Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan, 2010-2011. Final Report.

Publication date: 2012

Multiple Indicator Cluster Survey in the Republic of Kazakhstan 2010-2011 MONITORING THE SITUATION OF CHILDREN AND WOMEN Astana, 2012 2 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan 2010-2011 Monitoring the situation of children and women. Directed by Smailov A.A., Astana 2012, 378 p. Contributors to the report: Amirkhanova M. M. Tanibergenov S. T. Editorial Board: Ashuyev A. Z. Kukanova G. Z. Sissemaliyev R. A. Alkuatova N. Y. This Kazakhstan Multiple Indicator Cluster Survey (MICS) was carried out in 2010-2011 by the Agency of Statistics, RK in collaboration with the Republican State Enterprise Information Computing Centre. Financial and technical support was provided mainly by the United Nations Children’s Fund (UNICEF) and co-financed by the United Nations Population Fund (UNFPA). MICS is an international programme on household surveys developed by UNICEF. In Kazakhstan, MICS was conducted within the framework of the fourth global round of MICS surveys (MICS4). The MICS provides up-to-date information on the situation of children, women and men and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: The Agency of Statistics, RK, United Nations Children’s Fund (UNICEF), 2012 Multiple Indicator Cluster Survey (MICS) in the Republic of Kazakhstan, 2010-2011. Final Report. Astana, Kazakhstan: the Agency of Statistics, RK and the Republican State Enterprise Information Computing Center. Any information from this publication may be reproduced but proper acknowledgement of the source must be provided. This publication is not for sale. The Agency of Statistics, RK Entrance 4, House of Ministries Left Bank of Ishim River, 010000, Astana Tel: +7 (7172) 749016, Fax: +7 (7172) 749494, Website: www.stat.kz., www.stat.gov.kz The United Nations Children’s Fund (UNICEF) in the Republic of Kazakhstan Block 1, 10A, Beibitshilik str., 010000, Astana, Tel: +7 (7172) 321797, 322969, Fax: +7 (7172) 321803 Website: www.unicef.kz., www.unicef.org 3MONITORING THE SITUATION OF CHILDREN AND WOMEN Multiple Indicator Cluster Survey (MICS) In the Republic of Kazakhstan 2010-2011 The Agency of Statistics, RK Entrance 4, House of Ministries Left Bank of Ishim River, 010000, Astana Tel: +7(7172) 749016, Fax: +7(7172) 749494, Website: www.stat.kz., www.stat.gov.kz United Nations Children’s Fund (UNICEF) in the Republic of Kazakhstan Block 1, 10A, Beibitshilik str., 010000, Astana, Tel: +7 (7172) 321797, 322969, Fax: +7 (7172) 321803 Website: www.unicef.kz., www.unicef.org 4 Summary Table of Findings Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators in Kazakhstan, 2010-2011 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value CHILD MORTALITY Child Mortality 1.1 4.1 Under-5 mortality rate 31 per thousand 1.2 4.2 Infant mortality rate 28 per thousand NUTRITION Nutritional Status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 3,7 1,2 percent percent 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 13,1 5,4 percent percent 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 4,1 1,7 percent percent Breastfeeding and Infant Feeding 2.4 Children ever breastfed 96,4 percent 2.5 Early initiation of breastfeeding 67,8 percent 2.6 Exclusive breastfeeding under 6 months 31,8 percent 2.7 Continued breastfeeding at 1 year 50,8 percent 2.8 Continued breastfeeding at 2 years 26,1 percent 2.9 Predominant breastfeeding under 6 months 60,6 percent 2.10 Duration of breastfeeding 14,8 percent 2.11 Bottle feeding 46,7 percent 2.12 Introduction of solid, semi-solid or soft foods 49,4 percent 2.13 Minimum meal frequency 55,3 percent 2.14 Age-appropriate breastfeeding 31,0 percent 2.15 Milk feeding frequency for non-breastfed children 89,4 percent Salt Iodization 2.16 Iodized salt consumption 85,4 percent Low Birth Weight 2.18 Low-birthweight infants 4,5 percent 2.19 Infants weighed at birth 97,6 percent 5 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage (BCG) 99,2 percent 3.2 Polio immunization coverage (PIC) 81,3 percent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 93,0 percent 3.4 4.3 Measles immunization coverage 84,2 percent 3.5 Hepatitis B immunization coverage (Hep B) 67,0 percent Care of Illness 3.8 Oral rehydration therapy with continued feeding 54,0 percent 3.9 Care seeking for suspected pneumonia 81,2 percent 3.10 Antibiotic treatment of suspected pneumonia 86,6 percent Solid Fuel Use 3.11 Solid fuels 10,8 percent WATER AND SANITATION Water and Sanitation 4.1 7.8 Use of improved drinking water sources 93,9 percent 4.2 Water treatment 70,7 percent 4.3 7.9 Use of improved sanitation 97,3 percent 4.4 Safe disposal of child’s faeces 66,7 percent REPRODUCTIVE HEALTH Contraception and Unmet Need 5.1 5.4 Adolescent birth rate 23,4 per thousand 5.2 Early childbearing 2,3 percent 5.3 5.3 Contraceptive prevalence rate among Women age 15-49 Men age 15-49 51,0 48,0 percent percent 5.4 5.6 Unmet need 11,6 percent Maternal and Newborn Health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 99,2 87,0 percent percent 5.6 Content of antenatal care 98,9 percent 5.7 5.2 Skilled attendant at delivery 99,9 percent 5.8 Institutional deliveries 99,6 percent 5.9 Caesarean section 15,9 percent CHILD DEVELOPMENT Child Development 6.1 Support for learning 91,5 percent 6 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Child Development 6.2 Father’s support for learning 49,1 percent 6.3 Learning materials: children’s books 47,8 percent 6.4 Learning materials: playthings 44,8 percent 6.5 Inadequate care 4,4 percent 6.6 Early child development index 86,1 percent 6.7 Attendance in early childhood education 37,0 percent EDUCATION Literacy and Education 7.1 2.3 Literacy rate among young Women age 15-24 Men age 15-24 99,9 99,9 percent percent 7.2 School readiness 81,6 percent Literacy and Education 7.3 Net intake rate in primary education 93,8 percent 7.4 2.1 Primary school net attendance ratio (adjusted) 99,3 percent 7.5 Secondary school net attendance ratio (adjusted) 96,1 percent 7.6 2.2 Children reaching last grade of primary 100,0 percent 7.7 Primary completion rate 107,4 percent 7.8 Transition rate to secondary school 100,0 percent 7.9 Gender parity index (primary school) 1,00 ratio 7.10 Gender parity index (secondary school) 1,00 ratio CHILD PROTECTION Birth Registration 8.1 Birth registration 99,7 percent Child Discipline 8.5 Violent discipline 49,4 percent Early Marriage 8.6 Marriage before age 15 among Women age 15-49 Men age 15-49 0,2 0,3 percent percent 8.7 Marriage before age 18 among Women age 20-49 Men age 20-49 8,6 1,0 percent percent 8.8 Currently married or in union Women age 15-19 Men age 15-19 4,5 0.9 percent percent 8.10a 8.10b Spousal age difference Women age 15-19 Women age 20-24 8,4 7.2 percent percent 7 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Domestic Violence 8.14 Attitudes towards domestic violence: Women age 15-49 Men age 15-49 12,2 16,7 percent percent HIV/AIDS and SEXUAL BEHAVIOUR HIV/AIDS Knowledge and Attitudes 9.1 Comprehensive knowledge about HIV prevention Women age 15-49 Men age 15-49 38,0 37,9 percent percent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people Women age 15-24 Men age 15-24 36,2 34,1 percent percent 9.3 Knowledge of mother-to-child transmission of HIV Women age 15-49 Men age 15-49 52,5 38,4 percent percent HIV/AIDS Knowledge and Attitudes 9.4 Accepting attitude towards people living with HIV Women age 15-49 Men age 15-49 2,5 2,7 percent percent 9.5 Respondents who know where to be tested for HIV Women age 15-49 Men age 15-49 81,1 76,4 percent percent 9.6 Respondents who have been tested for HIV and know the results Women age 15-49 Men age 15-49 22,5 15,4 percent percent 9.7 Sexually active young people who have been tested for HIV and know the results Women age 15-24 Men age 15-24 34,3 16,2 percent percent 9.8 HIV counselling during antenatal care 58,1 percent 9.9 HIV testing during antenatal care 71,5 percent Sexual Behaviour 9.10 Young respondents who have never had sex Women age 15-24 Men age 15-24 90,4 55,4 percent percent 9.11 Sex before age 15 Among young women age 15-24 Among young men age 15-24 0,4 1,4 percent percent 8 Topic M IC S4 In di ca to r N um be r M D G In di ca to r N um be r Indicator Value Sexual Behaviour 9.12 Age-mixing among sexual partners Women age 15-24 Men age 15-24 7,9 2,5 percent percent 9.13 Sex with multiple partners Women age 15-24 Men age 15-24 1,2 16,6 percent percent 9.14 Condom use during sex with multiple partners Women age 15-24 Men age 15-24 73,5 76,2 percent percent 9.15 Sex with non-regular partners Women age 15-24 Men age 15-24 7,4 38,6 percent percent 9.16 6.2 Condom use with non-regular partners Women age 15-24 Men age 15-24 69,9 78,3 percent percent TOBACCO AND ALCOHOL USE Tobacco Use ТА.1 Tobacco use Women age 15-49 Men age 15-49 7,5 53,9 percent percent ТА.2 Smoking until age 15 Women age 15-49 Men age 15-49 1,3 8,7 percent percent Alcohol Use ТА.3 Alcohol use Women age 15-49 Men age 15-49 26,6 46,4 percent percent ТА.4 Alcohol use until age 15 Women age 15-49 Men age 15-49 0,9 3,5 percent percent MASS MEDIA AND ICI Access to mass media and use of information/ communication technologies МТ.1 Access to mass media Women age 15-49 Men age 15-49 22,9 30,3 percent percent МТ.2 Use of computers Women age 15-24 Men age 15-24 83,6 82,4 percent percent МТ.2 Use of the Internet Women age 15-24 Men age 15-24 67,5 69,7 percent percent 9 Table of Contents Summary Table of Findings.4 Table of Contents.9 List of Tables .11 List of Figures .16 List of Abbreviations .17 Acknowledgements .18 Executive Summary.22 I. Introduction .29 Background .30 Survey Objectives .31 II. Sample and Survey Methodology .32 Sample Design .33 Questionnaires .33 Training and Fieldwork .35 Data Processing .35 III. Sample Coverage and the Characteristics of Households and Respondents .36 Sample Coverage .37 Characteristics of Households .39 Characteristics of Female Respondents 15-49, Male Respondents 15-59 Years of Age and Children Under 5 .43 Children’s Living Arrangements and Orphanhood .49 IV. Child Mortality .52 V. Nutrition .56 Nutritional Status .57 Breastfeeding, Infant and Young Child Feeding .60 Salt Iodization .71 Low Birth Weight .73 VI. Child Health .76 Vaccinations .77 Oral Rehydration Treatment .82 Care Seeking and Antibiotic Treatment of Pneumonia .84 Solid Fuel Use .87 VII. Water and Sanitation .91 Use of Improved Water Sources.92 Use of Improved Sanitation Facilities .99 VIII. Reproductive Health .107 Fertility .108 Contraception .111 Unmet Need .115 Antenatal Care .118 Assistance at Delivery .122 Place of Delivery .124 Abortions .126 10 IX. Child Development .131 Early Childhood Education and Learning .132 Early Childhood Development .139 X. Literacy and Education.142 Literacy among Young Women and Men .143 School Readiness .143 Primary and Secondary School Participation .145 XI. Child Protection .153 Birth Registration .154 Child Discipline .155 Early Marriage .158 Attitude toward Domestic Violence .165 XII. HIV/AIDS and Sexual Behaviour .169 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS .170 Accepting Attitudes toward People Living with HIV/AIDS……………. .183 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care .187 Sexual Behaviour Related to HIV Transmission .196 Circumcision .206 XIII. Tobacco and Alcohol Use .208 Tobacco Use .209 Alcohol Use .215 XIV. Access to Mass Media and Use of Information/Communication Technologies .219 Access to Mass Media .220 Use of Information/Communication Technologies .223 XV. Domestic Violence .227 Appendix A. Sample Design .243 Appendix B. List of Personnel Involved in the Survey .251 Appendix C. Estimates of Sampling Errors .254 Appendix D. Data Quality Tables .295 Appendix E. MICS4 Indicators: Numerators and Denominators .307 Appendix F. Questionnaires.316 Appendix G. Table NU.1A : Assessment of nutritional status of children based on the international standards for population set by the National Centre for Health Statistics, USA (NCHS)/Center for Disease Control and Prevention, USA (CDC)/WHO .377 11 List of Tables Table HH.1: Results of household, women’s, men’s and under-5 interviews Table HH.2: Household age distribution by sex Table HH.3: Household composition Table HH.4: Women’s background characteristics Table HH.4M: Men’s background characteristics Table HH.5: Children’s background characteristics Table НH.6: Children’s living arrangements and orphanhood Table CM.1: Children ever born, children surviving and proportion dead Table CM.2: Child Mortality Table NU.1: Nutritional status of children Table NU.2: Initial breastfeeding Table NU.3: Breastfeeding Table NU.4: Duration of breastfeeding Table NU.5: Age-appropriate breastfeeding Table NU.6: Introduction of solid, semi-solid or soft food Table NU.7: Minimum meal frequency Table NU.8: Bottle feeding Table NU.9: Iodized salt consumption Table NU.11: Low birth weight infants Table CH.1: Vaccinations in first year of life Table CH.2: Vaccinations by background characteristics Table CH.4: Oral rehydration solutions and recommended homemade fluids Table CH.5: Feeding practices during diarrhoea Table CH.6: Oral rehydration therapy with continued feeding and other treatments Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Table CH.8: Knowledge of the two danger signs of pneumonia Table CH.9: Solid fuel use Table CH.10: Solid fuel use by place of cooking Table WS.1: Use of improved water sources Table WS.2: Household water treatment Table WS.3: Time to the source of drinking water Table WS.4: Person collecting water Table WS.5: Types of sanitation facilities Table WS.6: Use and sharing of sanitation facilities Table WS.7: Disposal of a child’s faeces Table WS.8: Drinking water and sanitation ladders 12 Table RH.1: Adolescent birth rate and total fertility rate Table RH.2: Early childbearing Table RH.3: Trends in early childbearing Table RH.4: Use of contraception among women Table RH.4M: Use of contraception among men Table RH.5: Unmet need for contraception Table RH.6: Antenatal care provider Table RH.7: Number of antenatal care visits Table RH.8: Content of antenatal care Table RH.9: Assistance during delivery Table RH.10: Place of delivery Table RH.10A: Lifetime experience with wasted pregnancies Table RH.10B: Induced abortion rates by residence Table RH.10C: Induced abortion rates by background characteristics Table RH.10D: Place of abortion Table RH.10E: Person that had the final say on taking the abortion decision Table RH.10F: Person assisting abortion Table CD.1: Early childhood education Table CD.2: Support for learning Table CD.3: Learning materials Table CD.4: Inadequate care Table CD.5: Early Child Development Index Table ED.1: Literacy among young people Table ED.2: School readiness Table ED.3: Primary school entry Table ED.4: Primary school Attendance Table ED.5: Secondary school Attendance Table ED.6: Children reaching last grade of primary school Table ED.7: Primary school completion and transition to secondary school Table ED.8: Education gender parity Table CP.1: Birth registration Table CP.4: Child discipline Table CP.5: Early marriage among women Table CP.5М: Early marriage among men Table CP.6: Trends in early marriage among women Table CP.6М: Trends in early marriage among men Table CP.7: Spousal age difference Table CP.11: Attitude towards domestic violence among women Table CP.11М: Attitude towards domestic violence among men 13 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about transmission among young women Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about transmission among young men Table НА.3: Knowledge of mother-to-child HIV transmission among women Table НА.3М: Knowledge of mother-to-child HIV transmission among men Table НА.4: Accepting attitudes toward people living with HIV/AIDS among women Table НА.4М: Accepting attitudes toward people living with HIV/AIDS among men Table НА.5: Knowledge of a place for HIV testing among women Table НА.5М: Knowledge of a place for HIV testing among men Table HA.6: Knowledge of a place for HIV testing among sexually active young women Table HA.6M: Knowledge of a place for HIV testing among sexually active young men Table НА.7: HIV counseling and testing during antenatal care Table НА.8: Sexual behaviour that increases the risk of HIV infection among women Table НА.8М: Sexual behaviour that increases the risk of HIV infection among men Table НА.9: Sex with multiple partners among women Table НА.9М Sex with multiple partners among men Table НА.10: Sex with non-regular partners (young women) Table НА.10M: Sex with non-regular partners (young men) Table HA.14: Male circumcision Table TA.1: Current and ever use of tobacco among women Table TA.1M: Current and ever use of tobacco among men Table TA.2: Age at first use of cigarettes and frequency of use among women Table TA.2M: Age at first use of cigarettes and frequency of use among men Table TA.3: Use of alcohol among women Table TA.3M: Use of alcohol among men Table MT.1: Exposure to mass media among women Table MT.1M. Exposure to mass media among men Table MT.2: Use of computers and internet among women Table MT.2M: Use of computers and internet among men Table DV.1: Experience of physical violence Table DV.2: Persons committing physical violence Table DV.3: Force at sexual initiation Table DV.4: Experience of sexual violence Table DV.5: Experience of different forms of violence Table DV.6: Violence during pregnancy Table DV.7: Degree of marital control experienced by husbands Table DV.8: Forms of spousal violence 14 Table DV.9: Spousal violence by background characteristics Table DV.10: Spousal violence by husband’s characteristics and empowerment indicators Table DV.11: Injuries to women caused by spousal violence Table DV.12: Help seeking to stop violence Table SD.1: Expected ratios of completed interviews of Women and Children under 5 in selected households by Urban/Rural areas Table SD.2: Expected number of selected households to reach the target of completed interviews by administrative regions Table SD.3: Proportional and disproportional (Sqrt) sample allocation Table SD.4: Values, standard errors (SE), design effects (deff) for selected indicators, Kazakhstan, MICS3 (2006) Table SD.5: Final recommended sample size Table SE.1: Indicators selected for sampling error calculations Table SE.2: Sampling errors: Total sample Table SE.3: Sampling errors: Urban areas Table SE.4: Sampling errors: Rural areas Table SE.5: Sampling errors: Akmola Table SE.6: Sampling errors: Aktobe Table SE.7: Sampling errors: Almaty Table SE.8: Sampling errors: Almaty city Table SE.9: Sampling errors: Astana city Table SE.10: Sampling errors: Atyrau Table SE.11: Sampling errors: East Kazakhstan Table SE.12: Sampling errors: Zhambyl Table SE.13: Sampling errors: West Kazakhstan Table SE.14: Sampling errors: Karaganda Table SE.15: Sampling errors: Kostanai Table SE.16: Sampling errors: Kyzylorda Table SE.17: Sampling errors: Mangistau Table SE.18: Sampling errors: Pavlodar Table SE.19: Sampling errors: North Kazakhstan Table SE.20: Sampling errors: South Kazakhstan Table DQ.1: Age distribution of household population Table DQ.2: Age distribution of eligible and interviewed women Table DQ.2M: Age distribution of eligible and interviewed men Table DQ.2M-A: Percentage of selected households for interviews of men and percentage of interviewed men by area and region Table DQ.3: Age distribution of under-5 household population and under-5 questionnaires Table DQ.4: Women’s completion rates by socio-economic characteristics of households Table DQ.4M: Men’s completion rates by socio-economic characteristics of households Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households 15 Table DQ.6: Completeness of reporting Table DQ.7: Completeness of information for anthropometric indicators Table DQ.8: Accumulation in the results of anthropometric measurements Table DQ.11: Observation of under-5 birth certificates Table DQ.12: Observation of vaccination cards Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 questionnaire Table DQ.14: Selection of children age 2-14 years for the child discipline module Table DQ.15: School attendance by one-year age group Table DQ.16: Sex ratio at birth among children ever born and living 16 List of Figures Figure HH.1: Age-sex distribution of household population in percent Figure CM.1: Under 5 years old children mortality rate by background characteristics Figure CM.2: Under 5 mortality trends Figure NU.1: Percentage of children under-5 who are underweight, stunted and wasted Figure NU.2: Initial Breastfeeding (within one hour and one day of birth) Figure NU.3: Infant feeding patterns by age Figure NU.4: Percentage of households consuming adequately iodized salt Figure NU.5: Percentage of infants weighing less than 2,500 grams at birth Figure CH.1: Percentage of children aged 15-26 months who received recommended vaccination by 12 months Figure WS.1: Percent distribution of households by sources of drinking water Figure WS.2: Use of improved sanitation facilities Figure CD.1: Percentage of children aged 36-59 months developmentally on track in the indicated domains Figure ED.1: Primary and secondary school net attendance ratio (NAR) (adjusted) Figure ED.2: Percentage of household members aged 5-24, attending school, by sex Figure CP.1: Percentage of children aged 2-14 ever disciplined by means of physical punishment, by sex Figure CP.2: Percentage of women aged 20-49 married before 18, by wealth index quintiles Figure HA.1: Percentage of women aged 15-49 who have comprehensive knowledge about HIV/AIDS transmission Figure HA.2: Sexual behaviour that increases the risk of HIV infection Figure TA.1: Alcohol consumption in one or more days within the last month by area of residence Figure MT.1: Use of computers and the Internet by women aged 15-24 Figure MT.1M: Use of computers and the Internet by men aged 15-24 Figure DQ.1: Number of household population by single ages 17 List of Abbreviations AIDS Acquired Immunodeficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CEE/CIS Central and Eastern Europe/Commonwealth of Independent States CIS Commonwealth of Independent States CDC Center for Disease Control and Prevention CSPro Census and Survey Processing System DHS Demographic Health Survey DPT Diphtheria Pertussis Tetanus EB Exclusive Breastfeeding ECD Early Child Development EPI Expanded Programme on Immunization FAP Feldsher Ambulatory Point GAR General Abortion Rate GPI Gender Parity Index Hep B Hepatitis B vaccine Hib Haemophilus influenza type B HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorder IQ Intelligence Quotient IUD Intrauterine Device LAM Lactational Amenorrhea Method Media Mass Media MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health MMR Measles, Mumps, Rubella NAR Net Attendance Rate NCHS National Center for Health Statistics OPV Poliomyelitis Vaccination ORT Oral Rehydration Treatment ppm Parts Per Million PSU Primary Sampling Unit RACS Registration of Acts of Civil Status RSE Republican State Enterprise SD Standard Deviation SPSS Statistical Package for Social Sciences STD Sexually Transmitted Diseases TAR Total Abortion Rate TFR Total Fertility Rate UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization 18 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Acknowledgements Foreword and acknowledgements by Mr. Alikhan Smailov, Chairman of the Agency of Statistics, RK It has been 20 years since the day Kazakhstan gained its independence and embarked on the path of reform, building an open democratic society with a market and socially oriented economy. Over these years, there have been significant changes in all areas of the society. The entire society needs to have information on the status of children, women and men in the country. In this context, the outcomes of the fourth round of Multiple Indicator Cluster Survey conducted in Kazakhstan in 2010/11 (MICS4) performed to obtain information for assessing the status of children, women and men in Kazakhstan and monitoring progress towards the Millennium Development Goals and targets of the ‘World Fit for Children’ (WFFC) document and other internationally agreed instruments, are of great interest. Due to significant discrepancies in social and economic development of the regions of the country, the Kazakhstan survey was conducted at the subnational level as well, which makes it unique. I hope that the survey findings will be useful for the Government and civil society institutions in planning and developing social programmes that meet the requirements of the current situation and needs of women and children both at the national level and at the level of each region. Many experts at different levels have contributed to the successful completion of MICS4 and publication of this Final Report. We should mention a noble and rewarding role played by the UN and its organizations in our country. In particular, I would like to thank and mention international organizations operating in Kazakhstan such as the UN Children’s Fund (UNICEF) and the UN Population Fund (UNFPA) for their technical and financial support in preparation and implementation of MICS4 in Kazakhstan. I would like to thank the staff of the UNICEF Office in Kazakhstan in the person of Mr. Jun Kukita, UNICEF Representative in Kazakhstan, Ms. Hanaa Singer, former UNICEF Representative in Kazakhstan, Mr. Radoslav Rzehak, Deputy Representative of UNICEF in Kazakhstan, Mr. Raimbek Sissemaliyev, UNICEF Programme Monitoring and Evaluation Officer, for their significant technical, methodological and financial support in training and preparing the staff of the Agency of Statistics, RK and ongoing support in preparation and conduct of this survey. I would like to thank Global MICS Coordinator Mr. Attila Hancioglu (USA, New York) and, in his person, dozens of UNICEF staff around the world who conducted a series of training workshops, developed questionnaires and data input and indicator computation programmes, provided overall management as well as advice at all stages of preparation, conduct and processing of the results of this global survey, and in particular, MICS Project Coordinator from UNICEF Regional Office Mr. Siraj Mahmudlu (Switzerland, Geneva), who provided the best possible assistance to the Agency’s staff in preparing and conducting the survey in Kazakhstan. We would like to express our particular appreciation to Mr. Oleg Benes, international sampling consultant, for his expert assistance in the Kazakhstan MICS sampling. I would like to thank UNFPA Kazakhstan in the person of Mr. Nikolai Botev, Director of Subregional Office of the UN Population Fund, Mr. Alexander Kosukhin, UNFPA Programme Coordinator in Kazakhstan, Ms. Gaziza Moldakulova, UNFPA 19MONITORING THE SITUATION OF CHILDREN AND WOMEN Programme Coordinator in Kazakhstan, for co- financing provided to train and prepare the Agency of Statistics, RK staff and MICS fieldwork. I would like to thank all senior officials from oblast/city statistics departments, supervisors, editors and interviewers as well as management of RSE Information and Computer Centre of the Agency of Statistics for their significant contribution to successful completion of this Project. On this occasion, I would like to express my appreciation to representatives of national ministries and agencies, non-governmental sector and international institutions, which expressed their interest in MICS4 survey findings and provided their feedback on this Final Report. Alikhan Smailov Chairman Agency of Statistics, RK 20 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Foreword and acknowledgments by Mr. Jun Kukita, Representative of the UN Children’s Fund (UNICEF) in Kazakhstan It is with great pleasure that I present the Final Report on findings of the 2010-2011 Kazakhstan Mul- tiple Indicator Cluster Survey (MICS). To assist the Government of Kazakhstan in achieving the global goals and national priorities, the UN System coordinates and integrates the efforts of individual UN Agencies at the country level using stra- tegic tools, such as the 2010- 2015 United Nations Development Assistance Framework Programme (UN- DAF). It should also be noted that Kazakhstan, via the Agency of Statistics, has implemented this Multiple Indicator Cluster Survey for the second time and has provided co-financing for a part of activities such as training, data entry and processing. Many experts from the Agency of Statistics and its territorial divisions as well as its structural subdivi- sion RSE ‘Information and Computer Centre’ have con- tributed to successful completion of the MICS. In this context, I would like to express my sincere appreciation for the assistance of Mr. Alikhan Smailov, Chairman of the Agency of Statistics, RK who set the stage for its successful completion and provided his ongoing sup- port to the MICS project1; Mr. Nurbolat Aidapkelov, Executive Secretary of the Agency of Statistics, RK- Project Director, for arrangement of the survey at the preparatory and data collection stages and Mr. Aidyn Ashuyev, Deputy Chairman of the Agency of Statis- tics, RK (since August 2011), for arrangement of the preparation of the Final Report and, in his capacity as Head of RSE ‘Information and Computer Centre’ (until July 2011) for timely data collection and processing. I would like to thank staff of the Agency of Sta- tistics, RK and Information and Computer Centre in- volved in the Project: Ms. Gyulnara Kukanova, Direc- tor of Social and Demographic Statistics Department of the Agency of Statistics, RK (‘SDSD’), for overall coordination of efforts of all entities involved in the Project and planning of organization efforts to prepare and implement MICS4 and training of field teams dur- ing regional training workshops; Mr. Yerbolat Mussa- bek, Deputy Director of SDSD, for forming field teams for data collection purposes; Ms. Maira Amirkhano- va, Head of the Social Statistics Division of the SDSD (until March 2011), for training field teams and assisting in development and adaptation of MICS4 tools, field- work monitoring and preparation of this Report (August- December 2011); Ms. Nurzhamal Alkuatova, Head of the Social Statistics Division of the SDSD (since March 2011) for her assistance in development of data entry and processing monitoring and adaptation of MICS4 tools for Kazakhstan; Mr. Eldar Kazganbayev, Director of RSE ‘ICC’; Ms. Zinagul Dzhumanbayeva, Deputy Director of RSE ‘Information and Computing Centre’ for arranging the collection and processing of MICS data and handling financial reports of the executive partner of the Project; staff of RSE ‘ICC’: Ms. Gulzhan Kopeyeva, Deputy Head of the Department of Statistics Informa- tion Management and Information Systems Operation, for high-quality entry of MICS primary data, Ms. Aigul Kapisheva, Deputy Head of the Information Manage- ment Unit, for adaptation of MICS software and output generation; Ms. Saule Dauylbayeva, Deputy Head of the Information Management Unit, for survey sam- 1 Mentioned job titles of all Project participants are those held at the time of preparation and implementation of the MICS (2010-2011). 21MONITORING THE SITUATION OF CHILDREN AND WOMEN pling and editing of MICS primary data input; as well as all other staff involved in data processing. I highly appreciate the assistance of all directors of territorial statistics departments in Kazakhstan for al- locating skilled and responsible human resources (civil servants) for fieldwork, thus greatly contributing to the implementation of the survey, as well as staff of terri- torial statistics departments involved in data collection fieldwork. I would like to express my particular apprecia- tion to field team supervisors for high level of fieldwork arrangement, implementation and development of optimal routes for teams; interviewers for high-quality and timely data collection in the field in compliance with MICS requirements; editors for quality question- naire editing, fieldwork monitoring and timely delivery of questionnaires to the central office; and drivers for delivering teams to population centres on schedule. Unlike the 2006 Final Report, this final report in- cludes several new chapters featuring topical issues and a lot of interesting information on the status of chil- dren, women and men in Kazakhstan, and I believe it will be very useful to government agencies, non- governmental organizations, international institutions, faculties, students and the general public exploring the aforementioned problems. Jun Kukita Representative UNICEF in Kazakhstan Executive Summary 23MONITORING THE SITUATION OF CHILDREN AND WOMEN 2 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division. United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. The Multiple Indicator Cluster Survey in Kazakhstan is a nationally representative household sample. The sample size was 16,380 households. The sample is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Sample Coverage Of the 16,380 households selected for the sample, 16,018 were found to be occupied. Of these, 15,800 were successfully interviewed for a household response rate of 98.6 percent. In the interviewed households 14,228 women (age 15-49) were identified. Of these, 14,014 women were successfully interviewed, yielding a response rate of 98.5 percent. For men (age 15-59), these indicators were 4,043 – listed, 3,846 – successfully interviewed that gives response rate at 95.1 percent. In addition, 5,227 children under-5 were listed in the household questionnaire. Questionnaires were completed for 5,181 of these children, which corresponds to a response rate of 99.1 percent. Overall response rates of 97.2 percent and 97.8 percent are calculated for 15-49-year-old women’s and under-5’s interviews respectively. This response rate calculated for men aged 15-59 was 93.8 percent. Infant and Child Mortality In MICS surveys, infant and under-5 mortality rates are calculated based on an indirect estimation technique known as the Brass method2. The infant mortality rate is estimated at 28 per 1,000 live births, while the probability of dying under-5 is around 31 per 1,000 live births (these estimates refer to 2006). Nutritional Status of under-5 children In Kazakhstan 3.7 percent of children under 5 are moderately underweight (weight for age) and 1.2 percent are classified as severely underweight. At the same time, 13.1 percent of children are moderately stunted and 5.4 percent are too short. About 4.1 percent of children are wasted (weight for height) and 1.7 percent are severely wasted. Breastfeeding and Infant and Young Child Feeding Mothers of children born within the 2 years preceding the survey were interviewed during the survey. Despite the importance of early start of lactation and establishment of a physical and emotional relationship between a baby and a mother, only 67.8 percent of babies are breastfed for the first time within one hour of birth, and 87.9 percent of mothers started breastfeeding not later than within one day of giving birth. Only 31.8 percent of children aged less than six months are exclusively breastfed (a level considerably lower than recommended). By age 12-15 months, 50.8 percent of children are breastfed and by age 20-23 months, 26.1 percent are still breastfed. Overall, 49.4 percent of infants aged 6-8 months received solid, semi-solid, or soft foods. 24 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Salt Iodization In almost all households (98.7 percent), salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. In an extremely small proportion of households (0.8 percent), there was no salt available. In an overwhelming majority of households (85.4 percent), salt was found to contain 15 parts per million (ppm) or more of iodine. Low Birth Weight In Kazakhstan, almost all children (97.6 percent) were weighed at birth and approximately 4.5 percent of infants are estimated to weigh less than 2,500 grams at birth. Vaccinations According to all sources of information (respondents’ reports/vaccination cards) approximately all children (99.2 percent) aged 15-26 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 98.4 percent. According to the same information sources, the percentage declines for subsequent doses of DPT to 96.8 percent for the second dose, and 93 percent for the third dose. Similarly, 98.1 percent of children received the polio vaccine by age 12 months and this declines to 81.3 percent by the third dose. The coverage for measles vaccine by 12 months is lower than for the other vaccines at 89 percent. At the same time, the percentage of children who had all the recommended vaccinations by their first birthday is 70.6 percent. Solid Fuel Use Overall, 10.8 percent of all households in Kazakhstan are using solid fuels for cooking. Use of solid fuels is very low in urban areas (3.1 percent), but high in rural areas, where 19.8 percent of the households are using solid fuels. About 87.8 percent of households use a separate room such as a kitchen for cooking; the percentage of such households is 94.5 percent in urban areas and 86.6 percent in rural areas. Use of Improved Water Sources In Kazakhstan, 93.9 percent of population use improved sources of drinking water. For 88.4 percent of households, the improved drinking water source is on the premises. For 3.9 percent of all households, it takes less than 30 minutes to get to the water source and bring water, while members of 1.6 percent of households spend 30 minutes or more for this purpose. A total of 70.7 percent of the population uses one or another way to treat drinking water obtained from all sources, both improved and unimproved sources. Over 55 percent of population boils water as the main method of water treatment, 11.4 percent of population let the water stay and settle, 12.4 percent uses filters and about one percent of population said that they strain water through a cloth. Other methods of water treatment are not very popular. Use of Improved Sanitation Close to 99.4 percent of the population in Kazakhstan are living in households using improved sanitation facilities. Almost 100 percent of population uses improved sanitation facilities almost in all regions (except for Mangistau Oblast – 88 percent). In Kazakhstan, 66.7 percent of children faeces were disposed safely. This figure was about the same in urban and rural areas. 25MONITORING THE SITUATION OF CHILDREN AND WOMEN Contraception Current use of contraception was reported by 51 percent of women currently married or in union. The most popular method is the intrauterine device (IUD) which is used by one in three (33.5 percent) women in Kazakhstan. The next most popular method is male condom (7.2. percent), while oral contraceptives are used by 7.1 percent of women. Only 40.6 percent of male respondents answered affirmatively to the question about their own or their partner’s use of any method of contraception. Unmet Need The survey shows that 11.6 percent of surveyed women have an unmet need for contraception. Unmet need for spacing and limiting are 6.9 and 4.7 percent respectively. Antenatal Care Coverage of antenatal care is very high in Kazakhstan with almost all women (99.2 percent) receiving skilled antenatal care (by a doctor, nurse, midwife or feldsher) at least once during the pregnancy. About 87 percent of women had more than four antenatal care visits during pregnancy. Assistance at Delivery In Kazakhstan all births (100 percent) occurring in the two years preceding the MICS survey were delivered by skilled personnel. Doctors assisted with the delivery of 81.7 percent of births, midwives and nurses assisted with 17.8 percent of births and feldshers and auxiliary midwives assisted with 0.4 percent. Abortions The average number of incomplete pregnancies per woman is 0.4. There are no major differences in abortion practice depending on the area, wealth quintile or the level of woman’s education. Age-related abortion rates increase after the age of 19 and stay at approximately the same level in the age groups 20-24, 25-29 and 30- 34 years old. An insignificantly larger number of induced abortions per 1,000 women may be observed in rural areas. Total abortion rate is 0.26 per woman. General abortion rate is 6.9 per 1,000 women. In 36.7 percent of the cases the woman makes an independent decision to have an abortion, at the same time every third woman (31.2 percent) is influenced by the doctor (medical worker), while every fourth respondent (26.3 percent) makes this decision together with her husband or partner. Literacy among Young Women and Men Literacy level among all women and men aged 15-24 is 99.9 percent. School Readiness Overall, 81.6 percent of children who are currently attending the first grade of primary school were attending pre- school the previous year in Kazakhstan. There are no significant differences across this indicator among boys and girls; however, there are differences across regions and socio-economic status of the households. It is important to note that compared to 2006 (MICS, Kazakhstan 2006)3, child pre-school attendance rate has increased by 5 times. 3 Multiple Indicator Cluster Survey 2006, Kazakhstan. Final Report. 26 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Primary and Secondary School Entry and Attendance Of all children of school entry age (7 years old) 93.8 percent entered the first grade. A total of 99.3 percent of children aged 7-10 are attending primary school4. Only 0.7 percent of children are out of school when they are expected to be participating in school. The proportion of children aged 11-17 attending secondary school is 96.1 percent. The ratio of girls to boys attending primary and secondary education is better known as the Gender Parity Index (GPI). The gender parity index for primary and secondary education in Kazakhstan is 1.00. Birth Registration The births of 99.7 percent of children aged under 5 in Kazakhstan were registered. Child Discipline In Kazakhstan, 49.4 percent of children aged 2-14 were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members in the month preceding the survey. As a whole, 2.1 percent of children were subjected to severe physical punishment in the country. It should also be noted that only a small part of respondents to household questionnaire (6.5 percent) believe that children should be physically punished to be raised properly; although in reality more than 29 percent of children aged 2-14 years were subjected to any form of physical punishment. Early Marriage In Kazakhstan, 4.5 percent of women aged 15-19 were married or in union. The proportion of women at the age of 15-49 who got married or lived in union with men before they turned 15 was 0.2 percent. This indicator for men in the age group 15-59 is 0.3 percent. The proportion of people at the age of 20-49 who married before they turned 18 was 8.6 percent among women and 1.1 percent among men. Slightly more than 7 percent of women aged 20- 24 and 8 percent of women aged 15-19 were married to a man ten or more years older at the time of the survey. The percentage of women reported that their husbands were younger is 9.8 percent. Attitude towards Domestic Violence Overall, 12.2 percent of women in Kazakhstan feel that a husband/partner has a right to hit or beat them for at least one of a variety of reasons. Women who approve their partner’s violence in most cases agree and justify violence in instances when they neglect the children (9.7 percent), or if they demonstrate their autonomy, e.g. go out without telling their husbands (3.1 percent) or argue with them (3.7 percent). Only 1.2 percent of women believe that a partner has a right to hit or beat them if they refuse to have sex with their partners or if they burn the food (0.8 percent). The percentage of men (16.7 percent) who agree to beat his wife refer at least one of the variety of reasons is higher than women (12.2 percent). 4 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. 27MONITORING THE SITUATION OF CHILDREN AND WOMEN Knowledge about HIV Transmission and Misconceptions about HIV/AIDS In Kazakhstan, almost all interviewed women (95.9 percent) have heard of HIV/AIDS. However, the percentage of women who know of two main ways of preventing HIV transmission (having only one faithful uninfected partner and using a condom every time while having sex) is only 70.5 percent. About 79 percent of interviewed women know of having one faithful uninfected sex partner and about the same percentage (78.9 percent) know of using a condom every time while having sex as main ways of preventing HIV transmission. Almost 95.6 percent of women in the 15-24 age group have heard about HIV, but only 67.2 percent of the respondents indicated that they were aware of at least two ways to prevent HIV transmission. Women aged 15-19 are less aware about ways to prevent HIV (61.5 percent) than those respondents (72.5 percent) who are older. The results of a similar survey among men showed that almost all interviewed men aged 15-59 years (94.6 percent) had ever heard of HIV, with the proportion of men knowing the two main ways of HIV prevention being 73.6 percent. The survey showed that men are better aware of HIV prevention methods than women. In terms of knowledge of where to get HIV tested, 81.1 percent of women and 75.5 percent of men knew where to be tested. Accepting Attitudes toward People Living with HIV/AIDS In Kazakhstan 90.7 percent of interviewed women who have heard of HIV/AIDS agree with at least one of the accepting attitudes. Men are less loyal to people with HIV/AIDS than women. The most popular loyal attitude is the readiness to take care of the family member with AIDS at home – 86.4 percent of interviewed women and 83.5 percent of interviewed men agreed to do it. Only 33.8 percent of women and 28.5 percent of men believe that a female teacher with HIV/AIDS should be allowed to continue teaching at school and only 18 percent of women and men are ready to buy fresh vegetables from an HIV/AIDS infected seller, while 15.3 percent of women and 14.5 percent of men would not keep secret that their family member is infected with the HIV virus. In Kazakhstan only a little over 2.5 percent of women and men agree with all loyal attitudes towards people living with HIV/AIDS. Use of Tobacco In Kazakhstan, tobacco use is more prevalent among men than among women. About 74.3 percent of men and 20.8 percent of women reported ever using a tobacco product. Major differences are found when 7.5 percent of women and 54.9 percent of men smoked cigarettes or used smokeless or smoking tobacco products on one or more days in the past month. Cigarettes are now the most popular tobacco product among men and women using tobacco (6.5 percent of women and 50.7 percent of men smoked only cigarettes in the past month). Those currently smoking cigarettes whith more than 20 cigarettes in the past 24 hours are vastly greater among men with 36.2 percent as compared to women with 9.7 percent. The survey showed that 1.3 percent of women aged 15-49 and 8.7 percent of men aged 15-49 smoked their first cigarette before the age of 15. Use of Alcohol In Kazakhstan, 26.6 percent of women aged 15-49 had at least one serving of alcohol on one or more days in the past month while among men, 45.6 percent aged 15-59 had at least one serving of alcohol on one or more days in the past month, which is higher than the same indicator among women (aged 15-49). The proportion of men who first had alcohol before the age of 15, is also higher than that of women (3.4 percent of men in the age group 15-49 compared to 0.9 percent of women in the age group 15 -49). 28 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Access to Mass Media A little over 60 percent of women and men read a newspaper, 29.1 percent of women and 40 percent of men listen to the radio and practically all interviewed women and men (98 percent each) watch television at least once a week. A small percentage of 0.8 of women are not exposed to some of the three mass media on a regular basis, whereas 22.9 percent are exposed to all three types of mass media at least once a week. Among men, the percentage of those exposed to all three types of mass media at least once a week is somewhat larger at 30.3 percent. Age groups 35-39 and 45-49 (67 percent in both groups) have a higher percentage of newspaper readers, whereas younger groups 15-19 and 20-24 have a higher percentage of radio listeners. Among men the highest percent of those reading newspapers is in the age group 45-49 (73.7 percent), men aged 20-24 and 25- 29 are most active radio listeners. Use of Information / Communication Technology According to the survey 95.1 percent of women aged 15-24 have ever used a computer, 83.6 percent used a computer within the past year, and 71 percent used it at least once a week during the past month. Overall, 76.6 percent of women aged 15-24 have ever used the Internet, while 67.5 percent used the Internet within the past year. The proportion of young women using the Internet more frequently, i.e., at least once a week during the past month, was smaller, 54 percent. The proportion of young men and women who used a computer and the Internet in the past year is almost the same. In the past year, 82.4 percent of men aged 15-24 years used computers and 55.7 percent used the Internet at least once. Domestic Violence In Kazakhstan 12.8 percent of ever-married women aged 15-49 experienced physical violence and 3.2 percent experienced sexual violence after the age 15. Of the women aged 15-49 who reported having been physically abused, 60.2 percent reported being abused by their husbands/partners and 39.6 percent by their ex-husbands/ partners. Of the currently married women who reported having been physically abused, 100 percent reported being abused by their husband/partner and 9.3 percent by their ex-husbands/ex-partners. Of the never married women who reported having been physically abused, 30.1 percent reported being abused by their mothers/ stepmothers, 18.4 percent by their sisters/brothers, 13.1 percent by their fathers/stepfathers and 18.8 percent by their ex-boyfriends. Husbands/partners demonstrated the following specific types of behaviour: jealousy (42.6 percent), constant control (44.3 percent), and accusing wife of unfaithfulness (10.9 percent). Limitations of contacts with the wife’s family and girlfriends could also be observed (4.1 percent and 9.0 percent respectively). Besides moral and psychological forms of abuse, there were also economic abuse of women demonstrated in not trusting wives with the money (7.0 percent). Of those who have ever sought help the largest proportion of women sought help from their families and their husbands’ families (33.7 and 14.3 percent respectively); only 8.8 percent of women sought help from policemen and 8.8 percent sought help from relatives. There were very few cases of women seeking help from advocates/lawyers and organizations providing social assistance (0.2 -0.4 percent respectively). 29MONITORING THE SITUATION OF CHILDREN AND WOMEN I. Introduction 30 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Background Declaration by the President of the Republic of Kazakhstan, the Government of the Republic of Kazakhstan committed itself to monitoring progress towards the Millennium Development Goals (MDGs) by 2015. Assessment of progress indicators is crucial both as input for further action and for assessment of changes. Long-term strategic development of This report is based on the Kazakhstan Multiple Indicator Cluster Survey (MICS), conducted in 2010- 2011 by the Agency of Statistics, RK primarily with technical and financial support of the United Nations Children’s Fund (UNICEF) and co-financing of the United Nations Population Fund (UNFPA). The survey provides valuable information on the situation of children, women and men in Kazakhstan, and was based, in large part, on the needs 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). Following the signing of the Millennium 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) 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.” 31MONITORING THE SITUATION OF CHILDREN AND WOMEN Kazakhstan is closely linked to the MDGs. State and sectoral programmes as well as national development strategies incorporate all MDGs and targets of the international conmitment. Strategic development priorities of Kazakhstan are also enshrined in the long- term National Strategy ‘Kazakhstan-2030’ and the Mid-Term Development Plan ‘Kazakhstan-2015’ and are focused on bridging gaps between the rich and the poor, strengthening human security through lower social vulnerability, better quality of social services, environment enhancement, civil society involvement in development and strengthening the institutional capacity of government authorities. Over the past 20 years Kazakhstan has made significant progress towards the MDGs. The Republic has developed a number of strategies and state programmes to achieve national goals and priorities such as: • 2000-2002 Programme to Combat Poverty and Unemployment in the Republic of Kazakhstan; • 2003-2005 State Poverty Reduction Programme; • 2005-2010 State Programme to Reform and Develop Public Healthcare; • 2005-2010/11 State Education Programme in Kazakhstan; • 2011-2020 State Education Development Programme of the Republic of Kazakhstan; • 2006-2016 Gender Equality Strategy of the Republic of Kazakhstan; • 2004-2010 Rural Development Programme; • 2002-2010 Sectoral Programme ‘Drinking Water’; • 2001-2005 Programme to Counteract AIDS Epidemics in the Republic of Kazakhstan; • 2006-2011 ‘Children of Kazakhstan’ Programme; • 2010-2014 Pre-Schooling Coverage Programme ‘Balapan’; • 2011-2015 State Healthcare Development Programme ‘Salamatty Kazakhstan’; • 2011-2020 Water Supply Programme ‘Ak Bulak’; • Programme to Upgrade the Housing and Public Utility Sector until 2020; • 2007-2009 Programme to Bridge Informational Divide in the Republic of Kazakhstan; • The Convention on the Rights of the Child; • The Convention on the Elimination of All Forms of Discrimination against Women; • UN Framework Development Assistance Programme This Final Report presents the results of the indicators and topics covered in the survey. Survey Objectives The primary objectives of the Kazakhstan MICS 2010-2011 are: • To provide up-to-date information for assessing the situation of children, women and men in Kazakhstan; • 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 Kazakhstan 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 disparities, to inform policies and interventions and develop state programmes on the improvement of all spheres of life. II. Sample and Survey Methodology 33MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Design The sample for MICS4 2010-2011 was de- signed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for 16 regions: Akmola, Aktobe, Almaty, Atyrau, East Ka- zakhstan, Zhambyl, West Kazakhstan, Karaganda, Kostanai, Kyzylorda, Mangistau, Pavlodar, North Ka- zakhstan and South Kazakhstan Oblasts and Astana and Almaty cities. The sample was selected in three stages. The sample was stratified down to urban and rural ar- eas as follows: each of 14 oblasts was divided into 2 groups: urban and rural, forming 28 strata, plus two urban strata, Astana and Almaty cities, thus result- ing in 30 strata (16 urban and 14 rural ones). Primary sampling units (PSUs) or clusters were determined based on the 2009 Population Census enumeration areas as one (or more) enumeration area per PSU. At the first stage, 780 PSUs throughout the country were selected with probability proportional to size within each stratum, where the measure of size of each PSU was based on the estimated number of segments. Some of the PSUs were so large that it was not economically possible to compile a new list of households, in such cases the use of smaller seg- ments as clusters was more effective. In Kazakhstan MICS for 2010-2011, the size of PSUs was measured by the number of standard segments determined by dividing the number of PSU households by 100 and rounding it up to the nearest whole number. At the second stage, each selected PSU was divided into segments with 100 households each, us- ing available maps or new sketch maps drawn up by enumerators in the field. Segmentation was only done for PSUs with a size corresponding to 2 or more seg- ments. In this case, the PSU was divided into parts equal to the number of segments and each segment had approximately the same number of households. Following that, one segment was selected with equal probability. A list of households was made for each of the selected segments and used afterwards during the third sampling stage. During the third stage, 21 households were selected systematically with equal probability in each selected PSU or segment. Thus, the total sample size was 16,380 households. The sample is not self-weighting. For report- ing national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires o Child Discipline o Salt Iodization The Questionnaire for Individual Women was ad- ministered to all women aged 15-49 years living in the households, and included the following modules: o Women’s Background o Access to Mass Media and Use of Information/ Communication Technology o Child Mortality o Desire for Last Birth o Maternal and Newborn Health o Illness Symptoms o Contraception o Unmet Need o Attitudes Towards Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Tobacco and Alcohol Use o Domestic Violence Four sets of questionnaires were used in the survey: 1) Household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) Women’s questionnaire administered in each house- hold to all women aged 15-49 years; 3) Under-5 questionnaire, administered to mothers or caretakers for all children under 5 living in the house- hold; 4) Men’s questionnaire was introduced in Kazakhstan MICS4 for the first time and was administered to se- lected men aged 15-59 living in every third household in the cluster. Each questionnaires included its own modules: The Household Questionnaire included the following modules: o Household Listing Form o Education o Water and Sanitation o Household Characteristics 34 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 5 The terms “children under 5”, “children aged 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 6 The model MICS4 questionnaires can be found at www.childinfo.org The Questionnaire for Individual Men was adminis- tered to each third man among all men aged 15-59 living in the households, and included the following modules: o Men’s Background o Access to Mass Media and Use of Information/ Communication Technology o Contraception o Attitudes Towards Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Circumcision o Tobacco and Alcohol Use The Questionnaire for Children Under 5 was admin- istered to mothers or caretakers of children under 5 5 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 fol- lowing modules: o Age o Birth Registration o Early Childhood Development o Breastfeeding o Care of Illness o Immunization o Anthropometry The questionnaires are based on the MICS 2006 model questionnaire6. From the MICS 2006 model Eng- lish version, the questionnaires were translated into Rus- sian and Kazakh. The MICS 2010-2011 questionnaires include new modules on Access to Mass Media and Use of Information and Communication Technology, Sexual Behaviour, Tobacco and Alcohol Use. As recommend- ed by UNFPA a module on Abortions was added and due to the adoption of the Law of the Republic of Ka- zakhstan on the Prevention of Domestic Violence. The Agency of Statistics suggested including a module on Domestic Violence. The questionnaires were pre-test- ed in Astana during July-August 2010. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires into Ka- zakh. A copy of the Kazakhstan MICS questionnaires is provided in Appendix F. In addition to conducting interviews, the teams working in the fields tested salt used for cooking in the households for iodine content and measured the weights and heights of children under 5. Details and findings of these measurements are provided in the respective sections of the report. 35MONITORING THE SITUATION OF CHILDREN AND WOMEN Training and Fieldwork tures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. To- wards the end of the training period, trainees spent 2 days in practice interviewing in Schuchye in Ak- mola Oblast. The data were collected by 16 teams; each was comprised of 6 interviewers (of them 5 wom- en and 1 man who was simultaneously measur- ing children’s weight and height), one driver, one editor, one measurer and a supervisor. Fieldwork began in November 2010 and concluded in Janu- ary 2011. The data were entered on 18 computers and carried out by 14 data entry operators and 4 data en- try supervisors (including 2 editors) using the CSPro software. In order to ensure quality control, all ques- tionnaires were double entered and internal consis- tency checks were performed. Procedures and stan- dard programmes developed under the global MICS4 programme and adapted to the Kazakhstan question- naire were used throughout. Data processing began simultaneously with data collection in November 2010. Data entry was completed in the end of January 2011; processing and editing of the primary database was completed in July – August 2011. In August 2011 the results of preliminary MICS4 analysis were presented to concerned authorities (representatives of various ministries and agencies) as well as international orga- nizations. The tables in certain new modules (for in- stance on Domestic Violence and Abortions) and the Questionnaire for Individual Men were discussed and corrected with the help of UNICEF international consul- tants up until the end of 2011. Data were analysed using the Statistical Pack- age for Social Sciences (SPSS) software programme, Version 18, and the model syntax and tabulation plans developed by UNICEF and adapted to the Ka- zakhstan questionnaires by a software expert from the Information and Computer Centre of the Agency of Statistics, RK. Data Processing The preparation of the Agency of Statistics, RK staff involved in Kazakhstan MICS4 was carried out by UNICEF headquarters in New York and UNICEF Regional Office for CEE/CIS countries who organized their participation in regional training seminars in 2009- 2011 (2009 – Amman (Jordan); 2010, 2011 – Istanbul (Turkey); 2010 – Belgrade (Serbia). Training seminar programmes focused on sampling design, survey lo- gistics and budget planning; themes for certain MICS4 questionaire modules, MICS indicators, data and tabu- lation processing as well as MICS results dissemina- tion. Training for the fieldwork was conducted for 12 days in September 2010. Training included lec- III. Sample Coverage and the Characteristics of Households and Respondents 37MONITORING THE SITUATION OF CHILDREN AND WOMEN Sample Coverage Of the 16,380 households selected for the sample, 16,018 were found to be occupied. Of these, 15,800 were successfully interviewed for a house- hold response rate of 98.6 percent. In the interviewed households, 14,228 women (age 15-49 years) were identified. Of these, 14,014 women were success- fully interviewed, yielding a response rate of 98.5 percent. For men (age 15-59 years), these indicators were 4,043 – listed, 3,846 – successfully interviewed giving response rate 95.1 percent. In addition, 5,227 children under 5 were listed in the household ques- tionnaire. Questionnaires were completed for 5,181 of these children, which corresponds to a response rate of 99.1 percent. Overall response rates of 97.2 and 97.8 percent are calculated for 15-49 year-old women’s and under-5’s interviews respectively. The response rate for men (aged 15-59 years) was 93,8 percent. Table HH.1: Results of household, women, men and under-5 interviews Numbers of households, and response rates of women, men and children under 5, Kazakhstan, 2010/11 Residence Total Urban Rural Households Households sampled 10038 6342 16380 Households occupied 9822 6196 16018 Households interviewed 9629 6171 15800 Overall response rate 98,0 99,6 98,6 Women Women eligible 8341 5887 14228 Women interviewed 8234 5780 14014 Women response rate 98,7 98,2 98,5 Women’s overall response rate 96,8 97,8 97,2 Men Men eligible 2332 1711 4043 Men interviewed 2207 1639 3846 Men response rate 94,6 95,8 95,1 Men’s overall response rate 92,8 95,4 93,8 Children under 5 Children under 5 eligible 2678 2549 5227 Interviewed children under 5 2653 2528 5181 Child response rate 99,1 99,2 99,1 Children’s overall response rate 97,1 98,8 97,8 38 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Continued REGIONS Akmola Oblast Aktobe Oblast Almaty Oblast Almaty city Astana Atyrau Oblast East Kazakhstan Oblast Zhambyl Oblast Households Households sampled 1176 882 1008 1008 924 798 1218 882 Households occupied 1134 849 975 1000 923 785 1177 866 Households interviewed 1118 813 956 990 920 774 1142 857 Household response rate 98,6 95,8 98,1 99,0 99,7 98,6 97,0 99,0 Women Eligible women 771 794 996 801 937 887 836 815 Interviewed women 744 788 985 800 931 859 819 804 Women response rate 96,5 99,2 98,9 99,9 99,4 96,8 98,0 98,7 Women’s overall response 95,1 95,0 97,0 98,9 99,0 95,5 95,1 97,6 Men Eligible men 267 226 268 217 233 225 276 229 Interviewed men 250 210 254 211 231 198 258 223 Men response rate 93,6 92,9 94,8 97,2 99,1 88,0 93,5 97,4 Men’s overall response rate 92,3 89,0 92,9 96,3 98,8 86,8 90,7 96,4 Children under 5 Eligible children under 5 239 297 357 138 294 383 258 387 Interviewed children under 5 229 295 356 137 294 382 255 386 Child response rate 95,8 99,3 99,7 99,3 100,0 99,7 98,8 99,7 Children’s overall response rate 94,5 95,1 97,8 98,3 99,7 98,3 95,9 98,7 Continued REGIONS West Kazakhstan Oblast Karaganda Oblast Kostanai Oblast Kyzylorda Oblast Mangistau Oblast Pavlodar Oblast North Kazakhstan Oblast South Kazakhstan Oblast Households Households sampled 966 1218 1260 798 798 1176 1260 1008 Households occupied 953 1210 1249 777 743 1144 1242 991 Households interviewed 949 1207 1237 776 714 1129 1240 978 Household response rate 99,6 99,8 99,0 99,9 96,1 98,7 99,8 98,7 Women Eligible women 843 955 879 874 887 917 906 1130 Interviewed women 840 944 871 869 863 881 893 1123 Women response rate 99,6 98,8 99,1 99,4 97,3 96,1 98,6 99,4 Women’s overall response 99,2 98,6 98,1 99,3 93,5 94,8 98,4 98,1 Men Eligible men 245 260 270 235 217 287 296 292 39MONITORING THE SITUATION OF CHILDREN AND WOMEN REGIONS West Kazakhstan Oblast Karaganda Oblast Kostanai Oblast Kyzylorda Oblast Mangistau Oblast Pavlodar Oblast North Kazakhstan Oblast South Kazakhstan Oblast Interviewed men 238 246 261 231 197 275 283 280 Men response rate 97,1 94,6 96,7 98,3 90,8 95,8 95,6 95,9 Men’s overall response rate 96,7 94,4 95,7 98,2 87,2 94,6 95,5 94,6 Children under 5 Eligible children under 5 291 314 250 455 468 268 218 610 Interviewed children under 5 291 312 249 453 457 259 218 608 Child response rate 100,0 99,4 99,6 99,6 97,6 96,6 100,0 99,7 Children’s overall response rate 99,6 99,1 98,6 99,4 93,8 95,4 99,8 98,4 It should be noted that household response rate is 99.6 percent in rural areas, which is slightly higher than in urban areas at 98 percent. The overall household response rate through- out the country was high and varied from 95.8 to 96.1 percent in Aktobe and Mangistau Oblasts, to 97 per- cent in East Kazakhstan Oblast, from 98.1 to 98.7 percent in Almaty, Akmola, Atyrau, South-Kazakhstan and Pavlodar Oblasts, from 99 to 99.9 percent in Kostanai, Zhambyl, West Kazakhstan, Karaganda, North-Kazakhstan and Kyzylorda Oblasts and Astana and Almaty cities. According to table HH.1, the response rate among men (95.1 percent) is slightly lower than the response rate among women (98.5 percent) and moth- ers/caretakers (99.1 percent). The age and sex distribution of survey popu- lation is provided in Table HH.2. The distribution is also used to produce the population pyramid in Fig- ure HH.1. A total of 54,549 household members were listed, from the 15,800 households successfully inter- viewed. These data also demonstrate that according to the assessment made during the 2009 Census, the size of an average household is 3.5 people. 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, by sex, Kazakhstan, 2010/11 MALES FEMALES TOTAL Number Percent Number Percent Number Percent Age 0–4 2654 10,2 2544 8,9 5198 9,5 5–9 2117 8,1 2217 7,8 4334 7,9 10–14 2056 7,9 2065 7,2 4120 7,6 15–19 2249 8,6 2039 7,2 4289 7,9 20–24 2361 9,1 2206 7,7 4567 8,4 25–29 2085 8,0 2036 7,1 4122 7,6 30–34 1960 7,5 2030 7,1 3990 7,3 35–39 1829 7,0 1916 6,7 3745 6,9 40–44 1788 6,9 1936 6,8 3724 6,8 45–49 1863 7,2 1993 7,0 3856 7,1 50–54 1599 6,1 2040 7,2 3639 6,7 Characteristics of Households 40 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MALES FEMALES TOTAL Number Percent Number Percent Number Percent 55–59 1120 4,3 1520 5,3 2640 4,8 60–64 919 3,5 1204 4,2 2123 3,9 65–69 445 1,7 679 2,4 1125 2,1 70-74 600 2,3 1020 3,6 1620 3,0 75-79 214 0,8 502 1,8 716 1,3 80-84 139 0,5 381 1,3 519 1,0 85+ 50 0,2 167 0,6 217 0,4 Missing/DK 0 0,0 3 0,0 3 0,0 Dependency age groups Below 15 6827 26,2 6825 23,9 13653 25,0 15–64 17774 68,2 18921 66,4 36695 67,3 65 and older 1449 5,6 2749 9,6 4198 7,7 Missing/DK 0 0,0 3 0,0 3 0,0 Children and adult populations Children age 0–17 8243 31,6 8080 28,4 16323 29,9 Adults 18+ 17807 68,4 20416 71,6 38223 70,1 Missing/DK 0 0,0 3 0,0 3 0,0 Total 26050 100,0 28499 100,0 54549 100,0 The population aged 0-14 make up 25 percent of the surveyed population, including 6,827 boys (26.2 percent of all men) and 6,825 girls (23.9 percent of all women). The population aged 15-64 make up 67.3 per- cent, where 68.2 percent or 17,744 are men and 66.4 percent or 18,925 are women. For the population aged above 65 were surveyed a total of 4,198 people or 7.7 percent including 1,449 men (5.6 percent) and 2,749 women (9.6 percent). There are 16,323 children aged 0-17, account- ing for 29.9 percent of all surveyed household mem- bers, 31.6 percent are males and 28.4 percent are females. Compared to the 2009 Census data, the MICS shows a 3, 0.3 and 0.7 percent larger popula- tion in the 0-14, 0-17 and 65+ age groups respec- tively, and a 2 percent smaller population in the age group 15-64. 41MONITORING THE SITUATION OF CHILDREN AND WOMEN From Figure HH.1, a total of 54,549 people aged 0 to 85 years and older were surveyed in these house- holds, of these 47.8 percent are men and 52.2 percent are women. As currently reported by the Agency of Sta- tistics, RK as of January 1, 2011, the proportion of men and women was 48.2 percent and 51.8 percent respec- tively, and the sample did not show large deviations. In the age-sex pyramid, age groups are broken down into five-year groups: 0-4 years, 5-9 years, and so forth to 85 years and above. The proportion of men and women in these age groups was grouped: based on 0-4 years with 4.8 percent male and 4.7 percent female; 5-9 years with 3.9 percent male and 4.1 percent female; 10-14 years with 3.8 percent male and 3.8 percent female; 15-19 years with 4.1 percent male and 3.7 percent female; 20-24 years with 4.3 percent male and 4.0 percent female; 25-29 years with 3.8 percent male and 3.7 percent female; 30-34 years with 3.6 percent male and 3.7 percent female; 35-39 years with 3.4 percent male and 3.5 percent female; 40-44 years with 3.3 percent male and 3.6 percent female. In the age group 85 years and above the make up of men is 0.1 percent and women is 0.3 percent. It should be noted that starting from the age group 55-59, the gap between the proportions of men and women widens, reaching 1.9 percent in the age group 70 and above. These data show the same trend in the age-sex population pyramid in current statistics as of Janu- ary 1, 2011. Distribution of male and female shares by these age groups in the sample is similar to the current statistics. Tables HH.3 to HH.5 provide basic information on the households, female respondents aged 15-49, male respondents aged 15-59 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 inter- viewed 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 present- ed only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background informa- tion on the households. Within households, the sex of the household head, region, residence, number of household members, education of household head and language/ethnicity7 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report. The fig- ures in the table are also intended to show the numbers of observations by major categories of analysis in the report. Table HH.3: Household composition Percentage distribution of households by selected characteristics, Kazakhstan, 2010/11 Weighted percent Number of Households weighted unweighted Sex of household head Male 63,9 10090 10136 Female 36,1 5710 5664 Region Akmola Oblast 5,6 884 1118 Aktobe Oblast 4,5 713 813 Almaty Oblast 9,3 1470 956 Almaty city 9,3 1473 990 Astana city 3,4 544 920 Atyrau Oblast 2,3 359 774 East Kazakhstan Oblast 10,6 1673 1142 Zhambyl Oblast 5,6 890 857 West Kazakhstan Oblast 4,1 647 949 Karaganda Oblast 10,3 1629 1207 Kostanai Oblast 7,1 1129 1237 7 Determined by asking the question regarding the mother tongue of the household head. The question was asked in the following way: HC1b. What is the mother tongue of the household head? 42 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Households weighted unweighted Kyzylorda Oblast 3,2 498 776 Mangistau Oblast 2,4 372 714 Pavlodar Oblast 5,9 931 1129 North Kazakhstan Oblast 5,0 795 1240 South Kazakhstan Oblast 11,4 1794 978 Residence Urban 60,7 9598 9629 Rural 39,3 6202 6171 Number of Household Members 1 15,7 2488 2462 2 20,8 3284 3292 3 19,7 3113 3147 4 17,9 2831 2910 5 11,9 1875 1859 6 6,9 1084 1070 7 3,8 597 558 8 1,6 256 243 9 0,9 147 133 10+ 0,8 125 126 Education of Household Head No 0,5 74 60 Incomplete secondary 12,0 1904 1896 Secondary 30,3 4793 4720 Specialized secondary 32,4 5120 5242 Higher 24,7 3910 3882 Ethnicity/language of Household Head Kazakh 53,8 8501 8740 Russian 32,6 5158 5051 Other ethnic groups 13,5 2141 2009 Total 100 15800 15800 Households with At least one child age 0-4 years 24,9 15800 15800 At least one child age 0-17 years 52,9 15800 15800 One woman age 15-49 67,6 15800 15800 One man age 15-59 73,9 15800 15800 Mean Household Size 3,5 15800 15800 43MONITORING THE SITUATION OF CHILDREN AND WOMEN The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, and at least one eligible woman aged 15-49 and one eligible man aged 15-59. The percentage of households with at least one child under 18 was 52.9 percent, 24.9 percent of households had children under 5, and the pro- portion of households with at least one woman (age 15-49) and one man (age 15-59) was 67.6 and 73.9 percent respectively. About 15.7 percent of households had one member (14.6 percent accord- ing to the 2009 census), 20.8 percent had 2-3 mem- bers (38.3 percent), 19.7 percent had 4-5 members (31 percent), 17.9 percent had 6-7 members (11.6 percent), 11.9 percent had 8-9 members (3 percent) and 6.9 percent had 10 or more members (1.5 percent). Characteristics of Female Respondents 15-49 / Male Respondents 15-59 Years of Age and Children Under 5 Tables HH.4, HH.4M and HH.5 provide infor- mation on the background characteristics of female respondents 15-49 years of age, male respondents 15-59 years of age and of children under 5. In all tables, the total numbers of weighted and unweighted obser- vations are equal, since sample weights have been normalized (standardized). 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.4: Women’s background characteristics Percentage distribution of women age 15-49 years by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Women Weighted Unweighted Region Akmola 4,3 603 744 Aktobe 4,9 694 788 Almaty 10,8 1518 985 Almaty city 8,5 1190 800 Astana city 3,8 539 931 Atyrau 2,9 409 859 East Kazakhstan 8,6 1210 819 Zhambul 6,0 836 804 West Kazakhstan 4,0 566 840 Karaganda 9,1 1274 944 Kostanai 5,6 791 871 Kyzylorda 3,9 553 869 Mangistau 3,3 461 863 Pavlodar 5,3 746 881 North Kazakhstan 4,1 577 893 South Kazakhstan 14,6 2048 1123 Residence Urban 57,5 8055 8234 Rural 42,5 5959 5780 44 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Women Weighted Unweighted Age 15-19 14,4 2022 2012 20-24 15,5 2178 2170 25-29 14,4 2016 2024 30-34 14,3 2005 1996 35-39 13,6 1901 1892 40-44 13,7 1919 1941 45-49 14,1 1972 1979 Marital/Union status Currently married/in union 60,2 8434 8426 Widowed 3,0 418 421 Divorced 6,3 888 885 Separated 2,2 311 318 Never married/in union 28,3 3963 3964 Motherhood Status Ever gave birth 67,6 9469 9490 Never gave birth 32,4 4545 4524 Births in Last Two Years Had a birth in last two years 14,2 1993 2027 Had no birth in last two years 85,8 12021 11987 Education None 0,2 25 26 Secondary incomplete 3,9 553 534 Secondary 31,5 4407 4227 Secondary specialised 32,4 4539 4705 High 32,0 4489 4522 Wealth Index Quintile Poorest 18,0 2528 2243 Second 18,5 2599 2527 Middle 19,6 2743 2812 Fourth 20,3 2839 2946 Richest 23,6 3305 3486 Religion/Language/Ethnicity of Household Head Kazakh 64,2 9003 9275 Russian 22,6 3168 3126 Other ethnic group 13,2 1843 1613 Total 100,0 14014 14014 45MONITORING THE SITUATION OF CHILDREN AND WOMEN 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 components 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 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: electricity, radio, colour TV set, mobile phone, stationary (non-mobile) telephone, refrigerator, PC/laptop, DVD player, dish washer, microwave oven, washing machine, vacuum cleaner as well as the following items belonging to household members such as bicycle, motorbike/, horse cart, vehicle, motor boat). The wealth index is assumed to capture the underlying long-term wealth through information on the household 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 for only 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 background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women ac- cording to region, residence, age, marital status, moth- erhood status, education8, wealth index quintiles9, and ethnicity/language. Key findings from Table HH.4 are as follows. In the weighted sample, 57.5 percent of women aged 15- 49 lived in an urban and 42.5 percent lived in a rural area. At the time 60.2 percent of women were married or in union, 11.5 percent were divorced/separated or widowed, and 28.3 percent were never married. In terms of the motherhood status, 67.6 percent of women had given birth at least once. By educational attainment, the distribution is as follows: 3.9 percent have incomplete secondary education, 31.5 percent have completed secondary education, 32.4 percent have completed specialized secondary education and 32 percent completed higher education. In terms of wealth, the share of second and poorest quintiles were about the same, 18.0 and 18.5 percent respectively. The middle quintile was 19.6 per- cent; while the fourth and richest quintiles were 20.3 percent and 23.6 percent respectively. In terms of eth- nicity 64.2 percent were headed by Kazakhs, 22.6 per- cent – by Russians, and 13.2 percent were headed by other ethnic groups. 46 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table HH.4М: Men’s background characteristics Percentage distribution of men age 15-59 years by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Men weighted weighted Region Akmola Oblast 4,6 178 250 Aktobe Oblast 4,7 182 210 Almaty Oblast 11,0 423 254 Almaty city 7,8 302 211 Astana city 3,2 125 231 Atyrau Oblast 2,9 112 198 East Kazakhstan Oblast 8,8 340 258 Zhambyl Oblast 6,2 240 223 West Kazakhstan Oblast 4,1 158 238 Karaganda Oblast 8,7 333 246 Kostanai Oblast 5,7 219 261 Kyzylorda Oblast 4,1 157 231 Mangistau Oblast 3,1 121 197 Pavlodar Oblast 5,3 206 275 North Kazakhstan Oblast 4,3 164 283 South Kazakhstan Oblast 15,3 587 280 Residence Urban 53,6 2061 2207 Rural 46,4 1785 1639 Age 15-19 10,2 394 398 20-24 11,3 433 425 25-29 11,3 434 439 30-34 14,3 548 557 35-39 14,0 539 519 40-44 11,8 453 444 45-49 11,2 432 431 50-54 9,4 361 363 55-59 6,5 251 270 Marital Status Currently married/in union 67,5 2595 2616 Widowed 0,7 26 24 Divorced 3,7 141 134 Separated 1,2 46 47 Never married/in union 27,0 1039 1025 Education of Household Head No 0,1 3 4 Incomplete secondary 4,8 184 194 Secondary 37,6 1444 1362 Specialized secondary 32,8 1261 1316 Higher 24,8 953 970 47MONITORING THE SITUATION OF CHILDREN AND WOMEN Weighted percent Number of Men weighted weighted Wealth Index Quintile Poorest 19,2 737 631 Second 19,4 748 702 Middle 20,1 773 785 Fourth 20,5 789 837 Richest 20,8 799 891 Ethnicity of Household Head Kazakh 61,7 2374 2386 Russian 24,8 952 1007 Other ethnic groups 13,5 520 453 Total 100,0 3846 3846 poorest quintiles was about the same, 19.2 and 19.4 percent respectively; the middle quintile was 20.1 percent; and the fourth and richest quintiles was 20.5 and 20.8 percent respectively. In terms of ethnicity, 61.7 percent of men were 20.5 and 20.8 percent lived in households headed by Kazakhs, 24.8 per- cent by Russians, and 13.5 percent lived in house- holds headed by other ethnic groups. Table HH.5 provides background characteristics of children under 5 including information on the distri- bution of children according to such attributes as sex, region, residence, age, mother’s/caretaker’s educa- tion, wealth index quintile and ethnicity. Table HH.4M provides background characteris- tics of male respondents. In the weighted sample, 53.6 percent of men aged 15-59 lived in an urban and 46.4 percent lived in a rural area. At the time of the survey 67.5 percent of men were married or in union, 5.6 per- cent were divorced/separated or widowed, and 27.0 percent were never married. By educational attainment, 4.8 percent of men have incomplete secondary education, 37.6. percent have completed secondary education, 32.8 percent have completed specialized secondary education and 24.8 percent completed higher education. In terms of wealth, the share of second and Table HH.5: Children’s background characteristics Percentage distribution of children under 5 by background characteristics, Kazakhstan, 2010/11 Weighted percent Number of Children Under 5 weighted weighted Sex of Household Head Male 51,0 2644 2615 Female 49,0 2537 2566 Region Akmola Oblast 3,7 189 229 Aktobe Oblast 5,0 260 295 Almaty Oblast 10,6 551 356 Almaty city 3,9 202 137 Astana city 3,2 166 294 Atyrau Oblast 3,5 182 382 East Kazakhstan Oblast 7,2 372 255 Zhambyl Oblast 7,7 400 386 West Kazakhstan Oblast 3,8 195 291 Karaganda Oblast 8,1 420 312 Kostanai Oblast 4,3 222 249 Kyzylorda Oblast 5,6 292 453 48 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weighted percent Number of Children Under 5 weighted weighted Mangistau Oblast 4,7 244 457 Pavlodar Oblast 4,2 217 259 North Kazakhstan Oblast 2,7 139 218 South Kazakhstan Oblast 21,8 1129 608 Residence Urban 48,4 2508 2653 Rural 51,6 2673 2528 Age 0-5 months 10,3 532 543 6-11 months 10,3 532 538 12-23 months 20,0 1037 1044 24-35 months 21,2 1097 1095 36-47 months 19,4 1005 998 48-59 months 18,9 978 963 Mother’s Education* No 0,2 9 8 Incomplete secondary 1,9 96 83 Secondary 37,0 1916 1803 Specialized secondary 27,6 1432 1502 Higher 33,4 1729 1785 Wealth Index Quintile Poorest 24,1 1249 1053 Second 21,9 1134 1082 Middle 19,6 1015 1072 Fourth 16,7 865 934 Richest 17,7 919 1040 Ethnicity of Household Head Kazakh 71,9 3724 3862 Russian 15,2 785 778 Other ethnic groups 13,0 672 541 Total 100,0 5181 5181 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5 ing levels of education. About 1.9 percent of mothers had incomplete secondary education, 37 percent of mothers had completed secondary education, 27.6 percent of mothers had secondary specialized educa- tion and 33.4 percent of mothers had completed high- er education. In terms of household’s wealth, children were distributed as follows: poorest – 24.1 percent, second – 21.9 percent, middle – 19.6 percent, fourth – 16.7 percent and richest – 17.7 percent. By ethnicity, 71.9 percent of children lived in households headed by Ka- zakhs, 15.2 percent by Russians and 13 percent lived in households headed by other ethnic groups. Key conclusions from Table HH.5 are as follows. The weighted and unweighted numbers of households are equal, since sample weights were normalized (see Appendix A). The weighted sample shows the following background characteristics of children under 5. A total of 5,181 children under 5 were surveyed including 51 percent of boys, and 49 percent of girls. 48.4 percent of children lived in urban and 51.6 percent lived in rural area. The distribution of the number of chil- dren in this age group are: under 6 months – 10.3 per- cent, 6-11 months – 10.3 percent, 12-23 months – 20 percent, 24-35 months – 21.2 percent, 36-47 months – 19.4 percent and 48-59 months – 18.9 percent. Mothers with children under 5 possessed vary- 49MONITORING THE SITUATION OF CHILDREN AND WOMEN Children’s living arrangements and orphanhood Table HH.6 provides information on living ar- rangements and prevalence of orphanhood among children under 18. Out of 16,323 children aged 0-17 covered by MICS, 81.9 percent live with both parents, 13.3 per- cent live with their mother only and 1 percent live only with their father. 3.3 percent of children live with neither of their biological parents. Only 2.7 percent of children live with neither of their living biological parents. A total of 9.4 percent of children live with their mother sepa- rately from their (biological) father. There are very few children who lost one or both parents. Close to 4.1 percent of children have only their father deceased, and they live with their mother, while 0.5 percent have only their mother deceased. Table HH.6 also shows that the percentage of children living with both parents is the highest in the poorest households (84.8 percent) and the lowest in the richest households (78 percent). There is only marginal difference between rural and urban popu- lation and between regions in prevalence of orphan- hood. 50 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Ta bl e Н H .6 : C hi ld re n’ s liv in g ar ra ng em en ts a nd o rp ha nh oo d P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 17 a cc or di ng t o liv in g ar ra ng em en ts , pe rc en ta ge o f ch ild re n ag e 0- 17 n ot l iv in g w ith b io lo gi ca l pa re nt s an d pe rc en ta ge o f c hi ld re n w ho h av e bo th p ar en ts d ea d, K az ak hs ta n, 2 01 0/ 11 Li vi ng w ith bo th pa re nt s Li vi ng w ith N ei th er P ar en t Li vi ng w ith M ot he r O nl y Li vi ng w ith Fa th er O nl y Im po s- si bl e to de te r- m in e To ta l N ot li vi ng w ith a b io - lo gi ca l p ar - en t1 O ne o r bo th pa re nt s de ad 2 N um be r o f ch ild re n ag e 0- 17 y ea rs O nl y fa th er al iv e O nl y m ot he r al iv e B ot h ar e al iv e B ot h ar e de ad Fa - th er al iv e Fa th er de ad M o- th er al iv e M ot he r de ad Se x M al e 81 ,1 0, 1 0, 2 2, 8 0, 4 9, 6 4, 1 0, 7 0, 5 0, 6 10 0, 0 3, 5 5, 3 82 43 Fe m al e 82 ,7 0, 2 0, 1 2, 5 0, 4 9, 2 3, 7 0, 4 0, 4 0, 3 10 0, 0 3, 2 4, 7 80 80 R eg io n A km ol a O bl as t 73 ,4 0, 9 0, 8 4, 2 0, 9 11 ,8 5, 6 1, 0 0, 4 1, 0 10 0, 0 6, 8 8, 6 63 1 A kt ob e O bl as t 82 ,6 0, 1 0, 0 2, 1 0, 6 8, 0 5, 9 0, 2 0, 3 0, 2 10 0, 0 2, 9 6, 9 77 3 A lm at y O bl as t 85 ,7 0, 1 0, 2 3, 2 0, 2 7, 6 2, 1 0, 2 0, 7 0, 2 10 0, 0 3, 6 3, 2 18 04 A lm at y ci ty 78 ,3 0, 0 0, 0 1, 7 0, 5 13 ,1 3, 4 1, 2 0, 4 1, 2 10 0, 0 2, 3 4, 4 80 6 A st an a ci ty 82 ,8 0, 0 0, 0 2, 3 0, 0 12 ,2 1, 9 0, 3 0, 2 0, 3 10 0, 0 2, 3 2, 2 46 4 A ty ra u O bl as t 84 ,9 0, 0 0, 4 1, 3 0, 4 5, 4 4, 9 0, 9 0, 1 1, 9 10 0, 0 2, 0 5, 7 51 1 E as t K az ak hs ta n O bl as t 76 ,7 0, 0 0, 2 3, 9 0, 2 15 ,2 3, 2 0, 5 0, 0 0, 1 10 0, 0 4, 4 3, 6 11 99 Zh am by l O bl as t 80 ,6 0, 1 0, 5 5, 5 0, 6 7, 8 3, 3 0, 5 0, 3 0, 7 10 0, 0 6, 7 5, 0 12 16 W es t K az ak hs ta n O bl as t 79 ,0 0, 0 0, 3 3, 9 0, 2 10 ,1 5, 3 0, 4 0, 1 0, 6 10 0, 0 4, 4 5, 9 60 4 K ar ag an da O bl as t 72 ,0 0, 3 0, 1 3, 9 0, 0 16 ,7 4, 8 1, 2 0, 8 0, 2 10 0, 0 4, 3 6, 0 13 62 K os ta na i O bl as t 76 ,0 0, 6 0, 2 1, 7 0, 1 15 ,9 3, 1 0, 5 0, 8 0, 9 10 0, 0 2, 7 5, 0 74 0 K yz yl or da O bl as t 87 ,0 0, 0 0, 0 2, 3 0, 7 5, 5 3, 2 0, 3 0, 8 0, 3 10 0, 0 3, 0 4, 6 86 9 M an gi st au O bl as t 89 ,4 0, 0 0, 0 0, 6 1, 0 1, 9 6, 3 0, 1 0, 2 0, 6 10 0, 0 1, 5 7, 5 65 5 P av lo da r O bl as t 73 ,7 0, 2 0, 1 2, 2 0, 4 16 ,7 3, 3 0, 8 1, 0 1, 6 10 0, 0 3, 0 5, 0 64 9 N or th K az ak hs ta n O bl as t 78 ,6 0, 1 0, 2 2, 1 0, 5 11 ,3 4, 5 1, 5 0, 6 0, 6 10 0, 0 2, 9 5, 9 54 4 51MONITORING THE SITUATION OF CHILDREN AND WOMEN S ou th K az ak hs ta n O bl as t 88 ,9 0, 0 0, 2 1, 4 0, 3 4, 4 4, 0 0, 4 0, 3 0, 0 10 0, 0 1, 9 4, 8 34 97 R es id en ce U rb an 78 ,8 0, 1 0, 2 2, 1 0, 4 12 ,5 4, 3 0, 7 0, 3 0, 6 10 0, 0 2, 8 5, 3 77 50 R ur al 84 ,7 0, 1 0, 2 3, 1 0, 4 6, 6 3, 5 0, 4 0, 6 0, 4 10 0, 0 3, 8 4, 8 85 73 A ge 0- 4 88 ,1 0, 1 0, 0 1, 7 0, 0 8, 0 1, 5 0, 2 0, 1 0, 3 10 0, 0 1, 9 1, 7 51 98 5- 9 82 ,7 0, 2 0, 1 2, 5 0, 2 9, 9 3, 1 0, 7 0, 2 0, 4 10 0, 0 3, 0 3, 8 43 34 10 -1 4 78 ,6 0, 2 0, 4 2, 6 0, 4 10 ,2 5, 6 0, 7 0, 8 0, 4 10 0, 0 3, 5 7, 4 41 20 15 -1 7 73 ,7 0, 1 0, 3 4, 7 1, 3 9, 9 7, 2 0, 8 1, 0 0, 9 10 0, 0 6, 5 10 ,1 26 70 W ea lth In de x Q ui nt ile P oo re st 84 ,8 0, 1 0, 1 3, 0 0, 2 6, 2 4, 7 0, 2 0, 5 0, 2 10 0, 0 3, 4 5, 6 40 49 S ec on d 82 ,9 0, 2 0, 2 3, 2 0, 5 7, 5 3, 7 0, 6 0, 8 0, 5 10 0, 0 4, 1 5, 4 35 68 M id dl e 83 ,0 0, 1 0, 2 2, 7 0, 6 8, 9 3, 1 0, 7 0, 2 0, 4 10 0, 0 3, 7 4, 2 31 42 Fo ur th 79 ,2 0, 1 0, 3 2, 4 0, 2 12 ,3 3, 9 0, 6 0, 4 0, 5 10 0, 0 3, 1 4, 9 27 42 R ic he st 78 ,0 0, 2 0, 1 1, 6 0, 4 14 ,1 3, 8 0, 7 0, 3 0, 8 10 0, 0 2, 2 4, 8 28 22 Et hn ic ity o f H ou se ho ld H ea d K az ak h 85 ,1 0, 1 0, 2 2, 8 0, 4 6, 3 3, 9 0, 4 0, 5 0, 4 10 0, 0 3, 4 5, 1 11 65 8 R us si an 68 ,8 0, 3 0, 2 2, 8 0, 4 21 ,1 4, 0 1, 2 0, 2 1, 1 10 0, 0 3, 6 5, 1 25 72 O th er e th ni c gr ou ps 80 ,2 0, 2 0, 2 1, 9 0, 3 12 ,4 3, 5 0, 7 0, 3 0, 3 10 0, 0 2, 6 4, 5 20 93 To ta l 81 ,9 0, 1 0, 2 2, 7 0, 4 9, 4 3, 9 0, 6 0, 4 0, 5 10 0, 0 3, 3 5, 0 16 32 3 1 M IC S In di ca to r 9 .1 7 2 M IC S In di ca to r 9 .1 8 IV. Child Mortality 53MONITORING THE SITUATION OF CHILDREN AND WOMEN 10 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division. United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and proportion dead by age of women, Kazakhstan, 2010/11 Children ever born Children Surviving Proportion dead Number of women Mean number of children ever born Mean number children surviving Mean number children surviving Total number of children surviving Age 15-19 0,028 57 0,027 55 0,037 2022 20-24 0,518 1128 0,509 1109 0,017 2178 25-29 1,327 2674 1,299 2619 0,021 2016 30-34 2,038 4087 1,956 3922 0,040 2005 35-39 2,352 4472 2,248 4274 0,044 1901 40-44 2,543 4880 2,408 4622 0,053 1919 45-49 2,601 5129 2,452 4835 0,057 1972 Total 1,600 22427 1,530 21436 0,044 14014 One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-5 mortality. Specifically, the MDGs call for the reduction in under-5 mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring child- hood mortality may seem easy, but attempts using di- rect questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, in- direct methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect meth- ods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing tech- nique. The infant mortality rate is the probability of dy- ing before the first birthday. The under-5 mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under-5 mortality rates are calculated based on an indirect estimation technique known as the Brass method10. The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women (Table CM.1). The technique converts the proportions of dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assum- ing a particular model age pattern of mortality. Based on previous information on mortality in Kazakh- stan, the East model life table was selected as most appropriate. Table CM.2 provides estimates of child mortality. The infant mortality rate is estimated at 28 per 1,000 live births, while the probability of dying under age 5 (U5MR) is around 31 per 1,000 live births. These es- timates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to 2006. There is some difference between the probabili- ties of dying among males and females. Mortality in boys is appreciably higher than in girls standing at 34 and 22 per thousand live births, and 38 and 25 for children under 5. Moreover, mortality rates differed signifi- cantly depending on the level of mother’s educa- 54 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN tion, the level of household wealth and ethnicity. In terms of residence there were some differen- ces in mortality rates: in rural area infant mortal- ity rate and under-5 child mortality rate was by 3 and 4 pro mille higher respectively compared to urban area. While in urban area child mortality rate was 26 per 1,000 live births, in rural area it was 29 per 1,000 births; similarly for under- 5child mortality rate – 29 as opposed to 33 per 1,000 live births. In terms of wealth, infant mortality was high in the second and poorest quintiles, 27 and 34 per 1,000 live births respectively, similarly for child mor- tality rate – 31 and 40 per 1,000 live births compared to 18 and 24 per 1,000 births and 20 and 27 per 1,000 live births in the fourth and richest quintiles. Table CM.2: Child Mortality Infant and under-5 mortality rates, East Model, Kazakhstan, 2010/11 Infant Mortality Rate1 Under-5 Mortality Rate2 Sex Male 34 38 Female 22 25 Residence Urban 26 29 Rural 29 33 Mother’s education Incomplete secondary 92 (*) Secondary 30 34 Specialized secondary 30 34 Higher 16 17 Wealth index quintile Poorest 34 40 Second 27 31 Middle 29 33 Fourth 18 20 Richest 24 27 Ethnicity of household head Kazakh 26 29 Russian 25 28 Other ethnic groups 40 46 Total 28 31 Rates for women with incomplete education not shown due to small number of cases 1 MICS Indicator 1.2; MDG Indicator 4.2 2 MICS Indicator 1.1; MDG Indicator 4.1 (*) the rates for the mothers with incomplete secondary education are not indicated due to limited number of cases * refers to 2006, East Model, in accordance with age staffs of mortality Differences in under-5 mortality rates by selected background characteristics are shown in Figure CM.1. 55MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CM.2 shows the series of under-5 mortality rate estimates of the survey, based on re- sponses of women in different age groups, and re- ferring to various points in time, thus showing the estimated trend in U5MR based on three surveys, DHS-1995, MICS-2006 and MICS-2010/11 as well as the country’s official statistics. The MICS surveys indicate that mortality has been declining for the past 15 years. Discrepancies between data until mid-2008 from different sources сan be explained in part by dif- ferent approaches to live birth definitions and child mortality estimation techniques beginning from 2008 when Kazakhstan started using new criteria on live and still births recommended by WHO. Further quali- fication of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. *Refers to 2006, East Model chosen in accordance with the age mortality structure r V. Nutrition 57MONITORING THE SITUATION OF CHILDREN AND WOMEN 11 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf Children’s nutritional status is a reflection of their overall health. When children have access to an ad- equate food supply they are not exposed to repeated illness and well cared for, 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. For those children undernourished who survive will ex- perience recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished. The MDG target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of mal- nutrition will also assist in the goal to reduce child mor- tality. In a well-nourished population height and weight for children under 5 are used as a reference. Under- nourishment in a population can be gauged by compar- ing children to a reference population. The reference population used in this report is based on new WHO growth standards11. 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 two standard deviations below the median of the refer- ence population are considered moderately or severe- ly 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. Nutritional Status Children whose height-for-age is more than two stan- dard deviations below the median of the reference pop- ulation are considered short for their age and are clas- sified 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 re- sult 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, weights and heights of all children un- der 5 were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). Find- ings in this section are based on the results of these measurements. Table NU.1 shows percentages of children clas- sified into each of these categories, based on the anthropometric measurements that were taken dur- ing fieldwork. Additionally, the table includes the per- centage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. Table NU.1: Nutritional status of children Percentage of children under 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kazakhstan, 2010/11 Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Sex Male 3,7 1,1 0,2 2555 13,2 5,5 -0,4 2541 4,4 1,9 14,8 0,6 2518 Female 3,6 1,3 0,2 2460 13,0 5,3 -0,4 2446 3,7 1,4 11,8 0,5 2436 58 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Region Akmola Oblast 1,8 0,9 0,4 183 8,1 2,8 -0,2 182 2,6 0,9 13,6 0,7 181 Aktobe Oblast 11,9 6,0 -0,1 248 36,2 19,7 -1,2 246 8,6 3,9 33,5 0,9 245 Almaty Oblast 4,8 0,9 0,1 529 10,8 4,2 -0,3 525 3,7 2,0 7,6 0,3 529 Almaty city 7,1 3,5 0,7 178 17,1 7,1 0,7 173 7,8 3,0 15,6 0,5 165 Astana city 2,5 1,0 0,6 165 19,7 10,1 -0,2 163 4,5 2,8 22,1 0,8 159 Atyrau Oblast 3,5 0,5 0,1 159 18,4 11,1 -0,8 159 3,2 1,9 16,2 0,7 158 East Kazakhstan Oblast 6,5 2,3 0,0 350 16,6 7,2 -0,6 350 8,1 2,7 20,2 0,6 340 Zhambyl Oblast 3,5 0,3 0,4 398 16,2 3,7 -0,6 394 2,8 1,4 21,3 1,0 394 West Kazakhstan Oblast 2,3 0,4 0,2 193 9,8 1,1 -0,3 190 1,8 1,1 6,6 0,5 191 Karaganda Oblast 2,3 1,1 0,2 397 4,8 1,5 -0,1 396 0,4 0,4 6,1 0,4 394 Kostanai Oblast 1,5 0,7 0,2 221 12,7 5,0 -0,4 220 0,4 0,0 6,6 0,6 221 Kyzylorda Oblast 2,1 0,2 0,2 291 7,1 1,8 -0,4 290 1,3 0,2 6,8 0,6 290 Mangistau Oblast 3,6 1,2 0,3 229 10,2 4,2 -0,3 228 4,5 1,7 15,7 0,7 226 Pavlodar Oblast 1,8 0,4 0,4 208 8,9 2,5 -0,1 204 2,7 1,5 13,6 0,6 202 North Kazakhstan Oblast 2,7 0,0 0,1 136 10,6 2,3 -0,6 136 1,7 0,4 11,6 0,6 136 South Kazakhstan Oblast 2,5 0,8 0,1 1129 12,1 5,8 -0,4 1127 5,8 2,0 11,1 0,4 1122 Residence Urban 4,0 1,5 0,2 2407 12,8 5,7 -0,2 2388 4,9 2,1 13,7 0,5 2363 Rural 3,3 0,9 0,1 2608 13,4 5,1 -0,5 2598 3,3 1,3 13,0 0,6 2591 Age 0-5 months 10,0 4,0 0,0 498 10,7 3,7 0,2 496 13,4 7,4 9,8 -0,1 485 6-11 months 3,0 1,0 0,5 525 13,8 6,6 0,1 519 4,4 1,0 19,0 0,7 521 12-23 months 3,2 1,2 0,4 1014 18,6 8,1 -0,5 1006 2,1 0,6 17,4 0,8 1009 24-35 months 3,5 1,4 0,2 1063 14,4 6,5 -0,6 1057 2,5 1,2 12,9 0,6 1050 36-47 months 2,3 0,4 0,1 968 11,6 5,3 -0,5 963 2,4 0,7 11,6 0,7 956 48-59 months 2,6 0,4 0,0 947 8,1 1,7 -0,4 945 4,5 1,8 9,7 0,4 935 Mother’s Education Incomplete secondary 2,7 1,0 0,1 96 12,9 3,9 -0,4 93 7,2 4,7 6,3 0,3 94 Secondary 4,6 1,3 0,1 1879 15,5 5,5 -0,6 1869 4,1 1,5 12,3 0,6 1869 Specialized secondary 2,7 1,1 0,3 1380 11,7 5,8 -0,3 1374 3,9 1,8 14,6 0,6 1355 Higher 3,4 1,2 0,3 1652 11,5 5,0 -0,2 1642 4,0 1,6 13,8 0,5 1628 Wealth Index Quintile Poorest 4,1 1,2 0,1 1239 14,4 5,1 -0,6 1235 4,9 2,3 12,8 0,6 1235 Second 3,9 0,8 0,1 1113 14,5 6,2 -0,6 1110 2,8 0,7 12,6 0,6 1105 Middle 2,8 1,1 0,2 982 9,9 3,9 -0,2 975 3,9 1,7 11,0 0,5 965 Fourth 4,0 1,6 0,2 817 13,9 5,8 -0,3 809 4,5 1,6 14,7 0,6 797 Richest 3,5 1,4 0,4 866 12,1 6,1 -0,1 857 4,3 2,0 16,3 0,6 852 59MONITORING THE SITUATION OF CHILDREN AND WOMEN Weight for age: N um be r o f c hi ld re n Height for age: N um be r o f c hi ld re n Weight for height: N um be r o f c hi ld re n Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Wasted O ve rw ei gh t % a bo ve % below % below % below % below - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 - 2 S D Ethnicity of Household Head Kazakh 3,9 1,3 0,2 3605 13,6 5,7 -0,4 3583 4,2 1,8 13,9 0,6 3557 Russian 2,9 0,6 0,2 746 11,9 5,4 -0,2 743 3,1 0,7 12,9 0,5 737 Other ethnic groups 3,2 1,2 0,1 664 11,5 3,9 -0,3 661 4,6 2,1 10,6 0,4 661 Total 3,7 1,2 0,2 5015 13,1 5,4 -0,4 4987 4,1 1,7 13,3 0,6 4955 ‘No education’ category has been excluded due to insignificant number of responses; 1 MICS Indicator 2.1a ; MDG Indicator 1.8 2 MICS Indicator 2.1b 3 MICS Indicator 2.2a; 4 MICS Indicator 2.2b 5 MICS Indicator 2.3a, 6 MICS Indicator 2.3b For children with no complete data regarding their birthdate (month and year) and measurement re- sults out of the acceptable range have been excluded from Table NU.1. Children are excluded from one or several anthropometric indices are excluded in case their weight or height were not measured. For instance, if the child was weighted but his/her height was not measured, this child is included into the underweight indice but is excluded from the stunted or wasted in- dice. Percentage of children by age and reasons for exclusion are shown in data quality verification tables DQ.6 and DQ.7. Overall, 96.8 percent of children had their weight and height measured (Table DQ.6). While 3.2 percent of children did not have their weight measured, 3.3 percent of children did not have their height measured. Table DQ.7 shows that due to unacceptable result measure- ments and missing data on weight and/or height, 3.6 percent of children were excluded from the calculation of the indice of weight for age. The proportion of children excluded from the indices on height for age and weight for height is 4.1 percent and 4.7 percent respectively. Most often the results of infants until the age of 6 months anthropometric measurement were excluded: 6.4 per- cent – weight to age and 7.2 percent – height for age and 9.2 percent – weight for height. In Kazakhstan 3.7 percent of children under 5 are underweight, including 1.2 percent severely un- derweight (table NU.1). at the same time 13.1 percent are stunted, including 5.4 percent severely stunted. 4.1 percent of children are wasted (weight for height) and 1.7 percent of children are severely wasted. Table NU.1 was compiled according to new height standards established by WHO. In order to compare nutrition status with MICS3 results we have made calculations using old standards from the Na- tional Center for Health Statistics (USA), Center for Disease Control and Prevention (USA) and the World Health Organization. The table calculated according to old standards is shown in Table NU1.A in Appendix G. 60 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Four percent of moderately underweight and 1.5 percent of severely underweight children were reported in MICS4. Children in Aktobe Oblast are more likely to be underweight for their age (11.9 percent) and stunted (36.2 percent). In this oblast, children are more exposed to the risk of being underweight or stunted than children in other regions. The highest proportion of moderately underweight children for their height (wasting) was found in Aktobe (8.6 percent) and East Kazakhstan Oblasts (8.1 percent). The highest proportion of moderately un- derweight and wasted children is found in urban areas, whereas that of stunted children is found in rural areas. Those children whose mothers have higher education are less likely to be underweight (3.4 percent), stunted (11.5 percent) and wasted (4 percent) compared to children of mothers with incomplete secondary or specialized secondary education combined. Age distribution shows that children in the age group 0-5 months are more likely to be underweight for age and height, with this group having the highest percentage. At the same time, the highest percentage (18.6 percent) of stunted children is found in the age group 12-23 months. About 13.3 percent of children are overweight, with the percentage of boys (14.8 percent) being higher than girls (11.8 percent). Percentage of urban children (13.7 percent) is slightly higher than that of children living in the rural area (13 percent). A higher percentage of overweight children is found in Aktobe Oblast (33.5 percent), Astana (22.1 percent) and in Zhambyl Oblast (21.3 percent). Such children are most likely to be found in the age group 6-11 months (19 percent). Breastfeeding and Infant and Young Child Feeding Feeding recommendations based on WHO and UNICEF are: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per Breastfeeding for the first few years of life pro- tects 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 contrib- ute to growth faltering and micronutrient malnutrition as when as unsafe if clean water is not readily available. 61MONITORING THE SITUATION OF CHILDREN AND WOMEN day for 6-8 month old; 3 times per day for 9-11 month old 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 meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding chil- dren (6-23 months) • Bottle feeding (0-23 months) Table NU.2: Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Kazakhstan, 2010/11 Percentage ever breastfed1 Percentage who were first breastfed Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth Within one hour of birth2 Within one day of birth Region Akmola Oblast 96,3 44,6 82,0 13,3 68 Aktobe Oblast 91,1 59,5 83,0 18,5 115 Almaty Oblast 92,0 69,0 85,3 2,3 194 Almaty city (100,0) (46,5) (97,7) (4,7) 68 Astana city 97,8 47,9 96,8 1,3 72 Atyrau Oblast 98,1 63,7 87,0 21,2 77 East Kazakhstan Oblast 93,7 71,9 87,1 9,0 143 Zhambyl Oblast 97,8 83,4 94,4 8,8 166 West Kazakhstan Oblast 96,9 72,1 90,8 16,2 75 Karaganda Oblast 97,3 74,2 88,1 23,0 148 Kostanai Oblast 97,1 61,7 83,6 20,0 86 Kyzylorda Oblast 95,5 82,7 88,7 4,8 119 Mangistau Oblast 98,7 54,7 80,6 27,1 99 Pavlodar Oblast 96,8 54,2 87,3 15,3 82 North Kazakhstan Oblast 96,1 67,3 86,4 25,2 46 South Kazakhstan Oblast 98,0 73,1 88,3 5,1 436 Residence Urban 96,4 66,2 88,6 11,7 983 Rural 96,3 69,4 87,3 10,9 1011 Months Since Last Birth 0-11 months 95,9 66,7 86,4 12,6 1023 12-23 months 96,9 69,0 89,5 9,9 970 Assistance at Delivery Skilled attendant 96,4 67,8 87,9 11,3 1990 62 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage ever breastfed1 Percentage who were first breastfed Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth Within one hour of birth2 Within one day of birth Traditional birth attendant (*) (*) (*) (*) 3 Place of Delivery Public sector health facility 96,3 67,8 87,8 11,1 1978 Private sector health facility (*) (*) (*) (*) 7 Home (*) (*) (*) (*) 8 Education Incomplete secondary (88,0) (61,3) (74,7) (12,5) 32 Secondary 95,7 68,8 87,5 10,1 698 Specialized secondary 97,5 64,2 87,6 11,2 565 Higher 96,5 69,9 89,2 12,6 695 Wealth Index Quintile Poorest 97,5 73,0 87,6 8,5 463 Second 95,7 69,3 87,8 11,0 443 Middle 95,5 68,7 88,7 9,2 406 Fourth 95,3 67,1 87,9 13,3 330 Richest 97,9 58,8 87,7 15,8 352 Ethnicity of Household Head Kazakh 97,6 70,0 89,4 11,8 1413 Russian 94,4 59,9 83,0 14,6 322 Other ethnic groups 92,0 65,9 86,1 4,4 259 Total 96,4 67,8 87,9 11,3 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.4 2 MICS Indicator 2.5 () Indicators are based on 25-49 cases of unweighted observations (*) Indicators are based on less than 25 cases of unweighted observations respectively). The highest proportion of women who started breastfeeding within one hour of birth was in Zhambyl (83.4 percent) and Kyzylorda (82.7 percent) Oblasts, the lowest proportion was found in Akmola Oblast (44.6 percent) and in Almaty (46.5 percent). The percentage of mothers who started breast- feeding within one day of birth were 87.9. The differ- ence between such women in urban and rural areas is marginal, 1.4 percent in favour of urban women (88.6 and 87.3 percent respectively). Only in two regions, Al- maty and Astana, over 95 percent of women started breastfeeding within one day of birth (97.7 and 96.8 percent respectively). The lowest percentage is found in Mangistau (80.6 percent) and Akmola (82 percent) Oblasts. Table NU.2 provides the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour of birth, and those who received a prelacteal feed. About 1,993 mothers of children born within the 2 years preceding the survey were interviewed during the survey. Although first breastfeeding is a very important step in manage- ment of lactation and establishment of a physical and emotional relationship between the baby and the moth- er, only 67.8 percent of babies are breastfed for the first time within one hour of birth. The difference between urban and rural women was 3.2 percent (66.2 and 69.4 percent respectively). Mothers from the richest households are less likely to start timely breastfeeding than those from the poorer households (58.8 percent and 73.0 percent 63MONITORING THE SITUATION OF CHILDREN AND WOMEN Breastfeeding status in Table NU.3 is based on the responses given by mothers/caretakers regarding food and liquids taken by children within the past 24 hours be- fore the survey. Exclusive breastfeeding relates to the in- fants who were receiving only breast milk (also vitamins, minerals and medication). This table shows the proportion of infants who were breastfed during the first 6 months of life and also the proportion of children who were still being breastfed at ages 12-15 and 20-23 months. Only 31.8 percent of children aged less than six months are exclusively breastfed (a level considerably lower than recommended), since 60.6 percent of children are predominantly breastfed. By age 12-15 months, 50.8 percent of children are still being breastfed and by age 20-23 months, 26.1 percent are still breastfed (Figure NU.3). Exclusive breastfeeding is found in urban areas more often than in rural areas (34.4 and 29.2 percent re- spectively). In older age groups, urban children continue receiving breast milk more often than rural children. The level of mothers’ education has a certain impact on the incidence of breastfeeding, with children of mothers with higher education more likely to be exclusively breastfed than children of women with lower education levels (34.8 percent compared to 30.1 percent). Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Kazakhstan, 2010/11 Children 0-5 months N um be r o f c hi ld re n Children 12-15 months N um be r o f c hi ld re n Children 20-23 months N um be r o f c hi ld re n Percent exclusively breastfed1 Percent exclusively breastfed2 Percent breastfed (Continued breastfeeding at 1 year) 3 Percent breastfed (Continued breastfeeding at 2 years) 4 Sex Male 32,4 61,1 264 55,1 158 24,4 169 Female 31,2 60,1 268 46,9 174 27,8 177 Residence Urban 34,4 62,2 268 51,1 160 17,9 178 Rural 29,2 59,0 265 50,5 171 34,9 168 Mother’s Education Incomplete Secondary (*) (*) 11 (*) 3 (*) 6 Secondary 31,0 56,9 179 49,3 115 32,3 123 64 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Children 0-5 months N um be r o f c hi ld re n Children 12-15 months N um be r o f c hi ld re n Children 20-23 months N um be r o f c hi ld re n Percent exclusively breastfed1 Percent exclusively breastfed2 Percent breastfed (Continued breastfeeding at 1 year) 3 Percent breastfed (Continued breastfeeding at 2 years) 4 Specialized Secondary 30,1 62,0 160 54,9 88 26,4 99 Higher 34,8 63,4 183 49,8 123 21,0 117 Wealth Index Quintile Poorest 33,8 60,5 120 51,7 80 33,1 63 Second 32,0 61,7 121 50,1 86 28,3 96 Middle 30,4 53,3 108 58,2 67 23,1 68 Fourth 30,2 64,7 104 52,2 55 17,4 45 Richest 32,7 63,6 81 37,5 44 25,5 74 Ethnicity of Household Head Kazakh 31,2 61,9 381 54,7 245 30,8 247 Russian 29,0 49,4 74 40,1 53 12,4 50 Other ethnic groups 37,4 64,9 77 (39,4) 33 (16,9) 49 Total 31,8 60,6 532 50,8 331 26,1 346 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.6 2 MICS Indicator 2.9 3 MICS Indicator 2.7 4 MICS Indicator 2.8 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 65MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.4 shows the median duration of breast- feeding by selected background characteristics. Among children under 3, the median duration is 14.8 months for any breastfeeding, 2.1 months for exclusive breastfeeding, and 4.2 months for predominant breastfeeding. Boys receive any kind of breastfeeding longer than girls. In rural areas, infants receive exclusive or any other type of breastfeeding a bit longer than in urban areas (1.1 vs. 0.9 months and 13.8 vs. 13.2 months respectively). Children are exclusively breastfed for the longest time (3 months) in Almaty city and shortest (0.5-0.6 months) in Almaty, West Kazakhstan, Kostanai, Karaganda and Mangistau Oblasts. At the same time, infants in South Kazakhstan, Aktobe, Atyrau and West Kazakhstan Oblasts (15.0-17.0 percent) receive any kind of breastfeeding and infants in East Kazakhstan, North Kazakhstan Oblasts and Almaty city receive mixed breastfeeding (4.1-5.4 months) longer than children in other regions. By level of household income, children from the poorest households are exclusively breastfed and children from the fourth and richest households receive mixed breastfeeding longer than others households. Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Kazakhstan, 2010/11 Median duration (in months) Number of children age 0-35 months Any Breastfeeding1 Exclusive Breastfeeding Predominant Breastfeeding Sex Male 13,9 1,2 3,6 1598 Female 13,0 0,7 3,4 1600 Region Akmola Oblast 13,9 1,0 2,3 117 Aktobe Oblast 15,2 0,7 2,5 166 Almaty Oblast 12,1 0,6 4,1 321 Almaty city 11,5 3,0 5,1 124 Astana city 13,7 1,3 3,3 101 Atyrau Oblast 16,6 0,7 2,5 120 East Kazakhstan Oblast 9,6 0,6 5,4 224 Zhambyl Oblast 13,0 1,6 3,8 250 West Kazakhstan Oblast 17,1 0,6 3,2 129 Karaganda Oblast 11,8 0,5 3,7 245 Kostanai Oblast 12,9 0,6 3,4 140 Kyzylorda Oblast 14,0 1,5 2,7 178 Mangistau Oblast 14,3 0,5 2,7 157 Pavlodar Oblast 13,8 1,7 3,2 135 North Kazakhstan Oblast 9,3 2,5 4,5 78 South Kazakhstan Oblast 14,9 2,0 3,6 712 Residence Urban 13,2 0,9 3,6 1562 Rural 13,8 1,1 3,4 1635 Education Incomplete secondary 7,5 0,6 2,7 61 Secondary 13,3 1,2 3,2 1129 Specialized secondary 14,7 0,7 3,5 900 Higher 13,4 1,2 3,8 1101 Wealth Index Quintile Poorest 14,8 1,7 3,5 762 Second 13,1 1,1 3,8 716 Middle 13,8 0,6 2,9 614 66 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Median duration (in months) Number of children age 0-35 months Any Breastfeeding1 Exclusive Breastfeeding Predominant Breastfeeding Fourth 13,6 0,9 3,8 535 Richest 12,5 0,7 3,4 571 Ethnicity of Household Head Kazakh 14,1 0,9 3,5 2311 Russian 11,0 0,8 2,5 489 Other ethnic groups 11,5 1,6 4,6 398 Mean for all children (0-35 months) 14,8 2,1 4,2 3198 1 MICS Indicator 2.10 children. There are 29.4 percent of boys and 32.2 per- cent of girls respectively who are adequately fed for chil- dren age 6-23 months. The share of children aged 6-23 months receiving complementary foods living in rich and poor households is almost the same at about 30- 32 percent. In the poorest quintile household this indica- tor is somewhat lower at 28.7 percent. There is certain variation depending on the level of mothers’ education, where children of mothers with specialized secondary education (32.7 percent), being more likely to be ade- quately fed. The largest proportion of children receiving complementary foods live in Akmola, Almaty, Kostanai, Pavlodar Oblasts and Astana (40.0- 46.2 percent) while the least number of children receiving complementary foods live in Atyrau and South Kazakhstan Oblasts (21.9 percent each). In addition, 31.0 percent of children at the age 0-23 months are being adequately breastfed. There are no significant deviations in terms of gender, residence, level of education and income as well as eth- nicity. The adequacy of infant feeding in children un- der 24 months is provided in Table NU.5. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, ex- clusive breastfeeding is considered as adequate feed- ing, while infants aged 6-23 months are considered to be adequately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of these feeding patterns, only 31.8 percent of children aged 0-5 months are being ade- quately fed. Among them, there are more boys (32.4 percent) than girls (31.2 percent); urban infants (34.4 percent) are more likely to be adequately fed than their rural peers (29.2 percent). The survey found that ade- quate feeding practically does not depend either on the level of household wealth or on the level of mother’s education. A slightly lower percentage of infants aged 6-23 months, 30.8 percent is adequately fed, of which 29.9 percent are urban children and 31.7 percent are rural Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Kazakhstan, 2010/11 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 N um be r o f ch ild re n Percent currently breastfeeding and receiving solid, semi-solid or soft foods N um be r o f ch ild re n Percent appropriately breastfed2 N um be r o f ch ild re n Sex Male 32,4 264 29,4 782 30,1 1047 Female 31,2 268 32,2 786 32,0 1055 Region Akmola Oblast (23,4) 21 41,2 52 36,1 73 Aktobe Oblast (14,1) 23 36,8 95 32,3 118 Almaty Oblast (39,4) 61 40,2 143 40,0 204 Almaty city (*) 13 (10,4) 58 (19,0) 71 Astana city (25,2) 20 45,3 55 39,9 75 Atyrau Oblast (23,7) 21 21,9 55 22,4 76 67MONITORING THE SITUATION OF CHILDREN AND WOMEN Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 N um be r o f ch ild re n Percent currently breastfeeding and receiving solid, semi-solid or soft foods N um be r o f ch ild re n Percent appropriately breastfed2 N um be r o f ch ild re n East Kazakhstan Oblast (32,7) 45 30,5 103 31,2 147 Zhambyl Oblast (34,7) 46 30,4 130 31,5 175 West Kazakhstan Oblast (22,8) 23 37,1 56 33,0 79 Karaganda Oblast (20,2) 33 28,0 128 26,4 162 Kostanai Oblast (30,8) 24 44,9 64 41,1 88 Kyzylorda Oblast (23,9) 25 27,4 101 26,7 126 Mangistau Oblast 13,9 31 31,3 76 26,3 107 Pavlodar Oblast (*) 19 46,2 62 42,5 81 North Kazakhstan Oblast (*) 12 33,1 37 37,7 49 South Kazakhstan Oblast 41,0 116 21,9 354 26,6 470 Residence Urban 34,4 268 29,9 754 31,1 1022 Rural 29,2 265 31,7 815 31,0 1079 Education Incomplete Secondary (*) 11 (*) 25 (10,3) 36 Secondary 31,0 179 30,4 566 30,5 745 Specialized Secondary 30,1 160 32,7 430 32,0 590 Higher 34,8 183 30,9 543 31,9 726 Wealth Index Quintile Poorest 33,8 120 28,7 370 29,9 490 Second 32,0 121 32,0 373 32,0 494 Middle 30,4 108 30,3 316 30,3 424 Fourth 30,2 104 32,1 231 31,5 335 Richest 32,7 81 31,5 278 31,7 359 Ethnicity of Household Head Kazakh 31,2 381 32,3 1131 32,0 1512 Russian 29,0 74 29,3 248 29,3 322 Other ethnic groups 37,4 77 23,7 190 27,7 267 Total 31,8 532 30,8 1569 31,0 2101 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.6 2 MICS Indicator 2.14 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 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. Overall, 49.4 percent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants this percentage is 48 percent, while 57.5 percent among infants are currently not breastfeeding. The proportion of girls receiving sol- id, semi-solid or soft foods is higher than that of boys in both groups. The percentage of children receiving solid, semi-solid or soft foods in urban areas is also higher than in rural areas. Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the pre- vention of undernutrition. Continued breastfeeding beyond six months should be accompanied by con- sumption of nutritionally adequate, safe and appropri- ate complementary foods that help meet nutritional requirements when breastmilk 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 six to eight months old, and three or more meals if they are 9-23 months of age. For children 68 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table NU.6: Introduction of solid, semi-solid or soft food Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Ka- zakhstan, 2010/11 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percent receiving solid, semi-solid or soft foods Number of children aged 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children aged 6-8 months Gender Male 41,5 125 (*) 17 41,3 142 Female 54,8 119 (*) 24 57,4 143 Residence Urban 53,1 112 (*) 20 53,7 131 Rural 43,7 133 (*) 22 45,7 155 Total 48,0 244 (57,5) 42 49,4 286 1 MICS Indicator 2.12 (*) indicators are based on less than 25 cases of unweighted observations Overall, more than half of children age 6-23 months (55.3 percent) were receiving solid, semi-solid and soft foods the minimum number of times. A slightly higher proportion of females (57.5 percent) were enjoying the minimum meal frequency compared to males (53.1 percent). Table NU.7 presents the proportion of chil- dren age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Table NU.7: Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non- breastfeeding children) the minimum number of times or more during the previous day, according to breastfeed- ing status, Kazakhstan, 2010/11 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid and soft foods the minimum number of times Number of children aged 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children aged 6-23 months Percent with minimum meal frequency 2 Number of children aged 6-23 months Sex Male 22,7 391 90,8 83,4 392 53,1 782 Female 26,4 390 88,0 88,0 397 57,5 786 Age 6-8 months 29,3 244 (97,3) (89,3) 42 38,0 286 9-11 months 11,5 167 91,5 92,2 79 37,5 246 12-17 months 24,8 235 89,0 85,7 289 58,4 523 18-23 months 31,6 135 88,4 84,0 379 70,2 514 Region Akmola Oblast (34,9) 26 (77,2) (80,6) 26 57,5 52 Aktobe Oblast 26,6 50 93,8 86,1 44 54,5 95 69MONITORING THE SITUATION OF CHILDREN AND WOMEN Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi- solid and soft foods the minimum number of times Number of children aged 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children aged 6-23 months Percent with minimum meal frequency 2 Number of children aged 6-23 months Almaty Oblast (40,8) 70 (81,1) (90,9) 72 66,2 143 Almaty city (*) 20 (*) (*) 38 (62,6) 58 Astana city 69,0 30 (96,6) (94,0) 25 80,5 55 Atyrau Oblast 13,1 29 89,2 71,9 26 41,2 55 East Kazakhstan Oblast (32,0) 45 (87,9) (95,1) 58 67,7 103 Zhambyl Oblast 17,0 65 91,0 90,3 65 53,6 130 West Kazakhstan Oblast (32,3) 27 (93,8) (88,4) 29 61,0 56 Karaganda Oblast (28,9) 49 89,2 94,4 79 69,3 128 Kostanai Oblast (46,1) 33 (66,7) (88,7) 31 66,6 64 Kyzylorda Oblast 13,5 53 94,8 89,4 48 49,3 101 Mangistau Oblast 15,4 45 98,2 88,1 31 45,3 76 Pavlodar Oblast (53,0) 32 (91,5) (86,8) 30 69,3 62 North Kazakhstan Oblast (*) 13 (86,9) (92,2) 24 85,2 37 South Kazakhstan Oblast 5,4 192 91,4 70,4 162 35,1 354 Residence Urban 29,6 348 92,4 90,5 406 62,4 754 Rural 20,5 432 86,1 80,6 382 48,7 815 Mother’s Education Incomplete Secondary (*) 6 (*) (*) 19 (*) 25 Secondary 24,5 280 87,4 81,8 286 53,4 566 Specialized Secondary 25,0 227 86,8 84,8 203 53,2 430 Higher 24,9 266 93,1 90,6 277 58,4 543 Wealth Index Quintile Poorest 17,5 204 86,6 78,2 166 44,8 370 Second 20,0 176 88,0 83,3 197 53,4 373 Middle 24,2 154 88,0 83,4 163 54,6 316 Fourth 31,5 112 90,2 92,9 119 63,1 231 Richest 35,6 135 95,4 94,4 144 66,0 278 Ethnicity of Household Head Kazakh 22,7 610 90,8 84,6 521 51,2 1131 Russian 38,2 95 88,7 93,4 153 72,2 248 Other ethnic groups 22,1 75 83,6 80,8 115 57,5 190 Total 24,5 780 89,4 85,7 788 55,3 1569 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.15 2 MICS Indicator 2.13 ( ) indicators are based on 25-49 cases of unweighted observations (*) indicators are based on less than 25 cases of unweighted observations 70 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Among currently breastfeeding children aged 6-8 months, minimum meal frequency is defined as children who also received solid, semi-solid or soft foods 2 times or more. Among currently breastfeed- ing children aged 9-23 months, receipt of solid, semi- solid or soft foods at least 3 times constitutes mini- mum meal frequency. For non-breastfeeding chil- dren aged 6-23 months, minimum meal frequency is defined as children receiving solid, semi-solid or soft foods, and milk feeds, at least 4 times during the previous day. Among currently breastfeeding children aged 6-23 months, nearly one-fourth of them (24.5 percent) were receiving solid, semi-solid and soft foods the minimum number of times and this proportion was higher among fe- males (26.4 percent) compared to males (22.7 percent). Children were most likely to receive solid, semi- solid and soft foods the minimum number of times a day in Astana (69 percent), and least likely in South- Kazakhstan Oblast (5.4 percent). The proportion of urban children receiving adequate complementary foods is 9.1 percent higher than that of rural infants. The survey found a clear variation by the welfare of households, with the proportion of breastfed children and children receiving solid, semi-solid and soft foods increasing with the household’s income. Among non-breastfeeding children, a majority (85.7 percent) of children were receiving solid, semi- solid and soft foods or milk feeds 4 times or more. Among them, the proportion of females was 88 per- cent, 4.6 percent higher than that of males. The share of infants living in urban areas is 9.9 percent higher than in rural areas. There is a clear variation by the level of mothers’ education and households’ welfare. Women with a higher level of education and those from the richest households are more likely to have children receiving solid, semi-solid, soft foods or milk feeds 4 and more times a day. 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.8 shows that bottle-feeding is quite prevalent in Ka- zakhstan. About 46.7 percent of children under 6 months are fed using a bottle with a nipple. Children in Kostanai (57.4 percent) and South Kazakhstan (57.2 percent) Oblasts are more likely to be fed using a bottle with a nipple, while children from Zhambyl Oblast (29 percent) are least likely to be fed using a bottle with a nipple. Table NU.8: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Kazakhstan, 2010/11 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months: Sex Male 47,7 1047 Female 45,8 1055 Age 0-5 months 40,7 532 6-11 months 53,6 532 12-23 months 46,4 1037 Region Akmola Oblast 48,9 73 Aktobe Oblast 41,7 118 Almaty Oblast 33,2 204 Almaty city (40,4) 71 Astana city 43,4 75 Atyrau Oblast 57,7 76 East Kazakhstan Oblast 40,4 147 Zhambyl Oblast 29,0 175 West Kazakhstan Oblast 46,5 79 Karaganda Oblast 41,8 162 Kostanai Oblast 57,4 88 Kyzylorda Oblast 44,9 126 Mangistau Oblast 70,0 107 Pavlodar Oblast 42,5 81 North Kazakhstan Oblast 50,3 49 71MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months: South Kazakhstan Oblast 57,2 470 Residence Urban 48,4 1022 Rural 45,2 1079 Mother’s Education Incomplete secondary (65,3) 36 Secondary 44,0 745 Specialized secondary 49,8 590 Higher 46,5 726 Wealth Index Quintile Poorest 44,2 490 Second 47,9 494 Middle 45,9 424 Fourth 46,2 335 Richest 50,2 359 Ethnicity of Household Head Kazakh 45,8 1512 Russian 51,5 322 Other ethnic groups 46,6 267 Total 46,7 2101 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.11 ( ) indicators are based on 25-49 cases of unweighted observations Salt Iodization mance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). Following global political recommendations, the Government of Kazakhstan committed itself to elimi- nate iodine deficiency in the country through universal salt iodization with potassium iodate during salt pro- duction at 40±15 РРМ both for home consumption, for the food industry and for animals. These commit- ments were documented in the legislation. Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cre- tinism. It also increases the risks of stillbirth and mis- carriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and develop- ment, contributing in turn to poor school performance, reduced intellectual ability, and impaired work perfor- Table NU.9: Iodized salt consumption Percentage of households consuming adequately iodized salt, Kazakhstan, 2010/11 Percent of households in which salt was tested Num- ber of house- holds Percentage of households with the salt test results Total Number of households in which salt was tested or with no salt Percent- age of house- holds not consum- ing salt Salt test results Non-io- dized salt 0 mg/kg >0 and <15 PPM 15+ PPM1 Region Akmola Oblast 97,6 884 2,4 0,8 1,6 95,2 100 884 72 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of households in which salt was tested Num- ber of house- holds Percentage of households with the salt test results Total Number of households in which salt was tested or with no salt Percent- age of house- holds not consum- ing salt Salt test results Non-io- dized salt 0 mg/kg >0 and <15 PPM 15+ PPM1 Aktobe Oblast 99,4 713 0,4 0,6 20,4 78,6 100 712 Almaty Oblast 99,8 1470 0,1 2,7 6,8 90,4 100 1469 Almaty city 94,6 1473 3,1 0,0 32,0 64,9 100 1437 Astana city 99,6 544 0,3 0,2 1,5 98,0 100 544 Atyrau Oblast 99,8 359 0,0 6,7 14,2 79,1 100 359 East Kazakhstan Oblast 99,6 1673 0,3 0,7 2,2 96,7 100 1671 Zhambyl Oblast 95,9 890 3,6 9,2 9,6 77,7 100 886 West Kazakhstan Oblast 99,6 647 0,3 1,7 1,8 96,1 100 646 Karaganda Oblast 99,7 1629 0,2 1,3 1,6 96,8 100 1627 Kostanai Oblast 99,8 1129 0,1 0,2 5,8 94,0 100 1128 Kyzylorda Oblast 99,7 498 0,3 6,6 8,3 84,9 100 498 Mangistau Oblast 99,0 372 0,4 2,7 19,7 77,1 100 370 Pavlodar Oblast 96,1 931 1,1 7,3 7,8 83,9 100 904 North Kazakhstan Oblast 99,6 795 0,3 1,4 0,9 97,4 100 794 South Kazakhstan Oblast 100,0 1794 0,0 20,3 15,6 64,0 100 1794 Residence Urban 98,1 9598 1,2 2,4 10,1 86,4 100 9530 Rural 99,5 6202 0,3 7,5 8,3 83,9 100 6192 Wealth Index Quintile Poorest 99,5 2624 0,5 10,3 11,2 78,0 100,0 2623 Second 99,5 2628 0,3 7,1 7,8 84,8 100,0 2623 Middle 98,5 3036 1,2 3,5 7,7 87,6 100,0 3026 Fourth 98,1 3845 1,1 2,0 8,8 88,1 100,0 3814 Richest 98,3 3667 0,9 1,3 11,3 86,5 100,0 3635 Total 98,7 15800 0,8 4,4 9,4 85,4 100 15722 1 MICS Indicator 2.16 South Kazakhstan Oblast (64 percent) and in Almaty City (64.9 percent) and highest in Astana City (98 per- cent) and North Kazakhstan Oblast (97.4 percent). 86.4 percent of urban households were found to be using adequately iodized salt as compared to 83.9 percent in rural areas (Figure NU.4). The difference between the richest and poorest households in terms of iodized salt consumption is 8.5 percent (86.5 and 78.0 percent respectively). In almost all households (98.7 percent), salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate (Table NU.9). Table NU.9 shows that in an extremely small proportion of households (0.8 percent), there was no salt available. In an overwhelming majority of house- holds (85.4 percent), salt was found to contain 15 PPM or more of iodine. Use of iodized salt was lowest in 73MONITORING THE SITUATION OF CHILDREN AND WOMEN Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the new- born’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 months and years. Those who survive have impaired immune function and increased risk of dis- ease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart dis- ease in later life. Children born underweight 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 most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particu- larly 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 74 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 12 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. growth if the mother becomes infected while preg- nant. In the industrialized 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 the risk of bearing underweight 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. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these es- timates are biased for most developing countries because the majority of newborns are not deliv- ered 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 2500 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. Table NU.11: Low birth weight infants Percentage of last-born children in the 2 years preceding the survey that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Kazakhstan, 2010/11 Percent of live births: Number of live births in the last 2 yearsBelow 2,500 grams 1 Weighed at birth 2 Region Akmola Oblast 5,9 97,6 84 Aktobe Oblast 3,7 96,9 130 Almaty Oblast 3,0 97,6 125 Almaty city (3,2) (87,0) 46 Astana city 3,0 100,0 125 Atyrau Oblast 4,5 97,5 162 East Kazakhstan Oblast 2,4 98,0 99 Zhambyl Oblast 7,6 97,5 158 West Kazakhstan Oblast 4,9 98,2 112 Karaganda Oblast 6,6 95,5 112 Kostanai Oblast 5,5 100,0 95 Kyzylorda Oblast 3,4 98,4 187 Mangistau Oblast 3,6 96,8 186 Pavlodar Oblast 3,4 97,9 97 North Kazakhstan Oblast 9,3 100,0 73 South Kazakhstan Oblast 4,4 97,9 236 Residence Urban 4,1 97,8 1069 Rural 5,1 97,5 958 Education Incomplete Secondary (10,4) (85,7) 28 Secondary 4,9 97,5 650 Specialized Secondary 4,4 98,3 606 Higher 4,1 97,8 740 75MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of live births: Number of live births in the last 2 yearsBelow 2,500 grams 1 Weighed at birth 2 Wealth Index Quintile Poorest 4,9 96,6 385 Second 5,3 98,6 424 Middle 4,3 97,9 430 Fourth 4,6 98,1 374 Richest 3,5 96,9 414 Ethnicity of Household Head Kazakh 4,3 97,9 1494 Russian 5,0 97,8 323 Other ethnic groups 5,8 95,7 210 Total 4,5 97,6 2027 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 2.18 2 MICS Indicator 2.19 ( ) indicators are based on 25-49 cases of unweighted observations In Kazakhstan, almost all children (97.6 per- cent) were weighed at birth and approximately 4.5 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.11). The survey found certain variation by region; the highest percentage of low birth weight children was found in North Ka- zakhstan Oblast (9.3 percent), while the lowest was found in East Kazakhstan Oblast (2.4 percent) (Fig- ure NU.5). In seven regions, the share of low weight children was 3-3.7 percent. The share of low birth weight infants is 1 percent higher in rural (5.1 per- cent) than in urban areas. 76 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN VI. Child Health 77MONITORING THE SITUATION OF CHILDREN AND WOMEN The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations 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 immunization and as a result, vaccine-preventable diseases cause more than 2 mil- lion deaths every year. A World Fit for Children goal is to ensure full immunization of children under one at 90 percent nationally, with at least 80 percent coverage in ev- ery district or equivalent administrative unit. Vaccinations National Vaccination Calendar, Kazakhstan, 2010 Age Tubercu- losis (BCG) Hepatitis В Polio- myelitis (OPV/IPV) Pertussis, Diphtheria, Tetanus (DPT) Haemophilus influenza (HIB) Diphtheria, Tetanus (DT) Diphtheria (DT with lower dose of anti- gens) Diphtheria, Tetanus (DPT with lower dose of antigens) MMR: Measles, mumps, rubella) 1-4 days х х 2 months х х х х 3 months х х х 4 months х х х х 12-15 months. х х 18 months х х 6 years (1st grade.) х Х х 12 years х 15 years 16 years х Every 10 years х Interviewers copied vaccination information from the cards onto the MICS questionnaire. If no cards were available, information was filled in based on mothers’ reports. To confirm mother’s reports and in cases when vaccination cards were stored in healthcare centres, the team editor visited them to complete a separate immunization module for each child under 5 years of age. Data were entered from the separate immuniza- tion module or based on mothers’ reports. According to UNICEF and WHO guidelines as well as Kazakhstani Vaccination Calendar, every child should receive a BCG vaccination to protect against tu- berculosis, three doses of DPT to protect against diph- theria, pertussis, and tetanus, three doses of hepatitis B vaccine, three doses of polio vaccine, the fourth po- lio vaccine and a measles, mumps and rubella vacci- nation at the age of 12-15 months. Mothers were asked to provide vaccination cards for children under 5. 78 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.1: Vaccinations in first year of life Percentage of children aged 15-26 months immunized against childhood diseases at any time before the survey and before the first birthday, Kazakhstan, 2010/2011 Percentage vaccinated at any time before the survey according to the vaccination card Vaccinated by 12 months of age Vaccination card Vaccinated at any time before the survey according to: mother’s report Vaccinated at any time before the survey according to: any source BCG1 96,0 3,4 99,5 99,2 Polio 1 95,5 3,6 99,1 98,9 2 94,5 3,1 97,6 96,1 32 86,3 2,1 88,4 81,3 DPT 1 95,3 3,5 98,8 98,4 2 95,1 3,3 98,5 96,8 33 94,2 2,6 96,8 93,0 Measles (MMR)4 90,5 3,4 93,9 89,0 Hepatitis B 1 76,1 20,4 96,6 95,9 2 75,0 18,5 93,5 91,9 35 63,1 7,1 70,2 67,0 All vaccinations 36,3 25,3 61,6 46,7 No vaccination 0,0 0,2 0,2 0,2 All, excluding hepatitis 54,7 28,9 83,6 70,6 None, excluding hepatitis 0,0 0,2 0,2 0,2 Number of children aged 15-26 months 1076 1076 1076 1076 For Measles or MRR vaccination is calculated until 15 months 1 MICS Indicator 3.1; 2 MICS Indicator 3.2; 3 MICS Indicator 3.3 4 MICS Indicator 3.4; MDG Indicator 4.3 5 MICS Indicator 3.5; percent by the third dose. Vaccination of children at the age from 2 to 4 is carried out via an injection of a vaccine, which consists of DPT vaccine, hepatitis B vaccine HepB, type B haemophilic infection vac- cine, with the simultaneous oral polio vaccine injection Hib (OPV). Kazakhstan positions itself as a polio free country, and the low coverage of polio vaccines in the second and third doses can be explained by the con- scious refusal of mothers to vaccinate as well as the absence of records on vaccines. In Kazakhstan, Hepatitis B vaccination is also recommended as part of the immunization schedule. The first HepB vaccine is introduced at age of 1-4 days of birth, the second one at age of 2 months and the third one at age of 4 months. By the age of 12 months 95.9 percent of children in survey received first dose of HepB vaccine. Percentage of coverage with the sec- ond dose was 91.9 percent and 67 percent with the third one (Tables CH.1). The denominator for the table is comprised of children age 15-26 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey accord- ing to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Approximately all children (99.2 percent) age 15-26 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 98.4 percent of children. The percentage declines for subsequent doses of DPT to 96.8 percent for the sec- ond dose, and 93 percent for the third dose (Figure CH.1). Similarly, 98.9 percent of children received Polio 1 by age 12 months and this declines to 81.3 79MONITORING THE SITUATION OF CHILDREN AND WOMEN In 2008 in order to introduce safe injection prac- tices, the Ministry of Healthcare of the Republic of Kazakhstan introduced the use of combined vaccina- tion for children. Vaccination of children aged 2 and 4 months is carried out by administering a single injec- tion consisting of DPT, Hepatitis B and Haemophilus in- fluenza type B with simultaneous administration of oral polio vaccine. Percentage of immunization coverage of children against DPT 3 is significantly higher (93.0 percent) than against Hepatitis B3 (67.0 percent), al- though according to the abovementioned, percentage of coverage by third dose vaccinations against Hep- atitis B and DPT should be approximately the same. The difference in findings on the level of coverage with DPT 3 and Hepatitis B vaccinations may be possible related to the fact that Vaccination cards most often re- flect DPT immunization and more rarely immunization against Hepatitis B. In this regard, according to survey findings the percentage of children who received full recommend- ed course of vaccination before their first birthday (12 months) was 70.6 percent, excluding vaccination against Hepatitis B and only 46.7 percent counting Hepatitis B vaccination. Table CH.2 shows the level of vaccination cover- age of children aged 15-26 months by main charac- teristics. The numbers include the number of children who had been vaccinated at some time prior to the sur- vey and are based both on the data from Vaccinations Cards and responses of mothers and caretakers. In Kazakhstan, at the time of the survey 61.6 per- cent of children aged 15-26 months (based on immuni- zation cards) had all necessary vaccinations. The rural immunization level is slightly higher (65.9 percent) than urban (56.8 percent). The highest immunization cover- age was reported in Karaganda (92.9 percent), Kosta- nai (90.1 percent), Zhambyl (88.5 percent), Pavlodar Oblasts (80.2 percent), whereas the lowest coverage rate was reported in Astana city (21.6 percent) and West Kazakhstan Oblast (26.9 percent). The interviewers saw vaccination cards of 65.9 percent of children and copies all types of vaccination received into a separate Mod- ule on Immunization during the visits of households or medical institutions. There was no difference in cover- age with BCG vaccination by sex, place of residence, mother’s education and household wealth. By the age of 26 months, 98.8 percent of chil- dren received first dose of DPT. The percentage de- clines to 98.5 percent for the second dose, and 96.8 percent for the third dose; the coverage of boys and girls and those living in urban and rural areas is almost the same. During the survey no major disparities were observed in terms of the region, mother’s education or wealth quintile. A somewhat different situation ex- ists with polio vaccination. A total 99.1 percent of chil- dren received OPV 1 and this declines to 88.4 percent by the third dose oral polio vaccine. OPV coverage of boys and girls was almost the same. Both in urban and rural areas by the third dose of OPV the proportion of children vaccinated against polio significantly decreas- es and is at 87.1 percent and 89.6 percent respectively compared to 99.0 percent and 99.2 percent for the first dose. About 93.9 percent of children age 15-26 months were covered with mumps, measles and rubella vaccine. One hundred percent measles vaccination coverage was only reported in Kostanai Oblast, while in other regions it is also high and exceeds 90 percent. A total of 70.2 per- cent of children received three doses of HepB vaccine by the age of 26 months; the share of rural children was 5.4 80 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN pe rc en t h ig he r t ha n ur ba n ch ild re n (7 2. 8 an d 67 .4 p er ce nt re sp ec tiv el y) . Ta bl e C H .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag ed 1 5- 26 m on th s cu rr en tly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, K az ak hs ta n, 2 01 0/ 20 11 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Percentage with vac- cination card seen Number of children age 15-26 months B C G Po lio D PT Measles+parotitis, rubella H ep B N on e A ll 1 2 3 1 2 3 1 2 3 Se x M al e 99 ,4 99 ,5 97 ,7 88 ,8 98 ,7 97 ,8 96 ,9 94 ,8 96 ,0 93 ,1 69 ,3 0, 1 62 ,2 64 ,0 55 7 Fe m al e 99 ,6 98 ,6 97 ,5 88 ,0 98 ,9 99 ,2 96 ,6 92 ,9 97 ,2 93 ,9 71 ,2 0, 3 60 ,9 68 ,0 51 9 R eg io n A km ol a (1 00 ,0 ) (9 6, 0) (9 1, 9) (7 2, 0) (9 8, 0) (9 5, 9) (9 6, 1) (9 7, 9) (9 4, 2) (8 4, 4) (5 0, 1) (0 ,0 ) (3 8, 1) (9 7, 4) 40 A kt ob e 10 0, 0 97 ,4 97 ,4 73 ,7 10 0, 0 10 0, 0 10 0, 0 91 ,5 98 ,3 91 ,5 68 ,1 0, 0 42 ,5 51 ,4 56 A lm at y 10 0, 0 10 0, 0 98 ,4 82 ,2 10 0, 0 98 ,4 95 ,3 94 ,8 98 ,4 90 ,9 82 ,3 0, 0 76 ,2 80 ,9 10 0 A lm at y ci ty (1 00 ,0 ) (1 00 ,0 ) (8 9, 6) (6 9, 8) (1 00 ,0 ) (9 6, 7) (7 3, 3) (9 0, 4) (9 2, 5) (7 5, 0) (1 6, 9) (0 ,0 ) (1 3, 2) (6 8, 9) 46 A st an a ci ty 10 0, 0 10 0, 0 97 ,3 79 ,8 98 ,6 10 0, 0 97 ,9 97 ,9 10 0, 0 84 ,2 30 ,3 0, 0 21 ,6 85 ,1 37 A ty ra u 10 0, 0 10 0, 0 10 0, 0 81 ,6 10 0, 0 10 0, 0 96 ,7 93 ,0 92 ,6 97 ,9 57 ,0 0, 0 40 ,5 24 ,6 38 E as t K az ak hs ta n 10 0, 0 98 ,1 98 ,1 96 ,3 98 ,1 98 ,1 98 ,1 90 ,7 98 ,1 98 ,1 77 ,6 0, 0 71 ,4 69 ,9 75 Zh am by l 10 0, 0 10 0, 0 10 0, 0 97 ,6 10 0, 0 10 0, 0 10 0, 0 93 ,2 10 0, 0 10 0, 0 96 ,6 0, 0 88 ,5 34 ,2 76 W es t K az ak hs ta n 10 0, 0 10 0, 0 98 ,3 95 ,4 10 0, 0 98 ,3 96 ,6 94 ,8 85 ,6 96 ,4 43 ,1 0, 0 26 ,9 96 ,3 40 K ar ag an da 97 ,0 97 ,3 97 ,0 94 ,3 95 ,7 97 ,0 97 ,0 97 ,0 97 ,0 97 ,0 97 ,0 1, 4 92 ,9 31 ,9 10 1 K os ta na i 10 0, 0 10 0, 0 10 0, 0 97 ,5 10 0, 0 10 0, 0 10 0, 0 10 0, 0 10 0, 0 10 0, 0 90 ,1 0, 0 90 ,1 28 ,0 45 K yz yl or da 99 ,2 99 ,2 99 ,2 97 ,4 99 ,2 99 ,2 98 ,1 97 ,3 90 ,8 99 ,2 79 ,4 0, 8 68 ,0 99 ,2 62 M an gi st au 96 ,4 98 ,8 97 ,1 87 ,6 98 ,8 98 ,8 98 ,8 97 ,9 10 0, 0 98 ,8 82 ,7 0, 0 75 ,9 56 ,4 58 P av lo da r 10 0, 0 97 ,2 93 ,7 84 ,9 95 ,2 95 ,2 93 ,4 93 ,3 94 ,8 93 ,4 83 ,8 0, 0 80 ,2 96 ,5 48 N or th K az ak hs ta n (1 00 ,0 ) (1 00 ,0 ) (9 5, 4) (8 8, 0) (1 00 ,0 ) (9 7, 6) (9 5, 3) (9 2, 9) (9 5, 1) (9 5, 1) (7 2, 6) (0 ,0 ) (6 6, 2) (4 2, 8) 25 S ou th K az ak hs ta n 10 0, 0 10 0, 0 99 ,0 91 ,4 99 ,0 99 ,0 99 ,0 90 ,4 97 ,3 91 ,2 57 ,3 0, 0 48 ,7 76 ,5 22 7 A re a U rb an 99 ,6 99 ,0 96 ,9 87 ,1 98 ,7 98 ,6 95 ,0 93 ,6 96 ,9 94 ,3 67 ,4 0, 4 56 ,8 64 ,0 51 2 R ur al 99 ,3 99 ,2 98 ,2 89 ,6 98 ,9 98 ,4 98 ,4 94 ,2 96 ,3 92 ,8 72 ,8 0, 0 65 ,9 67 ,7 56 4 M ot he r’s E du ca tio n S ec on da ry in co m pl et e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 S ec on da ry 99 ,1 98 ,9 96 ,7 88 ,3 98 ,3 97 ,8 96 ,6 94 ,3 96 ,9 95 ,3 74 ,0 0, 0 66 ,4 68 ,7 39 8 81MONITORING THE SITUATION OF CHILDREN AND WOMEN Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Percentage with vac- cination card seen Number of children age 15-26 months B C G Po lio D PT Measles+parotitis, rubella H ep B N on e A ll 1 2 3 1 2 3 1 2 3 S ec on da ry s pe ci al is ed 10 0, 0 98 ,8 98 ,6 88 ,3 98 ,8 98 ,4 96 ,3 93 ,8 97 ,2 92 ,8 71 ,1 0, 0 62 ,0 67 ,0 29 7 H ig h 99 ,5 99 ,5 97 ,7 88 ,6 99 ,2 99 ,2 97 ,2 93 ,8 95 ,7 91 ,8 64 ,4 0, 5 55 ,9 62 ,3 36 1 W ea lth In de x Q ui nt ile P oo re st 99 ,4 99 ,2 97 ,6 88 ,6 98 ,5 97 ,9 97 ,1 93 ,3 96 ,8 94 ,6 71 ,8 0, 0 62 ,6 74 ,3 24 9 S ec on d 10 0, 0 99 ,4 98 ,9 90 ,4 10 0, 0 98 ,9 98 ,9 93 ,7 98 ,7 97 ,4 71 ,7 0, 0 63 ,8 62 ,5 27 2 M id dl e 98 ,8 99 ,3 97 ,4 90 ,4 98 ,8 98 ,8 97 ,0 90 ,2 95 ,4 90 ,5 75 ,8 0, 0 64 ,8 68 ,9 19 8 Fo ur th 10 0, 0 98 ,4 96 ,3 83 ,6 97 ,0 97 ,7 94 ,4 95 ,9 96 ,9 90 ,4 66 ,5 0, 0 59 ,2 61 ,4 16 8 R ic he st 99 ,0 99 ,0 97 ,0 87 ,5 99 ,0 99 ,0 95 ,2 97 ,1 94 ,2 92 ,4 63 ,6 1, 0 55 ,5 60 ,8 18 9 R el ig io n/ La ng ua ge /E th ni ci ty o f H ou se ho ld H ea d K az ak h 99 ,7 99 ,3 98 ,8 90 ,5 99 ,3 98 ,9 97 ,9 94 ,7 97 ,0 94 ,6 71 ,3 0, 0 62 ,3 67 ,2 75 9 R us si an 99 ,2 97 ,8 93 ,8 81 ,3 98 ,2 97 ,8 93 ,4 93 ,5 95 ,8 89 ,6 66 ,5 0, 8 57 ,9 61 ,0 17 1 O th er e th ni c gr ou p 98 ,6 99 ,7 95 ,8 86 ,0 96 ,9 96 ,9 94 ,8 90 ,0 95 ,1 92 ,5 69 ,2 0, 3 62 ,0 64 ,9 14 6 To ta l 99 ,5 99 ,1 97 ,6 88 ,4 98 ,8 98 ,5 96 ,8 93 ,9 96 ,6 93 ,5 70 ,2 0, 2 61 ,6 65 ,9 10 76 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es ( ) i nd ic at or s ar e ba se d on 2 5- 49 c as es o f u nw ei gh te d ob se rv at io ns (* ) in di ca to rs a re b as ed o n le ss th an 2 5 ca se s of u nw ei gh te d ob se rv at io ns 82 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Diarrhoea is the second leading cause of death among children under 5 worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diar- rhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continu- ing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under by 2010 com- pared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under 5 by 2015 compared to 1990 (Millennium Develop- ment Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. Oral Rehydration Treatment Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Kazakhstan, 2010/11 Had diar- rhoea in last two weeks Num- ber of children aged 0-59 months Children with diarrhoea who received: Number of children aged 0–59 months with diarrhoea Oral rehydration solu- tions (Fluid from ORS packet or pre-pack- aged ORS fluid) Any recommended homemade fluids ORS or any recommended homemade fluid Sex Male 2,0 2644 (67,9) (20,9) (69,7) 53 Female 1,5 2537 (53,1) (23,7) (57,5) 37 Residence Urban 1,8 2508 (70,3) (25,8) (73,9) 46 Rural 1,6 2673 (53,0) (18,2) (55,1) 44 Education Incomplete secondary 1,6 96 (*) (*) (*) 1 Secondary 1,4 1916 (56,8) (32,0) (63,6) 28 Specialized secondary 1,7 1432 (61,2) (14,7) (61,2) 25 Higher 2,1 1729 (67,1) (18,9) (69,1) 36 Ethnicity of Household Head Kazakh 1,5 3724 71,8 24,2 71,8 54 Russian 2,7 785 (*) (*) (*) 21 Other 2,0 672 (*) (*) (*) 14 Total 1,7 5181 61,8 22,1 64,7 90 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • ORT with continued feeding In the MICS questionnaire, mothers (or caretak- ers) were asked to report whether their child had had di- arrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Since the survey was conducted in winter period for which the incidence of diarrhoea is uncharacteristic, only 1.7 percent or 90 under-5 children had diarrhoea in the two weeks preceding the survey (Table CH.4). Due to the small number of cases, data is distributed by residence and sex of children. Diarrhoea prevalence was slightly higher among boys; no difference between rural and urban areas was found. 83MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. About 61.8 percent received fluids from ORS packets or pre-packaged ORS fluids and 22.1 percent received recommended homemade fluids. Less than one third (29.9 percent) of under-5 children with diarrhoea drank more than usual while 30.2 percent drank the same (Table CH.5). Table CH.5: Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Kazakhstan, 2010/11 H ad d ia rr he a in la st tw o w ee ks N um be r o f c hi ld re n ag e 0- 59 m on th s Drinking practices during diarrhoea: To ta l Eating practices during diarrhoea: To ta l N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith di ar rh oe a G iv en m uc h le ss to dr in k G iv en s om ew ha t le ss to d rin k G iv en a bo ut th e sa m e to d rin k G iv en m or e to d rin k G iv en n ot hi ng to dr in k G iv en m uc h le ss to e at G iv en s om ew ha t le ss to e at G iv en a bo ut th e sa m e to e at G iv en m or e to e at S to pp ed fo od H ad n ev er b ee n gi ve n fo od M is si ng /D K Sex Male 2,0 2644 (5,5) (34,3) (28,7) (27,5) (3,9) 100 (7,7) (38,0) (43,3) (3,6) (0,0) (6,2) (1,3) 100 53 Female 1,5 2537 (10,1) (22,1) (32,2) (33,3) (2,3) 100 (24,7) (29,7) (37,3) (4,0) (2,2) (2,2) (0,0) 100 37 Residence Urban 1,8 2508 (1,0) (23,0) (32,9) (40,4) (2,7) 100 (11,2) (27,3) (49,4 (7,3) (0,0) (3,2) (1,5) 100 46 Rural 1,6 2673 (14,1) (35,8) (27,4) (18,9) (3,8) 100 (18,4) (42,0) (31,9) (0,0) (1,8) (5,9) (0,0) 100 44 Ethnicity of Household Head Kazakh 1,5 3724 12,2 26,7 26,2 30,2 4,7 100 18,7 31,9 35,4 6,1 1,5 5,2 1,2 100 54 Russian 2,7 785 (*) (*) (*) (*) (*) 100 (*) (*) (*) (*) (*) (*) (*) 100 21 Other 2,0 672 (*) (*) (*) (*) (*) 100 (*) (*) (*) (*) (*) (*) (*) 100 14 Total 1,7 5181 7,4 29,3 30,2 29,9 3,3 100 14,7 34,5 40,8 3,7 0,9 4,5 0,8 100 90 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments. Overall, 70 percent of children with diarrhoea received ORS or increased flu- ids, 71.1 percent received ORT (ORS or recommend- ed homemade fluids or increased fluids). Combining the information in Table CH.5 with those in Table CH.6 on oral rehydration therapy, it is observed that 54 per- cent of children either received ORT and, at the same time feeding was continued, which is based on what is recommended. In a number of cases children with diarrhoea received other medicine in addition to ORT. Whereby 17.2 percent of children received antibiot- ics through injections, 5.2 percent of children received antispasmodics in pills or syrup. 84 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.6: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who received other treatments, Kazakhstan, 2010/2011 Children with diarrhoea who received: Other treatment: N ot g iv en a ny tr ea tm en t or d ru g N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ith di ar rh oe a O R S o r i nc re as ed flu id s O R T (O R S o r r ec - om m en de d ho m e- m ad e flu id s or in cr ea se d flu id s) O R T w ith c on tin - ue d fe ed in g1 Pill or syrup Injections In tra ve no us H om e re m ed y/ H er ba l m ed ic in e O th er A nt ib io tic A nt im ot ili ty Zi nc O th er U nk no w n: A nt ib io tic In je ct io n N on an tib io tic In je ct io n U nk no w n Sex Male (71,5) (71,5) (59,7) (20,9) (5,7) (0,0) (3,2) (10,8) (0,0) (0,0) (0,0) (0,0) (8,8) (25,0) (8,9) 53 Female (68,0) (70,5) (45,8) (12,1) (4,5) (0,0) (4,5) (6,5) (4,1) (0,0) (0,0) (0,0) (2,1) (13,9) (20,3) 37 Residence Urban (85,3) (85,3) (69,4) (17,1) (10,2) (0,0) (7,4) (4,5) (2,1) (0,0) (0,0) (0,0) (3,5) (13,2) (8,5) 46 Rural (54,2) (56,3) (37,9) (17,4) (0,0) (0,0) (0,0) (13,8) (1,2) (0,0) (0,0) (0,0) (8,6) (27,9) (18,8) 44 Mother’s Education Incomplete Secondary (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 Secondary (60,2) (63,6) (51,3) (12,5) (0,0) (0,0) (0,0) (10,3) (0,0) (0,0) (0,0) (0,0) (2,9) (20,9) (16,2) 28 Specialized Secondary (73,9) (73,9) (59,8) (21,7) (6,9) (0,0) (6,9) (2,4) (2,2) (0,0) (0,0) (0,0) (9,4) (19,0) (7,3) 25 Higher (73,8) (73,8) (51,7) (18,5) (8,3) (0,0) (4,7) (13,0) (2,7) (0,0) (0,0) (0,0) (6,3) (19,2) (16,5) 36 Total 70,0 71,1 54,0 17,2 5,2 0,0 3,8 9,0 1,7 0,0 0,0 0,0 6,0 20,4 13,6 90 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 3.8 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Care Seeking and Antibiotic Treatment of Pneumonia A total of 2.8 percent or 145 children age 0-59 months were reported to have had symptoms of pneu- monia during the two weeks preceding the survey. Of these children, 81.2 percent sought care and advice in various healthcare facilities including 80.2 percent in public healthcare facilities, 10.1 percent in private fa- cilities and 3.7 percent in other sources of care. Among public healthcare hospitals, people were more likely to seek care in public hospitals and health centres (36.5 and 33.8 percent respectively), whereas among private institutions, most popular were private hospitals/clinics and private pharmacies (2.7 and 5.3 percent of total number of institutions, respectively). In urban areas, people were more likely to seek care for suspected pneumonia in public hospitals (49.5 percent), whereas in rural areas people were more likely to seek care in public healthcare centres (37.7 percent). Table CH.7 also presents the use of antibiotics for the treatment of suspected pneumonia in under-5s. In Kazakhstan, 86.6 percent of under-5 children with suspected pneumonia had received an antibiotic dur- ing the two weeks prior to the survey. Pneumonia is the leading cause of death in chil- dren and the use of antibiotics in under-5s with sus- pected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. The prevalence of suspected pneumonia was estimated by asking mothers or caretakers whether their child under 5 had an illness with a cough ac- companied by rapid or difficult breathing, and whose symptoms were due to a problem in the chest or both a problem in the chest and a blocked nose. • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia Table CH.7 presents the prevalence of sus- pected pneumonia and, if care was sought outside the home, the site of care. THE INDICATORS ARE: 85MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .7 : C ar e se ek in g fo r s us pe ct ed p ne um on ia a nd a nt ib io tic u se d ur in g su sp ec te d pn eu m on ia P er ce nt ag e of c hi ld re n ag e 0- 59 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks w ho w er e ta ke n to a h ea lth p ro vi de r a nd p er ce nt ag e of ch ild re n w ho w er e gi ve n an tib io tic s, K az ak hs ta n, 2 01 0/ 20 11 Had suspected pneumonia in the last two weeks Number of children age 0-59 months C hi ld re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : Any appropriate provider 1 Percentage of children with sus- pected pneumonia who received antibiotics in the last two weeks 2 Number of children age 0-59 months with suspected pneumo- nia in the last two weeks Pu bl ic s ec to r Pr iv at e se ct or O th er s ou rc es Public sector: Hospital Public sector: Basic health unit Public sector: Satellite clinic Village health worker Outreach clinic Other public sector health facilities Private hospital/clinic Private physician Private pharmacy Mobile clinic Other private health pro- vider Relative / Friend Shop Traditional practitioner Other Se x M al e 2,9 26 44 32 ,0 2,3 35 ,4 8,9 0,0 0,0 4,3 1,7 7,3 0,0 1,9 1,4 0,0 0,8 1,9 82 ,5 83 ,3 78 Fe m al e 2,6 25 37 41 ,8 0,9 32 ,0 5,9 0,0 1,5 0,9 0,5 3,0 0,0 0,0 3,0 0,0 0,0 0,0 79 ,6 90 ,4 67 R es id en ce U rb an 2,7 25 08 49 ,5 2,7 29 ,3 0,0 0,0 1,5 1,6 2,4 5,2 0,0 2,2 0,0 0,0 0,0 2,2 86 ,8 82 ,5 67 R ur al 2,9 26 73 25 ,3 0,8 37 ,7 14 ,0 0,0 0,0 3,7 0,0 5,4 0,0 0,0 4,0 0,0 0,8 0,0 76 ,2 90 ,2 77 A ge 0- 11 m on th s (3, 2) (10 64 ) (34 ,0) (4, 7) (31 ,0) (15 ,2) (0, 0) (0, 0) (8, 4) (0, 0) (10 ,3) (0, 0) (4, 3) (9, 2) (0, 0) (1, 9) (0, 0) (91 ,8) (93 ,3) 34 12 -2 3 m on th s (2, 9) (10 37 ) (42 ,6) (0, 0) (39 ,2) (5, 6) (0, 0) (0, 0) (0, 0) (1, 9) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (87 ,2) (93 ,7) 30 24 -3 5 m on th s (2, 6) (10 97 ) (33 ,3) (0, 0) (39 ,2) (9, 5) (0, 0) (0, 0) (0, 0) (2, 5) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (82 ,2) (69 ,9) 29 36 -4 7 m on th s (3, 1) (10 05 ) (31 ,7) (2, 6) (26 ,0) (0, 0) (0, 0) (0, 0) (1, 9) (1, 1) (10 ,1) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (4, 8) (58 ,1) (91 ,6) 31 48 -5 9 m on th s (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 21 Ed uc at io n In co m pl et e S ec on da ry (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 1 S ec on da ry (2, 6) (19 16 ) (27 ,1) (4, 8) (45 ,9) (6, 7) (0, 0) (0, 0) (0, 6) (1, 4) (10 ,9) (0, 0) (2, 9) (4, 0) (0, 0) (1, 3) (0, 0) (82 ,3) (80 ,5) 51 S pe ci al iz ed S ec on da ry (2, 8) (14 32 ) (37 ,8) (0, 0) (33 ,7) (4, 1) (0, 0) (2, 5) (0, 5) (1, 7) (5, 2) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (0, 0) (78 ,4) (88 ,3) 41 H ig he r 3,0 17 29 45 ,7 0,0 23 ,0 11 ,0 0,0 0,0 6,6 0,4 0,0 0,0 0,0 2,1 0,0 0,0 2,9 84 ,3 91 ,0 52 To tal 2,8 51 81 36 ,5 1,7 33 ,8 7,5 0,0 0,7 2,7 1,1 5,3 0,0 1,0 2,2 0,0 0,5 1,0 81 ,2 86 ,6 14 5 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es 1 M IC S In di ca to r 3 .9 2 M IC S In di ca to r 3 .1 0 ( ) – in di ca to rs a re b as ed o n 25 -4 9 ca se s of u nw ei gh te d ob se rv at io ns (* ) – in di ca to rs a re b as ed o n le ss th an 2 5 ca se s of u nw ei gh te d ob se rv at io ns 86 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 22.2 percent of women know of the two danger signs of pneumonia – fast and difficult breath- ing. The most commonly identified symptom for taking a child to a health facility is high fever (89.3 percent). 42.9 percent of mothers identified difficult breathing and 32.7 percent of mothers identified fast breath- ing as symptoms for taking children immediately to a health care provider. For over 45 percent of mothers one of the danger signs for seeking care is if the child becomes weaker, for 26.7 percent of mothers one of the danger signs is blood in stool, for 21.6 percent of mothers – if a child is not able to drink or breastfeed. Only 13.6 percent of mothers will seek care if a child drinks poorly. The highest percentage of mothers aware of two danger signs of pneumonia was found in Almaty (73.3 percent) and in Mangistau (48.4 percent) and East Kazakhstan (43.9 percent) Oblasts, the low- est was in Almaty (7.3 percent), South Kazakhstan (8.7 percent) and West Kazakhstan (9.6 percent) Oblasts. 27 percent of mothers in urban and 17.2 percent in rural area are aware of main pneumonia symptoms. Knowledge of two symptoms of pneumonia in- creases with women’s education (from 18.1 to 26 per- cent) and household wealth (from 15.8 in the poorest to 32.3 percent in the richest families). Table CH.8: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child M ot he rs /c ar et ak er s w ho re c- og ni ze th e tw o da ng er s ig ns o f pn eu m on ia N um be r o f m ot he rs /c ar et ak er s of ch ild re n ag ed 0 -5 9 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iffi cu lt br ea th in g H as b lo od in s to ol Is d rin ki ng p oo rly H as o th er s ym pt om s Region Akmola Oblast 8,5 37,9 87,1 41,7 55,4 45,3 10,5 14,4 32,7 159 Aktobe Oblast 32,3 42,9 86,7 32,2 32,1 16,4 12,6 8,9 14,9 206 Almaty Oblast 26,4 28,6 95,4 10,8 38,0 18,6 6,7 12,5 7,3 439 Almaty city 56,2 80,3 95,7 78,1 84,6 81,5 52,6 6,9 73,3 181 Astana city 21,9 49,7 89,9 30,2 35,3 29,3 24,6 7,0 20,1 136 Atyrau Oblast 28,2 46,9 97,0 49,6 43,9 13,3 20,4 1,1 32,8 131 East Kazakhstan Oblast 40,9 52,8 81,0 50,5 59,1 52,1 16,6 18,8 43,9 312 Zhambyl Oblast 13,4 28,6 92,5 33,7 29,8 16,0 12,7 26,7 15,3 282 West Kazakhstan Oblast 16,4 55,7 92,4 31,3 42,1 17,2 6,8 7,5 9,6 153 Karaganda Oblast 12,9 36,9 92,4 28,2 56,6 22,0 8,1 32,0 15,5 342 Kostanai Oblast 21,2 46,7 97,6 40,0 57,0 30,1 19,9 28,2 35,2 185 Kyzylorda Oblast 25,5 31,6 89,4 26,3 37,8 20,2 9,7 0,6 15,1 206 Mangistau Oblast 46,9 65,3 83,9 64,8 63,7 39,8 32,0 1,2 48,4 169 Pavlodar Oblast 11,1 45,9 78,5 25,3 51,1 31,9 15,4 58,1 23,1 190 87MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child M ot he rs /c ar et ak er s w ho re c- og ni ze th e tw o da ng er s ig ns o f pn eu m on ia N um be r o f m ot he rs /c ar et ak er s of ch ild re n ag ed 0 -5 9 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iffi cu lt br ea th in g H as b lo od in s to ol Is d rin ki ng p oo rly H as o th er s ym pt om s North Kazakhstan Oblast 10,6 23,7 94,9 25,9 38,6 24,6 7,4 57,5 20,0 122 South Kazakhstan Oblast 7,1 54,7 85,2 20,7 21,2 13,7 4,7 7,9 8,7 750 Residence Urban 24,8 49,1 89,2 37,6 50,6 34,2 16,9 18,5 27,0 2020 Rural 18,4 41,3 89,4 27,7 35,0 18,9 10,1 15,2 17,2 1944 Mother’s Education Incomplete secondary 21,6 40,3 90,0 25,0 34,7 22,8 14,8 13,6 18,1 65 Secondary 19,9 43,9 89,1 30,5 40,1 23,4 12,4 15,5 19,3 1380 Specialized secondary 21,8 45,5 89,5 31,6 43,0 27,8 13,9 17,9 21,3 1134 Higher 23,3 46,8 89,5 36,3 46,1 29,4 14,4 17,5 26,0 1381 Wealth Index Quintile Poorest 15,6 42,8 87,4 28,1 32,1 19,0 8,8 14,5 15,8 880 Second 19,6 38,3 90,6 24,9 33,4 18,2 9,3 14,8 15,7 816 Middle 23,1 46,1 89,0 33,0 41,4 26,2 13,8 16,9 20,4 782 Fourth 27,9 48,3 91,2 37,3 53,5 34,2 17,9 16,8 28,1 693 Richest 23,5 51,6 88,8 41,7 57,0 38,2 19,3 21,7 32,3 793 Ethnicity of Household Head Kazakh 22,5 45,0 89,2 33,1 41,4 25,2 14,4 13,9 21,5 2764 Russian 22,0 48,5 89,9 37,4 54,5 38,1 14,6 24,6 29,5 693 Other 16,3 42,2 89,2 24,3 35,4 19,5 7,8 22,7 15,8 507 Total 21,6 45,3 89,3 32,7 42,9 26,7 13,6 16,9 22,2 3964 ‘No education’ category has been excluded due to insignificant number of responses Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cook- ing and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstruc- tive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using sol- id fuels as the primary source of domestic energy for cooking. 88 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CH.9: Solid fuel use Percentage distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Kazakhstan, 2010/2011 Percentage of households using N um be r o f ho us eh ol d m em be rs E le ct ric ity Li qu efi ed pe tro le um g as / pr op an e N at ur al g as K er os en e Solid fuels O th er N o fo od c oo ke d in h ou se ho ld To ta l U se o f s ol id fu el fo r c oo ki n1 g C oa l/ br ow n co al C ha rc oa l W oo d A ni m al d un g Region Akmola Oblast 2,7 92,9 0,2 0,0 2,5 0,2 0,9 0,0 0,0 0,7 100,0 3,5 2470 Aktobe Oblast 0,6 13,2 73,4 0,0 5,5 3,0 0,6 3,7 0,0 0,0 100,0 12,8 2595 Almaty Oblast 1,0 89,2 9,4 0,0 0,0 0,0 0,0 0,2 0,2 0,0 100,0 0,3 5879 Almaty city 1,6 23,5 71,2 0,0 3,7 0,0 0,0 0,0 0,0 0,0 100,0 3,7 4129 Astana city 30,1 69,1 0,6 0,0 0,1 0,1 0,0 0,0 0,0 0,0 100,0 0,2 1710 Atyrau Oblast 3,0 4,5 84,6 0,0 3,2 0,1 0,3 4,2 0,0 0,0 100,0 7,9 1542 East Kazakhstan Oblast 43,4 38,5 0,6 0,0 9,7 0,3 3,5 4,0 0,0 0,0 100,0 17,5 4782 Zhambyl Oblast 0,3 29,2 46,0 0,0 18,5 2,1 3,3 0,4 0,0 0,0 100,0 24,5 3521 West Kazakhstan Oblast 0,2 11,0 63,9 0,0 0,2 0,6 8,6 15,6 0,0 0,0 100,0 25,0 2208 Karaganda Oblast 36,6 40,5 0,0 0,0 20,9 0,3 1,1 0,7 0,0 0,0 100,0 23,0 4838 Kostanai Oblast 7,2 33,1 53,8 0,0 4,6 0,0 1,2 0,1 0,0 0,0 100,0 5,9 3058 Kyzylorda Oblast 0,1 59,7 16,7 0,0 0,7 13,5 9,2 0,0 0,0 0,0 100,0 23,5 2292 Mangistau Oblast 0,6 8,5 90,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 0,0 1722 Pavlodar Oblast 67,5 30,2 0,0 0,0 2,2 0,0 0,0 0,0 0,0 0,0 100,0 2,2 2770 North Kazakhstan Oblast 9,4 87,1 0,5 0,1 1,0 0,0 1,9 0,0 0,0 0,0 100,0 2,9 2304 South Kazakhstan Oblast 2,1 37,2 49,4 0,0 0,4 2,7 4,9 3,3 0,0 0,0 100,0 11,3 8729 Residence Urban 19,8 35,2 41,8 0,0 2,8 0,3 0,1 0,0 0,0 0,0 100,0 3,1 29257 Rural 5,3 53,3 21,6 0,0 7,9 2,7 5,0 4,2 0,0 0,0 100,0 19,8 25292 Education of Household Head Incomplete Secondary 9,4 47,6 24,5 0,0 7,1 1,7 5,1 4,6 0,0 0,0 100,0 18,5 6151 Secondary 10,5 46,5 27,3 0,0 7,2 2,1 3,5 2,8 0,0 0,0 100,0 15,6 18496 Specialized Secondary 15,1 43,3 34,4 0,0 3,8 1,0 1,3 0,9 0,0 0,1 100,0 7,0 17226 Higher 16,2 37,6 41,4 0,0 2,7 0,5 0,9 0,6 0,0 0,0 100,0 4,8 12355 Wealth Index Quintile Poorest 1,7 51,1 13,2 0,0 11,5 4,7 9,1 8,6 0,0 0,0 100,0 34,0 10909 Second 4,1 56,5 26,1 0,0 8,0 1,8 2,3 1,0 0,0 0,0 100,0 13,2 10911 Middle 8,5 50,5 34,7 0,0 5,4 0,3 0,4 0,0 0,1 0,1 100,0 6,1 10909 Fourth 16,8 41,3 41,1 0,0 0,9 0,0 0,0 0,0 0,0 0,0 100,0 0,9 10905 Richest 34,2 18,6 47,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 0,0 10916 Ethnicity of Household Head Kazakh 9,5 42,5 32,9 0,0 6,8 2,0 3,4 2,8 0,0 0,0 100,0 15,1 34089 Russian 24,3 42,8 30,0 0,0 2,2 0,1 0,5 0,0 0,0 0,1 100,0 2,9 13089 Other 9,7 50,2 34,7 0,0 2,8 0,6 0,9 1,1 0,0 0,0 100,0 5,4 7371 Total 13,1 43,6 32,4 0,0 5,2 1,4 2,4 1,9 0,0 0,0 100,0 10,8 54549 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 3.11 89MONITORING THE SITUATION OF CHILDREN AND WOMEN Overall, 10.8 percent of all households in Ka- zakhstan are using solid fuels for cooking. Use of sol- id fuels is very low in urban areas (3.1 percent), but high in rural areas, where 19.8 percent of the house- holds are using solid fuels. Differences with respect to household wealth and the educational level of the household head are also significant. A total of 34.0 per- cent of poorest households and 0.9 percent of fourth quintile households use solid fuel for cooking. The sur- vey results show that solid fuels are virtually not used in Astana and in Almaty Oblast (0.2 and 0.3 percent, respectively) and not used in Mangistau Oblast at all. The highest percentage of use of solid fuels for cooking was reported in West Kazakhstan (25 percent), Zham- byl (24.5 percent), Kyzylorda (23.5 percent) and Kara- ganda (23 percent) Oblasts. The table also clearly shows that the overall per- centage of households using solid fuels is due to pre- dominant use of coal and wood for cooking purposes. Solid fuel use alone is a poor proxy for indoor air pol- lution, since the concentration of the pollutants is dif- ferent when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chim- ney or hood means that there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10. About 87.8 percent of households use a sepa- rate room such as a kitchen for cooking; the percent- age of such households is 94.5 percent in urban ar- eas and 86.6 percent in rural areas. 9.1 percent of households cook elsewhere in the house; percentage of furnaces used for cooking is lower in urban (4.6 per- cent) than in rural areas (10 percent). Other premises in the house (other than kitchen) are most common in the poorest (11.2 percent) households and are used only by 1.7 percent of richest households. There is no significant differential by education of household head. Other premises (other than kitchen) are primarily com- mon in Aktobe and Atyrau Oblasts (32.4 percent each). Separate buildings used for cooking are primarily com- mon in South Kazakhstan Oblast. Table CH.10: Solid fuel use by place of cooking Percentage distribution of household members in households using solid fuels by place of cooking, Kazakhstan, 2010/2011 Place of cooking Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Total Region Akmola Oblast 87,1 12,9 0,0 100,0 87 Aktobe Oblast 67,6 32,4 0,0 100,0 333 Almaty Oblast (*) (*) (*) 100,0 16 Almaty city 91,7 8,3 0,0 100,0 152 Astana city (*) (*) (*) 100,0 3 Atyrau Oblast 67,6 32,4 0,0 100,0 122 East Kazakhstan Oblast 77,1 22,0 1,0 100,0 838 Zhambyl Oblast 95,2 3,1 1,8 100,0 862 West Kazakhstan Oblast 100,0 0,0 0,0 100,0 552 Karaganda Oblast 98,1 1,2 0,7 100,0 1111 Kostanai Oblast 87,7 10,4 1,9 100,0 179 Kyzylorda Oblast 91,6 6,8 1,7 100,0 538 Pavlodar Oblast 100,0 0,0 0,0 100,0 61 North Kazakhstan Oblast 92,3 7,7 0,0 100,0 67 South Kazakhstan Oblast 77,6 8,6 13,8 100,0 985 Residence Urban 94,5 4,6 0,9 100,0 909 Rural 86,6 10,0 3,4 100,0 4998 Education of Household Head Incomplete secondary 86,8 6,4 6,8 100,0 1135 Secondary 87,4 10,4 2,2 100,0 2889 90 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Place of cooking Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Total Specialized secondary 89,3 8,7 2,0 100,0 1214 Higher 89,5 8,0 2,4 100,0 594 Wealth Index Quintile Poorest 85,1 11,2 3,7 100,0 3705 Second 91,0 6,5 2,5 100,0 1438 Middle 94,2 4,6 1,2 100,0 667 Fourth 98,3 1,7 0,0 100,0 97 Richest Ethnicity of Household Head Kazakh 87,3 9,6 3,1 100,0 5133 Russian 93,7 6,3 0,0 100,0 373 Other 89,3 5,6 5,1 100,0 400 Total 87,8 9,1 3,1 100,0 5906 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations 91MONITORING THE SITUATION OF CHILDREN AND WOMEN VII. Water and Sanitation 92 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carri- er of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, espe- cially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sus- tainable access to safe drinking water and basic sani- tation. A World Fit for Children goal calls for a reduc- tion in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation • Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website http://www.childinfo.org/wes.html. Use of Improved Water Sources The distribution of the population by source of drinking water is shown in Table WS.1 and Fig- ure WS.1. The population using improved sources of drinking water are those using any of the fol- lowing types of supply: piped water (into dwell- ing, compound, yard or plot, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as handwashing and cook- ing. Table WS.1: Use of improved water sources Percent distribution of household population (members) by main sources of drinking water and percentage of household members using improved sources of drinking water, Kazakhstan 2010/11 Main source of drinking water To ta l P er ce nt ag e u si ng im pr ov ed s ou rc - u si ng im pr ov ed s ou rc - us in g im pr ov ed s ou rc - im pr ov ed s ou rc - im pr ov ed s ou rc - s ou rc - so ur c- es o f d rin ki ng w at er 1 N um be r o f h ou se ho ld m em be rsImproved sources of drinking water1 Unimproved sources of drinking water Piped water Tu be -w el l/b or e- ho le P ro te ct ed w el l P ro te ct ed s pr in g R ai nw at er c ol le ct io n B ot tle d w at er U np ro te ct ed w el l U np ro te ct ed s pr in g Ta nk er tr uc k C ar t w ith ta nk / d ru m s S ur fa ce w at er (r iv er , s pr in g, da m , l ak e, p oo l) B ot tle d w at er * O th er P ip ed in to dw el lin g P ip ed in to ya rd / p lo t P ip ed to n ei gh bo ur P ub lic ta p/ st an d- pi pe Region Akmola Oblast 45,6 0,2 0,1 35,3 11,2 1,8 1,2 0,0 1,7 0,8 0,3 1,5 0,0 0,3 0,0 0,1 100,0 96,9 2470 Aktobe Oblast 55,5 7,7 1,8 17,7 0,5 13,9 0,7 0,0 1,8 0,0 0,0 0,0 0,0 0,0 0,4 0,0 100,0 99,6 2595 93MONITORING THE SITUATION OF CHILDREN AND WOMEN Main source of drinking water To ta l P er ce nt ag e u si ng im pr ov ed s ou rc - u si ng im pr ov ed s ou rc - us in g im pr ov ed s ou rc - im pr ov ed s ou rc - im pr ov ed s ou rc - s ou rc - so ur c- es o f d rin ki ng w at er 1 N um be r o f h ou se ho ld m em be rsImproved sources of drinking water1 Unimproved sources of drinking water Piped water Tu be -w el l/b or e- ho le P ro te ct ed w el l P ro te ct ed s pr in g R ai nw at er c ol le ct io n B ot tle d w at er U np ro te ct ed w el l U np ro te ct ed s pr in g Ta nk er tr uc k C ar t w ith ta nk / d ru m s S ur fa ce w at er (r iv er , s pr in g, da m , l ak e, p oo l) B ot tle d w at er * O th er P ip ed in to dw el lin g P ip ed in to ya rd / p lo t P ip ed to n ei gh bo ur P ub lic ta p/ st an d- pi pe Almaty Oblast 42,8 6,1 1,5 14,9 29,2 1,2 0,8 0,0 0,0 1,1 0,5 0,4 0,1 0,2 0,0 1,1 100,0 96,6 5879 Almaty city 94,7 4,5 0,0 0,0 0,0 0,0 0,0 0,0 0,7 0,0 0,0 0,0 0,0 0,0 0,1 0,0 100,0 99,9 4129 Astana city 83,8 1,3 2,7 10,1 0,2 0,1 0,0 0,0 1,8 0,1 0,0 0,0 0,0 0,0 0,0 0,0 100,0 99,9 1710 Atyrau Oblast 57,4 5,9 2,7 6,5 0,0 23,9 0,0 0,0 1,0 1,0 0,0 0,0 0,0 1,5 0,0 0,0 100,0 97,4 1542 East Kazakhstan Oblast 58,4 3,3 0,3 14,0 13,2 2,2 0,1 0,0 0,2 0,4 0,7 0,0 0,0 7,3 0,0 0,0 100,0 91,6 4782 Zhambyl Oblast 37,4 10,2 1,9 7,1 34,0 4,9 0,3 0,0 0,1 0,4 0,4 3,3 0,0 0,0 0,0 0,0 100,0 95,9 3521 West Kazakhstan Oblast 43,0 0,7 0,1 14,4 3,6 26,4 0,1 0,0 0,8 4,1 0,1 6,1 0,1 0,4 0,0 0,0 100,0 89,1 2208 Karaganda Oblast 70,3 0,9 0,2 11,3 4,5 2,6 2,0 0,0 5,4 0,0 2,1 0,2 0,3 0,0 0,1 0,0 100,0 97,3 4838 Kostanai Oblast 49,6 0,1 0,2 12,7 11,0 13,7 0,6 0,0 3,8 0,1 1,0 3,3 0,3 2,3 0,2 1,1 100,0 91,6 3058 Kyzylorda Oblast 46,3 11,7 3,8 18,7 0,2 9,6 0,2 0,0 0,5 0,2 0,0 8,3 0,0 0,5 0,0 0,0 100,0 91,0 2292 Mangistau Oblast 49,3 0,5 0,0 0,0 0,0 44,2 0,7 0,0 0,0 0,6 0,0 4,7 0,0 0,0 0,0 0,0 100,0 94,7 1722 Pavlodar Oblast 72,1 3,1 0,4 10,7 4,2 5,0 0,0 0,0 0,2 0,4 0,3 3,2 0,0 0,4 0,0 0,0 100,0 95,6 2770 North Kazakhstan Oblast 31,5 0,4 0,1 31,9 4,6 14,8 0,4 0,1 3,8 1,3 0,1 3,0 0,2 1,3 0,2 6,3 100,0 87,6 2304 South Kazakhstan Oblast 30,1 34,0 1,6 1,2 6,4 11,9 2,0 0,0 0,1 0,4 1,1 10,8 0,0 0,2 0,1 0,0 100,0 87,4 8729 Residence Urban 79,2 5,7 0,5 6,6 2,2 2,5 0,4 0,0 2,0 0,1 0,3 0,2 0,0 0,0 0,1 0,2 100,0 99,1 29257 Rural 21,2 12,4 1,6 17,0 18,2 15,9 1,2 0,0 0,3 1,2 0,9 6,9 0,1 2,1 0,0 0,8 100,0 87,9 25292 Education of Household Head Incomplete Secondary 35,7 10,8 0,5 16,7 13,0 13,3 1,4 0,0 0,3 1,5 1,2 3,6 0,1 1,1 0,0 0,9 100,0 91,7 6151 Secondary 38,7 10,3 1,7 15,1 12,8 11,8 1,0 0,0 0,5 0,8 0,4 4,5 0,1 1,7 0,0 0,5 100,0 92,0 18496 Specialized Secondary 58,3 7,9 0,9 10,2 8,7 6,9 0,6 0,0 1,4 0,3 0,8 2,7 0,0 0,7 0,0 0,5 100,0 95,0 17226 Higher 73,1 6,5 0,5 5,1 4,2 4,4 0,3 0,0 2,7 0,2 0,4 2,1 0,0 0,2 0,2 0,2 100,0 96,7 12355 Wealth Index Quintile Poorest 1,8 18,1 3,2 21,1 18,9 19,9 2,1 0,0 0,1 1,8 1,4 8,2 0,1 2,9 0,0 0,3 100,0 85,3 10909 Second 13,3 18,1 1,2 22,8 19,4 13,7 0,6 0,0 0,1 0,8 0,6 6,3 0,2 1,8 0,0 1,1 100,0 89,2 10911 Middle 56,2 7,5 0,6 12,6 9,3 9,2 0,6 0,0 0,4 0,3 0,3 1,7 0,0 0,3 0,0 0,9 100,0 96,5 10909 Fourth 94,4 0,2 0,2 0,5 0,4 0,6 0,4 0,0 2,5 0,0 0,4 0,2 0,0 0,0 0,1 0,0 100,0 99,2 10905 Richest 96,0 0,0 0,0 0,0 0,1 0,0 0,2 0,0 3,2 0,0 0,3 0,0 0,0 0,0 0,2 0,0 100,0 99,5 10916 Ethnicity of Household Head Kazakh 44,3 10,2 1,4 12,6 10,9 11,3 0,9 0,0 1,0 0,9 0,7 4,0 0,1 1,3 0,1 0,5 100,0 92,6 34089 Russian 75,5 2,6 0,3 8,3 5,2 3,4 0,3 0,0 1,9 0,1 0,4 0,8 0,1 0,5 0,1 0,4 100,0 97,6 13089 Other ethnic groups 48,6 13,2 0,7 11,3 11,4 6,1 1,0 0,0 1,1 0,1 0,6 4,6 0,0 0,5 0,0 0,6 100,0 93,6 7371 Total 52,3 8,8 1,0 11,4 9,6 8,7 0,8 0,0 1,2 0,6 0,6 3,3 0,1 1,0 0,1 0,5 100,0 93,9 54549 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 4.1; MDG Indicator 7.8 * Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and handwashing 94 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Overall 93.9 percent of population in Kazakhstan use improved sources of drinking water. This indicator is 99.1 percent urban area and 87.9 percent for rural area. The situation in West Kazakhstan, North Kazakhstan and South Kazakhstan Oblasts is significantly worse than in other regions; only 89.1 percent, 87.6 percent and 87.4 percent of population in these regions respec- tively use drinking water from improved sources. Among the sources of drinking water used by the population, the largest share takes centralized piped water (52.3 percent), and water piped to plot or yards (8.8 percent), as well as public standpipe (11.4 percent), tube well (9.6 percent) and protected well (8.7 percent). There are significant variations in their use across regions (Table WS.1). Thus, in South Ka- zakhstan Oblast 30.1 percent of population use drink- ing water piped to dwelling and 34.0 percent use drink- ing water piped to plot or yard. In Zhambyl Oblast this distribution is 37.4 percent and 10.2 percent respec- tively. Public standpipes are widely used across all re- gions (exceptions are Mangistau Oblast and Almaty), but they are most used in Akmola and North Kazakh- stan Oblasts (35.3 percent and 31.9 percent respec- tively), while bottled water is mostly used in Karagan- da, Kostanai and North Kazakhstan Oblasts (3.8 to 5.4 percent). Only two sources of drinking water were detected in Mangistau Oblast: piped water in the household (49.3 percent) and protected tube well or bore hole (44.2 percent). In all regions (except for As- tana and Almaty) the population uses water from pro- tected wells, however there is a high probability of their use in West Kazakhstan and Atyrau Oblasts. Overall 6.2 percent of population in Kazakhstan use unim- proved sources of drinking water. Use of in-house drinking water treatment is pre- sented in Table WS.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using un- improved water sources but using appropriate water treatment methods. In Kazakhstan, 70.7 percent of the population uses one or another way to treat drinking water obtained from all sources, both improved and unimproved. Al- most 55.7 percent of population boils water as the main method of water treatment, 11.4 percent of population let the water stay and settle, 12.4 percent uses filters and about one percent of population said that they strain water through a cloth. Other methods of water treatment are not very much popular. Almost 33 percent of popula- tion use no treatment of drinking water. The percentage of households using any method of drinking water treatment is high in South Kazakhstan Oblast (94.7 percent). Low percentage of water treatment was found in households of Mangistau (10.2 percent), Almaty (13.3 percent) and Zhambyl (31 percent) Oblasts. 95MONITORING THE SITUATION OF CHILDREN AND WOMEN Table WS.2: Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Kazakhstan, 2010/ 11 Water treatment method used in the household N um be r o f h ou se ho ld m em be rs Percentage of house- hold members in households using unimproved sources of drinking water and using appropri- ate water treatment method1 Number of household members in households using unim- proved sourc- es of drinking water N on e B oi l A dd b le ac h/ ch lo rin e S tra in th ro ug h a cl ot h U se w at er fi lte r S ol ar d is in fe ct io n Le t i t s ta nd a nd s et tle O th er N on e Region Akmola Oblast 38,6 49,8 0,0 0,2 12,5 0,0 21,7 0,0 0,0 2470 62,7 76 Aktobe Oblast 44,5 45,8 1,2 0,4 5,0 0,0 4,0 3,3 0,3 2595 (*) 12 Almaty Oblast 73,1 20,2 0,0 0,6 1,2 0,2 12,1 0,2 0,0 5879 13,3 201 Almaty city 19,7 75,6 0,0 0,5 14,8 0,3 14,0 0,0 0,0 4129 (*) 3 Astana city 19,1 53,5 0,1 0,1 42,9 0,0 4,7 2,1 0,0 1710 (*) 1 Atyrau Oblast 20,2 67,5 0,0 0,8 12,7 0,1 7,0 3,8 0,0 1542 63,2 40 East Kazakhstan Oblast 46,4 45,2 0,0 0,4 8,4 0,0 9,2 0,4 0,1 4782 70,4 401 Zhambyl Oblast 73,5 25,3 0,0 0,3 0,8 0,0 0,7 0,0 0,0 3521 31,0 143 West Kazakhstan Oblast 29,1 50,0 0,9 1,0 20,6 0,0 14,9 2,0 0,0 2208 70,2 241 Karaganda Oblast 16,5 64,2 0,1 0,7 20,5 0,1 22,0 0,3 0,0 4838 53,6 132 Kostanai Oblast 22,5 53,7 0,4 0,9 26,5 0,2 18,2 0,3 0,1 3058 77,4 255 Kyzylorda Oblast 16,4 73,2 0,1 0,3 6,8 0,0 31,8 1,5 0,0 2292 72,4 207 Mangistau Oblast 41,6 43,2 0,1 9,6 17,7 0,0 4,2 0,0 0,0 1722 10,2 91 Pavlodar Oblast 15,9 56,7 0,0 0,0 28,3 0,5 22,8 0,2 0,0 2770 72,5 121 North Kazakhstan Oblast 26,3 52,6 0,3 0,8 23,5 0,1 10,1 0,9 0,0 2304 65,0 286 South Kazakhstan Oblast 11,4 86,8 0,0 0,2 2,5 0,0 0,2 0,4 0,0 8729 94,7 1101 Residence Urban 26,7 56,4 0,1 0,7 20,0 0,1 13,4 1,1 0,0 29257 43,2 255 Rural 39,9 54,8 0,2 0,9 3,5 0,1 9,0 0,2 0,0 25292 73,0 3058 Education of Household Head Incomplete Secondary 44,0 49,2 0,1 0,4 4,7 0,1 11,0 0,4 0,1 6151 62,3 510 Secondary 35,9 56,3 0,2 0,8 6,5 0,0 11,4 0,3 0,0 18496 69,5 1488 Specialized Secondary 29,6 56,9 0,1 0,9 15,2 0,1 12,1 0,8 0,0 17226 76,2 864 Higher 26,7 56,6 0,2 0,7 21,5 0,2 10,7 1,3 0,0 12355 72,1 405 Wealth Index Quintile Poorest 37,1 60,0 0,2 0,8 0,6 0,0 8,1 0,0 0,0 10909 74,8 1607 Second 40,0 55,3 0,2 0,7 2,4 0,2 9,6 0,1 0,0 10911 69,3 1173 Middle 39,4 52,9 0,1 0,5 6,9 0,1 10,9 0,5 0,0 10909 62,5 385 96 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Water treatment method used in the household N um be r o f h ou se ho ld m em be rs Percentage of house- hold members in households using unimproved sources of drinking water and using appropri- ate water treatment method1 Number of household members in households using unim- proved sourc- es of drinking water N on e B oi l A dd b le ac h/ ch lo rin e S tra in th ro ug h a cl ot h U se w at er fi lte r S ol ar d is in fe ct io n Le t i t s ta nd a nd s et tle O th er N on e Fourth 30,1 53,5 0,0 0,8 18,5 0,1 14,9 1,2 0,1 10905 58,0 88 Richest 17,8 56,6 0,1 1,0 33,5 0,1 13,5 1,6 0,0 10916 57,7 60 Ethnicity of Household Head Kazakh 33,4 58,4 0,1 1,0 8,6 0,1 9,9 0,6 0,0 34089 72,0 2525 Russian 30,2 50,2 0,2 0,4 22,0 0,1 15,4 0,7 0,0 13089 67,4 318 Other ethnic groups 35,3 52,5 0,0 0,2 12,5 0,0 11,3 0,8 0,1 7371 65,9 470 Total 32,9 55,7 0,1 0,8 12,4 0,1 11,4 0,7 0,0 54549 70,7 3312 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 4.2 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that these re- sults refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 88.4% percent of households, the improved drink- ing water source is on the premises while in the rest of households drinking water has to be brought by household members. For 3.9 percent of all house- holds, it takes less than 30 minutes to get to the water source and bring water, while members of 1.6 percent of households spend 30 minutes or more for this pur- pose. The two last indicators show that members of second quintile and poorest households more often have to spend less than 30 minutes and 30 or more minutes to get drinking water from improved sources and return. A similar situation is reported for second quintile and poorest households getting drinking water from unimproved sources and returning. In rural areas, there are 5.6 times more household members having to spend some time to get water than in urban areas. Almaty, Zhambyl, West Kazakhstan and North Ka- zakhstan Oblasts show high proportion of households whose members spend 30 or more minutes to get to an improved source of drinking water (3.4 to 4.1 percent, respectively). 97MONITORING THE SITUATION OF CHILDREN AND WOMEN Table WS.3: Time to source of drinking water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Kazakhstan, 2010/11 Users of improved sources of drinking water Users of unimproved sources of drinking water To ta l N um be r o f h ou se ho ld m em be rs W at er o n pr em is es Le ss th an 3 0 m in ut es 30 m in ut es an d m or e D on ’t kn ow W at er o n pr em is es Le ss th an 3 0 m in ut es 30 m in ut es an d m or e D on ’t kn ow Region Akmola Oblast 91,1 4,2 1,6 0,0 0,2 2,5 0,3 0,0 100,0 2470 Aktobe Oblast 90,5 8,2 0,8 0,1 0,0 0,0 0,0 0,4 100,0 2595 Almaty Oblast 89,1 3,8 3,4 0,2 0,0 1,9 1,6 0,0 100,0 5879 Almaty city 99,9 0,0 0,0 0,0 0,1 0,0 0,0 0,0 100,0 4129 Astana city 99,7 0,2 0,0 0,0 0,1 0,0 0,0 0,0 100,0 1710 Atyrau Oblast 95,5 1,5 0,4 0,0 0,6 1,7 0,2 0,0 100,0 1542 East Kazakhstan Oblast 89,8 1,5 0,2 0,1 0,1 4,8 3,3 0,2 100,0 4782 Zhambyl Oblast 85,1 7,0 3,8 0,0 0,0 3,3 0,8 0,0 100,0 3521 West Kazakhstan Oblast 75,0 10,2 3,8 0,0 2,0 4,5 4,4 0,0 100,0 2208 Karaganda Oblast 92,6 2,3 2,3 0,0 0,0 1,1 1,6 0,0 100,0 4838 Kostanai Oblast 78,3 11,5 1,8 0,1 0,3 2,1 5,8 0,1 100,0 3058 Kyzylorda Oblast 85,5 4,1 1,3 0,0 6,0 2,3 0,7 0,1 100,0 2292 Mangistau Oblast 94,1 0,6 0,0 0,0 5,3 0,0 0,0 0,0 100,0 1722 Pavlodar Oblast 92,5 1,6 1,5 0,0 2,7 0,7 1,0 0,0 100,0 2770 North Kazakhstan Oblast 75,2 8,2 4,1 0,1 2,4 4,3 5,7 0,0 100,0 2304 South Kazakhstan Oblast 84,3 2,2 0,3 0,5 11,9 0,6 0,0 0,0 100,0 8729 Residence Urban 97,8 0,8 0,5 0,0 0,1 0,2 0,5 0,1 100,0 29257 Rural 77,4 7,4 2,8 0,3 5,7 3,7 2,7 0,0 100,0 25292 Education of Household Head Incomplete Secondary 82,1 6,9 1,8 0,9 3,0 3,2 2,1 0,0 100,0 6151 Secondary 84,5 5,3 2,2 0,0 3,6 2,3 2,2 0,0 100,0 18496 Specialized Secondary 90,6 2,7 1,6 0,0 2,2 1,7 1,1 0,0 100,0 17226 Higher 94,3 1,8 0,6 0,0 1,7 0,6 0,7 0,2 100,0 12355 Wealth Index Quintile Poorest 70,4 10,4 4,0 0,6 7,4 4,6 2,7 0,0 100,0 10909 Second 81,3 5,4 2,5 0,0 4,6 3,1 2,9 0,1 100,0 10911 Middle 92,4 3,3 0,8 0,0 1,3 1,0 1,2 0,0 100,0 10909 Fourth 98,6 0,3 0,3 0,0 0,2 0,2 0,3 0,0 100,0 10905 Richest 99,1 0,1 0,3 0,0 0,1 0,1 0,3 0,1 100,0 10916 Ethnicity of Household Head Kazakh 86,0 4,8 1,8 0,1 3,5 2,2 1,7 0,1 100,0 34089 Russian 94,9 1,8 0,9 0,0 0,3 0,9 1,2 0,0 100,0 13089 Other ethnic groups 87,9 3,5 1,8 0,3 3,6 1,5 1,3 0,0 100,0 7371 Total 88,4 3,9 1,6 0,1 2,7 1,8 1,5 0,0 100,0 54549 ‘No education’ category has been excluded due to insignificant number of responses 98 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table WS.4 shows that for 17.4 percent of households, an adult male (69.4 percent) is usually the person collecting the water, when the source of drink- ing water is not on the premises. Adult females collect water in 28.0 percent of cases, while for the rest of the households, female or male children under 15 collect water (0.4 and 1.9 percent respectively). Table WS.4: Person collecting water Percentage of households without drinking water on premises, and percent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Kazakhstan, 2010/11 P er ce nt ag e of ho us eh ol ds w ith ou t dr in ki ng w at er o n pr em is es N um be r o f h ou se - ho ld s Person collecting drinking water N um be r o f h ou se - ho ld s th at d o no t ha ve s ou rc es o f dr in ki ng w at er o n th e pr em is es A du lt w om an (a ge 1 5+ ) A du lt m an (a ge 15 + ) Fe m al e ch ild u n- de r a ge 1 5 M al e ch ild u nd er ag e 15 D on ’t kn ow To ta l Region Akmola Oblast 38,7 884 28,8 69,7 0,5 0,9 0,2 100,0 342 Aktobe Oblast 21,1 713 22,7 72,5 0,5 2,7 1,6 100,0 150 Almaty Oblast 19,4 1470 36,1 60,6 0,0 3,3 0,0 100,0 285 Almaty city 0,0 1473 (*) (*) (*) (*) (*) 100,0 0 Astana city 8,0 544 23,2 76,8 0,0 0,0 0,0 100,0 43 Atyrau Oblast 8,0 359 (25,0) (72,2) (0,0) (2,7) (0,0) 100,0 29 East Kazakhstan Oblast 19,3 1673 29,0 68,5 0,0 2,1 0,4 100,0 323 Zhambyl Oblast 19,0 890 33,5 61,5 0,9 4,1 0,0 100,0 170 West Kazakhstan Oblast 31,3 647 23,4 75,9 0,3 0,3 0,0 100,0 202 Karaganda Oblast 13,3 1629 19,5 80,5 0,0 0,0 0,0 100,0 216 Kostanai Oblast 28,7 1129 28,4 69,4 0,0 1,9 0,3 100,0 324 Kyzylorda Oblast 16,7 498 35,5 51,4 6,0 5,5 1,4 100,0 83 Mangistau Oblast 0,5 372 (*) (*) (*) (*) (*) 100,0 2 Pavlodar Oblast 12,2 931 18,9 77,6 0,6 2,8 0,0 100,0 114 North Kazakhstan Oblast 50,0 795 26,3 72,3 0,1 1,3 0,0 100,0 398 South Kazakhstan Oblast 4,1 1794 (40,9) (56,7) (0,0) (2,5) 0,0 100,0 74 Residence Urban 7,2 9598 25,7 72,3 0,1 1,1 0,7 100,0 688 Rural 33,3 6202 28,8 68,5 0,5 2,2 0,1 100,0 2066 Education of Household Head Incomplete secondary 27,3 1904 35,0 63,1 0,0 1,7 0,3 100,0 520 Secondary 24,4 4793 26,2 71,3 0,5 1,9 0,1 100,0 1172 Specialized secondary 14,8 5120 25,8 71,6 0,4 2,0 0,2 100,0 757 Higher 7,4 3910 27,7 69,0 0,5 1,7 1,1 100,0 289 Wealth Index Quintile Poorest 45,0 2624 30,4 66,6 0,4 2,3 0,2 100,0 1180 Second 37,2 2628 30,5 67,3 0,4 1,8 0,0 100,0 978 Middle 16,9 3036 20,2 77,9 0,3 1,5 0,1 100,0 514 Fourth 1,4 3845 13,9 84,5 0,0 0,0 1,6 100,0 53 Richest 0,8 3667 (11,9) (79,8) (0,0) (0,0) (8,4) 100,0 29 Ethnicity of Household Head Kazakh 20,5 8501 25,0 72,2 0,5 2,0 0,3 100,0 1746 Russian 11,8 5158 32,1 66,2 0,1 1,4 0,1 100,0 611 Other ethnic groups 18,6 2141 34,8 62,5 0,3 2,4 0,0 100,0 398 Total 17,4 15800 28,0 69,4 0,4 1,9 0,2 100,0 2754 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations 99MONITORING THE SITUATION OF CHILDREN AND WOMEN Use of Improved Sanitation Facilities Inadequate disposal of human excreta and per- sonal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Im- proved sanitation can reduce diarrheal disease by more than a third, and can significantly lessen the ad- verse health impacts of other disorders responsible for death and disease among millions of children in devel- oping countries. Improved sanitation facilities for excreta dispos- al include flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. Data on the use of improved sanitation facilities are presented in Table WS.5 of the survey. However, shared use of improved sanitation facilities puts under threat the safety of these facilities and therefore may be classified as the ab- sence of access to improved sanitation both within the context of this report (Tables WS.6, WS.8) and as an MDG indicator. Overall, almost the entire population of Kazakh- stan is living in households using improved sanitation facilities (99.4 percent) (Table WS.5). One hundred percent of population uses improved sanitation facili- ties almost in all regions except for Mangistau (88.0 percent), Karaganda (99.0 percent), Aktobe and Kyzy- lorda Oblasts and Astana city (99.3 percent each). In rural areas, the population is mostly using pit latrines with slabs; in contrast, the most common fa- cilities in urban areas are flush toilets with connection to a sewage system or a septic tank. In urban areas, most common are modern flush toilets used by almost 63.6 percent of households and pit latrines with slab (27.4 percent of households); in rural areas more than 85 percent of households use pit latrines with slab. By wealth level, 73 percent of fourth quintile and 99 per- cent of richest households use modern flush toilets, while 95-96 percent of poorest and second quntile households use pit latrines with slab. Use of modern sanitation facilities at large depends on incomes, which are higher for house- holds with higher levels of education. Residents of Almaty, Zhambyl, Kyzylorda and South Kazakhstan Oblasts are less likely than others to use flush toilets, which is possibly related mainly to the rural type of dwelling. 100 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table WS.5: Types of sanitation facilities Percent distribution of household members according to type of toilet facility used by the household, Kazakhstan, 2010/11 Type of toilet facility used by household N o fa ci lit ie s/ bu sh /fi el d To ta l N um be r o f h ou se ho ld m em be rs Improved sanitation facility Unimproved sanitation facility Flush/pour flush to Ve nt ila te d im pr ov ed pi t l at rin e P it la tri ne w ith s la b C om po st in g to ile t P it la tri ne w ith ou t sl ab B uc ke t H an gi ng to ile t/h an g- in g la tri ne O th er Fl us h to ile t / P ip ed se w er s ys te m S ep tic ta nk P it la tri ne Fl us h/ po ur fl us h to u nk no w n pl ac e/ no t s ur e/ do n’ t kn ow Region Akmola Oblast 32,5 10,1 0,0 0,0 0,0 57,0 0,0 0,0 0,0 0,0 0,0 0,4 100,0 2470 Aktobe Oblast 39,9 4,5 1,6 0,0 0,0 52,9 0,2 0,8 0,0 0,0 0,0 0,0 100,0 2595 Almaty Oblast 16,5 8,7 1,4 0,0 0,0 73,3 0,0 0,0 0,0 0,0 0,0 0,0 100,0 5879 Almaty city 73,8 5,6 12,0 0,1 0,6 7,7 0,0 0,1 0,0 0,0 0,0 0,0 100,0 4129 Astana city 75,3 9,0 0,7 0,0 0,1 14,0 0,0 0,0 0,0 0,2 0,7 0,0 100,0 1710 Atyrau Oblast 33,0 4,3 0,0 0,0 0,0 62,7 0,0 0,0 0,0 0,0 0,0 0,0 100,0 1542 East Kazakhstan Oblast 40,9 0,7 2,4 0,0 0,8 55,2 0,0 0,0 0,0 0,0 0,0 0,0 100,0 4782 Zhambyl Oblast 19,8 2,0 0,2 0,0 0,0 77,9 0,0 0,1 0,0 0,0 0,0 0,0 100,0 3521 West Kazakhstan Oblast 32,3 3,2 0,1 0,2 0,0 64,2 0,1 0,0 0,0 0,0 0,0 0,0 100,0 2208 Karaganda Oblast 64,6 6,8 0,8 0,0 0,0 26,9 0,0 0,1 0,1 0,0 0,8 0,0 100,0 4838 Kostanai Oblast 46,8 9,5 0,0 0,0 0,0 43,6 0,0 0,0 0,0 0,0 0,0 0,0 100,0 3058 Kyzylorda Oblast 19,0 1,8 0,0 0,0 1,6 76,9 0,0 0,7 0,0 0,0 0,0 0,0 100,0 2292 Mangistau Oblast 48,5 0,2 0,7 0,0 0,3 38,1 0,0 11,9 0,0 0,1 0,0 0,0 100,0 1722 Pavlodar Oblast 66,2 2,5 2,5 0,0 0,1 28,7 0,0 0,0 0,1 0,0 0,0 0,0 100,0 2770 North Kazakhstan Oblast 25,6 7,2 0,6 0,0 0,1 65,9 0,0 0,1 0,1 0,0 0,3 0,1 100,0 2304 South Kazakhstan Oblast 10,0 3,9 2,9 0,0 5,2 78,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 8729 Residence Urban 63,6 5,2 2,6 0,0 1,1 27,4 0,0 0,1 0,0 0,0 0,0 0,0 100,0 29257 Rural 6,1 4,8 1,6 0,0 1,0 85,3 0,0 0,9 0,0 0,0 0,2 0,1 100,0 25292 Education of Household Head Incomplete Secondary 19,9 4,0 2,2 0,0 1,8 71,3 0,0 0,4 0,1 0,0 0,3 0,0 100,0 6151 Secondary 23,1 3,4 2,2 0,0 1,2 69,3 0,0 0,6 0,0 0,0 0,1 0,0 100,0 18496 Specialized Secondary 42,5 5,9 2,1 0,0 0,8 48,1 0,0 0,4 0,0 0,0 0,1 0,0 100,0 17226 Higher 58,9 6,5 1,9 0,0 0,8 31,4 0,0 0,4 0,0 0,0 0,0 0,0 100,0 12355 Wealth Index Quintile Poorest 0,0 0,4 1,0 0,0 2,0 96,1 0,1 0,3 0,0 0,0 0,1 0,0 100,0 10909 Second 0,4 1,0 1,1 0,0 1,5 95,2 0,0 0,4 0,0 0,0 0,3 0,0 100,0 10911 Middle 12,4 8,3 4,7 0,0 1,4 71,7 0,0 1,3 0,0 0,0 0,1 0,0 100,0 10909 Fourth 73,0 14,4 3,6 0,0 0,3 8,2 0,0 0,4 0,0 0,0 0,1 0,0 100,0 10905 Richest 98,8 1,0 0,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 10916 Ethnicity of Household Head Kazakh 28,9 3,8 1,9 0,0 1,2 63,2 0,0 0,7 0,0 0,0 0,0 0,0 100,0 34089 Russian 61,7 6,6 2,2 0,0 0,7 28,3 0,0 0,1 0,1 0,0 0,2 0,0 100,0 13089 Other ethnic groups 29,9 7,7 2,7 0,0 0,8 58,6 0,0 0,0 0,0 0,0 0,1 0,1 100,0 7371 Total 36,9 5,0 2,1 0,0 1,0 54,2 0,0 0,5 0,0 0,0 0,1 0,0 100,0 54549 ‘ No education’ category has been excluded due to insignificant number of responses 101MONITORING THE SITUATION OF CHILDREN AND WOMEN Access to safe drinking-water and to basic san- itation is measured by the proportion of population using an improved sanitation facility. The MDGs and WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet facility. As shown in Table WS.6, 97.3 percent of the household population in Kazakhstan is using an im- proved sanitation facility. It should be noted that the use of a shared improved facility by several house- holds exists in the country. One percent of house- holds shares the facility with up to 5 households, and 0.5 percent of households with more than 5 house- holds. Shared use of sanitation facilities is more widespread among households using improved sani- tation facilities in urban areas. About 0.6 percent of the population in the country uses unimproved not shared sanitation facilities. 102 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table WS.6: Use and sharing of sanitation facilities Percent distribution of household population by use of private and public sanitation facilities and use of shared facilities, by users of improved and unimproved sanitation facilities, Kazakhstan, 2010/11 Improved sanitation facility users Unimproved sanitation facility users N o fa ci lit ie s/ bu sh /fi el d To ta l N um be r o f h ou se ho ld m em be rs N ot s ha re d1 P ub lic fa ci lit y Shared by N ot s ha re d P ub lic fa ci lit y Shared by 5 or le ss h ou se ho ld s M or e th an 5 h ou se ho ld s 5 or le ss h ou se ho ld s Region Akmola Oblast 96,3 0,2 2,3 0,7 0,0 0,0 0,0 0,4 100,0 2470 Aktobe Oblast 97,8 0,6 0,1 0,6 0,8 0,0 0,0 0,0 100,0 2595 Almaty Oblast 99,3 0,5 0,0 0,2 0,0 0,0 0,0 0,0 100,0 5879 Almaty city 95,9 0,8 2,2 0,9 0,2 0,0 0,0 0,0 100,0 4129 Astana city 90,8 0,6 5,2 2,5 0,3 0,6 0,0 0,0 100,0 1710 Atyrau Oblast 96,0 0,0 2,9 1,0 0,0 0,0 0,0 0,0 100,0 1542 East Kazakhstan Oblast 96,0 2,1 1,4 0,5 0,0 0,0 0,0 0,0 100,0 4782 Zhambyl Oblast 98,7 0,1 1,1 0,0 0,1 0,0 0,0 0,0 100,0 3521 West Kazakhstan Oblast 96,0 0,7 1,2 2,1 0,0 0,0 0,0 0,0 100,0 2208 Karaganda Oblast 98,3 0,2 0,6 0,0 0,8 0,0 0,1 0,0 100,0 4838 Kostanai Oblast 97,1 0,1 0,7 2,1 0,0 0,0 0,0 0,0 100,0 3058 Kyzylorda Oblast 98,2 0,6 0,4 0,1 0,7 0,0 0,0 0,0 100,0 2292 Mangistau Oblast 87,3 0,1 0,3 0,2 11,3 0,1 0,7 0,0 100,0 1722 Pavlodar Oblast 99,2 0,3 0,5 0,0 0,1 0,0 0,0 0,0 100,0 2770 North Kazakhstan Oblast 98,0 0,6 0,4 0,4 0,5 0,0 0,0 0,1 100,0 2304 South Kazakhstan Oblast 99,1 0,4 0,4 0,0 0,0 0,0 0,0 0,0 100,0 8729 Residence Urban 96,9 0,7 1,3 0,9 0,1 0,0 0,0 0,0 100,0 29257 Rural 97,8 0,3 0,6 0,1 1,0 0,0 0,1 0,1 100,0 25292 Education of Household Head Incomplete Secondary 97,7 0,3 1,0 0,2 0,8 0,0 0,0 0,0 100,0 6151 Secondary 96,9 0,5 1,1 0,7 0,7 0,0 0,0 0,0 100,0 18496 Specialized secondary 97,3 0,5 1,1 0,6 0,4 0,0 0,1 0,0 100,0 17226 Higher 97,7 0,8 0,7 0,3 0,4 0,0 0,0 0,0 100,0 12355 Wealth Index Quintile Poorest 97,8 0,5 1,0 0,2 0,3 0,0 0,1 0,0 100,0 10909 Second 97,6 0,4 0,9 0,3 0,6 0,0 0,1 0,0 100,0 10911 Middle 94,5 1,4 1,1 1,5 1,4 0,0 0,1 0,0 100,0 10909 Fourth 97,5 0,3 1,2 0,6 0,4 0,1 0,0 0,0 100,0 10905 Richest 99,1 0,2 0,6 0,0 0,0 0,0 0,0 0,0 100,0 10916 103MONITORING THE SITUATION OF CHILDREN AND WOMEN Improved sanitation facility users Unimproved sanitation facility users N o fa ci lit ie s/ bu sh /fi el d To ta l N um be r o f h ou se ho ld m em be rs N ot s ha re d1 P ub lic fa ci lit y Shared by N ot s ha re d P ub lic fa ci lit y Shared by 5 or le ss h ou se ho ld s M or e th an 5 h ou se ho ld s 5 or le ss h ou se ho ld s Ethnicity of Household Head Kazakh 96,7 0,7 1,1 0,6 0,7 0,0 0,1 0,0 100,0 34089 Russian 98,0 0,2 0,9 0,4 0,4 0,1 0,0 0,0 100,0 13089 Other ethnic groups 98,7 0,3 0,5 0,3 0,2 0,0 0,0 0,1 100,0 7371 Total 97,3 0,5 1,0 0,5 0,6 0,0 0,0 0,0 100,0 54549 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 4.3; MDG Indicator 7.9 about the same in urban and rural areas. Proportion of proper disposal of children’s faeces is reported in rich- est and poor households (69 percent in both cases). There was also significant difference by regions, for instance, a very low level of safe faeces disposal was found in Almaty (31.1 percent), Zhambyl (38.6 percent) and Mangistau Oblasts (45.8 percent) and in Astana (36.2 percent). This situation in the aforemen- tioned regions can be explained by a high percentage of child faeces thrown to garbage. Safe disposal of the child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of chil- dren 0-2 years of age is presented in Table WS.7. Mothers reported only 4.6 percent of children aged 0-2 years visiting toilet or latrine, in 62 percent of cases faeces were flushed to the toilet, in 26.6 percent - thrown to garbage. Percentage of children whose latest faeces were safely disposed made 66.7 percent; this indicator was Table WS.7: Disposal of a child’s faeces Percent distribution of children aged 0-2 years according to place of disposal of child’s faeces, and the percentage of children aged 0-2 years whose stools are disposed of safely, Kazakhstan, 2010/11 Place of disposal of child’s faeces P ro po rti on of c hi ld re n w ho se la te st s to ol s w er e di sp os ed o f s af el y1 N um be r o f c hi ld re n ag ed 0 –2 y ea rs C hi ld u se d to ile t P ut /ri ns ed in to to ile t o r l at rin e P ut /ri ns ed in to dr ai n or d itc h Th ro w n in to ga rb ag e B ur ie d Le ft in th e op en O th er D on ’t kn ow To ta l Type Improved 4,5 62,0 4,0 26,8 0,0 0,1 2,1 0,5 100,0 66,5 3172 Unimproved (9,4) (76,6) (3,1) (10,9) (0,0) (0,0) (0,0) (0,0) (100,0) (86,0) 26 Region Akmola Oblast 7,6 74,7 0,7 14,7 0,0 0,0 2,3 0,0 100,0 82,3 117 Aktobe Oblast 6,6 74,8 9,8 8,8 0,0 0,0 0,0 0,0 100,0 81,4 166 Almaty Oblast 5,4 25,7 3,7 60,4 0,0 0,9 0,5 3,4 100,0 31,1 321 Almaty city 17,9 34,5 0,0 47,6 0,0 0,0 0,0 0,0 100,0 52,4 124 Astana city 6,1 30,0 2,8 58,9 0,0 0,0 0,7 1,4 100,0 36,2 101 Atyrau Oblast 2,6 86,9 10,2 0,0 0,0 0,0 0,0 0,3 100,0 89,5 120 104 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 13 WHO/UNICEF JMP (2008), MDG assessment report - http://www.wssinfo.org/download?id_document=1279 Place of disposal of child’s faeces P ro po rti on of c hi ld re n w ho se la te st s to ol s w er e di sp os ed o f s af el y1 N um be r o f c hi ld re n ag ed 0 –2 y ea rs C hi ld u se d to ile t P ut /ri ns ed in to to ile t o r l at rin e P ut /ri ns ed in to dr ai n or d itc h Th ro w n in to ga rb ag e B ur ie d Le ft in th e op en O th er D on ’t kn ow To ta l East Kazakhstan Oblast 4,5 72,1 2,2 18,2 0,0 0,0 3,1 0,0 100,0 76,6 224 Zhambyl Oblast 1,7 36,9 15,2 46,2 0,0 0,0 0,0 0,0 100,0 38,6 250 West Kazakhstan Oblast 1,6 89,9 0,0 8,5 0,0 0,0 0,0 0,0 100,0 91,5 129 Karaganda Oblast 6,4 67,0 4,0 21,5 0,0 0,0 1,1 0,0 100,0 73,4 245 Kostanai Oblast 6,5 86,8 0,0 6,7 0,0 0,0 0,0 0,0 100,0 93,3 140 Kyzylorda Oblast 3,4 72,6 3,9 19,3 0,4 0,0 0,0 0,4 100,0 76,0 178 Mangistau Oblast 2,7 43,1 1,1 52,5 0,0 0,0 0,3 0,3 100,0 45,8 157 Pavlodar Oblast 9,3 85,3 0,0 4,2 0,0 0,0 0,0 1,3 100,0 94,6 135 North Kazakhstan Oblast 2,6 70,5 0,0 22,9 0,0 0,0 4,0 0,0 100,0 73,2 78 South Kazakhstan Oblast 1,5 69,2 2,9 19,4 0,0 0,0 7,0 0,0 100,0 70,7 712 Residence Urban 6,5 59,2 1,7 30,3 0,0 0,0 1,4 0,8 100,0 65,7 1562 Rural 2,7 65,0 6,1 23,1 0,0 0,2 2,8 0,2 100,0 67,6 1635 Mother’s Education Incomplete Secondary 5,2 80,3 5,3 9,1 0,0 0,0 0,0 0,0 100,0 85,5 61 Secondary 3,4 61,4 5,4 26,2 0,1 0,0 3,0 0,6 100,0 64,8 1129 Specialized Secondary 4,9 64,4 3,0 26,1 0,0 0,2 1,0 0,4 100,0 69,2 900 Higher 5,5 60,3 2,9 28,5 0,0 0,1 2,2 0,5 100,0 65,8 1101 Wealth Index Quintile Poorest 2,6 66,8 6,7 20,3 0,0 0,2 2,8 0,5 100,0 69,5 762 Second 2,3 61,3 5,5 25,9 0,0 0,0 4,2 0,8 100,0 63,5 716 Middle 2,6 65,4 4,4 25,1 0,1 0,2 1,8 0,4 100,0 68,0 614 Fourth 7,1 55,2 1,3 35,5 0,0 0,0 0,7 0,2 100,0 62,3 535 Richest 9,7 60,0 0,4 29,4 0,0 0,0 0,2 0,4 100,0 69,6 571 Ethnicity of Household Head Kazakh 3,9 62,8 4,7 26,1 0,0 0,1 1,9 0,5 100,0 66,6 2311 Russian 8,3 61,4 0,6 28,8 0,0 0,0 0,9 0,0 100,0 69,7 489 Other ethnic groups 4,0 59,3 3,4 27,1 0,0 0,0 5,0 1,2 100,0 63,3 398 Total 4,6 62,1 4,0 26,6 0,0 0,1 2,1 0,5 100,0 66,7 3198 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 4.4 ( ) – indicators are based on 25-49 cases of unweighted observations In its 2008 report13, the JMP (Joint Monitoring Programme) developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in “ladder” format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking- 105MONITORING THE SITUATION OF CHILDREN AND WOMEN water and a four-rung ladder for sanitation. For sanita- tion, this gives an understanding of the proportion of population: • with no sanitation facilities at all, • reliant on technologies defined by JMP as “unimproved,” • those sharing sanitation facilities of otherwise acceptable technology, and • those using “improved” sanitation facilities. Table WS.8 presents the percentages of house- hold population by drinking water and sanitation lad- ders. The table also shows the percentage of house- hold members using improved sources of drinking wa- ter and sanitary means of excreta disposal. To sum it up, it should be noted that 91.4 per- cent of the household population in Kazakhstan has access to improved sources of drinking water and im- proved sanitation conditions. Rural population has 10 percentage points less access to such conditions than urban population (86.0 percent and 96.0 percent re- spectively). One should also note that the poor and the poor- est groups have less access to improved drinking water sources and improved sanitation conditions. A low level of access to these conditions was found in the following oblasts: Mangistau and West Kazakhstan (85 percent), North Kazakhstan and South Kazakhstan (86 percent) Oblasts. Population of households with higher levels of education has access to improved sources of drinking water and improved sanitation facilities (94.5 percent). Among ethnic groups, 95.6 percent of the Russian pop- ulation and 89.6 percent of the Kazakh population was found to have access to these conditions. Table WS.8: Drinking water and sanitation ladders Percent distribution of household population by drinking water and sanitation ladders, Kazakhstan, 2010/11 Percentage of household population using N um be r o f h ou se ho ld m em be rs Improved drinking water sources1 U ni m pr ov ed d rin ki ng w at er s ou rc es To ta l U se o f i m pr ov ed sa ni ta tio n2 Unimproved sanitation facilities To ta l U se o f i m pr ov ed w at er so ur ce s an d im pr ov ed sa ni ta tio n fa ci lit ie s P ip ed in to dw el lin g, ya rd o r p lo t P ip ed in to dw el lin g, y ar d or p lo t S ha re d im pr ov ed sa ni ta tio n Fa ci lit ie s U ni m pr ov ed fa ci lit ie s N o to ile ts Region Akmola Oblast 82,3 14,6 3,1 100,0 96,3 3,3 0,0 0,4 100,0 93,4 2470 Aktobe Oblast 84,6 15,0 0,4 100,0 97,8 1,4 0,8 0,0 100,0 97,4 2595 Almaty Oblast 65,3 31,2 3,4 100,0 99,3 0,7 0,0 0,0 100,0 95,9 5879 Almaty city 99,9 0,0 0,1 100,0 95,9 3,9 0,2 0,0 100,0 95,9 4129 Astana city 99,6 0,3 0,1 100,0 90,8 8,3 0,9 0,0 100,0 90,7 1710 Atyrau Oblast 73,5 23,9 2,6 100,0 96,0 4,0 0,0 0,0 100,0 93,5 1542 East Kazakhstan Oblast 76,2 15,4 8,4 100,0 96,0 4,0 0,0 0,0 100,0 87,6 4782 Zhambyl Oblast 56,7 39,3 4,1 100,0 98,7 1,2 0,1 0,0 100,0 94,6 3521 West Kazakhstan Oblast 58,9 30,1 10,9 100,0 96,0 4,0 0,0 0,0 100,0 85,4 2208 Karaganda Oblast 88,0 9,3 2,7 100,0 98,3 0,8 0,9 0,0 100,0 95,7 4838 Kostanai Oblast 66,4 25,3 8,4 100,0 97,1 2,8 0,0 0,0 100,0 88,8 3058 Kyzylorda Oblast 81,0 9,9 9,0 100,0 98,2 1,1 0,7 0,0 100,0 90,0 2292 Mangistau Oblast 49,8 44,9 5,3 100,0 87,3 0,6 12,1 0,0 100,0 84,8 1722 Pavlodar Oblast 86,5 9,2 4,4 100,0 99,2 0,7 0,1 0,0 100,0 95,1 2770 North Kazakhstan Oblast 67,6 20,0 12,4 100,0 98,0 1,4 0,5 0,1 100,0 85,9 2304 South Kazakhstan Oblast 67,0 20,4 12,6 100,0 99,1 0,8 0,0 0,0 100,0 86,5 8729 106 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of household population using N um be r o f h ou se ho ld m em be rs Improved drinking water sources1 U ni m pr ov ed d rin ki ng w at er s ou rc es To ta l U se o f i m pr ov ed sa ni ta tio n2 Unimproved sanitation facilities To ta l U se o f i m pr ov ed w at er so ur ce s an d im pr ov ed sa ni ta tio n fa ci lit ie s P ip ed in to dw el lin g, ya rd o r p lo t P ip ed in to dw el lin g, y ar d or p lo t S ha re d im pr ov ed sa ni ta tio n Fa ci lit ie s U ni m pr ov ed fa ci lit ie s N o to ile ts Residence Urban 94,0 5,1 0,9 100,0 96,9 2,9 0,2 0,0 100,0 96,0 29257 Rural 52,5 35,4 12,1 100,0 97,8 1,1 1,1 0,1 100,0 86,0 25292 Education of Household Head Incomplete secondary 64,0 27,7 8,3 100,0 97,7 1,5 0,8 0,0 100,0 89,7 6151 Secondary 66,2 25,7 8,0 100,0 96,9 2,3 0,7 0,0 100,0 89,2 18496 Specialized secondary 78,7 16,3 5,0 100,0 97,3 2,2 0,5 0,0 100,0 92,4 17226 Higher 87,7 9,0 3,3 100,0 97,7 1,9 0,4 0,0 100,0 94,5 12355 Wealth Index Quintile Poorest 44,2 41,0 14,7 100 97,8 1,8 0,4 0,0 100 83,4 10909 Second 55,5 33,7 10,8 100 97,6 1,6 0,7 0,0 100 87,0 10911 Middle 77,3 19,2 3,5 100 94,5 4,0 1,5 0,0 100 91,3 10909 Fourth 97,6 1,6 0,8 100 97,5 2,1 0,5 0,0 100 96,7 10905 Richest 99,1 0,4 0,5 100 99,1 0,9 0,0 0,0 100 98,6 10916 Ethnicity of Household Head Kazakh 69,4 23,2 7,4 100,0 96,7 2,5 0,8 0,0 100,0 89,6 34089 Russian 88,5 9,1 2,4 100,0 98,0 1,5 0,4 0,0 100,0 95,6 13089 Other ethnic groups 75,0 18,7 6,4 100,0 98,7 1,1 0,2 0,1 100,0 92,3 7371 Total 74,7 19,2 6,1 100,0 97,3 2,1 0,6 0,0 100,0 91,4 54549 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 4.1; MDG Indicator 7.8 2 MICS Indicator 4.3; MDG Indicator 7.9 107MONITORING THE SITUATION OF CHILDREN AND WOMEN VIII. Reproductive Health 108 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In MICS4, adolescent birth rates and total fer- tility rates are calculated by using information on the date of last birth of each woman and are based on the one-year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to absence of information on multiple births (twins, triplets etc) and on women having mul- tiple deliveries during the one year period preceding the survey. Table RH.1 shows adolescent birth rates and total fertility rate. The adolescent birth rate (age-spe- cific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years dur- ing the one year period preceding the survey, divided by the average number of women age 15-19 (num- ber of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1,000 women. The total fertility rate (TFR) is calcu- lated by summing the age-specific fertility rates cal- culated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. According to current statistics, the TFR in Kazakhstan was 2.6 in 2010. According to MICS4 survey, the TFR was also 2.6; by region, Kyzylorda, South Kazakhstan and Zhambyl Oblasts have the highest TFR (4.5, 3.9 and 3.9 respectively), while Al- maty city and North Kazakhstan Oblast have the low- est, at 0.8 and 1.5 respectively. Given the other crite- ria, it can be said that the largest number of children is born in rural areas (3.3) to women with secondary education (3.0) from the poorest quintile (3.6). The MICS4 in Kazakhstan has reported the adolescent birth rate of 23.4 per 1,000 women. Fertility Table RH.1: Adolescent birth rate and total fertility rate, Adolescent birth rate and total fertility rate, Kazakhstan, 2010/11 Adolescent birth rate1 (Age-specific fertility rate for women aged 15-19) Total Fertility Rate Region Akmola Oblast 61,1 2,5 Aktobe Oblast 19,3 3,0 Almaty Oblast 24,7 2,7 Almaty city 26,6 0,8 Astana city 9,2 2,2 Atyrau Oblast 38,2 3,3 East Kazakhstan Oblast 7,7 2,4 Zhambyl Oblast 30,9 3,9 West Kazakhstan Oblast 42,9 2,4 Karaganda Oblast 14,9 2,0 Kostanai Oblast 24,5 2,1 Kyzylorda Oblast 49,8 4,5 Mangistau Oblast 44,4 3,5 Pavlodar Oblast 9,0 1,9 North Kazakhstan Oblast 9,3 1,5 South Kazakhstan Oblast 15,1 3,9 Residence Urban 17,1 2,2 Rural 31,5 3,3 Education Incomplete Secondary 0,0 2,9 Secondary 22,9 3,0 Specialized Secondary 25,9 2,6 Higher 29,2 2,4 109MONITORING THE SITUATION OF CHILDREN AND WOMEN Adolescent birth rate1 (Age-specific fertility rate for women aged 15-19) Total Fertility Rate Wealth Index Quintile Poorest 26,3 3,6 Second 33,6 3,0 Middle 18,0 2,9 Fourth 18,0 2,3 Richest 21,9 1,8 Ethnicity of Household Head Kazakh 21,9 3,0 Russian 25,8 1,7 Other ethnic groups 28,7 2,4 Total 23,4 2,6 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.1; MDG Indicator 5.4 live birth and only 0.9 percent were pregnant with their first child at the time of the survey. Women living in ru- ral areas had higher early childbearing rates than those in urban areas. Given other criteria, the highest early childbearing rates (previous live births, the first preg- nancy, early conception) are found among women with special secondary education (4.0, 1.9 and 5.9 percent, respectively), as well as among women with the poor- est quintile (4.3, 1.9 and 6.1, respectively). In the 20-24 age group, only 2.3 percent of respondents gave birth to one child before age 18. The largest number of re- spondents in this group had secondary education (6.0 percent). Sexual activity and childbearing early in life carry significant risks for young people all around the world. Table RH.2 presents some early child- bearing indicators for women age 15-19 and 20-24 while Table RH.3 presents the trends for early child- bearing. As shown in Table RH.2, 2.7 percent of women age 15-19 have already had a live birth while 1.1 percent are pregnant with their first child. Thus 3.8 percent of women age 15-19 have already begun childbearing. No live births before the age of 15 were observed. The largest number of pregnancies and births is found in Kostanai Oblast, where 6.2 percent of women age 15-19 have had a Table RH.2: Early childbearing Percentage of women age 15-19 who have had a live birth or who are pregnant with the first child; percentage of women age 15-19 who have begun childbearing before age 15, and the percentage of women age 20-24 who have had a live birth before age 18, Kazakhstan, 2010/11 Percentage of women age 15-19 N um be r o f w om en ag ed 1 5- 19 P er ce nt ag e of w om en a ge d 20 - 24 w ho h av e ha d a liv e bi rth b ef or e ag e 18 1 N um be r o f w om en ag ed 2 0- 24 H av e ha d a liv e bi rth A re p re gn an t w ith fi rs t c hi ld H av e be gu n ch ild be ar in g H av e ha d a liv e bi rth b ef or e ag e 15 Region Akmola Oblast 5,9 0,9 6,8 0,0 74 1,0 77 Aktobe Oblast 0,9 1,9 2,8 0,0 95 3,8 114 Almaty Oblast 3,8 0,6 4,3 0,0 256 1,8 254 Almaty city 1,4 0,0 1,4 0,0 107 0,7 207 Astana city 0,0 0,0 0,0 0,0 69 1,0 99 Atyrau Oblast 2,7 0,7 3,4 0,0 67 4,3 68 East Kazakhstan Oblast 1,6 0,9 2,4 0,0 180 4,2 169 Zhambyl Oblast 2,9 3,4 6,3 0,0 139 1,5 114 110 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of women age 15-19 N um be r o f w om en ag ed 1 5- 19 P er ce nt ag e of w om en a ge d 20 - 24 w ho h av e ha d a liv e bi rth b ef or e ag e 18 1 N um be r o f w om en ag ed 2 0- 24 H av e ha d a liv e bi rth A re p re gn an t w ith fi rs t c hi ld H av e be gu n ch ild be ar in g H av e ha d a liv e bi rth b ef or e ag e 15 West Kazakhstan Oblast 5,2 0,0 5,2 0,0 81 3,4 84 Karaganda Oblast 1,9 1,5 3,4 0,0 173 2,4 193 Kostanai Oblast 6,2 0,9 7,1 0,0 98 3,2 126 Kyzylorda Oblast 3,3 0,8 4,1 0,0 84 0,0 78 Mangistau Oblast 2,9 1,2 4,1 0,0 83 0,8 75 Pavlodar Oblast 3,5 0,0 3,5 0,0 94 3,9 111 North Kazakhstan Oblast 3,0 2,1 5,1 0,0 67 4,0 79 South Kazakhstan Oblast 1,4 1,2 2,6 0,0 354 1,9 331 Residence Urban 2,1 1,0 3,1 0,0 1091 2,1 1331 Rural 3,3 1,2 4,5 0,0 932 2,6 848 Education Incomplete Secondary (*) (*) (*) (*) 300 (*) 7 Secondary 3,2 1,1 4,3 0,0 828 6,0 502 Specialized Secondary 4,0 1,9 5,9 0,0 591 1,9 633 Higher 1,5 0,2 1,6 0,0 303 0,6 1034 Wealth Index Quintile Poorest 4,3 1,9 6,1 0,0 442 2,9 358 Second 3,2 1,3 4,5 0,0 393 4,0 397 Middle 2,1 0,9 2,9 0,0 446 1,4 438 Fourth 2,3 0,6 2,9 0,0 387 2,0 435 Richest 1,4 0,6 1,9 0,0 355 1,5 551 Ethnicity/Language of Household Head Kazakh 1,5 0,8 2,3 0,0 1444 1,8 1397 Russian 6,0 1,5 7,6 0,0 327 3,4 480 Other ethnic groups 4,8 2,0 6,9 0,0 251 2,5 302 Total 2,7 1,1 3,8 0,0 2022 2,3 2178 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.2 ( ) – indicators are based on 25-49 cases of unweighted observations Table RH.3 demonstrates early childbearing trends by age groups. In the age groups 35-39 and 40-44 the number of women giving birth before age 18 is 2.9 percent, then there is a sharp increase in early childbearing among women age 30-34 and the share of women giving livebirths sharply increases to 5.8 percent, followed by a decrease in the number of women with livebirths before age 18 – from 3.0 per- cent in the age group 25-29 to 2.3 percent in the age group 20-24. 111MONITORING THE SITUATION OF CHILDREN AND WOMEN Table RH.3: Trends in early childbearing Percentage of women who have had a live birth by age 15 and 18, by age groups, Kazakhstan, 2010/11 Urban Rural All P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 8 N um be r o f w om en P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 8 N um be r o f w om en P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om - en w ith a li ve b irt h be fo re a ge 1 8 N um be r o f w om en Age 15-19 0,0 1091 n/a n/a 0,0 932 n/a n/a 0,0 2022 n/a n/a 20-24 0,1 1331 2,1 1331 0,0 848 2,6 848 0,1 2178 2,3 2178 25-29 0,0 1205 2,7 1205 0,0 810 3,4 810 0,0 2016 3,0 2016 30-34 0,1 1128 5,1 1128 0,2 877 6,6 877 0,1 2005 5,8 2005 35-39 0,0 1113 3,1 1113 0,1 788 2,8 788 0,1 1901 2,9 1901 40-44 0,1 1079 2,9 1079 0,0 840 2,9 840 0,1 1919 2,9 1919 45-49 0,1 1108 2,2 1108 0,0 864 2,1 864 0,1 1972 2,2 1972 Total 0,1 8055 3,0 6964 0,0 5959 3,4 5028 0,1 14014 3,2 11992 n/a – not applicable Contraception and 43.1 percent of women in South Kazakhstan and Almaty Oblasts reported using any method. Adoles- cents use contraception far less than older women. Only 19.2 percent of married or in union women aged 15-19 currently use a method of contraception com- pared to 35.3 percent of 20-24 year olds and 56.8 per- cent of older women. Women’s education level is associated with con- traceptive prevalence. The percentage of women using any method of contraception rises from 46.0 percent among those with no completed secondary education to 52.9 percent among women with higher education. About 49.5 percent of women use modern methods of contraception, while only 1.5 percent of interviewed wom- en used traditional methods. Over 60 percent of women using modern contraception methods live in Astana and in West Kazakhstan Oblast and 50 to 59 percent – in Karaganda, Pavlodar, North Kazakhstan and Kostanai Oblasts and Almaty city. The percentage of women using a modern contraception method among women with two and more children exceeds 52.1 percent (56.8 percent of women with two children and 53.2 percent of women with three children, 52.1 percent of women with four and more children). Percentage of women without children using contraception was 16.4 percent. Appropriate family planning is important to the health of women and children by: 1) preventing preg- nancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. It is critical for all couples to have access to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by 51 percent of women currently married or in union (Table RH.4). The most popular method is the IUD which is used by one in three (33.5 percent) women in Kazakh- stan. The next most popular method is male condom (7.2. percent), oral contraceptives are used by 7.1 per- cent of women. Between 0.3 and 0.5 percent of women reported use of withdrawal, periodic abstinence, lacta- tional amenorrhea method (LAM) or injectables. In ad- dition, 0.1 percent of respondents use female condoms and diaphragms (jelly, foam). Contraceptive prevalence among married (in union) women is highest in Astana and Almaty cities (72.7 and 62.6 percent respectively), Kostanai (63.1 percent), West Kazakhstan (61.9 percent) and North Kazakhstan Oblasts (60.5 percent). In Aktobe, South Kazakhstan and Almaty Oblasts contraceptive use is lower; only 35.7 percent of women in Aktobe Oblast 112 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table RH.4: Use of contraception among women Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Kazakhstan, 2010/11 N ot u si ng an y m et ho d Percent of women (currently married or in union) using contraception Number of women currently married or in union Fe m al e st er ili za tio n M al e st er ili za tio n IU D (in tra ut er in e de vi ce ) In je ct ab le s Im pl an ts P ill M al e co nd om Fe m al e co nd om D ia ph ra gm / F oa m /je lly La ct at io na l am en or rh oe a m et ho d P er io di c ab st in en ce W ith dr aw al O th er A ny m od er n m et ho d A ny tr ad iti on al m et ho d A ny m et ho d 1 Region Akmola Oblast 54,5 1,3 0,2 29,8 0,0 0,0 4,2 8,7 0,0 0,0 0,5 0,2 0,4 0,2 44,2 1,3 45,5 379 Aktobe Oblast 64,3 0,0 0,0 29,5 0,0 0,0 1,1 4,2 0,6 0,0 0,0 0,0 0,2 0,0 35,5 0,2 35,7 397 Almaty Oblast 56,9 0,7 0,2 33,0 0,0 0,0 3,0 5,6 0,0 0,2 0,0 0,2 0,0 0,4 42,6 0,5 43,1 890 Almaty city 37,4 1,7 0,0 13,7 0,0 0,0 28,2 14,8 0,2 0,2 1,4 2,0 0,3 0,0 58,9 3,7 62,6 575 Astana city 27,3 2,5 0,0 48,5 0,0 0,0 15,6 6,0 0,0 0,0 0,0 0,0 0,0 0,1 72,6 0,1 72,7 284 Atyrau Oblast 51,8 1,2 0,0 35,7 0,0 0,0 3,6 5,6 0,0 0,0 0,0 0,0 1,1 1,1 46,0 2,2 48,2 238 East Kazakhstan Oblast 49,8 0,8 0,0 30,9 0,0 0,0 8,1 9,0 0,0 0,0 0,2 0,4 0,6 0,2 48,8 1,4 50,2 743 Zhambyl Oblast 55,6 2,2 0,0 35,9 0,7 0,0 1,8 3,2 0,0 0,0 0,0 0,6 0,0 0,0 43,8 0,6 44,4 543 West Kazakhstan Oblast 38,1 1,3 0,0 39,4 0,0 0,0 8,7 10,8 0,0 0,0 0,0 0,2 1,5 0,0 60,2 1,7 61,9 339 Karaganda Oblast 45,4 2,2 0,0 31,0 0,5 0,0 10,2 7,2 0,5 0,5 0,6 0,2 0,9 0,8 52,1 2,4 54,6 753 Kostanai Oblast 36,9 1,9 0,0 35,7 0,0 0,0 12,8 9,1 0,2 0,2 1,1 0,7 0,6 0,8 59,9 3,2 63,1 468 Kyzylorda Oblast 55,9 0,2 0,0 35,6 0,2 0,0 3,6 4,0 0,0 0,0 0,0 0,2 0,2 0,2 43,6 0,5 44,1 357 Mangistau Oblast 42,9 0,2 0,0 49,8 0,0 0,0 3,9 3,2 0,0 0,0 0,0 0,0 0,0 0,0 57,1 0,0 57,1 280 Pavlodar Oblast 41,7 1,0 0,0 36,6 0,0 0,0 7,9 11,2 0,2 0,0 0,0 0,8 0,1 0,4 56,9 1,4 58,3 433 North Kazakhstan Oblast 39,5 0,5 0,0 31,4 0,0 0,0 9,6 14,5 0,0 0,5 0,2 0,9 1,9 1,0 56,5 4,0 60,5 375 South Kazakhstan Oblast 56,9 0,9 0,0 36,0 1,2 0,0 0,7 3,5 0,0 0,0 0,1 0,3 0,4 0,0 42,2 0,9 43,1 1379 Residence Urban 46,1 1,3 0,1 30,8 0,3 0,0 10,9 8,5 0,2 0,2 0,3 0,5 0,4 0,4 52,2 1,7 53,9 4509 Rural 52,3 1,0 0,0 36,6 0,3 0,0 2,8 5,7 0,0 0,1 0,2 0,4 0,5 0,2 46,4 1,3 47,7 3925 Age 15-19 80,8 0,5 0,0 5,6 0,0 0,0 1,9 10,4 0,0 0,0 0,0 0,0 0,7 0,0 18,4 0,7 19,2 92 20-24 64,7 0,1 0,0 17,3 0,1 0,0 5,9 10,1 0,0 0,3 0,5 0,3 0,6 0,2 33,8 1,5 35,3 998 25-29 47,1 0,1 0,1 30,2 0,2 0,0 9,9 10,9 0,1 0,1 0,5 0,4 0,3 0,3 51,5 1,4 52,9 1415 30-34 43,2 1,0 0,0 37,0 0,5 0,0 9,8 7,1 0,0 0,1 0,2 0,2 0,6 0,3 55,5 1,3 56,8 1544 35-39 39,0 1,1 0,0 42,6 0,6 0,0 7,9 7,1 0,1 0,1 0,5 0,5 0,3 0,2 59,5 1,5 61,0 1483 40-44 43,0 2,1 0,1 40,4 0,3 0,0 6,3 5,5 0,4 0,1 0,1 0,7 0,6 0,6 55,1 1,9 57,0 1487 45-49 60,9 2,2 0,0 29,4 0,0 0,0 2,8 3,3 0,1 0,0 0,0 0,7 0,5 0,2 37,8 1,4 39,1 1416 Number of Living Children 0 83,1 0,6 0,0 2,9 0,1 0,0 5,9 6,8 0,0 0,1 0,0 0,0 0,5 0,0 16,4 0,5 16,9 691 1 52,4 0,5 0,1 22,1 0,1 0,0 12,8 9,9 0,1 0,1 0,4 0,6 0,5 0,4 45,7 1,9 47,6 1927 2 41,6 1,2 0,0 39,2 0,1 0,0 7,7 8,3 0,1 0,2 0,3 0,6 0,4 0,3 56,8 1,6 58,4 2831 3 45,5 1,7 0,0 41,0 0,2 0,0 4,4 5,8 0,1 0,0 0,2 0,4 0,5 0,2 53,2 1,3 54,5 1670 4+ 46,7 1,6 0,0 44,5 1,2 0,0 1,7 2,9 0,1 0,1 0,3 0,1 0,6 0,2 52,1 1,3 53,3 1316 Education Incomplete Secondary 54,0 1,7 0,0 33,3 1,1 0,0 3,1 5,4 0,0 0,0 0,5 0,0 0,8 0,0 44,7 1,4 46,0 184 Secondary 50,9 1,3 0,1 34,8 0,3 0,0 4,7 5,8 0,1 0,1 0,4 0,4 0,7 0,5 47,1 2,1 49,1 2787 Specialized Secondary 48,5 1,1 0,0 34,6 0,3 0,0 6,6 7,6 0,0 0,1 0,1 0,4 0,3 0,2 50,4 1,1 51,5 2872 Higher 47,1 1,0 0,0 30,8 0,3 0,0 10,6 8,4 0,2 0,1 0,3 0,5 0,3 0,2 51,5 1,4 52,9 2583 113MONITORING THE SITUATION OF CHILDREN AND WOMEN N ot u si ng an y m et ho d Percent of women (currently married or in union) using contraception Number of women currently married or in union Fe m al e st er ili za tio n M al e st er ili za tio n IU D (in tra ut er in e de vi ce ) In je ct ab le s Im pl an ts P ill M al e co nd om Fe m al e co nd om D ia ph ra gm / F oa m /je lly La ct at io na l am en or rh oe a m et ho d P er io di c ab st in en ce W ith dr aw al O th er A ny m od er n m et ho d A ny tr ad iti on al m et ho d A ny m et ho d 1 Wealth Index Quintile Poorest 54,4 1,7 0,0 37,6 0,8 0,0 1,4 3,1 0,0 0,1 0,2 0,2 0,5 0,0 44,6 1,0 45,6 1622 Second 53,9 0,8 0,1 36,3 0,0 0,0 2,4 5,6 0,0 0,0 0,1 0,2 0,4 0,2 45,1 1,0 46,1 1693 Middle 49,7 1,1 0,0 32,4 0,2 0,0 6,2 8,6 0,1 0,2 0,2 0,5 0,5 0,3 48,8 1,5 50,3 1671 Fourth 44,3 1,2 0,0 32,0 0,4 0,0 10,2 9,4 0,2 0,2 0,2 0,9 0,5 0,5 53,6 2,2 55,7 1599 Richest 43,2 1,1 0,0 29,6 0,1 0,0 14,8 9,1 0,3 0,0 0,6 0,4 0,4 0,4 55,0 1,8 56,8 1850 Ethnicity of Household Head Kazakh 51,7 1,0 0,0 36,5 0,4 0,0 4,1 5,2 0,1 0,1 0,2 0,4 0,2 0,1 47,4 0,9 48,3 5461 Russian 41,7 1,3 0,1 26,9 0,1 0,0 16,1 11,0 0,1 0,1 0,3 0,6 0,8 0,8 55,8 2,5 58,3 1831 Other ethnic groups 48,0 1,6 0,0 29,6 0,3 0,0 7,3 10,5 0,2 0,2 0,3 0,4 1,4 0,3 49,6 2,4 52,0 1141 Total 49,0 1,2 0,0 33,5 0,3 0,0 7,1 7,2 0,1 0,1 0,3 0,4 0,5 0,3 49,5 1,5 51,0 8434 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.3; MDG Indicator 5.3 The study also included a survey of men aged 15-59 regarding their own or their partners’ use of contraception (Table RH.4M). Only 40.6 percent of respondents answered affirmatively to a question about their own or partner’s use of any method of contraception. The most popular method is an intra- uterine device (24.2 percent), the second is male con- doms used by one in ten respondents (10.7 percent); the third most popular method is pills (4.3 percent). Other methods of contraception are used by about 3 percent of respondents. Men living in urban areas are more likely to use any contraception method than rural residents (42.6 and 38.5 percent respectively). At the same time, men or their partners living in ur- ban areas are more likely to use male condoms (13.1 and 8.1 percent, respectively) and pills (7.2 and 1.1 percent, respectively) than in rural areas. By region, different methods of contraception are most often used by residents of Astana (58.1 per- cent), Almaty Oblast (53.2 percent) and North Kazakh- stan Oblast (52.7 percent). The lowest contraception use rates are found among men living in Mangistau (18.2 percent), Aktobe (29.5 percent) and Akmola (29.9 percent) Oblasts. Contraceptive use clearly correlates with the lev- els of educational attainment and wealth. Thus, only 37.2 percent of men or their partners with secondary education use any contraceptive method, whereas 44.1 percent of men with higher education do so. Only 33.6 percent of men from the poorest households use any method of contraception compared to 45.9 percent of men from the richest households. The frequency of men’s use of a contraceptive method increases with age, from a minimum of 22 per- cent (20-24 years), to a maximum in the age group 35- 39 (55.7 percent), then dropping to 7.4 percent in the 55-59 age group. Most often, men (and their partners) prefer such contraceptives as intrauterine devices and male condoms. 114 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table RH.4M: Use of contraception among men Percentage of men age 15-59 years currently married or in union who are using (or whose partner is using) a contraceptive method, Kazakhstan, 2010/11 N ot u si ng an y m et ho d Percent of men (currently married or in union) using contraception Number of men currently married/in union Fe m al e st er ili za tio n M al e st er ili za tio n IU D (i nt ra ut er in e de vi ce ) In je ct ab le s Im pl an ts P ill M al e co nd om Fe m al e co nd om D ia ph ra gm / F oa m /je lly La ct at io na l am en or rh oe a m et ho d P er io di c A bs tin en ce /R hy th m W ith dr aw al O th er A ny m od er n m et ho d A ny tr ad iti on al m et ho d A ny m et ho d1 Region Akmola Oblast 70,1 0,0 0,0 17,2 0,7 0,0 2,6 8,3 0,0 0,0 0,0 1,2 0,0 0,0 28,7 1,2 29,9 115 Aktobe Oblast 70,5 0,0 0,0 22,8 0,0 0,0 0,0 6,0 0,0 0,0 0,0 0,0 0,0 0,7 28,8 0,7 29,5 119 Almaty Oblast 46,8 0,2 0,0 37,6 0,0 0,0 1,9 12,7 0,8 0,0 0,0 0,0 0,0 0,0 53,2 0,0 53,2 281 Almaty city 49,7 0,8 0,0 7,6 0,0 0,0 19,6 21,9 0,0 0,0 0,0 0,4 0,0 0,0 49,9 0,4 50,3 168 Astana city 41,9 0,0 0,0 37,8 0,0 0,0 13,9 6,5 0,0 0,0 0,0 0,0 0,0 0,0 58,1 0,0 58,1 82 Atyrau Oblast 54,5 1,9 0,0 29,5 0,0 0,0 0,8 12,9 0,0 0,0 0,0 0,0 0,0 0,4 45,1 0,4 45,5 74 East Kazakhstan Oblast 68,3 0,0 0,0 17,4 0,0 0,0 4,2 9,5 0,0 0,0 0,0 0,0 0,6 0,0 31,1 0,6 31,7 251 Zhambyl Oblast 65,6 0,0 0,0 30,0 0,0 0,0 1,5 2,9 0,0 0,0 0,0 0,0 0,0 0,0 34,4 0,0 34,4 160 West Kazakhstan Oblast 55,2 0,0 0,0 25,7 0,0 0,0 3,5 13,5 2,1 0,0 0,0 0,0 0,0 0,0 44,8 0,0 44,8 109 Karaganda Oblast 61,1 0,0 0,0 15,7 0,0 0,0 4,5 16,9 0,0 0,0 0,0 0,5 1,2 0,0 37,2 1,7 38,9 239 Kostanai Oblast 56,7 0,7 0,0 18,4 0,0 0,0 9,2 11,9 0,0 0,0 1,3 0,0 1,1 0,7 40,1 3,2 43,3 141 Kyzylorda Oblast 69,1 0,0 0,0 22,8 0,0 0,0 1,6 5,3 0,0 0,0 0,0 0,0 1,2 0,0 29,7 1,2 30,9 112 Mangistau Oblast 81,8 0,0 0,0 11,3 0,0 0,0 0,7 6,2 0,0 0,0 0,0 0,0 0,0 0,0 18,2 0,0 18,2 84 Pavlodar Oblast 58,7 1,6 0,0 21,3 0,0 0,0 6,0 11,8 0,0 0,0 0,0 0,5 0,0 0,0 40,7 0,5 41,3 145 North Kazakhstan Oblast 47,3 0,0 0,4 22,9 0,0 0,0 5,6 19,3 0,0 0,5 0,0 0,9 3,1 0,0 48,6 4,1 52,7 126 South Kazakhstan Oblast 59,9 0,5 0,0 33,8 0,6 0,0 0,0 5,2 0,0 0,0 0,0 0,0 0,0 0,0 40,1 0,0 40,1 389 Residence Urban 57,4 0,3 0,0 21,3 0,0 0,0 7,2 13,1 0,0 0,0 0,1 0,2 0,4 0,0 41,9 0,7 42,6 1360 Rural 61,5 0,4 0,0 27,4 0,2 0,0 1,1 8,1 0,3 0,0 0,1 0,2 0,5 0,2 37,6 0,9 38,5 1235 Age 15-19 100,0 (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 3 20-24 78,0 0,0 0,0 3,9 0,0 0,0 6,4 10,4 0,0 0,0 0,0 0,0 1,2 0,0 20,7 1,2 22,0 108 25-29 53,3 0,0 0,2 21,9 0,0 0,0 8,9 15,2 0,0 0,0 0,3 0,0 0,2 0,0 46,2 0,6 46,7 258 30-34 47,7 0,4 0,0 29,2 0,2 0,0 7,0 15,2 0,0 0,0 0,0 0,3 0,1 0,0 51,9 0,4 52,3 445 35-39 44,3 0,0 0,0 32,8 0,5 0,0 5,6 15,5 0,2 0,0 0,0 0,4 0,9 0,0 54,5 1,2 55,7 472 40-44 47,9 0,4 0,0 37,5 0,0 0,0 2,4 10,4 0,6 0,0 0,2 0,2 0,2 0,3 51,3 0,9 52,1 382 45-49 62,2 0,9 0,0 24,0 0,0 0,0 3,3 8,5 0,4 0,1 0,0 0,2 0,5 0,0 37,1 0,7 37,8 389 50-54 84,0 0,5 0,0 10,6 0,0 0,0 0,4 3,6 0,0 0,0 0,0 0,0 0,7 0,3 15,1 0,9 16,0 320 55-59 92,6 0,0 0,0 5,5 0,0 0,0 0,6 0,9 0,0 0,0 0,0 0,3 0,0 0,1 7,0 0,5 7,4 218 Education Incomplete Secondary 61,4 0,8 0,0 25,7 0,0 0,0 1,5 7,3 0,0 0,0 0,0 0,8 2,4 0,0 35,4 3,2 38,6 88 Secondary 62,8 0,3 0,0 25,6 0,1 0,0 2,0 8,5 0,1 0,0 0,2 0,0 0,3 0,1 36,6 0,6 37,2 977 Specialized econdary 57,9 0,2 0,0 24,2 0,3 0,0 5,2 11,0 0,2 0,1 0,0 0,3 0,5 0,1 41,2 0,9 42,1 880 Higher 55,9 0,4 0,1 21,9 0,0 0,0 7,0 14,0 0,1 0,0 0,0 0,2 0,3 0,0 43,6 0,5 44,1 647 Wealth Index Quintile Poorest 66,4 0,0 0,0 28,4 0,6 0,0 0,0 3,9 0,0 0,0 0,2 0,2 0,3 0,0 32,9 0,7 33,6 491 Second 61,5 0,8 0,0 26,7 0,0 0,0 1,5 8,2 0,1 0,0 0,0 0,0 0,8 0,4 37,4 1,2 38,5 516 Middle 58,7 0,6 0,1 22,9 0,0 0,0 4,0 12,8 0,4 0,0 0,0 0,2 0,2 0,0 40,9 0,4 41,3 509 115MONITORING THE SITUATION OF CHILDREN AND WOMEN 14 A women is postpartum amenorrheic if she had a birth in last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child 15 A women is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy OR (2) She declares that she has had hysterectomy, or that she has never menstruated or that she is menopausal, or that she has been trying to get pregnant for 2 or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey OR (3) She declares she cannot get pregnant when asked about desire for future birth OR (4) She has not had a birth in the preceding 5 years, is currently not using contraception and is currently married and was continuously married during the last 5 years preceding the survey N ot u si ng an y m et ho d Percent of men (currently married or in union) using contraception Number of men currently married/in union Fe m al e st er ili za tio n M al e st er ili za tio n IU D (i nt ra ut er in e de vi ce ) In je ct ab le s Im pl an ts P ill M al e co nd om Fe m al e co nd om D ia ph ra gm / F oa m /je lly La ct at io na l am en or rh oe a m et ho d P er io di c A bs tin en ce /R hy th m W ith dr aw al O th er A ny m od er n m et ho d A ny tr ad iti on al m et ho d A ny m et ho d1 Fourth 57,0 0,2 0,0 20,3 0,0 0,0 6,1 15,1 0,2 0,0 0,0 0,4 0,6 0,1 41,9 1,1 43,0 526 Richest 54,1 0,1 0,0 23,0 0,0 0,0 9,3 12,8 0,1 0,1 0,2 0,1 0,2 0,0 45,4 0,5 45,9 553 Ethnicity of Household Head Kazakh 61,6 0,4 0,0 26,7 0,0 0,0 2,1 8,5 0,2 0,0 0,1 0,1 0,2 0,1 37,9 0,4 38,4 1623 Russian 56,1 0,1 0,1 16,4 0,1 0,0 9,6 15,9 0,2 0,0 0,1 0,4 0,5 0,2 42,5 1,3 43,9 623 Other ethnic groups 54,7 0,3 0,0 26,3 0,7 0,0 5,0 11,4 0,0 0,2 0,0 0,0 1,5 0,0 43,8 1,5 45,3 349 Total (15-49) 52,0 0,3 0,0 28,3 0,1 0,0 5,3 12,8 0,2 0,0 0,1 0,2 0,4 0,0 47,2 0,8 48,0 2058 Total (15-59) 59,4 0,3 0,0 24,2 0,1 0,0 4,3 10,7 0,2 0,0 0,1 0,2 0,4 0,1 39,8 0,8 40,6 2595 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.3; MDG Indicator 5.3 (*) – indicators are based on less than 25 cases of unweighted observations Unmet Need • Are not pregnant and not postpartum amenorrheic and are fecund and unsure whether they want another child OR. • Are pregnant and say that pregnancy was mistimed: would have wanted to wait OR. • Are postpartum amenorrheic and say that the birth was mistimed: would have wanted to wait. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for lim- iting. The survey shows that 11.6 percent of surveyed women have an unmet need for contraception, which includes 6.9 and 4.7 percent of women have unmet need for spacing and limiting respectively. Unmet need for contraception is highest in Ak- mola Oblast (16.9 percent) and lowest in Astana, at 3.3 percent. Overall unmet need for contraception drops from 20.6 percent in the 15-19 age group to 5.8 percent among women aged 45-49. Unmet need for contraception refers to fecund women who are not using any method of contracep- tion, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.5 shows the results of the survey on contraception, unmet need, and the demand for con- traception satisfied. Unmet need for spacing is defined as percent- age of women who are not using a method of contra- ception in addition to the following: • Are not pregnant and not postpartum amenorrheic14 and are fecund15 and say they want to wait two or more years for their next birth OR. 116 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Ta bl e R H .5 : U nm et n ee d fo r c on tr ac ep tio n P er ce nt ag e of w om en a ge d 15 -4 9 ye ar s cu rr en tly m ar rie d or in u ni on w ith a n un m et n ee d fo r f am ily p la nn in g an d pe rc en ta ge o f d em an d fo r co nt ra ce pt io n sa tis fie d, K az ak hs ta n, 2 01 0/ 11 M et n ee d fo r c on tr ac ep tio n U nm et n ee d fo r c on tr ac ep tio n N um be r o f w om en , cu rr en tly m ar rie d or in u ni on P er ce nt ag e of d em an d fo r co nt ra ce pt io n sa tis fie d N um be r o f w om en , c ur re nt ly m ar rie d or in u ni on Fo r s pa ci ng Fo r l im iti ng To ta l Fo r l im iti ng Fo r s pa ci ng To ta l1 R eg io n A km ol a O bl as t 19 ,0 26 ,5 45 ,5 7, 8 9, 2 16 ,9 37 9 72 ,9 23 6 A kt ob e O bl as t 22 ,4 13 ,3 35 ,7 8, 0 4, 7 12 ,7 39 7 73 ,8 19 2 A lm at y O bl as t 21 ,4 21 ,7 43 ,1 11 ,8 4, 8 16 ,6 89 0 72 ,2 53 1 A lm at y ci ty 40 ,7 22 ,0 62 ,6 6, 3 3, 2 9, 5 57 5 86 ,8 41 5 A st an a ci ty 43 ,5 29 ,2 72 ,7 1, 5 1, 7 3, 3 28 5 95 ,7 21 6 A ty ra u O bl as t 28 ,8 19 ,3 48 ,2 7, 8 3, 0 10 ,8 23 8 81 ,7 14 0 E as t K az ak hs ta n O bl as t 24 ,1 26 ,1 50 ,2 5, 4 6, 5 11 ,9 74 3 80 ,8 46 1 Zh am by l O bl as t 22 ,0 22 ,4 44 ,4 9, 4 4, 4 13 ,8 54 3 76 ,3 31 6 W es t K az ak hs ta n O bl as t 26 ,3 35 ,6 61 ,9 3, 5 4, 5 8, 0 33 9 88 ,6 23 7 K ar ag an da O bl as t 27 ,6 26 ,9 54 ,6 5, 5 6, 7 12 ,2 75 3 81 ,7 50 3 K os ta na i O bl as t 27 ,2 35 ,9 63 ,1 6, 4 4, 4 10 ,8 46 8 85 ,4 34 6 K yz yl or da O bl as t 25 ,3 18 ,8 44 ,1 8, 8 2, 4 11 ,2 35 7 79 ,7 19 8 M an gi st au O bl as t 30 ,2 26 ,9 57 ,1 9, 4 1, 0 10 ,4 28 0 84 ,6 18 9 P av lo da r O bl as t 25 ,8 32 ,5 58 ,3 4, 7 6, 2 10 ,9 43 3 84 ,3 29 9 N or th K az ak hs ta n O bl as t 28 ,2 32 ,3 60 ,5 5, 0 4, 4 9, 4 37 5 86 ,6 26 2 S ou th K az ak hs ta n O bl as t 18 ,5 24 ,6 43 ,1 6, 3 3, 8 10 ,1 13 79 81 ,0 73 4 R es id en ce U rb an 29 ,3 24 ,6 53 ,9 6, 4 4, 8 11 ,2 45 09 82 ,8 29 33 R ur al 21 ,1 26 ,6 47 ,7 7, 5 4, 5 12 ,0 39 25 79 ,9 23 44 A ge 15 -1 9 18 ,6 0, 5 19 ,2 19 ,8 0, 8 20 ,6 92 (4 8, 2) 37 20 -2 4 33 ,4 2, 0 35 ,3 17 ,5 0, 9 18 ,4 99 8 65 ,8 53 6 25 -2 9 45 ,0 7, 9 52 ,9 12 ,0 1, 8 13 ,8 14 15 79 ,4 94 4 30 -3 4 38 ,2 18 ,5 56 ,8 8, 0 4, 7 12 ,6 15 44 81 ,8 10 71 35 -3 9 26 ,9 34 ,1 61 ,0 4, 1 6, 1 10 ,2 14 83 85 ,6 10 56 40 -4 4 9, 8 47 ,2 57 ,0 2, 1 8, 0 10 ,1 14 87 84 ,9 99 8 45 -4 9 2, 0 37 ,2 39 ,1 0, 4 5, 4 5, 8 14 16 87 ,2 63 6 117MONITORING THE SITUATION OF CHILDREN AND WOMEN M et n ee d fo r c on tr ac ep tio n U nm et n ee d fo r c on tr ac ep tio n N um be r o f w om en , cu rr en tly m ar rie d or in u ni on P er ce nt ag e of d em an d fo r co nt ra ce pt io n sa tis fie d N um be r o f w om en , c ur re nt ly m ar rie d or in u ni on Fo r s pa ci ng Fo r l im iti ng To ta l Fo r l im iti ng Fo r s pa ci ng To ta l1 Ed uc at io n In co m pl et e se co nd ar y 13 ,2 32 ,9 46 ,0 3, 7 6, 1 9, 9 18 4 82 ,4 10 3 S ec on da ry 22 ,4 26 ,7 49 ,1 7, 6 5, 8 13 ,4 27 87 78 ,6 17 43 S pe ci al iz ed s ec on da ry 22 ,5 29 ,0 51 ,5 5, 5 4, 9 10 ,4 28 72 83 ,1 17 78 H ig he r 33 ,0 19 ,8 52 ,9 7, 9 3, 1 11 ,0 25 83 82 ,8 16 51 W ea lth In de x Q ui nt ile P oo re st 17 ,5 28 ,1 45 ,6 7, 8 5, 8 13 ,6 16 22 77 ,0 96 0 S ec on d 22 ,0 24 ,1 46 ,1 7, 7 3, 2 10 ,9 16 93 80 ,9 96 4 M id dl e 25 ,1 25 ,2 50 ,3 6, 9 4, 5 11 ,5 16 71 81 ,4 10 32 Fo ur th 29 ,4 26 ,3 55 ,7 6, 8 5, 2 12 ,0 15 99 82 ,2 10 84 R ic he st 32 ,6 24 ,2 56 ,8 5, 4 4, 7 10 ,1 18 50 84 ,9 12 37 Et hn ic ity o f H ou se ho ld H ea d K az ak h 25 ,2 23 ,1 48 ,3 7, 3 3, 6 10 ,8 54 61 81 ,7 32 31 R us si an 28 ,1 30 ,2 58 ,3 5, 7 7, 3 13 ,0 18 31 81 ,8 13 06 O th er e th ni c gr ou ps 22 ,7 29 ,3 52 ,0 7, 1 5, 7 12 ,8 11 41 80 ,2 74 0 To ta l 25 ,5 25 ,5 51 ,0 6, 9 4, 7 11 ,6 84 34 81 ,5 52 77 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es 1 M IC S In di ca to r 5 .3 ; M D G In di ca to r 5 .3 ( ) – in di ca to rs a re b as ed o n 25 -4 9 ca se s of u nw ei gh te d ob se rv at io ns 118 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Met need for limiting includes women who are using a contraceptive method and who do not want any more children, are using male or female steriliza- tion or declare themselves as infecund. The survey in Kazakhstan showed that this indicator is 25.5 percent, with the highest levels found in Kostanai and West Kazakhstan Oblasts (36.0 percent each) as well as Pavlodar and North Kazakhstan Oblasts (32.0 percent each). About 47.2 percent of women aged 40-44 re- ported the highest met need for limiting, whereas wom- en aged 15-19 reported the lowest level, 0.5 percent. Met need for spacing includes women who are using a contraceptive method and who want to have another child or undecided whether to have another child. The national met need for spacing is 25.5 per- cent. It is the highest in Astana (43.5 percent) and Almaty (40.7 percent) and lowest in South Kazakhstan (18.5 percent) and Akmola (19.0 percent) Oblasts. According to age, women 25-29 years old have the highest met need for spacing (45.0 percent), whereas women 45-49 years old report the lowest level, at 2.0 percent. The total of met need for spacing and limit- ing adds up to the total met need for contraception. According to the survey, this indicator was 51 per- cent, with its maximum in Astana (72.7 percent), and minimum in Aktobe Oblast (35.7 percent). In terms of age groups, it increases from 19.2 percent (among 15-19 years old) to a maximum of 61.0 percent among women aged 35-39 and then declines to 39.1 percent among women aged 45-49 years old. Women with higher education (52.9 percent) reported the highest level of satisfaction, whereas women with incomplete secondary education re- ported the lowest level of met need for contraception (46.0 percent). Antenatal Care specific on the content on antenatal care visits, which include: • Blood pressure measurement • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anemia • Weight/height measurement (optional) Coverage of antenatal care (by a doctor, nurse, midwife or feldsher) is very high in Kazakhstan with al- most all women (99.2 percent) receiving antenatal care at least once during the pregnancy. The level of antenatal care in Kazakhstan is approximately 100 percent. In Kazakhstan, antenatal care is provided primarily by doctors (82.6 percent); nurses and midwives (15.3 percent of women), auxil- iary midwives (0.6 percent) and feldshers (0.7 percent). The antenatal period presents important oppor- tunities for reaching pregnant women with a number of interventions that may be vital to their health and well- being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For ex- ample, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may pro- vide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse out- comes such as low birth weight can be reduced through a combination of interventions to improve women’s nu- tritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV preven- tion and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antena- tal visits based on a review of the effectiveness of dif- ferent models of antenatal care. WHO guidelines are 119MONITORING THE SITUATION OF CHILDREN AND WOMEN Table RH.6: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Kazakhstan, 2010/11 Person providing antenatal care N o an te na ta l c ar e re ce iv ed To ta l At least once by skilled person- nel 1 Number of women who gave birth in two years preceding surveyD oc to r N ur se / M id - w ife A ux ili ar y m id - w ife A ss is ta nt nu rs e Region Akmola Oblast 91,6 4,8 0,0 0,0 3,6 100,0 96,4 68 Aktobe Oblast 98,6 1,4 0,0 0,0 0,0 100,0 100,0 115 Almaty Oblast 83,1 15,0 0,0 1,0 0,9 100,0 99,1 194 Almaty city (95,6) 0,0 0,0 0,0 (4,4) 100,0 (95,6) 68 Astana city 98,3 0,0 0,7 0,0 1,0 100,0 99,0 72 Atyrau Oblast 99,3 0,7 0,0 0,0 0,0 100,0 100,0 77 East Kazakhstan Oblast 85,2 11,1 0,0 2,7 1,1 100,0 98,9 143 Zhambyl Oblast 66,3 33,0 0,0 0,0 0,7 100,0 99,3 166 West Kazakhstan Oblast 89,3 10,0 0,7 0,0 0,0 100,0 100,0 75 Karaganda Oblast 94,2 4,9 0,0 0,0 0,9 100,0 99,1 148 Kostanai Oblast 83,7 5,8 0,0 9,2 1,2 100,0 98,8 86 Kyzylorda Oblast 93,2 5,6 0,0 0,0 1,2 100,0 98,8 119 Mangistau Oblast 98,6 0,8 0,0 0,0 0,6 100,0 99,4 99 Pavlodar Oblast 98,1 1,0 0,0 0,0 0,9 100,0 99,1 82 North Kazakhstan Oblast 84,9 15,1 0,0 0,0 0,0 100,0 100,0 46 South Kazakhstan Oblast 59,4 38,0 2,4 0,0 0,2 100,0 99,8 436 Residence Urban 91,9 7,0 0,1 0,0 1,0 100,0 99,0 983 Rural 73,5 23,4 1,1 1,4 0,6 100,0 99,4 1011 Mother’s Age at Birth Less than 20 83,9 9,2 3,3 0,8 2,9 100,0 97,1 97 20-34 82,8 15,9 0,3 0,5 0,5 100,0 99,5 1552 35-49 80,5 14,8 1,5 1,5 1,7 100,0 98,3 281 Education Incomplete Secondary (58,5) (29,2) 0,0 0,0 (12,3) 100,0 (87,7) 32 Secondary 73,8 22,6 1,0 1,5 1,1 100,0 98,9 698 Specialized Secondary 85,4 13,1 0,8 0,5 0,1 100,0 99,9 565 Higher 90,2 9,3 0,0 0,1 0,4 100,0 99,6 695 Wealth Index Quintile Poorest 62,7 31,6 2,5 1,9 1,2 100 98,8 463 Second 79,5 19,3 0,0 1,1 0,2 100 99,8 443 Middle 88,2 10,6 0,0 0,0 1,2 100 98,8 406 Fourth 93,4 5,9 0,0 0,0 0,7 100 99,3 330 Richest 95,9 3,3 0,0 0,0 0,8 100 99,2 352 Ethnicity/language of Household Head Kazakh 81,7 16,3 0,7 0,7 0,6 100,0 99,4 1413 Russian 94,9 4,1 0,0 0,3 0,7 100,0 99,3 322 Other ethnic groups 72,0 23,7 0,8 1,0 2,5 100,0 97,5 259 Total 82,6 15,3 0,6 0,7 0,8 100,0 99,2 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.5a; MDG Indicator 5.5 ( ) – indicators are based on 25-49 cases of unweighted observations 120 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN UNICEF and WHO recommend a minimum of at least four antenatal care visits during pregnancy. Table RH.7 shows number of antenatal care visits during the last pregnancy during the two years preceding the survey, regardless of provider by selected characteris- tics. In Kazakhstan, 87 percent of mothers had more than four antenatal care visits and only 1.1 percent of women received antenatal care three times. Less than 1 percent of women paid one or two antenatal care vis- its to a healthcare facility (officer). Women in Kostanai Oblast visited a healthcare facility (officer) most of all (97.7 percent), while residents of Astana receive ante- natal care least often (62.4 percent). Mothers with incomplete secondary education (77.9 percent) and those from middle income and poor- est households (87.3 and 87.7 percent respectively) are less likely to receive ANC four or more times. At the same time, not all women from richest households have four or more antenatal care visits, with only 82.5 percent of women reporting such visits. Table RH.7: Number of antenatal care visits Percentage of women who had a live birth during the two years preceding the survey by number of antenatal care visits, Kazakhstan, 2010/11 Frequency of ANC visits To ta l Number of women who gave birth in two years preceding survey N o an te - na ta l c ar e vi si ts O ne v is it Tw o vi si ts Th re e vi si ts 4 or m or e vi si ts 1 D K Регион Akmola Oblast 3,6 0,0 0,0 1,2 92,9 2,3 100 68 Aktobe Oblast 0,0 0,0 0,0 0,0 91,9 8,1 100 115 Almaty Oblast 0,9 0,0 0,0 0,0 84,7 14,4 100 194 Almaty city (4,4) 0,0 (2,1) (4,4) (84,9) (4,2) 100 68 Astana city 1,0 1,0 3,2 2,6 62,4 29,9 100 72 Atyrau Oblast 0,0 0,0 0,0 0,6 70,9 28,5 100 77 East Kazakhstan Oblast 1,1 0,9 2,7 1,0 87,0 7,4 100 143 Zhambyl Oblast 0,7 0,0 0,0 0,7 96,8 1,8 100 166 West Kazakhstan Oblast 0,0 0,0 1,1 0,9 91,1 7,0 100 75 Karaganda Oblast 0,9 0,0 1,1 2,6 95,4 0,0 100 148 Kostanai Oblast 1,2 0,0 0,0 0,0 97,7 1,1 100 86 Kyzylorda Oblast 1,2 0,7 0,5 0,4 95,4 1,7 100 119 Mangistau Oblast 0,6 0,0 2,3 2,6 88,9 5,6 100 99 Pavlodar Oblast 0,9 1,2 0,0 0,0 71,4 26,5 100 82 North Kazakhstan Oblast 0,0 0,0 0,0 0,0 87,7 12,3 100 46 South Kazakhstan Oblast 0,2 0,0 0,0 1,4 83,7 14,6 100 436 Residence Urban 1,0 0,2 0,6 0,8 85,5 11,8 100 983 Rural 0,6 0,2 0,7 1,4 88,4 8,6 100 1011 Mother’s Age at Birth Less than 20 2,9 0,0 0,5 1,9 74,9 19,9 100 97 20-34 0,6 0,2 0,7 1,1 87,5 9,9 100 1616 35-49 1,7 0,0 0,3 1,2 88,3 8,5 100 281 Education Incomplete secondary (12,3) (0,0) (0,0) (1,4) (77,9) (8,5) 100 32 Secondary 1,1 0,3 0,8 1,9 86,5 9,4 100 698 Specialized secondary 0,1 0,3 0,9 1,2 88,6 8,9 100 565 Higher 0,4 0,0 0,3 0,3 86,6 12,3 100 695 Wealth Index Quintile Poorest 1,2 0,0 0,8 0,3 87,7 9,9 100 463 Poor 0,2 0,5 0,9 1,1 87,8 9,5 100 443 Middle 1,2 0,2 0,4 2,6 87,3 8,3 100 406 Rich 0,7 0,0 1,0 0,3 89,3 8,6 100 330 Richest 0,8 0,3 0,1 1,2 82,5 15,1 100 352 121MONITORING THE SITUATION OF CHILDREN AND WOMEN Frequency of ANC visits To ta l Number of women who gave birth in two years preceding survey N o an te - na ta l c ar e vi si ts O ne v is it Tw o vi si ts Th re e vi si ts 4 or m or e vi si ts 1 D K Ethnicity household head Kazakh 0,6 0,2 0,8 1,0 87,3 10,1 100 1413 Russian 0,7 0,0 0,0 0,6 85,9 12,8 100 322 Other ethnic groups 2,5 0,3 0,6 2,5 86,5 7,7 100 259 Total 0,8 0,2 0,7 1,1 87,0 10,2 100 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.5b; MDG Indicator 5.5 ( ) – indicators are based on 25-49 cases of unweighted observations and 99.0 percent reported that urine specimen was taken. The fullest coverage with diagnostic services as part of antenatal care is found in Aktobe, Atyrau, West Kazakhstan and North Kazakhstan Oblasts (100 percent), while the minimum coverage is observed in Almaty (93.5 percent). In rural and urban areas antenatal coverage is approximately the same (99 percent). The types of services pregnant women received are shown in Table RH.8. In Kazakhstan, almost all women receive the minimum scope of antenatal care services. Thus, among those women who have given birth to a child during the two years preceding the survey, 99.0 percent reported that a blood sam- ple was taken during antenatal care visits, 98.9 per- cent reported that their blood pressure was checked Table RH.8: Content of antenatal care Percentage of women age 15-49 years who had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, Kazakhstan, 2010/11, Percent of pregnant women receiving types of ANC services Blood pressure measured, urine specimen and blood test taken1 Number of women who gave birth in two years preceding surveyBlood pressure measured Urine specimen taken Blood test taken Region Akmola Oblast 95,2 96,4 96,4 95,2 68 Aktobe Oblast 100,0 100,0 100,0 100,0 115 Almaty Oblast 99,1 99,1 99,1 99,1 194 Almaty city (93,5) (93,5) (93,5) (93,5) 68 Astana city 99,0 99,0 99,0 99,0 72 Atyrau Oblast 100,0 100,0 100,0 100,0 77 East Kazakhstan Oblast 97,9 97,9 97,9 97,9 143 Zhambyl Oblast 99,3 99,3 99,3 99,3 166 West Kazakhstan Oblast 100,0 100,0 100,0 100,0 75 Karaganda Oblast 99,1 99,1 99,1 99,1 148 Kostanai Oblast 97,7 98,8 98,8 97,7 86 Kyzylorda Oblast 98,8 98,8 98,8 98,8 119 Mangistau Oblast 99,4 99,4 99,4 99,4 99 Pavlodar Oblast 99,1 99,1 99,1 99,1 82 North Kazakhstan Oblast 100,0 100,0 100,0 100,0 46 South Kazakhstan Oblast 99,8 99,8 99,8 99,8 436 Residence Urban 98,7 98,8 98,8 98,7 983 Rural 99,1 99,2 99,2 99,1 1011 122 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of pregnant women receiving types of ANC services Blood pressure measured, urine specimen and blood test taken1 Number of women who gave birth in two years preceding surveyBlood pressure measured Urine specimen taken Blood test taken Mother’s Age at Birth Less than 20 96,3 97,1 97,1 96,3 97 20-34 99,2 99,2 99,2 99,2 1616 35-49 98,3 98,3 98,3 98,3 281 Education Incomplete secondary (87,7) (87,7) (87,7) (87,7) 32 Secondary 98,5 98,5 98,5 98,5 698 Specialized secondary 99,5 99,9 99,9 99,5 565 Higher 99,6 99,6 99,6 99,6 695 Wealth Index Quintile Poorest 98,4 98,4 98,4 98,4 463 Second 99,8 99,8 99,8 99,8 443 Middle 98,4 98,8 98,8 98,4 406 Fourth 98,8 98,8 98,8 98,8 330 Richest 99,2 99,2 99,2 99,2 352 Ethnicity of Household Head Kazakh 99,3 99,3 99,3 99,3 1413 Russian 99,1 99,3 99,3 99,1 322 Other ethnic groups 97,0 97,0 97,0 97,0 259 Total 98,9 99,0 99,0 98,9 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.6 ( ) – indicators are based on 25-49 cases of unweighted observations Assistance at Delivery Three quarters of all maternal deaths occur dur- ing delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium De- velopment target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to as- sess the proportion of births attended by a skilled at- tendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. 123MONITORING THE SITUATION OF CHILDREN AND WOMEN In Kazakhstan, all births (100 percent) occurring in the two years preceding the MICS survey were deliv- ered by skilled personnel (Table RH.9). This indicator was also 100 percent in all regions of the country. The level of educational attainment and wealth does not af- fect women’s access to skilled attendance at delivery; absolutely all women are attended by healthcare pro- fessionals at delivery. Only 17.8 percent of the births in the two years preceding the MICS survey were delivered with assis- tance by a midwife or a nurse. Doctors assisted with the delivery of 81.7 percent of births, and feldshers and auxiliary midwives assisted with 0.4 percent. Doctors were more likely to assist with the delivery in Atyrau, East Kazakhstan, North Kazakhstan, Akmola, Man- gistau Oblasts and Astana city (91.0 to 99.0 percent) and less likely in Kyzylorda Oblast (64.1 percent). Ac- cordingly, midwives and nurses were more likely to as- sist with the delivery in Kyzylorda and South Kazakh- stan Oblasts (35.9 percent and 29.0 percent respec- tively) and less likely in Mangistau Oblast (1.0 percent) and Astana city (2.8 percent). Regardless of the level of education and wealth quintile practically all women are provided with qualified medical assistance during delivery. In Kazakhstan, 15.9 percent of all births are de- livered by Caesarean section. This method of delivery slightly prevails in urban over rural areas; it is more often used for women in the age group 35-49 and on women with secondary specialized and higher edu- cation as well as those living in the richest and fourth quintile households. The largest share of births deliv- ered by Caesarean section is in Akmola (27.8 percent), East-Kazakhstan (23.8 percent), Karaganda (22.3 per- cent), Pavlodar (22.8 percent) and Kostanai (20.5 per- cent) Oblasts. Table RH.9: Assistance during delivery Percentage of women who had a birth in the two years preceding the survey by person assisting at delivery and percentage of births delivered by C-section, Kazakhstan, 2010/11 Person assisting at delivery Total Any skilled personnel1 Percent delivered by C-section2 Number of women who gave birth in preceding two yearsD oc to r N ur se /M id w ife A ux ili ar y m id w ife Tr ad iti on al bi rth a tte nd an t Fe ld sh er R el at iv e /F rie nd Region Akmola Oblast 91,6 8,4 0,0 0,0 0,0 0,0 100,0 100,0 27,8 68 Aktobe Oblast 74,4 23,3 1,4 0,0 0,9 0,0 100,0 100,0 16,2 115 Almaty Oblast 83,4 15,9 0,8 0,0 0,0 0,0 100,0 100,0 12,0 194 Almaty city (84,5) (15,5) 0,0 0,0 0,0 0,0 100,0 100,0 (6,8) 68 Astana city 97,2 2,8 0,0 0,0 0,0 0,0 100,0 100,0 15,6 72 Atyrau Oblast 94,5 5,5 0,0 0,0 0,0 0,0 100,0 100,0 13,2 77 East Kazakhstan Oblast 92,3 7,7 0,0 0,0 0,0 0,0 100,0 100,0 23,8 143 Zhambyl Oblast 76,3 21,1 1,2 1,4 0,0 0,0 100,0 98,6 15,8 166 West Kazakhstan Oblast 77,7 22,3 0,0 0,0 0,0 0,0 100,0 100,0 19,5 75 Karaganda Oblast 88,7 10,8 0,0 0,0 0,0 0,5 100,0 99,5 22,3 148 Kostanai Oblast 83,1 16,9 0,0 0,0 0,0 0,0 100,0 100,0 20,5 86 Kyzylorda Oblast 64,1 35,9 0,0 0,0 0,0 0,0 100,0 100,0 11,4 119 Mangistau Oblast 99,0 1,0 0,0 0,0 0,0 0,0 100,0 100,0 8,8 99 Pavlodar Oblast 89,7 10,3 0,0 0,0 0,0 0,0 100,0 100,0 22,8 82 North Kazakhstan Oblast 93,1 6,9 0,0 0,0 0,0 0,0 100,0 100,0 13,4 46 South Kazakhstan Oblast 71,0 29,0 0,0 0,0 0,0 0,0 100,0 100,0 13,0 436 Residence Urban 86,2 13,3 0,1 0,2 0,0 0,1 100,0 99,7 16,9 983 Rural 77,4 22,2 0,4 0,0 0,1 0,0 100,0 100,0 14,8 1011 Mother’s Age at Birth Less than 20 72,3 26,6 1,0 0,0 0,0 0,0 100,0 100,0 15,6 97 20-34 81,8 17,8 0,2 0,1 0,1 0,0 100,0 99,8 15,1 1616 124 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Person assisting at delivery Total Any skilled personnel1 Percent delivered by C-section2 Number of women who gave birth in preceding two yearsD oc to r N ur se /M id w ife A ux ili ar y m id w ife Tr ad iti on al bi rth a tte nd an t Fe ld sh er R el at iv e /F rie nd 35-49 84,5 15,0 0,5 0,0 0,0 0,0 100,0 100,0 20,5 281 Place of Delivery Public sector health facility 81,9 17,8 0,3 0,0 0,1 0,0 100,0 100,0 15,8 1978 Private sector health facility (*) (*) (*) (*) (*) (*) 100,0 100,0 (*) 7 Home (*) (*) (*) (*) (*) (*) 100,0 61,9 (*) 8 Education Incomplete secondary (91,3) (8,7) (0,0) (0,0) (0,0) (0,0) 100,0 100,0 (18,9) 32 Secondary 76,4 23,2 0,3 0,0 0,2 0,0 100,0 100,0 14,0 698 Specialized secondary 81,6 18,0 0,3 0,0 0,0 0,1 100,0 99,9 18,4 565 Higher 87,0 12,8 0,2 0,0 0,0 0,0 100,0 100,0 15,6 695 Wealth Index Quintile Poorest 72,8 26,3 0,4 0,0 0,5 0,0 100,0 99,5 15,1 463 Second 78,7 20,5 0,6 0,2 0,0 0,0 100,0 100,0 13,9 443 Middle 83,4 16,4 0,0 0,0 0,0 0,2 100,0 99,8 14,7 406 Fourth 85,8 14,2 0,0 0,0 0,0 0,0 100,0 100,0 17,7 330 Richest 91,5 8,3 0,2 0,0 0,0 0,0 100,0 100,0 18,9 352 Ethnicity of Household Head Kazakh 81,7 17,8 0,4 0,0 0,1 0,0 100,0 100,0 15,2 1413 Russian 87,6 12,4 0,0 0,0 0,0 0,0 100,0 100,0 18,5 322 Other ethnic groups 74,3 24,5 0,0 0,9 0,0 0,3 100,0 98,9 16,4 259 Total 81,7 17,8 0,3 0,1 0,1 0,0 100,0 99,9 15,9 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.7; MDG Indicator 5.2 2 MICS Indicator 5.9 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Place of Delivery Increasing the proportion of births that are deliv- ered in health facilities is an important factor in reduc- ing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions dur- ing delivery can reduce the risks of complications and infection that can cause morbidity and mortality to ei- ther the mother or the baby. Table RH.10 presents the percent distribution of women age 15-49 who had a live birth in the two years preceding the survey. The table provides breakdown of information by place of delivery and the percentage of births delivered in a health facil- ity, according to background characteristics. Almost all (99.6 percent) of births in Kazakhstan are delivered in a health facility; 99.2 percent of deliv- eries occur in public sector facilities and 0.4 percent occur in private sector facilities while 0.4 percent of births occur at home. By age, 99.5 percent of women aged 20-34 prefer to deliver in a health facility. There were no significant differences between women in ur- ban and rural areas and in terms of regions. There is no significant correlation between the place of delivery and level of educational attainment. No significant cor- relation is also found between the wealth quintile and ethnic background. 125MONITORING THE SITUATION OF CHILDREN AND WOMEN Table RH.10: Place of delivery Percentage of women with a birth in 2 years preceding the survey by place of delivery, Kazakhstan, 2010/11 Place of delivery Total Delivered in health facility 1 Number of women, who gave birth in 2 years preceding the survey Public sector health facility Private sector health facility Home Region Akmola Oblast 100,0 0,0 0,0 100,0 100,0 68 Aktobe Oblast 100,0 0,0 0,0 100,0 100,0 115 Almaty Oblast 99,2 0,8 0,0 100,0 100,0 194 Almaty city (100,0) (0,0) (0,0) 100,0 (100,0) 68 Astana city 98,9 1,1 0,0 100,0 100,0 72 Atyrau Oblast 99,3 0,0 0,7 100,0 99,3 77 East Kazakhstan Oblast 99,1 0,0 0,9 100,0 99,1 143 Zhambyl Oblast 97,4 1,2 1,4 100,0 98,6 166 West Kazakhstan Oblast 100,0 0,0 0,0 100,0 100,0 75 Karaganda Oblast 98,5 1,0 0,5 100,0 99,5 148 Kostanai Oblast 98,7 0,0 1,3 100,0 98,7 86 Kyzylorda Oblast 100,0 0,0 0,0 100,0 100,0 119 Mangistau Oblast 100,0 0,0 0,0 100,0 100,0 99 Pavlodar Oblast 98,1 1,9 0,0 100,0 100,0 82 North Kazakhstan Oblast 100,0 0,0 0,0 100,0 100,0 46 South Kazakhstan Oblast 99,6 0,0 0,4 100,0 99,6 436 Residence Urban 99,0 0,7 0,3 100,0 99,7 983 Rural 99,4 0,1 0,5 100,0 99,5 1011 Mother’s Age at Birth less than 20 100,0 0,0 0,0 100,0 100,0 97 20-34 99,1 0,4 0,5 100,0 99,5 1616 35-49 99,6 0,4 0,0 100,0 100,0 281 Number of Antenatal Care Visits None (*) (*) (*) (*) (*) 17 1-3 visits (98,1) (1,9) (0,0) (100,0) (100,0) 39 4+ visits 99,2 0,4 0,4 100,0 99,6 1734 Education Incomplete Secondary (100,0) (0,0) (0,0) (100,0) (100,0) 32 Secondary 99,4 0,0 0,6 100,0 99,4 698 Specialized Secondary 99,3 0,4 0,2 100,0 99,8 565 Higher 99,3 0,7 0,0 100,0 100,0 695 Wealth Index Quintile Poorest 98,6 0,0 1,4 100,0 98,6 463 Second 99,9 0,0 0,1 100,0 99,9 443 Middle 99,3 0,5 0,2 100,0 99,8 406 Fourth 99,0 1,0 0,0 100,0 100,0 330 Richest 99,4 0,6 0,0 100,0 100,0 352 Ethnicity/language of Household Head Kazakh 99,4 0,3 0,3 100,0 99,7 1413 Russian 99,3 0,7 0,0 100,0 100,0 322 Other ethnic groups 98,1 0,3 1,6 100,0 98,4 259 Total 99,2 0,4 0,4 100,0 99,6 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 5.8 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations 126 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Abortions asked whether they had ever had a pregnancy which had resulted in a miscarriage, stillbirth or abortion and in the case they had, many were asked how many pregnancies resulted in a miscarriage, stillbirth or abortion. In addition to this more detailed infor- mation was gathered in regard to induced abortions performed in the past 2 years, including data on the stage of pregnancy when it was terminated as well as the month and year of abortion. Table RH.10A presents data on the average number of live births and pregnancies wasted per woman at the age 15-49. The average number of in- complete pregnancies per woman is 0.4 pregnancies. UNFPA in Kazakhstan believes that abortions are a serious issue impacting both women’s and children’s survival and health. Due to this, additional questions on abortions have been included for the first time in this survey. The module on abortions is not a standard MICS module therefore DHS ques- tionnaires were used to obtain the required abortion indicators. Questionnaire for Individual Women in the MICS survey for Kazakhstan included an additional list of questions regarding incomplete pregnancies (miscarriages, stillbirths and abortions). These data were collected for women aged 15-49. Women were Table RH.10A: Lifetime experience with wasted pregnancies Number of live births and wasted pregnancies in average per a woman in age group of women 15-49 by background characteristics, Kazakhstan, 2010/11 Live Births Wasted Pregnancies Number of Women Age 15 – 19 0,0 0,0 2022 20 – 24 0,5 0,1 2178 25 – 29 1,3 0,2 2016 30 – 34 2,0 0,5 2005 35 - 39 2,4 0,6 1901 40 - 44 2,5 0,7 1919 45 - 49 2,6 0,8 1972 Residence Urban 1,3 0,4 8055 Rural 2,0 0,4 5959 Region Akmola Oblast 1,6 0,6 603 Aktobe Oblast 1,5 0,2 694 Almaty Oblast 1,5 0,4 1518 Almaty city 0,9 0,1 1190 Astana city 1,2 0,1 539 Atyrau Oblast 1,7 0,2 409 East Kazakhstan Oblast 1,4 0,5 1210 Zhambyl Oblast 1,9 0,4 836 West Kazakhstan Oblast 1,5 0,4 566 Karaganda Oblast 1,5 0,7 1274 Kostanai Oblast 1,4 0,7 791 Kyzylorda Oblast 2,1 0,3 553 Mangistau Oblast 1,7 0,1 461 Pavlodar Oblast 1,3 0,7 746 North Kazakhstan Oblast 1,4 0,7 577 South Kazakhstan Oblast 2,3 0,2 2048 Education Incomplete Secondary 1,3 0,3 553 Secondary 1,9 0,4 4407 Specialized Secondary 1,7 0,5 4539 Higher 1,2 0,3 4489 127MONITORING THE SITUATION OF CHILDREN AND WOMEN Live Births Wasted Pregnancies Number of Women Wealth Index Quintile Poorest 2,2 0,3 2528 Second 1,9 0,4 2599 Middle 1,6 0,4 2743 Fourth 1,3 0,5 2839 Richest 1,2 0,4 3305 Total 1,6 0,4 14014 ‘No education’ category has been excluded due to insignificant number of responses Table RH.10B presents age specific abortion rates, general abortion rates (GAR) and crude abortion rates (CAR). All abortion rates refer to the two year pe- riod preceding the survey. Age specific abortion rates denote the number of abortions per 1,000 women from specific age group. Crude abortion rate (CAR) re-cal- culated for every woman is a summary indicator com- bining age-specific abortion rates. CAR is interpreted as the indicator of the number of abortions which could be accounted for every woman during her lifetime pro- vided that current age-specific abortion rates remained the same throughout her childbearing period. General abortion rate (GAR) is the number of abortions per 1000 women aged 15-49. Age specific abortion rates increase after the age of 19 and remain approximately at the same level in the age groups 20-24, 25-29 and 30-34. There is no statistically significant larger number of induced abortions per 1000 women in rural areas. Total abortion rate in Kazakhstan is 0.26 abortions per woman. General abortion rate is 6.9 abortions per 1,000 women. RH.10B Induced abortion rates by residence Age-specific abortion rates (per 1000 women), total abortion rates (TAR) and general abortion rates (GAR) for the two year period preceding the survey, Kazakhstan, 2010/11 Area Total Urban Rural Age 15-19 1 1 1 20-24 11 12 11 25-29 14 15 14 30-34 10 15 12 35-39 11 7 9 40-44 4 5 4 45-49 0 0 0 TAR 15-49 0.26 0.27 0.26 GAR 6.4 7.6 6.9 * Age-specific abortion rate stands for the number of abortions per 1000 women from the five-year-age-group. * Total abortion rate (TAR) expressed in the re-calculation for one woman is an independent indicator combining age specific abortion rates. * General abortion rate (GAR) is the number of abortions per 1000 women aged 15-49. 128 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN RH.10C Induced abortion rates by background characteristics Total induced abortion rates for the two years preceding the survey among women age 15-49, Kazakhstan, 2010/11 Total abortion rate (TAR) Residence Urban 0.26 Rural 0.27 Education Incomplete secondary 0.29 Secondary 0.28 Specialized secondary 0.36 Higher 0.19 Wealth Index Quintile Poorest 60 % 0.26 Richest 40 % 0.27 Total 0.26 Table RH.10C presents total rates of induced abor- tions (TAR) by main characteristics. There are no signifi- cant variations in abortion rates in regard to the place of residence (urban or rural) and level of education. ceding the survey, by the place of abortion and main background characteristics. About 75.2 percent of in- duced abortions in Kazakhstan were performed in pub- lic hospitals/maternity homes, 6.2 percent – in public polyclinics/ambulatories and 6.7 percent in public women’s consultations. In regard to private institutions, in 5.2 percent of cases the abortion were performed in private hospitals and in 2.5 percent of cases – in private polyclinics. Only 1 percent of women reported having had an abortion at home. The place of abortion plays an important role during the performance of an induced abortion. Hav- ing special tools does not always guarantee success- ful results, though it is important to have appropriate technology and equipment in case of emergency re- suscitation related to abortion complications such as perforation of the uterus, hemorrhage, anaphylactic shock, etc. Table RH.10D presents the data on percent distribution of induced abortions in the 2 years pre- Table RH.10D: Place of abortion Percent distribution of last induced abortions in the two years prior to the survey by the place of abortion by background variables, Kazakhstan, 2010/11 Place of abortion To ta l N um be r o f l as t a bo rti on s in th e tw o ye ar s pr ec ed in g th e su rv ey Public Private Home O th er H os pi ta l/M at er ni ty H om e P ol yc lin ic /A m bu la to ry W om an ’s C on su lta tio n Fa m ily P la nn in g C en te r M ed ic al D ia gn os tic C en te r FA P /R ur al H ea lth P os t O th er P ub lic H os pi ta l/M at er ni ty H om e P ol yc lin ic /A m bu la to ry W om en ’s C on su lta tio n Fa m ily P la nn in g C en te r M ed ic al D ia gn os tic C en te r FA P /R ur al H ea lth P os t N G O O th er P riv at e M ed . Yo ur H om e O th er H om e Area Urban 72,9 5,0 7,5 0,6 1,1 0,0 0,5 5,7 2,4 0,0 1,0 0,8 0,0 0,0 1,0 1,6 0,0 0,0 100,0 127 Rural 78,4 7,8 3,8 0,0 0,0 0,0 0,0 4,4 2,6 1,1 1,0 0,0 0,0 0,0 0,9 0,0 0,0 0,0 100,0 89 Education Secondary incomplete (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 100,0 5 Secondary 76,5 7,5 6,5 0,0 0,0 0,0 0,0 4,4 2,4 1,4 0,0 0,0 0,0 0,0 1,2 0,0 0,0 0,0 100,0 68 129MONITORING THE SITUATION OF CHILDREN AND WOMEN Place of abortion To ta l N um be r o f l as t a bo rti on s in th e tw o ye ar s pr ec ed in g th e su rv ey Public Private Home O th er H os pi ta l/M at er ni ty H om e P ol yc lin ic /A m bu la to ry W om an ’s C on su lta tio n Fa m ily P la nn in g C en te r M ed ic al D ia gn os tic C en te r FA P /R ur al H ea lth P os t O th er P ub lic H os pi ta l/M at er ni ty H om e P ol yc lin ic /A m bu la to ry W om en ’s C on su lta tio n Fa m ily P la nn in g C en te r M ed ic al D ia gn os tic C en te r FA P /R ur al H ea lth P os t N G O O th er P riv at e M ed . Yo ur H om e O th er H om e Secondary specialised 71,1 7,2 6,8 0,0 0,0 0,0 0,7 7,9 2,5 0,0 1,4 0,0 0,0 0,0 0,0 2,4 0,0 0,0 100,0 86 High 77,7 3,6 4,5 1,3 2,5 0,0 0,0 2,4 2,6 0,0 1,5 1,7 0,0 0,0 2,2 0,0 0,0 0,0 100,0 57 Wealth Poorest 60% 76,5 8,3 5,3 0,0 0,0 0,0 0,0 5,5 2,0 0,9 0,8 0,0 0,0 0,0 0,7 0,0 0,0 0,0 100,0 113 Richest 40% 73,7 3,8 6,7 0,7 1,4 0,0 0,6 4,9 2,9 0,0 1,2 0,9 0,0 0,0 1,2 2,0 0,0 0,0 100,0 103 Total 75,2 6,2 6,0 0,3 0,6 0,0 0,3 5,2 2,5 0,5 1,0 0,5 0,0 0,0 1,0 1,0 0,0 0,0 100,0 216 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations Urban women more often take independent de- cisions on having an abortion (40.8 percent) whereas rural women more often listen to doctor’s/health work- er’s advice (35.3 percent) and only in 30.9 percent of the cases women from rural areas take this decision independently. Women from the richest households more often take an independent decision on having an abortion (41 percent) while women from the poorest households more often tend to agree with the doctor and health worker. Table RH.10E ‘Person that had the final say on taking the abortion decision’ presents the data on per- cent distribution of last induced abortions in the two years preceding the survey. In Kazakhstan, in 36.7 percent of cases, woman takes the decision regarding having an abortion by herself, while every third woman (31.2 percent) is influenced by the decision of doctor/ health worker and every fourth respondent (26.3 per- cent) takes this decision together with her husband or partner. Table RH.10E: Person that had the final say on taking the abortion decision Percent distribution of last induced abortions in the two years prior to the survey by the person that had the final say on taking the abortion decision by background variables, Kazakhstan, 2010/11 Person with the final say on taking the abortion decision To ta l Number of last abortions in the two years preceding the surveyD oc to r / H ea lth W or ke r R es po nd en t H us ba nd / P ar tn er R es po nd en t & h us ba nd / pa rtn er jo in tly S om eo ne e ls e R es po nd en t & so m eo ne e ls e jo in tly R el at iv e O th er Area Urban 28,3 40,8 3,8 25,6 0,8 0,0 0,0 0,8 100,0 127 Rural 35,3 30,9 6,5 27,3 0,0 0,0 0,0 0,0 100,0 89 Education Secondary incomplete (*) (*) (*) (*) (*) (*) (*) (*) 100,0 5 Secondary 35,5 37,9 4,3 22,3 0,0 0,0 0,0 0,0 100,0 68 Secondary specialised 23,6 38,2 7,1 30,1 0,0 0,0 0,0 1,1 100,0 86 High 36,0 33,6 2,9 25,9 1,7 0,0 0,0 0,0 100,0 57 Wealth Poorest 60% 33,4 32,9 7,5 26,2 0,0 0,0 0,0 0,0 100,0 113 Richest 40% 28,7 41,0 2,1 26,4 0,9 0,0 0,0 0,9 100,0 103 Total 31,2 36,7 4,9 26,3 0,4 0,0 0,0 0,4 100,0 216 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations 130 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table RH.10F: Person assisting abortion Percent distribution of last induced abortions in the two years prior to the survey by person assisting abortion by background variables, Kazakhstan, 2010/11 Person Assisting the Abortion Total Number of last abortions in the two years preceding the surveyD oc to r N ur se /M id w ife Tr ad iti on al B irt h A tte nd an t R el at iv e/ fr ie nd N o on e O th er Area Urban 90,5 7,8 0,0 0,0 0,3 1,3 100,0 127 Rural 90,3 9,7 0,0 0,0 0,0 0,0 100,0 89 Education Secondary incomplete (*) (*) (*) (*) (*) (*) 100,0 5 Secondary 87,5 12,5 0,0 0,0 0,0 0,0 100,0 68 Secondary specialised 91,3 6,3 0,0 0,0 0,5 1,9 100,0 86 High 91,9 8,1 0,0 0,0 0,0 0,0 100,0 57 Wealth Poorest 60% 93,2 6,8 0,0 0,0 0,0 0,0 100,0 113 Richest 40% 87,5 10,5 0,0 0,0 0,4 1,6 100,0 103 Total 90,4 8,6 0,0 0,0 0,2 0,8 100,0 216 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations In regard to the individuals who performed abortions (Table RH.10F), 90.4 percent of surveyed women reported that their pregnancy had been ter- minated by doctor while 8.6 percent of women noted that their pregnancy had been terminated by nurse/ midwife and in 0.8 percent of the cases the abortion had been performed by another individual. In the ma- jority of cases both in urban and rural areas abortion was performed by doctor (90.5 and 90.3 percent re- spectively). 131MONITORING THE SITUATION OF CHILDREN AND WOMEN IX. Child Development 132 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Attendance in pre-school education in an orga- nized learning or child education programme is impor- tant for the readiness of children to school. In Kazakhstan, 37 percent of children aged 36-59 months were attending organised early child- hood learning programmes (Table CD.1). Urban- rural and regional differences are very significant – the figure is as high as 45.3 percent in urban areas, compared to 29.4 percent in rural areas. Among children aged 36-59 months, attendance of early childhood learning programmes is more prevalent in Kostanai, West Kazakhstan, Pavlodar, Kara- ganda and North Kazakhstan Oblasts (from 56.8 to 69.4 percent) and lowest in Almaty, South Kazakh- stan and Mangistau Oblasts (15.1, 17.4 and 18.1 percent respectively). Differences in gender do not exist, but differ- ences by socioeconomic status are significant. About 52.4 and 60.5 percent of children living in the fourth and richest quintile households respectively attend learning programmes, while the figure drops to 29.4. and 18.7 percent in second and poorest quintile house- holds. It is interesting to note that the proportion of chil- dren attending early childhood learning programmes at the age 36-47 months is lower than at the ages 48-59 months, 32.4 and 41.7 percent respectively. Early Childhood Education and Learning Table CD.1: Early childhood education Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme, Kazakhstan, 2010/11 Percentage of children aged 36-59 months currently attending early childhood education1 Number of children aged 36-59 months Sex Male 35,9 1046 Female 38,1 937 Region Akmola Oblast 37,9 72 Aktobe Oblast 39,5 95 Almaty Oblast 15,1 230 Almaty city 47,6 78 Astana city 42,9 66 Atyrau Oblast 50,4 62 East Kazakhstan Oblast 53,8 147 Zhambyl Oblast 33,2 151 West Kazakhstan Oblast 59,3 65 Karaganda Oblast 56,9 175 Kostanai Oblast 69,4 82 Kyzylorda Oblast 36,4 114 Mangistau Oblast 18,1 87 Pavlodar Oblast 59,0 82 North Kazakhstan Oblast 56,8 61 South Kazakhstan Oblast 17,4 418 Residence Urban 45,3 946 Rural 29,4 1037 Age of Child 36-47 months 32,4 1005 48-59 months 41,7 978 Mother’s Education Incomplete Secondary (26,6) 35 Secondary 24,0 787 Specialized Secondary 40,8 531 133MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of children aged 36-59 months currently attending early childhood education1 Number of children aged 36-59 months Higher 50,7 627 Wealth Index Quintile Poorest 18,7 487 Second 29,4 419 Middle 33,9 401 Fourth 52,4 330 Richest 60,5 348 Ethnicity of Household Head Kazakh 35,9 1412 Russian 51,2 296 Other ethnic groups 27,0 275 Total 37,0 1983 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 6.7 ( ) – indicators are based on 25-49 cases of unweighted observations was only 49.1 percent. Only 14.1 percent of children were living in a household without their biological fa- thers. In most cases, children in these households re- ceived no support for learning. It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this con- text, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. Children should be physically healthy, mentally alert, emotion- ally secure, socially competent and ready to learn. Information on a number of activities that sup- port early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with chil- dren, and spending time with children naming, count- ing, or drawing things. In Kazakhstan, in the three days preceding the survey, 91.5 percent of under-5 children were en- gaged in more than four activities promoting learning and school readiness by an adult household member (Table CD.2). The average number of activities that adults engaged in with children was 5.3. The table also indicates that the father’s involvement in such activi- ties was somewhat limited. The average number of ac- tivities that fathers engaged with children was only 1.2. Fathers’ involvement in one or more types of activities 134 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CD.2: Support for learning Percentage of children age 36-59 months with whom an adult household member engaged in activities that promote learning and school readiness during the last three days, Kazakhstan, 2010/11 Percentage of children aged 0–59 months Mean number of activities P er ce nt ag e of c hi ld re n no t l iv in g w ith th ei r na tu ra l f at he r N um be r o f c hi ld re n ag ed 0 -5 9 m on th s With whom adult household members engaged in four or more activities1 With whom the father engaged in one or more activities2 Any adult household member engaged with the child the father engaged in with the child Sex Male 91,9 49,3 5,3 1,2 16,0 1046 Female 91,1 48,8 5,3 1,2 11,9 937 Region Akmola Oblast 92,8 57,0 5,5 1,6 15,4 72 Aktobe Oblast 94,5 50,2 5,5 1,4 10,6 95 Almaty Oblast 84,9 54,4 5,0 1,0 10,2 230 Almaty city 100,0 75,6 6,0 2,3 22,5 78 Astana city 99,1 57,8 5,8 1,7 17,5 66 Atyrau Oblast 96,7 30,6 5,6 0,7 10,1 62 East Kazakhstan Oblast 90,9 47,4 5,3 1,5 20,5 147 Zhambyl Oblast 94,2 37,7 5,3 0,9 14,6 151 West Kazakhstan Oblast 99,2 59,9 5,8 1,5 13,3 65 Karaganda Oblast 90,3 50,1 5,3 1,6 22,8 175 Kostanai Oblast 98,1 59,2 5,5 1,3 16,8 82 Kyzylorda Oblast 97,9 50,2 5,7 1,1 12,7 114 Mangistau Oblast 98,8 82,0 5,7 1,9 7,0 87 Pavlodar Oblast 91,1 58,9 5,2 1,5 17,2 82 North Kazakhstan Oblast 95,8 54,7 5,4 1,2 16,2 61 South Kazakhstan Oblast 84,2 31,6 5,0 0,6 9,5 418 Residence Urban 94,0 55,4 5,5 1,5 17,0 946 Rural 89,3 43,3 5,2 1,0 11,4 1037 Age 36-47 months 90,8 46,6 5,3 1,1 14,0 1005 48-59 months 92,3 51,6 5,4 1,3 14,1 978 Mother’s Education Incomplete Secondary (81,9) (41,6) (4,8) (1,0) (13,7) 35 Secondary 87,7 40,2 5,1 0,9 14,1 787 Specialized Secondary 95,8 53,4 5,4 1,4 15,6 531 Higher 93,4 57,2 5,5 1,4 12,6 627 Father’s Education Incomplete Secondary (94,0) (52,6) (5,4) (1,4) n/a 38 Secondary 88,7 50,9 5,2 1,1 n/a 715 Specialized Secondary 91,8 56,5 5,3 1,5 n/a 496 Higher 95,6 65,5 5,6 1,7 n/a 451 135MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of children aged 0–59 months Mean number of activities P er ce nt ag e of c hi ld re n no t l iv in g w ith th ei r na tu ra l f at he r N um be r o f c hi ld re n ag ed 0 -5 9 m on th s With whom adult household members engaged in four or more activities1 With whom the father engaged in one or more activities2 Any adult household member engaged with the child the father engaged in with the child Father is not home 91,7 4,7 5,3 na 100,0 279 Wealth Index Quintile Poorest 84,1 37,5 5,0 0,8 10,8 487 Second 88,8 43,4 5,2 1,0 11,9 419 Middle 95,7 49,7 5,5 1,2 14,4 401 Fourth 95,7 60,2 5,6 1,6 15,7 330 Richest 96,3 60,8 5,7 1,7 19,3 348 Ethnicity of Household Head Kazakh 92,7 48,0 5,4 1,2 12,2 1412 Russian 95,0 53,4 5,5 1,5 25,4 296 Other ethnic groups 81,7 49,8 5,0 1,0 11,4 275 Total 91,5 49,1 5,3 1,2 14,1 1983 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 6.1 2 MICS Indicator 6.2 ( ) – indicators are based on 25-49 cases of unweighted observations the lack of fathers’ attention already in early childhood. The following positive trait may be noted where moth- ers with higher level of education more often engage fathers in joint activities with their children. Exposure to books in early years not only pro- vides the child with greater understanding of the na- ture of print but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. The mother/caretaker of all children under 5 were asked about number of children’s books or picture books they have for the child, house- hold objects or outside objects, and homemade toys or toys that came from a shop that are available at home. In Kazakhstan, only 47.8 percent of children age 0-59 months are living in households where at least 3 children’s books are present. The share of children with 10 or more books was 26 percent. While no signifi- cant gender differences are observed, urban children appear to have more access to children’s books than those living in rural households. The presence of chil- dren’s books depends on the child’s age. In the homes of 60.3 percent of children aged 24–59 months, there are 3 and more books, while the figure is 29.5 percent for children aged 0-23 months. One should mention regions like Kyzylorda, Mangistau, South Kazakhstan and Zhambyl Oblasts, There are no gender differences in terms of adult activities with children. The proportion of fathers engaged in activities with male children is the same as for female children. No differences by socio-economic status were observed. There were some differences by region, with the highest adult engagement in activities with children in Almaty (100 percent). Across other re- gions this indicator ranged from 90 to 99 percent. It must be noted that compared to other regions this in- dicator was relatively low in Almaty and South Kazakh- stan Oblasts where only 84 percent of adult household members were engaged in activities with their children in more than 4 joint activities. Adults living in urban ar- eas in wealthier households and with higher levels of education are more often involved in 4 and more types of joint activities with their children. Fathers’ involvement in the said activities is highest in Mangistau Oblast (82 percent) and Almaty city (75.6 percent); the lowest indicators were reported in Atyrau (30.6 percent) and Zhambyl Oblasts (37.7 percent). In other oblasts their share was approxi- mately the same within 50-59 percent. Percentage of fathers’ participation in the said activities was similar where those with higher levels of education and living in urban area in the wealthier households was higher. Based on this it may be noted that children from the poorest and second quintile households suffer from 136 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN where 2.4 to 6 percent of households reported having 10 or more children’s books, while the figure was 71-80 percent for families in Astana and Almaty. This is partic- ularly true for rural areas, where percentage of children having more than 10 children’s books is almost 3 times lower than that of their urban peers. The existing situ- ation shows that the percentage of children having ten children’s books is quite low among the poorest house- holds and mothers with a low educational level. Among ethnic groups, Kazakhs possess a low percentage of children having ten books compared to other and Rus- sian ethnicity. Table CD.3: Learning materials Percentage of children under 5 by number of books in households and number of toys child plays, Kazakhstan, 2010/11 Children living in households with Child plays with 2 or more types of playthings2 Number of children under 5 3 or more children’s books1 10 or more children’s books Homemade toys Toys that came from a store Objects and materials found outside the home Sex Male 46,8 25,6 20,8 94,5 40,7 44,2 2644 Female 48,9 26,5 18,5 94,8 42,8 45,5 2537 Region Akmola Oblast 68,7 51,3 25,6 94,9 55,3 56,1 189 Aktobe Oblast 57,5 32,0 16,9 90,6 26,6 32,8 260 Almaty Oblast 46,2 14,8 20,3 95,7 73,1 73,7 551 Almaty city 88,4 71,2 32,3 96,3 59,3 63,5 202 Astana city 92,5 80,1 50,1 96,3 54,8 56,6 166 Atyrau Oblast 51,6 19,2 10,6 94,8 18,0 23,9 182 East Kazakhstan Oblast 61,5 38,8 12,3 93,8 32,4 36,1 372 Zhambyl Oblast 36,6 6,2 11,7 92,4 40,9 42,4 400 West Kazakhstan Oblast 54,4 25,2 27,8 93,3 54,9 59,6 195 Karaganda Oblast 66,5 47,2 21,6 96,5 50,9 54,3 420 Kostanai Oblast 84,7 60,2 16,3 96,1 57,4 59,8 222 Kyzylorda Oblast 21,0 2,4 19,8 90,9 43,9 48,8 292 Mangistau Oblast 18,5 3,0 29,8 91,9 29,8 36,8 244 Pavlodar Oblast 74,5 51,4 18,9 98,0 48,0 54,1 217 North Kazakhstan Oblast 71,8 47,0 26,5 93,6 64,3 65,6 139 South Kazakhstan Oblast 17,8 3,0 14,5 95,7 19,1 21,1 1129 Residence Urban 61,1 38,9 20,7 94,9 42,1 45,8 2508 Rural 35,4 13,9 18,6 94,4 41,4 44,0 2673 Age 0-23 months 29,5 16,4 13,5 88,4 29,9 31,8 2101 24-59 months 60,3 32,6 23,8 98,8 49,8 53,8 3080 Mother’s Education Incomplete secondary 37,4 21,0 18,3 90,6 35,2 33,9 96 Secondary 36,8 15,7 17,0 94,0 42,3 44,6 1916 Specialized secondary 50,7 28,9 21,2 94,9 41,0 45,3 1432 Higher 58,5 35,5 21,5 95,3 42,2 45,4 1729 Wealth Index Quintile Poorest 24,2 7,2 16,6 93,6 38,0 39,9 1249 Second 35,0 12,3 18,1 94,5 42,1 44,8 1134 137MONITORING THE SITUATION OF CHILDREN AND WOMEN Children living in households with Child plays with 2 or more types of playthings2 Number of children under 5 3 or more children’s books1 10 or more children’s books Homemade toys Toys that came from a store Objects and materials found outside the home Middle 51,6 25,7 18,4 95,3 41,3 45,1 1015 Fourth 64,9 41,3 22,9 94,4 44,0 47,8 865 Richest 75,6 54,6 24,0 95,5 44,8 48,6 919 Ethnicity of Household Head Kazakh 41,8 19,3 18,9 94,3 39,1 42,5 3724 Russian 80,6 60,2 25,1 96,3 54,1 56,9 785 Other ethnic groups 42,8 23,3 17,5 94,4 42,2 43,8 672 Total 47,8 26,0 19,6 94,6 41,7 44,8 5181 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 6.3 2 MICS Indicator 6.4 Table CD.4 shows that 3.4 percent of children aged 0-59 months were left in the care of other children, while 2 percent were left alone during the week preced- ing the interview. Combining the two care indicators, it is calculated that 4.4 percent of children were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child under 10. No differences were observed by the sex of the child or between urban and rural areas. On the oth- er hand, inadequate care was more prevalent among children whose mothers had a lower education level (10.2 percent), as opposed to children whose moth- ers had higher education (3.3 percent). Children aged 24-59 months were left with inadequate care more (6.2 percent) than those who were aged 0-23 months (1.7 percent). Differences are observed in regard to so- cioeconomic status of the household: inadequate care was reported in 5.0 percent of the poorest households and 4.0 percent of the richest households. Table CD.3 also shows that 44.8 percent of children aged 0-59 months had 2 or more different types of playthings to play with in their homes. The playthings in MICS4 included homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that 94.6 percent of children play with toys that come from a store, 41.7 percent of children play with household objects; however, the percentages for other types of toys are below 20. The proportion of children who have 2 or more different types of playthings to play with is 44.2 percent among male children and 45.5 percent among female children. Insignificant (1.8 percentage points) urban- rural differences are observed in this respect; differ- ences are observed in terms of mother’s education – in households where mother has primary/incomplete secondary education (33.9 percent) and in the poorest households (the gap is 11.5 and 8.7 percentage points respectively) this indicator is very low. In terms of the socioeconomic status of households, the gap between the richest and poorest households was 9.9 percent. Low percentages were recorded in South-Kazakhstan and Atyrau Oblasts (21.1 and 23.9 percent, respective- ly), Aktobe, East Kazakhstan and Mangistau Oblasts (32.8%, 36.1% and 36.8%, respectively). Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS4, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10. 138 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CD.4: Inadequate care Percentage of children under 5 left alone or in the care of other children under 10 for more than 1 hour at least once in the past week, Kazakhstan, 2010/11 Percentage of children under 5 Number of children under 5 Left alone in the past week Left in the care of children under 10 in past week Left with inadequate care in past week1 Sex Male 2,0 3,4 4,4 2644 Female 1,9 3,3 4,4 2537 Region Akmola Oblast 1,0 2,3 2,8 189 Aktobe Oblast 1,9 1,8 2,9 260 Almaty Oblast 0,2 0,5 0,7 551 Almaty city 1,4 2,9 2,9 202 Astana city 2,0 1,1 2,4 166 Atyrau Oblast 2,1 4,2 5,7 182 East Kazakhstan Oblast 2,8 5,3 6,2 372 Zhambyl Oblast 2,8 4,9 5,6 400 West Kazakhstan Oblast 1,2 1,9 3,0 195 Karaganda Oblast 1,7 1,0 2,0 420 Kostanai Oblast 2,9 4,0 6,1 222 Kyzylorda Oblast 1,8 3,9 4,7 292 Mangistau Oblast 8,2 7,9 12,7 244 Pavlodar Oblast 2,7 3,2 4,3 217 North Kazakhstan Oblast 1,8 5,1 6,0 139 South Kazakhstan Oblast 1,2 4,1 4,9 1129 Residence Urban 2,3 3,0 4,2 2508 Rural 1,7 3,7 4,6 2673 Age 0-23 months 1,0 1,0 1,7 2101 24-59 months 2,7 5,0 6,2 3080 Mother’s Education Incomplete Secondary 0,0 10,2 10,2 96 Secondary 1,9 3,9 5,0 1916 Specialized Secondary 2,3 3,4 4,6 1432 Higher 2,0 2,4 3,3 1729 Wealth Index Quintile Poorest 1,6 4,2 5,0 1249 Second 1,2 3,1 4,0 1134 Middle 2,3 3,4 4,4 1015 Fourth 2,6 3,3 4,5 865 Richest 2,5 2,5 4,0 919 Ethnicity of Household Head Kazakh 2,1 3,4 4,5 3724 Russian 1,5 2,3 3,0 785 Other ethnic groups 1,8 4,1 5,4 672 Total 2,0 3,4 4,4 5181 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 6.5 139MONITORING THE SITUATION OF CHILDREN AND WOMEN Early Childhood Development following is true: If the child gets along well with other children, if the child does not kick, bite, or hit other children and if the child does not get dis- tracted easily • Learning: If the child follows simple directions on how to do something correctly and/or when given something to do, is able to do it independently, then the child is considered to be developmentally on track in the learning domain. ECDI is then calculated as the percentage of children who are developmentally on track in at least three of these four domains. Findings on this section are presented in Table CD.5. ECDI in Kazakhstan is 86.1. It is important to note that 98.2 percent of children at the age 36-59 months in the country are on track in terms of their physical de- velopment. There is no difference in children’s physical development in terms of gender. Among all regions, the lowest share of this indicator is in Aktobe Oblast and is 76.6 percent, where 23.4 percent of children there do not develop according to the age norm of the above- mentioned indicator. The data in Table CD.5. demonstrate that ECDI among girls is higher compared to that of boys (89 ver- sus 83.5). As it was expected, ECDI was much high- er among children from older age groups where the figures are 89.4 among children aged 48-59 months compared to 82.9 among children aged 36-47 months since the skills children acquire get better when they grow older. It must be noted that children attending or- ganized educational programmes at early age or pro- grammes of pre-school institutions, have quite a high ECDI at 88.3, while children not attending such pro- grams have a lower ECDI at 84.9. Children, living in the poorest household have a lower ECDI (83.3) compared to children living in the wealthiest households (92.1). Early child development is defined as an orderly, predictable process along a continuous path, in which the child learns to handle more complicated levels of moving, thinking, speaking, feeling and relating to oth- ers. Physical growth, literacy and numeracy skills, so- cio-emotional development and readiness to learn are vital domains of the child’s overall development, which is a basis for overall human development. A 10-item module that had been developed for the MICS programme was used to calculate the Ear- ly Child Development Index (ECDI). The indicator is based on some benchmarks that children would be ex- pected to have if they are developing as the majority of children in that age group. The primary purpose of the ECDI is to inform public policy regarding the develop- mental status of children in Kazakhstan. Each of the 10 items is used in one of the four domains, to determine if children are developmen- tally on track in that domain. The domains in ques- tion are: • Literacy-numeracy: Children are identified as be- ing developmentally on track based on whether they can identify/name at least ten letters of the al- phabet, whether they can read at least four simple, popular words, and whether they know the name and recognize the symbols of all numbers from 1 to 10. If at least two of these is true, then the child is considered developmentally on track. • Physical: If the child can pick up a small object with two fingers, like a stick or a rock from the ground and/or the mother/caretaker does not indicate that the child is sometimes too sick to play, then the child is regarded as being developmentally on track in the physical domain. • In the social-emotional domain, children are con- sidered to be developmentally on track if two of the Table CD.5: Early Child Development Index Percentage of children aged 36-59 months who are developmentally on track in literacy-numeracy, physical, social-emotional, and learning domains, and the early child development index score, Kazakhstan, 2010/11 Percentage of children aged 36-59 months who are developmen- tally on track for indicated domain ECDI 1 Number of children aged 36-59 months Literacy- numeracy Physical Social-emotional Learning Sex Male 26,7 98,1 86,4 93,2 83,5 1046 Female 32,5 98,4 90,4 95,4 89,0 937 Region Akmola Oblast 26,3 100,0 79,1 100,0 80,3 72 Aktobe Oblast 34,5 76,6 96,3 70,8 69,0 95 Almaty Oblast 28,9 99,3 90,3 99,2 91,1 230 140 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of children aged 36-59 months who are developmen- tally on track for indicated domain ECDI 1 Number of children aged 36-59 months Literacy- numeracy Physical Social-emotional Learning Almaty city 44,1 98,3 84,4 98,4 89,0 78 Astana city 48,1 99,1 95,5 97,9 96,0 66 Atyrau Oblast 49,9 100,0 89,9 92,3 89,3 62 East Kazakhstan Oblast 38,7 99,1 79,1 96,2 83,2 147 Zhambyl Oblast 20,3 99,3 86,7 95,0 83,0 151 West Kazakhstan Oblast 29,0 100,0 83,6 97,4 85,0 65 Karaganda Oblast 30,6 100,0 87,0 100,0 92,3 175 Kostanai Oblast 40,6 96,9 92,2 95,7 92,4 82 Kyzylorda Oblast 34,4 99,5 94,7 95,5 92,0 114 Mangistau Oblast 34,1 100,0 86,2 94,6 87,4 87 Pavlodar Oblast 31,6 100,0 88,0 99,0 90,6 82 North Kazakhstan Oblast 25,2 100,0 84,5 100,0 86,5 61 South Kazakhstan Oblast 15,9 99,2 89,8 88,4 81,5 418 Residence Urban 34,4 98,3 87,3 95,7 87,2 946 Rural 24,9 98,2 89,2 92,9 85,1 1037 Age 36-47 months 17,4 98,1 87,2 92,7 82,9 1005 48-59 months 41,9 98,4 89,4 95,8 89,4 978 Attendance to early childhood education programmes Attending 43,7 98,0 88,0 95,2 88,3 733 Not attending 21,1 98,4 88,4 93,6 84,9 1250 1 MICS Indicator 6.6 ( ) – Indicators are based on 25-49 cases of unweighted observations Mother’s Education Incomplete Secondary (13,8) (100,0) (87,8) (94,3) (82,1) 35 Secondary 18,7 98,3 86,3 92,1 81,3 787 Specialized Secondary 33,8 98,4 88,0 96,4 88,9 531 Higher 40,3 98,0 91,0 95,1 89,9 627 Wealth Index Quintile Poorest 16,9 98,7 88,9 91,1 83,3 487 Second 24,1 97,4 87,6 93,6 82,8 419 Middle 31,4 98,7 90,2 96,3 88,6 401 Fourth 36,7 98,0 83,3 95,6 85,3 330 Richest 44,5 98,2 90,6 95,7 92,1 348 Ethnicity of Household Head Kazakh 29,3 98,1 89,0 93,8 86,2 1412 Russian 38,2 99,6 85,5 97,3 88,8 296 Other ethnic groups 20,7 97,5 87,3 93,3 83,0 275 Total 29,5 98,2 88,3 94,2 86,1 1983 141MONITORING THE SITUATION OF CHILDREN AND WOMEN percent are on track in literacy-numeracy, social- emotional and physical domains respectively. (Figure CD.1). The analysis of four domains of child devel- opment shows that 94.2 percent of children are on track in the learning domain; 29.5, 88.3 and 98.2 142 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN X. Literacy and Education 143MONITORING THE SITUATION OF CHILDREN AND WOMEN One of the World Fit for Children goals is to as- sure adult literacy. Adult literacy is also an MDG indi- cator, relating to both men and women. In MICS, since women’s and men’s questionnaires were administered, the results are based on females and males aged 15- 24. Literacy was assessed on the ability of women and men to read a short simple statement or on school at- tendance. The percentage of literate women and men is Literacy Among Young Women and Men presented in Table ED.1. Table ED.1 indicates that all women and men aged 15-24 in Kazakhstan are literate. Overall, in Kazakhstan, the literacy level was 99.9 percent. According to Law of the Republic of Kazakhstan ‘On Education’ secondary education is mandatory. In Kazakhstan, literacy is comprehen- sive, thus, no significant differences by residence, region, level of education, wealth and ethnicity of women were found. Table ED.1: Literacy among young people Percentage of women and men aged 15-24 years that are literate, Kazakhstan, 2010/11 Percentage literate 1 Number Women Men of womenaged 15-24 of men aged 15-24 Residence Urban 99,9 100 2422 465 Rural 100,0 99.8 1779 361 Total 99,9 99.9 4201 826 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.1; MDG Indicator 2.3 Pavlodar, Aktobe and West Kazakhstan Oblasts and Almaty (95.7-98.6 percent), Atyrau, Kostanai and Zhambyl Oblasts reported levels slightly above the national average (83.2-83.9 percent); Karaganda and East Kazakhstan Oblasts had 75.9 and 80.6 percent. Socioeconomic status appears to have a posi- tive correlation with school readiness – while the indicator is only 71.1-78.8 percent among poorer households, it increases to 86.5-91.6 percent among those children living in richer households. It should be noted that overall, the preschool attendance rate has doubled compared to 2006 (MICS, Kazakhstan 2006). In the future, the implementation of the 2011- 2020 National Education Development Programme of the Republic of Kazakhstan should achieve its Target indicator. Pre-school enrollment of children aged 3 to 6 will reach 73.5% by 2015 and 100% by 2020. Balapan Programme, which also aims to de- velop a network of public and private kindergartens, also provides for expansion of the preschool network in 2015. Attendance to pre-school education in an organ- ised learning or child education programme is impor- tant for the readiness of children to go to school. There- fore, development of early preschool education is one of the most important goals of the document ‘A World Fit for Children’. Table ED.2 shows the proportion of children in the first grade of primary school who attended pre- school the previous year. Overall, 81.6 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year in Kazakhstan. The proportion among males is slightly lower at 80.4 percent compared to females at 82.7 percent and is significantly lower among children living in rural areas at 78 percent compared to children living in urban areas with 85.6 percent. Regional differences are also very significant. The lowest pre-school attendance percentage was reported in Kyzylorda and South Kazakhstan Oblasts (67.2 and 70.1 percentage respectively); the highest pre-school attendance percentage was registered in School Readiness 144 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table ED.2: School readiness Percentage of children attending first grade of primary school who attended pre-school the previous year, Kazakhstan, 2010/11 Percentage of children attending first grade who attended preschool in previous year 1 Number of children attending first grade of primary school Sex Male 80,4 413 Female 82,7 423 Region Akmola Oblast (90,5) 26 Aktobe Oblast (96,1) 29 Almaty Oblast 81,4 91 Almaty city (97,4) 52 Astana city (93,3) 21 Atyrau Oblast 83,2 27 East Kazakhstan Oblast (80,6) 54 Zhambyl Oblast 83,9 72 West Kazakhstan Oblast 98,6 40 Karaganda Oblast 75,9 76 Kostanai Oblast 83,3 53 Kyzylorda Oblast 67,2 34 Mangistau Oblast (66,9) 21 Pavlodar Oblast (95,7) 37 North Kazakhstan Oblast (84,3) 28 South Kazakhstan Oblast 70,1 174 Residence Urban 85,6 391 Rural 78,0 445 Mother’s Education Incomplete Secondary (*) 26 Secondary 77,1 303 Specialized Secondary 83,3 263 Higher 85,3 245 Wealth Index Quintile Poorest 71,1 205 Second 78,8 173 Middle 83,2 147 Fourth 86,5 144 Richest 91,6 167 Household Ethnicity Head Kazakh 79,6 593 Russian 86,2 135 Other ethnic groups 87,0 108 Total 81,6 836 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.2 ( ) – indicators are based on 25-49 cases of unweighted observations 145MONITORING THE SITUATION OF CHILDREN AND WOMEN Primary and Secondary School Participation 7 years may be enrolled in primary school. In regard to this every parent makes an independent decision whether to send their children to school at the age of 6 or 7 years. When describing primary school entrance and attendance, the analysis of the age group 7 to 10 years is used while data on children at the age 7 to 17 years is used during the analysis of these indicators in secondary school. About 93.8 percent of all children reaching the age of 7 in Kazakhstan entered in first grade of primary school (Table ED.3). No significant differences are ob- served at this age by sex, residence of children or their mothers’ education in terms of the timely first grade en- trance, however it should be noted that there is some dependency on the level of household wealth: the share of children entering first grade on time is highest in the richest quintile households (99 percent) and lowest in the second quintile households (90.9 percent). The dif- ference by regions does exist: in Almaty and Pavlodar Oblasts all children of primary school entry age (age 7) attend the first grade; while the value of the indicator is quite low in Kyzylorda, Aktobe and Atyrau Oblasts (78.6, 83.6 and 89.0 percent respectively). Universal access to basic education and the achievement of primary education by the world’s chil- dren is one of the most important goals of the MDGs and A World Fit for Children. Education is a vital pre- requisite for combating poverty, empowering women, protecting children from hazardous and exploitative la- bour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influ- encing population growth. The indicators for primary and secondary school attendance include: • Net intake rate in primary education • Primary school net attendance ratio (adjusted) • Secondary school net attendance ratio (adjusted) • Female to male education ratio (or gender parity index - GPI) in primary and secondary school The indicators of school progression include: • Children reaching last grade of primary • Primary completion rate • Transition rate to secondary school According to Article 31 of the Law of the Repub- lic of Kazakhstan ‘On Education’, children aged 6 to Table ED.3: Primary school entry Percentage of children of primary school entry age (age 7) entering grade 1 (net intake rate), Kazakhstan, 2010/11 Percentage of children of primary school entry age (age 7) entering grade 1 Number of children of primary school entry age Sex Male 94,4 403 Female 93,1 442 Region Akmola Oblast (93,7) 25 Aktobe Oblast (83,6) 32 Almaty Oblast 100,0 102 Almaty city (*) 34 Astana city (100,0) 25 Atyrau Oblast 89,0 24 East Kazakhstan Oblast (97,6) 57 Zhambyl Oblast 92,8 61 West Kazakhstan Oblast (96,2) 29 Karaganda Oblast 93,8 74 Kostanai Oblast 98,1 49 Kyzylorda Oblast 78,6 43 Mangistau Oblast 89,6 32 Pavlodar Oblast (100,0) 32 North Kazakhstan Oblast (96,0) 31 South Kazakhstan Oblast 92,0 197 146 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 16 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. Percentage of children of primary school entry age (age 7) entering grade 1 Number of children of primary school entry age Residence Urban 94,0 388 Rural 93,6 458 Education Incomplete Secondary (*) 28 Secondary 94,6 355 Specialized Secondary 92,9 255 Higher 96,9 206 Wealth Index Quintile Poorest 92,6 207 Second 90,9 197 Middle 92,5 147 Fourth 95,1 144 Richest 99,0 152 Ethnicity of Household Head Kazakh 92,2 603 Russian 98,5 121 Other ethnic groups 96,9 122 Total 93,8 846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.3 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Primary school attendance rate by children in the age group 7-10 years is practically the same in urban and rural areas, at the same time no difference was ob- served in terms of gender. By age, it was observed that 98.4 percent of 7 year old children attended primary school while attendance rates for all other ages (8-10 years) were high, from 99.5 percent to 99.8 percent. In terms of wealth there was no significant differences for the age group 7 to 10 years. Table ED.4 provides the percentage of children of primary school age (7 to 10 years) who were attend- ing primary school at the time of the survey.16 It should be noted that 99.3 percent of children of primary school age were attending school in the in- dicated period. Only 0.7 percent of children are out of school when they are expected to be participating in school. In all regions Net Attendance Ratio (NAR) was about 99 percent and higher. Table ED.4: Primary School Attendance Percentage of children of primary school age (7-10 years) attending primary or secondary school (net attendance ratio), Kazakhstan, 2010/11 Male Female Total Net attendance ratio (adjusted) 1 Number of children Net attendance ratio (adjusted) 1 Number of children Net attendance ratio (adjusted) 1 Number of children Region Akmola Oblast 100,0 53 98,6 60 99,3 113 Aktobe Oblast 97,7 69 99,1 69 98,4 138 147MONITORING THE SITUATION OF CHILDREN AND WOMEN 17 Ratios presented in this table are “adjusted” since they include not only secondary school attendance, but also attendance to higher levels in the numerator. Male Female Total Net attendance ratio (adjusted) 1 Number of children Net attendance ratio (adjusted) 1 Number of children Net attendance ratio (adjusted) 1 Number of children Almaty Oblast 98,6 192 99,2 182 98,9 373 Almaty city 100,0 87 100,0 88 100,0 175 Astana city 100,0 41 100,0 43 100,0 84 Atyrau Oblast 100,0 48 100,0 47 100,0 95 East Kazakhstan Oblast 100,0 110 100,0 122 100,0 233 Zhambyl Oblast 100,0 132 99,0 113 99,5 245 West Kazakhstan Oblast 100,0 67 98,8 53 99,4 121 Karaganda Oblast 98,8 137 98,9 137 98,9 275 Kostanai Oblast 100,0 70 98,9 88 99,4 158 Kyzylorda Oblast 98,2 87 99,3 90 98,8 177 Mangistau Oblast 99,0 59 99,0 57 99,0 116 Pavlodar Oblast 100,0 56 100,0 63 100,0 119 North Kazakhstan Oblast 99,1 71 100,0 51 99,5 122 South Kazakhstan Oblast 99,4 341 99,4 369 99,4 710 Residence Urban 99,7 732 99,1 739 99,4 1471 Rural 99,1 889 99,5 894 99,3 1783 Age at Beginning of School Year 7 98,4 403 98,5 442 98,4 846 8 99,7 415 99,3 421 99,5 836 9 99,6 389 99,8 377 99,7 766 10 99,6 414 100,0 392 99,8 806 Mother’s Education Incomplete secondary 93,2 54 98,2 46 95,5 100 Secondary 99,4 635 99,5 707 99,5 1342 Specialized secondary 99,3 532 99,4 485 99,4 1016 Higher 100,0 401 99,5 391 99,7 792 Wealth Index Quintile Poorest 99,5 409 99,1 428 99,3 837 Second 98,3 365 99,4 370 98,8 735 Middle 99,6 320 98,5 292 99,1 612 Fourth 99,6 262 100,0 261 99,8 523 Richest 100,0 266 100,0 280 100,0 546 Ethnicity of Household Head Kazakh 99,5 1163 99,4 1145 99,5 2308 Russian 99,8 252 100,0 268 99,9 520 Other 98,1 206 98,1 219 98,1 425 Total 99,3 1621 99,4 1632 99,3 3253 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.4; MDG Indicator 2.1 tion stage attendance rate for children aged 11 is 95.7 percent. At the age of 12 to 15 years, the secondary school net attendance ratio is high and ranges from The secondary school NAR is presented in Table ED.517. The proportion of children aged 11-17 attend- ing secondary school is 96.1 percent. Percentages by sex and residence are at the same level. At this educa- 148 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 99.5 to 99.8 percent, at the age of 16 it drops to 96 percent and at the age of 17 it further drops to 82.1 percent. Analysis of mothers’ education level in this age group showed that the attendance ratio of chil- dren, whose mothers have higher education levels, is higher, though only slightly, than those whose mothers have secondary or incomplete secondary education. In terms of wealth of households where 11-17 year old children live, the richest quintile shows an in- dicator that is slightly higher compared to those in the poorest quintile. Table ED.5: Secondary School Attendance Percentage of children (11-17 years) attending secondary school, Kazakhstan, 2010/11 Male Female Total N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n Region Akmola Oblast 94,9 0,0 124 97,1 0,0 127 96,0 0,0 251 Aktobe Oblast 96,7 1,7 147 97,6 0,6 130 97,1 1,2 278 Almaty Oblast 90,9 2,4 365 94,9 0,0 327 92,8 1,3 692 Almaty city 90,1 0,0 162 91,6 2,3 146 90,8 1,1 307 Astana city 97,6 0,0 82 98,6 0,0 71 98,1 0,0 153 Atyrau Oblast 95,7 0,0 90 97,8 0,0 90 96,7 0,0 180 East Kazakhstan Oblast 97,0 0,6 241 93,9 0,6 233 95,4 0,6 474 Zhambyl Oblast 96,4 0,5 215 97,6 0,5 207 97,0 0,5 422 West Kazakhstan Oblast 97,9 0,5 116 99,3 0,0 107 98,6 0,2 223 Karaganda Oblast 97,2 0,7 246 96,7 0,6 258 96,9 0,6 504 Kostanai Oblast 97,8 0,0 159 97,3 1,4 137 97,5 0,6 296 Kyzylorda Oblast 96,3 0,5 160 97,3 0,8 145 96,8 0,7 305 Mangistau Oblast 96,3 0,0 106 95,8 0,0 112 96,0 0,0 218 Pavlodar Oblast 98,8 0,0 136 99,3 0,7 111 99,0 0,3 247 North Kazakhstan Oblast 98,3 0,0 111 96,1 0,0 100 97,3 0,0 211 South Kazakhstan Oblast 97,4 0,3 615 95,6 0,0 621 96,5 0,1 1235 Residence Urban 96,5 0,2 1472 95,7 0,4 1391 96,1 0,3 2864 Rural 95,5 0,9 1604 96,6 0,4 1530 96,0 0,7 3134 Age at Beginning of School Year 11 94,9 5,1 353 96,4 3,1 385 95,7 4,1 738 12 99,8 0,0 405 99,5 0,0 398 99,6 0,0 803 13 99,6 0,0 440 100,0 0,0 426 99,8 0,0 866 14 99,7 0,0 461 99,8 0,0 455 99,8 0,0 916 15 99,2 0,0 474 99,9 0,0 408 99,5 0,0 882 16 95,2 0,0 489 96,8 0,0 436 96,0 0,0 925 17 83,6 0,0 455 80,5 0,0 414 82,1 0,0 869 Education Incomplete Secondary 94,6 0,0 127 97,7 1,0 106 96,0 0,4 232 Secondary 96,5 0,3 1053 97,5 0,7 1075 97,0 0,5 2128 Specialized Secondary 98,2 0,7 1009 98,2 0,3 931 98,2 0,5 1940 Higher 97,0 1,2 673 98,9 0,1 614 97,9 0,7 1287 Cannot be determined 92,8 0,0 115 84,2 0,0 118 88,4 0,0 233 Wealth Index Quintile Poorest 95,1 0,4 779 96,4 0,3 747 95,7 0,4 1526 Second 96,2 0,6 645 95,9 0,4 626 96,1 0,5 1271 149MONITORING THE SITUATION OF CHILDREN AND WOMEN Male Female Total N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n N et at te nd an ce ra tio (a dj us te d) 1 P er ce nt ag e of c hi ld re n at te nd in g pr i- m ar y sc ho ol N um be r o f ch ild re n Middle 95,5 1,2 611 94,7 0,6 559 95,1 0,9 1170 Fourth 96,5 0,5 524 96,6 0,2 520 96,6 0,4 1044 Richest 97,1 0,1 518 97,6 0,7 469 97,3 0,4 987 Ethnicity of Household Head Kazakh 96,2 0,7 2167 96,7 0,4 2115 96,4 0,5 4282 Russian 96,3 0,7 505 94,4 0,9 463 95,4 0,8 968 Other 94,6 0,0 404 95,6 0,0 344 95,0 0,0 748 Total 96,0 0,6 3076 96,2 0,4 2922 96,1 0,5 5998 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.5 primary school NAR is somewhat higher (99.3 percent) than secondary school NAR (96.1 percent). Figure ED.1 demonstrates corrected NAR for primary and secondary school in Kazakhstan, where Figure ED.2 chart shows the percentage of household members aged 5-24 attending school, by sex. According to this figure the rate of school attendance of children aged 7-15 years is 100%. Among 16-17-year-old boys and girls school atten- dance starts to decline with the age. At the age of 18-20, it tends to decline dramatically. Gender differences in school attendance start to appear at the age of 15-16 and remain until the age of 21; however, there are no major differences at 21-24 years. Theoretically, by the age of 24, young people al- ready graduate and obtain their profession. 150 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN The percentage of children entering first grade who eventually reach the last grade of primary school is presented in Table ED.6. Of all children starting grade one, all of them will eventually reach the fifth grade of primary school. Notice that this number includes chil- dren that repeat grades and that eventually move up to reach last grade. Table ED.6: Children reaching last grade of primary school Percentage of children entering first grade of primary school who eventually reach the last grade of primary school (Survival rate to last grade of primary school), Kazakhstan, 2010/11 Percent attending grade 1 last year who are in grade 2 this year Percent attending grade 2 last year who are in grade 3 this year Percent attending grade 3 last year who are in grade 4this year Percent attending grade 4 last year who are in grade 5 this year1 Sex Male 100,0 100,0 100,0 100,0 Female 100,0 100,0 100,0 100,0 Total 100,0 100,0 100,0 100,0 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.6; MDG Indicator 2.2 age (11 years) were attending the 4th grade of primary school. By residence, the primary school completion rate of children in urban and rural areas was 101.9 and 112.1 percent respectively (taking into account children aged 6). The rate of transition to secondary education was 100 percent throughout Kazakhstan. For this indi- cator, no differences by age, residence, mother’s edu- cation, ethnicity and level of household wealth were noted. The primary school completion rate and transi- tion rate to secondary education are presented in Table ED.7. The primary completion rate is the ratio of the total number of students, regardless of age, entering the last grade of primary school for the first time, to the number of children of the primary graduation age at the beginning of the current (or most recent) school year (2010/11). At the moment of the survey, the primary school completion rate was 107.4 percent; it was also report- ed that 89.2 percent of children of primary completion 151MONITORING THE SITUATION OF CHILDREN AND WOMEN Table ED.7: Primary school completion and transition to secondary school. Primary school completion and transition to secondary school, Kazakhstan, 2010/11 Primary school completion rate1 Number of children of primary school completion age Transition rate to secondary school2 Number of children who were in the last grade of primary school the previous year Sex Male 105,5 414 100,0 353 Female 109,4 392 100,0 366 Residence Urban 101,9 366 100,0 335 Rural 112,1 439 100,0 384 Total 107,4 806 100,0 719 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.7 2 MICS Indicator 7.8 The ratio of girls to boys attending primary and secondary education is provided in Table ED.8. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross atten- dance ratios. The table shows that gender parity for primary school in Kazakhstan is 1.00. There is no difference in the attendance of girls and boys to primary and secondary school. No major differences in the primary and second- ary school attendance rates by residence, mother’s education and the economic status of households were found. Table ED.8: Education gender parity Education gender parity ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Kazakhstan, 2010/11 Primary school adjusted net attendance ratio, girls Primary school adjusted net attendance ratio, boys Gender parity index (GPI) for primary school 1 Secondary school adjusted net attendance ratio, girls Secondary school adjusted net attendance ratio, boys Gender parity index (GPI) for secondary school 2 Region Akmola Oblast 98,6 100,0 0,99 97,1 94,9 1,02 Aktobe Oblast 99,1 97,7 1,01 97,6 97,9 1,00 Almaty Oblast 99,2 98,6 1,01 97,6 94,7 1,03 Almaty city 100,0 100,0 1,00 93,1 93,8 0,99 Astana city 100,0 100,0 1,00 98,6 97,6 1,01 Atyrau Oblast 100,0 100,0 1,00 97,8 96,9 1,01 East Kazakhstan Oblast 100,0 100,0 1,00 93,9 97,0 0,97 Zhambyl Oblast 99,0 100,0 0,99 97,6 97,5 1,00 West Kazakhstan Oblast 98,8 100,0 0,99 99,3 97,9 1,01 Karaganda Oblast 98,9 98,8 1,00 97,2 97,2 1,00 Kostanai Oblast 98,9 100,0 0,99 97,3 97,8 1,00 Kyzylorda Oblast 99,3 98,2 1,01 98,2 97,2 1,01 Mangistau Oblast 99,0 99,0 1,00 96,5 97,3 0,99 Pavlodar Oblast 100,0 100,0 1,00 99,3 99,4 1,00 North Kazakhstan Oblast 100,0 99,1 1,01 96,8 98,3 0,98 South Kazakhstan Oblast 99,4 99,4 1,00 97,7 98,3 0,99 Residence Urban 99,1 99,7 0,99 96,6 97,2 0,99 152 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Primary school adjusted net attendance ratio, girls Primary school adjusted net attendance ratio, boys Gender parity index (GPI) for primary school 1 Secondary school adjusted net attendance ratio, girls Secondary school adjusted net attendance ratio, boys Gender parity index (GPI) for secondary school 2 Rural 99,5 99,1 1,00 97,6 97,0 1,01 Mother’s Education Incomplete Secondary 98,2 93,2 1,05 97,7 96,0 1,02 Secondary 99,5 99,4 1,00 98,2 97,4 1,01 Specialized Secondary 99,4 99,3 1,00 98,7 98,5 1,00 Higher 99,5 100,0 0,99 98,9 97,4 1,02 Cannot be determined n/a n/a n/a 86,4 94,0 0,92 Wealth Index Quintile Poorest 99,1 99,5 1,00 98,0 97,1 1,01 Second 99,4 98,3 1,01 97,2 96,8 1,00 Middle 98,5 99,6 0,99 95,4 96,2 0,99 Fourth 100,0 99,6 1,00 97,0 97,1 1,00 Richest 100,0 100,0 1,00 98,0 98,3 1,00 Ethnicity of Household Head Kazakh 99,4 99,5 1,00 97,6 97,3 1,00 Russian 100,0 99,8 1,00 95,1 96,4 0,99 Other 98,1 98,1 1,00 97,1 96,5 1,01 Total 99,4 99,3 1,00 97,1 97,1 1,00 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 7.9; MDG Indicator 3.1 2 MICS Indicator 7.10; MDG Indicator 3.1 n/a – not applicable 153MONITORING THE SITUATION OF CHILDREN AND WOMEN XI. Child Protection 154 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Birth Registration In Kazakhstan the Law “On Marriage and Fam- ily” regulates the procedures and time frame for birth registration. According to the Law, parents and guard- ians have to register the fact of birth within two months. There is no state duty for birth registration. Lump sum payment after the birth of the child and monthly allow- ances paid to mothers/guardians until the age of 1 serve as indirect stimulus for timely birth registration. About 99.7 percent of children under 5 in Kazakhstan have had their birth registered (Table CP.1.). There is no variation across regions in terms of gender, age or mother’s educational attainment. Table CP.1: Birth registration Percentage of children under 5 by whether birth is registered and percentage of children not registered whose mothers/caretakers know how to register birth, Kazakhstan, 2010/11 Children under 5 whose birth is registered Number of children Has birth certificate No birth certificate Total registered 1 Seen Not Seen Sex Male 81,5 17,9 0,4 99,8 2644 Female 82,0 17,4 0,3 99,7 2537 Region Akmola Oblast 95,3 3,0 0,4 98,8 189 Aktobe Oblast 33,6 65,8 0,3 99,6 260 Almaty Oblast 89,9 9,9 0,2 100,0 551 Almaty city 80,7 19,3 0,0 100,0 202 Astana city 97,3 2,7 0,0 100,0 166 Atyrau Oblast 86,8 12,3 0,5 99,7 182 East Kazakhstan Oblast 86,7 12,5 0,4 99,6 372 Zhambyl Oblast 86,5 11,7 1,5 99,7 400 West Kazakhstan Oblast 68,8 30,8 0,4 100,0 195 Karaganda Oblast 98,1 1,4 0,3 99,8 420 Kostanai Oblast 44,5 54,2 0,0 98,7 222 Kyzylorda Oblast 56,1 43,2 0,7 100,0 292 Mangistau Oblast 77,3 21,6 0,8 99,7 244 Pavlodar Oblast 92,2 6,6 0,8 99,6 217 North Kazakhstan Oblast 90,1 8,6 0,0 98,8 139 South Kazakhstan Oblast 88,3 11,7 0,0 100,0 1129 Residence Urban 82,9 16,5 0,4 99,9 2508 Rural 80,6 18,7 0,3 99,6 2673 Age 0-11 months 82,1 15,5 1,4 99,1 1064 12-23 months 79,9 19,8 0,1 99,9 1037 24-35 months 81,9 17,8 0,2 99,9 1097 36-47 months 81,6 18,2 0,1 99,9 1005 48-59 months 83,2 16,8 0,0 100,0 978 Mother’s Education Incomplete secondary 86,4 11,9 0,6 98,8 96 The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fun- damental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indi- cator is the percentage of children under 5 whose birth is registered. 155MONITORING THE SITUATION OF CHILDREN AND WOMEN Children under 5 whose birth is registered Number of children Has birth certificate No birth certificate Total registered 1 Seen Not Seen Secondary 80,5 18,5 0,6 99,6 1916 Specialized secondary 81,6 18,0 0,3 99,8 1432 Higher 82,9 16,8 0,2 99,9 1729 Wealth Index Quintile Poorest 80,5 18,6 0,5 99,5 1249 Second 82,8 16,8 0,1 99,8 1134 Middle 80,4 18,6 0,6 99,6 1015 Fourth 82,8 16,9 0,2 99,9 865 Richest 82,6 17,0 0,4 100,0 919 Ethnicity of Household Head Kazakh 80,8 18,7 0,3 99,8 3724 Russian 83,9 15,5 0,2 99,7 785 Other 84,6 14,3 0,7 99,6 672 Total 81,7 17,6 0,4 99,7 5181 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.1 Child Discipline was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/ caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. As stated in A World Fit for Children, “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Kazakhstan MICS survey, mothers/caretakers of children age 2-14 years were asked a series of ques- tions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 per household Table CP.4: Child discipline Percentage of children aged 2-14 years according to method of disciplining the child, Kazakhstan, 2010/11 Percentage of children 2-14 years of age who experience Num- ber of children aged 2-14 years Respondent believes that the child needs to be physically pun- ished Number of those who responded to child discipline questions Only nonviolent discipline Psycho- logical aggres- sion Physical punishment Any violent discipline1Any Severe Sex Male 33,8 47,6 32,6 2,3 53,7 5803 7,6 3466 Female 38,8 39,0 25,5 1,9 45,1 5744 5,3 3334 Region Akmola Oblast 33,4 52,9 31,3 0,5 59,7 451 6,5 296 Aktobe Oblast 30,3 50,8 31,8 1,2 58,3 526 1,1 317 Almaty Oblast 37,1 41,8 26,8 0,0 49,8 1278 1,3 749 Almaty city 62,4 23,1 12,1 1,1 27,3 594 2,9 424 156 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of children 2-14 years of age who experience Num- ber of children aged 2-14 years Respondent believes that the child needs to be physically pun- ished Number of those who responded to child discipline questions Only nonviolent discipline Psycho- logical aggres- sion Physical punishment Any violent discipline1Any Severe Astana city 54,7 30,4 21,6 0,0 38,6 318 0,2 220 Atyrau Oblast 44,9 41,5 19,7 0,5 44,7 354 3,2 194 East Kazakhstan Oblast 44,2 39,1 23,5 0,6 42,7 824 8,2 554 Zhambyl Oblast 37,5 50,0 30,3 0,9 56,1 845 7,9 466 West Kazakhstan Oblast 42,2 43,5 33,6 0,4 54,7 424 5,9 265 Karaganda Oblast 45,5 44,0 34,7 3,6 51,8 993 6,7 664 Kostanai Oblast 24,5 61,4 50,9 0,6 72,6 520 18,5 337 Kyzylorda Oblast 31,2 44,9 39,5 2,3 56,4 618 4,5 325 Mangistau Oblast 23,8 58,1 55,5 2,6 65,3 447 23,5 227 Pavlodar Oblast 30,9 48,2 25,6 1,5 54,3 452 5,2 325 North Kazakhstan Oblast 35,5 53,6 33,7 0,8 59,9 410 11,0 279 South Kazakhstan Oblast 27,2 37,1 22,0 5,5 38,9 2495 5,8 1159 Residence Urban 39,1 41,9 28,8 1,7 48,9 5418 6,3 3553 Rural 33,8 44,6 29,3 2,4 49,9 6129 6,7 3248 Age 2-4 35,4 38,5 32,4 1,5 47,6 3106 5,9 1877 5-9 33,2 46,4 31,8 2,5 52,7 4231 7,3 2441 10-14 40,0 43,7 23,9 2,1 47,4 4211 6,1 2482 Education of Household Head Incomplete secondary 29,3 48,9 37,7 3,0 54,7 1121 n/a n/a Secondary 35,8 44,4 29,4 2,7 50,2 4344 n/a n/a Specialized secondary 34,4 46,9 29,2 1,5 52,9 3463 n/a n/a Higher 42,9 34,4 24,8 1,5 41,2 2546 n/a n/a Education of Respondent Incomplete secondary n/a n/a n/a n/a n/a n/a 7,6 394 Secondary n/a n/a n/a n/a n/a n/a 7,0 2436 Specialized secondary n/a n/a n/a n/a n/a n/a 7,0 2129 Higher n/a n/a n/a n/a n/a n/a 5,1 1821 Wealth Index Quintile Poorest 32,9 46,5 28,8 2,6 50,3 2873 6,9 1402 Second 33,8 43,1 29,1 2,2 49,1 2569 5,0 1396 Middle 34,5 44,0 30,4 2,5 51,3 2172 6,8 1296 Fourth 38,8 42,5 29,7 1,2 50,0 1943 6,2 1294 Richest 43,8 39,1 27,4 1,6 46,1 1989 7,4 1413 157MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of children 2-14 years of age who experience Num- ber of children aged 2-14 years Respondent believes that the child needs to be physically pun- ished Number of those who responded to child discipline questions Only nonviolent discipline Psycho- logical aggres- sion Physical punishment Any violent discipline1Any Severe Ethnicity of Household Head Kazakh 37,0 41,9 28,2 2,0 48,2 8213 5,6 4550 Russian 37,0 47,3 32,2 1,6 54,2 1851 8,4 1393 Other 31,6 46,5 30,0 3,2 50,4 1484 7,9 858 Total 36,3 43,3 29,1 2,1 49,4 11547 6,5 6801 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.5 As follows from Table CP.4, in Kazakhstan, 49.4 percent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. In overall in the country 2.1 percent of children were subjected to severe physical punishment. It should also be noted that only a small part of parents/caretakers (6.5 percent) believe that children should be physically punished to be raised properly; al- though in reality more than 29 percent of children aged 2-14 years were subjected to any form of physical pun- ishment. These data indicate a contrast between views and actions of a certain part of parents or caretakers in this regard. As follows from the same table, male children were subjected more to both any and severe physi- cal discipline (32.6 percent) than female children (25.5 percent). Kostanai and Mangystau Oblasts report low percentages of only non-violent discipline methods (24 percent each) and high psychological pressure and physical punishment percentages and, as a con- sequence, these oblasts have a very high percentage of violent upbringing methods (72.6 and 65.3 percent respectively). Percentage of mothers/caretakers who believe that children should be subjected to physi- cal punishment is also high in these oblasts, 18.5 in Kostanai and 23.5 in Mangistau percent, respectively. In general, such a view is widespread among mothers and caretakers with incomplete secondary education as opposed to those with higher education (7.6 percent and 5.1 percent respectively). Figure CP.1 demonstrates that boys almost twice as often as girls experience any kinds of physical punishment. 158 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Early Marriage dren themselves, married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected by child marriage but the issue impacts girls in far larger numbers and with more in- tensity. Cohabitation – when a couple lives together as if married – raises the same human rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is of- ten that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship – for example, inheritance, citizenship and social recognition – might make girls in informal unions vulnerable in differ- ent ways than those who are in formally recognized marriages. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl’s risk of becoming married while still a child. Women who are married at younger ages were more likely to believe that it is sometimes ac- ceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mor- tality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infec- tion. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to repro- duce and the power imbalance resulting from the age differential lead to very low condom use among such couples. In Kazakhstan, the Law ‘On Marriage and Fam- ily’ determines the age of 18 as legal for marriage; in exceptional cases local executive authorities may de- cide to register marriage at an earlier age provided that there are certain reasons for this. Two of the indicators are to estimate the per- centage of women married before 15 years of age and percentage married before 18 years of age. The per- Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 64 million women age 20-24 were married/in union before the age of 18. Factors that in- fluence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate leg- islative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that con- done the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of hu- man rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforc- ing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights – with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices – and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Mar- riage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploita- tion of Children as a type of commercial sexual exploi- tation of children. Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertil- ity, and responsible for raising children while still chil- 159MONITORING THE SITUATION OF CHILDREN AND WOMEN centage of women married at various ages is provided in Table CP.5. As follows from Table CP.5, in Kazakhstan 4.5 percent of women at the age of 15-19 years selected in the sample for MICS, are married. This indicator is by 2.4 percent units higher in rural area compared to urban area (5.8 and 3.4 percent respectively). Women with higher education (3.2 percent) in this age group less often got married compared to women with spe- cialized education (7.9 percent). Women before age 20 from poorest and second quintile households more often got married (5.9 percent and 6.6 percent respectively). By regions, the highest proportion of married women from the age group 15-19 years who are cur- rently married is in Akmola Oblast and is at 12.3 per- cent which is almost 3 times higher than the average national. The survey identified an insignificant propor- tion of women in the age group 15-19 years who are currently married or in union in Almaty city and East Kazakhstan Oblast (1.4 and 1.6 percent respectively) while no such cases were observed in Astana city. Table CP.5: Early marriage among women Percentage of women aged 15-49 years who were first in marriage or union before their 15th birthday, percentage of women aged 20-49 years who were first in marriage or union before their 15th and 18th birthday, percentage of women aged 15-19 years currently in union, Kazakhstan, 2010/11 Percent- age married before age 151 Number of women age 15-49 years Percentage married before age 15 Percentage married before age 182 Number of women age 20-49 years Percentage of women 15-19 years currently married/in unionf3 Number of women age 15-19 years Region Akmola 0,4 603 0,5 10,8 529 12,3 74 Aktobe 0,1 694 0,2 5,2 598 2,8 95 Almaty 0,2 1518 0,3 7,9 1261 3,7 256 Almaty city 0,2 1190 0,3 5,7 1083 1,4 107 Astana city 0,1 539 0,1 5,3 470 0,0 69 Atyrau 0,0 409 0,0 5,5 342 4,4 67 East Kazakhstan 0,1 1210 0,1 7,6 1029 1,6 180 Zhambyl 0,4 836 0,3 12,8 697 5,8 139 West Kazakhstan 0,5 566 0,5 9,0 486 5,4 81 Karaganda 0,7 1274 0,7 12,7 1101 4,4 173 Kostanai 0,2 791 0,3 8,3 693 5,4 98 Kyzylorda 0,0 553 0,0 6,0 470 4,9 84 Mangistau 0,1 461 0,2 6,2 378 6,3 83 Pavlodar 0,2 746 0,3 11,2 651 5,3 94 North Kazakhstan 0,2 577 0,3 11,1 510 3,7 67 South Kazakhstan 0,1 2048 0,1 9,0 1694 5,9 354 Residence Urban 0,3 8055 0,3 7,7 6964 3,4 1091 Rural 0,2 5959 0,2 9,9 5028 5,8 932 Age 15-19 0,1 2022 n/a n/a n/a 4,5 2022 20-24 0,3 2178 0,3 6,1 2178 n/a n/a 25-29 0,2 2016 0,2 8,4 2016 n/a n/a 30-34 0,3 2005 0,3 12,9 2005 n/a n/a 35-39 0,2 1901 0,2 10,9 1901 n/a n/a 40-44 0,3 1919 0,3 6,9 1919 n/a n/a 45-49 0,3 1972 0,3 6,7 1972 n/a n/a 160 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent- age married before age 151 Number of women age 15-49 years Percentage married before age 15 Percentage married before age 182 Number of women age 20-49 years Percentage of women 15-19 years currently married/in unionf3 Number of women age 15-19 years Education Secondary incomplete 0,9 553 2,0 26,7 252 0,0 300 Secondary 0,4 4407 0,4 14,6 3579 4,3 828 Secondary specialised 0,2 4539 0,2 8,4 3949 7,9 591 High 0,1 4489 0,1 2,6 4186 3,2 303 Wealth Index Quintile Poorest 0,3 2528 0,3 9,7 2086 5,9 442 Second 0,2 2599 0,3 10,6 2206 6,6 393 Middle 0,3 2743 0,3 8,8 2297 4,3 446 Fourth 0,3 2839 0,2 8,3 2452 3,9 387 Richest 0,2 3305 0,2 6,6 2950 1,6 355 Religion/Language/Ethnicity of Household Head Kazakh 0,1 9003 0,1 6,5 7558 3,1 1444 Russian 0,5 3168 0,5 11,8 2841 6,8 327 Other ethnic group 0,4 1843 0,4 13,0 1592 9,7 251 Total 0,2 14014 0,3 8,6 11992 4,5 2022 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.6 2 MICS Indicator 8.7 3 MICS Indicator 8.8 n/a – not applicable The proportion of women at the age of 15-49 who got married or lived in union with men before they turned 15 was 0.2 percent. This indicator for men in the age group 15-59 is 0.3 percent. The MICS results show that early marriages at the age below 15 years are not widely spread in Kazakhstan. No such mar- riages were found in Atyrau and Kyzylorda Oblasts. In the remaining oblasts, the number of marriages below 15 years of age does not exceed 0.5 percent. The proportion of people at the age of 20- 49 who got married before they turned 18 was 8.6 percent among women and 1.1 percent among men. More often young women at the age below 18 marry in Pavlodar (11.0 percent), Zhambyl (12.8 percent), North Kazakhstan, Karaganda (12.7 percent) and Akmola (10.8 percent) Oblasts. The lowest percentage of such marriages was found in Aktobe (5.2 percent) and Atyrau (5.5 percent) Oblasts, Astana city (5.3 percent) and Almaty city (5.7 percent). Girls with lower educational attainment, more often, incomplete secondary education (26.7 percent) and non-Kazakh (Russians – 11.8 percent and other ethnic groups – 13 percent) got married before the age of 18 more often. A lower percentage of women from the richest households (6.6 percent) got married at a young age (before 18). 161MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CP.5М: Early marriage among men Percentage of men aged 15-49 years, who were first in marriage or union before their 15th birthday, percentage of men aged 20-49 years, who were first in marriage or union before their 15th and 18th birthday, percentage of men aged 15-19 years currently in union, Kazakhstan, 2010/11 Percentage married before age 151 Number of men age 15-59 years Percentage married before age 15 Percent- age married before age 182 Number of men age 20-59 years Percentage of men 15-19 years currently married/in union3 Number of men age 15-19 years Region Akmola 0,0 178 0,0 0,9 153 0,0 24 Aktobe 0,0 182 0,0 0,0 156 0,0 26 Almaty 0,4 423 0,5 2,4 378 0,0 45 Almaty city 0,4 302 0,4 1,7 278 0,0 24 Astana city 0,0 125 0,0 0,9 111 0,0 14 Atyrau 0,0 112 0,0 0,7 99 0,0 12 East Kazakhstan 0,4 340 0,4 0,8 320 0,0 20 Zhambyl 0,0 240 0,0 0,6 207 (2,9) 33 West Kazakhstan 0,0 158 0,0 1,5 142 0,0 17 Karaganda 0,4 333 0,4 0,8 308 0,0 25 Kostanai 0,4 219 0,4 1,8 198 0,0 21 Kyzylorda 0,0 157 0,0 0,2 143 0,0 14 Mangistau 0,0 121 0,0 1,3 106 0,0 15 Pavlodar 0,0 206 0,0 1,2 186 0,0 20 North Kazakhstan 0,3 164 0,4 1,1 154 0,0 11 South Kazakhstan 0,7 587 0,7 0,7 514 (3,4) 72 Residence Urban 0,4 2061 0,4 1,3 1837 0,4 224 Rural 0,1 1785 0,2 0,9 1616 1,4 169 162 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage married before age 151 Number of men age 15-59 years Percentage married before age 15 Percent- age married before age 182 Number of men age 20-59 years Percentage of men 15-19 years currently married/in union3 Number of men age 15-19 years Age 15-19 0,0 394 n/a n/a 0 0,9 394 20-24 0,0 433 0,0 0,3 433 n/a n/a 25-29 0,2 434 0,2 0,8 434 n/a n/a 30-34 0,1 548 0,1 1,3 548 n/a n/a 35-39 0,3 539 0,3 0,9 539 n/a n/a 40-44 0,3 453 0,3 0,7 453 n/a n/a 45-49 1,0 432 1,0 1,8 432 n/a n/a 50-54 0,6 361 0,6 2,3 361 n/a n/a 55-59 0,0 251 0,0 0,7 251 n/a n/a Education Secondary incomplete 0,0 184 0,0 0,6 118 0,0 67 Secondary 0,2 1444 0,3 1,1 1284 1,5 161 Secondary specialised 0,2 1261 0,2 1,0 1129 0,7 131 High 0,5 953 0,5 1,2 918 0,0 35 Wealth Index Quintile Poorest 0,0 737 0,0 0,3 667 3,4 71 Second 0,6 748 0,6 1,7 677 0,0 71 Middle 0,2 773 0,3 1,0 672 1,0 101 Fourth 0,3 789 0,4 0,9 714 0,0 74 Richest 0,3 799 0,3 1,6 724 0,0 76 Religion/Language/Ethnicity of Household Head Kazakh 0,2 2374 0,2 0,8 2113 0,0 261 Russian 0,6 952 0,7 2,2 877 0,0 76 Other ethnic group 0,0 520 0,0 0,5 462 (6,0) 57 Total (15-49) 0,3 3233 0,3 1,0 2840 0,9 394 Total (15-59) 0,3 3846 0,3 1,1 3452 0,9 394 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.6 2 MICS Indicator 8.7 3 MICS Indicator 8.8 ( ) – indicators are based on 25-49 cases of unweighted observations n/a – not applicable Tables CP.6 and CP.6M present the proportion of young people, who were first married or entered into a marital union before age 15 and 18 by resi- dence and age groups. Examining the percentages married before the age of 15 and 18 by different age groups, allows us to see the trends in early marriage over time. As mentioned above, only 0.2 percent of women married before the age of 15 and 8.6 percent married before the age of 18; this indicator for men is 0.3 and 1.1 percent respectively. Examining early marriage trends for women, we should note two particular age groups, 30-34 and 35- 39 years. In these groups, the share of young women first married before the age of 18 is 12.9 and 10.9 per- cent respectively. In all the groups in question (except 15-19 years) girls living in rural areas were more likely to marry be- fore the age of 18. 163MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CP.6: Trends in early marriage among women Percentage of women who were first married or entered into a marital union before age 15 and 18, by residence and age groups, Kazakhstan, 2010/11 Urban Rural Both P er ce nt ag e of w om en m ar rie d be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om en m ar rie d be fo re a ge 1 8 N um be r o f w om en P er ce nt ag e of w om en m ar rie d be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om en m ar rie d be fo re a ge 1 8 N um be r o f w om en P er ce nt ag e of w om en m ar rie d be fo re a ge 1 5 N um be r o f w om en P er ce nt ag e of w om en m ar rie d be fo re a ge 1 8 N um be r o f w om en Age 15-19 0,2 1091 n/a n/a 0,1 932 n/a n/a 0,1 2022 n/a n/a 20-24 0,3 1331 4,8 1331 0,2 848 8,2 848 0,3 2178 6,1 2178 25-29 0,2 1205 6,9 1205 0,3 810 10,6 810 0,2 2016 8,4 2016 30-34 0,3 1128 11,8 1128 0,3 877 14,3 877 0,3 2005 12,9 2005 35-39 0,4 1113 10,8 1113 0,0 788 11,2 788 0,2 1901 10,9 1901 40-44 0,2 1079 6,2 1079 0,4 840 7,8 840 0,3 1919 6,9 1919 45-49 0,4 1108 6,5 1108 0,1 864 7,1 864 0,3 1972 6,7 1972 Total 0,3 8055 7,7 6964 0,2 5959 9,9 5028 0,2 14014 8,6 11992 n/a – not applicable Table CP.6М: Trends in early marriage among men Percentage of men who were first married or entered into a marital union before age 15 and 18, by residence and age groups, Kazakhstan, 2010/11 Urban Rural Both P er ce nt ag e of m en m ar rie d be fo re a ge 1 5 N um be r o f m en P er ce nt ag e of m en m ar rie d be fo re a ge 1 8 N um be r o f m en P er ce nt ag e of m en m ar rie d be fo re a ge 1 5 N um be r o f m en P er ce nt ag e of m en m ar rie d be fo re a ge 1 8 N um be r o f m en P er ce nt ag e of m en m ar rie d be fo re a ge 1 5 N um be r o f m en P er ce nt ag e of m en m ar rie d be fo re a ge 1 8 N um be r o f m en Age 15-19 0,0 224 n/a n/a 0,0 169 n/a n/a 0,0 394 n/a n/a 20-24 0,0 241 0,6 241 0,0 192 0,0 192 0,0 433 0,3 433 25-29 0,3 251 1,1 251 0,0 183 0,4 183 0,2 434 0,8 434 30-34 0,0 311 0,9 311 0,2 237 1,9 237 0,1 548 1,3 548 35-39 0,7 278 1,5 278 0,0 262 0,3 262 0,3 539 0,9 539 40-44 0,5 229 1,4 229 0,0 224 0,0 224 0,3 453 0,7 453 45-49 2,0 220 3,1 220 0,0 213 0,5 213 1,0 432 1,8 432 50-54 0,0 173 0,7 173 1,1 188 3,7 188 0,6 361 2,3 361 55-59 0,0 134 1,3 134 0,0 118 0,0 118 0,0 251 0,7 251 Total 15-49 0,5 1754 1,4 1530 0,0 1479 0,5 1310 0,3 3233 1,0 2840 Total 15-59 0,4 2061 1,3 1837 0,1 1785 0,9 1616 0,3 3846 1,1 3452 n/a – not applicable 164 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Another component is the spousal age differ- ence with an indicator being the percentage of married/ in union women with a difference of 10 or more years younger than their current spouse. Table CP.7 presents the results of the age difference between husbands and wives. The results show that there are some important spousal age differences in Kazakhstan. Slightly more than 7 percent of women aged 20-24 and 8 percent of women aged 15-19 are currently married to a man who is older by ten years or more. In Kazakhstan as a whole, the share of women aged 20-24 with husbands/partners 0-4 years older was 58.5 percent and those with 5-9 years older were 23.8 percent. About 9.8 percent of women noted that they were older than their spouses. Marriages, when a husband is 10 and more years older in the groups of young women aged 20-24, are more prevalent in ru- ral areas and among rich households. In most cases, such marriages involve women with secondary edu- cation. Table CP.7: Spousal age difference Percent distribution of women currently married/in union age 15-19 and 20-24 years according to the age difference with their husband or partner, Kazakhstan, 2010/11 Percentage of currently married women aged 15-19, whose husband or partner is N um be r o f w om en a ge d 15 -1 9 cu rr en tly m ar rie d or in u ni on Percentage of currently married women aged 20-24, whose husband or partner is N um be r o f w om en a ge d 20 -2 4 cu rr en tly m ar rie d or in u ni on Yo un ge r 0- 4 ye ar s ol de r 5- 9 ye ar s ol de r 10 a nd m or e ye ar s ol de r 1 To ta l Yo un ge r 0- 4 ye ar s ol de r 5- 9 ye ar s ol de r 10 a nd m or e ye ar s ol de r 2 H us ba nd ’s / pa rtn er ’s a ge un kn ow n To ta l Region Akmola Oblast (*) (*) (*) (*) 100,0 9 (13,6) (52,8) (31,1) (2,5) (0,0) 100,0 33 Aktobe Oblast (*) (*) (*) (*) 100,0 3 9,9 53,5 25,1 11,5 0,0 100,0 52 Almaty Oblast (*) (*) (*) (*) 100,0 9 9,8 59,4 23,0 7,8 0,0 100,0 106 Almaty city (*) (*) (*) (*) 100,0 2 (11,1) (53,0) (18,8) (17,1) (0,0) 100,0 48 Astana city (*) (*) (*) (*) 100,0 0 15,3 48,4 27,5 8,8 0,0 100,0 36 Atyrau Oblast (*) (*) (*) (*) 100,0 3 11,6 66,1 14,5 1,5 6,2 100,0 35 East Kazakhstan Oblast (*) (*) (*) (*) 100,0 3 9,5 59,2 28,2 3,2 0,0 100,0 83 Zhambyl Oblast (*) (*) (*) (*) 100,0 8 6,5 62,5 24,1 6,9 0,0 100,0 61 West Kazakhstan Oblast (*) (*) (*) (*) 100,0 4 8,3 53,3 24,9 13,5 0,0 100,0 41 Karaganda Oblast (*) (*) (*) (*) 100,0 8 8,8 62,6 19,4 9,3 0,0 100,0 90 Kostanai Oblast (*) (*) (*) (*) 100,0 5 15,7 69,0 10,5 4,8 0,0 100,0 54 Kyzylorda Oblast (*) (*) (*) (*) 100,0 4 2,5 58,4 31,9 5,1 2,1 100,0 39 Mangistau Oblast (*) (*) (*) (*) 100,0 5 12,8 59,8 23,1 3,0 1,3 100,0 38 Pavlodar Oblast (*) (*) (*) (*) 100,0 5 10,6 46,9 33,7 8,9 0,0 100,0 48 North Kazakhstan Oblast (*) (*) (*) (*) 100,0 3 13,1 53,6 27,1 6,3 0,0 100,0 39 South Kazakhstan Oblast (*) (*) (*) (*) 100,0 21 7,7 60,3 23,6 6,2 2,2 100,0 195 Residence Urban (6,1) (50,9) (32,4) (10,6) 100,0 37 10,8 59,8 21,4 8,0 0,0 100,0 537 Rural 4,1 52,4 36,6 7,0 100,0 54 8,6 56,9 26,4 6,4 1,7 100,0 460 Age 15-19 4,9 51,8 34,9 8,4 100,0 92 n/a n/a n/a n/a n/a n/a n/a 20-24 n/a n/a n/a n/a n/a n/a 9,8 58,5 23,8 7,2 0,8 100,0 998 Education Incomplete secondary (*) (*) (*) (*) 100,0 0 (*) (*) (*) (*) (*) 100,0 4 Secondary (1,9) (50,3) (37,5) (10,3) 100,0 36 5,3 54,1 28,3 10,9 1,5 100,0 295 165MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of currently married women aged 15-19, whose husband or partner is N um be r o f w om en a ge d 15 -1 9 cu rr en tly m ar rie d or in u ni on Percentage of currently married women aged 20-24, whose husband or partner is N um be r o f w om en a ge d 20 -2 4 cu rr en tly m ar rie d or in u ni on Yo un ge r 0- 4 ye ar s ol de r 5- 9 ye ar s ol de r 10 a nd m or e ye ar s ol de r 1 To ta l Y ou ng er 0- 4 ye ar s ol de r 5- 9 ye ar s ol de r 10 a nd m or e ye ar s ol de r 2 H us ba nd ’s / pa rtn er ’s a ge un kn ow n To ta l Specialized secondary (5,9) (57,4) (31,3) (5,4) 100,0 47 9,1 64,6 20,9 5,2 0,2 100,0 319 Higher (*) (*) (*) (*) 100,0 10 13,7 56,4 22,9 6,2 0,8 100,0 379 Wealth Index Quintile Poorest (*) (*) (*) (*) 100,0 26 8,7 54,9 27,5 7,3 1,6 100,0 183 Second (*) (*) (*) (*) 100,0 26 8,5 54,6 26,8 8,8 1,4 100,0 220 Middle (6,9) (70,8) (17,9) (4,4) 100,0 19 10,9 61,6 20,6 6,1 0,8 100,0 218 Fourth (*) (*) (*) (*) 100,0 15 11,1 61,0 18,3 9,5 0,0 100,0 174 Richest (*) (*) (*) (*) 100,0 6 9,9 60,3 25,1 4,7 0,0 100,0 204 Ethnicity of Household Head Kazakh (4,9) (50,2) (40,0) (5,0) 100,0 45 10,4 59,1 21,8 8,2 0,5 100,0 634 Russian (10,4) (42,4) (36,3) (10,9) 100,0 22 9,0 55,8 28,7 6,5 0,0 100,0 217 Other (*) (*) (*) (*) 100,0 24 8,1 59,6 25,0 4,3 3,0 100,0 146 Total 4,9 51,8 34,9 8,4 100,0 92 9,8 58,5 23,8 7,2 0,8 100,0 998 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.10a 2 MICS Indicator 8.10b ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations n/a – not applicable In the course of MICS4, a number of questions were asked of women aged 15-49 and men aged 15- 59 to assess their attitudes towards whether husbands/ partners are justified to hit or beat their wives/partners for a variety of scenarios. These questions were asked to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assump- tion here is that women who agree with the statements indicating that husbands/partners are justified to beat their wives/partners under the situations described in reality tend to be abused by their own husbands/part- ners; just like men, who agree with such statements, in reality tend to use violence against their wives or partners. The responses to these questions can be found in Tables CP.11 (women) and CP.11M (men). Overall, 12.2 percent of women in Kazakhstan feel that their husband/ partner has a right to hit or beat them for at least one of a variety of reasons. Women who approve their partner’s violence, in most cases agree and justify violence in in- stances when they neglect the children (9.7 percent), or if they demonstrate their autonomy, e.g. go out without telling their husbands (3.1 percent) or argue with them (3.7 percent). About 1.2 percent of women believe that their partner has a right to hit or beat them if they re- fuse to have sex with him or if they burn the food (0.8 percent). Acceptance is more present among married women, less educated and poorest, who believe that a husband has a right to beat his wife/partner for any of the above reasons. Judging by women’s responses, the most unfavorable situation was observed in Zhambyl Oblast, where 24.3 percent of women admitted this pos- sibility, and Karaganda Oblast (21.9 percent). A similar Attitude towards Domestic Violence 166 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table CP.11: Attitude towards domestic violence among women Percentage of women aged 15-49 years who believe a husband is justified in beating his wife/partner in various circumstances, Kazakhstan, 2010/11 Percentage of women aged 15-49 who believe a husband is justified in beating his wife/partner Number of women aged 15-49 If goes out without telling him If she neglects the children If she argues with him If she refuses to have sex with him If she burns the food For any of these reasons1 Region Akmola Oblast 1,9 15,6 2,1 1,8 1,4 16,6 603 Aktobe Oblast 0,5 8,4 0,1 0,7 0,1 9,2 694 Almaty Oblast 0,6 12,7 1,3 0,6 0,4 12,7 1518 Almaty city 0,1 3,8 1,2 0,4 0,8 3,9 1190 Astana city 0,1 1,9 0,2 0,2 0,2 1,9 539 Atyrau Oblast 1,1 0,9 0,9 0,3 0,5 2,1 409 East Kazakhstan Oblast 0,5 5,1 1,7 1,0 0,3 6,2 1210 Zhambyl Oblast 9,5 15,4 14,6 5,0 4,5 24,3 836 West Kazakhstan Oblast 2,1 7,3 2,8 1,5 0,7 9,3 566 Karaganda Oblast 2,5 19,4 3,9 2,2 1,1 21,9 1274 Kostanai Oblast 1,3 16,3 3,4 1,4 0,7 17,5 791 Kyzylorda Oblast 2,1 3,8 4,1 1,4 0,8 7,4 553 Mangistau Oblast 0,5 3,4 2,2 0,7 0,2 4,7 461 Pavlodar Oblast 1,2 11,3 1,7 0,9 0,4 12,7 746 North Kazakhstan Oblast 1,2 12,0 1,7 0,9 0,4 13,0 577 South Kazakhstan Oblast 11,7 7,8 8,7 0,7 0,3 15,0 2048 Residence Urban 2,3 8,5 2,9 1,0 0,6 10,6 8055 Rural 4,2 11,4 4,7 1,5 1,0 14,3 5959 Age 15-19 2,1 7,8 3,3 0,4 0,5 9,4 2022 20-24 2,6 9,9 3,6 1,0 0,9 12,3 2178 25-29 3,7 9,1 3,1 1,3 0,6 11,8 2016 30-34 3,5 10,5 4,5 1,9 1,0 13,8 2005 35-39 2,9 10,8 4,1 1,4 0,9 13,3 1901 40-44 3,4 9,0 3,4 1,2 0,8 11,7 1919 45-49 3,7 11,1 4,1 1,4 0,8 13,1 1972 Marital/Union Status Currently married/in union 3,8 10,7 4,3 1,2 0,9 13,8 8434 Formerly married/in union 3,2 11,6 3,2 2,4 1,1 13,3 1617 Never married/in union 1,6 7,0 2,7 0,7 0,5 8,4 3963 Education Incomplete Secondary 3,0 9,9 3,5 1,4 0,8 11,3 553 Secondary 4,2 12,2 4,4 1,6 0,9 15,1 4407 Specialized Secondary 3,1 10,2 3,8 1,0 0,8 12,7 4539 Higher 2,0 6,8 2,9 1,1 0,6 9,0 4489 Wealth Index Quintile Poorest 6,4 12,2 6,3 2,0 1,4 16,6 2528 mentality was demonstrated in Akmola, Kostanai, North Kazakhstan and South Kazakhstan Oblasts, where the percentage of positive responses varied from 13 to 17 percent. High percentage of responses supporting this view was reported not only among women 30-49 years of age and women currently married/in union, but also among those already divorced. Less tolerant attitude towards domestic violence (less than 5 percent) was re- ported among women in Mangistau and Atyrau Oblasts and Astana and Almaty. 167MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of women aged 15-49 who believe a husband is justified in beating his wife/partner Number of women aged 15-49 If goes out without telling him If she neglects the children If she argues with him If she refuses to have sex with him If she burns the food For any of these reasons1 Second 4,5 11,7 5,5 1,5 0,9 14,7 2599 Middle 2,4 9,7 3,3 1,0 0,7 11,6 2743 Fourth 2,2 8,1 2,4 0,7 0,6 10,2 2839 Richest 0,9 7,8 1,8 1,0 0,5 9,1 3305 Ethnicity of Household Head Kazakh 3,6 9,4 4,3 1,4 0,8 12,3 9003 Russian 0,8 8,5 1,2 0,9 0,6 9,6 3168 Other 4,7 13,3 5,1 0,9 1,0 16,3 1843 Total 3,1 9,7 3,7 1,2 0,8 12,2 14014 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.14 As shown in Table CP.11M, percentage of men who tend to agree beating his wife for any of reasons is higher (16.7 percent) than women (12.2 percent). 10.5 percent of men agree that a man is justified in beating his wife if she neglects the children, 9.9 percent – if she argues with him, and 10 percent – if she goes out without telling him. Men from the poorest households (25.4 percent) are much more likely to agree with one of the reasons justifying violence against women than men from the richest households (9 percent). The high- est proportion of men approving at least one of these reasons is found in South Kazakhstan (49.1 percent), West Kazakhstan (17.1 percent) and Zhambyl (16.1 percent) Oblasts and in Almaty (16.7 percent), while the lowest figure is observed in Atyrau Oblast (0.6 per- cent) and Astana (2.8 percent). Table CP.11М: Attitude towards domestic violence among men Percentage of men aged 15-59 years who believe a husband is justified in beating his wife/partner in various circumstances, Kazakhstan, 2010/11 Percentage of men aged 15-59 who believe a husband is justified in beating his wife/partner Number of men aged 15-59 If goes out without telling him If she neglects the children If she argues with him If she refuses to have sex with him If she burns the food For any of these reasons1 Region Akmola Oblast 0,8 4,4 0,8 0,4 0,4 4,8 178 Aktobe Oblast 3,1 10,7 4,5 3,1 1,4 12,9 182 Almaty Oblast 4,1 11,5 11,6 4,2 1,1 14,2 423 Almaty city 4,0 14,9 5,1 2,8 0,9 16,7 302 Astana city 0,2 2,1 0,2 0,0 0,5 2,8 125 Atyrau Oblast 0,0 0,0 0,6 0,0 0,0 0,6 112 East Kazakhstan Oblast 3,7 9,9 3,6 2,6 0,8 11,0 340 Zhambyl Oblast 6,2 11,9 6,4 1,4 0,9 16,1 240 West Kazakhstan Oblast 6,5 11,9 9,0 0,4 1,6 17,1 158 Karaganda Oblast 3,7 5,9 3,2 0,4 0,0 8,2 333 Kostanai Oblast 1,0 14,1 3,0 1,1 0,0 15,5 219 Kyzylorda Oblast 2,4 1,9 4,0 0,6 0,0 5,9 157 Mangistau Oblast 0,5 12,3 3,9 1,0 0,5 13,6 121 Pavlodar Oblast 0,7 2,3 1,1 0,0 0,3 3,8 206 168 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of men aged 15-59 who believe a husband is justified in beating his wife/partner Number of men aged 15-59 If goes out without telling him If she neglects the children If she argues with him If she refuses to have sex with him If she burns the food For any of these reasons1 North Kazakhstan Oblast 2,1 9,6 2,1 1,4 0,7 10,6 164 South Kazakhstan Oblast 48,7 18,7 39,2 12,2 2,5 49,1 587 Residence Urban 6,5 8,4 6,1 1,9 0,7 13,3 2061 Rural 14,0 12,9 14,3 4,8 1,2 21,1 1785 Age 15-19 8,7 7,9 7,3 3,5 0,5 13,5 394 20-24 5,7 7,7 4,3 2,8 0,4 11,2 433 25-29 10,5 11,0 10,8 2,9 0,9 16,3 434 30-34 9,0 10,4 9,2 2,5 0,7 15,1 548 35-39 11,8 10,8 11,1 2,7 0,4 21,2 539 40-44 13,8 12,3 12,1 4,2 1,8 20,9 453 45-49 9,8 10,8 11,6 3,5 1,9 17,6 432 50-54 13,7 13,5 14,6 5,2 0,9 21,0 361 55-59 4,8 9,6 7,4 2,1 0,8 13,5 251 Marital/Union Status Currently married/ in union 10,6 10,4 10,6 3,0 0,8 17,3 2595 Formerly married/ in union 13,2 18,7 15,4 4,6 3,6 28,1 212 Never married/in union 7,9 9,1 7,0 3,6 0,7 13,7 1039 Education Incomplete Secondary 11,9 12,8 12,5 2,4 1,9 19,7 184 Secondary 11,5 12,4 11,7 4,1 1,4 19,8 1444 Specialized Secondary 10,1 10,2 9,9 2,9 0,6 16,8 1261 Higher 7,0 7,4 6,5 2,5 0,4 12,0 953 Wealth Index Quintile Poorest 18,2 13,8 17,0 4,8 1,4 25,4 737 Second 16,1 13,9 16,4 6,1 1,6 23,3 748 Middle 9,4 9,5 8,9 3,2 0,6 15,9 773 Fourth 4,7 8,7 5,5 1,7 0,9 12,0 789 Richest 2,5 7,1 2,6 0,8 0,1 9,0 799 Ethnicity of Household Head Kazakh 10,9 10,4 10,5 3,4 0,9 17,6 2374 Russian 3,8 8,8 4,3 1,3 1,0 11,4 952 Other 17,1 13,8 17,6 6,2 0,8 23,7 520 Total 15-49 10,0 10,2 9,6 3,1 0,9 16,7 3233 Total 15-59 10,.0 10,5 9,9 3,3 0,9 16,9 3846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 8.14 XII. HIV/AIDS and Sexual Behaviour 170 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN HIV transmission. Residents of Pavlodar Oblast are the most knowledgeable about the two main ways of HIV transmission (85.6 percent), while those in Kyzylorda Oblast are the least aware, 46.1 percent. Knowledge of HIV and HIV transmission is much higher in urban area (74.5 percent) than in rural (65.1 percent), and associ- ates with the education and income levels. Thus, wom- en with incomplete secondary education are the least aware, as only 51.8 percent of the respondents indi- cated they knew about the two main ways of preventing HIV transmission, compared to 78.2 percent of women with higher education. The proportion of women who know the two main ways to prevent HIV is particularly high in the age groups 25-29 and 30-39 (a little over 73 percent), while the lowest percentage (67.2 percent) was found in the age group 15-24. One of the most important prerequisites for re- ducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and of strategies for prevent- ing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconcep- tions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to im- prove the knowledge and skills of young people to pro- tect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UN- GASS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. In Kazakhstan MICS, all women who have heard of AIDS were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The re- sults are presented in Table HA.1. In Kazakhstan, almost all interviewed women (95.9 percent) have heard of HIV/AIDS. However, the percentage of women who know of two main ways of preventing HIV transmission (having only one faithful uninfected partner and using a condom every time while having sex) is only 70.5 percent. A total of 79 percent of interviewed women knows that having one faithful uninfected sex partner, and about the same percent- age (78.9 percent) knows that using a condom every time while having sex are two main ways of preventing Knowledge about HIV Transmission and Misconceptions about HIV/AIDS 171MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Percentage of women age 15-49 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can have the HIV virus, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Kazakhstan, 2010/11 P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of w om en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f w om en H av in g on ly o ne fa ith fu l u ni nf ec te d se x pa rtn er U si ng a c on do m e ve ry tim e M os qu ito b ite s S up er na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV Region Akmola Oblast 99,2 72,7 71,6 58,1 82,6 63,8 84,2 76,0 47,9 30,1 603 Aktobe Oblast 91,5 75,7 75,4 68,9 68,5 62,8 87,9 68,1 34,2 28,3 694 Almaty Oblast 96,1 85,6 82,0 78,4 58,0 87,0 86,4 78,5 50,1 47,7 1518 Almaty city 99,5 89,0 77,0 73,4 83,9 96,6 98,9 86,2 72,2 55,5 1190 Astana city 99,8 80,4 77,7 64,8 50,9 88,9 97,3 87,7 45,4 40,1 539 Atyrau Oblast 97,1 75,1 77,3 70,1 43,6 85,7 87,5 71,1 33,1 28,9 409 East Kazakhstan Oblast 90,0 76,5 77,8 69,8 66,1 64,7 78,1 73,3 44,0 38,9 1210 Zhambyl Oblast 95,0 68,6 74,3 60,5 41,0 62,5 78,8 64,1 26,6 22,0 836 West Kazakhstan Oblast 97,5 74,8 77,3 66,2 79,8 62,6 83,0 79,9 47,3 36,1 566 Karaganda Oblast 99,9 88,0 83,8 78,4 71,2 73,9 87,1 77,4 48,0 41,9 1274 Kostanai Oblast 99,8 85,4 88,0 78,7 80,6 78,3 90,9 75,6 55,4 47,3 791 Kyzylorda Oblast 92,6 53,6 61,8 46,1 48,8 71,7 79,6 50,4 24,0 13,6 553 Mangistau Oblast 95,6 81,5 80,4 70,2 39,3 74,8 89,7 71,4 23,3 16,6 461 Pavlodar Oblast 99,1 93,2 89,1 85,6 77,5 74,6 90,2 70,8 53,8 50,1 746 North Kazakhstan Oblast 99,4 82,6 82,6 71,8 80,6 60,9 79,7 73,7 42,7 35,4 577 South Kazakhstan Oblast 91,4 71,0 77,5 66,9 59,5 72,8 83,8 74,0 43,1 35,8 2048 Residence Urban 98,2 83,6 82,3 74,5 70,1 79,8 91,6 79,6 51,1 42,5 8055 Rural 92,8 72,9 74,2 65,1 58,8 67,9 79,1 67,8 37,9 31,9 5959 Age 15-24 95,6 75,5 75,8 67,2 62,4 76,6 86,6 73,2 43,8 36,2 4201 25-29 96,6 81,4 81,4 73,1 67,9 75,9 88,5 76,4 48,0 39,2 2016 30-39 97,1 82,1 81,3 73,3 67,1 75,4 87,2 76,4 46,9 40,3 3906 172 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Results for women age 15-24 are separately presented in Table HA.2. In Kazakhstan, 95.6 percent of all surveyed women in this age group had heard about HIV, but only 67.2 percent of the respondents indicated that they were aware of at least two ways to prevent HIV transmission. Women age 15-19 are less aware about ways to prevent HIV (61.5 percent) than older respondents (72.5 percent). Awareness about HIV and ways to prevent HIV transmission is higher in urban than in rural areas and also depends on the level of education and income of interviewed women. Residents of Kostanai Oblast are the most knowledgeable (84 percent), whereas only 32.4 percent of Kyzylorda Oblast residents are aware of two main ways of preventing HIV transmission. P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of w om en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f w om en H av in g on ly o ne fa ith fu l u ni nf ec te d se x pa rtn er U si ng a c on do m e ve ry tim e M os qu ito b ite s S up er na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV 40-49 94,8 78,6 78,4 69,8 65,4 71,6 83,9 73,2 44,4 37,0 3891 Marital/Union Status Married/in union 96,1 80,3 80,6 72,0 66,3 73,7 85,9 74,8 45,7 38,5 10051 Never married/ in union 95,4 75,8 74,6 66,6 62,8 77,5 87,4 73,8 44,9 36,7 3963 Woman’s Education Incomplete Secondary 89,2 61,1 62,2 51,8 45,9 60,1 74,3 58,5 28,4 19,9 553 Secondary 91,9 70,4 71,8 62,2 55,3 65,3 77,3 64,3 34,0 28,1 4407 Specialized Secondary 97,9 82,4 82,0 73,5 68,1 76,3 89,2 77,2 46,8 38,9 4539 Higher 99,1 86,7 85,1 78,2 75,1 84,7 94,1 84,3 57,7 49,2 4489 Wealth Index Quintile Poorest 88,4 63,5 67,1 55,9 51,2 60,7 72,5 60,5 31,0 25,2 2528 Second 94,4 73,7 75,4 65,8 58,8 71,0 82,0 69,9 38,0 31,4 2599 Middle 97,7 80,3 80,3 71,5 67,0 74,7 87,9 77,3 46,6 38,4 2743 Fourth 98,7 86,2 84,9 78,0 73,3 80,9 91,9 79,5 52,3 44,8 2839 Richest 99,1 87,9 84,3 78,0 72,9 83,2 94,0 82,5 55,5 46,9 3305 Ethnicity of Household Head Kazakh 95,4 76,4 76,7 67,7 61,0 74,4 84,8 72,8 42,0 34,8 9003 Russian 98,9 88,1 85,9 79,8 78,4 78,0 91,9 81,7 56,1 48,1 3168 Other 93,5 76,5 77,2 67,8 64,1 71,1 83,9 70,7 43,8 36,2 1843 Total 95,9 79,0 78,9 70,5 65,3 74,8 86,3 74,6 45,4 38,0 14014 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.1 173MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e H A .2 : K no w le dg e ab ou t H IV tr an sm is si on , m is co nc ep tio ns a bo ut H IV /A ID S an d co m pr eh en si ve k no w le dg e ab ou t t ra ns m is si on a m on g yo un g w om en P er ce nt ag e of y ou ng w om en a ge 1 5- 24 y ea rs w ho k no w th e m ai n w ay s of p re ve nt in g H IV tr an sm is si on , p er ce nt ag e w ho k no w th at a h ea lth y lo ok in g pe rs on ca n ha ve th e H IV v iru s, p er ce nt ag e w ho re je ct c om m on m is co nc ep tio ns , a nd p er ce nt ag e w ho h av e co m pr eh en si ve k no w le dg e ab ou t H IV tr an sm is si on , K az ak hs ta n, 2 01 0/ 11 Pe rc en t- ag e w ho ha ve he ar d of H IV Pe rc en ta ge w ho k no w tr an s- m is si on c an b e pr ev en te d by P er ce nt - ag e of w om en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a h ea lth y lo ok in g pe rs on ca n ha ve th e H IV v iru s Pe rc en ta ge w ho th in k th at H IV ca nn ot b e tr an sm itt ed b y P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns a nd kn ow th at a h ea lth y lo ok in g pe rs on c an ha ve th e H IV v iru s Percentage with comprehensive knowledge 1 Number of women age 15-24 H av in g on ly on e fa ith fu l un in fe ct ed s ex pa rtn er U si ng a c on - do m e ve ry ti m e M os - qu ito bi te s S up er - na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV R eg io n A km ol a O bl as t 98 ,9 70 ,9 69 ,3 54 ,8 88 ,3 65 ,5 84 ,7 77 ,1 52 ,7 32 ,0 15 2 A kt ob e O bl as t 96 ,3 76 ,8 74 ,5 68 ,4 68 ,3 68 ,1 92 ,9 69 ,1 33 ,8 27 ,0 21 0 A lm at y O bl as t 94 ,9 83 ,1 79 ,5 76 ,3 55 ,4 88 ,0 83 ,6 73 ,6 47 ,0 46 ,0 51 1 A lm at y ci ty 10 0, 0 84 ,9 74 ,2 69 ,0 83 ,2 97 ,4 99 ,4 82 ,5 68 ,6 50 ,4 31 4 A st an a ci ty 10 0, 0 80 ,5 77 ,9 64 ,5 53 ,5 90 ,3 98 ,2 90 ,8 48 ,1 41 ,8 16 8 A ty ra u O bl as t 97 ,0 68 ,2 70 ,6 63 ,5 34 ,7 83 ,9 86 ,3 66 ,9 26 ,2 22 ,4 13 5 E as t K az ak hs ta n O bl as t 90 ,9 71 ,8 75 ,5 65 ,7 64 ,6 66 ,1 76 ,5 75 ,9 42 ,6 34 ,3 34 9 Zh am by l O bl as t 96 ,3 67 ,2 70 ,9 58 ,1 38 ,4 66 ,3 82 ,8 65 ,7 25 ,4 22 ,1 25 2 W es t K az ak hs ta n O bl as t 98 ,7 70 ,2 75 ,3 62 ,1 76 ,4 71 ,4 88 ,6 84 ,6 48 ,0 34 ,0 16 4 K ar ag an da O bl as t 99 ,7 85 ,7 83 ,9 77 ,7 72 ,8 81 ,6 89 ,6 78 ,7 54 ,5 46 ,3 36 6 K os ta na i O bl as t 10 0, 0 88 ,3 91 ,5 84 ,0 78 ,3 84 ,1 94 ,5 74 ,1 56 ,6 52 ,1 22 4 K yz yl or da O bl as t 89 ,8 41 ,0 44 ,8 32 ,4 39 ,5 67 ,7 71 ,0 42 ,6 18 ,0 8, 8 16 2 M an gi st au O bl as t 91 ,9 77 ,8 77 ,0 67 ,0 32 ,9 69 ,3 85 ,8 65 ,1 16 ,6 11 ,9 15 8 P av lo da r O bl as t 98 ,4 90 ,1 86 ,3 81 ,2 77 ,4 74 ,8 89 ,0 68 ,6 53 ,8 49 ,8 20 5 N or th K az ak hs ta n O bl as t 10 0, 0 85 ,2 84 ,2 75 ,1 84 ,4 74 ,0 85 ,9 79 ,6 54 ,9 45 ,7 14 6 S ou th K az ak hs ta n O bl as t 90 ,1 64 ,3 70 ,8 60 ,1 54 ,6 69 ,0 83 ,9 70 ,7 37 ,0 29 ,3 68 5 R es id en ce U rb an 97 ,6 79 ,3 79 ,0 70 ,3 67 ,6 79 ,9 90 ,9 77 ,3 48 ,8 39 ,7 24 22 R ur al 92 ,9 70 ,4 71 ,5 63 ,1 55 ,3 72 ,2 80 ,7 67 ,7 37 ,0 31 ,3 17 79 174 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN P er ce nt - ag e w ho ha ve he ar d of H IV Pe rc en ta ge w ho k no w tr an s- m is si on c an b e pr ev en te d by P er ce nt - ag e of w om en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a h ea lth y lo ok in g pe rs on ca n ha ve th e H IV v iru s Pe rc en ta ge w ho th in k th at H IV ca nn ot b e tr an sm itt ed b y P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns a nd kn ow th at a h ea lth y lo ok in g pe rs on c an ha ve th e H IV v iru s Percentage with comprehensive knowledge 1 Number of women age 15-24 H av in g on ly on e fa ith fu l un in fe ct ed s ex pa rtn er U si ng a c on - do m e ve ry ti m e M os - qu ito bi te s S up er - na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV A ge 15 -1 9 93 ,8 70 ,2 69 ,7 61 ,5 55 ,5 72 ,9 83 ,7 68 ,6 37 ,5 30 ,2 20 22 20 -2 4 97 ,3 80 ,5 81 ,5 72 ,5 68 ,7 80 ,1 89 ,3 77 ,5 49 ,7 41 ,7 21 78 M ar ita l/u ni on S ta tu s M ar rie d/ in u ni on 97 ,3 80 ,6 82 ,3 72 ,9 67 ,0 77 ,5 87 ,8 75 ,2 47 ,1 39 ,5 12 11 N ev er m ar rie d/ in un io n 95 ,0 73 ,5 73 ,2 64 ,9 60 ,5 76 ,3 86 ,1 72 ,4 42 ,5 34 ,8 29 90 W om an ’s E du ca tio n In co m pl et e S ec on da ry 90 ,9 59 ,9 59 ,8 50 ,1 48 ,3 64 ,9 77 ,9 59 ,6 30 ,5 22 ,4 30 7 S ec on da ry 91 ,9 66 ,8 67 ,6 57 ,8 51 ,3 69 ,2 79 ,3 64 ,0 33 ,2 26 ,1 13 30 S pe ci al iz ed S ec on da ry 97 ,3 79 ,3 80 ,1 71 ,1 65 ,9 78 ,8 89 ,3 75 ,4 45 ,2 37 ,7 12 24 H ig he r 99 ,0 84 ,5 83 ,8 77 ,2 73 ,5 84 ,8 93 ,6 83 ,7 56 ,2 48 ,1 13 37 W ea lth In de x Q ui nt ile P oo re st 90 ,0 63 ,3 64 ,9 55 ,2 50 ,5 64 ,5 76 ,3 61 ,5 30 ,9 25 ,0 79 9 S ec on d 93 ,1 68 ,8 69 ,9 60 ,5 53 ,9 74 ,7 82 ,0 68 ,2 36 ,9 30 ,0 79 0 M id dl e 97 ,4 76 ,6 78 ,1 68 ,2 64 ,1 75 ,9 88 ,4 76 ,1 44 ,9 37 ,1 88 4 Fo ur th 98 ,4 83 ,0 82 ,4 75 ,8 71 ,8 81 ,8 92 ,0 78 ,0 51 ,1 43 ,3 82 2 R ic he st 98 ,4 84 ,3 82 ,4 74 ,9 70 ,0 85 ,0 93 ,0 80 ,9 53 ,5 44 ,0 90 6 Et hn ic ity o f H ou se ho ld H ea d K az ak h 95 ,3 73 ,3 73 ,2 64 ,6 58 ,2 76 ,1 85 ,6 72 ,3 39 ,9 32 ,3 28 42 R us si an 98 ,8 86 ,5 86 ,9 79 ,8 77 ,9 82 ,2 93 ,2 81 ,0 58 ,7 50 ,3 80 7 O th er 92 ,3 71 ,0 73 ,0 62 ,4 61 ,2 71 ,3 81 ,8 66 ,7 42 ,2 35 ,3 55 3 To ta l 95 ,6 75 ,5 75 ,8 67 ,2 62 ,4 76 ,6 86 ,6 73 ,2 43 ,8 36 ,2 42 01 ‘N o ed uc at io n’ c at eg or y ha s be en e xc lu de d du e to in si gn ifi ca nt n um be r o f r es po ns es 1M IC S In di ca to r 9 .2 ; M D G In di ca to r 6 .3 175MONITORING THE SITUATION OF CHILDREN AND WOMEN Tables HA.1 and HA.2 also present the percent- age of women who can correctly identify misconcep- tions concerning HIV. The indicator is based on the two most common and relevant misconceptions, that HIV can be transmitted by supernatural means and through mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by sharing food. Not all interviewed women can reject the two most common misconceptions and only 74.6 percent of women know that HIV cannot be transmitted by shar- ing food, 74.8 percent of women know that HIV can- not be transmitted through mosquito bites, while 86.3 percent of women know that HIV cannot be transmitted by supernatural means. Women aged 20-24 and 25-29 are the most knowledgeable. The level of awareness of misconceptions concerning HIV transmission also correlates with residence (residents of urban areas are more knowledgeable) and the level of women’s edu- cation and wealth. Women who have comprehensive knowledge about HIV prevention include women who know of the two ways of HIV prevention (having only one faithful uninfected partner and using a condom ev- ery time), who know that a healthy looking person can have the HIV virus, and who reject the two most com- mon misconceptions. Tables HA.1 and HA.2 also present the percent- age of women with comprehensive knowledge. Comprehensive knowledge of HIV prevention methods and transmission is still fairly low although there are significant regional differences. Overall, only 38 percent of women were found to have comprehen- sive knowledge, which was higher in urban areas than in rural ones (42.5 and 31.9 percent respectively). As expected, the percent of women with comprehensive knowledge increases pro rata to the woman’s education level, from 19.9 percent of women with incomplete sec- ondary education to 49.2 percent of those with higher education (Figure HA.1). Furthermore, percentage of women with comprehensive knowledge is the highest in the richest households, 46.9 percent. Percentage of women with comprehensive knowledge is the lowest in the age group 15-24, 36.2 percent. Percentage of women having sufficient knowledge of HIV prevention (can identify 2 ways of prevention and 3 misconcep- tions) is high in Almaty (55.5 percent), a low percent- age was found in Kyzylorda (13.6 percent), Mangistau (16.6 percent) and Zhambyl (22 percent) Oblasts. 176 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about HIV transmission Percentage of men age 15-59 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can have the HIV virus, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Kazakhstan, 2010/11 P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of m en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f m en H av in g on ly o ne fa ith fu l u ni nf ec te d se x pa rtn er U si ng a c on do m ev er y tim e M os qu ito b ite s S up er na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV Region Akmola Oblast 99,2 85,4 85,0 79,1 88,1 63,3 87,0 72,8 51,3 40,4 178 Aktobe Oblast 82,9 70,9 66,9 62,6 51,8 53,9 69,7 56,5 22,4 18,7 182 Almaty Oblast 87,2 72,5 78,7 69,4 55,6 84,0 84,6 81,6 54,5 47,4 423 Almaty city 98,1 89,6 79,5 76,1 84,8 91,4 95,4 87,5 72,5 58,5 302 Astana city 100,0 89,8 82,3 77,8 69,1 80,4 97,6 81,7 54,9 49,8 125 Atyrau Oblast 98,1 92,9 85,6 82,8 31,0 71,7 84,1 51,7 23,5 23,5 112 East Kazakhstan Oblast 85,1 73,6 76,6 67,4 58,3 56,6 76,0 69,3 35,5 32,5 340 Zhambyl Oblast 95,7 72,0 85,8 69,4 78,3 52,2 80,4 74,5 42,0 37,1 240 West Kazakhstan Oblast 97,2 70,0 71,5 60,5 73,9 49,9 78,0 72,0 36,8 29,6 158 Karaganda Oblast 100,0 88,5 89,6 82,1 76,5 65,5 83,3 78,5 51,7 48,2 333 Kostanai Oblast 100,0 84,0 83,8 74,5 70,7 77,7 91,7 65,7 42,8 39,1 219 Kyzylorda Oblast 86,6 82,1 79,8 78,5 50,5 78,8 81,8 73,9 45,8 45,0 157 Mangistau Oblast 95,0 78,9 57,6 51,8 46,7 85,8 88,5 78,3 40,7 22,1 121 Pavlodar Oblast 100,0 99,3 98,9 98,5 92,9 87,4 97,3 84,0 70,8 70,4 206 North Kazakhstan Oblast 98,9 82,2 84,3 72,2 88,5 55,6 84,3 76,3 46,7 39,9 164 South Kazakhstan Oblast 97,0 93,7 73,3 72,7 84,8 13,9 95,2 15,3 11,3 9,9 587 Residence Urban 97,5 87,8 83,6 78,3 77,1 71,0 91,0 74,5 51,2 44,9 2061 Rural 91,3 77,9 75,7 68,1 64,9 51,7 81,4 55,9 32,3 28,2 1785 Age 15-24 95,3 80,4 79,1 70,5 69,0 62,7 88,6 63,4 40,3 34,1 826 25-29 95,6 87,0 81,2 76,1 74,0 72,0 87,3 70,4 48,7 43,8 434 30-39 96,3 87,9 82,0 77,6 75,4 62,6 88,8 67,8 45,0 40,5 1088 40-49 93,0 81,5 79,7 73,1 67,5 60,4 85,1 65,7 40,8 35,2 885 50-59 92,4 78,4 76,6 69,3 71,4 55,7 81,4 62,9 38,5 33,6 613 Marital/Union Status Married/in union 94,7 84,2 80,5 74,6 72,7 61,8 86,5 66,4 43,0 37,9 2807 177MONITORING THE SITUATION OF CHILDREN AND WOMEN P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of m en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f m en H av in g on ly o ne fa ith fu l u ni nf ec te d se x pa rtn er U si ng a c on do m ev er y tim e M os qu ito b ite s S up er na tu ra l m ea ns S ha rin g fo od w ith so m eo ne w ith H IV Never married/in union 94,4 80,4 78,2 70,7 68,0 62,9 86,8 64,5 40,7 35,2 1039 Education Incomplete secondary 92,3 75,8 78,0 67,9 63,0 45,2 76,0 53,0 27,2 24,2 184 Secondary 90,4 76,5 72,8 65,1 62,0 53,5 80,4 57,5 31,8 27,5 1444 Specialized secondary 97,1 85,9 83,6 77,1 76,0 65,1 89,5 68,9 45,4 40,0 1261 Higher 98,4 91,6 86,3 83,0 81,4 74,6 94,3 77,3 57,6 50,7 953 Wealth Index Quintile Poorest 88,2 71,3 68,8 59,8 60,9 37,3 76,2 41,0 19,7 16,9 737 Second 92,1 78,4 75,3 67,2 69,5 51,4 83,7 55,2 33,7 28,7 748 Middle 95,6 85,4 82,3 76,1 73,1 63,6 87,8 69,3 45,2 39,9 773 Fourth 97,8 88,2 87,1 81,6 74,2 75,3 91,9 80,5 53,2 47,5 789 Richest 98,8 91,5 84,9 81,9 78,5 80,3 92,3 81,1 58,2 51,0 799 Ethnicity of Household Head Kazakh 93,2 81,3 76,5 70,1 66,2 58,4 84,8 60,8 37,0 31,9 2374 Russian 97,6 87,5 87,3 81,0 82,8 72,2 90,1 79,9 55,9 49,7 952 Other 95,8 84,1 81,9 75,9 74,2 60,3 88,0 63,5 42,3 38,4 520 Total (15-49) 95,0 84,1 80,5 74,4 71,4 63,3 87,5 66,4 43,2 37,9 3233 Total (15-59) 94,6 83,2 79,9 73,6 71,.4 62,1 86,6 65,9 42,4 37,2 3846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.1 Awareness about HIV and ways to prevent HIV trans- mission is much higher in urban areas (78.3 percent), than in rural areas (68.1 percent) and also correlates with the level of men’s education and income. Men with incomplete secondary education are the least knowledgeable, as only 67.9 percent of respondents indicated they knew about the two ways of preventing HIV transmission compared to 83 percent of men with higher education. The proportion of men aware of the two ways to prevent HIV is particularly high in the age group 30-39 (77.6 percent), while the lowest percent- age (69.3 percent) is found in the age group 50-59. Tables HA.1M and HA.2M also present the per- centage of men who can correctly identify misconcep- tions concerning HIV. The indicator is based on the two The results of a similar survey among men showed that almost all interviewed men aged 15-59 years (94.6 percent) had ever heard of HIV, with the proportion of men knowing the two main ways of HIV prevention being 73.6 percent. The survey showed that men are better aware of HIV prevention methods than women. About 83.2 percent of men know that having only one faithful un- infected sex partner is the main way of preventing HIV transmission; about the same percentage (79.9 per- cent) know that using a condom during each sexual contact is the other way. Residents of Pavlodar Oblast (98.5 percent) are the most aware of the two main ways to prevent HIV transmission, whereas residents of Mangistau Oblast are the least aware, 51.8 percent. 178 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS and comprehensive knowledge about transmission among young men Percentage of young men age 15-24 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can have the HIV virus, percentage who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Kazakhstan, 2010/11 P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of m en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f m en a ge 1 5- 24 H av in g on ly o ne fa ith - fu l u ni nf ec te d se x pa rtn er U si ng a c on do m e ve ry tim e M os qu ito b ite s Su pe rn at ur al m ea ns S ha rin g fo od w ith so m eo ne w ith A ID S Region Akmola Oblast 100,0 86,5 91,4 83,1 85,3 63,4 84,8 67,0 50,3 40,1 41 Aktobe Oblast 92,7 89,1 83,4 81,7 57,8 63,2 80,6 64,8 30,6 26,9 47 Almaty Oblast 91,2 59,3 74,7 53,9 44,5 86,8 91,2 83,7 44,5 30,5 97 Almaty city 98,1 79,7 75,1 69,3 78,8 95,3 96,5 83,8 63,8 49,8 73 Astana city 100,0 85,3 82,1 74,9 54,3 79,2 97,9 82,2 43,5 42,1 33 Atyrau Oblast 97,6 94,2 91,2 87,8 28,9 68,5 87,1 42,0 19,8 19,8 29 East Kazakhstan Oblast (90,9) (73,5) (84,4) (67,0) (56,1) (64,8) (72,5) (72,7) (43,4) (37,8) 45 Zhambyl Oblast 92,8 68,6 81,0 67,0 81,4 51,5 78,9 67,5 42,3 32,3 56 most common and relevant misconceptions, that HIV can be transmitted by supernatural means and through mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by sharing food. The survey has shown that men are slightly more aware of these issues than women. Not all interviewed men can reject the two most common misconceptions and only 65.9 percent of men know that HIV cannot be transmitted by sharing food, 62.1 percent of men know that HIV cannot be transmitted by mosquito bites, while 86.6 percent of men know that HIV cannot be transmitted by super- natural means. Men aged 25-29 and 30-39 are the most know- ledgeable. The level of awareness of misconceptions concerning HIV transmission also correlates with resi- dence (residents of urban areas are more knowledgeable – 51.2 percent versus 32.3 percent for those from rural areas), level of men’s education (men with higher levels of education are the most knowledgeable – 57.6 percent which is two times higher than that of the men with incom- plete secondary education (27.2 percent) and men with secondary education (31.8 percent)) and income (the share of aware men increases from 19.7 percent in the poorest to 58.2 percent in the richest households). Men who have comprehensive knowledge about HIV prevention include men who know of the two ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can have the HIV virus, and who reject the two most common misconceptions. Tables HA.1M and HA.2M also present the percentage of men with comprehensive knowledge. Comprehensive knowledge of HIV prevention meth- ods and transmission is still fairly low although there are significant regional differences. Overall, only 37.2 percent of men were found to have comprehensive knowledge, which was higher in urban areas than in rural ones (44.9 and 28.2 percent respectively). The percentage of men with comprehensive knowledge increases pro rata to their wealth level, from 16.9 percent in the poorest households to 51.0 percent in the richest households. Furthermore, percentage of women with comprehensive knowledge is the highest in the richest households, 47.3 percent. Percentage of men having sufficient knowledge of HIV prevention (can identify 2 ways of prevention and 3 misconcep- tions) is the highest in Pavlodar Oblast (70.4 percent), while the lowest was found in South Kazakhstan (9.9 percent) Oblast. 179MONITORING THE SITUATION OF CHILDREN AND WOMEN P er ce nt ag e w ho h av e he ar d of H IV Percentage who know transmission can be prevented by P er ce nt ag e of m en w ho k no w bo th w ay s P er ce nt ag e w ho k no w th at a he al th y lo ok in g pe rs on c an h av e th e H IV v iru s Percentage who think that HIV cannot be transmitted by P er ce nt ag e w ho re je ct th e tw o m os t c om m on m is co nc ep tio ns an d kn ow th at a h ea lth y lo ok in g pe rs on c an h av e th e H IV v iru s P er ce nt ag e w ith c om pr eh en si ve kn ow le dg e 1 N um be r o f m en a ge 1 5- 24 H av in g on ly o ne fa ith - fu l u ni nf ec te d se x pa rtn er U si ng a c on do m e ve ry tim e M os qu ito b ite s Su pe rn at ur al m ea ns S ha rin g fo od w ith so m eo ne w ith A ID S West Kazakhstan Oblast (100,0) (58,3) (79,9) (58,3) (82,5) (54,5) (89,7) (74,2) (43,2) (34,7) 30 Karaganda Oblast (100,0) (87,5) (91,0) (78,5) (89,1) (67,1) (88,7) (83,8) (53,7) (46,8) 51 Kostanai Oblast 100,0 81,3 87,8 74,7 76,7 74,5 96,2 64,9 45,0 40,3 49 Kyzylorda Oblast (90,7) (90,7) (85,8) (85,8) (63,8) (86,9) (88,1) (82,9) (59,8) (57,8) 32 Mangistau Oblast (90,0) (74,9) (57,4) (47,5) (25,1) (72,9) (81,6) (60,0) (15,7) (7,8) 30 Pavlodar Oblast (100,0) (97,9) (100,0) (97,9) (95,4) (95,6) (95,6) (85,0) (80,6) (78,5) 36 North Kazakhstan Oblast (97,5) (92,8) (87,8) (85,6) (92,9) (61,9) (81,6) (76,7) (54,3) (52,1) 23 South Kazakhstan Oblast 93,5 86,9 63,8 63,8 76,7 12,5 91,2 15,5 11,1 11,1 154 Residence Urban 97,7 85,7 84,2 77,3 76,1 71,0 90,7 69,9 48,9 43,1 465 Rural 92,2 73,4 72,6 61,7 59,8 52,0 85,8 55,0 29,3 22,6 361 Age 15-19 93,5 75,1 77,3 66,9 64,5 58,4 84,8 62,8 35,6 29,5 394 20-24 97,0 85,2 80,7 73,7 73,1 66,6 91,9 63,9 44,6 38,3 433 Marital/Union Status Married/in union 94,5 83,5 82,6 77,4 78,0 70,0 87,7 67,4 52,0 48,6 117 Never married/ in union 95,4 79,8 78,5 69,3 67,5 61,5 88,7 62,7 38,4 31,7 710 Education Incomplete Secondary 94,1 74,9 73,0 61,9 64,7 46,9 84,3 51,6 27,0 22,5 69 Secondary 91,6 74,8 75,2 64,4 59,3 56,9 84,2 58,2 31,6 26,7 291 Specialized Secondary 97,6 82,6 82,5 74,2 72,0 65,9 89,6 67,0 43,0 35,4 259 Higher 98,3 87,5 82,6 77,4 80,3 72,3 95,0 70,2 53,8 46,9 207 Wealth Index Quintile Poorest 87,3 62,8 60,4 49,4 53,1 36,9 81,0 40,8 16,8 13,0 140 Second 97,3 83,2 81,1 71,2 74,1 53,5 90,3 52,4 34,4 28,8 165 Middle 93,8 82,0 80,5 73,2 70,2 58,6 85,4 63,5 41,0 33,6 193 Fourth 98,2 84,3 85,0 76,1 69,0 77,9 91,0 78,1 50,8 43,6 168 Richest 99,1 86,7 85,5 79,1 76,1 83,9 94,6 78,8 55,2 48,9 160 Ethnicity of Household Head Kazakh 94,6 80,6 76,5 67,9 64,7 57,3 87,2 58,1 34,7 29,0 549 Russian 99,2 85,8 90,8 81,2 80,2 80,0 95,1 79,4 56,3 48,2 167 Other 92,9 71,1 74,3 67,2 73,3 63,5 85,6 65,4 44,2 38,5 111 Total 95,3 80,4 79,1 70,5 69,0 62,7 88,6 63,4 40,3 34,1 826 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.2; MDG Indicator 6.3 180 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table НА.3: Knowledge of mother-to-child HIV transmission Percentage of women age 15-49 years who correctly identify means of HIV mother-to-child transmission, Kazakhstan, 2010/11 Percentage who know HIV can be transmitted from mother to child Percent who know HIV can be transmitted Does not know any of the specific means Number of womenDuring pregnancy During delivery By breastfeeding All three means1 Region Akmola Oblast 89,2 86,4 76,2 51,7 48,1 10,0 603 Aktobe Oblast 79,2 77,1 74,3 64,1 62,5 12,3 694 Almaty Oblast 87,3 85,9 82,9 74,1 72,7 8,8 1518 Almaty city 94,2 93,0 89,1 57,0 55,5 5,3 1190 Astana city 95,2 86,1 89,9 65,4 62,9 4,6 539 Atyrau Oblast 78,8 75,4 52,1 59,4 45,0 18,3 409 East Kazakhstan Oblast 80,8 72,3 70,2 38,2 35,6 9,2 1210 Zhambyl Oblast 86,9 83,0 71,1 59,0 50,1 8,1 836 West Kazakhstan Oblast 87,6 81,0 78,0 65,5 57,2 9,9 566 Karaganda Oblast 91,8 88,1 74,1 42,7 37,2 8,1 1274 Kostanai Oblast 90,2 83,5 80,9 50,8 46,4 9,5 791 Kyzylorda Oblast 80,1 78,0 73,3 64,1 61,9 12,5 553 Mangistau Oblast 82,0 79,1 69,7 62,1 57,3 13,6 461 Pavlodar Oblast 92,5 83,2 81,5 48,5 41,2 6,5 746 North Kazakhstan Oblast 90,0 86,0 76,2 56,2 49,7 9,5 577 South Kazakhstan Oblast 87,3 85,2 76,1 59,3 55,0 4,1 2048 Residence Urban 91,0 86,1 80,8 56,8 52,5 7,3 8055 Rural 82,9 80,1 72,0 56,9 52,4 9,9 5959 Age group 15-24 83,6 79,1 71,4 54,1 48,6 12,0 4201 25+ 89,2 85,4 79,5 58,1 54,1 6,8 9813 Knowledge of mother-to-child transmission of HIV is also a first important step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be trans- mitted during pregnancy, delivery, and through breast- feeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.3. Overall, 87.6 percent of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 52.5 percent, while 8.4 percent of women did not know of any spe- cific way. The best known way of HIV mother-to-child transmission among women is transplacental, as 83.5 percent of respondents indicated that they know this mode of transmission. The least known way of HIV mother-to-child transmission is breastfeeding, as only 56.9 percent of women are aware of this way. In terms of regions, the highest proportion of women aware of the three ways of HIV mother-to-child transmission is found in Almaty Oblast (72.7 percent) and in Astana (62.9 percent), while the lowest awareness percent- age is found in Karaganda (37.2 percent) and East- Kazakhstan (35.6 percent) Oblasts. Awareness does not correlate with residence: more than 52.0 percent of urban and rural women are aware of the three ways of HIV mother-to-child trans- mission. At the same time, awareness depends on the level of education and wealth; only 39.5 percent of women with incomplete secondary education could identify the three ways of HIV mother-to-child transmis- sion, compared to 57.5 percent of women with higher education. Awareness also depends on the respon- dents’ age: only 43.7 percent of women aged 15-19 could identify the three ways of HIV mother-to-child transmission, this indicator peaks in the age group 25- 29 (55.5 percent) and drops to 52.8 percent in the age group 40-49. 181MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage who know HIV can be transmitted from mother to child Percent who know HIV can be transmitted Does not know any of the specific means Number of womenDuring pregnancy During delivery By breastfeeding All three means1 Age group 15-19 77,5 73,7 64,1 48,9 43,7 16,3 2022 20-24 89,4 84,2 78,1 58,9 53,2 8,0 2178 25-29 89,9 86,4 79,2 60,3 55,5 6,6 2016 30-39 90,8 86,5 80,7 59,0 54,7 6,4 3906 40-49 87,3 83,8 78,3 55,9 52,8 7,4 3891 Marital/Union Status Married/in union 89,8 85,9 79,6 58,6 54,5 6,4 10051 Never married/in union 81,9 77,6 70,6 52,3 47,4 13,5 3963 Education Incomplete secondary 71,8 67,7 58,4 43,4 39,5 17,5 553 Secondary 80,9 77,3 70,3 52,9 48,8 11,0 4407 Specialized secondary 91,0 86,5 80,1 57,8 52,9 6,9 4539 Higher 93,0 89,0 83,3 61,8 57,5 6,1 4489 Wealth Index Quintile Poorest 78,9 76,1 68,4 52,6 48,3 9,5 2528 Second 84,7 81,9 73,4 59,1 54,8 9,7 2599 Middle 88,9 85,1 77,5 59,6 54,7 8,8 2743 Fourth 90,2 84,8 79,8 57,5 53,0 8,5 2839 Richest 93,1 88,1 83,8 55,5 51,5 6,0 3305 Ethnicity of Household Head Kazakh 86,2 82,6 75,5 58,5 53,8 9,2 9003 Russian 92,2 86,7 82,1 53,0 49,6 6,7 3168 Other 86,2 82,7 75,6 55,3 51,0 7,2 1843 Total 87,6 83,5 77,0 56,9 52,5 8,4 14014 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.3 transmission is found in South Kazakhstan Oblast (63.7 percent) and in Almaty (56.7 percent), while the lowest awareness percentage is found in Zhambyl (13.7 percent) and East-Kazakhstan (20.0 percent) Oblasts. Men living in urban areas are better aware about the possibilities of HIV mother-to-child transmis- sion than those in rural areas (41.5 and 34.7 percent respectively). The level of awareness increases from 29.4 percent among men with primary/incomplete sec- ondary education to 47.9 percent among men with higher education. There is direct correlation between wealth and awareness, as only 35.5 percent of men from the poorest households could identify the three ways of HIV mother-to-child transmission, while this percentage among men from the wealthiest house- holds was 44.2. Men from age groups 25-29 and 30-39 are the most knowledgeable (39.4 and 42.3 per- cent respectively), while men aged 15-19 (30 percent) were the least knowledgeable. Men aged 15-59 years were also surveyed on their awareness of HIV mother-to-child transmission (Table HA.3M). Overall, men are less aware of possi- bilities and ways of transmission of HIV from mother to child than women. Only 78.9 percent of men know that HIV can be transmitted from mother to child (8.3 per- cent less than women). The proportion of men aware of all three ways of HIV mother-to-child transmission (38.3 percent) is also lower than that of women, while 15.7 percent of men are not aware about any of these ways. The best known way of HIV mother-to-child transmission among men (the same as for women) is transplacental, as 75.3 percent of respondents indi- cated that they know this mode of transmission. The least known way of HIV mother-to-child transmission is breastfeeding (the same as for women), as only 42.1 percent of men are aware of this. In terms of regions, the highest proportion of women aware of the three ways of HIV mother-to-child 182 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table НА.3М: Knowledge of mother-to-child HIV transmission Percentage of men age 15-59 years who correctly identify means of HIV mother-to-child transmission, Kazakhstan, 2010/11 Percentage who know HIV can be transmitted from mother to child Percent who know HIV can be transmitted Does not know any of the specific means Number of menDuring pregnancy During delivery By breastfeeding All three means1 Region Akmola Oblast 68,2 66,9 54,5 25,1 22,7 31,0 178 Aktobe Oblast 65,6 62,7 58,5 55,6 51,6 17,2 182 Almaty Oblast 74,1 73,3 35,5 24,6 24,2 13,1 423 Almaty city 96,0 96,0 94,6 56,7 56,7 2,1 302 Astana city 93,5 93,5 77,6 47,8 47,1 6,5 125 Atyrau Oblast 81,6 77,7 43,8 57,1 40,0 16,5 112 East Kazakhstan Oblast 59,1 47,0 49,5 22,8 20,0 25,9 340 Zhambyl Oblast 79,7 75,8 44,3 22,4 13,7 15,9 240 West Kazakhstan Oblast 70,2 62,3 49,3 36,8 27,5 26,9 158 Karaganda Oblast 76,7 72,5 59,4 50,2 41,5 23,3 333 Kostanai Oblast 69,8 63,4 61,9 33,2 30,9 30,2 219 Kyzylorda Oblast 78,6 78,2 76,3 46,2 44,8 8,0 157 Mangistau Oblast 73,4 61,4 61,7 61,0 49,6 21,6 121 Pavlodar Oblast 97,1 94,3 93,4 22,4 20,7 2,9 206 North Kazakhstan Oblast 84,5 78,9 66,0 47,5 40,4 14,4 164 South Kazakhstan Oblast 88,5 88,5 88,5 63,7 63,7 8,5 587 Residence Urban 83,9 80,2 72,1 44,8 41,5 13,6 2061 Rural 73,0 69,7 55,9 39,0 34,7 18,3 1785 Age group 15-24 72,7 70,2 58,7 37,2 34,2 22,7 826 25+ 80,6 76,7 66,2 43,4 39,5 13,9 3020 Age group 15-19 64,5 62,0 51,0 33,4 30,0 29,0 394 20-24 80,0 77,6 65,7 40,6 38,0 16,9 433 25-29 84,3 79,5 69,1 44,9 39,4 11,3 434 30-39 82,4 79,4 68,8 45,3 42,3 13,9 1088 40-49 79,3 74,6 63,3 41,7 36,9 13,7 885 50-59 76,6 73,1 63,9 41,5 38,2 15,8 613 Marital/Union Status Married/ in union 80,6 76,9 66,5 44,1 40,2 14,1 2807 Never married/in union 74,1 71,1 59,6 36,6 33,2 20,3 1039 Education Incomplete Secondary 69,0 63,9 53,9 34,8 29,4 23,3 184 Secondary 70,5 66,8 55,6 36,3 32,7 20,0 1444 183MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage who know HIV can be transmitted from mother to child Percent who know HIV can be transmitted Does not know any of the specific means Number of menDuring pregnancy During delivery By breastfeeding All three means1 Specialized Secondary 82,4 78,2 66,9 43,7 39,0 14,7 1261 Higher 89,1 86,7 77,5 50,2 47,9 9,4 953 Wealth Index Quintile Poorest 69,4 66,1 55,9 38,8 35,5 18,9 737 Second 75,0 72,1 59,2 41,6 38,0 17,2 748 Middle 79,3 76,2 61,3 40,6 36,1 16,2 773 Fourth 83,2 79,1 69,4 41,2 37,6 14,7 789 Richest 86,7 82,3 76,2 47,8 44,2 12,2 799 Ethnicity of Household Head Kazakh 78,1 75,1 62,9 43,6 39,4 15,1 2374 Russian 80,7 75,0 68,0 38,6 34,7 16,8 952 Other 79,0 77,1 66,5 41,5 40,3 16,8 520 Total (15-49) 79,3 75,7 64,7 42,2 38,4 15,7 3233 Total (15-59) 78,9 75,3 64,6 42,1 38,3 15,7 3846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.3 with accepting attitudes on this matter was found in some regions, such as Atyrau (6.6 percent) and Ak- tobe (7.7 percent) Oblasts. Overall, 33.8 percent of respondents believe that a female teacher with AIDS and no other diseases can be allowed to continue teaching; such attitude is found among 37.5 percent of urban respondents and 28.6 percent of rural respon- dents. Women with incomplete secondary education (22.3 percent) and the lowest income level (21.5 per- cent) are the least accepting. It should be noted that the minimum percentage of accepting respondents, 12.1 and 15.1 percent, is found in Atyrau and Aktobe Oblasts respectively. Overall, only 15.3 percent of respondents would not want to keep secret that a family member got in- fected with the HIV virus, including 18.8 percent in rural areas and 12.9 percent in urban areas. In terms of re- gions, the lowest percentage of accepting respondents is found in Mangistau (3.5 percent) and Karaganda (5.7 percent) Oblasts, while the highest percentage is found in West-Kazakhstan and Kyzylorda Oblasts (27.8 percent each). The highest percentage of accept- ing respondents was found in the poorest households (20.4 percent), while the lowest was found among women from households with the highest income (11.0 percent). The indicators on attitudes toward people liv- ing with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if re- spondents report an accepting attitude on the follow- ing four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.4 presents the attitudes of women towards people living with HIV/AIDS. In Kazakhstan, 90.7 percent of women, who have heard of AIDS, agree with at least one of accepting attitudes. The most com- mon accepting attitude is willingness to care for a fam- ily member sick with AIDS in own home: 86.4 percent of respondents agree with this, with the minimum per- centage of such respondents found in Aktobe Oblast (68.4 percent), and the maximum percentage found in West Kazakhstan and North Kazakhstan Oblasts (95.1 percent). The survey found that only 18 percent of women are willing to buy fresh vegetables from a shopkeeper or vendor with the HIV virus; among them, there are more urban residents than rural ones (20.6 and 14.2 percent respectively); the lowest percentage of people Accepting Attitudes toward People Living with HIV/AIDS 184 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table НА.4: Accepting attitudes toward people living with HIV/AIDS Percentage of women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV/AIDS, Kazakhstan, 2010/11 Accepting attitudes of women N um be r o f w om en , w ho h av e he ar d of A ID S Are willing to care for a family mem- ber with the HIV virus in own home Would buy fresh vegetables from a shopkeeper or vendor who has the HIV virus Believe that a female teacher with the HIV virus and is not sick should be allowed to con- tinue teaching Would not want to keep secret that a family member got infected with the HIV virus Agree with at least one accepting attitude Express accept- ing attitudes on all four indica- tors1 Region Akmola Oblast 87,1 13,1 31,4 14,2 91,4 1,6 598 Aktobe Oblast 68,4 7,7 15,1 9,9 74,3 2,0 635 Almaty Oblast 92,3 19,3 47,4 12,6 96,3 4,1 1459 Almaty city 90,7 27,5 40,6 19,9 97,4 3,2 1183 Astana city 77,6 21,0 32,2 8,4 88,5 0,7 538 Atyrau Oblast 79,1 6,6 12,1 22,3 83,3 1,0 397 East Kazakhstan Oblast 87,9 24,1 38,0 17,5 93,8 5,6 1088 Zhambyl Oblast 83,3 16,1 20,2 23,2 87,3 1,8 794 West Kazakhstan Oblast 95,1 17,2 33,1 27,8 97,5 2,7 552 Karaganda Oblast 92,4 20,0 43,3 5,7 95,0 0,8 1273 Kostanai Oblast 94,1 18,2 40,5 7,4 96,0 1,5 789 Kyzylorda Oblast 71,9 8,1 18,4 27,8 79,2 1,1 512 Mangistau Oblast 86,3 18,9 30,8 3,5 89,6 0,2 441 Pavlodar Oblast 84,8 17,8 45,6 7,0 90,1 1,0 739 North Kazakhstan Oblast 95,1 21,6 47,4 10,2 98,0 1,3 574 South Kazakhstan Oblast 81,6 15,0 21,7 23,3 83,3 4,2 1873 Residence Urban 86,3 20,6 37,5 12,9 91,2 2,5 7914 Rural 86,5 14,2 28,6 18,8 90,0 2,5 5531 Age 15-24 82,0 18,2 33,4 14,5 86,7 2,7 4017 25+ 88,3 17,9 34,0 15,7 92,4 2,4 9428 Age Group 15-19 76,9 15,0 30,7 13,4 81,7 1,9 1896 20-24 86,5 21,1 35,7 15,4 91,2 3,5 2121 25-29 87,5 18,7 33,9 14,2 91,6 2,5 1946 30-39 87,6 17,6 33,6 15,6 91,8 2,0 3795 40-49 89,4 17,9 34,6 16,6 93,4 2,9 3687 Marital/Union Status Married/in union 88,2 17,7 33,9 16,3 92,2 2,7 9663 Never married/ in union 81,8 18,6 33,6 13,0 86,8 2,2 3782 Education Incomplete Secondary 81,8 10,5 22,3 14,4 86,9 1,5 493 185MONITORING THE SITUATION OF CHILDREN AND WOMEN Accepting attitudes of women N um be r o f w om en , w ho h av e he ar d of A ID S Are willing to care for a family mem- ber with the HIV virus in own home Would buy fresh vegetables from a shopkeeper or vendor who has the HIV virus Believe that a female teacher with the HIV virus and is not sick should be allowed to con- tinue teaching Would not want to keep secret that a family member got infected with the HIV virus Agree with at least one accepting attitude Express accept- ing attitudes on all four indica- tors1 Secondary 84,8 14,0 26,1 17,0 88,5 2,1 4050 Specialized secondary 87,1 17,8 35,0 13,9 91,2 2,3 4446 Higher 87,7 22,6 41,1 15,4 92,6 3,3 4450 Wealth Index Quintile Poorest 85,9 12,4 21,5 20,4 88,7 2,5 2234 Second 85,9 15,8 28,7 19,2 89,5 3,2 2455 Middle 87,9 17,4 33,2 15,7 92,0 2,4 2679 Fourth 86,3 21,0 41,3 12,7 91,4 2,5 2801 Richest 86,0 21,3 40,3 11,0 91,2 2,2 3275 Ethnicity of Household Head Kazakh 85,0 16,0 29,4 16,7 89,2 2,5 8588 Russian 89,3 23,2 44,7 11,6 93,9 2,6 3134 Other 88,1 18,5 36,2 15,3 92,1 2,5 1723 Total 86,4 18,0 33,8 15,3 90,7 2,5 13445 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.4 cent) Oblasts. In Kazakhstan, only 28.5 percent of in- terviewed men believe that a female teacher with AIDS and no other diseases can be allowed to continue teaching; such attitude is found among 34.1 percent of urban respondents and 21.6 percent of rural re- spondents. Men with incomplete secondary education (20.0 percent) and the lowest income level (12.8 per- cent) are the least accepting. It should be noted that the minimum percentage of accepting respondents, 1.3 is found in South Kazakhstan Oblast. Overall, only 14.5 percent of interviewed men would not want to keep secret that a family member got infected with the HIV virus, including 15.3 percent in rural areas and 13.9 percent in urban areas. In terms of regions, the lowest percentage of accepting re- spondents is found in Mangistau (1.5 percent), Almaty (2 percent) and Pavlodar (3.5 percent) Oblasts. The highest percentage of accepting respondents was found among men with incomplete secondary educa- tion (16.3 percent) and members of the poorest house- holds (16.2 percent), while the lowest was found in households with the highest income (12.3 percent). Men aged 15-59 years were asked the same questions. Table HA.4M shows men’s attitudes towards people living with HIV/AIDS. Overall, the results of the survey show that men have less accepting attitudes to- wards people living with HIV/AIDS than women. In Kazakhstan, 88 percent of men who had heard of AIDS agree with at least one of accepting at- titudes. The most common accepting attitude is will- ingness to care for a family member sick with AIDS in own home: 83.5 percent of respondents agree with this, with the minimum percentage of such respon- dents found in South Kazakhstan Oblast (59.9 per- cent), and the maximum percentage found in Kostanai (96,1 percent), Pavlodar (95.9 percent) and Karaganda (95.4 percent) Oblasts. The survey found that only 17.7 percent of men are willing to buy fresh vegetables from a shopkeeper or vendor with the HIV virus; among them, there are more urban residents than rural ones (21.6 and 12.9 percent respectively). The lowest percentage of people with accept- ing attitudes on this matter was found in some regions, such as Mangistau (7.2 percent) and Aktobe (6.9 per- 186 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table НА.4М: Accepting attitudes toward people living with HIV/AIDS Percentage of men age 15-59 years who have heard of AIDS who express an accepting attitude towards people living with HIV/AIDS, Kazakhstan, 2010/11 Accepting attitudes of men Number of men, who have heard of HIV Are willing to care for a family member with the HIV virus in own home Would buy fresh vegetables from a shopkeeper or vendor who has the HIV virus Believe that a female teacher with the HIV virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the HIV virus Agree with at least one accepting attitude Express accepting attitudes on all four indicators1 Region Akmola Oblast 84,6 18,8 36,7 19,0 91,0 2,1 176 Aktobe Oblast 75,6 6,9 16,8 6,8 79,3 1,1 151 Almaty Oblast 89,6 29,2 35,0 2,0 91,3 1,5 369 Almaty city 81,6 25,7 38,8 20,8 94,9 3,2 296 Astana city 82,6 24,4 33,3 15,3 92,6 7,0 125 Atyrau Oblast 75,6 14,6 29,9 22,7 87,1 4,1 110 East Kazakhstan Oblast 83,1 23,7 32,5 18,7 89,4 8,1 289 Zhambyl Oblast 87,3 16,4 22,9 28,3 92,5 3,5 230 West Kazakhstan Oblast 83,0 11,3 19,5 22,7 88,1 0,4 154 Karaganda Oblast 95,4 23,6 40,3 22,3 98,4 2,9 333 Kostanai Oblast 96,1 19,0 35,6 8,5 96,9 2,3 219 Kyzylorda Oblast 93,9 36,8 40,1 30,2 97,3 8,7 136 Mangistau Oblast 92,0 7,2 23,2 1,5 93,8 0,5 115 Pavlodar Oblast 95,9 8,8 37,7 3,5 97,0 0,4 206 North Kazakhstan Oblast 92,0 25,2 45,4 17,4 98,0 2,3 163 South Kazakhstan Oblast 59,9 1,8 1,3 8,3 61,0 0,3 569 Residence Urban 86,3 21,6 34,1 13,9 91,2 3,4 2009 Rural 80,0 12,9 21,6 15,3 83,9 1,8 1630 Age 15-24 79,9 18,2 26,3 10,0 84,3 1,3 788 25+ 84,5 17,6 29,1 15,8 89,0 3,1 2852 Age Group 15-19 76,8 18,8 24,8 10,3 80,7 1,6 368 20-24 82,6 17,7 27,6 9,7 87,4 1,1 420 25-29 84,1 20,4 31,8 14,8 89,4 3,5 415 30-39 84,3 17,8 28,7 16,0 88,2 2,9 1047 40-49 85,1 17,5 27,2 14,7 89,5 3,3 824 50-59 84,3 15,2 30,8 17,6 89,3 2,8 566 Marital/Union Status Married/in union 84,9 17,0 28,6 16,1 89,2 3,0 2659 Never married/ in union 79,9 19,8 28,2 10,3 84,5 1,9 980 187MONITORING THE SITUATION OF CHILDREN AND WOMEN Accepting attitudes of men Number of men, who have heard of HIV Are willing to care for a family member with the HIV virus in own home Would buy fresh vegetables from a shopkeeper or vendor who has the HIV virus Believe that a female teacher with the HIV virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the HIV virus Agree with at least one accepting attitude Express accepting attitudes on all four indicators1 Education Incomplete secondary 77,4 10,6 20,0 16,3 82,6 1,6 170 Secondary 80,9 14,0 21,9 14,9 84,6 2,3 1306 Specialized secondary 87,3 17,6 28,6 14,4 91,2 2,6 1224 Higher 83,3 24,4 39,2 13,8 89,5 3,6 938 Wealth Index Quintile Poorest 75,7 8,4 12,8 16,2 79,5 1,8 650 Second 80,6 15,8 21,8 15,8 83,8 2,3 689 Middle 85,1 18,0 28,6 13,9 88,6 2,4 739 Fourth 87,5 23,9 37,9 14,9 92,7 4,3 771 Richest 87,1 20,8 38,1 12,3 93,4 2,6 790 Ethnicity of Household Head Kazakh 82,1 14,5 23,1 15,2 86,2 2,3 2213 Russian 86,9 24,7 41,4 15,9 92,6 4,2 929 Other 83,4 18,9 28,6 9,1 87,2 1,7 498 Total (15-49) 83,4 18,2 28,1 14,0 87,7 2,7 3073 Total (15-59) 83,5 17,7 28,5 14,5 88,0 2,7 3640 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.4 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care Despite the fact that 81.1 percent of women know where to get tested, only 59.9 percent have actu- ally been tested; 24.5 percent of women were tested in the past 12 months and only 22.5 percent have been tested and told the results. Residents of urban areas were more likely to be tested for HIV than rural women (61.6 and 57.6 percent respectively). The frequency of HIV testing also depends on the level of educa- tion and income, with women with higher education and from the wealthiest households tested more often (67 percent and 65.9 percent respectively). Women age 25-29 and 30-34 are more likely to be tested (74.4 per- cent and 73.7 percent respectively), while women aged 15-19 are less likely (22.4 percent). By regions, resi- dents of North-Kazakhstan Oblast (80.3 percent) were tested more often, while residents of East Kazakhstan (46.8 percent), and Almaty (47.9 percent) were tested less often. Another important indicator is the knowledge of where to be tested for HIV and use of such services. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of one’s status is also a critical fac- tor in the decision to seek treatment. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.5. In Kazakhstan, 81.1 percent of women knew where to be tested, percentage of such women is high- er in urban area (85.8 percent) and among respon- dents with higher education (90.5 percent), highest in- come (89.7 percent). The most aware are women from the age group 25-39 (86.6-88.7 percent). The lowest percentage was found in East Kazakhstan and Atyrau Oblasts (70.2 percent and 71.2 percent respectively), while the highest was found in Astana (96.4 percent). 188 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table НА.5: Knowledge of a place for HIV testing Percentage of women age 15-49 years who know where to get an HIV test, percentage of women who have ever been tested, percentage of women who have been tested in the last 12 months, and percentage of women who have been tested and have been told the result, Kazakhstan, 2010/11 Percent of women Number of womenKnow a place to get tested1 Have ever been tested for HIV Have been tested in the last 12 months Have been tested for HIV and have been told result2 Region Akmola Oblast 83,4 72,6 35,7 34,3 603 Aktobe Oblast 81,8 51,4 20,5 19,1 694 Almaty Oblast 78,8 55,5 22,1 19,0 1518 Almaty city 90,3 47,9 12,1 12,0 1190 Astana city 96,4 68,7 34,1 34,1 539 Atyrau Oblast 71,2 52,6 12,6 10,8 409 East Kazakhstan Oblast 70,2 46,8 20,1 18,2 1210 Zhambyl Oblast 74,6 50,1 20,4 20,0 836 West Kazakhstan Oblast 81,5 66,1 28,4 26,4 566 Karaganda Oblast 79,7 66,5 31,1 29,3 1274 Kostanai Oblast 88,0 75,1 32,3 29,0 791 Kyzylorda Oblast 79,7 63,1 25,6 16,9 553 Mangistau Oblast 79,6 51,4 12,9 8,5 461 Pavlodar Oblast 87,1 75,1 36,7 34,3 746 North Kazakhstan Oblast 91,1 80,3 40,9 38,7 577 South Kazakhstan Oblast 77,4 58,2 21,0 20,0 2048 Residence Urban 85,8 61,6 24,9 23,3 8055 Rural 74,8 57,6 24,0 21,5 5959 Age 15-19 58,7 22,4 15,0 13,5 2022 20-24 83,7 57,5 30,3 27,0 2178 25-29 88,6 74,4 29,4 26,6 2016 30-34 88,7 73,7 27,8 25,7 2005 35-39 86,6 70,8 25,8 23,9 1901 40-44 83,4 64,5 21,9 20,6 1919 45-49 78,3 57,2 21,1 20,1 1972 Marital/Union Status Married/in union 85,5 71,0 27,8 25,4 10051 Never married/in union 70,1 31,9 16,4 15,4 3963 Education Primary/ incomplete Secondary 55,4 29,8 12,6 10,8 553 Secondary 70,7 51,6 18,8 16,9 4407 Specialized Secondary 85,5 64,9 27,3 25,1 4539 Higher 90,5 67,0 29,0 27,1 4489 Wealth Index Quintile Poorest 68,3 51,4 20,1 18,5 2528 Second 76,9 58,9 24,5 21,9 2599 Middle 80,8 59,3 24,2 22,0 2743 189MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of women Number of womenKnow a place to get tested1 Have ever been tested for HIV Have been tested in the last 12 months Have been tested for HIV and have been told result2 Fourth 86,5 62,1 26,4 24,6 2839 Richest 89,7 65,9 26,6 24,8 3305 Ethnicity of Household Head Kazakh 79,0 57,4 23,7 21,6 9003 Russian 88,2 67,8 27,5 25,7 3168 Other 79,5 58,6 23,8 21,8 1843 Total 81,1 59,9 24,5 22,5 14014 1 MICS Indicator 9.5 2 MICS Indicator 9.6 were tested in the past 12 months and only 15.1 per- cent of respondents have been tested and told the results. Residents of urban areas were more likely to be tested for HIV than rural men (45.8 percent versus 33.1 percent). The frequency of HIV testing correlates with the level of income, with men from the richest households tested more often (52.7 per- cent). By regions, residents of North Kazakhstan and Pavlodar Oblasts and Astana (slightly more than 62 percent) were tested more often, while residents of South Kazakhstan (11.7 percent) were tested less often and no residents of Atyrau Oblast reported be- ing HIV tested. The results of the survey of men age 15-59 con- cerning their knowledge of a facility for HIV testing are presented in Table HA.5M. In Kazakhstan, 75.5 percent of men knew where to be tested; percentage of such men is higher in urban area (80.8 percent) and among respondents with high- est income. The lowest percentage was found among men age 15-19 (59.9 percent) and 55-59 (65.9 percent) and in Atyrau Oblast (27.6 percent), while the highest was found in Pavlodar Oblast (97.8 percent). Despite the fact that 75.5 percent of respon- dents know where to get tested, only 39.9 percent have actually been tested; 15.8 percent of women Table НА.5М: Knowledge of a place for HIV testing Percentage of men age 15-49 (59) years who know where to get an HIV test, percentage of women who have ever been tested, percentage of women who have been tested in the last 12 months, and percentage of women who have been tested and have been told the result, Kazakhstan, 2010/11 Percent of men Number of menKnow a place to get tested1 Have ever been tested for HIV Have been tested in the last 12 months Have been tested for HIV and have been told result2 Region Akmola Oblast 69,4 44,0 23,5 23,5 178 Aktobe Oblast 61,7 23,3 9,3 9,3 182 Almaty Oblast 73,1 47,9 10,3 10,3 423 Almaty city 87,6 45,7 13,1 13,1 302 Astana city 85,5 62,7 18,7 18,7 125 Atyrau Oblast 27,6 0,0 0,0 0,0 112 East Kazakhstan Oblast 60,5 20,0 8,1 8,1 340 Zhambyl Oblast 70,8 59,5 24,5 24,5 240 West Kazakhstan Oblast 67,9 43,1 15,1 15,1 158 Karaganda Oblast 75,0 49,5 19,3 19,3 333 Kostanai Oblast 78,6 53,2 16,9 16,9 219 190 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of men Number of menKnow a place to get tested1 Have ever been tested for HIV Have been tested in the last 12 months Have been tested for HIV and have been told result2 Kyzylorda Oblast 67,5 42,5 32,9 32,9 157 Mangistau Oblast 77,1 56,0 26,4 26,4 121 Pavlodar Oblast 97,8 62,5 46,4 46,4 206 North Kazakhstan Oblast 82,5 62,9 30,2 30,2 164 South Kazakhstan Oblast 87,7 11,7 0,6 0,6 587 Residence Urban 80,8 45,8 17,5 17,5 2061 Rural 69,3 33,1 13,9 13,9 1785 Age 15-19 59,9 23,2 13,8 13,8 394 20-24 80,8 35,2 15,4 15,4 433 25-29 78,5 43,5 17,5 17,5 434 30-34 79,0 48,4 17,7 17,7 548 35-39 82,3 46,6 18,3 18,3 539 40-44 76,8 39,8 13,9 13,9 453 45-49 74,2 42,1 15,4 15,4 432 50-54 73,3 36,1 13,7 13,7 361 55-59 65,9 36,9 14,9 14,9 251 Marital/Union Status Married/in union 77,0 43,4 16,6 16,6 2807 Never married/ in union 71,4 30,4 13,9 13,9 1039 Education Primary/ Incomplete Secondary 62,7 31,8 15,9 15,9 184 Secondary 66,2 30,9 11,4 11,4 1444 Specialized Secondary 78,6 43,8 17,1 17,1 1261 Higher 88,1 50,2 20,9 20,9 953 Wealth Index Quintile Poorest 64,1 25,3 8,7 8,7 737 Second 72,8 35,6 13,2 13,2 748 Middle 75,3 39,2 18,2 18,2 773 Fourth 78,3 45,4 17,7 17,7 789 Richest 85,8 52,7 20,8 20,8 799 Ethnicity of Household Head Kazakh 72,5 36,1 15,4 15,4 2374 Russian 81,6 49,6 18,9 18,9 952 Other 77,9 39,7 12,1 12,1 520 Total (15-49) 76,4 40,6 16,2 16,2 3233 Total (15-59) 75,5 39,9 15,8 15,8 3846 1 MICS Indicator 9.5 2 MICS Indicator 9.6 191MONITORING THE SITUATION OF CHILDREN AND WOMEN est in Karaganda Oblast (74.7 percent). In Kazakhstan, 69.4 percent of women age 15-24 have been tested, 39.2 percent of respondents were tested in the past 12 months, and only 34.3 percent of women had been tested and told the result. In urban areas, women are more aware of places where to get tested, with 87.2 percent of women answering affirmatively to this ques- tion compared to only 84.5 percent of rural residents. Despite their lower awareness, rural women were more likely to be tested for HIV than urban women, especially in the last 12 months (43.0 percent versus 36.6 percent). Table HA.6 presents the same results for sexu- ally active young women. The proportion of young women who have been tested and have been told the result provides a measure of the effectiveness of in- terventions that promote HIV counselling and testing among young people. This is important to know be- cause young people may feel that there are barriers to accessing services related to sensitive issues, such as sexual health. The survey found that 86.1 percent of young women know where to get tested, percentage of such women is the highest in Astana (95.3 percent) and low- Table HA.6: Knowledge of a place for HIV testing among sexually active young women Percentage of women age 15-24 years who have had sex in the last 12 months, and among women who have had sex in the last 12 months, the percentage who know where to get an HIV test, percentage of women who have ever been tested, percentage of women who have been tested in the last 12 months, and percentage of women who have been tested and have been told the result, Kazakhstan, 2010/11 Percent of women who have had sex in the last 12 months Number of women age 15- 24 Percent of women Number of women age 15-24 who have had sex in the last 12 months Know a place to get tested Have ever been tested for HIV Have been tested in the last 12 months Have been tested in the last 12 months and have been told result1 Region Akmola Oblast 42,9 152 80,9 71,7 48,0 44,4 65 Aktobe Oblast 31,5 210 91,1 67,7 30,1 28,6 66 Almaty Oblast 24,0 511 78,0 61,8 37,0 23,9 123 Almaty city 25,6 314 91,0 43,3 12,9 12,9 80 Astana city 34,0 168 95,3 78,5 48,4 48,4 57 Atyrau Oblast 28,2 135 92,7 80,5 39,2 33,6 38 East Kazakhstan Oblast 35,3 349 81,8 62,0 34,5 27,9 123 Zhambyl Oblast 30,2 252 83,6 72,4 40,1 38,8 76 West Kazakhstan Oblast 33,6 164 84,9 75,4 34,4 31,8 55 Karaganda Oblast 39,2 366 74,7 62,3 37,1 33,5 143 Kostanai Oblast 49,2 224 86,9 71,2 37,1 32,8 110 Kyzylorda Oblast 26,6 162 85,4 76,4 52,8 27,9 43 Mangistau Oblast 31,9 158 91,0 62,5 31,8 16,6 50 Pavlodar Oblast 44,7 205 92,8 81,8 45,0 39,6 91 North Kazakhstan Oblast 49,0 146 94,7 86,6 51,7 49,8 72 South Kazakhstan Oblast 31,5 685 89,1 73,6 46,6 45,0 216 Residence Urban 34,4 2422 87,2 68,6 36,6 32,2 833 Rural 32,4 1779 84,5 70,6 43,0 37,2 577 Age 15-19 8,3 2022 77,2 55,1 36,5 30,3 167 20-24 57,0 2178 87,2 71,3 39,6 34,8 1243 192 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of women who have had sex in the last 12 months Number of women age 15- 24 Percent of women Number of women age 15-24 who have had sex in the last 12 months Know a place to get tested Have ever been tested for HIV Have been tested in the last 12 months Have been tested in the last 12 months and have been told result1 Marital/Union Status Married/in union 94,9 1211 87,4 74,0 41,3 35,6 1150 Never married/in union 8,7 2990 80,2 49,0 30,0 28,4 260 Education Incomplete secondary 1,2 307 (*) (*) (*) (*) 4 Secondary 30,2 1330 80,9 68,6 37,0 31,3 402 Specialized secondary 39,3 1224 87,2 70,3 43,7 36,7 481 Higher 39,1 1337 89,1 69,3 37,1 34,4 523 Wealth Index Quintile Poorest 29,7 799 81,8 68,1 41,5 39,1 237 Second 35,3 790 86,4 69,8 41,7 34,0 279 Middle 32,3 884 85,2 70,9 38,4 32,5 285 Fourth 33,5 822 85,7 64,5 34,9 29,0 275 Richest 36,7 906 89,8 72,8 39,9 36,8 333 Ethnicity of Household Head Kazakh 27,3 2842 87,2 71,0 40,0 34,5 776 Russian 50,6 807 88,0 70,0 39,1 35,7 408 Other 40,9 553 78,5 62,7 36,7 30,9 226 Total 33,6 4201 86,1 69,4 39,2 34,3 1410 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.7 (*) – indicators are based on less than 25 cases of unweighted observations Table HA.6M presents the same results for sexu- ally active young men age 15-24. The survey found that 79.3 percent of young men know where to get tested. In Kazakhstan, 36 percent of men have been tested, 16.2 percent of respondents were tested in the past 12 months and 15.3 percent has been tested and told the result. 193MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HA.6M: Knowledge of a place for HIV testing among sexually active young men Percentage of men age 15-24 years who have had sex in the last 12 months, and among men who have had sex in the last 12 months, the percentage who know where to get an HIV test, percentage of men who have ever been tested, percentage of men who have been tested in the last 12 months, and percentage of men who have been tested and have been told the result, Kazakhstan, 2010/11 Percentage of men who have had sex in the last 12 months Number of men age 15-24 Percent of men Number of men age 15-24 who have had sex in the last 12 months Know a place to get tested Have ever been tested for HIV Have been tested in the last 12 months Have been tested and have been told the result1 Region Akmola Oblast 57,8 41 (61,9) (36,5) (15,5) (15,5) 24 Aktobe Oblast 40,4 47 (*) (*) (*) (*) 19 Almaty Oblast 22,6 97 (*) (*) (*) (*) 22 Almaty city 68,8 73 (90,0) (29,9) (5,5) (5,5) 50 Astana city 75,8 33 (58,2) (23,1) (12,4) (12,4) 25 Atyrau Oblast 44,7 29 (33,3) (0,0) (0,0) (0,0) 13 East Kazakhstan Oblast (48,8) 45 (*) (*) (*) (*) 22 Zhambyl Oblast 56,0 56 (78,5) (57,7) (33,7) (33,7) 32 West Kazakhstan Oblast 39,3 30 (*) (*) (*) (*) 12 Karaganda Oblast (55,3) 51 (*) (*) (*) (*) 28 Kostanai Oblast 67,7 49 (75,1) (42,5) (24,0) (18,9) 33 Kyzylorda Oblast (43,0) 32 (*) (*) (*) (*) 14 Mangistau Oblast (56,3) 30 (64,1) (29,0) (7,6) (7,6) 17 Pavlodar Oblast (63,9) 36 (96,6) (73,1) (50,4) (50,4) 23 North Kazakhstan Oblast (62,8) 23 (71,3) (39,3) (14,7) (10,8) 14 South Kazakhstan Oblast 42,5 154 (90,4) (8,1) (2,8) (2,8) 66 Residence Urban 56,2 465 80,3 37,8 16,9 16,0 261 Rural 42,0 361 77,7 32,8 15,0 14,2 152 Age 15-19 22,1 394 66,4 28,5 15,6 15,0 87 20-24 75,3 433 82,8 38,0 16,4 15,4 326 Marital/Union Status Married/in union 98,3 117 78,6 41,9 17,7 16,4 115 Never married/in union 42,0 710 79,6 33,7 15,6 14,9 298 Education Incomplete secondary 2,0 69 (*) (*) (*) (*) 1 Secondary 39,5 291 77,0 29,5 11,2 10,7 115 Specialized secondary 58,6 259 77,5 39,8 19,2 18,3 152 Higher 70,0 207 83,3 36,9 16,7 15,5 145 Wealth Index Quintile Poorest 40,2 140 74,2 22,9 9,0 9,0 56 Second 46,5 165 79,8 36,6 20,4 19,5 77 Middle 42,5 193 74,8 33,0 17,1 16,4 82 Fourth 60,5 168 80,6 38,7 18,4 16,8 102 194 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of men who have had sex in the last 12 months Number of men age 15-24 Percent of men Number of men age 15-24 who have had sex in the last 12 months Know a place to get tested Have ever been tested for HIV Have been tested in the last 12 months Have been tested and have been told the result1 Richest 60,0 160 84,6 42,8 14,1 13,3 96 Ethnicity of Household Head Kazakh 44,5 549 79,0 33,8 17,7 16,9 244 Russian 65,5 167 85,1 41,2 16,3 14,8 109 Other 53,6 111 70,1 35,1 10,0 10,0 59 Total 50,0 826 79,3 36,0 16,2 15,3 413 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.7 (*) – indicators are based on less than 25 cases of unweighted observations () – indicators are based on 25-49 cases of unweighted observations and got tested. There are certain differences by edu- cational attainment and wealth of households. Thus, women with secondary education are least likely to re- ceive HIV counseling (49.3 percent) and least likely to be HIV tested and receive the results (63.2 percent). The highest proportion of women who received HIV counseling is found in South Kazakhstan Oblast (80 percent), the lowest is found in Kostanai Oblast (27.5 percent). The percentage of women, who have been tested for HIV and told the result, is the highest in North-Kazakhstan Oblast (87.5 percent) and lowest in Mangistau Oblast (39.7 percent). Among women who had given birth within the two years preceding the survey, the percent who re- ceived counselling and HIV testing during antenatal care is presented in Table HA.7. About 99.2 percent of women in Kazakhstan re- ceived antenatal care, of them 86.5 percent tested for HIV during pregnancy and only 58.1 percent of women got HIV counselling. Urban women have better access to HIV counseling and testing than their rural counter- parts (52.2 and 47 percent received HIV counseling and were tested and told the result, respectively). Women aged 15-19 are least likely to receive HIV counseling Table НА.7: HIV counselling and testing during antenatal care Percent of women age 15-49 who gave birth in the last 2 years, percentage of women who received antenatal care during the last pregnancy, percentage who received HIV counselling, percentage who were offered and accepted an HIV test and received the results, Kazakhstan, 2010/11 Percent of women Number of women, who gave birth in the 2 years preceding the survey Received antenatal care from a health care professional Received HIV counseling during antenatal care 1 Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results 2 Received HIV counselling, were offered an HIV test, accepted and received the results Region Akmola Oblast 96,4 53,1 90,5 80,2 50,8 68 Aktobe Oblast 100,0 71,8 88,9 72,4 64,0 115 Almaty Oblast 99,1 29,8 80,3 50,5 21,5 194 Almaty city (95,6) (66,0) (76,6) (70,0) (59,4) 68 Astana city 99,0 74,6 94,6 87,1 67,5 72 Atyrau Oblast 100,0 74,2 96,8 68,6 56,2 77 East Kazakhstan Oblast 98,9 39,1 75,2 64,7 30,5 143 Zhambyl Oblast 99,3 67,5 84,9 83,0 66,1 166 West Kazakhstan Oblast 100,0 55,9 88,5 84,9 53,1 75 195MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of women Number of women, who gave birth in the 2 years preceding the survey Received antenatal care from a health care professional Received HIV counseling during antenatal care 1 Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results 2 Received HIV counselling, were offered an HIV test, accepted and received the results Karaganda Oblast 99,1 41,4 86,2 75,8 33,8 148 Kostanai Oblast 98,8 27,5 83,0 79,6 25,6 86 Kyzylorda Oblast 98,8 52,7 85,1 42,4 31,1 119 Mangistau Oblast 99,4 65,0 76,9 39,7 34,7 99 Pavlodar Oblast 99,1 47,6 97,3 72,6 34,4 82 North Kazakhstan Oblast 100,0 34,1 97,2 87,5 32,8 46 South Kazakhstan Oblast 99,8 80,0 90,6 83,2 75,0 436 Residence Urban 99,0 60,3 89,3 76,6 52,2 983 Rural 99,4 56,0 83,8 66,6 47,0 1011 Young Women 15-24 99,2 57,2 87,2 70,4 48,3 599 Age 15-19 94,5 43,0 82,0 60,1 38,3 50 20-24 99,6 58,5 87,7 71,3 49,2 549 25-29 99,5 56,5 85,1 71,1 48,7 607 30-34 99,3 60,5 86,9 71,8 51,6 444 35-49 98,4 59,2 87,3 73,6 51,0 345 Marital/Union Status Married/in union 99,2 58,1 86,5 71,6 49,7 1968 Never married/in union 93,9 55,2 87,2 63,7 37,7 26 Education Incomplete secondary (87,7) (50,7) (70,4) (59,4) (45,9) 32 Secondary 98,9 49,3 79,1 63,2 42,0 698 Specialized secondary 99,9 61,5 88,8 71,8 50,6 565 Higher 99,6 64,8 93,3 80,5 56,8 695 Wealth Index Quintile Poorest 98,8 55,2 79,2 66,4 48,9 463 Second 99,8 61,6 85,6 66,9 51,5 443 Middle 98,8 54,6 87,5 72,8 46,7 406 Fourth 99,3 56,8 90,1 77,3 49,7 330 Richest 99,2 62,7 92,7 76,9 51,4 352 Ethnicity of Household Head Kazakh 99,4 61,0 86,6 70,8 51,8 1413 Russian 99,3 49,3 90,3 77,4 41,6 322 Other 97,5 53,3 81,5 68,0 47,7 259 Total 99,2 58,1 86,5 71,5 49,6 1993 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.8 2 MICS Indicator 9.9 () – indicators are based on 25-49 cases of unweighted observations 196 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners, is especially important for reducing the spread of HIV. In most coun- tries over half of new HIV infections are among young people 15-24 years thus a change in behaviour among this age group will be especially important to reduce new infections. A module of questions was adminis- tered to women 15-24 years of age to assess their risk of HIV infection. Risk factors for HIV include sex at an early age, sex with older men, sex with a non-marital non-cohabitating partner, and failure to use a condom. Table НА.8: Sexual behaviour that increases the risk of HIV infection Percentage of never-married young women age 15-24 years who have never had sex, percentage of young women age 15-24 years who have had sex before age 15, and percentage of young women age 15-24 years who had sex with a man 10 or more years older during the last 12 months, Kazakhstan, 2010/11 Percentage of never-married women age 15-24 years who have never had sex1 Percentage of never-married women age 15-24 years Percent of women age 15-24 who had sex before age 152 Number of women age 15- 24 Percentage of women age 15-24 years who had sex in the last 12 months with a man 10 or more years older3 Number of women age 15-24 who had sex in the 12 months preceding the survey Region Akmola Oblast 80,9 103 2,0 152 8,6 65 Aktobe Oblast 93,5 151 0,0 210 9,2 66 Almaty Oblast 99,4 378 0,0 511 8,0 123 Almaty city 86,6 265 0,5 314 12,1 80 Astana city 84,4 127 0,0 168 9,0 57 Atyrau Oblast 99,7 93 0,0 135 2,7 38 East Kazakhstan Oblast 87,2 256 0,0 349 4,5 123 Zhambyl Oblast 98,6 175 0,4 252 8,2 76 West Kazakhstan Oblast 95,8 112 0,5 164 14,5 55 Karaganda Oblast 81,7 248 1,1 366 7,7 143 Kostanai Oblast 72,3 156 0,9 224 8,3 110 Kyzylorda Oblast 99,2 116 0,0 162 6,0 43 Mangistau Oblast 92,6 113 0,3 158 5,4 50 Pavlodar Oblast 76,9 145 1,3 205 11,1 91 North Kazakhstan Oblast 72,2 95 1,3 146 7,0 72 South Kazakhstan Oblast 99,3 456 0,0 685 6,5 216 Residence Urban 86,4 1772 0,5 2422 7,9 833 Rural 96,1 1218 0,3 1779 8,0 577 Age 15-19 96,3 1919 0,4 2022 8,1 167 20-24 79,8 1070 0,4 2178 7,9 1243 Marital/Union Status Married/in union n/a 0 0,9 1211 8,4 1150 Never married/in union 90,4 2990 0,2 2990 6,0 260 Education Incomplete Secondary 99,7 302 (*) (*) (*) 4 197MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of never-married women age 15-24 years who have never had sex1 Percentage of never-married women age 15-24 years Percent of women age 15-24 who had sex before age 152 Number of women age 15- 24 Percentage of women age 15-24 years who had sex in the last 12 months with a man 10 or more years older3 Number of women age 15-24 who had sex in the 12 months preceding the survey Secondary 95,1 949 0,7 1330 11,3 402 Specialized Secondary 86,5 820 0,6 1224 6,2 481 Higher 85,9 917 0,1 1337 7,1 523 Wealth Index Quintile Poorest 96,5 567 0,4 799 11,0 237 Second 95,7 509 0,2 790 8,0 279 Middle 92,1 634 0,5 884 5,6 285 Fourth 87,0 611 0,5 822 9,9 275 Richest 82,4 668 0,4 906 6,0 333 Ethnicity of Household Head Kazakh 95,8 2105 0,0 2842 8,3 776 Russian 70,0 528 1,7 807 8,0 408 Other 88,3 357 0,6 553 6,5 226 Total 90,4 2990 0,4 4201 7,9 1410 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.10 2 MICS Indicator 9.11 3 MICS Indicator 9.12 (*) – indicators are based on less than 25 cases of unweighted observations n/a – not applicable having had sexual intercourse with a man 10 and more years older in the past 12 months. The highest per- centage of such respondents is found in the group of respondents with secondary education (11.3 percent) and among poorest households. The frequency of sexual behaviours that increase the risk of HIV infection among women is presented in Table HA.8 and Figure HA.2. The survey showed that only 0.4 percent of women reported having had sex before age 15. About 7.9 percent of women reported 198 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN The frequency of sexual behaviours that in- crease the risk of HIV infection among men is pre- sented in Table HA.8M. The survey showed that 1.4 percent of men reported having had sex before age 15. 2.5 percent of men reported having had sex with a person 10 or more years older in the past 12 month; in rural areas the proportion of such men is higher than in urban areas, (4.2 percent and 1.4 percent respec- tively). In the households from the fourth quintile and richest households in the age group 15-24 years there were no men who had had sex with a person 10 and more years older in the past 12 months while there were 8.7 percent of such men from second quintile and 4.2 percent of men from middle quintile households. Table НА.8М: Sexual behaviour that increases the risk of HIV infection Percentage of never-married young men age 15-24 years who have never had sex, percentage of young men age 15-24 years who have had sex before age 15, and percentage of young men age 15-24 years who had sex with a person 10 or more years older during the last 12 months, Kazakhstan, 2010/11 Percentage of never-married men age 15-24 years who have never had sex1 Percentage of never- married men age 15-24 Percentage of men age 15-24 who had sex before age 15 2 Number of men age 15- 24 Percentage of young men age 15-24 who had sex in the last 12 months with a person 10 or more years older in the last 12 months 3 Number of men age 15-24 who had sex in the 12 months preceding the survey Residence Urban 49,5 400 1,6 465 1,4 261 Rural 63,0 310 1,0 361 4,2 152 Age 15-19 77,4 390 0,3 394 0,0 87 20-24 28,5 320 2,3 433 3,1 326 Marital/Union Status Married/in union n/a 0 3,8 117 0,0 115 Never married/in union 55,4 710 1,0 710 3,4 298 Education Incomplete secondary 96,5 68 0,0 69 (*) 1 Secondary 68,0 251 0,9 291 2,0 115 Specialized secondary 47,5 216 1,3 259 2,7 152 Higher 30,7 174 2,5 207 2,6 145 Wealth Index Quintile Poorest 64,7 128 1,1 140 0,0 56 Second 61,8 136 1,4 165 8,7 77 Middle 58,0 171 0,9 193 4,2 82 Fourth 47,2 137 2,6 168 0,0 102 Richest 45,2 137 0,8 160 0,0 96 Ethnicity of Household Head Kazakh 61,0 478 0,9 549 2,6 244 Russian 38,7 141 3,2 167 0,0 109 Other 51,6 91 1,0 111 6,4 59 Total 55,4 710 1,4 826 2,5 413 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator 9.10 2 MICS Indicator 9.11 3 MICS Indicator 9.12 199MONITORING THE SITUATION OF CHILDREN AND WOMEN Table НА.9: Sex with multiple partners among women Percentage of women age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Kazakhstan, 2010/11 Percentage of women age 15-24 Percent of women age 15-24 who have had sex with more than one partner in the last 12 months, who used a condom at last sex2 Number of women age 15-24 who have had sex with more than one partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Number of women age 15-24 Region Akmola Oblast 45,0 42,9 2,9 152 (*) 4 Aktobe Oblast 32,5 31,5 0,9 210 (*) 2 Almaty Oblast 26,5 24,0 0,4 511 (*) 2 Almaty city 26,5 25,6 4,7 314 (*) 15 Astana city 35,7 34,0 2,3 168 (*) 4 Atyrau Oblast 30,3 28,2 0,0 135 (*) 0 East Kazakhstan Oblast 36,2 35,3 0,5 349 (*) 2 Zhambyl Oblast 31,5 30,2 0,0 252 (*) 0 West Kazakhstan Oblast 34,7 33,6 0,0 164 (*) 0 Karaganda Oblast 44,6 39,2 1,0 366 (*) 4 Kostanai Oblast 49,5 49,2 2,5 224 (*) 6 Kyzylorda Oblast 28,3 26,6 0,0 162 (*) 0 Mangistau Oblast 32,8 31,9 1,3 158 (*) 2 Pavlodar Oblast 45,1 44,7 3,3 205 (*) 7 North Kazakhstan Oblast 52,7 49,0 4,2 146 (*) 6 South Kazakhstan Oblast 33,4 31,5 0,0 685 (*) 0 Residence Urban 36,5 34,4 2,0 2422 72,2 47 Rural 34,0 32,4 0,3 1779 (*) 5 Age 15-24 8,6 8,3 0,3 2022 (*) 5 25-29 60,3 57,0 2,2 2178 (72,4) 47 Sexual behaviour and condom use during sex with more than one partner was assessed in all wom- en and separately for women age 15-24 years of age who had sex with such a partner in the last 12 months (Tables HA.9). About 35.4 percent of women in the age group 15-24 years reported ever having sex, of them 60.3 percent are from the age group 20-24 years and 99.1 percent of women at the moment of survey were mar- ried or in union, in terms of urban and rural areas their proportion was approximately the same. Of all women who answered this question affirmatively – 33.2 per- cent had sex within the past 12 months prior to the sur- vey. 1.2 percent of women age 15-24 reported having sex with more than one partner, of them women from urban area and from older age group (20-24) more of- ten had sexual contacts while practically no difference in terms of marital status could be observed. In the 15-24 age group, 1.2 percent of respon- dents have had sex with more than one partner, of them most often those were women from urban areas and from older age group (20-24 years old), there was practically no difference in terms of mar- riage status. Despite the fact that 73.5 percent re- ported using a condom the last time they had sex, the number of unweighted observations by main background characteristics did not exceed 25 cases in most cases (marked with a (*) or are based on less than 50 cases – marked with a () and are not worth being mentioned). Among women from urban area at the age 15-24, 72.2 percent adhere to safe sexual behavior. 200 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of women age 15-24 Percent of women age 15-24 who have had sex with more than one partner in the last 12 months, who used a condom at last sex2 Number of women age 15-24 who have had sex with more than one partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Number of women age 15-24 Marital status Married/in union 99,1 94,9 1,3 1211 (*) 15 Never married/in union 9,6 8,7 1,2 2990 (81,1) 37 Education Incomplete secondary 1,4 1,2 0,0 307 (*) 0 Secondary 31,8 30,2 1,1 1330 (*) 14 Specialized secondary 41,9 39,3 1,3 1224 (*) 16 Higher 40,9 39,1 1,6 1337 (*) 22 Wealth Index Quintile Poorest 31,1 29,7 0,3 799 (*) 2 Second 38,1 35,3 0,9 790 (*) 7 Middle 33,7 32,3 1,1 884 (*) 10 Fourth 35,2 33,5 1,7 822 (*) 14 Richest 38,8 36,7 2,2 906 (*) 20 Ethnicity of Household Head Kazakh 28,7 27,3 0,6 2842 (*) 17 Russian 54,1 50,6 3,1 807 (73,7) 25 Other ethnic groups 43,0 40,9 1,8 553 (*) 10 Total 35,4 33,6 1,2 4201 73,5 52 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS indicator 9.13 2 MICS indicator 9.14 (*) – indicators are based on less than 25 cases of unweighted observations ( ) – indicators are based on 25-49 cases of unweighted observations Sexual behaviour of young men and condom use during sexual intercourse with more than one partner was also assessed (Table HA.9M). The re- sults of the survey show that men more often than women had sexual contacts with more than 1 partner in the past 12 months. About 50 percent of interviewed men in the age group 15-24 years had had sex in the past 12 months, 16.6 percent of men pointed out that they had had sex with more than 1 partner. Of those who had had sex in the 12 months prior to the survey 76.2 percent reported using condom during the inter- course. Frequency of safe sexual behavior among ur- ban men is 76.1 percent. It must be noted that among men who had never been married or had never been in union 82.3 percent reported using condom during last sexual intercourse. 201MONITORING THE SITUATION OF CHILDREN AND WOMEN Table НА.9М Sex with multiple partners among men Percentage of men age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Kazakhstan, 2010/11 Percentage of men age 15-24 Percentage of men age 15-24 who have had sex with more than one partner in the last 12 months who used a condom at last sex2 Number of men age 15-24 who have had sex with more than one partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Number of men age 15-24 Region Akmola Oblast 61,4 57,8 20,2 41 (*) 8 Aktobe Oblast 40,4 40,4 9,1 47 (*) 4 Almaty Oblast 24,1 22,6 0,0 97 (*) 0 Almaty city 68,8 68,8 36,1 73 (*) 26 Astana city 75,8 75,8 16,3 33 (*) 5 Atyrau Oblast 44,7 44,7 33,3 29 (*) 10 East Kazakhstan Oblast (48,8) (48,8) (22,4) 45 (*) 10 Zhambyl Oblast 56,0 56,0 17,9 56 (*) 10 West Kazakhstan Oblast (41,4) (39,3) (13,8) 30 (*) 4 Karaganda Oblast (70,2) (55,3) (24,9) 51 (*) 13 Kostanai Oblast 69,4 67,7 24,8 49 (*) 12 Kyzylorda Oblast (46,2) (43,0) (6,6) 32 (*) 2 Mangistau Oblast (56,3) (56,3) (16,2) 30 (*) 5 Pavlodar Oblast (66,3) (63,9) (20,9) 36 (*) 7 North Kazakhstan Oblast (65,4) (62,8) (35,3) 23 (*) 8 South Kazakhstan Oblast 45,1 42,5 7,2 154 (*) 11 Residence Urban 57,3 56,2 21,4 465 76,1 100 Rural 45,6 42,0 10,3 361 (76,4) 37 Age 15-19 23,3 22,1 7,6 394 (93,6) 30 20-24 78,5 75,3 24,7 433 71,3 107 Marital Status Married/in union 98,3 98,3 16,5 117 (*) 19 Never married/ in union 44,6 42,0 16,6 710 82,3 118 Education Incomplete Secondary 4,4 2,0 0,0 69 (*) 0 Secondary 41,4 39,5 12,3 291 (80,5) 36 Specialized Secondary 60,1 58,6 19,9 259 73,5 52 Higher 73,6 70,0 23,9 207 (75,8) 49 Wealth Index Quintile Poorest 41,1 40,2 7,8 140 (*) 11 Second 48,9 46,5 9,5 165 (*) 16 Middle 47,9 42,5 14,6 193 (66,3) 28 Fourth 61,3 60,5 24,5 168 (84,6) 41 202 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of men age 15-24 Percentage of men age 15-24 who have had sex with more than one partner in the last 12 months who used a condom at last sex2 Number of men age 15-24 who have had sex with more than one partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months1 Number of men age 15-24 Richest 60,8 60,0 25,6 160 (70,9) 41 Ethnicity of Household Head Kazakh 46,5 44,5 13,8 549 77,7 76 Russian 67,4 65,5 27,5 167 (78,7) 46 Other ethnic groups 57,4 53,6 13,8 111 (*) 15 Total 52,2 50,0 16,6 826 76,2 137 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS indicator 9.13 2 MICS indicator 9.14 (*) – indicators are based on less than 25 cases of unweighted observations ( ) – Indicators are based on 25-49 cases of unweighted observations cent) more often than women from the age group 15-24 years (8.3 percent) had sexual contacts. About 69.9 percent of women aged 15-24 who re- ported having had sex in the past 12 months with a partner they were not married /in union used condom during last sexual contact. At the same time 71.1 percent of women were from urban area compared to 64.4 percent of women from rural area and more often those were respondents with higher educational level (72.8 percent of women with higher education compared to 60.1 percent of women with secondary education). Table HA.10 shows the percentage of young women from the age group 15-24 years who have ever had sex, percentage of young women who have had sex in the past 12 months and percentage of young women who have had sex with a partner to whom they were not married/in union in the past 12 months, and percentage of those who used condom during last sex- ual contact with such a partner. Based on survey results, 35.4 percent of interviewed young women have ever had sex and 33.6 percent had sex in the past 12 months. Women from the age group 20-24 years (57.0 per- Table НА.10: Sex with non-regular partners (young women) Percentage of women age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Kazakhstan, 2010/11 Percent of women age 15-24 N um be r o f w om en a ge 1 5- 24 P er ce nt o f w om en w ho h ad se x in th e pa st 1 2 m on th s w ith a p ar tn er th ey w er e no t m ar rie d to o r w er e no t i n un io n w ith 1 N um be r o f w om en a ge 15 -2 4 w ho h av e ha d se x in th e la st 1 2 m on th s Percent of women age 15-24 who reported having had sex in the last 12 months with a partner they were not married to or were not in union with and that they used condom at last sex2 Number of women who had sex in the past 12 months with a partner they were not married to or were not in union with Ever had sex Had sex in the last 12 months Region Akmola Oblast 45,0 42,9 152 15,0 65 (73,6) 23 Aktobe Oblast 32,5 31,5 210 4,8 66 (*) 10 Almaty Oblast 26,5 24,0 511 0,7 123 (*) 4 Almaty city 26,5 25,6 314 10,4 80 (*) 33 Astana city 35,7 34,0 168 12,7 57 (92,6) 21 Atyrau Oblast 30,3 28,2 135 0,6 38 (*) 1 203MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of women age 15-24 N um be r o f w om en a ge 1 5- 24 P er ce nt o f w om en w ho h ad se x in th e pa st 1 2 m on th s w ith a p ar tn er th ey w er e no t m ar rie d to o r w er e no t i n un io n w ith 1 N um be r o f w om en a ge 15 -2 4 w ho h av e ha d se x in th e la st 1 2 m on th s Percent of women age 15-24 who reported having had sex in the last 12 months with a partner they were not married to or were not in union with and that they used condom at last sex2 Number of women who had sex in the past 12 months with a partner they were not married to or were not in union with Ever had sex Had sex in the last 12 months East Kazakhstan Oblast 36,2 35,3 349 9,4 123 (*) 33 Zhambyl Oblast 31,5 30,2 252 2,7 76 (*) 7 West Kazakhstan Oblast 34,7 33,6 164 4,9 55 (*) 8 Karaganda Oblast 44,6 39,2 366 11,1 143 (66,0) 40 Kostanai Oblast 49,5 49,2 224 22,5 110 74,4 50 Kyzylorda Oblast 28,3 26,6 162 0,4 43 (*) 1 Mangistau Oblast 32,8 31,9 158 4,9 50 (*) 8 Pavlodar Oblast 45,1 44,7 205 19,6 91 (61,0) 40 North Kazakhstan Oblast 52,7 49,0 146 20,8 72 (64,0) 31 South Kazakhstan Oblast 33,4 31,5 685 0,2 216 (*) 2 Residence Urban 36,5 34,4 2422 10,4 833 71,1 253 Rural 34,0 32,4 1779 3,2 577 64,6 58 Age 15-19 8,6 8,3 2022 3,5 167 69,2 71 20-24 60,3 57,0 2178 11,0 1243 70,1 240 Marital/ Union Status Married/in union 99,1 94,9 1211 4,2 1150 55,5 51 Never married/ in union 9,6 8,7 2990 8,7 260 72,8 259 Education Incomplete Secondary 1,4 1,2 307 (*) 4 (*) 1 Secondary 31,8 30,2 1330 4,4 402 60,1 58 Specialized Secondary 41,9 39,3 1224 9,5 481 72,0 116 Higher 40,9 39,1 1337 10,1 523 72,8 135 Wealth Index Quintile Poorest 31,1 29,7 799 3,2 237 (47,0) 26 Second 38,1 35,3 790 3,5 279 (71,0) 28 Middle 33,7 32,3 884 6,0 285 63,6 53 Fourth 35,2 33,5 822 9,8 275 73,8 80 Richest 38,8 36,7 906 13,7 333 74,6 124 Ethnicity of Household Head Kazakh 28,7 27,3 2842 3,3 776 69,5 94 204 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percent of women age 15-24 N um be r o f w om en a ge 1 5- 24 P er ce nt o f w om en w ho h ad se x in th e pa st 1 2 m on th s w ith a p ar tn er th ey w er e no t m ar rie d to o r w er e no t i n un io n w ith 1 N um be r o f w om en a ge 15 -2 4 w ho h av e ha d se x in th e la st 1 2 m on th s Percent of women age 15-24 who reported having had sex in the last 12 months with a partner they were not married to or were not in union with and that they used condom at last sex2 Number of women who had sex in the past 12 months with a partner they were not married to or were not in union with Ever had sex Had sex in the last 12 months Russian 54,1 50,6 807 20,1 408 69,6 162 Other 43,0 40,9 553 9,9 226 71,3 55 Total 35,4 33,6 4201 7,4 1410 69,9 310 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations ( ) – indicators are based on 25-49 cases of unweighted observations years more than twice more often than men from the age group 15-19 years had sex with irregular partners (54.3 percent and 21.2 percent respectively). Among men from the age group 15-24 years who in the past 12 months have had sex with a partner to whom they were not married/in union, 78.3 percent used condoms during the last time they had sex. At the same time there was only marginal difference between men from urban and rural area (79.8 percent and 75.5 percent respectively). Table HA.10M shows the results of interviews with men from the age group 15-24 years regarding sexual contacts with irregular partners. The survey has found that 52.2 percent of interviewed men have ever had sex and 50 percent have had sex in the past 12 months, of whom 38.6 percent have had sex with irregular partners. More often men from urban area had such sex- ual contacts (44.7 percent) compared to men from ru- ral area (30.8 percent). Men from the age group 20-24 Table НА.10M: Sex with non-regular partners (young men) Percentage of men age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Kazakhstan, 2010/11 Percent of men age 15-24 N um be r o f m en a ge 1 5- 24 P er ce nt o f w om en w ho h ad se x in th e pa st 1 2 m on th s w ith a p ar tn er th ey w er e no t m ar rie d to o r w er e no t in u ni on w ith 1 N um be r o f m en a ge 1 5- 24 w ho h av e ha d se x in th e la st 1 2 m on th s Percent of men age 15-24 who reported having had sex in the last 12 months with a partner they were not married to or were not in union with and that they used condom at last sex2 Number of men who had sex in the past 12 months with a partner they were not mar- ried to or were not in union with Ever had sex Had sex in the last 12 months Region Akmola Oblast 61,4 57,8 41 (49,6) 24 (93,4) 21 Aktobe Oblast 40,4 40,4 47 (*) 19 (*) 13 Almaty Oblast 24,1 22,6 97 (*) 22 (*) 8 Almaty city 68,8 68,8 73 (52,7) 50 (60,5) 39 Astana city 75,8 75,8 33 (57,3) 25 (96,5) 19 Atyrau Oblast 44,7 44,7 29 (34,4) 13 (*) 10 East Kazakhstan Oblast (48,8) (48,8) 45 (*) 22 (*) 17 Zhambyl Oblast 56,0 56,0 56 (48,4) 32 (46,7) 27 West Kazakhstan Oblast (41,4) (39,3) 30 (*) 12 (*) 10 Karaganda Oblast (70,2) (55,3) 51 (*) 28 (*) 22 205MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent of men age 15-24 N um be r o f m en a ge 1 5- 24 P er ce nt o f w om en w ho h ad se x in th e pa st 1 2 m on th s w ith a p ar tn er th ey w er e no t m ar rie d to o r w er e no t in u ni on w ith 1 N um be r o f m en a ge 1 5- 24 w ho h av e ha d se x in th e la st 1 2 m on th s Percent of men age 15-24 who reported having had sex in the last 12 months with a partner they were not married to or were not in union with and that they used condom at last sex2 Number of men who had sex in the past 12 months with a partner they were not mar- ried to or were not in union with Ever had sex Had sex in the last 12 months Kostanai Oblast 69,4 67,7 49 (59,1) 33 (88,5) 29 Kyzylorda Oblast (46,2) (43,0) 32 (*) 14 (*) 11 Mangistau Oblast (56,3) (56,3) 30 (43,2) 17 (*) 13 Pavlodar Oblast (66,3) (63,9) 36 (46,5) 23 (*) 17 North Kazakhstan Oblast (65,4) (62,8) 23 (55,0) 14 (*) 13 South Kazakhstan Oblast 45,1 42,5 154 (33,8) 66 (70,5) 52 Residence Urban 57,3 56,2 465 44,7 261 79,8 208 Rural 45,6 42,0 361 30,8 152 75,5 111 Age 15-19 23,3 22,1 394 21,2 87 81,1 84 20-24 78,5 75,3 433 54,3 326 77,3 235 Marital/ Union Status Married/in union 98,3 98,3 117 18,9 115 (*) 22 Never married/in union 44,6 42,0 710 41,8 298 78,5 297 Education Incomplete secondary 4,4 2,0 69 (*) 1 (*) 1 Secondary 41,4 39,5 291 28,6 115 74,6 83 Specialized secondary 60,1 58,6 259 46,2 152 82,4 120 Higher 73,6 70,0 207 55,7 145 76,5 115 Wealth Index Quintile Poorest 41,1 40,2 140 31,8 56 (65,5) 45 Second 48,9 46,5 165 31,4 77 (79,4) 52 Middle 47,9 42,5 193 33,6 82 82,4 65 Fourth 61,3 60,5 168 47,3 102 80,0 79 Richest 60,8 60,0 160 48,9 96 79,6 78 Ethnicity of Household Head Kazakh 46,5 44,5 549 34,6 244 79,6 190 Russian 67,4 65,5 167 53,4 109 80,3 89 Other 57,4 53,6 111 36,1 59 (67,6) 40 Total 52,2 50,0 826 38,6 413 78,3 319 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations ( ) – indicators are based on 25-49 cases of unweighted observations 1 MICS Indicator 9.15 2 MICS Indicator 9.16; MDG Indicator 6.2 206 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Circumcision During the survey, male circumcision phenom- enon in Kazakhstan has been studied (Table HA.14). According to data obtained, about 68 percent of men reported having been circumcised. The number of circumcised men prevails in rural areas compared to urban (76.6 percent and 60.7 percent respectively). The proportion of men who have been circumcised is lower among men living in the fourth and fifth quintile households (55.5 percent and 52.3 percent respec- tively). By regions, the highest incidence of circumcision is in Kyzylorda and South Kazakhstan Oblasts (97 per- cent and 93.7 percent respectively) while it is almost two times less in North Kazakhstan (34.4 percent) and Kostanai (35.7 percent) Oblasts. Prevailing number of men who have been circumcised is from families where the head of the household was Kazakh. Among men who reported having been circumcised 83.7 per- cent said that they were circumcised at the age 5-11 years while 12.9 percent at the age 1-4 years. Only 0.1 percent of men said they had been circumcised before the age of 1 year. Table HA.14: Male Circumcision Percentage of men aged 15-59 who reported having been circumcised by various background characteristics and the age of circumcision, Kazakhstan, 2010/11 Percent circumcised Number of men age 15-59 years Age at circumcision Number of men circumcised D ur in g in fa nc y 1- 4 ye ar s 5- 11 y ea rs 12 -1 7 ye ar s 18 + ye ar s D on ’t kn ow / M is si ng To ta l Region Akmola 50,2 178 0,0 33,5 64,3 0,8 1,4 0,0 100,0 89 Aktobe 83,3 182 0,0 19,1 77,3 0,0 0,6 3,1 100,0 151 Almaty 80,1 423 0,0 4,7 94,0 0,0 0,0 1,2 100,0 339 Almaty city 57,5 302 0,0 18,9 80,2 0,0 0,0 0,8 100,0 174 Astana city 70,3 125 0,0 34,9 65,1 0,0 0,0 0,0 100,0 88 Atyrau 92,6 112 0,0 26,4 72,4 0,0 0,0 1,1 100,0 103 East Kazakhstan 45,7 340 0,0 16,0 79,7 2,7 0,0 1,7 100,0 155 Zhambyl 87,9 240 0,5 6,0 93,1 0,0 0,5 0,0 100,0 211 West Kazakhstan 61,4 158 0,0 10,3 76,3 8,5 2,2 2,7 100,0 97 Karaganda 49,3 333 0,0 13,1 80,6 3,0 0,0 3,3 100,0 164 Kostanai 35,7 219 0,0 10,8 84,9 1,1 1,0 2,1 100,0 78 Kyzylorda 97,0 157 0,0 3,0 96,5 0,0 0,0 0,4 100,0 152 Mangistau 92,0 121 0,0 19,0 81,0 0,0 0,0 0,0 100,0 111 Pavlodar 47,0 206 0,0 21,7 73,4 2,4 1,8 0,7 100,0 97 North Kazakhstan 34,4 164 1,1 22,7 61,1 8,6 0,0 6,5 100,0 57 207MONITORING THE SITUATION OF CHILDREN AND WOMEN Percent circumcised Number of men age 15-59 years Age at circumcision Number of men circumcised D ur in g in fa nc y 1- 4 ye ar s 5- 11 y ea rs 12 -1 7 ye ar s 18 + ye ar s D on ’t kn ow / M is si ng To ta l South Kazakhstan 93,7 587 0,0 6,4 88,9 0,0 0,0 4,6 100,0 550 Area Urban 60,7 2061 0,1 14,9 82,2 0,8 0,3 1,8 100,0 1250 Rural 76,6 1785 0,0 11,1 85,0 1,2 0,3 2,3 100,0 1367 Age 15-24 74,1 826 0,0 12,8 83,2 1,1 0,1 2,8 100,0 612 15-19 75,3 394 0,0 12,3 82,9 1,6 0,0 3,3 100,0 296 20-24 72,9 433 0,0 13,3 83,5 0,6 0,2 2,4 100,0 316 25-29 65,5 434 0,0 9,3 87,1 1,8 0,8 1,0 100,0 284 30-39 67,8 1088 0,0 12,8 84,2 1,0 0,5 1,6 100,0 737 40-49 72,1 885 0,3 14,3 83,1 0,8 0,1 1,4 100,0 638 50-59 56,3 613 0,0 13,9 81,4 0,6 0,2 3,8 100,0 345 Education Primary/ Secondary incomplete 63,1 184 0,0 9,7 85,4 3,4 0,8 0,6 100,0 116 Secondary 72,0 1444 0,1 12,4 84,1 0,6 0,2 2,6 100,0 1040 Secondary specialised 60,1 1261 0,0 14,4 82,4 1,1 0,5 1,6 100,0 757 High 73,5 953 0,1 12,7 84,0 1,0 0,1 2,0 100,0 701 Wealth Index Quintiles Poorest 84,8 737 0,0 10,3 85,4 0,9 0,3 3,2 100,0 625 Second 80,1 748 0,1 10,5 86,2 0,9 0,4 2,0 100,0 599 Middle 69,5 773 0,0 14,1 83,0 1,0 0,2 1,7 100,0 537 Fourth 55,5 789 0,2 12,8 83,0 1,4 0,3 2,3 100,0 437 Richest 52,3 799 0,0 18,9 78,9 0,9 0,4 0,8 100,0 418 Ethnicity of Household Head Kazakh 96,2 2374 0,1 13,3 83,4 1,1 0,1 2,1 100,0 2284 Russian 3,3 952 (0,0) (9,4) (82,7) (0,0) (8,0) (0,0) (100,0) 31 Other ethnic group 58,1 520 0,0 10,7 85,8 0,4 0,8 2,2 100,0 302 Total 68,0 3846 0,1 12,9 83,7 1,0 0,3 2,1 100,0 2617 208 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN XIII. Tobacco and Alcohol Use 209MONITORING THE SITUATION OF CHILDREN AND WOMEN Table TA.1 presents data on tobacco use by women aged 15-49, Table TA.1M provides similar data for men in the age group 15-59. To compare the data for men with similar data for women indicators for age group 15-49 years are used. In Kazakhstan, tobacco use is more prevalent among men than among women. About 74.3 percent of men and 20.8 percent of women reported ever using a tobacco product. A total of 7.5 percent of women and 54.9 percent of men smoked cigarettes or used smokeless or smok- ing tobacco products on one or more days in the past month. Tobacco use is more prevalent among women living in urban (27.0 percent) areas than in rural areas (12.4 percent), while the proportion of men using to- bacco is about the same in rural and urban areas. The highest level of tobacco use among wom- en is reported in Pavlodar, North Kazakhstan, Kara- ganda, Akmola and Kostanai Oblasts and in Almaty (27.8 -37.3 percent) and that among men is reported in North Kazakhstan, Karaganda, Mangistau, Zham- byl, Akmola and Kostanai Oblasts and in Astana (81.9 -90.2 percent). Cigarettes are now the most popular tobac- co product among men and women using tobacco 18 U.S. Centers for Disease Prevention and Control, http://www.cdc.gov/ It is well-known known that tobacco use is a risk factor leading to the development of many deadly dis- eases. Smoking cigarettes, pipes and cigars increases the risk of cardiovascular and respiratory diseases and lung and other cancers. Smokeless tobacco products are also considered to cause cancer. Excessive alcohol use increases the risk of many health-damaging conditions. Long-term excessive alco- hol consumption can lead to cardiovascular and neurological disorders, liver disease and social problems. Abuse of alcohol is also associated with injuries and violence, including intimate partner violence and child abuse18. Tobacco and alcohol use data were collected in the course of a survey of men aged 15-59 and women aged 15-49. This information gives an idea of the following: • Use of cigarettes, ever and now, and age cigarette smoking was started; • Use of smoking and smokeless tobacco products, ever and now; • Intensity of use of cigarettes and smoking and smokeless tobacco products; • Use of alcohol and its intensity, ever and now. Tobacco Use (6.5 percent of women and 50.7 percent of men smoked only cigarettes in the past month). 210 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table TA.1: Current and ever use of tobacco Percentage distribution of women age 15-49 years by pattern of use of tobacco, Kazakhstan, 2010/11 Never smoked cigarettes or used other types of tobacco products Ever used Used tobacco products on one or more days in the past month1 Number of women aged 15-49 Only ciga- rettes Ciga- rettes and other tobacco products Only other tobacco products Any to- bacco products Only ciga- rettes Cigarettes and other tobacco products Only other tobacco products Any to- bacco products Age 15-19 92,6 5,6 1,2 0,7 7,4 1,7 0,0 0,9 2,6 2022 20-24 76,0 16,5 5,5 2,1 24,0 5,1 0,8 1,0 6,9 2178 25-29 71,9 21,6 5,4 1,1 28,1 8,1 0,8 0,9 9,8 2016 30-34 73,5 21,8 4,3 0,4 26,5 9,4 0,7 0,5 10,6 2005 35-39 76,3 19,8 3,0 0,9 23,7 8,9 0,4 0,4 9,7 1901 40-44 81,3 16,3 1,9 0,5 18,7 7,2 0,1 0,2 7,5 1919 45-49 83,1 16,0 0,8 0,1 16,9 5,5 0,1 0,1 5,7 1972 Region Akmola Oblast 65,1 33,2 1,6 0,1 34,9 8,9 0,4 0,0 9,3 603 Aktobe Oblast 81,7 15,9 2,3 0,1 18,3 4,4 0,0 0,1 4,6 694 Almaty Oblast 88,2 8,8 1,7 1,2 11,8 3,1 0,0 0,2 3,3 1518 Almaty city 72,2 15,7 10,5 1,6 27,8 5,0 1,6 3,3 9,9 1190 Astana city 80,2 15,9 3,2 0,6 19,8 4,4 0,4 0,5 5,3 539 Atyrau Oblast 96,4 3,4 0,1 0,1 3,6 1,8 0,0 0,0 1,8 409 East Kazakhstan Oblast 76,3 21,3 1,5 0,9 23,7 9,6 0,4 0,5 10,4 1210 Zhambyl Oblast 85,5 11,6 2,1 0,9 14,5 5,2 0,3 0,4 5,8 836 West Kazakhstan Oblast 78,7 18,8 1,9 0,6 21,3 5,9 0,1 0,2 6,3 566 Karaganda Oblast 65,0 29,0 5,4 0,6 35,0 14,8 0,6 0,3 15,6 1274 Kostanai Oblast 66,2 27,3 5,1 1,4 33,8 10,9 0,4 0,8 12,0 791 Kyzylorda Oblast 97,0 2,5 0,2 0,3 3,0 1,4 0,0 0,1 1,5 553 Mangistau Oblast 88,4 8,5 2,6 0,5 11,6 2,8 1,5 0,6 4,8 461 Pavlodar Oblast 62,7 30,7 5,2 1,4 37,3 13,6 0,8 0,6 15,0 746 North Kazakhstan Oblast 63,9 29,5 5,0 1,6 36,1 10,9 0,4 0,3 11,7 577 South Kazakhstan Oblast 92,8 5,9 0,8 0,5 7,2 1,9 0,0 0,3 2,2 2048 Residence Urban 73,0 20,9 5,0 1,1 27,0 8,9 0,7 0,9 10,5 8055 Rural 87,6 11,2 0,7 0,5 12,4 3,3 0,0 0,1 3,5 5959 Education Incomplete secondary 88,8 11,1 0,1 0,0 11,2 7,2 0,0 0,0 7,2 553 Secondary 83,4 14,1 2,0 0,4 16,6 7,0 0,3 0,4 7,7 4407 Specialized secondary 75,7 20,7 3,0 0,6 24,3 8,6 0,4 0,5 9,5 4539 Higher 77,3 16,2 5,0 1,5 22,7 3,9 0,6 0,9 5,4 4489 Maternity Status Pregnant 82,2 14,5 2,5 0,8 17,8 3,1 0,3 0,0 3,3 549 Breastfeeding (not pregnant) 92,2 7,4 0,3 0,0 7,8 0,9 0,0 0,3 1,2 268 Neither 78,8 17,0 3,3 0,9 21,2 6,8 0,4 0,6 7,8 13197 Wealth Index Quintile Poorest 91,5 7,8 0,5 0,2 8,5 3,6 0,1 0,1 3,8 2528 Second 86,7 12,2 0,7 0,3 13,3 4,5 0,0 0,2 4,8 2599 Middle 81,6 15,4 2,0 1,0 18,4 5,3 0,3 0,4 5,9 2743 Fourth 72,5 21,6 4,6 1,4 27,5 8,3 0,4 0,7 9,5 2839 211MONITORING THE SITUATION OF CHILDREN AND WOMEN Never smoked cigarettes or used other types of tobacco products Ever used Used tobacco products on one or more days in the past month1 Number of women aged 15-49 Only ciga- rettes Ciga- rettes and other tobacco products Only other tobacco products Any to- bacco products Only ciga- rettes Cigarettes and other tobacco products Only other tobacco products Any to- bacco products Richest 67,7 24,1 7,0 1,2 32,3 9,8 1,1 1,2 12,1 3305 Ethnicity of Household Head Kazakh 89,5 8,6 1,2 0,7 10,5 2,1 0,1 0,4 2,6 9003 Russian 52,8 37,2 8,8 1,2 47,2 18,0 1,2 1,3 20,4 3168 Other 74,2 21,4 3,3 1,1 25,8 8,4 0,4 0,4 9,2 1843 Total 79,2 16,8 3,2 0,8 20,8 6,5 0,4 0,6 7,5 14014 ‘No education’ category has been excluded due to insignificant number of responses 1MICS Indicator TA.1 Table TA.1M: Current and ever use of tobacco Percentage distribution of men age 15-59 years by pattern of use of tobacco, Kazakhstan, 2010/11 Never smoked cigarettes or used other types of to- bacco prod- ucts Ever used Used tobacco products on one or more days in the past month1 Number of men aged 15-59 Only ciga- rettes Ciga- rettes and other tobacco products Only other tobacco products Any to- bacco products Only ciga- rettes Cigarettes and other tobacco products Only other tobacco products Any to- bacco products Age 15-19 69,7 18,5 9,2 2,6 30,3 7,2 1,2 2,3 10,7 394 20-24 32,3 42,7 24,4 0,6 67,7 36,6 5,6 1,0 43,3 433 25-29 24,6 50,5 24,6 0,2 75,4 52,8 4,4 1,6 58,8 434 30-34 20,7 59,6 19,1 0,5 79,3 59,4 2,2 1,0 62,6 548 35-39 14,5 64,5 20,6 0,4 85,5 64,0 2,5 0,5 67,1 539 40-44 20,3 61,9 17,8 0,0 79,7 58,6 3,2 0,7 62,4 453 45-49 18,7 64,1 16,6 0,7 81,3 59,3 1,6 1,7 62,7 432 50-54 17,5 62,5 19,3 0,8 82,5 56,1 1,8 1,5 59,4 361 55-59 16,1 70,0 12,7 1,2 83,9 55,7 1,6 3,7 61,0 251 Region Akmola Oblast 16,4 62,4 20,1 1,1 83,6 56,1 2,7 1,6 60,5 178 Aktobe Oblast 38,2 51,8 9,6 0,4 61,8 42,8 0,5 0,0 43,4 182 Almaty Oblast 24,9 65,7 9,4 0,0 75,1 52,0 0,5 0,0 52,5 423 Almaty city 25,8 45,1 28,5 0,6 74,2 40,7 6,7 1,6 49,0 302 Astana city 17,3 46,1 36,6 0,0 82,7 54,8 2,7 1,0 58,6 125 Atyrau Oblast 43,6 56,2 0,3 0,0 56,4 48,4 0,0 0,0 48,4 112 East Kazakhstan Oblast 25,3 66,7 8,0 0,0 74,7 61,3 0,0 0,0 61,3 340 Zhambyl Oblast 15,9 62,9 19,3 1,8 84,1 45,7 2,6 2,4 50,7 240 West Kazakhstan Oblast 22,8 64,6 12,2 0,4 77,2 55,8 0,8 0,0 56,6 158 Karaganda Oblast 11,4 50,0 37,4 1,3 88,6 57,3 6,1 2,2 65,6 333 Kostanai Oblast 18,1 53,3 27,8 0,7 81,9 57,1 2,6 2,2 61,8 219 Kyzylorda Oblast 29,9 37,5 30,1 2,5 70,1 44,4 2,2 6,1 52,7 157 Mangistau Oblast 13,3 39,4 43,8 3,5 86,7 51,1 12,4 12,3 75,8 121 Pavlodar Oblast 32,7 56,5 9,7 1,0 67,3 54,7 4,4 0,7 59,8 206 North Kazakhstan Oblast 9,8 68,3 20,8 1,1 90,2 62,8 1,0 0,7 64,5 164 212 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Never smoked cigarettes or used other types of to- bacco prod- ucts Ever used Used tobacco products on one or more days in the past month1 Number of men aged 15-59 Only ciga- rettes Ciga- rettes and other tobacco products Only other tobacco products Any to- bacco products Only ciga- rettes Cigarettes and other tobacco products Only other tobacco products Any to- bacco products South Kazakhstan Oblast 43,1 46,6 10,3 0,0 56,9 40,7 2,0 0,0 42,7 587 Residence Urban 24,6 51,6 22,9 1,0 75,4 49,5 3,9 1,1 54,5 2061 Rural 27,0 58,7 13,9 0,4 73,0 52,2 1,4 1,7 55,4 1785 Education Incomplete secondary 38,4 49,7 11,6 0,3 61,6 48,2 2,5 0,3 51,0 184 Secondary 26,9 58,3 14,0 0,8 73,1 53,4 2,2 1,4 57,0 1444 Specialized secondary 20,8 56,8 21,8 0,6 79,2 55,6 3,0 1,4 60,1 1261 Higher 28,0 48,3 22,8 0,9 72,0 40,7 3,2 1,6 45,5 953 Wealth Index Quintile Poorest 29,0 58,7 12,0 0,3 71,0 55,4 0,9 1,5 57,8 737 Second 28,7 58,0 12,8 0,5 71,3 50,9 1,6 1,6 54,1 748 Middle 28,2 53,5 17,4 0,8 71,8 48,4 2,7 1,5 52,6 773 Fourth 20,7 54,7 23,9 0,7 79,3 50,6 3,8 1,0 55,4 789 Richest 22,4 49,9 26,5 1,2 77,6 48,7 4,7 1,4 54,8 799 Ethnicity of Household Head Kazakh 30,7 53,7 14,7 1,0 69,3 46,0 2,3 1,6 49,9 2374 Russian 12,9 60,3 26,4 0,4 87,1 63,8 3,8 1,1 68,7 952 Other 26,6 50,5 22,7 0,2 73,4 48,4 3,0 1,1 52,5 520 Total 15-49 27,4 52,9 19,1 0,7 72,6 49,8 3,0 1,2 53,9 3233 Total 15-59 25,7 54,9 18,7 0,7 74,3 50,7 2,8 1,4 54,9 3846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator TA.1 MICS shows that 8.7 percent of men aged 15- 59 smoked their first cigarette before the age of 15 (see Table TA.2M). The same indicator among women of age group 15-49 is 1.3 percent (see Table TA.2). About 0.7 percent to 2.0 percent of women from all age groups smoked their first cigarette before the age of 15. Approximately 10.0 percent of men in the age group 15-29 reported having smoked their first ciga- rette before the age of 15, while the same indicator drops down to approximately 6 to 8 percent for men in age groups 30 to 44 and then starting with age group 45-49 years it increases from 9.3 percent to 15.3 percent. As seen in Table TA.2M, 36.2 percent of men currently smoking cigarettes smoked more than 20 cigarettes in the past 24 hours. Women smoke less frequently: only 9.1 percent of women currently smok- ing cigarettes smoked 20 cigarettes in the past 24 hours. 26.4 percent of women and 44.3 percent of men smoked 10 or more cigarettes in the past 24 hours. 213MONITORING THE SITUATION OF CHILDREN AND WOMEN Table TA.2: Age at first use of cigarettes and frequency of use Percentage of women age 15-49 years who smoked a whole cigarette before age 15 and percentage distribution of current smokers by the number of cigarettes smoked in the last 24 hours, Kazakhstan, 2010/11 Proportion of women, who smoked a whole cigarette before the age of 151 Number of women aged 15-49 Number of cigarettes smoked in the past 24 hours Number of currently smoking women aged 15-49Less than 5 5-9 10-19 20+ Total Age 15-19 1,4 2022 (49,7) (36,6) (11,0) (2,7) 100,0 33 20-24 1,6 2178 39,5 30,9 22,4 7,2 100,0 128 25-29 2,1 2016 38,4 32,6 22,8 6,2 100,0 181 30-34 1,7 2005 31,3 31,2 26,7 10,7 100,0 201 35-39 0,7 1901 34,2 31,0 25,3 9,6 100,0 178 40-44 0,9 1919 26,4 30,7 32,7 10,2 100,0 141 45-49 0,7 1972 16,5 35,7 34,7 13,1 100,0 111 Region Akmola Oblast 2,5 603 49,0 32,1 11,9 7,0 100,0 56 Aktobe Oblast 0,1 694 (52,5) (32,5) (8,9) (6,1) 100,0 31 Almaty Oblast 0,4 1518 (23,1) (39,4) (24,3) (13,3) 100,0 48 Almaty city 2,7 1190 21,2 43,7 35,0 0,0 100,0 79 Astana city 0,7 539 (39,8) (33,7) (18,4) (8,0) 100,0 26 Atyrau Oblast 0,1 409 (*) (*) (*) (*) 100,0 8 East Kazakhstan Oblast 1,4 1210 33,1 27,8 30,0 9,2 100,0 122 Zhambyl Oblast 0,5 836 (50,1) (16,8) (30,7) (2,4) 100,0 46 West Kazakhstan Oblast 1,3 566 (36,4) (22,3) (29,5) (11,7) 100,0 34 Karaganda Oblast 3,2 1274 31,2 27,2 28,2 13,5 100,0 195 Kostanai Oblast 1,6 791 28,1 36,3 28,9 6,7 100,0 89 Kyzylorda Oblast 0,2 553 (*) (*) (*) (*) 100,0 8 Mangistau Oblast 0,1 461 (23,9) (30,0) (43,1) (0,00) 100,0 20 Pavlodar Oblast 2,7 746 21,6 30,9 29,0 18,4 100,0 108 North Kazakhstan Oblast 2,5 577 42,7 29,0 23,5 4,9 100,0 65 South Kazakhstan Oblast 0,4 2048 (*) (*) (*) (*) 100,0 39 Residence Urban 1,8 8055 31,8 32,1 27,1 8,9 100,0 771 Rural 0,6 5959 34,8 31,7 23,6 9,9 100,0 202 Education Incomplete secondary 1,7 553 (20,1) (49,3) (18,9) (11,7) 100,0 40 Secondary 1,5 4407 32,4 30,9 26,6 10,1 100,0 324 Specialized secondary 1,3 4539 29,2 31,2 28,5 11,1 100,0 407 Higher 1,1 4489 41,5 31,9 23,3 3,2 100,0 202 Maternity Status Pregnant 2,1 549 (*) (*) (*) (*) 100,0 18 Breastfeeding (not pregnant) 0,0 268 (*) (*) (*) (*) 100,0 2 Neither 1,3 13197 32,2 32,0 26,6 9,2 100,0 952 Wealth Index Quintile Poorest 0,9 2528 36,7 33,1 22,4 7,8 100,0 93 Second 0,6 2599 36,3 32,2 22,9 8,7 100,0 118 214 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Proportion of women, who smoked a whole cigarette before the age of 151 Number of women aged 15-49 Number of cigarettes smoked in the past 24 hours Number of currently smoking women aged 15-49Less than 5 5-9 10-19 20+ Total Middle 0,7 2743 32,1 27,7 25,7 14,4 100,0 153 Fourth 1,3 2839 30,6 31,4 27,7 10,3 100,0 250 Richest 2,7 3305 31,5 33,9 28,0 6,6 100,0 359 Ethnicity of Household Head Kazakh 0,3 9003 45,7 29,4 20,1 4,8 100,0 202 Russian 3,9 3168 27,7 31,8 29,5 10,9 100,0 609 Other 1,7 1843 33,9 35,9 22,5 7,7 100,0 162 Total 1,3 14014 32,5 32,0 26,4 9,1 100,0 973 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator TA.2 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Table TA.2M: Age at first use of cigarettes and frequency of use Percentage of men age 15-59 years who smoked a whole cigarette before age 15, and percentage distribution of current smokers by the number of cigarettes smoked in the last 24 hours, Kazakhstan, 2010/11 Proportion of men, who smoked a whole cigarette before the age of 151 Number of men aged 15-59 Number of cigarettes smoked in the past 24 hours Number of currently smoking men aged 15-59Less than 5 5-9 10-19 20+ Total Age 15-19 9,7 394 (21,9) (17,7) (37,1) (23,3) 100,0 33 20-24 10,2 433 11,2 23,3 43,3 22,2 100,0 186 25-29 10,1 434 8,0 16,8 46,0 29,2 100,0 248 30-34 8,9 548 5,6 14,8 45,7 33,9 100,0 338 35-39 6,0 539 5,4 14,8 43,8 36,0 100,0 359 40-44 7,8 453 6,0 10,7 46,5 36,8 100,0 280 45-49 9,3 432 6,5 9,4 40,6 43,5 100,0 264 50-54 11,0 361 7,8 7,3 41,3 43,6 100,0 209 55-59 15,3 251 5,2 10,7 35,0 49,1 100,0 144 Region Akmola Oblast 19,7 178 9,0 6,4 44,5 40,2 100,0 105 Aktobe Oblast 3,1 182 12,4 22,2 27,3 38,0 100,0 79 Almaty Oblast 2,0 423 4,6 25,0 56,5 14,0 100,0 222 Almaty city 23,7 302 9,2 31,0 36,1 23,7 100,0 143 Astana city 3,5 125 1,0 7,5 19,5 72,0 100,0 72 Atyrau Oblast 2,0 112 2,2 1,4 54,1 42,3 100,0 54 East Kazakhstan Oblast 9,5 340 7,1 6,7 47,5 38,7 100,0 208 Zhambyl Oblast 5,3 240 10,4 7,8 29,1 52,7 100,0 116 West Kazakhstan Oblast 7,8 158 9,6 10,5 32,1 47,8 100,0 90 Karaganda Oblast 19,5 333 15,6 15,7 35,7 33,0 100,0 214 Kostanai Oblast 11,7 219 4,2 9,9 39,2 46,7 100,0 131 Kyzylorda Oblast 3,2 157 13,3 11,8 50,7 24,3 100,0 73 Mangistau Oblast 2,7 121 0,8 2,1 65,0 32,0 100,0 77 215MONITORING THE SITUATION OF CHILDREN AND WOMEN Proportion of men, who smoked a whole cigarette before the age of 151 Number of men aged 15-59 Number of cigarettes smoked in the past 24 hours Number of currently smoking men aged 15-59Less than 5 5-9 10-19 20+ Total Pavlodar Oblast 13,6 206 1,3 4,4 55,4 39,0 100,0 122 North Kazakhstan Oblast 28,9 164 7,7 9,2 24,9 58,2 100,0 105 South Kazakhstan Oblast 0,3 587 2,1 17,8 53,6 26,4 100,0 251 Residence Urban 12,0 2061 7,4 15,2 42,1 35,3 100,0 1103 Rural 6,3 1785 6,5 11,6 44,7 37,1 100,0 957 Education Incomplete secondary 13,1 184 1,5 6,5 42,4 49,6 100,0 94 Secondary 8,8 1444 6,5 12,0 40,4 41,1 100,0 807 Specialized secondary 10,9 1261 6,7 12,8 42,7 37,7 100,0 739 Higher 7,6 953 9,8 19,4 49,9 20,9 100,0 419 Wealth Index Quintile Poorest 5,2 737 5,9 12,4 42,5 39,1 100,0 415 Second 7,5 748 9,4 9,9 40,8 39,9 100,0 394 Middle 9,6 773 4,9 13,6 46,1 35,4 100,0 396 Fourth 12,0 789 8,0 13,0 44,4 34,6 100,0 429 Richest 12,3 799 6,8 18,4 42,7 32,1 100,0 427 Ethnicity of Household Head Kazakh 4,9 2374 8,7 13,6 45,9 31,8 100,0 1149 Russian 19,5 952 4,7 12,7 38,2 44,3 100,0 644 Other 11,2 520 5,3 15,1 44,5 35,1 100,0 267 Total 15-49 8,7 3233 7,1 14,5 44,3 34,2 100,0 1707 Total 15-59 9,4 3846 7,0 13,5 43,3 36,2 100,0 2060 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator TA.2 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations Alcohol Use higher than that of women where 3.4 percent of men in the age group 15-49 first had alcohol before the age of 15 compared to 0.9 percent of women in the age group 15-49. There are certain wealth and residence differenc- es in the use of alcohol among men and women. In par- ticular, alcohol consumption is more prevalent among women from the richest households (34.3 percent) and those living in urban areas (30.5 percent) compared to women from poorest households (16.8 percent) and those living in rural areas (21.2 percent). Alcohol use is common for all regions of the country. It should be noted that the highest proportion of women consuming alcohol Table TA.3 presents data on alcohol use among women. A total of 26.6 percent of women aged 15-49 had at least one serving of alcohol on one or more days in the past month. About 1 percent of women in the same group first had alcohol before the age of 15. The share of women who had at least one serving of alcohol before the age of 15 is higher in younger age groups than in older age groups. The proportion of men using alcohol is higher than that of women (see Table TA.3M). 45.6 percent of men aged 15-49 had at least one serving of alcohol on one or more days in the past month. The proportion of men who first had alcohol before the age of 15 is also 216 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table TA.3: Use of alcohol Percentage of women age 15-49 who have never had one drink of alcohol, percentage who first had one drink of alcohol before age 15, and percentage of women who have had at least one drink of alcohol on one or more days during the last one month, Kazakhstan, 2010/11 Never had alcohol Had alcohol at least once before the age of 151 Had at least one sip of alcohol on one or more days in the past month2 Number of women aged 15-49 Age 15-19 81,0 1,7 6,9 2022 20-24 48,5 1,1 21,3 2178 25-29 38,6 1,4 27,5 2016 30-34 33,0 0,5 30,7 2005 35-39 32,5 0,4 32,7 1901 40-44 30,3 0,9 33,8 1919 45-49 32,5 0,6 34,4 1972 Region Akmola Oblast 25,2 1,3 36,0 603 Aktobe Oblast 47,4 0,3 19,9 694 Almaty Oblast 54,2 0,4 18,3 1518 Almaty city 53,4 1,2 22,8 1190 Astana city 51,4 0,2 13,4 539 Atyrau Oblast 62,0 0,2 14,3 409 East Kazakhstan Oblast 37,9 1,9 31,8 1210 Zhambyl Oblast 46,9 0,3 23,5 836 West Kazakhstan Oblast 29,9 0,9 34,2 566 Karaganda Oblast 29,5 2,0 40,5 1274 Kostanai Oblast 21,8 1,6 43,4 791 Kyzylorda Oblast 67,1 0,0 5,3 553 Mangistau Oblast 55,7 0,1 14,4 461 Pavlodar Oblast 23,9 1,8 46,6 746 North Kazakhstan Oblast 16,3 2,7 48,5 577 South Kazakhstan Oblast 50,8 0,1 16,1 2048 Residence Urban 38,3 1,2 30,5 8055 Rural 48,5 0,5 21,2 5959 Education Incomplete secondary 73,5 1,5 11,5 553 Secondary 48,2 0,9 23,1 4407 Specialized secondary 36,2 1,1 31,2 4539 Higher 39,6 0,8 27,3 4489 was reported in North Kazakhstan (48.5 percent), Pav- lodar (46.6 percent), Kostanai (43.4 percent) and Kara- ganda (40.5 percent) oblasts while women from Kyzy- lorda Oblast consumed alcohol the least (5.3 percent). Alcohol use among men from the wealthiest house- holds is more common (52.5 percent) than among men from the poorest households (45.8 percent) as well as among men living in urban areas (49.6 percent) compared to men living in rural areas (42.7 percent). The lowest pro- portion of men using alcohol was reported in Kyzylorda and Mangistau Oblasts (26.2 percent and 27.8 percent respectively). 217MONITORING THE SITUATION OF CHILDREN AND WOMEN Never had alcohol Had alcohol at least once before the age of 151 Had at least one sip of alcohol on one or more days in the past month2 Number of women aged 15-49 Wealth Index Quintile Poorest 52,8 0,2 16,8 2528 Second 49,4 0,3 20,8 2599 Middle 43,4 1,2 26,4 2743 Fourth 37,4 1,1 31,6 2839 Richest 33,5 1,7 34,3 3305 Ethnicity of Household Head Kazakh 51,2 0,3 18,6 9003 Russian 19,3 2,4 48,5 3168 Other 41,3 1,6 27,8 1843 Total 42,7 0,9 26,6 14014 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator TA.3 2 MICS Indicator TA.4 Table TA.3M: Use of alcohol Percentage of men age 15-59 who have never had one drink of alcohol, percentage who first had one drink of alcohol before age 15, and percentage of men who have had at least one drink of alcohol on one or more days during the last one month, Kazakhstan, 2010/11 Never had alcohol Had alcohol at least once before the age of 151 Had at least one sip of alcohol on one or more days in the past month2 Number of men aged 15-59 Age 15-19 70,1 5,0 10,2 394 20-24 30,4 4,9 38,8 433 25-29 23,5 6,0 46,2 434 30-34 17,6 3,6 52,0 548 35-39 15,9 1,5 55,4 539 40-44 18,3 1,3 54,1 453 45-49 10,7 2,3 54,9 432 50-54 8,5 2,5 51,7 361 55-59 12,9 6,0 49,2 251 Region Akmola Oblast 11,0 7,6 50,1 178 Aktobe Oblast 31,8 2,8 39,3 182 Almaty Oblast 24,8 0,0 33,4 423 Almaty city 35,3 7,1 44,4 302 Astana city 16,8 0,9 46,7 125 Atyrau Oblast 23,2 0,4 56,4 112 East Kazakhstan Oblast 20,9 3,3 60,1 340 Zhambyl Oblast 11,4 4,0 37,6 240 West Kazakhstan Oblast 11,5 1,8 55,7 158 Karaganda Oblast 10,5 7,5 53,5 333 Kostanai Oblast 9,8 4,6 67,9 219 Kyzylorda Oblast 28,3 0,4 26,2 157 Mangistau Oblast 14,2 2,5 27,8 121 218 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Never had alcohol Had alcohol at least once before the age of 151 Had at least one sip of alcohol on one or more days in the past month2 Number of men aged 15-59 Pavlodar Oblast 28,1 2,2 50,1 206 North Kazakhstan Oblast 5,8 14,0 58,9 164 South Kazakhstan Oblast 42,2 0,3 41,5 587 Residence Urban 21,8 4,6 49,6 2061 Rural 24,4 2,1 42,7 1785 Education Incomplete secondary 38,1 7,1 39,2 184 Secondary 24,8 2,7 43,3 1444 Specialized secondary 17,7 3,8 51,0 1261 Higher 24,4 3,6 46,3 953 Wealth Index Quintile Poorest 26,4 2,0 45,8 737 Second 25,6 2,4 37,9 748 Middle 24,0 3,5 43,6 773 Fourth 19,2 4,4 51,7 789 Richest 20,3 4,9 52,5 799 Ethnicity of Household Head Kazakh 27,6 1,1 38,7 2374 Russian 9,7 8,0 65,2 952 Other 26,3 6,1 47,2 520 Total 15-49 25,4 3,4 45,6 3233 Total 15-59 23,0 3,5 46,4 3846 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator TA.3 2 MICS Indicator TA.4 219MONITORING THE SITUATION OF CHILDREN AND WOMEN XIV. Access to Mass Media and Use of Information/ Communication Technologies 220 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN The proportion of women reading a newspaper, listening to the radio or watching television at least once a week is shown in Table MT.1. In Kazakhstan, 63.9 percent of women read a newspaper, 29.1 percent listen to the radio and 98.4 percent watch television at least once a week. Over- all, 0.8 percent of women are not exposed to any of The 2010-2011 MICS collected information about exposure of women aged 15-49 and men aged 15-59 to mass media and their use of computers and the Internet. This information is intended to obtain information on: • Exposure to newspapers/magazines, radio and television; • Usage of computer; • Usage of Internet. the three mass media on a regular basis, whereas 22.9 percent are exposed to all three types of mass media at least once a week. Age groups 35-39 and 45-49 (67 percent in both groups) have a higher per- centage of newspapers readers, whereas younger groups 15-19 and 20-24 have a higher percentage of radio listeners. Access to mass media Table MT.1: Exposure to mass media Percentage of women aged 15-49 exposed to specific mass media on a weekly basis, Kazakhstan, 2010/11 Percentage of women aged 15-49 All three media at least once a week1 No mass media at least once a week Number of women aged 15-49 Read a newspaper at least once a week Listen to the radio at least once a week Watch TV at least once a week Age 15-19 64,0 39,7 97,2 27,8 0,9 2022 20-24 61,4 35,5 97,8 27,0 1,1 2178 25-29 60,8 29,9 98,9 23,9 0,6 2016 30-34 61,9 25,5 98,6 20,1 0,8 2005 35-39 67,0 25,5 98,5 21,7 0,8 1901 40-44 65,4 23,7 99,2 19,4 0,5 1919 45-49 67,1 23,1 98,9 19,8 0,7 1972 Region Akmola Oblast 69,1 23,2 97,7 18,9 1,2 603 Aktobe Oblast 76,6 34,4 98,4 29,0 0,8 694 Almaty Oblast 47,3 10,0 99,7 8,4 0,3 1518 Almaty city 46,3 42,2 99,0 28,1 0,9 1190 Astana city 82,2 78,6 99,5 70,7 0,1 539 Atyrau Oblast 78,1 44,7 99,8 41,0 0,1 409 East Kazakhstan Oblast 67,1 30,1 96,0 22,4 1,7 1210 Zhambyl Oblast 65,8 24,6 99,1 20,6 0,1 836 West Kazakhstan Oblast 78,4 37,9 98,8 32,3 0,4 566 Karaganda Oblast 69,9 34,7 97,8 27,0 1,1 1274 Kostanai Oblast 75,2 24,4 97,8 20,3 1,0 791 Kyzylorda Oblast 66,2 24,1 98,5 18,8 1,0 553 Mangistau Oblast 52,4 38,3 99,1 28,1 0,4 461 Pavlodar Oblast 57,9 37,4 97,6 24,0 1,6 746 221MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of women aged 15-49 All three media at least once a week1 No mass media at least once a week Number of women aged 15-49 Read a newspaper at least once a week Listen to the radio at least once a week Watch TV at least once a week North Kazakhstan Oblast 72,8 28,5 97,6 20,8 0,7 577 South Kazakhstan Oblast 59,6 13,3 99,1 10,9 0,6 2048 Residence Urban 66,3 39,1 98,1 30,4 0,8 8055 Rural 60,6 15,7 98,9 12,8 0,8 5959 Education Incomplete secondary 51,0 24,7 97,7 16,6 1,8 553 Secondary 51,7 19,3 98,6 13,6 1,0 4407 Specialized secondary 67,2 29,5 98,7 23,3 0,7 4539 Higher 74,4 39,1 98,3 32,6 0,5 4489 Wealth Index Quintile Poorest 52,4 12,1 97,9 9,3 1,6 2528 Second 61,8 18,2 99,4 15,0 0,2 2599 Middle 66,3 27,8 97,5 21,3 0,7 2743 Fourth 67,7 38,4 98,8 30,4 0,7 2839 Richest 69,0 43,9 98,6 34,5 0,8 3305 Ethnicity of Household Head Kazakh 64,7 28,3 98,6 22,9 0,7 9003 Russian 66,6 35,5 98,1 26,8 1,0 3168 Other 55,2 22,6 98,2 16,5 1,0 1843 Total 63,9 29,1 98,4 22,9 0,8 14014 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator MT.1 There are significant differences by residence, education and socio-economic status in exposure to the mass media, primarily due to differences in expo- sure to print mass media and radio. As seen from Ta- ble MT.1, higher exposure to all types of mass media, 27.0 - 27.8 percent, is reported in women’s age groups 20-24 and 15-19; whereas in age groups 40-44 and 45-49 this figure is much lower, 19.4 and 19.8 percent respectively. Women with higher education tend to be ex- posed to all kinds of mass media nearly twice as much (32.6 percent) as women with incomplete secondary education and secondary education (16.6 percent and 13.6 percent respectively). Similarly, 34.5 percent of women from the richest households are exposed to all three types of mass media, whereas this indicator for women from the poorest households was only 9.3 percent. Women from urban areas are also twice as frequently exposed to all types of mass media than ru- ral women (30.4 percent vs. 12.8 percent). As far as regions are concerned, the most frequent exposure to all three types of mass media was reported in Astana (70.7 percent), while the lowest exposure was reported in South Kazakhstan (10.9 percent) and Almaty (8.4 percent) Oblasts. Men aged 15-59 demonstrate slightly higher exposure to all types of mass media than women, as shown in Table MT.1M. 61.7 percent of men read a newspaper, 40 percent listen to the radio and 98.6 percent watch TV at least once a week. Only 0.7 percent are not exposed to any of the three types of mass media on a regular basis. About 30.3 per- cent are exposed to all three types of mass media at least once a week. As follows from this table, relationships between exposure to mass media and basic characteristics are broadly similar to those observed among women. It should be noted, however, that the male model of ex- posure to mass media depending on the age is some- what different from the female one. Younger women are more likely to report weekly exposure to all three types of mass media than older women, whereas younger men are usually less likely to be exposed to all three types of mass media than older men, since they are less likely to read a newspaper or listen to the radio once a week. 222 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table MT.1M. Exposure to mass media Percentage of men aged 15-59 exposed to specific mass media on a weekly basis, Kazakhstan, 2010/11 Percentage of men aged 15-59 All three media at least once a week1 No mass media at least once a week Number of men aged 15-59 Read a newspaper at least once a week Listen to the radio at least once a week Watch TV at least once a week Age 15-19 45,6 39,6 97,9 22,4 0,7 394 20-24 49,7 44,1 98,0 28,6 0,5 433 25-29 59,1 45,6 98,5 35,6 0,9 434 30-34 62,6 42,5 99,3 32,8 0,7 548 35-39 62,9 37,8 98,4 30,2 0,4 539 40-44 64,5 40,9 99,5 30,4 0,5 453 45-49 73,7 36,4 98,2 31,0 0,8 432 50-54 70,1 36,3 98,5 31,7 1,3 361 55-59 70,1 33,1 99,3 27,8 0,7 251 Region Akmola Oblast 74,2 41,3 98,2 35,2 0,7 178 Aktobe Oblast 74,0 38,3 98,2 30,0 1,8 182 Almaty Oblast 43,5 14,8 99,7 9,7 0,3 423 Almaty city 73,3 76,4 99,6 60,7 0,0 302 Astana city 63,1 80,7 100,0 58,2 0,0 125 Atyrau Oblast 77,8 13,0 98,9 12,5 1,1 112 East Kazakhstan Oblast 58,3 33,9 98,5 23,3 0,4 340 Zhambyl Oblast 59,7 57,6 98,7 38,2 1,3 240 West Kazakhstan Oblast 67,0 42,7 95,8 33,4 2,3 158 Karaganda Oblast 76,5 58,6 97,3 46,5 0,6 333 Kostanai Oblast 69,2 28,4 96,3 21,4 1,9 219 Kyzylorda Oblast 74,2 42,9 99,0 35,6 0,0 157 Mangistau Oblast 53,9 43,4 98,5 25,7 1,5 121 Pavlodar Oblast 75,3 57,8 98,2 46,6 1,4 206 North Kazakhstan Oblast 78,7 46,4 98,1 37,9 0,3 164 South Kazakhstan Oblast 37,0 15,9 99,8 11,4 0,0 587 Residence Urban 68,2 53,6 98,2 41,9 0,8 2061 Rural 54,3 24,2 99,1 16,9 0,6 1785 Education Incomplete secondary 43,2 34,7 97,5 16,3 2,0 184 Secondary 50,6 30,0 99,2 19,8 0,6 1444 Specialized secondary 66,1 43,5 98,8 33,8 0,5 1261 Higher 76,6 51,6 97,9 44,3 0,9 953 Wealth Index Quintile Poorest 44,8 22,1 98,7 14,6 1,1 737 Second 53,4 24,8 99,2 17,9 0,3 748 Middle 66,1 38,7 98,2 28,2 0,5 773 Fourth 67,2 51,8 98,4 40,3 1,0 789 Richest 75,5 60,4 98,7 48,6 0,6 799 223MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of men aged 15-59 All three media at least once a week1 No mass media at least once a week Number of men aged 15-59 Read a newspaper at least once a week Listen to the radio at least once a week Watch TV at least once a week Ethnicity of Household Head Kazakh 60,9 37,5 98,7 27,9 0,5 2374 Russian 68,4 49,7 98,4 39,4 1,1 952 Other 53,2 33,6 98,7 24,5 0,7 520 Total 15-49 60,1 40,9 98,6 30,3 0,6 3233 Total 15-59 61,7 40,0 98,6 30,3 0,7 3846 ‘No education’ category has been excluded due to insignificant number of responses 1MICS Indicator MT.1 Thus, higher levels of Internet and computer use were reported by women living in urban areas (90.6 percent and 81.3 percent respectively) compared to women living in rural areas (74.2 percent and 48.7 per- cent respectively). About 71.1 percent of women with secondary education and 92.8 percent of women with higher education reported having used computer and the Internet (50.5 percent and 84.2 percent respective- ly) within the past year. Within the past year, the Internet was most often used in Kostanai, Karaganda and Pavlodar Oblasts, Astana and Almaty (77.5-94.8 percent) cities and least often in Almaty, Zhambyl, Kyzylorda and South Ka- zakhstan Oblasts; (58.2-40.6 percent), with 91.2 per- cent of young women from the richest households us- ing the Internet in contrast to 35.3 percent of women from the poorest households. Questions about computer and Internet use were only asked of men and women aged 15-24. As seen from Table MT.2, 95.1 percent of women aged 15-24 have ever used a computer, 83.6 percent used a computer within the past year, and 71 percent used it at least once a week during the past month. Overall, 76.6 percent of women aged 15-24 have ever used the Internet, while 67.5 percent visited the Internet within the past year. The proportion of young women using the Internet more frequently, i.e., at least once a week during the past month, was smaller, 54 percent. As expected, there were more women aged 15-19 among those using a computer and the Internet in the past 12 months (92.1 percent and 72.9 percent respectively). Furthermore, computer and Internet use strongly correlates with residence, wealth and educa- tion. Use of Information/Communication Technologies Table MT.2: Use of computers and internet Percentage of young women age 15-24 who have ever used a computer, percentage who have used a computer during the last 12 months, and frequency of use during the last one month, Kazakhstan, 2010/11 Percentage of women aged 15-24 Percentage of women aged 15-24 Number of women aged 15-24 ever used a computer used a computer in the past 12 months1 used a computer in the past 12 months at least once a week ever used Internet used Internet in the past 12 months2 used Internet in the past 12 months at least once a week Age 15-19 97,1 92,1 80,4 79,1 72,9 58,3 2022 20-24 93,3 75,8 62,2 74,2 62,5 50,1 2178 224 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of women aged 15-24 Percentage of women aged 15-24 Number of women aged 15-24 ever used a computer used a computer in the past 12 months1 used a computer in the past 12 months at least once a week ever used Internet used Internet in the past 12 months2 used Internet in the past 12 months at least once a week Region Akmola Oblast 96,6 86,7 68,8 75,6 71,4 53,2 152 Aktobe Oblast 96,7 86,4 75,5 90,9 71,8 61,2 210 Almaty Oblast 93,5 76,5 59,4 71,7 58,2 39,5 511 Almaty city 99,5 95,9 89,6 98,6 94,8 82,1 314 Astana city 99,6 96,2 89,8 97,8 94,8 85,7 168 Atyrau Oblast 97,9 92,9 71,8 84,7 74,1 58,3 135 East Kazakhstan Oblast 96,9 87,1 77,4 77,9 67,2 56,2 349 Zhambyl Oblast 94,1 76,1 65,6 73,2 57,9 44,4 252 West Kazakhstan Oblast 94,0 84,5 75,9 79,4 73,0 62,8 164 Karaganda Oblast 94,5 86,2 78,1 84,2 77,6 65,0 366 Kostanai Oblast 98,7 89,0 78,0 83,2 77,5 67,4 224 Kyzylorda Oblast 96,3 83,6 62,2 69,3 57,3 42,1 162 Mangistau Oblast 95,9 85,8 75,1 89,1 79,6 65,1 158 Pavlodar Oblast 98,0 89,7 79,5 84,8 78,7 67,1 205 North Kazakhstan Oblast 96,9 87,9 68,5 79,5 73,1 50,4 146 South Kazakhstan Oblast 89,0 71,2 55,8 48,6 40,6 28,6 685 Residence Urban 97,7 90,6 81,4 87,9 81,3 69,5 2422 Rural 91,6 74,2 56,8 61,2 48,7 33,0 1779 Education Incomplete secondary 96,9 93,8 82,3 73,1 67,0 51,7 307 Secondary 89,2 71,1 57,1 60,8 50,5 37,4 1330 Specialized secondary 97,1 84,9 69,7 79,1 68,0 52,9 1224 Higher 98,9 92,8 83,4 91,0 84,2 72,3 1337 Wealth Index Quintile Poorest 86,8 66,2 47,0 47,5 35,3 22,5 799 Second 94,2 76,4 58,1 64,7 52,7 35,6 790 Middle 96,9 85,4 74,2 83,1 70,9 54,1 884 Fourth 97,9 92,3 81,6 89,7 83,3 72,2 822 Richest 98,9 95,7 90,5 94,3 91,2 81,5 906 Ethnicity of Household Head Kazakh 96,0 84,6 71,1 76,0 66,3 52,6 2842 Russian 96,0 88,8 78,1 86,3 80,2 68,0 807 Other 89,1 71,3 59,8 65,4 55,4 41,1 553 Total 95,1 83,6 71,0 76,6 67,5 54,0 4201 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator MT.2 2 MICS Indicator MT.3 225MONITORING THE SITUATION OF CHILDREN AND WOMEN Table MT.2M: Use of computers and internet Percentage of young men age 15-24 who have ever used a computer, percentage who have used a computer during the last 12 months, and frequency of use during the last one month, Kazakhstan, 2010/11 Percentage of men aged 15-24 Percentage of men aged 15-24 Number of men aged 15-24 have ever used a computer used a computer in the past 12 months1 used a computer in the past 12 months at least once a week have ever used Internet used Internet in the past 12 months2 used Internet in the past 12 months at least once a week Age 15-19 97,9 91,3 79,9 85,5 75,8 60,3 394 20-24 96,4 74,3 60,7 80,1 64,1 51,5 433 Region Akmola Oblast 98,3 91,2 74,1 79,4 72,6 59,2 41 Aktobe Oblast 100,0 92,8 83,1 94,6 83,5 71,4 47 Almaty Oblast 92,9 67,0 55,5 69,8 53,3 40,2 97 Almaty city 100,0 98,3 94,2 100,0 98,3 94,2 73 Astana city 99,2 93,1 72,3 92,6 84,5 64,8 33 Atyrau Oblast 100,0 93,1 72,2 91,9 69,2 60,7 29 East Kazakhstan Oblast (100,0) (89,0) (72,7) (82,8) (69,9) (55,6) 45 Zhambyl Oblast 96,2 84,4 64,9 69,0 67,0 34,4 56 West Kazakhstan Oblast (98,2) (83,1) (76,7) (76,7) (69,5) (59,8) 30 Karaganda Oblast (100,0) (91,7) (89,1) (69,9) (64,1) (61,6) 51 Kostanai Oblast 100,0 89,5 84,0 89,8 79,0 64,5 49 Kyzylorda Oblast (100,0) (81,0) (73,9) (77,5) (62,3) (48,6) 32 As shown in Table MT.2M, 82.4 percent of young men used a computer and 69.7 percent of them used the Internet in the past year. Men aged 15-24 living in urban area use computer and the Internet (91.6 per- cent and 82.3 percent respectively) than those living in rural area (70.5 percent and 53.4 percent respectively). A total of 70.0 percent of men with secondary education and 86.8 percent of men with higher edu- cation reported having used computer within the past year, while for the Internet this proportion was 52.4 per- cent and 85.4 percent of men respectively. Among computer users the proportion of young men from the wealthiest households is 99.6 percent compared to 58.5 percent of men from poorest house- holds, while for the Internet this proportion is 93.0 per- cent and 39.3 percent respectively. Men aged 15-19 use both computer and the Internet (91.3 percent and 75.8 percent respectively) more often than men aged 20-24 (74.3 percent and 64.1 percent respectively). 226 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of men aged 15-24 Percentage of men aged 15-24 Number of men aged 15-24 have ever used a computer used a computer in the past 12 months1 used a computer in the past 12 months at least once a week have ever used Internet used Internet in the past 12 months2 used Internet in the past 12 months at least once a week Mangistau Oblast (92,7) (90,1) (64,9) (84,7) (83,3) (54,4) 30 Pavlodar Oblast (97,6) (95,2) (87,3) (89,1) (82,4) (72,8) 36 North Kazakhstan Oblast (94,9) (81,5) (71,2) (75,5) (70,5) (51,8) 23 South Kazakhstan Oblast 94,0 62,6 45,7 84,2 54,0 39,1 154 Residence Urban 98,6 91,6 81,9 91,1 82,3 69,8 465 Rural 95,1 70,5 54,3 71,8 53,4 37,6 361 Education Incomplete secondary 97,9 96,3 87,2 81,7 74,1 56,7 69 Secondary 94,5 70,0 54,3 70,8 52,4 38,3 291 Specialized secondary 99,7 89,2 75,5 87,8 75,5 58,1 259 Higher 97,4 86,8 78,9 93,5 85,4 77,0 207 Wealth Index Quintile Poorest 89,9 58,5 47,3 57,9 39,3 26,2 140 Second 96,9 71,9 51,2 75,6 55,6 40,0 165 Middle 98,3 84,5 71,7 89,6 74,5 56,4 193 Fourth 99,7 93,9 83,6 89,9 81,1 65,6 168 Richest 99,6 99,6 92,0 95,6 93,0 86,4 160 Ethnicity of Household Head Kazakh 97,3 82,4 69,2 80,5 66,9 52,3 549 Russian 98,8 89,6 80,6 87,5 79,9 71,7 167 Other 93,3 71,5 56,5 85,9 68,0 48,6 111 Total 97,1 82,4 69,8 82,7 69,7 55,7 826 ‘No education’ category has been excluded due to insignificant number of responses 1 MICS Indicator MT.2 2 MICS Indicator MT.3 ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations 227MONITORING THE SITUATION OF CHILDREN AND WOMEN XV. Domestic Violence 228 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN The Beijing Declaration and Platform for Action, adopted by 189 countries at the Fourth World Confer- ence on Women in Beijing in 1995, consolidated these gains by underlining that violence against women is both a violation of women’s human rights and an im- pediment to the full enjoyment by women of all human rights. The focus shifted to demanding state account- ability for action to prevent and eliminate violence against women. Violence against women persists in every country in the world as a pervasive violation of human rights and a major impediment to achieving gender equality. Early initiatives to address violence against women at the international level focused primarily on the family. Women’s activism on violence against women increased in the early 1980s and the issue was more prominent at the Third World Conference on Women in Nairobi. The Nairobi Forward-Looking Strategies for the Advancement of Women recognized the prevalence of violence against women in various forms in everyday life in all societies and identified di- verse manifestations of violence by calling attention to abused women in the home. Work in this sector demonstrated that it was a significantly underreported global phenomenon that was committed in different contexts and highlighted the need for appropriate laws. Lately, the issue of domestic violence prevention in Kazakhstan has been receiving significant attention and in 2009 the Law of the Re- public of Kazakhstan “On Prevention of Domestic Vio- lence” was adopted. The law defines legal, economic, social and organizational basis for the activity of state bodies, local self-governance bodies, organizations and citizens of the Republic of Kazakhstan in regard to the prevention of domestic violence. Within the frame- work of this law, violence may be expressed in the form of physical, psychological, sexual and (or) economic abuse. 1. Physical abuse is intentional infliction of harm on another person through the use of physical force and the infliction of physical pain. 2. Psychological abuse is intentional influence on the human psyche, honor and dignity by means of threats, harassment, intimidation or coercion (compul- sion) to commit crimes or acts dangerous to human life or health, as well as leading to the disturbance of mental, physical and personal development. 3. Sexual abuse is intentional illegal act infring- ing on sexual privacy and sexual freedom rights as well as sexual acts against minors. 4. Economic abuse – intentional deprivation of shelter, food, clothing, property, funds for which the person has statutory rights which may lead to the dis- turbance of physical and (or) mental health. Raising public awareness about the causes and consequences of different forms of violence against women and broadening the understanding of interna- tional standards in force in the legal field required to conduct the measurement of violence phenomenon within the MICS. Only one woman between age of the 15-49 using random sampling was selected from each household and interviewed for the module on Do- mestic Violence. This module is not a standard MICS module and was taken and adapted from DHS. The data obtained from the survey are presented in Tables DV.1 -DV.12 According to Table DV.1, the proportion of all women in the age group 15-49 years who have ever been physically abused since age 15 is 12.8 percent, almost half of the cases (5.5 percent) took place in the 12 months preceding the survey. 11.4 percent of physi- cally abused women in the past 12 months had been married or in union before while 6 percent were mar- ried or in union at the time of the survey. By regions, there are significant variations in data on the above mentioned indicator across Kara- ganda (10.0 percent), Pavlodar (8.8 percent), North Kazakhstan (8.2 percent) oblasts with the lowest in- dicators (1.8 to 2.2 percent) in Kyzylorda Oblast and Astana city. At the same time it was observed that women with secondary and specialized second- ary education were more often physically abused (14.8 percent). 229MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DV.1: Experience of physical violence Percentage of women age 15-49 who have ever experienced physical violence since age 15 and percentage who have experienced violence during the 12 months preceding the survey, Kazakhstan, 2010/11 Percentage who have ever experienced physical violence since age 15 Number of women age 15-49Ever experienced physical violence * In the past 12 months Often Sometimes Any Region Akmola 21.2 1.2 6.0 6.9 504 Aktobe 5.6 0.7 2.3 2.9 507 Almaty 13.7 1.1 5.8 6.3 1060 Almaty city 5.1 0.2 2.6 2.6 941 Astana city 3.5 0.1 2.2 2.2 397 Atyrau 6.6 1.9 5.0 5.2 282 East Kazakhstan 12.7 1.5 4.9 5.0 975 Zhambyl 8.1 1.2 4.8 5.3 629 West Kazakhstan 12.8 0.6 5.5 5.5 424 Karaganda 22.3 1.4 9.8 10.0 991 Kostanai 20.2 0.4 6.4 6.4 645 Kyzylorda 4.4 0.5 1.8 1.8 408 Mangistau 9.0 1.1 4.4 5.1 309 Pavlodar 22.0 1.5 8.5 8.8 580 North Kazakhstan 24.7 1.7 7.2 8.2 470 South Kazakhstan 8.5 0.9 3.7 4.1 1459 Residence Urban 13.1 1.0 5.1 5.4 6163 Rural 12.4 1.0 5.3 5.7 4418 Age 15 - 19 3.7 0.3 1.4 1.5 1009 20 - 24 8.8 0.8 4.2 4.5 1459 25 - 29 12.2 0.8 5.0 5.3 1681 30 - 39 16.0 1.4 7.4 7.9 3440 40 - 49 14.4 0.9 4.5 4.7 2992 Marital/Union Status Currently married/in union 11.5 0.7 5.7 6.0 7063 Formerly married/in union 37.2 4.1 10.1 11.4 1239 Never married/in union 3.5 0.1 0.9 0.9 2279 Education Primary/incomplete secondary 10.5 0.9 5.4 5.7 340 Secondary 14.8 1.3 6.4 6.8 3278 Specialized secondary 14.8 1.0 5.5 5.9 3436 Higher 9.2 0.7 3.7 3.9 3516 Wealth Index Quintiles Poorest 13.5 1.5 5.9 6.3 1863 Second 13.1 1.3 5.6 6.1 1896 Middle 12.1 0.8 4.7 5.1 2001 Fourth 12.7 0.8 5.0 5.2 2222 Richest 12.7 0.7 4.9 5.1 2599 Total 12.8 1.0 5.2 5.5 10581 ‘No education’ category has been excluded due to insignificant number of responses * – includes the last 12 months 230 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table DV.2: Persons committing physical violence Among women age 15-49 who have experienced physical violence since age 15, percentage who reported that specific persons committed the violence by marital status, Kazakhstan, 2010/11. Person who committed physical violence Currently married Formerly married Never married All women Current husband/partner 100.0 0.0 na 60.2 Former husband/partner 9.3 100.0 na 39.6 Mother/step mother 5.8 1.6 30.1 5.8 Father/step father 6.3 3.5 13.1 5.7 Sister/brother 2.8 1.2 18.4 3.2 Daughter/son 0.0 0.4 0.0 0.1 Other relatives 1.9 4.1 0.7 2.6 Current boyfriend 1.1 1.0 11.1 1.7 Former boyfriend 1.9 2.0 18.8 3.0 Mother-in-law 0.2 0.2 na 0.2 Father-in-law 0.2 0.0 na 0.1 Other-in-law 0.3 0.2 na 0.2 Teacher 0.0 0.0 0.0 0.0 Employer/someone at work 0.0 0.0 1.1 0.1 Police/soldier 0.0 0.0 0.0 0.0 Other 5.8 4.3 22.7 6.3 Number of women age 15-49 815 460 79 1354 ‘No education’ category has been excluded due to insignificant number of responses Table DV.2 shows data on persons who committed physical violence. According to the data, of the women aged 15-49 who reported having been physically abused, 60.2 percent reported being abused by their husands/partners and 39.6 percent by their ex-husbands/partners. Of the currently married women who reported having been physically abused, 100 percent reported being abused by their husband/ partner and 9.3 percent by their ex-husbands/ex-part- ners. Of the never married women who reported hav- ing been physically abused, 30.1 percent reported be- ing abused by their mothers/stepmothers, 18.4 percent by their sisters/brothers, 13.1 percent by their fathers/ stepfathers and 18.8 percent by their ex-boyfriends. forced against their will. A somewhat higher incidence was noted for women in the age group 15-19. It is im- possible to assess the situation of girls aged 15 within this group due to the small number of these incidents. Table DV.3 shows the percentage of women whose first sexual intercourse was forced on them against their will. Overall in the country 2.1 percent of women indicated that their first sexual intercourse was Table DV.3: Force at sexual initiation Among women age 15-24 who have ever had sexual intercourse, percentage who say their first experience of sexual intercourse was forced against their will, by age and sexual intercourse and whether the first sexual intercourse was at the time of marriage or before first marriage, Kazakhstan, 2010/11 Percentage whose first sexual intercourse was forced against their will Number of women who have ever had sexual intercourse Age at First Sexual Intercourse <15 (*) 10 15 – 19 2,5 631 20 – 24 1,1 426 First Sexual Intercourse At the time of first marriage/first cohabitation 1,2 616 Before first marriage/first cohabitation 3,7 263 Women not married 2,7 188 Total 2,1 1067 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations 231MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DV.4: Experience of sexual violence, Percentage of women age 15-49 who have experienced sexual violence, Kazakhstan, 2010/11 Percentage who have ever experi- enced sexual violence Number of women age 15-49 Age 15-19 0.8 1009 20-24 2.2 1459 25-29 2.4 1681 30-34 4.0 1832 35-39 4.3 1608 40-44 3.6 1491 45-49 4.4 1501 Marital/Union status Currently married/in union 2.9 7063 Formerly married/in union 10.2 1239 Never married/in union 0.5 2279 Number of Living Children 0 1.3 2797 1-2 4.2 5202 3-4 3.3 2189 5+ 3.5 393 Residence Urban 3.3 6163 Rural 3.2 4418 Region Akmola 5.8 504 Aktobe 1.0 507 Almaty 2.3 1060 Almaty city 1.6 941 Astana city 0.8 397 Atyrau 2.3 282 East Kazakhstan 2.6 975 Zhambyl 2.5 629 West Kazakhstan 3.5 424 According to Table DV.4 findings, 3.2 percent of women aged 15-49 reported having been sexu- ally abused. In terms of regions, the percentage of sexual violence towards young girls is high in Kara- ganda (8.2 percent), Akmola (5.8 percent), Pavlodar (5.3 percent) and North Kazakhstan (5.3 percent) Oblasts. Approximately 4 percent of women from age groups 30-34, 35-39, 40-44 and 45-49 reported facts of sexual violence which is twice as high as the 2 percent of women who were victims of sex- ual violence from age groups 20-24 and 25-29. Of all women who reported sexual abuse, 4.2 percent, have had 1 to 2 children, 3.5 percent have up to 5 and more children and 1.3 percent of them did not have children. Women with higher education experienced sex- ual violence (2.0 percent) twice less often compared to women with incomplete secondary education (4.3 percent). It must be noted that women from poorest households experienced sexual violence somewhat more often. When viewing the phenomenon in terms of marital status, it should be noted that women previ- ously married (10.2 percent) more often reported hav- ing been sexually abused. 232 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage who have ever experi- enced sexual violence Number of women age 15-49 Karaganda 8.2 991 Kostanai 2.7 645 Kyzylorda 1.6 408 Mangistau 0.8 309 Pavlodar 5.3 580 North Kazakhstan 5.3 470 South Kazakhstan 2.7 1459 Education Primary/incomplete secondary 4.3 340 Secondary 3.8 3278 Specialised secondary 3.8 3436 Higher 2.0 3516 Wealth Index Quintiles Poorest 4.0 1863 Second 2.7 1896 Middle 2.5 2001 Fourth 3.3 2222 Richest 3.5 2599 Total 3.2 10581 ‘No education’ category has been excluded due to insignificant number of responses “*- Includes those whose sexual initiation was forced against their will According to Table DV.5, among women aged 15-49, the percentage of women who have ever experienced sexual or physical violence is highest starting from age group 30-34 until 45-49 and is 16 to 17 percent compared to 13.8 percent nationwide. Table DV.5: Experience of different forms of violence, Percentage of women age 15-49 who have experienced different forms of violence by current age, Kazakhstan, 2010/11 Physical violence only Sexual violence only Physical and sexual violence Physical or sexual violence Number of women age 15-49 Age 15-19 3.3 0.4 0.4 4.0 1009 20-24 7.3 0.7 1.5 9.5 1459 25-29 10.4 0.5 1.9 12.8 1681 30-34 13.0 1.0 3.0 17.0 1832 35-39 12.9 1.2 3.1 17.2 1608 40-44 12.4 1.2 2.4 16.0 1491 45-49 11.3 1.7 2.7 15.7 1501 Total 10.5 1.0 2.3 13.8 10581 ‘No education’ category has been excluded due to insignificant number of responses “*- Includes those whose sexual initiation was forced against their will * – includes only currently married women 233MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DV.6: Violence during pregnancy Among women age 15-49 who have ever been pregnant percentage who have ever experienced physical violence during pregnancy by background characteristics, Kazakhstan, 2010/11 Percentage who have ever experienced physical violence during pregnancy Women age 15-49 who have ever been pregnant Age 15-19 0.4 49 20-24 1.2 706 25-29 2.1 1306 30-34 3.0 1628 35-39 2.4 1467 40-44 1.3 1407 45-49 1.8 1385 Marital/Union Status Currently married/in union 1.5 6635 Formerly married/in union 7.6 1141 Never married/in union 0.1 171 Number of Living Children 0 0.2 163 1-2 2.8 5202 3-4 1.9 2189 5+ 1.5 393 Residence Urban 1.9 4444 Rural 1.9 3502 Region Akmola 3.1 403 Aktobe 0.5 373 Almaty 2.8 779 Almaty city 0.2 568 Astana city 0.3 280 Atyrau 1.2 211 East Kazakhstan 2.2 747 Zhambyl 2.1 482 West Kazakhstan 0.8 329 Karaganda 3.2 771 Table DV.6 shows data on the exposure to physi- cal violence of women from age group 15-49 who have ever been pregnant. Nationwide the percentage of wom- en who have ever been physically abused during preg- nancy is 1.9 percent. Age groups 30-34 and 35-39 had the largest incidence of physical violence with the indica- tor at 3.0 percent and 2.4 percent respectively. Among respondents there is a large percentage of women who reported having been married or in union before (7.6 percent). Also, based on their responses it was pos- sible to gather data on the number of living children: 2.8 percent of women have 1-2 children, 1.9 percent have 3-4 children and 1.5 percent of women have 5 and more children. Women experienced physical violence during pregnancy regardless of their level of wealth, however there were fewer women with higher education (1.2 per- cent) compared to women with secondary and special- ized secondary education (2.2 – 2.4 percent). 234 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage who have ever experienced physical violence during pregnancy Women age 15-49 who have ever been pregnant Kostanai 2.2 494 Kyzylorda 1.7 317 Mangistau 0.0 231 Pavlodar 3.4 443 North Kazakhstan 2.7 367 South Kazakhstan 1.4 1154 Education Primary/Secondary incomplete 0.0 5 Secondary 0.4 174 Secondary specialized 2.2 2576 Higher 2.4 2741 Wealth Index Quintiles Poorest 2.4 1473 Second 2.0 1488 Middle 1.3 1496 Fourth 2.4 1598 Richest 1.5 1891 Total 1.9 7947 ‘No education’ category has been excluded due to insignificant number of responses On average 14.2 percent of husbands demon- strated 3 and more specific types of controlling be- haviour towards their wives/partners, the highest inci- dence was for women in the age group 15-19, 20-24 and older (38.5 and 16 percent respectively). In terms of family status, the proportion of women whose hus- band (ex husband, partner) demonstrated 3 and more specific types of behaviour is highest among divorced/ widowed women (37.1 percent) as well as those who were married more than once (21.0 percent) compared to women who were married or in union at the time of the survey or had been married/in union only once prior to the survey (10 and 13.5 percent respectively). Table DV.7 presents data based on the respons- es of married/formerly married women (from age group 15-49) in regard to their husbands’/partners’ actions, demonstrating specific types of controlling behaviour (in percentage). Specific types of husbands’/partners’ behaviour were expressed, in particular, by jealousy (42.6 percent), constant control (44.3 percent), accu- sations in unfaithfulness (10.9 percent). Also cases of limiting wife’s contacts with her family and friends could be observed (4.1 percent and 9.0 percent respective- ly). Besides moral and psychological forms of violence economic abuse expressed in not trusting the wife with money was also reported (7.0 percent). Table DV.7: Degree of marital control experienced by husbands Percentage of ever-married women age 15-49 whose current or most recent husband/partner have ever demonstrated specific types of controlling behaviour, Kazakhstan, 2010/11 Percentage of women whose husband N um be r o f w om en ag e 15 -4 9 Is je al ou s or a ng ry if sh e ta lk s to o th er m en Fr eq ue nt ly a cc us es he r o f b ei ng u nf ai th - fu l D o no t p er m it he r to m ee t h er fe m al e fri en ds Tr ie s to li m it he r co nt ac t w ith h er fa m ily In si st s of k no w in g w he re s he is a t a ll tim es D oe s no t t ru st h er w ith a ny m on ey D is pl ay s 3 or m or e of th e sp ec ifi c be ha vi ou rs D is pl ay s no ne o f th e sp ec ifi c be ha vi ou rs Age 15-19 70,1 15,1 24,4 9,4 69,1 21,0 38,5 23,2 67 20-24 52,6 10,5 11,1 4,6 51,8 8,1 16,0 32,6 850 235MONITORING THE SITUATION OF CHILDREN AND WOMEN Percentage of women whose husband N um be r o f w om en ag e 15 -4 9 Is je al ou s or a ng ry if sh e ta lk s to o th er m en Fr eq ue nt ly a cc us es he r o f b ei ng u nf ai th - fu l D o no t p er m it he r to m ee t h er fe m al e fri en ds Tr ie s to li m it he r co nt ac t w ith h er fa m ily In si st s of k no w in g w he re s he is a t a ll tim es D oe s no t t ru st h er w ith a ny m on ey D is pl ay s 3 or m or e of th e sp ec ifi c be ha vi ou rs D is pl ay s no ne o f th e sp ec ifi c be ha vi ou rs 25-29 48,5 10,5 10,2 3,6 47,4 6,4 14,7 35,4 1398 30-34 45,0 11,0 8,0 4,4 46,3 6,7 14,3 37,0 1676 35-39 41,1 10,2 8,0 3,6 44,3 6,8 13,3 40,8 1491 40-44 36,2 11,6 7,9 4,5 38,6 6,9 12,7 45,4 1409 45-49 34,5 11,4 8,9 3,8 38,8 6,8 13,6 48,5 1411 Number of Living Children 0 52.5 10.5 12.1 4.7 52.9 9.3 18.1 32.3 684 1-2 43.5 12.5 9.9 4.9 45.8 7.3 16.0 38.9 5040 3-4 37.3 7.9 6.2 2.6 38.2 5.5 9.4 45.5 2186 5+ 42.4 8.1 6.5 1.6 43.9 6.8 11.0 40.8 393 Marital/Union Status and Duration Never married women 39.6 7.1 6.8 2.3 42.8 5.4 10.2 42.2 7063 Currently married women 41.8 10.3 8.5 3.8 43.8 6.8 13.5 40.9 7540 Years Since Marriage 0-4 years 50,4 9,1 9,3 4,2 51,8 6,8 14,5 33,3 1438 5-9 years 44,1 9,1 10,1 3,5 44,3 6,5 14,2 39,5 1443 10 and more years 38,4 11,0 7,7 3,8 41,2 7,0 13,0 43,7 4659 Married more than once 50.4 17.0 13.9 7.0 49.2 8.4 21.0 33.3 762 Divorced/ separated/ widowed* 59.4 32.9 21.5 14.6 53.1 16.3 37.1 28.9 1239 Residence Urban 44.7 11.6 10.5 4.7 46.3 7.2 15.4 38.0 4665 Rural 39.9 10.0 7.0 3.3 41.7 6.8 12.7 43.1 3637 Region Akmola 50.3 16.2 15.3 4.4 60.3 11.8 21.5 25.5 409 Aktobe 36.5 6.5 5.1 3.3 22.7 6.5 8.6 54.3 378 Almaty 30.6 9.4 6.2 5.4 26.0 4.5 12.3 59.3 819 Almaty city 49.0 8.2 9.4 5.4 60.5 9.8 15.7 28.7 609 Astana city 22.9 3.6 5.9 1.5 21.1 2.5 5.2 66.3 297 Atyrau 38.1 5.3 7.1 1.2 35.2 1.9 8.3 52.8 220 East Kazakhstan 43.0 12.7 9.1 3.4 38.9 4.9 14.0 42.2 790 Zhambyl 43.7 8.7 7.8 4.4 44.7 5.3 11.1 37.7 503 West Kazakhstan 41.4 11.5 10.8 4.7 43.8 4.6 14.7 39.0 345 Karaganda 48.7 19.1 15.6 7.1 56.3 8.8 22.4 28.4 804 Kostanai 42.6 12.2 10.4 3.7 60.5 12.3 18.8 29.1 511 Kyzylorda 42.6 4.8 8.5 3.3 35.3 9.9 11.3 44.1 327 Mangistau 48.3 3.8 9.0 1.7 43.6 6.0 9.8 40.1 233 236 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Percentage of women whose husband N um be r o f w om en ag e 15 -4 9 Is je al ou s or a ng ry if sh e ta lk s to o th er m en Fr eq ue nt ly a cc us es he r o f b ei ng u nf ai th - fu l D o no t p er m it he r to m ee t h er fe m al e fri en ds Tr ie s to li m it he r co nt ac t w ith h er fa m ily In si st s of k no w in g w he re s he is a t a ll tim es D oe s no t t ru st h er w ith a ny m on ey D is pl ay s 3 or m or e of th e sp ec ifi c be ha vi ou rs D is pl ay s no ne o f th e sp ec ifi c be ha vi ou rs Pavlodar 48.1 18.9 12.3 6.2 53.5 10.3 20.8 31.9 466 North Kazakhstan 44.8 17.1 9.6 5.1 49.6 5.5 16.8 33.2 389 South Kazakhstan 43.9 7.2 4.2 1.7 43.2 5.8 9.3 42.2 1204 Education Primary/Secondary incomplete 44.2 15.1 12.2 2.6 44.9 7.3 16.7 37.4 182 Secondary 43.6 12.1 8.9 4.7 43.8 7.8 15.1 40.1 2679 Secondary specialized 43.6 12.0 9.8 4.1 45.3 7.2 14.7 38.3 2837 Higher 40.3 8.2 7.9 3.6 43.6 5.9 12.5 42.7 2600 Wealth Index Quintiles Poorest 42.4 10.4 6.6 4.0 39.7 7.5 12.5 43.1 1536 Second 40.5 10.5 8.5 3.6 42.9 7.3 13.7 41.8 1555 Middle 41.2 9.1 8.1 3.1 44.2 5.9 12.6 40.9 1541 Fourth 44.1 13.1 10.9 5.7 45.5 6.9 16.8 38.6 1692 Richest 44.1 11.1 10.2 4.1 48.0 7.2 14.8 37.6 1978 Total 42.6 10.9 9.0 4.1 44.3 7.0 14.2 40.2 8302 * – Women not currently married were asked questions about the behaviour of their most recent husband/partner using the past tense Table DV.8 demonstrates all types of abuse (physical, sexual, emotional) used against ever mar- ried women in the age group 15-49 (in percentage) by frequency of occurrence. About 15.5 percent of women experienced physical violence, 3.8 percent – sexual vi- olence and 13.8 percent experienced emotional abuse. 7.1 percent of women experienced physical vio- lence, 1.3 percent of women experienced sexual vio- lence and 8.5 percent of women experienced emotional violence often or sometimes within the past 12 months prior to the survey. 17.9 percent of women experienced any types of physical, sexual and/or emotional abuse. Table DV.8: Forms of spousal violence Percentage of ever married women age 15-49 who have ever experienced spousal violence (by husband/ partner) and the percentage who experienced spousal violence in the past 12 months according to type of violence, Kazakhstan, 2010/11 Ever In the past 12 months Often Some-times Often or sometimes Physical violence Any 15.5 1.3 6.7 7.1 Pushed her, shook her, or threw something at her 10.2 0.9 4.3 5.2 Slapped her 10.2 0.8 4.3 5.1 Twisted her arm or pulled her hair 3.4 0.4 1.2 1.5 Punched her with his fist or with something that could hurt her 5.7 0.5 2.1 2.6 Kicked her, dragged her, or beat her up 3.5 0.3 1.3 1.6 237MONITORING THE SITUATION OF CHILDREN AND WOMEN Ever In the past 12 months Often Some-times Often or sometimes Tried to choke her or burn her on purpose 1.2 0.1 0.4 0.5 Threatened her or attacked her with a knife, gun, or any other weapon 3.9 0.3 1.5 1.8 Sexual violence Any 3.8 0.2 1.1 1.3 Physically forced her to have sexual intercourse with him even when she did not want to 2.0 0.1 1.0 1.1 Forced her to perform any sexual acts she did not want to/ Physically forced her to have sexual intercourse with him even when she did not want to 1.2 0.1 0.6 0.7 Sexual initiation was with current or most recent husband was forced 1.8 0.0 0.0 0.0 Emotional violence Any 13.8 1.9 7.5 8.5 Said or did something to humiliate her in front of others 8.0 1.1 3.6 4.7 Threatened her or attacked her with a knife, gun, or any other weapon 3.9 0.3 1.5 1.8 Insulted her or made her feel bad about herself 11.7 1.4 5.7 7.1 Any form of physical and/or sexual violence 14.7 1.4 6.9 7.4 Any form of physical and sexual violence 2.6 0.1 0.9 1.0 Any form of emotional, physical and/or sexual violence 17.9 2.5 10.0 10.5 Any form of emotional, physical and sexual violence 2.1 0.1 0.6 0.7 Any form of physical and/or sexual violence 14.7 1.4 6.9 7.4 Ever married women 8302 7989 7989 7989 ‘No education’ category has been excluded due to insignificant number of responses twice, experienced violence compared to divorced or widowed women more often. Women with higher ed- ucation were abused less often. Women who experi- enced all forms of violence reported that their father used to beat their mother. Table DV.9 shows that women in the age group 15-19 experienced emotional, physical and sexual abuse more often. At the same time it may be noted that the longer the woman is married, the more she experiences violence; also women who were married Table DV.9: Spousal violence by background characteristics Percentage of ever-married women age 15-49 who have ever experienced emotional, physical or sexual violence committed by their husband partner, by background characteristics, Kazakhstan, 2010/11 Emo- tional violence Physi- cal vio- lence Sexual violence Physical and/or Sexual violence Physical and Sexual violence Emotional, Physical and/or Sexual vio- lence Emotional, Physical and Sexual violence Number of women age 15-49 Age 15-19 10.1 19.1 7.6 22.2 4.5 23.0 4.5 67 20-24 9.4 12.5 3.1 13.2 2.4 15.4 1.6 850 25-29 12.4 13.6 2.5 14.0 2.1 16.6 1.5 1398 30-34 15.6 17.2 4.0 18.1 3.1 21.4 2.3 1676 35-39 14.1 16.9 4.2 17.9 3.3 20.6 2.6 1491 40-44 13.0 15.5 3.7 16.7 2.5 19.7 2.1 1409 45-49 15.7 14.6 4.4 16.2 2.8 20.1 2.4 1411 238 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Emo- tional violence Physi- cal vio- lence Sexual violence Physical and/or Sexual violence Physical and Sexual violence Emotional, Physical and/or Sexual vio- lence Emotional, Physical and Sexual violence Number of women age 15-49 Number of Living Children 0 11.7 15.7 4.1 17.3 2.5 19.5 1.8 684 1-2 15.9 17.0 4.0 17.9 3.1 21.6 2.5 5040 3-4 9.4 11.4 3.0 12.3 2.1 13.9 1.5 2186 5+ 13.3 16.3 3.5 17.4 2.4 19.7 1.9 393 Years Since Marriage 0-4 8.2 10.4 2.3 11.1 1.7 13.5 1.1 1438 5-9 13.6 14.0 2.8 14.5 2.2 18.1 1.9 1443 10+ 13.8 14.8 3.6 15.8 2.6 18.5 2.2 4659 Marital/Union Status Currently married women 9.4 11.5 2.6 12.4 1.8 14.8 1.2 7063 Residence Urban 14.1 15.9 3.9 17.0 2.8 20.2 2.4 4665 Rural 13.2 14.7 3.5 15.5 2.7 18.2 1.9 3637 Years Since Marriage 0-4 years 8,2 10,4 2,3 11,1 1,7 13,5 1,1 1438 5-9 years 13,6 14,0 2,8 14,5 2,2 18,1 1,9 1443 10 and more years 13,8 14,8 3,6 15,8 2,6 18,5 2,2 4659 Married only once 12.7 13.8 3.2 14.6 2.4 17.5 1.9 7540 Married more than once 23.6 30.9 9.0 33.1 6.8 37.4 4.5 762 Divorced/ Separated/ Widowed 38.0 37.2 10.1 38.8 8.4 45.1 7.6 1239 Residence Urban 14.1 15.9 3.9 17.0 2.8 20.2 2.4 4665 Rural 13.2 14.7 3.5 15.5 2.7 18.2 1.9 3637 Region Akmola 23.7 24.4 6.1 26.2 4.3 31.4 3.9 409 Aktobe 5.3 6.7 1.3 6.7 1.3 8.2 0.8 378 Almaty 19.1 17.8 2.7 18.1 2.4 21.6 1.8 819 Almaty city 7.8 6.0 2.1 7.5 0.5 10.6 0.5 609 Astana city 5.0 4.2 0.8 4.4 0.6 6.5 0.6 297 Atyrau 4.4 8.4 2.6 8.4 2.6 9.2 1.8 220 East Kazakhstan 13.7 15.7 2.7 16.3 2.1 19.0 1.5 790 Zhambyl 8.1 9.9 3.2 10.4 2.7 12.1 2.6 503 West Kazakhstan 14.9 15.5 3.9 15.9 3.5 20.8 2.7 345 Karaganda 20.9 26.0 9.5 28.9 6.6 33.4 5.4 804 Kostanai 19.7 22.6 3.4 23.4 2.7 28.0 2.2 511 Kyzylorda 5.7 5.5 1.7 5.8 1.4 7.6 1.4 327 Mangistau 4.0 9.1 0.2 9.3 0.0 9.3 0.0 233 Pavlodar 23.9 25.5 5.4 26.6 4.3 32.0 3.8 466 North Kazakhstan 24.8 27.7 6.1 29.2 4.6 34.7 3.6 389 South Kazakhstan 7.1 10.0 3.2 11.1 2.1 11.5 0.9 1204 Education Primary/Secondary incomplete 17.5 17.0 6.2 19.5 3.7 22.3 3.2 182 Secondary 14.6 17.3 4.3 18.1 3.4 20.6 2.6 2679 239MONITORING THE SITUATION OF CHILDREN AND WOMEN Emo- tional violence Physi- cal vio- lence Sexual violence Physical and/or Sexual violence Physical and Sexual violence Emotional, Physical and/or Sexual vio- lence Emotional, Physical and Sexual violence Number of women age 15-49 Secondary specialized 15.2 17.1 4.3 18.2 3.2 22.0 2.5 2837 Higher 10.8 11.3 2.4 12.2 1.5 14.9 1.3 2600 Wealth Index Quintiles Poorest 13.1 15.9 4.5 16.8 3.6 18.4 2.6 1536 Second 13.5 15.5 3.1 16.3 2.3 19.0 1.8 1555 Middle 13.8 14.4 2.8 15.1 2.0 18.7 1.7 1541 Fourth 14.0 15.6 4.1 16.8 2.9 20.2 2.2 1692 Richest 13.9 15.4 4.1 16.5 2.9 20.1 2.5 1978 Respondent’s Father Beat Her Mother Yes 30.9 39.8 8.8 41.2 7.4 45.2 5.7 1133 No 10.3 10.8 2.9 11.6 2.1 14.3 1.6 6236 Don't know 16.3 17.1 3.5 18.7 1.9 22.5 1.6 880 Total 13.7 15.4 3.7 16.3 2.8 19.3 2.1 8302 ‘No education’ category has been excluded due to insignificant number of responses Table DV.10 shows that across all forms of vio- lence there is a large percent of abuse incidence to- wards women who were older than their husbands or of the same age with them. High percent of sexual vio- lence (3.8 percent) could be observed in couples where the husband was 10 years and more older than his wife. 7.6 percent of women whose husbands display none of the specific behaviours report having experienced emotional, physical and/or sexual violence compared with 82.3 percent of women whose husbands display five or six behaviours. About 75 percent of women whose husband displays 5-6 marital control behav- iours experience emotional violence. Women who do not find reasons justifying violence, are less likely to experience violence (17,1 percent), than women who find 3-4 reasons justifying violence (30,1 percent). Table DV.10: Spousal violence by husband’s characteristics and empowerment indicators, Percentage of ever-married women age 15-49 who have ever suffered emotional, physical or sexual violence committed by their husband partner, according to his characteristics and empowerment indicators, Kazakhstan, 2010/11 Emo- tional violence Physi- cal vio- lence Sexual violence Physical and/ or Sexual vio- lence Physical and Sexual violence Emotional , Physical and/ or Sexual vio- lence Emotional, Physical and Sexual vio- lence Number of ever-married women age 15-49 Spousal Age Difference Wife is older 11.9 15.8 2.9 16.5 2.2 19.6 1.3 840 Wife is same age 11.1 11.2 2.7 12.3 1.6 15.5 1.5 834 0-4 year 8.6 10.6 2.3 11.3 1.7 13.4 1.2 3303 5-9 year 9.4 11.6 2.8 12.5 1.8 14.7 1.1 1627 10+ year 7.2 10.6 3.8 12.7 1.7 15.0 1.1 405 Formerly married 38.0 37.2 10.1 38.8 8.4 45.1 7.6 1239 DK 11.0 12.7 0.9 12.7 0.9 12.7 0.0 55 Number of Marital Control Behaviours Displayed by Husband/Partner 0 4.2 5.3 1.2 5.9 0.5 7.6 0.3 3339 1-2 11.8 14.3 2.5 15.2 1.5 18.3 0.8 3785 3-4 40.8 41.6 12.4 43.6 10.4 50.1 9.0 970 5-6 75.0 75.1 27.6 76.7 26.0 82.8 24.9 207 Number of Reasons for Which Wife Beating is Justified 0 12,3 13,2 3,1 14,1 2,2 17,1 1,7 7165 240 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table DV.11: Injuries to women caused by spousal violence, Percentage of ever-married women age 15-49 who have ever experienced spousal violence by their current or most recent husband/partner, by specific injuries received, according to type of violence and whether the violence was experienced ever and in the 12 months preceding the survey, Kazakhstan, 2010/11 Type of spousal violence and timing of violence Percentage of women who have received Number of ever-married women age 15-49 Cuts, bruises or arches Eye injuries, sprains, dislocations, or burns Deep wounds, broken bones, broken teeth or any other serious injury Any of these injuries Experienced Physical Violence Ever* 51.0 14.6 7.6 52.0 1221 In the past 12 months (*) 60.0 19.0 8.3 61.1 560 Experienced Sexual Violence Ever2 52.6 22.6 12.8 53.1 291 In the past 12 months (*) 67.9 31.8 16.0 69.1 105 Experienced Physical or Sexual Violence Ever* 48.4 13.9 7.3 49.3 1299 In the past 12 months(*) 58.9 18.7 8.4 60.0 583 ‘No education’ category has been excluded due to insignificant number of responses * Includes in the past 12 months (*) Excludes widows Violence, whether it is physical or sexual, as- sociates with the possibility of inflicting injuries; Table DV.11 shows women’s injuries related to domestic violence. Various bodily injuries of different severity are the result of physical and sexual violence that women experience. Among women who have ever been physically abused by their husbands more than half (51.0 percent) received such bodily injuries as cuts and bruises, 14.6 percent of women had eye injuries, sprains, burns, while 7.6 percent of wom- en received severe bodily injuries as deep wounds, broken bones and teeth and other severe injuries. The proportion of women who had bodily injuries as a result of physical violence in the past 12 months is much higher at 61.1 percent. Of those who have ever experienced sexual violence from their present or former husbands/partners (3.2 percent), more than 50.0 percent of women also received various bodily injuries, of them 70 percent were received in the past 12 months. Table DV.12 shows that women turn to for help- to stop the violence. Nationwide, from the responses of women aged 15-49 who have ever experienced physical or sexual violence, it may be seen that one third of wom- en never told anyone about the fact (32.9 percent), more than half (50.6 percent) never asked anyone for help. Of those who sought help, the largest percent- Emo- tional violence Physi- cal vio- lence Sexual violence Physical and/ or Sexual vio- lence Physical and Sexual violence Emotional , Physical and/ or Sexual vio- lence Emotional, Physical and Sexual vio- lence Number of ever-married women age 15-49 1-2 21,6 29,6 7,3 30,6 6,3 33,1 4,7 991 3-4 24,4 25,3 6,2 26,4 5,0 30,0 3,7 128 5-6 (*) (*) (*) (*) (*) (*) (*) 17 Total 13,7 15,4 3,7 16,3 2,8 19,3 2,1 8302 ‘No education’ category has been excluded due to insignificant number of responses (*) – indicators are based on less than 25 cases of unweighted observations age of women sought help from their family or hus- band’s family (33.7 percent and 14.3 percent respec- tively); and only 8.8 percent of victims sought help from police and 8.8 percent sought help from relatives. The percentage of those seeking help from advocates/law- yers and organizations providing social services is very small (0.2 -0.4 percent respectively). 241MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DV.12: Help seeking to stop violence Percent distribution of women age 15-49 who have ever experienced physical or sexual violence by whether they told anyone about the violence and whether they sought help from any source to end the violence, according to type of violence, Kazakhstan, 2010/11 N ev er to ld a ny on e N ev er s ou gh t h el p Percentage who sought help from N um be r o f w om en a ge 1 5- 49 w ho h av e ex pe rie nc ed p hy si ca l or s ex ua l v io le nc e O w n fa m ily H us ba nd /P ar tn er 's fa m ily C ur re nt /L as t/L at e hu sb an d/ P ar tn er C ur re nt /F or m er b oy fri en d R el at iv es N ei gh bo ur R el ig io us le ad er D oc to r/M ed ic al p er so nn el P ol ic e La w ye r S oc ia l s er vi ce o rg an iz at io n O th er Type of Violence Physical only 32.0 51.1 34.4 13.7 1.3 0.2 8.8 2.6 0.1 1.6 7.3 0.3 0.0 2.8 1123 Sexual only 72.3 91.7 2.4 3.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 2.0 87 Both physical and sexual 22.2 32.9 42.5 21.2 1.8 0.3 12.3 4.3 0.3 3.6 19.0 1.1 1.4 4.0 231 Current Age 15-19 (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 41 20-24 30,7 51,0 28,7 8,6 0,6 1,0 5,4 2,0 0,0 3,3 10,1 0,0 0,0 6,7 138 25-29 25,3 43,1 43,7 16,2 0,4 0,0 6,8 2,5 0,0 2,2 8,3 1,4 0,0 2,2 211 30-34 29,7 48,4 36,0 19,3 2,2 0,3 10,5 3,4 0,0 1,3 8,6 0,4 0,0 1,3 309 35-39 34,1 50,4 35,1 13,4 2,4 0,2 9,4 1,7 0,3 1,2 7,7 0,0 0,2 2,0 272 40-44 40,8 59,0 27,8 12,3 0,0 0,0 6,1 1,1 0,0 1,7 8,0 0,5 0,6 2,3 238 45-49 35,1 50,4 29,9 13,9 1,3 0,0 13,5 6,0 0,3 2,6 12,2 0,0 0,5 4,5 233 Number of Living Children 0 31.1 55.7 28.9 4.3 0.0 0.0 8.6 2.5 0.4 3.3 5.8 0.0 0.0 5.8 192 1-2 30.7 48.2 36.8 15.5 1.2 0.3 8.8 1.5 0.1 1.1 10.0 0.4 0.0 2.8 911 3-4 33.4 50.7 29.7 17.8 1.9 0.0 9.2 7.0 0.0 3.7 8.7 0.8 1.0 1.7 270 5+ 65.2 69.1 23.2 11.2 3.4 0.0 9.1 3.3 0.0 0.0 1.0 0.0 0.8 2.0 68 Marital/Union Status and Duration Never married women 31.9 62.5 18.7 0.0 0.0 0.0 5.1 0.7 0.0 0.0 6.3 0.0 0.0 11.0 85 Currently married women 38.8 58.1 26.8 13.5 1.0 0.3 6.3 2.4 0.2 1.6 7.0 0.5 0.4 2.0 875 Married only once 34.0 51.3 34.2 16.0 1.2 0.2 8.9 2.8 0.1 2.0 7.6 0.2 0.1 1.9 1104 Years Since Marriage 0-4 30,5 48,3 38,1 11,9 1,1 0,0 2,5 0,9 0,0 2,7 6,8 0,4 0,0 2,5 159 5-9 26,3 44,2 41,5 19,8 0,4 0,7 11,8 3,2 0,0 2,9 9,1 0,4 0,0 1,3 209 10+ 37,0 53,9 31,3 15,8 1,4 0,2 9,4 3,1 0,1 1,6 7,4 0,2 0,1 2,0 735 Married more than once 28.0 43.8 36.8 11.4 2.0 0.0 10.0 3.1 0.3 1.6 14.6 1.0 1.1 4.6 252 Divorced separated widowed 23.7 39.1 44.5 15.5 1.7 0.1 12.8 3.3 0.0 2.2 11.4 0.2 0.0 4.3 566 Residence Urban 33.8 50.8 34.1 13.4 1.3 0.3 7.5 1.6 0.0 1.7 8.6 0.2 0.3 3.5 860 242 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN N ev er to ld a ny on e N ev er s ou gh t h el p Percentage who sought help from N um be r o f w om en a ge 1 5- 49 w ho h av e ex pe rie nc ed p hy si ca l or s ex ua l v io le nc e O w n fa m ily H us ba nd /P ar tn er 's fa m ily C ur re nt /L as t/L at e hu sb an d/ P ar tn er C ur re nt /F or m er b oy fri en d R el at iv es N ei gh bo ur R el ig io us le ad er D oc to r/M ed ic al p er so nn el P ol ic e La w ye r S oc ia l s er vi ce o rg an iz at io n O th er Rural 31.5 50.4 33.3 15.6 1.2 0.0 10.8 4.5 0.2 2.0 9.0 0.6 0.1 2.0 581 Region Akmola 31,5 47,7 35,4 20,0 2,8 0,0 9,9 0,0 0,0 0,0 7,9 0,0 0,0 1,5 115 Aktobe 35,0 (52,4) (34,9) (10,4) (10,0) (0,0) (13,5) (3,0) (0,0) (0,0) (2,7) (0,0) (0,0) (3,1) (28) Almaty 16,3 48,1 41,4 19,4 0,0 0,0 19,0 2,0 0,0 1,0 1,1 0,0 0,0 0,0 148 Almaty city (27,5) (57,1) (27,0) (7,9) (0,0) (0,0) (7,9) (0,0) (0,0) (3,0) (2,4) 0,0 0,0 (2,5) 58 Astana city (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 14 Atyrau 45,7) (49,9) (48,5) (13,9) (0,0) (0,0) (19,5) (0,0) (0,0) (2,9) (1,6) (6,6) (0,0) (0,0) (19) East Kazakhstan 30,2 50,0 35,3 8,3 3,4 1,1 5,0 1,0 0,0 3,6 13,5 0,0 1,1 2,6 128 Zhambyl 37,2 53,4 38,1 16,8 0,0 0,0 0,0 1,7 0,0 0,0 0,0 0,0 0,0 0,0 53 West Kazakhstan 49,2 57,9 25,0 13,5 1,2 1,4 16,9 5,6 0,0 2,8 6,3 0,0 1,0 1,2 55 Karaganda 43,2 50,4 31,3 9,1 0,0 0,0 7,1 1,8 0,0 1,7 11,4 0,3 0,5 3,3 248 Kostanai 17,7 45,4 33,8 12,3 0,0 0,0 12,6 4,3 0,0 1,3 12,7 0,6 0,0 5,3 134 Kyzylorda (41,8) (50,0) (37,2) (15,7) (0,0) (0,0) (0,0) (0,0) (0,0) (0,0) (0,0) (0,0) (0,0) (0,0) 19 Mangistau 45,5 55,3 17,5 14,6 1,7 0,0 3,4 1,6 0,0 0,0 3,7 2,1 0,0 20,6 28 Pavlodar 33,3 51,6 37,2 16,4 0,6 0,0 5,5 1,9 0,0 0,0 12,2 0,6 0,0 4,5 133 North Kazakhstan 31,4 51,0 29,9 13,7 0,0 0,0 3,3 2,7 1,1 2,7 15,2 0,0 0,0 5,0 123 South Kazakhstan 40,6 53,9 31,2 21,2 4,3 0,0 8,2 9,6 0,0 4,8 6,5 0,0 0,0 0,0 136 Education Primary/ Secondary incomplete (42,0) (59,2) (25,8) (8,2) (0,0) (0,0) (5,9) (8,4) (0,0) (0,0) (12,2) (0,0) (0,0) (4,7) 40 Secondary 33,7 51,3 33,9 14,7 1,8 0,2 8,0 3,1 0,0 1,7 8,1 0,4 0,4 2,6 510 Secondary specialized 33,3 48,6 34,8 14,4 0,9 0,4 10,2 3,0 0,3 2,7 9,3 0,3 0,2 3,3 541 Higher 30,0 51,8 32,6 14,2 1,1 0,0 8,2 1,2 0,0 0,9 8,5 0,6 0,0 2,6 349 Wealth Index Quintiles Poorest 33.6 49.5 34.7 17.0 1.7 0.0 11.1 5.7 0.3 0.7 7.2 0.3 0.2 2.4 267 Second 31.7 48.1 37.0 15.3 1.4 0.3 11.7 4.4 0.3 3.8 9.3 0.3 0.0 2.2 260 Middle 27.3 51.0 29.8 16.5 0.7 0.0 8.6 1.6 0.0 1.4 8.6 0.5 0.0 2.3 254 Fourth 33.7 50.3 31.4 11.9 1.6 0.2 8.9 1.5 0.0 0.2 8.3 0.4 0.0 4.9 304 Richest 36.5 53.3 35.5 11.9 0.9 0.4 5.2 1.2 0.0 2.9 10.1 0.3 0.8 2.5 355 Total 32.9 50.6 33.7 14.3 1.3 0.2 8.8 2.8 0.1 1.8 8.8 0.4 0.2 2.9 1441 ‘No education’ category has been excluded due to insignificant number of responses ( ) – indicators are based on 25-49 cases of unweighted observations (*) – indicators are based on less than 25 cases of unweighted observations 243MONITORING THE SITUATION OF CHILDREN AND WOMEN The major features of the sample design are de- scribed in this appendix. Sample design features in- clude target sample size, sample allocation, sampling frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Kazakhstan Multiple Indicator Cluster Survey MICS4 was to produce statistically reliable estimates of most indicators, at the national level, for urban and ru- ral areas at the national level, and for the following re- Appendix A Sample Design gional domains: Akmola, Aktobe, Atyrau, Almaty, East Kazakhstan, Zhambyl, West Kazakhstan, Karaganda, Kostanai, Kyzylorda, Mangistau, Pavlodar, North Ka- zakhstan, South Kazakhstan Oblasts and Astana and Almaty cities. Urban and rural areas in each of the 16 regions including Astana and Almaty cities were defined as the sampling strata. A multi-stage, stratified cluster sam- pling approach was used for the selection of the survey sample. Sample Size and Sample Allocation indicator, expressed in the form of a propor- tion • 1.1 is the factor necessary to raise the sam- ple size by 10 percent for the expected non- response [the actual factor will be based on the non-response level experienced in previ- ous surveys in the country] • f is the shortened symbol for deff (design effect) • 0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 percent of r (relative margin of error of r) • p is the proportion of the total population upon which the indicator, r, is based • is the average household size (number of persons per household). Review of potential key indicators was performed based on the outputs of MICS3. A number of indicators were excluded from consideration in Kazakhstan ei- ther because of their very high value producing a small sample size (vaccination coverage indicators – over 90 percent; school attendance >90 percent, antena- tal care – >90 percent), or because of their very small value, producing a very large sample size, that would be excessive for most of other indicators (prevalence of diarrhea and acute respiratory infections). Consideration was given to important country specific indicators that would have a relatively low prev- alence, and would yield a sufficient sample size for most of the MICS4 indicators. The following indicators were identified as matching the MICS guidelines on sample size calcula- tion requirements: The target sample size for the Kazakhstan MICS was calculated as 16,380 households. The population of each Oblast was divided into two strata, urban and rural areas, and the sample households were selected in three stages. Within each stratum, enumeration areas (EAs) were selected sys- tematically with probability proportional to size. At the second sampling stage the larger EAs were divided into smaller segments, and one segment was selected in sample EA. After the household listing was carried out within the selected EAs or segments, a sample of 21 households was drawn in each sample EA. The sample was stratified by region, as well as urban and rural areas and is not self-weighting. For reporting national level results, sample weights were used. The following formula was used to estimate the re- quired sample size for the key indicators: where • n is the required sample size, expressed as number of households • 4 is a factor to achieve the 95 percent level of confidence • r is the predicted or anticipated value of the 244 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN • Percentage of children aged 36-59 months cur- rently attending early childhood education (16 per- cent, MICS3); • Percentage of children attending first grade who attended preschool programme in previous year (40 percent, MICS3); • Percentage of children 0-11 months who were ap- propriately fed (21 percent, MICS3). As a target indicator “Percentage of children attending first grade who attended preschool pro- gramme in previous year” is proposed finally to be used for estimating the sample size (the indicator is based on one birth cohort accounting for 2.2 percent of the total population and has a value of 40 percent according to MICS3. The average household size in Kazakhstan ac- cording to MICS3 is estimated as 3.5. The 1999 census data reveals an average household size of 3.6 with im- portant variation by urban (3.1) and rural areas (4.4) as well as by different oblasts (ranging from 2.9 in Almaty to 5.1 in Kyzylorda). Unfortunately, during the mission time, there were no published data on the Kazakh- stan population 2009 census, therefore assessment of the average household size sampling was taken from Kazakhstan MICS3. In the situation where only nationally-repre- sentative estimates would have been sufficient, us- ing the above mentioned formula would result in a sample size of 8,929 households for MICS4 in Kazakhstan. Responding to the need to produce reliable sub- national oblast (region) based estimates in addition to national estimates and estimates by urban/rural do- mains, the following rationale was considered: main- Item Result No. of domains 16 Margin of error to be tolerated at region-base domain 0.3 Domain-based sample size (no. of households) 1,032 Total sample size (no. of households) 1,032 X 16 domains = 16,512 households Number of clusters (x21HHs) 786 Estimated Completed Observations on: Households 15007 Women age 15-49 14707 Children age 0-4 years 5379 Children age 12-23 months 1156 compromise between the level of precision for such estimates, budgetary and data quality constraints. For any regional domain estimate based on one birth co- hort denominator with the value of 48% and higher, a relative error of 30% or less is expected. The number of households selected in each pri- mary sampling unit (cluster) was defined as 21 house- It is expected that for any national estimate with the value of 12% or more based on one birth cohort denominator, the relative error (95 percent confidence level) will be less than 12% and for urban/rural esti- mates – less than 16%. For region-based domain estimates a higher relative error will be accepted to achieve a reasonable taining the precision requirement for the sub-national domains would require increasing the sample size for the domain-based estimate by a factor of D, where D is the number of domains of the sample. That would result in a sample size of 8,929 x 16 = 142,857 house- holds, and the sample size would be too large to be practical. The recommended option is to accept a higher relative margin of error for region-based estimates in order to achieve a reasonable compromise between the need for such estimates, budgetary constraints and having an efficient data quality assurance programme. According to the MICS manual reporting do- mains might have their margins of error relaxed con- siderably – even as high as 25 to 30 percent of r. Domain estimates were built using the following assumptions: • anticipated prevalence (coverage) rate for key in- dicator (r=0.48), • relative margin of error (RME=0.3), Relaxing the precision requirement for the sub- national domains to 0.3 as well as accepting that pre- cision for higher rates (>=0.48) would yield a domain sample size of 1032 households and an expected num- ber of 919 interviewed eligible women, 336 children 0-4 years of age and 72 children of one birth cohort. The table below shows sample size estimates for the scenario based on 16 domains (allowing separate estimates for each of the 16 main administrative re- gions of the country). Calculation of the overall sample size is based on estimates for one domain, increased by the factor 16. 245MONITORING THE SITUATION OF CHILDREN AND WOMEN holds, based on the logistics of the fieldwork and the statistical efficiency of the sample design. The total sample for the MICS 2010-2011 survey is to interview 16,512 selected households, and based on the level of non-response found in the MICS 2006 approximately 14,700 women age 15-49 and 5400 children under 5 will be interviewed. Based on the level of non-response found in DHS1999, approximately 5,000 men age 15- 59 will be interviewed. In Table SD.1 the assumption was made that the expected ratios of completed interviews of Women and Children under 5 in selected households in each of the 16 urban strata and each of the 14 rural strata will fol- low the same total Urban/Rural patterns as the MICS 2006. These estimates are based on the urban/rural response rates from that survey, and a proportional dis- tribution of rural/urban population in each of the sixteen oblasts. Table SD. 1: Expected ratios of completed interviews of Women and Children under 5 in selected households by Urban/Rural areas Domain Population review 2009 MICS 2006 Estimated # of popula- tion Distri- bution of pop- ula- tion Estimated # of HH Distri- bution of HH Se- lected No. of HHs* Sample HH distri- bution Completed eligible women Completed eligible Kids <5 Compl. Women / selected HH Compl. Kids <5 / selected HH Kazakhstan: Urban 8,560,408 0.54 2,761,422 0.62 8,640 0.576 7,611 1,942 0.88 0.22 Kazakhstan: Rural 7,439,075 0.46 1,690,699 0.38 6,360 0.424 6,959 2,474 1.09 0.39 Total 15,999,483 1 4,452,121 1 15,000 1 14,570 4,416 0.97 0.29 data. Administrative data on the number of women 15-49 and of children under 5 were provided by the Agency of Statistics, RK for the year 2009. In Table SD.2 the updated data on household distribution by urban/rural areas of each of the 16 ad- ministrative units are provided based on 2009 Census Table SD.2: Expected number of selected households to reach the target of completed interviews by administrative regions Domain Census 2009 household distribution MICS2006 Estimates # of HH Distribution of HH Response rates No. of Women / selected HH No. of Kids <5 / selected HH Total Urban Rural Urban Rural Eligible women Eligible Kids <5 W/HH CH/HH Akmola Oblast 230,661 117,515 113,146 0.51 0.49 0.87 0.94 0.75 0.23 Aktobe Oblast 198,517 129,746 68,771 0.65 0.35 0.97 0.97 1.00 0.35 Almaty Oblast 407,146 111,956 295,190 0.27 0.73 0.97 0.97 1.11 0.40 Atyrau Oblast 112,830 60,235 52,595 0.53 0.47 0.98 0.99 1.23 0.54 West Kazakhstan Oblast 163,880 87,530 76,350 0.53 0.47 0.96 0.98 1.01 0.32 Zhambyl Oblast 232,446 111,880 120,566 0.48 0.52 0.99 0.99 1.20 0.52 246 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Domain Census 2009 household distribution MICS2006 Estimates # of HH Distribution of HH Response rates No. of Women / selected HH No. of Kids <5 / selected HH Total Urban Rural Urban Rural Eligible women Eligible Kids <5 W/HH CH/HH Karaganda Oblast 429,281 352,580 76,701 0.82 0.18 0.98 0.98 0.86 0.24 Kostanai Oblast 284,405 159,478 124,927 0.56 0.44 0.99 0.99 0.85 0.20 Kyzylorda Oblast 137,398 65,702 71,696 0.48 0.52 0.99 0.99 1.24 0.59 Mangistau Oblast 101,163 65,597 35,566 0.65 0.35 0.99 0.99 1.20 0.60 South Kazakhstan Oblast 478,717 218,180 260,537 0.46 0.54 0.97 0.98 1.30 0.67 Pavlodar Oblast 246,453 180,909 65,544 0.73 0.27 0.98 0.98 0.85 0.23 North Kazakhstan Oblast 203,271 91,187 112,084 0.45 0.55 0.98 0.98 0.82 0.20 East Kazakhstan Oblast 439,061 273,567 165,494 0.62 0.38 0.98 0.98 0.86 0.24 Astana City 184,012 184,012 1.00 - 0.89 0.93 1.05 0.33 Almaty City 409,573 409,573 1.00 - 0.91 0.92 0.95 0.34 Kazakhstan 4,258,814 2,619,647 1,639,167 0.62 0.38 0.96 0.97 1.00 0.36 number of children shows an increase of the expected number of children under 5 per selected household to 0.36. This matches the observed increase of birth rates over the last 5 years, accompanied by the increase in the proportion of children under 5 in the overall popula- tion from 7.9 percent in 2005 to 10.25 percent in 2009. The following table (SD.3) shows the distribution of about 16,500 sample households by domain. The number of PSUs was calculated by major domain, using both proportional and disproportional (Sqrt) sample allocation. The final expected number of eligible women and eligible children under 5 per selected household was estimated using these two sources of data, as well as the response rates for eligible women and children under 5 observed in MICS3. It is worth mentioning that the expected number of eligible women in Table SD.2 is very close to MICS3 findings. The situation is different with the expected number of children under 5 per selected household – in MICS3 it was 0.29 while the updated population data based on Census 2009 and administrative data on the Table SD.3: Proportional and disproportional (Sqrt) sample allocation Domain Proportional allocation (HHs) Sqrt (HHs) Distribution Sqrt () Sqrt allocation (HHs) Adjusted Sqrt sample (HHs) Expected Completed Women Expected Completed Kids <5 Akmola Oblast 894 679 0.06 1,039 1,030 894 257 Aktobe Oblast 770 622 0.06 952 950 1,015 350 Almaty Oblast 1,579 878 0.08 1,343 1,340 1,501 541 Atyrau Oblast 437 475 0.04 726 730 920 400 West Kazakhstan Oblast 635 572 0.05 875 870 927 282 Zhambyl Oblast 901 682 0.06 1,043 1,040 1,260 551 Karaganda Oblast 1,664 871 0.08 1,332 1,330 1,195 341 Kostanai Oblast 1,103 753 0.07 1,151 1,150 998 233 Kyzylorda Oblast 533 524 0.05 802 800 1,003 480 247MONITORING THE SITUATION OF CHILDREN AND WOMEN Domain Proportional allocation (HHs) Sqrt (HHs) Distribution Sqrt () Sqrt allocation (HHs) Adjusted Sqrt sample (HHs) Expected Completed Women Expected Completed Kids <5 Mangistau Oblast 392 445 0.04 680 680 857 426 South Kazakhstan Oblast 1,856 978 0.09 1,495 1,490 1,980 1,019 Pavlodar Oblast 956 681 0.06 1,042 1,040 924 248 North Kazakhstan Oblast 788 637 0.06 974 970 808 199 East Kazakhstan Oblast 1,702 930 0.09 1,422 1,420 1,266 353 Astana City 713 429 0.04 656 660 772 235 Almaty City 1,588 640 0.06 979 980 1,021 361 Kazakhstan 16,512 10,795 1.00 16,512 16,480 17,339 6,276 the level of precision that can be expected with this sample size and allocation. A review of MICS3 standard error and Deff es- timates by Kazakhstan regions has been performed. Two indicators have been selected that are based on one birth cohort denominators: • CH.2 Fully immunized children 15-26 months of age and • ED.6 Primary completion rate. For regions with denominators based on 50 and more observations, for the rates with a value >= 0.8, the value of standard error was < 0.05 and the Deff was under 1.5 in most of the cases. The samples of the Almaty Oblast, Karaganda Oblast, South Kazakhstan Oblast, Zhambyl Oblast and East Kazakhstan Oblast are excessively large for the established precision objective of this survey, leading to unnecessary waste of time and resources. For this reason it was necessary to reduce the sam- pling rate for the above mentioned domains relative to other domains and increase the sampling rate for Astana City, North Kazakhstan Oblast, Pavlodar Oblast, Kostanai Oblast, West Kazakhstan Oblast, Akmola Oblast. It is important to estimate the confidence inter- vals for key indicators at the domain level to determine Table SD.4: Values, standard errors (SE), design effects (deff) for selected indicators, Kazakhstan, MICS2006 Regions Unweighted sample HHS CH.2 Fully immunized1 Value SE Deff Unweighted denominator 1 Akmola Oblast 846 0.967 * * 33 2 Aktobe Oblast 837 1 0 * 56 3 Almaty Oblast 1096 0.82 0.047 1.33 89 4 Atyrau Oblast 782 1 0 * 59 5 West Kazakhstan Oblast 820 0.946 * * 41 6 Zhambyl Oblast 974 1 0 * 89 7 Karaganda Oblast 1052 0.977 * * 46 8 Kostanai Oblast 921 1 * * 42 9 Kyzylorda Oblast 830 1 0 * 82 10 Mangistau Oblast 758 1 0 * 76 11 South Kazakhstan Oblast 1125 0.99 0.009 1.282 139 12 Pavlodar Oblast 873 1 * * 41 13 North Kazakhstan Oblast 847 1 * * 28 248 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Regions Unweighted sample HHS CH.2 Fully immunized1 Value SE Deff Unweighted denominator 14 East Kazakhstan Oblast 1082 0.948 0.038 1.581 56 15 Astana 755 0.718 * * 39 16 Almaty 966 1 0 * 57 14564 Regions Unweighted sample HHs ED.6 Primary completion rate2 Value SE Deff Unweighted denominator 1 Akmola Oblast 846 0.857 * * 41 2 Aktobe Oblast 837 0.885 0.031 0.56 60 3 Almaty Oblast 1096 0.797 0.039 0.811 87 4 Atyrau Oblast 782 0.904 0.032 0.809 69 5 West Kazakhstan Oblast 820 0.956 * * 40 6 Zhambyl Oblast 974 0.895 0.026 0.563 77 7 Karaganda Oblast 1052 0.902 * * 44 8 Kostanai Oblast 921 0.88 0.045 1 54 9 Kyzylorda Oblast 830 0.952 0.024 1.066 84 10 Mangistau Oblast 758 0.911 0.045 1.621 65 11 South Kazakhstan Oblast 1125 0.953 0.019 1.123 141 12 Pavlodar Oblast 873 0.815 * * 36 13 North Kazakhstan Oblast 847 * * * 23 14 East Kazakhstan Oblast 1082 0.793 * * 43 15 Astana 755 0.882 * * 34 16 Almaty 966 0.9 * * 30 1 Children aged 15-26 months 2 Children of primary school completion age The following table shows the distribution of sample PSUs and households for the MICS4 by the 16 reporting domains in Kazakhstan. The distribution of the 780 sample PSUs and sample households between domains areas are not proportional to the last population census distribution. That is due to the disproportional allocation of sample EAs. Therefore the household sample for the MICS4 is not a self-weighted household sample. A suggested final adjusted sample is provided to have at least 880 eligible women, 280 eligible men and not less than 250 eligible children under 5 completed in each domain that would yield at least 50 children per birth cohort. The overall sample size has been slightly re- duced to 16,380 households. The selected households are distributed in 780 clusters in Kazakhstan. Table SD.5: Final recommended sample size Domain Household sample for selection Expected Completed Women Expected Completed Kids No. of PSU for selection (x21HHs) Total Akmola Oblast 1176 886 276 56 Aktobe Oblast 882 878 310 42 Almaty Oblast 1008 1117 398 48 Atyrau Oblast 798 984 432 38 West Kazakhstan Oblast 966 982 306 46 Zhambyl Oblast 882 1056 464 42 249MONITORING THE SITUATION OF CHILDREN AND WOMEN Domain Household sample for selection Expected Completed Women Expected Completed Kids No. of PSU for selection (x21HHs) Karaganda Oblast 1218 1044 296 58 Kostanai Oblast 1260 1069 250 60 Kyzylorda Oblast 798 991 473 38 Mangistau Oblast 798 943 471 38 South Kazakhstan Oblast 1008 1311 677 48 Pavlodar Oblast 1176 1003 268 56 North Kazakhstan Oblast 1260 1031 254 60 East Kazakhstan Oblast 1218 1050 293 58 Astana City 924 966 304 44 Almaty City 1008 956 340 48 Area Urban 10,038 8,984 3,207 478 Rural 6,342 7,283 2,605 302 Kazakhstan 16,380 16,267 5,812 780 Sampling Frame and Selection of Clusters P1i = ( b si/Σ si ) where b: number of sample EAs in the MICS2010 se- lected in a given stratum, si: measure of size (the number of segments) of i-th EA within the stratum Σ si : cumulated measure of size for the corre- sponding stratum At the second stage of sampling, segmentation was performed in selected large EAs using available maps or sketch maps produced in the field. When the number of segments in the sample EA was equal to one, no segmentation was done, because the segment and the EA are one and the same. The segmentation was necessary only if the number of segments was greater than one. The sampled EAs were subdivided in parts equal to the number of segments, with each part containing roughly the same number of households. After segmentation, one segment was selected at random in each sample enumeration area. The probability of selection at this second stage is repre- sented by the following formula: P2i=1/si where si: number of segments of i-th EA, The primary sampling unit (PSU) – or cluster - for the MICS2010/2011 is defined on the basis of Cen- sus Sectors or enumeration areas (EAs) from the 2009 Census of population frame, as having one (or more) EAs per PSU. In rural places the selection of PSUs was car- ried out independently for each of the 14 rural strata, and in urban places independently for each of the 16 urban strata. Within each stratum implicit geographical stratification was introduced by ordering rayons/cities from North to South in a serpentine manner. Within each rayon, EAs were ordered sequentially by code of the EA. At the first stage, PSUs were selected in each stratum systematically with probabilities proportional to size. Some EAs were so large that it is not economi- cally feasible to carry out a new listing of all house- holds, so it was more efficient to divide them into segments. Each EA was assigned a measure of size equal to the desired number of “standard segments” it contained. In the MICS manual it is recommended that the number of standard segments be defined (and computed) by dividing the census population of the enumeration area by 500 and rounding to the nearest whole number. The next step was to select sample EA in each stratum using probability proportional to this measure of size (the number of segments). The selection was done using the following for- mula: 250 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In each selected segment of the sample EAs, a household listing operation was carried out by staff of the territorial statistics authorities to identify the location of all households within each segment; rural statisticians, employees of the raion, city and oblast statistics departments were involved, visiting each selected enumera- tion area and listing all occupied households. Listing was performed from October 28 through November 23, 2011. The updated list of house- holds obtained was used as the frame for the third stage of sampling. Listing Activities Selection of Households and Calculation of Sampling Weights Lists of households were prepared by the list- ing teams in the field for each enumeration area. The households were then sequentially numbered from 1 to n (the total number of households in each enumera- tion area) at the Information and Computer Centre of the Agency of Statistics, RK where the selection of 21 households in each enumeration area was carried out using a random systematic selection procedure. Households were selected to achieve a fixed sample take per cluster. However, since the MICS2010/2011 sample was not allocated proportion- ately among domain areas, the weights were calculat- ed based on the inverse of the probabilities of selec- tion, which vary by stratum and sample PSU to provide estimates at the national domain of study. In a given domain for the i-th cluster, if (c) is the fixed number of households selected out of the total households (Li) -found in the 2010 listing process – then the household probability in the selected i-th clus- ter can be expressed as P3i=( c / Li ) The final overall probability for the sample households in the i-th cluster could be calculated as fi = P1i * P2i * P3i and the sampling design weight for the i-th cluster is given as 1/ fi = 1/ ( P1i * P2i * P3i) 251MONITORING THE SITUATION OF CHILDREN AND WOMEN tive in the Republic of Kazakhstan; Gaziza Moldakulova – Programme Coordinator on Population and Development, UNFPA in the Republic of Kazakhstan. INTERNATIONAL CONSULTANTS David McGill – international expert on sampling (USA) Oleg Benes – international expert on sampling (Mol- dova) Yadigar Coskun – international expert on data entry and processing (Turkey). STAFF OF THE RSE ICC UNDER THE AGENCY FOR STATISTICS, RK Kazganbayev, Eldar – Director of RSE ICC AS; Dzhumanbayeva, Zinagul – Deputy Director of RSE ICC AS; Ibragimova, Aigul – budget monitoring (Astana); Yelibayeva, Gulzina – MICS budget monitoring (Almaty); Korzhov, Dmitriy - system maintenance of computer equipment; Kulekeyev Bakhytbek – responsible for materials and equipment; Dzhunsbayev, Orynbasar – delivery of questionnaires to ICC; Sabanchiyev, Kanat – delivery of questionnaires to ICC office. DATA ENTRY AND DATA PROCESSING STAFF Kopeyeva, Gulzhan – Deputy Director of the Depart- ment of Statistics Information Management and Infor- mation System Management, responsible for data en- try into the CSPRO software; Kapisheva, Aigul – Deputy Head of the Department of Information Management, programmist of data entry into the CSPRO software and transfer into SPSS. MANAGERIAL PERSONNEL19 Smailov, Alikhan – Chairman of the Agency of Statis- tics, RK; Aidapkelov, Nurbolat – Executive Secretary of the Agency of Statistics, RK, (starting May 2011), Deputy Chairman of the Agency for Statistics, RK (until May 2011); Ashuyev, Aidyn – Deputy Chairman of the Agency of Statistics, RK (starting August 2011), Director of RSE ICC under the Agency of Statistics, RK (2010 – June 2011); Kukanova, Gyulnara – Director of the Department of Social and Demographic Statistics, Agency of Statis- tics, RK; Musabek, Yerbolat – Deputy Director of the Depart- ment of Social and Demographic Statistics, Agency of Statistics, RK; Amirkhanova, Maira – Head of Social Statistics Divi- sion under the Department of Social and Demographic Statistics (till March 2011)); Alkuatova, Nurzhamal – Head of Social Statistics Division under the Department of Social and Demographic Statis- tics (starting March 2011), Agency of Statistics, RK. INTERNATIONAL ORGANIZATIONS Jun Kukita – UNICEF Representative in the Republic of Kazakhstan; Attila Hancioglu – Global MICS Coordinator, UNICEF Headquarters in New York (USA); Ivana Bjelic – UNICEF Headquarters, USA; Turgay Unalan – UNICEF Headquarters, USA; Siraj Mahmudlu – UNICEF Regional Office (Switzer- land); Radoslav Rzehak – UNICEF Deputy Representative in the Republic of Kazakhstan; Raimbek Sissemaliev – Monitoring and Evalution Of- ficer, UNICEF in the Republic of Kazakhstan; Nikolay Botev – UNFPA Central Asia Sub-Regional Di- rector; Aleksandr Kosukhin – UNFPA Assistant Representa- Appendix B. List of personnel involved in the survey Editors Controllers Dauylbayeva, Saule Akbalina, Gulbarshyn Tolebi, Abdykalyk Ibraymov, Beibit 252 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Data Entry Clerks Azhibayeva, Adina Iyemberdieyev, Yerkebulan Tuleyeva, Zhaukhar Appasova, Kuralai Beisembek, Kulpara Asubayeva, Ainur Arkhimandrikova, Polina Sembinova, Mariyam Voronina, Yelena Bozbanova, Saule Nurbayeva, Nurzhamal Abrazakova, Almagul Umbetova, Aigerim Anarbekova, Natalya OBLAST TEAMS CARRYING OUT FIELD WORK Akmola Oblast Aktobe Oblast Kasymova, Altyn – supervisor Zhekeyev, Kairat – supervisor Nurmaganov, Sagadat – editor Beisov, Zholdaskali – editor Sagyndykova, Zhanna – interviewer Agisova, Nazgul – interviewer Nurgaliyeva, Aida – interviewer Bekmagambetov, Damirlan – interviewer Ordabayeva, Roza – interviewer Dzhuldybayeva, Saule – interviewer Olzhabayeva, Shuga – interviewer Zainullina, Maira – interviewer Sagyndykova, Botagoz – interviewer Kashkenova, Aigul – interviewer Azhibayev, Rinat – interviewer Munusheva, Meruert – interviewer Almaty Oblast Atyrau Oblast Imirova, Svetlana – supervisor Mukhangaliyeva, Galya – supervisor Nukezhanov, Bolatkan – editor Tuleuov, Amankos – editor Bukenov, Marat – interviewer Samenov, Sansyzbai – interviewer Ivanova, Lyudmila – interviewer Kyzembayeva, Lazgul – interviewer Tokhtarbekova, Shargul – interviewer Urazgalieyeva, Gaini – interviewer Bayanova, Klara – interviewer Nigmetova, Gulnar – interviewer Kapanova, Gulnara – interviewer Bimakhova, Gulnaz – interviewer Simonova, Lyudmila – interviewer Anesova, Marzhan – interviewer West Kazakhstan Oblast Zhambyl Oblast Zhumanov, Amanzhan – supervisor Shevtsova, Inga – supervisor Nugmanov, Margulan – editor Abishova, Zhuldyz – editor Rafikova, Sabira – interviewer Ustabayeva, Zhanat – interviewer Sagitova, Mariya – interviewer Rakhimova, Mubara – interviewer Umbetiyarova, Gulsim - interviewer Tigay, Marianna – interviewer Nurtazina, Botagoz – interviewer Nurova, Zalina – interviewer Ziyedenova, Zhemiskhanym - interviewer Aidarkhanova, Ulmeken – interviewer Arenov, Kaisar – interviewer Atakhanov, Berik – interviewer Karaganda Oblast Kostanai Oblast Komutova, Saule – supervisor Ryschanova, Rakiya – supervisor Konakbayeva, Sayagul – editor Galymzhanov, Aibek – editor Nechet, Natalya – interviewer Krokhina, Tatyana – interviewe r Belgibayeva, Aisha – interviewer Kasenova,Anar – interviewer Finogenova, Darya – interviewer Levitskaya, Svetlana – interviewer Usembekov, Sagynysh – interviewer Yeleubekov, Damir – interviewer Tursumbekova, Saltanat – interviewer Valiyeva, Natalya – interviewer Yermukhanbetova, Auyes - interviewer Kurlayeva, Yelena – interviewer 253MONITORING THE SITUATION OF CHILDREN AND WOMEN Kyzylorda Oblast Mangistau Oblast Bayekeyeva, Mariyam – supervisor Utyusheva, Rimma – supervisor Mashenbayev, Ondash – editor Yermakhanova, Aigul – editor Doszhanova, Asel – interviewer Ketebayeva, Shraylym – interviewer Tokanova, Zhyldyz – interviewer Batysheva, Aigyz – interviewer Abshakirova, Roza – interviewer Kaliyeva, Gulzhaina – interviewer Ligay, Yelena – interviewer Tabyldiyeva, Zhanar – interviewer Tulegenova, Aigul – interviewer Anezova, Meruert – interviewer Tashpenov, Zhanabek – interviewer Balykbayev, Dinislam – interviewer South Kazakhstan Oblast Pavlodar Oblast Kultayev, Yernazar – supervisor Utegenov, Mukhamdezhan – supervisor Tasbolatov, Mirakhment – editor Isenova, Kulzhan – editor Tuyekbayev, Bakhyt – interviewer Mekesheva, Oral – interviewer Shanrakisheva Aliya – interviewer Karibayev, Kanat – interviewer Buribekova, Zhanat – interviewer Peterson, Yelena – interviewer Kablanova, Nurgul – interviewer Yesilbayeva, Gulmira – interviewer Kabylova, Nasikhat – interviewer Salykbayeva, Altyn – interviewer Sargaldakov, Nurbolat – interviewer Novokschenova, Tatyana – interviewer North Kazakhstan Oblast East Kazakhstan Oblast Ushakova, Nadezhda – supervisor Bekishev, Yerlan – supervisor Zelenova, Lybov – editor Zhakipov, Talgat – editor Abdulkhaimova, Saida – interviewer Dzhanbosinova, Zinazaip – interviewer Vdovina, Irina – interviewer Abisheva, Aigul – interviewer Kairzhanova, Yermek – interviewer Sakygozhina, Zhraylym – interviewer Kuzmina, Lyudmila – interviewer Bulgynova, Gulzhan – interviewer Semykina, Lyudmila – interviewer Dolgyh, Svetlana – interviewer Rebrov, Vitaliy – interviewer Beisembayev, Daniyar - interviewer Astana Almaty Serikbayeva, Zhanar – supervisor Shnazbayeva, Saulekhan – supervisor Aurbakirova, Sara – editor Shvabskaya, Galina – editor Kuderinova, Zhanat – interviewer Mityanina, Yulia – interviewer Raimkulova, Sheker – interviewer Yeshzhanova, Gulbanu – interviewer Aubakirova, Diyara – interviewer Yusupova, Nargiz – interviewer Naurzbekova, Asel – interviewer Satybaldieyev, Zhanibek – interviewer Baimagambetova, Nurgul – interviewer Turgambayeva, Aigul – interviewer Andasov, Arman – interviewer Belyayeva, Galina – interviewer 254 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN sample, while a deft value above 1.0 indicates the increase in the standard error due to the use of a more complex sample design.  Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall, with a specified level of confidence. For any given statistic calculated from the survey, the value of that statistic will fall within a range of plus or minus two times the standard error (r + 2.se or r – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, SPSS Version 18 Complex Samples module has been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. Sampling errors are calculated for indicators of primary interest, for the national level, for the regions, and for urban and rural areas. One of the selected indicators is based on households, 5 are based on household members, 18 are based on women, 10 are based on men, and 17 are based on children under 5. All indicators presented here are in the form of proportions. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Tables SE.2 to SE.20 show the calculated sampling errors for selected domains. Appendix C. Estimates of Sampling Errors The sample of respondents selected in the Kazakhstan Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data. The following sampling error measures are presented in this appendix for each of the selected indicators:  Standard error (se): Sampling errors are usually measured in terms of standard errors for particular indicators (means, proportions etc). Standard error is the square root of the variance of the estimate. The Taylor linearization method is used for the estimation of standard errors.  Coefficient of variation (se/r) is the ratio of the standard error to the value of the indicator, and is a measure of the relative sampling error.  Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling. The square root of the design effect (deft) is used to show the efficiency of the sample design in relation to the precision. A deft value of 1.0 indicates that the sample design is as efficient as a simple random 255MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.1: Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Kazakhstan, 2010/2011 MICS4 Indicator Base Population HOUSEHOLDS 2.16 Iodized salt consumption All households in which salt was tested or with no salt HOUSEHOLD MEMBERS 4.1 Use of improved drinking water sources All household members 4.3 Use of improved sanitation facilities All household members 7.5 Secondary school net attendance ratio (adjusted) Children of secondary school age 9.18 Prevalence of children with at least one parent dead Children age 0-17 years 8.5 Violent discipline Children age 2-14 years WOMEN - Pregnant women Women age 15-49 years 5.2 Early childbearing Women age 20-24 years 5.3 Contraceptive prevalence Women age 15-49 years who are currently married or in union 5.4 Unmet need Women age 15-49 years who are currently married or in union 5.5a Antenatal care coverage - at least once by skilled personnel Women age 15-49 years with a live birth in the 2 years preceding the survey 5.5b Antenatal care coverage – at least four times by any provider Women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the 2 years preceding the survey 5.8 Institutional deliveries Women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section Women age 15-49 years with a live birth in the 2 years preceding the survey 7.1 Literacy rate among young women Women age 15-24 years 8.7 Marriage before age 18 Women age 20-49 years 9.2 Comprehensive knowledge about HIV prevention among young people Women age 15-24 years 9.3 Knowledge of mother- to-child transmission of HIV Women age 15-49 years 9.4 Accepting attitudes towards people living with HIV Women age 15-49 years who have heard of HIV 9.6 Women who have been tested for HIV and know the results Women age 15-49 years 9.7 Sexually active young women who have been tested for HIV and know the results Women age 15-24 years who have had sex in the 12 months preceding the survey 9.11 Sex before age 15 among young women Women age 15-24 years 9.16 Condom use with non-regular partners Women age 15-24 years who had a non-marital, non-cohabiting partner in the 12 months preceding the survey MEN 7.1 Literacy rate among young men Men age 15-24 years 8.7 Marriage before age 18 Men age 20-49 years 9.2 Comprehensive knowledge about HIV prevention among young people Men age 15-24 years 9.3 Knowledge of mother- to-child transmission of HIV Men age 15-49 years 9.4 Accepting attitudes towards people living with HIV Men age 15-49 years who have heard of HIV 9.6 Men who have been tested for HIV and know the results Men age 15-49 years 256 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 9.7 Sexually active young men who have been tested for HIV and know the results Men age 15-24 years who have had sex in the 12 months preceding the survey 9.11 Sex before age 15 among young men Men age 15-24 years 9.16 Condom use with non-regular partners Men age 15-24 years who had a non-marital, non-cohabiting partner in the 12 months preceding the survey 9.21 Male circumcision Men age 15-59 years UNDER-5s 2.1a Underweight prevalence Children under 5 2.2a Stunting prevalence Children under 5 2.3a Wasting prevalence Children under 5 2.6 Exclusive breastfeeding under 6 months Total number of infants under 6 months of age 2.14 Age-appropriate breastfeeding Children age 0-23 months - Tuberculosis immunization coverage Children age 15-26 months - Received polio immunization Children age 15-26 months - Received DPT immunization Children age 15-26 months - Received measles and MMR (Measles, Mumps, Rubella) immunization Children age 15-26 months - Received Hepatitis B immunization Children age 15-26 months - Diarrhoea in the previous 2 weeks Children under 5 3.8 Oral rehydration therapy with continued feeding Children under 5 with diarrhoea in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia Children under 5 with suspected pneumonia in the previous 2 weeks 6.1 Support for learning Children age 36-59 months 6.7 Attendance to early childhood education Children age 36-59 months 8.1 Birth registration Children under 5 Table SE.2: Sampling errors: Total sample Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indicator Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,8540 0,0074 0,009 6,850 2,617 15722 15729 0,839 0,869 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9393 0,0079 0,008 17,452 4,178 54549 15800 0,923 0,955 Use of improved sanitation 4,3 0,9792 0,0029 0,003 6,398 2,529 54201 15680 0,973 0,985 Secondary school net attendance ratio (adjusted) 7,5 0,9238 0,0039 0,004 1,224 1,106 5935 5810 0,916 0,932 Prevalence of children with one or both parents dead 9,18 0,0504 0,0026 0,052 2,304 1,518 16323 16107 0,045 0,056 School attendance of orphans 9,19 1,0000 0,0000 0,000 . . 17 19 1,000 1,000 School attendance of non- orphans 9.20 0,9976 0,0008 0,001 0,991 0,995 3692 3577 0,996 0,999 Violent discipline 8,5 0,4941 0,0090 0,018 2,186 1,479 11547 6782 0,476 0,512 257MONITORING THE SITUATION OF CHILDREN AND WOMEN MICS Indicator Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se WOMEN Pregnant women - 0,0391 0,0018 0,047 1,267 1,126 14014 14014 0,035 0,043 Early childbearing 5,2 0,0227 0,0032 0,141 1,005 1,003 2178 2170 0,016 0,029 Contraceptive prevalence 5,3 0,5100 0,0064 0,012 1,369 1,170 8434 8426 0,497 0,523 Unmet need 5,4 0,1157 0,0042 0,037 1,470 1,212 8434 8426 0,107 0,124 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9916 0,0018 0,002 0,828 0,910 1993 2027 0,988 0,995 Antenatal care coverage – at least four times by any provider 5.5b 0,8698 0,0066 0,008 0,784 0,885 1993 2027 0,857 0,883 Skilled attendant at delivery 5,7 0,9985 0,0012 0,001 1,918 1,385 1993 2027 0,996 1,000 Institutional deliveries 5,8 0,9961 0,0016 0,002 1,412 1,188 1993 2027 0,993 0,999 Caesarean section 5,9 0,1586 0,0079 0,050 0,951 0,975 1993 2027 0,143 0,174 Literacy rate among young women 7,1 0,9994 0,0005 0,001 1,984 1,408 4201 4182 0,998 1,000 Marriage before age 18 8,7 0,0864 0,0030 0,035 1,384 1,176 11992 12002 0,080 0,092 Comprehensive knowledge about HIV prevention among young people 9,2 0,3616 0,0087 0,024 1,359 1,166 4201 4182 0,344 0,379 Knowledge of mother- to-child transmission of HIV 9,3 0,5247 0,0069 0,013 2,648 1,627 14014 14014 0,511 0,538 Accepting attitudes towards people living with HIV 9,4 0,0253 0,0022 0,087 2,679 1,637 13445 13519 0,021 0,030 Women who have been tested for HIV and know the results 9,6 0,2254 0,0051 0,023 2,071 1,439 14014 14014 0,215 0,236 Sexually active young women who have been tested for HIV and know the results 9,7 0,3425 0,0116 0,034 0,862 0,929 1410 1437 0,319 0,366 Sex before age 15 among young women 9,11 0,0041 0,0011 0,263 1,181 1,087 4201 4182 0,002 0,006 Condom use with non-regular partners 9,16 0,6991 0,0181 0,026 0,526 0,725 310 338 0,663 0,735 MEN Literacy rate among young men 7,1 0,7490 0,0150 0,020 0,986 0,993 826 823 0,719 0,779 Marriage before age 18 8,7 0,0058 0,0018 0,310 0,484 0,696 867 864 0,002 0,009 Comprehensive knowledge about HIV prevention among young people 9,2 0,3413 0,0158 0,046 0,912 0,955 826 823 0,310 0,373 Knowledge of mother- to-child transmission of HIV 9,3 0,3834 0,0099 0,026 1,580 1,257 3846 3846 0,364 0,403 Accepting attitudes towards people living with HIV 9,4 0,0271 0,0029 0,106 1,156 1,075 3640 3662 0,021 0,033 Men who have been tested for HIV and know the results 9,6 0,1514 0,0066 0,043 1,298 1,139 3846 3846 0,138 0,165 Sexually active young men who have been tested for HIV and know the results 9,7 0,1533 0,0108 0,071 0,394 0,627 413 436 0,132 0,175 Sex before age 15 among young men 9,11 0,0136 0,0024 0,175 0,346 0,589 826 823 0,009 0,018 258 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indicator Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Condom use with non-regular partners 9,16 0,7828 0,0151 0,019 0,453 0,673 319 341 0,753 0,813 Male circumcision 9,21 0,6804 0,0090 0,013 1,441 1,200 3846 3846 0,662 0,698 UNDER-5s Underweight prevalence 2.1a 0,0366 0,0032 0,088 1,480 1,216 5015 4997 0,030 0,043 Stunting prevalence 2.2a 0,1308 0,0061 0,047 1,652 1,285 4987 4968 0,119 0,143 Wasting prevalence 2.3a 0,0406 0,0034 0,085 1,501 1,225 4955 4937 0,034 0,047 Exclusive breastfeeding under 6 months 2,6 0,3180 0,0174 0,055 0,760 0,872 532 543 0,283 0,353 Age-appropriate breastfeeding 2,14 0,3105 0,0115 0,037 1,301 1,141 2101 2125 0,288 0,333 Tuberculosis immunization coverage - 0,9948 0,0025 0,003 1,326 1,151 1076 1084 0,990 1,000 Received polio immunization - 0,8842 0,0132 0,015 1,845 1,358 1074 1083 0,858 0,911 Received DPT immunization - 0,9677 0,0057 0,006 1,123 1,060 1074 1083 0,956 0,979 Received measles immunization - 0,9389 0,0080 0,009 1,208 1,099 1071 1081 0,923 0,955 Received Hepatitis B immunization - 0,7025 0,0166 0,024 1,426 1,194 1072 1080 0,669 0,736 Diarrhoea in the previous 2 weeks - 0,0173 0,0020 0,118 1,273 1,128 5181 5181 0,013 0,021 Illness with a cough in the previous 2 weeks - 0,0279 0,0032 0,115 1,961 1,400 5181 5181 0,021 0,034 Oral rehydration therapy with continued feeding 3,8 0,5395 0,0212 0,039 0,151 0,388 90 84 0,497 0,582 Antibiotic treatment of suspected pneumonia 3.10 0,8663 0,0024 0,003 0,007 0,083 145 144 0,862 0,871 Support for learning 6,1 0,9152 0,0097 0,011 2,364 1,538 1983 1961 0,896 0,935 Attendance to early childhood education 6,7 0,3696 0,0143 0,039 1,718 1,311 1983 1961 0,341 0,398 Birth registration 8,1 0,9974 0,0007 0,001 0,947 0,973 5181 5181 0,996 0,999 Table SE.3: Sampling errors: Urban areas Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) De- sign effect (deff) Square root of de- sign effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,8638 0,0109 0,013 9,698 3,114 9530 9569 0,842 0,886 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9913 0,0025 0,003 6,861 2,619 29257 9629 0,986 0,996 Use of improved sanitation 4,3 0,9706 0,0051 0,005 8,708 2,951 29205 9602 0,960 0,981 Secondary school net attendance ratio (adjusted) 7,5 0,9179 0,0057 0,006 1,218 1,104 2784 2794 0,906 0,929 259MONITORING THE SITUATION OF CHILDREN AND WOMEN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) De- sign effect (deff) Square root of de- sign effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Prevalence of children with one or both parents dead 9,18 0,0526 0,0040 0,076 2,521 1,588 7750 7956 0,045 0,061 School attendance of orphans 9,19 * * * * * 6 6 * * School attendance of non- orphans 9.20 0,9967 0,0016 0,002 1,301 1,141 1713 1703 0,994 1,000 Violent discipline 8,5 0,4886 0,0118 0,024 2,019 1,421 5418 3635 0,465 0,512 WOMEN Pregnant women - 0,0339 0,0020 0,059 0,998 0,999 8055 8234 0,030 0,038 Early childbearing 5,2 0,0206 0,0040 0,195 1,096 1,047 1331 1364 0,013 0,029 Contraceptive prevalence 5,3 0,5385 0,0090 0,017 1,516 1,231 4509 4638 0,520 0,557 Unmet need 5,4 0,1120 0,0056 0,050 1,463 1,210 4509 4638 0,101 0,123 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9896 0,0030 0,003 0,938 0,968 983 1069 0,984 0,996 Antenatal care coverage – at least four times by any provider 5.5b 0,8553 0,0093 0,011 0,743 0,862 983 1069 0,837 0,874 Skilled attendant at delivery 5,7 0,9970 0,0024 0,002 2,041 1,429 983 1069 0,992 1,000 Institutional deliveries 5,8 0,9970 0,0024 0,002 2,041 1,429 983 1069 0,992 1,000 Caesarean section 5,9 0,1693 0,0112 0,066 0,952 0,976 983 1069 0,147 0,192 Literacy rate among young women 7,1 0,9989 0,0009 0,001 2,040 1,428 2422 2489 0,997 1,000 Marriage before age 18 8,7 0,0775 0,0038 0,049 1,439 1,200 6964 7109 0,070 0,085 Comprehensive knowledge about HIV prevention among young people 9,2 0,3973 0,0120 0,030 1,496 1,223 2422 2489 0,373 0,421 Knowledge of mother- to-child transmission of HIV 9,3 0,5252 0,0103 0,020 3,471 1,863 8055 8234 0,505 0,546 Accepting attitudes towards people living with HIV 9,4 0,0253 0,0029 0,114 2,721 1,649 7914 8101 0,020 0,031 Women who have been tested for HIV and know the results 9,6 0,2329 0,0072 0,031 2,410 1,552 8055 8234 0,218 0,247 Sexually active young women who have been tested for HIV and know the results 9,7 0,3223 0,0152 0,047 0,919 0,959 833 870 0,292 0,353 Sex before age 15 among young women 9,11 0,0050 0,0017 0,335 1,400 1,183 2422 2489 0,002 0,008 Condom use with non-regular partners 9,16 0,7112 0,0200 0,028 0,523 0,723 253 271 0,671 0,751 MEN Literacy rate among young men 7,1 0,6900 0,0182 0,026 0,790 0,889 465 509 0,654 0,726 Marriage before age 18 8,7 0,0087 0,0028 0,321 0,486 0,697 492 536 0,003 0,014 Comprehensive knowledge about HIV prevention among young people 9,2 0,4310 0,0211 0,049 0,926 0,962 465 509 0,389 0,473 Knowledge of mother- to-child transmission of HIV 9,3 0,4150 0,0131 0,032 1,560 1,249 2061 2207 0,389 0,441 Accepting attitudes towards people living with HIV 9,4 0,0341 0,0044 0,129 1,273 1,128 2009 2158 0,025 0,043 Men who have been tested for HIV and know the results 9,6 0,1677 0,0096 0,057 1,444 1,202 2061 2207 0,149 0,187 260 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) De- sign effect (deff) Square root of de- sign effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Sexually active young men who have been tested for HIV and know the results 9,7 0,1599 0,0149 0,093 0,489 0,699 261 298 0,130 0,190 Sex before age 15 among young men 9,11 0,0163 0,0031 0,190 0,302 0,550 465 509 0,010 0,022 Condom use with non-regular partners 9,16 0,7978 0,0189 0,024 0,522 0,723 208 238 0,760 0,836 Male circumcision 9,21 0,6065 0,0125 0,021 1,441 1,200 2061 2207 0,582 0,632 UNDER-5s Underweight prevalence 2.1a 0,0402 0,0045 0,112 1,349 1,161 2407 2545 0,031 0,049 Stunting prevalence 2.2a 0,1277 0,0077 0,061 1,355 1,164 2388 2524 0,112 0,143 Wasting prevalence 2.3a 0,0486 0,0053 0,108 1,502 1,225 2363 2500 0,038 0,059 Exclusive breastfeeding under 6 months 2,6 0,3440 0,0199 0,058 0,504 0,710 268 289 0,304 0,384 Age-appropriate breastfeeding 2,14 0,3105 0,0137 0,044 0,969 0,984 1022 1102 0,283 0,338 Tuberculosis immunization coverage - 0,9963 0,0029 0,003 1,226 1,107 512 547 0,991 1,000 Received polio immunization - 0,8714 0,0144 0,017 1,014 1,007 510 546 0,843 0,900 Received DPT immunization - 0,9497 0,0094 0,010 1,005 1,002 510 546 0,931 0,968 Received measles immunization - 0,9358 0,0086 0,009 0,675 0,822 507 544 0,919 0,953 Received Hepatitis B immunization - 0,6740 0,0216 0,032 1,157 1,076 510 545 0,631 0,717 Diarrhoea in the previous 2 weeks - 0,0182 0,0027 0,148 1,082 1,040 2508 2653 0,013 0,024 Illness with a cough in the previous 2 weeks - 0,0268 0,0040 0,151 1,654 1,286 2508 2653 0,019 0,035 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 46 45 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 0,8254 0,0060 0,007 0,018 0,134 67 73 0,813 0,837 Support for learning 6,1 0,9399 0,0090 0,010 1,429 1,195 946 987 0,922 0,958 Attendance to early childhood education 6,7 0,4529 0,0193 0,043 1,480 1,217 946 987 0,414 0,491 Birth registration 8,1 0,9987 0,0008 0,001 1,234 1,111 2508 2653 0,997 1,000 (*) – the number of unweighted observations is less than 50 Table SE.4: Sampling errors: Rural areas Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,8390 0,0083 0,010 3,123 1,767 6192 6160 0,822 0,856 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,8791 0,0168 0,019 16,438 4,054 25292 6171 0,845 0,913 Use of improved sanitation 4,3 0,9892 0,0019 0,002 2,096 1,448 24996 6078 0,985 0,993 Secondary school net attendance ratio (adjusted) 7,5 0,9291 0,0052 0,006 1,244 1,116 3151 3016 0,919 0,940 261MONITORING THE SITUATION OF CHILDREN AND WOMEN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Prevalence of children with one or both parents dead 9,18 0,0484 0,0034 0,071 2,097 1,448 8573 8151 0,042 0,055 School attendance of orphans 9,19 * * * * * 11 13 * * School attendance of non- orphans 9.20 0,9984 0,0006 0,001 0,491 0,701 1979 1874 0,997 1,000 Violent discipline 8,5 0,4990 0,0133 0,027 2,234 1,495 6129 3147 0,472 0,526 WOMEN Pregnant women - 0,0463 0,0034 0,074 1,530 1,237 5959 5780 0,039 0,053 Early childbearing 5,2 0,0260 0,0053 0,204 0,890 0,943 848 806 0,015 0,037 Contraceptive prevalence 5,3 0,4772 0,0090 0,019 1,241 1,114 3925 3788 0,459 0,495 Unmet need 5,4 0,1200 0,0064 0,053 1,473 1,214 3925 3788 0,107 0,133 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9936 0,0021 0,002 0,691 0,831 1011 958 0,989 0,998 Antenatal care coverage – at least four times by any provider 5.5b 0,8839 0,0094 0,011 0,827 0,909 1011 958 0,865 0,903 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 1011 958 1,000 1,000 Institutional deliveries 5,8 0,9952 0,0023 0,002 1,031 1,016 1011 958 0,991 1,000 Caesarean section 5,9 0,1482 0,0112 0,076 0,955 0,977 1011 958 0,126 0,171 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 1779 1693 1,000 1,000 Marriage before age 18 8,7 0,0987 0,0049 0,049 1,307 1,143 5028 4893 0,089 0,108 Comprehensive knowledge about HIV prevention among young people 9,2 0,3131 0,0119 0,038 1,123 1,060 1779 1693 0,289 0,337 Knowledge of mother- to-child transmission of HIV 9,3 0,5240 0,0083 0,016 1,589 1,261 5959 5780 0,507 0,541 Accepting attitudes towards people living with HIV 9,4 0,0253 0,0035 0,136 2,617 1,618 5531 5418 0,018 0,032 Women who have been tested for HIV and know the results 9,6 0,2153 0,0069 0,032 1,609 1,268 5959 5780 0,202 0,229 Sexually active young women who have been tested for HIV and know the results 9,7 0,3717 0,0178 0,048 0,767 0,876 577 567 0,336 0,407 Sex before age 15 among young women 9,11 0,0028 0,0011 0,389 0,727 0,853 1779 1693 0,001 0,005 Condom use with non-regular partners 9,16 0,6459 0,0444 0,069 0,569 0,754 58 67 0,557 0,735 MEN Literacy rate among young men 7,1 0,8250 0,0257 0,031 1,431 1,196 361 314 0,774 0,876 Marriage before age 18 8,7 0,0020 0,0020 0,998 0,647 0,804 375 328 0,000 0,006 Comprehensive knowledge about HIV prevention among young people 9,2 0,2257 0,0216 0,096 0,836 0,914 361 314 0,183 0,269 Knowledge of mother- to-child transmission of HIV 9,3 0,3469 0,0148 0,043 1,583 1,258 1785 1639 0,317 0,376 Accepting attitudes towards people living with HIV 9,4 0,0184 0,0034 0,186 0,978 0,989 1630 1504 0,012 0,025 Men who have been tested for HIV and know the results 9,6 0,1326 0,0089 0,067 1,133 1,064 1785 1639 0,115 0,150 Sexually active young men who have been tested for HIV and know the results 9,7 0,1418 0,0147 0,103 0,242 0,492 152 138 0,112 0,171 262 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Sex before age 15 among young men 9,11 0,0103 0,0037 0,362 0,425 0,652 361 314 0,003 0,018 Condom use with non-regular partners 9,16 0,7546 0,0249 0,033 0,342 0,585 111 103 0,705 0,804 Male circumcision 9,21 0,7657 0,0125 0,016 1,434 1,197 1785 1639 0,741 0,791 UNDER-5s Underweight prevalence 2.1a 0,0332 0,0046 0,139 1,617 1,272 2608 2452 0,024 0,042 Stunting prevalence 2.2a 0,1337 0,0094 0,070 1,872 1,368 2598 2444 0,115 0,153 Wasting prevalence 2.3a 0,0333 0,0045 0,136 1,558 1,248 2591 2437 0,024 0,042 Exclusive breastfeeding under 6 months 2,6 0,2917 0,0284 0,097 0,985 0,992 265 254 0,235 0,348 Age-appropriate breastfeeding 2,14 0,3105 0,0181 0,058 1,567 1,252 1079 1023 0,274 0,347 Tuberculosis immunization coverage - 0,9934 0,0041 0,004 1,342 1,158 564 537 0,985 1,000 Received polio immunization - 0,8958 0,0216 0,024 2,676 1,636 564 537 0,853 0,939 Received DPT immunization - 0,9840 0,0066 0,007 1,498 1,224 564 537 0,971 0,997 Received measles immunization - 0,9417 0,0131 0,014 1,670 1,292 564 537 0,916 0,968 Received Hepatitis B immunization - 0,7283 0,0249 0,034 1,667 1,291 563 535 0,679 0,778 Diarrhoea in the previous 2 weeks - 0,0165 0,0030 0,185 1,443 1,201 2673 2528 0,010 0,023 Illness with a cough in the previous 2 weeks - 0,0289 0,0049 0,170 2,176 1,475 2673 2528 0,019 0,039 Oral rehydration therapy with continued feeding 3,8 * * * * * 44 39 * * Antibiotic treatment of suspected pneumonia 3.10 0,9017 0,0014 0,001 0,001 0,038 77 71 0,899 0,904 Support for learning 6,1 0,8925 0,0162 0,018 2,654 1,629 1037 974 0,860 0,925 Attendance to early childhood education 6,7 0,2936 0,0202 0,069 1,908 1,381 1037 974 0,253 0,334 Birth registration 8,1 0,9962 0,0011 0,001 0,833 0,913 2673 2528 0,994 0,998 (*) – the number of unweighted observations is less than 50 Table SE.5: Sampling errors: Akmola Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9519 0,0166 0,017 6,736 2,595 884 1118 0,919 0,985 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9693 0,0113 0,012 4,837 2,199 2470 1118 0,947 0,992 Use of improved sanitation 4,3 0,9671 0,0123 0,013 5,243 2,290 2460 1112 0,943 0,992 263MONITORING THE SITUATION OF CHILDREN AND WOMEN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Secondary school net attendance ratio (adjusted) 7,5 0,9084 0,0136 0,015 0,694 0,833 244 312 0,881 0,936 Prevalence of children with one or both parents dead 9,18 0,0855 0,0105 0,122 1,120 1,058 631 801 0,065 0,106 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 2 3 (*) (*) School attendance of non- orphans 9.20 0,9947 0,0052 0,005 0,938 0,968 146 186 0,984 1,000 Violent discipline 8,5 0,5975 0,0323 0,054 1,621 1,273 451 375 0,533 0,662 WOMEN Pregnant women - 0,0378 0,0063 0,166 0,807 0,898 603 744 0,025 0,050 Early childbearing 5,2 0,0101 0,0104 1,028 1,000 1,000 77 94 0,000 0,031 Contraceptive prevalence 5,3 0,4552 0,0150 0,033 0,421 0,649 379 467 0,425 0,485 Unmet need 5,4 0,1693 0,0202 0,119 1,353 1,163 379 467 0,129 0,210 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9639 0,0176 0,018 0,741 0,861 68 84 0,929 0,999 Antenatal care coverage – at least four times by any provider 5.5b 0,9294 0,0248 0,027 0,779 0,883 68 84 0,880 0,979 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 68 84 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 68 84 1,000 1,000 Caesarean section 5,9 0,2777 0,0461 0,166 0,878 0,937 68 84 0,186 0,370 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 152 187 1,000 1,000 Marriage before age 18 8,7 0,1085 0,0124 0,114 1,032 1,016 529 651 0,084 0,133 Comprehensive knowledge about HIV prevention among young people 9,2 0,3197 0,0302 0,095 0,782 0,884 152 187 0,259 0,380 Knowledge of mother- to-child transmission of HIV 9,3 0,4813 0,0220 0,046 1,434 1,198 603 744 0,437 0,525 Accepting attitudes towards people living with HIV 9,4 0,0164 0,0055 0,337 1,400 1,183 598 738 0,005 0,028 Women who have been tested for HIV and know the results 9,6 0,3428 0,0170 0,050 0,956 0,978 603 744 0,309 0,377 Sexually active young women who have been tested for HIV and know the results 9,7 0,4439 0,0419 0,094 0,554 0,744 65 79 0,360 0,528 Sex before age 15 among young women 9,11 0,0202 0,0099 0,492 0,929 0,964 152 187 0,000 0,040 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 23 27 (*) (*) MEN Literacy rate among young men 7,1 0,7102 0,0708 0,100 1,413 1,189 41 59 0,569 0,852 Marriage before age 18 8,7 (*) (*) (*) (*) (*) 35 49 (*) (*) Comprehensive knowledge about HIV prevention among young people 9,2 0,4007 0,0656 0,164 1,040 1,020 41 59 0,269 0,532 Knowledge of mother- to-child transmission of HIV 9,3 0,2268 0,0261 0,115 0,966 0,983 178 250 0,175 0,279 Accepting attitudes towards people living with HIV 9,4 0,0208 0,0094 0,454 1,082 1,040 176 248 0,002 0,040 Men who have been tested for HIV and know the results 9,6 0,2307 0,0382 0,165 2,045 1,430 178 250 0,154 0,307 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 24 34 (*) (*) 264 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Sex before age 15 among young men 9,11 0,0301 0,0214 0,709 0,906 0,952 41 59 0,000 0,073 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 21 29 (*) (*) Male circumcision 9,21 0,5019 0,0383 0,076 1,463 1,210 178 250 0,425 0,579 UNDER-5s Underweight prevalence 2.1a 0,0185 0,0064 0,348 0,504 0,710 183 222 0,006 0,031 Stunting prevalence 2.2a 0,0814 0,0172 0,211 0,868 0,932 182 221 0,047 0,116 Wasting prevalence 2.3a 0,0261 0,0108 0,415 1,006 1,003 181 219 0,004 0,048 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 21 26 (*) (*) Age-appropriate breastfeeding 2,14 0,3611 0,0305 0,085 0,356 0,596 73 89 0,300 0,422 Tuberculosis immunization coverage - (*) (*) (*) (*) (*) 40 49 (*) (*) Received polio immunization - (*) (*) (*) (*) (*) 40 49 (*) (*) Received DPT immunization - (*) (*) (*) (*) (*) 40 49 (*) (*) Received measles immunization - (*) (*) (*) (*) (*) 40 49 (*) (*) Received Hepatitis B immunization - (*) (*) (*) (*) (*) 40 49 (*) (*) Diarrhoea in the previous 2 weeks - 0,0223 0,0102 0,457 1,085 1,041 189 229 0,002 0,043 Illness with a cough in the previous 2 weeks - 0,0177 0,0107 0,606 1,504 1,226 189 229 0,000 0,039 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 4 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 3 4 (*) (*) Support for learning 6,1 0,9276 0,0154 0,017 0,300 0,548 72 86 0,897 0,958 Attendance to early childhood education 6,7 0,3791 0,0482 0,127 0,840 0,916 72 86 0,283 0,476 Birth registration 8,1 0,9878 0,0070 0,007 0,927 0,963 189 229 0,974 1,000 (*) – the number of unweighted observations is less than 50 265MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.6: Sampling errors: Aktubinsk Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,7857 0,0365 0,046 6,407 2,531 712 812 0,713 0,859 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9955 0,0024 0,002 1,086 1,042 2595 813 0,991 1,000 Use of improved sanitation 4,3 0,9863 0,0092 0,009 5,057 2,249 2574 805 0,968 1,000 Secondary school net attendance ratio (adjusted) 7,5 0,9181 0,0160 0,017 1,100 1,049 284 324 0,886 0,950 Prevalence of children with one or both parents dead 9,18 0,0695 0,0149 0,214 3,004 1,733 773 877 0,040 0,099 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 1 1 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 169 193 1,000 1,000 Violent discipline 8,5 0,5832 0,0317 0,054 1,493 1,222 526 361 0,520 0,647 WOMEN Pregnant women - 0,0311 0,0054 0,172 0,748 0,865 694 788 0,020 0,042 Early childbearing 5,2 0,0378 0,0147 0,389 0,768 0,876 114 130 0,008 0,067 Contraceptive prevalence 5,3 0,3573 0,0222 0,062 0,977 0,989 397 455 0,313 0,402 Unmet need 5,4 0,1270 0,0170 0,134 1,187 1,089 397 455 0,093 0,161 Antenatal care coverage - at least once by skilled personnel 5.5a 1,0000 0,0000 0,000 na na 115 130 1,000 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9192 0,0146 0,016 0,373 0,610 115 130 0,890 0,948 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 115 130 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 115 130 1,000 1,000 Caesarean section 5,9 0,1624 0,0359 0,221 1,224 1,107 115 130 0,091 0,234 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 210 235 1,000 1,000 Marriage before age 18 8,7 0,0521 0,0089 0,171 1,099 1,049 598 683 0,034 0,070 Comprehensive knowledge about HIV prevention among young people 9,2 0,2699 0,0289 0,107 0,991 0,995 210 235 0,212 0,328 Knowledge of mother- to-child transmission of HIV 9,3 0,6250 0,0273 0,044 2,494 1,579 694 788 0,571 0,680 Accepting attitudes towards people living with HIV 9,4 0,0198 0,0051 0,259 0,978 0,989 635 721 0,010 0,030 Women who have been tested for HIV and know the results 9,6 0,1909 0,0186 0,098 1,767 1,329 694 788 0,154 0,228 Sexually active young women who have been tested for HIV and know the results 9,7 0,2856 0,0323 0,113 0,373 0,611 66 74 0,221 0,350 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 210 235 0,000 0,000 266 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 10 11 (*) (*) MEN Literacy rate among young men 7,1 0,8139 0,0402 0,049 0,577 0,759 47 55 0,734 0,894 Marriage before age 18 8,7 (*) (*) (*) (*) (*) 42 49 (*) (*) Comprehensive knowledge about HIV prevention among young people 9,2 0,2692 0,0632 0,235 1,098 1,048 47 55 0,143 0,396 Knowledge of mother- to-child transmission of HIV 9,3 0,5160 0,0472 0,092 1,868 1,367 182 210 0,422 0,611 Accepting attitudes towards people living with HIV 9,4 0,0114 0,0081 0,708 0,998 0,999 151 174 0,000 0,027 Men who have been tested for HIV and know the results 9,6 0,0933 0,0223 0,239 1,225 1,107 182 210 0,049 0,138 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 19 22 (*) (*) Sex before age 15 among young men 9,11 0,0000 0,0000 0,000 na na 47 55 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 13 15 (*) (*) Male circumcision 9,21 0,8334 0,0286 0,034 1,227 1,108 182 210 0,776 0,891 UNDER-5s Underweight prevalence 2.1a 0,1187 0,0213 0,179 1,210 1,100 248 281 0,076 0,161 Stunting prevalence 2.2a 0,3623 0,0398 0,110 1,898 1,378 246 278 0,283 0,442 Wasting prevalence 2.3a 0,0859 0,0187 0,218 1,235 1,111 245 278 0,049 0,123 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 23 27 (*) (*) Age-appropriate breastfeeding 2,14 0,3232 0,0419 0,130 1,061 1,030 118 133 0,239 0,407 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 56 62 1,000 1,000 Received polio immunization - 0,7367 0,0742 0,101 1,731 1,316 56 62 0,588 0,885 Received DPT immunization - 1,0000 0,0000 0,000 na na 56 62 1,000 1,000 Received measles immunization - 0,9154 0,0263 0,029 0,546 0,739 56 62 0,863 0,968 Received Hepatitis B immunization - 0,6809 0,0702 0,103 1,385 1,177 56 62 0,540 0,821 Diarrhoea in the previous 2 weeks - 0,0190 0,0078 0,409 0,953 0,976 260 295 0,003 0,034 Illness with a cough in the previous 2 weeks - 0,0470 0,0289 0,616 5,497 2,345 260 295 0,000 0,105 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 5 6 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 0,8335 0,0000 0,000 0,000 0,000 12 12 0,834 0,834 Support for learning 6,1 0,9448 0,0267 0,028 1,453 1,205 95 107 0,891 0,998 Attendance to early childhood education 6,7 0,3948 0,0681 0,173 2,060 1,435 95 107 0,258 0,531 Birth registration 8,1 0,9962 0,0038 0,004 1,119 1,058 260 295 0,989 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 267MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.7: Sampling errors: Almaty Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9042 0,0109 0,012 1,309 1,144 1469 955 0,882 0,926 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9657 0,0130 0,013 4,862 2,205 5879 956 0,940 0,992 Use of improved sanitation 4,3 0,9935 0,0035 0,004 1,854 1,362 5877 955 0,986 1,000 Secondary school net attend- ance ratio (adjusted) 7,5 0,9150 0,0117 0,013 0,760 0,872 681 436 0,892 0,938 Prevalence of children with one or both parents dead 9,18 0,0322 0,0066 0,205 1,630 1,277 1804 1166 0,019 0,045 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 2 1 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 413 267 1,000 1,000 Violent discipline 8,5 0,4975 0,0287 0,058 1,595 1,263 1278 486 0,440 0,555 WOMEN Pregnant women - 0,0278 0,0051 0,184 0,952 0,976 1518 985 0,018 0,038 Early childbearing 5,2 0,0184 0,0106 0,579 1,047 1,023 254 168 0,000 0,040 Contraceptive prevalence 5,3 0,4312 0,0247 0,057 1,432 1,197 890 578 0,382 0,480 Unmet need 5,4 0,1659 0,0152 0,091 0,960 0,980 890 578 0,136 0,196 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9905 0,0007 0,001 0,007 0,083 194 125 0,989 0,992 Antenatal care coverage – at least four times by any provider 5.5b 0,8467 0,0227 0,027 0,491 0,701 194 125 0,801 0,892 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 194 125 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 194 125 1,000 1,000 Caesarean section 5,9 0,1197 0,0272 0,227 0,870 0,933 194 125 0,065 0,174 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 511 333 1,000 1,000 Marriage before age 18 8,7 0,0788 0,0103 0,131 1,194 1,093 1261 820 0,058 0,099 Comprehensive knowledge about HIV prevention among young people 9,2 0,4598 0,0227 0,049 0,686 0,828 511 333 0,414 0,505 Knowledge of mother- to-child transmission of HIV 9,3 0,7273 0,0158 0,022 1,236 1,112 1518 985 0,696 0,759 Accepting attitudes towards people living with HIV 9,4 0,0414 0,0090 0,217 1,916 1,384 1459 946 0,023 0,059 Women who have been tested for HIV and know the results 9,6 0,1902 0,0159 0,084 1,619 1,272 1518 985 0,158 0,222 Sexually active young women who have been tested for HIV and know the results 9,7 0,2392 0,0372 0,156 0,616 0,785 123 82 0,165 0,314 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 511 333 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 4 2 (*) (*) 268 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,8072 0,0617 0,076 1,370 1,171 97 57 0,684 0,931 Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 88 52 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 0,3054 0,0483 0,158 0,616 0,785 97 57 0,209 0,402 Knowledge of mother- to-child transmission of HIV 9,3 0,2422 0,0295 0,122 1,197 1,094 423 254 0,183 0,301 Accepting attitudes towards people living with HIV 9,4 0,0147 0,0084 0,574 1,077 1,038 369 221 0,000 0,031 Men who have been tested for HIV and know the results 9,6 0,0961 0,0224 0,233 1,460 1,208 423 254 0,051 0,141 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 22 13 (*) (*) Sex before age 15 among young men 9,11 0,0000 0,0000 0,000 na na 97 57 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 8 5 (*) (*) Male circumcision 9,21 0,8009 0,0335 0,042 1,779 1,334 423 254 0,734 0,868 UNDER-5s Underweight prevalence 2.1a 0,0477 0,0132 0,276 1,302 1,141 529 342 0,021 0,074 Stunting prevalence 2.2a 0,1081 0,0187 0,173 1,224 1,106 525 339 0,071 0,146 Wasting prevalence 2.3a 0,0368 0,0115 0,313 1,277 1,130 529 342 0,014 0,060 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 61 40 ((*)) ((*)) Age-appropriate breastfeeding 2,14 0,3999 0,0400 0,100 0,872 0,934 204 132 0,320 0,480 Tuberculosis immunization cov- erage - 1,0000 0,0000 0,000 na na 100 64 1,000 1,000 Received polio immunization - 0,8216 0,0478 0,058 0,980 0,990 100 64 0,726 0,917 Received DPT immunization - 0,9528 0,0170 0,018 0,404 0,636 100 64 0,919 0,987 Received measles immunization - 0,9483 0,0235 0,025 0,684 0,827 97 62 0,901 0,995 Received Hepatitis B immuniza- tion - 0,8232 0,0450 0,055 0,877 0,937 100 64 0,733 0,913 Diarrhoea in the previous 2 weeks - 0,0148 0,0069 0,465 1,157 1,076 551 356 0,001 0,029 Illness with a cough in the previ- ous 2 weeks - 0,0188 0,0060 0,318 0,688 0,830 551 356 0,007 0,031 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 8 6 (*) (*) Antibiotic treatment of suspect- ed pneumonia 3.10 (*) (*) (*) (*) (*) 10 7 (*) (*) Support for learning 6,1 0,8490 0,0328 0,039 1,222 1,105 230 147 0,783 0,914 Attendance to early childhood education 6,7 0,1509 0,0220 0,146 0,550 0,741 230 147 0,107 0,195 Birth registration 8,1 1,0000 0,0000 0,000 na na 551 356 1,000 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 269MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.8: Sampling errors: Almaty city Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,6487 0,0657 0,101 18,319 4,280 1437 969 0,517 0,780 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9992 0,0008 0,001 0,800 0,894 4129 990 0,998 1,000 Use of improved sanitation 4,3 0,9610 0,0212 0,022 11,848 3,442 4122 988 0,919 1,000 Secondary school net attendance ratio (adjusted) 7,5 0,8694 0,0215 0,025 0,793 0,890 297 195 0,826 0,912 Prevalence of children with one or both parents dead 9,18 0,0440 0,0085 0,192 0,914 0,956 806 538 0,027 0,061 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 3 2 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 187 123 1,000 1,000 Violent discipline 8,5 0,2729 0,0424 0,155 2,560 1,600 594 283 0,188 0,358 WOMEN Pregnant women - 0,0208 0,0039 0,187 0,592 0,770 1190 800 0,013 0,029 Early childbearing 5,2 0,0069 0,0069 1,007 0,965 0,982 207 139 0,000 0,021 Contraceptive prevalence 5,3 0,6262 0,0363 0,058 2,179 1,476 575 388 0,554 0,699 Unmet need 5,4 0,0954 0,0185 0,194 1,531 1,237 575 388 0,058 0,132 Antenatal care coverage - at least once by skilled personnel 5.5a (*) (*) (*) (*) (*) 68 46 (*) (*) Antenatal care coverage – at least four times by any provider 5.5b (*) (*) (*) (*) (*) 68 46 (*) (*) Skilled attendant at delivery 5,7 (*) (*) (*) (*) (*) 68 46 (*) (*) Institutional deliveries 5,8 (*) (*) (*) (*) (*) 68 46 (*) (*) Caesarean section 5,9 (*) (*) (*) (*) (*) 68 46 (*) (*) Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 314 212 1,000 1,000 Marriage before age 18 8,7 0,0570 0,0113 0,199 1,731 1,316 1083 727 0,034 0,080 Comprehensive knowledge about HIV prevention among young people 9,2 0,5041 0,0473 0,094 1,891 1,375 314 212 0,409 0,599 Knowledge of mother- to-child transmission of HIV 9,3 0,5546 0,0511 0,092 8,446 2,906 1190 800 0,452 0,657 Accepting attitudes towards people living with HIV 9,4 0,0315 0,0097 0,308 2,454 1,567 1183 796 0,012 0,051 Women who have been tested for HIV and know the results 9,6 0,1196 0,0279 0,233 5,895 2,428 1190 800 0,064 0,175 Sexually active young women who have been tested for HIV and know the results 9,7 0,1292 0,0437 0,338 0,900 0,949 80 54 0,042 0,217 Sex before age 15 among young women 9,11 0,0045 0,0045 1,002 0,961 0,980 314 212 0,000 0,014 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 33 22 (*) (*) 270 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,4560 0,0494 0,108 0,492 0,701 73 51 0,357 0,555 Marriage before age 18 8,7 0,0062 0,0063 1,007 0,418 0,647 97 67 0,000 0,019 Comprehensive knowledge about HIV prevention among young people 9,2 0,4979 0,0376 0,076 0,283 0,532 73 51 0,423 0,573 Knowledge of mother- to-child transmission of HIV 9,3 0,5668 0,0498 0,088 2,119 1,456 302 211 0,467 0,666 Accepting attitudes towards people living with HIV 9,4 0,0315 0,0099 0,313 0,658 0,811 296 207 0,012 0,051 Men who have been tested for HIV and know the results 9,6 0,1313 0,0355 0,270 2,319 1,523 302 211 0,060 0,202 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 50 35 (*) (*) Sex before age 15 among young men 9,11 0,0082 0,0083 1,010 0,422 0,649 73 51 0,000 0,025 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 39 27 (*) (*) Male circumcision 9,21 0,5751 0,0405 0,070 1,412 1,188 302 211 0,494 0,656 UNDER-5s Underweight prevalence 2.1a 0,0712 0,0183 0,257 0,611 0,782 178 122 0,035 0,108 Stunting prevalence 2.2a 0,1706 0,0343 0,201 0,979 0,989 173 119 0,102 0,239 Wasting prevalence 2.3a 0,0777 0,0224 0,288 0,783 0,885 165 113 0,033 0,122 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 13 9 (*) (*) Age-appropriate breastfeeding 2,14 (*) (*) (*) (*) (*) 71 47 (*) (*) Tuberculosis immunization coverage - (*) (*) (*) (*) (*) 46 31 (*) (*) Received polio immunization - (*) (*) (*) (*) (*) 46 31 (*) (*) Received DPT immunization - (*) (*) (*) (*) (*) 45 30 (*) (*) Received measles immunization - (*) (*) (*) (*) (*) 46 31 (*) (*) Received Hepatitis B immunization - (*) (*) (*) (*) (*) 45 30 (*) (*) Diarrhoea in the previous 2 weeks - 0,0215 0,0095 0,441 0,582 0,763 202 137 0,003 0,040 Illness with a cough in the previous 2 weeks - 0,0290 0,0118 0,408 0,675 0,822 202 137 0,005 0,053 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 4 3 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 6 4 (*) (*) Support for learning 6,1 1,0000 0,0000 0,000 na na 78 53 1,000 1,000 Attendance to early childhood education 6,7 0,4756 0,0908 0,191 1,719 1,311 78 53 0,294 0,657 Birth registration 8,1 1,0000 0,0000 0,000 na na 202 137 1,000 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 271MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.9: Sampling errors: Astana city Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9801 0,0055 0,006 1,425 1,194 544 919 0,969 0,991 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9991 0,0009 0,001 0,778 0,882 1710 920 0,997 1,000 Use of improved sanitation 4,3 0,9163 0,0186 0,020 4,101 2,025 1694 909 0,879 0,953 Secondary school net attendance ratio (adjusted) 7,5 0,9189 0,0160 0,017 0,932 0,966 152 272 0,887 0,951 Prevalence of children with one or both parents dead 9,18 0,0216 0,0063 0,294 1,555 1,247 464 816 0,009 0,034 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 101 177 1,000 1,000 Violent discipline 8,5 0,3865 0,0332 0,086 1,771 1,331 318 381 0,320 0,453 WOMEN Pregnant women - 0,0248 0,0045 0,183 0,795 0,891 539 931 0,016 0,034 Early childbearing 5,2 0,0100 0,0100 0,995 1,657 1,287 99 166 0,000 0,030 Contraceptive prevalence 5,3 0,7270 0,0231 0,032 1,341 1,158 284 500 0,681 0,773 Unmet need 5,4 0,0326 0,0086 0,263 1,167 1,080 284 500 0,015 0,050 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9905 0,0093 0,009 1,140 1,067 72 125 0,972 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,6238 0,0462 0,074 1,128 1,062 72 125 0,531 0,716 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 72 125 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 72 125 1,000 1,000 Caesarean section 5,9 0,1558 0,0452 0,290 1,925 1,387 72 125 0,065 0,246 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 168 292 1,000 1,000 Marriage before age 18 8,7 0,0531 0,0088 0,165 1,233 1,111 470 805 0,036 0,071 Comprehensive knowledge about HIV prevention among young people 9,2 0,4183 0,0403 0,096 1,944 1,394 168 292 0,338 0,499 Knowledge of mother- to-child transmission of HIV 9,3 0,6288 0,0337 0,054 4,522 2,126 539 931 0,561 0,696 Accepting attitudes towards people living with HIV 9,4 0,0069 0,0034 0,492 1,570 1,253 538 930 0,000 0,014 Women who have been tested for HIV and know the results 9,6 0,3414 0,0220 0,064 1,993 1,412 539 931 0,297 0,385 Sexually active young women who have been tested for HIV and know the results 9,7 0,4840 0,0417 0,086 0,668 0,817 57 97 0,401 0,567 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 168 292 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 21 36 (*) (*) 272 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,6239 0,0471 0,076 0,587 0,766 33 63 0,530 0,718 Marriage before age 18 8,7 0,0259 0,0194 0,750 1,018 1,009 36 69 0,000 0,065 Comprehensive knowledge about HIV prevention among young people 9,2 0,4213 0,0796 0,189 1,612 1,270 33 63 0,262 0,581 Knowledge of mother- to-child transmission of HIV 9,3 0,4705 0,0457 0,097 1,928 1,388 125 231 0,379 0,562 Accepting attitudes towards people living with HIV 9,4 0,0701 0,0200 0,285 1,410 1,187 125 231 0,030 0,110 Men who have been tested for HIV and know the results 9,6 0,1830 0,0387 0,212 2,308 1,519 125 231 0,106 0,261 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 25 49 (*) (*) Sex before age 15 among young men 9,11 0,0071 0,0071 0,991 0,438 0,662 33 63 0,000 0,021 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 19 36 (*) (*) Male circumcision 9,21 0,7027 0,0312 0,044 1,072 1,035 125 231 0,640 0,765 UNDER-5s Underweight prevalence 2.1a 0,0248 0,0084 0,339 0,847 0,920 165 291 0,008 0,042 Stunting prevalence 2.2a 0,1968 0,0335 0,170 2,051 1,432 163 289 0,130 0,264 Wasting prevalence 2.3a 0,0448 0,0152 0,340 1,527 1,236 159 282 0,014 0,075 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 20 33 (*) (*) Age-appropriate breastfeeding 2,14 0,3989 0,0351 0,088 0,667 0,817 75 131 0,329 0,469 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 37 65 1,000 1,000 Received polio immunization - 0,7984 0,0455 0,057 0,822 0,906 37 65 0,707 0,889 Received DPT immunization - 0,9787 0,0204 0,021 1,278 1,131 37 65 0,938 1,000 Received measles immunization - 0,9787 0,0204 0,021 1,278 1,131 37 65 0,938 1,000 Received Hepatitis B immunization - 0,3032 0,0526 0,173 0,838 0,915 37 65 0,198 0,408 Diarrhoea in the previous 2 weeks - 0,0187 0,0084 0,450 1,132 1,064 166 294 0,002 0,036 Illness with a cough in the previous 2 weeks - 0,0326 0,0095 0,291 0,838 0,915 166 294 0,014 0,052 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 3 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 5 13 (*) (*) Support for learning 6,1 0,9910 0,0088 0,009 0,990 0,995 66 116 0,973 1,000 Attendance to early childhood education 6,7 0,4293 0,0713 0,166 2,389 1,546 66 116 0,287 0,572 Birth registration 8,1 1,0000 0,0000 0,000 na na 166 294 1,000 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 273MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.10: Sampling errors: Atyrau Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,7906 0,0168 0,021 1,316 1,147 359 772 0,757 0,824 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9744 0,0141 0,014 6,118 2,474 1542 774 0,946 1,000 Use of improved sanitation 4,3 0,9604 0,0194 0,020 7,640 2,764 1542 774 0,922 0,999 Secondary school net attendance ratio (adjusted) 7,5 0,9609 0,0122 0,013 1,451 1,205 178 370 0,937 0,985 Prevalence of children with one or both parents dead 9,18 0,0571 0,0084 0,147 1,403 1,184 511 1071 0,040 0,074 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) * School attendance of non- orphans 9.20 0,9947 0,0053 0,005 1,121 1,059 107 216 0,984 1,000 Violent discipline 8,5 0,4465 0,0286 0,064 1,360 1,166 354 413 0,389 0,504 WOMEN Pregnant women - 0,0292 0,0066 0,226 1,323 1,150 409 859 0,016 0,042 Early childbearing 5,2 0,0429 0,0201 0,468 1,343 1,159 68 138 0,003 0,083 Contraceptive prevalence 5,3 0,4817 0,0292 0,061 1,713 1,309 238 503 0,423 0,540 Unmet need 5,4 0,1082 0,0188 0,174 1,841 1,357 238 503 0,071 0,146 Antenatal care coverage - at least once by skilled personnel 5.5a 1,0000 0,0000 0,000 na na 77 162 1,000 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,7093 0,0538 0,076 2,264 1,505 77 162 0,602 0,817 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 77 162 1,000 1,000 Institutional deliveries 5,8 0,9927 0,0073 0,007 1,195 1,093 77 162 0,978 1,000 Caesarean section 5,9 0,1318 0,0236 0,179 0,787 0,887 77 162 0,084 0,179 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 135 277 1,000 1,000 Marriage before age 18 8,7 0,0553 0,0088 0,158 1,056 1,027 342 720 0,038 0,073 Comprehensive knowledge about HIV prevention among young people 9,2 0,2241 0,0279 0,124 1,235 1,111 135 277 0,168 0,280 Knowledge of mother- to-child transmission of HIV 9,3 0,4505 0,0197 0,044 1,342 1,158 409 859 0,411 0,490 Accepting attitudes towards people living with HIV 9,4 0,0098 0,0044 0,452 1,695 1,302 397 836 0,001 0,019 Women who have been tested for HIV and know the results 9,6 0,1077 0,0124 0,115 1,363 1,167 409 859 0,083 0,132 Sexually active young women who have been tested for HIV and know the results 9,7 0,3360 0,0419 0,125 0,614 0,784 38 79 0,252 0,420 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 135 277 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 1 2 (*) * 274 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,7551 0,0466 0,062 0,624 0,790 29 54 0,662 0,848 Marriage before age 18 8,7 (*) (*) (*) (*) (*) 26 49 (*) (*) Comprehensive knowledge about HIV prevention among young people 9,2 0,1976 0,0476 0,241 0,756 0,869 29 54 0,103 0,293 Knowledge of mother- to-child transmission of HIV 9,3 0,3997 0,0450 0,113 1,662 1,289 112 198 0,310 0,490 Accepting attitudes towards people living with HIV 9,4 0,0407 0,0149 0,366 1,106 1,051 110 195 0,011 0,071 Men who have been tested for HIV and know the results 9,6 0,0000 0,0000 0,000 na na 112 198 0,000 0,000 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 13 25 (*) (*) Sex before age 15 among young men 9,11 0,0103 0,0105 1,018 0,573 0,757 29 54 0,000 0,031 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 10 19 (*) (*) Male circumcision 9,21 0,9258 0,0204 0,022 1,192 1,092 112 198 0,885 0,967 UNDER-5s Underweight prevalence 2.1a 0,0346 0,0136 0,393 1,848 1,360 159 334 0,007 0,062 Stunting prevalence 2.2a 0,1844 0,0302 0,164 2,022 1,422 159 334 0,124 0,245 Wasting prevalence 2.3a 0,0318 0,0117 0,369 1,477 1,215 158 331 0,008 0,055 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 21 46 (*) (*) Age-appropriate breastfeeding 2,14 0,2240 0,0268 0,120 0,674 0,821 76 164 0,170 0,278 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 38 80 1,000 1,000 Received polio immunization - 0,8162 0,0509 0,062 1,365 1,168 38 80 0,714 0,918 Received DPT immunization - 0,9671 0,0104 0,011 0,269 0,518 38 80 0,946 0,988 Received measles immunization - 0,9297 0,0394 0,042 1,875 1,369 38 80 0,851 1,000 Received Hepatitis B immunization - 0,5696 0,0547 0,096 0,963 0,981 38 80 0,460 0,679 Diarrhoea in the previous 2 weeks - 0,0075 0,0046 0,615 1,083 1,041 182 382 0,000 0,017 Illness with a cough in the previous 2 weeks - 0,0102 0,0063 0,614 1,482 1,217 182 382 0,000 0,023 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 1 3 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 2 5 (*) (*) Support for learning 6,1 0,9666 0,0177 0,018 1,238 1,113 62 128 0,931 1,000 Attendance to early childhood education 6,7 0,5038 0,0492 0,098 1,232 1,110 62 128 0,405 0,602 Birth registration 8,1 0,9971 0,0030 0,003 1,160 1,077 182 382 0,991 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 275MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.11: Sampling errors: East Kazakhstan Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9673 0,0058 0,006 1,215 1,102 1671 1141 0,956 0,979 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9162 0,0361 0,039 19,360 4,400 4782 1142 0,844 0,988 Use of improved sanitation 4,3 0,9600 0,0183 0,019 9,945 3,154 4782 1142 0,923 0,997 Secondary school net attendance ratio (adjusted) 7,5 0,8906 0,0169 0,019 0,963 0,981 474 329 0,857 0,924 Prevalence of children with one or both parents dead 9,18 0,0364 0,0085 0,233 1,708 1,307 1199 831 0,019 0,053 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 0,9947 0,0054 0,005 1,083 1,041 289 199 0,984 1,000 Violent discipline 8,5 0,4275 0,0401 0,094 2,498 1,580 824 382 0,347 0,508 WOMEN Pregnant women - 0,0308 0,0075 0,245 1,560 1,249 1210 819 0,016 0,046 Early childbearing 5,2 0,0420 0,0130 0,311 0,474 0,688 169 113 0,016 0,068 Contraceptive prevalence 5,3 0,5016 0,0229 0,046 1,068 1,034 743 509 0,456 0,547 Unmet need 5,4 0,1189 0,0141 0,119 0,969 0,985 743 509 0,091 0,147 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9895 0,0104 0,011 1,024 1,012 143 99 0,969 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,8697 0,0305 0,035 0,806 0,898 143 99 0,809 0,931 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 143 99 1,000 1,000 Institutional deliveries 5,8 0,9908 0,0092 0,009 0,909 0,953 143 99 0,972 1,000 Caesarean section 5,9 0,2384 0,0390 0,164 0,821 0,906 143 99 0,160 0,316 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 349 233 1,000 1,000 Marriage before age 18 8,7 0,0764 0,0080 0,105 0,636 0,798 1029 699 0,060 0,092 Comprehensive knowledge about HIV prevention among young people 9,2 0,3432 0,0305 0,089 0,959 0,980 349 233 0,282 0,404 Knowledge of mother- to-child transmission of HIV 9,3 0,3564 0,0242 0,068 2,083 1,443 1210 819 0,308 0,405 Accepting attitudes towards people living with HIV 9,4 0,0556 0,0153 0,275 3,255 1,804 1088 734 0,025 0,086 Women who have been tested for HIV and know the results 9,6 0,1816 0,0200 0,110 2,212 1,487 1210 819 0,142 0,222 Sexually active young women who have been tested for HIV and know the results 9,7 0,2786 0,0318 0,114 0,412 0,642 123 83 0,215 0,342 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 349 233 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 33 21 (*) (*) 276 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 45 34 (*) * Marriage before age 18 8,7 (*) (*) (*) (*) (*) 58 44 (*) * Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 45 34 (*) * Knowledge of mother- to-child transmission of HIV 9,3 0,2001 0,0212 0,106 0,719 0,848 340 258 0,158 0,242 Accepting attitudes towards people living with HIV 9,4 0,0805 0,0217 0,269 1,387 1,178 289 220 0,037 0,124 Men who have been tested for HIV and know the results 9,6 0,0812 0,0237 0,292 1,938 1,392 340 258 0,034 0,129 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 22 16 (*) * Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 45 34 (*) * Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 17 12 (*) * Male circumcision 9,21 0,4570 0,0409 0,089 1,728 1,315 340 258 0,375 0,539 UNDER-5s Underweight prevalence 2.1a 0,0652 0,0158 0,242 0,978 0,989 350 240 0,034 0,097 Stunting prevalence 2.2a 0,1663 0,0312 0,188 1,682 1,297 350 240 0,104 0,229 Wasting prevalence 2.3a 0,0809 0,0212 0,262 1,406 1,186 340 233 0,038 0,123 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 45 31 (*) (*) Age-appropriate breastfeeding 2,14 0,3119 0,0368 0,118 0,638 0,799 147 102 0,238 0,386 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 75 52 1,000 1,000 Received polio immunization - 0,9627 0,0255 0,026 0,921 0,960 75 52 0,912 1,000 Received DPT immunization - 0,9814 0,0186 0,019 0,967 0,983 75 52 0,944 1,000 Received measles immunization - 0,9073 0,0252 0,028 0,384 0,620 75 52 0,857 0,958 Received Hepatitis B immunization - 0,7761 0,0496 0,064 0,723 0,850 75 52 0,677 0,875 Diarrhoea in the previous 2 weeks - 0,0213 0,0092 0,430 1,021 1,011 372 255 0,003 0,040 Illness with a cough in the previous 2 weeks - 0,0463 0,0162 0,350 1,513 1,230 372 255 0,014 0,079 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 8 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 17 12 (*) (*) Support for learning 6,1 0,9092 0,0261 0,029 0,815 0,903 147 100 0,857 0,961 Attendance to early childhood education 6,7 0,5381 0,0440 0,082 0,771 0,878 147 100 0,450 0,626 Birth registration 8,1 0,9959 0,0040 0,004 1,004 1,002 372 255 0,988 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 277MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.12: Sampling errors: Zhambyl Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,7766 0,0265 0,034 3,446 1,856 886 853 0,724 0,830 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9594 0,0309 0,032 20,934 4,575 3521 857 0,898 1,000 Use of improved sanitation 4,3 0,9878 0,0050 0,005 1,800 1,341 3518 856 0,978 0,998 Secondary school net attendance ratio (adjusted) 7,5 0,9280 0,0172 0,019 1,769 1,330 413 399 0,894 0,962 Prevalence of children with one or both parents dead 9,18 0,0503 0,0105 0,208 2,676 1,636 1216 1167 0,029 0,071 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 4 4 (*) (*) School attendance of non- orphans 9.20 0,9954 0,0045 0,005 1,076 1,037 248 239 0,986 1,000 Violent discipline 8,5 0,5613 0,0270 0,048 1,326 1,151 845 448 0,507 0,615 WOMEN Pregnant women - 0,0629 0,0075 0,119 0,765 0,875 836 804 0,048 0,078 Early childbearing 5,2 0,0152 0,0114 0,751 0,951 0,975 114 110 0,000 0,038 Contraceptive prevalence 5,3 0,4437 0,0257 0,058 1,392 1,180 543 520 0,392 0,495 Unmet need 5,4 0,1381 0,0166 0,120 1,205 1,098 543 520 0,105 0,171 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9932 0,0066 0,007 1,025 1,012 166 158 0,980 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9682 0,0129 0,013 0,849 0,921 166 158 0,942 0,994 Skilled attendant at delivery 5,7 0,9864 0,0133 0,013 2,063 1,436 166 158 0,960 1,000 Institutional deliveries 5,8 0,9864 0,0133 0,013 2,063 1,436 166 158 0,960 1,000 Caesarean section 5,9 0,1583 0,0278 0,176 0,913 0,955 166 158 0,103 0,214 Literacy rate among young women 7,1 0,9910 0,0085 0,009 1,977 1,406 252 244 0,974 1,000 Marriage before age 18 8,7 0,1279 0,0151 0,118 1,377 1,173 697 670 0,098 0,158 Comprehensive knowledge about HIV prevention among young people 9,2 0,2211 0,0277 0,125 1,086 1,042 252 244 0,166 0,277 Knowledge of mother- to-child transmission of HIV 9,3 0,5007 0,0157 0,031 0,788 0,888 836 804 0,469 0,532 Accepting attitudes towards people living with HIV 9,4 0,0183 0,0054 0,293 1,223 1,106 794 765 0,008 0,029 Women who have been tested for HIV and know the results 9,6 0,1999 0,0241 0,121 2,923 1,710 836 804 0,152 0,248 Sexually active young women who have been tested for HIV and know the results 9,7 0,3878 0,0512 0,132 0,806 0,898 76 74 0,285 0,490 Sex before age 15 among young women 9,11 0,0037 0,0036 0,977 0,860 0,927 252 244 0,000 0,011 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 7 7 (*) (*) 278 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,8253 0,0331 0,040 0,387 0,622 56 52 0,759 0,891 Marriage before age 18 8,7 (*) (*) (*) (*) (*) 47 43 (*) (*) Comprehensive knowledge about HIV prevention among young people 9,2 0,3234 0,0620 0,192 0,895 0,946 56 52 0,200 0,447 Knowledge of mother- to-child transmission of HIV 9,3 0,1375 0,0164 0,119 0,503 0,709 240 223 0,105 0,170 Accepting attitudes towards people living with HIV 9,4 0,0346 0,0104 0,302 0,692 0,832 230 213 0,014 0,056 Men who have been tested for HIV and know the results 9,6 0,2450 0,0243 0,099 0,707 0,841 240 223 0,196 0,294 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 32 29 (*) (*) Sex before age 15 among young men 9,11 0,0000 0,0000 0,000 na na 56 52 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 27 25 (*) (*) Male circumcision 9,21 0,8794 0,0309 0,035 1,998 1,414 240 223 0,818 0,941 UNDER-5s Underweight prevalence 2.1a 0,0348 0,0117 0,337 1,563 1,250 398 383 0,011 0,058 Stunting prevalence 2.2a 0,1622 0,0192 0,118 1,023 1,012 394 380 0,124 0,201 Wasting prevalence 2.3a 0,0278 0,0059 0,214 0,494 0,703 394 379 0,016 0,040 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 46 43 (*) (*) Age-appropriate breastfeeding 2,14 0,3151 0,0395 0,125 1,202 1,096 175 167 0,236 0,394 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 76 73 1,000 1,000 Received polio immunization - 0,9756 0,0134 0,014 0,544 0,737 76 73 0,949 1,000 Received DPT immunization - 1,0000 0,0000 0,000 na na 76 73 1,000 1,000 Received measles immunization - 0,9316 0,0248 0,027 0,694 0,833 76 73 0,882 0,981 Received Hepatitis B immunization - 0,9659 0,0171 0,018 0,639 0,800 76 73 0,932 1,000 Diarrhoea in the previous 2 weeks - 0,0128 0,0067 0,527 1,379 1,174 400 386 0,000 0,026 Illness with a cough in the previous 2 weeks - 0,0343 0,0117 0,340 1,585 1,259 400 386 0,011 0,058 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 5 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 14 13 (*) (*) Support for learning 6,1 0,9421 0,0192 0,020 0,994 0,997 151 148 0,904 0,981 Attendance to early childhood education 6,7 0,3316 0,0458 0,138 1,390 1,179 151 148 0,240 0,423 Birth registration 8,1 0,9975 0,0026 0,003 1,011 1,005 400 386 0,992 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 279MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.13: Sampling errors: West Kazakhstan Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9615 0,0091 0,009 2,112 1,453 646 948 0,943 0,980 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,8908 0,0301 0,034 8,828 2,971 2208 949 0,831 0,951 Use of improved sanitation 4,3 0,9598 0,0142 0,015 4,955 2,226 2208 949 0,931 0,988 Secondary school net attendance ratio (adjusted) 7,5 0,9261 0,0154 0,017 1,106 1,052 213 320 0,895 0,957 Prevalence of children with one or both parents dead 9,18 0,0591 0,0129 0,218 2,693 1,641 604 905 0,033 0,085 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 127 190 1,000 1,000 Violent discipline 8,5 0,5468 0,0310 0,057 1,520 1,233 424 394 0,485 0,609 WOMEN Pregnant women - 0,0362 0,0072 0,198 1,235 1,111 566 840 0,022 0,050 Early childbearing 5,2 0,0342 0,0092 0,270 0,318 0,564 84 124 0,016 0,053 Contraceptive prevalence 5,3 0,6192 0,0246 0,040 1,292 1,137 339 506 0,570 0,668 Unmet need 5,4 0,0801 0,0115 0,144 0,906 0,952 339 506 0,057 0,103 Antenatal care coverage - at least once by skilled personnel 5.5a 1,0000 0,0000 0,000 na na 75 112 1,000 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9108 0,0227 0,025 0,706 0,841 75 112 0,865 0,956 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 75 112 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 75 112 1,000 1,000 Caesarean section 5,9 0,1955 0,0316 0,162 0,706 0,840 75 112 0,132 0,259 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 164 244 1,000 1,000 Marriage before age 18 8,7 0,0899 0,0094 0,105 0,776 0,881 486 720 0,071 0,109 Comprehensive knowledge about HIV prevention among young people 9,2 0,3402 0,0332 0,098 1,196 1,094 164 244 0,274 0,407 Knowledge of mother- to-child transmission of HIV 9,3 0,5715 0,0157 0,027 0,840 0,917 566 840 0,540 0,603 Accepting attitudes towards people living with HIV 9,4 0,0274 0,0054 0,198 0,902 0,950 552 818 0,017 0,038 Women who have been tested for HIV and know the results 9,6 0,2641 0,0190 0,072 1,552 1,246 566 840 0,226 0,302 Sexually active young women who have been tested for HIV and know the results 9,7 0,3183 0,0398 0,125 0,592 0,769 55 82 0,239 0,398 Sex before age 15 among young women 9,11 0,0047 0,0047 0,997 1,138 1,067 164 244 0,000 0,014 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 8 12 (*) (*) 280 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 30 46 (*) (*) Marriage before age 18 8,7 (*) (*) (*) (*) (*) 28 43 (*) (*) Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 30 46 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,2748 0,0245 0,089 0,715 0,846 158 238 0,226 0,324 Accepting attitudes towards people living with HIV 9,4 0,0039 0,0039 1,007 0,913 0,956 154 231 0,000 0,012 Men who have been tested for HIV and know the results 9,6 0,1425 0,0265 0,186 1,360 1,166 158 238 0,090 0,195 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 12 18 (*) (*) Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 30 46 (*) (*) Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 10 15 (*) * Male circumcision 9,21 0,6144 0,0364 0,059 1,322 1,150 158 238 0,542 0,687 UNDER-5s Underweight prevalence 2.1a 0,0228 0,0090 0,396 1,054 1,027 193 289 0,005 0,041 Stunting prevalence 2.2a 0,0985 0,0198 0,201 1,250 1,118 190 285 0,059 0,138 Wasting prevalence 2.3a 0,0183 0,0083 0,454 1,096 1,047 191 286 0,002 0,035 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 23 34 (*) * Age-appropriate breastfeeding 2,14 0,3296 0,0384 0,117 0,782 0,884 79 118 0,253 0,406 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 40 59 1,000 1,000 Received polio immunization - 0,9537 0,0217 0,023 0,619 0,787 40 59 0,910 0,997 Received DPT immunization - 0,9656 0,0238 0,025 0,988 0,994 40 59 0,918 1,000 Received measles immunization - 0,9484 0,0255 0,027 0,770 0,878 40 59 0,897 0,999 Received Hepatitis B immunization - 0,4310 0,0689 0,160 1,121 1,059 40 59 0,293 0,569 Diarrhoea in the previous 2 weeks - 0,0295 0,0109 0,370 1,211 1,101 195 291 0,008 0,051 Illness with a cough in the previous 2 weeks - 0,0164 0,0085 0,519 1,304 1,142 195 291 0,000 0,033 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 6 8 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 3 5 (*) (*) Support for learning 6,1 0,9918 0,0080 0,008 0,763 0,873 65 98 0,976 1,000 Attendance to early childhood education 6,7 0,5931 0,0750 0,126 2,262 1,504 65 98 0,443 0,743 Birth registration 8,1 1,0000 0,0000 0,000 na na 195 291 1,000 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 281MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.14: Sampling errors: Karaganda Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9680 0,0068 0,007 1,795 1,340 1627 1206 0,954 0,982 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9727 0,0131 0,013 7,746 2,783 4838 1207 0,947 0,999 Use of improved sanitation 4,3 0,9919 0,0049 0,005 3,563 1,888 4794 1198 0,982 1,000 Secondary school net attendance ratio (adjusted) 7,5 0,9336 0,0119 0,013 0,828 0,910 495 361 0,910 0,958 Prevalence of children with one or both parents dead 9,18 0,0602 0,0097 0,161 1,664 1,290 1362 1000 0,041 0,080 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 305 219 1,000 1,000 Violent discipline 8,5 0,5179 0,0208 0,040 0,836 0,914 993 485 0,476 0,559 WOMEN Pregnant women - 0,0468 0,0053 0,113 0,590 0,768 1274 944 0,036 0,057 Early childbearing 5,2 0,0235 0,0135 0,571 1,118 1,057 193 143 0,000 0,050 Contraceptive prevalence 5,3 0,5455 0,0237 0,043 1,262 1,123 753 557 0,498 0,593 Unmet need 5,4 0,1222 0,0146 0,119 1,101 1,049 753 557 0,093 0,151 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9909 0,0093 0,009 1,055 1,027 148 112 0,972 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9538 0,0115 0,012 0,333 0,577 148 112 0,931 0,977 Skilled attendant at delivery 5,7 0,9953 0,0047 0,005 0,518 0,720 148 112 0,986 1,000 Institutional deliveries 5,8 0,9953 0,0047 0,005 0,518 0,720 148 112 0,986 1,000 Caesarean section 5,9 0,2230 0,0252 0,113 0,407 0,638 148 112 0,173 0,273 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 366 270 1,000 1,000 Marriage before age 18 8,7 0,1275 0,0129 0,101 1,222 1,105 1101 817 0,102 0,153 Comprehensive knowledge about HIV prevention among young people 9,2 0,4630 0,0308 0,066 1,024 1,012 366 270 0,401 0,525 Knowledge of mother- to-child transmission of HIV 9,3 0,3723 0,0180 0,048 1,305 1,142 1274 944 0,336 0,408 Accepting attitudes towards people living with HIV 9,4 0,0078 0,0030 0,383 1,092 1,045 1273 943 0,002 0,014 Women who have been tested for HIV and know the results 9,6 0,2927 0,0154 0,053 1,078 1,038 1274 944 0,262 0,323 Sexually active young women who have been tested for HIV and know the results 9,7 0,3352 0,0513 0,153 1,229 1,109 143 105 0,233 0,438 Sex before age 15 among young women 9,11 0,0110 0,0082 0,745 1,659 1,288 366 270 0,000 0,027 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 40 30 (*) (*) 282 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 51 38 (*) (*) Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 70 50 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 51 38 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,4148 0,0302 0,073 0,918 0,958 333 246 0,355 0,475 Accepting attitudes towards people living with HIV 9,4 0,0288 0,0120 0,416 1,255 1,120 333 246 0,005 0,053 Men who have been tested for HIV and know the results 9,6 0,1933 0,0241 0,125 0,916 0,957 333 246 0,145 0,242 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 28 21 (*) (*) Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 51 38 (*) (*) Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 22 17 (*) (*) Male circumcision 9,21 0,4929 0,0376 0,076 1,388 1,178 333 246 0,418 0,568 UNDER-5s Underweight prevalence 2.1a 0,0233 0,0137 0,587 2,407 1,551 397 294 0,000 0,051 Stunting prevalence 2.2a 0,0475 0,0112 0,235 0,804 0,897 396 293 0,025 0,070 Wasting prevalence 2.3a 0,0036 0,0037 1,012 1,087 1,043 394 292 0,000 0,011 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 33 26 (*) (*) Age-appropriate breastfeeding 2,14 0,2636 0,0439 0,166 1,199 1,095 162 122 0,176 0,351 Tuberculosis immunization coverage - 0,9700 0,0220 0,023 1,228 1,108 101 75 0,926 1,000 Received polio immunization - 0,9434 0,0287 0,030 1,129 1,063 99 74 0,886 1,000 Received DPT immunization - 0,9700 0,0220 0,023 1,228 1,108 101 75 0,926 1,000 Received measles immunization - 0,9696 0,0225 0,023 1,259 1,122 99 74 0,924 1,000 Received Hepatitis B immunization - 0,9700 0,0220 0,023 1,228 1,108 101 75 0,926 1,000 Diarrhoea in the previous 2 weeks - 0,0208 0,0079 0,380 0,952 0,976 420 312 0,005 0,037 Illness with a cough in the previous 2 weeks - 0,0328 0,0091 0,278 0,814 0,902 420 312 0,015 0,051 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 9 7 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 14 11 (*) (*) Support for learning 6,1 0,9035 0,0272 0,030 1,080 1,039 175 128 0,849 0,958 Attendance to early childhood education 6,7 0,5694 0,0406 0,071 0,854 0,924 175 128 0,488 0,651 Birth registration 8,1 0,9983 0,0016 0,002 0,510 0,714 420 312 0,995 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 283MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.15: Sampling errors: Kostanai Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9401 0,0110 0,012 2,675 1,635 1128 1236 0,918 0,962 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9165 0,0312 0,034 15,743 3,968 3058 1237 0,854 0,979 Use of improved sanitation 4,3 0,9719 0,0161 0,017 11,799 3,435 3056 1235 0,940 1,000 Secondary school net attendance ratio (adjusted) 7,5 0,9103 0,0150 0,016 0,882 0,939 288 321 0,880 0,940 Prevalence of children with one or both parents dead 9,18 0,0497 0,0107 0,215 1,995 1,413 740 828 0,028 0,071 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 0,9947 0,0004 0,000 0,007 0,085 182 203 0,994 0,996 Violent discipline 8,5 0,7257 0,0255 0,035 1,232 1,110 520 377 0,675 0,777 WOMEN Pregnant women - 0,0230 0,0059 0,258 1,362 1,167 791 871 0,011 0,035 Early childbearing 5,2 0,0321 0,0154 0,480 1,040 1,020 126 137 0,001 0,063 Contraceptive prevalence 5,3 0,6310 0,0261 0,041 1,521 1,233 468 520 0,579 0,683 Unmet need 5,4 0,1082 0,0157 0,145 1,319 1,148 468 520 0,077 0,139 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9878 0,0122 0,012 1,164 1,079 86 95 0,963 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9768 0,0123 0,013 0,626 0,791 86 95 0,952 1,000 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 86 95 1,000 1,000 Institutional deliveries 5,8 0,9869 0,0009 0,001 0,006 0,075 86 95 0,985 0,989 Caesarean section 5,9 0,2048 0,0240 0,117 0,332 0,576 86 95 0,157 0,253 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 224 247 1,000 1,000 Marriage before age 18 8,7 0,0829 0,0119 0,144 1,422 1,192 693 761 0,059 0,107 Comprehensive knowledge about HIV prevention among young people 9,2 0,5213 0,0362 0,069 1,291 1,136 224 247 0,449 0,594 Knowledge of mother- to-child transmission of HIV 9,3 0,4638 0,0222 0,048 1,732 1,316 791 871 0,419 0,508 Accepting attitudes towards people living with HIV 9,4 0,0155 0,0040 0,261 0,932 0,966 789 869 0,007 0,024 Women who have been tested for HIV and know the results 9,6 0,2896 0,0191 0,066 1,541 1,241 791 871 0,251 0,328 Sexually active young women who have been tested for HIV and know the results 9,7 0,3277 0,0394 0,120 0,840 0,917 110 120 0,249 0,407 Sex before age 15 among young women 9,11 0,0086 0,0063 0,730 1,143 1,069 224 247 0,000 0,021 Condom use with non-regular partners 9,16 0,7436 0,0422 0,057 0,504 0,710 50 55 0,659 0,828 284 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,6585 0,0440 0,067 0,481 0,694 49 57 0,571 0,746 Marriage before age 18 8,7 0,0149 0,0008 0,051 0,002 0,049 53 62 0,013 0,016 Comprehensive knowledge about HIV prevention among young people 9,2 0,4025 0,0708 0,176 1,168 1,081 49 57 0,261 0,544 Knowledge of mother- to-child transmission of HIV 9,3 0,3095 0,0299 0,097 1,087 1,043 219 261 0,250 0,369 Accepting attitudes towards people living with HIV 9,4 0,0230 0,0074 0,321 0,632 0,795 219 261 0,008 0,038 Men who have been tested for HIV and know the results 9,6 0,1502 0,0270 0,180 1,490 1,221 219 261 0,096 0,204 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 33 39 (*) (*) Sex before age 15 among young men 9,11 0,0000 0,0000 0,000 na na 49 57 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 29 34 (*) (*) Male circumcision 9,21 0,3568 0,0341 0,096 1,317 1,148 219 261 0,289 0,425 UNDER-5s Underweight prevalence 2.1a 0,0148 0,0046 0,312 0,361 0,601 221 248 0,006 0,024 Stunting prevalence 2.2a 0,1270 0,0212 0,167 0,999 1,000 220 247 0,085 0,169 Wasting prevalence 2.3a 0,0043 0,0042 0,985 1,035 1,017 221 248 0,000 0,013 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 24 27 (*) (*) Age-appropriate breastfeeding 2,14 0,4112 0,0644 0,157 1,662 1,289 88 98 0,282 0,540 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 45 51 1,000 1,000 Received polio immunization - 0,9755 0,0245 0,025 1,255 1,120 45 51 0,926 1,000 Received DPT immunization - 1,0000 0,0000 0,000 na na 45 51 1,000 1,000 Received measles immunization - 1,0000 0,0000 0,000 na na 45 51 1,000 1,000 Received Hepatitis B immunization - 0,9010 0,0409 0,045 0,936 0,967 45 51 0,819 0,983 Diarrhoea in the previous 2 weeks - 0,0248 0,0129 0,522 1,716 1,310 222 249 0,000 0,051 Illness with a cough in the previous 2 weeks - 0,0192 0,0067 0,351 0,598 0,773 222 249 0,006 0,033 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 5 6 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 4 5 (*) (*) Support for learning 6,1 0,9806 0,0137 0,014 0,905 0,951 82 93 0,953 1,000 Attendance to early childhood education 6,7 0,6938 0,0548 0,079 1,300 1,140 82 93 0,584 0,803 Birth registration 8,1 0,9868 0,0073 0,007 1,023 1,011 222 249 0,972 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 285MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.16: Sampling errors: Kyzylorda Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,8486 0,0222 0,026 2,966 1,722 498 776 0,804 0,893 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9095 0,0455 0,050 19,480 4,414 2292 776 0,819 1,000 Use of improved sanitation 4,3 0,9892 0,0048 0,005 1,632 1,278 2275 771 0,980 0,999 Secondary school net attendance ratio (adjusted) 7,5 0,9433 0,0094 0,010 0,785 0,886 311 480 0,925 0,962 Prevalence of children with one or both parents dead 9,18 0,0460 0,0087 0,189 2,310 1,520 869 1337 0,029 0,063 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 2 3 (*) (*) School attendance of non- orphans 9.20 0,9922 0,0052 0,005 1,052 1,026 202 309 0,982 1,000 Violent discipline 8,5 0,5639 0,0212 0,038 0,911 0,955 618 501 0,522 0,606 WOMEN Pregnant women - 0,0637 0,0105 0,164 1,598 1,264 553 869 0,043 0,085 Early childbearing 5,2 0,0000 0,0000 0,000 na na 78 123 0,000 0,000 Contraceptive prevalence 5,3 0,4414 0,0190 0,043 0,815 0,903 357 555 0,403 0,479 Unmet need 5,4 0,1125 0,0134 0,120 1,003 1,001 357 555 0,086 0,139 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9880 0,0085 0,009 1,126 1,061 119 187 0,971 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,9543 0,0136 0,014 0,791 0,889 119 187 0,927 0,982 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 119 187 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 119 187 1,000 1,000 Caesarean section 5,9 0,1141 0,0265 0,232 1,291 1,136 119 187 0,061 0,167 Literacy rate among young women 7,1 0,9978 0,0022 0,002 0,581 0,762 162 257 0,993 1,000 Marriage before age 18 8,7 0,0598 0,0075 0,125 0,731 0,855 470 735 0,045 0,075 Comprehensive knowledge about HIV prevention among young people 9,2 0,0885 0,0191 0,216 1,164 1,079 162 257 0,050 0,127 Knowledge of mother- to-child transmission of HIV 9,3 0,6190 0,0171 0,028 1,074 1,036 553 869 0,585 0,653 Accepting attitudes towards people living with HIV 9,4 0,0107 0,0031 0,289 0,731 0,855 512 807 0,005 0,017 Women who have been tested for HIV and know the results 9,6 0,1692 0,0149 0,088 1,369 1,170 553 869 0,139 0,199 Sexually active young women who have been tested for HIV and know the results 9,7 0,2785 0,0533 0,192 0,935 0,967 43 67 0,172 0,385 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 162 257 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 1 1 (*) (*) 286 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 32 49 (*) (*) Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 36 53 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 32 49 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,4480 0,0402 0,090 1,500 1,225 157 231 0,368 0,528 Accepting attitudes towards people living with HIV 9,4 0,0875 0,0216 0,247 1,172 1,082 136 201 0,044 0,131 Men who have been tested for HIV and know the results 9,6 0,2923 0,0364 0,125 1,477 1,215 157 231 0,219 0,365 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 14 21 (*) (*) Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 32 49 (*) (*) Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 11 17 (*) (*) Male circumcision 9,21 0,9697 0,0065 0,007 0,335 0,579 157 231 0,957 0,983 UNDER-5s Underweight prevalence 2.1a 0,0209 0,0067 0,321 0,989 0,994 291 451 0,007 0,034 Stunting prevalence 2.2a 0,0707 0,0174 0,245 2,057 1,434 290 450 0,036 0,105 Wasting prevalence 2.3a 0,0131 0,0054 0,409 1,000 1,000 290 450 0,002 0,024 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 25 38 (*) (*) Age-appropriate breastfeeding 2,14 0,2666 0,0277 0,104 0,765 0,875 126 196 0,211 0,322 Tuberculosis immunization coverage - 0,9923 0,0078 0,008 0,767 0,876 62 97 0,977 1,000 Received polio immunization - 0,9736 0,0160 0,016 0,961 0,980 62 97 0,942 1,000 Received DPT immunization - 0,9812 0,0038 0,004 0,076 0,276 62 97 0,974 0,989 Received measles immunization - 0,9728 0,0220 0,023 1,753 1,324 62 97 0,929 1,000 Received Hepatitis B immunization - 0,7944 0,0490 0,062 1,411 1,188 62 97 0,696 0,892 Diarrhoea in the previous 2 weeks - 0,0018 0,0018 1,011 0,847 0,920 292 453 0,000 0,006 Illness with a cough in the previous 2 weeks - 0,0455 0,0120 0,264 1,507 1,227 292 453 0,021 0,070 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 1 1 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 13 21 * * Support for learning 6,1 0,9790 0,0106 0,011 0,962 0,981 114 177 0,958 1,000 Attendance to early childhood education 6,7 0,3638 0,0471 0,130 1,690 1,300 114 177 0,270 0,458 Birth registration 8,1 1,0000 0,0000 0,000 na na 292 453 1,000 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 287MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.17: Sampling errors: Mangistau Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,7712 0,0238 0,031 2,283 1,511 370 710 0,724 0,819 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9470 0,0151 0,016 3,240 1,800 1722 714 0,917 0,977 Use of improved sanitation 4,3 0,9930 0,0043 0,004 1,725 1,313 1514 653 0,984 1,000 Secondary school net attendance ratio (adjusted) 7,5 0,9437 0,0113 0,012 0,956 0,978 212 396 0,921 0,966 Prevalence of children with one or both parents dead 9,18 0,0750 0,0107 0,142 2,043 1,429 655 1244 0,054 0,096 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 1 2 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 127 238 1,000 1,000 Violent discipline 8,5 0,6531 0,0214 0,033 0,882 0,939 447 436 0,610 0,696 WOMEN Pregnant women - 0,0284 0,0052 0,183 0,844 0,919 461 863 0,018 0,039 Early childbearing 5,2 0,0076 0,0075 0,981 1,058 1,028 75 144 0,000 0,023 Contraceptive prevalence 5,3 0,5712 0,0217 0,038 1,002 1,001 280 523 0,528 0,615 Unmet need 5,4 0,1040 0,0137 0,132 1,059 1,029 280 523 0,076 0,131 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9941 0,0059 0,006 1,111 1,054 99 186 0,982 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,8890 0,0328 0,037 2,021 1,422 99 186 0,823 0,955 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 99 186 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 99 186 1,000 1,000 Caesarean section 5,9 0,0877 0,0273 0,312 1,729 1,315 99 186 0,033 0,142 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 158 297 1,000 1,000 Marriage before age 18 8,7 0,0619 0,0098 0,158 1,168 1,081 378 710 0,042 0,081 Comprehensive knowledge about HIV prevention among young people 9,2 0,1191 0,0154 0,129 0,668 0,817 158 297 0,088 0,150 Knowledge of mother- to-child transmission of HIV 9,3 0,5727 0,0262 0,046 2,415 1,554 461 863 0,520 0,625 Accepting attitudes towards people living with HIV 9,4 0,0025 0,0017 0,696 0,998 0,999 441 825 0,000 0,006 Women who have been tested for HIV and know the results 9,6 0,0847 0,0104 0,123 1,208 1,099 461 863 0,064 0,106 Sexually active young women who have been tested for HIV and know the results 9,7 0,1658 0,0369 0,223 0,956 0,978 50 98 0,092 0,240 Sex before age 15 among young women 9,11 0,0031 0,0031 1,003 0,920 0,959 158 297 0,000 0,009 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 8 16 (*) (*) 288 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 30 49 (*) (*) Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 30 50 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 30 49 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,4964 0,0247 0,050 0,477 0,690 121 197 0,447 0,546 Accepting attitudes towards people living with HIV 9,4 0,0046 0,0046 1,007 0,868 0,931 115 187 0,000 0,014 Men who have been tested for HIV and know the results 9,6 0,2491 0,0346 0,139 1,258 1,121 121 197 0,180 0,318 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 17 27 (*) * Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 30 49 (*) * Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 13 21 (*) * Male circumcision 9,21 0,9199 0,0176 0,019 0,826 0,909 121 197 0,885 0,955 UNDER-5s Underweight prevalence 2.1a 0,0361 0,0131 0,364 2,126 1,458 229 430 0,010 0,062 Stunting prevalence 2.2a 0,1024 0,0222 0,216 2,283 1,511 228 428 0,058 0,147 Wasting prevalence 2.3a 0,0447 0,0096 0,215 0,916 0,957 226 425 0,025 0,064 Exclusive breastfeeding under 6 months 2,6 0,1386 0,0270 0,195 0,343 0,585 31 57 0,085 0,193 Age-appropriate breastfeeding 2,14 0,2631 0,0306 0,116 0,953 0,976 107 199 0,202 0,324 Tuberculosis immunization coverage - 0,9638 0,0273 0,028 2,267 1,506 58 107 0,909 1,000 Received polio immunization - 0,8764 0,0390 0,044 1,488 1,220 58 107 0,798 0,954 Received DPT immunization - 0,9879 0,0111 0,011 1,092 1,045 58 107 0,966 1,000 Received measles immunization - 0,9793 0,0133 0,014 0,932 0,966 58 107 0,953 1,000 Received Hepatitis B immunization - 0,8274 0,0534 0,064 2,114 1,454 58 107 0,721 0,934 Diarrhoea in the previous 2 weeks - 0,0113 0,0049 0,431 0,973 0,986 244 457 0,002 0,021 Illness with a cough in the previous 2 weeks - 0,0141 0,0065 0,464 1,402 1,184 244 457 0,001 0,027 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 3 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 3 6 (*) (*) Support for learning 6,1 0,9877 0,0085 0,009 0,968 0,984 87 162 0,971 1,000 Attendance to early childhood education 6,7 0,1809 0,0303 0,168 1,000 1,000 87 162 0,120 0,242 Birth registration 8,1 0,9971 0,0028 0,003 1,242 1,115 244 457 0,991 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 289MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.18: Sampling errors: Pavlodar Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,8386 0,0164 0,020 2,174 1,474 904 1097 0,806 0,871 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,9565 0,0199 0,021 10,728 3,275 2770 1129 0,917 0,996 Use of improved sanitation 4,3 0,9925 0,0026 0,003 1,034 1,017 2768 1128 0,987 0,998 Secondary school net attendance ratio (adjusted) 7,5 0,9183 0,0148 0,016 0,876 0,936 242 300 0,889 0,948 Prevalence of children with one or both parents dead 9,18 0,0499 0,0097 0,195 1,589 1,261 649 798 0,030 0,069 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 1 1 (*) (*) School attendance of non- orphans 9.20 1,0000 0,0000 0,000 na na 130 161 1,000 1,000 Violent discipline 8,5 0,5428 0,0306 0,056 1,499 1,224 452 397 0,481 0,604 WOMEN Pregnant women - 0,0355 0,0054 0,152 0,747 0,864 746 881 0,025 0,046 Early childbearing 5,2 0,0387 0,0167 0,431 0,983 0,991 111 132 0,005 0,072 Contraceptive prevalence 5,3 0,5828 0,0161 0,028 0,546 0,739 433 512 0,551 0,615 Unmet need 5,4 0,1087 0,0153 0,141 1,239 1,113 433 512 0,078 0,139 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9909 0,0095 0,010 0,963 0,981 82 97 0,972 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,7141 0,0367 0,051 0,635 0,797 82 97 0,641 0,788 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 82 97 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 82 97 1,000 1,000 Caesarean section 5,9 0,2284 0,0400 0,175 0,871 0,933 82 97 0,148 0,308 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 205 245 1,000 1,000 Marriage before age 18 8,7 0,1120 0,0094 0,084 0,677 0,823 651 768 0,093 0,131 Comprehensive knowledge about HIV prevention among young people 9,2 0,4981 0,0368 0,074 1,324 1,151 205 245 0,424 0,572 Knowledge of mother- to-child transmission of HIV 9,3 0,4123 0,0194 0,047 1,368 1,170 746 881 0,373 0,451 Accepting attitudes towards people living with HIV 9,4 0,0101 0,0026 0,252 0,567 0,753 739 873 0,005 0,015 Women who have been tested for HIV and know the results 9,6 0,3434 0,0141 0,041 0,775 0,880 746 881 0,315 0,372 Sexually active young women who have been tested for HIV and know the results 9,7 0,3959 0,0518 0,131 1,212 1,101 91 109 0,292 0,500 Sex before age 15 among young women 9,11 0,0129 0,0070 0,548 0,953 0,976 205 245 0,000 0,027 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 40 48 (*) (*) 290 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 36 48 (*) (*) Marriage before age 18 8,7 0,0149 0,0155 1,038 0,980 0,990 45 61 0,000 0,046 Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 36 48 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,2068 0,0240 0,116 0,966 0,983 206 275 0,159 0,255 Accepting attitudes towards people living with HIV 9,4 0,0039 0,0038 0,993 1,048 1,024 206 275 0,000 0,012 Men who have been tested for HIV and know the results 9,6 0,4645 0,0267 0,057 0,785 0,886 206 275 0,411 0,518 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 23 31 (*) * Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 36 48 (*) (*) Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 17 22 (*) (*) Male circumcision 9,21 0,4705 0,0351 0,075 1,357 1,165 206 275 0,400 0,541 UNDER-5s Underweight prevalence 2.1a 0,0178 0,0107 0,600 1,614 1,271 208 248 0,000 0,039 Stunting prevalence 2.2a 0,0893 0,0199 0,223 1,185 1,088 204 244 0,049 0,129 Wasting prevalence 2.3a 0,0268 0,0120 0,446 1,315 1,147 202 241 0,003 0,051 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 19 22 (*) (*) Age-appropriate breastfeeding 2,14 0,4247 0,0555 0,131 1,196 1,094 81 96 0,314 0,536 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 48 58 1,000 1,000 Received polio immunization - 0,8492 0,0321 0,038 0,459 0,677 48 58 0,785 0,913 Received DPT immunization - 0,9345 0,0169 0,018 0,266 0,516 48 58 0,901 0,968 Received measles immunization - 0,9332 0,0242 0,026 0,536 0,732 48 58 0,885 0,982 Received Hepatitis B immunization - 0,8382 0,0233 0,028 0,229 0,478 48 58 0,792 0,885 Diarrhoea in the previous 2 weeks - 0,0076 0,0053 0,704 0,977 0,989 217 259 0,000 0,018 Illness with a cough in the previous 2 weeks - 0,0149 0,0089 0,595 1,382 1,176 217 259 0,000 0,033 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 2 2 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 3 4 (*) (*) Support for learning 6,1 0,9113 0,0215 0,024 0,559 0,747 82 99 0,868 0,954 Attendance to early childhood education 6,7 0,5900 0,0516 0,088 1,080 1,039 82 99 0,487 0,693 Birth registration 8,1 0,9960 0,0039 0,004 1,009 1,005 217 259 0,988 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 291MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.19: Sampling errors: North Kazakhstan Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,9743 0,0055 0,006 1,500 1,225 794 1239 0,963 0,985 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,8757 0,0331 0,038 12,474 3,532 2304 1240 0,809 0,942 Use of improved sanitation 4,3 0,9860 0,0050 0,005 2,255 1,502 2290 1228 0,976 0,996 Secondary school net attendance ratio (adjusted) 7,5 0,9387 0,0145 0,015 1,161 1,078 207 319 0,910 0,968 Prevalence of children with one or both parents dead 9,18 0,0591 0,0119 0,201 2,143 1,464 544 843 0,035 0,083 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 1 2 (*) (*) School attendance of non- orphans 9.20 0,9955 0,0044 0,004 0,902 0,950 137 210 0,987 1,000 Violent discipline 8,5 0,5988 0,0245 0,041 1,074 1,036 410 432 0,550 0,648 WOMEN Pregnant women - 0,0336 0,0055 0,164 0,835 0,914 577 893 0,023 0,045 Early childbearing 5,2 0,0395 0,0161 0,407 0,840 0,916 79 124 0,007 0,072 Contraceptive prevalence 5,3 0,6054 0,0195 0,032 0,919 0,959 375 579 0,566 0,644 Unmet need 5,4 0,0936 0,0104 0,111 0,737 0,858 375 579 0,073 0,114 Antenatal care coverage - at least once by skilled personnel 5.5a 1,0000 0,0000 0,000 na na 46 73 1,000 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,8775 0,0227 0,026 0,344 0,586 46 73 0,832 0,923 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 46 73 1,000 1,000 Institutional deliveries 5,8 1,0000 0,0000 0,000 na na 46 73 1,000 1,000 Caesarean section 5,9 0,1345 0,0333 0,247 0,684 0,827 46 73 0,068 0,201 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 146 228 1,000 1,000 Marriage before age 18 8,7 0,1113 0,0113 0,101 1,012 1,006 510 789 0,089 0,134 Comprehensive knowledge about HIV prevention among young people 9,2 0,4570 0,0369 0,081 1,247 1,117 146 228 0,383 0,531 Knowledge of mother- to-child transmission of HIV 9,3 0,4971 0,0193 0,039 1,332 1,154 577 893 0,458 0,536 Accepting attitudes towards people living with HIV 9,4 0,0135 0,0031 0,227 0,623 0,789 574 888 0,007 0,020 Women who have been tested for HIV and know the results 9,6 0,3875 0,0190 0,049 1,351 1,162 577 893 0,350 0,425 Sexually active young women who have been tested for HIV and know the results 9,7 0,4979 0,0379 0,076 0,636 0,798 72 112 0,422 0,574 Sex before age 15 among young women 9,11 0,0128 0,0075 0,582 0,998 0,999 146 228 0,000 0,028 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 31 47 (*) (*) 292 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 (*) (*) (*) (*) (*) 23 39 (*) (*) Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 32 55 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 (*) (*) (*) (*) (*) 23 39 (*) (*) Knowledge of mother- to-child transmission of HIV 9,3 0,4038 0,0260 0,064 0,791 0,889 164 283 0,352 0,456 Accepting attitudes towards people living with HIV 9,4 0,0228 0,0094 0,411 1,098 1,048 163 280 0,004 0,042 Men who have been tested for HIV and know the results 9,6 0,2408 0,0323 0,134 1,609 1,269 164 283 0,176 0,305 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 14 25 (*) (*) Sex before age 15 among young men 9,11 (*) (*) (*) (*) (*) 23 39 (*) (*) Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 13 22 (*) (*) Male circumcision 9,21 0,3438 0,0365 0,106 1,665 1,290 164 283 0,271 0,417 UNDER-5s Underweight prevalence 2.1a 0,0270 0,0114 0,424 1,061 1,030 136 214 0,004 0,050 Stunting prevalence 2.2a 0,1058 0,0260 0,246 1,524 1,235 136 214 0,054 0,158 Wasting prevalence 2.3a 0,0171 0,0060 0,349 0,453 0,673 136 214 0,005 0,029 Exclusive breastfeeding under 6 months 2,6 (*) (*) (*) (*) (*) 12 19 (*) (*) Age-appropriate breastfeeding 2,14 0,3770 0,0298 0,079 0,291 0,539 49 78 0,317 0,437 Tuberculosis immunization coverage - (*) (*) (*) (*) (*) 25 40 (*) (*) Received polio immunization - (*) (*) (*) (*) (*) 25 40 (*) (*) Received DPT immunization - (*) (*) (*) (*) (*) 25 40 (*) (*) Received measles immunization - (*) (*) (*) (*) (*) 25 40 (*) (*) Received Hepatitis B immunization - (*) (*) (*) (*) (*) 23 37 (*) (*) Diarrhoea in the previous 2 weeks - 0,0228 0,0083 0,364 0,671 0,819 139 218 0,006 0,039 Illness with a cough in the previous 2 weeks - 0,0313 0,0126 0,401 1,129 1,063 139 218 0,006 0,056 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 3 5 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 4 7 (*) (*) Support for learning 6,1 0,9578 0,0250 0,026 1,451 1,205 61 95 0,908 1,000 Attendance to early childhood education 6,7 0,5681 0,0442 0,078 0,747 0,864 61 95 0,480 0,656 Birth registration 8,1 0,9876 0,0090 0,009 1,442 1,201 139 218 0,970 1,000 (*) – the number of unweighted observations is less than 50 na – not applicable 293MONITORING THE SITUATION OF CHILDREN AND WOMEN Table SE.20: Sampling errors: South Kazakhstan Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Kazakhstan, 2010/11 MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se HOUSEHOLDS Iodized salt consumption 2,16 0,6404 0,0240 0,037 2,446 1,564 1794 978 0,592 0,688 HOUSEHOLD MEMBERS Use of improved drinking water sources 4,1 0,8738 0,0363 0,041 11,654 3,414 8729 978 0,801 0,946 Use of improved sanitation 4,3 0,9916 0,0029 0,003 1,010 1,005 8727 977 0,986 0,997 Secondary school net attendance ratio (adjusted) 7,5 0,9417 0,0098 0,010 1,188 1,090 1243 676 0,922 0,961 Prevalence of children with one or both parents dead 9,18 0,0484 0,0074 0,153 2,257 1,502 3497 1885 0,034 0,063 School attendance of orphans 9,19 (*) (*) (*) (*) (*) 0 0 (*) (*) School attendance of non- orphans 9.20 0,9979 0,0021 0,002 0,927 0,963 823 447 0,994 1,000 Violent discipline 8,5 0,3887 0,0282 0,073 2,108 1,452 2495 631 0,332 0,445 WOMEN Pregnant women - 0,0633 0,0079 0,124 1,169 1,081 2048 1123 0,048 0,079 Early childbearing 5,2 0,0185 0,0091 0,491 0,836 0,914 331 185 0,000 0,037 Contraceptive prevalence 5,3 0,4311 0,0159 0,037 0,777 0,881 1379 754 0,399 0,463 Unmet need 5,4 0,1011 0,0134 0,132 1,483 1,218 1379 754 0,074 0,128 Antenatal care coverage - at least once by skilled personnel 5.5a 0,9980 0,0020 0,002 0,483 0,695 436 236 0,994 1,000 Antenatal care coverage – at least four times by any provider 5.5b 0,8372 0,0149 0,018 0,385 0,620 436 236 0,807 0,867 Skilled attendant at delivery 5,7 1,0000 0,0000 0,000 na na 436 236 1,000 1,000 Institutional deliveries 5,8 0,9959 0,0041 0,004 0,949 0,974 436 236 0,988 1,000 Caesarean section 5,9 0,1303 0,0193 0,148 0,774 0,880 436 236 0,092 0,169 Literacy rate among young women 7,1 1,0000 0,0000 0,000 na na 685 381 1,000 1,000 Marriage before age 18 8,7 0,0897 0,0101 0,113 1,158 1,076 1694 927 0,069 0,110 Comprehensive knowledge about HIV prevention among young people 9,2 0,2927 0,0264 0,090 1,277 1,130 685 381 0,240 0,345 Knowledge of mother- to-child transmission of HIV 9,3 0,5502 0,0190 0,034 1,629 1,276 2048 1123 0,512 0,588 Accepting attitudes towards people living with HIV 9,4 0,0418 0,0078 0,187 1,566 1,252 1873 1030 0,026 0,057 Women who have been tested for HIV and know the results 9,6 0,2002 0,0140 0,070 1,364 1,168 2048 1123 0,172 0,228 Sexually active young women who have been tested for HIV and know the results 9,7 0,4499 0,0357 0,079 0,623 0,789 216 122 0,378 0,521 Sex before age 15 among young women 9,11 0,0000 0,0000 0,000 na na 685 381 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 2 1 (*) (*) 294 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of varia- tion (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weight- ed count Confidence limits r - 2se r + 2se MEN Literacy rate among young men 7,1 0,7503 0,0503 0,067 0,959 0,980 154 72 0,650 0,851 Marriage before age 18 8,7 0,0000 0,0000 0,000 na na 144 68 0,000 0,000 Comprehensive knowledge about HIV prevention among young people 9,2 0,1115 0,0481 0,432 1,661 1,289 154 72 0,015 0,208 Knowledge of mother- to-child transmission of HIV 9,3 0,6371 0,0398 0,062 1,911 1,382 587 280 0,558 0,717 Accepting attitudes towards people living with HIV 9,4 0,0032 0,0032 1,001 0,876 0,936 569 272 0,000 0,010 Men who have been tested for HIV and know the results 9,6 0,0065 0,0046 0,713 0,926 0,962 587 280 0,000 0,016 Sexually active young men who have been tested for HIV and know the results 9,7 (*) (*) (*) (*) (*) 66 31 * * Sex before age 15 among young men 9,11 0,0000 0,0000 0,000 na na 154 72 0,000 0,000 Condom use with non-regular partners 9,16 (*) (*) (*) (*) (*) 52 25 * * Male circumcision 9,21 0,9374 0,0165 0,018 1,293 1,137 587 280 0,904 0,970 UNDER-5s Underweight prevalence 2.1a 0,0246 0,0067 0,272 1,132 1,064 1129 608 0,011 0,038 Stunting prevalence 2.2a 0,1208 0,0155 0,129 1,378 1,174 1127 607 0,090 0,152 Wasting prevalence 2.3a 0,0578 0,0097 0,168 1,038 1,019 1122 604 0,038 0,077 Exclusive breastfeeding under 6 months 2,6 0,4098 0,0609 0,149 0,981 0,990 116 65 0,288 0,532 Age-appropriate breastfeeding 2,14 0,2664 0,0332 0,125 1,424 1,193 470 253 0,200 0,333 Tuberculosis immunization coverage - 1,0000 0,0000 0,000 na na 227 121 1,000 1,000 Received polio immunization - 0,9137 0,0437 0,048 2,906 1,705 227 121 0,826 1,000 Received DPT immunization - 0,9897 0,0101 0,010 1,196 1,094 227 121 0,969 1,000 Received measles immunization - 0,9040 0,0283 0,031 1,107 1,052 227 121 0,847 0,961 Received Hepatitis B immunization - 0,5726 0,0550 0,096 1,483 1,218 227 121 0,463 0,683 Diarrhoea in the previous 2 weeks - 0,0198 0,0054 0,270 0,895 0,946 1129 608 0,009 0,031 Illness with a cough in the previous 2 weeks - 0,0256 0,0086 0,335 1,790 1,338 1129 608 0,008 0,043 Oral rehydration therapy with continued feeding 3,8 (*) (*) (*) (*) (*) 22 12 (*) (*) Antibiotic treatment of suspected pneumonia 3.10 (*) (*) (*) (*) (*) 29 15 (*) (*) Support for learning 6,1 0,8418 0,0351 0,042 2,066 1,437 418 224 0,772 0,912 Attendance to early childhood education 6,7 0,1742 0,0394 0,226 2,412 1,553 418 224 0,095 0,253 Birth registration 8,1 1,0000 0,0000 0,000 na na 1129 608 1,000 1,000 (*) – the number of unweighted observations is less than 50 n/a – not applicable 295MONITORING THE SITUATION OF CHILDREN AND WOMEN Appendix D. Data Quality Tables Table DQ.1: Age distribution of household population Single-year age distribution of household population by sex, Kazakhstan, 2010/11 Age Male Female Age Male Female Number Percent Number Percent Number Percent Number Percent 0 520 2,0 541 1,9 41 376 1,4 394 1,4 1 527 2,0 517 1,8 42 346 1,3 426 1,5 2 558 2,1 546 1,9 43 324 1,2 340 1,2 3 546 2,1 459 1,6 44 342 1,3 384 1,3 4 502 1,9 481 1,7 45 390 1,5 382 1,3 5 420 1,6 515 1,8 46 386 1,5 422 1,5 6 450 1,7 456 1,6 47 348 1,3 409 1,4 7 427 1,6 451 1,6 48 351 1,3 398 1,4 8 417 1,6 414 1,5 49 389 1,5 382 1,3 9 403 1,5 381 1,3 50 377 1,4 540 1,9 10 409 1,6 395 1,4 51 342 1,3 410 1,4 11 345 1,3 384 1,3 52 311 1,2 387 1,4 12 418 1,6 403 1,4 53 288 1,1 344 1,2 13 430 1,6 404 1,4 54 280 1,1 359 1,3 14 455 1,7 479 1,7 55 274 1,1 322 1,1 15 472 1,8 403 1,4 56 243 0,9 334 1,2 16 475 1,8 424 1,5 57 208 0,8 305 1,1 17 468 1,8 427 1,5 58 193 0,7 301 1,1 18 427 1,6 396 1,4 59 203 0,8 258 0,9 19 406 1,6 390 1,4 60 222 0,9 284 1,0 20 438 1,7 391 1,4 61 205 0,8 275 1,0 21 489 1,9 453 1,6 62 188 0,7 229 0,8 22 483 1,9 478 1,7 63 167 0,6 245 0,9 23 467 1,8 481 1,7 64 137 0,5 172 0,6 24 484 1,9 404 1,4 65 82 0,3 131 0,5 25 484 1,9 388 1,4 66 60 0,2 93 0,3 26 428 1,6 393 1,4 67 77 0,3 84 0,3 27 400 1,5 433 1,5 68 115 0,4 189 0,7 28 373 1,4 423 1,5 69 112 0,4 182 0,6 29 399 1,5 401 1,4 70 127 0,5 204 0,7 30 411 1,6 405 1,4 71 137 0,5 198 0,7 31 375 1,4 429 1,5 72 115 0,4 237 0,8 32 404 1,6 350 1,2 73 115 0,4 185 0,7 33 395 1,5 415 1,5 74 106 0,4 196 0,7 34 375 1,4 430 1,5 75 56 0,2 126 0,4 35 355 1,4 427 1,5 76 41 0,2 109 0,4 36 369 1,4 385 1,4 77 34 0,1 92 0,3 37 349 1,3 347 1,2 78 45 0,2 95 0,3 38 392 1,5 388 1,4 79 38 0,1 79 0,3 296 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Age Male Female Age Male Female Number Percent Number Percent Number Percent Number Percent 39 364 1,4 369 1,3 80 + 189 0,7 548 1,9 40 400 1,5 392 1,4 DK/missing 0 0,0 3 0,0 Total 26050 100,0 28499 100,0 Table DQ.2: Age distribution of eligible and interviewed women Household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed, by five-year age groups, Kazakhstan, 2010/11 Age Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed (Questionnaire completion rate)Number Number Percent 10-14 2065 n/a n/a n/a 15-19 2039 2015 14,4 98,8 20-24 2206 2173 15,6 98,5 25-29 2036 2009 14,4 98,7 30-34 2030 1999 14,3 98,5 35-39 1916 1896 13,6 98,9 40-44 1936 1913 13,7 98,8 45-49 1993 1965 14,1 98,6 50-54 2040 n/a n/a n/a Total (15-49) 14157 13969 100,0 98,7 Ratio of 50-54 to 45-49 1,02 n/a – not applicable Note: weights for household population of women and women interviewed were household weights. The age was determined according to household questionnaire. 297MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DQ.2M: Age distribution of eligible and interviewed men Household population of men age 10-64, interviewed men age 15-59, by five-year age groups, Kazakhstan, 2010/11 Age Household population of men age 10-64 Interviewed men age 15-59 Number Number Percent 10-14 2056 na na. 15-19 2249 389 10,2 20-24 2361 427 11,2 25-29 2085 434 11,4 30-34 1960 549 14,4 35-39 1829 534 14,0 40-44 1788 446 11,7 45-49 1863 429 11,2 50-54 1599 358 9,4 55-59 1120 258 6,7 60-64 919 n/a n/a Total (15-59) 16855 3823 100,0 Ratio of 60-64 to 55-59 0,82 n/a – not applicable Note: weights for household population of men and men interviewed were household weights. The age was determined according to household questionnaire. Table DQ.2M-A: Percentage of selected households for men interviews and percentage of interviewed men by area and region, Kazakhstan, 2010/11 Percent of selected households for men interviews Percent of interviewed men Number of households Region Akmola 22,8 97,3 884 Aktobe 26,1 98,4 713 Almaty 26,7 98,8 1470 Almaty city 21,2 100,0 1473 Astana city 24,9 99,6 544 Atyrau 28,2 91,5 359 East Kazakhstan 22,5 99,6 1673 Zhambyl 26,0 100,0 890 West Kazakhstan 25,6 98,3 647 Karaganda 21,2 96,0 1629 Kostanai 21,5 98,0 1129 Kyzylorda 29,9 99,4 498 Mangistau 28,6 97,2 372 Pavlodar 25,0 97,4 931 North Kazakhstan 23,2 98,3 795 South Kazakhstan 29,2 98,7 1794 Area Urban 22,9 98,5 9598 Rural 27,3 98,1 6202 Total 24,6 98,3 15800 298 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table DQ.3: Age distribution of under-5 household population and under-5 questionnaires Household population of children age 0-7, children age 0-4 whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/caretakers were interviewed, by one-year age groups, Kazakhstan, 2010/11 Age Household population of children 0-7 years Interviewed under-5 children Percentage of eligible under-5s interviewed (Completion rate) Number Number Percent 0 1061 1052 20,4 99,1 1 1044 1036 20,1 99,2 2 1104 1096 21,3 99,3 3 1006 1001 19,4 99,5 4 983 974 18,9 99,1 5 935 n/a n/a n/a 6 906 n/a n/a n/a 7 878 n/a n/a n/a Total (0-4) 5198 5158 100,0 99,2 Ratio of 5 to 4 year olds 0,95 n/a – not applicable Note: weights for household population of children and children interviewed were household weights. The age was determined according to family questionnaire. Table DQ.4: Women’s completion rates by socio-economic characteristics of households Household population of women age 15-49, interviewed women age 15-49, and percentage of eligible women who were interviewed, by selected social and economic characteristics of the household, Kazakhstan, 2010/11 Household population of women age 15-49 years Interviewed women age 15-49 years Percent of eligible women interviewed (Questionnaire completion rates)Number Percent Number Percent Region Akmola 609 4,3 588 4,2 96,6 Aktobe 701 5,0 696 5,0 99,2 Almaty 1533 10,8 1517 10,9 98,9 Almaty city 1202 8,5 1201 8,6 99,9 Astana city 545 3,8 541 3,9 99,3 Atyrau 415 2,9 400 2,9 96,5 East Kazakhstan 1223 8,6 1197 8,6 97,9 Zhambyl 845 6,0 833 6,0 98,6 West Kazakhstan 572 4,0 570 4,1 99,7 Karaganda 1286 9,1 1272 9,1 98,9 Kostanai 800 5,6 792 5,7 99,1 Kyzylorda 558 3,9 556 4,0 99,5 Mangistau 465 3,3 453 3,2 97,3 Pavlodar 753 5,3 724 5,2 96,1 North Kazakhstan 583 4,1 575 4,1 98,6 South Kazakhstan 2067 14,6 2056 14,7 99,5 Area Urban 8138 57,5 8043 57,6 98,8 Rural 6019 42,5 5927 42,4 98,5 Household size 1-3 4657 32,9 4593 32,9 98,6 4-6 7482 52,9 7394 52,9 98,8 7+ 2018 14,3 1982 14,2 98,2 299MONITORING THE SITUATION OF CHILDREN AND WOMEN Household population of women age 15-49 years Interviewed women age 15-49 years Percent of eligible women interviewed (Questionnaire completion rates)Number Percent Number Percent Education of household head Incomplete Secondary 1121 8,0 1105 7,9 98,6 Secondary 4732 33,6 4654 33,5 98,3 Specialised Secondary 4749 33,7 4685 33,7 98,7 Higher 3491 24,8 3461 24,9 99,2 Wealth index quintiles Poorest 2548 18,0 2522 18,1 99,0 Second 2624 18,5 2589 18,5 98,6 Middle 2780 19,6 2729 19,5 98,1 Fourth 2869 20,3 2831 20,3 98,7 Richest 3335 23,6 3298 23,6 98,9 Ethnicity of household head Kazakh 9113 64,4 8976 64,3 98,5 Russian 3182 22,5 3154 22,6 99,1 Other ethnic group 1862 13,2 1840 13,2 98,8 Total 14157 100,0 13969 100,0 98,7 Table DQ.4M: Men’s completion rates by socio-economic characteristics of households Household population of men age 15-59, interviewed men age 15-59, and percentage of eligible men who were interviewed, by selected social and economic characteristics of the household, Kazakhstan, 2010/11 Household population of men age 15-59 years Interviewed men age 15-59 years Percent of eligible men interviewed (Questionnaire completion rates) Number Percent Number Percent Region Akmola 784 4,7 196 5,1 97,3 Aktobe 797 4,7 183 4,8 98,4 Almaty 1857 11,0 388 10,2 98,8 Almaty city 1327 7,9 313 8,2 100,0 Astana city 538 3,2 135 3,5 99,6 Atyrau 490 2,9 93 2,4 91,5 East Kazakhstan 1480 8,8 375 9,8 99,6 Zhambyl 1062 6,3 231 6,1 100,0 West Kazakhstan 690 4,1 163 4,3 98,3 Karaganda 1464 8,7 331 8,7 96,0 Kostanai 958 5,7 237 6,2 98,0 Kyzylorda 689 4,1 148 3,9 99,4 Mangistau 532 3,2 104 2,7 97,2 Pavlodar 903 5,4 227 5,9 97,4 North Kazakhstan 723 4,3 181 4,7 98,3 South Kazakhstan 2563 15,2 517 13,5 98,7 Area Urban 9040 53,6 2161 56,5 98,5 Rural 7815 46,4 1662 43,5 98,1 Household size 1-3 5803 34,4 1663 43,5 98,1 4-6 8627 51,2 1809 47,3 98,5 7+ 2425 14,4 350 9,2 98,6 Education of household head Incomplete Secondary 1519 9,1 350 9,2 98,5 300 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Household population of men age 15-59 years Interviewed men age 15-59 years Percent of eligible men interviewed (Questionnaire completion rates) Number Percent Number Percent Secondary 5949 35,5 1272 33,4 98,4 Specialized Secondary 5505 32,8 1276 33,5 97,6 Higher 3797 22,6 907 23,8 99,1 Wealth index quintiles Poorest 3365 20,0 689 18,0 98,5 Second 3316 19,7 713 18,7 98,3 Middle 3456 20,5 761 19,9 98,2 Fourth 3273 19,4 816 21,4 97,9 Richest 3445 20,4 843 22,1 98,7 Total 16855 100,0 3823 100,0 98,3 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households Household population of under-5 children, under-5 questionnaires completed, and percentage of under-5 children for whom interviews were completed, by selected socio-economic characteristics of the household, Kazakhstan, 2010/11 Household population of under-5 children Interviewed under-5 children Percent of eligible under-5s with completed under-5 questionnaires (Questionnaire completion rates)Number Percent Number Percent Region Akmola 190 3,6 182 3,5 95,9 Aktobe 261 5,0 259 5,0 99,3 Almaty 553 10,6 551 10,7 99,7 Almaty city 202 3,9 201 3,9 99,3 Astana city 167 3,2 167 3,2 100,0 Atyrau 183 3,5 183 3,5 99,8 East Kazakhstan 373 7,2 368 7,1 98,8 Zhambyl 402 7,7 401 7,8 99,7 West Kazakhstan 195 3,8 195 3,8 100,0 Karaganda 422 8,1 419 8,1 99,4 Kostanai 223 4,3 222 4,3 99,5 Kyzylorda 293 5,6 292 5,7 99,6 Mangistau 244 4,7 239 4,6 97,7 Pavlodar 218 4,2 211 4,1 96,7 North Kazakhstan 139 2,7 139 2,7 100,0 South Kazakhstan 1133 21,8 1130 21,9 99,7 Area Urban 2516 48,4 2492 48,3 99,0 Rural 2681 51,6 2666 51,7 99,4 Household size 1-3 605 11,6 599 11,6 99,1 4-6 3131 60,2 3113 60,4 99,4 7+ 1462 28,1 1446 28,0 98,9 Education of household head Incomplete secondary 484 9,4 482 9,4 99,5 Secondary 1923 37,2 1909 37,3 99,3 Specialised secondary 1517 29,4 1503 29,3 99,1 Higher 1241 24,0 1231 24,0 99,1 Wealth index quintiles Poorest 1249 24,0 1248 24,2 99,9 Second 1138 21,9 1131 21,9 99,3 301MONITORING THE SITUATION OF CHILDREN AND WOMEN Household population of under-5 children Interviewed under-5 children Percent of eligible under-5s with completed under-5 questionnaires (Questionnaire completion rates)Number Percent Number Percent Middle 1022 19,7 1009 19,6 98,7 Fourth 867 16,7 859 16,7 99,1 Richest 921 17,7 912 17,7 99,0 Ethnicity of household head Kazakh 3741 72,0 3709 71,9 99,1 Russian 782 15,0 779 15,1 99,5 Other ethnic group 674 13,0 670 13,0 99,4 Total 5198 100,0 5158 100,0 99,2 Table DQ.6: Completeness of reporting Percentage of observations with missing information for selected questions and indicators, Kazakhstan, 2010/11 Questionnaire and type of missing information Control Group Percent with missing/ incomplete information* Number of cases Household questionnaire Age Members of all households 0,0 54316 Salt testing All interviewed households with salt 0,0 15800 Starting time of interview All interviewed households 0,0 15800 Ending time of interview All interviewed households 0,0 15800 Questionnaire for individual women Woman’s date of birth All women age 15-49 0,0 54316 • Only month 0,0 14014 • Both month and year 0,0 14014 Date of first birth: All women age 15-49 who have had at least one live birth • Only month 0,1 9469 • Both month and year 0,0 9469 Number of complete years since first birth All women age 15-49 who have had at least one live birth, when the first child’s year of birth is unknown 0,0 2 Date of last birth All women age 15-49 who have had a live birth within the last two years • Only month 0,0 9469 • Both month and year 0,0 9469 Date of first marriage/union All ever married women age 15-49 • Only month 1,5 10051 • Both month and year 1,0 10051 Age at first marriage/union All ever married women age 15-49, whose age at the moment of entering the first marriage/union is unknown 0,0 10051 Age at first intercourse All women age 15-24 who have ever had sex 0,0 1489 Time since last intercourse All women age 15-24 who have ever had sex 0,0 1489 Starting time of interview All interviewed women 0,0 14014 Ending time of interview All interviewed women 0,0 14014 Questionnaire for individual men Man’s date of birth All men age 15-59 • Only month 0,0 3846 • Both month and year 0,0 3846 Date of first marriage/union All ever married men age 15-59 • Only month 2,3 2807 • Both month and year 3,2 2807 302 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Questionnaire and type of missing information Control Group Percent with missing/ incomplete information* Number of cases Age at first marriage/union All ever married men age 15-50 whose age at the moment of entering the first marriage/union is unknown 0,0 2807 Age at first intercourse All men age 15-24 who have ever had sex 0,0 431 Time since last intercourse All men age 15-24 who have ever had sex 0,0 431 Starting time of interview 0,0 3846 Ending time of interview 0,0 3846 Questionnaire for under-5 children Date of birth All children under 5 • Only month ,0 5181 • Both month and year ,0 5181 Anthropometric measurements All children under 5 Weight 3,2 5181 Height 3,3 5181 Both weight and height 3,2 5181 Starting time of interview All children under 5 0,0 5181 Ending time of interview All children under 5 0,0 5181 * Including ‘don’t know’ responses Table DQ.7: Completeness of information for anthropometric indicators Distribution of children under 5 by completeness of information for anthropometric indicators, Kazakhstan, 2010/11 Valid weight and date of birth Reason for exclusion from analysis Total Percent of chil- dren excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured, incomplete date of birth Flagged cases (pop-up obser-pop-up obser- vations ) Weight by age <6 months 93,6 0,0 0,0 0,0 6,4 100,0 6,4 543 6-11 months 98,5 0,0 0,0 0,0 1,5 100,0 1,5 538 12-23 months 97,2 0,0 0,0 0,0 2,8 100,0 2,8 1044 24-35 months 96,8 0,0 0,0 0,0 3,2 100,0 3,2 1095 36-47 months 95,8 0,1 0,0 0,0 4,1 100,0 4,2 998 48-59 months 96,4 0,0 0,0 0,0 3,6 100,0 3,6 963 Total 96,4 0,0 0,0 0,0 3,5 100,0 3,6 5181 Valid height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Height not measured Incomplete date of birth Height not measured, incomplete date of birth Flagged cases (pop-up observations ) Height by age <6 months 92,8 0,4 0,0 0,0 6,8 100,0 7,2 543 6-11 months 97,4 0,2 0,0 0,0 2,4 100,0 2,6 538 12-23 months 96,6 0,0 0,0 0,0 3,4 100,0 3,4 1044 24-35 months 96,2 0,3 0,0 0,0 3,6 100,0 3,8 1095 36-47 months 95,5 0,0 0,0 0,0 4,5 100,0 4,5 998 48-59 months 96,2 0,2 0,0 0,0 3,6 100,0 3,8 963 Total 95,9 0,2 0,0 0,0 4,0 100,0 4,1 5181 303MONITORING THE SITUATION OF CHILDREN AND WOMEN Valid weight and height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Height not measured Weight not measured, incomplete date of birth Flagged cases (pop-up observations) Weight by height <6 months 90,8 0,0 0,4 0,0 8,8 100,0 9,2 543 6-11 months 97,6 0,0 0,2 0,0 2,2 100,0 2,4 538 12-23 months 96,8 0,0 0,0 0,0 3,2 100,0 3,2 1044 24-35 months 95,6 0,0 0,3 0,0 4,1 100,0 4,4 1095 36-47 months 94,8 0,1 0,0 0,0 5,1 100,0 5,2 998 48-59 months 95,0 0,0 0,2 0,0 4,8 100,0 5,0 963 Total 95,3 0,0 0,2 0,0 4,5 100,0 4,7 5181 Table DQ.8: Accumulation in the results of anthropometric measurements Distribution of weight and height/length measurements by digits reported for decimals, Kazakhstan, 2010/11 Digits Weight Height Number Percent Number Percent 0 769 15,4 1969 39,4 1 466 9,3 388 7,8 2 645 12,9 549 11,0 3 503 10,1 410 8,2 4 379 7,6 218 4,4 5 525 10,5 672 13,4 6 419 8,4 192 3,8 7 419 8,4 243 4,9 8 494 9,9 216 4,3 9 378 7,6 141 2,8 0 or 5 1294 25,9 2641 52,8 Total 4997 100,0 4998 100,0 Table DQ.11: Observation of under-5’s birth certificates Percent distribution of children under 5 by presence of birth certificates and percentage of birth certificates seen, Kazakhstan, 2010/11 Child does not have birth certificate Child has birth certificate Missing/ DK Total Percent of birth certificates seen by the interviewer (1)/ (1+2)*100 Number of children under 5 Seen by the interviewer (1) Not seen by the interviewer (2) Region Akmola 1,7 95,2 3,1 0,0 100,0 96,9 229 Aktobe 0,7 34,6 64,7 0,0 100,0 34,8 295 Almaty 0,3 89,9 9,8 0,0 100,0 90,1 356 Almaty city 0,0 80,3 19,7 0,0 100,0 80,3 137 Astana city 0,0 96,9 3,1 0,0 100,0 96,9 294 Atyrau 0,8 87,2 12,0 0,0 100,0 87,9 382 East Kazakhstan 0,8 86,3 12,9 0,0 100,0 87,0 255 Zhambyl 1,8 85,8 12,4 0,0 100,0 87,3 386 West Kazakhstan 0,3 68,4 31,3 0,0 100,0 68,6 291 Karaganda 0,6 97,8 1,6 0,0 100,0 98,4 312 Kostanai 1,2 45,4 53,4 0,0 100,0 45,9 249 Kyzylorda 0,7 55,6 43,7 0,0 100,0 56,0 453 Mangistau 1,1 77,2 21,7 0,0 100,0 78,1 457 304 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Child does not have birth certificate Child has birth certificate Missing/ DK Total Percent of birth certificates seen by the interviewer (1)/ (1+2)*100 Number of children under 5 Seen by the interviewer (1) Not seen by the interviewer (2) Pavlodar 1,2 92,3 6,6 0,0 100,0 93,4 259 North Kazakhstan 1,4 89,9 8,7 0,0 100,0 91,2 218 South Kazakhstan 0,0 88,5 11,5 0,0 100,0 88,5 608 Area Urban 0,6 81,3 18,1 0,0 100,0 81,8 2653 Rural 0,9 77,5 21,7 0,0 100,0 78,1 2528 Child’s age 0 2,7 79,1 18,2 0,0 100,0 81,3 1075 1 0,3 78,3 21,4 0,0 100,0 78,5 1047 2 0,4 79,3 20,3 0,0 100,0 79,6 1098 3 0,3 79,4 20,3 0,0 100,0 79,6 998 4 0,0 81,1 18,9 0,0 100,0 81,1 963 Total 0,8 79,4 19,8 0,0 100,0 80,0 5181 Table DQ.12: Observation of vaccination cards Percent distribution of children under 5 by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Kazakhstan, 2010/11 Child does not have vaccination card Child has vaccination card M is si ng /D K To ta l Percent of vaccination cards seen by the interviewer (1)/ (1+2)*100 Number of children under 5 Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Region Akmola 0,0 0,4 94,3 5,2 0,0 100,0 94,7 229 Aktobe 2,7 0,0 42,7 54,6 0,0 100,0 43,9 295 Almaty 3,9 0,6 84,3 11,2 0,0 100,0 88,2 356 Almaty city 5,1 1,5 75,2 18,2 0,0 100,0 80,5 137 Astana city 0,3 0,0 87,8 11,9 0,0 100,0 88,1 294 Atyrau 0,0 0,0 31,2 68,8 0,0 100,0 31,2 382 East Kazakhstan 0,4 0,0 71,4 28,2 0,0 100,0 71,7 255 Zhambyl 0,3 0,8 33,4 65,5 0,0 100,0 33,8 386 West Kazakhstan 0,7 1,7 90,7 6,9 00,0 100,0 93,0 291 Karaganda 0,0 0,3 28,8 70,8 0,0 100,0 28,9 312 Kostanai 0,0 0,0 24,9 75,1 0,0 100,0 24,9 249 Kyzylorda 0,9 0,2 98,5 0,4 0,0 100,0 99,6 453 Mangistau 0,2 0,4 56,7 42,7 0,0 100,0 57,0 457 Pavlodar 0,0 0,4 98,5 1,2 0,0 100,0 98,8 259 North Kazakhstan 0,5 0,9 38,1 60,6 0,0 100,0 38,6 218 South Kazakhstan 1,0 0,3 75,0 23,7 0,0 100,0 76,0 608 Area Urban 0,9 0,5 64,9 33,7 0,0 100,0 65,8 2653 Rural 0,9 0,4 64,3 34,4 0,0 100,0 65,1 2528 Child’s age 0 1,0 0,7 66,6 31,6 0,0 100,0 67,8 1075 1 0,6 0,4 64,2 34,9 0,0 100,0 64,8 1047 2 0,7 0,5 64,1 34,6 0,0 100,0 64,9 1098 3 1,5 0,3 63,8 34,4 0,0 100,0 65,0 998 4 0,6 0,1 64,3 35,0 0,0 100,0 64,7 963 Total 0,9 0,4 64,6 34,1 0,0 100,0 65,5 5181 305MONITORING THE SITUATION OF CHILDREN AND WOMEN Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 questionnaire Distribution of children under 5 by whether the mother lives in the same household, and who is the person interviewed for the under-5 questionnaire, Kazakhstan, 2010/11 Age Mother in the household Mother not in the household Total Number of children under 5Mother interviewed Father interviewed Father interviewed Other adult female interviewed 0 99,2 0,0 0,1 0,8 100,0 1061 1 97,5 0,0 0,0 2,5 100,0 1044 2 97,9 0,1 0,1 2,0 100,0 1104 3 96,5 0,0 0,1 3,4 100,0 1006 4 97,4 0,0 0,1 2,5 100,0 983 Total 97,7 0,0 0,1 2,2 100,0 5198 Table DQ.14: Selection of children age 2-14 years for the child discipline module Percent of households with at least two children age 2-14 years where correct selection of one child for the child discipline module was performed, Kazakhstan, 2011 Percent of households where correct selection was performed Number of households with 2 or more children age 2-14 years Region Akmola 94,7 152 Aktobe 91,3 183 Almaty 90,5 241 Almaty city 92,1 89 Astana city 97,9 140 Atyrau 96,5 228 East Kazakhstan 90,3 144 Zhambyl 97,0 234 West Kazakhstan 93,8 176 Karaganda 95,5 179 Kostanai 97,4 152 Kyzylorda 96,0 276 Mangistau 84,3 254 Pavlodar 87,3 134 North Kazakhstan 96,3 162 South Kazakhstan 89,3 403 Area Urban 92,9 1409 Rural 92,8 1738 Number of households by number of children 2-14 2 93,8 2104 3 91,3 757 4 89,5 286 Total 92,8 3147 306 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Table DQ.15: School attendance by one-year age group, Distribution of household population age 5-24 by educational level and educational level and grade attended in the current (or most recent) school year, Kazakhstan, 2010/11 Not attending school Pre- school Primary Secondary Specialized secondary H ig he r Total Number of household members1 2 3 4 1 2 3 4 5 6 7 5 39,2 55,5 5,1 0,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 919 6 8,2 23,3 61,6 6,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 916 7 0,8 0,7 25,6 68,1 4,6 0,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 846 8 0,5 0,0 0,9 31,0 61,5 5,7 0,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 836 9 0,3 0,0 0,0 1,8 34,1 59,1 4,7 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 766 10 0,2 0,0 0,0 0,1 4,0 41,9 46,9 7,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 100,0 806 11 0,2 0,0 0,0 0,0 0,4 3,7 36,6 55,1 3,9 0,0 0,0 0,0 0,0 0,0 0,0 100,0 738 12 0,4 0,0 0,0 0,0 0,0 0,0 3,6 48,7 44,4 2,9 0,0 0,0 0,0 0,0 0,0 100,0 803 13 0,2 0,0 0,0 0,0 0,0 0,0 0,3 3,6 47,9 45,4 2,6 0,0 0,0 0,0 0,0 100,0 866 14 0,2 0,0 0,0 0,0 0,0 0,0 0,0 0,4 3,8 49,2 42,9 2,6 0,1 0,8 0,0 100,0 916 15 0,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,1 4,8 53,3 29,6 2,0 9,6 0,0 100,0 882 16 3,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,6 3,7 38,0 28,9 24,7 0,6 100,0 925 17 10,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 1,6 44,6 35,9 7,4 100,0 869 18 26,2 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,2 3,6 41,1 28,8 100,0 799 19 39,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,4 27,8 31,9 100,0 816 20 59,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 9,8 30,8 100,0 850 21 68,8 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 5,3 25,9 100,0 928 22 82,3 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 2,9 14,8 100,0 983 23 91,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 2,2 6,9 100,0 915 24 92,7 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,7 6,6 100,0 906 Table DQ.16: Sex ratio at birth among children ever born and living Sex ratio (number of males per 100 females) among children ever born (at birth), children living, and deceased children, by age of women, Kazakhstan, 2010/11 Children Ever Born Children Living Children Deceased N um be r o f w om en N um be r o f so ns e ve r bo rn N um be r o f da ug ht er s ev er b or n S ex ra tio N um be r o f so ns li vi ng N um be r o f da ug ht er s liv in g S ex ra tio N um be r o f de ce as ed so ns N um be r o f de ce as ed da ug ht er s S ex ra tio 15-19 31 31 1,00 29 30 0,97 2 1 2,00 2012 20-24 558 587 0,95 539 585 0,92 19 2 9,50 2170 25-29 1328 1321 1,01 1292 1300 0,99 36 21 1,71 2024 30-34 1983 1989 1,00 1900 1926 0,99 83 63 1,32 1996 35-39 2232 2141 1,04 2117 2073 1,02 115 68 1,69 1892 40-44 2499 2287 1,09 2343 2199 1,07 156 88 1,77 1941 45-49 2673 2388 1,12 2479 2277 1,09 194 111 1,75 1979 Total 11304 10744 1,03 10699 10390 1,01 605 354 2,82 14014 307MONITORING THE SITUATION OF CHILDREN AND WOMEN A pp en di x E. M IC S4 In di ca to rs : n um er at or s an d de no m in at or s In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 1. C H IL D M O R TA LI TY 1. 1 U nd er -5 c hi ld m or ta lit y ra te C M - B H P ro ba bi lit y of d yi ng u nt il th e ag e of 5 M D G 4 .1 1. 2 C hi ld m or ta lit y ra te C M - B H P ro ba bi lit y of d yi ng u nt il th e ag e of 1 M D G 4 .2 1. 5 C hi ld m or ta lit y ra te B H P ro ba bi lit y of d yi ng fo r t he a ge g ro up 1 -5 y ea rs in th e 5 ye ar p er io d pr ec ed in g th e su rv ey 2. N U TR IT IO N 2. 1a 2. 1b U nd er w ei gh t p re va le nc e A N N um be r o f c hi ld re n un de r- 5 w ho se in di ca to r o f w ei gh t fo r a ge (а ) i s by 2 s ta nd ar d de vi at io ns (m od er at e an d se ve re de gr ee s of d ev ia tio n fro m th e no rm ) (b ) i s by 3 s ta nd ar d de vi at io ns (s ev er e de gr ee o f de vi at io n fro m th e no rm ) le ss th an th e m ed ia n of in di ca to r f or c hi ld re n of th e sa m e ag e, e st ab lis he d by W H O To ta l n um be r o f c hi ld re n ag ed u nd er fi ve M D G 1 .8 2. 2a 2. 2b S tu nt in g pr ev al en ce A N N um be r o f c hi ld re n un de r- 5 w ho se in di ca to r o f h ei gh t f or ag e (а ) i s by 2 s ta nd ar d de vi at io ns ( m od er at e an d se ve re de gr ee s of d ev ia tio n fro m th e no rm ) (b ) i s by 3 s ta nd ar d de vi at io ns (s ev er e de gr ee o f de vi at io n fro m n or m ) Le ss th an th e m ed ia n of in di ca to r f or c hi ld re n of th e sa m e ag e, e st ab lis he d by W H O To ta l n um be r o f c hi ld re n ag ed u nd er fi ve 2. 3a 2. 3b W as tin g pr ev al en ce A N N um be r o f c hi ld re n un de r- 5 w ho se in di ca to r o f w ei gh t fo r h ei gh t (а ) i s by 2 s ta nd ar d de vi at io ns (m od er at e an d se ve re de gr ee s of d ev ia tio n fro m th e no rm ) (b ) i s by 3 s ta nd ar d de vi at io ns (s ev er e de gr ee o f de vi at io n fro m n or m ) Le ss th an th e m ed ia n of in di ca to r f or c hi ld re n of th e sa m e ag e, e st ab lis he d by W H O To ta l n um be r o f c hi ld re n ag ed u nd er fi ve 2. 4 C hi ld re n ev er b re as tfe d M N N um be r o f w om en w ho h ad a li ve b irt h in th e pa st tw o ye ar s pr io r t o th e su rv ey w ho h av e ev er b re as tfe d N um be r o f w om en w ho h ad a li ve b irt h in th e pa st 2 y ea rs p rio r t o su rv ey [M ] m ea ns th at if a q ue st io nn ai re fo r in di vi du al m en is in cl ud ed in th e nu m be r of q ue st io nn ai re s us ed fo r th e su rv ey , t hi s in di ca to r is a ls o ca lc ul at ed fo r m en in th e sa m e ag e gr ou p. T he ca lc ul at io ns a re m ad e ba se d on th e m od ul e in th e qu es ti on na ir e fo r m en . 20 S om e in di ca to rs a re b ui lt u po n th e qu es ti on s fr om s ev er al m od ul es . I n th es e ca se s on ly th e m od ul es c on ta in in g th e m ai n pa rt o f n ec es sa ry in fo rm at io n ar e m en ti on ed . 21 M il le nn iu m D ev el op m en t G oa ls , f or m ul at ed in th e U N M il le nn iu m D ec la ra ti on a s of F eb ru ar y 20 10 308 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 2. 5 In iti al b re as tfe ed in g M N N um be r o f w om en w ho h ad a li ve b irt h in th e pa st tw o ye ar s pr io r t o su rv ey w ho s ta rte d br ea st fe ed in g no la te r th an 1 h ou r a fte r t he b irt h N um be r o f w om en w ho h ad a li ve b irt h in th e pa st tw o ye ar s pr io r t o su rv ey 2. 6 E xc lu si ve b re as tfe ed in g un de r 6 m on th s B F N um be r o f i nf an ts u nd er th e ag e of 6 m on th s w ho w er e ex cl us iv el y br ea st fe d2 2 To ta l n um be r o f i nf an ts a t t he a ge o f u nt il 6 m on th s 2. 7 C on tin ue d br ea st fe ed in g at 1 ye ar B F N um be r o f c hi ld re n ag ed 1 2- 15 m on th s w ho a re cu rr en tly b re as tfe d To ta l n um be r o f c hi ld re n at th e ag e 12 -1 5 m on th s 2. 8 C on tin ue d br ea st fe ed in g at 2 ye ar s B F N um be r o f c hi ld re n ag ed 2 0- 23 m on th s w ho a re cu rr en tly b re as tfe d To ta l n um be r o f c hi ld re n at th e ag e of 2 0- 23 m on th s 2. 9 P re do m in an t b re as tfe ed in g un de r 6 m on th s B F N um be r o f i nf an ts u nd er 6 m on th s w ho re ce iv ed br ea st m ilk d ur in g th e pr ev io us d ay a s th e m ai n so ur ce of n ut rit io n2 3 To ta l n um be r o f i nf an ts u nt il th e ag e of 6 m on th s 2. 10 D ur at io n of b re as tfe ed in g B F A ge in m on th s w he n 50 % o f c hi ld re n in th e ag e gr ou p 0- 35 m on th s w er e no t r ec ei vi ng b re as tm ilk du rin g th e pr ev io us d ay 2. 11 B ot tle fe ed in g B F N um be r o f c hi ld re n in th e ag e gr ou p 0- 23 m on th s w ho w er e fe d fro m a b ot tle w ith n ip pl e du rin g th e pr ev io us da y To ta l n um be r o f c hi ld re n in th e ag e gr ou p 0- 23 m on th s 2. 12 In tro du ct io n of s ol id , s em i-s ol id or s of t f oo ds B F N um be r o f i nf an ts in th e ag e gr ou p 6- 8 m on th s w ho re ce iv ed s ol id , s em i-s ol id o r s of t f oo d du rin g th e da y To ta l n um be r o f i nf an ts in th e ag e gr ou p 6- 8 m on th s 2. 13 M in im um m ea l f re qu en cy B F N um be r o f c hi ld re n in th e ag e gr ou p 6- 23 m on th s w ho re ce iv ed s ol id , s em i-s ol id o r s of t f oo d (d ai ry n ut rit io n fo r ch ild re n w ho a re n ot b re as tfe d) m in im al n um be r o f t im es or m or e2 4 a cc or di ng to th e st at us o f b re as tfe ed in g du rin g th e pr ev io us d ay To ta l n um be r o f c hi ld re n in th e ag e gr ou p 6- 23 m on th s 2. 14 A ge -a pp ro pr ia te b re as tfe ed in g B F N um be r o f c hi ld re n in th e ag e gr ou p 0- 23 m on th s w ho w er e ad eq ua te ly b re as tfe d du rin g th e pr ev io us d ay 25 To ta l n um be r o f c hi ld re n ag ed 0 -2 3 m on th s 2. 15 M ilk fe ed in g fre qu en cy fo r n on - br ea st fe d ch ild re n B F N um be r o f c hi ld re n w ho a re n ot b re as tfe d in th e ag e gr ou p 6- 23 m on th s w ho re ce iv ed d ai ry n ut rit io n at le as t tw ic e du rin g th e pr ev io us d ay To ta l n um be r o f c hi ld re n w ho a re n ot br ea st fe d in th e ag e gr ou p 6- 23 m on th s 2. 16 Io di ze d sa lt co ns um pt io n S I N um be r o f h ou se ho ld s w ith th e re su lts o f s al t a na ly si s fo r 1 5 or m or e pa rts o f i od at e pe r m ill io n To ta l n um be r o f h ou se ho ld s w he re s al t w as no t t es te d or h ou se ho ld s w ith n o sa lt 2. 18 Lo w -b irt hw ei gh t i nf an ts M N N um be r o f i nf an ts w ho w er e bo rn la st a nd li vi ng in th e tw o ye ar s pr io r t o th e su rv ey w ith th e w ei gh t o f n o le ss th an 2 ,5 00 g ra m s To ta l n um be r o f l iv in g in fa nt s bo rn in th e pa st 2 ye ar s pr ec ed in g th e su rv ey 22 I nf an ts b re as tf ed a nd n ot r ec ei vi ng o th er li qu id s or fo od e xc ep t f or o ra l r eh yd ra ti on s ol ut io ns , v it am in a nd m in er al s up pl em en ts a nd d ru gs 23 I nf an ts r ec ei vi ng b re as t m il k an d so m e ot he r li qu id s (w at er a nd d ri nk s on w at er b as e, fr ui t j ui ce s, r it ua l l iq ui ds , o ra l r eh yd ra ti on s ol ut io ns , d ro ps , v it am in s, m in er al s up pl em en ts an d dr ug s) b ut n ot r ec ei vi ng a ny th in g el se ( m il k ot he r th an m ot he r’ s or li qu ef ie d nu tr it io n) 24 C hi ld re n br ea st fe d, - c hi ld re n re ce iv in g so li d, s em i- so li d or s of t f oo d (t w ic e a da y— ch il dr en a t t he a ge 6 -8 m on th s, 3 ti m es a d ay — ch il dr en a t t he a ge 9 -2 3 m on th s) ; ch il dr en n ot br ea st fe d, - c hi ld re n re ce iv in g so li d, s em i- so li d or s of t f oo d or d ai ry n ut ri ti on ( 4 ti m es — ch il dr en a t t he a ge 6 -2 3 m on th s) 25 I nf an ts a t t he a ge 0 -5 m on th s w ho a re c ur re nt ly e xc ep ti on al ly b re as tf ed , a nd c hi ld re n at th e ag e 6- 23 m on th s w ho a re b re as tf ed a nd r ec ei ve s ol id , s em i- so li d or s of t f oo d 309MONITORING THE SITUATION OF CHILDREN AND WOMEN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 2. 19 In fa nt s w ei gh ed a t b irt h M N To ta l n um be r o f i nf an ts b or n la st a nd li vi ng in th e pa st 2 ye ar s pr ec ed in g th e su rv ey w ho w er e w ei gh ed a t b irt h To ta l n um be r o f i nf an ts b or n la st a nd li vi ng in th e pa st 2 y ea rs p re ce di ng th e su rv ey 3. C H IL D H EA LT H 3. 1 Tu be rc ul os is im m un iz at io n co ve ra ge (B C G ) IM N um be r o f c hi ld re n in th e ag e gr ou p 15 -2 6 m on th s2 6 , w ho re ce iv ed B C G v ac ci na tio n To ta l n um be r o f c hi ld re n in th e ag e gr ou p 15 - 26 m on th s 3. 2 P ol io im m un iz at io n co ve ra ge (P IC ) IM N um be r o f c hi ld re n in th e ag e gr ou p 15 -2 6 m on th s w ho re ce iv ed O P V v ac ci na tio n un til th e fir st d ay o f b irt h To ta l n um be r o f c hi ld re n in th e ag e gr ou p 15 - 26 m on th s 3. 3 Im m un iz at io n co ve ra ge fo r di ph th er ia , p er tu ss is a nd te ta nu s (D P T) IM N um be r o f c hi ld re n in th e ag e gr ou p 15 -2 6 m on th s w ho re ce iv ed D P T va cc in at io n un til th e fir st d ay o f b irt h To ta l n um be r o f c hi ld re n in th e ag e gr ou p 15 - 26 m on th s 3. 4 M ea sl es im m un iz at io n co ve ra ge IM N um be r o f c hi ld re n in th e ag e gr ou p 15 -2 6 m on th s w ho re ce iv ed m ea sl es v ac ci na tio n un til 1 5 m on th s To ta l n um be r o f c hi ld re n in th e ag e gr ou p 15 - 26 m on th s M D G 4 .3 3. 5 H ep at iti s B im m un iz at io n co ve ra ge (H ep B ) IM N um be r o f c hi ld re n in th e ag e gr ou p 15 -2 6 m on th w ho re ce iv ed th ird v ac ci na tio n ag ai ns t H ep at iti s B To ta l n um be r o f c hi ld re n in th e ag e gr ou p 15 - 26 m on th s 3. 8 O ra l r eh yd ra tio n th er ap y w ith co nt in ue d fe ed in g C A N um be r o f c hi ld re n un de r t he a ge o f 5 w ho h ad d ia rr he a in th e pa st 2 w ee ks a nd re ce iv ed ( O R T pa ck ag e an d/ or re co m m en de d ho m em ad e la rg er a m ou nt o f l iq ui d) a nd co nt in ue d ea tin g du rin g di ar rh ea To ta l n um be r o f c hi ld re n un de r 5 w ho h ad di ar rh ea w ith in th e pa st tw o w ee ks 3. 9 C ar e se ek in g fo r s us pe ct ed pn eu m on ia C A N um be r o f c hi ld re n un de r 5 w ho w er e su sp ec te d to ha ve p ne um on ia in th e pa st tw o w ee ks a nd w ho w er e ta ke n to a m ed ic al fa ci lit y To ta l n um be r o f c hi ld re n un de r 5 w ho w er e su sp ec te d to h av e pn eu m on ia in th e pa st tw o w ee ks 3. 10 A nt ib io tic tr ea tm en t o f s us pe ct ed pn eu m on ia C A N um be r o f c hi ld re n un de r 5 w ho w er e su sp ec te d to ha ve p ne um on ia in th e pa st 2 w ee ks a nd w ho re ce iv ed an tib io tic s tre at m en t To ta l n um be r o f c hi ld re n un de r 5 w ho w er e su sp ec te d to h av e pn eu m on ia in th e pa st 2 w ee ks 3. 11 S ol id fu el s H C N um be r o f i nd iv id ua ls li vi ng in h ou se ho ld s us in g so lid ty pe s of fu el a s th e m ai n so ur ce o f e ne rg y fo r c oo ki ng fo od To ta l n um be r o f h ou se ho ld m em be rs 4. W AT ER A N D S A N IT AT IO N 4. 1 U se o f i m pr ov ed d rin ki ng w at er so ur ce s W S N um be r o f h ou se ho ld m em be rs w ho h av e ac ce ss to im pr ov ed s ou rc es o f d rin ki ng w at er To ta l n um be r o f h ou se ho ld m em be rs M D G 7 .8 4. 2 W at er tr ea tm en t W S N um be r o f h ou se ho ld m em be rs u si ng u ns af e so ur ce s of dr in ki ng w at er a nd w ho u se w at er tr ea tm en t m et ho ds To ta l n um be r o f h ou se ho ld m em be rs u si ng un im pr ov ed s ou rc es o f d rin ki ng w at er 4. 3 U se o f i m pr ov ed s an ita tio n W S N um be r o f h ou se ho ld m em be rs w ho u se im pr ov ed sa ni ta tio n fa ci lit ie s an d w ho d o no t s ha re th em w ith ot he r p eo pl e To ta l n um be r o f h ou se ho ld m em be rs M D G 7 .9 4. 4 S af e di sp os al o f c hi ld ’s fa ec es C A N um be r o f c hi ld re n in th e ag e gr ou p 0- 2 ye ar s w ho se la st fa ec es w er e di sp os ed o f s af el y To ta l n um be r o f c hi ld re n at th e ag e gr ou p 0- 2 ye ar s 26 I nd ic at or s 3. 1, 3 .2 , 3 .3 , 3 .4 , 3 .5 a nd 3 .6 m ay b e ca lc ul at ed in r eg ar d to o ld er a ge g ro up s su ch a s 15 -2 6 or 1 8- 29 m on th s de pe nd in g on n at io na l v ac ci na ti on c al en da r. 310 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 5. R EP R O D U C TI VE H EA LT H 5. 1 A do le sc en t b irt h ra te 27 C M - B H A ge -s pe ci fic f er til ity ra te a m on g w om en in th e ag e gr ou p 15 -1 9 ye ar s in th e la st y ea r p rio r t o th e su rv ey M D G 5 .4 5. 2 E ar ly c hi ld be ar in g C M N um be r o f w om en in th e ag e gr ou p 20 -2 4 ye ar s w ho ha d at le as t o ne li vi ng c hi ld b ef or e th e ag e of 1 8 To ta l n um be r o f w om en in th e ag e gr ou p 20 - 24 y ea s 5. 3 U se o f c on tra ce pt io n C P N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho a re cu rr en tly m ar rie d or a re u no ffi ci al ly li vi ng w ith a m an a nd w ho u se (o r w ho se p ar tn er u se s) s om e co nt ra ce pt io n m et ho d (m od er n or tr ad iti on al ) To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye as w ho a re c ur re nt ly m ar rie d or a re liv in g w ith a m an M D G 5 .3 5. 4 U nm et n ee d fo r c on tra ce pt io n2 8 U N N um be r o f f er til e w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho a re c ur re nt ly m ar rie d or a re u no ffi ci al ly li vi ng w ith a m an a nd w ho h av e a ne ed in s pa ci ng o r l im iti ng a nd a re no t u si ng a ny o f t he c on tra ce pt io n m et ho ds To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye as w ho a re c ur re nt ly m ar rie d or a re liv in g w ith a m an M D G 5 .6 5. 5a 5. 5b A nt en at al c ar e co ve ra ge M N N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d a liv in g ch ild w ith th e pa st 2 y ea rs p re ce di ng th e su rv ey a nd w ho re ce iv ed a nt en at al c ar e co ve ra ge : (a ) at le as t o nc e fro m a q ua lifi ed m ed ic al w or ke r (b ) a t l ea st 4 ti m es fr om s om e m ed ic al w or ke r To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s w ho h ad a li ve b irt h in th e pa st tw o ye ar s pr io r t o th e su rv ey M D G 5 .5 5. 6 C on te nt o f a nt en at al c ar e M N N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d a liv in g ch ild in th e pa st tw o ye ar s pr io r t o su rv ey an d w ho h ad th ei r b lo od p re ss ur e m ea su re d an d ur in e an d bl oo d sa m pl es ta ke n du rin g pr eg na nc y To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho h ad a li vi ng c hi ld in th e pa st 2 ye ar s pr ec ed in g th e su rv ey 5. 7 S ki lle d at te nd an t a t d el iv er y M N N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d a liv in g ch ild in th e pa st tw o ye ar s pr ec ed in g th e su rv ey a nd w ho h ad th ei r d el iv er y w ith th e as si st an ce o f qu al ifi ed m ed ic al p er so nn el To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho h ad a li vi ng c hi ld in th e pa st tw o ye ar s pr ec ed in g th e su rv ey M D G 5 .2 5. 8 In st itu tio na l d el iv er ie s M N N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d a liv in g ch ild in th e pa st tw o ye ar s pr ec ed in g th e su rv ey a nd w ho h ad th ei r d el iv er y at a m ed ic al fa ci lit y To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho h ad a li vi ng c hi ld in th e pa st tw o ye ar s pr ec ed in g th e su rv ey 5. 9 C ae sa re an s ec tio n M N N um be r o f l iv in g ch ild re n bo rn in th e pa st tw o ye ar s pr ec ed in g th e su rv ey b y ca es ar ea n se ct io n To ta l n um be r o f l iv e bi rth s in th e pa st tw o ye ar s pr ec ed in g th e su rv ey 5. 10 P os tn at al s ta y at th e m ed ic al fa ci lit y P N N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho se st ay a t t he m ed ic al fa ci lit y la st ed fo r 1 2 or m or e ho ur s up on d el iv er y or a li ve c hi ld in th e pa st tw o ye ar s pr ec ed in g th e su rv ey To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho h ad a li vi ng c hi ld in th e pa st tw o ye ar s pr ec ed in g th e su rv ey 27 In di ca to r is d ef in ed a s ag e- sp ec if ic fe rt il it y ra te a m on g w om en a t t he a ge 1 5- 19 y ea rs in th e pa st 3 y ea rs p ri or to s ur ve y if th is in di ca to r is c al cu la te d ba se d on b ir th h is to ry 28 Se e de ta il ed d es cr ip ti on in M IC S4 m an ua l. 311MONITORING THE SITUATION OF CHILDREN AND WOMEN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 6. C H IL D D EV EL O PM EN T 6. 1 S up po rt fo r l ea rn in g E C N um be r o f c hi ld re n in th e ag e gr ou p 36 -5 9 m on th s w ith w ho m a n ad ul t h ou se ho ld m em be r w as e ng ag ed in 4 o r m or e ty pe s of le ar ni ng a nd s ch oo l p re pa ra tio n ac tiv iti es w ith in th e pa st 3 d ay s To ta l n um be r o f c hi ld re n in th e ag e gr ou p 36 - 59 m on th s 6. 2 Fa th er ’s s up po rt fo r l ea rn in g E C N um be r o f c hi ld re n in th e ag e gr ou p 36 -5 9 m on th s w ho se fa th er s en ga ge d in o ne o r m or e le ar ni ng a nd sc ho ol p re pa ra tio n ac tiv iti es w ith in th e pa st 3 d ay s To ta l n um be r o f c hi ld re n in th e ag e gr ou p 36 - 59 m on th s 6. 3 Le ar ni ng m at er ia ls : c hi ld re n’ s bo ok s E C N um be r o f c hi ld re n un de r t he a ge o f 5 w ho h av e 3 an d m or e ch ild re n’ s bo ok s To ta l n um be r o f c hi ld re n un de r t he a ge o f 5 6. 4 Le ar ni ng m at er ia ls : p la yt hi ng s E C N um be r o f c hi ld re n un de r t he a ge o f 5 w ho h av e tw o or m or e ob je ct s fo r p la yi ng To ta l n um be r o f c hi ld re n un de r t he a ge o f 5 6. 5 In ad eq ua te c ar e E C N um be r o f c hi ld re n un de r t he a ge o f 5 w ho s ta ye d at ho m e al on e or u nd er th e ca re o f o th er c hi ld u nd er th e ag e of 1 0 fo r m or e th an a n ho ur w ith in th e pa st w ee k at le as t o nc e To ta l n um be r o f c hi ld re n un de r t he a ge o f 5 6. 6 E ar ly c hi ld d ev el op m en t i nd ex E C N um be r o f c hi ld re n in th e ag e gr ou p 36 -5 9 m on th s w ho ar e de ve lo pm en ta lly o n tra ck in th e ph ys ic al , s oc ia l- em ot io na l a nd le ar ni ng d om ai ns To ta l n um be r o f c hi ld re n in th e ag e gr ou p 36 - 59 m on th s 6. 7 A tte nd an ce to e ar ly c hi ld ho od ed uc at io n E C N um be r o f c hi ld re n in th e ag e gr ou p 36 -5 9 m on th s at te nd in g so m e ea rly c hi ld ho od d ev el op m en t p ro gr am To ta l n um be r o f c hi ld re n in th e ag e gr ou p 36 - 59 m on th s 7. L IT ER A C Y A N D E D U C AT IO N 7. 1 Li te ra cy ra te a m on g yo un g w om en [M ] W B N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho ca n re ad a s ho rt si m pl e se nt en ce re ga rd in g da ily li fe an d w ho w er e at te nd in g se co nd ar y or h ig he r e du ca tio n es ta bl is hm en t To ta l n um be r o f w om en in th e ag e gr ou p 15 - 24 y ea rs M D G 2 .3 7. 2 S ch oo l r ea di ne ss E D N um be r o f c hi ld re n at te nd in g 1s t g ra de o f p rim ar y sc ho ol w ho a tte nd ed p re -s ch oo l e st ab lis hm en t d ur in g th e ye ar be fo re To ta l n um be r o f c hi ld re n st ud yi ng in th e fir st gr ad e of p rim ar y sc ho ol 7. 3 N et in ta ke ra te in p rim ar y ed uc at io n E D N um be r o f c hi ld re n at s ch oo l e nt ry a ge w ho e nt er ed th e 1s t g ra de o f p rim ar y sc ho ol To ta l n um be r o f c hi ld re n at th e ag e of s ch oo l en try 7. 4 P rim ar y sc ho ol n et a tte nd an ce ra tio (a dj us te d) E D N um be r o f c hi ld re n of p rim ar y sc ho ol a ge w ho a re cu rr en tly a tte nd in g pr im ar y or s ec on da ry s ch oo l To ta l n um be r o f c hi ld re n of p rim ar y sc ho ol ag e M D G 2 .1 7. 5 S ec on da ry s ch oo l n et at te nd an ce ra tio (a dj us te d) E D N um be r o f c hi ld re n of s ec on da ry s ch oo l a ge w ho a re cu rr en tly a tte nd in g se co nd ar y or h ig he r e du ca tio n es ta bl is hm en t To ta l n um be r o f c hi ld re n of s ec on da ry s ch oo l ag e 7. 6 C hi ld re n re ac hi ng la st g ra de o f pr im ar y E D P ro po rti on o f c hi ld re n w ho a tte nd ed s ch oo l u nt il th e la st g ra de o f p rim ar y sc ho ol o f t ho se w ho e nt er ed fir st g ra de M D G 2 .2 7. 7 P rim ar y co m pl et io n ra te E D N um be r o f c hi ld re n w ho a re a tte nd in g la st g ra de o f pr im ar y sc ho ol (e xc ep t f or c hi ld re n w ho a re s ta yi ng fo r th e se co nd y ea r i n th e sa m e gr ad e) To ta l n um be r o f c hi ld re n of p rim ar y sc ho ol co m pl et io n ag e (i. e. o f t he a ge o f p rim ar y sc ho ol la st g ra de a tte nd an ce ) 312 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 7. 8 Tr an si tio n ra te to s ec on da ry sc ho ol E D N um be r o f c hi ld re n w ho a re a tte nd in g se co nd ar y sc ho ol fo r t he fi rs t y ea r i n cu rr en t a ca de m ic y ea r a nd w ho w er e at te nd in g la st g ra de o f p rim ar y sc ho ol in th e ye ar b ef or e To ta l n um be r o f c hi ld re n st ud yi ng in th e la st gr ad e of p rim ar y sc ho ol in th e pr ev io us y ea r 7. 9 G en de r P ar ity In de x (in p rim ar y ed uc at io n) E D P rim ar y sc ho ol n et a tte nd an ce ra tio a m on g gi rls P rim ar y sc ho ol n et a tte nd an ce ra tio a m on g bo ys M D G 3 .1 7. 10 G en de r P ar ity In de x (in se co nd ar y ed uc at io n) E D S ec on da ry s ch oo l n et a tte nd an ce ra tio a m on g gi rls S ec on da ry s ch oo l n et a tte nd an ce ra tio a m on g bo ys M D G 3 .1 8. C H IL D P R O TE C TI O N 8. 1 B irt h re gi st ra tio n B R N um be r o f c hi ld re n un de r 5 w ho se b irt h, re po rte dl y, w as re gi st er ed To ta l n um be r o f c hi ld re n un de r t he a ge o f 5 8. 5 Vi ol en t d is ci pl in e C D N um be r o f c hi ld re n in th e ag e gr ou p 2- 14 y ea rs w ho ex pe rie nc ed p sy ch ol og ic al o r p hy si ca l a bu se in th e pa st m on th To ta l n um be r o f c hi ld re n in th e ag e gr ou p 2- 14 ye ar s 8. 6 M ar ria ge b ef or e ag e 15 [M ] M A N um be r o f w om en in th e ag e gr ou p 15 -4 9 w ho fi rs t g ot m ar rie d or s ta rte d liv in g w ith a m an b ef or e th e ag e of 1 5 To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 8. 7 M ar ria ge b ef or e ag e 18 [M ] M A N um be r o f w om en in th e ag e gr ou p 20 -4 9 ye ar s w ho fir st g ot m ar rie d or s ta rte d liv in g w ith a m an b ef or e th e ag e of 1 8 To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 8. 8 Yo un g w om en a ge 1 5- 19 cu rr en tly m ar rie d or in u ni on [M ] M A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ar e cu rr en tly m ar rie d or a re li vi ng w ith a m an u no ffi ci al ly T ot al n um be r o f w om en in th e ag e gr ou p 15 - 19 y ea s 8. 10 a 8. 10 b S po us al a ge d iff er en ce M A N um be r o f m ar rie d w om en o r w om en in u ni on w ho se sp ou se o r p ar tn er is n o le ss th an 1 0 ye ar s ol de r t ha n th em , (а ) a m on g w om en in th e ag e gr ou p 15 -1 9 ye ar s (b ) a m on g w om en in th e ag e gr ou p 20 -2 4 ye ar s To ta l n um be r o f m ar rie d w om en o r w om en in un io n: (а ) i n th e ag e gr ou p 15 -1 9 ye ar s, (b ) i n th e ag e gr ou p 20 -2 4 ye ar s 8. 14 A tti tu de to w ar ds d om es tic vi ol en ce [M ] D V N um be r o f w om en w ho re po rt th at th ei r s po us e/ pa rtn er ca n be at h is w ife fo r a t l ea st o ne o f t he fo llo w in g re as on s: (1 ) i s sh e go es o ut w ith ou t t el lin g hi m , ( 2) is s he ne gl ec ts c hi ld re n , ( 3) if s he a rg ue s w ith h im , ( 4) if s he re fu se s to h av e se x w ith h im , ( 5) if s he b ur ns th e fo od To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 9. H IV /A ID S, S EX U A L B EH AV IO U R A N D O R PH A N H O O D 9. 1 C om pr eh en si ve k no w le dg e ab ou t H IV tr an sm is si on [M ] H A N um be r o f w om en in th e ag e gr ou p 1 5- 49 y ea rs w ho ca n co rr ec tly n am e 2 w ay s of H IV tr an sm is si on 29 , an d w ho k no w th at a h ea lth lo ok in g pe rs on c an be H IV in fe ct ed a nd c an re fu te tw o m os t c om m on m is co nc ep tio ns re ga rd in g H IV tr an sm is si on To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 29 U se o f c on do m a nd h av in g on ly o ne fa it hf ul u ni nf ec te d se xu al p ar tn er 313MONITORING THE SITUATION OF CHILDREN AND WOMEN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 9. 2 C om pr eh en si ve k no w le dg e ab ou t H IV tr an sm is si on a m on g yo un g pe op le [M ] H A N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho c an c or re ct ly n am e 2 w ay s of H IV tr an sm is si on pr ev en tio n1 2 , an d w ho k no w th at a h ea lth y lo ok in g pe rs on c an b e H IV in fe ct ed a nd c an re fu te tw o m os t co m m on m is co nc ep tio ns re ga rd in g H IV tr an sm is si on To ta l n um be r o f w om en in th e ag e gr ou p 15 - 24 y ea s M D G 6 .3 9. 3 K no w le dg e of m ot he r- to -c hi ld H IV tr an sm is si on [M ] H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ca n na m e al l t hr ee w ay s3 0 o f m ot he r- to -c hi ld H IV tra ns m is si on To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs 9. 4 A cc ep tin g at tit ud es to w ar d pe op le li vi ng w ith H IV /A ID S [M ] H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s de m on st ra tin g ac ce pt in g at tit ud e to w ar d al l 4 is su es 31 , re ve al in g th e le ve l o f t ol er an ce to w ar d pe op le li vi ng w ith H IV To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s w ho h av e he ar d ab ou t H IV 9. 5 K no w le dg e of a p la ce fo r H IV te st in g am on g w om en [ M ] H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho sa y th ey k no w w he re to b e H IV te st ed To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 9. 6 W om en w ho h av e be en H IV te st ed a nd re ce iv ed th e re su lts [M ] H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho in th e pa st 1 2 m on th s pr io r t o th e su rv ey w er e H IV te st ed an d re ce iv ed th e re su lt To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea s 9. 7 S ex ua lly a ct iv e yo un g w om en w ho h av e be en te st ed fo r H IV an d kn ow th e re su lts [M ] H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho in th e pa st 1 2 m on th s pr io r t o th e su rv ey h ad s ex a nd w er e H IV te st ed in th is ti m e pe rio d an d re ce iv ed th e re su lts To ta l n um be r o f w om en in th e ag e gr ou p 15 - 24 y ea rs w ho h ad s ex in th e pa st 1 2 m on th s pr io r t o th e su rv ey 9. 8 H IV c ou ns el in g du rin g an te na ta l ca re H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d a liv e bi rth in th e pa st 2 y ea rs p rio r t o th e su rv ey an d w ho re po rte d re ce iv in g H IV c ou ns el in g du rin g an te na ta l c ar e To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho g av e bi rth in th e pa st 2 y ea rs pr io r t o th e su rv ey 9. 9 H IV te st in g du rin g an te na ta l c ar e H A N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h ad a li ve b irt h in th e pa st 2 y ea rs p rio r t o th e su rv ey a nd re po rte d th at d ur in g an te na ta l c ar e th ey w er e of fe re d to b e H IV te st ed a nd th ey a gr ee d to a nd re ce iv ed th e re su lts To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs w ho g av e bi rth in th e pa st 2 y ea rs pr io r t o th e su rv ey 9. 10 Yo un g w om en w ho h av e ne ve r ha d se x [M ] S B N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho w er e ne ve r m ar rie d an d ne ve r h ad s ex To ta l n um be r o f w om en in th e ag e gr ou p 15 - 24 w ho w er e ne ve r m ar rie d 9. 11 S ex b ef or e ag e1 5 am on g yo un g w om en S B N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho ha d se x be fo re th e ag e of 1 5 To ta l n um be r o f w om en in th e ag e gr ou p 15 - 24 9. 12 A ge -m ix in g am on g se xu al pa rtn er s [M ] S B N um be r o f w om en in th e ag e gr ou p 15 -2 4 w ho in th e pa st 1 2 m on th s pr io r t o th e su rv ey h ad s ex w ith a pa rtn er 1 0 an d m or e ye ar s ol de r N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho h ad s ex in th e pa st 1 2 m on th s pr io r to th e su rv ey 30 T R A N SM IS SI O N D U R IN G P R E G N A N C Y, D E L IV E R Y A N D B R E A ST F E E D IN G 31 W om en ( 1) w ho th in k th at A ID S in fe ct ed te ac he r sh ou ld b e al lo w ed te ac hi ng a t s ch oo l, (2 ) w ho w ou ld b uy fr es h ve ge ta bl es fr om a s el le r if th ey k ne w th at th is p er so n is A ID S in - fe ct ed , ( 3) w ho w ou ld n ot w is h to k ee p se cr et a bo ut a fa m il y m em be r be in g in fe ct ed w it h A ID S, a nd ( 4) w ho w ou ld c ar e fo r a fa m il y m em be r in fe ct ed w it h A ID S 314 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 9. 13 S ex w ith m ul tip le p ar tn er s [M ] S B N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho in th e pa st 1 2 m on th s pr io r t o th e su rv ey h ad s ex w ith m or e th an o ne p ar tn er To ta l n um be r o f w om en in th e ag e gr ou p 15 - 49 y ea rs 9. 14 C on do m u se d ur in g se x w ith m ul tip le p ar tn er s [M ] S B N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho re po rte d th at in th e pa st 1 2 m on th s pr io r t o th e su rv ey ha d se x w ith m or e th an o ne p ar tn er a nd th at d ur in g th e la st ti m e th ey h ad s ex c on do m w as u se d N um be r o f w om en in th e ag e gr ou p 15 -4 9 w ho re po rte d ha vi ng h ad s ex w ith m or e th an 1 pa rtn er in th e pa st 1 2 m on th s pr io r t o th e su rv ey 9. 15 S ex w ith n on -r eg ul ar p ar tn er s [M ] S B N um be r o f s ex ua lly a ct iv e yo un g w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho in th e pa st 1 2 m on th s pr io r t o th e su rv ey h ad s ex w ith a p ar tn er th ey w er e no t m ar rie d to o r l iv in g w ith N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho h ad s ex in th e pa st 1 2 m on th s pr io r to th e su rv ey 9. 16 C on do m u se d ur in g se x w ith no n- re gu la r p ar tn er s [M ] S B N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho re po rte d ha vi ng s ex in th e pa st 1 2 m on th s pr io r t o th e su rv ey w ith a p ar tn er th ey w er e no t m ar rie d to o r l iv in g w ith a nd th at c on do m w as u se d du rin g la st s uc h co nt ac t N um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho re po rte d ha vi ng s ex in th e pa st 1 2 m on th s pr io r t o th e su rv ey w ith a p ar tn er th ey w er e no t m ar rie d to o r n ot li vi ng w ith M D G 6 .2 9. 17 C hi ld re n’ s liv in g ar ra ng em en ts H L N um be r o f c hi ld re n in th e ag e gr ou p 0- 17 y ea rs w ho a re no t l iv in g w ith w ith er o f t he ir bi ol og ic al p ar en ts To ta l n um be r o f c hi ld re n in th e ag e gr ou p 0- 17 ye ar s 9. 18 P ro po rti on o f c hi ld re n w ith o ne or b ot h pa re nt s de ad H L N um be r o f c hi ld re n in th e ag e gr ou p 0- 17 y ea rs w ho ha ve o ne o r b ot h pa re nt s de ad To ta l n um be r o f c hi ld re n in th e ag e gr ou p 0- 17 ye ar s 9. 19 S ch oo l a tte nd an ce b y or ph an s H L - E D N um be r o f c hi ld re n in th e ag e gr ou p 10 -1 4 ye ar s w ho ha ve lo st b ot h pa re nt s an d w ho a re a tte nd in g sc ho ol To ta l n um be r o f c hi ld re n in th e ag e gr ou p 0- 14 ye ar s w ho h av e lo st b ot h pa re nt s M D G 6 .4 9. 20 S ch oo l a tte nd an ce b y no n- or ph an s H L - E D N um be r o f c hi ld re n in th e ag e gr ou p 10 -1 4 ye ar s w ho se pa re nt s ar e al iv e an d w ho a re li vi ng w ith o ne o r b ot h pa re nt s an d ar e at te nd in g sc ho ol To ta l n um be r o f c hi ld re n in th e ag e gr ou p 10 - 14 y ea rs w ho se p ar en ts a re a liv e an d w ho a re liv in g w ith o ne o r b ot h pa re nt s M D G 6 .4 9. 21 M al e C irc um ci si on M M C To ta l n um be r o f m en in th e ag e gr ou p 15 -4 9 ye ar s w ho re po rte d ha vi ng b ee n ci rc um ci se d To ta l n um be r o f m en in th e ag e gr ou p 15 -4 9 ye ar s 10 . A C C ES S TO M A SS M ED IA A N D U SE O F IN FO R M AT IO N /C O M M U N IC AT IO N T EC H N O LO G IE S M T. 1 E xp os ur e to m as s m ed ia [M ] M T N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho re ad a n ew sp ap er o r m ag az in e, li st en to ra di o an d w at ch T V a t l ea st o nc e a w ee k To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s M T. 2 U se o f c om pu te r [ M ] M T N um be r o f y ou ng w om en in th e ag e gr ou p 15 -2 4 ye ar s w ho u se d a co m pu te r i n th e pa st 1 2 m on th s To ta l n um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s M T. 3 U se o f t he In te rn et [M ] M T N um be r o f y ou ng w om en in th e ag e gr ou p 15 - 24 y ea rs w ho u se d th e In te rn et in th e pa st 1 2 m on th s To ta l n um be r o f w om en in th e ag e gr ou p 15 -2 4 ye ar s 1 2. T O B A C C O A N D A LC O H O L U SE TA .1 To ba cc o us e [M ] TA N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho fo r o ne o r m or e da ys w er e sm ok in g ci ga re tte s or u si ng s m ok in g or n on -s m ok in g to ba cc o pr od uc ts w ith in th e pa st m on th To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s 315MONITORING THE SITUATION OF CHILDREN AND WOMEN In di ca to r M IC S4 [M ] M od ul e2 0 N um er at or D en om in at or M D G 21 TA .2 S m ok in g be fo re th e ag e of 15 [M ] TA N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h ad o ne c ig ar et te b ef or e th e ag e of 1 5 To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s TA .3 A lc oh ol u se [M ] TA N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h ad a t l ea st o ne d rin k of a lc oh ol fo r o ne o r m or e da ys w ith in th e pa st m on th To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s TA .4 A lc oh ol u se b ef or e th e ag e of 1 5 [M ] TA N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h ad a t l ea st o ne d rin k of a lc oh ol b ef or e th e ag e of 1 5 To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s B el ow a re c ou nt ry s pe ci fi c in di ca to rs o n D om es ti c V io le nc e w hi ch a re n ot s ta nd ar d M IC S in di ca to rs DV .1 E xp er ie nc e of p hy si ca l vi ol en ce D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho w er e ev er p hy si ca lly a bu se d si nc e th e ag e of 15 To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .2 P er so n co m m itt in g ph ys ic al vi ol en ce D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho w er e ev er p hy si ca lly a bu se d si nc e th e ag e of 15 To ta l n um be r o f s ur ve ye d w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .3 Fo rc e at s ex ua l i ni tia tio n D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho re po rte d th at th ei r fi rs t s ex ua l c on ta ct w as fo rc ed , a ga in st th ei r w ill To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h av e ev er h ad s ex DV .4 E xp er ie nc e of s ex ua l vi ol en ce D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho w er e ev er s ex ua lly a bu se d To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .5 E xp er ie nc e of d iff er en t f or m s of v io le nc e D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho e xp er ie nc ed v ar io us fo rm s of v io le nc e To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .6 Vi ol en ce d ur in g pr eg na nc y D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho w er e ev er p hy si ca lly a bu se d du rin g pr eg na nc y To ta l n um be r o f e ve r p re gn an t w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .7 D eg re e of m ar ita l co nt ro l ex pe rie nc ed b y hu sb an ds D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho se c ur re nt o r l as t h us ba nd /p ar tn er e ve r de m on st ra te d sp ec ifi c ty pe s of s po us al c on tro l To ta l n um be r o f e ve r m ar rie d w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .8 Fo rm s of s po us al v io le nc e D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s ev er e xp er ie nc in g sp ou sa l v io le nc e To ta l n um be r o f e ve r m ar rie d w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .11 In ju rie s to w om en c au se d by sp ou sa l v io le nc e D V N um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho re po rte d re ce iv in g bo di ly in ju rie s as a re su lt of s po us al v io le nc e To ta l n um be r o f e ve r m ar rie d w om en in th e ag e gr ou p 15 -4 9 ye ar s DV .12 H el p se ek in g to s to p vi ol en ce D V N um be r o f w om en in th e ag e gr ou p 15 -4 0 w ho so ug ht h el p to s to p th e vi ol en ce To ta l n um be r o f w om en in th e ag e gr ou p 15 -4 9 ye ar s w ho h av e ev er e xp er ie nc ed ph ys ic al a nd s ex ua l v io le nc e 316 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Appendix F. Questionnaires UNICEF UNITED NATIONS CHILDREN’S FUND IN THE REPUBLIC OF KAZAKHSTAN AGENCY OF STATISTICS, RK HOUSEHOLD QUESTIONNAIRE HOUSEHOLD INFORMATION HH HH1. Cluster number: ___ ___ ___ HH2. Household number: ___ ___ HH3. Name and number of Interviewer: HH4. Name and number of Supervisor: Name _________________________ ___ ___ Name __________________________ ___ ___ HH5. Day / Month / Year of interview: ___ ___ / ___ ___ / ___ ___ ___ ___ HH6. Area: Urban 1 Rural 2 HH7. Region/oblast: Akmola .1 Aktobe .2 Almaty .3 Almaty city. .4 Astana city. .5 Atyrau .6 East Kazakhstan .7 Zhambyl .8 West Kazakhstan .9 Karaganda .10 Kostanai .11 Kyzylorda .12 Mangistau .13 Pavlodar .14 North Kazakhstan .15 South Kazakhstan .16 HH7A. Was this household selected for interviewing men aged 15 - 59? Yes 1 No 2 We are from the Agency of statistics, RK. We are working on a project related to family health, education, status of women and children. I would like to talk to you about these subjects. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. May I start?  Yes, permission is given  Go to HH18, record the time and then begin the interview.  No, permission is not given  Complete HH9. Discuss this result with your supervisor. After all questionnaires for the household have been completed, fill in the following information: HH8. Name of head of household: ______________________________________________ HH9. Result of household interview: Completed 01 No household member or no competent respondent at home at time of visit 02 Entire household absent for extended period of time 03 Refused 04 Dwelling vacant / Address not a dwelling 05 Dwelling destroyed 06 Dwelling not found 07 Other (specify) 96 HH10. Respondent to household questionnaire: Name: _________________________________________ Line number: ___ ___ HH11. Total number of household members: ___ ___ HH12. Number of women age 15-49 years: ___ ___ HH13. Number of woman’s questionnaires completed: ___ ___ 317MONITORING THE SITUATION OF CHILDREN AND WOMEN HH12А. Number of men age 15-59 years: ___ ___ HH13B. Number of man’s questionnaires completed: ___ ___ HH14. Number of children under 5: ___ ___ HH15. Number of under-5 questionnaires completed: ___ ___ HH16. Field edited by (Name and number): Name _________________________ ___ ___ HH17. Data entry clerk (Name and number): Name ___________________________ ___ ___ 318 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN H H 18 . R ec or d th e tim e. H ou r _ _ __ M in ut es _ _ __ H O U SE H O LD L IS TI N G F O R M H L Fi rs t, pl ea se te ll m e th e na m e of e ac h pe rs on w ho u su al ly li ve s he re , e xc ep t s tu de nt s, s ol di er s be in g on a m ili ta ry s er vi ce fo r a re gu la r p er io d, a nd th os e st ay in g ou t o f h om e fo r m or e th an 1 2 m on th s. P le as e st ar t w ith th e he ad o f t he h ou se ho ld Li st th e he ad o f t he h ou se ho ld in li ne 0 1. L is t a ll ho us eh ol d m em be rs (H L2 ), th ei r r el at io ns hi p to th e ho us eh ol d he ad (H L3 ), an d th ei r s ex (H L4 ) Th en a sk : A re th er e an y ot he rs w ho li ve h er e, e ve n if th ey a re n ot a t h om e no w ? If ye s, c om pl et e lis tin g fo r q ue st io ns H L2 -H L4 . T he n, a sk q ue st io ns s ta rti ng w ith H L5 fo r e ac h pe rs on a t a ti m e. U se a n ad di tio na l q ue st io nn ai re , i f a ll ro w s in th e ho us eh ol d lis tin g fo rm h av e be en u se d. H L1 . Li ne nu m be r H L2 . N am e H L3 . W ha t i s th e re la tio n- sh ip of (n am e) to th e he ad o f ho us e- ho ld ? H L4 . Is (n am e) m al e or fe m al e? 1 M al e 2 Fe m al e H L5 . W ha t i s (n am e) ’s da te o f b irt h? H L6 . H ow o ld is (n am e) ? R ec or d in co m pl et ed ye ar s. If ag e is 9 5 or ab ov e, re co rd ‘9 5’ Fo r w om en a ge 1 5- 49 Fo r m en a ge 15 -5 9 Fo r c hi ld re n ag e 2- 14 Fo r c hi ld re n un de r 5 Fo r c hi ld re n ag e 0- 17 H L7 . C irc le lin e no . if w om an is a ge 15 -4 9 H L7 A. C irc le lin e no . if m an is a ge 15 -5 9 H L8 . W ho is th e m ot he r o r pr im ar y ca re - ta ke r o f t hi s ch ild ? R ec or d lin e no . of m ot he r/ ca re ta ke r H L9 . W ho is th e m ot he r o r p ri- m ar y ca re ta ke r of th is c hi ld ? R ec or d lin e no . of m ot he r/ ca re ta ke r H L1 1. Is (n am e) ’s na tu ra l m ot he r al iv e? 1 Ye s 2 N oø H L1 3 8 Н З ø H L1 3 H L1 2. D oe s (n am e) ’s n at - ur al m ot he r liv e in th is ho us eh ol d? R ec or d lin e no . of m ot he r or 0 0 fo r “N o” H L1 3. Is (n am e) ’s na tu ra l fa th er al iv e? 1 Ye s 2 N oø N ex t L in e 8 D Kø N ex t L in e H L1 4. D oe s (n am e) ’s na tu ra l f at he r l iv e in th is ho us eh ol d? R ec or d lin e no . of fa th er o r 00 fo r “ N o” Li ne N am e R el at io n* M F M on th Ye ar A ge M ot he r M ot he r Y N D K M ot he r Y N D K Fa th er 01 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 01 01 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 02 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 02 02 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 03 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 03 03 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 04 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 04 04 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 05 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 05 05 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 06 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 06 06 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 07 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 07 07 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 08 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 08 08 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 09 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 09 09 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 10 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 10 10 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 11 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 11 11 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 12 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 12 12 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 13 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 13 13 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 14 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 14 14 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 15 __ _ __ _ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 15 15 __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 319MONITORING THE SITUATION OF CHILDREN AND WOMEN C on tin ua tio n Ti ck h er e if ad di tio na l q ue st io nn ai re u se d  P ro be fo r a dd iti on al h ou se ho ld m em be rs . P ro be e sp ec ia lly fo r a ny in fa nt s or s m al l c hi ld re n no t l is te d, a nd o th er s w ho m ay n ot b e m em be rs o f t he fa m ily (s uc h as s er va nt s, fr ie nd s, o th er re la tiv es ) b ut w ho u su al ly li ve in th e ho us eh ol d. In se rt na m es o f a dd iti on al m em be rs in th e ho us eh ol d lis t a nd c om pl et e fo rm a cc or di ng ly. • N ow fo r e ac h w om an a ge 1 5- 49 y ea rs , w rit e he r n am e an d lin e nu m be r a nd o th er id en tif yi ng in fo rm at io n in th e in fo rm at io n pa ne l o f a s ep ar at e In di vi du al W om en ’s Q ue st io nn ai re . • N ow fo r e ac h m an a ge 1 5- 59 y ea rs , w rit e hi s na m e an d lin e nu m be r a nd o th er id en tif yi ng in fo rm at io n in th e in fo rm at io n pa ne l o f a s ep ar at e In di vi du al M en ’s Q ue st io nn ai re . • Fo r e ac h ch ild u nd er 5 , w rit e hi s/ he r n am e an d lin e nu m be r a nd th e lin e nu m be r o f h is /h er m ot he r o r c ar et ak er in th e in fo rm at io n pa ne l o f a s ep ar at e U nd er -5 Q ue st io nn ai re . Yo u sh ou ld n ow h av e a se pa ra te q ue st io nn ai re fo r e ac h el ig ib le w om an a ge 1 5 – 49 , s el ec te d m an a ge 1 5- 59 a nd e ac h ch ild u nd er 5 in th e ho us eh ol d. * C od es fo r H L3 : R el at io ns hi p to h ea d of h ou se ho ld : 01 H ea d 02 W ife / H us ba nd 03 S on / D au gh te r 04 S on -In -L aw / D au gh te r- In -L aw 05 G ra nd ch ild 06 P ar en ts /F at he r/M ot he r 07 P ar en t-I n- La w 08 B ro th er / Si st er 09 B ro th er -In -L aw / Si st er -In -L aw 10 U nc le / A un t 11 N ie ce / N ep he w 12 O th er re la tiv e 13 A do pt ed / Fo st er / St ep ch ild 14 N ot re la te d 98 D on ’t kn ow 320 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN E D U C AT IO N ED Fo r h ou se ho ld m em be rs a ge 5 a nd a bo ve Fo r h ou se ho ld m em be rs a ge 5 -2 4 E D 1. Li ne nu m - be r E D 2. N am e an d ag e C op y fro m H ou se ho ld L is tin g Fo rm , H L2 a nd H L6 E D 3. H as (n am e) ev er a t- te nd ed sc ho ol or p re - sc ho ol ? 1 Ye s 2 N o ø N ex t l in e E D 4. W ha t i s th e hi gh es t l ev el o f sc ho ol (n am e) a tte nd ed ? W ha t g ra de (n am e) c om pl et ed a t th is le ve l? E D 5. D ur in g th e cu rr en t (2 01 0- 20 11 ) sc ho ol ye ar , d id (n am e) at te nd sc ho ol o r pr es ch oo l at a ny tim e? 1Y es 2 N o ø ED 7 E D 6. D ur in g th is s ch oo l y ea r ( 20 10 - 20 11 ), w hi ch le ve l a nd g ra de is / w as (n am e) a tte nd in g? E D 7. D ur in g th e pr ev i- ou s sc ho ol y ea r, th at is (2 00 9- 20 10 ), d id (n am e) at te nd s ch oo l o r pr es ch oo l a t a ny tim e? 1 Ye s 2 N o ø N ex t L in e 8 D K ø N ex t L in e E D 8. D ur in g th at p re vi ou s sc ho ol y ea r (2 00 9- 20 10 ), w hi ch le ve l a nd gr ad e di d (n am e) a tte nd ? Le ve l: 0 P re sc ho ol 1 P rim ar y 2 S ec on da ry 3 S ec on da ry -s pe - ci al is ed 4 H ig he r 8 D K If le ve l = 0, s ki p to ED 5 G ra de : 98 D K If 1s t g ra de no t c om - pl et ed , w rit e 00 . Le ve l: 0 P re sc ho ol 1 P rim ar y 2 S ec on da ry 3 S ec on da ry -s pe - ci al is ed 4 H ig he r 8 D K If le ve l= 0, s ki p to ED 7 G ra de : 98 D K Le ve l: 0 P re sc ho ol 1 P rim ar y 2 S ec on da ry 3 S ec on da ry -s pe - ci al is ed 4 H ig he r 8 D K If le ve l= 0, g o to ne xt li ne G ra de : 98 D K Li ne N am e A ge Ye s N o Le ve l G ra de Ye s N o Le ve l G ra de y n dk Le ve l G ra de 01 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 02 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 03 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 04 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 05 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 06 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 07 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 08 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 09 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 10 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 11 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 12 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 13 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 14 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 15 __ _ __ _ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 0 1 2 3 4 8 __ _ _ __ 1 2 8 0 1 2 3 4 8 __ _ _ __ 321MONITORING THE SITUATION OF CHILDREN AND WOMEN WATER AND SANITATION WS WS1. What is the main source of drinking water for members of your household? Piped water Piped into dwelling .11 Piped into compound, yard or plot . 12 Piped to neighbour . 13 Public tap / standpipe . 14 Tube Well, Borehole . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank / drum . 71 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) . 81 Bottled water. 91 Other (specify) _________________________ 96 11WS6 12WS6 13WS6 14WS3 21WS3 31WS3 32WS3 41WS3 42WS3 51WS3 61WS3 71WS3 81WS3 96WS3 WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing? Piped water Piped into dwelling .11 Piped into compound, yard or plot . 12 Piped to neighbour . 13 Public tap / standpipe . 14 Tube Well, Borehole . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank / drum . 71 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) . 81 Bottled water. 91 Other (specify) _________________________ 96 11WS6 12WS6 13WS6 WS3. Where is that water source located? In own dwelling . 1 In own yard / plot . 2 Elsewhere . 3 1WS6 2WS6 WS4. How long does it take to go there, get water, and come back? Time in minutes . __ __ __ DK. 998 WS5. Who usually goes to this source to collect the water for your household? Probe: Is this person under age of 15? What sex? Adult woman (15 years and older). 1 Adult man (age 15 years and older) . 2 Female child (under 15). 3 Male child (under 15) . 4 DK. 8 WS6. Do you do anything to the water to make it safer to drink? Yes . 1 No . 2 DK. 8 2WS8 8WS8 322 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN WS7. What do you usually do to make the water safer to drink? Probe: Anything else? Circle all items mentioned. Boil. A Add bleach / chlorine .B Strain it through a cloth.C Use water filter (ceramic, sand, composite, etc.).D Solar disinfection .E Let it stand and settle . F Other (specify) . X DK. Z WS8. What type of toilet do members of your household usually use? If “flush” or “pour flush”, probe: Where does it flush to? If necessary, ask permission to observe the toilet. Flush / Pour flush Flush to piped sewer system .11 Flush to septic tank . 12 Flush to pit (latrine) . 13 Flush to somewhere else . 14 Flush to unknown place / Not sure / DK where . 15 Pit latrine Ventilated Improved Pit latrine (VIP) . 21 Pit latrine with slab . 22 Pit latrine without slab / Open pit . 23 Composting toilet . 31 Bucket. 41 Hanging toilet, Hanging latrine . 51 No facility, Bush, Field . 95 Other (specify) ________________________ 96 95 NEXT MODULE WS9. Do you share this facility with others who are not members of your household? Yes . 1 No . 2 2NEXT. MODULE WS10. Do you share this facility only with members of other households that you know, or is the facility open to the use of the general public? Only other households (not public) . 1 Public facility . 2 2 NEXT MODULE WS11. How many households in total use this toilet facility, including your own household? Number of households (if less than 10) . 0__ Ten or more households . 10 DK. 98 323MONITORING THE SITUATION OF CHILDREN AND WOMEN HOUSEHOLD CHARACTERISTICS HC HC1a. What is the religion of the head of this household? HC1b. What is the mother tongue/native language of the head of this household? Kazakh. 1 Russian. 2 Other language (specify) . 6 HC1c. To what ethnic group does the head of this household belong? Probe: What is the ethnicity of the head of household? Kazakhs . 1 Russians . 2 Other ethnic groups (specify) _____________ 6 HC3. Main material of the dwelling floor. Record observation. Natural floor Soil / Sand .11 Simple floor Wooden boards . 21 Finished floor Parquet or polished wood/laminat . 31 Vinyl, linoleum or asphalt strips . 32 Ceramic tiles . 33 Cement . 34 Carpet, tapis . 35 Other (specify) ________________________ 96 HC4. Main material of the roof. Record observation. Rudimentary Roofing Wood planks . 23 Finished roofing . Metal . 31 Wood . 32 Calamine / Cement fibre . 33 Ceramic tiles . 34 Cement . 35 Roofing shingles .….36 Other (specify) _________________________ 96 HC5. Main material of the exterior walls. Record observation. Rudimentary walls Stone with mud . 22 Uncovered adobe (saman) . 23 Plywood . 24 Reused wood . 26 Finished walls Cement . 31 Stone with lime / cement . 32 Bricks . 33 Cement blocks . 34 Covered adobe . 35 Wood planks / shingles . 36 Other (specify) _________________________ 96 324 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN HC6. What type of fuel does your household mainly use for cooking? Electricity . 01 Liquefied Petroleum Gas (LPG) . 02 Natural gas . 03 Biogas. 04 Kerosene . 05 Coal / Lignite. 06 Charcoal . 07 Wood . 08 Animal dung. 10 Diesel. 10 No food cooked in household . 95 Other (specify) _________________________ 96 01HC8 02HC8 03HC8 05HC8 95HC8 HC7. Is the cooking usually done in the house, in a separate building, or outdoors? If ‘In the house’, probe: is it done in a separate room used as a kitchen? In the house In a separate room used as kitchen . 1 Elsewhere in the house . 2 In a separate building . 3 Outdoors . 4 Other (specify) _________________________ 6 HC8. Does your household have:: [A] Electricity? [B] A radio? [C] A television? [D] A non-mobile telephone? [E] A refrigerator? [G] A washing machine? [H] A vacuum cleaner? [J] DVD player? [K] dishwasher? [L] microwave oven? Yes No Electricity .1 2 A radio .1 2 A television .1 2 A non-mobile telephone .1 2 A refrigerator .1 2 A washing machine.1 2 A vacuum cleaner .1 2 DVD player? .1 2 dishwasher? .1 2 microwave oven?.1 2 HC9. Does any member of your household own: [B] A mobile telephone? [C] A bicycle? [D] A motorcycle or scooter? [F] Light vehicle/truck/tractor? [G] A boat with a motor? [Н] A personal computer /laptop? Yes .No A mobile telephone . 1 . 2 A bicycle . 1 . 2 A motorcycle or scooter . 1 . 2 Light vehicle/truck/tractor. 1 . 2 A boat with a motor . 1 . 2 A personal computer /laptop . 1 . 2 325MONITORING THE SITUATION OF CHILDREN AND WOMEN HC10. Do you or someone living in this household own this dwelling? If “No”, then ask: Do you rent this dwelling from someone not living in this household? If “Rented from someone else”, circle “2”. For other responses, circle “6”. Own . 1 Rent . 2 Other (Not owned or rented). 6 HC11. Does any member of this household own any land that can be used for agriculture? Yes . 1 No . 2 2HC13 HC12. How many hectares of agricultural land do members of this household own? If less than 1, record “00”. If 95 or more, record ‘95’. If unknown, record ‘98’. Hectares . ___ ___ HC13. Does this household own any livestock, herds, other farm animals, or poultry? Yes . 1 No . 2 2HC15 HC14. How many of the following animals does this household have? [A] Cattle, milk cows, or bulls? [B] Horses, donkeys, or mules? [C] Goats? [D] Sheep? [E] Poultry: chickens/geese/ducks and others? [F] Pigs? If none, record ‘00’. If 95 or more, record ‘95’. If unknown, record ‘98’. Cattle, milk cows, or bulls . ___ ___ Horses, donkeys, or mules . ___ ___ Goats . ___ ___ Sheep . ___ ___ Poultry: chickens/geese/ducks and others?.___ ___ Pigs. ___ ___ Others (specify) ________________________ 96 HC15. Does any member of this household have an accumulation account or a bank deposit? Yes . 1 No . 2 326 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN CHILD DISCIPLINE CD TABLE 1: CHILDREN AGED 2-14 YEARS ELIGIBLE FOR CHILD DISCIPLINE QUESTIONS o List each of the children aged 2-14 years below in the order they appear in the Household Listing Form. Do not include other household members outside of the age range 2-14 years. o Record the line number, name, sex, and age for each child. o Then record the total number of children aged 2-14 in the box provided (CD6). o If there is only one child age 2-14 years in the household, then skip table 2 and go to CD8; write down’1’ and continue with CD9 TABLE 2: SELECTION OF RANDOM CHILD FOR CHILD DISCIPLINE QUESTIONS o Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household. o Check the last digit of the household number (HH2) from the cover page (from 0 and 9). This is the number of the row you should go to in the table below. o Check the total number of eligible children (2-14) in CD6 above. This is the number of the column you should go to. o Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child (CD1) about whom the questions will be asked. CD1. Rank number CD2. Line number from HL1 CD3. Name from HL2 CD4. Sex from HL4 CD5. Age from HL6 Rank № Line Name М F Age 1 __ __ 1 2 ___ ___ 2 __ __ 1 2 ___ ___ 3 __ __ 1 2 ___ ___ 4 __ __ 1 2 ___ ___ 5 __ __ 1 2 ___ ___ 6 __ __ 1 2 ___ ___ 7 __ __ 1 2 ___ ___ 8 __ __ 1 2 ___ ___ CD6. Total number of children aged 2-14 _____ CD7. Total Number Of Eligible Children In The Household (CD6) Last digit of household number (HH2) 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 327MONITORING THE SITUATION OF CHILDREN AND WOMEN CD9. Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8. Name _____________________________________ Line number __ __ CD10. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month. CD11. Took away privileges, forbade something (name) liked or did not allow him/her to leave house. Yes ……………………………………1 No .2 CD12. Explained why (name)’s behavior was wrong. Yes .1 No .2 CD13. Shook him/her. Yes .1 No .2 CD14. Shouted, yelled at or screamed at him/ her. Yes .1 No .2 CD15. Gave him/her something else to do, to take his/her attention from incorrect behavior. Yes .1 No .2 CD16. Spanked, hit or slapped him/her on the bottom with bare hand. Yes .1 No .2 CD17. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object. Yes .1 No .2 CD18. Called him/her dumb, lazy, or another name like that. Yes .1 No .2 CD19. Hit or slapped him/her on the face, head or ears. Yes .1 No .2 CD20. Hit or slapped him/her on the hand, arm, or leg. Yes .1 No .2 CD21. Beat him/her, that is hit over and over as hard as one could. Yes .1 No .2 CD22. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished? Yes .1 No .2 Don’t know / No opinion.8 HH19. Record the time. Hour and minutes . __ __ : __ __ SALT IODIZATION SI SI1. We would like to check whether the salt used in your household is iodized. May i have a sample of the salt used to cook meals in your household? Once you have tested the salt, circle number that corresponds to test outcome. Not iodized 0 PPM . 1 More than 0 PPM & less than 15 PPM . 2 15 PPM or more . 3 No salt in the house . 6 Salt not tested. 7 328 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN INSTRUCTION FOR SELECTION OF WOMEN AGE 15-49 For interviewing using a module “DOMESTIC VIOLENCE” OF WOMEN’S INDIVIDUAL QUESTIONNAIRE HH20A. DOES ANY ELIGIBLE WOMAN AGE 15-49 RESIDE IN THE HOUSEHOLD? CHECK HOUSEHOLD LISTING, COLUMN HL7 FOR ANY ELIGIBLE WOMAN. You should have a questionnaire with the Information Panel filled in for each eligible woman.  Yes.  Continue with Table 1.  No.  Go to HH20B. TABLE 1: WOMEN AGE 15-49 ELIGIBLE FOR DOMESTIC VIOLENCE MODULE List each of the women aged 15-49 years below in the order they appear in the Household Listing Form. Do not include other household members outside of the age range 15-49 years. Record the line number, name and age for each woman. Then record the total number of woman aged 15-49 in the relevant box HH20AA. Rank number Line number from HL1 Name from HL2 Age from HL6 Rank Line Name Age 1 __ __ ___ ___ 2 __ __ ___ ___ 3 __ __ ___ ___ 4 __ __ ___ ___ 5 __ __ ___ ___ 6 __ __ ___ ___ 7 __ __ ___ ___ 8 __ __ ___ ___ HH20AA Total number of women aged 15-49 ___ ___  If there is only one eligible woman age 15-49 years in the household, then skip table 2 and go to HH20AB; write down’1’, go to HH20AC and record the line number of a woman selected Go to Women’s Individual Questionnaire for interviewing by Domestic Violence Module  If there are several eligible women age 15-49 in the household, then go to table 2 TABLE 2: RANDOM SELECTION OF A WOMAN FOR DOMESTIC VIOLENCE MODULE o Check the last digit of the household number (HH2)(from 0 to 9) from the cover page. This is the number of the row you should go to in the table below. o Check the total number of eligible women (15-49) in HH20AA above. This is the number of the column you should go to. o Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the woman (HH20AB) about whom the questions on DOMESTIC VIOLENCE will be asked. Last digit of household number (HH2) Total Number Of Eligible Women In The Household 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 HH20AB. Record the rank number of the selected woman HH20AC. Write down name and line number of the women selected for this module Name Line number _ _ 329MONITORING THE SITUATION OF CHILDREN AND WOMEN INSTRUCTION FOR SELECTION OF MEN AGE 15-59 for MEN’S INDIVIDUAL QUESTIONNAIRE HH20B. DOES ANY ELIGIBLE MAN AGE 15-59 RESIDE IN THE HOUSEHOLD? CHECK HOUSEHOLD LISTING, COLUMN HL7A TO IDENTIFY ANY ELIGIBLE MAN. You should have a questionnaire with the Information Panel filled in for each eligible man.  Yes.  Go to table 1 “selection of men for men’s individual questionnaire”  No.  Finish your interview by thanking the respondent for cooperation. TABLE 1: MEN AGED 15-59 YEARS ELIGIBLE FOR MEN’S INDIVIDUAL QUESTIONNAIRE List each of the men aged 15-59 years below in the order they appear in the Household Listing Form. Do not include other household members outside of the age range 15-59 years. Record the line number, name and age for each man. Then record the total number of men aged 15-59 in the relevant box (HH20BA). Rank number Line number from HL1 Name from HL2 Age from HL6 Rank Line Name Age 1 __ __ ___ ___ 2 __ __ ___ ___ 3 __ __ ___ ___ 4 __ __ ___ ___ 5 __ __ ___ ___ 6 __ __ ___ ___ 7 __ __ ___ ___ 8 __ __ ___ ___ HH20ВA Total number of men aged 15-59 ___ ___  If there is only one eligible man age 15-59 years in the household, then skip table 2 and go to HH20BB; write down’1’, go to HH20BC and record the line number of a man selected Go to Men’s Individual Questionnaire  If there are several eligible men age 15-59 in the household, then go to table 2 TABLE 2: RANDOM SELECTION OF A MAN FOR MEN’S INDIVIDUAL QUESTIONNAIRE o Use table 2 for selection of one man within the age range of 15-59 if there are several men of this age group living in this household o Check the last digit of the household number (HH2) from the cover page (from 0 to 9). This is the number of the row you should go to in the table below. o Check the total number of eligible men (15-59) in HH20BA above. This is the number of the column you should go to. o Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the man (HH20BB) selected for Men’s Individual Questionnaire. Last digit of household number (HH2) Total Number Of Eligible Men In The Household 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 HH20BB. Record the rank number of the selected man . HH20BC. Write down name and line number of the men selected for the Men’s Individual Questionnaire Name Line number _ _ Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 330 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 331MONITORING THE SITUATION OF CHILDREN AND WOMEN 331MONITORING THE SITUATION OF CHILDREN AND WOMEN UNICEF UN CHILDREN’S FUND IN THE REPUBLIC OF KAZAKHSTAN AGENCY OF STATISTICS, THE REPUBLIC OF KAZAKHSTAN QUESTIONNAIRE FOR INDIVIDUAL WOMEN WOMAN’S INFORMATION PANEL WM This questionnaire is to be administered to all women age 15 through 49 (see Household Listing Form, column HL7). A separate questionnaire should be used for each eligible woman. WM1. Cluster number: WM2. Household number: ___ ___ ___ ___ ___ WM3. Woman’s name: WM4. Woman’s line number: Name ___________________________________ ___ ___ WM5. Name and number of Interviewer: WM6. Day / Month / Year of interview: Name_________________________ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___ WM6A. Check the Household questionnaire. H20AС. Is this woman selected for questions on domestic violence? Yes . 1 No . 2 Repeat greeting if not already read to this woman: We are from the agency of statistics, the republic of kazakhstan. We are working on a project concerned with family health, education, status of women and children. I would like to talk to you about these subjects. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following: Now I would like to talk to you more about your health and other topics. This interview will take about 20 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. May I start now?  Yes, permission is given ð Go to WM10 to record the time and then begin the interview.  No, permission is not given ð Complete WM7. Discuss this result with your supervisor. WM7. Result of woman’s interview. Completed . 01 Not at home . 02 Refused . 03 Partly completed. 04 Incapacitated. 05 Other (specify) ________ ____________96 WM8. Field edited by (Name and number): Name __________________________ ___ ___ WM9. Data entry clerk (Name and number): Name__________________________ ___ ___ WM10. Record the time. Hour and minutes . __ __ : __ __ 332 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 332 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN WOMAN’S BACKGROUNDWB WB WB1. In what month and year were you born? Date of birth Month .__ __ DK month .98 Year .__ __ __ __ DK year .9998 WB2. How old are you? Probe: How old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent Age (in completed years) . __ __ WB3. Have you ever attended school or preschool? Yes . 1 No . 2 2WB7 WB4. What is the highest level of school you attended? Preschool. 00 Primary . 11 Secondary . 22 Secondary specialised. 33 Higher . 44 0WB7 WB5. What is the highest grade you completed at that level? If less than 1 grade, enter “00” Grade. __ __ WB6. Check WB4:  Secondary, secondary special or higher.  Go to the next module  Primary  Continue from WB7 WB7. Now I would like you to read the following sentence for me please. Show from the card the sentence to the respondent. If respondent is not able to read the sentence in full ask: Would you please read a part of this sentence? Can not read at all . 1 Can read partially . 2 Can read the sentence in full . 3 Absence of the sentence on a required language . 4 (specify the language) Blind/mute, visually / speech impaired . 5 333MONITORING THE SITUATION OF CHILDREN AND WOMEN 333MONITORING THE SITUATION OF CHILDREN AND WOMEN ACCESS TO MASS MEDIA AND USE OF INFORMATION/ COMMUNICATION TECHNOLOGY MT MT1. Check WB7:  Question left blank (Respondent has secondary or higher education)  Continue with MT2  Able to read or no sentence in required language (codes 2, 3 or 4)  Continue with MT2  Cannot read at all or blind (codes 1 or 5)  Go to MT3 MT2. How often do you read a newspaper or magazine: Almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MT4. How often do you watch television: Would you say that you watch almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MT5. Check WB2: Age of respondent between 15 and 24?  Yes, Age 15-24  Continue with the question MT6  No, Age 25-49  Go to the next module MT6. Have you ever used a computer? Yes . 1 No . 2 2MT9 MT7. Have you used a computer from any location in the last 12 months? Yes . 1 No . 2 2MT9 MT8. During the last one month, how often did you use a computer? almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MT9. Have you ever used the internet? Yes . 1 No . 2 2Next Module MT10. In the last 12 months, have you used the internet? Yes . 1 No . 2 2 Next Module MT11. During the last one month, how often did you use the internet? almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 334 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 334 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN CHILD MORTALITY CM All questions from CM1 to CM12 refer only to LIVE births. CM1. Now i would like to ask about all the births you have had during your life. Have you ever given birth? Yes . 1 No . 2 2CM8 CM2. What was the date of your first birth? I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner. Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3. Date of first birth Day . __ __ DK day . 98 Month. __ __ DK month. 98 Year . __ __ __ __ DK year. 9998 CM4 CM3. How many years ago did you have your first birth? Completed years since first birth .__ __ CM4. Do you have any sons or daughters to whom you have given birth who are now living with you? Yes .1 No .2 2CM6 CM5. How many sons live with you? How many daughters live with you? If none, record ‘00’. Sons at home .__ __ Daughters at home .__ __ CM6. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? Yes .1 No .2 2CM8 CM7. How many sons are alive but do not live with you? How many daughters are alive but do not live with you? If none, record ‘00’. Sons elsewhere . __ __ Daughters elsewhere. __ __ CM8. Have you ever given birth to a boy or girl who was born alive but later died? If “No” probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life – even if he or she lived only a few minutes or hours? Yes . 1 No .2 2CM10 CM9. How many boys have died? How many girls have died? If none, record ‘00’. Boys dead. __ __ Girls dead . __ __ CM10. Sum answers to CM5, CM7, and CM9. Sum . __ __ CM11. Just to make sure that I have this right, you have had in total (total number in CM10) live births during your life. Is this correct? 335MONITORING THE SITUATION OF CHILDREN AND WOMEN 335MONITORING THE SITUATION OF CHILDREN AND WOMEN  Yes. Check below:  No live births  Go to ILLNESS SYMPTOMS Module  One or more live births  Continue with CM12  No  Check responses to CM1-CM10 and make corrections as necessary before proceeding to CM12 CM12. Of these (total number in CM10) births you have had, when did you deliver the last one (even if he or she has died)? Month and year must be recorded. Date of last birth Day . __ __ DK day.98 Month. __ __ Year . __ __ __ __ CM12A. Women sometimes have pregnancies which do not end in a live born child. Have you ever had a pregnancy that miscarried, was aborted, or ended with a stillbirth? Yes . 1 No . 2 2CM13 CM12B. How many such pregnancies (miscarriages, abortions or stillbirths) have you had over your lifetime? Number of miscarriages, abortions and stillbirths . ___ ___ CM12C. When did the last such pregnancy (miscarriages, abortions or stillbirths) end? Fill in both the month and the year Month.___ ___ DK .98 Year .___ ___ ___ ___ DK .9998 CM12D. Check CM12C: Last miscarriage, abortion or stillbirth ended within the last 2 years, that is, since _____________________ (month of interview) in 2008  No miscarriages, abortions or stillbirths in last 2 years.  Go to CM13.  One or more miscarriages, abortions or stillbirths in last 2 years.  Continue with CM12E CM12E. Ask the respondent to tell you, in which Month and Year each miscarrieage, abortion or live birth had a place during last 2 years and record Month and Year for each pregnancy in CM12F, started from the last miscarriage, abortion or stillbirth. Then, ask to answer the questions from CM12G till CM12H for each miscarriage, abortion and stillbirth. Last miscarriage, abortion, stillbirth First Second Third Prior to the last miscarriage, abortion, stillbirth CM12F. In which Month and Year the previous pregnancy ended? Already filled in СМ12С – no need to fill in Month. ___ ___ Year . __ __ __ __ Month.___ ___ Year__ __ __ __ Month.___ ___ Year__ __ __ __ CM12G. How many Months you were pregnant, when this pregnancy ended? Months___ __ Months___ __ Months___ __ Months___ __ 336 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 336 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN CM12H. Did that pregnancy end in a spontaneous miscarriage, an induced abortion, or a stillbirth? Miscarriage .1 Abortion .2 Stillbirth .3 Miscarriage . 1 Abortion . 2 Stillbirth . 3 Miscarriage . 1 Abortion . 2 Stillbirth . 3 Miscarriage . 1 Abortion . 2 Stillbirth . 3 CM12I. Check CM12H, the column Last miscarriage, Abortion or Stillbirth Dis that pregnancy end with the induced abortion?  Yes  Continue with CM12J.  No  Go to CM13. CM12J. Now let me ask you about your last pregnancy which ended with the Abortion in ___________________Month and Year from CM12C). Who was the person that had the final say on taking the abortion decision? Doctor / a Health Worker . 01 Respondent . 02 Husband/Partner . 03 Respondent together with husband/partner 04 Parents . 05 Respondent together with girlfriend . 06 Relatives . 07 Other______________________ . 96 (specify) CM12K. Who made the abortion? Specify the person with the highest qualification Health Personnel Doctor .11 Nurse/Midwife . 12 Other Person Traditional Birth Attendant . 21 Relative/friend. 22 No one . 31 Other______________________ . 96 (specify) CM12L. Where did that abortion take place ? Probe to identify the type of place and circle the appropriate code. If unable to determine whether the abortion took place in a hospital, health center or clinic, public or private institution,, write down the name of the place that the respondent provided. Public Sector Hospital/Maternity Home .11 Policlinic/Ambulatory . 12 Woman’s Consultation . 13 Family Planning Center . 14 Medical Diagnostic Center. 15 FAP/Rural Health Post. 16 Other Public________________ . 26 (specify) Private Sector Hospital/Maternity Home . 31 Policlinic/Ambulatory . 32 Women’s Consultation . 33 Family Planning Center . 34 Medical Diagnostic Center. 35 FAP/Rural Health Post. 36 NGO . 37 Other Private Med._____________________ . 46 (specify) Home Your Home . 51 Other Home . 52 Other_______________________ . 96 (specify) 337MONITORING THE SITUATION OF CHILDREN AND WOMEN 337MONITORING THE SITUATION OF CHILDREN AND WOMEN CM12M. What abortion technique was used for that abortion? Do not tell the respondent the methods and techniques used for Abortion. Abortion produced by a drug (RU-486) . 01 Suction-Aspiration . 02 Dilation and Curettage . 03 Dilation and Evacuation . 04 Dilation and Extraction. 05 Prostaglandin Abortion . 06 Salt Poisoning (Saline Injection) . 07 Hysterectomy. 08 Other_______________________ . 96 (specify) DK . 98 CM13. Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2008  No live birth in last 2 years.  Go to ILLNESS SYMPTOMS Module.  One or more live births in last 2 years.  Ask for the name of the child. Name of child_______________________ If child has died, take special care when referring to this child by name in the following modules. Continue with the next module. DESIRE FOR LAST BIRTH DB This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Check child mortality module CM13 and record name of last-born child here _____________________. Use this child’s name in the following questions, where indicated. DB1. When you got pregnant with (name), did you want to get pregnant at that time? Yes.1 No.2 1Next Module DB2. Did you want to have a baby later on, or did you not want any (more) children? Later.1 No more.2 2Next Module DB3. How much longer did you want to wait? Months.1 __ __ Years.2 __ __ DK.998 338 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 338 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MATERNAL AND NEWBORN HEALTH MN This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Check child mortality module CM13 and record name of last-born child here _____________________. Use this child’s name in the following questions, where indicated. MN1. Did you see anyone for antenatal care during your pregnancy with (name)? Yes .1 No .2 2MN17 MN2. Whom did you see? Probe: Any one else? Probe for the type of person seen and circle all answers given. Health professional: Doctor _________________________A Nurse / Midwife _________________ B Auxiliary midwife ________________ C Feldsher _______________________ D Other person Traditional birth attendant __________F Other (specify) ____________________ X MN3. How many times did you receive antenatal care during this pregnancy? Number of times .__ __ DK .98 MN4. As part of your antenatal care during this pregnancy, were any of the following done at least once: [A] Was your blood pressure measured? [B] Did you give a urine sample? [C] Did you give a blood sample? Yes No Blood pressure 1 . 2 Urine sample 1 . 2 Blood sample 1 . 2 MN17. Who assisted with the delivery of (name)? Probe: Any one else? Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. Health professional: Doctor .A Nurse / Midwife .B Auxiliary midwife . C Feldsher. D Other person Traditional birth attendant . F Community health worker . G Relative / Friend .H Other (specify) _____________________X No one . Y MN18. Where did you give birth to (name)? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Home Your home . 11 Other home .12 Public sector Govt. hospital/maternity .21 Govt. clinic / health centre .22 Other public (specify) _____________26 11MN20 12MN20 339MONITORING THE SITUATION OF CHILDREN AND WOMEN 339MONITORING THE SITUATION OF CHILDREN AND WOMEN Private Medical Sector Private hospital .31 Private clinic .32 Private maternity home .33 Other private medical (specify) ________________36 Other (specify) .96 96MN20 MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out? Yes .1 No .2 MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small? Very large .1 Larger than average .2 Average .3 Smaller than average .4 Very small .5 DK .8 MN21. Was (name) weighed at birth? Yes . 1 No . 2 DK . 8 2MN23 8MN23 MN22. How much did (name) weigh? Record weight from health card, if available. From card . 1 (kg) __ . __ __ __ From recall . 2 (kg) __ . __ __ __ DK .99998 MN23. Has your menstrual period returned since the birth of (name)? Yes .1 No .2 MN24. Did you ever breastfeed (name)? Yes .1 No .2 2Next Module MN25. How long after birth did you first put (name) to the breast? If less than 1 hour, record ‘00’ hours. If less than 24 hours, record hours. Otherwise, record days. Immediately .000 Hours .1 __ __ Days .2 __ __ Don’t know / remember .998 MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk? Yes .1 No .2 2 Next Module MN27. What was (name) given to drink? Probe: Anything else? Milk (other than breast milk) . A Plain water . B Sugar or glucose water.C Gripe water .D Sugar-salt-water solution . E Fruit juice . F Infant formula.G Tea / Infusions .H Honey .I Other (specify) . X 340 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 340 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN ILLNESS SYMPTOMS IS IS1. Check Household Listing, column HL9 Is the respondent the mother or caretaker of any child under age 5?  Yes  Continue with IS2.  No  Go to Next Module. IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions Child not able to drink or breastfeed. A Child becomes sicker . B Child develops a fever .C Child has fast breathing .D Child has difficult breathing . E Child has blood in stool . F Child is drinking poorly .G Other (specify) ______________________ X Other (specify) ______________________ Y Other (specify) ______________________ Z CONTRACEPTION CP CP1. I would like to talk with you about another subject – family planning. Are you pregnant now? Yes, currently pregnant .1 No .2 Unsure or DK .8 1Next Module CP2. Couples use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant? Yes . 1 No . 2 2Next Module CP3. What are you doing to delay or avoid a pregnancy? Do not prompt. If more than one method is mentioned, circle each one. Female sterilization. A Male sterilization . B IUD .C Injectables .D Implants . E Pill . F Male condom .G Female condom .H Diaphragm . I Foam / Jelly .J Lactational amenorrhoea method (LAM) . K Periodic abstinence / Rhythm .L Withdrawal . M Other (specify) ______________________X 341MONITORING THE SITUATION OF CHILDREN AND WOMEN 341MONITORING THE SITUATION OF CHILDREN AND WOMEN UNMET NEEDS UN UN1. Check CP1. Currently pregnant?  Yes, currently pregnant  Continue with UN2  No, unsure or DK  Go to UN5 UN2. Now I would like to talk to you about your current pregnancy. When you got pregnant, did you want to get pregnant at that time? Yes . 1 No . 2 1UN4 UN3. Did you want to have a baby later on or did you not want any (more) children? Later .1 No more .2 UN4. Now I would like to ask some questions about the future. After the child you are now expecting, would you like to have another child, or would you prefer not to have any more children? Have another child. 1 Would prefer no more / None . 2 Undecided / DK . 8 1UN7 2UN13 8UN13 UN5. Check CP3. Currently using “Female sterilization”?  Yes  Go to UN13  No  Continue with UN6 UN6. Now I would like to ask you some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children? Have (a/another) child . 1 Would prefer no more / None . 2 Says she cannot get pregnant . 3 Undecided / DK . 8 2UN9 3UN11 8UN9 UN7. How long would you like to wait before the birth of (a/another) child? Months . 1 __ __ Years . 2 __ __ Soon / Now . 993 Says she cannot get pregnant . 994 After marriage . 995 Other. 996 DK . 998 994UN11 UN8. Check CP1. Currently pregnant?  Yes, currently pregnant  Go to UN13  No, unsure or DK  Continue with UN9 UN9. Check CP2. Currently using a method?  Yes  Go to UN13  No  Continue with UN10 UN10. Do you think you are physically able to get pregnant at this time? Yes .1 No .2 DK .8 1 UN13 8 UN13 342 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 342 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN UN11. Why do you think you are not physically able to get pregnant? Infrequent sex / No sex. A Menopausal . B Never menstruated .C Hysterectomy (surgical removal of uterus) .D Has been trying to get pregnant for 2 years or more without result . E Postpartum amenorrheic . F Breastfeeding .G Too old .H Fatalistic . I Other (specify) ______________________X Don’t know . Z UN12. Check UN11. “Never menstruated” mentioned?  Mentioned  Go to Next Module  Not mentioned  Continue with UN13 UN13. When did your last menstrual period start? Days ago .1 __ __ Weeks ago .2 __ __ Months ago .3 __ __ Years ago .4 __ __ In menopause / Has had hysterectomy .994 Before last birth .995 Never menstruated .996 ATTITUDES TOWARD DOMESTIC VIOLENCE DV DV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: [A] If she goes out without telling him? [B] If she neglects the children? [C] If she argues with him? [D] If she refuses to have sex with him? [E] If she burns the food? Yes No DK Goes out without telling . 1 2 8 Neglects children . 1 2 8 Argues with him . 1 2 8 Refuses sex . 1 2 8 Burns food . 1 2 8 343MONITORING THE SITUATION OF CHILDREN AND WOMEN 343MONITORING THE SITUATION OF CHILDREN AND WOMEN MARRIAGE/UNION MA MA1. Are you currently married or living together with a man as if married? Yes, currently married . 1 Yes, living with a man . 2 No, not in union . 3 3MA5 MA2. How old is your husband/partner? Probe: How old was your husband/ partner on his last birthday? Age in years. __ __ DK . 98 MA7 MA7 MA5. Have you ever been married or lived together with a man as if married? Yes, formerly married . 1 Yes, formerly lived with a man . 2 No . 3 3 Next Module MA6. What is your marital status now: are you widowed, divorced or separated? Widowed . 1 Divorced . 2 Separated . 3 MA7. Have you been married or lived with a man only once or more than once? Only once . 1 More than once. 2 MA8. In what month and year did you first marry or start living with a man as if married? Date of the first marriage Month. __ ___ DK month. 98 Year . __ ___ DK year. 9998 Next Module MA9. How old were you when you started to live with your husband/partner? Age in years. ___ ___ SEXUAL BEHAVIOUR SB SB1А. Check WB2: Age of the respondent between 15 and 24?  Yes, age 15-24 Continue from the question SB1  No, age 25-49  Go to next module Check for the presence of others. Before continuing, ensure privacy. SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. The information you supply will remain strictly confidential. How old were you when you had sexual intercourse for the very first time? Never had intercourse.00 Age in years First time when started living with (first) husband/partner.95 00Next Module SB2. The first time you had sexual intercourse, was a condom used? Yes.1 No.2 DK / Don’t remember.8 SB3. When was the last time you had sexual intercourse? Record ‘years ago’ only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years. Days ago.1 __ __ Weeks ago.2 __ __ Months ago.3 __ __ Years ago.4 __ __ 4SB15 SB4. The last time you had sexual intercourse, was a condom used? Yes.1 No.2 344 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 344 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN SB5. What was your relationship to this person with whom you last had sexual intercourse? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If ‘boyfriend’, then ask: Were you living together as if married? If ‘yes’, circle ‘2’. If ‘no’, circle‘3’. Husband.1 Cohabiting partner.2 Boyfriend.3 Casual acquaintance.4 Other (specify)…….……….6 3SB7 4SB7 6SB7 SB6. Check MA1:  Currently married or living with a man (MA1 = 1 or 2)  Go to SB8  Not married / Not in union (MA1 = 3)  Continue with SB7 SB7. How old is this person? If response is DK , probe: About how old is this person? Age of sexual partner.__ __ DK .98 SB8. Have you had sexual intercourse with any other person in the last 12 months? Yes.1 No.2 2SB15 SB9. The last time you had sexual intercourse with this other person, was a condom used? Yes.1 No.2 SB10. What was your relationship to this person? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If ‘boyfriend’ then ask: Were you living together as if married? If ‘yes’, circle ‘2’. If ‘no’, circle’ 3’. Husband.1 Cohabiting partner.2 Boyfriend.3 Casual acquaintance.4 Other (specify)________________6 3SB12 4SB12 6SB12 SB11. Check MA1 and MA7:  Currently married or living with a man (MA1 = 1 or 2) AND Married only once or lived with a man only once (MA7 = 1)  Go to SB13  Else  Continue with SB12 SB12. How old is this person? If response is DK, probe: About how old is this person? Age of sexual partner.__ __ DK .98 SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months? Yes.1 No.2 2SB15 SB14. In total, with how many different people have you had sexual intercourse in the last 12 months? Number of partners.__ __ SB15. In total, with how many different people have you had sexual intercourse in your lifetime? If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write ‘95’. Number of lifetime partners__ __ DK .98 345MONITORING THE SITUATION OF CHILDREN AND WOMEN 345MONITORING THE SITUATION OF CHILDREN AND WOMEN HIV/AIDS HA HA1. Now I would like to talk with you about something else. Have you ever heard of an illness called HIV? Yes .1 No .2 2Next Module HA2. Can people reduce their chance of getting the HIV virus by having just one uninfected sex partner who has no other sex partners? Yes . 1 No . 2 DK . 8 HA3. Can people get the HIV virus because of witchcraft or other supernatural means? Yes . 1 No . 2 DK . 8 HA4. Can people reduce their chance of getting the HIV virus by using a condom every time they have sex? Yes . 1 No . 2 DK . 8 HA5. Can people get the HIV virus from mosquito bites? Yes . 1 No . 2 DK . 8 HA6. Can people get the HIV virus by sharing food with a person who has the HIV virus? Yes . 1 No . 2 DK . 8 HA7. Is it possible for a healthy-looking person to have the HIV virus? Yes . 1 No . 2 DK . 8 HA8. Can the virus that causes HIV be transmitted from a mother to her baby: [A] During pregnancy? [B] During delivery? [C] By breastfeeding? Yes No DK During pregnancy . 1 2 8 During delivery. 1 2 8 By breastfeeding. 1 2 8 HA9. In your opinion, if a female teacher has the HIV virus but is not sick, should she be allowed to continue teaching in school? Yes . 1 No . 2 DK / Not sure / Depends. 8 HA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the HIV virus? Yes . 1 No . 2 DK / Not sure / Depends. 8 HA11. If a member of your family got infected with the HIV virus, would you want it to remain a secret? Yes . 1 No . 2 DK / Not sure / Depends. 8 HA12. If a member of your family became sick with HIV, would you be willing to care for her or him in your own household? Yes . 1 No . 2 DK / Not sure / Depends. 8 HA13. Check CM13: Any live birth in last 2 years?  No live birth in last 2 years  Go to HA24  One or more live births in last 2 years  Continue with HA14 HA14. Check MN1: Received antenatal care?  Received antenatal care  Continue with HA15  Did not receive antenatal care  Go to HA24 346 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 346 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN HA15. During any of the antenatal visits for your pregnancy with (name), were you given any information about AIDS or HIV? Yes.1 No.2 DK .8 HA15A. During any of the antenatal visits for your pregnancy with (name), were you given any information about: [A] Babies getting the HIV virus from their mother? [B] Things that you can do to prevent getting the HIV virus? [C] Getting tested for the HIV virus? were you: [D] offered a test for the HIV virus? Y N DK AIDS from mother . 1 2 8 Things to do . 1 2 8 Tested for AIDS. 1 2 8 Offered a test . 1 2 8 HA16. I don’t want to know the results, but were you tested for the HIV virus as part of your antenatal care? Yes . 1 No . 2 DK . 8 2HA19 8HA19 HA17. I don’t want to know the results, but did you get the results of the test? Yes . 1 No . 2 DK . 8 2HA22 8HA22 HA18. Regardless of the result, all women who are tested are supposed to receive counseling after getting the result. After you were tested, did you receive counselling? Yes . 1 No . 2 DK . 8 1HA22 2HA22 8HA22 HA19. Check MN17: Birth delivered by health professional (A, B, C or D)?  Yes, birth delivered by health professional  Continue with HA20  No, birth not delivered by health professional  Go to HA24 HA20. I don’t want to know the results, but were you tested for the HIV virus between the time you went for delivery but before the baby was born? Yes . 1 No . 2 2HA24 HA21. I don’t want to know the results, but did you get the results of the test? Yes . 1 No . 2 HA22. Have you been tested for the HIV virus since that time you were tested during your pregnancy? Yes . 1 No . 2 1HA25 HA23. When was the most recent time you were tested for the HIV virus? Less than 12 months ago . 1 12-23 months ago. 2 2 or more years ago . 3 1Next module 2Next module 3Next module HA24. I don’t want to know the results, but have you ever been tested to see if you have the HIV virus? Yes . 1 No . 2 2HA27 HA25. When was the most recent time you were tested? Less than 12 months ago . 1 12-23 months ago. 2 2 or more years ago . 3 HA26. I don’t want to know the results, but did you get the results of the test? Yes . 1 No . 2 DK . 8 1Next module 2Next module 8Next module HA27. Do you know of a place where people can go to get tested for the HIV virus? Yes . 1 No . 2 347MONITORING THE SITUATION OF CHILDREN AND WOMEN 347MONITORING THE SITUATION OF CHILDREN AND WOMEN TOBACCO AND ALCOHOL USE TA TA1. Have you ever tried cigarette smoking, even one or two puffs? Yes .1 No .2 2TA6 TA2. How old were you when you smoked a whole cigarette for the first time? Never smoked a whole cigarette . 00 Age .___ ___ 00TA6 TA3. Do you currently smoke cigarettes? Yes .1 No .2 2TA6 TA4. In the last 24 hours, how many cigarettes did you smoke? Number of cigarettes .___ ___ TA5. During the last one month, on how many days did you smoke cigarettes? If less than 10 days, record the number of days. If 10 days but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days .0 ___ 10 days or more, but less than a month .10 Everyday / Almost every day .30 TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe? Yes .1 No .2 2TA10 TA7. During the last one month, did you use any smoked tobacco products? Yes .1 No .2 2TA10 TA8. What type of smoked tobacco product did you use or smoke? Circle all mentioned. Cigars ____________________________A Water pipe _________________________B Cigarillos _________________________ C Pipe _____________________________ D Other (specify) ______________________X TA9. During the last one month, on how many days did you use smoked tobacco products? If less than 10 days, record the number of days. If 10 days or more, but less than a month circle “10”. If “everyday” or “almost every day”, circle “30” Number of days .0 ___ 10 days or more but less than a month .10 Everyday / Almost every day .30 TA10. Have you tried other types of tabacco products free of smoke, such as chewing tabacco, snuff and dip?. Yes . 1 No . 2 2 TA14 TA11. During the last one month, did you use any smokeless tobacco products? Yes .1 No .2 2 TA14 TA12. What type of smokeless tobacco product did you use? Circle all mentioned. Chewing tobacco ____________________A Snuff _____________________________B Nasybai __________________________ C Other (specify) ______________________X TA13. During the last one month, on how many days did you use smokeless tobacco products? If less than 10 days, record the number of days. If 10 days or more but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days .0 ___ 10 days or more but less than a month .10 Everyday / Almost every day .30 348 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 348 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN TA14. Now I would like to ask you some questions about drinking alcohol. Have you ever drunk alcohol? Yes .1 No .2 2Next Module TA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or one shot of cognac, vodka, whiskey or rum. How old were you when you had your first drink of alcohol, other than a few sips? Never had one drink of alcohol . 00 Age . ___ ___ 00Next Module TA16. During the last one month, on how many days did you have at least one drink of alcohol? If respondent did not drink, circle “00”. If less than 10 days, record the number of days. If 10 days or more, circle “10”. If “everyday” or “almost every day”, circle “30” Did not have one drink in last one month 00 Number of days . 0 ___ 10 days or more. 10 Everyday / Almost every day . 30 00Next Module TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have? Number of drinks . ___ ___ DOMESTIC VIOLENCE DA DA1А. Check the question WM6A, from the information section about woman  Woman SELECTED for questions on Domestic Violence module  Continue from DA1В.  Woman NOT SELECTED for questions on Domestic Violence module  Go to WM11 DA1В. Check if anybody else is presented in the room. Do not continue unless you get the privacy with the respondent:  Privacy obtained  Continue from DA2  Privacy not possible  Go to DA34 Read to the respondent: Now I would like to ask you questions about some other important aspects of a woman’s life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in kazakhstan. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions. DA2. Check МА1 and МА5  Currently married or living with a man  Continue with DA3  Was married or lived with a man  Continue with DA3, but read questions in a past tense  Never married and never lived with a man  Go to DA14B 349MONITORING THE SITUATION OF CHILDREN AND WOMEN 349MONITORING THE SITUATION OF CHILDREN AND WOMEN DA3. First, I’m going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/ partner? [A] He (is/was) jealous or angry if you (talk/ talked) to other men? [B] He frequently (accuses/accused) you of being unfaithful? [C] He (does/did) not permit you to meet your female friends? [D] He (tries/tried) to limit your contact with your family? [E] He (insists/insisted) on knowing where you (are/were) at all times? [F] He (does/did) not trust you with any money? Yes No DK Jealous) .1 2 8 Accuses . 1 2 8 Not meet friends.1 2 8 No family.1 2 8 Where you are.1 2 8 Money.1 2 8 DA4. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question: [A1]. did your (last) husband/partner ever say or do something to humiliate you in front of others? Yes .1 No .2 2 B1 [А2]. Check МА6  If Respondent is not widow  Continue with A3  If Respondent is widow  Go to B1 [A3]. How often did this happen during the last 12 months? Often . 1 Sometimes . 2 Never . 3 [B1]. Your (ex) husband/partner threatened to hurt or harm you or someone else close to you? Yes . 1 No . 2 2 C1 [В2]. Check МА6  If Respondent is not widow  Continue with B3  If Respondent is widow  Go to C1 [B3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often .1 Sometimes .2 Never . 3 [C1]. Your (ex) husband/partner insulted you or made you feel bad about yourself? Yes . 1 No . 2 2 DA5 [С2]. Check МА6  If Respondent is not widow  Continue with C3  If Respondent is widow  Go to DA5 [C3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often .1 Sometimes .2 Never .3 350 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 350 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN DA5. (Does/did) your (last) husband/partner ever do any of the following things to you: [A1]. Push you, shake you, or throw something at you? Yes .1 No .2 2 B1 [А2]. Check МА6  If Respondent is not widow  Continue with A3  If Respondent is widow  Go to B1 [A3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never . 3 [B1]. Does/did) your (last) husband/ partner slaped you? Yes . 1 No . 2 2 C1 [В2]. Check МА6  If Respondent is not widow  Continue with B3  If Respondent is widow  Go to C1 [B3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never . 3 [C1]. Does/did your (last) husband/partner twist your arm or pull your hair? Yes . 1 No.2 2 D1 [C2]. Check МА6  If Respondent is not widow  Continue with C3  If Respondent is widow  Go to D1 C3. How often did this happen during the last 12 months: Often, Sometimes, Never? Often .1 Sometimes .2 Never .3 [D1]. Does/did your (last) husband/partner punch you with his fist or with something that could hurt you? Yes .1 No.2 2 E1 [D2]. Check МА6  If Respondent is not widow  Continue with D3  If Respondent is widow  Go to E1 [D3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never .3 [E1]. Does/did your (last) husband/partner kick you, drag you or beat you up? Yes .1 No.2 2 F1 [E2]. Check МА6  If Respondent is not widow  Continue with E3  If Respondent is widow  Go to F1 [E3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often .1 Sometimes .2 Never .3 351MONITORING THE SITUATION OF CHILDREN AND WOMEN 351MONITORING THE SITUATION OF CHILDREN AND WOMEN F1. Does/did your (last) husband/partner try to choke you or burn you on purpose? Yes.1 No.2 2 G1 [F2]. Check МА6  If Respondent is not widow  Continue with F3  If Respondent is widow  Go to G1 [F3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never .3 [G1]. Does/did your (last) husband/partner threaten or attack you with a knife, gun, or any other weapon? Yes.1 No.2 2 H1 [G2]. Check МА6  If Respondent is not widow  Continue with G3  If Respondent is widow  Go to H1 [G3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never .3 [H1]. Does/did your (last) husband/partner physically force you to have sexual intercourse with him even when you did not want to? Yes . 1 No.2 2 I1 [H2]. Check МА6  If Respondent is not widow  Continue with H3  If Respondent is widow  Go to I1 [H3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never .3 [I1]. Does/did your (last) husband/partner Force you to perform any sexual acts you did not want to? Yes.1 No.2 2 DA6 [I2]. Check МА6  If Respondent is not widow  Continue with I3  If Respondent is widow  Go to DA6 [I3]. How often did this happen during the last 12 months: Often, Sometimes, Never? Often . 1 Sometimes . 2 Never .3 DA6. Check DA6  At least one «Yes»  Continue with DA7  Not a single «Yes»  Go to DA9 DA7. How long after you first got married/ started living with your ( last) husband/ partner did (This/any of these things) first happen? If less than one year, record ’00’. Number of years . __ __ Before marriage/before living together . 95 352 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 352 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN DA8. Did the following ever happen as a result of what your ( last) husband/partner did to you: [A] You had cuts, bruises or arches? [B] You had eye injuries, sprains, dislocations, or burns? [C] You had deep wounds, broken bones, broken teeth, or any other serious injury? Yes No Cuts, bruises.1 2 Eye injuries, sprains, dislocations, burns . .1 2 Deep wounds, broken bones, broken teeth or other serious injury….1 2 DA9. Have you ever hit, slapped, kicked, or done anything else to physically hurt your ( last) husband/partner at times when he was not already beating or physically hurting you? Yes .1 No .2 2DA12 DA10. Check МА6  If Respondent is not widow  Continue with DA11  If Respondent is widow  Go to DA12 DA11. In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all Often .1 Only Sometimes .2 Never .3 DA12. Does (did) your husband/partner drink alcohol? Yes .1 No .2 2DA14 DA13. How often does (did) he get drunk: often, only sometimes, or never? Often . 1 Only Sometimes . 2 Never . 3 DA14. Check МА1 and МА5  Married or live with a man in unofficial union /was married or lived with a man in unofficial union  Continue from DA14A  Was never married or never lived with a man in unofficial union  Go to DA14B DA14A. From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically? Yes .1 No .2 Refused to answer/No answer.3 1DA15 2DA17 3DA17 DA14В. From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?? Yes .1 No .2 Refused to answer/No answer .3 2DA173 DA17 DA15. Who has hurt you in this way? Anyone else? Circle all mentioned. Mother/Step-mother ________________ A Father/Step-father _________________ B Sister/Brother _____________________ C Daughter/Son ____________________ D Other relative _____________________ E Former husband/Partner ____________ F Current boyfriend __________________G Former boyfriend __________________ H Mother-in-law ______________________I Father-in-law _____________________ J Other –in-law _____________________ K Teacher _________________________ L Employer/Someone at work _________M Police/Soldier _____________________ N Other (specify) ____________________ X 353MONITORING THE SITUATION OF CHILDREN AND WOMEN 353MONITORING THE SITUATION OF CHILDREN AND WOMEN DA16. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all? Often .1 Sometimes .2 Never .3 DA17. Check CM1, CM12, и CP1  Ever been pregnant, the pregnancy ended with maiscarriage, abortion or stillbirth  Continue with DA18  Never been pregnant  Go to DA20 DA18. Has anyone hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant? Yes .1 No .2 2DA20 DA19. Who has done any of these things to physically hurt you while you were pregnant? Anyone else? Circle all mentioned. Current husband/Partner .A Mother/Step-mother.B Father/Step-father .C Sister/Brother.D Daughter/Son .E Other relative .F Former husband/Partner . G Current boyfriend .H Former boyfriend . I Mother-in-law . J Father-in law .K Other in -law . L Teacher . M Employer/Someone at work .N Police/Soldier. O Other (specify) .X DA20. Check: have you had sexual intercourse?  Has had sexual intercourse before  Contirnue from DA21  Has never had sexual intercourse before  Go to DA28 DA21. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will? Wanted to . 1 Forced to . 2 Refused to answer/No response . 3 DA22. Check МА1 and МА5  Married or lives with a man in unofficial marriage / was married or lived with a man in unofficial marriage  Continue from DA22A  Not married or never lived with a man in unofficial marriage  Go to DA22B DA22А. In the last 12 months has anyone apart from your (present/former) husband forced you to have sexual intercourse against your will? Yes .1 No .2 Refused answer/no answer .3 1DA28 2DA28 3DA28 DA22В. In the last 12 months has anyone forced you to have sexual intercourse against your will? Yes .1 No .2 Refused answer/no answer .3 DA28. Check DA5 (A,B,C,D,E,F,G,H,I), DA14 (A,B) , DA18, DA21, DA22 (A,B) ( If there is an answer ‘Yes’ to one of these questions or DA21=2 ( Continue from DA29  If no ‘Yes’  Go to DA32 354 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN 354 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN DA29. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person (s) form doing this to you again? Yes . 1 No . 2 2DA31 DA30. From whom have you sought help? Anyone else? Circle all mentioned Own family . A Husband/Partner’s family . B Current/Last/Late husband/Partner . C Current/Former boyfriend .D Relatives . E Neighbor . F Religious Leader.G Doctor/Medical personnel .H Police .I Lawyer .J Social service organization . K Other (specify) . X  DA32  DA32  DA32  DA32  DA32  DA32  DA32  DA32  DA32  DA32  DA32  DA32 DA31. Have you ever told anyone else about this? Yes .1 No 2 DA32. As far as you know, did your father ever beat your mother? Yes .1 No .2 DK .8 Thank the respondent for her cooperation and reassure her about the confidentially of her answers. Fill out the questions below with reference to the domestic violence module only. DA33. Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interrupted it in any other way? Once More than once No Husband .1.2 . 8 Other male adult.1 .2 .8 Female adult .1 .2.8 DA34. Interviewer’s comments/ Explanation for not completing the domestic violence module WM11. Record the time. Hour and minutes . __ __ : __ __ WM12. Check Household Listing Form, column HL9. Is the respondent the mother or caretaker of any child age 0-4 living in this household?  Yes  Go to QUESTIONNAIRE FOR CHILDREN UNDER 5 for that child and start the interview with this respondent.  No  End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman or children under-5 in the household. 355MONITORING THE SITUATION OF CHILDREN AND WOMEN 355MONITORING THE SITUATION OF CHILDREN AND WOMEN Interviewer’s Observations Field Editor’s Observations 356 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN UNICEF UNITED NATIONS CHILDREN’S FUND IN THE REPUBLIC OF KAZAKHSTAN AGENCY OF STATISTICS, THE REPUBLIC OF KAZAKHSTAN QUESTIONNAIRE FOR INDIVIDUAL MEN MAN’S INFORMATION PANEL ME This questionnaire is to be administered to a man age 15 through 59, selected for Men’s Individual Questionnaire (see Household Listing Form, line HH20BС Instruction for selection of a man for Men’s Individual Questionnaire). A separate questionnaire should be used for eligible man. ME1. Cluster number: ME2. Household number: ___ ___ ___ ___ ___ ME3. Man’s name: ME4. Man’s line number: Name . ___ ___ ME5. Interviewer name and number: ME6. Day / Month / Year of interview: Name . ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___ Repeat greeting if not already read to this man: We are from Agency of Statistics, the Republic of Kazakhstan. We are working on a project concerned with family health, education, status of women and children. I would like to talk to you about these subjects. The interview will take about 10 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. If greeting at the beginning of the household questionnaire has already been read to this man, then read the following: Now I would like to talk to you more about your health and other topics. This interview will take about 10 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. May I start now?  Yes, permission is given  Go to ME10 to record the time and then begin the interview.  No, permission is not given  Complete ME7. Discuss this result with your supervisor. ME7. Result of man’s interview Completed .01 Not at home .02 Refused .03 Partly completed.04 Incapacitated.05 Other (specify) .96 ME8. Field edited by (Name and number): Name __________________________ ___ ___ ME9. Data entry clerk (Name and number): Name __________________________ ___ ___ ME10. Record the time. Hour and minutes . __ __ : __ __ 357MONITORING THE SITUATION OF CHILDREN AND WOMEN MAN’S BACKGROUND MB MB1. In what month and year were you born? Date of birth Month . __ __ DK month . 98 Year . __ __ __ __ DK year . 9998 MB2. How old are you? Probe: How old were you at your last birthday? Compare and correct MB1 and/or MB2 if inconsistent Age (in completed years). __ __ MB3. Have you ever attended school or preschool? Yes . 1 No . 2 2MB7 MB4. What is the highest level of school you attended? Preschool. 0 Primary . 1 Secondary . 2 Higher . 3 0MB7 MB5. What is the highest grade you completed at that level? If less than 1 grade, enter “00” Grade. __ __ MB6. Check MB4:  Secondary, secondary-special or higher.  Go to Next Module  Primary  Continue with MB7 MB7. Now I would like you to read this sentence to me. Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me? Cannot read at all . 1 Able to read only parts of sentence . 2 Able to read whole sentence . 3 No sentence in required language _________________ 4 (specify language) Blind / mute, visually / speech impaired . 5 358 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN ACCESS TO MASS MEDIA AND USE OF INFORMATION/ COMMUNICATION TECHNOLOGY MMT MMT1. Check MB7:  Question left blank (Respondent has secondary, secondary-special or higher education)  Continue with MMT2  Able to read or no sentence in required language (codes 2, 3 or 4)  Continue with MMT2  Cannot read at all or blind (codes 1 or 5)  Go to MMT3 MMT2. How often do you read a newspaper or magazine: Almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MMT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MMT4. How often do you watch television: Would you say that you watch almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MMT5. Check MB2: Age of respondent between 15 and 24?  Age 15-24  Continue with MMT6  Age 25-59  Go to Next Module MMT6. Have you ever used a computer? Yes . 1 No . 2 2MMT9 MMT7. Have you used a computer from any location in the last 12 months? Yes . 1 No . 2 2MMT9 MMT8. During the last one month, how often did you use a computer? almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 MMT9. Have you ever used the internet? Yes . 1 No . 2 2Next Module MMT10. In the last 12 months, have you used the internet? If necessary, probe for use from any location, with any device. Yes . 1 No . 2 2 Next Module MMT11. During the last one month, how often did you use the internet? almost every day, at least once a week, less than once a week or not at all? Almost every day . 1 At least once a week . 2 Less than once a week . 3 Not at all . 4 359MONITORING THE SITUATION OF CHILDREN AND WOMEN CONTRACEPTION MCP MCP2. Couples use various ways or methods to delay or avoid a pregnancy. Are you or (any of) your partners currently doing something or using any method to delay or avoid getting pregnant? Yes . 1 No . 2 2Next Module MCP3. What are you doing to delay or avoid a pregnancy? Do not prompt. If more than one method is mentioned, circle each one. Female sterilization. A Male sterilization . B IUD .C Injectables .D Implants . E Pill . F Male condom .G Female condom .H Diaphragm . I Foam / Jelly .J Lactational amenorrhoea method (LAM) . K Periodic abstinence / Rhythm .L Withdrawal . M Other (specify) ______________________X ATTITUDES TOWARD DOMESTIC VIOLENCE MDV MDV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: [A] If she goes out without telling him? [B] If she neglects the children? [C] If she argues with him? [D] If she refuses to have sex with him? [E] If she burns the food? Yes No DK Goes out without telling 1 2 8 Neglects children 1 2 8 Argues with him 1 2 8 Refuses sex 1 2 8 Burns food 1 2 8 MARRIAGE/UNION MMA MMA1. Are you currently married or living together with a woman as if married? Yes, currently married . 1 Yes, living with a man . 2 No, not in union . 3 3MMA5 MMA2. How old is your wife/partner? Probe: How old was your wife/partner on her last birthday? Age in years. __ __ DK. 98 3MMA7 3MMA7 MMA5. Have you ever been married or lived together with a woman as if married? Yes, formerly married . 1 Yes, formerly lived with a woman . 2 No . 3 3 Next Module 360 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MMA6. What is your marital status now: are you widowed, divorced or separated? Widowed . 1 Divorced . 2 Separated . 3 MMA7. Have you been married or lived with a woman only once or more than once? Only once . 1 More than once. 2 MMA8. In what month and year did you first marry or start living with a woman as if married? Date of first marriage Month. __ __ DK month. 98 Year . __ __ __ __ DK year. 9998 Next Module MMA9. How old were you when you started living with your first wife/partner? Age in years. __ __ SEXUAL BEHAVIOUR MSB MSB1А. Check МB2: Age of respondent from 15 to 24?  Age 15-24  Proceed with MSB1В  Age 25-59  Go to the next module Check for the presence of others. Before continuing, ensure privacy. MSB1B. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. The information you supply will remain strictly confidential. How old were you when you had sexual intercourse for the very first time? Never had intercourse . 00 Age in years. __ __ First time when started living with (first) wife/partner . 95 00Next Module MSB2. The first time you had sexual intercourse, was a condom used? Yes . 1 No . 2 DK / Don’t remember . 8 MSB3. When was the last time you had sexual intercourse? Record ‘years ago’ only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years. Days ago . 1 __ __ Weeks ago . 2 __ __ Months ago . 3 __ __ Years ago . 4 __ __ 4MSB15 MSB4. The last time you had sexual intercourse, was a condom used? Yes . 1 No . 2 361MONITORING THE SITUATION OF CHILDREN AND WOMEN MSB5. What was your relationship to this person with whom you last had sexual intercourse? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If ‘girlfriend’, then ask: Were you living together as if married? If ‘yes’, circle ‘2’. If ‘no’, circle‘3’. Wife . 1 Cohabiting partner . 2 Girlfriend . 3 Casual acquaintance . 4 Prostitute . 5 Other (specify) ______________________ 6 3MSB7 4MSB7 5MSB7 6MSB7 MSB6. Check MMA1:  Currently married or living with a woman (MMA1 = 1 or 2)  Go to MSB8  Not married / Not in union (MMA1 = 3)  Continue with MSB7 MSB7. How old is this person? If response is DK, probe: About how old is this person? Age of sexual partner . __ __ DK. 98 MSB8. Have you had sexual intercourse with any other person in the last 12 months? Yes . 1 No . 2 2MSB15 MSB9. The last time you had sexual intercourse with this other person, was a condom used? Yes . 1 No . 2 MSB10. What was your relationship to this person? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If ‘girlfriend’ then ask: Were you living together as if married? If ‘yes’, circle ‘2’. If ‘no’, circle’ 3’. Wife . 1 Cohabiting partner . 2 Girlfriend . 3 Casual acquaintance . 4 Prostitute . 5 Other (specify) ______________________ 6 3MSB12 4MSB12 5MSB12 6MSB12 MSB11. Check MMA1 and MMA7:  a) Currently married or living with a woman (MMA1 = 1 or 2) AND b) Married only once or lived with a woman only once (MMA7 = 1) Go to MSB13  Else  Continue with MSB12 MSB12. How old is this person? If response is DK, probe: About how old is this person? Age of sexual partner . __ __ DK. 98 MSB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months? Yes . 1 No . 2 2MSB15 MSB14. In total, with how many different people have you had sexual intercourse in the last 12 months? Number of partners. __ __ 362 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MSB15. In total, with how many different people have you had sexual intercourse in your lifetime? If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write ‘95’. Number of lifetime partners . __ __ DK. 98 HIV/AIDS MHA MHA1. Now I would like to talk with you about something else. Have you ever heard of an illness called HIV? Yes . 1 No . 2 2Next Module MHA2. Can people reduce their chance of getting the HIV virus by having just one uninfected sex partner who has no other sex partners? Yes . 1 No . 2 DK. 8 MHA3. Can people get the HIV virus because of witchcraft or other supernatural means? Yes . 1 No . 2 DK. 8 MHA4. Can people reduce their chance of getting the HIV virus by using a condom every time they have sex? Yes . 1 No . 2 DK. 8 MHA5. Can people get the HIV virus from mosquito bites? Yes . 1 No . 2 DK. 8 MHA6. Can people get the HIV virus by sharing food with a person who has the AIDS virus? Yes . 1 No . 2 DKм8 MHA7. Is it possible for a healthy-looking person to have the HIV virus? Yes . 1 No . 2 DK. 8 MHA8. Can the virus that causes HIV be transmitted from a mother to her baby: [A] During pregnancy? [B] During delivery? [C] By breastfeeding? Yes No DK During pregnancy 1 2 8 During delivery 1 2 8 By breastfeeding 1 2 8 MHA9. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school? Yes . 1 No . 2 DK / Not sure / Depends. 8 MHA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the HIV virus? Yes . 1 No . 2 DK / Not sure / Depends. 8 MHA11. If a member of your family got infected with the HIV virus, would you want it to remain a secret? Yes . 1 No . 2 DK / Not sure / Depends. 8 MHA12. If a member of your family became sick with HIV, would you be willing to care for her or him in your own household? Yes . 1 No . 2 DK / Not sure / Depends. 8 MHA24. I don’t want to know the results, but have you ever been tested to see if you have the HIV virus? Yes . 1 No . 2 2MHA27 363MONITORING THE SITUATION OF CHILDREN AND WOMEN MHA25. When was the most recent time you were tested? Less than 12 months ago . 1 12-23 months ago. 2 2 or more years ago . 3 MHA26. I don’t want to know the results, but did you get the results of the test? Yes . 1 No . 2 DK. 8 1Next Module 2 Next Module 8Next Module MHA27. Do you know of a place where people can go to get tested for the HIV virus? Yes . 1 No . 2 CIRCUMCISION MMC MMC1. Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised? Yes . 1 No . 2 2Next Module MMC2. How old were you when you got circumcised? Age in years. __ __ DK. 98 MMC3. Who did the circumcision? Health worker/Professional. 1 Traditional practitioner/family/friend/mullah 2 Other (specify) ______________________ 6 DK. 8 MMC4. Where was it done? Health facility . 1 Home of a health worker/professional . 2 Circumcision done at home . 3 Ritual site . 4 Other home/place (specify) ____________ 6 DK. 8 TOBACCO AND ALCOHOL USE MTA MTA1. Have you ever tried cigarette smoking, even one or two puffs? Yes . 1 No . 2 2MTA6 MTA2. How old were you when you smoked a whole cigarette for the first time? Never smoked a whole cigarette . 00 Age . ___ ___ 00MTA6 MTA3. Do you currently smoke cigarettes? Yes . 1 No . 2 2MTA6 MTA4. In the last 24 hours, how many cigarettes did you smoke? Number of cigarettes . ___ ___ MTA5. During the last one month, on how many days did you smoke cigarettes? If less than 10 days, record the number of days. If 10 days but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days . 0 ___ 10 days or more, but less than a month . 10 Everyday / Almost every day . 30 MTA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe? Yes . 1 No . 2 2MTA10 MTA7. During the last one month, did you use any smoked tobacco products? Yes . 1 No . 2 2MTA10 364 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN MTA8. What type of smoked tobacco product did you use or smoke? Circle all mentioned. Cigars . A Water pipe . B Cigarillos .C Pipe .D Other (specify) ______________________X MTA9. During the last one month, on how many days did you use smoked tobacco products? If less than 10 days, record the number of days. If 10 days or more, but less than a month circle “10”. If “everyday” or “almost every day”, circle “30” Number of days . 0 ___ 10 days or more but less than a month . 10 Everyday / Almost every day . 30 MTA10. Have you tried other types of tabacco products free of smoke, such as chewing tabacco, snuff and nasybai? Yes . 1 No . 2 2MTA14 MTA11. During the last one month, did you use any smokeless tobacco products? Yes . 1 No . 2 2MTA14 MTA12. What type of smokeless tobacco product did you use? Circle all mentioned. Chewing tobacco . A Snuff . B Nasybai.C Other (specify) ______________________X MTA13. During the last one month, on how many days did you use smokeless tobacco products? If less than 10 days, record the number of days. If 10 days or more but less than a month, circle “10”. If “everyday” or “almost every day”, circle “30” Number of days . 0 ___ 10 days or more but less than a month . 10 Everyday / Almost every day . 30 MTA14. Now I would like to ask you some questions about drinking alcohol. Have you ever drunk alcohol? Yes . 1 No . 2 2Next Module MTA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or one shot of cognac, vodka, whiskey or rum. How old were you when you had your first drink of alcohol, other than a few sips? Never had one drink of alcohol . 00 Age . ___ ___ 00Next Module MTA16. During the last one month, on how many days did you have at least one drink of alcohol? If respondent did not drink, circle “00”. If less than 10 days, record the number of days. If 10 days or more, circle “10”. If “everyday” or “almost every day”, circle “30” Did not have one drink in last one month . 00 Number of days . 0 ___ 10 days or more. 10 Everyday / Almost every day . 30 00Next Module MTA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have? Number of drinks . ___ ___ ME11. Record the time. Hour and minutes . __ __ : __ __ End the interview with this respondent by thanking him for his cooperation. 365MONITORING THE SITUATION OF CHILDREN AND WOMEN Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 366 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN UNICEF UNITED NATIONS CHILDREN’S FUND IN THE REPUBLIC OF KAZAKHSTAN AGENCY OF STATISTICS, THE REPUBLIC OF KAZAKHSTAN QUESTIONNAIRE FOR CHILDREN UNDER FIVE UNDER-FIVE CHILD INFORMATION PANEL UF This questionnaire is to be administered to all mothers or caretakers (see Household Listing Form, column HL9) who care for a child that lives with them and is under the age of 5 years (see Household Listing Form, column HL6). A separate questionnaire should be used for each eligible child. UF1. Cluster number: UF2. Household number: ___ ___ ___ ___ ___ UF3. Child’s name: UF4. Child’s line number: Name . ___ ___ UF5. Mother’s / Caretaker’s name: UF6. Mother’s / Caretaker’s line number: Name . ___ ___ UF7. Interviewer name and number: UF8. Day / Month / Year of interview: Name . ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___ Repeat greeting if not already read to this respondent: We are from Agency of Statistics, the Republic of Kazakhstan. We are working on a project concerned with family health, education, status of women and children. I would like to talk to you about these subjects. The interview will take about 15 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following: Now I would like to talk to you more about health (child’s name from UF3) and other topics. This interview will take about 15 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. May I start now?  Yes, permission is given  Go to UF12 to record the time and then begin the interview.  No, permission is not given  Complete UF9. Discuss this result with your supervisor UF9. Result of interview for children under 5 Codes refer to mother/caretaker. Completed .01 Not at home .02 Refused .03 Partly completed.04 Incapacitated.05 Other (specify) .96 UF10. File edited by (Name and number): Name . ___ ___ UF11. Data entry clerk (Name and number): Name . ___ ___ UF12. Record the time. Hour and minutes . __ __ : __ __ 367MONITORING THE SITUATION OF CHILDREN AND WOMEN AGE AG AG1. Now I would like to ask you some questions about the health of (name). In what month and year was (name) born? Probe: What is his / her birthday? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day Month and year must be recorded. Date of birth Day . __ __ DK day . 98 Month . __ __ Year . __ __ __ __ AG2. How old is (name)? Probe: How old was (name) at his / her last birthday? Record age in completed years. Record ‘0’ if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent. Age (in completed years). __ BIRTH REGISTRATION BR BR1. Does (name) have a birth certificate? If yes, ask: May i see it? Y es, seen . 1 Yes, not seen . 2 No . 3 DK. 8 1 Next Module 2 Next Module BR2. Has (name)’s birth been registered with the civil authorities? Yes . 1 No . 2 DK. 8 1 NEXT MODULE BR3. Do you know how to register your child’s birth? Yes . 1 No . 2 EARLY CHILDHOOD DEVELOPMENT EC EC1. How many children’s books or picture books do you have for (name)? None . 00 Number of children’s books . 0 __ Ten or more books . 10 EC2. I am interested in learning about the things that (name) plays with when he/she is at home. Does he/she play with: [A] homemade toys (such as dolls, cars, or other toys made at home)? [B] toys from a shop or manufactured toys? [C] household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, animal shells or leaves)? If the respondent says “YES” to the categories above, then probe to learn specifically what the child plays with to ascertain the response Y N DK Homemade toys . 1 2 8 Toys from a shop . 1 2 8 Household objects or outside objects . 1 2 8 368 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN EC3. Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children. On how many days in the past week was (name): [A] left alone for more than an hour? [B] left in the care of another child, that is, someone less than 10 years old, for more than an hour? If ‘none’ enter ’0’. If ‘don’t know’ enter’ 8’ Number of days left alone for more than an hour . __ Number of days left with other child less than 10 years old for more than an hour . __ EC4. Check AG2: Age of child  Child age 3 or 4  Continue with EC5  Child age 0, 1 or 2  Go to Next Module EC5. Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care/mini centres? Yes . 1 No . 2 DK. 8 2EC7 8EC7 EC6. Within the last seven days, about how many hours did (name) attend? Number of hours . __ __ EC7. In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with (name)? Circle all that apply. Mother Father Other Noone [A] Read books to or looked at picture books with (name)? Read books A B X Y [B] Told stories to (name)? Told stories A B X Y [C] Sang songs to (name) or with (name), including lullabies? Sang songs A B X Y [D] Took (name) outside the home, compound, yard or enclosure? Took outside A B X Y [E] Played with (name)? Played with A B X Y [F] Named, counted, or drew things to or with (name)? Named/ counted A B X Y 369MONITORING THE SITUATION OF CHILDREN AND WOMEN EC8. I would like to ask you some questions about the health and development of your child. Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects of your child’s development. Can (name) identify or name at least ten letters of the alphabet? Yes . 1 No . 2 DK. 8 EC9. Can (name) read at least four simple, popular words? Yes . 1 No . 2 DK. 8 EC10. Does (name) know the name and recognize the symbol of all numbers from 1 to 10? Yes . 1 No . 2 DK. 8 EC11. Can (name) pick up a small object with two fingers, like a stick or a rock from the ground? Yes . 1 No . 2 DK. 8 EC12. Is (name) sometimes too sick to play? Yes . 1 No . 2 DK. 8 EC13. Does (name) follow simple directions on how to do something correctly? Yes . 1 No . 2 DK. 8 EC14. When given something to do, is (name) able to do it independently? Yes . 1 No . 2 DK. 8 EC15. Does (name) get along well with other children? Yes . 1 No . 2 DK. 8 EC16. Does (name) kick, bite, or hit other children or adults? Yes . 1 No . 2 DK. 8 EC17. Does (name) get distracted easily? Yes . 1 No . 2 DK. 8 BREASTFEEDING BF BF1. Has (name) ever been breastfed? Yes . 1 No . 2 DK. 8 2BF3 8BF3 BF2. Is he/she still being breastfed? Yes . 1 No . 2 DK. 8 BF3. I would like to ask you about liquids that (name) may have had yesterday during the day or the night. I am interested in whether (name) had the item even if it was combined with other foods. Did (name) drink plain water yesterday, during the day or night? Yes . 1 No . 2 DK. 8 370 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN BF4. Did (name) drink infant formula yesterday, during the day or night? Yes . 1 No . 2 DK. 8 2BF6 8BF6 BF5. How many times did (name) drink infant formula? Number of times . __ __ BF6. Did (name) drink milk, such as tinned (condensed), powdered or fresh animal milk yesterday, during the day or night? Yes . 1 No . 2 DK. 8 2BF8 8BF8 BF7. How many times did (name) drink tinned (condensed), powdered or fresh animal milk? Number of times . __ __ BF8. Did (name) drink juice or juice drinks yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF9. Did (name) drink soup/bullion/sorpa yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF11. Did (name) drink ORS (oral rehydration solution) yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF12. Did (name) drink any other liquids yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF13. Did (name) drink or eat yogurt/kefir, airan or other fermented milk products yesterday, during the day or night? Yes . 1 No . 2 DK. 8 2BF15 8BF15 BF14. How many times did (name) drink or eat yogurt/kefir, airan or other fermented milk products yesterday, during the day or night? Number of times . __ __ BF15. Did (name) eat thin porridge yesterday, during the day or night? Yes . 1 No . 2 DK. 8 BF16. Did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night? Yes . 1 No . 2 DK. 8 2BF18 8BF18 BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night? Number of times . __ __ BF18. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple? Yes . 1 No . 2 DK. 8 CARE OF ILLNESS CA CA1. In the last two weeks, has (name) had diarrhoea? Yes . 1 No . 2 DK. 8 2CA7 8CA7 371MONITORING THE SITUATION OF CHILDREN AND WOMEN CA2. I would like to know how much (name) was given to drink during the diarrhoea (including breastmilk). During the time (name) had diarrhoea, was he/ she given less than usual to drink, about the same amount, or more than usual? If less, probe: Was he/she given much less than usual to drink, or somewhat less? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Nothing to drink . 5 DK. 8 CA3. During the time (name) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? If “less”, probe: Was he/she given much less than usual to eat or somewhat less? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Stopped food . 5 Never gave food . 6 DK. 8 CA4. During the episode of diarrhoea, was (name) given to drink any of the following: Read each item aloud and record response before proceeding to the next item. [A] ORS from a special packet? Anything else? [B] A pre-packed ORS fluid a special packet called regidron? [C] Homemade fluid Y N DK Fluid from ORS packet . 1 2 8 Pre-packaged ORS fluid . 1 2 8 Homemade fluid . 1 2 8 CA5. Was anything (else) given to treat the diarrhoea? Yes . 1 No . 2 DK. 8 2CA7 8CA7 CA6. What (else) was given to treat the diarrhoea? Probe: Anything else? Record all treatments given. Write brand name(s) of all medicines mentioned. (Name) Pills or Syrups Antibiotic . A Antimotility . B Zinc .C Other (Not antibiotic, antimotility or zinc) .G Unknown pill or syrup .H Injections Antibiotic .L Non-antibiotic . M Unknown injection .N Intravenous .O Home remedy / Herbal medicine .Q Other (specify) . X CA7. At any time in the last two weeks, has (name) had an illness with a cough? Yes . 1 No . 2 DK. 8 2CA14 8CA14 CA8. When (name) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing? Yes . 1 No . 2 DK. 8 2CA14 8CA14 CA9. Was the fast or difficult breathing due to a problem in the chest or a blocked nose? Problem in chest . 1 Blocked nose . 2 Both . 3 Other (specify) ______________________ 6 DK. 8 2CA14 6CA14 372 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN CA10. Did you seek any advice or treatment for the illness from any source? Yes . 1 No . 2 DK. 8 2CA12 8CA12 CA11. From where did you seek advice or treatment? Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. (Name of place) Public sector Govt. hospital . A Govt. health centre . B State Medical point/Rural Doctoral Ambulatory/FAP .C Rural health worker .D Mobile / Outreach clinic . E Other public (specify) _______________H Private medical sector Private hospital / clinic . I Private physician .J Private pharmacy . K Mobile clinic .L Other private medical (specify) _______O Other source Relative / Friend . P Shop .Q Traditional practitioner .R Other (specify) ______________________ X CA12. Was (name) given any medicine to treat this illness? Yes . 1 No . 2 DK. 8 2CA14 8CA14 CA13. What medicine was (name) given? Probe: Any other medicine? Circle all medicines given. Write brand name(s) of all medicines mentioned. (Names of medicines) Antibiotics Pills / Syrups . A Injection . B Paracetamol / Panadol / Acetaminophen . P Aspirin.Q Ibuprofen .R Other (specify) ______________________ X DK. Z CA14. Check AG2: Child aged under 3?  Yes.  Continue with CA15 No.  Go to Next Module CA15. The last time (name) passed stools, what was done to dispose of the stools? Child used toilet / latrine . 01 Put / Rinsed into toilet or latrine. 02 Put / Rinsed into drain or ditch . 03 Thrown into garbage (solid waste) . 04 Buried . 05 Left in the open . 06 Other (specify) _____________________ 96 DK. 98 373MONITORING THE SITUATION OF CHILDREN AND WOMEN IMMUNIZATION IM If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM16 are for registering vaccinations that are not recorded on the card. IM6-IM16 will only be asked when a card is not available. IM1. Do you have a card where (name)’s vaccinations are written down? (If yes) May I see it please? Yes, seen .1 Yes, not seen .2 No card .3 1IM3 2IM6 IM2. Did you ever have a vaccination card for (name)? Yes .1 No .2 1IM6 2IM6 IM3. (a) Copy dates for each vaccination from the card. Write ‘44’ in day column if card shows that vaccination was given but no date recorded. Date of Immunization Day Month Year BCG BCG Polio at birth(before 2008) OPV0 Polio 1 OPV1 Polio 2 OPV2 Polio 3 Polio 4 (from 2008) OPV3 DPT1 DPT1 DPT2 DPT2 DPT3 DPT3 DPT4 (antihemophilic infection of B type) (from 2008) HepB at birth H0 HepB1 H1 HepB2 H2 HepB3 H3 Measles (or MMR) (before 2005) Measles Measles, parotitis, rubella (MMR) (from 2005) 374 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN IM4. Check IM3. Are all vaccines (BCG to Measles) recorded?  Yes  Go to UF13  No  Continue with IM5 IM5. In addition to what is recorded on this card, did (name) receive any other vaccinations – including vaccinations received in campaigns or immunization days? Record ‘Yes’ only if respondent mentions vaccines shown in the table above. Yes . 1 (Probe for vaccinations and write ‘66’ in the corresponding day column for each vaccine mentioned. Then skip to UF13) No . 2 DK. 8 2 UF13 8 UF13 IM6. Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day? Yes . 1 No . 2 DK. 8 2 UF13 8UF13 IM7. Has (name) ever received a BCG vaccination against tuberculosis – that is, an injection in the arm or shoulder that usually causes a scar? Yes . 1 No . 2 DK. 8 IM8. Has (name) ever received any “vaccination drops in the mouth” to protect him/her from getting diseases – that is, polio? Yes . 1 No . 2 DK. 8 2IM11 8IM11 IM9. Was the first polio vaccine received in the first two weeks after birth or later? First two weeks . 1 Later . 2 IM10. How many times was the polio vaccine received? Number of times . __ IM11. Has (name) ever received a DPT vaccination – that is, an injection in the thigh or buttocks – to prevent him/her from getting tetanus, whooping cough, diphtheria? Probe by indicating that DPT vaccination is sometimes given at the same time as Polio Yes . 1 No . 2 DK. 8 2IM13 8IM13 IM12. How many times was a DPT vaccine received? Number of times . __ IM13. Has (name) ever been given a Hepatitis B vaccination – that is, an injection in the thigh or buttocks – to prevent him/her from getting Hepatitis B? Probe by indicating that the Hepatitis B vaccine is sometimes given at the same time as Polio and DPT vaccines Yes . 1 No . 2 DK. 8 2IM16 8IM16 IM14. Was the first Hepatitis B vaccine received within 24 hours after birth, or later? Within 24 hours.1 Later .2 DK.8 IM15. How many times was a hepatitis B vaccine received? Number of times . __ IM16. Has (name) ever received a Measles injection or an MMR injection – that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles? Yes .1 No .2 DK.8 UF13. Record the time. Hour and minutes .__ __ : __ __ 375MONITORING THE SITUATION OF CHILDREN AND WOMEN UF14. Is the respondent the mother or caretaker of another child age 0-4 living in this household?  Yes.  Indicate to the respondent that you will need to measure the weight and height of the child later. Go to the next QUESTIONNAIRE FOR CHILDREN UNDER 5 to be administered to the same respondent  No.  End the interview with this respondent by thanking him/her for his/her cooperation and tell her/him that you will need to measure the weight and height of the child. Check to see if there are other woman’s or under-5 questionnaires to be administered in this household. Move to another woman’s or under-5 questionnaire, or start making arrangements for anthropometric measurements of all eligible children in the household. ANTHROPOMETRY AN After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number on the household listing before recording measurements. AN1. Measurer’s name and number: Name ___ ___ AN2. Result of height / length and weight measurement Either or both measured .1 Child not present .2 Child or caretaker refused .3 Other (specify) _____________________ 6 2AN6 3AN6 6AN6 AN3. Child’s weight Kilograms (kg) .__ __ . __ Weight not measured .99.9 AN4. Child’s length or height Check age of child in AG2:  Child under 2 years old.  Measure length (lying down).  Child age 2 or more years.  Measure height (standing up). Length (cm) Lying down .1 __ __ __ . __ Height (cm) Standing up .2 __ __ __ . __ Length / Height not measured .9999.9 AN6. Is there another child in the household who is eligible for measurement?  Yes. Record measurements for next child.  No.  End the interview with this household by thanking all participants for their cooperation. Gather together all questionnaires for this household and check that all identification numbers are inserted on each page. Tally on the Household Information Panel the number of interviews completed. 376 MULTIPLE INDICATOR CLUSTER SURVEY IN THE REPUBLIC OF KAZAKHSTAN Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 377MONITORING THE SITUATION OF CHILDREN AND WOMEN Appendix G. The table below is prepared for comparing nutritional status of children with MICS3 data calculated by using NCHS/CDCP/WHO standards. Table NU.1А: Assessment of nutritional status of children based on the international standards for population set by the National Center for Health Statistics, USA (NCHS)/Center for Disease Control and Prevention, USA (CDCP)/WHO Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kazakhstan, 2010/11 Weight for age: Num- ber of chil- dren Height for age: Number of chil- dren Weight for height: Number of chil- dren Under- weight Mean Z- Score (SD) Stunted Mean Z- Score (SD) Under- weight Under- weight Mean Z- Score (SD) % below % below % below % below - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 + 2 SD5 - 3 SD6 + 2 SD Sex Male 3,6 0,8 0,1 2555 10,2 4,0 -0,2 2541 3,6 0,9 10,0 0,4 2537 Female 3,9 1,0 0,1 2460 10,3 3,8 -0,2 2445 3,3 1,1 9,5 0,4 2443 Residence Urban 4,2 1,2 0,2 2407 10,1 4,1 -0,1 2393 4,2 1,3 11,0 0,3 2390 Rural 3,4 0,6 0,0 2608 10,4 3,7 -0,3 2594 2,8 0,7 8,5 0,4 2590 Region Akmola Oblast 1,4 0,9 0,3 183 6,9 1,4 -0,1 182 1,7 0,4 9,8 0,5 181 Aktobe Oblast 14,2 5,3 -0,2 248 32,9 17,4 -1,1 248 8,9 2,1 26,6 0,7 248 Almaty Oblast 3,9 0,9 0,0 529 8,0 2,2 -0,1 525 3,1 1,7 5,1 0,1 527 Almaty city 7,1 2,6 0,7 178 13,1 5,3 1,0 177 10,7 4,5 15,6 0,2 175 Astana city 2,2 0,4 0,5 165 16,0 6,7 0,0 162 4,1 0,6 1