Jordan - Demographic and Health Survey - 2008

Publication date: 2008

Jordan Population and Family Health Survey 2007 J d 2007 Population and THE HASHEMITE KINGDOM OF JORDAN Jordan Population and Family Health Survey 2007 Department of Statistics Amman, Jordan Macro International Inc. Calverton, Maryland, USA August 2008 CONTRIBUTORS DEPARTMENT OF STATISTICS Fathi Nsour Kamal Saleh Ikhlas Aranki Wajdi Akeel Yazid Alomari MINISTRY OF HEALTH Dr. Adel Belbeisi Dr. Bassam Hijawi Dr. Ruwaida Rashid Dr. Khawla Kawa'a UNIVERSITY OF JORDAN Dr. Issa Masarweh MACRO INTERNATIONAL INC. Noah Bartlett Bernard Barrère Jasbir Sangha This report summarizes the findings of the 2007 Jordan Population and Family Health Survey (JPFHS) carried out by the Department of Statistics (DoS). The survey was funded by the Government of Jordan. Additional funding was provided by the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), and the United Nations Children’s Fund (UNICEF). Macro International Inc. provided technical assistance through the MEASURE DHS program. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the donor organizations. 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, Jordan (Telephone (962) 6-5-300-700; Fax (962) 6- 5-300-710; e-mail stat@dos.gov.jo). Additional information about the MEASURE DHS program may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone 301-572-0200; Fax 301- 572-0999; e-mail reports@measuredhs.com). Cover photo: Al-Deir (Petra) Jordan ©age fotostock Suggested citation: Department of Statistics [Jordan] and Macro International Inc. 2008. Jordan Population and Family Health Survey 2007. Calverton, Maryland, USA: Department of Statistics and Macro International Inc. Contents | iii CONTENTS Page TABLES AND FIGURES . vii PREFACE. xiii SUMMARY OF FINDINGS . xv MAP OF JORDAN . xx 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 . 4 1.5 Objectives of the Survey . 4 1.6 Methodology and Organization of the Survey . 5 1.6.1 Sample Design . 5 1.6.2 Updating of Sampling Frame. 6 1.6.3 Questionnaires. 6 1.6.4 Recruitment of Staff . 7 1.6.5 Training and Pretest . 7 1.6.6 Main Fieldwork. 7 1.6.7 Data Processing. 8 1.7 Results of the Household and Individual Interviews. 8 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. 16 2.6 Housing Characteristics . 17 2.7 Presence of Durable Goods. 20 2.8 Household Wealth. 20 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3.1 General Characteristics. 23 3.2 Respondents’ Level of Education. 24 3.3 Exposure to Mass Media . 26 3.4 Respondents’ Employment Characteristics. 27 3.4.1 Working Status. 27 3.4.2 Occupation. 29 3.5 Smoking Tobacco. 31 iv � Contents CHAPTER 4 FERTILITY 4.1 Fertility Levels and Trends . 33 4.2 Children Ever Born. 38 4.3 Birth Intervals. 39 4.4 Age at First Birth. 41 4.5 Teenage Fertility. 43 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 Number of Children at First Use of Contraception. 50 5.5 Knowledge of the Fertile Period . 50 5.6 Timing of Sterilization . 51 5.7 Source of Supply for Modern Methods. 52 5.8 Informed Choice. 53 5.9 Contraceptive Discontinuation . 54 5.10 Future Use of Family Planning. 57 5.11 Exposure to Family Planning Messages . 58 5.12 Contact of Nonusers with Family Planning Providers . 60 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY 6.1 Current Marital Status . 63 6.2 Polygyny . 65 6.3 Consanguinity . 65 6.4 Age at First Marriage . 67 6.5 Recent Sexual Activity . 68 6.6 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility . 70 6.7 Menopause. 72 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Children. 73 7.2 Need for Family Planning Services. 76 7.3 Ideal Number of Children . 78 7.4 Planning Status of Births . 81 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends . 84 8.2 Differentials in Infant and Child Mortality. 86 8.2.1 Differentials by Background Characteristics . 86 8.2.2 Differentials by Demographic Characteristics. 87 8.3 Perinatal Mortality. 89 8.4 High-Risk Fertility Behavior . 91 Contents | v CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care . 93 9.1.1 Number and Timing of ANC Visits . 93 9.1.2 Components of Antenatal Care . 98 9.1.3 Coverage of Tetanus Toxoid Vaccinations . 100 9.2 Delivery . 101 9.2.1 Place of Delivery. 101 9.2.2 Assistance at Delivery. 103 9.2.3 Delivery Characteristics . 105 9.2.4 Payment for Delivery . 105 9.3 Postnatal Care. 106 9.4 Problems in Accessing Health Care . 108 9.5 Premarital Medical Examinations. 109 9.6 Cancer Screening . 110 9.7 Knowledge of Tuberculosis. 112 CHAPTER 10 CHILD HEALTH 10.1 Birth Weight . 115 10.2 Vaccination Coverage . 116 10.2.1 Trends in Vaccination Coverage . 119 10.2.2 Additional Doses. 120 10.2.3 Additional Vaccinations. 122 10.3 Acute Respiratory Infection . 123 10.4 Prevalence of Fever. 125 10.5 Prevalence of Diarrhea. 127 10.5.1 Diarrhea Treatment. 127 10.5.2 Nutritional Practices during Diarrhea . 129 10.5.3 Knowledge of Diarrhea Treatment Solutions . 131 CHAPTER 11 NUTRITION 11.1 Nutritional Status of Children . 133 11.1.1 Breastfeeding and Child Feeding Practices . 133 11.1.2 Micronutrient Intake among Children . 141 11.2 Nutritional Status of Women. 143 11.2.1 Height and Body Mass Index (BMI). 143 11.2.2 Foods Consumed by Mothers. 144 11.2.3 Micronutrient Intake among Mothers . 145 CHAPTER 12 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS 12.1 Knowledge of HIV/AIDS and Methods of HIV Prevention. 147 12.2 Stigma Associated with AIDS. 153 12.3 Attitudes Towards Negotiating Safer Sexual Relations . 155 12.4 Knowledge of Symptoms of Sexually Transmitted Infections . 156 12.5 Knowledge and Use of Condoms . 158 vi � Contents CHAPTER 13 WOMEN’S EMPOWERMENT 13.1 Respondents’ Working Status . 159 13.2 Women’s Participation in Household Decision making . 161 13.3 Domestic Violence: Women’s Attitudes toward Wife Beating. 163 13.4 Women’s Agreement with Reasons for Refusing Sexual Relations . 165 13.5 Women’s Empowerment Indicators . 167 13.5.1 Current Use of Contraception by Women’s Empowerment . 168 13.5.2 Ideal Family Size and Unmet Need by Women’s Empowerment. 168 CHAPTER 14 DOMESTIC VIOLENCE 14.1 Physical Violence . 171 14.1.1 Prevalence of Physical Violence . 171 14.1.2 Perpetrators of Physical Violence . 173 14.1.3 Violence during Pregnancy . 173 14.2 Spousal Violence. 175 14.2.1 Prevalence of Various Forms of Spousal Violence. 175 14.2.2 Differentials in Prevalence of Spousal Violence . 176 14.2.3 Help-Seeking Behavior . 178 CHAPTER 15 EARLY CHILDHOOD DEVELOPMENT 15.1 Ability to Count. 181 15.2 Frequency of Reading and Name Recognition. 183 15.3 Participation in Family Discussions . 185 15.4 Management of Disagreements among Friends. 185 15.5 Teeth Brushing and Hand Washing . 187 APPENDIX A SAMPLE DESIGN A.1 Objectives of the Survey. 191 A.2 Sampling Frame. 191 A.3 Sample Allocation and Sample Selection . 192 A.4 Selection Probability and Sampling Weight. 194 A.5 Sample Implementation . 195 APPENDIX B ESTIMATES OF SAMPLING ERRORS .197 APPENDIX C DATA QUALITY TABLES . 219 APPENDIX D QUESTIONNAIRES . 225 Tables and Figures | vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews. 8 CHAPTER 2 HOUSEHOLD CHARACTERISTICS Table 2.1 Household population by age, sex, and residence. 10 Table 2.2 Household composition. 12 Table 2.3 Children's living arrangements and orphanhood. 13 Table 2.4 Educational attainment of the household population. 14 Table 2.5 Age-specific attendance rates of the de-jure population 6 to 24 years . 16 Table 2.6 Household characteristics . 18 Table 2.7 Household drinking water and sanitation facilities. 19 Table 2.8 Household durable goods . 20 Table 2.9 Wealth quintiles. 21 Figure 2.1 Male and Female Population by Single Year of Age. 9 Figure 2.2 Population Pyramid . 11 Figure 2.3 Population by Broad Age Groups, Various Surveys, 1976-2007. 11 Figure 2.4 Age-Specific Attendance Rates . 17 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS Table 3.1 Background characteristics of respondents . 23 Table 3.2 Educational attainment . 25 Table 3.3 Exposure to mass media. 26 Table 3.4 Working status . 28 Table 3.5 Occupation. 30 Table 3.6 Use of tobacco. 31 Figure 3.1 Percent Distribution of Women who Worked in the 7 Days Preceding the Survey, by Employment Status . 29 CHAPTER 4 FERTILITY Table 4.1 Trends in fertility. 34 Table 4.2 Current fertility . 35 Table 4.3 Fertility by background characteristics . 37 Table 4.4 Trends in age-specific fertility rates. 38 Table 4.5 Children ever born and living. 39 Table 4.6 Birth intervals. 40 Table 4.7 Age at first birth . 41 Table 4.8 Median age at first birth . 42 Table 4.9 Teenage pregnancy and motherhood. 43 viii | Tables and Figures Figure 4.1 Age-Specific Fertility Rates from Various Surveys,1976-2007. 35 Figure 4.2 Age-Specific Fertility Rates by Urban-Rural Residence, 2002 and 2007. 36 Figure 4.3 Age-Specific Fertility Rates for Five-Year Periods Preceding the Survey . 38 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 by age . 47 Table 5.4 Current use of contraception by background characteristics . 49 Table 5.5 Number of children at first use of contraception . 50 Table 5.6 Knowledge of fertile period. 51 Table 5.7 Timing of sterilization. 51 Table 5.8 Source of modern contraception methods . 52 Table 5.9 Informed choice . 54 Table 5.10 First-year contraceptive discontinuation rates . 55 Table 5.11 Reasons for discontinuation . 57 Table 5.12 Future use of contraception . 57 Table 5.13 Reason for not intending to use contraception in the future . 58 Table 5.14 Preferred method of contraception for future use. 58 Table 5.15 Exposure to family planning messages . 59 Table 5.16 Contact of nonusers with family planning providers . 61 Figure 5.1 Current Use of Modern Contraception Among Currently Married Women, 1990-2007. 48 Figure 5.2 Sources of Family Planning Methods Among Current Users of Modern Methods . 53 Figure 5.3 Contraceptive Discontinuation Rates by Reason and Method. 56 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY Table 6.1 Trends in the proportion of ever-married by age group . 63 Table 6.2 Current marital status. 64 Table 6.3 Number of co-wives . 65 Table 6.4 Consanguinity . 66 Table 6.5 Age at first marriage . 67 Table 6.6 Median age at first marriage. 68 Table 6.7 Recent sexual activity. 69 Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility. 70 Table 6.9 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility. 71 Table 6.10 Menopause. 72 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 74 Table 7.2 Desire to limit childbearing . 75 Table 7.3 Need and demand for family planning among currently married women . 77 Table 7.4 Ideal number of children . 79 Table 7.5 Mean ideal number of children. 80 Table 7.6 Fertility planning status. 81 Tables and Figures | ix Table 7.7 Wanted fertility rates. 82 Figure 7.1 Fertility Preferences of Currently Married Women 15-49 . 74 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 84 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 87 Table 8.3 Early childhood mortality rates by demographic characteristics. 88 Table 8.4 Perinatal mortality. 90 Table 8.5 High-risk fertility behavior . 91 Figure 8.1 Trends in Infant and Child Mortality by Five-year Periods. 85 Figure 8.2 Trends in Infant and Child Mortality, 1978-2005 . 85 Figure 8.3 Infant Mortality by Selected Demographic Characteristics . 88 CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care. 94 Table 9.2 Number of antenatal care visits . 96 Table 9.3 Timing of first antenatal care visit . 97 Table 9.4 Components of antenatal care . 99 Table 9.5 Tetanus toxoid injections . 100 Table 9.6 Place of delivery . 102 Table 9.7 Assistance during delivery . 104 Table 9.8 Cost of delivery. 106 Table 9.9 Timing of first postnatal checkup. 107 Table 9.10 Problems in accessing health care . 108 Table 9.11 Premarital medical examination. 110 Table 9.12 Breast cancer exam and pap smear. 111 Table 9.13 Knowledge and attitude concerning tuberculosis. 113 Figure 9.1 Distribution of Births by Place of Delivery . 101 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight at birth . 115 Table 10.2 Vaccinations by source of information. 117 Table 10.3 Vaccinations by background characteristics . 119 Table 10.4 Vaccinations in first year of life. 120 Table 10.5.1 Vaccinations of children 24-59 months by background characteristics (Part 1). 121 Table 10.5.2 Vaccinations of children 24-59 months by background characteristics (Part 2). 122 Table 10.6 Prevalence and treatment of symptoms of ARI . 124 Table 10.7 Prevalence and treatment of fever. 126 Table 10.8 Prevalence of diarrhea . 127 Table 10.9 Diarrhea treatment . 128 Table 10.10 Feeding practices during diarrhea . 130 Table 10.11 Knowledge of ORS packets or pre-packaged liquids. 131 x | Tables and Figures Figure 10.1 Percentage of Children Age 12-23 Months with Specific Vaccinations. 118 CHAPTER 11 NUTRITION Table 11.1 Initial breastfeeding. 134 Table 11.2 Breastfeeding status by age . 136 Table 11.3 Median duration and frequency of breastfeeding . 137 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview. 138 Table 11.5 Infant and young child feeding (IYCF) practices . 140 Table 11.6 Micronutrient intake among children . 142 Table 11.7 Nutritional status of women . 144 Table 11.8 Foods consumed by mothers in the day or night preceding the interview. 145 Table 11.9 Micronutrient intake among mothers . 146 CHAPTER 12 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS Table 12.1 Knowledge of AIDS. 148 Table 12.2 Knowledge of ways to avoid HIV/AIDS. 149 Table 12.3 Knowledge of HIV prevention methods. 150 Table 12.4 Comprehensive knowledge about AIDS . 152 Table 12.5 Knowledge of mother to child transmission of HIV. 153 Table 12.6 Accepting attitudes toward those living with HIV/AIDS. 154 Table 12.7 Attitudes toward negotiating safer sexual relations with husband. 155 Table 12.8 Discussion of HIV/AIDS with husband. 156 Table 12.9 Knowledge of symptoms of STIs . 157 Table 12.10 Knowledge of source of male condom . 158 Table 12.11 Use of condoms. 158 CHAPTER 13 WOMEN’S EMPOWERMENT Table 13.1 Employment of currently married women . 159 Table 13.2 Control over women's cash earnings and relative magnitude of women's earnings. 160 Table 13.3 Women's participation in decision making . 161 Table 13.4 Women's participation in decision making by background characteristics. 162 Table 13.5 Attitude toward wife beating. 164 Table 13.6 Attitude toward refusing sexual intercourse with husband . 166 Table 13.7 Indicators of women's empowerment. 167 Table 13.8 Women’s empowerment and current use of contraception. 168 Table 13.9 Women's empowerment and ideal number of children and unmet need for family planning . 169 Figure 13.1 Distribution of Women According to the Number of Decisions in Which They Participate in the Final Say . 163 Figure 13.2 Percentage of Women Who Agree with at Least One Reason Justifying a Husband Beating His Wife . 165 Tables and Figures | xi CHAPTER 14 DOMESTIC VIOLENCE Table 14.1 Experience of physical violence. 172 Table 14.2 Perpetrators of physical violence . 173 Table 14.3 Violence during pregnancy . 174 Table 14.4 Forms of spousal violence . 175 Table 14.5 Spousal violence by background characteristics. 177 Table 14.6 Spousal violence by husband's characteristics and empowerment indicators. 178 Table 14.7 Help-seeking behavior by women experiencing physical or sexual violence. 179 CHAPTER 15 EARLY CHILDHOOD DEVELOPMENT Table 15.1 Ability to count . 182 Table 15.2 Frequency of reading or being read to and name recognition. 184 Table 15.3 Participation in family discussions . 185 Table 15.4 Management of disagreements among friends. 186 Table 15.5 Teeth brushing and hand washing. 187 APPENDIX A SAMPLE DESIGN Table A.1 Distribution of clusters by governorate and by type of residence . 191 Table A.2 Population distribution by governorate and by type of residence. 192 Table A.3 Distribution of households by governorate and by type of residence . 192 Table A.4 Sample allocation of completed women interviews by governorate and by type of residence. 193 Table A.5 Sample allocation of households and clusters by governorate and by type of residence . 194 Table A.6 Sample implementation . 196 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 199 Table B.2 Sampling errors for national sample . 200 Table B.3 Sampling errors for urban sample. 201 Table B.4 Sampling errors for rural sample. 202 Table B.5 Sampling errors for Central sample. 203 Table B.6 Sampling errors for North sample. 204 Table B.7 Sampling errors for South sample. 205 Table B.8 Sampling errors for Amman sample. 206 Table B.9 Sampling errors for Balqa sample . 207 Table B.10 Sampling errors for Zarqa sample. 208 Table B.11 Sampling errors for Madaba sample . 209 Table B.12 Sampling errors for Irbid sample. 210 Table B.13 Sampling errors for Mafraq sample. 211 Table B.14 Sampling errors for Jarash sample. 212 Table B.15 Sampling errors for Ajloun sample. 213 Table B.16 Sampling errors for Karak sample . 214 Table B.17 Sampling errors for Tafiela sample. 215 Table B.18 Sampling errors for Ma’an sample . 216 xii | Tables and Figures Table B.19 Sampling errors for Aqaba sample . 217 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 219 Table C.2 Age distribution of eligible and interviewed women . 220 Table C.3 Completeness of reporting . 220 Table C.4 Births by calendar years . 221 Table C.5 Reporting of age at death in days . 222 Table C.6 Reporting of age at death in months. 223 Preface | xiii PREFACE The Department of Statistics (DoS) takes pleasure in presenting the principal report of the 2007 Jordan Population and Family Health Survey (JPFHS), which was conducted during June through November 2007. Like the previous three JPFHS, conducted in 1990, 1997 and 2002, the 2007 JPFHS was carried out by DoS in collaboration with Macro International Inc., which provided technical assistance through the worldwide MEASURE Demographic and Health Surveys (DHS) program. The main objective of the survey is to provide comprehensive data on fertility, mortality, family planning, maternal and child health, and nutrition, to be used as tools to evaluate existing population and health policies and programs. The sample was nationally-representative and has been designed to produce estimates of major survey variables at the national level, for urban and rural areas, for each of the three regions (Central, North, and South), the Badia and the non-Badia areas, and for each of the twelve governorates. Almost 15,000 households and 11,000 ever-married women aged 15 to 49 were interviewed. The 2007 JPFHS was funded primarily by the Government of Jordan and the United States Agency for International Development (USAID). Additional funding was provided by the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF). It is hoped that the 2007 JPFHS results will meet its objective of facilitating important government policies and programs promoting maternal and child health. Furthermore, the survey will also be useful to those interested in the fields of population, family planning, and health. The DoS would like to express its 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. Thanks go to all of the households interviewed during the survey for their time and willingness to provide the required information. Acknowledgment also goes to the Ministry of Health for its technical and logistic assistance. Thanks are due to the USAID, the UNFPA, and the UNICEF missions in Amman for their financial and technical support. Thanks also go to the Macro International team: Dr. Mohamed Ayad, DHS Regional Coordinator; Mr. Bernard Barrère, DHS Country Manager, who assisted in all stages of the survey; Mr. Ruilin Ren for his recommendations on the sampling design; and Mr. Noureddine Abderrahim for his valuable assistance in data processing. Special thanks are also due to the local and international experts who prepared the present report. Director General Dr. Haidar Fraihat Summary of Findings | xv SUMMARY OF FINDINGS The 2007 Jordan Population and Family Health Survey (JPFHS) was designed to provide data for monitoring the population and health situation in Jordan. The 2007 JPFHS is the fourth Population and Family Health Survey conducted in Jordan as part of the Demographic and Health Surveys pro- gram. The objective of the survey is to provide up- to-date information on fertility, family planning, childhood mortality, infant and child feeding prac- tices, maternal and child health, HIV/AIDS-related knowledge and behavior, domestic violence, and child development. A nationally representative sample of 14,564 households and ever-married 10,876 women aged 15-49 were interviewed. This represents a re- sponse rate of 99 percent for households and 98 percent for women. This sample provides esti- mates for Jordan as a whole, for urban and rural areas, the Badia and non-Badia areas, the North, Central, and South regions, and each of the 12 governorates. Fieldwork for the 2007 JPFHS was carried out between June and November 2007. HOUSEHOLD CHARACTERISTICS Household Composition. Jordanian households consist of an average of 5.3 persons. Only 10 per- cent of households in Jordan are headed by a woman. Housing Conditions. Most households have the basic necessities. Ninety-nine percent of house- holds have electricity, and 97 percent have an im- proved sanitation facility, that is, either a flush toilet, a ventilated improved pit latrine, or a pit latrine with a slab. Almost all households (97 per- cent) have access to improved drinking water and 98 percent of households have an independent bathroom. Education of Household Members. About half of the population has attended secondary school or beyond. Females are slightly more likely than males to be uneducated, especially in the older age groups. Overall, the same percentage of females as males has attended higher than secondary school. As expected, older females and males and those living in rural areas are least likely to be educated. Ownership of goods. Almost all households own a television (97 percent) and 90 percent own a mobile phone. More than one-third (36 percent) of households own a computer and 94 percent own a washing machine. Four in ten households own a car or pickup truck. Urban households are more likely to own goods than rural households. FERTILITY AND ITS DETERMINANTS Total Fertility Rate (TFR). Although fertility dropped dramatically between 1983 and 2002, it has remained almost constant since 2002. Cur- rently, women in Jordan have an average of 3.6 children, compared to 3.7 in 2002. Fertility is almost identical in urban and rural ar- eas, but does vary by governorate. Fertility is the lowest in Karak, at 3.2 children per woman, com- pared to 4.1 in Aqaba. Fertility is much higher in the Badia areas than in the non-Badia areas (4.2 compared to 3.5). Fertility increases as the wealth of the respon- dent’s household decreases. Women living in the poorest households, in general, have almost twice as many children as women who live in the wealthiest households (4.8 compared to 2.5 chil- dren per woman). Birth intervals. About two-fifths of children are born at least three years after their siblings. Half of children are born after an interval of 31.2 months or more. Desired Family Size. Women report a mean ideal family size of 3.9 children. Ideal family size is slightly higher among women in rural areas than urban areas (4.2 compared to 3.9). Ideal family size decreases as women’s education increases: xvi | Summary of Findings women with no education would like to have 4.7 children compared to only 3.8 among those with higher education. Age at First Marriage and First Birth. In Jor- dan, half of women are married by age 22.2. Only 18 percent are married by age 18. The median age at first marriage ranges from 21.1 in Aqaba to 23.8 in Karak. Women with high education get married five years later than those with no education (me- dian age of 24.7 compared to 19.7). Childbearing begins at a relatively late age in Jor- dan. Half of women have their first birth by age 23.9. Only 8 percent of women had their first birth by age 18. Urban women have their first birth at a slightly younger age than rural women—23.8 years versus 24.3 years. Women with more educa- tion wait much longer to have their first birth. Women with higher education have their first birth at a median age of more than 25 years, compared to only 21.6 among those who have had no educa- tion. Teenage Fertility. Teenage childbearing is rare in Jordan. Only 3 percent of teenage girls (age 15-19) have already had a birth, and another 1 percent is pregnant with their first child. In general, teenage childbearing is much more common among women with less education (16 percent among those with only elementary) and among those in the poorest households (8 percent). FAMILY PLANNING Knowledge of Family Planning. Knowledge of family planning methods in Jordan is universal: almost 100 percent of ever-married women age 15-49 know at least one modern method of family planning. The most commonly known methods are the IUD and pill (99 percent each). Use of Family Planning. Although contraception use increased greatly between 1990 and 2002, it has since stabilized. According to the 2007 JPFHS, 57 percent of married women are currently using a contraception method; 42 percent are using a modern method. The IUD is the most popular method, with 22 percent of married women, fol- lowed by the pill (8 percent). Use of modern family planning does not vary sig- nificantly by residence or governorate. Modern methods are used by 43 percent of married women in urban areas, compared with 36 percent in rural areas. Modern contraceptive use ranges from a low of 34 percent of married women in Ma’an and Ma- fraq to a high of 46 percent in Zarqa. Modern contraceptive use increases slightly as women’s education increases, from 36 percent of women with no education to 42 percent among those with higher education. Use of modern meth- ods increases more markedly with wealth—47 percent of married women in the wealthiest households use a modern method compared to only 35 percent of married women in the poorest households. Fifteen percent of married women use a traditional method of family planning. Withdrawal is used by 11 percent and 4 percent use periodic abstinence. Source of Family Planning Methods. Public sources such as government hospitals, health cen- ters, and the Royal Medical Services currently provide contraceptives to about 42 percent of cur- rent users, while private hospitals and clinics pro- vide methods to 58 percent of users. Pills and IUDs are most frequently obtained from private sources, while injectables and female sterilization are usually obtained through public sources. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of married women who want to space their next birth or stop childbearing entirely but are not using con- traception. The 2007 JPFHS reveals that 12 per- cent of married women have an unmet need for family planning—5 percent for spacing and 7 per- cent for limiting. Unmet need is highest among those with no education, and among those in the poorest households. Unmet need varies by gover- norate, ranging from only 9 percent in Zarqa to 21 percent in Ma’an. CHILDHOOD MORTALITY Levels and Trends. Childhood mortality is quite low in Jordan and has even decreased slightly since 2002. Currently, one in every 50 children in Jordan dies before his or her fifth birthday. Summary of Findings | xvii The infant mortality rate for the five years before the survey (2002- 2007) is 19 deaths per 1,000 live births and the under-five mortality rate is 21 deaths per 1,000 live births. This is slightly lower than the rates of 22 and 27, respectively, reported in 2002. Mortality rates are slightly higher in rural than urban areas, but they differ markedly by gover- norate. Under-five mortality ranges from only 10 deaths per 1,000 live births in Zarqa to 39 deaths per 1,000 live births in Karak (for the 10 years before the survey). Childhood mortality also de- creases as women’s education increases. Under- five mortality is more than twice as high among children whose mothers have no education com- pared to those with higher education (22 compared to 10). Birth Intervals and Childhood Mortality. Spac- ing children at least 36 months apart reduces risk of infant death. In Jordan, the average birth inter- val is 31 months. Infants born less than two years after a previous birth have particularly high infant mortality rates (26 deaths per 1,000 live births compared to only 13 deaths per 1,000 live births for infants born four or more years after the previ- ous birth). One-third of infants in Jordan are born less than two years after a previous birth. These infants are at particularly high risk of death. MATERNAL HEALTH Antenatal Care. Almost all (99 percent) women receive some antenatal care from a medical pro- fessional, either a doctor (96 percent) or a nurse/ midwife (3 percent). Nine in ten women had an antenatal care visit during the first trimester of pregnancy, as recommended. Most Jordanian women (74 percent) have seven or more antenatal care visits. While almost all pregnant women were weighed, had their blood pressure measured, and had urine and blood samples taken, only half were informed of signs of pregnant complications and only 38 percent were informed about complica- tions during the postnatal period. Only about one- quarter of births were protected against neonatal tetanus. Delivery and Postnatal Care. Almost all of Jor- dan’s births occur in health facilities—64 percent in the public sector and 35 percent in private sec- tor facilities. Three in four births are assisted by a doctor, while one in four is assisted by a nurse or midwife. Nineteen percent of births are delivered by C-section. Two in five deliveries are free of charge, while only about 15 percent cost more than 200 JD. Postnatal care helps prevent complications after childbirth. About seven in ten women had a post- natal checkup. Only 15 percent, however, had a checkup within four hours of birth, as recom- mended. Premarital medical exam. Eighteen percent of ever-married women report that they and/or their husband underwent a premarital medical examina- tion. Premarital medical exams are most common in Amman (21 percent) and among women with higher education (24 percent). Breast cancer exam and Pap smear. Almost four in five women had a breast cancer self-exam or an exam by a health specialist in the year before the survey. Older women, women in urban areas, women with higher levels of education, and women in the wealthiest households were most likely to have had a breast cancer exam. Three-quarters of women have heard of a Pap smear, but only 18 percent of women have ever had a Pap smear. Pap smears are more common among older women and among the most educated and wealthiest women. CHILD HEALTH Vaccination Coverage. According to the 2007 JPFHS, 87 percent of Jordanian children age 12–23 months had received all recommended vac- cines—one dose of BCG, measles, and three doses each of DPT and polio. Ninety-four percent had received all the basic vaccinations except BCG (which was only added to the recommended vac- cines list for Jordan in recent years). Less than 1 percent of children had not received any of the recommended vaccines. Vaccination coverage is slightly higher in urban areas than rural areas (94 versus 91 percent of children with all basic vaccines except BCG). There is marked variation in vaccination coverage by governorate, ranging from 84 percent fully vac- xviii | Summary of Findings cinated (except BCG) in Ma’an to 96 percent in Irbid. Vaccination coverage increases with mother’s education, but is fairly uniform across wealth quintiles. Childhood Illnesses. In the two weeks before the survey, 5 percent of children under five had symp- toms of an acute respiratory infection (ARI). For three-quarters of these children, treatment or ad- vice was sought from a health provider and 87 percent received antibiotics. One in seven children under five (14 percent) had a fever in the two weeks before the survey. In 70 percent of these cases, treatment or advice was sought from a pro- vider and 85 percent received antibiotics. During the two weeks before the survey, 16 per- cent of children under five had diarrhea. The rate was highest (32 percent) among children 6-11 months old. Fifty-five percent of children received treatment or advice from a health provider. Chil- dren with diarrhea should drink more fluids and should receive oral rehydration salts (ORS). Al- most all (94 percent) mothers with children born in the last five years know about ORS packets, but in the two weeks before the survey, only 20 percent of children with diarrhea were treated with ORS packets. Many more (46 percent) were offered increased fluids. In all, 57 percent of children with diarrhea were offered oral rehydration therapy (ORS or recommended home fluids) or increased fluids. Almost half of children were given antibi- otic drugs. More than one in five (22 percent) re- ceived no treatment at all. NUTRITION Breastfeeding and Complementary Foods. Breastfeeding is common in Jordan, with 93 per- cent of children ever breastfed. However, only about two in five infants are breastfed within one hour of birth, and more than half (58 percent) re- ceive a prelacteal feed. WHO recommends that children receive nothing but breast milk (exclusive breastfeeding) for the first six months of life. About 22 percent of chil- dren under six months of age in Jordan are exclu- sively breastfed. Infants should not be given water, juices, other milks, or complementary foods until six months of age, yet two-thirds of children under six months receive these. On average, children breastfeed until the age of 13 months, but exclu- sively breastfeed for less than one month. Complementary foods should be introduced when a child is six months old to reduce the risk of mal- nutrition. In Jordan, 66 percent of children ages 6–9 months are eating complementary foods. Women’s Nutritional Status. Almost half of Jor- danian women are overweight or obese (body mass index �25.0). Only 4 percent are thin (body mass index <18.5). KNOWLEDGE OF HIV/AIDS Knowledge. According to the 2007 JPFHS, almost all ever-married women have heard of AIDS, but knowledge of HIV-prevention measures is lower. Only 53 percent of women know that the risk of getting HIV can be reduced by using condoms, and only 43 percent know that abstaining from sexual intercourse reduces the risk of getting AIDS. More women (86 percent) know that limit- ing sexual intercourse to one uninfected partner reduces the risk. Prevention knowledge varies by governorate. Only 44 percent of women in Mad- aba know that using condoms can prevent HIV, compared to 58 percent of women in Irbid. Many women still have misconceptions about HIV/AIDS. Only four in ten women know that AIDS cannot be transmitted by mosquito bites, three in four know that a person cannot become infected by sharing food with a person who has AIDS, and four in five know that AIDS cannot be transmitted by shaking hands. Sexually Transmitted Infections (STIs). Two- thirds of ever-married women have not heard of any sexually transmitted infections (STIs) apart from HIV/AIDS. Only 17 percent of women know at least one STI symptom in a man or in a woman. WOMEN’S EMPOWERMENT Working status. Only 12 percent of married women are currently working. Of these women, most earn less money than their husbands. Almost all women who receive cash earnings for employ- ment (96 percent) report that they decide alone or along with their husbands how their earnings will be used. Summary of Findings | xix Participation in household decisions. Women contribute to many household decisions. More than 85 percent of married women report that they participate in decisions regarding their own health care and visits to family, and more than 70 percent say they contribute to decisions about making daily and major household purchases. Fifty-five percent report that they participate in all four of these decisions. Two percent of women do not participate at all in any of the four decisions. DOMESTIC VIOLENCE Experience of violence. One-third of ever-married women have ever experienced physical violence since age 15. Thirteen percent experienced physi- cal violence in the year before the survey. Women with lower levels of education and those from poorer households are more likely to report having ever experienced physical violence. The most common perpetrator of physical violence is the current or previous husband (64 percent). Broth- ers, fathers, and mothers are also common perpe- trators (about 20 percent each). Five percent of women experienced violence during pregnancy. Divorced women are the most likely to report hav- ing experienced any type of violence. Spousal violence. One in five ever-married women report that they ever experienced physical violence by their husband. For 12 percent of women, this violence had occurred within the year before the survey. Eight percent of ever-married women report sexual violence by their husband. One in five women also reported to have experi- enced emotional violence by their husband; 14 percent reported that this had occurred in the most recent year. In all, 23 percent of ever-married women reported ever having experienced physical or sexual violence by their husbands. Fifteen per- cent reported that this violence took place in the year before the survey. Women with lower levels of education and those living in poorer households are more likely to re- port spousal violence than those with more educa- tion or those living in the wealthier households. Reports of physical/sexual violence also vary by governorate. Only 10 percent of women in Mad- aba report ever experiencing physical or sexual violence by their husband, compared to 38 percent of women in Mafraq. Spousal violence is also more common in situations when the husband is better educated than the wife, and in households where women contribute to fewer decisions. Twenty-two percent of women who experienced spousal violence in the year before the survey sought any assistance. Women who experience frequent violence are more likely to have sought help. Among those who do seek help, mothers and fathers are the most common persons from whom assistance is sought. Women rarely seek the help of medical personnel, police, lawyers, or other external sources. xx | Map of Jordan 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 until the end of World War I. 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 accordance with the desires of the Arab states and the Palestinian National Authority, the West Bank was administratively 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 Jordan’s only outlet to the sea, as Palestine and Israel separate Jordan from the Mediterranean. Saudi Arabia lies to the south and east, Iraq to the northeast, and Syria to the north. Three climatic zones characterize 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. The total area of Jordan is 89,000 square kilometers, of which over 80 percent 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 7.3 percent in 1992 to 3.8 percent in 1997, then to 3.3 percent in 2002, and to 3.2 percent in 2006. The contribution of wholesale and retail trade, restaurants, and hotels to the GDP has not changed significantly; these sectors made up 9.3 percent of GDP in 1992 and 9.7 in 2006. There was a concomitant rise in the share of the manufacturing sector, rising from 12.4 percent in 1992 to 16.3 percent in 2002 and reaching about 18 percent in 2006. The share of the community and personal services sector also rose slightly during this period, from 2.4 percent in 1992 to 3.6 percent in 2006. The contribution of the transportation, storage and communication sector to the GDP has changed little over the past 15 years, rising about 2.1 percentage points between 1992 and 2002, and reaching about 16 percent in 2006. The GDP per capita at current prices has demonstrated a steady increase over time, rising from US$ 1,326 in 1992, to US$ 1,610 in 1997, to US$ 1,882 in 2002, to an average of US$ 2,522 in 2006. The cost of living index increased by 20 percent between 1992 and 1997, and increased by 8 percent between 1997 and 2002, while the percentage of increase was about 5 percent between 2006 and 2007. The balance of trade deficit rose sharply by 72 percent between 1990 and 1996, but declined by 14 percent between 1997 and 2001. While the deficit rose by 86 percent between 2002 and 2004 and remained stable between 2006 and 2007, it reached about 30 percent between 2004 and 2006. The rate of economic 2 | Introduction growth at constant prices has increased steadily over time: growth was 3.3 percent for 1997, 5.8 percent for 2002, and 6.3 percent for 2006. 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. The government has launched the process of integration and consolidation in the world economy by joining the World Trade Organization, signing a free trade agreement with the United States, a partnership agreement with the European Union, the Greater Arab Free Trade Agreement and the Qualified Industrial Zones Agreement. The government has also established several development areas, such as the Aqaba Special Economic Zone Authority. The government has launched the Socioeconomic Transition Program, the E-government Initiative, the National Agenda, All of Us the Jordan Gathering, as well as to fairly distribute the development outcomes among all citizens. Thus, private local and foreign investments have significantly increased, reaching levels never previously achieved, as a result of the continuity of implementing privatization programs and a good environment for investment. The government, and in response to the directives of His Majesty, has expanded the provision of decent housing for tens of thousands of poor households and those with limited and low income 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 the end of 2004, the population was estimated at about 5.35 million, while, it reached 5.72 million in 2007, and it is expected to reach 6.1 million by the year 2010. Population growth averaged 4.8 percent during the period 1961-1979, and 4.4 percent between 1979 and 1994. The high rates of growth have been due to 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 foreign workers, the high rate of natural increase, the return of about 300,000 Jordanians from the Gulf States as a result of the 1990 Gulf Crisis, as well as the return of some tens of thousands of Jordanians and the migration of hundreds of thousands of Iraqis as a result of the 2003 Second 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 education 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 2.3 percent in 2007. The average size of private household decreased from 6.7 persons in 1979 to 6.0 persons in 1994 and to 5.4 persons in 2004. In 2007, the average is estimated at about 5.2 persons. Urbanization is a particularly important topic in Jordan. Historically, internal rural-to-urban migration, as well as immigration, has contributed to rapid urban growth. Recent international crises have also impacted flows of migration into Jordan. The percent of the population living in urban areas increased by 14 percent between 1980 and 1994 (from 70 to 79 percent), reaching 83 percent in 2004, about a 5 percent increase compared to 1994. Results of the 2004 census indicate that the age structure of the population has changed considerably 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 37 percent by Introduction | 3 2004, while the proportion of those aged 60 and over has been rising, from 4.1 percent in 1979 to 5.2 percent in 2004. Fertility has been declining in Jordan since the mid-1970s. Surveys have found that the total fertility rate declined from 7.4 children per woman in 1976 to 5.6 in 1990, 4.4 in 1997, 3.7 in 2002 and to 3.6 children in 2007. These figures indicate a 40 percent decline (about three children fewer per woman) between 1976 and 1997; fertility fell another 19 percent, or by one child more, between 1997 and 2002. The decline was very slight between 2002 and 2007 (about 3 percent), insignificant compared to that decline that took place in the previous years. Mortality has also been declining in Jordan, even faster than fertility. The crude death rate, estimated at 18 per thousand in the early 1960s, had declined to 12 by the early 1980s. In 2007, the crude death rate was estimated at seven per thousand. The infant mortality rate also declined from 82 per thousand in 1976 to 22 in 2002, and reached 19 per thousand in 2007, decreasing by 14 percent compared to 2002. Drops in mortality, particularly infant mortality, have translated into an increased life expectancy for the population: in 2002, life expectancy in Jordan was 68 years for males and 71 years for females, increasing to 72 years for males and 74 years for females in 2007. With regard to the education of the population, the illiteracy rate among those aged 15 years and over has dropped by 70 percent since 1979, from 36 percent to 10 percent in 2002, reaching about 8 percent in 2007 (4 percent among males compared to 12 percent among females). In addition, almost one- third of Jordan’s population is currently enrolled in school, at various educational levels. Seventy-one percent of all students attend schools run by the government, which comprise 59 percent of all schools in Jordan in 2007. This percentage has been fairly constant during the last ten years. 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 satisfactory 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. From that period until 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 Association of Family Planning and Protection (JAFPP), as well as by some voluntary nongovernmental organizations, were invaluable in this regard. The first initiative for proposed population policy was taken in 1993, where the NPC adopted the Birth Spacing National Program, in an effort to promote better maternal and child health and to reduce fertility through advocating increased birth intervals. 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 National Population Strategy for Jordan, which was approved by the cabinet in 1996 and was updated in 2000 in the light of regional and international recommendations and national surveys. The strategy document comprised four main dimensions – namely, reproductive health; population and sustainable development; gender equality and equity; empowerment of women; and population and enhancing advocacy and media. 4 | Introduction This updated strategy was activated by the establishment of the Higher Population Council (HPC) at the beginning of 2002, designed to face the population and development challenges and follow up on the implementation of its work plan. This council is headed by the Prime Minister and is comprised of concerned ministers, in addition to relevant members from both the public and private sectors. The HPC is to continue the work of the NPC, as it is the higher authority commissioned with proposing and formulating national population policies, following up, presenting, updating and providing the supporting environment for achieving its objectives. This is to be in line with the national socio-economic plans, the socio-economic transition program and the National Agenda of Jordan. The HPC will work toward the promotion of public awareness in population and development issues and enhance advocacy in these areas. The HPC will collaborate and coordinate with regional and international bodies interested in population issues, in addition to building national capacities for officials working in these areas in different institutions. 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 priority 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. 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 National Health Strategy for the period 2006-2010. These plans focus on the following areas: 1. Coordination of primary, secondary, and tertiary health service delivery, in order to improve 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, hospitals, buildings, including equipping and computerization of new facilities, as needed. 4. Issuance of laws and regulations related to the organization of the health sector, in addition to reconsideration of some existing health laws and regulations expected to be approved during the plan period 2006-2010. 5. Computerization of the MOH existing health facilities all over the country, including the development of a Geographic Information System (GIS) for these facilities. 6. Increasing the coverage of health insurance to cover all people in the Jordanian society. 1.5 OBJECTIVES OF THE SURVEY As in the previous Demographic and Health Surveys (DHS) in Jordan, conducted in 1990, 1997 and 2002, the primary objective of the Jordan Population and Family Health Survey 2007 (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, a subsample of women and children were tested for anemia and anthropometry (height and weight). The JPFHS data will Introduction | 5 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 2007 JPFHS was significantly expanded from the 2002 survey to include additional questions on women’s status, reproductive health, domestic violence, and early childhood development. 1.6 METHODOLOGY AND ORGANIZATION OF THE SURVEY The JPFHS 2007 is designed to collect data on ever-married women of reproductive age. The areas covered include demographic and socioeconomic characteristics, reproduction, family planning, health care, breastfeeding and child health care, marriage and woman employment, fertility preferences, nutritional status of children under five years of age, knowledge of Acquired Immune Deficiency Syndrome (AIDS) and sexually-transmitted infections (STIs), domestic violence and early childhood development. The survey was funded primarily by the Jordanian government and the U.S. Agency for International Development (USAID). Additional funding was provided by UNFPA and UNICEF. Macro International Inc. provided technical assistance through the global Demographic and Health Surveys (DHS) program, in the domain of sample and questionnaire design, training activities, computer processing of survey data, and preparation of reports. A national technical committee was established to provide guidelines for the planning and implementation stages of the survey. 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 mapping, listing of households, sample design, and implementation of sampling procedures. At the same time, the survey questionnaires and instruction manuals were developed, pretested, and finalized. All of these activities were completed in May 2007. The second stage encompassed interviewing and the collection of data. This was carried out by 14 teams, consisting of 14 controllers, 8 field editors, 57 interviewers, and 8 female health technicians (for blood testing). Each team was provided with the required number of vehicles. The field work started on 14 June 2007 and finished on 19 November 2007. The third stage involved office editing of questionnaires, coding of open-ended questions, ensuring data completion and data consistency. Data processing using CSPro software, data entry and on line data verification started soon after the beginning of field work. Data processing operations (central editing of data, data entry, double-entry of all questionnaires, final editing, and verification of data accuracy and consistency) were completed at the end of December 2007. 1.6.1 Sample Design The 2007 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 12 governorates, and badia and non-badia areas. In order to ensure comparability with the previous surveys, the sample was designed to provide estimates for the three regions, North, Central and South. The grouping of the governorates into the regions is as follows: the North region consists of Irbid, Jarash, Ajloun, 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 2007 JPFHS sample was designed using the 2004 Population and Housing Census as the sampling 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 a probability proportional to the size of the PSU. A 6 | Introduction total of 930 PSUs were selected at this stage. In the second stage, a fixed number of 16 households were selected as final sampling units in each PSU, resulting in a sample size of about 15,000 households. Blood testing (anemia) and the measurements of height and weight were conducted among eligible individuals in the selected households in 465 PSUs (half of the sample). In addition, 310 selected PSUs (one third of the sample) which were not selected for the above measurements were chosen for collecting data on domestic violence in the household. The sample design is described in Appendix A and 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 housing unit and the name of the household head. These activities were completed during the second quarter of 2007. 1.6.3 Questionnaires The 2007 JPFHS used two questionnaires – namely, the Household Questionnaire and the Individual Questionnaire (See Appendix D). Both questionnaires were developed in English and Arabic, based on the questionnaires used in the 2002 survey, in collaboration with Macro International Inc. The Household Questionnaire was used to list all usual members of the sampled households and to obtain information on each household member’s age, sex, educational attainment, relationship to the head of household, and marital status. In addition, questions were included on the socio-economic 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 aged 15-49. In addition, in half of the households, all women aged 15-49 and children under five years of age were measured to determine nutritional status and tested for anemia. The household and women’s questionnaires were based on the DHS standard Questionnaire. Additions and modifications to the model questionnaire were made in order to provide detailed information specific to Jordan, using experience gained from the 1990, 1997 and 2002 Jordan Population and Family Health Surveys. For each ever-married woman aged 15-49, information on the following topics was collected: � Respondent’s general background � Birth history � Family planning � Pregnancy, postnatal health care and breastfeeding � Children immunization and children and mothers nutrition. � Marriage � Fertility preferences � Husband’s background and respondent’s employment � AIDS and STIs � Other health issues � Domestic violence � Early childhood development The last two sections of the questionnaire (domestic violence and early childhood development) were used for the first time in Jordan. In addition, information on births and pregnancies, contraceptive Introduction | 7 use and discontinuation, and marriage during the five years prior to the survey was collected using a monthly calendar. As previously mentioned, anthropometric data were collected during the JPFHS in a subsample of 50 percent of clusters. All women aged 15-49 and children aged 0-4 of these households were measured using Shorr height boards and electronic Seca scales were used to measure their weight. In addition, a drop of capillary blood was taken from these women and children to measure, in the field, their hemoglobin level using the HemoCue system. Hemoglobin testing was used to estimate the prevalence of anemia. Analysis of the anthropometric and hemoglobin data has revealed anomalies in the individual values resulting in unreliable estimates of children’s nutritional status and anemia prevalence among children and women. Therefore, these data are not included in this report. 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 geographic areas. Fieldworkers for the main survey were recruited from among those who participated in the 2004 census as well as those who took part in other demographic surveys conducted by the Department of Statistics (DoS), especially the 2002 JPFHS. The interviewers were all highly qualified females. Supervisors and field editors were selected from the DoS permanent staff or from those with good past experience in such surveys. 1.6.5 Training and Pretest Training of the interviewers took place in Amman for four weeks in May and June 2007. The training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instructions 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 additional training in methods of field editing, data quality control procedures, and fieldwork coordination. Conducting training in the Prince Hamzah Hospital was an advantage, as the interviewers who were assigned to take measurements of height and weight and conduct blood testing for anemia were able to practice with out-patients. Debriefing sessions were held with the pretest field staff, and modifications to the questionnaires and instructions were made based on lessons drawn from the exercise. The survey technical staff, MOH specialists, and experts from Macro International Inc. participated and lectured in the training program. Those are specialized in conducting height and weight measurements and blood testing for anemia as well as conducting training and technical application of the survey inputs. 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 14 controllers, 8 editors, 57 interviewers and 8 female health technicians (for blood testing). All teams were supervised by three controllers and two inspectors. During field work, these teams were combined or reformulated as necessary. Fieldwork was carried out between 14 June and 19 November 2007. 8 | Introduction To facilitate data collection, each interviewing team was assigned a number of blocks in the sample 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, interviewers were asked to conduct fewer interviews during the first three days of data collection; the completed questionnaires were then checked by the field editor and/or the supervisor to ensure completeness 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 re- interviewing some respondents. The original questionnaires were then matched to the re-interview questionnaires 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 attempting to persuade eligible women who were reluctant to be interviewed. Once a cluster was finished, the questionnaires were delivered to the central office in Amman for processing. 1.6.7 Data Processing Fieldwork and data processing activities overlapped. After two weeks 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 two weeks 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 December 2007. A data processing specialist from Macro International made a trip to Jordan in January 2008 to follow up data editing and cleaning and to work on the tabulation of results for the survey preliminary report, that was published in February 2008. The tabulations for the present final report were completed in May 2008. 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 14,880 households were selected for the survey from the sampling frame; among those selected house- holds, 14,748 households were found. Of those households, 14,564 (99 percent) were successfully interviewed. In those house- holds, 11,113 eligible women were identi- fied, and complete interviews were obtained with 10,876 of them (98 percent of all eligible women). The overall response rate (the households response rate multiplied by the eligible woman response rate) was about 97 percent. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Jordan 2007 Residence Result Urban Rural Total Household interviews Households selected 10,192 4,688 14,880 Households found 10,099 4,649 14,748 Households interviewed 9,954 4,610 14,564 Household response rate1 98.6 99.2 98.8 Interviews with women age 15-49 Number of eligible women 7,690 3,423 11,113 Number of eligible women interviewed 7,509 3,367 10,876 Eligible women response rate2 97.6 98.4 97.9 1 Households interviewed/households found 2 Respondents interviewed/eligible respondents 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 2007 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 household). 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 have been carried out using the de facto population only, unless otherwise specified. 2.1 POPULATION BY AGE AND SEX In many developing countries, data on age are affected by errors such as misstatement and preference for or avoidance of certain digits. In general, that was not the case in Jordan. The survey results indicated that not only a respondent’s age but the month and year of their birth are usually recorded. 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 JPFHS 2007 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Age (in years) 0 200 400 600 800 1000 1200 Number in the sample Female Male 10 | Household Characteristics 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, and the second is to describe the context in which various demographic processes are operating. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Jordan 2007 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 13.1 12.8 12.9 12.8 12.6 12.7 13.0 12.8 12.9 5-9 12.4 11.6 12.0 12.3 12.1 12.2 12.4 11.7 12.0 10-14 12.8 12.7 12.7 14.1 13.1 13.6 13.0 12.7 12.9 15-19 10.7 10.9 10.8 11.9 11.8 11.9 10.9 11.1 11.0 20-24 9.8 9.6 9.7 10.9 9.9 10.4 10.0 9.7 9.8 25-29 8.0 7.8 7.9 7.8 7.7 7.8 7.9 7.8 7.9 30-34 6.5 7.6 7.0 6.2 7.4 6.8 6.5 7.5 7.0 35-39 6.5 6.6 6.6 5.5 6.2 5.9 6.3 6.6 6.5 40-44 5.5 5.6 5.6 4.9 5.0 5.0 5.4 5.5 5.5 45-49 3.8 3.6 3.7 3.1 3.0 3.1 3.7 3.5 3.6 50-54 2.9 2.8 2.9 2.7 3.1 2.9 2.8 2.9 2.9 55-59 2.0 2.3 2.2 2.0 2.1 2.1 2.0 2.3 2.2 60-64 2.1 2.0 2.1 1.7 2.2 2.0 2.0 2.1 2.1 65-69 1.5 1.7 1.6 1.5 1.4 1.5 1.5 1.6 1.6 70-74 1.2 1.1 1.1 1.0 1.1 1.1 1.1 1.1 1.1 75-79 0.6 0.6 0.6 0.8 0.6 0.7 0.6 0.6 0.6 80 + 0.5 0.6 0.6 0.6 0.7 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 32,319 31,704 64,023 6,454 6,380 12,834 38,774 38,084 76,857 Table 2.1 shows that 38 percent of the population is under 15 years of age, an indicator that fertility remains high. The proportion under 15 years old is slightly higher in rural areas (39 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 (37 percent and 36 percent in urban and rural areas, respectively). However, differences in the age composition of the urban and rural populations tend to disappear as age increases. One may note an unusual pattern at the youngest ages in the population pyramid (Figure 2.2): while there are fewer children in the 5-9 age group than in the 10-14 age group, there are more children aged 0-4 years than 5-9 years. It is possible that the reduced proportion of children aged 5-9 was the consequence of the fast decline in fertility in the 1990s, while the increased proportion of the 0-4 age group may be a result of a pause in the decline in fertility. There are more males than females in Jordan with an overall sex ratio of 102 males for 100 females. The sex ratio varies by age: from 104 among those under 30 years of age, the sex ratio drops to 97 in the middle age group (30-59 years), and is just above 100 among people age 60 and above. Household Characteristics | 11 2.2 POPULATION BY AGE FROM OTHER SOURCES The percentage of the population under 15 years of age has declined substantially, from 51 percent in 1983, to 44 percent in 1990, 39 percent in 2002 and to its current 2007 level of 38 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, to 82 in 2002 and to 78 in 2007. Figure 2.2 Population Pyramid JPFHS 2007 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 01234567 0 1 2 3 4 5 6 7 Male Female Percent Figure 2.3 Population by Broad Age Groups, Various Surveys, 1976-2007 52 51 44 41 40 38 43 45 52 54 55 56 5 4 4 5 6 6 1976 JFS 1983 JFFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 0 10 20 30 40 50 60 70 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. House- hold 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, especially if they are headed by females, usually have limited financial resources. The average number of members in a household is 5.3. Household size is slightly smaller in urban areas (5.2) than in rural areas (5.7). Ten percent of house- holds, on average, are composed of nine or more persons. The figure is higher in rural areas (16 percent) than in urban areas (9 percent). The table shows that 10 percent of households in urban areas are headed by females, compared with 11 percent in rural areas. The table shows also that about 1 percent of households has at least one child under the age of 18 years who doesn’t live with both parents. A very low percentage of households (0.1 percent) include double orphans (both parents deceased) while 3 percent include single orphans (one parent deceased). The percentage of households with single orphans is higher in rural areas (4 percent) than in urban areas (2 percent). Table 2.3 indicates that the majority of children under 18 years of age (94 percent) are living with both parents: this proportion is 95 percent for children under 15 years of age. The range is between 98 percent for children aged 0-4 years and 92 percent for children aged 10-14 years. No variations were noted according to sex, urban-rural residence, region, or Badia area, while there are slight variations in these percentages by governorate, ranging between 92 percent for Ma’an and 95 percent for Amman and Zarqa. In addition, 3 percent of children under the age of 18 have experienced the death of one or both parents. No variations were noted in this percentage for children under the age of 18 years according to sex. Meanwhile, significant variations were noted according to urban-rural residence (3 and 4 percent, respectively), governorates (ranging from 2 percent in Amman and Irbid to 5 percent in Ma’an and Karak), region (particularly the South region, 4 percent), and Badia area (4 percent). Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18, according to residence, Jordan 2007 Residence Characteristic Urban Rural Total Household headship Male 89.8 89.1 89.7 Female 10.2 10.9 10.3 Total 100.0 100.0 100.0 Number of usual members 0 0.1 0.1 0.1 1 5.0 6.6 5.3 2 10.1 8.1 9.8 3 10.9 9.9 10.7 4 14.0 11.0 13.5 5 16.3 12.1 15.7 6 15.8 14.4 15.6 7 11.2 12.6 11.5 8 7.4 9.2 7.7 9+ 9.1 16.0 10.2 Total 100.0 100.0 100.0 Mean size of households 5.2 5.7 5.3 Percentage of households with orphans and foster children under 18 years of age Foster children1 0.9 1.3 0.9 Double orphans 0.1 0.1 0.1 Single orphans 2.4 3.8 2.6 Foster and/or orphan children 3.2 4.7 3.4 Number of households 12,272 2,292 14,564 Note: Table is based on de jure household members, i.e., usual residents 1 Foster children are those under age 18 living in households with neither their mother nor their father present. Household Characteristics | 13 Table 2.3 Children's living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Jordan 2007 Not living with either parent Living with mother but not father Living with father but not mother Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Informa- tion missing on father/ mother Total Percentage not living with a biological parent Percentage with one or both parents dead Number of children Age 0-4 98.0 1.2 0.4 0.2 0.1 0.1 0.0 0.0 0.0 0.0 100.0 0.1 0.5 9,491 <2 98.2 1.4 0.2 0.1 0.0 0.1 0.0 0.0 0.0 0.0 100.0 0.1 0.2 3,779 2-4 97.8 1.1 0.6 0.2 0.1 0.1 0.0 0.0 0.0 0.0 100.0 0.1 0.7 5,711 5-9 95.7 1.7 1.5 0.7 0.2 0.2 0.0 0.0 0.0 0.0 100.0 0.2 1.7 8,984 10-14 92.2 2.5 3.3 1.1 0.5 0.3 0.0 0.0 0.1 0.0 100.0 0.5 3.9 9,770 15-17 88.9 2.2 5.1 1.2 0.8 1.4 0.0 0.1 0.2 0.2 100.0 1.7 6.1 5,266 Sex Male 94.4 2.0 2.2 0.7 0.3 0.2 0.0 0.0 0.1 0.0 100.0 0.4 2.6 17,103 Female 94.0 1.8 2.4 0.8 0.4 0.5 0.0 0.0 0.0 0.0 100.0 0.6 2.9 16,408 Residence Urban 94.3 2.0 2.1 0.8 0.3 0.3 0.0 0.0 0.1 0.1 100.0 0.4 2.5 27,773 Rural 93.8 1.2 3.1 0.6 0.5 0.6 0.1 0.1 0.1 0.0 100.0 0.8 3.8 5,738 Governorate Amman 94.5 2.4 2.0 0.7 0.1 0.2 0.0 0.0 0.1 0.0 100.0 0.3 2.2 12,242 Balqa 93.9 1.0 2.9 0.9 0.6 0.5 0.1 0.0 0.1 0.0 100.0 0.7 3.7 2,145 Zarqa 94.6 1.2 2.3 0.9 0.5 0.3 0.0 0.0 0.0 0.0 100.0 0.4 2.8 5,246 Madaba 93.3 1.9 2.7 1.1 0.8 0.2 0.0 0.0 0.0 0.0 100.0 0.2 3.5 853 Irbid 94.3 2.2 1.8 0.8 0.1 0.5 0.0 0.1 0.0 0.1 100.0 0.6 2.1 6,448 Mafraq 93.9 1.0 2.6 0.8 0.6 0.7 0.2 0.1 0.1 0.0 100.0 1.1 3.5 1,580 Jarash 93.3 2.0 2.6 0.4 0.7 0.8 0.0 0.1 0.0 0.0 100.0 0.9 3.4 1,046 Ajloun 94.4 1.3 2.7 0.4 1.0 0.1 0.0 0.0 0.0 0.0 100.0 0.2 3.8 807 Karak 92.8 1.2 3.9 0.6 0.4 0.8 0.1 0.1 0.1 0.0 100.0 1.1 4.6 1,267 Tafiela 94.4 1.0 2.9 0.1 1.0 0.3 0.1 0.1 0.1 0.0 100.0 0.6 4.2 541 Ma'an 92.4 1.8 3.9 1.0 0.2 0.4 0.1 0.1 0.1 0.0 100.0 0.7 4.5 596 Aqaba 94.4 1.5 2.2 0.7 0.5 0.6 0.0 0.0 0.1 0.0 100.0 0.7 2.8 741 Region Central 94.4 1.9 2.2 0.8 0.3 0.3 0.0 0.0 0.1 0.0 100.0 0.4 2.6 20,485 North 94.2 1.9 2.1 0.7 0.3 0.5 0.0 0.1 0.0 0.1 100.0 0.7 2.6 9,881 South 93.4 1.3 3.3 0.6 0.5 0.6 0.1 0.1 0.1 0.0 100.0 0.8 4.1 3,146 Badia area Badia 93.9 1.5 3.1 0.6 0.3 0.3 0.1 0.1 0.0 0.0 100.0 0.5 3.6 2,815 Other 94.3 1.9 2.2 0.8 0.3 0.4 0.0 0.0 0.1 0.0 100.0 0.5 2.6 30,697 Total <15 95.3 1.8 1.7 0.7 0.2 0.2 0.0 0.0 0.0 0.0 100.0 0.3 2.1 28,245 Total <18 94.2 1.9 2.3 0.7 0.3 0.4 0.0 0.0 0.1 0.0 100.0 0.5 2.7 33,511 Note: Table is based on de jure household members, i.e., usual members. Total includes one child with information missing on sex. 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 2007 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. 14 | Household Characteristics Table 2.4 presents data on educational attainment as reported in the household questionnaire. In the 2007 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 90 percent of females have attended school. Furthermore, men tend to stay in school slightly longer than women. Table 2.4 Educational attainment of the household population Percent distribution of the de facto household populations age six and over by highest level of schooling attended and median grade completed, according to sex and background characteristics, Jordan 2007 Background characteristic No education Elementary Preparatory Secondary Higher Total1 Number Median years completed MALE Age 6-9 13.7 85.8 0.0 0.3 0.1 100.0 3,742 1.4 10-14 0.7 52.3 46.2 0.7 0.0 100.0 5,051 5.9 15-19 0.5 3.4 21.1 64.8 10.2 100.0 4,233 10.0 20-24 1.7 4.1 7.6 45.4 41.0 100.0 3,882 11.2 25-29 3.2 5.8 10.6 47.8 32.5 100.0 3,082 11.0 30-34 2.9 9.9 13.9 46.1 27.1 100.0 2,505 10.8 35-39 3.8 11.0 21.1 35.4 28.6 100.0 2,456 10.7 40-44 4.4 10.3 19.8 33.5 32.0 100.0 2,111 10.8 45-49 2.2 14.2 19.3 30.7 33.6 100.0 1,427 11.0 50-54 5.8 16.9 26.8 17.6 32.5 100.0 1,100 9.4 55-59 7.4 18.0 20.8 21.4 32.4 100.0 791 10.2 60-64 12.2 26.7 13.6 19.9 27.7 100.0 791 8.6 65+ 38.0 28.9 9.0 11.7 12.0 100.0 1,499 3.9 Residence Urban 5.0 25.0 18.7 29.8 21.4 100.0 27,202 9.2 Rural 8.3 26.6 18.8 32.5 13.7 100.0 5,470 8.5 Governorate Amman 4.7 24.0 17.8 29.1 24.2 100.0 12,692 9.5 Balqa 7.8 24.3 16.6 31.4 19.9 100.0 2,178 9.2 Zarqa 4.5 27.1 20.3 31.3 16.8 100.0 4,900 8.8 Madaba 6.5 24.2 16.8 33.2 19.3 100.0 806 9.4 Irbid 5.6 24.3 20.2 30.3 19.6 100.0 6,050 9.0 Mafraq 9.9 28.4 20.1 30.2 11.4 100.0 1,417 8.0 Jarash 4.7 28.4 18.4 30.7 17.8 100.0 938 8.8 Ajloun 4.9 26.5 19.9 33.4 15.2 100.0 710 8.8 Karak 8.3 26.1 16.1 32.0 17.4 100.0 1,244 8.9 Tafiela 6.1 27.8 20.5 32.3 13.3 100.0 473 8.4 Ma'an 8.2 28.4 19.9 29.0 14.5 100.0 553 8.1 Aqaba 5.6 28.9 19.1 30.9 15.5 100.0 712 8.4 Region Central 5.1 24.8 18.2 30.0 21.8 100.0 20,576 9.2 North 6.1 25.6 20.0 30.5 17.8 100.0 9,114 8.8 South 7.3 27.5 18.2 31.2 15.7 100.0 2,981 8.6 Badia area Badia 9.8 28.7 19.1 31.2 11.1 100.0 2,552 8.0 Other 5.2 25.0 18.7 30.2 20.9 100.0 30,119 9.1 Total 5.6 25.2 18.7 30.3 20.1 100.0 32,671 9.1 Continued… Household Characteristics | 15 Table 2.4—Continued Background characteristic No education Elementary Preparatory Secondary Higher Total1 Number Median years completed FEMALE Age 6-9 11.2 88.4 0.1 0.4 0.0 100.0 3,553 1.4 10-14 0.5 53.2 45.7 0.6 0.0 100.0 4,851 5.8 15-19 0.8 1.9 19.8 62.6 15.0 100.0 4,212 10.2 20-24 1.5 4.1 6.1 39.1 48.8 100.0 3,678 11.9 25-29 3.2 5.2 10.0 43.7 37.9 100.0 2,981 11.3 30-34 3.4 6.4 12.8 46.4 31.0 100.0 2,875 11.0 35-39 4.2 7.7 17.1 39.6 31.4 100.0 2,505 10.8 40-44 7.4 11.0 17.5 35.9 28.1 100.0 2,096 10.6 45-49 11.7 16.3 20.8 26.8 24.4 100.0 1,322 9.3 50-54 23.8 18.0 21.2 18.4 18.5 100.0 1,095 7.6 55-59 39.9 26.4 11.6 12.5 9.6 100.0 864 3.9 60-64 48.9 25.5 8.3 11.3 5.4 100.0 788 1.4 65+ 78.5 11.9 3.6 4.4 1.6 100.0 1,488 0.0 Residence Urban 9.1 23.7 17.0 29.4 20.7 100.0 26,902 9.0 Rural 15.6 25.0 16.6 25.9 17.0 100.0 5,410 7.8 Governorate Amman 8.4 22.6 16.7 29.5 22.6 100.0 12,775 9.3 Balqa 12.5 25.7 15.8 24.2 21.8 100.0 1,984 8.4 Zarqa 8.4 26.4 17.8 32.6 14.8 100.0 4,597 8.6 Madaba 11.6 24.6 15.3 28.3 20.3 100.0 801 8.7 Irbid 10.6 23.1 17.3 29.0 20.0 100.0 6,098 8.9 Mafraq 16.8 26.7 17.7 24.8 14.1 100.0 1,432 7.2 Jarash 11.3 25.6 17.4 27.8 17.8 100.0 934 8.4 Ajloun 10.9 23.0 16.1 29.2 20.8 100.0 722 9.0 Karak 13.9 22.6 15.8 25.2 22.6 100.0 1,332 8.6 Tafiela 14.6 24.2 17.5 24.2 19.4 100.0 483 7.9 Ma'an 15.8 26.5 15.9 23.5 18.2 100.0 530 7.4 Aqaba 10.6 27.3 17.3 27.6 17.2 100.0 624 8.1 Region Central 8.9 23.9 16.8 29.6 20.6 100.0 20,156 9.0 North 11.7 23.9 17.3 28.2 18.9 100.0 9,187 8.6 South 13.7 24.5 16.4 25.2 20.2 100.0 2,970 8.2 Badia area Badia 17.1 27.9 16.9 26.8 11.3 100.0 2,428 7.0 Other 9.6 23.6 16.9 29.0 20.8 100.0 29,884 9.0 Total 10.2 23.9 16.9 28.8 20.1 100.0 32,312 8.8 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 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. Total includes 1 male and 5 females for whom information on age is missing. 1 Including “Don’t know/Missing” 16 | Household Characteristics This table also shows that about half of males and females (50 and 49 percent, respectively) have attended secondary education or higher. Overall education levels have increased for both men and women since 2002 (46 percent of men and 43 percent of women had at least a secondary education in 2002) and the gender gap in education has decreased. Variations were noted in this percentage for both sexes according to urban-rural residence (educational attainment is higher in urban areas than in rural areas) and governorate (the percentage varies from 39 percent for females in Mafraq to 52 percent in Amman; for males, it ranges from 42 percent in Mafraq to 53 percent in Amman and Madaba). The variation is quite large between the Badia and non-Badia areas: 38 percent of women have at least a secondary education in Badia areas compared to 50 percent in non-Badia areas (for men, these percentages are 42 and 51 percent, respectively). The median number of years of schooling is 9.1 years for males and 8.8 years for females. Medians presented in Table 2.4 indicate an increase in the number of years of schooling as well as a reduction in the gender gap among the younger generations. The medians have increased from 8.6 for men and 8.0 for women in 2002 to 9.1 and 8.8, respectively, in 2007. Men aged 50-54 have a median of 9.4 years of education, while women in the same age cohort have 7.6 years. By ages 40-44, however, the median number of years of education is almost the same for males and females (10.8 and 10.6 years, respectively). The level of education is associated with residence, although differences by residence and by region are not great. In urban areas and in the Central region, the median years of education attained are higher than in the rest of the country, for both sexes. 2.5 SCHOOL ATTENDANCE Table 2.5 and Figure 2.4 show the proportion of the household population aged 6-24 years attending school, by age and sex. The data reflect the fact that school attendance in Jordan is very high, at almost 99 percent for both sexes among those aged 8 through 13. Few differences in attendance are observed between males and females of younger ages (7-13 years). Beyond the age of 13, attendance rates start to decline, especially for males. Nevertheless, the overall rate exceeds 92 percent for both sexes up to age 15. Age 15 marks the beginning of a gender- based divergence in attendance, where 94 percent of females and 92 percent of males are attending school. This gender gap continues through age 21, with 47 percent of females attending school as compared to 40 percent of males. Gender gaps in attendance are directionally inconsistent for the ages of 21 to 24. Table 2.5 Age-specific attendance rates of the de-jure population 6 to 24 years Percentage of the de jure household population age 6-24 years attending school, by age and sex, Jordan 2007 Age Percentage attending Number MALE 6 48.7 976 7 97.7 877 8 98.6 870 9 99.3 903 10 98.1 922 11 99.6 1,023 12 98.5 1,053 13 97.2 1,009 14 96.1 984 15 92.2 905 16 87.9 841 17 78.1 903 18 67.9 828 19 51.7 863 20 49.7 886 21 39.7 884 22 34.2 812 23 21.4 752 24 17.8 784 FEMALE 6 56.5 885 7 99.4 916 8 98.9 765 9 99.5 905 10 99.4 956 11 99.2 979 12 98.2 979 13 98.0 864 14 97.5 1,002 15 94.4 857 16 92.7 950 17 82.5 810 18 74.7 793 19 63.0 784 20 51.8 774 21 46.5 742 22 27.7 731 23 22.8 710 24 10.8 654 Household Characteristics | 17 2.6 HOUSING CHARACTERISTICS In the 2007 JPFHS, information on housing characteristics was collected in the household questionnaire. Table 2.6 indicates that more than three-fifths of housing units (63 percent) in urban areas are apartments, as compared to nearly one-fifth (19 percent) in rural areas. Dars, which are homes that are built with an enclosed central courtyard, form 80 percent of the dwellings in rural areas, compared to only 36 percent in urban areas. In general, 99 percent of total housing units in Jordan are either apartments or dars. About half of the housing units (46 percent) consist of two or three rooms and 45 percent consist of four or five rooms, whereas 6 percent consist of six or more rooms; only 4 percent of housing units consist of one room, with slight differences according to the place of residence. As for rooms used for sleeping, one in four housing units (26 percent) has one sleeping room, more than two-fifths (44 percent) have two, and about a quarter (26 percent) has three sleeping rooms, with slight differences according to place of residence. Table 2.6 also indicates that seven in ten dwellings have walls built from cement bricks and about a quarter built from clean cut-stone or from clean cut-stone and cement (27 percent). Dwellings in urban areas are more likely to be built from clean cut-stone or cut-stone and cement than those in rural areas (30 percent vs. 8 percent). Conversely, dwellings are more likely to be built from cement bricks in rural areas than in urban areas (84 and 67 percent, respectively). The data indicate that most of the households in urban areas (98 percent) and in rural areas (94 percent) have an independent kitchen, while most of the households in urban areas (98 percent) and in rural areas (96 percent) have an independent bathroom. Table 2.6 indicates that almost all households (99 percent) in urban areas have electricity, which differs little from rural areas (98 percent). Moreover, nearly all households use natural gas for cooking regardless of the place of residence. Figure 2.4 Age-Specific Attendance Rates (Percentage of the Population Age 6-24 Years Attending School) JPFHS 2007 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 18 | Household Characteristics Table 2.6 Household characteristics Percent distribution of households and de jure population by housing characteristics, according to residence, Jordan 2007 Households Population Housing characteristic Urban Rural Total Urban Rural Total Type of housing unit Apartment 62.9 18.7 55.9 59.2 17.4 52.1 Dar 35.7 79.6 42.6 39.3 81.5 46.5 Villa 1.1 0.7 1.0 1.2 0.8 1.1 Hut/barrack/other 0.3 1.1 0.4 0.2 0.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Electricity Yes 99.0 97.8 98.8 99.0 98.6 99.0 No 1.0 2.2 1.2 1.0 1.4 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Tile 86.6 82.4 85.9 87.5 85.4 87.1 Marble/ceramic tiles 8.1 1.2 7.0 7.7 1.1 6.6 Cement 5.2 16.2 6.9 4.8 13.3 6.2 Parquet, polished wood 0.1 0.1 0.1 0.0 0.0 0.0 Earth 0.0 0.2 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Main wall material Cement bricks 67.1 83.8 69.8 69.7 84.1 72.1 Cut stone 23.6 4.5 20.6 21.1 4.4 18.2 Cut stone and concrete 6.4 3.3 5.9 6.3 3.1 5.7 Concrete 2.2 7.3 3.0 2.3 7.8 3.3 Other 0.6 1.2 0.6 0.6 0.8 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of rooms One 3.3 5.2 3.6 1.4 1.9 1.5 Two 13.7 13.5 13.6 11.2 10.3 11.1 Three 32.3 29.9 31.9 31.5 29.1 31.1 Four 28.7 30.4 29.0 30.5 33.4 31.0 Five 16.2 15.0 16.0 18.2 17.9 18.1 Six or more 5.9 6.0 5.9 7.1 7.4 7.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 25.5 29.4 26.1 14.7 16.1 14.9 Two 43.8 43.5 43.7 45.6 47.0 45.8 Three 26.9 22.8 26.3 34.2 30.1 33.5 Four or more 3.8 4.3 3.9 5.6 6.8 5.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Household has separate room used as kitchen No 2.0 6.0 2.7 1.2 3.8 1.6 Yes 98.0 94.0 97.3 98.8 96.2 98.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Household has an independent bathroom No 1.6 4.1 2.0 1.3 3.0 1.6 Yes 98.3 95.9 97.9 98.7 97.0 98.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel LPG/natural gas 99.6 99.0 99.5 99.7 99.4 99.7 Other 0.4 1.0 0.5 0.3 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 12,272 2,292 14,564 63,681 13,000 76,681 LPG = Liquid petroleum gas Household Characteristics | 19 Table 2.7 indicates that 70 percent of households in urban areas use piped-in water compared to 74 percent in rural areas. Four percent of households in urban areas use rainwater compared to 13 percent of households in rural areas. About 25 percent of urban households and only 6 percent of rural households use bottled water for drinking. Overall, the majority of households in urban areas (98 percent) and in rural areas (93 percent) use safe water for drinking. Some households treat their water to make it safe for drinking. The table indicates that 4 percent of households in urban areas and 5 percent in rural areas boil water, whereas 18 percent of households in urban areas and 9 percent in rural areas use water filters for water purification. The results also indicate that four-fifths of households do not do anything for treating water (86 percent in rural areas compared to 78 percent in urban areas). Table 2.7 also shows that 80 percent of households have a private flush toilet, with marked differences between urban and rural households (83 and 62 percent, respectively). Only 3 percent of households share toilets with other households. Table 2.7 Household drinking water and sanitation facilities Percent distribution of households and de jure population by source of drinking water, percentage of households and de jure population by treatment of drinking water, and percent distribution of households and de jure population by type of toilet/latrine facilities according to residence, Jordan 2007 Households Population Urban Rural Total Urban Rural Total Household drinking water Source of drinking water Improved source 73.8 87.2 75.9 76.1 88.8 78.3 Piped water into dwelling/yard 69.6 74.0 70.3 71.6 75.7 72.3 Rainwater 4.2 13.2 5.6 4.6 13.1 6.0 Tanker truck 1.5 5.7 2.1 1.6 4.8 2.1 Bottled water, improved source for cooking/washing1 24.5 5.6 21.5 22.0 5.0 19.1 Other 0.2 1.5 0.4 0.3 1.4 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 98.3 92.8 97.4 98.2 93.8 97.4 Water treatment prior to drinking2 Boiled 3.5 4.7 3.7 3.5 4.7 3.7 Bleach/chlorine 1.0 0.6 0.9 1.2 0.6 1.1 Ceramic, sand, or other filter 17.8 9.0 16.4 18.1 9.7 16.7 Other 0.1 0.2 0.1 0.1 0.2 0.1 No treatment 77.5 85.5 78.8 77.2 84.8 78.5 Percentage using an appropriate treatment method3 22.0 14.3 20.8 22.5 14.9 21.2 Number 12,272 2,292 14,564 63,681 13,000 76,681 Sanitation facilities Improved, not shared facility Flush to piped sewer system 64.5 5.7 55.3 62.0 5.7 52.5 Flush to pit latrine 18.6 55.9 24.5 20.5 57.3 26.7 Ventilated improved pit (VIP) latrine 3.8 5.5 4.0 3.7 5.6 4.1 Pit latrine with slab 9.8 28.9 12.8 10.6 28.0 13.5 Non-improved facility Any facility shared with other households 3.0 2.3 2.9 3.0 2.1 2.8 Pit latrine without slab/open pit 0.2 0.9 0.3 0.2 1.0 0.3 No facility/field 0.0 0.8 0.2 0.1 0.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 12,272 2,292 14,564 63,681 13,000 76,681 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. 20 | Household Characteristics 2.7 PRESENCE OF DURABLE GOODS Jordan is a modern society, and most of the population enjoy the convenience of electrical appliances (Table 2.8). Ninety-seven percent of households have television sets, 95 percent have a refrigerator, 94 percent have a washing machine and 87 percent have a satellite. Table 2.8 Household durable goods Percentage of households and de jure population possessing various household effects and means of transportation by residence, Jordan 2007 Households Population Possession Urban Rural Total Urban Rural Total Bed or sofa bed 80.8 57.6 77.2 77.6 53.6 73.6 Radio/tape recorder 60.8 47.5 58.7 60.3 47.7 58.2 Television 97.7 94.5 97.2 98.5 96.9 98.3 Satellite 88.5 77.6 86.8 89.8 81.0 88.3 Mobile telephone 90.8 85.9 90.0 93.6 90.3 93.0 Land telephone 37.5 26.0 35.7 38.4 28.3 36.7 Refrigerator 95.1 91.5 94.6 96.6 94.8 96.3 Washing machine 94.6 89.6 93.8 96.9 94.1 96.5 Solar heater 13.9 8.6 13.0 14.1 8.9 13.2 Air conditioner 10.7 4.0 9.7 10.5 4.4 9.5 Fan 85.6 76.4 84.1 86.9 78.3 85.5 Water cooler 21.3 4.6 18.7 21.1 4.6 18.3 Microwave 24.6 6.3 21.7 23.3 5.9 20.3 Digital camera 9.8 3.9 8.8 9.8 4.1 8.8 Computer 38.6 23.5 36.2 43.3 28.1 40.8 Internet access at home 9.3 2.6 8.3 9.3 2.9 8.2 Credit cards 13.6 6.4 12.5 13.0 6.7 11.9 Car/pickup 40.5 38.3 40.2 43.5 43.6 43.5 Number 12,272 2,292 14,564 63,681 13,000 76,681 As further testament to the level of development in Jordan, 90 percent of households possess a mobile phone (with 64 percent of households owning 2 or more mobile phones), the results also indicate that 36 percent own a computer, and 8 percent have internet access. The possession of computer-related assets varies considerably between urban and rural areas: ownership of a computer in urban areas is 1.6 times than in rural areas, and internet access is about 3.6 times higher in urban than in rural areas. Of further interest is the fact that two in five households own a private car, with 4 percent owning two or more private cars. Thirteen percent of households have a solar heater. One in ten households owns an air conditioner, with differences according to urban-rural residence. Seventy-seven percent of households possess beds or a sofa bed for sleeping, with significant variations according to urban-rural residence (81 percent for urban areas compared to 58 percent in rural areas). Households in urban areas are more likely to have a water cooler (21 percent), a microwave (25 percent), and a digital camera (10 percent) than those in rural areas (5 percent, 6 percent and 4 percent respectively); households are also more likely to own a credit card in urban areas than in rural areas (14 vs. 6 percent). 2.8 HOUSEHOLD WEALTH One of the characteristics used for analysis in this report is the household wealth index. The data required for calculating this index includes household assets and property and is used to represent the wealth of surveyed households. Household Characteristics | 21 The household wealth index was developed and has been used in several countries to demonstrate the unequal distribution of income, use of health services and health outcomes (Rutstein 1999). The wealth index is constructed using household assets, such as the ownership of a television or a private car, as well as dwelling characteristics, such as the source of drinking water, type of toilet, type of the dwelling floor and other characteristics. Each asset is assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset and the scores were summed for each household; individuals were ranked according to the score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; no separate indices were prepared for the urban and rural population. This classification of population by quintiles is used as a background variable in the following sections to assess the demographic and health outcomes in relation to socio-economic status. Table 2.9 shows the distribution of the household population according to the wealth quintiles, from the lowest to the highest. About 44 percent of household members in urban areas fall into either the fourth or the highest wealth quintiles, while six in ten households in rural areas fall into either the lowest or the second quintiles. The table also indicates that there is a significant variation in the distribution of the population by governorates according to the wealth index. Whereas more than half of household members (55 percent) fall into either the fourth or the highest quintiles in Amman, more than half of the household members in Madaba (51 percent), Jarash (62 percent), Ajloun (58 percent), Karak (52 percent), Mafraq (64 percent), and Tafiela (56 percent) fall in the lowest or second quintiles. Table 2.9 Wealth quintiles Percent distribution of the de jure population by wealth quintiles according to residence and region, Jordan 2007 Wealth quintile Residence/ region Lowest Second Middle Fourth Highest Total Number of population Residence Urban 17.1 19.0 19.7 21.3 22.9 100.0 63,681 Rural 34.0 25.1 21.4 13.8 5.6 100.0 13,000 Governorate Amman 12.5 15.0 17.2 21.8 33.5 100.0 29,618 Balqa 28.0 18.5 17.8 18.7 17.0 100.0 4,909 Zarqa 15.7 22.9 24.7 23.1 13.7 100.0 11,289 Madaba 26.7 24.4 21.7 14.8 12.4 100.0 1,897 Irbid 23.0 23.3 21.2 20.4 12.2 100.0 14,330 Mafraq 37.0 27.0 20.3 11.2 4.6 100.0 3,419 Jarash 37.3 24.5 19.8 11.4 6.9 100.0 2,256 Ajloun 31.4 26.5 22.0 13.9 6.1 100.0 1,752 Karak 29.4 22.9 22.8 16.8 8.2 100.0 3,091 Tafiela 28.7 27.7 23.5 15.3 4.8 100.0 1,166 Ma'an 30.9 24.9 22.8 14.5 6.9 100.0 1,339 Aqaba 23.0 18.0 21.3 22.8 14.9 100.0 1,615 Region Central 15.4 17.6 19.2 21.5 26.2 100.0 47,713 North 27.3 24.3 21.0 17.5 10.0 100.0 21,757 South 28.1 22.9 22.6 17.5 8.9 100.0 7,210 Badia area Badia 40.4 26.6 18.8 10.4 3.8 100.0 6,078 Other 18.2 19.4 20.1 20.8 21.4 100.0 70,602 Total 20.0 20.0 20.0 20.0 20.0 100.0 76,681 Respondents’ Background Characteristics | 23 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3 This chapter highlights the basic characteristics of ever-married women aged 15-49 who were inter- viewed in the survey. It also presents data on the respondents’ exposure to mass media, employment status, and use of smoking tobacco. 3.1 GENERAL CHARACTERISTICS Table 3.1 presents the distribution of respon- dents by background characteristics, including age, marital status, residence, educational level attended, and household wealth. The distribution of ever-married women shows that, in 2007, 14 percent were under age 25, compared with 15 percent in 2002, 18 percent in 1997, and 22 percent in 1990. It is noteworthy that the proportion of women in the youngest age group (15-19) has dropped to 2.2 percent, whereas in 1990, women in this age group made up 6 percent of respondents. This decline in the proportion of young ever-married women is the consequence of increasing age at first marriage (see Chapter 6). Despite the decrease in the proportion of women aged 25-34 between 2002 and 2007 (from 42 percent to 39 percent), the proportion of women aged 40-49 was slightly higher in 2007 than it was in 2002 (from 25 percent to 29 percent). Among ever-married women, the percentage distribution by marital status indicates that 95 percent are currently married; the rest are either divorced (3 percent) or widowed (2 percent). The proportion of those currently married has remained the same as in 2002. Table 3.1 shows that 85 percent of respondents reside in urban areas (defined as localities with a popu- lation of 5,000 or more, as stated in the 2004 Census). Only 8 percent of all ever-married women live in the governorates of the South region (Karak, Tafiela, Ma’an and Aqaba) compared with 64 percent in the Central region and 27 percent in the North region. Two-fifths of women live in Amman, 18 percent in Irbid and 15 percent in Zarqa, compared to 1.3 percent in Tafiela and 1.5 percent in Ma’an. About 8 percent of women live in Badia areas. Table 3.1 also presents the weighted and un- weighted numbers of women in the sample. The Table 3.1 Background characteristics of respondents Percent distribution of ever-married women by background characteristics, Jordan 2007 Number of ever-married women Background characteristic Weighted percent Weighted Unweighted Age 15-19 2.2 236 222 20-24 11.7 1,276 1,272 25-29 18.2 1,977 2,014 30-34 20.3 2,213 2,251 35-39 18.9 2,052 2,063 40-44 17.3 1,884 1,809 45-49 11.4 1,239 1,245 Marital status Married 95.2 10,354 10,360 Divorced 2.7 292 244 Widowed 2.1 230 272 Residence Urban 85.0 9,249 7,509 Rural 15.0 1,627 3,367 Governorate Amman 40.8 4,442 1,341 Balqa 5.9 645 822 Zarqa 15.1 1,645 1,076 Madaba 2.4 262 893 Irbid 18.3 1,993 896 Mafraq 4.2 460 886 Jarash 2.7 293 860 Ajloun 2.1 228 848 Karak 3.5 378 775 Tafiela 1.3 146 842 Ma'an 1.5 164 793 Aqaba 2.0 221 844 Region Central 64.3 6,993 4,132 North 27.4 2,975 3,490 South 8.4 908 3,254 Badia area Badia 7.6 823 1,556 Other 92.4 10,053 9,320 Education No education 3.8 416 744 Elementary 7.5 813 1,026 Preparatory 15.5 1,681 1,761 Secondary 44.0 4,788 4,372 Higher 29.2 3,179 2,973 Wealth quintile Lowest 20.3 2,211 3,054 Second 21.1 2,296 2,707 Middle 20.3 2,206 2,267 Fourth 19.6 2,135 1,732 Highest 18.6 2,028 1,116 Total 100.0 10,876 10,876 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 24 | Respondents’ Background Characteristics unweighted 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 and North region (because of oversampling). For example, in the South region, although the weighted number of women is 908, in reality, data were collected from 3,254 women. The South region was oversampled to obtain sufficient women to yield statistically reliable estimates. The same also applies to the weighted and unweighted numbers in the governorates; for example, although the weighted number of women in Jarash is 293 women, in reality, data were collected from 860 women. This also applies to the Badia areas where data were collected from about twice the weighted number of women (1,556 women). Table 3.1 indicates that in 2007, 4 percent of ever-married women had not received any formal education, compared with 6 percent in 2002, 9 percent in 1997 and 24 percent in 1990. It is clear the degree to which access to education has spread in Jordanian society in a relatively short period of time. 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 corresponding figure in 1997 was 76 percent, in 2002 it was 83 percent and it was 89 percent of women who had attained preparatory or higher education in 2007. The table also indicates the semi-equal distribution of woman according to household wealth, as about 19 percent of women are concentrated in the highest quintile, compared with 21 percent in the second quintile. 3.2 RESPONDENTS’ LEVEL OF EDUCATION Table 3.2 presents the distribution of ever-married women by the level of education attended, according to background characteristics. Broad-based access to education for the Jordanian population has received greater emphasis over the past sixty years. The data indicate that older women are less likely to have had education than younger women; almost 11 percent of women aged 45-49 have had no education, while less than 1 percent of women between the ages of 15 and 29 have had no education. The median number of years of schooling according to age group reflects no major difference, except among women aged 45-49. The median number of years of education for all women is 10.8 years. While women aged 20-39 have a median of about 11 years of education, while those aged 45-49 have a median of 9.1 years of education. Women in urban areas are more likely to have had any education, as well as higher education, than their rural counterparts; three percent of women in urban areas have no education, compared to 10 percent of women in rural areas. There are no differences in terms of the median number of years of schooling according to urban-rural residence. There are pronounced differences in women’s educational attainment by region and governorate. In the Central region, 3 percent of women have no education, whereas in the South region, the proportion is 10 percent. Only 2 percent of women in Amman and Zarqa have no education, compared to 15 percent in Ma’an. In Badia areas, 14 percent of women have no education, compared with 3 percent in non-Badia areas. Regional differences also persist with regard to secondary or higher education: a greater proportion of women in the Central region attained secondary or higher education (76 percent) than in either the North (70 percent) or South (65 percent) regions. Significant differences also exist in terms of higher education by governorate; the percentage of women who have attained higher education is about one third of women in Amman, Balqa, Madaba, Ajloun and Karak, dropping to 18 percent in Mafraq. There is also a significant and notable difference for the woman residing in Badia areas, whereas the percentage of woman attaining higher education in non-Badia areas is about twofold that of women in Badia areas (30 and 16 percent, respectively). Respondents’ Background Characteristics | 25 The table also shows a higher proportion of women with no education in the lowest wealth quintile (11 percent) than in either the fourth or the highest quintiles (less than 1 percent each). The proportion of women who have attained higher education is highest in the wealthiest households (49 percent) and the lowest in the poorest households (13 percent). Table 3.2 Educational attainment Percent distribution of ever-married women age 15-49 by highest level of schooling attended, and median number of years of schooling, according to background characteristics, Jordan 2007 Education Background characteristic No education Elementary Preparatory Secondary Higher Total Median years completed Number of women Age 15-19 0.8 6.6 25.9 64.7 2.1 100.0 9.7 236 20-24 0.5 4.8 11.5 59.5 23.7 100.0 10.7 1,276 25-29 1.0 3.9 10.4 50.0 34.7 100.0 11.2 1,977 30-34 2.4 5.2 13.6 46.6 32.2 100.0 11.0 2,213 35-39 3.0 6.4 17.2 42.0 31.4 100.0 10.9 2,052 40-44 7.1 11.1 18.4 35.9 27.5 100.0 10.6 1,884 45-49 11.4 16.5 21.5 25.6 25.0 100.0 9.1 1,239 Residence Urban 2.7 6.9 15.2 45.2 29.9 100.0 10.9 9,249 Rural 10.4 10.5 16.7 37.1 25.3 100.0 10.3 1,627 Governorate Amman 2.3 6.2 14.2 44.6 32.7 100.0 11.1 4,442 Balqa 6.4 8.7 15.1 37.3 32.5 100.0 10.9 645 Zarqa 2.0 7.1 16.9 51.3 22.6 100.0 10.8 1,645 Madaba 6.8 9.0 12.0 39.7 32.4 100.0 11.1 262 Irbid 3.1 7.0 16.4 45.5 28.0 100.0 10.7 1,993 Mafraq 10.9 14.6 20.7 36.4 17.5 100.0 9.5 460 Jarash 4.1 8.3 19.3 40.9 27.4 100.0 10.5 293 Ajloun 2.8 5.6 14.9 43.8 32.9 100.0 10.7 228 Karak 8.4 8.4 12.3 35.4 35.6 100.0 10.8 378 Tafiela 10.1 11.7 18.8 32.1 27.3 100.0 10.1 146 Ma'an 14.6 15.9 14.6 29.3 25.6 100.0 9.7 164 Aqaba 9.1 9.8 15.4 43.4 22.3 100.0 10.4 221 Region Central 2.8 6.8 14.8 45.3 30.3 100.0 11.0 6,993 North 4.4 8.2 17.2 43.5 26.7 100.0 10.5 2,975 South 9.9 10.6 14.5 35.7 29.2 100.0 10.4 908 Badia area Badia 14.1 14.5 17.8 37.8 15.8 100.0 9.5 823 Other 3.0 6.9 15.3 44.5 30.3 100.0 10.9 10,053 Wealth quintile Lowest 10.6 14.6 21.4 40.8 12.6 100.0 9.4 2,211 Second 4.0 8.6 16.9 48.8 21.8 100.0 10.5 2,296 Middle 3.1 6.9 15.4 46.3 28.4 100.0 10.8 2,206 Fourth 0.8 4.2 13.5 45.3 36.1 100.0 11.3 2,135 Highest 0.2 2.5 9.4 38.3 49.4 100.0 12.0 2,028 Total 3.8 7.5 15.5 44.0 29.2 100.0 10.8 10,876 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 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. 26 | Respondents’ Background Characteristics 3.3 EXPOSURE TO MASS MEDIA The exposure of women to television, radio, and newspapers is shown in Table 3.3. Ninety-seven percent of women watch television, 31 percent listen to the radio, and 35 percent read newspapers at least once a week. While 16 percent of women were exposed to all three forms of media at least once a week, 2 percent were not exposed to any. Younger women are slightly less likely to be exposed to mass media than older women: whereas 8 percent of women aged 15-19 were exposed to all three forms of mass media, the proportion goes up to 19 percent among women aged 40-49. As expected, there is positive association between education and newspaper reading: a higher proportion of women with at least secondary education read newspapers than those with less education. Table 3.3 Exposure to mass media Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Jordan 2007 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 19.9 96.0 23.7 7.9 3.0 236 20-24 30.5 98.2 24.9 10.6 1.6 1,276 25-29 32.7 97.7 31.9 15.9 1.1 1,977 30-34 35.5 96.2 30.0 15.8 2.4 2,213 35-39 37.0 97.1 34.8 18.4 1.6 2,052 40-44 41.2 94.9 32.8 19.1 2.7 1,884 45-49 36.4 94.6 33.7 18.6 4.3 1,239 Residence Urban 37.5 96.5 32.3 17.6 2.0 9,249 Rural 23.6 96.0 26.2 9.8 3.2 1,627 Governorate Amman 44.8 95.8 38.3 22.5 2.2 4,442 Balqa 31.9 96.4 23.0 13.5 2.5 645 Zarqa 28.1 99.0 26.8 13.4 0.9 1,645 Madaba 32.8 98.1 24.4 13.8 1.4 262 Irbid 29.7 96.7 27.3 11.6 2.2 1,993 Mafraq 23.3 95.0 24.9 9.2 3.7 460 Jarash 19.9 96.6 24.4 7.4 2.3 293 Ajloun 25.6 97.2 27.5 10.8 1.8 228 Karak 33.1 95.1 30.9 14.2 3.6 378 Tafiela 27.6 96.6 30.7 12.0 2.2 146 Ma'an 26.0 93.3 28.8 11.5 4.4 164 Aqaba 39.8 93.0 26.1 14.9 5.1 221 Region Central 39.2 96.7 33.7 19.2 1.9 6,993 North 27.5 96.5 26.7 10.7 2.4 2,975 South 32.6 94.5 29.3 13.5 3.9 908 Badia area Badia 21.4 95.1 21.3 7.8 4.1 823 Other 36.6 96.6 32.2 17.1 2.1 10,053 Education No education 2.4 87.5 13.8 0.1 11.9 416 Elementary 9.6 95.2 23.1 3.1 3.7 813 Preparatory 23.5 96.3 25.2 10.9 2.7 1,681 Secondary 35.4 96.9 30.3 14.9 1.7 4,788 Higher 52.7 97.3 40.8 27.1 1.1 3,179 Wealth quintile Lowest 15.3 93.7 17.4 4.9 5.2 2,211 Second 25.6 97.1 24.3 9.1 1.5 2,296 Middle 34.3 97.3 30.9 13.6 1.4 2,206 Fourth 42.3 97.1 33.5 18.2 1.6 2,135 Highest 62.5 97.1 53.1 38.5 1.3 2,028 Total 35.4 96.5 31.4 16.4 2.2 10,876 Respondents’ Background Characteristics | 27 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 exposure to these kinds of media: women with the highest levels of education are more likely to report that they watch television and listen to the radio weekly. It should be noted that while about one-fourth of women with a higher than secondary education (27 percent) were exposed to all three media, almost no women with no education report the same. Women in urban areas are more likely to read the newspaper (38 percent) than women in rural areas (24 percent), while there is no variation as for watching television. The extent to which women listen to the radio varies substantially by urban-rural residence (32 percent in urban against 26 percent in rural). Women living in the Central region are more likely than women in the other regions to read newspapers, listen to the radio, and watch television (19 percent exposed to all three media in the Central region against 11 percent in the North and 14 percent in the South). Women in Amman and Aqaba are more likely to read the newspaper than women in other governorates, moreover women in Ma’an and Aqaba are less likely to watch television than women in the other governorates. While more than one-fifth of women in Amman (23 percent) are exposed to all three forms of mass media, this figure is only 9 percent in Mafraq and 7 percent in Jarash. The table also indicates the variation in these percentages by residence in Badia areas; 8 percent of women in Badia areas are exposed to all three media compared to 17 percent of women residing in non-Badia areas. Table 3.3 indicates significant variation in regard to the exposure of women to mass media according to the household wealth index. Women in the fourth and the highest quintiles are more likely to be exposed to mass media than women in the other quintiles. Only 5 percent of women in the lowest quintile are exposed to all three mass media compared to 39 percent in the highest quintile. 3.4 RESPONDENTS’ EMPLOYMENT CHARACTERISTICS In the 2007 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 and their employment status. 3.4.1 Working Status The majority of women (88 percent) are not working, nor have they worked during the last seven days preceding the survey (Table 3.4) while only 12 percent of women were working during the seven days preceding the survey. The proportion of women who were not working ranges from 100 percent among those aged 15-19 to 85 percent among those aged 35-39. There are no major differences in work status according to urban-rural residence. However, a higher proportion of women in the South region report being currently working (17 percent) compared to other regions. This finding seems contrary to the conventional wisdom that higher education increases the likelihood of employment, as women in the South region have the lowest levels of education. The table indicates also that there are notable variations in work status by governorates. Women in Balqa, Madaba, Ajloun, Karak, and Ma’an are more likely to work than woman residing in the other governorates. In addition, women in Badia areas are less likely to work compared to women residing in non-Badia areas. Women with post-secondary education are much more likely to report having been employed in the week preceding the survey (30 percent) than women with any other educational level. 28 | Respondents’ Background Characteristics Table 3.4 Working status Percent distribution of ever-married women by working status, according to back- ground characteristics, Jordan 2007 Background characteristic Worked in the 7 days preceding the survey1 Did not work in the 7 days preceding the survey Total Number of women Age 15-19 0.0 100.0 100.0 236 20-24 5.5 94.5 100.0 1,276 25-29 12.8 87.2 100.0 1,977 30-34 14.7 85.3 100.0 2,213 35-39 15.4 84.6 100.0 2,052 40-44 12.2 87.8 100.0 1,884 45-49 9.8 90.2 100.0 1,239 Marital status Married 11.8 88.2 100.0 10,354 Divorced/widowed 18.4 81.6 100.0 522 Number of living children 0 13.4 86.6 100.0 1,021 1-2 16.6 83.4 100.0 2,787 3-4 12.3 87.7 100.0 3,471 5+ 8.0 92.0 100.0 3,597 Residence Urban 11.9 88.1 100.0 9,249 Rural 13.0 87.0 100.0 1,627 Governorate Amman 11.9 88.1 100.0 4,442 Balqa 16.5 83.5 100.0 645 Zarqa 7.6 92.4 100.0 1,645 Madaba 18.0 82.0 100.0 262 Irbid 11.9 88.1 100.0 1,993 Mafraq 11.9 88.1 100.0 460 Jarash 10.4 89.6 100.0 293 Ajloun 15.0 85.0 100.0 228 Karak 21.3 78.7 100.0 378 Tafiela 14.5 85.5 100.0 146 Ma'an 16.2 83.8 100.0 164 Aqaba 10.7 89.3 100.0 221 Region Central 11.5 88.5 100.0 6,993 North 12.0 88.0 100.0 2,975 South 16.7 83.3 100.0 908 Badia area Badia 10.4 89.6 100.0 823 Other 12.2 87.8 100.0 10,053 Education No education 6.3 93.7 100.0 416 Elementary 5.4 94.6 100.0 813 Preparatory 3.2 96.8 100.0 1,681 Secondary 4.8 95.2 100.0 4,788 Higher 30.2 69.8 100.0 3,179 Wealth quintile Lowest 6.7 93.3 100.0 2,211 Second 7.7 92.3 100.0 2,296 Middle 12.3 87.7 100.0 2,206 Fourth 14.3 85.7 100.0 2,135 Highest 20.5 79.5 100.0 2,028 Total 12.1 87.9 100.0 10,876 1 "Worked" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Respondents’ Background Characteristics | 29 Marital status seems to have a bearing on working status. The proportion of working women rises from 12 percent among those married to 18 percent among widowed or divorced women. When the number of living children is considered, the percentage of working women rises from 13 percent for those with no children to 17 percent for those with one or two children, dropping to 8 percent for those with five or more children. Table 3.4 shows that there is a clear variation in work status of women according to wealth index. Women in the highest wealth quintile are much more likely to work than those in other wealth quintiles (21 percent in the highest wealth quintile compared to 7 percent in the lowest and 8 percent in the second wealth quintiles). 3.4.2 Occupation Table 3.5 shows that among women who report having been employed in the seven days preceding the survey, a large proportion is engaged in professional (46 percent) and technical occupations (27 percent). Seven percent are employed in sales, 7 percent as clerks, and 5 percent are craft and related trade workers. The percentages vary considerably by background characteristics of women, particularly by marital status, education and household wealth. The data also indicate that 89 percent of employed women are paid employees and 6 percent are self-employed (Figure 3.1). It is of interest to note that while the data reflect expected urban-rural differences for skilled agricultural employment (1 percent and 4 percent, respectively), there are not pronounced urban-rural differences in the professional and technical-managerial sectors (Table 3.5). The proportion of women employed in these two sectors has risen steadily from 64 percent in 1997 to 70 percent in 2002, and to 73 percent in 2007. Figure 3.1 Percent Distribution of Women who Worked in the 7 Days Preceding the Survey, by Employment Status JPFHS 2007 89 3 6 1 0.2 Employee Employer Self-employed Unpaid Family Worker Unpaid Worker 0 20 40 60 80 100 Percent 30 | Respondents’ Background Characteristics Table 3.5 Occupation Percent distribution of ever-married women who worked in the 7 days preceding the survey by occupation, according to background characteristics, Jordan 2007 Background characteristic Profes- sionnals Technicians and associate profes- sionals Clerks Service workers, shop, and market sales workers Skilled agricul- tural workers Craft and related trades workers Plant and machine operators and related occupa- tions Elemen- tary occupa- tions1 Total Number of women Age 20-24 60.2 30.2 2.4 0.0 1.3 5.3 0.0 0.6 100.0 70 25-29 58.9 22.9 5.4 4.9 0.8 2.6 0.0 4.5 100.0 253 30-34 51.1 27.3 5.6 6.3 0.1 4.8 0.0 4.8 100.0 325 35-39 39.2 29.3 8.6 8.9 0.2 4.5 0.0 9.3 100.0 316 40-44 37.6 25.6 10.3 9.0 2.3 5.8 1.7 7.8 100.0 230 45-49 27.9 33.2 2.3 10.6 6.6 9.8 0.0 9.7 100.0 122 Marital status Married 48.6 28.2 5.6 6.0 1.2 4.0 0.3 6.0 100.0 1,220 Divorced/widowed 9.0 15.7 20.2 21.8 2.9 17.2 0.0 13.3 100.0 96 Number of living children 0 48.1 24.3 7.2 10.0 0.0 3.6 0.0 6.8 100.0 137 1-2 54.5 25.2 7.8 5.1 1.3 2.2 0.0 3.8 100.0 464 3-4 48.4 29.2 6.5 5.6 0.2 4.1 0.0 5.9 100.0 426 5+ 26.4 29.3 4.7 11.4 3.7 11.2 1.4 12.0 100.0 289 Residence Urban 45.8 27.1 6.9 7.8 0.8 5.4 0.4 5.7 100.0 1,104 Rural 45.2 28.2 5.1 4.0 3.8 2.5 0.0 11.1 100.0 212 Governorate Amman 49.3 25.7 6.9 7.9 0.1 5.2 0.7 4.2 100.0 528 Balqa 39.7 29.2 6.9 10.2 0.0 2.7 0.0 11.4 100.0 106 Zarqa 38.0 25.4 6.9 12.7 0.0 7.8 0.0 9.2 100.0 126 Madaba 48.5 29.9 8.3 5.0 0.0 4.3 0.0 4.0 100.0 47 Irbid 42.4 28.6 4.9 4.4 4.8 6.8 0.0 8.2 100.0 237 Mafraq 51.6 17.2 5.8 2.8 4.2 6.5 0.0 11.9 100.0 55 Jarash 45.9 28.4 3.5 11.0 1.1 3.3 0.0 6.8 100.0 31 Ajloun 46.1 40.0 2.4 6.1 1.5 1.5 0.0 2.3 100.0 34 Karak 42.1 30.6 11.4 5.5 1.7 1.0 0.0 7.6 100.0 81 Tafiela 51.3 34.1 8.4 0.8 0.9 0.8 0.0 3.8 100.0 21 Ma'an 52.0 29.1 5.0 2.3 1.5 1.6 0.0 8.6 100.0 27 Aqaba 48.4 33.0 8.5 5.0 0.9 1.4 0.0 2.8 100.0 24 Region Central 46.2 26.3 7.0 8.8 0.1 5.2 0.5 5.9 100.0 807 North 44.5 27.9 4.7 4.8 4.1 6.0 0.0 8.1 100.0 357 South 46.1 31.2 9.4 4.2 1.4 1.1 0.0 6.5 100.0 152 Badia area Badia 46.8 27.7 4.3 3.0 3.8 4.0 0.0 10.3 100.0 86 Other 45.6 27.3 6.8 7.5 1.1 5.0 0.3 6.3 100.0 1,230 Education No education (0.0) (0.0) (0.0) (4.6) (26.9) (5.8) (0.0) (62.7) 100.0 26 Elementary (0.0) (0.0) (0.0) (13.0) (7.9) (38.0) (0.0) (41.0) 100.0 44 Preparatory 0.0 13.4 9.4 31.0 6.3 16.2 0.0 23.6 100.0 53 Secondary 0.0 9.2 33.7 23.0 1.4 16.1 0.0 16.6 100.0 232 Higher 62.7 34.5 0.4 1.8 0.0 0.1 0.4 0.1 100.0 960 Wealth quintile Lowest 14.8 22.2 9.6 7.5 8.8 8.4 0.0 28.7 100.0 149 Second 37.0 25.2 8.0 6.1 1.0 7.4 0.0 15.2 100.0 176 Middle 37.9 37.0 6.3 9.4 0.3 6.2 0.0 2.9 100.0 271 Fourth 47.2 31.4 5.7 8.1 0.4 6.0 0.0 1.2 100.0 304 Highest 64.5 20.8 5.9 5.3 0.1 1.1 0.9 1.3 100.0 415 Total 45.7 27.3 6.6 7.2 1.3 5.0 0.3 6.6 100.0 1,316 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Mainly in sales, services, and agriculture Respondents’ Background Characteristics | 31 3.5 SMOKING TOBACCO Tobacco use is widely regarded as the most preventable cause of death and disease among adults. In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux and hypertension. Tobacco and its various components have been associated with an increased risk of cancer of vari- ous body organs. Smoking is the most important contributor to the development of chronic bron- chitis and chronic abstractive pulmonary disease, which are characterized by chronic cough, phlegm and airflow obstruction. Smoking is well estab- lished as the cause of the majority of pulmonary emphysema. Smoking among women also creates particular risks for their offspring. Poor pregnancy outcomes, including low birth weight and intra- uterine growth retardation, are more frequent among women who smoke than among those who do not smoke. Table 3.6 shows the percentage of women who use tobacco for smoking. Overall, 11 percent of women smoke cigarettes and 5 percent smoke nargila, a slight increase since 2002 when 10 per- cent of women reported smoking cigarettes and 4 percent nargila. The data also indicate that older women are more likely to smoke cigarettes and nargila than younger women. Women living in urban areas are more likely to smoke cigarettes (11 percent) than women living in rural areas (6 percent). Also, women in the Central region are more likely to smoke cigarettes compared with women from the other regions. The data indicate that there are significant differences in regard to women who smoke cigarettes and nargila according to governorates and residence in Badia area; women living in Amman and Aqaba governorates and in non- Badia areas are more likely to smoke cigarettes than other women. Differences are also significant among governorates: 4 percent of women in Tafiela smoke cigarettes compared to 14 percent of those living in Amman. Women living in Badia areas are less likely to smoke nargila (2 percent) than women in non-Badia areas (6 percent). Table 3.6 indicates that there is an evident and significant variation in woman smoking cigarettes and nargila according to the wealth index. Women in the lowest wealth quintile are less likely to smoke cigarettes and nargila than woman in the highest quintile (8 and 3 percent, respectively in the lowest wealth quintile, compared to 17 and 12 percent in the highest wealth quintile). Table 3.6 Use of tobacco Percentage of ever-married women who smoke cigarettes or a nargila, according to background characteristics, Jordan 2007 Background characteristic Cigarettes Nargila Number of women Age 15-19 0.4 3.1 236 20-24 5.7 4.3 1,276 25-29 7.6 4.8 1,977 30-34 9.5 5.4 2,213 35-39 12.6 6.5 2,052 40-44 13.9 6.1 1,884 45-49 15.7 4.9 1,239 Residence Urban 11.3 6.0 9,249 Rural 6.4 1.7 1,627 Governorate Amman 14.3 8.7 4,442 Balqa 8.2 3.6 645 Zarqa 8.5 3.2 1,645 Madaba 5.8 2.3 262 Irbid 8.7 3.8 1,993 Mafraq 6.9 1.5 460 Jarash 6.9 2.5 293 Ajloun 4.3 2.0 228 Karak 7.0 2.2 378 Tafiela 4.4 0.7 146 Ma'an 7.7 1.7 164 Aqaba 11.5 3.0 221 Region Central 12.0 6.7 6,993 North 7.9 3.2 2,975 South 7.8 2.1 908 Badia area Badia 7.9 1.8 823 Other 10.8 5.7 10,053 Education No education 15.8 0.9 416 Elementary 13.3 2.9 813 Preparatory 12.0 4.7 1,681 Secondary 9.1 5.9 4,788 Higher 10.7 6.2 3,179 Maternity status Pregnant 4.1 2.6 1,315 Breastfeeding (not pregnant) 5.2 3.4 2,117 Neither 13.2 6.4 7,444 Wealth quintile Lowest 8.3 2.8 2,211 Second 7.4 2.6 2,296 Middle 9.8 3.3 2,206 Fourth 10.5 6.7 2,135 Highest 17.4 12.1 2,028 Total 10.6 5.4 10,876 32 | Respondents’ Background Characteristics Women with no education are more likely to smoke cigarettes (16 percent) than women who have secondary education (9 percent) or higher (11 percent). However, there is a different pattern of women who smoke nargila according to educational level; 1 percent of women with no education compared to 6 percent of women with secondary education and above smoke nargila. During pregnancy and lactation, more than 95 percent of women do not use tobacco. However, 4 percent of women smoke cigarettes during pregnancy and 5 percent during lactation, while about 3 percent of each category smoke nargila. Fertility | 33 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 2007 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 number 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 household 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 2007 JPFHS is the high quality of age and date reporting. Virtually all women were able to report their age and their date of marriage or age at 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 fertility measures. Two potential issues require some attention due to the fact that the fertility rates presented in this chapter are based on direct measures derived from the birth history section of the JPFHS. 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 potential bias. Although information on fertility 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 include age, residence, educational level and wealth index. Factors related to fertility, including the median age at first 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 2007 JPFHS are shown in Table 4.1, along with data from five previous surveys for comparison – the 1976 Jordan Fertility Survey (JFS), the 1983 Jordan Fertility and Family Health Survey (JFFHS), and the 1990, 1997 and 2002 JPFHS. Data for the 1976 survey were calculated based on the two years preceding the survey (1975-1976), while those for 1983, 1990, 1997, 2002, and 2007 refer to the three years preceding the survey (1981-1983, 1988-1990, 1995-1997, 2000-2002, and 2005-2007 respectively). Comparison of the findings from the six surveys shows trends in fertility levels over about a 30-year period. 34 | Fertility 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 currently observed age-specific rates. At current levels, a woman would give birth to an average of 3.6 children in her lifetime. This figure 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 increased until 1997, and has since slowed down. 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), and 21 percent between 1990 and 1997 (dropping from 5.6 to 4.4 births per woman). Between 1997 and 2002, the pace of fertility decline decreased by 16 percent (dropping from 4.4 to 3.7 births per woman). Recently, between 2002 and 2007, the level of fertility has remained almost unchanged (from 3.7 to 3.6 births per women). Overall, in the past seventeen years (1990-2007), the total fertility rate in Jordan has declined by 36 percent. Table 4.1 Trends in fertility Age-specific fertility rates and total fertility rates, various surveys, Jordan 1976-2007 Age group JFS 1976 JFFHS 1983 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 15-19 71 49 49 43 28 28 20-24 300 229 219 172 150 148 25-29 367 335 296 246 202 212 30-34 332 305 264 206 184 162 35-39 240 233 188 144 122 121 40-44 112 127 79 48 43 41 45-49 47 40 19 11 5 6 TFR 15-49 7.4 6.6 5.6 4.4 3.7 3.6 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1- 36 months prior to interview. TFR: Total fertility rate expressed per woman A decline in fertility levels has occurred among all age groups over the last three decades; however, the most significant proportional decline has been observed among teenagers: a 60 percent drop from 71 births per 1,000 women in 1976 to 28 births in 2007. 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 between 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. The 2007 JPFHS data indicate that there has not been a significant decline in fertility overall or among any age group. There was even a slight increase in the fertility level among the 25-29 age group (from 202 children per 1,000 women in 2002 to 212 children in 2007). Fertility | 35 Table 4.2 and Figure 4.2 present the age-specific fertility rates and cumulative fertility by urban-rural residence for the three- year period preceding the survey. Table 4.2 also presents the General Fertility Rate (GFR), that is the annual number of live births per 1,000 women aged 15-44 for the three years preceding the survey and the Crude Birth Rate (CBR), that is the annual number of live births per 1,000 population for the same period. Fertility levels are slightly higher in rural areas compared to urban areas (3.7 compared to 3.6 births per woman). The most significant differences are found in the middle of the women’s reproductive period (age 30- 34), where rural women have an average of 0.043 more births than urban women. However, what is more interesting in this context is that fertility rates are higher in urban areas compared to rural areas among women under 30 years. For example, women aged 20-24 years living in urban areas give birth to 0.024 more children than those living in rural areas. According to the age-specific fertility rates shown in the table, women in Jordan have, on average, less than one child (0.9 child) by age 25, but have almost three children (2.8) at the age of 35 years. Table 4.2 also indicates that the overall CBR is 28 per 1,000. The GFR reached 119 births per 1,000 women aged 15-44. As the case with the TFR, the CBR and the GFR do not differ according urban-rural residence. Table 4.2 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Jordan 2007 Residence Age group Urban Rural Total 15-19 30 19 28 20-24 152 128 148 25-29 214 208 212 30-34 155 198 162 35-39 118 137 121 40-44 40 49 41 45-49 5 7 6 TFR 3.6 3.7 3.6 GFR 119 118 119 CBR 28.1 28.2 28.1 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Figure 4.1 Age-Specific Fertility Rates from Various Surveys,1976-2007 � � � � � � �� � � � � � �� � � � � � � � � � � � � � � � � � � � � 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 JPFHS 2007 � � � � � 36 | Fertility Figure 4.2 also shows that the TFR has slightly increased since 2002 in urban areas, from 3.5 to 3.6 births per woman in 2007. However, during the same period, the TFR has dropped significantly in rural areas (from 4.2 to 3.7 births per woman), and the level of fertility is now almost the same in urban and rural areas (3.6 and 3.7 respectively). The fertility differentials according to background characteristics of women are shown in Table 4.3. The first column shows the total fertility rates for the three years preceding the survey; column two shows the percentage of women who were pregnant at the time of data collection; and column three shows the mean number of children ever born (CEB) to women aged 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 2007 JPFHS, however, the fact that the completed fertility rate (5.3 children per woman) is much higher than the total fertility rate (3.6 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 the surveys implemented in Jordan over the past thirty years (Table 4.1, Figure 4.1). Fertility levels do not show considerable variations by regions, although the TFR is highest in the North (3.8 children per woman). Fertility levels do vary according to governorate; the TFR ranges from 3.2 children per woman in Karak, to 3.8 in Zarqa, Irbid and Jarash, 4.0 children per women in Mafraq and Ma’an, and 4.1 in Aqaba. In addition, women living in Badia areas have higher fertility rates than other women (4.2 against 3.5 children per woman). Fertility varies significantly by education (2.6 children among women with no education and 3.9 children among women with an elementary education). The rate peaks at 4.5 births among women who have had a preparatory education. However, women who have had higher than secondary education have had almost one birth less than women who have had a secondary education. These figures suggest that post-secondary education for women is associated with lower levels of fertility. It is of interest to note Figure 4.2 Age-Specific Fertility Rates by Urban-Rural Residence, 2002 and 2007 � � � � � � � � � � � � � � � � � � � � � � � � � � � � 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 2002 Urban 2007 Rural 2002 Rural 2007 � � � � Fertility | 37 that the relationship of education to fertility is not in fact linear; rather, in Jordan it has an inverted U- shape. The TFR for Jordanian woman also varies considerably according to wealth index. In general, women in the lowest and the second quintiles have more children than women in the fourth and the highest quintiles. The rate varies from 4.8 children for the lowest wealth quintile to 2.5 children for the highest quintile: in other words, women in the poorest households would have, on average, 2.3 more children than women in the wealthiest households. The 2007 JPFHS data show that 7 percent of all women of reproductive age were pregnant at the time of the survey. The geographical variation in the proportion of pregnant women follows a pattern similar to that of fertility. However, women with secondary education and above are more likely to be pregnant than other women (see Table 4.3). Other- wise, the other variations follow a pattern similar to that of fertility. 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 and Figure 4.3 indicate that the fertility rate has been declining in all age groups1, mainly during the 5-19 year period preceding the survey. For example, the age-specific fertility rate for women aged 25-29 declined from 305 births per 1,000 women in the 15-19 years preceding the survey to 212 births per 1,000 women in the 5-9 year period before the survey, a 31 percent decline. More recently, between the 5-9 and 0-4 year period prior to the survey the pace of fertility decline has drastically decreased. The TFR limited to women aged 15-34 for which data are available for the four preceding periods, has dropped from 4.3 births per women 15-19 years before the survey, to 3.9 births 10-14 years before, and 3.1 births 5-9 years prior to the survey. The decline has been more limited between the last most two recent periods, from 3.1 to 2.8 births per women. 1 Omitted figures represented by dashes reflect the fact that women age 50 and older were not included 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 before the survey, because these women would have been age 50 or older at the time of the survey and, thus, were not interviewed. Table 4.3 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Jordan 2007 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 3.6 7.0 5.2 Rural 3.7 6.8 5.9 Governorate Amman 3.4 6.6 5.0 Balqa 3.7 6.9 5.3 Zarqa 3.8 7.6 5.3 Madaba 3.6 6.4 5.1 Irbid 3.8 7.0 5.5 Mafraq 4.0 7.2 6.2 Jarash 3.8 6.6 6.1 Ajloun 3.7 7.7 6.1 Karak 3.2 7.0 5.2 Tafiela 3.7 5.1 6.8 Ma'an 4.0 7.1 6.0 Aqaba 4.1 7.8 6.0 Region Central 3.5 6.9 5.1 North 3.8 7.0 5.7 South 3.6 6.9 5.7 Badia area Badia 4.2 8.0 6.1 Other 3.5 6.8 5.3 Education No education 2.6 3.8 5.9 Elementary 3.9 6.5 6.4 Preparatory 4.5 5.9 6.1 Secondary 3.9 7.7 5.0 Higher 3.2 6.7 4.4 Wealth quintile Lowest 4.8 2.7 5.2 Second 4.4 2.7 6.0 Middle 3.6 2.0 5.5 Fourth 2.8 2.2 5.6 Highest 2.5 1.7 4.7 Total 3.6 6.9 5.3 Note: Total fertility rates are for the period 1-36 months prior to interview. 38 | Fertility 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 2007 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 30 37 52 55 20-24 162 176 211 237 25-29 211 212 277 305 30-34 166 185 237 [261] 35-39 121 129 [166] 40-44 42 [48] 45-49 [7] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 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 2007 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 is 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 survey (i.e., single, divorced, or widowed). On average, women have given birth to 1.6 children by their late twenties, 3.8 children by their late thirties, and 5.8 children by the end of their reproductive period. Figure 4.3 Age-Specific Fertility Rates for Five-Year Periods Preceding the Survey � � � � � � � � � � � � � � � � � � � � � � 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 50 100 150 200 250 300 350 Births per 1,000 women Years preceding the survey 0-4 5-9 10-14 15-19� � � � JPFHS 2007 Fertility | 39 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 aged 15-49 (2.16 and 2.10 children, respectively). The data also indicate that, on average, currently married women have given birth to 2.4 children by their late twenties, 4.6 children by their late thirties, and about six children by the end of their reproductive period. The mean number of children ever born is 3.8 births, compared with 3.7 children still living. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Jordan 2007 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 97.0 2.5 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 4,091 0.04 0.04 20-24 71.4 12.1 11.5 3.9 1.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3,478 0.51 0.50 25-29 38.4 11.7 18.6 18.1 9.4 2.7 1.1 0.1 0.0 0.0 0.0 100.0 2,852 1.61 1.57 30-34 26.3 5.9 11.7 17.6 19.0 11.0 5.3 2.2 0.9 0.1 0.0 100.0 2,786 2.69 2.63 35-39 18.9 2.4 6.8 13.2 16.9 16.8 11.9 7.1 3.3 1.5 1.2 100.0 2,404 3.81 3.72 40-44 12.2 2.0 4.5 7.6 13.5 16.1 13.5 12.0 7.7 5.4 5.4 100.0 2,057 5.03 4.85 45-49 8.7 1.9 3.8 7.0 11.0 13.1 14.1 11.7 10.7 6.8 11.1 100.0 1,292 5.76 5.55 Total 48.0 6.0 8.4 9.0 8.8 6.8 4.9 3.3 2.1 1.3 1.5 100.0 18,960 2.16 2.10 CURRENTLY MARRIED WOMEN 15-19 47.0 43.5 9.3 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 233 0.63 0.62 20-24 20.5 33.3 32.1 11.0 3.0 0.1 0.0 0.0 0.0 0.0 0.0 100.0 1,233 1.43 1.40 25-29 10.7 16.6 27.0 26.3 13.6 4.0 1.6 0.1 0.0 0.0 0.0 100.0 1,932 2.35 2.29 30-34 6.0 7.0 14.5 22.7 24.4 14.3 6.9 2.9 1.1 0.2 0.0 100.0 2,127 3.46 3.39 35-39 4.4 2.3 7.1 15.4 20.4 20.2 14.4 8.6 4.0 1.7 1.5 100.0 1,968 4.55 4.44 40-44 3.6 1.7 4.2 7.7 14.8 18.2 15.4 13.4 8.9 6.2 5.9 100.0 1,746 5.61 5.42 45-49 4.3 1.8 3.3 6.6 11.6 14.1 14.7 12.9 11.3 7.3 12.0 100.0 1,115 6.12 5.92 Total 8.6 10.4 14.5 15.8 15.6 12.1 8.6 5.9 3.7 2.2 2.6 100.0 10,354 3.80 3.70 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 by number of months since preceding birth is shown in Table 4.6. Women in Jordan prefer relatively long birth intervals: the median birth interval among children born in the five years preceding the survey is 31.2 months—1.1 month longer than that recorded in the 2002 JPFHS. This slight increase in birth intervals (4 percent longer) may be a reflection of the implementation of Jordan’s National Health Program for Birth Spacing, which is one component of the National Population Strategy that was ratified by the government of Jordan in 1996. 40 | Fertility 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, and median number of months since preceding birth, according to background characteristics, Jordan 2007 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Number of non-first births Median number of months since preceding birth Age 15-19 * * * * * * * 22 * 20-29 22.0 26.8 28.8 14.6 5.9 2.0 100.0 2,834 24.3 30-39 11.7 13.1 25.8 19.4 11.7 18.4 100.0 3,909 35.7 40-49 6.6 8.8 20.4 14.7 9.9 39.7 100.0 902 47.4 Birth order 2-3 21.7 22.9 27.1 14.6 7.5 6.2 100.0 3,764 25.8 4-6 8.9 13.3 24.5 19.5 11.4 22.4 100.0 2,985 38.0 7+ 7.6 11.1 28.2 18.4 9.7 25.0 100.0 918 38.1 Sex of preceding birth Male 14.2 16.7 25.3 17.4 9.1 17.4 100.0 3,931 32.6 Female 15.9 18.9 27.1 16.6 9.6 12.0 100.0 3,736 29.8 Survival of preceding birth Living 14.4 17.8 26.1 17.2 9.5 15.0 100.0 7,497 31.6 Dead 43.6 15.7 29.7 5.5 1.3 4.3 100.0 170 19.6 Residence Urban 15.3 17.6 25.4 17.2 9.6 15.0 100.0 6,401 31.5 Rural 13.8 18.6 30.3 16.0 7.7 13.6 100.0 1,266 30.2 Governorate Amman 16.4 18.7 22.5 16.9 10.2 15.3 100.0 2,858 31.8 Balqa 13.4 18.2 30.8 16.5 9.7 11.5 100.0 486 30.0 Zarqa 16.2 17.8 26.7 17.0 9.4 12.9 100.0 1,199 30.2 Madaba 15.0 17.7 29.7 16.1 8.2 13.3 100.0 186 29.6 Irbid 11.9 15.7 26.0 18.8 8.3 19.4 100.0 1,453 33.7 Mafraq 15.1 19.7 32.8 14.7 7.6 10.1 100.0 389 28.8 Jarash 16.6 17.2 28.5 16.5 10.0 11.2 100.0 226 29.9 Ajloun 15.0 17.6 29.9 16.0 7.6 13.8 100.0 181 29.1 Karak 12.0 18.1 32.9 16.4 8.7 11.9 100.0 271 30.5 Tafiela 16.6 16.2 31.3 14.9 9.7 11.4 100.0 112 29.5 Ma'an 15.3 15.6 33.6 14.7 8.7 12.1 100.0 130 30.0 Aqaba 15.4 16.2 27.9 15.9 8.7 15.9 100.0 175 31.1 Region Central 16.0 18.4 24.7 16.9 9.9 14.2 100.0 4,729 31.1 North 13.2 16.7 27.7 17.6 8.3 16.5 100.0 2,249 31.7 South 14.2 16.8 31.5 15.7 8.9 12.9 100.0 688 30.3 Badia area Badia 18.2 18.9 31.2 14.2 8.0 9.5 100.0 693 27.9 Other 14.7 17.6 25.7 17.3 9.4 15.3 100.0 6,974 31.7 Education No education 8.7 14.5 41.5 15.2 8.6 11.5 100.0 220 31.0 Elementary 17.0 19.1 25.7 13.1 9.2 15.9 100.0 511 30.1 Preparatory 9.7 15.1 26.4 18.5 10.4 19.8 100.0 1,151 35.5 Secondary 16.3 19.0 25.3 17.0 8.5 13.8 100.0 3,673 29.8 Higher 15.8 16.9 26.2 17.2 10.2 13.7 100.0 2,112 31.4 Wealth quintile Lowest 17.7 22.0 32.1 13.8 6.0 8.4 100.0 1,916 27.2 Second 15.5 18.7 27.5 17.0 8.5 12.8 100.0 1,814 29.9 Middle 13.8 16.7 25.7 17.7 9.5 16.5 100.0 1,605 32.9 Fourth 13.3 16.1 20.6 19.8 10.8 19.5 100.0 1,330 36.1 Highest 13.4 11.7 20.7 18.1 14.9 21.3 100.0 1,002 38.4 Total 15.0 17.7 26.2 17.0 9.3 14.8 100.0 7,667 31.2 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility | 41 About two-thirds of all children (67 percent) are born at least two years after their siblings. This figure is identical to that found in 2002, but represents an increase compared with 1997 (56 percent). Almost two in five (41 percent) are born after an interval of three years or longer, compared with 37 percent in 2002 and 26 percent 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 32 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 and in Ajloun, Tafiela and Mafraq as well as those women in Badia areas are more likely than other subgroups to have shorter birth intervals. The data also indicate a shorter birth interval for births following a female child. In addition, woman with elementary and secondary education and those in the lowest quintile have shorter birth intervals than other women. 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 more than half had not yet given birth. Overall, for women 25-49 years old, median age at first birth has changed little between 2002 and 2007 (from 23.5 years in 2002 to 23.9 in 2007). Figures in the last column suggest an increasing median age at first birth across age cohorts. Women in younger cohorts are likely to have their first birth at an older age than women in older cohorts. Women aged 30-34 (median age 24.6) give birth for the first time one year later than women aged 35-39 (median age 23.7), and 2.7 years later than women aged 45-49 (median age 21.9). Table 4.7 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Jordan 2007 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.0 na na na na 97.0 4,091 a 20-24 0.1 4.0 12.8 na na 71.4 3,478 a 25-29 0.0 4.7 15.0 29.5 49.7 38.4 2,852 a 30-34 0.2 5.9 19.4 34.3 52.2 26.3 2,786 24.6 35-39 0.3 8.1 18.0 36.7 58.0 18.9 2,404 23.7 40-44 0.4 10.8 26.5 43.5 63.3 12.2 2,057 23.0 45-49 0.7 14.0 31.7 50.5 67.4 8.7 1,292 21.9 25-49 0.3 7.9 20.7 37.1 56.5 23.2 11,391 23.9 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 42 | Fertility Table 4.8 presents the differentials in age at first birth among women aged 25-49 by background characteristics. Overall, the median age at first birth is 23.9 years for women aged 25-49: this is slightly higher than for women aged 30-49 (23.5). This last value is equal to the median age at first birth found in 2002 for women aged 25-49. Rural women begin childbearing half a year later than urban women (24.3 years compared with 23.8 years). There are no significant differences in the median age at first birth by region or Badia areas, while there are variations according to governorates. Median age at first birth varies from 22.9 years in Aqaba, to 24.0 years in Irbid and Amman, 24.3 in Madaba and 24.6 years in Balqa. Women with a secondary education had a median age at first birth of 22.8 years; less than half of women with higher education have given birth before the age of 25, so a median age could not be calculated for them. Data revealed also that women in the lowest and the highest wealth quintiles are more likely to have a higher median age at first birth than women in other wealth quintiles. Table 4.8 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Jordan 2007 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Women age 30-49 Residence Urban 24.8 24.4 23.7 23.1 21.9 23.8 23.5 Rural a 25.2 23.6 22.6 22.1 24.3 23.6 Governorate Amman a 25.3 23.8 23.0 21.8 24.0 23.7 Balqa a 25.3 24.4 23.4 23.4 24.6 24.3 Zarqa 23.9 22.8 23.7 22.4 22.1 23.1 22.9 Madaba a 24.7 23.8 24.1 22.4 24.3 23.8 Irbid a 24.5 23.6 23.5 22.4 24.0 23.7 Mafraq a 23.5 22.9 22.3 21.0 23.5 22.6 Jarash 24.8 23.6 23.4 22.8 21.1 23.5 23.0 Ajloun a 24.2 22.7 23.7 21.9 23.9 23.1 Karak a 27.3 24.9 23.8 22.3 a 24.7 Tafiela a 23.6 23.2 20.9 20.1 23.2 22.4 Ma'an a 24.7 22.1 22.1 21.3 23.5 22.8 Aqaba 24.3 23.3 22.6 21.7 20.8 22.9 22.2 Region Central 24.9 24.6 23.8 22.9 22.0 23.9 23.6 North a 24.2 23.4 23.4 21.9 23.9 23.4 South a 25.0 23.6 22.6 21.3 24.1 23.5 Badia area Badia a 23.9 23.3 21.5 20.8 23.6 22.8 Other a 24.6 23.7 23.1 22.0 23.9 23.6 Education No education a 25.7 23.2 20.8 19.9 21.6 21.2 Elementary 22.8 24.4 24.0 20.8 19.8 21.5 21.3 Preparatory 23.0 20.4 21.9 20.1 20.1 20.8 20.5 Secondary 22.8 23.5 22.5 22.7 21.9 22.8 22.8 Higher a 26.2 25.9 25.5 25.4 a 25.8 Wealth quintile Lowest 24.4 25.1 23.8 24.3 22.8 24.3 24.3 Second 24.1 23.2 23.6 22.2 20.8 23.3 23.0 Middle 24.3 24.2 23.8 22.7 21.4 23.6 23.3 Fourth a 24.4 23.8 22.8 21.3 23.8 23.5 Highest a 25.9 23.4 23.2 22.9 24.6 23.9 Total a 24.6 23.7 23.0 21.9 23.9 23.5 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group Fertility | 43 4.5 TEENAGE FERTILITY Table 4.9 shows the extent of fer- tility among women aged 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 education. The level of fertility among teen- agers in Jordan is low. Only 4 percent of women have begun childbearing during their teens, the same figure as found in 2002, compared with 6 percent in 1997. Levels of teenage pregnancy vary markedly by urban- rural residence (4 percent in urban and 3 percent in rural area). Teens in the Central region, Badia areas and in Amman, Mafraq, and Jarash are more likely to have begun childbearing than women in other areas. The most significant differentials are found by age and education. At age 15, only 0.1 percent of women have begun childbearing, and only 0.5 percent 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 deter- mining the onset of childbearing. The pro- portion of teens that has begun childbearing declines as level of education increases; from 16 percent of elementary educated women to 4 percent of women with sec- ondary and 0.1 percent with higher than secondary education. Results also indicate that teenage mothers are more common in the lowest and the second wealth quintiles (8 and 6 percent, respectively) than in the highest wealth quintile (1 percent). Table 4.9 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child and percentage who have begun childbearing, by background characteristics, Jordan 2007 Percentage who: Background characteristic Have had a live birth Are pregnant with first child Percentage who have begun childbearing Number of women Age 15 0.1 0.0 0.1 850 16 0.4 0.1 0.5 906 17 3.0 1.4 4.4 826 18 4.0 2.1 6.1 755 19 8.6 1.8 10.4 753 Residence Urban 3.2 1.1 4.3 3,359 Rural 2.2 0.7 2.9 735 Governorate Amman 3.8 1.3 5.1 1,607 Balqa 2.6 1.2 3.8 250 Zarqa 2.2 1.7 4.0 551 Madaba 0.9 0.5 1.4 102 Irbid 2.6 0.0 2.6 811 Mafraq 3.7 1.4 5.2 193 Jarash 5.2 1.3 6.5 129 Ajloun 1.7 0.6 2.3 92 Karak 1.1 1.7 2.8 144 Tafiela 0.7 1.2 1.9 70 Ma'an 1.7 0.0 1.7 81 Aqaba 3.5 0.3 3.8 87 Region Central 3.2 1.4 4.6 2,487 North 3.0 0.4 3.4 1,233 South 1.7 0.9 2.6 382 Badia area Badia 4.1 0.5 4.6 319 Other 2.9 1.1 4.0 3,775 Education No education 0.9 0.0 0.9 51 Elementary 14.6 1.2 15.8 79 Preparatory 5.0 1.3 6.3 791 Secondary 2.8 1.2 4.0 2,564 Higher 0.1 0.0 0.1 620 Wealth quintile Lowest 6.3 1.3 7.6 620 Second 4.5 1.8 6.3 738 Middle 2.3 0.9 3.2 883 Fourth 2.2 1.4 3.7 878 Highest 1.3 0.0 1.3 928 Total 3.0 1.0 4.1 4,091 45 | Fertility Regulation FERTILITY REGULATION 5 This chapter considers a number of indicators from the 2007 JPFHS related to knowledge, attitudes, and use of family planning. This chapter also presents information on intended future use of contraception and exposure to mass media messages about family planning. Trends over time are examined by comparing the 2007 JPFHS findings with those of three earlier surveys: the 1990, 1997 and 2002 JPFHS. 5.1 KNOWLEDGE OF FAMILY PLANNING METHODS Determining the level of knowledge of contraceptive methods was a major objective of the 2007 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 10 modern methods: the pill, IUD, injectables, implants, 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 ques- tions were asked to elicit depth of knowledge, such as how a specific method is used. The 2007 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 (99 percent), followed by lactational amenorrhea method (LAM), male condom, injectables and female sterilization (91 percent, 89, 85, and 80 percent of ever-married women, respec- tively). The least recognized methods were emergency contraception and female condom, with 20 percent and 19 percent, respectively, of ever-married women having knowledge of these methods. Withdrawal is also known to most ever-married women (92 percent). On average, an ever-married woman knows about nine methods of family planning. Table 5.1 Knowledge of contraceptive methods Percentage of ever-married women, and currently married women age 15-49 who know any contraceptive method, by specific method, Jordan 2007 Method Ever- married women Currently married women Any method 99.7 99.8 Any modern method 99.7 99.8 Female sterilization 79.7 79.8 Male sterilization 25.3 25.7 Pill 98.7 98.9 IUD 99.4 99.5 Injectables 85.4 85.8 Implants 55.8 56.3 Male condom 89.3 90.0 Female condom 19.4 19.6 Lactational amenorrhea (LAM) 91.1 91.5 Emergency contraception 20.4 20.5 Any traditional method 95.7 96.1 Periodic abstinence 87.4 88.0 Withdrawal 92.3 92.9 Folk method 4.7 4.8 Mean number of methods known 8.5 8.5 Number of women 10,876 10,354 46 | Fertility Regulation Since knowledge of any family planning method or any modern method is universal, there is almost no variation in knowledge of any method or any modern method of contraception among subgroups by background characteristics (varying from 98 to 100 percent – Data not shown). 5.2 EVER USE OF CONTRACEPTION All ever-married women interviewed in the 2007 JPFHS who report having heard of a method of family planning were asked whether they had ever used the method. Table 5.2 shows that eight in ten ever-married women reported that they have used a contraceptive method at some time. 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 (47 percent) followed by the pill (38 percent). The percentage reporting ever use of other modern methods varies from 4 percent for female sterilization to 21 percent for lactational amenorrhea method (LAM) to 23 percent for male condoms. One percent or less have ever used either the female condom, implants, male sterilization or emergency contraception. The level of ever use of traditional contraceptive methods is fairly high in Jordan. Withdrawal, the most frequently used traditional method, has been used by 33 percent of currently married women, followed by periodic abstinence (18 percent). Table 5.2 Ever use of contraception Percentage of ever-married women and currently married women age 15-49 who have ever used any contraceptive method by method, according to age, Jordan 2007 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom Female con- dom LAM Emer- gency contra- ception Any tradi- tional method Periodic absti- nence With- drawal Folk method Number of women ALL EVER-MARRIED WOMEN 15-19 31.4 21.9 0.0 0.0 9.8 6.1 0.4 0.0 8.9 0.0 4.9 0.0 17.6 1.0 16.5 0.0 236 20-24 65.4 53.1 0.0 0.0 22.7 19.8 2.0 0.0 21.1 0.0 17.3 0.1 28.7 8.0 24.6 0.7 1,276 25-29 77.9 66.9 0.0 0.4 33.5 34.5 2.6 0.2 21.2 0.0 18.8 0.8 39.4 14.8 32.3 0.5 1,977 30-34 83.9 76.0 0.9 0.0 41.8 48.1 5.5 0.1 26.8 0.0 22.4 1.8 42.3 19.9 34.1 1.3 2,213 35-39 84.5 79.9 3.5 0.0 42.4 56.6 7.1 0.5 26.1 0.2 23.5 0.8 47.2 24.1 38.9 1.8 2,052 40-44 84.3 78.2 7.5 0.2 41.3 59.2 4.8 0.5 20.4 0.4 22.1 1.2 43.0 21.0 34.5 2.8 1,884 45-49 81.9 77.9 12.8 0.0 42.1 57.2 3.5 0.9 18.2 1.0 19.3 1.3 33.0 17.5 24.3 2.6 1,239 Total 79.5 71.8 3.6 0.1 37.4 46.0 4.4 0.4 22.5 0.2 20.5 1.0 39.6 17.9 32.1 1.5 10,876 CURRENTLY MARRIED WOMEN 15-19 31.8 22.1 0.0 0.0 9.9 6.2 0.4 0.0 9.0 0.0 5.0 0.0 17.8 1.0 16.7 0.0 233 20-24 66.8 54.2 0.0 0.0 23.1 20.5 2.1 0.0 21.5 0.0 17.3 0.1 29.3 8.3 25.1 0.4 1,233 25-29 78.8 67.5 0.0 0.4 34.0 34.5 2.6 0.2 21.4 0.0 19.2 0.8 40.0 14.9 32.7 0.5 1,932 30-34 85.7 77.6 1.0 0.0 42.5 49.5 5.7 0.1 27.6 0.0 22.9 1.9 43.5 20.6 34.9 1.3 2,127 35-39 86.0 81.2 3.6 0.0 43.2 57.5 6.7 0.5 26.3 0.2 23.7 0.9 48.0 24.8 39.4 1.9 1,968 40-44 87.0 80.7 8.0 0.2 43.1 61.8 5.0 0.5 21.2 0.4 22.5 1.1 45.0 22.0 36.0 2.9 1,746 45-49 85.5 81.9 13.6 0.0 44.2 61.2 3.8 1.0 19.7 1.1 20.5 1.3 34.6 18.0 25.3 2.7 1,115 Total 81.2 73.4 3.7 0.1 38.3 47.1 4.4 0.4 23.1 0.2 21.0 1.0 40.7 18.4 32.9 1.5 10,354 LAM = Lactational amenorrhea method 47 | Fertility Regulation 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 2007 JPFHS indicate that 57 percent of currently married women are using a contraceptive method; 42 percent using modern methods and 15 percent using traditional methods. The IUD is the most widely adopted modern method (22 percent), followed by the pill (8 percent), male condom (5 percent), female sterilization (4 percent), and LAM (1 percent). Less than 1 percent of women rely on other modern methods. Withdrawal (11 percent) and periodic abstinence (4 percent) are the most common traditional methods. Table 5.3 Current use of contraception by age Percent distribution of ever-married women and currently married women age 15-49 by contraceptive method currently used, according to age, Jordan, 2007 Modern method Traditional method Age Any method Any modern method Female sterili- zation Pill IUD Inject- ables Male con- dom LAM Other modern Any tradi- tional method Periodic absti- nence With- drawal Folk method Not currently using Total Number of women ALL EVER-MARRIED WOMEN 15-19 24.1 14.9 0.0 7.0 1.9 0.1 3.3 2.6 0.0 9.1 0.1 9.1 0.0 75.9 100.0 236 20-24 42.7 31.7 0.0 7.7 12.7 0.2 7.8 3.2 0.0 11.0 2.1 8.9 0.0 57.3 100.0 1,276 25-29 49.0 35.1 0.0 9.7 18.4 0.5 5.0 1.4 0.0 13.9 2.2 11.6 0.1 51.0 100.0 1,977 30-34 60.2 45.0 0.9 10.8 23.9 0.9 6.6 1.8 0.0 15.2 3.8 11.3 0.2 39.8 100.0 2,213 35-39 61.3 45.8 3.5 9.1 25.5 1.2 5.3 1.0 0.2 15.6 4.9 10.5 0.2 38.7 100.0 2,052 40-44 61.8 44.1 7.5 5.8 26.4 0.6 3.3 0.4 0.2 17.7 5.9 11.0 0.9 38.2 100.0 1,884 45-49 48.4 36.6 12.8 2.7 18.2 0.4 1.6 0.0 0.7 11.8 4.9 6.7 0.2 51.6 100.0 1,239 Total 54.5 40.0 3.6 8.0 21.2 0.7 5.0 1.3 0.1 14.5 3.9 10.3 0.3 45.5 100.0 10,876 CURRENTLY MARRIED WOMEN 15-19 24.4 15.1 0.0 7.1 1.9 0.1 3.3 2.7 0.0 9.3 0.1 9.2 0.0 75.6 100.0 233 20-24 44.2 32.9 0.0 8.0 13.2 0.3 8.1 3.4 0.0 11.4 2.2 9.2 0.0 55.8 100.0 1,233 25-29 50.1 35.9 0.0 9.9 18.9 0.6 5.1 1.4 0.0 14.2 2.3 11.9 0.1 49.9 100.0 1,932 30-34 62.5 46.8 1.0 11.3 24.9 0.9 6.9 1.9 0.0 15.7 3.8 11.7 0.2 37.5 100.0 2,127 35-39 63.9 47.7 3.6 9.5 26.6 1.2 5.6 1.1 0.2 16.2 5.1 10.9 0.2 36.1 100.0 1,968 40-44 66.6 47.5 8.0 6.2 28.5 0.6 3.5 0.4 0.2 19.1 6.3 11.8 1.0 33.4 100.0 1,746 45-49 53.1 40.0 13.6 3.1 20.3 0.4 1.8 0.0 0.8 13.1 5.5 7.4 0.2 46.9 100.0 1,115 Total 57.1 41.9 3.7 8.4 22.3 0.7 5.3 1.4 0.1 15.2 4.1 10.8 0.3 42.9 100.0 10,354 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Overall, the level of current contraceptive use among currently married women has increased substantially in the last two decades, from 40 percent of women in the 1990 JPFHS survey to 53 percent in the 1997 JPFHS survey, 56 percent in the 2002 JPFHS and 57 percent in the 2007 JPFHS (Figure 5.1). The relative increase in current use since the 2002 JPFHS survey is 2 percent for all methods and 2 percent for all modern methods. Comparing specific methods, there has been considerable change in the use of specific contraceptive methods in the period between 1990 and 2007. Most noticeable is the increased use of the IUD, which rose from 15 percent in 1990 to 22 percent in 2007. Use of the male condom has also increased during the same period, rising from less than 1 percent to 5 percent. 48 | Fertility Regulation Contraceptive use differs according to age (Table 5.3). Use among currently married women is lowest among those aged 15-19 (24 percent), peaks among women aged 40-44 (67 percent), then declines sharply among those aged 45-49 (53 percent). Most women in the younger age cohorts use contraception for spacing births, relying on the pill and male condom, 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 8 percent among 40-44 year-olds, and 14 percent among currently married women aged 45-49. The use of IUDs is also very popular among older women. 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 (58 percent) than among women in rural areas (52 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). There are also regional variations in current use of family planning. The Central region (which includes the capital, Amman) has the highest level of any contraceptive use (58 percent), followed by the North region (55 percent). The lowest level is the South region (53 percent). Differentials in the use of modern methods are similar to those for the use of any method. Current use of contraceptive methods also differs by governorates, ranging from one-half of women in Mafraq and Ma’an, to 59 percent in Amman and Zarqa and 60 percent in Tafiela. Considerable variation is also observed according to Badia areas: 46 percent in the Badia areas compared to 58 percent in the non-Badia areas. There are also differences in current use of contraception between currently married women who have attended school and those with little or no education. Current use of contraception increases steadily with women’s education. This pattern also holds for the current use of modern methods: 44 percent of women with no education are currently using a method and 58 percent of women with secondary education or higher are currently using a contraceptive method. However, it should be noted that use of the IUD increases with level of education, whereas use of female sterilization is negatively correlated Figure 5.1 Current Use of Modern Contraception Among Currently Married Women, 1990-2007 27 38 41 42 13 15 15 15 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 0 10 20 30 40 50 60 70 Percent Modern Traditional 40 53 56 57 49 | Fertility Regulation with level of education. Those correlations could be due in part to the fact that women with no education tend to be older and have more children 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 currently married women with no children to 70 percent among women with five or more children (Table 5.4). Use of contraceptive methods also increases with the increased level of household wealth, whether for any methods or any modern methods: for example, use of female sterilization and male condom increase with increases in household wealth, which is in contrast to use of withdrawal. Table 5.4 Current use of contraception by background characteristics Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Jordan 2007 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- zation Pill IUD Inject- ables Male con- dom LAM Other modern Any tradi- tional method Periodic absti- nence With- drawal Folk method Not currently using Total Number of women Residence Urban 58.1 43.0 3.7 8.7 23.0 0.6 5.5 1.3 0.1 15.1 4.2 10.6 0.3 41.9 100.0 8,803 Rural 51.6 36.0 3.6 7.1 18.2 1.2 4.0 1.9 0.0 15.6 3.5 11.8 0.4 48.4 100.0 1,551 Governorate Amman 59.0 44.4 4.1 9.4 23.3 0.5 5.0 1.8 0.4 14.6 4.3 9.9 0.3 41.0 100.0 4,242 Balqa 54.6 39.1 5.1 7.1 19.2 1.0 4.6 2.1 0.0 15.5 6.5 8.8 0.2 45.4 100.0 620 Zarqa 59.2 45.6 2.3 9.7 25.6 0.8 6.6 0.6 0.0 13.6 2.2 11.2 0.2 40.8 100.0 1,548 Madaba 53.0 39.1 3.3 9.0 20.4 1.0 4.1 1.4 0.0 14.0 4.7 8.9 0.3 47.0 100.0 248 Irbid 56.2 38.2 3.5 6.4 21.5 0.3 5.8 0.7 0.0 17.9 4.7 13.1 0.2 43.8 100.0 1,892 Mafraq 49.5 33.7 2.0 7.4 17.2 1.6 3.9 1.5 0.1 15.7 2.4 13.0 0.4 50.5 100.0 441 Jarash 55.7 39.9 5.1 7.3 19.7 1.7 4.6 1.4 0.0 15.8 1.9 14.0 0.0 44.3 100.0 278 Ajloun 58.4 41.5 4.0 4.1 28.5 0.4 3.9 0.7 0.0 16.8 2.9 13.7 0.2 41.6 100.0 218 Karak 51.1 40.2 4.6 9.7 16.6 1.3 6.4 1.5 0.2 10.9 4.3 6.3 0.3 48.9 100.0 363 Tafiela 60.0 41.5 6.4 8.5 19.3 1.0 4.4 1.7 0.0 18.5 4.9 13.6 0.0 40.0 100.0 139 Ma'an 50.0 34.4 6.5 6.8 13.2 1.6 4.4 1.8 0.0 15.7 5.2 10.1 0.3 50.0 100.0 154 Aqaba 53.7 38.4 2.2 8.4 22.0 1.1 3.6 1.1 0.0 15.3 6.3 8.5 0.5 46.3 100.0 212 Region Central 58.4 44.0 3.7 9.3 23.3 0.6 5.3 1.6 0.3 14.4 4.1 10.0 0.3 41.6 100.0 6,658 North 55.2 37.9 3.4 6.4 21.2 0.7 5.3 0.9 0.0 17.3 3.9 13.2 0.2 44.8 100.0 2,830 South 53.0 38.9 4.6 8.7 17.7 1.3 5.0 1.5 0.1 14.0 5.1 8.7 0.3 47.0 100.0 867 Badia area Badia 45.6 33.4 2.3 7.6 16.0 1.5 3.6 2.4 0.0 12.1 3.2 8.5 0.4 54.4 100.0 783 Other 58.0 42.6 3.8 8.5 22.8 0.6 5.4 1.3 0.1 15.4 4.2 11.0 0.3 42.0 100.0 9,571 Education No education 43.9 36.1 10.1 8.2 12.1 2.9 1.9 0.7 0.1 7.8 1.2 6.3 0.4 56.1 100.0 365 Elementary 51.9 39.5 6.8 6.2 20.6 1.4 3.2 1.2 0.0 12.5 1.6 10.8 0.0 48.1 100.0 734 Preparatory 57.1 45.3 7.0 9.0 23.2 0.8 2.6 2.1 0.4 11.9 2.7 9.0 0.1 42.9 100.0 1,581 Secondary 58.1 41.8 2.7 9.8 22.1 0.7 5.2 1.2 0.1 16.4 3.4 12.7 0.3 41.9 100.0 4,586 Higher 58.3 41.8 2.0 6.8 23.7 0.3 7.5 1.3 0.1 16.5 6.7 9.5 0.4 41.7 100.0 3,089 Number of living children 0 0.9 0.6 0.0 0.6 0.0 0.0 0.1 0.0 0.0 0.3 0.0 0.2 0.0 99.1 100.0 903 1-2 47.1 31.0 0.2 8.3 13.0 0.2 7.1 2.2 0.0 16.2 3.7 12.3 0.2 52.9 100.0 2,627 3-4 67.1 50.1 2.2 10.2 29.0 0.8 6.0 1.4 0.4 17.0 4.5 12.2 0.3 32.9 100.0 3,351 5+ 69.6 53.1 8.8 8.9 28.6 1.2 4.5 1.1 0.1 16.5 5.1 11.1 0.4 30.4 100.0 3,474 Wealth quintile Lowest 48.1 34.7 2.5 9.0 16.0 1.3 3.7 2.1 0.0 13.4 2.6 10.8 0.1 51.9 100.0 2,083 Second 52.7 38.3 3.5 6.6 19.6 1.1 5.5 2.0 0.0 14.3 3.7 10.5 0.1 47.3 100.0 2,184 Middle 60.0 41.0 2.4 7.9 22.9 0.5 6.0 1.2 0.2 18.9 4.0 14.6 0.4 40.0 100.0 2,104 Fourth 63.7 49.4 4.6 10.2 27.9 0.3 5.4 1.1 0.0 14.3 4.8 9.2 0.3 36.3 100.0 2,018 Highest 61.7 46.8 5.7 8.6 25.5 0.2 5.7 0.4 0.7 14.9 5.6 8.8 0.5 38.3 100.0 1,966 Total 57.1 41.9 3.7 8.4 22.3 0.7 5.3 1.4 0.1 15.2 4.1 10.8 0.3 42.9 100.0 10,354 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 50 | Fertility Regulation 5.4 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION Table 5.5 shows the number of living children at the time of first use of contraception by age among ever-married women. 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 (33 percent and 22 percent, respectively). In other words, 57 percent of women started using a method before having a third child. With the increasing adoption of family planning – particularly among younger women – the average parity of women at first use of contraception has been declining. Women are beginning to use family planning fairly early in the family building process. The proportion that started using contraception after marriage in order to delay the first birth has increased from less than 2 percent among women aged 35-49 to 4 percent among those aged 20-24. The proportion of women who started using contraception after the birth of the first child has increased sharply from 17 percent among women 45-49 to almost half of women aged 20-29. Table 5.5 Number of children at first use of contraception Percent distribution of ever-married women age 15-49 by number of living children at the time of first use of contraception, according to current age, Jordan 2007 Number of living children at time of first use of contraception Current age Never used 0 1 2 3 4+ Total Number of women 15-19 68.6 0.5 24.4 6.5 0.0 0.0 100.0 236 20-24 34.6 3.6 47.9 11.0 1.9 0.9 100.0 1,276 25-29 22.1 2.5 46.6 21.7 4.6 2.6 100.0 1,977 30-34 16.1 2.3 37.9 25.6 11.5 6.7 100.0 2,213 35-39 15.5 1.7 26.4 28.8 13.6 14.1 100.0 2,052 40-44 15.7 1.1 22.5 22.9 13.5 24.4 100.0 1,884 45-49 18.1 1.5 16.7 19.6 13.9 30.2 100.0 1,239 Total 20.5 2.0 33.1 22.2 9.9 12.3 100.0 10,876 5.5 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 18 percent of currently married women at some time, and it is currently being used by 4 percent of women. Since the failure rate for periodic abstinence 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 5.6 presents the distribution of ever-married women categorized by the time during the ovulatory cycle when they think a woman is most likely to get pregnant (perceived fertile period). The data are presented according to whether or not the woman is currently using periodic abstinence. To obtain these data, the respondents were asked at what point during the monthly cycle a woman has the greatest chance of becoming pregnant. The results indicate that the ovulatory cycle is well known to ever- married women, as well as to women who have used the periodic abstinence method. Three fifths of ever- married women can correctly identify a woman’s fertile period. Among women using periodic abstinence, 78 percent answered correctly, while 18 percent gave the response “right after the period ended.” Overall, women’s knowledge of the fertile period has declined slightly since 2002 (from 68 percent to 61 percent.) 51 | Fertility Regulation Despite the relatively large proportion of women who can correctly identify the fertile period, it should be noted that almost two-fifths of ever-married women said they did not know the fertile period or gave the wrong answer. Since periodic abstinence is being used by a substantial number of women, family planning workers need to provide more information on the physiology of reproduction, with emphasis on the ovulatory cycle. Table 5.6 Knowledge of fertile period Percent distribution of ever-married women age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of periodic abstinence, Jordan 2007 Perceived fertile period Users of periodic abstinence Nonusers of periodic abstinence All women Just before her menstrual period begins 0.1 2.6 2.5 During her menstrual period 0.0 0.3 0.3 Right after her menstrual period has ended 18.2 25.2 24.9 Halfway between two menstrual periods 77.7 60.7 61.3 Other 0.0 0.1 0.1 No specific time 3.8 4.2 4.2 Don't know 0.2 6.8 6.5 Total 100.0 100.0 100.0 Number of women 426 10,450 10,876 5.6 TIMING OF STERILIZATION Although use of female sterilization increased between 2002 and 2007 (from 3 to 4 percent), it still represents only 9 percent of the contraceptive use among users of modern methods. The age at which the operation takes place is of particular interest to family planning officials (Table 5.7). For 8 percent of women who have been sterilized, the operation took place before they were 30 years old; 27 percent were sterilized at 30-34 years, 45 percent at 35-39 years, and 20 percent at 40-49. Overall, women’s age at sterilization remained almost the same in Jordan between 2002 and 2007: the median age for women under age 40 was 35.4 years in 2002, compared with 35.5 years in 2007. Table 5.7 Timing of sterilization Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Jordan 2007 Age at time of sterilization Years since operation <25 25-29 30-34 35-39 40-44 45-49 Total Number of women Median age1 <2 0.0 0.0 13.6 61.1 22.5 2.9 100.0 78 37.8 2-3 0.0 0.5 13.6 29.5 47.7 8.8 100.0 42 36.4 4-5 (0.0) (6.0) (31.4) (39.9) (18.1) (4.6) 100.0 47 (35.1) 6-7 0.0 0.0 22.5 54.2 23.3 0.0 100.0 59 36.6 8-9 0.8 12.3 30.4 42.1 14.3 0.0 100.0 63 35.0 10+ 0.2 19.3 41.1 39.4 0.0 0.0 100.0 104 a Total 0.2 7.9 27.0 45.4 17.5 2.1 100.0 393 35.5 Note: Figures in parentheses are based on 25-49 unweighted cases. a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring. 52 | Fertility Regulation 5.7 SOURCE OF SUPPLY FOR MODERN METHODS In addition to information about the level of contraceptive use, program officials need to know where users obtain their methods. As in the 2002 JPFHS, the 2007 JPFHS survey included a question for current users of modern methods regarding the source of their method. Private sources serve about three fifths (58 percent) of current users, compared with 66 percent in 2002 survey. The Jordanian Association of Family Planning and Protection (JAFPP), pharmacies, and private hospitals are the major private sources of supply for modern contraceptive methods (Table 5.8 and Figure 5.2). The share of the public sector increased to 42 percent in 2007, compared with 34 percent in the 2002 survey. The sources of contraceptive methods vary by method used. Pharmacies are the primary source for users of methods that require resupply, including the pill (43 percent) and condoms (39 percent). Family planning clinics (JAFPP) are the primary source for IUDs (23 percent). Government hospitals are the major source for most female sterilizations (48 percent), followed by the private hospitals (31 percent) and Royal Medical Services (16 percent). Government health centers are the major source of injectables (45 percent), followed by public MCH (18 percent). Table 5.8 Source of modern contraception methods Percent distribution of women aged 15-49 currently using a modern contraceptive method, by most recent source of method, according to method, Jordan 2007 Source Female sterilization Pill IUD Injectables Male condom Total1 Public 67.8 38.1 36.8 74.4 45.4 41.8 Public government hospital 48.2 1.1 3.1 3.7 1.5 6.9 Public government health center 0.0 22.4 16.6 44.6 27.9 18.2 Public MCH 0.0 14.1 13.9 18.0 15.1 12.8 University hospital 3.4 0.1 0.5 0.9 0.0 0.6 Royal Medical Services 16.2 0.4 2.2 7.2 0.9 3.1 Other public 0.0 0.0 0.5 0.0 0.0 0.3 Private medical 32.2 61.3 62.7 25.0 53.1 57.6 Private hospital/clinic 30.8 1.1 15.8 0.7 0.9 12.0 Private doctor 0.0 1.1 14.3 7.0 0.1 8.2 Private pharmacy 0.0 43.2 1.7 5.4 39.0 15.0 JAFPP 0.0 3.0 22.8 2.4 3.7 13.6 UNRWA clinic 0.0 12.3 6.8 9.4 9.4 7.8 Other NGO 0.0 0.5 0.3 0.0 0.0 0.3 Other private 1.4 0.0 1.0 0.0 0.1 0.7 Other 0.0 0.6 0.5 0.7 1.5 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 393 875 2,308 73 544 4,209 1 Total includes 14 users of implants, 4 users of diaphragm, 1 user of foam/jelly, but excludes lactational amenorrhea method (LAM) 53 | Fertility Regulation 5.8 INFORMED CHOICE Women who are currently using a modern method of contraception and had adopted the method within the five years preceding the survey were asked whether they were informed about the side effects of the methods they were using, whether they were told what to do if they experienced any side effects, and whether they were informed about other methods of contraception they could use. Women who have been sterilized were asked if they were informed that they could not have any more children because of the operation. Table 5.9 shows that 72 percent of women were informed about the side effects of their method, while 64 percent were informed about what to do should they experience side effects. Seventy percent of women were also informed about alternative methods. The majority of women who use injectables were well informed: 77 percent had been told about side effects, 61 percent knew what to do when they had side effects, and 83 percent were informed about other available methods of contraception. Users of the IUD and pill were similarly well informed about side effects (IUD: 75 percent; pill: 70 percent), and were told in different proportions about other methods they could use (pill: 80 percent; IUD: 73 percent); however, those who use an IUD were more likely to have been told about what to do in case of side effects (68 percent) than users of the pill (59 percent). It should be noted that only 49 percent of sterilized women were informed about side effects and only 47 percent were informed about what to do if they experienced side effects; 40 percent were informed about other methods. Contraceptive users who obtained their methods from a public source were more likely to have received information about the method’s side effects than those who went to a private source (76 percent and 69 percent, respectively). Women who obtained their methods from public health centers or from the Royal Medical Services were the most likely to have received information about side effects (82 percent and 81 percent, respectively) and what to do if they experienced side effects (71 percent and 77 percent), followed by those who obtained their method from JAFPP (76 percent about side effect and 69 percent on what to do about them). Figure 5.2 Sources of Family Planning Methods Among Current Users of Modern Methods JPFHS 2007 Public 42% JAFPP 14% Private doctor 8% Pharmacy 15% UNRWA 8% Other 2% Private hospital/clini 12% Private hospital/clinic 54 | Fertility Regulation Table 5.9 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the five years preceding the survey, percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods that could use, by method and source; and among sterilized women, the percentage who were informed that the method is permanent, by initial source of method, Jordan 2007 Among women who started last episode of modern contraceptive method within five years preceding the survey: Among women who were sterilized: Method/source Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if side effects experienced Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Percentage who were informed that sterilization is permanent1 Number of women Method Female sterilization 48.7 47.4 39.9 142 95.9 142 Pill 69.6 59.2 79.8 768 na 0 IUD 74.6 68.0 73.2 1,707 na 0 Injectables 77.4 61.4 83.0 69 na 0 Implants * * * 14 na 0 Other na na 2.5 146 na 0 Initial source of method2 Public 75.6 65.0 74.9 1,103 96.3 95 Public government hospital 54.7 41.5 51.0 143 96.6 71 Public government health center 81.7 70.8 81.2 515 na 0 Public MCH 75.2 64.2 75.9 376 na 0 University hospital * * * 10 * 8 Royal medical services 80.7 77.1 73.2 55 * 16 Other public * * * 4 na 0 Private medical 69.3 63.3 70.8 1,629 (95.1) 47 Private hospital/clinic 69.5 62.8 62.7 309 (95.0) 46 Private doctor 63.7 61.6 62.5 266 na 0 Private pharmacy 60.4 56.0 72.8 323 na 0 JAFPP 76.4 69.1 74.8 453 na 0 UNRWA clinic 72.2 67.0 81.5 246 na 0 Other NGO * * * 10 na 0 Other private * * * 22 * 1 Other (64.0) (64.0) (2.5) 33 na 0 Total 71.9 64.1 69.8 2,846 95.9 142 Note: Table excludes users who obtained their method from friends/relatives. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Among women who were sterilized in the five years preceding the survey 2 Source at start of current episode of use. 5.9 CONTRACEPTIVE DISCONTINUATION A key concern of family planning officials is the extent to which women discontinue use of contraceptive methods and their reasons for doing so. Contraceptive discontinuation rates based on information collected in the calendar are presented in Table 5.10. Discontinuation rates were calculated for each method based on use during the first 12 months after beginning the method. The reasons for discontinuation were examined, then classified into four main categories: method failure (became pregnant while using), desire to become pregnant, women’s switching to another method, and other reasons (including problems related to the use of a particular method, husband’s disapproval, health reasons, cost, and absence of need to use a family planning method). Table 5.10 indicates that 7 percent of users stopped using before the end of the first year because the method failed; 9 percent said they stopped 55 | Fertility Regulation because they wanted to become pregnant; 13 percent because they switched to another method; and 11 percent for other reasons.1 These discontinuation rates remain the same as those found in the 2002 JPFHS. Discontinuation rates were highest for LAM (94 percent) – in part because, by definition, LAM can be used for a maximum of 6 months postpartum – followed by the pill (47 percent), the male condom (44 percent) and injectables (41 percent). The lowest discontinuation rate was for the IUD (the most common method), with 12 percent of women discontinuing the method during the first year of use. Part of the reason that the IUD has the lowest discontinuation rate may be because a woman has to seek the help of a medical professional to have it removed; she cannot stop using the method of her own volition. First- year discontinuation rates due to method failure are highest for periodic abstinence (21 percent) and withdrawal (13 percent) (Figure 5.3). Eleven percent of women who used periodic abstinence, 11 percent of women who used withdrawal, 12 percent who used the male condom, 12 percent who used LAM and 10 percent who used the pill discontinued the method in order to become pregnant. Table 5.10 First-year contraceptive discontinuation rates Percentage of contraceptive users who discontinued use of a method within 12 months after beginning its use, by reason for discontinuation and specific method, Jordan 2007 Method Method failure Desire to become pregnant Switched to another method1 Other reason Total Pill 5.9 10.3 12.9 17.4 46.5 IUD 0.8 3.3 4.9 2.9 11.8 Injectables 1.4 9.6 17.5 12.7 41.2 Male condom 9.4 12.3 15.6 6.2 43.6 Lactational amenorrhea 5.4 12.1 38.8 37.8 94.1 Periodic abstinence 20.5 11.4 5.3 1.6 38.9 Withdrawal 12.6 11.0 8.4 2.6 34.5 All methods 7.1 8.9 12.9 10.8 39.7 Number of episodes of use 658 831 1,241 1,040 3,770 Note: Table is based on episodes of contraceptive use that began 3-59 months prior to the survey 1 Used a different method in the month following discontinuation or said that they wanted a more effective method and started another method within two months of discontinuation 1 The rates are calculated from information collected in the calendar portion of the questionnaire. All episodes of contraceptive use between January 2002 and the date of interview are recorded in the calendar. Thus, discontinuation rates presented in this table refer to only to episodes of contraceptive use that began during the period of time covered by the calendar, not all episodes that occurred during this period. Specifically, the rates presented in Table 5.10 refer to the period 3-59 months prior to the survey—the month of interview and the two months prior are ignored in order to avoid the bias that may be introduced by unrecognized pregnancies. 56 | Fertility Regulation Table 5.11 provides information about women’s reasons for discontinuing contraception. The table includes all discontinuations in the five years preceding the survey, regardless of whether they occurred during the first 12 months of use or later. The reason given most frequently for discontinuation was the desire to get pregnant (38 percent), followed by method failure (17 percent) and health concerns (12 percent). The other reasons women cited for discontinuation were the desire to have a more effective method (11 percent), side effects (7 percent), and inconvenience of use (2 percent). About 2 percent of currently married women report husband’s disapproval of family planning as their reason for discontinuation. Discontinuation due to method failure is particularly high for the traditional methods of periodic abstinence (44 percent) and withdrawal (35 percent). Method failure was one of the main reasons given for discontinuation of male condoms (24 percent). Side effects were most frequently cited as the reason for discontinuation among women who had been using injectables (19 percent), pill (13 percent), and IUD (12 percent). Figure 5.3 Contraceptive Discontinuation Rates by Reason and Method 47 12 41 44 94 39 35 Pill IUD Injectables Condom LAM Periodic abstinence Withdrawal 0 20 40 60 80 100 Switched to another method Desire to become pregnant Method failure Other reasons JPFHS 2007 57 | Fertility Regulation Table 5.11 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason reported for discontinuation, according to specific method, Jordan 2007 Reason Pill IUD Injectables Male condom Lactational amenorrhea Periodic abstinence Withdrawal All methods1 Became pregnant while using 12.2 6.3 6.2 23.5 7.3 43.6 35.1 17.4 Wanted to become pregnant 38.3 49.3 28.1 38.8 13.2 41.6 43.7 38.4 Husband disapproved 0.8 0.6 0.1 8.5 0.2 1.3 3.1 1.8 Side effects 12.5 12.2 19.0 0.9 0.3 0.1 1.0 6.7 Health concerns 17.5 23.8 34.5 7.9 1.2 0.9 1.5 11.9 Access/availability 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Wanted a more effective method 3.6 0.9 5.8 10.4 38.5 8.6 10.9 10.5 Inconvenient to use 1.7 1.7 3.3 3.4 2.6 0.8 0.3 1.7 Infrequent sex/husband away 10.7 1.2 0.4 2.2 1.0 1.8 1.8 3.6 Costs too much 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Fatalistic 0.0 0.0 0.0 0.0 0.1 0.1 0.2 0.1 Difficult to get pregnant/menopausal 0.5 1.1 0.5 1.0 0.1 0.3 0.5 0.6 Marital dissolution/separation 0.7 0.8 0.3 0.7 0.0 0.0 1.1 0.6 Ramadan 0.7 1.5 0.6 1.2 21.0 0.2 0.5 3.9 End of BF period 0.0 0.0 0.0 0.0 0.0 0.6 0.0 0.0 Husband sick 0.2 0.3 0.1 0.0 14.0 0.0 0.0 2.2 Other 0.2 0.0 0.0 0.1 0.0 0.0 0.0 0.1 Don't know 0.2 0.2 0.9 0.3 0.0 0.0 0.0 0.2 Missing 0.0 0.2 0.0 1.1 0.4 0.0 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 2,003 2,113 186 757 1,271 616 1,605 8,602 1 Includes 4 users of implants, 49 users of other methods 5.10 FUTURE USE OF FAMILY PLANNING To obtain information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. Those who responded in the affirmative were also asked which method they would prefer to use. Table 5.12 presents the distribu- tion of currently married women who were not using contraception at the time of the survey, by their intention to use in the future, according to the number of living children. It is noted that 58 percent of women not currently using a contra- ceptive method in the 2007 JPFHS said that they intended to use family planning in the future, while more than one-third (37 percent) of nonusers said they do not intend to use in the future. In the 2002 JPFHS, the proportion of nonusers who intended to use a family planning method in the future was 60 percent. Table 5.12 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Jordan 2007 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 42.9 66.9 66.5 68.1 52.9 58.2 Unsure 13.0 5.0 5.4 2.5 2.9 5.0 Does not intend to use 44.1 28.0 28.1 29.4 44.2 36.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 614 729 675 675 1,750 4,442 1 Includes current pregnancy 58 | Fertility Regulation Intention to use contraception in the future appears not to have a strong positive association with the number of living children a woman has. Specifically, 68 percent of women with three children said they intend to use a method of family planning, compared with 43 percent of childless women and 53 percent of women with four or more children. The reasons women choose not to use family planning are of particular interest to family planning program officials. Table 5.13 presents the distribution of women who are not using contraception and have no intention to do so by their reason for not using and not intending to use. The primary reason given is the desire to have more children (20 percent), infecundity (17 percent), and health concerns (16 percent). The next most common reason for not using is menopause (11 percent). Other reasons for not intending to use contraceptive methods are fear of side effects (6 percent), and infrequent sexual relations (9 percent). Another 5 percent mention husband’s or respondent’s disapproval of contraception. Married women who were not using contraception at the time of the survey but reported that they intended to use, were asked about the method they intend to use. The results are shown in Table 5.14. The majority of women (79 percent) say they want to use a modern method of contraception and 11 percent want to use a traditional method. About half of the women (48 percent) who intend to use contraception say they want to use the IUD. The second most popular modern method is the pill (21 percent). Some programmatic impli- cations can be drawn from the data in Table 5.14. Because of the popularity of the IUD, the pill, male condom, and female sterilization, several issues need to be considered in anticipation of women’s carrying out their intentions to use those methods. First, the supply of pills must be adequate to meet the needs of women who want to use that method; second, for women who want to use the IUD or female sterilization, trained personnel must be available to provide the services; lastly, for women whose husbands desire to use condoms, they should be accessible with low prices. 5.11 EXPOSURE TO FAMILY PLANNING MESSAGES Radio and television are major sources of information about family planning, in addition to print and other media. To assess the effectiveness of those media for disseminating family planning information, all ever-married women were asked if they had heard, seen or read messages about family planning on the radio, television or other mentioned sources during the months preceding the survey. The results indicate that, overall, 67 and 24 percent of ever-married women are exposed to family planning messages via the electronic media of television and radio, respectively (Table 5.15). Differentials in access to family planning messages by age, place of residence, region, governorates, Badia area and Table 5.13 Reason for not intending to use contraception in the future Percent distribution of currently married women age 15-49 who are not using contraception and who do not intend to use in the future by main reason for not intending to use, Jordan 2007 Reason Percent distribution Fertility-related reasons Infrequent sex 8.8 Menopausal, hysterectomy 10.9 Subfecund, infecund 16.5 Wants more children 19.6 Spouse ill 2.2 Difficult pregnancy 8.2 Opposition to use Respondent opposed 3.1 Husband opposed 2.1 Religious prohibition 0.4 Lack of knowledge Knows no method 0.3 Method-related reasons Health concerns 16.3 Fear side effects 6.0 Costs too much 0.5 Inconvenient to use 0.8 Interferes with body's normal process 0.3 Other 3.3 Don't know 0.7 Total 100.0 Number of women 1,637 Table 5.14 Preferred method of contraception for future use Percent distribution of currently married women age 15-49 who are not using a contraceptive method but who intend to use in the future by preferred method, Jordan 2007 Method Percent distribution Female sterilization 2.4 Male sterilization 0.1 Pill 20.6 IUD 48.3 Injectables 1.8 Implants 0.6 Male condom 4.2 Female condom 0.0 Lactation amenorrhea 0.5 Periodic abstinence 3.5 Withdrawal 6.4 Other 1.2 Unsure 10.4 Total 100.0 Number of women 2,585 59 | Fertility Regulation education are generally evident, with those sources of information that require literacy showing particularly striking differentials by education. Nevertheless, 44 percent of women had been exposed to family planning information via bulletins and booklets followed by posters (42 percent) and newspapers and magazines (31 percent). Lectures were the least common sources of exposure to family planning messages (11 percent). The results also show that 18 percent of respondents reported that they hadn’t been exposed to family planning information via any of the six media sources. Younger women (15-19 years), older women (40-49 years), women living in Madaba and Aqaba, women living in the Badia areas, women with no education or elementary education and women in the lowest wealth quintiles were less likely to have been exposed to family planning messages through media than other women. Table 5.15 Exposure to family planning messages Percentage of women aged 15-49 who heard, saw or read a family planning message, by source of message, according to background characteristics, Jordan 2007 Background characteristic Radio Television Newspaper/ magazine Posters Bulletin, booklet Lecture None of these six media sources Number Age 15-19 20.7 59.0 25.4 36.3 38.6 7.6 21.2 236 20-24 18.1 65.6 28.4 43.6 43.9 8.1 17.6 1,276 25-29 23.2 67.6 28.2 42.6 48.8 9.2 17.3 1,977 30-34 24.6 67.4 30.7 45.4 49.3 11.5 15.8 2,213 35-39 26.0 68.9 32.1 42.8 46.5 11.4 16.6 2,052 40-44 26.2 67.5 34.3 39.9 41.5 11.5 21.0 1,884 45-49 26.5 63.4 29.6 32.6 30.8 12.2 24.0 1,239 Residence Urban 24.6 66.1 31.8 41.8 44.9 10.7 18.4 9,249 Rural 22.5 71.5 24.1 40.4 41.3 10.6 17.9 1,627 Governorate Amman 28.6 64.3 36.8 41.0 45.6 12.0 19.1 4,442 Balqa 23.1 72.3 33.6 47.4 47.0 11.3 19.1 645 Zarqa 29.2 66.9 21.5 39.2 42.3 10.0 16.9 1,645 Madaba 19.1 68.1 29.8 38.6 45.1 20.4 20.9 262 Irbid 14.2 66.3 26.4 42.5 44.8 6.4 18.1 1,993 Mafraq 17.2 73.1 23.2 38.2 32.8 5.2 17.9 460 Jarash 20.0 69.8 21.8 45.8 41.9 13.1 17.0 293 Ajloun 18.9 69.4 24.8 50.5 48.1 9.9 15.4 228 Karak 24.1 73.8 31.9 45.3 50.5 14.8 17.3 378 Tafiela 25.8 74.3 33.2 44.2 45.7 16.2 16.3 146 Ma'an 29.1 72.0 31.0 37.1 38.3 12.1 18.4 164 Aqaba 22.1 68.6 34.6 36.1 38.8 11.9 20.7 221 Region Central 27.9 65.8 32.6 41.1 44.9 11.8 18.7 6,993 North 15.6 67.9 25.3 42.8 42.9 7.1 17.8 2,975 South 24.8 72.3 32.6 41.4 44.7 13.8 18.2 908 Badia area Badia 21.7 71.5 20.8 31.8 36.8 13.5 19.9 823 Other 24.5 66.5 31.4 42.4 45.0 10.4 18.3 10,053 Education No education 19.8 58.9 5.3 11.5 8.1 6.4 37.7 416 Elementary 20.2 59.9 14.2 23.5 21.4 8.1 26.9 813 Preparatory 20.6 65.4 23.9 37.0 38.6 8.6 20.3 1,681 Secondary 24.3 68.4 30.6 43.3 46.7 9.7 16.0 4,788 Higher 27.8 68.4 41.8 49.9 54.5 14.4 16.2 3,179 Wealth quintile Lowest 17.4 65.6 17.0 33.7 34.9 7.6 21.3 2,211 Second 21.5 68.1 25.3 40.1 42.9 9.5 17.8 2,296 Middle 24.6 71.3 30.6 45.6 49.2 11.3 15.4 2,206 Fourth 26.4 67.5 34.6 43.2 46.2 11.8 18.2 2,135 Highest 32.2 61.5 47.3 45.8 49.2 13.5 19.2 2,028 Total 24.3 66.9 30.6 41.6 44.4 10.7 18.4 10,876 60 | Fertility Regulation 5.12 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Information on whether ever-married women had visited a health facility (seeking care for themselves or their children) in the last 12 months was collected in the 2007 JPFHS. This contact may provide an opportunity for them to receive family planning information; therefore, women who reported having visited a health facility in the past 12 months were asked whether anyone in the health facility had talked to them about family planning methods. In addition, information on whether ever-married women were visited by a health professional who spoke to them about family planning in the 12 months preceding the survey was also collected. Table 5.16 shows that while more than three-quarters of women (77 percent) had visited a health facility in the 12 months preceding the survey, only 17 percent had discussed family planning methods during their visit. The results also show that women aged 20-39 years, urban women, women living in the North region, and in Ajloun, and Irbid, and non-Badia areas, more educated women and those women in the second quintile were more likely to have discussed family planning during a visit to a health facility than other women. The data also reveal that 21 percent of women were visited by a fieldworker who discussed family planning. Women among age group 45-44, women living in urban areas, in Zarqa, Irbid and Ajloun, women living in non-Badia areas and the North region, more educated women and those in the first three wealth quintiles are more likely to have discussed family planning during the visit of a fieldworker than other women. 61 | Fertility Regulation Table 5.16 Contact of nonusers with family planning providers Among ever-married women age 15-49 who are not using contraception, the percentage who during the last 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who neither discussed family planning with a fieldworker nor at a health facility, by background characteristics, Jordan 2007 Percentage of women who visited a health facility in the past 12 months and who: Background characteristic Percentage of women who were visited by fieldworker who discussed family planning Discussed family planning Did not discuss family planning Percentage of women who neither discussed family planning with fieldworker nor at a health facility Number of women Age 15-19 13.9 14.9 59.1 77.5 179 20-24 19.5 18.2 63.7 71.5 731 25-29 22.7 23.9 58.8 63.5 1,009 30-34 23.8 21.8 59.9 63.9 881 35-39 21.4 17.5 59.9 68.7 793 40-44 21.8 10.6 59.1 73.3 719 45-49 14.8 7.9 57.3 80.0 640 Residence Urban 22.0 17.7 59.3 68.7 4,128 Rural 14.5 15.3 62.4 74.4 824 Governorate Amman 17.6 16.6 56.2 72.6 1,939 Balqa 17.0 11.0 66.7 76.6 304 Zarqa 32.4 19.1 64.5 60.5 725 Madaba 12.2 13.2 48.1 79.1 129 Irbid 29.3 20.2 59.2 62.4 931 Mafraq 14.8 14.6 66.0 74.3 242 Jarash 10.7 19.1 68.1 74.1 138 Ajloun 23.6 25.1 59.8 58.7 100 Karak 12.1 18.5 57.5 74.2 190 Tafiela 8.4 15.5 65.1 77.7 62 Ma'an 5.0 12.1 62.8 84.7 86 Aqaba 5.6 16.6 66.5 80.4 107 Region Central 20.8 16.5 58.8 70.4 3,097 North 24.6 19.5 61.2 65.4 1,411 South 8.6 16.4 61.7 78.2 445 Badia area Badia 16.6 13.0 63.4 74.2 465 Other 21.2 17.8 59.4 69.2 4,488 Education No education 12.3 6.5 51.4 81.9 253 Elementary 17.1 14.8 61.9 76.3 429 Preparatory 22.0 17.3 59.5 69.3 776 Secondary 23.2 18.5 60.2 67.1 2,116 Higher 19.0 18.4 60.1 69.4 1,378 Wealth quintile Lowest 18.2 16.5 61.0 72.2 1,206 Second 26.0 22.5 58.0 62.1 1,143 Middle 23.3 15.7 62.4 68.5 941 Fourth 18.1 14.5 57.2 73.1 848 Highest 16.9 16.2 60.1 74.3 815 Total 20.8 17.3 59.8 69.7 4,952 Nuptiality and Exposure to the Risk of Pregnancy | 63 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY 6 This chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant: nuptiality, postpartum amenorrhea, and secondary infertility. In addition, data pertaining to the timing of respondents’ most recent sexual activity were collected. Information on nuptiality is of particular interest because marriage is a primary determinant of the exposure of women to the risk of pregnancy, particularly in countries like Jordan where premarital fertility is rare. Marriage patterns are important for an understanding of fertility, since early age at first marriage is associated with early childbearing and high fertility. In this survey and for all data collection in Jordan, the term marriage refers to a formal, legal union. 6.1 CURRENT MARITAL STATUS Table 6.1 compares data on ever-married women from the 2007 JPFHS with previous surveys: the 1976 Jordan Fertility Survey (JFS), the 1983 Jordan Fertility and Family Health Survey (JFFHS), and the 1990, 1997, and 2002 Jordan Population and Family Health Surveys (JPFHS). During the 26 years between 1976 and 2002, the percentage of ever-married women decreased from 66 to 54 percent, a drop of 18 percent. However, between 2002 and 2007, the percentage of ever-married women has increased from 54 to 57 percent. This increase is mainly concentrated among young women of age groups 20-24 and 25-29. Table 6.1 Trends in the proportion of ever-married by age group Percentage of women age 15-49 who have ever married by age, various surveys, Jordan 1976-2007 Age JFS 1976 JFFHS 1983 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 15-19 19.5 9.4 10.6 8.2 6.2 5.8 20-24 64.1 42.0 45.2 38.8 34.1 36.7 25-29 87.4 76.3 73.7 66.2 65.3 69.3 30-34 95.3 90.1 89.1 80.7 79.6 79.4 35-39 97.4 94.9 94.6 89.9 87.3 85.4 40-44 98.0 96.8 97.3 94.4 92.6 91.6 45-49 98.3 97.1 98.0 96.0 95.4 95.9 Total 15-49 65.7 56.0 56.2 54.6 54.4 57.4 In Jordan, marriage is almost universal. In 2007, only 4 percent of women have not married by the end of their reproductive years (see Table 6.2). However, the percentage of women who have never married has increased over the years. For example, in 1976, less than 3 percent of women aged 35-39 had never married (see Figure 6.1); the proportion of never married women increased in this age group to about 5 percent between 1983 and 1990, doubled in 1997 (10 percent), rose again to 13 percent in 2002, and reached 15 percent in 2007. The pattern is similar for women in the younger age groups. The proportion of never-married women aged 20-24 increased from 36 percent in 1976 to 55 percent in 1990, then to 66 percent in 2002, but dropped to 63 percent in 2007. This same pattern also holds for the age group 25-29 years. Echoing this trend, the proportion of women aged 15-19 who had never married increased from 80 to 94 percent between 1976 and 2007. This change is the consequence of an increase of the age at first marriage among the youngest women. 64 | Nuptiality and Exposure to the Risk of Pregnancy Table 6.2 presents the distribution of women by current marital status. Of the 18,960 women aged 15-49 listed in the household schedule, 43 percent had never married, 55 percent were currently married, and the remaining 3 percent were either divorced or widowed. The proportion of women who are currently married increases steadily from 6 percent among women aged 15-19 to 82 percent among those aged 35-39, then to 86 percent for women in the oldest age group 45-49. As expected, the proportion of widows increases with age, reaching 7 percent among women aged 45-49. Less than 2 percent of women are divorced in Jordan. Table 6.2 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Jordan 2007 Marital status Age Never married Married Divorced Widowed Total Number of women 15-19 94.2 5.7 0.0 0.0 100.0 4,091 20-24 63.3 35.4 1.0 0.2 100.0 3,478 25-29 30.7 67.7 1.5 0.1 100.0 2,852 30-34 20.6 76.4 2.6 0.4 100.0 2,786 35-39 14.6 81.9 2.3 1.2 100.0 2,404 40-44 8.4 84.9 2.6 4.1 100.0 2,057 45-49 4.1 86.3 2.2 7.3 100.0 1,292 Total 15-49 42.6 54.6 1.5 1.2 100.0 18,960 80 35 19 5 3 91 58 24 10 5 89 55 29 11 5 92 61 39 19 10 94 66 35 20 13 94 63 31 21 15 15-19 20-24 25-29 30-34 35-39 Age group 0 20 40 60 80 100 Percent 1976 JFS 1983 JFFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS Figure 6.1 Percentage of Never-married Women 15-39 by Age Group, 1976-2007 Nuptiality and Exposure to the Risk of Pregnancy | 65 6.2 POLYGYNY Marital unions in Jordan are predomi- nantly of two types—those that are monogamous and those that are polygynous. The distinction has social significance and possible implications for fertility, although the relationship between type of union and fertility is complex and not easily understood. The proportion of currently married women in Jordan in a polygynous union is shown in Table 6.3. Overall, 5 percent of currently married women in 2007 are in a polygynous union, compared to 7 percent in 2002. Older women are more likely to be in a polygynous union than younger women (8 percent at aged 40-49 compared to less than 2 percent at ages 15-24). The prevalence of polygyny is also higher in rural areas. There are significant differences in type of marital union by region, governorate and particu- larly residence in Badia: in the Badia areas, 13 percent of married women are in polygynous union compared to 4 percent in the non-Badia areas. There are also large differences in polygy- nous union by household wealth quintile. The proportion of polygynous union among those in the lowest wealth quintile is 8 percent, compared to 4 percent in the highest wealth quintile, giving an inverse relationship between polygyny and household wealth. There is also an inverse relationship between polygyny and education. Among married women with no education, the proportion in a polygynous union is 20 percent; this decreases to 5 percent among women with preparatory educa- tion and to 3 percent among women with a secondary or higher education. 6.3 CONSANGUINITY Kinship marriage, also called consanguin- eous marriage, is relatively common in Jordan. Data in Table 6.4 indicated that 40 percent of women aged 15-49 reported that they are related to their current husband (or last husband, for divorced or widowed women). Data indicated that 5 percent were dual first cousin marriages (i.e., both father’s and mother’s sides). The proportion of marriages between first cousins on the father’s side is higher than those on the mother’s side (13 percent compared to 7 percent). Fifteen percent were marriages to second cousins or other relatives. Table 6.3 Number of co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Jordan 2007 Number of co-wives Background characteristic 0 1+ Total Number of women Age 15-19 99.0 1.0 100.0 233 20-24 98.2 1.8 100.0 1,233 25-29 97.6 2.4 100.0 1,932 30-34 96.4 3.6 100.0 2,127 35-39 94.2 5.8 100.0 1,968 40-44 91.6 8.4 100.0 1,746 45-49 93.3 6.7 100.0 1,115 Residence Urban 95.9 4.1 100.0 8,803 Rural 92.3 7.7 100.0 1,551 Governorate Amman 96.1 3.9 100.0 4,242 Balqa 93.4 6.6 100.0 620 Zarqa 96.0 4.0 100.0 1,548 Madaba 94.6 5.4 100.0 248 Irbid 96.3 3.7 100.0 1,892 Mafraq 90.2 9.8 100.0 441 Jarash 93.8 6.2 100.0 278 Ajloun 96.8 3.2 100.0 218 Karak 94.3 5.7 100.0 363 Tafiela 94.0 6.0 100.0 139 Ma'an 89.1 10.9 100.0 154 Aqaba 92.7 7.3 100.0 212 Region Central 95.8 4.2 100.0 6,658 North 95.2 4.8 100.0 2,830 South 92.9 7.1 100.0 867 Badia area Badia 87.2 12.8 100.0 783 Other 96.0 4.0 100.0 9,571 Education No education 80.5 19.5 100.0 365 Elementary 90.1 9.9 100.0 734 Preparatory 95.2 4.8 100.0 1,581 Secondary 96.2 3.8 100.0 4,586 Higher 97.2 2.8 100.0 3,089 Wealth quintile Lowest 92.3 7.7 100.0 2,083 Second 95.5 4.5 100.0 2,184 Middle 96.1 3.9 100.0 2,104 Fourth 96.4 3.6 100.0 2,018 Highest 96.5 3.5 100.0 1,966 Total 95.4 4.6 100.0 10,354 66 | Nuptiality and Exposure to the Risk of Pregnancy Table 6.4 Consanguinity Percent distribution of all ever-married women by their relationship to their current or first husband, according to background characteristics, Jordan 2007 Relationship to husband Background characteristic No relation First cousin: father and mother First cousin: mother and father First cousin: father First cousin: mother First cousin: father's sister First cousin: mother's sister Second cousin: father Second cousin: mother Other relative Total Number of women Age 15-19 62.1 2.7 1.2 8.3 3.3 2.8 7.8 7.0 4.7 0.1 100.0 236 20-24 62.4 3.3 2.0 7.2 4.5 4.6 5.0 7.6 3.0 0.5 100.0 1,276 25-29 63.0 2.4 1.4 8.6 2.9 3.9 3.8 8.6 4.6 0.7 100.0 1,977 30-34 61.8 2.5 1.9 8.5 1.7 3.5 5.1 9.8 4.3 0.9 100.0 2,213 35-39 59.6 2.9 2.7 8.7 2.8 3.3 3.9 9.6 4.6 1.9 100.0 2,052 40-44 60.4 2.4 1.1 9.6 3.7 3.3 5.0 8.7 5.0 0.8 100.0 1,884 45-49 53.8 3.9 1.3 8.7 2.1 2.9 5.8 15.0 6.0 0.6 100.0 1,239 Age at first marriage Under 15 48.8 2.3 2.1 18.4 2.8 2.8 3.0 13.0 4.3 2.6 100.0 333 15-17 49.0 3.4 2.2 12.6 2.9 3.6 5.8 13.8 5.9 0.8 100.0 2,178 18-19 54.8 3.9 2.5 9.2 3.5 4.4 6.0 11.4 3.7 0.7 100.0 2,272 20-21 57.7 3.8 1.6 8.8 3.2 3.6 4.7 10.0 5.6 1.0 100.0 2,072 22-24 67.6 1.6 1.3 6.4 3.0 3.9 4.2 6.6 4.1 1.2 100.0 2,234 25 or older 78.5 1.1 0.8 3.7 1.6 2.0 2.9 5.0 3.6 0.7 100.0 1,786 Co-wives 0 60.2 2.7 1.8 8.6 3.0 3.6 4.9 9.6 4.7 1.0 100.0 10,371 1+ 66.5 4.7 0.6 8.7 1.3 2.5 2.4 10.5 2.0 0.8 100.0 505 Marital duration 0-4 years 59.9 2.2 1.4 8.9 2.9 4.1 5.0 9.4 5.0 1.2 100.0 2,137 5-9 years 58.4 4.2 1.3 9.7 3.4 2.9 4.1 9.6 4.7 1.7 100.0 2,118 10-14 years 59.4 2.8 2.4 8.6 2.5 4.0 5.6 9.8 4.1 0.6 100.0 1,805 15-19 years 61.3 3.2 2.1 8.7 2.1 3.2 4.4 9.4 4.9 0.7 100.0 1,696 20-24 years 63.6 0.9 1.7 8.1 2.7 3.1 5.1 9.8 4.4 0.6 100.0 1,301 25+ years 59.1 3.7 2.0 8.5 3.6 3.2 5.6 8.9 5.0 0.4 100.0 1,057 Married more than once 65.3 2.1 0.5 4.8 2.5 4.5 2.7 12.3 5.1 0.2 100.0 238 Residence Urban 62.2 2.7 1.7 8.0 2.7 3.4 4.8 9.1 4.5 1.0 100.0 9,249 Rural 51.3 3.7 1.7 11.9 4.1 4.4 4.4 12.3 5.2 0.9 100.0 1,627 Governorate Amman 64.2 3.6 2.2 6.6 2.6 2.7 4.5 7.6 4.7 1.4 100.0 4,442 Balqa 55.6 0.7 0.6 11.3 4.1 3.9 5.3 12.6 5.3 0.6 100.0 645 Zarqa 61.6 1.7 1.1 9.1 3.2 4.2 4.9 10.4 3.8 0.0 100.0 1,645 Madaba 61.1 4.2 2.2 10.4 3.3 5.2 3.9 6.7 2.9 0.1 100.0 262 Irbid 59.3 2.5 1.9 9.5 2.2 4.0 4.6 11.3 4.3 0.6 100.0 1,993 Mafraq 52.6 3.9 1.5 10.8 3.2 4.0 4.9 13.4 4.7 1.0 100.0 460 Jarash 49.2 3.2 1.7 12.2 3.4 5.6 6.3 13.0 5.1 0.2 100.0 293 Ajloun 58.2 2.9 2.2 8.8 2.6 3.9 4.9 10.8 5.4 0.2 100.0 228 Karak 51.2 3.9 1.4 10.1 4.5 3.6 5.6 12.0 5.2 2.5 100.0 378 Tafiela 59.9 1.8 0.7 9.7 2.7 3.4 5.4 9.0 5.6 2.0 100.0 146 Ma'an 52.6 1.1 1.1 14.9 3.6 4.7 4.9 9.2 5.4 2.3 100.0 164 Aqaba 60.3 1.2 1.1 11.1 4.1 4.3 4.5 7.1 5.2 1.1 100.0 221 Region Central 62.7 2.9 1.8 7.7 2.9 3.2 4.6 8.7 4.5 1.0 100.0 6,993 North 57.2 2.8 1.8 9.9 2.5 4.1 4.9 11.7 4.6 0.6 100.0 2,975 South 55.1 2.4 1.2 11.2 3.9 3.9 5.2 9.8 5.3 2.0 100.0 908 Badia area Badia 52.9 4.5 1.7 11.3 3.6 4.3 3.7 12.4 4.0 1.6 100.0 823 Other 61.2 2.7 1.7 8.4 2.8 3.5 4.8 9.4 4.6 0.9 100.0 10,053 Education No education 52.6 3.3 1.0 14.1 2.6 4.0 6.1 12.9 2.0 1.4 100.0 416 Elementary 54.1 5.2 1.2 8.3 1.3 4.6 4.1 14.0 4.1 3.2 100.0 813 Preparatory 52.6 3.0 2.6 10.7 3.4 3.8 4.3 12.5 6.3 0.9 100.0 1,681 Secondary 59.3 2.8 2.1 9.1 3.0 3.6 5.4 9.7 4.6 0.4 100.0 4,788 Higher 69.3 2.1 0.9 6.1 2.9 2.9 4.0 6.4 4.1 1.2 100.0 3,179 Wealth quintile Lowest 56.2 3.2 1.5 8.5 3.5 4.8 5.0 11.9 3.8 1.6 100.0 2,211 Second 58.0 2.0 2.2 10.0 2.7 4.2 4.8 10.7 4.8 0.7 100.0 2,296 Middle 58.2 3.3 2.3 9.7 3.2 3.2 4.8 9.6 5.0 0.8 100.0 2,206 Fourth 63.5 2.8 1.1 8.5 2.9 3.1 5.0 7.6 4.9 0.7 100.0 2,135 Highest 67.6 2.7 1.6 6.2 2.1 2.3 4.1 8.0 4.3 1.1 100.0 2,028 Total 60.5 2.8 1.7 8.6 2.9 3.5 4.7 9.6 4.6 0.9 100.0 10,876 Nuptiality and Exposure to the Risk of Pregnancy | 67 As expected, kinship marriages are more common among rural women (49 percent) than among urban women (38 percent). Women in the North and South regions are more likely than those in the Central region to marry a relative (43 and 45 percent respectively, compared to 37 percent). The same is true for women in Badia areas compared to non-Badia areas (47 percent compared to 39 percent). Data reveal also that there are significant differences in kinship marriages by governorates. Women in Amman, Zarqa, Madaba, and Aqaba are more likely to marry a non-relative than women in other governorates. Further, less educated women are more likely to marry a relative than higher educated women: 31 percent of women with higher than secondary education married a relative, while 47 percent of women with no education did so. Little variations in consanguineous marriage exist by current age, with the exception of women aged 45-49, where kinship marriages are more common than among women in other age groups. Age at first marriage has an inverse relationship with kinship marriages; women who married at younger ages were more likely to marry a relative than those who first married at older ages. Data also show that there is an inverse relationship with household wealth quintile and kinship marriage: women in the poorest households are more likely to marry relatives than those living in the wealthiest households (44 percent in lowest quintile compared to 32 percent in the highest wealth quintile). Table 6.4 also shows that there are no significant differences in consanguinity among women according to duration of marriage. Women who married more than once are less likely to be in a consanguineous marriage. 6.4 AGE AT FIRST MARRIAGE In Jordan, almost all births occur within marriage; thus, age at first marriage is an important indicator of exposure to the risk of pregnancy and childbirth. In Jordan, the minimum age at marriage for both sexes is 18 years. Table 6.5 shows the percentages of women who have ever married by specified ages and the median age at first marriage according to their age at the time of the survey. Comparing percentages across age groups, the data indicate an increase in women’s age at first marriage. For example, among women aged 20-24, only 1 percent were married by age 15, 10 percent by age 18, and 22 percent by age 20. For women aged 25-29, the percentages at each specific age are all higher than those for the younger women. Older women married at even younger ages: 6 percent of women aged 45-49 were married by age 15, compared with less than 2 percent of women aged 30-34. This holds for all other ages at first marriage. Table 6.5 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Jordan 2007 Percentage first married by exact age: Current age 15 18 20 22 25 Percentage never married Number of women Median age at first marriage 15-19 0.3 na na na na 94.2 4,091 a 20-24 1.1 9.6 21.9 na na 63.3 3,478 a 25-29 1.4 13.0 25.6 40.2 58.9 30.7 2,852 23.3 30-34 1.7 15.3 30.9 45.7 63.0 20.6 2,786 22.7 35-39 1.8 14.8 32.0 49.9 66.9 14.6 2,404 22.0 40-44 3.4 23.4 39.3 55.1 73.4 8.4 2,057 21.2 45-49 6.3 28.8 47.7 60.3 79.1 4.1 1,292 20.4 20-49 2.2 15.7 30.6 na na 28.4 14,869 a 25-49 2.5 17.6 33.2 48.6 66.5 17.8 11,391 22.2 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group 68 | Nuptiality and Exposure to the Risk of Pregnancy The last column in Table 6.5 provides further indications of later marriage among younger women. The median age at first marriage has steadily increased, from 20.4 years among the cohort of women aged 45-49 at the time of the survey to 23.3 years among the cohort of women aged 25-29 at the time of the survey. The trend toward later marriage is supported, as mentioned earlier, by data showing that the proportion of women who married by age 15 has declined from 6 percent among women aged 45- 49 to less than 1 percent among women aged 15-19. Overall, among Jordanian women aged 25-49, 18 percent of women were married by age 18 and one in three was married by age 20. While the median age at first marriage increased significantly between 1990 and 2002 (from 19.6 to 21.8 years), there was a very slight change between 2002 and 2007 (from 21.8 to 22.2 years). Data reveal that there are only minor differences in median age at first marriage by residence and region. How- ever, there are significant variations by governorates: median age at first mar- riage varies from 21.1 years in Aqaba to 23.8 years in Karak. Education plays an important role in determining women’s age at marriage (Table 6.6). The improve- ment of educational opportunities, par- ticularly for girls, has increased their age at first marriage. Women with secondary education tend to marry almost two years later than those with no education or with an elementary or preparatory education, while the median age at first marriage for women with a higher than secondary edu- cation is 24.7 years. Thus, women with higher than secondary education marry at least five years later than those with no education or than those with elementary or preparatory education. The table also shows that women in the highest wealth quintile tend to get married at older ages than those in other wealth quintiles. 6.5 RECENT SEXUAL ACTIVITY In the absence of effective con- traception, the probability of becoming pregnant is related to the frequency of sexual intercourse. Information on sexual activity can, therefore, be used to refine measures of exposure to pregnancy. Cur- rently married women were asked about the timing of their most recent sexual intercourse. This information is presented in Table 6.7. Overall, nine in ten women stated that the most recent sexual intercourse was during the four weeks prior to the day of interview, 8 percent during the year preceding the survey, and 1 percent during one or more years before the survey. Table 6.6 Median age at first marriage Median age at first marriage among women age 25-49 by five-year age groups, according to background characteristics, Jordan 2007 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 23.1 22.6 22.1 21.3 20.4 22.2 Rural 24.5 23.4 21.6 21.1 20.2 22.5 Governorate Amman 23.3 23.5 22.4 21.0 20.4 22.4 Balqa 24.3 23.4 22.6 21.8 21.4 23.0 Zarqa 22.3 21.2 22.2 20.8 20.5 21.5 Madaba 24.2 22.9 22.0 21.5 20.6 22.5 Irbid 23.3 22.6 21.6 22.0 20.7 22.2 Mafraq 23.5 20.9 21.2 20.5 19.6 21.5 Jarash 23.2 21.7 21.3 21.0 18.9 21.7 Ajloun 23.7 22.1 21.2 22.3 20.3 22.2 Karak a 25.4 23.2 22.0 20.9 23.8 Tafiela 23.7 21.8 21.7 19.3 17.6 21.5 Ma'an 23.3 22.7 20.7 20.6 18.8 21.7 Aqaba 22.7 21.0 20.7 20.2 19.2 21.1 Region Central 23.1 22.8 22.3 21.1 20.6 22.2 North 23.4 22.1 21.5 21.7 20.3 22.0 South 24.3 23.4 21.9 20.9 19.4 22.4 Badia area Badia 23.4 21.7 21.3 20.2 19.5 21.7 Other 23.3 22.8 22.1 21.3 20.5 22.2 Education No education a 22.2 20.4 18.9 18.5 19.7 Elementary 20.7 22.3 21.8 18.9 17.8 19.4 Preparatory 20.6 18.7 20.0 18.0 18.3 19.0 Secondary 21.3 21.7 20.9 21.0 20.5 21.2 Higher a 24.7 24.3 24.1 24.1 24.7 Wealth quintile Lowest 22.5 22.4 21.7 22.3 20.4 22.2 Second 22.5 21.3 21.9 20.5 19.3 21.6 Middle 22.9 22.5 22.0 20.9 19.9 21.9 Fourth 23.8 22.7 22.5 21.2 19.7 22.3 Highest a 24.7 21.8 21.5 21.8 23.1 Total 23.3 22.7 22.0 21.2 20.4 22.2 a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group Nuptiality and Exposure to the Risk of Pregnancy | 69 Table 6.7 Recent sexual activity Percent distribution of currently married women age 15-49 by timing of last sexual intercourse, according to background characteristics, Jordan 2007 Timing of last sexual intercourse Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Total Number of women Age 15-19 90.0 10.0 0.0 0.0 100.0 233 20-24 91.2 8.3 0.5 0.1 100.0 1,233 25-29 89.6 9.7 0.6 0.2 100.0 1,932 30-34 92.0 7.1 0.6 0.3 100.0 2,127 35-39 92.7 6.4 0.7 0.2 100.0 1,968 40-44 90.5 7.0 1.8 0.7 100.0 1,746 45-49 86.2 9.5 4.1 0.2 100.0 1,115 Marital duration 0-4 years 88.0 11.1 0.7 0.2 100.0 2,133 5-9 years 92.2 7.1 0.4 0.3 100.0 2,119 10-14 years 94.1 5.4 0.4 0.1 100.0 1,805 15-19 years 92.6 5.5 1.4 0.5 100.0 1,705 20-24 years 89.5 7.3 2.7 0.6 100.0 1,301 25+ years 86.4 10.3 3.0 0.3 100.0 1,050 Married more than once 85.8 13.7 0.5 0.0 100.0 241 Current contraceptive method Not using 84.3 12.9 2.5 0.3 100.0 4,442 Pill 95.7 4.1 0.0 0.2 100.0 875 IUD 95.4 4.0 0.1 0.5 100.0 2,307 Condom 96.9 3.1 0.0 0.0 100.0 544 Female sterilization 90.5 8.0 1.4 0.1 100.0 384 Periodic abstinence 96.1 3.9 0.0 0.0 100.0 424 Withdrawal 96.2 3.6 0.0 0.2 100.0 1,117 Lactational amenorrhea 92.2 7.7 0.0 0.2 100.0 142 Other 97.7 1.6 0.0 0.6 100.0 119 Residence Urban 90.5 8.0 1.1 0.3 100.0 8,803 Rural 91.3 7.1 1.3 0.3 100.0 1,551 Governorate Amman 88.5 9.8 1.4 0.2 100.0 4,242 Balqa 92.0 6.9 0.8 0.4 100.0 620 Zarqa 94.3 4.5 1.0 0.1 100.0 1,548 Madaba 94.0 5.2 0.6 0.1 100.0 248 Irbid 91.1 7.5 1.1 0.3 100.0 1,892 Mafraq 90.4 7.9 1.3 0.4 100.0 441 Jarash 93.8 5.2 0.9 0.1 100.0 278 Ajloun 91.2 7.6 1.0 0.2 100.0 218 Karak 89.3 9.3 0.9 0.5 100.0 363 Tafiela 92.4 5.9 0.7 1.0 100.0 139 Ma'an 91.4 5.3 1.8 1.5 100.0 154 Aqaba 90.9 7.2 1.1 0.8 100.0 212 Region Central 90.4 8.2 1.2 0.2 100.0 6,658 North 91.3 7.3 1.1 0.3 100.0 2,830 South 90.6 7.5 1.1 0.8 100.0 867 Badia area Badia 91.0 7.5 1.2 0.2 100.0 783 Other 90.6 7.9 1.2 0.3 100.0 9,571 Education No education 86.8 6.1 6.7 0.5 100.0 365 Elementary 93.5 5.0 1.4 0.1 100.0 734 Preparatory 91.3 7.2 1.0 0.4 100.0 1,581 Secondary 90.7 8.2 0.8 0.4 100.0 4,586 Higher 90.1 8.7 1.0 0.2 100.0 3,089 Wealth quintile Lowest 91.4 6.6 1.9 0.1 100.0 2,083 Second 92.2 7.0 0.7 0.1 100.0 2,184 Middle 91.7 7.0 0.8 0.5 100.0 2,104 Fourth 92.6 6.4 0.7 0.3 100.0 2,018 Highest 85.2 12.6 1.7 0.5 100.0 1,966 Total 90.7 7.9 1.2 0.3 100.0 10,354 1 Excludes women who had sexual intercourse in the past 4 weeks 70 | Nuptiality and Exposure to the Risk of Pregnancy Variations of the frequency of recent sexual intercourse (in the four weeks preceding the interview) do not follow a clear pattern by age and duration of marriage. No significant differences in the frequency of recent sexual intercourse were noticed according to urban-rural residence, region, governorate, or Badia areas. However, users of contraception were more likely than nonusers to have had sexual intercourse with their husbands during the four weeks prior to the interview (95 percent compared to 84 percent). 6.6 POSTPARTUM AMENORRHEA, POSTPARTUM ABSTINENCE, AND INSUSCEPTIBILITY The risk of pregnancy is affected by several factors besides marriage patterns. There is a low risk of becoming pregnant during the period after childbirth before the return of menstruation (postpartum amenorrhea) and during the period before the resumption of sexual activity (postpartum abstinence). The duration of amenorrhea is directly related to the duration and intensity of breastfeeding: the longer a woman breastfeeds, the longer she is likely to remain amenorrheic. Since breastfeeding is an important issue in childhood nutrition (see Chapter 11), only postpartum amenorrhea and postpartum abstinence are considered in this section. Women are considered to be insusceptible when they are not exposed to the risk of pregnancy either because they are amenorrheic or because they are abstaining from sexual activity following a birth, or both. The estimates for postpartum amenorrhea, postpartum abstinence, and insusceptibility are based on current status measures – that is, the proportion of births occurring x months before the survey for which mothers were still amenorrheic, abstaining, or insusceptible at the time of the survey. The medians were calculated on the basis of current status proportions at each time period. The data are grouped by two-month intervals for greater stability. Table 6.8 presents the proportion of births in the 36 months preceding the survey for which mothers are amenorrheic, abstain- ing and insusceptible. Fifteen percent of mothers had not experienced the return of menstruation and 6 percent had not resumed sexual relations following their last birth. Combining the two conditions indicates that for 16 percent of births, mothers were still insusceptible to the risk of pregnancy. The mean duration of amenorrhea is about six months; the mean duration of abstinence is about three months. For 90 percent of births, mothers were still amenorrheic up to two months following childbirth. The percentage drops to 56 between two and three months after birth, and drops further to 35 percent in the next two months. In Jordan, as in other Islamic societies, women observe sexual abstinence after childbirth. The period of postpartum abstinence traditionally lasts 40 days. The observance of this practice is noticeable in the 2007 JPFHS data. Mothers of 77 percent of the children born during the two months before the survey were still abstaining from sexual relations at the time Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Jordan 2007 Percentage of births for which the mother is: Months since birth Amenorrheic Abstaining Insusceptible1 Number of births < 2 90.3 77.0 94.3 269 2-3 56.1 20.8 60.6 410 4-5 34.9 2.6 35.6 373 6-7 24.3 2.8 26.7 351 8-9 21.0 0.0 21.0 311 10-11 12.3 2.0 14.2 288 12-13 9.5 3.9 13.3 305 14-15 5.7 4.2 8.6 322 16-17 1.0 1.3 2.4 313 18-19 1.0 2.6 3.6 309 20-21 1.8 0.0 1.8 325 22-23 0.0 0.0 0.0 298 24-25 0.2 0.0 0.2 352 26-27 0.3 0.6 0.9 333 28-29 0.0 0.4 0.4 283 30-31 0.3 0.1 0.4 317 32-33 1.6 1.8 3.4 320 34-35 0.1 0.0 0.1 310 Total 14.8 6.3 16.3 5,791 Median 3.3 1.7 3.6 na Mean 5.5 2.8 6.0 na Note: Estimates are based on status at the time of the survey interview. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Nuptiality and Exposure to the Risk of Pregnancy | 71 of the survey. For births two and three months before the survey, 21 percent of mothers were still abstaining, with the percentage declining to less than 2 percent in subsequent months. Table 6.9 presents the median duration of postpartum amenorrhea (3.3 months), postpartum abstinence (1.7 months), and postpartum insusceptibility (3.6 months). There is no clear pattern for the three medians by background characteristics. For example, the duration of postpartum amenorrhea and, consequently, insusceptibility substantially vary by level of education, without following a clear pattern: the median duration of amenorrhea among women with elementary education (5.0 months) is about twice the median among women with no education and those with higher education (2.1 and 2.8 months, respectively). Table 6.9 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Jordan 2007 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother's age 15-29 3.0 1.7 3.3 30-49 3.7 1.8 4.1 Residence Urban 3.3 1.7 3.7 Rural 3.3 1.8 3.5 Governorate Amman 3.1 1.7 3.7 Balqa 3.9 1.8 4.0 Zarqa 3.1 1.3 3.2 Madaba 2.7 1.3 2.7 Irbid 3.3 1.8 3.4 Mafraq 4.2 2.1 4.2 Jarash 3.4 1.7 3.4 Ajloun 3.7 1.8 3.8 Karak 3.3 1.7 3.6 Tafiela 3.8 1.9 3.9 Ma'an 4.1 1.5 4.2 Aqaba 2.8 1.8 3.1 Region Central 3.2 1.6 3.6 North 3.5 1.8 3.6 South 3.4 1.7 3.6 Badia area Badia 3.2 1.8 3.3 Other 3.3 1.7 3.7 Education No education 2.1 1.4 2.2 Elementary 5.0 1.8 5.0 Preparatory 4.2 1.8 4.5 Secondary 3.3 1.6 3.6 Higher 2.8 1.9 3.2 Wealth quintile Lowest 3.5 1.7 3.6 Second 4.0 1.9 4.3 Middle 2.9 1.8 3.5 Fourth 3.1 1.1 3.4 Highest 2.5 1.8 2.8 Total 3.3 1.7 3.6 Note: Medians are based on the status at the time of the survey (current status). 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth 72 | Nuptiality and Exposure to the Risk of Pregnancy 6.7 MENOPAUSE This section addresses menopause (i.e. termination of exposure to pregnancy and childbearing) for women aged 30-49. Exposure to pregnancy is affected by the terminal amenorrhea of older women. Table 6.10 shows the percentage of women aged 30-49 who are menopausal. For the purpose of this survey, lack of a menstrual period in the six months preceding the survey among women who are neither pregnant nor postpartum amenorrheic is taken as evidence of menopause, and therefore infecundity. Table 6.10 shows few cases of menopausal women under the age of 40. Beyond this age, the percentage of menopausal women increases with age. The proportion rises from about 2 percent among women aged 40-43 to 12 percent among those aged 46-47, then further to more than one-fifth for older women (ages 48-49). Table 6.10 Menopause Percentage of women age 30-49 who are menopausal, by age, Jordan 2007 Age Percentage menopausal1 Number of women 30-34 0.5 2,213 35-39 0.8 2,052 40-41 1.6 821 42-43 1.6 742 44-45 5.0 552 46-47 12.3 500 48-49 22.1 508 Total 3.4 7,387 1 Percentage of all women who are not pregnant and not postpartum amenor- rheic whose last menstrual period occurred six or more months preceding the survey Fertility Preferences | 73 FERTILITY PREFERENCES 7 This chapter addresses questions about the need for contraception and the extent of unwanted fertility. Information collected from respondents includes whether they want more children and, if so, the gender they would prefer and how long they would want to wait before their next child. The respondents were also asked about the number of children they would like to have if they could start anew. Two other issues are also examined: the extent to which unwanted and mistimed births occur and the effect that preventing such births would have on fertility rates. Survey questions on fertility preferences have often been the subject of criticism. First, it is suggested that the answers respondents give are misleading because they may reflect uninformed, ephemeral views held with little conviction. Critics also argue that the questions do not take into account the effects of social pressure or the attitudes of other family members – particularly the husband, who may exert considerable influence on the wife’s reproductive decisions. The first objection is probably not relevant in Jordan, since family planning is widely used (presumably to realize fertility preferences). The second objection is correct in principle, but evidence from surveys in which both spouses are interviewed suggests that there are no significant differences between husbands and wives regarding their fertility preferences. Women who were pregnant at the time of the survey were asked whether they would want to have another child later. Taking into account the way in which the preference variable is defined for pregnant women, a current pregnancy is treated as being equivalent to a living child. Women who have been sterilized are classified as wanting no more children. 7.1 DESIRE FOR CHILDREN Women’s preferences concerning future childbearing serve as indicators of future fertility. However, sterilized women and women who state that they are infecund (declared infecund), have no impact on future fertility, because their potential contribution to fertility has been curtailed. The data on fertility preference also provide information on the potential need for contraceptive services for spacing and limiting births. Table 7.1 and Figure 7.1 show that half (51 percent) of currently married women want no more children at any time in the future, including 4 percent who are sterilized. These figures show an increase of about seven percentage points since the 2002 JPFHS (44 percent). The findings also show that about 26 percent of currently married women want to have another child later (after two or more years); this figure is about five percentage points less than that recorded in the 2002 JPFHS (31 percent). In general, about 73 percent of currently married women in Jordan have a potential need for family planning services for limiting or spacing their births. This figure is close to the one recorded in the 2002 JPFHS (72 percent). 74 | Fertility Preferences The desire for childbearing is strongly associated with the number of children that a woman has. It is found that 88 percent of women who have not started childbearing by the time of the survey want to have a child, and the majority of them (86 percent) want to have this child soon, that is, within the next two years. About 89 percent of women who have one child want to have another child, but the majority (55 percent) want to wait for at least two years before having the next child. Among those who have more than one child, the desire to stop childbearing increases rapidly with the number of children they have – from 22 percent among women who have two children to 89 percent among those with six children or more, including 11 percent who are sterilized. More than 11 percent of childless women declared themselves infecund, probably because they are or believe that they are sterile. The proportions of both sterilized and infecund women have increased since the 2002 JPFHS. Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Jordan 2007 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total Have another soon2 85.6 34.4 20.7 16.3 11.0 5.1 3.1 17.9 Have another later3 2.2 55.0 51.8 38.3 19.5 9.8 4.7 25.8 Have another, undecided when 0.1 1.9 1.8 1.3 1.0 0.9 1.1 1.2 Undecided 0.2 1.9 3.5 4.6 3.7 4.3 1.3 3.0 Want no more 0.7 5.2 21.6 37.6 60.9 74.2 77.6 46.8 Sterilized 0.0 0.0 0.3 1.3 3.1 4.1 10.9 3.7 Declared infecund 11.2 1.7 0.4 0.6 0.8 1.5 1.3 1.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 622 1,135 1,507 1,794 1,701 1,286 2,311 10,354 1 The number of living children includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years JPFHS 2007 Figure 7.1 Fertility Preferences of Currently Married Women 15-49 Want a child in <2 yea 18% Infecund 2% Want no more children 51% Undecided 3% Want a child in 2+ yea 26% Want a child undecid 1% in 2+ years in <2 years Want a child, undecided when 1% Fertility Preferences | 75 Differentials in the desire to stop childbearing are presented in Table 7.2. In general, women living in urban areas are slightly more likely to want to stop childbearing than rural women. Women in the Central and South regions are more likely to want to stop childbearing than those women in the North region. This preference also varies according to governorates (ranging from 44 percent in Mafraq to 56 percent in Tafiela) and according to residence in Badia areas (46 percent of women living in Badia areas compared to 51 percent for other women). The same pattern is seen when the data are analyzed on the basis of the number of living children a woman has. Table 7.2 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Jordan 2007 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 0.6 5.5 23.0 39.3 66.0 79.8 88.7 50.8 Rural 1.3 3.4 14.5 35.3 51.1 70.1 87.7 48.9 Governorate Amman 0.0 6.1 28.8 43.0 70.3 80.3 88.8 50.9 Balqa 1.8 5.0 15.8 38.4 60.4 77.4 89.1 50.9 Zarqa 0.0 1.4 18.8 41.5 64.3 82.0 92.4 54.0 Madaba 10.9 5.7 15.5 38.7 61.2 78.7 89.1 50.1 Irbid 1.9 6.3 15.5 29.7 57.2 80.3 85.0 48.2 Mafraq 1.5 3.1 9.8 27.3 42.0 60.9 84.1 43.5 Jarash 0.0 2.7 10.4 26.4 62.0 56.3 89.5 46.8 Ajloun 0.0 4.0 9.8 30.8 48.7 66.1 87.8 46.3 Karak 0.0 3.0 26.0 42.8 60.8 77.6 90.6 52.2 Tafiela 0.0 4.9 19.5 39.9 51.9 75.4 93.1 55.7 Ma'an 0.0 8.8 17.9 37.2 61.8 74.2 90.3 52.6 Aqaba 2.0 3.5 18.6 41.1 65.5 76.9 88.6 52.5 Region Central 0.5 5.2 25.0 42.2 67.7 80.4 89.8 51.6 North 1.5 5.3 13.7 29.1 54.7 73.8 85.6 47.2 South 0.4 4.4 21.5 41.0 60.7 76.6 90.6 52.9 Badia area Badia 0.8 2.5 14.7 33.7 52.8 64.2 85.0 45.9 Other 0.7 5.4 22.5 39.2 64.7 79.3 88.9 50.9 Education No education 2.7 25.5 49.5 65.9 70.5 79.6 88.7 73.2 Elementary 0.7 1.0 28.4 39.6 65.1 71.9 88.4 63.2 Preparatory 0.7 0.7 20.6 41.3 62.0 75.6 90.4 61.5 Secondary 0.2 5.6 20.2 36.7 61.3 78.4 88.3 47.5 Higher 1.3 5.2 22.8 40.3 68.5 82.0 86.0 43.7 Wealth quintile Lowest 0.7 6.4 11.7 40.2 51.5 69.2 85.8 41.8 Second 0.0 2.6 12.9 29.4 59.1 80.2 86.1 46.7 Middle 0.2 9.4 27.1 35.5 59.1 77.7 90.6 51.3 Fourth 2.3 3.0 17.9 45.2 64.6 79.9 88.9 54.6 Highest 0.4 3.5 40.9 44.4 81.7 81.8 92.0 59.1 Total 0.7 5.2 21.9 38.9 64.0 78.3 88.5 50.5 Note: Women who have been sterilized are considered to want no more children. 1 The number of living children includes the current pregnancy. 76 | Fertility Preferences Education is negatively associated with the desire to stop childbearing. The proportion of women who want no more children decreases as the level of education increases – from 73 percent among uneducated women to 44 percent among women who have more than secondary education. However, the fact that the effect of education diminishes when these women are analyzed by their number of living children suggests that the reason uneducated women are more likely to want to stop childbearing is that they already have more children than educated women. The data presented in Table 7.2 also show that there is a positive association between the desire of women to stop childbearing and household wealth quintile. The percentage of women who want no more children increases as the wealth quintile increases (from 42 percent of women in the lowest quintile to 59 percent of women in the highest quintile). This also holds for when analyzing data on the basis of number of living children. 7.2 NEED FOR FAMILY PLANNING SERVICES Information on fertility preferences is insufficient by itself to estimate the need for family planning services. Many women who do not want to have another child soon are not exposed to the risk of pregnancy, either because they are using contraception or for other reasons. Clearly, a more detailed analysis of unmet need for family planning is needed. In this analysis, unmet need for family planning is defined as pertaining to women 1) who are pregnant or amenorrheic and not using any method of family planning and whose last birth was mistimed or unwanted and 2) women who are neither pregnant nor amenorrheic and who are not using any method of family planning and say either that they want to delay their next childbirth for at least two years or that they want no more children. Table 7.3 presents information on the need for family planning services. The distribution of women who have an unmet need for family planning is shown in columns 1-3. Columns 4-6 show the distribution of women whose need for family planning has been met, i.e., women who are currently using a family planning method for spacing (want to wait 2 years or more for their next child) or for limiting births (want no more children). The total demand for family planning is shown in columns 7-9. Total demand is defined as the total number of women who have unmet need plus those women whose need has been met (current users).1 Column 10 of the table shows the percentage of the total demand for family planning that is satisfied – that is, the proportion of women using a method to the total demand. Data in Table 7.3 indicate that 12 percent of currently married women in Jordan have an unmet need for family planning. The percentage is split between a need for spacing births (5 percent) and a need for limiting them (7 percent). Total unmet need in the 2007 JPFHS is slightly higher than that recorded in 2002, when 11 percent of women had an unmet contraceptive need. This is a result of an increase in unmet need for limiting births. 1 Nonusers who are pregnant or amenorrheic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). Fertility Preferences | 77 Table 7.3 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage for the demand for contraception that is satisfied, by background characteristics, Jordan 2007 Unmet need for family planning1 Met need for family planning2 (currently using) Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 9.1 0.1 9.2 24.2 0.2 24.4 37.3 0.3 37.6 75.6 233 20-24 11.7 1.0 12.7 37.4 6.8 44.2 52.0 8.1 60.1 78.8 1,233 25-29 8.7 3.3 12.0 39.5 10.6 50.1 51.3 14.9 66.2 81.8 1,932 30-34 4.6 4.4 9.0 33.1 29.4 62.5 39.6 34.1 73.7 87.8 2,127 35-39 2.5 6.9 9.4 13.2 50.7 63.9 16.7 59.2 75.9 87.7 1,968 40-44 1.3 12.6 13.9 3.2 63.4 66.6 4.5 76.9 81.5 83.0 1,746 45-49 0.5 18.1 18.6 1.2 51.9 53.1 1.8 70.0 71.8 74.1 1,115 Residence Urban 4.5 7.0 11.5 22.8 35.2 58.1 28.9 43.0 71.9 84.0 8,803 Rural 7.1 7.4 14.5 19.6 32.0 51.6 28.5 39.9 68.4 78.8 1,551 Governorate Amman 4.3 7.0 11.3 23.3 35.7 59.0 29.2 43.5 72.7 84.5 4,242 Balqa 5.0 6.6 11.6 20.0 34.6 54.6 26.4 41.4 67.8 82.9 620 Zarqa 3.2 6.1 9.4 21.1 38.1 59.2 25.8 44.7 70.4 86.7 1,548 Madaba 5.3 7.4 12.7 21.2 31.9 53.0 27.9 39.7 67.7 81.2 248 Irbid 5.9 7.3 13.2 23.0 33.1 56.2 30.8 41.4 72.2 81.8 1,892 Mafraq 8.2 7.0 15.2 22.8 26.7 49.5 32.6 34.5 67.1 77.3 441 Jarash 4.8 5.0 9.7 23.9 31.8 55.7 30.2 37.1 67.3 85.5 278 Ajloun 4.5 5.5 9.9 26.1 32.3 58.4 32.6 38.6 71.2 86.1 218 Karak 7.4 9.2 16.6 18.2 32.9 51.1 26.9 43.4 70.3 76.4 363 Tafiela 5.7 8.1 13.8 21.0 39.0 60.0 28.4 47.7 76.2 81.8 139 Ma'an 10.3 10.7 21.0 18.1 32.0 50.0 30.1 43.5 73.6 71.5 154 Aqaba 5.6 9.7 15.3 19.6 34.1 53.7 26.5 44.7 71.2 78.5 212 Region Central 4.1 6.8 10.9 22.4 36.0 58.4 28.1 43.5 71.5 84.7 6,658 North 6.0 6.9 12.9 23.3 31.9 55.2 31.2 39.7 70.9 81.8 2,830 South 7.2 9.4 16.6 18.9 34.0 53.0 27.6 44.4 72.0 76.9 867 Badia area Badia 9.2 9.5 18.7 20.1 25.5 45.6 31.4 35.3 66.7 72.0 783 Other 4.6 6.8 11.4 22.5 35.5 58.0 28.7 43.1 71.8 84.1 9,571 Education No education 2.4 14.5 17.0 7.5 36.4 43.9 10.4 51.3 61.7 72.5 365 Elementary 3.9 10.8 14.8 10.1 41.8 51.9 14.8 54.2 69.0 78.6 734 Preparatory 4.9 9.4 14.3 14.4 42.7 57.1 20.6 52.5 73.2 80.4 1,581 Secondary 5.6 6.1 11.8 25.1 33.1 58.1 32.5 40.2 72.7 83.8 4,586 Higher 4.3 5.4 9.7 27.0 31.3 58.3 33.3 37.0 70.3 86.2 3,089 Wealth quintile Lowest 7.9 7.0 14.9 23.5 24.6 48.1 33.3 32.6 65.9 77.3 2,083 Second 6.1 7.0 13.1 22.4 30.3 52.7 30.7 38.1 68.9 81.0 2,184 Middle 5.2 7.1 12.3 24.3 35.7 60.0 31.4 43.4 74.7 83.6 2,104 Fourth 2.6 5.8 8.4 22.2 41.4 63.7 26.1 48.4 74.5 88.7 2,018 Highest 2.4 8.2 10.7 19.1 42.6 61.7 22.4 50.9 73.3 85.4 1,966 Total 4.9 7.0 11.9 22.3 34.7 57.1 28.9 42.5 71.4 83.3 10,354 1 Unmet need for spacing: Includes women who are fecund and not using family planning and who say they want to wait two or more years for their next birth, or who say they are unsure whether they want another child, or who want another child but are unsure when to have the child. In addition, unmet need for spacing includes pregnant women whose current pregnancy was mistimed, or whose last pregnancy was unwanted but who now say they want more children. Unmet need for spacing also includes amenorrheic women whose last birth was mistimed, or whose last birth was unwanted but who now say they want more children. Unmet need for limiting: Includes women who are fecund and not using family planning and who say they do not want another child. In addition, unmet need for limiting includes pregnant women whose current pregnancy was unwanted but who now say they do not want more children or who are undecided whether they want another child. Unmet need for limiting also includes amenorrheic women whose last birth was unwanted but who now say they do not want more children or who are undecided whether they want another child. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrheic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). 78 | Fertility Preferences Fifty-seven percent of women have a met need for contraception; in other words, they are currently using a method. Twenty-two percent of women are using contraception to delay their next birth, while 35 percent want to stop childbearing. When the proportion of women with a met need is combined with the proportion of women who are considered to have an unmet need, it is found that the total demand for family planning among currently married women in Jordan is 71 percent, of whom 83 percent of women have had their demand for family planning satisfied. Comparison with the findings of the 2002 JPFHS shows that the level of unmet need for family planning has not significantly changed (from 11 to 12 percent), compared with a 50 percent decline (from 22 percent to 11 percent) between 1990 and 2002. The proportion of total demand that is satisfied has decreased by 1 percentage point (from 84 percent to 83 percent) between 2002 and 2007. Unmet need for contraception for purposes of spacing births declines in relation to a woman’s age, whereas the need for limiting births increases as a woman ages. The needs for spacing and limiting are complementary, as evidenced by the fact that total unmet need varies little by age of the woman. Unlike unmet need for spacing births, unmet need for limiting births increases linearly with women’s age, which is the combined effect of rising number of children as women age. Unmet need is related to place of residence in urban-rural, region, governorate and Badia areas. Women living in rural areas, in the South region, in Badia areas and in Mafraq, Karak, Ma’an and Aqaba tend to have a greater unmet need than their counterparts in urban areas, other regions and governorates, and non-Badia areas. Twelve percent of urban women have an unmet need, as compared with 15 percent for rural women. Because urban women are more likely than rural women to use contraception (58 percent and 52 percent, respectively), a greater percentage of their total demand for family planning is satisfied. Unmet need is also associated with education. Women with no education have a higher level of unmet need (17 percent) than women who have secondary or higher education (12 and 10 percent, respectively). Since educated women are more likely to use a contraceptive method than uneducated women, a higher proportion of their total demand for family planning is satisfied. Unmet need is negatively associated with household wealth quintile. Unmet need is greater among women in the lowest wealth quintile (15 percent) than in the other wealth quintiles. 7.3 IDEAL NUMBER OF CHILDREN The focus of this chapter has been on the future reproductive intentions of women, implicitly taking into account their number of living children. To ascertain her ideal number of children, the respondent was asked to consider – abstractly and independently of her actual family size – the number of children she would choose if she could start childbearing again. There is usually a correlation between actual and ideal number of children. The reason is twofold. First, to the extent that women implement their preferences, those who want larger families tend to achieve larger families. Second, women may adjust their ideal family size upwards as their actual number of children increases. It is also possible that women with large families have larger ideal family sizes, because of attitudes they acquired 20 to 30 years ago. Despite the likelihood that some rationalization occurs in the determination of ideal family size, respondents often state ideal family sizes that are lower than their actual number of surviving children (see Table 7.4). The data in Table 7.4 can be grouped into three categories. The first group is women who have reached their ideal family size – i.e., women whose ideal number of children is exactly the same as their number of living children; it is represented by diagonal figures from 0 to 6+ children. The second group consists of women whose surviving children have exceeded their ideal family size (shown by the figures above the diagonal); the last group consists of women who have not reached their ideal family size (shown by the figures below the diagonal). The second category is of particular interest, because it permits the calculation of surplus or unwanted fertility (discussed in the next section). Fertility Preferences | 79 Table 7.4 Ideal number of children Percent distribution of women 15-49 by ideal number of children, and mean ideal number of children for all women and for currently married women, according to number of living children, Jordan 2007 Number of living children1 Ideal number of children 0 1 2 3 4 5 6+ Total 0 1.3 1.4 2.6 1.9 2.8 1.5 2.2 2.1 1 5.2 1.6 1.6 1.9 0.2 0.4 0.3 1.2 2 24.1 22.1 20.8 13.6 10.5 8.3 4.2 13.1 3 13.2 19.2 11.2 11.2 6.5 7.6 5.3 9.7 4 31.0 32.3 42.2 41.1 43.7 31.6 29.6 36.3 5 3.9 4.9 5.6 8.7 7.5 16.2 7.9 8.1 6+ 5.4 4.2 4.1 8.0 11.9 15.1 23.6 11.8 Non-numeric responses 16.0 14.3 11.9 13.6 16.9 19.4 26.9 17.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 737 1,215 1,590 1,860 1,754 1,333 2,387 10,876 Mean ideal number children for:2 All women 3.2 3.4 3.4 3.8 4.0 4.4 4.8 3.9 Number 619 1,041 1,401 1,607 1,458 1,075 1,744 8,946 Currently married women 3.3 3.4 3.4 3.8 4.0 4.4 4.8 4.0 Number 522 988 1,330 1,551 1,417 1,043 1,694 8,546 1 The number of living children includes current pregnancy. 2 Means are calculated excluding women who gave non-numeric responses. The data in Table 7.4 indicate that more than one-half of women (56 percent) consider the ideal family size to be at least 4 children, compared with 70 percent in the 2002 JPFHS. Only 13 percent of ever-married women report an ideal family size of two children, the number that is required for replacement level fertility. The mean ideal number of children is 3.9 among ever-married women and 4.0 among currently married women. Of concern to family planning program managers is the fact that half of women with 6 or more children have already exceeded their ideal family size, in many cases, by 2 children or more. Compared with the 2002 JPFHS, the percentage of women in the 2007 JPFHS who did not give a numeric response to the hypothetical question on ideal family size increased substantially from 4 percent to 18 percent. Failure to give a definite answer suggests either an absence of conscious consideration given to the matter or a strong belief that family size is determined by God. Women who have one to three children are most likely to state a numeric ideal family size; childless women are less likely to do so, perhaps indicating either that they want to have as many children as possible or that they have reached the end of their reproductive years, or that they have given up hope of having a child. Women who already have five or more children may avoid specifying a number, possibly because they have exceeded their ideal family size. Because of the significant increase in the percentage of women who did not give a numeric answer between 2002 and 2007, comparison of the mean ideal number of children (which is based only on women who gave a numeric answer) should be made with caution. Table 7.5 presents the mean ideal number of children by background characteristics. The mean ideal number of children in Jordan increases with age, from 3.6 children for ever-married women in the youngest age group (15-19) to 4.1 children among women aged 35-39 and to 4.4 among the oldest women (45-49). This trend indicates that the ideal family size has decreased in the younger cohorts. In general, women living in rural areas, women in the North and South regions, in Badia areas, and women in Balqa, Mafraq, Jarash and Ajloun have a slightly higher ideal family size. Ideal number of children is also associated with education. Women with no education have a higher ideal number of children (4.7) than women who have secondary or higher education (3.9 and 3.8, respectively). The ideal number of children does not show a clear association with household wealth. 80 | Fertility Preferences Table 7.5 Mean ideal number of children Mean ideal number of children for all ever- married women age 15-49 by background characteristics, Jordan 2007 Background characteristic Mean Number of women1 Age 15-19 3.6 202 20-24 3.7 1,118 25-29 3.7 1,674 30-34 3.8 1,848 35-39 4.1 1,679 40-44 4.3 1,503 45-49 4.4 922 Residence Urban 3.9 7,667 Rural 4.2 1,279 Governorate Amman 3.8 3,929 Balqa 4.2 489 Zarqa 4.1 1,249 Madaba 3.7 204 Irbid 4.1 1,579 Mafraq 4.2 347 Jarash 4.3 223 Ajloun 4.3 169 Karak 3.9 336 Tafiela 4.1 117 Ma'an 4.1 132 Aqaba 4.0 171 Region Central 3.9 5,872 North 4.1 2,318 South 4.0 757 Badia area Badia 4.1 630 Other 3.9 8,316 Education No education 4.7 261 Elementary 4.1 603 Preparatory 4.2 1,293 Secondary 3.9 4,035 Higher 3.8 2,753 Wealth quintile Lowest 3.9 1,740 Second 4.0 1,890 Middle 3.9 1,803 Fourth 4.0 1,753 Highest 3.8 1,761 Total 3.9 8,946 1 Number of women who gave a numeric response Fertility Preferences | 81 7.4 PLANNING STATUS OF BIRTHS Respondents in the 2007 JPFHS were asked a series of questions concerning each child born in the five years preceding the survey and for any current pregnancy, to determine whether the particular pregnancy was either planned, unplanned but wanted at a later date, or unwanted. These questions yielded data that provide a powerful indicator of the degree to which couples are able to control childbearing. Additionally, the data can be used to measure the effect of preventing unwanted births on the level of fertility for a period of time. The questions about the planning status of births are demanding. The respondent is required to accurately recall her wishes at one or more points in the preceding five years, and to report them honestly. The possibility of rationalization is present, since an unwanted conception may well turn out to be a cherished child. Despite problems of comprehension, recall, and truthfulness, the results from previous surveys indicate that the questions are effective in eliciting plausible information about the planning status of births. Although some postpartum rationalization does occur, respondents are willing to report unwanted conceptions. Overall, the estimates of unwanted fertility obtained from the data are probably low. Table 7.6 shows that about three-quarters (74 percent) of births during the five years preceding the survey were wanted at the time of conception, 15 percent were wanted later, and 11 percent were not wanted at all at the time of conception. The percentage of births wanted when conceived has significantly increased between 2002 and 2007 (from 67 to 74 percent), indicating better reproductive control exercised by couples. The percentage of births wanted at conception is negatively associated with birth order; conversely, the percentage of unwanted births increases with birth order. In other words, higher order (later) births are more likely than first or second births to have been either mistimed or unwanted. The low percentage of first births wanted later or not wanted at all indicates that almost all first order births are wanted. Table 7.6 Fertility planning status Percent distribution of births to women 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother's age at birth, Jordan 2007 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 93.3 5.9 0.8 0.0 100.0 2,437 2 74.5 22.6 2.9 0.0 100.0 2,344 3 72.4 20.5 6.9 0.1 100.0 1,961 4+ 63.5 12.9 23.5 0.1 100.0 4,436 Mother's age at birth <20 88.7 9.5 1.8 0.0 100.0 595 20-24 77.6 18.7 3.7 0.0 100.0 2,824 25-29 74.9 17.3 7.6 0.2 100.0 3,343 30-34 73.7 14.9 11.4 0.0 100.0 2,437 35-39 65.8 6.6 27.5 0.0 100.0 1,544 40-44 52.5 4.4 43.1 0.0 100.0 408 45-49 41.3 0.0 58.7 0.0 100.0 27 Total 73.9 14.7 11.3 0.0 100.0 11,179 82 | Fertility Preferences Births to young women tend to be wanted, whereas births to older women are more likely to be unwanted (Table 7.6). Although 89 percent of births to women under 20 years of age were wanted at the time of conception, the percentage declines to 41 percent among women aged 45-49. Another way of measuring the extent of unwanted fertility is to calculate the fertility rate if all unwanted births were avoided. This is known as the wanted fertility rate (Table 7.7). In Jordan, if all unwanted births were prevented, the total wanted fertility rate would be 2.8 children per woman, or 0.8 child less than the actual total fertility rate. That theoretical rate implies that the total fertility rate is inflated by 29 percent because of unwanted births. This is an improvement compared to 2002, when the TFR was inflated by 42 percent because of unwanted births. Table 7.7 also shows that the gap between actual and wanted fertility rates is slightly higher among women living in the North and South regions, women residing in Badia areas, and women who have elementary education or who have preparatory education. Women in the Central region and those who have more than secondary education, who also have the lowest fertility, are generally more successful in narrowing the gap between wanted and actual fertility rates (0.7 and 0.6 child respectively). Data indicate that the gap between wanted and actual fertility rates is higher among women in lowest wealth quintiles, in contrast women in highest wealth quintiles (who also have the lowest fertility) are more successful in narrowing the gap between wanted and actual fertility rates (ranging from 0.4 child in the highest wealth quintile to 1.1 child in the lowest wealth quintile). Table 7.7 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Jordan 2007 Background characteristic Total wanted fertility rate Total fertility rate Residence Urban 2.8 3.6 Rural 2.8 3.7 Governorate Amman 2.6 3.4 Balqa 2.9 3.7 Zarqa 3.1 3.8 Madaba 2.9 3.6 Irbid 2.8 3.8 Mafraq 3.0 4.0 Jarash 2.9 3.8 Ajloun 2.9 3.7 Karak 2.3 3.2 Tafiela 2.6 3.7 Ma'an 2.8 4.0 Aqaba 3.3 4.1 Region Central 2.8 3.5 North 2.9 3.8 South 2.7 3.6 Badia area Badia 3.2 4.2 Other 2.8 3.5 Education No education 1.8 2.6 Elementary 2.7 3.9 Preparatory 3.4 4.5 Secondary 3.0 3.9 Higher 2.6 3.2 Wealth quintile Lowest 3.7 4.8 Second 3.4 4.4 Middle 2.7 3.6 Fourth 2.1 2.8 Highest 2.1 2.5 Total 2.8 3.6 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.3. Infant and Child Mortality | 83 INFANT AND CHILD MORTALITY 8 Estimates of levels, trends, and differentials in neonatal, postneonatal, and child mortality are important both for monitoring and evaluating ongoing health programs and for use in formulating future policies. The levels of infant and child mortality are viewed as basic indicators of the socioeconomic situation, quality of life, and general standard of living in a society. In addition to addressing those issues, this chapter examines the risk factors for births in Jordan. The five measures of infant and child mortality used in this chapter are as follows: Neonatal mortality, the probability of dying in the first month of life Postneonatal mortality, the probability of dying after the first month of life but before the first birthday (the difference between infant and neonatal mortality rates) Infant mortality (1q0), the probability of dying before the first birthday Child mortality (4q1), the probability of dying between the first and fifth birthday Under-five mortality (5q0), the probability of dying before the fifth birthday. All of these rates are calculated per 1,000 live births, except for child mortality which is calculated per 1,000 children surviving to age one. Infant and child mortality rates are calculated from information collected in the birth history section of the individual questionnaire. In the 2007 JPFHS, each woman was asked about the number of sons and daughters living with her, the number living away, and the number who had died. Those questions were aimed at obtaining the total number of births the respondent has had. Next, the respondent was asked to give information on each of the children she had given birth to, including name, sex, date of birth, whether the birth was single or multiple, and survival status. If the child had died, the age at death was recorded. If the child was still living, questions were asked about his/her age at last birthday and whether the child lived with his/her mother. It should be noted that birth histories are often subject to inaccuracies in the reporting of events, errors that can result in biased rates and trends over time. Despite the disadvantages, birth histories provide data for analyses that would be impossible to collect by any other method of gathering data. The reliability of the mortality data depends on women’s recall about children who have died, the absence of significant differences between the displacement of birth dates of living and dead children, and accurate reporting of ages at death. Previous survey results have shown some heaping of age at death at exactly 12 months or one year. On the assumption that age at death is reported in completed months or years, deaths at 12 months are classified as child rather than infant deaths. In reality, some of those deaths may have occurred before the first birthday, so that their classification as child deaths tends to negatively bias infant mortality estimates and positively bias child mortality estimates. The distribution of death by age at death in months (see Table C.6 in Appendix C), shows that there is no heaping at 12 months for deaths reported during the most recent period (0-4 years prior to the survey), while a minor heaping appears during the preceding period (5-9 years prior to the survey). Therefore, current mortality levels (0- 4 years prior to the survey) are not affected, while estimates for the period 5-9 years before are very slightly affected; however, the heaping is so limited that it does not justify any adjustment. 84 | Infant and Child Mortality In addition to levels of mortality, this chapter also includes a table indicating the distribution of children and women according to characteristics of avoidable fertility behavior that place children at a greater risk of mortality. That information is useful for designing and monitoring programs aimed at both discouraging high-risk behavior and at coping with the elevated risks. 8.1 LEVELS AND TRENDS It is seldom possible to establish mortality levels with confidence for a period of more than 15 years before a survey. Even within the recent 15-year period considered here, apparent trends in mortality rates should be interpreted with caution. First, completeness of death reporting may be affected by the length of time before the survey. Second, the accuracy of reports of age at death and of date of birth may deteriorate with time. Thus, without a detailed evaluation of the quality of birth history data (which is not attempted in this report), conclusions regarding changes in mortality should be made with caution. Table 8.1 shows early childhood mortality rates in the 15 years preceding the survey. The under- five mortality rate in the 0-4 years before the survey (2002-2007) was 21 deaths per 1,000 live births. Most deaths included in the under-five mortality rate occur during the first year of life, where the rate was 19 per 1,000 live births. The child mortality rate (4q1) reached 2 per 1,000 children still living on their first birthday. As expected, neonatal mortality is higher than postneonatal mortality (14 per 1,000 and 6 per 1,000, respectively) and accounts for 74 percent of total infant mortality. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Jordan 2007 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality1 (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 14 6 19 2 21 5-9 16 5 21 3 24 10-14 15 8 23 3 26 0-9 15 5 20 2 22 1 Computed as the difference between the infant and neonatal mortality rates It is apparent from Table 8.1 and Figure 8.1 that infant mortality has been declining steadily for many years – from 23 deaths per 1,000 live births during the period 10-14 years preceding the survey (around 1995) to 19 deaths during the five years preceding the survey (around 2005). However, child mortality has not changed during the last ten years. In general, under-five mortality declined from 26 deaths per 1,000 live births in the period 10-14 years preceding the survey to about 21 deaths per 1,000 in the last period (0-4 years). Infant and Child Mortality | 85 The rates presented in Table 8.1 approximate the calendar periods 2002-2007, 1997-2002 and 1992-1997. Because fieldwork for the 2007, the 2002, and the 1997 JPFHS was carried out in the third quarter of the year, whereas the 1990 JPFHS was fielded in the fourth quarter of the year, comparison between estimates derived from those surveys is not absolutely precise. However, for purposes of trend analysis, the results of the four surveys have been compared (Figure 8.2). Ideally, the estimates for overlapping periods should be the same; although the estimates from the four surveys are very close, they are not exact due to some discrepancies caused by internal biases in each of the estimates. It is apparent, however, that infant mortality has been declining for many years. Figure 8.1 Trends in Infant and Child Mortality by Five-year Periods 23 3 26 21 3 24 19 2 21 Infant mortality (<1 year) Child mortality (1-4 years) Under-five mortality (0-4 years) 0 5 10 15 20 25 30 Deaths per 1,000 Five-year periods preceding the survey 10-14 5-9 0-4 JPFHS 2007 Figure 8.2 Trends in Infant and Child Mortality, 1978-2005 � ��� � � � �� � � � � �� � � � 1980 1985 1990 1995 2000 2005 Calendar year 0 10 20 30 40 50 Deaths per 1,000 Infant mortality Child mortality 2007 JPFHS 2002 JPFHS 1997 JPFHS 1990 JPFHS 86 | Infant and Child Mortality The pace of decline in infant and child mortality varies. Infant mortality shows a regular and continuous decline, from about 40 per thousand at the beginning of the 1980s, to about 30 per thousand at the beginning of the 1990s, and down to 19 per thousand at the beginning of the millennium in the most recent period. Child mortality declined at the beginning of the 1980s (from about 10 per thousand to 6 per thousand) and to 5 child deaths per thousand during the early part of this decade, but declined sharply and tangibly to 2 per thousand in 2007. It is also noted that there is a significant and tangible change during the last fifteen years of under-five mortality rate. To understand the differences in the patterns of decline between infant and child mortality, it should be recognized that the factors affecting infant mortality are different from those affecting child mortality. Infant mortality is dependent on the health of the mother during pregnancy, the length of the birth interval, and receipt of services such as antenatal and postnatal care – all factors that are relatively amenable to programmatic intervention. Child mortality, however, is more dependent on broader environmental, economic, and social factors that are less tractable. 8.2 DIFFERENTIALS IN INFANT AND CHILD MORTALITY 8.2.1 Differentials by Background Characteristics Differentials in neonatal, postneonatal, infant, child, and under-five mortality by socioeconomic characteristics are shown in Table 8.2. A ten-year period is used to calculate the mortality estimates by background characteristics, so as to obtain enough cases in each category. The use of the ten-year reference period improves the reliability of the mortality estimates. There are substantial differences in under-five mortality by type of residence. Children in urban areas have lower mortality rates than their counterparts in the rural areas (22 and 27 deaths per 1,000 live births, respectively). A similar pattern is found for infant mortality, as well as postneonatal mortality. Childhood mortality vary across regions. Infant and child mortality are higher in the South region (27 and 6 per 1,000, respectively) than in the North region (21 and 2 per 1,000, respectively) and Central region (19 and 2 deaths per 1,000, respectively). The data do not reveal a clear association between under-five mortality and mother’s education. Children of mothers who received elementary or secondary education, and those of mothers with no education are more likely to die in the first five years of life than children of mothers with preparatory education or higher education. Under-five mortality ranges from 35 per 1,000 for children of women who attended elementary school to 11 per 1,000 for children of women with more than secondary education. The data also indicate that there is no clear association between household wealth and under-five mortality. Children in the lowest (30 per 1,000) and highest (27 per 1,000) wealth quintiles are more likely to die during the first five years of age than children of mothers in other wealth quintiles. The under-five mortality rate reaches its lowest level in the third wealth quintile (14 per 1,000). The same pattern also holds for infant mortality rates. Infant and Child Mortality | 87 Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background characteristic, Jordan 2007 Background characteristic Neonatal mortality (NN) Postneonatal mortality1 (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Residence Urban 15 5 20 2 22 Rural 13 9 23 4 27 Governorate Amman 18 5 22 2 24 Balqa 14 5 18 6 24 Zarqa 7 3 10 0 10 Madaba 12 10 22 3 25 Irbid 14 4 19 2 21 Mafraq 15 14 30 2 32 Jarash 12 5 16 4 20 Ajloun 12 9 20 6 26 Karak 22 10 32 7 39 Tafiela 19 8 27 3 30 Ma'an 13 11 24 7 31 Aqaba 17 4 21 5 25 Region Central 14 5 19 2 21 North 14 6 21 2 23 South 19 8 27 6 32 Badia area Badia 10 8 18 3 21 Other 15 5 20 2 23 Education No education 12 10 22 4 27 Elementary 16 12 28 7 35 Preparatory 12 7 19 4 23 Secondary 21 5 25 2 27 Higher 6 4 10 1 11 Wealth quintile Lowest 17 8 25 5 30 Second 16 5 21 1 22 Middle 7 5 13 1 14 Fourth 13 4 17 2 19 Highest 21 4 25 2 27 Total 15 5 20 2 22 1 Computed as the difference between the infant and neonatal mortality rates 8.2.2 Differentials by Demographic Characteristics Besides socio-economic characteristics, demographic characteristics of the child and the mother have been found to affect mortality risks. Some of these factors include the sex of the child, mother’s age at birth, birth order, length of previous birth interval, and the size of the child at birth. The relationship between these demographic characteristics and mortality is shown in Table 8.3 and Figure 8.3. Mortality levels do not significantly differ by sex. The relationship between mother’s age at delivery and infant mortality shows a U-shaped curve. These mortality measures are substantially higher among children born to mothers less than 20 (37 per thousand births) and those aged 40 and over (27 per thousand births. 88 | Infant and Child Mortality Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic characteristics, Jordan 2007 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality1 (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 16 4 20 2 22 Female 13 7 20 3 23 Mother's age at birth <20 30 6 37 1 38 20-29 13 5 18 2 20 30-39 15 6 21 3 24 40-49 12 (15) (27) * * Birth order 1 15 4 20 2 22 2-3 13 6 18 2 20 4-6 13 5 18 3 21 7+ 24 10 34 2 36 Previous birth interval2 <2 years 18 8 26 3 28 2 years 15 6 22 3 25 3 years 11 5 16 2 18 4+ years 10 2 13 1 14 Birth size3 Small/very small 30 16 46 na na Average or larger 9 5 14 na na Total 15 5 20 2 22 Note: An asterisk indicates that the rate is based on fewer than 250 births and has been suppressed. Figures in parentheses are based on 250-499 unweighted births. na = Not applicable 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey Figure 8.3 Infant Mortality by Selected Demographic Characteristics Note: Rates refer to the 10-year period preceding the survey. JPFHS 2007 20 37 18 21 27 20 18 18 34 26 22 16 13 Jordan Mother's age <20 20-29 30-39 40-49 Birth order 1 2-3 4-6 7+ Birth interval <02 2 3 4+ 0 10 20 30 40 Deaths per 1,000 births <2 Infant and Child Mortality | 89 First births and higher-order births experience higher mortality, indicating a shallow U-shaped relationship between birth order and mortality. For example, infant mortality rates for first births and births of order seven and higher are 20 per 1,000 births and 34 per 1,000 births, respectively, compared with 18 per 1,000 births for second through sixth-order births. Mortality among children is negatively associated with the length of the previous birth interval. Infant mortality decreases sharply from a high of 26 per 1,000 for children born less than two years after a previous birth to 16 per 1,000 live births for children born three years after a previous birth and to 13 per 1,000 live births for children born four years or more after a previous birth. Children’s weight at birth is also closely associated with their chances of survival, particularly during the first month of life. Children reported as “small or very small” at birth were at three times the risk of dying compared with children whose size at birth was reported as “average or larger.” Of children reported to be “small or very small,” 46 per 1,000 did not survive to their first birthday, compared with 14 per 1,000 children reported to be average or larger. 8.3 PERINATAL MORTALITY The 2007 JPFHS survey asked women to report on pregnancy losses and the duration of the pregnancy for each loss for all such pregnancies ending in the five years before the survey. Pregnancy losses occurring after seven completed months of gestation (stillbirths) plus deaths to live births within the first seven days of life (early neonatal deaths) constitute perinatal deaths. The perinatal mortality rate is calculated by dividing the total number of perinatal deaths by the total number of pregnancies reaching seven months’ gestation. The routine collection of data to estimate rates of perinatal mortality is relatively new to sample survey research. An important consideration in the evaluation of the results of this new initiative is the quality or completeness of reports on stillbirths, which are susceptible to omission, underreporting, or misclassification (as early neonatal deaths). The distinction between a stillbirth and an early neonatal death may be a fine one, depending often on the observed presence or absence of some faint signs of life after delivery. The causes of stillbirths and early neonatal deaths are overlapping, and examining just one or the other can understate the true level of mortality around delivery. For this reason, it is suggested that both event types be combined and examined together. Table 8.4 shows perinatal mortality rates, according to background characteristics. At the national level, the perinatal mortality rate is estimated to be 15 perinatal deaths per 1,000 pregnancies reaching seven months of gestation. Perinatal mortality does not follow the expected reversed U-shaped pattern with regards to the mother’s age; the youngest and oldest women having the lowest perinatal mortality rates (3 per 1,000 and 8 per 1,000, respectively) while the highest rates are found among pregnancies of women aged 30-39 (18 per 1,000). Pregnancies with a short-preceding interpregnancy interval are also at high perinatal risk (29 per 1,000 for an interpregnancy interval of less than 15 months). Perinatal mortality is slightly higher in urban areas (15 per 1,000) than in rural areas (13 per 1,000). At the regional level, the perinatal mortality rates are the highest in the North region (17 per 1,000), while they are the lowest in the Badia areas than the non-Badia areas (11 per 1,000 and 15 per 1,000 respectively); however, it is worth noting that perinatal mortality is higher for women with elementary education or secondary education (19 and 18 per 1,000 respectively) than for those with preparatory education (about 8 per 1,000) and for those with higher than secondary or with no education (12 per 1,000). By wealth quintile, the data indicate that perinatal mortality is higher among those living in the lowest, fourth and the highest wealth quintiles than among those living in the second and third wealth quintiles (18-21 per 1,000, compared to 8-10 per 1,000 respectively). 90 | Infant and Child Mortality Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Jordan 2007 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother's age at birth <20 1 1 3 541 20-29 28 52 15 5,481 30-39 29 34 18 3,546 40-49 0 3 8 354 Previous pregnancy interval in months4 First pregnancy 19 12 15 2,029 <15 6 29 29 1,242 15-26 4 11 5 2,677 27-38 7 14 13 1,601 39+ 22 24 19 2,373 Residence Urban 47 79 15 8,309 Rural 11 11 13 1,612 Governorate Amman 19 32 13 3,802 Balqa 4 7 18 619 Zarqa 10 11 14 1,496 Madaba 1 2 14 243 Irbid 10 21 17 1,872 Mafraq 5 5 20 484 Jarash 2 2 14 293 Ajloun 2 1 11 235 Karak 1 5 18 350 Tafiela 1 1 15 141 Ma'an 1 1 15 169 Aqaba 1 1 10 218 Region Central 34 52 14 6,161 North 19 29 17 2,884 South 5 9 15 878 Badia area Badia 5 5 11 881 Other 52 85 15 9,040 Education No education 2 1 12 243 Elementary 5 7 19 596 Preparatory 7 4 8 1,372 Secondary 24 62 18 4,759 Higher 20 16 12 2,951 Wealth quintile Lowest 16 33 19 2,557 Second 11 13 10 2,353 Middle 6 11 8 2,067 Fourth 19 15 21 1,653 Highest 6 18 18 1,291 Total 58 90 15 9,922 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months' duration, expressed per 1,000 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. Infant and Child Mortality | 91 8.4 HIGH-RISK FERTILITY BEHAVIOR Table 8.5 presents the distribution of children born in the five years pre- ceding the survey who are at increased risk of dying because of the mother’s fer- tility characteristics. Children are at a higher risk of dying if the mother was too young or too old at time of birth, if they are of high birth order, or if they were born too soon after their next older sibling. In this report, a woman is clas- sified as “too young” if she is less than 18 years of age and “too old” if she is over 34 years of age at the time of delivery. A child is considered “high birth order” if the mother previously delivered three or more children. A “short birth interval” is defined as a birth occurring less than 24 months after a previous birth. In the analysis of birth intervals, only children whose preceding birth interval was less than 24 months are included, even though a short birth interval also increases the risk of dying for the previous child at the beginning of the interval. The latter rela- tionship is subject to reverse causality in that the death of the earlier child may cause the subsequent interval to be short. Sixty percent of the children born during the five years preceding the survey were at an elevated and avoidable risk of dying. In 38 percent of the cases, the risk is higher only because of a single risk category (mother’s age, birth order, or birth interval), and in 22 percent of the cases the risk is higher owing to multiple risk categories. The largest group of chil- dren at risk includes those who are of a high birth order and those whose pre- ceding birth interval was shorter than 24 months. Six percent of children were born with a preceding birth interval of less than 24 months and with birth order higher than three. Table 8.5 also shows the relative risk of dying for children born in the last five years by comparing the proportion dead in each risk category to the proportion dead among children with no risk factors. Column 2 of Table 8.5 presents the risk ratios for births during the five years preceding the survey (i.e., the ratio of the proportion dead in each risk category to the proportion dead among children who were not in any risk category). The single most detrimental factors are short birth intervals and birth to a women aged 35 and older. Children born less than 24 months after the previous birth and children born to a women aged 35 or older are three times (3.12 and 3.07 respectively as likely to die as children not in Table 8.5 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Jordan 2007 Births in the 5 years preceding the survey Risk category Percentage of births Risk ratio Percentage of currently married women1 Not in any high-risk category 20.1 1.00 15.5a Unavoidable risk category First-order births between ages 18 and 34 years 20.1 1.33 6.3 Single high-risk category Mother’s age <18 1.3 0.18 0.1 Mother’s age >34 2.0 3.07 5.4 Birth interval <24 months 16.3 3.12 9.3 Birth order >3 18.6 2.05 14.1 Subtotal 38.2 2.49 28.8 Multiple high-risk category Age <18 and birth interval <24 months2 0.2 * 0.1 Age >34 and birth interval <24 months 0.6 1.18 0.5 Age >34 and birth order >3 12.5 1.82 35.6 Age >34 and birth interval <24 months and birth order >3 2.3 0.60 4.7 Birth interval <24 months and birth order >3 6.1 1.57 8.4 Subtotal 21.7 1.59 49.4 In any avoidable high-risk category 59.8 2.17 78.2 Total 100.0 na 100.0 Number of births/women 9,864 na 10,354 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. An asterisk indicates that the figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women 92 | Infant and Child Mortality any risk category. Children of birth order four or higher are about twice (2.05) as likely to die as children not in any risk category. The combination of a mother’s giving birth at an older age and the child’s birth order higher than three is detrimental to children’s survival (1.82), as is the combination of a short birth interval and a high birth order (1.57). Children born to mothers over 34 years of age, and born less than 24 months after a preceding birth with a birth order higher than three are less likely to die (0.6 times) than children not in any risk category. The last column of Table 8.5 presents the distribution of currently married women according to category of increased risk. Women are placed in a categories according to the status they would have at the birth of a child conceived at the time of the survey: women who were 17 years and 3 months old or younger or 34 years and 2 months old or older, women whose most recent birth was less than 15 months before the survey, and women whose most recent birth was of order 3 or higher. Many women are protected from the risk of pregnancy by contraception, postpartum insusceptibility, and prolonged abstinence but, in this report, for the sake of simplicity, only sterilized women are classified as not being in any risk category. About eight of ten married women (78 percent) are susceptible to conceiving a child who will be at an increased risk of dying. About one half of married women fall in the multiple high-risk category, mainly those who are older than 34 and with a birth order of 4 or higher, while 29 percent of women fall in the single high-risk category, mainly because of a high birth order (14 percent). The figures in Table 8.5 demonstrate the strong influence of parity (the number of children the mother has had) on the risk of dying among children under five years of age. Maternal Health | 93 MATERNAL HEALTH 9 Health conditions in Jordan are among the best in the Middle East. This is due in large part to the Kingdom’s stability and to a range of effective development plans and projects that have included health as a major component. This chapter presents findings on important areas of maternal health: antenatal, delivery, and postnatal care. In addition, problems in accessing health care, breast and cervical cancer prevention, and knowledge of tuberculosis are also discussed. This information, in combination with data on child health and mortality, is useful in formulating programs and policies to improve maternal and child health services. 9.1 ANTENATAL CARE 9.1.1 Number and Timing of ANC Visits A mother’s well-being has a direct impact on her children’s well-being. Conversely, when mothers fare poorly, so do children. For newborns, health and survival is directly proportional to a mother’s health during pregnancy. The health care that a mother receives during pregnancy and at the time of delivery is important for the survival and well-being of both the mother and the child. Antenatal care (ANC) coverage is described according to the type of provider, number of ANC visits, stage of pregnancy at the time of the first and last visits, and number of visits, as well as services and information provided during ANC. It is recommended that, during ANC, women receive tetanus toxoid vaccine and adequate amounts of iron and folic acid tablets or syrup to prevent and treat anemia. Blood pressure checks and procedures to detect pregnancy complications are also part of ANC coverage. A well-designed and implemented ANC program facilitates detection and treatment of problems during pregnancy, such as anemia and infections, and provides an opportunity to disseminate health messages to women and their households. Information on ANC coverage was obtained from women who had a birth in the five years preceding the survey. For women with two or more live births during the five-year period, data refer only to the most recent birth. Table 9.1 shows the percent distribution of mothers in the five years preceding the survey by source of antenatal care received during pregnancy. Almost all women (99 percent) received ANC from medically-trained personnel (doctors, nurses or midwives): the majority of women (96 percent) received care during pregnancy from a doctor, and 3 percent received care from a nurse or midwife. Only 1 percent of women did not receive antenatal care for their last birth. Women less than 20 years of age are more likely to receive antenatal care from nurse/midwives compared with older women. Mothers are more likely to receive care from a doctor for the first birth (98 percent) than for births of order six and higher (93 percent). There are also small differences in the use of antenatal care services between urban and rural residence. Health professionals provided antenatal care for 99 percent of mothers in urban areas and 98 percent of mothers in rural areas. There are small differences in women receiving ANC by governorates and regions, however, the variation is greater by Badia area (96 percent of women receive ANC in the Badia areas compared to 99 percent in other areas). 94 | Maternatl Health Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth, according to background characteristics, Jordan 2007 Background characteristic Doctor Nurse/ midwife No one Total Number of women Mother's age at birth <20 94.4 3.4 2.2 100.0 273 20-34 96.6 2.5 0.9 100.0 4,766 35-49 94.7 3.0 2.3 100.0 1,407 Birth order 1 98.0 1.5 0.5 100.0 979 2-3 96.5 2.7 0.8 100.0 2,447 4-5 96.3 2.7 1.0 100.0 1,827 6+ 93.4 3.4 3.1 100.0 1,193 Residence Urban 96.3 2.6 1.1 100.0 5,417 Rural 95.1 2.8 2.1 100.0 1,029 Governorate Amman 96.3 2.6 1.2 100.0 2,469 Balqa 94.9 4.1 1.0 100.0 396 Zarqa 97.9 0.8 1.3 100.0 966 Madaba 95.1 3.4 1.5 100.0 157 Irbid 95.8 3.7 0.5 100.0 1,261 Mafraq 94.6 2.1 3.3 100.0 298 Jarash 93.4 4.1 2.5 100.0 185 Ajloun 96.8 2.1 1.1 100.0 150 Karak 96.2 2.3 1.5 100.0 229 Tafiela 94.7 3.4 1.8 100.0 88 Ma'an 92.6 5.1 2.3 100.0 107 Aqaba 97.6 1.5 0.9 100.0 140 Region Central 96.5 2.3 1.2 100.0 3,987 North 95.4 3.4 1.2 100.0 1,894 South 95.7 2.8 1.5 100.0 564 Badia area Badia 92.6 3.5 3.9 100.0 536 Other 96.4 2.6 1.0 100.0 5,910 Education No education 83.7 5.8 10.6 100.0 155 Elementary 90.1 5.7 4.2 100.0 351 Preparatory 95.5 3.0 1.5 100.0 917 Secondary 96.2 2.8 1.0 100.0 3,058 Higher 98.2 1.5 0.3 100.0 1,964 Wealth quintile Lowest 92.0 4.8 3.2 100.0 1,508 Second 95.0 3.8 1.2 100.0 1,501 Middle 97.7 1.6 0.7 100.0 1,378 Fourth 98.3 1.5 0.2 100.0 1,153 Highest 99.6 0.2 0.1 100.0 906 Total 96.1 2.7 1.2 100.0 6,446 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Maternal Health | 95 The use of antenatal care services is strongly associated with the mother’s level of education. Women with a secondary education or higher are more likely to receive antenatal care from any trained personnel (99 and 100 percent) than women with elementary education (96 percent) and, in particular, women with no education (89 percent). The use of antenatal care services is positively associated with household wealth. Women in the lowest wealth quintile are less likely to receive antenatal care from any trained personnel (97 percent) than those in the fourth and highest wealth quintiles (100 percent for each). Whereas almost all women in the highest wealth quintile received antenatal care from a doctor, this proportion drops to 92 percent for women in the lowest wealth quintile. Antenatal care is more effective for preventing adverse pregnancy outcomes when it is sought early on in the pregnancy, throughout the gestational period and during delivery. Obstetricians generally recommend that antenatal visits be made on a monthly basis until the 28th week (seventh month), fortnightly until the 36th week, and then weekly until the 40th week (until birth). If the first antenatal visit is made during the third month of pregnancy, this optimum schedule translates to a total of at least 12-13 visits during the pregnancy. Table 9.2 shows that 84 percent of women make six or more antenatal care visits during their entire pregnancy. The percentage of women who make six or more antenatal care visits is higher in urban areas (85 percent) than rural areas (79 percent), while it is higher in the Central region (86 percent) than in the North and South regions (80 percent and 77 percent respectively). There is a notable variation in antenatal care services by residence in the Badia and the non-Badia areas: women in the Badia areas make fewer antenatal care visits (75 percent have 6 or more visits) than those women residing in the non-Badia areas (84 percent). Data indicate that there is a strong association between the proportions of women who make six or more visits for receiving antenatal care during their entire pregnancy, and educational level and household wealth. The results show that the proportion of women who make six or more visits for antenatal care services increases with higher educational level and higher household wealth quintile. 96 | Maternatl Health Table 9.2 Number of antenatal care visits Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, according to background characteristics, Jordan 2007 Number of ANC visits Background characteristic None 1 2 3 4 5 6 7+ Total1 Number of women Mother's age at birth <20 2.2 0.0 0.3 1.1 2.4 2.8 6.5 84.7 100.0 273 20-34 0.9 0.7 1.4 2.5 3.7 6.7 9.7 74.3 100.0 4,766 35-49 2.3 0.5 1.1 3.3 3.7 7.9 10.9 70.2 100.0 1,407 Birth order 1 0.5 0.4 0.2 0.5 1.7 3.6 6.7 86.5 100.0 979 2-3 0.8 0.3 1.6 2.7 3.5 6.8 9.2 75.0 100.0 2,447 4-5 1.0 0.8 1.3 2.4 4.1 7.1 11.2 71.8 100.0 1,827 6+ 3.1 1.1 1.5 4.6 4.8 8.9 11.7 64.1 100.0 1,193 Residence Urban 1.1 0.5 1.1 2.4 3.4 6.8 9.8 74.8 100.0 5,417 Rural 2.1 1.1 2.5 3.6 4.7 7.0 10.3 68.7 100.0 1,029 Governorate Amman 1.2 0.3 1.2 2.5 3.4 5.1 7.4 78.7 100.0 2,469 Balqa 1.0 0.8 0.6 2.4 2.6 5.7 8.7 78.0 100.0 396 Zarqa 1.3 0.9 0.7 1.3 2.5 6.8 11.2 75.3 100.0 966 Madaba 1.5 0.1 0.9 3.6 3.8 3.6 3.8 82.6 100.0 157 Irbid 0.5 0.6 1.6 2.6 2.8 8.8 14.5 68.6 100.0 1,261 Mafraq 3.3 0.7 2.0 3.9 7.7 12.7 9.8 59.6 100.0 298 Jarash 2.5 1.1 2.4 3.2 4.5 8.0 9.8 68.4 100.0 185 Ajloun 1.1 1.2 2.0 3.4 7.8 6.8 13.5 63.8 100.0 150 Karak 1.5 1.3 2.1 4.6 5.8 7.8 9.8 67.2 100.0 229 Tafiela 1.8 0.6 2.3 3.3 7.2 11.0 7.8 65.3 100.0 88 Ma'an 2.3 2.2 2.8 7.2 6.7 8.4 10.6 59.2 100.0 107 Aqaba 0.9 1.0 0.8 2.1 3.6 5.7 8.1 77.9 100.0 140 Region Central 1.2 0.5 1.0 2.3 3.1 5.5 8.3 78.0 100.0 3,987 North 1.2 0.7 1.7 2.9 4.1 9.2 13.2 66.8 100.0 1,894 South 1.5 1.3 1.9 4.3 5.7 7.9 9.2 68.0 100.0 564 Badia area Badia 3.9 0.9 2.5 4.0 6.0 7.3 8.5 66.9 100.0 536 Other 1.0 0.6 1.2 2.5 3.4 6.8 10.0 74.4 100.0 5,910 Education No education 10.6 2.5 3.0 7.4 5.4 11.0 12.2 47.2 100.0 155 Elementary 4.2 0.9 2.7 5.7 2.8 6.6 10.2 65.5 100.0 351 Preparatory 1.5 1.0 1.3 2.9 5.3 9.1 9.3 69.6 100.0 917 Secondary 1.0 0.5 1.1 2.5 3.8 6.8 10.6 73.7 100.0 3,058 Higher 0.3 0.4 1.2 1.8 2.6 5.5 8.7 79.6 100.0 1,964 Wealth quintile Lowest 3.2 0.9 2.0 3.8 4.7 8.7 12.0 64.6 100.0 1,508 Second 1.2 0.7 1.6 2.7 3.3 5.9 12.0 72.6 100.0 1,501 Middle 0.7 0.8 1.0 1.9 4.6 7.6 10.2 73.0 100.0 1,378 Fourth 0.2 0.2 1.2 2.9 3.5 5.4 7.1 78.9 100.0 1,153 Highest 0.1 0.1 0.1 1.3 1.0 5.8 5.8 85.9 100.0 906 Total 1.2 0.6 1.3 2.6 3.6 6.8 9.9 73.8 100.0 6,446 1 Includes “don’t know/missing” Eighty-nine percent of women make their first antenatal care visit before the fourth month of pregnancy (Table 9.3). The proportion of women seeking antenatal care increases to almost 97 percent before six months of pregnancy. The median duration of pregnancy for the first antenatal care visit is 2.2 months. This indicates that, in Jordan, women start antenatal care at a relatively early stage of their pregnancy. Maternal Health | 97 Table 9.3 Timing of first antenatal casre visit Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by the timing of the first visit of antenatal care (ANC) for the most recent live birth, and median months pregnant at first visit for those with ANC, according to background characteristic, Jordan 2007 Number of months pregnant at time of first ANC visit Background characteristic No antenatal care <4 4-5 6-7 8+ Total1 Median months pregnant at first visit (for those with ANC) Number of women Mother's age at birth <20 2.2 93.8 4.0 0.0 0.0 100.0 1.9 273 20-34 0.9 90.5 7.2 1.2 0.3 100.0 2.2 4,766 35-49 2.3 84.0 11.0 2.1 0.6 100.0 2.5 1,407 Birth order 1 0.5 96.9 2.5 0.1 0.0 100.0 1.8 979 2-3 0.8 91.1 6.5 1.2 0.4 100.0 2.1 2,447 4-5 1.0 88.5 8.9 1.3 0.2 100.0 2.3 1,827 6+ 3.1 79.9 13.5 2.7 0.8 100.0 2.7 1,193 Residence Urban 1.1 89.7 7.8 1.2 0.3 100.0 2.2 5,417 Rural 2.1 86.5 8.4 2.2 0.7 100.0 2.2 1,029 Governorate Amman 1.2 91.3 6.6 0.9 0.1 100.0 2.1 2,469 Balqa 1.0 89.5 6.7 1.2 1.3 100.0 1.9 396 Zarqa 1.3 89.5 7.9 0.8 0.5 100.0 2.4 966 Madaba 1.5 92.5 4.5 1.4 0.2 100.0 1.8 157 Irbid 0.5 87.9 9.4 2.0 0.2 100.0 2.4 1,261 Mafraq 3.3 86.3 8.4 0.9 0.9 100.0 2.2 298 Jarash 2.5 84.2 9.3 2.5 1.3 100.0 2.3 185 Ajloun 1.1 83.3 12.6 3.1 0.0 100.0 2.4 150 Karak 1.5 85.9 9.1 2.8 0.8 100.0 2.3 229 Tafiela 1.8 82.0 13.9 1.7 0.5 100.0 2.6 88 Ma'an 2.3 81.7 11.3 3.8 0.8 100.0 2.5 107 Aqaba 0.9 90.9 7.4 0.8 0.1 100.0 2.3 140 Region Central 1.2 90.7 6.8 0.9 0.3 100.0 2.1 3,987 North 1.2 87.0 9.5 1.9 0.4 100.0 2.4 1,894 South 1.5 85.7 9.8 2.3 0.6 100.0 2.4 564 Badia area Badia 3.9 86.3 7.1 1.9 0.8 100.0 2.1 536 Other 1.0 89.4 7.9 1.3 0.3 100.0 2.2 5,910 Education No education 10.6 74.4 11.2 2.5 0.8 100.0 2.8 155 Elementary 4.2 80.3 11.6 3.1 0.9 100.0 2.5 351 Preparatory 1.5 86.9 9.1 2.0 0.4 100.0 2.4 917 Secondary 1.0 90.1 7.6 1.2 0.2 100.0 2.3 3,058 Higher 0.3 91.6 6.8 0.8 0.4 100.0 2.0 1,964 Wealth quintile Lowest 3.2 84.7 9.9 1.5 0.6 100.0 2.4 1,508 Second 1.2 90.3 6.6 1.6 0.3 100.0 2.3 1,501 Middle 0.7 89.2 8.4 1.3 0.4 100.0 2.2 1,378 Fourth 0.2 90.3 7.7 1.7 0.2 100.0 2.2 1,153 Highest 0.1 93.4 6.1 0.3 0.1 100.0 1.9 906 Total 1.2 89.2 7.9 1.3 0.4 100.0 2.2 6,446 1 Includes “don’t know/missing” 98 | Maternatl Health The table also indicates that the women who are the most likely to receive antenatal care services before the fourth month of pregnancy are those in younger age groups, those having their first birth, those living in urban areas, in the Central region and in the non-Badia areas, those with secondary education and higher and those in the highest wealth quintile. 9.1.2 Components of Antenatal Care The effectiveness of antenatal checkups in ensuring safe motherhood depends in part on the tests and measurements done and the advice given during the checkups. The 2007 JPFHS collected information on this important aspect of antenatal care by asking mothers who received antenatal checkups whether they received each of several components of ANC during their last pregnancy in the five years preceding the survey. Table 9.4 shows that half of mothers who received antenatal care reported that they were informed about pregnancy-related complications during their visits. About two-fifths of women (38 percent) were informed about pregnancy-related complications after delivery, while about two-thirds of mothers (68 percent) were informed that they should make two visits for medical checkup: one week and 30 days after delivery. A blood pressure test was part of antenatal care for 98 percent of mothers. Urine and blood samples were taken from 94 and 95 percent of women, respectively, while 97 percent of mothers have had their weight taken. In addition, 81 percent of women either received or purchased iron tablets or syrup during pregnancy (Table 9.4). Urban-rural differences are noticeable for the various components of antenatal care. Urban women were more likely than rural women to get each component of antenatal care. Data also indicate regional variations in receiving antenatal care. For example, women in the Central region, and the non- Badia areas are more likely to receive each of the antenatal care components, compared to women in the North and South regions and the Badia areas. Antenatal care content also varies significantly according to the mother’s education level. Women with secondary or higher education are more likely to have received all routine tests than women with less education. Women who were pregnant with their first child were also more likely to receive almost all components of ANC than women who already had children at the time of the pregnancy. A higher proportion of women in the highest wealth quintiles received antenatal care components than women in lower wealth quintiles. Maternal Health | 99 Table 9.4 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Jordan 2007 Percentage of women who during the pregnancy of their last birth Among women who received antenatal care for their most recent birth in the last five years, the percentage with selected services: Background characteristic Took iron tablets or syrup Number of women with a live birth in the last five years Informed of signs of pregnancy complications Informed of signs of complications during the postnatal period Told to have two postnatal visits: one week and 30 days after delivery Weighed Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother's age at birth <20 81.6 273 51.4 36.4 61.8 96.5 98.3 91.9 94.2 267 20-34 82.0 4,766 51.3 39.5 68.1 97.5 98.2 94.0 94.4 4,724 35-49 75.1 1,407 44.9 34.7 66.7 96.7 98.4 94.9 95.3 1,376 Birth order 1 85.9 979 57.3 40.8 66.0 98.0 98.8 95.2 96.8 974 2-3 82.6 2,447 50.2 40.2 70.1 97.4 98.5 94.1 94.4 2,429 4-5 79.3 1,827 49.3 37.8 68.4 97.2 98.3 94.0 94.4 1,808 6+ 73.5 1,193 43.8 33.2 61.9 96.6 97.2 93.4 93.5 1,155 Residence Urban 82.0 5,417 50.7 39.1 69.5 97.5 98.6 94.8 95.3 5,359 Rural 72.7 1,029 45.6 34.2 56.9 96.1 96.7 90.4 90.6 1,007 Governorates Amman 86.1 2,469 52.2 40.9 73.0 97.8 98.9 95.5 96.1 2,439 Balqa 87.2 396 46.4 41.7 77.5 98.7 99.5 97.1 97.3 392 Zarqa 81.4 966 49.5 44.1 70.7 98.3 98.6 96.4 96.4 953 Madaba 81.2 157 61.7 54.3 65.0 98.1 98.7 96.8 96.8 155 Irbid 75.0 1,261 46.9 29.7 58.8 96.4 97.9 92.8 93.9 1,254 Mafraq 60.7 298 41.7 27.8 58.2 96.7 97.9 83.3 84.8 288 Jarash 73.1 185 51.3 37.2 68.3 97.5 97.9 93.7 93.7 180 Ajlun 70.2 150 51.8 36.7 75.8 97.1 97.7 92.6 92.5 149 Karak 77.6 229 53.3 39.9 53.8 93.8 94.7 87.7 87.0 226 Tafiela 74.1 88 48.5 31.8 47.8 92.6 93.4 91.7 91.7 86 Ma'an 71.0 107 51.0 35.1 47.8 92.0 94.3 91.2 89.4 105 Aqaba 82.6 140 42.4 34.1 60.4 97.4 97.3 93.7 93.1 139 Region Central 84.9 3,987 51.4 42.3 72.6 98.0 98.9 95.9 96.3 3,939 North 72.2 1,894 46.9 30.7 61.0 96.7 97.9 91.4 92.4 1,872 South 77.1 564 49.4 36.3 53.3 94.2 95.1 90.5 89.7 556 Badia Badia 69.2 536 43.8 34.6 58.4 95.3 95.8 88.5 89.0 515 Other 81.5 5,910 50.4 38.7 68.3 97.5 98.5 94.6 95.1 5,851 Mother's education No education 56.0 155 33.1 26.7 42.1 86.8 88.9 78.2 78.0 139 Elementary 68.5 351 42.1 28.3 59.4 92.4 95.2 90.5 92.5 337 Preparatory 75.6 917 41.9 27.4 59.2 97.0 97.7 94.4 94.6 903 Secondary 81.5 3,058 50.2 39.5 68.9 97.8 98.6 94.4 94.8 3,029 Higher 85.2 1,964 55.6 44.2 72.4 98.1 99.2 95.2 95.8 1,959 Wealth quintile Lowest 71.1 1,508 46.8 34.7 61.4 95.4 96.4 91.9 92.3 1,460 Second 80.3 1,501 48.0 34.6 64.4 96.7 98.4 92.7 94.2 1,482 Middle 82.0 1,378 52.0 39.7 66.4 97.6 98.7 94.9 94.1 1,368 Fourth 86.3 1,153 50.0 37.8 68.6 98.6 99.1 94.8 96.6 1,150 Highest 86.7 906 54.5 49.2 82.5 99.1 99.3 97.9 97.2 905 Total 80.5 6,446 49.9 38.4 67.5 97.3 98.3 94.1 94.6 6,366 100 | Maternatl Health 9.1.3 Coverage of Tetanus Toxoid Vaccinations Tetanus toxoid injections are given during pregnancy for the prevention of neonatal tetanus, an important cause of death among infants. Neonatal tetanus is most common among children who are delivered in unhygienic environments and when un- specialized instruments are used to cut the umbilical cord. Tetanus usually develops during the first or second week of life and is fatal in 70-90 percent of cases. Neonatal tetanus, however, is a preventable disease. Full protection is considered to be provided to an infant if the mother has received two injections during her last pregnancy with a live birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within ten years of the last live birth), or five or more injections prior to the last birth. When the mother is vaccinated, immunity against tetanus is transferred to the fetus through the placenta. In the 2007 JPFHS, information was collected on the lifetime number of doses of tetanus toxoid that the mother received. Table 9.5 shows that 6 percent of women received two or more doses of tetanus toxoid vaccine during the last pregnancy, which is less than that observed in 2002 JPFHS (9 percent). However, for 27 percent of women the last birth was protected against tetanus because of the injections received during this pregnancy and injections received prior to the current pregnancy. Women residing in the North, in the non-Badia areas, and in Irbid, Jarash, and Ajloun are more likely to provide full protection against tetanus than women residing in other areas. The percentage of women providing full protection to their children increases with the mother’s age and the birth order. This is due to the cumulative effect of past vaccinations (whether during prior pregnancies or not). Because of this cumulative effect of injections received during prior pregnancies, full protection also Table 9.5 Tetanus toxoid injections Among women age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections (TTI) during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Jordan 2007 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of women Mother's age at birth <20 9.8 22.7 273 20-34 6.3 26.9 4,766 35-49 5.3 28.7 1,407 Birth order 1 13.1 23.6 979 2-3 4.9 27.6 2,447 4-5 4.6 27.3 1,827 6+ 5.6 28.8 1,193 Residence Urban 5.9 27.4 5,417 Rural 8.0 25.6 1,029 Governorate Amman 5.5 22.8 2,469 Balqa 4.3 27.7 396 Zarqa 5.9 26.0 966 Madaba 10.5 30.6 157 Irbid 6.0 33.9 1,261 Mafraq 2.7 19.5 298 Jarash 7.9 36.7 185 Ajloun 12.2 45.4 150 Karak 10.6 26.2 229 Tafiela 9.8 33.0 88 Ma'an 12.6 38.0 107 Aqaba 7.5 18.4 140 Region Central 5.7 24.3 3,987 North 6.2 32.8 1,894 South 10.1 27.6 564 Badia area Badia 7.0 22.4 536 Other 6.1 27.6 5,910 Education No education 8.3 22.2 155 Elementary 7.5 28.7 351 Preparatory 5.9 24.2 917 Secondary 5.4 29.3 3,058 Higher 7.1 25.3 1,964 Wealth quintile Lowest 9.2 30.5 1,508 Second 6.6 29.5 1,501 Middle 4.2 29.5 1,378 Fourth 5.1 25.1 1,153 Highest 5.1 16.5 906 Total 6.2 27.1 6,446 1 Includes women with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within ten years of the last live birth), or five or more injections prior to the last birth Maternal Health | 101 increases as household wealth decreases, a consequence of the highest fertility rates being among women of the lowest quintiles. 9.2 DELIVERY 9.2.1 Place of Delivery The objective of providing safe delivery services is to protect the life and health of the mother and her child by ensuring the safe delivery of the child. An important component of efforts to reduce the health risks to mother and child is to increase the proportion of infants delivered under the supervision of health professionals. Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may cause death or serious illness for the mother, the child, or both. Data on delivery care were obtained for all births that occurred in the five years preceding the survey. An overwhelming majority of births (99 percent) in the five years preceding the survey were delivered in a medical facility (Table 9.6 and Figure 9.1), an increase of two percentage points from the 2002 JPFHS survey. Of the deliveries that took place in medical facilities, 64 percent took place in public health facilities and 35 percent in private medical facilities. Only 1 percent of women gave births at home in 2007, a drop of 2 percentage points from the 2002 JPFHS survey (3 percent). JPFHS 2007 Figure 9.1 Distribution of Births by Place of Delivery Public health facility 64% Private health facilit 35% Home 1% facility 102 | Maternatl Health Table 9.6 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics, Jordan 2007 Background characteristic Government hospitals Royal Medical Services Other public health facility Any public health facility Private health sector Home Total1 Number of births Mother's age at birth <20 52.0 7.3 1.3 60.5 37.6 1.9 100.0 541 20-34 47.6 14.3 2.0 63.8 34.8 1.2 100.0 7,612 35-49 47.3 14.1 3.2 64.6 34.1 1.3 100.0 1,712 Birth order 1 44.0 13.7 2.6 60.3 39.4 0.3 100.0 2,161 2-3 47.2 11.9 2.1 61.2 37.2 1.5 100.0 3,797 4-5 49.7 14.6 2.0 66.3 32.5 1.1 100.0 2,390 6+ 51.5 17.8 2.1 71.4 26.3 2.3 100.0 1,516 Residence Urban 46.7 11.4 2.2 60.2 38.5 1.2 100.0 8,262 Rural 53.4 26.5 2.2 82.2 16.2 1.4 100.0 1,601 Governorate Amman 36.8 6.9 2.5 46.3 53.0 0.7 100.0 3,784 Balqa 54.1 14.8 5.8 74.7 23.4 1.9 100.0 615 Zarqa 54.8 13.6 1.0 69.4 29.2 1.4 100.0 1,486 Madaba 58.7 17.2 1.1 77.0 21.8 1.2 100.0 242 Irbid 54.2 15.5 2.1 71.9 26.0 1.8 100.0 1,861 Mafraq 64.2 12.0 2.5 78.7 19.4 1.8 100.0 479 Jarash 61.4 23.7 2.3 87.5 11.1 1.3 100.0 290 Ajloun 69.5 16.3 2.1 87.9 11.8 0.2 100.0 233 Karak 54.7 29.7 0.1 84.6 13.8 1.4 100.0 348 Tafiela 19.7 66.3 0.1 86.1 12.5 1.3 100.0 140 Ma'an 74.6 9.1 0.8 84.4 13.5 2.1 100.0 167 Aqaba 13.3 48.1 0.0 61.4 36.1 2.3 100.0 217 Region Central 43.8 9.7 2.4 55.9 43.0 1.0 100.0 6,127 North 57.9 15.8 2.2 75.9 22.2 1.6 100.0 2,864 South 42.6 36.2 0.2 79.1 19.1 1.8 100.0 873 Badia area Badia 63.1 14.2 1.4 78.7 18.8 2.4 100.0 876 Other 46.3 13.8 2.2 62.3 36.4 1.2 100.0 8,988 Mother's education No education 72.2 11.9 0.8 84.9 8.6 6.3 100.0 241 Elementary 67.7 13.9 1.7 83.3 12.8 3.8 100.0 591 Preparatory 58.5 15.7 2.1 76.2 22.0 1.8 100.0 1,365 Secondary 49.5 13.9 1.4 64.8 33.9 1.1 100.0 4,735 Higher 34.0 13.0 3.6 50.6 49.0 0.3 100.0 2,932 Antenatal care visits None 76.8 5.1 0.0 81.9 4.9 13.2 100.0 79 1-3 58.4 10.4 2.7 71.4 26.3 2.2 100.0 292 4+ 44.9 14.6 2.3 61.9 37.2 0.9 100.0 6,066 Wealth quintile Lowest 68.1 15.1 0.8 83.9 13.2 2.7 100.0 2,541 Second 56.2 18.5 2.3 77.0 21.3 1.6 100.0 2,342 Middle 45.7 15.4 2.3 63.4 36.0 0.5 100.0 2,061 Fourth 33.6 10.2 4.1 47.9 51.7 0.4 100.0 1,634 Highest 13.7 5.0 2.1 20.7 79.2 0.1 100.0 1,285 Total 2 47.8 13.8 2.2 63.8 34.9 1.3 100.0 9,864 1 Includes “don’t know/missing” 2 Total includes 8 missing cases for number of ANC visits Maternal Health | 103 Seventy-nine percent of births took place in a public health facility in the South region compared with 56 percent in the Central region. More women in the Central region (43 percent) went to a private health facility than women from the North or South regions (22 percent and 19 percent respectively). Younger women are more likely to deliver at a private health facility than older women. In rural areas, more children are born in public health facilities than in private health facilities. The percentage of children born at public health facilities is higher in the Badia areas than in the non-Badia areas (79 percent and 62 percent, respectively). There is also a strong association between mother’s level of education and the place of delivery. The proportion of births delivered in a public health facility is higher (85 percent) for uneducated mothers, compared to 51 percent of births to mothers with higher education. Similarly, about half of births delivered at private health facilities are to mothers with higher education, compared to 9 percent for mothers with no education. There is a six-percentage point difference in the proportion of births at home by uneducated women (6 percent) compared with women with higher education (less than 1 percent). Table 9.6 also shows that there is a strong, negative relationship between household wealth and delivery in the public sector. While 84 percent of births to mothers of the lowest wealth quintile took place in public sector, this proportion drops to about one-fifth (21 percent) for those mothers in the highest wealth quintile. 9.2.2 Assistance at Delivery Obstetric care by a trained provider during delivery is recognized as critical for the reduction of maternal and neonatal mortality. Table 9.7 shows the type of assistance during delivery by background characteristics of mothers. Almost all births in Jordan were delivered with the assistance of a health professional, that is, a doctor, nurse, or midwife. In all regions, the proportion of births assisted by a health professional is similar. However, women residing in the Central region are more likely to get assistance from a doctor than those in the North and South regions. Both urban and rural women get assistance from a health professional during delivery. However, urban women are more likely to receive assistance from a doctor (76 percent) than rural women (60 percent). First births are more likely to be assisted by a doctor than higher-order births (82 percent for the first birth compared to 65 percent for the sixth birth). Results also indicate that women in the non-Badia areas are more likely to get assistance from a doctor (75 percent) than those in the Badia areas (63 percent). The results also show that the proportion of women who got assistance from a doctor is lower (about one-half) in Mafraq, Jarash, Ajloun, Karak, Tafiela and Ma’an than in other governorates. Women’s education is positively associated with delivery by a medical professional. Almost all births to women with preparatory, secondary and higher education were assisted by a health professional. A relatively lower percentage (94 percent) of women with no education received delivery assistance from a health professional. The remaining women with no education sought assistance during delivery from relatives or other sources (5 percent) and about 2 percent of women did not receive any assistance during delivery. The same pattern also holds true for wealth quintile. All women in the highest wealth quintile got assistance during delivery from a health professional (93 percent from a doctor, and 7 percent from a nurse or midwife), compared with 98 percent of women in the lowest wealth quintile (62 percent from a doctor and 36 percent from a nurse or midwife). 104 | Maternatl Health Table 9.7 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage delivered by caesarean-section, and percentage whose the mother was given free sample of infant formula and was advised about family planning before discharge, according to background characteristics, Jordan 2007 Person providing assistance during delivery Background characteristic Doctor Nurse/ midwife Relative/ other No one Total Percentage delivered by C-section Given free sample of infant formula Talked to about family planning before discharge Number of births Mother's age at birth <20 79.3 18.4 1.0 1.3 100.0 14.1 13.0 11.5 541 20-34 73.0 26.1 0.6 0.3 100.0 16.6 13.1 12.8 7,612 35-49 75.4 23.7 0.8 0.1 100.0 28.7 11.9 14.5 1,712 Birth order 1 81.5 18.1 0.2 0.2 100.0 21.5 14.8 12.9 2,161 2-3 73.9 25.1 0.7 0.3 100.0 16.3 13.8 11.6 3,797 4-5 71.9 27.2 0.4 0.4 100.0 18.4 11.2 13.1 2,390 6+ 65.3 32.9 1.4 0.5 100.0 20.3 10.5 16.7 1,516 Place of delivery Health facility 74.7 25.2 0.0 0.1 100.0 18.8 13.1 13.2 9,731 Elsewhere 4.9 33.3 44.3 17.5 100.0 na na na 128 Residence Urban 76.4 22.7 0.6 0.3 100.0 18.8 13.1 13.3 8,262 Rural 60.3 38.3 0.8 0.6 100.0 17.4 11.6 11.7 1,601 Governorate Amman 85.8 13.4 0.3 0.5 100.0 19.7 17.5 14.2 3,784 Balqa 82.2 16.7 1.0 0.1 100.0 20.3 9.7 10.5 615 Zarqa 78.8 20.2 0.7 0.3 100.0 16.0 7.1 10.9 1,486 Madaba 80.7 18.8 0.3 0.1 100.0 22.6 20.0 11.3 242 Irbid 64.5 34.5 0.8 0.2 100.0 18.5 10.6 15.9 1,861 Mafraq 46.2 52.0 1.8 0.0 100.0 13.3 8.5 9.0 479 Jarash 50.1 49.2 0.5 0.2 100.0 14.6 8.8 16.7 290 Ajloun 48.0 51.7 0.1 0.2 100.0 14.2 8.4 12.8 233 Karak 54.5 44.5 0.3 0.7 100.0 22.1 12.8 11.0 348 Tafiela 48.8 49.9 0.5 0.8 100.0 18.9 16.5 8.2 140 Ma'an 50.8 47.6 1.0 0.5 100.0 19.1 10.6 5.2 167 Aqaba 63.6 34.5 1.5 0.4 100.0 20.0 11.6 6.9 217 Region Central 83.5 15.6 0.5 0.4 100.0 19.0 14.3 12.9 6,127 North 58.6 40.3 0.9 0.2 100.0 16.9 9.9 14.6 2,864 South 55.1 43.5 0.8 0.6 100.0 20.5 12.7 8.4 873 Badia area Badia 62.6 35.6 1.4 0.4 100.0 13.6 9.4 8.3 876 Other 74.9 24.3 0.5 0.3 100.0 19.0 13.2 13.5 8,988 Mother's education No education 55.6 38.3 4.7 1.5 100.0 20.5 5.6 9.3 241 Elementary 65.5 30.8 3.5 0.2 100.0 24.5 6.7 13.7 591 Preparatory 66.8 32.2 0.4 0.7 100.0 17.1 7.2 7.8 1,365 Secondary 72.3 27.0 0.4 0.3 100.0 17.0 13.4 14.0 4,735 Higher 82.6 17.0 0.2 0.3 100.0 20.3 16.5 14.0 2,932 Wealth quintile Lowest 61.5 36.5 1.6 0.4 100.0 15.4 8.1 12.2 2,541 Second 68.1 30.7 0.7 0.5 100.0 15.5 9.2 12.5 2,342 Middle 75.7 23.6 0.2 0.5 100.0 17.9 13.3 11.7 2,061 Fourth 83.2 16.6 0.1 0.2 100.0 21.3 16.1 12.6 1,634 Highest 93.3 6.7 0.0 0.0 100.0 27.8 24.3 18.4 1,285 Total1 73.8 25.3 0.6 0.3 100.0 18.5 12.9 13.0 9,864 Note: If the woman mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. na = Not applicable 1 Total includes 6 missing cases for place of delivery Maternal Health | 105 9.2.3 Delivery Characteristics Caesarean section (C-section) rates are one of the few indicators for measuring women’s access to obstetric care. C-sections are generally performed because the mother has medical problems or experiences complications at the time of delivery. Based on research and analysis, WHO has determined that the rate of C-sections in a given population should not be less than 5 percent and not more than 15 percent of all pregnancies if the lives of women and infants are to be protected (UNICEF, 1999). Rates below 5 percent indicate that many women and babies may be dying because of inadequate access to the whole spectrum of obstetric services. Rates above 15 percent indicate an unnecessarily high reliance on a major surgical procedure with numerous risks. It is essential that C-sections be performed only when necessary, and in facilities that are adequately equipped and staffed to ensure safety (UNICEF, 1999). The 2007 JPFHS obtained information on a number of key aspects of deliveries, including the frequency of C-sections. Table 9.7 shows that about one in five deliveries in the five-year period preceding the survey were by C-section (19 percent), a significant increase from the 2002 JPFHS (16 percent). Given the high C-section rates (19 percent) and the large increase in the proportion of births delivered by C-section since 1997, the indications for the performance of a Caesarean section needs to be reviewed and addressed in Jordan. C-sections are more frequent in the South region (21 percent) compared with the North (17 percent) and Central (19 percent) regions. Among older women, proportion of C-section is 29 percent while for younger women it is 14 percent. The percentage of C-section is also higher among women living in the non-Badia areas compared with women living in the Badia areas (19 and 14 percent, respectively). It is also higher among women with no education, elementary education, and those with higher than secondary education, in addition to women living in the highest wealth quintiles: this may be related to a woman’s previous history of having a C-section and the proclivity of the medical community to routinely deliver a woman by C-section if she has had one before. Women who delivered in a health facility were asked whether they were given a free sample of infant formula when they were discharged after delivery. Thirteen percent of women received infant formula by a health facility staff. This practice is particularly high in Amman (18 percent), Madaba (20 percent), and Tafiela (17 percent). The proportion of women who received infant formula increases significantly as level of education and wealth quintile increase. During the survey, women were also asked whether anyone at the health facility talked to them or advised them about family planning before they were discharged. Data in Table 9.7 indicate that 13 percent of women talked about family planning before checking out of the health facility after delivery. This percentage varies significantly according to various background characteristics. In particular, this percentage ranges from 5 percent in Ma’an to 17 percent in Jarash. 9.2.4 Payment for Delivery Table 9.8 shows that in the five years preceding the survey, 40 percent of births were free of charge for the respondents or their families: the corresponding figure for deliveries in public facilities was 56 percent compared to only 12 percent of births delivered in private health facilities. For about one fifth of births, the cost of delivery was less than JD 50, however, for 14 percent of births, the cost of delivery was 200 JD or more. In private sector, 39 percent of deliveries cost more than 100 but less than 200 JD, and 38 percent cost 200 JD or more. In the public sector, only 6 percent of deliveries cost 100 JD or more. Data in the table indicate that births to women residing in rural areas, the South and North regions, the Badia areas, women with preparatory education or less, and women in the lowest wealth quintiles are more likely to deliver free of charge. It is likely that they used government or private health insurance or any type of insurance including the Royal Medical Services for payment for delivery. 106 | Maternatl Health Table 9.8 Cost of delivery Percent distribution of live births in the five years preceding the survey by cost of delivery to the mother or her family, according to background characteristics, Jordan 2007 Cost of delivery (in JD) Background characteristic Free <50 50-<100 100-<200 200-<500 500+ Don't know/ missing Total Number of births Place of delivery Public 55.9 28.2 6.7 4.3 1.3 0.2 3.3 100.0 6,292 Private 11.9 2.9 4.3 38.7 25.9 12.5 3.8 100.0 3,439 Other 11.3 21.1 4.2 0.0 0.0 0.0 63.4 100.0 128 Residence Urban 34.6 20.7 6.1 17.7 11.2 5.0 4.7 100.0 8,262 Rural 67.5 12.2 4.2 8.5 3.1 1.8 2.6 100.0 1,601 Governorate Amman 21.4 21.3 6.6 21.2 16.1 8.4 5.0 100.0 3,784 Balqa 48.7 19.1 6.4 9.5 5.5 4.8 5.9 100.0 615 Zarqa 30.9 28.1 7.2 17.3 9.7 2.6 4.3 100.0 1,486 Madaba 60.4 12.0 3.5 9.3 6.3 5.0 3.6 100.0 242 Irbid 52.3 16.2 4.4 17.0 6.0 1.0 3.1 100.0 1,861 Mafraq 63.7 12.2 8.4 9.5 2.3 1.0 2.9 100.0 479 Jarash 65.5 17.6 4.2 6.5 3.1 0.9 2.2 100.0 290 Ajloun 77.7 7.4 3.5 6.1 3.0 0.6 1.7 100.0 233 Karak 67.2 15.5 2.4 6.2 3.6 2.3 2.8 100.0 348 Tafiela 78.2 7.9 2.0 3.8 1.6 1.4 5.0 100.0 140 Ma'an 66.5 12.5 3.8 4.8 3.0 1.6 7.9 100.0 167 Aqaba 56.7 10.3 3.5 14.1 6.4 2.8 6.3 100.0 217 Region Central 28.0 22.3 6.6 18.6 13.1 6.5 4.9 100.0 6,127 North 57.6 14.9 5.0 13.8 4.8 1.0 2.9 100.0 2,864 South 66.2 12.4 2.9 7.5 3.9 2.2 5.0 100.0 873 Badia area Badia 56.4 17.3 5.6 10.5 4.4 1.5 4.2 100.0 876 Other 38.3 19.5 5.8 16.8 10.4 4.8 4.3 100.0 8,988 Mother's education No education 52.1 15.1 9.3 5.5 2.2 1.2 14.4 100.0 241 Elementary 44.8 26.2 4.6 10.6 4.4 1.8 7.6 100.0 591 Preparatory 44.2 26.6 6.8 11.0 4.7 1.8 4.8 100.0 1,365 Secondary 37.5 21.1 6.5 17.6 9.7 4.2 3.4 100.0 4,735 Higher 39.9 12.0 4.2 18.5 14.3 7.1 4.0 100.0 2,932 Wealth quintile Lowest 49.0 24.5 6.0 10.0 3.2 1.4 5.8 100.0 2,541 Second 46.8 24.6 5.6 13.2 4.7 1.7 3.5 100.0 2,342 Middle 38.2 20.5 7.0 20.4 8.3 3.1 2.5 100.0 2,061 Fourth 33.2 13.5 4.6 24.2 14.9 5.4 4.3 100.0 1,634 Highest 21.0 5.0 5.5 17.2 28.8 16.8 5.8 100.0 1,285 Total1 40.0 19.3 5.8 16.2 9.9 4.5 4.3 100.0 9,864 1 Total includes 6 missing cases for place of delivery 9.3 POSTNATAL CARE A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Safe motherhood programs have recently increased their emphasis on the importance of postnatal care, recommending that all women receive a health check within two days of delivery. To assess the extent of postnatal care utilization, respondents were asked whether they had received a health check after the delivery of their last birth in the five years preceding the survey. Maternal Health | 107 Each woman with a birth in the five years preceding the survey was asked questions on the postnatal care she received for her latest birth, depending on where she gave birth. If she gave birth outside of a health facility, she was asked whether or not a health professional checked on her health after the birth. If she gave birth at a health facility, as did 99 percent of women, she was asked whether or not she received initial postnatal care shortly after birth while still in the facility; these women then were asked whether or not they received a postnatal check after they had been discharged from the facility. Table 9.9 shows that about one-third of women received a postnatal check-up less than 24 hours after delivery, 6 percent in the 2 days after delivery, and 28 percent between 3 and 41 days after delivery. The remaining 32 percent received no postnatal care. Table 9.9 Timing of first postnatal checkup Among women age 15-49 who had a live birth in the five years preceding the survey, the percent distribution of the woman’s first postnatal check-up for the last live birth by time after delivery, according to background characteristics, Jordan 2007 Timing after delivery of woman’s first postnatal checkup Background characteristic Less than 4 hours 4-23 hours 2 days 3-41 days Don't know/ missing No postnatal checkup1 Total Number of women Mother's age at birth <20 11.4 19.4 7.4 19.8 0.2 41.8 100.0 273 20-34 15.7 18.4 6.4 28.0 0.3 31.3 100.0 4,766 35-49 13.9 19.4 6.4 27.6 0.8 31.9 100.0 1,407 Birth order 1 13.7 16.4 7.8 35.0 0.1 27.0 100.0 979 2-3 15.9 18.1 5.3 29.7 0.2 30.6 100.0 2,447 4-5 15.2 18.6 7.1 24.7 0.7 33.7 100.0 1,827 6+ 14.4 21.5 6.4 21.5 0.6 35.7 100.0 1,193 Residence Urban 15.0 18.7 6.5 29.1 0.4 30.3 100.0 5,417 Rural 15.5 18.3 5.7 19.7 0.4 40.3 100.0 1,029 Governorate Amman 13.9 17.1 6.9 38.6 0.5 23.1 100.0 2,469 Balqa 21.2 25.1 8.4 20.2 1.0 24.0 100.0 396 Zarqa 16.1 14.0 7.3 22.7 0.2 39.7 100.0 966 Madaba 17.4 13.9 4.0 25.0 0.6 39.2 100.0 157 Irbid 12.8 25.9 4.7 20.0 0.2 36.4 100.0 1,261 Mafraq 17.4 13.2 4.7 16.4 0.4 47.9 100.0 298 Jarash 17.7 18.9 5.8 17.4 0.0 40.3 100.0 185 Ajloun 15.7 22.4 3.9 15.8 0.0 42.3 100.0 150 Karak 13.2 14.4 6.5 24.9 0.6 40.4 100.0 229 Tafiela 18.1 15.7 7.5 19.9 0.2 38.6 100.0 88 Ma'an 21.3 12.4 6.6 19.0 0.4 40.3 100.0 107 Aqaba 17.7 19.8 10.8 26.3 0.6 24.7 100.0 140 Region Central 15.3 17.0 7.0 32.4 0.5 27.9 100.0 3,987 North 14.2 23.0 4.7 18.8 0.2 39.1 100.0 1,894 South 16.6 15.6 7.7 23.3 0.5 36.2 100.0 564 Badia area Badia 18.8 15.0 6.7 18.0 0.1 41.4 100.0 536 Other 14.8 19.0 6.4 28.5 0.4 31.0 100.0 5,910 Education No education 10.9 18.6 9.8 15.8 0.0 45.0 100.0 155 Elementary 14.1 17.0 5.8 23.9 0.9 38.2 100.0 351 Preparatory 16.1 14.1 6.0 26.2 0.5 37.1 100.0 917 Secondary 15.5 18.3 6.6 26.6 0.4 32.6 100.0 3,058 Higher 14.5 21.5 6.2 31.4 0.3 26.2 100.0 1,964 Wealth quintile Lowest 16.3 16.8 7.5 19.6 0.3 39.6 100.0 1,508 Second 15.4 19.1 6.5 19.6 0.7 38.7 100.0 1,501 Middle 15.7 17.5 6.7 28.2 0.6 31.4 100.0 1,378 Fourth 13.6 21.5 5.0 34.7 0.1 25.1 100.0 1,153 Highest 13.6 18.9 5.9 44.4 0.0 17.1 100.0 906 Total 15.1 18.6 6.4 27.6 0.4 31.9 100.0 6,446 1 Includes women who received a checkup after 41 days 108 | Maternatl Health The table shows that women in older age groups and women with first-order births, women in urban areas, in the Central region, in the non-Badia areas, women with secondary education and above and women in the highest wealth quintile are more likely to receive postnatal checkups than other women. 9.4 PROBLEMS IN ACCESSING HEALTH CARE Many different factors can prevent women from getting medical advice or treatment for themselves. In the 2007 JPFHS, women were asked about various problems they face in accessing health care. Table 9.10 shows that 73 percent of women reported having at least one problem in accessing health care for themselves. Table 9.10 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Jordan 2007 Problems in accessing health care Background characteristic Knowing where to go Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern no female provider available At least one problem accessing health care Number of women Age 15-19 25.1 10.6 32.3 44.6 44.0 55.0 54.4 87.6 236 20-34 23.3 11.6 30.7 36.4 38.0 39.5 45.7 74.9 5,466 35-49 22.7 9.4 35.4 35.3 35.8 31.5 39.6 70.5 5,174 Number of living children 0 23.8 10.8 26.4 32.5 34.1 40.1 41.3 71.5 1,021 1-2 23.2 10.9 31.0 35.5 36.9 39.3 43.1 72.8 2,787 3-4 21.8 9.9 31.7 34.0 35.8 32.9 42.0 71.9 3,471 5+ 23.9 10.9 37.5 39.5 39.2 35.3 44.3 74.8 3,597 Marital status Married 23.2 10.6 31.9 36.2 37.1 36.2 43.3 73.1 10,354 Divorced /widowed 20.3 9.2 53.3 33.7 36.0 32.5 35.7 72.6 522 Employment Currently employed 18.0 4.8 20.0 29.4 30.5 27.9 31.8 60.3 1,316 Not employed 23.7 11.3 34.7 37.0 38.0 37.1 44.5 74.8 9,560 Residence Urban 22.6 10.4 32.4 34.0 34.8 34.7 42.5 72.1 9,249 Rural 25.8 11.6 35.8 47.6 50.1 43.3 45.4 78.4 1,627 Governorate Amman 23.1 12.0 31.4 31.1 32.4 35.1 43.3 72.9 4,442 Balqa 14.1 7.3 39.1 37.3 38.8 27.5 37.3 66.8 645 Zarqa 19.5 8.9 36.0 36.7 36.7 29.9 45.0 69.4 1,645 Madaba 9.8 8.1 25.1 26.0 26.0 30.4 33.7 51.6 262 Irbid 25.4 8.7 29.4 38.3 38.8 38.3 40.7 74.1 1,993 Mafraq 28.5 12.1 37.0 44.6 46.8 48.9 48.6 83.2 460 Jarash 18.4 8.3 38.5 43.0 44.8 38.1 42.9 74.3 293 Ajloun 26.2 6.2 29.4 42.3 41.8 40.4 48.4 77.4 228 Karak 35.3 16.5 32.0 51.2 55.5 42.9 47.1 83.8 378 Tafiela 28.3 13.8 40.5 48.2 50.9 51.6 44.9 82.5 146 Ma'an 33.9 18.1 43.8 52.0 51.0 54.7 51.3 86.8 164 Aqaba 27.7 10.5 40.2 39.9 40.3 40.6 38.0 75.8 221 Region Central 20.9 10.7 33.0 32.8 33.7 33.0 42.8 70.7 6,993 North 25.2 9.0 31.5 40.0 40.8 40.1 42.8 75.8 2,975 South 32.1 14.9 37.5 48.1 50.2 45.9 45.3 82.2 908 Badia area Badia 24.3 13.8 42.0 49.5 51.2 48.5 44.3 79.0 823 Other 22.9 10.3 32.2 35.0 35.9 35.0 42.9 72.6 10,053 Education No education 26.5 16.9 57.5 49.9 51.2 48.4 48.4 81.9 416 Elementary 27.5 14.9 49.1 43.7 48.3 42.7 45.3 78.7 813 Preparatory 22.9 12.2 41.6 41.0 41.8 39.7 46.5 78.6 1,681 Secondary 23.8 11.6 32.4 35.6 36.5 36.9 43.4 74.0 4,788 Higher 20.3 6.2 21.9 30.3 30.7 29.4 39.1 66.2 3,179 Wealth quintile Lowest 25.4 14.6 49.4 47.0 47.6 41.8 44.9 81.0 2,211 Second 26.3 13.3 39.1 43.1 45.5 40.2 45.7 78.5 2,296 Middle 21.9 10.5 33.0 34.7 37.7 37.7 44.9 73.8 2,206 Fourth 21.3 8.5 24.4 30.8 30.6 30.6 43.6 68.4 2,135 Highest 20.0 5.3 17.1 23.2 22.1 28.8 35.0 62.4 2,028 Total 23.0 10.6 33.0 36.1 37.1 36.0 43.0 73.1 10,876 Maternal Health | 109 Two in five women were concerned that there might not be a female provider at the health facility. The other major problems women reported in accessing health care were taking transport (37 percent), distance to health facility (36 percent), not wanting to go alone (36 percent), and getting money for treatment (33 percent). Younger women, women not employed, those living in rural areas and in the South region, women with lower or no education, and those in the lowest wealth quintiles reported more frequently than others that they have at least one problem in accessing health care. As expected, rural women were more likely than urban women to have problems related to distance to the health facility, need for transportation, and not wanting to go alone. Table 9.10 also shows that with the rise in educational level or household wealth, women face less problems in accessing health care than women with less education and lower household wealth. While eight of ten women with no education or living in the lowest wealth quintile faced at least one problem in accessing health care, two-thirds of women with higher education and 62 percent of women in the highest wealth quintile face at least one problem. 9.5 PREMARITAL MEDICAL EXAMINATIONS Premarital examinations, which normally include genetic testing (given the high proportion of consanguineous unions in Jordan), are considered an important aspect of the process of forming a marital union in Jordan; since 2004, these examinations have been required by law for all marriages. The lack of facilities providing this type of service and the desire to avoid premarital medical examinations are likely to result in increase in poor health outcomes for children if their parents are too closely related to one another by blood. Table 9.11 indicates that only 18 percent of ever-married women and/or their husbands underwent premarital medical examinations. This is particularly worrisome given that 40 percent of ever- married women are related in some way to their husband, and 16 percent of women report that they are first relatives to their spouses. The table also indicates that premarital examination is more frequent among women with older ages at first marriage, those residing in urban areas, in the Central region and in the non-Badia areas than among other women. Women with higher education (24 percent) are more likely to go for a premarital medical examination than women with no education (5 percent). Also, women in the highest wealth quintile (20 percent) are more likely to have had premarital examination than those in lowest wealth quintiles (16 percent). 110 | Maternatl Health Table 9.11 Premarital medical examination Percent distribution of all ever-married women by whether they and/or their husband underwent a premarital medical examination, according to background characteristics, Jordan 2007 Premarital medical exam Background characteristic Yes No Don’t know/ missing Total Number of women Age at first marriage 0-19 13.1 86.7 0.2 100.0 4,784 20-24 19.1 80.8 0.1 100.0 4,306 25-29 24.5 75.3 0.2 100.0 1,379 30-34 24.3 75.6 0.1 100.0 305 35+ 41.5 58.5 0.0 100.0 102 Residence Urban 17.8 82.0 0.2 100.0 9,249 Rural 15.7 84.2 0.1 100.0 1,627 Governorate Amman 21.0 78.8 0.2 100.0 4,442 Balqa 14.2 85.7 0.1 100.0 645 Zarqa 13.3 86.7 0.0 100.0 1,645 Madaba 14.3 85.7 0.0 100.0 262 Irbid 16.6 83.0 0.4 100.0 1,993 Mafraq 15.4 84.4 0.2 100.0 460 Jarash 15.5 84.5 0.0 100.0 293 Ajloun 14.6 85.4 0.0 100.0 228 Karak 16.0 83.9 0.1 100.0 378 Tafiela 14.9 85.0 0.1 100.0 146 Ma'an 14.2 85.7 0.2 100.0 164 Aqaba 16.4 83.4 0.2 100.0 221 Region Central 18.3 81.5 0.1 100.0 6,993 North 16.2 83.5 0.3 100.0 2,975 South 15.6 84.3 0.2 100.0 908 Badia area Badia 14.1 85.7 0.1 100.0 823 Other 17.8 82.0 0.2 100.0 10,053 Education No education 4.5 95.3 0.2 100.0 416 Elementary 9.2 90.1 0.6 100.0 813 Preparatory 13.3 86.5 0.2 100.0 1,681 Secondary 17.2 82.7 0.1 100.0 4,788 Higher 24.1 75.8 0.2 100.0 3,179 Wealth quintile Lowest 15.7 83.7 0.6 100.0 2,211 Second 16.4 83.6 0.0 100.0 2,296 Middle 18.5 81.5 0.1 100.0 2,206 Fourth 17.6 82.3 0.0 100.0 2,135 Highest 19.5 80.3 0.2 100.0 2,028 Total 17.5 82.3 0.2 100.0 10,876 9.6 CANCER SCREENING Women themselves detect most breast cancers. Therefore, breast self-examination (BSE) is a very important part of every adult woman’s personal health regimen. BSE should be performed monthly beginning at age 20 and should continue each month throughout a woman’s lifetime. In addition to BSE, adult women should receive regular physician-performed clinical breast exams. Table 9.12 shows the percentage of women who have had a breast cancer self-exam or an exam by a health specialist. Maternal Health | 111 Table 9.12 Breast cancer exam and pap smear Percentage of women who had a breast cancer self exam or an exam by a health specialist to detect breast cancer in the twelve months preceding the survey, percentage who have heard of Pap smear, and percentage who ever had a Pap smear, according to background characteristics, Jordan 2007 Background characteristic Had a breast cancer self- exam in past 12 months Had a breast cancer exam by a specialist in past 12 months Had a breast cancer self- exam or exam by a specialist in past 12 months Has heard of Pap smear Ever had a Pap smear Number of women Age 15-19 13.0 8.8 17.1 43.4 2.8 236 20-29 27.4 15.0 33.1 68.1 9.2 3,253 30-39 33.6 20.4 39.9 81.1 19.7 4,265 40-49 34.9 22.2 41.5 81.9 25.7 3,122 Number of living children 0 26.6 15.6 31.4 61.6 10.2 1,021 1-2 30.0 16.6 35.5 71.4 10.5 2,787 3-4 34.7 21.3 41.0 81.1 20.4 3,471 5+ 31.5 19.7 38.4 80.6 23.5 3,597 Residence Urban 32.8 19.8 39.1 77.4 18.8 9,249 Rural 24.9 14.9 30.3 72.4 12.7 1,627 Governorate Amman 31.8 21.2 38.1 74.1 20.5 4,442 Balqa 33.4 15.4 37.0 69.2 13.5 645 Zarqa 41.1 19.4 46.2 83.6 15.9 1,645 Madaba 31.8 24.4 37.3 71.6 19.4 262 Irbid 31.7 18.7 38.8 81.2 19.1 1,993 Mafraq 20.4 11.8 26.5 75.3 12.8 460 Jarash 29.4 26.0 40.1 84.0 24.5 293 Ajlun 29.2 16.5 37.8 86.4 20.5 228 Karak 23.5 13.3 28.9 67.4 8.1 378 Tafiela 17.3 9.9 21.9 70.4 7.3 146 Ma'an 14.9 7.4 18.5 62.6 5.2 164 Aqaba 16.6 13.5 23.7 74.1 12.2 221 Region Central 34.2 20.3 39.9 75.8 18.8 6,993 North 29.5 18.2 37.0 81.0 18.8 2,975 South 19.3 11.7 24.6 68.6 8.5 908 Badia area Badia 23.7 15.4 28.3 64.9 10.5 823 Other 32.3 19.3 38.6 77.6 18.5 10,053 Mother's education No education 13.6 11.6 16.8 56.6 9.1 416 Elementary 19.8 13.0 25.6 63.1 12.6 813 Preparatory 24.9 16.3 30.2 73.3 17.1 1,681 Secondary 30.2 19.1 36.8 77.3 17.7 4,788 Higher 42.9 22.9 49.3 83.4 21.2 3,179 Wealth quintile Lowest 25.4 13.7 29.7 65.9 9.4 2,211 Second 28.8 15.9 34.2 74.9 15.2 2,296 Middle 32.9 19.2 39.3 78.1 15.3 2,206 Fourth 31.9 17.9 37.4 80.2 21.1 2,135 Highest 40.1 29.3 49.5 84.9 29.5 2,028 Total 31.7 19.0 37.8 76.6 17.9 10,876 About two-fifths of women (38 percent) had a breast cancer exam in the twelve months preceding the survey, either by a self-examination (32 percent) or a clinical exam (19 percent). This represents a significant increase from 2002 (17 percent). Older women, those who have three children or more, women who live in urban areas, in the Central region in the non-Badia areas, women with higher education, and those in highest wealth quintiles are more likely to have had a breast cancer self-exam or an examination by a health professional than other women. 112 | Maternatl Health Pap smear or the Pap test checks for changes in the cells of the cervix (a lower part of the uterus/womb that opens into the birth canal) that show cervical cancer or conditions that may develop into cervical cancer. The pre-cancerous changes are usually caused by sexually-transmitted human papillomaviruses (HPV). The test aims to detect and prevent the progression of HPV-induced cervical cancer and other abnormalities in the female genital tract. If detected early, cervical cancer can be cured. All women aged 21 or older or sexually active should have an annual Pap smear. During the survey, women were also asked whether they have ever heard about the Pap smear for detecting cervical cancer. They were also asked if they ever had a Pap smear. Table 9.12 shows that 77 percent of women have heard about the Pap smear for detecting cervical cancer and 18 percent of women have ever undergone this test. As with breast cancer exams, older women, women who have three children or more, women residing in urban areas, in the Central and North regions, in the non-Badia areas, women with higher education and those in highest wealth quintiles are more likely to have had a Pap smear than other women. 9.7 KNOWLEDGE OF TUBERCULOSIS Tuberculosis (TB) is an infectious disease caused by mycobacteria. TB usually attacks the lungs (as pulmonary TB) but it can also affect other systems of the body. TB is spread through air when an infectious person coughs, sneeze or spits. In the 2007 JPFHS, women were asked if they have ever heard of tuberculosis. They were also asked which means of TB transmission they knew, if TB can be cured, and if they would be willing to take a TB test. Table 9.13 shows that 95 percent of women have ever heard of TB. No significant variation in knowledge of TB was observed according to most background characteristics of women. However, only 75 percent of ever-married women aged 15-19 have heard of TB; in addition, there are variations by women’s educational level and household wealth quintile. Results indicate that women with higher education and women in highest wealth quintiles are more knowledgeable about TB than women with less education and those in lowest wealth quintiles. Data indicate that, among women who have heard of TB, only 42 percent know how TB is transmitted from one person to another. Knowledge of the means of transmission of TB is the highest among women aged 40-49, women residing in the Central region and in the non-Badia areas. However, even among these women, only less than 50 percent know that TB is spread through the air by coughing or sneezing by an infected person. Wider variations are found by educational level of women and household wealth quintile. Knowledge of the mean of transmission of TB increases as educational level and wealth quintile increase. However, only 59 percent of women with higher education and 60 percent of women in the highest wealth quintile know how TB is spread from person to person. Maternal Health | 113 Table 9.13 also shows that 62 percent of women who have ever heard of TB reported that it can be cured. Variations according to background characteristics follow approximately the same pattern as the knowledge of the route of transmission of TB, however differences are negligible. Data also indicate that 59 percent of women would be willing to take a TB test: variations by background characteristics are smaller (from a minimum of 51 percent in Mafraq to a maximum of 67 percent in Jarash and Zarqa) and do not follow any clear pattern. Table 9.13 Knowledge and attitude concerning tuberculosis Percentage of ever-married women who have heard of tuberculosis (TB), and among women who have heard of TB, the percentages who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would be willing to take a tuberculosis test by background characteristics, Jordan 2007 Among all respondents Among respondents who have heard of TB, the percentage who: Background characteristic Percentage who have heard of TB Number Report that TB is spread through the air by coughing Believe that TB can be cured Would be willing to take a TB test Number Age 15-19 75.2 236 21.4 46.6 61.3 178 20-24 92.0 1,276 29.0 51.2 56.4 1,174 25-29 95.3 1,977 38.0 58.4 60.6 1,883 30-34 95.5 2,213 41.6 61.7 59.9 2,114 35-39 95.6 2,052 44.3 65.2 57.0 1,962 40-44 95.9 1,884 49.5 67.4 58.4 1,806 45-49 96.0 1,239 49.8 70.6 57.8 1,190 Residence Urban 94.9 9,249 42.9 62.3 58.1 8,775 Rural 94.1 1,627 36.6 62.4 61.3 1,530 Governorate Amman 95.1 4,442 46.0 62.6 57.9 4,225 Balqa 90.5 645 46.3 57.1 60.0 583 Zarqa 96.3 1,645 49.8 62.7 66.5 1,584 Madaba 93.8 262 47.6 70.6 64.8 246 Irbid 95.1 1,993 32.3 63.1 52.6 1,896 Mafraq 93.4 460 35.3 65.6 50.7 430 Jarash 94.6 293 38.2 59.0 67.2 277 Ajloun 95.5 228 26.5 57.1 66.4 218 Karak 94.0 378 34.3 60.4 55.3 355 Tafiela 93.0 146 32.4 58.1 55.3 136 Ma'an 91.0 164 34.2 63.2 56.5 149 Aqaba 93.5 221 31.5 60.2 62.3 207 Region Central 94.9 6,993 47.0 62.4 60.4 6,637 North 94.8 2,975 32.9 62.6 54.8 2,821 South 93.2 908 33.3 60.5 57.2 846 Badia area Badia 92.9 823 34.9 65.5 59.4 765 Other 94.9 10,053 42.6 62.1 58.5 9,540 Education No education 80.8 416 25.2 55.2 57.9 336 Elementary 87.9 813 26.7 51.8 51.9 715 Preparatory 92.6 1,681 32.9 56.7 59.0 1,557 Secondary 95.5 4,788 37.3 60.4 59.8 4,573 Higher 98.3 3,179 58.7 71.2 58.3 3,124 Wealth quintile Lowest 89.9 2,211 29.7 53.2 57.9 1,988 Second 94.4 2,296 36.2 61.8 61.3 2,166 Middle 95.0 2,206 38.6 62.0 57.7 2,096 Fourth 96.7 2,135 46.4 63.2 57.3 2,064 Highest 98.2 2,028 59.6 71.3 58.6 1,991 Total 94.7 10,876 42.0 62.3 58.6 10,305 Child Health | 115 CHILD HEALTH 10 This chapter presents findings on several areas of importance to child health: characteristics of the neonate (birth weight), vaccination status of children, and the prevalence and treatment of childhood illnesses, namely acute respiratory infection (ARI), fever, and diarrhea. 10.1 BIRTH WEIGHT Birth weight is an important indicator of a child’s vulnerability to the risk of childhood illness and chances of survival. Children whose birth weight is less than 2.5 kilograms are considered to have a higher than average risk of early childhood death. In the 2007 JPFHS, for all births during the five-year period preceding the survey, mothers were asked to report the weight in kilograms if the baby had been weighed after delivery. Table 10.1 shows that nearly all babies were weighed at birth. Among those births for which the baby’s weight was reported, about 11 percent were classified as low birth weight (i.e., they weighed less than 2.5 kilograms at birth) and 89 percent weighed 2.5 kilograms or more. Table 10.1 Child's weight at birth Percentage of live births in the five years preceding the survey with a reported birth weight, and percent distribution of live births in the five years preceding the survey with a reported birth weight by birth weight, according to background characteristics, Jordan 2007 Percent distribution of births with a reported birth weight1 Background characteristic Percentage of all births with a reported birth weight Number of births Less than 2.5 kg 2.5 kg or more Total Number of births Mother's age at birth <20 99.6 541 12.3 87.7 100.0 539 20-34 99.2 7,612 11.1 88.9 100.0 7,547 35-49 98.8 1,712 10.3 89.7 100.0 1,691 Birth order 1 99.5 2,161 12.5 87.5 100.0 2,150 2-3 99.5 3,797 11.4 88.6 100.0 3,778 4-5 98.9 2,390 9.7 90.3 100.0 2,363 6+ 98.0 1,516 10.0 90.0 100.0 1,486 Mother's smoking status Smokes cigarettes/nargila 99.2 904 16.7 83.3 100.0 897 Does not smoke 99.1 8,960 10.5 89.5 100.0 8,879 Residence Urban 99.2 8,262 10.7 89.3 100.0 8,200 Rural 98.4 1,601 13.0 87.0 100.0 1,576 Governorate Amman 99.5 3,784 11.2 88.8 100.0 3,765 Balqa 99.2 615 10.1 89.9 100.0 610 Zarqa 99.7 1,486 7.8 92.2 100.0 1,481 Madaba 99.1 242 13.4 86.6 100.0 240 Irbid 98.8 1,861 10.0 90.0 100.0 1,838 Mafraq 98.1 479 15.4 84.6 100.0 470 Jarash 99.4 290 12.4 87.6 100.0 289 Ajloun 99.9 233 12.4 87.6 100.0 233 Karak 98.9 348 10.3 89.7 100.0 344 Tafiela 98.2 140 17.0 83.0 100.0 138 Ma'an 95.6 167 23.0 77.0 100.0 160 Aqaba 96.1 217 15.2 84.8 100.0 209 Continued… 116 | Child Health Table 10.1—Continued Percent distribution of births with a reported birth weight1 Background characteristic Percentage of all births with a reported birth weight Number of births Less than 2.5 kg 2.5 kg or more Total Number of births Region Central 99.5 6,127 10.4 89.6 100.0 6,096 North 98.8 2,864 11.3 88.7 100.0 2,830 South 97.5 873 15.0 85.0 100.0 851 Badia area Badia 97.4 876 14.5 85.5 100.0 853 Other 99.3 8,988 10.7 89.3 100.0 8,923 Mother's education No education 93.8 241 23.6 76.4 100.0 226 Elementary 95.9 591 19.8 80.2 100.0 567 Preparatory 99.3 1,365 13.1 86.9 100.0 1,355 Secondary 99.5 4,735 10.5 89.5 100.0 4,713 Higher 99.4 2,932 8.2 91.8 100.0 2,915 Wealth quintile Lowest 98.0 2,541 16.6 83.4 100.0 2,491 Second 99.6 2,342 9.9 90.1 100.0 2,333 Middle 99.4 2,061 8.7 91.3 100.0 2,049 Fourth 99.3 1,634 7.2 92.8 100.0 1,623 Highest 99.6 1,285 10.9 89.1 100.0 1,281 Total 99.1 9,864 11.0 89.0 100.0 9,776 1 Based on either a written record or the mother's recall Births to mothers younger than 20 years, first-order births, and births to women who smoke are more likely to weigh less than 2.5 kg at birth. The proportion of low birth weight is higher in rural areas than in urban areas (13 percent, compared to 11 percent), in the Badia areas than the non-Badia areas (15 and 11 percent, respectively) and in the South region than in the North and Central regions (15 percent, compared to 11 and 10 percent, respectively). By governorate, the proportion of low birth weight varies from 8 percent in Zarqa to 23 percent in Ma’an. Low birth weight is also associated with mother’s education, ranging from 24 percent when the mother has no education to 8 percent for mothers with higher education. 10.2 VACCINATION COVERAGE Universal immunization of children from six vaccine-preventable diseases (tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles) is a crucial component in any strategy to reduce infant and child mortality. Differences in vaccination coverage among subgroups of the population are of great assistance for program planning and targeting resources to areas most in need. Additionally, information on immunization coverage is important for the monitoring and evaluation of the Expanded Program on Immunization (EPI). Jordan joined UNICEF’s “Child Survival Revolution” in 1980. Since then, the Ministry of Health has made the vaccination card a requirement for entry into the school system. The card is issued through various service providers at the time of a child’s first vaccination. Upon registering at the Maternal and Child Health Center, each child receives a health card that shows vaccinations and the child’s height and weight. Child Health | 117 The survey collected information on vaccination coverage for all living children born in the five years preceding the survey. According to the guidelines developed by the World Health Organization (WHO), children are considered fully vaccinated when they have received a vaccination against tuberculosis (BCG), three doses of DPT vaccine (against diphtheria, pertussis and tetanus), three doses of polio vaccine, and one dose of measles vaccination by the age of 12 months. BCG should be given at birth or at first clinical contact, DPT and polio require three vaccinations at approximately 4, 8, and 12 weeks of age, and measles should be given at nine months of age. Information on vaccination coverage was collected in two ways: from vaccination cards shown to the interviewer, and from mothers’ verbal reports. If the child’s vaccination card was available, the interviewer copied the vaccination dates from the card directly onto the questionnaire. When there was no vaccination card for the child, the respondent was asked to recall the vaccines given to her child. The proportion of vaccination cards seen by the interviewer (90 percent) is higher compared to 2002 JPFHS (78 percent). Table 10.2 and Figure 10.1 show the percentage of children age 12-23 months who have received various vaccinations by source of information, that is, whether from a vaccination card or mother’s report. Children age 12-23 months is the youngest cohort of children who have reached the age by which they should be fully vaccinated. Table 10.2 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Jordan 2007 DPT Polio Source of information BCG 1 2 3 1 2 3 Measles All basic vaccina- tions except BCG1 All basic vaccina- tions including BCG2 No vaccina- tions Number of children Vaccinated at any time before survey Vaccination card 82.7 90.0 89.6 88.9 90.2 89.9 89.4 85.8 85.5 79.0 0.0 1,688 Mother's report 8.6 8.9 8.8 8.6 8.9 8.9 8.6 8.5 8.2 8.0 0.8 182 Both sources 91.3 98.9 98.4 97.4 99.1 98.7 98.0 94.3 93.7 87.0 0.8 1,870 Vaccinated by 12 months of age3 89.5 98.4 97.4 96.0 98.6 97.6 96.6 85.8 85.2 79.2 1.3 1,870 1 Measles and three doses each of DPT and polio vaccine 2 BCG, measles, and three doses each of DPT and polio vaccine 3 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. Ninety-four percent of children have received all vaccines with the exception of BCG, which is similar to that of the previous survey in 2002. However, the percentage of children fully immunized including BCG (87 percent) has increased significantly compared to 2002 JPFHS (28 percent). Before 2002, children in Jordan did not always receive the BCG vaccine; it was only included as part of the national vaccination program following the 2002 JPFHS survey, hence the sharp increase in the percentage of children fully immunized (including BCG) in the 2007 survey. Ninety-four percent of children are vaccinated against measles; this figure includes children who have received either the measles vaccine or the MMR vaccine, a combination vaccine against measles, mumps and rubella. 118 | Child Health Coverage for the first and second doses of DPT is slightly higher (about 99 percent for the first dose and 98 percent for the second dose) than that for the third dose of DPT (97 percent). Although DPT and polio vaccines are often administered at the same time, polio coverage is slightly higher than DPT coverage. The dropout between the first and third doses of the polio vaccine is slightly higher than that between the first and third doses of DPT. Table 10.3 shows the vaccination coverage by background characteristics among children aged 12-23 months. Vaccination coverage is high regardless of background characteristic, an indication of the success of the immunization program in reaching out to all population subgroups. There are slight variations in vaccination coverage by sex: 86 percent of boys were fully vaccinated compared to 88 percent of girls. There are also slight variations in vaccination coverage between urban and rural areas (89 percent were fully vaccinated in urban areas compared to 77 percent in rural areas). Vaccination coverage in the Central and North regions and the non-Badia areas is higher than that for other children. Table 10.3 also shows significant variations according to the level of education of the mother. Women with no education show relatively low vaccination coverage for their children, particularly that of BCG (59 percent of children of women with no education are fully vaccinated compared to 89 percent of children of women with higher than secondary education). There are also differences in vaccination coverage by household wealth quintile. Children in the poorest households are least likely to be fully vaccinated (82 percent), while children living in households in the middle wealth quintile are more likely to be fully vaccinated (90 percent) than children in other households. 91 99 98 97 99 99 98 94 94 87 BCG 1 2 3 1 2 3 Measles All (except BCG) All 0 20 40 60 80 100 Percent Figure 10.1 Percentage of Children Age 12-23 Months with Specific Vaccinations JPFHS 2007 DPT Polio Child Health | 119 Table 10.3 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother's report), and percentage with a vaccination card, by background characteristics, Jordan 2007 DPT Polio Background characteristic BCG 1 2 3 1 2 3 Measles All basic vaccina- tions except BCG1 All basic vaccina- tions including BCG2 No vaccina- tions Percent- age with a vaccina- tion card seen Number of children Sex Male 90.9 99.0 98.3 96.6 99.1 98.5 97.2 93.3 92.0 85.7 0.9 87.9 899 Female 91.6 98.7 98.5 98.2 99.2 98.9 98.7 95.3 95.2 88.2 0.8 92.4 971 Birth order 1 92.8 97.8 97.7 97.7 97.8 97.7 97.7 94.5 94.4 90.0 2.2 83.8 391 2-3 92.2 99.6 99.3 97.8 99.6 99.3 98.6 95.1 93.8 87.7 0.4 90.0 761 4-5 90.7 99.0 97.9 97.6 100.0 99.2 98.5 93.9 93.4 85.8 0.0 93.6 470 6+ 87.1 98.0 97.7 95.8 98.2 97.7 95.8 92.8 92.6 82.3 1.7 95.0 248 Residence Urban 92.7 98.8 98.6 97.5 99.1 98.8 98.1 94.9 94.3 89.0 0.9 91.0 1,564 Rural 83.9 99.5 97.6 97.0 99.5 98.3 97.2 91.5 90.6 77.1 0.5 86.8 306 Governorate Amman 94.8 98.4 98.4 96.7 99.0 99.0 98.0 94.3 93.1 90.0 1.0 88.5 755 Balqa 92.5 100.0 100.0 100.0 100.0 100.0 100.0 96.2 96.2 89.6 0.0 96.2 108 Zarqa 90.6 99.3 98.7 98.7 99.3 98.7 98.7 95.8 95.8 87.3 0.7 96.9 260 Madaba 88.1 99.3 98.7 98.7 99.3 98.7 98.7 95.4 95.4 86.2 0.7 96.8 43 Irbid 95.3 99.2 98.7 98.7 99.2 99.2 98.7 96.8 96.3 92.4 0.8 87.7 348 Mafraq 90.2 98.9 97.2 96.6 98.9 97.2 96.6 90.5 90.5 82.3 1.1 86.1 85 Jarash 89.1 99.4 99.4 98.3 99.4 99.4 98.3 94.1 94.1 85.0 0.6 91.5 59 Ajloun 96.3 98.8 96.3 94.3 98.8 96.3 94.3 89.8 89.8 87.9 0.6 88.8 43 Karak 47.0 99.0 99.0 98.3 99.0 99.0 98.3 92.1 92.1 45.5 1.0 87.0 62 Tafiela 78.8 99.3 97.9 97.4 99.3 97.9 97.4 89.8 89.1 72.6 0.7 91.3 26 Ma'an 87.6 96.3 92.6 88.9 98.4 93.7 89.4 86.4 83.8 77.2 1.1 92.9 38 Aqaba 77.3 99.0 97.6 96.3 99.0 97.6 96.7 86.6 86.2 71.8 1.0 90.2 46 Region Central 93.4 98.8 98.6 97.5 99.2 99.0 98.3 94.9 94.1 89.2 0.8 91.4 1,165 North 93.9 99.1 98.3 97.9 99.1 98.6 97.9 94.9 94.6 89.6 0.8 88.0 535 South 68.8 98.5 97.1 95.5 98.9 97.3 95.8 89.0 88.2 63.5 1.0 89.8 170 Badia area Badia 88.1 98.9 96.8 95.6 99.1 96.9 95.9 90.3 89.6 80.8 0.8 88.2 181 Other 91.6 98.9 98.6 97.6 99.1 98.9 98.2 94.8 94.1 87.7 0.8 90.5 1,689 Mother's education No education 67.1 94.7 91.5 89.3 95.6 92.0 89.3 86.1 84.6 58.9 4.4 88.2 40 Elementary 84.3 96.8 95.3 90.8 96.8 95.3 90.8 82.0 82.0 71.6 3.1 89.5 116 Preparatory 87.7 98.9 96.9 96.4 98.9 97.8 96.4 93.9 93.0 82.8 1.1 93.5 203 Secondary 92.6 99.1 98.9 98.2 99.1 98.9 98.8 95.9 95.3 89.8 0.9 89.1 909 Higher 93.5 99.2 99.2 98.4 100.0 99.9 99.3 95.1 94.3 89.0 0.0 91.2 602 Wealth quintile Lowest 88.1 98.7 97.9 96.6 98.8 97.9 96.6 91.9 91.8 82.2 1.2 91.4 494 Second 92.2 99.0 98.4 97.3 99.0 98.5 97.4 94.8 94.0 87.9 1.0 92.4 464 Middle 92.2 99.5 99.5 97.8 99.6 99.5 99.4 97.0 95.4 90.0 0.3 90.1 386 Fourth 92.3 98.7 98.1 98.1 98.7 98.7 98.1 93.2 92.6 87.8 1.3 89.5 300 Highest 93.4 98.0 98.0 98.0 99.8 99.8 99.8 95.8 95.8 89.4 0.2 84.9 226 Total 91.3 98.9 98.4 97.4 99.1 98.7 98.0 94.3 93.7 87.0 0.8 90.3 1,870 1 Measles and three doses each of DPT and polio vaccine 2 BCG, measles, and three doses each of DPT and polio vaccine 10.2.1 Trends in Vaccination Coverage One way of measuring trends in vaccination coverage is to compare coverage among children of different ages. Table 10.4 shows the percentage of children aged 12-59 months who have received vaccinations during the first year of life according to their current age. This type of data can provide evidence of any trends in the vaccination coverage over the past five years. 120 | Child Health Table 10.4 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by 12 months of age, and percentage with a vaccination card, by current age of child, Jordan 2007 DPT Polio Age in months BCG 1 2 3 1 2 3 Measles All basic vaccina- tions except BCG1 All basic vaccina- tions including BCG2 No vaccina- tions Percent- age with a vaccina- tion card seen Numbe r of children 12-23 89.5 98.4 97.4 96.0 98.6 97.6 96.6 85.8 85.2 79.2 1.3 90.3 1,870 24-35 77.1 98.2 98.0 97.3 98.2 97.8 97.3 86.9 83.3 68.2 1.6 90.2 1,907 36-47 76.8 97.9 97.8 96.6 98.0 97.9 97.0 87.4 84.1 69.2 1.7 88.7 1,976 48-59 72.0 97.2 96.5 95.5 97.3 96.6 95.7 89.1 85.4 66.2 2.6 73.1 1,900 Total 78.9 97.9 97.5 96.4 98.1 97.5 96.7 87.3 84.7 70.7 1.8 85.6 7,652 Note: Information was obtained from the vaccination card or if there was no written record, from the mother. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccinations. 1 Measles and three doses each of DPT and polio vaccine 2 BCG, measles, and three doses each of DPT and polio vaccine There has been little change in the vaccination coverage over the past five years. Table 10.4 does not show any change in vaccination coverage for any vaccination, with the exception of BCG. There has been an increase of 16 percentage points in BCG coverage (72 percent in age group 48-59 months to 90 percent in age group 12-23 months). In the past five years, full vaccination coverage (including BCG) has increased from 66 to 79 percent, while the percentage of children receiving measles vaccination declined slightly (from 89 percent of children aged 48-59 months to 86 percent aged 12-23 months). Vaccination cards were seen by the interviewer for 90 percent of children aged 12-23 months compared to 73 percent of children aged 48-59 months. The lower percentage of cards shown for older children could be because vaccination cards for children in kindergarten are generally kept at the school and would not be available at the time of the survey. 10.2.2 Additional Doses Tables 10.5.1 and 10.5.2 show the percentage of children aged 24-59 months who received polio, DPT, Hepatitis, Hib, Measles and MMR vaccines at any time before the survey. Children generally receive the three polio doses at one-month intervals. In addition, a fourth dose of polio is given at nine months of age and a booster dose is given at 18 months of age. There are no significant differences observed in polio vaccination coverage for three doses of polio (more than 99 percent of children aged 24-59 months). However, there is a significant decrease between the proportion of children vaccinated with the fourth dose of polio (92 percent) and those vaccinated with the booster (87 percent). This drop in vaccination coverage for the polio booster could be due to the fact that only children less than five years of age were included in the 2007 JPFHS, while the booster dose is generally given to the children between the ages of 5 and 6 years. Therefore, a large percentage of children included in the survey were still too young to have received the booster dose. Coverage of the three doses of DPT in children aged 24-59 months is high (more than 99 percent). As is the case for polio, coverage for the DPT booster (88 percent), usually given at 18 months, is considerably lower than DPT 3 (99 percent). Child Health | 121 Table 10.5.1 Vaccinations of children 24-59 months by background characteristics (Part 1) Percentage of children age 24-59 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother's report), and percentage with a vaccination card, by background characteristics, Jordan 2007 Polio DPT Background characteristic 1 2 3 4 Booster 1 2 3 Booster Number of children Sex Male 99.6 99.4 99.2 91.8 87.1 99.5 99.4 99.3 88.5 2,963 Female 99.3 99.2 98.9 91.4 86.7 99.2 99.1 98.8 87.7 2,819 Birth order 1 99.2 99.1 99.1 92.0 87.3 99.0 98.9 98.9 88.5 1,311 2-3 99.5 99.4 99.1 90.7 86.3 99.6 99.4 99.3 87.9 2,163 4-5 99.5 99.5 99.4 92.8 88.8 99.5 99.5 99.4 89.6 1,402 6+ 99.4 99.2 98.4 91.4 85.1 99.1 99.0 98.1 85.9 906 Residence Urban 99.4 99.4 99.1 91.9 87.5 99.3 99.2 99.1 88.8 4,887 Rural 99.4 99.1 98.8 89.8 83.6 99.4 99.2 98.8 84.5 895 Governorate Amman 99.8 99.8 99.3 91.1 86.3 99.8 99.8 99.5 87.7 2,195 Balqa 100.0 100.0 100.0 90.9 88.7 100.0 100.0 100.0 89.6 367 Zarqa 99.1 98.7 98.7 93.4 89.4 99.1 98.7 98.7 90.8 943 Madaba 99.4 99.4 98.8 96.1 92.3 99.4 99.4 98.8 91.4 141 Irbid 99.2 99.2 99.2 94.0 89.6 98.7 98.7 98.7 90.9 1,053 Mafraq 98.4 98.4 98.3 92.2 89.3 98.6 98.6 98.4 89.7 280 Jarash 99.5 99.5 99.5 95.3 91.5 99.5 99.5 99.5 91.9 158 Ajloun 99.5 99.5 99.5 95.9 94.2 99.5 99.5 99.5 94.2 144 Karak 99.5 99.3 99.1 85.2 72.6 99.5 98.9 98.7 74.5 201 Tafiela 99.8 99.8 99.4 84.0 78.5 99.8 99.6 99.4 79.1 83 Ma'an 98.1 96.3 95.6 81.5 70.3 97.0 96.0 94.9 70.8 94 Aqaba 99.0 98.6 97.6 76.0 67.9 98.8 98.2 97.1 69.8 124 Region Central 99.6 99.5 99.2 91.9 87.6 99.6 99.5 99.3 88.8 3,645 North 99.1 99.1 99.1 94.0 90.1 98.9 98.9 98.8 91.1 1,635 South 99.2 98.7 98.1 82.0 72.0 98.9 98.3 97.7 73.4 502 Badia area Badia 99.0 98.5 97.9 90.1 84.4 98.9 98.5 97.8 84.7 502 Other 99.5 99.4 99.2 91.7 87.2 99.4 99.3 99.2 88.4 5,281 Mother's education No education 99.1 98.7 93.6 80.2 72.6 98.8 98.5 93.6 76.6 154 Elementary 98.9 98.8 97.2 89.5 82.8 98.9 98.7 98.4 87.0 362 Preparatory 99.6 99.6 99.6 94.1 90.7 99.6 99.6 99.6 90.0 810 Secondary 99.4 99.2 99.2 91.9 87.4 99.2 99.1 99.0 88.4 2,743 Higher 99.6 99.6 99.5 91.4 86.6 99.6 99.5 99.5 88.1 1,713 Wealth quintile Lowest 99.5 99.2 98.2 91.1 85.8 99.3 99.0 98.4 87.5 1,428 Second 99.5 99.4 99.4 93.9 90.2 99.3 99.3 99.2 90.5 1,319 Middle 99.6 99.6 99.6 92.9 89.3 99.7 99.6 99.6 89.7 1,210 Fourth 98.7 98.5 98.5 89.3 85.2 98.7 98.5 98.5 86.1 1,017 Highest 100.0 100.0 99.9 89.7 82.4 100.0 100.0 99.9 85.6 808 Total 99.4 99.3 99.1 91.6 86.9 99.4 99.2 99.0 88.1 5,782 122 | Child Health Table 10.5.2 Vaccinations of children 24-59 months by background characteristics (Part 2) Hepatitis B Hib Background characteristic 1 2 3 1 2 3 Measles MMR Percent- age with a vaccina- tion card seen Number of children Sex Male 99.6 99.3 99.0 99.4 99.2 99.1 98.5 96.1 84.2 2,963 Female 99.2 99.1 98.6 99.0 99.0 98.6 98.4 95.7 83.9 2,819 Birth order 1 99.0 98.9 98.6 99.0 98.9 98.9 98.2 96.8 84.5 1,311 2-3 99.6 99.4 99.1 99.3 99.2 99.1 98.7 95.9 83.4 2,163 4-5 99.5 99.4 99.2 99.5 99.4 99.2 98.9 97.0 86.2 1,402 6+ 99.1 98.9 98.0 99.0 98.8 97.8 97.6 92.9 82.0 906 Residence Urban 99.4 99.2 98.9 99.2 99.1 99.0 98.5 96.3 84.6 4,887 Rural 99.4 99.1 98.6 99.2 98.9 98.6 98.0 93.5 81.5 895 Governorate Amman 99.8 99.8 99.1 99.8 99.8 99.5 98.9 96.0 87.1 2,195 Balqa 100.0 100.0 100.0 100.0 100.0 99.8 99.6 98.5 86.1 367 Zarqa 99.1 98.7 98.7 99.1 98.7 98.7 98.6 98.0 88.0 943 Madaba 99.4 99.0 98.0 98.9 98.4 98.0 97.4 94.8 90.6 141 Irbid 98.7 98.7 98.7 98.5 98.5 98.5 97.9 95.5 77.8 1,053 Mafraq 98.6 98.6 98.4 98.4 98.4 98.3 97.7 95.0 78.4 280 Jarash 99.5 99.5 99.5 99.5 99.5 99.5 98.5 96.4 81.1 158 Ajloun 99.5 99.5 99.5 99.5 99.5 99.5 98.5 96.7 75.3 144 Karak 99.8 98.4 97.9 98.2 97.5 97.0 99.3 92.2 78.8 201 Tafiela 99.8 99.6 99.4 99.8 99.6 99.4 98.8 96.7 81.4 83 Ma'an 97.0 96.0 94.7 96.7 95.8 94.4 94.6 85.0 84.1 94 Aqaba 98.6 97.9 96.9 98.6 97.9 96.9 94.8 90.9 78.4 124 Region Central 99.6 99.5 99.0 99.6 99.5 99.3 98.9 96.7 87.4 3,645 North 98.9 98.9 98.8 98.7 98.7 98.7 98.0 95.6 78.0 1,635 South 99.0 98.0 97.3 98.3 97.6 96.9 97.2 91.3 80.1 502 Badia area Badia 98.9 98.4 97.6 98.8 98.3 97.6 96.7 92.5 84.6 502 Other 99.4 99.3 99.0 99.3 99.2 99.0 98.6 96.2 84.0 5,281 Mother's education No education 98.8 98.0 93.0 98.7 97.9 93.2 91.6 89.5 77.9 154 Elementary 98.9 98.6 98.2 98.9 98.6 98.2 96.2 93.9 83.7 362 Preparatory 99.6 99.6 99.5 99.6 99.6 99.5 99.1 95.3 87.8 810 Secondary 99.2 99.0 98.7 99.0 98.9 98.8 98.5 95.8 85.0 2,743 Higher 99.6 99.5 99.4 99.5 99.5 99.4 99.3 97.4 81.5 1,713 Wealth quintile Lowest 99.3 99.0 97.7 99.2 98.8 98.2 97.4 94.5 85.2 1,428 Second 99.3 99.2 99.1 99.2 99.1 99.0 98.8 97.1 86.0 1,319 Middle 99.7 99.6 99.5 99.5 99.5 99.5 99.5 97.5 85.0 1,210 Fourth 98.6 98.4 98.4 98.5 98.4 98.4 98.2 94.3 82.5 1,017 Highest 100.0 100.0 99.9 99.9 99.9 99.9 98.8 96.1 79.8 808 Total 99.4 99.2 98.8 99.2 99.1 98.9 98.5 95.9 84.1 5,782 10.2.3 Additional Vaccinations Hepatitis B Hepatitis B is a viral disease that primarily attacks the liver. Primary vaccination consists of three intramuscular injections: the first dose is administered at the end of the second month, and the second and third doses are given between the third and fourth month, and between the second and seventeenth month, respectively. The percentage of children vaccinated against Hepatitis B is shown in Table 10.5.2. Ninety- nine percent of children received three doses of Hepatitis vaccination. There is very little variation in vaccination coverage according to background characteristics. Child Health | 123 Haemophilus influenza type b (Hib) Haemophilus influenza type b (Hib) is a bacterial disease that can cause meningitis in infants and severe infection of the epiglottis in older children. Children should receive doses of Hib vaccine at two and three months of age, respectively, and a third dose may be given at four months of age. Results in Table 10.5.2 show that 99 percent of children age 24-59 months received the Hib vaccine, with a substantial increase compared to the 2002 JPFHS (only 11 percent of children received the first dose of Hib). Variations in vaccination coverage for Hib are negligible. Measles/MMR Since 1995, a routine two-dose schedule has been recommended for measles vaccination. The purpose of the second dose is to produce immunity to measles in a person who fails to respond to the first dose. Children generally receive the second dose of measles vaccine as a combined MMR vaccine. The first dose is administered at 9 months of age and the second dose, as part of the MMR vaccine, is recommended at 18 months. Ninety-nine percent of children age 24-59 months received the first dose of the measles vaccine (Table 10.5.2) and a combined MMR was given to 96 percent of children. A higher proportion of measles coverage (99 percent) is observed for children of mothers who have at least a preparatory education compared to children of mothers have no education (92 percent). There are slight variations in MMR coverage by birth order and residence and according to the mother’s level of education (97 percent for children of mothers with higher than secondary education compared to 90 percent for children of mothers with no education). 10.3 ACUTE RESPIRATORY INFECTION Acute Respiratory Infection (ARI) is a leading cause of childhood morbidity and mortality throughout the world. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths caused by ARI. In the 2007 JPFHS, the prevalence of ARI was estimated by asking mothers whether their children under age five had been ill in the two weeks preceding the survey with a cough accompanied by short, rapid breathing, which the mother considered to be chest-related. It should be noted that the morbidity data collected are subjective, as they are based on mother’s perception of illness with no validation from medical personnel. Table 10.6 shows the percentage of children under age five with symptoms of ARI during the two weeks preceding the survey. In total, 5 percent of children showed symptoms of ARI at some time in the two weeks preceding the survey. Prevalence of ARI varies by age of child: children aged 6-11 months are more likely to have ARI symptoms (9 percent) than children in any other age group. There are slight differences in the prevalence of ARI by sex of the child, urban-rural residence and residence in Badia areas. Prevalence of ARI also varies widely by governorate, from a minimum of 2 percent in Madaba and Tafiela to a maximum of 7 percent in Amman and Ajloun. Mother’s smoking status is directly proportional to the presence of ARI symptoms in children. Use of tobacco results in a higher prevalence of ARI symptoms in children (8 percent) compared to children of mothers who do not smoke (5 percent). 124 | Child Health Table 10.6 Prevalence and treatment of symptoms of ARI Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and percentage who received antibiotics as treatment, according to background characteristics, Jordan 2007 Children under age five with symptoms of ARI Children under age five Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 3.1 1,062 (92.9) (88.0) 33 6-11 8.9 955 78.2 68.5 85 12-23 6.4 1,870 74.9 82.5 120 24-35 5.1 1,907 67.3 86.7 96 36-47 4.1 1,976 65.8 70.3 81 48-59 3.8 1,900 83.8 82.9 72 Sex Male 5.7 4,917 78.5 84.1 282 Female 4.3 4,751 70.1 72.7 206 Mother's smoking status Smokes cigarettes/nargila 8.1 879 (84.2) (81.3) 72 Does not smoke 4.7 8,790 73.4 78.9 416 Residence Urban 5.4 8,096 74.0 79.1 433 Rural 3.5 1,572 83.2 80.8 54 Governorate Amman 6.8 3,692 73.3 72.4 250 Balqa 2.2 605 * * 13 Zarqa 2.8 1,469 (73.2) (82.2) 42 Madaba 1.5 237 * * 4 Irbid 5.2 1,826 (74.7) (94.3) 95 Mafraq 4.7 468 (86.3) (83.6) 22 Jarash 3.8 287 (59.7) (75.3) 11 Ajloun 6.7 230 69.6 79.8 15 Karak 6.3 338 (86.9) (83.7) 21 Tafiela 1.6 137 * * 2 Ma'an 2.8 164 * * 5 Aqaba 3.6 215 (63.4) (64.3) 8 Region Central 5.1 6,003 74.3 74.3 308 North 5.1 2,811 74.8 89.7 144 South 4.2 854 81.4 80.5 36 Badia area Badia 3.9 863 83.9 71.9 33 Other 5.2 8,806 74.3 79.8 455 Mother's education No education 4.7 238 * * 11 Elementary 7.2 573 (55.6) (61.1) 41 Preparatory 6.5 1,345 73.0 72.0 88 Secondary 5.7 4,612 77.2 85.0 264 Higher 2.9 2,901 77.8 81.9 84 Wealth quintile Lowest 4.9 2,480 66.0 71.4 122 Second 5.0 2,298 80.1 85.6 115 Middle 5.6 2,038 84.9 79.7 115 Fourth 6.0 1,597 67.1 73.2 96 Highest 3.2 1,255 * * 40 Total 5.0 9,669 75.0 79.3 488 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 Symptoms of ARI (cough accompanied by short, rapid breathing which was chest-related) is considered a proxy for pneumonia. 2 Excludes pharmacy, shop, and traditional practitioner Child Health | 125 Prevalence of ARI varies significantly by the level of education of the mother. While 7 percent of children of mothers with elementary education had ARI symptoms, this percentage drops to 3 percent for children of mothers with higher than secondary education. The percentage of children with ARI symptoms varies also according to household wealth. Prevalence of ARI is lowest among children living in the wealthiest households. Table 10.6 also shows that medical advice or treatment was sought for three–quarters of children who had ARI symptoms and 79 percent received antibiotics to treat the infection. There are significant variations in treatment by background characteristics, however, they do not follow any clear pattern. The results indicate that male children are more likely to be taken to health facility and receive antibiotics to treat ARI than female children. Children residing in the rural areas are slightly more likely to be taken to a health facility and receive antibiotics compared to children residing in the urban areas. 10.4 PREVALENCE OF FEVER Fever is a major manifestation of acute infections in children. Table 10.7 shows the percentage of children under age five who had fever in the two weeks preceding the survey and the percentage receiving treatment, by background characteristics. Overall, 14 percent of children had fever in the two weeks before the interview, compared to 9 percent in 2002. The prevalence of fever is high among children aged 6-11 months and 12-23 months (27 and 18 percent, respectively). There are no significant variations in the prevalence of fever by the sex of the child. However, there are noticeable variations by urban-rural residence (15 and 12 percent, respectively) and by governorate, ranging from 5 percent in Zarqa to 20 percent in Irbid. There is no clear pattern between mother’s education and the prevalence of fever; the prevalence ranges from 8 percent among children of mothers with no education to 16 percent among children of mothers with secondary education. Table 10.7 shows that medical advice or treatment was sought for 70 percent of children with fever and 85 percent received antibiotics to treat fever. These percentages vary widely by background characteristics. Female children are more likely to be taken to health facility and given antibiotics than male children. Treatment or advice for fever is sought more commonly in rural areas than in urban areas and in the South region compared to other regions. Use of antibiotics to treat fever is also most common in rural areas, in the North and the South regions, and in the non-Badia areas. 126 | Child Health Table 10.7 Prevalence and treatment of fever Among children under age five, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage of children for whom advice or treatment was sought from a health facility or provider, the percentage who took antibiotic drugs, by background characteristics, Jordan 2007 Children under age five with fever Among children under age five: Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antibiotic drugs Number of children Age in months <6 10.4 1,062 60.8 74.6 110 6-11 26.7 955 72.2 82.2 255 12-23 18.2 1,870 69.2 82.8 340 24-35 12.3 1,907 72.1 86.0 234 36-47 13.2 1,976 71.2 90.0 261 48-59 9.4 1,900 69.8 87.3 178 Sex Male 14.7 4,917 69.4 82.1 722 Female 13.8 4,751 70.7 87.2 655 Residence Urban 14.7 8,096 68.9 84.2 1,190 Rural 11.9 1,572 77.0 86.8 187 Governorate Amman 16.8 3,692 66.5 82.1 621 Balqa 7.4 605 80.1 83.8 45 Zarqa 5.2 1,469 (81.9) (85.5) 77 Madaba 7.2 237 78.0 81.3 17 Irbid 19.6 1,826 67.4 87.0 359 Mafraq 15.8 468 77.5 86.8 74 Jarash 12.8 287 78.3 89.0 37 Ajloun 17.3 230 70.8 85.1 40 Karak 16.4 338 77.5 89.8 55 Tafiela 8.9 137 80.7 89.1 12 Ma'an 11.6 164 73.9 81.7 19 Aqaba 9.9 215 77.8 83.1 21 Region Central 12.7 6,003 69.1 82.5 760 North 18.1 2,811 69.9 87.0 509 South 12.6 854 77.3 87.0 108 Badia area Badia 11.8 863 71.5 79.4 102 Other 14.5 8,806 69.9 84.9 1,275 Mother's education No education 8.3 238 (84.5) (87.9) 20 Elementary 12.7 573 57.1 71.6 73 Preparatory 14.6 1,345 72.0 92.0 196 Secondary 16.1 4,612 68.8 85.0 743 Higher 11.9 2,901 73.4 81.8 345 Wealth quintile Lowest 13.3 2,480 69.2 80.8 330 Second 14.3 2,298 70.5 87.0 329 Middle 13.9 2,038 69.7 83.7 283 Fourth 15.7 1,597 65.0 84.2 252 Highest 14.6 1,255 78.1 88.3 183 Total 14.2 9,669 70.0 84.5 1,377 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes pharmacy, shop, and traditional practitioner Child Health | 127 10.5 PREVALENCE OF DIARRHEA Table 10.8 shows the percentage of children under five with diarrhea in the two weeks preceding the survey, by background characteristics. Sixteen percent of all children under age five years experi- enced diarrhea at some time in the two weeks preceding the interview, an increase of one percent- age point compared to 2002. The occurrence of diarrhea varies by age of the child; children aged 6-23 months are more prone to diarrhea than chil- dren in the other age groups. There are variations in the prevalence of diarrhea by region (21 percent in the North region compared to 13 percent in the Cen- tral region) and by governorate (from a minimum of 9 percent in Zarqa and Madaba to a maximum of 22 percent in Irbid and Karak). Prevalence of diarrhea in children also varies according to the source of drinking water. Children who consume water from an improved source are less likely to have experi- enced diarrhea (16 percent) compared to those who consume water from sources that are not safe for drinking (26 percent). Similarly, children who use improved and unshared toilet facilities are less likely to experience diarrhea (16 percent) compared with those who use non-improved or shared toilet facilities (21 percent). Table 10.8 also shows that less than 1 percent of children have experienced diarrhea with blood in their stool. The prevalence of this type of severe diarrhea shows little variation, but is 2 percent among children who use non-improved toilet facilities and children from Mafraq. 10.5.1 Diarrhea Treatment Table 10.9 shows the percentage of children with diarrhea who received specific treatments and management practices by background character- istics. Treatment and/or advice was sought from a health facility or a provider for more than half (55 percent) of children with diarrhea in the two weeks preceding the survey. Treatment was more com- monly sought for children aged 6-35 months (who also have the highest prevalence of diarrhea) and for children who had blood in their stools. The pro- portion of children for which a treatment or advice was sought is higher in rural areas (60 percent) than in urban areas (54 percent). Variations are also found by governorate and residence in Badia areas. Table 10.8 Prevalence of diarrhea Percentage of children under age five who had diarrhea in the two weeks preceding the survey, by background characteristics, Jordan 2007 Diarrhea in the two weeks preceding the survey Background characteristic All diarrhea Diarrhea with blood Number of children Age in months <6 17.2 1.2 1,062 6-11 32.2 1.3 955 12-23 24.7 0.7 1,870 24-35 12.9 0.5 1,907 36-47 9.9 0.6 1,976 48-59 7.9 0.3 1,900 Sex Male 15.8 0.9 4,917 Female 16.1 0.5 4,751 Source of drinking water1 Improved 15.7 0.7 9,422 Not improved 26.1 0.5 247 Toilet facility1 Improved, not shared 15.8 0.6 9,336 Non-improved or shared 21.0 2.3 333 Residence Urban 15.7 0.7 8,096 Rural 17.4 0.8 1,572 Governorate Amman 15.7 0.2 3,692 Balqa 11.4 0.6 605 Zarqa 8.9 0.1 1,469 Madaba 8.6 0.6 237 Irbid 21.6 1.3 1,826 Mafraq 19.9 2.0 468 Jarash 17.8 1.7 287 Ajloun 16.2 1.1 230 Karak 22.3 1.3 338 Tafiela 16.8 1.7 137 Ma'an 21.4 1.2 164 Aqaba 16.2 1.2 215 Region Central 13.3 0.3 6,003 North 20.5 1.4 2,811 South 19.7 1.3 854 Badia area Badia 15.9 1.2 863 Other 16.0 0.6 8,806 Mother's education No education 9.9 0.6 238 Elementary 14.3 0.6 573 Preparatory 18.4 1.1 1,345 Secondary 17.0 0.7 4,612 Higher 13.9 0.4 2,901 Wealth quintile Lowest 18.3 0.9 2,480 Second 14.8 0.7 2,298 Middle 17.0 1.0 2,038 Fourth 14.0 0.6 1,597 Highest 14.2 0.0 1,255 Total 16.0 0.7 9,669 1 See Table 2.7 for definition of categories. 128 | Child Health Table 10.9 Diarrhea treatment Among children under age five who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by background characteristics, Jordan 2007 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 ORS packets or pre- packaged liquid Recom- mended home fluids (RHF) Either ORS or RHF Increased fluids ORT or increased fluids Anti- biotic drugs Intra- venous solution Home remedy/ other Missing No treat- ment Number of children Age in months <6 54.4 16.9 16.8 28.7 31.0 48.7 37.5 0.0 20.8 0.0 33.0 182 6-11 60.7 21.7 11.4 26.0 38.5 52.5 45.9 1.3 33.4 0.0 24.4 307 12-23 57.3 23.6 6.5 27.2 49.9 62.2 54.2 0.5 28.3 0.0 15.1 462 24-35 56.5 22.8 6.9 27.0 56.2 65.9 51.1 0.2 28.2 0.0 15.5 246 36-47 48.5 14.2 8.7 20.5 46.9 55.4 46.6 0.6 30.5 0.9 21.2 196 48-59 46.7 9.9 3.8 13.1 47.0 51.5 47.4 0.5 21.1 1.2 32.2 150 Sex Male 56.1 17.1 9.1 22.7 47.5 58.3 48.8 0.7 29.6 0.0 19.7 778 Female 54.6 22.5 8.4 27.1 43.9 56.4 48.1 0.4 26.3 0.5 23.5 765 Type of diarrhea Non bloody 54.2 19.0 8.2 23.9 45.4 56.4 47.6 0.5 27.7 0.2 22.3 1,467 Bloody 79.6 33.5 21.3 43.5 54.1 74.1 63.2 1.1 37.7 0.0 6.7 67 Residence Urban 54.3 19.7 8.9 24.7 46.0 57.8 47.8 0.4 27.2 0.3 21.5 1,269 Rural 60.3 19.9 8.2 25.9 44.5 55.2 51.4 1.2 31.9 0.0 22.0 274 Governorate Amman 53.0 25.4 9.6 30.1 46.6 60.6 39.5 0.8 31.5 0.0 19.3 578 Balqa 52.7 24.8 4.3 28.0 39.4 56.4 49.4 0.0 28.1 0.0 23.3 69 Zarqa 60.5 16.9 5.6 19.1 47.1 56.3 60.3 0.0 20.7 2.7 16.6 131 Madaba 55.2 22.1 7.9 28.4 41.0 52.4 51.8 4.2 22.3 0.0 25.4 20 Irbid 52.1 13.8 7.9 19.0 45.4 53.4 55.2 0.0 22.6 0.0 26.2 395 Mafraq 64.4 15.4 10.6 22.6 43.7 53.1 57.8 1.7 30.6 0.0 21.6 93 Jarash 67.4 21.1 11.6 28.4 44.2 57.7 55.7 1.3 37.0 0.0 21.1 51 Ajloun 48.0 18.0 6.4 23.6 50.1 59.3 55.8 0.0 28.6 0.0 21.3 37 Karak 62.8 16.3 9.8 21.3 39.7 52.7 39.4 0.7 27.5 0.0 27.6 75 Tafiela 56.6 11.0 15.2 23.2 57.2 67.9 51.0 0.0 29.9 0.0 17.5 23 Ma'an 58.2 20.5 10.7 28.0 49.2 63.3 44.9 0.0 32.3 0.0 16.6 35 Aqaba 65.3 17.7 11.3 25.9 50.4 63.7 51.0 1.3 36.4 0.0 15.0 35 Region Central 54.2 23.9 8.4 28.1 45.9 59.3 44.1 0.7 29.2 0.4 19.3 798 North 55.2 15.0 8.6 20.7 45.3 54.1 55.7 0.4 25.5 0.0 24.7 576 South 61.5 16.7 11.1 23.9 46.3 59.3 44.5 0.6 30.7 0.0 21.3 168 Badia area Badia 66.1 27.2 18.6 34.6 42.1 57.5 48.1 1.1 34.5 0.0 20.0 137 Other 54.3 19.0 7.8 23.9 46.1 57.4 48.5 0.5 27.4 0.2 21.7 1,406 Mother's education No education 73.5 31.3 9.8 35.3 33.3 59.9 59.6 0.0 33.7 0.0 18.5 24 Elementary 54.6 33.1 15.8 34.1 52.7 66.4 46.7 0.0 35.7 0.0 14.0 82 Preparatory 54.2 18.1 14.6 27.5 44.5 59.2 47.2 1.7 26.5 0.0 19.0 248 Secondary 58.4 18.5 6.8 22.5 46.1 56.9 48.7 0.2 26.6 0.4 22.1 785 Higher 49.2 19.8 7.5 25.5 45.1 55.2 48.5 0.6 29.7 0.0 23.8 404 Wealth quintile Lowest 57.0 18.3 13.1 26.2 41.0 55.6 49.4 0.2 27.0 0.8 23.6 453 Second 52.1 14.7 4.0 18.2 43.0 51.1 45.6 0.4 20.9 0.0 28.0 340 Middle 54.1 24.3 11.4 29.7 53.2 62.9 44.6 0.4 31.6 0.0 20.9 347 Fourth 53.2 15.3 5.6 20.0 41.9 56.4 49.7 0.5 34.7 0.0 18.2 223 Highest 62.8 29.9 5.7 30.9 53.2 64.3 57.7 2.2 28.7 0.0 9.5 179 Total 55.4 19.8 8.8 24.9 45.7 57.4 48.5 0.6 28.0 0.2 21.6 1,543 Note: ORT includes solution prepared from oral rehydration salt (ORS), pre-packaged ORS packet, and recommended home fluids (RHF). 1 Excludes pharmacy, shop, and traditional practitioner Child Health | 129 Children of mothers with no education are more likely to be taken to a health facility than children of mothers with higher education. The data also reveal that children of mothers in the highest and lowest wealth quintiles are more likely to be taken to health facilities for advice or treatment than other children. About a quarter (25 percent) of children with diarrhea were treated with some kind of oral rehydration therapy (ORT): 20 percent were treated with solution prepared from packets of oral rehydration salts (ORS) and 9 percent were given recommended home fluids (RHF) which were prepared at home. In addition, about half of children with diarrhea (46 percent) were given increased fluids. Overall, 57 percent of children received ORT and/or increased fluids. In addition, about half of children were given antibiotic drugs and 28 percent were given home remedies. However, twenty-two percent of children with diarrhea did not receive any type of treatment at all. Diarrhea treatment varies slightly with age. More children in the younger age groups are given RHF than older children. Slight variations also exist between urban and rural areas and with respect to the sex of the children. Children in urban areas (58 percent) are slightly more likely to receive ORT or an increase in fluids than children in rural areas (55 percent). 10.5.2 Nutritional Practices during Diarrhea Mothers are encouraged to treat children suffering from diarrhea by increasing their fluid intake and continuing to feed them normally. These practices help to reduce dehydration and minimize the adverse consequences of diarrhea on the child’s nutritional status. To assess knowledge of proper treatment practices, mothers with a child who suffered from diarrhea within two weeks preceding the survey were asked about the relative amounts of fluids and foods given to the child during the diarrheal episode. Table 10.10 shows that 46 percent of children with diarrhea were given more fluids during the illness while 36 percent were given the same amount of fluids as usual, and 18 percent were given less fluids (10 percent somewhat less and 7 percent much less). With respect to food intake during diarrheal episodes, 4 percent of children were given more food and 27 percent maintained their usual food intake. Three-fifths of children (57 percent) were given less food than usual, and about 3 percent were not given any food. Only a quarter of children with diarrhea (24 percent) were fed according to recommendations (more liquids and same amount of food) while they are sick. However, 32 percent of children with diarrhea continued to receive usual feedings and were given ORT and/or increased fluids for management of diarrhea. This practice is more common for children with bloody diarrhea. 130 | Child Health Table 10.10 Feeding practices during diarrhea Percent distribution of children under age five who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by background characteristics, Jordan 2007 Amount of liquids offered Amount of food offered Background characteristic More Same as usual Some- what less Much less None Total More Same as usual Some- what less Much less None Never gave food Don't know/ missing Total Percentage given increased fluids and continued feeding1, 2 Percentage who continued feeding and were given ORT and/or increased fluids Number of children with diarrhea Age in months <6 31.0 51.2 9.1 3.2 5.4 100.0 2.2 23.4 9.1 1.3 1.8 60.0 2.3 100.0 11.3 19.5 182 6-11 38.5 40.9 11.5 8.5 0.6 100.0 6.1 37.1 25.1 18.3 1.8 11.6 0.0 100.0 25.4 35.5 307 12-23 49.9 31.1 10.7 8.2 0.1 100.0 2.8 23.6 36.7 32.0 3.1 1.7 0.0 100.0 26.9 36.7 462 24-35 56.2 24.0 9.2 10.5 0.0 100.0 1.8 26.2 31.7 35.7 4.4 0.1 0.0 100.0 25.3 31.7 246 36-47 46.9 33.5 14.0 5.5 0.2 100.0 6.6 22.3 41.1 27.9 0.9 1.2 0.0 100.0 26.9 32.9 196 48-59 47.0 42.4 6.8 2.7 1.1 100.0 0.5 29.9 37.9 29.7 2.0 0.0 0.0 100.0 22.8 26.7 150 Sex Male 47.5 36.8 8.1 6.4 1.2 100.0 3.3 26.6 27.3 27.0 3.4 11.8 0.5 100.0 23.3 29.7 778 Female 43.9 34.7 12.8 8.0 0.7 100.0 3.7 27.6 34.8 23.9 1.6 8.3 0.0 100.0 25.0 34.7 765 Type of diarrhea Non bloody 45.4 36.7 10.2 6.8 0.9 100.0 3.7 27.3 30.9 25.1 2.5 10.3 0.3 100.0 24.0 32.0 1,467 Bloody 54.1 18.4 16.0 10.3 1.2 100.0 0.0 25.5 36.7 27.9 3.4 6.6 0.0 100.0 29.7 40.1 67 Residence Urban 46.0 36.2 9.4 7.8 0.7 100.0 3.9 27.9 29.3 26.6 2.5 9.5 0.3 100.0 23.3 31.3 1,269 Rural 44.5 33.6 15.3 4.4 2.2 100.0 1.7 23.4 39.0 20.5 2.7 12.7 0.0 100.0 28.0 36.2 274 Governorate Amman 46.6 34.4 8.1 10.7 0.2 100.0 5.5 25.9 25.7 30.4 1.9 9.8 0.7 100.0 18.4 28.2 578 Balqa 39.4 31.0 17.1 11.3 1.2 100.0 0.0 19.1 37.8 21.9 10.5 10.7 0.0 100.0 23.7 33.9 69 Zarqa 47.1 29.3 9.6 12.1 2.0 100.0 3.7 20.5 28.8 31.2 6.4 9.4 0.0 100.0 20.2 24.4 131 Madaba 41.0 35.0 6.8 15.3 1.9 100.0 1.9 40.7 21.4 25.3 0.0 10.7 0.0 100.0 21.6 30.0 20 Irbid 45.4 41.4 10.0 2.2 1.1 100.0 2.6 31.8 31.4 23.1 1.1 9.9 0.0 100.0 27.8 34.3 395 Mafraq 43.7 40.2 11.7 1.6 2.8 100.0 3.8 29.5 35.7 15.3 3.3 12.3 0.0 100.0 29.6 36.8 93 Jarash 44.2 34.8 18.9 2.1 0.0 100.0 2.0 26.8 43.2 12.3 2.7 12.9 0.0 100.0 30.8 41.1 51 Ajloun 50.1 30.6 16.4 2.1 0.8 100.0 3.6 25.1 42.3 15.1 3.0 10.9 0.0 100.0 34.3 41.5 37 Karak 39.7 40.1 12.9 6.7 0.7 100.0 0.0 32.9 36.2 22.0 0.7 8.2 0.0 100.0 25.7 36.8 75 Tafiela 57.2 26.3 12.9 3.0 0.7 100.0 0.9 26.2 35.3 26.4 2.4 8.9 0.0 100.0 40.3 43.7 23 Ma'an 49.2 27.3 15.4 5.3 2.7 100.0 0.6 22.0 45.9 18.2 0.6 12.7 0.0 100.0 38.1 45.3 35 Aqaba 50.4 28.3 11.8 8.0 1.4 100.0 0.0 17.2 42.9 28.0 3.0 8.9 0.0 100.0 30.7 35.2 35 Region Central 45.9 33.3 9.1 11.1 0.6 100.0 4.7 24.8 27.2 29.7 3.3 9.8 0.5 100.0 19.2 28.1 798 North 45.3 39.9 11.5 2.1 1.2 100.0 2.8 30.6 33.9 20.4 1.7 10.6 0.0 100.0 28.8 35.8 576 South 46.3 33.1 13.2 6.2 1.3 100.0 0.2 26.5 39.5 23.1 1.4 9.4 0.0 100.0 31.3 39.2 168 Badia area Badia 42.1 38.7 10.6 6.6 2.0 100.0 2.2 29.7 28.9 23.9 3.9 11.3 0.0 100.0 24.9 36.0 137 Other 46.1 35.4 10.4 7.2 0.8 100.0 3.6 26.9 31.2 25.7 2.4 10.0 0.3 100.0 24.0 31.8 1,406 Mother's education No education 33.3 44.8 15.4 1.6 4.9 100.0 0.0 32.0 31.7 22.0 3.7 10.5 0.0 100.0 11.9 29.5 24 Elementary 52.7 32.9 7.8 5.6 0.9 100.0 5.4 28.9 29.9 16.4 1.1 13.2 5.1 100.0 32.7 41.3 82 Preparatory 44.5 36.5 11.0 6.8 1.1 100.0 5.6 29.7 23.3 24.9 2.0 14.5 0.0 100.0 22.3 32.0 248 Secondary 46.1 34.3 12.1 6.9 0.8 100.0 2.0 27.8 34.1 22.5 3.5 10.1 0.0 100.0 26.0 33.2 785 Higher 45.1 38.1 7.2 8.7 0.9 100.0 4.9 23.6 29.9 33.7 1.2 6.7 0.0 100.0 20.6 28.7 404 Wealth quintile Lowest 41.0 39.6 12.0 6.7 0.7 100.0 3.0 32.1 27.8 21.8 2.1 12.3 0.9 100.0 21.1 32.4 453 Second 43.0 37.3 12.6 6.1 0.9 100.0 3.0 27.2 35.0 21.7 2.2 10.9 0.0 100.0 24.2 30.1 340 Middle 53.2 32.7 7.0 5.3 1.8 100.0 2.0 29.5 32.4 21.3 3.3 11.7 0.0 100.0 30.5 36.7 347 Fourth 41.9 29.7 12.2 15.7 0.4 100.0 5.0 15.9 29.7 41.3 2.2 5.9 0.0 100.0 19.7 25.2 223 Highest 53.2 36.2 6.8 3.6 0.3 100.0 6.6 24.0 30.7 30.6 3.2 4.8 0.0 100.0 24.7 35.4 179 Total 45.7 35.7 10.4 7.2 0.9 100.0 3.5 27.1 31.0 25.5 2.5 10.1 0.3 100.0 24.1 32.2 1,543 1 Equivalent to the UNICEF/WHO indicator "home management of diarrhea” 2 Continue feeding practices includes children who were given more, same as usual, or somewhat less food during the diarrhea episode Child Health | 131 10.5.3 Knowledge of Diarrhea Treatment Solutions A simple and effective response to dehydration caused by diarrhea is a prompt increase in the child’s fluid intake through some form of ORT, which may include the use of solutions prepared from packets of oral rehydration salts (ORS packets), known in Jordan as “Aquacall.” Women were asked whether they know about ORS or Aquacall pack- ets. Table 10.11 shows that the majority of women (94 per- cent) have knowledge about ORS packets for the treatment of diarrhea. Knowledge is high (over 90 percent) among all women, with the exception of young mothers aged 15-19 (69 percent), women with no education (74 percent), and those residing in Aqaba (89 percent). Table 10.11 Knowledge of ORS packets or pre- packaged liquids Percentage of women age 15-49 who gave birth in the five years preceding the survey who know about ORS packets or ORS pre-packaged liquids for treatment of diarrhea by background characteristics, Jordan 2007 Background characteristic Percentage of women who know about ORS packets or ORS pre- packaged liquids Number of women Age 15-19 69.3 124 20-24 91.7 986 25-34 94.9 3,344 35-49 95.6 1,992 Residence Urban 94.3 5,417 Rural 93.5 1,029 Governorate Amman 93.7 2,469 Balqa 91.7 396 Zarqa 95.5 966 Madaba 91.2 157 Irbid 95.5 1,261 Mafraq 93.5 298 Jarash 95.1 185 Ajloun 96.8 150 Karak 95.1 229 Tafiela 93.3 88 Ma'an 92.2 107 Aqaba 89.2 140 Region Central 93.8 3,987 North 95.2 1,894 South 92.8 564 Badia area Badia 91.3 536 Other 94.4 5,910 Education No education 74.3 155 Elementary 92.4 351 Preparatory 94.4 917 Secondary 93.8 3,058 Higher 96.4 1,964 Wealth quintile Lowest 91.5 1,508 Second 93.1 1,501 Middle 96.4 1,378 Fourth 95.3 1,153 Highest 95.5 906 Total 94.2 6,446 ORS = Oral rehydration salts Nutrition | 133 NUTRITION 11 This chapter focuses on infant feeding practices and the nutritional and micronutrient status of women and children. As mentioned in Chapter 1, anthropometric data were collected during the JPFHS in a subsample of 50 percent of clusters. All women aged 15-49 and children aged 0-4 living in these households were measured using Shorr height boards and weighed using electronic Seca scales. In addition, a drop of capillary blood was taken from these women and children to measure hemoglobin levels using the HemoCue system, in order to estimate the prevalence of anemia. However, analysis of the anthropometric and hemoglobin data has revealed anomalies in the individual values resulting in unreliable estimates of children’s nutritional status and anemia prevalence among children and women. Therefore, these data are not included in this report. The nutritional status of children is presented first in this chapter, beginning with infant feeding practices, including breastfeeding and complementary feeding practices. This is followed by a discussion of micronutrient intake among children. The second portion of the chapter focuses on the nutritional status of women. Anthropometric data (height and weight) collected in the survey are used to assess the current nutritional status of women. Other important nutritional issues, including mothers’ food consumption and micronutrient intake are also discussed. 11.1 NUTRITIONAL STATUS OF CHILDREN 11.1.1 Breastfeeding and Child Feeding Practices Breastfeeding and complementary feeding behaviors are important predictors of infant and child nutrition, health and survival. Poor nutritional status has been shown to increase the risk of illness and death among children. Breastfeeding practices also have an effect on the mother’s fertility. A well- documented effect of exclusive breastfeeding of sufficient intensity and duration is delayed return to ovulation, resulting in longer birth intervals and lower fertility, which is strongly related to infant and child survival. Initiation of Breastfeeding Breast milk excels as the most desirable source of nutrients for infants. Breastfeeding provides a complete source of nutrition for the first six months of life, half of all requirements in the second six months of life and one-third of requirements in the second year of life. The attributes of breast milk go beyond its nutrient content, as it offers the infant unsurpassed protection against infection. Colostrum, a pre-milk substance containing antibodies and white cells from the mother’s blood, is produced during the first 2-3 days of lactation. Colostrum contains maternal immune factors and helps protect the newborn infant from infections. There is evidence that links having been breastfed as a child with stronger intellectual development and a reduced risk of cancer, obesity and several chronic diseases. The early initiation of breastfeeding is also beneficial for the mother since it stimulates breast milk production and causes the uterus to retract, which reduces postpartum blood loss. Furthermore, women who breastfeed have a reduced risk of ovarian cancer and premenopausal breast cancer (ACC/SCN, 2000). 134 | Nutrition Table 11.1 shows that breastfeeding is common in Jordan. Among children born in the five years preceding the survey, 93 percent were breastfed. There are small differences in the percentage of infants ever breastfed by sex, residence, mother’s education and household wealth. Among children who were breastfed, Table 11.1 shows that 39 percent begin breastfeeding within an hour after delivery, and more than four-fifths (82 percent) of infants were breastfed within the first day. The North region shows a lower percentage of infants breastfeeding within an hour after delivery compared with the Central and South regions. Table 11.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and for the last children born in the five years preceding the survey ever breastfed, the percentage who started breastfeeding within one hour and within one day of birth and the percentage who received a prelacteal feed, by background characteristics, Jordan 2007 Among last-born children ever breastfed: Breastfeeding among children born in past five years Background characteristic Percentage ever breastfed Number of children born in past five years Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 92.9 4,994 38.2 80.0 59.2 3,106 Female 93.3 4,870 39.5 83.1 57.1 2,970 Residence Urban 93.0 8,262 38.6 81.2 57.4 5,101 Rural 93.7 1,601 39.9 83.0 62.0 976 Governorate Amman 92.1 3,784 35.8 78.9 55.7 2,313 Balqa 95.3 615 40.1 81.1 54.9 380 Zarqa 93.9 1,486 49.1 86.1 51.7 917 Madaba 89.5 242 63.7 86.0 53.9 141 Irbid 94.2 1,861 31.4 82.3 65.8 1,194 Mafraq 94.0 479 32.1 79.2 73.6 286 Jarash 93.7 290 44.3 85.8 61.1 175 Ajloun 96.1 233 36.0 86.9 56.0 145 Karak 89.6 348 48.0 80.9 58.0 209 Tafiela 93.9 140 47.0 82.9 51.4 84 Ma'an 92.6 167 51.2 80.5 52.5 101 Aqaba 93.6 217 39.4 77.8 65.0 131 Region Central 92.8 6,127 40.5 81.2 54.6 3,751 North 94.2 2,864 33.1 82.5 65.8 1,800 South 91.9 873 46.3 80.4 57.6 525 Badia area Badia 90.9 876 46.4 84.1 61.1 499 Other 93.3 8,988 38.2 81.3 57.9 5,577 Mother's education No education 91.4 241 47.8 84.8 54.8 140 Elementary 92.3 591 45.4 81.2 54.8 324 Preparatory 93.7 1,365 42.6 81.4 57.5 866 Secondary 93.0 4,735 40.9 82.4 56.4 2,894 Higher 93.3 2,932 32.0 79.9 62.1 1,852 Wealth quintile Lowest 92.5 2,541 48.3 85.8 51.0 1,404 Second 93.8 2,342 41.9 83.8 59.0 1,429 Middle 94.0 2,061 37.6 79.5 58.9 1,305 Fourth 92.8 1,634 35.0 82.3 57.4 1,093 Highest 92.0 1,285 24.8 72.5 68.4 846 Total 93.1 9,864 38.8 81.5 58.2 6,076 Note: Table is based on births in the past five years whether the children are living or dead at the time of interview 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life Nutrition | 135 Prelacteal feeding is the practice of giving other liquids to a child during the period after birth before the mother’s milk is flowing freely. Table 11.1 shows that a total of 58 percent received a prelacteal feed. The proportion of infants receiving a prelacteal feed is higher in the North region (66 percent) compared with the Central and South regions (55 and 58 percent, respectively). Also, the proportion receiving a prelacteal feed is highest among infants born to mothers living in the wealthiest quintile of households (68 percent). Among children receiving prelacteal liquid, 41 percent received sugar water, 39 percent received infant formula, 27 percent received tea, and 23 percent received milk other than breast milk (data not shown). Introduction of Complementary Feeding Exclusive breastfeeding, defined as the consumption of human milk as a sole source of energy, is the preferred method of feeding for normal full-term infants from birth to 6 months. Breastfeeding complemented by the appropriate introduction of other foods is recommended for the remainder of the first year or longer if desired. Early supplementation is discouraged for several reasons. First, it exposes infants to pathogens and increases their risk of infection, especially diarrheal disease. Second, it decreases infant’s intake of breast milk and therefore suckling, which reduces breast milk production. Third, in harsh socioeconomic environments, available supplementary food is often nutritionally inferior. On the other hand, after six months of age, breastfeeding alone provides insufficient nutrition for the infant, and must be supplemented with the introduction of other appropriate foods in order to promote the best growth possible. Information on supplementation was obtained by asking mothers about the current breastfeeding status of all children under five years of age, and about the foods (liquids and solids) given to the child the day before the survey. Although information on breastfeeding was collected for all children born in the five years preceding the survey, the tables are restricted to the youngest children born in the three years before the survey because most children are weaned by age three. Table 11.2 shows the percent distribution of living children in the three years before the survey by breastfeeding status. According to the World Health Organization’s recommendation, children should receive exclusive breastfeeding for up to first 6 months of life. However, only 39 percent of Jordanian children under 2 months of age are exclusively breastfed. By age 4-5 months, only 10 percent of children are exclusively breastfed. After the age of five months almost no children receive exclusive breastfeeding. For all children under six months, 22 percent are exclusively breastfed. The table shows that almost one third (31 percent) of children under six months of age consume other milk (e.g., fresh milk or powdered milk), 18 percent of children consume plain water and breast milk and 17 percent are given complementary food. More than two-thirds of children are still breastfed and consuming complementary food at 6-8 months. By 18-23 months, only 14 percent of children are still breastfed. Bottle-feeding is discouraged for very young children. It is usually associated with increased risk of illness, especially diarrheal disease, because of difficulty in sterilizing the nipples properly. Bottle- feeding also shortens the period of postpartum amenorrhea and increases the risk of pregnancy. The practice of bottle-feeding with a nipple is prevalent in 35 percent of children under two months of age and more than half of children aged 2-8 months are bottle-fed. 136 | Nutrition Table 11.2 Breastfeeding status by age Percent distribution of youngest children under three years who are living with their mother by breastfeeding status and the percentage currently breastfeeding; and the percentage of all children under three years using a bottle with a nipple, according to age in months, Jordan 2007 Breastfeeding and consuming: Age in months Not breast- feeding Exclusively breastfed Plain water only Non-milk liquids/ juice Other milk Comple- mentary foods Total Percentage currently breast- feeding Number of youngest child under three years Percentage using a bottle with a nipple1 Number of children 0-1 6.2 39.1 20.2 3.0 30.3 1.3 100.0 93.8 268 35.3 270 2-3 8.2 21.0 21.9 0.3 37.7 10.9 100.0 91.8 406 52.6 414 4-5 16.2 10.2 12.2 2.6 23.7 35.0 100.0 83.8 372 52.4 378 6-8 22.0 0.4 4.5 0.9 3.8 68.5 100.0 78.0 493 53.6 510 9-11 34.3 0.1 3.0 0.0 0.3 62.3 100.0 65.7 438 45.1 445 12-17 58.9 0.0 0.0 0.0 0.8 40.2 100.0 41.1 868 46.1 929 18-23 85.6 0.0 0.0 0.0 0.0 14.4 100.0 14.4 786 34.8 941 24-35 96.8 0.0 0.0 0.0 0.0 3.2 100.0 3.2 1,190 18.8 1,907 0-3 7.4 28.2 21.2 1.4 34.7 7.1 100.0 92.6 674 45.8 684 0-5 10.5 21.8 18.0 1.8 30.8 17.0 100.0 89.5 1,046 48.1 1,062 6-9 25.8 0.3 4.5 0.7 3.0 65.7 100.0 74.2 649 51.5 670 12-15 54.0 0.0 0.0 0.1 0.1 45.8 100.0 46.0 586 47.4 621 12-23 71.6 0.0 0.0 0.0 0.4 28.0 100.0 28.4 1,654 40.4 1,870 20-23 89.1 0.0 0.0 0.0 0.0 10.9 100.0 10.9 514 31.5 626 Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus children who receive breast milk and non-milk liquids and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years Duration and Frequency of Breastfeeding The median duration of breastfeeding by background characteristics is shown in Table 11.3. Estimates of the mean and median duration of breastfeeding are based on current status data, that is, the proportion of children under three years who were being breastfed at the time of the survey. The median duration of any breastfeeding is 12.5 months (Table 11.3). There is a slight difference in the duration of breastfeeding by sex of the child. Male children are breastfed for a slightly longer duration than female children. There are slight variations among different governorates, however, these do not appear to be significant. The duration of breastfeeding is inversely associated with mother’s education. Both duration and frequency of breastfeeding can affect the length of postpartum amenorrhea. Table 11.3 shows that the majority of children (91 percent) under six months of age were breastfed six or more times in the past 24 hours. Breastfeeding is more frequent in the daytime than at night, with the mean number of feeds in the daytime being 5.8 compared with 3.7 at night. Nutrition | 137 Table 11.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey interview, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey interview, and mean number of feeds (day/night), by background characteristics, Jordan 2007 Frequency of breastfeeding among children under six months2 Median duration (months) of breastfeeding among children born in the past three years1 Background characteristic Any breast- feeding Exclusive breast- feeding Predominant breast- feeding3 Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children Sex Male 13.8 0.6 1.7 91.7 6.0 3.7 498 Female 11.6 0.6 1.7 90.8 5.6 3.6 438 Residence Urban 12.4 0.6 1.9 91.6 5.9 3.8 767 Rural 13.3 0.6 0.7 90.1 5.5 3.4 168 Governorate Amman 11.7 0.5 1.0 88.2 5.8 4.1 360 Balqa 13.4 0.6 2.0 96.4 5.7 3.6 61 Zarqa 11.9 0.6 2.3 94.0 6.0 3.6 130 Madaba 11.3 0.6 0.7 91.3 5.8 3.7 24 Irbid 13.3 1.1 2.3 94.9 5.8 3.4 175 Mafraq 12.2 0.6 2.3 90.6 6.1 3.3 49 Jarash 13.6 1.2 1.7 92.5 6.3 3.4 27 Ajloun 14.1 0.8 1.8 92.2 5.6 3.2 24 Karak 12.8 0.5 0.7 85.2 5.4 3.5 37 Tafiela 12.8 0.6 0.7 90.2 5.4 3.6 14 Ma'an 11.4 0.7 1.1 94.4 5.2 3.6 17 Aqaba 13.1 0.5 0.5 92.4 5.4 3.6 18 Region Central 12.0 0.6 1.6 90.5 5.8 3.9 574 North 13.3 0.9 2.2 93.6 5.9 3.3 275 South 12.6 0.5 0.7 89.3 5.4 3.6 86 Badia area Badia 12.4 0.5 2.1 90.8 5.7 3.2 86 Other 12.6 0.6 1.7 91.4 5.8 3.7 849 Mother's education No education (15.5) (0.5) (1.5) (92.6) (4.9) (3.5) 15 Elementary 14.1 0.7 3.0 94.7 5.8 2.6 45 Preparatory 14.3 0.7 1.7 94.1 6.6 3.5 154 Secondary 12.2 0.6 2.0 91.9 5.8 3.9 449 Higher 11.6 0.6 1.2 88.2 5.5 3.7 273 Wealth quintile Lowest 12.4 0.6 2.1 94.4 5.7 4.0 260 Second 13.0 1.3 2.7 94.2 6.1 3.6 231 Middle 13.0 0.5 1.9 89.7 6.0 3.4 189 Fourth 12.4 0.7 0.8 89.0 5.6 3.8 134 Highest 10.0 0.4 0.5 84.5 5.3 3.6 122 Total 12.5 0.6 1.7 91.3 5.8 3.7 935 Mean for all children 13.0 2.0 3.3 na na na na Note: Median and mean durations are based on current status. Includes children living and deceased at the time of the survey. Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2 Excludes children without a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only 138 | Nutrition Types of Supplemental Food Information on the types of food given to children under three years of age in the 24 hours preceding the survey, according to breastfeeding status, is shown in Table 11.4. In Jordan, the introduction of other liquids such as water, juice, and formula takes place earlier than the recommended age of about 6 months. Even among the youngest breastfed children (under 2 months of age), almost one in three children receives infant formula, 13 percent receive milk other than breast milk and 7 percent consume other liquids. Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under three years of age who are living with the mother by type of foods consumed in the day or night preceding the interview, according to breastfeeding status and age, Jordan 2007 Solid or semi-solid foods Liquids Age in months Infant formula Other milk1 Other liquids2 Food made from grains Fruits and vege-tables rich in vitamin A3 Other fruits and vege- tables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry, and eggs Cheese, yogurt, other milk product Any solid or semi- solid food Food made with oil, fat, and butter Sugary foods Number of children BREASTFEEDING CHILDREN 0-1 32.7 13.4 6.6 1.4 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 252 2-3 48.1 26.1 6.3 10.5 0.3 0.2 0.3 0.2 0.4 1.7 11.6 0.1 0.5 373 4-5 45.1 34.3 26.1 34.6 5.3 10.3 7.5 1.2 4.8 17.9 41.4 7.1 7.8 311 6-8 42.7 37.6 55.7 78.6 34.3 50.5 23.7 16.6 30.4 56.7 86.7 37.6 34.5 384 9-11 21.7 35.9 69.9 84.8 49.8 56.9 36.9 30.1 52.1 78.0 93.8 63.2 58.5 287 12-17 32.6 49.1 84.7 94.0 61.3 69.5 42.0 45.1 69.7 82.8 97.8 79.6 63.4 357 18-23 16.1 50.1 83.0 99.6 62.6 79.5 36.1 56.4 83.5 92.0 100.0 93.2 73.8 113 24-35 19.8 73.1 99.1 100.0 61.0 82.5 31.3 55.7 86.5 80.6 100.0 97.1 70.0 38 6-23 31.6 42.0 71.1 87.0 49.4 60.9 34.0 32.9 53.4 73.7 93.3 62.7 53.5 1,142 Total 36.4 35.2 45.9 55.9 28.6 35.9 20.0 18.9 31.2 44.2 60.4 36.6 31.4 2,116 NONBREASTFEEDING CHILDREN 0-1 * * * * * * * * * * * * * 17 2-3 (99.1) (55.1) (2.4) (33.8) (0.0) (0.0) (0.0) (0.0) (0.0) (12.6) (46.4) (11.1) (10.0) 33 4-5 94.6 56.7 26.8 52.6 13.5 13.6 9.6 10.6 8.8 18.1 59.1 6.8 13.7 60 6-8 83.1 78.0 61.0 74.9 29.6 38.5 18.4 8.4 31.7 44.7 79.8 40.4 45.1 108 9-11 77.5 86.9 75.3 93.6 58.9 70.5 33.5 33.5 71.3 90.0 98.9 69.6 62.8 150 12-17 48.6 84.3 92.8 96.1 62.3 79.3 39.6 43.0 78.7 81.1 99.7 82.0 75.7 511 18-23 37.9 71.2 93.9 96.8 62.9 76.6 41.5 49.2 81.6 80.5 99.1 82.3 78.8 672 24-35 27.4 66.3 97.2 97.4 65.5 77.5 45.2 53.5 85.5 85.4 100.0 90.1 78.1 1,152 6-23 49.2 78.0 89.1 94.6 59.8 74.1 38.3 42.3 75.7 79.0 97.8 77.7 73.5 1,442 Total 41.9 72.2 89.6 93.7 60.1 72.8 39.9 45.6 77.0 79.1 96.8 80.1 72.9 2,705 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). 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 Other milk includes fresh, tinned and powdered cow or other animal milk 2 Does not include plain water 3 Includes carrots, red sweet potatoes, pumpkin, apricot, palm nuts, yellow melon, and green leafy vegetables WHO recommends the introduction of solid food to infants around the age of 6 months because by that age breast milk by itself is no longer sufficient to maintain a child’s optimal growth. Among children, cereals, grains and some solid and semi-solid foods are introduced even before 6 months of age. Breastfed children consume breads, cereals, grains and semi-solid or solid types of foods early in life. Among infants aged 4-5 months, 41 percent consume solid or semi-solid food. Beginning at age 6 months, the percentage of children who are fed solid or semi-solid food increases rapidly; 87 percent of children aged 6-8 months receive solid or semi-solid food. Among children who are not breastfed, almost half receive solid or semi-solid food by the age of 2-3 months. Nutrition | 139 Overall, 56 percent of breastfed children under three years of age consume foods made with grain and 31 percent receive meat, fish, poultry or eggs. In comparison, consumption of roots, tubers, legumes, and foods rich in vitamin A is lower in children. Appropriate Infant and Young Child Feeding (IYCF) Practices Appropriate Infant and Young Child Feeding (IYCF) practices include breastfeeding through the age of two years, the introduction of solid and semisolid foods at age 6 months, and a gradual increase in the amount of food given and the frequency of feeding as the child gets older. The average, healthy breastfed child should receive solid and semisolid foods 2-3 times per day at age 6-8 months and 3-4 times per day at age 9-23 months, with an additional snack 1-2 times per day. Infants with low breast- milk intake need to be fed more frequently than those with high breast-milk intake. For non-breastfed children, it is recommended that they be given solid and semisolid foods 4-5 times per day at age 6-23 months with an additional snack 1-2 times per day (PAHO/WHO, 2003). Appropriate nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. Studies have shown that plant-based complementary foods by themselves are not sufficient to meet the needs of some children for certain micronutrients (WHO/UNICEF, 1998). Therefore, it is advised that children eat meat, poultry, fish, or eggs daily, or as often as possible. Vegetarian diets may not meet children’s nutrient requirements unless supplements or fortified foods are also provided. Vitamin A-rich fruits and vegetables should be consumed daily, and the diets of children should include an adequate amount of fat. Tea and coffee are not recommended for children because they contain compounds that inhibit iron absorption. Sugary drinks and excessive juice consumption should be avoided because other than energy they contribute little to the diet and decrease the child’s appetite for more nutritious foods (PAHO/WHO, 2003). In summary, � Breastfed children aged 6-23 months should receive animal-source foods and vitamin A-rich fruits and vegetables daily. Three food groups are considered the minimum number appropriate for breastfed children. � Breastfed infants aged 6-8 months should receive complementary foods 2-3 times per day, with 1-2 snacks; breastfed children aged 9-23 months should be receive meals 3-4 times per day, with 1-2 snacks (PAHO/WHO, 2003). � Non-breastfed children aged 6-23 months should receive milk or milk products to ensure that their calcium needs are met. In addition, they need animal-source foods and vitamin A-rich fruits and vegetables. Four food groups are considered the minimum number appropriate for nonbreastfed young children. � Non-breastfed children aged 12-23 months should be fed meals 4-5 times per day, with 1-2 snacks (WHO, 2005). Table 11.5 shows the percentage of breastfed, non-breastfed, and all children aged 6-23 who were fed according to the appropriate Infant and Young Child Feeding (IYCF) practices. Overall, 99 percent of (youngest) children aged 6-23 months in Jordan living with the mother received breast milk or breast milk substitutes during the 24-hour period before the survey and 85 percent had an adequately diverse diet— i.e., they had been fed foods from the appropriate number of food groups depending on their age and breastfeeding status. Two-fifths of children (42 percent) had been fed the minimum standard number of times appropriate for their age. Feeding practices for 38 percent of children aged 6-23 months in Jordan met the minimum standard with respect to all three of these feeding practices. 140 | Nutrition Table 11.5 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based upon number of food groups and times they are fed during the day or night preceding the survey by breastfeeding status and background characteristics, Jordan 2007 Among breastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Among non-breastfed children 6-23 months, percentage fed: Background characteristic 3+ food groups1 Mini- mum times or more2 Both 3+ food groups and minimum times or more Number of breastfed children 6-23 months Milk or milk products3 4+ food groups 4+ times or more With 3 IYCF practices4 Number of non- breastfed children 6-23 motnh Breast- milk or milk products3 3+ or 4+ food groups5 Mini- mum times or more6 With all 3 IYCF practices Number of all children 6-23 months Age 6-8 61.1 72.6 57.4 384 93.2 42.5 20.4 14.2 108 98.5 57.0 61.1 47.9 493 9-11 79.4 46.7 43.4 287 99.6 88.7 19.7 19.5 150 99.9 82.6 37.4 35.2 438 12-17 91.2 61.4 59.6 357 98.5 92.5 28.1 25.8 511 99.1 92.0 41.8 39.7 868 18-23 98.8 70.2 70.2 113 96.8 95.3 27.9 26.0 672 97.3 95.8 34.0 32.4 786 Sex Male 81.2 67.4 60.8 618 97.7 89.7 27.6 25.4 654 98.8 85.6 46.9 42.6 1,272 Female 76.1 56.5 50.0 524 97.2 89.6 25.7 23.6 789 98.3 84.2 38.0 34.1 1,313 Residence Urban 78.9 61.3 54.8 916 97.6 90.1 27.5 25.3 1,221 98.6 85.3 42.0 38.0 2,137 Rural 78.7 66.6 60.1 226 96.6 87.1 21.4 19.2 221 98.3 82.9 44.2 39.9 447 Governorates Amman 79.0 62.5 57.5 414 97.2 89.0 31.7 28.4 594 98.4 84.9 44.4 40.3 1,008 Balqa 78.4 67.4 58.3 77 97.0 97.9 22.5 22.5 78 98.5 88.2 44.9 40.3 155 Zarqa 84.9 61.7 57.3 152 96.7 89.7 17.1 16.2 189 98.1 87.6 37.0 34.5 341 Madaba 81.2 61.4 57.9 26 98.4 86.0 17.4 15.9 36 99.1 84.0 35.9 33.5 62 Irbid 73.4 60.3 50.4 234 99.3 91.4 29.1 27.8 287 99.6 83.3 43.1 37.9 522 Mafraq 72.8 57.2 49.9 65 97.4 87.9 28.9 27.2 58 98.8 80.0 43.8 39.2 123 Jarash 82.1 63.8 55.6 46 95.9 90.9 13.0 13.0 41 98.1 86.3 39.7 35.4 87 Ajloun 83.8 59.1 54.3 27 99.1 95.4 20.3 19.4 28 99.5 89.7 39.2 36.4 55 Karak 85.0 64.2 60.0 35 95.0 83.8 27.7 23.0 51 97.0 84.3 42.6 38.0 85 Tafiela 87.9 64.6 61.7 18 96.1 84.9 22.8 21.8 17 98.1 86.4 44.0 42.0 35 Ma'an 75.6 75.2 64.3 19 95.4 82.4 22.7 19.9 28 97.3 79.7 43.8 37.8 47 Aqaba 80.5 68.3 61.8 30 95.6 84.0 8.3 6.6 35 97.6 82.4 35.7 31.8 65 Region Central 80.4 62.8 57.6 669 97.1 89.8 27.3 24.8 896 98.4 85.8 42.5 38.8 1,565 North 75.2 60.1 51.2 372 98.7 91.1 26.9 25.7 415 99.3 83.6 42.6 37.7 787 South 82.4 67.6 61.6 101 95.4 83.7 20.8 17.8 131 97.4 83.1 41.1 36.9 232 Badia area Badia 75.3 63.9 55.3 119 96.9 84.8 21.0 16.9 114 98.5 79.9 42.9 36.5 233 Other 79.3 62.2 55.9 1,023 97.5 90.0 27.0 25.0 1,328 98.6 85.4 42.3 38.5 2,351 Mother's education No education 72.2 65.0 57.0 28 93.3 77.4 29.2 29.2 23 96.9 74.5 48.8 44.4 52 Elementary 84.8 59.8 55.7 80 95.9 91.4 45.6 43.4 65 98.2 87.8 53.4 50.2 145 Preparatory 69.3 57.7 52.5 184 99.1 88.3 24.1 24.0 154 99.6 78.0 42.4 39.5 339 Secondary 77.4 62.7 54.1 539 96.3 88.5 24.3 22.4 713 97.9 83.7 40.9 36.0 1,251 Higher 86.1 64.9 60.9 311 98.9 92.0 27.9 24.7 486 99.4 89.7 42.3 38.8 797 Wealth quintile Lowest 76.7 62.2 55.0 317 96.6 86.2 20.6 19.5 361 98.2 81.8 40.0 36.1 679 Second 76.5 63.8 54.5 297 95.2 87.7 22.7 18.2 359 97.4 82.6 41.3 34.6 656 Middle 83.1 61.2 55.4 281 99.2 93.2 32.5 29.9 286 99.6 88.2 46.7 42.6 567 Fourth 78.1 57.3 55.6 146 98.2 90.8 21.1 21.1 245 98.8 86.1 34.6 34.0 391 Highest 81.6 69.4 64.3 101 99.7 92.9 43.3 41.2 191 99.8 89.0 52.3 49.2 292 Total 78.9 62.4 55.9 1,142 97.4 89.6 26.6 24.4 1,442 98.6 84.9 42.4 38.3 2,584 1 Food groups: a. infant formula, milk other than breastmilk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish; g. legumes and nuts; h. foods made with oil, fat, or butter 2 At least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Non-breastfed children ages 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding practices if they receive other milk or milk products and are fed at least the minimum number of times per day with at least the minimum number of food groups 5 3+ food groups for breastfed children and 4+ food groups for non-breastfed children 6 Fed solid or semi-solid food at least twice a day for infants 6-8 months, 3+ times for other breastfed children, and 4+ times for non-breastfed children Nutrition | 141 11.1.2 Micronutrient Intake among Children A serious contributor to childhood morbidity and mortality is micronutrient deficiency. Children can receive micronutrients from foods, food fortification, and direct supplementation. Table 11.6 looks at measures relating to intake of several key micronutrients among children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage. VAD can also increase severity of infections such as measles and diarrheal diseases in children and slows recovery from illness. Vitamin A is found in breast milk, other milks, liver, eggs fish, butter, red palm oil, mangoes, papayas, carrots, pumpkins, and dark green leafy vegetables. The liver can store an adequate amount of the vitamin for four to six months. Periodic dosing (usually every six months) of vitamin A supplements is one method of ensuring that children at risk do not develop VAD. The 2007 JPFHS collected information on the consumption of vitamin A-rich foods and on the coverage of supplements. Table 11.6 shows that 84 percent of last-born children aged 6-35 months living with the mother consumed vitamin A-rich foods in the 24-hour period before the survey. Consumption of vitamin A-rich foods increases from 46 percent among children aged 6-8 months to over 90 percent among children aged 18-35 months. Not surprisingly, breastfeeding children are much less likely to consume vitamin A-rich foods than non-breastfeeding children. Seventy-two percent of young children consume foods rich in iron. Differences in the consumption of iron-rich foods are similar to those seen for the consumption of vitamin A-rich foods. Only 9 percent of children aged 6-59 months received a vitamin A supplement in the six months before the survey. 142 | Nutrition Table 11.6 Micronutrient intake among children Among youngest children age 6-35 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey interview, and among all children 6- 59 months, the percentages who were given vitamin A supplements in the six months preceding the survey interview, by background characteristics, Jordan 2007 Among youngest children age 6-35 months living with the mother: Among all children age 6-59 months: Background characteristic Percentage who consumed foods rich in vitamin A in past 24 hours1 Percentage who consumed foods rich in iron in past 24 hours2 Number of children Percentage given vitamin A supplements in past 6 months Number of children Age in months 6-8 45.8 30.7 493 15.1 510 9-11 74.1 58.7 438 13.3 445 12-17 88.3 75.0 868 19.2 929 18-23 90.6 81.9 786 13.0 941 24-35 94.4 85.5 1,190 7.6 1,907 36-47 na na na 4.4 1,976 48-59 na na na 3.6 1,900 Sex Male 82.6 72.3 1,898 9.1 4,357 Female 84.4 71.8 1,876 7.9 4,250 Breastfeeding status Breastfeeding 69.2 54.5 1,180 16.7 1,210 Not breastfeeding 90.0 80.0 2,594 7.2 7,388 Residence Urban 84.5 73.2 3,165 8.7 7,223 Rural 78.4 66.3 610 7.6 1,384 Governorate Amman 85.3 73.4 1,459 9.6 3,277 Balqa 82.8 69.7 222 6.2 536 Zarqa 85.1 77.5 560 13.0 1,325 Madaba 78.7 65.5 90 10.1 209 Irbid 83.0 71.0 738 5.6 1,629 Mafraq 76.7 61.4 172 4.8 416 Jarash 81.8 72.0 114 5.8 254 Ajloun 85.7 78.8 84 3.3 204 Karak 85.6 67.6 128 8.8 296 Tafiela 79.4 68.5 53 9.2 122 Ma'an 76.7 66.8 67 9.6 146 Aqaba 72.7 62.9 88 5.9 195 Region Central 84.8 73.7 2,332 10.1 5,348 North 82.1 70.2 1,107 5.3 2,502 South 79.5 66.4 335 8.3 758 Badia area Badia 75.5 63.7 319 6.6 764 Other 84.2 72.8 3,455 8.7 7,843 Mother's education No education 71.6 58.7 77 7.1 213 Elementary 80.8 66.6 210 4.1 524 Preparatory 79.5 67.7 523 9.5 1,173 Secondary 82.1 69.6 1,786 9.3 4,109 Higher 88.6 79.5 1,179 7.9 2,588 Mother's age at birth 15-19 69.1 54.4 68 6.1 90 20-29 82.9 71.1 1,715 10.1 3,795 30-39 84.3 72.5 1,676 7.7 3,882 40-49 86.2 78.6 316 5.4 841 Wealth quintile Lowest 77.6 64.3 938 6.8 2,187 Second 82.7 71.9 939 9.2 2,043 Middle 86.2 76.1 783 8.9 1,816 Fourth 85.8 72.4 621 11.3 1,442 Highest 89.0 80.2 494 6.9 1,119 Total 83.5 72.1 3,775 8.5 8,607 Note: Information on vitamin A and iron supplements is based on the mother's recall. na = Not applicable 1 Includes meat, fish, poultry, eggs, carrots, red sweet potatoes, pumpkin, apricot, palm nuts, yellow melon, and green leafy vegetables. 2 Includes meat, fish, poultry, and eggs. Nutrition | 143 11.2 NUTRITIONAL STATUS OF WOMEN 11.2.1 Height and Body Mass Index (BMI) In the 2007 JPFHS, data were collected on the height and weight of all women aged 15-49 in half of the households sampled. Women’s nutritional status is important both as an indicator of overall health and as a predictor of pregnancy outcome for both mother and child. Two indices of women’s nutritional status are presented in Table 11.7: height and body mass index (BMI). Maternal height is a measure of past nutritional status and reflects in part the cumulative effect of social and economic outcomes on access to nutritional foods during childhood and adolescence. It can be used to predict the risks associated with difficult deliveries, since small stature is often associated with small pelvis size and a greater likelihood of obstructed labor. Short stature is also correlated with low birth weight in infants, high risk of stillbirths, and high rates of miscarriage. The BMI, which utilizes both height and weight and provides a better measure of thinness than weight alone, is defined as weight in kilograms divided by the square of the height in meters (kg/m2). In classifying BMI, a cutoff of 18.5 has been recommended for assessing chronic energy deficiency among non-pregnant women. At the other end of the BMI scale, women are considered overweight if their BMI ranges between 25.0 and 29.9 and obese if their BMI is 30.0 or greater. To avoid bias in the measurement of women’s nutritional status, pregnant women and women who had given birth in the two months preceding the survey were excluded from the calculation of body mass measure. The cutoff point for height, below which a woman can be identified as nutritionally at risk, varies among populations, but it is usually considered to be in the range of 140-150 centimeters (cm). The 2007 JPFHS found that only 1 percent of women are under 145 cm in height and can be considered short. The mean BMI of women in Jordan is 25.8, higher than the normal BMI range of 18.5-24.9. Half of women fall in the normal BMI category. Four percent of women fall below the cutoff of 18.5, indicating that the level of chronic energy deficiency is relatively low in Jordan. However, a very high proportion of women have a BMI of 25.0-29.9 and can be considered overweight (27 percent) or have a BMI of 30.0 or more and can be considered obese (20 percent). In total, almost half of women are either overweight or obese. Very young women (15-19) are more likely than other women to suffer from chronic energy deficiency. Older women and women with no education or elementary education are more likely to be overweight or obese. 144 | Nutrition Table 11.7 Nutritional status of women Among women age 15-49, the percentage with height under 145 cm, mean body mass index (BMI), and the percentage with specific BMI levels, by background characteristics, Jordan 2007 Body Mass Index1 Height Background characteristic Percent- age below 145 cm Number of women Mean Body Mass Index (BMI) 18.5-24.9 (total normal) <18.5 (total thin) 17.0-18.4 (mildly thin) <17 (moderately and severely thin) �25.0 (total over- weight or obese) 25.0-29.9 (over- weight) �30.0 (obese) Number of women Age 15-19 1.5 719 23.0 71.2 7.3 4.6 2.8 21.4 15.7 5.7 675 20-29 1.1 2,650 24.3 60.9 3.7 2.7 1.0 35.4 23.3 12.1 2,209 30-39 0.7 2,748 26.4 41.4 3.4 2.8 0.6 55.2 33.1 22.2 2,511 40-49 1.5 2,382 27.3 38.2 3.7 2.3 1.4 58.1 28.4 29.7 2,364 Residence Urban 1.1 7,028 25.7 49.3 3.9 2.7 1.2 46.8 27.2 19.7 6,418 Rural 1.6 1,471 26.3 45.3 4.0 3.0 1.0 50.7 28.2 22.4 1,341 Governorate Amman 0.2 3,242 25.4 51.2 3.9 2.9 1.0 45.0 27.8 17.2 2,993 Balqa 1.2 544 25.6 51.7 5.1 3.3 1.8 43.2 21.7 21.5 491 Zarqa 1.3 1,248 25.0 56.2 2.9 2.1 0.7 40.9 27.8 13.1 1,129 Madaba 1.6 218 26.8 39.8 2.6 2.3 0.3 57.6 30.7 26.9 202 Irbid 1.8 1,571 27.0 41.2 3.9 2.1 1.8 54.9 26.3 28.5 1,414 Mafraq 3.6 359 26.5 40.2 5.5 4.7 0.7 54.3 28.3 25.9 327 Jarash 1.8 256 25.4 52.7 4.2 2.6 1.6 43.0 24.6 18.4 233 Ajloun 2.1 178 27.0 40.4 3.3 2.7 0.6 56.3 28.5 27.8 157 Karak 1.9 393 26.0 44.9 4.6 3.4 1.2 50.5 30.4 20.2 358 Tafiela 1.0 140 26.8 43.1 2.0 1.6 0.4 54.8 29.9 24.9 131 Ma'an 1.5 152 25.7 46.4 5.3 4.0 1.4 48.3 27.8 20.5 140 Aqaba 1.7 198 25.6 46.7 6.1 4.7 1.3 47.2 29.1 18.1 183 Region Central 0.6 5,252 25.4 51.9 3.7 2.7 1.0 44.4 27.3 17.1 4,815 North 2.1 2,364 26.7 42.3 4.1 2.6 1.6 53.6 26.6 27.0 2,131 South 1.6 883 26.0 45.3 4.6 3.5 1.1 50.1 29.6 20.5 813 Badia area Badia 2.3 694 25.7 45.4 4.7 4.0 0.8 49.8 31.6 18.2 620 Other 1.0 7,806 25.8 48.9 3.8 2.7 1.2 47.3 27.0 20.3 7,139 Education No education 6.0 278 29.2 24.1 2.7 1.5 1.2 73.3 35.6 37.7 266 Elementary 1.7 516 29.4 29.2 0.5 0.2 0.4 70.2 26.7 43.5 476 Preparatory 1.4 1,259 27.2 37.8 5.1 3.7 1.4 57.0 28.3 28.8 1,160 Secondary 0.9 3,876 25.1 52.4 4.5 3.1 1.4 43.2 26.5 16.7 3,491 Higher 0.8 2,567 25.1 54.8 3.4 2.5 0.9 41.8 27.4 14.4 2,361 Wealth quintile Lowest 1.6 1,677 26.1 46.1 4.9 2.8 2.1 49.0 27.4 21.6 1,464 Second 1.6 1,641 26.2 45.1 3.9 3.0 0.8 51.1 29.9 21.2 1,449 Middle 1.3 1,748 25.9 48.1 3.4 2.8 0.6 48.5 27.5 21.0 1,607 Fourth 0.6 1,748 25.5 50.8 4.5 3.0 1.4 44.7 24.8 19.9 1,625 Highest 0.7 1,686 25.4 52.3 3.0 2.2 0.8 44.8 27.5 17.3 1,614 Total2 1.1 8,499 25.8 48.6 3.9 2.8 1.2 47.5 27.4 20.1 7,759 Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 1 Excludes pregnant women and women with a birth in the preceding 2 months 2 Includes 5 women with information missing on education 11.2.2 Foods Consumed by Mothers The quality and quantity of food that mothers consume influences their health and that of their children, especially the health of breastfeeding children. The 2007 JPFHS included questions on the type of foods consumed by mothers of children under age three during the day and night preceding the interview. Table 11.8 shows that most mothers of young children consume foods made from grains (92 percent), foods made with oil, fat or butter (88 percent), meat, fish, shellfish, poultry or eggs (84 percent) and cheese or yogurt (82 percent). Two-thirds of mothers consume fruits or vegetables rich in vitamin A and three-fourths consume other types of fruits and vegetables. Eighty-two percent of mothers drink tea or coffee while one-third drink milk. Nutrition | 145 Table 11.8 Foods consumed by mothers in the day or night preceding the interview Among mothers age 15-49 with a child under age three years living with them, the percentage who consumed specific types of foods in the day or night preceding the interview, by background characteristics, Jordan 2007 Solid or semi-solid foods Liquids Background characteristic Milk Tea/ coffee Other liquids Foods made from grains Foods made from roots/ tubers Foods made from legumes Meat/ fish/ shellfish/ poultry/ eggs Cheese/ yogurt Vitamin A -rich fruits/ vege- tables1 Other fruits/ vege- tables Other solid or semi- solid food Foods made with oil/ fat/ butter Sugary foods Number of women Age 15-19 26.2 66.7 81.4 95.2 41.1 45.1 75.9 75.9 58.4 74.0 46.4 85.7 69.1 123 20-29 37.0 77.5 89.8 92.1 40.4 57.4 84.8 80.1 67.1 75.2 34.8 87.7 63.1 2,301 30-39 35.3 85.4 86.4 90.9 40.6 57.2 83.3 83.2 64.2 76.8 37.3 87.5 59.0 2,027 40-49 31.2 93.3 83.2 94.5 47.9 68.1 84.9 85.5 69.1 75.9 41.9 93.0 53.6 369 Residence Urban 35.6 80.6 88.0 91.7 40.1 58.4 84.6 81.7 66.3 75.5 38.0 88.2 61.5 4,024 Rural 35.6 87.6 85.9 92.9 46.1 54.9 80.9 81.6 63.5 78.1 30.1 87.0 57.4 796 Governorate Amman 36.7 79.0 85.4 90.3 42.3 60.4 84.6 80.5 70.7 76.8 39.2 87.4 63.9 1,871 Balqa 39.6 87.2 89.6 97.1 45.4 62.4 82.8 80.2 63.0 77.9 35.3 86.2 57.4 288 Zarqa 36.3 87.1 90.9 86.9 32.7 50.3 84.2 77.5 50.1 72.2 37.1 85.3 52.1 701 Madaba 39.0 84.5 85.7 91.6 43.0 58.0 75.8 72.1 57.8 71.2 35.8 83.6 48.6 118 Irbid 30.8 76.9 90.7 94.6 40.3 57.7 87.6 88.0 72.6 73.6 38.3 91.4 64.7 934 Mafraq 45.7 88.2 84.9 95.6 43.3 53.0 77.4 85.9 64.6 77.5 31.8 91.2 60.1 224 Jarash 26.6 85.0 84.4 93.9 37.6 52.8 85.1 80.1 50.4 79.6 23.1 86.5 56.4 146 Ajloun 31.6 87.7 87.9 97.6 46.6 58.8 89.0 89.1 65.9 89.5 22.9 95.3 62.2 108 Karak 24.8 86.7 88.2 91.4 41.7 60.2 79.6 78.5 72.5 78.3 31.8 85.8 60.3 170 Tafiela 34.6 91.9 87.5 93.3 48.6 60.5 78.6 81.3 60.2 79.8 36.8 85.9 59.8 68 Ma'an 45.4 85.8 86.7 93.7 49.9 60.2 75.3 79.9 64.4 74.9 35.3 86.2 59.2 85 Aqaba 43.7 76.7 85.3 95.8 48.5 58.8 77.2 82.4 57.2 76.4 34.0 88.3 61.3 108 Region Central 37.0 82.0 87.1 90.2 40.4 58.1 84.0 79.4 64.6 75.6 38.2 86.6 59.9 2,978 North 32.8 80.4 88.9 94.9 41.0 56.5 85.8 87.0 68.5 76.0 34.5 91.2 62.9 1,412 South 35.2 84.9 87.1 93.3 46.1 59.9 78.0 80.2 65.1 77.4 33.8 86.5 60.3 431 Badia area Badia 46.6 88.9 79.8 91.1 46.9 58.3 75.8 81.4 58.9 74.7 35.3 84.4 51.1 418 Other 34.6 81.1 88.4 91.9 40.5 57.8 84.7 81.7 66.5 76.0 36.8 88.3 61.7 4,403 Education No education 34.9 94.2 78.6 94.1 43.8 40.5 59.3 63.5 45.0 64.4 38.5 87.4 32.6 101 Elementary 29.7 82.6 83.2 89.7 40.6 43.5 76.0 73.9 62.1 64.1 37.4 91.4 46.6 260 Preparatory 35.7 87.2 87.3 90.5 39.2 57.3 82.4 81.0 60.3 70.3 36.4 87.3 56.0 690 Secondary 33.4 80.6 86.1 91.7 37.5 58.4 83.4 81.9 64.4 75.3 37.7 87.7 60.0 2,284 Higher 39.9 80.0 91.5 92.9 47.3 60.8 88.7 84.3 72.5 82.2 35.0 88.1 68.7 1,486 Wealth quintile Lowest 32.4 81.4 84.6 91.6 40.8 52.8 77.9 76.4 59.9 68.3 37.3 86.6 51.9 1,227 Second 36.1 84.4 86.0 91.4 43.4 57.7 84.5 83.2 62.5 73.8 36.9 89.9 60.6 1,192 Middle 33.0 81.3 89.1 93.1 39.0 61.7 88.7 85.1 68.4 78.6 36.4 89.1 66.8 1,000 Fourth 39.1 81.2 91.0 92.2 37.1 61.4 84.3 83.8 70.7 79.3 35.9 85.0 58.4 773 Highest 40.9 78.9 90.2 90.8 45.1 57.1 86.9 81.3 73.4 86.2 36.6 88.7 72.0 629 Total 35.6 81.7 87.6 91.9 41.1 57.8 84.0 81.7 65.8 75.9 36.7 88.0 60.8 4,821 Note: Foods consumed in the past "24-hour" period (yesterday and last night) 1 Includes , carrots, red sweet potatoes, pumpkin, apricot, palm nuts, yellow melon, and green leafy vegetables 11.2.3 Micronutrient Intake among Mothers A mother's nutritional status during pregnancy is important both for the child's intrauterine development and for protection against maternal morbidity and mortality. Table 11.9 shows the micronutrient intake among mothers of young children by background characteristics. Nearly all mothers consumed vitamin A-rich foods and 84 percent consumed iron-rich foods in the 24 hours preceding the survey. Consumption of vitamin A and iron-rich foods is higher among mothers with a higher education and among women living in wealthier households. 146 | Nutrition In addition, women who had given birth during the five years prior to the survey were asked for how many days they took iron supplements during their last pregnancy. Half of mothers report taking iron tablets or syrup for more than three months during their last pregnancy. Nineteen percent of mothers report not taking any iron supplementation during their last pregnancy. Mothers with higher levels of education and those living in the wealthiest households were most likely to take at least 90 days worth of iron supplements. Table 11.9 Micronutrient intake among mothers Among women age 15-49 with a child under age three years living with her, the percentages who consumed vitamin A-rich and iron-rich foods in the 24 hours preceding the survey; among mothers age 15-49 percentage who, during the pregnancy of the last child born in the five years prior to the survey, took iron tablets or syrup for specific numbers of days, by background characteristics, Jordan 2007 Among women with a child under three years living with her Number of days women took iron tablets or syrup during pregnancy of last birth Background characteristic Percentage consumed Vitamin A rich foods1 Percentage consumed iron-rich foods2 Number of women None <60 60-89 90+ Don't know/ missing Number of women Age 15-19 86.7 75.9 123 17.1 19.5 10.9 52.3 0.3 124 20-29 92.9 84.8 2,301 17.9 16.7 11.7 51.8 2.0 2,676 30-39 93.6 83.3 2,027 18.8 14.4 13.6 51.4 1.8 2,912 40-49 90.8 84.9 369 26.4 14.5 11.1 44.7 3.2 735 Residence Urban 93.2 84.6 4,024 17.8 15.5 12.5 52.2 2.0 5,417 Rural 90.9 80.9 796 27.2 15.1 12.6 43.3 1.8 1,029 Governorate Amman 93.8 84.6 1,871 13.7 16.5 11.1 56.0 2.7 2,469 Balqa 90.8 82.8 288 12.6 7.3 10.5 68.6 1.0 396 Zarqa 90.9 84.2 701 18.0 14.0 16.5 49.8 1.8 966 Madaba 88.5 75.8 118 18.1 12.0 10.6 53.9 5.4 157 Irbid 96.0 87.6 934 24.8 15.6 14.2 44.1 1.3 1,261 Mafraq 89.2 77.4 224 39.2 18.8 10.0 31.4 0.7 298 Jarash 92.7 85.1 146 26.3 13.2 12.4 46.8 1.3 185 Ajloun 95.4 89.0 108 29.8 15.7 12.2 41.3 1.1 150 Karak 92.7 79.6 170 22.4 20.8 11.7 42.4 2.7 229 Tafiela 88.7 78.6 68 25.7 20.4 12.6 39.6 1.7 88 Ma'an 86.2 75.3 85 28.8 18.4 10.2 40.8 1.7 107 Aqaba 85.5 77.2 108 17.3 12.5 11.1 58.2 0.9 140 Region Central 92.6 84.0 2,978 14.8 14.8 12.3 55.7 2.4 3,987 North 94.5 85.8 1,412 27.6 15.9 13.2 42.1 1.2 1,894 South 89.0 78.0 431 22.8 18.3 11.4 45.6 1.9 564 Badia area Badia 87.7 75.8 418 30.6 15.8 8.1 43.6 1.9 536 Other 93.4 84.7 4,403 18.2 15.4 12.9 51.5 2.0 5,910 Education No education 71.6 59.3 101 42.1 15.7 10.4 28.5 3.3 155 Elementary 85.8 76.0 260 31.4 16.8 13.3 35.6 2.9 351 Preparatory 92.8 82.4 690 24.2 15.6 14.1 45.8 0.4 917 Secondary 92.7 83.4 2,284 18.1 16.1 12.0 51.3 2.5 3,058 Higher 95.8 88.7 1,486 14.8 14.1 12.6 56.9 1.7 1,964 Wealth quintile Lowest 89.0 77.9 1,227 28.6 17.8 10.6 40.5 2.4 1,508 Second 93.3 84.5 1,192 19.6 16.4 14.0 48.8 1.2 1,501 Middle 94.3 88.7 1,000 17.4 15.0 12.6 52.0 3.0 1,378 Fourth 94.9 84.3 773 13.5 13.0 14.4 56.6 2.5 1,153 Highest 94.9 86.9 629 13.3 13.6 10.4 62.1 0.5 906 Total 92.9 84.0 4,821 19.3 15.4 12.5 50.8 2.0 6,446 1 Includes meat, fish, poultry, eggs, carrots, red sweet potatoes, pumpkin, apricot, palm nuts, yellow melon, and green leafy vegetables 2 Includes meat, fish, poultry, and eggs HIV/AIDS and Sexually Transmitted Infections � 147 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS 12 Acquired immune deficiency syndrome (AIDS) is caused by a human immunodeficiency virus (HIV) that weakens the immune system, making the body susceptible to and unable to recover from other diseases. HIV/AIDS is a pandemic with cases reported from every country. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that approximately 33 million people worldwide were living with HIV in 2007. An estimated 2 million lost their lives to AIDS (UNAIDS, 2008). The first case of AIDS reported in Jordan was in 1986. By December 2007, there were 550 reported HIV infections in Jordan; a total of 185 cases among Jordanian nationals and the remaining among members of the expatriate community. As surveillance systems are not fully developed, and there exists pervasive fear of and stigma against HIV/AIDS in Jordan, it is believed that the number of HIV- infected individuals residing in Jordan exceeds the number of officially registered cases. According to available data, however, it is possible to discern that transmission occurs primarily among those aged 20- 49 years. The modes of transmission are estimated to be 60 percent via sexual contact, 17 percent via blood or blood products, 3 percent via injecting drug use, 2 percent via mother to child transmission and 18 percent of unknown routes. In 1986, Jordan launched a National AIDS Program within the Ministry of Health and is working with international bodies such as UNAIDS and the World Health Organization to combat the threat of AIDS in Jordan. The 2007 JPFHS collected information from ever-married women about HIV/AIDS, as well as information about knowledge of symptoms of sexually transmitted infections (STIs), which are known to be important predisposing factors for HIV epidemics. This chapter summarizes information on knowledge, perceptions, and behaviors of ever-married women aged 15-49 by background characteristics. 12.1 KNOWLEDGE OF HIV/AIDS AND METHODS OF HIV PREVENTION Table 12.1 shows the percentage of ever-married women who have heard of AIDS by background characteristics. Almost all of the women (99 percent) report that they have heard of AIDS. At least 96 percent of women of all background characteristics have heard of AIDS with the exception of women with no education (86 percent). To evaluate the level of knowledge about HIV/AIDS, women who had heard of the infection were asked whether there is anything a person can do to avoid getting infected with the virus that causes AIDS. If a woman reported that HIV infection could be prevented, she was asked two types of questions were asked about ways to prevent HIV infection. First, an open-ended question was asked and women were allowed to indicate any means that they know without prompting. Next, women were asked specific questions on whether condom use, having only one sexual partner, and abstaining from sex can reduce their chances of becoming infected with HIV. 148 | HIV/AIDS and Sexually Transmitted Infections Table 12.1 Knowledge of AIDS Percentage of ever married women age 15-49 who have heard of AIDS, by background characteristics, Jordan 2007 Background characteristic Has heard of AIDS Number of women Age 15-24 98.7 1,512 15-19 97.6 236 20-24 98.9 1,276 25-29 98.8 1,977 30-39 99.3 4,265 40-49 97.7 3,122 Marital status Married 98.7 10,354 Divorced/widowed 96.8 522 Residence Urban 98.9 9,249 Rural 97.2 1,627 Governorate Amman 99.0 4,442 Balqa 97.3 645 Zarqa 98.4 1,645 Madaba 97.2 262 Irbid 99.6 1,993 Mafraq 97.4 460 Jarash 99.3 293 Ajloun 98.7 228 Karak 97.0 378 Tafiela 98.0 146 Ma'an 96.9 164 Aqaba 96.6 221 Region Central 98.6 6,993 North 99.2 2,975 South 97.0 908 Badia area Badia 96.6 823 Other 98.8 10,053 Education No education 86.3 416 Elementary 96.9 813 Preparatory 98.8 1,681 Secondary 99.3 4,788 Higher 99.6 3,179 Wealth quintile Lowest 96.3 2,211 Second 98.9 2,296 Middle 99.0 2,206 Fourth 99.3 2,135 Highest 100.0 2,028 Total 98.7 10,876 HIV/AIDS and Sexually Transmitted Infections � 149 Table 12.2 shows the percentage of all women who spontaneously mentioned specific ways to avoid contracting the disease. The most frequently reported means to prevent HIV is avoidance of blood transfusions (56 percent), with limiting sex to one partner being the next most frequently mentioned way to prevent HIV (38 percent). Twenty-seven percent of women believe that avoiding sex with persons having multiple sexual partners would help to avoid HIV and 26 percent mentioned avoidance of injections; only one percent of women spontaneously mentioned condoms as a means of avoiding HIV. Table 12.2 Knowledge of ways to avoid HIV/AIDS Percentage of ever married women who spon- taneously mentioned ways to avoid HIV/AIDS, Jordan 2007 Ways to avoid HIV/AIDS Percentage of women Does not know of AIDS or if AIDS can be avoided 5.5 Believes no way to avoid AIDS 5.1 Does not know specific way1 5.3 Abstain from sexual intercourse 6.5 Use condoms 1.2 Limit sex to spouse 38.3 Limit number of sexual partners 6.8 Avoid prostitutes 14.1 Avoid sex with persons who have multiple partners 27.3 Aviod sex with homosexuals 11.3 Avoid sex with person taking injected drugs 9.7 Avoid blood transfusion 55.9 Avoid injections 26.2 Avoid sharing razors, blades 6.6 Avoid kissing 1.4 Avoid mosquito bites 0.1 Other 3.4 Number of women 10,876 1 Believes there is something a person can do to avoid AIDS, but cannot spontaneously mention any specific way HIV/AIDS prevention programs focus their messages and efforts on three important aspects of behavior: delaying sexual debut in young persons (abstinence), limiting the number of sexual partners or staying faithful to one partner, and use of condoms (the ABC message). To ascertain whether programs have effectively communicated these messages, women were prompted with specific questions about whether it is possible to reduce the chances of getting the AIDS virus by having just one faithful sexual partner, using a condom at every sexual encounter, and abstaining from sex. Table 12.3 presents the results on knowledge about these three key prevention strategies by background characteristics. It should be noted that this table is based on prompted questions on these three aspects of AIDS-prevention behavior, while Table 12.2 is based on spontaneous answers. 150 | HIV/AIDS and Sexually Transmitted Infections Table 12.3 Knowledge of HIV prevention methods Percentage of ever married women who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having one sex partner who is not infected and has no other partners, and by abstaining from sexual intercourse, by background characteristics, Jordan 2007 Percentage who say HIV can be prevented by Background characteristic Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1, 2 Abstaining from sexual intercourse Number of women Age 15-24 51.0 85.0 48.4 36.9 1,512 15-19 44.5 80.2 42.7 33.5 236 20-24 52.2 85.8 49.4 37.5 1,276 25-29 55.2 86.6 52.2 43.8 1,977 30-39 54.3 86.5 50.7 44.0 4,265 40-49 51.5 86.0 48.8 45.1 3,122 Marital status Married 53.7 86.5 50.6 43.3 10,354 Divorced/widowed 43.3 79.5 40.2 42.6 522 Residence Urban 53.9 86.6 50.9 43.6 9,249 Rural 49.2 83.5 45.7 41.2 1,627 Governorate Amman 55.9 89.9 53.8 47.3 4,442 Balqa 52.0 85.8 49.3 40.7 645 Zarqa 44.8 74.5 40.7 40.7 1,645 Madaba 43.7 84.1 39.3 36.2 262 Irbid 57.6 90.1 54.0 39.6 1,993 Mafraq 54.5 88.0 52.1 40.3 460 Jarash 48.9 90.7 47.2 37.3 293 Ajloun 56.3 93.8 54.3 36.3 228 Karak 51.0 80.0 43.9 45.0 378 Tafiela 48.8 77.0 41.9 48.6 146 Ma'an 48.3 76.0 42.1 45.7 164 Aqaba 47.4 71.6 42.5 44.6 221 Region Central 52.5 85.7 49.7 44.7 6,993 North 56.1 90.1 53.1 39.2 2,975 South 49.3 76.8 42.9 45.6 908 Badia area Badia 47.0 82.2 44.4 39.6 823 Other 53.7 86.5 50.5 43.6 10,053 Education No education 28.2 61.5 26.2 35.7 416 Elementary 43.1 79.1 40.2 39.2 813 Preparatory 47.7 86.9 45.9 42.0 1,681 Secondary 53.6 86.7 50.2 44.1 4,788 Higher 61.3 89.9 57.8 44.7 3,179 Wealth quintile Lowest 44.5 80.4 42.0 37.4 2,211 Second 50.8 84.6 47.8 43.5 2,296 Middle 52.8 84.5 49.2 44.0 2,206 Fourth 56.0 89.3 52.0 42.0 2,135 Highest 62.8 92.6 60.4 50.0 2,028 Total 53.2 86.2 50.1 43.3 10,876 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners HIV/AIDS and Sexually Transmitted Infections � 151 Ever-married women are most knowledgeable about limiting sexual intercourse to one uninfected partner (86 percent). Far fewer women know that using condoms or abstaining from sexual intercourse can reduce the risk of contracting HIV (53 percent and 43 percent, respectively). Not surprisingly, knowledge of these means of prevention is highest among urban women, women with higher levels of education and women living in wealthier households. There is a particularly strong relationship between education and knowledge of condom use as a means of HIV prevention; 28 percent of women with no education cite using condoms as a means of preventing HIV compared to 61 percent of women with a higher than secondary education. The 2007 JPFHS also included questions to assess the prevalence of common misconceptions about AIDS and HIV transmission. Women who had heard of HIV/AIDS were asked whether they think it is possible for a healthy-looking person to have the AIDS virus. They were also asked whether a person can get AIDS from mosquito bites, by shaking hands with someone who has AIDS or by sharing food with a person who has AIDS. The results in Table 12.4 indicate that many women lack accurate knowledge about the ways in which HIV can and cannot be transmitted. Only 66 percent of women know that a healthy-looking person can have (and thus transmit) the virus that causes AIDS. This represents however a significant increase from 2002, when only 46 percent of women reported knowing this. Many women also erroneously believe that AIDS can be transmitted by mosquito bites; only 40 percent of women reject this common misconception. Larger proportions of women are aware that the AIDS virus cannot be transmitted by sharing food with a person who has AIDS (73 percent) or by shaking hands with an infected person (79 percent). However, only one fourth of women (24 percent) are able to reject the two most common misconceptions about AIDS—that AIDS can be transmitted by mosquito bites and that a person can become infected with the AIDS virus by sharing food with someone who is infected—and know that a healthy-looking person can have the AIDS virus. Table 12.4 also provides an assessment of the level of comprehensive knowledge of HIV/AIDS prevention and transmission. Comprehensive knowledge is defined as: 1) knowing that both condom use and limiting sex partners to one uninfected person are HIV/AIDS prevention methods, 2) being aware that a healthy-looking person can have HIV, and 3) rejecting the two most common local misconceptions— that HIV/AIDS can be transmitted through mosquito bites and by sharing food. Overall, only 14 percent of ever-married women have a comprehensive knowledge of HIV/AIDS prevention and transmission. Comprehensive knowledge is positively associated with education; twenty-two percent of the highest educated women have a comprehensive knowledge about AIDS, compared to only 3 percent of women with no education. 152 | HIV/AIDS and Sexually Transmitted Infections Table 12.4 Comprehensive knowledge about AIDS Percentage of ever-married women who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Jordan 2007 Percentage of women who say that: Background characteristic A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by shaking hands A person cannot become infected by sharing food with a person who has AIDS Percentage who say that a healthy- looking person can have the AIDS virus and who reject the two most common local misconceptions1 Percentage with a comprehensive knowledge about AIDS2 Number of women Age 15-24 64.0 41.6 80.2 71.4 23.0 12.9 1,512 15-19 56.3 33.9 79.2 67.6 17.4 12.3 236 20-24 65.4 43.1 80.4 72.2 24.0 13.0 1,276 25-29 63.5 38.9 81.1 70.9 22.2 14.1 1,977 30-39 68.1 41.5 80.7 75.4 25.6 14.9 4,265 40-49 64.3 37.9 76.2 71.9 23.5 14.6 3,122 Marital status Married 65.9 40.0 79.8 73.3 24.2 14.6 10,354 Divorced/widowed 59.9 39.4 72.7 67.7 21.4 10.5 522 Residence Urban 66.1 40.9 80.6 74.4 24.6 14.8 9,249 Rural 62.4 34.8 72.5 65.3 21.0 12.0 1,627 Governorate Amman 70.3 42.2 84.7 78.8 27.0 16.3 4,442 Balqa 69.7 32.1 71.9 67.0 22.8 14.4 645 Zarqa 56.2 49.0 75.3 72.8 22.0 11.8 1,645 Madaba 66.5 48.1 75.2 69.8 34.4 12.8 262 Irbid 62.8 36.4 79.7 69.2 22.3 15.2 1,993 Mafraq 57.6 29.6 72.7 60.9 17.2 11.2 460 Jarash 67.8 34.2 79.1 73.1 21.2 11.9 293 Ajloun 66.5 30.5 76.1 67.7 20.4 12.8 228 Karak 67.1 33.4 72.6 65.9 20.6 11.7 378 Tafiela 64.0 31.3 70.0 64.1 16.8 8.7 146 Ma'an 63.3 31.6 65.9 61.1 17.9 8.9 164 Aqaba 65.2 35.7 72.9 71.8 22.5 13.0 221 Region Central 66.8 43.1 81.0 76.0 25.7 14.9 6,993 North 62.8 34.7 78.3 68.2 21.3 14.1 2,975 South 65.5 33.3 71.1 66.2 20.0 11.1 908 Badia area Badia 56.8 33.2 70.0 62.5 18.5 8.5 823 Other 66.3 40.6 80.2 73.9 24.5 14.9 10,053 Education No education 42.8 21.1 40.6 39.5 9.5 3.4 416 Elementary 48.0 28.5 62.6 55.4 13.6 8.5 813 Preparatory 55.4 37.4 73.9 67.2 17.9 9.8 1,681 Secondary 65.1 39.9 81.4 74.9 22.3 12.9 4,788 Higher 79.2 46.9 88.7 82.1 34.4 21.9 3,179 Wealth quintile Lowest 55.7 34.5 67.7 60.4 17.6 10.0 2,211 Second 61.6 40.9 77.9 70.2 22.1 12.3 2,296 Middle 64.9 37.5 78.9 71.6 22.5 12.6 2,206 Fourth 69.2 42.5 84.4 78.7 26.1 15.1 2,135 Highest 77.8 45.1 89.2 85.5 32.7 22.7 2,028 Total 65.6 40.0 79.4 73.0 24.0 14.4 10,876 1 Two most common local misconceptions: mosquito bites and sharing food 2 Comprehensive knowledge means knowing that consistent use of condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. The 2007 JPFHS asked women whether they thought the AIDS virus could be transmitted from mother to child during pregnancy, during delivery, and through breastfeeding (Table 12.5). The results indicate that while 86 percent know that HIV can be transmitted from mother to child during pregnancy and three-fourths (74 percent) know that the virus can be transmitted during delivery, only half know that it can be transmitted through breastfeeding (51 percent). Although knowledge of HIV transmission during pregnancy and through delivery is positively correlated with a woman’s education, there is no relationship between education levels and knowledge of transmission of HIV through breastfeeding. HIV/AIDS and Sexually Transmitted Infections � 153 Table 12.5 Knowledge of mother to child transmission of HIV Percentage of ever-married women who know about transmission from mother to child of HIV by background characteristics, Jordan 2007 Percentage who say HIV/AIDS can be transmitted from mother to child: Background characteristic During delivery During pregnancy Through breastfeeding Number of women Age 15-24 70.5 87.6 61.3 1,512 15-19 65.2 88.9 69.4 236 20-24 71.5 87.4 59.8 1,276 25-29 74.3 85.5 50.5 1,977 30-39 74.4 85.4 50.1 4,265 40-49 75.3 85.8 48.5 3,122 Marital status Married 74.3 85.9 51.1 10,354 Divorced/widowed 70.6 85.2 55.0 522 Currently pregnant Pregnant 70.5 83.6 49.9 1,315 Not pregnant or not sure 74.6 86.2 51.5 9,561 Residence Urban 74.6 86.4 50.6 9,249 Rural 71.3 82.5 55.3 1,627 Governorate Amman 73.9 87.4 47.6 4,442 Balqa 72.7 78.4 51.9 645 Zarqa 78.3 86.1 49.6 1,645 Madaba 74.1 80.9 58.3 262 Irbid 74.0 85.8 57.5 1,993 Mafraq 72.0 85.4 59.3 460 Jarash 77.9 88.0 62.9 293 Ajloun 73.4 86.3 58.1 228 Karak 73.7 85.1 51.8 378 Tafiela 68.1 84.0 45.8 146 Ma'an 65.0 83.3 48.5 164 Aqaba 65.6 83.3 38.1 221 Region Central 74.8 86.0 48.8 6,993 North 74.0 86.0 58.4 2,975 South 69.3 84.1 46.9 908 Badia area Badia 70.0 82.0 56.3 823 Other 74.4 86.2 50.9 10,053 Education No education 51.3 61.9 46.2 416 Elementary 65.2 74.7 55.4 813 Preparatory 72.7 86.3 54.5 1,681 Secondary 72.3 86.7 51.6 4,788 Higher 82.8 90.3 48.7 3,179 Wealth quintile Lowest 66.7 80.5 58.2 2,211 Second 72.7 84.2 54.1 2,296 Middle 73.8 88.0 51.9 2,206 Fourth 77.9 88.7 48.0 2,135 Highest 80.2 88.2 43.3 2,028 Total 74.1 85.9 51.3 10,876 12.2 STIGMA ASSOCIATED WITH AIDS Social aspects of HIV/AIDS include, among others, negative attitudes toward people living with AIDS. The stigma is related to the public’s perception of HIV/AIDS as associated with marginalized groups such as injecting drug users, prostitutes and homosexuals. Fear of being stigmatized has been implicated as an important barrier to HIV testing and programs aimed at assisting persons living with AIDS and their families. 154 | HIV/AIDS and Sexually Transmitted Infections In the 2007 JPFHS, women who had heard of AIDS were asked questions to assess the extent of stigma associated with AIDS. The results in Table 12.6 indicate that three-fourths of women would be willing to care for a relative with AIDS at home (74 percent). However, far fewer women would be willing to buy fresh vegetables from a shopkeeper with AIDS (24 percent) or allow a female teacher with AIDS to keep teaching (29 percent). Approximately one-third of women say that they would not keep secret the fact that a family member is HIV positive. Accepting attitudes are expressed on all four indicators of tolerance by only four percent of women, indicating that stigma surrounding AIDS is widespread in Jordan. Table 12.6 Accepting attitudes toward those living with HIV/AIDS Among ever married women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with AIDS, by background characteristics, Jordan 2007 Percentage of women who: Background characteristic Are willing to care for a family member with the AIDS virus in the woman’s home Would buy fresh vege-tables from shopkeeper who has the AIDS virus Say that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Percentage expressing acceptance attitudes on all four indicators Number of women who have heard of AIDS Age 15-24 73.1 25.8 29.0 33.5 4.8 1,492 15-19 61.5 29.3 27.2 36.1 4.8 230 20-24 75.2 25.1 29.3 33.0 4.8 1,262 25-29 73.3 23.0 25.5 35.9 4.1 1,953 30-39 74.7 25.8 30.7 34.7 4.6 4,233 40-49 74.7 22.1 28.0 36.0 2.9 3,050 Marital status Married 74.0 24.4 28.8 35.1 4.2 10,224 Divorced/widowed 78.9 21.8 28.0 34.9 2.1 505 Residence Urban 73.3 24.6 29.4 34.6 4.1 9,148 Rural 79.6 22.4 25.2 38.4 3.6 1,582 Governorate Amman 72.9 27.6 33.7 31.0 4.8 4,397 Balqa 60.6 24.6 29.3 27.0 1.9 627 Zarqa 60.6 24.4 23.6 33.3 2.5 1,618 Madaba 81.0 28.3 28.2 28.5 1.8 254 Irbid 81.5 18.1 23.5 38.0 3.7 1,986 Mafraq 82.9 19.6 24.0 38.6 3.0 448 Jarash 76.1 24.3 28.4 41.9 3.1 291 Ajloun 82.2 18.8 27.6 45.8 4.6 225 Karak 90.2 24.3 29.2 51.3 6.6 367 Tafiela 90.3 22.2 26.1 53.9 6.1 143 Ma'an 89.8 22.2 25.4 53.0 5.9 158 Aqaba 91.2 23.5 28.3 56.3 7.7 214 Region Central 69.2 26.6 30.7 31.1 3.9 6,897 North 81.2 19.0 24.4 39.1 3.6 2,951 South 90.4 23.4 27.8 53.2 6.6 882 Badia area Badia 81.6 23.8 25.1 38.6 3.4 795 Other 73.6 24.3 29.0 34.8 4.1 9,934 Education No education 78.0 16.9 14.1 47.6 1.2 359 Elementary 77.5 17.6 19.8 39.3 2.5 787 Preparatory 71.4 23.3 26.9 37.8 3.3 1,660 Secondary 74.0 25.3 28.8 34.0 4.1 4,756 Higher 74.8 25.7 33.5 32.9 5.1 3,167 Wealth quintile Lowest 74.9 21.1 22.6 36.6 3.6 2,128 Second 74.8 22.9 27.2 36.1 4.1 2,271 Middle 75.5 22.8 27.0 36.1 3.2 2,183 Fourth 72.8 28.0 30.0 34.6 4.7 2,120 Highest 73.0 26.8 37.5 31.9 4.7 2,028 Total 74.2 24.3 28.7 35.1 4.1 10,729 HIV/AIDS and Sexually Transmitted Infections � 155 12.3 ATTITUDES TOWARDS NEGOTIATING SAFER SEXUAL RELATIONS Knowledge about HIV transmission and ways to prevent it are of little use if people feel powerless to negotiate safer sex practices with their partner. In an effort to assess the ability of women to negotiate safer sex with a spouse who has a sexually transmitted infection (STI), women were asked if they thought a wife is justified in refusing to have sex with her husband when she knows he has a disease that can be transmitted through sexual contact, and if a woman in the same circumstances is justified in asking her husband to use a condom. Table 12.7 shows that nearly all women believe that, if she knows her husband has an STI, a woman is justified in either refusing to have sex with him or asking him to wear a condom (99 percent). Considering the two actions separately, a large majority of women believe that a woman is justified in refusing to have sexual intercourse (97 percent) or asking that they use a condom (89 percent). Table 12.7 Attitudes toward negotiating safer sexual relations with husband Percentage of ever married women who believe that, if a husband has a sexually transmitted disease, his wife is justified in refusing to have sexual intercourse with him or asking that they use a condom, by background characteristics, Jordan 2007 Woman is justified to: Background characteristic Refusing to have sexual intercourse Asking that they use a condom Refusing sexual intercourse or asking that they use a condom Number of women Age 15-24 96.1 87.5 97.6 1,512 15-19 92.1 83.4 94.1 236 20-24 96.9 88.3 98.2 1,276 25-29 99.1 91.9 99.4 1,977 30-39 96.9 90.2 98.7 4,265 40-49 96.6 87.7 98.3 3,122 Marital status Married 97.2 89.6 98.6 10,354 Divorced/widowed 95.6 84.7 96.9 522 Residence Urban 97.3 89.7 98.7 9,249 Rural 96.4 87.6 97.8 1,627 Governorate Amman 96.2 87.9 98.2 4,442 Balqa 98.0 91.1 98.3 645 Zarqa 98.4 92.5 99.1 1,645 Madaba 97.4 92.2 98.5 262 Irbid 98.6 90.8 99.2 1,993 Mafraq 97.7 90.4 99.2 460 Jarash 98.4 94.6 99.1 293 Ajloun 97.8 93.2 99.1 228 Karak 92.0 80.8 95.2 378 Tafiela 95.9 85.9 98.4 146 Ma'an 96.0 84.7 98.1 164 Aqaba 97.5 83.3 98.7 221 Region Central 96.9 89.4 98.5 6,993 North 98.4 91.3 99.2 2,975 South 94.7 83.0 97.1 908 Badia area Badia 96.4 85.9 97.5 823 Other 97.2 89.7 98.6 10,053 Education No education 89.3 77.2 92.3 416 Elementary 93.0 84.8 96.6 813 Preparatory 97.3 87.5 98.7 1,681 Secondary 97.5 89.5 98.8 4,788 Higher 98.6 93.1 99.4 3,179 Wealth quintile Lowest 95.4 87.4 97.7 2,211 Second 97.1 89.6 99.1 2,296 Middle 96.7 89.1 97.8 2,206 Fourth 98.2 89.8 98.8 2,135 Highest 98.4 91.4 99.4 2,028 Total 97.1 89.4 98.6 10,876 156 | HIV/AIDS and Sexually Transmitted Infections Currently married women were asked whether they had ever discussed HIV/AIDS prevention with their husband, since discussing HIV prevention with one’s partner is an important aspect of preventive behavior. Table 12.8 shows that approximately one-third of currently married women (36 percent) had discussed HIV/AIDS prevention with their husband while two-thirds (62 percent) had not. Again, young, rural, less educated women, as well as those living in poorer households were least likely to have talked to their spouses about this important issue. Those most likely to have broached the topic with their husband were women who had a higher-than-secondary education (45 percent), women living in the wealthiest households (45 percent) and women living in Zarqa (41 percent). Table 12.8 Discussion of HIV/AIDS with husband Percent distribution of women who are currently married by whether they ever discussed HIV/AIDS prevention with their husband, by background characteristics, Jordan 2007 Background characteristic Discussed HIV/AIDS prevention with husband Never discussed HIV/AIDS prevention with husband Has not heard of AIDS Total Number of women Age 15-24 28.8 69.9 1.4 100.0 1,466 15-19 22.5 75.0 2.5 100.0 233 20-24 29.9 68.9 1.2 100.0 1,233 25-29 35.5 63.3 1.2 100.0 1,932 30-39 38.7 60.6 0.7 100.0 4,095 40-49 37.5 60.5 2.0 100.0 2,861 Residence Urban 37.0 62.0 1.0 100.0 8,803 Rural 32.7 64.6 2.8 100.0 1,551 Governorate Amman 35.7 63.4 0.8 100.0 4,242 Balqa 36.9 60.4 2.7 100.0 620 Zarqa 40.9 57.5 1.6 100.0 1,548 Madaba 28.1 69.2 2.6 100.0 248 Irbid 37.2 62.6 0.3 100.0 1,892 Mafraq 33.1 64.1 2.8 100.0 441 Jarash 28.5 70.9 0.6 100.0 278 Ajloun 35.4 63.3 1.3 100.0 218 Karak 38.2 58.8 3.0 100.0 363 Tafiela 32.0 66.3 1.8 100.0 139 Ma'an 36.3 60.6 3.1 100.0 154 Aqaba 33.2 63.5 3.3 100.0 212 Region Central 36.8 62.0 1.3 100.0 6,658 North 35.6 63.7 0.8 100.0 2,830 South 35.7 61.5 2.9 100.0 867 Badia area Badia 29.7 66.8 3.5 100.0 783 Other 36.9 62.0 1.1 100.0 9,571 Education No education 14.4 72.2 13.4 100.0 365 Elementary 25.1 72.1 2.8 100.0 734 Preparatory 30.5 68.4 1.1 100.0 1,581 Secondary 36.0 63.3 0.7 100.0 4,586 Higher 45.0 54.6 0.4 100.0 3,089 Wealth quintile Lowest 27.2 69.3 3.5 100.0 2,083 Second 34.2 64.6 1.1 100.0 2,184 Middle 35.9 63.2 0.9 100.0 2,104 Fourth 40.4 58.9 0.7 100.0 2,018 Highest 44.6 55.3 0.0 100.0 1,966 Total 36.3 62.4 1.3 100.0 10,354 12.4 KNOWLEDGE OF SYMPTOMS OF SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections (STIs) are important predisposing factors of HIV/AIDS transmission. As such, the presence of STIs in a population increases the likelihood of the occurrence of HIV. AIDS prevention programs must therefore also address the prevention and treatment of STIs. Additional questions were included in the JPFHS to assess the level of awareness of STIs and knowledge of the symptoms of STIs among both men and women. HIV/AIDS and Sexually Transmitted Infections � 157 Table 12.9 shows that 69 percent of women had never heard of sexually transmitted infections, apart from AIDS. As expected, younger women, rural residents, women with less education, and women living in poorer households are more likely than others to have never heard about STIs. Only 17 percent of women were able to name at least one symptoms of an STI in a man; the same proportion was able to name at least one symptom in a woman. Table 12.9 Knowledge of symptoms of STIs Percent distribution of ever married women by knowledge of symptoms associated with sexually transmitted diseases (STIs) in a man and in a woman, according to background characteristics, Jordan 2007 Knowledge of symptoms of STIs in a man Knowledge of symptoms of STIs in a woman Background characteristic Has not heard of STIs (apart from AIDS) No symptoms mentioned One symptom mentioned Two or more symptoms mentioned No symptoms mentioned One symptom mentioned Two or more symptoms mentioned Number of women Age 15-24 77.9 11.0 3.7 7.4 10.9 4.1 7.1 1,512 15-19 82.6 9.2 4.3 3.9 7.7 5.9 3.9 236 20-24 77.0 11.3 3.6 8.1 11.5 3.8 7.7 1,276 25-29 71.7 13.2 4.8 10.4 13.7 3.6 11.1 1,977 30-39 66.2 15.0 4.2 14.6 14.8 3.3 15.6 4,265 40-49 67.1 15.0 5.3 12.6 14.8 4.6 13.4 3,122 Marital status Married 68.9 14.2 4.5 12.4 14.2 3.9 13.1 10,354 Divorced/widowed 73.7 11.2 5.3 9.8 12.3 3.1 10.9 522 Residence Urban 67.8 14.6 4.7 12.9 14.6 3.9 13.7 9,249 Rural 76.2 11.2 3.7 8.8 11.3 3.4 9.1 1,627 Governorate Amman 60.2 19.3 5.3 15.2 19.3 4.1 16.4 4,442 Balqa 71.7 9.8 4.5 14.0 9.0 4.2 15.1 645 Zarqa 73.9 11.1 2.6 12.4 10.7 2.2 13.1 1,645 Madaba 60.7 27.1 4.0 8.3 27.2 3.9 8.2 262 Irbid 77.5 8.7 5.3 8.5 8.8 4.7 8.9 1,993 Mafraq 82.8 7.4 2.9 7.0 7.8 2.8 6.7 460 Jarash 74.6 13.0 3.2 9.3 13.3 3.1 9.0 293 Ajloun 81.3 6.9 4.6 7.2 7.3 3.5 7.8 228 Karak 69.9 11.3 4.7 14.0 12.5 4.7 12.9 378 Tafiela 76.2 8.9 4.9 10.0 9.1 4.2 10.5 146 Ma'an 80.3 9.3 2.9 7.4 8.9 3.0 7.7 164 Aqaba 75.9 10.9 3.5 9.7 10.5 3.7 9.9 221 Region Central 64.5 16.8 4.6 14.1 16.7 3.7 15.2 6,993 North 78.3 8.8 4.6 8.2 9.0 4.2 8.5 2,975 South 74.3 10.5 4.1 11.1 10.8 4.1 10.8 908 Badia area Badia 76.9 13.9 2.6 6.6 14.5 2.5 6.1 823 Other 68.5 14.1 4.7 12.7 14.0 4.0 13.6 10,053 Education No education 92.1 5.5 0.9 1.5 5.9 0.5 1.5 416 Elementary 89.9 5.7 1.3 3.1 5.7 1.6 2.8 813 Preparatory 86.4 7.0 2.4 4.1 8.1 0.8 4.6 1,681 Secondary 73.4 13.5 3.4 9.7 12.7 3.5 10.4 4,788 Higher 45.2 22.0 8.7 24.2 22.4 7.0 25.4 3,179 Wealth quintile Lowest 84.8 8.5 1.7 5.0 8.9 1.6 4.6 2,211 Second 75.5 11.2 4.2 9.1 11.7 3.7 9.1 2,296 Middle 71.6 12.6 5.0 10.8 12.1 3.6 12.7 2,206 Fourth 63.8 16.5 5.7 14.1 16.5 4.7 15.0 2,135 Highest 47.5 22.5 6.5 23.5 22.0 5.7 24.7 2,028 Total 69.1 14.1 4.5 12.3 14.1 3.8 13.0 10,876 12.5 KNOWLEDGE AND USE OF CONDOMS In Chapter 5, the data indicated that 89 percent of ever-married women know about male condoms. Because of the important role that the condom plays in combating the transmission of HIV, women were asked if they knew where condoms could be obtained. 158 | HIV/AIDS and Sexually Transmitted Infections Table 12.10 shows that three-fourths of women (75 percent) knew about condoms and could cite a place where they could obtain a condom. Knowledge of a source for condoms follows expected patterns by background characteristics, with the exception being that women in the North region were somewhat more likely to know of a source for condoms than women in the South and Central regions (78 percent compared with 75 and 73 percent, respectively). However, knowledge of where to obtain condoms does not seem to translate into condom use in Jordan. Table 12.11 shows that, among women who had had sexual intercourse in the past year, only 6 percent say that they used a condom during the last sexual intercourse, a slight increase in condom use compared to the 2002 JPFHS (4 percent). Table 12.11 Use of condoms Among ever-married women who had sexual inter- course in the past year, percentage who used a condom during last sexual intercourse, by background character- istics, Jordan 2007 Background characteristic Percentage who used a condom during last sexual intercourse Number of women Age 15-24 6.4 1,478 15-19 3.9 236 20-24 6.9 1,241 25-29 6.2 1,924 30-39 6.7 4,065 40-49 3.9 2,779 Residence Urban 6.0 8,709 Rural 4.6 1,537 Governorate Amman 5.3 4,186 Balqa 5.5 614 Zarqa 7.4 1,544 Madaba 4.8 248 Irbid 6.4 1,870 Mafraq 4.2 436 Jarash 5.2 276 Ajloun 4.6 217 Karak 7.3 359 Tafiela 5.0 136 Ma'an 4.4 150 Aqaba 4.3 210 Region Central 5.8 6,592 North 5.8 2,799 South 5.7 855 Badia area Badia 3.5 776 Other 6.0 9,470 Education No education 3.5 340 Elementary 3.4 725 Preparatory 4.2 1,566 Secondary 5.2 4,557 Higher 8.3 3,059 Wealth quintile Lowest 4.2 2,049 Second 5.7 2,180 Middle 6.4 2,086 Fourth 6.1 2,006 Highest 6.6 1,926 Total 5.8 10,246 Table 12.10 Knowledge of source of male condom Percentage of ever married women who know a source for male condoms by background characteristics, Jordan 2007 Background characteristic Knows source for male condoms Number of women Age 15-24 69.1 1,512 15-19 45.7 236 20-24 73.4 1,276 25-29 77.9 1,977 30-39 79.0 4,265 40-49 69.6 3,122 Marital status Married 75.6 10,354 Divorced/widowed 57.1 522 Residence Urban 75.6 9,249 Rural 69.7 1,627 Governorate Amman 74.6 4,442 Balqa 74.8 645 Zarqa 71.0 1,645 Madaba 61.5 262 Irbid 79.2 1,993 Mafraq 71.7 460 Jarash 76.4 293 Ajloun 83.8 228 Karak 75.4 378 Tafiela 75.5 146 Ma'an 70.6 164 Aqaba 76.2 221 Region Central 73.3 6,993 North 78.1 2,975 South 74.8 908 Badia area Badia 65.2 823 Other 75.5 10,053 Education No education 42.6 416 Elementary 59.2 813 Preparatory 68.5 1,681 Secondary 76.9 4,788 Higher 83.0 3,179 Wealth quintile Lowest 65.7 2,211 Second 73.4 2,296 Middle 76.3 2,206 Fourth 76.7 2,135 Highest 82.4 2,028 Total 74.7 10,876 Women’s Empowerment � 159 WOMEN’S EMPOWERMENT 13 This chapter looks at indicators of women’s status and empowerment, such as working status, use of earnings and participation in decision making. It also presents data on women’s attitudes towards wife beating and a woman’s ability to refuse sexual intercourse with her husband. 13.1 RESPONDENTS’ WORKING STATUS In the 2007 JPFHS, respondents were asked a number of questions about their work, 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 decision about how their earnings are used, and what proportion of household expenditures are paid for by the income gained from their own employment. The majority of currently married women (88 percent) are not currently working, that is, they have not worked during the seven days prior to the interview (Table 13.1). The proportion of currently married women who are currently employed ranges from no women employed among those aged 15-19 to 15 percent among those aged 35-39. Among those who are currently working, the majority are employees, that is they work for someone else (89 percent), 3 percent are employers, 6 percent are self-employed, and 2 percent are unpaid workers. Women aged 45-49 are more likely to be self employed (18 percent) than younger women. Table 13.1 Employment of currently married women Percentage of currently married women age 15-49 who were employed at any time in the last 7 days and the percent distribution of currently married women employed in the last 7 days by employment status, according to age, Jordan 2007 Currently married women: Type of employment status Age Percentage employed Number of women Employee Employer Self- employed Unpaid worker Total Number of women 15-19 0.0 233 na na na na na 0 20-24 5.2 1,233 86.9 0.0 7.3 5.8 100.0 65 25-29 12.9 1,932 96.9 0.0 1.8 1.3 100.0 249 30-34 14.4 2,127 93.9 2.0 3.7 0.4 100.0 305 35-39 14.8 1,968 89.5 4.2 4.8 1.5 100.0 292 40-44 11.6 1,746 82.1 7.1 9.3 1.4 100.0 202 45-49 9.6 1,115 72.7 3.3 17.9 6.1 100.0 107 Total 15-49 11.8 10,354 89.3 3.0 5.9 1.8 100.0 1,220 na = Not applicable Currently married women earning cash for their work were asked who mainly decides how the woman’s earnings will be used and whether she earns more or less than her husband. Table 13.2 shows that 59 percent of women reported that they decide jointly with their husband how her earnings are to be spent, and 38 percent of women stated that it is the respondent’s sole decision. Women who reside in the South region, the Badia areas, and those with no children are less likely than other women to make independent decisions on spending their earnings. 160 | Women’s Empowerment Regarding the comparison between a woman’s earnings to those of her husband, Table 13.2 also shows that 56 percent of women reported earning less than their husband. Twenty-three percent of women report earning more than their husband while 18 percent report earning about the same amount. Women living in the poorest households are the most likely to earn more than their husbands (42 percent). In addition, older women, those living in rural areas, those living in the South region and those with a preparatory level of education are more likely to report earning more than their husbands. Table 13.2 Control over women's cash earnings and relative magnitude of women's earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 7 days preceding the survey interview by person who decides how wife's cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Jordan 2007 Person who decides how the wife's cash earnings are used: Women's cash earnings compared with husband's cash earnings: Background characteristic Mainly wife Wife and husband jointly Mainly husband Total More Less About the same Husband/ partner has no earnings Total1 Number of women Age 20-24 29.4 70.3 0.3 100.0 23.7 64.5 11.1 0.6 100.0 61 25-29 44.1 51.3 4.7 100.0 22.1 52.1 24.1 1.8 100.0 246 30-34 38.9 60.0 1.0 100.0 20.5 61.9 17.1 0.5 100.0 304 35-39 32.9 65.0 2.2 100.0 22.5 59.1 14.3 4.1 100.0 287 40-44 32.0 58.0 10.0 100.0 22.7 52.2 21.3 3.5 100.0 200 45-49 48.0 51.7 0.4 100.0 28.4 37.2 16.1 17.8 100.0 100 Number of living children 0 33.8 65.7 0.5 100.0 20.9 45.4 24.6 9.0 100.0 119 1-2 40.8 57.4 1.8 100.0 24.2 56.9 17.2 1.7 100.0 411 3-4 34.1 62.5 3.5 100.0 22.3 59.6 17.8 0.3 100.0 408 5+ 40.1 52.4 7.5 100.0 20.9 52.3 17.2 9.0 100.0 259 Residence Urban 37.9 58.8 3.3 100.0 22.0 56.6 17.9 3.4 100.0 1,003 Rural 36.3 59.5 4.2 100.0 25.2 51.1 19.3 4.4 100.0 195 Governorate Amman 37.0 59.8 3.1 100.0 21.7 51.5 23.3 3.5 100.0 482 Balqa 50.3 46.6 3.1 100.0 22.2 55.0 19.6 2.3 100.0 99 Zarqa 34.0 65.1 0.9 100.0 22.2 55.7 16.2 5.9 100.0 113 Madaba 35.2 57.4 7.4 100.0 23.4 56.0 18.6 2.1 100.0 44 Irbid 41.2 53.4 5.4 100.0 21.2 62.8 11.7 4.4 100.0 206 Mafraq 43.9 52.8 3.4 100.0 24.1 53.8 17.2 3.9 100.0 50 Jarash 30.8 64.2 5.0 100.0 13.7 61.8 19.2 5.3 100.0 27 Ajloun 35.0 64.1 0.9 100.0 25.6 58.6 15.8 0.0 100.0 33 Karak 25.6 72.3 2.1 100.0 31.0 56.1 11.1 1.9 100.0 76 Tafiela 28.2 68.2 3.5 100.0 21.6 63.4 12.6 2.4 100.0 20 Ma'an 38.9 59.8 1.3 100.0 30.8 52.5 12.6 4.0 100.0 25 Aqaba 31.8 60.0 8.1 100.0 18.8 68.9 9.1 3.2 100.0 23 Region Central 38.2 58.7 3.1 100.0 22.0 52.9 21.4 3.6 100.0 738 North 40.1 55.3 4.6 100.0 21.5 60.8 13.6 3.9 100.0 316 South 29.3 67.6 3.1 100.0 27.7 58.5 11.2 2.5 100.0 144 Badia area Badia 32.2 65.3 2.5 100.0 32.1 48.5 14.8 4.5 100.0 80 Other 38.0 58.4 3.5 100.0 21.8 56.2 18.4 3.5 100.0 1,118 Education No education * * * * * * * * * 14 Elementary (42.2) (32.7) (25.1) 100.0 (19.6) (33.4) (27.4) (19.6) 100.0 35 Preparatory 37.0 54.3 8.7 100.0 38.5 38.7 8.1 13.0 100.0 45 Secondary 49.2 49.2 1.6 100.0 20.0 61.2 14.1 4.7 100.0 174 Higher 35.2 62.1 2.7 100.0 22.6 56.7 18.8 1.9 100.0 931 Wealth quintile Lowest 33.6 55.1 11.4 100.0 41.5 27.6 19.9 11.0 100.0 120 Second 40.7 54.7 4.6 100.0 26.3 54.3 13.8 5.6 100.0 164 Middle 37.0 60.4 2.6 100.0 23.3 54.6 17.9 3.9 100.0 244 Fourth 38.2 59.4 2.4 100.0 20.6 60.9 17.4 0.9 100.0 269 Highest 37.6 60.5 1.9 100.0 16.2 61.7 20.0 2.1 100.0 402 Total 37.6 58.9 3.5 100.0 22.5 55.7 18.1 3.6 100.0 1,198 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 Includes “don’t know/missing” Women’s Empowerment � 161 13.2 WOMEN’S PARTICIPATION IN HOUSEHOLD DECISION MAKING In order to identify the role of women in household decision making, respondents were asked about the person who usually has the final decision on the following four issues: the respondent’s own health care, major household purchases, daily household purchases, and visits to family or relatives. Table 13.3 shows that the purchase of either large or daily household needs is often likely to be the decision of the husband alone (28 percent and 24 percent respectively) than any other category of decision making; however, most currently married women (71 percent and 74 percent, respectively) have a say in these matters, either alone or jointly with their spouse. Table 13.3 Women's participation in decision making Percent distribution of currently married women by person who usually makes decisions about four kinds of issues, Jordan 2007 Issue Mainly wife Wife and husband jointly Mainly husband Someone else Total Number of women Own health care 46.2 44.4 9.0 0.4 100.0 10,354 Major household purchases 11.0 59.6 28.4 0.9 100.0 10,354 Purchases of daily household needs 31.4 43.0 24.0 1.5 100.0 10,354 Visits to her family or relatives 11.4 73.6 14.4 0.5 100.0 10,354 As regards the respondents’ own health care, 46 percent of currently married women reported that they decide for themselves about seeking their own health care, and 44 percent said that such decision is made jointly with the husband. Nine percent of women reported that their husbands have the final say over their wives’ health care. Table 13.4 demonstrates women’s participation in household decision making according to background characteristics. Fifty-five percent of women decided alone or jointly with another person on all four of the cited issues (Figure 13.1), whereas only 2 percent of women did not have a say in making decisions on any of these issues. Women are most likely to have the final or joint say with regard to what their own health care (91 percent) and visits to her family or relatives (85 percent), while they are least likely to participate in decision making about large or daily household purchases (71 percent and 74 percent, respectively). Women with higher education, women living in the wealthiest households and women who work are more likely than women in other categories to participate in household decision making on all of the four issues. Fifty-three percent of women who are not currently working participate in all four decisions, in contrast to 68 percent of those who are working. Two-fifths of women with no education participate in all decisions, compared with two-thirds of women with higher than secondary education. It is interesting that there is very little regional variation within each of the specified categories of decision making. The decision that demonstrates the greatest regional variation is that regarding daily purchases: women living in the Central region are more likely to have a say in daily purchases (78 percent) than women living in the North or South regions (69 percent and 68 percent, respectively). Largely because of this, women in the Central region are the most likely to have a say in all specified decisions. 162 | Women’s Empowerment Table 13.4 Women's participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Jordan 2007 Background characteristic Own health care Making major household purchases Making purchases for daily household needs Visits to her family or relatives Percentage who participate in all four decisions Percentage who participate in none of the four decisions Number of women Age 15-19 86.8 64.1 70.5 79.1 51.5 4.8 233 20-24 87.7 67.3 66.4 77.8 49.0 3.5 1,233 25-29 90.3 68.9 73.9 84.9 53.6 1.8 1,932 30-34 90.5 70.4 76.3 86.7 56.1 2.1 2,127 35-39 91.9 73.1 77.2 87.2 58.1 2.0 1,968 40-44 91.4 73.0 76.1 87.4 55.6 1.8 1,746 45-49 92.1 70.8 73.6 83.8 57.5 3.0 1,115 Working status Working 94.0 85.6 81.3 92.5 67.7 0.9 1,220 Not working 90.2 68.6 73.5 84.0 53.4 2.5 9,134 Number of living children 0 88.6 70.1 71.7 81.5 55.4 3.9 903 1-2 89.7 69.7 70.8 83.3 53.7 2.5 2,627 3-4 90.6 72.7 77.0 87.3 57.1 2.0 3,351 5+ 91.9 69.4 75.3 85.0 54.2 2.1 3,474 Residence Urban 91.1 71.1 75.9 85.5 56.2 2.2 8,803 Rural 88.2 67.6 65.9 82.2 49.2 3.0 1,551 Governorate Amman 91.1 73.2 79.9 84.5 59.6 2.1 4,242 Balqa 89.1 59.6 66.2 80.4 50.7 4.4 620 Zarqa 94.2 71.0 76.2 92.1 60.0 2.2 1,548 Madaba 91.5 69.2 73.8 88.0 60.9 3.7 248 Irbid 89.3 71.2 70.9 84.1 49.8 1.8 1,892 Mafraq 87.5 61.5 62.8 76.0 39.6 3.3 441 Jarash 90.0 69.3 66.9 85.0 50.8 2.1 278 Ajloun 90.8 72.1 67.9 83.7 51.2 1.7 218 Karak 89.0 72.1 68.2 84.8 48.9 1.7 363 Tafiela 87.0 65.0 68.1 86.5 44.7 1.8 139 Ma'an 85.0 69.6 68.2 81.3 47.3 2.8 154 Aqaba 86.1 65.5 66.8 84.7 48.4 4.0 212 Region Central 91.7 71.3 77.5 86.0 58.9 2.4 6,658 North 89.2 69.6 69.0 82.9 48.4 2.1 2,830 South 87.3 68.9 67.9 84.4 47.9 2.5 867 Badia area Badia 87.9 64.0 67.0 78.5 47.7 4.2 783 Other 90.9 71.1 75.0 85.6 55.7 2.2 9,571 Education No education 83.9 54.4 57.8 73.8 40.6 6.6 365 Elementary 86.0 62.3 64.9 73.0 40.8 4.0 734 Preparatory 91.5 66.5 71.1 80.2 50.4 3.1 1,581 Secondary 90.1 68.6 73.9 85.4 53.9 2.6 4,586 Higher 92.9 79.6 81.0 91.1 64.4 0.5 3,089 Wealth quintile Lowest 88.6 62.5 68.2 78.8 47.3 3.5 2,083 Second 89.5 64.9 72.7 82.6 50.2 2.8 2,184 Middle 91.3 71.1 73.3 85.3 55.3 2.4 2,104 Fourth 90.8 76.6 77.8 88.4 59.8 1.3 2,018 Highest 93.2 78.9 80.5 90.6 63.9 1.5 1,966 Total 90.6 70.6 74.4 85.0 55.1 2.3 10,354 Women’s Empowerment � 163 13.3 DOMESTIC VIOLENCE: WOMEN’S ATTITUDES TOWARD WIFE BEATING For many years, there has been increasing concern about violence against women in general, and domestic violence in particular, in both developed and developing countries. Both tolerance of and experience of domestic violence are significant barriers to the empowerment of women, with consequences for women’s health, their health-seeking behavior, and the health of their children. In the 2007 JPFHS, women were asked questions with regard to whether they viewed wife beating as justified. Learning more about attitudes toward domestic violence is important in a context such as Jordan where, in some cases, domestic violence and even the murder of one’s wife or daughter, called “honor killing” (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, women were asked whether they thought that a husband is justified in beating his wife for each of the following reasons: if she burns the food, argues with him, insults the husband, disobeys the husband, goes out without telling him, neglects the children or has relations with another man. 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 13.5 gives the percentages of ever-married women who agree with various reasons for wife beating by background characteristics. The vast majority (90 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 (88 percent), while relatively few believe that a man is justified in hitting his wife if she burns the food (8 percent) or argues with him (16 percent). Sixty-six percent of women agree that a husband is justified in using violence against his wife if she insults him, and 55 percent believe the same if she disobeys her husband. Figure 13.1 Distribution of Women According to the Number of Decisions in Which They Participate in the Final Say JPFHS 2007 Four decisions 55% Three decisions 23% Two decisions 13% One decision 7% No decisions 2% 164 | Women’s Empowerment Table 13.5 Attitude toward wife beating Percentage of ever-married women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Jordan 2007 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Insults Disobeys Goes out without telling him Neglects the children Has relations with another man Percentage who agree with at least one specified reason Number Age 15-19 8.0 21.1 70.0 55.9 44.9 47.7 87.8 91.1 236 20-24 7.5 16.3 65.0 56.5 38.9 42.9 91.2 94.1 1,276 25-29 6.1 13.8 65.8 56.5 36.1 43.7 89.6 91.3 1,977 30-34 7.3 13.8 67.5 55.5 31.3 40.9 88.2 90.5 2,213 35-39 6.7 15.9 66.5 57.0 33.7 41.4 88.3 90.1 2,052 40-44 8.7 18.3 64.4 53.0 33.6 37.6 84.3 87.4 1,884 45-49 11.5 21.5 64.1 52.6 36.7 45.0 82.6 86.3 1,239 Working status Working 4.5 12.7 55.0 48.9 25.1 35.4 79.4 83.3 1,316 Not working 8.2 16.8 67.3 56.2 36.2 42.7 88.6 90.9 9,560 Marital status Married 7.5 16.1 66.0 55.4 35.1 42.0 87.6 90.1 10,354 Divorced/ widowed 12.5 21.3 63.5 53.2 31.0 37.9 84.8 88.8 522 Number of living children 0 9.2 19.1 64.7 57.0 37.4 41.5 87.6 88.7 1,021 1-2 6.3 14.7 60.8 51.8 32.2 39.2 85.7 88.7 2,787 3-4 6.7 13.9 64.3 52.2 32.0 40.2 86.6 89.1 3,471 5+ 9.4 19.0 71.6 60.6 38.9 45.4 89.7 92.3 3,597 Residence Urban 6.8 15.2 64.1 52.9 32.5 39.7 86.5 89.1 9,249 Rural 12.8 22.5 75.9 69.1 48.1 53.7 93.1 95.1 1,627 Governorate Amman 5.9 15.8 61.5 48.6 28.2 34.8 83.3 87.0 4,442 Balqa 4.9 9.7 48.1 35.7 22.1 20.6 85.9 87.5 645 Zarqa 4.4 15.3 61.9 45.1 32.3 34.4 82.8 85.5 1,645 Madaba 7.9 36.0 60.5 60.9 35.5 34.1 88.4 90.5 262 Irbid 11.8 12.6 75.2 69.1 44.8 58.9 95.3 96.3 1,993 Mafraq 13.3 22.8 82.0 77.3 52.4 62.7 94.7 96.7 460 Jarash 11.5 18.6 75.2 68.3 43.2 52.0 91.4 93.7 293 Ajloun 13.8 16.3 79.2 77.3 47.2 59.0 94.9 96.1 228 Karak 12.5 26.8 77.0 71.3 47.6 56.5 95.7 96.6 378 Tafiela 10.2 22.3 74.3 68.5 43.8 48.0 92.8 93.8 146 Ma'an 9.4 28.2 77.7 73.7 49.5 54.7 95.5 96.8 164 Aqaba 7.0 17.0 65.1 58.3 36.8 39.6 88.9 90.5 221 Region Central 5.5 15.9 60.3 47.0 28.8 33.4 83.6 86.8 6,993 North 12.1 15.0 76.5 70.9 46.0 58.8 94.8 96.1 2,975 South 10.2 23.9 73.8 68.1 44.7 50.7 93.5 94.7 908 Badia area Badia 13.9 30.4 77.9 70.0 49.5 54.7 93.1 95.7 823 Other 7.2 15.2 64.9 54.1 33.7 40.7 87.0 89.5 10,053 Education No education 29.7 48.3 88.0 82.8 65.5 68.9 95.5 98.1 416 Elementary 15.3 27.0 77.0 66.8 52.4 53.9 91.2 95.6 813 Preparatory 9.5 18.8 71.1 59.7 42.2 47.0 90.9 92.5 1,681 Secondary 6.4 15.1 68.1 56.8 34.2 42.6 89.2 91.6 4,788 Higher 4.0 9.9 54.0 44.2 23.4 31.1 81.1 83.8 3,179 Wealth quintile Lowest 12.4 23.8 76.7 67.8 45.1 52.0 94.4 96.4 2,211 Second 8.7 19.5 74.9 63.2 41.4 47.3 92.8 94.9 2,296 Middle 7.2 14.7 65.8 55.4 35.8 44.4 90.0 92.2 2,206 Fourth 6.5 12.8 62.0 51.2 28.9 38.2 83.9 85.9 2,135 Highest 3.4 10.0 47.9 37.0 21.6 25.2 75.0 79.4 2,028 Total 7.7 16.3 65.9 55.3 34.9 41.8 87.5 90.0 10,876 Women’s Empowerment � 165 There are also differences in terms of justification of violence between those who live in urban compared to rural areas, with urban women being less likely to accept justifications of violence (89 percent, compared to 95 percent in rural areas). Table 13.5 and Figure 13.2 also indicate that women who have more education or who are working are the least likely to agree with any of the reasons for justifying wife beating. 13.4 WOMEN’S AGREEMENT WITH REASONS FOR REFUSING SEXUAL RELATIONS The extent of control women have over when they have sex has important implications for demographic and health outcomes. To measure women’s agreement with a woman’s right to refuse her husband sex, the 2007 JPFHS asked women 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 knows her husband has intercourse with other women or she knows her husband has a sexually transmitted infection. 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 13.6 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 aged 15-49 agree that women can refuse to have sex with their husband: 97 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 knows her husband has intercourse with other women, and 75 percent also agree that a wife is justified in refusing sex with her husband if she is tired or not in the mood. In total, 72 percent of women agree that a woman can refuse sex for each of the above reasons. 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. Figure 13.2 Percentage of Women Who Agree with at Least One Reason Justifying a Husband Beating His Wife 90 98 96 93 92 84 91 83 Jordan No education Elementary Preparatory Secondary Higher Not employed Employed 0 20 40 60 80 100 Percent JPFHS 2007 EDUCATION WORKING STATUS 166 | Women’s Empowerment Table 13.6 Attitude toward refusing sexual intercourse with husband Percentage of ever-married women age 15-49 who believe that a wife is justified in refusing to have sexual intercourse with her husband in specific circumstances, by background characteristics, Jordan 2007 Wife is justified in refusing intercourse with her husband if she: Background characteristic Knows husband has a sexually transmitted infection Knows husband has intercourse with other women Is tired or not in the mood Percentage who agree with all of the specified reasons Percentage who agree with none of the specified reasons Number Age 15-19 92.1 92.3 79.3 74.2 3.3 236 20-24 96.9 94.7 72.5 69.7 0.6 1,276 25-29 99.1 94.7 75.3 73.3 0.2 1,977 30-34 96.5 95.6 73.8 70.8 0.7 2,213 35-39 97.4 93.7 74.3 71.2 0.7 2,052 40-44 96.2 95.0 74.7 71.2 0.9 1,884 45-49 97.3 93.1 76.1 72.1 0.7 1,239 Working status Working 98.5 95.5 76.6 74.9 0.4 1,316 Not working 96.9 94.4 74.2 71.0 0.7 9,560 Marital status Married 97.2 94.5 74.6 71.5 0.6 10,354 Divorced/ widowed 95.6 94.4 73.2 71.2 2.0 522 Number of living children 0 96.6 93.8 75.2 71.4 0.9 1,021 1-2 97.0 94.4 76.8 73.7 0.7 2,787 3-4 97.9 95.8 74.7 72.2 0.3 3,471 5+ 96.6 93.6 72.5 69.1 0.9 3,597 Residence Urban 97.3 94.6 74.4 71.5 0.6 9,249 Rural 96.4 94.0 75.1 71.4 1.1 1,627 Governorate Amman 96.2 92.7 72.9 69.0 1.0 4,442 Balqa 98.0 92.5 75.5 73.6 1.4 645 Zarqa 98.4 97.0 73.3 71.6 0.1 1,645 Madaba 97.4 94.3 72.0 69.6 0.9 262 Irbid 98.6 96.9 76.2 74.2 0.1 1,993 Mafraq 97.7 95.1 76.0 72.5 0.3 460 Jarash 98.4 97.1 81.6 79.8 0.1 293 Ajloun 97.8 96.2 77.3 75.2 0.5 228 Karak 92.0 90.6 76.7 69.0 2.0 378 Tafiela 95.9 96.2 75.9 72.4 0.8 146 Ma'an 96.0 95.2 79.5 76.0 0.8 164 Aqaba 97.5 95.2 78.5 75.6 0.2 221 Region Central 96.9 93.8 73.2 70.1 0.8 6,993 North 98.4 96.6 76.8 74.6 0.2 2,975 South 94.7 93.4 77.5 72.4 1.1 908 Badia area Badia 96.4 92.8 72.2 69.0 1.8 823 Other 97.2 94.6 74.7 71.7 0.6 10,053 Education No education 89.3 85.9 65.7 60.0 5.7 416 Elementary 93.0 90.6 68.2 63.8 2.2 813 Preparatory 97.3 94.9 72.5 70.0 0.5 1,681 Secondary 97.5 94.9 74.6 71.4 0.4 4,788 Higher 98.6 95.7 78.3 75.9 0.1 3,179 Wealth quintile Lowest 95.4 92.9 72.2 68.7 1.2 2,211 Second 97.1 94.9 72.3 69.5 0.5 2,296 Middle 96.7 93.8 72.2 69.5 1.3 2,206 Fourth 98.2 95.7 76.9 73.7 0.2 2,135 Highest 98.4 95.3 79.7 76.7 0.1 2,028 Total 97.1 94.5 74.5 71.5 0.7 10,876 Women’s Empowerment � 167 Because almost all women agree that wives are justified in refusing sex under the stated circumstances, there is little variation in agreement by background characteristics, 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 women who work are marginally more likely to agree with any reason than women who are not currently working. For example, 89 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, 99 percent agree with the wife’s right to refuse. 13.5 WOMEN’S EMPOWERMENT INDICATORS Table 13.7 provides a brief overview on how the three basic empowerment indicators—number of decisions in which women participate, number of reasons for which wife beating is justified, and number of reasons given for refusing to have sexual intercourse with husband—relate to each other. The findings indicate that women who participate in three or four of the specified household decisions more often tend to justify their right to refuse sexual intercourse with their husband for all reasons (73 percent). Similarly, women who do not support wife beating for any reason at all are most likely to think all the reasons for refusing sexual intercourse with their husband are justified (77 percent). Table 13.7 Indicators of women's empowerment Percentage of currently married women age 15-49 who participate in all decision making, percentage of ever-married women age 15-49 who disagree with all reasons for justifying wife beating, and percentage of all ever-married women age 15-49 who agree with all reasons for refusing sexual intercourse with husband, by value on each of the indicators of women's empowerment, Jordan 2007 Ever-married women Currently married women Empowerment indicator Percentage who participate in all decision making1 Number of women Percentage who disagree with all the reasons justifying wife beating Percentage who agree with all the reasons for refusing sexual intercourse with husband Number of women Number of decisions in which women participate 0 na 240 8.1 62.5 240 1-2 na 2,078 6.4 65.2 2,078 3-4 na 8,036 10.9 73.4 8,036 Number of reasons for which wife beating is justified2 0 68.4 1,029 na 77.2 1,088 1-2 56.8 3,208 na 73.0 3,388 3-4 54.6 3,063 na 74.7 3,193 5-7 49.5 3,054 na 64.8 3,208 Number of reasons given for refusing to have sexual intercourse with husband3 0 50.2 63 14.6 na 73 1-2 49.9 2,888 7.8 na 3,028 3 57.2 7,403 10.8 na 7,775 Total 55.1 10,354 10.0 71.5 10,876 1 Restricted to currently married women. See Table 13.4 for the list of decisions. 2 See Table 13.5 for the list of reasons. 3 See Table 13.6 for the list of reasons. na = Not applicable 168 | Women’s Empowerment 13.5.1 Current Use of Contraception by Women’s Empowerment A woman’s desire and ability to control her fertility and her choice of contraceptive method are in part affected by her own sense of empowerment. A woman who feels that she is unable to control her life may be less likely to feel that she can make and carry out decisions about her fertility. She may also feel the need to choose methods that are less obvious or which do not depend on her husband’s cooperation. Table 13.8 shows the distribution of currently married women by contraceptive method use, according to the three empowerment indicators. The data indicate that there is a positive relationship between use of contraception and participation in household decision making. For example, current use of modern contraceptive methods rises from 33 percent among women who participate in none of the household decisions to 44 percent among women who participate in 3-4 household decisions. Also noteworthy is the finding that women who believe that a wife is never justified in refusing to have sex with her husband are far less likely to use a modern method of contraception than women who believe that all three reasons justify her refusal (23 percent and 43 percent, respectively). Table 13.8 Women’s empowerment and current use of contraception Percent distribution of currently married women age 15-49 by current contraceptive method, by indicators of women’s empowerment, Jordan 2007 Modern methods Empowerment indicator Any method Any modern method Female sterilization Temporary modern female methods1 Male condom Any traditional method Not currently using Total Number of women Number of decisions in which women participate2 0 44.9 33.3 4.3 28.8 0.3 11.6 55.1 100.0 240 1-2 51.7 36.3 3.4 29.1 3.8 15.4 48.3 100.0 2,078 3-4 58.9 43.7 3.8 34.1 5.8 15.2 41.1 100.0 8,036 Number of reasons for which wife beating is justified3 0 62.2 44.9 3.8 36.3 4.9 17.3 37.8 100.0 1,029 1-2 57.8 43.4 3.2 34.2 6.0 14.5 42.2 100.0 3,208 3-4 59.0 42.3 4.5 32.5 5.3 16.8 41.0 100.0 3,063 5-7 52.7 39.1 3.5 31.1 4.5 13.6 47.3 100.0 3,054 Number of reasons given for refusing to have sexual intercourse with husband4 0 39.7 22.7 5.3 16.5 0.9 17.1 60.3 100.0 63 1-2 53.8 40.4 3.2 32.9 4.3 13.4 46.2 100.0 2,888 3 58.5 42.7 3.9 33.1 5.7 15.8 41.5 100.0 7,403 Total 57.1 41.9 3.7 33.0 5.3 15.2 42.9 100.0 10,354 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUD, injectables, implants, diaphragm, foam/jelly, and lactational amenorrhea method 2 See Table 13.4 for the list of decisions. 3 See Table 13.5 for the list of reasons. 4 See Table 13.6 for the list of reasons. 13.5.2 Ideal Family Size and Unmet Need by Women’s Empowerment The ability of women to make decisions effectively has important implications for their fertility preferences and the practice of family planning. An increase in women’s empowerment is recognized as important for efforts to reduce fertility through at least two main pathways: its negative association with Women’s Empowerment � 169 desired family size and its positive association with women’s ability to meet their own family-size goals through the effective use of contraception. Table 13.9 shows how women’s ideal family size and their unmet need for family planning vary by women’s empowerment indicators. There is a linear association between the number of reasons a woman cites justifying wife beating and the mean ideal number of children. Women who believe there are no reasons which justify a husband beating his wife consider the ideal number of children to be 3.6, compared to 4.0 for women who believe that there is at least one reason. There is no apparent relationship between the mean ideal number of children and the other indicators of women’s empowerment. The data also indicate that there is a direct association between the number of decisions in which a woman participates and unmet need for family planning. Women who participate in 3 or 4 decision have a lower level of unmet need (11 percent) than women who participate in no decisions (17 percent). There is no clear linear relationship between unmet need and the other indicators of women’s empowerment. Table 13.9 Women's empowerment and ideal number of children and unmet need for family planning Mean ideal number of children for ever-married women 15-49 and the percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women's empowerment, Jordan 2007 Percentage of currently married women with an unmet need for family planning2 Empowerment indicator Mean ideal number of children1 Number of women For spacing For limiting Total Number of women Number of decisions in which women participate3 0 4.0 173 5.8 11.2 16.9 240 1-2 4.1 1,674 6.8 7.5 14.2 2,078 3-4 3.9 6,700 4.4 6.8 11.2 8,036 Number of reasons for which wife beating is justified4 0 3.6 965 4.0 8.8 12.8 1,029 1-2 4.0 2,880 4.0 6.7 10.7 3,208 3-4 4.0 2,666 4.9 6.0 10.9 3,063 5-7 4.0 2,436 6.2 7.9 14.0 3,054 Number of reasons given for refusing to have sexual intercourse with husband5 0 3.5 57 1.2 9.3 10.5 63 1-2 4.1 2,479 5.9 6.5 12.4 2,888 3 3.9 6,411 4.6 7.2 11.8 7,403 Total 3.9 8,946 4.9 7.0 11.9 10,354 1 Mean excludes respondents who gave non-numeric responses. 2 See table 7.3.1 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 13.4 for the list of decisions. 4 See Table 13.5 for the list of reasons. 5 See Table 13.6 for the list of reasons. Domestic Violence � 171 DOMESTIC VIOLENCE 14 Domestic violence against women has been acknowledged worldwide as a violation of basic human rights, and an increasing amount of research highlights the health burdens, intergenerational effects, and demographic consequences of such violence (United Nations General Assembly, 1991; Heise et al., 1994, 1998; Jejeebhoy, 1998). The 2007 JPFHS included a special module designed to obtain information on the extent to which women experience domestic violence. The domestic violence module was administered to women in a subsample of one-third of the JPFHS clusters. To ensure confidentiality, only one woman in each household in the subsample was selected to be asked questions about domestic violence. The module included a series of questions to collect information on various forms of spousal violence including physical and emotional violence. Although the module focused on the extent of spousal violence, information also was obtained on any physical violence involving perpetrators other than the current (last) husband that the woman experienced since her fifteenth birthday. Women who reported recent spousal violence were asked about assistance they may have sought at the time the most recent episode of violence occurred. 14.1 PHYSICAL VIOLENCE 14.1.1 Prevalence of Physical Violence Approximately one-third of ever-married women age 15-49 reported that they had been hit, slapped, kicked, or subjected to some other form of physical violence at some point after their fifteenth birthday (Table 14.1). Thirteen percent of women reported that they had been subjected to some form of physical violence at least once within the 12-month period before the interview, including four percent who reported that they had often experienced some form of physical violence during the period. A woman’s marital status was strongly related to the likelihood that she had ever experienced physical violence; the prevalence of violence is more than twice as high among divorced women (74 percent) than among either currently-married or widowed women (31 percent and 38 percent, respectively). About one fifth of divorced women report having been subjected to violence often in the 12 months preceding the survey. Urban and rural women were equally likely to have experienced physical violence. Women living in the Mafraq and Irbid were more likely to report have ever experienced physical violence than women living in other governorates. The prevalence of physical violence was 33 percent and 26 percent among women with either a secondary or higher education, respectively, compared to 43 percent among women with either no education or only an elementary education. Women living in the poorest households were more likely than other women to report physical violence. 172 | Domestic Violence Table 14.1 Experience of physical violence Percentage of ever-married women age 15-49 who have ever experienced physical violence since age 15 and percentage who have experienced physical violence during the 12 months preceding the survey, by background characteristics, Jordan 2007 Percentage who have experienced physical violence in the past 12 months Background characteristic Percentage who have ever experienced physical violence since age 151 Often Sometimes At least once Number of women Woman's age 15-19 (19.8) (8.0) (1.7) (9.7) 53 20-29 32.1 3.9 11.3 15.3 1,098 30-39 33.6 3.8 9.4 13.2 1,361 40-49 31.5 3.1 8.4 11.5 932 Respondent currently working Employed 34.3 2.2 9.7 11.9 420 Not employed 32.0 3.9 9.6 13.5 3,024 Marital status Married 31.0 3.3 9.7 13.0 3,286 Divorced 73.9 18.8 4.5 23.3 98 Widowed 37.7 0.0 13.4 13.4 60 Number of living children 0 29.5 5.7 8.4 14.1 336 1-2 31.9 3.8 11.6 15.4 904 3-4 34.1 4.0 9.7 13.6 1,106 5+ 31.6 2.8 8.3 11.2 1,098 Residence Urban 32.2 3.8 9.6 13.4 2,938 Rural 33.1 3.2 9.5 12.8 506 Governorate Amman 30.7 4.5 10.7 15.1 1,384 Balqa 23.8 5.5 6.8 12.3 205 Zarqa 22.9 4.0 3.5 7.5 542 Madaba 21.1 1.3 3.5 4.8 84 Irbid 43.4 1.4 12.9 14.3 628 Mafraq 48.2 3.3 16.4 19.7 151 Jarash 34.5 2.1 8.3 10.3 97 Ajloun 37.6 0.3 7.8 8.1 73 Karak 31.4 6.1 9.8 15.9 117 Tafiela 28.8 4.2 9.9 14.1 43 Ma'an 30.4 2.8 12.5 15.3 54 Aqaba 37.2 9.2 9.3 18.5 66 Region Central 27.8 4.3 8.3 12.6 2,215 North 42.8 1.7 12.6 14.3 949 South 32.2 5.9 10.2 16.1 280 Badia area Badia 28.2 2.9 8.9 11.7 278 Other 32.7 3.8 9.7 13.5 3,166 Education No education 42.5 7.3 8.8 16.1 129 Elementary 43.1 6.3 12.5 18.8 217 Preparatory 36.9 3.1 9.7 12.8 488 Secondary 32.5 4.7 9.2 13.9 1,572 Higher 26.3 1.6 9.7 11.3 1,037 Wealth quintile Lowest 37.8 4.6 11.6 16.2 646 Second 37.6 3.2 11.0 14.3 761 Middle 29.7 3.6 6.5 10.2 707 Fourth 27.7 3.7 9.5 13.2 701 Highest 28.4 3.6 9.5 13.0 629 Total 32.3 3.7 9.6 13.3 3,444 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes in the past 12 months Domestic Violence � 173 14.1.2 Perpetrators of Physical Violence Table 14.2 shows the proportions of women who have ever experienced violence according to the persons identified as perpetrators of the violence. Husbands were named most frequently; almost two- thirds of women identified their current or previous husband as the perpetrator in at least one episode of physical violence. Approximately one in five women had experienced some form of physical violence by either their brother (22 percent), their father (20 percent), or their mother (19 percent). Table 14.2 Perpetrators of physical violence Among ever-married women age 15-49 who have experienced physical violence since age 15, percentage who report specific persons who committed the violence, according to the woman’s marital status, Jordan 2007 Marital status Current/ previous husband Father Brother Male perpetrator other than father/brother/ husband Mother Sister Female teacher Female perpetrator other than mother/sister/ teacher Number of women ever experiencing violence Married 61.5 20.4 23.6 1.9 19.0 6.7 10.7 2.0 1,018 Divorced (94.7) (7.1) (5.0) (5.0) (7.4) (2.1) (5.4) (0.7) 73 Widowed (91.4) (37.6) (9.3) (0.0) (30.5) (1.7) (27.9) (2.2) 23 Total 64.2 19.9 22.1 2.0 18.5 6.3 10.7 1.9 1,113 Note: Figures in parentheses are based on 25-49 unweighted cases. 14.1.3 Violence during Pregnancy Violence during pregnancy may threaten not only a woman’s well-being but that of her unborn child. Table 14.3 presents information on the proportion of women who have experienced some form of physical violence during pregnancy. Among women who had ever been pregnant, five percent were hit, slapped, kicked, or subjected to some other form of physical violence at least once during a pregnancy. Women who were divorced were far more likely to report violence during pregnancy (39 percent) than either currently-married women or widowed women. Women with no education or an elementary education were more likely to have experienced violence during pregnancy than women with a secondary or higher education. 174 | Domestic Violence Table 14.3 Violence during pregnancy Among women age 15-49 who have ever been pregnant, percentage who have ever experienced physical violence during pregnancy, by background characteristics, Jordan 2007 Background characteristic Percentage who have ever experienced physical violence during pregnancy Number of women who have ever been pregnant Age 15-29 5.0 1,015 30-39 5.7 1,305 40-49 5.6 893 Marital status Married 4.8 3,090 Divorced 38.9 64 Widowed 2.8 59 Number of living children 0 0.0 104 1-2 6.0 904 3-4 5.5 1,106 5+ 5.5 1,098 Residence Urban 5.2 2,729 Rural 7.0 483 Governorate Amman 5.6 1,264 Balqa 5.5 193 Zarqa 4.6 513 Madaba 2.3 80 Irbid 5.3 593 Mafraq 5.8 143 Jarash 7.9 91 Ajloun 2.1 70 Karak 9.3 114 Tafiela 6.0 41 Ma'an 4.5 51 Aqaba 8.2 62 Region Central 5.2 2,049 North 5.4 896 South 7.6 267 Badia area Badia 6.4 265 Other 5.4 2,948 Education No education 10.9 122 Elementary 9.2 192 Preparatory 7.1 460 Secondary 5.3 1,458 Higher 3.6 981 Wealth quintile Lowest 8.1 598 Second 4.3 703 Middle 6.1 673 Fourth 4.8 645 Highest 4.1 594 Total 5.4 3,213 Domestic Violence � 175 14.2 SPOUSAL VIOLENCE 14.2.1 Prevalence of Various Forms of Spousal Violence The domestic violence module obtained more detailed information on the forms of violence ever- married women had experienced in the relationships with their current husband or, in the case of widowed or divorced women, their most recent husband. Table 14.4 shows the proportions of women reporting they had ever and recently experienced episodes of physical, sexual or emotional violence in their relationship with their husband. Physical violence is the most common form of violence; 21 percent of ever-married women report being subjected to some form of physical violence by their current or most recent husband, and 12 percent report violence taking place within the 12 months preceding the survey. Table 14.4 Forms of spousal violence Percentage of ever-married women age 15-49 who have experienced various forms of violence committed by their husband, ever or in the 12 months preceding the survey, Jordan 2007 In the past 12 months Form of violence Ever Often Sometimes At least once Physical violence Any 20.6 3.2 9.0 12.2 Pushed her, shook her, or threw something at her 15.6 2.4 7.1 9.5 Slapped her 13.5 2.8 5.2 8.0 Punched her with his fist or with something that could hurt her 9.8 2.2 3.8 5.9 Kicked her, dragged her, or beat her up 6.1 1.6 2.3 3.9 Tried to choke her or burn her on purpose 1.5 0.4 0.6 1.0 Threatened her with a knife, gun, or any other weapon 0.8 0.2 0.4 0.5 Attacked her with a knife, gun, or any other weapon 0.5 0.0 0.2 0.3 Sexual violence Physically forced her to have sexual intercourse with him even when she did not want to 7.6 1.7 3.9 5.6 Emotional violence Any 20.0 5.2 8.8 14.0 Said or did something to humiliate her in front of others 15.2 3.8 6.4 10.3 Threatened to hurt or harm her or someone close to her 14.3 4.2 6.3 10.5 Any form of physical and/or sexual violence 23.0 4.1 10.5 14.6 Any form of physical and sexual violence 5.2 0.9 1.7 2.6 Any form of emotional, physical and/or sexual violence 30.2 6.6 13.6 20.2 Any form of emotional, physical and sexual violence 4.0 0.8 1.3 2.1 Number of ever-married women 3,444 3,444 3,444 3,444 176 | Domestic Violence The results indicate that the most common forms of physical violence included being pushed or shaken or having objects thrown at her by the husband (16 percent) and being slapped (14 percent). Ten percent of ever-married women report being punched with a fist or something that could hurt her while six percent report being kicked, dragged or beat up. Eight percent of women indicated that their spouse had at some point physically forced them to have sex and six percent reported that they had been forced to have sex by their spouse in the past 12 months. Table 14.4 also indicates that 20 percent of ever-married women reported they had ever experienced emotional violence, and 14 percent had experienced a recent episode of emotional violence. Fifteen percent report that their husbands said or did something to humiliate them in front of others, and 14 percent report that their husbands threatened to hurt or harm them, or someone close to them. 14.2.2 Differentials in Prevalence of Spousal Violence Table 14.5 presents differences in the levels of various forms of spousal violence by background characteristics, and Table 14.6 shows differences in the levels of violence by spousal characteristics. The results in Table 14.5 indicate that women who are divorced or widowed women and currently married women who have been married more than once were the most likely to have ever experienced either physical or sexual violence committed by the husbands (57 percent and 33 percent, respectively). By governorate, women in Mafraq (38 percent), Irbid (29 percent), Jarash (27 percent) and Ma’an (26 percent) are most likely to have ever experienced physical or sexual violence at the hands of their husbands. Women with less education and those living in poorer households were also more likely to have experienced violence from their husbands. As Table 14.6 shows, a woman was somewhat more likely to have ever experienced physical or sexual violence if the husband had no education (27 percent), an elementary education (25 percent), or a preparatory education (29 percent), than if he had a secondary or higher education (23 percent and 18 percent, respectively). Physical or sexual violence was least common when both partners had the same level of education (18 percent) or if neither had been educated (15 percent). In terms of the indicators of women’s empowerment, the more empowered a woman is, the less likely she is to have experienced violence. Thirty-seven percent of woman who do not participate in any household decisions have experienced physical or sexual violence at the hands of their husband, compared to one-fifth of women who participate in three or four household decisions (20 percent). In addition, 18 percent of women who believe that there are no reasons that justify a husband beating his wife have ever experienced physical or sexual violence, compared to 34 percent of women who believe that there are three or four reasons to justify wife-beating. Domestic Violence � 177 Table 14.5 Spousal violence by background characteristics Percentage of ever-married women age 15-49 by whether they have ever experienced emotional, physical or sexual violence committed by their husband, according to background characteristics, Jordan 2007 Type of violence Emotional Physical Sexual Physical or sexual Emotional, physical, or sexual Background characteristic Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Number of ever-married women Age 15-29 17.2 11.9 19.5 14.2 8.4 6.6 22.3 16.6 26.9 19.6 1,151 30-39 19.5 14.9 21.8 12.0 7.8 6.1 23.9 14.4 30.2 20.2 1,361 40-49 24.3 15.2 20.2 10.0 6.1 3.6 22.4 12.5 34.5 20.8 932 Respondent currently working Working 17.8 11.2 24.8 11.6 7.1 4.6 26.5 14.1 31.3 16.9 420 Not working 20.4 14.3 20.0 12.3 7.6 5.7 22.5 14.7 30.1 20.6 3,024 Number of living children 0 23.3 16.4 19.2 13.5 6.7 3.8 19.3 13.6 29.2 21.4 336 1-2 17.0 12.8 21.1 13.8 7.4 5.6 24.2 16.4 28.5 20.4 904 3-4 21.6 13.9 20.8 11.9 9.4 7.4 23.4 15.0 31.6 19.2 1,106 5+ 20.0 14.3 20.5 10.8 6.1 4.3 22.6 13.0 30.6 20.6 1,098 Marital status and duration Currently married woman 18.8 13.9 18.9 11.9 6.7 5.5 21.3 14.4 28.9 20.2 3,286 Married only once 18.5 13.6 18.5 11.6 6.6 5.4 21.1 14.2 28.6 20.0 3,204 0-4 years 11.1 9.9 15.2 12.0 5.3 5.3 18.4 15.1 21.6 18.7 690 5-9 years 18.5 12.8 16.4 12.1 6.7 5.4 18.7 13.8 25.2 18.1 661 10+ years 21.3 15.2 20.5 11.3 7.0 5.4 22.9 13.9 32.5 21.2 1,853 Married more than once 30.8 26.9 32.7 23.4 10.6 8.9 32.7 23.4 37.8 27.5 82 Divorced/widowed 45.3 14.4 56.4 19.1 26.3 8.2 56.7 19.3 58.8 19.5 158 Residence Urban 20.2 14.0 20.5 12.2 7.0 5.3 22.8 14.4 30.2 19.9 2,938 Rural 18.9 13.9 21.2 12.4 10.6 7.3 24.0 15.6 30.4 21.6 506 Governorate Amman 22.9 17.3 20.2 13.2 8.6 6.2 22.4 15.3 31.6 22.3 1,384 Balqa 34.2 26.8 19.5 12.3 5.8 4.4 20.2 13.3 35.2 27.1 205 Zarqa 17.1 8.9 15.3 6.6 2.9 2.1 15.6 7.4 21.9 11.2 542 Madaba 10.3 5.3 9.8 4.8 1.9 0.6 10.1 5.1 13.5 6.7 84 Irbid 14.7 8.7 25.7 14.3 6.6 5.0 28.8 17.4 32.9 19.7 628 Mafraq 21.8 15.3 33.6 19.0 15.9 11.1 37.9 24.2 41.4 29.4 151 Jarash 14.7 7.9 21.5 10.3 11.1 6.6 27.1 14.5 31.6 17.7 97 Ajloun 14.2 11.4 16.7 8.1 8.7 7.3 21.0 12.5 28.4 20.1 73 Karak 16.9 11.3 21.0 15.5 9.3 8.1 24.4 19.4 28.1 21.4 117 Tafiela 18.0 14.4 18.3 12.2 11.1 9.2 23.3 17.2 28.6 22.8 43 Ma'an 22.5 17.6 18.2 11.6 13.6 10.1 26.1 17.8 33.6 23.8 54 Aqaba 19.6 16.2 17.4 14.0 10.3 9.6 21.5 17.7 28.3 24.2 66 Region Central 22.0 15.7 18.5 11.2 6.7 4.8 20.1 12.8 28.9 19.5 2,215 North 15.8 9.9 25.8 14.2 8.7 6.3 29.5 17.8 33.8 21.1 949 South 18.8 14.1 19.2 13.9 10.6 9.0 23.9 18.3 29.3 22.7 280 Badia area Badia 20.0 15.2 19.6 11.4 9.7 6.9 22.0 14.1 28.3 20.6 278 Other 20.0 13.9 20.7 12.3 7.4 5.5 23.1 14.7 30.4 20.1 3,166 Education No education 32.5 22.9 29.2 15.6 13.7 6.5 33.5 18.8 42.9 26.5 129 Elementary 31.9 20.1 27.4 17.0 12.4 8.6 31.9 21.9 41.5 27.6 217 Preparatory 19.9 13.6 22.8 12.6 8.1 5.9 26.0 16.2 32.0 20.9 488 Secondary 20.4 14.6 21.6 13.1 7.4 5.9 23.5 15.3 30.9 21.3 1,572 Higher 15.5 10.8 15.6 9.2 5.7 4.3 17.6 10.8 24.4 15.8 1,037 Wealth quintile Lowest 23.9 17.0 25.9 15.9 8.4 7.0 28.7 19.4 35.5 24.2 646 Second 17.3 13.7 22.2 13.8 7.7 5.7 24.6 16.1 29.7 21.1 761 Middle 17.0 11.5 18.1 9.7 10.7 7.6 22.0 13.4 27.7 18.0 707 Fourth 21.0 14.5 18.8 12.2 5.7 4.8 21.2 14.4 28.7 20.7 701 Highest 21.8 13.5 18.1 9.4 5.0 2.6 18.2 9.5 30.2 16.7 629 Total 20.0 14.0 20.6 12.2 7.6 5.6 23.0 14.6 30.2 20.2 3,444 178 | Domestic Violence Table 14.6 Spousal violence by husband's characteristics and empowerment indicators Percentage of ever-married women age 15-49 who have ever experienced emotional, physical or sexual violence committed by their husband, according to his characteristics, marital characteristics, and empowerment indicators, Jordan 2007 Type of violence Emotional Physical Sexual Physical or sexual Emotional, physical or sexual Characteristic Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Number of ever- married women Husband's education No education 25.9 22.9 25.2 12.5 10.7 4.6 27.1 15.3 35.1 26.9 69 Elementary 23.1 16.2 22.6 12.5 9.4 6.6 24.9 15.1 33.3 22.3 407 Preparatory 24.5 17.2 24.4 13.4 7.8 5.7 28.7 16.6 38.4 25.3 655 Secondary 19.4 12.3 20.4 13.1 7.8 6.2 23.0 16.2 30.1 19.8 1,273 Higher 16.4 12.5 17.3 10.2 6.2 4.4 18.3 11.2 23.7 16.2 1,037 Spousal age difference 1 Wife older 13.9 8.8 18.7 13.0 7.6 6.1 22.2 16.8 26.4 18.1 185 Wife is same age 11.4 9.0 16.8 8.9 2.1 1.6 17.0 9.3 22.1 15.8 230 Wife's 1-4 years younger 20.1 14.6 19.1 12.3 7.4 5.4 21.7 14.3 29.4 19.9 987 Wife's 5-9 years younger 18.9 14.1 17.8 11.1 6.5 5.5 20.3 14.1 28.5 20.1 1,262 Wife's 10+ years younger 21.0 16.0 21.6 13.7 7.2 6.8 24.2 16.2 32.1 23.2 622 Spousal education difference Husband better educated 21.7 14.7 23.4 13.7 9.5 6.9 26.2 16.7 32.2 21.4 1,228 Wife better educated 19.9 14.1 20.1 11.9 6.9 5.6 23.0 14.5 30.9 20.9 1,391 Both equally educated 17.5 12.3 16.9 10.7 5.6 3.7 17.9 11.7 25.7 17.1 786 Neither educated 24.7 21.3 14.5 8.4 5.6 3.9 14.5 10.3 28.9 23.3 32 Number of decisions in which women participate 1 0 29.4 16.2 33.4 16.8 14.6 12.3 36.8 18.9 40.3 20.6 75 1-2 22.5 15.6 21.6 15.3 6.7 5.4 24.0 17.8 32.1 22.0 747 3-4 17.4 13.4 17.6 10.7 6.4 5.3 20.1 13.2 27.5 19.7 2,465 Number of reasons given for refusing to have sexual intercourse with husband 0 * * * * * * * * * * 9 1-2 19.1 13.8 19.3 11.2 5.8 4.2 20.6 12.8 27.5 18.4 964 3 20.3 13.9 21.0 12.5 8.2 6.1 23.8 15.2 31.2 20.8 2,471 Number of reasons for which wife beating is justified 0 19.6 12.4 16.4 9.0 6.4 4.4 18.3 10.9 27.5 17.2 1,634 1-2 19.6 15.2 23.0 14.6 8.1 6.4 25.7 17.3 31.4 22.3 1,480 3-4 24.4 16.1 30.9 17.4 10.7 7.8 33.7 21.2 38.7 25.7 331 Total 20.0 14.0 20.6 12.2 7.6 5.6 23.0 14.6 30.2 20.2 3,444 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Currently married women 14.2.3 Help-Seeking Behavior The 2007 JPFHS also collected information to assess the extent to which women seek help to deal with domestic violence episodes. To obtain these data, women who had experienced an episode of physical or sexual violence at the hands of their husband within the 12-month period before the survey were asked whether they had sought any help at any time during the year when their husband had done something to physically hurt them and, if so, from whom they had sought help. Domestic Violence � 179 The results in Table 14.7 indicate that about one-fifth of women who had experienced violence at least once within the 12 months preceding the survey sought assistance to deal with the violence. Women were almost three times as likely to seek help if the violence had occurred often (40 percent) rather than sometimes (15 percent). Most of the women who asked for help looked to relatives for assistance; among women who reported frequently being subject to violence, 23 percent sought help from their mother, 15 percent from their father and 10 percent from their brother. Seven percent of women who reported frequent violence sought help from the police, while 3 percent sought help from medical personnel or a lawyer. Table 14.7 Help-seeking behavior by women experiencing physical or sexual violence Percentage of women age 15-49 who have ever experienced physical or sexual violence committed by their husband within the past 12 months who reported seeking help from anyone to prevent or stop violence, by persons from whom assistance was sought, according to frequency of violence, Jordan 2007 Frequency of violence within past 12 months Help-seeking behavior At least once Often Sometimes Sought any assistance 22.2 40.1 15.3 Percentage who sought help from: Mother 12.2 22.5 8.3 Sister 1.1 3.7 0.1 Mother-in-law 4.6 6.3 4.0 Other female relative/in-law 1.5 4.6 0.3 Father 7.4 15.1 4.5 Brother 4.8 10.0 2.9 Father-in-law 4.1 6.0 3.3 Other male relative/in-law 1.8 3.8 1.0 Friend 1.5 2.4 1.1 Neighbor 1.3 4.1 0.2 Doctor/medical personnel 1.4 2.5 1.0 Police 2.0 7.2 0.0 Lawyer 0.7 2.5 0.0 Social service organization 0.2 0.4 0.1 Children 0.4 0.1 0.5 Relatives 0.2 0.7 0.0 Number of women 503 140 363 Early Childhood Development � 181 EARLY CHILDHOOD DEVELOPMENT 15 Early childhood, roughly described as ages 3 to 8, is a time of tremendous physical, social, emotional, and intellectual growth for children. One of the stated goals of the United Nation’s World Fit for Children is that children should be “physically healthy, mentally alert, emotionally secure, socially competent and able to learn.” Therefore, any comprehensive model of early childhood development must cover major areas of well-being including intellectual development, social development, emotional development and child health. Social development refers to the ability of young children to interact and sustain relationships with others, including parents, siblings, peers, teachers, and other adults. Emotional development, on the other hand, refers not to relationships but to children’s feelings about themselves and others. It includes such characteristics as self-control, self-efficacy (i.e., the sense of being able to affect events), and the ability to properly interpret the emotions of others. The behaviors which constitute healthy social and emotional development vary greatly according to the age of the child. For example, at age two, markers of good social development focus heavily on relationships with parents and caregivers, whereas by ages five and six, they would include working cooperatively and playing well with fellow students and being able to make friends. In addition, it should be understood that young children mature at different rates and that the range of behaviors that fall in the normal range (though not always optimal) can be quite wide. Good social skills and positive emotional characteristics are important outcomes in and of themselves. Also, they can have strong influences on intellectual development and early school performance.1 When recognized early, problems in any of these areas can often be addressed effectively and their long-term negative consequences can often be minimized and sometimes eliminated altogether. In order to obtain an overview of certain early childhood development indicators in Jordan, women were asked about basic developmental milestones regarding their youngest child aged 3-8. The results are presented in this chapter. 15.1 ABILITY TO COUNT Basic numerical abilities are present very early on in children’s development. Based on their daily interaction with the world, many young children begin developing basic mathematical concepts such as counting spontaneously. These early math skills serve as a starting point from which most children become ready for more formal mathematical instruction in school. Because mathematical skills build on each other, children lacking basic skills (such as understanding that numbers are used to count and counting to 10 forwards and backwards), will have difficulty with math in later years. To assess basic numerical skills among children, respondents in the 2007 JPFHS were asked how high their youngest children can count to. These results are presented in Table 15.1. Overall, for half of children aged 3-8, the highest number they can count to is between 1 and 10. Twenty percent of children can count to a number between 11 and 96 and 23 percent can count to the number 97 or higher. Overall, 7 percent of children cannot count. A child’s ability to count is strongly correlated to age. At age three, 14 percent cannot count while 76 percent cannot count past 10. At age four, 73 percent can count to a number up to ten and 19 percent can count to a number higher than 10. By age five, more than half of children can count to a number higher than 10. 1 Child Trends and Center for Child Health Research, 2004. Early Child Development in Social Context, New York. 182 | Early Childhood Development Table 15.1 Ability to count Percent distribution of youngest children aged 3-8 years, according to the highest number that the child can count to, by background characteristics, Jordan 2007 The highest number that the child can count to Background characteristic Cannot count 1-10 11-96 97 or higher Don’t know/ missing Total Number of children Age 3 14.3 76.1 9.0 0.4 0.3 100.0 1,963 4 7.9 72.8 16.5 2.1 0.7 100.0 1,623 5 2.8 45.2 40.9 10.9 0.1 100.0 1,193 6 0.7 13.7 36.1 48.3 1.2 100.0 785 7 1.3 1.9 10.0 85.7 1.1 100.0 620 8 0.7 3.7 3.8 89.2 2.6 100.0 464 Sex Male 8.1 49.4 19.4 22.3 0.8 100.0 3,515 Female 5.6 51.6 19.6 22.7 0.7 100.0 3,133 Residence Urban 6.3 49.9 19.9 23.2 0.7 100.0 5,645 Rural 10.2 53.2 17.4 18.5 0.8 100.0 1,003 Governorate Amman 5.9 46.8 22.0 24.4 0.9 100.0 2,607 Balqa 6.7 57.0 19.2 16.2 1.0 100.0 410 Zarqa 7.0 52.5 19.0 21.0 0.5 100.0 1,040 Madaba 7.6 53.5 15.1 23.7 0.2 100.0 158 Irbid 7.1 50.0 17.6 24.6 0.7 100.0 1,242 Mafraq 13.4 56.1 16.2 13.9 0.3 100.0 291 Jarash 9.3 53.0 17.3 19.8 0.6 100.0 184 Ajloun 4.1 60.4 14.1 21.3 0.2 100.0 151 Karak 7.6 49.6 19.3 23.1 0.4 100.0 227 Tafiela 6.4 55.8 15.2 22.6 0.0 100.0 95 Ma’an 9.3 53.6 19.3 17.2 0.6 100.0 101 Aqaba 8.2 52.3 16.9 22.0 0.6 100.0 142 Region Central 6.3 49.4 20.8 22.7 0.8 100.0 4,216 North 8.1 52.1 17.1 22.2 0.6 100.0 1,868 South 7.9 52.0 18.0 21.7 0.4 100.0 565 Badia area Badia 12.7 58.6 13.5 14.6 0.6 100.0 535 Other 6.4 49.7 20.0 23.2 0.7 100.0 6,113 Mother’s education No education 17.0 47.7 11.3 23.1 0.9 100.0 230 Elementary 7.5 53.0 14.3 24.1 1.0 100.0 461 Preparatory 7.6 50.9 18.6 21.8 1.1 100.0 979 Secondary 7.1 53.6 19.8 18.7 0.7 100.0 3,049 Higher 4.9 44.7 21.7 28.3 0.3 100.0 1,929 Father’s education No education 17.7 41.7 20.1 19.5 1.0 100.0 136 Elementary 8.4 49.7 16.8 23.8 1.3 100.0 769 Preparatory 6.4 49.2 19.3 24.5 0.6 100.0 1,345 Secondary 8.0 54.7 19.4 17.6 0.3 100.0 2,450 Higher 4.6 46.7 20.8 26.9 1.0 100.0 1,940 Wealth quintile Lowest 12.1 59.5 13.4 14.1 0.9 100.0 1,349 Second 6.3 53.7 19.6 20.2 0.2 100.0 1,435 Middle 7.2 53.9 18.4 19.6 0.8 100.0 1,385 Fourth 4.2 44.1 24.0 27.3 0.4 100.0 1,378 Highest 4.4 38.3 22.6 33.4 1.2 100.0 1,101 Total1 6.9 50.4 19.5 22.5 0.7 100.0 6,648 1 Total includes 9 cases for which father’s education is missing Early Childhood Development � 183 The inability of a child to count is strongly related to both mother’s and father’s education; 17 percent of children whose mother has no education and 18 percent of children whose father has no education cannot count. In addition, 12 percent of children living in the poorest households cannot count. 15.2 FREQUENCY OF READING AND NAME RECOGNITION Young children who are read to regularly by their parents develop better early literacy skills and are better readers when they reach basic school. Children who do not read well within the first few years of school are at greater risk of poor academic performance later on. Reading to young children also encourages children to enjoy books and to read on their own. Living in a strong literacy environment (as indicated by such characteristics as the number of children’s books in the home) contributes to children’s language and literacy development, which, in turn, are related to later success in school. In order to assess literacy skills among young children, the 2007 JPFHS asked how often respondent’s youngest children read or were read to in the last month. These results are presented in Table 15.2. More than half of children aged 3-8 read or are read to. Twelve percent of children often read or are read to, while 42 percent sometimes read or are read to. Thirty-eight percent of children do not read or are not read to and seven percent of children have no story books at home. The likelihood that a child reads or is read to increases with the parents education and with the wealth of the household. Two-thirds of children whose mother has no education and more than half of children whose father has no education do not read or are not read to, compared to approximately one- fourth of children of mothers or fathers with higher than secondary education. Identifying and understanding a child’s own name and the names of family members in a story is an important milestone in a early childhood development, particularly among pre-readers. In the 2007 JPFHS, respondents were asked if their youngest children can recognize their own name or the name of siblings/friends when heard in a story. Overall, just less than half of children aged 3-8 can recognize their own name or the names of family members when told in a story (Table 15.2). As expected, this ability is influenced by age; from 15 percent of children aged three and 24 percent of children aged four, the percentage climbs to over 95 percent by age seven. As with other child development indicators, children of higher educated parents and children living in wealthier households are more likely to possess this ability. 184 | Early Childhood Development Table 15.2 Frequency of reading or being read to and name recognition Percent distribution of youngest children aged 3-8 years, according to how often they read or are read to in the last month, and proportion who can recognize their own name or the name of siblings/friends in a story, by background characteristics, Jordan 2007 Frequency of reading or being read to in the past month Background characteristic Often Sometimes Did not read No story book Don’t know/ missing Total Can recognize a name in a story Number of children Age 3 9.8 38.8 42.0 8.9 0.5 100.0 15.4 1,963 4 12.6 40.4 39.6 6.6 0.8 100.0 24.0 1,623 5 11.8 42.3 38.2 7.5 0.2 100.0 53.3 1,193 6 12.6 46.2 36.1 3.8 1.3 100.0 86.3 785 7 11.3 51.9 28.8 7.3 0.8 100.0 95.4 620 8 17.0 40.4 34.3 7.0 1.3 100.0 96.1 464 Sex Male 11.4 41.5 38.8 7.7 0.5 100.0 45.8 3,515 Female 12.2 42.6 37.7 6.6 0.9 100.0 45.7 3,133 Residence Urban 12.1 43.1 37.9 6.3 0.7 100.0 46.8 5,645 Rural 10.3 36.1 40.5 12.6 0.4 100.0 40.0 1,003 Governorate Amman 15.0 43.5 37.4 3.3 0.9 100.0 54.2 2,607 Balqa 12.1 42.1 24.8 20.4 0.6 100.0 35.6 410 Zarqa 6.7 41.8 45.0 5.9 0.5 100.0 33.0 1,040 Madaba 11.8 35.9 42.9 8.9 0.6 100.0 43.7 158 Irbid 11.1 42.6 36.5 9.1 0.7 100.0 44.8 1,242 Mafraq 8.0 31.9 43.1 16.3 0.8 100.0 32.8 291 Jarash 5.3 32.8 41.6 19.7 0.5 100.0 34.7 184 Ajloun 8.9 40.8 43.0 7.4 0.0 100.0 39.0 151 Karak 13.0 45.2 37.0 4.0 0.8 100.0 59.0 227 Tafiela 13.2 43.1 38.2 4.9 0.6 100.0 50.3 95 Ma’an 11.1 45.3 39.3 4.1 0.2 100.0 47.5 101 Aqaba 12.9 44.7 36.1 6.1 0.2 100.0 46.0 142 Region Central 12.5 42.7 38.3 5.8 0.7 100.0 46.8 4,216 North 9.9 39.8 38.6 11.1 0.6 100.0 41.5 1,868 South 12.6 44.7 37.4 4.7 0.5 100.0 52.2 565 Badia area Badia 8.4 31.0 46.1 13.9 0.6 100.0 34.4 535 Other 12.1 43.0 37.6 6.6 0.7 100.0 46.8 6,113 Mother's education No education 6.1 11.9 66.1 15.1 0.8 100.0 38.6 230 Elementary 5.0 26.6 52.7 14.4 1.4 100.0 42.0 461 Preparatory 7.6 39.6 41.6 10.0 1.3 100.0 42.6 979 Secondary 10.4 43.2 39.0 7.1 0.4 100.0 43.1 3,049 Higher 18.5 48.8 28.7 3.3 0.7 100.0 53.4 1,929 Father's education No education 10.6 19.2 56.2 12.7 1.3 100.0 42.4 136 Elementary 7.9 31.1 46.6 13.2 1.2 100.0 41.4 769 Preparatory 10.4 37.6 41.5 10.0 0.6 100.0 44.3 1,345 Secondary 9.4 42.5 41.4 6.3 0.4 100.0 42.2 2,450 Higher 17.5 50.5 27.5 3.7 0.9 100.0 53.0 1,940 Wealth quintile Lowest 7.0 29.8 49.1 12.7 1.4 100.0 31.9 1,349 Second 10.7 38.2 41.0 9.9 0.1 100.0 42.3 1,435 Middle 10.7 45.3 37.9 5.6 0.5 100.0 44.6 1,385 Fourth 12.7 46.2 35.5 5.4 0.1 100.0 52.4 1,378 Highest 19.2 52.7 25.2 1.2 1.6 100.0 60.4 1,101 Total 1 11.8 42.0 38.3 7.2 0.7 100.0 45.8 6,648 1 Total includes 9 cases for which father’s education is missing. Early Childhood Development � 185 15.3 PARTICIPATION IN FAMILY DISCUSSIONS Children’s participation in family discussions is an important indicator of family involvement in child development. It is also seen as an important factor in a child’s psychosocial development, such as a means of providing children with a moral framework and providing them with social problem solving skills. Table 15.3 shows the proportion of children who participate in family discussions. In all, 84 percent of children are reported to participate in family discussions. Participation in family discussions is somewhat related to both mother’s and father’s education; only 71 percent of children whose mother has no education and 70 percent of children whose father has no education participate in family discussions. There are slight differences in the participation of children in family discussions by other background characteristics. 15.4 MANAGEMENT OF DISAGREEMENTS AMONG FRIENDS An important step in social development is the ability to get along with others in a constructive manner and attaining personal goals while maintaining positive relationships with others. Young children who demonstrate this ability are more likely to have positive developmental outcomes, including higher overall intelligence, positive self-worth and better mental health. Management of disagreements is also related to a child’s overall self-control, as well as a child’s compliance and positive social behavior. The 2007 JPFHS asked women about how their youngest child aged 3-8 years manage disagreements with their friends in the neighborhood. This information is presented in Table 15.4. When faced with a disagreement with their friends in the neighborhood, the majority of children aged 3-8 resort to shouting and/or violence (71 percent), while 16 percent withdraw from the situation. Ten percent of children discuss disagreements with friends in a positive way, while two percent cry and less than one percent run to their mother. The way children manage disputes varies according to age. Children are more likely to discuss disagreements in a positive way as they get older; only five percent of children aged three and six percent of children aged four are reported to discuss disagreements, compared to 20 percent of children aged eight. The percentage of children resorting to shouting and violence to resolve disputes declines somewhat according to the child’s age; from 77 percent of children aged three resorting to shouting and violence, this figure declines to 60 percent of children aged eight. Table 15.3 Participation in family discussions Proportion of youngest children aged 3-8 years who participate in family discussions, by background characteristics, Jordan 2007 Background characteristic Participate in family discussions Number of children Age 3 76.1 1,963 4 80.5 1,623 5 88.9 1,193 6 91.3 785 7 94.3 620 8 91.3 464 Sex Male 84.2 3,515 Female 83.8 3,133 Residence Urban 84.7 5,645 Rural 80.4 1,003 Governorate Amman 84.5 2,607 Balqa 85.4 410 Zarqa 83.4 1,040 Madaba 83.1 158 Irbid 85.9 1,242 Mafraq 76.9 291 Jarash 83.0 184 Ajloun 84.1 151 Karak 83.7 227 Tafiela 81.3 95 Ma'an 77.0 101 Aqaba 82.8 142 Region Central 84.3 4,216 North 84.1 1,868 South 81.9 565 Badia area Badia 77.0 535 Other 84.6 6,113 Mother's education No education 71.4 230 Elementary 80.1 461 Preparatory 82.0 979 Secondary 85.0 3,049 Higher 86.0 1,929 Father's education No education 70.3 136 Elementary 80.2 769 Preparatory 85.9 1,345 Secondary 83.4 2,450 Higher 85.9 1,940 Wealth quintile Lowest 78.4 1,349 Second 82.8 1,435 Middle 84.0 1,385 Fourth 88.0 1,378 Highest 87.5 1,101 Total 1 84.0 6,648 1 Total includes 9 cases for which father’s education is missing. 186 | Early Childhood Development Children are more likely to discuss disagreements in a positive way if the mother or father has a higher than secondary education, or if they live in a wealthier household. Children living in Madaba, Amman and Zarqa are most likely to manage disagreements in this way. Table 15.4 Management of disagreements among friends Percent distribution of youngest children aged 3-8 years, according to how they manage disagreements with their friends in the neighborhood, by background characteristics, Jordan 2007 Managing disagreements Background characteristic Discusses disagreements with friends in a positive way Withdraws from the situation Resorts to shouting and violence Crying Running to the mother Other Don't know/ missing Total Number of children Age 3 5.3 14.2 76.9 2.1 0.2 0.4 0.8 100.0 1,963 4 5.7 16.9 74.4 1.4 0.3 0.6 0.6 100.0 1,623 5 8.4 15.1 72.3 2.0 0.1 0.8 1.3 100.0 1,193 6 15.8 15.9 64.6 1.6 0.1 1.0 1.1 100.0 785 7 22.2 15.9 58.8 0.3 1.3 1.1 0.5 100.0 620 8 20.2 15.7 60.2 1.2 0.2 1.2 1.3 100.0 464 Sex Male 9.6 14.8 73.3 1.0 0.1 0.4 0.8 100.0 3,515 Female 10.1 16.2 68.7 2.4 0.5 1.0 1.0 100.0 3,133 Residence Urban 10.3 15.6 70.4 1.7 0.3 0.7 1.0 100.0 5,645 Rural 7.3 14.8 75.3 1.3 0.2 0.7 0.5 100.0 1,003 Governorate Amman 12.9 16.6 66.1 1.6 0.4 0.8 1.6 100.0 2,607 Balqa 8.7 9.3 80.1 0.6 0.2 0.3 0.8 100.0 410 Zarqa 10.6 11.4 76.0 1.3 0.0 0.4 0.3 100.0 1,040 Madaba 14.1 12.1 70.1 2.6 0.0 0.7 0.5 100.0 158 Irbid 6.8 16.5 73.6 2.2 0.0 0.5 0.4 100.0 1,242 Mafraq 3.4 17.6 76.1 2.1 0.0 0.2 0.5 100.0 291 Jarash 6.2 15.7 75.5 1.4 0.2 0.6 0.4 100.0 184 Ajloun 3.4 15.8 77.7 2.5 0.0 0.6 0.0 100.0 151 Karak 9.0 17.6 67.6 1.5 1.3 2.3 0.6 100.0 227 Tafiela 5.5 21.4 68.1 1.6 1.3 1.1 0.9 100.0 95 Ma'an 4.1 20.6 69.8 1.8 0.9 1.7 1.0 100.0 101 Aqaba 5.2 21.9 68.6 0.9 1.4 1.7 0.2 100.0 142 Region Central 12.0 14.4 70.0 1.4 0.3 0.6 1.2 100.0 4,216 North 5.9 16.5 74.5 2.1 0.0 0.5 0.4 100.0 1,868 South 6.6 19.9 68.3 1.4 1.2 1.9 0.6 100.0 565 Badia area Badia 6.9 17.4 71.0 3.4 0.1 0.5 0.7 100.0 535 Other 10.1 15.3 71.2 1.5 0.3 0.7 0.9 100.0 6,113 Mother's education No education 5.6 11.0 80.8 1.5 0.1 0.3 0.8 100.0 230 Elementary 9.6 15.9 70.1 2.2 0.1 0.4 1.6 100.0 461 Preparatory 9.1 13.3 74.1 1.6 0.3 0.6 1.1 100.0 979 Secondary 7.8 16.2 72.5 1.7 0.2 0.7 1.0 100.0 3,049 Higher 13.9 16.0 66.7 1.5 0.5 0.8 0.6 100.0 1,929 Father's education No education 10.7 14.7 65.6 3.0 2.9 1.5 1.6 100.0 136 Elementary 7.0 15.7 73.6 0.6 0.3 1.2 1.7 100.0 769 Preparatory 7.7 14.3 74.2 2.4 0.1 0.6 0.8 100.0 1,345 Secondary 9.2 15.1 72.5 1.5 0.2 0.7 0.8 100.0 2,450 Higher 13.2 16.9 66.7 1.6 0.4 0.5 0.8 100.0 1,940 Wealth quintile Lowest 6.1 16.6 73.8 1.6 0.1 0.6 1.3 100.0 1,349 Second 7.6 14.1 74.3 2.1 0.4 1.0 0.5 100.0 1,435 Middle 7.7 15.3 72.9 2.0 0.5 0.6 1.0 100.0 1,385 Fourth 12.4 12.4 71.6 1.6 0.4 0.9 0.6 100.0 1,378 Highest 16.7 20.1 61.0 0.6 0.0 0.3 1.3 100.0 1,101 Total1 9.8 15.5 71.2 1.6 0.3 0.7 0.9 100.0 6,648 1 Total includes 9 cases for which father’s education is missing. Early Childhood Development � 187 15.5 TEETH BRUSHING AND HAND WASHING Educating children on good hygiene, such as brush- ing teeth and washing hands before eating, after using the toilet and when they are ill, is one of the best ways to avoid the spread of infection and illness among children. Teach- ing children the principles of correct hygiene at an early age can help keep individuals healthy in later life. Overall, 60 percent of children aged 3-8 years brush their teeth (Table 15.5). Children living in urban households were more likely to brush their teeth than those living in rural households (61 percent and 54 percent, respectively). The proportion who brush their teeth is highest in Tafiela and Amman and lowest in Mafraq. In general, the higher the parents’ education, the more likely the child is to brush his or her teeth half of children whose parents have no education brush their teeth, compared to 71 percent of chil- dren whose parents have a higher than secondary education. Almost all of the youngest children aged 3-8 years wash their hands after using the bathroom (90 percent). The variations according to background characteristics are simi- lar to those seen in teeth brushing. Table 15.5 Teeth brushing and hand washing Proportion of youngest children aged 3-8 years who brush their teeth, and the proportion who wash their hands after using the toilet, by background characteristics, Jordan 2007 Background characteristic Brush teeth Wash hands Number of children Age 3 42.1 84.2 1,963 4 53.7 88.1 1,623 5 67.9 94.7 1,193 6 77.5 95.4 785 7 80.0 97.3 620 8 76.9 96.0 464 Sex Male 59.5 89.6 3,515 Female 59.9 91.3 3,133 Residence Urban 60.8 90.7 5,645 Rural 53.5 88.6 1,003 Governorate Amman 66.1 92.4 2,607 Balqa 54.4 90.2 410 Zarqa 50.3 88.0 1,040 Madaba 61.8 91.3 158 Irbid 59.8 89.8 1,242 Mafraq 43.5 81.2 291 Jarash 49.0 86.1 184 Ajloun 57.3 89.0 151 Karak 60.9 93.0 227 Tafiela 67.1 96.1 95 Ma'an 65.1 93.2 101 Aqaba 62.0 93.9 142 Region Central 60.9 91.0 4,216 North 56.0 88.0 1,868 South 63.0 93.8 565 Badia area Badia 49.4 85.1 535 Other 60.6 90.9 6,113 Mother's education No education 48.5 85.4 230 Elementary 50.7 88.8 461 Preparatory 49.4 87.0 979 Secondary 58.1 91.5 3,049 Higher 70.9 91.4 1,929 Father's education No education 50.0 79.9 136 Elementary 51.8 88.0 769 Preparatory 53.5 89.6 1,345 Secondary 57.3 91.0 2,450 Higher 71.0 91.9 1,940 Wealth quintile Lowest 41.7 84.5 1,349 Second 53.8 89.6 1,435 Middle 61.0 92.1 1,385 Fourth 69.7 92.7 1,378 Highest 75.2 93.9 1,101 Total1 59.7 90.4 6,648 1 Total includes 9 cases for which father’s education is missing References | 189 REFERENCES ACC/SCN. 2000. Fourth report on the world nutrition situation. Geneva: ACC/SCN in collaboration with IFPRI. Child Trends and Center for Child Health Research. 2004. Early Child Development in Social Context, New York. Department of Statistics [Jordan]. 1979. National Fertility Survey 1976. 2 vols. Amman, Jordan. Department of Statistics [Jordan]. 1989. Jordan Fertility and Family Health Survey 1983. Amman, Jordan. Department of Statistics [Jordan]. 2006. Population and Housing Census 2004. Amman, Jordan. Department of Statistics [Jordan] and ORC Macro. 2003. Jordan Population and Family health Survey 2002. Calverton, Maryland, USA: Department of Statistics and ORC Macro. Department of Statistics [Jordan] and Macro International Inc. 1998. Jordan Population and Family Health Survey 1997. Calverton, Maryland: Department of Statistics and Macro International. Faqir, F. 2001. Intrafamily femicide in defence of honour: The case of Jordan. Third World Quarterly 22(1):65-82. Gwatkin, D.R., S. Rutstein, K. Johnson, R.P. Pande, and A. Wagstaff. 2000. Socio-economic differences in health, nutrition and poverty. HNP/Poverty Thematic Group of The World Bank. Washington, D.C.: The World Bank. Heise, L., J. Pitanguy, and A. Germain. 1994. Violence against women: The hidden health burden. Wasington, D.C.: The World Bank. Heise, L., M. Ellsberg, and M. Goettemoeller. 1998. Ending violence among women. Population Reports, Series L, No. 11. Baltimore, Maryland: Population Information Program, Johns Hopkins University School of Public Health. Jejeebhoy, S.J. 1998. Associations between wife-beating and fetal and infant death: Impressions from a survey in rural India. Studies in Family Planning 29(3):300-308. PAHO/WHO. 2003. Guiding principles for complementary feeding of the breastfed child. Washington, D.C./Geneva, Switzerland: PAHO/WHO. Rutstein, S. 1999. Wealth versus expenditure: Comparison between the DHS wealth index and household expenditures in four departments of Guatemala. Calverton, Maryland: ORC Macro. UNICEF. 1999. Lack of obstetric care: Mothers and babies at risk. In The progress of nations 1999, p 15. New York, New York: UNICEF. 190 | References UNAIDS. 2008. Report on the Global HIV/AIDS Epidemic 2008.Geneva, Switzerland: UNAIDS. United Nations General Assembly. 1991. Advancement of women: Convention on the elimination of all forms of discrimination against women. Report of the Secretary General. New York: United Nations. World Health Organization (WHO). 2005. Guiding principles for feeding nonbreastfed children 6 to 24 months of age. Geneva, Switzerland: WHO. WHO/UNICEF. 1998. Complementary feeding of young children in developing countries: A review of current scientific knowledge. Geneva: World Health Organization. Zou’bi, A.A.A., S. Poedjastoeti, and M. Ayad. 1992. Jordan Population and Family Health Survey 1990. Columbia, Maryland, USA: Department of Statistics [Jordan], and IRD/Macro International Inc. Appendix A � 191 SAMPLE DESIGN Appendix A A.1 OBJECTIVES OF THE SURVEY The main objectives of the 2007 JPFHS survey are to provide up-to-date information on fertility and childhood mortality levels; fertility preferences; awareness, approval, and use of family planning methods; maternal and child health; knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections (STI). All ever-married women 15-49 who slept in the selected households the night before the survey interview were eligible for the survey. The sample is designed to produce representative results for the country as a whole, for the urban and rural areas, the Badia and non-Badia areas, and for each of the 12 governorates. A.2 SAMPLING FRAME Administratively, Jordan is divided into 12 governorates. Each governorate is subdivided into districts; each district into sub-districts; each sub-district into localities, and each locality into areas and then sub-areas. In addition to these administrative units, during the 2004 Jordan Population and Housing Census (JPHC 2004), each sub-area was subdivided into convenient area units called census blocks. An electronic file of a complete list of all the census blocks was created. This list contains census information on households, population, geographical locations and socio-economic characteristics etc. of each block. Based on this list, the census blocks were then regrouped to form a general statistical unit of moderate size (30 households or more), called a cluster, which could be widely used in various surveys. The sample of the 2007 JPFHS was selected from the frame of cluster units provided by the Department of Statistics (DOS). The frame excluded the population living in remote areas (most of whom are nomads), as well as those living in collective housing units, such as hotels, hospitals, work camps, prisons, and the like. Table A.1 gives the distribution of the clusters and their average size, by governorate and by urban-rural residence. Table A.1 Distribution of clusters by governorate and by type of residence Number of clusters Average cluster size Governorate Urban Rural Total Urban Rural Total Amman 4,657 329 4,986 77 61 76 Balqa 549 248 797 82 68 77 Zarqa 1,875 128 2,003 72 51 71 Madaba 234 112 346 70 56 65 Irbid 1,931 422 2,353 71 66 70 Mafraq 224 353 577 72 63 67 Jarash 217 142 359 75 66 72 Ajloun 222 80 302 71 59 68 Karak 176 373 549 66 64 65 Tafiela 152 61 213 63 56 61 Ma'an 133 121 254 64 55 60 Aqaba 249 38 287 62 57 62 Total 10,619 2,407 13,025 74 62 72 Source: 2004 Population and Housing Census 192 | Appendix A In total, there are 13,025 clusters in Jordan. The average size of a cluster is 74 households in the urban areas and 62 in the rural areas. The overall average size is 72 households, which is adequate for a sample take of 16 households per cluster for the 2007 JPFHS. Table A.2 and Table A.3 present the distribution of household population and the number of households by governorate and by urban-rural residence. In Jordan, 83 percent of the population live in urban areas (a locality with a population of 5,000 or more), occupying 84 percent of the households, according to the sampling frame. The urban-rural distribution was modified following the 2004 census. Table A.2 Population distribution by governorate and by type of residence Household population Proportion Governorate Urban Rural Total Urban Governorate Amman 1,790,064 115,035 1,905,099 0.940 0.380 Balqa 247,080 94,800 341,880 0.723 0.068 Zarqa 717,841 34,924 752,765 0.954 0.150 Madaba 91,760 37,347 129,107 0.711 0.026 Irbid 757,960 158,787 916,747 0.827 0.183 Mafraq 95,077 140,274 235,351 0.404 0.047 Jarash 95,371 57,242 152,613 0.625 0.030 Ajloun 89,954 28,834 118,788 0.757 0.024 Karak 65,553 135,199 200,752 0.327 0.040 Tafiela 53,616 20,482 74,098 0.724 0.015 Ma'an 49,618 40,340 89,958 0.552 0.018 Aqaba 81,467 13,622 95,089 0.857 0.019 Total 4,135,361 876,886 5,012,247 0.825 1.000 Source: 2004 Population and Housing Census Table A.3 Distribution of households by governorate and by type of residence Number of households Proportion Governorate Urban Rural Total Urban Governorate Amman 357,977 19,980 377,957 0.947 0.404 Balqa 44,805 16,827 61,632 0.727 0.066 Zarqa 135,770 6,578 142,348 0.954 0.152 Madaba 16,344 6,245 22,589 0.724 0.024 Irbid 137,550 27,668 165,218 0.833 0.177 Mafraq 16,234 22,150 38,384 0.423 0.041 Jarash 16,352 9,351 25,703 0.636 0.027 Ajloun 15,733 4,698 20,431 0.770 0.022 Karak 11,541 23,993 35,534 0.325 0.038 Tafiela 9,566 3,437 13,003 0.736 0.014 Ma'an 8,529 6,609 15,138 0.563 0.016 Aqaba 15,510 2,173 17,683 0.877 0.019 Total 785,911 149,709 935,620 0.840 1.000 Source: 2004 Population and Housing Census A.3 SAMPLE ALLOCATION AND SAMPLE SELECTION The sample for 2007 JPFHS is a stratified sample selected in two stages from the 2004 census frame. Stratification is achieved by separating each governorate into urban and rural areas. The rural areas of each governorate form a single stratum. The urban areas of each governorate form a single stratum if the governorate has no cities having a population of 100,000 or more; otherwise, the urban areas are further stratified in such a way that each city having a population of 100,000 or more forms a single stratum, while the rest of the urban areas together form a stratum. Therefore, the number of urban strata in Appendix A � 193 a governorate depends on the number of cities having a population of 100,000 or more. In three governorates, there are cities having a population of 100,000 or more: Amman, Zarqa, and Irbid. In total, 30 sampling strata have been constructed. Samples were selected independently in each stratum, by a two-stage selection. By using a probability proportional to size selection during the first sampling stage, an implicit stratification and proportional allocation was achieved at each of the lower administrative levels. This was done by sorting the clusters within each sampling stratum, according to the administrative levels and then by their socio-economic characteristics. In the first stage, 890 clusters were selected with probability proportional to the cluster size and with an independent selection in each sampling stratum. The cluster size is the number of residential households residing in the cluster given in the sampling frame. The sample allocation was designed to take the governorate level into account. The ideal sample would allocate the 10,000 completed women interviews proportionally to each sampling stratum according to the stratum size. But the proportional allocation would allocate too small a sample size for certain governorates (Tafiela, Ma'an and Aqaba, with less than 200 completed interviews each). DHS surveys in other countries show that in order to get a reasonable precision for most indicators at the regional level, at least 800 completed interviews of women aged 15-49 are needed. This means that a proportional allocation cannot meet the precision request for the small governorates. To assure that the survey precision is comparable across the governorates, it was decided to use an equal size allocation with an adjustment for the governorates of Amman, Zarqa and Irbid as they represent 38 percent, 15 percent and 18 percent, respectively, of the population in the Kingdom. After the sample allocation by governorate, the samples were proportionally allocated to each sampling stratum within each governorate. Table A.4 shows the sample allocation by governorate and by urban-rural areas within each governorate. The proportional allocation is also presented. Table A.4 Sample allocation of completed women interviews by governorate and by type of residence Proportional allocation Final allocation Governorate Urban Rural Total Urban Rural Total Amman 3,571 230 3,801 977 68 1,045 Balqa 493 189 682 591 227 818 Zarqa 1,432 70 1,502 807 46 853 Madaba 183 75 258 580 238 818 Irbid 1,512 317 1,829 693 160 853 Mafraq 190 280 470 330 488 818 Jarash 190 114 304 511 307 818 Ajloun 179 58 237 624 194 818 Karak 131 270 401 273 545 818 Tafiela 107 41 148 591 227 818 Ma'an 99 80 179 455 363 818 Aqaba 163 27 190 704 113 818 Total 8,250 1,750 10,000 7,136 2,976 10,112 Table A.5 shows the sample allocation of households and clusters to be selected in the urban and rural areas of each governorate based on the final allocation given in Table A.4. The parameters used to convert the number of completed women interviews to number of households and then to number of clusters were obtained by referencing the survey results of the 2002 JPFHS: 16 households were selected per cluster; the household response rate was assumed to be 95 percent; the individual response rate was assumed to be 95 percent; there are 0.795 ever-married women 15-49 per household. Both the household response rate and the women individual response rate were down-modified compared to the 2002 JPFHS survey to reflect the situation changes in the country. Since 2003, for example, a lot of foreigners such as Egyptians and Iraqis have come to Jordan for work. These people usually live in groups in ordinary housing units and form households of only men, as shown in the 2004 Population and Housing Census. 194 | Appendix A After the sample had been selected, it was decided to oversample the Badia Area located in the Central region. In total, 40 complementary clusters were selected in Amman and Zarqa: 2 urban clusters and 25 rural clusters in Amman; 7 urban clusters and 6 rural clusters in Zarqa. This oversampling increased the total number of clusters to 930, with 637 urban clusters and 293 rural clusters. Table A.5 Sample allocation of households and clusters by governorate and by type of residence Allocation of households Allocation of clusters Governorate Urban Rural Total Urban Rural Total Amman 1,366 99 1,465 86 6 92 Balqa 826 317 1,142 52 20 72 Zarqa 1,169 70 1,240 71 4 75 Madaba 812 330 1,142 51 21 72 Irbid 1,014 225 1,240 61 14 75 Mafraq 461 681 1,142 29 43 72 Jarash 714 428 1,142 45 27 72 Ajloun 865 277 1,142 55 17 72 Karak 373 769 1,142 24 48 72 Tafiela 827 316 1,142 52 20 72 Ma'an 630 512 1,142 40 32 72 Aqaba 979 164 1,142 62 10 72 Total 10,036 4,189 14,225 628 262 890 Before the main survey, a household listing operation was carried out in all of the selected clusters, and the resulting lists of households served as the sampling frame for the selection of households in the second stage. Household selection in the second stage was an equal probability systematic selection of fixed size: 16 households per cluster. With a fixed second stage sample size, it is easy to allocate the fieldwork load to different interviewers and easy to control the fieldwork quality. A spreadsheet was prepared for the household selection with selected household numbers highlighted for each cluster. The survey interviewer was asked to interview only the pre-selected households. In order to prevent bias, no replacements and no changes of the pre-selected households were allowed in the implementing stages. All ever-married women aged 15-49 who slept in the selected households the night before the survey interview were eligible for the survey. A.4 SELECTION PROBABILITY AND SAMPLING WEIGHT Sampling probabilities were calculated separately for each sampling stage and for each cluster. The following notations are used: P1hi: first-stage sampling probability of the ith cluster in stratum h P2hi: second-stage sampling probability within the ith cluster (household selection) Let ah be the number of clusters selected in stratum h, Mhi the number of households according to the sampling frame in the ith cluster, and M hi� the total number of households in the stratum. The probability of selecting the ith cluster in the 2007 JPFHS sample is calculated as follows: M M a hi hih � Appendix A � 195 Let hiL be the number of households listed in the household listing operation in cluster i in stratum h, and let hig be the number of households selected in the cluster. The second stage’s selection probability for each household in the cluster is calculated as follows: hi hi hi L gP �2 The overall selection probability of each household in cluster i of stratum h is therefore the product of the two stages selection probabilities: hihihi PPP 21 �� Because of the non-proportional allocation of the sample to the different governorates, sampling weights are required to ensure the actual representativity of the sample at the national level and at the governorate level as well. The sampling weight for each household in cluster i of stratum h is the inverse of its overall selection probability: hihi PW /1� A spreadsheet containing all sampling parameters and selection probabilities was prepared to facilitate the calculation of sampling weights. Sampling weights were adjusted for household non- response and as well as for individual non-response. Therefore, two sets of weight were calculated: one set for the households, one set for individual women. The difference of the household weight and the individual weight was introduced by the women non-response. The final weights were normalized in order to give the total number of unweighted cases equal to the total number of weighted cases at national level, for both household weights and individual weights. A.5 SAMPLE IMPLEMENTATION Table A.6 presents the sample implementation results by giving the number of households selected and interviewed, ever-married women found and interviewed. According to the definition of each category, the response rates for household survey and woman survey were calculated based on the following formulas. The household response rate was calculated by: DNFRPHPC C ���� *100 In a similar way, the woman individual response rate was calculated by: EWOEWIEWPCEWREWNHEWC EWC ����� *100 196 | Appendix A Table A.6 Sample implementation Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to urban-rural residence and region, Jordan 2007 Residence Region Result Urban Rural Central North South Total Selected households Completed (C) 97.7 98.3 97.7 97.4 98.5 97.9 Household present but no competent respondent at home (HP) 0.6 0.4 0.5 1.2 0.1 0.6 Postponed (P) 0.0 0.0 0.0 0.0 0.0 0.0 Refused (R) 0.8 0.4 0.5 0.8 0.7 0.7 Dwelling not found (DNF) 0.0 0.0 0.0 0.0 0.0 0.0 Household absent (HA) 0.4 0.2 0.4 0.5 0.0 0.3 Dwelling vacant/address not a dwelling (DV) 0.3 0.6 0.7 0.1 0.4 0.4 Dwelling destroy (DD) 0.1 0.0 0.0 0.0 0.2 0.1 Other (O) 0.1 0.1 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of sampled households 10,192 4,688 5,616 4,656 4,608 14,880 Household response rate (HRR) 1 98.6 99.2 99.0 98.0 99.2 98.8 Eligible women Completed (EWC) 97.6 98.4 97.9 97.9 97.8 97.9 Not at home (EWNH) 0.5 0.6 0.3 0.8 0.5 0.5 Refused (EWR) 0.6 0.6 0.3 0.6 1.0 0.6 Partly completed (EWPC) 0.1 0.0 0.1 0.0 0.0 0.0 Incapacitated (EWI) 0.8 0.4 0.7 0.7 0.7 0.7 Other (EWO) 0.4 0.1 0.7 0.0 0.0 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 7,690 3,423 4,221 3,564 3,328 11,113 Eligible women response rate (EWRR)2 97.6 98.4 97.9 97.9 97.8 97.9 Overall response rate (ORR)3 96.2 97.5 96.9 96.0 97.0 96.6 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ——————————— C + HP + P + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: 100 * EWC ————————————————————————— EWC + EWNH + EWR + EWPC + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100 Appendix B � 197 ESTIMATES OF SAMPLING ERRORS Appendix B The estimates from a sample survey are affected by two types of errors: non-sampling errors and sampling errors. Non-sampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2007 Jordan Population and Family Health Survey (2007 JPFHS) to minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2007 JPFHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2007 JPFHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2007 JPFHS is a Macro SAS procedure. This procedure used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: � � � � � � � � � � �� � � � � � �� H h h h m i hi h h m zz m m x frvarrSE h 1 2 1 2 2 2 1 1)()( in which hihihi rxyz �� , and hhh rxyz �� where h represents the stratum which varies from 1 to H, mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. 198 | Appendix B The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo- independent replications are thus created. In the 2007 JPFHS, there were 930 non-empty clusters. Hence, 930 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )� � � � � � in which )()1( ii rkkrr ��� where r is the estimate computed from the full sample of 930 clusters, r(i) is the estimate computed from the reduced sample of 929 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, the design effect (DEFT) for each estimate is calculated, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. The relative standard error and confidence limits for the estimates are also calculated. Sampling errors for the 2007 JPFHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, for the three geographical regions, and for each of the 12 governorates. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 to B.19 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to child-bearing. The confidence interval (e.g., as calculated for children ever born to women aged 40-49) can be interpreted as follows: the overall average from the national sample is 5.307 and its standard error is 0.074. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 5.307±2×0.074. There is a high probability (95 percent) that the true average number of children ever born to all women aged 40 to 49 is between 5.159 and 5.455. For the total sample, the value of the DEFT, averaged over all variables, is 1.6. This means that, due to multi-stage clustering of the sample, the average standard error is increased by a factor of 1.6 over that in an equivalent simple random sample. Appendix B � 199 Table B.1 List of selected variables for sampling errors, Jordan 2007 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion Ever-married women No education Proportion Ever-married women Secondary education or higher Proportion Ever-married women Currently married Proportion Ever-married women Married before age 20 Proportion Ever-married women Currently pregnant Proportion All women Children ever born Mean All women Children surviving Mean All women Children ever born to women age 40-49 Mean All women age 40-49 Knows any contraceptive method Proportion Currently married women Ever used any contraceptive method Proportion Currently married women Currently using any contraceptive method Proportion Currently married women Currently using pill Proportion Currently married women Currently using IUD Proportion Currently married women Currently using female sterilization Proportion Currently married women Currently using periodic abstinence Proportion Currently married women Using public sector source Proportion Current users of modern method Want no more children Proportion Currently married women Want to delay birth at least 2 years Proportion Currently married women Ideal family size Mean Ever-married women Mother completely protected against tetanus Proportion Women with at least one live birth in five years before survey Mother received medical assistance at delivery Proportion Births in past 5 years Had diarrhea in the 2 weeks before survey Proportion Children age 0 to 59 months Treated with oral rehydration salts (ORS) Proportion Children with diarrhea in two weeks before interview Taken to a health provider Proportion Children with diarrhea in two weeks before interview Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received DPT vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all vaccinations (BCG) Proportion Children 12-23 months Total fertility rate (3 years) Rate All women Neonatal mortality Rate Children exposed to the risk of mortality Post-neonatal mortality Rate Children exposed to the risk of mortality Infant mortality Rate Children exposed to the risk of mortality Child mortality Rate Children exposed to the risk of mortality Under-five mortality Rate Children exposed to the risk of mortality ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Mortality rates are calculated for the past 0-4 years for the national sample and past 0-9 years for regional samples. 200 | Appendix B Table B.2 Sampling errors for national sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.850 0.003 10876 10876 0.878 0.004 0.844 0.856 No education 0.038 0.003 10876 10876 1.501 0.072 0.033 0.044 Secondary education or higher 0.887 0.005 10876 10876 1.752 0.006 0.876 0.898 Currently married 0.952 0.004 10876 10876 1.927 0.004 0.944 0.960 Married before age 20 0.332 0.007 11437 11391 1.752 0.022 0.318 0.347 Currently pregnant 0.069 0.004 19482 18960 1.476 0.053 0.062 0.077 Children ever born 2.159 0.073 19482 18960 1.215 0.034 2.014 2.305 Children surviving 2.098 0.070 19482 18960 1.212 0.034 1.957 2.239 Children ever born to women age 40-49 5.307 0.074 3274 3348 1.598 0.014 5.159 5.455 Knowing any contraceptive method 0.998 0.001 10360 10354 1.501 0.001 0.997 0.999 Ever used any contraceptive method 0.812 0.007 10360 10354 1.764 0.008 0.798 0.825 Currently using any method 0.571 0.008 10360 10354 1.637 0.014 0.555 0.587 Currently using pill 0.084 0.004 10360 10354 1.639 0.053 0.076 0.093 Currently using IUD 0.223 0.006 10360 10354 1.575 0.029 0.210 0.236 Currently using female sterilization 0.037 0.003 10360 10354 1.596 0.080 0.031 0.043 Currently using periodic abstinence 0.041 0.003 10360 10354 1.575 0.075 0.035 0.047 Using public sector source 0.417 0.015 3954 4200 1.906 0.036 0.387 0.447 Want no more children 0.505 0.007 10360 10354 1.433 0.014 0.491 0.519 Want to delay birth at least 2 years 0.258 0.007 10360 10354 1.591 0.026 0.244 0.272 Ideal family size 3.948 0.036 8613 8946 1.868 0.009 3.875 4.020 Mother completely protected against tetanus 0.271 0.010 6725 6446 1.755 0.036 0.252 0.291 Mother received medical care at birth 0.990 0.002 10426 9864 1.457 0.002 0.987 0.994 Had diarrhea in the 2 weeks before survey 0.160 0.007 10237 9669 1.731 0.043 0.146 0.173 Treated with oral rehydration salts (ORS) 0.198 0.016 1659 1543 1.501 0.082 0.165 0.230 Taken to a health provider 0.554 0.022 1659 1543 1.634 0.039 0.510 0.597 Vaccination card seen 0.903 0.011 1980 1870 1.567 0.012 0.881 0.924 Received BCG vaccination 0.913 0.009 1980 1870 1.379 0.010 0.895 0.931 Received DPT vaccination (3 doses) 0.974 0.006 1980 1870 1.598 0.006 0.963 0.986 Received polio vaccination (3 doses) 0.980 0.005 1980 1870 1.467 0.005 0.970 0.989 Received measles vaccination 0.943 0.007 1980 1870 1.371 0.008 0.929 0.958 Received all vaccinations (BCG) 0.870 0.010 1980 1870 1.335 0.012 0.849 0.891 Total fertility rate (last 3 years) 3.591 0.064 na 53012 1.387 0.018 3.464 3.719 Neonatal mortality (0-4 years) 13.616 2.234 10520 9970 1.697 0.164 9.148 18.084 Post-neonatal mortality (0-4 years) 5.690 1.213 10475 9938 1.613 0.213 3.264 8.116 Infant mortality (0-4 years) 19.306 2.476 10523 9971 1.646 0.128 14.353 24.259 Child mortality (0-4 years) 2.031 0.597 10323 9763 1.346 0.294 0.837 3.225 Under-five mortality (0-4 years) 21.298 2.600 10536 9982 1.626 0.122 16.097 26.499 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 201 Table B.3 Sampling errors for urban sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 7509 9249 0.000 0.000 1.000 1.000 No education 0.027 0.003 7509 9249 1.428 0.099 0.021 0.032 Secondary education or higher 0.904 0.006 7509 9249 1.722 0.006 0.892 0.916 Currently married 0.952 0.005 7509 9249 1.846 0.005 0.943 0.961 Married before age 20 0.332 0.008 7807 9576 1.665 0.026 0.315 0.349 Currently pregnant 0.070 0.004 13381 15805 1.426 0.063 0.061 0.078 Children ever born 2.165 0.086 13381 15805 1.171 0.040 1.994 2.337 Children surviving 2.106 0.083 13381 15805 1.168 0.039 1.939 2.272 Children ever born to women age 40-49 5.197 0.084 2283 2857 1.540 0.016 5.030 5.365 Knowing any contraceptive method 0.998 0.001 7152 8803 1.503 0.001 0.997 1.000 Ever used any contraceptive method 0.820 0.008 7152 8803 1.705 0.009 0.804 0.835 Currently using any method 0.581 0.009 7152 8803 1.559 0.016 0.562 0.599 Currently using pill 0.087 0.005 7152 8803 1.558 0.060 0.076 0.097 Currently using IUD 0.230 0.007 7152 8803 1.484 0.032 0.215 0.245 Currently using female sterilization 0.037 0.003 7152 8803 1.523 0.092 0.030 0.044 Currently using periodic abstinence 0.042 0.004 7152 8803 1.476 0.083 0.035 0.049 Using public sector source 0.394 0.017 2862 3671 1.822 0.042 0.361 0.428 Want no more children 0.508 0.008 7152 8803 1.350 0.016 0.492 0.524 Want to delay birth at least 2 years 0.253 0.008 7152 8803 1.521 0.031 0.238 0.269 Ideal family size 3.911 0.041 5996 7667 1.759 0.011 3.828 3.993 Mother completely protected against tetanus 0.274 0.011 4563 5417 1.675 0.041 0.252 0.297 Mother received medical care at birth 0.991 0.002 7001 8262 1.426 0.002 0.987 0.995 Had diarrhea in the 2 weeks before survey 0.157 0.008 6879 8096 1.688 0.052 0.140 0.173 Treated with oral rehydration salts (ORS) 0.197 0.019 1100 1269 1.441 0.097 0.159 0.236 Taken to a health provider 0.543 0.026 1100 1269 1.591 0.047 0.492 0.595 Vaccination card seen 0.910 0.012 1323 1564 1.517 0.013 0.885 0.934 Received BCG vaccination 0.927 0.010 1323 1564 1.403 0.011 0.907 0.948 Received DPT vaccination (3 doses) 0.975 0.007 1323 1564 1.560 0.007 0.962 0.989 Received polio vaccination (3 doses) 0.981 0.006 1323 1564 1.444 0.006 0.970 0.992 Received measles vaccination 0.949 0.008 1323 1564 1.358 0.009 0.932 0.966 Received all vaccinations (BCG) 0.890 0.012 1323 1564 1.336 0.013 0.866 0.913 Total fertility rate (last 3 years) 3.571 0.074 na 44166 1.336 0.021 3.423 3.718 Neonatal mortality (0-9 years) 14.921 2.208 13680 15937 1.695 0.148 10.505 19.337 Post-neonatal mortality (0-9 years) 4.722 0.885 13676 15926 1.474 0.187 2.953 6.492 Infant mortality (0-9 years) 19.644 2.311 13688 15940 1.617 0.118 15.022 24.266 Child mortality (0-9 years) 1.931 0.506 13505 15732 1.379 0.262 0.919 2.943 Under-five mortality (0-9 years) 21.537 2.376 13698 15953 1.591 0.110 16.784 26.289 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 202 | Appendix B Table B.4 Sampling errors for rural sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 3367 1627 na na 0.000 0.000 No education 0.104 0.010 3367 1627 1.975 0.100 0.083 0.125 Secondary education or higher 0.791 0.012 3367 1627 1.736 0.015 0.766 0.815 Currently married 0.953 0.005 3367 1627 1.352 0.005 0.944 0.963 Married before age 20 0.335 0.012 3773 1813 1.601 0.035 0.312 0.359 Currently pregnant 0.068 0.005 6569 3157 1.140 0.073 0.058 0.077 Children ever born 2.130 0.124 6569 3157 1.141 0.058 1.882 2.377 Children surviving 2.057 0.119 6569 3157 1.142 0.058 1.819 2.296 Children ever born to women age 40-49 5.855 0.119 1015 499 1.354 0.020 5.617 6.092 Knowing any contraceptive method 0.997 0.001 3208 1551 0.889 0.001 0.996 0.999 Ever used any contraceptive method 0.768 0.011 3208 1551 1.428 0.014 0.746 0.789 Currently using any method 0.516 0.013 3208 1551 1.457 0.025 0.490 0.542 Currently using pill 0.071 0.005 3208 1551 1.107 0.071 0.061 0.081 Currently using IUD 0.182 0.010 3208 1551 1.413 0.053 0.162 0.201 Currently using female sterilization 0.036 0.004 3208 1551 1.241 0.113 0.028 0.044 Currently using periodic abstinence 0.035 0.005 3208 1551 1.523 0.141 0.025 0.045 Using public sector source 0.576 0.022 1092 529 1.439 0.037 0.533 0.619 Want no more children 0.489 0.013 3208 1551 1.420 0.026 0.464 0.514 Want to delay birth at least 2 years 0.284 0.010 3208 1551 1.313 0.037 0.263 0.305 Ideal family size 4.168 0.055 2617 1279 1.641 0.013 4.058 4.278 Mother completely protected against tetanus 0.256 0.014 2162 1029 1.450 0.053 0.229 0.284 Mother received medical care at birth 0.986 0.003 3425 1601 1.211 0.003 0.981 0.992 Had diarrhea in the 2 weeks before survey 0.174 0.009 3358 1572 1.181 0.049 0.157 0.192 Treated with oral rehydration salts (ORS) 0.199 0.023 559 274 1.294 0.115 0.153 0.245 Taken to a health provider 0.603 0.029 559 274 1.271 0.048 0.545 0.661 Vaccination card seen 0.868 0.020 657 306 1.491 0.023 0.827 0.908 Received BCG vaccination 0.839 0.016 657 306 1.066 0.019 0.807 0.870 Received DPT vaccination (3 doses) 0.970 0.008 657 306 1.180 0.008 0.954 0.986 Received polio vaccination (3 doses) 0.972 0.008 657 306 1.197 0.008 0.956 0.988 Received measles vaccination 0.915 0.013 657 306 1.176 0.014 0.889 0.941 Received all vaccinations (BCG) 0.771 0.020 657 306 1.163 0.025 0.732 0.810 Total fertility rate (last 3 years) 3.727 0.080 na 8827 1.162 0.022 3.567 3.888 Neonatal mortality (0-9 years) 13.312 1.687 6690 3127 1.056 0.127 9.938 16.687 Post-neonatal mortality (0-9 years) 9.267 1.694 6644 3107 1.437 0.183 5.879 12.654 Infant mortality (0-9 years) 22.579 2.295 6690 3127 1.174 0.102 17.988 27.170 Child mortality (0-9 years) 4.376 0.974 6564 3063 1.182 0.223 2.428 6.325 Under-five mortality (0-9 years) 26.857 2.466 6696 3130 1.146 0.092 21.925 31.788 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 203 Table B.5 Sampling errors for Central sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.927 0.003 4132 6993 0.705 0.003 0.921 0.932 No education 0.028 0.003 4132 6993 1.256 0.116 0.021 0.034 Secondary education or higher 0.905 0.007 4132 6993 1.531 0.008 0.891 0.919 Currently married 0.952 0.006 4132 6993 1.683 0.006 0.941 0.963 Married before age 20 0.322 0.010 4305 7236 1.466 0.031 0.302 0.342 Currently pregnant 0.069 0.005 7562 11844 1.135 0.072 0.059 0.079 Children ever born 2.142 0.088 7562 11844 0.818 0.041 1.967 2.318 Children surviving 2.088 0.085 7562 11844 0.812 0.041 1.918 2.258 Children ever born to women age 40-49 5.080 0.098 1267 2170 1.377 0.019 4.884 5.275 Knowing any contraceptive method 0.998 0.001 3929 6658 1.253 0.001 0.996 1.000 Ever used any contraceptive method 0.814 0.010 3929 6658 1.569 0.012 0.794 0.833 Currently using any method 0.584 0.011 3929 6658 1.419 0.019 0.562 0.607 Currently using pill 0.093 0.006 3929 6658 1.368 0.068 0.080 0.105 Currently using IUD 0.233 0.009 3929 6658 1.342 0.039 0.215 0.251 Currently using female sterilization 0.037 0.004 3929 6658 1.396 0.113 0.029 0.046 Currently using periodic abstinence 0.041 0.004 3929 6658 1.340 0.104 0.032 0.049 Using public sector source 0.361 0.020 1564 2827 1.625 0.055 0.322 0.401 Want no more children 0.516 0.010 3929 6658 1.206 0.019 0.497 0.535 Want to delay birth at least 2 years 0.241 0.009 3929 6658 1.354 0.038 0.223 0.260 Ideal family size 3.872 0.050 3297 5872 1.568 0.013 3.771 3.972 Mother completely protected against tetanus 0.243 0.014 2450 3987 1.559 0.056 0.216 0.271 Mother received medical care at birth 0.991 0.002 3786 6127 1.149 0.002 0.987 0.995 Had diarrhea in the 2 weeks before survey 0.133 0.010 3720 6003 1.585 0.073 0.114 0.152 Treated with oral rehydration salts (ORS) 0.239 0.029 430 798 1.372 0.120 0.182 0.296 Taken to a health provider 0.542 0.037 430 798 1.548 0.068 0.468 0.617 Vaccination card seen 0.914 0.015 700 1165 1.419 0.017 0.884 0.944 Received BCG vaccination 0.934 0.012 700 1165 1.292 0.013 0.909 0.959 Received DPT vaccination (3 doses) 0.975 0.009 700 1165 1.464 0.009 0.958 0.992 Received polio vaccination (3 doses) 0.983 0.007 700 1165 1.400 0.007 0.970 0.997 Received measles vaccination 0.949 0.011 700 1165 1.252 0.011 0.928 0.970 Received all vaccinations (BCG) 0.892 0.014 700 1165 1.214 0.016 0.863 0.921 Total fertility rate (last 3 years) 3.503 0.087 na 33249 1.146 0.025 3.329 3.678 Neonatal mortality (0-9 years) 14.361 2.797 7411 11829 1.537 0.195 8.768 19.954 Post-neonatal mortality (0-9 years) 4.573 1.112 7399 11807 1.406 0.243 2.349 6.797 Infant mortality (0-9 years) 18.934 2.914 7412 11830 1.482 0.154 13.106 24.762 Child mortality (0-9 years) 1.829 0.623 7290 11669 1.280 0.341 0.582 3.076 Under-five mortality (0-9 years) 20.728 2.986 7418 11840 1.446 0.144 14.755 26.700 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 204 | Appendix B Table B.6 Sampling errors for North sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.756 0.006 3490 2975 0.871 0.008 0.744 0.769 No education 0.044 0.006 3490 2975 1.727 0.136 0.032 0.056 Secondary education or higher 0.874 0.009 3490 2975 1.651 0.011 0.856 0.893 Currently married 0.951 0.006 3490 2975 1.600 0.006 0.939 0.963 Married before age 20 0.357 0.013 3646 3137 1.757 0.037 0.331 0.384 Currently pregnant 0.070 0.007 6403 5382 1.549 0.093 0.057 0.083 Children ever born 2.202 0.148 6403 5382 1.499 0.067 1.905 2.499 Children surviving 2.130 0.144 6403 5382 1.502 0.067 1.842 2.417 Children ever born to women age 40-49 5.716 0.135 1000 885 1.522 0.024 5.446 5.987 Knowing any contraceptive method 1.000 0.000 3330 2830 0.685 0.000 0.999 1.000 Ever used any contraceptive method 0.814 0.009 3330 2830 1.335 0.011 0.796 0.832 Currently using any method 0.552 0.012 3330 2830 1.400 0.022 0.528 0.577 Currently using pill 0.064 0.006 3330 2830 1.522 0.100 0.052 0.077 Currently using IUD 0.212 0.010 3330 2830 1.357 0.045 0.193 0.231 Currently using female sterilization 0.034 0.004 3330 2830 1.350 0.124 0.026 0.043 Currently using periodic abstinence 0.039 0.005 3330 2830 1.497 0.129 0.029 0.049 Using public sector source 0.492 0.024 1239 1048 1.664 0.048 0.445 0.540 Want no more children 0.472 0.012 3330 2830 1.381 0.025 0.448 0.496 Want to delay birth at least 2 years 0.296 0.012 3330 2830 1.509 0.040 0.272 0.320 Ideal family size 4.132 0.056 2663 2318 1.643 0.014 4.019 4.245 Mother completely protected against tetanus 0.328 0.015 2241 1894 1.535 0.047 0.298 0.359 Mother received medical care at birth 0.990 0.004 3476 2864 1.739 0.004 0.982 0.997 Had diarrhea in the 2 weeks before survey 0.205 0.012 3415 2811 1.571 0.058 0.181 0.229 Treated with oral rehydration salts (ORS) 0.150 0.018 646 576 1.190 0.117 0.115 0.185 Taken to a health provider 0.552 0.027 646 576 1.322 0.048 0.498 0.605 Vaccination card seen 0.880 0.017 655 535 1.328 0.020 0.845 0.914 Received BCG vaccination 0.939 0.013 655 535 1.395 0.014 0.912 0.966 Received DPT vaccination (3 doses) 0.979 0.007 655 535 1.238 0.007 0.965 0.993 Received polio vaccination (3 doses) 0.979 0.007 655 535 1.238 0.007 0.965 0.993 Received measles vaccination 0.949 0.011 655 535 1.207 0.011 0.928 0.970 Received all vaccinations (BCG) 0.896 0.016 655 535 1.297 0.018 0.865 0.928 Total fertility rate (last 3 years) 3.809 0.106 na 14906 1.377 0.028 3.598 4.021 Neonatal mortality (0-9 years) 14.088 2.326 6756 5524 1.472 0.165 9.435 18.740 Post-neonatal mortality (0-9 years) 6.463 1.303 6737 5521 1.282 0.202 3.857 9.069 Infant mortality (0-9 years) 20.551 2.627 6758 5525 1.403 0.128 15.297 25.805 Child mortality (0-9 years) 2.408 0.719 6640 5434 1.153 0.298 0.970 3.845 Under-five mortality (0-9 years) 22.909 2.763 6765 5531 1.404 0.121 17.383 28.435 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 205 Table B.7 Sampling errors for South sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.572 0.010 3254 908 1.123 0.017 0.552 0.591 No education 0.099 0.009 3254 908 1.762 0.093 0.081 0.118 Secondary education or higher 0.794 0.014 3254 908 1.949 0.017 0.767 0.822 Currently married 0.955 0.004 3254 908 1.067 0.004 0.947 0.963 Married before age 20 0.330 0.011 3638 1013 1.444 0.033 0.308 0.351 Currently pregnant 0.069 0.005 6248 1742 1.082 0.067 0.060 0.078 Children ever born 2.134 0.113 6248 1742 1.078 0.053 1.907 2.361 Children surviving 2.056 0.109 6248 1742 1.079 0.053 1.837 2.274 Children ever born to women age 40-49 5.749 0.120 1033 293 1.374 0.021 5.510 5.988 Knowing any contraceptive method 0.997 0.001 3101 867 0.946 0.001 0.995 0.999 Ever used any contraceptive method 0.794 0.009 3101 867 1.174 0.011 0.777 0.811 Currently using any method 0.530 0.012 3101 867 1.387 0.023 0.505 0.555 Currently using pill 0.087 0.006 3101 867 1.263 0.074 0.074 0.100 Currently using IUD 0.177 0.009 3101 867 1.365 0.053 0.159 0.196 Currently using female sterilization 0.046 0.004 3101 867 1.056 0.086 0.038 0.054 Currently using periodic abstinence 0.051 0.005 3101 867 1.226 0.095 0.041 0.060 Using public sector source 0.665 0.019 1151 324 1.371 0.029 0.627 0.703 Want no more children 0.529 0.010 3101 867 1.133 0.019 0.509 0.549 Want to delay birth at least 2 years 0.263 0.010 3101 867 1.214 0.036 0.244 0.282 Ideal family size 3.971 0.038 2653 757 1.206 0.009 3.896 4.047 Mother completely protected against tetanus 0.276 0.013 2034 564 1.329 0.048 0.250 0.302 Mother received medical care at birth 0.986 0.003 3164 873 1.163 0.003 0.981 0.992 Had diarrhea in the 2 weeks before survey 0.197 0.009 3102 854 1.166 0.046 0.179 0.215 Treated with oral rehydration salts (ORS) 0.167 0.019 583 168 1.159 0.111 0.130 0.205 Taken to a health provider 0.615 0.022 583 168 1.026 0.036 0.571 0.659 Vaccination card seen 0.898 0.015 625 170 1.181 0.016 0.869 0.927 Received BCG vaccination 0.688 0.025 625 170 1.327 0.037 0.638 0.739 Received DPT vaccination (3 doses) 0.955 0.010 625 170 1.174 0.011 0.935 0.975 Received polio vaccination (3 doses) 0.958 0.010 625 170 1.199 0.011 0.937 0.978 Received measles vaccination 0.890 0.014 625 170 1.091 0.016 0.862 0.918 Received all vaccinations (BCG) 0.635 0.025 625 170 1.271 0.039 0.585 0.686 Total fertility rate (last 3 years) 3.612 0.087 na 4865 1.111 0.024 3.438 3.785 Neonatal mortality (0-9 years) 18.556 2.335 6203 1711 1.207 0.126 13.886 23.227 Post-neonatal mortality (0-9 years) 8.397 1.212 6184 1705 1.014 0.144 5.974 10.821 Infant mortality (0-9 years) 26.954 2.487 6208 1712 1.090 0.092 21.980 31.928 Child mortality (0-9 years) 5.572 1.189 6139 1691 1.199 0.213 3.194 7.950 Under-five mortality (0-9 years) 32.376 2.687 6211 1712 1.084 0.083 27.001 37.750 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 206 | Appendix B Table B.8 Sampling errors for Amman sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.950 0.002 1341 4442 0.415 0.003 0.945 0.955 No education 0.023 0.004 1341 4442 1.068 0.189 0.014 0.032 Secondary education or higher 0.915 0.010 1341 4442 1.280 0.011 0.895 0.934 Currently married 0.955 0.008 1341 4442 1.413 0.008 0.939 0.971 Married before age 20 0.315 0.015 1386 4600 1.225 0.047 0.285 0.344 Currently pregnant 0.066 0.007 2654 7593 0.884 0.105 0.053 0.080 Children ever born 2.053 0.121 2654 7593 0.603 0.059 1.811 2.295 Children surviving 1.995 0.117 2654 7593 0.598 0.058 1.761 2.228 Children ever born to women age 40-49 4.964 0.142 406 1362 1.136 0.029 4.679 5.248 Knowing any contraceptive method 0.998 0.001 1277 4242 1.074 0.001 0.995 1.001 Ever used any contraceptive method 0.833 0.014 1277 4242 1.344 0.017 0.805 0.861 Currently using any method 0.590 0.016 1277 4242 1.166 0.027 0.558 0.622 Currently using pill 0.094 0.009 1277 4242 1.133 0.098 0.076 0.113 Currently using IUD 0.233 0.013 1277 4242 1.077 0.055 0.207 0.258 Currently using female sterilization 0.041 0.006 1277 4242 1.134 0.155 0.028 0.053 Currently using periodic abstinence 0.043 0.006 1277 4242 1.101 0.145 0.031 0.056 Using public sector source 0.302 0.027 512 1808 1.340 0.090 0.247 0.356 Want no more children 0.509 0.013 1277 4242 0.964 0.026 0.483 0.536 Want to delay birth at least 2 years 0.227 0.013 1277 4242 1.148 0.059 0.200 0.254 Ideal family size 3.756 0.071 1174 3929 1.273 0.019 3.614 3.898 Mother completely protected against tetanus 0.228 0.020 775 2469 1.327 0.089 0.187 0.269 Mother received medical care at birth 0.992 0.003 1199 3784 0.982 0.003 0.987 0.997 Had diarrhea in the 2 weeks before survey 0.157 0.015 1173 3692 1.292 0.095 0.127 0.186 Treated with oral rehydration salts (ORS) 0.254 0.038 185 578 1.084 0.149 0.178 0.329 Taken to a health provider 0.530 0.048 185 578 1.243 0.091 0.433 0.627 Vaccination card seen 0.885 0.022 243 755 1.065 0.025 0.840 0.930 Received BCG vaccination 0.948 0.017 243 755 1.125 0.018 0.914 0.981 Received DPT vaccination (3 doses) 0.967 0.013 243 755 1.097 0.013 0.941 0.993 Received polio vaccination (3 doses) 0.980 0.010 243 755 1.068 0.010 0.960 1.000 Received measles vaccination 0.943 0.015 243 755 0.981 0.016 0.913 0.973 Received all vaccinations (BCG) 0.900 0.020 243 755 0.997 0.022 0.861 0.940 Total fertility rate (last 3 years) 3.358 0.119 na 21865 0.935 0.035 3.121 3.596 Neonatal mortality (0-9 years) 17.504 4.456 2278 7185 1.188 0.255 8.591 26.417 Post-neonatal mortality (0-9 years) 4.889 1.729 2265 7161 1.154 0.354 1.430 8.348 Infant mortality (0-9 years) 22.393 4.606 2278 7185 1.152 0.206 13.182 31.604 Child mortality (0-9 years) 1.877 0.965 2241 7071 1.071 0.514 0.000 3.807 Under-five mortality (0-9 years) 24.228 4.711 2280 7193 1.124 0.194 14.806 33.650 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 207 Table B.9 Sampling errors for Balqa sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.755 0.018 822 645 1.169 0.023 0.720 0.790 No education 0.064 0.012 822 645 1.456 0.195 0.039 0.089 Secondary education or higher 0.849 0.021 822 645 1.679 0.025 0.807 0.891 Currently married 0.961 0.008 822 645 1.115 0.008 0.946 0.976 Married before age 20 0.283 0.016 912 718 1.127 0.057 0.250 0.315 Currently pregnant 0.069 0.007 1509 1153 0.974 0.106 0.054 0.084 Children ever born 2.191 0.168 1509 1153 1.070 0.077 1.854 2.527 Children surviving 2.128 0.163 1509 1153 1.071 0.077 1.801 2.454 Children ever born to women age 40-49 5.280 0.181 267 210 1.152 0.034 4.918 5.642 Knowing any contraceptive method 0.998 0.001 789 620 0.913 0.001 0.995 1.001 Ever used any contraceptive method 0.785 0.018 789 620 1.211 0.023 0.749 0.820 Currently using any method 0.546 0.021 789 620 1.189 0.039 0.504 0.588 Currently using pill 0.071 0.009 789 620 1.030 0.133 0.052 0.090 Currently using IUD 0.192 0.015 789 620 1.047 0.077 0.163 0.221 Currently using female sterilization 0.051 0.008 789 620 1.082 0.166 0.034 0.068 Currently using periodic abstinence 0.065 0.009 789 620 1.065 0.144 0.046 0.084 Using public sector source 0.537 0.036 290 229 1.242 0.068 0.464 0.610 Want no more children 0.509 0.022 789 620 1.211 0.042 0.466 0.552 Want to delay birth at least 2 years 0.247 0.015 789 620 0.961 0.060 0.217 0.276 Ideal family size 4.169 0.078 622 489 1.246 0.019 4.013 4.325 Mother completely protected against tetanus 0.277 0.023 506 396 1.170 0.084 0.230 0.324 Mother received medical care at birth 0.989 0.005 786 615 1.070 0.005 0.979 1.000 Had diarrhea in the 2 weeks before survey 0.114 0.015 773 605 1.150 0.129 0.085 0.144 Treated with oral rehydration salts (ORS) 0.248 0.051 91 69 1.012 0.208 0.145 0.351 Taken to a health provider 0.527 0.051 91 69 0.885 0.097 0.425 0.628 Vaccination card seen 0.962 0.016 136 108 0.974 0.017 0.930 0.994 Received BCG vaccination 0.925 0.025 136 108 1.131 0.027 0.874 0.976 Received DPT vaccination (3 doses) 1.000 0.000 136 108 na 0.000 1.000 1.000 Received polio vaccination (3 doses) 1.000 0.000 136 108 na 0.000 1.000 1.000 Received measles vaccination 0.962 0.016 136 108 0.991 0.017 0.930 0.995 Received all vaccinations (BCG) 0.896 0.028 136 108 1.067 0.031 0.840 0.951 Total fertility rate (last 3 years) 3.665 0.148 na 3217 0.996 0.040 3.370 3.960 Neonatal mortality (0-9 years) 13.595 3.173 1559 1219 0.913 0.233 7.248 19.942 Post-neonatal mortality (0-9 years) 4.898 1.883 1558 1220 1.095 0.384 1.132 8.664 Infant mortality (0-9 years) 18.493 3.728 1560 1220 0.981 0.202 11.036 25.950 Child mortality (0-9 years) 5.605 2.054 1531 1200 0.996 0.366 1.498 9.712 Under-five mortality (0-9 years) 23.994 4.288 1562 1221 1.019 0.179 15.418 32.571 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 208 | Appendix B Table B.10 Sampling errors for Zarqa sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.964 0.004 1076 1645 0.744 0.004 0.956 0.973 No education 0.020 0.004 1076 1645 1.029 0.221 0.011 0.028 Secondary education or higher 0.909 0.011 1076 1645 1.224 0.012 0.887 0.930 Currently married 0.941 0.009 1076 1645 1.288 0.010 0.923 0.960 Married before age 20 0.361 0.014 1068 1641 0.996 0.039 0.333 0.389 Currently pregnant 0.076 0.008 1847 2655 0.979 0.111 0.059 0.093 Children ever born 2.362 0.163 1847 2655 0.803 0.069 2.036 2.689 Children surviving 2.324 0.160 1847 2655 0.802 0.069 2.003 2.645 Children ever born to women age 40-49 5.292 0.147 332 521 1.076 0.028 4.998 5.586 Knowing any contraceptive method 0.999 0.001 1015 1548 1.058 0.001 0.997 1.001 Ever used any contraceptive method 0.786 0.015 1015 1548 1.200 0.020 0.755 0.817 Currently using any method 0.592 0.017 1015 1548 1.113 0.029 0.558 0.626 Currently using pill 0.097 0.009 1015 1548 0.943 0.090 0.080 0.115 Currently using IUD 0.256 0.016 1015 1548 1.168 0.062 0.224 0.288 Currently using female sterilization 0.023 0.004 1015 1548 0.952 0.196 0.014 0.032 Currently using periodic abstinence 0.022 0.004 1015 1548 0.968 0.202 0.013 0.031 Using public sector source 0.455 0.031 442 696 1.300 0.068 0.393 0.517 Want no more children 0.540 0.016 1015 1548 1.014 0.029 0.508 0.572 Want to delay birth at least 2 years 0.267 0.013 1015 1548 0.965 0.050 0.240 0.294 Ideal family size 4.148 0.063 809 1249 1.101 0.015 4.021 4.274 Mother completely protected against tetanus 0.260 0.020 633 966 1.164 0.078 0.219 0.300 Mother received medical care at birth 0.990 0.004 974 1486 1.010 0.004 0.983 0.997 Had diarrhea in the 2 weeks before survey 0.089 0.010 965 1469 0.962 0.108 0.070 0.108 Treated with oral rehydration salts (ORS) 0.169 0.044 86 131 1.026 0.261 0.081 0.257 Taken to a health provider 0.605 0.070 86 131 1.206 0.116 0.464 0.745 Vaccination card seen 0.969 0.017 175 260 1.309 0.018 0.934 1.004 Received BCG vaccination 0.906 0.025 175 260 1.052 0.028 0.856 0.956 Received DPT vaccination (3 doses) 0.987 0.009 175 260 1.065 0.009 0.968 1.006 Received polio vaccination (3 doses) 0.987 0.009 175 260 1.065 0.009 0.968 1.006 Received measles vaccination 0.958 0.016 175 260 1.025 0.016 0.926 0.990 Received all vaccinations (BCG) 0.873 0.027 175 260 1.026 0.031 0.819 0.928 Total fertility rate (last 3 years) 3.778 0.174 na 7388 1.032 0.046 3.431 4.125 Neonatal mortality (0-9 years) 7.434 2.308 1923 2942 1.180 0.310 2.818 12.050 Post-neonatal mortality (0-9 years) 2.717 1.213 1923 2943 1.057 0.447 0.290 5.143 Infant mortality (0-9 years) 10.150 2.636 1923 2942 1.194 0.260 4.878 15.422 Child mortality (0-9 years) 0.000 0.000 1912 2930 na na 0.000 0.000 Under-five mortality (0-9 years) 10.150 2.636 1923 2942 1.194 0.260 4.878 15.422 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 209 Table B.11 Sampling errors for Madaba sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.713 0.013 893 262 0.835 0.018 0.688 0.739 No education 0.068 0.011 893 262 1.329 0.164 0.046 0.091 Secondary education or higher 0.842 0.017 893 262 1.354 0.020 0.808 0.875 Currently married 0.948 0.009 893 262 1.174 0.009 0.931 0.966 Married before age 20 0.317 0.013 952 279 0.920 0.042 0.290 0.344 Currently pregnant 0.064 0.007 1628 476 0.938 0.115 0.049 0.079 Children ever born 2.083 0.172 1628 476 0.868 0.082 1.740 2.427 Children surviving 2.029 0.168 1628 476 0.872 0.083 1.693 2.365 Children ever born to women age 40-49 5.084 0.174 267 78 1.069 0.034 4.736 5.431 Knowing any contraceptive method 0.987 0.005 848 248 1.204 0.005 0.977 0.996 Ever used any contraceptive method 0.728 0.018 848 248 1.165 0.024 0.693 0.764 Currently using any method 0.530 0.019 848 248 1.101 0.036 0.493 0.568 Currently using pill 0.090 0.010 848 248 1.045 0.114 0.069 0.110 Currently using IUD 0.204 0.015 848 248 1.057 0.072 0.175 0.233 Currently using female sterilization 0.033 0.006 848 248 1.020 0.191 0.020 0.045 Currently using periodic abstinence 0.047 0.007 848 248 0.987 0.152 0.033 0.062 Using public sector source 0.374 0.033 320 94 1.217 0.088 0.308 0.440 Want no more children 0.501 0.018 848 248 1.021 0.035 0.466 0.536 Want to delay birth at least 2 years 0.306 0.016 848 248 1.031 0.053 0.273 0.339 Ideal family size 3.702 0.103 692 204 1.407 0.028 3.496 3.907 Mother completely protected against tetanus 0.306 0.024 536 157 1.224 0.080 0.258 0.355 Mother received medical care at birth 0.996 0.002 827 242 1.067 0.002 0.991 1.001 Had diarrhea in the 2 weeks before survey 0.086 0.012 809 237 1.091 0.139 0.062 0.109 Treated with oral rehydration salts (ORS) 0.221 0.057 68 20 1.069 0.256 0.108 0.335 Taken to a health provider 0.552 0.070 68 20 1.065 0.128 0.411 0.692 Vaccination card seen 0.968 0.014 146 43 0.961 0.015 0.940 0.996 Received BCG vaccination 0.881 0.026 146 43 0.962 0.029 0.829 0.932 Received DPT vaccination (3 doses) 0.987 0.009 146 43 0.980 0.009 0.968 1.005 Received polio vaccination (3 doses) 0.987 0.009 146 43 0.980 0.009 0.968 1.005 Received measles vaccination 0.954 0.019 146 43 1.072 0.020 0.917 0.991 Received all vaccinations (BCG) 0.862 0.030 146 43 1.051 0.035 0.801 0.922 Total fertility rate (last 3 years) 3.571 0.157 na 1404 0.989 0.044 3.257 3.885 Neonatal mortality (0-9 years) 11.821 3.135 1651 483 0.943 0.265 5.550 18.091 Post-neonatal mortality (0-9 years) 10.462 2.759 1653 484 1.101 0.264 4.944 15.979 Infant mortality (0-9 years) 22.282 4.248 1651 483 1.049 0.191 13.786 30.778 Child mortality (0-9 years) 3.084 1.369 1606 469 0.972 0.444 0.346 5.822 Under-five mortality (0-9 years) 25.298 4.607 1653 484 1.055 0.182 16.084 34.512 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 210 | Appendix B Table B.12 Sampling errors for Irbid sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.853 0.008 896 1993 0.692 0.010 0.837 0.870 No education 0.031 0.008 896 1993 1.334 0.248 0.016 0.047 Secondary education or higher 0.899 0.013 896 1993 1.264 0.014 0.873 0.924 Currently married 0.949 0.008 896 1993 1.154 0.009 0.932 0.966 Married before age 20 0.346 0.019 952 2118 1.284 0.054 0.309 0.384 Currently pregnant 0.070 0.009 1616 3598 1.100 0.130 0.052 0.088 Children ever born 2.165 0.198 1616 3598 1.033 0.091 1.769 2.560 Children surviving 2.096 0.192 1616 3598 1.035 0.091 1.713 2.479 Children ever born to women age 40-49 5.514 0.185 276 619 1.116 0.033 5.145 5.884 Knowing any contraceptive method 1.000 0.000 851 1892 0.000 0.000 1.000 1.000 Ever used any contraceptive method 0.826 0.013 851 1892 0.978 0.015 0.801 0.851 Currently using any method 0.562 0.017 851 1892 1.010 0.031 0.527 0.596 Currently using pill 0.064 0.009 851 1892 1.121 0.147 0.045 0.082 Currently using IUD 0.215 0.014 851 1892 0.970 0.064 0.188 0.242 Currently using female sterilization 0.035 0.006 851 1892 0.976 0.177 0.022 0.047 Currently using periodic abstinence 0.047 0.007 851 1892 1.013 0.157 0.032 0.061 Using public sector source 0.511 0.034 318 710 1.193 0.066 0.444 0.578 Want no more children 0.482 0.017 851 1892 1.000 0.036 0.448 0.517 Want to delay birth at least 2 years 0.285 0.017 851 1892 1.110 0.060 0.250 0.319 Ideal family size 4.068 0.080 713 1579 1.183 0.020 3.907 4.229 Mother completely protected against tetanus 0.339 0.022 564 1261 1.110 0.065 0.295 0.384 Mother received medical care at birth 0.990 0.006 832 1861 1.225 0.006 0.979 1.001 Had diarrhea in the 2 weeks before survey 0.216 0.018 817 1826 1.150 0.082 0.181 0.251 Treated with oral rehydration salts (ORS) 0.138 0.023 177 395 0.860 0.168 0.092 0.184 Taken to a health provider 0.521 0.037 177 395 0.954 0.072 0.446 0.595 Vaccination card seen 0.877 0.025 156 348 0.951 0.029 0.827 0.927 Received BCG vaccination 0.953 0.019 156 348 1.116 0.020 0.915 0.991 Received DPT vaccination (3 doses) 0.987 0.010 156 348 1.059 0.010 0.967 1.006 Received polio vaccination (3 doses) 0.987 0.010 156 348 1.059 0.010 0.967 1.006 Received measles vaccination 0.968 0.014 156 348 1.015 0.015 0.939 0.997 Received all vaccinations (BCG) 0.924 0.022 156 348 1.038 0.024 0.880 0.968 Total fertility rate (last 3 years) 3.779 0.148 na 9933 1.021 0.039 3.482 4.076 Neonatal mortality (0-9 years) 14.485 3.487 1599 3565 1.075 0.241 7.511 21.459 Post-neonatal mortality (0-9 years) 4.381 1.812 1599 3568 1.096 0.414 0.758 8.005 Infant mortality (0-9 years) 18.866 3.903 1599 3565 1.058 0.207 11.060 26.672 Child mortality (0-9 years) 1.779 1.016 1575 3514 0.942 0.571 0.000 3.810 Under-five mortality (0-9 years) 20.611 4.092 1601 3569 1.069 0.199 12.426 28.796 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 211 Table B.13 Sampling errors for Mafraq sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.418 0.012 886 460 0.744 0.030 0.393 0.442 No education 0.109 0.018 886 460 1.729 0.167 0.072 0.145 Secondary education or higher 0.746 0.021 886 460 1.460 0.029 0.703 0.788 Currently married 0.958 0.006 886 460 0.869 0.006 0.946 0.969 Married before age 20 0.397 0.018 904 469 1.160 0.045 0.361 0.432 Currently pregnant 0.072 0.008 1556 818 1.037 0.110 0.056 0.088 Children ever born 2.309 0.156 1556 818 0.951 0.068 1.997 2.620 Children surviving 2.223 0.151 1556 818 0.955 0.068 1.922 2.525 Children ever born to women age 40-49 6.246 0.208 239 123 1.100 0.033 5.830 6.662 Knowing any contraceptive method 0.999 0.001 849 441 0.953 0.001 0.997 1.001 Ever used any contraceptive method 0.768 0.016 849 441 1.078 0.020 0.736 0.799 Currently using any method 0.495 0.020 849 441 1.152 0.040 0.455 0.534 Currently using pill 0.074 0.008 849 441 0.858 0.104 0.059 0.090 Currently using IUD 0.172 0.014 849 441 1.105 0.083 0.143 0.200 Currently using female sterilization 0.020 0.005 849 441 1.031 0.249 0.010 0.030 Currently using periodic abstinence 0.024 0.005 849 441 1.037 0.227 0.013 0.035 Using public sector source 0.492 0.040 274 142 1.316 0.081 0.412 0.572 Want no more children 0.435 0.017 849 441 0.993 0.039 0.401 0.469 Want to delay birth at least 2 years 0.316 0.016 849 441 1.028 0.052 0.283 0.348 Ideal family size 4.245 0.074 668 347 1.092 0.017 4.098 4.392 Mother completely protected against tetanus 0.195 0.019 575 298 1.152 0.098 0.157 0.233 Mother received medical care at birth 0.982 0.006 924 479 1.268 0.006 0.970 0.993 Had diarrhea in the 2 weeks before survey 0.199 0.016 902 468 1.087 0.082 0.167 0.232 Treated with oral rehydration salts (ORS) 0.154 0.036 180 93 1.127 0.234 0.082 0.226 Taken to a health provider 0.644 0.040 180 93 1.045 0.063 0.563 0.725 Vaccination card seen 0.861 0.029 166 85 1.062 0.033 0.803 0.918 Received BCG vaccination 0.902 0.026 166 85 1.128 0.029 0.849 0.954 Received DPT vaccination (3 doses) 0.966 0.015 166 85 1.036 0.015 0.936 0.995 Received polio vaccination (3 doses) 0.966 0.015 166 85 1.036 0.015 0.936 0.995 Received measles vaccination 0.905 0.025 166 85 1.067 0.027 0.856 0.954 Received all vaccinations (BCG) 0.823 0.031 166 85 1.034 0.038 0.761 0.885 Total fertility rate (last 3 years) 3.970 0.182 na 2327 1.055 0.046 3.605 4.335 Neonatal mortality (0-9 years) 15.314 2.765 1809 938 0.937 0.181 9.785 20.844 Post-neonatal mortality (0-9 years) 14.352 2.518 1803 935 0.903 0.175 9.317 19.388 Infant mortality (0-9 years) 29.667 3.315 1809 938 0.831 0.112 23.036 36.298 Child mortality (0-9 years) 2.331 1.069 1774 918 0.980 0.459 0.192 4.469 Under-five mortality (0-9 years) 31.928 3.379 1811 939 0.829 0.106 25.170 38.687 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 212 | Appendix B Table B.14 Sampling errors for Jarash sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.631 0.012 860 293 0.735 0.019 0.607 0.655 No education 0.041 0.008 860 293 1.144 0.188 0.026 0.057 Secondary education or higher 0.876 0.011 860 293 1.017 0.013 0.853 0.899 Currently married 0.950 0.009 860 293 1.157 0.009 0.932 0.967 Married before age 20 0.380 0.018 903 308 1.169 0.046 0.345 0.415 Currently pregnant 0.066 0.006 1598 542 0.879 0.093 0.054 0.078 Children ever born 2.248 0.167 1598 542 1.104 0.074 1.915 2.581 Children surviving 2.181 0.160 1598 542 1.096 0.073 1.861 2.501 Children ever born to women age 40-49 6.119 0.235 231 79 1.151 0.038 5.649 6.589 Knowing any contraceptive method 1.000 0.000 817 278 na 0.000 1.000 1.000 Ever used any contraceptive method 0.796 0.015 817 278 1.092 0.019 0.765 0.827 Currently using any method 0.557 0.017 817 278 0.995 0.031 0.522 0.592 Currently using pill 0.073 0.009 817 278 0.995 0.124 0.055 0.091 Currently using IUD 0.197 0.016 817 278 1.171 0.083 0.165 0.230 Currently using female sterilization 0.051 0.007 817 278 0.960 0.145 0.036 0.066 Currently using periodic abstinence 0.019 0.005 817 278 0.972 0.247 0.009 0.028 Using public sector source 0.428 0.033 315 107 1.165 0.076 0.363 0.493 Want no more children 0.468 0.019 817 278 1.072 0.040 0.431 0.506 Want to delay birth at least 2 years 0.318 0.017 817 278 1.038 0.053 0.284 0.351 Ideal family size 4.252 0.065 654 223 1.068 0.015 4.121 4.383 Mother completely protected against tetanus 0.367 0.021 543 185 1.004 0.057 0.326 0.409 Mother received medical care at birth 0.993 0.004 851 290 1.118 0.004 0.985 1.000 Had diarrhea in the 2 weeks before survey 0.178 0.017 841 287 1.189 0.095 0.144 0.211 Treated with oral rehydration salts (ORS) 0.211 0.041 150 51 1.160 0.192 0.130 0.292 Taken to a health provider 0.674 0.044 150 51 1.079 0.065 0.586 0.762 Vaccination card seen 0.915 0.023 171 59 1.087 0.025 0.869 0.962 Received BCG vaccination 0.891 0.024 171 59 0.993 0.027 0.844 0.938 Received DPT vaccination (3 doses) 0.983 0.010 171 59 1.010 0.010 0.963 1.003 Received polio vaccination (3 doses) 0.983 0.010 171 59 1.010 0.010 0.963 1.003 Received measles vaccination 0.941 0.017 171 59 0.943 0.018 0.906 0.975 Received all vaccinations (BCG) 0.850 0.030 171 59 1.089 0.035 0.790 0.909 Total fertility rate (last 3 years) 3.771 0.136 na 1549 0.989 0.036 3.499 4.044 Neonatal mortality (0-9 years) 11.618 2.711 1669 570 0.955 0.233 6.197 17.040 Post-neonatal mortality (0-9 years) 4.700 1.594 1663 568 0.960 0.339 1.512 7.889 Infant mortality (0-9 years) 16.319 3.243 1669 570 1.000 0.199 9.833 22.805 Child mortality (0-9 years) 3.773 1.495 1618 552 0.969 0.396 0.783 6.764 Under-five mortality (0-9 years) 20.031 3.622 1671 571 1.017 0.181 12.786 27.276 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 213 Table B.15 Sampling errors for Ajloun sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.752 0.010 848 228 0.650 0.013 0.733 0.771 No education 0.028 0.005 848 228 0.939 0.188 0.018 0.039 Secondary education or higher 0.915 0.010 848 228 1.097 0.011 0.894 0.936 Currently married 0.958 0.007 848 228 1.046 0.008 0.943 0.972 Married before age 20 0.345 0.016 903 243 1.076 0.047 0.312 0.377 Currently pregnant 0.077 0.008 1561 418 0.891 0.110 0.060 0.094 Children ever born 2.285 0.214 1561 418 0.908 0.094 1.857 2.713 Children surviving 2.206 0.206 1561 418 0.908 0.094 1.793 2.619 Children ever born to women age 40-49 6.095 0.178 242 65 0.989 0.029 5.739 6.452 Knowing any contraceptive method 0.999 0.001 813 218 0.999 0.001 0.996 1.001 Ever used any contraceptive method 0.823 0.014 813 218 1.054 0.017 0.794 0.851 Currently using any method 0.584 0.015 813 218 0.883 0.026 0.553 0.614 Currently using pill 0.041 0.007 813 218 1.027 0.175 0.027 0.055 Currently using IUD 0.285 0.015 813 218 0.958 0.053 0.254 0.315 Currently using female sterilization 0.040 0.007 813 218 0.985 0.169 0.026 0.054 Currently using periodic abstinence 0.029 0.007 813 218 1.174 0.238 0.015 0.043 Using public sector source 0.422 0.028 332 89 1.016 0.065 0.367 0.477 Want no more children 0.463 0.016 813 218 0.938 0.035 0.430 0.496 Want to delay birth at least 2 years 0.329 0.016 813 218 0.978 0.049 0.297 0.361 Ideal family size 4.344 0.074 628 169 1.138 0.017 4.197 4.492 Mother completely protected against tetanus 0.454 0.023 559 150 1.099 0.051 0.407 0.500 Mother received medical care at birth 0.997 0.002 869 233 1.235 0.002 0.992 1.002 Had diarrhea in the 2 weeks before survey 0.162 0.015 855 230 1.115 0.096 0.131 0.193 Treated with oral rehydration salts (ORS) 0.180 0.037 139 37 0.996 0.206 0.106 0.254 Taken to a health provider 0.480 0.044 139 37 0.941 0.092 0.392 0.568 Vaccination card seen 0.888 0.028 162 43 1.129 0.032 0.832 0.945 Received BCG vaccination 0.963 0.015 162 43 0.999 0.015 0.933 0.993 Received DPT vaccination (3 doses) 0.943 0.018 162 43 0.980 0.019 0.907 0.979 Received polio vaccination (3 doses) 0.943 0.018 162 43 0.980 0.019 0.907 0.979 Received measles vaccination 0.898 0.023 162 43 0.976 0.026 0.852 0.944 Received all vaccinations (BCG) 0.879 0.026 162 43 1.026 0.030 0.827 0.932 Total fertility rate (last 3 years) 3.739 0.160 na 1229 0.860 0.043 3.420 4.058 Neonatal mortality (0-9 years) 11.510 2.823 1679 451 0.922 0.245 5.864 17.155 Post-neonatal mortality (0-9 years) 8.710 2.409 1672 450 1.093 0.277 3.891 13.528 Infant mortality (0-9 years) 20.219 3.692 1681 452 0.975 0.183 12.836 27.602 Child mortality (0-9 years) 5.679 1.794 1673 450 0.921 0.316 2.091 9.268 Under-five mortality (0-9 years) 25.784 4.398 1682 452 1.012 0.171 16.988 34.580 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 214 | Appendix B Table B.16 Sampling errors for Karak sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.327 0.018 775 378 1.057 0.055 0.291 0.362 No education 0.084 0.017 775 378 1.749 0.208 0.049 0.119 Secondary education or higher 0.833 0.028 775 378 2.071 0.033 0.777 0.888 Currently married 0.960 0.007 775 378 0.935 0.007 0.947 0.973 Married before age 20 0.256 0.020 950 462 1.421 0.076 0.217 0.295 Currently pregnant 0.070 0.007 1550 761 0.956 0.097 0.056 0.083 Children ever born 1.975 0.151 1550 761 1.062 0.077 1.673 2.278 Children surviving 1.898 0.145 1550 761 1.061 0.076 1.608 2.188 Children ever born to women age 40-49 5.221 0.219 290 141 1.333 0.042 4.783 5.660 Knowing any contraceptive method 0.999 0.001 744 363 0.921 0.001 0.997 1.001 Ever used any contraceptive method 0.791 0.015 744 363 0.999 0.019 0.761 0.820 Currently using any method 0.511 0.024 744 363 1.303 0.047 0.463 0.559 Currently using pill 0.097 0.012 744 363 1.121 0.126 0.072 0.121 Currently using IUD 0.166 0.018 744 363 1.286 0.106 0.131 0.201 Currently using female sterilization 0.046 0.007 744 363 0.887 0.149 0.032 0.059 Currently using periodic abstinence 0.043 0.008 744 363 1.047 0.181 0.028 0.059 Using public sector source 0.759 0.033 287 140 1.294 0.043 0.694 0.825 Want no more children 0.522 0.018 744 363 0.980 0.034 0.486 0.558 Want to delay birth at least 2 years 0.257 0.018 744 363 1.109 0.069 0.222 0.293 Ideal family size 3.870 0.062 691 336 1.099 0.016 3.745 3.995 Mother completely protected against tetanus 0.262 0.026 469 229 1.289 0.100 0.210 0.315 Mother received medical care at birth 0.990 0.005 712 348 1.168 0.005 0.981 1.000 Had diarrhea in the 2 weeks before survey 0.223 0.018 692 338 1.084 0.082 0.186 0.259 Treated with oral rehydration salts (ORS) 0.163 0.033 153 75 1.024 0.201 0.097 0.228 Taken to a health provider 0.628 0.037 153 75 0.864 0.058 0.555 0.702 Vaccination card seen 0.870 0.033 125 62 1.090 0.037 0.805 0.935 Received BCG vaccination 0.470 0.052 125 62 1.175 0.112 0.365 0.575 Received DPT vaccination (3 doses) 0.983 0.012 125 62 1.016 0.012 0.959 1.006 Received polio vaccination (3 doses) 0.983 0.012 125 62 1.016 0.012 0.959 1.006 Received measles vaccination 0.921 0.022 125 62 0.909 0.024 0.877 0.964 Received all vaccinations (BCG) 0.455 0.051 125 62 1.136 0.111 0.353 0.556 Total fertility rate (last 3 years) 3.206 0.162 na 2191 1.051 0.050 2.883 3.529 Neonatal mortality (0-9 years) 22.289 4.957 1412 690 1.111 0.222 12.375 32.204 Post-neonatal mortality (0-9 years) 10.020 2.361 1406 686 0.896 0.236 5.298 14.742 Infant mortality (0-9 years) 32.310 5.020 1412 690 0.969 0.155 22.269 42.350 Child mortality (0-9 years) 6.591 2.412 1400 683 1.047 0.366 1.767 11.414 Under-five mortality (0-9 years) 38.687 5.312 1413 690 0.956 0.137 28.063 49.311 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 215 Table B.17 Sampling errors for Tafiela sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.713 0.015 842 146 0.966 0.021 0.683 0.744 No education 0.101 0.015 842 146 1.461 0.151 0.070 0.131 Secondary education or higher 0.782 0.021 842 146 1.508 0.027 0.740 0.825 Currently married 0.952 0.007 842 146 0.893 0.007 0.939 0.965 Married before age 20 0.402 0.021 887 154 1.330 0.053 0.359 0.445 Currently pregnant 0.051 0.007 1653 285 0.966 0.145 0.037 0.066 Children ever born 2.297 0.283 1653 285 0.946 0.123 1.732 2.863 Children surviving 2.206 0.274 1653 285 0.953 0.124 1.659 2.754 Children ever born to women age 40-49 6.827 0.195 267 46 1.094 0.029 6.437 7.216 Knowing any contraceptive method 0.996 0.002 802 139 0.973 0.002 0.992 1.001 Ever used any contraceptive method 0.815 0.014 802 139 1.053 0.018 0.786 0.844 Currently using any method 0.600 0.015 802 139 0.885 0.026 0.569 0.630 Currently using pill 0.085 0.010 802 139 0.988 0.114 0.066 0.105 Currently using IUD 0.193 0.014 802 139 0.993 0.072 0.166 0.221 Currently using female sterilization 0.064 0.009 802 139 1.023 0.138 0.046 0.082 Currently using periodic abstinence 0.049 0.007 802 139 0.899 0.139 0.036 0.063 Using public sector source 0.747 0.033 322 55 1.349 0.044 0.681 0.812 Want no more children 0.557 0.017 802 139 0.990 0.031 0.522 0.592 Want to delay birth at least 2 years 0.248 0.014 802 139 0.944 0.058 0.220 0.277 Ideal family size 4.054 0.080 678 117 1.188 0.020 3.893 4.214 Mother completely protected against tetanus 0.330 0.025 511 88 1.182 0.075 0.281 0.380 Mother received medical care at birth 0.987 0.004 807 140 1.013 0.004 0.978 0.996 Had diarrhea in the 2 weeks before survey 0.168 0.013 790 137 0.872 0.079 0.142 0.195 Treated with oral rehydration salts (ORS) 0.110 0.030 131 23 1.033 0.273 0.050 0.170 Taken to a health provider 0.566 0.045 131 23 0.956 0.079 0.476 0.655 Vaccination card seen 0.913 0.023 148 26 1.008 0.026 0.867 0.960 Received BCG vaccination 0.788 0.040 148 26 1.152 0.050 0.709 0.868 Received DPT vaccination (3 doses) 0.974 0.013 148 26 0.957 0.013 0.949 0.999 Received polio vaccination (3 doses) 0.974 0.013 148 26 0.957 0.013 0.949 0.999 Received measles vaccination 0.898 0.029 148 26 1.146 0.032 0.841 0.955 Received all vaccinations (BCG) 0.726 0.043 148 26 1.158 0.060 0.639 0.812 Total fertility rate (last 3 years) 3.708 0.164 na 817 1.042 0.044 3.379 4.037 Neonatal mortality (0-9 years) 18.817 4.693 1615 281 1.118 0.249 9.431 28.203 Post-neonatal mortality (0-9 years) 8.063 2.214 1607 279 0.984 0.275 3.634 12.491 Infant mortality (0-9 years) 26.880 5.073 1618 281 1.085 0.189 16.734 37.025 Child mortality (0-9 years) 2.730 1.379 1609 279 1.055 0.505 0.000 5.489 Under-five mortality (0-9 years) 29.537 5.409 1619 281 1.114 0.183 18.719 40.354 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 216 | Appendix B Table B.18 Sampling errors for Ma’an sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.607 0.017 793 164 1.006 0.029 0.572 0.642 No education 0.146 0.019 793 164 1.546 0.133 0.107 0.185 Secondary education or higher 0.695 0.025 793 164 1.549 0.036 0.644 0.746 Currently married 0.943 0.008 793 164 0.966 0.008 0.927 0.959 Married before age 20 0.379 0.019 855 176 1.207 0.050 0.341 0.417 Currently pregnant 0.071 0.011 1549 322 1.077 0.149 0.049 0.092 Children ever born 2.144 0.242 1549 322 0.983 0.113 1.660 2.627 Children surviving 2.059 0.231 1549 322 0.979 0.112 1.596 2.522 Children ever born to women age 40-49 5.978 0.234 232 48 1.131 0.039 5.509 6.446 Knowing any contraceptive method 0.992 0.003 749 154 0.984 0.003 0.985 0.998 Ever used any contraceptive method 0.765 0.018 749 154 1.131 0.023 0.730 0.800 Currently using any method 0.500 0.022 749 154 1.181 0.043 0.457 0.544 Currently using pill 0.068 0.010 749 154 1.045 0.141 0.049 0.088 Currently using IUD 0.132 0.014 749 154 1.121 0.105 0.104 0.159 Currently using female sterilization 0.065 0.010 749 154 1.164 0.161 0.044 0.086 Currently using periodic abstinence 0.052 0.009 749 154 1.120 0.174 0.034 0.071 Using public sector source 0.625 0.035 242 50 1.113 0.055 0.556 0.695 Want no more children 0.526 0.018 749 154 1.007 0.035 0.490 0.563 Want to delay birth at least 2 years 0.298 0.017 749 154 1.028 0.058 0.263 0.332 Ideal family size 4.133 0.087 636 132 1.287 0.021 3.959 4.307 Mother completely protected against tetanus 0.380 0.027 522 107 1.287 0.072 0.325 0.435 Mother received medical care at birth 0.984 0.005 818 167 0.883 0.005 0.975 0.993 Had diarrhea in the 2 weeks before survey 0.214 0.018 801 164 1.183 0.086 0.177 0.251 Treated with oral rehydration salts (ORS) 0.205 0.040 168 35 1.245 0.196 0.125 0.286 Taken to a health provider 0.582 0.047 168 35 1.171 0.082 0.487 0.677 Vaccination card seen 0.929 0.021 180 38 1.075 0.022 0.888 0.970 Received BCG vaccination 0.876 0.033 180 38 1.326 0.037 0.811 0.941 Received DPT vaccination (3 doses) 0.889 0.034 180 38 1.470 0.039 0.820 0.957 Received polio vaccination (3 doses) 0.894 0.035 180 38 1.509 0.039 0.825 0.963 Received measles vaccination 0.864 0.037 180 38 1.451 0.043 0.790 0.938 Received all vaccinations (BCG) 0.772 0.044 180 38 1.411 0.057 0.684 0.861 Total fertility rate (last 3 years) 3.966 0.150 na 917 0.913 0.038 3.666 4.267 Neonatal mortality (0-9 years) 12.911 2.932 1593 327 0.934 0.227 7.047 18.775 Post-neonatal mortality (0-9 years) 10.792 2.587 1588 326 0.952 0.240 5.619 15.966 Infant mortality (0-9 years) 23.703 3.887 1595 327 0.959 0.164 15.929 31.478 Child mortality (0-9 years) 7.332 2.177 1567 321 1.032 0.297 2.979 11.686 Under-five mortality (0-9 years) 30.862 4.422 1595 327 0.951 0.143 22.019 39.705 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B � 217 Table B.19 Sampling errors for Aqaba sample, Jordan 2007 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.871 0.009 844 221 0.813 0.011 0.852 0.889 No education 0.091 0.016 844 221 1.591 0.173 0.060 0.123 Secondary education or higher 0.811 0.021 844 221 1.551 0.026 0.769 0.853 Currently married 0.956 0.009 844 221 1.221 0.009 0.939 0.973 Married before age 20 0.396 0.019 837 220 1.150 0.048 0.358 0.433 Currently pregnant 0.078 0.010 1391 374 1.109 0.123 0.059 0.098 Children ever born 2.332 0.226 1391 374 1.261 0.097 1.881 2.783 Children surviving 2.265 0.219 1391 374 1.263 0.097 1.827 2.704 Children ever born to women age 40-49 6.001 0.169 223 58 1.045 0.028 5.663 6.339 Knowing any contraceptive method 0.998 0.002 806 212 1.169 0.002 0.995 1.002 Ever used any contraceptive method 0.808 0.017 806 212 1.258 0.022 0.773 0.843 Currently using any method 0.537 0.023 806 212 1.313 0.043 0.491 0.584 Currently using pill 0.084 0.013 806 212 1.310 0.152 0.059 0.110 Currently using IUD 0.220 0.020 806 212 1.344 0.089 0.180 0.259 Currently using female sterilization 0.022 0.006 806 212 1.170 0.276 0.010 0.034 Currently using periodic abstinence 0.063 0.012 806 212 1.387 0.189 0.039 0.087 Using public sector source 0.464 0.040 300 79 1.382 0.086 0.384 0.544 Want no more children 0.525 0.022 806 212 1.239 0.042 0.481 0.569 Want to delay birth at least 2 years 0.258 0.019 806 212 1.255 0.075 0.219 0.297 Ideal family size 3.989 0.072 648 171 1.134 0.018 3.844 4.134 Mother completely protected against tetanus 0.184 0.018 532 140 1.065 0.097 0.148 0.220 Mother received medical care at birth 0.981 0.007 827 217 1.204 0.007 0.968 0.994 Had diarrhea in the 2 weeks before survey 0.162 0.015 819 215 1.045 0.090 0.132 0.191 Treated with oral rehydration salts (ORS) 0.177 0.030 131 35 0.904 0.170 0.117 0.238 Taken to a health provider 0.653 0.045 131 35 0.996 0.069 0.563 0.744 Vaccination card seen 0.902 0.024 172 46 1.019 0.027 0.854 0.950 Received BCG vaccination 0.773 0.039 172 46 1.206 0.051 0.695 0.852 Received DPT vaccination (3 doses) 0.963 0.015 172 46 0.957 0.016 0.932 0.993 Received polio vaccination (3 doses) 0.967 0.015 172 46 0.987 0.016 0.936 0.997 Received measles vaccination 0.866 0.025 172 46 0.951 0.029 0.815 0.917 Received all vaccinations (BCG) 0.718 0.039 172 46 1.111 0.054 0.640 0.795 Total fertility rate (last 3 years) 4.116 0.141 na 1027 0.965 0.034 3.834 4.398 Neonatal mortality (0-9 years) 16.624 3.176 1583 414 0.975 0.191 10.272 22.977 Post-neonatal mortality (0-9 years) 4.054 1.702 1583 414 0.959 0.420 0.651 7.458 Infant mortality (0-9 years) 20.679 3.711 1583 414 0.967 0.179 13.257 28.100 Child mortality (0-9 years) 4.525 2.061 1563 408 1.185 0.456 0.402 8.647 Under-five mortality (0-9 years) 25.110 4.058 1584 414 0.985 0.162 16.994 33.226 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C � 219 DATA QUALITY TABLES Appendix C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Jordan 2007 Female Male Age Number Percent Number Percent 0 993 2.6 1,086 2.8 1 989 2.6 909 2.3 2 925 2.4 1,032 2.7 3 998 2.6 1,046 2.7 4 961 2.5 977 2.5 5 905 2.4 1,051 2.7 6 921 2.4 1,010 2.6 7 938 2.5 903 2.3 8 770 2.0 903 2.3 9 923 2.4 926 2.4 10 967 2.5 934 2.4 11 997 2.6 1,040 2.7 12 983 2.6 1,066 2.8 13 881 2.3 1,016 2.6 14 1,022 2.7 995 2.6 15 861 2.3 901 2.3 16 951 2.5 837 2.2 17 823 2.2 893 2.3 18 794 2.1 799 2.1 19 783 2.1 803 2.1 20 772 2.0 853 2.2 21 739 1.9 840 2.2 22 762 2.0 766 2.0 23 729 1.9 710 1.8 24 676 1.8 713 1.8 25 658 1.7 673 1.7 26 512 1.3 665 1.7 27 630 1.7 629 1.6 28 635 1.7 522 1.3 29 546 1.4 593 1.5 30 636 1.7 598 1.5 31 513 1.3 484 1.2 32 559 1.5 459 1.2 33 594 1.6 496 1.3 34 572 1.5 468 1.2 35 591 1.6 547 1.4 36 404 1.1 556 1.4 37 543 1.4 505 1.3 38 501 1.3 455 1.2 39 466 1.2 392 1.0 40 496 1.3 504 1.3 41 412 1.1 414 1.1 42 425 1.1 397 1.0 43 397 1.0 374 1.0 44 366 1.0 422 1.1 45 254 0.7 379 1.0 46 266 0.7 323 0.8 47 271 0.7 240 0.6 48 285 0.7 221 0.6 49 246 0.6 264 0.7 50 207 0.5 266 0.7 51 212 0.6 210 0.5 52 217 0.6 247 0.6 53 246 0.6 226 0.6 54 213 0.6 152 0.4 55 215 0.6 202 0.5 56 189 0.5 169 0.4 57 155 0.4 140 0.4 58 124 0.3 120 0.3 59 181 0.5 161 0.4 60 223 0.6 209 0.5 61 142 0.4 132 0.3 62 170 0.4 167 0.4 63 141 0.4 145 0.4 64 112 0.3 138 0.4 65 211 0.6 181 0.5 66 107 0.3 116 0.3 67 103 0.3 122 0.3 68 94 0.2 88 0.2 69 106 0.3 90 0.2 70+ 869 2.3 903 2.3 Don't know/missing 5 0.0 1 0.0 Total 38,084 100.0 38,774 100.0 220 | Appendix C Table C.2 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), by five-year age groups, Jordan 2007 Interviewed women age 15-49 Age group Household population of women age 10-54 Ever-married women age 10-54 Number Percent Percent of women 10-14 4,851 0 na na na 15-19 4,212 244 237 2.2 96.9 20-24 3,678 1,351 1,281 11.8 94.8 25-29 2,981 2,067 1,978 18.2 95.7 30-34 2,875 2,284 2,218 20.4 97.1 25-39 2,505 2,139 2,055 18.9 96.1 40-44 2,096 1,917 1,881 17.3 98.1 45-49 1,322 1,267 1,240 11.4 97.8 50-54 1,095 1,034 na na na 15-49 19,668 11,270 10,889 100.0 96.6 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Jordan 2007 Subject Reference group Percentage with information missing Number of cases Birth date Births in past 15 years Month Only) 0.24 28,081 Month and Year 0.03 28,081 Age at death Deceased children born in the past 15 years 0.00 659 Age/date at first union 1 Ever married women 0.00 10,876 Respondent's education Ever married women 0.07 10,876 Diarrhea in past 2 weeks Living children 0-59 months 0.15 9,669 1 Both year and age missing Appendix C � 221 Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living (L), dead (D), and total (T) children (weighted), Jordan 2007 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year L D T L D T L D T L D T 2007 1,272 7 1,280 100.0 100.0 100.0 113.4 330.4 114.1 na na na 2006 1,829 37 1,866 100.0 100.0 100.0 94.7 70.8 94.2 na na na 2005 1,954 48 2,002 100.0 100.0 100.0 106.7 63.9 105.4 103.4 121.4 103.8 2004 1,948 42 1,990 100.0 100.0 100.0 100.4 76.9 99.8 99.7 103.9 99.8 2003 1,954 33 1,987 100.0 100.0 100.0 101.6 70.4 101.0 103.2 75.0 102.5 2002 1,840 46 1,886 100.0 100.0 100.0 124.6 50.1 121.9 95.4 133.6 96.0 2001 1,906 36 1,941 99.6 94.6 99.5 110.9 162.4 111.6 103.9 79.0 103.3 2000 1,828 44 1,873 99.9 95.2 99.8 95.8 130.0 96.5 100.8 128.2 101.3 1999 1,722 34 1,756 99.7 96.6 99.7 112.4 110.3 112.4 98.6 74.8 98.0 1998 1,664 45 1,709 99.3 99.6 99.4 102.1 111.0 102.3 97.7 90.0 97.5 2003-2007 8,957 168 9,124 100.0 100.0 100.0 102.6 74.8 102.0 na na na 1998-2002 8,960 205 9,165 99.7 97.4 99.7 108.8 103.0 108.7 na na na 1993-1997 8,788 275 9,063 99.7 92.7 99.5 104.1 194.0 106.0 na na na 1988-1992 6,769 224 6,993 99.7 96.1 99.6 100.7 167.4 102.3 na na na < 1988 6,304 294 6,598 99.3 94.6 99.1 109.0 154.0 110.7 na na na All 39,778 1,166 40,944 99.7 95.7 99.6 105.0 137.9 105.8 na na na na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x 222 | Appendix C Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey (weighted), Jordan 2007 Number of years preceding the survey Age at death (days) 0-4 5-9 10-14 15-19 Total 0-19 <1 31 23 31 21 106 1 15 24 15 21 75 2 10 9 10 4 32 3 12 16 14 4 46 4 14 8 1 2 26 5 2 8 2 1 12 6 6 5 1 4 16 7 4 17 15 15 51 8 13 5 0 0 18 9 0 0 5 2 8 10 8 1 2 4 15 11 6 14 8 1 28 12 0 5 4 5 14 13 2 1 1 0 4 14 3 1 5 1 10 15 0 0 1 2 4 16 0 0 0 0 0 17 0 0 5 0 5 18 0 1 0 0 1 19 0 0 0 1 1 20 1 0 5 1 8 21 0 0 0 0 0 22 7 0 4 0 11 23 0 0 0 0 0 25 0 0 0 0 1 26 0 0 0 0 0 28 0 0 2 0 3 29 0 2 0 0 2 30 0 0 0 0 1 31+ 0 0 1 0 1 Total 0-30 134 143 130 89 496 Percent early neonatal1 66.8 65.1 56.6 63.2 63.0 1 = 6 days/= 30 days Appendix C � 223 Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five-year periods of birth preceding the survey, Jordan 2007 Number of years preceding the survey Age at death (months) 0-4 5-9 10-14 15-19 Total 0-19 <1a 134 143 130 89 496 1 6 8 20 12 46 2 13 9 9 8 39 3 2 4 7 9 22 4 4 3 5 9 21 5 0 1 10 3 14 6 5 3 9 9 26 7 5 1 2 2 10 8 7 1 1 1 10 9 6 5 1 1 14 10 6 2 2 7 18 11 0 2 3 7 11 12 1 7 2 3 13 13 0 0 0 0 0 14 1 0 1 0 2 15 1 0 0 0 1 16 0 0 6 1 7 18 1 1 1 0 3 19 0 0 1 0 1 20 0 0 1 0 1 21 0 0 0 0 1 1 Year 0 1 0 0 1 Total 0-11 188 183 198 158 728 Percent neonatal1 71.3 78.1 65.4 56.4 68.2 1 Under one month/under one year a Includes deaths under one month reported in days QUESTIONNAIRES Appendix D 225Appendix D | 9 June 2007 The Hashemite Kingdom of Jordan Department of Statistics JORDAN POPULATION AND Household Survey Directorate FAMILY HEALTH SURVEY 2007 HOUSEHOLD QUESTIONNAIRE Survey Contents Confidential by Statistical Law IDENTIFICATION QUESTIONNAIRE No.: . . . . . . . . . . . . . GOVERNORATE: BLOCK No.: . . . . . . . . . . . . . . . . . . . DISTRICT: BUILDING No.: SUB-DISTRICT: HOUSING UNIT No.: LOCALITY: CLUSTER No.: . . . . . . . . . . . . . . . . . AREA: HOUSEHOLD No.: . . . . . . . . . . . . . . . SUB-AREA: TELEPHONE/ STRATUM: MOBILE No. (if available) URBAN/RURAL (Urban=1; Rural=2) HOUSEHOLD SELECTED FOR ANTHROPOMETRY AND ANEMIA TESTING (YES = 1; NO = 2) HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (YES = 1; NO = 2) . . . . . . . . . INTERVIEWER VISITS FINAL VISIT DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. NUMBER RESULT* RESULT NEXT VISIT: DATE TOTAL NUMBER TIME OF VISITS *RESULT CODES: 1 COMPLETED TOTAL PERSONS 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT IN HOUSEHOLD AT HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 4 POSTPONED TOTAL ELIGIBLE 5 REFUSED WOMEN 6 HOUSING UNIT VACANT OR ADDRESS NO MORE A DWELLING 7 HOUSING UNIT DESTROYED LINE NO. OF 8 HOUSING UNIT NOT FOUND RESPONDENT 9 OTHER HOUSEHOLD (SPECIFY) QUESTIONNAIRE SUPERVISOR FIELD EDITOR NAME NAME DATE DATE EDITOR OFFICE KEYED BY 1 2 3 2 0 0 7 227Appendix D | Introduction and Consent Hello. My name is _______________________________________ and I am working with the Department of Statistics. We are conducting a national survey about various health issues. We would very much appreciate your participation in this survey. The interview usually takes between 10 and 15 minutes to complete. As part of the survey we would first like to ask some questions about your household. All of the answers you give will be confidential. Participation in the survey is completely voluntary. If we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope you will participate in the survey since your views are important. At this time, do you want to ask me anything about the survey? May I begin the interview now? Signature of interviewer: Date: . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . 2 ENDRESPONDENT AGREES TO BE INTERVIEWED 228 | Appendix D IF A G E 15 O R O L D E R LI N E U S U A L R E S ID E N T S A N D D A T E O F B IR T H A G E N A T IO N A LI T Y E LI G IB IL IT Y N O . V IS IT O R S IN D IV ID U A L IN T E R V IE W P le as e gi ve m e th e na m es W ha t i s th e Is D oe s D id In w ha t m on th a nd y ea r w as H ow o ld is W ha t i s W ha t i s C IR C LE of th e pe rs on s w ho u su al ly re la tio ns hi p of (N A M E ) (N A M E ) (N A M E ) (N A M E ) bo rn ? (N A M E )? (N A M E 'S ) (N A M E 'S ) LI N E liv e in y ou r ho us eh ol d an d (N A M E ) to th e m al e or us ua lly st ay na tio na lit y? cu rr en t m ar ita l N U M B E R A N T H R O P O M E T R Y A N D gu es ts o f t he h ou se ho ld he ad o f t he fe m al e? liv e he re IF D O N 'T K N O W M O N T H , R E C O R D IF A G E = 95 +, st at us ? O F A N E M IA M E A S U R E M E N T S w ho s ta ye d he re la st n ig ht , ho us eh ol d? he re ? la st 98 ' F O R M O N T H . R E C O R D 9 5. W O M E N C IR C LE C IR C LE st ar tin g w ith th e he ad o f ni gh t? 1 = JO R D A N IA N 1 = N E V E R - E LI G IB LE LI N E LI N E th e ho us eh ol d. S E E C O D E S IF D O N 'T K N O W Y E A R , R E C O R D C O M P A R E A N D 2 = E G Y P T IA N M A R R IE D F O R N U M B E R N U M B E R B E LO W . 99 98 ' F O R Y E A R . C O R R E C T 6 A 3 = S Y R IA N 2 = M A R R IE D IN D IV ID U A L O F A LL O F A LL A F T E R L IS T IN G T H E A N D /O R 7 IF 4= IR A Q I 3 = D IV O R C E D S U R V E Y W O M E N C H IL D R E N N A M E S A N D R E C O R D IN G IN C O N S IS T E N T . 5 = O T H E R A R A B 4 = W ID O W E D (E V E R - A G E B O R N IN T H E R E LA T IO N S H IP 6 = N O T A R A B 5 = S E P A R A T E D M A R R IE D 15 -4 9. 20 02 O R A N D S E X F O R E A C H 8= D O N 'T K N O W W O M E N LA T E R , O R P E R S O N , A S K A G E 1 5- 49 ). C H IL D R E N Q U E S T IO N S 2 A -2 C A G E 0 -5 T O B E S U R E T H A T T H E Y E A R S LI S T IN G IS C O M P LE T E . (I F D A T E O F B IR T H T H E N A S K A P P R O P R IA T E N O T Q U E S T IO N S IN C O LU M N S K N O W N ). 5- 32 F O R E A C H P E R S O N . N O T K N O W N ). (1 ) (2 ) (6 ) (9 ) (1 0) (1 1) M F Y N Y N M O N T H Y E A R IN Y E A R S 01 1 2 1 2 1 2 01 01 01 02 1 2 1 2 1 2 02 02 02 03 1 2 1 2 1 2 03 03 03 04 1 2 1 2 1 2 04 04 04 05 1 2 1 2 1 2 05 05 05 06 1 2 1 2 1 2 06 06 06 07 1 2 1 2 1 2 07 07 07 C O D E S F O R Q .3 : R E L A T IO N S H IP T O H E A D O F H O U S E H O L D 01 = H E A D 06 = P A R E N T 11 = A D O P T E D / 02 = W IF E O R H U S B A N D 07 = P A R E N T -I N -L A W F O S T E R E D C H IL D 03 = S O N O R D A U G H T E R 08 = B R O T H E R O R S IS T E R 12 = N O T R E LA T E D 04 = S T E P S O N O R 09 = G R A N D F A T H E R /M O T H E R 98 = D O N 'T K N O W S T E P D A U G H T E R 10 = O T H E R R E LA T IV E 05 = G R A N D C H IL D IS S E L E C T E D F O R A N D A N E M IA M A R IT A L S T A T U S H O U S E H O L D S C H E D U L E R E LA T IO N S H IP T O H E A D O F H O U S E H O LD S E X R E S ID E N C E (3 ) (4 ) (5 ) (5 A ) (7 ) C H E C K C O V E R P A G E IF T H IS H O U S E H O L D (6 A ) (8 ) 229Appendix D | IF A G E 15 O R O L D E R LI N E U S U A L R E S ID E N T S A N D D A T E O F B IR T H A G E N A T IO N A LI T Y E LI G IB IL IT Y N O . V IS IT O R S IN D IV ID U A L IN T E R V IE W P le as e gi ve m e th e na m es W ha t i s th e Is D oe s D id In w ha t m on th a nd y ea r w as H ow o ld is W ha t i s W ha t i s C IR C LE of th e pe rs on s w ho u su al ly re la tio ns hi p of (N A M E ) (N A M E ) (N A M E ) (N A M E ) bo rn ? (N A M E )? (N A M E 'S ) (N A M E 'S ) LI N E liv e in y ou r ho us eh ol d an d (N A M E ) to th e m al e or us ua lly st ay na tio na lit y? cu rr en t m ar ita l N U M B E R A N T H R O P O M E T R Y A N D gu es ts o f t he h ou se ho ld he ad o f t he fe m al e? liv e he re IF D O N 'T K N O W M O N T H , R E C O R D IF A G E = 95 +, st at us ? O F A N E M IA M E A S U R E M E N T S w ho s ta ye d he re la st n ig ht , ho us eh ol d? he re ? la st 98 ' F O R M O N T H . R E C O R D 9 5. W O M E N C IR C LE C IR C LE st ar tin g w ith th e he ad o f ni gh t? 1 = JO R D A N IA N 1 = N E V E R - E LI G IB LE LI N E LI N E th e ho us eh ol d. S E E C O D E S IF D O N 'T K N O W Y E A R , R E C O R D C O M P A R E A N D 2 = E G Y P T IA N M A R R IE D F O R N U M B E R N U M B E R B E LO W . 99 98 ' F O R Y E A R . C O R R E C T 6 A 3 = S Y R IA N 2 = M A R R IE D IN D IV ID U A L O F A LL O F A LL A F T E R L IS T IN G T H E A N D /O R 7 IF 4= IR A Q I 3 = D IV O R C E D S U R V E Y W O M E N C H IL D R E N N A M E S A N D R E C O R D IN G IN C O N S IS T E N T . 5 = O T H E R A R A B 4 = W ID O W E D (E V E R - A G E B O R N IN T H E R E LA T IO N S H IP 6 = N O T A R A B 5 = S E P A R A T E D M A R R IE D 15 -4 9. 20 02 O R A N D S E X F O R E A C H 8= D O N 'T K N O W W O M E N LA T E R , O R P E R S O N , A S K A G E 1 5- 49 ). C H IL D R E N Q U E S T IO N S 2 A -2 C A G E 0 -5 T O B E S U R E T H A T T H E Y E A R S LI S T IN G IS C O M P LE T E . (I F D A T E O F B IR T H T H E N A S K A P P R O P R IA T E N O T Q U E S T IO N S IN C O LU M N S K N O W N ). 5- 32 F O R E A C H P E R S O N . N O T K N O W N ). IS S E L E C T E D F O R A N D A N E M IA M A R IT A L S T A T U S R E LA T IO N S H IP T O H E A D O F H O U S E H O LD S E X R E S ID E N C E C H E C K C O V E R P A G E IF T H IS H O U S E H O L D (1 ) (2 ) (6 ) (9 ) (1 0) (1 1) M F Y N Y N M O N T H Y E A R 08 1 2 1 2 1 2 08 08 08 09 1 2 1 2 1 2 09 09 9 10 1 2 1 2 1 2 10 10 10 11 1 2 1 2 1 2 11 11 11 12 1 2 1 2 1 2 12 12 12 13 1 2 1 2 1 2 13 13 13 14 1 2 1 2 1 2 14 14 14 T IC K H E R E IF C O N T IN U A T IO N S H E E T U S E D C O D E S F O R Q . 3 : R E L A T IO N S H IP T O H E A D O F H O U S E H O L D 2A ) Ju st to m ak e su re th at I ha ve a c om pl et e lis tin g. A re th er e an y ot he r 01 = H E A D 06 = P A R E N T 11 = A D O P T E D / pe rs on s su ch a s sm al l c hi ld re n or in fa nt s th at w e ha ve n ot li st ed ? Y E S N O 02 = W IF E O R H U S B A N D 07 = P A R E N T -I N -L A W F O S T E R E D C H IL D 2B ) A re th er e an y ot he r pe op le w ho m ay n ot b e m em be rs o f y ou r fa m ily , 03 = S O N O R D A U G H T E R 08 = B R O T H E R O R S IS T E R 12 = N O T R E LA T E D su ch a s do m es tic s er va nt s, lo dg er s, o r fr ie nd s w ho u su al ly li ve h er e? Y E S N O 04 = S T E P S O N O R 09 = G R A N D F A T H E R /M O T H E R 98 = D O N 'T K N O W 2C ) A re th er e an y gu es ts o r te m po ra ry v is ito rs s ta yi ng h er e, o r an yo ne S T E P D A U G H T E R 10 = O T H E R R E LA T IV E el se w ho s ta ye d he re la st n ig ht , w ho h av e no t b ee n lis te d? Y E S N O 05 = G R A N D C H IL D (8 ) IN Y E A R S (7 ) (6 A ) (3 ) (4 ) (5 ) (5 A ) A D D T O T A B LE A D D T O T A B LE A D D T O T A B LE 230 | Appendix D IF A G E 0- 17 Y E A R S IF A G E 5 Y E A R S O R O L D E R LI N E S U R V IV O R S H IP A N D R E S ID E N C E O F B IO LO G IC A L E V E R A T T E N D E D N O . P A R E N T S S C H O O L Is D oe s Is D oe s H as C an ( N A M E ) W ha t i s th e W ha t i s th e D id (N A M E )'s (N A M E )'s (N A M E )'s (N A M E )'s (N A M E ) re ad a nd hi gh es t l ev el hi gh es t g ra de (N A M E ) na tu ra l na tu ra l na tu ra l na tu ra l ev er w rit e? of s ch oo l (N A M E ) at te nd m ot he r al iv e? m ot he r fa th er a liv e? fa th er at te nd ed (N A M E ) ha s co m pl et ed sc ho ol us ua lly us ua lly sc ho ol ? at te nd ed ? at th at le ve l? at a ny liv e in th is liv e in th is tim e ho us eh ol d ho us eh ol d S E E C O D E S . S E E C O D E S . du rin g or w as s he or w as h e th e a gu es t a gu es t (2 00 6 - la st n ig ht ? la st n ig ht ? 20 07 ) sc ho ol IF Y E S : IF Y E S : ye ar ? W ha t i s W ha t i s he r na m e? hi s na m e? R E C O R D R E C O R D M O T H E R 'S F A T H E R 'S LI N E LI N E N U M B E R . N U M B E R . IF N O , IF N O , R E C O R D R E C O R D '0 0' . '0 0' . (1 3) (1 6) (1 6A ) (1 7) (1 7A ) Y N D K Y N D K Y N Y N LE V E L G R A D E Y N C O D E S F O R E D U C A T IO N L E V E L ( Q .1 7) 01 1 2 8 1 2 8 1 2 1 2 1 2 O L D S Y S T E M 01 = O LD E LE M E N T A R Y G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 02 = O LD P R E P A R A T O R Y 02 1 2 8 1 2 8 1 2 1 2 1 2 N E W S Y S T E M 04 = N E W B A S IC G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 05 = N E W S E C O N D A R Y 03 1 2 8 1 2 8 1 2 1 2 1 2 07 = B A C H E LO R 08 = H IG H E R E D U C A T IO N G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 04 1 2 8 1 2 8 1 2 1 2 1 2 C O D E S F O R G R A D E ( Q .1 7A ) G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 00 = L E S S T H A N O N E Y E A R C O M P LE T E D 05 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 06 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 07 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E IF A G E 5 - 24 Y E A R S (1 8) (1 2) (1 4) (1 5) 03 = O LD S E C O N D A R Y 98 = D O N 'T K N O W 06 = IN T E R M E D IA T E D IP LO M A 98 = D O N 'T K N O W 231Appendix D | IF A G E 0- 17 Y E A R S IF A G E 5 Y E A R S O R O L D E R LI N E S U R V IV O R S H IP A N D R E S ID E N C E O F B IO LO G IC A L E V E R A T T E N D E D N O . P A R E N T S S C H O O L Is D oe s Is D oe s H as C an ( N A M E ) W ha t i s th e W ha t i s th e D id (N A M E )'s (N A M E )'s (N A M E )'s (N A M E )'s (N A M E ) re ad a nd hi gh es t l ev el hi gh es t g ra de (N A M E ) na tu ra l na tu ra l na tu ra l na tu ra l ev er w rit e? of s ch oo l (N A M E ) at te nd m ot he r al iv e? m ot he r fa th er a liv e? fa th er at te nd ed (N A M E ) ha s co m pl et ed sc ho ol us ua lly us ua lly sc ho ol ? at te nd ed ? at th at le ve l? at a ny liv e in th is liv e in th is tim e ho us eh ol d ho us eh ol d S E E C O D E S . S E E C O D E S . du rin g or w as s he or w as h e th e a gu es t a gu es t (2 00 6 - la st n ig ht ? la st n ig ht ? 20 07 ) sc ho ol IF Y E S : IF Y E S : ye ar ? W ha t i s W ha t i s he r na m e? hi s na m e? R E C O R D R E C O R D M O T H E R 'S F A T H E R 'S LI N E LI N E N U M B E R . N U M B E R . IF N O , IF N O , R E C O R D R E C O R D '0 0' . '0 0' . IF A G E 5 - 24 Y E A R S (1 3) (1 6) (1 6A ) (1 7) (1 7A ) Y N D K Y N D K Y N Y N LE V E L G R A D E Y N C O D E S F O R E D U C A T IO N L E V E L ( Q s. 17 ) 08 1 2 8 1 2 8 1 2 1 2 1 2 O L D S Y S T E M 01 = O LD E LE M E N T A R Y G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 02 = O LD P R E P A R A T O R Y 09 1 2 8 1 2 8 1 2 1 2 1 2 N E W S Y S T E M 04 = N E W B A S IC G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 05 = N E W S E C O N D A R Y 10 1 2 8 1 2 8 1 2 1 2 1 2 07 = B A C H E LO R 08 = H IG H E R E D U C A T IO N G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 11 1 2 8 1 2 8 1 2 1 2 1 2 C O D E S F O R G R A D E ( Q s. 17 A ) 00 = L E S S T H A N O N E Y E A R C O M P LE T E D G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 12 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 13 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E 14 1 2 8 1 2 8 1 2 1 2 1 2 G O T O 14 G O T O 16 G O T O 17 N E X T LI N E (1 2) (1 4) (1 8) (1 5) 98 = D O N 'T K N O W 03 = O LD S E C O N D A R Y 06 = IN T E R M E D IA T E D IP LO M A 98 = D O N 'T K N O W 232 | Appendix D NO. QUESTIONS AND FILTERS SKIP 100 TYPE OF HOUSING UNIT. APARTMENT . . . . . . . . . . . . . . . . . . . . . . 1 DAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 RECORD OBSERVATION. VILLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 HUT/BARRACK . . . . . . . . . . . . . . . . . . . . 4 OTHER _________________________ 6 (SPECIFY) 101 What is the main source of drinking water for members PIPED WATER of your household? PIPED INTO HOUSING UNIT . . . . . . . 11 PIPED TO YARD . . . . . . . . . . . . . . . . . . 12 SPRING . . . . . . . . . . . . . . . . . . . . . . . . . . 21 RAINWATER . . . . . . . . . . . . . . . . . . . . . . 31 TANKER TRUCK . . . . . . . . . . . . . . . . . . 41 BOTTLED WATER . . . . . . . . . . . . . . . . . . 51 OTHER 96 (SPECIFY) 101A Is water normally available all day from this source? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 101B In the last two weeks, was water unavailable for an entire YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 day or longer? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 106 Do you do anything to the water to make it safer to drink? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 108 107 What do you usually do to make the water safer to drink? BOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . A ADD BLEACH/CHLORINE . . . . . . . . . . B Anything else? USE WATER FILTER . . . . . . . . . . . . . C RECORD ALL MENTIONED. OTHER X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . Z 108 What kind of toilet facility do members of your FLUSH OR POUR FLUSH TOILET household usually use? FLUSH TO PIPED SEWER SYSTEM . . . . . . . . . . . . . . . . . . . . 11 IF FLUSH TOILET: FLUSH TO PIT LATRINE . . . . . . . . . . 12 Is your toilet connected to a public sewer system, a FLUSH TO SOMEWHERE ELSE . . . 13 septic tank, a pit latrine or somewhare else? PIT LATRINE VENTILATED IMPROVED PIT LATRINE . . . . . . . . . . . . . . . . . . 21 PIT LATRINE WITH SLAB . . . . . . . . . . 22 PIT LATRINE WITHOUT SLAB/ OPEN PIT . . . . . . . . . . . . . . . . . . . . 23 NO FACILITY/BUSH/FIELD . . . . . . . . . . 61 110A OTHER 96 (SPECIFY) 109 Do you share this toilet facility with other households? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 110A Is your house connected with electricity? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 110B Does your household have a bed or sofa bed? IF YES: How many beds or sofa beds does your household have? NUMBER OF BEDS . . . . . . . . . . . . . . . IF NONE, RECORD '0'. IF 7 OR MORE, RECORD 7. HOUSING UNIT AND HOUSEHOLD CHARACTERISTICS CODING CATEGORIES 233Appendix D | NO. QUESTIONS AND FILTERS SKIPCODING CATEGORIES 111 Does your household have: YES NO A radio/tape recorder? RADIO/TAPE RECORDER . 1 2 A television? TELEVISION . . . . . . . . . . . . . . 1 2 Satellite? SATELLITE . . . . . . . . . . . . . . . . 1 2 A land telephone? LAND TELEPHONE . . . . . . . 1 2 A refrigerator? REFRIGERATOR . . . . . . . . . . 1 2 A washing machine? WASHING MACHINE . . . . . 1 2 Solar heater? SOLAR HEATER . . . . . . . . . . 1 2 Air conditioner? AIR CONDITIONNER . . . . . . . 1 2 Fan? FAN . . . . . . . . . . . . . . . . . . . . 1 2 Water cooler? WATER COOLER . . . . . . . 1 2 Microwave? MICROWAVE . . . . . . . . . . . . 1 2 Digital camera? DIGITAL CAMERA . . . . . . . 1 2 111A Does you household have a computer? IF YES: How many? IF NONE, RECORD '0'. IF 7 OR MORE, RECORD 7. NUMBER OF COMPUTERS . . . . . . . . . . 111B Does you household have a mobile? IF YES: How many? IF NONE, RECORD '0'. IF 7 OR MORE, RECORD 7. NUMBER OF MOBILES . . . . . . . . . . . . 111C CHECK 111A and 111B: 111A OR 111B = 1 OR MORE 111A AND 111B = 0 112 111D Do you have internet access at home? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 112 What type of fuel does your household mainly use ELECTRICITY . . . . . . . . . . . . . . . . . . . . . . 1 for cooking? NATURAL GAS . . . . . . . . . . . . . . . . . . . . 2 KEROSENE . . . . . . . . . . . . . . . . . . . . . . 3 COAL/WOOD . . . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) 116 Do you have a separate room which is used as a kitchen? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 116A Do you have an independent bathroom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 117 MAIN MATERIAL OF THE FLOOR. NATURAL FLOOR EARTH . . . . . . . . . . . . . . . . . . . . . . . . 11 FINISHED FLOOR PARQUET OR POLISHED WOOD . . . . . . . . . . . . . . . . . . . . . . 31 TILE . . . . . . . . . . . . . . . . . . . . . . . . . . 32 MARBLE/CERAMIC TILES . . . . . . . 33 CEMENT . . . . . . . . . . . . . . . . . . . . . . 34 OTHER 96 (SPECIFY) 119 MAIN MATERIAL OF THE EXTERIOR WALLS. RUDIMENTARY MUD BRICKS . . . . . . . . . . . . . . . . . . . . 21 RECORD OBSERVATION. MUD BRICKS WITH STONES . . . . . 22 ASBESTOS/WOOD/ZINC . . . . . . . . . . 23 FINISHED CEMENT BRICKS . . . . . . . . . . . . . . . . 31 CUT STONE . . . . . . . . . . . . . . . . . . . . 32 CUT STONE AND CONCRETE . . . . . 33 CONCRETE . . . . . . . . . . . . . . . . . . . 34 HAIR/WOOL/CLOTH . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) 119A How many rooms do you have in your house? NUMBER OF ROOMS . . . . . . . 120 How many rooms in this household are used for sleeping? ROOMS FOR SLEEPING . . . 120A Does your household own a private car or pickup? IF YES: How many? IF NONE, RECORD '0'. IF 7 OR MORE, RECORD 7. NUMBER OF CARS/PICKUPS . . . . . . . 126A Does any member of this household have a credit card? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 234 | Appendix D USE THIS TABLE WHEN: 1) The household is selected for the domestic violence module AND 2) There is more than one eligible women in the household RANDOM NUMBER TABLE FOR CHECK THE HOUSEHOLD NUMBER ON THE COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE. THIS IS THE NUMBER OF THE ROW TO SELECT. CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN IN COLUMN 9 OF THE HOUSEHOLD SCHEDULE. THIS IS THE NUMBER OF THE COLUMN TO SELECT. FIND THE BOX WHERE THE ROW AND THE COLUMN MEET AND CIRCLE THAT NUMBER. THIS IS THE POSITION NUMBER OF THE WOMAN WHO WILL BE ASKED THE DOMESTIC VIOLENCE MODULE. IN COLUMN 9 OF THE HOUSEHOLD SCHEDULE, DRAW A BOX AROUND THE LINE NUMBER OF THE ELIGIBLE WOMAN IN THAT POSITION. EXAMPLE: IF THE LAST DIGIT OF THE HOUSEHOLD NUMBER IS 6, AND THERE ARE 3 ELIGIBLE WOMEN, THE NUMBER IN THE BOX WHERE ROW 6 AND COLUMN 3 MEET IS 2, THAT MEANS THAT THE 2ND ELIGIBLE WOMAN WILL BE SELECTED FOR THE MODULE. NOW SUPPOSE THE THREE ELIGIBLE WOMEN'S LINE NUMBERS ARE '02', '03', AND '07', THEN THE 2ND ELIGIBLE WOMAN (LINE NUMBER '03') IS SELECTED FOR THE MODULE. HOUSEHOLD NUMBER 1 2 3 4 5 6 0 1 2 2 3 5 5 1 1 1 3 4 1 6 2 1 2 1 1 2 1 3 1 1 2 2 3 2 4 1 2 3 3 4 3 5 1 1 1 4 5 4 6 1 2 2 1 1 5 7 1 1 3 2 2 6 8 1 2 1 3 3 1 9 1 1 2 4 4 2 10 1 2 3 1 5 3 11 1 1 1 2 1 4 12 1 2 2 3 2 5 13 1 1 3 4 3 6 14 1 2 1 1 4 1 15 1 1 2 2 5 2 Total number of eligible women in the household SELECTION OF WOMAN AS RESPONDENT TO DOMESTIC VIOLENCE MODULE 235Appendix D | WEIGHT, HEIGHT AND HEMOGLOBIN MEASUREMENT FOR CHILDREN AGE 0-5 201 CHECK COLUMN 11. RECORD THE LINE NUMBER AND AGE FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 202. IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S). A FINAL OUTCOME MUST BE RECORDED FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 208 AND FOR THE ANEMIA PROCEDURE IN 213 CHILD 1 CHILD 2 CHILD 3 202 LINE NUMBER FROM COLUMN 11 LINE LINE LINE NUMBER . . . NUMBER . . . NUMBER . . . NAME FROM COLUMN 2 NAME NAME NAME 203 IF MOTHER INTERVIEWED, COPY MONTH AND YEAR FROM BIRTH DAY . . . . . . . . . . DAY . . . . . . . . . . DAY . . . . . . . . . . HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: MONTH . . . . . MONTH . . . . . MONTH . . . . . What is (NAME'S) birth date? YEAR YEAR YEAR 204 CHECK 203: YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 CHILD BORN IN JANUARY 2002 OR NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 LATER? (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT CHILD OR, IF NO CHILD OR, IF NO CHILD OR, IF NO MORE, GO TO 215) MORE, GO TO 215) MORE, GO TO 215) 205 WEIGHT IN KILOGRAMS KG. . . . . KG. . . . . KG. . . . . 206 HEIGHT IN CENTIMETERS CM. . CM. . CM. . 207 MEASURED LYING DOWN OR LYING DOWN . . . . . . . 1 LYING DOWN . . . . . . . 1 LYING DOWN . . . . . . . 1 STANDING UP? STANDING UP. . . . . . . 2 STANDING UP. . . . . . . 2 STANDING UP. . . . . . . 2 208 RESULT OF WEIGHT AND HEIGHT MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASUREMENT NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 209 CHECK 203: 0-5 MONTHS . . . . . . . 1 0-5 MONTHS . . . . . . . 1 0-5 MONTHS . . . . . . . 1 IS CHILD AGE 0-5 MONTHS, I.E., WAS (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT CHILD BORN IN MONTH OF CHILD OR, IF NO CHILD OR, IF NO CHILD OR, IF NO INTERVIEW OR FIVE PREVIOUS MORE, GO TO 215) MORE, GO TO 215) MORE, GO TO 215) MONTHS? OLDER . . . . . . . . . . . . 2 OLDER . . . . . . . . . . . . 2 OLDER . . . . . . . . . . . . 2 210 LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR THE LINE LINE LINE CHILD (COLUMN 1) NUMBER . . . NUMBER . . . NUMBER . . . RECORD '00' IF NOT LISTED. 211 READ CONSENT STATEMENT GRANTED 1 GRANTED 1 GRANTED 1 TO PARENT/OTHER ADULT RESPONSIBLE FOR CHILD. (SIGN) (SIGN) (SIGN) CIRCLE CODE AND SIGN. REFUSED . . . . . . . . . . 2 REFUSED . . . . . . . . . . 2 REFUSED . . . . . . . . . . 2 (IF REFUSED, GO TO 213) (IF REFUSED, GO TO 213) (IF REFUSED, GO TO 213) 212 RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET G/DL . . G/DL . . G/DL . . 213 RECORD RESULT CODE OF MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 HEMOGLOBIN MEASUREMENT NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 214 GO BACK TO 203 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, GO TO 215. CONSENT STATEMENT FOR ANEMIA FOR CHILDREN As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia. We request that all children born in 2002 or later participate in the anemia testing part of this survey and give a few drops of blood from a finger. The equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result told to you right away. The result will be kept confidential. Do you have any questions? You can say yes to the test, or you can say no. It is up to you to decide. Will you allow (NAME(S) OF CHILD(REN) to participate in the anemia test? 2 0 2 0 2 0 236 | Appendix D WEIGHT, HEIGHT AND HEMOGLOBIN MEASUREMENT FOR CHILDREN AGE 0-5 CHILD 4 CHILD 5 CHILD 6 202 LINE NUMBER FROM COLUMN 11 LINE LINE LINE NUMBER . . . NUMBER . . . NUMBER . . . NAME FROM COLUMN 2 NAME NAME NAME 203 IF MOTHER INTERVIEWED, COPY MONTH AND YEAR FROM BIRTH DAY . . . . . . . . . . DAY . . . . . . . . . . DAY . . . . . . . . . . HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: MONTH . . . . . MONTH . . . . . MONTH . . . . . What is (NAME'S) birth date? YEAR YEAR YEAR 204 CHECK 203: YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 CHILD BORN IN JANUARY 2002 OR NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 LATER? (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT CHILD OR, IF NO CHILD OR, IF NO CHILD OR, IF NO MORE, GO TO 215) MORE, GO TO 215) MORE, GO TO 215) 205 WEIGHT IN KILOGRAMS KG. . . . . KG. . . . . KG. . . . . 206 HEIGHT IN CENTIMETERS CM. . CM. . CM. . 207 MEASURED LYING DOWN OR LYING DOWN . . . . . . . 1 LYING DOWN . . . . . . . 1 LYING DOWN . . . . . . . 1 STANDING UP? STANDING UP. . . . . . . 2 STANDING UP. . . . . . . 2 STANDING UP. . . . . . . 2 208 RESULT OF WEIGHT AND HEIGHT MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASUREMENT NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 209 CHECK 203: 0-5 MONTHS . . . . . . . 1 0-5 MONTHS . . . . . . . 1 0-5 MONTHS . . . . . . . 1 IS CHILD AGE 0-5 MONTHS, I.E., WAS (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT (GO TO 203 FOR NEXT CHILD BORN IN MONTH OF CHILD OR, IF NO CHILD OR, IF NO CHILD OR, IF NO INTERVIEW OR FIVE PREVIOUS MORE, GO TO 215) MORE, GO TO 215) MORE, GO TO 215) MONTHS? OLDER . . . . . . . . . . . . 2 OLDER . . . . . . . . . . . . 2 OLDER . . . . . . . . . . . . 2 210 LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR THE LINE LINE LINE CHILD (COLUMN 1) NUMBER . . . NUMBER . . . NUMBER . . . RECORD '00' IF NOT LISTED. 211 READ CONSENT STATEMENT GRANTED 1 GRANTED 1 GRANTED 1 TO PARENT/OTHER ADULT RESPONSIBLE FOR CHILD. (SIGN) (SIGN) (SIGN) CIRCLE CODE AND SIGN. REFUSED . . . . . . . . . . 2 REFUSED . . . . . . . . . . 2 REFUSED . . . . . . . . . . 2 (IF REFUSED, GO TO 213) (IF REFUSED, GO TO 213) (IF REFUSED, GO TO 213) 212 RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET G/DL . . G/DL . . G/DL . . 213 RECORD RESULT CODE OF MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 MEASURED . . . . . . . 1 HEMOGLOBIN MEASUREMENT NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 NOT PRESENT . . . . . 2 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 REFUSED . . . . . . . . . . 3 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . 6 214 GO BACK TO 203 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, GO TO 215. 2 0 2 0 2 0 237Appendix D | WEIGHT, HEIGHT AND HEMOGLOBIN MEASUREMENT TESTING FOR WOMEN AGE 15-49 215 CHECK COLUMN 10. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 216. IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S). A FINAL OUTCOME MUST BE RECORDER FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 219 AND FOR THE ANEMIA TEST PROCEDURE IN 227 WOMAN 1 WOMAN 2 WOMAN 3 216 LINE NUMBER LINE LINE LINE (COLUMN 10) NUMBER . . . . . . . . . . NUMBER . . . . . . . . . . . . NUMBER . . . . . . . . . . . . NAME (COLUMN 2) NAME NAME NAME 217 WEIGHT IN KILOGRAMS KG. . . . . . . . . KG. . . . . . . KG. . . . . . . 218 HEIGHT IN CENTIMETERS CM. . . . . . . . . CM. . . . . . . CM. . . . . . . 219 RESULT OF MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1 WEIGHT NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2 AND HEIGHT REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3 MEASUREMENT OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6 220 AGE: CHECK 15-17 YEARS . . . . . . . . . . . . . . . . 1 15-17 YEARS . . . . . . . . . . . . . . . . 1 15-17 YEARS . . . . . . . . . . . . . . . . . . 1 COLUMN 7. 18-49 YEARS . . . . . . . . . . . . . . . . 2 18-49 YEARS . . . . . . . . . . . . . . . . 2 18-49 YEARS . . . . . . . . . . . . . . . . . . 2 (GO TO 223) (GO TO 223) (GO TO 223) 221 MARITAL STATUS: CODE 1 (NEVER MARRIED. . . . . 1 CODE 1 (NEVER MARRIED. . . . . 1 CODE 1 (NEVER MARRIED. . . . . . . 1 CHECK COLUMN 8. CODES 2-5 (EVER MARRIED . . . 2 CODES 2-5 (EVER MARRIED . . . 2 CODES 2-5 (EVER MARRIED . . . . . 2 (GO TO 223) (GO TO 223) (GO TO 223) 222 FROM COLUMN 1 RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPON- SIBLE FOR LINE NUMBER OF LINE NUMBER OF LINE NUMBER OF ADOLESCENT. PARENT OR OTHER PARENT OR OTHER PARENT OR OTHER RECORD '00' RESPONSIBLE ADULT . RESPONSIBLE ADULT . RESPONSIBLE ADULT . IF NOT LISTED. 223 READ ANEMIA GRANTED . . . . . . . . . . . . . . . . . . 1 GRANTED . . . . . . . . . . . . . . . . . . 1 GRANTED . . . . . . . . . . . . . . . . . . 1 TEST CONSENT PARENT/OTHER RESPONSIBLE PARENT/OTHER RESPONSIBLE PARENT/OTHER RESPONSIBLE STATEMENT. FOR ADULT REFUSED . . . . . . . . . . . . 2 ADULT REFUSED . . . . . . . . . . . . 2 ADULT REFUSED . . . . . . . . . . . . 2 NEVER-IN-UNION RESPONDENT RESPONDENT RESPONDENT WOMEN REFUSED . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . 3 AGE 15-17, ASK CONSENT FROM PARENT/OTHER (SIGN) (SIGN) (SIGN) ADULT IDENTIFIED IN 222 BEFORE (IF REFUSED, GO TO 227). (IF REFUSED, GO TO 227). (IF REFUSED, GO TO 227). ASKING RESPON- DENT'S CONSENT. CONSENT STATEMENT FOR ANEMIA TEST READ CONSENT STATEMENT TO EACH RESPONDENT. CIRCLE CODE '1' IN 223 IF RESPONDENT CONSENTS TO THE ANEMIA TEST AND CODE '3' IF SHE REFUSES. FOR NEVER-IN-UNION WOMEN AGE 15-17, ASK CONSENT FROM THE PARENT OR OTHER ADULT IDENTIFIED AS RESPONSIBLE FOR THE ADOLESCENT (SEE QUESTION 222) BEFORE ASKING THE ADOLESCENT FOR HER CONSENT. CIRCLE CODE '2' IN 223 IF THE PARENT (OTHER ADULT) REFUSES. CONDUCT THE TEST ONLY IF BOTH THE PARENT (OTHER ADULT) AND THE ADOLESCENT CONSENT. As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia. For the anemia testing, we will need a few drops of blood from a finger. The equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result told to you right away. The result will be kept confidential. Do you have any questions? You can say yes to the test, or you can say no. It is up to you to decide. Will you (allow NAME OF ADOLESCENT to) take the anemia test? 238 | Appendix D WOMAN 1 WOMAN 2 WOMAN 3 LINE NUMBER LINE LINE LINE (COLUMN 10) NUMBER . . . . . . . . . . NUMBER . . . . . . . . . . . . NUMBER . . . . . . . . . . . . NAME (COLUMN 2) NAME NAME NAME 224 PREGNANCY STATUS: CHECK COLUMN 8: YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF EVER MARRIED NO/DK . . . . . . . . . . . . . . . . . . . . . . . . 2 NO/DK . . . . . . . . . . . . . . . . . . . . . . . . 2 NO/DK . . . . . . . . . . . . . . . . . . . . . . . . 2 (CODES 2-5), ASK: Are you pregnant? NEVER MARRIED . . . . . . . . . . . . . . 3 NEVER MARRIED . . . . . . . . . . . . . . 3 NEVER MARRIED . . . . . . . . . . . . . . 3 IF NEVER MARRIED (CODE 1), CIRCLE '3' 225 CHECK 223 AND PREPARE EQUIPMENT AND SUPPLIES FOR THE TEST FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST. A FINAL OUTCOME FOR THE THE ANEMIA TEST PROCEDURE MUST BE RECORDED IN 227 FOR EACH ELIGIBLE WOMAN EVEN IF SHE WAS NOT PRESENT, REFUSED, OR COULD NOT BE TESTED FOR SOME OTHER REASON. 226 RECORD HEMO- GLOBIN LEVEL G/DL . . . . . . . . . . . G/DL . . . . . . . . . . . G/DL . . . . . . . . . . . HERE AND IN ANEMIA PAMPHLET 227 RECORD RESULT MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1 MEASURED . . . . . . . . . . . . . . . . . . 1 CODE OF HEMO- NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2 NOT PRESENT . . . . . . . . . . . . . . . . 2 GLOBIN MEASURE- REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3 REFUSED . . . . . . . . . . . . . . . . . . . . 3 MENT. OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . . . . . . . . . . . . . . . . . . . . . 6 239Appendix D | 9 JUNE 2007 The Hashemite Kingdom of Jordan Department of Statistics JORDAN POPULATION AND Household Survey Directorate FAMILY HEALTH SURVEY 2007 Survey Contents Confidential by Statistical Law IDENTIFICATION QUESTIONNAIRE No.: . . . . . . . . . . . . . . GOVERNORATE: BLOCK No.: . . . . . . . . . . . . . . . . . . . . DISTRICT: BUILDING No.: SUB-DISTRICT: HOUSING UNIT No.: LOCALITY: CLUSTER No.: . . . . . . . . . . . . . . . . . . AREA: HOUSEHOLD No.: . . . . . . . . . . . . . . . . SUB-AREA: TELEPHONE/ STRATUM: MOBILE No. (if available) URBAN/RURAL (Urban=1; Rural=2) NAME AND LINE NUMBER OF WOMAN: WOMAN SELECTED FOR DOMESTIC VIOLENCE SECTION (YES = 1; NO = 2) . . . . . . . . . . . . . . . . . . . . . . INTERVIEWER VISITS FINAL VISIT DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. NUMBER RESULT* RESULT NEXT VISIT: DATE TOTAL NUMBER TIME OF VISITS *RESULT CODES: 1 COMPLETED 4 REFUSED 7 OTHER 2 NOT AT HOME 5 PARTLY COMPLETED 3 POSTPONED 6 INCAPCITATED SUPERVISOR FIELD EDITOR NAME NAME DATE DATE 3 2 WOMAN'S QUESTIONNAIRE (SPECIFY) 1 2 EDITOR OFFICE KEYED BY 0 0 7 241Appendix D | SECTION 1. RESPONDENT'S BACKGROUND INTRODUCTION AND CONSENT INFORMED CONSENT Hello. My name is _______________________________________ and I am working with the Department of Statistics. We are conducting a national survey that asks women about the health of women and their children. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The interview usually takes about 40 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important. At this time, do you want to ask me anything about the survey? May I begin the interview now? Signature of interviewer: Date: RESPONDENT AGREES TO BE INTERVIEWED . . . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . 2 END NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. HOUR . . . . . . . . . . . . . . . . . . . . MINUTE . . . . . . . . . . . . . . . . . 101A What is your marital status now: are you married, widowed, divorced, or separated? MARRIED . . . . . . . . . . . . . . . . . . . . . . 1 DIVORCED . . . . . . . . . . . . . . . . . . . . . . 2 IF THE WOMAN IS NOT MARRIED, WIDOWED, DIVORCED OR WIDOWED . . . . . . . . . . . . . . . . . . . . . . 3 SEPARATED, END THE INTERVIEW, AND CORRECT MARITAL SEPARATED . . . . . . . . . . . . . . . . . . . . 4 STATUS AND ELIGIBILITY IN THE HOUSEHOLD QUESTIONNAIRE NEVER MARRIED . . . . . . . . . . . . . . . . 5 END 102 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? YEARS . . . . . . . . . . . . . . . . . . IF LESS THAN ONE YEAR, RECORD '00' YEARS. ALWAYS . . . . . . . . . . . . . . . . . . . . . . 95 VISITOR . . . . . . . . . . . . . . . . . . . . . . 96 104 In what month and year were you born? MONTH . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . DON'T KNOW YEAR . . . . . . . . . . . . 9998 105 How old were you at your last birthday? AGE IN COMPLETED YEARS COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT. 106 Have you ever attended school? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 113 107 What is the highest level of school you attended: OLD SYSTEM Old elementary, old preparatory, old secondary, new basic, ELEMENTARY . . . . . . . . . . . . . . . . . . 1 new secondary, intermediate diploma, bachelor, or higher? PREPARATORY . . . . . . . . . . . . . . . . 2 SECONDARY . . . . . . . . . . . . . . . . . . 3 NEW SYSTEM BASIC . . . . . . . . . . . . . . . . . . . . . . . . 4 SECONDARY . . . . . . . . . . . . . . . . . . 5 INTERMEDIATE DIPLOMA . . . . . . . . . . 6 BACHELOR . . . . . . . . . . . . . . . . . . . . 7 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . 8 242 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 108 What is the highest grade you completed at that level? GRADE . . . . . . . . . . . . . . . . . . 113 Do you read a newspaper or magazine almost every day, ALMOST EVERY DAY . . . . . . . . . . . . . . 1 3-5 times a week, once or twice a week, once a month, few 3-5 TIMES A WEEK . . . . . . . . . . . . . . . . 2 times a year, or never? ONCE OR TWICE A WEEK . . . . . . . . . . 3 ONCE A MONTH . . . . . . . . . . . . . . . . . 4 FEW TIMES A YEAR . . . . . . . . . . . . . . 5 NEVER. . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CANNOT READ/ILLITERATE . . . . . . . . 7 114 Do you listen to the radio almost every day, at least once a ALMOST EVERY DAY . . . . . . . . . . . . . . 1 week, at least once a month, few times a year, or never? AT LEAST ONCE A WEEK . . . . . . . . . . 2 AT LEAST ONCE A MONTH . . . . . . . . 3 FEW TIMES A YEAR . . . . . . . . . . . . . . 4 NEVER. . . . . . . . . . . . . . . . . . . . . . . . . . . 5 115 Do you watch television almost every day, at least once a ALMOST EVERY DAY . . . . . . . . . . . . . . 1 week, at least once a month, few times a year, or never? AT LEAST ONCE A WEEK . . . . . . . . . . 2 AT LEAST ONCE A MONTH . . . . . . . . 3 FEW TIMES A YEAR . . . . . . . . . . . . . . 4 NEVER. . . . . . . . . . . . . . . . . . . . . . . . . . . 5 243Appendix D | SECTION 2. REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Now I would like to ask about all the births you have had during YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 your life. Have you ever given birth? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 202 Do you have any sons or daughters to whom you have given YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 birth who are now living with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 204 203 How many sons live with you? SONS AT HOME . . . . . . . . . . . . And how many daughters live with you? DAUGHTERS AT HOME . . . . . IF NONE, RECORD '00'. 204 Do you have any sons or daughters to whom you have given YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 birth who are alive but do not live with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 205 How many sons are alive but do not live with you? SONS ELSEWHERE . . . . . . . . And how many daughters are alive but do not live with you? DAUGHTERS ELSEWHERE . IF NONE, RECORD '00'. 206 Have you ever given birth to a boy or girl who was born alive but later died? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF NO, PROBE: Any baby who cried or showed signs of life but NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 208 did not survive? 207 How many boys have died? BOYS DEAD . . . . . . . . . . . . . . And how many girls have died? GIRLS DEAD . . . . . . . . . . . . . . IF NONE, RECORD '00'. 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'. TOTAL . . . . . . . . . . . . . . . . . . . . 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct? PROBE AND YES NO CORRECT 201-208 AS NECESSARY. 210 CHECK 208: ONE OR MORE NO BIRTHS BIRTHS 226 244 | Appendix D 211 Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW). IF ALIVE: IF ALIVE: IF ALIVE: IF DEAD: What name Were Is In what month Is How old was Is (NAME) RECORD How old was (NAME) Were there was given to any of (NAME) and year was (NAME) (NAME) at living with HOUSE- when he/she died? any other your these a boy or (NAME) born? still his/her last you? HOLD LINE live births (first/next) births a girl? alive? birthday? NUMBER OF IF '1 YR', PROBE: between baby? twins? PROBE: CHILD How many months old (NAME OF What is his/her RECORD (RECORD '00' was (NAME)? PREVIOUS birthday? AGE IN COM- IF CHILD NOT RECORD DAYS IF BIRTH) and PLETED LISTED IN LESS THAN 1 (NAME), YEARS. HOUSE- MONTH; MONTHS IF including IF LESS THAN HOLD). LESS THAN TWO any children 1 YEAR, YEARS; OR YEARS. who died RECORD '00' after birth? 01 MONTH LINE NUMBER DAYS . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 YEAR MONTHS 2 MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 (NEXT BIRTH) YEARS . . 3 220 02 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 03 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 04 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 05 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 06 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 07 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 214 215 216 217 220 221218 219 AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS 212 213 (NAME) AGE IN YEARS AGE IN YEARS 245Appendix D | IF ALIVE: IF ALIVE: IF ALIVE: IF DEAD: What name Were Is In what month Is How old was Is (NAME) RECORD How old was (NAME) Were there was given to any of (NAME) and year was (NAME) (NAME) at living with HOUSE- when he/she died? any other your next these a boy or (NAME) born? still his/her last you? HOLD LINE live births baby? births a girl? alive? birthday? NUMBER OF IF '1 YR', PROBE: between twins? PROBE: CHILD How many months old (NAME OF What is his/her RECORD (RECORD '00' was (NAME)? PREVIOUS birthday? AGE IN COM- IF CHILD NOT RECORD DAYS IF BIRTH) and PLETED LISTED IN LESS THAN 1 (NAME), YEARS. HOUSE- MONTH; MONTHS IF including IF LESS THAN HOLD). LESS THAN TWO any children 1 YEAR, YEARS; OR YEARS. who died RECORD '00' after birth? 08 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 09 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 10 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 11 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 12 MONTH LINE NUMBER DAYS . . . 1 YES . . . . 1 SING 1 BOY 1 YES . . 1 YES . . . 1 ADD YEAR MONTHS 2 BIRTH MULT 2 GIRL 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 (GO TO 221) YEARS . . 3 NEXT 220 BIRTH 222 Have you had any live births since the birth of (NAME OF LAST YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE. NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 223 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS NUMBERS ARE ARE SAME DIFFERENT (PROBE AND RECONCILE) CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH BIRTH SINCE JANUARY 2002: MONTH AND YEAR OF BIRTH ARE RECORDED. FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. 224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2002 OR LATER. IF NONE, RECORD '0' AND SKIP TO 226. 221220217216 218 219215214213212 AGE IN YEARS (NAME) AGE IN YEARS YEARS AGE IN AGE IN AGE IN YEARS YEARS 246 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 225 FOR EACH BIRTH SINCE JANUARY 2002, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) 226 Are you pregnant now? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . 8 229 227 How many months pregnant are you? MONTHS . . . . . . . . . . . . . . . . . . . . . . RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COULMN 1 OF THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS. 228 At the time you became pregnant, did you want to become THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pregnant then, did you want to wait until later, or did you not want LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 to have any (more) children at all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 229 Have you ever had a pregnancy that miscarried, was aborted, or YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ended in a stillbirth? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 237 229A The last time you had a such pregnancy, did the pregnancy end MISCARRIAGE . . . . . . . . . . . . . . . . . . 1 in a miscarriage, an induced abortion or a stillbirth? INDUCED ABORTION . . . . . . . . . . . . . . 2 STILLBIRTH . . . . . . . . . . . . . . . . . . . . . . 3 230 When did the last such pregnancy end? MONTH . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . 231 CHECK 230: LAST PREGNANCY LAST PREGNANCY ENDED IN ENDED BEFORE 237 JAN. 2002 OR LATER JAN. 2002 231A Did this (MISCARRIAGE/ABORTION/STILLBIRTH - FROM Q.229A) HEALTH FACILITY . . . . . . . . . . . . . . . . 1 231D last such pregnancy take place in a health facility, YOUR HOME/OTHER HOME . . . . . . . . 2 at home, or in another place? OTHER PLACE 6 (SPECIFY) 231B Did you seek care for this (MISCARRIAGE/ABORTION/ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 STILLBIRTH - FROM Q.229A)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 232 231C Where did you go for this (MISCARRIAGE/ABORTION/ PUBLIC MEDICAL SECTOR STILLBIRTH - FROM Q.229A)? GOVT. HOSPITAL . . . . . . . . . . . . 11 GOVT. HEALTH CENTER . . . . . . . . 12 231D In which type of health facility did you go? UNIVERSITY HOSPITAL . . . . . . . . . . 13 ROYAL MEDICAL HOSPITAL . . . . . 14 PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. OTHER PUBLIC 16 IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER PRIVATE MEDICAL SECTOR OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE PRIVATE HOSPITAL/CLINIC . . . . . 21 THE NAME OF THE PLACE. OTHER PRIVATE MEDICAL 26 (NAME OF PLACE) _ _ _ _ _ _ _ _ _ _ _ _ ________________ (SPECIFY) ________________ (SPECIFY) 247Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 232 How many months pregnant were you when the last such pregnancy ended? NUMBER OF MONTHS . . . . . RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COL. 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS. 233 Since January 2002, have you had any other pregnancies YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 that did not result in a live birth? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 235 233A Since January 2002, how many other pregnancies that did not result in a live birth have you had? NUMBER OF PREGNANCIES . 234 ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2002. ENTER 'T' IN COLUMN 1 OF THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS. 235 Did you have any miscarriages, abortions or stillbirths that YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ended before 2002? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 237 236 When did the last such pregnancy that terminated before 2002 end? MONTH . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . 237 When did your last menstrual period start? DAYS AGO . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . 2 MONTHS AGO . . . . . . . . 3 (DATE, IF GIVEN) YEARS AGO . . . . . . . . . . 4 IN MENOPAUSE/ HAS HAD HYSTERECTOMY . . . 994 BEFORE LAST BIRTH . . . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . . . 996 238 From one menstrual period to the next, are there certain days YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 when a woman is more likely to become pregnant if she has NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 sexual intercourse? DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 301 239 Is this time just before her period begins, during her period, right JUST BEFORE HER PERIOD after her period has ended, or halfway between two periods? BEGINS . . . . . . . . . . . . . . . . . . . . . . 1 DURING HER PERIOD . . . . . . . . . . . . 2 RIGHT AFTER HER PERIOD HAS ENDED . . . . . . . . . . . . 3 HALFWAY BETWEEN TWO PERIODS . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 ________________________ 248 | Appendix D SECTION 3. CONTRACEPTION 301 Now I would like to talk about family planning - the various ways or methods that 302 Have you ever used a couple can use to delay or avoid a pregnancy. (METHOD)? Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)? CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302. 01 FEMALE STERILIZATION Women can have an operation to avoid YES . . . . . . . . . . . . . 1 Have you ever had an operation to having any more children. NO . . . . . . . . . . . . . 2 avoid having any more children? YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 02 MALE STERILIZATION Men can have an operation to avoid having YES . . . . . . . . . . . . . 1 Have you ever had a husband who any more children. NO . . . . . . . . . . . . . 2 had an operation to avoid having any more children? YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 03 PILL Women can take a pill every day to avoid becoming pregnant. YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 04 IUD Women can have a loop or coil placed inside them by a doctor or YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 a midwife. NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 05 INJECTABLES Women can have an injection by a health provider YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 that stops them from becoming pregnant usually for 3 months. NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 06 IMPLANTS Women can have several small rods placed in their upper YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 arm by a doctor or nurse which can prevent pregnancy usually for NO . . . . . . . . . . . . . 2 3 years. NO . . . . . . . . . . . . . . . . . . 2 07 CONDOM Men can put a rubber sheath on their penis before sexual YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 intercourse. NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 08 FEMALE CONDOM Women can place a sheath in their vagina before YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 sexual intercourse. NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 09 LACTATIONAL AMENORRHEA METHOD (LAM) YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 10 PERIODIC ABSTINENCE Every month that a woman is sexually YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 active she can avoid pregnancy by not having sexual intercourse on NO . . . . . . . . . . . . . 2 the days of the month she is most likely to get pregnant. NO . . . . . . . . . . . . . . . . . . 2 11 WITHDRAWAL Men can be careful and pull out before climax. YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 12 EMERGENCY CONTRACEPTION As an emergency measure after YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 unprotected sexual intercourse, women can take special pills at any NO . . . . . . . . . . . . . 2 time within five days to prevent pregnancy. NO . . . . . . . . . . . . . . . . . . 2 13 Have you heard of any other ways or methods that women or men can YES . . . . . . . . . . . . . 1 use to avoid pregnancy? YES . . . . . . . . . . . . . . . . . . 1 (SPECIFY) NO . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . 1 (SPECIFY) NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . 2 303 CHECK 302: NOT A SINGLE AT LEAST ONE "YES" "YES" 307 (NEVER USED) (EVER USED) 249Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 304 Have you ever used anything or tried in any way to delay or avoid YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 306 getting pregnant? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 305 ENTER '0' IN COLUMN 1 OF THE CALENDAR IN EACH BLANK MONTH. 333 306 What have you used or done? CORRECT 302 AND 303 (AND 301 IF NECESSARY). 307 Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. NUMBER OF CHILDREN . . . . . How many living children did you have at that time, if any? IF NONE, RECORD '00'. 308 CHECK 302 (01): WOMAN NOT WOMAN STERILIZED STERILIZED 311A 309 CHECK 226: NOT PREGNANT PREGNANT OR UNSURE 322 310 Are you currently doing something or using any method to delay YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or avoid getting pregnant? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 322 311 Which method are you using? FEMALE STERILIZATION . . . . . . . . . . A MALE STERILIZATION . . . . . . . . . . . . B CIRCLE ALL MENTIONED. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . C IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . D IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INJECTABLES . . . . . . . . . . . . . . . . . . E INSTRUCTION FOR HIGHEST METHOD IN LIST. IMPLANTS . . . . . . . . . . . . . . . . . . . . . . F CONDOM . . . . . . . . . . . . . . . . . . . . . . G FEMALE CONDOM . . . . . . . . . . . . . . H 311A CIRCLE 'A' FOR FEMALE STERILIZATION. DIAPHRAGM . . . . . . . . . . . . . . . . . . . . I FOAM/JELLY . . . . . . . . . . . . . . . . . . . . J LACTATIONAL AMEN. METHOD . . . K PERIODIC ABSTINENCE . . . . . . . . . . L WITHDRAWAL . . . . . . . . . . . . . . . . . . M OTHER ______________________ X (SPECIFY) 311B Who advised you to use this method? NO ONE . . . . . . . . . . . . . . . . . . . . . . . . 01 IF MORE THAN ONE METHOD CIRCLED IN 311/311A, THIS DOCTOR . . . . . . . . . . . . . . . . . . . . . . 02 QUESTION SHOULD REFER TO THE HIGHEST METHOD NURSE . . . . . . . . . . . . . . . . . . . . . . 03 IN THE LIST. MIDWIFE . . . . . . . . . . . . . . . . . . . . . . 04 HUSBAND . . . . . . . . . . . . . . . . . . . . . . 05 MOTHER/MOTHER IN LAW . . . . . . . . . . 06 OTHER RELATIVE . . . . . . . . . . . . . . 07 FRIENDS . . . . . . . . . . . . . . . . . . . . . . 08 NEIGHBOURS . . . . . . . . . . . . . . . . . . . . 09 OTHER ______________________ 96 (SPECIFY) 311C CHECK 311/311A: FEMALE STERILIZATION . . . . . . . A MALE STERILIZATION . . . . . . . . . . B 316 CIRCLE METHOD(S) CODE PILL . . . . . . . . . . . . . . . . . . . . . . . . . . C IUD . . . . . . . . . . . . . . . . . . . . . . . . . . D INJECTABLES . . . . . . . . . . . . . . . . . . E 315 IMPLANTS . . . . . . . . . . . . . . . . . . . . F CONDOM . . . . . . . . . . . . . . . . . . . . G 314 FEMALE CONDOM . . . . . . . . . . . . . . H DIAPHRAGM . . . . . . . . . . . . . . . . . . I 315 FOAM/JELLY . . . . . . . . . . . . . . . . . . J LACTATIONAL AMEN. METHOD . . . K PERIODIC ABSTINENCE . . . . . . . . . . L 319A WITHDRAWAL . . . . . . . . . . . . . . . . M OTHER METHOD . specify X 250 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 312 May I see the package of pills you are using? PACKAGE SEEN CERAZETTE . . . . . . . . . . 11 IF PACKAGE SEEN RECORD CODE OF BRAND USING OVRETTE . . . . . . . . . . . . 12 THE FIRST LIST OF CODES LOFEMENAL 13 MICROGYNON 14 YASMIN . . . . . . . . . . . . . . . . . . 15 IF PACKAGE NOT SEEN, ASK: OTHER . . . . . . . . . . . . . . . . . . . . . . 16 Do you know the brand name of the pills you are using? PACKAGE NOT SEEN CERAZETTE . . . . . . . . . . 21 OVRETTE . . . . . . . . . . . . 22 RECORD CODE OF BRAND USING THE SECOND LIST OF LOFEMENAL 23 CODES. MICROGYNON 24 YASMIN . . . . . . . . . . . . . . . . . . 25 OTHER . . . . . . . . . . . . . . . . . . . . . . 26 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 314 RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311. YES (USING NO (USING NUMBER OF PILL PILL) CONDOM BUT CYCLES/CONDOMS . . NOT PILL) The last time you obtained The last time you obtained DON'T KNOW . . . . . . . . . . . . . . . . . . 998 the pills, how many pill cycles the condoms, how many did you get? condoms did you get? 315 The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method COST IN JD . . . . . . . . . . . . and any consultation you may have had? FREE . . . . . . . . . . . . . . . . . . . . . . . . 995 IF MORE THAN 990 JD, RECORD 990 DON'T KNOW . . . . . . . . . . . . . . . . . . 998 315A CHECK 311: USING IUD NOT USING IUD CODE 'D' CIRCLED CODE 'D' 319A NOT CIRCLED 315B Who inserted your IUD? MALE DOCTOR . . . . . . . . . . . . . . . . . . 1 FEMALE DOCTOR . . . . . . . . . . . . . . . . 2 MIDWIFE . . . . . . . . . . . . . . . . . . . . . . . . 3 319A OTHER ______________________ 6 (SPECIFY) 316 In what facility did the sterilization take place? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . 11 PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE UNIVERSITY HOSPITAL . . . . . . . 12 THE APPROPRIATE CODE. ROYAL MEDICAL SERVICES 13 OTHER PUBLIC 16 (SPECIFY) IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER PRIVATE MEDICAL SECTOR OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE PRIVATE HOSPITAL/CLINIC . . . 21 THE NAME OF THE PLACE. OTHER PRIVATE MEDICAL 26 (SPECIFY) (NAME OF PLACE) DON'T KNOW . . . . . . . . . . . . . . . . . . 98 317 CHECK 311/311A: CODE 'A' CODE 'B' CIRCLED CIRCLED Before your sterilization Before the sterilization operation, YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 operation, were you told was your husband told NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 that you would not be able that he would not be able to DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 to have any (more) children have any (more) children because of the operation? because of the operation? 318 How much was paid in total for the sterilization, including any consultation you (he) may have had? COST IN JD . . . . . . . . . . . . IF MORE THAN 990 JD, RECORD 990 FREE . . . . . . . . . . . . . . . . . . . . . . . . 995 DON'T KNOW . . . . . . . . . . . . . . . . . . 998 251Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 318A Do you regret that you had the operation not to have any (more) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 children? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 319 In what month and year was the sterilization performed? 319A Since what month and year have you been using (CURRENT MONTH . . . . . . . . . . . . . . . . . . METHOD) without stopping? YEAR . . . . . . . . . . . . PROBE: For how long have you been using (CURRENT METHOD) now without stopping? 320 CHECK 319/319A, 215 AND 230: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YES NO YEAR OF START OF USE OF CONTRACEPTION IN 319/319A GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION). 321 CHECK 319/319A: YEAR IS 2002 OR LATER YEAR IS 2001 OR EARLIER ENTER CODE FOR METHOD USED IN MONTH OF ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN INTERVIEW IN COL. 1 OF THE CALENDAR AND EACH MONTH BACK TO THE DATE STARTED USING. EACH MONTH BACK TO JANUARY 2002 THEN SKIP TO 322 I would like to ask you some questions about the times you or your husband may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2002. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COULMN 1: ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH. ILLUSTRATIVE QUESTIONS: COLUMN 1: * When was the last time you used a method? Which method was that? * When did you start using that method? How long after the birth of (NAME)? * How long did you use the method then? IN COLUMN 2: ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COL.2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COL.1 ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. ILLUSTRATIVE QUESTIONS: COLUMN 2: * Why did you stop using the (METHOD)? * Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER ‘0’ IN EACH SUCH MONTH IN COLUMN 1 323 CHECK 311/311A: NO CODE CIRCLED . . . . . . . . . . . . 00 333 FEMALE STERILIZATION . . . . . . . 01 326 CIRCLE METHOD CODE: MALE STERILIZATION . . . . . . . . . . 02 335 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, IUD . . . . . . . . . . . . . . . . . . . . . . . . . . 04 CIRCLE CODE FOR HIGHEST METHOD IN LIST. INJECTABLES . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . 10 LACTATIONAL AMEN. METHOD . . . 11 324A PERIODIC ABSTINENCE . . . . . . . . . . 12 324A WITHDRAWAL . . . . . . . . . . . . . . . . 13 335 OTHER METHOD . . . . . . . . . . . . . . 96 335 331 252 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 324 Where did you obtain (CURRENT METHOD) when you started PUBLIC MEDICAL SECTOR using it? GOVT. HOSPITAL . . . . . . . . . . . . 11 GOVT. HEALTH CENTER . . . . . 12 GOVT. MCH . . . . . . . . . . . . . . . . 13 UNIVERSITY HOSPITAL . . . . . . . 14 ROYAL MEDICAL SERVICES . . . 15 OTHER PUBLIC ______________ 16 (SPECIFY) 324A Where did you learn how to use priodic abstinence/the lactational PRIVATE MEDICAL SECTOR amenorhea method? PRIVATE HOSPITAL/CLINIC . . . 21 PRIVATE DOCTOR . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . 23 IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR JORDANIAN AS. OF FP AND CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF PROTECTION (JAFPP) . . . . . 24 THE PLACE. UNRWA CLINIC . . . . . . . . . . . . . . 25 OTHER NON-GOV ORGANIZATION 26 OTHER PRIVATE MEDICAL 27 (NAME OF PLACE) (SPECIFY) OTHER SOURCE FRIEND/RELATIVE . . . . . . . . . . . . 33 OTHER ______________________ 96 (SPECIFY) 325 CHECK 311/311A: PILL . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . 04 CIRCLE METHOD CODE: INJECTABLES . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . 06 IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CONDOM . . . . . . . . . . . . . . . . . . . . 07 332 CIRCLE CODE FOR HIGHEST METHOD IN LIST. FEMALE CONDOM . . . . . . . . . . . . . . 08 329 DIAPHRAGM . . . . . . . . . . . . . . . . . . 09 329 FOAM/JELLY . . . . . . . . . . . . . . . . . . 10 329 LACTATIONAL AMEN. METHOD . . . 11 335 PERIODIC ABSTINENCE . . . . . . . . . . 12 335 326 You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 328 that time, were you told about side effects or problems you NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 might have with the method? 327 Were you ever told by a health or family planning worker about YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 side effects or problems you might have with the method? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 329 328 Were you told what to do if you experienced side effects YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or problems? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 329 CHECK 326: CODE '1' CODE '1' CIRCLED NOT CIRCLED At that time, were you told When you obtained (CURRENT about other methods of family METHOD FROM 323) from planning that you could use? (SOURCE OF METHOD FROM 316 OR 324) were you told YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 331 about other methods of family NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 planning that you could use? 330 Were you ever told by a health or family planning worker about YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 other methods of family planning that you could use? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 253Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 331 CHECK 311/311A: FEMALE STERILIZATION . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . 02 335 CIRCLE METHOD CODE: PILL . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . 04 IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, INJECTABLES . . . . . . . . . . . . . . . . . . 05 CIRCLE CODE FOR HIGHEST METHOD IN LIST. IMPLANTS . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . 10 LACTATIONAL AMEN. METHOD . . . 11 PERIODIC ABSTINENCE . . . . . . . 12 WITHDRAWAL . . . . . . . . . . . . . . . . 13 335 OTHER METHOD . . . . . . . . . . . . . . 96 332 Where did you obtain (CURRENT METHOD) the last time? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . 11 PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE GOVT. HEALTH CENTER . . . . . 12 THE APPROPRIATE CODE. GOVT. MCH . . . . . . . . . . . . . . . . 13 UNIVERSITY HOSPITAL/CLINIC 14 IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER ROYAL MEDICAL SERVICES 15 OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE OTHER PUBLIC ________________ 16 THE NAME OF THE PLACE. (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . 21 (NAME OF PLACE) PRIVATE DOCTOR . . . . . . . . . . . . 22 335 PHARMACY . . . . . . . . . . . . . . . . . . 23 JORDANIAN AS. OF FP AND PROTECTION (JAFPP) . . . . . 24 UNRWA CLINIC . . . . . . . . . . . . . . 25 OTHER NON-GOV ORGANIZATION 26 OTHER PRIVATE MEDICAL 27 (SPECIFY) OTHER SOURCE FRIEND/RELATIVE . . . . . . . . . . . . 33 OTHER ______________________ 96 (SPECIFY) 333 Do you know of a place where you can obtain a method of family YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 planning? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 335 334 Where is that? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . . . A Any other place? GOVT. HEALTH CENTER . . . . . . . B GOVT. MCH . . . . . . . . . . . . . . . . . . C PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE UNIVERSITY HOSPITAL/CLINIC . . . D THE APPROPRIATE CODE(S). ROYAL MEDICAL SERVICES . . . . . E OTHER PUBLIC ________________ F (SPECIFY) IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER PRIVATE MEDICAL SECTOR OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE PRIVATE HOSPITAL/CLINIC . . . . . G THE NAME OF THE PLACE. PRIVATE DOCTOR . . . . . . . . . . . . . . H PHARMACY . . . . . . . . . . . . . . . . . . . . I JORDANIAN AS. OF FP AND (NAME OF PLACE(S)) PROTECTION (JAFPP) . . . . . J UNRWA CLINIC . . . . . . . . . . . . . . K OTHER NON-GOV ORGANIZATION L OTHER PRIVATE MEDICAL M (SPECIFY) OTHER SOURCE FRIEND/RELATIVE . . . . . . . . . . . . . . N OTHER ________________________ X (SPECIFY) 254 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 335 In the last 12 months, were you visited by a health worker who YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 talked to you about family planning? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 336 In the last 12 months, have you visited a health facility for care YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 for yourself (or your children)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 401 337 Did any staff member at the health facility speak to you about YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 family planning methods? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 255Appendix D | SECTION 4. PREGNANCY AND POSTNATAL CARE 401 CHECK 224: ONE OR MORE NO 548 BIRTHS BIRTHS IN 2002 OR LATER IN 2002 OR LATER 402 CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES). Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.) 403 LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH LINE NUMBER FROM 212 LINE NO. LINE NO. LINE NO. 404 NAME ________________ NAME ________________ NAME _________________ FROM 212 AND 216 LIVING DEAD LIVING DEAD LIVING DEAD 405 At the time you became pregnant THEN . . . . . . . . . . . . 1 THEN . . . . . . . . . . . . 1 THEN . . . . . . . . . . . . 1 with (NAME), did you want to (SKIP TO 407) (SKIP TO 426) (SKIP TO 426) become pregnant then, did you LATER . . . . . . . . . . . . 2 LATER . . . . . . . . . . . . 2 LATER . . . . . . . . . . . . 2 want to wait until later, or did you not want to have any (more) NOT AT ALL . . . . . 3 NOT AT ALL . . . . . 3 NOT AT ALL . . . . . 3 children at all? (SKIP TO 407) (SKIP TO 426) (SKIP TO 426) 406 How much longer would you have liked to wait? MONTHS MONTHS MONTHS YEARS YEARS YEARS DON'T KNOW . . . 998 DON'T KNOW . . . 998 DON'T KNOW . . . 998 407 Did you see anyone for antenatal HEALTH PERSONNEL care for this pregnancy? DOCTOR . . . . . . . . A NURSE/MIDWIFE B IF YES: Whom did you see? OTHER PERSON Anyone else? X PROBE TO IDENTIFY EACH TYPE (SPECIFY) OF PERSON AND RECORD ALL NO ONE . . . . . . . . . . Y MENTIONED. (SKIP TO 414) 408 Where did you receive antenatal HOME care for this pregnancy? YOUR HOME . . . A OTHER HOME . . . B Anywhere else? PUBLIC MED. SECTOR GOVT. HOSPITAL C PROBE TO IDENTIFY TYPE(S) GOVT. HEALTH OF SOURCE(S) AND CIRCLE CENTER . . . . . D THE APPROPRIATE CODE(S). UNIVERSITY HOSPITAL . . . E IF UNABLE TO DETERMINE ROYAL MEDICAL SERVICES . . . F IF A HOSPITAL, HEALTH OTHER PUBLIC CENTER, OR CLINIC IS G PUBLIC OR PRIVATE (SPECIFY) MEDICAL, WRITE THE PRIVATE MED. SECTOR THE NAME OF THE PLACE. PVT. HOSPITAL/ CLINIC . . . . . . . . H UNRWA HEALTH CENTER . . . . . I OTHER PRIVATE (NAME OF PLACE(S)) MED. J (SPECIFY) OTHER X (SPECIFY) . .1 . .2 . .1 . .2 . .1 . .2 256 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 409 How many months pregnant were NUMBER OF you when you first received MONTHS . . . antenatal care for this pregnancy? DON'T KNOW . . . . . 98 410 How many times did you receive NUMBER antenatal care during this OF TIMES . pregnancy? DON'T KNOW . . . . . 98 411 As part of your antenatal care during this pregnancy, were any of the following done at least once? YES NO Were you weighed? WEIGHT . . . 1 2 Was your blood pressure measured? BP . . . . . . . . 1 2 Did you give a urine sample? URINE . . . . . 1 2 Did you give a blood sample? BLOOD . . . 1 2 412 During (any of) your antenatal YES . . . . . . . . . . . . . . 1 care visit(s), were you told about NO . . . . . . . . . . . . . . 2 the signs of pregnancy (SKIP TO 413A) complications? DON'T KNOW . . . . . 8 413 Were you told where to go if you YES . . . . . . . . . . . . . . 1 had any of these complications? NO . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . 8 413A During (any of) your antenatal YES . . . . . . . . . . . . . . 1 care visit(s), were you told about NO . . . . . . . . . . . . . . 2 the signs of complications during DON'T KNOW . . . . . 8 the postnatal period? 413B During (any of) your antenatal YES . . . . . . . . . . . . . . 1 care visit(s), were you told about NO . . . . . . . . . . . . . . 2 having postnatal care visits one DON'T KNOW . . . . . 8 week and 30 days after delivery? 414 During this pregnancy, were you YES . . . . . . . . . . . . . . 1 given an injection in the arm to prevent the baby from getting NO . . . . . . . . . . . . . . 2 tetanus, that is, convulsions (SKIP TO 417) after birth? DON'T KNOW . . . . . 8 415 During this pregnancy, how many times did you get this tetanus TIMES . . . . . . . . . . injection? DON'T KNOW . . . 8 416 CHECK 415: 2 OR MORE 1 OR DK TIMES (SKIP TO 421) 417 At any time before this pregnancy, YES . . . . . . . . . . . . . . 1 did you receive any tetanus NO . . . . . . . . . . . . . . 2 injections, either to protect (SKIP TO 421) yourself or another baby? DON'T KNOW . . . . . 8 418 Before this pregnancy, how many other times did you receive a TIMES . . . . . . . . . . tetanus injection? IF 7 OR MORE TIMES, DON'T KNOW . . . 8 RECORD '7'. 257Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 419 In what month and year did you receive the last tetanus injection MONTH . . . before this pregnancy? DK MONTH . . . . . . . . 98 YEAR (SKIP TO 421) DK YEAR . . . . . . . . 9998 420 How many years ago did you YEARS receive that tetanus injection? AGO . . . . . 421 During this pregnancy, were you YES . . . . . . . . . . . . . . 1 given or did you buy any iron tablets or iron syrup? NO . . . . . . . . . . . . . . 2 (SKIP TO 426) DON'T KNOW . . . . . 8 422 During the whole pregnancy, for how many days did you take the DAYS . tablets or syrup? DON'T KNOW . . . 998 IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS. 426 When (NAME) was born, was VERY LARGE . . . . . 1 VERY LARGE . . . . . 1 VERY LARGE . . . . . 1 he/she very large, larger than LARGER THAN LARGER THAN LARGER THAN average, average, smaller than AVERAGE . . . . . 2 AVERAGE . . . . . 2 AVERAGE . . . . . 2 average, or very small? AVERAGE . . . . . . . . 3 AVERAGE . . . . . . . . 3 AVERAGE . . . . . . . . 3 SMALLER THAN SMALLER THAN SMALLER THAN AVERAGE . . . . . 4 AVERAGE . . . . . 4 AVERAGE . . . . . 4 VERY SMALL . . . . . 5 VERY SMALL . . . . . 5 VERY SMALL . . . . . 5 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 427 Was (NAME) weighed at birth? YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 (SKIP TO 429) (SKIP TO 429) (SKIP TO 429) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 428 How much did (NAME) weigh? KG FROM CARD KG FROM CARD KG FROM CARD RECORD WEIGHT IN . . . KILOGRAMS FROM HEALTH CARD, IF AVAILABLE. KG FROM RECALL KG FROM RECALL KG FROM RECALL . . . DON'T KNOW . 99998 DON'T KNOW . 99998 DON'T KNOW . 99998 429 Who assisted with the delivery HEALTH PERSONNEL HEALTH PERSONNEL HEALTH PERSONNEL of (NAME)? DOCTOR . . . . . A DOCTOR . . . . . A DOCTOR . . . . . A NURSE/MIDWIFE . B NURSE/MIDWIFE . B NURSE/MIDWIFE . B Anyone else? PROBE FOR THE TYPE(S) OF OTHER PERSON X OTHER PERSON X OTHER PERSON X PERSON(S) AND RECORD ALL MENTIONED. (SPECIFY) (SPECIFY) (SPECIFY) (SKIP TO 430) (SKIP TO 430) (SKIP TO 430) IF RESPONDENT SAYS NO ONE NO ONE . . . . . . . . . . Y NO ONE . . . . . . . . . . Y NO ONE . . . . . . . . . . Y ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. 2 11 2 1 2 258 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 429A How much did you pay the COST COST COST service provider for this delivery? IN JD IN JD IN JD RECORD THE TOTAL COST FREE . . . . . . . . 9995 FREE . . . . . . . . 9995 FREE . . . . . . . . 9995 IN DINARS DON' T KNOW . 9998 DON' T KNOW . 9998 DON' T KNOW . 9998 430 Where did you give birth to HOME HOME HOME (NAME)? YOUR HOME . . . 11 YOUR HOME . . . 11 YOUR HOME . . . 11 (SKIP TO 437) (SKIP TO 438) (SKIP TO 438) PROBE TO IDENTIFY THE TYPE OTHER HOME . . . 12 OTHER HOME . . . 12 OTHER HOME . . . 12 OF SOURCE AND CIRCLE THE APPROPRIATE CODE. PUBLIC MED. SECTOR PUBLIC MED. SECTOR PUBLIC MED. SECTOR GOVT. HOSPITAL 21 GOVT. HOSPITAL 21 GOVT. HOSPITAL 21 IF UNABLE TO DETERMINE GOVT. HEALTH GOVT. HEALTH GOVT. HEALTH IF A HOSPITAL, HEALTH CENTER . . . . . 22 CENTER . . . . . 22 CENTER . . . . . 22 CENTER, OR CLINIC IS UNIVERSITY UNIVERSITY UNIVERSITY PUBLIC OR PRIVATE HOSPITAL . . . 23 HOSPITAL . . . 23 HOSPITAL . . . 23 MEDICAL, WRITE THE ROYAL MEDICAL ROYAL MEDICAL ROYAL MEDICAL THE NAME OF THE PLACE. SERVICES . . . 24 SERVICES . . . 24 SERVICES . . . 24 OTHER PUBLIC 26 OTHER PUBLIC 26 OTHER PUBLIC 26 (NAME OF PLACE) (SPECIFY) (SPECIFY) (SPECIFY) PRIVATE MED. SECTOR PRIVATE MED. SECTOR PRIVATE MED. SECTOR PVT. HOSPITAL/ PVT. HOSPITAL/ PVT. HOSPITAL/ CLINIC . . . . . . . . 31 CLINIC . . . . . . . . 31 CLINIC . . . . . . . . 31 OTHER PRIVATE OTHER PRIVATE OTHER PRIVATE MED. 36 MED. 36 MED. 36 (SPECIFY) (SPECIFY) (SPECIFY) OTHER 96 OTHER 96 OTHER 96 (SPECIFY) (SPECIFY) (SPECIFY) (SKIP TO 437) (SKIP TO 438) (SKIP TO 438) 431 How long after (NAME) was delivered did you stay there? HOURS 1 HOURS 1 HOURS 1 IF LESS THAN ONE DAY, DAYS 2 DAYS 2 DAYS 2 RECORD HOURS. IF LESS THAN ONE WEEK, WEEKS 3 WEEKS 3 WEEKS 3 RECORD DAYS. DON'T KNOW . 998 DON'T KNOW . . . 998 DON'T KNOW . . . 998 432 Was (NAME) delivered by YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 caesarean section? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 432A When you were discharged after YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 (NAME) was born, were you given NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 any free sample of infant formula by the health facility staff? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 432B Before you were discharged after YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 (NAME) was born, did anyone in the health facility talk to you or advise NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 you about family planning? 433 Before you were discharged after YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 (NAME) was born, did any health NO . . . . . . . . . . . . . . 2 (SKIP TO 449) (SKIP TO 449) care provider check on your health? (SKIP TO 436) NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 259Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 434 How long after delivery did the first check take place? HOURS 1 IF LESS THAN ONE DAY, DAYS 2 RECORD HOURS. IF LESS THAN ONE WEEK, WEEKS 3 RECORD DAYS. DON'T KNOW . . . 998 435 Who checked on your health HEALTH PERSONNEL at that time? DOCTOR . . . . . . . . 1 NURSE/MIDWIFE 2 PROBE FOR MOST QUALIFIED OTHER PERSON 6 PERSON. (SPECIFY) 436 After you were discharged, did YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 any health care provider (SKIP TO 439A) (SKIP TO 449) (SKIP TO 449) check on your health? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 436A What is the main reason you did NO NEED/NO SICK . 01 not seek a health professionnal NOT AWARE AVAI- check on your health after (NAME) LABILITY OF POST- was born? NATAL SERVICE . 02 NOT SUPPOSED TO GO OUT DURING THIS PERIOD . . . 03 NO ONE TO TAKE CARE OF MY BABY DURING VISIT . . . 04 TOO FAR . . . . . . 05 TOO EXPENSIVE . 06 NO QUALIFIED PERSONNEL . . . 07 HUSBAND OPPOSED . . . . . 08 OTHER 96 (SPECIFY) (SKIP TO 448) 437 Why didn't you deliver in a health COST TOO MUCH . . A facility? FACILITY NOT OPEN . B TOO FAR/ NO TRANS- PORTATION C PROBE: Any other reason? DON'T TRUST FACILITY/POOR RECORD ALL MENTIONED. QUALITY SERVICE D NO FEMALE PROVID- ER AT FACILITY . . E HUSBAND/FAMILY DID NOT ALLOW . . F NOT NECESSARY . . G NOT CUSTOMARY . . H OTHER (SPECIFY) X 438 After (NAME) was born, did YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 any health care provider (SKIP TO 439) (SKIP TO 449) (SKIP TO 449) check on your health? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 260 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 438A What is the main reason you did NO NEED/NO SICK . 01 not seek a health professionnal NOT AWARE AVAI- check on your health after (NAME) LABILITY OF POST- was born? NATAL SERVICE . 02 NOT SUPPOSED TO GO OUT DURING THIS PERIOD . . . 03 NO ONE TO TAKE CARE OF MY BABY DURING VISIT . . . 04 TOO FAR . . . . . . 05 TOO EXPENSIVE . 06 NO QUALIFIED PERSONNEL . . . 07 HUSBAND OPPOSED . . . . . 08 OTHER 96 (SPECIFY) (SKIP TO 443) 439 How long after delivery did the first check take place? HOURS 1 439A How long after delivery, did this DAYS 2 check take place? WEEKS 3 IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. DON'T KNOW . . . 998 440 Who checked on your health HEALTH PERSONNEL at that time? DOCTOR . . . . . . . . 1 NURSE/MIDWIFE 2 PROBE FOR MOST QUALIFIED OTHER PERSON PERSON. 6 (SPECIFY) 441 Where did this (first) check HOME take place? YOUR HOME . . . 11 OTHER HOME . . . 12 PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE PUBLIC MED. SECTOR APPROPRIATE CODE. GOVT. HOSPITAL 21 GOVT. HEALTH IF UNABLE TO DETERMINE CENTER . . . . . 22 IF A HOSPITAL, HEALTH GOVT. MCH . . . 23 CENTER, OR CLINIC IS UNIVERSITY PUBLIC OR PRIVATE HOSPITAL . . . 24 MEDICAL, WRITE THE ROYAL MEDICAL THE NAME OF THE PLACE. SERVICES . . . 25 OTHER PUBLIC 26 (NAME OF PLACE) (SPECIFY) PRIVATE MED. SECTOR PVT. HOSPITAL/ CLINIC . . . . . . . . 31 UNRWA HEALTH CENTER . . . . . 32 OTHER PRIVATE MED. 36 (SPECIFY) OTHER 96 (SPECIFY) 261Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 441A How much did you pay for this COST (first) postnatal visit? IN JD RECORD THE TOTAL COST FREE . . . . . 995 IN DINARS DON' T KNOW . . 998 441B After this (first) visit, did you come YES . . . . . . . . . . . . . . 1 back a second time for a health NO . . . . . . . . . . . . . . 2 care provider to check on your (SKIP TO 441D) health? 441C How long after delivery did this check take place? HOURS 1 DAYS 2 IF LESS THAN ONE DAY, RECORD HOURS. WEEKS 3 IF LESS THAN ONE WEEK, RECORD DAYS. DON'T KNOW . . . 998 441D Did anyone at the health facility talk YES . . . . . . . . . . . . . . 1 to you or advise you about family planning during any of your NO . . . . . . . . . . . . . . 2 postnatal check? 442 CHECK 436: YES (SKIP TO 448) 443 In the two months after (NAME) was born, did any health YES . . . . . . . . . . . . . . 1 care provider check on his/her NO . . . . . . . . . . . . . . 2 health? (SKIP TO 448) DON'T KNOW . . . . . 8 444 How many hours, days or weeks HRS AFTER after the birth of (NAME) did the BIRTH . . 1 first check take place? DAYS AFTER BIRTH . . 2 IF LESS THAN ONE DAY, WKS AFTER RECORD HOURS. BIRTH . . 3 IF LESS THAN ONE WEEK, RECORD DAYS. DON'T KNOW . . . 998 445 Who checked on (NAME)'s health HEALTH PERSONNEL at that time? DOCTOR . . . . . . . . 1 NURSE/MIDWIFE 2 PROBE FOR MOST QUALIFIED OTHER PERSON 6 PERSON. (SPECIFY) NOT ASKED 262 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 446 Where did this first check of HOME (NAME) take place? YOUR HOME . . . 11 OTHER HOME . . . 12 PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE PUBLIC MED. SECTOR APPROPRIATE CODE. GOVT. HOSPITAL 21 GOVT. HEALTH IF UNABLE TO DETERMINE CENTER . . . . . 22 IF A HOSPITAL, HEALTH GOVT. MCH . . . 23 CENTER, OR CLINIC IS UNIVERSITY PUBLIC OR PRIVATE HOSPITAL . . . 24 MEDICAL, WRITE THE ROYAL MEDICAL THE NAME OF THE PLACE. SERVICES . . . 25 OTHER PUBLIC 26 (NAME OF PLACE) (SPECIFY) PRIVATE MED. SECTOR PVT. HOSPITAL/ CLINIC . . . . . . . . 31 UNRWA HEALTH CENTER . . . . . 32 OTHER PRIVATE MED. 36 (SPECIFY) OTHER 96 (SPECIFY) 448 Has your menstrual period returned YES . . . . . . . . . . . . . . 1 since the birth of (NAME)? (SKIP TO 450) NO . . . . . . . . . . . . . . 2 (SKIP TO 451) 449 Did your period return between YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 the birth of (NAME) and your NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 next pregnancy? (SKIP TO 453) (SKIP TO 453) 450 For how many months after the birth of (NAME) did you not have MONTHS . . . MONTHS . . . MONTHS . . . a period? DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 451 CHECK 226: NOT PREGNANT PREG- OR IS RESPONDENT PREGNANT? NANT UNSURE (SKIP TO 453) 452 Have you begun to have YES . . . . . . . . . . . . . . 1 sexual intercourse again since NO . . . . . . . . . . . . . . 2 the birth of (NAME)? (SKIP TO 454) 453 For how many months after the birth of (NAME) did you not have MONTHS . . . MONTHS . . . MONTHS . . . sexual intercourse? IF LESS THAN 1 MONTH, DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 RECORD '00' 454 Did you ever breastfeed (NAME)? YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 (SKIP TO 460) (SKIP TO 460) NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 (SKIP TO 461) (SKIP TO 461) (SKIP TO 461) 263Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 455 How long after birth did you first put (NAME) to the breast? IMMEDIATELY . . . 000 IF LESS THAN 1 HOUR, RECORD ‘00' HOURS. IF LESS THAN 24 HOURS, HOURS 1 RECORD HOURS. OTHERWISE, RECORD DAYS. DAYS 2 456 In the first three days after YES . . . . . . . . . . . . . . 1 delivery, was (NAME) given NO . . . . . . . . . . . . . . 2 anything to drink other than (SKIP TO 458) breast milk? 457 What was (NAME) given to drink? MILK (OTHER THAN BREAST MILK ) . A Anything else? PLAIN WATER . . . B SUGAR OR GLU- RECORD ALL LIQUIDS COSE WATER . . . C MENTIONED. GRIPE WATER . . . D SUGAR-SALT-WATER SOLUTION . . . . . E FRUIT JUICE . . . . . F INFANT FORMULA . G TEA/INFUSIONS . . . H HONEY . . . . . . . . . . I OTHER X (SPECIFY) 458 CHECK 404: LIVING DEAD IS CHILD LIVING? (SKIP TO 460) 459 Are you still breastfeeding YES . . . . . . . . . . . . . . 1 (NAME)? (SKIP TO 462) NO . . . . . . . . . . . . . . 2 460 For how many months did you breastfeed (NAME)? MONTHS . . . MONTHS . . . MONTHS . . . STILL BF . . . . . . . . 95 STILL BF . . . . . . . . 95 DON'T KNOW . . . 98 DON'T KNOW . . . 98 DON'T KNOW . . . 98 461 CHECK 404: LIVING DEAD LIVING DEAD LIVING DEAD IS CHILD LIVING? (GO BACK TO (GO BACK TO (GO BACK TO 405 405 IN NEXT 405 IN NEXT IN NEXT-TO-LAST COLUMN; OR, COLUMN; OR, COLUMN OF NEW IF NO MORE IF NO MORE QUESTIONNAIRE; OR, BIRTHS, GO BIRTHS, GO IF NO MORE (SKIP TO 464) TO 501) (SKIP TO 464) TO 501) (SKIP TO 464) BIRTHS, GO TO 501) 462 How many times did you breastfeed last night between NUMBER OF sunset and sunrise? NIGHTTIME FEEDINGS . IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. 264 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 463 How many times did you NUMBER OF breastfeed yesterday during DAYLIGHT the daylight hours? FEEDINGS . IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. 464 Did (NAME) drink anything from YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 a bottle with a nipple yesterday NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 or last night? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 465 GO BACK TO 405 IN GO BACK TO 405 IN GO BACK TO 405 IN NEXT COLUMN; OR, IF NEXT COLUMN; OR, IF NEXT-TO-LAST NO MORE BIRTHS, GO NO MORE BIRTHS, GO COLUMN OF NEW TO 501. TO 501. QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 501. 265Appendix D | SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION 501 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES). 502 LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH LINE NUMBER LINE LINE LINE FROM 212 NUMBER . . . . . . . . NUMBER . . . . . . . . NUMBER . . . . . . . 503 NAME NAME NAME FROM 212 AND 216 LIVING DEAD LIVING DEAD LIVING DEAD (GO TO 503 (GO TO 503 (GO TO 503 IN NEXT- IN NEXT COLUMN IN NEXT COLUMN TO-LAST COLUMN OF OR, IF NO MORE OR, IF NO MORE NEW QUESTIONNAIRE, BIRTHS, GO TO 547) BIRTHS, GO TO 547) OR IF NO MORE BIRTHS, GO TO 547) 504 Do you have a card where (NAME'S) YES, SEEN . . . . . . . . . . . . 1 YES, SEEN . . . . . . . . . . . . 1 YES, SEEN . . . . . . . . . . . 1 vaccinations are (SKIP TO 506) (SKIP TO 506) (SKIP TO 506) written down? YES, NOT SEEN . . . . . . . . 2 YES, NOT SEEN . . . . . . . . 2 YES, NOT SEEN . . . . . . . 2 IF YES: (SKIP TO 508) (SKIP TO 508) (SKIP TO 508) May I see it please? NO CARD . . . . . . . . . . . . . . 3 NO CARD . . . . . . . . . . . . . . 3 NO CARD . . . . . . . . . . . . 3 505 Did you ever have YES . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . 1 a vaccination (SKIP TO 508) (SKIP TO 508) (SKIP TO 508) card for (NAME)? NO . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 506 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE ‘44' IN ‘DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH DAY MONTH YEAR DAY MONTH YEAR DAY MONTH YEAR Hib1 HEP1 HEP2 HEP3 MMR (Measles/ /Mumps/ Rubella) Hib (TETRA/PENTA) 2 Hib (TETRA/PENTA) 3 HEPATITIS (TETRA/ PENTA) 1 HEPATITIS (TETRA/ PENTA) 2 HEPATITIS (TETRA/ PENTA) 3 MEASLES Hib (TETRA/PENTA) 1 P4 P b DTP1 DTP2 MMR MEA MMR DTP3 DTPb HEP1 Hib1 Hib3 MEA Hib2 DTPbDTP Booster POLIO (OPV) 3 POLIO (OPV) 4 POLIO Booster DPT (TETRA/PENTA) 1 DPT (TETRA/PENTA) 2 DPT (TETRA/PENTA) 3 DTP2 DTP3 P4 P b BCG POLIO (IPV/OPV) 1 POLIO (IPV/OPV) 2 BCG P1 P2 Hib3 BCG P1 P2 Hib2 P3 P3 HEP2 HEP3 DTP1 266 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 507 Has (NAME) received any YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 vaccinations that are not recorded (PROBE FOR (PROBE FOR (PROBE FOR on this card, including vaccinations VACCINATIONS AND VACCINATIONS AND VACCINATIONS AND received in a immunization WRITE ‘66' IN THE WRITE ‘66' IN THE WRITE ‘66' IN THE campaign? CORRESPONDING CORRESPONDING CORRESPONDING DAY COLUMN IN 506) DAY COLUMN IN 506) DAY COLUMN IN 506) RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS (SKIP TO 510A) (SKIP TO 514) (SKIP TO 514) BCG, POLIO 1-4, POL. Booster DPT 1-3, DPT Booster, NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 HEPATITIS 1-3, Hib 1-3, (SKIP TO 510A) (SKIP TO 514) (SKIP TO 514) MEASLES AND/OR MMR. DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 508 Did (NAME) ever receive any vaccinations to prevent him/her YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 from getting diseases, including NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 vaccinations received in an (SKIP TO 514) (SKIP TO 514) (SKIP TO 514) immunization campaign? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 509 Please tell me if (NAME) received any of the following vaccinations: 509A A BCG vaccination against YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 tuberculosis, that is, an injection NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 in the arm or shoulder that DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 usually causes a scar? 509B Polio vaccine, that is, usually YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 drops in the mouth or sometimes NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 an injection in the thigh? (SKIP TO 509D) (SKIP TO 509D) (SKIP TO 509D) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 509C How many times was the polio NUMBER NUMBER NUMBER vaccine received? OF TIMES . . . . . OF TIMES . . . . . OF TIMES . . . . . 509D A DPT vaccination, that is, an YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 injection given in the thigh, some- NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 times at the same times as polio (SKIP TO 509F) (SKIP TO 509F) (SKIP TO 509F) to prevent diptheria, pertusis, DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 and tetanus. Sometimes, DPT is part of the TETRA or PENTA vaccine. 509E How many times was a DPT NUMBER NUMBER NUMBER vaccination received? OF TIMES . . . . . OF TIMES . . . . . OF TIMES . . . . . 509F An injection to prevent Hepatitis, YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 that is an injection given some- NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 times at the same times as polio (SKIP TO 509H) (SKIP TO 509H) (SKIP TO 509H) and DPT injection. DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 Sometimes, DPT is part of the TETRA or PENTA vaccine. 509G How many times was a Hepatitis NUMBER NUMBER NUMBER vaccination received? OF TIMES . . . . . OF TIMES . . . . . OF TIMES . . . . . 509H A Hib vaccination, that is an YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 injection given sometimes at the NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 same times as polio, DPT and (SKIP TO 509J) (SKIP TO 509J) (SKIP TO 509J) Hepatitis to prevent meningitis. DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 Sometimes, DPT is part of the TETRA or PENTA vaccine. 509I How many times was a Hib NUMBER NUMBER NUMBER vaccination received? OF TIMES . . . . . OF TIMES . . . . . OF TIMES . . . . . 509J An measles injection, that is a YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 shot in the arm at the age of 9 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 months or older to prevent DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 measles? 267Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 509K A MMR vaccination, that is an YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 injection to prevent Measles, NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 Mumps and Rubella, usually DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 given at the age of 18 months. 510A CHECK 506 AND 509E: AT LEAST ONE DK DPT INJECTION (SKIP TO 510G) 510B Where did (NAME) receive the PUBLIC FACILITY . 1 first vaccination to prevent DPT? PRIVATE FACILITY 2 UNRWA . . . . . . . . . . 3 OTHER . . . . . . . . . . 6 DON'T KNOW . . . . . 8 510C CHECK 506 AND 509E: AT LEAST TWO DPT INJECTION (SKIP TO 510G) 510D Where did (NAME) receive the PUBLIC FACILITY . 1 second vaccination to prevent PRIVATE FACILITY 2 DPT? UNRWA . . . . . . . . . . 3 OTHER . . . . . . . . . . 6 DON'T KNOW . . . . . 8 510E CHECK 506 AND 509E: AT LEAST THREE DPT INJECTION (SKIP TO 510G) 510F Where did (NAME) receive the PUBLIC FACILITY . 1 third vaccination to prevent PRIVATE FACILITY 2 DPT? UNRWA . . . . . . . . . . 3 OTHER . . . . . . . . . . 6 DON'T KNOW . . . . . 8 510G CHECK 506 AND 509J: YES DK MEASLES INJECTION (SKIP TO 510I) 510H Where did (NAME) receive the PUBLIC FACILITY . 1 vaccination to prevent measles? PRIVATE FACILITY 2 UNRWA . . . . . . . . . . 3 OTHER . . . . . . . . . . 6 DON'T KNOW . . . . . 8 510I CHECK 506 AND 509K: YES DK MMR INJECTION (SKIP TO 514) 510J Where did (NAME) receive the PUBLIC FACILITY . 1 vaccination to prevent measles, PRIVATE FACILITY 2 mumps, and rubella. UNRWA . . . . . . . . . . 3 OTHER . . . . . . . . . . 6 DON'T KNOW . . . . . 8 514 HAS (NAME) ever received a vitamin A dose (like this/ YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 any of these)? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 SHOW COMMON TYPES OF (SKIP TO 518) (SKIP TO 518) (SKIP TO 518) CAPSULES. DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 515 Did (NAME) receive a vitamin A YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 dose within the last six months? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 NO OR NONE OR ONLY ONE TWO NO OR 268 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 518 Has (NAME) had diarrhea in the YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 last 2 weeks? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 (SKIP TO 531) (SKIP TO 531) (SKIP TO 531) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 519 Was there any blood in the YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 stools? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 520 Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 amount, or more than usual to SOMEWHAT LESS 2 SOMEWHAT LESS 2 SOMEWHAT LESS 2 drink? ABOUT THE SAME 3 ABOUT THE SAME 3 ABOUT THE SAME 3 IF LESS, PROBE: Was he/she MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 given much less than usual to NOTHING TO DRINK 5 NOTHING TO DRINK 5 NOTHING TO DRINK 5 drink or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 521 When (NAME) had diarrhea, was he/she given less than usual to MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 eat, about the same amount, more SOMEWHAT LESS 2 SOMEWHAT LESS 2 SOMEWHAT LESS 2 than usual, or nothing to eat? ABOUT THE SAME 3 ABOUT THE SAME 3 ABOUT THE SAME 3 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 IF LESS, PROBE: Was he/she STOPPED FOOD . 5 STOPPED FOOD . 5 STOPPED FOOD . 5 given much less than usual to NEVER GAVE FOOD 6 NEVER GAVE FOOD 6 NEVER GAVE FOOD 6 eat or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 522 Did you seek advice or treatment YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 for the diarrhea from any source? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 (SKIP TO 527) (SKIP TO 527) (SKIP TO 527) 523 Where did you seek advice or PUBLIC MED. SECTOR PUBLIC MED. SECTOR PUBLIC MED. SECTOR treatment? GOVT. HOSP. . A GOVT. HOSP. . A GOVT. HOSP. . A GOVT. HEALTH GOVT. HEALTH GOVT. HEALTH Anywhere else? CENTER . . . . . B CENTER . . . . . B CENTER . . . . . B GOVT. MCH . . . C GOVT. MCH . . . C GOVT. MCH . . . C PROBE TO IDENTIFY EACH UNIVERSITY UNIVERSITY UNIVERSITY TYPE OF SOURCE AND HOSPITAL . . . D HOSPITAL . . . D HOSPITAL . . . D CIRCLE THE APPROPRIATE ROYAL MEDICAL ROYAL MEDICAL ROYAL MEDICAL CODE(S). SERVICES . . . E SERVICES . . . E SERVICES . . . E OTHER PUBLIC F OTHER PUBLIC F OTHER PUBLIC F IF UNABLE TO DETERMINE (SPECIFY) (SPECIFY) (SPECIFY) IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PRIVATE MED. SECTOR PRIVATE MED. SECTOR PRIVATE MED. SECTOR PUBLIC OR PRIVATE PVT. HOSPITAL/ PVT. HOSPITAL/ PVT. HOSPITAL/ MEDICAL, WRITE THE CLINIC . . . . . G CLINIC . . . . . G CLINIC . . . . . G THE NAME OF THE PLACE. PHARMACY . . . H PHARMACY . . . H PHARMACY . . . H PVT DOCTOR . . . I PVT DOCTOR . . . I PVT DOCTOR . . . I UNRWA HEALTH UNRWA HEALTH UNRWA HEALTH (NAME OF PLACE(S)) CENTER . . . . . J CENTER . . . . . J CENTER . . . . . J OTHER PRIVATE OTHER PRIVATE OTHER PRIVATE MED. K MED. K MED. K (SPECIFY) (SPECIFY) (SPECIFY) OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) 269Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 524 CHECK 523: TWO OR ONLY TWO OR ONLY TWO OR ONLY MORE ONE MORE ONE MORE ONE CODES CODE CODES CODE CODES CODE CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED (SKIP TO 526) (SKIP TO 526) (SKIP TO 526) 525 Where did you first seek advice or treatment? FIRST PLACE . . . FIRST PLACE . . . FIRST PLACE . . . USE LETTER CODE FROM 523. 526 How many days after the diarrhea began did you first seek advice or treatment for (NAME)? DAYS . . . . . DAYS . . . . . DAYS . . . . . IF THE SAME DAY, RECORD '00'. 527 Does (NAME) still have diarrhea? YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 528 Was he/she given any of the following to drink at any time since he/she started having the diarrhea: YES NO DK YES NO DK YES NO DK A fluid made from a special AQUA- AQUA- AQUA- packet called Aquacell or CELL/ CELL/ CELL/ Paralait? PARALAIT 1 2 8 PARALAIT 1 2 8 PARALAIT 1 2 8 Thin watery gruel made from GRUEL . . 1 2 8 GRUEL . . 1 2 8 GRUEL . . 1 2 8 rice, carrots, wheat, etc? Soup? SOUP . . . 1 2 8 SOUP . . . 1 2 8 SOUP . . . 1 2 8 Home made sugar-salt-water solution? SU-SALT . 1 2 8 SU-SALT . 1 2 8 SU-SALT . 1 2 8 Milk or infant formula? MILK/FOR. 1 2 8 MILK/FOR. 1 2 8 MILK/FOR. 1 2 8 Yoghurt-based drink? YOGHURT 1 2 8 YOGHURT 1 2 8 YOGHURT 1 2 8 Water WATER . 1 2 8 WATER . 1 2 8 WATER . 1 2 8 Any other liquid? OTH. LIQ. 1 2 8 OTH. LIQ. 1 2 8 OTH. LIQ. 1 2 8 529 Was anything (else) given to YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 treat the diarrhea? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 (SKIP TO 531) (SKIP TO 531) (SKIP TO 531) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 530 What (else) was given to treat PILL OR SYRUP PILL OR SYRUP PILL OR SYRUP the diarrhea? ANTIBIOTIC . . . . . A ANTIBIOTIC . . . . . A ANTIBIOTIC . . . . . A NON-ANTIBIO. . . B NON-ANTIBIO. . . B NON-ANTIBIO. . . B Anything else? UNKNOWN PILL UNKNOWN PILL UNKNOWN PILL OR SYRUP . . . C OR SYRUP . . . C OR SYRUP . . . C RECORD ALL TREATMENTS INJECTION INJECTION INJECTION GIVEN. ANTIBIOTIC . . . . . D ANTIBIOTIC . . . . . D ANTIBIOTIC . . . . . D NON-ANTIBIO. . . E NON-ANTIBIO. . . E NON-ANTIBIO. . . E UNKNOWN UNKNOWN UNKNOWN INJECTION . . . F INJECTION . . . F INJECTION . . . F (IV) INTRAVENOUS G (IV) INTRAVENOUS G (IV) INTRAVENOUS G HOME REMEDY/ HOME REMEDY/ HOME REMEDY/ HERBAL MED- HERBAL MED- HERBAL MED- ICINE . . . . . . . . . . H ICINE . . . . . . . . . . H ICINE . . . . . . . . . . H OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) DON'T KNOW . . . . . Z DON'T KNOW . . . . . Z DON'T KNOW . . . . . Z g) h) a) b) d) c) e) f) 270 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 531 Has (NAME) been ill with a fever YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 at any time in the last 2 weeks? NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 532 Has (NAME) had an illness with YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 a cough at any time in the NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 last 2 weeks? (SKIP TO 535) (SKIP TO 535) (SKIP TO 535) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 533 When (NAME) had an illness with YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 a cough, did he/she breathe faster NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 than usual with short, rapid breaths (SKIP TO 536) (SKIP TO 536) (SKIP TO 536) or have difficulty breathing? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 534 Was the fast or difficult breathing CHEST ONLY . . . 1 CHEST ONLY . . . 1 CHEST ONLY . . . 1 due to a problem in the chest or to NOSE ONLY . . . . . 2 NOSE ONLY . . . . . 2 NOSE ONLY . . . . . 2 a blocked or runny nose? BOTH . . . . . . . . . . . . 3 BOTH . . . . . . . . . . . . 3 BOTH . . . . . . . . . . . . 3 OTHER 6 OTHER 6 OTHER 6 (SPECIFY) (SPECIFY) (SPECIFY) DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 (SKIP TO 536) (SKIP TO 536) (SKIP TO 536) 535 CHECK 531: YES NO OR DK YES NO OR DK YES NO OR DK HAD FEVER? (GO BACK TO (GO BACK TO (GO TO 503 503 IN NEXT 503 IN NEXT IN NEXT-TO-LAST COLUMN; OR, COLUMN; OR, COLUMN OF NEW IF NO MORE IF NO MORE QUESTIONNAIRE; OR, BIRTHS, GO BIRTHS, GO IF NO MORE BIRTHS, TO 547) TO 547) GO TO 547) 536 Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 amount, or more than usual to SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 drink? ABOUT THE SAME . 3 ABOUT THE SAME . 3 ABOUT THE SAME . 3 IF LESS, PROBE: Was he/she MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 given much less than usual to NOTHING TO DRINK 5 NOTHING TO DRINK 5 NOTHING TO DRINK 5 drink or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 537 When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 MUCH LESS . . . . . 1 same amount, more than usual, SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 SOMEWHAT LESS . 2 or nothing to eat? ABOUT THE SAME . 3 ABOUT THE SAME . 3 ABOUT THE SAME . 3 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 MORE . . . . . . . . . . . . 4 IF LESS, PROBE: Was he/she STOPPED FOOD . 5 STOPPED FOOD . 5 STOPPED FOOD . 5 given much less than usual to NEVER GAVE FOOD 6 NEVER GAVE FOOD 6 NEVER GAVE FOOD 6 eat or somewhat less? DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 538 Did you seek advice or treatment YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 from any source for the illness NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 with a (fever/cough)? (SKIP TO 543) (SKIP TO 543) (SKIP TO 543) 271Appendix D | LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 539 Where did you seek advice or PUBLIC MED. SECTOR PUBLIC MED. SECTOR PUBLIC MED. SECTOR treatment? GOVT. HOSP. . A GOVT. HOSP. . A GOVT. HOSP. . A GOVT. HEALTH GOVT. HEALTH GOVT. HEALTH Anywhere else? CENTER . . . . . B CENTER . . . . . B CENTER . . . . . B GOVT. MCH . . . C GOVT. MCH . . . C GOVT. MCH . . . C PROBE TO IDENTIFY EACH UNIVERSITY UNIVERSITY UNIVERSITY TYPE OF SOURCE AND HOSPITAL . . . D HOSPITAL . . . D HOSPITAL . . . D CIRCLE THE APPROPRIATE ROYAL MEDICAL ROYAL MEDICAL ROYAL MEDICAL CODE(S). SERVICES . . . E SERVICES . . . E SERVICES . . . E OTHER PUBLIC F OTHER PUBLIC F OTHER PUBLIC F IF UNABLE TO DETERMINE (SPECIFY) (SPECIFY) (SPECIFY) IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PRIVATE MED. SECTOR PRIVATE MED. SECTOR PRIVATE MED. SECTOR PUBLIC OR PRIVATE PVT. HOSPITAL/ PVT. HOSPITAL/ PVT. HOSPITAL/ MEDICAL, WRITE THE CLINIC . . . . . G CLINIC . . . . . G CLINIC . . . . . G THE NAME OF THE PLACE. PHARMACY . . . H PHARMACY . . . H PHARMACY . . . H PVT DOCTOR . . . I PVT DOCTOR . . . I PVT DOCTOR . . . I UNRWA HEALTH UNRWA HEALTH UNRWA HEALTH (NAME OF PLACE(S)) CENTER . . . . . J CENTER . . . . . J CENTER . . . . . J OTHER PRIVATE OTHER PRIVATE OTHER PRIVATE MED. K MED. K MED. K (SPECIFY) (SPECIFY) (SPECIFY) OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) 540 CHECK 539: TWO OR ONLY TWO OR ONLY TWO OR ONLY MORE ONE MORE ONE MORE ONE CODES CODE CODES CODE CODES CODE CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED CIRCLED (SKIP TO 542) (SKIP TO 542) (SKIP TO 542) 541 Where did you first seek advice or treatment? FIRST PLACE . . . FIRST PLACE . . . FIRST PLACE . . . USE LETTER CODE FROM 539 542 How many days after the illness began did you first seek advice or treatment for (NAME)? DAYS . . . . . DAYS . . . . . DAYS . . . . . IF THE SAME DAY, RECORD '00'. 543 Is (NAME) still sick with a (fever/ FEVER ONLY . . . . . 1 FEVER ONLY . . . . . 1 FEVER ONLY . . . . . 1 cough)? COUGH ONLY . . . 2 COUGH ONLY . . . 2 COUGH ONLY . . . 2 BOTH FEVER AND BOTH FEVER AND BOTH FEVER AND COUGH . . . . . . . . 3 COUGH . . . . . . . . 3 COUGH . . . . . . . . 3 NO, NEITHER . . . . . 4 NO, NEITHER . . . . . 4 NO, NEITHER . . . . . 4 DON'T KNOW . . . 8 DON'T KNOW . . . 8 DON'T KNOW . . . 8 544 At any time during the illness, did YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . 1 (NAME) take any drugs for the NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . 2 illness? (GO BACK TO 503 (GO BACK TO 503 (GO TO 503 IN IN NEXT COLUMN; IN NEXT COLUMN; NEXT-TO-LAST OR, IF NO MORE OR, IF NO MORE COLUMN OF NEW BIRTHS, GO TO 547) BIRTHS, GO TO 547) QUESTIONNAIRE; DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 OR, IF NO MORE BIRTHS, GO TO 547) DON'T KNOW . . . . . 8 272 | Appendix D LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NO. QUESTIONS AND FILTERS NAME ________________ NAME ________________ NAME _________________ 545 What drugs did (NAME) take? PILL OR SYRUP PILL OR SYRUP PILL OR SYRUP ANTIBIOTIC . . . . . A ANTIBIOTIC . . . . . A ANTIBIOTIC . . . . . A NON-ANTIBIO. . . B NON-ANTIBIO. . . B NON-ANTIBIO. . . B Any other drugs? UNKNOWN PILL UNKNOWN PILL UNKNOWN PILL OR SYRUP . . . C OR SYRUP . . . C OR SYRUP . . . C RECORD ALL MENTIONED. INJECTION INJECTION INJECTION ANTIBIOTIC . . . . . D ANTIBIOTIC . . . . . D ANTIBIOTIC . . . . . D NON-ANTIBIO. . . E NON-ANTIBIO. . . E NON-ANTIBIO. . . E UNKNOWN UNKNOWN UNKNOWN INJECTION . . . F INJECTION . . . F INJECTION . . . F (IV) INTRAVENOUS G (IV) INTRAVENOUS G (IV) INTRAVENOUS G HOME REMEDY/ HOME REMEDY/ HOME REMEDY/ HERBAL MED- HERBAL MED- HERBAL MED- ICINE . . . . . . . . . . H ICINE . . . . . . . . . . H ICINE . . . . . . . . . . H OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) DON'T KNOW . . . . . Z DON'T KNOW . . . . . Z DON'T KNOW . . . . . Z 546 GO BACK TO 503 IN GO BACK TO 503 IN GO TO 503 IN NEXT COLUMN; OR, IF NEXT COLUMN; OR, IF NEXT-TO-LAST NO MORE BIRTHS, GO NO MORE BIRTHS, GO COLUMN OF NEW TO 547. TO 547. QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 547. 273Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 547 CHECK 528(a), ALL COLUMNS: NO CHILD ANY CHILD RECEIVED AQUACELL RECEIVED 549 OR PARALAIT AQUACELL OR PARALAIT 548 Have you ever heard of a special product called Aquacell or YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Paralait you can get for the treatment of diarrhea? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 549 Have you had fever at any time in the last 6 months? WITHIN PAST TWO WEEKS . . . . . . . . 1 MORE THAN 2 WEEKS BUT IF YES: LESS THAN ONE MONTH . . . . . . . . 2 When was the last time you had fever? ONE MONTH OR MORE . . . . . . . . . . 3 IF NO FEVER, RECORD '4' NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 550A 550 The last time you had a fever, did you get medecine to treat the fever? COST . . . . . . . . . . . . . . . . IF YES: How much did you spend to obtain the medecine? FREE . . . . . . . . . . . . . . . . . . . . . . . . 994 RECORD THE TOTAL COST IN DINARS NO MEDECINE . . . . . . . . . . . . . . . . 995 IF NO MEDECINE OBTAINED, RECORD '995' DON'T KNOW . . . . . . . . . . . . . . . . . . 998 550A Have you performed a breast cancer self exam to detect breast YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 cancer in yourself within the last 12 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK BREAST CANCER/ DK SELF EXAM . . . . . . . . . . . . . . 8 550B Have you had a breast cancer clinical exam to detect breast YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 cancer in the last 12 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SURE . . . . . . . . . . . . . . . . . . . . . . 8 550C Have you ever heard of a pap smear, that is, an exam that YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 consists of removing cells from the cervix to detect changes that can suggest the presence of cancer in a woman's womb? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 550E 550D Have you ever had such an exam in your life time? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 550E Do you smoke: YES NO Cigarettes? CIGARETTES . . . . . . . . . . . . 1 2 Nargila? NARGILA . . . . . . . . . . . . . . . . 1 2 551 CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2004 OR LATER LIVING WITH THE RESPONDENT ONE OR MORE NONE 601 RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 552) (NAME) 552 Now I would like to ask you about liquids or foods (NAME FROM 551) had yesterday during the day or at night. Did (NAME FROM 551) (drink/eat): YES NO DK Plain water? PLAIN WATER . . . . . . . . . . . . 1 2 8 Commercially produced infant formula? FORMULA . . . . . . . . . . . . . . 1 2 8 Any (other) porridge or gruel? OTHER PORRIDGE/GRUEL. . 1 2 8 274 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 553 Now I would like to ask you about (other) liquids or foods that (NAME FROM 551)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods. CHILD MOTHER Did (NAME FROM 551)/you drink (eat): YES NO DK YES NO DK a) Milk such as tinned, powdered, or fresh animal milk? a 1 2 8 1 2 8 b) Fruit juice? b 1 2 8 1 2 8 c) Soup broth? c 1 2 8 1 2 8 d) Tea? d 1 2 8 1 2 8 e) Any other liquids such as sugar water or carbonated drinks? e 1 2 8 1 2 8 f) Bread, pasta, rice, maize, or any other food made from grains? f 1 2 8 1 2 8 g) Carrots, red sweet potatoes, or pumpkin? g 1 2 8 1 2 8 h) Any other food made from roots or tubers, such as white potatoes, or other roots/tubers? h 1 2 8 1 2 8 i) Any green leafy vegetables, such as spinach, or mouloukia? i 1 2 8 1 2 8 j) Apricot, palm nuts, or yellow melon? j 1 2 8 1 2 8 k) Any other fruits or vegetables? k 1 2 8 1 2 8 l) Meat, poultry, fish, or eggs? l 1 2 8 1 2 8 m) Any food made from legumes, such as lentils, beans, or chickpeas? m 1 2 8 1 2 8 n) Any type of nuts or seeds, such as pistachio, almonds, cashew, peanuts, or sesame seeds? n 1 2 8 1 2 8 o) Cheese or yoghurt? o 1 2 8 1 2 8 p) Any oil, fats, or butter, or foods made with any of these? p 1 2 8 1 2 8 q) Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits? q 1 2 8 1 2 8 r) Any other solid or semi-solid food? r 1 2 8 1 2 8 554 CHECK 552 (LAST CATEGORY: PORRIDGE/GRUEL) AND 553 (CATEGORIES f THROUGH r FOR CHILD): AT LEAST ONE NOT A SINGLE "YES" 601 "YES' 555 How many times did (NAME FROM 551) eat solid, semisolid, or NUMBER OF soft foods yesterday during the day or at night? TIMES . . . . . . . . . . . . . . . . . . . . IF 7 OR MORE TIMES, RECORD ‘7'. DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 275Appendix D | SECTION 6. MARRIAGE AND SEXUAL ACTIVITY NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 601 CHECK 101A: WIDOWED/ CURRENTLY SEPARATED/ 606 MARRIED/ DIVORCED 602 Is your husband living with you now or is he staying LIVING WITH HER . . . . . . . . . . . . . . . . 1 elsewhere? STAYING ELSEWHERE . . . . . . . . . . . . 2 603 RECORD THE HUSBAND'S NAME AND LINE NAME _____________________________ NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. LINE NO. . . . . . . . . . . . . . . . . . . 604 Does your husband have another wife (other wives) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 besides you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 606 605 Including yourself, in total, how many wives does your husband have? TOTAL NUMBER OF WIVES . . DON'T KNOW . . . . . . . . . . . . . . . . . . 8 606 Have you been married only once or more than once? ONLY ONCE . . . . . . . . . . . . . . . . . . . . 1 MORE THAN ONCE . . . . . . . . . . . . . . 2 607 CHECK 606: MARRIED MARRIED MONTH . . . . . . . . . . . . . . . . ONLY ONCE MORE THAN ONCE DON'T KNOW MONTH . . . . . . . . . . 98 In what month and year Now I would like to ask about did you start living with your first husband. your husband In what month and year YEAR . . . . . . . . . . . . 609 (consummate mariage)? did you start living with him (consummate mariage)? DON'T KNOW YEAR . . . . . . . . . . . . 9998 608 How old were you when you first started living with him? AGE . . . . . . . . . . . . . . . . . . . . 609 Before you got married, was your [first] husband related YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 to you in any way? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 611 610 What type of relation was it? FIRST COUSIN ON BOTH FATHER AND MOTHER’S SIDE . . . 01 FIRST COUSIN ON BOTH MOTHER AND FATHER’S SIDE 02 FIRST COUSIN ON FATHER'S SIDE (IBN AL AMM) 03 FIRST COUSIN ON MOTHER'S SIDE (IBN AL KHAL) . . . . . . . . 04 FIRST COUSIN ON FATHER'S SIDE (IBN AL AMMAH) . . . . . . . . . . . . . . . . 05 FIRST COUSIN ON MOTHER'S SIDE (IBN AL KHALAH) . . . . . . . . . . . . . . 06 SECOND COUSIN (FATHER’S SIDE) 07 SECOND COUSIN (MOTHER’S SIDE) 08 OTHER RELATIVE . . . . . . . . . . . . . . . . 09 DON’T KNOW 98 611 CHECK 609: MARRIED MARRIED YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ONLY ONCE MORE THAN ONCE NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Did your husband have Now I would like to ask about a premarital medical your last marriage. DON’T KNOW 8 exam? Did your husband have a premarital medical exam? 276 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 611A Did you have a premarital medical exam? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 612 611B Where did you go for the premarital medical exam? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . . . 11 GOVT. HEALTH CENTER . . . . . . . .12 GOVT. MCH . . . . . . . . . . . . . . . . . . 13 UNIVERSITY HOSPITAL . . . . . . . . . . 14 ROYAL MEDICAL SERVICES 15 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . 21 PRIVATE DOCTOR . . . . . . . . . . . . 22 JORDANIAN AS. OF FP AND PROTECTION (JAFPP) . . . . . 23 UNRWA HEALTH CENTER . . . . . 24 OTHER NON GOV. ORGANIZATION. 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER 96 (SPECIFY) 612 When was the last time you had sexual intercourse? DAYS AGO . . . . . . . . . . . . 1 IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. WEEKS AGO . . . . . . . . . . 2 IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS. MONTHS AGO . . . . . . . . 3 YEARS AGO . . . . . . . . . . 4 614 613 The last time you had sexaul intercourse, was a condom YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 used? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 614 Do you know of a place where a person can get condoms? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 700 615 Where is that? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . . . A Any other place? GOVT. HEALTH CENTER . . . . . . . . B GOVT. MCH . . . . . . . . . . . . . . . . . . C PROBE TO IDENTIFY EACH TYPE OF SOURCE AND UNIVERSITY HOSPITAL/CLINIC D CIRCLE THE APPROPRIATE CODE(S). ROYAL MEDICAL SERVICES . . . E OTHER PUBLIC ________________ F (SPECIFY) IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER PRIVATE MEDICAL SECTOR OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE PRIVATE HOSPITAL/CLINIC . . . . . G THE NAME OF THE PLACE. PRIVATE DOCTOR . . . . . . . . . . . . . . H PHARMACY . . . . . . . . . . . . . . . . . . I JORDANIAN AS. OF FP AND (NAME OF PLACE(S)) PROTECTION (JAFPP) . . . . . J UNRWA CLINIC . . . . . . . . . . . . . . K OTHER NON-GOV ORGANIZATION L OTHER PRIVATE MEDICAL M (SPECIFY) OTHER SOURCE FRIEND/RELATIVE . . . . . . . . . . . . . . N OTHER ________________________ X (SPECIFY) 277Appendix D | SECTION 7. FERTILITY PREFERENCES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 700 CHECK 101A: CURRENTLY CURRENTLY MARRIED WIDOWED, 713 DIVORCED, OR SEPARATED 701 CHECK 311/311A: NEITHER HE OR SHE STERILIZED STERILIZED 713 702 CHECK 226: NOT PREGNANT PREGNANT OR UNSURE HAVE (A/ANOTHER) CHILD . . . . . . . . 1 Now I have some questions Now I have some questions NO MORE/NONE . . . . . . . . . . . . . . . . 2 704 about the future. about the future. SAYS SHE CAN'T GET PREGNANT . 3 713 Would you like to have After the child you are UNDECIDED/DON'T KNOW AND (a/another) child, or would you expecting now, would you like PREGNANT . . . . . . . . . . . . . . . . . . 4 709 prefer not to have any (more) to have another child, or would UNDECIDED/DON'T KNOW children? you prefer not to have any AND NOT PREGNANT OR more children? UNSURE . . . . . . . . . . . . . . . . 5 708 703 CHECK 226: MONTHS . . . . . . . . . . . . . . 1 NOT PREGNANT PREGNANT OR UNSURE YEARS . . . . . . . . . . . . . . 2 How long would you like to wait After the birth of the child you SOON/NOW . . . . . . . . . . . . . . . . . . 993 708 from now before the birth of are expecting now, how long SAYS SHE CAN'T GET PREGNANT 994 713 (a/another) child? would you like to wait before the birth of another child? OTHER ______________________ 996 (SPECIFY) 708 DON'T KNOW . . . . . . . . . . . . . . . . . . 998 704 CHECK 226: NOT PREGNANT PREGNANT OR UNSURE 709 705 CHECK 310: USING A CONTRACEPTIVE METHOD? NOT NOT CURRENTLY ASKED CURRENTLY USING 713 USING 706 CHECK 703: NOT 24 OR MORE MONTHS 00-23 MONTHS ASKED OR 02 OR MORE YEARS OR 00-01 YEAR 709 278 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 707 CHECK 702 AND 703: FERTILITY-RELATED REASONS NOT HAVING SEX . . . . . . . . . . . . . . A WANTS TO HAVE WANTS NO INFREQUENT SEX . . . . . . . . . . . . . . B A/ANOTHER CHILD MORE/ MENOPAUSAL/HYSTERECTOMY . C BUT NOT BEFORE NONE SUBFECUND/INFECUND . . . . . . . . D 2 YEARS POSTPARTUM AMENORRHEIC . . . E BREASTFEEDING . . . . . . . . . . . . . . F You have said that you do not You have said that you do not DIFFICULT TO GET PREGNANT . . . G want (a/another) child soon, but want any (more) children, but you are not using any method to you are not using any method to OPPOSITION TO USE avoid pregnancy. avoid pregnancy. RESPONDENT OPPOSED . . . . . . . . H HUSBAND OPPOSED . . . . . . . . . . . . I Can you tell me why you are Can you tell me why you are OTHERS OPPOSED . . . . . . . . . . . . J not using a method? not using a method? RELIGIOUS PROHIBITION . . . . . . . . K RUMORS . . . . . . . . . . . . . . . . . . . . . . L Any other reason? Any other reason? LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . . . M KNOWS NO SOURCE . . . . . . . . . . . . N RECORD ALL REASONS MENTIONED. METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . O FEAR OF SIDE EFFECTS . . . . . . . . P LACK OF ACCESS/TOO FAR . . . . . Q COSTS TOO MUCH . . . . . . . . . . . . R INCONVENIENT TO USE . . . . . . . . S INTERFERES WITH BODY'S NORMAL PROCESSES . . . . . . . . T OTHER ______________________ X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . Z 708 CHECK 310: USING A CONTRACEPTIVE METHOD? NOT NO, YES, ASKED NOT CURRENTLY USING CURRENTLY USING 713 709 Do you think you will use a contraceptive method to delay or avoid YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pregnancy at any time in the future? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 711 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 713 710 Which contraceptive method would you prefer to use? FEMALE STERILIZATION . . . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . . . 02 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 INJECTABLES . . . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . . . 08 713 DIAPHRAGM . . . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . . . 10 LACTATIONAL AMEN. METHOD . . . . . 11 RHYTHM METHOD/PERIOD. ABSTIN. . 12 WITHDRAWAL . . . . . . . . . . . . . . . . . . 13 OTHER ______________________ 96 (SPECIFY) DK/UNSURE. . . . . . . . . . . . . . . . . . . . . . 98 279Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 711 What is the main reason that you think you will not use a FERTILITY-RELATED REASONS contraceptive method at any time in the future? INFREQUENT SEX/NO SEX . . . 11 MENOPAUSAL/HYSTERECTOMY 12 SUBFECUND/INFECUND . . . . . 13 713 WANTS AS MANY CHILDREN AS POSSIBLE . . . . . . . . . . . . . . . . 14 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . 21 HUSBAND OPPOSED . . . . . . . . . . . . 22 OTHERS OPPOSED . . . . . . . . . . 23 RELIGIOUS PROHIBITION . . . . . 24 RUMORS 25 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . 31 KNOWS NO SOURCE . . . . . . . . . . 32 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . 41 713 FEAR OF SIDE EFFECTS . . . . . 42 LACK OF ACCESS/TOO FAR . . . 43 COSTS TOO MUCH . . . . . . . . . . 44 INCONVENIENT TO USE . . . . . . . . 45 INTERFERES WITH BODY'S NORMAL PROCESSES . . . . . 46 OTHER ______________________ 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . 98 711A Why does your husband disapprove of using contraception? AGAINST RELIGION . . . . . . . . . . . . . . A CAUSE HEALTH PROBLEMS . . . . . . . . B FEAR OF SIDE EFFECTS. . . . . . . . . . . . C COST TOO MUCH . . . . . . . . . . . . . . . . D INTERFERES WITH BODY'S RECORD ALL REASONS MENTIONED. NORMAL PROCESSES . . . . . . . . . . E FATALISTIC . . . . . . . . . . . . . . . . . . . . F OTHER ______________________ X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . Z 713 CHECK 216: HAS LIVING CHILDREN NO LIVING CHILDREN NONE . . . . . . . . . . . . . . . . . . . . . . . . 00 715 If you could go back to the time If you could choose exactly the you did not have any children number of children to have in NUMBER . . . . . . . . . . . . . . . . . . and could choose exactly the your whole life, how many number of children to have in would that be? your whole life, how many OTHER ______________________ 96 715 would that be? (SPECIFY) PROBE FOR A NUMERIC RESPONSE. 714 How many of these children would you like to be boys, how many BOYS GIRLS EITHER would you like to be girls and for how many would the sex not matter? NUMBER OTHER ______________________ 96 (SPECIFY) 280 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 715 In the last 6 months have you: YES NO Heard about family planning on the radio? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 Seen about family planning on the television? TELEVISION . . . . . . . . . . . . . . . . 1 2 Read about family planning in a newspaper or magazine? NEWSPAPER OR MAGAZINE . . . 1 2 Seen or read about family planning on posters? POSTER . . . . . . . . . . . . . . . . . . . . 1 2 Read about family planning in bulletins/booklets? BULLETIN/BOOKLET . . . . . . . . . . 1 2 Heard about family planning in lectures? LECTURE. . . . . . . . . . . . . . . . . . . . 1 2 Heard about family planning from women you associate with? WOMEN . . . . . . . . . . . . . . . . . . . . 1 2 Heard about family planning from any other people you associate with? OTHER PEOPLE . . . . . . . . . . . . . . 1 2 716 Where and from whom would you prefer to get information INTERPERSONAL about family planning? GOVERN. HEALTH WORKER . . . . . 11 PRIVATE DOCTOR/NURSE . . . . . . . . 12 JAFPP STAFF . . . . . . . . . . . . . . . . . . 13 CIRCLE ONLY ONE ASNWER. HUSBAND . . . . . . . . . . . . . . . . . . . . 14 OTHER RELATIVES . . . . . . . . . . . . . . 15 FRIENDS . . . . . . . . . . . . . . . . . . . . . . 16 MEDIA RADIO . . . . . . . . . . . . . . . . . . . . . . . . 21 TV . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 PRINT MATERIALS . . . . . . . . . . . . . . 23 SCHOOL, LIBRARY/ACADEMIC . . . 24 COMMUNITY/PUBLIC MEETING . . . 25 LECTURES . . . . . . . . . . . . . . . . . . . . 26 OTHER ______________________ 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 717 CHECK 101A: CURRENTLY CURRENTLY WIDOWED, MARRIED DIVORCED, OR 801 SEPARATED 718 CHECK 311/311A: CODE B, G, OR M CIRCLED OTHER 720 CODES NO CODE CIRCLED CIRCLED 720A 719 Does your husband know that you are using YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a method of family planning? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 720 Would you say that using contraception is mainly your MAINLY RESPONDENT . . . . . . . . . . 1 decision, mainly your husband's decision, or did MAINLY HUSBAND . . . . . . . . . . . . . . . . 2 you both decide together? JOINT DECISION . . . . . . . . . . . . . . . . 3 OTHER 6 (SPECIFY) 720A Now I want to ask you about your husband’s views on APPROVES . . . . . . . . . . . . . . . . . . . . 1 family planning. DISAPPROVES . . . . . . . . . . . . . . . . . . 2 Do you think that your husband approves or disapproves of DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 couples using a contraceptive method to avoid pregnancy? 721 CHECK 311/311A: NEITHER HE OR SHE STERILIZED STERILIZED 801 722 Does your husband want the same number of SAME NUMBER . . . . . . . . . . . . . . . . . . 1 children that you want, or does he want more or fewer than you MORE CHILDREN . . . . . . . . . . . . . . . . 2 want? FEWER CHILDREN . . . . . . . . . . . . . . . . 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 281Appendix D | SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 801 CHECK 101A: CURRENTLY CURRENTLY WIDOWED, 803 MARRIED DIVORCED, OR SEPARATED 802 How old was your husband on his last birthday? AGE IN COMPLETED YEARS 803 Did your (last) husband ever attend school? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 806 804 What is the highest level of school he attended: OLD SYSTEM Old elementary, old preparatory, old secondary, new basic, ELEMENTARY . . . . . . . . . . . . . . . . . . 01 new secondary, intermediate diploma, bachelor, or higher? PREPARATORY . . . . . . . . . . . . . . . . 02 SECONDARY . . . . . . . . . . . . . . . . . . 03 NEW SYSTEM BASIC . . . . . . . . . . . . . . . . . . . . . . . . 04 SECONDARY . . . . . . . . . . . . . . . . . . 05 INTERMEDIATE DIPLOMA . . . . . . . . . . 06 BACHELOR . . . . . . . . . . . . . . . . . . . . 07 HIGHER . 08 DON'T KNOW . . . . . . . . . . . . . . . . . . 98 806 805 What was the highest grade he completed at that level? GRADE . . . . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . . . . . . . . 98 806 CHECK 101A: CURRENTLY CURRENTLY WIDOWED, 811 MARRIED DIVORCED, OR SEPARATED 807 Has your husband done any work in the last seven days, even YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 809 for one hour? By “work”, I mean any paid work, any work in a business completely or partially owned by your husband, any NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 work in a business owned by the household without payment, or work in other business? 808 Does your husband have any job, but he did not practice it YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 during the last seven days for a reason such as vacation, travel, or illness? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 811 809 What is your husband’s current occupation, that is, what kind of work does he mainly do? 810 What is your husband’s employment status: is he an employee, EMPLOYEE . . . . . . . . . . . . . . . . . . . . . . 1 an employer, is he self-employed, is he working for his family EMPLOYER . . . . . . . . . . . . . . . . . . . . . . 2 without payment, or is he working for someone else without SELF-EMPLOYED . . . . . . . . . . . . . . . . 3 payment? UNPAID FAMILY WORKER . . . . . . . . . . 4 UNPAID WORKER . . . . . . . . . . . . . . . . 5 811 Have you done any work in the last seven days, even for one YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 813 hour? By “work”, I mean any paid work, any work in a business completely or partially owned by yourself, any work in a business NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 owned by the household without payment, or work in other business? 812 Do you have any job, but you did not practice it during the last YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 seven days for a reason such as vacation, travel, or illness? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 818 282 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 813 What is your current occupation, that is, what kind of work do you mainly do? 814 What is your employment status: are you an employee, an EMPLOYEE . . . . . . . . . . . . . . . . . . . . . . 1 employer, are you self-employed, are you working for your EMPLOYER . . . . . . . . . . . . . . . . . . . . . . 2 family without payment, or are you working for someone else SELF-EMPLOYED . . . . . . . . . . . . . . . . 3 without payment? UNPAID FAMILY WORKER . . . . . . . . . . 4 UNPAID WORKER . . . . . . . . . . . . . . . . 5 818 CHECK 101A: CURRENTLY CURRENTLY WIDOWED, MARRIED DIVORCED, OR SEPARATED 827 819 CHECK 814: CODE 4, OR 5 CODE 1, 2, OR 3 CIRCLED OR CIRCLED 814 NOT ASKED 822 820 Who usually decides how the money you earn will be used: RESPONDENT . . . . . . . . . . . . . . . . . . 1 mainly you, mainly your husband, or you and your husband HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 jointly? RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 OTHER 6 (SPECIFY) 821 Would you say that the money that you earn is more than what MORE THAN HIM . . . . . . . . . . . . . . . . . . 1 your husband earns, less than what he earns, or about the same? LESS THAN HIM . . . . . . . . . . . . . . . . . . 2 ABOUT THE SAME . . . . . . . . . . . . . . . . 3 HUSBAND DOESN'T BRING IN ANY MONEY . . . . . . . . . . . . . . . . . . 4 822A DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 822 Who usually decides how your husband's earnings RESPONDENT . . . . . . . . . . . . . . . . . . 1 will be used: you, your husband, or you and your husband HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 jointly? RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 HUSBAND HAS NO EARNINGS . . . . . 4 OTHER 6 (SPECIFY) 822A CHECK 814: CODES CODE 4, OR 5 1, 2, 0R 3 CIRCLED OR YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CIRCLED 814 NOT ASKED In addition to your emplyoment Do you have income from NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 823 income, do you have income any source such as real from any other source, such estate, retirement, as real estate, retirement, allowances, etc. ? allowances, etc. ? 822B Who usually decides how the (additional) money you earn will RESPONDENT . . . . . . . . . . . . . . . . . . 1 be used: mainly you, mainly your husband, or you and your HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 husband jointly? RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 OTHER 6 (SPECIFY) 823 Who usually makes decisions about health care for yourself: RESPONDENT . . . . . . . . . . . . . . . . . . 1 you, your husband, you and your husband jointly, or HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 someone else? RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 SOMEONE ELSE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) 283Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 824 Who usually makes decisions about making major RESPONDENT . . . . . . . . . . . . . . . . . . 1 household purchases? HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 SOMEONE ELSE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) 825 Who usually makes decisions about making purchases RESPONDENT . . . . . . . . . . . . . . . . . . 1 for daily household needs? HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 SOMEONE ELSE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) 826 Who usually makes decisions about visits to your family RESPONDENT . . . . . . . . . . . . . . . . . . 1 or relatives? HUSBAND . . . . . . . . . . . . . . . . . . . . . . 2 RESPONDENT AND HUSBAND JOINTLY . . . . . . . . . . . . . . 3 SOMEONE ELSE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) 827 PRESENCE OF OTHERS AT THIS POINT (PRESENT AND PRES./ PRES./ NOT LISTENING, PRESENT BUT NOT LISTENING, OR NOT LISTEN. NOT PRES. PRESENT) LISTEN. CHILDREN < 10 . . . . . 1 2 3 HUSBAND . . . . . . . . . . 1 2 3 OTHER MALES . . . . . 1 2 3 OTHER FEMALES . . . 1 2 3 828 Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: YES NO DK If she goes out without telling him? GOES OUT . . . . . . . . . . 1 2 8 If she neglects the children? NEGL. CHILDREN . . . 1 2 8 If she burns the food? BURNS FOOD . . . . . . . . 1 2 8 If she insults him? INSULTS . . . . . . . . . . . . 1 2 8 If she disobeys him? DISOBEYS . . . . . . . . . . 1 2 8 If she argues with him? ARGUES . . . . . . . . . . . . 1 2 8 If she has relation with another man? ANOTHER MAN . . . . . 1 2 8 828A In your opinion, what do you consider to be violence against women? CIRCLE CODE '1' FOR EACH SPONTANEOUS ANSWER, THEN FOR EACH CASE NOT MENTIONED SPONTANEOUSLY, ASK: "In your opinion, do you consider (ITEM NOT MENTIONED SPONTANEOUSLY) to be violence against women"? YES YES SPONTA- PRO- IF 'YES' CIRCLE 2 (YES PROBE), IF NO, CIRCLE '3'(NO). NEOUSLY BE NO Beating? BEATING . . . . . . . . . . . . 1 2 3 Physical threats? PHYSICAL THREATS . 1 2 3 Insults? INSULTS . . . . . . . . . . . . 1 2 3 Rape? RAPE . . . . . . . . . . . . . . 1 2 3 Sexual harassment? SEXUAL HARASS. . . . 1 2 3 Early marriage? EARLY MARRIAGE . . . 1 2 3 Compulsory marriage? COMPULSORY MAR. . 1 2 3 Unwanted sexual intercourse? UNWANTED SEX. . . . 1 2 3 OTHER 1 (SPECIFY) 284 | Appendix D SECTION 9. HIV/AIDS AND STI NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 901 Now I would like to talk about something else. YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Have you ever heard of an illness called AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 916 901A Is there anything a person can do to avoid getting the AIDS YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 virus? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 902 901B What can a person do? ABSTAIN FROM SEXUAL INTERCOURSE . . . . . . . . . . . . . . . . A USE CONDOMS . . . . . . . . . . . . . . . . . . B LIMIT SEX TO SPOUSE/STAY FAITHFUL TO SPOUSE . . . C Anything else? LIMIT NUMBER OF SEX. PARTNERS . D AVOID SEX WITH PROSTITUTES . . . E AVOID SEX WITH PERSONS WHO RECORD ALL WAYS MENTIONED. HAVE MANY PARTNERS. . . . . . . . . . F AVOID SEX WITH HOMOSEXUALS . . . G AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY . H AVOID BLOOD TRANSFUSION . . . . . I AVOID INJECTIONS. . . . . . . . . . . . . . . . J AVOID SHARING RAZORS/BLADES K AVOID KISSING . . . . . . . . . . . . . . . . . . L AVOID MOSQUITO BITES . . . . . . . . . . M SEEK PROTECTION FROM TRADITIONAL PRACTITIONER . . . N OTHER W (SPECIFY) OTHER (SPECIFY) X DON'T KNOW Z 902 Can people reduce their chance of getting the AIDS virus YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 by having just one uninfected sex partner who has no other NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 sex partners? DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 903 Can people get the AIDS virus from mosquito bites? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 904 Can people reduce their chance of getting the AIDS virus by YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 using a condom every time they have sex? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 905 Can people get the AIDS virus by sharing food with a person who YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 has AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 906 Can people reduce their chance of getting the AIDS virus by YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 not having sexual intercourse at all? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 907 Can people get the AIDS virus by shaking hands with or hugging YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a person who has AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 907A Can people get the AIDS virus by sharing razors or blades when YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 shaving their beard or having their hair cut? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 908 Is it possible for a healthy-looking person to have the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 285Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 909 Can the virus that causes AIDS be transmitted from a mother to her baby: YES NO DK During pregnancy? DURING PREG. . . . . . 1 2 8 During delivery? DURING DELIVERY . . . 1 2 8 By breastfeeding? BREASTFEEDING . . . 1 2 8 910 Do you know of a place where people can go to get tested for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 the AIDS virus? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 912 911 Where is that? PUBLIC MEDICAL SECTOR GOVT. HOSPITAL . . . . . . . . . . . . . . A Any other place? GOVT. HEALTH CENTER . . . . . . . . B GOVT. MCH . . . . . . . . . . . . . . . . . . C PROBE TO IDENTIFY EACH TYPE OF SOURCE AND UNIVERSITY HOSPITAL . . . . . . . . . . D CIRCLE THE APPROPRIATE CODE(S). ROYAL MEDICAL SERVICES . . . . . E TESTING & COUNCELING CENTER F OTHER PUBLIC G IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER (SPECIFY) VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, PRIVATE MEDICAL SECTOR WRITE THE NAME OF THE PLACE. PRIVATE HOSPITAL/CLINIC . . . . . H PRIVATE DOCTOR . . . . . . . . . . . . I JORDANIAN AS. OF FP AND (NAME OF PLACE(S)) PROTECTION (JAFPP) . . . . . J PRIVATE LABORATORY . . . . . K OTHER NON GOV. ORGANIZATION. L OTHER PRIVATE MEDICAL M (SPECIFY) OTHER X (SPECIFY) 912 Would you buy fresh vegetables from a shopkeeper or vendor YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 if you knew that this person had the AIDS virus? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 913 If a member of your close family got infected with the AIDS virus, YES, REMAIN A SECRET 1 would you want it to remain a secret or not? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS 8 914 If a member of your close family became sick with AIDS, would you YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 be willing to care for her or him in your own household? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 915 In your opinion, if a female teacher has the AIDS virus but SHOULD BE ALLOWED . . . . . . . . . . . . 1 is not sick, should she be allowed to continue teaching SHOULD NOT BE ALLOWED . . . . . . . . 2 in the school? DK/NOT SURE/DEPENDS . . . . . . . . . . 8 915A CHECK 101A: CURRENTLY WIDOWED/ MARRIED DIVORCED/SEPARATED 915C 915B Have you ever talked about ways to prevent getting the virus that YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 causes AIDS with your husband? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 915C In the last 6 months have you heard, seen, or received any YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 information about HIV/AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 916 915D Where did you hear or see that information? TELEVISION . . . . . . . . . . . . . . . . . . . . A RADIO . . . . . . . . . . . . . . . . . . . . . . . . . . . B NEWSPAPER/MAGAZINE . . . . . . . . . . C Anywhere else? PAMPHLET/BROCHURE . . . . . . . . . . . . D POSTER . . . . . . . . . . . . . . . . . . . . . . . . . E COMMUNITY MEETING . . . . . . . . . . . . F RECORD ALL MENTIONNED HOME VISIT BY HEALTH WORKER . G HEALTH FACILITY STAFF . . . . . . . . . H HUSBAND . . . . . . . . . . . . . . . . . . . . . . I OTHER RELATIVES/ FRIENDS/ NEIGHBORS . . . . . J OTHER X (SPECIFY) . . . . . . . . . . . . . . . . . . . . 286 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 916 CHECK 901: HEARD ABOUT NOT HEARD AIDS ABOUT AIDS Apart from AIDS, have Have you heard about infections you heard about other that can be transmitted through infections that can be sexual contact? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 transmitted through NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 917 sexual contact? 916A If a man has a sexually transmitted disease, what symptoms ABDOMINAL PAIN . . . . . . . . . . . . . . . . A might he have? GENITAL DISCHARGE/DRIPPING . . . B FOUL SMELLING DISCHARGE . . . . . C Any other symptoms? BURNING PAIN ON URINATION . . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . . E RECORD ALL MENTIONNED SWELLING IN GENITAL AREA. . . . . . . . F GENITAL SORES/ULCERS . . . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H GENITAL ITCHING . . . . . . . . . . . . . . . . I BLOOD IN URINE . . . . . . . . . . . . . . . . J LOSS OF WEIGHT . . . . . . . . . . . . . . . . K IMPOTENCE . . . . . . . . . . . . . . . . . . . . L FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . M OTHER X (SPECIFY) NO SYMPTOMS . . . . . . . . . . . . . . . . . . Y DON'T KNOW . . . . . . . . . . . . . . . . . . . . Z 916B If a woman has a sexually transmitted disease, what symptoms ABDOMINAL PAIN . . . . . . . . . . . . . . . . A might she have? GENITAL DISCHARGE . . . B FOUL SMELLING DISCHARGE . . . . . C Any other symptoms? BURNING PAIN ON URINATION . . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . . E RECORD ALL MENTIONNED SWELLING IN GENITAL AREA. . . . . . . . F GENITAL SORES/ULCERS . . . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H GENITAL ITCHING . . . . . . . . . . . . . . . . I BLOOD IN URINE . . . . . . . . . . . . . . . . J LOSS OF WEIGHT . . . . . . . . . . . . . . . . K HARD TO GET PREGNANT/ HAVE A CHILD . . . . . . . . . . . . . . . . L FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . M OTHER X (SPECIFY) NO SYMPTOMS . . . . . . . . . . . . . . . . . . Y DON'T KNOW . . . . . . . . . . . . . . . . . . . . Z 917 Husbands and wives do not always agree on everything. YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 If a wife knows her husband has a disease that she can get NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 during sexual intercourse, is she justified in refusing to have DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 sex with him? 918 If a wife knows her husband has a disease that she can get YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 during sexual intercourse, is she justified in asking that they use NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 a condom when they have sex? DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 919 Is a wife justified in refusing to have sex with her husband when YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 she is tired or not in the mood? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 920 Is a wife justified in refusing to have sex with her husband YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 when she knows her husband has sex with women other than NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 his wives? DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 287Appendix D | SECTION 10. OTHER HEALTH ISSUES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 1001 Have you ever heard of an illness called tuberculosis? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1013 1002 How does tuberculosis spread from one person to another? THROUGH THE AIR WHEN COUGHING OR SNEEZING . . . . . A PROBE: Any other ways? THROUGH SHARING UTENSILS . . . B THROUGH TOUCHING A PERSON RECORD ALL MENTIONED. WITH TB . . . . . . . . . . . . . . . . . . . . . . C THROUGH FOOD . . . . . . . . . . . . . . . . D THROUGH SEXUAL CONTACT . . . E THROUGH MOSQUITO BITES . . . . . F OTHER X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . Z 1003 Can tuberculosis be cured? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1003A Would you be willing to take a test for tuberculosis? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1013 Now I would like to ask you some questions about medical care for you yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and BIG NOT A BIG want to get medical advice or treatment, is each of the following PROB- PROB- a big problem or not? LEM LEM Knowing where to go? WHERE TO GO . . . . . . . . 1 2 Getting permission to go? PERMISSION TO GO . . . 1 2 Getting money needed for treatment? GETTING MONEY . . . . . 1 2 The distance to the health facility? DISTANCE . . . . . . . . . . . . 1 2 Having to take transport? TAKING TRANSPORT . 1 2 Not wanting to go alone? GO ALONE . . . . . . . . . . . . 1 2 Concern that there may not be a female health provider? NO FEMALE PROV. . . . 1 2 288 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 1101 CHECK DOMESTIC VIOLENCE BOX ON COVER PAGE: IS THIS WOMAN SELECTED FOR THE DOMESTIC VIOLENCE MODULE? YES NO 1201 1102 CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED. PRIVACY PRIVACY OBTAINED . . . . . . . . . 1 NOT POSSIBLE . . . . . . . . 2 1118 READ TO THE RESPONDENT Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Jordan. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions. 1103 CHECK 101A:: WIDOWED/SEPARATED/ DIVORCED CURRENTLY MARRIED (READ IN PAST TENSE) 1104 Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question. 1104A (Does/did) your (last) husband ever: 1104B How often did this happen during the last 12 months: often, only sometimes, or not at all? OFTEN SOME- NOT AT NOT AP- TIMES ALL PLICABLE a) say or do something to humiliate you YES 1 1 2 3 4 in front of others? NO 2 b) threaten to hurt or harm you YES 1 1 2 3 4 or someone close to you? NO 2 1105 1105A (Does/did) your (last) husband ever do 1105B How often did this happen during any of the following things to you: the last 12 months: often, only sometimes, or not at all? OFTEN SOME- NOT AT NOT AP- TIMES ALL PLICABLE 1) push you, shake you, or throw something YES 1 1 2 3 4 at you? NO 2 2) slap you or twist your arm? YES 1 1 2 3 4 NO 2 3) punch you with his fist or with something YES 1 1 2 3 4 that could hurt you? NO 2 4) kick you, drag you or beat you up? YES 1 1 2 3 4 NO 2 5) try to choke you or burn you on YES 1 1 2 3 4 purpose? NO 2 6) threaten you with a knife, gun, or YES 1 1 2 3 4 any other weapon? NO 2 7) attack you with a knife, gun, or YES 1 1 2 3 4 any other weapon? NO 2 8) physically force you to have sexual YES 1 1 2 3 4 intercourse with him even when you NO 2 did not want to? SECTION 11. DOMESTIC VIOLENCE 289Appendix D | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 1106 CHECK 1105A: AT LEAST ONE NOT A SINGLE 'YES' 'YES' 1108 1107 Did the following ever happen as a result of what your (last) husband did to you: YES NO a) BRUISES/ACHES . . . . . . . . . . . . . . 1 2 b) You had an injury or a broken bone? INJURY/BROKEN BONE . . . . . . . . 1 2 c) You went for treatment? WENT FOR TREATMENT . . . . . . . . 1 2 1108 From the time you were 15 years old has anyone other than your YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 (last) husband hit, slapped, kicked, or done anything else NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 to hurt you physically? REFUSED TO ANSWER/ NO ANSWER . . . . . . . . . . . . . . . . . . . 3 1111 1109 Who has hurt you in this way? MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . A FATHER . . . . . . . . . . . . . . . . . . . . . . . . . B STEP-MOTHER . . . . . . . . . . . . . . . . . . . . . . C STEP-FATHER . . . . . . . . . . . . . . . . . . . . . . D BROTHER . . . . . . . . . . . . . . . . . . . . . . . . . E SISTER . . . . . . . . . . . . . . . . . . . . . . . . . F Anyone else? SON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G DAUGHTER . . . . . . . . . . . . . . . . . . . . . . H RECORD ALL MENTIONED. EX-HUSBAND . . . . . . . . . . . . . . . . . . . . . . I MOTHER-IN-LAW . . . . . . . . . . . . . . . . . . . J FATHER-IN-LAW . . . . . . . . . . . . . . . . . . . K OTHER FEMALE RELATIVE/IN-LAW . . L OTHER MALE RELATIVE/IN-LAW . . M FEMALE FRIEND/ACQUAINTANCE . . N MALE FRIEND/ACQUAINTANCE . . . . . . . O FEMALE TEACHER . . . . . . . . . . . . . . . . . P MALE TEACHER . . . . . . . . . . . . . . . . . . . Q FEMALE EMPLOYER . . . . . . . . . . . . . . . R MALE EMPLOYER . . . . . . . . . . . . . . . . . S FEMALE STRANGER T MALE STRANGER . . . . . . . . . . . . . . . . . U POLICE/SOLDIER . . . . . . . . . . . . . . . . . . . V OTHER X 1110 In the last 12 months, how often have you been hit, OFTEN . . . . . . . . . . . . . . . . . . . . . . . . . 1 slapped, kicked, or physically hurt by this/these person(s): SOMETIMES . . . . . . . . . . . . . . . . . . . 2 often, only sometimes, or not at all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . 3 1111 CHECK 201, 226, AND 229: EVER BEEN PREGNANT NEVER BEEN (YES ON 201 PREGNANT OR 226 OR 229) 1114 1112 Has any one ever hit, slapped, kicked, or done anything else to YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 hurt you physically while you were pregnant? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1114 You had cuts, bruises or aches? (SPECIFY) 290 | Appendix D NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 1113 Who has done any of these things to physically hurt you while CURRENT HUSBAND . . . . . . . . . . . . . . . A you were pregnant? MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . B FATHER . . . . . . . . . . . . . . . . . . . . . . . . . C STEP-MOTHER . . . . . . . . . . . . . . . . . . . . . . D Anyone else? STEP-FATHER . . . . . . . . . . . . . . . . . . . . . . E BROTHER . . . . . . . . . . . . . . . . . . . . . . . . . F SISTER . . . . . . . . . . . . . . . . . . . . . . . . . G RECORD ALL MENTIONED. SON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H DAUGHTER . . . . . . . . . . . . . . . . . . . . . . I EX-HUSBAND . . . . . . . . . . . . . . . . . . . . . . J MOTHER-IN-LAW . . . . . . . . . . . . . . . . . . . K FATHER-IN-LAW . . . . . . . . . . . . . . . . . . . L OTHER FEMALE RELATIVE/IN-LAW . . M OTHER MALE RELATIVE/IN-LAW . . N FEMALE FRIEND/ACQUAINTANCE . . O MALE FRIEND/ACQUAINTANCE . . . . . . . P FEMALE TEACHER . . . . . . . . . . . . . . . . . Q MALE TEACHER . . . . . . . . . . . . . . . . . . . R FEMALE EMPLOYER . . . . . . . . . . . . . . . S MALE EMPLOYER . . . . . . . . . . . . . . . . . T FEMALE STRANGER U MALE STRANGER . . . . . . . . . . . . . . . . . V POLICE/SOLDIER . . . . . . . . . . . . . . . . . . . W OTHER X 1114 CHECK 1105B: CODE '1' (OFTEN) OR NOT A SINGLE CODE '2' (SOMETIMES) CODE '1' OR '2' 1117 CIRCLED FOR AT LEAST CIRCLED ONE ITEM 1115 At any time during the last 12 months when your (last) husband did something to phisically hurt you, did you try to get help to YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 prevent or stop him for hurting you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1117 1116 From whom have you sought help? MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . A FATHER . . . . . . . . . . . . . . . . . . . . . . . . . B Anyone else? SISTER . . . . . . . . . . . . . . . . . . . . . . . . . C BROTHER . . . . . . . . . . . . . . . . . . . . . . . . . D RECORD ALL MENTIONED. MOTHER-IN-LAW . . . . . . . . . . . . . . . . . . . E FATHER-IN-LAW . . . . . . . . . . . . . . . . . . . F OTHER FEMALE RELATIVE/IN-LAW . . G OTHER MALE RELATIVE/IN-LAW . . . . H FRIEND . . . . . . . . . . . . . . . . . . . . . . . . . I NEIGHBOR . . . . . . . . . . . . . . . . . . . . . . . . . J TEACHER . . . . . . . . . . . . . . . . . . . . . . . . . K EMPLOYER . . . . . . . . . . . . . . . . . . . . . . L RELIGIOUS FIGURE . . . . . . . . . . . . . . . . . M DOCTOR/MEDICAL PERSONNEL . . . . N POLICE . . . . . . . . . . . . . . . . . . . . . . . . . O LAWYER . . . . . . . . . . . . . . . . . . . . . . . . . P SOCIAL SERVICE ORGANIZATION . . . . Q OTHER X 1117 DID YOU HAVE TO INTERRUPT THE YES YES, MORE INTERVIEW BECAUSE SOME ADULT WAS ONCE THAN ONCE TRYING TO LISTEN, OR CAME INTO THE HUSBAND . . . . . . . . . . . . . . . . . 1 2 3 ROOM, OR INTERFERED IN ANY OTHER OTHER MALE ADULT . . . . . 1 2 3 WAY? FEMALE ADULT . . . . . . . . . . . . 1 2 3 1118 INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE NO (SPECIFY) (SPECIFY) 291Appendix D | SECTION 12. EARLY CHILDHOOD DEVELOPMENT NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 1201 CHECK 217: ANY LIVING CHILD 3-8 YEARS OLD? YES NO 1210 1202 CHECK 217: SELECT THE YOUNGEST CHILD AGED 3-8 YEARS AND RECORD NAME AND LINE NUMBER NAME OF THE YOUNGEST LINE NUMBER OF THE CHILD FROM Q. 212 YOUNGEST CHILD FROM Q. 211 READ TO THE RESPONDENT Now I would like to ask you questions about (NAME OF THE CHILD FROM 1202), your youngest child who is 3-8 years old. 1203 Can (CHILD'S NAME FROM 1202) count? CANNOT COUNT . . . . . . . . . . . . . . . . . . . . 00 IF YES, ASK: To which number he/she can count? CAN COUNT (NUMBER) RECORD THE NUMBER CAN COUNT TO 97 OR MORE 97 IF ' 97' OR MORE, RECORD 97 DON'T KNOW 98 1204 Can (CHILD'S NAME FROM 1202) identify his/her own name, or the YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 names of his/her siblings or friends when he/she sees them in a story, NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 a book, or elsewhere? DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1205 How does (CHILD' S NAME FROM 1202) manage a DISCUSSES DISAGREEMENT WITH misunderstanding with his/her friends in the neighborhood? FRIENDS IN A POSITIVE WAY . . . . . 1 WITHDRAWS FROM THE SITUATION . . . 2 RESORTS TO SHOUTING AND VIOLENCE . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER 4 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1206 Does (CHILD'S NAME FROM 1202) brush his/her teeth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1207 Does (CHILD'S NAME FROM 1202) wash his/her hands YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 after using the toilet? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 1208 During last month, has (CHILD'S NAME FROM 1202) read YES ALWAYS: MORE THAN 12 TIMES . 1 or has anyone read him/her magazines, stories or books other YES SOMETIMES: AROUND 4 TIMES . 2 than his/her school books? NO STORY READ . . . . . . . . . . . . . . . . . . . . 3 NO STORY BOOK . . . . . . . . . . . . . . . . . . . . 4 IF YES, ASK: How often? DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . 8 1209 Does (CHILD'S NAME FROM 1202) participate in family discussions? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT ALLOWED TO PARTICIPATE . . . . . 3 RECORD THE TIME. HOUR . . . . . . . . . . . . . . . . . . . . . . . . MINUTE . . . . . . . . . . . . . . . . . . . . 1210 (SPECIFY) 292 | Appendix D INTERVIEWER'S OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: SUPERVISOR'S OBSERVATIONS NAME OF SUPERVISOR: DATE: EDITOR'S OBSERVATIONS NAME OF EDITOR: DATE: 293Appendix D | INSTRUCTIONS: COL. 1 COL.2 ONLY ONE CODE SHOULD APPEAR IN ANY BOX. 12 DEC 01 01 DEC 12 IN COLUMN 1, ALL MONTHS SHOULD BE FILLED IN. 11 NOV 02 02 NOV 11 10 OCT 03 03 OCT 10 INFORMATION TO BE CODED FOR EACH COLUMN 09 SEP 04 04 SEP 09 2 08 AUG 05 05 AUG 08 2 COL.1 BIRTHS, PREGNANCIES, CONTRACEPTIVE USE ** 0 07 JUL 06 06 JUL 07 0 B BIRTHS 0 06 JUN 07 07 JUN 06 0 P PREGNANCIES 7 05 MAY 08 08 MAY 05 7 T TERMINATIONS 04 APR 09 09 APR 04 03 MAR 10 10 MAR 03 0 NO METHOD 02 FEB 11 11 FEB 02 1 FEMALE STERILIZATION 01 JAN 12 12 JAN 01 2 MALE STERILIZATION 3 PILL 12 DEC 13 13 DEC 12 4 IUD 11 NOV 14 14 NOV 11 5 INJECTABLES 10 OCT 15 15 OCT 10 6 IMPLANTS 09 SEP 16 16 SEP 09 7 CONDOM 2 08 AUG 17 17 AUG 08 2 8 FEMALE CONDOM 0 07 JUL 18 18 JUL 07 0 9 DIAPHRAGM 0 06 JUN 19 19 JUN 06 0 J FOAM OR JELLY 6 05 MAY 20 20 MAY 05 6 K LACTATIONAL AMENORRHEA METHOD 04 APR 21 21 APR 04 L PERIODIC ABSTINENCE 03 MAR 22 22 MAR 03 M WITHDRAWAL 02 FEB 23 23 FEB 02 X OTHER 01 JAN 24 24 JAN 01 (SPECIFY) 12 DEC 25 25 DEC 12 NOTE: In case of a multiple birth which ended 11 NOV 26 26 NOV 11 with live and non-live birth outcomes 10 OCT 27 27 OCT 10 record BIRTH to the calendar 09 SEP 28 28 SEP 09 2 08 AUG 29 29 AUG 08 2 0 07 JUL 30 30 JUL 07 0 0 06 JUN 31 31 JUN 06 0 5 05 MAY 32 32 MAY 05 5 04 APR 33 33 APR 04 COL. 2: DISCONTINUATION OF CONTRACEPTIVE USE 03 MAR 34 34 MAR 03 0 INFREQUENT SEX/HUSBAND AWAY 02 FEB 35 35 FEB 02 1 BECAME PREGNANT WHILE USING 01 JAN 36 36 JAN 01 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 12 DEC 37 37 DEC 12 4 WANTED MORE EFFECTIVE METHOD 11 NOV 38 38 NOV 11 5 HEALTH CONCERNS 10 OCT 39 39 OCT 10 6 SIDE EFFECTS 09 SEP 40 40 SEP 09 7 LACK OF ACCESS/TOO FAR 2 08 AUG 41 41 AUG 08 2 8 COSTS TOO MUCH 0 07 JUL 42 42 JUL 07 0 9 INCONVENIENT TO USE 0 06 JUN 43 43 JUN 06 0 F FATALISTIC 4 05 MAY 44 44 MAY 05 4 A DIFFICULT TO GET PREGNANT/MENOPAUSAL 04 APR 45 45 APR 04 D WIDOW/DIVORCE/SEPARATION 03 MAR 46 46 MAR 03 R RAMADAN 02 FEB 47 47 FEB 02 X OTHER 01 JAN 48 48 JAN 01 (SPECIFY) Z DON'T KNOW 12 DEC 49 49 DEC 12 11 NOV 50 50 NOV 11 10 OCT 51 51 OCT 10 09 SEP 52 52 SEP 09 2 08 AUG 53 53 AUG 08 2 0 07 JUL 54 54 JUL 07 0 0 06 JUN 55 55 JUN 06 0 3 05 MAY 56 56 MAY 05 3 04 APR 57 57 APR 04 03 MAR 58 58 MAR 03 02 FEB 59 59 FEB 02 01 JAN 60 60 JAN 01 12 DEC 61 61 DEC 12 11 NOV 62 62 NOV 11 10 OCT 63 63 OCT 10 09 SEP 64 64 SEP 09 2 08 AUG 65 65 AUG 08 2 0 07 JUL 66 66 JUL 07 0 0 06 JUN 67 67 JUN 06 0 2 05 MAY 68 68 MAY 05 2 04 APR 69 69 APR 04 03 MAR 70 70 MAR 03 02 FEB 71 71 FEB 02 01 JAN 72 72 JAN 01 294 | Appendix D Front Matter Title Page Citation Page Table of Contents List of Table and Figures Preface Summary of Findings Map of Jordan Chapter 01 - Introduction Chapter 02 - Household Characteristics Chapter 03 - Respondents' Background Characteristics Chapter 04 - Fertility Chapter 05 - Fertility Regulation Chapter 06 - Nuptiality and Exposure to the Risk of Pregnancy Chapter 07 - Fertility Preferences Chapter 08 - Infant and Child Mortality Chapter 09 - Maternal Health Chapter 10 - Child Health Chapter 11 - Nutrition Chapter 12 - HIV/AIDS and Sexually Transmitted Infections Chapter 13 - Women's Empowerment Chapter 14 - Domestic Violence Chapter 15 - Early Childhood Development References Appendix A - Sample Design Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - Questionnaires Household Questionnaire Woman's Questionnaire

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