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 pregnan

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