Kyrgyz Republic - Demographic and Health Survey - 1998

Publication date: 1998

World Summit for Children Indicators: Kyrgyz Republic 1997 __________________________________________________________________________________________________ Value__________________________________________________________________________________________________ BASIC INDICATORS__________________________________________________________________________________________________ Childhood mortality Infant mortality rate 61 per 1,000 Under-five mortality rate 72 per 1,000 Maternal mortality Maternal mortality ratio 72 per 100,0001 Childhood undernutrition Percent stunted (of children under 3 years) 24.8 Percent wasted (of children under 3 years) 3.4 Percent underweight (of children under 3 years) 11.0 Clean water supply Percent of households within 15 minutes of a safe water supply2 69.2 Sanitary excreta disposal Percent of households with flush toilets or VIP latrines 22.9 Basic education Percent of women 15-49 with completed primary education 99.1 Percent of men 15-49 with completed primary education 99.2 Percent of girls 6-12 attending school 82.3 Percent of boys 6-12 attending school 83.8 Percent of women 15-49 who are literate 99.6 Children in especially Percent of children who are orphans (both parents dead) 0.1 difficult situations Percent of children who do not live with their natural mother 6.7 Percent of children who live in single adult households 2.6 __________________________________________________________________________________________________ SUPPORTING INDICATORS__________________________________________________________________________________________________ Women's Health Birth spacing Percent of births within 24 months of a previous birth3 29.6 Safe motherhood Percent of births with medical antenatal care 97.4 Percent of births with antenatal care in first trimester 72.2 Percent of births with medical assistance at delivery 98.1 Percent of births in a medical facility 95.8 Percent of births at high risk 43.3 Family planning Contraceptive prevalence rate (any method, married women) 59.5 Percent of currently married women with an unmet demand for family planning 11.6 Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 10.0 Nutrition Maternal nutrition Percent of mothers with low BMI 4.7 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 6.3 Breastfeeding Percent of children under 4 months who are exclusively breastfed 30.1 Iodine Percent of households with iodized salt 27.2 Child Health Measles Percent of children age 12-23 months with measles vaccination 85.4 Full vaccination Percent of children age 12-23 months fully vaccinated 82.2 Diarrhea control Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 43.9 Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel 48.0 __________________________________________________________________________________________________ 1 Data from the Ministry of Health 2 Piped, well, and bottled water 3 First births are excluded. Kyrgyz Republic Demographic and Health Survey 1997 Research Institute of Obstetrics and Pediatrics Ministry of Health of the Kyrgyz Republic Bishkek City, Kyrgyz Republic Macro International Inc. Calverton, Maryland USA August 1998 This report summarizes the findings of the 1997 Kyrgyz Republic Demographic and Health Survey (KRDHS) conducted by the Research Institute of Obstetrics and Pediatrics, Ministry of Health of the Kyrgyz Republic. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development (USAID). The KRDHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Kyrgyz Republic survey may be obtained from the Research Institute of Obstetrics and Pediatrics, 1 Togolok Moldo St., Bishkek, Kyrgyz Republic (telephone: 996-3312-264423 and fax: 996-3312-660500). Additional information about the DHS program may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA (telephone: 301-572-0200 and fax: 301-572-0999). Recommended citation: Research Institute of Obstetrics and Pediatrics [Kyrgyz Republic] and Macro International Inc. 1998. Kyrgyz Republic Demographic and Health Survey, 1997. Calverton, Maryland: Research Institute of Obstetrics and Pediatrics, Ministry of Health of the Kyrgyz Republic and Macro International Inc. iii CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of the Kyrgyz Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Naken K. Kasiev 1.1 Geography, Population and Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 History of the Kyrgyz Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.3 Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.5 Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6 Demographic and Health Data Collection System in the Kyrgyz Republic . . . . . . . . . . 5 1.7 Objectives and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.7.1 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.7.2 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.7.3 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.7.4 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.7.5 Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . 11 Talaibek S. Builashev and Abdumanap A. Muratov 2.1 Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.1.1 Sex and Age Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.1.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.2 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.2.1 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.3 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.3.1 Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.3.2 Educational Level of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3.3 School Attendance and Reasons for Leaving School . . . . . . . . . . . . . . . . . . . . 20 2.3.4 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.3.5 Women's Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.3.6 Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.3.7 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 iv Page 2.3.8 Decisions on Use of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.3.9 Child Care While Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Naken K. Kasiev, Duishe K. Kudayarov and Talaibek S. Builashev 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.2 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.3 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.4 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.5 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.6 Pregnancy and Motherhood Among Women Age 15-19 . . . . . . . . . . . . . . . . . . . . . . . . 37 CHAPTER 4 CONTRACEPTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Talaibek S. Builashev, Jumabubu A. Doskeeva and Maken S. Mysyraliev 4.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.5 Knowledge of the Fertile Period and of the Contraceptive Effect of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.6 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.8 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.9 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.10 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . . . . . . . . 57 4.11 Acceptability of Use of Electronic Media to Disseminate Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.12 Exposure to Family Planning Messages in Print Media . . . . . . . . . . . . . . . . . . . . . . . . 58 4.13 Attitudes of Couples toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 CHAPTER 5 INDUCED ABORTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Jeremiah M. Sullivan, Talaibek S. Builashev and Guldana D. Duishenbieva 5.1 Pregnancy Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.2 Lifetime Experience with Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 5.3 Rates of Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 5.4 Trends in Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.5 Abortion Rates from the Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 5.6 Contraceptive Use before Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 5.7 Service Providers and Medical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 5.8 Complications of Abortion and Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . . 73 Kia I. Weinstein, Talaibek S. Builashev and Gulnara U. Asimbekova 6.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 v Page 6.2 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6.3 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 6.4 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6.5 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . . 80 6.6 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 CHAPTER 7 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Kia I. Weinstein, Talaibek S. Builashev and Apisa K. Kushbakieva 7.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 7.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 7.3 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 7.4 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 CHAPTER 8 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Naken K. Kasiev, Jeremiah M. Sullivan, Duishe K. Kudayarov and Talaibek S. Builashev 8.1 Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.2 Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 8.3 Infant Mortality Rates from the Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 8.4 Socioeconomic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 96 8.5 Demographic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 8.6 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 CHAPTER 9 MATERNAL AND CHILD HEALTH Talaibek S. Builashev, Jumabubu A. Doskeeva, Janar B. Botbaeva and Abdumanap A. Muratov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 9.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 9.2 Assistance and Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 9.3 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 9.4 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 9.5 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 9.6 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 9.7 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 CHAPTER 10 NUTRITION OF WOMEN AND CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Duishe K. Kudayarov, Apisa K. Kushbakieva, Kalia K. Toguzbaeva and Talaibek S. Builashev 10.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 10.1.1 Initiation of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 10.1.2 Age Pattern of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 10.1.3 Types of Supplemental Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 vi Page 10.2 Nutritional Status of Children under Age Three . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 10.2.1 Measures of Nutritional Status in Childhood . . . . . . . . . . . . . . . . . . . . . . 119 10.2.2 Levels of Child Undernutrition in the Kyrgyz Republic . . . . . . . . . . . . . 121 10.3 Women's Anthropometric Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 CHAPTER 11 ANEMIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Almaz T. Sharmanov, Duishe K. Kudayarov and Kalia K. Toguzbaeva 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 11.2 Anemia Measurement Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 11.3 Anemia Prevalence Among Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 11.4 Anemia Prevalence Among Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Thanh Lê A.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 A.2 Sampling frames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 A.3 Characteristics of the KRDHS Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 A.4 Sample Allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 A.5 Stratification and Systematic Selection of uchastoks and villages . . . . . . . . . . . . . . . 143 A.6 Segmentation of large uchastoks and villages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 A.7 Sampling probabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Mamadou Thiam APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX D SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX E PERSONS INVOLVED IN THE 1997 KYRGYZ REPUBLIC DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 APPENDIX F QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 vii TABLES Page Table 1.1 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.1 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.2 Population by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 2.5 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.6 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.7 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.8 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.9 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.10 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.11 Ethnicity, religion and residence by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.12 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.13 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.14 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.15 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2.16 Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 2.17 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 2.18 Decision on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 2.19 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 3.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.3 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.4 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 3.5 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.6 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.7 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.8 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 3.9 Pregnancy and motherhood among women age 15-19 . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 3.10 Children born to women age 15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.2 Knowledge of contraceptive methods by background characteristics . . . . . . . . . . . . . . 43 Table 4.3 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.4 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.5 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 48 Table 4.6 Use of pill brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.7 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 4.8 Knowledge of the fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 4.9 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 4.10 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.11 Reasons for using current source of supply for contraceptive methods . . . . . . . . . . . . 55 Table 4.12 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.13 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.14 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 viii Page Table 4.15 Exposure to family planning messages on radio and television . . . . . . . . . . . . . . . . . . 58 Table 4.16 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 4.17 Exposure to family planning messages in print media . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 4.18 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 4.19 Wives’ perceptions of their husbands’ attitudes toward family planning . . . . . . . . . . . 62 Table 5.1 Pregnancy outcomes by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5.2 Lifetime experience with indeed abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 5.3 Induced abortion rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.4 Induced abortion rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.5 Trends in age-specific induced abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.6 Comparison of abortion rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.7 Use of contraception prior to pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.8 Source of services, provider and procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 5.9 Health problems following abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 6.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table 6.2 Sexual relationships of nonmarried women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 6.3 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 6.4 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.5 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.6 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 6.7 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 6.8 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 80 Table 6.9 Median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.10 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 7.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 7.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 7.3 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.4 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 7.5 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 7.6 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . 90 Table 7.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table 7.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 8.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 8.2 Trends in infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 8.3 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 97 Table 8.4 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 98 Table 8.5 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 9.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 9.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 103 Table 9.3 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 9.4 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 9.5 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 106 ix Page Table 9.6 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table 9.7 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table 9.8 Prevalence of acute respiratory infection and fever . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 9.9 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 9.10 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 9.11 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 9.12 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 10.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 10.2 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table 10.3 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table 10.4 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . 120 Table 10.5 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . . . . . . 121 Table 10.6 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . . 123 Table 10.7 Anthropometric indicators of female nutritional status . . . . . . . . . . . . . . . . . . . . . . . . 124 Table 10.8 Nutritional status of women by background characteristics . . . . . . . . . . . . . . . . . . . . 125 Table 11.1 Anemia among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Table 11.2 Anemia among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table 11.3 Anemia among children born to anemic mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table A.1 Population of the Kyrgyz Republic, by urban-rural residence, 1997 . . . . . . . . . . . . . 140 Table A.2 Percent distribution of the population, by urban-rural residence, 1997 . . . . . . . . . . . 140 Table A.3 Proportional sample allocation by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . 140 Table A.4 Proposed sample allocation by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table A.5 Number of sample points by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table A.6 Proposed number of sample points by urban-rural residence . . . . . . . . . . . . . . . . . . . 141 Table A.7 Expected number of women by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . 142 Table A.8 Estimated average number of women age 15-49 per household by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table A.9 Average number of households to be selected in each cluster by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table B.1 Selected variables for sampling errors, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . 152 Table B.2 Sampling errors - National sample, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . 153 Table B.3 Sampling errors - Urban, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table B.4 Sampling errors - Rural, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table B.5 Sampling errors - Bishkek City, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . . 156 Table B.6 Sampling errors - North Region, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . 157 Table B.7 Sampling errors - East Region, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . . . 158 Table B.8 Sampling errors - South Region, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . . . . . 159 Table B.9 Sampling errors - Kyrgyz ethnic group, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . 160 Table B.10 Sampling errors - Russian ethnic group, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . 161 Table B.11 Sampling errors - Uzbek ethnic group, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . . 162 Table B.12 Sampling errors - Other ethnic groups, Kyrgyz Republic 1997 . . . . . . . . . . . . . . . . . 163 Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . 168 x Page Table C.3 Completeness of report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Table C.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Table D.1 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 xi FIGURES Page Figure 1.1 Oblast Composition of Regions in the Kyrgyz Republic, 1997 . . . . . . . . . . . . . . . . . . . 7 Figure 2.1 Population Pyramid of the Kyrgyz Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 2.2 School Enrollment by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Figure 3.1 Age-Specific Fertility Rates by Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Figure 3.2 Total Fertility Rate, by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Figure 3.3 Trends in Age-Specific Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Figure 3.4 Percentage of Non-First Births Born Within 24 Months of Previous Birth . . . . . . . . .35 Figure 4.1 Use of Specific Contraceptive Methods Among Currently Married Women . . . . . . . . 47 Figure 4.2 Current Use of Family Planning by Background Characteristics . . . . . . . . . . . . . . . . . 49 Figure 4.3 Distribution of Current Users of Contraception by Source of Supply . . . . . . . . . . . . . 54 Figure 5.1 Age-Specific Rates of Fertility (ASFR) and Induced Abortion (ASAR) . . . . . . . . . . . 67 Figure 5.2 Total Induced Abortion Rate, by Background Characteristics . . . . . . . . . . . . . . . . . . . 68 Figure 6.1 Marital Status of Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Figure 6.2 Percentage of Women Married by Exact Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Figure 7.1 Fertility Preferences Among Currently Married Women 15-49 . . . . . . . . . . . . . . . 84 Figure 7.2 Fertility Preferences Among Currently Married Women, by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Figure 7.3 Percentage of Currently Married Women With Unmet Need and With Met Need for Family Planning Services, by Background Characteristics. . . . . . . . . . . 88 Figure 8.1 Under-five Mortality by Selected Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Figure 9.1 Percent Distribution of Births by Antenatal Care and Delivery Characteristics . . . . . 103 Figure 9.2 Vaccination Coverage Among Children Age 12-23 Months . . . . . . . . . . . . . . . . . . . . 109 Figure 9.3 Prevalence of Respiratory Illness and Diarrhea in the Last 2 Weeks, by Age of the Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Figure 10.1 Prevalence of Stunting, by Age of Child and Length of Birth Interval . . . . . . . . . . . . 122 Figure 10.2 Prevalence of Stunting, by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . 123 Figure 11.1 Prevalence of Moderate Anemia Among Women Age 15-49, by Pregnancy Status and Breastfeeding Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Figure 11.2 Percent Distribution of Women Age 15-49 by Hemoglobin Level . . . . . . . . . . . . . . . 131 xiii LIST OF CONTRIBUTORS Naken K. Kasiev, M.D. Minister of Health, Kyrgyz Republic Ministry of Health 148 Moskovskaya Street Bishkek City, Kyrgyz Republic 720040 Jeremiah M. Sullivan, Ph.D. Deputy Director, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Duishe K. Kudayarov, M.D., Ph.D. Director, Research Institute of Obstetrics and Pediatrics Ministry of Health, Kyrgyz Republic 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Gulnara U. Asimbekova, M.D., Ph.D. Deputy Director, Research Institute of Obstetrics and Pediatrics Ministry of Health, Kyrgyz Republic 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Talaibek S. Builashev, M.D. Deputy Director, Research Institute of Obstetrics and Pediatrics Ministry of Health, Kyrgyz Republic 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Almaz T. Sharmanov, M.D., Ph.D. Health Specialist, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Kia I. Weinstein, Ph.D. Consultant, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Jumabubu A. Doskeeva, M.D. Chief, Department of Maternal and Child Health Ministry of Health, Kyrgyz Republic 148 Moskovskaya Street Bishkek City, Kyrgyz Republic 720040 xiv Guldana D. Duishenbieva, M.D. Senior Gynecologist Ministry of Health, Kyrgyz Republic 148 Moskovskaya Street Bishkek City, Kyrgyz Republic 720040 Apisa K. Kushbakieva M.D. Senior Pediatrician Ministry of Health, Kyrgyz Republic 148 Moskovskaya Street Bishkek City, Kyrgyz Republic 720040 Thanh Lê Sampling Statistician, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Mamadou Thiam Sampling Statistician, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Abdumanap A. Muratov, M.D. Kyrgyz Medical State Academy 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Kalia K. Toguzbaeva, M.D. Research Institute of Obstetrics and Pediatrics Ministry of Health, Kyrgyz Republic 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Janar B. Botbaeva, M.D. Research Institute of Obstetrics and Pediatrics Ministry of Health, Kyrgyz Republic 1, T. Moldo Street Bishkek City, Kyrgyz Republic 720040 Maken S. Mysyraliev, M.D., Ph.D. Kyrgyz Medical State Academy 92, I. Ahynbaeva Street Bishkek City, Kyrgyz Republic 720020 xv PREFACE The 1997 Kyrgyz Republic Demographic and Health Survey (KRDHS) was the first national-level population and health survey in the Kyrgyz Republic. The purpose of the survey was to provide the Ministry of Health of the Kyrgyz Republic with information on fertility, reproductive practices of women, maternal care, child health and mortality, child nutrition practices, breastfeeding, nutritional status and anemia. This information is important for understanding the factors that influence the reproductive health of women and the health and survival of infants and young children. It can be used in planning effective policies and programs regarding the health and nutrition of women and their children. The successful completion of the KRDHS and publication of this volume is due to the contribution of many people. I would like to express my appreciation to the specialists from the Ministry of Health and staff members of the Research Institute of Obstetrics and Pediatrics. The survey fieldwork was completed smoothly and successfully with the help of government officials and public health workers at the levels of oblast, raion, and village in the Kyrgyz Republic. I would like to thank the KRDHS technical staff: Drs. Talaibek Builashev, Beisenbai Tulebekov, Sultanaly Borbiev, Zhanar Botbaeva, Kaliya Toguzbaeva, Abdimanap Muratov, as well as all field coordinators, interviewing teams, and data entry groups for their devotion and sincere efforts in accomplishing the survey activities. I would like to express my special appreciation to Dr. Duishe Kudayarov, KRDHS Executive Director, for efficient management and coordination of this study. The KRDHS would not have been feasible without technical assistance, which was provided by the Demographic and Health Surveys (DHS) program of Macro International Inc., and the financial support of the U.S. Agency for International Development. First, I would like to thank Dr. Jeremiah M. Sullivan, DHS Deputy Director, for assisting with overall project design, analyses of the survey results, and report production, and Mr. Fred Arnold, Deputy Director of MEASURE Project, for his help during the initial stages of the survey. I would also like to thank: Dr. Almaz Sharmanov, for assisting with questionnaire development, field staff training, analysis of the survey results, and writing some of the chapters in this report; Mr. Trevor Croft for writing the computer programs, setting up the data processing operation, and producing the tabulations; and Ms. Thanh Lê for the sampling design. Special thanks are also due to Dr. Kia Weinstein for writing chapters of this report, Mr. Mamadou Thiam for estimation of sampling errors, Dr. Sidney Moore for editing the manuscript, and Ms. Celia Siebenmann for report production. I would like to thank Dr. Tilek Meimanaliev, Director of the Health Reform Program, “Manas”, as well as many others whose names are listed in Appendix E. I hope that the findings of the KRDHS will become a useful source of information for the ongoing health care reform in the Kyrgyz Republic. Dr. Naken Kasiev KRDHS National Director Minister of Health The Kyrgyz Republic xvii SUMMARY OF FINDINGS Naken K. Kasiev The 1997 the Kyrgyz Republic Demographic and Health Survey (KRDHS) is a nationally representative survey of 3,848 women age 15-49. Fieldwork was conducted from August to November 1997. The KRDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Research Institute of Obstetrics and Pediatrics implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program. PURPOSE The purpose of the KRDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, nutritional status, and anemia. Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, and ethnicity. Additionally, the survey provides statistics on some issues not previously available in the Kyrgyz Republic: for example, breastfeeding practices and anemia status of women and children. When considered together, existing MOH data and the KRDHS data provide a more complete picture of the health conditions in the Kyrgyz Republic than was previously available. FERTILITY Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of the Kyrgyz Republic of 3.4 children per woman. Fertility levels differ for different population groups. The TFR for women living in urban areas (2.3 children per woman) is substantially lower than for women living in rural areas (3.9). The TFR for Kyrgyz women (3.6 children per woman) is higher than for women of Russian ethnicity (1.5) but lower than Uzbek women (4.2). Among the regions of the Kyrgyz Republic, the TFR is lowest in Bishkek City (1.7 children per woman), and the highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and3.9, respectively). Time Trends. The KRDHS data show that fertility has declined in the Kyrgyz Republic in recent years. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year olds to a 38 percent decline among 35-39 year olds. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 40-49 is 4.6 children which is more than one child greater than the current TFR (3.4). Birth Intervals. Overall, 30 percent of births in the Kyrgyz Republic take place within 24 months of the previous birth. The median birth interval is 31.9 months. Age at Onset of Childbearing. The median age at which women in the Kyrgyz Republic begin childbearing has been holding steady over the past two decades at approximately 21.6 years. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20. Nearly half of married women in the Kyrgyz Republic (45 percent) do not want to have more children. Additional one-quarter of women (26 percent) want to delay their next birth by at least two years. These are the women who are potentially in need of some method of family planning. xviii FAMILY PLANNING Ever Use. Among currently married women, 83 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30-44 (among both currently married and all women). Current Use. Overall, among currently married women, 60 percent report that they are currently using a contraceptive method. About half (49 percent) are using a modern method of contraception and another 11 percent are using a traditional method. The IUD is by far the most commonly used method; 38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills (2 percent), condoms (6 percent), and injectables and female sterilization (1 and 2 percent, respectively). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD. Source of Methods. The vast majority of women obtain their contraceptives through the public sector (97 percent): 35 percent from a government hospital, and 36 percent from a women counseling center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at women counseling centers (42 percent) or hospitals (39 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also obtain supplies from women counseling centers or (33 percent). Fertility Preferences. A majority of women in the Kyrgyz Republic (45 percent) indicated that they desire no more children. By age 25-29, 20 percent want no more children, and by age 30-34, nearly half (46 percent) want no more children. Thus, many women come to the preference to stop childbearing at relatively young ages—when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization. However, there is a deficiency of use of this method in the Kyrgyz Republic. In the interests of providing a broad range of safe and effective methods, information about and access to sterilization should be increased so that individual women can make informed decisions about using this method. INDUCED ABORTION Abortion Rates. From the KRDHS data, the total abortion rate (TAR)—the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates—was calculated. For the Kyrgyz Republic, the TAR for the period from mid-1994 to mid-1997 is 1.6 abortions per woman. The TAR for the Kyrgyz Republic is lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakhstan (1.8), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively), but higher than for Uzbekistan (0.7). The TAR is higher in urban areas (2.1 abortions per woman) than in rural areas (1.3). The TAR in Bishkek City is 2.0 which is two times higher than in other regions of the Kyrgyz Republic. Additionally the TAR is substantially lower among ethnic Kyrgyz women (1.3) than among women of Uzbek and Russian ethnicities (1.9 and 2.2 percent, respectively). INFANT MORTALITY In the KRDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992). Mortality Rates. For the five-year period before the survey (i.e., approximately mid-1992 to mid- 1997), infant mortality in the Kyrgyz Republic is estimated at 61 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 32 and 30 per 1,000. xix The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the KRDHS. Infant mortality rates based on the MOH data for the years 1983 through 1996 show a persistent declining trend throughout the period, starting at about 40 per 1,000 in the early 1980s and declining to 26 per 1,000 in 1996. This time trend is similar to that displayed by the rates estimated from the KRDHS. Thus, the estimates from both the KRDHS and the Ministry document a substantial decline in infant mortality; 25 percent over the period from 1982-87 to 1992-97 according to the KRDHS and 28 percent over the period from 1983-87 to 1993-96 according to the MOH estimates. This is strong evidence of improvements in infant survivorship in recent years in the Kyrgyz Republic. It should be noted that the rates from the survey are much higher than the MOH rates. For example, the KRDHS estimate of 61 per 1,000 for the period 1992-97 is twice the MOH estimate of 29 per 1,000 for 1993-96. Certainly, one factor leading to this difference are the differences in the definitions of a live birth and infant death in the KRDHS survey and in the MOH protocols. A thorough assessment of the difference between the two estimates would need to take into consideration the sampling variability of the survey’s estimate. However, given the magnitude of the difference, it is likely that it arises from a combination of definitional and methodological differences between the survey and MOH registration system. MATERNAL AND CHILD HEALTH The Kyrgyz Republic has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women counseling centers, and doctor’s assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout the rural areas. Delivery. Virtually all births in the Kyrgyz Republic (96 percent) are delivered at health facilities: 95 percent in delivery hospitals and another 1 percent in either general hospitals or FAPs. Only 4 percent of births are delivered at home. Almost all births (98 percent) are delivered under the supervision of medically trained persons: 61 percent by a doctor and 37 percent by a nurse or midwife. Antenatal Care. As expected, the survey data indicate that a high proportion of respondents (97 percent) receive antenatal care from professional health providers: the majority from a doctor (65 percent) and a significant proportion from a nurse or midwife (32 percent). The general pattern in the Kyrgyz Republic is that women seek antenatal care early and continue to receive care throughout their pregnancies. The median number of antenatal care visits reported by respondents is 8. Immunization. Information on vaccination coverage was collected in the KRDHS for all children under three years of age. In the Kyrgyz Republic, child health cards are maintained in the local health care facilities or day care centers rather than in the homes of respondents. The vaccination data were obtained from the health cards in the health facilities or day care centers. In the Kyrgyz Republic, the percentage of children 12-23 months of age who have received all World Health Organization (WHO) recommended vaccinations is high (82 percent). BCG vaccination is usually given in delivery hospitals and was nearly universal (99 percent). Almost all children (100 percent) have received the first doses of polio and DPT/DT. Coverage for the second doses of polio and DPT/DT is also nearly universal (98 percent). The third doses of polio and DPT/DT have been received by 95 percent of children. This represents a dropout rate of 5 percent for both the polio and DPT/DT vaccinations. A high proportion of children (85 percent) have received the measles vaccine. xx NUTRITION Breastfeeding. Breastfeeding is almost universal in the Kyrgyz Republic; 95 percent of children born in the three years preceding the survey are breastfed. Overall, 41 percent of children are breastfed within an hour of delivery and 65 percent within 24 hours of delivery. The median duration of breastfeeding is lengthy (16 months). However, durations of exclusive and full breastfeeding, recommended by WHO, are short (2.1 and 2.9 months, respectively). Supplementary feeding. Supplementary feeding starts early in the Kyrgyz Republic. At age 0-3 months, 10 percent of breastfeeding children are given infant formula and 13 percent are given powdered or evaporated milk. By 4-7 months of age, 17 percent of breastfeeding children are given foods high in protein (meat, poultry, fish, and eggs) and 33 percent are given fruits or vegetables. Nutritional Status. In the KRDHS, the height and weight of children under three years of age were measured. These data are used to determine the proportion of children who are stunted (short for their age, a condition which may reflect chronic undernutrition) and the proportion who are wasted (underweight according to their height, a condition which may reflect an acute episode of undernutrition resulting from a recent illness). In a well-nourished population of children, it is expected that about 2.3 percent of children will be measured as moderately or severely stunted or wasted. For all of the Kyrgyz Republic, the survey found that 25 percent of children are severely or moderately stunted and 3 percent are severely or moderately wasted. PREVALENCE OF ANEMIA Testing of women and children for anemia was one of the major efforts of the 1997 KRDHS. Anemia has been considered a major public health problem in the Kyrgyz Republic for decades. Nevertheless, this was the first anemia study in the Kyrgyz Republic done on a national basis. The study involved hemoglobin (Hb) testing for anemia using the Hemocue system. Women. Thirty-eight percent of the women in the Kyrgyz Republic suffer from some degree of anemia. The great majority of these women have either mild (28 percent) or moderate anemia (9 percent). One percent have severe anemia. Children. Fifty percent of children under the age of three suffer from some degree of anemia. Twenty-four percent have moderate anemia. One percent of children are severely anemic. Thirty-two percent of the children living in the North Region and 24 percent of children living in the South and East Regions were diagnosed as having moderate or severe anemia. In Bishkek City the prevalence of moderate anemia among children was relatively low (13 percent). Certain relationships are observed between the prevalence of anemia among mothers and their children. Among children of mothers with moderate anemia, 0.5 percent have severe anemia and 37 percent have moderate anemia. The prevalence of moderate anemia among these children is more than twice as high as among children of non-anemic mothers. xxii 1 CHAPTER 1 INTRODUCTION Naken K. Kasiev 1.1 Geography, Population, and Culture The Kyrgyz Republic is located in the center of Central Asia and shares borders with Kazakhstan, Uzbekistan, Tajikistan, and China. The Kyrgyz Republic is primarily mountainous with dry fertile valleys and deep gorges. The two main areas which are the base of Kyrgyz agriculture are the Ferghana Valley, in the Southwest, and the Chu Valley, in the North. Lake Issyk-Kul, located in Northeast Kyrgyzstan, is the second deepest mountain lake in the world. It is the main tourist and recreational spot in the country. The population of the Kyrgyz Republic is more than 4.5 million. The country has an ethnically diverse population. According to the National Statistical Committee, in 1997 the ethnic breakdown was as follows: 61 percent Kyrgyz, 15 percent Russian, 14 percent Uzbek, and 10 percent a mix of Ukrainian, German, Kazakh, Tatar, Dungan, Tajik, Uigur, Korean, and others. Thirty-four percent of the population lives in urban areas, 66 percent in rural areas (National Statistical Committee, 1997). The national language is Kyrgyz, which belongs to the Turkic language group. Russian is widely spoken and is an important language of communication. The primary religion of the people of the Kyrgyz Republic is Sunni Islam. There are many ancient and modern cultural values in the Kyrgyz Republic. The great epic “Manas” characterizes the Kyrgyz people’s independence and courage, and glorifies the legendary nobleman Manas. It is one of the longest epics in world literature (longer than the Iliad and the Odyssey combined), and is passed on orally from generation to generation. It is estimated to be nearly one million lines long, and makes early observations of the Kyrgyz people on geography, medicine, and astronomy. 1.2 History of the Kyrgyz Republic The Kyrgyz belong anthropologically to the south Siberian group of the Mongolian race. There are different theories of ethnogenetic origin of the Kyrgyz. According to one of them the Kyrgyz are believed to have emerged from various groups that settled in Central Asia over 2,000 years ago. In the 9th and 12th centuries, some of these tribes moved to the central and western Tien Shan and Pamir regions and eventually formed what is today the Kyrgyz ethnic community. The area that Kyrgyzstan now occupies has been a crossroads for centuries. Lying on one branch of the fabled Silk Road, armies and traders have left their marks on the land and history of Kyrgyzstan. Many kaganats (kingdoms) have ruled the area in different centuries. During the 10th to 12th centuries, the Kara Khanid dynasty ruled from their capital Balasagun, not far from present day Bishkek. The beginning of the 13th century brought Mongol rule and eventually Timurlane’s hordes. In the middle of the 19th century, Central Asia and its people were incorporated into the Russian Empire. In 1924, seven years after the 1917 Bolshevik Revolution, the Soviet Union established the Kara-Kyrgyz autonomous region, later renamed The Kyrgyz Autonomous Republic. In 1936, its status was elevated to a Kyrgyz Soviet Socialist Republic of the USSR. 2 On August 31, 1991, after the collapse of the former Soviet Union, the Kyrgyz Republic officially declared itself an independent state. Through the leadership of President Askar Akaev, the Kyrgyz Republic has started on the road to economic and political reforms, reclaiming the democratic and independent roots of the Kyrgyz people. 1.3 Economy The dominating sectors of the Kyrgyz economy are industry and agriculture. According to the World Bank, the GDP in 1995 was US$ 3.2 billion (US$700 per capita) (World Bank, 1997). Within the industrial sector, the most developed areas are electrical production and mining. In 1993, industry accounted for 37.8 percent of the GDP, agriculture for 28.6 percent, service for 22.6 percent, construction for 6.9 percent, and transportation/telecommunications for 4.8 percent. The industrial sector of the Kyrgyz Republic is represented primarily by light industry (30 percent), food industry (22 percent), and manufacturing-building industry (20 percent). The mining and metallurgy industries provide 10 percent of industrial production and employ 11 percent of the industrial labor force. At present, the main areas of mining and production are gold, antimony, antimony oxide, metallic mercury, uranium oxide molybdenum, coal, oil, and gas. Agriculture is the second most important sector of the Kyrgyz economy after industry. It includes wool, livestock, and fruit and vegetable production. Labor resources and output of the stockbreeding sector amount to two-thirds of the agricultural GDP. Following three years of sharply declining production—output is currently 45 percent below the 1991 level—the Kyrgyz economy showed the first signs of recovery in 1995, led by modest growth in crop production and a growing private service sector. Preliminary data suggest that GDP grew by 1 percent in 1995 and at an annual rate of 2 percent in the first quarter of 1996. Indications are good for growth of 2 to 3 percent for 1996 as a whole. This positive result reflects the wide range of stabilization and adjustment measures the government has pursued, including introducing a new currency (the som), bringing inflation down to low monthly rates, nearly completing liberalization of the trade regime, removing controls on current and capital account transactions, privatizing most industrial and trade enterprises, dismantling state and collective farms, and distributing land-use rights. The Kyrgyz Republic has entered into a three-year Enhanced Structural Adjustment Facility arrangement with the IMF (World Bank Review, 1997). The Kyrgyz Republic is shifting to a market economy based on equal development of different forms of ownership, encouragement of entrepreneurship, and privatization. The new economic policy is based on recent legislation on land, entrepreneurship, and banking adopted by the parliament of the Republic. 1.4 Health Care System The health care system in the Kyrgyz Republic, which developed as part of the Soviet-planned system, was designed to provide adequate access to health services for all citizens and to emphasize preventive care. Primary health care in the Kyrgyz Republic is provided in such institutions as polyclinics, outpatient clinics (ambulatories), doctor’s assistant/midwife posts (FAPs), primary health facilities at large enterprises, women’s consulting centers (which are a primary source of family planning services in urban areas), and delivery hospitals. The main focus of the health services in these institutions is disease prevention (for example, immunization against infectious diseases), and providing antenatal care services, delivery assistance, and family planning services. 3 On the secondary level, health services are provided by specialized dispensaries and city and rayon hospitals where screening programs are carried out to identify individuals with early manifestations of disease, and treatment programs are implemented to halt the progress of the disease. Tertiary health services in the Kyrgyz Republic are provided within oblast and republican hospitals, specialized hospitals and dispensaries, and research institutes. The clinical treatment offered at these facilities is aimed at minimizing the effects of disease and disability. Maternal and child health services in the Kyrgyz Republic are largely provided through wide network of primary health care institutions. Almost all deliveries occur at delivery hospitals and, in rare cases, at regular hospitals. Antenatal care is provided mainly by doctors at the women’s consulting centers (part of urban polyclinics), rayon and rural ambulatories, FAPs. Antenatal care starts early in pregnancy (usually during the first trimester of pregnancy) and continues on a monthly basis throughout the pregnancy. Child health services in the Kyrgyz Republic include neonatal care, which is usually provided in the first week after delivery when a woman and her newborn are still in the delivery hospital, and other pediatric services at older ages. After discharge from the delivery hospital, a child is visited by a patronage nurse who provides the mother with general counseling on child care and carries out a physical examination of the child. A mother is required to bring her child in for a regular checkup and vaccination at the polyclinic or outpatient clinic several times during the first two years of life. A doctor in the polyclinic can refer the child to a pediatrician in case the child develops disease or other conditions that require special care or hospitalization. The child vaccination schedule in the Kyrgyz Republic requires that BCG and oral polio vaccines be given in the delivery hospital during the first 3-4 days of life. Revaccination with oral polio vaccine is usually done at age 2, 3.5, 5, 16, and 18 months, and 6-7 years. The vaccination schedule for diphtheria, pertussis, and tetanus toxoid (DPT) is similar to the schedule for the polio, except that the first DPT vaccination is given at age 2 months. Measles vaccinations are given at 12 months and 6-7 years of age (Steinglass, 1995). The vaccination schedule is controlled throughout childhood by several mechanisms. During the first two years of life, the patronage nurse is responsible for maintaining vaccination records and ensuring that the child receives vaccinations at the appropriate time. After that period, the vaccination schedule may still be under the control of the pediatrician of polyclinics or the records can be transferred to a day care center if the child attends one. In the latter case, vaccination is coordinated by the day care nurse. Finally, when the child starts to attend primary school at the age of seven, the school nurse becomes responsible for the child’s vaccinations. Unfortunately, maintaining such a system requires substantial and continuous budgetary support and enormous human resources and appropriate management. The socioeconomic changes in the Kyrgyz Republic during the last five years have influenced the health sector. The reduction in financial resources has become the main obstacle to ensuring medical care and services, and this in turn has led to a deterioration in the health of the population. The epidemiological situation in the Republic continues to be tense with regard to many infectious diseases such as tuberculosis, brucellosis, sexually transmitted diseases, respiratory infections, and diarrhea, as well as noncommunicable diseases such as coronary heart disease, stroke, chronic obstructive pulmonary disease, and cancer. 4 These factors prompted the Ministry of Health to take immediate action, which resulted in a variety of activities. With the technical assistance from the World Health Organization, the Ministry of Health developed the Manas Health Care Reform Program, which will develop consistent health care reform policies and strategies to improve the health of the population through the year 2006. The basic principles of the health care reform are (1) improvement of the health status of the population, (2) achievement of health equity by reducing and eliminating differences in health indicators between regions and between urban and rural areas, (3) provision of guaranteed access to existing health services, and (4) assurance of protection of patients rights. These goals can be accomplished through restructuring of the health care system, prioritization of services, and changes in the health finance system (Ministry of Health, 1996). Under the health reform program the following priorities were set: - improvement of health of mother and child; - control of tuberculosis and sexually transmitted diseases; - prevention of cardiovascular diseases; - environmental protection; - introduction and implementation of family doctor practices; - transformation of rural hospitals into primary health centers; - restructuring of ambulatory care services; - introduction of compulsory health insurance system; - transition to per capita financing. 1.5 Family Planning Policies and Programs The Ministry of Health is responsible for providing family planning services throughout the country. The main goal of the family planning policy is to ensure low-risk pregnancies and safe motherhood, to reduce complications due to inadequately spaced pregnancies, and to reduce the incidence and prevalence of pregnancy complications and extragenital diseases among women of reproductive age. The Ministry of Health manages a broad spectrum of activities including providing intensive family planning education for the population and supplying contraceptives throughout the country. The private sector is also involved in marketing contraceptives. While promoting awareness of family planning and access of women to a variety of contraceptives, the Ministry also is concerned with the quality, safety and effectiveness of contraceptive methods. In order to control family planning services, the Ministry of Health considers them as part of maternal and child protection and requires that adequate counseling on the selection and use of contraceptive methods be done by health professionals with skills in obstetrics and gynecology. In the Kyrgyz Republic, one of the primary methods of birth control is induced abortion which is usually done at the outpatient departments of general hospitals or at delivery hospitals. Induced abortion is legal in the Kyrgyz Republic if done during the first 12 weeks of pregnancy. In some cases induced abortion can be performed after 12 weeks if certain medical or social indications exist. These cases require strong supervision of qualified medical personnel in a hospital setting. Abortion can be done free of charge. Lately fee-for-services facilities have become available to perform mini-abortions by the vacuum aspiration technique. Despite some indications that the number of induced abortions has declined in recent years, the abortion issue remains a public health concern in the Kyrgyz Republic because of the prevalence of complications and the overall adverse effects on women’s health. 5 Due to the policy of promoting the use of safe methods of family planning, wide use of contraception has been observed in the Kyrgyz Republic during the last several years. Among the most popular methods of contraception is the intrauterine device. Traditionally, many women continue to rely on the intrauterine device as a convenient and safe method. For many years oral contraceptives were less available in the Kyrgyz Republic because of the order “On the Side Effects and Complications of Oral Contraceptives”, published by the Ministry of Health of the former Soviet Union in 1974. This document, in effect, banned the distribution and use of oral contraceptives (United Nations, 1995). Women in the Kyrgyz Republic now have broad access to a variety of methods of contraception including oral contraceptives and injectables. They are distributed centrally through pharmacies and women’s consulting centers. and privately via private pharmacies. 1.6 Demographic and Health Data Collection System in the Kyrgyz Republic The demographic and health data collection system in the Kyrgyz Republic is based on the registration of events and periodic censuses. The data on births, deaths, marriages, and divorces are registered at the local administrative level of an internal passport control system. These data are then forwarded to the National Statistical Committee through the raion- and oblast-level statistical offices. The National Statistical Office is responsible for conducting censuses and maintaining this registration system. The last census in the Kyrgyz Republic was conducted in 1989, and the census results were published in 1990. In addition, the National Statistical Committee is responsible for tabulating and publishing an annual report of demographic data generated by the registration system. The next census in the Kyrgyz Republic is planned for 1999. Collection of health data is a primary responsibility of the Health Information Center of the Ministry of Health. Health information is generated by staff at the facilities delivering services and then sent to the Health Information Center through the raion- and oblast-level health statistical information departments. The Health Information Center of the Ministry of Health compiles and analyzes these data and issues annual reports entitled Health of the Population of the Republic of the Kyrgyz Republic and Health Resources. The health data collected and published by the Health Information Center of the Ministry of Health consist of the following major categories: 1) morbidity specified by type of disease (infectious and non- infectious); 2) mortality specified by causes of death; 3) infant deaths, including data on antenatal, perinatal, and early neonatal deaths; 4) maternal mortality specified by causes of maternal death; 5) data on maternal and child health, including antenatal care and delivery assistance, contraceptive clients, induced abortion rates, pediatric services, etc; 6) number of health facilities, medical personnel, hospital beds, and length of average stay in the hospital; and 7) health data specified by type of medical services including medical care for patients with cancer, tuberculosis, mental disorders, drug abuse, and sexually transmitted diseases. These data are usually tabulated at the national and oblast levels, and for some categories, by the age groups 0-14 and 15 or more years. 1.7 Objectives and Organization of the Survey The purpose of the 1997 Kyrgyz Republic Demographic and Health Survey (KRDHS) was to provide an information base to the Ministry of Health for the planning of policies and programs regarding the health of women and children. The KRDHS collected data on women’s reproductive histories, knowledge and use of contraception, breastfeeding practices, and nutrition, vaccination coverage, and episodes of illness among children under the age of three. The survey also included, for all women of reproductive age and for children under the age of three, measurement of the hemoglobin level in the blood (to assess the prevalence of anemia) and measurements of height and weight (to assess nutritional status). 6 A secondary objective of the survey was to enhance the capabilities of institutions in the Kyrgyz Republic to collect, process, and analyze population and health data. The 1997 KRDHS was the first national-level population and health survey in the Kyrgyz Republic. It was implemented by the Research Institute of Obstetrics and Pediatrics of the Ministry of Health of the Kyrgyz Republic. The 1997 KRDHS was funded by the United States Agency for International development (USAID) and technical assistance was provided by Macro International Inc. (Calverton, Maryland USA) through its contract with USAID. 1.7.1 Sample Design and Implementation The KRDHS employed a representative probability sample of women age 15 to 49. Selected survey estimates were to be produced for four survey regions. The capital city of Bishkek and Narynskaya oblast, which is located in the mountainous eastern part of the Republic, constituted two survey regions by themselves (survey regions 1 and 3, respectively). The remaining two survey regions consisted of groups of contiguous oblasts located in the north (Survey Region 2) and south (Survey Region 4) of the Kyrgyz Republic (Figure 1.1). The four survey regions were defined as follows: Survey Region 1: Bishkek City Survey Region 2 (North): Issyk-Kulskaya, Chuiskaya and Talasskaya oblasts. Survey Region 3 (East): Narynskaya oblast. Survey Region 4 (South): Oshskaya and Dzhelal-Abadskaya oblasts. In rural areas, the primary sampling units (PSUs) were the raions, which were selected with probabilities proportional to size, the size being the population size as published by Goskomstat. At the second stage, one village was selected in each selected raion, from the list of villages collected by the Institute of Obstetrics and Pediatrics. This resulted in 76 rural clusters being selected. Very large villages (with 400 households or more) that were selected were divided in the field into smaller segments, and one segment was selected prior to the household listing operation. A complete listing of the households in the selected clusters was carried out. The lists of households served as the frame for third-stage sampling, i.e., the selection of the households to be visited by the KRDHS interviewing teams. In each selected household, all women age 15-49 were eligible to be interviewed. In the urban areas, the sampling frame is the list of therapeutical uchastoks that have been collected by the Institute of Obstetrics and Pediatrics. However the list of uchastoks only exists for main cities and not for small towns. For small towns, each town was divided into segments of equal size (around 2,000 population), and these segments have been treated as if they were uchastoks. The selected uchastoks were segmented prior to the household listing operation, which provided the household lists for the third-stage selection of households. In total, 86 uchastoks were selected. On average, 20 households were selected in each urban cluster, and 30 households were selected in each rural cluster. It was expected that the sample would yield interviews with approximately 4,000 women between the ages of 15 and 49. Because of the nonproportional distribution of the sample in the different survey regions, sampling weights were applied to the data in this report. Details of the KRDHS sample design are given in Appendix A and the estimation of sampling errors for selected variables is in Appendix B. 7 8 1.7.2 Questionnaires Two questionnaires were used for the KRDHS: the Household Questionnaire and the Individual Questionnaire. The questionnaires were based on the model survey instruments developed in the DHS program. The questionnaires were adapted to the data needs of the Kyrgyz Republic during consultations with specialists in the areas of reproductive health and child health in the Kyrgyz Republic. Both questionnaires were developed in English and then translated into Russian and Kyrgyz. A pretest was conducted in June 1997. Based on the pretest experience, the questionnaires were further modified. The Household Questionnaire was used to enumerate all usual members and visitors in a sample household and to collect information relating to the socioeconomic position of the household. In the first part of the Household Questionnaire, information was collected on age, sex, educational attainment, and relationship to the head of household of each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire was to identify women who were eligible for the individual interview. In the second part of the Household Questionnaire, questions were included on the dwelling unit, such as the number of rooms, the flooring material, the source of drinking water, and the type of toilet facilities, and on the availability of a variety of consumer goods. The Individual Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following major topics: • Background characteristics • Pregnancy history • Outcome of pregnancies and antenatal care • Child health and nutrition practices • Child immunization and episodes of diarrhea and respiratory illness • Knowledge and use of contraception • Marriage and fertility preferences • Husband’s background and woman’s work • Maternal and child anthropometry • Hemoglobin measurement of women and children One of the major efforts of the KRDHS was the testing of women and children for anemia. Testing was done by measuring hemoglobin levels in the blood, using the Hemocue technique. Before collecting the blood sample, each woman was asked to sign a consent form, giving permission for the collection of a blood droplet from her and her children. Results of the anemia testing were kept confidential (as are all KRDHS data); however, strictly with the consent of respondents, local health care facilities were informed of women who had severely low levels of hemoglobin (less than 7 g/dl). 1.7.3 Training and Fieldwork The KRDHS questionnaires were pretested in June 1997. Eight interviewers were trained over a two-week period at the Institute of Obstetrics and Pediatrics. The pretest included one week of interviewing in an urban area (Bishkek City) and one week in a rural area. A total of 120 women were interviewed. Pretest interviewers were retained to serve as supervisors and field editors for the main survey. A total of 40 people (mainly the staff members of the Institute of Obstetrics and Pediatrics: physicians, researchers and nurses), were recruited as field supervisors, editors, interviewers and medical technicians for the main survey. They were trained for three weeks in July-August 1997. Training consisted of in-class lectures and practice, as well as interviewing in the field. Interviewers were selected based on their performance during the training period. 9 Table 1.1 Results of the household and individual interviews Number of households, number of interviews and response rates, Kyrgyz Republic 1997 __________________________________________________ Residence _______________ Result Urban Rural Total __________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews Number of eligible women Number of eligible women interviewed Eligible woman response rate 1,757 2,064 3,821 1,686 2,009 3,695 1,668 2,004 3,672 98.9 99.8 99.4 1,517 2,437 3,954 1,485 2,363 3,848 97.9 97.0 97.3 The KRDHS data collection was carried out by three teams. Each team consisted of eight members: the team supervisor, one editor, one household interviewer, four individual women interviewers, and one medical technician (responsible for height and weight measurement and anemia testing). All interviewers were female. All three interviewing teams began work in Region 1 (Bishkek City) on August 8. After about two weeks of interviewing in Bishkek City, all teams were assigned to the remaining survey regions and fieldwork started in Regions 2 through 4. The data collection was completed on November 8, 1997 1.7.4 Data Processing Questionnaires were returned to the Institute of Obstetrics and Pediatrics in Bishkek for data processing. The office editing staff checked that questionnaires for all selected households and eligible respondents were returned from the field. The few questions which had not been pre-coded (e.g., occupation, type of chronic disease) were coded at this time. Data were then entered and edited on microcomputers using the ISSA (Integrated System for Survey Analysis) package, with the data entry software translated into Russian. Office editing and data entry activities began on September 15, and were completed on December 17, 1997. 1.7.5 Response Rates Table 1 presents information on the coverage of the KRDHS sample including household and individual response rates. A total of 3,821 households were selected in the sample, of which 3,695 were occupied at the time fieldwork was conducted. The main reason for the difference was that some dwelling units which were occupied at the time of the household listing operation were either vacant or the household was away for an extended period at the time of interviewing. Of the 3,695 occupied households, 3,672 were interviewed, yielding a household response rate of 99 percent. 10 In the interviewed households, 3,954 women were eligible for the individual interview (i.e., all women 15-49 years of age who were either usual residents or visitors who had spent the previous night in the household). Interviews were successfully completed with 3,848 of these women, yielding a response rate of 97 percent. The principal reason for nonresponse was a failure to find an eligible woman at home after repeated visits to the household. The overall response rate for the survey, the product of the household and the individual response rates, was 97 percent. 11 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Talaibek S. Builashev and Abdumanap A. Muratov Data pertaining to the background characteristics of household members and respondents to the Woman's Questionnaire are presented in this chapter. Since demographic and health parameters are influenced by sociobiological factors, this information is important in interpreting results. Moreover, data on characteristics of households and respondents can serve as an indicator of the representativeness of the sample and of the quality of the data obtained. This chapter includes three sections: characteristics of the household population (household structure, age-sex characteristics and level of education of the household members); housing characteristics (presence of electricity, source of drinking water, sanitation, etc.) and background characteristics of respondents to the Woman's Questionnaire (residence, age, ethnicity, marital status, occupation, etc.). 2.1 Household Population The KRDHS Household Questionnaire collected data on the sociodemographic characteristics of the members and visitors in each sampled household. A household was defined as a person or group of persons usually living and eating together and jointly running the household's economy (de jure population). Visitors were persons who were not household members but had spent the night before the interview in a sampled household. All female household members and visitors 15-49 years of age were eligible as respondents for the individual interview. The total de facto population in the selected households was 16,728 people. 2.1.1 Sex and Age Composition Table 2.1 presents the distribution of the de facto household population by five-year age groups according to sex and residence. In excess of one-third of the population consists of children under 14 years of age (38 percent), with the proportion of children in rural areas being higher than in urban areas (41 and 32 percent, respectively). In urban areas, the number of women exceeds the number of men, while in rural areas this proportion is almost the same. As seen in Figure 2.1, the age-sex structure of the Kyrgyz Republic population has the form of a pyramid with a wide base, gradually tapering to a sharp peak. The relatively small size of the male and female population in the age interval 50-54 is a reflection of the low birth rates during World War II (i.e., 50 to 54 years prior to the KRDHS). The percent distribution of the KRDHS population by broad age groups is presented in Table 2.2. Thirty-eight percent of the population of the Kyrgyz Republic are people under 15 years of age, 56 percent are 15-64 years of age, and 6 percent are 65 and older. It is interesting to compare 1997 KRDHS data with the 1997 data reported by the National Statical Committee. The correspondence of the percent distribution of the population between these two sources confirms the representativeness of the KRDHS samples. 12 Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by age, according to sex and residence, Kyrgyz Republic 1997 ___________________________________________________________________________ Urban Rural Total ____________________ ____________________ ____________________ Age Male Female Total Male Female Total Male Female Total __________________________________________________________________________ 0-4 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+ Total Number 9.8 8.8 9.3 13.4 13.2 13.3 12.4 11.8 12.1 13.1 10.4 11.7 13.7 12.7 13.2 13.5 12.0 12.7 12.0 10.2 11.0 14.8 14.3 14.6 14.0 13.0 13.5 8.7 8.6 8.7 9.9 9.4 9.7 9.6 9.2 9.4 7.6 7.7 7.6 8.7 8.0 8.3 8.3 7.9 8.1 6.6 6.8 6.7 7.6 6.3 7.0 7.3 6.5 6.9 7.8 9.6 8.7 5.9 7.1 6.5 6.4 7.9 7.2 8.4 7.3 7.8 6.8 7.0 6.9 7.2 7.1 7.2 6.1 5.8 5.9 4.7 4.9 4.8 5.1 5.1 5.1 5.3 4.5 4.8 3.3 3.4 3.3 3.8 3.8 3.8 3.3 3.3 3.3 1.8 1.8 1.8 2.2 2.3 2.2 3.0 4.1 3.6 2.4 2.8 2.6 2.6 3.2 2.9 3.3 4.9 4.2 2.3 2.8 2.5 2.6 3.5 3.0 2.4 3.1 2.8 2.5 2.6 2.5 2.5 2.7 2.6 1.3 2.4 1.9 1.3 1.6 1.5 1.3 1.9 1.6 0.6 1.3 1.0 0.6 1.0 0.8 0.6 1.1 0.9 0.8 1.2 1.0 0.5 1.1 0.8 0.6 1.1 0.8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,326 2,700 5,026 5,881 5,821 11,702 8,207 8,521 16,728 13 Table 2.2 Population by age Percent distribution of the de jure population by age group, selected sources, Kyrgyz Republic 1997 ___________________________________________ National Statistical KRDHS Office Age 1997 1997 ___________________________________________ <15 15-64 65+ Total Median age Dependency ratio 37.7 37.3 56.4 57.2 5.9 5.5 100.0 100.0 21.8 - 77.3 74.8 Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and percentage of households with foster children, according to residence, Kyrgyz Republic 1997 ______________________________________________ Residence ______________ Characteristic Urban Rural Total ______________________________________________ Household headship Male Female Number of members 1 2 3 4 5 6 7 8 9+ Mean size Percent with foster children 61.4 82.0 73.6 38.6 18.0 26.4 16.1 2.5 8.0 19.0 6.3 11.5 17.8 9.9 13.1 19.4 15.5 17.1 13.5 20.0 17.3 7.1 17.8 13.5 3.6 12.7 9.0 1.9 6.2 4.5 1.2 9.2 5.9 3.5 5.4 4.6 3.6 8.6 6.6 ______________________________________________ Note: Table is based on de jure members; i.e., usual residents. 2.1.2 Household Composition Table 2.3 presents information on the size and composition of households according to urban-rural residence. The head of household (as reported by the household respondent) and the relationship of each household member to the head was determined in each household. In general, heads of households are mainly males (74 percent). In urban areas the proportion of households headed by men (61 percent) is less than in rural areas (82 percent). About 50 percent of households consist of between one and four members, with the average size of a household in the Kyrgyz Republic being 4.6 mem- bers. There are significant differences in the household size between urban and rural areas, with the average urban household consisting of 3.5 members compared to 5.4 in rural households. About 7 percent of households include foster children under 15 years old. In rural areas this number (9 percent) is more than twice as high as in urban areas (4 percent). Table 2.4 presents information on children under age 15 by survival status of the parents according to selected sociobiological factors. Eighty-three percent of children under age 15 live with both parents. Rural children are more likely than urban children to live with both parents. Eleven percent of children under age 15 are living with only their mother; of these, 3 percent have lost their fathers and 8 percent have fathers who are still alive. There are distinctions in this parameter depending on age of children, their sex and place of residence. It is notable that a significant number of children (5 percent) are not living with their parents though both parents are alive. Regarding orphanhood, about 3 percent of children under age 15 have fathers who have died, and less than 1 percent have mothers who have died, and while only a small fraction have lost both parents. 2.1.3 Educational Level of Household Members The Kyrgyz Republic’s primary and secondary educational system has three levels: primary (classes 1-4, age 6/7 - 10/11 years); principal (classes 5-9, age 11-15 years); secondary (classes 10-11, age 16-17 years). The primary and principal education levels are compulsory. Those who leave after the principal level of education (9 classes) may continue in secondary- special (vocational) education. 14 Table 2.4 Fosterhood and orphanhood Percent distribution of de facto children under age fifteen by their living arrangement and survival status of parents, according to child's age, sex, residence, and region, Kyrgyz Republic 1997 ___________________________________________________________________________________________________________ Living Living with mother with father Not living with but not father but not mother either parent Living _____________ _____________ _________________________ Missing with Father Mother info. on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children ___________________________________________________________________________________________________________ Age 0-2 3-5 6-8 9-11 12-14 Sex Male Female Residence Urban Rural Region Bishkek City North East South Total 86.1 10.1 0.4 0.1 0.0 2.9 0.0 0.1 0.0 0.3 100.0 1,172 81.5 9.7 1.4 1.4 0.0 5.6 0.1 0.0 0.0 0.3 100.0 1,249 81.6 7.6 2.9 0.6 0.6 6.3 0.1 0.1 0.0 0.2 100.0 1,296 83.6 6.1 3.1 1.7 0.7 4.4 0.0 0.1 0.2 0.2 100.0 1,374 80.7 6.5 4.9 1.2 0.6 4.8 0.2 0.3 0.3 0.5 100.0 1,318 83.2 7.0 2.7 1.1 0.3 4.9 0.1 0.1 0.1 0.3 100.0 3,273 82.0 8.8 2.4 0.9 0.5 4.7 0.1 0.1 0.2 0.3 100.0 3,136 78.4 13.2 2.7 0.7 0.1 4.1 0.1 0.1 0.1 0.4 100.0 1,607 84.1 6.1 2.6 1.1 0.5 5.1 0.1 0.1 0.1 0.2 100.0 4,802 78.8 13.0 1.9 0.6 0.1 3.5 0.0 0.5 0.5 0.9 100.0 461 79.0 7.5 3.3 2.5 0.4 6.7 0.1 0.1 0.2 0.4 100.0 1,964 84.6 5.5 3.4 0.1 1.0 4.8 0.2 0.0 0.0 0.3 100.0 398 84.9 7.7 2.2 0.4 0.4 4.0 0.1 0.1 0.0 0.1 100.0 3,586 82.6 7.9 2.6 1.0 0.4 4.8 0.1 0.1 0.1 0.3 100.0 6,409 ___________________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either parent. This includes orphans, i.e., children both of whose parents are dead. The secondary-special (vocational) educational system in the Kyrgyz Republic provides a combination of general education and technical skills to students age 15-20 during 2-4 years of schooling. The number of years in the secondary-special schools depends on the curriculum under study. Those who finish secondary and secondary-special school can continue their education at a higher level—at universities or academic training institutes. The KRDHS confirms the high education level of the Kyrgyz Republic population. As can be seen in Table 2.5, 97 percent of women have had at least some education. A high percentage of the women have secondary-special and higher education, especially those in the 20-54 age group. Overall, the median years of schooling for women is 10 years. The education level of urban women is higher than for rural women. There are also education differences between women in Bishkek City and other regions. Data in Table 2.6 show that men in the Kyrgyz Republic also have a high education level. Thirty percent of men have secondary-special and higher education, and in certain age groups, the proportion is almost 60 percent. The proportion of men with higher education is greater in urban than in rural areas (20 and 7 percent, respectively) and greater in Bishkek City (29 percent) than in the other regions (7 to 9 percent). To predict a general education level of the population of the country, it is important to have information about school enrollment of the children and young people under age 24. As can be seen in Table 2.7 and Figure 2.2, 90 percent of children age 7-17 were enrolled in school, with only slight differences by residence and sex. 15 Table 2.5 Educational level of the female household population Percent distribution of the de facto female household population age seven and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Kyrgyz Republic 1997 ______________________________________________________________________________________________ Level of education ______________________________________________________ Median Background No Primary/ Secondary- years of characteristic education Secondary Special Higher Missing Total Number schooling _____________________________________________________________________________________________ Age 7-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Bishkek City North East South Total 4.7 95.2 0.1 0.0 0.0 100.0 596 2.1 0.9 98.9 0.2 0.0 0.0 100.0 1,107 5.6 0.7 76.0 12.9 10.4 0.0 100.0 780 10.2 0.2 54.3 30.2 15.3 0.0 100.0 675 11.0 0.6 42.7 39.7 17.0 0.0 100.0 550 10.7 0.6 41.3 38.9 19.2 0.0 100.0 670 10.8 1.0 48.0 32.8 18.2 0.0 100.0 608 10.7 0.0 51.2 29.7 19.1 0.0 100.0 439 10.8 1.3 51.0 28.0 19.5 0.2 100.0 320 10.8 3.0 54.1 19.8 23.1 0.0 100.0 193 10.7 3.5 70.1 14.4 12.0 0.0 100.0 273 10.0 9.8 65.2 12.0 13.0 0.0 100.0 299 7.8 21.6 63.1 9.6 5.7 0.0 100.0 577 5.4 2.8 50.7 24.7 21.8 0.0 100.0 2,352 10.5 3.5 73.4 16.7 6.3 0.0 100.0 4,736 10.0 1.9 41.1 25.2 31.8 0.1 100.0 962 11.0 2.7 64.7 22.5 10.1 0.0 100.0 2,229 10.1 3.5 70.2 19.2 7.1 0.0 100.0 397 10.2 4.0 72.9 15.8 7.3 0.0 100.0 3,499 10.0 3.3 65.9 19.4 11.5 0.0 100.0 7,087 10.1 Not everyone continues studying in secondary-special and higher educational institutions after secondary school. Only 18 percent of men and 25 percent of women age 18-20 and 7 percent of men and 9 percent of women age 21-24 are enrolled in school. Enrollment among men and women age 18-24 living in urban areas is higher than among those living in rural areas. 2.2 Housing Characteristics In order to assess the socioeconomic conditions of respondents, appropriate information on housing was collected. Table 2.8 presents the data on availability of electricity, source of drinking water, sanitation facilities, type of floor and persons per sleeping room, all of which are determinants of the health status of household members, particularly of children. As can be seen from Table 2.8, virtually all sampled households in the Kyrgyz Republic are supplied with electricity. The source of drinking water usually determines its quality. Seventy-five percent of households in the Kyrgyz Republic have piped water, mostly piped into the residence. Six percent of the population use water from wells, and 17 percent from rivers. Almost all urban households use piped water (96 percent), almost all of which have the pipes inside. In rural areas, 59 percent of households have piped water, while more than one-fourth of the population uses water from rivers. Almost 80 percent of households in the Kyrgyz Republic are within 15 minutes of the source of their water. 16 Table 2.6 Educational level of the male household population Percent distribution of the de facto male household population age seven and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Kyrgyz Republic 1997 ______________________________________________________________________________________________ Level of education ______________________________________________________ Median Background No Primary/ Secondary- years of characteristic education Secondary Special Higher Missing Total Number schooling _____________________________________________________________________________________________ Age 7-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Bishkek City North East South Total 4.2 95.6 0.2 0.0 0.0 100.0 705 1.9 0.8 99.2 0.1 0.0 0.0 100.0 1,150 5.7 0.8 79.3 12.9 6.9 0.0 100.0 787 10.2 0.8 62.4 26.0 10.9 0.0 100.0 685 10.8 0.6 52.5 35.4 11.5 0.0 100.0 599 10.8 0.5 46.8 36.8 16.0 0.0 100.0 528 10.8 0.2 42.4 36.8 20.7 0.0 100.0 594 10.8 0.4 41.7 38.2 19.8 0.0 100.0 420 10.9 0.0 46.0 30.4 23.7 0.0 100.0 315 10.9 0.0 48.3 27.0 24.6 0.0 100.0 179 10.9 2.1 67.9 14.8 15.3 0.0 100.0 210 10.4 2.5 64.1 16.5 17.0 0.0 100.0 209 10.1 7.2 71.1 9.2 12.5 0.0 100.0 408 7.5 1.6 55.4 22.7 20.4 0.0 100.0 1,983 10.5 1.4 74.0 18.0 6.7 0.0 100.0 4,806 10.1 0.9 45.9 24.2 29.0 0.0 100.0 766 10.9 0.9 71.1 19.8 8.2 0.0 100.0 2,209 10.2 2.9 78.8 11.1 7.1 0.0 100.0 380 10.3 1.7 70.8 18.9 8.6 0.0 100.0 3,434 10.1 1.4 68.5 19.3 10.7 0.0 100.0 6,789 10.2 Table 2.7 School enrollment Percentage of the de facto household population age 7-24 years enrolled in school, by age, sex, and residence, Kyrgyz Republic 1997 ____________________________________________________________________________________________ Male Female Total ______________________ ______________________ ______________________ Age Urban Rural Total Urban Rural Total Urban Rural Total ____________________________________________________________________________________________ 7-17 18-20 21-24 90.7 89.6 89.9 92.7 89.3 90.2 91.7 89.4 90.0 39.1 10.5 18.4 47.0 15.5 25.1 43.4 13.0 21.9 18.3 3.4 7.0 20.3 4.0 9.1 19.4 3.6 8.0 17 One indicator of sanitary conditions is the type of toilet in a household. In the Kyrgyz Republic, a majority of households (77 percent) have pit toilets (latrines) and 23 percent have flush toilets. In urban areas, 52 percent of households have flush toilets, while in rural areas, 97 percent have pit toilets. During the interview, interviewers noted the type of material from which the floor in each household was made. As can be seen from the data, 81 percent of households have a wooden floor, 5 percent of households use earth and 12 percent of households use linoleum. In rural areas, floors are mainly made from wood (90 percent) and in urban areas, along with wood (68 percent), people use linoleum (29 percent). An important indicator of housing conditions is the level of crowding, which was estimated by the number of persons sleeping in one room and the average number of persons per sleeping room. In 88 percent of households 1-2 persons sleep in one room. The average number of persons per sleeping room is significantly higher in rural areas than in urban areas (1.8 and 1.5 percent, respectively). 2.2.1 Household Durable Goods One criterion of the socioeconomic well-being of a household is ownership of various durable goods (radio, television, telephone, and refrigerator), and means of transport (bicycle, motorcycle, and private car). The presence of a radio and television set in a household is also an indicator of the availability of information to household members. Table 2.9 shows that urban households are more likely than rural households to have these durable goods, especially, telephones, television sets, and refrigerators. An approximately equal proportion of urban and rural households own radios, bicycles and private vehicles. The higher proportion of rural than urban households owning a motorcycle is due to the greater need for transport in rural areas. Overall, 85 percent of households in the Kyrgyz Republic have television, and 67 percent have refrigerators. Forty-one percent of households have radios and 30 percent have telephones. More than one-fifth of households have a car. 18 Table 2.8 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Kyrgyz Republic 1997 _____________________________________________ Residence ______________ Characteristic Urban Rural Total _____________________________________________ Electricity Yes No Total Source of drinking water Piped into residence Public tap Well in residence Public well Spring River/stream Pond/lake Tanker truck Total Time to water source (in minutes) Within 15 minutes Median time to source Sanitation facility Own flush toilet Shared flush toilet Traditional pit toilet Ventilated improved pit latrine No facility/bush Total Floor material Earth/sand Wood planks Straw/sawdust Parquet/polished wood Linoleum/asphalt Ceramic tiles Cement Total Persons per sleeping room 1-2 3-4 5-6 7 + Missing/Don’t know Total Mean persons per sleeping room Number of households 100.0 99.6 99.8 0.0 0.4 0.2 100.0 100.0 100.0 87.4 27.6 51.9 9.2 31.7 22.6 0.9 3.4 2.4 0.8 5.6 3.7 0.1 3.6 2.2 1.6 27.2 16.8 0.0 0.1 0.0 0.0 0.7 0.4 100.0 100.0 100.0 94.9 67.3 78.5 - 10.1 - 51.1 3.1 22.6 0.5 0.0 0.2 48.2 96.7 77.0 0.2 0.0 0.1 0.1 0.1 0.1 100.0 100.0 100.0 0.3 8.0 4.8 67.8 90.1 81.1 1.1 0.6 0.8 1.9 0.1 0.8 28.8 1.1 12.3 0.0 0.1 0.0 0.1 0.1 0.1 100.0 100.0 100.0 90.2 86.6 88.1 7.8 11.0 9.7 1.0 1.8 1.5 0.2 0.2 0.2 0.8 0.4 0.6 100.0 100.0 100.0 1.5 1.8 1.7 1,491 2,181 3,672 Table 2.9 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Kyrgyz Republic 1997 _____________________________________________ Residence ______________ Durable goods Urban Rural Total _____________________________________________ Radio Television Telephone Refrigerator Bicycle Motorcycle Private car None of the above Number of households 41.6 41.0 41.2 87.6 82.5 84.5 53.9 13.8 30.1 83.0 56.2 67.1 10.5 10.2 10.3 3.4 7.0 5.5 23.2 20.8 21.8 5.3 9.4 7.7 1,491 2,181 3,672 2.3 Characteristics of Survey Respondents 2.3.1 Background Characteristics The information in this section is important for the interpretation of the results of the study. Table 2.10 presents the percent distribution of women 15-49 by age, marital status, residence, region, education level, religion, and ethnicity. To obtain the age of a respondent, the KRDHS Women's Questionnaire included two questions: "In what month and year were you born?" and "How old were you at your last birthday?" Special attention was given to these questions during the training of the interviewers. Interviewers learned how to use probing techniques for situations in which respondents did not know their date of birth. As shown in Table 2.10, the percentage of women in five-year age groups declines steadily with increasing age. One exception are women in age group 25-29 (14 percent), the percentage of which is lower than the percentage of women in the following age group 30-34 (16 percent). The majority of the women are married or living with a man (70 percent), but a significant proportion are never- married (22 percent), or are widowed, divorced, or separated (9 percent). Thirty-four percent of women live in urban areas; 67 percent in rural areas. 19 Table 2.10 Background characteristics of respondents Percent distribution of women 15-49 by selected background characteristics, Kyrgyz Republic 1997__________________________________________________ Number of women __________________ Background Weighted Un- characteristic percent Weighted weighted__________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married Living together Widowed Divorced Not living together Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Respondent still in school Yes No Religion Muslim Christian Other Not religious Don't know Ethnicity Kyrgyz Russian Kazak Uzbek Korean Dungan Uigur Tatar Ukrainian German Other Total 19.3 743 740 16.9 649 639 13.8 530 552 16.4 630 616 15.0 579 567 10.7 410 415 8.0 307 319 21.5 827 834 66.7 2,566 2,545 2.8 109 132 2.5 95 102 5.3 204 199 1.2 47 36 33.5 1,290 1,485 66.5 2,558 2,363 13.5 518 893 30.9 1,188 1,023 5.6 215 770 50.1 1,926 1,162 53.4 2,053 1,929 l29.9 1,151 1,181 16.7 643 738 13.1 504 548 86.9 3,344 3,300 86.3 3,323 3,221 10.7 410 458 0.1 5 7 2.8 106 156 0.1 4 6 61.9 2,380 2,560 10.7 412 493 1.8 67 72 18.0 691 439 0.9 33 23 0.9 34 32 2.0 77 78 1.0 38 31 0.9 33 33 0.6 22 22 1.5 59 65 100.0 3,848 3,848 The percent distribution of the inter viewed women by regions of their residence is as follows: 14 percent live in Bishkek City, 31 percent in the North Region, 6 percent in the East Region (Naryn oblast), and 50 percent in the South Region. The survey respondents are well edu- cated. All respondents had attended at least primary/secondary school, 30 percent having a secondary-special education and 17 percent having a higher education. Thirteen percent are still in school. Table 2.11 shows the distribution of women 15-49 by ethnicity, religion, and resi- dence according to region. Sixty-two percent of respondents are ethnic Kyrgyz, 18 percent are ethnic Uzbeks, 11 percent are ethnic Rus- sian. Most of the Russians live in Bishkek City and North Region, while the Uzbek popu- lation is mostly concentrated in the South Region of the Kyrgyz Republic. 2.3.2 Educational Level of Respondents Table 2.12 shows the percent distribution of women by the highest level of education attended according to background characteris- tics. As will be seen later in the report, differ- ences in the receipt of maternal health care by women are related to differences in education. Fifty-three percent of respondents have attended primary/secondary school, 30 percent have attended secondary-special school, and 17 percent have had higher education. There are significant differences in education be- tween urban and rural areas and between regions. The proportion of respondents with higher education in urban areas is three times higher than in rural areas. This proportion is also higher in Bishkek City compared to other regions. There is a strong relationship be- tween level of education and ethnicity. Fifty- three percent of Kyrgyz women have pri- mary/secondary education, 29 percent have secondary-special education, and 19 percent have higher education. Among women of Russian ethnicity 30 percent have attended 20 Table 2.11 Ethnicity, religion and residence by region Percent distribution of women 15-49 by ethnicity, religion and residence, according to region, Kyrgyz Republic 1997 ___________________________________________________________________ Region ____________________________________ Background characteristic Bishkek City North East South Total ___________________________________________________________________ Ethnicity Kyrgyz Russian Kazak Uzbek Korean Dungan Uigur Tatar Ukrainian German Other Religion Muslim Christian Other Not religious Don't know Residence Urban Rural Total Number 47.1 66.9 99.5 58.5 61.9 35.4 15.7 0.2 2.2 10.7 3.4 3.4 0.2 0.5 1.8 2.0 1.0 0.0 34.7 18.0 0.2 0.6 0.0 1.3 0.9 0.4 2.7 0.0 0.0 0.9 2.9 4.3 0.0 0.6 2.0 1.5 0.7 0.0 1.2 1.0 1.8 1.5 0.0 0.3 0.9 0.8 1.5 0.0 0.0 0.6 4.5 1.7 0.0 0.8 1.5 55.5 80.1 99.1 97.1 86.3 29.3 17.1 0.2 2.8 10.7 0.6 0.2 0.0 0.0 0.1 14.1 2.5 0.5 0.1 2.8 0.4 0.1 0.1 0.0 0.1 100.0 21.4 23.6 24.2 33.5 0.0 78.6 76.4 75.8 66.5 100.0 100.0 100.0 100.0 100.0 518 1,188 215 1,926 3,848 primary/secondary school, 44 percent have attained a secondary-special level of education, and 27 percent have had higher education. Among Uzbek women 71 percent have attended primary/secondary school, and only 4 percent have had higher education. 2.3.3 School Attendance and Reasons for Leaving School Because of the association between education and many other demographic and health indicators, it is interesting to analyze the reasons why women leave school. As shown in Table 2.13, 34 percent of women age 15-24 currently attend school. The main reasons for leaving school are marriage and the perceived sufficiency of the obtained education. 21 Table 2.12 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Kyrgyz Republic 1997 ________________________________________________________________________ Highest level of education _________________________________ Number Background Primary/ Secondary- of characteristic Secondary special Higher Total women _______________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Ethnicity Kyrgyz Russian Uzbek Other Total 77.0 12.3 10.7 100.0 743 54.2 30.4 15.4 100.0 649 42.2 40.4 17.3 100.0 530 40.9 39.9 19.2 100.0 630 47.9 32.7 19.4 100.0 579 51.0 29.5 19.5 100.0 410 52.5 28.3 19.3 100.0 307 36.2 33.2 30.6 100.0 1,290 62.0 28.3 9.7 100.0 2,558 27.2 30.2 42.6 100.0 518 48.2 36.0 15.8 100.0 1,188 57.0 32.4 10.6 100.0 215 63.2 25.8 11.0 100.0 1,926 52.9 28.5 18.6 100.0 2,380 29.3 44.0 26.6 100.0 412 71.4 24.5 4.1 100.0 691 49.2 33.8 17.0 100.0 364 53.4 29.9 16.7 100.0 3,848 2.3.4 Access to Mass Media During the KRDHS interviews, women were asked about their exposure to the mass media which is an indicator of their access to information about health and family planning. Table 2.14 shows that 90 percent of women watch TV weekly, while 69 percent read a newspaper at least once a week. Daily radio listening is also widespread at 52 percent. There is little difference by age in access to the mass media. Women in Bishkek City and the North Region have more access to all three types of mass media (56 percent each) than women in the South and East Regions (27 and 20 percent, respectively). There is an association between a respondent’s exposure to mass media and her education level; the higher the education level, the more often women watch TV, read newspapers, and listen to the radio. Russian women are more likely than Kyrgyz or Uzbek women to avail themselves of all three media. 2.3.5 Women's Employment Status Table 2.15 presents information on women's employment status according to age, residence, region, educational level, and ethnicity. Overall, 57 percent of women age 15-49 are not currently employed and 48 percent have not been employed for the last 12 months. Unemployment is more common among younger women, those living in rural areas, in the East and North Regions, those with a lower education level, and Uzbek and Kyrgyz women. Four percent of the employed women work for less than five days a week and 14 percent of the women are employed only seasonally or occasionally. 22 Table 2.13 School attendance and reasons for leaving school Percent distribution of women 15 to 24 by whether attending school and reason for leaving school, according to highest level of education attended and residence, Kyrgyz Republic 1997 ____________________________________________________________ Educational attainment _____________________________ Reason for Incomplete Complete leaving school secondary secondary Higher Total ____________________________________________________________ TOTAL____________________________________________________________ Currently attending Got pregnant Got married Take care of younger children Family need help Need to earn money Graduated/Enough school Did not pass exams Did not like school School not accessible Applying for school Other Don't know/missing Total Number 46.7 18.6 79.1 34.4 0.0 0.6 0.1 0.4 11.0 28.4 1.2 19.9 0.4 1.6 1.5 1.3 10.0 9.5 0.3 8.5 4.8 9.9 0.6 7.3 7.7 12.8 16.8 11.9 1.0 6.4 0.0 4.1 9.2 3.3 0.0 4.6 1.1 1.1 0.0 0.9 4.5 4.1 0.0 3.7 2.4 2.1 0.3 2.0 1.1 1.5 0.0 1.2 100.0 100.0 100.0 100.0 394 816 179 1,390 ____________________________________________________________ URBAN____________________________________________________________ Currently attending Got pregnant Got married Take care of younger children Family need help Need to earn money Graduated/Enough school Did not pass exams Did not like school School not accessible Applying for school Other Don't know/missing Total Number 60.3 26.2 78.9 48.9 0.0 1.0 0.2 0.6 9.3 25.4 0.5 14.7 1.7 1.1 2.3 1.6 7.7 4.7 0.5 4.3 4.2 13.3 1.0 7.7 5.4 9.4 16.0 10.3 0.0 9.0 0.0 4.4 6.1 3.9 0.0 3.3 0.0 1.7 0.0 0.8 2.1 1.3 0.0 1.2 2.7 1.7 0.5 1.6 0.6 1.2 0.0 0.7 100.0 100.0 100.0 100.0 101 203 115 419 ____________________________________________________________ RURAL____________________________________________________________ Currently attending Got pregnant Got married Take care of younger children Family need help Need to earn money Graduated/Enough school Did not pass exams Did not like school School not accessible Applying for school Other Don't know/missing Total Number 42.1 16.1 79.4 28.1 0.0 0.4 0.0 0.3 11.6 29.3 2.4 22.2 0.0 1.8 0.0 1.1 10.8 11.1 0.0 10.3 5.0 8.8 0.0 7.0 8.5 14.0 18.2 12.6 1.3 5.6 0.0 3.9 10.3 3.1 0.0 5.1 1.4 0.8 0.0 1.0 5.3 5.1 0.0 4.8 2.3 2.2 0.0 2.1 1.3 1.6 0.0 1.4 100.0 100.0 100.0 100.0 294 613 64 971 23 Table 2.14 Access to mass media Percentage of women who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background characteristics, Kyrgyz Republic 1997 ____________________________________________________________________________ Mass media ____________________________________ No Read Watch Listen to All Number Background mass newspaper television radio three of characteristic media weekly weekly daily media women ____________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 5.0 68.4 87.2 48.2 35.5 743 5.0 67.2 89.2 51.6 39.5 649 5.5 71.8 89.4 51.0 39.6 530 5.5 69.5 87.8 46.9 37.0 630 3.2 67.5 94.5 54.2 40.7 579 4.2 68.9 91.2 56.4 42.4 410 6.3 67.9 90.5 62.6 45.9 307 2.5 78.6 92.9 55.5 46.5 1,290 6.2 63.7 88.1 50.0 35.7 2,558 1.2 89.7 95.6 59.2 56.3 518 1.7 88.7 92.8 61.5 56.0 1,188 14.9 47.7 76.1 36.4 20.2 215 6.8 53.1 87.7 45.6 26.6 1,926 7.3 56.4 86.0 47.5 29.7 2,053 3.2 77.4 92.8 53.5 45.6 1,151 0.5 92.7 96.0 62.8 59.0 643 6.1 70.0 86.9 49.7 37.9 2,380 0.6 92.3 97.6 68.7 65.1 412 4.9 46.4 92.1 47.0 25.6 691 2.1 76.1 94.7 56.0 46.0 364 4.9 68.7 89.7 51.9 39.3 3,848 2.3.6 Employer Table 2.16 shows the percent distribution of currently employed women by type of employer, according to background characteristics. Sixty-one percent of employed women work in state enterprises. 11 percent of women work in private firms. Thirteen percent of women are self-employed and 14 percent work in a family or their own business. 2.3.7 Occupation Twenty-six percent of employed women work in agriculture (Table 2.17), primarily on state or family land. Women in the South Region are more likely to be working in agriculture mostly on state land, while women in the North Region are mostly working on family land. Seventy-four percent of employed women are not engaged in agriculture. Almost half work in professional, technical, and managerial occupations, 22 percent in sales and trade, and 14 percent in manual labor. These parameters differ by age, residence, region, and respondent's ethnicity. Significant differences are also seen by education level—women with higher education are engaged mainly in professional and technical fields, with few employed in manual labor. 24 Table 2.15 Employment Percent distribution of women by whether currently employed and distribution of employed women by continuity of employment, according to background characteristics, Kyrgyz Republic 1997 ___________________________________________________________________________________________________ Not currently employed Currently employed __________________ ______________________________________ Did not work Worked All year in last in _________________ Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Total women ___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 82.6 2.9 5.5 0.6 7.1 1.4 100.0 743 59.9 14.0 15.0 1.8 8.3 1.0 100.0 649 41.0 17.7 24.3 4.9 10.5 1.6 100.0 530 34.6 12.0 29.5 5.1 17.1 1.7 100.0 630 26.9 8.6 36.5 5.4 21.2 1.3 100.0 579 29.8 4.0 42.2 6.7 16.2 1.1 100.0 410 36.2 1.7 38.7 8.0 13.6 1.8 100.0 307 42.2 8.4 37.3 6.1 4.1 2.0 100.0 1,290 50.1 9.6 18.6 3.1 17.5 1.1 100.0 2,558 39.9 6.7 40.3 6.9 4.4 1.8 100.0 518 50.0 6.4 25.4 3.4 12.9 1.9 100.0 1,188 62.7 4.8 26.1 2.6 3.5 0.4 100.0 215 46.2 12.0 20.2 4.0 16.5 1.1 100.0 1,926 57.4 6.8 12.2 3.8 18.8 1.0 100.0 2,053 37.1 12.8 34.5 4.7 8.6 2.4 100.0 1,151 34.3 10.2 48.1 4.0 2.6 0.9 100.0 643 49.1 9.5 23.4 3.4 13.6 1.1 100.0 2,380 32.4 7.1 44.7 7.8 5.0 2.9 100.0 412 51.4 11.0 16.4 3.8 16.4 0.9 100.0 691 46.6 5.8 27.6 5.2 12.1 2.8 100.0 364 47.5 9.2 24.8 4.1 13.0 1.4 100.0 3,848 2.3.8 Decisions on Use of Earnings When the status of women is assessed, their independence in making decisions on the use of their earnings is a valuable indicator. Table 2.18 shows that almost 29 percent of employed women make their own decisions on the use of their earnings, while 53 percent decide together with their husband or partner, and 10 percent make decisions jointly with someone other than a husband. Four percent of women report that their husbands alone decide how to spend their earnings. Independent decision making on use of earnings tends to be higher among women in urban areas (especially Bishkek City), the North Region and among unmarried and Russian women. 2.3.9 Child Care While Working Preschool age children in the family pose employment obstacles, since child care requires significant time and energy. When child care is provided completely by the mother, her work possibilities are limited. 25 Table 2.16 Employer Percent distribution of currently employed women by employer, according to background characteristics, Kyrgyz Republic 1997 ______________________________________________________________________________ Employer _______________________________________________ Govern- ment or State Family, Private Number Background enter- own firm, Self- of characteristic prise business person employed Total women ______________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 40.4 19.4 22.3 17.9 100.0 108 58.0 18.7 11.8 11.4 100.0 169 57.8 14.0 13.8 14.4 100.0 219 57.5 16.0 9.2 17.2 100.0 337 64.8 13.3 10.7 11.3 100.0 373 67.7 10.1 9.2 13.0 100.0 271 68.6 13.3 10.6 7.5 100.0 191 62.6 6.5 14.7 16.3 100.0 638 60.1 19.3 9.4 11.3 100.0 1,030 57.2 6.5 21.2 15.1 100.0 277 53.2 18.3 13.1 15.4 100.0 517 79.8 4.5 2.3 13.4 100.0 70 65.8 15.4 7.7 11.1 100.0 804 51.9 20.2 12.2 15.7 100.0 733 61.4 12.5 12.3 13.7 100.0 577 79.2 5.4 8.2 7.2 100.0 358 63.3 17.6 6.7 12.3 100.0 986 59.6 5.9 20.3 14.1 100.0 249 60.2 11.9 12.7 15.2 100.0 260 51.5 11.8 23.1 13.6 100.0 174 61.1 14.4 11.4 13.2 100.0 1,668 As Table 2.19 shows, 35 percent of employed women have a child under age six at home. It is notable that the likelihood of a working woman having a child under six years is greater in rural areas (41 percent), the East and South Regions (44 and 42 percent, respectively) and among Kyrgyz and Uzbek women (40 and 42 percent, respectively). Almost half of them is enrolled in agriculture. Only 6 percent of women care for the children themselves, 8 percent are cared for by the husband or partner, and 37 percent are cared for by relatives. Fifteen percent of children use preschool child care institutions despite the mass shutdown during recent years. Use of institutional child care is greatest in urban areas (34 percent), Bishkek City (40 percent), and among women with higher education (22 percent). When other children are used as child care providers, the caretaker is much more likely to be a sister (17 percent) than a brother (5 percent). The role of other people (neighbors, servants) in providing child care is not significant. 26 Table 2.17 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Kyrgyz Republic 1997 ____________________________________________________________________________________________ Agricultural Nonagricultural ______________________________________________________ Prof./ Number Background Family Rented State tech./ Sales/ Skilled Unskilled of characteristic land land land manag. services manual manual Total women ____________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 12.9 12.4 22.2 10.2 25.4 14.9 1.9 100.0 108 13.7 2.0 11.9 37.5 20.1 11.2 3.7 100.0 169 5.6 3.4 9.0 39.4 27.2 11.1 4.4 100.0 219 12.0 3.2 12.4 35.3 23.8 7.1 6.2 100.0 337 10.9 4.9 15.4 39.4 18.9 7.3 3.2 100.0 373 9.7 1.4 9.2 44.8 21.4 6.2 7.4 100.0 271 10.2 3.8 6.5 43.3 17.9 5.7 12.6 100.0 191 0.3 0.4 1.0 46.3 32.2 12.1 7.6 100.0 638 16.9 6.0 18.9 32.5 15.3 5.9 4.5 100.0 1,030 0.2 0.0 0.2 44.2 36.9 12.6 5.9 100.0 277 13.6 6.1 5.2 37.2 23.9 10.4 3.7 100.0 517 4.5 0.0 0.0 65.8 19.6 2.3 7.8 100.0 70 12.7 4.0 21.5 33.5 15.5 6.0 6.8 100.0 804 18.1 7.0 23.2 11.2 21.8 7.5 11.2 100.0 733 7.2 1.8 4.4 46.6 26.2 12.1 1.7 100.0 577 0.4 0.7 1.3 78.2 14.8 3.7 0.9 100.0 358 14.9 2.3 10.8 41.5 20.1 4.2 6.2 100.0 986 1.5 1.3 1.1 43.0 26.5 21.0 5.5 100.0 249 8.9 7.7 27.6 22.6 20.0 8.4 4.6 100.0 260 1.5 10.4 11.4 32.0 27.2 13.1 4.4 100.0 174 10.6 3.8 12.0 37.8 21.8 8.3 5.7 100.0 1,668 ____________________________________________________________________________________________ Note: Professional, technical, managerial includes professional, technical, clerical and managerial occupations. 27 Table 2.18 Decision on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Kyrgyz Republic 1997 __________________________________________________________________________________________ Person who decides how earnings are used ______________________________________________ Jointly with Jointly Background Self Husband/ husband/ Someone with characteristic only partner partner else someone Total Number __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Marital status Not married Currently married Total 22.0 1.5 0.8 26.9 48.8 100.0 104 30.6 3.7 25.3 12.1 28.3 100.0 168 32.6 1.9 51.3 2.5 11.8 100.0 217 26.5 6.9 58.8 0.5 7.4 100.0 332 25.5 4.8 65.5 0.4 3.7 100.0 370 30.6 3.5 63.2 0.0 2.7 100.0 264 38.3 2.4 58.7 0.0 0.6 100.0 187 42.0 1.7 47.1 0.2 9.0 100.0 637 21.1 5.5 56.6 5.5 11.3 100.0 1,005 42.7 1.3 45.5 0.4 10.1 100.0 276 35.2 5.8 47.3 2.5 9.2 100.0 495 18.8 6.1 69.4 0.0 5.7 100.0 69 21.8 3.7 57.5 5.4 11.6 100.0 803 22.7 3.9 53.5 5.4 14.5 100.0 719 34.8 4.0 50.7 2.8 7.7 100.0 567 33.6 4.4 55.2 0.6 6.2 100.0 356 25.6 4.3 56.7 3.5 9.9 100.0 964 44.2 2.6 43.3 0.5 9.5 100.0 247 18.4 6.0 58.3 6.0 11.4 100.0 260 44.6 1.9 37.3 3.6 12.6 100.0 172 60.0 0.4 0.0 9.4 30.2 100.0 422 18.6 5.3 71.2 1.4 3.5 100.0 1,221 29.2 4.0 52.9 3.5 10.4 100.0 1,642 28 Table 2.19 Child care while working Percent distribution of currently employed women by whether they have a child under six years of age, and the percent distribution of employed mothers who have a child under six at home by person who cares for child wh ile mother is at work, according to background characteristics, Kyrgyz Republic 1997 ____________________________________________________________________________________________________________________________ Employed women with: _____________ One or more Child's caretaker while mother is at work No chil- _______________________________________________________________________________ Number child dren Hus- Serv- Child Not of under under Re- band/ Other ants/ Institu- Other Other lives worked em- Background six at six at spond- part- rela- Neigh- Hired tional female male else- since Miss- ployed characteristic home home ent ner tive bor help care child child where birth1 Other ing Total women ____________________________________________________________________________________________________________________________ Residence Urban Rural Education Primary/Secondary Secondary-special Higher Work status For family member For someone else Self-employed Region Bishkek City North East South Ethnicity Kyrgyz Russian Uzbek Other Occupation Agricultural Nonagricultural Employment status All year, full week All year, part week Seasonal Occasional Total 75.8 24.2 5.1 5.1 24.2 0.0 3.7 34.7 10.1 0.8 7.9 2.7 0.3 5.3 100.0 638 58.8 41.2 6.8 8.8 41.3 0.1 0.0 7.8 19.7 6.6 1.3 0.9 1.1 5.7 100.0 1,030 62.3 37.7 7.3 6.6 35.6 0.0 0.0 9.1 23.2 7.1 2.0 1.3 1.8 5.9 100.0 733 64.9 35.1 6.4 7.5 40.1 0.1 0.0 19.5 12.4 2.6 3.5 0.9 0.0 6.9 100.0 577 72.1 27.9 3.4 12.1 33.2 0.0 5.7 22.1 9.6 4.3 4.9 2.6 0.3 2.0 100.0 358 53.9 46.1 7.1 1.9 43.9 0.0 0.0 4.2 27.9 6.6 1.8 2.7 0.0 3.8 100.0 240 70.9 29.1 9.8 0.0 36.0 0.0 0.0 20.6 19.5 4.8 3.1 0.0 2.8 3.3 100.0 190 69.7 30.3 14.7 8.2 34.9 0.0 3.2 6.2 16.3 4.1 4.0 2.7 0.4 5.3 100.0 220 82.6 17.4 8.4 1.2 27.7 0.0 0.0 41.0 3.6 2.4 9.6 2.4 0.0 3.6 100.0 277 68.5 31.5 7.0 9.9 42.4 0.0 0.9 11.0 18.4 1.4 3.1 1.7 0.7 3.6 100.0 517 56.5 43.5 6.5 9.3 28.5 0.9 0.0 4.4 22.0 3.7 1.7 2.7 3.6 16.6 100.0 70 58.1 41.9 5.7 7.7 36.1 0.0 1.3 14.1 18.0 7.3 2.2 0.9 0.9 5.9 100.0 804 60.5 39.5 4.8 9.7 36.9 0.1 0.4 14.1 19.7 5.3 3.2 0.9 1.4 3.8 100.0 986 85.6 14.4 14.9 0.0 41.4 0.0 0.0 32.0 0.0 0.0 3.9 0.0 0.0 7.8 100.0 249 57.8 42.2 9.5 7.1 30.3 0.0 3.9 13.4 14.6 7.1 1.4 2.8 0.0 9.9 100.0 260 74.5 25.5 5.0 0.0 48.1 0.0 0.0 12.4 14.5 2.5 5.1 3.2 0.0 9.2 100.0 174 52.7 47.3 7.2 5.0 40.2 0.0 0.0 3.0 28.3 8.7 1.5 0.0 1.5 4.6 100.0 441 69.8 30.2 5.8 9.5 34.8 0.1 1.5 21.5 10.8 3.0 3.9 2.1 0.6 6.2 100.0 1,227 70.4 29.6 4.4 8.2 36.7 0.1 1.2 23.9 11.6 3.0 3.7 1.1 0.7 5.4 100.0 956 70.9 29.1 3.4 23.0 25.5 0.0 4.6 13.9 6.4 3.4 1.8 7.0 0.0 11.0 100.0 158 53.5 46.5 7.7 4.4 40.7 0.0 0.0 3.9 26.7 8.3 1.8 0.0 1.3 5.1 100.0 501 68.2 31.8 26.6 8.2 15.6 0.0 0.0 20.7 6.5 0.0 11.7 9.1 1.6 0.0 100.0 54 65.3 34.7 6.3 7.9 36.8 0.0 1.0 14.9 17.1 5.1 3.0 1.4 0.9 5.6 100.0 1,668 ____________________________________________________________________________________________________________________________ Note: Figures may not add to 100.0 due to rounding. 1 Respondent was employed but had not actually worked since the birth; therefore, current caretaker status is not applicable. 1 Numerators for age-specific fertility rates are calculated by summing the number of live births which occurred in the 1-36 months preceding the survey (determined from the date of interview and birth date of the child), and classifying them by age (in five-year groups) of the mother at the time of birth (determined from the birth date of the mother). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preced ing the survey. 29 CHAPTER 3 FERTILITY Naken K. Kasiev, Duishe K. Kudayarov and Talaibek S. Builashev A complete pregnancy history was collected from each woman interviewed in the 1997 KRDHS. Respondents were asked separate questions about pregnancies that resulted in live births, induced abortions (including mini-abortions), miscarriages, and stillbirths. An accounting of live births was achieved by asking separately about the number of sons and daughters living with the respondent, the number living elsewhere, and the number who had died. To encourage complete reporting of pregnancies, all pregnancy intervals of four or more years in duration were probed for intervening pregnancies. The pregnancy history was collected in reverse chronological order from the most recent to the first pregnancy. Pregnancy outcome (live birth, abortion, miscarriage, or stillbirth) and date (month and year) of termination were recorded for each pregnancy. For each live birth, the sex of the child, survival status, and age (for living children) or age at death (for deceased children) were also collected. This chapter presents the findings pertaining to live births. Chapter 5 presents the findings pertaining to pregnancy loss. 3.1 Current Fertility Table 3.1 and Figure 3.1 present age-specific fertility rates for the three-year period preceding the survey.1 Rates are expressed per 1,000 women. The sum of the age-specific rates, known as the total fertility rate (TFR), is used to summarize the current level of fertility. The TFR is interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. Two other summary measures are presented in Table 3.1: the general fertility rate (GFR) and the crude birth rate (CBR). The GFR represents the annual number of births in the population per 1,000 women age 15-44. The crude birth rate is the annual number of births in the population per 1,000 population. The latter two measures are calculated from the birth history data for the three-year period preceding the survey, and the age and sex distribution of the household population. If fertility were to remain constant at current levels, a woman in the Kyrgyz Republic would give birth to an average of 3.4 children. This national average is the result of two different levels of fertility. Fertility among rural women is higher than among urban women throughout all the childbearing years, resulting in a TFR among rural women that is 1.6 children higher than among urban women. If fertility were to remain constant at current levels, rural women would have 3.9 children, while urban women would have only 2.3 children. Both urban and rural women experience their peak childbearing years during their early twenties (age 20-24). No women age 45-49 reported having a live birth in the previous three years. 30 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the general fertility rate and crude birth rate for the three years preceding the survey, by urban-rural residence and ethnicity, Kyrgyz Republic 1997 _________________________________________________________________________________________ Residence Ethnicity ______________ ___________________________________ Age Urban Rural Kyrgyz Russian Uzbek Other Total _________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 55 84 83 (42) 72 (58) 75 165 283 240 (105) (352) (236) 246 136 204 192 (100) (227) (112) 179 61 143 121 ( 27) (137) (91) 113 38 51 58 (14) (40) (24) 47 4 18 16 (3) (8) (17) 13 0 0 0 (0) (0) (0) 0 2.29 3.91 3.56 1.46 4.19 2.69 3.37 2.29 3.91 3.56 1.46 4.19 2.69 3.37 79 137 125 49 146 94 118 19 29 27 10 33 22 26 _________________________________________________________________________________________ Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates in parentheses indicate that they are based on fewer than 250 woman-years of exposure. TFR: Total fertility rate, expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 31 Table 3.2 Fertility by background characteristics Total fertility rates for the three years preceding the survey, percentage of women currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Kyrgyz Republic 1997 ____________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant1 age 40-49 ______________________________________________________ Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Bishkek Russian Uzbek Other Total 2.29 4.04 3.15 3.91 6.59 5.34 1.65 3.47 2.14 3.12 4.44 4.72 4.34 7.05 5.76 3.89 7.00 5.12 3.70 5.57 5.39 3.31 6.16 3.70 2.39 5.52 3.56 3.56 6.39 5.29 1.46 2.49 2.15 4.19 7.28 4.86 2.69 2.24 3.48 3.37 5.74 4.55 ______________________________________________________ 1 Women age 15-49 years Ethnic differentials in fertility are even greater than the urban/rural differentials. Ethnic Uzbeks achieve the highest TFR of 4.2, which is nearly three children greater than the lowest TFR of 1.5, exhibited by Russian women. Fertility levels among Kyrgyz women fall between the levels exhibited by Uzbek and Russian women, although Kyrgyz women age 15-19 have the highest fertility rate. Women of all ethnicities achieve their peak fertility during their early twenties. Russian women maintain the lowest fertility rate at all childbearing ages. Table 3.2 and Figure 3.2 present TFRs for the three years preceding the survey by background characteristics. It can be seen that regional variation in fertility is substantial, varying by as much as 2.7 children. The TFR is lowest among women in Bishkek City (1.7 children per woman), highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and 3.9, respectively). Women in the Kyrgyz Republic exhibit a childbearing pattern observed in many societies of decreasing fertility with increasing education. The TFR declines steadily from 3.7 children per woman among women with primary or secondary schooling to 3.3 among women with secondary-special schooling and then to 2.4 children per woman among those with higher education. A crude assessment of trends in fertility over time can be made by comparing the TFR (a measure of current fertility) with the mean number of children ever born (CEB) to women age 40-49 (a measure of completed fertility). If there had been no change in fertility for three or more decades prior to the survey, the TFR and CEB would be nearly the same. The fact that the TFR (3.4 children per woman) is lower than the CEB (4.6) indicates that fertility has declined in the Kyrgyz Republic over the past three decades. The TFR is lower than the CEB among both urban and rural women, in every region, at every educational level, and among ethnic Kyrgyz women and women of other ethnicities. Table 3.2 also shows the percentage of women who reported themselves to be currently pregnant. Because women at early stages of pregnancy may not yet know they are pregnant, this proportion may be underestimated. Percentages look generally reasonable for the given levels of fertility. 2 Truncation progressively limits how far into the past fertility rates can be calculated. For example, rates cannot be calculated for women age 40-44 for the period 10-14 years before the survey because these women were over age 50 years at the time of the survey and therefore not interviewed. Partial rates (based on partial exposure time) can be calculated for women age 40-44 for the period 5-9 years before the survey because some of these women were age 45-49 at the time of the survey, and therefore included for interview. Partial rates which are subject to truncation are shown in brackets in Table 3.3. 32 Table 3.3 Trends in age-specific fertility rates Age-specific fertility rates for five-years periods preceding the survey, by mother's age at the time of birth, Kyrgyz Republic 1997 _________________________________________________ Number of years preceding the survey Mother's _________________________________ age 0-4 5-9 10-14 15-19 _________________________________________________ 15-19 79 55 48 44 20-24 257 278 295 286 25-29 188 214 265 264 30-34 118 155 183 [220] 35-39 44 71 [117] - 40-44 15 [34] - - 45-49 [0] - - - _________________________________________________ Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 3.2 Fertility Trends To examine fertility trends more directly, it is possible to look at the ASFRs over time. Age- specific fertility rates can be calculated for the preceding 20 years from the KRDHS data.2 Table 3.3 presents age-specific fertility rates for five- year periods preceding the survey using data on live births from respondents’ pregnancy histories. With the exception of 15-19 year-olds, there is evidence of a decline in fertility for all cohorts for which rates can be calculated. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year-olds to a 38 percent decline among 35-39 year-olds. Figure 3.3 shows a graphical representation of these declines. 33 Table 3.4 Trends in fertility by marital duration Fertility rates for ever-married women by duration (years) since first marriage for five-year periods preceding the survey, Kyrgyz Republic 1997 _______________________________________________ Marriage Number of years preceding the survey duration _________________________________ at birth 0-4 5-9 10-14 15-19 _______________________________________________ 0-4 332 366 408 408 5-9 168 214 257 261 10-14 101 137 182 231 15-19 45 75 155 * 20-24 17 50 * - 25-29 6 * - - _______________________________________________ Note: Duration-specific fertility rates are per 1,000 women. An asterisk indicates that a rate is based on fewer than 125 unweighted years of exposure and has been suppressed. Table 3.4 presents fertility rates for ever- married women by duration since first marriage for five-year periods preceding the survey. The decline in fertility has occurred at all marital durations; however, the decline is greatest among women with longer marital durations. Fertility within the first several years of marriage typically remains less resistant to change, even when fertility is declining, because fertility decline usually begins among older women who want to stop childbearing, not among young couples postponing births. Table 3.4 shows dramatic declines in fertility for all marital durations of five or more years and a 19 percent decline for marriages of less than five years. 3.3 Children Ever Born and Living Table 3.5 presents the distribution of all women and currently married women by number of children ever born. The greatest difference between the data for currently married women and the total sample occurs among young women, due to the large number of unmarried young women with minimal fertility. Differences at older ages reflect the general fertility-reducing impact of marital dissolution (divorce or widowhood). The table also shows the mean number of children ever born by five-year age groups. The mean number of CEB is 3.1, although the distribution is fairly spread out. The modal number of children among currently married women tends to 34 Table 3.5 Children ever born and living Percent distribution of all women and of currently married women age 15-49 by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Kyrgyz Republic 1997 _____________________________________________________________________________________________________________ Mean Number of children ever born Number Mean no. of Age _____________________________________________________________ of no. of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children _____________________________________________________________________________________________________________ ALL WOMEN _____________________________________________________________________________________________________________ 15-19 93.7 6.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 743 0.06 0.06 20-24 34.5 33.3 24.8 6.7 0.6 0.0 0.0 0.0 0.0 0.0 0.0 100.0 649 1.06 0.97 25-29 10.0 24.2 34.3 23.2 6.5 1.6 0.2 0.0 0.0 0.0 0.0 100.0 530 1.98 1.83 30-34 5.5 11.2 22.3 26.7 18.8 9.4 4.3 1.4 0.4 0.0 0.0 100.0 630 2.97 2.73 35-39 3.1 7.7 15.1 19.3 24.3 15.9 9.0 3.9 1.3 0.0 0.4 100.0 579 3.68 3.33 40-44 3.1 5.9 17.3 12.8 17.3 15.4 10.8 8.1 5.6 2.4 1.5 100.0 410 4.28 3.84 45-49 2.7 4.4 15.5 14.0 10.1 14.6 8.3 13.4 8.6 3.1 5.4 100.0 307 4.90 4.25 Total 27.2 14.1 17.9 14.1 10.4 7.0 3.9 2.7 1.6 0.5 0.6 100.0 3,848 2.35 2.12 _____________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN _____________________________________________________________________________________________________________ 15-19 51.9 47.2 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 91 0.49 0.49 20-24 17.5 38.7 33.7 9.5 0.6 0.0 0.0 0.0 0.0 0.0 0.0 100.0 460 1.37 1.27 25-29 5.0 23.6 36.2 26.3 7.2 1.5 0.2 0.0 0.0 0.0 0.0 100.0 458 2.13 1.97 30-34 2.2 8.5 22.4 29.1 20.7 10.1 4.9 1.6 0.5 0.0 0.0 100.0 557 3.18 2.93 35-39 2.0 6.3 13.7 20.7 25.0 16.7 9.3 4.4 1.5 0.1 0.4 100.0 511 3.82 3.46 40-44 0.7 4.2 15.3 12.4 18.7 17.3 11.1 9.5 6.3 2.8 1.8 100.0 342 4.61 4.15 45-49 1.3 4.4 13.2 14.6 10.5 14.4 9.5 14.6 7.6 3.7 6.1 100.0 256 5.08 4.41 Total 6.7 16.2 22.5 19.1 13.8 9.1 5.2 3.8 1.9 0.7 0.9 100.0 2,675 3.08 2.80 increase by one with each increasing age group up to 35-39. In other words, most 15-19 year-olds have no children (just barely the modal category), most 20-24 year-olds have one child, most 25-29 year-olds have two children, most 30-34 year-olds have three children, and most 35-39 year-olds have four children. This is reflected in the ever increasing mean number of children ever born, which increases steadily from 0.5 among married 15-19 year-olds to 5.1 among 45-49 year-olds. A cursory view of the survival status of children can be made by comparing the mean number of children ever born with the mean number surviving, also shown in Table 3.5. Overall, 91 percent of all children born had survived to the time of the survey. The proportion surviving declines only minimally with increasing age of the mother. 3.4 Birth Intervals The length of birth intervals is an important component of childbearing. Research has shown that children born too close to a previous birth have an increased risk of dying, especially when the interval between births is less than 24 months. Table 3.6 presents the percent distribution of second- and higher-order births in the five years prior to the survey by the number of months since the previous birth. The median 35 Table 3.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Kyrgyz Republic 1997 _____________________________________________________________________________________________________ Median Number of months since previous birth number of Number ____________________________________________ months since of Characteristic 7-17 18-23 24-35 36-47 48+ Total previous birth births ____________________________________________________________________________________________________ Age of mother 15-19 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of prior birth Male Female Survival of prior birth Deceased Still living Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total * * * * * 100.0 * 1 17.1 26.8 32.8 12.9 10.4 100.0 25.6 668 6.7 10.8 25.2 16.4 40.9 100.0 40.2 661 0.0 4.7 19.1 26.6 49.6 100.0 47.2 62 13.6 22.4 29.7 13.2 21.1 100.0 29.2 868 8.4 12.7 25.6 16.5 36.9 100.0 37.5 451 3.8 3.3 34.0 30.0 28.9 100.0 38.2 73 11.0 17.9 28.8 15.5 26.7 100.0 32.3 671 11.8 18.5 28.3 14.9 26.5 100.0 31.6 721 44.4 22.0 17.7 5.6 10.3 100.0 19.6 120 8.3 17.9 29.6 16.1 28.1 100.0 32.9 1,272 11.8 16.5 23.2 17.2 31.3 100.0 34.1 315 11.3 18.8 30.1 14.6 25.2 100.0 31.4 1,076 13.2 14.7 18.6 15.5 38.0 100.0 38.4 75 12.5 18.9 24.6 13.2 30.8 100.0 31.7 386 14.2 13.8 30.6 15.9 25.5 100.0 31.2 104 10.4 18.8 31.1 16.0 23.7 100.0 31.8 826 12.1 17.3 30.1 15.5 25.0 100.0 31.7 715 10.6 20.0 31.2 13.3 25.0 100.0 31.0 494 11.0 17.1 15.5 19.0 37.4 100.0 39.5 182 12.4 17.6 27.7 16.2 26.0 100.0 31.5 988 0.0 23.4 17.5 2.1 57.0 100.0 - 27 8.4 19.6 33.3 11.9 26.8 100.0 32.5 292 14.0 19.2 25.7 17.9 23.2 100.0 31.0 84 11.4 18.2 28.6 15.2 26.6 100.0 31.9 1,391 ____________________________________________________________________________________________________ Note: First 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 rate is based on fewer than 25 unweighted years of exposure and has been suppressed. birth interval length is 31.9 months or about 2.7 years. Overall, 30 percent of births occur within 24 months of the previous birth (see Figure 3.4). Nearly three-quarters (71 percent) of closely spaced births which occurred in the previous five years were to women in their twenties. As many as 44 percent of births to women in their twenties were born 36 within 24 months of the previous birth. Because these are young women, the lowest birth orders (2 or 3 births) also show the greatest likelihood of being born soon after the previous birth. Births which occur after a prior death are more than twice as likely as births following a living child to be born within 24 months. Aside from age of the mother, parity, and survival status of the previous birth, the distribution of birth interval lengths is fairly similar across the other background characteristics shown in the table. The shortest median birth intervals occur regarding births to women in their twenties, second and third order births, and births following a previous death. It should be noted that while births to mothers in Bishkek City exhibit a longer median birth interval than births to mothers in other regions, these births are no less likely than those in other regions to be born within 24 months of the previous birth. The longer median interval among mothers in Bishkek City (38 months) is due to more births occurring at the longest interval lengths (four or more years) than at intermediate interval lengths (two or three years), not to fewer births occurring at the shortest interval lengths (28 percent of births to mothers in Bishkek City were born within 24 months of the previous birth). The same can be said of the longer median birth interval among births to mothers with higher education. While they are more likely to have births at the longest interval lengths, they are not less likely to have births at the shortest intervals. 3.5 Age at First Birth The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of women and children. Early initiation into childbearing is generally associated with large family size and rapid population growth when family planning is not widely practiced. 37 Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Kyrgyz Republic 1997 ____________________________________________________________________________________________________ Women Median with Age at first birth Number age at no _____________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth ____________________________________________________________________________________________________ 15-19 93.7 0.0 1.4 4.9 na na na 100.0 743 a 20-24 34.5 0.0 4.2 32.4 23.4 5.4 na 100.0 649 a 25-29 10.0 0.0 1.6 21.7 35.8 23.8 7.2 100.0 530 21.5 30-34 5.5 0.0 2.3 19.0 31.2 28.5 13.6 100.0 630 21.8 35-39 3.1 0.2 1.0 18.4 32.1 29.9 15.3 100.0 579 21.9 40-44 3.1 0.0 2.5 21.5 30.6 28.9 13.5 100.0 410 21.7 45-49 2.7 0.0 5.3 22.5 28.5 25.0 16.0 100.0 307 21.4 ____________________________________________________________________________________________________ na = Not applicable a Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x Table 3.7 presents the percent distribution of women by age at first birth according to current age. The median age at which women begin childbearing has been holding steady at around 21.6. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20; one-third of 20-24 year-olds have given birth before age 20. While the median age at first birth does not vary greatly by age cohort, there is some variability by background characteristics of respondents. Table 3.8 presents the median age at first birth for cohorts age 25 and above across background characteristics. Urban women have a median age at first birth (22.2) that is nearly a year older than rural women (21.5). Women in the North, East and South Regions all exhibit a median age of 21.6, while women in Bishkek City marry an average of one year later (22.8). The educational differentials are as expected—women initiate childbearing later as their educational level increases. The median age at first birth increases from 20.9 among women with primary education, to 22.0 among secondary-special women, and then to 24.0 years among women with higher education. 3.6 Pregnancy and Motherhood Among Women Age 15-19 Fertility among women age 15-19 warrants special attention because young mothers and their children are at high risk of encountering social and health problems. There has been much research done on this topic, but the causality of the problems has proven difficult to identify. Children born to young mothers are associated with higher levels of illness and mortality during childhood than are children born to older mothers. Table 3.9 shows the percentage of women age 15-19 who are mothers or are pregnant with their first child. Early childbearing is not very prevalent in the Kyrgyz Republic; 9 percent of women age 15-19 have begun childbearing (have already given birth, or are pregnant with their first child at the time of the survey). However, giving birth at age 19 is not uncommon; 28 percent of women age 19 have given birth or are pregnant with their first child. Table 3.10 indicates that having more than one child before the age of 20 is highly uncommon in the Kyrgyz Republic. 38 Table 3.8 Median age at first birth Median age at first birth among women 25-49, by current age and selected background characteristics, Kyrgyz Republic 1997 __________________________________________________________________________________ Current age Women Background ____________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 __________________________________________________________________________________ Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 21.6 22.2 22.4 22.2 22.6 22.2 21.5 21.6 21.7 21.4 20.7 21.5 22.5 22.7 23.3 22.5 23.0 22.8 21.7 21.9 21.7 20.9 21.4 21.6 21.2 22.2 22.0 21.3 20.4 21.6 21.3 21.6 21.8 21.8 21.1 21.6 21.0 20.7 21.1 20.9 20.5 20.9 21.7 22.1 22.3 22.1 21.7 22.0 23.2 24.1 23.9 24.0 24.1 23.9 21.6 21.8 21.7 21.4 21.2 21.6 21.7 21.1 22.7 22.5 22.7 22.3 21.3 21.8 21.8 22.2 20.6 21.6 21.4 23.7 23.3 21.5 21.4 22.1 21.5 21.8 21.9 21.7 21.4 21.7 __________________________________________________________________________________ Note: The medians for cohorts 15-19 and 20-24 could not be determined because half the women had not had a birth before reaching age 15 and age 20, respectively. 39 Table 3.9 Pregnancy and motherhood among women age 15-49 Percentage of women age 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Kyrgyz Republic 1997 ________________________________________________________________ Percentage who are: Percentage _________________ who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women ________________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 0.0 0.0 0.0 175 0.0 0.4 0.4 161 1.7 5.0 6.7 126 9.0 5.7 14.7 138 22.7 5.5 28.2 143 3.8 1.5 5.3 226 7.5 3.7 11.2 517 4.4 4.4 8.8 79 5.4 1.5 6.9 226 8.1 4.1 12.2 48 7.0 3.6 10.6 390 6.1 3.4 9.6 573 6.9 2.6 9.5 91 7.3 0.7 8.1 79 7.4 2.5 9.9 467 2.6 4.4 7.1 64 4.2 5.3 9.5 147 7.0 0.9 7.9 65 6.3 3.1 9.4 743 Table 3.10 Children born to women age 15-19 Percent distribution of women age 15-19 by number of children ever born (CED), according to single year of age, Kyrgyz Republic 1997 _________________________________________________________________________ Number of Mean children ever born number Number _____________________ of of Age 0 1 2+ Total CEB women _________________________________________________________________________ 15 100.0 0.0 0.0 100.0 0.00 175 16 100.0 0.0 0.0 100.0 0.00 161 17 98.3 1.7 0.0 100.0 0.02 126 18 91.0 9.0 0.0 100.0 0.09 138 19 77.3 22.1 0.6 100.0 0.23 143 Total 93.7 6.2 0.1 100.0 0.06 743 1 The currently married category includes women in both formal unions (civil or religious) and informal unions (living together). 41 CHAPTER 4 CONTRACEPTION Talaibek S. Builashev, Jumabubu A. Doskeeva and Maken S. Mysyraliev A primary function of family planning programs is to advocate conscious entry into parenthood for both men and women, i.e., to grant families the right to define their desired number of children and provide them the means to achieve that goal. Family planning involves the control of reproductive behavior, including conception, preservation of the fetus, and childbearing, as well as prevention of conception and interruption of pregnancy. Family planning not only helps couples to avoid undesired pregnancies, but also allows them to control the timing of their childbearing. By controlling the time they enter into parenthood, the time they stop childbearing, and the intervals between births, couples can achieve their ultimate desired family size. Family planning has positive effects on the overall health of both mother and child, and is also a contributing factor in the reduction of maternal and infant mortality, and secondary sterility. The efficacy of family planning depends on people’s knowledge of methods and on the availability of methods to meet the varying needs of a wide spectrum of potential users. Availability of methods, in turn, depends on the quality and quantity of service providers and on the availability of financial and technical resources. Family planning topics addressed in this chapter include knowledge of contraceptive methods, sources of supply, use of methods in the past and present, reasons for nonuse, desire to use in the future, and attitudes and exposure to family planning messages. These data can serve as an information base for the Ministry of Health and family planning organizations to better define the need for contraceptives and better define the allocation of resources. 4.1 Knowledge of Contraceptive Methods Determining levels of knowledge and use of contraceptive methods was one of the major objectives of the KRDHS. Data on contraceptive knowledge were collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if she recognized it. The respondent was also asked whether she had ever used each method. Current use of contraception was determined by asking whether the respondent (or her partner) was currently using a method, and if so, which one. Contraceptive methods include both modern and traditional methods. Modern methods include the pill, IUD, injectables, female sterilization, and the barrier methods (diaphragm, foam, jelly, and condom). Traditional methods include periodic abstinence (rhythm method), withdrawal, and vaginal douching. Information on knowledge of contraceptive methods is presented in Table 4.1 for all women, for currently married women,1 and for women who have never had sexual intercourse. Knowledge of at least one method of contraception is nearly universal (97 percent). Also, 97 percent of respondents know at least one modern method and 69 percent know at least one traditional method. Women know, on average, five methods of contraception. Currently married women know an average of six methods, while women who have never had sex know an average of three methods. 42 Table 4.1 Knowledge of contraceptive methods Percentage of all women, of currently married women, and of women who have never had sex who know specific contraceptive methods, Kyrgyz Republic 1997 ______________________________________________________ Currently Women Contraceptive All married who never method women women had sex _____________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilization Any traditional method Periodic abstinence Withdrawal Douche Other methods Any traditional/folk method Number of respondents Mean number of methods 97.1 99.8 87.6 97.1 99.8 87.3 67.7 73.3 49.0 95.6 99.6 81.5 58.0 67.1 29.6 25.8 29.9 11.2 81.1 85.2 65.8 51.2 59.3 23.6 68.9 80.8 26.6 52.8 60.8 22.2 56.3 67.5 15.8 11.8 14.9 2.1 1.5 1.7 0.4 69.0 80.8 26.6 3,848 2,675 814 5.0 5.6 3.0 _____________________________________________________ Note: All women includes 7 unmarried sexually active women. The most commonly known method is the IUD (known by 96 percent of women). The condom and the pill are the next most commonly known methods, known by 81 and 68 percent of women, respectively. The lesser known modern methods are still known by a significant proportion of women—58 percent have knowledge of injectables, 51 percent have knowledge of female sterilization, and 26 percent know of vaginal barrier methods such as the diaphragm, foam or jelly. The data in Table 4.1 show that knowledge of all methods is higher among currently married women than among women who have never had sex. Eighty-two percent of women who have never had sex know of the IUD and two-thirds know of the condom. For purposes of communicating family planning information, women of reproductive age who have not yet engaged in sexual intercourse are as important an audience as sexually active women because these women are certain to engage in sexual relations in the near future. Periodic abstinence and withdrawal are traditional methods known by 61 and 68 percent of currently married women, respectively. Traditional methods are not as commonly known among women who have never had sex (22 percent have heard of periodic abstinence and 16 percent have heard of withdrawal). Table 4.2 presents the percentage of currently married women who know of at least one method of contraception (modern or traditional) and the percentage who know of at least one modern method, by background characteristics. Virtually all currently married women know of at least one modern method of contraception. This level of knowledge includes women of all ages, all regions of the country, all educational levels, and all ethnicities. 43 Table 4.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women who reported having heard of at least one contraceptive method and at least one modern method, by selected background characteristics, Kyrgyz Republic 1997 _____________________________________________________ Knowledge of contraception ________________ Knows Knows Number Background any modern of characteristic method method women _____________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-45 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 99.1 97.4 91 100.0 100.0 460 99.3 99.3 458 99.8 99.8 557 100.0 100.0 511 100.0 100.0 342 100.0 100.0 256 99.9 99.9 856 99.8 99.7 1,819 99.8 99.8 349 99.9 99.9 836 99.8 99.8 152 99.8 99.7 1,338 99.7 99.6 1,314 99.8 99.8 908 100.0 100.0 452 99.8 99.8 1,632 100.0 100.0 300 100.0 99.7 504 99.1 99.1 240 99.8 99.8 2,675 4.2 Ever Use of Contraception All respondents who had heard of a method of contraception were asked whether they (or a partner) had ever used the method; each method was inquired about separately. Results are presented in Table 4.3 for all women and for currently married women by five-year age groups. Overall, 83 percent of currently married women have used a method of contraception at some time in their life. Sixty-four percent of all women age 15-49 have used a method at some time. Levels of ever-use among all women are somewhat lower than among currently married women because the former includes women who are not sexually active; the most significant differential is among 15-19 year-old women. While 39 percent of currently married 15-19 year-olds have used a method at some time, only 6 percent of all 15-19 year-olds have done so; however, only 14 percent of all 15-19 year-olds have ever had sex. 44 Ta bl e 4. 3 E ve r u se o f c on tra ce pt io n Pe rc en ta ge o f a ll w om en a nd o f c ur re nt ly m ar rie d w om en w ho h av e ev er u se d an y co nt ra ce pt iv e m et ho d, b y sp ec ifi c m et ho d an d ag e, K yr gy z R ep ub lic , 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ A ny A ny Fe m al e O th er A ny Pe rio di c A ny tra d. / N um be r A ny m od er n In je ct - C on - st er ili - m od er n tra di tio na l ab st i- W ith - fo lk fo lk of A ge m et ho d m et ho d Pi ll IU D ab le s do m za tio n m et ho d m et ho d ne nc e dr aw al D ou ch e m et ho d m et ho d w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ A LL W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 6 .3 4 .4 1 .2 1 .8 0. 0 2 .2 0. 0 0. 0 3 .6 1 .6 3 .0 0 .1 0. 0 3 .6 74 3 20 -2 4 51 .8 43 .5 5 .8 32 .5 1. 2 19 .9 0. 0 0. 9 26 .5 6 .6 20 .3 5 .7 0. 0 26 .5 64 9 25 -2 9 78 .7 68 .7 13 .6 55 .6 4. 2 29 .2 0. 6 0. 5 41 .5 16 .6 27 .9 9 .0 0. 4 41 .7 53 0 30 -3 4 86 .1 81 .2 12 .0 74 .6 3. 6 27 .1 0. 6 1. 1 42 .2 15 .7 29 .2 9 .9 0. 5 42 .2 63 0 35 -3 9 87 .9 84 .0 14 .5 76 .4 5. 4 23 .9 1. 7 2. 4 40 .9 16 .9 26 .1 10 .4 0. 3 40 .9 57 9 40 -4 4 85 .3 80 .7 13 .4 70 .4 3. 8 20 .4 5. 3 5. 5 43 .3 21 .3 26 .0 15 .9 2. 1 44 .3 41 0 45 -4 9 81 .9 76 .3 12 .2 63 .8 3. 2 25 .7 4. 7 3. 5 45 .8 18 .0 26 .6 17 .9 0. 9 46 .6 30 7 To ta l 63 .7 58 .3 9 .6 49 .8 2. 9 20 .1 1. 4 1. 6 32 .2 12 .5 21 .5 8 .5 0. 5 32 .4 3, 84 8 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C U R R EN TL Y M A R R IE D W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 39 .2 26 .5 4 .8 14 .9 0. 3 12 .2 0. 0 0. 0 22 .3 7 .8 17 .0 1 .2 0. 0 22 .3 9 1 20 -2 4 66 .6 56 .0 7 .4 42 .5 1. 7 25 .0 0. 0 1. 3 33 .3 8 .1 25 .6 7 .7 0. 0 33 .3 46 0 25 -2 9 84 .4 73 .9 14 .7 61 .5 4. 8 31 .4 0. 6 0. 6 45 .1 17 .0 31 .4 9 .8 0. 4 45 .3 45 8 30 -3 4 90 .5 86 .5 12 .9 80 .9 4. 1 28 .5 0. 5 1. 1 44 .5 16 .4 30 .6 10 .9 0. 6 44 .5 55 7 35 -3 9 91 .8 87 .9 14 .9 80 .2 6. 0 25 .5 1. 8 2. 5 43 .3 17 .3 28 .4 10 .8 0. 3 43 .3 51 1 40 -4 4 90 .5 85 .8 15 .7 74 .9 4. 0 21 .7 6. 1 5. 4 47 .2 23 .0 28 .7 17 .1 2. 5 48 .3 34 2 45 -4 9 85 .0 80 .7 12 .9 68 .6 3. 7 26 .8 5. 4 4. 2 46 .5 19 .2 27 .7 16 .5 0. 4 47 .0 25 6 To ta l 83 .3 76 .7 12 .7 66 .7 4. 0 26 .2 1. 8 2. 1 42 .2 16 .1 28 .5 11 .2 0. 6 42 .5 2, 67 5 45 The women most likely to have used a modern method of contraception at sometime are those age 30-44 (among both currently married and all women). By far the most widely used method is the IUD. Overall, 50 percent of all women age and 67 percent of currently married women have used an IUD at some time. Among currently married women in their thirties, 80 percent have used an IUD. Condoms are the next most commonly used modern method with 26 percent of currently married women having used a condom. Pills are the third most commonly used modern method with 13 percent of currently married women having used them at some time. Other modern methods (injectables, diaphragm and female sterilization) have been used by only 4 percent of married women. While more women have used modern methods than traditional methods, many women have in fact used a traditional method at some time. Overall, 42 percent of currently married women have used a traditional method at some time in their life, while 32 percent of all women have done so. Withdrawal and periodic abstinence are the traditional methods most likely to have been used by women at some time in their life. Twenty-nine percent of married women have used withdrawal, and 16 percent have used periodic abstinence. Eleven percent of currently married women have used vaginal douching as a method of contraception. 4.3 Current Use of Contraception Table 4.4 presents levels of current use of contraception for all women and for currently married women by five-year age groups. Figure 4.1 shows the distribution of currently married women by method currently used. One out of every three women of reproductive age (35 percent) is currently using a modern method of contraception, while 8 percent are using a traditional method. Among currently married women, half (49 percent) are using modern methods of contraception and 11 percent are using traditional methods. The IUD is by far the most commonly used method—38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: condoms (6 percent), and pills, injectables and female sterilization (each 2 percent or less). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD, although the pill, condoms, injectables and female sterilization are widely known (known to at least half of all women). As the goal of the family planning program is to provide each woman with a choice of safe and effective methods, more effort should be made to provide information and access to the range of methods. For example, women who want no more children and want to avoid any risk of childbearing may want to use female sterilization rather than the IUD. Use of modern methods of contraception increases steadily by age, peaking at age 35-39 (59 percent of currently married women) and then declines. Use of traditional methods remains relatively constant over all ages. Of course, the desire to avoid pregnancy varies greatly over the course of a woman’s reproductive life; use of contraception in relation to age and in the context of fertility preferences is discussed in Chapter 7. Levels of contraceptive use by background characteristics of respondents are presented in Table 4.5 and Figure 4.2 for currently married women. While there is some variation in levels of use, Table 4.5 shows that the level of modern contraceptive use observed for the population as a whole (49 percent) is generally maintained across background characteristics of respondents. The most notable variations in usage of modern methods are the higher levels seen among urban women, women in Bishkek City, and Russian women. 46 Ta bl e 4. 4 C ur re nt u se o f c on tra ce pt io n Pe rc en t d is tri bu tio n of a ll w om en a nd o f c ur re nt ly m ar rie d w om en w ho a re c ur re nt ly u si ng a c on tra ce pt iv e m et ho d by sp ec ifi c m et ho d, a cc or di ng to a ge , K yr gy z R ep ub lic 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M od er n m et ho d Tr ad iti on al m et ho d _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ A ny Fe m al e O th er A ny Pe rio di c N ot N um be r A ny m od er n In je ct - C on - st er ili - m od er n tra di tio na l ab st i- W ith - cu rr en tly of A ge m et ho d m et ho d Pi ll IU D ab le s do m za tio n m et ho d m et ho d ne nc e dr aw al D ou ch e us in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ A LL W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 3 .9 2 .9 0 .1 1 .8 0. 0 0 .9 0. 0 0. 0 1 .1 0 .5 0. 6 0. 0 96 .1 10 0. 0 74 3 20 -2 4 35 .7 28 .9 0 .9 22 .5 0. 2 5 .2 0. 0 0. 0 6 .8 1 .6 4. 2 1. 1 64 .3 10 0. 0 64 9 25 -2 9 50 .3 41 .2 1 .4 33 .4 0. 4 5 .1 0. 6 0. 3 9 .0 2 .5 5. 6 1. 0 49 .7 10 0. 0 53 0 30 -3 4 63 .5 52 .7 2 .4 41 .8 2. 0 5 .7 0. 6 0. 2 10 .8 2 .7 5. 7 2. 4 36 .5 10 0. 0 63 0 35 -3 9 64 .1 54 .8 2 .3 43 .8 2. 1 4 .8 1. 7 0. 0 9 .3 2 .6 6. 0 0. 8 35 .9 10 0. 0 57 9 40 -4 4 55 .5 45 .0 0 .7 34 .1 1. 0 3 .8 5. 3 0. 0 10 .5 5 .4 3. 8 1. 3 44 .5 10 0. 0 41 0 45 -4 9 38 .8 31 .8 0 .6 22 .7 1. 1 2 .8 4. 7 0. 0 7 .0 1 .4 4. 5 1. 1 61 .2 10 0. 0 30 7 To ta l 42 .8 35 .3 1 .2 27 .6 0. 9 4 .1 1. 4 0. 1 7 .5 2 .2 4. 2 1. 1 57 .2 10 0. 0 3, 84 8 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C U R R EN TL Y M A R R IE D W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 29 .3 20 .5 0 .0 14 .9 0. 3 5 .4 0. 0 0. 0 8 .8 4 .1 4. 6 0. 0 70 .7 10 0. 0 9 1 20 -2 4 48 .7 39 .2 1 .3 30 .4 0. 3 7 .3 0. 0 0. 0 9 .5 2 .1 5. 9 1. 5 51 .3 10 0. 0 46 0 25 -2 9 56 .9 46 .5 1 .6 37 .6 0. 5 5 .9 0. 6 0. 4 10 .3 2 .8 6. 3 1. 2 43 .1 10 0. 0 45 8 30 -3 4 69 .9 57 .7 2 .7 45 .9 2. 2 6 .2 0. 5 0. 2 12 .2 3 .1 6. 4 2. 7 30 .1 10 0. 0 55 7 35 -3 9 69 .5 59 .0 2 .6 46 .8 2. 4 5 .5 1. 8 0. 0 10 .5 2 .8 6. 8 0. 9 30 .5 10 0. 0 51 1 40 -4 4 64 .2 51 .6 0 .8 38 .9 1. 2 4 .6 6. 1 0. 0 12 .6 6 .5 4. 6 1. 5 35 .8 10 0. 0 34 2 45 -4 9 45 .8 37 .4 0 .7 26 .7 1. 3 3 .3 5. 4 0. 0 8 .5 1 .7 5. 4 1. 3 54 .2 10 0. 0 25 6 To ta l 59 .5 48 .9 1 .7 38 .2 1. 3 5 .7 1. 8 0. 1 10 .7 3 .2 6. 0 1. 5 40 .5 10 0. 0 2, 67 5 47 A majority of women in Bishkek City report themselves to be using a modern method of contraception (60 percent). Women in Bishkek City also exhibit the lowest fertility levels. Levels of contraceptive use in the other regions of the country do not vary to the degree that might be expected from the fertility differentials by region. A more complete investigation of regional fertility differentials would have to consider factors such as age at marriage, breastfeeding practices, and induced abortion, in addition to the use of contraception. Unlike many other countries, women with less education are no less likely to be using a method of contraception than women with more education. Women of Kyrgyz, Uzbek and other ethnicities are all equally likely to be using a modern method of contraception (48 percent). Women of Russian ethnicity are somewhat more likely than other women to be using a modern method (58 percent). The level of contraceptive use does increase with an increasing number of living children, but reaches its maximum fairly quickly. Women with four or more children are as likely to be using a modern method as women with two or three children. Differentials in the method mix are largely overshadowed by heavy reliance on the IUD among women of all background characteristics (with the exception of those with one or no children). However, women with higher than average levels of use (urban women, women in Bishkek City, and Russian women) exhibit the broadest method mix. It is these women who show higher levels of condom and pill use. Sixteen percent of currently married women in Bishkek City report that they are currently using condoms, compared with 5 percent or less in other regions. Another 5 percent of women in Bishkek City report that they are currently using the pill, compared with 1-2 percent in other regions. The method mix among women of Russian ethnicity and urban women is similar to that of women in Bishkek City. 48 Ta bl e 4. 5 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s Pe rc en t d is tri bu tio n of c ur re nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to se le ct ed b ac kg ro un d ch ar ac te ris tic s, K yr gy z R ep ub lic 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d T ra di tio na l m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ A ny Fe m al e O th er A ny Pe rio di c N ot N um be r A ny m od er n In je ct - C on - st er ili - m od er n tra di tio na l ab st i- W ith - cu rr en tly of A ge m et ho d m et ho d Pi ll IU D ab le s do m za tio n m et ho d m et ho d ne nc e dr aw al D ou ch e us in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ R es id en ce U rb an 65 .8 55 .0 3. 0 37 .6 1. 1 10 .6 2. 4 0. 2 10 .8 5. 4 3 .7 1. 7 34 .2 10 0. 0 85 6 R ur al 56 .6 46 .0 1. 2 38 .4 1. 5 3 .4 1. 5 0. 1 10 .6 2. 1 7 .1 1. 4 43 .4 10 0. 0 1, 81 9 R eg io n B is hk ek C ity 68 .9 59 .6 5. 0 33 .3 1. 2 15 .8 3. 8 0. 5 9. 3 6. 5 1 .0 1. 8 31 .1 10 0. 0 34 9 N or th 59 .2 50 .3 1. 6 40 .5 1. 6 4 .5 1. 9 0. 1 8. 9 3. 4 2 .8 2. 7 40 .8 10 0. 0 83 6 E as t 54 .0 51 .6 0. 9 43 .5 3. 3 2 .0 1. 8 0. 0 2. 4 1. 8 0 .2 0. 4 46 .0 10 0. 0 15 2 S ou th 58 .0 44 .9 1. 1 37 .4 1. 0 4 .2 1. 2 0. 0 13 .1 2. 3 9 .9 0. 9 42 .0 10 0. 0 1, 33 8 Ed uc at io n P rim ar y/ Se co nd ar y 58 .2 47 .0 1. 1 39 .4 1. 3 3 .6 1. 6 0. 0 11 .2 1. 7 8 .1 1. 4 41 .8 10 0. 0 1, 31 4 S ec on da ry -s pe ci al 59 .4 50 .5 1. 7 39 .4 1. 7 6 .1 1. 5 0. 1 8 .9 3. 5 4 .0 1. 4 40 .6 10 0. 0 90 8 H ig he r 63 .7 51 .2 3. 9 32 .4 0. 5 11 .0 3. 0 0. 4 12 .5 6. 6 4 .0 1. 9 36 .3 10 0. 0 45 2 Et hn ic ity K yr gy z 55 .8 47 .0 1. 1 39 .2 1. 4 3 .4 1. 8 0. 0 8. 7 2. 7 4 .6 1. 4 44 .2 10 0. 0 1, 63 2 R us si an 71 .8 58 .1 5. 6 31 .5 0. 8 17 .8 2. 0 0. 4 13 .8 9. 7 2 .7 1. 3 28 .2 10 0. 0 30 0 U zb ek 62 .7 49 .5 1. 5 41 .1 1. 2 4 .6 1. 2 0. 0 13 .2 0. 3 12 .3 0. 6 37 .3 10 0. 0 50 4 O th er 63 .2 48 .7 1. 4 33 .5 2. 0 8 .3 3. 0 0. 5 14 .5 3. 8 6 .5 4. 2 36 .8 10 0. 0 24 0 N o. o f l iv in g ch ild re n 0 20 .1 17 .5 3. 1 3 .1 0. 6 10 .0 0. 6 0. 0 2 .6 1. 9 0 .3 0. 4 79 .9 10 0. 0 19 6 1 46 .1 35 .7 1. 7 26 .2 0. 3 6 .9 0. 4 0. 3 10 .4 5. 1 4 .5 0. 8 53 .9 10 0. 0 46 4 2 66 .5 54 .0 2. 3 41 .0 0. 7 7 .7 2. 1 0. 1 12 .5 3. 5 5 .9 3. 0 33 .5 10 0. 0 66 0 3 67 .9 55 .1 1. 3 44 .6 1. 5 4 .9 2. 5 0. 2 12 .8 3. 3 7 .6 1. 9 32 .1 10 0. 0 53 3 4 + 65 .5 55 .6 1. 3 46 .8 2. 4 2 .8 2. 3 0. 0 9 .9 2. 0 7 .2 0. 7 34 .5 10 0. 0 82 3 To ta l 59 .5 48 .9 1. 7 38 .2 1. 3 5 .7 1. 8 0. 1 10 .7 3. 2 6 .0 1. 5 40 .5 10 0. 0 2, 67 5 49 Table 4.6 Use of pill brands Percent distribution of pill users by the brand of pills used, Kyrgyz Republic 1997 ________________________________ Pill brand Total ________________________________ Diane-35 1.2 Marvelon 4.5 Microgynon 12.1 Postinor 6.7 Rigevidon 33.1 Triziston 1.2 Triquilar 5.7 Triquilar ED Gy 3.3 Tri-regol 7.4 Mini-pills 1.2 Atsovin 15.2 Don’t know 8.4 Total 100.0 Number 47 In order to gather data on pill brands, users of the pill were asked to show their pill packet to the interviewer, who then recorded the brand name of the pills. Overall, 80 percent of pill users were able to show their packets to the interviewer. Respondents who were unable to show their packet were asked to report the brand name of their pills. In total, brand information was obtained from 47 respondents. Table 4.6 presents the distribution of pill users by brand of pills. The table presents data for all pill users, regardless of marital status. Eleven brands of pills were reported as being used, with the most commonly used brand being Rigevidon (33 percent). 4.4 Number of Children at First Use of Contraception To make some assessment of the motivations behind using family planning methods, women were asked how many living children they had at the time they first used a method of family planning. Women who use a method before ever having a child presumably want to delay their childbearing to some time in the future. Women who first employ a method after they have had one or two children may either want to delay the next child or limit their childbearing to one or two children. Women who use a method for the first time after having several children are more likely to be using family planning to stop childbearing, rather than simply spacing their childbearing. Table 4.7 presents the percent distribution of all ever-married women by the number of living children they had at the time they first used a method of family planning. 50 Table 4.7 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, Kyrgyz Republic 1997 ____________________________________________________________________________________________________ Median Never Number of living children at time number used of first use of contraception Number of children contra- ___________________________________________________ of at first Current age ception 0 1 2 3 4+ Missing Total women use1 ____________________________________________________________________________________________________ 15-19 57.8 21.5 20.8 0.0 0.0 0.0 0.0 100.0 102 0.0 20-24 35.7 9.9 38.9 12.5 2.3 0.3 0.4 100.0 521 1.6 25-29 18.0 9.0 38.8 27.1 5.4 1.4 0.3 100.0 506 1.8 30-34 11.8 4.2 27.2 29.1 17.9 9.9 0.0 100.0 614 2.4 35-39 11.5 2.5 19.2 27.3 18.2 21.1 0.2 100.0 574 2.8 40-44 13.7 2.6 19.7 19.4 14.5 30.2 0.0 100.0 404 3.1 45-49 16.8 2.0 15.9 17.6 12.1 35.5 0.2 100.0 302 3.5 Total 19.2 5.8 27.3 22.1 11.5 13.9 0.2 100.0 3,021 2.3 ____________________________________________________________________________________________________ 1 Median number of children at first use of contraception among those who have ever used contraception Table 4.8 Knowledge of fertile period Percent distribution of all women and of women who are currently using periodic abstinence or the calendar rhythm method by knowledge of the fertile period during the ovulatory cycle, Kyrgyz Republic 1997 ______________________________________________________ Current users of: __________________ Perceived All Periodic Calendar fertile period women abstinence rhythm _____________________________________________________ During her period 0.3 0.0 0.0 After period ended 12.0 5.1 3.9 Middle of the cycle 19.0 83.8 84.8 Before period begins 1.0 3.8 3.9 At any time 19.1 3.1 3.2 Other 0.1 0.0 0.0 Don't know 48.5 4.2 4.2 Total 100.0 100.0 100.0 Number 3,848 86 84 _______________________________________________________ Note: Two respondents reported using the symptothermal method. Use of family planning to delay the first pregnancy is uncommon in the Kyrgyz Republic (6 percent of women have done so). Older women (over the age of 39) had a median of three or more children before they first used contraception; younger women have a median of fewer than two children at first use of contraception. Overall, 27 percent of ever-married women of reproductive age had one living child at the time they first used a method of contraception, and the likelihood of using a method after having just one child has been increasing over time. Up to 40 percent of women in their twenties first used a method of contraception after having one child. 4.5 Knowledge of the Fertile Period and of the Contraceptive Effect of Breastfeeding Knowledge of reproductive physiology is an important prerequisite for effective use of traditional contraceptive methods. To successfully practice periodic sexual abstinence, a woman must know at which point during the ovulation cycle she is most likely to become pregnant. All women were asked whether they thought there was a time during their monthly cycle that they were more likely to become pregnant, and if so, to identify when that was. Table 4.8 presents the percent distribution of all women, women who are currently using any form of periodic abstinence, and women who are currently using the calendar rhythm method, by knowledge of the fertile period. 2 Data collection included recording of the name of the source so that team supervisors and editors could verify the type of source. 51 One out of five women properly identified the middle of the cycle as the most likely time to become pregnant. Most respondents said either that they did not know which time is more likely than another (49 percent), or that no time is more likely than another (19 percent). On the other hand, most women who are using either periodic abstinence or the calendar rhythm method know about the varying likelihood of becoming pregnant. Eighty-four percent of women who are using periodic abstinence and 85 percent of women who are using the calendar method could properly identify the time during which they are most fertile. Exclusive and frequent breastfeeding can prolong the period of time following a birth during which a woman is amenorrheic (not menstruating) and anovulatory (not ovulating). It has also been shown that even after the resumption of menstruation the probability of pregnancy is lower among women who continue to breastfeed than among women who have stopped (Hobcraft and Guz, 1991; Potts et al., 1985). Women were asked what effect, if any, breastfeeding has on the risk of pregnancy. Women were also asked whether they have ever relied on breastfeeding as a method of contraception and whether they are currently doing so. These data are shown in Table 4.9 for currently married women. Overall, about one in three currently married women (36 percent) report that breastfeeding reduces the risk of becoming pregnant. This level of perception is generally maintained across most background characteristics. The most notable deviation is that women of Russian ethnicity are less inclined to believe that breastfeeding has any contraceptive effectiveness (27 percent). Twenty-nine percent of currently married women have used breastfeeding as a means of contraception at some time in their lives, and 14 percent of women report they are currently doing so. Women of Kyrgyz and Uzbek ethnicity are the most likely to have used breastfeeding for family planning purposes (32 and 30 percent, respectively) and are also the most likely to be current users (16 and 17 percent, respectively). Table 4.9 also presents the proportion of currently married women who meet the lactational amenorrheic method (LAM) criteria. In order to meet these criteria, a woman must be fully breastfeeding a child who is less than six months old, and she must also be amenorrheic. Two percent of women meet the LAM criteria. 4.6 Source of Family Planning Methods All women currently using a modern method were asked where they most recently obtained their method.2 Table 4.10 shows the percent distribution of current users of modern contraceptives by the source from which they most recently obtained their method. The vast majority of women obtained their contraceptives through the public sector (97 percent). Thirty-five percent of users obtained their method from a hospital, and 36 percent from a family planning clinic (women counseling centers). The source of supply is related to the method used. For example, most women using IUDs obtain them at hospitals (39 percent) or family planning clinics (42 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also go to family planning clinics to obtain their pills (33 percent). Figure 4.3 summarizes the distribution of current users of modern methods by source of method. 52 Table 4.9 Perceived contraceptive effect of breastfeeding Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding, percentage who previously relied or who currently rely on breastfeeding to avoid pregnancy, and percentage who meet lactational amenorrheic method (LAM) criteria, according to selected background characteristics, Kyrgyz Republic 1997 _____________________________________________________________________________________________________ Reliance on breastfeeding Perceived risk of pregnancy to avoid associated with breastfeeding pregnancy _________________________________________ ______________ Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends Missing Total ously rently criteria1 women _____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Bishkek City North East South Education Primary/Secondary Secondary-special Higher Ethnicity Kyrgyz Russian Uzbek Other Total 58.6 14.2 17.5 9.4 0.3 100.0 10.5 8.8 10.2 91 44.0 14.7 35.5 4.6 1.2 100.0 25.8 16.0 6.2 460 42.6 13.1 36.7 6.9 0.6 100.0 31.2 12.8 2.6 458 37.0 20.2 36.4 6.3 0.2 100.0 29.6 15.7 1.8 557 37.0 19.1 39.1 4.8 0.0 100.0 30.0 15.2 0.7 511 44.5 16.8 32.2 6.5 0.0 100.0 30.3 14.5 0.0 342 39.0 17.6 35.2 8.1 0.0 100.0 28.9 10.5 0.0 256 45.0 15.3 34.4 5.1 0.2 100.0 23.6 9.9 2.5 856 39.2 17.7 36.0 6.6 0.4 100.0 31.1 16.3 2.3 1,819 54.4 8.0 32.8 4.7 0.2 100.0 22.1 6.2 1.5 349 47.0 6.8 40.3 5.1 0.7 100.0 24.4 12.6 3.2 836 50.5 8.6 36.8 3.8 0.2 100.0 28.2 13.8 1.5 152 32.8 26.5 33.1 7.4 0.2 100.0 33.1 17.5 2.2 1,338 38.2 20.1 34.6 6.6 0.6 100.0 30.6 15.5 2.3 1,314 43.2 13.6 37.5 5.5 0.3 100.0 27.6 14.4 1.8 908 45.2 14.6 34.0 6.2 0.0 100.0 25.2 10.6 3.7 452 38.4 16.7 37.3 7.1 0.5 100.0 32.2 15.9 2.9 1,632 59.9 8.7 27.2 4.2 0.0 100.0 15.0 4.3 1.0 300 38.1 24.0 32.4 5.5 0.0 100.0 30.3 17.4 1.9 504 42.0 14.0 40.2 3.4 0.5 100.0 18.7 9.2 1.8 240 41.1 16.9 35.5 6.1 0.4 100.0 28.7 14.3 2.4 2,675 _____________________________________________________________________________________________________ 1 Currently fully breastfeeding, child is less than 6 months old and mother is postpartum amenorrheic All current users of modern methods were asked whether they know a source for family planning other than the source from which they most recently obtained their method. Women who know an alternative source were asked to explain the main reason they went to their most recent source instead of the alternative source. Results are presented in Table 4.11 by background characteristics of respondents. Seventy percent of women who were using modern methods at the time of the survey reported knowing of more than one place to obtain their method. Among those who knew of an alternative place, half chose their current source of supply because it was closer to home. Other reasons for choosing the place they did included the quality of the staff and the fact that they went to that source for other services as well. 53 Table 4.10 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, Kyrgyz Republic 1997 ___________________________________________________________________________________ Modern method __________________________________________________ Female All Inject- Con- sterili- modern Source of supply Pill IUD ables dom zation Other methods ______________________________________________________________________________________ Public 90.1 98.8 (99.2) 85.5 100.0 40.7 96.9 Hospital 7.1 38.6 (15.4) 2.9 98.4 0.0 35.0 Polyclinic 2.9 14.4 (39.4) 2.4 1.1 0.0 12.7 Women counseling center 33.3 41.7 (44.4) 4.7 0.5 20.4 35.6 Public pharmacy 46.1 3.9 (0.0) 74.8 0.0 20.4 13.3 Community health worker 0.6 0.2 (0.0) 0.7 0.0 0.0 0.2 Other public 0.0 0.1 (0.0) 0.0 0.0 0.0 0.0 Private medical 0.0 0.2 (0.8) 3.9 0.0 0.0 0.6 Private hosp, clinic 0.0 0.0 (0.8) 0.0 0.0 0.0 0.0 Private pharmacy 0.0 0.0 (0.0) 3.5 0.0 0.0 0.4 Private doctor 0.0 0.1 (0.0) 0.0 0.0 0.0 0.1 Private mobile clinic 0.0 0.1 (0.0) 0.0 0.0 0.0 0.1 Other private 0.0 0.0 (0.0) 0.4 0.0 0.0 0.0 Other source 7.0 0.0 (0.0) 9.7 0.0 20.4 1.4 Shop 1.2 0.0 (0.0) 4.2 0.0 0.0 0.5 Friends, relatives 2.5 0.0 (0.0) 4.5 0.0 0.0 0.6 Other 3.3 0.0 (0.0) 1.0 0.0 20.4 0.3 Missing 3.0 0.9 (0.0) 0.9 0.0 38.9 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 47 1,063 36 156 53 3 1,358 ______________________________________________________________________________________ Note: Total includes four (unweighted) women using other modern methods. Figures in parentheses are based on 25-49 unweighted women. Whether or not users of modern methods know of more than one place to obtain methods varies by background characteristics of respondents. Rural women are more likely than urban women to know of only one source of supply (34 and 24 percent, respectively). Women in the East and South Regions are more likely than women in Bishkek City and the North Region to know of only one source of supply (43 and 38 percent versus 19 and 23 percent, respectively). 4.7 Intention to Use Family Planning Among Nonusers Intentions of women to use family planning methods in the future provide a basis for forecasting potential requirements of family planning services. The KRDHS asked nonusers of contraception whether they intend to use a method at some time in the future, and more specifically, whether they intend to do so within the next 12 months. Table 4.12 presents the results for currently married women according to their past experience with contraception and by the number of living children they have. Overall, 66 percent of currently married nonusers intend to use a method of family planning at some time in the future; 40 percent intend to use within the next 12

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