of antenatal care visits and timing of first visit . 97 Table 9.3 Components of antenatal care . 98 Table 9.4 Tetanus toxoid injections . 99 Table 9.5 Place of delivery . 100 Table 9.6 Assistance during delivery . 102 Table 9.7 Delivery characteristics . 103 Table 9.8 Payment for delivery. 104 Table 9.9 Reasons for no postnatal check . 106 Tables and Figures | xi Page Table 9.10 Problems in accessing health care . 107 Table 9.11 Use of smoking tobacco. 108 Table 9.12 Premarital medical examinations . 109 Table 9.13 Breast cancer examinations. 110 Table 9.14 Vaccinations by source of information . 111 Table 9.15 Vaccinations of children 12-23 months by background characteristics . 113 Table 9.16 Vaccinations in first year of life. 114 Table 9.17 Vaccinations of children 24-59 months by background characteristics .115 Table 9.18 Prevalence and treatment of symptoms of acute respiratory infection (ARI) and fever .117 Table 9.19 Prevalence of diarrhea .119 Table 9.20 Knowledge of ORS packets .120 Table 9.21 Diarrhea treatment .121 Figure 9.1 Place of delivery .101 Figure 9.2 Postnatal care by timing of first postnatal checkup .105 Figure 9.3 Percentage of children vaccinated by 12-23 months of age.112 Figure 9.4 Percentage of children under five years with symptoms of ARI, fever, and diarrhea in the two weeks preceding the survey.118 CHAPTER 10 NUTRITIONAL STATUS, PREVALENCE OF ANEMIA, AND MICRONUTRIENT SUPPLEMENTATION Table 10.1 Initial breastfeeding .124 Table 10.2 Breastfeeding status by child’s age .126 Table 10.3 Median duration and frequency of breastfeeding.127 Table 10.4 Foods consumed by children in the day or night preceding the interview .128 Table 10.5 Frequency of foods consumed by children in the day or night preceding the interview .129 Table 10.6 Frequency of foods consumed by children in preceding seven days .130 Table 10.7 Nutritional status of children.133 Table 10.8 Nutritional status of women by background characteristics.135 Table 10.9 Prevalence of anemia in children.137 Table 10.10 Prevalence of anemia in women.139 Table 10.11 Prevalence of anemia in children by anemia status of mother .140 Table 10.12 Intake of iron supplements during pregnancy.141 Table 10.13 Intake of fruits and vegetables rich in vitamin A among children .142 Figure 10.1 Nutritional status of children by age. 134 Figure 10.2 Prevalence of anemia in children and women . 140 CHAPTER 11 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS Table 11.1 Knowledge of HIV/AIDS . 144 Table 11.2 Knowledge of ways to avoid HIV/AIDS . 145 Table 11.3 Knowledge of programmatically important ways to avoid HIV/AIDS. 146 Table 11.4 Knowledge of HIV/AIDS-related issues. 148 Table 11.5 Discussion of HIV/AIDS with husband . 149 Table 11.6 Social aspects of HIV/AIDS . 150 Table 11.7 Knowledge of symptoms of STIs. 151 xii | Tables and figures Tables and Figures | xiii Page Table 11.8 Knowledge of source for male condoms . 152 Table 11.9 Use of condoms . 152 Figure 11.1 Knowledge of at least one programmatically important way to avoid HIV/AIDS . 147 APPENDIX A SAMPLE DESIGN Table A.1 Proportional allocation and final allocation by governorate . 157 Table A.2 Sample implementation. 158 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 163 Table B.2 Sampling errors for selected variables, total sample . 164 Table B.3 Sampling errors for selected variables, urban area sample . 165 Table B.4 Sampling errors for selected variables, rural area sample . 166 Table B.5 Sampling errors for selected variables, Central region sample. 167 Table B.6 Sampling errors for selected variables, North region sample . 168 Table B.7 Sampling errors for selected variables, South region sample . 169 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 171 Table C.2 Age distribution of eligible and interviewed women. 172 Table C.3 Completeness of reporting . 172 Table C.4 Births by calendar years . 173 Table C.5 Reporting of age at death in days . 174 Table C.6 Reporting of age at death in months . 175 PREFACE The Department of Statistics (DOS) takes pleasure in presenting the principal report of the 2002 Jordan Population and Family Health Survey (JPFHS), which was conducted during July through September 2002. Like the previous two JPFHS, conducted in 1990 and 1997, the 2002 JPFHS was carried out by DOS in collaboration with ORC Macro, who provided technical assistance through the worldwide Demographic and Health Surveys (DHS) program. The 2002 JPFHS received financial assistance from the United States Agency for International Development (USAID) mission in Amman. The main objective of the survey is to provide comprehensive data on fertility, mortality, family planning, as well as maternal and child health and nutrition, as main tools to evaluate existing population and health policies and programs. The survey covered a national sample of 8,000 households, in which about 6,000 ever-married women age 15 to 49 were interviewed. The sample has been designed to produce estimates of major survey variables at the national level, urban and rural areas, the three regions, and each of the three major governorates, namely Amman, Irbid and Zarqa. The DOS would like to express its thanks and appreciation to the individuals and organizations that contributed to the success of the survey. The timely and high quality data are the result of hard work from all the survey staff. The cooperation of all households interviewed during the survey for their time and willingness to provide the required information is highly appreciated. Acknowledgement also goes to the Ministry of Health for its technical and logistic assistance. Thanks are also due to the USAID mission in Amman for its financial support and technical input, and to the ORC Macro team for its valuable assistance in all stages of the survey. Special thanks are also due to the local and international experts who prepared the present report. The DOS hopes that the 2002 JPFHS results will benefit planners, policymakers and decision- makers in formulating population and health programs in general and maternal and child health programs in particular. Dr. Hussein Shakhatreh Director General of Statistics Preface | xv SUMMARY AND RECOMMENDATIONS The 2002 Jordan Population and Family Health Survey (JPFHS) is a nationally representative survey in which 7,825 households and a total of 6,006 ever-married women between the ages of 15 and 49 were successfully interviewed. The survey was fielded between July and September 2002. This survey is the third in a series of Demographic and Health Surveys (DHS) in Jor- dan carried out by the Department of Statistics. The DHS project of ORC Macro provided tech- nical assistance under a contract funded by the United States Agency for International Devel- opment (USAID). The JPFHS was designed to provide information on levels and trends of fertility, fertility prefer- ences, infant and child mortality, and family planning. The survey also gathered information on breastfeeding, maternal and child health care, knowledge of HIV/AIDS, as well as the charac- teristics of households and household members. Anthropometry measurements and blood sam- ples for anemia testing were collected from women and children under five. Survey results are representative at the national level, by urban and rural residence, and for each of the three regions in the country. Results of this survey can be compared with those of previous demo- graphic surveys, including the 1976 Jordan Fer- tility Survey, the 1983 Jordan Fertility and Fam- ily Health Survey and the 1990 and 1997 JPFHS. Results can be used by program manag- ers and policy makers to evaluate and improve existing programs. CURRENT STATUS AND PROGRESS Fertility • The JPFHS indicates that fertility con- tinues to decline in Jordan. The total fertility rate for the five-year period prior to the survey indi- cates that on average, women have 3.7 children by the end of their reproductive years – fifty percent fewer children than the rate recorded in 1976 (7.4 children per woman). Fertility de- clined most rapidly between 1990 and 1997; while fertility has continued to fall in recent years, its pace of decline has slowed since 1997, when the TFR was 4.4. • Fertility levels vary across regions. The total fertility rate in the Central region is 3.5 births per woman, while women in the North and South re- gions have about 4 children per woman. • There has been a reduction in childbearing in adolescence; currently the overall level of child- bearing among married women age 15-19 is 4 per- cent, a 33 percent reduction in teenage childbearing from 6 percent in 1997. • There are large differences in fertility by educational attainment of women. Women who have attended higher than secondary education have the fewest children in their lifetime (3.1), while women with preparatory education have 4.4 children – more than women with no education, who have an average of 3.6 children. • Although fertility has declined significantly in Jordan over the past twenty-five years, still further decline in fertility can be expected in the future. Al- most half (44 percent) of currently married women in Jordan do not want any more children or have been sterilized, and 31 percent want to delay their next birth for at least two years. If women’s desired family size were achieved, the fertility rate would be only 2.6 children per woman, which is about one child less than the observed rate. Family Planning • Increased use of family planning, especially modern methods, has played a major role in fertility decline. Widespread knowledge of family planning is also supportive of further fertility decline. In Jor- dan, all ever-married women know at least one method of contraception, and on average, an ever- married woman knows about 10 family planning methods. Summary and Recommendations | xvii • In 2002, 56 percent of currently married women were using a method of family planning, and most of these women (41 percent of cur- rently married women) were using a modern contraceptive method. The most popular modern methods are the IUD (24 percent) and the pill (8 percent). Withdrawal (9 percent) and periodic abstinence (5 percent) are the most frequently employed traditional methods. • Private health facilities play an impor- tant role in supplying contraceptive methods to those who need them. Seventy-six percent of users of modern methods obtain their method from a private source, compared with 72 percent in 1997. The share of the public sector increased correspondingly to about one third (34 percent), compared with 28 percent in 1997 survey. • Women age 40-44, women with 3 or more living children, and better educated women as well as urban women are more likely than other women to use a family planning method. Contraceptive prevalence is highest in the Cen- tral region (58 percent) compared with the North region (54 percent), and the South region (48 percent). • Contraceptive use increases with parity: while almost no childless women are using con- traception, 44 percent of women with 1 or 2 children are using contraception, and more than 66 percent of women with 3 or more children are using a family planning method. • Sixty percent of married women who are not currently using contraception say that they intend to adopt a family planning method some time in the future; more than half of the women who expressed an intention to use con- traception in the future said they would prefer to use the IUD. Other Fertility Determinants • Staying in school appears to be a moti- vation for delaying marriage, which in the Jor- danian context translates to delays in age at first birth: women who have higher than secondary education marry at least 5 years later than women with the least education. Median age at marriage has increased only slightly between 1997 and 2002, inching up from 21.5 to 21.8, respectively. • In addition to marriage patterns, the risk of pregnancy is affected by postpartum amenorrhea, the period after childbirth when menstruation has not yet returned, and postpartum abstinence, the period when sexual activity has not yet been resumed. On average, women start menstruating again 6 months after childbirth and resumed sexual relations a little more than 2 months after childbirth. The length of postpartum insusceptibility has increased somewhat since 1997. Maternal and Child Health • For virtually all births in the past five years, mothers received at least one prenatal checkup from a health professional. In Jordan, maternal and child health care is widespread; however, differences ac- cording to level of education are noteworthy: while 97 percent of women with higher than secondary education received antenatal care, a smaller propor- tion of women with no education received the same (85 percent). Most women had 6 or more antenatal care visits (81 percent), and the majority of women had their first antenatal care visit within the first tri- mester (85 percent). • Ninety-seven percent of deliveries took place in a health facility, and virtually all births in Jordan were assisted by health personnel during de- livery. Sixteen percent of births were delivered by Caesare an section. • In Jordan, 98 percent of infants age 12-23 months have been fully immunized against DPT and polio, and 95 percent have received the vaccine against measles. While BCG is recommended by the Ministry of Health to be given at school entry, 29 percent of infants age 12-23 months has already re- ceived the vaccine against tuberculosis. Immuniza- tion coverage varies across regions: 96 percent of infants age 12-23 months in the North region have received vaccinations against measles, diphtheria, pertussis, tetanus, and polio, while the proportion in the South region is 90 percent, and in the Central region is 95 percent. All immunization indicators have shown improvement since 1997. • In the two weeks preceding the survey, 6 percent of children under five had a cough with xviii | Summary and Recommendations rapid breathing, and 15 percent had diarrhea. Among children with diarrhea, over half were taken to a health facility and two thirds were given oral rehydration therapy. • Breastfeeding is common in Jordan: among children born in the five years preceding the survey, 94 percent were breastfed – a figure similar to the one reported in the 1997 JPFHS. There is a small variation in ever-breastfed in- fants with respect to place of delivery: children who were delivered at home were more likely to have been breastfed than those children who were delivered in a health facility (98 percent and 94 percent, respectively). • In the 2002 JPFHS, all children born in the five years preceding the survey who were listed in the household questionnaire were weighed and measured. Two percent of children under five are thin for their height (wasted), 9 percent are short for their age (stunted), and 4 percent are underweight according to their age. • In the 2002 JPFHS, mother’s nutritional status was measured using two indices, height and body mass index (BMI). The mean height of mothers measured in the survey was 158 centi- meters; only 1 percent of mothers were shorter than 145 centimeters. Five percent of women had a BMI of less than 18.5, indicating malnutri- tion. • Biomarker data were collected in the 2002 JPFHS, in order to determine prevalence of anemia. The results indicate that 26 percent of women in Jordan have some degree of anemia, and 34 percent of children under age 5 were shown to have anemia. Severe anemia, however, is not a serious public health problem in Jordan for either women or children. Infant and Child Mortality • Twenty-four of 1,000 infants born in the five years prior to the survey will not survive to their first birthday. For the same period, 29 chil- dren will not live to be 5 years old. These mor- tality rates indicate that there has been an im- provement in child survival in Jordan since 1997, when infant and under-five mortality rates were 29 and 34 deaths per thousand children, respec- tively. • Under-five mortality varies inversely by mother’s education: children of mothers with no education have the highest risk of dying (44 deaths per 1,000 births), while children of mothers with education beyond secondary school have the lowest risk of dying (24 per 1,000 births). Knowledge of HIV/AIDS • Almost all of the respondents in the 2002 JPFHS report that they have heard of HIV/AIDS (97 percent); however, those with less education are sig- nificantly less likely to have heard of AIDS (no edu- cation: 80 percent; elementary education: 91 per- cent). • The 2002 JPFHS found that although a little over two-thirds of respondents know that HIV can be transmitted from mother to child during preg- nancy, only about half know the virus can be trans- mitted during delivery (55 percent), and fewer know it can be transmitted through breastfeeding (43 per- cent). Continuing Challenges • Despite the increased use of family planning methods, the increase in age at first marriage, and the apparent decline in fertility, the 2002 Jordan Population and Family Health Survey reveals a number of continuing challenges. While fertility lev- els are declining, 17 percent of births in the five years preceding the survey were mistimed, and 16 percent were not wanted at all. If these unwanted births had been prevented, women would have had an average of 2.6 births, instead of 3.7 births. • Although it is encouraging to note that the level of unmet need for family planning services in 2002 was lower than that in the 1997 JPFHS, many women want to stop childbearing or delay the next birth for at least two years, but are not using a con- traceptive method. • Two in three births in the five years preced- ing the survey were high-risk births either because the interval since the previous birth was too short (less than two years), the mother was too young (un- Summary and Recommendations | xix xx | Summary and Recommendations der age 18), too old (age 35 and over), or had too many prior births (3 or more). • Breastfeeding in Jordan is universal. However, the practice of breastfeeding is charac- terized by supplementation at an early age, and widespread use of a bottle and a nipple. Recommendations The results of the 2002 JPFHS reinforce findings from previous surveys that coverage of maternal and child health (MCH) programs in Jordan continues to improve. This is demon- strated by increased use of MCH services, along with knowledge and use of family planning. However, the survey data also note that: • Information, education and communication programs on the benefits of adopting family plan- ning for the purpose of delaying or limiting child- bearing need to be strengthened. These programs should be specifically directed toward women with the most need for family planning, particularly less educated women, women with high parity, and women in the South region. • Potential users of family planning should be counseled on the most appropriate method for their age, fertility desires, and personal situation. • Emphasis should be placed on the health benefits for mothers and children of smaller families and longer birth intervals; an effort to decrease lev- els of unmet need for family planning would be an appropriate means of helping women to space and limit their births. IRAQ Ma’an Mafraq Aqaba Amman Amman Zarqa Karak Irbid Tafielah Balqa Madaba Ajloun Jarash SAUDI ARABIA SYRIA PALESTINE JORDAN xx | Map of Jordan R e d S e a Dead Sea North Central South Introduction │ 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY Jordan, one of the most modern countries in the Middle East, was part of the Ottoman Empire. It was declared a political entity known as Transjordan under the mandate of the British government in 1923, until it gained independence and was declared a Kingdom in 1946. In 1950, Transjordan and the West Bank were united and assumed the current name of the Hashemite Kingdom of Jordan. The next major change for the Kingdom came in 1967, when the occupation of the West Bank and Gaza Strip by Israeli forces caused a massive wave of migrants to flow into the East Bank. Two decades later, in accor- dance with the desires of the Arab states and the Palestinian National Authority, the West Bank was ad- ministratively disengaged from the Kingdom in order to facilitate the establishment of the Palestinian state. Geographically, Jordan is almost entirely landlocked. The port of Aqaba in the far south is Jor- dan’s only outlet to the sea, as Palestine and Israel separate Jordan from the Mediterranean. Saudi Arabia lies to the south and east, Iraq is to the northeast, and Syria is to the north. Three climactic zones charac- terize Jordan, running from the west to east of the country. These include the Jordan Valley, which is largely below sea level and considered semitropical; the highlands east of the Jordan Valley, which range in elevation from 100 to 1,500 meters above sea level, and can be considered to have a Mediterranean climate; and the low-lying desert to the east of the highlands. Over 80 percent of Jordan’s 89,000 square kilometers is characterized by semidesert conditions; however, there do exist some wetlands, including the Azraq Basin. Administratively, the country is divided into 12 governorates, which are then grouped into three regions – the North region (Irbid, Jarash, Ajloun, and Mafraq), the Central region (Amman, Zarqa, Balqa, and Madaba), and the South region (Karak, Tafielah, Ma’an, and Aqaba). The major cities are Amman (the capital), Zarqa, and Irbid. With regard to the economy, the national government still controls most community services; however, Jordan is moving towards a free market economy. There has been a slight shift in the economic sectoral shares of gross domestic product (GDP). The share of agriculture in GDP at constant prices dropped from 6.2 percent in 1990 to 3.8 percent in 1997, then to as low as 2.9 percent in 2001. Similarly, the contribution of the wholesale and retail trade, restaurants, and hotels to GDP declined from 11.9 per- cent in 1990 to 10.2 by 2001. There was a concomitant rise in the share of the manufacturing sector, which rose from 10.7 percent in 1990 to 13.8 percent in 2001. The share of the community and personal services sector also rose slightly during this period, from 2.2 percent to 3.5 percent. The contribution of the transportation, storage and communication sector to the GDP has changed little over the past decade, rising about one percentage point between 1990 and 2001. The GDP per capita at current prices has demonstrated a steady increase over time, rising from US$1,185 in 1990, to US$1,577 in 1997, and to US$ 1706 in 2001. The cost of living index increased by 20 percent between 1992 and 1997, and increased by 8.2 percent between 1997 and 2002. The balance of trade deficit rose sharply by 72 percent between 1990 and 1996, but declined by 14 percent between 1997 and 2001. The rate of economic growth at constant prices has increased steadily over time: growth was 3.3 percent for 1997, 4.2 percent for 2001, and 5 percent for 2002. 2 │ Introduction To restructure economic activities in the country, the government began a reformation program in the early 1990s. Since the mid-1990s, the government has actively encouraged the privatization of certain community services as part of the program, and in 2000 issued the Privatization Act No. 25 for 2000 to establish the legal and institutional framework for privatization in Jordan. 1.2 POPULATION The first population census in Jordan was carried out in 1961. The population then totaled 901,000. As a result of the Arab-Israeli wars in 1948 and 1967, and the subsequent Israeli occupation of the West Bank and the Gaza Strip, a large number of Palestinians moved into the East Bank. In 1979, the population of Jordan numbered 2.13 million; it nearly doubled to 4.14 million by 1994. As of 2002, the population was estimated at 5.3 million, and it is expected to reach 5.6 million by the year 2005. Population growth averaged 4.8 percent during the period 1961-1979, and 4.4 percent between 1979 and 1994. The high rates of growth reflected the influx of immigrants to the East Bank from the West Bank and Gaza Strip in the late 1960s, the inflow of large numbers of guest workers, the high rate of natural increase, and the return of about 300,000 Jordanian nationals from the Gulf States as a result of the 1990 Gulf War. The rapid increases in population have created several problems for the country – namely, shortages in food, water, housing, and employment opportunities, as well as strains on the educa- tion system and the urban infrastructure. Fertility declines in Jordan have contributed to slowing the population growth rate down to 3.2 percent in the second half of the 1990s, and to 2.8 percent in 2002. Urbanization is a particularly important topic in Jordan. Historically, internal rural-to-urban mi- gration, as well as immigration, has contributed to rapid urban growth. Recent international crises have also impacted flows of migration into Jordan. The urban population increased by 14 percent between 1980 and 1994, increasing from 70 to 79 percent. Results of the 1994 census indicate that the age structure of the population has changed consid- erably since 1979 – the result of changes in fertility, mortality, and migration dynamics. The proportion of the population under 15 years of age declined from 51 percent in 1979 to 39 percent by 2002, while the proportion of those age 65 and over has been rising. Fertility has been declining in Jordan since the mid-1970s. Studies have found that the total fer- tility rate declined from 7.4 children per woman in 1976 to 5.6 in 1990, and to 4.4 in 1997 and finally to 3.7 in 2002. These figures indicate a 40 percent decline – about three children fewer per woman – be- tween 1976 and 1997; fertility fell another 19 percent, or by one child more, between 1997 and 2002. Mortality has also been declining in Jordan, even faster than fertility. The crude death rate, esti- mated at 18 per thousand in the early 1960s, had declined to 12 by the early 1980s. In 1990, the crude death rate was estimated at seven per thousand; by 2002 it had dropped to five. The infant mortality rate also declined from 82 per thousand in 1976 to 22 in 2002. Drops in mortality, particularly infant mortal- ity, translated into increased life expectancy for the population: in 2002, life expectancy in Jordan reached 69.0 years for both sexes; 68.8 for males and 71.1 for females. With regard to the education of the population, the illiteracy rate among those age 15 years and over has dropped by 70 percent since 1979 (from 35.5 percent to 10.3 percent of the population in 2002). In addition, almost one-third of Jordan’s population is currently enrolled at various educational levels. Seventy-two percent of all students attend schools run by governmental agencies, which comprise 58 per- cent of all schools in Jordan in 2001. Introduction │ 3 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMS Until the 1990s, Jordan had no explicit and official population policy. In 1973, the National Population Commission (NPC) was established, with the mandate to formulate and implement a national population policy and to address all population-related activities. However, the designing of a satisfac- tory population policy was controversial. Because of the sensitive nature of the topic, the NPC took no distinct actions or steps. The Commission was revitalized in the late 1980s to backstop several agencies working in the population field. During that period, and before 1993, both the public and private sectors made efforts to provide family planning services. The Ministry of Health (MOH), through its Maternal and Child Health Centers (MCH), provided optional and predominantly free family planning services as an unofficial and indirect intervention in the population policy. The efforts made by the Jordan Associa- tion of Family Planning and Protection (JAFPP), as well as by some voluntary nongovernmental organi- zations, were invaluable in this regard. In 1991, the NPC adopted the Birth Spacing National Program, in an effort to promote better ma- ternal and child health as well as reduce fertility through advocating increased birth intervals. The NPC prepared an integrated proposal, and submitted it to the government and to the public as a suggested population policy. This program was discussed nationwide and in 1993 the government approved the program as an official population policy, taking into consideration the religious, social, national, and free- choice dimensions of Jordanian society. The NPC created the final national population strategy for Jordan, which was approved by the cabinet in 1996 and was updated in 2000. The strategy document comprised multiple dimensions – namely, reproductive health; gender equality and equity; empowerment of women; and population and sustainable development. It also addressed the matter of the various kinds of support that would be needed in order to sustain the implementation of the strategy. This document served as a guide for de- velopment plans and other national strategies in the country. For the purposes of policy formulation and enhancement of public awareness in population is- sues, and as a substitute for the national population commission, the government established the Higher Population Council (HPC) in 2002. This council is headed by the Prime Minister, and is comprised of the membership of concerned ministers, in addition to relevant members from both the public and private sectors. The HPC mandate is to propose population policies that ensure the achievement of socioeco- nomic development objectives. The HPC will serve as a coordinating body in the area of population ac- tivities, dissemination of information, and strengthening of NGO participation in planning, management and implementation of population programs and projects in compliance with the national population strat- egy. The HPC will work toward the promotion of public awareness in population and development issues and enhance advocacy in these areas. The HPC will also collaborate and coordinate with regional and international bodies interested in population issues, in addition to building national capacities for of- ficials working in these areas in different institutions. Further, the HPC will conduct population surveys and studies for the purpose of updating the national population strategy. 1.4 HEALTH PRIORITIES AND PROGRAMS The MOH is committed to making health services available, accessible, and acceptable in all communities, and seeks to ensure equitable distribution of these services. The government has given pri- ority to the health sector and has developed a national health strategy. This strategy is aimed at creating a comprehensive health care system, utilizing both public and private service providers, and covering all levels of care, from preventive care to tertiary and rehabilitative care. 4 │ Introduction The MOH developed short-term and long-term plans to improve the health care system and the delivery of services to the population, the last of which was the plan for the period 2002-2005. These plans focus on the following areas: 1. Coordination of primary, secondary, and tertiary health service delivery, in order to im- prove the efficiency of the health system and to avoid duplication among health providers and waste of resources. 2. Development of health-sector human resources through training programs for medical staff to raise standards in all health-sector human resources categories and to maintain quality standards throughout the system. 3. Facility development by upgrading and/or expanding the existing health centers and hospitals, and building, equipping and computerization of new facilities as needed. 4. Issuance of laws and regulations related to the organization of the health sector, in addi- tion to reconsideration of some existing health laws and regulations expected to be approved dur- ing the plan period 2002-2005. 5. Computerization of the MOH existing health facilities all over the country, including the development of a Geographic Information System (GIS) for these facilities. 1.5 OBJECTIVES OF THE SURVEY As in the previous Demographic and Health Surveys (DHS) in Jordan, the primary objective of the Jordan Population and Family Health Survey (JPFHS) is to provide reliable estimates of demographic parameters, such as fertility, mortality, family planning, fertility preferences, as well as maternal and child health and nutrition that can be used by program managers and policy makers to evaluate and improve existing programs. In addition, the JPFHS data will be useful to researchers and scholars interested in analyzing demographic trends in Jordan, as well as those conducting comparative, regional or cross- national studies. The content of the 2002 JPFHS was significantly expanded from the 1997 survey to include addi- tional questions on women’s status, reproductive health, and family planning. In addition, all women age 15-49 and children less than five years of age were tested for anemia. 1.6 METHODOLOGY AND ORGANIZATION OF THE SURVEY The JPFHS is designed to collect data on ever-married women of reproductive age. The areas covered include demographic and socioeconomic characteristics, marriage and reproduction, family plan- ning, health care, breastfeeding and child care, fertility preferences, nutritional status of children under five years of age, and knowledge of Acquired Immune Deficiency Syndrome (AIDS) and sexually- transmitted infections (STIs). The survey was funded primarily by the U.S. Agency for International De- velopment (USAID) as part of the worldwide DHS program. ORC Macro provided technical assistance especially in the sample and questionnaire design, the training activities, the computer processing of sur- vey data, and the preparation of reports. A national advisory committee, headed by the Director General of Statistics, was established to provide guidelines for the planning and implementation stages of the sur- vey. The committee consisted of representatives from various government and non-government agencies involved in population and health issues. The survey was executed in three stages; the first was the preparatory stage, which involved map- ping, listing of households, and design and implementation of sampling procedures. At the same time, Introduction │ 5 the survey questionnaires and instruction manuals were developed, pretested, and finalized. All of these activities were completed in June 2002. The second stage encompassed interviewing and the collection of data. This was carried out by ten female teams, each consisting of one supervisor, one field editor, and four interviewers and a health technician. Data collection took place from July through September 2002. The third stage involved data entry, which started soon after the beginning of fieldwork and continued until October 2002. Data entry was followed by data cleaning, evaluation, and analysis. 1.6.1 Sample Design The 2002 JPFHS sample was designed to produce reliable estimates of major survey variables for the country as a whole, urban and rural areas, each of the three regions, and for each of the three major governorates: Amman, Irbid and Zarqa. The grouping of the governorates into regions is as follows: the North consists of Irbid, Jarash, Ajlun, and Mafraq; the Central region consists of Amman, Madaba, Balqa and Zarqa; and the South region consists of Karak, Tafielah, Ma’an and Aqaba. The 2002 JPFHS sample is a subsample of the master sample that was designed using the 1994 Census of Population and Housing as the frame. The sampling frame was stratified by governorate, major cities, other urban, and rural within each stratum. A two-stage sampling procedure was employed. First, blocks were selected systematically as primary sampling units (PSUs) with probability proportional to size of the PSU. A total of 498 PSUs were selected at this stage. In the second stage, a fixed number of 16 households were selected in each selected PSU. The sample design is described in Appendix A; the sampling errors are presented in Appendix B. 1.6.2 Updating of Sampling Frame Prior to the main fieldwork, mapping operations were carried out and the sample units/blocks were selected and then identified and located in the field. The selected blocks were delineated and the outer boundaries were demarcated with special signs. During this process, the numbers on buildings and housing units and households were updated, listed and documented, along with the name of the owner/tenant of the unit or household, and the name of the household head. These activities were com- pleted during the first half of 2002. 1.6.3 Questionnaires The 2002 JPFHS used two questionnaires – namely, the Household Questionnaire and the Indi- vidual Questionnaire (See Appendix D). Both questionnaires were developed in English and translated into Arabic. The Household Questionnaire was used to list all usual members of the sampled households and to obtain information on each member’s age, sex, educational attainment, relationship to the head of household, and marital status. In addition, questions were included on the socioeconomic characteristics of the household, such as source of water, sanitation facilities, and the availability of durable goods. The Household Questionnaire was also used to identify women who are eligible for the individual interview: ever-married women age 15-49. In addition, all women age 15-49 and children under five years living in the household were measured to determine nutritional status and tested for anemia. The household and women’s questionnaires were based on the DHS Model “A” Questionnaire, which is designed for use in countries with high contraceptive prevalence. Additions and modifications to the model questionnaire were made in order to provide detailed information specific to Jordan, using ex- perience gained from the 1990 and 1997 Jordan Population and Family Health Surveys. For each ever- married woman age 15 to 49, information on the following topics was collected: 1. Respondent’s background 2. Birth history 3. Knowledge and practice of family planning 6 │ Introduction 4. Maternal care, breastfeeding, immunization, and health of children under five years of age 5. Marriage 6. Fertility preferences 7. Husband’s background and respondent’s employment 8. Knowledge of AIDS and STIs In addition, information on births and pregnancies, contraceptive use and discontinuation, and marriage during the five years prior to the survey was collected using a monthly calendar. 1.6.4 Recruitment of Staff Different supervisory and executive levels of survey staff members were recruited according to certain criteria, such as experience, educational and personal qualifications, and familiarity with geo- graphic areas. Fieldworkers for the main survey were recruited from among those who participated in the 1994 census as well as those who took part in other demographic surveys conducted by the Department of Statistics (DOS), especially the 1997 JPFHS. The interviewers were all highly qualified females. Super- visors and field editors were selected from the DOS permanent staff or from those with good past experi- ence in such surveys. 1.6.5 Training and Pretest Training of the interviewers took place in Amman for four weeks in June 2002. The training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children and women, anemia testing, mock interviews between participants in the classroom, and practice interviews. After the training, pretest fieldwork was conducted over a one-week period in three urban clusters and one rural cluster. Field practice in anemia testing was carried out during the pretest for persons who were assigned as team health technicians. In addition, team members practiced their ability to weigh and measure women and children. Also during this period, field editors and team supervisors were provided with addi- tional training in methods of field editing, data quality control procedures, and fieldwork coordination. Debriefing sessions were held with the pretest field staff, and modifications to the questionnaires and in- structions were made based on lessons drawn from the exercise. The survey technical staff, MOH spe- cialists, Johns Hopkins University experts in Jordan and ORC Macro experts participated and lectured in the training program. 1.6.6 Main Fieldwork The survey fieldwork was organized in such a way as to ensure control over field logistics by DOS field offices all over the country. The workload, the dispersion of sample units, and transportation facilities served as criteria for identifying the number of field staff in each area. The field staff consisted of ten teams; each team was comprised of one supervisor, one field editor, four interviewers and a health technician. All teams were supervised by three controllers and two inspectors. During fieldwork, each team was regrouped as necessary. Each team was provided with the required number of vehicles. Field- work was carried out between July 1 and September 30, 2002. To facilitate data collection, each interviewing team was assigned a number of blocks in the sam- ple area. Each inspector, in collaboration with the supervisor, divided his team so as to ensure that all adjacent sampled households were completed by one interviewer. To ensure good data quality, inter- viewers were asked to conduct fewer interviews during the first three days of data collection; the com- pleted questionnaires were then checked by the field editor and/or the supervisor to ensure completeness Introduction │ 7 Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––– Result Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household interviews Households selected 5,616 2,352 7,968 Households found 5,573 2,334 7,907 Households interviewed 5,504 2,321 7,825 Household response rate (%) 98.8 99.4 99.0 Individual Interviews Eligible women 4,314 1,837 6,151 Eligible women interviewed 4,196 1,810 6,006 Eligible woman response rate (%) 97.3 98.5 97.6 Overall response rate (%) 96.1 98.0 96.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The overall response rate = (household response rate) × (eligible woman response rate). and consistency of data. Under the supervision of controllers and inspectors, the field editor and/or the supervisor conducted spot checks by randomly visiting some sampled households and completing some parts of the same questionnaire (previously filled in by the interviewer). Both questionnaires were then matched and any differences were discussed. Interviewers made repeated attempts to obtain the responses of eligible respondents by calling back to interview eligible women who were not home at the time of the first visit, or by endeavoring to persuade eligible women who were reluctant to be interviewed. The questionnaires were then delivered to the central office in Amman for further processing. 1.6.7 Data Processing Fieldwork and data processing activities overlapped. After a week of data collection, and after field editing of questionnaires for completeness and consistency, the questionnaires for each cluster were packaged together and sent to the central office in Amman where they were registered and stored. Special teams were formed to carry out office editing and coding of the open-ended questions. Data entry and verification started after one week of office data processing. The process of data entry, including one hundred percent re-entry, editing and cleaning, was done by using PCs and the CSPro (Census and Survey Processing) computer package, developed specially for such surveys. The CSPro program allows data to be edited while being entered. Data processing operations were completed by the end of October 2002. A data processing specialist from ORC Macro made a trip to Jordan in Oc- tober and November 2002 to follow up data editing and cleaning and to work on the tabulation of results for the survey preliminary report. The tabulations for the present final report were completed in Decem- ber 2002. 1.7 RESULTS OF THE HOUSEHOLD AND INDIVIDUAL INTERVIEWS Table 1.1 is a summary of the results from both the household and the individual interviews. A total of 7,968 households were selected for the survey from the sampling frame; among those selected households, 7,907 households were found. Of those households, 7,825 (99 percent) were successfully in- terviewed. In those households, 6,151 eligible women were identified, and complete interviews were obtained with 6,006 of them (98 percent of all eligible women). The overall response rate was 97 percent. Household Characteristics │ 9 HOUSEHOLD CHARACTERISTICS 2 This chapter describes the general characteristics of the sample population, including composition by age and sex, residence, household size, education, housing facilities, and presence of durable goods in the household. The questionnaire for the 2002 Jordan Population and Family Health Survey (JPFHS) included two questions distinguishing between the de jure population (persons who usually live in the selected household) and the de facto population (persons who spent the night before the interview in the house- hold). It was found, however, that the difference between them was small, and since sample selection for the JPFHS was based on the de facto population, as it had been in past demographic surveys, tabulations for the JPFHS household data were carried out on the basis of the de facto population only. 2.1 POPULATION BY AGE AND SEX In many developing countries, data on age are affected by errors such as misstatement and prefer- ence for or avoidance of certain digits. In general, that was not the case in Jordan. The survey results indicated that not only age but month and year of birth are widely recognized. Also, the distribution of the population by single years of age (Figure 2.1) indicates that although there is some preference for ages ending in 0 or 5, the problem is limited. Figure 2.1 Male and Female Population by Single Year of Age 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70+ Age (in years) 0 200 400 600 800 Number in the sample Male Female JPFHS 2002 Table 2.1 shows the percent distribution of the population by age and sex, according to urban- rural residence. The table serves two purposes. The first is to show the effects of past demographic trends on the population and to give an indication of future trends. The second is to describe the context in which various demographic processes are operating. 10 │ Household Characteristics The figures in Table 2.1 show that 39 percent of the population is under 15 years of age, an indi- cator that fertility remains high. The proportion under 15 years old is higher in rural areas (43 percent) than it is in urban areas (38 percent); this relationship holds for those under 20 as well. The opposite is true in the broad age category of 20-44 years old (36 percent and 33 percent in urban and rural areas, re- spectively). The latter difference is due to rural-urban migration, especially of males, as well as the influx of migrants from abroad, to urban areas in search of employment. One may note an unusual pattern at the youngest ages in the population pyramid (Figure 2.2), such that there are fewer children in the 0-4 age group than in the 5-9 age group. This pattern may be ex- plained by several circumstances: 1) a significant decrease in the fertility of the population has occurred, 2) heaping has occurred as a result of respondents rounding the age of a child up to the next year rather than reporting the exact age of the child at the time of the survey, or 3) heaping has occurred as a result of interviewers transferring children under age five to the age group 5-9 in order to avoid the time- consuming effort of taking the height, weight, and anemia measures from eligible children (all children under five years of age in the household). Indeed, it is possible to see the heaping of under-five children into the next age group in Figure 2.1. It is probable that a combination of all three of the suggested cir- cumstances contributed to the apparent heaping. As is the case in most countries, there are more females than males in Jordan; however, the over- all sex ratio is not particularly exaggerated: there are 99 males for every 100 females. The sex ratio does vary by age: among those under 25 years of age, the sex ratio is on average 102; among people age 60 and above, the ratio is 92, on average. In the middle age groups (25-59 years old), the sex ratio drops to 94. The low ratio for this age group reflects in part the emigration of Jordanian males abroad. Table 2.1 Household population by age, residence, and sex Percent distribution of the de facto household population by five-year age group, according to sex and residence, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Rural Total ––––––––––––––––––––– –––––––––––––––––––– ––––––––––––––––––––– Age Male Female Total Male Female Total Male Female Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0-4 12.7 12.5 12.6 14.6 13.4 14.0 13.1 12.7 12.9 5-9 13.8 13.5 13.7 15.5 14.7 15.1 14.2 13.8 14.0 10-14 12.2 11.5 11.8 13.6 13.6 13.6 12.5 11.9 12.2 15-19 11.3 11.4 11.3 12.9 11.8 12.3 11.6 11.5 11.6 20-24 10.6 9.6 10.1 9.3 10.3 9.8 10.3 9.8 10.1 25-29 8.2 8.4 8.3 7.5 7.6 7.6 8.1 8.2 8.2 30-34 7.0 7.8 7.4 5.7 7.5 6.6 6.7 7.7 7.2 35-39 5.6 5.8 5.7 5.6 5.3 5.4 5.6 5.7 5.6 40-44 4.2 4.4 4.3 3.5 3.6 3.5 4.1 4.2 4.1 45-49 3.2 3.3 3.3 2.8 2.8 2.8 3.1 3.2 3.2 50-54 2.3 3.0 2.6 2.1 2.5 2.3 2.3 2.9 2.6 55-59 2.9 2.5 2.7 1.8 1.8 1.8 2.7 2.4 2.5 60-64 2.3 2.2 2.3 1.9 1.9 1.9 2.2 2.2 2.2 65-69 1.5 1.7 1.6 1.2 1.3 1.3 1.4 1.6 1.5 70-74 1.1 1.2 1.1 1.1 0.8 0.9 1.1 1.1 1.1 75-79 0.6 0.6 0.6 0.5 0.4 0.4 0.5 0.6 0.6 80 + 0.5 0.6 0.5 0.6 0.6 0.6 0.5 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 17,393 17,614 35,007 4,669 4,736 9,405 22,062 22,350 44,412 Household Characteristics │ 11 Figure 2.2 Population Pyramid of Jordan JPFHS 2002 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Age 02468 0 2 4 6 8 Male Female Percent 0 2.2 POPULATION BY AGE FROM OTHER SOURCES The percentage of the population under 15 years of age declined substantially, from 51 percent in 1983, to 44 percent in 1990, to its current 2002 level of 39 percent, with proportional increases in the 15- 59 age group (Figure 2.3). That pattern is typical of populations that are experiencing a fertility decline (see Chapter 4 for more discussion on fertility in Jordan). The change in the age structure is favorable in economic terms. The dependency ratio, calculated as the ratio of persons in the “dependent” ages (under 15, and 60 and over) to those in the working-age category (15-59) on the basis of those figures, fell from 130 in 1976, to 86 in 1997, and to 82 in 2002. Figure 2.3 Population by Broad Age Groups, Various Surveys, 1976 - 2002 52 51 44 41 40 43 45 52 54 55 5 4 4 5 6 1976 JFS 1983 JFFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 0 10 20 30 40 50 60 Percent Age groups 0-14 15-59 60+ 12 │ Household Characteristics 2.3 HOUSEHOLD SIZE Table 2.2 provides information on the size of the sampled households. Household characteristics affect the social and economic well-being of the members of the household. Large household size may be associated with crowding, which can lead to unfavorable health conditions. Single-parent families, espe- cially if they are headed by females, usually have limited financial resources. Large households are common in Jordan. The average number of members in a household is 5.7. Household size is slightly smaller in urban areas (5.5) than in rural areas (6.2). Fifteen percent of house- holds, on average, are composed of nine or more persons. The figure is higher in rural areas (22 percent) than in urban areas (13 percent). The table shows that 12 percent of households in urban areas are headed by females, compared with 10 percent in rural areas. Results shown in Table 2.3 indicate that the majority of children under 15 years of age (94 per- cent) are living with both parents. The range is between 98 percent for children age 0-2 years and 90 per- cent for children age 10-14 years. No variations were noted according to sex, urban-rural residence or region, and no differences are noted over time between the 1997 and 2002 surveys. In addition, 3 percent of children under the age of 15 have experienced the death of one or both parents. Table 2.2 Household composition Percent distribution of households by sex of head of house- hold and household size, according to residence, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Characteristic Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––– Sex of head of household Male 88.1 90.4 88.5 Female 11.9 9.6 11.5 Total 100.0 100.0 100.0 Number of usual members 1 4.5 3.8 4.4 2 9.2 7.6 8.9 3 9.9 9.0 9.8 4 12.7 11.5 12.5 5 16.2 11.7 15.3 6 14.6 11.9 14.0 7 11.6 12.3 11.7 8 8.2 10.0 8.6 9+ 13.0 22.2 14.8 Total 100.0 100.0 100.0 Number of households 6,276 1,549 7,825 Mean size of household 5.5 6.2 5.7 –––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure members, i.e., usual residents. Household Characteristics │ 13 2.4 LEVEL OF EDUCATION OF THE HOUSEHOLD POPULATION Education is an important variable with regard to its association with demographic behavior. Higher education is usually associated with greater knowledge and use of health practices and family planning methods. The education system in Jordan has been in place for a long time. Basic education is free of cost and compulsory, starting at age six and lasting for 10 years. A further two-year period, known as the secondary cycle, is virtually cost-free. In the JPFHS, questions on education were asked for persons six years of age and older, to be used to calculate rates of school enrollment as well as overall education levels of the population. Table 2.4 presents data on the educational composition of the population reported in the house- hold questionnaire. In the 2002 JPFHS, information on educational attainment refers to the highest level of education attended, and the highest grade completed at that level. An important observation is that women have less education than men: 94 percent of males in Jordan have had some schooling, whereas about 88 percent of females have attended school. Furthermore, men are likely to stay in school longer than women. This table also shows that 46 percent of males and 43 percent of females have attended secondary education or higher. The median number of years of schooling is 8.6 years for males and 8 years for fe- males in 2002. This indicates that while there has been no improvement in the gender gap in education levels from that in 1997 (when the median was 7.5 and 6.9 years for males and females respectively), overall education levels have increased equally for both men and women. Table 2.3 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 15 by children’s living arrangements and survival status of parents, according to background characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Living Living with mother with father Not living with but not father but not mother either parent Living ––––––––––––– –––––––––––––– ––––––––––––––––––––––––– with Only Only Number Background both Father Father Mother Mother Both father mother Both of characteristic parents alive dead alive dead alive alive alive dead Total children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age <2 98.2 1.4 0.1 0.1 0.0 0.2 0.0 0.0 0.0 100.0 2,200 2-4 96.2 2.4 0.9 0.3 0.0 0.1 0.1 0.0 0.0 100.0 3,270 5-9 93.9 2.6 2.0 0.6 0.2 0.4 0.1 0.2 0.0 100.0 6,079 10-14 90.1 3.1 3.8 1.2 0.9 0.3 0.1 0.2 0.1 100.0 5,310 Sex Male 94.0 2.7 2.0 0.6 0.4 0.3 0.1 0.1 0.0 100.0 8,525 Female 93.4 2.4 2.2 0.8 0.4 0.4 0.1 0.2 0.0 100.0 8,334 Residence Urban 93.3 3.0 2.0 0.6 0.4 0.3 0.1 0.2 0.0 100.0 12,872 Rural 94.9 1.1 2.3 0.9 0.3 0.3 0.2 0.0 0.0 100.0 3,987 Region Central 93.5 2.9 2.0 0.7 0.4 0.3 0.1 0.1 0.0 100.0 10,113 North 94.0 2.4 2.2 0.7 0.4 0.2 0.0 0.1 0.0 100.0 4,969 South 94.3 1.0 2.6 0.7 0.4 0.6 0.1 0.2 0.2 100.0 1,777 Total 93.7 2.6 2.1 0.7 0.4 0.3 0.1 0.1 0.0 100.0 16,859 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Orphans are children with both parents dead. 14 │ Household Characteristics Table 2.4 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of education attended, according to background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended ––––––––––––––––––––––––––––––––––––––––––––––––––– Median Preparatory number Background No Ele- Prepara- Secon- and of characteristic education mentary tory dary Higher secondary Total Number years –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MALE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 16.0 84.0 0.0 0.0 0.0 0.0 100.0 2,523 1.3 10-14 0.5 54.7 44.5 0.3 0.0 44.8 100.0 2,751 5.8 15-19 0.7 3.5 21.6 67.2 7.0 88.8 100.0 2,567 9.9 20-24 1.0 7.1 11.4 46.5 34.0 57.9 100.0 2,282 10.9 25-29 1.5 8.0 21.1 39.3 30.0 60.4 100.0 1,779 10.7 30-34 2.2 6.4 23.0 36.1 32.2 59.1 100.0 1,483 10.9 35-39 3.1 9.0 20.8 34.0 33.1 54.8 100.0 1,229 11.1 40-44 3.2 11.9 25.6 24.0 35.2 49.7 100.0 895 10.7 45-49 3.1 15.2 22.7 24.5 34.5 47.2 100.0 692 10.8 50-54 5.9 21.4 19.7 17.9 35.2 37.6 100.0 502 10.2 55-59 8.9 30.4 16.7 17.4 26.5 34.1 100.0 591 8.4 60-64 18.9 29.4 14.3 15.7 21.8 30.0 100.0 491 6.5 65+ 44.1 33.8 8.7 7.5 5.8 16.3 100.0 787 3.0 Residence Urban 5.3 27.2 20.3 27.2 20.0 47.5 100.0 14,722 8.7 Rural 9.3 29.4 19.4 30.0 12.1 49.3 100.0 3,849 8.0 Region Central 5.4 26.9 19.7 27.8 20.3 47.4 100.0 11,854 8.8 North 6.8 28.4 21.3 27.7 15.9 48.9 100.0 4,947 8.3 South 8.9 30.3 19.8 28.3 12.6 48.2 100.0 1,769 7.9 Total 6.1 27.6 20.1 27.8 18.4 47.9 100.0 18,571 8.6 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– FEMALE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 13.2 86.8 0.0 0.0 0.0 0.0 100.0 2,552 1.4 10-14 0.5 52.9 46.3 0.2 0.0 46.6 100.0 2,668 5.8 15-19 0.6 3.3 19.3 65.8 11.0 85.1 100.0 2,564 10.1 20-24 1.8 5.6 9.9 40.4 42.3 50.3 100.0 2,186 11.5 25-29 2.2 7.3 16.6 43.2 30.7 59.8 100.0 1,843 10.8 30-34 4.3 8.2 19.5 35.1 32.9 54.7 100.0 1,731 10.9 35-39 6.1 12.6 17.9 34.4 29.1 52.3 100.0 1,270 10.6 40-44 11.0 16.2 19.5 24.8 28.5 44.3 100.0 937 10.0 45-49 19.2 27.4 21.0 15.9 16.5 36.9 100.0 711 6.6 50-54 34.9 26.7 12.8 16.3 9.3 29.1 100.0 642 4.7 55-59 50.6 24.3 9.1 10.6 5.4 19.7 100.0 533 0.0 60-64 69.6 18.0 4.4 6.5 1.6 10.9 100.0 481 0.0 65+ 82.9 8.6 4.6 3.0 0.9 7.7 100.0 861 0.0 Residence Urban 11.4 26.2 17.6 26.8 18.0 44.4 100.0 15,009 8.3 Rural 16.7 29.0 17.7 24.0 12.6 41.7 100.0 3,970 6.7 Region Central 11.6 25.5 17.6 27.3 18.0 44.9 100.0 12,030 8.4 North 13.6 28.9 18.1 24.6 14.8 42.7 100.0 5,166 7.4 South 15.9 29.1 16.5 23.8 14.7 40.3 100.0 1,783 6.9 Total 12.5 26.8 17.6 26.2 16.8 43.9 100.0 18,979 8.0 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of education attended, whether or not that level was com- pleted. Elementary eduation corresponds to the first six years of school, preparatory corresponds to the next three years, and secondary to the last three years, for a total of 12 years of schooling. In this report, the “preparatory” and “secondary” categories are shown separately; whereas, in the 1990 and 1997 reports, the “secondary” cate- gory represents both categories together. Household Characteristics │ 15 The figures for median number of years of schooling indicate that education has a long history in Jordan. Men age 50-54 have had a median of 10.2 years of education, while women in the same age co- hort have had 4.7 years. Among persons age 40-44, the median for men is 10.7 years of education, com- pared with 10 years for females. The median number of years of education is almost the same for males and females at ages 25-34, and in the younger age groups, the median number of years of education is slightly higher for females than for males. The level of education is associated with residence, though differences by residence and by region are not great. In urban areas and in the Central region (Amman, Zarqa, Balqa, and Madaba), the median years of education attained are higher than in the rest of the country. 2.5 SCHOOL ATTENDANCE Figure 2.4 and Table 2.5 show the proportion of the household population age 6-24 years attend- ing school, by age and sex. The data reflect the fact that school attendance in Jordan is very high, at al- most 99 percent for both sexes among those ages 8 through 13. Few differences in attendance are ob- served between males and females of younger ages (7-13 years). Figure 2.4 Age-Specific Attendance Rates (Percentage of the de Facto Household Population Age 6-24 Years Attending School) 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female JPFHS 2002 Beyond the age of 13, attendance rates start to decline, especially for males. Nevertheless, the overall rate exceeds 90 percent for both sexes up to age 15. Age 15 marks the beginning of a gender- based divergence in attendance, where 95 percent of females and 90 percent of males are attending school. This gender gap continues through age 20, with 43 percent of females attending school as com- pared to 38 percent of males. Gender gaps in attendance are inconsistent in direction between the ages of 21 and 24. 16 │ Household Characteristics Table 2.5 Age-specific attendance rates Percentage of the household population age 6-24 years attend- ing school, by age and sex, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Male Female ––––––––––––––––––– –––––––––––––––––––– Attendance Attendance Age rate (%) Number rate (%) Number ––––––––––––––––––––––––––––––––––––––––––––––––––––– 6 41.9 661 44.3 608 7 98.2 632 97.8 648 8 99.4 578 99.9 636 9 99.0 607 99.6 600 10 99.4 547 99.5 506 11 99.5 543 99.4 521 12 98.7 540 97.7 497 13 98.6 503 98.6 538 14 94.1 567 95.9 548 15 90.3 531 94.8 523 16 88.8 509 90.9 525 17 79.1 545 84.4 523 18 66.1 524 72.9 493 19 42.3 510 55.3 461 20 38.3 542 43.3 457 21 41.4 508 38.1 448 22 29.1 506 26.1 462 23 16.4 426 20.0 426 24 13.6 426 7.5 370 2.6 HOUSING CHARACTERISTICS In the JPFHS 2002, information on housing characteristics was collected in the household ques- tionnaire. Thus, the sample is comprised of the households interviewed. Table 2.6 indicates that about two in three housing units (69 percent) in urban areas are apartments, as compared to nearly one in four (23 percent) in rural areas. Dars, which are homes that are built with an enclosed central courtyard, form 76 percent of the dwellings in rural areas, compared to only 29 percent in urban areas. In general, 98 per- cent of total housing units in Jordan are either apartments or dars. About half of the housing units (47 percent) consist of two or three rooms, and 44 percent consist of four or five rooms, whereas 6 percent consist of six or more rooms; only 3 percent of housing units consist of one room, with slight differences according to the place of residence. As for sleeping rooms, one in five housing units has one sleeping room, more than two-fifths (44 percent) have two rooms, and one in three (31 percent) has three rooms. Table 2.6 indicates that almost all households (99.7 percent) in urban areas have electricity, which differs little from rural areas (98.7 percent). Moreover, nearly all households use natural gas for cooking regardless of the place of residence. Piped-in water is widely available – particularly in urban areas (87 percent), but somewhat less often (83 percent) in rural areas. About 9 percent of urban house- holds and only 1 percent of rural households use bottled water for drinking. Consequently, the majority of households in urban areas (96 percent) and in rural areas (84 percent) use safe water for drinking. About 12 percent of rural dwellings use water that may be unsafe for drinking and other purposes. The problem is further aggravated if households using tankers to obtain water (another 5 percent) are added, as the source of the water carried by tanker trucks may be unknown. Household Characteristics │ 17 Table 2.6 Housing characteristics Percent distribution of households by housing characteristics, accord- ing to residence, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Housing –––––––––––––––– characteristic Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––– Type of housing unit Apartment 69.2 23.4 60.1 Dar 28.8 75.6 38.0 Villa 1.9 0.7 1.6 Other 0.2 0.4 0.2 Total 100.0 100.0 100.0 Rooms in the house 1 3.3 3.5 3.3 2 14.8 15.5 14.9 3 32.8 30.0 32.2 4 26.6 30.4 27.4 5 17.2 14.2 16.6 6+ 5.4 6.4 5.6 Total 100.0 100.0 100.0 Sleeping rooms 1 20.3 23.9 21.0 2 43.7 43.3 43.6 3 31.3 27.1 30.5 4+ 4.7 5.6 4.9 Total 100.0 100.0 100.0 Electricity Yes 99.7 98.7 99.5 No 0.3 1.3 0.5 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 86.5 82.8 85.8 Rainwater 3.0 10.8 4.5 Tanker truck 1.1 4.5 1.7 Bottled water 9.3 0.8 7.6 Other 0.2 1.1 0.3 Total 100.0 100.0 100.0 Sanitation facility Flush toilet 92.0 76.2 88.8 Traditional pit toilet 8.0 23.5 11.1 No facility 0.0 0.3 0.1 Total 100.0 100.0 100.0 Public sewage Yes 73.4 6.5 60.1 No 26.6 93.5 39.9 Total 100.0 100.0 100.0 Flooring material Tiles 89.2 79.9 87.4 Ceramic tiles 3.1 0.5 2.6 Cememt 7.5 19.0 9.8 Earth/sand 0.1 0.6 0.2 Total 100.0 100.0 100.0 Type of cooking fuel LPG, natural gas 99.6 99.2 99.5 Other 0.4 0.8 0.5 Total 100.0 100.0 100.0 Number of households 6,276 1,549 7,825 Table 2.6 also shows that a large majori- ty of households (89 percent) have a flush toilet (with marked differences between urban and rural households). Seventy-three percent of urban households have access to a public sewage net- work, in contrast with only 7 percent of rural households. About nine in ten dwellings have floors made of ceramic or tile; another 10 percent have cement floors. The proportions differ reciprocally by urban-rural residence: urban households are more likely to have ceramic or tile flooring, while rural households tend to have cement flooring. 2.7 PRESENCE OF DURABLE GOODS IN THE HOUSEHOLD Jordan is a modern society, and most of the population enjoys the convenience of electrical appliances (Table 2.7). Ninety-six per- cent of households have television sets, 93 per- cent have a refrigerator, and 93 percent have a washing machine. As further testament to the level of development in Jordan, 73 percent of households possess a land-line or mobile phone (with 13 percent of households owning 2 or more mobile phones), one in six households owns a computer, and five percent have internet access. The pos- session of computer-related assets varies con- siderably between urban and rural areas: owner- ship of a computer in urban areas is fourfold that in rural areas, and internet access is about nine times higher in urban than in rural areas. Of further interest is the fact that two in five households own a private car, and one in five has a solar heater. Overall, less than 1 per- cent of households owns none of the seven specified durable goods. 18 │ Household Characteristics Table 2.7 Household durable goods Percentage of households possessing various durable con- sumer goods, by urban-rural residence, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Durable consumer goods Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––– Radio 82.1 69.8 79.7 Television 96.7 94.8 96.3 Telephone 56.5 46.0 54.4 Mobile phone 50.2 38.9 48.0 Phone or mobile 74.7 64.4 72.6 Refrigerator 94.4 87.9 93.2 Satellite 47.9 19.3 42.3 Washing machine 93.9 89.1 92.9 Solar heater 21.4 11.1 19.3 Computer 19.1 5.3 16.4 Internet access 6.1 0.7 5.0 Car/pickup 39.0 34.0 38.0 None of the above 0.5 1.6 0.7 Number of households 6,276 1,549 7,825 Respondents’ Background Characteristics │ 19 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3 This chapter highlights the basic characteristics of ever-married women age 15-49 who were in- terviewed in the survey. It also presents data on the respondents’ exposure to mass media, employment status, living arrangements, and women’s participation in household decisionmaking. 3.1 GENERAL CHARACTERISTICS Table 3.1 presents the distribution of respondents by background characteristics, including age, marital status, residence, educational level attended, and religion. The distribution of ever-married women shows that 15 percent are under age 25 in 2002, compared with 18 percent in 1997, and 22 percent in 1990. It is noteworthy that the proportion of women in the younger age group (15-19) has dropped by one percentage point in 2002 from that in 1997 (from 3.7 percent to 2.6 percent); in 1990, women in this age group made up 6 percent of the female population. This decline in the proportion of young women in the ever-married population is the consequence of increasing age at marriage (see Chapter 5). Despite the similar proportion of women age 25-34 in both years, the proportion of women age 40-49 was slightly higher in 2002 than it was in 1997. Among ever-married women, the percent distribution by marital status indicates that 95 percent are currently married; the rest are either divorced or widowed. The proportion married has declined by one percentage point in 2002 from that in 1997. The population of Jordan is highly urbanized (Table 3.1). Eighty percent of respondents reside in urban areas (localities with a population of 5,000 or more, as stated in the 1994 Census). Only 9 percent of all ever-married women live in the governorates of the South region (Karak, Tafielah, Ma’an, and Aqaba) compared with 65 percent in the Central region and 26 percent in the North region. Table 3.1 also presents the weighted and unweighted numbers of women in the sample. The un- weighted numbers of women in the Central region (Amman, Zarqa, Balqa, and Madaba) are smaller than the weighted numbers. The opposite is true in the South region (because of oversampling). For example, in the South region, although the weighted number of women is 566, in reality data were collected from 1,458 women. The South region was oversampled to obtain sufficient women to yield statistically reliable estimates. Table 3.1 indicates that in 2002, 6 percent of ever-married women had not received any formal education. Compared with the proportion of women with no education in 1997 (9 percent) and in 1990 (24 percent), the degree to which access to education has spread in Jordanian society in a relatively short period of time becomes apparent. Education has spread deeply as well as broadly over time in Jordan: only 54 percent of women had ever attended preparatory or higher levels of schooling in 1990; the corre- sponding figure in 1997 was 76 percent, and by 2002, 83 percent of women had attained preparatory or higher education. 20 │ Respondents’ Background Characteristics Table 3.1 Background characteristics of respondents Percent distribution of ever-married women by background characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of women –––––––––––––––––––– Background Weighted Un- characteristic percent Weighted weighted ––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 2.6 158 155 20-24 12.1 728 753 25-29 19.6 1,175 1,195 30-34 22.5 1,354 1,342 35-39 17.8 1,071 1,090 40-44 14.3 862 843 45-49 11.0 659 628 Marital status Married 95.0 5,706 5,727 Divorced 2.2 130 111 Widowed 2.8 170 168 Residence Urban 79.9 4,799 4,196 Rural 20.1 1,207 1,810 Region Central 64.9 3,898 2,788 North 25.7 1,542 1,760 South 9.4 566 1,458 Educational level attended No education 6.0 363 526 Elementary 11.5 689 783 Preparatory 20.5 1,231 1,248 Secondary 37.4 2,247 2,067 Higher 24.6 1,476 1,382 Preparatory + secondary 57.9 3,478 3,315 Religion Muslim 98.4 5,912 5,898 Christian 1.6 94 108 Total 100.0 6,006 6,006 –––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of educa- tion attended, whether or not that level was completed. Ele- mentary education corresponds to the first six years of school, preparatory corresponds to the next three years, and secondary to the last three years, for a total of 12 years of schooling. In this report, the “preparatory” and “secondary” categories are shown separately; whereas, in the 1990 and 1997 JPFHS reports, the “secondary” category represents both categories together. 3.2 RESPONDENTS’ LEVEL OF EDUCATION Table 3.2 shows the relationship between level of education attended and background characteris- tics. Broad-based access of the Jordanian population to education has received greater emphasis over the past fifty years, as evidenced by data from the JPFHS surveys that indicate that older women are less likely to have had education than younger women: almost 20 percent of women age 45-49 have had no education, while less than 2 percent of women between the ages of 15 and 29 have had no education. Respondents’ Background Characteristics │ 21 The median number of years of schooling according to age group reflects that young women have been able to continue in school for longer periods of time than have older women. The median number of years of education for all women is 10 years; however, women age 20-39 have a median of almost 11 years of education, while those age 45-49 have a median of 6 years of education. Women in urban areas are more likely to have had any education, as well as higher education, than their rural counterparts. While the proportion of urban women with no education did not exceed 4 percent, it rises to 14 percent for rural women. Differences also exist in terms of the median number of schooling years by residence: urban women have about 2 years of education more than rural women (11 years and 9 years in urban and rural areas respectively). There are also pronounced regional differences in women’s educational attainment. In the Central region, 4 percent of women have no education, whereas in the South region, the proportion is 14 percent. Regional differences persist with regard to secondary or higher education: a greater proportion of women in the Central Region attain preparatory or higher educa- tion (85 percent) than in either the North (80 percent) or South (71 percent) regions. 3.3 EXPOSURE TO JORDANIAN MASS MEDIA The exposure of women to Jordanian television, radio, and newspapers is shown in Table 3.3. Eighty-one percent of women in the sample watch Jordanian television, 44 percent listen to the Jordanian radio, and 36 percent read newspapers at least once a week. While 17 percent of women were exposed to all three forms of media at least once a week, 10 percent were not exposed to any. Although exposure to mass media varies little across age groups, younger women are slightly less likely to be exposed to mass Table 3.2 Educational attainment of women by background characteristics Percent distribution of all ever-married women by highest level of schooling attended and median number of years of schooling, according to background characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended Median ––––––––––––––––––––––––––––––––––––––––––––––––––– number Preparatory Number of years Background No Ele- Prepara- Secon- and of of characteristic education mentary tory dary Higher secondary Total women schooling ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.4 11.4 33.0 51.4 2.8 84.4 100.0 158 9.2 20-24 1.1 7.0 17.0 56.8 18.1 73.8 100.0 728 10.5 25-29 1.9 6.4 21.0 47.4 23.2 68.4 100.0 1,175 10.5 30-34 3.4 7.3 21.9 36.1 31.3 58.0 100.0 1,354 10.8 35-39 5.7 11.6 18.4 36.1 28.2 54.5 100.0 1,071 10.6 40-44 11.0 15.4 20.8 25.0 27.9 45.7 100.0 862 9.9 45-49 19.3 28.7 20.6 15.9 15.5 36.5 100.0 659 6.3 Residence Urban 4.0 10.4 20.8 38.9 26.0 59.6 100.0 4,799 10.5 Rural 14.2 15.9 19.3 31.7 18.9 51.0 100.0 1,207 9.1 Region Central 4.3 10.5 20.4 39.8 24.9 60.3 100.0 3,898 10.5 North 7.6 12.5 21.6 34.5 23.7 56.1 100.0 1,542 10.0 South 13.8 15.3 17.9 28.6 24.3 46.5 100.0 566 9.5 Total 6.0 11.5 20.5 37.4 24.6 57.9 100.0 6,006 10.3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of education attended, whether or not that level was com- pleted. Elementary education corresponds to the first six years of school, preparatory corresponds to the next three years, and secondary to the last three years, for a total of 12 years of schooling. In this report, the “pre- paratory” and “secondary” categories are shown separately; whereas, in the 1990 and 1997 JPFHS reports, the “secondary” category represents both categories together. 22 │ Respondents’ Background Characteristics media than older women: whereas 13 percent of women age 15-19 were exposed to all three forms of mass media, the proportion goes up to 19 percent among women age 40-49. As expected, there is a linear and positive association between education and newspaper reading: a higher proportion of women with at least secondary education reads newspapers than those with less education. There is no consistent relationship between television viewing or radio listenership and education; however, those who fall into the educational extremes do tend to differ somewhat with regard to their ex- posure to these kinds of media: women with the highest levels of education are the least likely to report that they watch television weekly, while women with no education are the least likely to report listening to the radio. It should be noted that while about one-fourth of women with higher than secondary educa- tion were exposed to all three media, less than 1 percent of women with no education report the same. The relationship between residence and exposure to mass media varies depending on the type of media. Women in urban areas are more likely to read the newspaper (38 percent) than women in rural areas (28 percent). The opposite holds for viewing television, where rural women are more likely than urban women to watch television (90 percent and 79 percent respectively). The extent to which women Table 3.3 Exposure to Jordanian mass media Percentage of ever-married women who usually read a Jordanian newspaper at least once a week, watch Jordanian television at least once a week, and listen to Jordanian radio at least once a week, by background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure ––––––––––––––––––––––––––––––––– Reads a Watches Listens to Jordanian Jordanian Jordanian newspaper television radio at least at least at least All No Number Background once once once three mass of characteristic a week a week a week media media women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 27.2 79.7 44.3 12.8 14.2 158 20-24 32.2 81.8 42.3 16.3 10.1 728 25-29 35.6 80.2 39.1 15.4 9.6 1,175 30-34 36.5 81.1 45.3 17.9 9.9 1,354 35-39 39.7 80.7 42.6 17.3 9.3 1,071 40-44 39.1 79.1 43.1 19.7 10.7 862 45-49 33.9 85.2 51.7 18.3 7.8 659 Residence Urban 38.4 78.8 43.7 17.8 10.7 4,799 Rural 27.6 89.8 43.4 15.3 6.1 1,207 Region Central 40.3 76.4 46.1 18.8 11.3 3,898 North 28.2 90.3 37.9 14.3 6.7 1,542 South 30.3 88.0 42.1 15.4 7.7 566 Educational level attended No education 0.7 86.0 36.6 0.7 12.0 363 Elementary 11.5 83.1 41.1 5.8 12.0 689 Preparatory 29.0 87.0 43.4 15.7 8.2 1,231 Secondary 41.2 80.9 45.6 19.6 8.6 2,247 Higher 54.8 74.1 43.7 24.5 11.3 1,476 Preparatory + secondary 36.9 83.1 44.8 18.2 8.4 3,478 Total 36.2 81.1 43.6 17.3 9.8 6,006 Respondents’ Background Characteristics │ 23 listen to the radio does not vary substantially by urban-rural residence. Women living in the Central re- gion are more likely than in the other two regions to read newspapers and listen to the radio, but less likely to watch television. 3.4 RESPONDENTS’ EMPLOYMENT CHARACTERISTICS In the 2002 JPFHS, respondents were asked a number of questions about their employment, including whether they were currently working or not. Women who were currently working were then asked a number of questions about the kind of work they do, their employment status, who makes the de- cision about how their earnings are used, and what proportion of household expenditures are paid for by the income gained from their own employment. 3.4.1 Employment Status The majority of women (90 percent) are not working, nor have they worked during the last seven days prior to the survey (Table 3.4): only one in ten women was employed in the seven days preceding the survey. The proportion of women who were not employed ranges from 99 percent among those age 15-19 to 87 percent among those age 35-44. Differentials in employment status by urban-rural residence are small; however, a greater propor- tion of women in the South region report current employment (16 percent) than in other regions. This finding seems contrary to the conventional wisdom that higher education increases the likelihood of em- ployment, as women in the South region are the least likely to have any education. While women with post-secondary education are much more likely to report having been employed in the week prior to the survey than any other educational group, those with the second-greatest amount of education (preparatory and secondary) are less likely to work than women with no education at all. Marital status seems to have a bearing on employment status. The proportion of working women rises from 10 percent among those married and widowed to 16 percent among divorced women. When the number of living children is considered, the percentage of working women rises from 9 percent for those with no children to 12 percent for those with one or two children, and then drops to 7 percent for those with five or more children. 24 │ Respondents’ Background Characteristics 3.4.2 Occupation Table 3.5 shows that among women who report having been employed in the seven days prior to the survey, a large proportion is engaged in professional and technical occupations (70 percent), while 9 percent are employed in sales work. About 7 percent of women are engaged in clerical work, and 6 per- cent in craft and related trade occupations. The percentages vary considerably by background characteris- tics of women. The data also indicate that 86 percent of employed women are paid workers and 8 percent are self-employed (data not shown). Table 3.4 Employment status Percent distribution of ever-married women by employment status, according to background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed Not employed in the 7 days in the 7 days Background preceding preceding Number characteristic the survey the survey Total of women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.2 98.8 100.0 158 20-24 4.4 95.6 100.0 728 25-29 7.1 92.9 100.0 1,175 30-34 11.9 88.1 100.0 1,354 35-39 12.8 87.2 100.0 1,071 40-44 13.3 86.7 100.0 862 45-49 8.0 92.0 100.0 659 Marital status Married 9.6 90.4 100.0 5,706 Divorced 16.0 84.0 100.0 130 Widowed 9.9 90.1 100.0 170 Number of living children 0 8.7 91.3 100.0 521 1-2 12.2 87.8 100.0 1,490 3-4 11.3 88.7 100.0 1,807 5+ 7.0 93.0 100.0 2,188 Residence Urban 9.4 90.6 100.0 4,799 Rural 11.0 89.0 100.0 1,207 Region Central 8.4 91.6 100.0 3,898 North 10.6 89.4 100.0 1,542 South 16.4 83.6 100.0 566 Educational level attended No education 5.7 94.3 100.0 363 Elementary 2.6 97.4 100.0 689 Preparatory 2.2 97.8 100.0 1,231 Secondary 4.7 95.3 100.0 2,247 Higher 27.8 72.2 100.0 1,476 Preparatory + secondary 3.8 96.2 100.0 3,478 Total 9.7 90.3 100.0 6,006 Respondents’ Background Characteristics │ 25 It is of interest to note that while Table 3.5 reflects expected urban-rural differences for agricul- tural employment (1 percent and 6 percent, respectively), there is not a pronounced urban-rural difference in the professional-technical-managerial sector: 71 percent of employed urban women are in this sector, as compared with 68 percent of employed rural women. The proportion of women employed in the pro- fessional-technical-managerial sector is up from 64 percent in 1997 to 70 percent in 2002. Table 3.5 Occupation Percent distribution of all ever-married women employed in the 7 days preceding the survey by occupation, according to background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Occupation ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Plant and Service Skilled Craft machine Technicians workers, agricultural and operators Ele- Legislators and associ- shop, and and related and related mentary Number Background and senior Pro- ate pro- market sales fishery trades occu- occupa- of characteristic officials fessionals fessionals Clerks workers workers workers pations tions1 Missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 * * * * * * * * * * * 2 20-24 (0.0) (30.3) 24.9 8.6 25.8 0.0 10.4 0.0 0.0 0.0 100.0 32 25-29 0.0 45.1 32.9 7.0 9.7 1.3 3.5 0.0 0.6 0.0 100.0 83 30-34 0.2 37.2 34.1 7.0 11.9 0.0 2.7 1.4 4.7 0.7 100.0 162 35-39 0.0 33.8 35.5 7.9 4.8 2.9 7.3 0.0 6.9 0.8 100.0 137 40-44 0.0 31.3 44.2 6.0 2.4 0.4 9.7 0.0 6.1 0.0 100.0 115 45-49 0.0 29.0 22.3 5.7 8.7 11.0 6.9 0.0 16.3 0.0 100.0 53 Marital status Married 0.1 35.8 36.6 7.3 7.3 1.8 5.4 0.4 5.0 0.4 100.0 546 Divorced * * * * * * * * * * * 21 Widowed * * * * * * * * * * * 17 Number of living children 0 0.0 27.3 43.9 14.4 6.8 0.0 2.3 0.0 5.3 0.0 100.0 45 1-2 0.0 44.4 30.7 4.1 10.9 0.5 7.4 0.0 2.1 0.0 100.0 181 3-4 0.2 40.8 32.5 8.8 7.4 0.9 4.1 1.1 3.6 0.5 100.0 204 5+ 0.0 19.0 40.3 5.6 7.6 5.6 8.3 0.0 12.9 0.7 100.0 153 Residence Urban 0.1 36.3 34.2 6.9 9.9 0.8 6.4 0.5 4.9 0.0 100.0 450 Rural 0.0 31.1 37.0 7.1 3.5 5.9 5.1 0.0 8.6 1.7 100.0 133 Region Central 0.0 36.1 30.2 7.7 10.7 1.9 8.5 0.7 4.0 0.3 100.0 327 North 0.2 34.4 41.2 2.9 7.3 1.6 3.8 0.0 7.9 0.7 100.0 164 South 0.0 32.9 40.2 11.5 2.7 2.9 1.8 0.0 8.0 0.0 100.0 93 Educational level attended No education (0.0) (0.0) (0.0) (0.0) (15.4) (35.4) (9.8) (0.0) (39.4) (0.0) 100.0 21 Elementary (0.0) (0.0) (0.0) (0.0) (16.8) (13.5) (31.5) (0.0) (38.2) (0.0) 100.0 18 Preparatory 0.0 0.0 3.6 3.2 16.9 5.9 32.7 0.0 37.6 0.0 100.0 28 Secondary 0.0 0.0 21.5 30.9 24.9 0.0 16.1 2.2 3.5 1.1 100.0 106 Higher 0.1 49.8 43.7 1.7 3.0 0.0 0.4 0.0 1.0 0.3 100.0 411 Preparatory + secondary 0.0 0.0 17.8 25.2 23.3 1.2 19.5 1.7 10.5 0.8 100.0 134 Total 0.1 35.1 34.9 7.0 8.5 2.0 6.1 0.4 5.7 0.4 100.0 584 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Mainly in sales, services, and agriculture 26 │ Respondents’ Background Characteristics 3.4.3 Decision on Use of Women’s Earnings Women earning cash for their work were asked who mainly decides how their earnings will be used, and the proportion of household expenditures that is met by their earnings. Table 3.6 shows that 49 percent of women reported that they and their husband or someone else jointly decide on how the money is to be spent, and 46 percent of women stated that it is their sole decision. Older women, women Table 3.6 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of ever-married women employed in the 7 days preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to back- ground characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person who decides how Proportion of household expenditures earnings are used met by earnings –––––––––––––––––––––––––– –––––––––––––––––––––––––––––––– Someone Almost Less Half Number Background Self else none/ than or of characteristic only Jointly1 only2 Total none half more All Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 * * * * * * * * * 2 20-24 (40.7) (43.9) (15.4) (100.0) (8.2) (30.9) (54.2) (6.7) (100.0) 31 25-29 39.9 54.1 6.0 100.0 12.3 19.8 57.2 10.6 100.0 82 30-34 43.4 52.8 3.8 100.0 7.0 23.4 56.2 13.4 100.0 157 35-39 46.7 48.7 4.6 100.0 4.2 14.7 67.3 13.8 100.0 133 40-44 49.1 46.6 4.3 100.0 6.5 10.8 61.8 20.9 100.0 113 45-49 (64.4) (31.3) (4.3) (100.0) (0.0) (24.3) (55.2) (20.5) (100.0 ) 46 Marital status Married 42.8 52.0 5.2 100.0 6.3 18.4 63.1 12.3 100.0 526 Divorced * * * * * * * * * 21 Widowed * * * * * * * * * 17 Number of living children 0 59.5 35.9 4.5 100.0 20.6 28.7 45.1 5.6 100.0 45 1-2 38.8 55.6 5.6 100.0 6.0 21.7 57.0 15.3 100.0 179 3-4 43.8 50.8 5.4 100.0 5.8 14.2 66.9 13.1 100.0 199 5+ 54.8 41.1 4.2 100.0 3.6 18.0 59.0 19.4 100.0 141 Residence Urban 47.2 47.4 5.4 100.0 7.4 19.1 59.3 14.2 100.0 441 Rural 42.7 53.2 4.1 100.0 3.1 17.4 62.6 16.9 100.0 123 Region Central 48.3 46.9 4.8 100.0 8.6 19.0 56.1 16.3 100.0 317 North 47.4 47.9 4.8 100.0 2.9 19.1 66.8 11.2 100.0 155 South 36.9 56.3 6.8 100.0 5.2 17.2 62.0 15.6 100.0 91 Educational level attended No education * * * * * * * * * 16 Elementary * * * * * * * * * 13 Preparatory (81.5) (11.8) (6.7) (100.0) (7.3) (23.4) (37.9) (31.5) (100.0) 23 Secondary 47.4 45.0 7.6 100.0 1.9 23.1 60.9 14.1 100.0 104 Higher 41.7 54.2 4.1 100.0 8.1 17.1 63.2 11.7 100.0 407 Preparatory + secondary 53.7 38.9 7.4 100.0 2.9 23.1 56.7 17.3 100.0 127 Total 46.2 48.7 5.1 100.0 6.5 18.7 60.0 14.8 100.0 564 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 With husband or someone else 2 Includes husband Respondents’ Background Characteristics │ 27 in urban areas, women who reside in the North and Central regions, and those with no children are more likely than women in other categories to make independent decisions on spending their earnings. As re- gards the proportion of household expenditures met by women’s earnings, Table 3.6 shows that 60 per- cent of women reported that their earnings meet half or more of household expenditures, 19 percent said that they meet less than half and 15 percent reported that they cover all household expenditures. In gen- eral, older women, women with more children, rural women and those living in the Central and South regions are more likely than women in other categories to fully cover household expenditures from their earnings. 3.5 WOMEN’S PARTICIPATION IN HOUSEHOLD DECISIONMAKING In order to identify the role of women in household decisionmaking, the respondents were asked about the person who usually has the final decision on the following five issues: respondent’s own health care, large household purchases, daily household purchases, visits to family or relatives, and what food to cook daily. Table 3.7 shows that currently married women have the final say on what food to be cooked daily (69 percent), whereas 66 percent reported that visiting family and relatives is decided jointly with the husband. Purchase of either large or daily household needs is more likely to be the decision of the hus- band alone (34 percent and 31 percent respectively) than any other category of decisionmaking; however, most currently married women (64 percent) have a say in these matters, either alone or jointly with their spouse. As regards the respondents’ own health care, 61 percent of currently married women reported that they decide for themselves about seeking their own health care, and one in four women said that such de- cision is made jointly with the husband. Twelve percent of women reported that their husbands have the final say over their wives’ health care. Regarding currently unmarried women, Table 3.7 indicates that divorced or widowed women are more likely to have the final say regarding their own health care (88 percent) than are married women (61 percent). Women who are not currently married are much more likely to have the final say with re- gard to decisions made about any kind of purchase, or with regard to visiting family or relatives, than are currently married women. However, it is of interest to note that for a full 25 percent of these women, someone else has the final word when it comes to making decisions about purchases. Table 3.7 Women’s participation in decisionmaking Percent distribution of all ever-married women by person who has the final say in making specific decisions, according to current marital status and type of decision, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married Not married1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––– Jointly Jointly Decision Jointly Decision with with Hus- Someone not Number with Someone not Number Self hus- someone band else made/not of Self someone else made/not of Decision only band else only only applicable Total women only else only applicable Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Own health care 61.4 25.9 0.5 11.7 0.5 0.0 100.0 5,706 87.7 4.6 7.2 0.6 100.0 300 Large household purchases 10.5 53.0 0.5 33.6 2.2 0.2 100.0 5,706 59.4 11.2 25.3 4.1 100.0 300 Daily household purchases 37.4 26.8 0.8 31.2 3.7 0.0 100.0 5,706 62.5 8.0 25.5 4.0 100.0 300 Visits to family/relatives or friends 15.5 66.0 0.7 16.8 0.9 0.1 100.0 5,706 61.6 15.5 18.8 4.0 100.0 300 What food to cook each day 69.2 19.1 4.5 4.0 3.0 0.2 100.0 5,706 60.9 15.4 20.0 3.7 100.0 300 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Divorced or widowed women 28 │ Respondents’ Background Characteristics Table 3.8 demonstrates women’s participation in household decisionmaking according to back- ground characteristics. Forty-two percent of women decided alone or jointly with another person on all five of the said issues (Figure 3.1), whereas only one percent of women did not have a say in making de- cisions on any of these issues. Women are most likely to have the final or joint say with regard to what foods are cooked each day (92 percent) and their own health care (88 percent), while they are least likely to participate in decisionmaking about large or daily household purchases (64 percent and 65 percent, re- spectively). Table 3.8 Women’s participation in decisionmaking by background characteristics Percentage of all ever-married women who say that they alone or jointly have the final say in specific decision, by background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Alone or jointly has final say in: ––––––––––––––––––––––––––––––––––––––––––––––– Daily Visits to What None Own Large household family, food All of the Number Background health household pur- relatives, to cook specified specified of characteristic care purchases chases friends daily decisions decisions women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 78.9 41.1 46.3 58.2 71.4 17.6 5.2 158 20-24 83.4 58.4 52.8 71.7 85.3 31.5 2.9 728 25-29 87.7 59.2 61.4 79.0 91.6 36.4 0.5 1,175 30-34 89.1 64.1 68.6 84.3 93.4 42.7 0.5 1,354 35-39 89.6 68.0 68.7 85.6 96.1 47.2 0.6 1,071 40-44 90.7 70.2 73.5 86.7 94.8 50.7 1.0 862 45-49 87.9 72.5 67.3 87.1 91.9 47.1 0.2 659 Marital status Married 87.8 64.0 65.0 82.2 92.8 41.1 0.9 5,706 Divorced 92.2 49.5 50.4 55.4 55.6 31.9 3.8 130 Widowed 92.3 86.7 85.8 93.6 92.2 75.3 1.3 170 Number of living children 0 82.9 57.8 55.0 74.8 81.8 32.8 2.8 521 1-2 87.4 61.4 61.2 77.2 88.3 37.8 1.3 1,490 3-4 88.3 66.6 67.3 85.2 94.1 44.3 0.7 1,807 5+ 89.5 66.0 68.8 84.3 95.2 44.8 0.5 2,188 Residence Urban 88.5 64.6 66.8 83.2 91.8 43.0 1.0 4,799 Rural 86.3 63.4 59.1 77.1 92.9 37.2 0.8 1,207 Region Central 88.9 64.9 67.7 81.7 91.7 44.5 1.1 3,898 North 86.3 64.2 61.0 83.2 92.6 36.8 0.6 1,542 South 86.9 61.0 60.5 80.6 92.5 37.7 0.8 566 Educational level attended No education 83.4 55.0 58.2 72.6 91.6 35.4 0.8 363 Elementary 85.8 59.2 65.1 75.1 91.5 37.8 1.7 689 Preparatory 87.0 60.0 64.0 79.4 90.3 38.8 1.6 1,231 Secondary 88.5 63.3 65.6 82.0 91.2 41.8 0.9 2,247 Higher 90.5 74.2 67.6 89.6 95.0 48.0 0.2 1,476 Preparatory + secondary 87.9 62.1 65.0 81.1 90.9 40.7 1.2 3,478 Employment Not employed 87.6 63.1 64.9 81.3 91.9 41.0 1.1 5,422 Employed 92.3 76.0 68.2 88.3 93.0 50.1 0.1 584 Total 88.1 64.3 65.3 82.0 92.0 41.9 1.0 6,006 Respondents’ Background Characteristics │ 29 Figure 3.1 Distribution of Women According to the Number of Decisions in Which They Participate in the Final Say JPFHS 2002 Four decisions 27% Five decisions 42% Three decisions 17% Two decisions 9% One decision 4% 0 decisions 1% Older women, those with more living children, those living in urban areas, women with higher education, and employed women are more likely than women in other categories to participate in house- hold decisionmaking on all of the five issues. Eighty-three percent of uneducated women participate in the final decision regarding their own health care, in contrast to 91 percent of those with higher than sec- ondary education. One in two uneducated women participates in the final say on household large pur- chases, compared with three in four women with higher than secondary education. Widowed women have the greatest amount of decisionmaking power compared with currently married or divorced women. It is interesting that there is very little regional variation within each of the specified categories of decisionmaking. The decision that demonstrates the greatest regional variation is that regarding daily pur- chases: women living in the Central Region are more likely to have a say in daily purchases (68 percent) than women living in the North or South regions (61 percent). Women in the Central Region are also the most likely to have a say in all specified decisions. 3.6 DOMESTIC VIOLENCE: WOMEN’S ATTITUDES TOWARD WIFE BEATING In recent years, there has been increasing concern about violence against women in general, and domestic violence in particular, in both developed and developing countries (United Nations General As- sembly, 1991). Not only has domestic violence against women been acknowledged worldwide as a viola- tion of the basic human rights of women, but an increasing amount of research highlights the health bur- dens, intergenerational effects, and demographic consequences of such violence (Heise et al., 1998, 1994; Jejeebhoy, 1998; Ramasubban and Singh, 1998; Rao and Bloch, 1993). Both tolerance of and experience of domestic violence are significant barriers to the empower- ment of women, with consequences for women’s health, their health-seeking behavior, and the health of their children. In JPFHS 2002, women were asked questions with regard to whether they viewed wife beating as justified. 30 │ Respondents’ Background Characteristics Learning more about attitudes toward domestic violence is important in a context such as Jordan where, in some cases, domestic violence and even murder of one’s wife or daughter, called “honour kill- ing” (Faqir, 2001), has been justified by ideas about family honor and what is required to keep it intact. In order to assess women’s attitudes toward wife beating, the survey asked whether respondents thought that a husband is justified in beating his wife for each of the following reasons: if she burns the food, argues with him, goes out without telling him, neglects the children, disobeys the husband, insults the husband, betrays the husband, violates the religion, or disrespects his family. These reasons, which range from reasons that involve suspicions about a wife’s moral character to those that may be considered more trivial, such as not cooking properly, were chosen to provide variation in the perceived seriousness of violations of behavioral norms. Table 3.9 gives the percentages of ever-married women who agree with various reasons for wife beating by background characteristics. The vast majority (87 percent) of women accept at least one reason as a justification for wife beating. Women are most likely to agree that betraying the husband justifies wife beating (83 percent), while almost no women cite a woman’s violation of religion or her disrespect of the husband’s family as reasons for wife beating (0.2 percent), and relatively few believe that a man is justified in hitting his wife if she argues with him (4 percent) or insults him (10 percent). Sixty percent of women agree that a hus- band is justified in using violence against his wife if she burns the food, and 52 percent believe the same if she disobeys her husband. Table 3.9 indicates that the youngest women are the most likely to agree with each of the different reasons justifying wife beating, with the exception being if a wife argues with her husband, with which reason the oldest age group is most likely to agree. With regard to marital status, the only consis- tent pattern is that widowed women are the most likely to agree with most of the specified justifications for wife beating. Women with no children look quite a lot like women with several children in terms of their will- ingness to accept justifications for wife beating: 90 percent of women with no children accept at least one reason for wife beating, as do 90 percent of women with five or more children. Women with 1-2 and 3-4 children are somewhat less likely to justify wife beating. There are also differences in terms of justification of violence between those who live in urban versus rural areas, with urban women being less likely to accept justifications of violence (urban: 86 per- cent; rural: 92 percent). Table 3.9 and Figure 3.2 also indicate that women who have more education, who are employed, or who have more say in household decisionmaking are the least likely to agree with any of the reasons for justifying wife beating. Respondents’ Background Characteristics │ 31 Table 3.9 Women’s attitude toward wife beating Percentage of all ever-married women who agree that a husband is justified in hitting or beating his wife for specific reasons, according to back- ground characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Husband is justified in hitting or beating his wife if she: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Shows Agrees Goes out disrespect with at Burns Argues without Neglects Disobeys Insults Betrays Violates for least one Number Background the with telling the the the the the husband’s specified of characteristic food him him children husband husband husband religion family reason women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 72.9 4.7 34.7 45.9 69.9 18.1 90.9 0.0 0.0 94.8 158 20-24 63.2 2.6 26.8 38.4 56.1 9.2 89.1 0.4 0.2 91.3 728 25-29 60.0 2.7 21.7 34.1 52.1 7.5 85.6 0.0 0.1 89.3 1,175 30-34 56.3 3.3 20.1 31.3 48.2 8.7 83.3 0.1 0.0 86.2 1,354 35-39 59.4 4.5 24.9 36.8 52.3 9.8 82.8 0.4 0.4 86.7 1,071 40-44 57.9 5.0 22.7 37.2 49.8 11.7 79.3 0.0 0.3 83.4 862 45-49 59.8 8.6 31.2 46.6 55.6 17.5 78.3 0.7 0.0 83.6 659 Marital status Married 59.5 4.0 23.9 36.3 52.1 10.1 83.6 0.2 0.2 87.2 5,706 Divorced 58.9 6.1 25.0 39.1 52.0 12.3 77.3 0.0 0.0 81.1 130 Widowed 60.2 7.6 27.6 44.1 59.5 16.8 81.9 0.0 0.0 86.3 170 Number of living children 0 62.5 7.4 31.7 41.6 56.9 12.8 86.2 0.3 0.1 90.3 521 1-2 55.7 2.4 20.5 32.2 48.0 7.1 81.2 0.1 0.2 84.9 1,490 3-4 54.9 2.6 18.7 29.4 47.2 7.7 81.0 0.1 0.1 84.3 1,807 5+ 65.1 6.0 29.1 44.3 58.3 14.2 86.3 0.4 0.3 90.0 2,188 Residence Urban 56.1 3.0 20.8 33.2 49.1 8.2 82.4 0.2 0.1 85.7 4,799 Rural 72.9 9.0 37.1 49.9 64.8 19.0 87.7 0.2 0.5 92.2 1,207 Region Central 56.1 3.1 20.7 32.4 49.8 8.9 82.3 0.2 0.2 85.2 3,898 North 63.8 5.0 27.4 43.1 54.3 11.1 84.2 0.2 0.0 90.0 1,542 South 70.7 9.1 37.9 47.7 63.7 18.1 89.2 0.7 0.5 91.8 566 Educational level attended No education 84.1 21.0 63.1 73.6 82.8 41.7 93.0 0.0 0.0 96.9 363 Elementary 77.6 10.5 48.0 57.3 72.5 23.1 90.8 0.4 0.1 94.5 689 Preparatory 69.3 5.4 28.2 43.1 61.5 13.5 86.3 0.2 0.2 91.0 1,231 Secondary 58.9 1.4 19.5 34.0 49.8 5.4 85.3 0.1 0.2 88.2 2,247 Higher 37.6 0.3 6.7 16.4 31.4 1.6 72.4 0.5 0.3 76.1 1,476 Preparatory + secondary 62.6 2.8 22.6 37.2 53.9 8.3 85.6 0.1 0.2 89.2 3,478 Employment Not employed 61.3 4.4 25.5 38.3 54.0 10.9 84.7 0.2 0.2 88.4 5,422 Employed 42.6 1.8 11.1 20.8 35.8 5.7 71.2 0.5 0.4 74.5 584 Number of decisions in which woman has final say 0 69.0 10.8 41.3 49.7 65.8 30.3 92.4 0.0 0.0 97.6 58 1-2 69.7 8.7 36.9 49.5 63.7 18.5 89.8 0.1 0.0 92.9 765 3-4 62.7 3.6 24.4 36.6 55.6 9.7 86.4 0.2 0.2 89.9 2,669 5 52.7 3.3 19.4 32.3 45.0 8.2 78.1 0.3 0.2 82.0 2,515 Total 59.5 4.2 24.1 36.6 52.3 10.4 83.4 0.2 0.2 87.0 6,006 32 │ Respondents’ Background Characteristics Figure 3.2 Percentage of Women Who Agree with at Least One Reason Justifying a Husband Beating His Wife 87 97 95 91 88 76 88 75 Jordan No education Elementary Preparatory Secondary Higher Not employed Employed 0 20 40 60 80 100 Percent JPFHS 2002 EDUCATION EMPLOYMENT 3.7 WOMEN’S AGREEMENT WITH REASONS FOR REFUSING SEXUAL RELATIONS The extent of control women have over when they have sex has important implications for demo- graphic and health outcomes. To measure women’s agreement with a woman’s right to refuse her hus- band sex, the JPFHS 2002 asked respondents whether a wife is justified in refusing to have sex with her husband under three circumstances: she is tired or not in the mood, she has recently given birth, and she knows her husband has a sexually transmitted infection or AIDS. These three circumstances for which women’s opinions are sought were chosen because they are effective in combining women’s rights and women’s health issues. Table 3.10 shows the percentage of women who say that women are justified in refusing sex to their husband for specific reasons by background characteristics. Note that, unlike in the case of the previous indicator of empowerment, this indicator is positively related to empowerment: the more reasons women agree with, the higher is their “empowerment” in terms of their belief in women’s sexual rights. For any given reason, the majority of women age 15-49 in Jordan agree that women can refuse sex to their husband: 94 percent believe a wife is justified in refusing her husband sex if he has a sexually transmitted infection, 95 percent believe the same if a wife has recently given birth, and 69 percent also agree that a wife is justified in refusing sex with her husband if she is tired or not in the mood. A very small proportion of women (1 percent) said that women were not justified in refusing their husband sex for any of the given reasons. Because almost all Jordanian women agree that wives are justified in refusing sex under the stated circumstances, there is little variation in agreement by demographic factors, especially regarding refusal due to husband’s STI or due to recent childbirth. Nevertheless, some patterns of agreement do emerge: agreement with reasons for refusing sex increases with level of education, and employed women are marginally more likely to agree with any reason than women who are not employed. For example, 79 percent of women with no education agree that a wife is justified in refusing sexual relations with her husband if he has an STI; among those with higher than secondary education, 98 percent agree with the wife’s right to refuse. Respondents’ Background Characteristics │ 33 Table 3.10 Women’s attitude toward refusing sex with husband Percentage of all ever-married women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, according to background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife is justified in refusing sex with her husband if she: ––––––––––––––––––––––––––––––––––––––––––––– Percentage Knows who agree husband has Is tired with none a sexually Has or not of the Number Background transmitted recently in the specified of characteristic disease given birth mood reasons women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 89.5 94.0 65.0 0.2 158 20-24 93.1 96.3 64.4 0.9 728 25-29 93.7 94.5 70.5 1.6 1,175 30-34 96.4 95.6 69.4 0.9 1,354 35-39 95.5 95.7 69.8 1.2 1,071 40-44 94.1 96.0 68.5 1.9 862 45-49 92.4 93.5 68.3 2.7 659 Marital status Married 94.4 95.3 68.8 1.3 5,706 Divorced 92.6 92.3 73.1 4.5 130 Widowed 93.0 95.8 62.9 3.0 170 Number of living children 0 92.1 92.9 62.5 1.5 521 1-2 95.0 96.0 70.6 1.2 1,490 3-4 95.5 95.5 70.2 1.1 1,807 5+ 93.5 95.2 67.6 1.8 2,188 Residence Urban 94.9 95.5 68.8 1.3 4,799 Rural 92.3 94.5 68.4 1.6 1,207 Region Central 94.2 95.0 67.4 1.5 3,898 North 95.3 96.7 71.8 0.7 1,542 South 93.0 93.7 69.2 2.3 566 Educational level attended No education 79.3 86.7 61.5 7.3 363 Elementary 90.6 91.6 65.1 3.2 689 Preparatory 93.7 96.0 68.4 1.0 1,231 Secondary 96.2 96.4 70.7 0.8 2,247 Higher 97.6 96.9 69.4 0.4 1,476 Preparatory + secondary 95.3 96.2 69.9 0.9 3,478 Employment Not employed 94.1 95.2 68.5 1.5 5,422 Employed 96.5 96.4 70.3 0.5 584 Number of decisions in which woman has final say 0 84.8 82.9 60.1 8.4 58 1-2 90.7 93.0 67.4 3.3 765 3-4 94.6 95.8 66.8 0.9 2,669 5 95.4 95.7 71.3 1.2 2,515 Number of reasons wife beating is justified 0 96.5 97.3 76.6 0.4 778 1-2 96.2 96.4 71.6 0.9 2,086 3-4 94.2 95.1 65.1 1.3 1,925 5+ 90.1 92.3 64.5 3.0 1,217 Total 94.4 95.3 68.7 1.4 6,006 34 │ Respondents’ Background Characteristics As would be expected, women who are most empowered in terms of the number of decisions in which they participate in the final say are also the most likely to agree that a wife is justified in refusing sex to her husband. This relationship holds in terms of justification of domestic violence: women who say that domestic violence is never justified are the most likely to agree with any of the three reasons for re- fusing sex. Among women who do not agree with any justifications of domestic violence, 76 percent think that a wife is justified in refusing sex if she is tired or not in the mood, while among women who agree with 5 or more justifications for wife beating, 65 percent believe a wife who is tired or not in the mood is justified in refusing sexual relations. Fertility │ 35 FERTILITY 4 Fertility measures in this chapter are based on the reported birth histories of ever-married women age 15 to 49 who were interviewed in the 2002 JPFHS. Data were collected in two sections. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the num- ber living elsewhere, and the number who had died. Next, for each live birth, she was asked to report the sex, date of birth, whether the birth was single or multiple, and whether the child was living in the house- hold or elsewhere. The survival status of each live birth was also asked. For deceased children, the age at death was recorded. As an indicator of future fertility, information was collected on whether married women were pregnant at the time of the interview. Through previous experience in using birth histories to estimate fertility levels and trends, it has been found that the underreporting of children ever born and the displacement of children’s dates of birth are common in many countries. Underreporting of children affects estimates of fertility levels, whereas misreporting of children’s date of birth distorts fertility trends over time. Regarding the latter, one of the characteristics of the 2002 JPFHS is the high quality of age and date reporting. Virtually all women knew their age, their age at marriage and their date of marriage. For children’s age and date of birth reporting, both month and year of birth are documented for all births recorded in the birth history (see Table C.3 in Appendix C). This information lends confidence to the quality of basic data used in the estimation of fer- tility measures. Because fertility rates presented in this chapter are based on direct measures derived from the birth history section of the JPFHS, two potential drawbacks require some attention. First, only surviving women were interviewed in the survey. This would bias the rates if mortality of women of childbearing age were high and if fertility of surviving and non-surviving women differed significantly – neither of which is the case in Jordan. Limiting the survey respondents to ever-married women presents another po- tential bias. The number of births to single women in Jordan is negligible. Although information on fertil- ity was obtained only from ever-married women, estimates can be made for all women (regardless of marital status) based on information in the household questionnaire; these estimates assume that women who have never been married have had no children. This chapter also analyzes levels of fertility by background characteristics of women, which in- clude age, residence, and education level. Factors related to fertility – including the mean age at birth, birth intervals, and teenage fertility – are also analyzed. 4.1 FERTILITY LEVELS AND TRENDS Age-specific fertility rates and total fertility rates (TFR) for the three-year period preceding the survey are shown in Table 4.1, along with data from four previous surveys for comparison – the 1976 Jordan Fertility Survey (JFS), the 1983 Jordan Fertility and Family Health Survey (JFFHS), and the 1990 and 1997 JPFHS. Data for the 1976 survey are calculated based on the two years preceding the survey (1975-1976), while those for 1983, 1990, 1997 and 2002 refer to the three years preceding the survey (1981-1983, 1988-1990, 1995-1997, and 2000-2002 respectively). Comparison of the findings from the five surveys shows the trends in fertility levels over a 26-year period. The TFR is the sum of the age-specific fertility rates; it represents the average number of children a woman in Jordan would have at the end of her reproductive years if she were subject to the observed 36 │ Fertility age-specific rates. At current levels, a woman would give birth to an average of 3.7 children in her life- time. That is 50 percent lower than the rate recorded in 1976 (7.4 births per woman). Data in Table 4.1 indicate that the pace of fertility decline has been faster in recent years. For example, fertility declined 11 percent between 1976 and 1983 (dropping from 7.4 to 6.6 births per woman), 15 percent between 1983 and 1990 (dropping from 6.6 to 5.6 births per woman), 21 percent between 1990 and 1997 (dropping from 5.6 to 4.4 births per woman), and 16 percent between 1997 and 2002 (dropping from 4.4 to 3.7 births per woman). In the past twelve years (1990-2002), the total fertility rate in Jordan has declined by 34 percent. Decline in fertility levels in Jordan occurred among all age groups; however, the most significant proportional decline is that which has been observed among teenagers – a 60 percent drop from 71 births in the 1976 JFS to 28 births per 1,000 women in the 2002 JPFHS. Figure 4.1 shows that the bulk of the decline in fertility since 1990 can be attributed to the decrease in the number of births among women be- tween the ages of 20 and 39. At the same time, the age-specific fertility rates in all of the surveys are highest for the 25-29 age group. Table 4.1 Trends in fertility Age-specific fertility rates and total fertility rates, selected surveys, Jordan 1976-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– JFS JFFHS JPFHS JPFHS JPFHS Age group 19761 19832 19902 19972 20022 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 71 49 49 43 28 20-24 300 229 219 172 150 25-29 367 335 296 246 202 30-34 332 305 264 206 184 35-39 240 233 188 144 122 40-44 112 127 79 48 43 45-49 47 40 19 11 5 TFR 15-49 7.4 6.6 5.6 4.4 3.7 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– TFR: Total fertility rate, expressed per woman 1 Based on the two years preceding the survey 2 Based on the three years preceding the survey Fertility │ 37 Table 4.2 Current fertility Age-specific and cumulative fertility rates, the gen- eral fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Age group Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––– 15-19 30 20 28 20-24 146 162 150 25-29 196 225 202 30-34 176 213 184 35-39 117 140 122 40-44 39 62 43 45-49 4 7 5 TFR 15-49 3.5 4.2 3.7 GFR 118 132 122 CBR 28.4 31.3 29.0 ––––––––––––––––––––––––––––––––––––––––––– Note: Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by num- ber of women 15-44) expressed per 1,000 women CBR: Crude birth rate expressed per 1,000 popu- lation Figure 4.1 Trends in Age-specific Fertility Rates, Various Sources, 1976-2002 , , , , , , ,) ) ) ) ) ) )' ' ' ' ' ' ' & & & & & & & # # # # # # # 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 100 200 300 400 Births per 1,000 women JFS 1976 JFFHS 1983 JPFHS 1990 JPFHS 1997 JPFHS 2002# & ' ) , Table 4.2 and Figure 4.2 present the age-specific fertility rates and cumulative fertility for the three-year period preceding the survey by urban-rural residence. In Table 4.2, the general fertility rate (GFR) is the annual number of live births per 1,000 women age 15-44 in the three years preceding the survey. The crude birth rate (CBR) is the annual number of live births per 1,000 population for the same period. In general, women in rural areas have almost one child more than urban women (4.2 births compared with 3.5 births). The most significant differences are found in the middle of the women’s reproductive period (age 30-34), where rural women have an average 0.037 births more than urban women. Ac- cording to the age-specific fertility rates shown in the table, women in Jordan will have, on average, less than one child by age 25, but will have almost three children (2.8) by the time they are 35 years old. Table 4.2 also indicates that the overall crude birth rate is 29 per 1,000, yet it is slightly higher in rural than in urban areas (31 per 1,000 and 28 per 1,000 respectively). The GFR reached 122 births per 1,000 women age 15-44. The rate differs according to residence, where it is higher in rural areas (132 per 1,000) compared with urban areas (118 per 1,000). 38 │ Fertility Table 4.3 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by back- ground characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––– Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant1 age 40-49 ––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 3.5 6.1 5.7 Rural 4.2 7.3 7.1 Region Central 3.5 5.9 5.5 North 3.9 6.8 6.9 South 4.0 8.1 6.4 Educational level attended No education 3.6 5.3 7.4 Elementary 3.7 5.8 6.9 Preparatory 4.4 7.6 6.9 Secondary 3.9 6.4 5.1 Higher 3.1 5.7 4.1 Preparatory + secondary 4.0 6.8 6.0 Total 3.7 6.3 5.9 ––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Rate for women age 15-49 years Figure 4.2 Age-specific Fertility Rates by Urban-rural Residence JPFHS 2002 ) ) ) ) ) ) ) # # # # # # # 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 50 100 150 200 250 Births per 1,000 women Urban Rural# ) The fertility differentials according to background characteristics of women are shown in Table 4.3. Column one shows the total fertility rates for the three years preceding the survey; column two, the percentage of women who were pregnant at the time of the fieldwork; and column three, the mean number of children ever born (CEB) to women age 40-49. CEB is an indicator of cumulative fertility and reflects the fertility of older women who are nearing the end of their reproductive years, representing completed fertility. When fertility remains constant over time, TFR and CEB will be the same or almost the same. In the 2002 JPFHS, however, the fact that the completed fertility rate (5.9 children per woman) is much higher than the total fertility rate (3.7 children per woman) indicates a considerable decline in fertility; this finding corresponds to the decline in fertility over time demonstrated by the comparison of data from several Jordanian surveys executed over the past thirty years (Table 4.1, Figure 4.1). The TFR is 4.0 births per woman in the South region and 3.9 in the North region, while in the Central region (which comprises the most urbanized areas of the country, including Amman governorate) the TFR is 3.5 children per woman (see Table 4.3). Among women who have had no education and those who have had up to Fertility │ 39 elementary education, fertility varies little (3.6 and 3.7 children successively). The rate peaks (4.4 births) among women who have had up to preparatory education. However, women who have had higher than secondary education have almost 1 birth less (0.8) than women who have had up to secondary education. These figures suggest that post-secondary education for women is associated with lower levels of fertility. It is of interest to note that the relationship of education to fertility is not in fact linear; rather, in Jordan it has an inverted U-shape (Figure 4.3). The 2002 JPFHS data show that 6 percent of all women of reproductive age were pregnant at the time of the survey compared with 7 percent in 1997. The geographical variation in the proportion of preg- nant women follows a pattern similar to that of fertility. Rural women and those living in the South region are more likely to be pregnant than women in other areas. Women with preparatory education are more likely to be pregnant than other women (see Table 4.3, Figure 4.3). Figure 4.3 Total Fertility Rates and Percentage of Women Currently Pregnant by Educational Level Attended JPFHS 2002 3.6 3.7 4.4 3.9 3.1 5.3 5.8 7.6 6.4 5.7 No education Elementary Preparatory Secondary Higher 0.0 1.0 2.0 3.0 4.0 5.0 Births per 1,000 women 0.0 5.0 10.0 Percent TFR Currently pregnant Comparing data from previous surveys is but one means of studying trends in fertility. Trends can also be investigated by using retrospective data from a single survey. The birth history information collected in the JPFHS is used for this purpose. Data in Table 4.4 indicate that the fertility rate has been declining in all age groups. For example the age-specific fertility rate for women age 25-29 declined from 349 births per 1,000 women in the 15-19 years preceding the survey to 208 births per 1,000 women in the 0-4 year period before the survey, a 40 percent decline. Omitted figures represented by dashes reflect the fact that women age 50 and older were not in- cluded in the survey: the further back in time that rates are calculated, the more severe the truncation. For example, rates cannot be calculated for women in the age group 45-49 years for the period 5-19 years be- fore the survey, because these women would have been over age 50 at the time of the survey and, thus, were not interviewed. 40 │ Fertility 4.2 CHILDREN EVER BORN Table 4.5 presents the distribution of all women and currently married women by the number of children they have had. In the 2002 JPFHS, since the respondents are ever-married women, information on the reproductive history of never-married women was not collected. However, since almost no births in Jordan take place before marriage, it can be assumed that never-married women have had no births. The data represent the accumulation of births over time. The difference in fertility between all women and currently married women is due to the proportion of women who were not married at the time of the sur- vey (i.e., single, divorced, or widowed). On average, women have given birth to 1.7 children by their late twenties, 4.4 children by their late thirties, and 6.5 children by the end of their reproductive period. Differences in the mean number of children born and living are notable after women have reached the age of 40. Caution should be exercised in interpreting the data for women in the oldest age groups because of possible recall problems; older women are more likely to omit a child, particularly if the child died at a young age or is living away from the mother. Data in Table 4.5 indicate very little variation between the mean number of children ever born and the mean number of children still living for all women age 15-49 (2.20 and 2.12 children, respec- tively). This table also presents the same data for currently married women. The data indicate that on av- erage, women have given birth to 2.6 children by their late twenties, 5 children by their late thirties, and about 7 children by the end of their reproductive period. The mean number of children ever born is 4.1 births, compared with 3.9 children still living. Table 4.4 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, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Mother’s age –––––––––––––––––––––––––––––––––– at time of the birth 0-4 5-9 10-14 15-19 ––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 30 51 57 70 20-24 151 210 225 276 25-29 208 263 284 349 30-34 186 223 241 [279] 35-39 118 161 [163] - 40-44 44 [70] - - 45-49 [5] - - - ––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Age-specific fertility rates are per 1,000 women. Esti- mates in brackets are truncated. Fertility │ 41 4.3 BIRTH INTERVALS A birth interval is the period of time between two successive live births. Research has shown that children born soon after a previous birth are at greater risk of illness and death. The percent distribution of births in the five years before the survey is shown in Table 4.6. Women in Jordan favor relatively long birth intervals: the median birth interval among children born in the five years preceding the survey is 30.1 months – 4.6 months longer than that recorded in the 1997 JPFHS. This relatively large increase (18 percent longer) in length of birth interval may be a reflec- tion of the implementation of Jordan’s National Health Program for Birth Spacing, which is one compo- nent of the National Population Strategy that was ratified by the government of Jordan in 1996. About two-thirds of all children (67 percent) are born at least two years after their siblings in 2002 compared with 56 percent in 1997, and almost two in five (37 percent) are born after an interval of three years or longer in 2002 compared with one in four in 1997. As expected, children born to younger women and low-parity women have shorter birth intervals than those born to older women and high- parity women. The birth interval following a child who has died is shorter than the interval following the birth of a surviving child (20 months, compared with 30 months). The length of birth intervals varies little according to education. There exists only a small amount of variation in birth interval by residence; the data show that women in rural areas and those living in the South region are more likely than other sub- groups to have shorter birth intervals. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of chil- dren ever born and mean number of living children, according to age group, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mean Mean Number of children ever born Number number number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– of of children of living Age 0 1 2 3 4 5 6 7 8 9 10+ Total women ever born children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 97.0 2.5 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,563 0.04 0.04 20-24 72.2 12.5 9.9 4.3 0.9 0.2 0.0 0.0 0.0 0.0 0.0 100.0 2,135 0.50 0.48 25-29 40.2 9.7 14.9 18.5 11.5 3.4 1.4 0.4 0.0 0.0 0.0 100.0 1,799 1.69 1.64 30-34 24.3 5.2 10.7 16.1 17.0 11.1 8.4 4.7 2.1 0.4 0.1 100.0 1,700 3.03 2.93 35-39 17.3 2.4 4.0 9.0 15.8 16.9 13.1 9.4 6.3 3.0 2.7 100.0 1,226 4.37 4.23 40-44 11.8 2.3 4.1 5.9 11.0 12.6 13.4 13.5 9.5 7.3 8.6 100.0 930 5.47 5.24 45-49 8.8 0.9 3.2 6.8 8.3 10.6 9.5 10.6 10.1 10.6 20.6 100.0 690 6.55 6.16 Total 50.2 5.9 7.1 8.3 7.9 5.9 4.7 3.6 2.5 1.7 2.3 100.0 11,044 2.20 2.12 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 50.8 40.1 8.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 154 0.60 0.59 20-24 18.1 36.1 29.6 12.8 2.6 0.7 0.0 0.0 0.0 0.0 0.0 100.0 710 1.48 1.44 25-29 8.1 14.1 23.1 28.6 17.9 5.3 2.3 0.6 0.0 0.0 0.0 100.0 1,136 2.62 2.54 30-34 4.0 5.9 13.5 20.6 21.8 14.3 10.7 6.0 2.6 0.5 0.1 100.0 1,314 3.86 3.74 35-39 4.7 2.3 4.2 10.4 18.5 19.9 15.2 11.0 7.2 3.4 3.2 100.0 1,034 5.07 4.91 40-44 4.7 2.2 3.8 6.0 12.0 13.0 14.5 15.0 11.0 8.3 9.6 100.0 782 6.02 5.78 45-49 3.2 1.0 3.4 6.4 9.7 12.0 8.9 9.7 10.9 11.0 23.9 100.0 575 7.05 6.63 Total 8.0 10.5 13.3 15.4 14.9 11.0 8.5 6.5 4.5 3.0 4.3 100.0 5,706 4.07 3.91 42 │ Fertility 4.4 AGE AT FIRST BIRTH The onset of childbearing is an important indicator of fertility. In Jordan, the postponement of first births (reflecting a later age at first marriage) has made a large contribution to the overall decline in fertility. Table 4.7 shows the distribution of women by age at first birth. Women under age 25 were not included in the calculation of median age at first birth because most had not given birth. Figures in the last column suggest increasing ages at first birth across age cohorts, such that women in younger cohorts are likely to be older at their first birth than were women in older cohorts at the time of their first births. Women age 25-29 (median age 24.8) give birth for the first time 1.3 years later than women age 35-39 (median age 23.5), and 3.6 years later than women age 45-49 (median age 21.2). Table 4.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median number of Number of months since preceding birth Number months since Background ––––––––––––––––––––––––––––––––––––––––––––––––– of preceding characteristic 7-17 18-23 24-35 36-47 48+ Total births1 birth –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 72.7 3.6 23.6 0.0 0.0 100.0 15 16.4 20-29 23.1 22.7 29.2 14.6 10.4 100.0 1,717 25.1 30-39 10.7 16.7 29.9 16.7 26.0 100.0 2,465 32.5 40-49 7.0 10.1 23.9 16.6 42.5 100.0 418 43.7 Birth order 2-3 21.3 21.8 28.6 14.0 14.2 100.0 2,112 26.2 4-6 9.8 15.9 27.9 17.6 28.9 100.0 1,831 34.3 7+ 10.5 13.9 33.7 16.8 25.1 100.0 672 33.0 Sex of preceding birth Male 15.9 17.5 28.0 14.7 23.9 100.0 2,312 30.3 Female 14.5 19.1 30.2 17.0 19.3 100.0 2,303 29.9 Survival of preceding birth Living 14.3 18.3 29.3 16.1 21.9 100.0 4,476 30.3 Dead 42.3 17.2 20.6 6.4 13.6 100.0 139 19.9 Residence Urban 14.9 17.5 27.7 16.7 23.3 100.0 3,535 30.9 Rural 16.1 20.9 33.7 13.0 16.2 100.0 1,080 27.5 Region Central 14.9 17.9 27.4 16.5 23.3 100.0 2,836 30.8 North 16.0 18.7 30.5 15.1 19.6 100.0 1,303 29.1 South 14.3 19.8 35.1 13.8 17.0 100.0 475 28.3 Educational level attended No education 13.3 15.6 37.0 13.4 20.7 100.0 218 30.4 Elementary 18.0 17.9 26.7 15.5 21.9 100.0 416 29.6 Preparatory 13.9 20.0 30.0 13.5 22.7 100.0 974 28.8 Secondary 16.3 18.7 29.4 16.5 19.1 100.0 1,855 29.5 Higher 13.7 17.0 27.1 17.3 24.9 100.0 1,151 31.8 Preparatory + secondary 15.5 19.1 29.6 15.5 20.3 100.0 2,829 29.2 Total 15.2 18.3 29.1 15.8 21.6 100.0 4,615 30.1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 1 First-order births are excluded. Fertility │ 43 Table 4.8 presents the differentials in age at first birth among women age 25-49 by background characteristics. Overall, the median age at first birth is 23.5 years in 2002 compared with 23.2 years in 1997. Urban women begin childbearing half a year later than rural women (23.6 years compared with 23 years). There are no significant differences in the median age at first birth by region. Differentials by edu- cation exist only at the secondary and higher levels, at which point more educational attainment translates into later median ages at first birth: women with secondary education had a median age at first birth of 22.7 years; less than half of women with higher education have given birth before the age of 25, so a me- dian age could not be calculated for them. Table 4.7 Age at first birth Percentage of all women who gave birth by specific exact ages, and median age at first birth, by current age, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Median Women who gave birth by exact age: who have Number age at ––––––––––––––––––––––––––––––––––––––––––––––––––– never of first Current age 15 18 20 22 25 given birth women birth ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 0.0 na na na na 97.0 2,563 a 20-24 0.1 5.0 12.7 na na 72.2 2,135 a 25-29 0.2 6.5 20.4 34.5 51.2 40.2 1,799 24.8 30-34 0.1 8.7 20.9 36.2 56.0 24.3 1,700 24.0 35-39 0.4 11.1 24.0 39.3 61.9 17.3 1,226 23.5 40-44 1.2 14.0 31.9 45.3 64.0 11.8 930 22.6 45-49 1.6 18.7 40.3 57.6 74.8 8.8 690 21.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 4.8 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age and background character- istics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Background ––––––––––––––––––––––––––––––––––––––––––––––– age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 24.7 24.2 23.6 22.7 21.4 23.6 Rural 24.9 23.3 22.5 22.0 20.1 23.0 Region Central 24.7 24.3 23.5 22.9 21.6 23.7 North 24.9 23.4 23.6 22.2 20.3 23.3 South 25.0 23.6 22.9 22.2 20.9 23.3 Educational level attended No education 23.8 21.5 20.5 20.4 20.4 20.8 Elementary a 22.9 22.5 21.4 19.7 21.4 Preparatory 21.2 21.5 21.1 19.0 19.6 20.5 Secondary 23.1 22.8 22.3 22.2 21.7 22.7 Higher a 26.4 25.2 25.9 25.0 a Preparatory + secondary 22.6 22.3 22.0 20.6 20.7 21.9 Total 24.8 24.0 23.5 22.6 21.2 23.5 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– a Omitted because less than 50 percent of the women had a birth before the beginning of the age group 44 │ Fertility 4.5 TEENAGE FERTILITY Table 4.9 examines the extent of fertility among women age 15-19. This issue is a major social and health concern because teenage mothers and their children usually have higher risk of illness and death. At the same time, women who become mothers in their teens are more likely to curtail their educa- tion. Among teenagers in Jordan, the level of fertility is low. Only 4 percent of women began child- bearing during their teens in 2002, compared with 6 percent in 1997. Levels of teenage pregnancy vary markedly by urban-rural residence (4.8 percent and 2.2 percent in urban and rural areas respectively). The most significant differentials are age and education. At age 15, no women have begun childbearing; only 2 percent of women have begun childbearing at age 16. By age 19, one in ten will have become a mother or will be pregnant with her first child. Women’s education plays an important part in determining the onset of childbearing. The proportion of teens that has begun childbearing declines as level of education increases – from 14 percent of uneducated women to 1 percent of women with higher than secondary education. Table 4.9 Teenage pregnancy and motherhood Percentage of all women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who are: Percentage ––––––––––––––––––––– who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15 0.0 0.0 0.0 531 16 0.8 1.0 1.8 568 17 2.8 1.1 3.8 502 18 4.8 1.3 6.2 497 19 7.6 2.9 10.6 465 Residence Urban 3.4 1.4 4.8 2,006 Rural 1.6 0.6 2.2 557 Region Central 3.0 1.1 4.2 1,580 North 3.2 1.2 4.4 747 South 2.4 1.8 4.2 246 Educational level attended No education 12.0 2.0 14.0 15 Elementary 8.4 3.7 12.1 84 Preparatory 5.8 2.5 8.3 497 Secondary 2.4 0.7 3.1 1,684 Higher 0.0 1.0 1.0 287 Preparatory + secondary 3.2 1.1 4.3 2,181 Total 3.0 1.2 4.3 2,563 Fertility Regulation │ 45 Table 5.1 Knowledge of contraceptive methods Percentage of all ever-married women, of currently married women, and of currently unmarried women who know specific contraceptive methods, Jordan 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– All Currently Currently ever-married married unmarried Contraceptive method women women women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Any method 100.0 100.0 99.9 Any modern method 100.0 100.0 99.7 Female sterilization 97.9 97.8 98.2 Male sterilization 21.8 21.9 19.7 Pill 99.7 99.7 99.7 IUD 99.9 99.9 99.5 Injectables 92.7 92.9 89.0 Implants 53.7 54.3 41.9 Male condom 90.2 91.0 74.3 Female condom 17.5 17.6 16.3 Diaprhagm 16.8 16.9 14.6 Foam/jelly 66.1 66.8 54.2 Emergency contraception 12.9 12.9 13.1 Lactational amenorrhea (LAM) 97.8 97.8 96.7 Any traditional method 96.1 96.5 89.2 Periodic abstinence 87.2 87.7 77.6 Withdrawal 92.3 92.8 81.9 Folk method 2.1 2.1 1.2 Mean number of methods known 9.5 9.5 8.8 Number of women 6,006 5,706 300 FERTILITY REGULATION 5 This chapter considers a number of indicators from the 2002 JPFHS relating to knowledge, atti- tudes, and use of family planning. This chapter also presents information on intended future use of con- traception and exposure to mass media messages about family planning. Trends over time are examined by comparing the 2002 JPFHS findings with those of two earlier surveys: the 1990 and 1997 Jordan Population and Family Health Survey (JPFHS). 5.1 KNOWLEDGE OF FAMILY PLANNING METHODS Determining the level of knowledge of contraceptive methods was a major objective of the 2002 JPFHS, since knowledge of specific methods is a precondition for using them. Information about women’s knowledge of contraceptive methods was collected by asking the respondents an open-ended question about which contraceptive methods they had heard of. When a respondent failed to mention any of the listed methods, the interviewer would describe a method and ask whether the respondent had heard of it. All methods mentioned spontaneously or recognized by the respondent after hearing a description of it were recorded as knowledge. Information on knowledge was collected for 12 modern methods: the pill, the IUD, inject- ables, implants, vaginal methods (foam, jelly, or diaphragm), emergency contraception, lactational amenorrhea method (LAM), the male and female condom, and female and male sterilization. Two traditional methods were also included: periodic abstinence and withdrawal. In addition, provision was made in the questionnaire to record any other methods that respondents named without any prompting. It should be noted that knowledge of a family planning method in the JPFHS and all DHS surveys is defined simply as having heard of a method. No questions were asked to elicit depth of knowledge, such as how a specific method is used. The 2002 JPFHS results indicate that all ever-married women in Jordan know at least one method of family planning (Table 5.1). Among modern methods, the pill and IUD are the best known (100 percent), followed by female sterilization (98 percent). Knowledge of the male condom and injectables exists among 90 percent and 93 percent of ever-married women, respectively. The least recognized methods were emergency contracep- tion, diaphragm, and female condom, with 13 percent, 17 percent and 18 percent, respectively, of ever- married women having knowledge of these methods. As expected, the lactational amenorrhea method (LAM) is known to nearly all ever-married women (98 percent). Periodic abstinence (87 percent) and withdrawal (92 percent) are also well known. On average, an ever-married woman knows about 10 family planning methods. 46 │ Fertility Regulation Since knowledge of any family planning method or any modern method is universal, there is al- most no variation among subgroups on the basis of background characteristics; thus, no table is shown. 5.2 EVER USE OF CONTRACEPTION All ever-married women interviewed in the 2002 JPFHS who said they had heard of a method of family planning were asked whether they had ever used it. Table 5.2 shows that eight in ten ever-married women reported that they had used a contraceptive method at some time, including 17 percent who had used the lactational amenorrhea method (LAM). Ever use among currently married women (81 percent) is almost the same as for ever-married women (80 percent). Modern methods have been used by 73 percent of currently married women. The IUD is the most popular method (50 percent), followed by the pill (41 percent). The percentage reporting ever use of other modern methods, with the exception of female con- dom, diaphragm, implants, and emergency contraception, varies from 3 percent for female sterilization to 22 percent for male condoms. The level of ever use of traditional contraceptive methods is fairly high in Jordan. Withdrawal, the most frequently adopted traditional method, has been used by 35 percent of currently married women, followed by periodic abstinence (23 percent). Table 5.2 Ever use of contraception Percentage of all women and of currently married women who have ever used any contraceptive method, by specific method and age, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––– Any Any Female Other tradi- Periodic Number Any modern sterili- Inject- Im- Male- Foam/ modern tional absti- With- Folk of Age method method zation Pill IUD ables plants condom jelly LAM methods method nence drawal method women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL EVER-MARRIED WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 32.1 21.3 0.0 10.0 4.3 0.0 0.0 6.4 0.0 6.1 0.0 13.5 2.4 12.7 0.0 158 20-24 59.4 47.0 0.0 21.4 22.2 1.3 0.0 14.6 1.2 11.1 0.2 32.5 10.1 27.6 0.0 728 25-29 80.1 68.7 0.0 38.8 41.0 3.9 0.0 20.9 3.7 17.5 0.2 45.0 22.4 34.7 0.2 1,175 30-34 85.6 79.2 0.5 42.3 56.4 4.2 0.4 24.4 6.5 20.3 0.3 48.6 25.4 39.5 0.4 1,354 35-39 86.1 80.8 4.2 45.6 62.7 6.2 0.6 24.3 9.8 17.5 0.6 45.5 26.9 37.3 0.5 1,071 40-44 85.9 81.5 6.7 48.5 61.0 3.6 0.2 23.6 10.0 18.7 0.6 43.9 27.2 33.6 0.3 862 45-49 82.1 76.8 9.7 46.4 52.8 2.1 0.0 15.2 9.1 16.5 1.0 38.8 22.7 26.6 1.4 659 Total 79.7 72.1 2.9 40.2 49.2 3.7 0.2 20.9 6.5 17.1 0.4 42.7 22.6 33.8 0.4 6,006 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 32.2 21.2 0.0 9.5 4.4 0.0 0.0 6.6 0.0 6.3 0.0 13.9 2.5 13.1 0.0 154 20-24 60.2 47.6 0.0 21.8 22.7 1.4 0.0 14.6 1.3 11.3 0.2 33.3 10.3 28.2 0.0 710 25-29 81.4 69.9 0.0 39.1 41.5 3.8 0.0 21.4 3.8 17.9 0.2 46.2 23.0 35.5 0.2 1,136 30-34 86.9 80.3 0.5 42.9 57.5 4.0 0.4 24.6 6.5 20.7 0.3 49.1 26.0 39.9 0.4 1,314 35-39 87.1 82.1 4.4 46.5 63.7 6.4 0.6 25.1 10.0 17.8 0.6 46.4 27.2 38.0 0.5 1,034 40-44 87.0 82.1 7.3 49.3 61.9 3.6 0.3 25.3 10.4 18.8 0.6 46.7 29.2 35.8 0.3 782 45-49 84.8 79.0 9.7 47.2 57.1 2.4 0.0 16.5 9.6 17.1 1.2 41.8 24.8 28.7 1.6 575 Total 80.9 73.0 2.9 40.6 50.2 3.8 0.2 21.6 6.6 17.4 0.5 44.0 23.3 34.8 0.4 5,706 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– LAM = Lactational amenorrhea method Fertility Regulation │ 47 5.3 CURRENT USE OF CONTRACEPTION The level of current use of contraception is one of the indicators most frequently used to assess the success of family planning activities. It is also widely used as a measure in analyzing the determinants of fertility. Results from the 2002 JPFHS indicate that 56 percent of married women are using a contracep- tive method, including 41 percent who are using modern methods and 15 percent using traditional meth- ods. Contraceptive prevalence has increased slightly between 1997 and 2002 survey (from 53 to 56 per- cent; see Table 5.3). The IUD is the most widely adopted modern method (24 percent), followed by the pill (8 percent), and male condom, female sterilization, and LAM (3 percent for each). Less than 1 percent of women rely on other modern methods. Withdrawal (9 percent) and periodic abstinence (5 percent) are the most frequently employed traditional methods. Overall, the level of current contraceptive use of any method among currently married women has increased substantially in the last 12 years, from 40 percent in the 1990 JPFHS survey to 53 percent in the 1997 JPFHS survey and 56 percent in the 2002 JPFHS (Figure 5.1). The relative increase in use dur- ing the five years preceding the 2002 JPFHS is 6 percent for all methods, and 9 percent for all modern methods. However, most of the increase in modern method use is due to the addition of LAM to the range of modern methods. If LAM were removed to create strict comparability in the list of modern methods asked about in both 1997 and 2002, the increase in modern method use is only 2 percent. The correspond- ing increase for the period 1990-1997 was 32 percent of all methods and 40 percent of modern methods. Comparing specific methods, there was considerable change in the use of specific contraceptive methods in the period between 1990 and 2002. Most noticeable is the increased use of the IUD, which rose from 15 percent in 1990 to 24 percent in 2002. Use of the male condom also increased during the same period, rising from less than 1 percent to just over 3 percent. Table 5.3 Current use of contraception Percent distribution of currently married women by contraceptive method currently used, according to age, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––– Any Any Female Other tradi- Periodic Not Number Any modern sterili- Inject- Male- modern tional absti- With- Folk currently of Age method method zation Pill IUD ables condom LAM methods method nence drawal method using Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 21.3 13.4 0.0 4.3 3.0 0.0 2.7 3.4 0.0 7.9 2.5 5.4 0.0 78.7 100.0 154 20-24 42.2 28.0 0.0 6.9 13.6 0.2 3.7 3.6 0.0 14.1 3.2 10.9 0.0 57.8 100.0 710 25-29 54.0 40.0 0.0 11.1 20.6 1.3 3.3 3.6 0.2 14.0 4.4 9.7 0.0 46.0 100.0 1,136 30-34 60.1 46.5 0.5 8.7 28.8 0.9 3.7 3.8 0.1 13.6 4.5 9.1 0.0 39.9 100.0 1,314 35-39 63.9 48.7 4.4 6.6 30.0 1.4 3.8 2.2 0.3 15.2 5.9 9.3 0.0 36.1 100.0 1,034 40-44 65.6 49.0 7.3 6.1 29.9 0.8 3.2 0.6 1.0 16.6 7.3 9.2 0.1 34.4 100.0 782 45-49 47.5 31.3 9.7 2.6 15.9 0.6 1.9 0.1 0.5 16.2 7.9 8.0 0.4 52.5 100.0 575 Total 55.8 41.2 2.9 7.5 23.6 0.9 3.4 2.6 0.3 14.6 5.2 9.3 0.1 44.2 100.0 5,706 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in the tabulation. LAM = Lactational amenorrhea method 48 │ Fertility Regulation Figure 5.1 Current Use of Modern Contraceptive Methods Among Currently Married Women, 1990-2002 27 38 41 13 15 15 JPFHS 1990 JPFHS 1997 JPFHS 2002 0 10 20 30 40 50 60 70 Percent Modern Traditional 40 53 56 Use of contraceptive methods differs according to age: the use of contraception increases steadily up to age 40-44 and declines thereafter (Table 5.3); use among currently married women is lowest among those age 15-19 (21 percent), peaks among women age 40-44 (66 percent), then declines sharply among those age 45-49 (48 percent). Most women in the younger cohorts use contraception for spacing births, relying on the pill, male condom and traditional methods, while older women are using more permanent methods. Female sterilization in particular rises in popularity among women 35 years of age and older, with the prevalence of sterilization increasing from 4 percent among 35-39 year-olds, to 7 percent among 40-44 year-olds, to 10 percent among currently married women age 45-49; the use of IUDs is also very popular among older women. It should be noted that male sterilization is virtually nonexistent in Jordan. Current use of contraceptive methods also differs by background characteristics (Table 5.4). The level of contraceptive use is higher by 13 percent among women living in urban areas (57 percent) than among women in rural areas (51 percent). The percentage using modern methods among women living in urban areas is 19 percent higher than the percentage among those living in rural areas (43 percent and 36 percent, respectively; see Figure 5.2). There is also regional variation in current use of family planning. The Central region (which in- cludes the capital, Amman) has the highest level of any contraceptive use (58 percent), followed by the North region (54 percent). The lowest level is the South region (48 percent). Differentials in the use of modern methods are similar to those for the use of any method. Current use of contraception varies primarily between currently married women who have at- tended school and those with little or no education. This pattern also holds for the current use of modern methods. Current use of contraception increases steadily with women’s education. While 41 percent of women with no education are currently using a method, 54 percent of women with preparatory education and 60 percent of women with higher than secondary education are currently using a contraceptive method. It should be noted, however, that use of the IUD increases with level of education, whereas use of female sterilization is negatively correlated with level of educational attainment. Those correlations could be due in part to the fact that women with no education tend to be older and have more children Fertility Regulation │ 49 than women who have attended school, and thus the former are more likely to want to stop childbearing altogether. The use of traditional methods also increases with level of education. Use of contraception increases with the number of living children, from 1 percent among cur- rently married women with no children to 68 percent among women with five or more children (Table 5.4). It should be noted that 54 percent of contraceptive users are using a method for spacing their births, while 46 percent of users employ contraception in order to stop childbearing (data not shown). In addition, 18 percent of users would like to shift to another method: three out of five want to switch to IUDs, 13 percent to the pill, and 12 percent to female sterilization. Twenty six percent of women mentioned the doctor’s advice as a reason for not using their preferred method. Other women mentioned husband’s objection (12 percent), not having enough knowledge about a method (9 percent), and high cost (5 percent) as reasons behind not using their preferred method (tables not shown). Table 5.4 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––– Any Any Female In- Male Other tradi- Periodic Not Number Background Any modern sterili- ject- con- modern tional absti- With- Folk currently of characteristic method method zation Pill IUD ables dom LAM methods method nence drawal merthod using Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 57.1 42.6 2.8 7.6 25.3 0.8 3.6 2.1 0.4 14.5 5.4 9.1 0.0 42.9 100.0 4,546 Rural 50.5 35.8 3.3 6.8 17.2 1.2 2.4 4.8 0.1 14.6 4.7 9.8 0.1 49.5 100.0 1,160 Region Central 57.5 43.3 2.6 7.8 25.9 0.8 3.6 2.3 0.3 14.2 5.5 8.6 0.1 42.5 100.0 3,683 North 54.4 39.0 3.2 6.7 21.3 0.9 3.1 3.4 0.4 15.4 4.7 10.8 0.0 45.6 100.0 1,480 South 48.0 33.3 4.1 7.2 14.9 1.3 2.8 2.7 0.3 14.7 4.8 9.7 0.2 52.0 100.0 542 Educational level attended No education 40.6 33.0 13.1 4.3 9.3 2.8 0.9 2.6 0.0 7.6 1.9 5.4 0.3 59.4 100.0 324 Elementary 46.7 34.9 6.1 4.3 19.0 1.4 1.9 2.3 0.0 11.8 3.7 8.1 0.0 53.3 100.0 638 Preparatory 53.5 41.0 2.9 8.1 24.2 0.8 2.0 2.5 0.4 12.5 2.4 10.0 0.2 46.5 100.0 1,144 Secondary 58.9 44.6 1.2 9.2 25.6 0.8 4.3 3.1 0.3 14.3 4.5 9.8 0.0 41.1 100.0 2,159 Higher 60.3 41.0 1.7 6.5 25.5 0.4 4.3 2.1 0.4 19.3 10.0 9.3 0.0 39.7 100.0 1,441 Preparatory + secondary 57.0 43.3 1.8 8.8 25.1 0.8 3.5 2.9 0.4 13.7 3.8 9.9 0.1 43.0 100.0 3,303 Number of living children 0 1.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 0.8 0.4 0.0 98.7 100.0 468 1-2 43.6 27.5 0.0 6.7 13.5 0.3 3.5 3.4 0.0 16.1 5.2 10.9 0.0 56.4 100.0 1,407 3-4 66.2 50.7 0.8 10.9 31.0 0.8 4.3 2.6 0.4 15.5 6.9 8.6 0.0 33.8 100.0 1,751 5+ 67.5 51.8 7.3 6.7 29.6 1.6 3.3 2.7 0.5 15.8 4.9 10.8 0.1 32.5 100.0 2,080 Total 55.8 41.2 2.9 7.5 23.6 0.9 3.4 2.6 0.3 14.6 5.2 9.3 0.1 44.2 100.0 5,706 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in the tabulation. LAM = Lactational amenorrhea method 50 │ Fertility Regulation Figure 5.2 Current Use of Contraception Among Currently Married Women by Background Characteristics JPFHS 2002 57 50 58 54 48 41 47 54 59 60 RESIDENCE Urban Rural REGION Central North South EDUCATION No education Elementary Preparatory Secondary Higher 0 10 20 30 40 50 60 70 Modern Traditional 5.4 CURRENT USE BY WOMEN’S STATUS A woman’s ability to use contraceptive methods to control her fertility is likely to be affected by her status and degree of empowerment. Women who are more empowered are expected to be better able to control all aspects of their lives including their fertility. The JPFHS 2002 collected information on three indicators of women’s empowerment: number of decisions in which the respondent participates in the final say, the number of reasons for which a woman can refuse to have sexual relations with her hus- band, and the number of reasons for which the respondent feels a husband is justified in beating his wife. This section focuses on the relationship between contraceptive use and women’s status. (See Chapter 3 for an explanation of these indicators.) According to Table 5.5, currently married women who have more say with regard to household decisionmaking are more likely to use a contraceptive method, particularly a modern method than women with less say in household decisionmaking: whereas 59 percent of women who have a say in all five specified decisions are currently using a method, only 45 percent of women who have a say in one or two household decisions are current users of contraception. Currently married women who agree with a variety of circumstances under which they would feel justified in refusing their husband sex are also more likely to be currently using a contraceptive method: among women agreeing with all three circumstances under which a wife would be justified in denying her husband sex, 57 percent are currently using a method, compared with 47 percent among those who be- lieve that none of the specified circumstances constitute justification for a wife’s refusal to have sex with her husband. Finally, the more that a woman considers wife beating justifiable, the less likely she is to use a contraceptive method. Among women who believe that wife beating is never justified, 63 percent are cur- rently using a contraceptive method. The numbers are significantly lower for those who agree with most or all of the justifications for wife beating: only 46 percent of these are currently using contraception. Fertility Regulation │ 51 Table 5.5 indicates that women who are most empowered according to the definition set forth here are also the most likely to use a contraceptive method. This table also indicates that women who are least empowered are the most likely to be sterilized. For example, among women who cannot justify a wife refusing sex to her husband for any of the specified reasons, 9 percent are sterilized, compared with women who believe that a wife would be justified in refusing sex to her husband under any of the given circumstances, among whom only 3 percent are sterilized. 5.5 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION Table 5.6 shows the number of living children at the time of first use of contraception by age among ever-married women. With the increasing adoption of family planning – particularly among younger women – the average parity of women at first use of contraception has been declining. About two-thirds of women age 40-49 used any family planning method before having four or more children, compared with about 97 percent of women age 25-29. Women are adopting family planning fairly early in the family building process. The proportion that started using contraception after marriage to delay the first birth has increased from 1 percent among women age 35-49 to 11 percent among those age 15-19. In general, the results show that the majority of women prefer to start using a contraceptive method after they have had one or two children (41 percent and 27 percent, respectively). In other words, 71 percent of women prefer to use a method before having a third child. Table 5.5 Current use of contraception by women’s status Percent distribution of currently married women by contraceptive method currently used, according to selected indicators of women’s status, Jordan 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––– Any Any Female In- Male Other tradi- Periodic Not Number Background Any modern sterili- ject- con- modern tional absti- With- Folk currently of characteristic method method zation Pill IUD ables dom LAM methods method nence drawal merthod using Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say 0 (41.8 ) (32.1) (5.4) (9.4) (13.2) (0.0) (0.0) (4.0) (0.0) (9.8) (2.6) (7.2) (0.0) (58.2) 100.0 51 1-2 45.0 32.4 2.4 6.3 16.8 0.8 3.0 3.0 0.0 12.6 3.0 9.2 0.3 55.0 100.0 706 3-4 56.2 41.8 2.4 8.3 23.9 0.8 3.5 2.6 0.3 14.3 5.3 8.9 0.0 43.8 100.0 2,604 5 58.9 43.4 3.5 6.8 25.6 1.1 3.4 2.5 0.5 15.5 5.8 9.7 0.0 41.1 100.0 2,345 Number of reasons to refuse sex with husband 0 46.8 34.8 9.3 1.3 15.6 0.0 1.7 6.9 0.0 12.0 1.1 10.3 0.6 53.2 100.0 74 1-2 52.9 39.0 2.6 7.8 21.4 0.8 3.4 2.6 0.2 14.0 4.4 9.5 0.0 47.1 100.0 1,876 3+ 57.4 42.5 2.9 7.4 24.9 1.0 3.4 2.5 0.4 14.9 5.7 9.1 0.1 42.6 100.0 3,757 Number of reasons wife beating is justified 0 63.4 42.7 1.3 6.6 27.4 0.6 3.5 2.1 1.2 20.7 9.7 11.1 0.0 36.6 100.0 730 1-2 58.9 43.2 2.3 7.9 25.0 0.9 4.5 2.7 0.0 15.6 6.0 9.5 0.1 41.1 100.0 2,006 3-4 55.3 42.6 2.9 7.9 24.5 0.9 3.1 2.8 0.3 12.7 4.1 8.6 0.0 44.7 100.0 1,824 5+ 46.3 34.5 4.9 6.5 17.5 1.1 1.7 2.6 0.2 11.8 2.8 8.9 0.1 53.7 100.0 1,146 Total 55.8 41.2 2.9 7.5 23.6 0.9 3.4 2.6 0.3 14.6 5.2 9.3 0.1 44.2 100.0 5,706 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in the tabulation. Figures in parentheses are based on 25-49 unweighted cases. LAM = Lactational amenorrhea method 52 │ Fertility Regulation 5.6 KNOWLEDGE OF THE FERTILE PERIOD A basic knowledge of reproductive physiology provides a useful background for the successful practice of coitus-dependent methods (such as withdrawal, condom, or barrier methods), and even more so for the practice of periodic abstinence. As noted earlier, periodic abstinence has been used by 23 per- cent of currently married women at some time, and it is currently being used by 5 percent of recently sur- veyed women. Since the failure rate for using the safe period method is high, it is important to find out if women who are practicing the method know when during the ovulatory cycle they should avoid having sexual intercourse. Table 5.7 presents the distribution of ever-married women who are currently using periodic absti- nence, categorized by the time during the ovulatory cycle when they think a woman is most likely to get pregnant (perceived fertile period). To obtain these data, the respondents were asked when during the monthly cycle a woman has the greatest chance of becoming pregnant. The results indicate that the ovula- tory cycle is well known to ever-married women, as well as to women who have used the safe period method. Two-thirds of ever-married women can correctly identify the safe period. Among women using periodic abstinence, 88 percent answered correctly, while 11 percent gave the response “after the period ended.” Table 5.6 Number of children at first use of contraception Percent distribution of all ever-married women who have ever used contraception by number of living children at the time of first use of contraception, according to current age, Jord

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