Jordan - Demographic and Health Survey - 2010

Publication date: 2010

Jordan Population and Family Health Survey 2009 Jordan 2009 Population and Fam ily H ealth Survey THE HASHEMITE KINGDOM OF JORDAN Jordan Population and Family Health Survey 2009 Department of Statistics Amman, Jordan ICF Macro Calverton, Maryland, USA May 2010 CONTRIBUTORS DEPARTMENT OF STATISTICS Dr. Haidar Fraihat Fathi Nsour Ikhlas Aranki Kamal Saleh Wajdi Akeel Zeinab Dabbagh Ahmad Hiyari MINISTRY OF HEALTH Dr. Adel Belbeisi Dr. Bassam Hijawi UNIVERSITY OF JORDAN Dr. Issa Masarweh ICF MACRO Bernard Barrère Lyndsey Wilson-Williams Mohamed Ayad Nourredine Abderrahim This report summarizes the findings of the 2009 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) and the United Nations Population Fund (UNFPA). ICF Macro provided technical assistance through the MEASURE DHS program. The JPFHS is part of the worldwide Demographic and Health Surveys Program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Jordan survey may be obtained from the Department of Statistics, P.O. Box 2015, Amman 11181, Jordan (Telephone (962) 6-5-300-700; Fax (962) 6-5- 300-710; e-mail stat@dos.gov.jo). Additional information about the MEASURE DHS program may be obtained from ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone 301-572-0200; Fax 301-572-0999; e-mail reports@measuredhs.com). Suggested citation: Department of Statistics [Jordan] and ICF Macro. 2010. Jordan Population and Family Health Survey 2009. Calverton, Maryland, USA: Department of Statistics and ICF Macro. Contents | iii CONTENTS Page TABLES AND FIGURES . vii PREFACE . xi SUMMARY OF FINDINGS . xiii MAP OF JORDAN . xvi 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 . 6 1.6 Methodology and Organization of the Survey . 6 1.6.1 Sample Design . 7 1.6.2 Updating of Sampling Frame . 7 1.6.3 Questionnaires . 7 1.6.4 Recruitment of Staff . 8 1.6.5 Training and Pretest . 8 1.6.6 Main Fieldwork . 9 1.6.7 Data Processing . 9 1.7 Results of the Household and Individual Interviews . 10 CHAPTER 2 HOUSEHOLD CHARACTERISTICS 2.1 Population by Age and Sex . 11 2.2 Population by Age from Other Sources . 13 2.3 Household Size . 14 2.4 Level of Education of the Household Population . 17 2.5 School Attendance . 19 2.6 Housing Characteristics . 20 2.7 Presence of Durable Goods . 23 2.8 Household Wealth . 24 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3.1 General Characteristics . 27 3.2 Respondents’ Level of Education . 28 3.3 Respondents’ Employment Characteristics . 30 3.3.1 Working Status . 30 3.3.2 Occupation . 31 3.4 Smoking Tobacco . 33 iv | Contents CHAPTER 4 FERTILITY 4.1 Fertility Levels and Trends . 35 4.2 Children Ever Born . 40 4.3 Birth Intervals . 41 4.4 Age at First Birth . 43 4.5 Teenage Fertility . 44 CHAPTER 5 FERTILITY REGULATION 5.1 Knowledge of Family Planning Methods . 47 5.2 Ever Use of Contraception . 48 5.3 Current Use of Contraception . 48 5.4 Number of Children at First Use of Contraception . 53 5.5 Timing of Female Sterilization . 53 5.6 Source of Supply for Modern Methods . 54 5.7 Contraceptive Discontinuation . 55 5.8 Future Use of Family Planning . 57 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY 6.1 Current Marital Status . 59 6.2 Polygyny . 61 6.3 Age at First Marriage . 62 6.4 Recent Sexual Activity . 64 6.5 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility . 65 6.6 Menopause . 66 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Children . 69 7.2 Need for Family Planning Services . 72 7.3 Ideal Number of Children . 74 7.4 Planning Status of Births . 76 CHAPTER 8 NUTRITIONAL STATUS AND PREVALENCE OF ANEMIA 8.1 Nutritional Status Of Children . 79 8.1.1 Measurement of Nutritional Status among Young Children . 79 8.1.2 Results of Data Collection . 80 8.1.3 Levels of Child Malnutrition . 82 8.1.4 Trends in Children’s Nutritional Status . 83 8.2 Nutritional Status of Women . 85 8.3 Anemia . 86 8.3.1 Prevalence of Anemia in Children . 87 8.3.2 Prevalence of Anemia in Women . 89 Contents | v CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Levels and Trends . 94 9.2 Socioeconomic Differentials in Infant and Child Mortality . 96 9.3 Demographic Differentials in Infant and Child Mortality . 97 9.4 Perinatal Mortality . 99 9.5 High-Risk Fertility Behavior . 101 REFERENCES . 103 APPENDIX A SAMPLE DESIGN A.1 Objectives of the Survey . 105 A.2 Sampling Frame . 105 A.3 Sample Allocation and Sample Selection . 106 A.4 Selection Probability and Sampling Weight . 108 A.5 Sample Implementation . 109 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 111 APPENDIX C DATA QUALITY . 133 APPENDIX D QUESTIONNAIRES . 139 Tables and Figures | vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 10 CHAPTER 2 HOUSEHOLD CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 12 Table 2.2 Household composition . 15 Table 2.3 Children’s living arrangements and orphanhood . 16 Table 2.4 Educational attainment of the household population . 17 Table 2.5 Age-specific attendance rates of the de jure population 6 to 24 years . 19 Table 2.6 Household characteristics . 21 Table 2.7 Household drinking water . 22 Table 2.8 Household durable goods . 23 Table 2.9 Wealth quintiles . 25 Figure 2.1 Male and Female Population by Single Year of Age, 2009 . 11 Figure 2.2 Population Pyramid, 2009 . 13 Figure 2.3 Population by Broad Age Groups, Various Surveys, 1983-2009 . 14 Figure 2.4 Age-Specific Attendance Rates, 2009 . 20 CHAPTER 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS Table 3.1 Background characteristics of respondents . 27 Table 3.2 Educational attainment . 29 Table 3.3 Working status . 30 Table 3.4 Occupation . 32 Table 3.5 Use of tobacco: Women . 33 Figure 3.1 Percent Distribution of Women Who Worked in the 7 Days Preceding the Survey, by Employment Status, 2009 . 31 CHAPTER 4 FERTILITY Table 4.1 Trends in fertility . 36 Table 4.2 Current fertility . 37 Table 4.3 Fertility by background characteristics . 39 Table 4.4 Trends in age-specific fertility rates . 40 Table 4.5 Children ever born and living . 41 Table 4.6 Birth intervals . 42 Table 4.7 Age at first birth . 43 Table 4.8 Median age at first birth . 44 Table 4.9 Teenage pregnancy and motherhood . 45 viii | Tables and Figures Figure 4.1 Trends in Age-Specific Fertility Rates, Various Sources, 1997-2009 . 37 Figure 4.2 Total Fertility Rate by Residence and Region from Various Surveys, 2002-2009 . 38 Figure 4.3 Age-Specific Fertility Rates for Five-Year Periods Preceding the Survey, 2009 . 40 CHAPTER 5 FERTILITY REGULATION Table 5.1 Knowledge of contraceptive methods . 47 Table 5.2 Ever use of contraception: Women . 49 Table 5.3 Current use of contraception by age . 50 Table 5.4 Current use of contraception by background characteristics . 52 Table 5.5 Number of children at first use of contraception . 53 Table 5.6 Timing of sterilization . 53 Table 5.7 Source of modern contraception methods . 54 Table 5.8 First-year contraceptive discontinuation rates . 55 Table 5.9 Reasons for discontinuation . 56 Table 5.10 Future use of contraception . 57 Table 5.11 Reason for not intending to use contraception in the future . 57 Table 5.12 Preferred method of contraception for future use . 58 Figure 5.1 Current Use of Contraception among Currently Married Women, Various Surveys, 1990-2009 . 48 Figure 5.2 Sources of Family Planning Methods among Current Users of Modern Methods, 2009 . 54 CHAPTER 6 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY Table 6.1 Trends in the proportion of ever-married by age group . 59 Table 6.2 Current marital status . 60 Table 6.3 Number of co-wives . 61 Table 6.4 Age at first marriage . 62 Table 6.5 Median age at first marriage . 63 Table 6.6 Recent sexual activity . 64 Table 6.7 Postpartum amenorrhea, abstinence, and insusceptibility . 65 Table 6.8 Median duration of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility . 66 Table 6.9 Menopause . 67 Figure 6.1 Percentage of Never-married Women Age 15-39 by Age Group, Various Surveys, 1990-2009 . 60 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 70 Table 7.2 Desire to limit childbearing . 71 Table 7.3 Need and demand for family planning among currently married women . 73 Table 7.4 Ideal number of children . 75 Table 7.5 Mean ideal number of children. 76 Table 7.6 Fertility planning status . 77 Table 7.7 Wanted fertility rates . 78 Figure 7.1 Fertility Preferences of Currently Married Women 15-49, 2009 . 70 Tables and Figures | ix CHAPTER 8 NUTRITIONAL STATUS AND PREVALENCE OF ANEMIA Table 8.1 Nutritional status of children . 81 Table 8.2 Nutritional status of women . 86 Table 8.3 Prevalence of anemia in children . 88 Table 8.4 Prevalence of anemia in women . 90 Figure 8.1 Nutritional Status of Children by Age, 2009 . 83 Figure 8.2 Chronic Malnutrition (Stunting) among Children under Five, JPFHS 2002 and JPFHS 2009 . 84 Figure 8.3 Acute Malnutrition (Wasting) among Children under Five, JPFHS 2002 and JPFHS 2009 . 84 Figure 8.4 Prevalence of Anemia among Children 6-59 Months, JPFHS 2002 and JPFHS 2009 . 89 Figure 8.5 Prevalence of Anemia among All Women, JPFHS 2002 and JPFHS 2009 . 91 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 94 Table 9.2 Early childhood mortality rates by socioeconomic characteristics . 97 Table 9.3 Early childhood mortality rates by demographic characteristics . 98 Table 9.4 Perinatal mortality . 100 Table 9.5 High-risk fertility behavior . 101 Figure 9.1 Trends in Infant and Child Mortality by Five-year Periods Preceding the Survey, 2009 . 95 Figure 9.2 Trends in under-Five Mortality, 1990-2009 . 96 Figure 9.3 Infant Mortality by Selected Demographic Characteristics, 2009 . 99 APPENDIX A SAMPLE DESIGN Table A.1 Distribution of clusters by governorate and by type of residence . 105 Table A.2 Population distribution by governorate and by type of residence . 106 Table A.3 Distribution of households by governorate and by type of residence . 106 Table A.4 Sample allocation of completed women interviews by governorate and by type of residence . 107 Table A.5 Sample allocation of households and clusters by governorate and by type of residence . 108 Table A.6 Sample implementation . 110 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Jordan 2009 . 113 Table B.2 Sampling errors: Total sample, Jordan 2009 . 114 Table B.3 Sampling errors: Urban sample, Jordan 2009 . 115 Table B.4 Sampling errors: Rural sample, Jordan 2009 . 116 Table B.5 Sampling errors: Central sample, Jordan 2009 . 117 x | Tables and Figures Table B.6 Sampling errors: North sample, Jordan 2009 . 118 Table B.7 Sampling errors: South sample, Jordan 2009 . 119 Table B.8 Sampling errors: Amman sample, Jordan 2009 . 120 Table B.9 Sampling errors: Balqa sample, Jordan 2009 . 121 Table B.10 Sampling errors: Zarqa sample, Jordan 2009. 122 Table B.11 Sampling errors: Madaba sample, Jordan 2009 . 123 Table B.12 Sampling errors: Irbid sample, Jordan 2009 . 124 Table B.13 Sampling errors: Mafraq sample, Jordan 2009. 125 Table B.14 Sampling errors: Jarash sample, Jordan 2009 . 126 Table B.15 Sampling errors: Ajloun sample, Jordan 2009 . 127 Table B.16 Sampling errors: Karak sample, Jordan 2009 . 128 Table B.17 Sampling errors: Tafiela sample, Jordan 2009 . 129 Table B.18 Sampling errors: Ma’an sample, Jordan 2009 . 130 Table B.19 Sampling errors: Aqaba sample, Jordan 2009 . 131 APPENDIX C DATA QUALITY Table C.1 Household age distribution . 133 Table C.2 Age distribution of eligible and interviewed women . 134 Table C.3 Completeness of reporting . 134 Table C.4 Births by calendar years . 135 Table C.5 Reporting of age at death in days . 136 Table C.6 Reporting of age at death in months . 137 Table C.7 Nutritional status of children (JPFHS 2002 based on the WHO Child Growth Standards) . 138 Preface | xi PREFACE The Department of Statistics (DoS) takes pleasure in presenting the principal report of the 2009 Jordan Population and Family Health Survey (JPFHS), which was conducted from October through December 2009. The 2009 JPFHS is the fifth Population and Family Health Survey to be conducted in Jordan over the last 19 years. Like the first four surveys, conducted respectively in 1990, 1997, 2002, and 2007, the 2009 survey was carried out by the DoS. The main objective of the survey is to provide comprehensive information on fertility, family planning, fertility preferences, mortality, and nutrition as a tool to evaluate existing population and health policies and programs. The survey sample is nationally representative and was 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) and 12 governorates, and for the Badia and non-Badia areas. Almost 15,000 households and 10,000 ever-married women age 15 to 49 were interviewed. The 2009 JPFHS was funded by the government of Jordan. Additional funding was provided by the U.S. Agency for International Development (USAID) and the United Nations Population Fund (UNFPA). ICF Macro provided technical assistance through the worldwide MEASURE Demographic and Health Surveys (DHS) program. It is hoped that the 2009 JPFHS data will meet its objective of facilitating important government policies and programs that promote family planning and maternal and child health. Furthermore, the survey will also be useful to those interested in the fields of population, family planning, and nutrition, and in particular, researchers, scientists, students, and other interest groups. The Jordan DoS would like to express its appreciation to all individuals and organizations that contributed to the success of the survey. The timely, 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 also due to the USAID and the UNFPA missions in Amman for their financial support, and to the ICF Macro team: Mohamed Ayad and Bernard Barrère, DHS coordinators, who assisted in all stages of the survey, Ruilin Ren for his recommendations on the sampling design, and 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 | xiii SUMMARY OF FINDINGS The 2009 Jordan Population and Family Health Survey (JPFHS) was designed to provide data for monitoring the population and health situ- ation in Jordan. The 2009 JPFHS is the fifth Popu- lation and Family Health Survey conducted in Jor- dan as part of the Demographic and Health Sur- veys program. The objective of the survey is to provide up-to-date information on fertility, family planning, childhood mortality, and nutrition among women and children. A nationally representative sample of 13,577 households and 10,109 ever-married women age 15-49 were interviewed. This represents a re- sponse rate of 97 percent for households and 97 percent for women. This sample provides esti- mates for Jordan as a whole, for urban and rural areas, the Badia and non-Badia areas, for the North, Central, and South regions, and for each of the 12 governorates. Fieldwork for the 2009 JPFHS was carried out between October and De- cember 2009. HOUSEHOLD CHARACTERISTICS Household Composition. Jordanian house- holds consist of an average of 5.1 persons. Only 11 percent of households in Jordan are headed by a woman. Housing Conditions. Most households have the basic necessities. Ninety-nine percent of households have electricity, and 99 percent have an improved sanitation facility, that is, either a flush toilet, a ventilated improved pit latrine, or a pit latrine with a slab. Almost all households (98 percent) have access to improved drinking water, and 99 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 old- er age groups. The median number of years of schooling completed is 9.2 years for men and 8.9 years for women. As expected, older women and men and those living in rural areas and Badia areas are least likely to be educated. Ownership of Goods. Almost all households own a television (98 percent), and 97 percent own a mobile phone. Almost half (45 percent) of households own a computer, and 95 percent own a washing machine. Almost five 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. Current- ly, women in Jordan have an average of 3.8 child- ren compared with 3.7 in 2002. Fertility is almost identical in urban and rural areas, but it does vary by governorate. Fertility is the lowest in Madaba, at 3.6 children per woman, compared with 4.5 in Jarash. Fertility is much higher in the Badia areas than in the non-Badia areas (4.5 compared to 3.8). 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 weal- thiest households (4.9 compared with 2.7 children per woman). Birth Intervals. The interval between births is relatively long in Jordan. The median number of months since the preceding birth is 31.3. One-third of births occur within 24 months of a previous birth, while two-fifths of infants are born at least three years after their siblings. Desired Family Size. Women report a mean ideal family size of 4.2 children. Ideal family size is slightly higher among women in rural areas than in urban areas (4.4 compared with 4.1). Ideal fami- ly size decreases as women’s education increases: women with no education would like to have 4.9 xiv | Summary of Findings children compared with only 4.2 children among those with higher education. Age at First Marriage and First Birth. In Jordan, half of women are married by age 22.4. Only 16 percent are married by age 18. The me- dian age at first marriage ranges from 21.7 in Zar- qa to 23.6 in Karak. Women with higher education get married almost five years later than those with no education (median age of 24.7 compared with 20.2). Childbearing begins at a relatively late age in Jordan. Over half of women have their first birth by age 24.0. Only 8 percent of women have had their first birth by age 18. Urban and rural women have their first birth at the same age (24.0 versus 24.1 years). Women in the wealthiest households wait much longer to have their first child than women in the poorest households (24.7 years ver- sus 23.8 years). 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 per- cent is pregnant with their first child. In general, teenage childbearing is much more common among women with no education (18 percent) and among those in the poorest households (5 percent). FAMILY PLANNING Knowledge of Family Planning. Knowledge of family planning methods in Jordan is universal: 100 percent of ever-married women age 15-49 know at least one modern method of family plan- ning. The most commonly known methods are the IUD and the pill (100 percent each). Use of Family Planning. Although contracep- tion use increased greatly between 1990 and 2002, it has since stabilized. According to the 2009 JPFHS, 59 percent of married women are currently using a contraception method, and 42 percent are using a modern method. The IUD is the most pop- ular method, with 23 percent of married women using it, followed by use of the pill (8 percent). Use of modern family planning does not vary significantly 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 28 percent of married women in Ma’an to a high of 45 percent in Madaba. Modern contraceptive use increases as wom- en’s education increases, from 24 percent of wom- en with no education to 41 percent among those with higher education. Use of modern methods also increases with wealth—49 percent of married women in the wealthiest households use a modern method compared with only 37 percent of married women in the poorest households. Seventeen percent of married women use a traditional method of family planning. Withdrawal is used by 13 percent, and 4 percent use periodic abstinence. Source of Family Planning Methods. Public sources such as government hospitals, health cen- ters, public MCH, and the Royal Medical Services currently provide contraceptives to about 46 per- cent of current users, while private hospitals and clinics provide various methods to 54 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 percen- tage of married women who want to space their next birth or stop childbearing entirely but are not using contraception. The 2009 JPFHS reveals that 11 percent of married women have an unmet need for family planning—5 percent have a need for spacing and 7 percent have a need for limiting. Unmet need is highest among those with no educa- tion, and among those in the poorest households. Unmet need varies by governorate, ranging from only 9 percent in Jarash to 13 percent in Karak. NUTRITION Children’s Nutritional Status. Using recent- ly developed WHO Child Growth Standards, the 2009 JPFHS found that 8 percent of children showed evidence of chronic malnutrition or stunt- ing, of which one in four (2 percent) are severely stunted. Seven percent of children were classified as overweight, with boys more frequently being overweight than girls (8 percent versus 5 percent). Summary of Findings | xv Stunting is strongly associated with residence. Rural children are more likely to be chronically malnourished than are urban children (12 percent versus 7 percent). The prevalence of stunting ranges from 6 percent in Amman and Zarqa to 13 percent in Karak and Aqaba and 14 percent in Ma’an. In general, children with uneducated mothers and those living in the poorest households are most likely to be malnourished. Women’s Nutritional Status. The mean BMI of all women age 15-49 is 27.0. Over half of Jor- danian women have a BMI of 25.0 or higher and are considered overweight (28 percent) or obese (29 percent). Only 4 percent are thin (body mass index <18.5), which indicates chronic energy defi- ciency. Older women and women with no educa- tion or elementary education are most likely to be overweight or obese. ANEMIA Prevalence of Anemia among Children. One-third (34 percent) of children age 6-59 months have some degree of anemia. In 15 percent of the cases the anemia was moderate. Prevalence of anemia is higher in rural areas (40 percent) than in urban areas (33 percent). Anemia prevalence is also high among children living in Badia areas (38 percent). The prevalence of anemia varies from 24 percent in Madaba governorate to 43 percent in Ma’an governorate and to 45 percent in Karak go- vernorate. Prevalence of Anemia among Women. Twenty-five percent of women have some degree of anemia, of which 21 percent have mild anemia. Women age 40-49 have the highest prevalence of anemia (32 percent). The prevalence of anemia is highest in Balqa and Aqaba governorates (35 per- cent). Among ever-married women, 30 percent have some degree of anemia. About 24 percent have mild and 6 percent have moderate forms of ane- mia. The prevalence of anemia among ever- married women increases as a woman gives birth to more children. CHILDHOOD MORTALITY Levels and Trends. Childhood mortality is quite low in Jordan and has remained stable since 2002. Currently, one in every 36 children in Jor- dan dies before his or her fifth birthday. The infant mortality rate for the five years be- fore the survey (2004-2009) is 23 deaths per 1,000 live births, and the under-five mortality rate is 28 deaths per 1,000 live births. Mortality rates are consistently higher in urban than in rural areas, and they differ markedly by governorate. Under-five mortality ranges from only 17 deaths per 1,000 live births in Zarqa to 39 deaths per 1,000 live births in Amman and Jarash (for the 10 years before the survey). Childhood mortality also decreases as women’s education increases. Infant mortality is more than three times higher among children whose mothers have an elementary education compared with mothers with higher education (49 compared with 15). Birth Intervals and Childhood Mortality. Spacing children at least 36 months apart reduces the risk of infant death. In Jordan, the average birth interval is 31.3 months. Infants born less than two years after a previous birth have a particularly high infant mortality rate (35 deaths per 1,000 live births compared with only 22 deaths per 1,000 live births for infants born more than four years after the previous 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. xvi | 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 1921, and remained so until it gained independence and was declared a kingdom in 1946. In 1950, the Kingdom of 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. In 1988, 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 west to east in 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 about 89,000 square kilometers, of which over 80 percent is characterized by semi-desert 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, Tafiela, Ma’an, and Aqaba) (see map). The major cities are Amman (the capital), Zarqa, and Irbid. With regard to the economy, the government of Jordan 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 percent in 2008. 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 the GDP in 1992, 9.9 percent in 2006, and 10 percent in 2008. 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 17 percent in 2008. The share of the community and personal services sector also rose slightly during this period, from 2.4 percent in 1992 to 3.9 percent in 2008. 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 15 percent in 2008. 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$ 2,646 in 2008. The cost of living index increased by 20 percent between 1992 and 1997, and increased by 8 percent between 1997 and 2002, and by about 19 percent between 2006 and 2008. The balance of trade deficit rose sharply, by 72 percent between 1990 and 1996, but declined by 14 percent between 1997 and 2001. The 2 | Introduction deficit rose by 86 percent between 2002 and 2004 and remained stable between 2006 and 2007; it reached about 43 percent between 2006 and 2008. The rate of economic growth at constant prices has increased steadily over time: growth was 3.3 percent for 1997, 5.8 percent for 2002, and 8.8 percent for 2008. To restructure economic activities in the country, the government began a progressive reform 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 it issued the Privatization Act No. 25 for 2000 to establish the legal and institutional framework for privatization in Jordan. The government 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, and All of Us the Jordan Gathering. In addition economic zones have been created in some governorates in order to fairly distribute 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, in response to the directives of His Majesty King Abdullah II, 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 of Jordan. 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, and it further rose to 5.72 million in 2007 and 6 million in February 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, health services, and 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 2.2 percent in 2009. The average size of a private household decreased from 6.7 persons in 1979 to 6.0 persons in 1994 and to 5.4 persons in 2004. In 2009, the average household size 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 affected flows of migration into Jordan. The population living in urban areas increased by 14 percent between 1980 and 1994 (from 70 to 79 percent), and rose to 83 percent in 2004, which is about a 4 percentage point increase compared with 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 Introduction | 3 proportion of the population under age 15 declined from 51 percent in 1979 to 37 percent by 2004 and to 36.5 in 2009, while the proportion of those age 60 and over has been rising, from 4.1 percent in 1979 to 6 percent in 2009. 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, and 3.7 in 2002, thereafter increasing slightly to reach 3.8 children in 2009. 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 rise was insignificant between 2002 and 2009 (about 3 percent); however, it indicates that the decline in the TFR has stopped in Jordan. 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 slightly increased to 23 per thousand in 2009. 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 2009. With regard to the education of the population, the illiteracy rate among those age 15 years and over has dropped by 70 percent since 1979, from 36 percent to 10 percent in 2002, reaching about 7 percent in 2009 (4 percent among males compared with 11 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 comprised 58 percent of all schools in Jordan in 2008. 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 design 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 then 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 adopted in 1993, when 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 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 and empowerment of women; and population and enhancing advocacy and media. 4 | Introduction In 2002 the Higher Population Council (HPC) was established to address population and development challenges and to implement the National Population Strategy work plan. The council is headed by the Prime Minister and is comprised of concerned ministers and members of 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, and with following up, presenting, updating, and providing a supportive environment for achieving its objectives. This is to be in line with the national socioeconomic plans, the socioeconomic transition program, and the national agenda of Jordan. The HPC works toward the promotion of public awareness in population and development issues and enhance advocacy in these areas. The HPC also collaborates and coordinates with regional and international bodies interested in population issues, in addition to building national capacities for officials from different institutions working in these areas. In 2009 the prime minister’s cabinet approved a policy document by HPC, which addresses the concept of a ‘demographic opportunity’. The demographic opportunity occurs when the percentage of the population who are working (age 15-64) is significantly higher than those who are dependent (children under 15 and adults over age 65). The importance of this document stems from the expectation that Jordan--like other countries that have witnessed a recent decline in their high fertility rates--is on the verge of a historic demographic change that holds a “Demographic Opportunity” or “Demographic Window of Opportunity”. This opportunity is usually accompanied by various social and economic changes, which if not handled appropriately can take the form of challenges. Prior preparation, planning, and monitoring of these changes creates opportunities that occur in conjunction with the continued decline in fertility rates. Unlike developed countries, which closed the demographic window several decades ago, the demographic window of many developing countries, including Jordan, is yet to occur. The HPC policy document includes policies for achieving and investing in the population opportunity and maximizing the benefits from the accompanying changes. These policies have been made to include three main topics which are (1) the policy of accelerating the demographic shift to reach the demographic opportunity period, (2) the policy of benefiting from the proceeds of the demographic opportunity, and (3) the social protection and post-demographic opportunity policies. 1.4 HEALTH PRIORITIES AND PROGRAMS The Ministry of Health (MOH) is responsible for all health affairs in the Hashemite Kingdom of Jordan according to Health Law No. 47 for 2008. Its tasks include the provision of preventive health services and curative care. Additionally, the MOH organizes health services provided by the public and private sectors, provides health insurance for Jordanian citizens with available human and financial resources, and establishes educational and health training institutes. Health services have been the main concern of the Hashemite leadership for improving its level of services and for coping with rapid changes at local, regional, and international levels. This requires the development of health polices and strategic plans by improving health services for all citizens, so that the health sector in Jordan will occupy a pioneer ranking in the region. Introduction | 5 In light of the challenges facing the health sector, the Ministry has prepared a Health Strategy (2008-2012), based on a vision, a mission and goals attainable which maintain the acquired profits, and achieves the comprehensive development goals stated in the National Agenda Document and the National Health Strategy. Executive plans, programs and policies from these strategy documents mainly focus on the following topic areas: • Primary Healthcare The main goals include the enhancement of healthy lifestyle patterns (such as physical activity, tobacco prevention, and following safe nutrition patterns), enhancement of reproductive health services and child health, decreasing chronic disease prevalence and its complications, improvement of mother and child nutrition status, and improvement of first aid and emergency care. Its goals also include maintaining a low prevalence of HIV/AIDS and sexuality-transmitted infection; programs for screening hereditary diseases among newborns; adding micronutrients to flour (flour fortification); fighting prevailing diseases and maintaining high vaccination coverage; introducing new vaccines to vaccination programs; and providing early diagnosis, evaluation, and health insurance coverage to those with special needs. • Human Resources Management Capacity building of staff is receiving considerable attention by the MOH. Activities include training courses (both internal and external) and on the job training and scholarships aimed at maintaining the provision of high quality services. • Secondary and Tertiary Care Ministry of Health hospitals located in the governorates and districts provide basic curative care services, such as medication disbursement, rehabilitation, and blood transfusions through the National Blood Bank. The positive effects of these services are reflected in the decreases seen in the child mortality and maternal mortality rates and the increases in the life expectancy at birth for both sexes. Both of these positive health outcomes reflect positively on the socioeconomic level of the population. • Monitoring and Control The MOH monitors health professionals and other health institutions in the public and private sectors and monitors these institutions by participating in the drafting of their laws and regulations related to clinics, hospitals, and medical laboratories. • Financial Management Jordan is characterized as a medium income country, with good infrastructure and modern health services. The average health expenditure represents about 10 percent of the Gross Domestic Product (GDP). Per capita health expenditures were 250 JD in 2007, and the expenditure on primary health care amounted to 20 percent of the budget of the MOH. Expenditures on secondary and tertiary health care have increased in Jordan. This increased spending contradicts international directives, particularly those of the World Health 6 | Introduction Organization (WHO). The WHO recommends an increase in expenditures on primary health care because those health services maintain and protect the health of citizens. The MOH would like to provide health insurance coverage to all of its citizens in the coming years. Currently, 85 percent of the population has health insurance. • Knowledge Management Introducing the concept of knowledge management into the strategies of the Ministry will form a future methodology that will benefit from available knowledge assets. These include information, skills, and experiences. The MOH is computerizing and developing a geographic information system (GIS) for all affiliated health facilities. Most central directorates in the Ministry have established electronic websites. The Health Insurance Directorate has also been computerized and linked to all governorates. Additionally, some central directorates and hospitals have been computerized. Scientific research provides information that can be used for planning and decision making purposes. The MOH has prepared a document that includes national priorities in the field of health research. Additionally, several studies have been conducted jointly between the MOH and various international agencies and Jordanian universities. 1.5 OBJECTIVES OF THE SURVEY As in the previous Demographic and Health Surveys (DHS) conducted in 1990, 1997, 2002 and 2007 in Jordan, the primary objective of the 2009 Jordan Population and Family Health Survey (JPFHS) is to provide reliable estimates of demographic parameters, such as fertility, family planning, fertility preferences, and child mortality as well as the nutritional status of women and children. The data from these surveys can be used by program managers and policy makers to evaluate and improve existing programs. In addition, the JPFHS data will be useful to researchers and scholars interested in analyzing demographic trends in Jordan, as well as those conducting comparative, regional, or cross-national studies. The content of the 2009 JPFHS has been significantly decreased from the 2007 survey: it does not include data on mother and child health, reproductive health, women’s status, domestic violence, and early childhood development. However, a sub-sample of women age 15-49 and children age 6-59 months were tested to measure the prevalence of anemia. Height and weight of all women age 15-49 and children age five and under were also measured to assess their nutritional status. 1.6 METHODOLOGY AND ORGANIZATION OF THE SURVEY The 2009 JPFHS was designed to collect data on ever-married women of reproductive age. The areas covered include demographic and socioeconomic characteristics, reproduction, family planning, marriage, fertility preferences, woman employment, and nutritional status of all women age 15-49 and children under five years of age. The survey was funded primarily by the Jordanian government and the U.S. Agency for International Development (USAID). Additional funding was provided by UNFPA. ICF Macro provided technical assistance through the global Demographic and Health Surveys (DHS) program, in the domain of sample and questionnaire design, training activities, processing of survey data, and preparation of reports. Introduction | 7 The survey was implemented in three stages; the first was the preparatory stage, which involved sample design and implementation of sampling procedures, such as mapping and listing of households. At the same time, the survey questionnaires and instruction manuals were developed, pretested, and finalized. All of these activities were completed in June 2009. The second stage encompassed interviewing and the collection of data. This was carried out by 18 teams, consisting of 18 controllers, 11 field editors, 65 interviewers, and 11 female health technicians (for blood testing). Each team was provided with the required number of vehicles. The field work started on October 7, 2009, and finished on December 28, 2009. The third stage involved office editing of questionnaires, coding of open-ended questions, and ensuring data completion and data consistency. Data processing using CSPro (Census and Survey Processing) 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 by January 6, 2010. 1.6.1 Sample Design The 2009 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. To ensure comparability with the previous surveys, the sample was also 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, Tafiela, Ma’an, and Aqaba. The 2009 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 other 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 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 (for anemia) and the measurements of height and weight were conducted among eligible individuals in the selected households in 465 PSUs (half of the sample). 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, 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 2009. 1.6.3 Questionnaires The 2009 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 2007 survey, in collaboration with ICF Macro. The Household Questionnaire was used to list all usual members and visitors 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 socioeconomic characteristics 8 | Introduction of the household, such as source of water, sanitation facilities, and availability of durable goods. The Household Questionnaire was also used to identify women who were eligible for the individual interview: ever-married women age 15-49. In addition, in half of the households, all women age 15-49 and children under five years of age were measured to determine nutritional status. Children age 6-59 months and women age 15-49 were 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, 2002, and 2007 JPFHS. For each ever-married woman age 15-49, information on the following topics was collected: • Respondent’s general background • Birth history • Family planning • Marriage • Fertility preferences • Respondent’s employment In addition, information on births and pregnancies, contraceptive use and discontinuation, and marriage during the five years prior to the survey was collected using a monthly calendar for this purpose. As previously mentioned, anthropometric data were collected during the 2009 JPFHS in a sub- sample of 50 percent of clusters. All women age 15-49 and children age 0-4 in these households were measured using Shorr height boards and weighed using electronic Seca scales. In addition, a drop of capillary blood was taken from these women and children age 6-59 months to measure, in the field, their hemoglobin level using the HemoCue system. Hemoglobin testing was used to estimate the prevalence of anemia. 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 other demographic surveys conducted by the Department of Statistics (DoS), especially the 2007 JPFHS. The interviewers were all highly qualified women. 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 three weeks in September and October 2009. 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 15 urban clusters and 4 rural clusters. Introduction | 9 Field practice in anemia testing was carried out during the pretest by the assigned team health technicians. In addition, team members practiced weighing and measuring the height of 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. Training was conducted in the Ministry of Health centers, 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 in these centers. 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 and experts from ICF Macro participated and lectured in the training program. 1.6.6 Main Fieldwork The survey fieldwork was organized in such a way as to ensure control over field logistics by DoS field offices all over the country. The workload, the dispersion of sample units, and transportation facilities served as criteria for identifying the number of field staff in each area. The field staff consisted of 18 teams that consisted of 18 controllers, 11 editors, 65 interviewers, and 11 female health technicians (for blood testing). All teams were supervised by three supervisors. During field work, these teams were combined or reformulated as necessary. Fieldwork was carried out between October 7 and December 28, 2009. To facilitate data collection, each interviewing team was assigned a number of blocks in the sample area. Each supervisor, in collaboration with the controller, divided the 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, the supervisor, or both to ensure completeness and consistency of data. Under the supervision of controllers and supervisors, the field editor, the controller, or both 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 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 January 2010. A data processing specialist from ICF Macro made a trip to Jordan in January 2010 to follow up on data editing and cleaning and to work on the tabulation of results for the survey preliminary report. The preliminary report was then published in February 2010. The tabulations for the present final report were completed in March 2010. 10 | Introduction 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 14,872 households were selected for the survey from the sampling frame; among those selected households, 13,959 households were found. Of those households, 13,577 (97 percent) were successfully interviewed. In those households, 10,401 eligible women were identified, and complete interviews were obtained with 10,109 of them (97 percent of all eligible women). The overall response rate (the household’s response rate multiplied by the eligible woman response rate) was about 95 percent. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Jordan 2009 Result Residence Total Urban Rural Household interviews Households selected 10,184 4,688 14,872 Households occupied 9,550 4,409 13,959 Households interviewed 9,250 4,327 13,577 Household response rate1 96.9 98.1 97.3 Interviews with women age 15-49 Number of eligible women 7,134 3,267 10,401 Number of eligible women interviewed 6,918 3,191 10,109 Eligible women response rate2 97.0 97.7 97.2 1 Households interviewed/households occupied. 2 Respondents interviewed/eligible respondents. Household Characteristics | 11 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 2009 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). The differences between these populations are small. Therefore, since past demographic surveys have generally been based on de facto populations, the 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 indicate that not only a respondent’s age but also the month and year of their birth were 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. 0 200 400 600 800 1000 1200 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Age (in years) Female Male JPFHS 2009 Number in the sample Figure 2.1 Male and Female Population by Single Year of Age, 2009 12 | 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 2009 Age Urban Rural Male Female Total Male Female Total Male Female Total <5 13.4 13.0 13.2 14.1 13.4 13.8 13.5 13.1 13.3 5-9 12.1 11.9 12.0 12.5 12.0 12.3 12.2 11.9 12.0 10-14 11.8 10.8 11.3 12.5 12.7 12.6 11.9 11.2 11.6 15-19 11.4 10.8 11.1 12.7 11.1 11.9 11.6 10.8 11.2 20-24 10.1 9.2 9.7 9.6 9.2 9.4 10.0 9.2 9.6 25-29 7.9 8.6 8.3 8.3 8.0 8.1 8.0 8.5 8.2 30-34 6.5 7.6 7.1 6.0 7.6 6.8 6.4 7.6 7.0 35-39 6.2 6.1 6.2 5.9 6.5 6.2 6.1 6.2 6.2 40-44 5.4 6.1 5.8 4.9 5.1 5.0 5.3 5.9 5.6 45-49 4.3 4.2 4.3 3.4 3.6 3.5 4.1 4.1 4.1 50-54 2.6 2.9 2.8 2.4 3.1 2.8 2.6 3.0 2.8 55-59 2.3 2.4 2.3 2.3 2.3 2.3 2.3 2.4 2.3 60-64 2.0 2.2 2.1 1.6 1.5 1.6 2.0 2.1 2.0 65-69 1.7 1.5 1.6 1.4 1.4 1.4 1.7 1.5 1.6 70-74 1.1 1.2 1.1 1.1 1.2 1.2 1.1 1.2 1.1 75-79 0.7 0.7 0.7 0.7 0.6 0.6 0.7 0.6 0.7 80 + 0.5 0.7 0.6 0.6 0.6 0.6 0.6 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 28,594 28,068 56,662 5,841 5,763 11,604 34,435 33,831 68,266 The population pyramid shown in Figure 2.2 was constructed using the sex and age distribution of the 2009 JPFHS household population. The pyramid has a wide base. This pattern is typical of countries that have experienced relatively high fertility in the recent past. Table 2.1 and Figure 2.2 show that 37 percent of the population is under 15 years of age, an indicator that fertility remains high. The proportion under age 15 is slightly higher in rural areas (39 percent) than it is in urban areas (37 percent); this relationship holds for those under age 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. Household Characteristics | 13 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Percent Age Male Female 7 6 5 4 3 2 1 Figure 2.2 Population Pyramid, 2009 JPFHS 2009 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 105 among those under 30 years of age, to 94 among the middle age group (30-59 years), and about 107 among people age 60 and above. 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, 40 percent in 2002, 38 percent in 2007 and to its current level of 37, with proportional increases in the 15-59 age group (Figure 2.3). This 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, defined as the ratio of the non-productive population (persons under age 15 and age 60 and over) to the population age 15-59, is calculated based of these figures. The ratio fell from 122 in 1983, to 86 in 1997, to 82 in 2002, to 78 in 2007, and to 75 in 2009. 14 | Household Characteristics 51 44 41 40 38 37 45 52 54 55 56 57 4 4 5 6 6 6 0 10 20 30 40 50 60 70 1983 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 JPFHS Percent 0-14 15-59 60+ Figure 2.3 Population by Broad Age Groups, Various Surveys, 1983-2009 Age groups 2.3 HOUSEHOLD SIZE Table 2.2 presents the distribution of households in the 2009 JPFHS sample by sex of the head of the household and by the number of de jure household members. These characteristics are important because they can 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. In addition, single-parent families, especially if they are headed by females, usually have limited financial resources. Household Characteristics | 15 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 2009 Characteristic Residence Total Urban Rural Household headship Male 88.6 88.5 88.6 Female 11.4 11.5 11.4 Total 100.0 100.0 100.0 Number of usual members 1 4.6 4.4 4.6 2 10.6 9.7 10.5 3 11.9 11.2 11.8 4 15.3 13.5 15.0 5 16.8 14.0 16.3 6 15.1 13.3 14.8 7 12.3 12.2 12.2 8 7.2 9.1 7.5 9+ 6.2 12.5 7.2 Total 100.0 100.0 100.0 Mean size of households 5.0 5.4 5.1 Percentage of households with orphans and foster children under 18 years of age Foster children1 1.6 1.6 1.6 Double orphans 0.1 0.2 0.2 Single orphans 3.1 3.4 3.1 Foster and/or orphan children 4.4 4.6 4.4 Number of households 11,377 2,200 13,577 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. The average 2009 JPFHS household had 5.1 persons per household. Seven percent of households, on average, are composed of nine or more persons. In general, rural households are larger than urban households. For example, only 6 percent of urban households had nine or more members compared with 13 percent of rural households. The table shows that 11 percent of households in urban and rural areas are headed by females. The table also shows that almost 2 percent of households have at least one child under age 18who does not live with both parents. A very low percentage of households (0.2 percent) include double orphans (both parents deceased), and 3 percent include single orphans (one parent deceased). More than nine out of ten children under age 18 are living with both parents: this proportion increases to 95 percent for children under age 15 years (Table 2.3). Among children age 0-4 years, 98 percent are living with both parents; this decreases to 92 percent for children age 10-14 years. No variations were noted according to sex, urban-rural residence, region, or Badia area. Slight variations in percentage of children living with both parents were seen by governorate, ranging from 92 percent in Ma’an and Zarqa to 95 percent in Jarash, Ajloun, and Tafiela governorates. In addition, 3 percent of children under the age of 18 have experienced the death of one or both parents. No variations in percentage of children with one or both parents dead were seen according to sex and urban-rural residence. Meanwhile, variations were noted according to governorates (3 percent in Amman, Irbid, Mafraq, Jarash, Ajloun, Tafiela, and Aqaba to 5 percent in Balqa and Ma’an governorates), according to region (from 3 percent in the North to 4 percent in the Central and South regions), and according to residence in Badia areas (4 percent). The percentage of children with one or both parents dead was lower in households located in the second, middle, and fourth wealth quintiles (3 percent) compared with children in the highest wealth quintile (5 percent). 16 | Household Characteristics 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 2009 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biological parent Percent- age with one or both parents dead Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing informa- tion on father/ mother Age 0-4 97.5 1.4 0.5 0.2 0.2 0.1 0.0 0.0 0.0 0.0 100.0 0.2 0.7 8,847 <2 98.3 1.3 0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.2 3,564 2-4 97.0 1.5 0.8 0.2 0.3 0.2 0.0 0.0 0.0 0.0 100.0 0.2 1.1 5,282 5-9 95.5 1.6 1.4 0.6 0.4 0.2 0.0 0.0 0.1 0.0 100.0 0.4 2.0 8,186 10-14 91.6 2.2 3.7 0.9 0.9 0.3 0.1 0.1 0.2 0.0 100.0 0.7 4.9 7,850 15-17 84.5 3.0 6.4 1.2 1.3 2.7 0.2 0.3 0.3 0.2 100.0 3.5 8.4 4,900 Sex Male 93.3 2.1 2.6 0.7 0.6 0.5 0.1 0.0 0.1 0.0 100.0 0.7 3.4 15,443 Female 93.2 1.8 2.5 0.6 0.6 0.8 0.1 0.1 0.2 0.1 100.0 1.2 3.5 14,340 Residence Urban 93.1 2.1 2.5 0.7 0.7 0.7 0.1 0.1 0.1 0.1 100.0 0.9 3.4 24,423 Rural 94.1 1.3 3.0 0.6 0.3 0.5 0.1 0.1 0.1 0.0 100.0 0.8 3.6 5,359 Governorates Amman 92.7 2.4 2.5 0.5 0.7 0.9 0.0 0.1 0.2 0.1 100.0 1.1 3.3 10,827 Balqa 92.8 1.1 3.4 0.7 1.0 0.5 0.4 0.0 0.1 0.0 100.0 1.0 4.9 1,947 Zarqa 92.3 2.0 2.7 0.9 0.8 0.7 0.1 0.0 0.2 0.2 100.0 1.1 3.9 4,370 Madaba 93.1 1.6 3.2 0.6 0.7 0.5 0.2 0.1 0.0 0.0 100.0 0.8 4.2 720 Irbid 94.4 1.6 2.1 0.8 0.3 0.3 0.0 0.1 0.1 0.0 100.0 0.6 2.8 5,770 Mafraq 93.3 2.6 2.4 0.4 0.4 0.7 0.1 0.2 0.0 0.0 100.0 1.0 3.1 1,535 Jarash 95.1 1.3 2.0 0.4 0.5 0.5 0.1 0.0 0.0 0.1 100.0 0.6 2.6 1,058 Ajloun 94.6 1.9 1.7 0.4 1.0 0.3 0.0 0.0 0.2 0.0 100.0 0.4 2.9 739 Karak 94.0 1.1 3.5 0.8 0.2 0.2 0.0 0.0 0.1 0.0 100.0 0.3 3.8 1,199 Tafiela 95.4 0.9 2.7 0.3 0.5 0.2 0.0 0.0 0.0 0.0 100.0 0.3 3.2 468 Ma’an 92.3 1.2 4.7 0.6 0.4 0.5 0.0 0.1 0.1 0.0 100.0 0.7 5.3 524 Aqaba 93.4 1.7 2.7 0.9 0.3 0.7 0.2 0.1 0.0 0.0 100.0 1.1 3.3 627 Region Central 92.6 2.1 2.7 0.6 0.7 0.8 0.1 0.1 0.2 0.1 100.0 1.1 3.7 17,863 North 94.3 1.8 2.1 0.7 0.4 0.4 0.1 0.1 0.1 0.0 100.0 0.7 2.8 9,102 South 93.8 1.2 3.4 0.7 0.3 0.4 0.1 0.0 0.1 0.0 100.0 0.6 3.9 2,817 Badia area Badia 92.7 2.0 3.3 0.5 0.6 0.5 0.2 0.1 0.1 0.0 100.0 0.8 4.3 2,839 Other 93.3 1.9 2.5 0.7 0.6 0.7 0.1 0.1 0.1 0.1 100.0 0.9 3.4 26,944 Wealth quintile Lowest 92.5 2.3 3.0 0.9 0.6 0.4 0.2 0.1 0.1 0.0 100.0 0.7 3.9 6,541 Second 94.2 1.1 2.0 0.6 0.6 0.9 0.0 0.1 0.4 0.1 100.0 1.4 3.1 6,525 Middle 94.2 1.5 2.2 0.6 0.6 0.8 0.1 0.0 0.0 0.0 100.0 0.9 2.8 6,177 Fourth 93.2 2.6 2.0 0.6 0.6 0.6 0.1 0.1 0.1 0.0 100.0 0.9 3.0 5,780 Highest 91.9 2.4 4.0 0.4 0.6 0.4 0.0 0.0 0.0 0.2 100.0 0.5 4.6 4,760 Total <15 95.0 1.7 1.8 0.6 0.5 0.2 0.1 0.0 0.1 0.0 100.0 0.4 2.5 24,883 Total <18 93.3 1.9 2.6 0.7 0.6 0.6 0.1 0.1 0.1 0.0 100.0 0.9 3.4 29,783 Note: Table is based on de jure members, i.e., usual residents. Household Characteristics | 17 2.4 LEVEL OF EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristic of the household because it is 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 2009 JPFHS, questions on education were asked for persons age six and older, in order to calculate rates of school enrollment as well as overall education levels of the population. Table 2.4 presents data on educational attainment as reported in the Household Questionnaire. In the 2009 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: 97 percent of males in Jordan have had some schooling, whereas about 92 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 or completed and median grade completed, according to sex and background characteristics, Jordan 2009 Background characteristic No education Elementary Preparatory Secondary Higher Total Number Median years completed MALE Age 6-9 1.0 99.0 0.0 0.0 0.0 100.0 3,321 1.0 10-14 0.6 59.8 39.4 0.2 0.0 100.0 4,112 5.5 15-19 0.7 4.8 29.4 53.2 11.9 100.0 4,002 9.7 20-24 1.2 4.5 7.2 43.6 43.5 100.0 3,438 11.2 25-29 1.8 8.0 7.6 46.9 35.7 100.0 2,741 10.9 30-34 2.4 9.8 12.7 48.6 26.6 100.0 2,199 10.6 35-39 2.9 7.6 18.9 41.4 29.1 100.0 2,108 10.7 40-44 3.8 8.6 19.1 38.2 30.3 100.0 1,840 10.8 45-49 3.9 10.7 17.5 29.1 38.7 100.0 1,425 11.1 50-54 4.2 17.7 19.9 19.3 38.8 100.0 890 10.9 55-59 6.0 15.9 16.1 26.4 35.5 100.0 798 10.9 60-64 12.3 25.5 16.3 15.6 30.3 100.0 672 8.4 65+ 28.9 31.3 11.2 12.9 15.7 100.0 1,379 5.1 Residence Urban 3.0 27.1 17.3 29.4 23.2 100.0 24,067 9.3 Rural 5.5 28.2 19.0 32.1 15.1 100.0 4,859 8.6 Governorates Amman 2.7 25.4 16.1 28.7 27.0 100.0 11,277 9.8 Balqa 5.4 25.6 18.7 29.0 21.3 100.0 1,908 9.0 Zarqa 3.1 31.2 19.9 30.2 15.7 100.0 4,204 8.4 Madaba 4.1 26.7 18.1 31.3 19.6 100.0 704 9.1 Irbid 2.9 27.2 17.8 30.2 21.7 100.0 5,284 9.3 Mafraq 6.0 29.2 19.2 31.9 13.7 100.0 1,320 8.4 Jarash 3.1 28.1 20.5 32.0 16.3 100.0 890 8.8 Ajloun 3.8 29.0 18.2 32.7 16.3 100.0 650 8.9 Karak 5.0 27.0 17.0 31.3 19.6 100.0 1,181 9.1 Tafiela 3.7 28.9 17.5 33.4 16.6 100.0 403 9.0 Ma’an 4.7 29.9 18.8 30.3 16.3 100.0 493 8.5 Aqaba 4.7 30.0 17.7 31.7 15.9 100.0 612 8.7 Region Central 3.2 26.8 17.3 29.2 23.5 100.0 18,094 9.3 North 3.5 27.8 18.4 30.9 19.4 100.0 8,144 9.0 South 4.7 28.5 17.6 31.5 17.7 100.0 2,689 8.9 Badia area Badia 5.8 32.6 18.5 30.2 12.8 100.0 2,535 8.1 Other 3.2 26.7 17.5 29.9 22.7 100.0 26,392 9.3 Total 3.4 27.3 17.6 29.9 21.8 100.0 28,927 9.2 Continued… 18 | Household Characteristics Table 2.4—Continued Background characteristic No education Elementary Preparatory Secondary Higher Total Number Median years completed FEMALE Age 6-9 1.5 98.3 0.2 0.0 0.0 100.0 3,217 1.1 10-14 0.6 57.4 41.7 0.3 0.0 100.0 3,773 5.6 15-19 1.0 1.7 26.5 50.6 20.2 100.0 3,657 10.0 20-24 3.2 4.5 7.7 32.6 52.0 100.0 3,120 12.1 25-29 3.4 6.2 7.7 38.3 44.3 100.0 2,885 11.5 30-34 2.9 7.2 12.7 43.3 34.0 100.0 2,582 10.9 35-39 2.9 5.7 17.3 43.8 30.3 100.0 2,101 10.7 40-44 4.3 9.8 17.9 34.8 33.2 100.0 2,005 10.9 45-49 8.6 13.7 17.9 29.6 30.1 100.0 1,390 10.4 50-54 18.4 21.1 22.7 19.4 18.3 100.0 1,003 7.6 55-59 29.3 25.0 18.9 12.1 14.6 100.0 800 5.5 60-64 49.5 21.1 10.4 8.7 10.3 100.0 716 1.7 65+ 71.4 14.7 4.8 4.9 4.3 100.0 1,355 0.0 Residence Urban 7.4 24.5 17.0 26.7 24.3 100.0 23,759 9.2 Rural 12.8 27.5 16.5 24.7 18.4 100.0 4,846 7.8 Governorates Amman 6.8 23.3 16.3 27.2 26.3 100.0 11,246 9.7 Balqa 9.5 26.9 17.0 23.2 23.2 100.0 1,822 8.5 Zarqa 8.0 27.2 19.9 27.8 17.1 100.0 3,956 8.4 Madaba 10.5 25.4 16.1 26.7 21.3 100.0 681 8.7 Irbid 8.0 24.6 16.6 26.4 24.3 100.0 5,432 9.1 Mafraq 13.6 29.6 16.3 23.4 17.2 100.0 1,331 7.3 Jarash 8.8 27.9 17.9 25.4 20.0 100.0 910 8.3 Ajloun 9.6 23.5 15.5 26.5 24.8 100.0 665 9.3 Karak 12.1 23.9 14.9 25.0 24.1 100.0 1,164 8.8 Tafiela 12.0 26.0 16.3 23.2 22.6 100.0 410 8.3 Ma’an 13.1 27.6 14.2 24.0 21.1 100.0 462 8.2 Aqaba 9.4 28.4 17.4 25.4 19.4 100.0 525 8.2 Region Central 7.5 24.6 17.2 26.9 23.7 100.0 17,706 9.1 North 9.1 25.7 16.6 25.8 22.7 100.0 8,337 8.8 South 11.7 25.8 15.5 24.6 22.4 100.0 2,562 8.5 Badia area Badia 14.3 31.0 15.4 25.6 13.6 100.0 2,428 6.9 Other 7.8 24.5 17.0 26.5 24.2 100.0 26,177 9.1 Total 8.3 25.0 16.9 26.4 23.3 100.0 28,605 8.9 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. In Jordan, about half of males and females (52 and 50 percent, respectively) have attended secondary education or higher. Overall education levels have increased for both men and women; in 2007 50 percent of males and 49 percent of females had at least a secondary education. Variations were noted in the percentage of both sexes who had at least a secondary education according to urban-rural residence (educational attainment is higher in urban than in rural areas) and governorates. Among females the percentage varies from 41 percent in Mafraq to 54 percent in Amman; for males, it ranges from 46 percent in Zarqa and Mafraq to 56 percent in Amman. The variation is quite large between Badia and non-Badia areas; 39 percent of women have at least a secondary education in Badia areas compared with 51 percent in non-Badia areas. The difference in education level is the same for men, 43 percent who live in Badia areas have at least a secondary education compared with 53 percent of men in non-Badia areas. An examination of the education distributions for successive cohorts indicates that there have been changes over time in the educational attainment of both men and women. For example, the median number of years of schooling has increased from 8.6 for men and 8.0 for women in 2002 to 9.1 and 8.8, respectively in 2007 and to 9.2 for males and 8.9 for females in 2009. Household Characteristics | 19 The gap in the educational attainment between males and females has almost disappeared among younger cohorts. For example, the differential in the median number of years of schooling is 3.3 years between men and women age 50-54. By ages 35-39, however, the median number of years of education is the same for males and females (10.7 years). Above the age of 54, the median age of schooling is considerably higher for males than females, indicating an important gender gap in the oldest generation. 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 for both sexes are higher than in the rest of the country. The largest difference is seen in Badia areas, where the median number of years of schooling is 6.9 years for women compared with 9.1 years for women in non-Badia areas. 2.5 SCHOOL ATTENDANCE Table 2.5 and Figure 2.4 show the proportion of the household population age 6-24 years attending school, by age and sex. The data reflect the fact that school attendance in Jordan is very high; 99 percent of both sexes that are ages 8 through 13 atten Beyond the age of 13, attendance rates start to decline, especially for males. Among both sexes up to age 15 the overall rate exceeds 92 percent. Age 15 marks the beginning of a gender- based divergence in attendance, where 95 percent of females and 93 percent of males are attending school. This gender gap continues through age 21, with 48 percent of females attending school compared with 43 percent of males. More females attend school than males in the age group 16-21. Table 2.5 Age-specific attendance rates of the de jure population 6 to 24 years Percentage of the de jure household pop- ulation age 6-24 years attending school, by age and sex, Jordan 2009 Age Percentage attending Number MALE 6 20.9 883 7 97.7 841 8 99.4 822 9 99.5 777 10 99.0 817 11 99.4 779 12 98.2 829 13 97.2 890 14 96.2 788 15 92.5 874 16 83.2 903 17 80.5 841 18 62.6 755 19 43.9 704 20 41.6 740 21 42.9 772 22 38.7 779 23 31.0 717 24 14.8 735 FEMALE 6 18.1 910 7 97.8 718 8 98.5 766 9 99.5 807 10 99.4 644 11 98.7 807 12 97.7 736 13 97.7 797 14 96.1 761 15 95.0 812 16 91.8 720 17 80.3 749 18 81.2 695 19 69.2 704 20 56.7 662 21 47.9 635 22 37.7 613 23 24.7 601 24 13.3 590 20 | Household Characteristics 0 10 20 30 40 50 60 70 80 90 100 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age Male Female Figure 2.4 Age-Specific Attendance Rates, 2009 (Percentage of the Population Age 6-24 Years Attending School) JPFHS 2009 2.6 HOUSING CHARACTERISTICS In the 2009 JPFHS, information on housing characteristics was collected in the Household Questionnaire. Table 2.6 indicates that three-quarters of housing units (74 percent) in urban areas are apartments compared with nearly one-third (31 percent) in rural areas. Dars account for 69 percent of the dwellings in rural areas compared with only 25 percent in urban areas. In general, 99 percent of total housing units in Jordan are either apartments or dars. About 45 percent of housing units consist of two or three rooms, and 47 percent consist of four or five rooms. The remaining 10 percent consist of six or more rooms (5 percent) or one room (4 percent). There are slight differences in number of rooms according to the place of residence. One in four housing units (25 percent) has one sleeping room, more than two-fifths (44 percent) have two, and little more than a quarter (28 percent) have 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 with the remaining dwellings built from clean cut stone or from clean cut stone and concrete (30 percent). Dwellings in urban areas are more likely to be built from clean cut stone or cut stone and concrete than those in rural areas (33 percent versus 9 percent). Conversely, dwellings in rural areas are more likely to be built from cement bricks than those in urban areas (88 percent versus 66 percent). More than four- fifths of housing units in both urban and rural areas have tile floors (84 percent); the remainder have either marble/ceramic tiles or cement floors. Housing units in urban areas (12 percent) are more likely to have marble or ceramic tiles than housing units in rural areas (3 percent). Almost all households in urban and rural areas have an independent kitchen (98 percent) and an independent bathroom (99 percent). Household Characteristics | 21 Table 2.6 Household characteristics Percent distribution of households and de jure population by housing characteristics, according to residence, Jordan 2009 Housing characteristic Households Population Urban Rural Total Urban Rural Total Type of housing unit Apartment 74.0 30.5 67.0 71.0 27.9 63.5 Dar 24.9 68.5 32.0 27.9 71.2 35.4 Villa 0.9 0.5 0.9 0.9 0.6 0.9 Other 0.1 0.4 0.2 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Electricity Yes 99.6 98.5 99.4 99.5 98.8 99.4 No 0.4 1.5 0.6 0.5 1.2 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Tile 83.7 84.1 83.8 85.0 85.2 85.0 Marble/Ceramic tiles 11.8 2.5 10.3 10.9 2.8 9.5 Cement 4.4 13.0 5.8 4.1 11.5 5.4 Parquet, polished wood 0.1 0.1 0.1 0.1 0.0 0.1 Earth 0.0 0.4 0.1 0.0 0.5 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Main wall material Cement bricks 65.5 88.2 69.1 67.3 87.7 70.8 Cut stone 22.5 3.9 19.5 20.9 4.3 18.0 Cut stone and concrete 10.9 5.3 10.0 10.8 5.5 9.8 Concrete 0.9 2.1 1.1 0.9 2.1 1.1 Other 0.2 0.6 0.3 0.2 0.5 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of rooms One 3.4 3.6 3.5 1.9 1.7 1.9 Two 11.6 13.1 11.9 9.6 10.4 9.7 Three 33.0 31.4 32.8 31.7 30.5 31.5 Four 29.8 32.5 30.2 31.1 34.5 31.6 Five 17.2 14.3 16.7 19.7 16.5 19.1 Six or more 4.9 5.2 5.0 6.1 6.4 6.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 24.3 27.9 24.9 13.9 15.2 14.1 Two 43.7 44.1 43.7 44.8 46.3 45.1 Three 28.7 24.9 28.1 36.3 33.4 35.8 Four or more 3.4 3.1 3.3 5.0 5.1 5.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Household has separate room used as kitchen Yes 98.2 97.6 98.1 98.7 98.4 98.7 No 1.8 2.4 1.9 1.3 1.6 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Own an independent bathroom Yes 98.7 97.5 98.5 98.7 97.7 98.6 No 1.3 2.5 1.5 1.3 2.3 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel LPG/natural gas 99.5 99.7 99.5 99.7 99.7 99.7 Other 0.5 0.3 0.5 0.3 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 11,377 2,200 13,577 57,145 11,969 69,114 LPG = Liquid petroleum gas 22 | Household Characteristics Table 2.6 indicates that almost all households in Jordan have electricity (99 percent). Moreover, nearly all households use natural gas for cooking regardless of the place of residence. Table 2.7 indicates that 58 percent of households in urban areas use piped-in water for drinking compared with 67 percent in rural areas. Five percent of households in urban areas use rainwater compared with 13 percent of households in rural areas. About 35 percent of urban households and only 14 percent of rural households use bottled water for drinking. Overall, the majority of households in urban areas (99 percent) and in rural areas (94 percent) use safe water for drinking. Some households treat their water to make it safe for drinking. Table 2.7 indicates that 2 percent of households in urban areas and 3 percent in rural areas boil water, whereas 22 percent of households in urban areas and 14 percent in rural areas use water filters for water purification. The results also indicate that three-quarters of households do not do anything to treat their water (83 percent in rural areas compared with 75 percent in urban areas). Table 2.7 Household drinking water 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 2009 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 63.7 79.9 66.3 66.8 81.3 69.3 Piped water into dwelling/yard/ plot 58.4 66.5 59.7 61.3 68.7 62.5 Rainwater 5.3 13.4 6.6 5.5 12.6 6.7 Tanker truck 1.2 5.2 1.8 1.2 5.6 2.0 Bottled water, improved source for cooking/washing1 34.9 13.6 31.5 31.8 11.9 28.4 Other 0.2 1.3 0.4 0.2 1.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 98.6 93.5 97.8 98.6 93.1 97.6 Water treatment prior to drinking2 Boiled 2.2 2.7 2.3 2.2 2.5 2.3 Bleach/chlorine 0.4 0.2 0.4 0.4 0.3 0.4 Ceramic, sand or other filter 22.3 13.9 21.0 23.4 15.1 21.9 Other 0.2 0.1 0.2 0.2 0.1 0.2 No treatment 74.9 83.1 76.2 73.8 82.1 75.3 Percentage using an appropriate treatment method3 24.9 16.8 23.6 26.0 17.8 24.6 Number 11,377 2,200 13,577 57,145 11,969 69,114 SANITATION FACILITIES Improved, not shared facility Flush to piped sewer system 68.5 4.0 58.0 66.5 4.0 55.7 Flush to pit latrine 29.4 91.8 39.5 31.5 92.0 42.0 Ventilated improved pit (VIP) latrine 0.0 0.3 0.1 0.0 0.3 0.1 Pit latrine with slab 0.6 2.3 0.8 0.5 2.2 0.8 Non-improved facility Any facility shared with other households 1.5 1.4 1.5 1.4 1.3 1.4 Pit latrine without slab/open pit 0.0 0.0 0.0 0.0 0.0 0.0 No facility/field 0.0 0.1 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 11,377 2,200 13,577 57,145 11,969 69,114 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. Household Characteristics | 23 Table 2.7 also shows that nearly all households (98 percent) have a private flush toilet, with no marked differences between urban and rural households (98 and 96 percent, respectively). Only 2 percent of households share toilets with other households. 2.7 PRESENCE OF DURABLE GOODS Jordan is a modern society, and most of the population enjoys the convenience of electrical appliances (Table 2.8). Ninety-eight percent of households have television sets, 97 percent have a refrigerator, 95 percent have a washing machine, and 96 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 2009 Possession Households Population Urban Rural Total Urban Rural Total Bed or sofa bed 83.8 65.5 80.8 81.8 61.9 78.3 Radio/tape recorder 50.4 38.7 48.5 50.3 37.7 48.1 Television 98.7 96.7 98.4 99.2 97.9 99.0 Satellite 96.6 92.5 96.0 97.7 94.3 97.1 Mobile telephone 97.3 96.2 97.1 98.7 97.8 98.6 Land telephone 25.6 12.2 23.5 24.9 12.6 22.8 Refrigerator 97.2 95.1 96.8 98.0 96.6 97.8 Washing machine 95.7 92.4 95.1 97.4 95.2 97.0 Solar heater 14.7 7.6 13.5 14.2 7.8 13.1 Air conditioner 18.6 7.2 16.8 18.1 7.6 16.3 Fan 87.9 80.5 86.7 88.8 81.3 87.5 Water cooler 30.7 9.4 27.3 30.6 10.4 27.1 Microwave 41.5 17.3 37.6 40.5 16.8 36.4 Digital camera 11.2 3.4 10.0 11.1 3.5 9.8 Computer 47.6 31.6 45.0 52.7 36.7 49.9 Internet access at home 15.4 4.7 13.6 15.6 5.3 13.8 Credit cards 9.9 2.2 8.7 9.8 2.3 8.5 Car/truck 46.7 45.3 46.5 50.4 51.1 50.5 Number 11,377 2,200 13,577 57,145 11,969 69,114 As further testament to the level of development in Jordan, 97 percent of households possess a mobile phone. Almost half of households own a computer (45 percent), and 14 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 1.5 times that in rural areas, and Internet access is about 3.3 times higher in urban than in rural areas. Of further interest is the ownership of a private car; 47 percent of households own one, regardless of their urban or rural residence. Fourteen percent of households have a solar heater. One in six households owns an air conditioner, with differences according to urban-rural residence. Eighty one percent of households possess beds or a sofa bed for sleeping, with significant variations according to urban-rural residence (84 percent for urban areas compared with 66 percent in rural areas). Urban households were more likely to have most items than rural households. For example, households in urban areas are more likely to have a water cooler (31 percent), a microwave (42 percent), a digital camera (11 percent), and a credit card (10 percent) than those in rural areas (9 percent, 17 percent 3 percent and 2 percent respectively). The percentage of household owning these apparatuses and services has increased in 2009 compared with 2007. For example, the percentage of household possessing a satellite has increased by nine percentage points (from 87 percent in 2007 to 96 percent in 2009), mobile phone ownership has increased by seven percentage points (from 90 percent to 97 percent), air conditioner possession has increased by seven percentage points (from 10 percent to 17 percent), and 24 | Household Characteristics presence of a water cooler has increased by eight percentage points (19 percent to 27 percent). The possession of a microwave has seen the largest increase, (from 22 percent to 38 percent), followed by computer ownership (from 36 percent to 45 percent), and Internet access (from 8 percent to 14 percent). Possession of a few items has decreased, such as the fixed line telephone (24 percent in 2009 versus 36 percent in 2007), radio and tape recorder (49 percent in 2009 versus 59 percent in 2007), and credit cards (9 percent in 2009 versus 13 percent in 2007). 2.8 HOUSEHOLD WEALTH Information on household assets and property was used to create an index representing the wealth of households interviewed in the 2009 JPFHS. The wealth index is a proxy for long-term standard of living of the household (Rutstein and Johnson, 2004). 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 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. 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 socioeconomic status. Table 2.9 shows the distribution of the household population by wealth quintile and residence. Almost half (46 percent) of household members in urban areas fall into either the fourth or the highest wealth quintiles (compared with 44 percent in 2007); in contrast, seven in ten households in rural areas fall into either the lowest or the second quintiles (compared with six in ten in 2007). The table also indicates that there is significant variation in the distribution of the population by governorates according to the wealth index. Whereas, about three-fifths of household members (59 percent) fall into either the fourth or the highest quintiles in Amman, more than half of the household members in Madaba (52 percent), Ajloun (60 percent), Ma’an (61 percent), Karak (63 percent), Tafiela (65 percent), Jarash (66 percent), and Mafraq (73 percent) fall in the lowest or second quintiles. Household Characteristics | 25 Table 2.9 Wealth quintiles Percent distribution of the de jure population by wealth quintiles according to residence and region, Jordan 2009 Residence/ region Wealth quintile Total Number of population Lowest Second Middle Fourth Highest Residence Urban 14.7 18.8 21.0 22.2 23.4 100.0 57,145 Rural 45.3 26.0 15.5 9.4 3.8 100.0 11,969 Governorates Amman 9.1 13.4 18.2 24.4 35.0 100.0 26,661 Balqa 25.3 21.7 19.1 21.2 12.7 100.0 4,433 Zarqa 17.3 22.3 26.0 22.0 12.4 100.0 9,803 Madaba 26.1 25.5 18.7 17.3 12.4 100.0 1,662 Irbid 22.6 25.5 22.3 17.0 12.6 100.0 12,947 Mafraq 47.9 25.2 13.3 9.0 4.5 100.0 3,304 Jarash 38.6 27.1 17.8 10.9 5.7 100.0 2,208 Ajloun 29.6 30.6 20.7 13.3 5.9 100.0 1,615 Karak 39.5 23.7 17.7 12.2 6.8 100.0 2,882 Tafiela 38.3 26.7 19.3 10.6 5.0 100.0 1,027 Ma’an 36.4 24.4 20.0 13.4 5.7 100.0 1,191 Aqaba 24.5 14.3 20.3 27.0 13.9 100.0 1,381 Region Central 13.3 16.8 20.1 23.2 26.6 100.0 42,560 North 29.1 26.1 20.2 14.7 10.0 100.0 20,074 South 35.6 22.3 19.0 15.3 7.8 100.0 6,481 Badia area Badia 50.4 23.4 15.4 7.6 3.2 100.0 6,153 Other 17.0 19.7 20.5 21.2 21.6 100.0 62,961 Total 20.0 20.0 20.0 20.0 20.0 100.0 69,114 Respondents’ Background Characteristics | 27 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3 This chapter highlights the basic characteristics of ever-married women age 15-49 who were inter- viewed in the survey. It also presents data on employ- ment 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 completed, and household wealth. The distribution of ever-married women shows that, in 2009, 13 percent were under age 25 compared with 14 percent in 2007, 15 percent in 2002, and 22 percent in 1990. It is noteworthy that the proportion of women in the youngest age group (15-19) has dropped to 2.5 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 age 25-34 between 2002 and 2009 (from 42 percent to 39 percent), the proportion of women age 40- 49 was slightly higher in 2009 than it was in 2002 (30 percent compared with 25 percent). Among ever- married women, the percentage distribution by marital status indicates that 96 percent are currently married; the rest are either divorced (2 percent) or widowed (2 percent). The proportion of those currently married has remained the same since 2002. Table 3.1 shows that 84 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 9 percent of all ever-married women live in the governorates of the South region (Karak, Tafiela, Ma’an, and Aqaba) compared with 63 percent in the Central region and 28 percent in the North region. Two- fifths of women live in Amman, 19 percent in Irbid, and 15 percent in Zarqa, compared with 1.4 percent in Tafiela and 1.6 percent in Ma’an. About 9 percent of women live in Badia areas. Table 3.1 also presents the weighted and un- weighted numbers of women in the sample. The un- weighted numbers of women in the Central region Table 3.1 Background characteristics of respondents Percent distribution of ever-married women by background characteristics, Jordan 2009 Background characteristic Number of women Weighted percent Weighted Unweighted Age 15-19 2.5 249 229 20-24 10.9 1,107 1,184 25-29 18.8 1,903 1,930 30-34 20.3 2,053 2,018 35-39 17.5 1,771 1,925 40-44 17.3 1,751 1,636 45-49 12.6 1,274 1,187 Marital status Married 95.5 9,651 9,639 Divorced 2.1 217 214 Widowed 2.4 241 256 Residence Urban 84.0 8,490 6,918 Rural 16.0 1,619 3,191 Governorates Amman 39.6 3,998 1,177 Balqa 6.2 625 781 Zarqa 14.7 1,491 985 Madaba 2.2 226 811 Irbid 18.7 1,894 844 Mafraq 4.5 456 845 Jarash 3.0 301 839 Ajloun 2.2 218 805 Karak 3.8 389 769 Tafiela 1.4 142 789 Ma’an 1.6 167 760 Aqaba 2.0 202 704 Region Central 62.7 6,340 3,754 North 28.4 2,870 3,333 South 8.9 899 3,022 Badia area Badia 8.5 855 1,513 Other 91.5 9,254 8,596 Education No education 2.8 287 527 Elementary 7.1 718 912 Preparatory 15.5 1,567 1,528 Secondary 42.8 4,329 4,037 Higher 31.7 3,208 3,105 Wealth quintile Lowest 19.2 1,942 3,029 Second 20.9 2,113 2,485 Middle 21.0 2,119 2,052 Fourth 20.8 2,098 1,609 Highest 18.2 1,836 934 Total 100.0 10,109 10,109 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 28 | Respondents’ Background Characteristics (Amman, Zarqa, Balqa, and Madaba) are smaller than the weighted numbers. The opposite is true in the South and North regions (because of oversampling). For example, in the South region, although the weighted number of women is 899, in reality, data were collected from 3,022 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 301 women, in reality, data were collected from 839 women. This also applies to the Badia areas where data were collected from about twice the weighted number of women (1,513 women). Table 3.1 indicates that in 2009, 3 percent of ever-married women had not received any formal education compared with 4 percent in 2007, 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 and in 2002 it was 83 percent. By 2007, it had increased to 89 percent of women who had attained preparatory or higher education and by 2009 to 90 percent. The table also indicates the semi-equal distribution of women according to household wealth. About 18 percent of women are concentrated in the highest quintile compared with 21 percent in the second quintile. In 2007, there was no significant difference in the distribution of women according to household wealth (19 percent and 21 percent respectively). 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; 8 percent of women age 45-49 have had no education, while 1 percent of women between the ages of 15 and 29 have had no education. The median number of years of schooling is similar across age groups except among women age 25-29. The median number of years of education for all women is 10.8 years. Women age 25-29 have a median of about 11.4 years of education; those age 45-49 have a median of 10.4 years of education. The median number of years of education for all women has not changed since 2007 (10.8 years). Women in urban areas are more likely to have had some education, as well as higher education, than their rural counterparts; two percent of women in urban areas have no education, compared with 8 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, 2 percent of women have no education, whereas in the South region, the proportion is 8 percent. Only 1 percent of women in Amman have no education compared with 12 percent in Ma’an. In Badia areas, 10 percent of women have no education compared with 2 percent in non-Badia areas. Regional differences also persist with regard to secondary or higher education: a greater proportion of women in the North region attained secondary or higher education (76 percent) than in either the Central (74 percent) or South (70 percent) regions. Significant differences also exist in terms of higher education by governorate; the percentage of women who have attained higher education is 37 percent in Ajloun and Karak, 36 percent in Irbid and Tafiela, about 33 percent in Amman, Balqa, and Jarash, and then drops to 25 percent in Zarqa and Mafraq. Respondents’ Background Characteristics | 29 Table 3.2 Educational attainment Percent distribution of ever-married women age 15-49 by highest level of schooling attended, and median years completed, according to background characteristics, Jordan 2009 Background characteristic Education Total Median years completed Number of women No education Elementary Preparatory Secondary Higher Age 15-24 1.3 5.0 17.0 54.6 22.1 100.0 10.5 1,356 15-19 2.9 7.0 32.0 56.9 1.2 100.0 9.4 249 20-24 1.0 4.5 13.6 54.1 26.8 100.0 10.7 1,107 25-29 1.0 4.3 9.1 45.2 40.6 100.0 11.4 1,903 30-34 1.5 6.0 13.2 45.4 33.9 100.0 10.9 2,053 35-39 2.6 5.3 18.1 44.3 29.7 100.0 10.8 1,771 40-44 3.8 10.2 19.1 36.1 30.8 100.0 10.8 1,751 45-49 8.3 13.7 18.7 29.9 29.4 100.0 10.4 1,274 Residence Urban 1.8 6.4 15.4 43.7 32.6 100.0 10.9 8,490 Rural 8.2 10.7 15.9 38.2 27.0 100.0 10.4 1,619 Governorates Amman 1.4 6.1 15.2 45.2 32.1 100.0 11.0 3,998 Balqa 4.7 10.4 16.2 35.1 33.6 100.0 10.8 625 Zarqa 2.2 7.7 20.8 44.9 24.5 100.0 10.5 1,491 Madaba 4.3 9.1 15.5 39.9 31.1 100.0 10.9 226 Irbid 1.8 4.9 12.8 44.4 36.0 100.0 11.0 1,894 Mafraq 8.1 12.6 18.1 36.5 24.7 100.0 10.2 456 Jarash 2.6 8.8 17.9 37.2 33.4 100.0 10.6 301 Ajloun 2.3 5.8 10.9 43.5 37.5 100.0 10.9 218 Karak 7.5 8.9 10.9 35.7 37.0 100.0 10.8 389 Tafiela 7.1 8.7 15.1 32.8 36.3 100.0 10.7 142 Ma’an 11.8 12.8 10.8 34.7 29.8 100.0 10.4 167 Aqaba 7.4 8.4 14.0 43.0 27.3 100.0 10.7 202 Region Central 2.0 7.0 16.6 43.9 30.4 100.0 10.9 6,340 North 2.9 6.6 14.0 42.3 34.1 100.0 10.8 2,870 South 8.2 9.5 12.2 36.7 33.4 100.0 10.7 899 Badia area Badia 10.4 14.0 15.3 41.0 19.3 100.0 10.1 855 Other 2.1 6.5 15.5 43.0 32.9 100.0 10.9 9,254 Wealth quintile Lowest 8.9 13.4 20.5 43.0 14.2 100.0 9.9 1,942 Second 3.5 9.1 18.9 47.2 21.2 100.0 10.4 2,113 Middle 1.1 6.2 16.2 46.4 30.1 100.0 10.7 2,119 Fourth 0.5 4.4 13.9 42.8 38.4 100.0 11.3 2,098 Highest 0.3 2.3 7.4 33.4 56.6 100.0 13.1 1,836 Total 2.8 7.1 15.5 42.8 31.7 100.0 10.8 10,109 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. There is also a significant and notable difference for the women residing in Badia areas: the percentage of women attaining higher education in non-Badia areas is about twofold that of women in Badia areas (33 and 19 percent, respectively). The table also shows a higher proportion of women with no education in the lowest wealth quintile (9 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 (57 percent) and lowest in the poorest households (14 percent). 30 | Respondents’ Background Characteristics 3.3 RESPONDENTS’ EMPLOYMENT CHARACTERISTICS In the 2009 JPFHS, respondents were asked a number of questions about their em- ployment, including whether they were currently working or not. Women who were currently working were then asked a number of questions about the type of work they do and their em- ployment status. 3.3.1 Working Status The majority of women (85 percent) have not worked during the last seven days pre- ceding the survey (Table 3.3) while only 15 per- cent 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 age 15-19 to 82 percent among those age 30-44. The percentage of ever- married women currently working has increased compared with the 2007 survey (from 12 to 15 percent): this increase affects all age groups. There are no major differences in work status according to urban-rural residence (15 percent in urban compared with 14 percent in rural). However, a higher proportion of women in the South region report being currently working (22 percent) compared with other re- gions. This finding seems contrary to the con- ventional wisdom that higher education in- creases 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 governo- rates. Women in Balqa, Madaba, Irbid, Karak, Tafiela, and Ma’an are more likely to work than woman residing in the other governorates. In addition, women in Badia areas are less likely than women residing in non-Badia areas to work. Women with post-secondary education are much more likely to report working in the 7 days preceding the survey (35 percent) than women at any other educational level. Marital status seems to have a bearing on working status. The proportion of working women rises from 15 percent among those married to 22 percent among widowed or Table 3.3 Working status Percent distribution of ever-married women by working status, according to background characteristics, Jordan 2009 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 0.1 99.9 100.0 249 20-24 6.2 93.8 100.0 1,107 25-29 15.3 84.7 100.0 1,903 30-34 18.3 81.7 100.0 2,053 35-39 18.0 82.0 100.0 1,771 40-44 17.6 82.4 100.0 1,751 45-49 13.4 86.6 100.0 1,274 Marital status Married 14.9 85.1 100.0 9,651 Divorced/ widowed 21.8 78.2 100.0 458 Number of living children 0 19.6 80.4 100.0 975 1-2 17.0 83.0 100.0 2,756 3-4 17.0 83.0 100.0 3,203 5+ 10.4 89.6 100.0 3,175 Residence Urban 15.4 84.6 100.0 8,490 Rural 14.2 85.8 100.0 1,619 Governorates Amman 13.7 86.3 100.0 3,998 Balqa 18.4 81.6 100.0 625 Zarqa 8.2 91.8 100.0 1,491 Madaba 18.9 81.1 100.0 226 Irbid 19.0 81.0 100.0 1,894 Mafraq 14.8 85.2 100.0 456 Jarash 15.0 85.0 100.0 301 Ajloun 16.9 83.1 100.0 218 Karak 25.0 75.0 100.0 389 Tafiela 20.8 79.2 100.0 142 Ma’an 22.5 77.5 100.0 167 Aqaba 16.8 83.2 100.0 202 Region Central 13.0 87.0 100.0 6,340 North 17.8 82.2 100.0 2,870 South 22.0 78.0 100.0 899 Badia area Badia 10.6 89.4 100.0 855 Other 15.6 84.4 100.0 9,254 Education No education 6.9 93.1 100.0 287 Elementary 10.2 89.8 100.0 718 Preparatory 4.1 95.9 100.0 1,567 Secondary 5.9 94.1 100.0 4,329 Higher 35.0 65.0 100.0 3,208 Wealth quintile Lowest 8.4 91.6 100.0 1,942 Second 13.6 86.4 100.0 2,113 Middle 12.9 87.1 100.0 2,119 Fourth 17.2 82.8 100.0 2,098 Highest 24.5 75.5 100.0 1,836 Total 15.2 84.8 100.0 10,109 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 | 31 divorced women. The number of living children a woman has also affects working status. The percentage of working women decreases from 20 percent for those with no children to 17 percent for those with 1-4 children, to a low of 10 percent for those with five or more children. Table 3.3 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 (25 percent in the highest wealth quintile compared with 13 percent in the middle quintile and 8 percent in the lowest wealth quintile). 3.3.2 Occupation Table 3.4 shows that among women who report employment in the seven days preceding the survey, the majority engaged in professional (44 percent) and technical occupations (27 percent). Eleven percent are employed in sales, 4 percent as clerks, and 3 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 88 percent of employed women are paid employees, and 7 percent are self-employed (Figure 3.1). 1 2 7 2 88 0 20 40 60 80 100 Unpaid worker Unpaid family worker Self-employed Employer Employee Percent Figure 3.1 Percent Distribution of Women Who Worked in the 7 Days Preceding the Survey, by Employment Status, 2009 JPFHS2009 It is of interest to note that while the data reflect expected urban-rural differences for those working in services and in sales (12 percent and 3 percent, respectively), there are not pronounced urban- rural differences in the professional and technical-managerial sectors (Table 3.4). The proportion of women employed in these two sectors has risen steadily from 64 percent in 1997 to 73 percent in 2007 and has declined slightly to 71 percent in 2009. 32 | Respondents’ Background Characteristics Table 3.4 Occupation Percent distribution of ever-married women who worked in the 7 days preceding the survey by occupation, according to background characteristics, Jordan 2009 Background characteristic Professionals Technicians and associate professionals Clerks Service workers, shop, and market sales workers Skilled agricultural workers Craft and related trades workers Plant and machine operators and related occupations Elementary occupations Total Number of women Age 20-24 44.4 15.3 3.3 10.9 0.0 0.2 0.0 25.8 100.0 68 25-29 59.9 22.7 1.9 10.1 0.0 0.1 0.0 5.4 100.0 292 30-34 54.8 26.9 3.9 5.6 0.2 2.2 0.0 6.4 100.0 375 35-39 33.1 29.0 6.9 15.6 0.2 2.2 0.0 13.0 100.0 320 40-44 29.2 33.4 3.9 13.4 0.2 5.0 0.6 14.2 100.0 309 45-49 40.2 25.1 5.7 11.6 0.0 3.8 0.0 13.4 100.0 171 Marital status Married 46.2 28.2 3.5 10.0 0.1 2.3 0.1 9.5 100.0 1,435 Divorced/widowed 11.7 11.4 16.6 25.9 0.2 4.1 0.0 30.0 100.0 100 Number of living children 0 44.9 27.1 2.5 12.9 0.0 3.1 0.0 9.5 100.0 191 1-2 52.5 23.3 5.4 9.0 0.0 1.4 0.0 8.4 100.0 469 3-4 45.9 28.9 5.3 9.7 0.0 2.2 0.0 8.0 100.0 544 5+ 28.3 29.7 2.1 15.0 0.5 4.2 0.6 19.5 100.0 331 Residence Urban 43.1 27.4 4.2 12.4 0.0 2.6 0.1 10.1 100.0 1,305 Rural 48.9 25.6 5.2 3.2 0.7 1.6 0.0 14.7 100.0 230 Governorates Amman 42.9 23.9 5.3 16.3 0.0 3.6 0.0 7.9 100.0 547 Balqa 42.9 24.7 5.0 11.4 1.2 2.1 0.0 12.6 100.0 115 Zarqa 31.3 37.8 4.0 13.4 0.0 4.1 1.6 7.8 100.0 122 Madaba 47.3 26.8 6.3 9.3 0.0 3.1 0.0 6.2 100.0 43 Irbid 45.6 29.5 0.5 7.8 0.0 1.1 0.0 15.5 100.0 360 Mafraq 56.1 22.0 3.0 1.2 0.0 2.3 0.0 15.5 100.0 68 Jarash 55.0 24.7 3.7 4.5 0.0 2.5 0.0 9.6 100.0 45 Ajloun 49.4 23.8 2.1 3.6 0.0 4.9 0.0 16.1 100.0 37 Karak 37.2 33.3 9.4 8.5 0.0 0.0 0.0 11.5 100.0 97 Tafiela 61.7 21.4 6.8 4.6 0.0 0.6 0.0 4.8 100.0 30 Ma’an 47.5 25.9 8.0 6.4 0.7 1.1 0.0 10.4 100.0 37 Aqaba 45.1 30.5 10.2 5.9 0.7 1.1 0.0 6.5 100.0 34 Region Central 41.4 26.2 5.1 14.8 0.2 3.4 0.2 8.5 100.0 827 North 48.1 27.6 1.2 6.3 0.0 1.7 0.0 15.1 100.0 510 South 44.2 29.7 8.9 7.1 0.2 0.5 0.0 9.5 100.0 198 Badia area Badia 50.2 25.7 2.4 1.6 0.5 1.2 0.0 18.4 100.0 90 Other 43.6 27.2 4.4 11.6 0.1 2.5 0.1 10.3 100.0 1,444 Education No education (0.0) (0.0) (0.0) (4.7) (4.9) (0.0) (0.0) (90.4) 100.0 20 Elementary 0.3 0.0 1.0 24.6 1.3 13.2 0.0 59.6 100.0 74 Preparatory 0.0 2.4 7.1 44.5 0.0 4.8 0.0 41.2 100.0 64 Secondary 3.2 9.1 21.2 34.1 0.0 6.9 0.0 25.4 100.0 253 Higher 59.3 34.9 0.6 3.1 0.0 0.7 0.2 1.2 100.0 1,124 Wealth quintile Lowest 23.4 16.0 4.1 14.3 0.7 4.2 0.0 37.4 100.0 164 Second 36.8 25.9 3.7 13.8 0.2 5.5 0.0 14.1 100.0 288 Middle 40.8 34.9 3.6 11.4 0.0 1.6 0.0 7.7 100.0 274 Fourth 39.2 35.6 6.3 11.8 0.0 2.8 0.5 3.8 100.0 361 Highest 61.9 20.5 3.6 7.2 0.0 0.2 0.0 6.5 100.0 449 Total 44.0 27.1 4.3 11.0 0.1 2.5 0.1 10.8 100.0 1,535 Note: Figures in parentheses are based on 25-49 unweighted cases. Respondents’ Background Characteristics | 33 3.4 SMOKING TOBACCO Tobacco use is widely regarded as the most prevent- able 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 various body organs. Smoking is the most important contributor to the development of chronic bronchitis and chronic abstractive pulmonary dis- ease, which are characterized by chronic cough, phlegm production, and airflow obstruction. Smoking is well estab- lished as the cause of the majority of cases of pulmonary emphysema. Smoking among women also creates particular risks for their offspring. Poor pregnancy outcomes, including low birth weight and intrauterine growth retardation, are more frequent among women who smoke than among those who do not smoke. Table 3.5 shows the percentage of women who use tobacco for smoking. Overall, 9 percent of women smoke cigarettes and 6 percent smoke nargila (compared with 11 percent and 5 percent in 2007). Differentials by age and residence are seen among women who smoke cigarettes. Women 40-49 years old are more likely to smoke cigarettes than younger women. Women living in urban areas are more likely to smoke ciga- rettes (9 percent) than women living in rural areas (5 per- cent), with women in the Central region more likely to smoke cigarettes than women living in other regions. 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 gover- norates: 3 percent of women in Tafiela smoke cigarettes compared with 11 percent of those living in Amman and Aqaba. In general nargila use is lower among women than cigarette use. Nargila use is the same across age groups, ex- cept among 25-29 year olds where the percent of women smoking nargila is higher. Similar to smoking, there are sig- nificant differences with regard to women who smoke nargila according to governorates and residence in Badia area. Women living in Badia areas are less likely to smoke nargila (3 percent) than women in non-Badia areas (6 percent). Table 3.5 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 (6 and 2 percent, respectively) are less likely to smoke cigarettes and nargila than woman in the highest quintile (14 and 12 percent respectively). Table 3.5 Use of tobacco: Women Percentage of ever-married women who smoke cigarettes or nargila, according to background characteristics, Jordan 2009 Background characteristic Cigarettes Nargila Number of women Age 15-19 0.9 4.8 249 20-24 4.6 4.9 1,107 25-29 5.9 7.4 1,903 30-34 7.6 5.1 2,053 35-39 8.7 5.0 1,771 40-44 13.0 5.4 1,751 45-49 13.8 4.4 1,274 Residence Urban 9.3 6.3 8,490 Rural 5.4 1.1 1,619 Governorates Amman 10.9 8.0 3,998 Balqa 8.3 3.9 625 Zarqa 8.7 5.9 1,491 Madaba 6.3 4.9 226 Irbid 7.4 3.9 1,894 Mafraq 6.3 1.2 456 Jarash 5.0 1.9 301 Ajloun 4.6 2.6 218 Karak 4.9 1.6 389 Tafiela 2.9 0.8 142 Ma’an 5.1 1.0 167 Aqaba 10.4 3.3 202 Region Central 10.0 7.0 6,340 North 6.8 3.2 2,870 South 5.9 1.7 899 Badia area Badia 7.7 2.6 855 Other 8.8 5.7 9,254 Education No education 8.7 0.2 287 Elementary 9.3 3.0 718 Preparatory 10.7 5.2 1,567 Secondary 9.3 6.5 4,329 Higher 6.8 5.2 3,208 Maternity status Pregnant 2.9 4.1 1,136 Breastfeeding (not pregnant) 5.4 2.8 1,899 Neither 10.5 6.4 7,074 Wealth quintile Lowest 6.2 2.0 1,942 Second 6.1 2.7 2,113 Middle 7.5 4.7 2,119 Fourth 10.5 6.3 2,098 Highest 13.7 12.2 1,836 Total 8.7 5.5 10,109 34 | Respondents’ Background Characteristics Women with preparatory education are more likely to smoke cigarettes (11 percent) than women who have higher education (7 percent). However, a different pattern is observed among women who smoke nargila; less than 1 percent of women with no education compared with 6 percent of women with secondary education smoke nargila. The proportion of women smoking cigarettes and/or nargila decreases during pregnancy and lactation. However, 3 percent of women smoke cigarettes during pregnancy and 5 percent smoke during lactation. Levels of nargila use are similar, 4 percent of women smoke nargila during pregnancy and 3 percent smoke nargila during lactation. Fertility | 35 FERTILITY 4 Fertility measures in this chapter are based on the reported birth histories of ever-married women age 15 to 49 who were interviewed in the 2009 JPFHS. Data were collected in two parts. First, each woman was asked a series of questions about 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 the name, sex, date of birth, age, and survival status of each birth. For deceased children, the age at death was recorded. As an indicator of future fertility, information was also collected on whether she was 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 dates of birth distorts fertility trends over time. The 2009 JPFHS is notable for the 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. Fertility rates presented in this chapter are based on direct measures derived from the birth history section of the 2009 JPFHS. Therefore, it is important to note that only surviving women were interviewed in the survey. This would bias fertility 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 gathered from 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 (ASFRs) and Total Fertility Rates (TFRs) for the three-year period preceding the 2009 JPFHS are shown in Table 4.1, along with data from five previous surveys for comparison—the 1983, 1990, 1997, 2002, and 2007 JPFHS. The calculated rates for these surveys refer to the three years preceding each survey (1981-1983, 1988-1990, 1995-1997, 2000-2002, 2005-2007, and 2007-2009 respectively). Comparison of the findings from the six surveys shows trends in fertility levels over about a 28-year period. The TFR is the sum of the ASFRs; 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 3.8 children in her lifetime; a 42 percent decline from the rate recorded in 1983 (6.6 births per woman). Table 4.1 indicates a continual decline in fertility from 1983 to 1997. Fertility declined 15 percent between 1983 and 1990 (dropping from 6.6 to 5.6 births per woman), 21 percent between 1990 and 1997 (dropping from 5.6 to 4.4 births per woman), and 16 percent between 1997 and 2002 (dropping from 4.4 to 3.7 births per woman). The level of fertility has remained almost unchanged between the years 2002 and 2009. Overall, in the past nineteen years (1990-2009), the total fertility rate in Jordan has declined by 32 percent. 36 | Fertility Table 4.1 Trends in fertility Age-specific fertility rates and total fertility rates, various surveys, Jordan 1983-2009 Age group JFFHS 1983 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 15-19 49 49 43 28 28 32 20-24 229 219 172 150 148 152 25-29 335 296 246 202 212 238 30-34 305 264 206 184 162 182 35-39 233 188 144 122 121 126 40-44 127 79 48 43 41 37 45-49 40 19 11 5 6 3 TFR 15-49 6.6 5.6 4.4 3.7 3.6 3.8 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 The estimated TFR based on the results of the 2009 JPFHS (3.8 births per woman) is slightly higher than its previous estimates from the 2002 and 2007 JPFHS (3.7 and 3.6 births per woman respectively). Although the differences in the estimates of the TFR for the last three surveys are not statistically significant and cannot be interpreted as an increase in fertility, these results do indicate that the decline of the TFR has temporarily stopped in Jordan. This phenomenon (stability in the TFR after a long decline) has been observed in neighboring countries, such as Egypt and Syria, as well. 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 women 40-49: a 71 percent drop from 127 births per 1,000 women in 1983 to 37 births in 2009 for women age 40-44. Women age 35-39 have experienced a 46 percent decline in fertility levels (from 233 births per 1,000 women in 1983 to 126 births in 2009), and fertility rates among women under age 30 years declined by around one-third during this period. Figure 4.1 shows that the bulk of the decline in fertility since 1997 can be attributed to the decrease in the number of births among women between the ages of 20 and 39. Among all the surveys the age-specific fertility rates are highest for the 25-29 age group. It is evident from the graph that the 2009 JPFHS data show no significant decline in fertility overall or among any age group. Additionally, the ASFRs have not changed between 2002 and 2009 for women under age 25 and over age 34 years. An increase was seen in the fertility rates of women age 25-29 (from 202 births per 1,000 women in 2002 to 212 in 2007, and to 238 births per 1,000 women in 2009). Moreover, the ASFR for the age group 30-34 years is higher in 2009 compared with 2007 but equal to that in 2002. Fertility | 37 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Bi rt hs p er 1 ,0 00 w om en Age group JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 Figure 4.1 Trends in Age-specific Fertility Rates, Various Sources, 1997-2009 Table 4.2 presents the ASFRs 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), which is the annual number of live births per 1,000 women age 15-44 for the three years preceding the survey, and the Crude Birth Rate (CBR), which is the annual number of live births per 1,000 population for the Fertility levels are slightly higher in rural areas compared with urban areas (4.0 compared with 3.8 births per woman). The most significant urban-rural differences are found in the middle of the women’s reproductive period (age 30-34) where rural women have an average of 0.028 more births than urban women. However, fertility rates are higher in urban areas among women age 25-29 and 15-19 years than in rural areas among women who are the same ages. For example, women age 25- 29 years living in urban areas give birth to 0.04 more children than those living in rural areas. Currently, a woman in Jordan will have an average of less than one child (0.9 child) by her 25th birthday and three children (3.0) by her 35th birthday. Figure 4.2 shows that the TFR has increased slightly in urban areas since 2002 (3.8 births per woman compared with 3.6 in 2007 and 3.5 births per woman in 2002), while slightly decreasing in rural areas (4.0 compared with 4.2 births per woman in 2002). A decrease in the TFR in the South region between 2002 and 2007 (from 4.0 births per woman to 3.6 births per woman) is not confirmed by the 2009 survey (4.1 births per woman). In comparison, the TFR remains stable in the North region, while the number of live births per woman in the Central region has increased slightly from 2002 and 2007 (3.8 births per woman compared with 3.5 births per woman). Thus, the differences in fertility rates that previously existed between urban and rural residences and among the three regions have almost disappeared. 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 2009 Age group Residence Total Urban Rural 15-19 34 24 32 20-24 150 163 152 25-29 245 205 238 30-34 177 205 182 35-39 122 147 126 40-44 35 47 37 45-49 3 6 3 TFR (15-49) 3.8 4.0 3.8 GFR (15-44) 127 129 127 CBR 30.6 30.7 30.6 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 GFR: General fertility rate expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 38 | Fertility 3.7 3.5 4.2 3.5 3.9 4.0 3.6 3.6 3.7 3.5 3.8 3.6 3.8 3.8 4.0 3.8 4.0 4.1 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Jordan Urban Rural Central North South N um be r o f B ir th s pe r W om an JPFHS 2002 JPFHS 2007 JPFHS 2009 Figure 4.2 Total Fertility Rate by Residence and Region from Various Surveys, 2002-2009 Preliminary analysis of age at marriage, age at first birth, birth intervals, and use of modern contraceptive methods does not reveal any significant change in these measures. Thus, in-depth analysis of other factors and determinants of fertility is important to explain the stability of fertility in Jordan since 2002. For instance, the proportion of married women in the age group 15-29 years has increased by about 3 percentage points (34 percent in 2009 compared with 31 percent in 2002). In addition, the percentage of women who discontinued use of family planning methods during the last 12 months before the survey has also slightly increased (42 percent in 2002 compared with 45 percent in 2009). Table 4.2 also indicates that the overall CBR is 31 per 1,000 (versus 29 per 1,000 in 2002). The GFR reached 127 births per 1,000 women age 15-44 (versus 122 in 2002). As is the case with the TFR, the CBR and the GFR do not differ by urban-rural residence. The fertility differentials according to background characteristics of women are shown in Table 4.3. The first column shows the TFR 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 age 40-49. CEB is an indicator of cumulative fertility and reflects the fertility of older women who are nearing the end of their reproductive years, representing completed fertility. When fertility remains constant over time, TFR and CEB will be the same or almost the same. In the 2009 JPFHS the completed fertility rate (4.9 births per woman) is higher than the total fertility rate (3.8 births per woman), indicating a considerable decline in fertility. This finding corresponds with the decline in fertility seen over time in the surveys implemented in Jordan over the past 12 years (Table 4.1 and Figure 4.1). Fertility levels do not show considerable variations by region, although the TFR is highest in the South (4.1 children per woman). Fertility levels do vary according to governorate; the TFR ranges from 3.6 births per woman in Madaba, to 3.7 in Amman, 3.8 in Irbid and Karak, 4.2 births in Mafraq and Aqaba, and 4.5 in Jarash. In addition, women living in Badia areas have higher fertility rates than other women (4.5 versus 3.8 births per woman). Fertility | 39 It is of interest to note that the relationship of education to fertility is not in fact linear; rather, in Jordan it has an inverted U-shape. The figures suggest that post-secondary education for women is associated with lower levels of fertility. Women with post- secondary education have had almost one fewer births than women with a preparatory level of education. TFR varies from 4.1 births among women with no education and those with elementary and secondary education to 3.5 births among women with higher education. The rate peaks at 4.7 births among women who have had a preparatory education. The TFR for woman in Jordan also varies considerably according to wealth index. In general, women in the lowest and the second quintiles have more births than women in the other quintiles. The rate varies from 4.9 births for the lowest wealth quintile to 2.7 children for the highest quintile: in other words, women in the poorest households have, on average, 2.2 more births than women in the wealthiest households. The 2009 JPFHS data show that about 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. Looking at education differences, women with elementary and secondary education and above are more likely to be pregnant than other women (Table 4.3). Otherwise, wealth quintile variations follow a pattern similar to that of fertility. Comparing data from previous surveys is one way 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 age 25-29 declined from 281 births per 1,000 women in the 15-19 years preceding the survey to 208 births per 1,000 women in the 5-9 year period before the survey, a 26 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, and the ASFR in the 25-29-year age group has increased. The TFR among women age 15-34 for which data are available for the four preceding periods, has dropped from 4.0 births per women 15-19 years before the survey, to 3.4 births 10-14 years before, and 3.0 births 5-9 years and 0-4 years prior to the survey. 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 5-9 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 2009 Background characteristic Total fertility rate Percentage women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 3.8 6.4 4.7 Rural 4.0 7.6 5.7 Governorates Amman 3.7 5.8 4.6 Balqa 3.9 6.2 5.3 Zarqa 3.9 7.3 4.6 Madaba 3.6 7.5 5.3 Irbid 3.8 6.6 4.9 Mafraq 4.2 8.4 5.9 Jarash 4.5 7.3 5.8 Ajloun 4.0 7.8 5.9 Karak 3.8 7.1 4.9 Tafiela 4.3 8.2 6.0 Ma’an 4.3 7.3 5.9 Aqaba 4.2 7.9 5.3 Region Central 3.8 6.2 4.7 North 4.0 7.1 5.2 South 4.1 7.4 5.3 Badia area Badia 4.5 8.9 5.9 Other 3.8 6.4 4.8 Education No education 4.1 4.2 5.5 Elementary 4.1 7.7 5.7 Preparatory 4.7 5.6 5.9 Secondary 4.1 7.1 4.8 Higher 3.5 6.4 3.9 Wealth quintile Lowest 4.9 8.8 5.5 Second 4.4 7.7 5.6 Middle 3.9 8.3 4.8 Fourth 3.6 5.4 5.0 Highest 2.7 3.5 4.0 Total 3.8 6.6 4.9 Note: Total fertility rates are for the period 1-36 months prior to interview. 40 | 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 2009 Mother’s age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 32 36 48 51 20-24 153 178 197 236 25-29 232 208 237 281 30-34 175 185 198 [234] 35-39 121 121 [145] 40-44 36 [67] 45-49 [3] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Bi rt hs p er 1 ,0 00 w om en Age group 0-4 5-9 10-14 15-19 Figure 4.3 Age-specific Fertility Rates for Five-year Periods Preceding the Survey, 2009 JPFHS 2009 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 2009 JPFHS, all respondents are ever-married women; therefore 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, 3.7 children by their late thirties, and 5.4 children by the end of their reproductive life. The data also indicate that, on average, currently married women have given birth to 2.3 children by their late twenties, 4.5 children by their late thirties, and about six children by the end of their reproductive life. Fertility | 41 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 2009 Age Number of children ever born Total Number of women Mean number of children ever born Mean number of living children 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 96.8 2.7 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.00 3,679 0.04 0.04 20-24 71.6 12.4 11.4 3.8 0.7 0.1 0.0 0.0 0.0 0.0 0.0 100.00 2,994 0.50 0.48 25-29 35.1 13.0 24.6 15.9 8.0 2.4 0.8 0.1 0.1 0.0 0.0 100.00 2,664 1.60 1.57 30-34 22.1 7.5 12.1 21.5 17.3 11.3 5.6 1.9 0.5 0.2 0.0 100.00 2,507 2.75 2.66 35-39 19.5 2.7 5.9 11.6 19.7 17.1 11.7 6.8 3.1 1.3 0.4 100.00 2,091 3.73 3.61 40-44 15.9 2.7 3.2 9.2 14.6 17.3 14.5 9.7 7.2 3.3 2.3 100.00 1,951 4.49 4.35 45-49 14.1 2.0 3.4 6.9 10.6 13.4 13.4 10.2 9.9 6.0 10.2 100.00 1,392 5.35 5.07 Total 46.9 6.6 9.0 9.2 8.7 7.1 5.1 3.0 2.1 1.1 1.1 100.00 17,278 2.13 2.06 CURRENTLY MARRIED WOMEN 15-19 52.7 38.5 7.7 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.00 242 0.57 0.56 20-24 22.4 33.2 31.7 10.6 1.9 0.2 0.0 0.0 0.0 0.0 0.0 100.00 1,078 1.37 1.33 25-29 8.1 18.2 34.8 22.6 11.4 3.4 1.1 0.2 0.2 0.0 0.0 100.00 1,860 2.28 2.23 30-34 4.0 8.7 15.0 26.3 21.6 14.1 7.0 2.4 0.6 0.2 0.0 100.00 2,000 3.41 3.30 35-39 4.8 2.6 6.8 13.5 23.5 20.5 14.2 8.3 3.7 1.6 0.5 100.00 1,704 4.45 4.31 40-44 5.5 1.9 3.2 9.7 16.2 20.3 17.1 11.1 8.5 3.9 2.5 100.00 1,628 5.14 4.97 45-49 6.2 1.6 2.2 7.9 11.5 14.9 15.1 11.7 11.6 5.7 11.5 100.00 1,139 5.94 5.62 Total 8.7 10.9 15.6 16.0 15.1 12.4 8.8 5.2 3.6 1.7 1.9 100.00 9,651 3.67 3.54 Data in Table 4.5 indicate very little variation between the mean number of children ever born and the mean number of children still living for all women age 15-49 (2.13 and 2.06 children, respectively). As expected, differences in the mean number of children ever born and living children are notable after women have reached the age of 40. However, 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. Among women currently married, the mean number of children ever born is 3.7, compared with 3.5 children still living. 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 31.3 months—1.2 month longer than that recorded in the 2002 JPFHS. This slight increase in birth intervals (4 percent longer) may reflect the implementation of Jordan’s National Health Program for Birth Spacing, a component of the National Population Strategy ratified by the government of Jordan in 1996. About two-thirds of all children (67 percent) are born at least two years after their siblings. This figure is identical to that found in 2007 and 2002 but represents an increase from 1997 data (56 percent). Almost two in five children (42 percent) were born after an interval of three years or longer in 2009 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 (21.7 months, compared with 31.6 months). The data also indicate a shorter birth interval for births following a female child (30.7 months compared with 31.7 months when the previous child is a boy). 42 | 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 2009 Background characteristic Months since preceding birth Total Number of non- first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 (45.0) (32.9) (22.1) (0.0) (0.0) (0.0) 100.0 21 18.7 20-29 27.0 23.1 27.3 13.9 5.4 3.3 100.0 2,473 24.0 30-39 12.7 13.7 23.9 18.3 13.1 18.4 100.0 3,644 35.8 40-49 3.8 7.9 22.5 14.5 12.3 38.9 100.0 838 48.7 Birth order 2-3 22.7 21.1 25.4 14.4 8.3 8.1 100.0 3,563 26.4 4-6 11.0 11.5 24.2 17.8 12.5 23.1 100.0 2,760 37.8 7+ 9.0 11.1 25.4 19.4 11.5 23.6 100.0 654 38.0 Sex of preceding birth Male 17.3 16.0 22.5 16.1 11.3 16.9 100.0 3,464 31.7 Female 16.3 16.8 27.3 16.4 9.2 14.1 100.0 3,513 30.7 Survival of preceding birth Living 16.2 16.3 25.1 16.4 10.3 15.6 100.0 6,785 31.6 Dead 37.4 19.0 19.0 9.0 6.1 9.4 100.0 192 21.7 Residence Urban 16.8 16.0 24.3 16.2 10.5 16.2 100.0 5,751 31.7 Rural 16.6 18.3 27.6 16.5 8.8 12.1 100.0 1,226 29.6 Governorates Amman 19.0 14.5 24.3 16.2 10.0 16.1 100.0 2,623 31.2 Balqa 16.8 19.5 26.6 14.5 9.8 12.7 100.0 441 29.7 Zarqa 14.3 16.6 24.4 17.9 9.8 17.0 100.0 1,001 32.6 Madaba 17.3 15.3 23.9 17.6 11.8 14.1 100.0 156 32.4 Irbid 14.9 17.0 23.5 15.1 12.5 16.9 100.0 1,323 32.6 Mafraq 18.7 17.7 28.1 15.3 9.9 10.3 100.0 366 29.1 Jarash 18.7 19.4 29.5 15.4 7.0 10.1 100.0 244 27.5 Ajloun 15.2 18.3 22.7 17.2 10.4 16.1 100.0 165 31.2 Karak 14.0 17.2 27.3 18.9 8.5 14.1 100.0 271 31.4 Tafiela 15.4 16.8 29.6 16.5 9.3 12.6 100.0 109 29.6 Ma’an 15.3 19.1 26.1 16.4 8.8 14.3 100.0 126 29.1 Aqaba 13.0 19.2 26.9 16.6 8.0 16.3 100.0 151 30.9 Region Central 17.6 15.6 24.5 16.5 10.0 15.9 100.0 4,221 31.5 North 16.1 17.5 24.9 15.3 11.2 14.9 100.0 2,099 31.0 South 14.2 17.9 27.3 17.5 8.6 14.4 100.0 657 30.4 Badia area Badia 20.5 17.0 27.4 13.6 9.7 11.8 100.0 674 27.9 Other 16.4 16.3 24.7 16.5 10.3 15.9 100.0 6,303 31.7 Education No education 13.3 16.7 34.5 14.4 7.6 13.5 100.0 162 31.6 Elementary 22.8 12.4 27.8 15.5 7.7 13.8 100.0 409 28.4 Preparatory 15.9 13.4 24.3 15.2 10.2 21.0 100.0 1,063 33.8 Secondary 17.3 17.7 23.8 16.3 9.9 15.0 100.0 3,211 30.7 Higher 15.6 16.6 25.6 16.9 11.3 13.9 100.0 2,132 32.0 Wealth quintile Lowest 19.5 18.7 28.8 15.3 7.9 10.0 100.0 1,705 28.0 Second 18.4 17.5 25.4 15.9 9.3 13.5 100.0 1,622 29.4 Middle 15.9 16.2 24.1 17.5 9.4 17.0 100.0 1,461 31.7 Fourth 16.0 13.1 23.9 14.4 12.0 20.6 100.0 1,261 34.2 Highest 11.6 15.0 19.6 19.1 15.1 19.6 100.0 928 38.0 Total 16.8 16.4 24.9 16.2 10.2 15.5 100.0 6,977 31.3 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parenthesis are based on 25-49 unweighted cases. Fertility | 43 There exists only a small variation in the length of birth interval by residence; the data show that women in rural areas and those living in the South region and in Jarash, Ma’an, and Mafraq as well as those women in Badia areas are more likely than other subgroups to have short birth intervals. Birth intervals in non-Badia areas are 3.8 months longer than in Badia areas. The length of birth intervals increases with the wealth quintile: in the highest quintile, the median birth interval is 10 months longer than in the lowest quintile (38.0 months versus 28.0 months) In addition, woman with elementary education 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 2009 (from 23.5 years in 2002 to 24.0 years in 2009). 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 age 30-34 (median age 24.4) give birth for the first time 0.6 year later than women age 35-39 (median age 23.8), and 2.1 years later than women age 45-49 (median age 22.3). 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 2009 Current age Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth 15 18 20 22 25 15-19 0.0 na na na na 96.8 3,679 a 20-24 0.1 3.5 13.1 na na 71.6 2,994 a 25-29 0.1 4.2 13.6 27.6 50.7 35.1 2,664 24.9 30-34 0.2 6.4 18.7 33.4 53.6 22.1 2,507 24.4 35-39 0.1 6.5 18.8 36.5 57.6 19.5 2,091 23.8 40-44 0.6 10.3 24.3 38.3 59.7 15.9 1,951 23.6 45-49 0.6 13.6 32.5 48.2 65.6 14.1 1,392 22.3 25-49 0.3 7.6 20.3 35.4 56.3 22.7 10,605 24.0 30-49 0.4 8.7 22.5 38.0 58.2 18.5 7,941 23.7 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group. Table 4.8 presents the differentials in age at first birth among women age 25-49 by background characteristics. Overall, the median age at first birth is 24.0 years for women age 25-49. The median age at first birth has not changed much since 2002; in 2007 it was 23.9 years and in 2002 it was 23.5 years. Women in the South region begin childbearing half a year later than women in the Central region (24.4 years compared with 23.9 years). There are no significant differences in the median age at first birth by place of residence (24.0 in urban areas compared with 24.1 in rural areas), while women in Badia areas begin childbearing half a year earlier than women in non-Badia areas. There are small variations according to governorates: median age at first birth varies from 23.5 years in Aqaba and Zarqa governorates, to 24.0 years in Amman, and to 24.6 years in Madaba. Women with a secondary education had a median age at first birth of 22.9 years compared with 20.8 years for women with preparatory education. Less than half of women age 25-49 with higher education have given birth before the age of 25, so a median age could not be calculated for them. Data also revealed that women in the fourth and the highest wealth quintiles are more likely to have a higher median age at first birth than women in lower wealth quintiles. 44 | Fertility Table 4.8 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Jordan 2009 Background characteristic Current age Women age 25-49 Women age 30-49 25-29 30-34 35-39 40-44 45-49 Residence Urban 24.9 24.3 23.8 23.6 22.5 24.0 23.7 Rural a 25.2 23.8 23.2 21.1 24.1 23.7 Governorates Amman 24.9 24.7 24.0 23.2 22.4 24.0 23.7 Balqa a 25.5 25.4 23.3 22.0 24.4 24.1 Zarqa 24.0 22.6 23.9 23.9 21.4 23.5 23.2 Madaba a 25.6 24.6 23.6 21.9 24.6 23.9 Irbid a 24.3 23.4 24.1 22.8 24.2 23.8 Mafraq 24.3 25.2 23.5 22.6 20.5 23.7 23.4 Jarash a 23.9 22.8 23.9 21.4 23.8 23.3 Ajloun a 24.2 23.1 23.2 22.4 23.9 23.3 Karak a 27.4 24.2 25.0 23.6 a 25.3 Tafiela 24.7 24.4 23.6 23.0 21.3 23.9 23.5 Ma’an 24.9 23.8 23.3 22.3 21.5 23.6 22.9 Aqaba 24.5 23.3 22.9 23.0 23.0 23.5 23.0 Region Central 24.8 24.3 24.1 23.4 22.1 23.9 23.7 North a 24.3 23.3 23.9 22.4 24.0 23.6 South 24.9 25.6 23.6 24.0 22.6 24.4 24.1 Badia area Badia a 23.7 23.4 21.8 21.2 23.5 22.7 Other 24.9 24.5 23.8 23.7 22.4 24.0 23.7 Education No education a 24.2 23.5 22.9 20.6 22.6 22.3 Elementary 22.9 24.4 21.6 20.3 20.6 21.5 21.1 Preparatory 20.9 21.9 21.1 21.3 19.2 20.8 20.8 Secondary 23.0 23.0 23.3 22.6 21.7 22.9 22.8 Higher a 26.3 25.7 26.3 25.6 a 26.1 Wealth quintile Lowest 24.4 23.8 23.2 24.1 22.8 23.8 23.6 Second 24.1 23.4 23.8 23.2 20.8 23.5 23.1 Middle 24.7 23.8 23.6 22.6 22.3 23.7 23.2 Fourth 24.6 26.3 24.2 23.9 22.1 24.1 24.0 Highest a 25.5 24.3 24.1 22.8 24.7 24.3 Total 24.9 24.4 23.8 23.6 22.3 24.0 23.7 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 4.5 TEENAGE FERTILITY Teenage fertility is a major social and health concern because teenage mothers and their children usually have a higher risk of illness and death. Childbearing during the teenage years also frequently has adverse social consequences, particularly on female educational attainment, because women who become mothers in their teens are more likely to curtail their education. Table 4.9 shows the extent of fertility among women age 15-19. Fertility | 45 The level of fertility among teenagers in Jordan is low. Only 5 percent of women have be- gun childbearing during their teens, compared with 4 percent in 2002 and 2007 and 6 percent in 1997. The percentage of teenagers who have begun childbearing increases rapidly with age, from 0.2 percent among 15-year-olds, to almost 2 percent among 16-year-olds, and to 6 percent among 17 and 18-year-olds. By age 19, one in ten will have become a mother or will be pregnant with their first child. Levels of teenage pregnancy vary slightly by urban-rural residence (5 percent in urban and 4 percent in rural area). Teens in the Central region and Badia areas are more likely to have begun childbearing than teens in other areas. Large vari- ations exist by governorates: the percentage of teenagers who have begun childbearing varies from less than 2 percent in Irbid, Ajloun, and Ma’an to 6 percent in Amman, Zarqa, and Jarash governorates. The level of teenage fertility was strongly associated with a woman’s educational level. The proportion of women age 15-19 who had begun childbearing was highest among women with no education (18 percent). Women with secondary (5 percent) or higher (0.3 percent) levels of education were much more likely to have delayed childbearing. Results do not show a clear pattern according to wealth quintile: teenage mothers are more common in the lowest, middle, and fourth wealth quintiles (5, 7, and 5 percent respectively) than in the second and highest wealth quintiles (4 and 3 percent respectively). 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 2009 Background characteristic Percentage who: Percentage who have begun childbearing Number of women Have had a live birth Are pregnant with first child Age 15 0.0 0.2 0.2 787 16 1.3 0.4 1.7 733 17 4.1 2.0 6.1 747 18 4.3 1.6 5.9 704 19 6.8 3.2 9.9 709 Residence Urban 3.4 1.4 4.8 3,055 Rural 2.6 1.4 4.0 628 Governorates Amman 4.1 2.1 6.1 1,432 Balqa 3.2 1.6 4.8 255 Zarqa 4.7 1.2 5.9 464 Madaba 1.9 1.7 3.5 88 Irbid 1.4 0.4 1.8 737 Mafraq 3.3 1.5 4.8 175 Jarash 4.3 1.4 5.7 130 Ajloun 1.6 0.3 1.9 96 Karak 2.1 0.9 3.0 126 Tafiela 1.3 2.3 3.6 55 Ma’an 1.0 0.8 1.8 66 Aqaba 2.3 2.5 4.8 67 Region Central 4.1 1.8 5.9 2,208 North 2.1 0.7 2.7 1,138 South 1.7 1.4 3.1 329 Badia area Badia 3.0 2.3 5.3 302 Other 3.2 1.3 4.6 3,380 Education No education 15.4 2.4 17.8 36 Elementary 9.2 6.3 15.5 64 Preparatory 5.1 0.9 6.1 963 Secondary 3.1 2.0 5.0 1,889 Higher 0.1 0.2 0.3 730 Wealth quintile Lowest 3.0 2.0 5.0 609 Second 3.2 0.6 3.8 731 Middle 4.1 2.5 6.6 740 Fourth 3.5 1.6 5.1 862 Highest 2.1 0.6 2.6 759 Total 3.2 1.4 4.7 3,679 Fertility Regulation | 47 FERTILITY REGULATION 5 This chapter considers a number of indicators from the 2009 JPFHS related to knowledge, attitudes, and use of family planning. This chapter also presents information on intended future use of contraception. Trends over time are examined by comparing the 2009 JPFHS findings with those of four earlier surveys: the 1990, 1997, 2002 and 2007 JPFHS. 5.1 KNOWLEDGE OF FAMILY PLANNING METHODS Determining the level of knowledge of contraceptive methods was a major objective of the 2009 JPFHS because 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 2009 JPFHS results indicate that all ever- married women in Jordan know at least one method of family planning (Table 5.1). Among modern methods, the pill and IUD are the best known (100 percent), fol- lowed by male condom (93 percent), lactational amenorrhea method (LAM) (92 percent), injectables (88 percent), and female sterilization (87 percent of ever- married women). The least recognized methods were the female condom and emergency contraception, with 23 percent and 16 percent, respectively, of ever-married women having knowledge of these methods. With- drawal is also known to most ever-married women (94 percent). On average, an ever-married woman knows about nine methods of family planning. Knowledge of any family planning method or any modern method is universal in Jordan; therefore, almost no variation in knowledge of any method or any modern method of contraception is seen among subgroups by background characteristics (varying from 98 to 100 percent—data not shown). 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 2009 Method Ever- married women Currently married women Any method 99.8 99.9 Any modern method 99.8 99.9 Female sterilization 86.6 86.8 Male sterilization 26.2 26.6 Pill 99.5 99.5 IUD 99.5 99.6 Injectables 88.3 88.6 Implants 68.2 68.8 Male condom 93.2 93.6 Female condom 22.5 22.5 Lactational amenorrhea (LAM) 91.7 91.9 Emergency contraception 15.7 15.7 Any traditional method 96.2 96.4 Periodic abstinence 88.6 89.0 Withdrawal 93.7 93.9 Folk method 6.7 6.8 Mean number of methods known 8.8 8.8 Number of respondents 10,109 9,651 48 | Fertility Regulation 5.2 EVER USE OF CONTRACEPTION All ever-married women interviewed in the 2009 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 use of a contraceptive method at some time in their lives. Ever use among currently married women (83 percent) is almost the same as for ever-married women (82 percent). Modern methods have been used by 75 percent of currently married women. The IUD is the most popular method (48 percent) followed by the pill (41 percent). The percentage reporting ever use of other modern methods varies from 3 percent for female sterilization, 20 percent for lactational amenorrhea method (LAM), and 27 percent for male condoms. Less than one percent of currently married women have ever used 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 36 percent of currently married women, followed by periodic abstinence (20 percent). 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 2009 JPFHS (Table 5.3) indicate that 59 percent of currently married women are using a contraceptive method: 42 percent using modern methods and 17 percent using traditional methods. The IUD is the most widely adopted modern method (23 percent), followed by the pill (8 percent), male condom (6 percent), female sterilization (3 percent), and LAM (2 percent). Less than 1 percent of women rely on other modern methods. Withdrawal (13 percent) and periodic abstinence (4 percent) are the most common traditional methods. 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 to 53 percent in the 1997 JPFHS, to 56 percent in the 2002 JPFHS, to 57 percent in the 2007 JPFHS, and to 59 percent in the 2009 JPFHS (Figure 5.1). The relative increase in current use during the seven years before the 2009 survey is 5 percent for all methods and 2 percent for all modern methods. 27 38 41 42 42 13 15 15 15 17 0 10 20 30 40 50 60 70 JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 Pe rc en t Traditional Modern Figure 5.1 Current Use of Contraception among Currently Married Women, Various Surveys, 1990-2009 53 56 57 59 40 Fe rt ili ty R eg ul at io n | 4 9 T ab le 5 .2 E ve r u se o f c on tra ce pt io n: W om en P er ce nt ag e of e ve r- m ar rie d w om en a nd c ur re nt ly m ar rie d w om en a ge 1 5- 49 w ho h av e ev er u se d an y co nt ra ce pt iv e m et ho d by m et ho d, a cc or di ng to a ge , J or da n 20 09 A ge An y m et ho d An y m od er n m et ho d M od er n m et ho d An y tra di - tio na l m et ho d Tr ad iti on al m et ho d N um be r o f w om en Fe m al e st er ili - za tio n M al e st er ili - za tio n Pi ll IU D In je ct - ab le s Im pl an ts M al e co nd om Fe m al e co nd om LA M Em er - ge nc y co nt ra - ce pt io n Pe rio di c ab st i- ne nc e W ith - dr aw al Fo lk m et ho d EV ER -M A RR IE D W O M EN 15 -1 9 37 .9 25 .3 0. 0 0. 0 10 .0 4. 7 0. 3 0. 0 8. 7 0. 0 3. 7 1. 5 17 .5 1. 1 17 .1 0. 2 24 9 20 -2 4 63 .8 52 .0 0. 0 0. 0 24 .8 19 .1 2. 2 0. 0 17 .8 0. 0 10 .6 0. 7 30 .1 5. 9 26 .6 0. 4 1, 10 7 25 -2 9 83 .7 72 .9 0. 0 0. 0 39 .0 36 .2 4. 4 0. 3 25 .9 0. 3 17 .8 0. 0 43 .8 14 .9 35 .7 1. 8 1, 90 3 30 -3 4 85 .6 76 .7 0. 4 0. 0 44 .6 48 .8 5. 8 0. 1 33 .0 0. 4 20 .6 0. 6 49 .7 21 .7 38 .1 2. 4 2, 05 3 35 -3 9 87 .2 81 .9 2. 4 0. 0 48 .2 56 .7 7. 3 1. 1 30 .7 0. 1 23 .1 0. 7 49 .0 24 .3 39 .6 1. 7 1, 77 1 40 -4 4 85 .2 79 .3 5. 8 0. 0 43 .3 60 .8 5. 8 1. 0 25 .2 0. 3 22 .1 0. 6 46 .1 26 .3 36 .1 3. 0 1, 75 1 45 -4 9 84 .2 81 .1 9. 7 0. 1 43 .7 58 .7 4. 2 0. 7 23 .8 0. 4 21 .8 0. 2 43 .1 25 .0 29 .8 5. 6 1, 27 4 To ta l 81 .7 73 .9 2. 8 0. 0 40 .8 46 .8 5. 1 0. 5 26 .5 0. 3 19 .4 0. 5 44 .1 19 .8 34 .7 2. 4 10 ,1 09 C U RR EN TL Y M A RR IE D W O M EN 15 -1 9 39 .0 26 .0 0. 0 0. 0 10 .3 4. 9 0. 4 0. 0 9. 0 0. 0 3. 9 1. 6 18 .0 1. 2 17 .5 0. 2 24 2 20 -2 4 65 .0 52 .9 0. 0 0. 0 25 .3 19 .6 2. 2 0. 0 17 .8 0. 0 10 .9 0. 7 30 .7 6. 0 27 .1 0. 4 1, 07 8 25 -2 9 84 .7 73 .9 0. 0 0. 0 39 .5 36 .7 4. 5 0. 3 26 .0 0. 3 17 .9 0. 0 44 .2 15 .0 36 .2 1. 8 1, 86 0 30 -3 4 86 .8 77 .7 0. 5 0. 0 45 .2 49 .8 5. 9 0. 1 33 .3 0. 3 20 .9 0. 6 51 .0 22 .3 39 .1 2. 4 2, 00 0 35 -3 9 87 .9 82 .9 2. 5 0. 0 49 .0 57 .2 7. 3 1. 1 31 .2 0. 1 23 .5 0. 7 49 .2 24 .6 39 .7 1. 7 1, 70 4 40 -4 4 86 .9 80 .6 6. 1 0. 0 44 .3 63 .1 5. 4 1. 0 25 .8 0. 3 22 .7 0. 2 48 .4 27 .3 37 .9 3. 2 1, 62 8 45 -4 9 85 .6 82 .7 8. 9 0. 1 44 .5 61 .4 4. 0 0. 7 24 .5 0. 4 20 .7 0. 2 43 .9 26 .2 29 .8 5. 6 1, 13 9 To ta l 82 .9 74 .9 2. 6 0. 0 41 .4 47 .7 5. 0 0. 5 26 .9 0. 2 19 .5 0. 4 45 .0 20 .3 35 .5 2. 4 9, 65 1 L A M = L ac ta tio na l a m en or rh ea m et ho d | 49Fertility Regulation 50 | F er til ity R eg ul at io n T ab le 5 .3 C ur re nt u se o f c on tra ce pt io n by a ge P er ce nt d ist rib ut io n of e ve r- m ar rie d w om en a nd c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to a ge , J or da n 20 09 A ge An y m et ho d An y m od er n m et ho d M od er n m et ho d An y tra di - tio na l m et ho d Tr ad iti on al m et ho d N ot cu rr en tly us in g To ta l N um be r o f w om en Fe m al e st er ili - za tio n Pi ll IU D In je ct - ab le s Im pl an ts M al e co nd om Fe m al e co nd om LA M Pe rio di c ab st i- ne nc e W ith - dr aw al Fo lk m et ho d EV ER -M A RR IE D W O M EN 15 -1 9 26 .2 15 .5 0. 0 7. 6 2. 9 0. 2 0. 0 3. 0 0. 0 1. 8 10 .7 0. 2 10 .4 0. 2 73 .8 10 0. 0 24 9 20 -2 4 41 .5 29 .7 0. 0 9. 3 12 .5 0. 7 0. 0 5. 6 0. 0 1. 6 11 .8 1. 0 10 .6 0. 2 58 .5 10 0. 0 1, 10 7 25 -2 9 56 .7 40 .9 0. 0 11 .1 18 .3 0. 9 0. 2 7. 8 0. 3 2. 4 15 .8 2. 3 13 .1 0. 3 43 .3 10 0. 0 1, 90 3 30 -3 4 60 .2 41 .4 0. 4 8. 4 23 .5 0. 9 0. 0 6. 5 0. 0 1. 6 18 .8 4. 2 13 .7 0. 9 39 .8 10 0. 0 2, 05 3 35 -3 9 65 .0 48 .1 2. 4 8. 6 27 .9 1. 0 0. 0 6. 5 0. 0 1. 6 16 .9 2. 8 13 .9 0. 2 35 .0 10 0. 0 1, 77 1 40 -4 4 64 .3 45 .5 5. 8 6. 2 27 .3 0. 5 0. 0 4. 9 0. 1 0. 6 18 .8 5. 1 13 .3 0. 4 35 .7 10 0. 0 1, 75 1 45 -4 9 49 .3 34 .3 9. 7 1. 7 18 .3 0. 1 0. 0 4. 3 0. 0 0. 1 15 .0 7. 9 6. 6 0. 5 50 .7 10 0. 0 1, 27 4 To ta l 56 .8 40 .4 2. 8 7. 8 21 .6 0. 7 0. 1 6. 0 0. 1 1. 4 16 .5 3. 8 12 .2 0. 4 43 .2 10 0. 0 10 ,1 09 C U RR EN TL Y M A RR IE D W O M EN 15 -1 9 27 .0 15 .9 0. 0 7. 8 3. 0 0. 2 0. 0 3. 0 0. 0 1. 9 11 .0 0. 2 10 .7 0. 2 73 .0 10 0. 0 24 2 20 -2 4 42 .6 30 .5 0. 0 9. 5 12 .9 0. 7 0. 0 5. 8 0. 0 1. 6 12 .1 1. 1 10 .9 0. 2 57 .4 10 0. 0 1, 07 8 25 -2 9 58 .0 41 .8 0. 0 11 .3 18 .7 0. 9 0. 2 7. 9 0. 3 2. 5 16 .2 2. 4 13 .4 0. 3 42 .0 10 0. 0 1, 86 0 30 -3 4 61 .8 42 .5 0. 5 8. 7 24 .1 0. 9 0. 0 6. 7 0. 0 1. 7 19 .3 4. 3 14 .1 0. 9 38 .2 10 0. 0 2, 00 0 35 -3 9 67 .6 50 .0 2. 5 9. 0 29 .0 1. 1 0. 0 6. 8 0. 0 1. 7 17 .6 2. 9 14 .4 0. 2 32 .4 10 0. 0 1, 70 4 40 -4 4 69 .0 48 .7 6. 1 6. 7 29 .3 0. 5 0. 0 5. 3 0. 1 0. 7 20 .2 5. 5 14 .3 0. 5 31 .0 10 0. 0 1, 62 8 45 -4 9 53 .2 36 .4 8. 9 1. 9 20 .5 0. 1 0. 0 4. 9 0. 0 0. 1 16 .8 8. 8 7. 4 0. 6 46 .8 10 0. 0 1, 13 9 To ta l 59 .3 42 .0 2. 6 8. 2 22 .6 0. 7 0. 1 6. 3 0. 1 1. 5 17 .2 4. 0 12 .8 0. 5 40 .7 10 0. 0 9, 65 1 N ot e: If m or e th an o ne m et ho d is us ed , o nl y th e m os t e ffe ct iv e m et ho d is co ns id er ed in th is ta bu la tio n. LA M = L ac ta tio na l a m en or rh ea m et ho d 50 | Fertility Regulation Fertility Regulation | 51 There has been considerable change in the use of specific contraceptive methods between 1997 and 2009. Most noticeable is the increased use of the male condom, which rose from 2 percent in 1997 to 6 percent in 2009. Contraceptive use differs according to age (Table 5.3). Among currently married women use is lowest among those age 15-19 (27 percent), peaks among women age 40-44 (69 percent), and then declines sharply among those age 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 use 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 3 percent among currently married women age 35-39, to 6 percent among women age 40-44, and 9 percent among women age 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 seven percentage points higher among women living in urban areas (60 percent) than among women living in rural areas (53 percent). The percentage of women using modern methods in urban areas is 8 percentage points higher than the percentage of women using modern methods 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 (61 percent), followed by the North region (58 percent) and the South region (54 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 Karak, to 60 percent in Irbid and 62 percent in Amman and Madaba. Currently married women in non-Badia areas are more likely to use any method of contraception than women in Badia areas (60 percent versus 51 percent). 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; 32 percent of women with no education are currently using a method, and 61 percent of women with preparatory education or higher are currently using a contraceptive method. Moreover, it should be noted that use of the IUD increases with level of education, whereas use of female sterilization negatively correlates with level of education. The 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. 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 2 percent among currently married women with no children to 73 percent among women with five or more children (Table 5.4). As expected, contraceptive use also increases with the wealth quintile. Current use of any method or any modern method rose, from 54 percent for all methods among women in the lowest wealth quintile to 65 percent for women in the highest wealth quintile. There was a strong direct relationship between wealth and the level of IUD and male condom use. Women in the highest wealth quintile were almost two times more likely to use either the IUD or male condom than women in the lowest quintile. On the other hand, injectable and LAM use decreased with the wealth quintile. 52 | F er til ity R eg ul at io n T ab le 5 .4 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s P er ce nt d ist rib ut io n of c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, Jo rd an 2 00 9 B ac kg ro un d ch ar ac te ris tic An y m et ho d An y m od er n m et ho d M od er n m et ho d An y tr ad i- tio na l m et ho d Tr ad iti on al m et ho d N ot cu rr en tly us in g To ta l N um be r o f w om en Fe m al e st er ili - za tio n Pi ll IU D In je ct - ab le s Im pl an ts M al e co nd om Fe m al e co nd om LA M Pe rio di c ab st i- ne nc e W ith - dr aw al Fo lk m et ho d R es id en ce U rb an 60 .4 43 .3 2. 5 8. 2 23 .8 0. 7 0. 1 6. 6 0. 1 1. 4 17 .1 4. 1 12 .6 0. 4 39 .6 10 0. 0 8, 10 2 Ru ra l 53 .2 35 .5 3. 1 8. 1 16 .3 1. 1 0. 0 4. 9 0. 0 2. 0 17 .7 3. 1 14 .1 0. 5 46 .8 10 0. 0 1, 54 9 G ov er no ra te s Am m an 61 .6 43 .8 2. 0 8. 6 25 .3 0. 5 0. 0 6. 2 0. 2 1. 1 17 .8 5. 6 11 .8 0. 5 38 .4 10 0. 0 3, 80 5 Ba lq a 58 .0 41 .7 2. 2 8. 2 21 .9 1. 1 0. 1 6. 1 0. 0 2. 1 16 .2 5. 2 10 .9 0. 1 42 .0 10 0. 0 59 7 Za rq a 58 .2 43 .9 2. 4 6. 9 23 .9 0. 7 0. 1 7. 2 0. 1 2. 6 14 .3 2. 8 10 .8 0. 7 41 .8 10 0. 0 1, 41 1 M ad ab a 62 .2 45 .4 3. 6 10 .1 22 .6 1. 3 0. 0 6. 3 0. 0 1. 5 16 .8 5. 1 11 .3 0. 4 37 .8 10 0. 0 21 4 Irb id 59 .5 42 .1 3. 8 8. 8 21 .2 0. 6 0. 1 6. 7 0. 0 0. 8 17 .4 2. 2 14 .7 0. 5 40 .5 10 0. 0 1, 83 1 M af ra q 53 .7 33 .2 2. 1 7. 0 14 .6 1. 9 0. 0 5. 5 0. 0 2. 1 20 .5 3. 2 17 .3 0. 0 46 .3 10 0. 0 43 4 Ja ra sh 59 .1 40 .4 2. 7 7. 4 21 .3 1. 8 0. 0 4. 5 0. 0 2. 7 18 .7 3. 4 14 .8 0. 5 40 .9 10 0. 0 28 9 Aj lo un 56 .3 40 .6 2. 4 4. 6 25 .8 0. 1 0. 0 4. 7 0. 0 3. 0 15 .7 2. 3 13 .0 0. 4 43 .7 10 0. 0 21 0 Ka ra k 50 .3 35 .4 3. 1 9. 8 14 .3 1. 2 0. 0 6. 3 0. 0 0. 7 14 .9 1. 7 12 .4 0. 8 49 .7 10 0. 0 37 4 Ta fie la 57 .9 37 .9 4. 6 9. 5 15 .2 1. 1 0. 0 5. 9 0. 0 1. 4 20 .0 1. 2 18 .8 0. 0 42 .1 10 0. 0 13 7 M a’ an 53 .5 27 .8 4. 2 4. 5 11 .0 0. 7 0. 1 6. 0 0. 0 1. 1 25 .7 3. 2 22 .1 0. 4 46 .5 10 0. 0 15 6 Aq ab a 58 .0 40 .3 1. 5 8. 4 21 .9 1. 0 0. 1 4. 5 0. 0 2. 8 17 .7 2. 7 14 .7 0. 3 42 .0 10 0. 0 19 2 R eg io n C en tr al 60 .5 43 .7 2. 2 8. 2 24 .5 0. 6 0. 0 6. 5 0. 1 1. 5 16 .8 4. 9 11 .4 0. 5 39 .5 10 0. 0 6, 02 8 N or th 58 .3 40 .4 3. 3 8. 0 20 .6 0. 9 0. 1 6. 2 0. 0 1. 3 17 .9 2. 5 15 .0 0. 4 41 .7 10 0. 0 2, 76 4 So ut h 53 .8 35 .5 3. 2 8. 5 15 .5 1. 1 0. 1 5. 8 0. 0 1. 4 18 .3 2. 1 15 .7 0. 5 46 .2 10 0. 0 85 9 B ad ia a re a Ba di a 50 .6 32 .6 2. 5 7. 7 13 .2 1. 6 0. 1 5. 2 0. 1 2. 2 18 .0 3. 4 14 .3 0. 3 49 .4 10 0. 0 80 8 O th er 60 .1 42 .9 2. 6 8. 2 23 .4 0. 7 0. 1 6. 4 0. 1 1. 4 17 .2 4. 0 12 .7 0. 5 39 .9 10 0. 0 8, 84 4 E du ca tio n N o ed uc at io n 31 .7 24 .2 6. 8 3. 4 9. 4 1. 8 0. 3 0. 7 0. 0 1. 8 7. 5 0. 2 7. 4 0. 0 68 .3 10 0. 0 25 9 El em en ta ry 50 .3 33 .7 5. 5 4. 5 18 .2 1. 2 0. 0 1. 8 0. 0 2. 5 16 .6 2. 7 13 .7 0. 1 49 .7 10 0. 0 64 6 Pr ep ar at or y 61 .5 46 .4 5. 2 9. 5 22 .3 0. 6 0. 1 6. 8 0. 0 2. 0 15 .1 2. 1 11 .6 1. 4 38 .5 10 0. 0 1, 48 5 Se co nd ar y 61 .0 43 .5 1. 7 9. 5 24 .0 0. 9 0. 1 5. 9 0. 0 1. 4 17 .5 4. 2 13 .1 0. 2 39 .0 10 0. 0 4, 15 2 H ig he r 60 .0 41 .2 1. 6 7. 0 22 .9 0. 3 0. 0 8. 1 0. 2 1. 0 18 .8 5. 0 13 .3 0. 4 40 .0 10 0. 0 3, 10 9 N um be r of li vi ng ch ild re n 0 1. 8 0. 4 0. 0 0. 1 0. 0 0. 0 0. 0 0. 4 0. 0 0. 0 1. 3 0. 1 1. 3 0. 0 98 .2 10 0. 0 87 8 1- 2 50 .4 33 .1 0. 0 8. 8 13 .8 0. 5 0. 0 8. 0 0. 2 1. 8 17 .3 3. 4 13 .6 0. 3 49 .6 10 0. 0 2, 61 7 3- 4 69 .5 49 .6 1. 1 10 .6 27 .9 1. 0 0. 1 7. 3 0. 0 1. 6 19 .9 4. 0 15 .7 0. 2 30 .5 10 0. 0 3, 09 6 5+ 73 .0 53 .9 7. 1 7. 5 31 .3 0. 9 0. 0 5. 6 0. 0 1. 5 19 .1 5. 5 12 .6 1. 0 27 .0 10 0. 0 3, 05 9 W ea lth q ui nt ile Lo w es t 53 .5 36 .6 2. 6 7. 8 17 .9 1. 4 0. 1 4. 4 0. 1 2. 4 16 .9 2. 3 13 .9 0. 7 46 .5 10 0. 0 1, 84 5 Se co nd 58 .0 42 .7 2. 5 8. 9 22 .3 1. 0 0. 1 6. 2 0. 0 1. 7 15 .3 2. 0 12 .9 0. 4 42 .0 10 0. 0 2, 03 4 M id dl e 58 .7 41 .1 2. 9 7. 6 20 .5 0. 6 0. 0 7. 8 0. 0 1. 6 17 .6 2. 9 14 .4 0. 3 41 .3 10 0. 0 2, 03 3 Fo ur th 61 .2 41 .1 3. 2 9. 0 21 .4 0. 3 0. 0 5. 9 0. 3 1. 0 20 .1 6. 1 13 .4 0. 7 38 .8 10 0. 0 2, 01 8 H ig he st 65 .3 49 .2 1. 7 7. 5 31 .8 0. 4 0. 1 7. 1 0. 0 0. 6 16 .0 6. 8 9. 1 0. 1 34 .7 10 0. 0 1, 72 1 To ta l 59 .3 42 .0 2. 6 8. 2 22 .6 0. 7 0. 1 6. 3 0. 1 1. 5 17 .2 4. 0 12 .8 0. 5 40 .7 10 0. 0 9, 65 1 N ot e: If m or e th an o ne m et ho d is us ed , o nl y th e m os t e ffe ct iv e m et ho d is co ns id er ed in th is ta bu la tio n. LA M = L ac ta tio na l a m en or rh ea m et ho d 52 | Fertility Regulation Fertility Regulation | 53 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 (37 percent and 24 percent, respectively). In other words, 63 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 1 percent among women age 35-49 to 3 percent among those age 20-24. The proportion of women who started using contraception after the birth of the first child has increased sharply, from 22 percent among women 45-49, to about 45 percent of women age 20-24, and to more than half (55 percent) among women 25-29. 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 2009 Current age Never used Number of living children at time of first use of contraception Total Number of women 0 1 2 3 4+ 15-19 62.1 6.5 28.5 2.9 0.0 0.0 100.0 249 20-24 36.2 3.3 44.9 13.5 1.8 0.2 100.0 1,107 25-29 16.3 3.6 54.9 19.3 4.0 1.8 100.0 1,903 30-34 14.4 1.7 42.9 28.7 8.1 4.2 100.0 2,053 35-39 12.8 1.0 29.6 32.5 12.0 12.2 100.0 1,771 40-44 14.8 1.4 24.9 26.5 11.4 21.0 100.0 1,751 45-49 15.8 0.4 22.2 20.7 13.8 27.1 100.0 1,274 Total 18.3 2.0 37.0 23.9 8.4 10.4 100.0 10,109 5.5 TIMING OF FEMALE STERILIZATION Use of female sterilization has remained stable between 2002 and 2009 (about 3 percent for both years), and it represents only 6 percent of the contraceptive use among users of modern methods in 2009. The age at which the operation takes place is of particular interest to family planning officials (Table 5.6). For 5 percent of women who have been sterilized, the operation took place before they were 30 years old; 23 percent were sterilized at 30-34 years, 54 percent at 35-39 years, and 18 percent at 40-49. Overall, women’s age at sterilization has increased in Jordan by about one year between 2002 and 2009: the median age in 2002 was 35.4 years, compared with 36.5 years in 2009. Table 5.6 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 2009 Years since operation Age at time of sterilization Total Number of women Median age1 <25 25-29 30-34 35-39 40-44 45-49 <2 (0.0) (0.0) (11.0) (52.0) (16.3) (20.8) 100.0 39 38.0 2-3 0.0 8.9 7.6 59.4 24.0 0.0 100.0 52 37.2 4-5 (0.0) (0.0) (16.7) (65.1) (18.2) (0.0) 100.0 46 37.3 6-7 (0.0) (1.2) (7.6) (52.3) (38.9) (0.0) 100.0 28 38.3 8-9 (0.0) (5.4) (33.7) (54.5) (6.3) (0.0) 100.0 48 36.3 10+ 3.3 5.4 46.6 44.7 0.0 0.0 100.0 66 a Total 0.8 4.0 23.3 54.3 14.7 2.9 100.0 278 36.5 Note: Figures in parenthesis 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 at less than 40 years of age to avoid problems of censoring. 54 | Fertility Regulation 5.6 SOURCE OF SUPPLY FOR MODERN METHODS In addition to information about levels of contraceptive use, program officials need to know where users obtain their methods. In the 2009 JPFHS, women who reported using a modern contraceptive method at the time of the survey were asked where they obtained the method the last time they acquired it. Table 5.7 and Figure 5.2 show the distribution of current users by source. Overall, current family planning users were more likely to obtain their method from a private sector source than from a public source. Private sources serve more than half (54 percent) of current users, compared with 66 percent in the 2002 JPFHS and 58 percent in the 2007 survey. The Jordanian Association of Family Planning and Protection (JAFPP), private pharmacies, and private doctors are the major private sources of supply for modern contraceptive methods (Table 5.7 and Figure 5.2). The public sector’s share increased to 46 percent in 2009, compared with 34 percent in the 2002 JPFHS and 42 percent in the 2007 survey. This increase may be due to a decline in use of JAFPP, from 20 percent in 2002 to 12 percent in 2009. Table 5.7 Source of modern contraception methods Percent distribution of women age 15-49 currently using a modern contraceptive method, by most recent source of method, according to method, Jordan 2009 Source Female sterilization Pill IUD Injectables Male condom Total1 Public 80.4 48.8 39.1 72.3 48.8 46.0 Public government hospital 62.5 1.3 2.5 5.5 0.1 6.2 Public government health center 0.0 28.2 13.0 35.9 23.4 17.1 Public MCH 0.0 18.2 21.4 30.6 22.8 19.6 University hospital 1.5 0.5 1.1 0.0 0.1 0.8 Royal medical services 16.3 0.5 1.0 0.4 2.4 2.2 Other public 0.0 0.0 0.2 0.0 0.0 0.1 Private medical 19.5 51.1 60.9 27.7 51.2 54.0 Private hospital/clinic 19.5 0.8 10.9 0.4 0.3 7.7 Private doctor 0.0 2.1 22.6 2.3 0.5 13.1 Private pharmacy 0.0 36.0 0.5 5.9 36.0 13.3 JAFPP 0.0 2.0 20.5 5.6 1.9 12.1 UNRWA clinic 0.0 10.1 6.3 13.5 12.5 7.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 278 789 2,180 71 609 3,940 1 Total includes 5 users of implants and 7 users of the female condom but excludes users of the lactational amenorrhea method (LAM). Public, 46% Private hospital/clinic, 8% Private doctor, 13% Private pharmacy, 13% JAFPP, 12% UNRWA clinic, 8% Figure 5.2 Sources of Family Planning Methods among Current Users of Modern Methods, 2009 JPFHS 2009 Fertility Regulation | 55 The sources of contraceptive methods vary by method used. Pharmacies are the primary source for users of methods that require resupply, including the pill and condoms (36 percent for each). Private doctors and family planning clinics (JAFPP) are the primary source for IUDs (23 percent and 21 percent, respectively). Government hospitals are the major source for most female sterilizations (63 percent), followed by private hospitals (20 percent) and Royal Medical Services (16 percent). Government health centers are the major source of injectables (36 percent), followed by public MCH (31 percent) and UNRWA clinics (14 percent). 5.7 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 5.8. Discontinuation rates were separately calculated for each method based on use of a method within 12 months after beginning the method. The reasons for discontinuation were examined and classified into four main categories: method failure (became pregnant while using), desire to become pregnant, switching to a more effective method, and other reasons (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 5.8 indicates that 8 percent of users stopped using a family planning method before the end of the first year because the method failed; 10 percent said they stopped because they wanted to become pregnant; 17 percent because they switched to a more effective method; and 11 percent for other reasons.1 Table 5.8 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 2009 Method Method failure Desire to become pregnant Switched to another method1 Other reason Total Pill 8.1 11.8 19.5 11.5 50.9 IUD 1.1 4.7 6.0 3.3 15.1 Injectables 1.6 5.8 32.4 24.5 64.3 Male condom 10.1 12.9 18.7 9.8 51.5 Lactational amenorrhea 6.7 10.3 40.9 41.1 99.1 Periodic abstinence 20.6 11.9 11.1 2.3 45.9 Withdrawal 12.8 11.3 11.5 4.2 39.8 Other 12.9 6.2 28.6 15.3 62.9 All methods 8.2 9.6 16.5 10.8 45.1 Number of episodes of use 845 978 1,713 1,114 4,650 Note: Table is based on episodes of contraceptive use that began 3-62 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. Compared with the 2002 findings, the percentage of discontinuation due to method failure has decreased from 11 percent to 8 percent, while the percentages in the other three categories have all increased. The desire to become pregnant has increased from 9 percent to 10 percent, switched to another 1 The rates are calculated from information collected in the calendar portion of the questionnaire. All episodes of contraceptive use between January 2004 and the date of interview are recorded in the calendar. Thus, discontinuation rates presented in this table refer 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 5.8 refer to the period 3-62 months prior to the survey—the month of interview and the two months prior are not included in order to avoid the bias that may be introduced by unrecognized pregnancies. 56 | Fertility Regulation method increased from 15 percent to 17 percent, and other reasons increased from 8 percent to 11 percent. Overall, more than two out of five women using a method of family planning (45 percent) stopped using that method within 12 months after beginning its use. Table 5.8 also shows that discontinuation rates were highest for LAM (99 percent)—in part because, by definition, LAM can be used for a maximum of 6 months postpartum—followed by injectables (64 percent), the male condom (52 percent), pills (51 percent) and periodic abstinence (46 percent). The IUD had the lowest discontinuation rate (the most common method); only 15 percent of women discontinued the method during the first year of use, with 6 percent of those women switching to another method. Part of the reason 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. Method failure was most often mentioned as the reason for discontinuation during the first year of use for traditional methods, specifically periodic abstinence (21 percent) and withdrawal (13 percent). Discontinuation of a method in order to become pregnant was most often mentioned by those using the male condom (13 percent), periodic abstinence and the pill (12 percent each), withdrawal (11 percent), and LAM (10 percent). Table 5.9 looks in greater detail at the reasons 2009 JFPHS respondents gave for discontinuing contraception use. The table shows the percent distribution of all discontinuations in the five-year period prior to the survey by the main reason for discontinuing, according to the specific method. More than one- third of all discontinuations during the five-year period before the 2009 JFPHS occurred because the user wanted to have a child (35 percent). Method failure accounted for 17 percent and the desire to use a more effective method accounted for 13 percent of all discontinuations. Other reasons women cited for discontinuation included side effects (12 percent), health concerns (9 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. Table 5.9 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason reported for discontinuation, according to specific method, Jordan 2009 Reason Pill IUD Injection Condom Lactation amen- orrhea Periodic abstinence Withdrawal All methods1 Became pregnant while using 12.7 6.2 3.3 18.4 6.9 44.6 30.7 17.1 Wanted to become pregnant 34.4 46.2 16.3 37.4 10.0 32.5 40.1 34.7 Husband disapproved 0.5 0.9 0.2 11.0 0.3 0.6 3.2 2.3 Side effects 23.5 19.7 39.0 5.1 0.1 0.5 0.8 11.5 Health concerns 14.1 19.5 27.6 4.6 0.1 1.7 2.3 9.4 Access/availability 0.2 0.0 1.8 0.6 0.0 0.0 0.0 0.2 Wanted a more effective method 4.2 0.5 3.7 12.6 45.4 14.1 14.4 12.6 Inconvenient to use 2.9 2.3 1.8 2.0 4.2 1.3 0.9 2.3 Infrequent sex/husband away 5.9 2.1 2.4 6.7 0.4 1.7 5.8 4.0 Cost too much 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Fatalistic 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.1 Difficult to get pregnant/menopausal 0.2 0.6 0.2 0.2 0.0 2.3 0.6 0.5 Marital dissolution separation 0.3 0.6 1.7 1.0 0.0 0.0 0.5 0.5 Ramadan 0.0 0.2 0.2 0.0 0.2 0.0 0.0 0.1 Other 0.8 1.1 1.6 0.4 32.3 0.7 0.3 4.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 2,091 2,097 242 1,017 1,134 684 1,940 9,328 1 Includes 1 user of implants, 2 users of female condom, and 121 users of other methods. LAM = Lactational amenorrhea method Fertility Regulation | 57 Method failure was most often mentioned as the reason for discontinuation of the traditional methods of periodic abstinence (45 percent) and withdrawal (31 percent). Among modern methods, method failure was also frequently a factor in discontinuation of male condoms (18 percent). Side effects were most frequently cited as the reason for discontinuation among women who had been using injectables (39 percent), the pill (24 percent), and IUD (20 percent). 5.8 FUTURE USE OF FAMILY PLANNING To obtain information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. Those who responded in the affirmative were also asked which method they would prefer to use. Table 5.10 presents the distribution of currently married women who were not using contraception at the time of the survey, by their intention to use in the future, according to number of living children. Table 5.10 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Jordan 2009 Intention Number of living children1 Total 0 1 2 3 4+ Intends to use 42.8 65.4 71.7 65.2 51.9 58.1 Unsure 10.5 6.0 3.7 3.6 2.1 4.6 Does not intend to use 46.6 28.6 24.6 31.2 46.0 37.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 636 650 649 630 1,367 3,931 1 Includes current pregnancy Among all currently married nonusers, 58 percent intended to use family planning in the future, 37 percent did not intend to use in the future, and the remaining non- users were unsure of their intentions. There is no change between 2007 and 2009 in the percentage of nonusers who intended to use in the future, while in the 2002 JPFHS, the proportion of nonusers who intended to use a family planning method in the future was slightly higher (60 percent). The intention to use contraception in the future ap- pears to not have a strong positive association with the number of living children a woman has. Specifically, 65 percent of women with three children said they intend to use a method of family planning, compared with 43 per- cent of childless women and 52 percent of women with four or more children. The reasons for nonuse are of particular interest to family planning program officials because they help to identify areas for potential interventions to support the adoption of contraception by nonusers. Table 5.11 presents the distribution of currently married nonusers who do not Table 5.11 Reason for not intending to use contraception in the future Percent distribution of currently married women age 15-49 who are not using contraception and who do not intend to use in the future by main reason for not intending to use, Jordan 2009 Reason Percent distribution Fertility-related reasons Infrequent sex 8.4 Menopausal, hysterectomy 11.7 Subfecund, infecund 18.8 Wants more children 25.4 Difficult to get pregnant 7.1 Opposition to use Respondent opposed 4.2 Husband opposed 2.4 Religious prohibition 0.9 Method-related reasons Health concerns 10.1 Fear side effects 7.3 Cost too much 0.1 Inconvenient to use 1.2 Interfere with body’s normal process 0.5 Other 1.6 Don’t know 0.4 Total 100.0 Number of women 1,467 58 | Fertility Regulation intend to use in the future by the main reason they gave for not using. Seven in ten nonusers had various fertility-related reasons for not planning to adopt contraception. These reasons included a perceived lack of need for contraception because the woman wanted more children (25 percent), was subfecund or infecund (19 percent), was menopausal or had had a hysterectomy (12 percent), or had infrequent sexual relations (8 percent). Method-related reasons were cited by nonusers also; 10 percent had health concerns and 7 percent mentioned fear of side effects. In addition, 7 percent mentioned either their husband’s or their own disapproval of contraception. Currently married nonusers who planned to use contraception in the future were asked about the method they intend to use. The majority of women (80 percent) say they want to use a modern method of contraception, and 15 percent say they want to use a traditional method. About two-thirds of the nonusers intending to use contraception in the future expressed a preference for the IUD (45 percent) and the pill (23 percent). Some programmatic implications can be drawn from the data in Table 5.12. Due to the popularity of the IUD, the pill, male condom, and female sterilization, several issues need to be considered in anticipation of women carrying out their intentions to use those methods. First, the supply of pills must be adequate to meet the needs of women who want to use that method; second, for women who want to use the IUD or female sterilization, trained personnel must be available to provide the services; and last, for women whose husbands desire to use condoms, they should be accessible at low prices. Table 5.12 Preferred method of contraception for future use Percent distribution of currently married women age 15-49 who are not using a contraceptive method but who intend to use in the future by preferred method, Jordan 2009 Method Percent distribution Female sterilization 1.8 Male sterilization 0.0 Pill 22.5 IUD 44.6 Injectables 3.1 Implants 1.6 Condom 5.8 Female condom 0.0 Lactation amenorrhea 0.6 Periodic abstinence 3.3 Withdrawal 11.3 Other 0.4 Unsure 4.9 Total 100.0 Number of women 2,284 Nuptiality and Exposure to the Risk of Pregnancy | 59 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY 6 This chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant: nuptiality, postpartum amenorrhea, and secondary infertility. In addition, data pertaining to the timing of respondents’ most recent sexual activity were collected. Information on nuptiality is of particular interest because marriage is a primary determinant of the exposure of women to the risk of pregnancy, particularly in countries like Jordan where premarital fertility is rare. Marriage patterns are important to fertility because an early age at first marriage is associated with early childbearing and high fertility. In this survey and for all data collection in Jordan, the term marriage refers to a formal, legal union. 6.1 CURRENT MARITAL STATUS Table 6.1 compares data on ever-married women from the 2009 JPFHS with data from four previous surveys: the 1990, 1997, 2002, and 2007 JPFHS. Over a period of 12 years, between 1990 and 2002, the percentage of ever-married women decreased from 56 to 54 percent. However, between 2002 and 2007, the percentage of ever-married women increased from 54 to 57 percent and then to 59 percent in 2009. This increase is mainly concentrated among young women in the age groups 20-24, 25-29, and 30-34. Table 6.1 Trends in the proportion of ever-married by age group Percentage of women age 15-49 who have ever been married by age, according to various surveys, Jordan 1990- 2009 Age JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 15-19 10.6 8.2 6.2 5.8 6.8 20-24 45.2 38.8 34.1 36.7 37.0 25-29 73.7 66.2 65.3 69.3 71.5 30-34 89.1 80.7 79.6 79.4 81.9 35-39 94.6 89.9 87.3 85.4 84.7 40-44 97.3 94.4 92.6 91.6 89.8 45-49 98.0 96.0 95.4 95.9 91.5 Total 15-49 56.2 54.6 54.4 57.4 58.5 In Jordan, marriage is almost universal. In 2009, only 9 percent of women had not married by the end of their reproductive years (Table 6.2). However, the percentage of women who had never married has increased over the years. For example, 5 percent of women age 35-39 had never married in 1990; the proportion doubled in 1997 (10 percent), rose again to 13 percent in 2002, and reached 15 percent in 2007 and 2009 (Figure 6.1). The pattern is similar for women in the younger age groups. The proportion of never-married women age 20-24 increased from 55 percent in 1990 to 66 percent in 2002 but dropped to 63 percent in 2007 and 2009. Similarly, the proportion of never-married women age 25-29 increased from 26 percent in 1990 to 35 percent in 2002 and then dropped to 29 percent in 2009. Echoing this trend, the proportion of women age 15-19 who had never married increased from 89 to 94 percent between 1990 and 2007, and then slightly decreased in 2009 (93 percent). This change is the consequence of an increase of the age at first marriage among the youngest women during the period 1990-2002; since 2002, age at first marriage has remained almost unchanged. 60 | Nuptiality and Exposure to the Risk of Pregnancy 89 55 26 11 5 92 61 34 19 10 94 66 35 20 13 94 63 31 21 15 93 63 29 18 15 0 10 20 30 40 50 60 70 80 90 100 15-19 20-24 25-29 30-34 35-39 Pe rc en t Age group JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 Figure 6.1 Percentage of Never-married Women Age 15-39 by Age Group, Various Surveys, 1990-2009 Table 6.2 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Jordan 2009 Age Marital status Total Number of women Never married Married Divorced Widowed 15-19 93.2 6.6 0.2 0.0 100.0 3,679 20-24 63.0 36.0 0.1 0.1 100.0 2,994 25-29 28.5 69.8 1.4 0.2 100.0 2,664 30-34 18.1 79.8 1.8 0.4 100.0 2,507 35-39 15.3 81.5 1.5 1.7 100.0 2,091 40-44 10.2 83.5 2.2 4.1 100.0 1,951 45-49 8.5 81.8 2.1 7.7 100.0 1,392 Total 15-49 41.5 55.9 1.3 1.4 100.0 17,278 Table 6.2 presents the distribution of women by current marital status. Of the 17,278 women age 15-49 listed in the household schedule, 42 percent had never married, 56 percent were currently married, and the remaining 3 percent were either divorced or widowed. The proportion of women who are currently married increases steadily from 7 percent among women age 15-19, to 82 percent among those age 35-39, and then to 84 percent for women in the age group 40-44. As expected, the proportion of widows and divorced women (less than 2 percent each) increases with age; the proportion of widows increases from less than 1 percent among women age 15-34 to 8 percent among women 45-49. Nuptiality and Exposure to the Risk of Pregnancy | 61 6.2 POLYGYNY Marital unions in Jordan are predominantly of two types—those that are monogamous and those that are polygynous. The distinction has social significance and possible implications for fertility, although the relationship between type of union and fertility is complex and not easily understood. The proportion of currently married women in Jordan in a polygynous union is shown in Table 6.3. Table 6.3 Number of co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Jordan 2009 Background characteristic Number of co-wives Total Number of women 0 1+ Age 15-19 99.6 0.4 100.0 242 20-24 98.6 1.4 100.0 1,078 25-29 97.0 3.0 100.0 1,860 30-34 95.7 4.3 100.0 2,000 35-39 93.5 6.5 100.0 1,704 40-44 93.0 7.0 100.0 1,628 45-49 89.8 10.2 100.0 1,139 Residence Urban 95.4 4.6 100.0 8,102 Rural 92.0 8.0 100.0 1,549 Governorates Amman 94.5 5.5 100.0 3,805 Balqa 94.3 5.7 100.0 597 Zarqa 95.2 4.8 100.0 1,411 Madaba 94.5 5.5 100.0 214 Irbid 96.8 3.2 100.0 1,831 Mafraq 92.3 7.7 100.0 434 Jarash 93.8 6.2 100.0 289 Ajloun 95.6 4.4 100.0 210 Karak 94.5 5.5 100.0 374 Tafiela 94.7 5.3 100.0 137 Ma’an 91.0 9.0 100.0 156 Aqaba 92.9 7.1 100.0 192 Region Central 94.6 5.4 100.0 6,028 North 95.7 4.3 100.0 2,764 South 93.5 6.5 100.0 859 Badia area Badia 88.1 11.9 100.0 808 Other 95.5 4.5 100.0 8,844 Education No education 79.2 20.8 100.0 259 Elementary 89.3 10.7 100.0 646 Preparatory 93.9 6.1 100.0 1,485 Secondary 95.9 4.1 100.0 4,152 Higher 96.4 3.6 100.0 3,109 Wealth quintile Lowest 90.7 9.3 100.0 1,845 Second 95.4 4.6 100.0 2,034 Middle 96.2 3.8 100.0 2,033 Fourth 96.6 3.4 100.0 2,018 Highest 95.0 5.0 100.0 1,721 Total 94.8 5.2 100.0 9,651 Overall, 5 percent of currently married women are in a polygynous union compared with 7 percent in 2002. More older women are in a polygynous union than younger women (8 percent of women age 40-49 compared with 1 percent of women age 15-24). The prevalence of polygyny is also higher in rural areas (8 percent versus 5 percent in urban areas). There are significant differences in type of marital 62 | Nuptiality and Exposure to the Risk of Pregnancy union by region and governorate (3 percent in Irbid, 7 percent in Aqaba, and 9 percent in Ma’an). In Badia areas, 12 percent of married women are in a polygynous union compared with 5 percent of married women in non-Badia areas. There are also large differences in polygynous union by household wealth quintile. The proportion of polygynous unions among women in the lowest wealth quintile is higher (9 percent) than among women in the highest wealth quintile (5 percent), showing an inverse relationship between polygyny and household wealth. A similar inverse relationship is seen between polygyny and education. Among married women with no education, the proportion in a polygynous union is 21 percent; this decreases to 6 percent among women with preparatory education and to 4 percent among women

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