Montenegro - Multiple Indicator Cluster Survey - 2013

Publication date: 2013

Montenegro and Montenegro Roma Settlements Monitoring the situation of children and women Multiple Indicator Cluster Survey 2013 Statistical Office of Montenegro United Nations Children’s Fund Publisher UNICEF Montenegro For publisher Benjamin Perks Representative Proofreading Peter Stonelake Design Zeljko Krgovic Cover photo Risto Bozovic Printed by Printing House “Obod“ AD, Cetinje Print run 250 ISBN 978-9940-582-05-0 Published in September, 2014 The Montenegro Multiple Indicator Cluster Survey (2013 Montenegro MICS) and Montenegro Roma Settlements Multiple Indicator Cluster Survey (2013 Montenegro Roma Settlements MISC) were carried out in 2013 by the Statistical Office of Montenegro (MONSTAT). Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and UN Montenegro. MICS is an international household survey programme developed by UNICEF. The 2013 Montenegro MICS and 2013 Montenegro Roma Settlements MISC were conducted as part of the fifth global round of MICS surveys (MICS5). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs), EU integration and other internationally agreed upon commitments. Additional information on the global MICS programme may be obtained from www.childinfo.org. Suggested citation: Statistical Office of Montenegro (MONSTAT) and UNICEF. 2014. 2013 Montenegro Multiple Indicator Cluster Survey and 2013 Montenegro Roma Settlements Multiple Indicator Cluster Survey, Final Report. Podgorica, Montenegro: Statistical Office of Montenegro (MONSTAT) and UNICEF. MONTENEGRO AND MONTENEGRO ROMA SETTLEMENTS MULTIPLE INDICATOR CLUSTER SURVEY 2013 MONTENEGRO AND MONTENEGRO ROMA SETTLEMENTS MULTIPLE INDICATOR CLUSTER SURVEY 2013 STATISTICAL OFFICE OF MONTENEGRO (MONSTAT) UNITED NATIONS CHILDREN’S FUND (UNICEF) September 2014 The Statistical Office of Montenegro (MONSTAT) would like to acknowledge all participants of the 2013 Montenegro MICS and 2013 Montenegro Roma Settlements MICS surveys who gave their contribution in the implementation of the survey and in the preparation of this report. Survey implementation was made possible through the financial support of UNICEF and UN Montenegro. We express our thanks to the staff and consultants of the UNICEF Montenegro, UNICEF Geneva Regional Office, and the global MICS team at UNICEF New York who provided precious assistance and support in all phases of the preparation of the survey. Our special thanks goes to the regional MICS team led by Siraj Mahmudlu, UNICEF Regional MICS Coordinator, and members of the regional team in particular to Ana Abdelbasit, Aleksandar Zoric, and Sinan Turkyilmaz, regional MICS consultants, whose continuous technical and logistical support was of vital importance for all phases of the survey. Their assistance included defining the sample for the survey, supervising the training of interviewers, supervising the fieldwork, data processing and preparation of the final report. A number of local and international experts provided critical support and inputs in the data collection process and during the preparation of the report. Members of the MICS Steering Committee provided valuable advice and comments during the preparation of the survey, the development of the questionnaires, and the drafting of the report. We express our thanks to Prof. Dragan Lausevic, MD, who provided valuable inputs and explanations about the national immunisation programme in Montenegro. We would also like to thank the Statistical Office of the Republic of Serbia for lending us the translated version of the questionnaire from the previous MICS round that significantly accelerated preparation and translation of the MICS questionnaire in Montenegro. The national staff of the survey must be congratulated for their strong and continuous commitment to the success of the survey. Special recognition goes to the MICS coordinators in MONSTAT, data processing staff, sampling expert, interviewers, measurers, editors, supervisors, listing experts, and data entry operators. In the end, it has to be noted that the data collection would not have been possible without the individuals and households of Montenegro, including those living in Roma settlements, who generously opened their homes and gave their time to the realisation of this survey. Their contribution cannot be overstated, and therefore, our greatest appreciation goes to all of them. The aim of this report is to give contribution towards an improvement of living conditions for all children in Montenegro. It is our hope that this report will prove to be valuable tool in achieving this aim. Acknowledgments MONTENEGRO I contents Acknowledgments I lIst of tAbles IV lIst of fIgures X lIst of AbbreVIAtIons XI summAry tAble of fIndIngs XIII eXecutIVe summAry XIX I IntroductIon 1 Background 1 Survey Objectives 2 II sAmple And surVey methodology 3 Sample Coverage of the Montenegro MICS 3 Sample Coverage of the Roma Settlements MISC 3 Questionnaires 4 Training and Fieldwork 5 Data Processing 5 How to Read Tables 5 III sAmple coVerAge And the chArActerIstIcs of households And respondents 7 Sample Coverage of the Montenegro MICS 7 Characteristics of Households 9 Characteristics of Female and Male Respondents Age 15–49 Years and Children Under 5 11 Sample Coverage in Roma Settlements 18 Characteristics of Households in Roma Settlements 19 Characteristics of Female and Male Respondents Age 15–49 Years and Children Under 5 in Roma Settlements 21 IV nutrItIon 27 Low Birth Weight 27 Low Birth Weight in Roma Settlements 29 Nutritional Status 30 Nutritional Status in Roma Settlements 33 Breastfeeding and Infant and Young Child Feeding 35 Breastfeeding and Infant and Young Child Feeding in Roma Settlements 43 V chIld heAlth 51 Vaccinations 51 Vaccinations in Roma Settlements 55 Oral Rehydration Treatment 58 Oral Rehydration Treatment 60 in Roma Settlements 60 Acute Respiratory Infections 62 Acute Respiratory Infections in Roma Settlements 64 Care of Children During Fever Episode 66 Care of Children During Fever Episode in Roma Settlements 68 Solid Fuel Use 70 Solid Fuel Use in Roma Settlements 72 VI wAter And sAnItAtIon 75 Use of Improved Water Sources 76 Use of Improved Water Sources in Roma Settlements 81 Use of Improved Sanitation 85 Use of Improved Sanitation in Roma Settlements 89 Handwashing in Roma Settlements 92 VII reproductIVe heAlth 95 Fertility 95 Fertility in Roma Settlements 98 Contraception 100 Contraception in Roma Settlements 102 Unmet Need 104 Unmet Need in Roma Settlements 107 Antenatal Care 108 Antenatal Care in Roma Settlements 112 Assistance at Delivery 115 Assistance at Delivery in Roma Settlements 117 Place of Delivery 118 Place of Delivery in Roma Settlements 119 Postnatal Health Checks 120 Abortions 128 Postnatal Health Checks in Roma Settlements 129 Abortions in Roma Settlements 134 VIII chIld deVelopment 135 Early Childhood Education and Learning 135 Early Childhood Education and Learning in Roma Settlements 141 Early Childhood Development 145 Early Childhood Development in Roma Settlements 147 IX lIterAcy And educAtIon 149 Literacy among Young Women and Men 149 Literacy Among Young Women and Men in Roma Settlements 151 School Readiness 152 School Readiness in Roma Settlements 153 Primary and Secondary School Participation 154 Primary and Secondary School Participation in Roma Settlements 161 X chIld protectIon 169 Birth Registration 169 Birth Registration in Roma Settlements 171 Child Labour 172 Child Labour in Roma Settlements 176 Child Discipline 179 Child Discipline in Roma Settlements 181 Early Marriage 183 Early Marriage in Roma Settlements 188 Attitudes Toward Domestic Violence 193 Attitudes Toward Domestic Violence in Roma Settlements 196 Children’s Living Arrangements and Orphanhood 199 Children’s Living Arrangements and Orphanhood in Roma Settlements 201 XI hIV/AIds And seXuAl behAVIour 203 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS 203 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS in Roma Settlements 209 Accepting Attitudes Toward People Living with HIV 215 Accepting Attitudes Toward People Living with HIV in Roma Settlements 218 Knowledge of a Place for HIV Testing, Counselling and Testing During Antenatal Care 221 Knowledge of a Place for HIV Testing, Counselling and Testing During Antenatal Care in Roma Settlements 226 Sexual Behaviour Related to HIV Transmission 230 Sexual Behaviour Related to HIV Transmission in Roma Settlements 239 XII tobAcco And Alcohol use 247 Tobacco Use 247 Tobacco Use in Roma Settlements 253 Alcohol Use 258 Alcohol Use in Roma Settlements 260 XIII subjectIVe well-beIng 263 Subjective Well-Being 263 Subjective Well-Being in Roma Settlements 270 AppendIX 277 Appendix A. Sample Design for Montenegro MICS 279 Sample Design for Montenegro National Sample 279 Sample Design for Roma Settlements Sample 283 Appendix B. List of Personnel Involved in the Survey 286 Appendix C. Estimates of Sampling Errors 287 Estimates of Sampling Errors, Roma Settlements 295 Appendix D. Data Quality Tables 303 Data Quality Tables, Roma Settlements 313 Appendix E. 2013 Montenegro MICS Indicators: Numerators and Denominators 324 Appendix F. 2013 Montenegro MICS Questionnaires 332 Appendix G. ISCED Tables 416 Education in Montenegro according to the International Standard Classification of Education (ISCED) 416 Education in Roma Settlements according to the International Standard Classification of Education (ISCED) 424 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY IIIII 76 Table WS.1: Use of improved water sources 78 Table WS.2: Household water treatment 79 Table WS.3: Time to source of drinking water 80 Table WS.4: Person collect- ing water 81 Table WS.1R: Use of im- proved water sources 82 Table WS.2R: Household water treatment 83 Table WS.3R: Time to source of drinking water 84 Table WS.4R: Person collect- ing water 85 Table WS.5: Types of sanita- tion facilities 86 Table WS.6: Use and sharing of sanitation facilities 87 Table WS.7: Drinking water and sanitation ladders 88 Table WS.8: Disposal of child’s faeces 89 Table WS.5R: Types of sani- tation facilitiesa 90 Table WS.6R: Use and shar- ing of sanitation facilities 91 Table WS.7R: Drinking water and sanitation ladders 92 Table WS.8R: Disposal of child’s faeces 93 Table WS.9R: Water and soap at place for handwashing 94 Table WS.10R: Availability of soap or other cleansing agent 95 Table RH.1: Fertility rates 96 Table RH.2: Early childbear- ing 97 Table RH.3: Trends in early childbearing 98 Table RH.1R: Early child- bearing 99 Table RH.2R: Trends in early childbearing 101 Table RH.4: Use of contra- ception 103 Table RH.3R: Use of contra- ception 105 Table RH.5: Unmet need for contraception 107 Table RH.4R: Unmet need for contraception 109 Table RH.6: Antenatal care coverage 110 Table RH.7: Number of ante- natal care visits 111 Table RH.8: Content of ante- natal care 112 Table RH.5R: Antenatal care coverage 113 Table RH.6R: Number of antenatal care visits 114 Table RH.7R: Content of antenatal care 116 Table RH.9: Assistance during delivery and caesare- an section 117 Table RH.8R: Assistance during delivery and caesare- an section 118 Table RH.10: Place of deliv- ery 119 Table RH.9R: Place of deliv- ery 121 Table RH.11: Postpartum stay in health facility 122 Table RH.12: Postnatal health checks for newborns 123 Table RH.13: Postnatal care visits for newborns within one week of birth 125 Table RH.14: Postnatal health checks for mothers 127 Table RH.15: Postnatal health checks for mothers and newborns 128 Table RH.16: Lifetime experi- ence with abortions 129 Table RH.10R: Postpartum stay in health facility 130 Table RH.11R: Postnatal health checks for newborns 131 Table RH.12R: Postnatal care visits for newborns within one week of birth 132 Table RH.13R: Postnatal health checks for mothers 133 Table RH.14R: Postnatal health checks for mothers and newborns 134 Table RH.15R: Lifetime expe- rience with abortions 135 Table CD.1: Early childhood education 137 Table CD.2: Support for learning 139 Table CD.3: Learning materi- als 140 Table CD.4: Inadequate care 141 Table CD.1R: Early childhood education list of tAbles 8 Table HH.1: Results of household, women’s, men’s and under-5 interviews 9 Table HH.2: Household age distribution by sex 10 Table HH.3: Household com- position 11 Table HH.4: Women’s back- ground characteristics 12 Table HH.4.M: Men’s back- ground characteristics 13 Table HH.5: Under-5’s back- ground characteristics 14 Table HH.6: Housing charac- teristics 16 Table HH.7: Household and personal assets 17 Table HH.8: Wealth quintiles 18 Table HH.1R: Results of household, women’s, men’s and under-5 interviews 19 Table HH.2R: Household age distribution by sex 20 Table HH.3R: Household composition 21 Table HH.4R: Women’s back- ground characteristics 22 Table HH.4R.M: Men’s back- ground characteristics 23 Table HH.5R: Under-5’s back- ground characteristics 24 Table HH.6R: Housing char- acteristics 25 Table HH.7R: Household and personal assets 26 Table HH.8R: Wealth quin- tiles 28 Table NU.1: Low birth weight infants 29 Table NU.1R: Low birth weight infants 31 Table NU.2: Nutritional status of children 33 Table NU.2R: Nutritional status of children 36 Table NU.3: Initial breastfeed- ing 37 Table NU.4: Breastfeeding 38 Table NU.5: Duration of breastfeeding 39 Table NU.6: Age-appropriate breastfeeding 40 Table NU.7: Introduction of solid, semi-solid, or soft foods 41 Table NU.8: Infant and young child feeding (IYCF) practic- es 42 Table NU.9: Bottle feeding 43 Table NU.3R: Initial breast- feeding 45 Table NU.4R: Breastfeeding 46 Table NU.5R: Duration of breastfeeding 47 Table NU.6R: Age-appropri- ate breastfeeding 48 Table NU.7R: Infant and young child feeding (IYCF) practices 49 Table NU.8R: Bottle feeding 52 Table CH.1: Vaccinations in the first years of life 54 Table CH.2: Vaccinations by background characteristics 55 Table CH.1R: Vaccinations in the first years of life 57 Table CH.2R: Vaccinations by background characteristics 59 Table CH.3: Reported disease episodes 60 Table CH.3R: Reported dis- ease episodes 63 Table CH.4: Knowledge of the two danger signs of pneumo- nia 65 Table CH.4R: Knowledge of the two danger signs of pneumonia 66 Table CH.5: Care-seeking during fever 67 Table CH.6: Treatment of chil- dren with fever 68 Table CH.5R: Care-seeking during fever 69 Table CH.6R: Treatment of children with fever 70 Table CH.7: Solid fuel use 71 Table CH.8: Solid fuel use by place of cooking 72 Table CH.7R: Solid fuel use 73 Table CH.8R: Solid fuel use by place of cooking MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY VIV 201 Table CP.11R: Children’s living arrangements and orphanhood 202 Table CP.12R: Children with parents living abroad 204 Table HA.1: Knowledge about HIV transmission, miscon- ceptions about HIV, and com- prehensive knowledge about HIV transmission (women) 205 Table HA.1.M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowl- edge about HIV transmission (men) 207 Table HA.2: Knowledge of mother-to-child HIV trans- mission (women) 208 Table HA.2.M: Knowledge of mother-to-child HIV trans- mission (men) 210 Table HA.1R: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowl- edge about HIV transmission (women) 211 Table HA.1R.M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowl- edge about HIV transmission (men) 213 Table HA.2R: Knowledge of mother-to-child HIV trans- mission (women) 214 Table HA.2R.M: Knowledge of mother-to-child HIV trans- mission (men) 216 Table HA.3: Accepting atti- tudes toward people living with HIV (women) 217 Table HA.3.M: Accepting at- titudes toward people living with HIV (men) 219 Table HA.3R: Accepting at- titudes toward people living with HIV (women) 220 Table HA.3R.M: Accepting at- titudes toward people living with HIV (men) 222 Table HA.4: Knowledge of a place for HIV testing (women) 223 Table HA.4.M: Accepting at- titudes toward people living with HIV (men) 225 Table HA.5: HIV counselling and testing during antenatal care 227 Table HA.4R: Knowledge of a place for HIV testing (women) 228 Table HA.4R.M: Accepting at- titudes toward people living with HIV (men) 229 Table HA.5R: HIV counselling and testing during antenatal care 231 Table HA.6.: Sex with multi- ple partners (women) 232 Table HA.6.M: Sex with multi- ple partners (men) 234 Table HA.7: Key HIV and AIDS indicators (young wom- en) 235 Table HA.7.M: Key HIV and AIDS indicators (young men) 237 Table HA.8: Key sexual behaviour indicators (young women) 238 Table HA.8.M: Key sexual behaviour indicators (young men) 240 Table HA.6R: Sex with multi- ple partners (women) 241 Table HA.6R.M: Sex with multiple partners (men) 242 Table HA.7R: Key HIV and AIDS indicators (young wom- en) 243 Table HA.7R.M: Key HIV and AIDS indicators (young men) 244 Table HA.8R: Key sexual behaviour indicators (young women) 245 Table HA.8R.M: Key sexual behaviour indicators (young men) 248 Table TA.1: Current and ever use of tobacco (women) 249 Table TA.1.M: Current and ever use of tobacco (men) 251 Table TA.2: Age at first use of cigarettes and frequency of use (women) 252 Table TA.2.M: Age at first use of cigarettes and frequency of use (men) 254 Table TA.1R: Current and ever use of tobacco (women) 255 Table TA.1R.M: Current and ever use of tobacco (men) 256 Table TA.2R: Age at first use of cigarettes and frequency of use (women) 257 Table TA.2R.M: Age at first use of cigarettes and fre- quency of use (men) 259 Table TA.3: Use of alcohol (women) 259 Table TA.3.M: Use of alcohol (men) 142 Table CD.2R: Support for learning 143 Table CD.3R: Learning mate- rials 144 Table CD.4R: Inadequate care 145 Table CD.5: Early child devel- opment index 147 Table CD.5R: Early child development index 150 Table ED.1: Literacy (young women) 150 Table ED.1.M: Literacy (young men) 151 Table ED.1R: Literacy (young women) 151 Table ED.1R.M: Literacy (young men) 152 Table ED.2: School readiness 153 Table ED.2R: School readi- ness 154 Table ED.3: Primary school entry 155 Table ED.4: Primary school attendance and out-of-school children 156 Table ED.5: Secondary school attendance and out- of-school children 157 Table ED.6: Children reach- ing last grade of primary school 158 Table ED.7: Primary school completion and transition to secondary school 159 Table ED.8: Education gen- der parity 160 Table ED.9: Out-of-school gender parity 161 Table ED.3R: Primary school entry 162 Table ED.4R: Primary school attendance and out-of-school children 163 Table ED.5R: Secondary school attendance and out- of-school children 164 Table ED.6R: Children reach- ing last grade of primary school 165 Table ED.7R: Primary school completion 166 Table ED.8R: Education gender parity 167 Table ED.9R: Out-of-school gender parity 170 Table CP.1: Birth registration 171 Table CP.1R: Birth registra- tion 173 Table CP.2: Children’s involvement in economic activities 174 Table CP.3: Children’s involvement in household chores 175 Table CP.4: Child labour 176 Table CP.2R: Children’s involvement in economic activities 177 Table CP.3R: Children’s involvement in household chores 178 Table CP.4R: Child labour 179 Table CP.5: Child discipline 180 Table CP.6: Attitudes toward physical punishment 181 Table CP.5R: Child discipline 182 Table CP.6R: Attitudes to- ward physical punishment 184 Table CP.7: Early marriage (women) 185 Table CP.7.M: Early marriage (men) 186 Table CP.8: Trends in early marriage (women) 186 Table CP.8.M: Trends in early marriage (men) 187 Table CP.9: Spousal age difference 189 Table CP.7R: Early marriage (women) 190 Table CP.7R.M: Early mar- riage (men) 191 Table CP.8R: Trends in early marriage (women) 191 Table CP.8R.M: Trends in early marriage (men) 192 Table CP.9R: Spousal age difference 194 Table CP.10: Attitudes toward domestic violence (women) 195 Table CP.10.M: Attitudes toward domestic violence (men) 197 Table CP.10R: Attitudes toward domestic violence (women) 198 Table CP.10R.M: Attitudes toward domestic violence (men) 199 Table CP.11: Children’s living arrangements and orphan- hood 200 Table CP.12: Children with parents living abroad MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY VIIVI 311 Table DQ.19: Selection of children age 1-17 years for the child labour and child discipline modules 312 Table DQ.20: School atten- dance by single age 312 Table DQ.21: Sex ratio at birth among children ever born and living 313 Table DQ.1R: Age distribu- tion of household population 314 Table DQ.2R: Age distribu- tion of eligible and inter- viewed women 314 Table DQ.3R: Age distribu- tion of eligible and inter- viewed men 314 Table DQ.4R: Age distribu- tion of children in household and under-5 questionnaires 315 Table DQ.5R: Birth date reporting: Household popula- tion 315 Table DQ.6R: Birth date and age reporting: Women 316 Table DQ.7R: Birth date and age reporting: Men 316 Table DQ.8R: Birth date and age reporting: Under-5s 316 Table DQ.9R: Birth date reporting: Children, adoles- cents and young people 317 Table DQ.10R: Birth date re- porting: First and last births 318 Table DQ.11R: Completeness of reporting 318 Table DQ.12R: Completeness of information for anthro- pometric indicators: Under- weight 319 Table DQ.13R: Completeness of information for anthropo- metric indicators: Stunting 319 Table DQ.14R: Completeness of information for anthropo- metric indicators: Wasting 320 Table DQ.15R: Heaping in an- thropometric measurements 320 Table DQ.16R: Observation of birth certificates 321 Table DQ.17R: Observation of vaccination cards 321 Table DQ.18R: Observation places for handwashing 322 Table DQ.19R: Presence of mother in the household and the person interviewed for the under-5 questionnaire 322 Table DQ.20R: Selection of children age 1-17 years for the child labour and child discipline modules 323 Table DQ.21R: School atten- dance by single age 323 Table DQ.22R: Sex ratio at birth among children ever born and living 417 Table ED.1 ISCED: Selected MICS education indicators following ISCED classifica- tion 418 Table ED.4 ISCED: Primary school attendance and out- of-school children 419 Table ED.5 ISCED: Second- ary school attendance and out-of-school children 420 Table ED.5 (a) ISCED: Lower secondary school attendance and out-of-school children 421 Table ED.5 (b) ISCED: Upper secondary school attendance and out-of-school children 422 Table ED.8 ISCED: Education gender parity 423 Table ED.9 ISCED: Out-of- school gender parity 424 Table ED.1R ISCED: Selected MICS education indicators following ISCED classifica- tion 425 Table ED.4R ISCED: Primary school attendance and out- of-school children 426 Table ED.5R ISCED: Second- ary school attendance and out-of-school children 427 Table ED.5R (a) ISCED: Lower secondary school attendance and out-of-school children 428 Table ED.5R (b) ISCED: Upper secondary school attendance and out-of-school children 429 Table ED.8R ISCED: Educa- tion gender parity 430 Table ED.9R ISCED: Out-of- school gender parity 261 Table TA.3R: Use of alcohol (women) 261 Table TA.3R.M: Use of alco- hol (men) 264 Table SW.1: Domains of life satisfaction (women) 265 Table SW.1.M: Domains of life satisfaction (men) 266 Table SW.2: Overall life satisfaction and happiness (women) 267 Table SW.2.M: Overall life satisfaction and happiness (men) 268 Table SW.3: Perception of a better life (women) 269 Table SW.3.M: Perception of a better life (men) 270 Table SW.1R: Domains of life satisfaction (women) 271 Table SW.1R.M: Domains of life satisfaction (men) 272 Table SW.2R: Overall life satisfaction and happiness (women) 273 Table SW.2R.M: Overall life satisfaction and happiness (men) 274 Table SW.3R: Perception of a better life (women) 275 Table SW.3R.M: Perception of a better life (men) 280 Table SD.1: Allocation of sample clusters (Primary Sampling Units) and house- holds to sampling strata 283 Table SD.1R: Allocation of sample clusters (Primary Sampling Units) and house- holds to sampling strata 288 Table SE.1: Indicators selected for sampling error calculations 289 Table SE.2: Sampling errors: Total sample 290 Table SE.3: Sampling errors: Urban 291 Table SE.4: Sampling errors: Rural 292 Table SE.5: Sampling errors: North 293 Table SE.6: Sampling errors: Centre 294 Table SE.7: Sampling errors: South 296 Table SE.1R: Indicators selected for sampling error calculations 297 Table SE.2R: Sampling errors: Total sample 298 Table SE.3R: Sampling errors: Urban 299 Table SE.4R: Sampling errors: Rural 300 Table SE.5R: Sampling errors: North 301 Table SE.6R: Sampling errors: Centre 302 Table SE.7R: Sampling errors: South 303 Table DQ.1: Age distribution of household population 304 Table DQ.2: Age distribution of eligible and interviewed women 304 Table DQ.3: Age distribution of eligible and interviewed men 304 Table DQ.4: Age distribution of children in household and under-5 questionnaires 305 Table DQ.5: Birth date report- ing: Household population 305 Table DQ.6: Birth date and age reporting: Women 306 Table DQ.7: Birth date and age reporting: Men 306 Table DQ.8: Birth date and age reporting: Under-5s 306 Table DQ.9: Birth date report- ing: Children, adolescents and young people 307 Table DQ.10: Birth date re- porting: First and last births 307 Table DQ.11: Completeness of reporting 308 Table DQ.12: Completeness of information for anthro- pometric indicators: Under- weight 308 Table DQ.13: Completeness of information for anthro- pometric indicators: Under- weight 308 Table DQ.14: Completeness of information for anthropo- metric indicators: Wasting 309 Table DQ.15: Heaping in an- thropometric measurements 309 Table DQ.16: Observation of birth certificates 310 Table DQ.17: Observation of vaccination cards 310 Table DQ.18: Presence of mother in the household and the person interviewed for the under-5 questionnaire MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY IXVIII AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARI Acute Respiratory Infection ASFR Age-specific Fertility Rate BCG Bacillus Calmette–Guérin (Tuberculosis) CBR Crude Birth Rate CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus EPI Expanded Programme on Immunisation GFR General Fertility Rate GPI Gender Parity Index HepB Hepatitis B Hib Haemophilus influenzae Type b HIV Human Immunodeficiency Virus ISCED International Standard Classification of Education IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth Global Round of Multiple Indicator Clusters Surveys Programme MMR Measles, Mumps and Rubella MONSTAT Statistical Office of Montenegro NAR Net Attendance Rate ORS Oral Rehydration Salts ORT Oral Rehydration Treatment PNC Postnatal Care PNHC Postnatal Health Checks RHF Recommended Home Fluid SPSS Statistical Package for Social Sciences TFR Total Fertility Rate UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WHO World Health Organization list of AbbreviAtionslist of figures 10 Figure HH.1: Age and sex distribution of household population, Montenegro, 2013 20 Figure HH.1R: Age and sex distribution of the house- hold population, Roma settlements, 2013 32 Figure NU.1: Percentage of children under age 5 who are underweight, stunted, wasted and overweight, Montenegro, 2013 34 Figure NU.1R: Percentage of children under age 5 who are underweight, stunted, wasted and over- weight, Roma settlements, 2013 35 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Montenegro, 2013 38 Figure NU.3: Infant feeding patterns by age, Montene- gro, 2013 44 Figure NU.2R: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Roma settlements, 2013 44 Figure NU.3R: Infant feed- ing patterns by age, Roma settlements, 2013 53 Figure CH.1: Percentage of children age 24–35 months who received the recom- mended vaccinations by 12 months of age (by 24 months for HepB3, mea- sles and full immunisation coverage), Montenegro, 2013 56 Figure CH.1R: Percentage of children age 24–35 months who received the recommended vaccina- tions by 12 months of age (by 24 months for HepB3, measles and full immuni- sation coverage), Roma settlements, 2013 77 Figure WS.1: Percent distribution of household members by source of drinking water, Montene- gro, 2013 82 Figure WS.1R: Percent distribution of household members by source of drinking water, Roma settlements, 2013 160 Figure ED.1: Percentage of household members age 5-24 years attending school, by sex, Montene- gro, 2013 167 Figure ED.1R: Percentage of household members age 5-24 years attending school, by sex, Roma settlements, 2013 206 Figure HA.1: Percentage of women age 15-49 years who have comprehensive knowledge of HIV trans- mission, Montenegro, 2013 206 Figure HA.1.M: Percentage of men age 15-49 years who have comprehensive knowledge of HIV trans- mission, Montenegro, 2013 212 Figure HA.1R: Percentage of women age 15-49 years who have comprehensive knowledge of HIV trans- mission, Roma settle- ments, 2013 212 Figure HA.1R.M: Percent- age of men 15-49 years who have comprehensive knowledge of HIV trans- mission, Roma settle- ments, 2013 304 Figure DQ.1: Number of household population by single ages, Montenegro, 2013 314 Figure DQ.1R: Number of household population by single ages, Roma settle- ments, 2013 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XIX MONTENEGRO XIII Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators1, Montenegro and Montenegro Roma Settlements Survey, 2013 1 See Appendix E for more details about indicator definitions. summAry tAble of findings Topic MICS5 Indicator Number MDG Indicator Number Indicator Value Montenegro Romasettlements NUTRITION Nutritional status Underweight prevalence 2.1a 1.8 Moderate and Severe (-2 SD) 1.0 7.3 percent 2.1b Severe (-3 SD) 0.1 1.7 percent Stunting prevalence 2.2a Moderate and Severe (-2 SD) 9.4 26.8 percent 2.2b Severe (-3 SD) 5.6 13.0 percent Wasting prevalence 2.3a Moderate and Severe (-2 SD) 2.8 3.7 percent 2.3b Severe (-3 SD) 1.2 1.5 percent 2.4 Overweight prevalence 22.3 17.5 percent Breastfeeding and infant feeding 2.5 Children ever breastfed 88.3 90.2 percent 2.6 Early initiation of breastfeeding 14.4 20.3 percent 2.7 Exclusive breastfeeding under 6 months 16.8 14.3 percent 2.8 Predominant breastfeeding under 6 months 35.4 43.6 percent 2.9 Continued breastfeeding at 1 year 23.9 (57.6) percent 2.10 Continued breastfeeding at 2 years 9.0 (39.7) percent 2.11 Duration of breastfeeding 6.9 20.7 months 2.12 Age-appropriate breastfeeding 21.4 37.9 percent 2.13 Introduction of solid, semi-solid or soft foods 95.1 * percent 2.14 Milk feeding frequency for non-breastfed children 89.5 48.4 percent 2.15 Minimum meal frequency 86.2 66.1 percent 2.16 Minimum dietary diversity 81.3 28.8 percent 2.17a Minimum acceptable diet (breastfed) 54.3 12.3 percent 2.17b Minimum acceptable diet (non-breastfed) 70.7 15.5 percent 2.18 Bottle feeding 75.2 75.6 percent Low birth weight 2.20 Low birth weight infants 4.0 12.3 percent 2.21 Infants weighed at birth 98.6 93.0 percent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunisation coverage 99.4 76.5 percent 3.2 Polio immunisation coverage 80.3 29.9 percent 3.3 Diphtheria, pertussis and tetanus (DPT) immunisation coverage 84.5 34.8 percent 3.4 4.3 Measles immunisation coverage 92.2 71.8 percent 2013 MULTIPLE INDICATOR CLUSTER SURVEYXII MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XVXIV Topic MICS5 Indicator Number MDG Indicator Number Indicator Value Montenegro Romasettlements Topic MICS5 Indicator Number MDG Indicator Number Indicator Value Montenegro Romasettlements Vaccinations 3.5 Hepatitis B immunisation coverage 87.4 43.2 percent 3.6 Haemophilus influenzae type B (Hib) immuni-sation coverage 80.3 29.8 percent 3.8 Full immunisation coverage 60.7 11.6 percent Care of illness 3.10 Care-seeking for diarrhoea (56.4) (59.6) percent 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc2 (31.9) (24.3) percent 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding (62.7) (66.9) percent 3.13 Care-seeking for children with acute respira-tory infection (ARI) symptoms * (65.8) percent 3.14 Antibiotic treatment for children with ARI symptoms * (75.8) percent 3.20 Care-seeking for fever 74.0 53.7 percent Solid fuel use 3.15 Use of solid fuels for cooking 44.8 79.9 percent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 99.4 98.9 percent 4.2 Water treatment 4.5 (0.0) percent 4.3 7.9 Use of improved sanitation 95.7 80.8 percent 4.4 Safe disposal of child's faeces 21.3 9.7 percent 4.5 Place for handwashing nd 65.0 percent 4.6 Availability of soap or other cleansing agent nd 83.0 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 12 † per 1,000 5.2 Early childbearing 2.7 36.9 percent 5.3 5.3 Contraceptive prevalence rate 23.3 4.1 percent 5.4 5.6 Unmet need 21.8 47.6 percent Maternal and newborn health Antenatal care coverage 5.5a 5.5 At least once by skilled personnel 91.7 85.7 percent 5.5b At least four times by any provider 86.6 63.5 percent 5.6 Content of antenatal care 89.3 77.1 percent 5.7 5.2 Skilled attendant at delivery 99.0 98.6 percent 5.8 Institutional deliveries 99.0 98.6 percent 5.9 Caesarean section 19.9 18.8 percent Postnatal health checks 5.10 Postpartum stay in health facility 99.5 99.4 percent 5.11 Postnatal health check for the newborn 98.7 96.9 percent 5.12 Postnatal health check for the mother 94.8 79.1 percent Child development 6.1 Attendance to early childhood education 39.9 18.5 percent 6.2 Support for learning 97.7 59.0 percent 6.3 Father's support for learning 45.1 15.3 percent 6.4 Mother’s support for learning 91.2 21.9 percent 6.5 Availability of children’s books 72.7 19.1 percent 6.6 Availability of playthings 59.7 60.6 percent 6.7 Inadequate care 2.6 4.1 percent 6.8 Early child development index 94.3 62.5 percent EDUCATION Literacy and education Literacy rate among young people 7.1 2.3 women age 15–24 years 99.2 40.0 percent men age 15–24 years 99.0 62.9 percent 7.2 School readiness 45.8 23.8 percent 7.3 Net intake rate in primary education 90.8 51.8 percent ISCED classification3 7.4 2.1 Primary school net attendance ratio (adjusted) 97.9 64.5 percent 7.5 Secondary school net attendance ratio (adjusted) 94.4 21.1 percent — Lower secondary school net attendance ratio (adjusted) 94.4 31.2 percent — Upper secondary school net attendance ratio (adjusted) 93.1 5.5 percent 7.6 2.2 Children reaching last grade of primary (5 th grade) 100.0 (88.1) percent 7.7 Primary completion rate 111.5 85.2 percent 7.8 Transition rate to secondary school 98.1 94.9 percent 7.9 Gender parity index (primary school) 1.00 1.09 ratio 7.10 Gender parity index (secondary school) 1.01 0.55 ratio National education system classification4 7.4n Primary school net attendance ratio (adjusted) 98.2 57.8 percent 7.5n Secondary school net attendance ratio (adjusted) 93.1 5.5 percent 7.6n Children reaching last grade of primary (9 th grade) 98.5 (63.2) percent 7.7n Primary completion rate 98.7 29.3 percent 7.8n Transition rate to secondary school 100.0 * percent 7.9n Gender parity index (primary school) 1.00 0.95 ratio 7.10n Gender parity index (secondary school) 1.01 0.60 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 99.4 94.5 percent Child labour 8.2 Child labour 12.5 6.7 percent Child discipline 8.3 Violent discipline 69.3 64.2 percent Early marriage 8.4 Marriage before age 15 women age 15–49 years 0.5 18.2 percent men age 15–49 years 0.1 6.5 percent 8.5 Marriage before age 18 women age 20–49 years 6.2 56.4 percent men age 20–49 years 0.8 34.9 percent 2 In Montenegro, no children received zinc supplements as treatment for diarrhoea. 3 The classification of primary school and secondary school education in Montenegro according to ISCED 2011 comprises the following: (i) ISCED 1 – primary school, corresponding to grades 1–5 of primary school (typically for ages 6–10 years); (ii) ISCED 2 – lower secondary school, corresponding to grades 6–9 of primary school within the national education system (typically for ages 11–14 years); and (iii) ISCED 3 – upper secondary school, corresponding to grades 1–4 of secondary school within the national education system (typically for ages 15–18 years). For global reporting purposes, lower secondary school and upper secondary school are combined as secondary school education. 4 The national education system classification comprises nine grades of primary school education (typically for ages 6–14 years), and four grades of secondary school education (typically for ages 15–18 years). MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XVIIXVI Topic MICS5 Indicator Number MDG Indicator Number Indicator Value Montenegro Romasettlements Topic MICS5 Indicator Number MDG Indicator Number Indicator Value Montenegro Romasettlements Early marriage Young women and men age 15–19 currently married or in union 8.6 women age 15–19 years 2.4 28.1 percent 8.7 men age 15–19 years 0.4 16.5 percent Spousal age difference 8.8a women age 15–19 years * 1.0 percent 8.8b women age 20–24 years 22.2 6.6 percent Domestic violence 8.12 Attitudes toward domestic violence women age 15–49 years 2.7 41.1 percent men age 15–49 years 4.5 52.9 percent 8.13 Children’s living arrangements 0.3 3.3 percent 8.14 Prevalence of children with one or both parents dead 2.0 3.2 percent 8.15 Children with at least one parent living abroad 0.8 1.4 percent HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes 9.1 6.3 Knowledge about HIV prevention among young people women age 15–24 years 47.7 6.1 percent men age 15–24 years 36.9 7.2 percent 9.2 Knowledge of mother-to-child transmission of HIV women age 15–49 years 57.6 24.7 percent men age 15–49 years 33.2 26.0 percent 9.3 Accepting attitudes towards people living with HIV women age 15–49 years 19.3 5.4 percent men age 15–49 years 12.8 4.2 percent 9.4 Women who know where to be tested for HIV 71.2 22.4 percent Men who know where to be tested for HIV 74.9 42.1 percent 9.5 Women who have been tested for HIV and know the results 0.6 0.1 percent Men who have been tested for HIV and know the results 1.6 0.0 percent 9.6 Sexually active young women who have been tested for HIV and know the results 0.5 0.3 percent Sexually active young men who have been tested for HIV and know the results 0.8 0.0 percent 9.7 HIV counselling during antenatal care 2.5 0.3 percent 9.8 HIV testing during antenatal care 1.7 0.3 percent Sexual behaviour 9.9 Young women who have never had sex 67.1 97.6 percent Young men who have never had sex 37.0 46.1 percent 9.10 Sex before age 15 among young people women age 15–24 years 0.1 19.5 percent men age 15–24 years 3.4 11.4 percent 9.10 Sex before age 15 among young people women age 15–24 years * * percent men age 15–24 years 54.7 31.5 percent 9.11 Age-mixing among sexual partners women age 15–24 years 8.7 5.9 percent Sexual behaviour 9.12 Multiple sexual partnerships women age 15–49 years 0.6 0.3 percent men age 15–49 years 15.9 17.2 percent 9.13 Condom use at last sex among people with multiple sexual partnerships women age 15–49 years 27.1 2.6 percent men age 15–49 years 58.8 40.9 percent 9.14 Sex with non-regular partners women age 15–24 years 27.1 2.6 percent men age 15–24 years 58.8 40.9 percent 9.15 Condom use with non-regular partners women age 15–24 years 62.2 * percent men age 15–24 years 65.1 47.7 percent TOBACCO AND ALCOHOL USE Tobacco use 12.1 Tobacco use women age 15–49 years 30.7 25.0 percent men age 15–49 years 30.7 43.0 percent 12.2 Smoking before age 15 women age 15–49 years 2.7 9.8 percent men age 15–49 years 8.2 21.9 percent Alcohol use 12.3 Use of alcohol women age 15–49 years 23.2 3.8 percent men age 15–49 years 51.5 26.5 percent 12.3 Use of alcohol before age 15 women age 15–49 years 1.8 7.5 percent men age 15–49 years 10.3 21.0 percent SUBJECTIVE WELL-BEING Subjective well-being 11.1 Life satisfaction women age 15–24 years 97.8 85.1 percent men age 15–24 years 98.5 87.1 percent 11.2 Happiness women age 15–24 years 98.0 93.9 percent men age 15–24 years 96.9 90.6 percent 11.3 Perception of a better life women age 15–24 years 37.9 32.1 percent men age 15–24 years 33.0 38.6 percent ( ) Figures that are based on 25–49 unweighted cases * Figures that are based on fewer than 25 unweighted cases † Figures that are based on fewer than 125 person-years of exposure nd – denotes no data collected for the survey on the topic MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XIXXVIII The 2013 Montenegro MICS and 2013 Montenegro Roma Settlements MICS are nationally representative sample surveys of households, women, young men and children. The 2013 Montenegro MICS was carried out on a nationally representative sample, while the 2013 Montenegro Roma Settlements MICS was carried out on a separate sample of Roma settlements in Montenegro. Both surveys were carried out in 2013 by MONSTAT with financial and technical support from the United Nations Children’s Fund (UNICEF). The findings pertain to March–May 2013, when the fieldwork was conducted. Findings from both surveys are presented jointly in this report. Nutritional status ■ The prevalence of child malnourishment (moderate and severe) of children under the age of five in Montenegro is low: 1 percent of children are underweight, 9 percent stunted, and 3 percent are wasted. However, one in five children are overweight (22 percent). ■ In Roma settlements the prevalence of malnourishment is higher than the national average – 7 percent of children are underweight, 27 percent are stunted and 4 percent are wasted. Similar to the national average, 18 percent of children are overweight. Low birth weight ■ In Montenegro, 4 percent of live births were below 2500 grams. ■ In Roma settlements, percentage of underweight live births is higher (12 percent). Breastfeeding and child feeding ■ In Montenegro, only 14 percent of last-born children in the two years preceding the survey were breastfed for the first time within one hour of birth, and 66 percent were breastfed for the first time within one day of birth. Only 17 percent of children were exclusively breastfed until the age of 6 months. ■ Two-thirds of children age 6–23 months received minimum acceptable diet (66 percent). ■ In Roma settlements, a slightly higher percentage of last-born children in the two years preceding the survey were breastfed for the first time within one hour of birth (20 percent), and within one day of birth (79 percent). Similarly, only 14 percent of children were exclusively breastfed until the age of 6 months. ■ Only 13 percent of children age 6–23 months from Roma settlements received the minimum acceptable diet. Vaccinations ■ In Montenegro, 61 percent of children age 24–35 months are fully vaccinated . ■ Almost all children age 24–35 months received a BCG vaccination by the age of 12 months (98 percent). The first dose of DPT was given to 97 percent of children by the age of 12 months and that percentage declines for the third dose (81 percent). Similarly, 93 percent of children received Polio 1 by age 12 months and that percentage declines to 80 percent for the third dose. In Montenegro, 95 percent of children received HepB 1 by the age of 12 months and that percentage declines to 87 percent for the third dose. ■ The coverage of children age 12–35 months with the Hib vaccine ranges from 94 percent for the first dose executive summAry MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XXIXX to 80 percent for the third dose. ■ 92 percent of children age 24–35 months were covered by the measles vaccine (MMR1) at the age of 12 months or later. ■ On the other hand, only 12 percent of children from Roma settlements are fully vaccinated. ■ Three-quarters of children age 24–35 months in Roma settlements received a BCG vaccination by the age of 12 months (77 percent). A lower percentage of children received the first dose of DPT by the age of 12 months (67 percent), and that percentage declines for the third dose (35 percent). Only one-half of children from Roma settlements received the first dose of Polio by the age of 12 months (52 percent) and that percentage declines to 30 percent by the third dose. Two-thirds of children received HepB 1 by age 12 months (64 percent) and less than half the second and third dose (43 percent). ■ For children age 12–35 months from Roma settlements the coverage for the Hib vaccine is much lower than for other children ranging from 53 percent for the first dose to 30 percent for the third dose. ■ 72 percent for children age 24–35 months from Roma settlements received the measles vaccine (MMR1) by 24 months. Solid fuel use ■ In Montenegro, almost one-half of the population live in households that use solid fuels for cooking (45 percent). ■ A much higher percentage of the population from Roma settlements live in households that use solid fuels for cooking (80 percent). Water and sanitation ■ In Montenegro, almost all of the population uses an improved source of drinking water (99 percent). 82 percent of the population uses water piped into their dwelling from a public or local water supply as their main source of drinking water. A higher percentage of the population in the richest quintile uses water piped into their dwelling (97 percent) than the population in the poorest quintile (47 percent). ■ A high proportion of population in Montenegro uses improved sanitation facility (96 percent). In the North, 89 percent of the household population use improved sanitation facilities compared to all in the Central region and the South. ■ 94 percent of the population has a flush toilet connected either to a sewage system or septic tank. Septic tanks are much more common in rural areas (70 percent) compared to urban areas (34 percent). ■ 95 percent of the household population in Montenegro uses improved drinking water sources and improved sanitation. ■ The situation is similar in Roma settlements where almost all of the population uses an improved source of drinking water (99 percent). However, a lower percentage of the population uses water piped into their dwelling from a public or local water supply as their main source of drinking water (72 percent). Only 11 percent of the population in the poorest quintile uses water piped into their dwelling compared to all the population in the richest quintile. ■ A similar percentage of the population in Roma settlements uses an improved sanitation facility (97 percent). However, only three-quarters have a flush toilet connected either to a sewage system or a septic tank (77 percent). The use of septic tanks are more common in urban areas (50 percent) than in rural areas (21 percent). ■ A lower percentage of households in Roma settlements use improved drinking water sources and improved sanitation (80 percent), when compared to the national average. Handwashing ■ In Roma settlements, a specific place for handwashing was observed in 97 percent of the households. Two-thirds of households have a specific place for handwashing where water and soap or other cleansing agents are present (65 percent). Fertility ■ In Montenegro, early childbearing indicators are low – only 1 percent of women age 15–19 have begun childbearing, i.e. have had a live birth or are pregnant with their first child. ■ Only 3 percent of women age 20-24 years had a live birth before age 18. ■ On the other hand, in Roma settlements early childbearing indicators for women age 15–19 years are much higher – 23 percent have begun childbearing, and 20 percent have already had a live birth. ■ More than one-third of women age 20–24 years from Roma settlements had a live birth before the age of 18 (37 percent). Contraception ■ In Montenegro, current use of contraception was reported by 23 percent of women age 15–49, currently married or in a union. Modern methods are more popular than traditional ones, 15 percent compared to 8 percent. The most popular method is withdrawal and the male condom which are each used by 7 percent of women currently married or in a union. ■ The use of contraception by women currently married or in a union differs across regions, being the highest in the Central region (33 percent), followed by the South and North (24 and 8 percent). ■ In Roma settlements, the use of contraception was reported by only 4 percent of women age 15– 49, currently married or in a union (3 percent use modern and 1 percent traditional methods). The most popular method is the pill, used by 1 percent of women. Unmet need ■ In Montenegro, one in five women age 15–49, married or in a union, had an unmet need for contraception (22 percent), and more than one-half had their demand for contraception satisfied (52 percent). ■ In Roma settlements, almost one-half of women age 15–49, married or in a union, had an unmet need for contraception (48 percent) and only 8 percent had their demand for contraception satisfied. Antenatal care ■ Coverage of antenatal care in Montenegro is high – 92 percent of women age 15–49 years with a live birth in the last two years received antenatal care during their pregnancy from any skilled provider (medical doctor or nurse/midwife). ■ The majority of antenatal care in Montenegro is provided by medical doctors (91 percent). ■ The highest percentage of women who did not receive antenatal care was in the Northern region (27 percent), women with primary education (20 percent), women from the poorest quintile (16 percent) and women living in rural areas (14 percent). ■ In the case of antenatal care visits, two-thirds of the mothers from the poorest quintile reported four or more antenatal care visits (67 percent), while this percentage is higher among women from the richest quintile (91 percent). Women with primary education are less likely to have 4 or more visits (73 percent) compared to women with secondary education (86 percent) and with higher education (97 percent). ■ In terms of the content of antenatal care that women age 15–49 years received during antenatal care, 89 percent had their blood pressure measured, and urine and blood samples taken, and in 55 percent of cases a genetic analysis was conducted. ■ On the other hand, antenatal care coverage of women from Roma settlements is lower – 86 percent women age 15–49 years with a live birth in the last two years received antenatal care from a skilled provider. ■ Women from Roma settlements without education and from the poorest 60 percent of the household population are more likely not to receive antenatal care during pregnancy (17 percent). ■ A lower percentage of mothers from Roma settlements received antenatal care four or more times (64 percent). A higher percentage of mothers from rural areas (73 percent), with primary education (76 percent) and from the top two quintiles (76 percent) received antenatal care four or more times. ■ In terms of the content of antenatal care, again a lower percentage of women from Roma settlements reported that their blood pressure was measured, and urine and blood samples taken (77 percent), and in 32 percent of cases genetic analysis was conducted. MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XXIIIXXII Assistance at delivery ■ Almost all births in Montenegro occurring in the two years preceding the survey were delivered by skilled personnel (99 percent). ■ Almost all births in Montenegro were delivered in a health facility (99 percent), and almost all deliveries occur in public sector facilities, while a very small proportion take place in private sector facilities. ■ Every fifth woman in Montenegro age 15–49 years, with a live birth in the last two years gave birth by Caesarean section (C-section) (20 percent). This practice is more frequent among older women – 35 percent of women age 35–49 compared to 18 percent among women age 20–34 years. The percentage of births delivered by C-section ranges from 17 percent in the Central region to 25 percent in the North. ■ The same applies for deliveries of women from Roma settlements, age 15–49 years, with a live birth in the last two years – almost all births were delivered by skilled personnel, and almost all births were delivered in a public health facility (99 percent each). 1 percent of women from Roma settlements delivered their baby at home. ■ Similarly, 19 percent of women from Roma settlements gave birth by C-section. Postnatal health checks (PNC) ■ In Montenegro, almost all women age 15–49 who gave birth in a health facility in the two years preceding the survey stayed for 12 hours or more in the facility after delivery. 15 percent of women stayed for 1–2 days, while 85 percent of women stayed in a health facility for three days or more. Only 4 percent of women in the North stayed in a health facility for 1–2 days, while that percentage is higher for women in the South and the Central region (8 and 22 percent). ■ Almost all newborns received a health check following birth while in a facility or at home (99 percent). With regards to PNC visits for newborns, 52 percent receive a PNC visit after the first week following birth, while 12 percent do not receive any. Newborns in urban areas are more likely not to receive a PNC visit for newborns (14 percent) than women in rural areas (8 percent). ■ More than one-half of the first PNC visits within one week of birth for newborns occur in a public facility (52 percent) and less than 1 percent in the private sector. 53 percent of the first PNC visits for newborns are provided by either a doctor/nurse/ midwife and the remaining 47 percent by an auxiliary midwife. ■ As regards PNC health checks for mothers, 95 percent receive a health check following birth while in a facility or at home. Almost two-thirds of women in Montenegro receive no PNC visit (63 percent) while 30 percent receive such a visit after the first week following birth (30 percent) but there are differentials by region – 25 percent in the Central region compared to 27 and 45 percent in the North and in the South. ■ For 94 percent of live births, both mothers and their newborns received postnatal health checks within 2 days of the most recent birth, whereas postnatal health checks were received by neither mothers nor newborns in 1 percent of cases. ■ Almost all women from Roma settlements who gave birth in a health facility in the two years preceding the survey stayed for 12 hours or more in the facility after delivery. 19 percent of women stayed for 1–2 days while 80 percent stayed for three days or more. ■ A high percentage of newborns from Roma settlements received a health check following birth while in a facility or at home (95 percent). ■ 25 percent of PNC visits for newborns occur after the first week and the same percentage on the first day following birth (25 percent). ■ One in five women from Roma settlements receive no PNC visit for newborns (19 percent). 24 percent of women from Roma settlements from the bottom three quintiles receive no PNC visit for newborns compared to 9 percent of women from the top two quintiles. On the other hand, 71 percent of the first PNC visits for newborns from Roma settlements occur in a public facility and 23 percent at home. 78 percent of the first PNC visits for newborns are provided by either a doctor/nurse/midwife, or by an auxiliary midwife (22 percent). ■ Mothers from Roma settlements are less likely to receive a health check following birth while in a facility or at home (79 percent) and PNC visits predominantly occur after one day following birth (21 percent). ■ Almost two-thirds of women from Roma settlements receive no PNC visit (63 percent). ■ 79 percent of both mothers and newborns from Roma settlements received postnatal health checks and in 3 percent of cases neither the mother nor the newborn received postnatal health checks. Abortions ■ In Montenegro, 12 percent of women age 15–49 years have had at least one induced abortion. Among women who have had an abortion, 1 percent had four or more abortions. ■ Similarly, 14 percent of women from Roma settlements have had at least one induced abortion. Among women who have had an abortion, 10 percent had four or more abortions. Child development ■ In Montenegro, 40 percent of children age 36–59 months attend an organised early childhood education programme. Urban–rural, regional and wealth status differentials are notable – the figure is as high as 51 percent in urban areas, compared to 20 percent in rural areas. Attendance in early childhood education programmes is most prevalent in the Central region (54 percent), and lowest in the North (17 percent). Only 7 percent of children from the poorest quintile attend an organised early childhood education programme compared to two-thirds of children from the richest quintile (66 percent). ■ 73 percent of children age 0–59 months live in households where at least three children’s books are present for the child, while 60 percent have two or more types of playthings to play with. ■ For almost all children age 36–59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the three days preceding the survey (98 percent). Both father’s and mother’s engagement in four or more activities were positively associated with their education level. ■ 3 percent of children under the age of 5 were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child younger than 10 years. ■ In Roma settlements, children age 36–59 months are less likely to attend early childhood education (19 percent). Only 5 percent of children from the second quintile attend early childhood education compared to almost one-quarter of children from the richest quintile (24 percent). ■ The percentage of adult household members from Roma settlements who are engaged in four or more activities that promote learning and school readiness is lower (59 percent). ■ In Roma settlements, one in five children live in households where at least three children’s books are present (19 percent) and similarly to other children, 61 percent have two or more types of playthings to play with. ■ In Roma settlements, 4 percent of children under the age of 5 were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child younger than 10 years. Early child development index (ECDI) ■ In Montenegro, 94 percent of children age 36–59 months are developmentally on track. 98 percent of children are on track in the learning domain, 99 percent in the physical domain, and 94 percent in the socio-emotional domain. However, a much lower percentage of children are on track in the literacy– numeracy domain (24 percent). ■ In Roma settlements, 63 percent of children age 36– 59 months are developmentally on track. 93 percent of children are on track in the physical domain, 86 percent are on track in the learning domain, while 72 percent are on track in the social-emotional domain. Notably a lower percentage of children are on track in the literacy–numeracy domain (only 10 percent). Literacy among young women and men ■ The literacy rate for young women and men age 15–24 years is 99 percent, and is lower among women and men with only primary education (88 and 86 percent). ■ On the other hand, only 40 percent of young women and 63 percent of young men from Roma settlements are literate. This percentage is even lower among young women age 20–24 years (32 percent) and from the bottom three quintiles (30 percent), while among young men the lower literacy is associated with wealth status only (46 percent among the bottom three quintiles). MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XXVXXIV School readiness ■ Overall, 46 percent of children who are currently attending the first grade of primary school were attending preschool the previous year. 54 percent of first-graders in urban areas and 33 percent in rural areas attended preschool the previous year. There are clear regional differentials in attendance of preschool education; a higher proportion of first graders in the South (76 percent) have attended preschool than their peers in the Central and in the Northern region (58 and 11 percent). ■ On the other hand, about one-quarter of children from Roma settlements who are currently attending the first grade of primary school attended preschool the previous year (24 percent). Primary and secondary school participation ■ In Montenegro, 91 percent of children of primary school entry age (age 6) are attending the first grade of primary school, while almost all children of primary school age are attending school (98 percent) ■ 1 percent of children are out of school when they are expected to be participating in school. ■ Of all children starting grade one of primary school, almost all will eventually reach the last, ninth grade (99 percent). ■ In Montenegro, 93 percent of children of secondary school age (15–18 years) are attending secondary school, 6 percent are out of school and 1 percent are attending primary school. Secondary school attendance is positively associated with wealth status – 82 percent of children from the poorest quintile are attending secondary school, compared to 98 percent from the richest quintile. ■ In Montenegro, the Gender Parity Index (GPI) for primary school is 1.00, indicating no difference in the attendance of girls and boys to primary school. The indicator increases to 1.01 for secondary education. For secondary school, there is clear advantage among girls in the Central region and the South, as well as among children living in urban areas. ■ In Roma settlements, a much lower percentage of children of primary school entry age are attending the first grade of primary school (52 percent), and only 58 percent of children of primary school age are attending school. There is a strong positive correlation between the primary school attendance of children from Roma settlements and wealth status. 45 percent of children from the poorest quintile attend primary school compared to 70 percent from the richest quintile. ■ The percentage of primary school age out-of-school children is much higher in Roma settlements (42 percent). ■ Of all children from Roma settlements starting first grade of primary school, only 63 percent will eventually reach the last (ninth) grade but this data is based on a small number of cases and should be treated with caution. Only 6 percent of children of secondary school age (15–18 years) from Roma settlements are attending secondary school. 87 percent of children are out of school and 8 percent are attending primary school. A higher percentage of girls of secondary-school age (90 percent) are out of school compared to boys (83 percent). ■ In Roma settlements, the GPI for primary school is 0.95, indicating that for every 100 boys in primary school there are 95 girls. For secondary education, the indicator decreases to 0.60 meaning that girls are even more disadvantaged in secondary education. Birth registration ■ Almost all births of children under 5 in Montenegro have been registered (99 percent), while 2 percent of children had no birth certificate. Children living in the North (6 percent), whose mothers have primary education (10 percent) and children from the poorest quintile (6 percent) are more likely to be without a birth certificate. ■ The births of 95 percent of children under 5 from Roma settlements have been registered. 1 percent of children from Roma settlements had no birth certificate. Child labour ■ In Montenegro, no children are involved in household chores for the number of hours that would classify the work as child labour (more than 28 hours for children age 5–11 and 12–14 years, and more than 43 hours for children age 15–17 years). ■ In Montenegro, 13 percent of children age 5–17 years were engaged in child labour during the last week preceding the survey, and 6 percent work under hazardous conditions. Male children are more engaged in child labour than female children (15 and 10 percent respectively). In addition, a higher proportion of children from the poorest quintile are engaged in child labour (20 percent) than children from the richest quintile (10 percent). ■ In Roma settlements, 1 percent of children age 5–11 and 4 percent of children age 12–14 years were involved in household chores for 28 hours or more, which classifies the work as child labour. ■ Children age 5–17 years from Roma settlements are less likely to be engaged in child labour than other children (7 percent), and 5 percent of them work under hazardous conditions. Children at this age living in rural areas (20 percent) and in the South (32 percent) are more likely to be engaged in child labour. Child discipline ■ In Montenegro, 69 percent of children age 1–14 years were subjected to at least one form of psychological or physical punishment by their parents or other adult household members during the month preceding the survey, while 2 percent of them were subjected to severe physical punishment. Only 16 percent experienced methods of non-violent disciplining. ■ Boys were subjected more to minor physical discipline (36 percent) than girls (26 percent). A higher proportion of children from the poorest quintile were subjected to any physical punishment (44 percent) than children from the richest quintile (20 percent). ■ 6 percent of respondents to the household questionnaires believe that children need to be physically punished in order to bring up, raise, or educate them properly, which implies an interesting contrast with the actual prevalence of physical discipline (31 percent of children are subjected to any physical punishment). ■ In Roma settlements, a similar percentage of children age 1–14 years were subjected to at least one form of psychological or physical punishment by their parents or other adult household members (64 percent) and 5 percent were subjected to severe physical punishment. Only 11 percent experienced methods of non-violent disciplining. Similarly, boys were subjected slightly more to minor physical discipline than girls (38 and 31 percent). ■ On the other hand, 40 percent of respondents from Roma settlements believe that children need to be physically punished, which is in line with the actual prevalence of physical discipline (35 percent of children are subjected to any physical punishment). A higher percentage of female respondents believe that a child needs to be physically punished (58 percent) than male respondents (32 percent). Early marriage ■ In Montenegro, 2 percent of young women and less than 1 percent of young men age 15–19 years are currently married or in a union. 6 percent of women and 1 percent of men age 20–49 years got married before age 18. ■ The proportion of women and men age 15–49 who got married before the age of 15 is very low (1 percent and less than 1 percent). ■ In Roma settlements early marriage is much more common – 28 percent of young women and 17 percent of young men age 15–19 years are currently married or in a union. More than one-half of women (56 percent) and more than one-third of men age 20–49 years (35 percent) got married before age 18. ■ There is also a higher proportion of women and men age 15–49 who got married before the age of 15 (18 and 7 percent). Domestic violence ■ Overall, 3 percent of women and 5 percent of men in Montenegro feel that a husband has a right to hit or beat his wife for at least one of a variety of reasons. Acceptance of domestic violence is more present among women and men living in poorer and less educated households. ■ Domestic violence is much more accepted in Roma settlements where 41 percent of women and 53 percent of men feel it can be justified. Less educated women and men, and those living in urban areas have higher level of acceptance of domestic violence. Children’s living arrangements and orphanhood ■ In Montenegro, 92 percent of children age 0–17 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY XXVIIXXVI years live with both parents, 6 percent live with their mother only, while 2 percent live with their father only. Less than 1 percent of children at this age live with neither of their biological parents while both of them are alive. 2 percent of children age 0–17 lost one or both parents, and 1 percent of children at this age have at least one parent living abroad. ■ Similarly, 86 percent of children from Roma settlements live with both parents, 7 percent of children live with their mother only, while 3 percent live with their father only. 3 percent of children at this age live with neither of their biological parents while both of them are alive. ■ In Roma settlements, 3 percent of children age 0–17 lost one or both parents, and 1 percent of children at this age have at least one parent living abroad. Knowledge about HIV transmission ■ In Montenegro, 97 percent of young women and young men age 15–24 had heard of AIDS. ■ A higher percentage of young women age 15–24 reject the two most common misconceptions and know that a healthy-looking person can be HIV- positive (52 percent) compared to young men (41 percent). ■ 47 percent of women and 39 percent of men age 15–49 years had a comprehensive knowledge about HIV transmission, which is positively associated with their education level. ■ Overall, 89 percent of women and 68 percent of men age 15–49 know that HIV can be transmitted from mother to child by at least one of three means. The percentages of women and men who know all three ways of mother-to-child transmission are 58 percent and 33 percent respectively. ■ In Roma settlements however, only 47 percent of young women and 73 percent of young men had heard of AIDS. ■ Only 7 percent of young women and 10 percent of young men age 15–24 years reject the two most common misconceptions and know that a healthy- looking person can be HIV-positive. ■ Only 5 percent of women and 8 percent of men age 15–49 years have comprehensive knowledge about HIV transmission. Again, knowledge about HIV transmission is positively associated with their education level. ■ Knowledge about mother-to-child HIV transmission is also lower – 37 percent of women and 46 percent of men from Roma settlement know that HIV can be transmitted from mother to child by at least one of three means. One-quarter of women and men know all three ways of mother-to-child transmission (25 and 26 percent). Sexual behaviour ■ About 1 percent of young women and 22 percent of young men age 15–24 years who ever had sex, had sex with more than one partner in the last 12 months. The mean number of sexual partners in their lifetime for women and men at this age also differs, being 2 for women and 5 for men. ■ Less than 1 percent of young women and 3 percent of young men age 15–24 had sex before the age of 15. ■ In terms of age difference between sexual partners, 9 percent of young women age 15–24 who had sex in the last 12 months, had sex with a man 10 or more years older. ■ Similarly, in Roma settlements less than 1 percent of young women and 17 percent of young men age 15– 24 years had had sex with more than one partner in the last 12 months, while the mean number of sexual partners in their lifetime for women and men at this age is 1 and 6 respectively. ■ A higher percent of young women and men age 15–24 from Roma settlements had sex before age 15 (20 and 11 percent). ■ 6 percent of young women age 15–24 who had had sex in the last 12 months, had sex with a man 10 or more years older. Tobacco use ■ In Montenegro, use of tobacco products is more common among men than among women. 52 percent of women and 58 percent of men age 15–49 reported ever having used a tobacco product. ■ Almost one-third of women and men smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month preceding the survey (31 percent each). ■ 3 percent of women smoked a cigarette for the first time before age 15 compared to 8 percent of men. ■ Among men who currently smoke cigarettes, 75 percent smoked 20 or more cigarettes in the last 24 hours, while a smaller percentage of women smoke as much (47 percent). ■ Similarly, in Roma settlements 33 percent of women and 55 percent of men reported having ever used a tobacco product. ■ One-quarter of women (25 percent) and almost one-half of men (43 percent) smoked any tobacco product at any time during the last month preceding the survey. ■ 10 percent of women and 15 percent of men smoked a cigarette for the first time before age 15. ■ In Roma settlements, a higher percentage of men and women who currently smoke cigarettes, smoked 20 or more cigarettes in the last 24 hours – almost two-thirds of men (63 percent) and one-half of women (46 percent). Alcohol use ■ Almost one-quarter of women (23 percent) and more than one-half of men (52 percent) age 15–49 years had at least one alcoholic drink at any time during the last one month. ■ In addition, 2 percent of women and 10 percent of men age 15–49 years had had at least one alcoholic drink before the age of 15. ■ On the other hand, 40 percent of women and 18 percent of men had never had an alcoholic drink. ■ In Roma settlements, women and men age 15–49 drink less – 4 percent of women and 27 percent of men had at least one alcoholic drink at any time during the last one month. ■ However, higher percentages of women and men at this age had had at least one alcoholic drink before the age of 15 (8 and 21 percent), ■ More than two-thirds of women (69 percent) and one-third of men (35 percent) had never had an alcoholic drink. Subjective well-being ■ In Montenegro, almost all young women and men age 15–24 years are satisfied with life overall (98 and 99 percent). A high percentage of young women from the richest quintile are satisfied with life overall (99 percent) while that percentage is lower for young women from the poorest quintile (92 percent). Among young men, differences in life satisfaction by wealth status are even less pronounced. ■ Both young women and men are least satisfied with their current income (76 and 74 percent are very or somewhat satisfied with their income), with 39 percent of young women and 41 percent of young men having an income. ■ A high percentage of young women and men are very or somewhat happy (98 and 97 percent). ■ A similar proportion of young women and men age 15–24 years think that their lives improved during the last one year and expect that their lives will get better after one year: 38 and 33 percent, respectively. ■ In Roma settlements, a lower percentage of young women and men age 15–24 years are satisfied with life, overall (85 and 87 percent). Life satisfaction among young women and men is positively associated with wealth status. ■ Only 3 percent of young women have a job and 7 percent have an income while among young men 37 percent have a job and 47 percent have an income. 62 percent of young men are very or somewhat satisfied with their income. ■ 94 percent of women and 91 percent of men age 15–24 years are very or somewhat happy. ■ In Roma settlements, a slightly higher proportion of young men (39 percent) than young women (32 percent) think that their lives improved during the last one year and expect that their lives will get better after one year. MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1XXVIII Background This report is based on the 2013 Montenegro MICS, conducted in 2013 by MONSTAT with technical support from UNICEF. The survey provides valuable information on the situation of children, women and men in Montenegro, and was based, in large part, on the need to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” I introduction 1 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 32 In Montenegro, commitment to these international priorities has been demonstrated through development and implementation of national strategies and plans; through the EU integration process; and by meeting international obligations. Namely, the Montenegrin government adopted numerous documents and strategies aimed at protecting the rights for all children, women and men in the country such as: the National Action Plan for Children (2013–2017), the Strategy for Development of Health Protection in Montenegro (2003), the Strategy for Preservation and Improvement of Reproductive and Sexual Health in Montenegro (2013–2020), the Inclusive Education Strategy (2008), the Strategy for Reduction of Poverty and Social Exclusion (2007–2011), the Strategy for Social and Child Protection in Montenegro (2013–2017), the Strategy for the Integration of Persons with Disabilities in Montenegro (2008–2016), and the Strategy for Improvement of the Position of Roma and Egyptians in Montenegro (2012–2016). Montenegro signed and ratified numerous international conventions and protocols and introduced international laws that particularly relate to the protection of children and women and human rights. As a signatory to the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination Against Women, Montenegro has committed itself to provide conditions for the respect of the rights of all children and women. Montenegro participated in the third global round of MICS surveys (MICS3) in 2005, at that time as part of the State Union of Serbia and Montenegro. In the fifth round of the MICS surveys (MICS5), scheduled for 2012–2014, Montenegro participated for the first time as a sovereign state. The survey provides a rich foundation of comparative data for comprehensive reporting on progress towards national MDGs targets and EU integration. The 2013 Montenegro MICS survey captures rapid changes in key indicators between this and the previous round of the survey especially regarding the situation of the most vulnerable children – children in the poorest households, Roma children or those living in rural areas – and in that way contributes to expanding the evidence base for policies and programmes. This final report presents the results of the indicators and topics covered in the survey for both the Montenegro and Roma sample. Data from the Roma sample representing the population living in Roma settlements in Montenegro is clearly referred to in the sub-headings, text, tables and figures throughout the report as data for ‘Roma settlements’. Survey Objectives The 2013 Montenegro MICS and 2013 Montenegro Roma Settlements MISC have as their primary objectives: ■ To provide up-to-date information for assessing the situation of children and women in Montenegro; ■ To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed-upon goals, as a basis for future action; ■ To contribute to the improvement of data and monitoring systems in Montenegro and to strengthen technical expertise in the design, implementation and analysis of such systems. ■ To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. Sample Coverage of the Montenegro MICS The MICS was carried out in Montenegro on two samples — a national sample representative of the whole population of Montenegro (referred to as the Montenegro sample); and a Roma settlements sample representative of the population living in Roma settlements in Montenegro. A more detailed description of the sample designs of both samples can be found in Appendix A. Most of the steps in the sample design processes were common to both surveys. In cases where the sample design process for the Roma settlements survey differs, those differences are mentioned specifically and explained. The 2013 Montenegro MICS has a stratified, two- stage cluster sample design. The sample for the 2013 Montenegro MICS was designed to provide estimates for a large number of indicators on the situation of children and women and men at the national level, for urban and rural areas, and for the three regions of Montenegro: the South, Centre and North. Urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. Before the fieldwork commenced, complete listing of the households that had been selected in the sample was conducted in their respective enumeration areas (EAs) from 22 January until 10 February 2013. The purpose of the listing was to collect data on: the number of households in the EA; the detailed address of households; the name of the head of household; and identification of those households with and without children under 5 years. In total, 270 EAs were listed with about 18,000 households, for both the national and Roma survey samples. After a household listing was carried out within the selected enumeration areas, the listed households were divided into households with and without children under 5, and a separate systematic sample of households was drawn from each group. A total of 4,600 target households were selected for interviews in 230 clusters, each consisting of 20 households, in the national sample. Interviews with men were conducted in half of the selected households. The sample is not self- weighting and for reporting the results, sample weights are used. Sample Coverage of the Roma Settlements MISC The sample for the 2013 Montenegro Roma Settlements MICS was designed to provide estimates of a large number of indicators on the situation of children, women and men in the Roma settlements of Montenegro, at the level of Montenegro. It was decided that it would be both cost-effective and analytically appropriate to limit the 2013 Montenegro Roma Settlements MICS to EAs with 10 or more Roma households. The complete listing of households that had been selected in the 2013 Montenegro Roma Settlements MICS sample was conducted in respective enumeration areas (EAs). The purpose of the listing was to collect data on: the number of households in the EA; the detailed address of a household; the name of the head of household; identification of households with and without children under 5 years; and to identify households with at least one household member who is Roma or Egyptian. If at least one member of the household was found to be Roma or Egyptian that household was classified as a Roma household. II sAmple And survey methodology MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 54 2 The Handwashing module was administered only within the survey of Roma Settlements. 3 The Fertility module included country-specific questions on abortions. 4 The HIV/AIDS modules in the Questionnaire for Individual Women and the Questionnaire for Individual Men included a country-specific question in the set of questions on misconceptions, specifically, whether people can get the HIV virus by hugging or shaking hands with a person who is infected with AIDS. 5 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 6 The model MICS5 questionnaires can be found at http://www.childinfo.org/mics5_questionnaire.html After a household listing was carried out within the selected 33 enumeration areas, the listed Roma households were divided into households with and without children under 5, and a separate systematic sample of households was selected for each group. A total of 685 Roma households were selected. The sample for the 2013 Montenegro Roma Settlements MICS is not self-weighting. For reporting the results sample weights were used. Questionnaires Four sets of questionnaires were used in the two surveys: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a women’s questionnaire carried out in each household on all women age 15–49 years; 3) a men’s questionnaire carried out on all men age 15–49 years in half of the selected sample; and 4) an under- 5s’ questionnaire, carried out on mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: ■ List of Household Members ■ Education ■ Child Labour ■ Child Discipline ■ Household Characteristics ■ Water and Sanitation ■ Handwashing2 The Questionnaire for Individual Women was carried out on all women aged 15–49 years living in the households, and included the following modules: ■ Women’s Background ■ Fertility3 ■ Desire for Last Birth ■ Maternal and Newborn Health ■ Postnatal Health Checks ■ Illness Symptoms ■ Contraception ■ Unmet Need ■ Attitudes Toward Domestic Violence ■ Marriage/Union ■ Sexual Behaviour ■ HIV/AIDS4 ■ Tobacco and Alcohol Use ■ Life Satisfaction The Questionnaire for Individual Men was administered to all men aged 15–49 years living in the households, and included the following modules: ■ Men’s Background ■ Attitudes Toward Domestic Violence ■ Marriage/Union ■ Sexual Behaviour ■ HIV/AIDS ■ Tobacco and Alcohol Use ■ Life Satisfaction The Questionnaire for Children Under 5 was administered to mothers or caretakers of children under 5 years of age5 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: ■ Age ■ Birth Registration ■ Early Childhood Development ■ Breastfeeding and Dietary Intake ■ Immunisation ■ Care of Illness ■ Anthropometry The questionnaires6 are based on the MICS5 model questionnaire. The questionnaires were translated into Montenegrin from the English version of the MICS5 model and were pre-tested in Podgorica, Niksic and Cetinje during January 2013. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the 2013 Montenegro MICS questionnaires is provided in Appendix F. In addition to the conducting of questionnaires, fieldwork teams observed the place for handwashing10, and measured the weight and height of children under 5 years of age. The details and findings of these measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted over 12 days in February 2013 for both surveys. 55 participants attended the fieldwork training. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent two days in practice interviewing in Bar in both urban and rural areas. Trainees also practiced measuring the weight and height of children in a kindergarten in Bar. The data were collected by nine teams – eight teams for the general population survey and one team for the Roma population survey; each was comprised of two interviewers, one editor, one measurer and a supervisor. In one of the teams two interviewers and a measurer/driver were Roma who were responsible for interviewing only Roma households in Podgorica. In all other municipalities, the same interviewers conducted interviews for both Roma households and for households from general population. Training, fieldwork and data processing were conducted at the same time for both the Montenegro and Roma Settlements MICS samples. Fieldwork began for both surveys on 4 March 2013 and was concluded on 10 May 2013. Data Processing Data was entered using CSPro software. The data was entered on 10 microcomputers and carried out by 15 data entry operators and one data entry supervisor. In order to ensure quality control, all questionnaires were entered twice and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS5 programme and adapted to the Montenegro questionnaire were used throughout. Data processing began simultaneously with data collection in March 2013 and was completed in May 2013 for both surveys. Data was analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. How to Read Tables The following data, collected through this survey, has not been presented in the tables of this report: - A small number of cases (fewer than 25 unweighted cases) per disaggregation category - The education category “None” for the 2013 Montenegro MICS (except in HH tables), which is based on fewer than 25 unweighted cases and is therefore too small to be reported separately. - The education category “Higher” within the 2013 Montenegro Roma Settlements MICS, which is based on fewer than 25 unweighted cases and is therefore too small to be reported separately. As such, the category “Higher” has been combined with the category “Secondary” and presented (except in HH tables) as “Secondary or higher”. - Apart from Montenegrin, Serbian and Albanian, data for ethnicity of the head of household is in most cases based on fewer than 25 unweighted cases. Therefore no data for any ethnic group is presented in the report. Note: - When education is used as a background characteristic in the tables, primary and secondary education levels are defined in line with the national education system classification (nine grades of primary school and four grades of secondary school). - (M) — the letter ‘M’ after a table/figure code indicates that it refers to the male population - (R) — letter ‘R’ after a table/figure code indicates that it refers to the Roma settlements sample - (number) — values in parenthesis indicate that the percentage or proportion is based on only 25–49 unweighted cases and should be treated with caution - * — an asterisk in tables indicates that the percentage or proportion has been suppressed because it is based on fewer than 25 unweighted cases - Age groups presented in this report also include MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 76 Sample Coverage of the Montenegro MICS The MICS was carried out in Montenegro on two samples — a national sample representative of the whole population of Montenegro (referred to as the Montenegro sample); and a Roma settlements sample representative of the population living in Roma settlements in Montenegro. A more detailed description of the sample designs of both samples can be found in Appendix A. Most of the steps in the sample design processes were common to both surveys. In cases where the sample design process for the Roma settlements survey differs, those differences are mentioned specifically and explained. The 2013 Montenegro MICS has a stratified, two- stage cluster sample design. The sample for the 2013 Montenegro MICS was designed to provide estimates for a large number of indicators on the situation of children and women and men at the national level, for urban and rural areas, and for the three regions of Montenegro: the South, Centre and North. Urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. Before the fieldwork commenced, complete listing of the households that had been selected in the sample was conducted in their respective enumeration areas (EAs) from 22 January until 10 February 2013. The purpose of the listing was to collect data on: the number of households in the EA; the detailed address of households; the name of the head of household; and identification of those households with and without children under 5 years. In total, 270 EAs were listed with about 18,000 households, for both the national and Roma survey samples. After a household listing was carried out within the selected enumeration areas, the listed households were divided into households with and without children under 5, and a separate systematic sample of households was drawn from each group. A total of 4,600 target households were selected for interviews in 230 clusters, each consisting of 20 households, in the national sample. Interviews with men were conducted in half of the selected households. The sample is not self- weighting and for reporting the results, sample weights are used. III sAmple coverAge And the chArActeristics of households And respondents those persons that had reached the full age indicated by the upper limit for an age group; for instance, respondents age 15–49 include persons who had fully reached 49 years of age. Similary, the age group of children age 20–23 months includes those who had fully reached 23 months. MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 98 Area Region Total Urban Rural North Centre South Households Sampled 4596 2919 1677 1400 1799 1397 Occupied 4425 2797 1628 1357 1732 1336 Interviewed 4052 2517 1535 1308 1563 1181 Household response rate 91.6 90.0 94.3 96.4 90.2 88.4 Women Eligible 3606 2302 1304 1170 1452 984 Interviewed 3493 2217 1276 1144 1412 937 Women's response rate 96.9 96.3 97.9 97.8 97.2 95.2 Women's overall response rate 88.7 86.7 92.3 94.2 87.8 84.2 Men Eligible 1872 1154 718 625 720 527 Interviewed 1799 1099 700 608 700 491 Men's response rate 96.1 95.2 97.5 97.3 97.2 93.2 Men's overall response rate 88.0 85.7 91.9 93.8 87.7 82.4 Children under 5 Eligible 1441 911 530 472 644 325 Mothers/caretakers interviewed 1420 900 520 469 641 310 Under-5's response rate 98.5 98.8 98.1 99.4 99.5 95.4 Under-5's overall response rate 90.2 88.9 92.5 95.8 89.8 84.3 Total Males Females Number Percent Number Percent Number Percent Total 13799 100.0 6845 100.0 6954 100.0 Age 0-4 916 6.6 492 7.2 424 6.1 5-9 822 6.0 429 6.3 393 5.6 10-14 902 6.5 452 6.6 450 6.5 15-19 1079 7.8 557 8.1 522 7.5 20-24 1119 8.1 567 8.3 552 7.9 25-29 971 7.0 476 6.9 496 7.1 30-34 993 7.2 485 7.1 507 7.3 35-39 909 6.6 450 6.6 459 6.6 40-44 850 6.2 429 6.3 421 6.1 45-49 943 6.8 459 6.7 484 7.0 50-54 906 6.6 465 6.8 441 6.3 55-59 835 6.1 432 6.3 403 5.8 60-64 881 6.4 409 6.0 473 6.8 65-69 509 3.7 228 3.3 282 4.0 70-74 486 3.5 247 3.6 239 3.4 75-79 355 2.6 138 2.0 217 3.1 80-84 189 1.4 78 1.1 111 1.6 85+ 126 0.9 50 0.7 76 1.1 Missing/DK 8 0.1 3 0.0 5 0.1 Dependency age groups 0-14 2640 19.1 1373 20.1 1266 18.2 15-64 9486 68.7 4728 69.1 4758 68.4 65+ 1665 12.1 740 10.8 925 13.3 Missing/DK 8 0.1 3 0.0 5 0.1 Child and adult populations Children age 0-17 years 3262 23.6 1709 25.0 1552 22.3 Adults age 18+ years 10529 76.3 5132 75.0 5397 77.6 Missing/DK 8 0.1 3 0.0 5 0.1 Table HH.1: Results of household, women’s, men’s and under-5 interviews Number of households, women, men, and children under 5 by interview results of the household, women’s, men’s and under-5’s interviews, and household, women’s, men’s and under-5’s response rates, Montenegro, 2013 Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Montenegro, 2013 As can be seen in Table HH.1, response rates were similar across urban and rural areas. The response rates in the South were slightly lower than in other regions, but this was expected because of the specifics of the coastal area. Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 4,052 households successfully interviewed in the survey, 13,799 household members were listed. Of these, 6,845 were males, and 6,954 were females. The distribution of respondents by five-year age groups and sex in the 2013 Montenegro MICS is in line with the 2011 Census. The predominant group consists of people age 20–24 years (8 percent) and the greatest difference from the data of 2011 Census (7 percent) is for this age group. The reason for this difference could be that within the 2011 Census, students studying abroad were covered MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1110 7 This was determined by asking the questions “What is the religion of the household head?” Please refer to the Household Questionnaire in Appendix F for a detailed view of the questions. but not included in the total population, which is in line with international recommendations for the census. We assume that the 2013 Montenegro MICS survey included that population group (students studying abroad). In Montenegro, positive population growth can be seen in the greater share of children age 0–14 years in the total population (19 percent) compared to the share of the population age 65 and over (12 percent). Children under 18 years make up 24 percent of the population. Characteristics of Female and Male Respondents Age 15–49 Years and Children Under 5 Tables HH.4, HH.4.M and HH.5 provide information on the background characteristics of female and male respondents age 15–49 years of age and of children under 5. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalised (standardised). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. households (54 percent) have a household head with secondary education. Almost two-thirds of households (60 percent) have 2–4 members. The table also shows the weighted average household size for Montenegro, which is 3.4 members. Tables HH.3 – HH.5 provide basic information on the households, female respondents age 15–49, male respondents 15–49 and children under 5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men and children under 5 covered by the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households disaggregated by region, area, number of household members as well as sex, education and religion7 of the household head, which are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report.The table also shows the weighted average household size estimated by the survey. The gender structure for heads of households is almost the same, when comparing 2011 Census and 2013 Montenegro MICS data. More than one-half of Figure HH.1: Age and sex distribution of household population, Montenegro, 2013 Weighted percent Number of households Weighted Unweighted Total 100.0 4052 4052 Sex of household head Male 78.7 3189 3309 Female 21.3 863 743 Region North 27.7 1122 1308 Centre 47.3 1918 1563 South 25.0 1012 1181 Area Urban 64.4 2610 2517 Rural 35.6 1442 1535 Number of household members 1 15.6 634 519 2 19.8 802 692 3 17.7 716 744 4 22.2 898 934 5 13.6 550 615 6 6.2 250 297 7 2.9 116 143 8 1.2 49 57 9 0.4 17 26 10+ 0.5 19 25 Education of household head None 1.9 79 71 Primary 19.2 778 795 Secondary 54.0 2187 2230 Higher 24.9 1007 956 Religion of household head Orthodox 79.8 3234 3131 Catholic 2.7 111 126 Islamic 15.2 616 715 Other religion 2.3 91 80 Mean household size 3.4 4052 4052 Weighted percent Number of women Weighted Unweighted Total 100.0 3493 3493 Region North 27.8 970 1144 Centre 49.2 1720 1412 South 23.0 803 937 Area Urban 66.9 2335 2217 Rural 33.1 1158 1276 Age 15-19 15.2 531 487 20-24 16.1 563 515 25-29 14.3 501 558 30-34 14.6 509 599 35-39 13.3 463 500 40-44 12.4 434 413 45-49 14.1 492 421 Marital/union status Currently married/in union 56.0 1955 2167 Widowed 1.2 40 37 Divorced 3.6 125 103 Separated 0.7 26 33 Never married/in union 38.6 1347 1153 Weighted percent Number of women Weighted Unweighted Motherhood and recent births Never gave birth 44.1 1542 1317 Ever gave birth 55.9 1951 2176 Gave birth in last two years 9.4 328 494 No birth in last two years 46.5 1623 1682 Education None 0.5 17 17 Primary 10.2 355 401 Secondary 56.4 1969 2003 Higher 33.0 1153 1072 Wealth index quintiles Poorest 14.6 511 571 Second 17.6 613 669 Middle 21.7 756 717 Fourth 23.2 810 760 Richest 23.0 802 776 Religion of household head Orthodox 76.3 2666 2557 Catholic 2.9 102 110 Islamic 18.9 659 765 Other religion 1.9 66 61 Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Montenegro, 2013 Table HH.4: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Montenegro, 2013 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1312 8 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 9 Principal component analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into five equal parts (quin- tiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: source of drinking water; type of sanitation facility; number of rooms used for sleeping; main material of dwelling’s floor, roof and exterior walls; presence in the household of electricity, a television, refrigerator, electric stove, bed, table with chairs, vacuum cleaner, personal com- puter/laptop, Internet connection, closet, washing machine, drying machine, dishwashing machine, video monitoring system; presence in the household of a mobile phone, bicycle, motorcycle/ scooter, car/truck; and possession of a bank account. The wealth index is assumed to capture the underlying long-term wealth through information on the household’s assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable only to the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Gwatkin, D.R., Rutstein, S., Johnson, K. ,Pande, R. and Wagstaff. A., 2000. Socio-Economic Differences in Health, Nutrition, and Population. HNP/Poverty Thematic Group, Washington, DC: World Bank. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. Table HH.4 provides the background characteristics of female respondents age 15–49 years. The table includes information on the distribution of women according to region, area, age, marital status, motherhood status and births in the last two years, education8, Wealth index quintiles9 and religion of the household head. Approximately, 49 percent of women live in the Central region, 23 percent live in the South and 28 percent in the North of Montenegro. This pattern is expected and follows demographic estimates based on the vital statistics for 2012. The proportion of young women is lower, with 15 percent in the 15–19 years age group. 56 percent of all women in this sample are currently married/in a union, while 39 percent have never been married/in a union. The distribution by motherhood status is similar: 56 percent of women have given birth, compared to 44 percent that have never given birth. More than one-half of women have secondary education (56 percent), while the proportion of women with no education is 1 percent, and with primary education, 10 percent. Those with higher education constitute one-third of all women (33 percent). As far as Wealth index quintiles are concerned, a smaller proportion of women live in households within the poorest quintile (15 percent) while 18 to 23 percent of women live in the households within the remaining wealth quintiles. Similarly, Table HH.4.M provides background characteristics of male respondents 15–49 years of age. The table shows information on the distribution of men according to region, area, age, marital status, education, Wealth index quintiles and religion. 22 percent of men live in the South, 30 percent live in the North of Montenegro, and the remaining 48 percent live in the Central region. The smallest group in Montenegro are men between 40–44 years of age (12 percent). The proportion of younger men is higher — there are 17 percent of men in the 15–19 years age group. 46 percent of all men in this sample are currently married/in a union, while 52 percent have never been married/in a union. The majority of interviewed men have secondary education (67 percent), while the proportion of men with no education is less than 1 percent. 7 percent of men have only primary education, and 26 percent have higher education. As for the Wealth index quintiles, a smaller proportion of men live in households within the poorest quintile (18 percent) while approximately a similar percentage of men belong to each of the remaining wealth quintiles (17 to 24 percent). Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age, mother’s or caretaker’s education, wealth and religion. The proportion of male and female children within the population of Montenegro under 5 are 54 and 46 percent respectively. The majority of children under 5 in Montenegro live in urban areas – 65 percent. 19 percent of children are in the Southern region while in the Northern and Central region are 29 and 52 percent of children are respectively. The age distribution of children age 0–59 months is lower for children from 0–5 months and 6–11 months (9 and 8 percent respectively), the distribution is quite balanced for the remaining one-year age groups. More than half of children under 5 (56 percent) have a mother with secondary education. Weighted percent Number of men Weighted Unweighted Total 100.0 1799 1799 Region North 30.1 541 608 Centre 47.6 857 700 South 22.3 401 491 Area Urban 64.4 1158 1099 Rural 35.6 641 700 Age 15-19 17.4 313 275 20-24 16.6 298 265 25-29 12.6 226 228 30-34 13.5 243 278 35-39 13.7 247 278 40-44 12.2 220 237 45-49 14.0 252 238 Marital/union status Currently married/in union 45.8 824 939 Widowed 0.1 1 2 Divorced 1.3 23 29 Separated 0.5 9 10 Never married/in union 52.4 942 819 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 1420 1420 Male 53.8 764 744 Female 46.2 656 676 Region North 29.2 414 469 Centre 51.6 733 641 South 19.2 272 310 Area Urban 64.5 916 900 Rural 35.5 504 520 Age 0-5 months 8.5 121 108 6-11 months 8.3 118 122 12-23 months 18.0 255 266 24-35 months 18.8 267 275 36-47 months 23.8 338 333 48-59 months 22.6 321 316 Respondent to the under-5 questionnaire Mother 99.6 1414 1409 Other primary caretaker 0.4 5 10 Weighted percent Number of under-5 children Weighted Unweighted Mother’s educationa None 0.9 13 11 Primary 15.4 219 218 Secondary 55.5 788 800 Higher 28.2 400 391 Wealth index quintiles Poorest 17.7 251 270 Second 19.5 278 288 Middle 19.7 280 265 Fourth 20.6 293 291 Richest 22.5 320 306 Religion of household head Orthodox 69.7 989 1007 Catholic 2.6 37 36 Islamic 25.9 368 348 Other religion 1.8 26 29 Weighted percent Number of men Weighted Unweighted Education None 0.3 5 6 Primary 6.8 122 137 Secondary 66.6 1198 1210 Higher 26.3 473 446 Wealth index quintiles Poorest 18.0 324 346 Second 17.4 312 331 Middle 19.2 345 340 Fourth 21.2 381 361 Richest 24.3 437 421 Religion of household head Orthodox 75.9 1365 1324 Catholic 2.0 36 45 Islamic 19.7 355 398 Other religion 2.4 43 32 Table HH.4.M: Men’s background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Montenegro, 2013 Table HH.5: Under-5’s background characteristics Percent and frequency distribution of children under 5 years of age by selected characteristics, Montenegro, 2013 a In this table and throughout the report, mother’s education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1514 Table HH.6 presents percent distribution of households by selected housing characteristics, according to area of residence and regions. Almost all households in Montenegro have electricity. There are no differences by area and by region. Regarding flooring, 94 percent of households have a finished floor. In rural areas this percentage is lower (87 percent) compared to urban areas (97 percent). In the South and the Central region 99 and 98 percent of households, respectively, have a finished floor while in the North 81 percent of households have a finished floor. Regarding roofing, 96 percent of households have a finished roof. In rural area this percentage is slightly lower (93 percent) compared to urban areas (98 percent). In the South and the Central region almost all households have a finished roof (98 and 99 percent respectively) while in the North this proportion is 90 percent. As regards exterior walls, 94 percent of households have finished exterior walls. Differentials by area and region are small. The mean number of persons per room used for sleeping in Montenegro is 1.79. There are no differences by area while there are some differences by region. In the North, the mean number of persons per room used for sleeping is 1.91 compared to 1.79 in the Central region and 1.67 in the South. Table HH.7 presents the percentage of households by ownership of selected household and personal assets, and the percent distribution by ownership of dwelling, according to the area of residence and region. 99 percent of households own a television, refrigerator, table with chair, and closet. Similarly, 95 percent of households own a vacuum cleaner and washing machine and 94 percent own an electric stove while 79 percent of households own a radio. There are no differences by area or region. 59 percent of households own a non-mobile telephone, while 62 percent of households in Montenegro own a PC or laptop, and 55 percent have access to the Internet. There are differences by area and region in access to the Internet. 40 percent of households in rural areas have access to the Internet compared to 64 percent in urban areas. In the North access to the Internet is lower than in the other two regions (40 percent), while 58 percent of households in the Central region and 68 percent in the South have access to the Internet. 47 percent of households in Montenegro own an air conditioner. A higher percentage of households in urban areas own an air conditioner (57 percent) than in rural areas (31 percent). There are also regional differences where 74 of households in the South own an air conditioner compared to 61 percent in the Central region and only 1 percent in the North. 42 percent of households own agricultural land and 20 percent own farm animals/livestock, while 84 percent of households use a dwelling owned by a household member and 8 percent of households use a rented dwelling. Mobile telephones are the most common item among households and in 97 percent of households in Montenegro at least one member owns one. Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and region, Montenegro, 2013 Total Area Region Urban Rural North Centre South Electricity Yes 99.7 99.6 99.9 99.7 99.6 99.9 No 0.2 0.3 0.1 0.3 0.3 0.1 Missing/DK 0.1 0.1 0.0 0.0 0.2 0.0 Flooring Natural floor 0.0 0.1 0.0 0.0 0.1 0.0 Rudimentary floor 6.2 2.7 12.7 18.8 1.7 1.0 Finished floor 93.5 97.1 87.0 80.8 98.1 98.9 Other 0.2 0.1 0.3 0.4 0.1 0.1 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Roof Natural roofing 0.0 0.0 0.0 0.0 0.0 0.0 Rudimentary roofing 0.2 0.0 0.5 0.3 0.0 0.3 Finished roofing 95.9 97.6 92.9 90.1 98.5 97.5 Other 3.9 2.4 6.6 9.6 1.5 2.1 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Exterior walls Natural walls 0.1 0.0 0.1 0.2 0.0 0.0 Rudimentary walls 0.6 0.5 0.8 1.1 0.3 0.6 Finished walls 94.4 95.4 92.8 93.9 96.2 91.8 Other 4.9 4.1 6.3 4.8 3.6 7.6 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Rooms used for sleeping 1 32.7 33.4 31.5 32.8 31.9 34.2 2 41.6 43.4 38.3 41.2 43.4 38.5 3 or more 25.5 23.0 30.0 25.9 24.4 27.1 Missing/DK 0.2 0.3 0.2 0.2 0.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 4052 2610 1442 1122 1918 1012 Mean number of persons per room used for sleeping 1.79 1.80 1.79 1.91 1.79 1.67 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1716 Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and region, Montenegro, 2013 Table HH.8: Wealth quintiles Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and region, Montenegro, 2013 Total Area Region Urban Rural North Centre South Percentage of households that own a Radio 78.7 78.0 79.9 76.1 79.0 80.9 Television 99.2 99.4 98.8 98.9 99.3 99.3 Non-mobile telephone 58.6 63.9 49.0 42.2 60.3 73.5 Refrigerator 99.0 99.4 98.4 97.2 99.7 99.8 Electric stove 93.8 97.6 87.1 81.4 98.4 99.1 Bed 99.7 99.7 99.9 99.9 99.5 100.0 Table with chairs 98.8 98.8 98.8 96.5 99.6 99.8 Vacuum cleaner 95.2 97.6 90.7 92.6 95.5 97.4 PC/Laptop 61.9 69.7 47.8 48.2 64.7 71.9 Internet 55.2 63.6 40.1 39.5 57.8 67.8 Closet 98.8 99.1 98.1 98.0 99.0 99.2 Washing machine 94.9 97.6 89.9 90.9 95.9 97.4 Drying machine 10.4 12.7 6.4 3.9 13.1 12.8 Dishwashing machine 39.9 46.7 27.6 20.0 47.5 47.5 Air conditioner 47.3 56.5 30.5 0.6 60.6 73.8 Video monitoring system 2.6 3.2 1.6 0.4 3.1 4.1 Percentage of households that own Agricultural land 42.0 29.7 64.3 62.7 38.4 26.0 Farm animals/Livestock 20.0 6.5 44.2 40.4 13.5 9.4 Percentage of households where at least one member owns or has a Watch 78.7 82.7 71.4 66.0 81.3 87.8 Mobile telephone 97.0 97.3 96.5 97.8 96.8 96.7 Bicycle 39.8 42.1 35.8 31.5 46.6 36.3 Motorcycle or scooter 7.0 7.7 5.8 3.9 6.0 12.3 Animal-drawn cart 1.0 0.3 2.2 2.4 0.5 0.3 Car or truck 69.2 70.7 66.5 58.0 72.3 75.8 Boat with motor 3.4 3.0 4.2 0.1 1.9 10.0 Bank account 73.2 81.7 57.7 51.7 81.4 81.3 Ownership of dwelling Owned by a household member 84.4 79.6 93.0 93.0 81.4 81.3 Not owned 15.6 20.4 7.0 7.0 18.6 19.6 Rented 8.3 11.9 1.7 4.2 8.2 12.9 Other 7.4 8.5 5.3 2.8 10.4 6.7 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 4052 2610 1442 1122 1918 1012 Wealth index quintiles Total Number of household membersPoorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.1 19.9 100.0 13799 Area Urban 5.8 20.1 25.1 28.5 20.6 100.0 8672 Rural 44.0 19.9 11.5 5.9 18.7 100.0 5127 Region North 41.1 25.5 15.8 10.9 6.6 100.0 4143 Centre 12.3 17.9 22.8 24.5 22.5 100.0 6447 South 8.2 17.1 19.8 23.2 31.7 100.0 3209 Table HH.8 presents the percent distribution of the household population by Wealth index quintiles, according to area of residence and region. 44 percent of the household population from rural areas and 41 percent in the North is from the poorest quintiles. Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 1918 Sample Coverage in Roma Settlements In Roma settlements, of the 685 households selected for the sample, 649 were found to be occupied. Of these, 615 were successfully interviewed for a household response rate of 95 percent. In the interviewed households, 1,001 women (age 15–49 years) were identified. Of these, 980 were successfully interviewed, yielding a response rate of 98 percent within interviewed households. In addition, 549 men (age 15–49 years) were listed in the household questionnaire. Questionnaires were completed for 536 of eligible men, which corresponds to a response rate of 98 percent within interviewed households. There were 663 children under 5 listed in the household questionnaire. Questionnaires were completed for 660 of these children, which corresponds to a response rate of nearly 100 percent within interviewed households. Overall response rates of 93, 93, and 94 percent are calculated for the women’s, men’s and under-5s’ interviews respectively (Table HH.1R). Characteristics of Households in Roma Settlements The weighted age and sex distribution of the survey population is provided in Table HH.2R. The distribution is also used to produce the population pyramid for Roma settlements in Figure HH.1R. In the 615 households successfully interviewed in the survey 3,886 household members were listed. Of these, 1,945 were males and 1,941 were females. In the 15–19 year age group for women there is some spill-over of cases coming from the younger 10–14 year age group. Area Region Total Urban Rural North Centre South Households Sampled 685 529 156 116 471 98 Occupied 649 504 145 115 440 94 Interviewed 615 476 139 95 432 88 Household response rate 94.8 94.4 95.9 82.6 98.2 93.6 Women Eligible 1001 841 160 107 799 95 Interviewed 980 822 158 104 783 93 Women's response rate 97.9 97.7 98.8 97.2 98.0 97.9 Women's overall response rate 92.8 92.3 94.7 80.3 96.2 91.6 Men Eligible 549 460 89 58 430 61 Interviewed 536 449 87 56 422 58 Men's response rate 97.6 97.6 97.8 96.6 98.1 95.1 Men's overall response rate 92.5 92.2 93.7 79.8 96.4 89.0 Children under 5 Eligible 663 540 123 87 509 67 Mothers/caretakers interviewed 660 539 121 86 509 65 Under-5's response rate 99.5 99.8 98.4 98.9 100.0 97.0 Under-5's overall response rate 94.3 94.3 94.3 81.7 98.2 90.8 Table HH.1R: Results of household, women’s, men’s and under-5 interviews Number of households, women, men, and children under 5 by interview results of the household, women’s, men’s and under-5’s interviews, and household, women’s, men’s and under-5’s response rates, Roma settlements, 2013 Total Males Females Number Percent Number Percent Number Percent Total 3886 100.0 1945 100.0 1941 100.0 Age 0-4 734 18.9 369 19.0 365 18.8 5-9 499 12.9 261 13.4 238 12.3 10-14 442 11.4 238 12.2 204 10.5 15-19 511 13.1 236 12.1 275 14.2 20-24 364 9.4 178 9.2 186 9.6 25-29 304 7.8 157 8.1 147 7.6 30-34 250 6.4 117 6.0 132 6.8 35-39 202 5.2 109 5.6 93 4.8 40-44 167 4.3 74 3.8 93 4.8 45-49 153 3.9 71 3.7 82 4.2 50-54 84 2.2 42 2.2 42 2.2 55-59 74 1.9 42 2.1 32 1.6 60-64 54 1.4 27 1.4 27 1.4 65-69 15 0.4 5 0.3 10 0.5 70-74 18 0.5 11 0.6 6 0.3 75-79 7 0.2 4 0.2 3 0.2 80-84 1 0.0 0 0.0 1 0.0 85+ 1 0.0 0 0.0 1 0.0 Missing/DK 6 0.2 3 0.1 3 0.2 Dependency age groups 0-14 1675 43.1 868 44.6 807 41.6 15-64 2163 55.7 1054 54.2 1109 57.1 65+ 42 1.1 20 1.0 22 1.1 Missing/DK 6 0.2 3 0.1 3 0.2 Child and adult populations Children age 0-17 years 2015 51.8 1022 52.6 992 51.1 Adults age 18+ years 1865 48.0 920 47.3 945 48.7 Missing/DK 6 0.2 3 0.1 3 0.2 Table HH.2R: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Roma settlement, 2013 Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 2120 Figure HH.1R: Age and sex distribution of the household population, Roma settlements, 2013 Weighted percent Number of households Weighted Unweighted Total 100.0 615 615 Sex of household head Male 82.8 509 513 Female 17.2 106 102 Region North 14.0 86 95 Centre 74.3 457 432 South 11.7 72 88 Area Urban 79.3 487 476 Rural 20.7 128 139 Number of household members 1 4.7 29 40 2 3.5 22 27 3 8.6 53 52 4 10.3 63 66 5 15.7 97 95 6 17.7 109 104 7 14.1 86 83 8 8.1 50 50 9 4.8 30 26 10+ 12.6 77 72 Education of household head None 46.4 285 285 Primary 48.1 296 298 Secondary or higher 5.5 34 32 Mean household size 6.3 615 615 Table HH.3R: Household composition Percent and frequency distribution of households by selected characteristics, Roma settlements, 2013 Tables HH.3R – HH.5R provide basic information on the households in Roma settlements, female respondents age 15–49, male respondents 15–49 and children under 5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men and children under 5 interviewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3R provides basic background information on the Roma households. Within households, the sex of the household head, region, area, number of household members, education of household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalised (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, at least one eligible woman age 15–49 and at least one man age 15–49. The table also shows the weighted average household size estimated by the survey. The gender structure for heads of households in table shown that among 83 percent of interviewed households, the head of household is a man. 95 percent of households have a household head with either no education or with only primary education. Almost one-half of households (48 percent) have 5 to 7 members; the estimated average household size was 6.3 members. Characteristics of Female and Male Respondents Age 15–49 Years and Children Under 5 in Roma Settlements Tables HH.4R, HH.4R.M and HH.5R provide information on the background characteristics of female and male respondents age 15–49 years and of children under 5 in Roma settlements. In all three tables, the total numbers of weighted and unweighted observations are equal, since the sample weights have been normalised (standardised). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4R provides background characteristics of female respondents 15–49 years of age. The table includes information on the distribution of women according to region, area, age, marital status, motherhood status, births in last two years, education10, Weighted percent Number of women Weighted Unweighted Total 100.0 980 980 Region North 10.1 99 104 Centre 82.4 807 783 South 7.5 74 93 Area Urban 85.1 834 822 Rural 14.9 146 158 Age 15-19 27.3 267 265 20-24 18.4 180 178 25-29 14.5 142 145 30-34 13.3 130 128 35-39 9.2 90 92 40-44 9.3 92 89 45-49 8.0 79 83 Marital/union status Currently married/in union 65.4 641 636 Widowed 1.8 17 19 Divorced 4.8 47 43 Separated 1.7 17 21 Never married/in union 26.4 258 261 Weighted percent Number of women Weighted Unweighted Motherhood and recent births Never gave birth 32.4 317 324 Ever gave birth 67.6 663 656 Gave birth in last two years 23.9 235 224 No birth in last two years 43.7 428 432 Education None 61.0 598 590 Primary 34.8 341 348 Secondary or higher 4.2 41 42 Wealth index quintiles Poorest 16.5 162 81 Second 16.3 160 183 Middle 19.1 187 217 Fourth 22.8 224 234 Richest 25.2 247 265 Table HH.4R: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Roma settlements, 2013 Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 2322 Wealth index quintiles11 or wealth index. In the tables where the denominators for Wealth index quintiles are too small, data is merged into two groups – 60 percent of the poorest and 40 percent of the richest – in order to be able to present data by wealth status. The highest proportion of women in Roma settlements are in the 15–19 year age group (27 percent). 65 percent of all women in Roma settlements are currently married/in a union, while 26 percent have never been married/in a union. The distribution by motherhood status is similar: 68 percent of women have given birth, compared to 32 percent that have never given birth. The majority of women do not have an education (61 percent), while the proportion of women with primary education is 35 percent, and a very small percentage of women have secondary or higher education. As far as Wealth index quintiles are concerned, a smaller percentage of women live in households in the poorest quintile (17 percent) and second quintile (16 percent), compared to the middle, fourth and richest quintiles. 10 Unless otherwise stated, “education” refers to the educational level attained by the respondent throughout this report when it is used as a background variable. 11 The assets used in these calculations were as follows: source of drinking water; type of sanitation facility; number of rooms used for sleeping; main material of dwelling floor, roof and exterior walls; presence in the household of electricity, a television, refrigerator, electric stove, bed, table with chairs, vacuum cleaner, personal computer/laptop, Internet connection, closet, washing machine, drying machine, dishwash- ing machine, video monitoring system; presence in the household of a mobile phone, bicycle, motorcycle/scooter, car/truck; and possession of a bank account. Weighted percent Number of men Weighted Unweighted Total 100.0 536 536 Region North 10.5 56 56 Centre 80.8 433 422 South 8.7 47 58 Area Urban 84.3 452 449 Rural 15.7 84 87 Age 15-19 26.3 141 144 20-24 20.6 110 113 25-29 17.1 92 81 30-34 11.0 59 58 35-39 10.0 54 55 40-44 7.9 43 45 45-49 7.0 38 40 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 660 660 Male 50.0 330 342 Female 50.0 330 318 Region North 13.8 91 86 Centre 78.7 519 509 South 7.6 50 65 Area Urban 81.5 538 539 Rural 18.5 122 121 Age 0-5 months 13.1 87 79 6-11 months 6.2 41 47 12-23 months 16.8 111 116 24-35 months 15.7 104 103 36-47 months 25.7 170 172 48-59 months 22.5 148 143 Weighted percent Number of under-5 children Weighted Unweighted Respondent to the under-5 questionnaire Mother 97.0 639 638 Other primary caretaker 3.0 20 21 Mother’s educationa None 66.7 440 445 Primary 29.3 193 193 Secondary or higher 4.0 26 22 Wealth index quintiles Poorest 23.6 155 78 Second 20.2 133 156 Middle 19.6 129 147 Fourth 18.5 122 133 Richest 18.1 119 146 Weighted percent Number of men Weighted Unweighted Marital/union status Currently married/in union 62.0 332 328 Widowed 0.3 2 1 Divorced 3.0 16 14 Separated 0.9 5 5 Never married/in union 33.8 181 188 Education None 34.1 183 193 Primary 56.8 304 290 Secondary or higher 9.1 49 53 Wealth index quintiles Poorest 15.9 85 46 Second 16.8 90 102 Middle 16.9 90 104 Fourth 23.9 128 137 Richest 26.5 142 147 Table HH.4R.M: Men’s background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Roma settlements, 2013 Table HH.5R: Under-5’s background characteristics Percent and frequency distribution of children under 5 years of age by selected characteristics, Roma settlements, 2013 Similarly, Table HH.4R.M provides background characteristics of male respondents age 15–49 years. The table shows information on the distribution of men according to region, area, age, marital status, education, Wealth index quintiles and religion. The smallest group in the sample are men age 45–49 years (7 percent). The proportion of younger men is significantly higher — there are 26 percent of men in the 15–19 years age group, and 21 percent in the 20–24 years age group. 62 percent of all men in Roma settlements are currently married/in a union, while 34 percent have never been married/in a union. The majority of men have primary education (57 percent), while the proportion of men with no education is 34 percent. 9 percent of men have secondary education and very few of them have higher education. As for the Wealth index quintiles, a smaller percentage of men age 15–49 live in households within the poorest quintile (16 percent). Some background characteristics of children under 5 are presented in Table HH.5R. These include the distribution of children by several attributes: sex, region and area, age, mother’s or caretaker’s education, wealth and religion. The proportion of male and female children under 5 is the same (50 percent). The majority of children under 5 in Roma settlements live in urban areas (82 percent). The distribution of children age 0–59 months is lowest for children from 6–11 months (6 percent), with the highest percentage of children being in the 36–47 month age group (26 percent). The majority of children under 5 (67 percent) have a mother without education. Table HH.6R presents the percent distribution of households by selected housing characteristics, according to area of residence and regions. Almost 79 percent of households in Roma settlements have electricity. In urban areas 75 percent have electricity while in rural areas that figure is 97 percent. Regarding region, the lowest percentage of households who have electricity is in the Central region (74 percent). Regarding flooring, in Roma settlements 74 percent of households have a finished floor. In the North and the Central region 72 and 78 percent of households, respectively, have a finished floor while in the South 55 percent of households have a finished floor. Regarding roofing, in Roma settlements, 82 percent of households have a finished roof. In rural areas this percentage is lower (60 percent) compared to a In this table and throughout the report, mother’s education refers to the educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 2524 Table HH.6R: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and region, Roma settlements, 2013 Total Area Region Urban Rural North Centre South Electricity Yes 79.4 74.9 96.5 92.3 74.2 97.1 No 20.6 25.1 3.5 7.7 25.8 2.9 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Flooring Natural floor 1.6 0.6 5.4 4.4 0.5 5.3 Rudimentary floor 11.3 9.2 19.2 23.8 4.4 40.2 Finished floor 74.2 73.9 75.3 71.8 77.8 54.6 Other 12.9 16.3 0.0 0.0 17.4 0.0 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Roof Natural roofing 5.2 6.6 0.0 0.0 7.1 0.0 Rudimentary roofing 7.3 3.5 21.4 2.4 0.9 53.1 Finished roofing 81.5 87.1 59.9 89.1 87.8 32.5 Other 6.0 2.7 18.7 8.5 4.2 14.4 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Exterior walls Natural walls 0.2 0.0 1.1 1.6 0.0 0.0 Rudimentary walls 3.5 2.4 7.3 5.6 2.0 10.0 Finished walls 79.1 76.9 87.3 90.3 76.3 83.3 Other 17.0 20.3 4.3 2.4 21.4 6.7 Missing/DK 0.2 0.3 0.0 0.0 0.3 0.0 Rooms used for sleeping 1 42.4 40.3 50.6 40.2 39.2 65.5 2 33.4 31.0 42.7 50.5 31.1 27.8 3 or more 23.8 28.4 6.2 7.6 29.6 6.7 Missing/DK 0.3 0.3 0.5 1.6 0.2 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 615 487 128 86 457 72 Mean number of persons per room used for sleeping 3.65 3.63 3.73 3.55 3.65 3.74 urban areas (87 percent). In the North and the Central region 89 and 88 percent of households, respectively, have a finished roof while in the South 33 percent of households have a finished roof. Regarding exterior walls, in Roma settlements, 79 percent of households have finished exterior walls. In urban areas this percentage is lower (77 percent) compared to rural areas (87 percent). In the South and North 83 and 90 percent of households, respectively, have finished exterior walls while in the Central region 76 percent of households have finished exterior walls. The mean number of persons per room used for sleeping in Roma settlements is 3.65. There are no differences by area or region. Table HH.7R presents the percentage of households in Roma settlements by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and region. 61 percent of households own a radio and 86 own a television. One-third of households in Roma settlements (33 percent) own a PC or laptop, while 24 percent have Table HH.7R: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and region, Roma settlements, 2013 Total Area Region Urban Rural North Centre South Percentage of households that own a Radio 60.5 63.6 48.7 43.4 65.5 48.8 Television 85.9 84.3 92.0 85.6 84.6 94.3 Non-mobile telephone 15.7 16.7 11.9 9.7 17.3 12.4 Refrigerator 74.0 72.7 79.2 65.8 73.6 86.6 Electric stove 45.9 48.2 37.0 13.2 52.7 41.1 Bed 80.2 78.9 85.3 83.3 79.8 79.4 Table with chairs 63.6 64.6 60.1 59.6 66.5 50.7 Vacuum cleaner 38.1 40.4 29.5 20.4 43.1 27.8 PC/Laptop 33.1 33.6 30.9 17.7 34.8 40.2 Internet 23.6 24.1 21.7 14.9 25.1 24.4 Closet 69.6 71.2 63.5 49.8 72.5 75.1 Washing machine 47.6 47.8 47.1 30.9 49.3 56.9 Drying machine 2.7 3.0 1.6 0.8 3.2 1.9 Dishwashing machine 3.8 3.7 4.3 0.8 4.1 5.8 Air conditioner 21.8 25.5 7.6 0.0 26.0 21.1 Video monitoring system 0.5 0.6 0.0 0.0 0.7 0.0 Percentage of households that own Agricultural land 2.9 2.5 4.1 6.9 2.3 1.9 Farm animals/Livestock 5.0 4.1 8.4 5.6 4.1 10.0 Percentage of households where at least one member owns or has a Watch 65.4 73.8 33.3 24.6 75.7 48.8 Mobile telephone 94.0 94.0 94.0 87.5 95.3 93.8 Bicycle 50.7 57.2 25.9 25.6 59.8 23.0 Motorcycle or scooter 7.0 7.6 4.3 0.8 8.0 7.7 Animal-drawn cart 1.0 1.2 0.0 0.8 1.2 0.0 Car or truck 37.2 36.0 42.0 32.2 37.8 39.7 Boat with motor 0.3 0.3 0.0 0.0 0.4 0.0 Bank account 47.4 46.6 50.4 32.6 50.6 44.5 Ownership of dwelling Owned by a household member 84.4 87.8 71.3 80.7 90.2 52.2 Not owned 15.6 12.2 28.7 19.3 9.8 47.8 Rented 7.8 7.2 9.8 15.3 7.1 2.9 Other 7.8 4.9 19.0 4.0 2.7 45.0 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 615 487 128 86 457 72 Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 2726 access to the internet. In rural areas this percentage is lower than in urban areas, and also in the North compared to the South and the Central region. Less than half of households own a washing machine (48 percent) and an electric stove (46 percent), while 16 percent own a non-mobile telephone. There are 94 percent of households where at least one member owns or has a mobile telephone. 22 percent of households in Roma settlements own an air conditioner. A higher percentage of households in urban areas own an air conditioner (26 percent) than in rural areas (8 percent). There are also regional differences where 21 percent of households in the South own an air conditioner compared to 26 percent in the Central region, while in the North no households own an air conditioner. 3 percent of households from Roma settlements own agricultural land and 5 percent own farm animals/ livestock, while 84 percent of households use a dwelling owned by a household member and 8 percent of households use a rented dwelling. Table HH.8R presents the percent distribution of the household population by Wealth index quintiles, according to the area of residence and region. Table HH.8R: Wealth quintiles Percent distribution of the household population by Wealth index quintiles, according to area of residence and region, Roma settlements, 2013 Wealth index quintiles Wealth index Poorest Second Middle Fourth Richest Poorest 60 percent Richest 40 percent Total Number of household members Total 20.0 20.2 19.8 20.1 20.0 60.0 40.0 100.0 3886 Area Urban 20.2 15.1 19.3 22.0 23.4 54.6 45.4 100.0 3177 Rural 18.8 43.0 22.3 11.3 4.6 84.2 15.8 100.0 709 Region North 24.2 51.5 18.7 5.0 0.7 94.3 5.7 100.0 509 Centre 20.3 11.7 19.6 23.6 24.8 51.6 48.4 100.0 3032 South 11.1 48.1 23.1 11.4 6.4 82.2 17.8 100.0 346 Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with a low birth weight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have the most impact: the mother’s poor nutritional status before conception, short stature (due mostly to undernutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialised world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low-birth-weight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2,500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth12. In Montenegro, almost all live-born children in the last two years were weighed at birth (99 percent), and 4 percent of last live-born children are estimated to have weighed below 2,500 grams at birth. There are no major differentials in the percentage of live births weighed at birth and live-births below 2,500 grams by background characteristics (Table NU.1). IV nutrition 12 For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 2928 Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Montenegro, 2013 Table NU.1R: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Roma settlements, 2013 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average Richest Below 2,500 grams1 Weighed at birth2 Total 0.6 5.7 71.1 21.5 1.1 100.0 4.0 98.6 328 Mother's age at birth Less than 20 years * * * * * 100.0 * * 18 20-34 years 0.7 5.6 70.4 22.0 1.3 100.0 4.1 98.3 272 35-49 years 0.0 7.2 71.0 21.8 0.0 100.0 4.0 100.0 38 Birth order 1 1.1 3.5 70.4 23.1 1.9 100.0 3.7 98.1 135 2-3 0.2 7.2 71.2 21.0 0.3 100.0 4.2 99.7 168 4-5 (0.0) (9.8) (76.0) (11.8) (2.3) 100.0 (5.2) (97.7) 20 6+ * * * * * 100.0 * * 5 Region North 0.0 9.7 69.8 19.2 1.3 100.0 5.0 97.4 80 Centre 0.0 4.2 72.2 22.9 0.7 100.0 2.9 99.3 181 South 2.9 4.9 69.9 20.3 2.0 100.0 6.1 98.0 66 Area Urban 0.2 5.2 69.7 23.8 1.2 100.0 3.4 98.3 215 Rural 1.4 6.7 73.9 17.1 0.9 100.0 5.3 99.1 113 Mother’s educationa Primary 0.7 8.2 67.5 21.6 2.0 100.0 5.1 96.1 52 Secondary 0.0 3.9 75.3 20.0 0.8 100.0 2.8 99.2 169 Higher 1.5 7.5 65.4 24.4 1.2 100.0 5.6 98.8 104 Wealth index quintiles Poorest 0.7 10.5 69.2 17.5 2.1 100.0 6.1 95.9 50 Second 0.0 5.0 75.0 20.0 0.0 100.0 3.2 100.0 67 Middle 2.0 2.5 71.9 21.9 1.6 100.0 4.3 98.4 77 Fourth 0.0 5.5 69.7 22.8 1.9 100.0 3.4 98.1 69 Richest 0.0 6.8 69.3 23.9 0.0 100.0 3.8 100.0 65 Religion of household head Orthodox 0.7 6.3 72.0 20.5 0.6 100.0 4.4 99.4 224 Catholic * * * * * 100.0 * * 11 Islamic 0.4 5.2 71.5 21.6 1.3 100.0 3.7 97.5 81 Other religion * * * * * 100.0 * * 12 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average Richest Below 2,500 grams1 Weighed at birth2 Total 2.8 8.5 67.1 17.8 3.8 100.0 12.3 93.0 235 Mother's age at birth Less than 20 years 2.1 9.3 59.1 25.4 4.1 100.0 12.3 85.9 64 20-34 years 2.2 7.6 70.8 15.8 3.6 100.0 11.5 95.7 158 35-49 years * * * * * 100.0 * * 13 Birth order 1 (0.0) (10.1) (77.1) (7.4) (5.5) 100.0 (11.2) (91.0) 46 2-3 3.3 3.2 62.8 26.7 4.0 100.0 10.5 91.4 94 4-5 2.7 14.7 68.7 12.8 1.1 100.0 14.9 96.5 63 6+ (5.4) (9.4) (61.6) (17.0) (6.6) 100.0 (13.9) (93.4) 31 Region North (0.0) (26.5) (54.1) (17.3) (2.0) 100.0 (17.6) (95.9) 33 Centre 1.6 3.0 71.5 19.2 4.8 100.0 9.3 91.7 174 South (13.8) (21.2) (55.0) (10.0) (0.0) 100.0 (25.2) (97.5) 27 Area Urban 2.3 2.9 70.7 19.6 4.6 100.0 9.6 91.6 181 Rural 4.4 27.2 55.1 12.0 1.3 100.0 21.5 97.5 54 Mother’s educationa None 2.6 6.6 67.4 17.7 5.7 100.0 11.2 89.9 156 Primary 1.0 14.0 64.4 20.6 0.0 100.0 14.0 100.0 69 Secondary or higher * * * * * 100.0 * * 10 Wealth index Poorest 60 percent 3.6 10.7 66.1 16.5 3.1 100.0 13.8 94.9 155 Richest 40 percent 1.3 4.0 69.0 20.5 5.3 100.0 9.4 89.2 79 Low Birth Weight in Roma Settlements Table NU.1R presents data on the percentage of last live-born children weighed at birth in Roma settlements. Overall, 93 percent of last live births in the last two years were weighed at birth. According to mother’s assessment of size at birth, 67 percent of those children were of average size at birth. 18 percent were larger than average or very large, while 3 percent were very small and 9 percent were smaller than average. 12 percent of live births in Roma settlements were below 2,500 grams. The percentage of children with a low birth weight is higher among older mothers as well as mothers from rural areas. 23 percent of the last live-born children in the last two years born to mothers age 35–49 years weighed below 2,500 grams at birth, compared to 12 percent among mothers in younger age groups. 10 percent of the last live-born children in the last two years in urban areas weighed below 2,500 grams at birth compared to 22 percent in rural areas. 1 MICS indicator 2.20 - Low-birth weight infants 2 MICS indicator 2.21 - Infants weighed at birth a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.20 - Low-birth weight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 3130 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well-nourished. Malnutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and those who survive have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age 5. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards13. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for- age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height- for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In MICS, the weight and height of all children under 5 years were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). The findings in this section are based on the results of these measurements. 13 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf Weight for age Num- ber of children under age 5 Height for age Num- ber of children under age 5 Weight for height Num- ber of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z-Score (SD) Wasted Over-weight Mean Z-Score (SD)Percent below Percent below Percent below Percent above + 2 SD7- 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 Total 1.0 0.1 0.9 1392 9.4 5.6 0.2 1361 2.8 1.2 22.3 0.9 1300 Sex Male 1.1 0.2 1.0 744 10.3 6.0 0.2 725 3.1 1.8 24.7 1.0 683 Female 0.9 0.0 0.8 648 8.4 5.2 0.1 636 2.4 0.6 19.6 0.9 617 Region North 0.9 0.0 0.8 400 4.4 3.0 0.5 388 4.8 2.0 15.3 0.6 386 Centre 1.0 0.2 1.0 722 10.7 7.1 0.0 706 0.9 0.3 26.2 1.2 650 South 1.1 0.0 0.8 269 13.3 5.5 0.2 266 4.6 2.4 23.0 0.9 264 Area Urban 1.0 0.1 1.0 901 9.5 6.4 0.1 881 2.4 1.1 24.2 1.0 827 Rural 1.0 0.0 0.8 491 9.3 4.2 0.2 480 3.6 1.4 19.0 0.8 473 Age 0-5 months 3.4 0.0 0.0 118 9.5 7.6 -0.1 118 9.2 6.1 13.4 0.1 117 6-11 months 1.5 0.0 0.7 114 6.8 6.8 0.5 109 6.1 3.1 14.4 0.7 109 12-23 months 0.9 0.0 1.1 252 12.4 6.8 0.1 242 0.7 0.0 32.3 1.4 241 24-59 months 0.6 0.1 1.0 908 8.9 4.9 0.2 892 2.1 0.6 21.7 1.0 833 Mother’s educationa Primary 0.4 0.0 0.6 213 13.5 6.9 -0.2 209 4.4 2.9 23.0 0.8 202 Secondary 1.2 0.0 0.9 779 8.6 5.5 0.2 754 1.9 0.8 20.3 1.0 723 Higher 0.9 0.3 1.0 387 8.8 5.3 0.3 384 3.8 1.1 26.1 1.0 362 Wealth index quintiles Poorest 0.4 0.0 0.6 244 4.7 3.1 0.2 240 3.5 2.4 15.8 0.6 237 Second 1.0 0.0 1.0 272 9.7 4.1 0.2 266 3.2 1.5 26.3 1.1 260 Middle 2.8 0.4 0.9 277 10.6 6.8 0.2 264 3.4 1.1 20.3 0.9 253 Fourth 0.5 0.0 0.9 286 12.8 8.8 0.1 283 1.9 0.3 22.8 1.0 266 Richest 0.3 0.0 1.1 313 8.6 5.0 0.1 307 2.2 1.0 25.5 1.2 283 Religion of household head Orthodox 1.1 0.1 0.9 965 9.1 6.1 0.2 944 2.4 1.1 23.3 1.0 897 Catholic (2.9) (0.0) (0.9) 37 (7.0) (1.7) (0.6) 37 (4.3) (0.0) (14.4) (0.7) 35 Islamic 0.4 0.0 0.8 364 10.0 4.6 0.0 355 3.6 1.8 20.3 0.9 341 Other religion (2.3) (0.0) (1.1) 26 (13.5) (7.5) (0.4) 26 (2.3) (0.0) (24.1) (1.3) 26 Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Montenegro, 2013 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases Roma settlements MONITORING THE SITUATION OF CHILDREN AND WOMENMULTIPLE INDICATOR CLUSTER SURVEY 2013 3332 Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weight or height was not measured, whichever is applicable. For example if a child was weighed but his/her height has not been measured, the child was included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reason for exclusion are shown in the data quality tables DQ.12, DQ.13 and DQ.14. Overall 93 percentage of children had both their weight and height measured (Table DQ.14). Tables DQ.12, DQ.13 and DQ.14 show that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 2 percent of children have been excluded from calculations of the weight-for-age indicator, while the figures are 4 percent for the height-for-age indicator, and 7 percent for the weight-for-height indicator. One in a hundred children under age 5 in Montenegro are moderately or severely underweight (1 percent). (Table NU.2). 9 percent of children are moderately or severely stunted or too short for their age and 3 percent are moderately or severely wasted or too thin for their height. 22 percent of children are overweight. There are no clear differentials in stunting per region. In contrast, the percentage of wasted is higher in the North and South (5 percent each), compared to the Central region (1 percent). The prevalence of overweight children in Montenegro ranges from 13 percent for children age 0–5 months to 32 percent among children age 12–23 months. Figure NU.1 shows that 3 percent of children age 0–5 months are underweight and 9 percent of children this age are wasted, while 9 percent of children age 24–59 months are stunted, and 32 percent of children age 12–23 months are overweight. Figure NU.1: Percentage of children under age 5 who are underweight, stunted, wasted and overweight, Montenegro, 2013 Nutritional Status in Roma Settlements Overall 96 percent of children in Roma settlements had both their weight and height measured (Table DQ.14R). Tables DQ.12R, DQ.13R and DQ.14R show that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 1 percent of children have been excluded from calculations of the weight- for-age indicator, while the figures are 2 percent for the height-for-age indicator, and 4 percent for the weight- for-height indicator. Weight for age Num- ber of children under age 5 Height for age Num- ber of children under age 5 Weight for height Num- ber of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z-Score (SD) Wasted Over-weight Mean Z-Score (SD)Percent below Percent below Percent below Percent above + 2 SD7- 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 Total 7.3 1.7 -0.1 655 26.8 13.0 -1.1 645 3.7 1.5 17.5 0.7 640 Sex Male 8.9 2.4 0.0 328 26.3 11.1 -1.0 319 3.4 1.9 16.2 0.7 321 Female 5.7 0.9 -0.1 327 27.3 14.8 -1.2 326 4.0 1.1 18.9 0.8 319 Region North 10.7 1.8 -0.6 89 28.5 2.8 -1.1 89 1.1 1.1 3.8 0.1 88 Centre 6.7 1.7 0.0 516 26.6 15.2 -1.1 507 4.3 1.7 19.6 0.8 505 South 7.0 1.3 -0.2 49 26.3 8.3 -1.2 49 2.6 0.0 20.8 0.8 48 Area Urban 6.7 1.6 0.0 533 26.4 15.0 -1.1 523 4.1 1.5 19.7 0.8 520 Rural 10.1 1.8 -0.5 122 28.7 4.3 -1.1 122 1.8 1.3 8.4 0.3 121 Age 0-11 months 6.9 3.7 0.0 127 18.2 1.2 -0.1 123 12.3 3.9 16.4 0.1 123 12-23 months 5.9 2.6 -0.2 109 30.7 14.1 -1.2 107 3.7 3.1 13.2 0.5 110 24-59 months 7.8 0.8 0.0 419 28.4 16.1 -1.4 415 1.1 0.3 19.1 1.0 407 Mother’s educationa None 8.1 2.1 -0.1 436 28.9 14.6 -1.1 431 4.3 1.7 18.5 0.7 425 Primary 3.5 0.0 0.1 193 21.5 8.9 -1.0 188 2.1 0.3 15.4 0.8 189 Second. or higher * * * 26 * * * 26 * * * * 26 Wealth index quintiles Poorest 11.7 1.8 -0.2 155 51.7 29.8 -2.0 151 1.0 0.6 29.7 1.0 151 Second 8.0 1.9 -0.3 129 22.4 4.6 -1.0 129 1.0 0.5 10.2 0.5 128 Middle 5.0 2.8 -0.2 129 15.3 5.8 -0.6 126 4.1 2.7 5.6 0.3 128 Fourth 6.2 1.5 0.1 122 21.8 13.6 -0.9 121 5.2 1.0 16.4 0.8 119 Richest 4.5 0.0 0.3 119 17.4 7.6 -0.8 118 8.3 2.8 24.3 0.9 114 Table NU.2R: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Roma settlements, 2013 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence * Figures that are based on fewer than 25 unweighted cases Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 3534 Table NU.2R shows that seven in a hundred children under the age of 5 in Roma settlements are moderately underweight (7 percent). 27 percent of children are moderately stunted or too short for their age and 4 percent are moderately wasted or too thin for their height. The prevalence of overweight children in Roma settlements is 18 percent. There is a negative correlation of stunting with wealth. Moderate stunting ranges from 52 percent for the poorest quintile and is much lower in the remaining four quintiles, being 17 and 22 percent for the richest and fourth quintiles. There are differences in percentages of children severely stunted by area. In urban areas 15 percent of children are severely stunted compared to 4 percent in rural areas. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. The percentage overweight is higher in the South and the Central region (21 and 20 percent, respectively) compared to the North (4 percent). Figure NU.1R shows that the highest proportion for each of the four indices (moderate and severe) by age group is as follows: underweight – among children age 24–59 months (8 percent); stunted – among children age 12–23 months (31 percent); wasted – among children age 0–11 months (12 percent), and overweight – among children age 24–59 months (19 percent). Figure NU.1R: Percentage of children under age 5 who are underweight, stunted, wasted and overweight, Roma settlements, 2013 Breastfeeding and Infant and Young Child Feeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. WHO/UNICEF have the following feeding recommendations: ■ Exclusive breastfeeding for the first six months ■ Continued breastfeeding for two years or more ■ Safe and age-appropriate complementary foods beginning at 6 months ■ Frequency of complementary feeding: two times per day for 6–8 month olds; three times per day for 9–11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: ■ Early initiation of breastfeeding (within one hour of birth) ■ Exclusive breastfeeding rate (< 6 months) ■ Predominant breastfeeding (< 6 months) ■ Continued breastfeeding rate (at 1 year and at 2 years) ■ Duration of breastfeeding ■ Age-appropriate breastfeeding (0–23 months) ■ Introduction of solid, semi-solid and soft foods (6–8 months) ■ Minimum acceptable diet for breastfed and non- breastfed children (6–23 months) ■ Milk feeding frequency for non-breastfeeding children (6–23 months) ■ Minimum dietary diversity (6–23 months) ■ Minimum meal frequency (6–23 months) ■ Bottle feeding (0–23 months) Table NU.3 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 14 percent of babies are breastfed for the first time within one hour of birth, while 66 percent of newborns in Montenegro start breastfeeding within one day of birth. Figure NU.2 shows that 37 percent of newborn babies in the North were first breastfed within one hour of birth, while in the Central region and the South this percentage is much lower (5 and 13 percent, respectively). There is no clear difference by region in the percentage of children who were first breastfed within one day of birth. The percentage of newborns who were first breastfed within one hour of birth ranges from 9 percent among children whose mothers have higher education to 30 percent among those whose mothers have primary education. Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Montenegro, 2013 MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 3736 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live- born children in the last two years Within one hour of birth2 Within one day of birth Total 88.3 14.4 65.6 42.5 328 Region North 91.3 36.6 67.9 28.1 80 Centre 86.5 5.2 64.5 47.3 181 South 89.6 12.7 65.6 46.8 66 Area Urban 87.3 11.4 64.0 47.5 215 Rural 90.3 19.9 68.5 33.1 113 Months since last birth 0-11 months 88.5 12.1 65.2 44.3 156 12-23 months 89.6 17.5 68.7 40.3 158 Assistance at delivery Skilled attendant 89.2 14.5 66.2 42.9 325 No one/Missing * * * * 3 Place of delivery Public sector health facility 89.2 14.4 66.2 43.0 324 Private sector health facility * * * * 0 Other/Missing * * * * 3 Mother’s educationa Primary 92.2 29.7 64.5 35.5 52 Secondary 86.0 12.3 65.2 42.5 169 Higher 89.9 8.8 65.7 47.2 104 Wealth index quintiles Poorest 89.1 28.9 69.1 22.5 50 Second 89.4 21.1 65.7 38.9 67 Middle 87.8 9.9 70.7 39.2 77 Fourth 89.3 10.7 58.3 55.4 69 Richest 86.2 5.6 64.4 51.6 65 Religion of household head Orthodox 87.1 8.7 64.9 45.3 224 Catholic * * * * 11 Islamic 91.1 27.9 65.4 33.6 81 Other religion * * * * 12 Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Montenegro, 2013 Table NU.4: Breastfeedingb Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Montenegro, 2013 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breast- fed (Continued breastfeeding at 1 year)3 Number of children Percent breast- fed (Continued breastfeeding at 2 years)4 Number of children Total 16.8 35.4 121 23.9 84 9.0 82 Sex Male 17.5 37.1 66 (20.6) 39 (9.4) 44 Female (16.0) (33.2) 55 26.7 45 (8.4) 38 Region North (12.1) (37.8) 22 (33.8) 21 * 20 Centre 12.6 30.6 84 (26.7) 39 (10.3) 45 South * * 16 * 24 * 17 Area Urban 13.9 30.5 90 (16.4) 48 8.9 50 Rural (25.2) (49.3) 31 (33.9) 36 (9.1) 32 Mother’s educationa Primary * * 23 * 19 * 14 Secondary 12.8 36.3 56 (10.6) 36 (6.0) 38 Higher (28.4) (39.8) 42 (25.7) 28 (3.0) 29 Religion of household head Orthodox 18.7 35.8 89 22.6 56 5.2 54 Catholic * * 2 * 3 * 1 Islamic (12.7) (37.3) 30 * 24 * 22 Other religion * * 1 * 1 * 5 In Table NU.4, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at age 12–15 and 20–23 months. 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table * Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table b Figures for the categories ‘Wealth index quintiles’ are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 3938 Figure NU.3: Infant feeding patterns by age, Montenegro, 2013 Breastfed and other milk / formula, 13.5 Breastfed and plain water only, 13.5 Breastfed and complimentary foods, 41.5 Exclusively breastfed, 16.8 Weaned (not breastfed), 92.0 Figure NU.3 shows the detailed pattern of breastfeeding of children by six-month age groups. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. At 6–11 months of age, the percentage of children exclusively breastfed is below 1 percent. 92 percent of children age 18–23 months are weaned. Approximately, 17 percent of children age 0–5 months are exclusively breastfed. By age 12–17 months, 24 percent of children are still being breastfed and by age 20–23 months, 9 percent are still breastfed. Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 6.9 months for any breastfeeding, 0.6 months for exclusive breastfeeding, and 1.4 months for predominant breastfeeding. The median duration of predominant breastfeeding is longer among girls (1.6 months) than boys (1.3 months). The median duration of any breastfeeding is longer in the Central region and the North, 7.7 and 5.9 months respectively, while it is slightly lower in the South (5.3 months). On the other hand, the duration of predominant breastfeeding is longer in the South (3.0 months), while in the Central region and the North it is 1.2 and 0.5 months respectively. The median duration of any breastfeeding was slightly longer for children whose mothers have higher or secondary education compared to children whose mothers have only primary education. Median duration (in months) of: Number of children age 0-35 months Any breast- feeding1 Exclusive breast- feeding Predom- inant breast- feeding Median 6.9 0.6 1.4 761 Sex Male 7.0 0.6 1.3 388 Female 7.5 0.8 1.6 372 Region North 5.9 0.4 0.5 220 Centre 7.7 0.6 1.2 395 South 5.3 2.3 3.0 145 Area Urban 6.3 0.6 1.4 491 Rural 7.2 0.7 0.7 269 Mother’s educationa Primary 5.3 1.1 1.2 123 Secondary 7.6 0.4 1.2 416 Higher 7.2 1.1 1.6 215 Wealth index quintiles Poorest 6.7 0.5 0.5 132 Second 10.8 1.8 2.2 151 Middle 9.8 0.4 0.4 171 Fourth 3.8 0.5 1.6 154 Richest 6.9 0.7 1.9 153 Religion of household head Orthodox 7.3 0.6 1.4 514 Catholic * * * 21 Islamic 7.6 0.9 1.1 206 Other religion * * * 20 Mean for all children (0-35 months) 9.2 1.2 2.4 761 Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Montenegro, 2013 Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Montenegro, 2013 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 16.8 121 22.9 373 21.4 494 Sex Male 17.5 66 21.0 197 20.1 263 Female (16.0) 55 24.9 176 22.8 231 Region North (12.1) 22 28.0 96 25.1 118 Centre 12.6 84 22.3 193 19.4 277 South * 16 18.2 84 22.5 100 Area Urban 13.9 90 21.4 231 19.3 321 Rural (25.2) 31 25.2 142 25.2 173 Mother’s educationa Primary * 23 28.7 58 22.0 81 Secondary 12.8 56 21.9 202 19.9 257 Higher (28.4) 42 18.4 109 21.2 151 Wealth index quintiles Poorest * 20 33.6 56 26.5 76 Second * 19 22.2 77 23.3 96 Middle * 23 24.3 92 20.4 115 Fourth (14.2) 44 17.6 62 16.2 106 Richest * 15 18.6 86 22.2 101 Religion of household head Orthodox 18.7 89 21.4 247 20.7 335 Catholic * 2 * 14 * 16 Islamic (12.7) 30 25.5 96 22.4 126 Other religion * 1 * 16 * 17 The adequacy of infant feeding in children under 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0–5 months, exclusive breastfeeding is considered age-appropriate feeding, while infants age 6–23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. As a result of these feeding patterns, only 23 percent of children age 6–23 months are being appropriately fed. Age-appropriate feeding among all infants age 0–5 months drops to 17 percent. 1 MICS indicator 2.11 - Duration of breastfeeding a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table * Figures that are based on fewer than 25 unweighted cases 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 4140 Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Montenegro, 2013 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Total (89.8) 27 (100.0) 29 95.1 56 Appropriate complementary feeding of children from 6 months to 2 years of age is particularly important for growth and development and the prevention of undernutrition. Continued breastfeeding beyond 6 months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are 6–8 months old, and three or more meals if they are 9–23 months of age. For children 6–23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. In Montenegro, 95 percent of infants age 6–8 months receive solid, semi-solid or soft foods. Because of the low numbers of cases, results by background characteristics are not presented in table NU.7. Table NU.8 presents the percentage of children age 6–23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status (see the notes in Table NU.8 for definitions of the minimum acceptable diet, the minimum dietary diversity and the minimum meal frequency for breastfeeding and non-breastfeeding children). Overall, more than three-quarters of children age 6–23 months (81 percent) receive the minimum dietary diversity and 86 percent of children age 6–23 months receive meals at the minimum frequency. 66 percent of children of this age receive the minimum acceptable diet. There is a positive correlation for all three abovementioned indicators for all children age 6–23 months with the education level of the mother. Among currently breastfeeding children age 6–23 months, nearly two-thirds (64 percent) receive the minimum dietary diversity, 78 percent receive the minimum meal frequency and 54 percent receive the minimum acceptable diet. Among non-breastfeeding children age 6–23 months, 87 percent receive the minimum dietary diversity, 89 percent receive the minimum meal frequency and 71 percent receive the minimum acceptable diet. Additionally, 90 percent of this group of children receive at least two milk feeds. 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25-49 unweighted cases Currently breastfeeding Currently not breastfeeding All Percent of children who received: Num- ber of children age 6-23 months Percent of children who received: Num- ber of children age 6-23 months Percent of children who received: Num- ber of children age 6-23 months Minimum dietary diversitya Minimum meal frequen- cyb Minimum accept- able diet1, c Minimum dietary diversitya Minimum meal frequen- cyb Minimum accept- able diet2, c At least 2 milk feeds3 Minimum dietary diversi- ty4, a Minimum meal frequen- cy5, b Minimum accept- able dietc Total 63.9 78.4 54.3 90 87.3 89.0 70.7 89.5 248 81.3 86.2 66.4 373 Sex Male (64.4) (83.0) (53.9) 43 85.0 91.5 70.0 89.1 137 79.0 89.5 66.1 197 Female (63.4) (74.3) (54.7) 47 90.2 85.9 71.7 90.1 111 83.8 82.4 66.6 176 Age 6-8 months (18.6) (84.9) (18.6) 27 (56.0) (100.0) (46.6) (100.0) 22 41.5 91.8 31.3 56 9-11 months (87.1) (67.4) (67.4) 26 (87.4) (92.9) (78.2) (100.0) 33 85.5 81.6 73.4 62 12-17 months (84.0) (79.7) (73.2) 27 91.9 94.7 78.1 90.4 85 90.0 91.0 76.9 129 18-23 months * * * 10 90.1 81.1 67.5 83.5 107 87.9 81.5 67.2 127 Region North (67.6) (60.1) (42.2) 27 72.2 81.6 51.8 91.2 61 68.8 75.0 48.8 96 Centre (61.1) (85.3) (58.1) 47 91.1 92.9 76.7 88.7 128 83.7 90.9 71.7 193 South * * * 16 95.0 88.2 77.7 89.8 58 90.0 88.5 74.8 84 Area Urban 60.9 78.0 51.9 54 90.6 89.4 72.5 87.7 154 82.7 86.4 67.1 231 Rural (68.6) (79.1) (58.1) 36 82.0 88.4 67.8 92.7 94 79.0 85.8 65.1 142 Mother’s educationd Primary * * * 18 (76.4) (82.8) (54.4) (85.3) 38 68.4 74.6 50.2 58 Secondary (64.1) (84.5) (54.4) 46 85.3 87.9 68.9 89.4 133 80.0 87.0 65.2 202 Higher * * * 22 96.3 94.1 82.0 92.0 76 90.7 91.5 77.0 109 Wealth index quintiles Poorest * * * 19 (71.3) (84.6) (60.1) (87.7) 36 67.8 79.4 56.7 56 Second * * * 18 85.6 77.2 57.2 85.3 51 82.3 74.1 55.5 77 Middle * * * 24 84.3 96.8 68.1 86.1 53 80.3 95.2 66.1 92 Fourth * * * 13 95.3 87.2 77.4 91.7 45 85.6 85.5 74.8 62 Richest * * * 17 94.8 95.9 85.3 95.5 62 87.1 93.2 76.6 86 Religion of household head Orthodox 65.0 81.1 55.2 56 92.4 95.0 78.7 92.2 166 85.2 91.4 72.8 247 Catholic * * * 5 * * * * 8 * * * 14 Islamic (55.9) (71.3) (43.7) 26 77.0 77.3 55.0 84.5 62 71.7 75.5 51.7 96 Other religion * * * 3 * * * * 12 * * * 16 Table NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Montenegro, 2013 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least four of seven food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods two times or more daily for children age 6-8 months and three times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least four times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while for non-breastfed children it further requires at least two milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. d Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 4342 The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that bottle-feeding is still prevalent in Montenegro. 75 percent of children under 24 months are fed using a bottle with a nipple. Feeding with a bottle with a nipple is more common among children age 12–23 months and those age 6–11 months (80 percent in both cases), than among children age 0–5 months (60 percent). The prevalence of bottle- feeding ranges from 71 percent in the North to 82 percent in the South. Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 75.2 494 Sex Male 75.1 263 Female 75.2 231 Age 0-5 months 60.4 121 6-11 months 79.7 118 12-23 months 80.1 255 Region North 70.7 118 Centre 74.5 277 South 82.1 100 Area Urban 75.3 321 Rural 74.9 173 Mother’s educationa Primary 74.8 81 Secondary 74.7 257 Higher 76.0 151 Wealth index quintiles Poorest 78.7 76 Second 67.9 96 Middle 73.5 115 Fourth 79.5 106 Richest 76.7 101 Religion of household head Orthodox 76.1 335 Catholic * 16 Islamic 72.3 126 Other religion * 17 Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Montenegro, 2013 1 MICS indicator 2.18 - Bottle feeding a Figures for the education category “None” are based on less than 25 unweighted cases and are not shown in the table * Figures that are based on fewer than 25 unweighted cases Breastfeeding and Infant and Young Child Feeding in Roma Settlements In Roma settlements, the percentage of last live-born children in the last two years who were ever breastfed is 90 (Table NU.3R). Additionally, 20 percent of babies are breastfed for the first time within one hour of birth, while 79 percent of newborns start breastfeeding within one day of birth. Almost one-third of mothers with pri- mary education started breastfeeding within one hour of birth (30 percent), while this was less common amongst mothers without education (14 percent). Table NU.3R: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Roma settlements, 2013 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live- born children in the last two years Within one hour of birth2 Within one day of birth Total 90.2 20.3 79.2 43.1 235 Region North (92.2) (19.1) (75.5) (40.1) 33 Centre 90.3 21.8 81.6 45.7 174 South (87.5) (12.5) (68.7) (30.0) 27 Area Urban 91.0 21.7 82.6 44.4 181 Rural 87.6 15.6 67.7 38.8 54 Months since last birth 0-11 months 89.3 21.0 77.7 43.3 139 12-23 months 91.1 20.4 81.4 41.6 90 Assistance at delivery Skilled attendant 90.1 20.6 78.9 43.7 231 No one/Missing * * * * 3 Place of deliverya Public sector health facility 90.1 20.6 78.9 43.7 231 Home * * * * 3 Mother’s education None 88.5 14.2 76.9 40.7 156 Primary 92.7 29.5 82.5 46.1 69 Secondary or higher * * * * 10 Wealth index Poorest 60 percent 87.5 23.8 77.8 39.7 155 Richest 40 percent 95.5 13.5 81.9 49.8 79 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding a Row “Private sector health facility” is not presented in the table because there are no cases. ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 4544 Figure NU.2R shows differences by wealth status and area in terms of starting breastfeeding within one hour and within one day of birth. 22 percent of newborn babies in urban areas were first breastfed within one hour of birth, while in rural areas this percentage is lower (16 percent). In terms of wealth status, 24 percent of mothers from the poorest 60 percent of the household population first breastfed within one hour compared to 14 percent of mothers from the richest 60 percent of the household population. Figure NU.2R: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Roma settlements, 2013 Table NU.4R: Breastfeedinga Percentage of living children according to breastfeeding status at selected age groups, Roma settlements, 2013 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclu- sively breastfed1 Percent predomi- nantly breastfed2 Number of children Percent breast- fed (Continued breastfeeding at 1 year)3 Number of children Percent breast- fed (Continued breastfeeding at 2 years)4 Number of children Total 14.3 43.6 87 (57.6) 32 (39.7) 29 Sex Male (16.0) (41.3) 47 * 21 * 14 Female (12.3) (46.3) 40 * 10 * 15 Region North * * 12 * 5 * 1 Centre 3.7 39.1 68 (54.7) 24 (43.7) 23 South * * 7 * 2 * 6 Area Urban 5.4 41.5 69 (58.9) 27 (42.6) 23 Rural * * 18 * 5 * 6 Mother’s education None 15.4 46.7 61 * 20 * 14 Primary * * 24 * 11 * 14 Secondary or higher * * 2 * 1 * 1 Wealth index Poorest 60 percent (20.7) (37.9) 53 (61.4) 25 * 19 Richest 40 percent (4.4) (52.4) 34 * 6 * 10 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding a Figures for the education category “None” are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases * Figures for the 6-11 month age group are based on 25-49 unweighted cases Approximately, 14 percent of children age 0–5 months in Roma settlements are exclusively breastfed and 44 percent are predominantly breastfed (Table NU.4R). By age 12–15 months, 58 percent of children are still being breastfed and by age 20–23 months, 40 percent are still breastfed. The percentages for continued breastfeeding at 1 year and 2 years are based on 25–49 unweighted cases and should be treated with caution. Figure NU.3R shows the detailed pattern of breastfeeding of children by six-month age groups. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. At 6–11 months of age, the percentage of children exclusively breastfed is 6 percent. Almost one-half of children age 18–23 months are weaned (48 percent). Figure NU.3R: Infant feeding patterns by age, Roma settlements, 2013 Breastfed and complimentary foods, 31.2 Breastfed and non-milk liquids, 9.5 Breastfed and plain water only, 19.8 Exclusively breastfed, 14.3 Exclusively breastfed, 5.9 Weaned (not breastfed), 48.3 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years a Figures for the categories ‘Wealth index quintiles’ are based on fewer than 25 unweighted cases and are not shown in the table ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 4746 Table NU.5R shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 20.7 months for any breastfeeding, 0.5 months for exclusive breastfeeding, and 1.7 months for predominant breastfeeding. The median duration of predominant breastfeeding is slightly higher among girls (2.3 months) than boys (0.7 months). The median duration of any breastfeeding was longer among children whose mothers have no education (21.4 months) compared to children whose mothers have primary education (15.9 months). The adequacy of infant feeding in children under 24 months in Roma settlements is provided in Table NU.6R. As mentioned previously, different criteria of feeding are used depending on the age of the child: for infants age 0–5 months, exclusive breastfeeding is considered age-appropriate feeding, while infants age 6–23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi- solid or soft food. As a result of these feeding patterns, only 38 percent of children age 0–23 months are being appropriately breastfed. In terms of age-appropriate feeding, only 14 percent of children age 0–5 months are being adequately fed (exclusive breastfeeding), while the percentage of children adequately fed for their age increases to 51 percent among children age 6–23 months. For the 2013 Montenegro Roma settlements MICS, the data on the percentage of infants age 6–8 months who received solid, semi-solid, or soft foods during the previous day (MICS indicator 2.13) is based on fewer than 25 unweighted cases and is not presented in the report. Table NU.7R presents information on infant and young child feeding practices in Roma settlements. Overall, 29 percent of all children age 6–23 months from Roma settlements receive the minimum dietary diversity, 66 percent of children this age receive the minimum meal frequency, while 13 percent receive the minimum acceptable diet. Among currently breastfeeding children age 6–23 months, 22 percent receive the minimum dietary diversity, 68 percent receive the minimum meal frequency and 12 percent receive the minimum acceptable diet. Among non-breastfeeding children age 6–23 months 40 percent receive the minimum dietary diversity, 62 percent receive the minimum meal frequency and 16 percent receive the minimum acceptable diet. Additionally, 48 percent of children not currently breastfeeding receive at least two milk feeds. Table NU.5R: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Roma settlements, 2013 Table NU.6R: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Roma settlements, 2013 Median duration (in months) of: Number of children age 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 20.7 0.5 1.7 342 Sex Male 21.4 0.5 0.7 159 Female 12.8 0.6 2.3 183 Region North 24.5 5.8 6.0 52 Centre 20.9 0.4 0.7 261 South (15.2) (2.0) (2.1) 30 Area Urban 20.8 0.4 0.7 270 Rural 20.2 2.4 2.8 72 Mother’s education None 21.4 0.5 1.7 232 Primary 15.9 1.1 1.8 97 Secondary or higher * * * 13 Wealth index quintiles Poorest (23.4) (0.5) (0.5) 79 Second 14.0 2.0 2.4 80 Middle 14.4 0.8 3.2 72 Fourth 16.8 – 1.1 59 Richest 16.3 0.5 5.2 53 Mean 17.6 1.2 3.6 342 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 14.3 87 51.4 152 37.9 239 Sex Male (16.0) 47 65.2 74 46.2 121 Female (12.3) 40 38.3 78 29.4 118 Region North * 12 (37.1) 25 (47.2) 37 Centre 3.7 68 56.3 109 36.1 178 South * 7 * 17 (37.2) 24 Area Urban 5.4 69 57.3 116 38.0 185 Rural * 18 (32.2) 36 37.5 53 Mother’s education None 15.4 61 52.7 97 38.4 158 Primary * 24 (56.4) 48 41.9 71 Secondary or higher * 2 * 7 * 9 Wealth index Poorest 60 percent (20.7) 53 49.1 109 39.8 161 Richest 40 percent (4.4) 34 57.1 43 33.9 77 1 MICS indicator 2.11 - Duration of breastfeeding ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases ‘-‘ denotes 0 unweighted cases in that cell 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases Roma settlements Roma settlements MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 4948 Currently breastfeeding Currently not breastfeeding All Percent of children who received: Num- ber of children age 6-23 months Percent of children who received: Num- ber of children age 6-23 months Percent of children who received: Num- ber of children age 6-23 months Minimum dietary diversitya Minimum meal frequen- cyb Minimum accept- able diet1, c Minimum dietary diversitya Minimum meal frequen- cyb Minimum accept- able diet2, c At least 2 milk feeds3 Minimum dietary diversi- ty4, a Minimum meal frequen- cy5, b Minimum accept- able dietc Total 22.1 68.2 12.3 90 40.1 61.8 15.5 48.4 45 28.8 66.1 13.4 152 Sex Male 23.3 68.8 9.5 53 * * * * 13 26.5 66.1 11.0 74 Female (20.4) (67.3) (16.3) 37 (43.5) (64.5) (14.8) (45.6) 32 31.0 66.0 15.6 78 Age 6-8 months * * * 17 * * * * 1 * * * 20 9-11 months * * * 15 * * * * 5 * * * 21 12-17 months (17.3) (63.1) (6.4) 29 * * * * 19 25.6 58.7 8.5 54 18-23 months * * * 30 (49.5) (62.9) (20.8) (39.9) 20 38.4 70.8 17.2 57 Region North * * * 15 * * * * 7 (57.5) (15.9) (11.5) 25 Centre 16.2 87.7 12.7 65 (20.7) (63.7) (9.0) (41.5) 32 17.5 79.7 11.5 109 South * * * 10 * * * * 6 * * * 17 Area Urban 17.5 81.6 11.7 71 (21.8) (63.2) (8.7) (39.9) 34 18.6 75.6 10.7 116 Rural * * * 19 * * * * 11 (62.3) (33.6) (22.4) 36 Mother’s education None 22.3 65.8 13.5 61 (28.8) (36.5) (0.0) (47.1) 23 24.0 57.8 9.8 97 Primary (21.7) (73.2) (9.8) 29 * * * * 15 (37.7) (78.3) (19.4) 48 Secondary or higher - - - 0 * * * * 7 * * * 7 Wealth index Poorest 60 percent 22.9 59.6 9.2 64 (44.2) (61.9) (17.2) (45.7) 29 30.9 60.3 11.7 109 Richest 40 percent (20.1) (89.6) (20.1) 26 * * * * 16 23.7 79.0 17.1 43 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 75.6 239 Sex Male 82.1 121 Female 68.9 118 Age 0-5 months 70.4 87 6-11 months (75.6) 41 12-23 months 79.6 111 Region North (49.1) 37 Centre 81.4 178 South (73.1) 24 Area Urban 79.4 185 Rural 62.3 53 Mother’s education None 75.3 158 Primary 81.8 71 Secondary or higher * 9 Wealth index Poorest 60 percent 68.7 161 Richest 40 percent 89.9 77 Table NU.7R: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Roma settlements, 2013 Table NU.8R: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Roma settlements, 2013 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least four of seven food groups: 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods two times or more daily for children age 6-8 months and three times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least four times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least two milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases ‘-‘ denotes 0 unweighted cases in that cell 1 MICS indicator 2.18 - Bottle feeding ( ) Figures that are based on 25-49 unweighted cases * Figures that are based on fewer than 25 unweighted cases Table NU.8R shows that bottle-feeding is still prevalent in Roma settlements. 76 percent of children younger than 24 months are fed using a bottle with a nipple. The percentage of children fed with a bottle with a nipple ranges from 70 percent for children age 0–5 months to 80 percent for children age 12–23 months. By sex, results show that more boys under 24 months are fed with a bottle with a nipple (82 percent) compared to girls (69 percent). 90 percent of children from the richest 40 percent of the household population are fed with a bottle with a nipple compared to 69 percent from the poorest 60 percent of the household population. MONTENEGRO2013 MULTIPLE INDICATOR CLUSTER SURVEY 5150 Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two-thirds between 1990 and 2015. Immunisation plays a key part in this goal. Immunisations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunisation and as a result, vaccine- preventable diseases cause more than two million deaths every year. A goal of A World Fit for Children is to ensure full immunisation of children under 1 year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of the polio vaccine, three doses of the Hepatitis B (HepB) vaccine, three doses of the Haemophilus influenzae type b (Hib) vaccine, and a measles vaccination by the age of 12 months. The abovementioned vaccinations follow the current vaccination schedule of the Montenegro National Immunisation Programme. In this schedule, all vaccinations are expected to be received during the first year of life. In the current vaccination schedule, adapted since 2011, the third dose of the HepB vaccine is expected to be received by 9 months of age. According to the previous vaccination schedule, children should receive the third dose

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