Lesotho - Demographic and Health Survey - 2005

Publication date: 2005

Lesotho Demographic and Health Survey 2004 Millennium Development Goal Indicators, Lesotho 2004 Goal Indicator Value 1. Eradicate extreme poverty and hunger Prevalence of underweight children under five years of age Male: 18.9% Female: 20.8% Total: 19.8% 2. Achieve universal primary education Net enrolment ratio in primary education1 Male: 81.4% Female: 87.7% Total: 84.5% Proportion of pupils starting grade 1 who reach grade 51 Male: 33.9% Female: 51.1% Total: 42.6% Literacy rate of 15-24-year olds2 Male: 75.2% Female: 91.9% Total: 87.2% 3. Promote gender equality and empower women Ratio of girls to boys in primary and secondary education Primary education: 0.97 Secondary education: 1.32 Ratio of literate women to men, 15-24 years old 1.22 Share of women in wage employment in the non-agricultural sector3 27.0% 4. Reduce child mortality Under-five mortality rate (per 1,000 live births) 113 per 1,000 Infant mortality rate (per 1,000 live births) 91 per 1,000 Proportion of 1-year-old children immunised against measles Male: 85.5% Female: 84.3% Total: 84.9% 5. Improve maternal health Maternal Mortality Ratio (per 100,000 live births) 762 per 100,000 Proportion of births attended by skilled health personnel 55.4% 6. Combat HIV/AIDS, malaria, and other diseases Condom use rate of the contraceptive prevalence rate (any modern method, currently married women 15-49) 14.5% Condom use at last high-risk sex (population age 15-24)4 Male: 47.6% Female: 50.1% Percentage of population age 15-24 years with comprehensive correct knowledge of HIV/AIDS5 Male: 18.4% Female: 25.8% Contraceptive prevalence rate (any modern method, currently married women 15-49) 35.2% Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 years 1.0 7. Ensure environmental sustainability Proportion of population using solid fuels6 Urban: 9.9% Rural: 80.2% Total: 67.8% Proportion of population with sustainable access to an improved water source, urban and rural7 Urban: 90.1% Rural: 57.3% Total: 50.9% Proportion of population with access to improved sanitation, urban and rural8 Urban: 92.3% Rural: 48.0% Total: 55.8% 1 Excludes children with parental status missing 2 Refers to respondents who attended secondary school or higher and women who can read a whole sentence 3 Wage employment includes respondents who receive wages in cash or in cash and kind. 4 High risk refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent; time frame is 12 months preceding the survey. 5 A person is considered to have a comprehensive knowledge about AIDS when they say that use of condoms for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, that a healthy-looking person can have the AIDS virus, and when they reject the two most common local misconceptions. The most common misconceptions in Lesotho are that AIDS can be transmitted through mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is infected. 6 Charcoal, firewood, straw, dung, or crop waste 7 Improved water sources are: household connection (piped), public standpipe, borehole, protected dug well, protected spring, or rainwater collection. 8 Improved sanitation technologies are: connection to a public sewer, connection to septic system, pour-flush latrine, simple pit latrine, or ventilated improved pit latrine. Lesotho Demographic and Health Survey 2004 Ministry of Health and Social Welfare Maseru, Lesotho Bureau of Statistics Maseru, Lesotho ORC Macro Calverton, Maryland, USA November 2005 The 2004 Lesotho Demographic and Health Survey (2004 LDHS) is part of the worldwide MEASURE DHS project which is funded by Government of Lesotho, Development Cooperation Ireland (DCI), World Bank, UNICEF, DFID, WHO, and USAID’s Regional HIV/AIDS Program (USAID/RHAP). Additional information about the 2004 LDHS may be obtained from the Ministry of Health and Social Welfare, address. P.O. Box 514, Maseru 100, Lesotho, Southern Africa, Telephone +266-22317707 or +266-22324561, Fax +266-22311014 and the Bureau of Statistics, address P.O. Box 455, Maseru, Lesotho, Southern Africa, Telephone +266-22323852, Fax +266- 22310177. The authors’ views expressed in this publication do not necessarily reflect the views of the Government of Lesotho or the donor agencies. Additional information about the DHS project may be obtained from ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@orcmacro.com, Internet: http://www.measuredhs.com. Recommended citation: Ministry of Health and Social Welfare (MOHSW) [Lesotho], Bureau of Statistics (BOS) [Lesotho], and ORC Macro. 2005. Lesotho Demographic and Health Survey 2004. Calverton, Maryland: MOH, BOS, and ORC Macro. Contents | iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii SUMMARY OF FINDINGS . xix MAP OF LESOTHO . xxiv CHAPTER 1 INTRODUCTION Mahlape Ramoseme 1.1 Geography, History, and Economy.1 1.1.1 Geography .1 1.1.2 History .1 1.1.3 Economy.1 1.2 Population .1 1.3 Objectives of the Survey .2 1.4 Organisation of the Survey .3 1.5 Sample Design .3 1.6 Questionnaires.3 1.7 Haemoglobin And HIV Testing.4 1.7.1 Haemoglobin Testing .5 1.7.2 HIV Testing .5 1.8 Training and Fieldwork .6 1.9 Data Processing.6 1.10 Response Rates .7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS John Nkonyana 2.1 Household Population by Age and Sex.9 2.2 Household Composition .11 2.3 Educational Attainment of Household Members.11 2.4 Housing Characteristics .17 2.5 Household Durable Goods .19 2.6 Residency Status .20 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Respondents.23 3.2 Educational Attainment and Literacy .23 3.3 Access to Mass Media .29 3.4 Employment .31 3.4.1 Employment Status.31 iv │ Contents 3.4.2 Occupation.34 3.4.3 Type of Employer, Form of Earnings, and Continuity of Employment.36 3.4.4 Control Over Earnings and Women’s Contribution to Household Expenditures .37 3.5 Women’s Empowerment .40 3.5.1 Women’s Participation in Decisionmaking .40 3.5.2 Women’s Attitudes Towards Wife Beating.43 3.5.3 Attitudes Towards Refusing Sex with Husband.46 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction.51 4.2 Current Fertility.51 4.3 Fertility by Background Characteristics .52 4.4 Fertility Trends .53 4.5 Children Ever Born and Children Surviving.54 4.6 Birth Intervals.55 4.7 Age at First Birth.57 4.8 Teenage Fertility.58 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.61 5.2 Ever Use of Contraception .65 5.3 Current Use of Contraceptive Methods .67 5.4 Trends in Contraceptive Use .68 5.5 Differentials in Contraceptive Use by Background Characteristics.69 5.6 Current Use of Contraceptives by Women’s Status.71 5.7 Timing of First Use of Contraception .72 5.8 Knowledge of the Fertile Period .73 5.9 Source of Contraception .73 5.10 Informed Choice.74 5.11 Future Use of Contraception .76 5.12 Reasons for Not Intending to Use .76 5.13 Preferred Method for Future Use .77 5.14 Exposure to Family Planning Messages .78 5.15 Contact of Nonusers with Family Planning Providers .80 5.16 Discussion of Family Planning .81 5.17 Attitudes of Respondents Towards Family Planning .82 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Introduction.87 6.2 Marital Status .87 6.3 Polygyny .88 6.4 Age at First Marriage .89 6.5 Age at First Sexual Intercourse.91 Contents | v 6.6 Recent Sexual Activity .93 6.7 Postpartum Amenorrhoea, Abstinence, and Insusceptibility.96 6.8 Termination of Exposure to Pregnancy .98 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children .99 7.2 Need for Family Planning Services. 102 7.3 Ideal Family Size . 107 7.4 Wanted and Unwanted Fertility . 109 7.5 Ideal Family Size and Unmet Need by Women’s Status. 111 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality. 114 8.2 Socioeconomic Differentials in Infant and Child Mortality . 115 8.3 Demographic Differentials in Infant and Child Mortality. 117 8.4 Differentials in Infant and Child Mortality by Women’s Status . 118 8.5 High-Risk Fertility Behaviour . 119 CHAPTER 9 MATERNAL AND CHILD HEALTH Mahlape Ramoseme 9.1 Antenatal Care . 123 9.2 Delivery Care. 128 9.3 Birth Registration. 133 9.4 Postnatal Care. 135 9.5 Reproductive Health Care and Women’s Status . 136 9.6 Vaccination of Children. 137 9.7 Acute Respiratory Infection and Fever . 141 9.8 Diarrhoeal Disease. 143 9.9 Child Health Indicators and Women’s Status. 148 9.10 Women’s Perceptions of Problems in Obtaining Health Care . 149 9.11 Health Card/Bukana. 151 9.12 Smoking and Alcohol Use . 152 CHAPTER 10 NUTRITION Mahlape Ramoseme 10.1 Breastfeeding and Supplementation . 157 10.1.1 Initiation of Breastfeeding . 157 10.1.2 Infant and Young Child Feeding . 159 10.1.3 Complementary Feeding. 162 10.1.4 Frequency of Foods Consumed by Children. 163 10.2 Micronutrients . 164 10.2.1 Iodisation of Household Salt . 164 10.2.2 Vitamin A Intake among Children . 165 vi │ Contents 10.2.3 Vitamin A Intake among Women . 167 10.2.4 Prevalence of Anaemia in Children . 168 10.2.5 Prevalence of Anaemia in Women . 170 10.2.6 Prevalence of Anaemia in Children by Anaemia Status of Mother. 170 10.3 Nutritional Status of Children Under Five . 172 10.3.1 Stunting . 173 10.3.2 Wasting . 175 10.3.3 Underweight. 175 10.4 Nutritional Status of Women. 176 CHAPTER 11 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR John Nkonyana 11.1 Introduction. 179 11.2 Knowledge of AIDS and HIV Transmission . 180 11.2.1 Awareness of AIDS. 180 11.2.2 Knowledge of Ways to Reduce AIDS Transmission . 182 11.2.3 Rejection of Misconceptions about AIDS Transmission. 184 11.2.4 Knowledge of Mother-to-Child Transmission. 187 11.3 Stigma Towards HIV-Infected People . 189 11.4 Attitudes Towards Negotiating Safer Sex. 192 11.5 Adult Support for Education about Condom Use. 194 11.6 Multiple Sexual Partnerships . 195 11.7 Paid Sex and Condom Use. 198 11.8 Testing for HIV and Knowledge of Source of Test . 200 11.9 Self-Reporting of Sexually Transmitted Infections. 206 11.10 Male Circumcision . 208 11.11 Prevalence of Injections . 210 11.12 HIV/AIDS-Related Knowledge and Behaviour among Youth . 212 11.12.1 Knowledge of HIV Transmission and Source for Condoms . 212 11.12.2 Age at First Sex among Youth . 214 11.12.3 Higher-Risk Sex among Youth . 219 11.13 Orphanhood and Children’s Living Arrangements . 225 CHAPTER 12 HIV PREVALENCE AND ASSOCIATED FACTORS 12.1 Coverage of HIV Testing. 230 12.2 HIV Prevalence . 233 12.2.1 HIV Prevalence by Socioeconomic Characteristics . 233 12.2.2 HIV Prevalence by Other Sociodemographic Characteristics . 236 12.2.3 HIV Prevalence by Sexual Behaviour. 237 12.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 239 12.2.5 HIV Prevalence and Male Circumcision . 240 12.2.6 HIV Prevalence and Youth . 242 12.2.7 HIV Prevalence among Cohabiting Couples . 244 12.2.8 Nutrition Status, Anaemia Level, and HIV Status . 245 12.2.9 HIV Prevalence and Fertility. 246 Contents | vii 12.2.10 HIV Prevalence and Child Mortality . 246 12.3 Distribution of the HIV Burden in Lesotho . 247 CHAPTER 13 TUBERCULOSIS Dr. Davis Rumisha 13.1 Background on Tuberculosis . 249 13.2 Respondents’ Knowledge of Tuberculosis . 249 13.3 Self-Reported Diagnosis, Symptoms, and Treatment. 254 13.4 Willingness to Work with Someone Who Has Previously been Treated for Tuberculosis. 260 CHAPTER 14 ADULT AND MATERNAL MORTALITY 14.1 Data. 263 14.2 Estimates of Adult Mortality. 264 14.3 Estimates of Maternal Mortality . 266 CHAPTER 15 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 15.1 Advice or Care during Antenatal, Delivery, and Postnatal Periods. 267 15.2 Contact with Health Care Providers . 268 15.3 Knowledge of Pregnancy Complications. 270 15.4 Knowledge of ORS Packets and Feeding Practices During Diarrhoea. 270 REFERENCES .273 APPENDIX A SAMPLE IMPLEMENTATION . 275 APPENDIX B ESTIMATES OF SAMPLING ERRORS. 281 APPENDIX C DATA QUALITY TABLES . 293 APPENDIX D PERSONS INVOLVED IN THE 2004 LESOTHO DEMOGRAPHIC AND HEALTH SURVEY. 299 APPENDIX E QUESTIONNAIRES . 303 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators. 2 Table 1.2 Results of the household and individual interviews. 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence. 10 Table 2.2 Household composition. 11 Table 2.3.1 Educational attainment of household population: women. 12 Table 2.3.2 Educational attainment of household population: men . 13 Table 2.4 School attendance . 14 Table 2.5 School attendance ratios . 16 Table 2.6 Grade repetition and dropout rates. 17 Table 2.7 Household characteristics . 18 Table 2.8 Household durable goods . 20 Table 2.9 Residency status. 21 Figure 2.1 Population pyramid . 10 Figure 2.2 Percentage of males and females currently attending school, by age . 14 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents . 24 Table 3.2.1 Educational attainment by background characteristics: women . 25 Table 3.2.2 Educational attainment by background characteristics: men. 26 Table 3.3.1 Literacy: women. 27 Table 3.3.2 Literacy: men. 28 Table 3.4.1 Exposure to mass media: women. 29 Table 3.4.2 Exposure to mass media: men. 30 Table 3.5.1 Employment status: women . 32 Table 3.5.2 Employment status: men. 33 Table 3.6.1 Occupation: women. 34 Table 3.6.2 Occupation: men . 35 Table 3.7.1 Type of employment: women. 36 Table 3.7.2 Type of employment: men. 37 Table 3.8.1 Decision on use of earnings and contribution of earnings to household expenditures: women . 38 Table 3.8.2 Decision on use of earnings and contribution of earnings to household expenditures: men. 39 Table 3.9 Women's control over earnings . 40 Table 3.10 Women’s participation in decisionmaking. 41 x | Tables and Figures Table 3.11 Women's participation in decisionmaking by background characteristics. 42 Table 3.12.1 Attitude towards wife beating: women. 44 Table 3.12.2 Attitude towards wife beating: men . 45 Table 3.13.1 Attitude towards refusing sex with husband: women. 47 Table 3.13.2 Attitude towards refusing sex with husband: men. 48 Table 3.14 Reprimanding for refusing sex with husband . 50 Figure 3.1 Access to mass media . 31 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility . 51 Table 4.2 Fertility by background characteristics . 52 Table 4.3 Trends in fertility. 53 Table 4.4 Trends in age-specific fertility rates. 54 Table 4.5 Children ever born and living. 55 Table 4.6 Birth intervals. 56 Table 4.7 Age at first birth . 57 Table 4.8 Median age at first birth by background characteristics. 58 Table 4.9 Teenage pregnancy and motherhood. 59 Figure 4.1 Total fertility rate by background characteristics . 53 Figure 4.2 Total fertility rates, Lesotho 1976-2004. 54 CHAPTER 5 FAMILY PLANNING Table 5.1.1 Knowledge of contraceptive methods: women. 62 Table 5.1.2 Knowledge of contraceptive methods: men . 63 Table 5.2 Knowledge of contraceptive methods by background characteristics . 64 Table 5.3.1 Ever use of contraception: women. 65 Table 5.3.2 Ever use of contraception: men. 66 Table 5.4 Current use of contraception: women. 67 Table 5.5 Trends in current contraceptive use . 68 Table 5.6 Current use of contraception by background characteristics: currently married women . 70 Table 5.7 Current use of contraception by women's status. 72 Table 5.8 Number of children at first use of contraception . 73 Table 5.9 Knowledge of the fertile period. 73 Table 5.10 Source of contraception. 74 Table 5.11 Informed choice . 75 Table 5.12 Future use of contraception . 76 Table 5.13 Reason for not intending to use contraception . 77 Table 5.14 Preferred method of contraception for future use. 78 Table 5.15 Exposure to family planning messages . 79 Table 5.16 Contact of nonusers with family planning providers . 80 Table 5.17 Discussion of family planning with husband . 81 Table 5.18 Discussion of family planning: currently married men . 82 Table 5.19 Attitudes towards family planning: currently married women . 83 Table 5.20 Attitudes towards family planning: all men. 84 Tables and Figures | xi Table 5.21 Men's attitude about contraception. 85 Table 5.22 Men's attitudes towards condoms. 86 Figure 5.1 Current use of family planning among currently married women age 15-49, selected countries in East Africa and Southern Africa. 69 Figure 5.2 Current use of any contraceptive method among currently married women age 15-49, by background characteristics. 71 Figure 5.3 Percent distribution of currently married women currently using contra- ception by person responsible for the decision to use family planning . 71 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status . 87 Table 6.2 Polygyny: Currently married men. 88 Table 6.3.1 Age at first marriage: women . 89 Table 6.3.2 Age at first marriage: men . 90 Table 6.4 Median age at first marriage. 91 Table 6.5 Age at first sexual intercourse . 92 Table 6.6 Median age at first intercourse . 93 Table 6.7.1 Recent sexual activity: women. 94 Table 6.7.2 Recent sexual activity: men. 95 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility. 96 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 97 Table 6.10 Menopause. 98 Figure 6.1 Percentage of currently married men who have more than one wife . 89 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 99 Table 7.2 Desire to limit childbearing . 101 Table 7.3 Need for family planning among currently married women. 103 Table 7.4.1 Need for family planning among all women. 105 Table 7.4.2 Need for family planning among women who are not currently married . 106 Table 7.5 Ideal number of children . 107 Table 7.6 Mean ideal number of children by background characteristics . 108 Table 7.7 Fertility planning status. 109 Table 7.8 Wanted fertility rates. 110 Table 7.9 Ideal number of children and unmet need by women's status . 111 Figure 7.1 Fertility preferences of currently married women age 15-49. 100 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 114 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 116 Table 8.3 Early childhood mortality rates by demographic characteristics. 117 Table 8.4 Early childhood mortality rates by women's status . 119 Table 8.5 High-risk fertility behaviour . 121 xii | Tables and Figures Figure 8.1 Trends in infant, child, and under-five mortality, 2001 LDS and 2004 LDHS . 115 Figure 8.2 Under-five mortality by background characteristics . 116 Figure 8.3 Under-five mortality by socioeconomic characteristics . 118 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care. 124 Table 9.2 Number of antenatal care visits and timing of first visit . 125 Table 9.3 Components of antenatal care . 126 Table 9.4 Tetanus toxoid injections . 128 Table 9.5 Place of delivery . 129 Table 9.6 Assistance during delivery . 131 Table 9.7 Delivery characteristics . 133 Table 9.8 Birth registration . 134 Table 9.9 Postnatal care by background characteristics . 136 Table 9.10 Reproductive health care by women's status . 137 Table 9.11 Vaccinations by source of information. 138 Table 9.12 Vaccinations by background characteristics . 140 Table 9.13 Vaccinations in first year of life. 141 Table 9.14 Prevalence and treatment of symptoms of ARI and fever. 142 Table 9.15 Disposal of children's stools. 144 Table 9.16 Prevalence of diarrhoea . 145 Table 9.17 Knowledge of ORS packets . 146 Table 9.18 Diarrhoea treatment . 147 Table 9.19 Feeding practices during diarrhoea . 148 Table 9.20 Children's health care by women's status. 149 Table 9.21 Problems in accessing health care . 150 Table 9.22 Health card/Bukana . 151 Table 9.23.1 Use of smoking tobacco: women . 152 Table 9.23.2 Use of smoking tobacco: men. 153 Table 9.24 Use of alcohol. 154 Figure 9.1 Antenatal care, tetanus vaccinations, place of delivery, and delivery assistance. 130 Figure 9.2 Percentage of children age 12-23 months with specific vaccinations, according to health cards or mother’s reports. 139 CHAPTER 10 NUTRITION Table 10.1 Initial breastfeeding. 158 Table 10.2 Breastfeeding status by age . 159 Table 10.3 Median duration and frequency of breastfeeding . 161 Table 10.4 Foods consumed by children in the day or night preceding the interview. 162 Table 10.5 Frequency of foods consumed by children in the day or night preceding the interview. 163 Table 10.6 Iodisation of household salt. 165 Table 10.7 Micronutrient intake among children . 166 Table 10.8 Micronutrient intake among mothers . 168 Tables and Figures | xiii Table 10.9 Prevalence of anaemia in children . 169 Table 10.10 Prevalence of anaemia in women . 171 Table 10.11 Prevalence of anaemia in children by anaemia status of mother. 172 Table 10.12 Nutritional status of children . 174 Table 10.13 Nutritional status of women by background characteristics. 177 Figure 10.1 Breastfeeding practices by age . 160 CHAPTER 11 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 11.1 Knowledge of AIDS. 181 Table 11.2 Knowledge of HIV prevention methods. 183 Table 11.3.1 Misconceptions and comprehensive knowledge about AIDS: women . 185 Table 11.3.2 Misconceptions and comprehensive knowledge about AIDS: men. 186 Table 11.4 Knowledge of prevention of mother-to-child transmission of HIV. 188 Table 11.5.1 Accepting attitudes towards those living with HIV: women . 190 Table 11.5.2 Accepting attitudes towards those living with HIV: men . 191 Table 11.6 Attitudes towards negotiating safer sex . 193 Table 11.7 Adult support for education about condom use to prevent AIDS. 194 Table 11.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women . 196 Table 11.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 197 Table 11.9 Payment for sexual intercourse: men . 199 Table 11.10.1 Coverage of prior HIV testing: women . 201 Table 11.10.2 Coverage of prior HIV testing: men. 202 Table 11.11.1 Knowledge of and source for HIV testing: women. 204 Table 11.11.2 Knowledge of and source for HIV testing: men . 205 Table 11.12 Pregnant women who received information and counselling about HIV/AIDS. 206 Table 11.13 Self-reporting of sexually transmitted infections (STI) and STI symptoms. 207 Table 11.14 Male circumcision. 209 Table 11.15 Prevalence of injections . 211 Table 11.16 Comprehensive knowledge about AIDS and of a source of condoms among youth . 213 Table 11.17 Age at first sex among young women and men . 215 Table 11.18 Condom use at first sexual intercourse among youth. 216 Table 11.19 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 218 Table 11.20.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women . 220 Table 11.20.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men . 221 Table 11.21 Age-mixing . 222 Table 11.22 Drunkenness during sexual intercourse among youth. 223 Table 11.23 Recent HIV tests among youth . 224 Table 11.24 Orphanhood and children's living arrangements. 226 xiv | Tables and Figures Figure 11.1 Reasons for HIV testing among women and men age 15-49 who have ever been tested . 203 Figure 11.2 Percentage of women and men reporting an STI or symptoms of an STI in the past 12 months who sought care, by source of advice or treatment . 208 CHAPTER 12 HIV PREVALENCE AND ASSOCIATED FACTORS Table 12.1 Coverage of HIV testing by sex, residence, and district . 230 Table 12.2 Coverage of HIV testing by background characteristics . 232 Table 12.3 HIV prevalence by age. 233 Table 12.4 HIV prevalence by socioeconomic characteristics. 235 Table 12.5 HIV prevalence by selected sociodemographic characteristics . 236 Table 12.6 HIV prevalence by sexual behaviour . 238 Table 12.7 HIV prevalence by other characteristics. 239 Table 12.8 HIV prevalence by prior HIV testing. 240 Table 12.9 HIV prevalence by circumcision: men. 241 Table 12.10 HIV prevalence among young people . 243 Table 12.11 HIV prevalence among couples. 244 Table 12.12 Nutritional status of women by HIV status. 245 Table 12.13 Prevalence of anaemia in women by HIV status . 245 Table 12.14 Fertility and HIV status . 246 Table 12.15 Early childhood mortality rates by mother's current HIV status. 246 Figure 12.1 HIV prevalence by age. 233 CHAPTER 13 TUBERCULOSIS Table 13.1 Knowledge of tuberculosis . 250 Table 13.2 Knowledge of specific symptoms of tuberculosis . 251 Table 13.3 Knowledge of the cause of tuberculosis. 251 Table 13.4.1 Knowledge of TB causes and transmission modes by background characteristics: women . 252 Table 13.4.2 Knowledge of TB causes and transmission modes by background characteristics: men . 253 Table 13.5.1 Experience of symptoms of tuberculosis: women . 255 Table 13.5.2 Experience of symptoms of tuberculosis: men. 256 Table 13.6.1 Reasons for not seeking treatment for symptoms of tuberculosis: women. 258 Table 13.6.2 Reasons for not seeking treatment for symptoms of tuberculosis: men. 259 Table 13.7 Diagnosis of tuberculosis . 260 Table 13.8 Positive attitudes towards those with TB. 261 Figure 13.1 Percentage of women and men who had symptoms of tuberculosis since age 15 . 257 CHAPTER 14 ADULT AND MATERNAL MORTALITY Table 14.1 Data on siblings . 264 Table 14.2 Adult mortality rates. 265 Table 14.3 Maternal mortality . 266 Tables and Figures | xv CHAPTER 15 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Table 15.1 Advice or care received by mother during pregnancy and delivery, and after delivery. 268 Table 15.2 Main reason for not receiving advice or care during pregnancy and delivery, and after delivery. 269 Table 15.3 Father’s contact with a health care provider about wife’s health and pregnancy. 270 Table 15.4 Knowledge of pregnancy complications . 271 Table 15.5 Knowledge of ORS packets and feeding practices during diarrhoea. 272 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women . 275 Table A.2 Sample implementation: men. 276 Table A.3 Coverage of HIV testing among interviewed women by sociodemographic characteristics . 277 Table A.4 Coverage of HIV testing among interviewed men by sociodemographic characteristics . 278 Table A.5 Coverage of HIV testing among women who ever had sex by risk status variables . 279 Table A.6 Coverage of HIV testing among men who ever had sex by risk status variables . 280 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 284 Table B.2 Sampling errors for national sample . 285 Table B.3 Sampling errors for urban sample. 286 Table B.4 Sampling errors for rural sample. 287 Table B.5 Sampling errors for Lowlands sample . 288 Table B.6 Sampling errors for Foothills sample . 289 Table B.7 Sampling errors for Mountains sample. 290 Table B.8 Sampling errors for Senqu River Valley sample . 291 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 293 Table C.2 Age distribution of eligible and interviewed women . 294 Table C.3 Completeness of reporting . 295 Table C.4 Births by calendar years . 296 Table C.5 Reporting of age at death in days . 297 Table C.6 Reporting of age at death in months. 298 Foreword | xvii FOREWORD The 2004 Lesotho Demographic and Health Survey (LDHS) was commissioned by the Ministry of Health and Social Welfare to provide countrywide population-based information on maternal and child mortality, nutrition, fertility levels, family planning, sexually transmitted infections (STIs), HIV/AIDS and tuberculosis (TB). The findings from the survey will provide data to benchmark progress on the on- going Health Sector Reforms and at the same time complement information needs for defining global tar- gets such as the Millennium Development Goals (MDGs) and the United Nations General Assembly Spe- cial Summit on HIV/AIDS (UNGASS). The mainstay of the survey was a structured interview with a nationally representative sample of residents of more than 9,000 households on their health status, knowledge, attitudes, and behaviour. Se- lected biomarkers including anaemia and HIV testing as well as a number of anthropometric indices were also measured. The main findings of the survey included relatively high coverage for basic childhood immunisa- tions, increasing contraceptive prevalence, relatively low fertility levels and high levels of ANC atten- dance. An important aspect of the survey was the large amount of information obtained on HIV/AIDS, STIs, and TB knowledge and behaviour. The survey findings indicated high levels of infant mortality and maternal mortality and high prevalence of HIV. The Ministry of Health and Social Welfare (MOHSW) wishes to applaud the technical partner- ship between the Lesotho Bureau of Statistics (BOS) and the MOHSW during the implementation of the survey. The arrangement highlighted synergies between the two sister institutions that should be strength- ened. Among others, the joint implementation of the survey by the MOHSW and BOS ensured maximum utilisation of the resources and skills in field surveys and bio-surveys of both these institutions. The success of this survey would not have been possible without the additional financial support received from Development Cooperation of Ireland (DCI), The World Bank and United Nations Chil- dren’s Fund (UNICEF). Other supporting partners were the United Kingdom Department for International Development (DFID), the World Health Organisation (WHO) and the United States Agency for Interna- tional Development (USAID). Our sincere appreciation also goes to the District Secretaries and the various local structures, par- ticularly the Chiefs in the areas that were selected for the survey, who contributed to the success of the survey in many ways. The Ministry appreciates the dedication shown by the field coordinators, supervisors, editors, in- terviewers, laboratory staff, and data operators. Special thanks and recognition goes to the respondents who graciously gave their time to provide the information needed and undertook various tests, some of which were invasive. They can rest assured that the information provided has added value to knowledge in Lesotho and it will be treated with the highest level of confidence. xviii | Foreword The MOHSW also wishes to express its appreciation for the professional guidance received from ORC Macro, from preparation to completion of the survey. The staff from the MOHSW and BOS who worked closely with ORC Macro, for almost two years, benefited from their integrity and work ethics. They were able to pick up some best practices that will be of use in future surveys. Mrs. M. Makhakhe 2004 Lesotho Demographic and Health Survey Director Director, Health Planning and Statistics Ministry of Health and Social Welfare Summary of Findings | xvii SUMMARY OF FINDINGS The 2004 Lesotho Demographic and Health Survey (2004 LDHS) is a nationally representa- tive survey of 7,095 women age 15-49 and 2,797 men age 15-59 from 8,592 households covering 405 sample points (enumeration areas) through- out Lesotho. This survey is the first national-level population and health survey conducted as part of the global Demographic and Health Surveys (DHS) programme and is designed to provide data to monitor the population and health situation in Lesotho. The survey utilised a two-stage sample based on the 1996 Population Census and was designed to produce separate estimates for key indicators for each of the ten districts in Lesotho. Data collection took place over a three-month pe- riod, from late September 2004 to mid-January 2005. The survey obtained detailed information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortal- ity, maternal and child health, awareness and be- haviour regarding HIV/AIDS, other sexually transmitted infections (STIs), and tuberculosis. In addition, the 2004 LDHS carried out anaemia test- ing in children and adults and HIV testing in adults. The 2004 LDHS was implemented by the Lesotho Ministry of Health and Social Welfare (MOHSW) in collaboration with the Lesotho Bu- reau of Statistics (BOS). Technical assistance was provided by ORC Macro through the MEASURE DHS programme. Financial support for the survey was provided by the Government of Lesotho and a number of donor agencies namely, Development Cooperation of Ireland (DCI), the World Bank, the United Nations Children’s Fund (UNICEF), the British Department for International Devel- opment (DFID), the World Health Organisation (WHO, and the United States Agency for Interna- tional Development (USAID). FERTILITY Fertility Levels and Trends. Lesotho has a wealth of demographic data. Changes in fertility lev- els over time can be tracked by examining fertility estimates from various surveys and censuses, span- ning the last three decades. Comparing data from the 2004 LDHS with that of previous censuses and sur- veys indicates that the total fertility rate (TFR) de- clined significantly over the last three decades of the 20th century, going from a high of 5.4 children per woman in the mid-1970s and 5.3 in the mid-1980s to 4.1 in the mid-1990s, 4.2 children in 2001, and 3.5 children per woman in 2004. With a current TFR of 3.5, Lesotho’s fertility rate is one of the lowest in sub- Saharan Africa. Fertility Differentials. Differentials by back- ground characteristics are marked. Rural women have more than twice as many children (4.1 children per woman) as urban women (1.9 children per woman). The total fertility rate is highest in the Mountains zone (4.9 children per woman) and lowest in the Lowlands (2.9 children per woman). As expected, a woman’s education is strongly associated with fertility. For ex- ample, the TFR decreases from 4.2 children for women with some primary education to 2.8 children for women with at least some secondary education. Fertility is also very closely related to household eco- nomic status. Women who live in households in the lowest wealth quintile have high fertility (5.2 chil- dren) while those in households in the highest wealth quintile have low fertility (2.0 children). Unplanned Fertility. Despite a steady rise in the level of contraceptive use over the last fifteen years, the 2004 LDHS data indicate that unplanned pregnan- cies are common in Lesotho. Overall, 38 percent of births in Lesotho are unwanted, while 12 percent are mistimed (wanted later). Fertility Preferences. There is considerable de- sireon the part of currently married women in Lesotho to control the timing and number of births. More than xviii | Summary of Findings half of married women (54 percent) either do not want a/nother child or are sterilised. Nationally, 43 percent of married women want to have an- other child—26 percent want a child later and 17 percent want a child soon (within two years). The 2004 LDHS results show that the mean ideal fam- ily size among women in Lesotho is 3.5 children. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is nearly universal, with 97 percent of all women age 15-49 and 96 percent of all men age 15-59 knowing at least one modern method of family planning. Among women, the most widely known methods of family planning are the male condom (94 percent), injectables (86 percent), the pill (85 percent), and the female con- dom (72 percent). Sixty-two of women have heard of the IUCD, while 52 percent have heard of fe- male sterilisation. Use of Contraception. The contraceptive prevalence rate among married women is 37 per- cent. More than one-third of currently married women use a modern method (35 percent), while 2 percent use a traditional method. Injection, the pill, and the male condom are the most commonly used contraceptive methods, and are currently used by 15, 11, and 5 percent of currently married women, respectively. Trends in Contraceptive Use. Current use of contraception by married women decreased between the 2001 Lesotho Demographic Survey (41 percent) and the 2004 LDHS survey (37 per- cent). However, it is difficult to interpret this trend because the two surveys differed considerably in their approach to data collection regarding contra- ceptive knowledge and use, as well as sample size. Differentials in Contraceptive Use. Cur- rently married women in urban areas are more likely to use contraception (50 percent) than those in rural areas (34 percent). Considering ecological zones, married women in the Lowlands (46 per- cent) are more than twice as likely to be using contraception as women in the Mountains (22 percent). Current contraceptive use also varies markedly by district; it is highest among married women in Mafeteng (49 percent) and lowest in Mokhotlong (15 percent). With the exception of Mafeteng, for all residential categories, injectables are generally the most widely used method, followed by the pill. Contraceptive use increases with level of edu- cation, from 9 percent among currently married women with no education to 49 percent among cur- rently married women who have at least some secon- dary education. Source of Modern Methods. In Lesotho, public (government) facilities provide contraceptive methods to 57 percent of users, while 12 percent are supplied through CHAL, 19 percent through the pri- vate medical sector, and 10 percent through other pri- vate sources (e.g., shops). Most users obtain methods at fixed sites; less than 2 percent say they got their method through community-based distribution or a community health worker. The most common source of contraceptive methods in Lesotho is government health centres, which supply just over one-fourth of all users of mod- ern methods. Government hospitals supply about one- fifth of users. Somewhat surprisingly, government sources supply a larger proportion of users of pills and injections than users of long-term methods like the IUCD. Public sector providers are the most common source for male condoms followed by other sources such as shops, friends, or relatives (42, 26, and 11 per- cent, respectively). Unmet Need for Family Planning. Almost one- third of married women in Lesotho have an unmet need for family planning. Unmet need for limiting births (20 percent) is higher than unmet need for spac- ing births (11 percent). Only 55 percent of the demand for family planning is currently being met, implying that the needs of about one in two women in Lesotho are not being met. MATERNAL HEALTH Antenatal Care. A relatively high percentage of women, 90 percent, receive antenatal care from a medical professional, either from doctors (7 percent) or nurses or midwives (83 percent). One percent of women receive antenatal care from traditional birth attendants, while 9 percent do not receive any antena- tal care. The 2004 LDHS data indicate an improve- ment since the 2000 End of Decade Multiple Cluster Survey (EMICS), which reported 53 percent coverage for antenatal care from a health professional. Summary of Findings | xix Sixty percent of women received at least two doses of tetanus toxoid for their most recent birth in the five years preceding the survey, 19 percent received one tetanus toxoid injection and 18 per- cent received none. Delivery Care. Nationally, more than half of births in the five years preceding the survey (52 percent) were delivered in health facilities: 38 percent in public health facilities, 2 percent in pri- vate health facilities, and 13 in CHAL facilities. Forty-five percent of births occurred at home. The data also show that medically trained providers assisted with 55 percent of deliveries, TBAs as- sisted with 13 percent of deliveries, and relatives or friends attended 30 percent of deliveries. Postnatal Care. About one in four women (23 percent) who had a live birth in the five years preceding the survey received postnatal care within two days of delivery, 3 percent received postnatal care 3-6 days after delivery, and 2 per- cent received postnatal care 7-41 days after deliv- ery. About three-fourths of women who had a live birth in the five years preceding the survey did not receive any postnatal care. CHILD HEALTH Childhood Mortality. Data from the 2004 LDHS show an upward trend in the early child- hood mortality rates over time. Data for the most recent five-year period suggests that one of every nine children dies before reaching age five― under-five mortality is 113 deaths per 1,000 live births. About eight in ten of these deaths occur in the first year of life―infant mortality is 91 deaths per 1,000 live births and child mortality is 24 deaths per 1,000 children age one. Neonatal and postneonatal mortality each accounted for 46 deaths per 1,000 live births in the most recent five-year period. The pattern shows that deaths occurring during the neonatal and postneonatal periods account for 81 percent of all deaths under the age of five years. Childhood Vaccination Coverage. Nation- ally, 68 percent of children age 12-23 months are fully immunised, while 2 percent have received no vaccinations. Ninety-five percent of children have received BCG and the first dose of polio vaccine, while 94 percent have received the first dose of DPT. While coverage for the first dose of DPT and polio is high, the proportion of children receiving the recommended third dose of DPT and polio is lower (83 percent and 80 percent, respectively), as is the proportion receiving a measles vaccination (85 per- cent). Hepatitis B1, B2, and B3 have recently been added to the Lesotho immunisation schedule for chil- dren. Overall, 31 percent of children age 12-23 months received Hepatitis B1 vaccine, 22 percent re- ceived Hepatitis B2, and 14 percent received Hepatitis B3. Child Illness and Treatment. Among children under five years of age, 19 percent were reported to have had symptoms of acute respiratory illness in the two weeks preceding the survey and 26 percent were reported to have had fever during the same period. Of these, 54 percent were taken to a health facility or provider for treatment. Fourteen percent of children under five years had diarrhoea in the two weeks pre- ceding the survey. Thirty-one percent of children with diarrhoea were taken to a health provider. Forty-one percent of children with diarrhoea were given a solu- tion made from oral rehydration salts (ORS), 55 per- cent received recommended home fluids (RHF) and 32 percent were given increased fluids. Overall, eight in ten children received ORS, RHF, or increased fluids. NUTRITION Breastfeeding Practices. The data indicate that the majority (95 percent) of children in Lesotho are breastfed for some period of time. Sixty-three percent of infants were put to the breast within one hour of birth, and 85 percent started breastfeeding within the first day. The 2004 LDHS data indicate that supple- mentary feeding of children begins early. Among newborns less than two months of age, 27 percent are receiving supplementary foods or liquids other than water. The median duration of breastfeeding in Leso- tho is 21 months. The median duration of exclusive breastfeeding is at less than one month. One in three children under six months in Leso- tho is given a feeding bottle with a nipple. Iodisation of household salt. Ninety-three per- cent of the households interviewed in the 2004 LDHS had their salt tested for iodine, while 5 percent had no salt available in the household. Only 2 percent of households are consuming salt that is not iodised, xx | Summary of Findings 7 percent of households are consuming inade- quately iodised salt (<15 ppm) and 91 percent are consuming adequately iodised salt (15+ ppm). Intake of Vitamin A. Ensuring that children between six months and 59 months receive enough vitamin A may be the single most effec- tive child survival intervention. Deficiencies in this micronutrient can cause blindness and can increase the severity of infections such as measles and diarrhoea. Fifty-five percent of children age 6-59 months are reported to have received a vita- min A supplement in the 6 months preceding the survey. Forty-nine percent of children under age three who live with their mothers consume fruits and vegetables rich in vitamin A. Seventeen percent of mothers with a birth in the past five years reported receiving a vitamin A dose postpartum. Four percent of interviewed women reported night blindness during preg- nancy. When this figure was adjusted for blind- ness not attributed to vitamin A deficiency during pregnancy, the data showed that only 1 percent of women experienced night blindness during their last pregnancy. Prevalence of Anaemia. Iron-deficiency anaemia is a major threat to maternal health and child health. Overall, about half of children age 6- 59 months in Lesotho (49 percent) have some level of anaemia, including 22 percent of children who are mildly anaemic, 25 percent who are mod- erately anaemic, and 1 percent who are severely anaemic. The prevalence of anaemia is less pro- nounced among women than among children. Twenty-seven percent of women age 15-49 are anaemic, with 19 percent mildly anaemic, 8 per- cent moderately anaemic, and about 1 percent se- verely anaemic. Nutritional Status of Children. According to the 2004 LDHS, 38 percent of children under five are stunted and 15 percent are severely stunted. Four percent of children under five are wasted and 1 percent are severely wasted. Weight- for-age results show that 20 percent of children under five are underweight, with 4 percent se- verely underweight. Children whose biological mothers were not in the household are more likely to be malnourished than children whose mothers were interviewed. The proportion of children under five who are stunted has decreased from 45 percent in 2000 to 38 percent in 2004. The proportion underweight in- creased slightly from 18 percent in 2000 to 20 percent in 2004. Nutritional Status of Women. The mean height of women in Lesotho is 157 centimetres, which is above the critical height of 145 centimetres. Only 2 percent are below 145 centimetres. Six percent of women were found to be chronically malnourished (BMI less than 18.5), while 42 percent are overweight or obese. Awareness of AIDS. Almost all (94 percent) women and men (93 percent) have heard of AIDS, indicating that awareness of AIDS in Lesotho is uni- versal. Almost eight in ten women (78 percent) and seven in ten men age 15-49 (70 percent) know that condom use is an important method of AIDS- prevention. Eighty-two percent of women and 76 per- cent of men said that the chances of getting the AIDS virus (HIV) can be reduced by limiting sex to one faithful uninfected partner. Knowledge of both of these ways of avoiding HIV transmission is high, with 71 percent of women and 60 percent of men citing both as ways of reducing the risk of contracting HIV/AIDS. Three-fourths of women (78 percent) and men (75 percent) know that abstaining from sex re- duces the chances of getting AIDS. Knowledge that a healthy-looking person can have the AIDS virus is widespread. Three-fourths of women (75 percent) and about seven in ten men (69 percent) are aware that a healthy-looking person can have the AIDS virus. The two most common mis- conceptions about the transmission of the AIDS virus are that HIV can be transmitted by mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is in- fected with HIV/AIDS. Forty-four percent of women and 43 percent of men know that HIV cannot be transmited by mosquito bites, while 58 percent of women and 49 percent of men know that a person cannot become infected with the AIDS virus by shar- ing food or utensils with someone who has AIDS. A person is considered to have a comprehensive knowledge about AIDS when they report that 1) using Summary of Findings | xxi a condom every time sexual intercourse occurs and having just one uninfected and faithful partner can reduce the chances of contracting HIV/AIDS, 2) a healthy-looking person can have the AIDS virus, and 3) that they reject the two most com- mon local misconceptions about how HIV/AIDS is transmitted. In Lesotho, only 24 percent of women and 19 percent of men age 15-49 have comprehensive knowledge of HIV/AIDS trans- mission and prevention methods. HIV-Related Behavioural Indicators. One of the strategies for reducing the risk of contract- ing a sexually transmitted infection (STI) is for young persons to delay the age at which they be- come sexually active. Fifteen percent of young women and 27 percent of young men have had sex by age 15. Forty-seven percent of women and 52 percent of men reported they had first sexual intercourse by age 18. Sexual intercourse with a non-marital or non- cohabiting partner is associated with an increased risk of contracting sexually transmitted infections. Thirty-six percent of women and 63 percent of men age 15-49 reported engaging in higher-risk sexual behaviour in the 12 months preceding the survey. Even more disturbing is the fact that four in ten (42 percent) women age 15-24 and half of men in the same age cohort reported engaging in higher-risk sexual behaviour during the past year. Sexual intercourse with more than one part- ner is associated with a high risk of exposure to sexually transmitted infections. Eleven percent of women and 30 percent of men age 15-49 reported having sexual intercourse with more than one partner in the 12 months preceding the survey. Promoting the use of condoms is an impor- tant strategy in the fight against HIV/AIDS trans- mission. Overall, 42 percent of women and 49 percent of men age 15-49 used a condom dur- ing the time they had higher-risk sex. HIV Prevalence. HIV tests were conducted for 81 percent of the 3,758 eligible women and 68 percent of the 3,305 eligible men. Results from the 2004 LDHS indicate that 24 percent of adults in Leso- tho are HIV positive. HIV prevalence in women age 15-49 is 26 percent, while for men age 15-59, it is 19 percent. This female-to-male ratio is found in most population-based studies in Africa and implies that young women are particularly vulnerable to HIV in- fection compared with young men. For both sexes, rates of infection rise with age, peaking at 43 percent among women in their late 30s and 41 percent among men age 30-34. HIV prevalence is substantially higher among women than men under age 30 while, at ages 40-49, the pattern reverses and prevalence among men exceeds that among women. Patterns of HIV Prevalence. Urban residents are more likely to be HIV positive than rural residents (29 and 22 percent, respectively), with the urban-rural differential for women being higher than that for men. Among the four ecological zones, Lowlands has the highest rates of infection for both females and males (28 and 20 percent, respectively). Looking at the dis- tricts, Leribe has the highest infection rate for both women and men, while Thaba-Tseka and Mokhotlong have the lowest rate for women, and Mokhotlong and Qacha’s Nek have the lowest rate for men. Differences in infection levels across educa- tion categories are not large, although having attended school is related to somewhat lower infection levels among both women and men. One-third of employed women and one-fourth of employed men are HIV positive, compared with 23 percent of unemployed women and 16 percent of unemployed men. The rela- tionship between HIV status and economic level (wealth quintile) is not uniform; however, the lowest HIV rates are found among women and men in the lowest wealth quintile. Results from the 2004 LDHS indicate that for 66 percent of cohabiting couples, both partners are HIV negative, while in 20 percent of couples, both partners are HIV positive. In 13 percent of couples, there is discordance in HIV-positive status, i.e., one partner is infected and the other is not. xxiv | Map of Lesotho Introduction | 1 INTRODUCTION 1 Mahlape Ramoseme 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography Lesotho is a small mountain Kingdom situated in the southern part of Africa and is completely surrounded by the Republic of South Africa. The country is divided into 10 administrative districts, which differ in terms of size, topography, climate and stage of development. It has a total area of about 30,355 square kilometres of which slightly more than 10 percent of the land is arable. Lesotho can be distinguished by high altitude terrain, which is why it is sometimes referred to as the “Mountain Kingdom” or the “Kingdom in the Sky” and often called “The Roof of Africa.” The country has been subdivided into two residential areas, urban and rural and further divided into four ecological zones, the Lowlands, Foothills, Mountains and Senqu River Valley. In Lesotho, there are four seasons in a year; summer from December to February, with January being the warmest month; autumn from March to May; winter from June to August; and spring from September to November. In winter, temperatures can drop to below zero centigrade and snowfall is not unexpected especially in the mountains. Spring is Lesotho’s rainy season. 1.1.2 History Lesotho gained its independence on 4th October 1966 after being a British colony for almost 100 years (1868-1966). The three largest religious organizations are the Roman Catholic Church, the Lesotho Evangelical Church, and the Anglican Church. Lesotho has two official languages, Sesotho and English. 1.1.3 Economy Lesotho is primarily a country of subsistence farming. Most Basotho (the name for people living in Lesotho) grow food for their own consumption. Maize, wheat, and sorghum are commonly harvested as well as peas, beans, and potatoes. Traditionally, cattle are prized as a sign of family wealth; they are also used in agricultural work such as ploughing. Lesotho’s gross domestic product (GDP) is 8.832 billion Maluti with an annual growth rate of 3.1 percent. Manufacturing contributes 20.3 percent of the GDP, while agriculture contributes 17.1 percent. (BOS, 2005). Water is one of the most important resources in Lesotho. It is the source of the 30-year, multi- million-dollar Lesotho Highlands Water Project (LHWP), which was initiated in 1986. The LHWP is designed to capture, store, and transfer water from the Orange River system to South Africa’s Free State province and the greater Johannesburg area, which have among the largest concentrations of population, industry, and agriculture in South Africa. 1.2 POPULATION Currently, the population of Lesotho is estimated at 2.2 million (BOS, 2003). Table 1.1 shows that the population of Lesotho increased from 1.6 million in 1986 to 1.9 million in 1996. The annual population growth rate was 1.5 percent per annum during the 1986-1996 period (BOS, 1996). 2 | Introduction According to the 1996 population census, the crude birth rate (CBR) for Lesotho was 30 births per 1,000 compared with 37 per 1,000 in the 1986 population census. As shown in Table 1.1, the total fertility rate (TFR) in Lesotho declined by more than one child between 1986 and 1996. The crude death rate increased from 11.6 deaths to 12.8 deaths per 1,000 over the same period. The infant mortality rate (IMR) has been declining steadily. It was estimated at 113 deaths per 1,000 live births in 1976 (BOS, 1976) and it fell to 85 deaths per 1,000 in 1986 and 74 deaths per 1,000 in 1996 (BOS, 1996). Data from consecutive population censuses show that the population of Lesotho is predominantly rural. However, the proportion living in urban areas has increased from 12 percent in 1986 to 17 percent in 1996. Similarly, life expectancy at birth has increased from 55 years in 1986 to 59 years in 1996. Table 1.1 Basic demographic indicators Selected demographic indicators for Lesotho, 1976, 1986, and 1996 Indicator 1976 1986 1996 Population (millions) 1.2 1.6 1.9 Intercensal growth rate (percent) 2.3 2.6 1.5 Density (pop./km2) 40 53 61 Percent urban 11 12 17 Crude birth rate 38-40 37 30.0 Crude death rate 16-18 11.6 12.8 Total fertility rate 5.4 5.3 4.1 Infant mortality rate (per 1,000 births) 113 85 74 Life expectancy (years) 51 55 59 Male 49.3 49.3 58.6 Female 52.7 56.7 60.2 Source: BOS, 1976; BOS, 1986; BOS, 1996 (census reports) 1.3 OBJECTIVES OF THE SURVEY The Ministry of Health and Social Welfare (MOHSW) initiated the 2004 Lesotho Demographic and Health Survey (LDHS) to collect population-based data to inform the Health Sector Reform Programme (2000-2009). The 2004 LDHS will assist in monitoring and evaluating the performance of the Health Sector Reform Programme since 2000 by providing data to be compared with data from the first baseline survey, which was conducted when the reform programme began. The LDHS survey will also provide crucial information to help define the targets for Phase II of the Health Sector Reform Programme (2005-2008). Additionally, the 2004 LDHS results will serve as the main source of key demographic indicators in Lesotho until the 2006 population census results are available. The LDHS was conducted using a representative sample of women and men of reproductive age. The specific objectives were to: • Provide data at national and district levels that allow the determination of demographic indicators, particularly fertility and childhood mortality rates; • Measure changes in fertility and contraceptive use and at the same time analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding patterns, and important social and economic factors; Introduction | 3 • Examine the basic indicators of maternal and child health in Lesotho, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and immunisation coverage for children; • Describe the patterns of knowledge and behaviour related to the transmission of HIV/AIDS, other sexually transmitted infections, and tuberculosis; • Estimate adult and maternal mortality ratios at the national level; • Estimate the prevalence of anaemia among children, women and men, and the prevalence of HIV among women and men at the national and district levels. 1.4 ORGANISATION OF THE SURVEY The 2004 LDHS was implemented by MOHSW in collaboration with the Bureau of Statistics (BOS). Technical assistance was provided through the MEASURE DHS programme. Financial support for the survey was provided by the Government of Lesotho and a number of donor agencies namely, Development Cooperation of Ireland (DCI), the World Bank, the United Nations Children’s Fund (UNICEF), the British Department for International Development (DFID), the World Health Organisation (WHO) and USAID. 1.5 SAMPLE DESIGN The sample for the 2004 LDHS covered the household population. A representative probability sample of more than 9,000 households was selected for the 2004 LDHS sample. This sample was constructed to allow for separate estimates for key indicators in each of the ten districts in Lesotho, as well as for urban and rural areas separately. The survey utilized a two-stage sample design. In the first stage, 405 clusters (109 in the urban and 296 in the rural areas) were selected from a list of enumeration areas from the 1996 Population Census frame. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected for participation in the survey. All women age 15-49 who were either permanent household residents in the 2004 LDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in every second household selected for the survey, all men age 15-59 years were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. In the households selected for the men’s survey, height and weight measurements were taken for eligible women and children under five years of age. Additionally, eligible women, men, and children under age five were tested in the field for anaemia, and eligible women and men were asked for an additional blood sample for anonymous testing for HIV. 1.6 QUESTIONNAIRES Three questionnaires were used for the 2004 LDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. To reflect relevant issues in population and health in Lesotho, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations and international donors. The final draft of the questionnaire was discussed at a large meeting of the LDHS Technical Committee organized by the MOHSW and BOS. The adapted questionnaires were translated from English into Sesotho and pretested during June 2004. 4 | Introduction The Household Questionnaire was used to list all of the usual members and visitors in the selected households. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Some basic information was also collected on the characteristics of each person listed, including age, sex, education, residence and emigration status, and relationship to the head of the household. For children under 18, survival status of the parents was determined. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and access to health facilities. For households selected for the male survey subsample, the questionnaire was used to record height, weight, and haemoglobin measurements of women, men and children, and the respondents’ decision about whether to volunteer to give blood samples for HIV. The Women’s Questionnaire was used to collect information from all women age 15-49. The women were asked questions on the following topics: • Background characteristics (education, residential history, media exposure, etc.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Awareness and behaviour regarding AIDS, other sexually transmitted infections (STIs), and tuberculosis (TB) • Maternal mortality The Men’s Questionnaire was administered to all men age 15-59 living in every other household in the 2004-05 LDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health, nutrition, and maternal mortality. Geographic coordinates were collected for each EA in the 2004 LDHS. 1.7 HAEMOGLOBIN AND HIV TESTING In all households selected for the male survey, children under five years of age, women age 15-49 and men age 15-59 were tested for anaemia. In addition, all eligible women and men were tested for HIV. Anaemia and HIV testing were carried out only if consent was given by the respondent or, in the case of a minor (under age 18), by the parent or guardian. The protocol for haemoglobin and HIV testing was approved by the Lesotho Ministry of Health and Social Welfare Ethics Committee in Maseru and the ORC Macro Institutional Review Board in Calverton, Maryland, USA. All interviewers were trained on how to take anthropometric measurements, how to administer the anaemia and HIV informed consent forms, and blood collection procedures. Introduction | 5 1.7.1 Haemoglobin Testing Anaemia is a major problem in Lesotho, especially among young children and pregnant women. Determining anaemia levels among women and their children was an important component of the 2004 LDHS because little was known about the prevalence of anaemia in the general population. Anaemia levels were determined by measuring the level of haemoglobin in the blood, a decreased concentration of which characterizes anaemia. For haemoglobin measurement, capillary blood was taken from the finger using sterile, single-use lancets that allowed a relatively painless puncture. The concentration of haemoglobin in the blood was measured in the field using the HemoCue system, a portable photometer. Data collection personnel were specially trained for this procedure. Prior to participating in the study, respondents were informed of their right to not participate in the anaemia testing and were asked for their permission to collect a blood droplet from them and the eligible children. Levels of anaemia were classified as severe, moderate, or mild according to criteria developed by the World Health Organisation (DeMaeyer et al., 1989). Respondents were informed of their anaemia status. Additionally, an informational brochure on anaemia was printed and distributed to respondents eligible for anaemia testing. 1.7.2 HIV Testing In the households selected for the men’s survey, all eligible women and men were asked to voluntarily provide some drops of blood for HIV testing. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed by DHS and approved by ORC Macro’s Institutional Review Board. The protocol allowed for the merging of the HIV results to the sociodemographic data collected in the individual questionnaires, provided that the information that could potentially identify an individual was destroyed before linking is effected. This required that identification codes be deleted from the data file and that the back page of the Household Questionnaire that contained the bar code labels and names of respondents be destroyed prior to merging the HIV results with the individual data file. As part of the procedure to obtain informed consent for blood taking for HIV testing, the interviewer described the testing procedures, the confidentiality of the data, including the fact that test results could not be linked or made available to the subject, and gave information on where to go for voluntary counselling and testing (VCT) services to establish their HIV status. For never-married respondents age 15-17, consent was first obtained from the parent or guardian and then from the respondent him/herself. For respondents who consented, the interviewer collected 3 to 5 blood spots on a filter paper card from a finger prick using a single-use, spring-loaded, sterile lancet. Each filter paper was given a bar code label, with a duplicate label was attached to the Household Questionnaire on the line showing consent for that respondent. A third copy of the same bar code label was affixed to a Blood Transmittal Form to track the blood samples from the field to the BOS and then to the laboratory. Filter papers were dried overnight in a plastic drying box, after which the interviewer packed them in individual Ziploc bags with desiccants and a humidity indicator card and placed them in a larger Ziploc bag for that particular EA. Blood samples were periodically collected in the field along with the completed questionnaires and transported to BOS headquarters in Maseru. There they were logged in, after which they were taken to the Lesotho Blood Transfusion Services for HIV testing. At the Lesotho Blood Transfusion Services all samples were tested using the first test, an ELISA, Vironostika HIV Uniform II Plus O. A negative result was considered negative. All positives were tested with a second ELISA test, originally Genscreen HIV1/2, and later with a more accurate test, Enzygnost. Positive samples on the second test were considered positive. If the results from the two tests were 6 | Introduction discordant, the samples were retested again with both tests. If on the repeat of both tests, the results were negative, the samples were rendered negative; if results were positive, the samples were rendered positive. However, in the rare event of discordant results on the repeat of both tests, a third test, Abbott Determine was used as the tie breaker. The same steps were also followed for 10 percent of the samples testing negative on the first test. Additional internal quality control measures included testing a number of panels in each plate. This was done to check the accuracy of the laboratory technicians. About 5 percent of randomly selected samples were sent for retesting to the National Institute for Communicable Diseases (NICD) in South Africa as part of the external quality control. 1.8 TRAINING AND FIELDWORK Eighty-two people (about half women and half men) were recruited by the MOHSW and BOS to serve as supervisors, field editors, male and female interviewers, and reserves. They all participated in the main interviewer training, which began on 16 August 2004 in Roma and lasted for a period of about four weeks. The trainees came from the BOS and the MOHSW from both the central and district levels. Most of the participants from the BOS had had prior experience as interviewers in other surveys, while most of the participants from the MOHSW had had experience with blood collection and HIV/AIDS testing and counselling. The training was conducted mainly in English and included lectures, presentations, practical demonstrations, and practice interviewing in small groups. The training included two days of field practice with households living close to the training site. The participants also received training relating to height and weight measurements, haemoglobin testing, and blood collection for HIV. The trainers were officers of BOS and MOHSW as well as staff from ORC Macro. In addition to the main trainers, guest lecturers gave presentations in plenary sessions on specialized topics, such as family planning, nutrition, maternal and child health, and HIV/AIDS. Towards the end of the training course, some interviewers were selected as supervisors and field editors. This group was further trained on how to supervise fieldwork and editing of the questionnaires in the field, as well as how to read global positioning system (GPS) coordinates. Data collection began on 28 September 2004. The 12 data collection teams were made up of one supervisor, one field editor, three female interviewers and one male interviewer (with the exception of two teams that had two female interviewers and two male interviewers). Fieldwork was completed on 18 January 2005. Fieldwork supervision was coordinated at MOHSW and BOS headquarters; three teams of Regional Coordinators consisting of one representative from MOHSW and one from BOS for each team periodically visited the field teams to review their work and to monitor data quality. Additionally, close contact between MOHSW and BOS headquarters and the field teams was maintained through mobile phones. 1.9 DATA PROCESSING The processing of the 2004 LDHS results began shortly after the fieldwork commenced. Completed questionnaires were returned periodically from the field to BOS headquarters, where they were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included two supervisors, two questionnaire administrators/office editors—who ensured that the expected number of questionnaires from each cluster was received—16 data entry operators, and two secondary editors. The concurrent processing of the data was an advantage because BOS was able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in May 2005. Introduction | 7 1.10 RESPONSE RATES Table 1.2 shows household and individual response rates for the 2004 LDHS. Response rates are important because high non-response may affect the reliability of the results. A total of 9,903 households were selected for the sample, of which 9,025 were found to be occupied during data collection. Of the 9,025 existing households, 8,592 were successfully interviewed, yielding a household response rate of 95 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Lesotho 2004 Residence Result Urban Rural Total Household interviews Households selected 2,743 7,160 9,903 Households occupied 2,498 6,527 9,025 Households interviewed 2,235 6,357 8,592 Household response rate 89.5 97.4 95.2 Interviews with women Number of eligible women 2,030 5,492 7,522 Number of eligible women interviewed 1,945 5,150 7,095 Eligible woman response rate 95.8 93.8 94.3 Household interviews for men Households selected 1,348 3,515 4,863 Households occupied 1,237 3,189 4,426 Households interviewed 1,092 3,093 4,185 Household response rate 88.3 97.0 94.6 Interviews with men Number of eligible men 791 2,514 3,305 Number of eligible men interviewed 694 2,103 2,797 Eligible man response rate 87.7 83.7 84.6 In these households, 7,522 women were identified as eligible for the individual interview. Interviews were completed with 94 percent of these women. Of the 3,305 eligible men identified, 85 percent were successfully interviewed. The response rate for urban women and men is somewhat higher than for rural respondents (96 percent compared with 94 percent for women and 88 percent compared with 84 percent for men). The principal reason for non-response among eligible women and men was the failure to find individuals at home despite repeated visits to the household. The lower response rate for men reflects the more frequent and longer absences of men from the household, principally because of employment and life style. Response rates for the HIV testing component were lower than those for the interviews. Details of the HIV testing response rates are discussed in Chapter 12. Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 John Nkonyana This chapter presents information on the social, economic, and demographic characteristics of the household population, focusing mainly on such background characteristics as age, sex, educational attendance and attainment, place of residence, and socioeconomic conditions of households. The information provided is intended to facilitate interpretation of the key demographic, socioeconomic, and health indices. It is further intended to assist in the assessment of the representativeness of the survey. One of the background characteristics used throughout this report is an index of socioeconomic status. The economic index used here was recently developed and tested in a large number of countries in relation to inequities in household income, use of health services, and health outcomes (Rutstein et al., 2000). It is an indicator of the level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The economic index was constructed using household asset data with principal components analysis. The asset information was collected through the Household Questionnaire of the 2004 LDHS and covers information on household ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of material used for flooring. Each asset was assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; separate indices were not prepared for the urban and rural populations. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX The 2004 LDHS Household Questionnaire solicited information on key demographic and socioeconomic characteristics; parental survivorship and residence for people age 17 years and under; educational attendance and attainment; and housing characteristics. A household was defined as a person or group of people, related or unrelated to each other, who live together in the same dwelling unit and share a common source of food. Table 2.1 presents the distribution of the 2004 LDHS household population by five-year age groups, according to sex and urban-rural residence. The household population constitutes 32,747 persons, of which 47 percent are males and 53 percent are females. There are more persons in the younger age groups than in the older groups for both sexes. Figure 2.1 shows the age-sex structure of the Lesotho population. The household population age- structure is wide based, as depicted by the population pyramid. Lesotho’s population is still young. This implies that the share of the Lesotho population under age 15 is 41 percent, and the older age groups (65 years and above) make up just 7 percent of the total household population. The recent decline in fertility is also apparent in the narrowing at the base of the pyramid. The jutting out of the bars for women age 50-54 and for men age 60-64 is most likely a result of deliberate age displacement by interviewers to place respondents outside of the age range of eligibility for the interview, thus reducing the interviewer’s workload. 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Lesotho 2004 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 9.3 8.5 8.9 13.8 12.0 12.8 13.0 11.3 12.1 5-9 12.2 9.7 10.8 14.9 13.1 14.0 14.5 12.5 13.4 10-14 13.3 12.3 12.8 16.4 14.8 15.6 15.9 14.4 15.1 15-19 12.6 9.9 11.1 13.3 10.5 11.9 13.2 10.4 11.7 20-24 10.2 11.6 11.0 9.6 8.2 8.8 9.7 8.8 9.2 25-29 10.4 11.0 10.7 5.7 5.2 5.5 6.5 6.3 6.4 30-34 7.9 6.9 7.4 4.3 4.4 4.3 4.9 4.9 4.9 35-39 5.5 5.8 5.7 3.2 4.1 3.7 3.6 4.4 4.0 40-44 4.6 4.9 4.7 2.6 4.3 3.5 3.0 4.4 3.7 45-49 3.6 4.1 3.9 2.6 3.4 3.0 2.8 3.5 3.2 50-54 3.0 6.0 4.6 2.5 4.0 3.3 2.6 4.4 3.5 55-59 1.7 2.9 2.4 2.1 3.4 2.8 2.1 3.3 2.7 60-64 2.6 1.7 2.1 2.9 3.3 3.1 2.9 3.0 2.9 65-69 1.3 1.7 1.5 2.0 2.4 2.2 1.9 2.2 2.1 70-74 0.8 1.6 1.2 2.2 3.0 2.6 1.9 2.7 2.3 75-79 0.7 0.5 0.6 0.9 1.5 1.2 0.8 1.3 1.1 80 + 0.4 1.0 0.8 0.9 2.3 1.6 0.8 2.0 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,628 3,226 5,854 12,867 14,026 26,893 15,495 17,252 32,747 Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810121416 0 2 4 6 8 10 12 14 16 LDHS 2004 Age Male Percent Female Household Population and Housing Characteristics | 11 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows the distribution of households by sex of the head of household and by household size, according to rural-urban residence. According to the 2004 LDHS, women head 37 percent of households in Lesotho, an increase from 29 percent as shown in the 1996 population census (BOS, 1996). There are modest differences in female-headed households between urban and rural areas (41 and 36 percent, respectively). This may be somewhat attributed to rural to urban migration exacerbated by the proliferation of textile industries in the cities whose employees are predominantly women. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Lesotho 2004 Residence Characteristic Urban Rural Total Sex of head of household Male 59.5 63.7 62.7 Female 40.5 36.3 37.3 Total 100.0 100.0 100.0 Number of usual members 1 29.4 11.9 16.0 2 19.4 14.2 15.4 3 18.3 15.6 16.3 4 14.3 17.9 17.0 5 9.1 14.3 13.1 6 4.3 11.1 9.5 7 2.7 6.2 5.3 8 0.9 4.1 3.3 9+ 1.4 4.6 3.8 Total 100.0 100.0 100.0 Number of households 2,043 6,549 8,592 Mean size 2.9 4.2 3.9 Note: Table is based on de jure members, i.e., usual residents. Table 2.2 further shows that the mean size of a Lesotho household is 3.9 persons, 1.1 person lower than the mean household size of 5 found in the 1996 population census (BOS, 1996 IIIB: 4). As expected, urban households have, on average, much smaller household sizes (2.9 persons) than rural households (4.2 persons). In the 2004 LDHS, the mean household size in both rural and urban areas is lower than in the 1996 population census (3.9 persons for urban areas and 5.2 persons for rural areas). 2.3 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Tables 2.3.1 and 2.3.2 show the percent distribution of the de facto female and male household population age six years and over by highest level of education attended, according to background characteristics. Eight percent of females and 19 percent of males have no education at all, while seven in ten women and six in ten men have attended or completed primary education only. Among both males and females, about 5 percent have completed secondary or higher education. The proportion of the household population age six years and above who have attended school is significantly higher for females than males in all age groups. The median number of years of schooling is higher in females (4.8 years) than males (2.8 years). 12 | Household Population and Housing Characteristics Table 2.3.1 shows that the proportion of women with no education is higher among older women, suggesting some improvement in education over the years. Urban women are more likely to be educated than rural women. For example, 4 percent of urban females have no education, compared with 9 percent of rural females. The proportion of urban females with some secondary education or higher (42 percent) is more than twice as high as that of rural females (16 percent). Table 2.3.1 Educational attainment of household population: women Percent distribution of the de facto female household population age six and over by highest level of education attended or completed, according to background characteristics, Lesotho 2004 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median number of years Age 6-9 18.9 80.7 0.0 0.0 0.0 0.0 0.4 100.0 1,797 0.2 10-14 1.0 88.9 6.5 3.4 0.0 0.0 0.1 100.0 2,480 3.4 15-19 1.0 38.8 22.6 35.4 1.7 0.4 0.1 100.0 1,793 6.4 20-24 1.7 23.4 28.1 33.4 10.7 2.5 0.2 100.0 1,517 6.9 25-29 2.3 22.7 28.1 31.7 11.0 4.2 0.0 100.0 1,085 6.9 30-34 2.7 23.3 31.2 31.3 8.6 2.9 0.1 100.0 844 6.8 35-39 3.6 22.5 31.2 33.1 7.1 2.1 0.4 100.0 757 6.7 40-44 4.9 39.3 26.2 20.2 5.8 3.0 0.5 100.0 760 6.2 45-49 5.5 49.8 25.8 11.6 3.3 3.7 0.3 100.0 607 5.6 50-54 11.9 61.7 12.3 9.8 2.0 2.2 0.1 100.0 757 4.4 55-59 7.9 74.6 9.3 4.8 0.9 2.4 0.1 100.0 569 3.6 60-64 16.2 73.3 5.0 2.0 0.9 1.6 1.0 100.0 513 3.1 65+ 24.2 69.2 3.7 1.8 0.3 0.4 0.3 100.0 1,440 2.3 Residence Urban 3.9 36.3 17.2 27.4 10.0 5.0 0.3 100.0 2,913 6.6 Rural 8.5 59.3 15.6 13.7 2.0 0.6 0.2 100.0 12,034 4.3 Ecological zone Lowlands 5.5 49.4 16.7 20.8 5.1 2.2 0.3 100.0 8,579 5.5 Foothills 7.6 62.8 15.7 11.5 1.4 0.9 0.1 100.0 1,798 4.1 Mountains 12.3 62.4 14.6 8.9 1.2 0.4 0.2 100.0 3,573 3.6 Senqu River Valley 8.6 59.4 14.8 13.9 2.5 0.8 0.1 100.0 997 4.3 District Butha-Buthe 5.5 54.6 17.3 17.5 2.9 2.2 0.1 100.0 905 5.1 Leribe 5.6 54.5 17.2 18.3 3.5 0.8 0.1 100.0 2,196 5.1 Berea 5.6 59.4 18.2 13.1 2.5 0.8 0.4 100.0 1,696 4.8 Maseru 6.5 44.2 16.7 22.0 6.9 3.3 0.4 100.0 3,757 5.9 Mafeteng 5.7 57.3 14.6 19.0 2.4 0.9 0.1 100.0 1,555 4.6 Mohale's Hoek 9.1 58.6 14.2 14.4 2.6 1.0 0.1 100.0 1,455 4.2 Quthing 11.5 59.2 13.9 12.2 2.1 0.6 0.5 100.0 1,027 4.0 Qacha's Nek 11.0 64.0 11.7 11.1 1.6 0.6 0.0 100.0 532 3.8 Mokhotlong 12.0 62.1 14.5 9.4 1.2 0.8 0.0 100.0 772 3.6 Thaba-Tseka 12.7 63.2 15.1 7.2 1.4 0.2 0.3 100.0 1,052 3.5 Wealth quintile Lowest 15.7 69.2 10.6 4.1 0.3 0.0 0.1 100.0 2,816 2.7 Second 9.3 64.4 16.3 8.7 0.8 0.0 0.4 100.0 2,857 3.7 Middle 6.9 59.4 16.3 15.2 1.5 0.4 0.3 100.0 2,979 4.7 Fourth 3.7 50.2 19.6 21.7 3.8 0.7 0.2 100.0 2,993 5.6 Highest 3.4 34.3 16.4 29.8 10.3 5.7 0.1 100.0 3,302 6.7 Total 7.6 54.8 15.9 16.4 3.6 1.5 0.2 100.0 14,947 4.8 Note: Total includes 25 women with missing information on age who are not shown separately. 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level Household Population and Housing Characteristics | 13 Women who live in the Mountains zone are more disadvantaged educationally than other women. Among all districts, the highest proportion of women who never went to school is in Thaba-Tseka (13 percent) and Mokhotlong (12 percent) and the lowest in Butha-Buthe, Leribe, Berea, and Mafeteng (6 percent each). It is worth noting that the proportion of female household members who have never attended school decreases with higher wealth status. Sixteen percent of women in the lowest wealth quintile have no education compared with only 3 percent in the highest quintile. Table 2.3.2 shows that 22 percent of males in rural areas have no education compared with 8 percent in urban areas. There is a marked urban-rural differential in secondary and higher education: 18 percent of males in urban areas have completed secondary or higher education, compared with only 3 percent in rural areas. Table 2.3.2 Educational attainment of household population: men Percent distribution of the de facto male household population age six and over by highest level of education attended or completed, according to background characteristics, Lesotho 2004 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median number of years Age 6-9 21.9 77.0 0.0 0.6 0.0 0.0 0.5 100.0 1,848 0.0 10-14 6.2 89.8 2.6 1.4 0.0 0.0 0.1 100.0 2,461 2.5 15-19 8.3 57.1 10.2 23.3 0.9 0.2 0.1 100.0 2,045 5.0 20-24 13.4 36.5 15.2 22.5 8.4 3.8 0.2 100.0 1,497 6.0 25-29 16.7 32.2 16.1 19.8 10.3 4.4 0.6 100.0 1,009 6.1 30-34 22.3 35.3 15.2 15.2 8.9 3.0 0.0 100.0 756 4.9 35-39 20.0 35.8 14.8 16.3 8.9 4.1 0.0 100.0 560 5.0 40-44 27.5 39.8 10.4 13.0 5.6 3.7 0.0 100.0 459 3.6 45-49 31.7 39.1 8.4 10.1 4.7 6.0 0.0 100.0 427 2.8 50-54 36.5 43.9 5.0 8.0 4.0 2.6 0.0 100.0 401 1.7 55-59 39.1 47.1 4.7 3.2 3.6 2.3 0.0 100.0 318 1.3 60-64 42.0 45.6 4.7 3.7 2.0 1.9 0.1 100.0 443 1.1 65+ 48.5 42.9 2.9 3.6 0.8 1.1 0.2 100.0 844 0.1 Residence Urban 7.7 41.0 10.1 23.4 11.1 6.5 0.3 100.0 2,334 6.1 Rural 21.7 59.7 7.3 8.5 1.8 0.7 0.2 100.0 10,751 2.3 Ecological zone Lowlands 11.9 56.4 9.3 14.6 5.0 2.5 0.3 100.0 7,582 3.8 Foothills 22.8 60.9 6.5 7.8 1.3 0.5 0.1 100.0 1,608 2.1 Mountains 35.1 53.4 4.5 4.8 1.2 0.8 0.2 100.0 3,103 0.7 Senqu River Valley 19.6 59.4 9.0 9.0 2.3 0.7 0.0 100.0 791 2.6 District Butha-Buthe 13.5 61.5 8.5 11.9 3.2 1.3 0.1 100.0 824 3.4 Leribe 15.1 59.0 8.6 12.0 3.5 1.6 0.2 100.0 1,834 3.2 Berea 14.8 64.7 7.7 9.2 2.6 0.7 0.4 100.0 1,583 2.9 Maseru 14.1 48.7 9.5 16.8 6.7 3.9 0.3 100.0 3,326 4.3 Mafeteng 15.3 63.1 8.3 10.7 1.9 0.5 0.2 100.0 1,379 2.7 Mohale's Hoek 24.9 55.2 6.5 9.1 2.6 1.5 0.1 100.0 1,257 2.0 Quthing 26.1 57.2 6.7 7.9 1.9 0.3 0.0 100.0 822 1.9 Qacha's Nek 25.8 61.5 4.9 5.6 1.8 0.4 0.0 100.0 471 1.7 Mokhotlong 36.1 49.8 5.4 6.1 1.4 1.1 0.1 100.0 707 0.5 Thaba-Tseka 34.8 53.4 5.1 4.6 0.7 1.2 0.4 100.0 883 0.6 Wealth quintile Lowest 39.0 54.1 4.2 2.0 0.3 0.1 0.3 100.0 2,634 0.4 Second 25.0 63.0 6.1 5.1 0.8 0.0 0.1 100.0 2,513 1.7 Middle 15.3 62.3 10.1 9.7 1.7 0.5 0.4 100.0 2,663 3.0 Fourth 10.4 58.5 10.2 15.6 4.0 1.0 0.2 100.0 2,635 3.9 Highest 6.7 44.3 8.4 22.9 10.4 7.1 0.2 100.0 2,640 5.9 Total 19.2 56.4 7.8 11.1 3.5 1.8 0.2 100.0 13,085 2.8 Note: Total includes 17 men with missing information on age who are not shown separately. 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level 14 | Household Population and Housing Characteristics Across districts, the pattern among the male population is similar to that exhibited by the females. The variation in education among the male population according to wealth quintile is also similar to that among the female population. Wealthy males are less likely to have no education, with 7 percent of males in the highest wealth quintile having no education compared with 39 percent in the lowest. Table 2.4 shows the percentage of the household population age 6-24 years who are currently attending school, by age, sex, and residence. Eighty-one percent of people age 6-17 years are in school, with urban attendance higher than rural attendance (86 and 81 percent, respectively) and female attendance higher than male attendance (85 and 78 percent, respectively). However, at age group 18-21, attendance levels drop dramatically, and they are noticeably higher in urban than in rural areas (42 and 27 percent, respectively) and higher for males than females (34 and 25 percent, respectively). Table 2.4 School attendance Percentage of the de jure household population age 6-24 years currently attending school, by age, sex, and residence, Lesotho 2004 Male Female Total Age Urban Rural Total Urban Rural Total Urban Rural Total 6-12 83.2 81.0 81.3 89.1 87.4 87.6 86.3 84.1 84.5 13-17 85.4 71.2 73.3 84.2 79.8 80.6 84.8 75.2 76.7 6-17 84.2 76.9 77.9 87.0 84.4 84.9 85.7 80.5 81.3 18-21 53.0 29.9 33.7 32.9 23.2 25.2 41.9 26.7 29.5 22-24 20.5 8.9 11.1 12.5 3.9 6.1 15.9 6.5 8.6 Figure 2.2 shows that attendance rates for both males and females are 81 and 88 percent, respectively, at age group 6-12 years. Both boys and girls tend to drop out of school, so that at age group 13-17 years, 73 percent of boys and 81 percent of girls are attending school. After age 13-17 years, girls drop out of school more rapidly than boys. Among youth age 22-24 years, 11 percent of males and 6 percent of females attend school. The largest drop in attendance for both sexes occurs at age 18-21 years (34 percent for males and 25 percent for females). Figure 2.2 Percentage of Males and Females Currently Attending School, by Age LDHS 2004 , , , , # # # # 6-12 13-17 18-21 22-24 Age in years 0 20 40 60 80 100 Male Female# , Percent Household Population and Housing Characteristics | 15 Table 2.5 presents net attendance ratios (NARs) and gross attendance ratios (GARs) for the de jure household population by level of schooling and sex, according to background characteristics. The NAR for primary school measures the proportion of children of primary school age who are attending primary school, while the GAR represents the total number of primary school students age 5-24 as a percentage of children of primary school age. In the Lesotho context, the levels refer to 6 to 12 years for primary and 13 to 17 years for secondary. The GAR is usually higher than the NAR because the GAR includes participation of those who may be older or younger than the official age range for that level. Students who are over age for a given level of school may have started school late, may have repeated one or more grades in school, or may have dropped out of school and later returned. The NAR indicates that 85 percent of children of primary school age are attending primary school. There is a gender gap among the children who are attending primary school; the NAR is 88 percent for girls and 81 percent for boys. NARs for primary school do not differ by urban-rural residence. Among districts, NARs are highest in Butha-Buthe (92 percent) and lowest in Mokhotlong (79 percent). The GAR indicates that there are children in primary school who are not of primary school age, with ratios of 130 for males and 126 for females. This is probably a result of the introduction of free primary education about six years ago. As expected, both the NAR and GAR are lower at the secondary school level. The NAR indicates that only 21 percent of the secondary school age population are attending secondary school. Net secondary school attendance is higher for females (NAR of 27) than for males (NAR of 16). The GAR shows that there are many secondary school students who are not of secondary school age. School attendance ratios at the secondary level are lower in rural than in urban areas. For instance, the NAR at the secondary school level in rural areas is 17 percent compared with 42 percent in urban areas. Similarly, the GAR at secondary school is 29 percent in rural areas compared with 73 percent in urban areas. There is a strong relationship between household economic status and school attendance that can be seen at both the primary and secondary levels and among males and females. The NAR increases from 75 percent among students from poorer households (lowest wealth quintile) in primary school to 88 percent among students from richer households (highest wealth quintile). Similarly, the GAR rises dramatically from 6 percent among secondary school attendees in the lowest wealth quintile to 77 percent among those in the highest wealth quintile. The Gender Parity Index (GPI) represents the ratio of the GAR for females to the GAR for males. It is presented at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI less than 1 indicates that a smaller proportion of females than males attend school. In Lesotho, the GPI is slightly less than 1 (0.97) for primary school attendance, indicating that the gender gap is relatively small, while for secondary school attendance it is greater than 1 (1.32), indicating that females are advantaged at this educational level. There are no marked differences in GPI by place of residence. 16 | Household Population and Housing Characteristics Table 2.5 School attendance ratios Net attendance ratios (NAR), gross attendance ratios (GAR), and gender parity index (GPI) for the de jure household population age 6-24 by level of schooling and sex, according to background characteristics, Lesotho 2004 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 81.6 88.0 85.0 124.1 117.2 120.4 0.94 Rural 81.4 87.6 84.5 131.0 127.3 129.2 0.97 Ecological zone Lowlands 85.9 88.5 87.2 137.9 122.3 130.2 0.89 Foothills 81.6 88.3 85.0 136.7 129.6 133.1 0.95 Mountains 71.8 85.1 78.3 109.6 128.4 118.8 1.17 Senqu River Valley 85.2 90.0 87.7 138.9 134.2 136.5 0.97 District Butha-Buthe 91.7 92.8 92.2 149.2 125.8 137.4 0.84 Leribe 86.5 91.5 89.1 137.1 126.7 131.7 0.92 Berea 87.2 89.6 88.3 140.1 130.1 135.5 0.93 Maseru 81.8 83.8 82.8 129.5 115.7 122.5 0.89 Mafeteng 83.2 89.6 86.5 147.9 124.3 135.6 0.84 Mohale's Hoek 74.6 84.6 79.6 119.6 127.3 123.5 1.06 Quthing 79.7 87.5 83.5 120.8 132.4 126.4 1.10 Qacha's Nek 75.4 88.0 81.2 120.8 134.0 126.9 1.11 Mokhotlong 72.9 86.9 79.4 103.1 131.4 116.2 1.27 Thaba-Tseka 73.1 87.1 80.0 115.4 132.6 123.9 1.15 Wealth quintile Lowest 66.9 83.8 75.1 104.0 126.7 115.0 1.22 Second 79.2 87.2 83.1 126.1 131.6 128.8 1.04 Middle 87.4 87.6 87.5 145.3 128.2 136.9 0.88 Fourth 87.7 92.5 90.1 143.1 128.0 135.6 0.89 Highest 88.3 87.7 88.0 135.2 113.7 123.9 0.84 Total 81.4 87.7 84.6 130.1 125.7 127.9 0.97 SECONDARY SCHOOL Residence Urban 36.9 46.9 42.1 72.0 73.5 72.8 1.02 Rural 11.9 22.2 16.6 24.6 34.7 29.3 1.41 Ecological zone Lowlands 21.2 34.8 27.5 40.7 53.0 46.4 1.30 Foothills 10.4 17.0 13.4 26.9 32.1 29.3 1.19 Mountains 5.7 12.4 8.8 12.5 20.0 16.0 1.60 Senqu River Valley 13.3 26.5 20.0 30.1 41.5 35.9 1.38 District Butha-Buthe 16.2 36.2 25.2 41.2 62.8 50.9 1.53 Leribe 16.0 29.1 22.3 32.2 45.2 38.5 1.40 Berea 12.9 27.8 19.9 30.9 39.3 34.8 1.27 Maseru 24.1 35.5 29.4 45.0 55.5 49.9 1.23 Mafeteng 13.0 22.4 16.9 24.3 37.1 29.6 1.53 Mohale's Hoek 19.4 23.6 21.5 34.1 36.0 35.0 1.06 Quthing 12.0 26.4 19.4 28.4 41.4 35.1 1.46 Qacha's Nek 4.5 12.9 8.4 12.2 22.8 17.2 1.86 Mokhotlong 7.0 14.7 10.6 14.7 22.3 18.3 1.51 Thaba-Tseka 4.6 7.7 6.0 11.5 12.8 12.1 1.12 Wealth quintile Lowest 1.1 4.9 2.8 4.9 7.1 5.9 1.47 Second 4.9 12.6 8.6 12.5 17.6 15.0 1.41 Middle 13.3 24.9 18.6 24.3 39.0 31.0 1.61 Fourth 18.1 31.7 24.4 42.4 51.3 46.5 1.21 Highest 38.0 53.6 45.6 69.2 84.8 76.8 1.23 Total 15.6 26.6 20.7 31.6 41.7 36.3 1.32 1 The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school GAR for females to the GAR for males. The Gender Parity Index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. Household Population and Housing Characteristics | 17 Table 2.6 shows repetition and dropout rates for the de jure household population age 5-24 by school grade, according to background characteristics. Repetition and dropout rates describe the flow of students through the school sys- tem. The repetition rate for the primary education ranges from 6 percent for the sixth grade to 23 percent for the first grade. The repetition rates are higher at every grade for males and rural residents when compared with females and urban resi- dents. There is no clear pattern of repe- tition rates when looking at other back- ground characteristics. The dropout rate increases with grade, from 2 percent of students in first grade to 18 percent of those in seventh grade. Dropout rates are higher among male than female students, with the exception of the seventh grade, when this pattern is reversed. Dropout rates are more pronounced in rural than urban areas and among those in the Mountains zone. 2.4 HOUSING CHARACTERISTICS Given that there is a strong rela- tionship between household economic con- ditions and exposure to diseases, informa- tion on housing characteristics, such as access to electricity, source of drinking water, sanitary facilities, and flooring and roofing materials, is key to explaining the interrelationships between the social and economic conditions of the household and likely exposure to and prevalence of dis- eases. Table 2.7 shows the percent distri- bution of households by housing charac- teristics, according to residence. The table shows that only 7 per- cent of Lesotho households have elec- tricity. There is a large discrepancy be- tween urban and rural areas in the pro- portion of households that have electricity: 26 percent of urban households have electricity compared with less than 1 per- cent of rural households. Table 2.6 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background characteristics, Lesotho 2004 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE 1 Sex Male 24.6 15.3 10.9 11.4 12.6 6.6 11.7 Female 21.4 9.0 8.3 7.4 11.8 5.9 10.6 Residence Urban 16.7 9.3 8.0 5.1 8.2 4.3 2.8 Rural 23.9 12.8 9.9 10.0 13.1 6.7 13.8 Ecological zone Lowlands 20.2 12.6 10.0 9.4 11.3 6.7 9.6 Foothills 20.9 8.1 13.1 12.2 17.2 6.3 18.1 Mountains 29.0 14.0 8.9 6.9 11.9 5.9 12.3 Senqu River Valley 19.9 13.1 2.4 10.9 12.2 3.1 12.0 District Butha-Buthe 14.1 15.2 12.8 10.9 16.6 7.1 6.6 Leribe 19.0 13.6 11.1 13.8 15.2 10.5 10.6 Berea 26.3 12.3 14.8 11.1 7.7 6.3 29.9 Maseru 17.8 9.8 10.9 8.4 12.0 5.0 6.2 Mafeteng 25.7 13.6 6.9 6.8 16.0 6.8 10.1 Mohale's Hoek 25.5 6.8 4.7 4.1 6.1 2.9 3.7 Quthing 19.5 12.7 2.0 10.9 12.5 4.1 11.2 Qacha's Nek 23.4 13.3 8.9 14.0 19.8 5.5 2.4 Mokhotlong 38.3 15.3 10.3 7.6 0.4 6.2 10.7 Thaba-Tseka 25.2 18.5 8.1 5.1 15.8 7.4 13.5 Wealth quintile Lowest 26.0 9.9 8.0 7.6 13.6 2.5 15.6 Second 28.9 13.8 8.8 13.8 8.1 5.5 15.7 Middle 25.0 10.4 12.1 8.7 15.2 9.8 13.2 Fourth 16.8 15.9 10.7 9.7 13.1 4.3 11.4 Highest 15.0 12.1 8.2 5.8 10.2 6.2 6.5 Total 23.1 12.4 9.7 9.3 12.2 6.2 11.1 DROPOUT RATE2 Sex Male 2.1 2.2 2.5 3.6 3.1 4.7 14.5 Female 0.7 0.6 1.2 2.5 2.9 3.3 19.8 Residence Urban 1.0 0.1 0.0 0.1 0.9 0.5 8.4 Rural 1.5 1.7 2.2 3.5 3.5 4.7 20.6 Ecological zone Lowlands 0.4 0.0 0.8 2.3 0.9 1.8 14.4 Foothills 1.3 1.6 1.9 3.3 3.4 5.0 21.6 Mountains 3.1 4.4 4.4 5.0 8.8 7.7 32.8 Senqu River Valley 1.5 2.2 2.1 2.2 3.0 9.1 13.3 District Butha-Buthe 1.2 0.0 0.0 1.3 0.4 4.6 14.4 Leribe 0.8 0.0 0.0 1.0 1.8 4.5 12.1 Berea 0.0 0.0 1.7 3.3 1.4 2.6 14.8 Maseru 0.3 0.8 2.0 3.0 0.8 2.0 13.0 Mafeteng 0.8 0.3 0.8 4.3 4.4 1.6 32.4 Mohale's Hoek 4.7 4.6 5.5 9.2 5.9 2.3 24.6 Quthing 1.2 0.9 1.9 0.0 5.3 10.1 10.5 Qacha's Nek 4.6 4.4 2.3 6.9 1.5 19.3 32.9 Mokhotlong 0.6 4.4 6.2 1.2 14.0 8.7 44.4 Thaba-Tseka 3.1 4.2 2.5 2.0 4.8 2.2 18.9 Wealth quintile Lowest 2.2 2.5 3.9 2.5 7.5 10.5 28.9 Second 3.0 2.5 1.6 5.3 4.9 6.1 26.1 Middle 0.7 1.7 2.7 4.6 3.9 5.6 25.3 Fourth 0.5 0.1 0.6 1.4 1.0 2.7 20.8 Highest 0.0 0.2 0.0 1.2 0.3 0.1 3.6 Total 1.5 1.5 1.9 3.0 3.0 3.9 17.5 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. 18 | Household Population and Housing Characteristics Table 2.7 Household characteristics Percent distribution of households by household characteristics, according to residence, Lesotho 2004 Residence Household characteristic Urban Rural Total Electricity Yes 26.2 0.8 6.8 No 73.6 99.0 93.0 Missing 0.1 0.2 0.2 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 11.9 0.6 3.3 Piped into yard/plot 39.5 1.5 10.5 Piped into someone else's yard/plot 17.0 1.0 4.8 Public tap 22.0 50.0 43.3 Open well in dwelling/yard/plot 0.0 0.2 0.2 Open public well 3.4 21.7 17.3 Protected well in dwelling/yard/plot 0.7 1.3 1.2 Protected well in someone else's yard/plot 1.3 1.2 1.2 Protected public well 2.9 13.2 10.7 Spring 0.8 6.9 5.4 River, stream 0.0 2.2 1.7 Dam 0.0 0.1 0.1 Tanker truck 0.2 0.1 0.1 Other/missing 0.2 0.1 0.2 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 75.5 37.0 46.1 Median time to source 0.0 19.4 14.5 Sanitation facility Flush toilet 7.7 0.2 2.0 Traditional pit toilet 44.4 29.7 33.2 Ventilated improved pit latrine 40.7 15.7 21.6 No facility, bush, field 7.1 54.4 43.2 Other/missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Type of cooking fuel Electricity 7.0 0.2 1.8 LPG, natural gas 58.2 10.7 22.0 Charcoal 0.0 0.2 0.1 Firewood, straw 6.6 71.0 55.7 Dung 0.5 7.4 5.7 Paraffin 27.4 9.2 13.5 Crop waste 0.1 1.1 0.9 Other/missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Flooring material Mud/earth/dung 6.6 51.1 40.5 Wood planks 0.4 0.1 0.2 Parquet, polished wood 0.1 0.0 0.0 Brick tiles 0.5 0.2 0.3 Tiles 16.8 5.9 8.5 Cement 43.1 14.4 21.2 Carpet 13.0 9.9 10.6 Vinyl, linoleum 19.3 18.2 18.4 Other/missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number of households 2,043 6,549 8,592 Household Population and Housing Characteristics | 19 The availability of and accessibility to potable water may, to a large extent, minimise the prevalence of potentially fatal water-borne diseases among household members. The source of drinking water is an important determinant of potentially fatal diarrhoeal diseases, such as typhoid, cholera, and dysentery. In Lesotho, more than four in ten households (43 percent) get their drinking water from a public tap. Seventeen percent of the households draw their drinking water from open public wells, while 11 percent each use protected public well or piped water located in their yard or plot. Less than 5 percent of households use other types of water supply sources. Forty-six percent of the households are within 15 minutes of their water source, with a median time to water source of about 15 minutes. In urban areas, the main source is piped water in the yard or plot (40 percent), followed by public tap (22 percent). In rural areas, half of the household get their drinking water from a public tap, and more than one in five (22 percent) from an open public well. The availability of toilet facilities in households ensures a more efficient and hygienic method of human waste disposal. Fifty-seven percent of the households in Lesotho have access to some type of sanitary facility. Three in ten households in Lesotho have traditional pit toilets, while about one in five (22 percent) have ventilated improved pit latrines. Only 2 percent of the households have flush toilets. Traditional pit toilets are more common in urban (44 percent) areas than rural areas (30 percent). As expected, flush toilets are more widely used in urban (8 percent) than in rural areas (less than 1 percent). The most common source of cooking fuel in Lesotho is firewood or straw (56 percent), followed by LPG or natural gas (22 percent). In urban households, the two most commonly used sources are LPG or natural gas (58 percent) and paraffin (27 percent). In rural areas, seven in ten households use firewood or straw for cooking, and one in ten use LPG or natural gas (11 percent) or paraffin (9 percent). The type of flooring material used in dwellings is a proxy indicator of the socioeconomic status of the household as well as its likely exposure to disease-causing agents. The predominant flooring materials used by Lesotho households are mud, earth, or dung with a share of 41 percent. Cement is the next most common flooring material, with a share of 21 percent. Forty-three percent of urban households use cement for flooring their houses, and 51 percent of rural households use mud, earth, or dung. 2.5 HOUSEHOLD DURABLE GOODS Table 2.8 shows the percentage of households possessing various durable goods by urban-rural residence. This indicator provides a rough measure of the socioeconomic status of households. Of the 11 selected durable household goods, sofa or mattress, radio, and horse or donkey or mule were most frequently available. Seventy-nine percent of households in Lesotho own a sofa and mattress, 54 percent own a radio, and 29 percent own a horse or donkey or mule. There is noticeable urban-rural variation in the proportion of households owning durable goods. Ninety-two percent of households in urban areas have a sofa or mattress, compared with 75 percent of rural households. Similarly, 79 percent of urban households have a radio, compared with 47 percent of rural households. Four percent of urban households and 14 percent of rural households have none of the selected durable goods. 20 | Household Population and Housing Characteristics Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Lesotho 2004 Residence Durable consumer goods Urban Rural Total Energy battery/generator/solar 27.5 15.4 18.3 Radio 78.7 46.5 54.1 Television 32.9 6.9 13.1 Telephone 44.0 9.6 17.8 Refrigerator 28.8 7.5 12.5 Sofa/mattress 91.9 74.8 78.8 Bicycle 4.6 2.6 3.0 Motorcycle/scooter 0.4 0.1 0.2 Car/truck 10.5 2.6 4.5 Horse/donkey/mule 2.5 37.1 28.9 Scotch cart 1.3 12.3 9.7 None of the above 3.5 13.8 11.3 Number of households 2,043 6,549 8,592 2.6 RESIDENCY STATUS Table 2.9 shows the residency status of the household population in Lesotho. One in ten men (10 percent) and women (11 percent) live elsewhere in Lesotho. There are no significant variations in the proportion of the population who lives elsewhere in Lesotho by various background characteristics, except for education. The proportion of population living elsewhere in Lesotho generally increases with education attainment. Seven percent of men and 3 percent of women live in the Republic of South Africa (RSA). Again, the differentials by background characteristics are not pronounced, except for education and wealth index. The proportion of household population who live in RSA increases with increasing education and wealth index quintile. The patterns are more clear for men than for women because of the larger proportion of men who live in RSA. The 2004 LDHS results show that 5 percent of the household population live outside of Lesotho, either in RSA or in another country (calculation based on Table 2.9). Household Population and Housing Characteristics | 21 Table 2.9 Residency status Percentage of household population by residency status, according to background characteristics, Lesotho 2004 Male Female Percentage usually living: Percentage usually living: Background characteristic In the house- hold Else- where in Lesotho In RSA In a country other than RSA Total Number In the house- hold Else- where in Lesotho In RSA In a country other than RSA Total Number Age 0-9 94.3 5.3 0.4 0.1 100.0 4,551 93.2 6.1 0.5 0.1 100.0 4,459 10-19 89.2 9.7 1.0 0.1 100.0 5,250 86.4 12.2 1.2 0.2 100.0 5,035 20-29 72.7 17.3 9.4 0.5 100.0 3,565 75.9 19.6 4.1 0.4 100.0 3,481 30-39 67.6 13.2 18.3 0.8 100.0 1,972 81.0 13.1 5.7 0.1 100.0 2,004 40-49 59.9 9.4 28.1 2.5 100.0 1,498 84.6 8.7 5.9 0.7 100.0 1,662 50-59 71.0 8.7 19.8 0.5 100.0 1,043 90.4 4.9 4.6 0.1 100.0 1,511 60+ 92.9 4.1 2.6 0.3 100.0 1,414 95.6 3.1 1.1 0.2 100.0 2,089 Residence Urban 83.0 10.2 6.4 0.4 100.0 3,186 87.7 9.8 2.3 0.2 100.0 3,778 Rural 82.0 9.9 7.6 0.5 100.0 16,132 86.4 10.6 2.7 0.2 100.0 16,493 Ecological zone Lowlands 82.2 9.5 7.8 0.6 100.0 10,878 86.2 10.8 2.7 0.2 100.0 11,418 Foothills 83.3 9.6 6.9 0.2 100.0 2,392 87.9 9.9 2.0 0.1 100.0 2,479 Mountains 81.8 11.6 6.3 0.2 100.0 4,815 87.6 9.9 2.2 0.1 100.0 5,014 Senqu River Valley 80.8 8.4 9.8 1.1 100.0 1,233 84.8 10.4 4.3 0.6 100.0 1,361 District Butha-Buthe 78.9 8.6 11.8 0.7 100.0 1,269 83.7 10.0 5.8 0.4 100.0 1,271 Leribe 85.0 7.2 7.3 0.4 100.0 2,583 90.3 7.7 1.8 0.2 100.0 2,836 Berea 86.0 6.6 6.5 0.8 100.0 2,203 90.3 7.5 2.0 0.2 100.0 2,210 Maseru 84.0 11.1 4.6 0.3 100.0 4,629 87.5 11.0 1.2 0.2 100.0 4,970 Mafeteng 77.7 11.0 10.8 0.4 100.0 2,180 81.5 14.7 3.7 0.1 100.0 2,216 Mohale's Hoek 79.0 12.1 8.3 0.7 100.0 1,935 83.3 13.0 3.4 0.1 100.0 2,022 Quthing 81.1 7.8 9.9 1.2 100.0 1,272 85.9 9.2 4.1 0.8 100.0 1,418 Qacha's Nek 76.0 11.2 12.4 0.4 100.0 781 81.8 10.6 7.3 0.3 100.0 783 Mokhotlong 83.9 10.9 5.2 0.0 100.0 1,089 87.1 10.4 2.4 0.0 100.0 1,101 Thaba-Tseka 81.8 13.6 4.4 0.1 100.0 1,377 89.6 9.8 0.5 0.0 100.0 1,446 Education No education 86.1 8.5 5.0 0.4 100.0 5,811 92.4 6.5 0.9 0.1 100.0 3,763 Primary, incomplete 84.9 7.8 6.9 0.4 100.0 8,960 91.0 6.8 2.0 0.1 100.0 9,240 Primary, complete 70.1 15.0 13.9 1.0 100.0 1,534 81.3 14.4 4.0 0.2 100.0 2,989 Secondary+ 72.6 16.4 10.2 0.7 100.0 2,982 76.5 18.8 4.2 0.5 100.0 4,247 Wealth quintile Lowest 84.7 11.1 3.9 0.2 100.0 3,868 87.4 10.1 2.2 0.1 100.0 3,921 Second 84.6 9.4 5.6 0.3 100.0 3,774 87.6 9.6 2.6 0.2 100.0 3,971 Middle 82.7 9.7 7.0 0.6 100.0 3,897 86.6 10.0 3.2 0.1 100.0 3,970 Fourth 80.2 8.7 10.5 0.5 100.0 3,951 86.1 10.9 2.7 0.2 100.0 4,086 Highest 78.5 10.8 10.0 0.7 100.0 3,828 85.7 11.5 2.3 0.4 100.0 4,324 Total1 82.1 9.9 7.4 0.5 100.0 19,318 86.7 10.5 2.6 0.2 100.0 20,272 RSA = Republic of South Africa 1 Total includes 30 cases missing information on age and 15 cases missing information on the residency status. Characteristics of Survey Respondents | 23 CHARACTERISTICS OF SURVEY RESPONDENTS 3 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Information on the basic characteristics of women and men interviewed in the survey is essential for the interpretation of findings subsequently presented in the report. Background characteristics of the 7,095 women and 2,797 men interviewed in the 2004 LDHS are presented in Table 3.1. For both sexes, the proportion of respondents in each age group declines as age increases, reflecting the comparatively young age structure of the population. Slightly more than half of female respondents are currently married, compared with 42 percent of males. Almost all respondents in current unions declared themselves as living in formal unions with less than 1 percent of females and males saying they were living together in an informal union. Among female respondents, the proportion divorced or separated is 6 percent compared with 4 percent among males. Nine percent of female respondents are widowed compared with 2 percent of males. Never-married females account for one-third of all women, and around half of males have never married. Slightly more than three-quarters of both female and male respondents are rural residents. The Lowlands have the largest proportion of respondents followed by the Mountains zone, and Foothills and Senqu River Valley zones have the smallest proportions. By district, the proportions of respondents range from around 3 percent in Qacha’s Nek to about 26 percent in Maseru. Female respondents are less likely than male respondents to have never attended school (2 and 17 percent, respectively). Among those who attended school, female respondents are more likely than males to have attended secondary school. Comparatively few respondents of either gender have gone to school beyond the secondary level (1 percent of females and 3 percent of males), as shown in Tables 3.2.1 and 3.2.2. Almost half of the survey respondents are Roman Catholic, with one in five belonging to the Lesotho Evangelical Church and another one in five belonging to other Christian denominations (Table 3.1). 3.2 EDUCATIONAL ATTAINMENT AND LITERACY Tables 3.2.1 and 3.2.2 present the distributions of female and male respondents, respectively, by the highest level of education attained according to selected demographic and socioeconomic character- istics. The results reveal that younger persons have reached higher levels of school than older people. The results also show that the female-male differential in educational attainment is evident in every age group although the gap, particularly in the proportion who have ever attended school, is much greater among older than younger respondents. Generally, urban residents have higher educational attainment than rural residents. For example, 58 percent of females in urban areas have attended at least some secondary school, compared with 33 per- cent of rural residents, and the corresponding figures for males are 52 and 21 percent, respectively.1 1 These figures were attained by adding together three education categories: some secondary, completed secondary, and more than secondary.) 24 | Characteristics of Survey Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Lesotho 2004 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 24.1 1,710 1,761 26.6 743 752 20-24 20.6 1,463 1,456 18.1 507 508 25-29 14.7 1,044 1,026 13.4 374 367 30-34 11.5 816 807 10.9 305 306 35-39 10.3 728 740 8.3 233 226 40-44 10.4 741 714 5.9 164 163 45-49 8.3 592 591 6.1 170 173 50-54 na na na 5.9 164 165 55-59 na na na 4.9 137 137 Marital status Never married 33.4 2,373 2,358 50.7 1,419 1,403 Married 51.6 3,662 3,668 42.2 1,179 1,191 Living together 0.7 47 58 0.4 12 16 Divorced/separated 5.6 401 382 4.4 124 121 Widowed 8.6 613 629 2.2 60 64 Residence Urban 23.7 1,682 1,945 21.5 603 694 Rural 76.3 5,413 5,150 78.5 2,194 2,103 Ecological zone Lowlands 60.6 4,299 3,118 62.0 1,734 1,248 Foothills 11.1 787 999 11.0 307 392 Mountains 22.2 1,572 2,274 20.9 585 877 Senqu River Valley 6.2 437 704 6.1 171 280 District Butha-Buthe 6.5 458 774 6.5 182 304 Leribe 15.0 1,065 845 14.1 393 297 Berea 10.9 776 685 12.5 350 330 Maseru 26.3 1,868 1,059 26.5 741 405 Mafeteng 10.6 755 709 10.6 297 285 Mohale's Hoek 9.6 684 803 10.1 281 331 Quthing 6.5 461 574 6.0 167 200 Qacha's Nek 3.3 233 497 3.6 99 213 Mokhotlong 5.1 360 605 4.6 130 238 Thaba-Tseka 6.1 435 544 5.6 156 194 Education No education 2.0 145 169 17.1 479 549 Primary, incomplete 30.1 2,136 2,244 42.7 1,194 1,165 Primary, complete 27.3 1,936 1,939 12.2 342 333 Secondary+ 40.6 2,878 2,743 28.0 783 750 Religion Roman Catholic Church 44.9 3,187 3,153 46.5 1,300 1,257 Lesotho Evangelical Church 20.3 1,442 1,378 21.6 605 561 Anglican Church 9.7 691 675 9.1 253 264 Other Christian 24.0 1,704 1,813 16.9 473 525 No religion 0.7 52 60 5.6 158 182 Wealth quintile Lowest 13.9 987 1,160 16.7 466 543 Second 18.2 1,294 1,405 18.4 514 553 Middle 17.7 1,258 1,259 20.2 566 551 Fourth 22.5 1,595 1,455 22.2 621 568 Highest 27.6 1,962 1,816 22.5 630 582 Total 100.0 7,095 7,095 100.0 2,797 2,797 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Survey Respondents | 25 Respondents living in the Lowlands are more likely to have a secondary or higher education than respondents from the other zones. Looking at districts, the proportions of respondents with a secondary education are lowest in Thaba-Tseka for both sexes and highest in Mafeteng and Maseru for females and in Maseru for males. As expected, the level of education increases with the wealth index. Among females in the lowest wealth quintile only 12 percent have at least some secondary education, compared with 62 percent of those in the highest quintile. Table 3.2.1 Educational attainment by background characteristics: women Percent distribution of women by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Lesotho 2004 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of women Median years of schooling Age 15-19 0.3 35.8 23.6 37.3 3.0 0.0 100.0 1,710 6.6 20-24 1.2 24.5 28.5 33.9 10.7 1.2 100.0 1,463 6.9 25-29 2.1 25.1 27.3 32.3 11.0 2.4 100.0 1,044 6.8 30-34 2.4 25.1 33.7 29.5 7.8 1.5 100.0 816 6.7 35-39 2.9 25.4 31.7 32.5 6.3 1.3 100.0 728 6.7 40-44 4.4 41.1 27.9 20.7 4.4 1.5 100.0 741 6.2 45-49 4.8 50.7 27.2 12.0 2.3 2.9 100.0 592 5.6 Residence Urban 0.8 17.7 23.8 40.2 14.7 2.8 100.0 1,682 8.1 Rural 2.4 35.6 29.2 27.7 4.2 0.8 100.0 5,413 6.4 Ecological zone Lowlands 1.1 24.5 27.1 36.4 9.2 1.6 100.0 4,299 6.9 Foothills 1.8 39.4 29.9 24.1 3.4 1.4 100.0 787 6.3 Mountains 4.6 45.2 28.9 18.7 2.1 0.5 100.0 1,572 6.0 Senqu River Valley 2.8 34.4 28.1 28.9 5.0 0.8 100.0 437 6.5 District Butha-Buthe 1.7 28.3 29.0 32.3 6.1 2.5 100.0 458 6.7 Leribe 0.8 28.5 29.7 33.9 6.1 1.0 100.0 1,065 6.7 Berea 1.3 33.7 32.6 26.5 4.9 1.0 100.0 776 6.4 Maseru 0.9 22.0 25.9 36.5 12.5 2.2 100.0 1,868 7.1 Mafeteng 1.5 28.5 27.3 37.1 5.0 0.6 100.0 755 6.7 Mohale's Hoek 2.9 37.7 25.0 28.9 4.6 0.8 100.0 684 6.4 Quthing 4.0 41.0 26.4 24.2 3.8 0.7 100.0 461 6.2 Qacha's Nek 5.4 44.9 22.5 23.3 3.2 0.7 100.0 233 6.0 Mokhotlong 6.8 44.0 26.8 18.8 2.5 1.2 100.0 360 6.0 Thaba-Tseka 3.5 45.1 33.4 15.2 2.5 0.3 100.0 435 6.0 Wealth quintile Lowest 6.2 55.7 26.2 11.0 0.9 0.0 100.0 987 5.3 Second 3.7 45.0 32.7 17.2 1.2 0.1 100.0 1,294 6.0 Middle 1.5 33.2 29.8 31.4 3.4 0.7 100.0 1,258 6.5 Fourth 0.7 23.0 31.1 37.9 6.7 0.6 100.0 1,595 6.8 Highest 0.3 15.8 21.7 43.0 15.4 3.7 100.0 1,962 8.2 Total 2.0 31.4 27.9 30.6 6.7 1.3 100.0 7,095 6.6 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level 26 | Characteristics of Survey Respondents Table 3.2.2 Educational attainment by background characteristics: men Percent distribution of men by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Lesotho 2004 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of men Median years of schooling Age 15-19 4.3 55.9 11.8 25.7 2.0 0.3 100.0 743 5.4 20-24 12.9 34.0 18.6 24.4 8.0 2.2 100.0 507 6.2 25-29 18.5 33.3 12.4 20.5 11.2 4.1 100.0 374 5.8 30-34 22.1 38.3 16.1 12.6 8.1 2.8 100.0 305 4.8 35-39 18.4 41.5 13.0 16.4 5.7 5.0 100.0 233 4.5 40-44 23.3 37.6 15.1 15.2 7.0 1.8 100.0 164 3.8 45-49 34.7 33.9 6.8 5.8 7.0 11.8 100.0 170 2.6 50-54 36.7 42.9 4.0 10.5 4.4 1.5 100.0 164 2.0 55-59 32.3 57.2 1.6 2.9 4.1 1.9 100.0 137 1.4 Residence Urban 5.6 26.3 15.8 30.5 14.0 7.7 100.0 603 7.3 Rural 20.3 47.2 11.7 15.5 4.0 1.4 100.0 2,194 4.3 Ecological zone Lowlands 9.6 41.0 14.3 23.3 8.1 3.7 100.0 1,734 5.9 Foothills 19.4 53.1 9.4 14.0 2.9 1.3 100.0 307 3.7 Mountains 37.0 42.2 8.4 8.3 2.9 1.2 100.0 585 2.5 Senqu River Valley 20.9 42.5 15.4 16.7 3.5 0.9 100.0 171 5.0 District Butha-Buthe 12.3 45.1 14.6 21.1 4.6 2.3 100.0 182 5.4 Leribe 13.2 41.5 11.7 18.9 11.8 2.8 100.0 393 5.6 Berea 13.1 52.1 13.0 16.6 4.2 1.0 100.0 350 4.7 Maseru 10.9 34.3 13.5 25.6 9.6 6.1 100.0 741 6.3 Mafeteng 14.2 49.7 14.3 19.8 1.9 0.1 100.0 297 4.4 Mohale's Hoek 23.1 43.5 12.3 15.7 3.7 1.7 100.0 281 4.1 Quthing 28.6 43.7 10.7 12.6 3.8 0.5 100.0 167 3.8 Qacha's Nek 24.2 53.1 6.6 11.9 3.6 0.6 100.0 99 3.6 Mokhotlong 33.7 38.0 9.2 14.7 2.7 1.7 100.0 130 3.4 Thaba-Tseka 35.0 42.5 13.2 5.6 1.0 2.7 100.0 156 2.8 Wealth quintile Lowest 43.2 46.1 6.7 3.1 0.5 0.4 100.0 466 1.2 Second 22.5 56.0 10.2 9.3 2.0 0.0 100.0 514 3.4 Middle 14.6 49.1 15.4 16.1 3.8 1.0 100.0 566 5.0 Fourth 8.4 39.2 18.0 26.2 7.4 0.8 100.0 621 6.1 Highest 4.2 26.9 11.1 33.0 14.5 10.2 100.0 630 8.1 Total 17.1 42.7 12.6 18.7 6.1 2.7 100.0 2,797 5.0 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level The 2004 LDHS interviewers asked respondents to read a simple, short sentence to establish literacy. The sentences were written in Sesotho and English (for those who were interviewed in English). Tables 3.3.1 and 3.3.2 show the percent distributions of female and male respondents, respectively, by level of literacy and the percent literate, according to background characteristics. Characteristics of Survey Respondents | 27 Table 3.3.1 Literacy: women Percent distribution of women by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Lesotho 2004 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Missing Total Number of women Percent literate1 Age 15-19 40.3 51.0 5.3 2.5 0.0 0.8 100.0 1,710 96.6 20-24 45.8 45.3 4.4 3.9 0.1 0.6 100.0 1,463 95.5 25-29 45.6 45.2 5.3 3.5 0.0 0.4 100.0 1,044 96.1 30-34 38.8 51.1 5.5 4.2 0.1 0.3 100.0 816 95.4 35-39 40.1 50.7 4.5 4.3 0.1 0.3 100.0 728 95.3 40-44 26.6 58.4 6.7 7.9 0.1 0.3 100.0 741 91.7 45-49 17.3 65.3 6.7 10.1 0.0 0.6 100.0 592 89.2 Residence Urban 57.7 38.2 1.9 1.9 0.0 0.3 100.0 1,682 97.8 Rural 32.8 54.9 6.4 5.3 0.1 0.6 100.0 5,413 94.0 Ecological zone Lowlands 47.2 45.8 3.4 3.0 0.0 0.5 100.0 4,299 96.5 Foothills 28.9 58.3 8.0 4.4 0.0 0.4 100.0 787 95.2 Mountains 21.3 59.9 9.4 8.7 0.2 0.5 100.0 1,572 90.7 Senqu River Valley 34.6 55.4 4.2 4.9 0.0 0.8 100.0 437 94.3 District Butha-Buthe 41.0 52.4 2.7 3.6 0.0 0.3 100.0 458 96.1 Leribe 41.0 51.7 4.5 2.3 0.0 0.5 100.0 1,065 97.1 Berea 32.4 57.8 4.1 4.5 0.2 0.9 100.0 776 94.4 Maseru 51.2 39.5 6.0 3.0 0.0 0.3 100.0 1,868 96.7 Mafeteng 42.6 49.3 4.9 3.2 0.0 0.0 100.0 755 96.8 Mohale's Hoek 34.4 56.9 3.4 4.3 0.0 1.0 100.0 684 94.7 Quthing 28.7 57.2 6.0 7.0 0.2 0.9 100.0 461 91.9 Qacha's Nek 27.3 47.3 15.4 8.8 0.7 0.5 100.0 233 90.0 Mokhotlong 22.4 60.9 6.3 9.7 0.0 0.5 100.0 360 89.7 Thaba-Tseka 18.1 64.7 5.9 10.9 0.0 0.5 100.0 435 88.6 Wealth quintile Lowest 11.9 64.4 11.4 11.6 0.2 0.5 100.0 987 87.7 Second 18.5 63.6 9.7 7.9 0.0 0.3 100.0 1,294 91.8 Middle 35.5 55.6 4.4 3.7 0.2 0.5 100.0 1,258 95.5 Fourth 45.2 49.0 2.7 2.2 0.0 0.9 100.0 1,595 96.9 Highest 62.1 34.3 2.1 1.1 0.0 0.3 100.0 1,962 98.5 Total 38.7 50.9 5.3 4.5 0.1 0.5 100.0 7,095 94.9 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence The literacy rate is higher for females (95 percent) than for males (75 percent). This pattern is not unexpected in view of the generally higher educational attainment of females than males. Looking at other differentials, the literacy rate decreases with increasing age, particularly among male respondents. Among female respondents, there are relatively minor differences in literacy rates by residence, with urban females only slightly more likely to be able to read than rural females (98 and 94 percent, respectively). Among male respondents, the residential differential is more pronounced, with the literacy rate for urban males (91 percent) being 20 percentage points higher than the rate for rural males. Literacy rates rise with increasing wealth, with variations being more significant for males than for females. 28 | Characteristics of Survey Respondents Table 3.3.2 Literacy: men Percent distribution of men by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Lesotho 2004 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Missing Total Number of men Percent literate1 Age 15-19 28.0 48.9 8.9 13.6 0.0 0.6 100.0 743 85.8 20-24 34.6 36.4 6.8 21.0 0.3 1.0 100.0 507 77.7 25-29 35.8 32.5 5.2 26.6 0.0 0.0 100.0 374 73.4 30-34 23.5 36.8 8.1 31.4 0.0 0.2 100.0 305 68.4 35-39 27.1 36.1 11.5 25.4 0.0 0.0 100.0 233 74.6 40-44 24.0 42.5 6.8 26.7 0.0 0.0 100.0 164 73.3 45-49 24.6 30.2 10.3 34.9 0.0 0.0 100.0 170 65.1 50-54 16.4 39.5 7.4 36.3 0.5 0.0 100.0 164 63.3 55-59 8.9 45.0 5.1 41.0 0.0 0.0 100.0 137 59.0 Residence Urban 52.3 34.3 4.4 8.8 0.0 0.2 100.0 603 91.0 Rural 20.9 41.3 8.7 28.6 0.1 0.4 100.0 2,194 70.9 Ecological zone Lowlands 35.1 41.3 7.5 15.6 0.1 0.4 100.0 1,734 83.9 Foothills 18.1 40.9 10.5 30.0 0.0 0.5 100.0 307 69.5 Mountains 12.4 32.4 7.5 47.4 0.1 0.3 100.0 585 52.2 Senqu River Valley 21.1 47.9 7.2 23.8 0.0 0.0 100.0 171 76.2 District Butha-Buthe 28.0 47.8 6.3 17.9 0.0 0.0 100.0 182 82.1 Leribe 33.5 38.5 10.6 16.4 0.0 1.1 100.0 393 82.6 Berea 21.8 47.1 6.7 24.2 0.0 0.1 100.0 350 75.7 Maseru 41.2 32.2 8.4 17.7 0.0 0.4 100.0 741 81.9 Mafeteng 21.7 44.2 8.0 25.3 0.5 0.3 100.0 297 73.9 Mohale's Hoek 21.1 47.3 6.1 25.4 0.0 0.0 100.0 281 74.6 Quthing 17.0 40.9 7.1 34.3 0.0 0.5 100.0 167 65.1 Qacha's Nek 16.1 32.5 15.5 35.2 0.8 0.0 100.0 99 64.1 Mokhotlong 19.1 33.4 3.7 43.1 0.0 0.6 100.0 130 56.3 Thaba-Tseka 9.4 39.8 4.1 46.7 0.0 0.0 100.0 156 53.3 Wealth quintile Lowest 4.0 32.2 9.1 54.5 0.0 0.2 100.0 466 45.3 Second 11.4 45.3 8.5 34.6 0.1 0.2 100.0 514 65.1 Middle 20.9 49.3 9.4 20.2 0.0 0.3 100.0 566 79.5 Fourth 34.4 42.4 8.0 14.5 0.2 0.5 100.0 621 84.8 Highest 57.7 29.8 4.8 6.9 0.0 0.7 100.0 630 92.4 Total 27.6 39.8 7.8 24.3 0.1 0.4 100.0 2,797 75.2 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Survey Respondents | 29 3.3 ACCESS TO MASS MEDIA Mass media access is essential in increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behaviour. In the survey, exposure to media was assessed by asking respondents how often they read newspapers, watched television, or listened to a radio. Tables 3.4.1 and 3.4.2 show the percentage of female and male respondents exposed to different types of mass media by various background characteristics such as age, residence, education, and wealth index. This information is important in helping to identify population groups that are more commonly reached by mass media for purposes of assisting health, poverty alleviation, HIV/AIDS, and other development programmes to spread information more efficiently. Table 3.4.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Lesotho 2004 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number of women Age 15-19 15.3 16.3 52.0 5.6 43.1 1,710 20-24 13.9 12.0 51.2 3.3 45.1 1,463 25-29 13.5 16.0 56.3 5.3 40.0 1,044 30-34 13.6 14.7 62.0 3.4 34.9 816 35-39 13.5 13.4 58.8 3.9 37.4 728 40-44 11.5 13.8 54.4 3.1 43.6 741 45-49 10.0 10.4 49.0 2.8 48.6 592 Residence Urban 22.2 34.6 74.1 10.8 20.2 1,682 Rural 10.8 7.8 48.2 2.1 48.8 5,413 Ecological zone Lowlands 17.3 21.3 66.3 6.1 29.3 4,299 Foothills 9.2 5.4 48.0 1.7 49.9 787 Mountains 6.5 1.8 28.1 0.8 69.4 1,572 Senqu River Valley 9.3 4.2 41.6 1.3 55.1 437 District Butha-Buthe 15.9 8.8 57.0 3.3 38.8 458 Leribe 14.1 16.1 58.1 4.7 38.4 1,065 Berea 18.3 13.4 59.7 4.0 35.0 776 Maseru 17.6 26.1 67.8 7.7 28.0 1,868 Mafeteng 12.7 11.7 59.3 3.6 38.0 755 Mohale's Hoek 8.2 11.3 52.1 2.2 45.0 684 Quthing 8.9 3.1 37.9 1.1 59.1 461 Qacha's Nek 8.1 3.7 33.4 1.2 63.8 233 Mokhotlong 10.4 2.0 31.9 1.2 65.1 360 Thaba-Tseka 3.7 0.9 16.7 0.3 81.0 435 Education No education 0.0 0.1 22.7 0.0 77.3 145 Primary, incomplete 5.0 5.3 36.2 0.7 61.1 2,136 Primary, complete 9.7 8.7 51.7 1.3 44.9 1,936 Secondary+ 23.1 25.1 71.2 8.8 24.2 2,878 Wealth quintile Lowest 4.6 1.0 10.5 0.3 86.2 987 Second 6.9 2.4 31.0 0.2 65.4 1,294 Middle 8.0 4.0 48.7 0.7 49.0 1,258 Fourth 14.0 7.1 67.9 1.7 29.4 1,595 Highest 25.5 40.8 84.4 12.9 10.3 1,962 Total 13.5 14.1 54.3 4.2 42.1 7,095 30 | Characteristics of Survey Respondents Table 3.4.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Lesotho 2004 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number of men Age 15-19 12.7 20.2 52.2 6.1 43.5 743 20-24 16.3 21.6 58.9 7.9 37.1 507 25-29 20.3 24.2 58.3 9.1 35.5 374 30-34 14.8 21.4 53.0 7.2 42.9 305 35-39 19.3 23.3 61.3 11.9 35.1 233 40-44 22.0 17.9 57.0 10.5 40.2 164 45-49 21.1 23.4 54.4 14.2 44.3 170 50-54 15.0 20.5 54.5 10.2 44.6 164 55-59 15.5 11.9 48.7 3.0 48.0 137 Residence Urban 34.0 46.0 77.7 21.2 16.2 603 Rural 11.7 14.2 49.4 4.7 47.4 2,194 Ecological zone Lowlands 21.2 30.0 66.6 11.7 28.7 1,734 Foothills 11.5 8.4 48.9 2.8 48.4 307 Mountains 7.5 4.9 28.9 2.4 68.7 585 Senqu River Valley 8.4 8.0 45.3 3.2 52.2 171 District Butha-Buthe 16.8 18.4 62.2 7.0 34.3 182 Leribe 20.7 26.5 60.3 12.2 36.8 393 Berea 16.0 24.2 57.2 7.0 37.2 350 Maseru 25.1 32.2 68.8 14.9 27.0 741 Mafeteng 10.7 15.6 52.4 3.6 42.3 297 Mohale's Hoek 9.7 20.0 56.2 4.4 40.1 281 Quthing 9.9 3.9 39.6 1.9 58.0 167 Qacha's Nek 13.0 8.1 35.4 3.2 61.3 99 Mokhotlong 7.8 5.3 35.3 2.9 62.3 130 Thaba-Tseka 5.6 1.9 19.3 1.3 78.5 156 Education No education 0.7 5.4 30.3 0.0 68.7 479 Primary, incomplete 6.4 13.7 47.3 2.3 49.2 1,194 Primary, complete 18.4 20.1 64.7 7.3 32.3 342 Secondary+ 40.7 42.2 79.2 22.8 14.1 783 Wealth quintile Lowest 2.5 3.3 15.7 0.6 82.3 466 Second 7.3 7.8 41.0 1.0 55.3 514 Middle 11.1 12.7 54.5 4.6 41.1 566 Fourth 16.7 20.9 66.4 4.4 28.7 621 Highest 39.1 52.6 86.8 27.0 9.3 630 Total 16.5 21.0 55.5 8.3 40.6 2,797 Radio has the widest audience, with 54 percent of females and and 56 percent of males saying they listen to the radio at least once a week (Figure 3.1). In comparison, 14 percent of females and 21 percent of males, watch television at least once a week and 14 percent of females and 17 percent of males report they read a newspaper or a magazine weekly. Nearly identical percentages of females and males are not exposed to any type of media on a regular basis (42 and 41 percent, respectively). Only 4 percent of women and 8 percent of men are exposed to all three of these media sources weekly. The data show that there are relatively large differences for both sexes in the proportions having access to media by residence. For example, urban residents are much more likely to have been exposed to some form of media than rural residents for both sexes. Considering other residential categories, exposure to media is most common in the Lowlands zone and in Maseru district. The proportion with access to media increases with increasing education level and wealth of respondents. Characteristics of Survey Respondents | 31 3.4 EMPLOYMENT 3.4.1 Employment Status The 2004 LDHS asked respondents whether they were employed at the time of the survey and, if not, whether they were employed in the 12 months preceding the survey. Tables 3.5.1 and 3.5.2 show that 38 percent of women and 32 percent of men are currently employed and that 6 percent of women and 14 percent of men were not working at the time of the survey but had been employed at some point in the 12 months preceding the survey. The proportion of women currently employed increases with age up to age group 25-29 and, for men, it increases up to age group 35-39 before falling somewhat at older ages. Women who are divorced, separated, or widowed are most likely to be employed (51 percent), followed by those who are married (43 percent). In contrast, married men are somewhat more likely to be employed than divorced, separated, or widowed men. Urban residents are more likely to be currently employed than rural residents. Looking at the pattern by district, the percentages currently employed are highest for both sexes in Maseru (48 and 39 percent, respectively). Mokhotlong has the lowest percentage of women currently employed (27 per- cent), and the percentage of currently employed men is lowest in Butha-Buthe and Quthing (22 and 21 percent respectively). The proportion currently employed is higher in men with no education (36 percent) and in women who have attended or completed secondary education or higher (42 percent). The proportion currently employed generally increases as the wealth index increases, with those in the highest wealth quintile much more likely to be currently employed than individuals in the bottom four quintiles. 14 14 54 4 17 21 56 8 Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media Women Men Figure 3.1 Access to Mass Media LDHS 2004 32 | Characteristics of Survey Respondents Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Lesotho 2004 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of respondents Age 15-19 15.3 3.4 81.3 0.0 100.0 1,710 20-24 33.9 8.1 58.0 0.0 100.0 1,463 25-29 50.0 9.9 40.0 0.0 100.0 1,044 30-34 48.2 5.8 46.0 0.0 100.0 816 35-39 50.8 6.8 42.0 0.3 100.0 728 40-44 49.8 6.2 44.0 0.0 100.0 741 45-49 52.5 5.5 42.0 0.0 100.0 592 Marital status Never married 26.3 5.5 68.2 0.0 100.0 2,373 Married or living together 42.6 6.5 50.8 0.0 100.0 3,709 Divorced/separated/widowed 51.4 8.1 40.4 0.1 100.0 1,014 Number of living children 0 26.4 5.3 68.3 0.0 100.0 2,386 1-2 43.7 7.8 48.6 0.0 100.0 2,563 3-4 47.5 6.3 46.2 0.0 100.0 1,327 5+ 42.1 5.6 52.0 0.3 100.0 820 Residence Urban 55.0 7.4 37.7 0.0 100.0 1,682 Rural 33.2 6.1 60.6 0.0 100.0 5,413 Ecological zone Lowlands 41.4 6.7 51.8 0.0 100.0 4,299 Foothills 32.3 4.5 63.1 0.1 100.0 787 Mountains 34.2 6.6 59.2 0.0 100.0 1,572 Senqu River Valley 34.3 6.1 59.5 0.0 100.0 437 District Butha-Buthe 29.7 4.1 66.1 0.0 100.0 458 Leribe 42.5 4.3 53.1 0.1 100.0 1,065 Berea 34.6 9.8 55.5 0.0 100.0 776 Maseru 47.8 7.3 45.0 0.0 100.0 1,868 Mafeteng 33.2 3.0 63.8 0.0 100.0 755 Mohale's Hoek 33.3 8.5 58.1 0.2 100.0 684 Quthing 31.8 5.5 62.7 0.0 100.0 461 Qacha's Nek 31.8 10.6 57.6 0.0 100.0 233 Mokhotlong 27.3 7.1 65.6 0.0 100.0 360 Thaba-Tseka 40.8 5.2 54.0 0.0 100.0 435 Education No education 34.4 7.5 57.2 0.9 100.0 145 Primary, incomplete 35.3 5.4 59.2 0.0 100.0 2,136 Primary, complete 37.5 7.5 55.0 0.0 100.0 1,936 Secondary+ 41.5 6.4 52.1 0.0 100.0 2,878 Wealth quintile Lowest 31.5 6.7 61.9 0.0 100.0 987 Second 31.5 6.1 62.2 0.1 100.0 1,294 Middle 32.2 7.2 60.5 0.1 100.0 1,258 Fourth 36.3 6.6 57.1 0.0 100.0 1,595 Highest 52.1 5.9 42.1 0.0 100.0 1,962 Total 38.4 6.4 55.1 0.0 100.0 7,095 Characteristics of Survey Respondents | 33 Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Lesotho 2004 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 13.5 7.0 77.0 2.6 100.0 743 20-24 30.3 11.9 56.5 1.3 100.0 507 25-29 39.4 23.5 36.5 0.6 100.0 374 30-34 42.4 19.8 33.7 4.2 100.0 305 35-39 52.4 12.4 34.4 0.8 100.0 233 40-44 41.1 17.1 40.0 1.8 100.0 164 45-49 47.9 13.2 37.2 1.7 100.0 170 50-54 32.0 20.4 47.5 0.1 100.0 164 55-59 32.4 15.4 51.4 0.7 100.0 137 Marital status Never married 22.4 10.4 65.0 2.2 100.0 1,419 Married or living together 43.2 17.6 38.0 1.2 100.0 1,191 Divorced/separated/widowed 35.5 20.6 41.9 2.0 100.0 184 Number of living children 0 24.3 11.2 62.5 1.9 100.0 1,561 1-2 44.1 16.3 37.7 1.9 100.0 635 3-4 42.4 20.5 35.3 1.8 100.0 359 5+ 35.4 17.3 46.8 0.4 100.0 242 Residence Urban 44.1 14.1 40.0 1.8 100.0 603 Rural 28.8 14.1 55.3 1.8 100.0 2,194 District Butha-Buthe 22.2 20.0 55.5 2.2 100.0 182 Leribe 35.8 15.3 47.9 1.0 100.0 393 Berea 37.7 13.0 47.5 1.9 100.0 350 Maseru 39.1 12.7 45.4 2.7 100.0 741 Mafeteng 26.9 9.2 63.6 0.2 100.0 297 Mohale's Hoek 25.2 14.8 59.0 1.0 100.0 281 Quthing 20.6 12.1 66.2 1.1 100.0 167 Qacha's Nek 38.2 25.6 35.2 1.0 100.0 99 Mokhotlong 27.0 22.2 49.5 1.4 100.0 130 Thaba-Tseka 23.3 9.4 63.2 4.0 100.0 156 Education No education 35.7 18.5 43.4 2.4 100.0 479 Primary, incomplete 30.4 13.6 54.1 1.9 100.0 1,194 Primary, complete 33.8 12.8 51.0 2.4 100.0 342 Secondary+ 31.8 12.7 54.6 0.9 100.0 783 Wealth quintile Lowest 27.3 19.3 51.9 1.5 100.0 466 Second 26.6 13.2 58.1 2.1 100.0 514 Middle 30.0 16.5 52.2 1.3 100.0 566 Fourth 30.4 14.4 52.9 2.4 100.0 621 Highest 43.7 8.6 46.2 1.4 100.0 630 Total 32.1 14.1 52.0 1.8 100.0 2,797 34 | Characteristics of Survey Respondents 3.4.2 Occupation The distributions of women and men employed in the 12 months preceding the survey by occu- pation are shown in Tables 3.6.1 and 3.6.2. One in three working women and almost four in ten working men are engaged in agricultural occupations. Among both women and men, the next most common occupation is skilled manual labour (27 and 32 percent, respectively). The sales and service sector is the third most common occupation category, engaging 18 percent of women and 12 percent of men. Ten percent of employed women do domestic work, and 7 percent work in professional, technical, or managerial fields. Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2004 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of women Age 15-19 1.9 0.6 13.1 9.7 7.1 27.9 39.7 100.0 320 20-24 3.5 3.1 17.8 33.9 2.5 11.2 28.0 100.0 614 25-29 7.0 4.5 15.1 37.7 1.8 9.0 24.9 100.0 626 30-34 8.2 3.4 17.7 29.4 1.6 8.0 31.6 100.0 441 35-39 7.8 2.8 21.6 25.8 5.8 4.2 32.1 100.0 420 40-44 11.8 1.3 21.8 19.1 2.0 4.2 39.7 100.0 415 45-49 7.4 4.9 18.4 19.3 2.6 7.2 40.2 100.0 344 Marital status Never married 5.3 4.5 17.9 31.1 3.6 19.3 18.2 100.0 755 Married or living together 7.1 2.8 16.7 26.0 2.7 5.4 39.2 100.0 1,822 Divorced/separated/widowed 7.5 2.1 21.5 24.8 3.5 10.7 29.9 100.0 603 Number of living children 0 5.3 4.3 16.2 29.7 3.9 18.0 22.5 100.0 757 1-2 7.2 3.2 19.6 32.0 2.1 8.1 27.8 100.0 1,318 3-4 8.3 2.6 16.9 23.0 3.5 6.8 38.8 100.0 714 5+ 5.2 1.2 17.0 12.4 3.8 4.8 55.8 100.0 391 Residence Urban 7.9 6.1 22.4 48.1 2.4 10.3 2.9 100.0 1,048 Rural 6.2 1.6 15.7 16.7 3.4 9.5 47.0 100.0 2,132 Ecological zone Lowlands 6.9 3.8 19.6 35.0 2.2 9.9 22.6 100.0 2,071 Foothills 7.9 1.4 13.4 14.0 5.7 9.8 47.7 100.0 290 Mountains 6.4 1.0 14.9 11.7 4.3 9.5 52.2 100.0 642 Senqu River Valley 4.3 4.5 15.8 11.0 4.3 9.2 50.8 100.0 177 District Butha-Buthe 13.0 2.5 24.2 12.1 4.2 11.9 32.1 100.0 155 Leribe 5.6 1.4 17.8 31.1 2.1 6.9 35.1 100.0 499 Berea 7.6 3.0 14.3 23.4 2.1 12.8 36.8 100.0 345 Maseru 6.8 4.4 21.4 43.8 2.0 8.6 13.0 100.0 1,028 Mafeteng 6.5 3.5 14.9 20.3 5.1 10.0 39.7 100.0 273 Mohale's Hoek 4.2 3.0 18.2 12.3 4.7 12.7 44.9 100.0 285 Quthing 3.8 4.5 14.9 11.5 4.4 7.4 53.4 100.0 172 Qacha's Nek 8.8 1.9 19.3 9.3 2.8 14.1 43.8 100.0 99 Mokhotlong 10.5 1.5 17.0 10.4 4.2 16.3 40.0 100.0 124 Thaba-Tseka 6.0 0.5 7.6 11.4 4.7 7.0 62.7 100.0 200 Education No education 1.6 0.2 13.6 11.0 2.9 9.3 61.4 100.0 61 Primary, incomplete 0.8 0.4 13.7 15.5 4.5 13.8 51.2 100.0 870 Primary, complete 1.3 0.8 16.3 29.6 2.7 14.0 35.5 100.0 871 Secondary+ 14.2 6.3 21.7 33.4 2.4 4.5 17.5 100.0 1,378 Wealth quintile Lowest 3.1 0.2 9.7 10.7 4.2 8.5 63.7 100.0 376 Second 2.9 0.2 13.8 14.1 5.0 10.8 53.2 100.0 487 Middle 4.8 1.7 15.2 20.5 3.6 10.3 43.9 100.0 496 Fourth 6.0 1.9 19.2 31.8 3.4 7.6 30.1 100.0 685 Highest 10.9 6.5 22.7 37.9 1.4 10.8 9.7 100.0 1,136 Total 6.7 3.1 17.9 27.0 3.1 9.7 32.5 100.0 3,180 Characteristics of Survey Respondents | 35 Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2004 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of men Age 15-19 3.4 1.4 4.7 3.1 13.1 0.1 74.3 100.0 152 20-24 4.6 1.8 8.2 18.6 13.5 1.6 51.6 100.0 214 25-29 5.6 5.8 15.8 36.4 7.9 0.1 28.5 100.0 235 30-34 4.6 6.0 14.7 44.6 6.4 0.1 23.7 100.0 189 35-39 11.2 5.0 17.3 42.2 3.3 0.6 20.3 100.0 151 40-44 6.2 2.4 21.5 37.3 0.0 0.0 32.6 100.0 95 45-49 19.2 0.7 3.7 40.9 9.0 0.0 26.5 100.0 104 50-54 8.0 1.4 12.1 36.5 3.2 0.9 38.0 100.0 86 55-59 2.3 1.4 9.0 33.2 1.0 0.0 53.2 100.0 66 Marital status Never married 4.7 3.3 8.7 17.4 11.2 1.0 53.6 100.0 465 Married or living together 8.5 2.8 15.5 39.9 5.6 0.0 27.5 100.0 724 Divorced/separated/widowed 3.9 7.5 3.3 38.0 4.2 0.7 42.3 100.0 103 Number of living children 0 4.8 3.2 9.2 20.7 11.5 0.9 49.8 100.0 555 1-2 7.1 5.6 18.2 43.4 3.6 0.0 22.1 100.0 383 3-4 13.2 2.1 11.1 36.6 7.1 0.4 29.6 100.0 226 5+ 2.9 0.0 8.3 35.5 2.7 0.0 50.5 100.0 128 Residence Urban 13.2 7.1 26.1 40.8 6.1 0.1 6.7 100.0 351 Rural 4.4 2.0 6.9 28.3 8.1 0.6 49.8 100.0 942 Ecological zone Lowlands 8.5 4.2 15.0 36.6 8.5 0.4 26.7 100.0 795 Foothills 3.9 2.4 4.0 23.9 6.4 0.7 58.8 100.0 147 Mountains 4.6 1.1 8.4 21.6 4.6 0.4 59.3 100.0 289 Senqu River Valley 1.8 5.6 11.5 33.3 12.3 0.0 35.6 100.0 61 District Butha-Buthe 5.7 1.8 12.8 42.4 4.8 0.0 32.5 100.0 77 Leribe 10.6 2.5 12.9 35.5 5.6 0.5 32.4 100.0 201 Berea 2.9 3.9 7.1 22.2 8.7 0.8 54.3 100.0 177 Maseru 11.2 4.8 18.0 31.6 7.0 0.5 26.9 100.0 385 Mafeteng 0.2 2.0 8.7 33.2 8.6 0.0 47.2 100.0 107 Mohale's Hoek 3.5 5.2 3.0 46.7 12.0 0.0 29.6 100.0 112 Quthing 2.5 5.1 13.5 22.7 16.0 0.0 40.3 100.0 54 Qacha's Nek 1.9 1.0 10.6 22.1 5.0 1.5 58.0 100.0 63 Mokhotlong 5.1 0.4 9.5 25.8 5.0 0.2 53.9 100.0 64 Thaba-Tseka 7.8 0.6 11.3 26.4 4.4 0.3 49.3 100.0 51 Education No education 1.0 0.4 5.0 26.9 5.8 0.4 60.6 100.0 260 Primary, incomplete 2.3 0.7 8.8 30.7 7.2 0.2 50.2 100.0 525 Primary, complete 2.1 8.2 11.3 43.3 6.5 0.9 27.6 100.0 159 Secondary+ 20.1 7.4 22.7 31.3 9.8 0.6 8.0 100.0 349 Wealth quintile Lowest 1.1 0.1 4.7 24.2 6.2 0.0 63.7 100.0 217 Second 4.1 1.2 8.4 25.7 8.3 0.5 51.8 100.0 205 Middle 3.7 3.1 3.4 30.2 7.6 1.7 50.2 100.0 263 Fourth 4.9 4.7 10.6 41.5 10.5 0.1 27.8 100.0 278 Highest 16.3 6.0 27.4 33.1 5.4 0.0 11.8 100.0 330 Total 6.8 3.4 12.1 31.7 7.5 0.4 38.1 100.0 1,293 36 | Characteristics of Survey Respondents Differences by background characteristics show that rural women (47 percent) and men (50 per- cent) are more likely to be employed in agricultural jobs than urban women (3 percent) and men (7 per- cent). In turn, urban residents are more likely than rural residents to be engaged in skilled manual or sales and service occupations. Among women, domestic service is particularly high among never-married (19 percent) and younger respondents age 15-19 (28 percent). 3.4.3 Type of Employer, Form of Earnings, and Continuity of Employment Table 3.7.1 presents the percent distribution of employed women, by type of earnings and em- ployment characteristics, according to type of employment (agricultural or nonagricultural). The data show that slightly more than 60 percent of employed women receive cash for their work, and almost one in three is unpaid. Women are more likely to be paid in kind or not paid at all if they are employed in agricultural activities. Less than half of working women are employed by a nonfamily member, and 38 percent are self-employed. Women are more likely to be self-employed if they are doing agricultural work than if they are engaged in nonagricultural work. Women are also more prone to seasonal work if they are employed in agricultural activities (90 percent) than if they are in non- agricultural occupations (16 percent) and, conversely, continuity of employment is more assured for women who are engaged in nonagricultural work, 74 percent of whom are engaged throughout the year. Table 3.7.1 Type of employment: women Percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Lesotho 2004 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 6.4 85.7 59.9 Cash and in-kind 1.3 3.5 2.8 In-kind only 9.1 2.4 4.6 Not paid 83.2 7.9 32.4 Total 100.0 100.0 100.0 Type of employer Employed by family member 31.5 4.7 13.4 Employed by nonfamily member 13.7 65.0 48.4 Self-employed 54.8 29.9 38.0 Total 100.0 100.0 100.0 Continuity of employment All year 7.6 73.6 52.2 Seasonal 89.5 15.7 39.6 Occasional 2.8 10.3 7.8 Total 100.0 100.0 100.0 Number of respondents 1,032 2,147 3,180 Note: Total includes 15 women with missing information on type of employment who are not shown separately. For the male respondents, questions on the type of employment were somewhat more limited than those for women. For example, men were not asked about the type of employer and the continuity or seasonality of their employment. Table 3.7.2 provides information on the type of earnings and employment patterns for men. Results show that 67 percent of men earn cash for the work they do, and 23 percent are not paid for their work. Characteristics of Survey Respondents | 37 Table 3.7.2 Type of employment: men Percent distribution of men employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or nonagricultural), Lesotho 2004 Type of earnings Agricultural work Nonagricultural work Total Cash only 24.8 88.9 64.5 Cash and in-kind 2.8 2.4 2.6 In-kind only 18.3 1.5 7.9 Not paid 54.1 4.5 23.4 Total 100.0 100.0 100.0 Number of men 492 800 1,293 Note: Total includes 4 men with missing information on type of employment who are not shown separately. 3.4.4 Control Over Earnings and Women’s Contribution to Household Expenditures Women and men who were working and receiving cash earnings were asked who makes the decisions on how their earnings are used. They were also asked what proportion of household expendi- tures is met by their earnings. Table 3.8.1 shows that 70 percent of working women say they decide by themselves how their earnings are used, and an additional 22 percent make the decision jointly with someone else. Table 3.8.2 shows that working men are somewhat less likely than working women to say they alone decide on their own how earnings will be used (57 percent) and somewhat more likely to make these decisions jointly with someone else (28 percent). Only 9 percent of women and 14 percent of men report that the decision on how to use their earnings is made entirely by someone else. Tables 3.8.1 and 3.8.2 also look at how the degree of control over a respondent’s earnings varies by background characteristics. The results generally show that, regardless of background characteristics, the majority of respondents make the decisions on how their cash earnings are used themselves. Married women and men, compared with their unmarried counterparts, are somewhat more likely to involve another person in making the decision. Women and men are more likely to report that someone else makes the decisions about their earnings if they are under age 20 (20 and 35 percent, respectively). The proportions of both women and men in the lowest wealth quintile who report that decisions about the use of their earnings are made by someone are also comparatively high (20 and 23 percent, respectively). Regarding the proportion of household expenditures met by their earnings, 4 percent of working women reported that their earnings supported all household expenditure, and 36 percent reported that their earmings constitute more than half of household expenditures. Younger women and women who are married or living together with their partner are more likely to provide all of the financial support for their households. Seven percent of working men report that their earnings cover all household expenditures. 38 | Characteristics of Survey Respondents Table 3.8.1 Decision on use of earnings and contribution of earnings to household expenditures: women Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Lesotho 2004 Person who decides how earnings are used Proportion of household expenditures met by earnings Background characteristic Self only Jointly1 Someone else only2 Missing Total Almost none/ none Less than half Half or more All Missing Total Number of women Age 15-19 67.3 11.9 20.3 0.5 100.0 8.5 52.6 32.3 6.6 0.0 100.0 160 20-24 68.0 18.7 12.8 0.5 100.0 8.4 48.7 39.6 3.3 0.0 100.0 405 25-29 68.4 23.3 8.3 0.0 100.0 10.8 51.6 34.6 2.6 0.3 100.0 442 30-34 69.0 26.3 4.8 0.0 100.0 10.7 46.4 39.4 3.6 0.0 100.0 286 35-39 70.8 23.6 5.1 0.5 100.0 8.5 51.0 36.8 2.9 0.9 100.0 266 40-44 74.4 19.8 5.8 0.0 100.0 10.9 50.7 34.0 4.5 0.0 100.0 246 45-49 69.9 23.7 6.4 0.0 100.0 9.0 60.1 27.4 3.5 0.0 100.0 187 Marital status Never married 83.8 4.7 11.0 0.6 100.0 8.8 55.0 32.7 3.5 0.0 100.0 569 Married or living together 52.0 38.4 9.5 0.1 100.0 9.8 47.4 38.7 3.8 0.2 100.0 1,025 Divorced/separated/ widowed 94.1 2.3 3.7 0.0 100.0 10.4 54.2 32.1 3.0 0.4 100.0 401 Number of living children 0 75.2 11.4 12.9 0.5 100.0 6.9 52.9 36.0 3.9 0.3 100.0 532 1-2 68.3 24.9 6.8 0.0 100.0 10.6 50.3 35.8 3.1 0.2 100.0 900 3-4 66.3 25.4 8.3 0.0 100.0 10.0 48.8 37.0 4.2 0.0 100.0 406 5+ 65.7 26.6 7.2 0.5 100.0 12.6 53.4 30.2 3.3 0.5 100.0 157 Residence Urban 72.9 21.7 5.1 0.3 100.0 9.5 52.7 34.0 3.8 0.0 100.0 968 Rural 66.3 21.4 12.2 0.1 100.0 9.8 49.2 37.3 3.3 0.4 100.0 1,026 District Butha-Buthe 66.6 22.1 11.4 0.0 100.0 27.1 42.4 29.3 1.2 0.0 100.0 102 Leribe 75.4 17.3 7.4 0.0 100.0 7.3 36.9 51.8 4.0 0.0 100.0 292 Berea 69.9 14.8 15.1 0.2 100.0 5.8 53.1 37.2 3.8 0.0 100.0 202 Maseru 70.0 22.6 7.2 0.3 100.0 10.7 53.8 31.4 4.1 0.0 100.0 861 Mafeteng 60.8 35.1 3.6 0.5 100.0 3.5 58.8 32.0 3.7 2.0 100.0 145 Mohale's Hoek 66.9 22.9 10.1 0.0 100.0 5.5 56.6 34.4 3.5 0.0 100.0 139 Quthing 71.0 21.8 7.2 0.0 100.0 17.9 55.4 21.4 5.4 0.0 100.0 66 Qacha's Nek 75.2 14.8 10.0 0.0 100.0 8.7 50.0 40.1 1.2 0.0 100.0 54 Mokhotlong 69.2 18.6 10.9 1.3 100.0 7.8 52.9 37.5 0.5 1.3 100.0 61 Thaba-Tseka 60.9 20.9 18.2 0.0 100.0 8.3 47.7 43.8 0.2 0.0 100.0 73 Education No education (81.8) (12.7) (5.5) (0.0) (100.0) (15.9) (51.6) (32.5) (0.0) (0.0) (100.0) 19 Primary, incomplete 71.4 16.0 12.4 0.2 100.0 11.7 56.9 27.0 4.0 0.4 100.0 385 Primary, complete 69.5 20.7 9.8 0.0 100.0 9.4 51.2 36.5 2.9 0.0 100.0 532 Secondary+ 68.7 24.1 6.9 0.3 100.0 8.9 48.6 38.4 3.8 0.2 100.0 1,059 Wealth quintile Lowest 63.4 16.9 19.6 0.0 100.0 8.2 53.4 38.2 0.2 0.0 100.0 127 Second 71.1 17.8 10.7 0.4 100.0 15.0 49.0 32.1 3.4 0.4 100.0 210 Middle 63.7 22.2 14.2 0.0 100.0 8.9 50.8 37.1 2.7 0.6 100.0 256 Fourth 68.5 20.9 10.1 0.5 100.0 11.9 49.6 36.7 1.9 0.0 100.0 438 Highest 72.0 23.0 4.9 0.1 100.0 7.9 51.7 35.2 5.0 0.2 100.0 964 Total 69.5 21.5 8.8 0.2 100.0 9.7 50.9 35.7 3.6 0.2 100.0 1,995 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 With husband or someone else 2 Includes husband Characteristics of Survey Respondents | 39 Table 3.8.2 Decision on use of earnings and contribution of earnings to household expenditures: men Percent distribution of men employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Lesotho 2004 Person who decides how earnings are used Proportion of household expenditures met by earnings Background characteristic Self only Jointly1 Someone else only2 Missing Total Almost none/ none Less than half Half or more All Missing Total Number of men Age 15-19 40.1 21.4 35.4 3.1 100.0 11.9 55.1 29.8 0.0 3.1 100.0 47 20-24 64.1 14.2 21.7 0.0 100.0 15.8 52.8 27.6 3.8 0.0 100.0 129 25-29 64.1 24.3 11.6 0.0 100.0 6.9 54.6 35.8 2.7 0.0 100.0 181 30-34 53.6 33.3 13.1 0.0 100.0 9.7 45.9 41.9 2.5 0.0 100.0 154 35-39 53.2 37.9 8.9 0.0 100.0 13.1 36.5 40.8 9.6 0.0 100.0 131 40-44 52.3 34.3 13.4 0.0 100.0 11.3 35.4 36.4 16.9 0.0 100.0 67 45-49 55.3 33.3 11.4 0.0 100.0 6.2 33.4 45.6 14.9 0.0 100.0 73 50-54 60.0 25.3 14.7 0.0 100.0 5.9 38.4 43.0 12.7 0.0 100.0 57 55-59 (53.9) (40.4) (5.8) (0.0) (100.0) (9.0) (26.7) (61.0) (3.2) (0.0) (100.0) 28 Marital status Never married 71.7 9.5 18.2 0.6 100.0 14.6 52.7 29.8 2.3 0.6 100.0 258 Married or living together 46.0 41.1 13.0 0.0 100.0 7.6 40.9 42.4 9.1 0.0 100.0 537 Divorced/separated/ widowed 87.2 1.7 11.1 0.0 100.0 13.8 46.0 37.5 2.6 0.0 100.0 71 Number of living children 0 69.4 13.4 16.8 0.4 100.0 13.5 51.9 31.4 2.7 0.4 100.0 326 1-2 52.3 35.4 12.3 0.0 100.0 5.6 45.7 40.7 8.1 0.0 100.0 312 3-4 45.5 41.1 13.3 0.0 100.0 14.3 31.0 45.1 9.6 0.0 100.0 161 5+ 46.5 38.7 14.8 0.0 100.0 5.9 39.4 44.0 10.7 0.0 100.0 67 Residence Urban 64.1 28.5 7.5 0.0 100.0 8.4 43.5 40.3 7.9 0.0 100.0 323 Rural 52.9 28.4 18.5 0.3 100.0 11.3 45.6 37.0 5.7 0.3 100.0 544 District Butha-Buthe 66.1 21.1 12.8 0.0 100.0 19.0 30.4 47.1 3.5 0.0 100.0 51 Leribe 60.4 26.0 13.7 0.0 100.0 7.1 41.2 44.6 7.1 0.0 100.0 129 Berea 60.7 18.9 18.9 1.5 100.0 6.0 51.1 37.0 4.4 1.5 100.0 94 Maseru 61.6 26.6 11.8 0.0 100.0 11.4 43.7 36.7 8.2 0.0 100.0 291 Mafeteng 42.3 50.4 7.3 0.0 100.0 0.4 56.6 35.4 7.6 0.0 100.0 63 Mohale's Hoek 49.0 36.8 14.1 0.0 100.0 8.0 44.6 40.7 6.6 0.0 100.0 94 Quthing 51.0 33.0 16.0 0.0 100.0 25.0 48.0 24.0 3.0 0.0 100.0 46 Qacha's Nek 56.2 16.3 27.5 0.0 100.0 6.5 50.7 36.2 6.7 0.0 100.0 30 Mokhotlong 42.8 39.4 17.8 0.0 100.0 8.2 50.9 33.5 7.4 0.0 100.0 37 Thaba-Tseka 54.9 18.3 26.8 0.0 100.0 22.4 33.9 42.8 0.9 0.0 100.0 31 Education No education 48.4 30.6 21.0 0.0 100.0 19.3 45.3 31.0 4.4 0.0 100.0 133 Primary, incomplete 56.7 26.7 16.2 0.5 100.0 6.6 46.4 41.0 5.6 0.5 100.0 312 Primary, complete 65.2 15.6 19.2 0.0 100.0 7.4 55.8 30.2 6.6 0.0 100.0 121 Secondary+ 58.0 34.4 7.7 0.0 100.0 11.1 38.6 41.9 8.4 0.0 100.0 300 Wealth quintile Lowest 55.9 21.0 23.1 0.0 100.0 10.7 52.9 30.4 6.0 0.0 100.0 98 Second 50.0 31.8 18.2 0.0 100.0 15.4 38.8 43.3 2.5 0.0 100.0 119 Middle 61.8 21.4 16.8 0.0 100.0 13.7 50.8 30.8 4.7 0.0 100.0 146 Fourth 61.3 28.6 9.4 0.7 100.0 9.4 47.7 39.6 2.7 0.7 100.0 210 Highest 54.9 32.9 12.3 0.0 100.0 6.8 39.5 41.6 12.0 0.0 100.0 294 Total 57.0 28.4 14.4 0.2 100.0 10.2 44.8 38.3 6.5 0.2 100.0 866 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 With husband or someone else 2 Includes wife 40 | Characteristics of Survey Respondents Table 3.9 shows information on how decisions on use of women’s earnings are related to the pro- portional contribution of these earnings to the household expenditures, according to marital status. The analysis indicates that independence in decisionmaking is slightly inversely related to the proportion of women’s contribution to the household expenses. For instance, 62 percent of currently married women whose contribution to household expenditures is minimal decide for themselves how their earnings are used. Only 55 percent of women who support all of their household’s expenses decide for themselves how their earnings are used, and 34 percent share the decision with their husband and 11 percent say that their husband alone makes decisions. Almost all unmarried women (between 87 and 92 percent) make their own decisions regarding their earnings, regardless of their contribution to the household expendi- tures. Table 3.9 Women's control over earnings Percent distribution of women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to current marital status, and the proportion of household expenditures met by earnings, Lesotho 2004 Currently married or living together Not married1 Contribution to household expenditures Self only Jointly with husband Jointly with someone else Husband only Someone else only Missing Total Number of women Self only Jointly with someone else Someone else only Missing Total Number of women Almost none/ none 61.8 33.3 4.1 0.8 0.0 0.0 100.0 101 90.9 0.9 7.5 0.8 100.0 92 Less than half 52.2 35.3 2.0 9.7 0.8 0.0 100.0 486 88.2 3.0 8.4 0.5 100.0 530 Half or more 49.4 37.8 2.4 10.2 0.2 0.0 100.0 397 87.0 6.0 6.9 0.0 100.0 315 All (55.0) (33.9) (0.0) (11.1) (0.0) (0.0) (100.0) 39 (92.0) (0.0) (8.0) (0.0) (100.0) 32 Total 52.0 36.1 2.3 9.1 0.4 0.1 100.0 1,025 88.0 3.7 7.9 0.3 100.0 969 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Never married, divorced, separated, or widowed women 3.5 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the 2004 LDHS collected information from both women and men on other measures of women’s autonomy and status. Questions were asked about women’s roles in making household decisions, on acceptance of wife beating, and on opinions about when a wife should be able to deny sex to her husband. Such information provides insight into women’s control over their environment and their attitudes towards gender roles, both of which are relevant to understanding women’s demographic and health behaviour. 3.5.1 Women’s Participation in Decisionmaking To assess women’s decisionmaking autonomy, the 2004 LDHS sought information on women’s participation in five different types of household decisions: on the respondents’ own health care; on making large household purchases; on making household purchase for daily needs; on visits to family or relatives; and on what food should be cooked each day. Table 3.10 shows the percent distribution of women according to who in the household usually has the final say on each aspect. A woman is considered to have autonomy in a decision if she either makes the decision herself or participates jointly with someone else in the decisions. Among currently married women, the degree of sole decisionmaking ranges from a high of 81 percent in decisions about what food to cook daily to a low 14 percent in decisions about large household purchases. Although 50 percent of married women make decisions on their own health care by Characteristics of Survey Respondents | 41 themselves or jointly, 44 percent of women say that their husband alone makes these decisions. Decisions about visits to relatives or friends are generally made by the woman herself or jointly (61 percent). Unmarried women are generally less autonomous than married women. The proportions of un- married women reporting that decisions are made by someone else ranges from 46 percent in the case of what food to cook to 59 percent in the case of large household purchases. These patterns are not sur- prising because the majority of the unmarried are younger women who still live with their guardians or parents. Table 3.10 Women's participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to current marital status and type of decision, Lesotho 2004 Currently married or living together Not married1 Decision Self only Jointly with hus- band Jointly with some- one else Hus- band only Some- one else only Decision not made/ not applic- able Total Number of respond- ents Self only Jointly with some- one else Some- one else only Decision not made/ not applic- able Total Number of respond- ents Own health care 37.0 12.3 0.8 43.8 6.0 0.1 100.0 3,709 38.8 7.9 52.7 0.5 100.0 3,386 Large household purchases 14.1 29.0 1.4 48.0 7.2 0.3 100.0 3,709 30.3 5.4 59.0 5.1 100.0 3,386 Daily household purchases 67.4 10.1 0.9 14.9 6.3 0.2 100.0 3,709 35.1 5.0 55.7 4.0 100.0 3,386 Visits to family or relatives 24.3 35.1 1.9 31.1 5.6 1.8 100.0 3,709 34.0 7.4 54.2 4.2 100.0 3,386 What food to cook each day 80.5 7.6 0.8 5.6 4.5 0.8 100.0 3,709 44.7 4.7 45.5 4.8 100.0 3,386 1 Never married, divorced, separated, or widowed women Table 3.11 shows that although 30 percent of women have a say in all five areas of decisionmaking, another 23 percent have no say at all in any of the specified areas. Women who are under age 20, have never married, and have no children are least likely to participate in all decisions. Older women, urban residents, and those living in Mafeteng are among the most likely to be involved in all decisions. Cash employment also is related to increased decisionmaking power. More than half (53 per- cent) of women who are employed for cash participate in making all decisions, compared with 31 percent who are employed but do not earn cash and 21 percent of unemployed women. 42 | Characteristics of Survey Respondents Table 3.11 Women's participation in decisionmaking by background characteristics Percentage of women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Lesotho 2004 Alone or jointly have final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives What food to cook each day All specified decisions None of the specified decisions Number of women Age 15-19 22.1 11.5 18.3 17.1 30.1 8.1 59.3 1,710 20-24 40.8 30.3 50.6 41.5 63.9 19.3 25.9 1,463 25-29 58.1 50.8 74.6 64.0 84.4 35.8 9.3 1,044 30-34 63.3 54.8 83.4 72.2 89.7 41.5 6.6 816 35-39 66.4 62.0 85.3 73.4 92.5 50.1 4.7 728 40-44 65.8 60.3 86.8 74.0 93.7 49.4 3.6 741 45-49 62.7 58.0 83.2 74.0 91.4 46.8 3.2 592 Marital status Never married 31.6 17.8 22.3 23.9 33.7 15.8 54.0 2,373 Married or living together 50.1 44.5 78.5 61.3 88.9 27.5 6.6 3,709 Divorced/separated/widowed 82.0 77.7 82.1 82.5 86.2 73.5 9.8 1,014 Number of living children 0 30.7 18.8 27.1 25.4 38.5 15.2 51.0 2,386 1-2 54.9 47.6 71.0 61.2 81.3 33.6 12.3 2,563 3-4 62.9 57.3 85.6 71.8 92.9 44.9 3.9 1,327 5+ 57.0 52.5 81.8 67.3 90.1 39.5 5.1 820 Residence Urban 59.3 52.5 66.0 61.2 72.3 43.7 21.6 1,682 Rural 45.2 36.5 58.4 48.9 69.4 26.0 23.3 5,413 Ecological zone Lowlands 51.2 42.1 61.7 54.9 72.0 32.5 21.4 4,299 Foothills 40.2 38.9 60.0 49.1 71.2 26.2 24.7 787 Mountains 44.2 34.7 57.6 43.2 66.3 24.6 25.5 1,572 Senqu River Valley 53.0 45.2 55.7 57.7 62.7 34.4 24.5 437 District Butha-Buthe 46.3 45.3 67.4 49.8 78.0 31.5 19.1 458 Leribe 46.1 33.7 63.0 52.7 73.8 22.4 18.1 1,065 Berea 36.4 31.2 55.5 44.7 64.4 21.8 29.8 776 Maseru 51.3 47.5 62.6 55.4 70.5 36.4 24.5 1,868 Mafeteng 65.8 49.3 67.6 67.3 81.4 41.7 11.1 755 Mohale's Hoek 42.7 34.8 52.0 46.4 67.7 25.9 25.8 684 Quthing 59.3 48.8 58.2 62.2 61.2 36.8 21.4 461 Qacha's Nek 44.0 35.2 58.7 46.0 63.7 28.1 32.0 233 Mokhotlong 46.0 33.5 54.6 37.6 60.4 22.8 28.5 360 Thaba-Tseka 38.5 29.1 51.5 35.2 65.6 22.8 27.3 435 Education No education 53.3 47.8 69.9 60.0 81.1 37.9 12.2 145 Primary, incomplete 41.7 37.0 59.1 48.6 69.1 25.9 24.4 2,136 Primary, complete 50.9 40.7 63.6 53.5 73.6 30.9 19.7 1,936 Secondary+ 51.7 42.0 58.3 52.8 67.9 32.5 24.5 2,878 Employment Not employed 39.5 30.4 49.3 42.5 61.8 21.4 30.9 4,366 Employed for cash 73.0 64.4 81.4 73.6 86.1 53.2 7.5 1,633 Employed not for cash 47.6 44.0 72.4 56.7 79.6 31.2 13.5 1,081 Wealth quintile Lowest 43.9 37.4 58.2 45.3 69.6 26.8 23.7 987 Second 41.9 35.6 58.0 46.4 69.1 23.8 23.0 1,294 Middle 42.7 33.5 55.5 46.8 68.3 23.4 25.1 1,258 Fourth 50.9 42.2 62.5 56.4 71.6 31.5 21.4 1,595 Highest 56.9 47.7 63.9 58.2 70.8 39.4 22.2 1,962 Total 48.5 40.3 60.2 51.8 70.1 30.2 22.9 7,095 Note: Total includes 15 women with missing information on employment status. Characteristics of Survey Respondents | 43 3.5.2 Women’s Attitudes Towards Wife Beating Violence against women is an area that is increasingly being recognised as affecting women’s health and autonomy. Violence against women has serious consequences for their mental and physical well-being, including their reproductive and sexual health (World Health Organisation, 1999). If violence against women is tolerated and accepted in a society, its eradication is made more difficult. To gauge the acceptability of domestic violence, women and men interviewed in the 2004 LDHS were asked whether they thought a husband would be justified in hitting or beating his wife in each of the following five situa- tions: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses to have sexual relations with him. Tables 3.12.1 and 3.12.2 show that many women and men, respectively, find wife beating to be justified in certain circumstances. Nearly 48 percent of women and 51 percent of men agree that at least one of these factors is sufficient justification for wife-beating. The most widely accepted reasons for wife-beating are neglecting the children (37 percent of women and 38 percent of men) and arguing with the husband (36 percent of women and 39 percent of men). Twenty-four percent of women and 30 percent of men think that going out without informing the husband is a justifiable reason for beating. About one-fifth of women and men feel that denying sex to the husband is a justification for wife beating. Even smaller proportions believe that burning the food is a justifiable reason to hit or beat the wife. The tables also show attitudes towards wife beating by background characteristics. Acceptance of wife beating for at least one of the specified reasons is higher among women and men who are under age 25 than among older individuals. Considering residence, the proportions are higher among women and men who live in rural areas, the Mountains zone, or Qacha’s Nek, Mokhotlong, and Thaba-Tseka districts than among those living in other areas. Acceptance of wife beating declines as the level of education increases. Similarly, acceptance of wife beating by women and men declines markedly as wealth increases. 44 | Characteristics of Survey Respondents Table 3.12.1 Attitude towards wife beating: women Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2004 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number of women Age 15-19 14.7 43.4 29.0 43.0 20.1 56.1 1,710 20-24 11.7 38.7 22.9 39.2 18.4 50.2 1,463 25-29 11.2 32.2 22.1 31.3 18.9 43.2 1,044 30-34 11.8 33.2 23.1 35.4 19.7 44.2 816 35-39 11.3 29.4 21.3 32.2 19.2 41.9 728 40-44 11.7 32.3 21.3 33.1 22.4 45.4 741 45-49 15.7 33.9 27.7 38.3 24.7 47.8 592 Marital status Never married 12.3 36.5 23.0 37.9 15.5 48.8 2,373 Married or living together 12.8 36.7 25.5 37.0 22.8 48.9 3,709 Divorced/separated/widowed 12.7 33.6 23.5 35.6 20.8 45.2 1,014 Number of living children 0 12.4 37.7 24.5 38.9 17.5 50.3 2,386 1-2 11.7 36.2 23.2 35.4 19.4 47.3 2,563 3-4 12.0 31.1 22.2 35.0 20.7 44.2 1,327 5+ 17.1 40.1 30.8 40.3 28.5 52.7 820 Residence Urban 6.4 21.4 12.9 27.3 9.7 34.1 1,682 Rural 14.6 40.8 27.9 40.1 23.3 52.8 5,413 Ecological zone Lowlands 9.7 31.7 19.3 33.4 14.9 43.5 4,299 Foothills 13.7 41.0 28.1 40.2 24.2 53.6 787 Mountains 20.5 47.7 37.1 46.6 32.9 61.0 1,572 Senqu River Valley 11.2 30.2 21.8 33.0 16.9 41.1 437 District Butha-Buthe 13.2 35.9 25.5 38.2 21.0 48.0 458 Leribe 9.8 32.3 20.2 32.6 17.0 44.5 1,065 Berea 10.7 43.1 29.8 43.4 23.7 54.4 776 Maseru 9.3 29.4 17.6 32.9 14.7 43.8 1,868 Mafeteng 10.2 31.9 17.8 28.6 14.0 40.4 755 Mohale's Hoek 17.3 41.7 28.5 41.3 22.6 52.3 684 Quthing 9.6 27.5 18.7 31.1 16.2 37.4 461 Qacha's Nek 17.4 47.6 42.0 50.1 26.6 64.4 233 Mokhotlong 21.3 51.9 43.0 51.2 38.4 64.5 360 Thaba-Tseka 27.0 51.8 38.7 49.4 35.1 64.0 435 Education No education 24.2 45.7 43.2 48.5 39.7 64.5 145 Primary, incomplete 18.6 49.1 35.5 47.2 29.8 60.4 2,136 Primary, complete 12.9 37.9 26.2 38.4 21.7 49.3 1,936 Secondary+ 7.4 25.0 13.9 28.1 10.8 38.0 2,878 Employment Not employed 13.3 39.6 26.4 40.0 21.5 51.7 4,366 Employed for cash 9.0 24.5 17.1 28.1 13.2 37.3 1,633 Employed not for cash 15.5 40.5 27.2 38.8 24.6 51.7 1,081 Number of decisions in which woman has final say1 0 14.5 42.5 29.1 43.0 19.3 55.2 1,623 1-2 14.5 42.2 27.8 42.0 23.7 54.5 1,558 3-4 13.2 37.9 24.4 36.9 22.0 49.7 1,772 5 9.4 25.7 18.2 29.1 16.4 37.6 2,142 Wealth quintile Lowest 23.1 51.9 39.6 50.6 34.8 64.0 987 Second 16.1 46.3 33.4 43.9 28.1 58.8 1,294 Middle 13.6 40.0 25.5 38.7 19.7 51.3 1,258 Fourth 9.5 33.0 19.8 35.3 16.4 45.6 1,595 Highest 7.0 21.8 13.7 26.1 10.6 33.9 1,962 Total 12.6 36.2 24.4 37.1 20.1 48.3 7,095 Note: Total includes 15 women with missing information on employment status. 1 Either by herself or jointly with others Characteristics of Survey Respondents | 45 Table 3.12.2 Attitude towards wife beating: men Percentage of men who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2004 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number of men Age 15-19 17.6 46.1 33.0 45.8 19.4 60.1 743 20-24 13.7 42.8 30.3 40.3 18.0 54.2 507 25-29 9.5 38.0 22.6 32.4 19.1 46.7 374 30-34 9.9 35.0 29.3 35.6 15.1 46.6 305 35-39 11.3 30.5 31.7 33.2 22.0 43.5 233 40-44 12.7 38.0 28.4 34.8 26.8 50.5 164 45-49 9.4 38.3 33.0 37.5 21.8 52.2 170 50-54 11.6 31.4 30.5 31.7 27.7 45.9 164 55-59 8.6 26.2 22.2 28.9 13.6 37.6 137 Marital status Never married 15.8 42.0 29.5 40.1 18.5 54.8 1,419 Married or living together 9.6 35.1 29.6 35.1 19.8 47.0 1,191 Divorced/separated/widowed 11.9 43.8 31.6 41.3 27.8 53.8 184 Number of living children 0 15.2 42.0 29.8 40.2 19.0 54.8 1,561 1-2 8.2 34.8 27.1 34.1 16.9 43.9 635 3-4 11.4 35.4 32.1 36.4 26.8 50.9 359 5+ 12.5 37.3 31.8 36.6 20.1 49.2 242 Residence Urban 6.4 23.7 20.0 25.0 12.6 34.2 603 Rural 14.7 43.3 32.3 41.6 21.5 56.1 2,194 Ecological zone Lowlands 11.9 37.2 27.3 34.9 16.2 47.0 1,734 Foothills 14.2 43.6 31.8 40.9 20.8 58.2 307 Mountains 16.5 45.7 35.8 45.9 30.3 61.9 585 Senqu River Valley 8.6 28.5 29.2 37.8 15.5 47.2 171 District Butha-Buthe 9.0 34.5 24.3 33.0 16.0 46.1 182 Leribe 11.3 39.9 32.1 38.1 20.3 51.1 393 Berea 10.9 45.5 34.9 45.0 14.9 57.0 350 Maseru 9.5 33.7 23.5 29.8 15.5 45.4 741 Mafeteng 15.6 38.3 25.3 34.3 21.5 48.4 297 Mohale's Hoek 22.5 43.9 34.4 45.1 22.4 54.8 281 Quthing 5.8 26.1 27.5 37.6 14.3 44.5 167 Qacha's Nek 14.3 46.5 35.5 50.3 34.4 66.6 99 Mokhotlong 15.4 48.3 39.0 49.0 30.6 58.8 130 Thaba-Tseka 24.3 48.4 37.9 45.0 30.6 65.1 156 Education No education 15.8 44.1 33.1 44.3 25.4 57.4 479 Primary, incomplete 15.5 47.1 36.4 46.0 26.5 60.8 1,194 Primary, complete 15.2 41.1 31.0 36.0 14.7 51.7 342 Secondary+ 6.1 23.0 16.9 23.0 7.7 33.2 783 Employment Not employed 13.5 41.8 31.2 39.3 19.2 53.7 1,895 Employed for cash 10.1 29.5 23.3 30.0 15.6 40.6 587 Employed not for cash 14.6 41.7 32.9 45.9 30.3 58.1 311 Number of decisions in which woman has final say1 0 17.2 46.0 36.6 48.5 29.3 58.8 137 1-2 19.0 54.0 40.3 53.0 29.7 68.5 686 3-4 11.9 40.0 29.1 37.3 18.6 51.1 1,123 5-6 8.6 24.8 20.7 25.2 11.3 36.8 851 Wealth quintile Lowest 17.6 46.9 37.8 48.1 30.2 62.3 466 Second 19.3 48.6 35.6 45.8 25.7 61.7 514 Middle 10.2 40.3 32.5 39.5 19.0 54.3 566 Fourth 11.6 37.6 25.0 34.6 16.6 46.9 621 Highest 7.9 26.1 21.0 26.3 10.3 36.7 630 Total 12.9 39.1 29.7 38.0 19.6 51.4 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others 46 | Characteristics of Survey Respondents 3.5.3 Attitudes Towards Refusing Sex with Husband The extent of control women have over matters such as when and with whom they have sex has important implications for demographic and health outcomes, such as transmission of HIV and other sexually transmitted infections. To measure beliefs about sexual empowerment of women, the 2004 LDHS asked all respondents whether they think a wife is justified in refusing to have sex with her husband in the following circumstances: when she knows that her husband has a sexually transmitted disease, when she knows that her husband has sex with other women, when she has recently given birth, and when she is tired or not in the mood. Tables 3.13.1 and 3.13.2 show the responses of women and men, respectively. Sixty-one percent of women and 41 percent of men agree that all of the above reasons are acceptable justifications for a woman to refuse to have sexual relations with her husband, and 7 percent of women and 11 percent of men consider none of the reasons acceptable. For women and men, the most acceptable reason for a wife to refuse having sex is if the wife has recently given birth (85 and 81 percent, respectively), and the least acceptable reason is the wife being tired or not in the mood (73 and 59 percent, respectively). Women and men age 15-19, those with no children, those who have never married, those living in the Mountains zone, especially Qacha’s Nek district, and those with the least autonomy in making household decisions are the most likely to agree with none of the reasons for refusing sex. Characteristics of Survey Respondents | 47 Table 3.13.1 Attitude towards refusing sex with husband: women Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Lesotho 2004 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number of women Age 15-19 75.6 75.1 78.7 64.9 54.3 13.5 1,710 20-24 82.5 80.2 88.2 77.8 63.4 4.7 1,463 25-29 84.1 83.6 88.5 73.7 61.1 3.9 1,044 30-34 86.4 81.4 87.6 75.1 64.5 4.5 816 35-39 85.6 83.6 86.0 75.6 63.2 3.8 728 40-44 83.6 79.7 86.3 75.0 61.2 5.8 741 45-49 81.4 77.5 84.0 71.0 60.0 8.5 592 Marital status Never married 80.2 79.1 81.2 70.0 59.2 10.5 2,373 Married or living together 82.1 80.0 87.2 73.5 60.4 5.3 3,709 Divorced/separated/widowed 85.0 79.7 86.5 76.0 63.7 5.2 1,014 Number of living children 0 77.9 77.4 80.3 68.1 56.2 11.1 2,386 1-2 84.2 81.5 88.8 76.1 63.9 4.4 2,563 3-4 85.3 82.0 86.9 74.6 61.9 4.6 1,327 5+ 80.5 76.9 84.6 72.4 59.8 7.3 820 Residence Urban 88.2 87.4 88.6 78.1 67.6 3.6 1,682 Rural 79.9 77.3 84.0 71.0 58.2 8.1 5,413 Ecological zone Lowlands 85.7 83.8 87.1 74.9 64.0 5.2 4,299 Foothills 81.6 75.7 85.8 70.3 56.8 6.3 787 Mountains 70.0 69.2 78.2 66.0 49.6 12.4 1,572 Senqu River Valley 87.3 84.4 88.6 79.9 71.0 6.9 437 District Butha-Buthe 82.2 78.6 83.8 70.5 58.5 7.3 458 Leribe 81.9 79.7 82.4 71.6 62.0 8.8 1,065 Berea 84.5 82.4 86.8 72.2 61.6 5.2 776 Maseru 85.6 82.9 86.4 73.7 61.8 4.8 1,868 Mafeteng 83.8 79.9 90.2 73.4 60.4 4.4 755 Mohale's Hoek 83.9 81.0 90.1 77.5 65.2 5.8 684 Quthing 84.3 84.9 86.5 78.9 70.6 8.8 461 Qacha's Nek 60.7 62.5 61.2 61.8 39.2 19.5 233 Mokhotlong 68.9 67.9 81.2 63.5 51.2 14.2 360 Thaba-Tseka 73.7 73.1 82.1 72.5 52.0 7.5 435 Education No education 64.6 60.2 76.2 64.3 42.8 15.6 145 Primary, incomplete 74.3 72.5 80.7 66.3 52.5 11.2 2,136 Primary, complete 82.4 79.2 85.1 72.9 60.1 5.9 1,936 Secondary+ 88.0 86.2 88.8 77.8 67.5 4.2 2,878 Employment Not employed 79.9 77.8 84.4 71.7 59.5 8.4 4,366 Employed for cash 88.2 86.1 86.8 76.2 65.3 3.9 1,633 Employed not for cash 80.2 77.3 85.5 71.5 56.9 6.2 1,081 Number of decisions in which woman has final say1 0 77.4 76.0 80.9 68.7 57.5 11.3 1,623 1-2 78.4 77.3 83.8 70.1 55.7 8.3 1,558 3-4 81.9 79.4 86.3 73.2 59.2 5.3 1,772 5 87.7 84.4 88.2 77.2 67.3 4.3 2,142 Number of reasons wife beating is justified 0 85.0 83.3 86.6 78.4 68.5 6.9 3,665 1-2 79.7 76.7 82.6 68.5 53.0 6.8 1,685 3-4 79.3 76.2 85.2 64.5 50.9 7.0 1,276 5-6 72.1 71.2 82.2 65.4 50.6 8.9 469 Wealth quintile Lowest 71.8 67.4 78.9 65.7 49.7 12.5 987 Second 78.6 76.0 83.9 69.7 55.9 8.2 1,294 Middle 80.2 79.2 84.4 71.3 59.7 7.7 1,258 Fourth 84.8 81.8 87.0 74.3 62.7 6.0 1,595 Highest 87.8 86.9 87.9 77.8 67.5 3.9 1,962 Total 81.9 79.7 85.1 72.7 60.5 7.0 7,095 Note: Total includes 15 women with missing information on employment status. 1 Either by herself or jointly with others 48 | Characteristics of Survey Respondents Table 3.13.2 Attitude towards refusing sex with husband: men Percentage of men who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Lesotho 2004 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number of men Age 15-19 65.5 58.5 72.3 52.8 37.6 18.8 743 20-24 70.6 63.8 84.5 58.2 39.8 8.5 507 25-29 74.7 64.0 84.1 63.1 43.4 7.9 374 30-34 71.2 62.6 83.7 65.6 42.4 7.4 305 35-39 73.0 67.7 85.2 62.2 45.9 7.1 233 40-44 77.5 66.2 83.7 60.3 46.8 8.6 164 45-49 76.1 58.1 83.9 52.5 32.5 10.6 170 50-54 76.9 58.8 80.9 62.4 41.7 5.1 164 55-59 78.2 72.0 84.9 60.7 53.4 10.0 137 Marital status Never married 68.1 60.6 76.7 56.1 39.1 14.5 1,419 Married or living together 75.4 65.3 85.4 61.6 43.8 7.3 1,191 Divorced/separated/widowed 73.1 58.4 84.0 59.9 40.4 7.1 184 Number of living children 0 68.5 60.7 77.6 55.6 39.1 13.7 1,561 1-2 75.7 65.4 87.5 67.4 46.0 5.8 635 3-4 73.7 65.7 83.5 58.7 42.5 9.4 359 5+ 77.4 62.1 81.2 56.3 40.7 8.5 242 Residence Urban 73.6 67.9 83.3 61.6 48.1 9.2 603 Rural 71.0 61.1 80.2 57.9 39.3 11.4 2,194 Ecological zone Lowlands 71.4 63.8 81.8 60.4 42.7 10.1 1,734 Foothills 67.3 58.8 77.3 52.9 36.0 14.8 307 Mountains 70.3 57.0 76.8 52.8 35.0 13.2 585 Senqu River Valley 85.0 75.5 92.4 72.1 57.4 4.3 171 District Butha-Buthe 68.1 60.3 80.3 56.3 37.5 12.1 182 Leribe 70.8 65.2 76.2 57.6 43.4 13.7 393 Berea 74.4 64.9 79.5 60.0 39.2 8.7 350 Maseru 72.3 63.5 81.3 57.9 42.5 10.5 741 Mafeteng 56.2 49.5 80.6 52.9 29.3 16.1 297 Mohale's Hoek 80.2 64.8 88.1 67.6 50.2 5.9 281 Quthing 88.2 78.9 90.4 69.0 59.1 5.2 167 Qacha's Nek 57.4 49.5 67.2 52.2 24.6 19.8 99 Mokhotlong 72.6 61.7 83.3 57.3 44.8 11.3 130 Thaba-Tseka 71.6 61.0 78.9 55.0 33.8 8.7 156 Education No education 68.4 52.5 77.8 53.4 33.3 12.8 479 Primary, incomplete 67.7 61.6 76.2 52.5 37.3 13.7 1,194 Primary, complete 80.9 68.5 86.3 60.8 46.0 6.4 342 Secondary+ 75.2 67.5 87.6 70.6 50.0 7.6 783 Employment Not employed 71.8 62.7 80.3 59.1 40.9 10.8 1,895 Employed for cash 75.6 69.1 86.3 64.4 48.9 7.8 587 Employed not for cash 62.2 49.0 74.5 45.4 28.5 17.1 311 Number of decisions in which woman has final say1 0 57.7 50.4 65.6 41.9 29.1 22.1 137 1-2 71.0 57.9 78.3 55.3 33.5 9.6 686 3-4 73.6 63.5 82.4 58.4 42.9 10.7 1,123 5-6 71.6 67.0 83.5 64.6 47.3 10.5 851 Number of reasons wife beating is justified 0 73.2 65.0 81.3 64.2 48.6 12.6 1,360 1-2 69.8 60.8 78.9 57.3 36.3 10.5 663 3-4 71.2 60.0 81.5 53.3 33.7 7.7 621 5-6 65.9 58.6 83.6 37.7 27.6 11.2 153 Wealth quintile Lowest 71.6 58.3 76.3 53.3 35.4 12.4 466 Second 69.0 58.2 80.0 54.5 36.5 12.5 514 Middle 72.3 64.5 82.0 60.0 43.2 11.7 566 Fourth 71.6 61.5 78.5 58.2 40.6 10.8 621 Highest 72.9 68.5 86.4 65.6 48.2 8.0 630 Total 71.6 62.5 80.9 58.7 41.2 10.9 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others Characteristics of Survey Respondents | 49 Male respondents in the 2004 LDHS were further asked whether they thought that a husband had the right to take specific actions if his wife refused to have sex with him. The specified actions were to get angry and reprimand her, to refuse to give her money or other means of financial support, to use force and have sex with her even if she does not want to, and to have sex with another woman. Table 3.14 presents the results. Data show that 56 percent of men think that the husband has the right to get angry and reprimand his wife if she refuses to have sex with him. Eighteen percent of men think that a husband has the right to refuse giving money or other means of financial support to his wife if she refuses to have sex, and an equal proportion think that a husband has the right to have sex with another woman if wife refuse to have sex with him. Twelve percent of men believe that a husband has the right to use force to have sex with his wife if she refuses to have sex with him. 50 | Characteristics of Survey Respondents Table 3.14 Reprimanding for refusing sex with husband Percentage of men who believe that if a woman refuses to have sex with her husband when he wants to, he has the right to reprimand her, by background characteristics, Lesotho 2004 Percent that think if a woman refuses sex with husband, the husband has the right to: Background characteristic Get angry and reprimand her Refuse to give her money or other means of financial support Use force and have sex with her even is she doesn't want to Have sex with another woman Number of men Age 15-19 51.0 17.6 12.3 13.7 743 20-24 58.2 18.1 11.0 19.1 507 25-29 56.0 12.4 9.6 20.0 374 30-34 58.2 15.1 12.0 18.7 305 35-39 61.0 18.3 13.1 16.2 233 40-44 52.5 18.5 13.4 22.8 164 45-49 65.3 23.1 18.6 21.0 170 50-54 66.3 24.3 16.0 18.8 164 55-59 49.8 16.4 11.6 14.3 137 Marital status Never married 53.1 15.8 10.9 16.8 1,419 Married or living together 59.3 19.1 13.9 16.8 1,191 Divorced/separated/ widowed 61.8 20.3 14.3 28.9 184 Number of living children 0 54.2 16.5 12.0 17.0 1,561 1-2 56.9 15.6 9.6 17.3 635 3-4 62.0 20.4 14.9 20.9 359 5+ 61.0 24.6 18.1 16.9 242 Residence Urban 48.5 13.5 10.1 16.6 603 Rural 58.6 18.6 13.0 17.8 2,194 Ecological zone Lowlands 53.7 16.2 10.2 16.0 1,734 Foothills 61.8 18.7 12.1 20.0 307 Mountains 61.7 23.6 20.5 21.8 585 Senqu River Valley 56.2 7.7 7.2 14.6 171 District Butha-Buthe 53.3 9.2 9.9 12.7 182 Leribe 57.7 21.0 12.5 15.2 393 Berea 66.6 22.1 13.2 16.9 350 Maseru 52.2 15.5 9.8 18.0 741 Mafeteng 44.2 12.8 9.7 20.9 297 Mohale's Hoek 61.8 18.8 12.2 16.5 281 Quthing 49.7 7.1 7.4 11.3 167 Qacha's Nek 58.1 28.3 23.0 25.2 99 Mokhotlong 61.8 25.8 24.1 25.4 130 Thaba-Tseka 68.8 21.5 19.4 19.3 156 Education No education 58.0 22.9 18.7 23.0 479 Primary, incomplete 57.8 18.7 14.7 19.6 1,194 Primary, complete 57.5 16.7 9.8 13.0 342 Secondary+ 52.8 12.7 6.1 13.1 783 Employment Not employed 55.8 16.4 11.8 16.3 1,895 Employed for cash 58.1 19.1 10.6 16.6 587 Employed not for cash 56.5 21.5 19.5 27.2 311 Number of decisions in which woman has final say1 0 55.0 24.9 19.6 23.5 137 1-2 63.4 25.4 16.0 21.9 686 3-4 58.0 16.0 13.3 17.0 1,123 5-6 48.8 12.0 7.0 13.8 851 Number of reasons wife beating is justified 0 43.8 9.3 5.8 9.8 1,360 1-2 59.8 18.1 12.0 20.5 663 3-4 74.8 31.1 21.0 28.2 621 5-6 78.6 32.4 37.6 30.4 153 Wealth quintile Lowest 61.5 21.6 20.2 22.5 466 Second 61.3 20.8 16.8 23.2 514 Middle 56.8 15.5 10.7 15.2 566 Fourth 51.3 15.4 7.6 14.8 621 Highest 53.3 15.6 9.3 14.2 630 Total 56.4 17.5 12.4 17.6 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others Fertility Levels, Trends, and Differentials | 51 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4 4.1 INTRODUCTION Fertility is one of the three principal components of population dynamics, the others being mortality and migration (United Nations, 1973). This chapter presents an analysis of the fertility data collected in the 2004 LDHS. It includes a discussion on levels, trends, and differentials in fertility by selected background characteristics; data on lifetime fertility (children ever born and living); and a scrutiny of age at first birth and birth intervals. This discussion is followed by a brief discussion on adolescent fertility, which has become critical to the issue of fertility transition, particularly in the wake of a new policy on adolescent reproductive health. The fertility data were collected by asking all women of reproductive age (15-49 years) to provide complete birth histories of all children they had given birth to, those who were currently living with them, those who were living away, and those who had died. The following information was also collected for each live birth: name, sex, date of birth, survival status, current age (if alive), and age at death (if dead). It is important to mention at the outset that the birth history approach has some limitations that might distort fertility levels and patterns. For instance, women may include relatives’ children as their own or omit children who died young, while older women may forget grown children who have left home (United Nations, 1983). There is also an implicit assumption that the fertility of surviving women is similar to that of women who have died. Accordingly, the results should be viewed with these caveats in mind. 4.2 CURRENT FERTILITY Measures of current fertility are presented in Table 4.1 for the three-year period preceding the survey, corresponding to the period from late 2001 to late 2004. Several measures of current fertility are shown. Age-specific fertility rates (ASFRs) are calculated by dividing the number of births to women in a specific age group by the number of woman-years lived during a given period.1 The total fertility rate (TFR) is a common measure of current fertility and is defined as the average number of children a woman would have if she went through her entire reproductive period (15-49 years) reproducing at the prevailing ASFR. The general fertility rate (GFR) represents the annual number of births per 1,000 women age 15-44, and the crude birth rate (CBR) represents the annual number of births per 1,000 population. The CBR is estimated using the birth history data in conjunction with the population data collected in the household schedule. 1 Numerators for the age-specific fertility rates are calculated by summing all births that occurred during the 1 to 36 months preceding the survey, classified by the age of the mother at the time of birth in 5-year age groups. The de- nominators are the number of woman-years lived in each specific 5-year age group during the 1 to 36 months pre- ceding the survey. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Lesotho 2004 Residence Age group Urban Rural Total 15-19 45 103 91 20-24 98 206 177 25-29 92 190 160 30-34 66 142 122 35-39 51 118 101 40-44 33 50 46 45-49 0 11 9 TFR 1.9 4.1 3.5 GFR 69 138 121 CBR 19.3 26.7 25.3 Note: Rates for age group 45-49 may be slightly biased because of truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 52 | Fertility Levels, Trends, and Differentials Table 4.1 shows a TFR of 3.5 children per woman for the three-year period preceding the survey (late-2001 to late-2004). Fertility is considerably higher in the rural areas (4.1 children per woman) than urban areas (1.9 children per woman). Considering the age pattern, fertility peaks at age 20-24, remains relatively high at age 25-29, and then drops off, falling sharply after age 39. Although the age pattern is generally similar with peak fertility occurring at age 20-24 for both urban and rural women, rural rates are higher than urban rates at every age. 4.3 FERTILITY BY BACKGROUND CHARACTERISTICS Differences in current fertility (as assessed by the total fertility rate and the percentage currently pregnant) by urban-rural residence, district, educational attainment, and wealth quintile are shown in Table 4.2. The percentage currently pregnant is likely to be an underestimate because women in the early stages of pregnancy may not be aware that they are pregnant, or are unsure, and some may choose not to report that they are pregnant. Current fertility is lowest in the Lowlands zone and highest in the Mountains zone (Figure 4.1). By district, the TFR ranges from a low of 2.5 births in Maseru to a high of 5.1 births per woman in Thaba- Tseka. Butha-Buthe and Mafeteng have the lowest proportions of women reporting they are pregnant (about 4 percent), while Mokhotlong (9 percent) and Thaba-Tseka (8 percent) have the highest proportions. As expected, a woman’s education is strongly associated with fertility. For example, the TFR de- creases from 4.2 births for women with primary incomplete education to 2.8 births for women with at least some secondary education. Fertility is also closely associated with wealth whereby the lowest quintile displays higher fertility (5.2 births) and the highest quintile shows the lowest fertility (2.0 births). Table 4.2 also presents a crude assessment of trends in fertility in the various subgroups by comparing current fertility with a measure of completed fertility, the mean number of children ever born (CEB) to women age 40-49. The mean number of children ever born takes into account the lifetime fertility of older women who are nearing the end of their reproductive period and, thus, represents com- pleted fertility of women who began their child- bearing during the three decades preceding the sur- vey. If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 are expected to be similar. When fertility levels have been falling, the TFR will be substantially lower than the mean CEB among women age 40-49. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Lesotho 2004 Background characteristic Total fertility rate Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 1.9 3.9 3.5 Rural 4.1 6.7 5.0 Ecological zone Lowlands 2.9 4.8 4.4 Foothills 4.3 7.1 5.1 Mountains 4.9 8.7 5.2 Senqu River Valley 4.0 6.4 5.1 District Butha-Buthe 3.4 3.7 4.8 Leribe 3.6 6.0 5.1 Berea 3.9 6.4 5.2 Maseru 2.5 6.3 4.0 Mafeteng 3.3 4.1 4.5 Mohale's Hoek 4.0 5.1 4.9 Quthing 4.1 7.1 5.1 Qacha's Nek 4.4 6.4 4.7 Mokhotlong 4.6 8.8 4.8 Thaba-Tseka 5.1 8.2 5.4 Education No education * * * Primary, incomplete 4.2 6.4 5.1 Primary, complete 3.9 6.7 4.9 Secondary+ 2.8 5.2 3.7 Wealth quintile Lowest 5.2 9.6 5.6 Second 4.5 8.0 5.2 Middle 3.8 5.8 5.1 Fourth 3.4 4.4 4.7 Highest 2.0 4.4 3.7 Total 3.5 6.1 4.7 Note: An asterisk indicates that a figure is based on fewer than 250 woman-years of exposure and has been suppressed. 1 Women age 15-49 years Fertility Levels, Trends, and Differentials | 53 Current fertility generally falls substantially below lifetime fertility of women 40-49, except for the small number of respondents with no education. The comparison suggests that fertility has fallen by more than one birth during the past few decades. The implied fertility decline is largest among urban women, women living in the Lowlands zone, and women living in Leribe and Maseru districts (Table 4.2). 1.9 4.1 2.9 4.3 4.9 4.0 3.4 3.6 3.9 2.5 3.3 4.0 4.1 4.4 4.6 5.1 4.2 3.9 2.8 RESIDENCE Urban Rural ECOLOGICAL ZONE Lowlands Foothills Mountains Senqu River Valley DISTRICT Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka EDUCATION No education Primary, incomplete Primary, complete Secondary+ 0.0 2.0 4.0 6.0 Figure 4.1 Total Fertility Rate by Background Characteristics LDHS 2004 Births per woman * Note: An asterisk indicates that a figure is based on fewer than 250 woman-years of exposure and has been suppressed. 4.4 FERTILITY TRENDS Lesotho is endowed with a wealth of demographic data. Accordingly, changes in fertility levels over time can be tracked by examining fertility estimates from various surveys and censuses, spanning the last three decades. Table 4.3 and Figure 4.2 indicate that the TFR declined significantly during the last three decades of the 20th century, changing from a high of 5.4 children per woman in the mid-1970s and 5.3 in the mid-1980s to 4.1 in the mid-1990s, 4.2 in 2001, and 3.5 children in 2004. Table 4.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, 1976, 1986, and 1996 Population and Housing Censuses, 2001 LDS, and 2004 LDHS Age group 1976 Census 1986 Census 1996 Census 2001 LDS 2004 LDHS 15-19 65 70 37 81 91 20-24 239 246 145 196 177 25-29 259 256 153 204 160 30-34 222 223 131 122 122 35-39 165 178 106 148 101 40-44 96 95 66 60 46 45-49 39 30 27 28 9 TFR 5.4 5.3 4.1 4.2 3.5 Sources: BOS 1976, BOS 1986, BOS 1996, BOS 2001, MOHSW, BOS, and ORC Macro, 2005 54 | Fertility Levels, Trends, and Differentials Furthermore, data on other fertility correlates collected in the 2004 LDHS are internally con- sistent with this trend. Fertility changes can be examined by looking at the trend in age-specific fertility rates for successive five-year periods before the survey, using the birth histories obtained from 2004 LDHS respondents. The age-specific fertility rates shown in Table 4.4 were gener- ated from the birth history data collected in the 2004 LDHS. The numerators of the rates are classified by five-year seg- ments of time preceding the survey and the mother’s age at the time of birth. Because women 50 years and over were not interviewed in the survey, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and more preceding the survey, because women in that age group would have been 50 years or older at the time of the survey. The results in Table 4.4 confirm that fertility has fallen substantially among all age groups, with the most rapid relative decline among women in their 30s. 4.5 CHILDREN EVER BORN AND CHILDREN SURVIVING Table 4.5 shows the distribution of all women and currently married women age 15-49 by number of children ever born and mean number of children ever born and living. More than four-fifths of women age 15-19 (85 percent) have never given birth. However, this proportion declines rapidly to less than 6 percent for women age 30 and above, indicating that childbearing among women is nearly universal. On average, women attain a parity of 5.2 children by the end of their childbearing years, with 4.4 of these children surviving. Table 4.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Lesotho 2004 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 98 95 110 112 20-24 211 223 252 265 25-29 184 195 232 237 30-34 145 174 179 (216) 35-39 116 126 (172) - 40-44 57 (68) - - 45-49 (12) - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 5.4 5.3 4.1 4.2 3.5 1976 Census 1986 Census 1996 Census 2001 LDS 2004 LDHS 0 1 2 3 4 5 6 Figure 4.2 Total Fertility Rates, Lesotho 1976-2004 Births per woman Fertility Levels, Trends, and Differentials | 55 The same pattern is replicated for currently married women, except that only 46 percent of married women age 15-19 have not borne a child. As with all women, this proportion declines, although more rapidly, to 7 percent or less for currently married women age 25 and above compared with 16 percent or less of all women age 25 and above. On average, currently married women age 45-49 have borne 5.5 children, with less than one child having died. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Lesotho 2004 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 84.7 14.5 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,710 0.16 0.15 20-24 37.2 40.1 18.6 3.6 0.4 0.1 0.0 0.0 0.0 0.0 0.0 100.0 1,463 0.90 0.82 25-29 15.7 28.2 29.2 18.6 6.3 1.8 0.2 0.0 0.0 0.0 0.0 100.0 1,044 1.78 1.59 30-34 5.8 16.1 24.3 23.2 17.0 8.7 3.7 1.1 0.2 0.0 0.0 100.0 816 2.77 2.49 35-39 3.3 9.5 15.3 25.8 14.9 15.9 10.2 3.2 0.9 0.9 0.1 100.0

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