Jordan Population and Family Health Survey 2012

Publication date: 2014

Jordan Population and Family Health Survey 2012 THE HASHEMITE KINGDOM OF JORDAN Jordan Population and Family Health Survey 2012 Department of Statistics Amman, Jordan ICF International Calverton, Maryland, USA October 2013 CONTRIBUTORS DEPARTMENT OF STATISTICS Fathi Nsour Kamal Saleh Ikhlas Aranki Batoul Obaid Manal Sweidan Dr. Ahmad Abu-Haidar Ahmad Mowafi Ghaida Khasawneh Eman Bny Mfarej MINISTRY OF HEALTH Dr. Kareman Al-Zain Dr. Ahlam Abodiab Dr. Bassam Hijawi ARAB INSTITUTE FOR TRAINING & RESEARCH IN STATISTICS Dr. Issa Al-Masarweh ICF INTERNATIONAL Dr. Pav Govindasamy Bernard Barrère Dr. Ruilin Ren Nourredine Abderrahim Anne Cross This report summarizes the findings of the 2012 Jordan Population and Family Health Survey (JPFHS) carried out by the Department of Statistics (DoS). The survey was funded by the government of Jordan. Additional funding was provided by the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF). ICF International 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 International, 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 International. 2013. Jordan Population and Family Health Survey 2012. Calverton, Maryland, USA: Department of Statistics and ICF International. Contents • iii CONTENTS LIST OF TABLES AND FIGURES . vii PREFACE . xiii MILLENIUM DEVELOPMENT GOALS INDICATORS . xv MAP OF JORDAN . xvi 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 . 5 1.6 Methodology and Organization of the Survey . 5 1.6.1 Sample Design . 6 1.6.2 Updating of Sampling Frame . 6 1.6.3 Questionnaires . 7 1.6.4 Recruitment of Staff . 7 1.6.5 Pretest and Training . 8 1.6.6 Main Fieldwork . 8 1.6.7 Data Processing . 8 1.7 Results of the Household and Individual Interviews . 9 2 HOUSEHOLD CHARACTERISTICS 2.1 Housing Characteristics . 11 2.2 Household Wealth . 16 2.3 Population by Age and Sex . 17 2.4 Household Composition . 19 2.5 Birth Registration . 20 2.6 Education of the Household Population . 23 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3.1 General Characteristics . 27 3.2 Respondents’ Level of Education . 29 3.3 Exposure to Mass Media . 31 3.4 Respondents’ Employment Characteristics . 32 3.4.1 Working Status . 32 3.4.2 Occupation . 34 3.5 Smoking Tobacco . 36 4 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY 4.1 Current Marital Status . 39 4.2 Polygyny . 40 4.3 Consanguinity . 42 4.4 Age at First Marriage . 43 4.5 Recent Sexual Activity . 45 iv • Contents 5 FERTILITY 5.1 Current Fertility . 48 5.2 Fertility Differentials By Background Characteristics . 49 5.3 Fertility Trends . 50 5.4 Children Ever Born . 52 5.5 Birth Intervals . 53 5.6 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility . 55 5.7 Menopause . 57 5.8 Age at First Birth . 57 5.9 Teenage Fertility . 59 6 FERTILITY PREFERENCES 6.1 Desire for Children. 61 6.2 Ideal Number of Children . 64 6.3 Planning Status of Births . 67 7 FAMILY PLANNING 7.1 Knowledge of Family Planning Methods . 69 7.2 Current Use of Contraception . 70 7.3 Timing of Sterilization . 75 7.4 Source of Supply for Modern Methods . 75 7.5 Use of Social Marketing Brands of Contraceptives . 76 7.6 Informed Choice . 78 7.7 Contraceptive Discontinuation . 79 7.8 Knowledge of the Fertile Period . 81 7.9 Need for Family Planning Services . 81 7.10 Future Use of Family Planning . 85 7.11 Exposure to Family Planning Messages . 85 7.12 Contact of Nonusers with Family Planning Providers . 87 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends . 92 8.2 Differentials in Infant and Child Mortality . 94 8.2.1 Differentials by Background Characteristics . 94 8.2.2 Differentials by Demographic Characteristics . 95 8.3 Perinatal Mortality . 97 8.4 High-Risk Fertility Behavior. 99 9 MATERNAL HEALTH 9.1 Antenatal Care . 101 9.1.1 Number and Timing of ANC Visits . 103 9.1.2 Components of Antenatal Care . 105 9.1.3 Coverage of Tetanus Toxoid Vaccinations . 107 9.2 Delivery . 109 9.2.1 Place of Delivery . 109 9.2.2 Assistance at Delivery . 110 9.2.3 Delivery Characteristics . 112 9.2.4 Payment for Delivery . 112 9.3 Postnatal Care . 113 9.3.1 Postnatal Care for Mother . 114 9.3.2 Postnatal Care for Newborn . 115 9.4 Problems in Accessing Health Care . 119 9.5 Premarital Medical Examinations . 120 9.6 Cancer Screening . 121 Contents • v 10 CHILD HEALTH 10.1 Birth Weight . 123 10.2 Vaccination Coverage . 125 10.2.1 Additional Doses of Polio and DPT . 127 10.2.2 Additional Vaccinations . 128 10.2.3 Trends in Vaccination Coverage . 130 10.3 Acute Respiratory Infection . 131 10.4 Prevalence of Fever . 133 10.5 Prevalence of Diarrhea . 135 10.5.1 Diarrhea Treatment . 136 10.5.2 Nutritional Practices during Diarrhea . 138 10.5.3 Knowledge of Diarrhea Treatment Solutions . 141 11 NUTRITIONAL STATUS AND PREVALENCE OF ANEMIA 11.1 Nutritional Status of Children . 143 11.1.1 Measurement of Nutritional Status among Young Children . 144 11.1.2 Results of Data Collection . 145 11.1.3 Levels of Child Malnutrition . 145 11.1.4 Trends in Children’s Nutritional Status . 149 11.2 Breastfeeding and Complementary Feeding . 149 11.2.1 Initiation of Breastfeeding . 149 11.2.2 Breastfeeding Status by Age . 152 11.2.3 Duration of Breastfeeding . 154 11.2.4 Types of Complementary Foods . 155 11.3 Appropriate Infant and Young Child Feeding (IYCF) Practices . 155 11.4 Prevalence of Anemia in Children . 159 11.5 Micronutrient Intake among Children . 162 11.6 Nutritional Status of Women . 163 11.7 Prevalence of Anemia in Women . 165 11.8 Micronutrient Intake among Mothers . 167 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12.1 Knowledge of HIV/AIDS and Methods of HIV Prevention . 170 12.2 Stigma Associated with AIDS . 176 12.3 Attitudes Towards Negotiating Safer Sexual Relations . 177 12.4 Knowledge of Sexually Transmitted Infections . 179 12.5 Exposure to Media Messages about AIDS . 180 12.6 AIDS-Related Knowledge among Youth . 181 12.7 Knowledge of Tuberculosis . 182 13 WOMEN’S EMPOWERMENT 13.1 Women’s Work Status . 185 13.2 Women’s Control Over Their Own Earnings and Relative Magnitude of Women’s Earnings . 186 13.3 Control Over Husbands’ Earnings . 187 13.4 Women’s Ownership of Assets . 189 13.5 Women’s Participation in Decision Making . 190 13.6 Women’s Attitudes toward Wife Beating . 193 13.7 Women’s Empowerment Indicators . 195 13.8 Current Use of Contraception by Women’s Empowerment . 195 13.9 Ideal Family Size and Unmet Need by Women’s Empowerment . 196 vi • Contents 14 DOMESTIC VIOLENCE 14.1 Physical Violence . 199 14.2 Sexual Violence . 202 14.3 Physical and Sexual Violence . 204 14.4 Violence During Pregnancy . 204 14.5 Marital Control by Husband. 206 14.6 Spousal Violence . 208 14.7 Spousal Violence and Women’s Empowerment . 210 14.8 Spousal Violence in the Past 12 Months . 211 14.9 Injuries From Spousal Violence . 213 14.10 Help-Seeking Behavior by Abused Women . 213 15 EARLY CHILDHOOD DEVELOPMENT AND CHILD DISCIPLINE 15.1 Early Childhood Education and Learning . 218 15.2 Early Childhood Development . 224 15.3 Child Discipline . 226 REFERENCES . 229 APPENDIX A SAMPLE IMPLEMENTATION A.1 Objectives of the survey . 233 A.2 Sampling frame . 233 A.3 Sample allocation and sample selection . 234 A.4 Selection probability and sampling weight . 236 A.5 Sample Implementation . 237 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 239 APPENDIX C DATA QUALITY TABLES . 265 APPENDIX D QUESTIONNAIRES . 271 List of Tables and Figures • vii LIST OF TABLES AND FIGURES 1 INTRODUCTION Table 1.1 Basic demographic indicators . 2 Table 1.2 Results of the household and individual interviews . 9 2 HOUSEHOLD CHARACTERISTICS Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 12 Table 2.3 Household characteristics . 14 Table 2.4 Household possessions . 15 Table 2.5 Wealth quintiles . 16 Table 2.6 Household population by age, sex, and residence. 18 Table 2.7 Household composition . 20 Table 2.8 Birth registration of children under age five . 21 Table 2.9 Children's living arrangements and orphanhood . 22 Table 2.10.1 Educational attainment of the female household population . 24 Table 2.10.2 Educational attainment of the male household population . 25 Figure 2.1 Male and female population by single year of age, 2012 . 17 Figure 2.2 Population pyramid . 18 Figure 2.3 Population by broad age groups, various surveys, 1983-2012 . 19 Figure 2.4 Age-specific attendance rates, 2012 (percentage of the population age 6-24 attending school) . 26 3 RESPONDENTS’ BACKGROUND CHARACTERISTICS Table 3.1 Background characteristics of women . 28 Table 3.2 Educational attainment . 30 Table 3.3 Exposure to mass media . 32 Table 3.4 Employment status . 33 Table 3.5 Occupation . 35 Table 3.6 Use of tobacco . 37 Figure 3.1 Women’s current employment status . 36 4 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY Table 4.1 Current marital status . 39 Table 4.2 Trends in the proportion of ever-married women by age group . 40 Table 4.3 Number of women's co-wives . 41 Table 4.4 Consanguinity . 42 Table 4.5 Age at first marriage . 44 Table 4.6 Median age at first marriage by background characteristics . 45 Table 4.7 Recent sexual activity . 46 5 FERTILITY Table 5.1 Current fertility . 48 Table 5.2 Fertility by background characteristics . 49 Table 5.3 Trends in age-specific fertility rates . 50 Table 5.4 Trends in fertility . 51 Table 5.5 Children ever born and living . 52 Table 5.6 Birth intervals . 54 Table 5.7 Postpartum amenorrhea, abstinence, and insusceptibility . 55 Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 56 viii • List of Tables and Figures Table 5.9 Menopause . 57 Table 5.10 Age at first birth . 57 Table 5.11 Median age at first birth . 58 Table 5.12 Teenage pregnancy and motherhood . 59 Figure 5.1 Age-specific fertility rates by urban-rural residence . 48 Figure 5.2 Total fertility rates by background characteristics . 50 Figure 5.3 Age-specific fertility rates for five-year periods preceding the survey . 51 Figure 5.3 Trends in age-specific fertility rates, various sources, 1990-2012 . 52 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . 62 Table 6.2 Desire to limit childbearing . 63 Table 6.3 Ideal number of children by number of living children . 65 Table 6.4 Mean ideal number of children by background characteristics . 66 Table 6.5 Fertility planning status . 67 Table 6.6 Wanted fertility rates . 68 Figure 6.1 Fertility preferences of currently married women age 15-49 . 62 7 FAMILY PLANNING Table 7.1 Knowledge of contraceptive methods . 70 Table 7.2 Current use of contraception by age . 71 Table 7.3 Current use of contraception by background characteristics . 74 Table 7.4 Source of modern contraception methods . 75 Table 7.5 Use of social marketing brand pills . 77 Table 7.6 Informed choice . 78 Table 7.7 Twelve-month contraceptive discontinuation rates . 79 Table 7.8 Reasons for discontinuation . 80 Table 7.9 Knowledge of fertile period . 81 Table 7.10 Need and demand for family planning among currently married women . 84 Table 7.11 Future use of contraception . 85 Table 7.12 Exposure to family planning messages . 86 Table 7.13 Meaning of Hayatee Ahla message . 88 Table 7.14 Contact of nonusers with family planning providers . 89 Figure 7.1 Current use of contraception among currently married women, various surveys, 1990-2012 . 72 Figure 7.2 Sources of family planning methods among current users of modern methods, 2012 . 76 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 93 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 95 Table 8.3 Early childhood mortality rates by demographic characteristics . 96 Table 8.4 Perinatal mortality . 98 Table 8.5 High-risk fertility behavior . 99 Figure 8.1 Trends in childhood mortality, Jordan 2012 . 93 Figure 8.2 Trends in under-5 mortality, 1990-2012 . 94 Figure 8.3 Under-5 mortality rates by selected demographic characteristics . 96 9 MATERNAL HEALTH Table 9.1 Antenatal care . 102 Table 9.2 Number of antenatal care visits. 104 Table 9.3 Timing of first antenatal care visit . 105 Table 9.4 Components of antenatal care . 106 Table 9.5 Tetanus toxoid injections . 108 Table 9.6 Place of delivery . 110 Table 9.7 Assistance during delivery . 111 List of Tables and Figures • ix Table 9.8 Cost of delivery. 113 Table 9.9 Timing of first postnatal checkup for the mother . 114 Table 9.10 Timing of first postnatal checkup for the newborn . 116 Table 9.11 Heel prick and hearing test for the newborn . 117 Table 9.12 Cost of postnatal checkup . 118 Table 9.13 Problems in accessing health care . 119 Table 9.14 Premarital medical exams by background characteristics . 120 Table 9.15 Breast cancer exam and Pap smear . 122 10 CHILD HEALTH Table 10.1 Child's size and weight at birth . 124 Table 10.2 Vaccinations by source of information . 125 Table 10.3 Basic vaccinations of children age 12-23 months by background characteristics . 127 Table 10.4 Basic and booster vaccinations of children 24-59 months by background characteristics . 128 Table 10.5 Additional vaccinations of children 24-59 months by background characteristics . 129 Table 10.6 Vaccinations in first year of life. 130 Table 10.7 Prevalence and treatment of symptoms of ARI . 132 Table 10.8 Prevalence and treatment of fever . 133 Table 10.9 Children taken for treatment of fever by number of days . 134 Table 10.10 Prevalence of diarrhea . 135 Table 10.11 Diarrhea treatment . 137 Table 10.12 Feeding practices during diarrhea . 139 Table 10.13 Children taken for treatment of diarrhea by number of days . 140 Table 10.14 Knowledge of ORS packets or pre-packaged liquids . 141 Figure 10.1 Percentage of children age 12-23 months with specific vaccinations . 126 11 NUTRITIONAL STATUS AND PREVALENCE OF ANEMIA Table 11.1 Nutritional status of children . 146 Table 11.2 Initial breastfeeding . 151 Table 11.3 Breastfeeding status by age . 152 Table 11.4 Median duration of breastfeeding . 154 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 156 Table 11.6 Infant and young child feeding (IYCF) practices . 157 Table 11.7 Prevalence of anemia in children . 160 Table 11.8 Micronutrient intake among children . 162 Table 11.9 Nutritional status of women . 164 Table 11.10 Prevalence of anemia in women . 166 Table 11.11 Micronutrient intake among mothers . 168 Figure 11.1 Nutritional status of children by age . 148 Figure 11.2 Trends in nutritional status of children under age five, 2002, 2009, and 2012 . 149 Figure 11.3 Breastfeeding Status, 2002, 2007, 2012 . 153 Figure 11.4 Trends in anemia status among children 6-59 months . 161 Figure 11.5 Trends in anemia status among women age 15-49 . 167 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 12.1 Knowledge of AIDS . 170 Table 12.2 Knowledge of HIV prevention methods . 171 Table 12.3 Comprehensive knowledge about AIDS . 172 Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV . 174 Table 12.5 Knowledge of where to get an HIV test . 175 Table 12.6 Accepting attitudes toward those living with HIV/AIDS . 176 Table 12.7 Attitudes toward negotiating safer sexual relations with husband . 177 Table 12.8 Talked about AIDS with husband . 178 Table 12.9 Knowledge of sexually transmitted infections (STIs) . 179 x • List of Tables and Figures Table 12.10 Exposure to media messages about AIDS . 180 Table 12.11 Comprehensive knowledge about AIDS and of a source of condoms among young women . 181 Table 12.12 Knowledge of tuberculosis . 182 Table 12.13 Comprehensive knowledge of tuberculosis and willingness to be tested . 183 13 WOMEN’S EMPOWERMENT Table 13.1 Employment of currently married women . 185 Table 13.2 Control over women's cash earnings and relative magnitude of women's cash earnings . 187 Table 13.3 Control over husband's earnings . 188 Table 13.4 Women's control over their own earnings and over those of their husbands . 189 Table 13.5 Ownership of assets . 190 Table 13.6 Participation in decision making . 191 Table 13.7 Women's participation in decision making by background characteristics . 192 Table 13.8 Attitude toward wife beating . 194 Table 13.9 Indicators of women's empowerment . 195 Table 13.10 Current use of contraception by women's empowerment . 196 Table 13.11 Ideal number of children and unmet need for family planning by women’s empowerment . 197 Figure 13.1 Number of decisions in which currently married women participate . 191 14 DOMESTIC VIOLENCE Table 14.1 Experience of physical violence . 201 Table 14.2 Persons committing physical violence . 202 Table 14.3 Experience of sexual violence . 203 Table 14.4 Experience of different forms of violence . 204 Table 14.5 Experience of violence during pregnancy . 205 Table 14.6 Marital control exercised by husbands . 207 Table 14.7 Forms of spousal violence . 208 Table 14.8 Spousal violence by background characteristics . 209 Table 14.9 Spousal violence by husband's characteristics and empowerment indicators . 211 Table 14.10 Frequency of physical or sexual violence . 212 Table 14.11 Injuries to women due to spousal violence . 213 Table 14.12 Help seeking to stop violence . 214 Table 14.13 Sources for help to stop violence . 215 15 EARLY CHILDHOOD DEVELOPMENT AND CHILD DISCIPLINE Table 15.1 Early childhood education . 218 Table 15.2 Support for learning . 220 Table 15.3 Learning materials . 222 Table 15.4 Inadequate care . 223 Table 15.5 Early child development index . 225 Table 15.6 Child discipline . 227 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Enumeration areas . 234 Table A.2 Households . 234 Table A.3 Sample allocation of enumeration areas . 235 Table A.4 Sample allocation of households . 236 Table A.5 Sample allocation of expected interviews with women . 236 Table A.6 Sample implementation . 238 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of indicators for sampling errors, Jordan 2012 . 241 Table B.2 Sampling errors: Total sample, Jordan 2012 . 242 Table B.3 Sampling errors: Urban sample, Jordan 2012 . 243 Table B.4 Sampling errors: Rural sample, Jordan 2012 . 244 Table B.5 Sampling errors: Central sample, Jordan 2012 . 245 Table B.6 Sampling errors: North sample, Jordan 2012 . 246 List of Tables and Figures • xi Table B.7 Sampling errors: South sample, Jordan 2012 . 247 Table B.8 Sampling errors: Amman sample, Jordan 2012 . 248 Table B.9 Sampling errors: Balqa sample, Jordan 2012 . 249 Table B.10 Sampling errors: Zarqa sample, Jordan 2012 . 250 Table B.11 Sampling errors: Madaba sample, Jordan 2012 . 251 Table B.12 Sampling errors: Irbid sample, Jordan 2012 . 252 Table B.13 Sampling errors: Mafraq sample, Jordan 2012 . 253 Table B.14 Sampling errors: Jarash sample, Jordan 2012 . 254 Table B.15 Sampling errors: Ajloun sample, Jordan 2012 . 255 Table B.16 Sampling errors: Karak sample, Jordan 2012 . 256 Table B.17 Sampling errors: Tafiela sample, Jordan 2012 . 257 Table B.18 Sampling errors: Ma'an sample, Jordan 2012 . 258 Table B.19 Sampling errors: Aqaba sample, Jordan 2012 . 259 Table B.20 Sampling errors: Non Badia sample, Jordan 2012 . 260 Table B.21 Sampling errors: Badia sample, Jordan 2012 . 261 Table B.22 Sampling errors: Non camp sample, Jordan 2012 . 262 Table B.23 Sampling errors: Camp sample, Jordan 2012 . 263 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 265 Table C.2 Age distribution of eligible and interviewed women . 266 Table C.3 Completeness of reporting . 266 Table C.4 Births by calendar years . 267 Table C.5 Reporting of age at death in days . 267 Table C.6 Reporting of age at death in months . 268 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 269 Preface • xiii PREFACE he Department of Statistics (DoS) takes pleasure in presenting the principal report of the 2012 Jordan Population and Family Health Survey (JPFHS), which includes the detailed main results. The survey was conducted from September to December 2012. The 2012 Jordan Population and Family Health Survey (JPFHS) is the sixth Demographic and Health Survey conducted in Jordan. Like the first five JPFHS, conducted respectively in 1990, 1997, 2002, 2007, and 2009, the 2012 JPFHS was carried out by the Department of Statistics (DoS). The main objective of the survey is to provide comprehensive data on fertility, mortality, family planning, and fertility preferences, as well as maternal and child health and nutrition, that can be used by program managers and policymakers to evaluate and improve existing programs. In addition, the JPFHS data will be useful for researchers and scholars interested in analyzing trends in demographic parameters in Jordan as well as conducting comparative, regional or cross-national studies and in-depth analyses. The sample is nationally representative and has been designed to produce estimates of major survey variables at the national level, for urban and rural areas, for the country’s three regions (Central, North, and South) and 12 governorates, and for Badia areas and refugee camp areas. Over 15,000 households and more than 11,000 ever-married women age 15-49 were interviewed. The 2012 JPFHS was funded by the Government of Jordan. Additional funding was provided by the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), and the United Nations Children’s Fund (UNICEF). ICF International provided technical assistance through the worldwide MEASURE Demographic and Health Surveys (DHS) program. It is hoped that the 2012 JPFHS data will meet the survey’s objective of facilitating important government policies and programs promoting maternal and child health. Furthermore, the survey will also be useful to those interested in the fields of population, family planning, and health. The DoS would like to express its thanks and appreciation to the individuals and organizations that contributed to the success of the survey. The timely and high-quality data are the result of hard work from all of 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 logistical assistance. In addition, thanks are due to USAID, UNFPA and UNICEF in Amman for their financial and technical support. Thanks also go to the ICF International team: Bernard Barrere, DHS Deputy Director for Survey Operations; Pav Govindasamy, Technical Director, who participated in all stages of the survey; Ruilin Ren, for his contribution in the sampling design; Anne Cross, who assisted in preparing the preliminary results; and Noureddine Abderrahim for his valuable assistance in data processing. Finally, thanks are due to the local and international experts who prepared the present report. Fathi Nsour Director General T Millennium Development Goal Indicators • xv MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Jordan 2012 Indicator Sex Total Male Female 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age five1 3.3 2.7 3.0 4. Reduce child mortality 4.1 Under-five mortality rate2 22 19 21 4.2 Infant mortality rate2 19 16 17 4.3 Percentage of children age one immunized against measles 94.9 93.9 94.4 5. Improve maternal health 5.2 Percentage of births attended by skilled health personnel3 na na 99.6 5.3 Contraceptive prevalence rate4 na 61.2 na 5.4 Adolescent birth rate5 na 25.6 na 5.5 Antenatal care coverage 5.5a At least one visit6 na 99.1 na 5.5b Four or more visits7 na 94.5 na 5.6 Unmet need for family planning na 11.7 na 6. Combat HIV/AIDS, malaria, and other diseases 6.3 Percentage of the population age 15-24 with comprehensive correct knowledge of HIV/AIDS8 na 8.6 na 6.4 Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 1.03 0.55 0.80 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved water source9 99.4 95.9 98.8 7.9 Percentage of population using an improved sanitation facility10 99.9 100.0 99.9 na = Not applicable 1 Proportion of children age 0-59 months who are below -2 standard deviations from the median of the WHO Child Growth Standards in weight-for-age. 2 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 3 Among births in the five years preceding the survey. 4 Percentage of currently married women age 15-49 using any method of contraception. 5 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19. 6 With a skilled provider. 7 With any health care provider. 8 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 9 Percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, rainwater collection, or bottled water. 10 Percentage of de jure population whose household has a flush toilet, ventilated improved pit latrine, pit latrine with a slab, or composting toilet and does not share this facility with other households. xvi • Map of Jordan Introduction • 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY ordan, one of the most modern countries in the Middle East, was part of the Ottoman Empire until the end of World War I. It was declared a political entity known as Transjordan under the mandate of the British government in 1923, until it gained independence and was declared a kingdom in 1946. In 1950, Transjordan and the West Bank were united and assumed the current name of the Hashemite Kingdom of Jordan. The next major change for the kingdom came in 1967, when the occupation of the West Bank and Gaza Strip by Israeli forces caused a massive wave of migrants to flow into the East Bank. Two decades later, in accordance with the desires of the Arab states and the Palestinian National Authority, the West Bank was administratively disengaged from the kingdom in order to facilitate the establishment of the Palestinian state. Geographically, Jordan is almost entirely landlocked. The port of Aqaba in the far south is Jordan’s only outlet to the sea, as Palestine and Israel separate Jordan from the Mediterranean. Saudi Arabia lies to the south and east, Iraq to the northeast, and Syria to the north. Three climatic zones characterize Jordan, running from the west to the east of the country. These include the Jordan Valley, which is largely below sea level and considered semitropical; the highlands east of the Jordan Valley, which range in elevation from 100 to 1,500 meters above sea level, and can be considered to have a Mediterranean climate; and the low-lying desert to the east of the highlands. The total area of Jordan is about 89,000 square kilometers, of which over 80 percent is characterized by semidesert conditions; however, there do exist some wetlands, including the Azraq Basin. Administratively, the country is divided into 12 governorates, which are then grouped into three regions—the North region (Irbid, Jarash, Ajloun, and Mafraq), the Central region (Amman, Zarqa, Balqa, and Madaba), and the South region (Karak, Tafielah, Ma’an, and Aqaba). The major cities are Amman (the capital), Zarqa, and Irbid. With regard to the economy, the Jordanian government still controls most community services; however, Jordan is moving towards a free market economy. There has been a slight shift in the economic sectoral shares of gross domestic product (GDP) in the last two decades. The share of agriculture in GDP at constant prices dropped from 7 percent in 1992 to 3 percent in 2002, and remained at 3 percent in 2012. The contribution of wholesale and retail trade, restaurants, and hotels to the GDP has not changed J Key Findings • The 2012 Jordan Population and Family Health Survey (JPFHS) is a nationally representative survey of 15,190 households and 11,352 ever- married women age 15-49. • The 2012 JPFHS is the sixth comprehensive survey conducted in Jordan as part of the worldwide Demographic and Health Surveys project. • The primary purpose of the JPFHS is to furnish policymakers and planners with detailed information on fertility and family planning; infant and child mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. • In two-thirds of the selected households, women age 15-49 and children age 6-59 months were weighed and measured and tested for anemia. 2 • Introduction significantly; these sectors made up 9 percent of GDP in 1992 and 10 percent in 2012. There was a concomitant rise in the share of the manufacturing sector, from 12 percent in 1992 to 16 percent in 2002 and 17 percent in 2012. The share of the community and personal services sector also rose slightly during this period, from 2 percent in 1992 to 4 percent in 2012. The contribution of the transportation, storage, and communication sector to the GDP has changed little over the past 20 years, rising about 2 percentage points between 1992 and 2002, and was 15 percent in 2012 (Department of Statistics [DoS], 2013a). The GDP per capita at current prices has risen steadily over time from US$ 1,381 in 1992 to US$ 1,880 in 2002, to an average of US$ 4,850 in 2012. The cost of living index increased, by 20 percent between 1992 and 1997, 8 percent between 1997 and 2002, and 36 percent between 2006 and 2012. The balance of trade deficit rose sharply, by 72 percent between 1990 and 1996, but declined by 14 percent between 1997 and 2001. While the deficit rose by 86 percent between 2002 and 2004 and remained stable between 2006 and 2012, it reached about 30 percent between 2004 and 2006. The rate of economic growth at constant prices has increased steadily over time: growth was 3.3 percent in 1997, 5.8 percent in 2002, 8.1 percent in 2006, and 2.7 percent in 2012 (DoS, 2013a). To restructure economic activities in the country, the government began a reformation program in the early 1990s. Since the mid-1990s, the government has actively encouraged the privatization of certain community services as part of the program, and in 2000 issued the Privatization Act No. 25 to establish the legal and institutional framework for privatization in Jordan. The government has launched the process of integration and consolidation in the world economy by joining the World Trade Organization, signing a free trade agreement with the United States, a partnership agreement with the European Union, the Greater Arab Free Trade Agreement, and the Qualified Industrial Zones Agreement. The government has also established several development areas, such as the Aqaba Special Economic Zone Authority. The government has launched initiatives to fairly distribute the earnings generated from the progress made in the economic sector among all citizens through the Socioeconomic Transition Program, the E-government Initiative, the National Agenda, and the All of Us: the Jordan Initiative. Private local and foreign investments have significantly increased, reaching levels never previously achieved, as a result of continued implementation of privatization programs and a healthy environment for investment. The government, in response to the directives of His Majesty, the King of Jordan, has expanded the provision of decent housing for tens of thousands of poor and low-income households. 1.2 POPULATION The first comprehensive population census in Jordan was carried out in 1961. The population then totaled 901,000 (Table 1.1). As a result of the Arab-Israeli wars in 1948 and 1967, and the subsequent Israeli occupation of the West Bank and the Gaza Strip, a large number of Palestinians moved into the East Bank. In 1979, the population of Jordan numbered 2.1 million; it nearly doubled to 4.1 million by 1994. According to the 2004 census, the population was 5.1 million, while it is estimated to have reached 6.3 million in 2012 (DoS, 2013b). Table 1.1 Basic demographic indicators Demographic indicators from selected sources, Jordan Indicators 1961 census 1979 census 1994 census 2004 census 2012 estimates Population (millions) 0.9 2.1 4.1 5.1 6.3 Intercensal growth rate (percent) u 4.8 4.4 2.6 2.2 Density (population/km2) 10.1 24 46.6 60.3 71.9 Percent urban 59.1 70.0 78.7 82.6 82.6 Life expectancy (years) u u 69.3 71.5 73.0 Male u u 68.5 70.6 71.6 Female u u 69.2 72.4 74.1 Source: Department of Statistics, 1997; Department of Statistics, 2006; Department of Statistics, 2013a; Department of Statistics, 2013b. u = No information Introduction • 3 Population growth averaged 4.8 percent during the period 1961-1979, 4.4 percent between 1979 and 1994, 2.6 percent between 1994 and 2004, and 2.2 percent between 2004 and 2012 (DoS, 2013b). 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, and 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 increase in the population has created several problems for the country—namely, shortages in food, water, housing and employment opportunities, as well as placing a heavy burden on the education system, health services, and urban infrastructure. Fertility declines in Jordan have contributed to a slowing down in the population growth rate from 3.2 percent in the second half of the 1990s, to 2.3 percent in 2007, and to 2.2 percent in 2012. The average size of private households decreased from 6.7 persons in 1979 to 6.0 persons in 1994 and to 5.4 persons in 2004. In 2012, the average is estimated at about 5.2 persons (DoS, 2013b). Urbanization is particularly important in Jordan. Historically, rural-to-urban migration, as well as immigration, has contributed to rapid urban growth. The recent international crises in Iraq and Syria have also impacted urban growth in Jordan. The percentage of the population living in urban areas increased by 13 percent between 1979 and 1994, reaching 83 percent in 2004 and remaining there in 2012, about a 5 percent increase compared to 1994. In 1994, the life expectancy was 69 years for males and females. This increased to 71 years for males and 72 years for females in 2004. In 2012, the estimated life expectancy was 72 years for males and 74 years for females (DoS, 2013b). 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMS Until the 1990s, Jordan had no explicit and official population policy. In 1973, the National Population Commission (NPC) was established, with the mandate to formulate and implement a national population policy and to address all population-related activities. However, the designing of a satisfactory population policy was controversial and, due to its sensitive nature, the NPC took no specific actions. The commission was revitalized in the late 1980s to backstop several agencies working in the population field. From that period until 1993, both public and private sectors made clear efforts to provide family planning services. The Ministry of Health (MoH), through its Mother and Child Health Centers (MCH) located in the governorates, provided optional and predominantly free family planning services as an unofficial and indirect intervention. 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 a proposed population policy was taken in 1993, when the NPC adopted the National Birth Spacing Program, in an effort to promote better maternal and child health and to reduce fertility through advocating increased birth intervals. This program was discussed nationwide and, in 1993, the government approved the program as an official population policy, taking into consideration the religious, social, national, and free-choice dimensions of Jordanian society. The NPC created the National Population Strategy for Jordan, which was approved by the cabinet in 1996 and was updated in 2000 in the light of regional and international recommendations and national surveys. The strategy document comprised four main dimensions—namely, reproductive health, population and sustainable development, gender equality and equity and empowerment of women, and population and enhancing advocacy (Higher Population Council, 2013). This updated strategy was activated by the establishment of the Higher Population Council (HPC) at the beginning of 2002, designed to face the population and development challenges and follow up on the implementation of the work plan. This council is headed by the Prime Minister and is comprised of several ministers, in addition to relevant members from both the public and private sectors. The HPC continues the work of the NPC, as it is the higher authority commissioned with proposing and formulating national 4 • Introduction population policies, following up, presenting, updating, and providing the supporting environment for achieving its objectives. This is 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 enhances advocacy in these areas. The HPC collaborates and coordinates with regional and international bodies interested in population issues, in addition to building national capacities for officials working in these areas in different institutions. 1.4 HEALTH PRIORITIES AND PROGRAMS The Ministry of Health (MoH) is responsible for all health matters in the Hashemite Kingdom of Jordan according to the Public Health Law No. 47 of 2008. Its tasks include the provision of primary health care services (preventive health services) and secondary and tertiary health care services. Additionally, the MoH organizes health services provided by the public and private sectors, provides health insurance for Jordanian citizens, and establishes educational and health training institutes to support the health sector with graduates specialized in medical occupations. In light of the challenges facing the health sector, the MoH has prepared a National Health Strategy for the years 2008-2012 and the years 2013-2017, in line with the comprehensive development goals stated in the National Agenda Document (MoH, 2013). Executive plans, programs, and policies from these strategy documents mainly focus on the following areas: • Primary Healthcare The main goals include enhancement of healthy lifestyle patterns (such as physical activity, tobacco prevention, and following safe nutrition habits), 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 sexually transmitted infections; strengthening diseases and epidemics monitoring systems, setting up programs for screening for 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 MoH hospitals located in the governorates and districts provide basic curative health 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 in child mortality and maternal mortality rates and increases in the life expectancy at birth for both sexes. Introduction • 5 • Monitoring and Control The MoH monitors health professionals and other health institutions in the public and private sectors and participates in the drafting of laws and regulations related to clinics, hospitals, and medical laboratories with the aim of supervising, evaluating and developing the quality of these services. • 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 GDP. Per capita health expenditures were 250 Jordanian dinars (JD) (US$ 350) in 2012, 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 also increased in Jordan. 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 MoH will enhance the benefit from available knowledge assets such as 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, comprehensive health centers 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) in Jordan conducted in 1990, 1997, 2002, 2007, and 2009, the primary objective of the 2012 Jordan Population and Family Health Survey (JPFHS) is to provide reliable estimates of demographic parameters, such as fertility, mortality, family planning, and fertility preferences, as well as maternal and child health and nutrition, that can be used by program managers and policymakers to evaluate and improve existing programs. 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 2012 JPFHS was significantly expanded from the 2007 and 2009 surveys to include additional questions on women’s status, reproductive health, domestic violence, early childhood development, and child discipline. 1.6 METHODOLOGY AND ORGANIZATION OF THE SURVEY The 2012 JPFHS was designed to collect data on ever-married women of reproductive age (age 15-49). The areas covered include demographic and socioeconomic characteristics, reproduction, family planning, maternal health care, breastfeeding and child health care, marriage and employment, fertility preferences, nutritional status of children under age 5, knowledge of acquired immune deficiency 6 • Introduction syndrome (AIDS) and sexually transmitted infections (STIs), domestic violence, early childhood development, and child discipline. The survey was implemented by the Department of Statistics (DoS) and funded by the Jordanian government and the U.S. Agency for International Development (USAID). Additional funding was provided by UNFPA and UNICEF. ICF International provided technical assistance, through the global Demographic and Health Surveys (DHS) program, in sample and questionnaire design, training activities, computer processing of survey data, and preparation of reports. A national technical committee was established to provide guidelines for the planning and implementation stages of the survey. The committee consisted of representatives from various government and non-government agencies involved in population and health issues. The survey was executed in three stages; the first was the preparatory stage, which involved sample design, mapping, listing of households, and implementation of sampling procedures. At the same time, the survey questionnaires and instruction manuals were developed, pretested, and finalized. All of these activities were completed by August 2012. The second stage encompassed interviewing and the collection of data, while the third stage involved office editing of questionnaires, coding of open-ended questions, ensuring data completion and data consistency, data processing operations, final editing, and verification of data accuracy and consistency. 1.6.1 Sample Design The 2012 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 for the two special domains: the Badia areas and people living in refugee camps. To facilitate comparisons with previous surveys, the sample was also designed to produce estimates for the three regions (North, Central, and South). The grouping of the governorates into regions is as follows: the North consists of Irbid, Jarash, Ajloun, and Mafraq governorates; the Central region consists of Amman, Madaba, Balqa, and Zarqa governorates; and the South region consists of Karak, Tafiela, Ma’an, and Aqaba governorates. The 2012 JPFHS sample was selected from the 2004 Jordan Population and Housing Census sampling frame. The frame excludes the population living in remote areas (most of whom are nomads), as well as those living in collective housing units such as hotels, hospitals, work camps, prisons, and the like. For the 2004 census, the country was subdivided into convenient area units called census blocks. For the purposes of the household surveys, the census blocks were regrouped to form a general statistical unit of moderate size (30 households or more), called a “cluster”, which is widely used in surveys as a primary sampling unit (PSU). Stratification was achieved by first separating each governorate into urban and rural areas and then, within each urban and rural area, by Badia areas, refugee camps, and other. A two-stage sampling procedure was employed. In the first stage, 806 clusters were selected with probability proportional to the cluster size, that is, the number of residential households counted in the 2004 census. A household listing operation was then carried out in all of the selected clusters, and the resulting lists of households served as the sampling frame for the selection of households in the second stage. In the second stage of selection, a fixed number of 20 households was selected in each cluster with an equal probability systematic selection. A subsample of two-thirds of the selected households was identified for anthropometry measurements. 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 clusters were selected and then identified and located in the field. The selected clusters were delineated and the outer boundaries were mapped. During this process, the numbers on buildings and housing units were updated, Introduction • 7 listed, and documented, along with the name of the household head. These activities were completed during the second quarter of 2012. 1.6.3 Questionnaires The 2012 JPFHS used two questionnaires, namely the Household Questionnaire and the Woman’s Questionnaire (see Appendix D). The Household Questionnaire was used to list all usual members of the sampled households, and visitors who slept in the household the night before the interview, and to obtain information on each household member’s age, sex, educational attainment, relationship to the head of the household, and marital status. In addition, questions were included on the socioeconomic characteristics of the household, such as source of water, sanitation facilities, and the availability of durable goods. Moreover, the questionnaire included questions about child discipline. The Household Questionnaire was also used to identify women who were eligible for the individual interview (ever-married women age 15- 49 years). In addition, all women age 15-49 and children under age 5 living in the subsample of households were eligible for height and weight measurement and anemia testing. The Woman’s Questionnaire was administered to ever-married women age 15-49 and collected information on the following topics: • Respondent’s background characteristics • Birth history • Knowledge, attitudes, and practice of family planning and exposure to family planning messages • Maternal health (antenatal, delivery, and postnatal care) • Immunization and health of children under age 5 • Breastfeeding and infant feeding practices • Marriage and husband’s background characteristics • Fertility preferences • Respondent’s employment • Knowledge of AIDS and sexually transmitted infections (STIs) • Other health issues specific to women • Early childhood development • Domestic violence In addition, information on births, pregnancies, and contraceptive use and discontinuation during the five years prior to the survey was collected using a monthly calendar. The Household and Woman’s Questionnaires were based on the model questionnaires developed by the MEASURE DHS program. Additions and modifications to the model questionnaires were made in order to provide detailed information specific to Jordan. The questionnaires were then translated into Arabic. Anthropometric data were collected during the 2012 JPFHS in a subsample of two-thirds of the selected households in each cluster. All women age 15-49 and children age 0-4 in these households were measured for height using Shorr height boards and for weight using electronic Seca scales. In addition, a drop of capillary blood was taken from these women and children in the field to measure 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 specific 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 8 • Introduction the many surveys as well as those who took part in other demographic surveys conducted by the DoS, especially the 2007 and 2009 JPFHS. The interviewers were all highly qualified women. Supervisors and field editors were selected from the DoS permanent staff or from those with experience in such surveys. 1.6.5 Pretest and Training Training of the interviewers for the pretest and main fieldwork survey took place in Amman in two phases—July 26 to August 16, 2012, and August 26 to September 2, 2012—for four weeks. The training course consisted of instructions on interviewing techniques and field procedures, a detailed review of the questionnaires, instruction and practice in weighing and measuring children and women, anemia testing, mock interviews between participants in the classroom, and practice interviews. Field practice in anemia testing was also carried out by persons who were assigned as team health technicians. In addition, team members practiced their ability to weigh and measure women and children in health centers affiliated with the Ministry of Health (Amman Comprehensive Health Center, Abu Nsair Comprehensive Health Center, and Sahab Comprehensive Health Center). Prior to the start of fieldwork, the questionnaires were pretested to make sure that the translation into Arabic were clear and could be understood by the respondents. The pretest fieldwork was conducted over a period of one week from September 2 to September 6 in three urban and one rural cluster not selected for the main survey. Following the completion of pretest, debriefing sessions were held with the field staff and modifications to the questionnaires and instructions were made based on lessons drawn from the exercise. 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. 1.6.6 Main Fieldwork The fieldwork was organized 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 26 field teams, each made up of one supervisor, one field editor, one biomarker technician, and three to four interviewers; two field coordinators supervised the 26 teams. During field work, these teams were combined or reformulated as necessary. Fieldwork was carried out between 9 September and 20 December, 2012. To facilitate data collection, each interviewing team was assigned a number of clusters in the sample area. Each field supervisor, in collaboration with the field coordinator, divided his team so as to ensure that all adjacent sampled households were completed by one interviewer. To ensure good data quality, interviewers were asked to conduct fewer interviews during the first three days of data collection; the completed questionnaires were then checked by the field editor and the supervisor to ensure completeness and consistency of data. Under the supervision of the survey director and field coordinators, the field editor and the supervisor conducted spot checks by randomly visiting some sampled households and reinterviewing respondents with the household schedule. The original questionnaires were then matched to the reinterview questionnaires, and any differences were discussed with the interviewer and reconciled where necessary. Interviewers made at least three call backs to attempt to successfully complete the interview of eligible women. Once a cluster was finished, the questionnaires were delivered to the DoS central office in Amman for processing. 1.6.7 Data Processing Fieldwork and data processing activities overlapped. Data processing began two weeks after the start of the fieldwork. 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. Introduction • 9 Data entry and verification started after two weeks of office data processing. The process of data entry, including 100 percent reentry, editing, and cleaning, was done by using PCs and the CSPro (Census and Survey Processing) computer package, developed specially for such surveys. The CSPro program allows data to be edited while being entered. Data processing operations were completed by early January 2013. A data processing specialist from ICF International made a trip to Jordan in February 2013 to follow up on data editing and cleaning and to work on the tabulation of results for the survey preliminary report, which was published in March 2013. The tabulations for this report were completed in April 2013. 1.7 RESULTS OF THE HOUSEHOLD AND INDIVIDUAL INTERVIEWS Table 1.2 is a summary of the results from both the household and the individual interviews. In all, 16,120 households were selected for the survey and, of these, 15,722 were found to be occupied households. Of these households, 15,190 (97 percent) were successfully interviewed. In the households interviewed, 11,673 ever-married women age 15-49 were identified and interviews were completed with 11,352 women, or 97 percent of all eligible women. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Jordan 2012 Result Residence Total Urban Rural Household interviews Households selected 11,480 4,640 16,120 Households occupied 11,161 4,561 15,722 Households interviewed 10,727 4,463 15,190 Household response rate (HRR)1 96.1 97.9 96.6 Interviews with women age 15-49 Number of eligible women 8,296 3,377 11,673 Number of eligible women interviewed 8,034 3,318 11,352 Eligible women response rate2 96.8 98.3 97.3 Overall women response rate (EWRR)3 93.1 96.1 94.0 1 Households interviewed/households occupied. 2 Respondents interviewed/eligible respondents. 3 HRR * EWRR/100. Household Characteristics • 11 HOUSEHOLD CHARACTERISTICS 2 his chapter provides an overview of socioeconomic characteristics of the household population, including housing facilities and characteristics, sources of drinking water, sanitation facilities, availability of electricity, and possession of household durable goods. Information on household assets is used to create an indicator of household economic status—the wealth index. This chapter also describes the demographic characteristics of the household population, including age, sex, educational attainment, and employment status. In the 2012 Jordan Population and Family Health Survey (JPFHS), information was collected about all usual residents of a selected household (de jure population) as well as persons who stayed in the selected household the night before the interview (de facto population). The difference between these two populations is very small, and all tables in this report refer to the de facto population, unless otherwise specified, to maintain comparability with other JPFHS reports. 2.1 HOUSING CHARACTERISTICS Water and Sanitation Access to safe water and sanitation are basic determinants of better health. Limited access to safe drinking water and sanitation facilities and poor hygiene are associated with acute respiratory infections (ARIs) and diarrheal diseases. Table 2.1 presents information on household drinking water by urban-rural residence. Access to an improved source of drinking water is universal in Jordan (99 percent). The table also indicates that 49 percent of households in urban areas use piped water compared with 52 percent in rural areas. Five percent of households in urban areas use rainwater compared with 13 percent of households in rural areas. About half of urban households (46 percent) and 31 percent of rural households use bottled water for drinking. Overall, all households in urban areas, compared with 96 percent in rural areas, use an improved source of water for drinking. Some households treat their water to make it safe for drinking. The table indicates that 1 percent of households in urban areas and 2 percent in rural areas boil water, whereas 25 percent of households in urban areas and 15 percent in rural areas use water filters for water purification. Nationally, 25 percent of households use an appropriate water treatment method. Rural households are much less likely than urban households to treat their water appropriately (17 percent and 26 percent, respectively). Table 2.2 shows that almost all households in Jordan have a private flush toilet, with little variation by place of residence. T Key Findings • Access to safe drinking water is universal in Jordan (99 percent). • Almost all households in Jordan have a private flush toilet, with little variation by place of residence. • More than half of households in Jordan own a private car or truck. • Fifty-eight percent of households are exposed daily to secondhand smoke. • A large proportion of the Jordanian population (36 percent) is under age 15. • Thirteen percent of households are female-headed. • Ninety-nine percent of births in Jordan are registered. 12 • Household Characteristics Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water and treatment of drinking water, according to residence, Jordan 2012 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 99.5 96.2 98.9 99.4 95.9 98.8 Piped into dwelling 48.9 51.7 49.4 52.3 53.7 52.5 Piped to yard/plot 0.1 0.7 0.2 0.2 0.7 0.3 Rainwater 4.8 13.1 6.2 4.8 12.2 6.1 Bottled water 45.6 30.7 43.1 42.2 29.3 39.9 Non-improved source 0.5 3.8 1.1 0.6 4.1 1.2 Unprotected spring 0.2 1.9 0.4 0.2 1.8 0.5 Tanker truck 0.4 1.9 0.6 0.4 2.3 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 1.1 1.6 1.2 1.0 1.6 1.1 Bleach/chlorine added 0.4 0.2 0.3 0.4 0.2 0.4 Water filter 24.9 15.0 23.3 26.4 16.1 24.6 Other 0.1 0.1 0.1 0.1 0.1 0.1 No treatment 73.5 83.2 75.1 72.0 82.1 73.8 Percentage using an appropriate treatment method2 26.4 16.7 24.8 27.9 17.8 26.1 Number 12,660 2,530 15,190 63,281 13,640 76,920 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Jordan 2012 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 99.8 99.5 99.7 99.7 99.6 99.7 Flush/pour flush to piped sewer system 71.3 4.8 60.2 68.5 4.9 57.2 Flush/pour flush to pit latrine 28.4 94.1 39.3 31.1 94.2 42.3 Ventilated improved pit (VIP) latrine 0.0 0.4 0.1 0.0 0.3 0.1 Pit latrine with slab 0.0 0.2 0.1 0.0 0.2 0.1 Shared facility1 0.2 0.4 0.2 0.2 0.3 0.3 Non-improved facility 0.0 0.1 0.0 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 12,660 2,530 15,190 63,281 13,640 76,920 1 Facilities that would be considered improved if they were not shared by two or more households. Housing Characteristics In the 2012 JPFHS, information on housing characteristics was collected in the household questionnaire. Table 2.3 indicates that more than three-quarters of housing units (77 percent) in urban areas are apartments, compared with more than one-third (35 percent) in rural areas. Dars, which are homes that are built with an enclosed central courtyard, form 64 percent of the dwellings in rural areas, compared with only 21 percent in urban areas. In general, 99 percent of all housing units in Jordan are either apartments or dars. Table 2.3 indicates that access to electricity is universal in Jordan (100 percent), with no difference by place of residence. Household Characteristics • 13 Table 2.3 shows that the vast majority (79 percent) of households in Jordan have tile flooring, with urban areas slightly less likely than rural households to have tile flooring (78 and 85 percent, respectively). On the other hand, urban households are more than twice as likely (18 percent) as rural households (7 percent) to have marble or ceramic tile flooring. Cement flooring is much more common in rural than urban households. The table also indicates that three-quarters of dwellings have walls built from cement bricks and about one in five dwellings have walls built from cut stone or cut stone and concrete (22 percent). Walls of dwellings are more likely to be built from cement bricks in rural areas than in urban areas (87 and 73 percent, respectively). Conversely, dwellings in urban areas are more likely to be built from cut stone or cut stone and concrete than those in rural areas (25 percent versus 8 percent). Almost all households in Jordan have concrete roofs (99 percent). More than two-fifths of housing units (41 percent) have two or three rooms and more than one in two (51 percent) have four or five rooms, with 6 percent having six or more rooms; only 2 percent of housing units consist of one room. There are only slight differences in the number of rooms in a housing unit by place of residence. As for rooms used for sleeping, one in five housing units (23 percent) has one sleeping room, more than two-fifths (41 percent) have two, and about one-third (36 percent) have three sleeping rooms, with slight differences by place of residence. The data also indicate that almost all households in Jordan have a separate room used as a kitchen (99 percent) and a separate bathroom (99 percent). In addition, nearly all households use natural gas for cooking regardless of the place of residence. Information on smoking was collected in the 2012 JPFHS to assess the percentage of household members who are exposed to secondhand smoke (SHS), which is a risk factor for those who do not smoke. Pregnant women who are exposed to SHS have a higher risk of giving birth to a low birth weight baby (Windham et al., 1999). Also, children who are exposed to SHS are at a higher risk of respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). Table 2.3 provides information on the frequency of smoking in the home, which is used as a proxy for level of SHS exposure. Overall, 58 percent of households are exposed daily to SHS, with small differences by place of residence. 14 • Household Characteristics Table 2.3 Household characteristics Percent distribution of households by housing characteristics and frequency of smoking in the home, according to residence, Jordan 2012 Housing characteristic Residence Total Urban Rural Type of housing unit Apartment 77.3 35.0 70.3 Dar 21.1 64.2 28.2 Villa 1.6 0.8 1.5 Hut/barrack 0.0 0.1 0.0 Total 100.0 100.0 100.0 Electricity Yes 99.5 99.4 99.5 No 0.5 0.6 0.5 Total 100.0 100.0 100.0 Flooring material Earth 0.0 0.2 0.1 Parquet or polished wood 0.1 0.2 0.1 Tile 77.5 84.6 78.7 Marble/ceramic tile 18.4 7.4 16.6 Cement 3.9 7.6 4.5 Total 100.0 100.0 100.0 Main wall material Cement bricks 72.5 86.7 74.9 Cut stone 20.5 5.3 18.0 Cut stone and concrete 4.6 2.8 4.3 Concrete 2.1 4.6 2.5 Other 0.3 0.7 0.4 Total 100.0 100.0 100.0 Main roof material Concrete 99.0 98.9 99.0 Other 1.0 1.1 1.0 Total 100.0 100.0 100.0 Rooms in the house 1 1.6 1.5 1.6 2 10.4 10.4 10.4 3 30.9 29.1 30.6 4 30.2 34.1 30.9 5 20.7 17.6 20.2 6 or more 6.1 7.3 6.3 Total 100.0 100.0 100.0 Rooms used for sleeping 1 22.4 24.6 22.8 2 41.1 40.1 40.9 3 or more 36.5 35.3 36.3 Total 100.0 100.0 100.0 Has separate bathroom Yes 99.5 98.7 99.4 No 0.5 1.3 0.6 Total 100.0 100.0 100.0 Has separate room used as kitchen Yes 99.3 98.4 99.2 No 0.7 1.6 0.8 Total 100.0 100.0 100.0 Cooking fuel Natural gas 99.9 99.6 99.8 Other 0.1 0.4 0.2 Total 100.0 100.0 100.0 Frequency of smoking in the home Daily 57.3 58.2 57.5 Weekly 2.2 1.6 2.1 Monthly 0.6 0.4 0.5 Less than monthly 0.2 0.2 0.2 Never 39.7 39.6 39.7 Total 100.0 100.0 100.0 Number 12,660 2,530 15,190 Household Characteristics • 15 Household Possessions Jordan is a modern society, and most of the population enjoys the convenience of electrical appliances. Table 2.4 indicates that almost all households have a television, a refrigerator, a washing machine, and a satellite. Table 2.4 Household possessions Percentage of households possessing various household effects and means of transportation, by residence, Jordan 2012 Possession Residence Total Urban Rural Household effects Bed or sofa bed 84.6 70.1 82.2 Radio 39.1 27.8 37.3 Television 99.2 98.3 99.1 Mobile telephone 98.6 97.8 98.4 Land telephone 21.7 9.5 19.7 Refrigerator 98.4 97.8 98.3 Satellite 98.7 97.4 98.5 Freezer 18.0 10.2 16.7 Washing machine 97.7 96.3 97.4 Dishwasher 2.2 0.6 1.9 Solar heater 15.7 8.6 14.5 Air conditioner 28.1 15.9 26.1 Fan 93.3 90.0 92.7 Water cooler 45.9 25.2 42.4 Microwave 52.7 33.2 49.4 Digital camera 12.7 5.0 11.4 Computer 59.1 44.1 56.6 Internet access at home 44.7 32.1 42.6 Credit card 9.8 2.8 8.6 Means of transport Car/truck 51.6 54.1 52.0 Number 12,660 2,530 15,190 As further testament to the level of development in Jordan, possession of mobile phones has increased from 90 percent of households in 2007 to 98 percent in 2012. The data also indicate that 57 percent of households own a computer, and four out of ten households (43 percent) have Internet access at home. The possession of computer-related assets varies considerably between urban and rural areas; urban households are more likely to own a computer than rural households (59 and 44 percent, respectively). Moreover, 45 percent of urban households have access to the Internet at home compared with 32 percent of rural households. Fifteen percent of households have a solar heater. About one-quarter of households own an air conditioner, with marked differences between urban and rural households (28 and 16 percent, respectively). Eight in ten households possess beds or a sofa bed for sleeping, with significant variations by urban-rural residence (85 percent for urban areas compared with 70 percent in rural areas). Households in urban areas are also more likely to have a water cooler (46 percent), a microwave (53 percent), and a digital camera (13 percent) than those in rural areas (25 percent, 33 percent, and 5 percent, respectively); urban households are also more likely to have a credit card than rural households (10 versus 3 percent). Of further interest is the fact that more than half of households in Jordan own a private car or truck. 16 • Household Characteristics 2.2 HOUSEHOLD WEALTH One of the background characteristics used for analysis in this report is the household wealth index. The data required for calculating this index include household assets and property, and the index is used to represent the relative wealth of surveyed households. The household wealth index was developed and has been used in several countries to demonstrate the unequal distribution of income, use of health services, and health outcomes (Rutstein, 1999). The wealth index is constructed using household assets, such as the ownership of a television or a private car, as well as dwelling characteristics, such as source of drinking water; type of toilet; type of floor, wall, and roof; and other household characteristics. Each asset is assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores are standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household is then assigned a score for each asset and the scores are summed for each household; individuals are ranked according to the score of the household in which they reside. The sample is then divided into quintiles from one (lowest) to five (highest). For this report, a single asset index was developed for the whole sample; separate indices were prepared for the urban and rural population. This classification of population by quintiles is used as a background variable in the report to assess the demographic and health outcomes in relation to socioeconomic status. Table 2.5 shows the distribution of the household population according to wealth quintiles, from the lowest to the highest. Urban households are generally wealthier than rural households. Forty- five percent of the population in urban areas fall into either the fourth or the highest wealth quintiles, while six in ten (57 percent) people in rural areas fall into either the lowest or the second quintiles. Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to place of residence, Jordan 2012 Place of residence Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 18.4 18.0 19.0 21.2 23.4 100.0 63,281 0.15 Rural 27.7 29.2 24.6 14.6 3.9 100.0 13,640 0.06 Region Central 17.0 18.1 18.6 21.1 25.1 100.0 47,879 0.12 North 24.1 23.2 22.9 18.1 11.7 100.0 21,640 0.12 South 27.3 22.9 20.7 18.2 10.9 100.0 7,401 0.07 Governorate Amman 14.4 14.6 16.1 20.7 34.2 100.0 29,457 0.16 Balqa 23.4 23.4 18.9 21.3 13.0 100.0 5,446 0.12 Zarqa 19.7 24.1 24.2 22.8 9.3 100.0 10,853 0.13 Madaba 24.0 23.0 23.3 18.5 11.2 100.0 2,123 0.11 Irbid 18.9 20.5 24.6 21.2 14.9 100.0 13,739 0.11 Mafraq 37.4 28.4 17.7 11.0 5.5 100.0 3,882 0.12 Jarash 29.5 26.8 22.9 14.1 6.7 100.0 2,264 0.11 Ajloun 29.0 28.1 21.7 15.0 6.1 100.0 1,755 0.11 Karak 28.7 25.9 20.2 19.1 6.1 100.0 3,189 0.07 Tafiela 29.8 26.0 20.7 16.3 7.1 100.0 1,139 0.10 Ma'an 36.3 24.4 20.7 13.3 5.3 100.0 1,362 0.10 Aqaba 15.8 13.8 21.7 21.8 26.9 100.0 1,710 0.10 Badia Badia 44.0 28.6 17.9 7.0 2.5 100.0 5,001 0.10 Non Badia 18.3 19.4 20.2 20.9 21.2 100.0 71,920 0.14 Camps Camp 40.7 29.3 18.3 9.6 2.0 100.0 2,917 0.13 Non camp 19.2 19.6 20.1 20.4 20.7 100.0 74,003 0.13 Total 20.0 20.0 20.0 20.0 20.0 100.0 76,920 0.10 Household Characteristics • 17 The table also indicates that there is a significant variation in the distribution of the population by governorates according to the wealth index. Whereas more than half of household members in Amman (55 percent) fall into either the fourth or the highest quintiles, more than half of those in Mafraq (66 percent), Ma’an (61 percent), Ajloun (57 percent), Jarash (56 percent), Tafiela (56 percent), and Karak (55 percent) fall in the lowest two quintiles. The data also indicate that about seven in ten people in Badia areas (73 percent) as well as in camps (70 percent) fall in the lowest two quintiles. Variations are also observed regionally, with the South region having the highest percentage of population in the lowest quintile (27 percent) compared with the Central and North regions (17 and 24 percent, respectively) and the lowest percentage in the highest quintile (11 percent) compared with the other two regions (25 and 12 percent, respectively). 2.3 POPULATION BY AGE AND SEX In many developing countries, data on age are affected by errors such as misstatement and preference for or avoidance of certain digits. In general, that was not the case in Jordan. The survey results indicated that for nearly all respondents age, month, and year of birth are recorded. Also, the distribution of the population by single years of age (Figure 2.1 and Appendix Table C.1) indicates that, although there is some preference for ages ending in 0 or 5, digit preference is not severe. Figure 2.1 Male and female population by single year of age, 2012 JPFHS 2012 Table 2.6 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 operate. Thirty-six percent of the population is under age 15, an indicator that fertility remains high. The proportion under age 15 is slightly higher in rural areas (38 percent) than it is in urban areas (35 percent); this relationship holds for those under 20 as well. The opposite is true in the broad age category of age 20-44 (36 percent and 35 percent in urban and rural areas, respectively). 0 200 400 600 800 1000 1200 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Number in the sample Age (in years) Female Male 18 • Household Characteristics Table 2.6 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 2012 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 13.0 11.9 12.4 14.7 12.7 13.7 13.3 12.0 12.6 5-9 12.0 11.7 11.8 13.4 11.9 12.6 12.2 11.7 12.0 10-14 11.6 10.4 11.0 11.8 11.2 11.5 11.6 10.5 11.1 15-19 11.9 11.2 11.6 11.9 11.6 11.8 11.9 11.3 11.6 20-24 10.0 9.5 9.8 8.9 9.1 9.0 9.8 9.5 9.6 25-29 7.6 7.7 7.7 7.1 7.7 7.4 7.5 7.7 7.6 30-34 5.6 6.9 6.3 6.7 7.5 7.1 5.8 7.0 6.4 35-39 5.7 6.6 6.1 5.9 6.7 6.3 5.7 6.6 6.2 40-44 5.7 6.0 5.9 4.8 5.7 5.2 5.5 6.0 5.8 45-49 4.8 4.5 4.7 4.1 4.0 4.1 4.7 4.5 4.6 50-54 3.1 3.9 3.5 2.6 2.8 2.7 3.0 3.7 3.4 55-59 2.5 3.0 2.7 2.1 2.6 2.4 2.4 3.0 2.7 60-64 2.0 2.3 2.2 1.8 2.0 1.9 2.0 2.2 2.1 65-69 1.7 1.5 1.6 1.7 1.8 1.7 1.7 1.5 1.6 70-74 1.3 1.4 1.4 1.1 1.2 1.1 1.3 1.4 1.3 75-79 0.8 0.7 0.8 0.7 0.7 0.7 0.8 0.7 0.8 80 + 0.7 0.7 0.7 0.7 0.9 0.8 0.7 0.7 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 31,283 31,653 62,937 6,680 6,685 13,365 37,963 38,339 76,302 One may note that at the youngest ages in the population pyramid (Figure 2.2): there are more children in the 0-4 and 5-9 age groups than in the 10-14 age group, indicating that the reduced population age 10-14 was the consequence of the fast decline in fertility in the 1990s, while the increased population in the 0-9 age group may be a result of a recent pause in the decline in fertility. Figure 2.2 Population pyramid 8 6 4 2 0 2 4 6 8 <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 JPFHS 2012 8 6 4 2 Household Characteristics • 19 The percentage of the population under age 15 has declined substantially, from 51 percent in 1983 to 36 percent in 2012, 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 5 for more discussion on fertility in Jordan). The change in the age structure is favorable in economic terms. The dependency ratio, calculated as the ratio of persons in the “dependent” ages (under 15 and 60 and over) to those in the working-age category (15-59) on the basis of those figures, fell from 122 in 1983 to 73 in 2012. Figure 2.3 Population by broad age groups, various surveys, 1983-2012 According to results from the 2012 JPFHS, there are more females than males in Jordan, with an overall sex ratio of 99 males for 100 females. The sex ratio varies by age: from 105 among those under age 30 to 87 in the middle age group (30-59) and about 98 among those age 60 and above. 2.4 HOUSEHOLD COMPOSITION Household characteristics affect the social and economic well-being of the members of the household. Large household sizes may be associated with crowding, which can lead to unfavorable health conditions. Single-parent families, especially if they are headed by females, usually have limited financial resources. Table 2.7 shows that the average number of members in a household is 5.1. Household size is smaller in urban areas (5.0) than in rural areas (5.4). Seven percent of households, on average, are composed of nine or more persons. The figure is higher in rural areas (10 percent) than in urban areas (7 percent). The table shows that 13 percent of households in urban areas are headed by females, compared with 12 percent in rural areas. The table also shows that about 1 percent of households have at least one child under age 18 who doesn’t live with both parents. A very low percentage of households (0.1 percent) include double orphans (both parents deceased), while 3 percent include single orphans (one parent deceased). However, there are no significant differences among households with single orphans according to urban-rural residence. 51 44 41 40 38 37 36 45 52 54 55 56 57 58 4 4 5 6 6 6 6 0 10 20 30 40 50 60 70 1983 JFFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 JPFHS 2012 JPFHS Percentage Age groups 0-14 15-59 60+ 20 • Household Characteristics Table 2.7 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 years of age, according to residence, Jordan 2012 Characteristic Residence Total Urban Rural Household headship Male 86.9 88.1 87.1 Female 13.1 11.9 12.9 Total 100.0 100.0 100.0 Number of usual members 1 4.4 4.3 4.3 2 11.2 10.2 11.0 3 12.2 10.6 12.0 4 16.1 12.6 15.5 5 16.0 15.4 15.9 6 14.8 14.2 14.7 7 11.3 13.0 11.6 8 7.2 10.1 7.7 9+ 6.6 9.7 7.1 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 1.3 1.2 1.3 Double orphans 0.1 0.2 0.1 Single orphans2 2.9 2.8 2.9 Foster and/or orphan children 4.0 3.8 3.9 Number of households 12,660 2,530 15,190 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. 2 Includes children with one dead parent and an unknown survival status of the other parent. 2.5 BIRTH REGISTRATION The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; UNGASS, 2002). For the first time in the series of JPFHS surveys, the 2012 JPFHS Household Questionnaire included a question for all children under age 5 as to whether the child had a birth certificate or not. Table 2.8 shows the percentage of children under age 5 whose births were officially registered. The data show that 99 percent of births in Jordan are registered, with birth certificates being shown to interviewers for 47 percent; for 52 percent, a birth certificate was not seen. Only a tiny fraction of births are not registered. The proportion of children whose births are registered is above 97 percent by all background characteristics. Consequently, differentials in birth registration by background characteristics are very minor. Household Characteristics • 21 Table 2.8 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Jordan 2012 Background characteristic Children whose births are registered Number of children Percentage for whom a birth certificate was seen Percentage for whom a birth certificate was not seen Percentage registered Age <2 48.1 49.8 98.0 3,541 2-4 46.1 53.7 99.7 5,796 Sex Male 47.5 51.7 99.3 4,870 Female 46.1 52.7 98.8 4,468 Residence Urban 44.5 54.5 99.0 7,546 Rural 56.9 42.6 99.5 1,792 Region Central 36.8 62.5 99.3 5,665 North 63.9 34.9 98.7 2,751 South 58.0 40.9 98.9 921 Governorate Amman 38.7 60.3 99.0 3,292 Balqa 36.1 63.6 99.7 691 Zarqa 30.3 69.5 99.7 1,407 Madaba 49.4 49.6 99.1 276 Irbid 59.4 39.2 98.6 1,648 Mafraq 73.7 24.8 98.6 558 Jarash 68.4 30.7 99.1 323 Ajloun 65.9 33.7 99.7 223 Karak 53.8 45.3 99.1 399 Tafiela 56.5 41.4 97.9 152 Ma'an 63.3 35.9 99.2 166 Aqaba 63.0 36.0 99.0 204 Badia Badia 65.0 34.0 98.9 748 Non Badia 45.3 53.8 99.1 8,590 Camps Camp 48.1 51.4 99.6 382 Non camp 46.8 52.2 99.0 8,956 Wealth quintile Lowest 47.2 51.1 98.3 2,139 Second 46.9 52.1 99.0 2,032 Middle 48.6 50.9 99.5 1,998 Fourth 43.2 55.8 99.0 1,820 Highest 48.6 51.2 99.8 1,349 Total 46.9 52.2 99.1 9,338 Table 2.9 indicates that the majority of children under age 18 (93 percent) are living with both parents: this proportion is 94 percent for children under age 15. The range is between 96 percent for children age 0-4 and 87 percent for children age 15-17. No variations were noted according to sex, region, or Badia or camp areas, while there are variations in these percentages by governorate (ranging from 89 percent in Ma’an to 96 percent in Tafiela and Ajloun) and urban-rural residence (93 and 95 percent, respectively). The proportion of children under 18 living with both parents tends to increase with wealth before falling at the highest quintile. In addition, 3 percent of children under age 18 have experienced the death of one or both parents. 22 • Household Characteristics Table 2.9 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 2012 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 Percent- age not living with a biolo- gical parent Percent- age with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Total Age 0-4 96.3 2.7 0.4 0.2 0.1 0.2 0.0 0.0 0.0 100.0 0.3 0.6 9,338 <2 96.8 2.9 0.2 0.0 0.0 0.1 0.0 0.0 0.0 100.0 0.2 0.2 3,541 2-4 96.0 2.6 0.6 0.3 0.2 0.3 0.0 0.0 0.0 100.0 0.4 0.8 5,796 5-9 95.0 2.5 1.2 0.8 0.2 0.2 0.1 0.1 0.0 100.0 0.5 1.6 9,070 10-14 91.8 2.2 3.2 1.2 0.9 0.5 0.1 0.0 0.1 100.0 0.7 4.3 8,435 15-17 87.0 3.0 5.2 1.2 1.4 1.7 0.2 0.1 0.2 100.0 2.2 7.2 5,398 Sex Male 93.4 2.6 2.2 0.7 0.5 0.3 0.1 0.0 0.1 100.0 0.5 2.9 16,690 Female 93.0 2.5 2.1 0.9 0.5 0.8 0.1 0.1 0.1 100.0 1.0 2.9 15,550 Residence Urban 92.9 2.7 2.2 0.8 0.6 0.6 0.1 0.1 0.1 100.0 0.8 3.0 26,263 Rural 94.6 1.7 2.2 0.7 0.3 0.4 0.0 0.1 0.1 100.0 0.6 2.7 5,977 Region Central 93.1 2.7 2.2 0.7 0.5 0.5 0.1 0.1 0.1 100.0 0.7 2.9 19,715 North 93.1 2.7 1.7 0.9 0.8 0.5 0.2 0.0 0.1 100.0 0.8 2.8 9,260 South 93.7 1.6 3.0 0.8 0.2 0.6 0.1 0.1 0.0 100.0 0.8 3.4 3,265 Governorate Amman 92.5 3.1 2.3 0.9 0.6 0.5 0.1 0.0 0.0 100.0 0.6 3.1 11,582 Balqa 94.1 1.5 2.5 0.6 0.4 0.5 0.1 0.1 0.1 100.0 0.8 3.2 2,352 Zarqa 94.0 2.2 1.9 0.6 0.2 0.7 0.0 0.2 0.1 100.0 1.1 2.4 4,874 Madaba 94.2 1.9 2.9 0.2 0.4 0.4 0.0 0.0 0.0 100.0 0.5 3.3 906 Irbid 92.8 3.2 1.2 1.1 0.9 0.6 0.2 0.0 0.1 100.0 0.9 2.4 5,633 Mafraq 92.0 2.5 3.0 0.9 0.7 0.5 0.0 0.2 0.1 100.0 0.8 4.1 1,794 Jarash 94.5 1.4 2.0 0.6 0.8 0.4 0.0 0.1 0.2 100.0 0.7 3.1 1,052 Ajloun 96.0 1.0 2.2 0.2 0.3 0.2 0.0 0.1 0.0 100.0 0.4 2.6 780 Karak 95.0 0.9 2.5 0.5 0.1 0.7 0.2 0.2 0.0 100.0 1.0 2.9 1,358 Tafiela 96.0 1.5 1.7 0.3 0.2 0.2 0.1 0.0 0.0 100.0 0.3 2.0 513 Ma'an 89.3 2.2 6.0 1.5 0.2 0.7 0.0 0.1 0.0 100.0 0.8 6.3 627 Aqaba 93.5 2.4 2.1 1.1 0.3 0.5 0.0 0.1 0.0 100.0 0.7 2.6 767 Badia Badia 91.5 3.2 3.3 0.9 0.5 0.4 0.0 0.1 0.1 100.0 0.6 4.0 2,349 Non Badia 93.3 2.5 2.1 0.8 0.5 0.5 0.1 0.1 0.1 100.0 0.8 2.8 29,891 Camps Camp 93.7 2.3 1.7 0.6 0.3 1.0 0.0 0.2 0.0 100.0 1.2 2.3 1,365 Non camp 93.2 2.6 2.2 0.8 0.5 0.5 0.1 0.1 0.1 100.0 0.7 3.0 30,876 Wealth quintile Lowest 90.0 4.1 3.7 0.6 0.6 0.6 0.2 0.1 0.1 100.0 1.0 4.7 7,232 Second 93.3 1.5 2.4 1.1 0.6 0.7 0.1 0.1 0.2 100.0 1.1 3.4 6,767 Middle 94.7 2.7 1.3 0.4 0.2 0.5 0.1 0.0 0.0 100.0 0.7 1.7 6,668 Fourth 95.3 1.6 1.7 0.4 0.6 0.3 0.0 0.0 0.0 100.0 0.3 2.3 6,276 Highest 93.0 2.7 1.4 1.5 0.8 0.5 0.1 0.0 0.0 100.0 0.6 2.3 5,297 Total <18 93.2 2.6 2.2 0.8 0.5 0.5 0.1 0.1 0.1 100.0 0.8 2.9 32,240 Total <15 94.4 2.5 1.5 0.7 0.4 0.3 0.1 0.0 0.0 100.0 0.5 2.1 26,842 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent. Household Characteristics • 23 2.6 EDUCATION OF THE HOUSEHOLD POPULATION Education is an important variable with regard to its association with demographic behavior. Higher education is usually associated with greater knowledge and use of health practices and family planning methods. The education system in Jordan has been in place for a long time. Basic education is free 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 2012 JPFHS, questions on education were asked for persons age 6 and older, to be used to calculate rates of school enrollment as well as overall education levels of the population. Tables 2.10.1 and 2.10.2 present data on educational attainment as reported in the Household Questionnaire. In the 2012 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: 98 percent of males in Jordan have had some schooling, compared with 92 percent of females. More than half of males and females (54 and 52 percent, respectively) have attained secondary education or higher. Overall education levels have continued to increase for both men and women. In 2007 the percentages of men and women who attained secondary education or higher were 50 and 49 percent, respectively; in 2002 they were 46 percent and 43 percent among men and women, respectively, with a narrowing in the gender gap in overall educational attainment. There are variations in educational attainment by urban-rural residence and governorate. For example, educational attainment beyond preparatory school is higher in urban areas than in rural areas. The percentage varies from 38 percent for females in Ma’an to 55 percent in Amman; for males, it ranges from 44 percent in Ma’an to 57 percent in Amman. The difference in educational attainment is quite large between the Badia and non Badia areas. The percentages of women with at least some secondary education are 41 and 53 percent, respectively, and the percentages for men are 44 and 55 percent, respectively. A significant difference was also noted according to camp and non camp areas; the percentages of women who have at least some secondary education are 41 and 53 percent, respectively. Medians presented in Tables 2.10.1 and 2.10.2 indicate an increase in the number of years of schooling as well as a reduction in the gender gap among the younger generations. Overall, men have a slightly longer stay in school than women, with a median of 9.5 years of education, compared with 9.4 for women. The medians have increased from 8.6 for men and 8.0 for women in 2002, to 9.1 for men and 8.8 for women in 2007, and further to 9.5 and 9.4, respectively, in 2012. At age 65 and over, men have an average of six years of schooling, with women having none. However, the male-female gender gap narrows, and by age 40-44 median years of schooling for women and men are identical at 10.7 years. Between ages 15 and 39, women have higher median years of schooling than men, with no gender gap among those age 6-14. 24 • Household Characteristics Table 2.10.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended, according to background characteristics, Jordan 2012 Background characteristic Education Total1 Number Median years completed No education Elementary Preparatory Secondary Higher Don't know, missing Age 6-9 1.5 98.4 0.0 0.0 0.1 0.0 100.0 3,598 1.2 10-14 0.7 59.5 39.7 0.0 0.0 0.0 100.0 4,027 5.5 15-19 0.5 2.1 22.0 54.1 21.3 0.0 100.0 4,332 10.2 20-24 2.3 2.7 6.7 30.4 57.7 0.2 100.0 3,629 13.0 25-29 2.8 5.9 7.3 39.7 44.2 0.2 100.0 2,955 11.5 30-34 3.0 6.0 12.5 39.6 38.8 0.0 100.0 2,693 11.2 35-39 3.1 9.0 13.7 45.0 28.9 0.2 100.0 2,520 10.7 40-44 4.6 9.0 16.4 39.3 30.5 0.2 100.0 2,294 10.7 45-49 5.7 13.5 16.7 35.8 28.3 0.0 100.0 1,707 10.5 50-54 13.0 20.1 18.7 21.1 25.9 1.1 100.0 1,435 8.7 55-59 20.6 25.3 17.4 20.8 15.9 0.0 100.0 1,138 6.8 60-64 37.3 24.8 9.7 11.3 16.9 0.0 100.0 856 4.5 65+ 66.6 16.8 4.6 5.2 6.8 0.0 100.0 1,649 0.0 Residence Urban 6.7 24.8 15.3 27.7 25.4 0.2 100.0 27,152 9.5 Rural 11.7 25.7 14.6 26.8 21.2 0.0 100.0 5,688 8.6 Region Central 6.6 24.8 15.4 28.1 24.9 0.2 100.0 20,583 9.5 North 8.7 24.8 15.0 27.2 24.3 0.0 100.0 9,181 9.2 South 10.3 26.5 14.3 24.9 23.9 0.0 100.0 3,076 8.8 Governorate Amman 6.2 23.6 14.6 28.1 27.2 0.3 100.0 12,986 9.9 Balqa 9.0 26.1 15.5 25.5 23.9 0.0 100.0 2,281 8.9 Zarqa 6.2 27.8 17.6 29.8 18.6 0.0 100.0 4,448 8.8 Madaba 8.7 23.3 14.7 27.8 25.6 0.0 100.0 868 9.6 Irbid 7.4 24.0 14.8 27.9 25.9 0.0 100.0 5,887 9.6 Mafraq 12.4 28.3 15.3 24.7 19.3 0.0 100.0 1,595 8.0 Jarash 9.0 25.8 16.3 27.0 21.9 0.0 100.0 948 8.8 Ajloun 9.7 22.5 14.5 27.3 26.0 0.0 100.0 751 9.6 Karak 10.8 24.4 13.4 25.3 26.1 0.0 100.0 1,338 9.3 Tafiela 9.8 25.6 14.7 23.8 26.1 0.0 100.0 464 9.0 Ma'an 13.6 33.1 15.0 19.7 18.7 0.0 100.0 550 6.6 Aqaba 7.2 26.1 15.2 28.9 22.6 0.0 100.0 724 9.3 Badia Badia 15.1 28.9 15.3 25.4 15.2 0.0 100.0 2,045 7.3 Non Badia 7.0 24.7 15.2 27.7 25.3 0.1 100.0 30,795 9.5 Camps Camp 7.3 31.0 20.3 27.4 13.9 0.0 100.0 1,192 7.8 Non camp 7.6 24.7 15.0 27.6 25.0 0.1 100.0 31,648 9.4 Wealth quintile Lowest 14.3 30.8 20.0 25.5 9.5 0.0 100.0 6,421 6.8 Second 8.8 27.8 16.2 31.0 16.2 0.0 100.0 6,460 8.6 Middle 6.0 26.5 16.7 29.1 21.7 0.0 100.0 6,343 9.1 Fourth 4.8 22.2 13.9 28.0 31.0 0.0 100.0 6,523 10.3 Highest 4.3 18.1 9.7 24.5 42.8 0.6 100.0 7,094 11.2 Total1 7.5 25.0 15.2 27.6 24.6 0.1 100.0 32,840 9.4 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. 1 Total includes one woman missing information on age who is not shown separately. Household Characteristics • 25 Table 2.10.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended, according to background characteristics, Jordan 2012 Background characteristic Education Total Number Median years completed No education Elementary Preparatory Secondary Higher Age 6-9 1.4 98.6 0.0 0.0 0.0 100.0 3,645 1.1 10-14 0.7 59.3 39.6 0.3 0.0 100.0 4,419 5.5 15-19 0.9 4.1 24.2 56.9 13.9 100.0 4,511 9.9 20-24 0.6 3.5 10.8 40.1 45.0 100.0 3,726 11.3 25-29 0.5 4.1 7.7 44.5 43.3 100.0 2,858 11.3 30-34 1.4 8.7 9.8 49.9 30.2 100.0 2,204 10.8 35-39 1.4 9.7 19.2 43.4 26.3 100.0 2,173 10.5 40-44 1.3 10.4 21.2 37.8 29.2 100.0 2,100 10.7 45-49 1.9 7.9 19.5 35.1 35.7 100.0 1,771 11.2 50-54 1.5 16.0 15.6 28.1 38.8 100.0 1,152 11.1 55-59 3.2 17.0 18.9 18.9 41.9 100.0 908 11.3 60-64 6.0 22.9 17.8 21.6 31.7 100.0 757 9.8 65+ 19.7 30.1 11.7 13.8 24.7 100.0 1,702 6.0 Residence Urban 1.9 26.0 17.7 29.6 24.9 100.0 26,434 9.6 Rural 3.9 28.6 16.4 34.3 16.9 100.0 5,493 9.2 Region Central 1.8 25.8 17.6 29.4 25.4 100.0 20,232 9.6 North 2.5 27.1 17.5 31.7 21.1 100.0 8,694 9.4 South 3.8 28.2 16.6 33.1 18.3 100.0 3,001 9.2 Governorate Amman 1.5 24.4 17.3 27.3 29.4 100.0 12,463 9.9 Balqa 2.9 26.4 17.8 31.7 21.2 100.0 2,292 9.4 Zarqa 1.8 29.1 18.5 33.9 16.7 100.0 4,591 9.0 Madaba 3.3 27.6 15.5 30.2 23.4 100.0 885 9.6 Irbid 1.9 25.9 17.2 30.9 24.1 100.0 5,594 9.7 Mafraq 4.3 30.1 18.7 33.9 13.0 100.0 1,535 8.6 Jarash 3.1 29.9 18.3 31.1 17.6 100.0 881 8.8 Ajloun 3.1 27.3 16.9 33.7 19.0 100.0 685 9.4 Karak 4.0 26.2 16.8 33.3 19.8 100.0 1,265 9.5 Tafiela 2.6 27.6 18.3 34.0 17.6 100.0 444 9.2 Ma'an 5.9 33.1 16.5 31.3 13.1 100.0 583 8.0 Aqaba 2.6 28.0 15.2 33.9 20.4 100.0 709 9.6 Badia Badia 6.2 31.8 18.1 33.2 10.8 100.0 1,969 8.2 Non Badia 2.0 26.1 17.4 30.2 24.4 100.0 29,959 9.6 Camps Camp 3.6 34.1 22.2 28.3 11.9 100.0 1,224 7.7 Non camp 2.2 26.1 17.3 30.5 24.0 100.0 30,703 9.6 Wealth quintile Lowest 5.6 34.3 22.6 30.2 7.2 100.0 6,129 7.5 Second 2.4 29.2 21.0 34.8 12.4 100.0 6,335 8.7 Middle 2.1 27.5 17.1 34.0 19.4 100.0 6,467 9.4 Fourth 0.9 24.0 15.9 30.5 28.6 100.0 6,467 10.1 Highest 0.2 17.6 11.0 22.5 48.7 100.0 6,529 11.6 Total 2.2 26.4 17.5 30.4 23.5 100.0 31,927 9.5 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Elementary education corresponds to the first six years of school, preparatory corresponds to the next three years, and secondary to the last three years, for a total of 12 years of schooling. 26 • Household Characteristics Figure 2.4 shows the proportion of the household population age 6-24 attending school, by age and sex. The data reflect the fact that school attendance in Jordan is very high, at almost 98 percent for both sexes among those age 7 through 12. Few differences in attendance are observed between males and females at younger ages (7-13 years). Beyond the age of 13, attendance rates start to decline, especially for males. Nevertheless, the overall rate exceeds 90 percent for both sexes up to age 15. Age 14 marks the beginning of a gender-based divergence in attendance, where 92 percent of males and 96 percent of females are attending school. This gender gap continues through age 21, with 48 percent of females attending school as compared with 38 percent of males. Between age 22 and 24, men are more likely than women to be in school. Figure 2.4 Age-specific attendance rates, 2012 (percentage of the population age 6-24 attending school) 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 Percentage Age Male Female JPFHS 2012 Respondents’ Background Characteristics • 27 RESPONDENTS’ BACKGROUND CHARACTERISTICS 3 his chapter highlights the basic characteristics of ever-married women age 15-49 who were interviewed in the survey. It also presents data on women’s exposure to the mass media, their employment status, and tobacco use. 3.1 GENERAL CHARACTERISTICS Table 3.1 presents the distribution of respondents by background characteristics, including age, marital status, residence, educational level, and household wealth. The distribution of ever-married women shows that, in 2012, less than one-third of ever-married women (31 percent) are under age 30. This represents a decline from 34 percent in 2002 and 32 percent in 2007 and 2009. In contrast, the proportion of ever-married women age 30-49 has increased from 66 percent in 2002 to 68 percent in 2007 and 2009 and to 69 percent in 2012. Among ever-married women, the percent distribution by marital status indicates that 95 percent are currently married; the rest are either divorced or separated (3 percent) or widowed (2 percent). The proportion of those currently married has remained about the same as in 2007 and 2009. Table 3.1 shows that in 2012, 83 percent of ever-married women live in urban areas (defined as localities with a population of 5,000 or more, as stated in the 2004 Population and Housing Census). Almost two in three women live in the Central region (Amman, Zarqa, Balqa, and Madaba), about 28 percent in the North region (Irbid, Mafraq, Jarash, and Ajloun), and only 9 percent live in the South region (Karak, Tafiela, Ma’an, and Aqaba). T Key Findings • The median number of years of education for ever-married women age 15-49 is 10.8 years, with large differences in educational attainment by governorates. • Seventeen percent of women read a newspaper, listen to the radio, and watch television at least once a week; 2 percent were not exposed to any of the three media. • The majority of ever-married women (68 percent) have never been employed, while 16 percent are currently employed, and 16 percent have been previously employed. • Among working women, the majority (66 percent) are engaged in professional, technical, and managerial work. • Overall, 11 percent of women smoke cigarettes and 10 percent smoke nargila (water pipe). 28 • Respondents’ Background Characteristics Table 3.1 Background characteristics of women Percent distribution of ever-married women age 15-49 by selected background characteristics, Jordan 2012 Background characteristic Number of women Weighted percent Weighted number Unweighted number Age 15-19 2.4 278 239 20-24 10.6 1,207 1,190 25-29 17.7 2,006 2,110 30-34 18.8 2,136 2,169 35-39 18.5 2,098 2,164 40-44 18.1 2,055 1,999 45-49 13.8 1,571 1,481 Marital status Married 95.1 10,801 10,746 Divorced/separated 3.1 350 346 Widowed 1.8 201 260 Residence Urban 83.3 9,458 8,034 Rural 16.7 1,894 3,318 Region Central 63.3 7,181 4,051 North 27.5 3,120 3,980 South 9.3 1,051 3,321 Governorate Amman 39.2 4,454 1,106 Balqa 6.7 765 945 Zarqa 14.6 1,659 1,139 Madaba 2.7 303 861 Irbid 17.5 1,986 1,137 Mafraq 5.0 562 1,000 Jarash 2.8 320 945 Ajloun 2.2 251 898 Karak 3.9 441 873 Tafiela 1.5 167 819 Ma'an 1.6 178 781 Aqaba 2.3 265 848 Badia Badia 6.2 705 1,265 Non Badia 93.8 10,647 10,087 Camps Camp 3.6 413 904 Non camp 96.4 10,939 10,448 Education No education 2.3 267 408 Elementary 7.6 860 981 Preparatory 14.8 1,677 1,610 Secondary 44.7 5,073 4,799 Higher 30.6 3,475 3,554 Wealth quintile Lowest 18.8 2,137 2,695 Second 20.6 2,343 2,896 Middle 21.7 2,461 2,601 Fourth 20.6 2,336 2,050 Highest 18.3 2,076 1,110 Total 15-49 100.0 11,352 11,352 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Respondents’ Background Characteristics • 29 The distribution of ever-married women by governorate is comparable to the distribution of the total population in the 2004 census. About two in five (39 percent) women live in Amman, 18 percent in Irbid, and 15 percent in Zarqa. Six percent of ever-married women live in Badia areas and 4 percent live in refugee camp areas. The overall level of education among women continues to improve. The percentage of ever- married women age 15-49 years who had no schooling has steadily declined from 6 percent in 2002 to 4 percent in 2007, 3 percent in 2009, and 2 percent in 2012. The percentage who have attended school beyond secondary level increased from 25 percent in 2002 to 29 percent in 2007, 32 percent in 2009, and 31 percent in 2012. Table 3.1 also presents the weighted and unweighted numbers of women in the sample. The unweighted numbers of women in the three largest governorates are smaller than the weighted numbers. The opposite is true for all other governorates because of oversampling. For example, in Ma’an governorate, although the weighted number of women is 178, in reality data were collected from 781 women: Ma’an governorate was oversampled to obtain a sufficient sample of women to yield statistically reliable estimates. 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 continued to increase over the past 65 years. The data indicate that older women are less likely to have had education than younger women; almost 5 percent of women age 45-49 have had no education, compared with less than 1 percent of women between the ages of 15 and 24. The median number of years of schooling according to age group reflects no major difference. The median number of years of education for all ever-married women is 10.8 years. While women age 15-24 and age 45-49 have a median of 10.5 years of education, those age 25-29 and 30-34 have a median of 11.1 years of education. Ever-married women in urban areas are more likely to have had some education, as well as higher education, than their rural counterparts; 2 percent of women in urban areas have no education, compared with 6 percent of women in rural areas. There are small differences in terms of the median number of years of schooling according to urban-rural residence. There are pronounced differences in the proportion of women with no education by region and governorate. In the Central region, 2 percent of women have no education, whereas in the South region, the proportion is 6 percent. Only 1 percent of women in Irbid and Zarqa have no education, compared with 13 percent in Ma’an. Regional differences in secondary or higher education are small. Considerable differences exist in terms of higher education by governorate; only one in four women have attained higher education in Zarqa, Mafraq, and Ma’an in contrast to about two in five women in Ajloun and Karak. In Badia areas, 13 percent of ever-married women age 15-49 have no education, compared with 2 percent in non-Badia areas. There is also a significant and notable difference in the percentage of woman attaining higher education between Badia and non- Badia areas (20 and 31 percent, respectively) and camp and non camp areas (19 percent and 31 percent, respectively). The table also shows an inverse relationship between wealth and educational attainment, with a higher proportion of women in the lowest wealth quintile having no education (8 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 (55 percent) and lowest in the poorest households (10 percent). 30 • Respondents’ Background Characteristics Table 3.2 Educational attainment Percent distribution of ever-married women age 15-49 by highest level of schooling attended, according to background characteristics, Jordan 2012 Background characteristic Education Total Median years completed Number of women No education Elementary Preparatory Secondary Higher Age 15-24 0.8 4.6 17.7 52.6 24.2 100.0 10.5 1,485 15-19 0.1 5.3 30.4 62.7 1.5 100.0 9.6 278 20-24 1.0 4.4 14.8 50.3 29.4 100.0 10.7 1,207 25-29 1.4 5.2 8.1 48.9 36.4 100.0 11.1 2,006 30-34 1.7 5.1 14.0 42.7 36.5 100.0 11.1 2,136 35-39 1.9 8.7 15.7 47.4 26.2 100.0 10.7 2,098 40-44 3.8 9.0 16.7 40.4 30.2 100.0 10.7 2,055 45-49 4.6 13.6 17.7 36.4 27.7 100.0 10.5 1,571 Residence Urban 1.7 7.2 15.1 45.3 30.7 100.0 10.8 9,458 Rural 5.5 9.5 13.4 41.6 30.1 100.0 10.6 1,894 Region Central 1.9 7.5 15.7 45.9 29.1 100.0 10.8 7,181 North 2.3 7.1 14.1 44.0 32.5 100.0 10.8 3,120 South 5.8 9.7 10.6 38.3 35.6 100.0 10.8 1,051 Governorate Amman 1.8 7.4 15.8 45.1 30.0 100.0 10.9 4,454 Balqa 3.3 9.2 14.2 40.3 33.0 100.0 10.8 765 Zarqa 1.4 7.1 16.7 51.4 23.5 100.0 10.6 1,659 Madaba 2.0 5.9 12.1 43.4 36.5 100.0 11.2 303 Irbid 1.1 5.9 13.6 46.1 33.4 100.0 10.9 1,986 Mafraq 7.2 13.1 16.2 37.0 26.6 100.0 10.3 562 Jarash 1.8 7.0 16.7 42.6 31.9 100.0 10.7 320 Ajloun 1.6 3.9 9.9 44.6 40.0 100.0 11.0 251 Karak 4.1 7.5 9.6 38.1 40.6 100.0 11.0 441 Tafiela 4.9 9.9 12.2 35.3 37.8 100.0 10.8 167 Ma'an 13.3 19.1 11.9 29.2 26.5 100.0 9.9 178 Aqaba 4.2 6.8 10.4 46.5 32.1 100.0 11.0 265 Badia Badia 12.8 15.0 16.2 35.9 20.2 100.0 9.8 705 Non Badia 1.7 7.1 14.7 45.3 31.3 100.0 10.8 10,647 Camps Camp 1.9 11.7 21.9 45.7 18.8 100.0 10.1 413 Non camp 2.4 7.4 14.5 44.6 31.1 100.0 10.8 10,939 Wealth quintile Lowest 8.3 16.6 25.3 39.4 10.3 100.0 8.9 2,137 Second 2.7 10.1 17.4 50.1 19.8 100.0 10.4 2,343 Middle 0.6 6.7 15.3 48.6 28.7 100.0 10.8 2,461 Fourth 0.3 3.2 11.2 44.9 40.4 100.0 11.4 2,336 Highest 0.2 1.3 4.4 39.2 54.9 100.0 13.1 2,076 Total 2.3 7.6 14.8 44.7 30.6 100.0 10.8 11,352 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. Respondents’ Background Characteristics • 31 3.3 EXPOSURE TO MASS MEDIA The exposure of ever-married women to television, radio, and newspapers is shown in Table 3.3. Ninety-seven percent of women watch television, 37 percent listen to the radio, and 35 percent read newspapers at least once a week. While 17 percent of women were exposed to all three forms of media at least once a week, 2 percent were not exposed to any. Younger women are slightly less likely to be exposed to mass media than older women: whereas 13 percent of women age 15-19 were exposed to all three forms of mass media, the proportion goes up to 18-19 percent among women age 30-49. There is a steady increase with education level in the proportions of women who read a newspaper, watch television, and listen to the radio at least once a week. It should be noted that while about one-fourth of women with a higher than secondary education (27 percent) were exposed to all three media, almost no women with no education report the same. Women in urban areas are more likely to read a newspaper (37 percent) than women in rural areas (25 percent), while there is no difference in exposure to the television. The extent to which women listen to the radio varies by urban-rural residence (37 percent in urban areas versus 33 percent in rural areas). Women living in the Central region are more likely than women in the other regions to read newspapers, listen to the radio, and watch television (20 percent exposed to all three media in the Central region versus 12 percent in the North and 17 percent in the South). Women in Amman and Aqaba are more likely to read the newspaper than women in other governorates. While more than one-fourth of women in Aqaba (29 percent) are exposed to all three forms of mass media, this figure is only 9 percent in Ma’an and 7 percent in Mafraq. The table also indicates the variation in these percentages by residence in Badia and camp areas; 8 percent of women in Badia and camp areas are exposed to all three media compared with 18 percent of women residing in non- Badia and non camp areas. Table 3.3 also shows a positive relationship between exposure to mass media and household wealth, with exposure to all three media sources increasing from 4 percent of women in the lowest quintile to 37 percent in the highest quintile. 32 • Respondents’ Background Characteristics Table 3.3 Exposure to mass media Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Jordan 2012 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 28.0 99.1 30.4 13.0 0.5 278 20-24 31.1 98.0 33.5 15.2 0.9 1,207 25-29 33.7 96.9 37.4 15.3 1.8 2,006 30-34 34.7 95.6 35.8 18.1 2.4 2,136 35-39 35.4 96.7 36.1 17.9 2.6 2,098 40-44 35.3 97.9 39.9 17.9 1.3 2,055 45-49 38.7 95.7 36.2 19.0 2.8 1,571 Residence Urban 36.7 96.7 37.2 18.1 2.0 9,458 Rural 25.2 97.2 33.4 12.7 2.0 1,894 Region Central 38.1 96.4 40.3 19.5 2.2 7,181 North 27.8 97.7 29.7 12.1 1.5 3,120 South 32.8 97.1 31.4 16.5 1.9 1,051 Governorate Amman 41.4 96.1 42.6 21.1 2.2 4,454 Balqa 32.0 96.8 39.7 16.7 1.6 765 Zarqa 33.1 96.9 34.6 16.8 2.4 1,659 Madaba 32.2 97.6 39.8 18.4 1.8 303 Irbid 31.0 98.3 31.6 13.7 1.0 1,986 Mafraq 18.9 96.8 22.8 7.0 2.7 562 Jarash 25.7 95.9 30.8 12.1 2.8 320 Ajloun 25.1 97.3 28.2 10.9 1.3 251 Karak 28.0 97.8 27.6 14.6 1.7 441 Tafiela 25.9 95.4 27.9 10.4 3.6 167 Ma'an 19.7 96.7 28.5 8.6 2.3 178 Aqaba 53.9 97.1 41.9 28.8 0.9 265 Badia Badia 18.0 94.2 27.9 8.4 5.0 705 Non Badia 35.9 97.0 37.1 17.8 1.8 10,647 Camps Camp 23.5 95.4 21.3 8.3 3.3 413 Non camp 35.2 96.9 37.1 17.5 1.9 10,939 Education No education 0.0 86.5 16.5 0.0 13.1 267 Elementary 6.8 93.6 26.8 2.5 4.9 860 Preparatory 21.7 95.9 31.1 8.9 1.9 1,677 Secondary 35.2 97.7 35.9 16.9 1.6 5,073 Higher 50.1 97.5 44.0 26.6 1.0 3,475 Wealth quintile Lowest 14.6 94.2 20.1 3.7 4.1 2,137 Second 25.8 96.9 30.9 11.0 2.1 2,343 Middle 32.3 97.3 35.1 14.4 1.9 2,461 Fourth 40.6 97.7 43.8 21.5 0.8 2,336 Highest 62.1 97.9 53.6 36.6 1.1 2,076 Total 34.8 96.8 36.5 17.2 2.0 11,352 3.4 RESPONDENTS’ EMPLOYMENT CHARACTERISTICS In the 2012 JPFHS, respondents were asked a number of questions about their employment, including whether they were currently working or not. Women who were currently working were then asked a number of questions about the kind of work they do and their employment status. In the 2012 JPFHS, women were defined as currently employed if they worked in the seven days preceding the survey. Respondents’ Background Characteristics • 33 3.4.1 Working Status The majority of ever-married women (68 percent) have never been employed, while only 16 percent worked during the seven days preceding the survey (Table 3.4). An additional 16 percent of women had worked in the past, but not during the seven days preceding the survey. The proportion of women who were currently working ranged from 1 percent among those age 15-19 to 20 percent among those age 30-34 and 45-49. Table 3.4 Employment status Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Jordan 2012 Background characteristic Worked in the 7 days preceding the survey1 Did not work in the 7 days preceding the survey but worked sometime in the past Never employed Total Number of women Age 15-19 0.8 6.0 93.2 100.0 278 20-24 5.4 8.8 85.8 100.0 1,207 25-29 15.8 17.3 66.9 100.0 2,006 30-34 20.1 16.6 63.3 100.0 2,136 35-39 17.1 14.2 68.6 100.0 2,098 40-44 17.8 15.9 66.3 100.0 2,055 45-49 20.1 21.3 58.6 100.0 1,571 Marital status Married 16.0 15.4 68.6 100.0 10,801 Divorced/separated/widowed 23.3 22.0 54.7 100.0 551 Number of living children 0 19.0 18.9 62.0 100.0 1,107 1-2 20.6 18.8 60.6 100.0 3,031 3-4 16.6 16.0 67.4 100.0 3,795 5+ 11.4 11.6 76.9 100.0 3,419 Residence Urban 16.2 16.5 67.3 100.0 9,458 Rural 17.1 11.9 71.0 100.0 1,894 Region Central 15.4 17.2 67.4 100.0 7,181 North 16.2 14.0 69.8 100.0 3,120 South 23.1 10.5 66.4 100.0 1,051 Governorate Amman 14.9 18.0 67.0 100.0 4,454 Balqa 22.4 15.4 62.1 100.0 765 Zarqa 11.8 16.4 71.8 100.0 1,659 Madaba 24.8 14.1 61.2 100.0 303 Irbid 16.5 16.2 67.3 100.0 1,986 Mafraq 15.7 9.0 75.3 100.0 562 Jarash 15.7 12.3 71.9 100.0 320 Ajloun 15.0 10.6 74.4 100.0 251 Karak 27.9 8.7 63.4 100.0 441 Tafiela 21.2 12.0 66.9 100.0 167 Ma'an 20.9 9.1 70.0 100.0 178 Aqaba 17.8 13.6 68.6 100.0 265 Badia Badia 12.5 8.7 78.9 100.0 705 Non Badia 16.6 16.2 67.2 100.0 10,647 Camps Camp 9.9 16.0 74.1 100.0 413 Non camp 16.6 15.7 67.7 100.0 10,939 Education No education 11.1 7.0 81.9 100.0 267 Elementary 7.3 12.4 80.2 100.0 860 Preparatory 4.7 10.5 84.8 100.0 1,677 Secondary 7.5 11.5 81.0 100.0 5,073 Higher 37.5 25.9 36.6 100.0 3,475 Wealth quintile Lowest 7.7 12.2 80.1 100.0 2,137 Second 11.0 13.7 75.3 100.0 2,343 Middle 14.5 15.1 70.5 100.0 2,461 Fourth 21.3 15.8 62.8 100.0 2,336 Highest 27.8 22.4 49.9 100.0 2,076 Total 16.3 15.7 67.9 100.0 11,352 1 Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for travel, illness, vacation, or any other such reason. 34 • Respondents’ Background Characteristics There are no major differences in work status according to urban-rural residence. However, a higher proportion of women in the South region report being currently employed (23 percent) compared with other regions. The table also indicates that there are notable variations in work status by governorates. Women in Zarqa are least likely to be currently employed (12 percent) and women in Karak most likely (28 percent). In addition, women are also more likely to be employed if they live in the non Badia and non camp areas. Women with postsecondary education are much more likely to report having been employed in the week preceding the survey (38 percent) than women with any other educational level. Marital status seems to have a bearing on work status. Only 16 percent of currently married women are currently employed compared with 23 percent of divorced, separated, and widowed women. When the number of living children is considered, the percentage of working women rises from 19 percent among those with no children to 21 percent among those with one or two children, and drops to 11 percent among those with five or more children. Not surprisingly, there is a direct relationship between household wealth and current employment, with the percentage of women currently employed increasing from 8 percent in the poorest households to 28 percent in the richest households. The 2012 JPFHS also asked women who had worked in the past but were not currently working for the reasons they stopped working. One in three women (33 percent) had stopped work because they got married, 15 percent stopped because they became pregnant, 11 percent lost their job, 8 percent stopped work because their husbands were opposed, and 6 percent each stopped work due to retirement or illness (data not shown separately). 3.4.2 Occupation Table 3.5 shows that among ever-married women who report being employed in the seven days preceding the survey, the majority (54 percent) are engaged in professional work, with much smaller proportions employed in services and sales (13 percent), elementary occupations (9 percent), clerical work (8 percent), and craft and related trades (5 percent). The percentages vary considerably by background characteristics of women, particularly by marital status, education, and household wealth. It is of interest to note that the data do not reflect the expected urban-rural difference in women’s involvement in the professional sector (53 percent and 58 percent, respectively). Employment in the professionalsector is higher among younger than older women, currently married than formerly married women, and women with fewer than five children than among women with five or more children. Employment in this sector is notably higher among women with higher education (76 percent) than among lesser educated women and rises with household wealth. Women in non camp areas are also more likely to be engaged in professional work (55 percent) than women in camp areas (32 percent). Differences by region, governorate, and Badia areas are smaller. Respondents’ Background Characteristics • 35 Table 3.5 Occupation Percent distribution of ever-married women age 15-49 currently employed by occupation, according to background characteristics, Jordan 2012 Background characteristic Professionals Technicians and associate professionals Clerks Service workers, shop, and market sales workers Skilled agricultural and fishery workers Craft and related trades workers Elementary occupations Total Number of women Age 15-19 * * * * * * * 100.0 2 20-24 71.4 7.3 6.1 8.4 0.0 1.2 5.6 100.0 65 25-29 63.4 10.7 5.9 12.4 0.0 1.4 6.2 100.0 317 30-34 64.9 13.4 6.0 7.2 0.2 3.2 5.2 100.0 429 35-39 55.7 10.3 11.2 10.8 0.1 4.6 7.2 100.0 359 40-44 43.2 14.1 8.1 16.5 0.4 4.4 13.3 100.0 366 45-49 37.8 9.3 8.3 18.5 0.6 10.0 15.5 100.0 315 Marital status Married 56.5 11.5 7.3 11.8 0.2 4.6 8.1 100.0 1,726 Divorced/separated/ widowed 22.4 12.2 15.4 23.6 0.5 3.6 22.3 100.0 128 Number of living children 0 46.2 16.4 10.7 10.9 0.0 2.7 13.1 100.0 211 1-2 63.7 9.3 7.6 11.7 0.0 2.9 4.8 100.0 624 3-4 53.9 13.7 8.5 12.2 0.1 5.9 5.9 100.0 630 5+ 43.3 9.1 5.9 15.7 1.1 5.8 19.1 100.0 390 Residence Urban 53.2 11.4 7.8 13.2 0.2 5.3 8.9 100.0 1,530 Rural 58.4 12.0 8.2 10.0 0.6 0.5 10.3 100.0 325 Region Central 52.0 10.8 7.8 14.7 0.2 5.3 9.2 100.0 1,107 North 57.5 12.7 6.3 8.7 0.2 4.2 10.4 100.0 504 South 56.8 12.6 11.5 11.1 0.7 1.3 6.1 100.0 243 Governorate Amman 50.9 9.9 6.8 16.6 0.0 6.2 9.7 100.0 665 Balqa 50.4 11.9 10.8 9.9 0.9 2.4 13.7 100.0 172 Zarqa 54.3 12.8 7.6 13.8 0.0 6.1 5.4 100.0 195 Madaba 59.3 10.4 11.2 11.5 0.6 2.3 4.7 100.0 75 Irbid 55.4 12.9 6.4 8.7 0.0 5.0 11.6 100.0 328 Mafraq 63.5 13.2 6.4 6.1 0.6 0.9 9.2 100.0 88 Jarash 55.6 12.0 8.8 10.9 0.7 5.0 6.9 100.0 50 Ajloun 64.3 11.2 1.8 11.2 0.0 4.1 7.4 100.0 38 Karak 57.2 12.4 11.6 10.8 1.2 1.4 5.4 100.0 123 Tafiela 62.0 13.9 12.3 6.1 0.0 3.6 2.2 100.0 35 Ma'an 56.9 9.1 10.1 8.6 0.0 0.0 15.2 100.0 37 Aqaba 51.5 15.0 11.8 17.7 0.6 0.0 3.5 100.0 47 Badia Badia 63.8 5.9 2.8 11.6 0.9 0.6 14.3 100.0 88 Non Badia 53.6 11.8 8.2 12.7 0.2 4.7 8.9 100.0 1,766 Camps Camp 31.7 12.9 5.1 25.9 0.0 9.6 14.8 100.0 41 Non camp 54.6 11.5 8.0 12.3 0.3 4.4 9.0 100.0 1,813 Education No education * * * * * * * 100.0 30 Elementary 0.0 1.2 0.4 23.2 2.0 15.3 57.9 100.0 63 Preparatory 2.9 2.6 8.6 28.8 1.2 9.6 46.4 100.0 78 Secondary 1.7 3.3 25.2 39.1 0.5 13.2 17.0 100.0 378 Higher 76.2 15.2 3.4 3.7 0.0 1.2 0.3 100.0 1,305 Wealth quintile Lowest 16.3 9.1 5.5 13.4 1.8 9.8 44.0 100.0 165 Second 38.0 9.8 6.0 23.1 0.4 6.3 16.4 100.0 259 Middle 49.7 11.7 16.0 12.9 0.1 5.1 4.5 100.0 356 Fourth 64.9 11.0 7.4 9.1 0.1 2.3 5.2 100.0 498 Highest 65.5 13.3 4.8 10.6 0.0 3.6 2.1 100.0 577 Total 54.1 11.5 7.9 12.6 0.3 4.5 9.1 100.0 1,854 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 36 • Respondents’ Background Characteristics It is of interest to note that the data do not reflect the expected urban-rural difference in women’s involvement in the professional, technical, and managerial sector (65 percent and 70 percent, respectively). Employment in professional, technical, and managerial work is higher among younger than older women, currently married than formerly married women, and women with fewer than five children than among women with five or more children. Employment in this sector is notably higher among women with higher education (91 percent) than among lesser educated women and rises with household wealth. Differences by region, governorate, and Badia and camp areas are smaller. The data also indicate that 88 percent of employed women are paid employees and 9 percent are self-employed (Figure 3.1). Figure 3.1 Women’s current employment status JPFHS 2012 3.5 SMOKING TOBACCO Tobacco use is widely regarded as the most preventable cause of death and disease among adults. In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcers, reproductive disorders, esophageal reflux, and hypertension. Tobacco and its various components have been associated with an increased risk of various types of cancer. Smoking is the most important contributor to the development of chronic bronchitis and chronic obstructive pulmonary disease, which are characterized by chronic cough, phlegm, and airflow obstruction. Smoking is well established as the cause of the majority of pulmonary emphysema. Smoking among women also creates particular risks for their offspring. Poor pregnancy outcomes, including low birth weight and intrauterine growth retardation, are more frequent among women who smoke than among those who do not smoke. Table 3.6 shows the percentage of women who smoke cigarettes or a water pipe (nargila). Overall, 11 percent of women smoke cigarettes and 10 percent smoke nargila, a slight increase since 2009, when 9 percent of women reported smoking cigarettes and 6 percent nargila. The data also indicate that older women are more likely to smoke cigarettes but younger women prefer nargila. Smoking (both cigarettes and nargila) is also higher among women who are neither pregnant nor breastfeeding than among pregnant or breastfeeding women. Women living in urban areas are more likely to use tobacco than women living in rural areas. Also, women in the Central region are more likely to use tobacco compared with women from the other regions. Respondents’ Background Characteristics • 37 Table 3.6 Use of tobacco Percentage of ever-married women age 15-49 who smoke cigarettes or a water pipe, according to background characteristics and maternity status, Jordan 2012 Background characteristic Uses tobacco Does not use tobacco Number of women Cigarettes Water pipe (nargila) Age 15-19 8.2 14.1 84.5 278 20-24 5.8 15.4 81.3 1,207 25-29 9.3 11.1 83.5 2,006 30-34 7.6 10.2 84.7 2,136 35-39 11.2 8.0 82.9 2,098 40-44 14.0 11.0 78.6 2,055 45-49 16.6 6.9 80.0 1,571 Maternity status Pregnant 4.6 7.1 90.4 1,085 Breastfeeding (not pregnant) 5.8 8.4 87.3 1,869 Neither 12.7 11.1 79.8 8,399 Residence Urban 11.7 11.4 80.4 9,458 Rural 6.4 4.6 90.4 1,894 Region Central 12.4 12.0 79.4 7,181 North 8.5 8.2 85.6 3,120 South 7.0 4.9 89.4 1,051 Governorate Amman 13.9 13.4 77.2 4,454 Balqa 7.9 9.7 84.8 765 Zarqa 11.3 10.2 81.4 1,659 Madaba 7.5 6.7 87.5 303 Irbid 8.9 9.2 84.2 1,986 Mafraq 7.5 6.9 87.5 562 Jarash 9.7 7.6 85.4 320 Ajloun 5.7 3.4 92.1 251 Karak 3.8 4.0 92.9 441 Tafiela 5.7 3.7 92.2 167 Ma'an 11.3 3.8 86.6 178 Aqaba 10.4 8.1 83.5 265 Badia Badia 8.0 4.2 89.2 705 Non Badia 11.0 10.7 81.6 10,647 Camps Camp 7.9 5.0 89.1 413 Non camp 10.9 10.5 81.8 10,939 Education No education 17.1 2.6 82.2 267 Elementary 16.0 6.6 79.7 860 Preparatory 16.4 11.8 76.3 1,677 Secondary 10.1 11.4 82.1 5,073 Higher 7.4 9.4 85.3 3,475 Wealth quintile Lowest 10.7 5.5 86.1 2,137 Second 10.7 7.1 85.1 2,343 Middle 9.1 9.6 84.4 2,461 Fourth 8.8 11.4 82.4 2,336 Highest 15.3 18.5 71.2 2,076 Total 10.8 10.3 82.0 11,352 38 • Respondents’ Background Characteristics The data indicate that there are significant differences in tobacco use by women according to governorates, with women in Amman most likely to use tobacco and women in Karak least likely. Women living in the Badia and camp areas are less likely to smoke than women living in the non Badia and non camp areas. Table 3.6 also indicates that there is a direct relationship between smoking and wealth, with the proportion of women smoking increasing with wealth from 14 percent among women in the lowest wealth quintile to 29 percent of women in the highest wealth quintile. Women with no education are more likely to smoke cigarettes (17 percent) than women who have secondary education (10 percent) or higher (7 percent). However, the pattern differs when nargila use is considered. Only 3 percent of women with no education use tobacco with a pipe compared to 9-12 percent of women with preparatory education or higher. Among women who smoked cigarettes, nearly one in two (47 percent) smoked 10 or more cigarettes in the past 24 hours, 8 percent smoked 6-9 cigarettes, 16 percent smoked 3-5 cigarettes, and 19 percent smoked 1-2 cigarettes. Eleven percent of women mentioned that they did not smoke any cigarettes in the past 24 hours (data not shown separately). Marriage and Exposure to the Risk of Pregnancy • 39 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY 4 his chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant: marriage, postpartum amenorrhea, and secondary infertility. In addition, data pertaining to the timing of respondents’ most recent sexual activity were collected. Information on nuptiality is of particular interest because marriage is a primary determinant of the exposure of women to the risk of pregnancy, particularly in countries like Jordan where premarital fertility is rare. Marriage patterns are important for an understanding of fertility, since early age at first marriage is associated with early childbearing and high fertility. In this survey and for all data collection in Jordan, the term marriage refers to a formal, legal union. 4.1 CURRENT MARITAL STATUS Table 4.1 presents the distribution of women by current marital status. Of the 19,891 women age 15-49 listed in the household schedule, 43 percent had never married, 54 percent were currently married, and the remaining 3 percent were either divorced, separated, or widowed. Table 4.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Jordan 2012 Age Marital status Total Number of respondents Never married Married Divorced Separated Widowed 15-19 93.7 6.0 0.3 0.0 0.0 100.0 4,411 20-24 66.4 32.6 1.0 0.0 0.0 100.0 3,588 25-29 30.2 67.3 2.0 0.0 0.4 100.0 2,875 30-34 17.3 79.6 2.7 0.0 0.4 100.0 2,583 35-39 13.7 82.8 2.2 0.1 1.2 100.0 2,430 40-44 10.5 84.7 1.9 0.3 2.6 100.0 2,295 45-49 8.0 83.1 3.5 0.3 5.1 100.0 1,708 Total 15-49 42.9 54.3 1.7 0.1 1.0 100.0 19,891 T Key Findings • The percentage of women age 15-49 who had ever been married decreased from 59 percent to 57 percent between 2009 and 2012. • Marriage is nearly universal in Jordan, with only 8 percent of women not married by the end of their reproductive age in 2012. • Five percent of currently married women are in a polygynous union, with older women more likely to be in a polygynous union than younger women. • Kinship marriages are common in Jordan and more prevalent among women living in Badia and camp areas than among other women. • Data from the 2012 JPFHS show some evidence of a rising age at marriage in Jordan. 40 • Marriage and Exposure to the Risk of Pregnancy The proportion of women who are currently married increases steadily from 6 percent among women age 15-19 to 83 percent among those age 35-39, then to 85 percent for women in the age group 40-44 and back to 83 percent among women age 45-49. As expected, the proportion of widows increases with age, reaching 5 percent among women age 45-49. Less than 2 percent of women in Jordan are divorced. Table 4.2 compares data on ever-married women age 15-49 from the 2012 JPFHS with data from five previous surveys: the 1990, 1997, 2002, 2007, and 2009 JPFHS. Over a period of 12 years, between 1990 and 2002, the percentage of ever-married women age 15-49 decreased from 56 to 54 percent. However, between 2002 and 2007, the percentage of ever-married women increased from 54 to 57 percent. This increase was mainly concentrated among young women in the age groups 20-24 and 25-29. Between 2009 and 2012 the percentage of ever-married women decreased from 59 to 57 percent. Table 4.2 Trends in the proportion of ever-married women by age group Percentage of women age 15-49 who have ever been married by age, according to various surveys, Jordan 1990-2012 Age JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 JPFHS 2012 15-19 10.6 8.2 6.2 5.8 6.8 6.3 20-24 45.2 38.8 34.1 36.7 37.0 33.6 25-29 73.7 66.2 65.3 69.3 71.5 69.9 30-34 89.1 80.7 79.6 79.4 81.9 82.7 35-39 94.6 89.9 87.3 85.4 84.7 86.3 40-44 97.3 94.4 92.6 91.6 89.8 89.5 45-49 98.0 96.0 95.4 95.9 91.5 92.0 Total 15-49 56.2 54.6 54.4 57.4 58.5 57.1 In Jordan, marriage is almost universal. In 2012, only 8 percent of women had not married by the end of their reproductive years (see Table 4.2). However, the percentage of women who have never married has generally increased over the years. For example, in 1990, 5 percent of women age 35-39 had never married; the proportion doubled in 1997 (10 percent), rose again to 13 percent in 2002, and reached 15 percent in 2007 and 2009. This percentage dropped to 14 percent in 2012. Echoing this trend, the proportion of women age 15-19 who had never married increased from 89 to 94 percent between 1990 and 2012. This change is the consequence of an increase in the age at first marriage among the youngest cohort of women. 4.2 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 4.3. Marriage and Exposure to the Risk of Pregnancy • 41 Table 4.3 Number of women's co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Jordan 2012 Background characteristic Number of co-wives Total Number of women 0 1 2+ Age 15-19 99.5 0.5 0.0 100.0 264 20-24 99.4 0.5 0.0 100.0 1,171 25-29 96.9 3.0 0.1 100.0 1,935 30-34 97.1 2.7 0.2 100.0 2,055 35-39 94.7 4.7 0.6 100.0 2,012 40-44 92.7 6.5 0.8 100.0 1,944 45-49 88.4 10.5 1.1 100.0 1,419 Residence Urban 95.3 4.3 0.4 100.0 8,983 Rural 93.5 5.9 0.6 100.0 1,818 Region Central 94.9 4.7 0.3 100.0 6,839 North 95.7 3.7 0.6 100.0 2,966 South 93.3 5.9 0.8 100.0 996 Governorate Amman 94.9 4.8 0.3 100.0 4,262 Balqa 94.9 4.6 0.6 100.0 724 Zarqa 95.2 4.5 0.3 100.0 1,564 Madaba 94.6 5.0 0.4 100.0 289 Irbid 96.2 3.2 0.6 100.0 1,892 Mafraq 94.4 4.9 0.7 100.0 528 Jarash 94.1 5.6 0.3 100.0 306 Ajloun 96.2 3.2 0.6 100.0 239 Karak 94.0 5.5 0.5 100.0 420 Tafiela 93.8 5.9 0.3 100.0 161 Ma'an 89.5 8.3 2.2 100.0 163 Aqaba 94.4 5.0 0.6 100.0 253 Badia Badia 89.3 9.2 1.5 100.0 666 Non Badia 95.4 4.3 0.4 100.0 10,135 Camps Camp 93.3 6.3 0.4 100.0 387 Non camp 95.0 4.5 0.5 100.0 10,414 Education No education 78.0 17.5 4.5 100.0 226 Elementary 89.4 8.9 1.7 100.0 788 Preparatory 93.6 5.9 0.6 100.0 1,547 Secondary 96.1 3.7 0.2 100.0 4,863 Higher 96.4 3.3 0.3 100.0 3,376 Wealth quintile Lowest 91.3 7.4 1.2 100.0 1,975 Second 94.2 5.4 0.4 100.0 2,179 Middle 96.4 3.3 0.2 100.0 2,364 Fourth 96.6 3.2 0.2 100.0 2,274 Highest 95.9 3.8 0.3 100.0 2,009 Total 95.0 4.6 0.5 100.0 10,801 Overall, 5 percent of currently married women in 2012 are in a polygynous union. The percentage of women in a polygynous union has not changed in the past five years. Older women are more likely to be in a polygynous union than younger women (12 percent at age 45-49 compared with less than 1 percent at age 15-24). The prevalence of polygyny is also slightly higher in rural areas (7 percent) than in urban areas (5 percent). There are differences in type of marital union by region, governorate, and particularly residence in Badia areas: in the Badia areas, 11 percent of married women are in a polygynous union compared with 5 percent in the non Badia areas. The results show much smaller differences between camp and non camp areas (7 and 5 percent, respectively). There are also large differences in polygynous unions by household wealth. The proportion of women in the lowest wealth quintile who are in a polygynous union is 9 percent, compared with 4 percent of those in the highest wealth quintile, indicating an inverse relationship between polygyny and household wealth. 42 • Marriage and Exposure to the Risk of Pregnancy There is also an inverse relationship between polygyny and education. Among married women with no education, the proportion in a polygynous union is 22 percent; this declines to 7 percent among women with preparatory education and to 4 percent among women with a secondary or higher education. 4.3 CONSANGUINITY Kinship marriage, also called consanguineous marriage, is relatively common in Jordan. Data in Table 4.4 indicate that 35 percent of ever-married women age 15-49 reported that they are related to their current husband or first husband (for those married more than once or last husband for divorced or widowed women). Data indicate that 1 percent were dual first cousin marriages (i.e., on both the father’s and mother’s sides). The proportion of marriages between first cousins on the father’s side is higher than those on the mother’s side (13 percent compared with 9 percent). Twelve percent were marriages to second cousins or other relatives. Table 4.4 Consanguinity Percent distribution of all ever-married women by their relationship to their current or first husband, according to background characteristics, Jordan 2012 Background characteristic Relationship to husband Total Number of women Not related First cousin on both father and mother's side First cousin on both mother and father's side First cousin on father's side First cousin on mother's side First cousin on father's side (aunt) First cousin on mother's side (aunt) Second cousin on father's side Second cousin on mother's side Other relative Age 15-19 57.1 0.2 0.8 9.4 4.5 3.2 7.6 12.3 4.7 0.4 100.0 278 20-24 70.4 0.6 0.3 7.1 2.5 3.3 5.9 7.0 2.1 0.7 100.0 1,207 25-29 66.6 0.3 0.6 7.9 3.3 5.9 5.5 6.0 3.1 0.7 100.0 2,006 30-34 69.1 0.7 0.2 7.3 2.5 3.8 4.3 7.8 3.1 1.2 100.0 2,136 35-39 62.6 0.6 1.0 7.7 4.4 4.3 6.0 9.5 3.3 0.6 100.0 2,098 40-44 61.0 0.6 0.8 10.9 3.2 5.3 5.7 8.9 2.6 1.0 100.0 2,055 45-49 66.0 0.8 0.8 9.0 3.0 3.0 5.5 9.1 2.1 0.8 100.0 1,571 Residence Urban 66.5 0.6 0.6 7.9 3.2 4.3 5.4 7.9 2.8 0.9 100.0 9,458 Rural 59.9 0.6 0.7 11.0 3.4 4.9 6.0 9.7 3.2 0.5 100.0 1,894 Region Central 66.2 0.6 0.6 8.3 3.1 4.4 5.3 8.0 2.4 1.1 100.0 7,181 North 64.6 0.6 0.8 8.3 3.3 4.1 6.1 8.5 3.4 0.4 100.0 3,120 South 62.2 0.6 0.4 9.8 3.8 5.2 4.7 8.9 4.1 0.3 100.0 1,051 Governorate Amman 68.2 0.6 0.5 7.6 3.0 4.0 5.3 7.9 1.9 0.9 100.0 4,454 Balqa 60.7 0.4 0.9 10.4 2.7 4.6 4.9 10.5 3.8 1.2 100.0 765 Zarqa 64.8 0.5 0.6 8.4 3.8 4.8 5.4 6.9 3.0 1.7 100.0 1,659 Madaba 59.0 0.9 0.4 11.0 3.1 5.8 6.5 9.4 3.5 0.2 100.0 303 Irbid 67.3 0.3 0.6 8.0 3.4 3.4 5.7 7.9 3.1 0.2 100.0 1,986 Mafraq 60.1 0.9 0.5 8.8 3.2 5.8 7.0 10.1 3.1 0.5 100.0 562 Jarash 58.8 2.4 2.6 9.2 2.5 5.1 6.4 8.0 4.0 1.0 100.0 320 Ajloun 60.5 0.3 0.5 7.7 3.8 4.6 6.9 9.6 5.1 1.1 100.0 251 Karak 61.8 0.5 0.1 8.9 3.5 6.6 5.1 9.5 3.8 0.1 100.0 441 Tafiela 64.9 0.1 0.4 9.0 3.3 4.3 5.2 7.4 4.6 0.7 100.0 167 Ma'an 56.1 0.5 0.2 12.8 4.9 4.2 4.8 10.9 5.0 0.6 100.0 178 Aqaba 65.3 1.0 0.9 9.8 3.9 4.3 3.7 7.4 3.6 0.2 100.0 265 Badia Badia 56.3 0.4 0.5 12.9 3.2 5.5 5.9 11.0 3.9 0.5 100.0 705 Non Badia 66.0 0.6 0.6 8.1 3.2 4.3 5.5 8.0 2.8 0.9 100.0 10,647 Camps Camp 58.3 1.2 1.0 10.8 3.6 4.8 5.6 10.2 3.6 0.9 100.0 413 Non camp 65.7 0.6 0.6 8.3 3.2 4.3 5.5 8.1 2.8 0.8 100.0 10,939 Education No education 61.1 0.2 0.1 14.3 2.6 2.8 3.4 11.8 3.4 0.4 100.0 267 Elementary 61.0 1.4 1.3 13.9 3.3 4.1 2.8 9.2 2.4 0.5 100.0 860 Preparatory 60.2 0.8 0.7 10.9 3.3 5.6 5.5 9.0 3.1 1.0 100.0 1,677 Secondary 63.3 0.6 0.7 8.9 3.2 4.8 6.0 8.8 2.9 0.8 100.0 5,073 Higher 72.4 0.3 0.4 4.7 3.2 3.4 5.6 6.5 2.7 0.9 100.0 3,475 Wealth quintile Lowest 58.0 0.3 0.9 12.6 4.3 4.2 6.1 10.2 3.1 0.4 100.0 2,137 Second 62.4 1.2 0.8 9.7 3.0 5.5 5.0 8.6 2.6 1.3 100.0 2,343 Middle 64.7 0.6 0.6 8.4 3.1 4.5 6.2 8.8 2.5 0.5 100.0 2,461 Fourth 66.4 0.4 0.7 6.5 3.7 3.5 6.0 7.8 3.8 1.2 100.0 2,336 Highest 76.2 0.3 0.1 4.8 2.0 4.0 4.1 5.5 2.2 0.8 100.0 2,076 Total 65.4 0.6 0.6 8.4 3.2 4.4 5.5 8.2 2.8 0.8 100.0 11,352 Marriage and Exposure to the Risk of Pregnancy • 43 As expected, kinship marriages are more common among rural women (40 percent) than among urban women (34 percent). Women in the South region are slightly more likely than those in the Central and North regions to marry a relative (38 percent compared with 34 percent and 35 percent, respectively). The same is true for women in Badia areas compared with non Badia areas (44 percent compared with 34 percent). Table 4.4 also shows that women in camps are more likely to marry a relative than women in non camps (42 percent versus 34 percent). Data also reveal that there are significant differences in kinship marriages by governorates. Women in Madaba, Jarash, and Ma’an are more likely to marry a relative than women in other governorates. Further, less educated women are more likely to marry a relative than highly educated women: 28 percent of women with higher than secondary education married a relative, while 39 percent of women with no education did so. Few variations in consanguineous marriage exist by current age, with the exception of women age 15-19, where kinship marriages are more common than among women in other age groups. Data also show that there is an inverse relationship between kinship marriage and household wealth: women in the poorest households are more likely to marry relatives than those living in the wealthiest households (42 percent versus 24 percent). 4.4 AGE AT FIRST MARRIAGE In Jordan, almost all births occur within marriage; thus, age at first marriage is an important indicator of exposure to the risk of pregnancy and childbirth. The legal minimum age at marriage in Jordan for both women and men is 18 years. Table 4.5 shows the percentage of women who have ever married by specified exact ages and the median age at first marriage according to their age at the time of the survey. Overall, among Jordanian women age 25-49, 15 percent of women were married by age 18 and about one in three was married by age 20. The data indicate some evidence of rising age at marriage. For example, the proportion of women married by age 18 declines from 18 percent among women age 45-49 to 8 percent among women age 20-24. A similar pattern is seen in the percentage of women married by exact age 20, 22, and 25 by women’s current age. The last column in Table 4.5 provides further indication of later marriage among younger women. The median age at first marriage has increased, from 22.0 years among the cohort of women age 45-49 at the time of the survey to 23.0 years among the cohort of women age 25-29 and 30-34 at the time of the survey. Another way to assess trends in age at first marriage is to compare data across surveys. The median age at first marriage for women age 25-49 rose slightly between 2002 and 2007 (from 21.8 to 22.2 years), but there was no change in the median age at first marriage between 2009 and 2012 (22.4 years). 44 • Marriage and Exposure to the Risk of Pregnancy Table 4.5 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Jordan 2012 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 15-19 0.5 na na na na 93.7 4,411 a 20-24 0.3 8.4 19.4 na na 66.4 3,588 a 25-29 0.5 11.1 26.3 42.0 63.7 30.2 2,875 23.0 30-34 1.7 13.1 27.5 43.8 63.3 17.3 2,583 23.0 35-39 1.5 17.2 34.3 49.2 66.9 13.7 2,430 22.1 40-44 2.7 18.2 35.6 52.8 71.0 10.5 2,295 21.7 45-49 2.0 18.0 34.1 50.3 67.1 8.0 1,708 22.0 20-49 1.3 13.6 28.4 na na 28.5 15,480 a 25-49 1.6 15.1 31.1 47.1 66.2 17.0 11,892 22.4 Note: The age at first marriage is defined as the age at which the respondent began living with her first husband. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women began living with their husband for the first time before reaching the beginning of the age group. Table 4.6 shows the median age at marriage by background characteristics. There are only minor differences in the median age at first marriage by urban-rural residence and region. However, there are sizeable variations by governorates: the median age at first marriage ranges from 21.5 years in Zarqa governorate to 23.5 years in Karak. Women in non Badia and non camp areas tend to get married later than women in the Badia and camp areas. Education plays an important role in determining women’s age at marriage. Women with higher education tend to marry more than five years later than women with preparatory education, four years later than women with elementary or secondary education, and three years later than women with no education. The table also shows that women in the highest wealth quintile tend to get married later than those in the other wealth quintiles. Marriage and Exposure to the Risk of Pregnancy • 45 Table 4.6 Median age at first marriage by background characteristics Median age at first marriage among women age 25-49, according to background characteristics, Jordan 2012 Background characteristic Women age 25-49 Residence Urban 22.3 Rural 22.8 Region Central 22.3 North 22.5 South 22.7 Governorate Amman 22.4 Balqa 23.1 Zarqa 21.5 Madaba 23.2 Irbid 22.6 Mafraq 22.2 Jarash 22.0 Ajloun 22.1 Karak 23.5 Tafiela 22.1 Ma'an 21.9 Aqaba 21.9 Badia Badia 21.9 Non Badia 22.4 Camps Camp 21.5 Non camp 22.4 Education No education 21.9 Elementary 20.9 Preparatory 19.5 Secondary 20.8 Higher 25.0 Wealth quintile Lowest 21.7 Second 22.1 Middle 21.9 Fourth 22.7 Highest 23.2 Total 22.4 Note: The age at first marriage is defined as the age at which the respondent began living with her first husband. 4.5 RECENT SEXUAL ACTIVITY In the absence of effective contraception, the probability of becoming pregnant is related to the frequency of sexual intercourse. Information on sexual activity can, therefore, be used to refine measures of exposure to pregnancy. Currently married women were asked about the timing of their most recent sexual intercourse. This information is presented in Table 4.7. Overall, about nine in ten (89 percent) women stated that their most recent sexual intercourse was within the four weeks prior to the day of interview, 8 percent within the year preceding the survey, and 2 percent within one or more years before the survey. 46 • Marriage and Exposure to the Risk of Pregnancy Table 4.7 Recent sexual activity Percent distribution of currently married women age 15-49 by timing of last sexual intercourse, according to background characteristics, Jordan 2012 Background characteristic Timing of last sexual intercourse Total Number of women Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 91.8 7.7 0.4 0.1 100.0 264 20-24 92.3 7.0 0.2 0.4 100.0 1,171 25-29 89.2 9.2 0.9 0.7 100.0 1,935 30-34 90.7 7.1 0.6 1.6 100.0 2,055 35-39 90.5 7.8 0.6 1.1 100.0 2,012 40-44 88.6 7.7 2.7 1.0 100.0 1,944 45-49 83.2 10.0 5.9 0.8 100.0 1,419 Marital duration 0-4 years 89.7 9.0 0.6 0.7 100.0 2,122 5-9 years 89.7 8.5 0.8 1.0 100.0 2,160 10-14 years 91.7 6.6 0.8 0.9 100.0 1,809 15-19 years 92.5 5.6 0.6 1.2 100.0 1,648 20-24 years 87.2 8.2 3.5 1.2 100.0 1,605 25+ years 83.8 10.1 5.4 0.7 100.0 1,094 Married more than once 81.9 13.1 3.6 1.3 100.0 363 Residence Urban 88.8 8.5 1.8 1.0 100.0 8,983 Rural 91.4 6.5 1.3 0.8 100.0 1,818 Region Central 87.6 9.4 2.0 0.9 100.0 6,839 North 92.3 5.8 1.1 0.7 100.0 2,966 South 91.1 5.8 1.3 1.8 100.0 996 Governorate Amman 85.1 11.3 2.3 1.3 100.0 4,262 Balqa 91.4 7.0 1.3 0.3 100.0 724 Zarqa 91.7 6.1 1.8 0.4 100.0 1,564 Madaba 92.1 6.1 1.2 0.6 100.0 289 Irbid 92.3 5.8 1.1 0.8 100.0 1,892 Mafraq 91.8 6.1 1.4 0.6 100.0 528 Jarash 92.2 6.3 0.5 0.9 100.0 306 Ajloun 93.7 5.4 0.3 0.6 100.0 239 Karak 92.3 6.1 0.8 0.8 100.0 420 Tafiela 88.4 6.7 2.2 2.7 100.0 161 Ma'an 90.7 6.1 1.8 1.4 100.0 163 Aqaba 91.2 4.4 1.3 3.1 100.0 253 Badia Badia 89.4 7.5 2.2 0.8 100.0 666 Non Badia 89.2 8.2 1.7 1.0 100.0 10,135 Camps Camp 90.1 7.8 1.8 0.3 100.0 387 Non camp 89.2 8.1 1.7 1.0 100.0 10,414 Education No education 86.2 8.2 5.1 0.4 100.0 226 Elementary 87.0 8.6 3.1 1.3 100.0 788 Preparatory 87.5 9.2 3.0 0.3 100.0 1,547 Secondary 91.0 7.3 0.9 0.7 100.0 4,863 Higher 88.2 8.6 1.7 1.6 100.0 3,376 Wealth quintile Lowest 88.4 8.4 2.9 0.4 100.0 1,975 Second 92.9 5.2 1.2 0.7 100.0 2,179 Middle 90.0 8.2 1.6 0.2 100.0 2,364 Fourth 90.6 6.6 1.3 1.5 100.0 2,274 Highest 83.6 12.6 1.7 2.2 100.0 2,009 Total 89.2 8.1 1.7 1.0 100.0 10,801 1 Excludes women who had sexual intercourse within the last 4 weeks. The relationship between recent sexual activity and age, marital duration, education, and wealth quintile is mixed. Recent sexual activity is slightly higher in rural than urban areas, is highest in the North region, with little difference between Badia and non Badia and camp and non camp areas. Currently married women in Amman are noticeably less likely to have reported recent sexual activity than women in other governorates. Women with no education are also somewhat less likely to have had sexual activity in the four weeks before the survey than women with education. Fertility • 47 FERTILITY 5 ertility measures in this chapter are based on the reported birth histories of ever-married women age 15-49 who were interviewed in the 2012 JPFHS. Data were collected in two sections. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who had died. Second, for each live birth, she was asked to report the sex, date of birth, whether the birth was single or multiple, and whether the child was living in the household or elsewhere. The survival status of each live birth was also asked. For deceased children, the age at death was recorded. As an indicator of future fertility, information was collected on whether currently married women were pregnant at the time of the interview. Through previous experience in using birth histories to estimate fertility levels and trends, it has been found that the underreporting of children ever born and the displacement of children’s dates of birth are common in many countries. Underreporting of children affects estimates of fertility levels, whereas misreporting of children’s date of birth distorts fertility trends over time. Regarding the latter, one of the characteristics of the 2012 JPFHS is the high quality of age and date reporting. All women were able to report their age and their date of marriage or age at marriage. For children’s age and date of birth reporting, both month and year of birth are documented for all births recorded in the birth history (see Table C.3 in Appendix C). This information lends confidence to the quality of basic data used in the estimation of fertility measures. Two potential issues require some attention due to the fact that the fertility rates presented in this chapter are based on the birth history section of the JPFHS. First, only surviving women were interviewed in the survey. This would bias the rates if mortality of women of childbearing age were high and if fertility of surviving and non-surviving women differed significantly—neither of which is the case in Jordan. Limiting the survey respondents to ever-married women presents another potential bias. Although information on fertility was obtained only from ever-married women, estimates can be made for all women (regardless of marital status) based on information in the Household Questionnaire; these estimates assume that women who have never been married have had no children. This chapter also analyzes levels of fertility by background characteristics of women, which include age, residence, educational level, and wealth index. Factors related to fertility, including the median age at first birth, birth intervals, and teenage fertility, are analyzed as well. This chapter also addresses the principal factors, other than fertility, that affect a woman’s risk of becoming pregnant: postpartum amenorrhea, postpartum abstinence, and insusceptibility. F Key Findings • The total fertility rate for the three years preceding the survey is 3.5 births per woman, a 38 percent decline from the rate recorded in 1990. • Fertility decline has stalled in the past decade, with a mere 5 percent decline between 2002 and 2012. • More than two-thirds of all children (68 percent) are born at least two years after their siblings. • The median age at first birth has changed little between 2007 and 2012 but has declined by almost one year between 1997 and 2012. • Five percent of adolescent women age 15-19 are already mothers or pregnant with their first child. 48 • Fertility 5.1 CURRENT FERTILITY Data on current fertility is important because it reflects the prevailing situation in a country and is relevant to population policies and programs. Table 5.1 and Figure 5.1 present the age- specific fertility rates and cumulative fertility by urban-rural residence for the three-year period preceding the survey. Table 5.1 also presents the general fertility rate (GFR), that 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), that is, the annual number of live births per 1,000 population for the same period. At current levels, a woman would give birth to an average of 3.5 children in her lifetime—a 8 percent decline from the rate recorded in 2009 (3.8 births per woman). Fertility levels are higher in rural areas than in urban areas (3.9 compared with 3.4 births per woman). The most significant difference between rural and urban fertility is seen in the age group 25-29, where rural women have an average of 35 more births per 1,000 than urban women. This is in contrast to the pattern seen in 2009 when urban women had an average of 40 births more per 1,000 than rural women. Fertility rates are higher in urban areas than in rural areas among women under age 20. Women age 15-19 living in urban areas give birth to 9 more children per 1,000 than those living in rural areas, similar to the pattern seen in 2009. According to the age-specific fertility rates shown in the table, women in Jordan have, on average, just under one child (0.8 child) by age 25, but have almost three children (2.8) by age 35. Table 5.1 also indicates that the overall CBR is 27 per 1,000, with the urban CBR lower (27 per 1000) than the rural CBR (30 per 1,000). The GFR is 112 births per 1,000 women age 15-44. There is a significant difference in GFR between urban and rural areas (109 and 125 births per 1,000 women, respectively). This is a decrease from the 2009 JPFHS of 127 in the GFR and 31 in the CBR. Figure 5.1 Age-specific fertility rates by urban-rural residence JPFHS 2012 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women Age group Urban Rural Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Jordan 2012 Age group Residence Total Urban Rural 15-19 27 18 26 20-24 138 142 139 25-29 202 237 209 30-34 176 200 180 35-39 108 125 111 40-44 31 49 34 45-49 3 5 3 TFR(15-49) 3.4 3.9 3.5 GFR 109 125 112 CBR 26.7 29.8 27.2 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 age 15-44. CBR: Crude birth rate, expressed per 1,000 population. Fertility • 49 5.2 FERTILITY DIFFERENTIALS BY BACKGROUND CHARACTERISTICS Fertility differentials according to background characteristics of women are shown in Table 5.2 and Figure 5.2. The first column of the table shows the total fertility rates for the three years preceding the survey; column two shows the percentage of women who were pregnant at the time of data collection; and column three shows the mean number of children ever born (CEB) to women 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 2012 JPFHS, however, the fact that the completed fertility rate (4.6 children per woman) is much higher than the total fertility rate (3.5 children per woman) indicates a considerable decline in fertility; this finding is consistent with the decline in fertility in Jordan over the past 30 years. Urban women have on average half a child less than rural women. Fertility is highest in the North (3.8 children per woman), followed by the South (3.7) and the Central (3.4). Fertility levels vary considerably by governorate; the TFR ranges from a low of 3.2 children per woman in Amman to a high of 4.3 children per woman in Jarash. In addition, women living in Badia areas have on average one child more than women living in the non Badia areas (4.4 and 3.4 children per woman, respectively). Fertility varies significantly by education. It is of interest to note that the relationship of education to fertility is not linear as in most other countries; rather, in Jordan it has an inverted U-shape. Surprisingly, women who have secondary education have the highest fertility (4.2 births per woman), in contrast with women with no education and those with higher education who have the lowest fertility (3.0 children per woman). However, women who have higher than secondary education have 1.2 fewer births than women with a secondary education. These figures suggest that postsecondary education for women is associated with lower levels of fertility. The TFR also varies considerably according to wealth index in an inverse pattern that is commonly seen in other countries. Fertility declines as household wealth increases, from 4.4 births per woman among women in the poorest households to 2.6 children among women in the richest households. Table 5.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Jordan 2012 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 3.4 5.5 4.5 Rural 3.9 5.4 5.0 Region Central 3.4 5.1 4.4 North 3.8 6.2 4.8 South 3.7 5.7 5.1 Governorate Amman 3.2 5.0 4.4 Balqa 3.8 5.4 4.3 Zarqa 3.6 5.0 4.5 Madaba 3.5 5.8 4.9 Irbid 3.6 6.3 4.6 Mafraq 4.1 6.0 5.1 Jarash 4.3 5.5 5.4 Ajloun 3.8 7.1 5.5 Karak 3.5 5.7 4.6 Tafiela 3.9 7.7 5.5 Ma'an 4.1 5.0 5.9 Aqaba 3.7 5.4 5.0 Badia Badia 4.4 6.8 5.6 Non Badia 3.4 5.4 4.5 Camps Camp 3.7 3.9 5.0 Non camp 3.5 5.5 4.5 Education No education 3.0 3.4 5.8 Elementary 3.9 5.1 5.3 Preparatory 3.8 3.2 5.0 Secondary 4.2 6.7 4.6 Higher 3.0 5.6 3.9 Wealth quintile Lowest 4.4 5.2 5.5 Second 3.9 5.6 4.9 Middle 3.6 7.4 4.4 Fourth 3.1 4.8 4.3 Highest 2.6 4.5 3.9 Total 3.5 5.5 4.6 Note: Total fertility rates are for the period 1-36 months prior to interview. 50 • Fertility Table 5.2 also shows that 6 percent of all women of reproductive age were pregnant at the time of the survey. The percentages of women pregnant by region, Badia, and education follow a pattern roughly similar to that of fertility. The percentage of women pregnant ranges from a high of 8 percent in Tafiela to a low of 5 percent in Amman, Zarqa, and Ma’an. By wealth quintile, women in the middle wealth quintile were most likely to be pregnant at the time of the survey (7 percent), and women in the highest wealth quintile least likely (5 percent). Figure 5.2 Total fertility rates by background characteristics 5.3 FERTILITY TRENDS Fertility trends can also be investigated by using retrospective data from a single survey. The birth history information collected in the 2012 JPFHS is used for this purpose. Data in Table 5.3 and Figure 5.3 indicate that fertility has been declining in all age groups. For example, the age-specific fertility rate for women age 25-29 declined from 274 births per 1,000 women in the 15-19 years preceding the survey to 218 births per 1,000 women in the 5-9 year period before the survey, a 20 percent decline. More recently, between the 5-9 and 0-4 year period prior to the survey a slower pace in fertility decline is observed—a 3 percent decline. 3.5 3.4 3.9 3.4 3.8 3.7 4.4 3.9 3.6 3.1 2.6 TOTAL RESIDENCE Urban Rural REGION Central North South WEALTH QUINTILE Lowest Second Middle Fourth Highest Total fertility rate JPFHS 2012 Table 5.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Jordan 2012 Mother's age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 27 37 42 61 20-24 149 176 189 229 25-29 211 218 227 274 30-34 183 181 190 [220] 35-39 115 120 [120] 40-44 38 [51] 45-49 [3] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. Fertility • 51 Figure 5.3 Age-specific fertility rates for five-year periods preceding the survey JPFHS 2012 These trends in fertility decline from retrospective data collected in the 2012 JPFHS are consistent with the fertility trends observed from comparing with the five previous surveys—the 1990, 1997, 2002, 2007, and 2009 JPFHS. The calculated rates for these surveys refer to the three years preceding each survey (1988-1990, 1995-1997, 2000-2002, 2005-2007, 2007-2009, and 2010-2012, respectively). Comparison of the findings from these surveys shows trends in fertility levels over more than two decades. Data in Table 5.4 indicate that the pace of fertility decline was rapid until 2002, but has since slowed down. Fertility declined by 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). However, the fertility decline has stagnated in the last decade, with fertility decline a mere 5 percent (from 3.7 to 3.5 births per woman). Table 5.4 Trends in fertility Age-specific fertility rates and total fertility rates, various surveys, Jordan 1990-2012 Age group JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 JPFHS 2012 15-19 49 43 28 28 32 26 20-24 219 172 150 148 152 139 25-29 296 246 202 212 238 209 30-34 264 206 184 162 182 180 35-39 188 144 122 121 126 111 40-44 79 48 43 41 37 34 45-49 19 11 5 6 3 3 TFR 15-49 5.6 4.4 3.7 3.6 3.8 3.5 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 most significant proportional decline has been observed among women 40-49: a 57 percent drop from 79 births per 1,000 women in 1990 to 34 births in 2012 for women age 40-44 and an 84 percent decline for women age 45-49 over the same period (Figure 5.4). The bulk of the decline in fertility since 2002 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. These results indicate that the decline of the TFR has temporarily stalled in Jordan. This phenomenon (stability in the TFR after a long decline) has been observed in neighboring countries, such as Egypt (El-Zanaty and Way, 2009), as well. 0 100 200 300 400 500 600 700 800 900 1000 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women 0-4 5-9 10-14 15-19 52 • Fertility Figure 5.4 Trends in age-specific fertility rates, various sources, 1990-2012 5.4 CHILDREN EVER BORN Table 5.5 presents the distribution of all women and currently married women by the number of children they have had. In the 2012 JPFHS, 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 4.7 children by the end of their reproductive period. Table 5.5 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born, and mean number of living children, according to age group, Jordan 2012 Age Number of children ever born Total Number of women Mean number of children ever born Mean number of living children0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 96.5 2.9 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 4,411 0.04 0.04 20-24 74.7 12.1 8.9 3.8 0.4 0.1 0.0 0.0 0.0 0.0 0.0 100.0 3,588 0.43 0.43 25-29 37.2 13.1 20.4 17.2 8.0 3.5 0.4 0.1 0.2 0.0 0.0 100.0 2,875 1.59 1.55 30-34 21.5 7.9 14.6 20.2 18.4 10.5 4.9 1.2 0.6 0.1 0.1 100.0 2,583 2.68 2.63 35-39 18.8 3.2 6.4 13.1 20.5 16.9 11.4 4.8 3.3 1.2 0.4 100.0 2,430 3.66 3.55 40-44 15.2 2.5 4.2 9.8 15.7 16.9 14.6 8.6 6.6 3.0 3.0 100.0 2,295 4.48 4.33 45-49 14.8 2.6 4.6 11.0 14.4 13.9 11.7 10.2 7.1 4.3 5.5 100.0 1,708 4.67 4.46 Total 48.4 6.7 8.2 9.5 9.2 7.1 4.8 2.6 1.9 0.9 0.9 100.0 19,891 2.03 1.97 CURRENTLY MARRIED WOMEN 15-19 42.8 47.8 9.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 264 0.67 0.65 20-24 24.1 35.8 27.3 11.4 1.3 0.2 0.0 0.0 0.0 0.0 0.0 100.0 1,171 1.31 1.28 25-29 8.5 18.7 29.9 25.3 11.6 5.1 0.6 0.1 0.3 0.0 0.0 100.0 1,935 2.33 2.27 30-34 4.0 9.1 16.9 25.3 22.8 13.2 6.2 1.5 0.7 0.1 0.1 100.0 2,055 3.32 3.24 35-39 4.8 3.2 6.9 15.5 24.3 19.9 13.7 5.8 3.7 1.5 0.5 100.0 2,012 4.32 4.19 40-44 3.8 2.5 4.4 11.0 17.8 19.5 16.8 10.1 7.5 3.2 3.4 100.0 1,944 5.10 4.93 45-49 6.7 2.7 5.0 12.2 14.4 15.3 13.4 11.3 7.9 4.7 6.3 100.0 1,419 5.18 4.94 Total 8.4 11.5 14.5 17.0 16.2 12.7 8.6 4.7 3.3 1.5 1.5 100.0 10,801 3.61 3.50 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 Births per 1,000 women Age group JPFHS 1990 JPFHS 1997 JPFHS 2002 JPFHS 2007 JPFHS 2009 JPFHS 2012 Fertility • 53 Differences in the mean number of children born and living are notable after women have reached the age of 40. Caution should be exercised in interpreting the data for women in the oldest age groups because of possible recall problems; older women are more likely to omit a child, particularly if the child died at a young age or is living away from the mother. Data in Table 5.5 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 (2.03 and 1.97 children, respectively). The data also indicate that, on average, currently married women have given birth to 2.3 children by their late twenties, 4.3 children by their late thirties, and about 5.2 children by the end of their reproductive period. The mean number of children ever born is 3.6, compared with 3.5 children still living. 5.5 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 5.6. Women in Jordan prefer relatively long birth intervals: the median birth interval among children born in the five years preceding the survey is 31.7 months, 0.5 months longer than that recorded in the 2007 JPFHS. More than two-thirds of all children (68 percent) are born at least two years after their siblings. This figure is only marginally higher than that found in 2007 and 2002, but represents a marked increase when compared with 1997 (56 percent). More than two in five (42 percent) children are born after an interval of three years or longer, compared with 41 percent in 2007, 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 months compared with 32 months). The length of birth intervals varies little according to urban-rural residence, region, and camps. Birth interval is shortest in Jarash and longest in Irbid. Women in Badia areas have shorter birth intervals than women in the non Badia areas. Birth interval increases with education and wealth quintile. Women with no education have a median birth interval about four months shorter than women with secondary and higher education. Similarly, women in the lowest wealth quintile have a birth interval seven months shorter than women in the highest wealth quintile. 54 • Fertility Table 5.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Jordan 2012 Background characteristic Months since preceding birth Total Number of non-first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 * * * * * * 100.0 24 * 20-29 22.6 23.7 30.7 13.7 5.5 3.8 100.0 2,578 25.1 30-39 12.0 14.7 25.2 17.9 13.1 17.2 100.0 3,895 35.1 40-49 6.2 7.9 19.3 14.0 16.7 35.7 100.0 982 49.9 Sex of preceding birth Male 14.6 15.4 25.7 16.6 11.1 16.6 100.0 3,800 32.8 Female 15.5 18.5 27.0 15.1 10.8 13.2 100.0 3,679 30.4 Survival of preceding birth Living 14.5 16.9 26.6 16.0 11.0 15.0 100.0 7,310 31.9 Dead 36.7 18.5 16.3 8.9 5.3 14.2 100.0 169 21.1 Birth order 2-3 19.9 20.2 29.4 13.9 8.3 8.3 100.0 3,809 27.4 4-6 10.0 13.4 22.4 18.8 13.8 21.5 100.0 2,997 38.7 7+ 9.9 13.6 26.4 13.7 13.1 23.3 100.0 673 36.0 Residence Urban 14.8 17.3 26.3 15.0 11.1 15.5 100.0 6,062 31.7 Rural 15.9 15.3 26.7 19.3 10.1 12.7 100.0 1,417 31.6 Region Central 15.1 16.7 26.7 15.3 11.0 15.2 100.0 4,585 31.7 North 14.4 17.3 25.6 17.1 11.0 14.7 100.0 2,142 32.1 South 16.5 17.1 26.3 15.7 10.2 14.2 100.0 751 30.7 Governorate Amman 15.0 16.4 26.1 15.4 10.7 16.4 100.0 2,720 32.3 Balqa 16.1 17.2 28.8 13.9 9.6 14.3 100.0 546 29.5 Zarqa 14.6 18.1 26.7 15.2 12.5 12.9 100.0 1,110 30.7 Madaba 17.1 12.6 28.5 17.5 10.4 14.0 100.0 209 32.3 Irbid 12.9 16.9 24.8 17.3 11.7 16.5 100.0 1,260 34.0 Mafraq 16.5 17.8 28.1 17.1 8.9 11.6 100.0 447 29.5 Jarash 18.5 17.5 26.6 16.2 10.0 11.3 100.0 258 29.4 Ajloun 13.2 18.3 24.1 17.5 12.6 14.2 100.0 178 32.3 Karak 16.2 15.8 28.3 16.0 11.7 12.1 100.0 317 31.2 Tafiela 16.1 18.4 25.5 17.2 9.4 13.4 100.0 120 30.0 Ma'an 18.2 18.5 27.3 13.3 8.8 14.0 100.0 142 29.6 Aqaba 16.2 17.6 22.4 16.0 9.2 18.6 100.0 172 31.2 Badia Badia 17.4 18.2 30.5 15.2 8.4 10.2 100.0 606 28.7 Non Badia 14.8 16.8 26.0 15.9 11.1 15.3 100.0 6,873 32.0 Camps Camp 12.5 16.2 30.7 15.0 12.1 13.6 100.0 320 31.2 Non camp 15.2 16.9 26.1 15.9 10.9 15.0 100.0 7,159 31.7 Education No education 15.9 19.8 29.3 14.1 8.9 12.0 100.0 176 28.1 Elementary 15.6 19.8 26.2 12.2 9.4 16.9 100.0 542 28.9 Preparatory 14.9 17.5 26.0 14.2 10.6 16.8 100.0 1,060 31.0 Secondary 15.6 15.6 26.1 16.1 10.8 15.8 100.0 3,591 32.3 Higher 14.0 17.9 26.7 17.4 11.8 12.3 100.0 2,109 32.0 Wealth quintile Lowest 16.3 19.5 28.5 15.1 9.6 11.0 100.0 1,866 28.7 Second 19.9 18.5 25.0 14.8 10.0 11.8 100.0 1,645 28.8 Middle 12.7 16.4 26.9 16.8 11.2 15.9 100.0 1,570 33.2 Fourth 12.0 14.5 25.5 18.8 11.7 17.4 100.0 1,411 34.6 Highest 12.7 13.7 24.7 13.2 13.2 22.4 100.0 988 35.7 Total 15.0 16.9 26.3 15.9 10.9 14.9 100.0 7,479 31.7 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility • 55 5.6 POSTPARTUM AMENORRHEA, POSTPARTUM ABSTINENCE, AND INSUSCEPTIBILITY The risk of pregnancy is affected by several factors besides marriage patterns. There is a low risk of becoming pregnant during the period after childbirth before the return of menstruation (postpartum amenorrhea) and during the period before the resumption of sexual activity (postpartum abstinence). The duration of amenorrhea is directly related to the duration and intensity of breastfeeding: the longer a woman breastfeeds, the longer she is likely to remain amenorrheic. Since breastfeeding is an important issue in childhood nutrition, only postpartum amenorrhea and postpartum abstinence are considered in this section. Women are considered to be insusceptible when they are not exposed to the risk of pregnancy either because they are amenorrheic or because they are abstaining from sexual activity following a birth, or both. The estimates for postpartum amenorrhea, postpartum abstinence, and insusceptibility are based on current status measures—that is, the proportion of births occurring in the three years before the survey for which mothers were still amenorrheic, abstaining, or insusceptible at the time of the survey. The medians were calculated on the basis of current status proportions at each time period. The data are grouped by two-month intervals for greater stability. Table 5.7 presents the proportion of births in the 36 months preceding the survey for which mothers are amenorrheic, abstaining, and insusceptible. For 13 percent of births, mothers had not experienced the return of menstruation, and for 5 percent of births, mothers had not resumed sexual relations following their last birth. Combining the two conditions indicates that for 13 percent of births, mothers were still insusceptible to the risk of pregnancy. The mean duration of amenorrhea is about five months; the mean duration of abstinence is about two months. Table 5.7 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Jordan 2012 Months since birth Percentage of births for which the mother is: Number of births Amenorrheic Abstaining Insusceptible1 < 2 95.1 82.4 96.2 216 2-3 52.4 14.2 52.8 323 4-5 30.2 1.0 31.1 307 6-7 26.2 0.8 26.6 300 8-9 12.1 0.6 12.7 272 10-11 10.5 0.2 10.5 328 12-13 8.0 0.2 8.2 345 14-15 7.6 0.2 7.6 311 16-17 1.1 0.3 1.4 284 18-19 4.2 0.7 4.9 321 20-21 1.3 2.4 3.7 361 22-23 0.6 0.9 1.5 329 24-25 0.3 0.2 0.5 334 26-27 0.3 0.0 0.3 263 28-29 0.1 0.1 0.1 324 30-31 0.4 0.3 0.7 365 32-33 4.0 0.4 4.4 360 34-35 0.0 0.2 0.2 303 Total 12.5 4.5 13.0 5,648 Median 3.1 1.8 3.1 na Mean 5.4 2.4 5.5 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth. 56 • Fertility For 95 percent of births, mothers were still amenorrheic in the first two months following childbirth. The percentage drops to 52 between two and three months after birth, and drops further to 30 percent in the subsequent two months. In Jordan, as in other Islamic societies, women observe sexual abstinence after childbirth. The period of postpartum abstinence traditionally lasts 40 days. The observance of this practice is noticeable in the 2012 JPFHS data. Mothers of 82 percent of the children born during the two months before the survey were still abstaining from sexual relations at the time of the survey. For births two and three months before the survey, 14 percent of mothers were still abstaining, with the percentage declining to 1 percent and below in subsequent months. Table 5.8 presents the median duration of postpartum amenorrhea (3.1 months), postpartum abstinence (1.8 months), and postpartum insuscepti- bility (3.1 months). There is no clear pattern for the three medians by background characteristics. For example, the duration of postpartum amenorrhea and, consequently, insusceptibility both decline slightly with increasing level of education. Postpartum insusceptibility is one month lower among women who live in the South region than among women in the Central region. Women in the lowest wealth quintile are insusceptible for about two months less than women in the highest wealth quintile. Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Jordan 2012 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother's age 15-29 2.9 1.7 3.0 30-49 3.2 1.8 3.2 Residence Urban 3.2 1.8 3.2 Rural 2.7 1.7 2.8 Region Central 3.3 1.9 3.4 North 2.8 1.6 3.0 South 2.3 1.7 2.4 Governorate Amman 3.6 (2.0) 3.6 Balqa * * * Zarqa 2.9 * 2.9 Madaba 3.3 * 3.4 Irbid 2.6 * 2.8 Mafraq 3.3 * 3.4 Jarash 3.0 (1.4) 3.2 Ajloun * * 2.7 Karak * * * Tafiela 3.6 * 3.7 Ma'an 3.4 * 3.4 Aqaba * * * Badia Badia 3.0 (1.6) 3.0 Non Badia 3.1 1.8 3.1 Camps Camp 3.4 * 3.4 Non camp 3.0 1.8 3.1 Education No education * * * Elementary * * * Preparatory 3.4 (2.3) 3.5 Secondary 3.2 1.7 3.3 Higher 2.9 1.7 3.0 Wealth quintile Lowest 2.5 1.5 2.5 Second 3.4 1.7 3.5 Middle 2.7 1.7 2.9 Fourth 3.0 (2.0) 3.0 Highest 4.4 * 4.5 Total 3.1 1.8 3.1 Note: Medians are based on the status at the time of the survey (current status). Figures in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth. Fertility • 57 5.7 MENOPAUSE This section addresses menopause (i.e., termination of exposure to pregnancy and childbearing) for women age 30-49. Exposure to pregnancy is affected by the terminal amenorrhea of older women. Table 5.9 shows the percentage of ever-married women age 30-49 who are menopausal. For the purpose of this survey, lack of a menstrual period in the six months preceding the survey among women who are neither pregnant nor postpartum amenorrheic is taken as evidence of menopause, and therefore infecundity. Table 5.9 shows few cases of menopausal women under the age of 40. Beyond this age, the percentage of menopausal women increases with age. The proportion rises from 2 percent among women age 42-43 to 13 percent among those age 46-47, and further to 21 percent for women age 48-49. 5.8 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 contributed to the overall decline in fertility. Table 5.10 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 2007 and 2012, but has declined by almost one year between 1997 and 2012. 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. For example, women age 25-29 give birth to their first child one year later than women age 45-49. Table 5.10 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Jordan 2012 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 96.5 4,411 a 20-24 0.0 3.6 10.8 na na 74.7 3,588 a 25-29 0.0 3.8 14.3 29.0 51.9 37.2 2,875 24.7 30-34 0.1 6.0 16.9 30.9 52.5 21.5 2,583 24.6 35-39 0.0 7.4 22.3 38.0 56.5 18.8 2,430 24.0 40-44 0.0 7.2 22.4 39.4 63.4 15.2 2,295 23.2 45-49 0.5 7.6 21.4 36.9 58.0 14.8 1,708 23.6 25-49 0.1 6.2 19.1 34.4 56.1 22.6 11,892 24.0 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group. Table 5.9 Menopause Percentage of ever-married women age 30-49 who are menopausal, by age, Jordan 2012 Age Percentage menopausal1 Number of women 30-34 0.5 2,136 35-39 0.3 2,098 40-41 1.4 888 42-43 2.0 747 44-45 6.3 785 46-47 12.8 638 48-49 21.4 568 Total 3.8 7,860 1 Percentage of ever-married women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey. 58 • Fertility Table 5.11 presents the differentials in age at first birth among women age 25-49 by background characteristics. Rural women begin childbearing half a year later than urban women (24.5 years compared with 23.9 years), and a similar pattern is seen between the non Badia and Badia areas (24.1 years compared with 23.6 years, respectively) and non camp and camp areas (24.1 years and 23.3 years, respectively). There are smaller differences in the median age at first birth by region, while there are noticeable variations according to governorates. The median age at first birth varies from 23.1 years in Zarqa to 24.9 years in Madaba. Contrary to the pattern seen in most other countries, the median age at first birth is two years higher among women with no education (24.5 years) than among women with secondary education (22.4 years). Not surprisingly, women in the poorest households have their first child more than a year earlier than women in the wealthiest households (23.5 versus 24.8). Table 5.11 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Jordan 2012 Background characteristic Women age 25-49 Residence Urban 23.9 Rural 24.5 Region Central 23.9 North 24.2 South 24.3 Governorate Amman 24.0 Balqa 24.8 Zarqa 23.1 Madaba 24.9 Irbid 24.4 Mafraq 23.9 Jarash 23.7 Ajloun 24.0 Karak a Tafiela 23.8 Ma'an 23.8 Aqaba 23.5 Badia Badia 23.6 Non Badia 24.1 Camps Camp 23.3 Non camp 24.1 Education No education 24.5 Elementary 22.9 Preparatory 21.3 Secondary 22.4 Higher a Wealth quintile Lowest 23.5 Second 24.1 Middle 23.5 Fourth 24.1 Highest 24.8 Total 24.0 a = Omitted because less than 50 percent of the women had a birth before reaching age 25. Fertility • 59 5.9 TEENAGE FERTILITY Table 5.12 shows the extent of fertility among women age 15-19. This issue is a major social and health concern because teenage mothers and their children usually have a higher risk of illness and death. At the same time, women who become mothers in their teens are more likely to curtail their education. Table 5.12 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Jordan 2012 Background characteristic Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Have had a live birth Are pregnant with first child Age 15 0.0 0.1 0.1 815 16 0.9 0.3 1.2 883 17 2.1 0.8 2.9 974 18 5.5 1.4 6.9 912 19 9.1 2.8 11.9 827 Residence Urban 3.8 1.2 5.0 3,634 Rural 2.0 0.4 2.4 774 Region Central 3.8 0.8 4.5 2,750 North 3.5 1.6 5.1 1,278 South 1.2 1.5 2.6 412 Governorate Amman 4.2 0.6 4.8 1,784 Balqa 2.4 1.1 3.4 304 Zarqa 3.5 0.9 4.4 540 Madaba 2.8 1.2 4.0 117 Irbid 3.9 2.0 5.9 839 Mafraq 2.6 0.7 3.3 219 Jarash 3.4 0.9 4.3 139 Ajloun 1.6 0.7 2.3 86 Karak 1.2 0.0 1.2 140 Tafiela 0.8 0.5 1.4 62 Ma'an 1.8 0.9 2.7 80 Aqaba 1.1 4.6 5.7 108 Badia Badia 2.9 0.8 3.7 300 Non Badia 3.5 1.1 4.6 4,111 Camps Camp 2.0 1.2 3.2 351 Non camp 3.4 1.0 4.4 4,272 Education No education * * * 8 Elementary 6.9 1.7 8.6 86 Preparatory 3.0 0.4 3.4 2,080 Secondary 6.7 2.7 9.4 1,271 Higher 0.1 0.3 0.4 925 Wealth quintile Lowest 3.6 0.6 4.1 964 Second 4.0 0.9 4.9 894 Middle 5.5 2.1 7.6 748 Fourth 2.7 1.6 4.3 1,002 Highest 1.8 0.1 1.8 905 Total 3.5 1.1 4.5 4,411 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 60 • Fertility The level of fertility among teenagers in Jordan is low; only 5 percent have begun childbearing. This percentage is similar to that found in 2007 (4 percent). Teenage pregnancy is twice as high in urban as in rural areas. Teenage pregnancy is much higher in the Central and North regions than in the South. Teenage pregnancy varies from a low of 1 percent in Karak and Tafiela to a high of 6 percent in Aqaba and Irbid. The most significant differentials are found by age and education. At age 15 less than 1 percent of women have begun childbearing, but this increases steadily to 7 percent by age 18 and by age 19, 12 percent have become mothers or are pregnant with their first child. The relationship between early childbearing and education is mixed. Teenage pregnancy is higher among women with elementary or secondary education than among women with preparatory or higher education. Similarly, teenage childbearing and wealth do not have a consistent pattern. Teenage pregnancy is highest among women in the middle wealth quintile and lowest among women in the highest wealth quintile. Fertility Preferences • 61 FERTILITY PREFERENCES 6 his chapter addresses questions about the need for contraception and the extent of unwanted fertility. Information collected from respondents includes their desire for more children, the gender they would prefer, and the length of time women want to wait before their next child. Respondents were also asked about the number of children they would like to have if they could start anew. Two other issues are also examined: the extent to which unwanted and mistimed births occur and the effect that preventing such births would have on fertility rates. Survey questions on fertility preferences have often been the subject of criticism. First, it is suggested that the answers respondents give are misleading because they may reflect uninformed, ephemeral views held with little conviction. Critics also argue that the questions do not take into account the effects of social pressure or the attitudes of other family members—particularly the husband, who may exert considerable influence on the wife’s reproductive decisions. The first objection is probably not relevant in Jordan because family planning is widely used (presumably to realize fertility preferences). The second objection is correct in principle, but evidence from surveys in which both spouses are interviewed suggests that there are no significant differences between husbands and wives regarding their fertility preferences. Women who were pregnant at the time of the survey were asked whether they would want to have another child later. Taking into account the way in which the preference variable is defined for pregnant women, a current pregnancy is treated as being equivalent to a living child. Women who have been sterilized are classified as wanting no more children. 6.1 DESIRE FOR CHILDREN Women’s preferences concerning future childbearing serve as indicators of future fertility. However, sterilized women and women who state that they are infecund (declared infecund) have no impact on future fertility, because their potential contribution to fertility has been curtailed. T Key Findings • More than half (53 percent) of currently married women age 15-49 want no more children or are sterilized. • The desire to stop childbearing among married women has increased only slightly in the past five years, from 51 percent in 2007 to 53 percent in 2012. • Women report an ideal family size of about four children. The mean ideal number of children among ever-married women has not changed in the last five years. • Overall, the current fertility rate in Jordan is about one child more per woman than it would be if all unwanted births were avoided. This implies that the total fertility rate of 3.5 children per woman is 46 percent higher than it would be if unwanted births were avoided. 62 • Fertility Preferences Table 6.1 and Figure 6.1 show that half (53 percent) of currently married women either want no more children at any time in the future or are sterilized. These figures show an increase of about 2 percentage points since the 2007 JPFHS (51 percent). The findings also show that 23 percent of currently married women want to have another child later (after two or more years); this figure is about 3 percentage points less than that recorded in the 2007 JPFHS (26 percent). In general, about 74 percent of currently married women in Jordan have a potential need for family planning services for limiting or spacing their births. This figure is close to the one recorded in the 2007 JPFHS (73 percent). Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Jordan 2012 Desire for children Number of living children1 Total 15-49 0 1 2 3 4 5 6+ Have another soon2 82.8 43.0 19.0 14.9 8.4 5.6 2.6 18.4 Have another later3 1.7 48.2 47.1 32.8 15.6 8.0 2.5 23.1 Have another, undecided when 0.9 0.4 0.5 0.3 0.1 0.5 0.0 0.3 Undecided 0.5 0.6 2.8 3.1 3.4 2.2 1.1 2.2 Want no more 0.8 5.7 29.3 45.6 69.6 79.1 80.5 50.6 Sterilized4 0.0 0.0 0.7 0.6 1.1 1.5 8.7 2.2 Declared infecund 13.3 2.1 0.6 2.7 1.8 3.1 4.6 3.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 678 1,239 1,703 1,949 1,789 1,458 1,986 10,801 1 The number of living children includes the current pregnancy. 2 Wants next birth within 2 years. 3 Wants to delay next birth for 2 or more years. 4 Includes both female and male sterilization. Figure 6.1 Fertility preferences of currently married women age 15-49 The desire for childbearing is strongly associated with the number of children that a woman has. Eighty-five percent of women who have not started childbearing by the time of the survey want to have a child, and the majority (83 percent) want to have this child soon, that is, within the next two years. Ninety- Have another soon 18% Have another later 23% Have another, undecided when 0% Undecided 2% Want no more 51% Sterilized 2% Declared infecund 4% JPFHS 2012 <1% Fertility Preferences • 63 two percent of women who have one child want to have another child, but the majority (48 percent) want to wait at least two years before having the next child. Among those who have more than one child, the desire to stop childbearing increases rapidly with the number of children they have—from 30 percent among women who have two children to 89 percent among those with six children or more, including 9 percent who are sterilized. Thirteen percent of childless women declared themselves infecund, probably because they are or believe that they are sterile. The proportion of sterilized women has decreased slightly while the proportion of infecund women has increased since the 2007 JPFHS. Differentials in the desire to stop childbearing are presented in Table 6.2. In general, women living in urban areas are slightly more likely to want to stop childbearing than rural women. Women in the Central and South regions are more likely to want to stop childbearing than women in the North region. This preference also varies according to governorate (ranging from 46 percent in Mafraq to 56 percent in Amman) and according to residence in Badia areas (50 percent of women living in Badia areas compared to 53 percent for other women). The same pattern is seen when the data are analyzed on the basis of the number of living children a woman has. Table 6.2 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Jordan 2012 Background characteristic Number of living children1 Total 0 1 2 3 4 5 6+ Residence Urban 0.9 6.0 31.8 47.0 72.3 80.9 89.1 53.2 Rural 0.0 4.4 20.3 41.5 61.9 79.3 89.6 50.5 Region Central 1.0 5.5 35.7 49.7 74.6 82.4 89.9 55.0 North 0.4 5.0 19.5 37.8 62.0 77.4 87.8 47.4 South 0.5 9.1 21.1 43.8 69.0 76.8 89.4 53.2 Governorate Amman 0.0 5.8 41.5 52.0 76.7 82.7 90.7 56.2 Balqa (0.0) 4.4 23.1 45.9 67.4 80.6 90.2 52.9 Zarqa 3.9 5.0 29.6 46.7 72.7 83.3 87.6 54.2 Madaba 0.0 6.5 18.6 41.5 71.6 75.8 89.7 48.9 Irbid 0.4 6.4 21.5 39.8 65.8 79.5 87.7 47.6 Mafraq 0.0 1.2 13.8 35.9 48.4 75.3 90.3 46.0 Jarash (0.0) 1.9 14.2 27.6 65.2 75.5 84.5 47.9 Ajloun 1.7 3.5 22.6 35.6 51.8 70.0 87.9 48.5 Karak 0.0 11.3 16.1 40.0 71.8 79.8 89.0 52.1 Tafiela (0.0) 6.6 25.2 43.9 74.1 76.5 90.7 54.9 Ma'an (0.0) 16.8 22.5 39.8 48.6 69.6 92.8 54.7 Aqaba (2.3) 4.5 25.8 50.1 73.8 77.0 85.6 52.8 Badia Badia 0.0 3.3 19.0 42.1 44.0 72.1 92.1 49.5 Non Badia 0.8 5.8 30.7 46.5 72.1 81.2 88.9 53.0 Camps Camp (2.6) 2.4 20.3 43.1 69.5 72.9 86.8 55.9 Non camp 0.7 5.8 30.3 46.3 70.8 81.0 89.3 52.7 Education No education * * (28.8) (37.4) (67.8) (63.9) 90.1 63.1 Elementary 0.0 1.7 34.3 45.6 75.9 74.7 90.0 61.4 Preparatory 0.0 12.8 26.9 46.0 72.0 74.0 93.3 61.1 Secondary 1.1 3.9 29.5 41.2 70.2 83.5 86.5 53.3 Higher 1.0 5.7 31.0 53.2 70.1 82.1 88.8 45.5 Wealth quintile Lowest 0.0 3.9 27.6 43.7 63.1 73.3 90.3 56.4 Second 1.5 5.3 25.7 39.8 65.9 77.0 88.1 49.7 Middle 0.2 2.6 26.2 40.4 67.2 82.3 87.9 48.4 Fourth 0.2 8.3 26.3 44.9 73.2 86.2 91.3 52.2 Highest (2.2) 8.1 44.5 59.3 82.6 82.3 87.4 58.4 Total 0.8 5.7 30.0 46.2 70.7 80.6 89.2 52.8 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The number of living children includes the current pregnancy. 64 • Fertility Preferences Education is negatively associated with the desire to stop childbearing. The proportion of women who want no more children decreases as the level of education increases, from 63 percent among uneducated women to 46 percent among women who have more than secondary education. However, the relationship between education and the desire to limit childbearing is mixed when analyzed by the number of living children. An inverse relationship between education and the desire to limit childbearing is only true of women with four children. The desire to limit childbearing is higher among women with elementary education than women with higher education when the number of living children is two or four. The impact of education diminishes for women with six or more children. The data presented in Table 6.2 also show that overall there is a U-shaped association between the desire of women to stop childbearing and household wealth. The percentage of women who want no more children decreases from 56 percent among women in the lowest wealth quintile to 48 percent among women in the middle wealth quintile and increases again to 58 percent among women in the highest wealth quintile. However, there is no consistent association between the desire to stop childbearing and household wealth when analyzing data on the basis of the number of living children; however, women in the highest quintile are the most likely to want to stop childbearing at 2, 3, and 4 children. 6.2 IDEAL NUMBER OF CHILDREN The focus of this chapter is on the future reproductive intentions of women, implicitly taking into account their number of living children. To ascertain her ideal number of children, the respondent was asked to consider—abstractly and independently of her actual family size—the number of children she would choose if she could start childbearing again. There is usually a correlation between actual and ideal number of children. The reason is twofold. First, to the extent that women implement their preferences, those who want larger families tend to achieve larger families. Second, women may adjust their ideal family size upwards as their actual number of children increases. It is also possible that women with large families have larger ideal family sizes, because of attitudes they acquired 20 to 30 years ago. Despite the likelihood that some rationalization occurs in the determination of ideal family size, respondents often state ideal family sizes that are lower than their actual number of surviving children. The data in Table 6.3 can be grouped into three categories. The first group is women who have reached their ideal family size—that is, women whose ideal number of children is exactly the same as the number of living children; it is represented by data along the diagonal line from 0 to 6+ children. The second group consists of women whose surviving children have exceeded their ideal family size (shown by data above the diagonal); the last group consists of women who have not reached their ideal family size (shown by data below the diagonal). The second category is of particular interest, because it permits the calculation of surplus or unwanted fertility (discussed in the next section). The data in Table 6.3 indicate that 63 percent of ever-married women consider the ideal family size to be at least four children, compared with 56 percent in the 2007 JPFHS. Only 18 percent of ever- married women report an ideal family size of two children, the number that is just below replacement level fertility. The mean ideal number of children among ever-married women and currently married women is identical (3.9). Of concern to family planning program managers is the fact that about two-thirds of women with five or more children have already exceeded their ideal family size, in many cases by two or more children. Fertility Preferences • 65 Table 6.3 Ideal number of children by number of living children Percent distribution of ever-married women 15-49 by ideal number of children, and mean ideal number of children for ever-married women and for currently married women, according to the number of living children, Jordan 2012 Ideal number of children Number of living children1 Total 0 1 2 3 4 5 6+ 0 1.4 0.9 1.0 0.9 0.7 0.7 1.0 0.9 1 3.3 2.8 3.6 3.4 2.0 1.1 0.5 2.3 2 31.0 22.8 22.7 15.8 20.1 13.7 9.6 18.1 3 13.0 20.2 15.3 13.5 6.5 9.6 6.7 11.6 4 35.6 41.2 44.1 47.0 47.0 40.2 39.5 42.8 5 3.8 5.4 4.7 7.8 7.2 14.6 7.6 7.5 6+ 8.1 5.9 6.4 8.6 13.4 17.4 26.6 13.1 Non-numeric responses 3.9 0.8 2.2 3.1 3.0 2.6 8.4 3.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of ever-married women 854 1,315 1,778 1,999 1,862 1,491 2,054 11,352 Mean ideal number children for:2 Ever-married women 3.4 3.5 3.5 3.8 3.9 4.3 4.7 3.9 Number of ever-married women 820 1,305 1,738 1,936 1,806 1,452 1,882 10,938 Currently married women 3.5 3.5 3.5 3.8 3.9 4.3 4.7 3.9 Number of currently married women 646 1,230 1,666 1,889 1,734 1,419 1,816 10,399 1 The number of living children includes the current pregnancy. 2 Means are calculated excluding respondents who gave non-numeric responses. Compared with the 2007 JPFHS, the percentage of women in the 2012 JPFHS who did not give a numeric response to the hypothetical question on ideal family size decreased substantially from 18 percent to 4 percent. Failure to give a definite answer suggests either an absence of conscious consideration given to the matter or a strong belief that family size is determined by God. Table 6.4 presents the mean ideal number of children by background characteristics. The mean ideal number of children in Jordan increases with age, from 3.4 children for ever-married women in the youngest age group (15-19) to 4.0 children among women age 35-39 and to 4.5 among the oldest cohort of women (45-49). In general, women living in rural areas, women in the Badia areas, women in camp areas, and women in Ajloun and Ma’an have a slightly higher ideal family size than their counterparts in the other areas. 66 • Fertility Preferences Table 6.4 Mean ideal number of children by background characteristics Mean ideal number of children for ever-married women age 15-49 by background characteristics, J

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