Maldives - Demographic and Health Survey - 2018

Publication date: 2018

Republic of Maldives Maldives Demographic and Health Survey 2016-17 Ministry of Health Malé, Maldives The DHS Program ICF Rockville, Maryland, USA December 2018 The 2016-17 Maldives Demographic and Health Survey (2016-17 MDHS) was implemented by the Ministry of Health (MOH). Funding for the survey was provided by the Government of the Maldives, WHO, UNICEF, and UNFPA. ICF provided technical assistance to the project. Additional information about the 2016-17 MDHS may be obtained from the Policy Planning and International Health Division of the Ministry of Health, Sosun Magu, Malé, Maldives; Telephone: +960 332-8887; email: ppd@health.gov.mv. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; email: info@DHSprogram.com; Internet: www.DHSprogram.com. ISBN Number: 178-LBK/2019/027 Cover photos: Mohamed Ali, Moomina Abdullah Suggested citation: Ministry of Health (MOH) [Maldives] and ICF. 2018. Maldives Demographic and Health Survey 2016-17. Malé, Maldives, and Rockville, Maryland, USA: MOH and ICF. Contents • iii CONTENTS TABLES AND FIGURES . ix PREFACE . xvii ACKNOWLEDGEMENT . xix READING AND UNDERSTANDING TABLES FROM THE 2016-17 MALDIVES DHS . xxi SUSTAINABLE DEVELOPMENT GOALS INDICATORS . xxix ACRONYMS AND ABBREVIATIONS . xxxi MAP OF MALDIVES . xxxiv 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 2 1.3 Questionnaires . 3 1.4 Anthropometry and Anaemia Testing . 4 1.5 Pretest . 5 1.6 Training of Field Staff . 5 1.7 Fieldwork . 6 1.8 Data Processing . 6 1.9 Response Rates . 6 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 2.1 Drinking Water Sources and Treatment . 9 2.2 Sanitation . 10 2.3 Housing Characteristics . 11 2.3.1 Exposure to Smoke inside the Home . 11 2.3.2 Other Housing Characteristics . 11 2.3.3 Housing Materials . 11 2.3.4 Household Durable Goods . 12 2.4 Household Wealth . 12 2.5 Hand Washing . 13 2.6 Household Population and Composition . 13 2.7 Children’s Living Arrangements and Parental Survival . 14 2.8 Birth Registration . 15 2.9 Education . 15 2.9.1 Educational Attainment . 15 2.9.2 School Attendance . 16 2.9.3 Other Measures of School Attendance . 16 2.10 Disability . 17 3 CHARACTERISTICS OF RESPONDENTS . 33 3.1 Background Characteristics of Survey Respondents . 33 3.2 Education and Literacy . 34 3.3 Mass Media Exposure and Internet Usage . 35 3.4 Employment . 36 3.5 Occupation . 37 3.6 Type of Women’s Employment . 37 3.7 Health Insurance Coverage . 38 3.8 Tobacco Use . 38 iv • Contents 4 MARRIAGE AND SEXUAL ACTIVITY . 57 4.1 Marital Status . 57 4.2 Polygyny . 58 4.3 Age at First Marriage . 58 4.4 Age at First Sexual Intercourse . 59 4.5 Recent Sexual Activity . 60 5 FERTILITY . 67 5.1 Current Fertility . 67 5.2 Children Ever Born . 69 5.3 Birth Intervals . 69 5.4 Insusceptibility to Pregnancy . 70 5.5 Age at First Birth . 71 5.6 Teenage Childbearing . 71 6 FERTILITY PREFERENCES . 79 6.1 Desire for Another Child . 79 6.2 Ideal Family Size . 80 6.3 Fertility Planning Status . 81 6.4 Wanted Fertility Rates . 82 7 FAMILY PLANNING . 89 7.1 Contraceptive Knowledge and Use . 89 7.2 Knowledge of Women’s Fertile Period . 91 7.3 Timing of Female Sterilisation . 92 7.4 Source of Modern Contraceptive Methods . 92 7.5 Informed Choice . 92 7.6 Discontinuation of Contraceptives . 93 7.7 Demand for Family Planning . 93 7.8 Decision Making about Family Planning . 94 7.9 Future Use of Contraception . 95 7.10 Exposure to Family Planning Messages in the Media . 95 7.11 Contact of Nonusers with Family Planning Providers . 95 8 INFANT AND CHILD MORTALITY . 107 8.1 Infant and Child Mortality . 108 8.2 Perinatal Mortality . 109 8.3 High-risk Fertility Behaviour . 110 9 MATERNAL HEALTH CARE . 115 9.1 Antenatal Care Coverage and Content . 116 9.1.1 Skilled Providers . 116 9.1.2 Timing and Number of ANC Visits . 116 9.2 Components of ANC . 116 9.3 Protection against Neonatal Tetanus . 117 9.4 Delivery Services . 118 9.4.1 Institutional Deliveries . 118 9.4.2 Skilled Assistance during Delivery . 118 9.4.3 Delivery by Caesarean Section . 119 9.5 Postnatal Care . 120 9.5.1 Postnatal Health Check for Mothers . 120 9.5.2 Postnatal Health Check for Newborns . 120 9.6 Problems in Accessing Health Care . 121 Contents • v 10 CHILD HEALTH . 135 10.1 Birth Weight . 135 10.2 Vaccination of Children . 136 10.3 Symptoms of Acute Respiratory Infection . 138 10.4 Fever . 138 10.5 Diarrhoeal Disease . 139 10.5.1 Prevalence of Diarrhoea . 139 10.5.2 Feeding Practices . 139 10.5.3 Oral Rehydration Therapy and Other Treatments for Diarrhoea . 140 10.5.4 Treatment-seeking Behaviour . 141 10.5.5 Knowledge of ORS Packets . 141 10.6 Disposal of Children’s Stools . 141 11 NUTRITION OF CHILDREN AND ADULTS . 153 11.1 Nutritional Status of Children . 153 11.1.1 Measurement of Nutritional Status among Young Children . 153 11.1.2 Data Collection . 155 11.1.3 Levels of Child Malnutrition . 155 11.2 Infant and Young Child Feeding Practices . 156 11.2.1 Breastfeeding . 156 11.2.2 Median Duration of Breastfeeding . 157 11.2.3 Complementary Feeding . 157 11.2.4 Minimum Acceptable Diet . 158 11.3 Anaemia Prevalence in Children . 160 11.4 Micronutrient Intake and Supplementation among Children . 161 11.5 Adults’ Nutritional Status . 162 11.5.1 Nutritional Status of Women . 162 11.5.2 Nutritional Status of Men Age 15-49 Years . 163 11.6 Anaemia Prevalence in Women. 163 11.7 Iron Supplementation among Mothers . 164 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 179 12.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 179 12.2 Knowledge about Mother-to-Child Transmission . 181 12.3 Discriminatory Attitudes towards People Living with HIV . 181 12.4 Men’s Sexual Behaviour . 182 12.5 Coverage of HIV Testing Services . 182 12.6 Self-reporting of Sexually Transmitted Infections . 183 12.7 HIV/AIDS-Related Knowledge and Behaviour among Young People . 184 12.7.1 Knowledge . 184 12.7.2 First Sex . 184 12.7.3 Premarital Sex . 184 12.7.4 Coverage of HIV Testing Services . 185 13 WOMEN’S EMPOWERMENT . 197 13.1 Married Women’s and Men’s Employment . 198 13.2 Control over Women’s Earnings . 198 13.3 Control over Men’s Earnings . 199 13.4 Women’s and Men’s Ownership of House . 200 13.5 Ownership and Use of Bank Accounts and Mobile Phones . 200 13.6 Women’s Participation in Decision Making . 201 13.7 Attitudes towards Wife Beating . 202 13.8 Attitude towards Negotiating Safe Sex . 203 vi • Contents 13.9 Ability to Negotiate Sexual Relations . 203 13.10 Women’s Empowerment and Demographic and Health Outcomes . 204 14 VIOLENCE AGAINST WOMEN . 219 14.1 Measurement of Violence . 220 14.2 Women’s Experience of Physical Violence from Anyone . 220 14.2.1 Prevalence of Physical Violence . 220 14.2.2 Perpetrators of Physical Violence . 221 14.3 Experience of Sexual Violence . 221 14.3.1 Prevalence of Sexual Violence . 221 14.3.2 Perpetrators of Sexual Violence . 221 14.4 Experience of Different Forms of Violence . 222 14.5 Marital Control by Husband . 222 14.6 Forms of Spousal Violence . 223 14.6.1 Prevalence of Spousal Violence . 223 14.6.2 Onset of Spousal Violence . 225 14.7 Injuries to Women due to Spousal Violence . 225 14.8 Violence Initiated by Women against Husbands . 226 14.9 Response to Violence . 226 14.9.1 Help-Seeking among Women Who Have Experienced Violence . 226 14.9.2 Sources for Help . 227 15 OTHER HEALTH ISSUES. 243 15.1 Hypertension and Diabetes . 243 15.2 Other Non-Communicable Diseases . 244 15.3 Thalassemia . 244 15.4 Tuberculosis Knowledge and Attitudes . 245 15.5 Knowledge about Dengue Fever . 246 16 EARLY CHILDHOOD DEVELOPMENT . 255 16.1 Early Childhood Education . 255 16.2 Childhood Learning . 256 16.2.1 Support for Learning . 256 16.2.2 Children’s Books and Playthings . 256 16.3 Adequate Care for Young Children . 257 16.4 Developmentally On Track . 258 17 FEMALE CIRCUMCISION . 265 17.1 Knowledge of Female Circumcision . 266 17.2 Prevalence of and Age at Circumcision among Women . 266 17.2.1 Prevalence of Female Circumcision . 266 17.2.2 Age at Circumcision . 267 17.3 Prevalence of Circumcision for Girls Age 0-14 . 267 17.4 Opinions about Female Circumcision . 268 REFERENCES . 277 APPENDIX A SAMPLE DESIGN . 277 A.1 Introduction . 277 A.2 Sample Frame . 277 A.3 Sample Design and Implementation . 279 A.4 Sample Probabilities and Sampling Weights . 281 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 307 Contents • vii APPENDIX C DATA QUALITY TABLES . 307 APPENDIX D PERSONNEL INVOLVED IN THE 2016-17 MALDIVES DEMOGRAPHIC AND HEALTH SURVEY . 313 APPENDIX E QUESTIONNAIRES . 317 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 7 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 Table 2.1 Household drinking water . 19 Table 2.2 Availability of water . 19 Table 2.3 Household sanitation facilities . 20 Table 2.4 Housing characteristics . 21 Table 2.5 Housing materials . 22 Table 2.6 Household possessions . 22 Table 2.7 Wealth quintiles . 23 Table 2.8 Handwashing . 23 Table 2.9 Household population by age, sex, and residence . 24 Table 2.10 Household composition . 25 Table 2.11 Children’s living arrangements and orphanhood . 26 Table 2.12 Birth registration of children under age 5 . 27 Table 2.13.1 Educational attainment of the female household population . 28 Table 2.13.2 Educational attainment of the male household population . 29 Table 2.14 School attendance ratios . 30 Table 2.15.1 Disability among the female household population . 31 Table 2.15.2 Disability among the male household population . 32 3 CHARACTERISTICS OF RESPONDENTS . 33 Table 3.1 Background characteristics of respondents . 39 Table 3.2.1 Educational attainment: Women . 40 Table 3.2.2 Educational attainment: Men . 41 Table 3.3.1 Literacy: Women . 42 Table 3.3.2 Literacy: Men . 43 Table 3.4.1 Exposure to mass media: Women . 44 Table 3.4.2 Exposure to mass media: Men . 45 Table 3.5.1 Internet usage: Women . 46 Table 3.5.2 Internet usage: Men . 47 Table 3.6.1 Employment status: Women . 48 Table 3.6.2 Employment status: Men . 49 Table 3.7.1 Occupation: Women . 50 Table 3.7.2 Occupation: Men . 51 Table 3.8 Type of employment . 51 Table 3.9.1 Health insurance coverage: Women . 52 Table 3.9.2 Health insurance coverage: Men . 53 Table 3.10.1 Tobacco smoking: Women . 54 Table 3.10.2 Tobacco smoking: Men . 55 Table 3.11 Average number of cigarettes smoked daily: Men . 56 Figure 3.1 Education of survey respondents . 34 Figure 3.2 Postsecondary education by region . 34 Figure 3.3 Exposure to mass media . 35 x • Tables and Figures Figure 3.4 Employment status by residence . 36 Figure 3.5 Occupation . 37 4 MARRIAGE AND SEXUAL ACTIVITY . 57 Table 4.1 Current marital status . 60 Table 4.2.1 Number of women’s co-wives . 61 Table 4.2.2 Number of men’s wives . 62 Table 4.3 Age at first marriage . 63 Table 4.4 Median age at first marriage by background characteristics . 63 Table 4.5 Age at first sexual intercourse . 64 Table 4.6 Median age at first sexual intercourse according to background characteristics . 64 Table 4.7.1 Recent sexual activity: Women . 65 Table 4.7.2 Recent sexual activity: Men . 66 Figure 4.1 Marital status . 57 Figure 4.2 Median age at first sex and first marriage . 58 Figure 4.3 Women’s median age at marriage by education . 59 5 FERTILITY . 67 Table 5.1 Current fertility . 72 Table 5.2 Fertility by background characteristics . 73 Table 5.3.1 Trends in age-specific fertility rates . 73 Table 5.3.2 Trends in age-specific fertility rates . 74 Table 5.4 Children ever born . 74 Table 5.5 Birth intervals . 75 Table 5.6 Postpartum amenorrhoea, abstinence and insusceptibility . 76 Table 5.7 Median duration of amenorrhoea, postpartum abstinence and postpartum insusceptibility . 76 Table 5.8 Menopause . 77 Table 5.9 Age at first birth . 77 Table 5.10 Median age at first birth . 78 Table 5.11 Teenage pregnancy and motherhood . 78 Figure 5.1 Trends in fertility by residence . 68 Figure 5.2 Trends in age-specific fertility . 68 Figure 5.3 Fertility by region . 68 Figure 5.4 Fertility by education . 68 Figure 5.5 Fertility by household wealth . 69 Figure 5.6 Birth intervals . 69 6 FERTILITY PREFERENCES . 79 Table 6.1 Fertility preferences by number of living children . 84 Table 6.2.1 Desire to limit childbearing: Women . 84 Table 6.2.2 Desire to limit childbearing: Men . 85 Table 6.3 Ideal number of children according to number of living children . 86 Table 6.4 Mean ideal number of children according to background characteristics . 87 Table 6.5 Fertility planning status . 87 Table 6.6 Wanted fertility rates . 88 Figure 6.1 Trends in desire to limit childbearing . 80 Figure 6.2 Desire to limit childbearing by number of living children . 80 Figure 6.3 Ideal family size . 81 Tables and Figures • xi Figure 6.4 Ideal family size by number of living children . 81 Figure 6.5 Fertility planning status . 82 Figure 6.6 Trends in wanted and actual fertility . 83 7 FAMILY PLANNING . 89 Table 7.1 Knowledge of contraceptive methods . 96 Table 7.2 Knowledge of contraceptive methods according to background characteristics . 97 Table 7.3 Current use of contraception according to age . 98 Table 7.4 Trends in the current use of contraceptive methods . 98 Table 7.5 Current use of contraception according to background characteristics . 99 Table 7.6 Knowledge of fertile period . 99 Table 7.7 Knowledge of fertile period by age . 100 Table 7.8 Timing of sterilisation . 100 Table 7.9 Source of modern contraception methods . 100 Table 7.10 Informed choice . 101 Table 7.11 Twelve-month contraceptive discontinuation rates . 101 Table 7.12 Reasons for discontinuation . 102 Table 7.13.1 Need and demand for family planning among currently married women . 102 Table 7.13.2 Need and demand for family planning for all women and for sexually active unmarried women . 103 Table 7.14 Decisionmaking about family planning . 104 Table 7.15 Future use of contraception . 105 Table 7.16 Exposure to family planning messages . 105 Table 7.17 Contact of nonusers with family planning providers . 106 Figure 7.1 Trends in contraceptive use . 90 Figure 7.2 Trends in contraceptive use by method . 91 Figure 7.3 Contraceptive use by region . 91 Figure 7.4 Use of contraceptive methods by education . 91 Figure 7.5 Source of modern contraceptive methods . 92 Figure 7.6 Demand for family planning . 94 Figure 7.7 Unmet need by wealth . 94 8 INFANT AND CHILD MORTALITY . 107 Table 8.1 Early childhood mortality rates . 110 Table 8.2 Five-year early childhood mortality rates according to child’s sex and residence . 111 Table 8.3 Ten-year early childhood mortality rates according to additional characteristics . 111 Table 8.4 Perinatal mortality . 112 Table 8.5 High-risk fertility behaviour . 113 Figure 8.1 Early childhood mortality rates . 108 Figure 8.2 Under-five mortality by region . 109 Figure 8.3 Childhood mortality by previous birth interval . 109 9 MATERNAL HEALTH CARE . 115 Table 9.1 Antenatal care . 122 Table 9.2 Number of antenatal care visits and timing of first visit . 123 Table 9.3 Components of antenatal care . 124 Table 9.4 Tetanus toxoid injections . 125 Table 9.5 Place of delivery . 126 xii • Tables and Figures Table 9.6 Assistance during delivery . 127 Table 9.7 Caesarean section . 128 Table 9.8 Duration of stay in health facility after birth . 128 Table 9.9 Timing of first postnatal check for the mother . 129 Table 9.10 Type of provider of first postnatal check for the mother . 130 Table 9.11 Timing of first postnatal check for the newborn . 131 Table 9.12 Type of provider of first postnatal check for the newborn . 132 Table 9.13 Content of postnatal care for newborns . 133 Table 9.14 Problems in accessing health care . 134 Figure 9.1 Trends in antenatal care coverage . 116 Figure 9.2 Components of antenatal care . 117 Figure 9.3 Trends in health facility births . 118 Figure 9.4 Health facility births by region . 118 Figure 9.5 Assistance during delivery . 119 Figure 9.6 Trends in caesarean sections . 119 10 CHILD HEALTH . 135 Table 10.1 Child’s size and weight at birth. 143 Table 10.2 Vaccinations by source of information . 144 Table 10.3 Vaccinations by background characteristics . 145 Table 10.4 Possession and observation of vaccination cards, according to background characteristics . 146 Table 10.5 Prevalence and treatment of fever . 147 Table 10.6 Source of advice or treatment for children with fever . 148 Table 10.7 Prevalence of diarrhoea . 148 Table 10.8 Feeding practices during diarrhoea . 149 Table 10.9 Oral rehydration therapy, zinc and other treatments for diarrhoea . 149 Table 10.10 Source of advice or treatment for children with diarrhoea . 149 Table 10.11 Knowledge of ORS packets or pre-packaged liquids. 150 Table 10.12 Disposal of children’s stools . 151 Figure 10.1 Childhood vaccinations . 137 Figure 10.2 Trends in childhood vaccinations . 138 Figure 10.3 Feeding practices during diarrhoea . 140 Figure 10.4 Treatment of diarrhoea . 140 Figure 10.5 Prevalence and treatment of childhood illness . 141 11 NUTRITION OF CHILDREN AND ADULTS . 153 Table 11.1 Nutritional status of children . 165 Table 11.2 Initial breastfeeding . 166 Table 11.3 Breastfeeding status by age . 167 Table 11.4 Infant and young child feeding indicators on breastfeeding status . 167 Table 11.5 Median duration of breastfeeding . 168 Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview . 169 Table 11.7 Minimum acceptable diet . 170 Table 11.8 Coverage of testing for anaemia in children . 171 Table 11.9 Prevalence of anaemia in children . 172 Table 11.10 Micronutrient intake among children . 173 Table 11.11.1 Nutritional status of women . 174 Table 11.11.2 Nutritional status of men . 175 Table 11.12 Prevalence of anaemia in women . 176 Tables and Figures • xiii Table 11.13 Iron supplementation among mothers . 177 Figure 11.1 Trends in nutritional status of children . 155 Figure 11.2 Stunting in children by age . 155 Figure 11.3 Stunting in children by region . 155 Figure 11.4 Breastfeeding practices by age . 157 Figure 11.5 IYCF indicators on minimum acceptable diet . 159 Figure 11.6 Childhood anaemia . 160 Figure 11.7 Childhood anaemia . 161 Figure 11.8 Nutritional status of women and men . 162 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 179 Table 12.1 Knowledge of HIV prevention methods . 186 Table 12.2 Comprehensive knowledge about HIV . 187 Table 12.3 Knowledge of prevention of mother-to-child transmission of HIV . 187 Table 12.4 Discriminatory attitudes towards people living with HIV . 188 Table 12.5 Mean number of lifetime sexual partners among men . 189 Table 12.6 Payment for sexual intercourse . 190 Table 12.7.1 Coverage of prior HIV testing: Women . 190 Table 12.7.2 Coverage of prior HIV testing: Men . 191 Table 12.8 Self-reported prevalence of sexually transmitted infections and STI symptoms . 192 Table 12.9 Women and men seeking treatment for STIs . 193 Table 12.10 Comprehensive knowledge about HIV among young people . 193 Table 12.11 Age at first sexual intercourse among young people . 194 Table 12.12 Premarital sexual intercourse among young people . 194 Table 12.13 Recent HIV tests among young people . 195 Figure 12.1 Knowledge of HIV prevention methods . 180 Figure 12.2 Knowledge of mother-to-child transmission . 181 Figure 12.3 Discriminatory attitudes towards people living with HIV by age . 182 Figure 12.4 HIV testing . 183 Figure 12.5 Recent HIV testing by education . 183 Figure 12.6 Comprehensive HIV knowledge among youth . 184 13 WOMEN’S EMPOWERMENT . 197 Table 13.1 Employment and cash earnings of currently married women and men . 205 Table 13.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 206 Table 13.2.2 Control over men’s cash earnings . 207 Table 13.3 Women’s control over their earnings and over those of their husbands . 208 Table 13.4 Ownership of house . 208 Table 13.5.1 Ownership and use of bank accounts and mobile phones: Women . 209 Table 13.5.2 Ownership and use of bank accounts and mobile phones: Men . 210 Table 13.6 Participation in decision making . 210 Table 13.7.1 Women’s participation in decision making by background characteristics . 211 Table 13.7.2 Men’s participation in decision making by background characteristics . 212 Table 13.8.1 Attitude towards wife beating: Women . 213 Table 13.8.2 Attitude towards wife beating: Men . 214 Table 13.9 Attitudes towards negotiating safer sexual relations with husband . 215 Table 13.10 Ability to negotiate sexual relations with husband . 216 Table 13.11 Indicators of women’s empowerment . 216 Table 13.12 Current use of contraception by women’s empowerment . 217 xiv • Tables and Figures Table 13.13 Ideal number of children and unmet need for family planning by women’s empowerment . 217 Table 13.14 Reproductive health care by women’s empowerment . 218 Figure 13.1 Employment by age . 198 Figure 13.2 Control over women’s earnings . 199 Figure 13.3 Ownership of assets . 200 Figure 13.4 Women’s participation in decision making. 201 Figure 13.5 Attitudes towards wife beating . 202 14 VIOLENCE AGAINST WOMEN . 219 Table 14.1 Results of interviews with the domestic violence module . 227 Table 14.2 Experience of physical violence . 228 Table 14.3 Experience of violence during pregnancy . 229 Table 14.4 Persons committing physical violence . 229 Table 14.5 Experience of sexual violence. 230 Table 14.6 Persons committing sexual violence . 231 Table 14.7 Age at first experience of sexual violence . 231 Table 14.8 Experience of different forms of violence . 231 Table 14.9 Marital control exercised by husbands . 232 Table 14.10 Forms of spousal violence . 233 Table 14.11 Spousal violence by background characteristics . 234 Table 14.12 Spousal violence by husband’s characteristics and empowerment indicators . 235 Table 14.13 Violence by any husband/partner in the last 12 months. 236 Table 14.14 Experience of spousal violence by duration of marriage . 236 Table 14.15 Injuries to women due to spousal violence . 237 Table 14.16 Violence by women against their husband by women’s background characteristics . 238 Table 14.17 Violence by women against their husband by husband’s characteristics and empowerment indicators . 239 Table 14.18 Help seeking to stop violence . 240 Table 14.19 Sources for help to stop the violence . 241 Table 14.20 Places where women sought help to stop the violence . 241 Figure 14.1 Women’s experience of violence by marital status . 221 Figure 14.2 Forms of spousal physical or sexual violence . 223 Figure 14.3 Forms of spousal emotional violence . 224 Figure 14.4 Forms of spousal violence . 224 Figure 14.5 Help seeking by type of violence experienced . 226 15 OTHER HEALTH ISSUES. 243 Table 15.1 Self-reported hypertension and diabetes prevalence . 247 Table 15.2 Hypertension treatments . 248 Table 15.3 Diabetes treatments . 248 Table 15.4 Diagnosis of other non-communicable diseases . 249 Table 15.5 Thalassemia knowledge and diagnosis . 250 Table 15.6 Type of thalassemia . 251 Table 15.7.1 Knowledge and attitudes about tuberculosis: Women . 252 Table 15.7.2 Knowledge and attitudes about tuberculosis: Men . 253 Table 15.8 Knowledge about dengue fever . 254 Tables and Figures • xv Figure 15.1 Self-reported prevalence of hypertension and diabetes. 244 Figure 15.2 Thalassemia knowledge and diagnosis . 245 Figure 15.3 Knowledge and attitudes about tuberculosis . 245 16 EARLY CHILDHOOD DEVELOPMENT . 255 Table 16.1 Early childhood education . 259 Table 16.2 Support for learning . 260 Table 16.3 Learning materials . 261 Table 16.4 Inadequate care . 262 Table 16.5 Early child development index . 263 Figure 16.1 Early childhood education by wealth . 256 Figure 16.2 Availability of children’s or picture books by wealth . 257 Figure 16.3 Inadequate care . 258 Figure 16.4 Development index . 258 17 FEMALE CIRCUMCISION . 265 Table 17.1 Knowledge of female circumcision . 269 Table 17.2 Prevalence of female circumcision . 270 Table 17.3 Age at circumcision . 270 Table 17.4 Prevalence of circumcision and age at circumcision: Girls 0-14 . 271 Table 17.5 Circumcision of girls age 0-14 by mother’s background characteristics . 271 Table 17.6 Opinions of women about whether circumcision is required by religion . 272 Table 17.7 Opinions of women about whether the practice of circumcision should continue . 273 Figure 17.1 Female circumcision by age . 266 Figure 17.2 Female circumcision by region . 267 Figure 17.3 Age at female circumcision . 267 Figure 17.4 Prevalence of female circumcision among women and their daughters . 268 Figure 17.5 Attitudes about female circumcision by circumcision status . 268 APPENDIX A SAMPLE DESIGN. 277 Table A.1 Distribution and percent distribution of the Maldivian population and households by region and atoll, Maldives . 278 Table A.2 Number of islands/wards, number of census blocks, and average size of CBs in number of residential Maldivian households by region and atoll, Maldives . 279 Table A.3 Sample allocation of clusters and households by region and atoll, 2016-17 MDHS . 280 Table A.4 Sample allocation of expected number of women and men age 15-49 by region and atoll, 2016-17 MDHS . 281 Table A.5 Sample implementation . 283 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 307 Table B.1 List of selected variables for sampling errors, Maldives DHS 2016-17 . 287 Table B.2 Sampling errors: Total sample, Maldives DHS 2016-17 . 288 Table B.3 Sampling errors: Malé region sample, Maldives DHS 2016-17 . 289 Table B.4 Sampling errors: Other atolls sample, Maldives DHS 2016-17 . 290 Table B.5 Sampling errors: North region sample, Maldives DHS 2016-17 . 291 Table B.6 Sampling errors: North Central region sample, Maldives DHS 2016-17 . 292 Table B.7 Sampling errors: Central region sample, Maldives DHS 2016-17 . 293 Table B.8 Sampling errors: South Central region sample, Maldives DHS 2016-17 . 294 xvi • Tables and Figures Table B.9 Sampling errors: South region sample, Maldives DHS 2016-17 . 295 Table B.10 List of selected variables for sampling errors at atoll level, Maldives DHS 2016-17 . 296 Table B.11 Sampling errors: North Thiladhunmathi (HA) sample, Maldives Atolls DHS 2016-17 . 297 Table B.12 Sampling errors: South Thiladhunmathi (HDh) sample, Maldives Atolls DHS 2016-17 . 297 Table B.13 Sampling errors: North Miladhunmadulu (Sh) sample, Maldives Atolls DHS 2016-17 . 298 Table B.14 Sampling errors: South Miladhunmadulu (N) sample, Maldives Atolls DHS 2016-17 . 298 Table B.15 Sampling errors: North Maalhosmadulu (R) sample, Maldives Atolls DHS 2016-17 . 299 Table B.16 Sampling errors: South Maalhosmadulu (B) sample, Maldives Atolls DHS 2016-17 . 299 Table B.17 Sampling errors: Faadhippolhu (Lh) sample, Maldives Atolls DHS 2016-17 . 300 Table B.18 Sampling errors: Malé Atoll (K) sample, Maldives Atolls DHS 2016-17 . 300 Table B.19 Sampling errors: North Ari Atoll (AA) sample, Maldives Atolls DHS 2016-17 . 301 Table B.20 Sampling errors: South Ari Atoll (ADh) sample, Maldives Atolls DHS 2016-17 . 301 Table B.21 Sampling errors: Felidhe Atoll (V) sample, Maldives Atolls DHS 2016-17 . 302 Table B.22 Sampling errors: Mulakatholhu (M) sample, Maldives Atolls DHS 2016-17 . 302 Table B.23 Sampling errors: North Nilandhe Atoll (F) sample, Maldives Atolls DHS 2016-17 . 303 Table B.24 Sampling errors: South Nilandhe Atoll (Dh) sample, Maldives Atolls DHS 2016-17 . 303 Table B.25 Sampling errors: Kolhumadulu (Th) sample, Maldives Atolls DHS 2016-17 . 304 Table B.26 Sampling errors: Hadhdhunmathi (L) sample, Maldives Atolls DHS 2016-17 . 304 Table B.27 Sampling errors: North Huvadhu Atoll (GA) sample, Maldives Atolls DHS 2016-17 . 305 Table B.28 Sampling errors: South Huvadhu Atoll (GDh) sample, Maldives Atolls DHS 2016-17 . 305 Table B.29 Sampling errors: Gnaviyani (Gn) sample, Maldives Atolls DHS 2016-17 . 306 Table B.30 Sampling errors: Addu Atoll (S) sample, Maldives Atolls DHS 2016-17 . 306 APPENDIX C DATA QUALITY TABLES . 307 Table C.1 Household age distribution . 307 Table C.2.1 Age distribution of eligible and interviewed women . 308 Table C.2.2 Age distribution of eligible and interviewed men . 308 Table C.3 Completeness of reporting . 309 Table C.4 Births by calendar years . 309 Table C.5 Reporting of age at death in days . 310 Table C.6 Reporting of age at death in months . 310 Table C.7 Height and weight data completeness and quality for children . 311 Preface • xvii PREFACE he Ministry of Health (MoH) is pleased to present the final report on the 2016-17 Maldives Demographic and Health Survey (MDHS). The survey is designed to provide indicators on fertility, fertility preferences, family planning practice, childhood mortality, maternal and child health, nutrition, and knowledge and attitudes regarding HIV/AIDS. Also included were several biomarkers such as anthropometric measurements and anaemia testing. These indicators are crucial in policymaking, programme planning, and monitoring and evaluation of population and health programmes, including those anchored in the attainment of related Sustainable Development Goals (SDGs). The 2016-17 MDHS was the second DHS survey to be conducted in the Maldives in collaboration with the worldwide Demographic and Health Surveys Program. Fieldwork for the survey was carried out from 17 March 2016 to 27 November 2017 covering a national sample of over 6,000 households. The 2016-17 MDHS was funded by the Government of the Maldives, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). Great appreciation is due to the survey team of MoH for their hard work and dedication: the staff of the Policy Planning and International Health Division, the Director General of Health Protection Agency of the Maldives and other department/divisions of MoH who worked tirelessly throughout all stages of the survey; the staff of health facilities and local councils for supporting the data collection activities, and to all the interviewing teams composed of team supervisors and interviewers. Finally, the MoH is grateful to the survey respondents who patiently shared their time and information. Ms. Khadeeja Abdul Samad Abdulla Permanent Secretary Ministry of Health October 2018 T Acknowledgement • xix ACKNOWLEDGEMENT he Ministry of Health (MoH) wishes to acknowledge the effort and dedication of all individuals and organisations who had substantially contributed to the successful implementation of the 2016-17 Maldives Demographic and Health Survey. Firstly, we would like to extend our appreciation to the various senior officials and staff, especially Ms. Aishath Samiya (Deputy Director General), Ms. Moomina Abdullah (Director), Ms. Fathimath Shamah (Senior Research Officer) of Policy Planning and International Health Division of our ministry for their stewardship in the conduction of the second round of Maldives Demographic and Health Survey. We also express our sincere gratitude to Ms. Maimoona Aboobakuru, the Director General of Health Protection Agency for her valuable support and guidance throughout the various stages of the survey. We also would like to acknowledge the State Minsters, Mr. Hussain Rasheed and Ms. Dunya Maumoon, and the Deputy Minister, Dr. Shaafiee Abdul Munim, of the Ministry of Health for their valuable input and stewardship. We are grateful to the Government of Maldives, WHO, UNICEF and UNFPA for their financial contribution to the survey. We also express our gratitude to ICF, in particular to the technical team who coordinated very closely with our local team and provided the necessary technical assistance for the successful completion of the survey. We also greatly appreciate the support and contribution by the steering committee representing key stakeholder organisations during the initial planning and design phase of the survey. We also acknowledge the work done by the report finalisation team. This includes stakeholders from health, other sectors and UN agencies. Great appreciation is also due to the core Maldives Demographic and Health Survey team including the survey director, survey managers, logistic and accounting officer and IT officers for their dedication to the smooth implementation of the survey. Additionally, we express our heartfelt gratitude to all the members of the field work teams for their relentless work in various situations and circumstances to complete the data collection phase of the survey. On this note, we thank the staff from health facilities and local councils for their assistance during the conduction of the field work. We recognise the valuable support extended by the respective staff of various department/ divisions and agencies within our ministry for their role in the successful implementation of the survey. We also acknowledge the support provided by the National Bureau of Statistics who shared their expertise during various stages of the survey implementation. Lastly, this survey would not have been completed successfully without the support by the survey respondents. On this regard, we would like to thank all the survey respondents for generously contributing their time to provide the information that was required to formulate this report. T Reading and Understanding Tables from the 2016-17 Maldives DHS • xxi READING AND UNDERSTANDING TABLES FROM THE 2016-17 MALDIVES DHS he new format of the 2016-17 Maldives DHS final report is based on approximately 200 tables of data. They are located for quick reference through links in the text (electronic version) and at the end of each chapter. Additionally, this more reader-friendly version features about 90 figures that clearly highlight trends, subnational patterns, and background characteristics. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, MDHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organisation of MDHS tables, the presentation of background characteristics, and a brief summary of sampling and understanding denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting MDHS tables. T xxii • Reading and Understanding Tables from the 2016-17 Maldives DHS Example 1 – Exposure to Mass Media Women A Question Asked of All Survey Respondents Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Maldives DHS 2016-17 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 34.4 87.5 25.4 9.3 7.8 1,099 20-24 56.5 84.8 25.2 12.6 6.2 1,223 25-29 57.9 85.3 31.0 19.3 6.1 1,379 30-34 61.3 86.5 34.0 20.4 5.1 1,372 35-39 55.6 88.2 42.3 24.7 4.9 1,044 40-44 48.2 85.3 49.7 22.6 4.7 845 45-49 39.0 85.8 53.7 17.6 5.3 737 Residence Malé region 59.1 89.6 28.1 15.6 3.2 3,424 Other atolls 45.9 83.5 41.6 19.8 7.9 4,275 Region Malé 59.1 89.6 28.1 15.6 3.2 3,424 North 42.2 81.9 45.3 19.8 9.5 981 North Central 45.5 81.1 35.9 17.7 9.7 913 Central 44.7 89.4 48.5 19.4 3.4 507 South Central 39.2 86.2 42.4 17.1 5.4 844 South 55.7 81.9 39.0 24.1 8.8 1,030 Education No education 26.4 77.0 56.7 14.5 10.8 323 Primary 38.3 87.1 52.7 20.7 5.3 1,712 Secondary 51.3 86.9 30.5 16.9 6.1 4,044 More than secondary 72.2 85.3 26.1 18.3 4.5 1,619 Wealth quintile Lowest 37.6 78.1 46.3 16.5 9.8 1,393 Second 44.9 86.3 40.7 19.3 6.2 1,449 Middle 52.2 82.7 36.8 20.5 7.3 1,533 Fourth 59.1 91.7 28.9 17.1 2.7 1,629 Highest 61.8 90.6 27.8 16.3 3.7 1,694 Total 51.7 86.2 35.6 17.9 5.8 7,699 Step 1: Read the title and subtitle—highlighted in orange in Example 1. They tell you the topic and the specific population group being described. In this case, the table is about women age 15-49 and their exposure to different types of media. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information is categorised. In this table, the first three columns of data show different types of media that women access at least once a week. The fourth column shows women who access all three types of media, while the fifth column shows women who do not access any of the three types of media at least once a week. The last column lists the number of women age 15-49 interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to mass media by age, residence, region, educational level, and wealth quintile. Most of the tables in the MDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in pink. These percentages represent the totals of all women age 15-49 and their access to different types of media. In this case, 51.7%* of women * For the purpose of this document data are presented exactly as they appear in the table including decimal places. However, the text in the remainder of this report rounds data to the nearest whole percentage point. 1 2 3 4 5 Reading and Understanding Tables from the 2016-17 Maldives DHS • xxiii age 15-49 read a newspaper at least once a week, 86.2% watch television at least once a week, and 35.6% listen to the radio at least once week. Step 5: To find out what percentage of women age 15-49 with more than secondary education read a newspaper on a weekly basis, draw two imaginary lines, as shown on the table. This shows that 72.2% of women with more than secondary education read a newspaper at least once a week. Step 6: By looking at patterns by background characteristics, we can see how exposure to mass media varies across the Maldives. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help programme planners and policy makers determine how to most effectively reach their target populations. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of women in the Maldives do not access any of the three media at least once a week? b) Which age group of women is most likely to listen to the radio at least once a week? c) Compare women in Malé region to women in other atolls – which group is more likely to read a newspaper at least once a week? d) What are the lowest and highest percentages (range) of women who access all three media at least once a week by region? e) Is there a clear pattern in exposure to radio at least once a week by education level? f) Is there a clear pattern in exposure to newspapers at least once a week by wealth quintile? Answers: a) 5.8% b) Women age 45-49 – 53.7% of women in this age group listen to the radio at least once a week. c) Women in Malé region, 59.1% read a newspaper on a weekly basis, compared with 45.9% of women in other atolls. d) Weekly exposure to all three media ranges from a low of 15.6% in Malé to a high of 24.1% in South region. e) Yes, exposure to a radio at least once a week decreases as a women’s educational level increases; 56.7% of women with no education listen to the radio at least once a week, compared with 26.1% of women with more than secondary education. f) Yes, exposure to newspapers at least once a week increases as household wealth increases; 37.6% of women from the lowest wealth quintile read a newspaper at least once a week, compared with 61.8% of women in the highest wealth quintile. xxiv • Reading and Understanding Tables from the 2016-17 Maldives DHS Example 2 – Prevalence and Treatment of Fever A Question Asked of a Subgroup of Survey Respondents Table 10.5 Prevalence and treatment of fever Among children under age 5, percentage who had a fever in the 2 weeks preceding the survey and among children with fever in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought, and percentage who received antibiotics as treatment, according to background characteristics, Maldives DHS 2016-17 Among children under age 5: Among children under age 5 with fever: Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought1 Percentage for whom treatment was sought same or next day Percentage who took antibiotic drugs Number of children with fever Age in months <6 15.5 290 (76.3) (0.0) (31.6) 45 6-11 23.9 271 81.7 2.2 30.1 65 12-23 26.1 518 87.7 4.4 42.8 135 24-35 28.1 512 88.5 3.9 46.3 144 36-47 26.3 568 86.2 2.8 47.3 149 48-59 22.7 553 84.6 4.8 47.3 126 Sex Male 25.1 1,377 82.4 4.7 45.0 346 Female 23.8 1,335 89.0 2.2 41.7 318 Residence Malé region 34.0 952 84.9 3.4 45.1 324 Other atolls 19.3 1,759 86.2 3.5 41.8 340 Region Malé 34.0 952 84.9 3.4 45.1 324 North 21.4 425 82.3 5.0 42.7 91 North Central 16.2 389 85.3 0.8 42.9 63 Central 35.2 226 89.7 7.1 41.1 80 South Central 14.6 335 85.4 1.8 39.2 49 South 14.9 384 89.2 0.9 42.4 57 Mother’s education No education (30.7) 34 * * * 10 Primary 26.2 466 82.2 1.1 31.5 122 Secondary 23.5 1,625 87.4 5.3 47.2 382 More than secondary 25.5 587 83.7 0.6 44.0 150 Wealth quintile Lowest 20.8 553 86.8 1.8 40.0 115 Second 20.2 586 84.6 5.5 46.7 118 Middle 22.0 610 79.3 2.4 51.0 134 Fourth 29.7 479 88.1 3.1 32.2 142 Highest 32.0 483 (88.6) (4.6) (47.0) 155 Total 24.5 2,712 85.6 3.5 43.4 664 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 Includes advice or treatment from the following sources: Public sector, private medical sector and shop. Excludes advice or treatment from a traditional practitioner Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age 5 (a) and children under age 5 with fever in the 2 weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to children under age 5 (a), and then isolate the columns that refer only to children under age 5 with fever in the 2 weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age 5 had fever in the 2 weeks before the survey? It’s 24.5%. Now look at the second panel. How many children under age 5 are there who had fever in the 2 weeks before the survey? It’s 664 children or 24.5% of the 2,712 children under age 5. The second panel is a subset of the first panel. Step 4: Only 24.5% of children under age 5 had fever in the 2 weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable.  What percentage of children under age 6 months who had fever in the 2 weeks before the survey had advice or treatment sought? It’s 76.3%. This percentage is in parentheses because there are between 1 2 3 4 a b Reading and Understanding Tables from the 2016-17 Maldives DHS • xxv 25 and 49 unweighted cases in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 4.)  What percentage of children under age 5 who had fever in the 2 weeks before the survey whose mothers have no education had advice or treatment sought? There is no number in this cell—only an asterisk. This is because fewer than 25 unweighted cases. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. xxvi • Reading and Understanding Tables from the 2016-17 Maldives DHS Example 3 – Understanding Sampling Weights in MDHS Tables A sample is a group of people who have been selected for a survey. In the MDHS, the sample is designed to represent the national population age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a minimum sample size per area. For the 2016-17 MDHS, the survey sample is representative at the national and regional levels, and for urban and rural areas. To generate statistics that are representative of the country as a whole and the six regions, the number of women surveyed in each region should contribute to the size of the total (national) sample in proportion to size of the region. However, if some regions have small populations, then a sample allocated in proportion to each region’s population may not include sufficient women from each region for analysis. To solve this problem, regions with small populations are oversampled. For example, let’s say that you have enough money to interview 7,699 women and want to produce results that are representative of the Maldives as a whole and its regions (as in Table 3.1). However, the total population of the Maldives is not evenly distributed among the regions: some regions, such as Malé, are heavily populated while others, such as Central region are not. Thus, Central region must be oversampled. A sampling statistician determines how many women should be interviewed in each region in order to get reliable statistics. The blue column (1) in the table at the right shows the actual number of women interviewed in each region. Within the regions, the number of women interviewed ranges from 996 in both Malé and Central region to 1,688 in South Central. The number of interviews is sufficient to get reliable results in each region. With this distribution of interviews, some regions are overrepresented and some regions are underrepresented. For example, the population in Malé is about 45% of the population in the Maldives, while Central region’s population contributes only 7% of the population in the Maldives. But as the blue column shows, the number of women interviewed in Malé accounts for only about 13% of the total sample of women interviewed (996 / 7,699) and the number of women interviewed in the Central region accounts for the same percentage of the total sample of women interviewed (13%, or 996 / 7,699). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of the Maldives, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small region, like Central region, should only contribute a small amount to the national total. Women from a large region, like Malé, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each region so that each region’s contribution to the total is proportional to the actual population of the region. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at the regional level. The total national sample size of 7,699 women has not changed after weighting, but the distribution of the women in the regions has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the green column (3) to the actual population distribution Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Maldives DHS 2016-17 Women Background characteristic Weighted percent Weighted number Unweighted number Region Malé 44.5 3,424 996 North 12.7 981 1,297 North Central 11.9 913 1,434 Central 6.6 507 996 South Central 11.0 844 1,688 South 13.4 1,030 1,288 Total 15-49 100.0 7,699 7,699 1 2 3 Reading and Understanding Tables from the 2016-17 Maldives DHS • xxvii of the Maldives, you would see that women in each region are contributing to the total sample with the same weight that they contribute to the population of the country. The weighted number of women in the survey now accurately represents the proportion of women who live in Malé and the proportion of women who live in Central region. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national and regional levels. In general, only the weighted numbers are shown in each of the MDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Sustainable Development Goals Indicators  xxix SUSTAINABLE DEVELOPMENT GOALS INDICATORS Sustainable Development Goals Indicators, Maldives DHS 2016-17 Sex Total Table number Indicator Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 16.3 14.2 15.3 11.1 2.2.2 Prevalence of malnutrition among children under 5 years of age1 16.9 11.1 14.1a 11.1 a) Prevalence of wasting among children under 5 years of age 10.1 8.1 9.1 11.1 b) Prevalence of overweight among children under 5 years of age 6.7 3.0 4.9 11.1 3. Good health and well-being 3.1.2 Proportion of births attended by skilled health personnel na na 99.5 9.6 3.2.1 Under-five mortality rate2 24 16 20 8.2 3.2.2 Neonatal mortality rate2 13 10 11 8.2 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods na 29.4 na 7.13.2 3.7.2 Adolescent birth rates per 1,000 women a) Girls aged 10-14 years3 na 0 na na b) Women aged 15-19 years4 na 10 na 5.1 3.a.1 Age-standardised prevalence of current tobacco use among persons aged 15 years and older5 42.4 2.7 22.5a 3.10 3.b.1 Proportion of the target population covered by all vaccines included in their national programme6 75.4 77.4 76.4 10.3 a) Coverage of DPT containing vaccine (3rd dose)7 84.6 85.4 85.0 10.3 b) Coverage of measles containing vaccine (2nd dose)8 74.3 76.4 75.3 10.3 4. Quality education 4.2.1 Proportion of children under 5 years of age who are developmentally on track in health, learning, and psychosocial well-being, by sex9 90.0 94.0 92.0 16.5 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months10,11 na 16.7 na 14.13 a) Physical violence na 5.5 na 14.13 b) Sexual violence na 0.7 na 14.13 c) Psychological violence na 14.1 na 14.13 5.3.1 Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 a) Before age 15 na 0.0 na 4.3 b) Before age 18 na 2.2 na 4.3 5.3.2 Proportion of girls and women aged 15-49 years who have undergone female genital cutting na 12.9 na 17.2 5.6.1 Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care12 na 53.9 na na 5.b.1 Proportion of individuals who own a mobile telephone13 96.7 95.5 96.1a 13.5 Residence Malé region Other atolls 6. Clean water and sanitation 6.1.1 Proportion of the population using safely managed drinking water services14 99.3 98.0 98.6 2.1 6.2.1 Proportion of the population using safely managed sanitation services, including a handwashing facility with soap and water15 98.9 97.9 98.3 2.3 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity 99.7 99.9 99.8 2.4 7.1.2 Proportion of population with primary reliance on clean fuels and technology16 99.6 98.5 99.0 2.4 Sex Male Female 8. Decent work and economic growth 8.10.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money- service provider17 73.6 63.4 68.5a 13.5 16. Peace, justice, and strong institutions 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 98.5 99.1 98.8 2.12 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet18 86.8 78.3 82.6a 3.5 na = Not applicable 1 Defined as the sum of the prevalence of wasting and the prevalence of overweight 2 Expressed in terms of deaths per 1,000 live births for the 5-year period preceding the survey 3 Age-specific fertility rate for girls age 10-14 for the 3-year period preceding the survey, expressed in terms of births per 1,000 girls age 10-14 4 Age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 5 Data are not age-standardised and are available for women and men age 15-49 only. 6 Percentage of children age 12-23 months who received BCG, hepatitis B (birth dose), three doses of Pentavalent, three doses of polio vaccine, and one dose of measles 7 Percentage of children age 12-23 months who received three doses of DPT containing vaccine (Pentavalent) 8 Percentage of children age 24-35 months who received two doses of measles containing vaccine 9 Measured for children age 36-59 months 10 Data are available for women age 15-49 who have ever been in union only. 11 In the DHS, psychological violence is termed emotional violence. 12 Data are available for currently married women who are not pregnant only. 13 Data are available for women and men age 15-49 only. 14 Measured as the percentage of de jure population using an improved water source, i.e., whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, or rainwater collection. Households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and handwashing. 15 Measured as the percentage of de jure population using an improved sanitation facility, i.e., whose household has a flush or pour flush toilet to a piped water system, septic tank or pit latrine; ventilated improved pit latrine; pit latrine with a slab; or composting toilet and does not share this facility with other households. 16 Measured as the percentage of the population using clean fuel for cooking. 17 Data refer to women and men age 15-49 who have and use an account at a bank or other financial institution; information on use of a mobile-money-service provider is not available 18 Data are available for women and men age 15-49 who have used the internet in the past 12 months. a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females Acronyms and Abbreviations • xxxi ACRONYMS AND ABBREVIATIONS AIDS acquired immunodeficiency syndrome ANC antenatal care ARI acute respiratory infection ART antiretroviral therapy ASAR age-specific attendance rate (school) ASFR age-specific fertility rate BCG Bacille-Calmette-Guerin vaccine against tuberculosis BMI body mass index CAPI computer-assisted personal interviewing CB census block CBR crude birth rate COPD chronic obstructive pulmonary disease CPR contraceptive prevalence rate CSG community-based support group CSPro software used by the DHS Program DEFT design effect DHS Demographic and Health Survey DPT diphtheria, pertussis, and tetanus vaccine EA enumeration area EPI Expanded Program on Immunisation GAR gross attendance ratio GFR general fertility rate GPI gender parity index HepB hepatitis B Hib haemophilis influenzae type b HIV human immunodeficiency virus HMIS health management information system IFSS internet file streaming system IPV inactivated polio vaccine IUD intrauterine device IYCF infant and young child feeding LAM lactational amenorrhoea method LCL lower confidence limit LPG liquified petroleum gas MAD minimum acceptable diet MDD minimum dietary diversity MDHS Maldives Demographic and Health Survey MMF minimum meal frequency xxxii  Acronyms and Abbreviations MMR measles, mumps and rubella MoH Ministry of Health MTCT mother-to-child transmission na not applicable NAR net attendance ratio NGO nongovernmental organization N unweighted number of cases NN neonatal mortality OPV oral polio vaccine ORS oral rehydration salts ORT oral rehydration therapy PMTCT prevention of mother-to-child transmission (of HIV) PNN postneonatal mortality PPS probability proportional to size PSU primary sampling unit RHF recommended homemade fluids SD standard deviation SDG Sustainable Development Goals SDM standard days method SE standard error STI sexually transmitted infection TB tuberculosis TFR total fertility rate TWFR total wanted fertility rate UCL upper confidence limit UN United Nations UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund VAD vitamin A deficiency VIP ventilated improved pit WHO World Health Organization WN weighted number of cases xxxiv • Map of Maldives Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2016-17 Maldives Demographic and Health Survey (MDHS) is the second Demographic and Health Survey conducted in the Maldives. It was implemented by the Ministry of Health (MOH). Data collection took place from 17 March 2016 to 27 November 2017. Financial support for the 2016-17 MDHS was provided by the Government of the Maldives, WHO, UNICEF and UNFPA. ICF provided technical assistance through the DHS Program, which offers support and technical assistance for the implementation of population and health surveys in countries worldwide. 1.1 SURVEY OBJECTIVES The primary objective of the 2016-17 MDHS is to provide up-to-date estimates of key demographic and health indicators. The MDHS provides a comprehensive overview of population, maternal, and child health issues in the Maldives. More specifically, the 2016-17 MDHS:  Collected data at the national level that allowed calculation of key demographic indicators, particularly fertility and under-5 mortality rates  Explored the direct and indirect factors that determine levels and patterns of fertility and child mortality  Measured levels of contraceptive knowledge and practice  Collected data on key aspects of family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery  Obtained data on child feeding practices, including breastfeeding  Collected anthropometric measures to assess the nutritional status of children under age 5, women age 15-49, and men age 15-49  Conducted haemoglobin testing on children age 6-59 months and women age 15-49 to provide information on the prevalence of anaemia in these groups  Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and assessed the coverage of past HIV testing  Collected data on the prevalence of disabilities among all household members  Collected data on early childhood education, support for children’s learning, and the level of inadequate care for young children  Assessed the level of knowledge and self-reported prevalence of certain non-communicable diseases such as hypertension, diabetes, thalassemia, and tuberculosis  Collected data on knowledge and prevalence of female circumcision among women age 15-49 and their daughters age 0-14  Obtained data on women’s experience of emotional, physical, and sexual violence. T 2 • Introduction and Survey Methodology As the second DHS conducted in the Maldives, following the 2009 MDHS survey, the 2016-17 MDHS provides valuable information on trends in key demographic and health indicators over time. The information collected through the 2016-17 MDHS is intended to assist policymakers and programme managers in evaluating and designing programs and strategies for improving the health of the country’s population. 1.2 SAMPLE DESIGN The sampling frame used for the 2016-17 MDHS is the 2014 Maldives Population and Housing Census, provided by the National Bureau of Statistics in Maldives. The census frame is a complete list of all 997 census blocks (CB) created for the 2014 census. A CB is a geographic area containing an average of 58 households. The sampling frame contains information about the CB location and estimated number of residential households. Each CB has accompanying cartographic materials. These materials delineate geographic locations, boundaries, main access, and landmarks in or outside the CB that help identify the CB. At the time of the census, the population of the Republic of Maldives was distributed on 188 inhabited islands with the population size of the islands varying from 73 (Thinadhoo island in Felidhu/Vaavu [V] atoll) to 133,412 (in Malé city). Each inhabited island is an administrative unit with an island council. The islands are grouped to form atolls, which is a higher level administrative unit with an atoll council. In total, excluding the Malé area (Malé, Villimale, and Hulhumale), there are 20 atolls in the country. These 20 atolls along with the Malé area are regrouped to form six geographical regions (Malé region, North region, North Central region, Central region, South Central region, and South region) according to their locations as follows:  Malé region—Malé, Villimalé and Hulhumale  North region—Haa Alif (HA), Haa Dhaal (H. Dh) and Shaviyani (Sh)  North Central region—Noonu (N), Raa (R), Baa (B) and Lhaviyani (Lh)  Central region—Kaafu (K), Alif Alif (AA), Alif Dhaal (A Dh) and Vaavu (V)  South Central region—Meemu (M), Faafu (F), Dhaalu (Dh), Thaa (Th) and Laamu (L)  South region—Gaafu Alif (Ga), Gaafu Dhaal (GDh), Gnaviyani (Gn) and Seenu (S) In the Maldives, there is no urban-rural designation for residential households. In place of urban-rural, for this survey, the residence variable was defined as Malé region and other atolls. This corresponds with the urban-rural residence categories used in the 2009 MDHS. Consequently, readers should be aware that households labelled as “urban” in 2009 are equivalent to those labelled “Malé region” in 2016-17 and those labelled as “rural” in 2009 are labelled as “other atolls” in this survey. The 2016-17 MDHS sample is designed to yield representative information for most indicators for the country as a whole, for residence, and for each of Maldives’s six regions. Also, the MDHS sample is designed to yield representative information for some selected indicators for each of the atolls of the country. The sample for the 2016-17 MDHS was a stratified sample selected in two stages from the sampling frame. Stratification was achieved by separating each region into atolls; in total, 21 sampling strata were created, within each of which samples were selected independently. In the first stage, 266 CBs were selected with probability proportional to size according to the sample allocated to each stratum. The CB size is the number of residential households residing in the CB based on the 2014 census. Because of the large variation in the size of atolls, a proportional allocation of the sample points to the atolls is not adequate since the small atolls will receive too few sample points. The allocation adopted is a somewhat adjusted equal size allocation at atoll level except Malé which consists of 38% of the total residential population of the Maldives. This allocation will guarantee a better precision at atoll level and comparability across atolls. Introduction and Survey Methodology • 3 Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling. After the selection of CBs and immediately before interviewing, a household listing operation was carried out. The household listing operation was implemented by the teams of fieldworkers who, upon entering a sampled CB, would disperse to record on their tablet computers all occupied Maldivian residential households found in the CB with the address and the name of the head of the household. The resulting list of households served as the sampling frame for the selection of households in the second stage. In the second stage of selection, a fixed number of 25 households was selected in every CB (cluster) (except for Felidhu Atoll (V) where about 42 households on average were selected in all the six clusters of the atoll), by an equal probability systematic sampling based on the household listing. Selection of households was done on the supervisor’s tablet in the field. A total of 6,750 households was sampled, 1,075 households in Malé region and 5,675 households in other areas. The survey interviewers were required to interview only the pre-selected households. No replacements and no changes of the pre- selected households were allowed in order to prevent bias. Unlike the 2009 MDHS in which only ever-married women and men were interviewed, in the 2016-17 MDHS, all women and men age 15-49 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. Among women eligible for an individual interview, one woman per household was selected for questions about domestic violence. In all of the selected households, height and weight measurements were collected from children age 0-59 months, women age 15-49, and men age 15-49. Anaemia testing was performed on consenting women age 15-49 and on children age 6-59 months whose parent/guardian consented to the testing. The MDHS was for the most part limited to Maldivian citizens; non-Maldivians were included in the survey only if they were the spouse, son, or daughter of a Maldivian. Survey weights have been calculated, added to the data file, and applied so that weighted results are representative estimates of indicators at the regional and national levels. 1.3 QUESTIONNAIRES Four questionnaires were used for the 2016-17 MDHS: the Household Questionnaire, Woman’s Questionnaire, Man’s Questionnaire, and Biomarker Questionnaire. All questionnaires were based on the DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires that were adapted to reflect the population and health issues relevant to the Maldives. Input was solicited from various stakeholders representing relevant department and divisions within MOH, other government agencies, universities, non-governmental organisations and international agencies. All questionnaires were translated from English to Dhivehi and back-translated into English. The Household Questionnaire was used to list all members of the households and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also collected information on disability for each household member and characteristics of the household’s housing unit, such as source of water, type of toilet facility, materials used for the floors, walls, and roof of the housing unit, and ownership of various durable goods. The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: 4 • Introduction and Survey Methodology  Background characteristics (including age, marital status, education, and media exposure)  Birth history and childhood mortality  Family planning, including knowledge, use, and sources of contraceptive methods  Fertility preferences (including desire for more children and ideal number of children)  Antenatal, delivery, and postnatal care  Breastfeeding and infant feeding practices  Vaccinations and childhood illnesses  Women’s work and husbands’ background characteristics  Knowledge and awareness regarding HIV/AIDS and other sexually transmitted diseases (STDs)  Self-reported prevalence of smoking and selected diseases (e.g., hypertension, diabetes)  Female circumcision  Early childhood development and support for learning  Violence against women The Man’s Questionnaire was administered to all men age 15-49. This questionnaire collected much of the same information elicited from the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history, questions on maternal and child health, or questions on domestic violence. The Biomarker Questionnaire was used to record biomarker data collected from respondents by health workers, nurses, and trained interviewers. The Household, Woman’s and Man’s Questionnaires were programmed into tablet computers to allow for computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose either of the languages for each questionnaire. The tablets were equipped with Bluetooth® technology to enable remote electronic transfer of files (transfer of assignment sheets from team editors to interviewers and transfer of completed questionnaires from interviewers to supervisors). The computer-assisted personal interviewing (CAPI) data collection system employed in the 2016-17 MDHS was developed by the DHS Program using the mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, the DHS Program, and Serpro S.A. 1.4 ANTHROPOMETRY AND ANAEMIA TESTING The 2016-17 MDHS incorporated the following biomarkers: anthropometry and anaemia testing. These biomarkers were collected in all households. In contrast with the data collection procedures for the household and individual interviews, biomarker data were initially recorded on the paper-based Biomarker Questionnaire and subsequently entered into interviewers’ tablet computers. The survey protocol, including biomarker collection, was reviewed and approved by the National Health Research Committee of the Maldives and the Institutional Review Board of ICF. Anthropometry. Height and weight measurements were carried out on women age 15-49, men age 15-49, and children under age 5 in all selected households. Weight measurements were obtained using lightweight SECA mother-infant scales with a digital screen designed and manufactured under the guidance of UNICEF. Height measurements were carried out using a measuring board also provided by UNICEF. Children younger than 24 months were measured for height while lying down, and older children were measured while standing. Anaemia testing. Blood specimens for anaemia testing were collected from women age 15-49 who voluntarily consented to be tested and from children age 6-59 months for whom consent was obtained from their parents or other adults responsible for them. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Haemoglobin analysis was carried out on-site using a battery-operated portable HemoCue analyser. Results were provided verbally and in writing. Parents or responsible adults of children whose haemoglobin level was below 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their haemoglobin Introduction and Survey Methodology • 5 levels were below 7 g/dl and 9 g/dl, respectively. All households in which anaemia testing was conducted were given a brochure explaining the causes and prevention of anaemia. 1.5 PRETEST Training for the pretest for the 2016-17 MDHS was conducted in early October 2015 at the Customs Building in Malé. Participants included 5 women and 5 men recruited as interviewers as well as 1 survey director, 3 survey managers, 2 computer specialists to manage the CAPI aspect of the survey, and other senior staff from the MoH. Three representatives from The DHS Program assisted with the training. Sessions included in-class training, practice interviews, guest lectures, hands-on practice with tablet computers, and field practice days. Participants were also trained on how to weigh and measure adults and children; however, anaemia testing was not included in the pretest. Pretest training also included instructions on how to list households and update the listing provided by the 2014 Census prior to selecting the 25 households for interviews, using the CSPro program on listing. The field practice was conducted in four census blocks/clusters (2 in Malé to represent Malé region and 2 in the island of Guraidhoo to represent other atolls) that were not included in the 2016-17 MDHS sample. In addition, pretesting of listing activities in CAPI was conducted in all 4 census blocks. Following the field practice, a 1-day debriefing session was held at the MoH to review issues that arose during the pretest exercise. 1.6 TRAINING OF FIELD STAFF Two rounds of training were conducted for the main fieldwork of the MDHS. The first training took place from 14 February to 15 March 2016 at Dharubaruge in Malé with 57 participants. The training was also attended by 3 survey managers, 1 logistic and accounting officer and 2 computer specialists to manage the CAPI aspect of the survey. Participants were trained initially using the paper questionnaires, starting with a complete review of all questions. Practice interviews between participants gave trainees experience in asking questions and recording answers. Training also included practice of height and weight measurements, with a few children coming to the training hall to be measured, and orientation on filling in the Biomarker Questionnaire. In addition, trainees participated in a 2-day practice in the field using the paper questionnaire in non-sampled census blocks in Malé. Participants then moved to learning how to use the CAPI system on the tablet computers. CAPI sessions were practical and involved role-playing in order to first carry out household listing and to complete the Household, Woman’s, and Man’s Questionnaires on the tablet. At the end of the training, interviewers and supervisors were familiar with the tablets for use in data collection, managing and transferring questionnaires among team members, as well as supervisory responsibilities. Towards the end of the training, a standardisation exercise on height and weight measurement was conducted as part of the training at a local pre-school in Malé. Also, towards the end of the training, the supervisors and survey managers were oriented on how to fill the assignment sheets and quality control checklist. Five health workers in Malé were separately trained on how to implement the anaemia testing. During the first round of training, field practice was conducted in Malé from 8-12 March 2016 with seven teams, each composed of one supervisor and three pairs of interviewers (one female, one male). Each team was assigned a cluster of 25 households that was not included in the survey’s sample. They were able to perform all CAPI procedures including household listing, sample selection, household assignment to interviewers, conducting interviews, entering biomarker questionnaires, and closing their respective clusters. Field practice data were sent over the Internet File Streaming System (IFSS) to the central office. The survey commenced its second round of training from 19 March to 13 April 2017 at Asaree Hall (SHE building). A total of 37 enumerators were trained during this round under similar procedures used in the first training. Although the first round of training consisted mainly of enumerators recruited from the 6 • Introduction and Survey Methodology general public, the second round of enumerators were recruited from different public health facilities across the Maldives. Hence, several nurses and community health workers were part of the enumerators in the second round. Field practice was conducted for 3 days within census blocks in Malé in clusters that were not selected for the survey sample. 1.7 FIELDWORK Data collection took place over a 20-month period, from 17 March 2016 to 27 November 2017. Fieldwork was carried out in two phases. The first phase was carried out from 17 March to 31 October 2016. During this phase, data collection was completed in the Malé region, Kaafu atoll (K), North Ari atoll (AA), and South Ari atoll (ADh). Initially, there were 6 field teams, each consisting of one team supervisor, one health worker, and either 6 or 8 interviewers (half female and half male) during the data collection in the Malé region. However, since a few team members were unable to join fieldwork in the atolls, the teams were regrouped to form five teams composing of one team supervisor and either 6 or 8 interviewers. Anaemia testing was carried out either by trained enumerators or with assistance from health facilities located on site. The second phase of fieldwork took place from mid-April to 27 November 2017. Five teams, each composed of one team supervisor and 6-8 interviewers, were initially dispatched to complete data collection in the remaining atolls. Towards the end of the survey, teams were reduced to align with the few remaining atolls. Special attention was given to ensure that either an experienced nurse or community health worker was placed in each team to assist in anaemia testing. Electronic data files were transferred to the MoH central office in Malé every few days via the secured IFSS. Staff from MoH coordinated and supervised fieldwork activities. Field check tables based on data from completed questionnaires were generated periodically by the central office and used to monitor progress and provide feedback to the field teams. 1.8 DATA PROCESSING All electronic data files for the 2016-17 MDHS were transferred via IFSS to the MoH central office in Malé, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of open- ended questions. Data editing was accomplished using CSPro software. During the duration of fieldwork, tables were generated to check various data quality parameters and specific feedback was given to the teams to improve performance. Secondary editing and data processing were initiated in March 2016 and completed in April 2018. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2016-17 MDHS. A total of 6,697 households were selected for the sample, of which 6,608 were occupied. Of the occupied households, 6,050 were successfully interviewed, yielding a response rate of 92%. In the interviewed households, 9,170 women age 15-49 were identified for individual interviews; these interviews were completed with 7,699 women, yielding a response rate of 84%. In addition, 6,335 men age 15-49 were identified, of whom 4,342 were interviewed for a response rate of 69%. All response rates are considerably lower in Malé region than in other atolls; for example, the response rate of women to individual interviews was only 68% in Malé, compared with 87% in other atolls. Overall, the response rate at the household level (92%) is slightly higher than it was for the 2009 MDHS (90%). Introduction and Survey Methodology • 7 Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Maldives DHS 2016-17 Residence Total Result Malé region Other atolls Household interviews Households selected 1,070 5,627 6,697 Households occupied 1,034 5,574 6,608 Households interviewed 776 5,274 6,050 Household response rate1 75.0 94.6 91.6 Interviews with women age 15-49 Number of eligible women 1,461 7,709 9,170 Number of eligible women interviewed 996 6,703 7,699 Eligible women response rate2 68.2 87.0 84.0 Interviews with men age 15-49 Number of eligible men 1,228 5,107 6,335 Number of eligible men interviewed 628 3,714 4,342 Eligible men response rate2 51.1 72.7 68.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings  Drinking water: In the Maldives, 98% of households have access to an improved source of drinking water; almost half of households get drinking water from rainwater.  Toilet facilities: Similarly, 98% of households use flush toilets.  Hand washing: Soap and water, the essential hand washing agents, were observed in 98% of households.  Electricity: In the Maldives, 100% of households have access to electricity.  Household population and composition: Less than one- third of Maldivians are under age 15 (30%), while 6% are age 65 and older.  Disability: The prevalence of disability is low in the Maldives. Only 4% of the household population were reported to have any disability. nformation on the socioeconomic characteristics of the household population in the 2016-17 MDHS provides a context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on sources of drinking water, sanitation, exposure to smoke inside the home, wealth, hand washing, household population and composition, educational attainment, school attendance, birth registration, children’s living arrangements, parental survivorship, and disability. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, and rainwater. Households that use bottled water for drinking are classified as using an improved source only if the water they use for cooking and hand washing comes from an improved source. Sample: Households It is important to note that an improved source of water does not necessarily provide clean, safe water. For example, almost half of households in the Maldives (47%) use rainwater for drinking. Although rainwater is considered to be an improved source, its cleanliness depends on the conditions in which it is collected and stored. On the other hand, 16% of households use piped water for drinking. Piped water in the Maldives is produced by sea water desalination, all of which is considered to be clean and safe. I 10 • Housing Characteristics and Household Population In the Maldives, 98% of households have access to an improved source of drinking water (Table 2.1). Households rely on different sources of drinking water depending on residence. The most common sources of drinking water in Malé region are bottled water (76%) and water piped into the household’s dwelling, yard, or plot (23%). By contrast, households in the other atolls obtain their drinking water mainly from rainwater (75%), followed by piped water (11%), and bottled water (10%) (Figure 2.1). Overall, 21% of households in the Maldives (13% in Malé region and 25% in other atolls) are using an appropriate treatment method. Appropriate treatment methods include boiling, adding bleach/chlorine, filtering, and solar disinfecting (Table 2.1). Trends: The proportion of households with an improved source of drinking water has increased only slightly, from 97% in 2009 to 98% in 2016-17. However, there have been changes in the specific sources of drinking water. For example, the proportion of households using rainwater decreased from 67% in 2009 to 47% in 2016-17, while the proportion using bottled water increased from 13% to 35% over the same period. Table 2.2 presents information on the percentage of households using piped water that reported availability of water in the last 2 weeks. Eighty-two percent of households in the Maldives reported having water with no interruption of at least 1 day in the last 2 weeks. Households in Malé region were more likely than households in other atolls to report no availability of water for at least 1 day (20% versus 10%). 2.2 SANITATION Improved toilet facilities Include any non-shared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; and pit latrines with slabs. Sample: Households Figure 2.1 Household drinking water by residence 16 23 11 47 <1 75 35 76 101 <1 1 2 1 2 Total Malé region Other atolls Percent distribution of households by source of drinking water Unimproved source Other improved source Bottled water Rainwater Piped water into dwelling/yard/plot Housing Characteristics and Household Population • 11 Overall, 98% of households in the Maldives use improved toilet facilities (99% in in Malé region and 98% in other atolls) (Figure 2.2). Households outside of Malé region are more likely to have toilets that flush into septic tanks, whereas almost all households in Malé have toilets that flush into a piped sewer system. (Table 2.3). Trends: There has been some slight improvement in household sanitation facilities. The proportion of households with improved sanitation facilities has increased from 94% in 2009 to 98% in 2016-17. 2.3 HOUSING CHARACTERISTICS 2.3.1 Exposure to Smoke inside the Home Exposure to smoke inside the home, either from cooking with solid fuels or smoking tobacco, has potentially harmful health effects. Less than 1% of households in the Maldives uses some type of solid fuel for cooking, with the vast majority using liquefied petroleum gas (LPG) or natural gas (Table 2.4). Exposure to cooking smoke is greater when cooking takes place inside the house rather than in a separate building or outdoors. In the Maldives, 72% of households cook inside the house (96% of households in Malé region and 57% of households in other atolls); however, since 98% of households use clean fuel for cooking, cooking inside the house is not an important source of air pollution in Maldives. Rather, the most important source of smoke inside the home in the Maldives is due to smoking. In more than one in five households (22%), someone smokes inside the house on a daily basis. 2.3.2 Other Housing Characteristics The 2016-17 MDHS also collected data on access to electricity and the number of rooms used for sleeping. All households (100%) in the Maldives have electricity (Table 2.4). Half of the households have three or more rooms that are used for sleeping. 2.3.3 Housing Materials The 2016-17 MDHS collected data on the types of materials used for flooring, roofing, and walls of the households covered in the survey. The two most commonly used materials for flooring in the Maldives are ceramic tiles (84% of households) and cement or slake lime (11%). Households outside Malé region are more likely to have cement floors than households in Malé region, almost all of which have ceramic tile floors (93%). With regard to roofing materials, 6 in 10 households use galvanised sheets. Galvanised roofs are more common in other atolls than in Malé region, where concrete roofs are almost as common. More than three-quarters of households in the Maldives (78%) live in housing with cement walls, which are much more common for households in Malé region (94%) than households in other atolls (68%) (Table 2.5). Figure 2.2 Household toilet facilities by residence 60 98 36 39 1 62 2 1 2 Total Malé region Other atolls Percent distribution of households by type of toilet facilities Unimproved, shared or no facility Flush to septic/latrine Flush to sewer system 12 • Housing Characteristics and Household Population 2.3.4 Household Durable Goods The survey also collected information on household effects and means of transportation. The most commonly found item in all households is a mobile phone (99%). Other items owned by more than 9 in 10 households include a refrigerator (98%), a washing machine (98%), and a television (94%). Ownership of a satellite or cable television connection is widespread (83% of households), as is ownership of a watch (71%), a computer (70%), and internet connection (67%)1 (Table 2.6 and Figure 2.3). Regarding means of transport, 6 in 10 households in the Maldives own either a motorcycle or scooter, while 4 in 10 own a bicycle. Only 5% of households own a car or truck. Households in Malé region are more likely than those in other atolls to possess household goods such as computers (87% versus 60%), air conditioners (72% versus 50%), and internet connection (73% versus 63%). As might be expected, households outside the Malé region are more likely than those in Malé region to own a radio (69% versus 41%) and a bicycle (59% versus 13%) (Table 2.6). Trends: It is interesting to track changes in the proportion of households owning specific durable goods. For example, the proportion of households with a radio has decreased significantly, from 83% in 2009 to 59% in 2016-17. However, the proportion owning a refrigerator has increased from 85% to 98% over the same time period. The proportion owning televisions and mobile phones has remained fairly constant. Ownership of a motorcycle or scooter has increased from 42% of households in 2009 to 60% in 2016-17. 2.4 HOUSEHOLD WEALTH Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, in addition to housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by her or his score, and then dividing the distribution into five equal categories, each comprising 20% of the population. Sample: Households 1 The question ‘Does your household have internet connection’ may have produced an underestimate of internet connectivity, given the almost universal access to mobile phones—most of which include internet coverage. Figure 2.3 Ownership of household assets 99 98 98 94 83 71 70 67 59 59 7 Mobile phone Refrigerator Washing machine Television Satellite/cable TV Watch Computer Internet connection Radio Air conditioner Non-mobile phone Percentage of households owning specific assets Housing Characteristics and Household Population • 13 Table 2.7 presents data on wealth quintiles according to residence and region. The wealthiest households are concentrated in Malé region (49%). In contrast, approximately two-thirds of the population in other atolls (64%) falls in the lowest two wealth quintiles (Figure 2.4). Other than Malé, regional variations in wealth are small. 2.5 HAND WASHING To obtain hand washing information, interviewers asked to see the place where members of the household most often wash their hands. Interviewers were able to see a place for hand washing in 97% of households. The essential hand washing agents— soap and water—were observed in 98% of households. Differences by residence, region, and wealth are small (Table 2.8). 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors). De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview. How data are calculated All tables are based on the de facto population unless otherwise specified. Household composition and population data provide information on the socioeconomic characteristics of the households and respondents surveyed in terms of age, sex, and place of residence. A total of 32,191 individuals stayed overnight in the households interviewed in the 2016-17 MDHS. Almost 54% of them (17,260) were female, and 46% (14,931) were male (Table 2.9). Children under age 15 (30%) represent nearly one-third of the population, while individuals age 15-64 (64%) represent almost two-thirds of the population. Only 6% of Maldivians are age 65 or older. The population pyramid in Figure 2.4 Household wealth by residence 1 33 4 31 8 29 38 8 49 <1 Malé region Other atolls Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest 14 • Housing Characteristics and Household Population Figure 2.5 shows the population distribution by 5-year age groups, separately for males and females. The relatively narrow base of the pyramid is suggestive of a decline in fertility levels. The pyramid also shows a bulge for women ages 20-34, as well as an excess of women ages 20-59 relative to men, which is probably due to the greater likelihood of men working outside the home.2 The average household size in the Maldives is 5.4 persons. Households in Malé region (5.7 persons) are slightly larger than those in other atolls (5.2 persons). Men head the majority of Maldivian households (56%), with 44% of households headed by women (Table 2.10). Trends: The age distribution of the household population has changed little since 2009, when children under age 15 accounted for 31% of the population and individuals age 65 and older accounted for 5%. However, average household size has decreased from 6.4 persons in 2009 to 5.4 in 2016-17. The percentage of female-headed households increased during that period (35% in 2009 versus 44% in 2016-17). 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents who are dead. Sample: Children under age 18 Only 2% of children under age 18 are orphans, with one or both parents dead. The percentage of children who are orphans rises rapidly with age from less than 1% among children under age 5 to 5% among children age 15-17. With regard to living arrangements, only 5% of children under age 18 are not living with either biological parent; however, only 56% live with both parents. Over one-third of children under 18 live with their mother but not their father. Fifteen percent of children age 15-17 are not living with either parent, even though both of their parents are alive (Table 2.11). Trends: The percentage of children under age 18 who are orphans declined slightly between 2009 and 2016-17, from 3% to 2%. The percentage of children under age 18 who do not live with a biological parent also declined slightly, from 6% to 5%. However, the proportion of children living with both biological parents declined considerably between 2009 and 2016-17, from 71% to 56%, with many more children now living with only their mothers. 2 In the Maldives, many men are employed in tourist resorts where they live in staff quarters and did not qualify to fall in the sample. Others work on fishing boats for extended periods and may not have been listed in the household population. Figure 2.5 Population pyramid 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 2610 Housing Characteristics and Household Population • 15 2.8 BIRTH REGISTRATION Registered birth Child has a birth certificate or child does not have a birth certificate, but his/her birth is registered with the civil authorities. Sample: De jure children under age 5 Table 2.12 presents information on birth registration of children under age 5. At the time of the survey, the births of 99% of children under age 5 had been registered with the civil authorities. Almost all of these children have birth certificates. There are almost no differences in these proportions by background characteristics. Trends: Birth registration coverage has increased since 2009, from 93% of births registered in 2009 to 99% in 2016-17 (Figure 2.6). 2.9 EDUCATION Education is one of the most important aspects of social and economic development. Education improves capabilities and is strongly associated with various socioeconomic variables such as lifestyle, income, and fertility for both individuals and societies. 2.9.1 Educational Attainment Median educational attainment Half of the population has completed less than the median number of years of schooling, and half of the population has completed more than the median number of years of schooling. Sample: De facto household population age 6 and older Overall, 16% of females and males age 6 and over have never attended school.3 However, this statistic masks enormous differences by age group. For example, the proportion of women with no formal education decreases from 69% of those age 65 and over to less than 1% among those aged 15-19. Similarly, among all females age 6 and over, only 15% have completed higher secondary (Grade 12) or more; however, among women age 20-24, 41% have completed higher secondary or gone on to higher education. Educational attainment tends to be greater among those in Malé region than in the outer atolls and among those in the higher wealth quintiles (Tables 2.13.1 and 2.13.2). Trends: Educational attainment at the household level has increased since 2009. The percentage of women age 6 and over with no formal education decreased from 25% in 2009 to 16% in 2016-17, while the percentage of men with no education declined from 23% in 2009 to 16% in 2016-17. 3 In this report, education and schooling refer to formal education only. Figure 2.6 Trends in birth registration 93 99 2009 2016-17 Percentage of de jure children under age 5 whose births are registered with the civil authorities 16 • Housing Characteristics and Household Population 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary (Grades 1-7) or lower or higher secondary school (Grades 8-12). Sample: Children age 6-12 for primary school NAR and children age 13-17 for secondary school NAR In the Maldives, the primary school net attendance ratio (NAR) for the population age 6-12 is 94% (93% for girls and 94% for boys). The secondary school NAR drops to 77% (Table 2.14). Patterns by background characteristics  The primary school NAR is slightly higher in other atolls than in Malé region, while at the secondary school level, they are almost identical.  Among regions, the primary school NAR is highest in North region and lowest in Malé. The secondary school NAR is higher in North, South Central and Central regions than in other regions.  Oddly, the primary school NAR tends to decrease with increasing household wealth; however, the secondary school NAR shows a U-shaped pattern with household wealth, increasing and then decreasing at the highest quintile. 2.9.3 Other Measures of School Attendance Gross attendance ratios (GAR) The total number of children attending primary school divided by the official primary school-age population and the total number of children attending secondary school (either lower or higher) divided by the official secondary school-age population. Sample: Children age 6-12 for primary school GAR and children age 13-17 for secondary school GAR Gender parity index (GPI) The ratio of female to male students attending primary school and the ratio of female to male children attending secondary school. The index reflects the magnitude of the gender gap. Sample: Primary and secondary school students The gross attendance ratio (GAR) is 100% (98% for girls and 101% for boys) at the primary school level and 94% (96% for girls and 92% for boys) at the secondary school level. These figures indicate that, at the primary level, a few boys outside the official primary school-age population are attending primary school, while at the secondary level, not all of those who should be attending secondary school are doing so (Table 2.14). A gender parity index (GPI) of 1 indicates parity or equality between male and female school participation ratios. A GPI lower than 1 indicates a gender disparity in favour of males, with a higher proportion of males than females attending that level of schooling. A GPI higher than 1 indicates a gender disparity in favour of females. The GPI for the NAR is 0.99 at the primary school level and 1.00 at the secondary school level, which indicates that there is very little difference in overall primary school attendance by girls and boys. Similarly, the GPI for the GAR at the primary school level is 0.97 and at the secondary school level is 1.04, which indicates general gender parity in schooling (Table 2.14). Housing Characteristics and Household Population • 17 Patterns by background characteristics  Differences in the GPI by background characteristics tend to be small. Age-specific attendance rate (ASAR) Children attending school, irrespective of whether they are attending the appropriate grade for their age. Sample: De facto household population age 6-24 attending school Age-specific attendance rates (ASARs) for the population age 6 to 24 are presented in Figure 2.7 by age and sex. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. The patterns are generally the same for females and males. Approximately half of children age 6 are attending school. Between age 7 and age 16, more than 90% of children attend school. The attendance rate declines rapidly from age 16 to age 24, and in this age group ASARs are higher for females than males. 2.10 DISABILITY In the 2016-17 MDHS, respondents to the Household Questionnaire were asked whether any household member suffered from a disability. Questions were asked separately for each member. If the answer was affirmative, the interviewer asked what type of disability the household member had (e.g., vision problems, hearing loss, paralysis, etc.). Results indicate that disability is relatively rare in the Maldives. Only 4% of the household population was reported to have any disability. Among those with disabilities, medical disabilities (i.e., disability due to disease) were most commonly mentioned, followed by visual problems among women and mental problems among men (Tables 2.15.1 and 2.15.2). Among those with disabilities, approximately half receive an allowance from the government (data not shown in table). Patterns by background characteristics  The prevalence of any disability increases with age, from 1% of females under age 5 to 10% of those age 60 and over. Among males, prevalence rises from 2% of those under age 5 to 11% of those age 60 and over (Tables 2.15.1 and 2.15.2).  Disability varies by wealth quintile. Among both women and men, the proportion of the household population with any disability declines as wealth increases. For example, 7% of men in the lowest wealth quintile suffer from a disability, compared with only 3% of those in the highest quintile. Figure 2.7 Age-specific school attendance 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percentage of females and males currently attending school by age Females Males 18 • Housing Characteristics and Household Population LIST OF TABLES For more information on household population and housing characteristics, see the following tables:  Table 2.1 Household drinking water  Table 2.2 Availability of water  Table 2.3 Household sanitation facilities  Table 2.4 Housing characteristics  Table 2.5 Housing materials  Table 2.6 Household possessions  Table 2.7 Wealth quintiles  Table 2.8 Handwashing  Table 2.9 Household population by age, sex, and residence  Table 2.10 Household composition  Table 2.11 Children’s living arrangements and orphanhood  Table 2.12 Birth registration of children under age 5  Table 2.13.1 Educational attainment of the female household population  Table 2.13.2 Educational attainment of the male household population  Table 2.14 School attendance ratios  Table 2.15.1 Disability among the female household population  Table 2.15.2 Disability among the male household population Housing Characteristics and Household Population • 19 Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water and by time to obtain drinking water; percentage of households and de jure population using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Maldives DHS 2016-17 Households Population Characteristic Malé region Other atolls Total Malé region Other atolls Total Source of drinking water Improved source 99.2 97.5 98.2 99.3 98.0 98.6 Piped into dwelling/yard plot 23.0 11.4 15.8 27.3 11.7 18.1 Public tap/standpipe 0.0 0.1 0.1 0.0 0.1 0.1 Protected dug well 0.0 0.7 0.4 0.0 0.8 0.5 Rainwater—Tank in compound 0.3 74.2 46.0 0.4 76.2 45.4 Rainwater—Public/communal tank 0.0 1.1 0.7 0.0 0.9 0.5 Bottled water, improved source for cooking/handwashing1 75.9 10.0 35.2 71.7 8.3 34.1 Unimproved source 0.5 2.1 1.5 0.3 1.7 1.1 Unprotected dug well 0.0 0.0 0.0 0.0 0.0 0.0 Bottled water, unimproved source for cooking/handwashing1 0.5 2.1 1.5 0.3 1.7 1.1 Other 0.3 0.4 0.3 0.4 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 99.9 95.0 96.8 99.9 95.9 97.5 Less than 30 minutes 0.0 4.4 2.7 0.0 3.5 2.1 30 minutes or longer 0.0 0.4 0.2 0.0 0.4 0.2 Don’t know 0.1 0.2 0.2 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 4.2 4.7 4.5 4.5 4.6 4.6 Bleach/chlorine added 0.3 0.6 0.5 0.2 0.7 0.5 Strained through cloth 0.0 53.5 33.1 0.0 54.5 32.3 Ceramic, sand or other filter 9.3 20.6 16.3 11.3 21.3 17.2 Solar disinfection 0.0 0.2 0.1 0.0 0.2 0.1 Let it stand and settle 0.0 1.0 0.6 0.0 1.0 0.6 Other 0.0 23.5 14.5 0.0 24.3 14.4 No treatment 86.8 20.8 46.0 84.7 19.3 45.9 Percentage using an appropriate treatment method3 13.2 25.1 20.6 15.3 25.9 21.6 Number 2,310 3,740 6,050 13,282 19,361 32,643 1 Households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and handwashing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100%. 3 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Table 2.2 Availability of water Among households and de jure population using piped water, percent distribution by availability of water in the last 2 weeks, according to residence, Maldives DHS 2016-17 Households Population Availability of water in last 2 weeks Malé region Other atolls Total Malé region Other atolls Total Not available for at least 1 day 19.8 9.9 18.0 19.1 10.8 17.7 Available with no interruption of at least one day 79.5 90.1 81.5 80.4 89.2 81.9 Don’t know 0.6 0.0 0.5 0.5 0.0 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number using piped water1 2,272 511 2,784 13,073 2,653 15,726 1 Includes households/population reporting piped water as their main source of drinking water and households/population reporting bottled water as their main source of drinking water if their main source of water for cooking and handwashing is piped water. 20 • Housing Characteristics and Household Population Table 2.3 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities and percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, according to residence, Maldives DHS 2016-17 Households Population Type and location of toilet/latrine facility Malé region Other atolls Total Malé region Other atolls Total Improved sanitation 98.9 97.8 98.2 98.9 97.9 98.3 Flush/pour flush to piped sewer system 98.0 35.8 59.6 97.6 38.1 62.4 Flush/pour flush to septic tank 0.0 61.2 37.9 0.0 59.0 35.0 Flush/pour flush to pit latrine 0.9 0.6 0.7 1.2 0.6 0.9 Ventilated improved pit (VIP) latrine 0.0 0.1 0.0 0.0 0.1 0.1 Pit latrine with slab 0.0 0.1 0.0 0.0 0.1 0.0 Unimproved sanitation 1.1 2.2 1.8 1.1 2.1 1.7 Shared facility1 0.7 0.7 0.7 0.7 0.6 0.6 Flush/pour flush to piped sewer system 0.6 0.3 0.4 0.5 0.2 0.3 Flush/pour flush to septic tank 0.0 0.4 0.3 0.0 0.4 0.2 Flush/pour flush to pit latrine 0.1 0.0 0.1 0.1 0.0 0.1 Unimproved facility 0.4 1.3 0.9 0.5 1.3 1.0 Flush/pour flush not to sewer/septic tank/pit latrine 0.2 1.1 0.8 0.3 1.2 0.8 Pit latrine without slab/open pit 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.1 0.1 0.1 0.2 0.1 0.2 Open defecation (no facility/bush/ field) 0.0 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 2,310 3,740 6,050 13,282 19,361 32,643 Location of toilet facility In own dwelling 97.8 92.3 94.4 97.9 92.6 94.7 In own yard/plot 2.2 7.5 5.5 2.1 7.3 5.2 Elsewhere 0.0 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population with a toilet/latrine facility 2,310 3,731 6,041 13,282 19,333 32,615 1 Facilities that would be considered improved if they were not shared by two or more households. Housing Characteristics and Household Population • 21 Table 2.4 Housing characteristics Percent distribution of households and de jure population by housing characteristics, percentage using solid fuel for cooking, percentage using clean fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Maldives DHS 2016-17 Households Population Housing characteristic Malé region Other atolls Total Malé region Other atolls Total Electricity Yes 99.7 99.8 99.8 99.7 99.9 99.8 No 0.3 0.2 0.2 0.3 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 22.3 14.3 17.3 15.1 7.5 10.5 Two 38.8 29.6 33.1 34.7 23.0 27.8 Three or more 38.9 56.1 49.6 50.3 69.5 61.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Mean number of persons per sleeping room 2.4 1.8 2.0 na na na Place for cooking In the house 96.0 57.4 72.1 96.7 54.9 71.9 In a separate building 2.8 40.5 26.1 2.5 44.3 27.3 Outdoors 0.3 0.2 0.2 0.4 0.2 0.3 No food cooked in household 0.9 1.6 1.3 0.4 0.4 0.4 Other 0.0 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 3.4 2.4 2.8 2.8 1.9 2.3 LPG/natural gas 95.7 93.3 94.2 96.8 94.9 95.7 Biogas 0.0 1.5 0.9 0.0 1.7 1.0 Kerosene 0.0 0.1 0.0 0.0 0.0 0.0 Wood 0.0 0.9 0.6 0.0 1.0 0.6 Other 0.0 0.2 0.1 0.0 0.1 0.0 No food cooked in household 0.9 1.6 1.3 0.4 0.4 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 0.0 0.9 0.6 0.0 1.0 0.6 Percentage using clean fuel for cooking2 99.1 97.2 97.9 99.6 98.5 99.0 Frequency of smoking in the home Daily 14.7 26.2 21.8 17.4 29.2 24.4 Weekly 1.0 1.8 1.5 1.0 2.0 1.6 Monthly 0.3 0.3 0.3 0.3 0.4 0.4 Less than once a month 0.6 0.4 0.5 0.8 0.4 0.5 Never 83.4 71.2 75.8 80.4 68.1 73.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 2,310 3,740 6,050 13,282 19,361 32,643 na = not applicable LPG = Liquefied petroleum gas 1 Includes charcoal and wood 2 Includes electricity and LPG/natural gas/biogas 22 • Housing Characteristics and Household Population Table 2.5 Housing materials Percent distribution of households and de jure population by type of materials used for housing, according to residence, Maldives DHS 2016-17 Households Population Housing materials Malé region Other atolls Total Malé region Other atolls Total Flooring material Earth, sand 0.4 1.4 1.1 0.5 1.4 1.0 Wood/planks 0.4 0.1 0.2 0.2 0.1 0.1 Palm 0.0 0.1 0.1 0.0 0.1 0.0 Parquet or polished wood 1.9 0.5 1.0 1.9 0.6 1.1 Vinyl or asphalt strips 1.7 3.0 2.5 1.3 2.7 2.1 Ceramic tiles 93.2 78.6 84.2 93.8 80.3 85.8 Cement/Slake lime 1.6 16.0 10.5 1.3 14.6 9.2 Carpet 0.7 0.2 0.4 1.0 0.2 0.5 Other 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Roofing material No roof 0.0 0.0 0.0 0.0 0.0 0.0 Thatch/palm leaf 0.2 0.0 0.1 0.3 0.0 0.1 Galvanised sheets 41.2 73.6 61.2 41.8 73.7 60.7 Wood 2.8 0.2 1.2 2.6 0.2 1.2 Roofing tiles 9.3 3.1 5.5 8.7 3.1 5.4 Roofing shingles 6.6 22.0 16.1 6.0 21.9 15.4 Concrete sheet 39.3 0.3 15.2 40.1 0.4 16.5 Other 0.5 0.8 0.7 0.5 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Wall material No walls 3.6 11.1 8.2 2.9 10.4 7.3 Thin plywood/wood sticks 0.4 0.0 0.2 0.5 0.0 0.2 Thatch and sticks 0.0 0.1 0.1 0.0 0.2 0.1 Reused wood 0.2 0.1 0.2 0.2 0.1 0.1 Cement 93.7 68.3 78.0 94.6 70.0 80.0 Stone with lime/cement 1.9 12.5 8.5 1.8 11.7 7.7 Bricks 0.0 7.5 4.6 0.0 7.2 4.3 Other 0.1 0.4 0.3 0.1 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population 2,310 3,740 6,050 13,282 19,361 32,643 Table 2.6 Household possessions Percentage of households possessing various household effects and means of transportation, according to residence, Maldives DHS 2016-17 Residence Total Possession Malé region Other atolls Household effects Radio 41.2 69.1 58.5 Television 94.2 93.6 93.8 Satellite/cable TV connection 80.1 85.2 83.2 Internet connection 73.4 63.4 67.2 Mobile phone 98.6 98.8 98.7 Non-mobile telephone 14.5 2.8 7.3 Computer 86.9 59.8 70.1 Refrigerator 98.7 97.2 97.8 Air conditioner 72.2 50.1 58.5 Washing machine 98.2 97.2 97.6 Watch 78.3 65.9 70.6 Means of transport Bicycle 13.2 58.7 41.3 Motorcycle/scooter 76.8 49.4 59.9 Car/truck 5.9 5.0 5.3 Pickup/lorry 2.7 2.6 2.6 Fishing boat 1.7 4.5 3.5 Any other boat 2.8 12.0 8.5 Number 2,310 3,740 6,050 Housing Characteristics and Household Population • 23 Table 2.7 Wealth quintiles Percent distribution of the de jure population by wealth quintiles and the Gini coefficient, according to residence and region, Maldives DHS 2016-17 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Malé region 0.9 4.3 7.6 38.1 49.2 100.0 13,282 0.04 Other atolls 33.1 30.8 28.5 7.5 0.0 100.0 19,361 0.03 Region Malé 0.9 4.3 7.6 38.1 49.2 100.0 13,282 0.04 North 34.7 28.6 28.3 8.3 0.0 100.0 4,233 0.02 North Central 33.4 33.9 28.3 4.4 0.0 100.0 4,026 0.03 Central 28.1 35.6 27.4 8.9 0.0 100.0 2,340 0.01 South Central 36.1 27.3 26.5 10.1 0.0 100.0 3,977 0.02 South 31.5 30.5 31.1 6.8 0.1 100.0 4,785 0.00 Total 20.0 20.0 20.0 20.0 20.0 100.0 32,643 0.01 Table 2.8 Handwashing Percentage of households in which the place most often used for washing hands was observed by whether the location was fixed or mobile and total percentage of households in which the place for handwashing was observed; and among households in which the place for handwashing was observed, percent distribution by availability of water, soap and other cleansing agents, according to background characteristics Maldives DHS 2016-17 Percentage of households in which place for washing hands was observed: Number of house- holds Among households in which place for handwashing was observed, percentage with: Number of house- holds in which a place for hand- washing was observed Background characteristic And place for hand- washing was a fixed place And place for hand- washing was mobile Total Soap and water1 Water and cleansing agent other than soap only2 Water only Soap but no water3 No water, no soap, no other cleansing agent Total Residence Malé region 99.1 0.1 99.3 2,310 97.3 0.3 1.5 1.0 0.0 100.0 2,293 Other atolls 91.4 4.0 95.5 3,740 98.2 0.2 1.3 0.3 0.0 100.0 3,570 Region Malé 99.1 0.1 99.3 2,310 97.3 0.3 1.5 1.0 0.0 100.0 2,293 North 94.8 3.8 98.5 860 98.7 0.0 1.3 0.0 0.0 100.0 847 North Central 83.4 7.0 90.5 823 98.4 0.0 1.3 0.2 0.0 100.0 745 Central 97.4 0.6 97.9 390 94.9 1.3 3.0 0.7 0.1 100.0 382 South Central 93.7 3.1 96.8 707 97.5 0.2 1.7 0.6 0.1 100.0 684 South 91.2 3.8 95.1 960 99.3 0.0 0.5 0.2 0.0 100.0 912 Wealth quintile Lowest 84.6 7.0 91.5 1,489 96.1 0.4 3.0 0.5 0.1 100.0 1,362 Second 95.2 2.3 97.5 1,263 98.5 0.4 0.9 0.2 0.0 100.0 1,231 Middle 96.8 1.6 98.3 1,116 99.5 0.0 0.4 0.1 0.0 100.0 1,098 Fourth 99.3 0.1 99.4 1,053 97.7 0.3 1.2 0.8 0.0 100.0 1,047 Highest 99.5 0.2 99.7 1,128 97.6 0.0 1.3 1.2 0.0 100.0 1,125 Total 94.4 2.5 96.9 6,050 97.8 0.2 1.4 0.6 0.0 100.0 5,864 1 Soap includes soap or detergent in bar, liquid, powder or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud or sand 3 Includes households with soap only as well as those with soap and another cleansing agent 24 • Housing Characteristics and Household Population Table 2.9 Household population by age, sex, and residence Percent distributions of the de facto household population by various age groups and percentage of the de facto household population age 10-19, according to sex and residence, Maldives DHS 2016-17 Malé region Other atolls Total Total Age Male Female Total Male Female Total Male Female <5 10.0 8.5 9.2 12.9 10.3 11.5 11.7 9.6 10.6 5-9 10.5 8.1 9.2 14.1 10.7 12.2 12.6 9.7 11.0 10-14 6.8 6.6 6.7 11.5 8.8 10.0 9.6 7.9 8.7 15-19 9.3 9.2 9.3 8.2 6.4 7.2 8.6 7.5 8.0 20-24 11.9 12.4 12.2 5.9 7.5 6.8 8.4 9.4 9.0 25-29 11.5 11.7 11.6 7.0 10.1 8.7 8.9 10.7 9.9 30-34 9.0 11.1 10.1 6.6 9.5 8.2 7.6 10.2 9.0 35-39 7.3 7.7 7.5 4.8 7.4 6.2 5.9 7.5 6.8 40-44 6.2 6.2 6.2 4.3 5.6 5.0 5.1 5.9 5.5 45-49 3.8 5.2 4.5 4.0 5.0 4.5 3.9 5.1 4.5 50-54 4.5 4.0 4.2 5.4 6.1 5.8 5.0 5.2 5.1 55-59 3.4 3.7 3.6 4.6 4.2 4.4 4.1 4.0 4.1 60-64 1.6 1.4 1.5 3.1 2.4 2.7 2.5 2.0 2.2 65-69 1.6 1.7 1.6 2.7 2.3 2.5 2.2 2.1 2.1 70-74 1.1 1.2 1.2 2.1 1.5 1.8 1.7 1.4 1.5 75-79 0.7 0.6 0.6 1.2 0.9 1.0 1.0 0.8 0.9 80 + 0.7 0.8 0.8 1.8 1.1 1.4 1.3 1.0 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency age groups 0-14 27.4 23.1 25.1 38.5 29.8 33.8 33.9 27.2 30.3 15-64 68.6 72.6 70.7 53.8 64.3 59.5 59.9 67.6 64.0 65+ 4.1 4.3 4.2 7.7 5.9 6.7 6.2 5.3 5.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Child and adult populations 0-17 32.2 28.0 30.0 43.9 33.9 38.5 39.1 31.6 35.1 18+ 67.8 72.0 70.0 56.1 66.1 61.5 60.9 68.4 64.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Adolescents 10-19 16.1 15.8 16.0 19.7 15.2 17.3 18.2 15.5 16.7 Number of persons 6,191 6,806 12,997 8,740 10,454 19,194 14,931 17,260 32,191 Housing Characteristics and Household Population • 25 Table 2.10 Household composition Percent distribution of households by sex of head of household and by household size; mean size of households; and percentage of households with orphans and foster children under age 18, according to residence, Maldives DHS 2016-17 Residence Total Characteristic Malé region Other atolls Household headship Male 62.0 51.8 55.7 Female 38.0 48.2 44.3 Total 100.0 100.0 100.0 Number of usual members 1 1.9 6.1 4.5 2 8.5 10.0 9.5 3 11.9 13.4 12.8 4 18.7 16.9 17.6 5 16.1 15.7 15.9 6 12.3 12.1 12.2 7 7.7 8.2 8.0 8 8.5 5.8 6.9 9+ 14.3 11.6 12.6 Total 100.0 100.0 100.0 Mean size of households 5.7 5.2 5.4 Percentage of households with orphans and foster children under 18 years of age Double orphans 0.1 0.0 0.1 Single orphans1 2.3 2.7 2.6 Foster children2 9.6 5.9 7.3 Foster and/or orphan children 11.0 7.7 9.0 Number of households 2,310 3,740 6,050 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes children with one dead parent and an unknown survival status of the other parent. 2 Foster children are those under age 18 living in households with neither their mother nor their father present, and the mother and/or the father are alive. 26 • Housing Characteristics and Household Population Table 2.11 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, percentage of children not living with a biological parent, and percentage of children with one or both parents dead, according to background characteristics, Maldives DHS 2016-17 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biolo- gical parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing infor- mation on father/ mother Age 0-4 60.5 36.8 0.3 0.7 0.0 1.4 0.1 0.0 0.0 0.2 100.0 1.5 0.4 3,376 <2 62.8 35.7 0.2 0.2 0.0 0.6 0.1 0.0 0.0 0.3 100.0 0.7 0.4 1,298 2-4 59.1 37.5 0.3 1.0 0.0 1.9 0.0 0.1 0.0 0.2 100.0 2.0 0.4 2,078 5-9 56.5 37.6 0.9 2.1 0.0 2.4 0.1 0.1 0.0 0.3 100.0 2.6 1.1 3,562 10-14 53.8 35.1 2.4 2.7 0.2 4.7 0.3 0.2 0.1 0.5 100.0 5.3 3.3 2,788 15-17 49.7 26.2 2.8 4.2 0.1 14.7 0.9 0.6 0.1 0.6 100.0 16.3 4.7 1,541 Sex Male 57.1 34.3 1.3 2.6 0.1 4.0 0.2 0.2 0.0 0.4 100.0 4.4 1.8 5,816 Female 55.1 36.1 1.4 1.7 0.1 4.7 0.3 0.2 0.1 0.3 100.0 5.3 2.0 5,451 Residence Malé region 66.9 21.4 1.2 2.9 0.1 6.3 0.2 0.2 0.1 0.9 100.0 6.7 1.7 3,883 Other atolls 50.4 42.4 1.4 1.7 0.1 3.3 0.3 0.1 0.0 0.1 100.0 3.8 2.0 7,384 Region Malé 66.9 21.4 1.2 2.9 0.1 6.3 0.2 0.2 0.1 0.9 100.0 6.7 1.7 3,883 North 47.4 48.0 0.9 0.8 0.1 2.2 0.6 0.1 0.0 0.1 100.0 2.8 1.7 1,687 North Central 42.9 50.9 1.3 1.4 0.3 2.7 0.3 0.1 0.1 0.1 100.0 3.1 2.0 1,587 Central 60.7 32.6 1.5 1.9 0.0 2.9 0.1 0.0 0.1 0.1 100.0 3.1 1.9 859 South Central 60.2 32.0 1.4 1.8 0.1 4.2 0.2 0.2 0.0 0.1 100.0 4.5 1.8 1,514 South 46.7 43.3 2.1 2.7 0.0 4.6 0.2 0.3 0.0 0.1 100.0 5.1 2.6 1,737 Wealth quintile Lowest 46.1 45.3 2.3 2.1 0.1 3.3 0.4 0.2 0.0 0.2 100.0 3.8 3.1 2,443 Second 51.1 42.1 1.3 1.7 0.1 3.3 0.2 0.1 0.0 0.1 100.0 3.6 1.7 2,518 Middle 53.7 37.8 1.5 1.5 0.1 5.0 0.2 0.2 0.1 0.0 100.0 5.4 2.0 2,404 Fourth 61.2 27.4 0.8 2.3 0.1 6.5 0.4 0.3 0.0 1.1 100.0 7.1 1.5 2,047 Highest 73.5 17.6 0.5 3.4 0.0 4.1 0.0 0.2 0.1 0.7 100.0 4.4 0.8 1,854 Total <15 57.1 36.6 1.1 1.8 0.1 2.7 0.1 0.1 0.0 0.3 100.0 3.0 1.5 9,726 Total <18 56.1 35.2 1.3 2.1 0.1 4.4 0.2 0.2 0.0 0.4 100.0 4.8 1.9 11,267 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead and one parent dead but missing information on survival status of the other parent. Housing Characteristics and Household Population • 27 Table 2.12 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Maldives DHS 2016-17 Percentage of children whose births are registered and who: Number of children Background characteristic Had a birth certificate Did not have birth certificate Total percentage of children whose births are registered Age <2 90.3 7.5 97.9 1,298 2-4 92.3 7.2 99.4 2,078 Sex Male 91.4 7.2 98.5 1,730 Female 91.7 7.5 99.1 1,646 Residence Malé region 96.4 1.8 98.3 1,171 Other atolls 88.9 10.2 99.2 2,205 Region Malé 96.4 1.8 98.3 1,171 North 98.9 0.7 99.6 527 North Central 72.6 27.2 99.7 484 Central 96.7 2.5 99.2 295 South Central 94.3 4.4 98.7 428 South 84.9 13.5 98.4 471 Wealth quintile Lowest 90.7 8.2 98.9 661 Second 89.1 10.1 99.2 746 Middle 88.5 10.7 99.1 769 Fourth 95.7 3.3 99.0 617 Highest 95.3 2.6 97.8 584 Total 91.5 7.3 98.8 3,376 28 • Housing Characteristics and Household Population Table 2.13.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Maldives DHS 2016-17 Background characteristic No formal education Some primary Completed primary1 Some lower secondary Completed lower secondary2 Some higher secondary Completed higher secondary3 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 25.2 74.1 0.2 0.0 0.0 0.0 0.0 0.0 0.5 100.0 1,351 0.7 10-14 0.8 67.2 15.4 16.1 0.2 0.0 0.0 0.0 0.3 100.0 1,365 5.1 15-19 0.3 0.8 1.2 28.7 45.1 8.1 8.8 6.9 0.1 100.0 1,302 9.4 20-24 1.2 0.8 1.1 3.6 51.1 0.8 13.5 27.1 0.9 100.0 1,627 9.8 25-29 1.1 0.9 3.5 6.2 56.8 0.1 5.9 24.3 1.3 100.0 1,849 9.7 30-34 1.3 4.4 14.7 7.0 46.7 0.0 2.2 22.5 1.2 100.0 1,753 9.5 35-39 3.7 14.4 28.8 9.0 26.6 0.2 0.5 14.9 2.0 100.0 1,299 7.3 40-44 12.7 24.1 27.6 9.5 11.4 0.0 0.7 11.6 2.3 100.0 1,011 6.4 45-49 21.4 27.1 28.5 7.1 4.1 0.0 0.7 6.6 4.5 100.0 877 5.8 50-54 43.1 30.1 10.1 2.0 3.5 0.0 0.3 3.7 7.2 100.0 906 1.2 55-59 54.6 21.0 10.6 2.1 1.5 0.0 0.0 1.8 8.5 100.0 695 0.0 60-64 56.6 27.9 7.2 0.1 3.0 0.0 0.0 0.4 4.9 100.0 345 0.0 65+ 69.1 18.0 3.7 0.6 0.6 0.0 0.4 0.0 7.5 100.0 908 0.0 Residence Malé region 11.8 15.7 8.6 8.5 26.6 1.1 5.2 19.7 2.7 100.0 6,135 9.1 Other atolls 18.0 26.4 12.7 7.4 24.2 0.6 2.1 6.3 2.2 100.0 9,153 6.4 Region Malé 11.8 15.7 8.6 8.5 26.6 1.1 5.2 19.7 2.7 100.0 6,135 9.1 North 16.5 28.4 13.9 7.4 24.1 0.2 1.7 5.0 2.7 100.0 2,084 6.3 North Central 17.6 27.9 11.5 6.6 26.7 0.6 2.3 5.0 1.8 100.0 1,955 6.3 Central 23.8 19.2 14.6 7.3 25.8 0.4 1.7 4.8 2.5 100.0 1,023 6.4 South Central 16.8 27.4 12.6 8.1 22.7 0.7 1.4 7.4 2.7 100.0 1,821 6.4 South 18.0 25.9 12.0 7.7 22.6 1.0 3.0 8.4 1.4 100.0 2,271 6.5 Wealth quintile Lowest 21.1 29.3 13.6 8.0 20.4 0.4 1.7 3.2 2.3 100.0 3,103 5.7 Second 17.1 25.9 13.2 8.6 24.9 0.7 1.8 5.8 1.8 100.0 3,050 6.5 Middle 15.7 22.1 11.6 6.6 26.9 0.6 3.1 11.2 2.2 100.0 3,080 7.0 Fourth 12.5 18.0 9.5 9.4 29.3 0.9 3.5 15.2 1.7 100.0 3,059 8.9 Highest 11.0 15.1 7.4 6.7 24.3 1.4 6.6 23.5 4.0 100.0 2,995 9.3 Total 15.5 22.1 11.1 7.9 25.2 0.8 3.3 11.7 2.4 100.0 15,288 7.0 1 Completed 7th grade at the primary level 2 Completed 10th grade at the secondary level 3 Completed 12th grade at the higher secondary level Housing Characteristics and Household Population • 29 Table 2.13.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Maldives DHS 2016-17 Background characteristic No formal education Some primary Completed primary1 Some lower secondary Completed lower secondary2 Some higher secondary Completed higher secondary3 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 26.5 73.2 0.0 0.0 0.0 0.0 0.0 0.0 0.3 100.0 1,496 0.7 10-14 0.4 68.4 17.5 13.4 0.1 0.0 0.0 0.0 0.1 100.0 1,432 5.0 15-19 0.7 1.9 3.5 32.7 41.6 6.4 7.0 4.9 1.2 100.0 1,289 9.3 20-24 0.5 1.7 3.4 9.9 51.0 0.7 16.7 15.0 1.2 100.0 1,255 9.7 25-29 1.5 2.1 8.3 7.7 50.6 0.2 8.2 19.0 2.3 100.0 1,328 9.6 30-34 2.0 5.1 14.5 7.4 39.2 0.2 3.8 24.5 3.2 100.0 1,133 9.5 35-39 3.7 9.6 20.9 10.9 28.8 0.0 4.0 18.7 3.4 100.0 875 9.1 40-44 8.0 12.9 25.0 11.4 20.1 0.0 0.9 16.9 4.6 100.0 757 7.3 45-49 24.1 20.0 22.3 6.0 6.8 0.0 1.0 10.6 9.1 100.0 585 6.1 50-54 35.2 24.4 13.8 2.3 3.3 0.0 0.0 8.1 12.8 100.0 747 2.7 55-59 47.6 22.4 8.3 2.4 3.3 0.0 0.0 6.7 9.4 100.0 611 0.0 60-64 54.8 18.1 8.0 3.5 3.2 0.0 0.0 3.8 8.6 100.0 367 0.0 65+ 66.0 17.0 4.6 1.2 1.3 0.0 0.0 1.3 8.7 100.0 925 0.0 Residence Malé region 10.8 16.9 8.2 9.1 26.7 1.0 6.3 16.4 4.6 100.0 5,456 9.1 Other atolls 20.0 29.0 12.2 9.5 18.4 0.6 2.1 5.0 3.2 100.0 7,343 5.9 Region Malé 10.8 16.9 8.2 9.1 26.7 1.0 6.3 16.4 4.6 100.0 5,456 9.1 North 18.5 30.8 12.6 9.7 16.7 0.2 2.3 5.0 4.3 100.0 1,546 5.7 North Central 20.6 30.1 11.5 9.1 20.1 0.3 1.5 3.7 3.2 100.0 1,489 5.5 Central 26.9 20.9 13.1 9.3 19.4 0.5 1.5 3.3 5.1 100.0 881 5.9 South Central 17.1 30.7 12.2 10.5 17.1 0.7 2.1 6.8 2.8 100.0 1,507 6.1 South 20.0 28.9 12.0 9.0 19.0 1.0 2.9 5.4 1.8 100.0 1,922 6.0 Wealth quintile Lowest 22.4 30.9 12.6 10.2 15.7 0.3 1.6 2.8 3.5 100.0 2,517 4.9 Second 20.5 28.3 11.7 10.4 18.3 0.4 1.4 5.9 3.0 100.0 2,518 6.0 Middle 16.2 25.3 11.2 9.4 22.8 1.4 3.4 7.6 2.7 100.0 2,480 6.6 Fourth 11.2 18.6 9.7 8.5 28.2 1.0 6.2 11.2 5.3 100.0 2,590 8.8 Highest 10.6 16.7 7.5 8.3 24.3 0.6 6.6 21.0 4.5 100.0 2,695 9.2 Total 16.1 23.8 10.5 9.3 21.9 0.7 3.9 9.9 3.8 100.0 12,799 6.8 1 Completed 7th grade at the primary level 2 Completed 10th grade at the secondary level 3 Completed 12th grade at the higher secondary level 30 • Housing Characteristics and Household Population Table 2.14 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Maldives DHS 2016-17 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Malé region 93.2 90.4 91.9 0.97 100.5 95.0 97.8 0.95 Other atolls 94.8 94.3 94.6 0.99 101.2 99.7 100.5 0.99 Region Malé 93.2 90.4 91.9 0.97 100.5 95.0 97.8 0.95 North 97.3 96.7 97.0 0.99 102.4 102.1 102.3 1.00 North Central 95.2 94.0 94.6 0.99 102.0 98.1 100.1 0.96 Central 93.8 93.2 93.5 0.99 102.8 95.9 99.5 0.93 South Central 93.5 91.1 92.4 0.97 99.7 97.0 98.4 0.97 South 94.0 95.6 94.7 1.02 100.2 103.1 101.5 1.03 Wealth quintile Lowest 96.1 95.0 95.6 0.99 103.8 101.2 102.5 0.97 Second 95.6 94.2 95.0 0.99 100.6 100.2 100.4 1.00 Middle 93.7 92.5 93.1 0.99 100.5 97.5 99.0 0.97 Fourth 93.3 91.7 92.5 0.98 95.8 97.2 96.5 1.01 Highest 91.8 90.4 91.2 0.98 103.6 92.9 98.5 0.90 Total 94.3 93.0 93.7 0.99 101.0 98.1 99.6 0.97 SECONDARY SCHOOL Residence Malé region 78.4 77.2 77.8 0.99 101.0 103.5 102.3 1.02 Other atolls 76.3 77.4 76.8 1.01 86.8 90.4 88.5 1.04 Region Malé 78.4 77.2 77.8 0.99 101.0 103.5 102.3 1.02 North 78.2 82.1 80.0 1.05 91.2 95.2 93.1 1.04 North Central 72.0 74.2 73.0 1.03 78.7 84.9 81.6 1.08 Central 78.4 80.7 79.5 1.03 89.3 98.1 93.4 1.10 South Central 78.5 81.0 79.7 1.03 91.7 96.6 94.0 1.05 South 75.7 72.6 74.1 0.96 84.6 83.6 84.1 0.99 Wealth quintile Lowest 75.9 74.4 75.2 0.98 85.2 82.5 83.9 0.97 Second 76.8 77.0 76.9 1.00 83.5 94.3 88.8 1.13 Middle 80.0 76.1 78.2 0.95 95.7 92.2 94.1 0.96 Fourth 80.3 82.6 81.6 1.03 110.1 101.9 105.4 0.93 Highest 71.5 75.9 73.7 1.06 89.5 111.5 100.4 1.25 Total 77.1 77.3 77.2 1.00 91.9 95.7 93.8 1.04 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 100.0 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 NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for males. Housing Characteristics and Household Population • 31 Table 2.15.1 Disability among the female household population Among the de facto female household population, percent distribution by disability status and percentage who have specific types of disabilities, according to background characteristics, Maldives DHS 2016-17 Any disability Type of disability1 No disa- bility Don’t know Total Number of women Background characteristic Blind/ partially blind Deaf/ partially deaf Para- lysed Missing limb Mentally disabled Speech impaired Medical disability2 Learning disability Don’t know/ missing Age 0-4 1.4 0.0 0.0 0.1 0.0 0.1 0.2 0.6 0.4 0.0 98.0 0.6 100.0 1,335 5-9 3.4 0.4 0.0 0.0 0.1 0.4 0.4 1.1 0.7 0.1 96.6 0.1 100.0 1,817 10-14 2.8 0.7 0.3 0.0 0.0 0.8 0.2 0.4 0.3 0.2 96.7 0.4 100.0 1,425 15-19 3.7 0.9 0.3 0.1 0.1 0.8 0.1 1.3 0.2 0.1 96.1 0.2 100.0 1,321 20-29 2.3 0.6 0.2 0.1 0.0 0.7 0.1 0.5 0.1 0.0 97.4 0.3 100.0 3,535 30-39 2.8 0.5 0.6 0.1 0.0 0.5 0.3 0.6 0.0 0.1 96.7 0.5 100.0 3,078 40-49 3.9 0.6 0.9 0.1 0.0 1.0 0.1 1.1 0.0 0.0 95.9 0.2 100.0 1,891 50-59 5.2 0.8 1.0 0.5 0.1 0.6 0.0 2.1 0.1 0.0 93.9 0.9 100.0 1,601 60+ 9.8 1.8 1.5 2.0 0.2 0.5 0.0 3.8 0.0 0.1 89.5 0.7 100.0 1,257 Age 15 and over 3.9 0.8 0.6 0.3 0.0 0.7 0.1 1.2 0.1 0.1 95.6 0.4 100.0 12,683 Residence Malé region 3.0 0.9 0.3 0.2 0.0 0.6 0.1 0.7 0.3 0.0 96.4 0.7 100.0 6,806 Other atolls 4.0 0.5 0.6 0.3 0.1 0.6 0.2 1.4 0.1 0.1 95.8 0.2 100.0 10,454 Region Malé 3.0 0.9 0.3 0.2 0.0 0.6 0.1 0.7 0.3 0.0 96.4 0.7 100.0 6,806 North 4.1 0.5 0.9 0.3 0.0 0.6 0.1 1.3 0.2 0.0 95.5 0.4 100.0 2,399 North Central 3.8 0.5 0.5 0.1 0.0 0.5 0.4 1.6 0.0 0.1 96.2 0.0 100.0 2,245 Central 3.1 0.5 0.6 0.3 0.2 0.4 0.2 0.7 0.2 0.1 96.4 0.4 100.0 1,196 South Central 3.9 0.5 0.7 0.3 0.1 0.6 0.1 1.1 0.3 0.2 95.9 0.2 100.0 2,076 South 4.4 0.6 0.4 0.4 0.1 0.9 0.0 1.9 0.0 0.1 95.3 0.3 100.0 2,537 Wealth quintile Lowest 5.3 0.8 0.9 0.3 0.1 0.8 0.2 1.8 0.2 0.2 94.4 0.3 100.0 3,501 Second 3.9 0.4 0.5 0.4 0.1 0.9 0.2 1.1 0.2 0.2 95.9 0.2 100.0 3,482 Middle 2.9 0.4 0.5 0.1 0.0 0.6 0.1 1.1 0.0 0.0 96.7 0.3 100.0 3,532 Fourth 2.7 0.7 0.1 0.3 0.0 0.3 0.2 1.0 0.2 0.0 96.7 0.6 100.0 3,411 Highest 2.9 1.0 0.4 0.2 0.0 0.6 0.1 0.5 0.3 0.0 96.3 0.7 100.0 3,334 Total 3.6 0.7 0.5 0.2 0.0 0.6 0.2 1.1 0.2 0.1 96.0 0.4 100.0 17,260 1 If a person was reported to have a disability, only one type of disability was recorded. 2 Refers to disabilities related to disease. 32 • Housing Characteristics and Household Population Table 2.15.2 Disability among the male household population Among the de facto male household population, percent distribution by disability status and percentage who have specific types of disabilities, according to background characteristics, Maldives DHS 2016-17 Any disability Type of disability1 No disa- bility Don’t know Total Number of men Background characteristic Blind/ partially blind Deaf/ partially deaf Para- lysed Missing limb Mentally disabled Speech impaired Medical disability2 Learning disability Don’t know/ missing Age 0-4 1.6 0.2 0.0 0.0 0.0 0.0 0.2 1.0 0.1 0.1 97.8 0.6 100.0 1,396 5-9 5.4 0.1 0.2 0.0 0.2 1.1 0.9 2.0 0.3 0.5 94.0 0.6 100.0 2,032 10-14 5.0 0.5 0.2 0.1 0.0 0.9 0.1 1.1 1.7 0.4 95.0 0.0 100.0 1,501 15-19 3.8 0.5 0.4 0.0 0.0 1.2 0.3 0.8 0.4 0.1 95.7 0.5 100.0 1,301 20-29 3.7 0.4 0.3 0.1 0.1 1.2 0.4 1.1 0.0 0.1 95.9 0.4 100.0 2,648 30-39 4.2 0.9 0.9 0.2 0.2 1.0 0.2 0.7 0.0 0.2 95.6 0.2 100.0 2,045 40-49 3.8 0.9 0.4 0.5 0.0 0.4 0.4 1.0 0.0 0.1 95.6 0.6 100.0 1,345 50-59 7.4 1.0 1.3 0.9 0.6 0.9 0.3 2.4 0.0 0.2 91.4 1.2 100.0 1,367 60+ 11.4 2.1 1.3 3.0 0.4 0.6 0.4 3.3 0.0 0.3 87.3 1.2 100.0 1,297 Age 15 and over 5.3 0.9 0.7 0.7 0.2 0.9 0.3 1.4 0.1 0.2 94.0 0.6 100.0 10,002 Residence Malé region 3.4 0.5 0.4 0.2 0.1 0.6 0.2 0.8 0.3 0.2 95.7 0.9 100.0 6,191 Other atolls 6.1 0.8 0.6 0.6 0.2 1.0 0.5 1.9 0.2 0.2 93.6 0.3 100.0 8,740 Region Malé 3.4 0.5 0.4 0.2 0.1 0.6 0.2 0.8 0.3 0.2 95.7 0.9 100.0 6,191 North 5.6 0.5 0.7 0.8 0.2 0.9 0.5 1.3 0.5 0.3 94.1 0.3 100.0 1,868 North Central 5.7 0.4 0.8 0.4 0.1 1.1 0.4 2.3 0.1 0.1 94.3 0.1 100.0 1,790 Central 5.3 0.7 0.9 0.6 0.3 1.4 0.5 0.6 0.1 0.2 93.9 0.8 100.0 1,061 South Central 6.9 1.1 0.6 0.8 0.3 1.0 0.5 1.7 0.3 0.5 92.9 0.2 100.0 1,790 South 6.5 1.1 0.4 0.5 0.1 0.9 0.4 2.7 0.2 0.1 93.2 0.3 100.0 2,232 Wealth quintile Lowest 7.4 0.9 0.8 0.9 0.2 1.5 0.4 2.2 0.2 0.4 92.1 0.5 100.0 2,944 Second 5.9 1.1 0.6 0.5 0.1 1.0 0.6 1.7 0.2 0.2 93.5 0.6 100.0 2,988 Middle 4.3 0.4 0.6 0.5 0.1 0.6 0.4 1.3 0.3 0.2 95.1 0.6 100.0 2,958 Fourth 4.3 0.5 0.4 0.1 0.2 0.9 0.2 1.4 0.3 0.3 95.3 0.4 100.0 2,971 Highest 2.9 0.5 0.3 0.3 0.2 0.4 0.2 0.6 0.3 0.2 96.3 0.8 100.0 3,070 Total 5.0 0.7 0.5 0.5 0.2 0.9 0.4 1.4 0.3 0.2 94.5 0.6 100.0 14,931 1 If a person was reported to have a disability, only one type of disability was recorded. 2 Refers to disabilities related to disease. Characteristics of Respondents • 33 CHARACTERISTICS OF RESPONDENTS 3 Key Findings  Education: Only 4% of all women and 3% of all men age 15-49 have no formal education. Women have generally attained higher levels of education than men; 21% of women age 15-49 have attended school beyond the secondary level, compared with only 15% of men.  Literacy: Ninety-nine percent of women and 96% of men age 15-49 are literate.  Exposure to mass media: Just over half of women and men read a newspaper at least once a week, while 86% of women and 78% of men watch television weekly.  Internet usage: Eighty percent of women and almost 90% of men age 15-49 have ever used the internet.  Employment: Four in ten (42%) of women and 77% of men were employed in the 7 days preceding the survey. Over half of women and 16% of men had not been employed in the past 12 months.  Tobacco use: Smoking is uncommon among women (3%); however, 42% of men smoke any type of tobacco. his chapter presents information on demographic and socioeconomic characteristics of the survey respondents such as sex, age, education, and wealth status. The survey also collected data on use of mass media and the internet, health insurance coverage, and tobacco smoking. This information is useful in understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviours. 3.1 BACKGROUND CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 shows the percent distribution of all women and men age 15-49 by background characteristics. Approximately half of women and men are under age 30 (48% of women and 54% of men). The largest proportions of women tend to be in age groups 25-29 and 30-34, whereas among men, the percentage of the population in each age group decreases as age increases. This difference in age patterns by sex most probably reflects the fact that working age men are more likely than women to have been omitted from the survey because they work away from home and may not live in residential households. The proportion of women who are currently married or living together with a partner is higher than that among men (69% versus 55%). Women are less likely than men to have never been married (23% versus 41%) and more likely to be widowed, divorced or separated (8% versus 4%). A person’s place of residence, in Malé region or in other atolls, determines her or his access to services and information about health and other aspects of life. Just over half of women and more than three-quarters of men live in other atolls outside Malé (56% of women and 78% of men). T 34 • Characteristics of Respondents At the time of the survey, the highest percentage of men were living in South Central region (23%), whereas other than Malé (with 45% of women), women are more equally distributed across regions. 3.2 EDUCATION AND LITERACY Literacy Respondents who had attended higher than secondary school were assumed to be literate. All other respondents were given a sentence to read, and they were considered literate if they could read all or part of the sentence. Sample: Women and men age 15-49 Education is an important factor influencing an individual’s attitudes and opportunities. Tables 3.2.1 and 3.2.2 show that women are slightly better educated than men. Only 4% of women and 3% of men age 15-49 have no formal education. Women have generally attained higher levels of education than men. For example, 21% of women have attended school beyond the secondary level, compared with only 15% of men (Figure 3.1). Patterns by background characteristics  The percentage of women and men with no education is higher among older respondents and lower among younger respondents, suggesting an improvement in educational access over time.  Residents of Malé region generally have more education than residents of other atolls. The residential difference is more pronounced at the secondary or higher levels of education. For example, 32% of women in Malé region have more than a secondary education, compared with only 13% of women in other atolls. Similarly, 26% of men in Malé region have more than a secondary education, compared with 12% of men in other atolls.  Educational attainment varies by region, but mainly between Malé and the other atolls. The proportion of women with more than a secondary education varies from 9% in North region to 32% in Malé, while the proportion of men varies from 9% in Central region to 26% in Malé (Figure 3.2).  Educational attainment also varies by wealth quintile. Only 8% of women in the lowest wealth quintile have more than a secondary education, compared with 38% of women in the highest quintile. Similarly, only 7% of men in the lowest Figure 3.1 Education of survey respondents Figure 3.2 Post secondary education by region 4 3 9 8 13 15 48 55 4 5 21 15 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed higher secondary Some secondary Primary complete Primary incomplete No education Note: Values may not add up to 100% due to rounding. 32 9 12 10 14 15 26 13 10 9 15 12 Malé North North Central Central South Central South Percentage of women and men age 15-49 with more than a secondary education by region Women Men Characteristics of Respondents • 35 wealth quintile have more than a secondary education, compared with 34% of those in the highest quintile.  Differences by background characteristics in the median number of years of education completed mirror those discussed above.  Almost all women and men age 15-49 are literate (99% of women and 96% of men). Differences by background characteristics are very slight (Tables 3.3.1 and 3.3.2). 3.3 MASS MEDIA EXPOSURE AND INTERNET USAGE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered to be regularly exposed to that form of media. Exposure to the internet The internet is a global communication network that allows almost all computers worldwide to connect and exchange information. Respondents were asked to report the frequency of their use of the internet. Sample: Women and men age 15-49 Tables 3.4.1 and 3.4.2 show the percentage of women and men who are exposed to different types of media, by background characteristics. The level of exposure to mass media is high in the Maldives. Among both women and men, television is the most frequently accessed type of media, with 86% of women and 78% of men watching at least once a week, followed by newspapers (52% and 54%, respectively). Radio listening is the least popular of the three media: only 36% of women and 23% of men report listening to the radio at least once a week. Very few respondents access all three media at least once a week (18% of women and 12% of men) (Figure 3.3). The internet is also a critical tool through which information is accessed. Overall, 80% of women and 89% of men age 15-49 have ever used the internet and 78% and 87% have used it in the past 12 months. Of those who said they used the internet in the 12 months before the survey, more than four-fifths say they use it almost every day (Tables 3.5.1 and 3.5.2). Patterns by background characteristics  Among both women and men, newspaper reading increases with age to age 30-34 and then decreases, whereas radio listening tends to increase with age. The proportion who watch television at least once a week does not vary much with age.  Women and men in Malé region are more likely to read a newspaper and to watch television at least once a week than women and men in other atolls. However, they are less likely to listen to the radio than women and men in other atolls.  Exposure to newspapers increases with increasing education. For example, only 26% of women with no formal education read a newspaper at least once a week, compared with 72% of those with more Figure 3.3 Exposure to mass media 52 86 36 18 6 54 78 23 12 11 Reads newspaper Watches television Listens to radio All three media None of these media Percentage of women and men age 15-49 who are exposed to media on a weekly basis Women Men 36 • Characteristics of Respondents than a secondary education. Among men, newspaper readership increases from 30% of those with no education to 82% of those with more than a secondary education. The proportion of women and men who listen to the radio at least once a week decreases as education increases.  Exposure to newspapers and to some extent, to television also increase with wealth. Only 38% of women in the lowest wealth quintile read a newspaper at least once a week, compared with 62% of women in the highest quintile.  The proportion of women and men who have ever used the internet decreases as age increases.  Internet usage increases sharply as level of education increases. For example, 30% of women with no formal education have ever used the internet, compared with 98% of those with more than a secondary education. Internet use also increases with increasing wealth. 3.4 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey; includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Sample: Women and men age 15-49 In the 2016-17 MDHS, respondents were asked whether they were employed at the time of the survey (that is, had worked in the past 7 days) and, if not, whether they had worked at any time during the 12 months preceding the survey. Tables 3.6.1 and 3.6.2 show that 42% of women and 77% of men are currently employed. An additional 6% of women and men reported that they had worked in the past 12 months but were not currently employed. Trends: Among ever-married women age 15-49, current employment increased from 40% in 2009 to 43% in 2016-17. In the same period, current employment among ever-married men age 15-49 barely changed from 93% to 94%. Patterns by background characteristics  Divorced, separated, or widowed women are more likely to be employed than those who are currently married and those who have never been married. Among men, those who are currently married are the most likely to be employed, followed by those who are divorced, separated, or widowed and then those who have never been married.  Women in Malé region are more likely to be currently employed than women in other atolls (48% versus 38%). However, among men, there is no difference by residence (77% for both Malé region and other atolls) (Figure 3.4).  The percentage of women who are currently employed generally increases with increasing education, from 32% among women with no Figure 3.4 Employment status by residence 42 48 38 77 77 77 Total Malé region Other atolls Percentage of women and men age 15-49 who are currently employed Women Men Characteristics of Respondents • 37 formal education to 68% among women with more than a secondary education. There is no such pattern among men.  The percentage of women who are employed also increases with increasing wealth, from 35% among those in the lowest wealth quintile to 51% among those in highest quintile. Among men, there is only a slight increase in the proportion employed as wealth quintile increases. 3.5 OCCUPATION Occupation Categorised as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, domestic service, agriculture, armed forces and other. Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Respondents who were currently employed or had worked in the 12 months before the survey were asked to state their occupation. Tables 3.7.1 and 3.7.2, respectively, show that 46% of working women and 35% of working men age 15-49 are engaged in professional, technical, or managerial occupations, while 20% of women and 10% of men are employed in skilled manual labour and 7% of women and 14% of men are engaged in unskilled manual labour. While almost no working women are employed in agriculture (<1%), 12% of working men are engaged in agriculture (including fishing). Men are also more likely than women to be employed in domestic service jobs (9% versus 2%) (Figure 3.5). Patterns by background characteristics  Women with a secondary education or higher tend to be employed in professional, technical, or managerial occupations, whereas women with no education or only primary education tend to be employed in skilled manual jobs.  Among both women and men, employment in professional/technical/managerial occupations generally increases with increasing education and wealth, while employment in skilled manual and unskilled manual jobs decreases with increasing education and wealth.  Among working men, the proportion employed in the agricultural sector is highest in South Central region; it decreases with increasing education and wealth. 3.6 TYPE OF WOMEN’S EMPLOYMENT Table 3.8 presents the percent distribution of women who were employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment. Almost all women (97%) are paid in cash only, while less than 2% are unpaid workers. Almost half of working women (48%) are self- employed, while 40% work for a non-family employer and 12% are employed by a family member. The vast majority of working women are employed year-round (84%). Figure 3.5 Occupation 46 20 7 14 2 5 <1 5 35 10 14 7 9 3 12 12 Professional Skilled manual Unskilled manual Sales/services Domestic service Clerical Agriculture/fishing Other Percent distribution of women and men age 15-49 employed in the past 12 months by occupation Women Men 38 • Characteristics of Respondents Trends: Although data from the 2009 MDHS are based on ever-married women only, results imply that there has been little change in the type of employment between 2009 and 2016-17. 3.7 HEALTH INSURANCE COVERAGE In 2012, the Maldives introduced a universal health insurance scheme called Aasandha, which was expanded to Husnuvaa Aasandha from 2014 as an unlimited health insurance scheme provided by the government. The benefit package covers all outpatient and inpatient services at the health centre and hospital levels other than services related to dentures, eyeglasses, and cosmetic procedures. Because the Aasandha programme is universal, respondents in the 2016-17 MDHS were asked if they had any health insurance other than Aasandha. Tables 3.9.1 and 3.9.2 show that, overall, only 8% of women and 12% of men age 15-49 were covered by any type of health insurance other than Husnuvaa Aasandha, with the most common coverage being insurance obtained through employers. 3.8 TOBACCO USE Table 3.10.1 shows that cigarette smoking and use of any type of tobacco are not common among women (less than 3%). On the other hand, 4 in 10 men smoke any type of tobacco (42%), among whom almost all smoke cigarettes (Table 3.10.2). Among men who smoke cigarettes daily, close to one-half (45%) smoke 15-24 cigarettes each day; 9% of daily cigarette smokers smoke 25 or more cigarettes each day (Table 3.11). Patterns by background characteristics  Use of tobacco is highest among men in their 20s, over half of whom smoke some type of tobacco.  The prevalence of tobacco smoking among men shows no clear relationship with either education or wealth. LIST OF TABLES For more information on the characteristics of respondents, see the following tables:  Table 3.1 Background characteristics of respondents  Table 3.2.1 Educational attainment: Women  Table 3.2.2 Educational attainment: Men  Table 3.3.1 Literacy: Women  Table 3.3.2 Literacy: Men  Table 3.4.1 Exposure to mass media: Women  Table 3.4.2 Exposure to mass media: Men  Table 3.5.1 Internet usage: Women  Table 3.5.2 Internet usage: Men  Table 3.6.1 Employment status: Women  Table 3.6.2 Employment status: Men  Table 3.7.1 Occupation: Women  Table 3.7.2 Occupation: Men  Table 3.8 Type of employment: Women  Table 3.9.1 Health insurance coverage: Women  Table 3.9.2 Health insurance coverage: Men  Table 3.10.1 Tobacco smoking: Women  Table 3.10.2 Tobacco smoking: Men  Table 3.11 Average number of cigarettes smoked daily: Men Characteristics of Respondents • 39 Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Maldives DHS 2016-17 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 14.3 1,099 1,015 21.5 935 950 20-24 15.9 1,223 1,118 16.0 693 638 25-29 17.9 1,379 1,456 16.5 716 709 30-34 17.8 1,372 1,424 15.3 663 682 35-39 13.6 1,044 1,063 10.8 469 480 40-44 11.0 845 852 10.3 449 459 45-49 9.6 737 771 9.6 417 424 Marital status Never married 23.1 1,779 1,488 40.8 1,772 1,750 Married 68.2 5,251 5,596 54.2 2,353 2,395 Living together 0.4 29 24 0.7 33 23 Divorced/separated 7.5 581 544 4.1 179 170 Widowed 0.8 60 47 0.1 5 4 Residence Malé region 44.5 3,424 996 22.3 968 628 Other atolls 55.5 4,275 6,703 77.7 3,374 3,714 Region Malé 44.5 3,424 996 22.3 968 628 North 12.7 981 1,297 11.2 488 704 North Central 11.9 913 1,434 12.4 537 746 Central 6.6 507 996 16.3 706 540 South Central 11.0 844 1,688 23.0 999 1,008 South 13.4 1,030 1,288 14.8 644 716 Atoll Malé Atoll 44.5 3,424 996 22.3 968 628 HA Atoll 3.6 279 424 3.4 149 227 HDh Atoll 5.2 403 405 4.7 202 247 Sh Atoll 3.9 299 468 3.1 136 230 N Atoll 2.7 210 345 2.7 119 168 R Atoll 4.5 345 411 2.7 119 186 B Atoll 2.4 183 346 4.4 191 230 Lh Atoll 2.3 175 332 2.5 109 162 K Atoll 1 3.0 234 340 6.7 290 195 AA Atoll 1.6 127 222 3.5 154 121 ADh Atoll 1.5 113 289 3.5 150 134 V Atoll 0.4 33 145 2.6 112 90 M Atoll 1.4 109 322 3.4 146 187 F Atoll 1.3 102 386 4.5 197 178 Dh Atoll 1.6 124 307 4.6 200 194 Th Atoll 2.7 205 281 4.3 185 186 L Atoll 4.0 304 392 6.2 270 263 GA Atoll 2.3 174 320 3.7 162 212 GDh Atoll 2.9 223 289 3.3 142 148 Gn Atoll 2.6 200 352 2.8 120 174 S Atoll 5.6 434 327 5.1 220 182 Education No education 4.2 323 364 3.0 131 140 Primary 22.2 1,712 2,065 22.5 975 1,010 Secondary 52.5 4,044 4,095 59.4 2,581 2,570 More than secondary 21.0 1,619 1,175 15.1 655 622 Wealth quintile Lowest 18.1 1,393 2,138 22.9 993 1,127 Second 18.8 1,449 2,096 23.4 1,017 1,141 Middle 19.9 1,533 2,091 26.9 1,169 1,217 Fourth 21.2 1,629 892 15.9 691 542 Highest 22.0 1,694 482 10.9 472 315 Total 100.0 7,699 7,699 100.0 4,342 4,342 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Excludes Malé region. 40 • Characteristics of Respondents Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Maldives DHS 2016-17 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some lower secondary Completed lower secondary2 Some higher secondary Completed higher secondary3 More than secondary Age 15-24 0.2 0.5 0.8 15.9 45.4 4.1 11.4 21.8 100.0 9.7 2,322 15-19 0.1 0.4 0.9 28.8 43.3 8.1 9.0 9.5 100.0 9.5 1,099 20-24 0.2 0.5 0.7 4.3 47.3 0.6 13.6 32.8 100.0 9.9 1,223 25-29 0.9 1.3 2.9 5.8 55.5 0.0 3.8 29.8 100.0 9.7 1,379 30-34 0.6 4.6 15.8 6.4 44.4 0.1 0.7 27.4 100.0 9.5 1,372 35-39 3.9 15.1 28.1 10.6 24.0 0.1 0.5 17.7 100.0 7.4 1,044 40-44 9.2 29.4 29.1 11.3 12.4 0.0 0.5 8.1 100.0 6.4 845 45-49 24.3 29.9 24.5 6.0 4.6 0.0 0.5 10.2 100.0 5.0 737 Residence Malé region 3.1 6.1 8.4 9.6 33.6 1.6 5.9 31.7 100.0 9.7 3,424 Other atolls 5.1 11.9 16.5 10.7 39.0 1.1 3.3 12.5 100.0 9.1 4,275 Region Malé 3.1 6.1 8.4 9.6 33.6 1.6 5.9 31.7 100.0 9.7 3,424 North 4.5 13.7 18.4 11.5 39.2 0.8 2.6 9.3 100.0 9.0 981 North Central 3.6 12.7 17.2 8.2 42.3 0.8 3.1 12.1 100.0 9.2 913 Central 8.8 11.5 16.7 9.3 39.8 0.7 2.9 10.4 100.0 9.1 507 South Central 3.9 13.3 16.3 12.0 37.3 1.2 1.9 14.1 100.0 9.1 844 South 6.2 8.5 14.3 11.8 36.8 1.6 5.3 15.4 100.0 9.2 1,030 Atoll Malé Atoll 3.1 6.1 8.4 9.6 33.6 1.6 5.9 31.7 100.0 9.7 3,424 HA Atoll 3.3 13.7 17.2 14.7 33.8 1.0 4.2 12.2 100.0 9.0 279 HDh Atoll 5.7 11.5 18.5 10.1 44.8 0.5 1.8 7.1 100.0 9.1 403 Sh Atoll 4.2 16.5 19.4 10.3 36.7 1.1 2.3 9.4 100.0 8.9 299 N Atoll 3.8 18.2 16.7 10.7 38.0 0.6 2.9 9.1 100.0 9.0 210 R Atoll 2.6 14.3 15.6 8.2 43.4 1.2 3.7 11.0 100.0 9.2 345 B Atoll 3.1 8.8 19.5 6.2 40.3 0.9 2.3 19.0 100.0 9.3 183 Lh Atoll 5.7 6.8 18.6 7.4 47.4 0.0 3.1 11.0 100.0 9.2 175 K Atoll 4 8.3 12.6 16.1 9.7 39.6 0.3 3.5 9.9 100.0 9.1 234 AA Atoll 8.7 10.2 23.0 8.5 35.5 0.5 2.3 11.3 100.0 8.9 127 ADh Atoll 11.7 11.7 8.3 10.3 46.3 1.3 2.3 8.1 100.0 9.2 113 V Atoll 2.6 8.0 24.9 5.2 35.5 1.9 2.6 19.4 100.0 9.3 33 M Atoll 2.5 9.7 21.7 6.9 37.7 2.1 1.9 17.6 100.0 9.2 109 F Atoll 2.1 10.6 17.6 10.9 38.6 3.3 2.6 14.3 100.0 9.2 102 Dh Atoll 2.0 19.3 18.9 11.4 34.8 0.7 3.3 9.8 100.0 8.8 124 Th Atoll 1.1 11.0 19.4 12.2 44.6 0.6 2.9 8.3 100.0 9.1 205 L Atoll 7.7 14.6 10.8 14.2 32.9 0.7 0.5 18.6 100.0 9.1 304 GA Atoll 5.6 9.4 11.0 12.2 41.5 0.6 2.8 16.9 100.0 9.3 174 GDh Atoll 2.2 12.8 17.2 12.7 35.2 0.3 2.0 17.5 100.0 9.1 223 Gn Atoll 10.0 6.3 8.8 9.7 38.4 0.0 6.3 20.6 100.0 9.4 200 S Atoll 6.7 7.0 16.8 12.2 34.9 3.4 7.6 11.3 100.0 9.2 434 Wealth quintile Lowest 6.5 15.4 18.3 13.2 35.3 0.4 3.0 7.9 100.0 8.6 1,393 Second 5.6 11.3 18.5 11.3 38.9 1.3 2.4 10.7 100.0 9.1 1,449 Middle 3.4 9.1 12.5 8.3 41.4 1.1 4.5 19.7 100.0 9.4 1,533 Fourth 4.1 6.7 10.0 11.3 37.5 0.9 4.5 25.0 100.0 9.5 1,629 Highest 1.9 5.3 6.9 7.6 30.5 2.5 7.2 38.1 100.0 9.9 1,694 Total 4.2 9.3 12.9 10.2 36.6 1.3 4.4 21.0 100.0 9.4 7,699 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Completed 7th grade at the primary level 2 Completed 10th grade at the secondary level 3 Completed 12th grade at the higher secondary level 4 Excludes Malé region. Characteristics of Respondents • 41 Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Maldives DHS 2016-17 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some lower secondary Completed lower secondary2 Some higher secondary Completed higher secondary3 More than secondary Age 15-24 0.4 1.4 3.2 27.4 45.2 4.3 8.8 9.4 100.0 9.4 1,628 15-19 0.5 0.7 2.6 38.4 42.0 6.7 5.2 3.9 100.0 9.2 935 20-24 0.2 2.2 4.0 12.5 49.5 1.0 13.7 16.9 100.0 9.6 693 25-29 0.2 3.4 7.7 10.2 53.7 0.1 5.8 18.9 100.0 9.5 716 30-34 0.7 6.1 19.1 8.1 40.7 0.1 1.9 23.3 100.0 9.4 663 35-39 1.8 11.6 29.5 10.4 26.4 0.0 1.5 18.7 100.0 8.3 469 40-44 6.4 18.5 31.7 11.0 15.7 0.0 0.5 16.2 100.0 6.8 449 45-49 19.8 27.5 29.5 7.7 3.5 0.0 0.0 12.1 100.0 6.1 417 Residence Malé region 1.2 4.3 6.4 14.5 36.2 2.7 8.4 26.3 100.0 9.7 968 Other atolls 3.5 8.8 17.0 16.7 37.0 1.4 3.7 11.9 100.0 9.1 3,374 Region Malé 1.2 4.3 6.4 14.5 36.2 2.7 8.4 26.3 100.0 9.7 968 North 3.3 8.0 17.8 17.7 36.0 0.8 3.3 13.1 100.0 9.1 488 North Central 4.3 7.3 15.7 13.7 44.4 0.4 4.7 9.7 100.0 9.2 537 Central 4.0 9.4 20.6 14.6 40.4 0.8 1.5 8.7 100.0 9.0 706 South Central 3.4 9.7 16.5 19.4 30.4 2.3 3.5 14.9 100.0 9.0 999 South 2.8 8.6 14.5 16.5 38.3 1.8 6.0 11.6 100.0 9.2 644 Atoll Malé Atoll 1.2 4.3 6.4 14.5 36.2 2.7 8.4 26.3 100.0 9.7 968 HA Atoll 4.0 6.7 20.7 17.0 33.1 1.4 3.9 13.4 100.0 9.1 149 HDh Atoll 3.5 7.5 17.3 16.2 41.7 0.7 1.1 11.9 100.0 9.1 202 Sh Atoll 2.4 10.4 15.2 20.7 30.7 0.4 5.8 14.4 100.0 9.0 136 N Atoll 8.4 8.9 14.3 12.8 42.9 0.4 1.8 10.5 100.0 9.1 119 R Atoll 3.4 8.7 12.4 15.9 46.5 0.5 3.5 9.0 100.0 9.2 119 B Atoll 2.0 4.9 16.7 14.0 42.3 0.5 7.3 12.4 100.0 9.3 191 Lh Atoll 4.8 8.1 19.2 11.6 47.2 0.0 4.5 4.6 100.0 9.1 109 K Atoll 4 3.6 12.1 20.9 14.3 43.6 0.4 0.9 4.1 100.0 8.9 290 AA Atoll 3.1 10.8 24.2 13.6 27.5 1.7 3.1 16.0 100.0 8.8 154 ADh Atoll 7.4 6.0 12.5 19.6 46.0 0.9 0.0 7.6 100.0 9.1 150 V Atoll 1.5 5.1 26.1 10.3 42.5 0.0 2.7 11.8 100.0 9.2 112 M Atoll 1.2 6.7 20.0 15.1 30.5 3.3 3.9 19.4 100.0 9.2 146 F Atoll 2.3 5.8 19.6 23.8 21.8 5.0 6.8 14.9 100.0 8.9 197 Dh Atoll 6.8 11.5 14.9 21.8 30.6 3.9 5.0 5.5 100.0 8.7 200 Th Atoll 0.0 10.8 19.8 22.2 35.6 0.3 1.9 9.4 100.0 8.8 185 L Atoll 5.2 12.0 11.1 14.7 32.7 0.0 1.0 23.3 100.0 9.2 270 GA Atoll 2.4 11.0 10.3 10.8 45.5 1.0 3.5 15.4 100.0 9.3 162 GDh Atoll 0.8 9.4 17.8 20.2 39.9 0.0 2.1 9.8 100.0 9.0 142 Gn Atoll 5.8 7.3 11.9 14.5 39.4 2.7 3.5 14.9 100.0 9.3 120 S Atoll 2.9 7.0 16.8 19.4 31.2 2.9 11.7 8.1 100.0 9.1 220 Wealth quintile Lowest 4.1 10.7 20.0 20.4 33.7 1.1 2.6 7.3 100.0 8.6 993 Second 4.0 10.1 16.1 18.3 35.7 0.9 3.2 11.6 100.0 9.0 1,017 Middle 2.8 6.4 14.8 13.8 40.6 2.0 4.9 14.6 100.0 9.3 1,169 Fourth 1.5 6.0 11.4 12.1 40.3 2.6 6.7 19.5 100.0 9.5 691 Highest 1.4 2.9 4.8 14.6 31.4 2.1 9.3 33.5 100.0 9.8 472 Total 3.0 7.8 14.7 16.2 36.8 1.6 4.8 15.1 100.0 9.2 4,342 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Completed 7th grade at the primary level 2 Completed 10th grade at the secondary level 3 Completed 12th grade at the higher secondary level 4 Excludes Malé region. 42 • Characteristics of Respondents Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Maldives DHS 2016-17 Higher than secondary schooling No schooling, primary or secondary school Total Percent- age literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Age 15-24 21.8 77.4 0.5 0.3 0.0 100.0 99.7 2,322 15-19 9.5 90.1 0.2 0.2 0.0 100.0 99.8 1,099 20-24 32.8 65.9 0.9 0.4 0.0 100.0 99.6 1,223 25-29 29.8 68.0 1.9 0.3 0.0 100.0 99.7 1,379 30-34 27.4 68.4 3.9 0.3 0.2 100.0 99.6 1,372 35-39 17.7 71.3 9.7 1.1 0.2 100.0 98.6 1,044 40-44 8.1 77.0 11.4 3.0 0.5 100.0 96.5 845 45-49 10.2 71.0 16.0 2.3 0.5 100.0 97.2 737 Residence Malé region 31.7 63.8 3.5 0.8 0.2 100.0 99.0 3,424 Other atolls 12.5 79.7 6.7 1.0 0.1 100.0 98.8 4,275 Region Malé 31.7 63.8 3.5 0.8 0.2 100.0 99.0 3,424 North 9.3 84.4 4.7 1.4 0.3 100.0 98.3 981 North Central 12.1 82.4 5.1 0.3 0.1 100.0 99.7 913 Central 10.4 73.2 14.6 1.4 0.4 100.0 98.2 507 South Central 14.1 78.9 6.5 0.3 0.1 100.0 99.5 844 South 15.4 76.6 6.4 1.6 0.0 100.0 98.4 1,030 Wealth quintile Lowest 7.9 82.1 8.4 1.4 0.2 100.0 98.4 1,393 Second 10.7 80.9 7.0 1.2 0.2 100.0 98.7 1,449 Middle 19.7 74.2 5.2 0.7 0.3 100.0 99.0 1,533 Fourth 25.0 69.9 4.4 0.5 0.1 100.0 99.3 1,629 Highest 38.1 58.9 2.2 0.8 0.0 100.0 99.2 1,694 Total 21.0 72.6 5.3 0.9 0.2 100.0 98.9 7,699 1 Refers to women who attended schooling higher than the secondary level and women who can read a whole sentence or part of a sentence Characteristics of Respondents • 43 Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Maldives DHS 2016-17 Higher than secondary schooling No schooling, primary or secondary school Total Percent- age literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Age 15-24 9.4 82.4 5.4 2.8 0.0 100.0 97.2 1,628 15-19 3.9 87.2 6.1 2.9 0.0 100.0 97.1 935 20-24 16.9 76.0 4.6 2.6 0.0 100.0 97.4 693 25-29 18.9 71.3 6.5 3.3 0.0 100.0 96.7 716 30-34 23.3 65.8 7.8 2.9 0.1 100.0 96.9 663 35-39 18.7 68.6 9.2 3.2 0.3 100.0 96.5 469 40-44 16.2 69.2 12.1 2.0 0.6 100.0 97.5 449 45-49 12.1 62.3 15.3 9.8 0.4 100.0 89.8 417 Residence Malé region 26.3 62.8 4.8 5.9 0.1 100.0 94.0 968 Other atolls 11.9 76.2 8.9 2.8 0.2 100.0 97.0 3,374 Region Malé 26.3 62.8 4.8 5.9 0.1 100.0 94.0 968 North 13.1 78.6 6.9 1.2 0.2 100.0 98.6 488 North Central 9.7 74.7 12.7 2.7 0.3 100.0 97.0 537 Central 8.7 77.9 10.4 3.1 0.0 100.0 96.9 706 South Central 14.9 75.2 6.4 3.1 0.3 100.0 96.6 999 South 11.6 75.3 9.6 3.5 0.0 100.0 96.5 644 Wealth quintile Lowest 7.3 79.8 8.6 4.2 0.1 100.0 95.7 993 Second 11.6 74.7 10.8 2.5 0.2 100.0 97.2 1,017 Middle 14.6 75.1 8.3 1.8 0.2 100.0 98.0 1,169 Fourth 19.5 68.5 6.0 5.8 0.2 100.0 94.0 691 Highest 33.5 58.5 3.1 4.9 0.0 100.0 95.1 472 Total 15.1 73.2 8.0 3.5 0.2 100.0 96.3 4,342 1 Refers to men who attended schooling higher than the secondary level and men who can read a whole sentence or part of a sentence 44 • Characteristics of Respondents Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Maldives DHS 2016-17 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 34.4 87.5 25.4 9.3 7.8 1,099 20-24 56.5 84.8 25.2 12.6 6.2 1,223 25-29 57.9 85.3 31.0 19.3 6.1 1,379 30-34 61.3 86.5 34.0 20.4 5.1 1,372 35-39 55.6 88.2 42.3 24.7 4.9 1,044 40-44 48.2 85.3 49.7 22.6 4.7 845 45-49 39.0 85.8 53.7 17.6 5.3 737 Residence Malé region 59.1 89.6 28.1 15.6 3.2 3,424 Other atolls 45.9 83.5 41.6 19.8 7.9 4,275 Region Malé 59.1 89.6 28.1 15.6 3.2 3,424 North 42.2 81.9 45.3 19.8 9.5 981 North Central 45.5 81.1 35.9 17.7 9.7 913 Central 44.7 89.4 48.5 19.4 3.4 507 South Central 39.2 86.2 42.4 17.1 5.4 844 South 55.7 81.9 39.0 24.1 8.8 1,030 Atoll Malé Atoll 59.1 89.6 28.1 15.6 3.2 3,424 HA Atoll 40.7 81.8 46.2 18.7 8.9 279 HDh Atoll 44.6 79.2 39.7 18.4 12.3 403 Sh Atoll 40.3 85.6 51.9 22.5 6.5 299 N Atoll 39.5 75.1 35.2 16.6 16.2 210 R Atoll 40.0 82.5 41.7 18.3 8.6 345 B Atoll 57.8 87.6 32.5 19.3 5.3 183 Lh Atoll 50.9 78.7 28.7 16.0 8.8 175 K Atoll 1 50.3 89.2 49.6 23.1 3.2 234 AA Atoll 38.7 90.2 42.1 12.7 3.2 127 ADh Atoll 37.5 88.7 52.3 18.9 5.0 113 V Atoll 52.1 90.6 51.5 20.2 0.7 33 M Atoll 30.7 88.8 48.2 16.8 6.2 109 F Atoll 42.0 80.8 50.9 21.0 7.0 102 Dh Atoll 30.9 88.2 43.6 12.7 4.9 124 Th Atoll 51.3 87.3 36.9 18.2 3.2 205 L Atoll 36.5 85.6 40.8 16.9 6.2 304 GA Atoll 55.6 86.6 52.8 29.6 4.1 174 GDh Atoll 42.5 86.6 33.5 16.2 8.7 223 Gn Atoll 60.8 65.9 46.9 31.3 17.5 200 S Atoll 60.2 85.0 32.7 22.6 6.8 434 Education No education 26.4 77.0 56.7 14.5 10.8 323 Primary 38.3 87.1 52.7 20.7 5.3 1,712 Secondary 51.3 86.9 30.5 16.9 6.1 4,044 More than secondary 72.2 85.3 26.1 18.3 4.5 1,619 Wealth quintile Lowest 37.6 78.1 46.3 16.5 9.8 1,393 Second 44.9 86.3 40.7 19.3 6.2 1,449 Middle 52.2 82.7 36.8 20.5 7.3 1,533 Fourth 59.1 91.7 28.9 17.1 2.7 1,629 Highest 61.8 90.6 27.8 16.3 3.7 1,694 Total 51.7 86.2 35.6 17.9 5.8 7,699 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Excludes Malé region. Characteristics of Respondents • 45 Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Maldives DHS 2016-17 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 30.1 77.8 17.5 5.6 14.5 935 20-24 54.0 73.4 15.2 9.0 15.3 693 25-29 62.7 76.8 20.9 11.1 8.7 716 30-34 69.8 76.6 18.2 12.2 8.3 663 35-39 64.6 78.3 26.8 16.6 7.1 469 40-44 63.7 83.0 34.7 20.9 7.4 449 45-49 48.0 80.3 42.8 19.9 9.5 417 Residence Malé region 62.5 81.5 17.8 10.0 6.9 968 Other atolls 51.9 76.4 24.5 12.8 11.8 3,374 Region Malé 62.5 81.5 17.8 10.0 6.9 968 North 54.3 81.1 31.1 17.3 9.2 488 North Central 51.6 67.9 18.5 11.9 19.2 537 Central 51.4 80.7 24.0 12.2 8.8 706 South Central 47.1 78.4 25.7 11.6 11.5 999 South 58.5 72.3 23.3 12.8 11.3 644 Atoll Malé Atoll 62.5 81.5 17.8 10.0 6.9 968 HA Atoll 46.8 78.3 19.9 10.1 14.4 149 HDh Atoll 59.9 82.2 46.1 25.6 6.5 202 Sh Atoll 54.2 82.6 21.1 13.0 7.4 136 N Atoll 39.9 65.6 22.7 14.9 25.7 119 R Atoll 53.1 70.6 21.6 13.5 14.2 119 B Atoll 63.0 74.4 10.5 5.6 10.6 191 Lh Atoll 42.8 56.1 24.6 17.9 32.6 109 K Atoll 1 53.3 83.0 27.0 14.2 7.5 290 AA Atoll 56.8 82.7 22.6 12.7 5.7 154 ADh Atoll 38.0 74.0 20.7 6.3 15.9 150 V Atoll 57.1 80.8 22.7 13.9 7.1 112 M Atoll 48.3 88.5 33.1 14.0 3.5 146 F Atoll 47.2 80.7 34.1 15.4 7.8 197 Dh Atoll 41.8 67.3 25.1 11.0 23.6 200 Th Atoll 49.1 78.4 16.9 9.3 12.0 185 L Atoll 48.9 79.5 21.9 9.6 9.4 270 GA Atoll 57.7 84.7 23.5 12.5 5.1 162 GDh Atoll 59.7 84.7 25.9 13.9 4.7 142 Gn Atoll 57.4 58.2 30.1 20.2 20.0 120 S Atoll 58.8 63.0 17.8 8.4 15.4 220 Education No education 30.1 64.5 44.1 12.2 21.3 131 Primary 45.6 80.0 34.1 16.2 10.5 975 Secondary 51.9 77.3 18.9 10.0 11.8 2,581 More than secondary 81.5 77.8 18.5 15.1 4.7 655 Wealth quintile Lowest 44.2 72.4 27.8 12.8 14.5 993 Second 51.1 79.4 22.7 11.6 10.9 1,017 Middle 56.3 75.8 21.7 11.5 10.8 1,169 Fourth 59.3 81.0 24.2 14.4 8.5 691 Highest 70.1 83.6 15.3 10.6 5.3 472 Total 54.3 77.6 23.0 12.2 10.7 4,342 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Excludes Malé region. 46 • Characteristics of Respondents Table 3.5.1 Internet usage: Women Percentage of women age 15-49 who have ever used the internet, and percentage who have used the internet in the past 12 months; and among women who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Maldives DHS 2016-17 Ever used the internet Used the internet in the past 12 months Number Among respondents who have used the internet in the past 12 months, percentage who, in the past month, used internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Total Number Age 15-19 91.0 88.9 1,099 78.2 14.7 5.0 2.1 100.0 977 20-24 95.5 94.1 1,223 85.8 10.2 3.3 0.7 100.0 1,151 25-29 92.0 89.7 1,379 86.2 9.6 1.8 2.4 100.0 1,237 30-34 86.4 85.1 1,372 87.9 8.7 2.1 1.3 100.0 1,167 35-39 72.3 70.8 1,044 82.3 13.0 2.3 2.4 100.0 739 40-44 53.4 53.1 845 80.9 13.0 5.2 0.9 100.0 449 45-49 42.6 41.6 737 81.5 11.7 5.9 1.0 100.0 307 Residence Malé region 89.5 88.2 3,424 88.7 8.2 2.0 1.2 100.0 3,019 Other atolls 72.0 70.4 4,275 79.4 14.1 4.4 2.1 100.0 3,008 Region Malé 89.5 88.2 3,424 88.7 8.2 2.0 1.2 100.0 3,019 North 66.1 64.4 981 79.4 15.9 3.8 0.9 100.0 632 North Central 69.3 67.9 913 75.5 17.0 5.5 2.0 100.0 620 Central 71.8 70.5 507 76.7 14.7 5.4 3.1 100.0 358 South Central 71.0 69.5 844 73.1 17.3 5.4 4.2 100.0 587 South 80.9 78.8 1,030 87.9 8.1 2.9 1.1 100.0 812 Atoll Malé Atoll 89.5 88.2 3,424 88.7 8.2 2.0 1.2 100.0 3,019 HA Atoll 62.7 60.8 279 81.0 15.1 3.5 0.4 100.0 169 HDh Atoll 71.6 70.2 403 81.0 12.7 4.9 1.4 100.0 283 Sh Atoll 61.7 60.1 299 75.4 21.6 2.2 0.7 100.0 180 N Atoll 64.8 63.6 210 67.0 22.9 7.4 2.7 100.0 133 R Atoll 64.5 63.2 345 75.1 18.3 4.6 2.0 100.0 218 B Atoll 73.8 72.9 183 81.0 11.7 4.9 2.5 100.0 134 Lh Atoll 79.4 77.0 175 79.2 14.3 5.7 0.8 100.0 135 K Atoll 1 72.4 71.6 234 78.1 14.4 3.3 4.2 100.0 168 AA Atoll 72.2 70.9 127 74.7 12.4 10.8 2.1 100.0 90 ADh Atoll 68.1 65.6 113 72.0 19.9 5.0 3.2 100.0 74 V Atoll 78.1 78.1 33 87.7 10.6 1.7 0.0 100.0 26 M Atoll 66.4 66.4 109 74.3 19.6 4.7 1.4 100.0 72 F Atoll 69.1 66.5 102 79.4 13.6 4.3 2.7 100.0 68 Dh Atoll 67.4 66.1 124 67.1 23.6 4.4 4.9 100.0 82 Th Atoll 74.6 72.8 205 76.7 11.8 4.1 7.5 100.0 150 L Atoll 72.3 70.9 304 70.6 19.0 7.2 3.1 100.0 216 GA Atoll 73.7 72.5 174 78.8 13.9 5.2 2.1 100.0 126 GDh Atoll 73.7 71.7 223 79.1 15.0 4.8 1.0 100.0 160 Gn Atoll 88.3 86.9 200 93.5 4.9 1.3 0.3 100.0 174 S Atoll 84.1 81.3 434 92.5 4.5 1.9 1.1 100.0 353 Education No education 30.4 29.1 323 75.2 17.3 3.3 4.2 100.0 94 Primary 46.8 45.7 1,712 73.8 18.8 4.9 2.6 100.0 782 Secondary 90.2 88.2 4,044 81.7 12.4 4.1 1.8 100.0 3,566 More than secondary 98.4 97.8 1,619 94.9 4.1 0.3 0.7 100.0 1,584 Wealth quintile Lowest 61.9 59.8 1,393 73.9 17.0 6.3 2.8 100.0 833 Second 70.6 69.0 1,449 77.0 14.4 5.8 2.8 100.0 1,001 Middle 80.7 79.2 1,533 85.0 11.0 2.5 1.5 100.0 1,214 Fourth 86.9 85.0 1,629 84.2 12.5 2.1 1.3 100.0 1,385 Highest 94.7 94.1 1,694 92.9 5.0 1.4 0.7 100.0 1,594 Total 79.8 78.3 7,699 84.0 11.1 3.2 1.6 100.0 6,027 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Excludes Malé region. Characteristics of Respondents • 47 Table 3.5.2 Internet usage: Men Percentage of men age 15-49 who have ever used the internet, and percentage who have used the internet in the past 12 months; and among men who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Maldives DHS 2016-17 Ever used the internet Used the internet in the past 12 months Number Among respondents who have used the internet in the past 12 months, percentage who, in the past month, used internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Total Number Age 15-19 91.5 88.8 935 75.0 16.6 5.4 3.0 100.0 830 20-24 97.5 96.3 693 88.3 8.7 0.8 2.3 100.0 668 25-29 97.1 96.0 716 87.4 8.0 3.0 1.6 100.0 687 30-34 93.7 92.8 663 88.2 7.8 1.5 2.4 100.0 616 35-39 87.5 85.6 469 84.7 8.7 4.1 2.5 100.0 401 40-44 81.2 79.0 449 83.2 11.8 1.7 3.3 100.0 355 45-49 53.5 51.0 417 79.3 15.0 4.0 1.7 100.0 213 Residence Malé region 96.1 94.5 968 90.3 6.8 1.7 1.1 100.0 915 Other atolls 86.4 84.6 3,374 81.7 12.1 3.3 2.9 100.0 2,855 Region Malé 96.1 94.5 968 90.3 6.8 1.7 1.1 100.0 915 North 85.7 83.7 488 85.1 10.7 2.4 1.8 100.0 408 North Central 85.0 83.5 537 81.3 13.9 3.6 1.2 100.0 449 Central 87.0 86.1 706 84.0 10.0 3.7 2.3 100.0 608 South Central 84.8 82.6 999 76.4 14.0 4.0 5.6 100.0 825 South 90.1 87.8 644 85.1 11.0 2.4 1.6 100.0 565 Atoll Malé Atoll 96.1 94.5 968 90.3 6.8 1.7 1.1 100.0 915 HA Atoll 81.3 79.7 149 84.6 9.7 3.1 2.6 100.0 119 HDh Atoll 88.7 86.5 202 86.4 10.9 2.1 0.7 100.0 175 Sh Atoll 86.2 83.9 136 83.7 11.6 2.2 2.5 100.0 114 N Atoll 85.4 83.7 119 76.7 18.3 4.3 0.7 100.0 99 R Atoll 82.4 80.9 119 81.0 14.3 2.8 1.9 100.0 96 B Atoll 88.4 86.5 191 84.1 9.9 4.7 1.3 100.0 166 Lh Atoll 81.4 80.7 109 81.5 16.1 1.8 0.7 100.0 88 K Atoll 1 87.5 86.2 290 88.3 6.6 3.3 1.8 100.0 250 AA Atoll 86.0 86.0 154 73.6 16.2 6.3 3.9 100.0 132 ADh Atoll 86.3 86.3 150 83.5 10.8 2.6 3.2 100.0 129 V Atoll 87.7 85.8 112 88.0 9.3 2.7 0.0 100.0 97 M Atoll 84.8 81.9 146 73.8 15.0 4.2 7.0 100.0 120 F Atoll 86.2 84.6 197 71.7 18.1 4.6 5.6 100.0 167 Dh Atoll 80.4 78.9 200 77.0 15.6 5.9 1.5 100.0 158 Th Atoll 87.2 86.1 185 80.6 9.6 2.5 7.2 100.0 159 L Atoll 85.6 81.8 270 77.8 12.4 3.1 6.8 100.0 221 GA Atoll 85.3 81.5 162 77.3 20.3 0.4 2.0 100.0 132 GDh Atoll 90.2 87.1 142 82.8 9.8 5.7 1.6 100.0 123 Gn Atoll 94.9 94.0 120 88.1 9.6 2.3 0.0 100.0 113 S Atoll 90.9 89.6 220 90.0 6.1 1.7 2.2 100.0 198 Education No education 38.0 36.3 131 63.0 27.0 7.9 2.1 100.0 48 Primary 70.8 67.6 975 73.5 16.3 3.5 6.7 100.0 659 Secondary 95.5 93.8 2,581 83.8 11.2 3.2 1.8 100.0 2,422 More than secondary 98.2 98.0 655 96.1 2.6 1.0 0.3 100.0 642 Wealth quintile Lowest 81.7 78.9 993 76.0 15.3 4.2 4.5 100.0 783 Second 84.8 82.9 1,017 80.7 11.3 4.1 3.9 100.0 843 Middle 90.4 88.9 1,169 85.6 10.4 2.7 1.3 100.0 1,039 Fourth 94.9 93.7 691 86.7 10.1 1.5 1.6 100.0 648 Highest 97.6 96.8 472 94.8 3.9 1.3 0.0 100.0 457 Total 88.6 86.8 4,342 83.8 10.8 2.9 2.4 100.0 3,770 Note: For the full names of the atolls, see Appendix A, Table A.1. Atoll-specific results may not be reliable due to small sample sizes. 1 Excludes Malé region. 48 • Characteristics of Respondents Table 3.6.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Maldives DHS 2016-17 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 24.1 8.5 67.5 100.0 1,099 20-24 51.3 7.5 41.2 100.0 1,223 25-29 46.8 5.7 47.4 100.0 1,379 30-34 42.3 4.3 53.4 100.0 1,372 35-39 40.2 4.2 55.6 100.0 1,044 40-44 43.4 3.2 53.4 100.0 845 45-49 47.5 5.4 47.1 100.0 737 Marital status Never married 38.6 8.1 53.3 100.0 1,779 Married or living together 41.7 4.9 53.4 100.0 5,280 Divorced/separated/widowed 57.1 4.8 38.0 100.0 641 Number of living children 0 44.7 7.3 47.9 100.0 2,699 1-2 42.3 5.4 52.4 100.0 3,143 3-4 38.1 2.8 59.1 100.0 1,385 5+ 40.4 5.9 53.7 100.0 472 Residence Malé region 47.5 8.9 43.7 100.0 3,424 Other atolls 38.1 3.0 58.9 100.0 4,275 Region Malé 47.5 8.9 43.7 100.0 3,424 North 37.1 1.1 61.8 100.0 981 North Central 35.9 1.2 62.9 100.0 913 Central 45.3 6.8 47.9 100.0 507 South Central 39.4 4.8 55.8 100.0 844 South 36.5 3.2 60.3 100.0 1,030 Education No education 31.9 4.1 64.0 100.0 323 Primary 36.5 3.5 60.0 100.0 1,712 Secondary 35.3 5.9 58.8 100.0 4,044 More than secondary 67.7 7.6 24.7 100.0 1,619 Wealth quintile Lowest 34.9 3.1 62.0 100.0 1,393 Second 37.7 4.0 58.3 100.0 1,449 Middle 40.4 4.5 55.1 100.0 1,533 Fourth 45.2 7.4 47.5 100.0 1,629 Highest 51.2 8.4 40.4 100.0 1,694 Total 42.3 5.6 52.1 100.0 7,699 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 49 Table 3.6.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Maldives DHS 2016-17 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 32.2 6.9 60.9 100.0 935 20-24 76.4 12.7 10.9 100.0 693 25-29 90.6 6.6 2.8 100.0 716 30-34 94.7 3.0 2.3 100.0 663 35-39 94.4 3.3 2.2 100.0 469 40-44 93.5 3.7 2.7 100.0 449 45-49 92.4 5.0 2.6 100.0 417 Marital status Never married 53.1 9.0 37.8 100.0 1,772 Married or living together 94.9 3.8 1.3 100.0 2,386 Divorced/separated/widowed 82.2 11.5 6.3 100.0 184 Number of living children 0 61.5 8.6 30.0 100.0 2,276 1-2 94.4 3.9 1.7 100.0 1,341 3-4 95.6 3.4 1.0 100.0 586 5+ 94.1 3.6 2.4 100.0 138 Residence Malé region 76.9 7.2 15.9 100.0 968 Other atolls 77.4 6.0 16.6 100.0 3,374 Region Malé 76.9 7.2 15.9 100.0 968 North 78.7 4.2 17.1 100.0 488 North Central 76.5 7.3 16.2 100.0 537 Central 82.1 3.8 14.1 100.0 706 South Central 78.1 5.9 16.0 100.0 999 South 71.1 8.7 20.2 100.0 644 Education No education 90.9 3.3 5.8 100.0 131 Primary 90.2 5.0 4.8 100.0 975 Secondary 68.3 7.9 23.8 100.0 2,581 More than secondary 90.9 2.4 6.7 100.0 655 Wealth quintile Lowest 75.7 6.8 17.6 100.0 993 Second 76.4 6.0 17.6 100.0 1,017 Middle 78.5 5.7 15.8 100.0 1,169 Fourth 76.9 7.8 15.3 100.0 691 Highest 80.5 4.9 14.7 100.0 472 Total 77.3 6.3 16.4 100.0 4,342 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 50 • Characteristics of Respondents Table 3.7.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Maldives DHS 2016-17 Background characteristic Profes- sional/ technical/ mana- gerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Armed forces Other Total Number of women Age 15-19 44.5 14.3 30.6 2.4 1.2 2.3 0.0 0.0 4.6 100.0 357 20-24 51.8 6.5 22.7 7.7 2.3 2.6 0.0 1.0 5.5 100.0 719 25-29 58.3 3.3 14.2 11.6 3.7 2.1 0.3 0.0 6.4 100.0 725 30-34 46.9 4.6 12.4 20.2 7.4 3.0 0.1 0.5 4.9 100.0 639 35-39 36.7 6.1 4.7 32.7 12.8 0.8 0.5 0.0 5.7 100.0 463 40-44 36.2 0.1 5.6 35.0 16.8 3.0 0.9 0.0 2.4 100.0 394 45-49 30.5 0.5 5.6 40.9 12.5 3.3 2.0 0.3 4.3 100.0 390 Marital status Never married 48.7 10.1 27.1 3.3 2.3 2.7 0.0 0.4 5.4 100.0 831 Married or living together 46.0 3.5 9.3 24.8 8.3 2.0 0.6 0.1 5.3 100.0 2,459 Divorced/separated/widowed 37.7 3.3 16.7 22.5 11.5 4.3 0.3 1.2 2.6 100.0 397 Number of living children 0 52.7 7.7 22.5 4.9 3.3 2.5 0.0 0.5 5.9 100.0 1,405 1-2 48.9 4.6 10.6 21.2 6.4 2.7 0.3 0.3 5.0 100.0 1,497 3-4 30.9 1.0 5.5 41.5 13.9 1.6 1.2 0.0 4.4 100.0 567 5+ 17.0 0.0 6.5 47.3 22.6 2.3 2.5 0.0 1.7 100.0 219 Residence Malé region 49.7 7.3 17.6 12.9 4.2 2.1 0.0 0.5 5.6 100.0 1,929 Other atolls 41.4 2.3 10.3 27.2 10.7 2.7 0.9 0.1 4.4 100.0 1,759 Region Malé 49.7 7.3 17.6 12.9 4.2 2.1 0.0 0.5 5.6 100.0 1,929 North 40.2 2.3 9.7 32.1 8.5 2.7 1.9 0.3 2.3 100.0 375 North Central 41.6 2.4 6.7 30.0 12.0 2.1 0.4 0.0 4.9 100.0 338 Central 36.4 2.1 14.7 23.9 12.6 4.2 0.5 0.0 5.5 100.0 264 South Central 36.7 2.0 9.2 28.6 14.5 1.9 0.8 0.0 6.3 100.0 373 South 49.7 2.7 11.8 21.0 7.2 3.1 1.0 0.0 3.5 100.0 408 Education No education 9.9 0.0 5.3 49.9 24.9 7.1 1.3 0.0 1.7 100.0 116 Primary 12.5 0.6 9.5 47.6 20.3 2.6 1.8 0.2 4.9 100.0 685 Secondary 39.2 7.9 22.4 17.2 5.1 2.8 0.1 0.0 5.2 100.0 1,667 More than secondary 76.7 3.8 6.1 4.5 1.4 1.4 0.1 0.8 5.3 100.0 1,219 Wealth quintile Lowest 28.9 1.8 12.1 35.1 14.6 3.6 1.0 0.0 2.8 100.0 529 Second 39.3 2.5 12.0 28.0 10.2 2.3 1.4 0.0 4.3 100.0 604 Middle 50.4 3.7 11.3 18.4 8.2 2.8 0.4 0.0 4.7 100.0 689 Fourth 47.0 5.0 18.9 15.7 4.9 2.3 0.0 0.9 5.3 100.0 856 Highest 54.1 8.9 14.3 10.9 3.2 1.7 0.0 0.3 6.7 100.0 1,009 Total 45.7 4.9 14.1 19.7 7.3 2.4 0.4 0.3 5.0 100.0 3,687 Characteristics of Respondents • 51 Table 3.7.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Maldives DHS 2016-17 Background characteristic Profes- sional/ technical/ mana- gerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Armed forces Other Total Number of men Age 15-19 31.1 1.9 15.8 9.0 13.5 4.5 12.2 0.0 11.9 100.0 366 20-24 36.3 3.6 7.9 6.7 11.2 11.5 10.7 0.6 11.4 100.0 618 25-29 31.7 3.1 6.3 8.8 14.4 11.6 10.7 1.0 12.5 100.0 696 30-34 39.4 2.3 3.7 10.0 14.3 11.1 9.8 1.4 8.2 100.0 648 35-39 33.9 2.7 5.1 14.1 13.7 5.0 12.6 2.8 10.2 100.0 458 40-44 39.4 2.3 4.9 10.1 13.8 7.4 9.4 1.7 10.9 100.0 436 45-49 33.3 2.2 6.0 12.8 14.0 5.3 19.6 0.0 6.9 100.0 406 Marital status Never married 33.3 2.4 12.5 8.1 13.2 8.1 11.0 0.1 11.3 100.0 1,102 Married or living together 36.3 2.9 4.4 10.8 13.6 8.8 12.0 1.6 9.8 100.0 2,354 Divorced/separated/widowed 32.7 1.8 1.1 10.6 14.9 12.5 13.9 0.0 12.4 100.0 172 Number of living children 0 34.5 2.5 9.7 7.5 13.2 9.1 10.8 0.7 11.9 100.0 1,594 1-2 38.0 3.0 4.3 11.0 14.4 9.8 9.4 1.5 8.5 100.0 1,318 3-4 32.3 2.1 4.8 14.3 12.5 5.8 16.4 1.5 10.3 100.0 580 5+ 28.2 3.0 3.4 9.5 12.9 6.6 25.8 0.0 10.6 100.0 135 Residence Malé region 41.3 3.6 10.2 5.9 9.7 11.1 2.0 3.6 12.6 100.0 814 Other atolls 33.4 2.4 5.7 11.1 14.6 8.0 14.6 0.4 9.7 100.0 2,814 Region Malé 41.3 3.6 10.2 5.9 9.7 11.1 2.0 3.6 12.6 100.0 814 North 29.1 3.6 6.6 13.2 20.6 7.7 9.6 0.6 9.0 100.0 405 North Central 33.5 0.9 5.0 16.2 18.6 4.5 10.7 0.5 10.2 100.0 450 Central 42.9 2.9 3.5 10.4 7.5 10.3 10.8 0.0 11.5 100.0 607 South Central 32.6 2.1 5.9 10.0 11.4 7.8 22.5 0.1 7.7 100.0 839 South 27.0 2.7 7.9 7.6 20.2 9.2 13.5 0.9 11.1 100.0 514 Education No education 21.0 0.0 5.8 17.3 18.1 7.3 21.9 0.0 8.5 100.0 124 Primary 24.3 1.3 5.4 15.6 16.7 6.7 21.5 0.1 8.4 100.0 928 Secondary 32.9 3.1 8.0 9.1 14.1 10.3 9.8 1.2 11.5 100.0 1,966 More than secondary 61.7 4.0 4.8 2.6 6.0 7.0 1.3 2.5 10.0 100.0 611 Wealth quintile Lowest 28.2 1.4 5.1 12.5 16.5 8.7 17.9 0.1 9.6 100.0 818 Second 31.2 2.1 7.0 11.0 15.3 6.9 17.0 0.1 9.4 100.0 837 Middle 38.4 3.7 5.9 10.2 13.3 8.4 10.2 0.6 9.4 100.0 985 Fourth 40.3 4.0 7.7 8.7 9.9 9.9 5.9 2.1 11.6 100.0 585 Highest 42.2 2.2 10.1 3.7 9.7 11.6 0.9 4.8 14.6 100.0 403 Total 35.2 2.7 6.7 9.9 13.5 8.7 11.8 1.1 10.4 100.0 3,628 Table 3.8 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer and continuity of employment, Maldives DHS 2016-17 Employment characteristic Total Type of earnings Cash only 97.0 Cash and in-kind 0.8 In-kind only 0.7 Not paid 1.5 Total 100.0 Type of employer Employed by family member 11.8 Employed by nonfamily member 40.1 Self-employed 48.1 Total 100.0 Continuity of employment All year 84.1 Seasonal 9.4 Occasional 6.5 Total 100.0 Number of women employed during the last 12 months 3,687 52 • Characteristics of Respondents Table 3.9.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage (other than Aasandha), and percentage with any health insurance, according to background characteristics, Maldives DHS 2016-17 Background characteristic Health insurance through employer Other privately purchased commercial insurance Other None Any health insurance Number of women Age 15-19 1.3 1.3 0.9 96.5 3.5 1,099 20-24 6.1 1.2 2.8 90.2 9.8 1,223 25-29 5.6 2.0 3.0 89.4 10.6 1,379 30-34 3.1 1.8 3.7 91.4 8.6 1,372 35-39 2.9 1.8 2.9 92.4 7.6 1,044 40-44 2.3 1.7 0.5 95.5 4.5 845 45-49 1.6 2.1 1.7 94.5 5.5 737 Residence Malé region 6.3 2.8 3.5 87.5 12.5 3,424 Other atolls 1.3 0.8 1.5 96.5 3.5 4,275 Region Malé 6.3 2.8 3.5 87.5 12.5 3,424 North 0.4 0.0 1.3 98.3 1.7 981 North Central 0.8 1.3 1.1 96.7 3.3 913 Central 2.1 0.9 2.3 94.6 5.4 507 South Central 2.7 0.4 1.0 95.9 4.1 844 South 1.1 1.2 1.8 95.9 4.1 1,030 Education No education 1.0 1.5 0.9 96.6 3.4 323 Primary 0.4 0.5 1.4 97.7 2.3 1,712 Secondary 3.3 1.7 1.6 93.5 6.5 4,044 More than secondary 8.0 2.9 5.8 83.6 16.4 1,619 Wealth quintile Lowest 1.3 0.7 1.5 96.4 3.6 1,393 Second 1.4 0.6 1.1 96.9 3.1 1,449 Middle 1.3 1.3 1.5 95.9 4.1 1,533 Fourth 5.6 1.3 2.2 90.9 9.1 1,629 Highest 7.2 4.1 5.1 83.8 16.2 1,694 Total 3.5 1.7 2.4 92.5 7.5 7,699 Characteristics of Respondents • 53 Table 3.9.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage (other than Aasandha), and percentage with any health insurance, according to background characteristics, Maldives DHS 2016-17 Background characteristic Health insurance through employer Other privately purchased commercial insurance Other None Any health insurance Number of men Age 15-19 0.6 0.6 0.4 98.4 1.6 935 20-24 9.3 2.8 1.7 86.6 13.4 693 25-29 14.4 2.8 2.8 80.1 19.9 716 30-34 12.2 3.6 1.9 82.6 17.4 663 35-39 9.8 3.6 1.6 85.0 15.0 469 40-44 9.0 3.4 1.0 86.6 13.4 449 45-49 4.2 1.8 1.6 92.4 7.6 417 Residence Malé region 17.3 4.5 0.2 78.2 21.8 968 Other atolls 5.6 1.9 1.9 90.6 9.4 3,374 Region Malé 17.3 4.5 0.2 78.2 21.8 968 North 4.7 1.3 2.0 92.1 7.9 488 North Central 4.8 0.7 1.7 93.0 7.0 537 Central 10.0 3.5 1.5 85.4 14.6 706 South Central 2.4 1.5 2.3 93.8 6.2 999 South 7.3 2.4 2.1 88.3 11.7 644 Education No education 0.4 0.7 2.2 96.7 3.3 131 Primary 5.8 1.3 0.7 92.2 7.8 975 Secondary 8.4 2.9 1.5 87.4 12.6 2,581 More than secondary 13.0 3.3 3.0 81.1 18.9 655 Wealth quintile Lowest 3.8 1.8 1.6 92.9 7.1 993 Second 5.4 2.4 1.5 90.7 9.3 1,017 Middle 7.8 1.2 2.2 88.8 11.2 1,169 Fourth 12.3 3.9 1.4 82.7 17.3 691 Highest 18.8 5.4 0.0 76.1 23.9 472 Total 8.2 2.5 1.5 87.8 12.2 4,342 54 • Characteristics of Respondents Table 3.10.1 Tobacco smoking: Women Percentage of women age 15-49 who smoke various tobacco products, according to background characteristics, Maldives DHS 2016-17 Percentage who smoke:1 Number of women Background characteristic Cigarettes Other type of tobacco2 Any type of tobacco Age 15-19 0.9 0.8 1.7 1,099 20-24 1.4 1.1 2.2 1,223 25-29 1.1 1.0 2.1 1,379 30-34 1.9 0.6 2.1 1,372 35-39 2.6 0.7 3.2 1,044 40-44 0.9 2.5 3.3 845 45-49 1.8 4.2 5.3 737 Residence Malé region 2.5 1.7 3.9 3,424 Other atolls 0.7 1.1 1.7 4,275 Region Malé 2.5 1.7 3.9 3,424 North 0.4 0.6 1.0 981 North Central 0.3 0.7 0.9 913 Central 2.0 2.5 3.9 507 South Central 0.6 1.1 1.7 844 South 0.8 1.1 1.9 1,030 Education No education 3.5 5.5 7.1 323 Primary 1.4 2.2 3.3 1,712 Secondary 1.4 0.7 2.0 4,044 More than secondary 1.6 1.2 2.6 1,619 Wealth quintile Lowest 1.5 2.0 3.3 1,393 Second 1.0 1.0 1.9 1,449 Middle 0.9 0.6 1.3 1,533 Fourth 2.2 1.7 3.5 1,629 Highest 1.8 1.5 3.1 1,694 Total 1.5 1.4 2.7 7,699 1 Includes daily and occasional (less than daily) use 2 Includes hooka/shishah, bidis, cigars, pipes, and e-cigarettes Characteristics of Respondents • 55 Table 3.10.2 Tobacco smoking: Men Percentage of men age 15-49 who smoke various tobacco products, and percent distribution of men by smoking frequency, according to background characteristics, Maldives DHS 2016-17 Percentage who smoke:1 Smoking frequency Total Number of men Background characteristic Cigarettes Other type of tobacco2 Any type of tobacco Daily smoker Occasional smoker3 Non-smoker Age 15-19 24.9 7.6 26.5 20.2 4.5 75.4 100.0 935 20-24 53.4 15.2 56.0 47.4 6.0 46.6 100.0 693 25-29 52.1 5.5 53.0 47.6 4.5 47.9 100.0 716 30-34 48.5 2.6 49.0 44.1 4.3 51.7 100.0 663 35-39 41.9 1.8 42.2 37.6 4.4 58.1 100.0 469 40-44 37.5 2.2 37.8 32.7 4.8 62.5 100.0 449 45-49 30.8 0.7 31.3 27.3 3.4 69.2 100.0 417 Residence Malé region 42.2 10.1 44.5 36.8 5.2 58.0 100.0 968 Other atolls 41.0 4.7 41.8 36.5 4.4 59.1 100.0 3,374 Region Malé 42.2 10.1 44.5 36.8 5.2 58.0 100.0 968 North 34.6 1.9 34.9 30.5 4.1 65.4 100.0 488 North Central 44.1 5.6 46.1 40.3 3.6 56.1 100.0 537 Central 46.0 9.4 46.7 41.4 4.4 54.2 100.0 706 South Central 39.1 2.1 39.4 32.4 6.7 60.9 100.0 999 South 40.6 4.9 41.6 38.7 1.9 59.4 100.0 644 Education No education 35.6 0.5 36.1 33.8 1.9 64.4 100.0 131 Primary 46.8 3.2 46.9 42.6 4.0 53.3 100.0 975 Secondary 42.0 7.4 43.5 37.3 4.6 58.0 100.0 2,581 More than secondary 31.0 5.0 32.4 25.0 6.0 69.0 100.0 655 Wealth quintile Lowest 46.1 5.1 46.9 40.8 5.1 54.1 100.0 993 Second 42.2 4.8 42.7 37.9 4.4 57.8 100.0 1,017 Middle 37.9 5.3 39.3 34.1 3.8 62.1 100.0 1,169 Fourth 41.1 7.9 42.6 35.9 5.0 59.1 100.0 691 Highest 37.3 8.0 39.3 31.9 5.4 62.7 100.0 472 Total 41.2 5.9 42.4 36.5 4.6 58.8 100.0 4,342 1 Includes daily and occasional (less than daily) use 2 Includes hooka/shishah, bidis, cigars, pipes, and e-cigarettes 3 Occasional refers to less often than daily use 56 • Characteristics of Respondents Table 3.11 Average number of cigarettes smoked daily: Men Among men age 15-49 who smoke cigarettes daily, percent distribution by average number of cigarettes smoked per day, according to background characteristics, Maldives DHS 2016-17 Average number of cigarettes smoked per day Number of respondents who smoke cigarettes daily1 Background characteristic <5 5-9 10-14 15-24 >=25 Total Age 15-19 17.4 29.3 22.8 24.8 5.7 100.0 188 20-24 5.4 14.6 18.4 48.9 12.7 100.0 328 25-29 8.3 12.6 27.1 43.5 8.5 100.0 341 30-34 5.2 14.7 20.9 48.8 10.3 100.0 292 35-39 5.5 15.1 19.3 49.1 11.1 100.0 176 40-44 9.9 15.2 20.1 49.4 5.5 100.0 147 45-49 12.7 11.5 23.0 47.6 5.2 100.0 114 Residence Malé region 5.5 17.3 22.4 45.1 9.8 100.0 356 Other atolls 9.2 15.4 21.7 44.8 8.9 100.0 1,231 Region Malé 5.5 17.3 22.4 45.1 9.8 100.0 356 North 13.1 16.2 21.7 43.5 5.6 100.0 149 North Central 9.9 15.5 25.8 41.5 7.3 100.0 217 Central 6.9 12.0 23.8 44.5 12.7 100.0 293 South Central 10.6 16.2 17.9 47.1 8.2 100.0 323 South 7.0 17.8 20.6 45.6 8.9 100.0 249 Education No education (9.3) (25.7) (14.8) (42.9) (7.2) (100.0) 44 Primary 8.6 10.3 21.6 50.3 9.2 100.0 416 Secondary 8.1 17.6 22.2 43.2 8.8 100.0 963 More than secondary 8.9 16.5 22.1 40.9 11.5 100.0 164 Wealth quintile Lowest 8.0 15.2 24.9 43.4 8.6 100.0 405 Second 13.3 13.0 16.8 46.7 10.2 100.0 385 Middle 6.5 17.3 20.4 46.5 9.3 100.0 399 Fourth 7.3 17.0 23.2 44.0 8.4 100.0 248 Highest 3.3 19.0 27.8 40.9 9.0 100.0 151 Total 8.4 15.8 21.8 44.8 9.1 100.0 1,587 Note: Table includes only men who report that they smoke every day. Figures in parentheses are based on 25-49 unweighted cases. Marriage and Sexual Activity • 57 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings  Current marital status: Sixty-nine percent of women and 55% of men in the Maldives are currently in a marital union.  Polygyny: Less than 2% of currently married women report that their husband has another wife/wives.  Age at first marriage: Marriage is nearly universal in the Maldives, although women marry about 4 years earlier than men. Median age at first marriage is 20.9 years among women and 24.7 years among men.  Sexual initiation: The median age at first sexual inter- course is 20.7 years for women and 23.1 years for men. arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have profound consequences for women’s and men’s lives. 4.1 MARITAL STATUS Currently married or living together Women and men who report being married or living together with a partner as though married at the time of the survey. Sample: Women and men age 15-49 Marriage is nearly universal in the Maldives. By age 45-49, less than 1% of women and 3% of men have never been married. Almost seven in ten (69%) women age 15-49 are currently married (68%) or living together with a partner (<1%). Among men age 15-49, 55% are currently married (54%) or living together (1%) (Table 4.1 and Figure 4.1). Overall, women are more likely than men to be separated, divorced, or widowed. Women are less likely than men to be single; one in four women (23%) and 41% of men have never been married. Trends: Although the overall proportion of women who are currently in a union has increased since 2009, this is largely a reflection of a change in the age distribution. Within age groups, the proportion married has remained at the same level or declined since the 2009 MDHS. M Figure 4.1 Marital status Percent distribution of women and men age 15-49 Never married 23% Married or living together 69% Divorced/ separated 8% Widowed 1% Women Never marri ed 41% Married or living together 55% Divorced/ separated 4% Widowed <1% Men 58 • Marriage and Sexual Activity Patterns by background characteristics  There are marked differences in marital status by sex and age. The percentage of women in a union is higher than that among men until age group 35-39. For example, 50% of women age 20-24 are currently married or living together with a partner, as compared with only 20% of men in the same age category.  In general, the proportion of women who are divorced, separated, or widowed tends to increase with age, reaching a high at age 45-49. Among men, the highest proportion who are divorced, separated, or widowed is reached at age 30-34, presumably because men are more likely than women to re-marry after a marital dissolution. 4.2 POLYGYNY Polygyny Women who report that their husband or partner has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 Less than 2% of currently married women age 15-49 reported that their husband or partner has other wives (Table 4.2.1), while less than 1% of married men reported having more than one wife (Table 4.2.2). Patterns by background characteristics  Older women are more likely than younger women to have co-wives. The percentage of women with co-wives ranges from 0% among those age 15-19 to 3% among those age 45-49 (Table 4.2.1).  The proportion of married women with co-wives decreases with increasing education, from 6% of women with no education to 1% of those with more than a secondary education (Table 4.2.1). 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women and men age 25-49 In the Maldives, women tend to marry earlier than men. The median age at first marriage is 20.9 years among women and 24.7 years among men (Figure 4.2). Twenty-one percent of women and only 3% of men age 25-49 marry before their 18th birthday (Table 4.3). Trends: The median age at first marriage among women age 25-49 has increased since 2009, from 19.0 years to 20.9. During the same period, the percentage of women marrying before age 18 has declined from 38% in 2009 to 21% in 2016-17. When the data are analysed by cohort of women, defined by their age at the time of the interview, these changes look more dramatic: in 2016-17, the Figure 4.2 Median age at first sex and first marriage 20.7 20.9 23.1 24.7 Median age at first sex Median age at first marriage Median age in years Women age 25-49 Men age 25-49 Marriage and Sexual Activity • 59 percentage of women 45-49 who married before age 18 is 52%, while this indicator is 2% for women 20-24. Patterns by background characteristics  Women living in Malé region marry later than women living in other atolls. The median age at first marriage is 1.3 years older among women in Malé region than women in other atolls (21.7 years versus 20.4 years) (Table 4.4).  The median age at first marriage varies by region, from 19.6 years among women in Central region to 21.7 years among women in Malé.  The median age at first marriage increases with increasing education, from 16.7 years among women with no education to 22.9 years among women with more than a secondary education (Figure 4.3). 4

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