Myanmar - Demographic and Health Survey - 2017

Publication date: 2017

Myanmar 2015-16Demographic andHealth Survey M yanm ar 2015-16 D em ographic and H ealth S urvey MYANMAR DEMOGRAPHIC AND HEALTH SURVEY 2015-16 Ministry of Health and Sports Nay Pyi Taw, Myanmar The DHS Program ICF Rockville, Maryland, USA March 2017 The 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) was implemented by the Ministry of Health and Sports of the Republic of the Union of Myanmar. The funding for the MDHS was provided by the United States Agency for International Development (USAID) and the Three Millennium Development Goal Fund (3MDG). ICF provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2015-16 MDHS may be obtained from the Ministry of Health and Sports, Building No 47, Nay Pyi Taw, Myanmar; Telephone: (+) 95-067-431075; Fax: (+) 95-067-431076; Website: www.mohs.gov.mm. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo: ©2015 Dr. Htin Aung Latt Suggested citation: Ministry of Health and Sports (MoHS) and ICF. 2017. Myanmar Demographic and Health Survey 2015-16. Nay Pyi Taw, Myanmar, and Rockville, Maryland USA: Ministry of Health and Sports and ICF. Contents • iii CONTENTS TABLES AND FIGURES . vii FOREWORD . xv READING AND UNDERSTANDING THE 2015-16 MYANMAR DEMOGRAPHIC AND HEALTH SURVEY (MDHS) . xvii CONTRIBUTORS TO THE REPORT . xxv ACRONYMS AND ABBREVIATIONS . xxvii MAP OF MYANMAR . xxx 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 1 1.3 Questionnaires . 2 1.4 Anthropometry, and Anemia Testing . 3 1.5 Training of Trainers and Pretest . 3 1.6 Training of Field Staff . 4 1.7 Fieldwork . 4 1.8 Data Processing . 5 1.9 Response Rates . 6 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 2.1 Drinking Water Sources and Treatment . 7 2.2 Sanitation . 8 2.3 Exposure to Smoke inside the Home . 9 2.4 Household Wealth . 9 2.5 Hand Washing . 10 2.6 Household Population and Composition . 11 2.7 Birth Registration . 11 2.8 Children’s Living Arrangements and Parental Survival . 13 2.9 Education . 13 2.9.1 Educational Attainment . 13 2.9.2 School Attendance . 14 3 CHARACTERISTICS OF RESPONDENTS . 27 3.1 Basic Characteristics of Survey Respondents . 27 3.2 Education and Literacy . 28 3.3 Mass Media Exposure . 29 3.4 Employment . 30 3.5 Occupation . 31 3.6 Tobacco Use . 32 3.7 Knowledge of Tuberculosis . 33 4 MARRIAGE AND SEXUAL ACTIVITY . 53 4.1 Marital Status . 53 4.2 Polygyny . 54 4.3 Age at First Marriage . 55 4.4 Age at First Sexual Intercourse . 55 4.5 Recent Sexual Activity . 56 iv • Contents 5 FERTILITY . 67 5.1 Current Fertility . 67 5.2 Children Ever Born and Living . 69 5.3 Birth Intervals . 69 5.4 Insusceptibility to Pregnancy . 70 5.5 Age at First Birth . 70 5.6 Teenage Childbearing . 71 6 FERTILITY PREFERENCES . 79 6.1 Desire for Another Child . 79 6.2 Ideal Family Size . 80 6.3 Fertility Planning Status . 81 6.4 Wanted Fertility Rates . 82 7 FAMILY PLANNING . 89 7.1 Contraceptive Knowledge and Use . 89 7.2 Timing of Female Sterilization . 91 7.3 Source of Modern Contraceptive Methods . 92 7.4 Social Marketing Brands . 92 7.5 Informed Choice . 92 7.6 Discontinuation of Contraceptives . 93 7.7 Demand for Family Planning . 93 7.8 Contact of Nonusers with Family Planning Providers . 95 8 INFANT AND CHILD MORTALITY . 111 8.1 Early Childhood Mortality . 112 8.2 Biodemographic Risk Factors . 113 8.3 Perinatal Mortality . 114 9 MATERNAL HEALTH CARE . 121 9.1 Antenatal Care Coverage and Content . 122 9.1.1 Skilled Providers . 122 9.1.2 Timing and Number of ANC Visits . 122 9.2 Components of ANC Visits . 123 9.3 Protection against Neonatal Tetanus . 123 9.4 Delivery Services . 124 9.4.1 Institutional Deliveries . 124 9.4.2 Skilled Assistance during Delivery . 125 9.4.3 Delivery by Caesarean . 126 9.5 Postnatal Care . 126 9.5.1 Postnatal Health Check for Mothers . 126 9.5.2 Postnatal Health Checks for Newborns . 127 9.6 Problems in Accessing Health Care . 127 10 CHILD HEALTH . 141 10.1 Birth Weight . 141 10.2 Vaccination of Children . 142 10.3 Symptoms of Acute Respiratory Infection . 144 10.4 Fever . 145 10.5 Diarrheal Disease . 145 10.5.1 Prevalence of Diarrhea . 145 10.5.2 Treatment of Diarrhea . 146 10.5.3 Feeding Practices . 147 10.5.4 Knowledge of ORS Packets . 147 10.6 Knowledge regarding Treatment of Childhood Illnesses . 148 10.7 Disposal of Children’s Stools . 148 Contents • v 11 NUTRITION OF CHILDREN AND WOMEN . 161 11.1 Nutritional Status of Children . 161 11.1.1 Measurement of Nutritional Status among Young Children . 161 11.1.2 Data Collection . 163 11.1.3 Levels of Child Malnutrition . 163 11.2 Infant and Young Child Feeding Practices . 164 11.2.1 Breastfeeding . 164 11.2.2 Exclusive Breastfeeding . 165 11.2.3 Median Duration of Breastfeeding . 166 11.2.4 Complementary Feeding . 166 11.2.5 Minimum Acceptable Diet . 167 11.3 Anemia Prevalence in Children . 168 11.4 Micronutrient Intake and Supplementation among Children. 169 11.5 Presence of Iodized Salt in Households . 170 11.6 Nutritional Status of Women . 170 11.7 Anemia Prevalence in Women . 171 11.8 Micronutrient Intake among Mothers . 172 12 MALARIA . 189 12.1 Ownership of Insecticide-Treated Nets . 190 12.2 Household Access to and Use of ITNs . 191 12.3 Use of ITNs by Children and Pregnant Women . 192 12.4 Case Management of Malaria in Children . 193 12.5 Prevalence of Low Hemoglobin in Children . 194 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 205 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 205 13.2 Knowledge about Mother-to-Child Transmission . 207 13.3 HIV/AIDS Attitudes . 207 13.3.1 Attitudes toward People Living with HIV/AIDS . 207 13.3.2 Attitudes toward Negotiating Safer Sexual Relations with Husbands . 208 13.3.3 Attitudes toward Condom Education for Young People . 209 13.4 Paid Sex . 209 13.5 Coverage of HIV Testing Services . 209 13.5.1 Awareness of HIV Testing Services and Experience with HIV Testing . 209 13.5.2 HIV Testing of Pregnant Women . 211 13.6 Male Circumcision . 211 13.7 Self-reporting of Sexually Transmitted Infections . 211 13.8 Injections . 212 13.9 HIV/AIDS-related Knowledge and Behavior among Young People . 212 13.9.1 Knowledge . 212 13.9.2 First Sex . 213 13.9.3 Coverage of HIV Testing Services . 213 14 ADULT AND MATERNAL MORTALITY . 235 14.1 Data . 235 14.2 Direct Estimates of Adult Mortality . 236 14.3 Direct Estimates of Pregnancy-related Mortality . 237 15 WOMEN’S EMPOWERMENT . 241 15.1 Married Women’s and Men’s Employment . 242 15.2 Control over Women’s Earnings . 242 15.3 Control over Men’s Earnings . 243 vi • Contents 15.4 Women’s and Men’s Ownership of Assets . 243 15.5 Women’s Participation in Decision Making . 244 15.6 Attitudes toward Wife Beating . 245 15.7 Women’s Empowerment and Demographic and Health Outcomes . 246 16 DOMESTIC VIOLENCE . 261 16.1 Measurement of Violence . 261 16.2 Experience of Physical Violence from Anyone . 262 16.2.1 Prevalence of Physical Violence . 262 16.2.2 Perpetrators of Physical Violence . 263 16.3 Experience of Sexual Violence . 264 16.3.1 Prevalence of Sexual Violence . 264 16.3.2 Perpetrators of Sexual Violence . 264 16.4 Experience of Different Forms of Violence . 264 16.5 Marital Control . 265 16.6 Spousal Violence . 265 16.6.1 Prevalence of Spousal Violence . 265 16.6.2 Onset of Spousal Violence . 267 16.7 Injuries due to Spousal Violence . 267 16.8 Violence Initiated by Women against Husbands . 268 16.9 Response to Violence . 268 16.9.1 Help-seeking Behavior to Stop the Violence . 268 16.9.2 Sources for Help . 269 17 EARLY CHILD DEVELOPMENT AND CHILD DISCIPLINE . 285 17.1 Early Childhood Education . 285 17.2 Childhood Learning . 286 17.2.1 Support for Learning . 286 17.2.2 Children’s Books and Playthings . 287 17.3 Adequate Care for Young Children . 288 17.4 Child Discipline . 289 17.4.1 Prevalence of Disciplinary Approaches . 289 17.4.2 Disciplinary Approaches by Background Characteristics . 290 REFERENCES. 297 APPENDIX A SAMPLE DESIGN . 299 A.1 Introduction . 299 A.2 Sample Frame . 299 A.3 Sample Design and Implementation . 301 A.4 Sample Probabilities and Sampling Weights . 302 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 307 APPENDIX C DATA QUALITY TABLES . 329 APPENDIX D QUESTIONNAIRES . 335 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 6 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 Table 2.1 Household drinking water . 16 Table 2.2 Household sanitation facilities . 17 Table 2.3 Household characteristics . 18 Table 2.4 Household possessions . 19 Table 2.5 Wealth quintiles . 19 Table 2.6 Handwashing . 20 Table 2.7 Household population by age, sex, and residence . 20 Table 2.8 Household composition . 21 Table 2.9 Birth registration of children under age 5 . 22 Table 2.10 Children’s living arrangements and orphanhood . 23 Table 2.11.1 Educational attainment of the female household population . 24 Table 2.11.2 Educational attainment of the male household population . 25 Table 2.12 School attendance ratios . 26 Figure 2.1 Household drinking water by residence . 8 Figure 2.2 Household toilet facilities by residence . 8 Figure 2.3 Household wealth by residence. 10 Figure 2.4 Population Pyramid . 11 Figure 2.5 Birth registration by household wealth . 12 Figure 2.6 Birth registration by states and regions . 12 Figure 2.7 Secondary school net attendance ratio by household wealth . 14 3 CHARACTERISTICS OF RESPONDENTS . 27 Table 3.1 Background characteristics of respondents . 34 Table 3.2.1 Educational attainment: Women . 35 Table 3.2.2 Educational attainment: Men . 36 Table 3.3.1 Literacy: Women . 37 Table 3.3.2 Literacy: Men . 38 Table 3.4.1 Exposure to mass media: Women . 39 Table 3.4.2 Exposure to mass media: Men . 40 Table 3.5.1 Employment status: Women . 41 Table 3.5.2 Employment status: Men . 42 Table 3.6.1 Occupation: Women . 43 Table 3.6.2 Occupation: Men . 44 Table 3.7 Type of employment: Women . 45 Table 3.8.1 Use of tobacco: Women . 46 Table 3.8.2 Use of tobacco: Men . 47 Table 3.9.1 Use of betel quid: Women . 48 Table 3.9.2 Use of betel quid: Men . 49 Table 3.10.1 Knowledge of tuberculosis: Women . 50 Table 3.10.2 Knowledge of tuberculosis: Men . 51 viii • Tables and Figures Figure 3.1 Education of survey respondents . 28 Figure 3.2 Women with some, completed, or more than secondary education by states and regions . 29 Figure 3.3 Exposure to mass media . 29 Figure 3.4 Employment by education . 31 Figure 3.5 Occupation . 31 4 MARRIAGE AND SEXUAL ACTIVITY . 53 Table 4.1 Current marital status . 58 Table 4.2.1 Number of women’s co-wives . 58 Table 4.2.2 Number of men’s wives . 59 Table 4.3 Age at first marriage . 60 Table 4.4 Median age at first marriage by background characteristics . 61 Table 4.5 Age at first sexual intercourse . 62 Table 4.6 Median age at first sexual intercourse by background characteristics . 63 Table 4.7.1 Recent sexual activity: Women. 64 Table 4.7.2 Recent sexual activity: Men . 65 Figure 4.1 Marital status . 53 Figure 4.2 Polygyny by states and regions . 54 Figure 4.3 Median age at first sex and first marriage . 56 5 FERTILITY . 67 Table 5.1 Current fertility . 72 Table 5.2 Fertility by background characteristics . 72 Table 5.3 Trends in age-specific fertility rates . 73 Table 5.4 Children ever born and living . 73 Table 5.5 Birth intervals . 74 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 75 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 75 Table 5.8 Menopause . 76 Table 5.9 Age at first birth . 76 Table 5.10 Median age at first birth . 77 Table 5.11 Teenage pregnancy and motherhood . 78 Figure 5.1 Age-specific fertility rates . 68 Figure 5.2 Fertility by mother’s education . 68 Figure 5.3 Fertility by states and regions . 69 Figure 5.4 Birth intervals . 69 Figure 5.5 Teenage childbearing by education . 71 6 FERTILITY PREFERENCES . 79 Table 6.1 Fertility preferences by number of living children . 84 Table 6.2.1 Desire to limit childbearing: Women . 85 Table 6.2.2 Desire to limit childbearing: Men . 85 Table 6.3 Ideal number of children by number of living children . 86 Table 6.4 Mean ideal number of children . 87 Table 6.5 Fertility planning status . 87 Table 6.6 Wanted fertility rates . 88 Tables and Figures • ix Figure 6.1 Desire to limit childbearing by number of living children . 80 Figure 6.2 Ideal family size . 81 Figure 6.3 Ideal family size by number of living children . 81 Figure 6.4 Fertility planning status . 82 Figure 6.5 Wanted and actual fertility by residence . 82 7 FAMILY PLANNING . 89 Table 7.1 Knowledge of contraceptive methods . 96 Table 7.2 Knowledge of contraceptive methods by background characteristics . 97 Table 7.3 Current use of contraception by age . 98 Table 7.4 Current use of contraception by background characteristics . 99 Table 7.5 Timing of sterilization . 100 Table 7.6 Source of modern contraception methods . 100 Table 7.7 Use of social marketing brand pills . 101 Table 7.8 Informed choice . 102 Table 7.9 Twelve-month contraceptive discontinuation rates . 103 Table 7.10 Reasons for discontinuation . 103 Table 7.11 Knowledge of fertile period . 104 Table 7.12.1 Need and demand for family planning among currently married women . 105 Table 7.12.2 Need and demand for family planning for all women . 106 Table 7.13 Future use of contraception . 106 Table 7.14.1 Exposure to family planning messages: Women . 107 Table 7.14.2 Exposure to family planning messages: Men . 108 Table 7.15 Contact of nonusers with family planning providers . 109 Figure 7.1 Contraceptive use . 90 Figure 7.2 Use of modern methods by education . 91 Figure 7.3 Use of modern methods by states and regions . 91 Figure 7.4 Source of modern contraceptive methods . 92 Figure 7.5 Demand for family planning . 94 Figure 7.6 Unmet need for family planning by states and regions . 94 8 INFANT AND CHILD MORTALITY . 111 Table 8.1 Early childhood mortality rates . 116 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 116 Table 8.3 Early childhood mortality rates by demographic characteristics . 117 Table 8.4 Perinatal mortality . 118 Table 8.5 High-risk fertility behavior . 119 Figure 8.1 Trends in early childhood mortality rates . 112 Figure 8.2 Under-5 mortality by household wealth . 113 Figure 8.3 Under-5 mortality by states and regions . 113 Figure 8.4 Under-5 mortality by previous birth interval . 114 9 MATERNAL HEALTH CARE . 121 Table 9.1 Antenatal care . 129 Table 9.2 Number of antenatal care visits and timing of first visit . 130 Table 9.3 Components of antenatal care . 131 Table 9.4 Tetanus toxoid injections . 132 Table 9.5 Place of delivery . 133 Table 9.6 Assistance during delivery . 134 Table 9.7 Timing of first postnatal checkup for the mother . 135 Table 9.8 Type of provider of first postnatal checkup for the mother . 136 x • Tables and Figures Table 9.9 Timing of first postnatal checkup for the newborn . 137 Table 9.10 Type of provider of first postnatal checkup for the newborn . 138 Table 9.11 Problems in accessing health care . 139 Figure 9.1 Antenatal care coverage . 122 Figure 9.2 Institutional deliveries by education . 124 Figure 9.3 Institutional deliveries by states and regions . 125 Figure 9.4 Delivery assistance. 125 Figure 9.5 Delivery assistance by household wealth . 126 Figure 9.6 Postnatal care by place of delivery . 127 10 CHILD HEALTH . 141 Table 10.1 Child’s size and weight at birth. 150 Table 10.2 Vaccinations by source of information . 151 Table 10.3 Vaccinations by background characteristics . 151 Table 10.4 Vaccinations in first year of life . 152 Table 10.5 Prevalence and treatment of symptoms of ARI . 153 Table 10.6 Prevalence and treatment of fever . 154 Table 10.7 Prevalence of diarrhea . 155 Table 10.8 Diarrhea treatment . 156 Table 10.9 Feeding practices during diarrhea . 157 Table 10.10 Symptoms of childhood illness that prompt treatment. 158 Table 10.11 Disposal of children’s stools . 159 Figure 10.1 Childhood vaccinations . 143 Figure 10.2 Vaccination coverage by states and regions. 144 Figure 10.3 Diarrhea prevalence by age . 146 Figure 10.4 Treatment of diarrhea . 146 Figure 10.5 Feeding practices during diarrhea . 147 Figure 10.6 Prevalence and treatment of childhood illnesses . 148 11 NUTRITION OF CHILDREN AND WOMEN . 161 Table 11.1 Nutritional status of children . 173 Table 11.2 Mid-upper-arm circumference among children . 175 Table 11.3 Initial breastfeeding . 177 Table 11.4 Breastfeeding status by age . 178 Table 11.5 Median duration of breastfeeding . 178 Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview . 179 Table 11.7 Infant and young child feeding (IYCF) practices . 180 Table 11.8 Prevalence of anemia in children . 182 Table 11.9 Micronutrient intake among children . 183 Table 11.10 Presence of iodized salt in household . 184 Table 11.11 Nutritional status of women . 185 Table 11.12 Prevalence of anemia in women . 186 Table 11.13 Micronutrient intake among mothers . 187 Figure 11.1 Nutritional status of children . 163 Figure 11.2 Stunting in children by mother’s education . 163 Figure 11.3 Stunting in children by states and regions . 164 Figure 11.4 Breastfeeding practices by age . 165 Figure 11.5 IYCF breastfeeding indicators . 166 Figure 11.6 IYCF indicators on minimum acceptable diet . 168 Tables and Figures • xi Figure 11.7 Childhood anemia status by residence . 169 Figure 11.8 Anemia prevalence in children by states and regions . 169 Figure 11.9 Anemia in women . 171 12 MALARIA . 189 Table 12.1 Household possession of mosquito nets . 196 Table 12.2 Source of mosquito nets . 197 Table 12.3 Access to an insecticide-treated net (ITN) . 197 Table 12.4 Use of mosquito nets by persons in the household . 198 Table 12.5 Use of existing ITNs . 199 Table 12.6 Use of mosquito nets by children . 200 Table 12.7 Use of mosquito nets by pregnant women . 201 Table 12.8 Prevalence, diagnosis, and prompt treatment of children with fever . 202 Table 12.9 Source of advice or treatment for children with fever . 203 Table 12.10 Hemoglobin <8.0 g/dl in children . 204 Figure 12.1 Household ownership of ITNs . 190 Figure 12.2 ITN ownership by household wealth . 191 Figure 12.3 Access to and use of ITNs by residence . 192 Figure 12.4 Access to ITNs by states and regions . 192 Figure 12.5 Use of ITNs . 193 Figure 12.6 Low hemoglobin by age . 194 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 205 Table 13.1 Knowledge of AIDS . 214 Table 13.2 Knowledge of HIV prevention methods . 215 Table 13.3.1 Comprehensive knowledge about HIV: Women . 216 Table 13.3.2 Comprehensive knowledge about HIV: Men . 217 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 218 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 219 Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 220 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 221 Table 13.7 Adult support of education about condom use to prevent AIDS . 222 Table 13.8 Payment for sexual intercourse and condom use at last paid sexual intercourse . 223 Table 13.9.1 Coverage of prior HIV testing: Women . 224 Table 13.9.2 Coverage of prior HIV testing: Men . 225 Table 13.10 Pregnant women counseled and tested for HIV . 226 Table 13.11 Male circumcision . 227 Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 228 Table 13.13 Prevalence of medical injections. 229 Table 13.14 Comprehensive knowledge about AIDS and a source of condoms among young people . 231 Table 13.15 Age at first sexual intercourse among young people . 232 Table 13.16 Recent HIV tests among young people . 233 Figure 13.1 Knowledge of HIV prevention methods by residence . 206 Figure 13.2 Knowledge of HIV prevention methods by states and regions . 206 Figure 13.3 Knowledge of mother-to-child transmission (MTCT) of HIV . 207 Figure 13.4 Discriminatory attitudes towards people living with HIV by education . 208 Figure 13.5 HIV testing . 210 Figure 13.6 HIV testing by education . 210 Figure 13.7 Recent HIV testing (or ever tested) by states and regions . 211 Figure 13.8 STI advice or treatment seeking-behavior . 212 xii • Tables and Figures 14 ADULT AND MATERNAL MORTALITY . 235 Table 14.1 Completeness of information on siblings . 239 Table 14.2 Adult mortality rates . 239 Table 14.3 Adult mortality probabilities . 239 Table 14.4 Pregnancy-related mortality rates . 240 Figure 14.1 Adult mortality rates by age . 237 15 WOMEN’S EMPOWERMENT . 241 Table 15.1 Employment and cash earnings of currently married women and men . 248 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 249 Table 15.2.2 Control over men’s cash earnings . 250 Table 15.3 Women’s control over their own earnings and over those of their husbands . 251 Table 15.4.1 Ownership of assets: Women . 252 Table 15.4.2 Ownership of assets; Men . 253 Table 15.5 Participation in decision making . 253 Table 15.6.1 Women’s participation in decision making by background characteristics . 254 Table 15.6.2 Men’s participation in decision making by background characteristics . 255 Table 15.7.1 Attitude toward wife beating: Women . 256 Table 15.7.2 Attitude toward wife beating: Men . 257 Table 15.8 Indicators of women’s empowerment . 258 Table 15.9 Current use of contraception by women’s empowerment . 258 Table 15.10 Ideal number of children and unmet need for family planning by women’s empowerment . 259 Table 15.11 Reproductive health care by women’s empowerment . 259 Table 15.12 Early childhood mortality rates by women’s status . 260 Figure 15.1 Control over women’s earnings . 242 Figure 15.2 Ownership of house and land . 243 Figure 15.3 Women’s participation in decision making. 244 Figure 15.4 Attitudes toward wife beating . 245 16 DOMESTIC VIOLENCE . 261 Table 16.1 Experience of physical violence . 270 Table 16.2 Experience of violence during pregnancy . 271 Table 16.3 Persons committing physical violence . 272 Table 16.4 Experience of sexual violence. 273 Table 16.5 Persons committing sexual violence . 274 Table 16.6 Experience of different forms of violence . 274 Table 16.7 Marital control exercised by husbands . 275 Table 16.8 Forms of spousal violence . 276 Table 16.9 Spousal violence by background characteristics . 277 Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators . 278 Table 16.11 Physical or sexual violence in the past 12 months by any husband . 279 Table 16.12 Experience of spousal violence by duration of marriage . 280 Table 16.13 Injuries to women due to spousal violence . 280 Table 16.14 Women’s violence against their spouse by background characteristics . 281 Table 16.15 Women’s violence against their spouse by husband’s characteristics and empowerment indicators . 282 Table 16.16 Help seeking to stop violence . 283 Table 16.17 Sources for help to stop the violence . 284 Tables and Figures • xiii Figure 16.1 Women’s experience of violence by marital status . 263 Figure 16.2 Violence during pregnancy by education . 263 Figure 16.3 Spousal violence by states and regions . 266 Figure 16.4 Spousal violence by husband’s alcohol consumption . 267 Figure 16.5 Help seeking by type of violence experienced . 268 17 EARLY CHILD DEVELOPMENT AND CHILD DISCIPLINE . 285 Table 17.1 Early childhood education . 291 Table 17.2 Support for learning . 292 Table 17.3 Learning materials . 293 Table 17.4 Child care arrangements . 294 Table 17.5 Child discipline . 295 Table 17.6 Child discipline by background characteristics . 296 Figure 17.1 Early childhood education by mother’s education . 286 Figure 17.2 Adult support for learning by parent’s education . 287 Figure 17.3 Child discipline by household wealth . 290 APPENDIX A SAMPLE DESIGN . 299 Table A.1 Distribution of residential households by state/region and type of residence . 300 Table A.2 Distribution of residential household population by state/region and type of residence . 300 Table A.3 Master sample allocation of clusters by state/region and type of residence. 301 Table A.4 Sample allocation of EAs and households by state/region and type of residence . 302 Table A.5 Sample allocation of expected number of interviews by state/region and type of residence . 302 Table A.6 Sample implementation: Women . 305 Table A.7 Sample implementation: Men . 306 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 307 Table B.1 List of selected variables for sampling errors, Myanmar 2015-16. 309 Table B.2 Sampling errors: National sample, Myanmar 2015-16 . 310 Table B.3 Sampling errors: Urban sample, Myanmar 2015-16 . 311 Table B.4 Sampling errors: Rural sample, Myanmar 2015-16 . 312 Table B.5 Sampling errors: Kachin sample, Myanmar 2015-16 . 313 Table B.6 Sampling errors: Kayah sample, Myanmar 2015-16 . 314 Table B.7 Sampling errors: Kayin sample, Myanmar 2015-16 . 315 Table B.8 Sampling errors: Chin sample, Myanmar 2015-16 . 316 Table B.9 Sampling errors: Sagaing sample, Myanmar 2015-16 . 317 Table B.10 Sampling errors: Tanintharyi sample, Myanmar 2015-16 . 318 Table B.11 Sampling errors: Bago sample, Myanmar 2015-16 . 319 Table B.12 Sampling errors: Magway sample, Myanmar 2015-16 . 320 Table B.13 Sampling errors: Mandalay sample, Myanmar 2015-16 . 321 Table B.14 Sampling errors: Mon sample, Myanmar 2015-16 . 322 Table B.15 Sampling errors: Rakhine sample, Myanmar 2015-16. 323 Table B.16 Sampling errors: Yangon sample, Myanmar 2015-16 . 324 Table B.17 Sampling errors: Shan sample, Myanmar 2015-16 . 325 Table B.18 Sampling errors: Ayeyarwady sample, Myanmar 2015-16 . 326 Table B.19 Sampling errors: Nay Pyi Taw sample, Myanmar 2015-16 . 327 Table B.20 Sampling errors for adult and maternal mortality rates, Myanmar 2015-16 . 328 xiv • Tables and Figures APPENDIX C DATA QUALITY TABLES . 329 Table C.1 Household age distribution . 329 Table C.2.1 Age distribution of eligible and interviewed women . 330 Table C.2.2 Age distribution of eligible and interviewed men . 330 Table C.3 Completeness of reporting . 331 Table C.4 Births by calendar years . 331 Table C.5 Reporting of age at death in days . 332 Table C.6 Reporting of age at death in months . 333 Table C.7 Sibship size and sex ratio of siblings . 333 Foreword • xv FOREWORD he Myanmar Demographic and Health Survey (MDHS) 2015-16 is the first survey of its kind to be implemented in the country as part of the worldwide Demographic and Health Surveys (DHS) Program. It was implemented by the Ministry of Health and Sports (MoHS), with the objective of providing reliable, accurate, and up-to-date data for the country. We hope that the information in this report will assist policymakers and program managers in policy formulation and monitoring and designing programs and strategies for improving maternal, child health, and family planning services in Myanmar. This report presents the findings of the survey. The 2015-16 MDHS is a national sample survey that provides up-to-date information on fertility levels; marriage; fertility preferences; awareness and use of family planning methods; child feeding practices; nutrition; adult and childhood mortality; awareness and attitudes regarding HIV/AIDS; women’s empowerment; and domestic violence. The target groups were women and men age 15-49 residing in randomly selected households across the country. In addition to national estimates, the report provides estimates of key indicators for both urban and rural areas in Myanmar and also for the 15 states and regions. The successful completion of the 2015-16 MDHS was made possible through contributions from a number of like-minded organizations and professionals. In this regard, the MoHS especially appreciates the overall support, including funding, given by the United States Agency for International Development in Myanmar (USAID) and the Three Millennium Development Goal Fund (3MDG). We would like to put on record that the United Nations Children’s Fund (UNICEF) provided technical support for training of surveyors. The technical advice provided by the Technical Committee and the Steering Committee during different phases of the survey was critical for the success of the survey. The MoHS would also like to appreciate the invaluable assistance provided by the Department of Population, Ministry of Labor, Immigration and Population, for providing the sampling frame and household lists and maps of the selected enumeration areas for the survey. Furthermore, the support and collaboration rendered by the national, state, and regional administration, nongovernmental and international development organizations, and other major stakeholders is greatly acknowledged. We are grateful to the 2015 MDHS core team for managing technical, administrative, and logistical aspects of the survey; the master trainers for their support in training and monitoring of the field work; the field staff, for data collection; the data processing team; and, in particular, the survey respondents. Similarly, we wish to express our deep appreciation to ICF International for its technical assistance in all stages of the survey. We wish to also acknowledge Baker Tilly Consulting (Myanmar) for providing accounting and disbursement services that allowed for the timely and efficient transfer of project funds throughout the survey period. Dr. Myint Htwe Union Minister for the Ministry of Health and Sports T Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) • xvii READING AND UNDERSTANDING THE 2015-16 MYANMAR DEMOGRAPHIC AND HEALTH SURVEY (MDHS) n 2016, The DHS Program began producing final reports with a new format and style. The new style features about 90 figures to highlight subnational patterns and background characteristics. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. All of the standard tables that have historically been included in the DHS continue to be included in this new style. They are located at the end of each chapter. Each DHS final report is based on approximately 200 tables of data. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, DHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of DHS tables, the presentation of background characteristics, and a brief summary of sampling and understanding denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting DHS tables. I xviii • Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) EXAMPLE 1: EXPOSURE TO MASS MEDIA Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Myanmar 2015-16 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 18.5 68.8 30.2 8.9 24.3 1,810 20-24 17.6 63.3 28.6 8.0 28.2 1,867 25-29 16.4 59.9 24.2 7.0 32.9 1,867 30-34 13.7 60.7 24.1 5.5 30.7 2,037 35-39 15.9 58.2 21.5 5.1 33.8 1,954 40-44 11.9 52.4 21.5 3.6 37.6 1,733 45-49 14.3 53.8 22.9 4.5 36.0 1,617 Residence Urban 29.8 80.6 21.0 10.2 14.9 3,768 Rural 9.6 51.1 26.3 4.4 38.8 9,117 States/Regions Kachin 19.2 48.3 25.6 7.5 40.3 374 Kayah 15.7 67.4 26.1 6.2 27.0 65 Kayin 12.5 53.2 15.5 4.8 40.5 303 Chin 17.7 54.8 19.2 8.2 40.3 102 Sagaing 8.5 55.3 26.8 4.0 35.1 1,410 Tanintharyi 9.6 54.1 19.9 3.8 39.3 283 Bago 15.3 63.9 26.7 6.4 28.0 1,244 Magway 14.5 50.9 40.6 6.6 31.3 1,081 Mandalay 16.2 55.1 25.8 4.7 33.8 1,541 Mon 18.7 47.9 28.5 6.0 37.3 463 Rakhine 8.5 28.5 13.3 2.9 64.7 777 Yangon 22.2 88.3 12.7 6.2 9.8 1,927 Shan 11.6 51.1 19.0 5.1 43.9 1,368 Ayeyarwady 20.1 65.4 35.3 11.3 24.9 1,650 Nay Pyi Taw 14.7 68.1 27.4 5.6 25.4 300 Education1 No education 1.1 33.8 13.6 0.3 59.9 1,606 Primary 7.4 52.3 24.3 2.8 37.3 5,305 Secondary 21.1 71.4 27.9 8.8 21.3 4,646 More than secondary 45.6 80.1 28.9 17.0 12.2 1,325 Wealth quintile Lowest 5.0 33.1 22.1 2.1 56.2 2,274 Second 9.6 45.9 26.0 4.4 42.9 2,408 Middle 10.5 57.0 27.5 4.7 31.6 2,633 Fourth 15.5 73.6 25.7 6.7 20.4 2,702 Highest 33.4 81.8 22.3 11.6 13.9 2,868 Total 15.5 59.7 24.7 6.1 31.8 12,885 1 Total includes three women with missing information on education. Step 1: Read the title and subtitle. They tell you the topic and the specific population group being described. In this case, the table is about exposure to mass media among women age 15-49. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information is categorized. In this table, the first column of data shows the percentage of women who read a newspaper at least once a week. The second column shows the percentage of women who watch television at least once a week. The third column shows the percentage of women who listen to the radio at least once a week. The fourth column shows the percentage of women who access all three types of mass media (newspaper, television, and radio) weekly, while the fifth column indicates women who do not access any of these three forms of media weekly. The last column lists the number of women age 15-49 who were included in the survey in each subgroup. 1 2 3 4 Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) • xix Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to mass media by age, urban-rural residence, state/region, educational level, and wealth quintile. Step 4: Look at the row at the bottom of the table highlighted in pink. These percentages represent the total percentage of women age 15-49 who are exposed to each type of media. In this case, 15.5%* of women read a newspaper at least once a week, while 59.7% watch television at least once a week. Step 5: To find out what percentage of women age 15-49 in rural areas listen to the radio weekly, draw two imaginary lines, as shown on the table. This shows that 26.3% of women age 15-49 in rural areas listen to the radio at least once a week. Step 6: By looking at patterns by background characteristics, we can see how exposure to the media varies across Myanmar. Access to media is not universal; knowing how women access media can help program planners and policy makers determine how to most effectively use resources to communicate health messages. *For the purpose of this document data are presented exactly as they appear in the table including decimal places. However, the text in the standard DHS final report chapters rounds data to the nearest whole percentage point. Practice: Use the table in Example 1 to answer the following questions about women’s exposure to media: a) Which of the three types of mass media is most commonly accessed? b) Is there a clear pattern in access to media by a woman’s education? c) What are the lowest and highest percentages (range) of access to all 3 types of media by state/region? d) Is there a clear pattern in access to media by wealth quintile? Answers: a) Television is the most commonly accessed type of media, viewed by 59.7% of Myanmar women at least once a week b) Yes, access to each of the three types of media increase with a woman’s education. Conversely, access to NONE of these 3 types of media decreases with education. c) Very few women in Myanmar access all three types of media weekly, ranging from 2.9% in Rakine State to 11.3% in Ayeyarwady Region. d) In general, access to media increases with household wealth. This relationship is strong for newspapers and television watching, while listening to the radio is not closely tied to household wealth. xx • Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) EXAMPLE 2: PREVALENCE AND TREATMENT OF ARI Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Myanmar 2015-16 Among children under age five: Among children under age five with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 2.0 404 * * 8 6-11 1.6 403 * * 7 12-23 4.7 852 71.1 54.2 40 24-35 3.9 782 66.2 38.3 30 36-47 3.4 866 (47.2) (30.1) 29 48-59 2.1 792 (44.4) (45.1) 17 Sex Male 3.8 2,131 64.8 44.5 81 Female 2.6 1,968 47.6 41.5 51 Mother's smoking status Smokes cigarettes/tobacco 5.4 85 * * 5 Does not smoke 3.2 4,014 58.2 44.7 127 Cooking fuel3 Electricity or gas 2.5 728 (77.4) (54.7) 18 Charcoal 4.0 593 (63.0) (55.3) 24 Wood/straw4 3.2 2,758 53.5 37.3 88 Animal dung * 13 * * 1 No food cooked in household * 5 * * 0 Residence Urban 3.0 925 (76.6) (53.8) 28 Rural 3.2 3,174 53.2 40.5 103 States/Regions Kachin 7.5 162 (34.2) (25.1) 12 Kayah 7.6 31 (61.1) (71.4) 2 Kayin 5.3 140 * * 7 Chin 15.6 60 40.4 47.2 9 Sagaing 0.3 456 * * 1 Tanintharyi 5.9 125 * * 7 Bago 2.2 360 * * 8 Magway 4.8 299 * * 14 Mandalay 2.0 411 * * 8 Mon 2.2 140 * * 3 Rakhine 8.3 294 (79.1) (69.1) 24 Yangon 0.4 423 * * 2 Shan 1.7 564 * * 10 Ayeyarwady 3.7 542 * * 20 Nay Pyi Taw 1.9 92 * * 2 Mother's education No education 3.3 730 (45.3) (40.4) 24 Primary 3.3 1,879 55.3 45.2 62 Secondary 3.1 1,175 63.0 41.8 37 More than secondary 2.7 314 * * 8 Wealth quintile Lowest 4.1 1,211 45.3 38.0 50 Second 3.5 906 62.1 54.7 32 Middle 2.9 691 (58.8) (20.1) 20 Fourth 2.7 699 (71.4) (57.1) 19 Highest 1.9 593 * * 11 Total 3.2 4,099 58.2 43.3 131 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI include cough accompanied by short, rapid breathing which was chest-related and/or by difficult breathing which was chest-related 2 Excludes pharmacy, shop, market, and traditional practitioner 1 3 3 4 a 4 b 2 Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) • xxi Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age five (a) and children under age five who had symptoms of acute respiratory infection (ARI) in the two weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under age five (a), and then isolate the columns that refer only to those children under age five who had symptoms of ARI in the two weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age five had symptoms of ARI in the two weeks before the survey? It’s 3.2%. Now look at the second panel. How many children under age five are there who had symptoms of ARI in the two weeks before the survey? It’s 131 children or 3.2% of the 4,099 children under age five (with rounding). The second panel is a subset of the first panel. Step 4: Only 3.2% of children under age five had symptoms of ARI in the two weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable.  What percentage of children under age five in urban areas who had symptoms of ARI in the two weeks before the survey received antibiotics? 53.8%. This percentage is in parentheses because there are between 25 and 49 children (unweighted) in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 3.)  What percentage of children under age five in Kayin state who had symptoms of ARI in the two weeks before the survey received antibiotics? There is no number in this cell—only an asterisk. This is because fewer than 25 children under age five in Kayin state had symptoms of ARI in the two weeks before the survey. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. xxii • Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) EXAMPLE 3: UNDERSTANDING SAMPLING WEIGHTS IN MDHS TABLES A sample is a group of people who have been selected for a survey. In the 2015-16 MDHS, the sample is designed to represent the national population age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a minimum sample size per area. For the 2015-16 MDHS, the survey sample is representative at the national, state/regional levels, and for urban and rural areas. To generate statistics that are representative of the country as a whole and the 15 states/regions, the number of women surveyed in each state/region should contribute to the size of the total (national) sample in proportion to size of the district. However, if some states/regions have small populations, then a sample allocated in proportion to each state’s/region’s population may not include sufficient women from each state/region for analysis. To solve this problem, states/regions with small populations are oversampled. For example, let’s say that you have enough money to interview 12,885 women and want to produce results that are representative of Myanmar as a whole and its 15 states/regions (as in Table 3.1). However, the total population of Myanmar is not evenly distributed among the states/regions: some regions, such as Yangon, are heavily populated while others, such as Kayah State, are not. Thus, Kayah State must be oversampled. A sampling statistician determines how many women should be interviewed in each state/region in order to get reliable statistics. The blue column (1) in the table at the right shows the actual number of women interviewed in each state/district. Within the states/districts, the number of women interviewed ranges from 717 in Tanintharyi Region to 1,065 in Yangon Region. The number of interviews is sufficient to get reliable results in each district. With this distribution of interviews, some regions/states are overrepresented and some regions/states are underrepresented. For example, the population in Yangon Region is about 15% of the population in Myanmar, while Kayah State’s population contributes less than 1% of the population in Myanmar. But as the blue column shows, the number of women interviewed in Yangon Region accounts for only about 8% of the total sample of women interviewed (1,065/12,885) and the number of women interviewed in Kayah State accounts 6% of the total sample of women interviewed (757/12,885). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of Myanmar, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small state, like Kayah, should only contribute a small amount to the national total. Women from a large region, like Yangon, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each state/region so that each state/region’s contribution to the total is proportional to the actual population of the state/region. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at state/regional level. The total national sample size of 12,885 women has not changed after weighting, but the distribution of the women in the states/regions has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the pink column (3) to the actual population distribution of Myanmar, you would see that women in each region/state are contributing to the total sample with the same weight that they contribute to the population of the country. The weighted number of women in the Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Myanmar 2015-16 Women Background characteristic Weighted percent Weighted number Unweighted number States/Regions Kachin 2.9 374 804 Kayah 0.5 65 757 Kayin 2.4 303 751 Chin 0.8 102 750 Sagaing 10.9 1,410 1,039 Tanintharyi 2.2 283 717 Bago 9.7 1,244 939 Magway 8.4 1,081 947 Mandalay 12.0 1,541 963 Mon 3.6 463 789 Rakhine 6.0 777 911 Yangon 15.0 1,927 1,065 Shan 10.6 1,368 778 Ayeyarwady 12.8 1,650 919 Nay Pyi Taw 2.3 300 756 Total 100.0 12,885 12,885 3 2 1 Reading and Understanding the 2015-16 Myanmar Demographic and Health Survey (MDHS) • xxiii survey now accurately represents the proportion of women who live in Yangon Region and the proportion of women who live in Kayah State. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national and regional/state levels. In general, only the weighted numbers are shown in each of the MDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Contributors to the Report • xxv CONTRIBUTORS TO THE REPORT Dr. Thet Thet Mu, Director, Health Management Information Systems, Ministry of Health and Sports Dr. Yin Nyein Htut, Medical Officer, Occupational and Environmental Health, Ministry of Health and Sports Dr. Nan Naing Naing Shein, Deputy Director, Noncommunicable Disease Program Dr. Thida, Deputy Director, Department of Medical Research, Pyin Oo Lwin Daw Kay Thi Aung, Staff Officer, Planning Department Daw Myo Thandar, Staff Officer, Department of Population Dr. Hnin Hnin Lwin, Deputy Director, Maternal and Reproductive Health, Ministry of Health and Sports Daw Thin Thin Kyu, Assistant Director, Central Statistical Organization Dr. Nyan Hein, Medical Officer, Maternal and Reproductive Health, Ministry of Health and Sports Dr. Tin Tun Win, Medical Officer, Expanded Program on Immunization, Ministry of Health and Sports Dr. Khine Mar Zaw, Deputy Director, National Nutrition Center, Ministry of Health and Sports Dr. Tint Wai, Team Leader, Malaria Program, Ministry of Health and Sports Dr. Kyaw Zin Linn, Team Leader, National AIDS Program, Pyin Oo Lwin Dr. Ei Shwe Sin Win, Assistant Director, Health Management Information Systems, Ministry of Health and Sports Dr. Zaw Myo Aung, Assistant Director, Child Health Development Dr. Kyaw Thu Soe, Research Officer, Department of Medical Research, Pyin Oo Lwin Dr. Lwin Lwin Aung, Assistant Director, Health Management Information Systems, Ministry of Health and Sports Daw Ei Pyae Win, Staff Officer, Ministry of Education Acronyms and Abbreviations • xxvii ACRONYMS AND ABBREVIATIONS ACT artemisinin-based combination therapy AIDS acquired immunodeficiency syndrome AMW auxiliary mid-wives ANC antenatal care API annual parasite incidence ARI acute respiratory infection ART antiretroviral therapy ASFR age-specific fertility rate BCG Bacille-Calmette-Guerin vaccine against tuberculosis BMI body mass index CAFE computer-assisted field editing CCM community case management CHW community health worker CSG community-based support group DHS Demographic and Health Survey DPT Diphtheria, pertussis, and tetanus vaccine EA enumeration area EPI Expanded Program on Immunization F-IMNCI facility-based integrated management of neonatal and childhood illnesses GAR gross attendance ratio GFR general fertility rate GPI gender parity index HIV human immunodeficiency virus HMIS health management information system ICD International Classification of Diseases IMNCI integrated management of neonatal and childhood illnesses ITN insecticide-treated net IU international unit IUD intrauterine device IYCF infant and young child feeding LAM lactational amenorrhea method LHV lady health visitor LLIN long-lasting insecticide-treated net LPG liquid petroleum gas MARC Myanmar Artemisinin Resistance Containment MCH maternal and child health 3MDG Three Millennium Development Goal Fund MDHS Myanmar Demographic and Health Survey MICS Multiple Indicators Cluster Survey xxviii • Acronyms and Abbreviations MR measles and rubella MoHS Ministry of Health and Sports MTCT mother-to-child transmission MUAC mid-upper-arm circumference NAR net attendance ratio NGO nongovernmental organization NN neonatal mortality OPV oral polio vaccine ORS oral rehydration salts ORT oral rehydration therapy PCV pneumococcal conjugate vaccine PNN postneonatal mortality PPS probability proportional to size PRM pregnancy-related mortality PSU primary sampling unit RHC rural health center RHF recommended homemade fluids SD standard deviation STI sexually transmitted infection TB tuberculosis TFR total fertility rate UHC urban health center UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency VIP ventilated improved pit WHO World Health Organization ZnSO4 zinc sulphate xxx • Map of Myanmar Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) is the first Demographic and Health Survey to be conducted in Myanmar. The survey was implemented by the Ministry of Health and Sports (MoHS), and data collection took place from December 7, 2015, to July 7, 2016. Funding was provided by the United States Agency for International Development (USAID) and the Three Millennium Development Goal Fund (3MDG). ICF provided technical assistance through The DHS Program. 1.1 SURVEY OBJECTIVES The primary objective of the 2015-16 MDHS was to provide up-to-date estimates of basic demographic and health indicators. Specifically, the survey collected information on fertility levels, marital status, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, mother and child mortality and health, HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues, such as smoking and knowledge of tuberculosis. The information collected through the 2015-16 MDHS is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population. Moreover, this survey has come at a beneficial time for Myanmar, as the results will be used to develop the next 5-year National Health Plan (2017-2021) and to update the national comprehensive development plan. 1.2 SAMPLE DESIGN The sampling frame consisted of 76,990 primary sampling units (PSUs) across the country. A PSU is either a census enumeration area (EA) or a ward or village tract in a sensitive area not enumerated during the census. Each PSU had cartographic materials that delineated its geographic location, boundaries, main access points, and landmarks. The sampling frame contained information about each PSU’s administrative subordinations (state or region and district), the type of residence (urban or rural), and the estimated number of residential households. The sampling frame excluded institutional populations, such as persons in hotels, barracks, and prisons, but included those from internally-displaced population camps. A master sample was created under the aegis of the Department of Population within the Ministry of Labor, Immigration and Population. The sample was based on the 2014 census frame, which is used to coordinate household-based surveys conducted in Myanmar, including the current 2015-16 MDHS. The master sample is a large, nationally representative sample consisting of 4,000 PSUs drawn from the entire census frame; these can be used for sub-selecting multi-stage household-based survey samples. The master sample is large enough to provide design flexibility for the various household-based surveys in Myanmar. The master sample is a stratified sample, selected with probability proportional to size (PPS). Stratification is achieved by separating each state or region into urban and rural areas, each of which formed a separate sampling stratum. In total, 30 sampling strata were created. Samples were selected independently in each sampling stratum. Implicit stratification and proportional allocation were achieved at each of the lower administrative unit levels. This was done before sample selection by sorting the sampling frame within the explicit stratum, according to administrative unit, and by using a PPS selection procedure. The 2015-16 MDHS followed a stratified two-stage sample design and was intended to allow estimates of key indicators at the national level, in urban and rural areas, and for each of the seven States and eight Regions of Myanmar. The first stage involved selecting sample points (clusters) consisting of EAs or ward/village tracts. A total of 442 clusters (123 urban and 319 rural) were selected from the master sample. T 2 • Introduction and Survey Methodology At the second stage, a fixed number of 30 households was selected from each of the selected clusters (a total of 13,260 households), using equal probability systematic sampling. For the clusters, which were completely enumerated during the population census, the census household listings were taken as the base and updated in the field by the household listing teams. These updated lists were used for selecting the sample households. For the clusters that were not enumerated or partially enumerated during the census, an independent household listing operation was carried out. Because of the non-proportional sample allocation, the sample was not a self-weighting sample. Weighting factors had to be calculated, added to the data file, and applied so that results are representative at the national as well as regional level. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. In half of the selected households (every second household), all men age 15-49 who were either residents or visitors who stayed in the household the night before the survey were eligible to be interviewed. During the course of the fieldwork, 4 clusters were identified as insecure and were replaced with other clusters in the vicinity. In addition, 1 urban cluster had to be dropped due to worsening security. Overall, the survey was successfully carried out in 441 clusters. 1.3 QUESTIONNAIRES Three sets of questionnaires were used in the 2015-16 MDHS: a Household Questionnaire, a Woman’s Questionnaire, and a Man’s Questionnaire. These questionnaires, developed for the worldwide DHS program, were revised to accord with Myanmar culture as well as to reflect some country-specific health issues. A questionnaire design workshop was conducted with multiple stakeholders from MoHS and other related ministries, UN agencies, donor groups, and local and international nongovernmental organizations. The final draft was approved by the MDHS Technical Committee, translated into Myanmar, and back translated to English. The survey protocol was reviewed and approved by the Ethics Review Committee on Medical Research including Human Subjects in the Department of Medical Research, Ministry of Health and Sports. Similarly, the survey protocol was approved by the ICF Institutional Review Board. The Household Questionnaire listed all usual household members and any visitors who stayed in the household the night before the survey, along with basic information on their age, sex, education, relationship to the head of the household, marital status, and, for children under age 18, survival status of the parents. Data on age and sex were used to identify women and men eligible for individual interviews. The Household Questionnaire also collected information on the household’s dwelling characteristics, such as water source, toilet facilities, fuel use, and flooring materials, and on possessions, such as durable goods and mosquito nets. In addition, a small sample of salt was requested from each household and was tested for iodine content using a rapid test kit. Measurements of height, weight, and mid-upper arm circumference (MUAC) were taken, and results of blood testing for anemia were entered. The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics:  Background characteristics (including age, education, and media exposure)  Complete birth history and child mortality  Knowledge and use of family planning methods  Fertility preferences  Antenatal, delivery, and postnatal care  Breastfeeding and infant feeding practices  Vaccinations and childhood illnesses Introduction and Survey Methodology • 3  Women’s work and husbands’ background characteristics  Knowledge, awareness, and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs)  Adult mortality, including maternal mortality  Knowledge, attitudes, and behavior related to other health issues (e.g., tuberculosis)  Domestic violence (questions asked of one woman per household in the subsample of households selected for the male survey) The Man’s Questionnaire was administered to all men age 15-49 in half of the selected households. The questionnaire was similar to the Woman’s Questionnaire but shorter because it did not contain the complete birth history, sections on maternal and child health, or the section on domestic violence. 1.4 ANTHROPOMETRY, AND ANEMIA TESTING The 2015-16 MDHS incorporated several “biomarkers”: anthropometry, including mid-upper-arm circumference measurement, and anemia testing. Anthropometry. Height and weight measurements were recorded for children age 0-59 months and women age 15-49. In addition, mid-upper-arm circumference (MUAC) was recorded for children age 0-59 months. Measurements were taken using measuring boards specially made by Shorr Productions for use in survey settings and lightweight SECA scales with digital screens. Anemia testing. Blood specimens for anemia testing were collected from women age 15-49 who voluntarily consented to be tested and from all children age 6-59 months for whom consent was obtained from their parents or the adult responsible for the children. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Hemoglobin analysis was carried out on site using a battery-operated portable HemoCue analyzer. Results were provided verbally and in writing. Parents/guardians of children with a hemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their hemoglobin levels were below 7 g/dl and 9 g/dl, respectively. All households in which anthropometry and anemia testing were conducted were given a brochure explaining the causes and prevention of anemia. 1.5 TRAINING OF TRAINERS AND PRETEST The training of trainers was conducted from October 18 to November 3, 2014, for nine master trainers from the Department of Public Health of MoHS. The purpose of the training was to familiarize the participants with some key components of the Demographic and Health Survey (DHS), as it was the first such survey in the country. The DHS Program survey manager facilitated the sessions, highlighting the concept of adult learning principles and guidelines on conducting effective training of field staff. The training focused on key components like probing for age, types of interview techniques, and procedures for completing the MDHS questionnaires; filling out a contraceptive calendar; completing the vaccination section; and standardization procedures for anthropometry. The participants worked in groups to develop teach-backs on these topics using various training techniques, for example, slide presentation, use of flip charts, interactive question-and-answer session, case study, and role play. They were encouraged to develop participatory methods for the training. These participants were trained to be involved during the pretest, lead the sessions during the main training, and also monitor the fieldwork of the survey. Over a 3-week period in January 2015, 19 women and 3 men participated in a training to pretest the MDHS survey protocol. Most of the participants were staff of the various divisions of the Department of 4 • Introduction and Survey Methodology Public Health such as Health Information, HIV, TB, and Maternal and Reproductive Health. One representative from the Central Statistical Organization also participated. Twelve days of classroom training were provided at the training hall of the MoHS. The training was led by The DHS Program staff, and supported by the in-country MDHS core team that had members who participated in the training of trainers. Further, resource persons from the Child Health Department, Expanded Immunization Program, and Maternal and Reproductive Health Department of MoHS attended the sessions to provide technical background on topics such as family planning, reproductive health, child health, and nutrition. The fieldwork for the pretest was carried out in one urban and two rural locations of Mandalay, using the Myanmar language questionnaires. Following the field practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF Fourteen trainers, who were previously taught during the training of trainers session in October/November 2014 and in the pretest training in January 2015, participated in a 5-day refresher training held from September 14-18, 2015, which was conducted in preparation for the main training. Because the main training was carried out 8 months after the pretest, a refresher course for the trainers was held so that they could facilitate the main training efficiently. For the main fieldwork, the MoHS recruited 148 people, including 108 candidates from the government and 40 candidates from the nongovernment sector, which included the Central Statistical Organization, the Health Assistants Association, and various ethnic group associations from Kachin State, Kayin State, and Shan State (Pao and Danu). They served as supervisors, field editors, interviewers, and reserve interviewers. The field staff main training took place from September 28 to October 23, 2015, at the Shwe Pyi Taw Hotel in Nay Pyi Taw. The main fieldwork training was led by the master trainers of the MoHS and by The DHS Program trainers. The training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of questionnaire content, and instruction on how to administer the paper questionnaires. Also taught were measuring height and weight, anemia testing of eligible women and children, and computer-assisted field editing (CAFE) procedures. The sessions included discussion of concepts, procedures, and methodology of conducting the survey. Participants were guided through the questionnaires. Further, resource persons from the MoHS and UNICEF attended the sessions to provide technical advice. The master trainers used various techniques they had learned to facilitate the training sessions. These included presentations, lectures, hands-on exercises, mock interviews, role plays, group work, and quizzes. In-class exercises included probing for age, checking age consistency, filling out vaccination dates, completing the reproductive calendar, and practicing interviews. The trainees were taken for field practice in nonsampled areas near the training site, where they had an opportunity to implement the survey in a real world situation. Additional practice for anemia testing among children was carried out in the Outpatient Department of the General Hospital run under the aegis of the MoHS. Participants were evaluated through in-class exercises, quizzes, and observations made during field practice. Ultimately, 19 supervisors and 19 field editors were identified based on their performance. Similarly, 110 participants were selected to serve as interviewers; some were specially recruited to carry out fieldwork in sensitive areas in Shan and Rakhine. The supervisors received additional training in data quality control procedures, fieldwork coordination, and management, while the field editors received extra training on editing the questionnaires. 1.7 FIELDWORK Although the training of the field staff was completed on October 23, 2015, there was no permission to carry out the field practice or launch the fieldwork because of the uncertain outcome of the upcoming Introduction and Survey Methodology • 5 general election. The election was held peacefully on November 8, 2015. After approval for conducting the fieldwork was received, a refresher training was carried out on November 30 in three locations: Yangon, Mawlamyine, and Mandalay. A field practice was then held for 2 days with review sessions conducted in the end. The fieldwork was launched in these three locations under close supervision on December 7, 2015. Data collection was carried out by 19 field teams, each consisting of one team supervisor, one field editor, three to four female interviewers, and one male interviewer. However, the team composition had to be adjusted during the different phases of the fieldwork operation. Data collection took place from December 7, 2015, through July 7, 2016, although most of the teams completed the fieldwork by April 2015. The extension of fieldwork in some states and regions reflected sensitivity toward ethnic groups and occurred in non-state-controlled areas where additional advocacy strategies had to be implemented. Karen Department Health and Welfare facilitated the data collection in some enumeration areas of Kayin State. The Wa Health Department and Health Poverty Action also supported data collection in two enumeration areas from Wa Special Region. Despite substantial challenges in the field, the MDHS field teams successfully completed the fieldwork. Travel plans for data collection by the teams were shared with the central health office and state and regional offices, including local administrative offices. Each team had to inform the MDHS core team as well as the respective state and regional public health departments of their fieldwork’s location and progress. Field supervision was carried out by the state and regional public health directors and officers. A standard supervisory protocol was developed to monitor coverage, and an orientation was conducted by the MDHS team. Technical monitoring was carried out by the MDHS core team and the master trainers. In addition, field supervision visits were conducted by the Deputy Health Minister, two Deputy Survey Managers, the DHS resident advisor from ICF, and other members of the MDHS Technical Committee. The DHS Program survey manager from ICF conducted field monitoring at different stages of field data collection. Additionally, a mechanism was developed to generate weekly field check tables to monitor the data quality, and immediate feedback was provided to the field teams. 1.8 DATA PROCESSING The 2015-16 MDHS used computer-assisted field editing (CAFE) procedures with tablet computers. Thus, data processing began simultaneously with the fieldwork. All completed questionnaires were entered into the tablets while in the field by the field editors after they edited them on paper. Entries were checked by the supervisors before the questionnaires were dispatched to the data processing center at the MoHS central office in Nay Pyi Taw. These completed questionnaires were reviewed and re-entered by 13 data processing personnel specially trained for this task. All data were thus entered twice (100 percent verification), once in the field by the field editors and then again in the data processing center in Nay Pyi Taw. Data were entered using the CSPro computer package. The operation included secondary editing, using CSPro software, to resolve computer-identified inconsistencies and to code open-ended questions. The concurrent processing of the data offered a distinct advantage, because it maximized the likelihood of the data being error-free and accurate. Moreover, the double entry of data enabled easy comparison and identification of errors and inconsistencies. Inconsistencies were resolved by tallying with the paper questionnaire entries. The secondary editing was implemented by four editors and was completed in the second week of July 2016. The final cleaning of the data set was carried out by the DHS Program data processing specialist by the end of July 2016. 6 • Introduction and Survey Methodology 1.9 RESPONSE RATES Table 1.1 shows the response rates for household and individual interviews. The total number of households selected was 13,238, of which 12,780 households were occupied. Of those occupied, 12,500 households were interviewed, yielding a 98% response rate. In the interviewed households, 13,454 women were identified as eligible for the individual Woman’s Questionnaire. Interviews were successfully completed with 12,885 women, yielding a 96% response rate. In the subsample of one-half of the households, 5,218 men were identified as eligible for individual interview. Interviews were completed for 4,737 men, with a 91% response rate. The response rates are lower in the urban areas than in the rural areas. The difference is slightly more noticeable among men than women, probably reflecting the fact that men in urban areas are often away from their households for employment. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Myanmar DHS 2015-16 Residence Result Urban Rural Total Household interviews Households selected 3,672 9,566 13,238 Households occupied 3,524 9,256 12,780 Households interviewed 3,399 9,101 12,500 Household response rate1 96.5 98.3 97.8 Interviews with women age 15-49 Number of eligible women 4,039 9,415 13,454 Number of eligible women interviewed 3,785 9,100 12,885 Eligible women response rate2 93.7 96.7 95.8 Interviews with men age 15-49 Number of eligible men 1,512 3,706 5,218 Number of eligible men interviewed 1,321 3,416 4,737 Eligible men response rate2 87.4 92.2 90.8 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 7 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings  Drinking water: Eighty percent of all households have access to an improved drinking water source, as do 89% of urban households and 77% of rural households.  Sanitation: Almost half of all households have an improved sanitation facility; however, less than 1% have a flush toilet linked to a sewer system.  Household population and composition: Twenty-nine percent of the Myanmar population is under age 15. The sex ratio in Myanmar is 85 men per 100 women.  Indoor smoke: Seventy-seven percent of all households use solid fuel for cooking. Forty-five percent of households are exposed daily to secondhand smoke.  Birth registration: Eighty-one percent of children under age 5 have had their births registered.  Orphans: Seventy-five percent of children under age 18 live with both parents, 8% are orphans, and 9% do not live with either parent.  School attendance: The net attendance rate decreases from 83% in primary school to 60% in secondary school. There is no difference by gender in school attendance in primary school, but more girls than boys attend secondary school. nformation on the socioeconomic characteristics of the household population in the 2015-16 MDHS provides context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on source of drinking water, sanitation, exposure to smoke inside the home, wealth, handwashing, household population composition, educational attainment, school attendance, birth registration, and family living arrangements. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, rainwater, and bottled water Sample: Households I 8 • Housing Characteristics and Household Population Improved sources of water protect against outside contamination so that water is more likely to be safe to drink. In Myanmar, 80% of households have an improved source of drinking water, including 89% of households in urban areas and 77% in rural areas. One in five households has an unimproved source of drinking water (Figure 2.1). The most common improved source of drinking water in urban areas is bottled water (48%), and in rural areas is a tubewell or borehole (33%) (Table 2.1). Thirty-seven percent of all households have drinking water on their premises, including 30% of urban households and 39% of rural households. Over half (56%) of households in Myanmar must get their water off their premises and spend less than 30 minutes round-trip. Only 6% of households spend 30 minutes or longer getting water. One in four households does not treat water to make it drinkable. Urban households are less likely to treat their drinking water (45%) than rural households (19%). This is likely because almost half of urban households use bottled water for drinking. Straining through a cloth is the most common water treatment method, used by 56% of all households, followed by boiling (25%). Overall 33% of households use an appropriate method to treat their drinking water. 2.2 SANITATION Improved toilet facilities Include any non-shared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; pit latrines with slabs; and composting toilets Sample: Households Use of improved toilet facilities, defined as non- shared facilities that prevent people from coming into contact with human waste, helps reduce the transmission of communicable diseases such as cholera and typhoid. Nearly half of households in Myanmar (48%) have improved toilet facilities, including 65% in urban areas and 42% in rural areas (Table 2.2). Eleven percent of households have no toilet facility, and rural households are more likely to lack a toilet facility than urban households (14% versus 1%) (Figure 2.2). The most common type of toilet facility in rural areas is an open pit or a pit latrine without a slab (31%). By contrast, a toilet that flushes to a pit latrine is the most common type of toilet in urban areas (37%). Figure 2.1 Household drinking water by residence Figure 2.2 Household toilet facilities by residence 6 8 6 3 3 3 28 16 33 25 13 29 16 48 4 20 11 23 Total Urban Rural Unimproved source Bottled water Protected well or spring Tubewell or borehole Public tap/standpipe Piped water into dwelling/yard/plot Percent distribution of households by source of drinking water 48 65 42 10 12 9 31 22 35 11 1 14 Total Urban Rural No facility/bush/field Unimproved facility Shared facility Improved facility Percent distribution of households by type of toilet facilities Housing Characteristics and Household Population • 9 2.3 EXPOSURE TO SMOKE INSIDE THE HOME Cooking with solid fuel and smoking of tobacco are the main sources of smoke inside the home. Exposure to smoke has potentially harmful health effects, particularly for young children, mothers, and the elderly who spend most of their time indoors. In Myanmar, 62% of households cook inside their home, including 73% in urban areas and 57% in rural areas. Most households (77%) use solid fuels for cooking, which can be harmful to health. Use of solid fuels is more common in rural households (90%) than in urban households (39%). Wood is the most common type of fuel used in rural areas (77%), while electricity (58%) is the most common type of fuel in urban areas. Charcoal is also often used in urban households (23% ) (Table 2.3). Exposure to smoke from persons smoking tobacco inside the home is also high in Myanmar. In nearly half of the households (45%), someone smokes daily inside the home, and in 6% of households someone smokes at least weekly inside the home. Persons living in rural households (48%) are more likely to be exposed to secondhand smoke than persons living in urban households (36%). Other Housing Characteristics The survey also collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. Electrification in Myanmar is far from complete. Only 56% of households have electricity. Urban households are more likely to have access to electricity than rural households (92% versus 42%). Wood planks are the most common flooring material used in the country (39%), and this material is more widely used in rural areas (41%) than urban areas (35%). Palm and bamboo is the second most common flooring material used in Myanmar. Table 2.3 provides complete information about housing characteristics. 2.4 HOUSEHOLD WEALTH Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, plus housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by their score, and then dividing the distribution into five equal categories, each with 20% of the population. Sample: Households 10 • Housing Characteristics and Household Population More than half of the urban de jure population (56%) belong to the wealthiest quintile, compared with only 7% of the rural population (Figure 2.3). Twenty-six percent of the rural population is in the lowest quintile, compared with only 4% of the urban population. Among states and regions, Yangon Region has the highest share of population in the wealthiest quintile (47%) and the lowest in the lowest quintile (6%), whereas, Rakhine State has the highest share of population in the lowest quintile (53%) and the lowest in the highest quintile (4%) (Table 2.5). Table 2.5 also includes the Gini coefficient, a measure of the level of concentration of wealth, with 0 being an equal wealth distribution and 1 a totally unequal wealth distribution. The Gini coefficient of Myanmar is 0.27, which suggests that wealth is fairly evenly distributed across the population. Household Durable Goods Information about household effects, means of transportation, agricultural land, and farm animals is shown in Table 2.4. Seventy-three percent of households have mobile telephones. While almost all households in urban areas (93%) have a mobile phone, only two-thirds of households in rural areas have one. Only 4% of households own a computer, 14% of urban households and 1% of rural households. Half of households own a motorcycle or scooter for transportation, including 53% in urban areas and 49% in rural areas. Only 5% of households own a car or truck. Urban households are more likely than rural households to own a car or truck (12% versus 3%). Rural households are more likely to own agricultural land (51%) than urban households (9%). 2.5 HAND WASHING Handwashing is one of the most effective ways to prevent germs from spreading. In Myanmar, 84% of households have soap and water for washing hands, while 3% of households have no water, soap, or other cleansing agent on the premises (Table 2.6). This information is based on 94% of the households in which the place for handwashing was observed, making the data fairly representative. Patterns by background characteristics  Ninety-five percent of urban households have soap and water available for washing hands, compared with 80% of rural households.  Twelve percent of households in Kayin State have no water, soap, or other cleansing agent, followed by 10% of households in Kayah State.  The availability of soap and water on the premises increases with wealth. Almost all the households in the wealthiest quintile have soap and water for handwashing on the premises, whereas in the lowest quintile only 67% of households do. Figure 2.3 Household wealth by residence 4 265 25 10 24 26 18 56 7 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 11 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors) De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview The 2015-16 MDHS found a de- facto population of 51,130 people in the 12,500 interviewed households. Forty-six percent of the total population is male and 54% is female, yielding a sex ratio of 85 males per 100 females. Twenty-nine percent of the population is under age 15 (Table 2.7 and Figure 2.4). Women head 23% of households. Households headed by a woman are slightly more common in urban areas (27%) than in rural areas (21%). On average, households in Myanmar have 4.2 members. There is little difference in household size by urban-rural residence. Thirteen percent of households have one or more foster or orphan children under age 18 (Table 2.8). 2.7 BIRTH REGISTRATION Registered birth Child has a birth certificate or the birth is registered with the civil authority Sample: De jure children under age 5 Figure 2.4 Population Pyramid 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 261210 12 • Housing Characteristics and Household Population Birth registration helps ensure access to basic services, including immunizations, health care, and school enrollment at the appropriate age (UNICEF 2006). Eighty-one percent of children under age 5 have had their births registered; 74% also have a birth certificate (Table 2.9). Patterns by background characteristics  Urban children are more likely to have their births registered than rural children (94% versus 78%).  Ninety-seven percent of children in the wealthiest quintile, but only 69% of children in the poorest quintile, have had their birth registered (Figure 2.5).  Birth registration varies by states and regions. Children are most likely to have their births registered in Kayah State (96%) and least likely in Rakhine State (45%) (Figure 2.6).  Figure 2.6 Birth registration by states and regions Percentage of de jure children under age 5 whose births are registered with the civil authorities Figure 2.5 Birth registration by household wealth 69 76 86 91 97 Lowest Second Middle Fourth Highest Percentage of de jure children under age 5 whose births are registered with the civil authorities Poorest Wealthiest Housing Characteristics and Household Population • 13 2.8 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents dead Sample: Children under age 18 Seventy-five percent of children under age 18 live with both of their parents. Eight percent of children under age 18 in Myanmar are orphans, and 9% of children under age 18 do not live with either biological parent (Table 2.10). Patterns by background characteristics  Orphanhood is more prevalent among children age 15-17 (14%) than among children under age 2 (1%).  Rural children are more likely to live with both parents than urban children (77% versus 70%).  The highest proportion of orphaned children is in Kachin State (10%), and the lowest proportion is in Chin State (5%). 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Number of years of schooling completed by half of the population Sample: De facto household population age 6 and older In Myanmar, about one in five women and men age 6 and older have no education. A relatively high proportion of women and men have some secondary education or more: 36% of women and 41% of men. There is little difference by sex in the median years of education completed (4.2 versus 4.5) (Tables 2.11.1 and 2.11.2). Patterns by background characteristics  Urban residents are much more likely to have completed secondary school than rural residents: among women in urban households, 22% have completed secondary school or have higher education compared with 4% of women in rural households. Men in urban areas are also more likely than men in rural areas (19% versus 4%) to have completed secondary school.  Educational attainment varies by states and regions. Forty-three percent of women and 40% of men in Shan State have no education; by contrast, only 10% of women and 8% of men in Yangon Region have no education.  Educational attainment is associated with wealth. Thirty-four percent of women and 29% of men from the poorest households have never been to school, compared with only 10% of women and 9% of men from the wealthiest households. 14 • Housing Characteristics and Household Population 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary or secondary school Sample: Children age 5-9 for primary school NAR and children age 10-15 for secondary school NAR Gross attendance ratio (GAR) The total number of primary and secondary school students expressed as a percentage of the official primary and secondary school-age population Sample: Children age 5-9 for primary school GAR and children age 10-15 for secondary school GAR The net attendance ratio for primary school is 83%, and there is little difference by sex of child. The NAR is much lower for secondary school. Only 60% of children age 10-15 attend secondary school. The NAR for secondary school is slightly higher for girls (62%) than for boys (58%) (Table 2.12). Patterns by background characteristics  Seventy-five percent of urban children age 10-15 attend secondary school compared with 56% of rural children. The primary school NAR does not differ much by urban-rural residence.  Shan has the lowest NAR for both primary (72%) and secondary (36%) school. Mon has the highest NAR for primary school (89%) and Yangon has the highest for secondary school (72%).  Children in the wealthiest quintile are more likely to attend school at appropriate ages than children in the poorest quintile. The primary school NAR varies from 89% in the highest quintile to 75% in the poorest quintile, and the secondary school NAR varies from 81% in the highest quintile to 37% in the lowest quintile (Table 2.12). The pattern is similar for girls and boys (Figure 2.7). Other Measures of School Attendance The gross attendance ratio (GAR) and Gender Parity Index (GPI) are also shown in Table 2.12. A value of more than 100 percent for the GAR for primary school means that a significant number of primary school students are not of the official primary- school-age. In Myanmar, the primary school GAR is 109%, and the secondary school GAR is 70%. A GPI of more than 1 means that more girls are attending school than boys. In Myanmar, the GPI is 0.99 in primary school, suggesting that boys and girls are equally likely to attend primary school; however, the GPI for secondary school is 1.07, indicating that more girls than boys attend secondary school. Figure 2.7 Secondary school net attendance ratio by household wealth 38 59 67 76 84 37 53 60 72 78 Lowest Second Middle Fourth Highest Girls Boys WealthiestPoorest Net attendance ratio for secondary school among children age 10-15 Housing Characteristics and Household Population • 15 LIST OF TABLES For more information on household population and housing characteristics, see the following tables:  Table 2.1 Household drinking water  Table 2.2 Household sanitation facilities  Table 2.3 Household characteristics  Table 2.4 Household possessions  Table 2.5 Wealth quintiles  Table 2.6 Handwashing  Table 2.7 Household population by age, sex, and residence  Table 2.8 Household composition  Table 2.9 Birth registration of children under age 5  Table 2.10 Children’s living arrangements and orphanhood  Table 2.11.1 Educational attainment of the female household population  Table 2.11.2 Educational attainment of the male household population  Table 2.12 School attendance ratios 16 • Housing Characteristics and Household Population Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Myanmar DHS 2015-16 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 89.2 76.9 80.2 89.5 77.0 80.4 Piped into dwelling/yard plot 8.1 5.7 6.3 8.4 6.1 6.7 Public tap/standpipe 3.2 3.1 3.2 3.0 3.0 3.0 Tubewell/borehole 15.7 32.7 28.1 16.1 32.5 28.1 Protected dug well 12.7 25.8 22.3 13.1 25.7 22.3 Protected spring 0.7 3.5 2.7 0.7 3.5 2.8 Rain water 0.7 2.4 2.0 0.5 2.5 1.9 Bottled water 48.1 3.8 15.5 47.7 3.6 15.5 Non-improved source 10.7 22.9 19.6 10.4 22.8 19.5 Unprotected dug well 4.0 10.2 8.5 3.9 10.5 8.8 Unprotected spring 0.5 2.5 1.9 0.5 2.6 2.0 Tanker truck/cart with drum 4.0 1.6 2.3 3.8 1.7 2.2 Surface water 2.2 8.6 6.9 2.2 8.0 6.4 Other source 0.1 0.2 0.2 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 30.0 39.2 36.8 30.0 40.4 37.6 Less than 30 minutes 66.0 52.5 56.1 65.9 51.1 55.1 30 minutes or longer 2.4 7.6 6.2 2.5 7.8 6.3 Don’t know/missing 1.6 0.7 1.0 1.7 0.7 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 23.8 25.6 25.1 22.6 25.1 24.4 Bleach/chlorine added 0.3 0.6 0.6 0.3 0.7 0.6 Strained through cloth 39.0 61.5 55.5 39.3 61.3 55.4 Ceramic, sand or other filter 6.6 9.5 8.7 7.3 9.0 8.6 Let it stand and settle 4.8 8.4 7.4 4.3 8.3 7.2 Other 1.3 1.4 1.4 1.1 1.3 1.3 No treatment 44.8 18.6 25.6 44.5 19.3 26.1 Percentage using an appropriate treatment method2 29.0 34.1 32.7 28.2 33.3 31.9 Number 3,315 9,185 12,500 14,216 38,581 52,797 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. As only four households used solar disinfection, the category not shown separately. Housing Characteristics and Household Population • 17 Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type and location of toilet/latrine facilities, according to residence, Myanmar DHS 2015-16 Households Population Type and location of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 0.7 0.1 0.3 0.7 0.1 0.3 Flush/pour flush to septic tank 15.7 2.3 5.9 15.7 2.3 6.0 Flush/pour flush to pit latrine 36.5 24.6 27.7 37.5 25.2 28.5 Ventilated improved pit (VIP) latrine 2.9 2.3 2.5 2.9 2.4 2.6 Pit latrine with slab 8.6 11.3 10.6 8.9 11.1 10.5 Composting toilet 0.1 1.6 1.2 0.1 1.7 1.2 Total 64.5 42.2 48.1 65.9 42.9 49.1 Shared facility1 Flush/pour flush to piped sewer system 0.1 0.0 0.0 0.1 0.0 0.0 Flush/pour flush to septic tank 2.3 0.2 0.8 2.2 0.2 0.7 Flush/pour flush to pit latrine 7.1 5.1 5.6 6.4 4.7 5.1 Ventilated improved pit (VIP) latrine 0.6 0.7 0.7 0.5 0.7 0.6 Pit latrine with slab 2.0 2.8 2.6 1.9 2.3 2.2 Composting toilet 0.0 0.4 0.3 0.0 0.4 0.3 Total 12.2 9.2 10.0 11.0 8.2 9.0 Unimproved facility Flush/pour flush not to sewer/septic tank/pit latrine 2.1 1.3 1.5 2.1 1.3 1.5 Pit latrine without slab/open pit 19.4 31.4 28.2 19.1 31.3 28.0 Bucket 0.0 0.1 0.1 0.0 0.1 0.1 Hanging toilet/hanging latrine 0.4 1.5 1.2 0.5 1.7 1.3 No facility/bush/field 1.2 13.9 10.5 1.1 14.2 10.7 Other 0.3 0.4 0.4 0.3 0.3 0.3 Total 23.4 48.6 41.9 23.1 48.9 41.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,315 9,185 12,500 14,216 38,581 52,797 1 Facilities that would be considered improved if they were not shared by two or more households 18 • Housing Characteristics and Household Population Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Myanmar DHS 2015-16 Residence Housing characteristic Urban Rural Total Electricity Yes 92.3 42.3 55.6 No 7.7 57.7 44.4 Total 100.0 100.0 100.0 Flooring material Earth/sand 5.6 12.3 10.6 Dung 0.1 0.2 0.2 Wood planks 34.9 40.8 39.2 Palm/bamboo 5.4 22.0 17.6 Parquet or polished wood 19.3 13.8 15.3 Vinyl or asphalt strips 0.1 0.0 0.1 Ceramic tiles 3.1 0.4 1.1 Cement 30.6 10.2 15.6 Carpet 0.5 0.0 0.2 Other 0.3 0.1 0.2 Total 100.0 100.0 100.0 Rooms used for sleeping One 41.8 52.3 49.5 Two 36.0 34.2 34.7 Three or more 20.5 11.6 14.0 Missing 1.8 1.8 1.8 Total 100.0 100.0 100.0 Place for cooking1 In the house 73.0 57.4 61.5 In a separate building 15.6 28.9 25.4 Outdoors 10.4 13.2 12.5 No food cooked in household 0.9 0.5 0.6 Total 100.0 100.0 100.0 Cooking fuel2 Electricity 57.7 9.5 22.3 LPG/natural gas/biogas 1.9 0.1 0.6 Coal/lignite 0.2 0.1 0.1 Charcoal 22.6 10.2 13.5 Wood 16.5 77.4 61.2 Straw/shrubs/grass 0.0 0.2 0.2 Agricultural crop 0.1 1.9 1.4 Animal dung 0.0 0.2 0.1 No food cooked in household 0.9 0.5 0.6 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking3 39.4 89.9 76.5 Frequency of smoking in the home Daily 36.0 48.4 45.1 Weekly 6.3 5.3 5.5 Monthly 1.1 1.4 1.3 Less than monthly 3.6 3.3 3.4 Never 53.0 41.7 44.7 Total 100.0 100.0 100.0 Number 3,315 9,185 12,500 LPG = Liquefied petroleum gas 1 As only one household used other place for cooking, it is not shown separately. 2 As only four households used other type of cooking fuel, it is not shown separately. 3 Includes coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung Housing Characteristics and Household Population • 19 Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, and ownership of agricultural land and livestock/farm animals by residence, Myanmar DHS 2015-16 Residence Possession Urban Rural Total Household effects Radio 30.6 35.1 33.9 Television 85.3 46.9 57.1 Mobile telephone 92.7 65.9 73.0 Non-mobile telephone 12.0 5.1 6.9 Refrigerator 44.8 5.5 16.0 Table 79.7 66.5 70.0 Chair 80.2 54.2 61.1 Sofa 8.5 1.4 3.3 Bed 59.7 35.2 41.7 Cupboard 81.6 58.1 64.3 Electric fan 67.0 12.5 27.0 Air conditioner 12.4 0.5 3.7 Sewing machine 23.2 12.0 15.0 Computer 13.7 0.8 4.2 Means of transport Bicycle 54.9 37.7 42.2 Animal drawn cart 1.0 21.4 16.0 Motorcycle/scooter 52.9 49.2 50.2 Tuk Tuk/htawlargyi (trailer) 2.0 5.1 4.3 Car/truck 12.2 2.6 5.1 Boat with a motor 0.2 1.1 0.9 Boat without a motor 1.0 7.5 5.8 Ownership of agricultural land 9.2 50.6 39.6 Ownership of farm animals1 13.4 64.4 50.9 Number 3,315 9,185 12,500 1 Cattle, cows, bulls, horses, donkeys/mules, goats, sheep, pigs, chickens, or ducks Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Myanmar DHS 2015-16 Residence/States or Regions Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 3.6 5.4 10.0 25.5 55.6 100.0 14,216 0.17 Rural 26.1 25.4 23.7 18.0 6.9 100.0 38,581 0.26 States/Regions Kachin 13.2 23.0 22.0 25.1 16.7 100.0 1,619 0.29 Kayah 11.3 21.3 25.2 26.5 15.7 100.0 285 0.26 Kayin 24.3 18.5 17.1 21.5 18.5 100.0 1,510 0.31 Chin 21.3 29.4 27.6 13.7 8.0 100.0 506 0.29 Sagaing 8.0 22.4 28.0 27.9 13.7 100.0 5,856 0.20 Tanintharyi 24.9 22.3 17.8 20.6 14.4 100.0 1,349 0.32 Bago 18.9 23.6 23.4 20.1 14.0 100.0 4,929 0.30 Magway 18.5 23.4 27.4 18.4 12.3 100.0 4,179 0.24 Mandalay 6.9 17.8 23.3 24.3 27.7 100.0 5,986 0.23 Mon 20.2 15.7 21.0 21.2 21.9 100.0 2,004 0.30 Rakhine 52.8 21.8 12.9 8.2 4.2 100.0 3,377 0.35 Yangon 6.0 9.1 14.9 23.1 46.9 100.0 7,066 0.22 Shan 18.5 20.4 15.2 20.8 25.0 100.0 5,924 0.28 Ayeyarwady 41.8 24.6 15.8 11.4 6.4 100.0 7,005 0.32 Nay Pyi Taw 22.8 20.7 19.4 16.3 20.7 100.0 1,202 0.38 Total 20.0 20.0 20.0 20.0 20.0 100.0 52,797 0.27 20 • Housing Characteristics and Household Population Table 2.6 Handwashing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for handwashing was observed, percent distribution by availability of water, soap, and other cleansing agents, Myanmar DHS 2015-16 Percentage of households in which place for washing hands was observed Number of households Among households where place for handwashing was observed, percentage with: Number of households with place for hand- washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Total Residence Urban 97.2 3,315 94.6 0.3 2.4 1.5 0.1 1.1 100.0 3,221 Rural 92.8 9,185 79.5 0.6 12.1 3.6 0.1 4.1 100.0 8,520 States/Regions Kachin 91.0 365 85.6 1.4 4.1 5.0 0.6 3.3 100.0 332 Kayah 88.0 65 63.2 0.1 23.3 3.5 0.0 9.8 100.0 57 Kayin 94.6 335 74.3 1.6 6.6 5.8 0.1 11.6 100.0 317 Chin 98.6 105 73.1 2.9 21.1 1.5 0.1 1.2 100.0 104 Sagaing 99.6 1,295 82.0 0.9 13.3 2.4 0.0 1.4 100.0 1,289 Tanintharyi 92.0 306 91.0 0.6 5.2 2.0 0.0 1.2 100.0 281 Bago 89.5 1,269 73.8 0.7 11.1 8.7 0.4 5.3 100.0 1,135 Magway 99.3 1,062 82.9 0.2 13.8 0.6 0.0 2.6 100.0 1,054 Mandalay 95.2 1,461 84.8 0.4 7.1 3.4 0.2 4.0 100.0 1,390 Mon 97.7 466 89.7 1.3 7.7 0.7 0.0 0.7 100.0 456 Rakhine 77.7 695 77.1 0.6 18.9 1.3 0.0 2.1 100.0 540 Yangon 99.3 1,730 98.3 0.1 1.1 0.2 0.0 0.2 100.0 1,718 Shan 87.1 1,339 77.8 0.0 10.8 4.9 0.1 6.3 100.0 1,167 Ayeyarwady 94.4 1,705 82.3 0.2 11.0 2.6 0.0 3.9 100.0 1,610 Nay Pyi Taw 95.6 303 81.7 1.0 7.4 4.8 0.7 4.6 100.0 290 Wealth quintile Lowest 85.2 2,583 66.7 0.8 17.8 5.5 0.2 9.0 100.0 2,202 Second 92.3 2,593 76.3 0.8 13.8 4.2 0.1 4.6 100.0 2,394 Middle 96.7 2,503 85.4 0.4 8.7 3.0 0.2 2.4 100.0 2,420 Fourth 97.6 2,424 90.9 0.3 6.1 1.9 0.1 0.7 100.0 2,365 Highest 98.4 2,397 97.7 0.2 1.3 0.6 0.0 0.2 100.0 2,360 Total 93.9 12,500 83.6 0.5 9.4 3.0 0.1 3.3 100.0 11,740 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by 5-year age groups, according to sex and residence, Myanmar DHS 2015-16 Urban Rural Age1 Male Female Total Male Female Total Male Female Total <5 8.5 6.5 7.4 10.9 8.6 9.7 10.3 8.0 9.0 5-9 9.1 7.1 8.0 11.3 10.1 10.7 10.8 9.2 9.9 10-14 10.2 7.9 8.9 11.7 10.4 11.0 11.3 9.7 10.4 15-19 8.3 8.0 8.1 7.3 6.6 6.9 7.6 7.0 7.2 20-24 8.1 7.9 7.9 6.4 7.0 6.7 6.9 7.2 7.1 25-29 7.6 7.6 7.6 6.8 7.3 7.1 7.0 7.4 7.2 30-34 7.3 7.3 7.3 6.6 7.9 7.3 6.8 7.7 7.3 35-39 6.5 7.7 7.2 6.9 7.2 7.1 6.8 7.4 7.1 40-44 6.6 6.7 6.7 5.8 6.5 6.2 6.0 6.6 6.3 45-49 6.5 6.9 6.7 5.9 5.9 5.9 6.0 6.2 6.1 50-54 6.1 7.3 6.8 5.7 6.3 6.0 5.8 6.5 6.2 55-59 4.8 6.2 5.6 4.5 4.9 4.7 4.6 5.2 4.9 60-64 3.8 4.7 4.3 3.6 3.8 3.7 3.6 4.0 3.8 65-69 2.7 2.9 2.8 2.5 2.9 2.7 2.6 2.9 2.8 70-74 1.8 2.1 2.0 1.6 1.8 1.7 1.7 1.9 1.8 75-79 1.1 1.4 1.3 1.2 1.4 1.3 1.2 1.4 1.3 80 + 1.0 1.9 1.5 1.2 1.6 1.4 1.2 1.7 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,300 7,662 13,962 17,247 19,921 37,168 23,547 27,583 51,130 1 Total includes six cases with missing information on age, not shown separately. Housing Characteristics and Household Population • 21 Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Myanmar DHS 2015-16 Residence Characteristic Urban Rural Total Household headship Male 72.6 79.3 77.5 Female 27.4 20.7 22.5 Total 100.0 100.0 100.0 Number of usual members 1 6.3 5.0 5.4 2 14.6 13.0 13.4 3 19.0 20.5 20.1 4 21.4 23.0 22.6 5 15.0 17.1 16.6 6 9.9 10.4 10.3 7 5.9 5.4 5.5 8 3.0 3.0 3.0 9+ 4.9 2.7 3.3 Total 100.0 100.0 100.0 Mean size of households 4.3 4.2 4.2 Percentage of households with orphans and foster children under age 18 Foster children1 9.8 8.9 9.2 Double orphans 0.5 0.6 0.5 Single orphans2 7.1 5.8 6.2 Foster and/or orphan children 14.5 12.8 13.2 Number of households 3,315 9,185 12,500 Note: Table is based on de jure household members, that is, usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2Single orphans are children with one dead parent and an unknown survival status of the other parent. 22 • Housing Characteristics and Household Population Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Myanmar DHS 2015-16 Children whose births are registered Background characteristic Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Number of children Age <2 71.8 9.5 81.3 1,810 2-4 75.6 5.7 81.3 2,823 Sex Male 75.5 6.4 81.9 2,420 Female 72.6 7.9 80.6 2,213 Residence Urban 89.6 4.3 93.9 1,029 Rural 69.7 8.0 77.7 3,604 States/Regions Kachin 77.9 14.2 92.1 165 Kayah 92.6 3.8 96.4 33 Kayin 77.7 9.0 86.8 192 Chin 62.3 9.5 71.7 64 Sagaing 84.2 2.0 86.3 506 Tanintharyi 76.8 11.7 88.5 149 Bago 72.4 6.3 78.7 409 Magway 86.9 5.7 92.6 335 Mandalay 85.2 7.8 92.9 444 Mon 78.1 9.2 87.3 194 Rakhine 33.0 12.1 45.0 323 Yangon 85.1 6.5 91.6 485 Shan 59.5 4.8 64.2 651 Ayeyarwady 78.6 7.3 85.9 584 Nay Pyi Taw 64.3 14.1 78.5 97 Wealth quintile Lowest 59.0 9.6 68.5 1,344 Second 68.5 7.4 75.8 1,005 Middle 79.6 6.3 85.9 807 Fourth 85.6 5.7 91.4 796 Highest 92.5 4.6 97.2 681 Total 74.1 7.1 81.3 4,633 H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n • 2 3 Ta bl e 2. 10 C h ild re n’ s liv in g a rr an g em en ts a n d or p ha nh o od P er ce nt d is tr ib ut io n of d e ju re c hi ld re n un de r ag e 18 b y liv in g ar ra ng em en ts a nd s ur vi va l s ta tu s of p ar en ts , t he p er ce nt ag e of c hi ld re n no t l iv in g w ith a b io lo gi ca l p ar en t, an d th e pe rc en ta ge o f c hi ld re n w ith o ne o r bo th p ar en ts d ea d, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, M ya nm ar D H S 2 01 5- 16 B ac kg ro un d ch ar ac te ris tic Li vi ng w ith bo th pa re nt s Li vi ng w ith m ot he r bu t no t w ith fa th er Li vi ng w ith fa th er b ut no t w ith m ot he r N ot li vi ng w ith e ith er p ar en t T ot al P er ce nt ag e no t l iv in g w ith a bi ol og ic al pa re nt P er ce nt ag e w ith o ne o r bo th pa re nt s de ad 1 N um be r of ch ild re n Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad B ot h al iv e O nl y fa th er al iv e O nl y m ot he r al iv e B ot h de ad M is si ng in fo rm at io n on fa th er / m ot he r A ge 0- 4 81 .3 10 .7 1. 7 0. 6 0. 3 4. 6 0. 4 0. 2 0. 1 0. 1 10 0. 0 5. 3 2. 6 4, 63 3 <2 84 .3 11 .9 0. 7 0. 1 0. 2 2. 3 0. 3 0. 0 0. 1 0. 0 10 0. 0 2. 7 1. 3 1, 81 0 2- 4 79 .4 9. 9 2. 3 0. 9 0. 3 6. 0 0. 4 0. 3 0. 1 0. 1 10 0. 0 6. 9 3. 5 2, 82 3 5- 9 75 .4 9. 0 3. 4 1. 5 0. 5 8. 1 0. 6 0. 9 0. 3 0. 3 10 0. 0 9. 8 5. 8 5, 12 6 10 -1 4 72 .1 6. 9 6. 5 1. 5 1. 3 8. 1 0. 7 1. 5 0. 9 0. 3 10 0. 0 11 .3 11 .0 5, 44 4 15 -1 7 70 .2 6. 2 9. 0 1. 4 1. 8 7. 9 0. 6 1. 5 1. 0 0. 4 10 0. 0 11 .0 14 .0 2, 43 3 S ex M al e 75 .8 8. 3 4. 7 1. 4 0. 9 6. 9 0. 5 0. 8 0. 5 0. 2 10 0. 0 8. 7 7. 4 8, 97 2 Fe m al e 74 .6 8. 6 4. 7 1. 1 0. 8 7. 4 0. 7 1. 2 0. 5 0. 3 10 0. 0 9. 7 7. 9 8, 66 4 R es id en ce U rb an 70 .3 8. 9 6. 3 1. 7 0. 9 9. 3 0. 7 1. 1 0. 5 0. 4 10 0. 0 11 .6 9. 5 4, 10 5 R ur al 76 .7 8. 3 4. 2 1. 1 0. 9 6. 5 0. 6 0. 9 0. 5 0. 3 10 0. 0 8. 5 7. 1 13 ,5 32 S ta te s/ R eg io ns K ac hi n 75 .7 6. 4 7. 4 1. 4 0. 4 6. 1 0. 3 1. 1 1. 0 0. 2 10 0. 0 8. 5 10 .2 58 6 K ay ah 75 .9 10 .8 4. 7 1. 3 0. 5 5. 2 0. 4 0. 4 0. 7 0. 0 10 0. 0 6. 8 6. 8 11 5 K ay in 58 .2 11 .7 4. 1 2. 1 1. 1 20 .1 0. 9 0. 9 0. 5 0. 5 10 0. 0 22 .3 7. 5 64 4 C hi n 83 .5 6. 7 3. 2 0. 9 0. 6 4. 1 0. 3 0. 4 0. 3 0. 1 10 0. 0 5. 0 4. 8 22 2 S ag ai ng 75 .0 10 .4 4. 1 1. 6 1. 5 4. 9 0. 9 0. 8 0. 6 0. 1 10 0. 0 7. 3 7. 9 1, 99 9 T an in th ar yi 63 .4 10 .0 4. 1 1. 5 0. 4 18 .2 0. 8 1. 0 0. 5 0. 1 10 0. 0 20 .4 6. 8 56 6 B ag o 77 .2 6. 5 3. 2 0. 8 1. 0 7. 6 1. 2 1. 7 0. 3 0. 5 10 0. 0 10 .8 7. 4 1, 56 8 M ag w ay 79 .6 9. 6 3. 4 0. 4 0. 9 4. 5 0. 6 0. 4 0. 6 0. 0 10 0. 0 6. 1 5. 9 1, 30 8 M an da la y 76 .7 6. 9 5. 3 1. 2 1. 5 6. 3 0. 5 0. 9 0. 4 0. 4 10 0. 0 7. 9 8. 6 1, 70 9 M on 59 .2 13 .3 3. 4 1. 2 1. 0 19 .8 0. 2 0. 8 0. 7 0. 6 10 0. 0 21 .4 6. 1 75 2 R ak hi ne 74 .0 12 .4 4. 6 0. 8 0. 9 4. 9 0. 3 1. 0 1. 0 0. 1 10 0. 0 7. 2 7. 8 1, 28 8 Y an go n 78 .1 6. 7 6. 0 1. 5 0. 2 5. 6 0. 5 0. 8 0. 0 0. 7 10 0. 0 6. 8 7. 6 1, 95 3 S ha n 74 .9 8. 4 4. 7 1. 9 0. 6 6. 9 0. 5 1. 2 0. 7 0. 2 10 0. 0 9. 3 7. 7 2, 17 4 A ye ya rw ad y 80 .2 5. 8 5. 7 1. 1 0. 8 4. 4 0. 5 1. 0 0. 4 0. 0 10 0. 0 6. 3 8. 4 2, 35 6 N ay P yi T aw 79 .6 6. 4 3. 4 1. 0 1. 1 5. 1 0. 6 1. 4 0. 9 0. 4 10 0. 0 8. 0 7. 4 39 7 W ea lt h q ui nt ile Lo w es t 78 .8 7. 5 5. 8 0. 6 0. 9 4. 2 0. 5 0. 9 0. 5 0. 3 10 0. 0 6. 0 8. 6 4, 55 9 S ec on d 77 .9 8. 0 3. 8 1. 1 1. 3 6. 0 0. 5 0. 9 0. 5 0. 1 10 0. 0 7. 9 6. 9 3, 95 2 M id dl e 73 .5 8. 1 4. 6 1. 7 0. 8 8. 7 0. 7 1. 1 0. 7 0. 2 10 0. 0 11 .2 7. 9 3, 35 4 Fo ur th 72 .1 9. 3 4. 6 1. 5 0. 9 9. 0 0. 5 1. 2 0. 5 0. 3 10 0. 0 11 .3 7. 8 3, 05 1 H ig he st 71 .1 10 .0 4. 3 1. 8 0. 4 9. 8 0. 8 0. 9 0. 4 0. 5 10 0. 0 11 .9 6. 8 2, 72 0 T ot al < 15 76 .0 8. 8 4. 0 1. 2 0. 7 7. 0 0. 6 0. 9 0. 4 0. 3 10 0. 0 8. 9 6. 7 15 ,2 03 T ot al < 18 75 .2 8. 4 4. 7 1. 3 0. 9 7. 2 0. 6 1. 0 0. 5 0. 3 10 0. 0 9. 2 7. 7 17 ,6 36 N ot e: T ab le is b as ed o n de ju re m em be rs , t ha t i s, u su al r es id en ts . 1 In cl ud es c hi ld re n w ith fa th er d ea d, m ot he r d ea d, b ot h de ad , a nd o ne p ar en t d ea d bu t m is si ng in fo rm at io n on s ur vi va l s ta tu s of th e ot he r pa re nt 24 • Housing Characteristics and Household Population Table 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Myanmar DHS 2015-16 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed Age3 6-9 24.2 74.7 1.0 0.1 0.0 0.0 100.0 2,074 1.1 10-14 4.2 25.4 19.2 51.3 0.0 0.0 100.0 2,670 5.1 15-19 7.1 12.3 12.3 53.8 13.1 1.5 100.0 1,928 7.6 20-24 7.7 14.8 16.8 40.6 8.0 12.2 100.0 1,994 6.9 25-29 12.1 16.1 20.5 33.6 3.4 14.3 100.0 2,031 5.2 30-34 12.0 23.5 23.1 25.8 3.3 12.4 100.0 2,127 4.6 35-39 14.1 28.7 20.4 22.2 2.3 12.3 100.0 2,031 4.4 40-44 16.5 29.8 21.4 23.2 1.6 7.6 100.0 1,820 4.2 45-49 21.2 26.5 22.1 21.5 1.0 7.7 100.0 1,698 4.1 50-54 29.2 27.8 20.4 16.6 0.9 5.1 100.0 1,806 3.5 55-59 32.3 23.7 19.2 17.7 1.7 5.5 100.0 1,445 3.5 60-64 39.8 22.5 18.8 14.6 1.4 2.8 100.0 1,114 2.9 65+ 57.5 19.4 12.4 7.5 1.5 1.7 100.0 2,159 0.0 Residence Urban 10.5 19.9 11.6 36.0 6.0 16.0 100.0 7,079 6.5 Rural 24.0 29.5 19.6 22.5 1.7 2.6 100.0 17,822 3.7 States/Regions Kachin 10.5 34.2 10.9 34.8 3.9 5.7 100.0 721 4.5 Kayah 22.1 25.1 10.2 32.8 3.7 6.1 100.0 128 4.2 Kayin 25.5 32.0 12.2 22.6 2.8 4.9 100.0 685 3.2 Chin 21.9 25.9 14.0 30.9 3.5 3.8 100.0 215 4.2 Sagaing 19.2 23.3 24.7 27.4 1.7 3.7 100.0 2,689 4.3 Tanintharyi 10.6 36.1 18.3 28.5 0.7 5.7 100.0 601 4.2 Bago 14.4 26.7 20.5 29.8 2.6 6.0 100.0 2,420 4.4 Magway 20.7 25.1 20.9 24.5 2.8 5.9 100.0 2,035 4.2 Mandalay 20.9 24.3 19.6 25.3 2.3 7.6 100.0 2,948 4.2 Mon 15.4 33.2 14.4 26.8 2.8 7.5 100.0 944 4.1 Rakhine 30.6 31.7 12.9 19.1 2.5 3.1 100.0 1,606 2.8 Yangon 9.6 24.0 12.6 34.8 5.0 13.9 100.0 3,521 5.7 Shan 43.1 22.9 9.9 17.9 3.3 2.9 100.0 2,653 1.5 Ayeyarwady 16.6 30.6 21.4 24.4 2.7 4.3 100.0 3,172 4.1 Nay Pyi Taw 16.8 27.2 18.7 25.2 2.9 9.2 100.0 563 4.3 Wealth quintile Lowest 33.7 37.6 15.6 12.5 0.4 0.2 100.0 4,557 2.2 Second 24.4 33.0 19.9 20.9 1.1 0.7 100.0 4,840 3.4 Middle 18.5 28.0 22.1 27.0 2.3 2.1 100.0 5,008 4.2 Fourth 17.0 22.4 17.7 33.7 3.2 6.1 100.0 5,102 4.6 Highest 9.7 15.1 11.6 35.4 7.1 21.0 100.0 5,393 7.5 Total 20.2 26.8 17.3 26.4 2.9 6.4 100.0 24,901 4.2 1 Completed grade 5 at the primary level 2 Completed grade 11 at the secondary level 3 Total includes four cases with missing information on age, not shown separately. Housing Characteristics and Household Population • 25 Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Myanmar DHS 2015-16 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age3 6-9 26.1 73.2 0.6 0.1 0.0 0.0 0.0 100.0 2,049 1.0 10-14 4.3 30.8 19.0 45.8 0.0 0.0 0.1 100.0 2,663 4.8 15-19 7.3 11.6 12.4 60.2 7.8 0.6 0.0 100.0 1,778 7.4 20-24 9.4 13.5 13.4 48.3 9.3 6.0 0.1 100.0 1,619 7.1 25-29 10.2 13.3 17.8 42.4 5.8 10.5 0.0 100.0 1,649 6.7 30-34 13.2 19.4 19.4 36.0 3.9 8.1 0.0 100.0 1,604 4.9 35-39 14.4 21.8 21.6 29.7 3.6 8.9 0.0 100.0 1,598 4.6 40-44 14.4 19.9 21.5 35.8 2.2 6.2 0.0 100.0 1,422 4.7 45-49 19.2 17.7 21.6 34.2 2.7 4.4 0.1 100.0 1,424 4.6 50-54 24.9 20.3 22.6 24.8 2.1 5.1 0.1 100.0 1,361 4.2 55-59 25.6 20.4 20.0 26.9 2.2 4.9 0.0 100.0 1,076 4.2 60-64 31.7 17.1 18.5 23.9 3.6 5.2 0.0 100.0 854 4.1 65+ 49.1 13.1 15.0 16.6 2.2 4.0 0.0 100.0 1,551 1.0 Residence Urban 8.0 17.5 10.2 45.8 7.1 11.4 0.1 100.0 5,661 7.2 Rural 21.5 26.8 19.1 28.8 1.9 1.9 0.0 100.0 14,989 4.1 States/Regions Kachin 10.7 29.8 12.4 39.3 3.5 4.3 0.0 100.0 628 4.8 Kayah 16.2 31.5 9.9 35.0 3.3 4.1 0.0 100.0 113 4.2 Kayin 29.5 29.5 11.7 23.6 3.2 2.5 0.1 100.0 565 2.9 Chin 13.2 25.3 14.2 38.9 4.9 3.4 0.0 100.0 189 4.8 Sagaing 16.0 20.2 23.8 34.2 3.2 2.6 0.0 100.0 2,312 4.6 Tanintharyi 14.4 34.6 14.5 31.8 0.9 3.8 0.0 100.0 516 4.1 Bago 11.5 24.4 20.2 36.0 3.1 4.9 0.0 100.0 1,930 4.7 Magway 19.3 21.2 21.4 30.9 3.0 4.1 0.1 100.0 1,580 4.4 Mandalay 15.6 20.7 20.2 34.0 3.1 6.3 0.0 100.0 2,355 4.7 Mon 17.9 30.2 11.8 32.6 3.9 3.7 0.0 100.0 746 4.2 Rakhine 23.9 28.0 13.6 29.3 2.6 2.6 0.0 100.0 1,182 3.8 Yangon 7.6 20.9 10.6 45.4 5.4 10.0 0.1 100.0 2,882 6.9 Shan 40.3 24.5 10.6 20.0 2.4 2.2 0.1 100.0 2,335 2.0 Ayeyarwady 14.9 28.0 18.3 33.1 3.3 2.4 0.0 100.0 2,815 4.4 Nay Pyi Taw 12.2 21.1 20.2 37.2 3.4 5.9 0.0 100.0 502 4.8 Wealth quintile Lowest 28.5 34.7 17.2 18.9 0.4 0.2 0.0 100.0 3,877 2.9 Second 21.2 30.2 19.9 27.1 1.0 0.6 0.0 100.0 4,077 3.9 Middle 16.9 24.4 19.7 35.5 2.2 1.3 0.0 100.0 4,223 4.4 Fourth 14.3 19.5 17.0 41.1 3.7 4.4 0.0 100.0 4,269 5.0 Highest 9.0 13.4 9.4 43.3 9.2 15.6 0.1 100.0 4,203 7.9 Total 17.8 24.2 16.6 33.5 3.4 4.5 0.0 100.0 20,649 4.5 1 Completed grade 5 at the primary level 2 Completed grade 11 at the secondary level 3 Total includes two cases with missing information on age, not shown separately. 26 • Housing Characteristics and Household Population Table 2.12 School attendance ratios Net attendance ratio (NAR) and gross attendance ratio (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Myanmar DHS 2015-16 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 87.4 85.0 86.2 0.97 109.9 99.1 104.6 0.90 Rural 82.6 82.5 82.6 1.00 113.6 108.0 110.8 0.95 States/Regions Kachin 87.0 90.9 88.8 1.05 110.3 109.9 110.1 1.00 Kayah 85.9 85.5 85.7 1.00 118.2 107.4 113.2 0.91 Kayin 82.3 82.9 82.6 1.01 111.4 118.1 114.6 1.06 Chin 81.5 81.4 81.4 1.00 113.7 110.8 112.3 0.97 Sagaing 87.4 86.3 86.8 0.99 112.3 102.8 107.6 0.92 Tanintharyi 82.7 88.2 85.2 1.07 121.8 128.6 124.9 1.06 Bago 83.0 81.6 82.3 0.98 115.1 103.7 109.2 0.90 Magway 85.6 87.5 86.6 1.02 111.6 104.3 108.0 0.93 Mandalay 86.4 89.7 88.1 1.04 109.7 107.3 108.5 0.98 Mon 88.5 89.4 89.0 1.01 126.0 111.7 118.4 0.89 Rakhine 76.6 75.6 76.1 0.99 111.2 109.8 110.5 0.99 Yangon 86.5 83.2 84.9 0.96 109.0 98.1 103.6 0.90 Shan 72.9 72.0 72.4 0.99 107.0 97.5 101.8 0.91 Ayeyarwady 85.9 81.9 84.0 0.95 118.1 109.7 114.1 0.93 Nay Pyi Taw 86.7 89.1 87.8 1.03 107.8 114.6 111.0 1.06 Wealth quintile Lowest 76.7 74.0 75.3 0.96 114.2 106.2 110.2 0.93 Second 85.3 85.4 85.3 1.00 118.6 110.1 114.2 0.93 Middle 84.6 86.4 85.5 1.02 114.2 107.1 110.6 0.94 Fourth 87.4 85.4 86.5 0.98 105.4 105.3 105.3 1.00 Highest 88.8 88.7 88.8 1.00 108.2 98.4 103.3 0.91 Total 83.7 83.0 83.4 0.99 112.8 106.0 109.4 0.94 SECONDARY SCHOOL Residence Urban 72.9 76.2 74.5 1.05 86.1 93.8 89.8 1.09 Rural 53.4 58.1 55.7 1.09 61.8 66.4 64.1 1.08 States/Regions Kachin 62.5 76.8 70.1 1.23 77.2 87.8 82.8 1.14 Kayah 55.1 71.9 63.0 1.30 62.9 87.1 74.3 1.39 Kayin 44.7 55.2 50.3 1.23 50.3 63.3 57.3 1.26 Chin 57.0 66.8 62.1 1.17 71.7 89.3 80.9 1.25 Sagaing 66.9 68.4 67.6 1.02 77.2 81.9 79.4 1.06 Tanintharyi 52.2 57.0 54.6 1.09 59.9 67.9 63.8 1.13 Bago 58.6 69.1 64.3 1.18 64.1 80.9 73.2 1.26 Magway 65.8 72.7 69.2 1.11 74.0 81.3 77.6 1.10 Mandalay 64.1 75.1 69.5 1.17 78.1 85.0 81.5 1.09 Mon 49.8 59.9 54.6 1.20 53.9 71.7 62.3 1.33 Rakhine 51.5 45.9 48.6 0.89 66.4 54.5 60.2 0.82 Yangon 72.1 70.9 71.5 0.98 85.4 85.0 85.2 1.00 Shan 35.6 36.2 35.9 1.02 38.3 43.1 40.7 1.12 Ayeyarwady 57.5 60.6 59.0 1.05 68.3 68.7 68.5 1.01 Nay Pyi Taw 69.2 67.3 68.3 0.97 77.1 81.7 79.3 1.06 Wealth quintile Lowest 36.6 37.7 37.1 1.03 42.5 41.0 41.8 0.96 Second 53.0 58.6 55.9 1.11 60.0 65.4 62.8 1.09 Middle 59.9 66.7 63.3 1.11 71.0 79.7 75.3 1.12 Fourth 71.9 75.9 73.9 1.06 81.4 90.7 86.0 1.11 Highest 78.3 84.0 81.0 1.07 94.4 102.8 98.4 1.09 Total 58.2 62.3 60.2 1.07 67.8 72.8 70.3 1.07 1 The NAR for primary school is the percentage of the primary-school (age 5-9) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school (age 10-15) population that is attending secondary school. By definition the NAR cannot exceed 100%. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary- school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over- and underage students at a given level of schooling, the GAR can exceed 100%. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for males. Characteristics of Respondents • 27 CHARACTERISTICS OF RESPONDENTS 3 Key Findings  Education: Forty-six percent of women and 52% of men age 15-49 in Myanmar have attended secondary school. However, only 10% of women and 7% of men have completed more than secondary education.  Literacy: About 9 in 10 women (88%) and men (91%) age 15-49 can read.  Exposure to mass media: About 3 in 10 women (32%) and men (29%) have no regular exposure to any mass media.  Employment: Sixty-seven percent of women and 91% of men are currently employed.  Tobacco use: Two percent of women and 32% of men smoke cigarettes, while 2% of women and 14% of men smoke pipes or cheroots, and 18% of women and 59% of men chew betel quid. his chapter presents information on demographic and socioeconomic characteristics of the survey respondents, such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of contraceptives and reproductive health services as well as other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS The 2015-16 MDHS interviewed 12,885 women and 4,737 men age 15-49 (Table 3.1). Women and men are more or less similarly distributed across all age groups (14% to 16%), except for the age group 45-49, to which 13% of women and 12% of men belong. In Myanmar, adolescents (age 15-19) constitute 14% of women and 15% of men, while youth age 15-24 constitute 29% of women and 30% of men. About 6 in 10 women and men are currently married. Women are more likely to be divorced or separated and widowed (3% each) than men (2% and 1%, respectively). Women and men are similarly distributed by residence and across regions and states. About 7 in 10 live in rural areas. The highest proportion lives in Yangon Region (15% each of women and men), while the lowest proportion resides in Kayah State (0.5% each). About one in eight women (13%) and men (12%) have no education. Women and men are more or less equally likely to share wealth across a range of wealth quintiles (18% to 22%). T 28 • Characteristics of Respondents 3.2 EDUCATION AND LITERACY Literacy Respondents who have attended secondary or a higher level of school are assumed to be literate. All other respondents were given a sentence to read, and they were considered to be literate if they could read all or part of the sentence. Sample: Women and men age 15-49 About half of women (46%) and men (52%) have attended secondary school or higher (Figure 3.1, Tables 3.2.1 and 3.2.2). Women and men age 15-49 have, on average, completed 5 years of schooling, although youth (age group 15-24) have completed more than 7 years (Tables 3.2.1 and 3.2.2). In Myanmar, the literacy rate is high among both women (85%) and men (91%) age 15-49 (Tables 3.3.1 and 3.3.2). Patterns by background characteristics  Young respondents have the most education. Women and men age 15-24 are twice as likely to have completed secondary school or higher compared with those age 45-49 (18% versus 9% for women and 13% versus 7% for men) Tables 3.2.1 and 3.2.2.  Urban women are almost five times more likely than rural women to have studied beyond secondary school (24% versus 5%), and urban men are about four times as likely as rural men to have higher education (15% versus 4%). Notably, a much higher proportion of urban women have more than a secondary education compared with urban men in the same age group. Figure 3.1 Education of survey respondents 13 12 23 18 18 17 32 41 4 5 10 7 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed secondary Some secondary Primary complete Primary incomplete No education Characteristics of Respondents • 29  The proportion of both women and men who have no education is highest in Shan State (35%) followed by Rakhine State (26%) and Kayin State (22%) for women and Kayin State (32%) and Rakhine State (15%) for men. The percentage of women with completed secondary or higher education is highest in Yangon Region (25%) followed by Mon State (17%) (Figure 3.2).  Literacy also varies by state and region. The proportion of literate women is highest in Kachin State (95%) and lowest in Shan State (61%), while for men, it is highest in Yangon Region (98%) and lowest in Shan State (67%) (Tables 3.3.1 and 3.3.2).  The literacy rate increases with wealth for both women and men, rising from 66% for women in the lowest wealth quintile to 95% for women in the highest quintile; the corresponding increase for men is from 78% to 95%. 3.3 MASS MEDIA EXPOSURE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered to be regularly exposed to that form of media. Sample: Women and men age 15-49 Mass media convey messages on preventing communicable diseases, including HIV/AIDS, tuberculosis, and malaria; healthy life styles for preventing noncommunicable diseases; and other health topics. In Myanmar, men are slightly more likely than women to be regularly exposed to all forms of media, but especially newspapers. Television is the most common form of media used by women and men (60% each). About one-fourth of women (25%) and men (28%) listen to the radio. Exposure to newspapers varies most by gender: 16% of women and 27% of men read newspapers at least once a week (Tables Figure 3.2 Women with some, completed, or more than secondary education by states and regions Percent of women age 15-49 with some secondary education or higher Figure 3.3 Exposure to mass media 16 60 25 6 3227 60 28 9 29 Reads newspaper Watches television Listens to radio All three media None of these media Percentage of women and men age 15-49 who are exposed to media on a weekly basis Women Men 30 • Characteristics of Respondents 3.4.1 and 3.4.2). About 3 in 10 women (32%) and men (29%) are not regularly exposed to any of these forms of media (Figure 3.3). Patterns by background characteristics  The exposure to all three media is highest among women age 15-19 (9%). Media exposure generally declines with age for women, but varies inconsistently by age for men.  More urban than rural women read newspapers (30% versus 10%) and watch television (81% versus 51%), while more rural than urban women listen to the radio (26% versus 21%). Consequently, women in urban areas (10%) are more than twice as likely to be exposed to all three media as their rural counterparts (4%). A similar pattern by residence occurs for men.  The proportion of women and men who access none of the three media at least once a week is highest in Rakhine State (65% and 61%, respectively) and lowest in Yangon Region (10% and 6%, respectively).  For both women and men, exposure to newspapers and television increases sharply with both education and wealth; exposure to radio also increases with education, but does not vary much or vary consistently by wealth. 3.4 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey Sample: Women and men age 15-49 Men are more likely to be currently employed than women are. Ninety-one percent of men age 15-49 currently work compared with 67% of women in the same age group (Tables 3.5.1 and 3.5.2). Patterns by background characteristics  More than half of women age 15-19 and about two-thirds of older women are currently employed; 7 in 10 men age 15-19 and 9 in 10 older men are currently employed.  Women are more likely to work if they are divorced, separated, or widowed than if they are married (78% versus 64%), but the reverse is true for men (87% versus 97%). Never-married men are less likely to be employed than ever-married men.  Women with no living children are more likely to be employed (69%) than women with children (62% to 66%), but the reverse is true for men. Eighty-three percent of men with no children are employed compared with 94% to 97% of men with one or more children.  Both women and men in rural areas are more likely to be employed than those in urban areas, although the differences in percentage currently employed are not large: 69% versus 61% for women and 92% versus 87% for men.  The proportion of currently employed women is highest in Mandalay Region (84%) and lowest in Rakhine State (47%), while the proportion of currently employed men is highest in Nay Pyi Taw (95%) and lowest in Kayin State (76%). Characteristics of Respondents • 31  The employment status of women does not vary consistently by education or wealth. Among men, the percentage currently employed tends to decline with wealth, but does not vary consistently by education (Figure 3.4). 3.5 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, domestic service, and agriculture Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Women age 15-49 most often work in unskilled manual labor (34%), followed by sales and services (25%) and agriculture (20%) (Table 3.6.1). Men age 15-49 are also most commonly employed in unskilled manual labor (31%), followed by agriculture (29%) and skilled manual labor (21%) (Table 3.6.2). Eight percent of women and 7% of men work in professional, technical, or managerial occupations (Figure 3.5). Patterns by background characteristics  Unskilled manual labor is the most common occupation for women irrespective of age, marital status, and number of living children. This pattern is also generally true for men. Only divorced, separated, or widowed women are more likely to labor in sales and services (34%).  In urban areas, the most common occupations are sales and services for women (44%) and skilled manual labor for men (39%). In rural areas, the leading occupation is unskilled manual labor for women (41%) and agriculture (38%) for men.  Unskilled manual labor is the common occupation for women in most states and regions except Kachin State, Kayin State, Chin State, and Sagaing Region, where agricultural jobs predominate, and Tanintharyi Region and Yangon Region where sales and services is the most common occupation. For men, unskilled manual labor or agriculture is the most common occupation in all states and regions, except Yangon Region where skilled manual labor accounts for the highest proportion of employed men. Figure 3.4 Employment by education Figure 3.5 Occupation 71 69 61 71 94 96 86 89 No education Primary Secondary More than secondary Percentage of women and men age 15-49 who are currently employed Women Men 7 2 10 21 31 29 8 2 25 11 34 20 Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Percentage of women and men age 15-49 employed in the 12 months before the survey by occupation Men Women 32 • Characteristics of Respondents  Professional, technical or managerial occupations account for the highest proportion of employed women (45%) and men (33%) with more than secondary education. Women and men with no education most often work at unskilled manual labor (50% and 46%, respectively).  Employed women and men in the lowest wealth quintile are concentrated in unskilled manual labor (56% and 51%, respectively), whereas, in the highest wealth quintile, the most common occupations are sales and services for women (41%) and skilled manual labor for men (34%). Most employed women (86%) earn cash only. Work for cash only is more prevalent in nonagricultural occupations (90%) than in agricultural occupations (69%). Thirty-eight percent of employed women work for a nonfamily member, 32% are self-employed, and 30% work for a family member. About two-thirds of employed women (65%) work all year, while 28% work specific seasons, and 7% work occasionally. Women employed in agriculture are more likely than other employed women to work only seasonally (Table 3.7). 3.6 TOBACCO USE In Myanmar, most women age 15-49 (96%) do not smoke or use other tobacco products (Table 3.8.1). Two percent each of women smoke cigarettes and pipes or cheroots. By contrast, 32% of men age 15-49 smoke cigarettes and 14% smoke pipes or cheroots (Table 3.8.2). About 1 in 6 male cigarette smokers reported smoking 10 or more cigarettes in the 24 hours prior to the interview. In Myanmar, 18% of women and 59% of men age 15-49 chew betel quid (contains betel leaf, areca nut, and slaked lime, and may contain tobacco). Among those who chew betel quid, more than 1 in 5 women and about 2 in 5 men chewed 10 or more pieces in the 24 hours before the interview (Tables 3.9.1 and 3.9.2). Patterns by background characteristics  Cigarette and pipe or cheroot smoking and betel quid chewing rises with age in women. Among men, cigarette smoking is most prevalent (37% to 38%) in younger age groups (age 20-29) while pipe or cheroot smoking is mostly found (21% to 22%) in older age groups (age 40-49).  Smoking does not vary among women by maternity status, and betel quid chewing also remains as high among pregnant women and breastfeeding mothers as among other women (18-22%).  Tobacco use is slightly more prevalent among rural women than among urban women (5% versus 1%). Men in urban areas are more likely to smoke cigarettes (35%) than men in rural areas (30%), whereas rural men are more likely to smoke pipes or cheroots (16%) and use other tobacco products (3%) than urban men (11% and 1%, respectively). The prevalence of betel quid chewing is higher among rural women (20%) and rural men (60%) than among their urban counterparts (13% and 57%, respectively).  Among women, cigarette smoking is highest in Kayin State (10%), smoking pipes or cheroots is highest in Rakhine State (11%), and use of other tobacco products is highest in Chin State (15%). Among men, cigarette smoking is most prevalent in Tanintharyi Region (51%), followed by Kayin State (49%) and Rakhine State (48%); pipe or cheroot smoking is most prevalent in Bago Region (28%); and use of other tobacco products is most prevalent in Sagaing Region (12%).  By state and region, women in Rakhine State are most likely (50%) to chew betel quid, followed by those in Kayin State (41%) and Kayah State (36%). Among men, betel quid chewing is most prevalent in Rakhine State (79%), followed by Bago Region (75%) and Ayeyarwady Region (68%). Characteristics of Respondents • 33  Tobacco use and betel quid chewing decline with increasing education and wealth in women, but among men, smoking tends to decline with increasing education but not consistently by wealth; betel quid chewing declines with wealth. 3.7 KNOWLEDGE OF TUBERCULOSIS More than nine in ten women and men age 15-49 have heard of tuberculosis (TB). The lowest level of knowledge about TB is among women and men in Shan State, where only two-thirds have heard of TB. Knowledge of TB is also relatively low among those with no education, with only about 7 in 10 having heard of TB. Among women and men who have heard of TB, a majority (71% of women and 63% of men) know that TB spreads through coughing. About 9 in 10 know that TB is curable. Three percent of women and 4% of men learned from a doctor or nurse that they have TB (Tables 3.10.1 and 3.10.2). LIST OF TABLES For more information on the characteristics of survey respondents, see the following tables:  Table 3.1 Background characteristics of respondents  Table 3.2.1 Educational attainment: Women  Table 3.2.2 Educational attainment: Men  Table 3.3.1 Literacy: Women  Table 3.3.2 Literacy: Men  Table 3.4.1 Exposure to mass media: Women  Table 3.4.2 Exposure to mass media: Men  Table 3.5.1 Employment status: Women  Table 3.5.2 Employment status: Men  Table 3.6.1 Occupation: Women  Table 3.6.2 Occupation: Men  Table 3.7 Type of employment: Women  Table 3.8.1 Use of tobacco: Women  Table 3.8.2 Use of tobacco: Men  Table 3.9.1 Use of betel quid: Women  Table 3.9.2 Use of betel quid: Men  Table 3.10.1 Knowledge of tuberculosis: Women  Table 3.10.2 Knowledge of tuberculosis: Men 34 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Myanmar DHS 2015-16 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 14.0 1,810 1,835 15.4 731 768 20-24 14.5 1,867 1,893 14.6 692 690 25-29 14.5 1,867 1,880 14.3 677 687 30-34 15.8 2,037 1,971 14.7 698 674 35-39 15.2 1,954 1,918 14.3 679 671 40-44 13.5 1,733 1,746 14.5 689 681 45-49 12.6 1,617 1,642 12.1 571 566 Marital status Never married 33.2 4,278 4,146 34.7 1,646 1,695 Married 60.2 7,759 7,870 62.4 2,957 2,916 Divorced/separated 3.3 431 448 2.1 100 94 Widowed 3.2 417 421 0.7 35 32 Residence Urban 29.2 3,768 3,785 28.5 1,350 1,321 Rural 70.8 9,117 9,100 71.5 3,387 3,416 States/Regions Kachin 2.9 374 804 3.4 161 328 Kayah 0.5 65 757 0.5 23 264 Kayin 2.4 303 751 2.4 115 300 Chin 0.8 102 750 0.8 39 296 Sagaing 10.9 1,410 1,039 10.9 514 394 Tanintharyi 2.2 283 717 2.2 103 249 Bago 9.7 1,244 939 9.6 454 346 Magway 8.4 1,081 947 6.8 320 291 Mandalay 12.0 1,541 963 12.7 601 372 Mon 3.6 463 789 3.4 162 269 Rakhine 6.0 777 911 4.7 222 261 Yangon 15.0 1,927 1,065 14.8 703 404 Shan 10.6 1,368 778 11.4 542 286 Ayeyarwady 12.8 1,650 919 13.8 653 364 Nay Pyi Taw 2.3 300 756 2.7 126 313 Education1 No education 12.5 1,606 1,592 12.1 575 559 Primary 41.2 5,305 5,129 35.5 1,684 1,630 Secondary 36.1 4,646 4,838 45.2 2,139 2,224 More than secondary 10.3 1,325 1,324 7.2 339 324 Wealth quintile Lowest 17.7 2,274 2,364 18.8 890 904 Second 18.7 2,408 2,451 19.3 916 933 Middle 20.4 2,633 2,633 20.7 979 1,016 Fourth 21.0 2,702 2,739 20.8 986 995 Highest 22.3 2,868 2,698 20.4 966 889 Total 100.0 12,885 12,885 100.0 4,737 4,737 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 1 Total includes three women with missing information on education. Characteristics of Respondents • 35 Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Myanmar DHS 2015-16 Highest level of schooling Median years completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of women Age 15-24 7.2 13.9 13.7 47.4 9.3 8.6 100.0 7.3 3,677 15-19 6.9 12.1 11.4 53.2 12.5 3.9 100.0 7.6 1,810 20-24 7.5 15.6 15.9 41.9 6.1 13.0 100.0 6.8 1,867 25-29 10.7 17.2 19.8 34.8 2.6 15.0 100.0 5.4 1,867 30-34 11.8 24.2 22.4 25.5 3.4 12.5 100.0 4.6 2,037 35-39 14.4 31.8 18.2 22.0 2.0 11.7 100.0 4.2 1,954 40-44 16.9 31.7 18.4 24.0 1.6 7.3 100.0 4.1 1,733 45-49 20.3 30.0 19.9 21.2 1.1 7.5 100.0 4.0 1,617 Residence Urban 5.1 13.8 9.0 40.3 7.9 23.9 100.0 9.0 3,768 Rural 15.5 27.0 21.8 28.4 2.7 4.7 100.0 4.3 9,117 States/Regions Kachin 2.8 25.0 13.6 43.2 4.1 11.2 100.0 6.3 374 Kayah 14.7 18.5 11.7 40.1 4.7 10.4 100.0 6.0 65 Kayin 22.2 25.6 11.3 27.0 4.6 9.3 100.0 4.2 303 Chin 13.9 14.4 15.8 43.0 6.1 6.9 100.0 6.6 102 Sagaing 9.6 20.7 26.6 34.0 2.0 7.1 100.0 4.7 1,410 Tanintharyi 4.5 26.2 18.2 39.0 0.9 11.2 100.0 5.2 283 Bago 6.0 23.7 20.8 35.4 4.5 9.6 100.0 5.0 1,244 Magway 11.6 22.7 23.0 28.2 4.7 9.7 100.0 4.7 1,081 Mandalay 10.7 20.7 22.6 31.1 2.9 12.0 100.0 4.8 1,541 Mon 9.2 27.1 12.8 33.6 4.5 12.9 100.0 5.1 463 Rakhine 25.9 31.7 11.6 22.6 3.4 4.8 100.0 3.4 777 Yangon 4.7 19.9 10.4 39.7 6.3 18.9 100.0 7.9 1,927 Shan 35.3 18.5 11.9 22.8 5.2 6.2 100.0 3.4 1,368 Ayeyarwady 8.7 28.6 22.0 29.3 4.2 7.3 100.0 4.6 1,650 Nay Pyi Taw 9.8 26.3 19.6 28.4 4.5 11.4 100.0 4.7 300 Wealth quintile Lowest 28.3 37.8 18.3 14.5 0.6 0.5 100.0 2.9 2,274 Second 15.7 31.2 23.6 26.1 2.0 1.3 100.0 4.1 2,408 Middle 9.4 23.9 24.8 34.4 3.4 4.1 100.0 4.7 2,633 Fourth 8.0 17.9 16.4 42.4 5.1 10.3 100.0 6.3 2,702 Highest 4.3 9.0 8.5 38.1 8.9 31.2 100.0 9.4 2,868 Total 12.5 23.1 18.0 31.8 4.2 10.3 100.0 4.8 12,885 1 Completed grade 5 at the primary level 2 Completed grade 11 at the secondary level 36 • Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Myanmar DHS 2015-16 Highest level of schooling Median years completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of men Age 15-24 7.6 12.7 11.0 55.9 6.9 5.8 100.0 7.5 1,423 15-19 8.0 10.8 10.2 62.1 6.8 2.2 100.0 7.6 731 20-24 7.3 14.6 12.0 49.3 7.1 9.7 100.0 7.2 692 25-29 9.6 15.3 17.4 38.4 7.1 12.2 100.0 6.7 677 30-34 12.8 20.5 20.0 35.0 4.4 7.2 100.0 4.8 698 35-39 14.7 25.9 20.4 27.8 2.9 8.4 100.0 4.5 679 40-44 15.1 22.9 21.2 33.0 1.8 6.0 100.0 4.6 689 45-49 19.0 17.6 21.7 35.2 2.2 4.3 100.0 4.6 571 Residence Urban 4.5 11.0 9.1 51.4 8.7 15.3 100.0 9.0 1,350 Rural 15.2 21.1 20.6 36.1 3.1 3.9 100.0 4.7 3,387 States/Regions Kachin 6.7 24.1 11.3 47.9 3.4 6.6 100.0 6.2 161 Kayah 11.1 19.9 11.7 48.5 2.4 6.4 100.0 6.0 23 Kayin 31.7 16.4 9.7 32.5 6.2 3.5 100.0 4.2 115 Chin 3.5 15.6 15.1 52.9 7.6 5.3 100.0 7.2 39 Sagaing 9.4 11.3 25.4 43.5 6.4 4.0 100.0 5.5 514 Tanintharyi 7.0 25.3 12.8 45.5 0.7 8.6 100.0 5.8 103 Bago 8.2 19.3 20.1 42.3 3.8 6.3 100.0 5.3 454 Magway 10.2 15.7 26.0 35.8 4.7 7.7 100.0 4.9 320 Mandalay 8.2 15.5 20.1 41.6 7.0 7.6 100.0 5.9 601 Mon 13.6 20.1 13.4 42.1 4.7 6.0 100.0 5.4 162 Rakhine 15.1 23.5 13.6 36.9 3.9 6.9 100.0 4.8 222 Yangon 3.8 15.6 9.2 53.4 4.4 13.5 100.0 8.4 703 Shan 35.4 23.3 11.2 20.9 4.1 5.0 100.0 3.2 542 Ayeyarwady 10.1 21.5 21.4 38.2 3.0 5.7 100.0 4.9 653 Nay Pyi Taw 7.4 13.2 22.9 43.4 6.7 6.4 100.0 5.9 126 Wealth quintile Lowest 24.1 32.0 20.1 23.2 0.5 0.1 100.0 3.6 890 Second 13.4 25.7 25.2 32.8 1.4 1.5 100.0 4.4 916 Middle 11.3 15.1 21.5 44.7 4.6 2.8 100.0 5.2 979 Fourth 7.7 13.4 14.5 51.2 5.8 7.4 100.0 7.1 986 Highest 5.3 6.4 6.0 48.4 10.6 23.2 100.0 9.4 966 Total 12.1 18.2 17.4 40.5 4.7 7.2 100.0 5.4 4,737 1 Completed grade 5 at the primary level 2 Completed grade 11 at the secondary level Characteristics of Respondents • 37 Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 65.2 19.1 5.3 10.3 0.1 0.0 100.0 89.6 3,677 15-19 69.6 15.9 4.7 9.7 0.1 0.0 100.0 90.2 1,810 20-24 61.0 22.2 5.8 10.8 0.2 0.0 100.0 88.9 1,867 25-29 52.4 28.8 5.6 13.2 0.0 0.0 100.0 86.7 1,867 30-34 41.5 38.0 7.4 13.2 0.0 0.0 100.0 86.8 2,037 35-39 35.7 37.3 9.5 17.4 0.0 0.0 100.0 82.5 1,954 40-44 33.0 39.6 8.8 18.4 0.0 0.1 100.0 81.4 1,733 45-49 29.8 39.8 10.7 19.1 0.0 0.6 100.0 80.3 1,617 Residence Urban 72.1 16.2 5.2 6.4 0.0 0.1 100.0 93.5 3,768 Rural 35.7 38.0 8.4 17.8 0.0 0.1 100.0 82.1 9,117 States/Regions Kachin 58.5 25.7 10.9 4.8 0.0 0.1 100.0 95.1 374 Kayah 55.2 25.1 5.0 14.6 0.1 0.0 100.0 85.3 65 Kayin 40.9 26.8 7.7 24.5 0.1 0.0 100.0 75.4 303 Chin 56.0 8.6 8.1 26.8 0.1 0.4 100.0 72.6 102 Sagaing 43.1 40.1 8.0 8.8 0.0 0.0 100.0 91.2 1,410 Tanintharyi 51.2 33.6 5.3 7.8 1.3 0.7 100.0 90.0 283 Bago 49.5 38.0 5.3 7.2 0.0 0.0 100.0 92.8 1,244 Magway 42.6 38.1 8.3 10.6 0.0 0.2 100.0 89.1 1,081 Mandalay 45.9 40.3 3.1 10.5 0.1 0.0 100.0 89.4 1,541 Mon 50.9 28.0 7.2 13.1 0.0 0.8 100.0 86.1 463 Rakhine 30.8 20.8 11.4 36.9 0.0 0.1 100.0 63.0 777 Yangon 65.0 16.6 12.5 5.8 0.0 0.1 100.0 94.1 1,927 Shan 34.2 21.1 5.2 39.4 0.0 0.0 100.0 60.5 1,368 Ayeyarwady 40.8 41.8 6.4 11.0 0.0 0.0 100.0 89.0 1,650 Nay Pyi Taw 44.4 37.6 4.6 13.4 0.0 0.0 100.0 86.6 300 Wealth quintile Lowest 15.6 39.5 10.9 33.9 0.0 0.1 100.0 66.0 2,274 Second 29.5 40.9 10.3 19.1 0.0 0.1 100.0 80.7 2,408 Middle 41.9 39.7 8.5 9.8 0.0 0.1 100.0 90.1 2,633 Fourth 57.7 28.1 5.3 8.7 0.1 0.1 100.0 91.1 2,702 Highest 78.3 13.4 3.4 4.8 0.0 0.1 100.0 95.0 2,868 Total 46.3 31.6 7.4 14.4 0.0 0.1 100.0 85.4 12,885 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 38 • Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Myanmar DHS 2015-16 Secondary school or higher No schooling or primary school Percentage literate1 Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Number of men Age 15-24 68.6 16.4 6.2 8.6 0.0 0.0 0.0 100.0 91.3 1,423 15-19 71.1 15.7 4.8 8.5 0.0 0.0 0.0 100.0 91.5 731 20-24 66.1 17.2 7.8 8.8 0.1 0.0 0.0 100.0 91.1 692 25-29 57.7 24.8 8.7 8.8 0.0 0.0 0.0 100.0 91.2 677 30-34 46.7 35.6 8.0 9.7 0.0 0.0 0.0 100.0 90.3 698 35-39 39.1 38.3 12.2 10.4 0.0 0.0 0.0 100.0 89.6 679 40-44 40.8 38.4 10.5 10.0 0.1 0.1 0.0 100.0 89.8 689 45-49 41.7 38.8 9.6 9.7 0.1 0.1 0.0 100.0 90.2 571 Residence Urban 75.4 17.4 3.3 3.9 0.0 0.0 0.0 100.0 96.1 1,350 Rural 43.1 34.3 10.9 11.6 0.0 0.0 0.0 100.0 88.3 3,387 States/Regions Kachin 57.9 25.3 13.0 3.8 0.0 0.0 0.0 100.0 96.2 161 Kayah 57.3 20.1 10.4 12.2 0.0 0.0 0.0 100.0 87.8 23 Kayin 42.2 14.7 15.1 27.2 0.7 0.0 0.0 100.0 72.1 115 Chin 65.8 12.2 7.2 13.4 0.0 1.0 0.3 100.0 85.2 39 Sagaing 54.0 33.6 8.2 4.2 0.0 0.0 0.0 100.0 95.8 514 Tanintharyi 54.8 25.5 8.5 10.5 0.3 0.4 0.0 100.0 88.8 103 Bago 52.4 35.3 4.0 8.3 0.0 0.0 0.0 100.0 91.7 454 Magway 48.1 42.4 5.1 4.4 0.0 0.0 0.0 100.0 95.6 320 Mandalay 56.3 37.1 3.6 3.1 0.0 0.0 0.0 100.0 96.9 601 Mon 52.8 33.8 3.7 9.7 0.0 0.0 0.0 100.0 90.3 162 Rakhine 47.8 23.2 7.2 21.5 0.0 0.4 0.0 100.0 78.2 222 Yangon 71.3 24.7 2.1 1.9 0.0 0.0 0.0 100.0 98.1 703 Shan 30.1 22.7 14.0 33.2 0.0 0.0 0.0 100.0 66.8 542 Ayeyarwady 47.0 25.1 22.3 5.6 0.0 0.0 0.0 100.0 94.4 653 Nay Pyi Taw 56.5 36.3 4.5 2.7 0.0 0.0 0.0 100.0 97.3 126 Wealth quintile Lowest 23.9 37.0 17.3 21.8 0.0 0.0 0.0 100.0 78.1 890 Second 35.6 41.1 12.8 10.4 0.0 0.1 0.0 100.0 89.5 916 Middle 52.1 35.8 7.1 4.9 0.0 0.1 0.0 100.0 95.0 979 Fourth 64.4 24.2 5.2 6.2 0.1 0.0 0.0 100.0 93.8 986 Highest 82.3 10.6 2.4 4.8 0.0 0.0 0.0 100.0 95.2 966 Total 52.3 29.5 8.7 9.4 0.0 0.0 0.0 100.0 90.5 4,737 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Respondents • 39 Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Myanmar DHS 2015-16 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 18.5 68.8 30.2 8.9 24.3 1,810 20-24 17.6 63.3 28.6 8.0 28.2 1,867 25-29 16.4 59.9 24.2 7.0 32.9 1,867 30-34 13.7 60.7 24.1 5.5 30.7 2,037 35-39 15.9 58.2 21.5 5.1 33.8 1,954 40-44 11.9 52.4 21.5 3.6 37.6 1,733 45-49 14.3 53.8 22.9 4.5 36.0 1,617 Residence Urban 29.8 80.6 21.0 10.2 14.9 3,768 Rural 9.6 51.1 26.3 4.4 38.8 9,117 States/Regions Kachin 19.2 48.3 25.6 7.5 40.3 374 Kayah 15.7 67.4 26.1 6.2 27.0 65 Kayin 12.5 53.2 15.5 4.8 40.5 303 Chin 17.7 54.8 19.2 8.2 40.3 102 Sagaing 8.5 55.3 26.8 4.0 35.1 1,410 Tanintharyi 9.6 54.1 19.9 3.8 39.3 283 Bago 15.3 63.9 26.7 6.4 28.0 1,244 Magway 14.5 50.9 40.6 6.6 31.3 1,081 Mandalay 16.2 55.1 25.8 4.7 33.8 1,541 Mon 18.7 47.9 28.5 6.0 37.3 463 Rakhine 8.5 28.5 13.3 2.9 64.7 777 Yangon 22.2 88.3 12.7 6.2 9.8 1,927 Shan 11.6 51.1 19.0 5.1 43.9 1,368 Ayeyarwady 20.1 65.4 35.3 11.3 24.9 1,650 Nay Pyi Taw 14.7 68.1 27.4 5.6 25.4 300 Education1 No education 1.1 33.8 13.6 0.3 59.9 1,606 Primary 7.4 52.3 24.3 2.8 37.3 5,305 Secondary 21.1 71.4 27.9 8.8 21.3 4,646 More than secondary 45.6 80.1 28.9 17.0 12.2 1,325 Wealth quintile Lowest 5.0 33.1 22.1 2.1 56.2 2,274 Second 9.6 45.9 26.0 4.4 42.9 2,408 Middle 10.5 57.0 27.5 4.7 31.6 2,633 Fourth 15.5 73.6 25.7 6.7 20.4 2,702 Highest 33.4 81.8 22.3 11.6 13.9 2,868 Total 15.5 59.7 24.7 6.1 31.8 12,885 1 Total includes three women with missing information on education. 40 • Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Myanmar DHS 2015-16 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 25.2 67.1 28.9 9.9 25.5 731 20-24 29.2 65.1 25.3 6.1 25.9 692 25-29 31.3 64.0 28.2 11.6 27.0 677 30-34 28.3 57.9 23.8 9.5 33.8 698 35-39 23.4 57.2 26.9 7.8 30.5 679 40-44 25.6 53.8 29.2 9.4 33.7 689 45-49 27.1 53.3 37.1 8.0 28.6 571 Residence Urban 51.2 77.8 21.7 13.2 15.9 1,350 Rural 17.5 52.9 30.9 7.2 34.6 3,387 States/Regions Kachin 46.2 59.9 42.8 25.7 24.2 161 Kayah 18.1 46.3 28.1 6.8 39.2 23 Kayin 10.0 45.0 11.7 2.1 50.3 115 Chin 9.3 34.5 16.3 1.7 53.6 39 Sagaing 19.9 63.2 29.8 5.6 25.3 514 Tanintharyi 25.6 79.4 38.7 14.2 14.3 103 Bago 15.9 61.6 30.4 6.0 28.8 454 Magway 28.2 58.3 46.3 13.0 21.7 320 Mandalay 36.8 60.2 33.0 13.3 25.4 601 Mon 28.4 73.2 42.0 13.1 14.4 162 Rakhine 10.9 28.5 20.9 3.3 60.8 222 Yangon 55.9 89.5 16.3 9.7 6.2 703 Shan 11.8 52.6 14.8 3.3 42.2 542 Ayeyarwady 15.4 40.4 31.3 7.9 46.9 653 Nay Pyi Taw 41.1 60.0 42.7 14.6 20.0 126 Education No education 4.5 37.4 16.0 1.1 53.0 575 Primary 13.8 52.4 27.4 5.2 36.1 1,684 Secondary 37.3 68.7 31.5 11.4 20.3 2,139 More than secondary 67.5 81.4 32.9 25.0 11.5 339 Wealth quintile Lowest 11.2 30.7 26.2 4.2 54.8 890 Second 14.7 47.1 31.4 5.7 38.1 916 Middle 20.8 61.8 32.4 7.6 25.6 979 Fourth 31.5 72.6 28.3 12.3 20.8 986 Highest 55.6 84.5 23.0 14.3 9.7 966 Total 27.1 60.0 28.3 8.9 29.3 4,737 Characteristics of Respondents • 41 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Myanmar DHS 2015-16 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Total Number of women Age 15-19 54.1 5.4 40.6 100.0 1,810 20-24 63.9 8.6 27.5 100.0 1,867 25-29 66.2 7.3 26.4 100.0 1,867 30-34 70.1 6.0 23.9 100.0 2,037 35-39 71.0 5.9 23.1 100.0 1,954 40-44 70.9 4.7 24.4 100.0 1,733 45-49 69.1 5.4 25.6 100.0 1,617 Marital status Never married 69.5 4.7 25.9 100.0 4,278 Married 63.6 7.1 29.2 100.0 7,759 Divorced/separated/ widowed 77.8 5.5 16.6 100.0 848 Number of living children 0 68.9 5.6 25.5 100.0 5,331 1-2 64.9 7.0 28.1 100.0 4,510 3-4 65.8 5.3 28.9 100.0 2,279 5+ 61.8 7.8 30.4 100.0 765 Residence Urban 60.7 4.5 34.8 100.0 3,768 Rural 68.9 6.9 24.2 100.0 9,117 States/Regions Kachin 58.9 3.3 37.7 100.0 374 Kayah 58.9 18.9 22.2 100.0 65 Kayin 48.2 8.2 43.5 100.0 303 Chin 65.7 8.7 25.6 100.0 102 Sagaing 65.0 9.2 25.8 100.0 1,410 Tanintharyi 61.3 9.6 29.1 100.0 283 Bago 68.7 7.6 23.7 100.0 1,244 Magway 79.0 6.0 14.9 100.0 1,081 Mandalay 84.4 3.2 12.4 100.0 1,541 Mon 58.7 6.3 35.0 100.0 463 Rakhine 46.8 10.7 42.4 100.0 777 Yangon 52.8 2.3 44.9 100.0 1,927 Shan 78.3 4.8 16.8 100.0 1,368 Ayeyarwady 65.3 8.1 26.7 100.0 1,650 Nay Pyi Taw 65.9 6.6 27.4 100.0 300 Education2 No education 70.5 5.7 23.8 100.0 1,606 Primary 69.2 7.1 23.7 100.0 5,305 Secondary 60.9 5.8 33.3 100.0 4,646 More than secondary 70.7 4.6 24.7 100.0 1,325 Wealth quintile Lowest 63.8 9.2 26.9 100.0 2,274 Second 67.3 7.4 25.2 100.0 2,408 Middle 70.5 5.7 23.8 100.0 2,633 Fourth 67.6 5.0 27.5 100.0 2,702 Highest 63.3 4.3 32.4 100.0 2,868 Total 66.5 6.2 27.3 100.0 12,885 1 Currently employed is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 2 Total includes three women with missing information on education. 42 • Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Myanmar DHS 2015-16 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Total Number of men Age 15-19 69.3 5.1 25.6 100.0 731 20-24 89.6 3.5 6.8 100.0 692 25-29 95.2 3.3 1.6 100.0 677 30-34 95.5 3.1 1.3 100.0 698 35-39 95.7 3.4 1.0 100.0 679 40-44 96.5 2.0 1.6 100.0 689 45-49 94.6 3.7 1.7 100.0 571 Marital status Never married 80.2 4.7 15.1 100.0 1,646 Married 96.6 2.7 0.8 100.0 2,957 Divorced/separated/widowed 87.4 5.4 7.2 100.0 135 Number of living children 0 83.4 4.5 12.1 100.0 2,077 1-2 96.9 2.0 1.1 100.0 1,669 3-4 95.4 3.4 1.2 100.0 792 5+ 93.5 5.2 1.3 100.0 200 Residence Urban 86.8 3.4 9.8 100.0 1,350 Rural 92.1 3.5 4.4 100.0 3,387 States/Regions Kachin 90.9 5.5 3.6 100.0 161 Kayah 83.9 11.6 4.6 100.0 23 Kayin 75.8 11.9 12.3 100.0 115 Chin 94.0 3.3 2.7 100.0 39 Sagaing 89.6 2.5 7.9 100.0 514 Tanintharyi 90.5 3.3 6.1 100.0 103 Bago 89.5 5.3 5.2 100.0 454 Magway 91.2 0.3 8.6 100.0 320 Mandalay 92.2 1.7 6.1 100.0 601 Mon 91.5 4.5 3.9 100.0 162 Rakhine 81.7 10.8 7.5 100.0 222 Yangon 91.3 1.4 7.3 100.0 703 Shan 93.8 3.4 2.8 100.0 542 Ayeyarwady 91.6 3.6 4.8 100.0 653 Nay Pyi Taw 94.6 2.2 3.2 100.0 126 Education No education 93.5 4.5 2.0 100.0 575 Primary 96.0 2.8 1.2 100.0 1,684 Secondary 85.8 3.8 10.4 100.0 2,139 More than secondary 89.2 2.5 8.3 100.0 339 Wealth quintile Lowest 93.0 4.4 2.6 100.0 890 Second 92.1 4.6 3.2 100.0 916 Middle 91.8 2.9 5.3 100.0 979 Fourth 89.4 2.4 8.2 100.0 986 Highest 87.0 3.0 10.0 100.0 966 Total 90.6 3.4 5.9 100.0 4,737 1 Currently employed is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 43 Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 4.6 1.5 21.4 16.7 37.3 0.4 17.5 0.6 100.0 1,076 20-24 9.7 3.9 20.8 14.2 31.5 0.3 18.9 0.7 100.0 1,354 25-29 9.8 3.1 21.5 14.0 31.8 0.4 19.2 0.2 100.0 1,373 30-34 7.7 1.6 26.1 10.2 33.4 0.4 20.2 0.3 100.0 1,550 35-39 8.0 2.0 28.5 8.2 33.5 0.1 19.4 0.3 100.0 1,502 40-44 6.2 1.5 31.0 6.6 33.8 0.6 19.9 0.4 100.0 1,310 45-49 7.8 2.2 27.2 5.0 34.8 0.2 22.7 0.1 100.0 1,204 Marital status Never married 10.8 4.0 23.0 15.0 30.0 0.3 16.6 0.4 100.0 3,171 Married 6.4 1.5 25.6 8.4 35.8 0.3 21.8 0.4 100.0 5,489 Divorced/separated/ widowed 5.0 1.1 34.0 8.3 32.5 1.1 17.6 0.4 100.0 707 Number of living children 0 10.1 3.7 23.0 15.0 30.3 0.3 17.1 0.4 100.0 3,972 1-2 7.7 1.7 28.3 8.4 34.1 0.3 18.9 0.5 100.0 3,243 3-4 4.3 0.7 26.8 6.4 37.7 0.3 23.6 0.2 100.0 1,620 5+ 1.7 0.1 19.7 3.6 42.2 0.8 31.6 0.3 100.0 533 Residence Urban 15.1 6.8 43.9 16.9 13.0 1.1 2.5 0.7 100.0 2,457 Rural 5.2 0.7 18.7 8.4 40.9 0.1 25.8 0.3 100.0 6,910 States/Regions Kachin 14.9 1.2 34.7 6.5 13.3 0.0 29.4 0.0 100.0 233 Kayah 11.9 1.3 18.8 6.0 57.6 0.0 4.0 0.3 100.0 50 Kayin 11.4 0.7 36.9 4.8 14.9 0.0 30.8 0.5 100.0 171 Chin 12.9 3.6 12.7 3.1 7.8 0.0 59.9 0.0 100.0 76 Sagaing 4.7 1.6 26.8 13.1 26.7 0.0 26.8 0.3 100.0 1,046 Tanintharyi 6.6 3.7 36.2 10.4 35.3 0.2 7.6 0.0 100.0 201 Bago 4.9 2.1 23.8 8.8 31.6 0.2 28.6 0.1 100.0 949 Magway 5.8 1.5 15.8 5.0 41.9 0.1 28.9 1.1 100.0 919 Mandalay 5.6 1.8 21.5 13.0 55.0 0.0 2.8 0.3 100.0 1,350 Mon 10.0 2.5 33.5 13.6 37.3 0.0 3.0 0.2 100.0 301 Rakhine 9.0 1.4 26.3 11.4 40.2 0.2 11.3 0.1 100.0 446 Yangon 10.7 7.5 39.8 22.6 14.5 1.7 2.8 0.3 100.0 1,061 Shan 10.8 1.1 14.7 8.7 35.5 0.0 28.1 1.1 100.0 1,137 Ayeyarwady 7.0 1.1 27.8 5.2 30.1 0.2 28.7 0.0 100.0 1,210 Nay Pyi Taw 13.8 2.0 23.6 3.1 30.2 3.1 24.1 0.1 100.0 218 Education1 No education 5.4 0.0 12.8 3.1 50.2 0.4 27.8 0.3 100.0 1,223 Primary 1.3 0.2 21.6 8.1 43.5 0.3 24.8 0.3 100.0 4,047 Secondary 5.2 2.2 34.9 17.8 23.4 0.5 15.6 0.4 100.0 3,097 More than secondary 45.2 13.9 26.1 7.8 4.7 0.0 1.8 0.6 100.0 998 Wealth quintile Lowest 2.0 0.1 12.5 5.3 55.8 0.2 24.0 0.1 100.0 1,661 Second 2.3 0.3 17.5 7.1 42.8 0.3 29.5 0.3 100.0 1,800 Middle 4.2 0.9 21.4 11.0 37.1 0.2 24.9 0.3 100.0 2,008 Fourth 9.9 1.9 32.1 13.4 24.8 0.7 17.0 0.2 100.0 1,959 Highest 19.4 7.8 40.8 15.2 11.3 0.2 4.3 1.0 100.0 1,939 Total 7.8 2.3 25.3 10.6 33.6 0.3 19.7 0.4 100.0 9,367 1 Total includes three women with missing information on education. 44 • Characteristics of Respondents Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Profes- sional/ technical/ mana- gerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Missing Total Number of men Age 15-19 3.1 0.7 8.9 22.4 34.9 0.3 29.6 0.0 100.0 544 20-24 8.0 2.0 8.9 23.3 29.2 0.6 27.9 0.0 100.0 644 25-29 8.3 2.7 12.1 22.2 28.0 0.3 26.4 0.0 100.0 667 30-34 5.8 1.6 7.7 23.0 29.4 0.3 31.5 0.6 100.0 689 35-39 9.2 1.9 8.9 21.8 31.6 0.2 26.0 0.5 100.0 672 40-44 7.6 0.9 10.7 20.1 33.0 0.1 27.3 0.3 100.0 678 45-49 6.9 1.0 10.7 16.8 32.1 0.2 31.9 0.3 100.0 561 Marital status Never married 6.8 2.0 10.8 21.9 29.3 0.1 29.0 0.0 100.0 1,397 Married 7.2 1.5 9.1 21.1 32.0 0.4 28.4 0.3 100.0 2,933 Divorced/separated/ widowed 8.2 0.0 12.1 23.6 27.3 0.0 27.7 1.1 100.0 125 Number of living children 0 7.6 2.1 10.4 22.1 29.4 0.1 28.2 0.0 100.0 1,825 1-2 8.0 1.6 10.3 23.6 30.4 0.4 25.2 0.4 100.0 1,651 3-4 4.5 0.8 8.3 18.2 34.5 0.5 32.7 0.5 100.0 782 5+ 4.7 0.1 3.8 10.2 37.8 0.0 43.4 0.0 100.0 197 Residence Urban 13.6 3.6 22.5 38.7 16.9 0.8 3.7 0.3 100.0 1,218 Rural 4.6 0.8 4.9 15.0 36.4 0.1 37.9 0.2 100.0 3,237 States/Regions Kachin 8.8 0.7 4.5 31.0 11.9 0.0 43.2 0.0 100.0 155 Kayah 9.0 1.6 3.8 16.1 63.8 0.0 5.7 0.0 100.0 22 Kayin 4.4 0.8 10.2 17.9 19.2 0.0 47.1 0.4 100.0 101 Chin 16.6 3.3 3.0 25.5 14.2 0.4 37.0 0.0 100.0 38 Sagaing 5.0 0.5 8.2 18.4 15.9 0.3 51.3 0.3 100.0 474 Tanintharyi 2.9 1.5 4.6 25.7 48.8 0.0 16.1 0.4 100.0 96 Bago 4.5 1.5 7.3 17.5 23.1 0.6 45.5 0.0 100.0 430 Magway 6.7 0.5 3.1 15.7 47.0 0.0 25.7 1.2 100.0 292 Mandalay 4.7 3.5 9.7 29.2 47.8 0.0 5.0 0.0 100.0 564 Mon 4.6 0.9 13.2 26.7 44.8 0.0 9.9 0.0 100.0 156 Rakhine 6.9 2.5 8.0 13.1 52.9 0.0 16.6 0.0 100.0 205 Yangon 8.4 3.3 23.8 35.0 14.4 1.4 13.6 0.2 100.0 652 Shan 15.6 0.9 4.4 16.9 33.8 0.0 27.8 0.6 100.0 527 Ayeyarwady 4.0 0.3 8.8 10.9 35.5 0.0 40.5 0.0 100.0 621 Nay Pyi Taw 11.9 1.0 4.0 20.6 21.7 0.0 40.8 0.0 100.0 122 Education No education 8.5 0.0 2.3 10.8 45.9 0.2 31.8 0.5 100.0 564 Primary 2.3 0.1 6.6 16.2 39.8 0.2 34.5 0.3 100.0 1,663 Secondary 6.6 1.8 12.5 30.3 22.6 0.5 25.5 0.1 100.0 1,917 More than secondary 33.1 11.1 22.4 14.0 9.6 0.0 9.9 0.0 100.0 311 Wealth quintile Lowest 3.2 0.0 2.5 9.3 51.4 0.1 33.4 0.2 100.0 867 Second 3.1 0.3 4.4 15.4 35.8 0.2 40.5 0.2 100.0 886 Middle 4.0 1.0 6.7 21.0 32.4 0.2 34.5 0.3 100.0 928 Fourth 7.6 2.0 10.9 27.8 24.6 0.7 26.1 0.3 100.0 905 Highest 17.8 4.7 24.2 33.6 11.2 0.2 8.0 0.2 100.0 869 Total 7.1 1.6 9.7 21.4 31.1 0.3 28.6 0.2 100.0 4,455 Characteristics of Respondents • 45 Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Myanmar DHS 2015-16 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 69.3 90.1 86.0 Cash and in-kind 13.1 4.0 5.8 In-kind only 10.4 1.4 3.2 Not paid 7.2 4.4 5.0 Total 100.0 100.0 100.0 Type of employer Employed by family member 59.8 22.4 29.8 Employed by nonfamily member 18.0 42.9 38.0 Self-employed 22.2 34.7 32.2 Total 100.0 100.0 100.0 Continuity of employment All year 45.3 70.3 65.4 Seasonal 49.4 22.4 27.7 Occasional 5.4 7.4 6.9 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 1,846 7,486 9,367 Note: Total includes women with missing information on type of employment who are not shown separately. 46 • Characteristics of Respondents Table 3.8.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe/cheroot or use other tobacco products, according to background characteristics and maternity status, Myanmar DHS 2015- 16 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Pipe/ Cheroot Other tobacco Age 15-19 0.2 0.4 0.0 99.5 1,810 20-24 0.3 0.4 0.2 99.2 1,867 25-29 0.8 0.9 0.2 98.1 1,867 30-34 1.4 1.3 0.4 96.9 2,037 35-39 2.3 3.1 0.3 94.3 1,954 40-44 3.0 3.5 0.5 93.5 1,733 45-49 4.1 4.4 0.6 91.0 1,617 Maternity status Pregnant 1.6 1.8 0.2 96.6 466 Breastfeeding (not pregnant) 1.5 2.5 0.5 95.6 1,855 Neither 1.7 1.8 0.3 96.3 10,564 Residence Urban 0.8 0.3 0.2 98.8 3,768 Rural 2.0 2.6 0.4 95.1 9,117 States/Regions Kachin 1.1 0.8 0.0 98.3 374 Kayah 0.4 0.1 0.0 99.5 65 Kayin 9.7 7.5 0.1 83.2 303 Chin 4.3 2.7 15.3 79.2 102 Sagaing 1.4 0.2 0.3 98.2 1,410 Tanintharyi 3.1 0.0 0.9 96.0 283 Bago 1.2 2.4 0.2 96.4 1,244 Magway 0.8 0.7 0.3 98.3 1,081 Mandalay 0.3 0.2 0.0 99.5 1,541 Mon 3.3 3.9 0.2 92.9 463 Rakhine 1.9 10.8 0.5 87.0 777 Yangon 1.3 0.0 0.0 98.7 1,927 Shan 1.4 1.6 0.3 96.8 1,368 Ayeyarwady 2.3 3.3 0.2 94.3 1,650 Nay Pyi Taw 1.6 0.4 0.0 98.0 300 Education1 No education 4.6 5.3 0.4 90.0 1,606 Primary 2.1 2.8 0.4 94.8 5,305 Secondary 0.5 0.4 0.2 98.9 4,646 More than secondary 0.3 0.0 0.1 99.6 1,325 Wealth quintile Lowest 4.0 6.0 0.4 89.7 2,274 Second 2.0 2.7 0.6 94.9 2,408 Middle 1.5 1.2 0.3 97.1 2,633 Fourth 1.0 0.3 0.2 98.5 2,702 Highest 0.2 0.3 0.1 99.4 2,868 Total 1.7 1.9 0.3 96.2 12,885 1 Total includes three women with missing information on education. Characteristics of Respondents • 47 Table 3.8.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe/cheroot or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Myanmar DHS 2015-16 Uses tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Number of cigarette smokers Background characteristic Cigarettes Pipe/ Cheroot Other tobacco 0 1-2 3-5 6-9 10+ Total Age 15-19 20.2 6.1 0.6 731 9.2 34.6 30.8 9.2 16.2 100.0 148 20-24 37.6 9.5 1.2 692 5.3 29.0 38.2 9.0 18.4 100.0 260 25-29 37.0 13.5 2.3 677 7.0 30.7 40.6 10.9 10.7 100.0 250 30-34 31.2 15.8 2.3 698 3.0 34.5 39.2 6.1 17.2 100.0 218 35-39 34.9 14.7 2.6 679 3.4 26.8 40.1 7.6 22.2 100.0 237 40-44 34.2 20.7 2.0 689 5.0 31.5 39.3 9.9 14.4 100.0 236 45-49 27.1 22.0 3.9 571 3.4 39.1 36.8 7.1 13.6 100.0 155 Residence Urban 35.0 11.3 0.7 1,350 3.2 26.4 40.3 9.6 20.5 100.0 473 Rural 30.4 15.6 2.6 3,387 5.9 34.2 37.4 8.2 14.2 100.0 1,030 States/Regions Kachin 44.8 5.0 1.3 161 0.6 22.4 46.5 9.3 21.2 100.0 72 Kayah 23.7 15.5 0.0 23 16.5 34.4 27.9 8.3 12.8 100.0 5 Kayin 48.5 6.9 1.1 115 0.7 28.8 40.9 9.5 20.1 100.0 56 Chin 43.1 15.3 5.3 39 4.8 23.9 39.1 11.0 21.3 100.0 17 Sagaing 32.9 19.1 12.0 514 6.7 39.0 39.8 6.9 7.7 100.0 169 Tanintharyi 50.7 23.9 0.0 103 3.9 20.4 45.0 10.6 20.1 100.0 52 Bago 28.1 28.0 1.5 454 33.2 30.8 21.0 7.2 7.9 100.0 128 Magway 13.0 21.1 0.3 320 (6.3) (41.8) (30.8) (11.6) (9.6) 100.0 42 Mandalay 25.8 18.1 0.0 601 1.1 46.3 35.9 8.3 8.4 100.0 155 Mon 30.9 12.0 3.4 162 3.5 33.0 34.9 7.4 21.3 100.0 50 Rakhine 47.5 9.7 0.4 222 2.4 21.0 48.3 13.6 14.8 100.0 106 Yangon 32.0 11.4 0.2 703 1.5 31.3 41.5 5.0 20.7 100.0 225 Shan 41.4 3.5 1.4 542 2.7 21.7 31.7 14.9 29.0 100.0 224 Ayeyarwady 26.6 8.6 1.2 653 0.0 34.5 49.4 3.4 12.7 100.0 174 Nay Pyi Taw 23.0 25.0 0.0 126 0.0 55.9 24.9 10.5 8.7 100.0 29 Education No education 41.8 14.7 2.3 575 4.1 26.6 35.3 8.2 25.9 100.0 240 Primary 30.0 17.8 2.9 1,684 4.2 35.6 39.2 8.4 12.6 100.0 505 Secondary 31.2 12.6 1.7 2,139 5.8 31.1 39.8 7.7 15.6 100.0 667 More than secondary 27.1 7.6 0.0 339 7.7 28.2 30.8 18.1 15.1 100.0 92 Wealth quintile Lowest 33.0 18.8 2.5 890 4.7 27.9 40.3 8.1 18.9 100.0 294 Second 31.1 16.8 3.1 916 3.1 37.2 40.0 8.9 10.8 100.0 285 Middle 29.2 16.8 2.8 979 8.0 35.0 35.5 7.1 14.4 100.0 286 Fourth 33.7 10.3 1.3 986 5.6 30.3 41.4 8.9 13.8 100.0 332 Highest 31.8 9.5 0.7 966 4.0 28.8 34.1 10.1 23.0 100.0 307 Total 31.7 14.3 2.1 4,737 5.1 31.7 38.3 8.6 16.2 100.0 1,504 Note: Figures in parentheses are based on 25-49 unweighted cases. 48 • Characteristics of Respondents Table 3.9.1 Use of betel quid: Women Percentage of women age 15-49 who chew betel quid, and the percent distribution of women who chew betel quid by number of pieces consumed in preceding 24 hours, according to background characteristics, Myanmar DHS 2015-16 Percentage of women chewing betel quid Number of women Percent distribution of women who chew betel quid by number of betel quid chewed in the past 24 hours Total Number of women Background characteristic 0 1-2 3-5 6-9 10+ Age 15-19 4.9 1,810 10.7 58.9 20.7 4.0 5.7 100.0 88 20-24 10.7 1,867 5.7 38.9 32.2 8.8 14.4 100.0 200 25-29 13.9 1,867 3.6 33.1 32.1 8.7 22.5 100.0 259 30-34 20.2 2,037 3.4 28.5 34.4 10.4 23.2 100.0 412 35-39 24.9 1,954 2.6 24.9 36.2 13.1 23.2 100.0 486 40-44 26.0 1,733 1.7 20.4 42.5 8.7 26.8 100.0 450 45-49 27.7 1,617 0.6 22.0 42.1 10.9 24.3 100.0 448 Maternity status Pregnant 17.6 466 1.5 31.7 44.7 6.9 15.2 100.0 82 Breastfeeding (not pregnant) 21.9 1,855 3.6 28.0 35.7 8.9 23.8 100.0 406 Neither 17.6 10,564 2.8 27.2 36.7 10.6 22.7 100.0 1,855 Residence Urban 12.8 3,768 3.2 22.2 29.2 15.9 29.5 100.0 483 Rural 20.4 9,117 2.8 28.9 38.8 8.7 20.8 100.0 1,860 States/Regions Kachin 5.2 374 (32.4) (25.2) (27.3) (8.8) (6.3) 100.0 19 Kayah 36.1 65 4.4 26.0 34.4 8.4 26.9 100.0 23 Kayin 41.2 303 7.1 33.6 40.9 7.4 10.9 100.0 125 Chin 12.9 102 11.5 37.5 35.4 6.3 9.3 100.0 13 Sagaing 11.5 1,410 1.8 23.0 45.8 6.5 23.0 100.0 162 Tanintharyi 17.7 283 4.1 29.0 34.4 6.5 26.0 100.0 50 Bago 25.6 1,244 1.9 18.3 44.0 11.1 24.7 100.0 318 Magway 6.4 1,081 3.0 18.7 43.0 15.6 19.8 100.0 69 Mandalay 7.3 1,541 2.1 22.1 44.1 7.7 24.0 100.0 113 Mon 21.2 463 3.0 36.1 32.8 9.1 18.9 100.0 98 Rakhine 50.2 777 4.5 32.3 36.3 9.5 17.4 100.0 390 Yangon 11.7 1,927 0.0 24.8 22.0 19.9 33.3 100.0 226 Shan 10.8 1,368 1.5 26.6 34.9 13.5 23.6 100.0 148 Ayeyarwady 30.7 1,650 1.5 32.3 36.7 7.2 22.2 100.0 506 Nay Pyi Taw 27.9 300 4.3 22.9 27.8 10.1 34.8 100.0 84 Education1 No education 28.1 1,606 1.4 24.8 39.9 13.1 20.7 100.0 452 Primary 24.7 5,305 2.3 27.6 39.0 9.0 22.1 100.0 1,311 Secondary 11.2 4,646 5.0 28.7 29.5 10.7 26.1 100.0 519 More than secondary 4.6 1,325 7.0 34.9 30.9 8.9 18.3 100.0 61 Wealth quintile Lowest 35.0 2,274 2.0 28.4 40.6 10.2 18.8 100.0 796 Second 22.8 2,408 2.2 29.0 38.7 10.4 19.7 100.0 548 Middle 16.2 2,633 2.9 29.5 36.0 7.8 23.9 100.0 427 Fourth 12.5 2,702 4.9 24.5 33.0 11.9 25.8 100.0 336 Highest 8.2 2,868 4.2 21.8 26.9 11.4 35.6 100.0 235 Total 18.2 12,885 2.9 27.5 36.8 10.2 22.6 100.0 2,343 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Total includes three women with missing information on education. Characteristics of Respondents • 49 Table 3.9.2 Use of betel quid: Men Percentage of men age 15-49 who chew betel quid, and the percent distribution of men who chew betel quid by number of pieces consumed in preceding 24 hours, according to background characteristics, Myanmar DHS 2015-16 Percent of men chewing betel quid Percent distribution of men who chew betel quid by number of betel quid chewed in the past 24 hours Background characteristic Number of men 0 1-2 3-5 6-9 10+ Total Number of men Age 15-19 39.1 731 6.0 25.2 28.6 16.0 24.2 100.0 286 20-24 60.1 692 3.0 14.3 28.3 20.3 34.1 100.0 416 25-29 65.1 677 1.8 13.3 22.6 12.3 49.9 100.0 441 30-34 62.8 698 3.9 10.4 20.3 16.1 49.2 100.0 438 35-39 64.5 679 1.7 10.6 29.7 14.9 42.7 100.0 438 40-44 63.3 689 1.2 7.9 24.0 16.6 50.2 100.0 436 45-49 59.0 571 1.1 10.2 27.5 17.0 44.3 100.0 337 Residence Urban 57.1 1,350 2.4 8.3 17.8 17.9 53.3 100.0 771 Rural 59.7 3,387 2.6 14.2 28.6 15.5 39.1 100.0 2,021 States/Regions Kachin 33.4 161 0.8 32.5 29.3 9.0 28.4 100.0 54 Kayah 66.1 23 7.3 10.2 36.2 14.4 31.8 100.0 15 Kayin 62.4 115 1.1 16.9 33.2 17.0 31.7 100.0 72 Chin 52.4 39 33.9 16.0 23.8 7.4 19.0 100.0 20 Sagaing 57.8 514 5.2 19.6 28.4 14.5 32.4 100.0 297 Tanintharyi 55.8 103 5.1 26.9 32.6 10.5 24.8 100.0 57 Bago 75.0 454 5.1 10.1 22.3 15.8 46.6 100.0 341 Magway 54.5 320 1.1 12.9 29.3 19.7 37.0 100.0 174 Mandalay 53.7 601 0.5 11.0 24.3 18.3 45.8 100.0 323 Mon 58.2 162 0.6 20.5 31.3 15.0 32.6 100.0 94 Rakhine 79.0 222 0.0 18.9 37.4 16.7 27.0 100.0 175 Yangon 67.0 703 0.0 3.7 16.9 18.6 60.4 100.0 471 Shan 33.1 542 10.8 22.2 34.4 7.6 25.0 100.0 179 Ayeyarwady 68.2 653 0.4 7.2 23.5 15.6 53.2 100.0 445 Nay Pyi Taw 59.1 126 0.5 11.7 22.2 26.1 39.5 100.0 74 Education No education 50.8 575 1.5 17.0 32.4 15.3 33.7 100.0 292 Primary 66.3 1,684 1.8 12.6 25.4 16.7 43.3 100.0 1,117 Secondary 56.5 2,139 3.5 12.5 24.0 15.3 44.7 100.0 1,208 More than secondary 51.6 339 2.1 5.2 27.4 19.7 45.6 100.0 175 Wealth quintile Lowest 64.8 890 1.8 15.8 25.5 14.3 42.5 100.0 577 Second 62.1 916 3.0 13.1 30.0 17.8 36.1 100.0 569 Middle 59.5 979 2.2 14.2 27.8 16.8 39.0 100.0 583 Fourth 56.1 986 4.1 9.9 24.4 17.1 44.5 100.0 553 Highest 53.0 966 1.5 9.4 19.8 14.4 54.4 100.0 511 Total 58.9 4,737 2.5 12.6 25.6 16.1 43.0 100.0 2,792 50 • Characteristics of Respondents Table 3.10.1 Knowledge of tuberculosis: Women Percentage of women age 15-49 who have heard of tuberculosis (TB), and among women who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who have ever been told by a doctor or nurse that they have TB, according to background characteristics and maternity status, Myanmar DHS 2015-16 Among all respondents: Among respondents who have heard of TB: Background characteristic Percentage who have heard of TB Number Percentage who report that TB is spread though coughing Percentage who believe that TB can be cured Percentage who have been told by doctor/nurse that they have TB Number Age 15-19 89.6 1,810 67.3 83.1 1.9 1,621 20-24 92.8 1,867 69.3 87.9 2.4 1,732 25-29 92.9 1,867 74.1 89.5 2.6 1,735 30-34 94.7 2,037 72.5 90.0 2.2 1,929 35-39 93.8 1,954 73.4 91.3 2.9 1,832 40-44 94.6 1,733 71.5 88.1 2.6 1,639 45-49 94.2 1,617 70.7 90.7 3.0 1,523 Maternity status Pregnant 91.0 466 68.0 86.2 1.2 424 Breastfeeding (not pregnant) 91.9 1,855 67.5 84.9 1.8 1,705 Neither 93.6 10,564 72.1 89.5 2.7 9,883 Residence Urban 98.3 3,768 83.8 95.5 3.6 3,706 Rural 91.1 9,117 65.8 85.7 2.0 8,306 States/Regions Kachin 94.8 374 66.9 87.1 3.1 355 Kayah 94.7 65 64.1 85.9 2.0 61 Kayin 88.9 303 66.4 84.5 2.7 269 Chin 80.9 102 47.2 81.1 3.9 82 Sagaing 96.9 1,410 70.8 86.8 0.9 1,366 Tanintharyi 97.4 283 70.3 84.3 2.9 276 Bago 97.3 1,244 75.7 91.3 3.1 1,210 Magway 97.2 1,081 74.8 86.2 2.3 1,050 Mandalay 96.9 1,541 76.1 91.1 2.9 1,493 Mon 96.5 463 67.1 85.3 3.3 446 Rakhine 87.5 777 46.1 73.7 1.2 680 Yangon 99.1 1,927 85.2 97.4 3.5 1,910 Shan 68.0 1,368 58.8 77.5 1.9 930 Ayeyarwady 96.8 1,650 68.9 93.6 2.5 1,597 Nay Pyi Taw 95.1 300 66.1 88.8 2.1 285 Education1 No education 71.7 1,606 47.7 73.7 1.8 1,152 Primary 94.0 5,305 64.0 86.2 2.2 4,985 Secondary 97.9 4,646 79.0 92.5 2.6 4,547 More than secondary 100.0 1,325 93.1 98.0 4.0 1,325 Wealth quintile Lowest 85.5 2,274 53.2 80.1 2.0 1,945 Second 90.9 2,408 63.3 84.4 1.7 2,189 Middle 94.4 2,633 70.2 88.4 1.9 2,485 Fourth 96.1 2,702 77.3 91.8 2.7 2,595 Highest 97.5 2,868 85.7 95.5 3.9 2,797 Total 93.2 12,885 71.3 88.7 2.5 12,012 1 Total includes three women with missing information on education. Characteristics of Respondents • 51 Table 3.10.2 Knowledge of tuberculosis: Men Percentage of men age 15-49 who have heard of tuberculosis (TB), and among men who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who have ever been told by a doctor or nurse that they have TB, according to background characteristics, Myanmar DHS 2015-16 Among all respondents: Among respondents who have heard of TB: Background characteristic Percentage who have heard of TB Number Percentage who report that TB is spread though coughing Percentage who believe that TB can be cured Percentage who have been told by doctor/nurse that they have TB Number Age 15-19 88.3 731 51.7 83.7 4.3 646 20-24 89.7 692 63.5 89.4 3.2 620 25-29 95.0 677 64.4 89.4 3.1 644 30-34 91.6 698 64.0 90.7 3.9 639 35-39 92.6 679 65.7 88.1 3.3 629 40-44 93.5 689 65.1 91.0 3.3 644 45-49 93.8 571 68.5 91.0 4.5 535 Residence Urban 97.3 1,350 76.7 93.6 5.6 1,314 Rural 89.8 3,387 57.2 87.0 2.8 3,043 States/Regions Kachin 93.4 161 62.9 82.7 4.2 150 Kayah 96.3 23 43.4 79.0 2.7 22 Kayin 81.4 115 55.8 78.8 3.1 94 Chin 85.8 39 35.9 86.2 6.1 33 Sagaing 95.3 514 59.0 89.3 3.2 490 Tanintharyi 98.2 103 55.3 82.0 5.7 101 Bago 98.6 454 65.4 93.9 6.3 448 Magway 94.9 320 61.0 89.7 1.2 304 Mandalay 94.9 601 65.1 86.4 4.2 570 Mon 95.3 162 59.5 87.4 4.6 154 Rakhine 92.5 222 57.0 87.4 1.3 205 Yangon 99.6 703 81.0 98.2 3.1 700 Shan 66.8 542 58.0 74.8 4.1 362 Ayeyarwady 92.9 653 55.1 90.7 3.1 607 Nay Pyi Taw 92.6 126 57.7 90.1 3.1 116 Education No education 69.8 575 41.6 74.0 2.6 401 Primary 91.3 1,684 52.2 85.5 3.2 1,537 Secondary 97.2 2,139 71.0 92.9 4.2 2,079 More than secondary 100.0 339 90.0 99.1 3.3 339 Wealth quintile Lowest 85.3 890 44.5 82.9 2.6 759 Second 88.7 916 55.8 86.2 3.4 813 Middle 93.3 979 62.4 87.7 2.6 914 Fourth 94.5 986 67.2 90.2 3.3 932 Highest 97.2 966 81.2 96.5 6.0 939 Total 92.0 4,737 63.1 89.0 3.6 4,357 Marriage and Sexual Activity • 53 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings  Age at first marriage: The median age at first marriage is 22.1 for women and 24.5 for men, which means that women tend to marry 2 years earlier than men. Fourteen percent of women and 5% of men age 45-49 have never married.  Polygyny: Five percent of married women report that their husbands have other wives.  Sexual initiation: The median age at first sexual intercourse is slightly later than the median age at first marriage for women and earlier for men, suggesting that women, on average, have first sexual intercourse only after marriage and men, on average, engage in sex before marriage. arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have profound consequences for women’s and men’s lives. 4.1 MARITAL STATUS Currently married Women and men who report being married or living together with a partner as though married at the time of the survey Sample: Women and men age 15-49 In Myanmar, 60% of women age 15-49 and 62% of men age 15-49 are married. Three percent of women and 2% of men are divorced or separated, and 3% of women and 1% of men are widowed. About one-third of women and men have never married (Figure 4.1). Not all women in Myanmar get married, although most men do: even among those age 45-49, 14% of women are never married, compared with only 5% of men. Seven percent of women age 40-44 and 10% of women age 45-49 are widows, but only 2% of men in this age group are widowers. This is likely because women marry men who are older than themselves, and widowers are generally more likely to re-marry than women who are widowed (Table 4.1). The proportion of the M Figure 4.1 Marital status Percent distribution of women and men age 15-49 Never married 33% Married 60% Divorced/ separated 3% Widowed 3% Women Never married 35% Married 62% Divorced/ separated 2% Widowed 1% Men 54 • Marriage and Sexual Activity population that is currently married increases with age, and by age 45-49, 72% of women and 90% of men are currently married. At age 15-19, the proportion of women who are married is two and a half times that of men (13% versus 5%). Early marriage increases the risk of teenage pregnancy which can have a profound effect on the health and lives of young women. 4.2 POLYGYNY Polygyny Women who report that their husband has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 In the MDHS, currently married women were asked how many wives their husband had, and currently married men were also asked about the number of their wives. Results show that polygyny is relatively uncommon in Myanmar. Only 5% of currently married women said their husbands have more than one wife (Table 4.2.1), and 4% of currently married men said that they have more than one wife (Table 4.2.2). Patterns by background characteristics  A higher prevalence of polygyny is found among older age groups for both sexes. Six percent of married women age 45-49 say that their husband has one or more co-wives, and 8% of men age 45-49 say that they have more than one wife (Table 4.2.1 and Table 4.2.2).  As reported by women, the prevalence of polygyny is slightly higher in rural areas (6%) than in urban areas (4%), but the proportion of married men with more than one wife does not vary by rural and urban residence.  The proportion of married women who have one or more co-wives ranges from a high of 9% in Shan State, followed by 7% each for women in Bago Region, Rakhine State, Chin State, and Magway Region to a low of 1% in Kayah State (Figure 4.2). The pattern of variation in polygyny by states and regions according to men’s reports is somewhat different from the pattern based on women’s reports. According to men’s reports, polygyny is highest in Kayin State (10%) followed by Kachin State (9%) and Mandalay Region (8%), and lowest in Mon State, where no man reported having more than one wife.  Both women and men with no education are more likely than those with education to have polygynous marriages. According to women’s reports, polygyny is less than 1% among married women who have more than secondary education but is 11% among women with no education. According to men’s Figure 4.2 Polygyny by states and regions Percent of currently married women age 15-49 in a polygynous union Marriage and Sexual Activity • 55 reports, the proportion of men with more than one wife is also 1% among men with more than secondary education but is 6% among men with no education.  The prevalence of polygynous marriages declines with increasing wealth among both women and men. Nine percent of women in the lowest wealth quintile report having a co-wife compared with 3% of those in the highest wealth quintile. Among men, the proportion who report having more than one wife is 6% for men in the lowest wealth quintile and 2% for men in the highest wealth quintile. 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women age 25-49 and men age 25-49 The median age at first marriage for women age 25-49 is 22.1, and for men age 25-49 the median age is 24.5. Women first marry more than 2 years earlier than men do (Table 4.3). Child marriage, that is marriage before age 18, is still quite common among Myanmar women: 19% of women age 20-49 were married before age 18. Among men age 20-49, by contrast, only 7% were married before their 18th birthday. Even though marriage before 18 is common, very early marriage (before age 15) is not. Patterns by background characteristics  The median age at first marriage among rural women is 21.3, 3 years younger than the median age at first marriage among urban women, which is 24.5 (Table 4.4).  The median age at first marriage among women from Mandalay Region is 24.0, and among those from Yangon Region is 24.2, while women from Shan State and Rakhine State marry earlier, at age 20.4 and age 20.3. Among men, the median age at first marriage varies by about one year across states and regions.  The median age at first marriage increases with education and wealth quintile among women. Women with secondary education marry four years later than women with no education (23.6 versus 19.3) and women in the fourth wealth quintile marry 3 years later than women in the lowest wealth quintile. 4.4 AGE AT FIRST SEXUAL INTERCOURSE Median age at first sexual intercourse Age by which half of respondents have had sexual intercourse. Sample: Women age 25-49 and men age 25-49 56 • Marriage and Sexual Activity The median age at first sexual intercourse among women age 25-49 is 22.5, older than the median age at first marriage (22.1) for women in this age group. By contrast, the median age at first sexual intercourse among men age 25-49 is 23.6 years, one year earlier than their median age at first marriage (24.5) (Figure 4.3). By age 18, 17% of women age 25-49 have had sexual intercourse (Table 4.5). This percentage is lower than that of women who are married by age 18 (19%) (Table 4.3). Eight percent of men age 25-49 have had sexual intercourse before the age of 18 (Table 4.5), which is higher than the percentage of men married by age 18 (7%) (Table 4.3). These findings suggest that women, on average, first have sexual intercourse after they are married, whereas men, on average, do so before they are married. The percentage who have never had sexual intercourse is 19% among women age 25-49 and as high as 14% among women age 45-49. Among men age 25-49 the percentage who have never had sex is 12%, but only 5% of men age 45-49 have never had sex (Table 4.5). Patterns by background characteristics  The median age at first sexual intercourse for rural women age 25-49 is 21.7, 3 years earlier than urban women (25.0). Similarly, rural men first have sex 2 years earlier than urban men (23.1 versus 24.8) (Table 4.6).  Regional variation in the median age at first sex is sizeable: it varies from age 20.6 for women in Shan State and age 20.7 in Rakhine State to age 24.6 for women in Yangon Region and age 24.4 in Mandalay Region. For men, the median age at first sex varies from age 21.7 in Chin State and age 22.3 in Kachin State to age 24.7 in Yangon Region and Tanintharyi Region to age 25.0 in Kayin State.  Median age at first sex among women and men increases with increasing education. Women with no education have a median age at first sexual intercourse of 19.5, 4 years younger than women with secondary education (median age of 23.9). The educational differential for men is much less, only 2 years.  The median age at first sex tends to increase with wealth for both women and men. 4.5 RECENT SEXUAL ACTIVITY Sexual activity exposes women to the risk of pregnancy if no contraceptive method is being used. Information on timing of last sexual intercourse can be used to refine measures of exposure to pregnancy. In the 2015-16 MDHS, women and men age 15-49 were asked when they last had sexual intercourse. Forty-seven percent of women and 53% of men age 15-49 had sexual intercourse during the 4 weeks preceding the survey; 33% of women and 31% of men had never had sex. An additional 11% of women and 10% of men had not had sex recently but had it in the year before the survey (Table 4.7.1 and Table 4.7.2). Patterns by background characteristics  Recent sexual activity among women increases sharply by age from 11% for women age 15-19 to 62% for women age 35-39, before falling to 49% for women age 45-49. For men, recent sexual activity also increases sharply from 5% at age 15-19 to 75% at age 35-39, after which it falls to 66% for men age 45-49. Figure 4.3 Median age at first sex and first marriage 22.5 22.1 23.6 24.5 Median age at first sex Median age at first marriage Median age in years Women age 25-49 Men age 25-49 Marriage and Sexual Activity • 57  Except for a slight decline after 25 years of marriage, recent sexual activity does not vary greatly by duration of marriage for either sex (Table 4.7.1 and Table 4.7.2).  Recent sexual activity is more common in rural than in urban areas for both women and men.  The proportion of women and men who recently had sex varies by states and regions. Recent sexual activity is highest in Nay Pyi Taw and Bago Region (52%) and lowest in Kachin State (38%) for women and is highest in Bago Region (60%) and lowest in Kachin State (42%) for men.  The proportion of women who had sexual intercourse in the 4 weeks before the survey decreases with increasing education level. Although the proportion of men with recent sexual activity does not vary consistently by education, it is lower among men with secondary schooling than among less educated men.  The likelihood of having had sex recently among both women and men is lower in the higher wealth quintiles than in the lower quintiles. Among women, the proportion is 39% in the highest quintile and 55% in the lowest quintile; the corresponding proportions for men are 47% in the highest wealth quintile and 59% in the lowest wealth quintile. LIST OF TABLES For more information on marriage and sexual activity, see the following tables:  Table 4.1 Current marital status  Table 4.2.1 Number of women’s co-wives  Table 4.2.2 Number of men’s wives  Table 4.3 Age at first marriage  Table 4.4 Median age at first marriage by background characteristics  Table 4.5 Age at first sexual intercourse  Table 4.6 Median age at first sexual intercourse by background characteristics  Table 4.7.1 Recent sexual activity: Women  Table 4.7.2 Recent sexual activity: Men 58 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Myanmar DHS 2015-16 Marital status Total Percentage of respondents currently in union Number of respondents Age Never married Married Divorced Separated Widowed WOMEN 15-19 86.4 12.6 0.8 0.1 0.1 100.0 12.6 1,810 20-24 51.9 44.6 2.8 0.4 0.3 100.0 44.6 1,867 25-29 27.5 67.4 3.5 0.4 1.2 100.0 67.4 1,867 30-34 20.9 73.9 3.0 0.2 1.9 100.0 73.9 2,037 35-39 16.9 75.9 3.5 0.3 3.4 100.0 75.9 1,954 40-44 14.7 74.0 4.2 0.5 6.5 100.0 74.0 1,733 45-49 13.5 72.3 3.3 0.5 10.4 100.0 72.3 1,617 Total 33.2 60.2 3.0 0.3 3.2 100.0 60.2 12,885 MEN 15-19 94.7 5.0 0.3 0.0 0.0 100.0 5.0 731 20-24 65.2 33.0 1.4 0.4 0.1 100.0 33.0 692 25-29 31.5 66.0 2.1 0.1 0.3 100.0 66.0 677 30-34 18.3 78.6 2.5 0.0 0.5 100.0 78.6 698 35-39 10.5 86.5 2.4 0.3 0.3 100.0 86.5 679 40-44 8.8 86.2 2.8 0.2 2.0 100.0 86.2 689 45-49 5.2 90.3 1.8 0.5 2.1 100.0 90.3 571 Total 34.7 62.4 1.9 0.2 0.7 100.0 62.4 4,737 Table 4.2.1 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Myanmar DHS 2015-16 Number of co-wives Number of women Background characteristic 0 1 2+ Don’t know/ missing Total Age 15-19 95.0 3.5 0.2 1.3 100.0 227 20-24 95.2 4.2 0.2 0.4 100.0 834 25-29 96.0 3.2 0.9 0.0 100.0 1,258 30-34 95.3 4.1 0.2 0.3 100.0 1,505 35-39 93.2 6.3 0.4 0.1 100.0 1,482 40-44 93.0 5.7 1.0 0.2 100.0 1,283 45-49 93.6 5.2 1.0 0.2 100.0 1,169 Residence Urban 95.9 3.8 0.1 0.2 100.0 2,022 Rural 93.8 5.1 0.8 0.2 100.0 5,737 States/Regions Kachin 94.2 4.3 1.3 0.2 100.0 238 Kayah 98.7 0.9 0.2 0.2 100.0 40 Kayin 95.2 4.5 0.3 0.0 100.0 201 Chin 93.5 5.2 1.3 0.0 100.0 66 Sagaing 95.2 4.1 0.3 0.3 100.0 828 Tanintharyi 93.4 5.4 0.5 0.7 100.0 174 Bago 92.3 6.9 0.4 0.4 100.0 780 Magway 93.5 5.9 0.6 0.0 100.0 642 Mandalay 96.2 3.3 0.4 0.0 100.0 838 Mon 95.2 4.5 0.4 0.0 100.0 278 Rakhine 92.9 6.0 0.7 0.4 100.0 454 Yangon 97.6 2.2 0.2 0.0 100.0 1,042 Shan 90.6 7.1 1.5 0.9 100.0 901 Ayeyarwady 93.9 5.2 0.8 0.1 100.0 1,083 Nay Pyi Taw 98.0 1.6 0.2 0.2 100.0 195 Education1 No education 89.0 9.0 1.6 0.4 100.0 1,193 Primary 93.8 5.3 0.7 0.2 100.0 3,656 Secondary 96.9 2.8 0.1 0.3 100.0 2,285 More than secondary 98.7 0.9 0.0 0.4 100.0 621 Wealth quintile Lowest 90.5 7.7 1.5 0.3 100.0 1,622 Second 94.1 4.7 0.9 0.3 100.0 1,586 Middle 95.1 4.4 0.4 0.1 100.0 1,556 Fourth 95.9 3.6 0.2 0.2 100.0 1,509 Highest 96.4 3.3 0.0 0.3 100.0 1,487 Total 94.4 4.8 0.6 0.2 100.0 7,759 1 Total includes three women with missing information on education. Marriage and Sexual Activity • 59 Table 4.2.2 Number of men’s wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 (100.0) (0.0) 100.0 36 20-24 97.4 2.6 100.0 228 25-29 98.9 1.1 100.0 447 30-34 97.5 2.5 100.0 549 35-39 97.5 2.5 100.0 587 40-44 94.1 5.9 100.0 593 45-49 92.3 7.7 100.0 516 Residence Urban 96.0 4.0 100.0 767 Rural 96.2 3.8 100.0 2,190 States/Regions Kachin 91.1 8.9 100.0 93 Kayah 99.4 0.6 100.0 15 Kayin 90.2 9.8 100.0 70 Chin 95.6 4.4 100.0 24 Sagaing 97.4 2.6 100.0 308 Tanintharyi 98.4 1.6 100.0 57 Bago 99.3 0.7 100.0 309 Magway 94.4 5.6 100.0 215 Mandalay 92.4 7.6 100.0 358 Mon 100.0 0.0 100.0 82 Rakhine 98.8 1.2 100.0 139 Yangon 98.8 1.2 100.0 413 Shan 97.1 2.9 100.0 371 Ayeyarwady 93.5 6.5 100.0 419 Nay Pyi Taw 96.8 3.2 100.0 81 Education No education 93.6 6.4 100.0 430 Primary 96.4 3.6 100.0 1,260 Secondary 96.4 3.6 100.0 1,085 More than secondary 98.6 1.4 100.0 181 Wealth quintile Lowest 94.4 5.6 100.0 627 Second 95.9 4.1 100.0 605 Middle 95.8 4.2 100.0 603 Fourth 96.7 3.3 100.0 590 Highest 98.2 1.8 100.0 531 Total 96.1 3.9 100.0 2,957 Note: Figures in parentheses are based on 25-49 unweighted cases. 60 • Marriage and Sexual Activity Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married, by specific exact ages, and median age at first marriage, according to current age, Myanmar DHS 2015-16 Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage Current age 15 18 20 22 25 WOMEN 15-19 1.1 na na na na 86.4 1,810 a 20-24 1.9 16.0 30.5 na na 51.9 1,867 a 25-29 3.5 18.3 33.2 47.9 64.2 27.5 1,867 22.3 30-34 4.4 18.6 33.9 49.0 62.6 20.9 2,037 22.2 35-39 2.9 19.2 34.7 47.2 62.2 16.9 1,954 22.5 40-44 2.8 20.7 36.8 52.0 66.2 14.7 1,733 a 45-49 3.1 19.2 37.6 52.3 64.6 13.5 1,617 21.6 20-49 3.1 18.6 34.3 na na 24.5 11,075 a 25-49 3.4 19.2 35.1 49.5 63.9 18.9 9,208 22.1 MEN 15-19 0.0 na na na na 94.7 731 a 20-24 0.0 5.0 14.8 na na 65.2 692 a 25-29 0.0 5.8 15.5 31.7 52.7 31.5 677 24.6 30-34 0.0 7.6 18.4 32.1 52.5 18.3 698 24.7 35-39 0.0 8.1 18.3 33.1 52.4 10.5 679 24.6 40-44 0.0 7.8 21.2 39.3 54.9 8.8 689 a 45-49 0.0 6.0 17.1 36.0 54.8 5.2 571 24.3 20-49 0.0 6.7 17.6 na na 23.8 4,006 a 25-49 0.0 7.1 18.1 34.4 53.4 15.2 3,314 24.5 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse. na = Not applicable due to censoring a = Omitted because less than 50% of the women or men began living with their spouse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 61 Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women and men age 25- 49, according to background characteristics, Myanmar DHS 2015-16 Women age 25-49 Men age 25-49 Background characteristic Residence Urban 24.5 a Rural 21.3 23.8 States/Regions Kachin 21.7 a Kayah 22.1 a Kayin 21.8 24.9 Chin 21.3 24.1 Sagaing 22.0 23.8 Tanintharyi 22.1 25.0 Bago 21.8 24.5 Magway 22.9 23.8 Mandalay 24.0 24.2 Mon 22.3 24.9 Rakhine 20.3 23.7 Yangon 24.2 a Shan 20.4 23.8 Ayeyarwady 21.3 24.4 Nay Pyi Taw 21.7 24.7 Education No education 19.3 23.1 Primary 21.1 23.2 Secondary 23.6 a More than secondary a a Wealth quintile Lowest 19.8 22.8 Second 20.7 22.8 Middle 22.1 24.6 Fourth 22.9 a Highest a a Total 22.1 24.5 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse. a = Omitted because less than 50% of the respondents began living with their spouse for the first time before reaching the beginning of the age group 62 • Marriage and Sexual Activity Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Myanmar DHS 2015-16 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Median age at first intercourse Current age 15 18 20 22 25 Number WOMEN 15-19 0.9 na na na na 86.4 1,810 a 20-24 1.3 14.0 29.4 na na 51.7 1,867 a 25-29 2.1 16.3 31.7 46.1 62.1 27.2 1,867 22.8 30-34 2.0 16.0 32.4 46.0 60.0 20.9 2,037 22.9 35-39 2.0 17.2 33.4 45.9 59.9 16.9 1,954 22.7 40-44 1.5 17.9 34.0 48.8 62.1 14.6 1,733 a 45-49 2.2 17.9 37.3 50.8 62.3 13.5 1,617 21.9 20-49 1.9 16.5 32.9 na na 24.4 11,075 a 25-49 2.0 17.0 33.6 na na 18.9 9,208 22.5 15-24 1.1 na na na na 68.8 3,677 a MEN 15-19 0.5 na na na na 92.5 731 a 20-24 0.0 5.6 20.5 na na 56.2 692 a 25-29 0.1 6.3 20.0 39.4 61.7 24.7 677 23.5 30-34 0.5 7.8 21.2 37.3 56.6 14.7 698 24.0 35-39 0.8 8.2 20.1 35.6 54.8 8.2 679 24.0 40-44 0.6 7.9 22.5 43.4 57.6 7.3 689 a 45-49 0.0 8.6 21.7 44.1 60.1 4.6 571 22.9 20-49 0.4 7.4 21.0 na na 19.7 4,006 a 25-49 0.4 7.7 21.1 na na 12.1 3,314 23.6 15-24 0.3 na na na na 74.9 1,423 a na = Not applicable due to censoring a = Omitted because less than 50% of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 63 Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 25-49, and median age at first sexual intercourse among men age 25-49, according to background characteristics, Myanmar DHS 2015-16 Women’s age Men’s age Background characteristic 25-49 25-49 Residence Urban 25.0 24.8 Rural 21.7 23.1 States/Regions Kachin 21.2 22.3 Kayah 21.9 a Kayin 22.0 25.0 Chin 21.5 21.7 Sagaing 22.2 23.6 Tanintharyi 22.2 24.7 Bago 22.1 23.6 Magway 23.3 23.7 Mandalay 24.4 23.0 Mon 22.9 23.5 Rakhine 20.7 22.9 Yangon 24.6 24.7 Shan 20.6 22.9 Ayeyarwady 21.9 23.7 Nay Pyi Taw 21.9 24.0 Education No education 19.5 22.0 Primary 21.4 22.8 Secondary 23.9 24.1 More than Secondary a a Wealth quintile Lowest 20.1 22.5 Second 20.9 22.5 Middle 22.3 23.8 Fourth 23.5 24.2 Highest a a Total 22.5 23.6 a = Omitted because less than 50% of the respondents had intercourse for the first time before reaching the beginning of the age group 64 • Marriage and Sexual Activity Table 4.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Timing of last sexual intercourse Never had sexual intercourse Number of women Within the past 4 weeks Within 1 year1 One or more years Missing Total Age 15-19 10.5 1.8 0.9 0.4 86.4 100.0 1,810 20-24 36.0 8.1 3.7 0.4 51.7 100.0 1,867 25-29 53.6 12.5 6.2 0.6 27.2 100.0 1,867 30-34 58.4 12.2 7.8 0.7 20.9 100.0 2,037 35-39 61.7 11.9 8.9 0.6 16.9 100.0 1,954 40-44 54.7 14.4 15.4 0.9 14.6 100.0 1,733 45-49 49.2 17.6 19.0 0.7 13.5 100.0 1,617 Marital status Never married 0.1 0.1 0.1 0.0 99.7 100.0 4,278 Married 77.1 17.1 4.8 1.0 0.0 100.0 7,759 Divorced/separated/ widowed 1.6 11.9 86.1 0.4 0.0 100.0 848 Marital duration2 0-4 years 79.5 16.5 3.0 1.1 0.0 100.0 1,474 5-9 years 78.5 15.8 4.7 1.0 0.0 100.0 1,388 10-14 years 79.9 14.5 4.3 1.3 0.0 100.0 1,321 15-19 years 79.2 15.1 4.8 1.0 0.0 100.0 1,228 20-24 years 74.9 19.3 5.1 0.8 0.0 100.0 1,004 25+ years 68.9 22.2 8.4 0.5 0.0 100.0 899 Married more than once 72.7 21.2 4.8 1.2 0.0 100.0 445 Residence Urban 40.9 10.1 9.1 0.8 39.2 100.0 3,768 Rural 48.9 11.5 8.4 0.6 30.6 100.0 9,117 States/Regions Kachin 38.4 16.7 9.7 7.0 28.1 100.0 374 Kayah 39.7 11.2 8.0 9.8 31.4 100.0 65 Kayin 46.7 15.6 11.4 0.1 26.2 100.0 303 Chin 49.2 12.6 10.7 0.7 26.9 100.0 102 Sagaing 46.9 10.1 8.0 0.1 34.9 100.0 1,410 Tanintharyi 40.4 18.4 8.3 0.3 32.6 100.0 283 Bago 52.2 8.0 7.7 0.2 31.9 100.0 1,244 Magway 44.2 13.3 7.5 0.3 34.8 100.0 1,081 Mandalay 41.0 11.9 7.9 0.0 39.2 100.0 1,541 Mon 40.0 12.8 11.2 1.0 35.0 100.0 463 Rakhine 45.2 12.7 11.0 0.2 30.9 100.0 777 Yangon 46.1 5.9 8.0 0.2 39.8 100.0 1,927 Shan 49.8 12.5 10.0 1.2 26.4 100.0 1,368 Ayeyarwady 51.0 12.3 8.2 0.6 27.9 100.0 1,650 Nay Pyi Taw 52.4 11.7 7.8 0.1 27.9 100.0 300 Education3 No education 55.2 16.2 12.9 1.0 14.8 100.0 1,606 Primary 54.2 12.1 9.7 0.5 23.5 100.0 5,305 Secondary 38.3 8.7 6.8 0.6 45.7 100.0 4,646 More than secondary 34.8 9.4 5.3 0.7 49.8 100.0 1,325 Wealth quintile Lowest 55.0 14.3 9.6 0.6 20.5 100.0 2,274 Second 51.8 11.2 9.4 0.6 27.0 100.0 2,408 Middle 46.4 10.5 8.3 0.3 34.5 100.0 2,633 Fourth 43.6 9.6 8.2 0.6 38.0 100.0 2,702 Highest 38.5 10.5 7.7 0.8 42.5 100.0 2,868 Total 46.6 11.1 8.6 0.6 33.1 100.0 12,885 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 3 Total includes three women with missing information on education Marriage and Sexual Activity • 65 Table 4.7.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Myanmar DHS 2015-16 Timing of last sexual intercourse Never had sexual intercourse Total Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Number of men Age 15-19 4.8 2.0 0.7 0.1 92.5 100.0 731 20-24 32.5 6.6 4.1 0.5 56.2 100.0 692 25-29 59.8 8.1 6.9 0.6 24.7 100.0 677 30-34 66.6 12.7 5.5 0.5 14.7 100.0 698 35-39 75.3 10.3 5.7 0.5 8.2 100.0 679 40-44 70.2 13.8 8.2 0.5 7.3 100.0 689 45-49 66.1 19.3 9.3 0.7 4.6 100.0 571 Marital status Never married 1.9 3.2 5.6 0.2 89.1 100.0 1,646 Married 83.4 13.9 2.1 0.6 0.0 100.0 2,957 Divorced/separated/ widowed 3.5 11.7 83.9 0.0 0.9 100.0 135 Marital duration2 0-4 years 85.2 13.2 0.9 0.7 0.0 100.0 605 5-9 years 86.2 11.8 1.4 0.7 0.0 100.0 577 10-14 years 88.2 10.3 1.3 0.2 0.0 100.0 549 15-19 years 83.5 13.4 2.1 1.0 0.0 100.0 437 20-24 years 81.2 14.3 4.1 0.5 0.0 100.0 397 25+ years 66.7 26.3 6.6 0.4 0.0 100.0 227 Married more than once 79.0 18.6 1.3 1.1 0.0 100.0 165 Residence Urban 47.0 11.3 6.9 0.7 34.0 100.0 1,350 Rural 55.1 9.6 5.1 0.4 29.8 100.0 3,387 States/Regions Kachin 41.5 17.3 9.1 1.9 30.3 100.0 161 Kayah 43.5 8.3 3.8 11.7 32.7 100.0 23 Kayin 49.1 12.8 3.7 0.0 34.5 100.0 115 Chin 42.5 18.1 8.0 2.3 29.2 100.0 39 Sagaing 51.3 9.4 5.5 0.0 33.7 100.0 514 Tanintharyi 45.9 8.1 6.9 1.6 37.4 100.0 103 Bago 59.8 10.5 4.2 0.0 25.5 100.0 454 Magway 54.7 9.0 7.0 1.4 27.9 100.0 320 Mandalay 50.6 9.6 7.0 0.6 32.2 100.0 601 Mon 42.1 10.0 5.2 2.0 40.7 100.0 162 Rakhine 58.2 6.0 5.5 0.0 30.3 100.0 222 Yangon 54.5 7.9 2.8 0.3 34.6 100.0 703 Shan 52.2 14.9 8.6 0.0 24.3 100.0 542 Ayeyarwady 55.1 8.1 4.9 0.0 31.9 100.0 653 Nay Pyi Taw 53.6 14.2 5.4 0.3 26.5 100.0 126 Education No education 61.0 11.8 7.3 0.2 19.8 100.0 575 Primary 62.9 11.8 4.6 0.7 20.1 100.0 1,684 Secondary 43.7 8.3 6.2 0.4 41.4 100.0 2,139 More than secondary 46.9 10.2 4.9 0.2 37.9 100.0 339 Wealth quintile Lowest 59.1 11.2 4.0 0.4 25.2 100.0 890 Second 54.9 11.1 5.5 0.7 27.8 100.0 916 Middle 52.6 8.2 6.1 0.1 33.0 100.0 979 Fourth 51.2 9.6 4.8 0.4 33.9 100.0 986 Highest 46.9 10.6 7.7 0.6 34.2 100.0 966 Total 52.8 10.1 5.6 0.5 31.0 100.0 4,737 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married Fertility • 67 FERTILITY 5 Key Findings  Total fertility rate: The current total fertility rate in Myanmar is 2.3 children per woman: 1.9 children in urban areas and 2.4 children in rural areas. Fertility peaks in the age group 25-29.  Patterns of fertility: Fertility levels are markedly lower among highly educated women and women living in wealthy households compared with other women.  Birth intervals: In Myanmar, intervals between births are generally quite long, with the median birth interval being 49 months. Thirty-two percent of births occur within 3 years of a previous birth, and only 13% occur within 24 months.  Age at first birth: The median age of a woman at her first birth is 24.7 years; only 7% of women give birth before they are 18. he number of children that a woman bears depends on many factors, including the age at which she begins childbearing, how long she waits between births, and her fecundity. Postponing first births and extending the interval between births have reduced fertility levels in many countries. These factors also have positive health consequences. In contrast, short birth intervals (less than 24 months) can lead to harmful outcomes for both newborns and their mothers, such as preterm birth, low birth weight, and death. Childbearing at a very young age is associated with an increased risk of complications during pregnancy and childbirth and higher rates of neonatal mortality. This chapter describes the current level of fertility in Myanmar and some of its proximate determinants. It presents information on the total fertility rate, birth intervals, insusceptibility to pregnancy (due to postpartum amenorrhea, postpartum abstinence, or menopause), age at first birth, and teenage childbearing. 5.1 CURRENT FERTILITY Total fertility rate The average number of children a woman would have by the end of her childbearing years if she bore children at the current age-specific fertility rates. Age-specific fertility rates are calculated for the 3 years before the survey, based on detailed birth histories provided by women. Sample: Women age 15-49 T 68 • Fertility The total fertility rate (TFR) in Myanmar is 2.3 children per woman; in urban areas it is 1.9 children, and in rural areas it is 2.4 children. The 2014 Myanmar Census reported the TFR to be 2.5 children (Ministry of Labor, Immigration and Population 2016). Childbearing peaks at age 25-29 when the age- specific fertility rate is 128. It drops sharply thereafter. Age-specific fertility rates (ASFRs) for every age group are lower in urban areas than in rural areas (Figure 5.1) . In Myanmar, the general fertility rate is 77 and the crude birth rate is 18. Both of these rates are higher in rural areas than in urban areas (Table 5.1). Four percent of women age 15-49 are currently pregnant, and the mean number of children ever born to women age 40-49 is 3.0 (Table 5.2). Survey results indicate that ASFRs for 5-year periods preceding the survey have declined substantially over the last 2 decades (Table 5.3). The fertility decline is highest among the cohort age 25-29 (dropping from 166 births to 121 births between the period 15-19 years before the survey and the period 0-4 years before the survey). Results are incomplete because the rates for older age groups become progressively more truncated for periods further from the survey date, since women age 50 and older were not interviewed in the survey. Patterns by background characteristics  Women with no education have a TFR of 3.6 children, two children more than the TFR for women with more than secondary education, 1.5 children (Figure 5.2). Figure 5.1 Age-specific fertility rates Figure 5.2 Fertility by mother’s education 0 50 100 150 200 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group Births per 1,000 women Urban Total Rural 3.6 2.6 2.0 1.5 No education Primary Secondary More than secondary TFR for the 3 years before the survey Fertility • 69  By state and region, the TFR is lowest in Magway Region and Yangon Region at 1.8 children each, and is highest in Chin State at 4.6 children (Figure 5.3).  Women in the lowest wealth quintile have twice as many children, on average, as women in the highest wealth quintile (Table 5.2). 5.2 CHILDREN EVER BORN AND LIVING The survey also collected information on the mean number of children ever born. The mean number of children ever born is 1.6 for all women and 2.5 for currently married women (Table 5.4). The mean number of children born to women age 45- 49—those who are no longer fertile—is 3.2 children; and the mean number born to currently married women in this age group is 3.9 children. Despite the relatively low number of children ever born to older women, it is notable that 17% of women age 45-49 have given birth to six or more children. In Myanmar, many women complete their reproductive years without having children, however. Among women age 40-49, 17%-18% have not had any births. 5.3 BIRTH INTERVALS Median birth interval Number of months since the preceding birth by which half of children are born Sample: Non-first births in the 5 years before the survey Birth interval is the length of time between two successive live births. Short birth intervals (of less than 24 months) are associated with an increased risk of death for mother and child. In Myanmar, only 13% of non-first births occurred within 24 months after the preceding birth, and 5% occurred less than 18 months after the preceding birth (Table 5.5, Figure 5.4). The median birth interval for Myanmar as a whole is more than 4 years (49 months)—54 months in urban areas and 48 months in rural areas. Patterns by background characteristics  The percentage of births occurring within a very short interval (less than 18 months) is almost two and a half times higher for children whose previous sibling died than for children whose previous sibling survived (10% and 4%, respectively).  Mothers with more education have longer birth intervals: among women with no education, the median birth interval is 40 months, but for women with more than secondary education, the median birth interval is 59 months. Figure 5.3 Fertility by states and regions Total fertility rate for the 3 years before the survey Figure 5.4 Birth intervals 7-17 5% 18-23 8% 24-35 18% 36-47 17% 48-59 14% 60+ 38% Percent distribution of non-first births by number of months preceding birth 70 • Fertility  By wealth, the median birth interval is the shortest for women in the lowest wealth quintile at 42 months. The longest interval is for women in the highest wealth quintile, at 59 months. 5.4 INSUSCEPTIBILITY TO PREGNANCY Median duration of postpartum amenorrhea Number of months after childbirth by which time half of women have begun menstruating Sample: Women who gave birth in the 3 years before the survey Median duration of postpartum insusceptibility Number of months after childbirth by which time half of women are no longer protected against pregnancy either by postpartum amenorrhea or abstinence from sex Sample: Women who gave birth in the 3 years before the survey Most women (96%) are insusceptible to pregnancy during the first 2 months after a birth (Table 5.6). The proportion of women insusceptible to pregnancy falls to 9%-12% for women 22-35 months after birth. In Myanmar, the median duration of postpartum amenorrhea is 3.4 months, and women abstain from sexual intercourse for a median of 2.2 months after giving birth. Women are insusceptible to pregnancy after childbirth (either still amenorrheic or still abstaining) for a median of 4.5 months (Table 5.7). Menopause Women are considered to have reached menopause if they are neither pregnant nor postpartum amenorrheic and have not had a menstrual period in the 6 months before the survey, or if they report being menopausal. Sample: Women age 30-49 Sixteen percent of women age 30-49 are menopausal (Table 5.8). This proportion increases with age from 10% among women age 30-34 to 50% among women age 48-49. 5.5 AGE AT FIRST BIRTH Median age at first birth Age by which half of women have had their first child Sample: Women age 25-49 Childbearing in Myanmar occurs relatively late. Only 7% of women age 25-49 gave birth before age 18. The median age at first birth in Myanmar is 24.7 years among women age 25-49 (Table 5.9). Patterns by background characteristics  There is regional variation in the median age at first birth, with women in Rakhine State and Shan State giving birth at younger median ages (age 22.6 and age 22.8) than women in other states and regions (Table 5.10).  Women with no education have a lower median age at first birth than those with primary education (21.5 versus 23.5 years).  Women in the lowest wealth quintile tend to give birth earlier than those in other quintiles. Fertility • 71 5.6 TEENAGE CHILDBEARING Teenage childbearing Percentage of women age 15-19 who have given birth or are pregnant with their first child Sample: Women age 15-19 Childbearing during teenage years can reduce women’s educational and employment opportunities and is associated with higher level of fertility. In Myanmar, 6% of women age 15-19 have begun childbearing: 5% have given birth, and an additional 1% are pregnant with their first child (Table 5.11). Patterns by background characteristics  The percentage of women who have begun childbearing increases with age from 1% at age 15 to 18% at age 19.  The percentage of teenagers who have begun childbearing is lowest at 2% in Mandalay Region and is highest at 11% each in Kachin State, Chin State, and Shan State.  The level of teenage fertility is influenced by education. Nineteen percent of teenagers who have never been to school have begun childbearing, compared with 3% who have a secondary education and 1% who have more than secondary education (Figure 5.5).  The level of teenage fertility is also associated with wealth: 9% of the poorest teenagers have begun childbearing, compared with 3% of the richest. LIST OF TABLES For more information on fertility levels and some of the determinants of fertility, see the following tables:  Table 5.1 Current fertility  Table 5.2 Fertility by background characteristics  Table 5.3 Trends in age-specific fertility rates  Table 5.4 Children ever born and living  Table 5.5 Birth intervals  Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility  Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility  Table 5.8 Menopause  Table 5.9 Age at first birth  Table 5.10 Median age at first birth  Table 5.11 Teenage pregnancy and motherhood Figure 5.5 Teenage childbearing by education 19 11 3 0.5 No education Primary Secondary More than secondary Percentage of women age 15-19 who have begun childbearing 72 • Fertility Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the 3 years preceding the survey, by residence, Myanmar DHS 2015-16 Residence Age group Urban Rural Total 15-19 36 37 36 20-24 88 122 112 25-29 115 133 128 30-34 85 96 93 35-39 47 68 62 40-44 12 26 22 45-49 0 4 3 TFR(15-49) 1.9 2.4 2.3 GFR 64 83 77 CBR 16 19 18 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Table 5.2 Fertility by background characteristics Total fertility rate for the 3 years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Myanmar DHS 2015-16 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 1.9 2.8 2.3 Rural 2.4 3.9 3.3 States/Regions Kachin 3.0 5.9 3.5 Kayah 3.3 4.8 3.9 Kayin 3.9 4.9 3.7 Chin 4.6 6.6 5.2 Sagaing 2.1 2.4 3.3 Tanintharyi 3.1 3.9 3.9 Bago 1.9 2.8 2.8 Magway 1.8 2.9 2.8 Mandalay 2.0 2.9 2.7 Mon 2.3 3.7 3.3 Rakhine 2.7 4.9 3.8 Yangon 1.8 2.6 2.4 Shan 3.0 4.4 3.5 Ayeyarwady 2.3 5.4 2.9 Nay Pyi Taw 2.0 2.6 3.1 Education No education 3.6 3.9 4.3 Primary 2.6 3.8 3.2 Secondary 2.0 3.4 2.3 More than secondary 1.5 3.1 1.2 Wealth quintile Lowest 3.5 6.1 4.3 Second 2.5 3.9 3.6 Middle 2.1 2.9 3.2 Fourth 1.9 2.8 2.7 Highest 1.6 2.9 2.0 Total 2.3 3.6 3.0 Note: Total fertility rates are for the period 1-36 months prior to interview. Fertility • 73 Table 5.3 Trends in age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, by mother’s age at the time of the birth, Myanmar DHS 2015-16 Number of years preceding survey Mother’s age at birth 0-4 5-9 10-14 15-19 15-19 37 40 44 47 20-24 112 121 128 139 25-29 121 126 155 166 30-34 98 114 128 [141] 35-39 63 78 [102] 40-44 24 [40] 45-49 [3] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. Table 5.4 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born, and mean number of living children, according to age group, Myanmar DHS 2015-16 Number of children ever born Total Number of women Mean number of children ever born Mean number of living children Age 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 95.0 4.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,810 0.06 0.05 20-24 68.1 23.4 6.5 1.6 0.5 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,867 0.43 0.41 25-29 37.6 30.2 20.0 8.3 2.6 0.9 0.2 0.1 0.0 0.0 0.0 100.0 1,867 1.12 1.05 30-34 28.3 20.9 23.3 15.3 7.4 3.0 1.2 0.3 0.2 0.0 0.0 100.0 2,037 1.69 1.56 35-39 21.1 14.3 24.1 18.5 10.2 5.5 3.4 1.6 0.9 0.4 0.1 100.0 1,954 2.29 2.06 40-44 17.9 9.7 18.9 20.1 13.3 8.0 5.4 3.6 1.8 0.6 0.7 100.0 1,733 2.86 2.51 45-49 17.4 9.0 15.9 18.1 11.7 10.9 6.0 5.5 2.8 1.1 1.7 100.0 1,617 3.21 2.77 Total 40.9 16.3 15.8 11.6 6.4 3.9 2.2 1.5 0.8 0.3 0.3 100.0 12,885 1.64 1.46 CURRENTLY MARRIED WOMEN 15-19 62.4 32.8 4.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 227 0.42 0.41 20-24 33.0 48.8 13.7 3.5 0.9 0.1 0.0 0.0 0.0 0.0 0.0 100.0 834 0.91 0.86 25-29 12.9 41.8 28.0 11.7 3.9 1.3 0.4 0.1 0.0 0.0 0.0 100.0 1,258 1.57 1.47 30-34 9.0 25.6 30.0 19.7 9.3 3.9 1.7 0.4 0.3 0.1 0.0 100.0 1,505 2.17 1.99 35-39 4.5 16.5 29.7 22.7 12.2 6.8 4.1 1.8 0.9 0.5 0.2 100.0 1,482 2.78 2.51 40-44 3.7 9.1 21.9 25.1 16.2 9.9 6.2 4.0 2.2 0.8 0.8 100.0 1,283 3.41 2.99 45-49 3.7 8.7 18.0 20.8 14.3 13.3 7.3 6.9 3.8 1.4 1.9 100.0 1,169 3.86 3.34 Total 11.3 23.9 24.0 17.7 9.7 5.9 3.3 2.1 1.2 0.4 0.5 100.0 7,759 2.46 2.21 74 • Fertility Table 5.5 Birth intervals Percent distribution of non-first births in the 5 years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Months since preceding birth Number of non-first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Total Age 15-19 * * * * * * 100.0 11 * 20-29 7.1 13.3 27.0 21.5 12.8 18.3 100.0 825 36.9 30-39 4.0 6.6 15.1 15.4 14.9 44.0 100.0 1,505 54.8 40-49 2.1 4.9 13.6 14.4 12.2 52.8 100.0 436 63.2 Sex of preceding birth Male 5.2 7.7 17.4 16.5 13.6 39.6 100.0 1,430 50.9 Female 4.4 9.2 19.6 17.5 14.0 35.3 100.0 1,347 47.6 Survival of preceding birth Living 4.3 7.9 17.8 17.1 14.3 38.6 100.0 2,541 50.1 Dead 10.3 14.2 24.8 15.7 8.9 26.2 100.0 236 36.3 Birth order 2-3 4.3 7.5 16.4 17.6 14.1 40.2 100.0 1,789 51.2 4-6 5.1 9.3 20.6 15.8 14.1 35.1 100.0 783 47.5 7+ 8.3 13.3 27.4 16.8 10.0 24.1 100.0 204 36.5 Residence Urban 4.1 7.2 16.1 15.8 13.5 43.3 100.0 513 54.2 Rural 4.9 8.7 18.9 17.3 13.9 36.3 100.0 2,264 48.1 States/Regions Kachin 4.7 7.3 27.3 19.6 14.4 26.7 100.0 119 41.2 Kayah 8.1 15.1 27.0 18.9 12.1 18.8 100.0 23 35.9 Kayin 2.9 11.8 23.0 17.9 11.9 32.5 100.0 109 43.9 Chin 12.1 17.1 34.0 19.6 6.2 11.0 100.0 51 30.4 Sagaing 2.0 7.2 19.7 17.0 17.4 36.7 100.0 334 50.3 Tanintharyi 9.0 10.9 19.9 16.8 16.0 27.4 100.0 95 41.1 Bago 3.5 6.3 14.4 19.6 14.7 41.5 100.0 229 52.6 Magway 4.8 4.7 13.2 17.6 12.6 47.2 100.0 197 57.1 Mandalay 1.2 3.9 19.2 11.9 16.8 47.0 100.0 259 57.3 Mon 4.8 4.7 14.6 18.1 18.6 39.2 100.0 97 51.7 Rakhine 9.9 11.3 21.0 18.1 13.6 25.9 100.0 202 41.2 Yangon 6.3 7.9 8.0 15.1 12.2 50.5 100.0 241 60.5 Shan 6.3 12.9 25.5 17.3 11.3 26.6 100.0 402 40.1 Ayeyarwady 3.4 8.3 13.9 15.7 11.5 47.3 100.0 361 57.7 Nay Pyi Taw 4.8 7.1 14.5 25.3 17.6 30.8 100.0 58 47.2 Education No education 7.9 12.2 23.5 17.0 13.9 25.6 100.0 641 39.9 Primary 4.3 7.7 17.1 17.7 13.3 39.9 100.0 1,403 50.7 Secondary 3.5 6.5 17.7 15.3 14.4 42.6 100.0 603 53.4 More than secondary 0.8 6.4 10.6 17.6 16.1 48.5 100.0 130 58.8 Wealth quintile Lowest 6.5 12.9 20.8 18.8 13.1 27.9 100.0 952 42.3 Second 4.7 7.2 22.9 16.2 13.3 35.7 100.0 681 47.0 Middle 5.4 4.8 15.3 17.7 13.2 43.7 100.0 449 54.5 Fourth 2.4 5.5 13.2 13.3 16.9 48.7 100.0 411 58.5 Highest 1.7 6.4 12.2 17.1 14.0 48.5 100.0 284 59.4 Total 4.8 8.4 18.4 17.0 13.8 37.6 100.0 2,777 49.0 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility • 75 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the 3 years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Myanmar DHS 2015-16 Months since birth Percentage of births for which the mother is: Number of births Amenorrheic Abstaining Insusceptible1 < 2 87.1 89.7 96.3 94 2-3 55.5 40.5 67.2 166 4-5 36.9 18.8 42.8 157 6-7 35.1 17.4 38.5 140 8-9 24.0 9.4 31.3 153 10-11 19.8 8.1 26.2 120 12-13 28.3 7.9 35.5 177 14-15 21.8 5.5 25.6 169 16-17 20.2 5.0 23.3 123 18-19 12.0 2.8 14.8 135 20-21 16.5 3.8 19.4 131 22-23 6.1 3.6 9.4 126 24-25 7.3 2.5 9.9 150 26-27 7.4 3.4 10.8 143 28-29 5.2 7.7 11.3 124 30-31 6.9 3.1 10.1 139 32-33 5.4 6.2 11.5 130 34-35 8.5 3.3 11.4 128 Total 22.1 12.3 27.2 2,506 Median 3.4 2.2 4.5 na Mean 8.4 5.1 10.2 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the 3 years preceding the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother’s age 15-29 2.9 2.1 4.2 30-49 4.1 (2.5) 5.2 Residence Urban (2.1) (2.0) 2.9 Rural 4.2 2.3 5.1 Education No education 5.0 3.3 5.9 Primary 4.3 (2.0) 5.3 Secondary 2.7 (2.4) 3.8 Wealth quintile Lowest 4.7 (2.0) 5.2 Second 3.6 3.0 4.6 Middle 4.3 * 5.2 Fourth 2.6 * 3.4 Highest * * 4.4 Total 3.4 2.2 4.5 Note: Medians are based on the status at the time of the survey (current status). Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth 76 • Fertility Table 5.8 Menopause Percentage of women age 30-49 who are menopausal, by age, Myanmar DHS 2015-16 Age Percentage menopausal1 Number of women Age 30-34 9.6 2,037 35-39 11.4 1,954 40-41 10.0 698 42-43 13.5 653 44-45 17.0 761 46-47 29.1 668 48-49 50.0 571 Total 16.1 7,341 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred 6 or more months preceding the survey Table 5.9 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Myanmar DHS 2015-16 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.3 na na na na 95.0 1,810 a 20-24 0.3 5.1 15.4 na na 68.1 1,867 a 25-29 0.8 5.8 17.9 31.1 50.3 37.6 1,867 25.0 30-34 1.0 7.6 18.7 32.7 48.5 28.3 2,037 25.3 35-39 0.4 7.6 18.5 33.1 51.0 21.1 1,954 24.8 40-44 0.7 8.3 21.8 36.7 54.7 17.9 1,733 24.1 45-49 1.1 7.3 22.4 37.8 54.5 17.4 1,617 24.0 20-49 0.7 6.9 19.0 na na 32.1 11,075 a 25-49 0.8 7.3 19.7 34.1 51.6 24.8 9,208 24.7 na = Not applicable due to censoring a = Omitted because less than 50% of women had a birth before reaching the beginning of the age group Fertility • 77 Table 5.10 Median age at first birth Median age at first birth among women age 25-49, according to background characteristics, Myanmar DHS 2015-16 Women age 25-49 Background characteristic Residence Urban a Rural 23.8 States/Regions Kachin 23.6 Kayah 23.8 Kayin 23.4 Chin 23.1 Sagaing 24.3 Tanintharyi 23.8 Bago 24.7 Magway a Mandalay a Mon 24.5 Rakhine 22.6 Yangon a Shan 22.8 Ayeyarwady 23.9 Nay Pyi Taw 24.5 Education No education 21.5 Primary 23.5 Secondary a More than secondary a Wealth quintile Lowest 22.0 Second 22.9 Middle 24.7 Fourth a Highest a Total 24.7 a = Omitted because less than 50% of the women had a birth before reaching the beginning of the age group 78 • Fertility Table 5.11 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Myanmar DHS 2015-16 Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Background characteristic Have had a live birth Are pregnant with first child Age 15 0.7 0.1 0.8 340 16 1.0 0.8 1.8 390 17 1.9 1.3 3.2 366 18 5.4 1.2 6.5 357 19 16.1 1.4 17.5 357 Residence Urban 3.7 0.7 4.3 591 Rural 5.6 1.1 6.7 1,219 States/Regions Kachin 7.3 3.8 11.1 59 Kayah 6.5 1.0 7.5 9 Kayin 6.2 1.1 7.3 41 Chin 5.9 4.7 10.5 17 Sagaing 4.0 0.9 4.8 164 Tanintharyi 4.9 0.9 5.8 41 Bago 4.8 0.0 4.8 180 Magway 4.0 0.9 5.0 133 Mandalay 1.8 0.0 1.8 188 Mon 6.2 1.0 7.1 66 Rakhine 6.2 2.0 8.2 128 Yangon 2.9 0.5 3.5 316 Shan 9.0 2.1 11.1 233 Ayeyarwady 5.9 0.0 5.9 195 Nay Pyi Taw 3.8 1.9 5.7 39 Education No education 18.1 1.0 19.1 125 Primary 8.8 1.9 10.7 425 Secondary 2.5 0.6 3.1 1,189 More than secondary 0.0 0.5 0.5 71 Wealth quintile Lowest 7.6 1.6 9.1 321 Second 7.3 1.6 9.0 329 Middle 3.3 0.3 3.6 382 Fourth 5.6 0.3 5.9 389 Highest 1.8 1.1 2.9 388 Total 5.0 0.9 5.9 1,810 Fertility Preferences • 79 FERTILITY PREFERENCES 6 Key Findings  Desire for another child: Overall 13% of currently married women age 15-49 want to have another child soon, 18% want to wait at least 2 years, and 61% want no more children or are sterilized.  Limiting childbearing: Women are more likely than men to want no more children, no matter how many children they already have. Among married couples with three children, 84% of women and 65% of men say they do not want another child.  Ideal family size: Women currently want 2.5 children, on average, while men want 2.8 children.  Unwanted births: When asked about the desirability of births in the past 5 years and current pregnancies, 91% were wanted at the time of conception, 4% were mistimed, and 5% were unwanted. nformation on fertility preferences can help family planning program managers assess the desire for children, the extent of mistimed and unwanted pregnancies, and the demand for contraception to space or limit births. Trends in this information may suggest the direction that fertility patterns will take in the future. This chapter presents information on whether and when married women and men want more children, ideal family size, whether the last birth was wanted, and the theoretical fertility rate if all unwanted births were prevented. 6.1 DESIRE FOR ANOTHER CHILD Desire for another child Women and men were asked whether they wanted more children and, if so, how long they would prefer to wait before the next child. Women and men who are sterilized are assumed not to want any more children. Sample: Currently married women and men age 15-49 Table 6.1 presents fertility preferences of currently married women and men age 15-49 by number of living children. Thirty-three percent of women say that they want to have another child: 13% want a child within 2 years, 18% prefer to wait for two or more years, and 2% want another child but are undecided about when to have that child. Six in 10 married women (61%) want no more children or have been sterilized. Three percent of married women are undecided about whether they want more children. Fifty-three percent of currently married women with no child want to have a child within 2 years. This proportion falls to 18% among women with one child and falls even lower among women with more than one child. Forty-one percent of women with one child want to delay having their next child for 2 or more I 80 • Fertility Preferences years, and a large majority of women with two or more children want no more children. Even among currently married women with only one living child, one-third want no more children. Fertility preferences of men are similar to those of women. Forty-six percent of currently married men want to have another child. Twenty-five percent of all currently married men want to wait 2 or more years. Another 46% of married men do not want to have another child (or have been sterilized), and 4% are undecided. The desire to limit childbearing rises with increasing number of living children, from 10% among married women with no living children to 86%-87% among women with four or more living children. Even among women with two children, the percentage who want no more is 70% (Table 6.2.1 and Figure 6.1). Patterns by background characteristics  The percentage of married women who want no more children is slightly higher in urban areas (64%) than in rural areas (59%) (Table 6.2.1).  There is considerable variation across states and regions; Rakhine State has the smallest proportion of women wishing to curtail their fertility (47%), whereas Shan State has the highest proportion (66%).  The desire to limit childbearing declines with education: 68% of women with no education want to limit childbearing, compared with 52% of women with more than secondary education. This is likely because a higher percentage of educated women are younger women who are still in the process of having their desired number of children (see Chapter 3 -Table 3.2.1).  The desire to limit childbearing among women generally increases somewhat with increasing household wealth, from 59% of women in the lowest and middle wealth quintile wanting no more children to 63% of women in the highest wealth quintile.  In general, the pattern of men’s desire to limit childbearing varies similarly to that of women by background characteristics. However, women have a greater desire not to have any more children at every parity than men (Table 6.2.1 and Table 6.2.2). 6.2 IDEAL FAMILY SIZE Ideal family size Respondents with no children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” Respondents who had children were asked: “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Sample: Women and men age 15-49 Figure 6.1 Desire to limit childbearing by number of living children 10 34 70 84 87 87 86 0 1 2 3 4 5 6+ Number of living children Percentage of currently married women age 15-49 who want no more children Fertility Preferences • 81 The mean ideal family size for all women age 15-49 in Myanmar is 2.5 children, and for all men in the same age group, it is 2.8 children (Table 6.3). The mean ideal family size for currently married women, at 2.9 children, and for currently married men, at 3.0 children, is slightly higher than for all women and all men age 15-49, respectively (Figure 6.2). Among women with no living children, 35% would like to have two children, 20% would like to have three children, and 17% would like to have no children. Also notably, only 6% of women with no children want four or more children. Although women’s and men’s ideal family size increases with the number of children they already have, men’s ideal family size is typically larger than women’s, and this gender difference is greatest in the case of 6 or more living children. The ideal family size of women with 6 or more living children is 4.7 children, compared with 5.8 children for men with 6 or more children (Table 6.3 and Figure 6.3). Patterns by background characteristics  The mean ideal number of children increases gradually with increasing age for both women and men. For women, ideal family size increases from two children among women age 15-19 to three children among women age 45-49; for men it increases from 2.4 children among men age 15-19 to 3.3 children among men age 45-49 (Table 6.4).  By state and region, the lowest mean ideal number of children is found in Yangon Region for women (2.1) and is found in Ayeyarwady Region for men (2.0). However, the highest mean ideal number of children is found among both women (4.1) and men (4.4) in Chin State.  For both women and men, ideal family size decreases with increasing education. For women the decrease is from 2.8 children among women with no education to 2.3 children among women with more than secondary education, and for men the decrease is from 3.3 children among men with no education to 2.4 children among men with more than secondary education.  Mean ideal family size decreases with increasing wealth among both women and men: from 3.0 and 3.2 children, respectively, in the lowest wealth quintile, to 2.2 and 2.5 children in the highest wealth quintile, respectively. 6.3 FERTILITY PLANNING STATUS Planning status of birth Women reported whether their most recent birth was wanted at the time (planned birth), at a later time (mistimed birth), or not at all (unwanted birth). Sample: Current pregnancies and births in the 5 years before the survey to women age 15-49 Figure 6.2 Ideal family size Figure 6.3 Ideal family size by number of living children 2.5 2.9 2.8 3.0 All Currently married Mean ideal number of children among women and men age 15-49 Women Men 1.9 2.3 2.7 3.2 3.7 4.0 4.7 2.4 2.5 2.7 3.4 3.9 4.5 5.8 0 1 2 3 4 5 6+ Number of living children Mean ideal number of children Women Men 82 • Fertility Preferences In Myanmar, the vast majority of births were wanted at the time of conception (91%), and only 4% of births were mistimed, that is, wanted at a later date. Only 5% of births were not wanted at all (Table 6.5 and Figure 6.4). Patterns by background characteristics  The proportion of unwanted births rises with birth order, increasing from 1% among first births to 3% among second-order births, 7% among third-order births, and, finally, 12% among fourth- and higher-order births (Table 6.5).  The percentage of unwanted births also increases with mother’s age at birth from 3% of births to women under age 20 to 13% in the age group 40-44. 6.4 WANTED FERTILITY RATES Wanted fertility rate The number of children the average woman would have over the course of her lifetime if she bore children at current age-specific fertility rates, excluding unwanted births. A birth is considered wanted if the number of living children at the time of conception is lower than the ideal number of children currently reported by the respondent. Sample: Births to women age 15-49 during the 3 years before the survey The wanted fertility rate indicates what fertility would be if women had only the children they desired. The total wanted fertility rate in Myanmar is 2 children, 0.3 children less than the current total fertility rate of 2.3 children (Table 6.6 and Figure 6.5). Patterns by background characteristics  The gap between wanted and actual fertility rates among women living in urban areas and among those living in rural areas is small (0.2 children and 0.3 children, respectively) (Figure 6.5).  The largest gap between wanted and actual fertility is almost one child in Chin State, where the total fertility rate is 4.6, while the smallest gap of 0.1 children is in Mon State, where the total fertility rate is 2.3.  The difference between wanted and actual fertility falls as women’s education increases: the difference is 0.7 children for women with no education but only 0.1 children for women with more than secondary education. This finding suggests that women with higher education are better able to have only the number of children they actually want. Figure 6.4 Fertility planning status Figure 6.5 Wanted and actual fertility by residence Wanted then 91% Mistimed 4% Unwanted 5% Percent distribution of births to women age 15-49 in the five years before the survey (including current pregnancies) by planning status of births 2.0 1.7 2.1 0.3 0.2 0.3 Total Urban Rural 1.9 2.4 Total wanted fertility Difference TFR2.3 Wanted and actual number of children per woman Fertility Preferences • 83  The gap between wanted and actual fertility among women in the lowest wealth quintile (0.6 children) is slightly larger than that among women in other wealth quintiles. LIST OF TABLES For more information on fertility preferences, see the following tables:  Table 6.1 Fertility preferences by number of living children  Table 6.2.1 Desire to limit childbearing: Women  Table 6.2.2 Desire to limit childbearing: Men  Table 6.3 Ideal number of children by number of living children  Table 6.4 Mean ideal number of children  Table 6.5 Fertility planning status  Table 6.6 Wanted fertility rates 84 • Fertility Preferences Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women and currently married men age 15-49 by desire for children, according to number of living children, Myanmar DHS 2015-16 Number of living children Total 15-49 Desire for children 0 1 2 3 4 5 6+ WOMEN1 Have another soon2 52.5 17.6 7.3 5.6 2.6 2.5 3.1 13.2 Have another later3 19.0 40.5 16.1 5.0 5.0 1.9 2.5 18.4 Have another, undecided when 1.9 2.0 1.9 1.2 0.6 0.7 2.0 1.6 Undecided 10.5 3.6 2.9 1.8 1.8 2.1 1.2 3.4 Want no more 10.1 33.7 63.9 73.2 78.7 81.6 81.7 55.5 Sterilized4 0.2 0.7 5.9 10.8 8.4 5.6 4.4 5.0 Declared infecund 5.7 1.7 2.0 2.3 2.9 5.5 5.1 2.7 Missing 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 756 2,025 2,134 1,402 738 356 349 7,759 MEN5 Have another soon2 47.0 24.3 13.3 12.2 7.2 6.0 9.1 18.8 Have another later3 19.4 45.5 24.4 14.4 6.6 9.7 8.1 25.3 Have another, undecided when 2.3 3.2 2.5 1.2 1.7 0.0 0.8 2.2 Undecided 10.8 4.4 3.3 3.9 2.4 6.3 2.0 4.4 Want no more 8.6 20.1 53.4 62.3 75.0 74.6 73.7 44.4 Sterilized4 0.0 0.4 1.1 2.4 2.7 0.4 2.3 1.2 Declared infecund 11.9 2.0 2.0 3.6 4.5 3.0 4.0 3.6 Missing 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 310 823 831 521 268 91 113 2,957 1 The number of living children includes the current pregnancy. 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization 5 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 85 Table 6.2.1 Desire to limit childbearing: Women Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Number of living children1 0 1 2 3 4 5 6+ Total Residence Urban 9.8 42.3 82.4 89.0 91.5 87.3 (97.0) 64.0 Rural 10.6 31.0 65.0 82.3 86.1 87.2 84.8 59.3 States/Regions Kachin (2.8) 18.3 57.8 86.5 82.2 * (91.7) 57.8 Kayah (8.7) 18.0 60.2 75.6 (68.5) (88.4) 89.7 58.1 Kayin (4.0) 17.2 48.5 70.6 82.8 (85.5) * 55.2 Chin (6.8) 8.3 31.9 52.7 69.4 78.0 82.7 50.2 Sagaing (11.6) 19.3 61.7 77.3 93.5 (87.8) (86.3) 59.5 Tanintharyi (7.9) 11.2 39.7 72.7 76.5 (76.0) (83.6) 48.8 Bago 22.7 45.1 77.3 88.5 (90.9) * * 64.2 Magway (6.7) 33.1 74.5 84.6 86.9 (100.0) * 60.0 Mandalay 4.6 29.6 70.1 83.2 (81.8) * * 56.6 Mon (7.3) 24.7 54.3 87.3 85.7 (93.9) (80.1) 58.9 Rakhine 14.8 15.4 53.8 63.1 72.9 (77.7) 82.2 47.1 Yangon 9.2 46.2 84.2 91.7 (94.7) * * 64.9 Shan (7.5) 35.7 72.8 88.4 (91.5) (91.3) * 66.0 Ayeyarwady 7.6 45.2 71.5 89.4 86.8 * * 64.0 Nay Pyi Taw 16.0 30.7 71.7 81.5 (89.5) * * 57.1 Education No education 11.5 31.5 63.3 76.0 87.8 90.1 81.1 67.9 Primary 13.7 36.0 67.1 83.0 85.6 86.1 90.0 63.6 Secondary 7.9 33.3 72.5 89.4 91.8 82.4 83.3 54.2 More than secondary 8.0 34.0 85.9 96.3 * * * 51.7 Wealth quintile Lowest 10.8 30.1 59.4 76.2 82.6 85.0 86.4 59.2 Second 8.5 29.0 63.8 81.4 89.4 85.0 84.4 60.4 Middle 12.0 34.3 67.4 81.4 85.4 89.6 83.9 58.9 Fourth 11.6 36.6 74.8 89.0 88.4 91.0 89.9 61.6 Highest 8.6 40.0 81.4 93.4 95.2 * * 62.7 Total 10.4 34.4 69.8 84.0 87.1 87.2 86.1 60.5 Note: Women who have been sterilized or whose husband has been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The number of living children includes the current pregnancy. Table 6.2.2 Desire to limit childbearing: Men Percentage of currently married men age 15-49 who want no more children, by number of living children, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Number of living children1 0 1 2 3 4 5 6+ Total Residence Urban 13.0 22.6 66.5 73.2 (91.4) * * 47.7 Rural 6.6 19.5 50.2 62.2 75.1 74.7 74.6 44.9 Education No education (11.4) 27.6 50.7 48.3 79.5 (76.9) (70.0) 50.6 Primary 7.0 19.5 52.6 65.4 74.6 69.6 79.6 47.8 Secondary 9.2 19.6 56.0 71.1 82.3 (80.2) (79.6) 42.4 More than secondary (7.8) 21.9 (67.5) * * * * 37.7 Wealth quintile Lowest (5.1) 14.1 47.9 59.4 71.3 (73.0) 70.3 44.6 Second (19.5) 24.9 48.6 51.2 80.4 (75.0) (79.1) 48.4 Middle 0.4 18.6 46.2 71.2 79.8 (69.8) (79.2) 40.8 Fourth 10.3 13.9 58.2 67.3 (76.9) * * 42.5 Highest 13.9 29.6 70.9 84.5 (84.6) * * 52.4 Total 8.6 20.5 54.5 64.7 77.7 74.9 76.0 45.6 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. State and region level estimates are not shown due to few cases. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). 86 • Fertility Preferences Table 6.3 Ideal number of children by number of living children Percent distribution of women and men 15-49 by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to the number of living children, Myanmar DHS 2015-16 Number of living children Ideal number of children 0 1 2 3 4 5 6+ Total WOMEN1 0 17.2 3.0 3.2 2.4 3.7 3.6 3.9 8.7 1 10.2 13.3 3.0 3.1 0.9 1.5 0.2 7.4 2 35.3 41.2 39.1 11.6 11.5 7.1 5.5 31.0 3 19.5 33.7 35.7 51.1 19.5 25.4 17.9 28.8 4 3.5 3.6 9.4 12.9 38.0 12.5 14.1 8.4 5 1.9 2.5 5.2 12.4 13.2 27.0 12.9 5.6 6+ 0.4 0.4 0.9 2.0 5.9 11.4 27.6 2.2 Non-numeric responses 12.2 2.4 3.5 4.7 7.2 11.6 17.9 7.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,169 2,276 2,333 1,516 803 400 388 12,885 Mean ideal number of children for:2 All women 1.9 2.3 2.7 3.2 3.7 4.0 4.7 2.5 Number 4,540 2,220 2,252 1,446 745 354 318 11,874 Currently married women 2.2 2.3 2.7 3.2 3.8 4.0 4.8 2.9 Number of currently married women 739 1,982 2,070 1,342 686 314 286 7,420 MEN3 0 7.8 4.1 8.5 7.1 11.8 12.8 5.1 7.4 1 7.4 10.1 2.4 1.7 0.1 1.1 2.8 5.7 2 39.3 36.6 32.5 6.7 6.5 2.1 1.9 30.4 3 25.7 33.0 32.5 38.1 8.1 13.5 8.2 27.9 4 7.3 7.6 11.0 17.0 37.5 7.3 6.0 10.9 5 4.0 4.5 6.4 20.6 17.1 35.6 12.2 8.0 6+ 1.5 1.6 2.1 3.4 14.4 24.1 51.8 4.2 Non-numeric responses 7.0 2.5 4.6 5.4 4.6 3.5 11.9 5.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,005 863 855 530 278 91 115 4,737 Mean ideal number of children for:2 All men 2.4 2.5 2.7 3.4 3.9 4.5 5.8 2.8 Number 1,865 841 816 501 265 88 101 4,477 Currently married men 2.3 2.5 2.7 3.4 3.9 4.5 5.8 3.0 Number of currently married men 298 803 793 493 256 87 101 2,831 1 The number of living children includes current pregnancy for women. 2 Means are calculated excluding respondents who gave non-numeric responses. 3 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 87 Table 6.4 Mean ideal number of children Mean ideal number of children for all women and men age 15-49 by background characteristics, Myanmar DHS 2015-16 Background characteristic Mean Number of women1 Mean Number of men1 Age 15-19 2.0 1,520 2.4 673 20-24 2.3 1,714 2.5 649 25-29 2.5 1,774 2.8 655 30-34 2.6 1,946 2.8 670 35-39 2.6 1,847 2.9 653 40-44 2.8 1,583 3.0 646 45-49 3.0 1,491 3.3 533 Residence Urban 2.2 3,462 2.4 1,292 Rural 2.7 8,413 3.0 3,185 States/Regions Kachin 3.0 362 3.4 154 Kayah 3.2 52 3.5 21 Kayin 3.2 271 3.0 113 Chin 4.1 95 4.4 35 Sagaing 2.8 1,348 3.3 506 Tanintharyi 3.0 269 3.4 97 Bago 2.3 1,131 2.8 423 Magway 2.7 1,009 2.8 286 Mandalay 2.2 1,508 2.9 587 Mon 2.7 363 3.3 157 Rakhine 3.1 633 3.9 218 Yangon 2.1 1,709 2.4 694 Shan 2.6 1,229 2.8 463 Ayeyarwady 2.4 1,615 2.0 607 Nay Pyi Taw 2.5 281 3.0 116 Education2 No education 2.8 1,219 3.3 526 Primary 2.6 4,166 3.0 1,588 Secondary 2.4 5,489 2.6 2,038 More than secondary 2.3 1,001 2.4 326 Wealth quintile Lowest 3.0 2,044 3.2 824 Second 2.7 2,230 3.0 853 Middle 2.5 2,440 2.8 936 Fourth 2.4 2,530 2.6 944 Highest 2.2 2,630 2.5 920 Total 2.5 11,874 2.8 4,477 1 Number of women and men who gave a numeric response 2 Total includes three women with missing information on education. Table 6.5 Fertility planning status Percent distribution of births to women age 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother's age at birth, Myanmar 2015-16 Planning status of birth Number of births Birth order and mother's age at birth Wanted then Wanted later Wanted no more Total Birth order 1 95.6 3.5 1.0 100.0 1,664 2 92.6 4.6 2.7 100.0 1,237 3 88.5 4.6 6.9 100.0 764 4+ 85.3 3.1 11.6 100.0 1,086 Mother's age at birth <20 93.7 3.5 2.8 100.0 363 20-24 92.1 6.0 1.9 100.0 1,118 25-29 91.5 3.9 4.5 100.0 1,329 30-34 92.0 3.4 4.6 100.0 1,060 35-39 88.8 2.5 8.7 100.0 630 40-44 86.8 0.2 12.9 100.0 239 45-49 * * * 100.0 12 Total 91.3 3.9 4.8 100.0 4,752 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 88 • Fertility Preferences Table 6.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 1.7 1.9 Rural 2.1 2.4 States/Regions Kachin 2.4 3.0 Kayah 3.1 3.3 Kayin 3.4 3.9 Chin 3.8 4.6 Sagaing 1.9 2.1 Tanintharyi 2.8 3.1 Bago 1.5 1.9 Magway 1.6 1.8 Mandalay 1.8 2.0 Mon 2.2 2.3 Rakhine 2.1 2.7 Yangon 1.5 1.8 Shan 2.5 3.0 Ayeyarwady 2.1 2.3 Nay Pyi Taw 1.8 2.0 Education No education 2.9 3.6 Primary 2.2 2.6 Secondary 1.8 2.0 More than secondary 1.4 1.5 Wealth quintile Lowest 2.9 3.5 Second 2.2 2.5 Middle 1.9 2.1 Fourth 1.7 1.9 Highest 1.4 1.6 Total 2.0 2.3 Note: Rates are calculated based on births to women age 15- 49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2. Family Planning • 89 FAMILY PLANNING 7 Key Findings  Contraceptive use: Overall, 52% of currently married women use a method of family planning, with 51%using a modern method and 1% using a traditional method. Among modern methods, injectables are most commonly used (28%), followed by the pill (14%), female sterilization (5%), and the IUD (3%).  Sources of modern methods: Over half of modern contraceptive users (54%) receive their method from public sector sources—government hospitals, health centers, and clinics.  Contraceptive discontinuation: Two out of every five times (39%) that women began to use a contraceptive method in the 5 years before the survey discontinued the method within 12 months. The most common reason for discontinuing a method is the desire to become pregnant (34%) followed by method-related health concerns or side effects (28%).  Unmet need for family planning: Sixteen percent of currently married women have an unmet need for family planning: they want to space or limit births but are not currently using contraception.  Demand for family planning: Three-quarters of the total demand for family planning is satisfied by modern methods (75%). ouples can use contraceptive methods to limit or space the number of children they have. This chapter presents information on the uses and sources of contraceptive methods, informed choice of methods, and rates and reasons for discontinuing contraceptives. It also examines the potential demand for family planning and how much contact nonusers have with family planning providers. The benefits of family planning are not limited to promoting maternal or child health. Family planning can significantly enhance opportunities to attain higher socioeconomic status, education, employment, and empowerment, especially for girls and women. Myanmar committed in 2013 to the Family Planning 2020 (FP2020) global initiative. The goal is to reach more women with lifesaving family planning information and access to contraceptives by the year 2020 (Family Planning 2020, 2013). 7.1 CONTRACEPTIVE KNOWLEDGE AND USE Knowledge of contraceptive methods is almost universal in Myanmar, with 97% of all women and 95% of all men knowing at least one method of contraception. On average, women have heard of seven methods and men have heard of six methods, with most having heard about modern methods (Table 7.1). The most commonly known method among women is injectables (95%), followed by the pill (93%), and female sterilization (84%), while among men, it is the male condom (86%), followed by injectables (85%), and C 90 • Family Planning the pill (84%). Knowledge about emergency contraception is relatively poor, with only one in four women and men having heard about it. For more information on contraceptive knowledge by method, see Table 7.1. For information about differentials in knowledge of any method and any modern method by background characteristics, see Table 7.2. Contraceptive prevalence rate Percentage who use any contraceptive method Sample: Currently married women age 15-49 The contraceptive prevalence rate among currently married women age 15-49 is 52%, with almost all women using modern methods (51%) (Table 7.3). This indicates that Myanmar is on track for meeting its commitment to Family Planning 2020, a global partnership for women on reproductive rights. In 2013 Myanmar announced it would increase modern contraceptive use from 41 percent to 50 percent by 2015 and to more than 60 percent by 2020 (Family Planning 2020, 2013). Modern methods Include male and female sterilization, injectables, intrauterine devices (IUDs), contraceptive pills, implants, male condoms, and the lactational amenorrhea method (LAM) Among married women, injectables are the most commonly used method (28%), followed by the pill (14%), female sterilization (5%), and the IUD (3%) (Figure 7.1). Modern contraceptive use peaks at 62% among currently married women age 35-39 (Table 7.3). More than half of currently married adolescents (women age 15-19) (53%) use modern contraceptive methods. Patterns by background characteristics  Modern contraceptive use is highest among married women with 1-2 living children (58%) and generally declines as the number of living children goes up. (Table 7.4).  Women in urban areas are somewhat more likely to use modern contraceptives than those in rural areas (57% versus 49%). Figure 7.1 Contraceptive use 52 51 28 14 5 3 1 1 1 Any method Any modern method Injectables Pill Female sterilization IUD Implants Male condom Traditional method Percentage of currently married women age 15-49 currently using a contraceptive method Family Planning • 91  Contraceptive use increases substantially with education. Married women with secondary education or higher are more likely to use modern methods of contraception than those with no education (57-58% versus 38%) (Figure 7.2).  There are big differences in contraceptive use among currently married women across states and regions. The use of modern contraception ranges from a low of 25% in Chin State to a high of 60% in Bago Region and Yangon Region (Figure 7.3). Figure 7.3 Use of modern methods by states and regions 7.2 TIMING OF FEMALE STERILIZATION Given the importance of female sterilization as a means of preventing unwanted pregnancies among women in high risk groups, the family planning program targets timely intervention. As indicated earlier in Figure 7.1, 5% of currently married women in Myanmar are sterilized. Table 7.5 shows information about age at female sterilization. The median age at sterilization for women is 33.1 years. Figure 7.2 Use of modern methods by education 38 51 58 57 No education Primary Secondary More than secondary Percentage of currently married women age 15-49 92 • Family Planning 7.3 SOURCE OF MODERN CONTRACEPTIVE METHODS Source of modern contraceptives Place where the modern method currently being used was obtained the last time it was acquired Sample: Women age 15-49 currently using a modern contraceptive method (excluding LAM) More than half of modern contraceptive users receive their method from public (government) sector sources—hospitals, rural health centers (RHCs), sub- centers, and mobile clinics (54%). Three in ten women obtain their methods from sources in the private medical sector (29%) (Table 7.6 and Figure 7.4). Injectables: Around three-quarters of women obtain injectables from the public sector, mainly from government sub-centers and government rural health centers (RHCs) (37% and 14%). IUD and implant: While the predominant source for IUDs is the public sector (44%), implants are most commonly provided by the non-governmental sector, that is, Marie Stopes International (45%). Pills and male condoms: The private medical sector is the main source for nearly half of pill users (47%) and male condom users (47%). 7.4 SOCIAL MARKETING BRANDS In Myanmar, social marketing of contraceptives is being carried out by Population Services International and Marie Stopes International. Both organizations aim to respond to the needs, wants, and interests of the target population. They introduce contraceptives with brand names such as OK and Sure. Table 7.7 highlights the finding that 40% of women use pills that are promoted through social marketing, while 84% of women who use male condoms use the Ahphaw brand (data not shown)1. Urban women, those with secondary or higher education, and those in the high wealth quintiles are most likely to use brands of pills promoted through social marketing. 7.5 INFORMED CHOICE Informed choice Informed choice consists of women being informed at the time they started the current episode of method use about side effects of the method, what to do if they experience side effects, and other methods they could use. Sample: Women age 15-49 who are currently using selected modern contraceptive methods and who started the most recent episode of use within the 5 years before the survey 1 As very few women (1%) reported using the male condom, and disaggregated data are not presented. Figure 7.4 Source of modern contraceptive methods Public sector, 54% Private medical sector, 29% Non- government sector, 2% Other source, 12% Percent distribution of current users of modern methods by most recent source of method Family Planning • 93 Two in five women using a modern method of contraception were informed about the side effects or other problems they could face with the method they are using (40%), and 31% were informed about what to do if they experienced side effects. About half of the women were informed of other methods they could use. Implant users were most likely to be informed about side effects or problems of the method (81%), about what to do if they experienced side effects (70%), and about other methods that could be used (78%) (Table 7.8). 7.6 DISCONTINUATION OF CONTRACEPTIVES Contraceptive discontinuation rate Percentage of contraceptive initiation episodes discontinued within 12 months Sample: Episodes of contraceptive use initiated in the 5 years before the survey for women who are currently age 15-49 Two out of every five times (39%) that women began to use a contraceptive method in the 5 years before the survey, they discontinued the method within 12 months. Discontinuation rates are high for pill (43%) and injectable (42%) use, the two most commonly used methods (Table 7.9). Overall, the most common reason for discontinuing a method is the desire to become pregnant (34%), followed by method-related health concerns or side effects (28%), wanting more effective methods (10%), and failure of the method and infrequent sex (8% each) (Table 7.10). Women are far more likely to cite health concerns and side effects as a reason for discontinuing IUDs (37%) and injectables (35%) than other methods. Knowledge of the Fertile Period The survey also collected data on women and men’s knowledge of the fertile period. Only 5% of women and men age 15-49 know that a woman is most likely to conceive halfway between two periods (Table 7.11). Seventeen percent of men mentioned that the fertile period was during a woman’s menstrual period. Overall, nearly half of women and men are not aware of the fertile period. 7.7 DEMAND FOR FAMILY PLANNING Unmet need for family planning Proportion of women who (1) are not pregnant and not postpartum amenorrheic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrheic and their last birth in the last 2 years was mistimed or unwanted. Sample: All women age 15-49 and currently married women age 15-49 Demand for family planning: Unmet need for family planning + current contraceptive use (any method) Proportion of demand satisfied: Current contraceptive use (any method) Unmet need + current contraceptive use (any method) Proportion of demand satisfied by modern methods: Current contraceptive use (any modern method) Unmet need + current contraceptive use (any method) 94 • Family Planning Overall, 16% of married women in Myanmar have an unmet need for family planning, 5% for spacing births and 11% for limiting births, but are not currently using contraception (Figure 7.5). Fifty-two percent of married women have a met need, that is, they are currently using contraception. Thus, the total demand for family planning constitutes 69% of married women, of which three-quarters is satisfied by the use of modern methods (Table 7.12.1). All women are less likely than married women to be in need of family planning; only 10% of all women have an unmet need for family planning, compared with 16% for married women (Table 7.12.2). Patterns by background characteristics  The proportion of married women with an unmet need for spacing births is highest at age 15-19 (14%), while unmet need for limiting births is highest at age group 40-49 (21%) (Table 7.12.1).  Unmet need for family planning varies widely by states and regions, ranging from a high of 23% in Rakhine State and Chin State to a low of 12% in Yangon Region and Nay Pyi Taw (Figure 7.6).  Unmet need for family planning is three times higher among married women with no education (24%) than among those with more than secondary education (8%). Future Use of Contraception The survey also collected information about non- users’ intent to use contraception. More than half of currently married women who are not using a contraceptive method said that they did not intend to use one in the future (57%), with an even higher proportion among those who have four or more living children (71%). Women with one living child are most likely to intend to use contraception in the future (Table 7.13). Exposure to Family Planning Messages in the Media Table 7.14.1 offers information on women’s exposure to family planning messages in the media. Fifteen percent of women age 15-49 reported hearing a family planning message in the past few months on radio. Similarly, 25% of women heard a message on television, while 18% read a family planning message in a newspaper or magazine. Overall, 65% of women have no exposure to family planning messages in any of these three main mass media (radio, television, and newspaper/magazine). Figure 7.5 Demand for family planning Figure 7.6 Unmet need for family planning by states and regions Unmet need for spacing 5% Unmet need for limiting 11% Met need for spacing 18% Met need for limiting 35% No need for family planning 31% Percent distribution of currently married women age 15-49 by need for family planning Family Planning • 95 There are other sources that play important roles in Myanmar for providing knowledge on family planning, of which, the Internet (30%) and billboards (10%) are prominent. Fifty-five percent of women are not exposed to family planning messages from any of these five sources (including media). Table 7.14.2 offers similar information on men’s exposure to family planning messages. Fourteen percent of men age 15-49 reported hearing a family planning message in the past few months on radio, while a quarter of men reported seeing a message on television or in a newspaper or magazine (25% each). Overall, men are more exposed to family planning messages than women. 7.8 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Contact of nonusers with family planning providers Respondent discussed family planning in the 12 months before the survey with auxiliary mid-wives (AMWs), community health workers (CHWs), and a community-based support group (CSG) members or during a visit to a health facility. Sample: Women age 15-49 who are not currently using any contraceptive methods In the survey, women were asked if they had discussed family planning with any of a variety of health workers. The vast majority of women who were not using a contraceptive method said they had discussed family planning with neither any auxiliary midwife, community health worker, community-based support group nor at a health facility in the 12 months before the survey (92%) (Table 7.15). Among non-users, only 6% reported discussing family planning either with an auxiliary midwife, a community health worker, or a community-based support group, while only 3% discussed family planning at a health facility. LIST OF TABLES For more information on family planning, see the following tables:  Table 7.1 Knowledge of contraceptive methods  Table 7.2 Knowledge of contraceptive methods by background characteristics  Table 7.3 Current use of contraception by age  Table 7.4 Current use of contraception by background characteristics  Table 7.5 Timing of sterilization  Table 7.6 Source of modern contraception methods  Table 7.7 Use of social marketing brand pills  Table 7.8 Informed choice  Table 7.9 Twelve-month contraceptive discontinuation rates  Table 7.10 Reasons for discontinuation  Table 7.11 Knowledge of fertile period  Table 7.12.1 Need and demand for family planning among currently married women  Table 7.12.2 Need and demand for family planning for all women  Table 7.13 Future use of contraception  Table 7.14.1 Exposure to family planning messages: Women  Table 7.14.2 Exposure to family planning messages: Men  Table 7.15 Contact of nonusers with family planning providers 96 • Family Planning Table 7.1 Knowledge of contraceptive methods Percentage of all respondents and currently married respondents age 15-49 who know any contraceptive method, by specific method, Myanmar DHS 2015-16 Women Men Method All women Currently married women All men Currently married men Any method 96.7 98.5 94.9 96.9 Any modern method 96.6 98.4 94.7 96.6 Female sterilization 84.4 88.8 72.9 80.0 Male sterilization 50.7 60.2 41.5 51.1 Pill 93.0 96.1 83.6 88.7 IUD 70.5 80.1 46.3 56.0 Injectables 94.6 97.7 85.4 91.6 Implants 61.1 70.3 31.0 36.6 Male condom 73.0 76.8 85.5 86.8 Female condom 28.4 31.0 30.4 33.1 Lactational amenorrhea method (LAM) 36.5 43.9 20.1 22.9 Emergency contraception 25.4 28.7 25.7 27.0 Other modern method 1.3 1.8 2.1 2.5 Any traditional method 46.7 58.8 66.3 75.0 Rhythm 39.7 50.3 49.5 60.0 Withdrawal 33.9 45.0 57.6 64.7 Other 0.0 0.0 0.1 0.1 Mean number of methods known by respondents 15-49 6.9 7.7 6.3 7.0 Number of respondents 12,885 7,759 4,737 2,957 Family Planning • 97 Table 7.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men age 15-49 who have heard of at least one contraceptive method and who have heard of at least one modern method by background characteristics, Myanmar DHS 2015-16 Women Men Background characteristic Heard of any method Heard of any modern method1 Number Heard of any method Heard of any modern method1 Number Residence Urban 99.8 99.7 2,022 99.0 99.0 767 Rural 98.0 98.0 5,737 96.2 95.7 2,190 States/Regions Kachin 99.3 99.3 238 97.7 97.7 93 Kayah 99.8 99.8 40 98.3 98.3 15 Kayin 98.0 98.0 201 96.6 96.6 70 Chin 87.5 86.7 66 96.1 95.0 24 Sagaing 98.6 98.6 828 97.4 97.0 308 Tanintharyi 99.8 99.8 174 98.8 98.8 57 Bago 99.9 99.9 780 99.7 99.7 309 Magway 99.6 99.4 642 96.1 96.1 215 Mandalay 99.6 99.6 838 98.3 97.4 358 Mon 99.6 99.6 278 95.8 95.1 82 Rakhine 93.7 93.7 454 94.5 94.5 139 Yangon 100.0 100.0 1,042 99.6 99.6 413 Shan 94.0 93.8 901 88.9 87.8 371 Ayeyarwady 100.0 100.0 1,083 99.1 99.1 419 Nay Pyi Taw 99.2 99.2 195 96.3 95.8 81 Education2 No education 92.9 92.8 1,193 87.5 85.4 430 Primary 99.2 99.1 3,656 97.9 97.8 1,260 Secondary 99.9 99.8 2,285 99.0 99.0 1,085 More than secondary 100.0 100.0 621 100.0 100.0 181 Wealth quintile Lowest 96.6 96.5 1,622 94.2 93.8 627 Second 98.1 98.0 1,586 96.0 95.6 605 Middle 98.8 98.8 1,556 97.9 97.3 603 Fourth 99.5 99.5 1,509 97.9 97.6 590 Highest 99.7 99.5 1,487 99.1 99.1 531 Total 98.5 98.4 7,759 96.9 96.6 2,957 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, lactational amenorrhea method (LAM), emergency contraception, and other modern methods 2 Total includes three women with information missing on education 98 • F am ily P la nn in g Ta bl e 7. 3 C ur re n t us e o f c o nt ra ce pt io n b y ag e P er ce nt d is tri bu tio n of a ll w om en a nd c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to a ge , M ya nm ar D H S 2 01 5- 16 M od er n m et ho d A ny tra di tio na l m et ho d T ra di tio na l m et ho d N um be r of w om en A ge A ny m et ho d A ny m od er n m et ho d Fe m al e st er ili - za tio n M al e st er ili - za tio n P ill IU D In je ct - ab le s Im pl an ts M al e co nd om O th er 1 R hy th m W ith - dr aw al O th er N ot cu rr en tly us in g T ot al A LL W O M E N 15 -1 9 6. 8 6. 7 0. 0 0. 0 1. 8 0. 1 4. 8 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 93 .2 10 0. 0 1, 81 0 20 -2 4 26 .7 26 .7 0. 2 0. 0 9. 9 0. 5 15 .6 0. 3 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 73 .3 10 0. 0 1, 86 7 25 -2 9 39 .9 39 .3 0. 8 0. 0 11 .8 2. 0 23 .1 0. 8 0. 7 0. 0 0. 6 0. 2 0. 3 0. 1 60 .1 10 0. 0 1, 86 7 30 -3 4 42 .8 42 .3 2. 2 0. 0 11 .1 2. 6 24 .2 1. 1 1. 1 0. 0 0. 5 0. 2 0. 3 0. 0 57 .2 10 0. 0 2, 03 7 35 -3 9 48 .2 47 .2 4. 9 0. 1 11 .6 3. 2 25 .1 1. 1 1. 0 0. 2 1. 0 0. 3 0. 7 0. 0 51 .8 10 0. 0 1, 95 4 40 -4 4 35 .6 34 .7 7. 3 0. 4 7. 7 2. 2 16 .1 0. 4 0. 7 0. 0 1. 0 0. 4 0. 6 0. 0 64 .4 10 0. 0 1, 73 3 45 -4 9 17 .3 16 .3 5. 8 0. 7 3. 1 1. 3 4. 6 0. 0 0. 7 0. 0 1. 0 0. 3 0. 4 0. 2 82 .7 10 0. 0 1, 61 7 T ot al 31 .6 31 .1 2. 9 0. 2 8. 3 1. 7 16 .7 0. 6 0. 6 0. 0 0. 6 0. 2 0. 3 0. 0 68 .4 10 0. 0 12 ,8 85 C U R R E N T LY M A R R IE D W O M E N 15 -1 9 54 .0 53 .2 0. 0 0. 0 14 .2 0. 5 38 .5 0. 0 0. 0 0. 0 0. 8 0. 0 0. 8 0. 0 46 .0 10 0. 0 22 7 20 -2 4 59 .5 59 .3 0. 4 0. 0 22 .0 1. 0 34 .7 0. 8 0. 3 0. 1 0. 1 0. 0 0. 1 0. 0 40 .5 10 0. 0 83 4 25 -2 9 58 .7 57 .9 1. 2 0. 0 17 .4 3. 0 34 .1 1. 1 0. 9 0. 0 0. 8 0. 3 0. 4 0. 1 41 .3 10 0. 0 1, 25 8 30 -3 4 57 .8 57 .1 2. 9 0. 0 15 .0 3. 5 32 .8 1. 5 1. 4 0. 0 0. 7 0. 2 0. 4 0. 0 42 .2 10 0. 0 1, 50 5 35 -3 9 63 .1 61 .8 6. 2 0. 1 15 .3 4. 2 33 .0 1. 3 1. 4 0. 2 1. 3 0. 4 0. 9 0. 0 36 .9 10 0. 0 1, 48 2 40 -4 4 47 .9 46 .6 9. 7 0. 5 10 .5 2. 8 21 .8 0. 5 0. 9 0. 0 1. 3 0. 5 0. 8 0. 0 52 .1 10 0. 0 1, 28 3 45 -4 9 23 .7 22 .3 7. 9 1. 0 4. 3 1. 8 6. 4 0. 0 1. 0 0. 0 1. 3 0. 4 0. 6 0. 3 76 .3 10 0. 0 1, 16 9 T ot al 52 .2 51 .3 4. 8 0. 3 13 .8 2. 8 27 .6 0. 9 1. 0 0. 0 1. 0 0. 3 0. 6 0. 1 47 .8 10 0. 0 7, 75 9 N ot e: If m or e th an o ne m et ho d is u se d, o nl y th e m os t e ffe ct iv e m et ho d is c on si de re d in th is ta bu la tio n. 1 I nc lu de s la ct at io na l a m en or rh ea m et ho d (L A M ) Fa m ily P la nn in g • 9 9 Ta bl e 7. 4 C ur re n t us e o f c o nt ra ce pt io n b y b ac kg ro u n d ch ar ac te ri st ic s P er ce nt d is tri bu tio n of c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, M ya nm ar D H S 2 01 5- 16 A ny m et ho d A ny m od er n m et ho d M od er n m et ho d A ny tra di tio na l m et ho d T ra di tio na l m et ho d N ot cu rr en tly us in g N um be r of w om en B ac kg ro un d ch ar ac te ris tic Fe m al e st er ili - za tio n M al e st er ili - za tio n P ill IU D In je ct - ab le s Im pl an ts M al e co nd om O th er 1 R hy th m W ith - dr aw al O th er T ot al N um b er o f l iv in g ch ild re n 0 31 .3 29 .9 0. 1 0. 1 14 .1 0. 4 14 .8 0. 1 0. 2 0. 1 1. 4 0. 5 0. 7 0. 2 68 .7 10 0. 0 91 6 1- 2 59 .0 58 .1 3. 3 0. 1 16 .9 3. 4 31 .9 1. 2 1. 3 0. 0 0. 9 0. 4 0. 5 0. 0 41 .0 10 0. 0 4, 06 1 3- 4 54 .9 53 .9 9. 7 0. 5 10 .6 3. 2 28 .1 0. 8 1. 0 0. 1 1. 0 0. 1 0. 7 0. 2 45 .1 10 0. 0 2, 09 8 5+ 31 .8 31 .2 4. 8 0. 3 5. 2 1. 9 18 .0 0. 3 0. 3 0. 3 0. 6 0. 2 0. 4 0. 0 68 .2 10 0. 0 68 4 R es id en ce U rb an 59 .6 57 .3 9. 6 0. 4 18 .1 4. 3 21 .4 1. 3 2. 1 0. 1 2. 3 0. 8 1. 3 0. 1 40 .4 10 0. 0 2, 02 2 R ur al 49 .6 49 .1 3. 1 0. 2 12 .3 2. 3 29 .8 0. 7 0. 6 0. 0 0. 5 0. 1 0. 3 0. 1 50 .4 10 0. 0 5, 73 7 S ta te s/ R eg io ns K ac hi n 43 .5 41 .6 4. 0 0. 3 15 .0 0. 9 17 .1 0. 9 3. 0 0. 4 1. 9 0. 9 1. 0 0. 0 56 .5 10 0. 0 23 8 K ay ah 54 .5 50 .6 10 .2 2. 1 10 .2 4. 0 22 .1 0. 7 1. 1 0. 2 3. 9 1. 7 2. 2 0. 0 45 .5 10 0. 0 40 K ay in 40 .5 39 .5 6. 9 0. 1 14 .7 1. 8 13 .9 0. 8 1. 3 0. 0 1. 0 0. 4 0. 6 0. 0 59 .5 10 0. 0 20 1 C hi n 25 .4 25 .2 5. 1 0. 0 5. 7 4. 0 4. 8 5. 6 0. 0 0. 0 0. 2 0. 2 0. 0 0. 0 74 .6 10 0. 0 66 S ag ai ng 51 .2 51 .1 6. 4 0. 2 9. 4 2. 2 31 .4 1. 0 0. 5 0. 0 0. 1 0. 0 0. 1 0. 0 48 .8 10 0. 0 82 8 T an in th ar yi 44 .0 43 .3 9. 3 1. 1 10 .9 0. 2 20 .8 0. 9 0. 0 0. 0 0. 7 0. 0 0. 7 0. 0 56 .0 10 0. 0 17 4 B ag o 60 .7 60 .1 3. 5 0. 6 15 .8 2. 2 36 .7 1. 0 0. 4 0. 0 0. 5 0. 0 0. 4 0. 2 39 .3 10 0. 0 78 0 M ag w ay 47 .3 45 .4 2. 6 0. 2 8. 9 4. 2 26 .2 1. 6 1. 5 0. 1 1. 9 0. 5 1. 4 0. 0 52 .7 10 0. 0 64 2 M an da la y 55 .7 55 .3 4. 7 0. 5 11 .8 4. 0 32 .1 1. 0 1. 1 0. 2 0. 4 0. 2 0. 2 0. 0 44 .3 10 0. 0 83 8 M on 45 .0 44 .6 5. 8 0. 0 14 .3 1. 3 21 .8 1. 1 0. 5 0. 0 0. 4 0. 0 0. 4 0. 0 55 .0 10 0. 0 27 8 R ak hi ne 37 .1 36 .9 0. 8 0. 0 13 .2 0. 0 22 .9 0. 0 0. 0 0. 0 0. 2 0. 2 0. 0 0. 0 62 .9 10 0. 0 45 4 Y an go n 62 .7 60 .2 7. 4 0. 0 21 .3 3. 1 26 .0 1. 1 1. 2 0. 0 2. 5 1. 1 1. 2 0. 2 37 .3 10 0. 0 1, 04 2 S ha n 47 .0 46 .1 6. 5 0. 0 9. 5 4. 9 22 .2 0. 4 2. 5 0. 2 0. 9 0. 0 0. 6 0. 2 53 .0 10 0. 0 90 1 A ye ya rw ad y 55 .6 55 .4 2. 6 0. 3 17 .9 2. 7 31 .0 0. 6 0. 3 0. 0 0. 2 0. 0 0. 2 0. 0 44 .4 10 0. 0 1, 08 3 N ay P yi T aw 58 .6 54 .7 2. 0 0. 6 11 .0 1. 8 37 .7 0. 2 1. 4 0. 0 3. 9 1. 8 1. 9 0. 2 41 .4 10 0. 0 19 5 E du ca ti o n2 N o ed uc at io n 38 .2 37 .5 2. 8 0. 4 9. 1 2. 1 22 .1 0. 4 0. 5 0. 2 0. 7 0. 1 0. 4 0. 2 61 .8 10 0. 0 1, 19 3 P rim ar y 51 .1 50 .6 3. 6 0. 3 13 .0 2. 7 29 .8 0. 7 0. 4 0. 0 0. 5 0. 1 0. 4 0. 0 48 .9 10 0. 0 3, 65 6 S ec on da ry 59 .0 58 .0 6. 1 0. 1 17 .1 3. 0 29 .2 1. 0 1. 4 0. 1 1. 0 0. 2 0. 7 0. 1 41 .0 10 0. 0 2, 28 5 M or e th an se co nd ar y 61 .3 57 .2 10 .6 0. 4 15 .9 4. 2 19 .3 3. 0 3. 8 0. 0 4. 1 2. 3 1. 5 0. 3 38 .7 10 0. 0 62 1 W ea lt h q ui nt ile Lo w es t 46 .8 46 .3 1. 2 0. 1 11 .6 2. 0 30 .5 0. 7 0. 0 0. 1 0. 6 0. 2 0. 3 0. 1 53 .2 10 0. 0 1, 62 2 S ec on d 50 .5 50 .2 2. 8 0. 0 13 .2 2. 1 31 .5 0. 4 0. 1 0. 1 0. 3 0. 0 0. 2 0. 0 49 .5 10 0. 0 1, 58 6 M id dl e 50 .2 49 .8 3. 7 0. 3 12 .2 2. 9 29 .2 0. 8 0. 8 0. 0 0. 5 0. 1 0. 4 0. 0 49 .8 10 0. 0 1, 55 6 Fo ur th 55 .7 54 .7 5. 0 0. 4 15 .7 2. 1 29 .4 0. 9 1. 1 0. 1 1. 0 0. 2 0. 8 0. 0 44 .3 10 0. 0 1, 50 9 H ig he st 58 .6 55 .9 11 .9 0. 4 16 .6 5. 2 16 .8 1. 7 3. 2 0. 0 2. 7 1. 1 1. 3 0. 2 41 .4 10 0. 0 1, 48 7 T ot al 52 .2 51 .3 4. 8 0. 3 13 .8 2. 8 27 .6 0. 9 1. 0 0. 0 1. 0 0. 3 0. 6 0. 1 47 .8 10 0. 0 7, 75 9 N ot e: If m or e th an o ne m et ho d is u se d, o nl y th e m os t e ffe ct iv e m et ho d is c on si de re d in th is ta bu la tio n. 1 In cl ud es la ct at io na l a m en or rh ea m et ho d (L A M ) 2 T ot al in cl ud es th re e w om en w ith m is si ng in fo rm at io n on e du ca tio n 100 • Family Planning Table 7.5 Timing of sterilization Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Myanmar DHS 2015-16 Years since operation Age at time of sterilization Number of women Median age1 <25 25-29 30-34 35-39 40-44 45-49 Total <2 2.6 10.4 29.9 41.1 16.1 0.0 100.0 64 34.9 2-3 5.0 12.2 42.8 27.1 12.7 0.2 100.0 69 33.2 4-5 6.3 18.4 24.6 42.6 8.1 0.0 100.0 51 33.9 6-7 3.6 7.1 48.1 38.0 3.2 0.0 100.0 49 34.5 8-9 (8.1) (29.3) (26.5) (34.9) (1.3) (0.0) 100.0 41 (32.7) 10+ 10.2 28.7 45.4 15.7 0.0 0.0 100.0 107 a Total 6.4 18.5 37.9 30.5 6.6 0.0 100.0 380 33.1 Note: Figures in parentheses are based on 25-49 unweighted cases. a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring. Table 7.6 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Myanmar DHS 2015-16 Source Female sterilization Pill IUD Injectables Implants Male condom Total Public sector 76.0 13.8 44.1 73.9 32.4 9.8 54.2 Government hospital 75.2 2.2 21.6 9.8 16.7 3.7 14.8 Government rural health center (RHC) 0.8 2.9 4.1 14.3 10.3 1.1 9.1 Government health post (sub-center) 0.0 7.2 12.0 37.1 2.8 5.0 22.7 Community health worker/auxiliary midwives 0.0 1.1 0.6 9.9 0.0 0.0 5.6 Mobile clinic 0.0 0.1 1.1 0.2 2.5 0.0 0.3 UHC/MCH center 0.0 0.3 4.8 2.6 0.0 0.0 1.8 Nongovernmental sector 0.0 0.2 22.8 0.8 47.2 7.0 2.8 Marie Stopes 0.0 0.1 19.3 0.4 45.0 0.0 2.1 Other 0.0 0.1 3.4 0.4 2.2 7.0 0.6 Private medical sector 23.4 47.3 33.1 19.8 20.5 46.7 28.9 Private hospital/clinic 23.2 2.8 30.6 16.2 17.8 7.3 14.0 Pharmacy 0.0 43.9 0.0 1.5 0.0 37.3 13.3 Private doctor 0.3 0.3 1.7 1.1 0.0 2.0 0.8 Other 0.0 0.3 0.9 1.1 2.6 0.0 0.8 Other source 0.0 38.5 0.0 2.5 0.0 36.5 12.4 Shop 0.0 38.1 0.0 1.6 0.0 36.0 11.8 Friend/relative 0.0 0.4 0.0 0.9 0.0 0.5 0.6 Other 0.1 0.1 0.0 2.9 0.0 0.0 1.6 Don't know 0.4 0.0 0.0 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 380 1,074 222 2,148 73 81 3,996 Note: Total includes 20 women whose husbands are sterilized and are not shown separately due to few cases but excludes women using the lactational amenorrhea method (LAM). RHC = Rural Health Center; UHC= Urban Health Center; MCH = Maternal and Child Health Family Planning • 101 Table 7.7 Use of social marketing brand pills Percentage of pill users age 15-49 using a social marketing brand, according to background characteristics, Myanmar DHS 2015-16 Among pill users Background characteristic Percentage using brand OK Pills and brand Sure Number of women using the pill Age 15-19 (34.0) 32 20-24 46.5 185 25-29 43.6 220 30-34 37.4 225 35-39 38.4 227 40-44 28.7 134 45-49 (41.7) 51 Residence Urban 49.3 366 Rural 34.4 708 States/Regions Kachin 60.5 36 Kayah (23.9) 4 Kayin 30.1 29 Chin (10.8) 4 Sagaing 41.7 78 Tanintharyi (30.5) 19 Bago 41.5 123 Magway 32.7 57 Mandalay 42.3 99 Mon 34.0 40 Rakhine 25.4 61 Yangon 50.4 222 Shan (51.7) 86 Ayeyarwady 23.8 194 Nay Pyi Taw 47.7 21 Education No education 26.7 108 Primary 30.8 476 Secondary 51.4 390 More than secondary 47.9 99 Wealth quintile Lowest 22.0 189 Second 29.5 210 Middle 39.7 190 Fourth 48.4 237 Highest 52.4 247 Total 39.5 1,074 Note: Table excludes pill users who do not know the brand name. Figures in parentheses are based on 25-49 unweighted cases. 102 • Family Planning Table 7.8 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the 5 years preceding the survey, the percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method and initial source, Myanmar DHS 2015-16 Among women who started their last episode of modern contraceptive method use within 5 years preceding the survey: Method/source Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Method Female sterilization 56.3 44.3 55.7 160 Pill 26.7 17.3 42.1 856 IUD 75.3 64.3 75.8 153 Injectables 40.2 31.6 49.2 1,748 Implants 81.4 70.3 78.1 71 Initial source of method1 Public sector 45.6 37.4 53.5 1,642 Government hospital 52.8 43.2 57.9 401 Government rural health center (RHC) 41.6 36.6 51.1 281 Government health post (sub-center) 46.0 37.9 54.9 739 Village health worker 27.7 20.4 37.0 152 Mobile clinic * * * 9 UHC/MCH center (55.8) (41.8) (60.8) 58 Nongovernmental sector 87.5 82.0 84.1 82 Marie Stopes 87.5 82.0 84.1 82 Private medical sector 35.6 23.6 49.1 799 Private hospital/clinic 48.6 32.8 58.3 401 Pharmacy 22.0 13.9 39.1 366 Private doctor * * * 22 Other * * * 11 Other source 17.1 8.3 30.5 393 Shop 14.7 7.6 27.7 298 Friend/relative 24.5 10.4 39.6 94 Other 27.3 23.6 26.3 62 Total 40.0 30.8 49.6 2,989 Note: Table includes users of only the methods listed individually. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Source at start of current episode of use; total includes sources with too few users to show separately and one case missing on source of method. RHC = Rural Health Center; UHC= Urban Health Center; MCH = Maternal and Child Health Family Planning • 103 Table 7.9 Twelve-month contraceptive discontinuation rates Among women age 15-49 who started an episode of contraceptive use within the 5 years preceding the survey, the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Myanmar DHS 2015-16 Method Method failure Desire to become pregnant Other fertility- related reasons2 Side effects/ health concerns Wanted more effective method Other method- related reasons3 Other reasons Any reason4 Switched to another method5 Number of episodes of use6 Pill 5.4 14.3 7.3 7.9 5.6 2.3 0.3 43.0 10.4 2,015 IUD (1.0) (0.0) (0.9) (3.3) (0.0) (1.1) (0.8) (7.1) (4.4) 203 Injectables 1.0 9.7 4.2 16.2 4.7 2.7 3.0 41.5 11.6 3,674 Other1 1.1 2.8 1.6 2.4 4.6 1.9 0.6 15.0 9.1 452 All methods 2.4 10.4 4.9 12.1 4.8 2.5 1.9 39.1 10.8 6,344 Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the survey. Figures in parentheses are based on 125-249 women exposed to method use. 1 Includes female sterilization, implants, rhythm, and withdrawal 2 Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation 3 Includes lack of access/too far, costs too much, and inconvenient to use 4 Reasons for discontinuation are mutually exclusive and add to the total given in this column. 5 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A woman is considered to have switched to another method if she used a different method in the month following discontinuation or if she gave "wanted a more effective method" as the reason for discontinuation and started another method within 2 months of discontinuation. 6 All episodes of use that occur within the 5 years preceding the survey are included. Episodes of use include episodes that were discontinued during the period of observation and episodes of use that were not discontinued during the period of observation. Table 7.10 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the 5 years preceding the survey by main reason stated for discontinuation, according to specific method, Myanmar 2015-16 Reason Pill IUD Injectables Male condom Other1 All methods Became pregnant while using 14.0 6.8 4.2 9.6 17.8 8.1 Wanted to become pregnant 39.8 32.6 30.5 25.9 26.1 33.7 Husband disapproved 0.1 1.7 0.1 4.6 0.9 0.2 Wanted a more effective method 10.4 9.2 10.0 15.2 19.7 10.4 Health concerns/side effects 17.1 37.4 35.4 7.1 15.3 28.2 Lack of access/too far 0.9 0.0 1.3 0.1 0.0 1.1 Cost too much 0.3 0.0 0.2 0.0 0.0 0.2 Inconvenient to use 2.9 6.0 3.4 13.7 4.1 3.4 Up to God/fatalistic 0.1 0.0 0.1 0.0 0.0 0.1 Difficult to get pregnant/menopausal 1.5 0.1 1.8 1.2 0.7 1.7 Infrequent sex/husband away 10.6 2.9 5.8 17.1 9.4 7.7 Marital dissolution/separation 1.1 1.4 2.0 0.0 0.4 1.6 Other 0.9 1.9 4.9 5.5 5.6 3.4 Don't know 0.0 0.0 0.1 0.0 0.0 0.1 Missing 0.1 0.1 0.2 0.0 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 1,720 109 2,874 66 96 4,865 1 Implants, rhythm, and withdrawal are included in the discontinuation rate for other methods. 104 • Family Planning Table 7.11 Knowledge of fertile period Percent distribution of women age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of the rhythm method, Myanmar DHS 2015-16 Perceived fertile period All women All men Just before her menstrual period begins 3.1 2.9 During her menstrual period 7.9 16.9 Right after her menstrual period has ended 14.1 12.2 Halfway between two menstrual periods 5.1 4.6 Other 0.1 0.2 No specific time 23.6 15.5 Don't know 46.1 47.8 Total 100.0 100.0 Number 12,885 4,737 Family Planning • 105 Table 7.12.1 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, the percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Myanmar DHS 2015-16 Background characteristic Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percent- age of demand satisfied2 Percent- age of demand satisfied by modern methods3 Number of women For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Age 15-19 14.0 4.9 18.9 42.9 11.1 54.0 56.9 16.0 72.9 74.1 73.0 227 20-24 9.8 3.7 13.5 41.1 18.4 59.5 50.9 22.1 73.0 81.5 81.3 834 25-29 8.0 5.5 13.6 34.5 24.1 58.7 42.5 29.7 72.2 81.2 80.1 1,258 30-34 6.8 7.9 14.7 20.3 37.5 57.8 27.1 45.4 72.5 79.7 78.7 1,505 35-39 2.6 11.0 13.6 10.5 52.6 63.1 13.1 63.6 76.7 82.3 80.6 1,482 40-44 1.0 19.6 20.6 2.0 45.9 47.9 3.0 65.5 68.5 70.0 68.1 1,283 45-49 0.4 20.7 21.2 0.3 23.3 23.7 0.8 44.1 44.8 52.8 49.8 1,169 Residence Urban 3.2 9.6 12.8 18.1 41.6 59.6 21.3 51.1 72.4 82.3 79.2 2,022 Rural 5.3 12.1 17.4 17.4 32.2 49.6 22.8 44.3 67.1 74.0 73.2 5,737 States/Regions Kachin 4.6 13.3 17.9 15.3 28.2 43.5 19.9 41.5 61.4 70.9 67.8 238 Kayah 6.1 9.2 15.3 16.7 37.8 54.5 22.8 46.9 69.8 78.1 72.6 40 Kayin 8.4 13.1 21.5 13.8 26.7 40.5 22.2 39.8 62.0 65.3 63.7 201 Chin 9.5 13.8 23.3 8.2 17.2 25.4 17.7 31.0 48.7 52.2 51.7 66 Sagaing 5.5 9.8 15.3 17.2 34.0 51.2 22.7 43.8 66.5 77.0 76.7 828 Tanintharyi 7.8 12.7 20.5 18.5 25.5 44.0 26.3 38.2 64.5 68.2 67.1 174 Bago 1.6 12.1 13.7 19.7 41.0 60.7 21.3 53.0 74.4 81.6 80.9 780 Magway 8.3 14.0 22.3 15.3 32.0 47.3 23.6 46.0 69.6 68.0 65.3 642 Mandalay 3.5 9.4 12.9 23.5 32.2 55.7 27.0 41.6 68.6 81.2 80.7 838 Mon 5.0 12.3 17.2 13.7 31.3 45.0 18.6 43.6 62.2 72.3 71.7 278 Rakhine 9.0 14.0 23.0 17.6 19.5 37.1 26.6 33.5 60.1 61.7 61.4 454 Yangon 2.4 9.5 11.9 19.1 43.6 62.7 21.4 53.1 74.5 84.1 80.8 1,042 Shan 6.9 13.8 20.7 11.1 35.9 47.0 18.0 49.7 67.7 69.4 68.1 901 Ayeyarwady 3.1 10.5 13.6 19.0 36.6 55.6 22.1 47.1 69.2 80.3 80.1 1,083 Nay Pyi Taw 3.4 8.4 11.8 21.9 36.7 58.6 25.3 45.1 70.4 83.3 77.8 195 Education4 No education 5.9 18.1 24.0 9.4 28.8 38.2 15.2 47.0 62.2 61.4 60.4 1,193 Primary 4.2 12.3 16.5 15.5 35.6 51.1 19.7 47.9 67.6 75.6 74.8 3,656 Secondary 5.2 8.6 13.8 23.8 35.2 59.0 29.1 43.8 72.8 81.0 79.6 2,285 More than secondary 4.4 4.0 8.4 22.9 38.3 61.3 27.4 42.3 69.7 87.9 82.1 621 Wealth quintile Lowest 6.0 13.9 19.9 17.0 29.9 46.8 23.0 43.8 66.8 70.1 69.3 1,622 Second 4.9 11.7 16.5 17.4 33.1 50.5 22.3 44.8 67.0 75.3 74.9 1,586 Middle 5.1 11.1 16.2 17.7 32.5 50.2 22.8 43.7 66.4 75.6 74.9 1,556 Fourth 4.7 10.8 15.5 18.3 37.4 55.7 23.0 48.2 71.2 78.2 76.8 1,509 Highest 3.2 9.4 12.6 17.6 41.0 58.6 20.9 50.4 71.2 82.3 78.5 1,487 Total 4.8 11.4 16.2 17.6 34.7 52.2 22.4 46.1 68.5 76.3 74.9 7,759 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al. 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, and lactational amenorrhea method (LAM). 4 Total includes three women with missing information on education. 106 • Family Planning Table 7.12.2 Need and demand for family planning for all women Percentage of all women age 15-49 with unmet need for family planning, percentage with met need for family planning, total demand for family planning, and percentage of the demand for contraception that is satisfied, by background characteristics, Myanmar DHS 2015-16 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Number of women ALL WOMEN Age 15-19 1.8 0.6 2.4 5.4 1.4 6.8 7.1 2.0 9.2 73.9 72.8 1,810 20-24 4.4 1.7 6.1 18.4 8.3 26.7 22.8 10.0 32.8 81.4 81.2 1,867 25-29 5.5 3.7 9.2 23.5 16.4 39.9 28.9 20.2 49.1 81.2 80.1 1,867 30-34 5.0 6.0 11.0 15.0 27.7 42.8 20.0 33.7 53.8 79.5 78.6 2,037 35-39 2.0 8.3 10.3 7.9 40.3 48.2 9.9 48.6 58.5 82.4 80.7 1,954 40-44 0.8 14.5 15.4 1.5 34.2 35.6 2.3 48.7 51.0 69.9 68.0 1,733 45-49 0.3 15.0 15.3 0.3 17.0 17.3 0.6 32.0 32.6 53.0 50.1 1,617 Residence Urban 1.7 5.1 6.9 9.8 22.5 32.3 11.5 27.7 39.2 82.4 79.3 3,768 Rural 3.4 7.7 11.1 11.0 20.4 31.4 14.4 28.0 42.4 73.9 73.2 9,117 States/Regions Kachin 2.9 8.7 11.6 9.9 18.1 28.0 12.8 26.8 39.6 70.7 67.7 374 Kayah 3.8 5.7 9.4 10.3 23.6 34.0 14.1 29.3 43.4 78.2 72.7 65 Kayin 5.6 8.7 14.3 9.1 18.1 27.2 14.7 26.8 41.5 65.6 64.0 303 Chin 6.2 8.9 15.2 5.4 11.1 16.5 11.7 20.0 31.7 52.1 51.7 102 Sagaing 3.2 5.8 9.0 10.1 20.0 30.1 13.3 25.8 39.1 77.0 76.8 1,410 Tanintharyi 4.8 7.8 12.6 11.5 15.8 27.4 16.3 23.7 40.0 68.4 67.4 283 Bago 1.0 7.6 8.6 12.4 25.7 38.0 13.4 33.3 46.6 81.6 80.9 1,244 Magway 4.9 8.3 13.2 9.1 19.0 28.1 14.0 27.3 41.3 68.0 65.3 1,081 Mandalay 1.9 5.2 7.1 12.8 17.7 30.5 14.7 22.9 37.6 81.1 80.6 1,541 Mon 3.0 7.4 10.4 8.2 19.0 27.2 11.2 26.3 37.5 72.4 71.8 463 Rakhine 5.2 8.4 13.7 10.4 11.6 22.0 15.7 20.0 35.7 61.7 61.4 777 Yangon 1.3 5.1 6.4 10.3 23.7 34.0 11.6 28.8 40.4 84.1 80.8 1,927 Shan 4.8 9.1 13.9 7.5 23.8 31.3 12.3 32.9 45.2 69.2 68.0 1,368 Ayeyarwady 2.0 6.9 8.9 12.5 24.2 36.8 14.6 31.1 45.7 80.5 80.2 1,650 Nay Pyi Taw 2.5 5.5 7.9 14.2 24.0 38.3 16.7 29.5 46.2 82.9 77.4 300 Education4 No education 4.5 13.7 18.2 7.0 21.7 28.7 11.5 35.4 46.8 61.2 60.2 1,606 Primary 2.9 8.5 11.4 10.7 24.7 35.4 13.6 33.2 46.8 75.7 74.9 5,305 Secondary 2.6 4.2 6.9 11.8 17.4 29.1 14.4 21.6 36.0 80.9 79.6 4,646 More than secondary 2.1 1.9 4.0 10.8 18.1 28.9 12.9 20.0 32.9 87.9 82.1 1,325 Wealth quintile Lowest 4.4 10.0 14.4 12.1 21.5 33.6 16.5 31.5 48.0 70.1 69.2 2,274 Second 3.2 7.7 11.0 11.4 22.0 33.5 14.7 29.8 44.5 75.3 74.9 2,408 Middle 3.0 6.6 9.6 10.5 19.3 29.7 13.5 25.9 39.3 75.6 74.9 2,633 Fourth 2.7 6.1 8.8 10.2 20.9 31.1 12.9 27.0 39.9 78.0 76.7 2,702 Highest 1.7 4.9 6.6 9.3 21.5 30.8 10.9 26.4 37.3 82.4 78.6 2,868 Total 2.9 6.9 9.8 10.6 21.0 31.6 13.6 27.9 41.5 76.3 74.9 12,885 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al. 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, and lactational amenorrhea method (LAM). 4 Total includes three women with missing information on education. Table 7.13 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Myanmar 2015-16 Number of living children1 Intention to use in the future 0 1 2 3 4+ Total Intends to use 39.3 52.4 43.0 29.1 24.6 38.2 Unsure 5.7 6.0 5.0 6.3 4.0 5.3 Does not intend to use 55.0 41.4 52.0 64.7 71.4 56.5 Missing 0.0 0.2 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 469 878 883 614 862 3,705 1 Includes current pregnancy Family Planning • 107 Table 7.14.1 Exposure to family planning messages: Women Percentage of women age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper or magazine, or on the Internet or a billboard in the past few months, according to background characteristics, Myanmar DHS 2015-16 Women Background characteristic Radio Television Newspaper/ magazine None of these three media sources1 Billboard Internet Percentage of women with no exposure to any of the sources2 Number of women Residence Urban 14.1 43.7 33.0 46.6 22.2 50.2 32.3 3,768 Rural 14.8 17.9 11.4 72.6 4.4 22.2 64.6 9,117 States/Regions Kachin 15.1 17.9 19.7 68.8 9.6 26.6 59.6 374 Kayah 6.3 19.4 13.9 72.7 10.2 14.5 67.1 65 Kayin 6.4 11.2 9.5 81.7 7.9 11.6 77.5 303 Chin 12.0 12.9 16.4 74.4 6.6 34.7 57.7 102 Sagaing 17.6 32.4 15.1 59.7 4.5 27.2 50.9 1,410 Tanintharyi 7.2 12.1 7.6 82.1 5.8 23.7 69.2 283 Bago 12.9 22.7 16.9 68.5 10.8 33.4 55.2 1,244 Magway 23.8 23.9 19.1 61.6 8.1 35.4 52.5 1,081 Mandalay 13.4 22.1 15.7 67.9 9.9 33.4 56.3 1,541 Mon 17.5 23.8 22.3 61.9 13.5 35.4 50.0 463 Rakhine 11.7 12.8 10.6 78.5 6.3 11.6 74.0 777 Yangon 10.3 45.3 31.5 46.5 19.5 52.7 29.4 1,927 Shan 7.1 19.2 10.2 77.9 6.7 16.8 74.5 1,368 Ayeyarwady 23.1 22.1 17.3 63.7 5.8 24.4 57.0 1,650 Nay Pyi Taw 15.2 22.5 15.3 66.2 10.6 22.7 59.0 300 Education3 No education 7.7 7.5 1.7 88.1 0.5 7.9 84.7 1,606 Primary 14.4 19.2 9.8 72.4 2.5 22.3 63.9 5,305 Secondary 15.9 32.1 23.8 57.0 12.8 38.4 44.6 4,646 More than secondary 18.8 48.6 47.5 35.5 37.8 61.8 21.3 1,325 Wealth quintile Lowest 13.3 10.2 6.5 80.8 1.6 13.9 75.2 2,274 Second 14.6 14.6 9.7 76.1 2.8 20.0 68.2 2,408 Middle 15.3 21.4 13.6 68.7 4.9 26.0 59.0 2,633 Fourth 14.4 31.2 18.3 60.8 9.5 35.7 48.1 2,702 Highest 15.1 44.9 36.6 43.6 25.9 51.1 31.4 2,868 Total 14.6 25.4 17.7 65.0 9.6 30.4 55.1 12,885 1 None of radio, television, or newspaper/magazine 2 Includes those with no exposure to any source: radio, television, newspaper/magazine, Internet, or billboard. 3 Total includes three women with missing information on education. 108 • Family Planning Table 7.14.2 Exposure to family planning messages: Men Percentage of men age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper or magazine, or on the Internet or a billboard in the past few months, according to background characteristics, Myanmar DHS 2015-16 Men Background characteristic Radio Television Newspaper/ magazine None of these three media sources1 Billboard Internet Percentage of men with no exposure to any of the sources2 Number of men Residence Urban 11.7 38.0 40.2 46.7 33.4 54.4 28.7 1,350 Rural 15.0 19.9 18.2 66.4 10.8 30.8 53.2 3,387 States/Regions Kachin 17.3 17.7 21.8 68.1 8.1 25.5 60.3 161 Kayah 16.8 20.9 24.7 63.8 10.1 28.6 58.4 23 Kayin 11.1 19.7 14.4 73.5 11.0 13.4 68.3 115 Chin 6.2 10.1 6.4 82.8 5.6 22.3 66.6 39 Sagaing 12.6 18.8 19.9 68.3 13.1 29.5 54.3 514 Tanintharyi 15.5 25.0 12.9 66.5 18.5 39.3 48.7 103 Bago 22.5 38.0 41.5 41.4 28.4 49.4 31.2 454 Magway 20.1 22.8 19.9 60.3 12.2 42.1 43.5 320 Mandalay 15.0 21.6 29.0 60.3 14.4 44.6 38.9 601 Mon 18.4 28.7 25.2 55.3 25.7 33.6 43.9 162 Rakhine 12.1 12.2 13.2 74.5 12.2 18.3 67.2 222 Yangon 8.1 44.4 43.0 39.5 35.9 67.2 16.5 703 Shan 10.6 26.9 18.5 66.2 12.2 24.0 58.2 542 Ayeyarwady 15.5 12.8 9.9 75.1 5.9 22.9 62.1 653 Nay Pyi Taw 7.2 12.1 15.8 75.6 15.0 30.9 58.9 126 Education No education 7.4 11.6 4.2 82.2 2.2 13.7 75.7 575 Primary 16.0 20.2 16.1 67.6 6.7 30.7 53.9 1,684 Secondary 13.9 29.9 31.5 53.7 24.1 44.8 37.0 2,139 More than secondary 16.6 41.7 55.5 35.7 51.7 65.7 16.6 339 Wealth quintile Lowest 14.5 11.1 9.7 75.6 4.1 20.0 64.2 890 Second 14.3 15.8 14.9 72.7 5.5 28.1 59.8 916 Middle 15.3 24.7 24.8 59.2 13.4 37.8 45.8 979 Fourth 13.6 29.6 27.7 56.3 21.0 45.1 38.4 986 Highest 12.7 42.5 43.5 42.1 40.4 54.5 25.1 966 Total 14.1 25.1 24.5 60.8 17.2 37.5 46.2 4,737 1 None of radio, television, or newspaper/magazine 2 Includes those with no exposure to any source: radio, television, newspaper/magazine, Internet, or billboard. Family Planning • 109 Table 7.15 Contact of nonusers with family planning providers Among women age 15-49 who are not using contraception, the percentage who during the past 12 months were visited by AMW, CHW, or CSG who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with AMW, CHW, or CSG or at a health facility, by background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage of women who were visited by AMW, CHW, or CSG who discussed family planning Percentage of women who visited a health facility in the past 12 months and who: Percentage of women who did not discuss family planning either with AMW, CHW, or CSG or at a health facility Discussed family planning Did not discuss family planning Number of women Age 15-19 2.7 0.5 37.1 96.9 1,687 20-24 4.4 2.6 45.8 93.8 1,368 25-29 7.0 4.4 49.7 90.3 1,123 30-34 9.1 4.9 47.1 88.3 1,166 35-39 7.9 3.5 45.7 89.8 1,012 40-44 7.5 1.8 48.9 91.5 1,115 45-49 7.7 1.4 49.1 91.5 1,338 Residence Urban 4.2 2.5 50.0 93.9 2,551 Rural 7.2 2.6 43.9 91.4 6,258 States/Regions Kachin 4.9 3.3 37.8 93.7 269 Kayah 12.8 5.4 51.5 83.6 43 Kayin 4.5 4.4 41.7 92.6 220 Chin 18.7 4.9 27.2 78.5 85 Sagaing 3.4 2.9 57.7 94.8 985 Tanintharyi 1.0 2.1 48.3 97.1 206 Bago 4.7 0.9 42.1 94.4 770 Magway 12.2 2.0 45.3 86.7 777 Mandalay 7.8 3.1 63.2 91.0 1,071 Mon 3.1 3.0 40.4 94.5 337 Rakhine 3.4 3.7 31.3 93.8 606 Yangon 4.5 1.1 37.6 94.6 1,272 Shan 5.7 3.2 41.7 92.0 940 Ayeyarwady 10.9 3.0 46.7 88.0 1,043 Nay Pyi Taw 4.1 2.1 44.3 94.2 185 Education1 No education 5.0 2.1 37.3 93.7 1,145 Primary 8.4 2.9 44.3 90.1 3,426 Secondary 5.2 2.3 47.6 93.3 3,293 More than secondary 4.5 2.7 53.9 93.4 942 Wealth quintile Lowest 6.7 2.8 34.1 91.9 1,510 Second 8.9 3.0 42.3 89.5 1,602 Middle 7.5 2.5 46.3 91.0 1,850 Fourth 5.3 2.2 50.7 93.6 1,861 Highest 3.9 2.4 52.0 94.1 1,986 Total 6.3 2.5 45.7 92.1 8,809 AMW = Auxiliary mid-wife; CHW = Community health worker; CSG = Community-based support group 1 Total includes three women with missing information on education. Infant and Child Mortality • 111 INFANT AND CHILD MORTALITY 8 Key Findings  Current levels: The infant mortality rate is 40 deaths per 1,000 live births. This means that 1 in 25 children does not reach his or her first birthday. Most of these deaths in the first year of life, more than 60%, occur within the first month.  Trends: Under-5 mortality fell from 103 to 50 deaths per 1,000 live births in the decade or so preceding the survey. Other mortality rates also fell during this period.  State/regional differences: Large variations in childhood mortality rates are seen among states and regions. Under-5 mortality ranges from a low of 44 deaths per 1,000 live births in Mon State to a high of 104 deaths per 1,000 live births in Chin State.  Short birth intervals: The under-5 mortality rate is 159 deaths per 1,000 live births for children born within 2 years of a previous birth. The rate is much lower—48 deaths per 1,000 live births—for children born at least 4 years after a previous birth. nformation on infant and child mortality is relevant to a demographic assessment of the population, and is an important indicator of a country’s socioeconomic development, quality of life, and quality of health care services. It can also help identify the children at highest risk of death and lead to strategies to reduce this risk. This chapter presents information on levels, trends, and differentials in perinatal, neonatal, infant, and under-5 mortality rates. It also examines biodemographic factors and fertility behaviors that affect mortality risks for infants and children. The information is collected as part of a retrospective birth history, in which women list all children they have borne, along with each child’s date of birth, survivorship status, and current age or age at death. The quality of mortality estimates calculated from birth histories depends on the mother’s ability to recall all of the children she has given birth to, as well as their birth dates and ages at death. Potential data quality problems include:  The selective omission from the birth histories of those births that did not survive, which can result in underestimation of childhood mortality.  The displacement of birth dates, which may distort mortality trends. An interviewer may knowingly record a birth as occurring in a different year than the one in which it took place. This may happen if an interviewer tries to cut down on his or her overall work load because live births occurring during the 5 years before the interview are the subject of a lengthy set of additional questions. I 112 • Infant and Child Mortality  The quality of reporting of age at death. Misreporting the child’s age at death may distort the age pattern of mortality, especially if the net effect of the age misreporting is to transfer deaths from one age bracket to another. Any method of measuring childhood mortality that relies on the mothers’ reports (for example, birth histories) assumes that female adult mortality is not high, or if it is high, that the mortality risks of the mothers and those of their children show little correlation. Selected indicators of the quality of the mortality data on which the estimates of mortality in this chapter are based are presented in Appendix C, Tables C.4-C.6. 8.1 EARLY CHILDHOOD MORTALITY Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the probability of dying between the first month of life and first birthday (computed as the difference between infant and neonatal mortality) Infant mortality: the probability of dying between birth and the first birthday Child mortality: the probability of dying between the first and fifth birthday Under-5 mortality: the probability of dying between birth and the fifth birthday In Myanmar, neonatal mortality is 25 deaths per 1,000 live births, infant mortality is 40 deaths per 1,000 live births, and under-5 mortality is 50 deaths per 1,000 live births in the 5-year period preceding the survey. These rates imply that 1 in 25 children dies before reaching the first birthday, and 1 in 20 dies before reaching the fifth birthday (Table 8.1). All three indicators of childhood mortality have declined sharply in Myanmar during the 14 years preceding the survey (Figure 8.1). These trend data are based on the complete birth histories collected in the 2015-16 MDHS, which allow the estimation of mortality rates for children born not just 0-4 years preceding the survey but also 5-9 years and 10-14 years preceding the survey. Patterns by background characteristics  Mortality estimates by background characteristics are calculated for the 10-year period before the survey to ensure that there are sufficient cases to produce statistically reliable estimates (Table 8.2).  The under-5 mortality rate in urban areas is 42 deaths per 1,000 live births, about half of the rate in rural areas where it is 80 deaths per 1,000 live births. Similarly, the neonatal mortality and infant mortality rates are about twice as high in rural areas as in urban areas (Table 8.2).  All childhood mortality rates decrease uniformly as a mother’s education increases. In fact, the infant and under-5 mortality rates for mothers with no education, at 83 and 108 deaths per 1,000 live births, respectively, are higher than those for children with any other background characteristic.  Figure 8.1 Trends in early childhood mortality rates 103 92 50 84 75 4038 39 25 10-14 years preceding the survey 5-9 years preceding the survey 0-4 years preceding the survey Deaths per 1,000 live births Under-5 mortality Infant mortality Neonatal mortality Infant and Child Mortality • 113  Children who are born in families in the lowest wealth quintile are more likely to die in early childhood than children born in families in the other quintiles. For example, the under-5 mortality rate ranges from 99 deaths per 1,000 live births in the lowest wealth quintile to 26 deaths per 1,000 live births in the highest wealth quintile (Figure 8.2).  Neonatal mortality and under-5 mortality are both highest in Chin State, at 44 and 104 deaths per 1,000 live births. However, infant mortality is highest in Bago Region where it is 80 deaths per 1,000 live births. Infant and under-5 mortality rates are lowest in Mon State, at 37 and 44 deaths per 1,000 live births. Neonatal mortality, however, is lowest in Tanintharyi Region, at 20 deaths per 1,000 live births. These variations are likely due to differences among states and regions in accessibility to health care and sociocultural contexts (Figure 8.3). 8.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and the circumstances of the birth. Table 8.3 illustrates the relationship between these risk factors and neonatal, infant, and under-5 mortality, calculated for the 10-year period preceding the survey. Patterns by biodemographic risk factors  Male children are more likely to die in early childhood than female children. The under-5 mortality rate for male children is 78 deaths per 1,000 live births and for female children is 66 deaths per 1,000 live births.  Mortality rates are higher for children whose mother was less than 20 years old when born than for children born to older women.  Generally, all child mortality rates are higher for fourth and higher order births. For example, the under-5 mortality rate for seventh and higher order births is 137 deaths per 1,000 live births, more than twice as high as the rate for births in orders 1-3. Figure 8.2 Under-5 mortality by household wealth Figure 8.3 Under-5 mortality by states and regions Deaths per 1,000 live births in the 10-year period before the survey 99 90 66 42 26 Lowest Second Middle Fourth Highest Deaths per 1,000 live births for the 10-year period before the survey Poorest Wealthiest 114 • Infant and Child Mortality  Children born after a short birth interval, that is, an interval less than 2 years, have higher mortality rates than children born after longer birth intervals. For example, infant mortality, which is highly influenced by short birth intervals, varies from 137 deaths per 1,000 live births for birth intervals less than 2 years compared with 39 deaths per 1,000 live births for birth intervals of 3 years or more (Figure 8.4).  Neonatal mortality is higher for children whose mothers recalled their size at birth as small or very small rather than average or large. 8.3 PERINATAL MORTALITY Perinatal mortality rate Perinatal deaths include stillbirths (pregnancy loss that occurs after 7 months of gestation) and early neonatal deaths (deaths of live births within the first 7 days of life). The perinatal mortality rate is calculated as the number of perinatal deaths per 1,000 pregnancies of 7 or more months’ duration. Sample: Number of pregnancies of 7 or more months’ duration to women age 15-49 in the 5 years before the survey. The number of stillbirths recorded in the MDHS was 51, and the number of early neonatal deaths was 81 for the 5-year period preceding the survey. This yields a perinatal mortality rate of 30 deaths per 1,000 pregnancies of 7 or more months’ duration (Table 8.4). Patterns by background characteristics  By age, the perinatal mortality rate is highest for the oldest mothers (47 per 1,000 pregnancies), that is, women who gave birth in their 40s.  Perinatal mortality is twice as high among women who become pregnant 15-26 months after a previous pregnancy (54 per 1,000 pregnancies), as for women who become pregnant 39 months or more after a previous pregnancy (25 per 1,000 pregnancies).  The perinatal mortality rate is higher in rural areas, at 33 deaths per 1,000, than in urban areas, at 22 deaths per 1,000 pregnancies.  Perinatal mortality ranges from 15 deaths per 1,000 pregnancies in Tanintharyi Region (a coastal area) and Yangon Region (a delta area) to more than three times as many, at 54 deaths per 1,000 pregnancies, in Chin State, a mountainous region.  Perinatal mortality is higher for mothers with no education than for mothers with education. 8.4 HIGH-RISK FERTILITY BEHAVIOR Childhood mortality depends on the magnitude of several known risk factors, such as mother’s age at birth, previous birth interval, and parity. Mothers with one or more risk factors are likely to have higher child mortality. Table 8.5 gives the percent distribution of children born in the 5 years preceding the survey by category of elevated risk of mortality, the risk ratio, and the percent distribution of currently married women by their category of risk if they were to conceive a child at the time of the survey. Figure 8.4 Under-5 mortality by previous birth interval 137 159 74 96 39 54 39 48 Infant mortality Under-5 mortality Previous birth interval: Deaths per 1,000 live births for the 10-year period before the survey <2 years 2 years 3 years 4+ years Infant and Child Mortality • 115 Thirty-one percent of births in the 5 years preceding the survey are not in any high-risk category. Thirty- two percent of births are in the unavoidable risk category, which includes first births to women between age 18 and 34; 24% are in a single high-risk category, which includes mother’s age less than 18 years, mother’s age more than 34 years, birth interval less than 24 months, and birth order more than three; and 14% of births are in multiple high-risk categories. The risk ratio shows the relationship between risk factors and child mortality. Among those in the single high-risk category, the risk ratio is highest at 2.24 for births that occur within 24 months of a previous birth. However, the risk ratio is much higher among births in the multiple risk categories, at an average of 2.65. The highest risk ratio, 4.1, is for women older than age 34, with a birth interval less than 24 months, and a birth order more than 3. This means that children born to women in this category have a risk of dying that is four times higher than the risk for children born to women not in any high-risk category. Only 1% of births fall in this multiple risk category. The last column of Table 8.5 shows that 66% of currently married women in Myanmar would have belonged to an avoidable high-risk category if they had conceived at the time of the survey, 33% would have belonged to a multiple high-risk category, and 34% would have belonged to a single high-risk category. Only 25% would not have belonged at the time to any high-risk category. Almost 9% of currently married women would have belonged to an unavoidable risk category. LIST OF TABLES For more information on infant and child mortality, see the following tables:  Table 8.1 Early childhood mortality rates  Table 8.2 Early childhood mortality rates by socioeconomic characteristics  Table 8.3 Early childhood mortality rates by demographic characteristics  Table 8.4 Perinatal mortality  Table 8.5 High-risk fertility behavior 116 • Infant and Child Mortality Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-5 mortality rates for 5-year periods preceding the survey, Myanmar DHS 2015-16 Years preceding the survey Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 0-4 25 16 40 10 50 5-9 39 36 75 18 92 10-14 38 46 84 20 103 1 Computed as the difference between the infant and neonatal mortality rates Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Residence Urban 18 19 37 5 42 Rural 36 29 64 17 80 States/Regions Kachin 30 20 50 12 61 Kayah 26 12 38 13 50 Kayin 33 32 66 20 84 Chin 44 31 75 32 104 Sagaing 35 17 52 17 68 Tanintharyi 20 36 56 29 83 Bago 43 36 80 4 83 Magway 28 21 48 7 55 Mandalay 32 27 59 7 65 Mon 26 11 37 7 44 Rakhine 32 15 47 12 58 Yangon 21 (18) (39) (7) (46) Shan 31 43 74 27 99 Ayeyarwady 36 29 66 18 82 Nay Pyi Taw 30 30 60 20 79 Mother's education No education 36 47 83 28 108 Primary 34 28 63 13 75 Secondary 26 13 39 6 44 More than secondary 26 0 26 (3) (29) Wealth quintile Lowest 35 43 78 23 99 Second 46 30 76 15 90 Middle 29 23 52 14 66 Fourth 22 13 35 7 42 Highest 17 5 22 4 26 Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. 1 Computed as the difference between the infant and neonatal mortality rates Infant and Child Mortality • 117 Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Myanmar DHS 2015-16 Demographic characteristic Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Child's sex Male 34 29 64 15 78 Female 29 24 53 13 66 Mother's age at birth <20 43 37 80 17 96 20-29 30 21 51 12 62 30-39 32 32 64 17 79 40-49 (34) (32) (67) * * Birth order 1 31 20 51 10 61 2-3 30 20 50 10 60 4-6 30 44 74 26 98 7+ 55 57 113 27 137 Previous birth interval2 <2 years 65 72 137 26 159 2 years 37 37 74 24 96 3 years 19 20 39 15 54 4+ years 24 15 39 9 48 Birth size3 Small/very small 70 (14) (84) na na Average or larger 17 17 34 na na Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. An asterisk indicates that a rate is based on fewer than 250 person-years of exposure to the risk of death and has been suppressed. na = Not available 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the 5-year period before the survey 118 • Infant and Child Mortality Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother's age at birth <20 6 4 29 351 20-29 20 41 27 2,211 30-39 18 32 33 1,549 40-49 6 4 47 226 Previous pregnancy interval in months4 First pregnancy 19 22 28 1,455 <15 5 10 33 429 15-26 5 19 54 456 27-38 7 7 31 441 39+ 15 23 25 1,555 Residence Urban 6 15 22 959 Rural 45 66 33 3,378 States/Regions Kachin 1 2 22 169 Kayah 0 1 23 32 Kayin 1 3 29 148 Chin 1 3 54 66 Sagaing 11 13 51 485 Tanintharyi 1 1 15 133 Bago 3 8 28 376 Magway 3 4 25 313 Mandalay 3 10 31 435 Mon 1 2 19 145 Rakhine 3 7 32 306 Yangon 2 5 15 437 Shan 3 12 24 610 Ayeyarwady 15 9 41 582 Nay Pyi Taw 2 1 39 98 Mother's education No education 11 23 43 801 Primary 27 33 30 1,990 Secondary 11 17 22 1,223 More than secondary 2 8 31 324 Wealth quintile Lowest 15 22 29 1,293 Second 9 25 35 974 Middle 18 14 44 739 Fourth 5 11 23 721 Highest 3 9 20 611 Total 51 81 30 4,337 1 Stillbirths are fetal deaths in pregnancies lasting 7 or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 Perinatal mortality rate is the sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of 7 or more months' duration, expressed per 1,000. 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. Infant and Child Mortality • 119 Table 8.5 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Myanmar DHS 2015-16 Risk category Births in the 5 years preceding the survey Percentage of currently married women1 Percentage of births Risk ratio Not in any high risk category 30.6 1.00 25.3a Unavoidable risk category First order births between ages 18 and 34 years 31.6 1.16 8.7 Single high-risk category Mother's age <18 2.3 0.80 0.4 Mother's age >34 7.6 1.12 19.7 Birth interval <24 months 4.4 2.24 7.5 Birth order >3 9.8 1.70 6.0 Subtotal 24.1 1.53 33.5 Multiple high-risk category Age <18 and birth interval <24 months2 0.2 * 0.1 Age >34 and birth interval <24 months 0.3 * 0.9 Age >34 and birth order >3 9.5 2.32 26.7 Age >34 and birth interval <24 months and birth order >3 1.0 4.10 2.1 Birth interval <24 months and birth order >3 2.7 3.52 2.8 Subtotal 13.7 2.65 32.5 In any avoidable high-risk category 37.8 1.94 66.1 Total 100.0 na 100.0 Number of births/women 4,286 na 7,759 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women Maternal Health Care • 121 MATERNAL HEALTH CARE 9 Key Findings  Antenatal care coverage: Eighty-one percent of women age 15-49 who had a live birth in the 5 years preceding the survey received antenatal care from a skilled provider for their most recent birth. Three-fifths of women (59%) had four or more antenatal care visits.  Components of antenatal care: Pregnant women are more likely to have their blood pressure measured (91%) than to be informed about signs of pregnancy complications (76%) as part of antenatal care. Only about three in ten women had either a urine or blood sample taken during an antenatal care visit.  Protection against neonatal tetanus: Nearly three- quarters of women had their last birth protected against neonatal tetanus (72%).  Delivery: Only 37% of births take place in a health facility; however, 60% of these births are delivered by skilled providers.  Postnatal checks: Seventy-one percent of mothers and 36% of newborns receive the recommended postnatal checkup within the first 2 days after birth. ealth care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. Antenatal care (ANC) can reduce health risks for mothers and their babies through monitoring of pregnancies and screening for complications. Delivery at a health facility, with skilled medical attention and hygienic conditions, reduces complications and infections during labor and delivery. Timely postnatal care treats complications arising from delivery and teaches the mother how to care for herself and her infant. Utilization of these services contributes to policies and programs to further improve maternal and child health care. Maternal and child health care is the priority issue in the National Health Plan of Myanmar. The country is committed to promoting overall reproductive health for reducing maternal mortality and improving the quality and accessibility of reproductive health services. The goal of the reproductive health program is to attain a better quality of life for people by improving the reproductive health status of women, men, adolescents, and youth. The first part of this chapter presents information on ANC providers, the number and timing of ANC visits, and various components of care. The second part focuses on childbirth and presents information on the place of delivery, assistance during delivery, and caesarean deliveries. The third section focuses on postnatal care and presents information on postnatal health checks for mothers and newborns. The conclusion examines the barriers that women may face when seeking health care during illness. H 122 • Maternal Health Care 9.1 ANTENATAL CARE COVERAGE AND CONTENT 9.1.1 Skilled Providers Antenatal care (ANC) from a skilled provider Pregnancy care received from skilled providers, that is, doctors, nurses/midwives, and lady health visitors. Sample: Women age 15-49 who had a live birth in the 5 years before the survey The World Health Organization (WHO) recommends that pregnant women receive a minimum of four antenatal care visits from skilled providers to ensure that problems are identified and managed. Myanmar adopted this recommendation in its standard national guidelines for antenatal care and postnatal care. The 2015-16 MDHS reveals that four in five women age 15-49 (81%) received at least one ANC visit with skilled providers during the pregnancy for their most recent birth (Table 9.1). Patterns by background characteristics  Women are less likely to get ANC from a skilled provider for higher order births (Table 9.1). Only 60% of women with a sixth or higher order birth received ANC from a skilled provider, compared with 89% of women giving birth to their first child.  Ninety-four percent of women in urban areas received ANC from a skilled provider, compared with only 77% of those in rural areas. Women in rural areas are also more likely than women in urban areas to receive no ANC (16% versus 4%).  Among states and regions, ANC coverage by skilled providers is lowest in Shan State (68%) and highest in Yangon Region (95%).  Women with more than secondary education are almost two times more likely than those with no education to receive ANC from skilled providers.  Women in the highest wealth quintile are more likely to receive ANC from skilled providers than women in the lowest quintile (98% versus 67%). 9.1.2 Timing and Number of ANC Visits Fifty-nine percent of pregnant women in Myanmar receive at least four antenatal care visits, as recommended by WHO (Table 9.2). Thirteen percent of women receive no ANC visits. Forty percent of women get ANC within their first trimester of pregnancy, while 30% of women initiate ANC during the fourth to fifth month, and 3% delay until the eight month or even later. Women in urban areas (84%) are more likely to have at least four antenatal care visits than women in rural areas (51%) (Figure 9.1). Figure 9.1 Antenatal care coverage 81 59 40 94 84 41 77 51 40 Received any ANC from a skilled provider Had 4+ ANC visits Had ANC in first trimester (<4 months) Percentage of women age 15-49 who had a live birth in the 5 years before the survey (for the most recent birth) Total Urban Rural Maternal Health Care • 123 9.2 COMPONENTS OF ANC VISITS Standard national guidelines for antenatal care have been developed in Myanmar. These guidelines emphasize that every pregnant mother should receive ANC from a skilled provider that includes services such as a thorough physical examination, blood tests for infection screening and anemia, a urine test, tetanus toxoid injections, iron and folate supplements, and deworming medications. In Myanmar, 87% of women age 15-49 said that they took iron supplements (tablets or syrup), and 55% took drugs for intestinal parasites during the pregnancy of their most recent birth in the 5 years preceding the survey (Table 9.3). Among those who received ANC, about 6 in 10 women had a blood sample (61%) and a urine sample (62%) taken as a part of an ANC visit, while 91% had their blood pressure measured. Three-fourths of the women received information about signs of pregnancy complications during their ANC visits (76%). For complete information on these components of ANC, see Table 9.3. 9.3 PROTECTION AGAINST NEONATAL TETANUS Protection against neonatal tetanus The number of tetanus toxoid injections needed to protect a baby from neonatal tetanus depends on the mother’s vaccinations. A birth is protected against neonatal tetanus if the mother has received any of the following:  Two tetanus toxoid injections during that pregnancy  Two or more injections, the last one within 3 years of the birth  Three or more injections, the last one within 5 years of the birth  Four or more injections, the last one within 10 years of the birth  Five or more injections at any time prior to the birth Sample: Last live births in the 5 years before the survey to women age 15-49 Tetanus toxoid vaccination for pregnant women has been part of the routine Expanded Program on Immunization (EPI) in Myanmar since 1978. It is usually provided by midwives during antenatal care visits. The MDHS shows that 72% of women’s most recent births in the 5 years before the survey were protected against neonatal tetanus (Table 9.4). Patterns by background characteristics  First births are more likely to be protected against neonatal tetanus than sixth and higher order births (75% versus 60%)  Women in urban areas are more likely to have their births protected against neonatal tetanus (81%) than women in rural areas (69%).  The proportion of births protected against neonatal tetanus is lowest among women with no education (56%) and those in the lowest wealth quintile (62%) (Table 9.4). 124 • Maternal Health Care 9.4 DELIVERY SERVICES 9.4.1 Institutional Deliveries Institutional deliveries Deliveries that take place in a health facility Sample: All live births in the 5 years before the survey Access to health facilities in rural areas is more difficult than in urban areas because of distance, inaccessibility, and lack of appropriate facilities. Although institutional delivery has been promoted in Myanmar, home delivery is still common, mostly in hard-to-reach areas. The reproductive health programs in the country encourage use of skilled birth attendants wherever the delivery takes place. Even at home deliveries, it is highly recommended that skilled providers be present so that deliveries are clean and safe. The use of clean delivery kits and birth preparedness procedures is recommended. The 2015-16 MDHS indicates that 37% of the live births in the 5 years preceding the survey were delivered in a health facility and 63% were delivered at home (Table 9.5). Patterns by background characteristics  Sixth and higher order births are more likely to be delivered at home (84%) than first births (44%). Only 16% of higher order births take place in health facilities, compared with 55% of first births.  Among live births in the 5 years preceding the survey, delivery in a health facility is about two and a half times higher in urban areas (70%) than in rural areas (28%).  Institutional deliveries are more common among women with more than secondary education than those with no education (83% versus 13%) (Figure 9.2). Figure 9.2 Institutional deliveries by education 13 29 53 83 No education Primary Secondary More than secondary Percentage of live births in the 5 years before the survey that were delivered in a health facility Maternal Health Care • 125  Institutional delivery is lowest in Chin State (15%) followed by Rakhine State (19%) (Figure 9.3). Figure 9.3 Institutional deliveries by states and regions 9.4.2 Skilled Assistance during Delivery Skilled assistance during delivery Births delivered with the assistance of doctors, nurses/midwives, or lady health visitors Sample: All live births in the 5 years before the survey In Myanmar, three-fifths of births are assisted by skilled providers (60%) that include nurses, midwives, and doctors. Another 29% of births are assisted by traditional birth attendants, 6% are assisted by auxiliary midwives, and 4% are assisted by relatives or friends (Table 9.6 and Figure 9.4). Patterns by background characteristics  Skilled assistance declines sharply with birth order: Three-quarters of first births have skilled assistance (76%), compared with only one-third of sixth or higher order births (33%).  Skilled assistance during delivery is much more common in urban areas (88%) than rural areas (52%). Three-fifths of urban deliveries (65%) are Figure 9.4 Delivery assistance Nurse/ midwife/ LHV 28% Doctor 32% Auxiliary midwife 6% Relative/ friend 4% Traditional birth attendant 29% No one 1% Percent distribution of births in the 5 years before the survey 126 • Maternal Health Care assisted by doctors, whereas one-third of rural deliveries (35%) are assisted by traditional birth attendants.  Births to women with more than secondary education are three times (95%) more likely to receive skilled assistance at delivery than those to women with no education (28%).  There are large differences by states and regions in the proportion of births assisted by skilled providers, ranging from 83% in Yangon Region to only 30% in Rakhine State.  Births in the highest wealth quintile are almost three times more likely than those in lowest quintile to be assisted by skilled providers (97% versus 36%) (Figure 9.5). 9.4.3 Delivery by Caesarean Access to caesarean sections can reduce maternal and neonatal mortality and complications such as obstetric fistula. However, use of caesarean section without medical need can put women at risk of short- term and long-term health problems. WHO advises that caesarean sections be done when medically necessary, but does not recommend a specific rate for countries to achieve at the population level. Research conducted by WHO has found that increases in countries’ caesarean section rates up to 10% are associated with a decline in maternal and neonatal mortality. However, increases in caesarean section rates beyond 10% are not associated with reductions in maternal and newborn mortality rates (WHO 2015a). In Myanmar, the MDHS found a caesarean section rate of 17% of all births (Table 9.6). Patterns by background characteristics  Caesarean section rates are higher for first births (27%) than for those of higher orders.  The cesarean section rate in urban areas is more than 3 times (36%) that in rural areas (12%).  Births to women with more than secondary education are 13 times more likely to be delivered by caesarean section than those to women with no education (54% versus 4%). 9.5 POSTNATAL CARE 9.5.1 Postnatal Health Check for Mothers The World Health Organization (WHO) recommends that women receive a postnatal health check within 24 hours after delivery (WHO 2015b). Fifty-seven percent of mothers with a live birth in the 2 years prior to the survey received a postnatal check-up within 24 hours after delivery. Overall, 71% of mothers receive postnatal check-ups in the first two days after delivery and 24% do not receive any postnatal check-up (Table 9.7). Patterns by background characteristics  Women who deliver in a health facility are more likely to receive a postnatal check-up than those who deliver elsewhere (89% versus 56%). Figure 9.5 Delivery assistance by household wealth 36 51 65 80 97 Lowest Second Middle Fourth Highest Percentage of live births in the 5 years before the survey assisted by a skilled provider WealthiestPoorest Maternal Health Care • 127  Women in urban areas are more likely to receive a postnatal check-up in the 2 days after delivery than women in rural areas (Figure 9.6).  The proportion of women receiving postnatal check-ups in the 2 days after delivery varies widely by region, from a low of 21% in Chin State to a high of 92% in Magway Region. Type of Provider Nearly three-fifths of the women giving birth in the 2 years before the survey (58%) received postnatal care from doctors, nurses, midwives, or lady health visitors, while 10% received care from traditional birth attendants, and 3% received care from auxiliary midwives (Table 9.8). 9.5.2 Postnatal Health Checks for Newborns According to the World Health Organization (WHO), postnatal care services for newborns should start as soon as possible after birth because many neonatal deaths occur within the first 48 hours of life (WHO 2015b). In Myanmar, of last births in the 2 years preceding the survey only 36% received a postnatal checkup in the first 2 days after birth, while the majority of newborns (60%) received no postnatal checkup in the first week after birth (Table 9.9). Patterns by background characteristics  Postnatal check-ups for newborns are least common in Chin State (5%) and most common in Kayah State and Nay Pyi Taw (62% each).  Births to women with more than secondary education are more likely to receive a postnatal check-up in the first two days after birth than those to women with no education (44% and 29%, respectively). Type of Provider Twenty-eight percent of newborns receive a postnatal check-up within 2 days after birth from either a doctor, nurse, midwife, or lady health visitor, while 2% receive a check-up from an auxiliary midwife, and 7% from traditional birth attendant (Table 9.10). 9.6 PROBLEMS IN ACCESSING HEALTH CARE Problems in accessing health care Women were asked whether each of the following factors is a big problem or not in seeking medical advice or treatment for themselves when they are sick:  Getting permission to go to the doctor  Getting money for advice or treatment  Distance to a health facility  Not wanting to go alone Sample: Women age 15-49 Many factors can prevent women from getting medical advice or treatment for themselves when they are sick. Information on such factors is particularly important in understanding and addressing the barriers women face in seeking care during pregnancy and at time of delivery. Figure 9.6 Postnatal care by residence 71 36 81 35 68 37 Women Newborns Percentage of last births in the 2 years before the survey for which women and newborns received a postnatal check within 2 days after birth Total Urban Rural 128 • Maternal Health Care Nearly half of women age 15-49 in Myanmar report having at least one of the specified problems in accessing health care. Among these problems, getting money for advice or treatment was the leading issue (34%), followed by not wanting to go alone (31%), and distance to a health facility (23%). LIST OF TABLES For more information on maternal health care, see the following tables:  Table 9.1 Antenatal care  Table 9.2 Number of antenatal care visits and timing of first visit  Table 9.3 Components of antenatal care  Table 9.4 Tetanus toxoid injections  Table 9.5 Place of delivery  Table 9.6 Assistance during delivery  Table 9.7 Timing of first postnatal checkup for the mother  Table 9.8 Type of provider of first postnatal checkup for the mother  Table 9.9 Timing of first postnatal checkup for the newborn  Table 9.10 Type of provider of first postnatal checkup for the newborn  Table 9.11 Problems in accessing health care Maternal Health Care • 129 Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Myanmar DHS 2015-16 Antenatal care provider Total Percentage receiving antenatal care from a skilled provider1 Number of women Background characteristic Doctor Nurse/ midwife/ LHV Auxiliary midwife Community/ village health worker Traditional birth attendant Other No ANC Mother’s age at birth <20 25.0 51.9 4.1 1.2 0.7 0.3 16.7 100.0 77.0 249 20-34 27.8 53.6 3.5 1.3 2.1 0.2 11.6 100.0 81.4 2,614 35-49 22.9 56.5 2.1 0.6 1.8 0.1 16.1 100.0 79.3 720 Birth order 1 38.4 50.3 3.3 0.8 0.3 0.2 6.6 100.0 88.8 1,235 2-3 25.6 56.0 2.9 1.5 2.2 0.2 11.5 100.0 81.7 1,531 4-5 11.6 58.5 4.1 0.9 4.5 0.0 20.3 100.0 70.2 531 6+ 8.3 51.6 3.1 1.1 2.5 0.3 33.1 100.0 59.9 286 Residence Urban 59.2 35.2 0.4 0.2 1.2 0.0 3.9 100.0 94.4 838 Rural 16.6 59.9 4.1 1.4 2.1 0.2 15.6 100.0 76.5 2,744 States/Regions Kachin 30.3 49.7 6.2 0.8 2.8 0.3 9.9 100.0 80.0 133 Kayah 47.3 46.0 0.4 0.0 0.7 0.0 5.7 100.0 93.3 24 Kayin 13.6 58.1 4.7 0.4 1.0 0.0 22.1 100.0 71.7 113 Chin 4.6 68.9 4.1 0.3 0.9 0.0 21.1 100.0 73.5 43 Sagaing 15.8 69.0 1.7 0.0 0.7 0.0 12.7 100.0 84.8 398 Tanintharyi 35.3 45.3 2.4 0.0 3.3 1.6 12.0 100.0 80.6 102 Bago 23.5 56.0 3.9 7.9 3.1 0.4 5.2 100.0 79.5 329 Magway 21.1 61.4 3.9 0.0 0.9 0.0 12.7 100.0 82.5 274 Mandalay 32.1 53.3 2.7 0.0 0.4 0.0 11.5 100.0 85.4 383 Mon 34.2 59.0 0.0 0.0 0.0 1.5 5.3 100.0 93.2 121 Rakhine 20.2 50.9 0.0 0.0 0.4 0.0 28.5 100.0 71.1 238 Yangon 55.9 38.6 0.0 0.0 1.3 0.0 4.2 100.0 94.6 387 Shan 26.8 41.3 3.5 2.9 1.1 0.0 24.4 100.0 68.1 459 Ayeyarwady 13.9 64.4 8.2 0.0 6.5 0.0 7.0 100.0 78.3 497 Nay Pyi Taw 35.0 43.9 1.4 0.0 0.0 0.5 19.2 100.0 78.9 83 Education No education 11.2 44.9 4.0 2.4 1.5 0.0 36.1 100.0 56.1 587 Primary 17.0 63.1 3.3 1.2 2.6 0.3 12.5 100.0 80.1 1,629 Secondary 38.0 51.8 3.6 0.6 1.7 0.1 4.2 100.0 89.8 1,069 More than secondary 68.5 31.0 0.4 0.0 0.0 0.0 0.1 100.0 99.5 298 Wealth quintile Lowest 7.6 59.5 4.3 0.7 4.0 0.2 23.6 100.0 67.1 981 Second 16.4 58.7 5.3 2.8 2.1 0.4 14.4 100.0 75.0 787 Middle 22.8 61.0 2.8 0.9 1.0 0.0 11.5 100.0 83.8 624 Fourth 33.9 56.4 2.2 0.7 1.1 0.1 5.6 100.0 90.4 638 Highest 70.8 27.3 0.2 0.3 0.0 0.1 1.4 100.0 98.1 552 Total 26.6 54.1 3.3 1.1 1.9 0.2 12.8 100.0 80.7 3,583 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and lady health visitor (LHV). 130 • Maternal Health Care Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Myanmar DHS 2015-16 Residence Number and timing of ANC visits Urban Rural Total Number of ANC visits None 3.9 15.6 12.8 1 1.9 4.7 4.0 2-3 9.4 28.4 23.9 4+ 84.2 50.8 58.6 Don’t know/missing 0.7 0.6 0.6 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 3.9 15.6 12.8 <4 40.9 39.6 39.9 4-5 36.7 27.5 29.7 6-7 16.7 13.3 14.1 8+ 1.6 3.5 3.1 Don’t know/missing 0.1 0.5 0.4 Total 100.0 100.0 100.0 Number of women 838 2,744 3,583 Median months pregnant at first visit (for those with ANC) 4.4 4.2 4.2 Number of women with ANC 806 2,317 3,123 Maternal Health Care • 131 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the 5 years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the 5 years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Myanmar DHS 2015-16 Among women with a live birth in the past 5 years, the percentage who during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the 5 years, the percentage with selected services Background characteristic Took iron tablets or syrup Took intestinal parasite drugs Number of women with a live birth in the past 5 years Informed of signs of pregnancy complications Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother’s age at birth <20 79.9 45.3 249 67.2 87.9 57.5 50.8 207 20-34 88.9 57.2 2,614 77.6 91.9 62.0 62.3 2,311 35-49 84.6 51.9 720 75.3 88.6 62.3 59.5 605 Birth order 1 91.4 57.3 1,235 78.9 93.9 66.0 67.7 1,153 2-3 89.6 56.7 1,531 77.0 91.1 63.3 60.5 1,355 4-5 81.6 51.7 531 71.1 86.0 50.4 49.5 423 6+ 69.1 46.0 286 69.8 83.3 50.0 49.8 191 Residence Urban 94.8 59.8 838 85.5 97.6 85.7 86.3 806 Rural 85.1 54.0 2,744 73.3 88.7 53.4 52.2 2,317 States/Regions Kachin 92.6 59.0 133 71.6 93.1 60.1 64.9 119 Kayah 92.5 63.3 24 79.3 96.6 77.6 75.0 22 Kayin 82.2 51.7 113 80.9 95.6 74.8 81.8 88 Chin 74.4 46.9 43 76.5 85.2 43.2 35.6 34 Sagaing 89.8 58.6 398 69.2 89.9 62.6 58.5 347 Tanintharyi 88.4 63.0 102 71.9 90.7 53.1 61.0 89 Bago 93.2 60.7 329 73.1 86.1 59.6 61.2 312 Magway 88.3 52.1 274 82.7 90.6 54.8 61.7 239 Mandalay 88.4 43.8 383 73.4 96.0 68.4 64.6 339 Mon 92.2 65.3 121 69.5 95.4 62.2 68.4 115 Rakhine 76.5 48.6 238 72.5 81.6 35.8 32.9 170 Yangon 97.0 66.8 387 89.9 97.8 87.8 81.9 371 Shan 71.1 39.0 459 77.9 93.4 57.1 62.0 347 Ayeyarwady 91.8 65.8 497 76.4 86.4 54.5 47.4 463 Nay Pyi Taw 90.2 52.5 83 70.8 85.2 54.0 58.3 67 Education No education 63.8 39.5 587 65.0 85.5 46.5 47.8 375 Primary 89.1 58.4 1,629 74.4 89.3 55.8 54.2 1,426 Secondary 94.9 59.7 1,069 80.4 93.1 69.5 68.4 1,024 More than secondary 97.3 54.0 298 87.2 98.9 82.3 85.1 298 Wealth quintile Lowest 78.6 52.6 981 71.7 83.9 45.5 43.8 750 Second 84.6 52.6 787 72.2 88.0 54.6 54.6 674 Middle 89.8 59.8 624 75.7 92.0 59.8 60.5 553 Fourth 95.2 59.7 638 79.2 95.9 72.0 69.3 602 Highest 95.3 53.9 552 86.0 98.0 83.6 83.9 544 Total 87.4 55.3 3,583 76.4 91.0 61.7 61.0 3,123 132 • Maternal Health Care Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the 5 years preceding the survey, the percentage receiving two or more tetanus toxoid injections during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother’s age at birth <20 62.5 63.1 249 20-34 70.3 72.4 2,614 35-49 70.9 73.0 720 Birth order 1 73.5 75.2 1,235 2-3 71.2 73.4 1,531 4-5 63.9 65.9 531 6+ 58.4 60.3 286 Residence Urban 79.9 80.5 838 Rural 66.9 69.2 2,744 States/Regions Kachin 77.9 80.2 133 Kayah 74.8 75.9 24 Kayin 65.8 67.3 113 Chin 68.5 69.1 43 Sagaing 65.2 67.7 398 Tanintharyi 67.8 68.9 102 Bago 68.8 72.6 329 Magway 64.7 66.5 274 Mandalay 77.2 78.6 383 Mon 79.2 83.5 121 Rakhine 72.7 74.1 238 Yangon 84.2 84.6 387 Shan 55.7 57.9 459 Ayeyarwady 69.2 71.0 497 Nay Pyi Taw 69.7 72.2 83 Education No education 54.5 55.5 587 Primary 67.3 69.8 1,629 Secondary 78.9 80.7 1,069 More than secondary 82.2 84.1 298 Wealth quintile Lowest 60.4 62.3 981 Second 67.2 70.1 787 Middle 72.4 74.1 624 Fourth 77.0 78.5 638 Highest 79.8 81.3 552 Total 69.9 71.9 3,583 1 Includes mothers with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth. Maternal Health Care • 133 Table 9.5 Place of delivery Percent distribution of live births in the 5 years preceding the survey by place of delivery and percentage delivered in a health facility, according to background characteristics, Myanmar DHS 2015-16 Health facility Percentage delivered in a health facility Number of births Background characteristic Public sector Private sector NGO sector Home Other Total Mother’s age at birth <20 26.9 4.4 0.0 68.1 0.6 100.0 31.4 345 20-34 30.6 6.6 0.0 62.5 0.3 100.0 37.3 3,153 35-49 32.7 6.0 0.0 61.3 0.0 100.0 38.7 789 Birth order 1 45.3 10.1 0.0 44.4 0.2 100.0 55.4 1,509 2-3 27.0 5.6 0.0 67.2 0.2 100.0 32.6 1,789 4-5 15.4 2.3 0.1 81.5 0.7 100.0 17.8 635 6+ 14.3 1.4 0.1 84.1 0.0 100.0 15.9 352 Antenatal care visits1 None 6.2 0.3 0.0 92.9 0.6 100.0 6.5 460 1-3 24.2 2.3 0.0 73.0 0.5 100.0 26.5 1,002 4+ 44.1 10.6 0.0 45.2 0.1 100.0 54.7 2,099 Residence Urban 52.7 17.4 0.0 29.7 0.2 100.0 70.1 953 Rural 24.4 3.2 0.0 72.1 0.3 100.0 27.6 3,333 States/Regions Kachin 22.6 6.9 0.0 70.5 0.0 100.0 29.5 168 Kayah 28.4 0.5 0.0 70.5 0.5 100.0 29.0 32 Kayin 24.6 11.6 0.6 62.1 1.2 100.0 36.8 147 Chin 13.2 1.4 0.0 85.3 0.0 100.0 14.7 65 Sagaing 31.4 2.5 0.0 66.1 0.0 100.0 33.9 474 Tanintharyi 33.4 4.1 0.0 62.4 0.0 100.0 37.6 133 Bago 30.9 8.4 0.0 60.5 0.2 100.0 39.3 373 Magway 33.4 4.1 0.0 61.7 0.8 100.0 37.5 310 Mandalay 33.8 13.0 0.0 53.2 0.0 100.0 46.8 431 Mon 29.1 7.9 0.0 62.6 0.4 100.0 37.0 144 Rakhine 18.7 0.5 0.0 80.8 0.0 100.0 19.2 303 Yangon 54.0 11.4 0.0 34.6 0.0 100.0 65.4 435 Shan 22.6 5.0 0.0 71.9 0.5 100.0 27.6 607 Ayeyarwady 29.7 4.3 0.0 65.8 0.2 100.0 34.0 567 Nay Pyi Taw 28.5 7.3 0.0 64.2 0.0 100.0 35.8 96 Mother’s education No education 11.9 0.8 0.1 86.8 0.4 100.0 12.8 789 Primary 26.4 2.8 0.0 70.4 0.3 100.0 29.3 1,963 Secondary 44.5 8.9 0.0 46.5 0.1 100.0 53.4 1,212 More than secondary 51.0 31.6 0.0 17.4 0.0 100.0 82.6 322 Wealth quintile Lowest 15.3 1.5 0.0 83.0 0.2 100.0 16.8 1,277 Second 23.5 2.0 0.0 74.1 0.4 100.0 25.5 965 Middle 33.2 3.9 0.1 62.3 0.5 100.0 37.2 721 Fourth 45.2 4.9 0.0 49.9 0.0 100.0 50.1 716 Highest 54.5 28.0 0.0 17.4 0.1 100.0 82.5 608 Total 30.7 6.3 0.0 62.7 0.2 100.0 37.1 4,286 1 Includes only the most recent birth in the 5 years preceding the survey. Total includes 22 cases with missing information on antenatal care visits. 134 • Maternal Health Care Table 9.6 Assistance during delivery Percent distribution of live births in the 5 years preceding the survey by person providing assistance during delivery, percentage of births assisted by a skilled provider, and percentage of births delivered by caesarean section, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C- section Doctor Nurse/ midwife/ LHV Auxiliary midwife Traditional birth attendant Relative/ other No one Total Number of births Mother’s age at birth <20 24.6 32.9 5.7 31.5 5.3 0.0 100.0 57.4 7.8 345 20-34 31.9 28.6 6.3 28.9 3.8 0.5 100.0 60.5 17.2 3,153 35-49 34.0 26.3 6.0 29.4 3.3 1.0 100.0 60.3 20.4 789 Birth order 1 47.6 28.3 4.6 16.7 2.8 0.0 100.0 75.9 26.7 1,509 2-3 27.6 31.6 7.5 30.4 2.7 0.3 100.0 59.2 14.6 1,789 4-5 15.1 25.8 7.0 44.3 6.6 1.2 100.0 40.9 6.8 635 6+ 14.1 18.7 4.8 49.7 9.3 3.4 100.0 32.8 6.8 352 Antenatal care visits2 None 5.7 10.7 4.8 66.8 9.7 2.2 100.0 16.4 1.5 460 1-3 21.5 30.4 8.1 35.6 3.9 0.5 100.0 51.8 11.7 1,002 4+ 47.8 31.4 5.4 14.0 1.3 0.0 100.0 79.2 27.0 2,099 Place of delivery Health facility 83.4 15.9 0.5 0.2 0.1 0.0 100.0 99.2 46.1 1,588 Elsewhere 1.3 36.0 9.6 46.3 6.0 0.9 100.0 37.2 0.0 2,699 Residence Urban 64.6 23.3 1.8 9.1 1.1 0.1 100.0 87.8 35.9 953 Rural 22.3 30.0 7.5 35.0 4.6 0.7 100.0 52.3 11.7 3,333 States/Regions Kachin 25.9 37.8 6.6 26.6 2.5 0.5 100.0 63.7 12.9 168 Kayah 33.4 19.8 6.0 21.9 18.3 0.5 100.0 53.2 15.1 32 Kayin 20.0 29.6 5.7 44.1 0.6 0.0 100.0 49.6 9.5 147 Chin 11.1 24.4 15.9 10.3 37.0 1.2 100.0 35.6 6.1 65 Sagaing 29.8 35.5 8.3 25.2 1.2 0.0 100.0 65.3 19.4 474 Tanintharyi 28.9 36.4 7.5 24.7 2.5 0.0 100.0 65.3 13.4 133 Bago 31.2 31.7 9.9 26.8 0.4 0.0 100.0 62.9 21.8 373 Magway 32.2 36.2 6.8 18.9 4.8 1.2 100.0 68.4 21.5 310 Mandalay 43.9 34.7 6.8 13.8 0.8 0.0 100.0 78.7 25.1 431 Mon 32.8 34.0 7.5 22.8 2.9 0.0 100.0 66.8 15.1 144 Rakhine 16.2 13.5 1.2 66.7 2.4 0.0 100.0 29.7 9.3 303 Yangon 60.5 22.1 1.8 14.1 1.5 0.0 100.0 82.5 25.8 435 Shan 26.4 20.3 6.2 32.0 12.0 3.0 100.0 46.7 10.4 607 Ayeyarwady 21.4 28.6 5.7 42.9 1.3 0.0 100.0 50.0 14.2 567 Nay Pyi Taw 41.5 25.0 5.5 25.6 1.3 1.2 100.0 66.5 16.2 96 Mother’s education No education 11.3 16.7 6.1 51.5 11.9 2.4 100.0 28.0 4.2 789 Primary 23.1 32.9 7.1 34.2 2.5 0.2 100.0 56.0 11.6 1,963 Secondary 46.6 32.1 5.7 13.8 1.6 0.1 100.0 78.7 24.5 1,212 More than secondary 77.1 17.6 2.7 2.4 0.2 0.0 100.0 94.8 54.2 322 Wealth quintile Lowest 10.7 25.6 6.4 50.8 5.5 1.0 100.0 36.3 5.1 1,277 Second 19.2 31.5 8.1 36.5 4.2 0.5 100.0 50.7 10.6 965 Middle 32.7 32.0 7.3 23.5 3.7 0.8 100.0 64.7 17.1 721 Fourth 44.6 35.0 6.4 10.6 3.1 0.3 100.0 79.6 22.8 716 Highest 78.9 18.1 1.4 1.0 0.6 0.0 100.0 97.0 45.6 608 Total 31.7 28.5 6.2 29.2 3.8 0.6 100.0 60.2 17.1 4,286 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and lady health visitor (LHV). 2 Includes only the most recent birth in the 5 years preceding the survey. Total includes 22 cases with missing information on antenatal care visits. Maternal Health Care • 135 Table 9.7 Timing of first postnatal checkup for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution of the mother’s first postnatal check-up for the last live birth by time after delivery, and the percentage of women with a live birth in the 2 years preceding the survey who received a postnatal checkup in the first 2 days after giving birth, according to background characteristics, Myanmar DHS 2015-16 Time after delivery of mother’s first postnatal checkup Percentage of women with a postnatal checkup in the first 2 days after birth Background characteristic Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don’t know/ missing No postnatal checkup1 Total Number of women Mother’s age at birth <20 37.3 12.9 16.4 5.2 0.0 0.0 28.2 100.0 66.6 125 20-34 45.2 12.3 13.5 3.2 2.1 0.4 23.4 100.0 71.0 1,226 35-49 47.2 10.7 15.9 1.0 2.0 0.1 23.0 100.0 73.8 318 Birth order 1 51.7 14.3 12.5 1.8 1.7 0.3 17.7 100.0 78.5 612 2-3 44.2 11.5 13.5 4.1 2.1 0.4 24.2 100.0 69.2 719 4-5 35.3 9.1 18.1 3.9 1.2 0.0 32.4 100.0 62.5 226 6+ 33.2 8.8 19.1 0.0 2.8 0.4 35.7 100.0 61.1 113 Place of delivery Health facility 63.4 15.0 10.9 0.7 1.4 0.4 8.2 100.0 89.3 755 Elsewhere 29.8 9.5 16.9 4.8 2.3 0.2 36.5 100.0 56.2 914 Residence Urban 52.3 13.8 15.0 1.0 2.5 0.3 15.2 100.0 81.1 419 Rural 42.5 11.4 13.9 3.6 1.7 0.3 26.5 100.0 67.8 1,250 States/Regions Kachin 33.0 4.0 24.8 7.7 0.7 1.5 28.2 100.0 61.9 56 Kayah 62.0 2.7 4.9 2.8 6.2 0.0 21.3 100.0 69.7 12 Kayin 46.6 9.0 9.5 2.1 0.0 0.7 32.1 100.0 65.2 66 Chin 9.6 2.2 9.3 5.3 10.9 0.0 62.8 100.0 21.0 24 Sagaing 33.3 7.0 34.1 7.4 4.6 0.7 12.9 100.0 74.4 172 Tanintharyi 57.9 15.3 13.6 0.0 0.9 0.0 12.2 100.0 86.9 48 Bago 21.7 32.1 26.2 3.2 2.0 0.0 14.8 100.0 80.0 135 Magway 73.5 11.8 6.9 0.9 0.0 0.0 6.8 100.0 92.3 119 Mandalay 41.6 19.7 17.8 2.7 3.4 0.0 14.7 100.0 79.1 183 Mon 64.0 7.3 3.9 1.0 1.0 0.8 22.0 100.0 75.2 59 Rakhine 27.1 16.3 10.9 3.3 2.2 0.0 40.3 100.0 54.2 121 Yangon 60.1 6.3 12.3 1.9 0.0 0.0 19.3 100.0 78.8 193 Shan 40.7 7.3 4.6 3.3 2.2 0.0 41.9 100.0 52.7 232 Ayeyarwady 50.2 10.9 9.7 1.4 0.9 0.9 26.0 100.0 70.8 217 Nay Pyi Taw 75.1 5.0 3.8 0.0 0.8 0.0 15.3 100.0 83.9 32 Education No education 30.4 8.3 8.9 3.4 2.4 0.3 46.2 100.0 47.6 264 Primary 43.9 12.0 16.3 3.4 0.9 0.3 23.2 100.0 72.2 730 Secondary 49.5 11.8 15.3 2.7 2.6 0.4 17.7 100.0 76.5 532 More than secondary 60.6 19.6 9.0 0.8 3.1 0.0 6.8 100.0 89.2 143 Wealth quintile Lowest 35.3 9.9 12.9 4.4 1.7 0.1 35.9 100.0 58.0 444 Second 41.5 10.1 15.0 4.7 2.2 0.6 26.0 100.0 66.5 367 Middle 46.5 14.3 16.2 2.1 0.6 0.6 19.6 100.0 77.1 286 Fourth 46.0 13.2 15.4 2.2 2.6 0.0 20.5 100.0 74.7 303 Highest 63.0 14.4 11.7 0.1 2.3 0.2 8.4 100.0 89.0 270 Total 45.0 12.0 14.2 3.0 1.9 0.3 23.7 100.0 71.2 1,669 1 Includes women who received a checkup after 41 days 136 • Maternal Health Care Table 9.8 Type of provider of first postnatal checkup for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution by type of provider of the mother’s first postnatal health check in the 2 days after the last live birth, according to background characteristics, Myanmar DHS 2015-16 Type of health provider of mother’s first postnatal checkup No postnatal checkup in the first 2 days after birth Background characteristic Doctor/ nurse/ midwife/LHV Auxiliary midwife Community health worker Traditional birth attendant Total Number of women Mother’s age at birth <20 53.0 6.0 1.5 6.1 33.4 100.0 125 20-34 57.3 2.9 0.1 10.5 29.0 100.0 1,226 35-49 64.0 2.1 0.0 7.7 26.2 100.0 318 Birth order 1 69.9 2.4 0.6 5.7 21.5 100.0 612 2-3 57.2 3.2 0.0 8.9 30.8 100.0 719 4-5 41.0 4.4 0.0 17.2 37.5 100.0 226 6+ 37.0 2.9 0.0 21.2 38.9 100.0 113 Place of delivery Health facility 88.7 0.4 0.2 0.0 10.7 100.0 755 Elsewhere 33.1 5.2 0.2 17.6 43.8 100.0 914 Residence Urban 77.7 0.7 0.5 2.2 18.9 100.0 419 Rural 51.8 3.8 0.1 12.2 32.2 100.0 1,250 States/Regions Kachin 52.2 3.9 0.4 5.4 38.1 100.0 56 Kayah 61.4 5.5 0.0 2.7 30.3 100.0 12 Kayin 44.7 3.4 0.0 17.0 34.8 100.0 66 Chin 19.3 1.1 0.6 0.0 79.0 100.0 24 Sagaing 55.4 6.6 0.0 12.4 25.6 100.0 172 Tanintharyi 69.4 6.1 0.0 11.4 13.1 100.0 48 Bago 61.7 5.2 1.1 12.0 20.0 100.0 135 Magway 81.7 2.6 0.0 8.0 7.7 100.0 119 Mandalay 74.5 3.7 0.0 0.9 20.9 100.0 183 Mon 63.3 4.8 0.0 7.1 24.8 100.0 59 Rakhine 31.9 1.4 0.0 21.0 45.8 100.0 121 Yangon 68.7 0.0 1.0 9.1 21.2 100.0 193 Shan 43.4 2.0 0.0 7.2 47.3 100.0 232 Ayeyarwady 56.2 1.8 0.0 12.8 29.2 100.0 217 Nay Pyi Taw 78.9 2.5 0.0 2.5 16.1 100.0 32 Education No education 27.7 2.7 0.1 17.1 52.4 100.0 264 Primary 56.2 3.6 0.5 11.9 27.8 100.0 730 Secondary 68.3 3.1 0.0 5.2 23.5 100.0 532 More than secondary 88.0 0.3 0.0 0.9 10.8 100.0 143 Wealth quintile Lowest 37.8 4.2 0.0 16.1 42.0 100.0 444 Second 48.8 1.9 0.4 15.4 33.5 100.0 367 Middle 64.6 4.4 0.1 8.0 22.9 100.0 286 Fourth 67.6 3.2 0.6 3.3 25.3 100.0 303 Highest 87.7 1.0 0.0 0.3 11.0 100.0 270 Total 58.3 3.0 0.2 9.7 28.8 100.0 1,669 LHV = lady health visitor Maternal Health Care • 137 Table 9.9 Timing of first postnatal checkup for the newborn Percent distribution of last births in the 2 years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal checkup in the first 2 days after birth, according to background characteristics, Myanmar DHS 2015-16 Time after birth of newborn’s first postnatal checkup Percentage of births with a postnatal checkup in the first 2 days after birth Background characteristic Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don’t know/ missing No postnatal checkup1 Total Number of births Mother’s age at birth <20 6.8 11.9 8.2 6.9 4.9 0.0 61.4 100.0 33.7 125 20-34 11.2 12.7 6.4 6.9 3.4 0.4 59.1 100.0 37.1 1,226 35-49 11.2 10.5 4.5 8.5 1.9 0.7 62.8 100.0 34.7 318 Birth order 1 12.5 14.5 7.7 5.8 2.5 0.2 56.7 100.0 40.6 612 2-3 8.7 12.0 5.8 6.5 4.0 0.6 62.3 100.0 33.1 719 4-5 12.0 9.4 5.3 10.8 3.8 0.7 57.9 100.0 37.6 226 6+ 12.7 6.5 1.7 11.3 1.0 0.4 66.4 100.0 32.2 113 Place of delivery Health facility 14.0 14.0 5.6 3.9 1.0 0.0 61.6 100.0 37.5 755 Elsewhere 8.2 10.8 6.7 9.8 5.1 0.8 58.6 100.0 35.5 914 Residence Urban 11.2 12.8 5.4 5.7 0.1 0.0 64.7 100.0 35.2 419 Rural 10.7 12.0 6.4 7.6 4.3 0.6 58.3 100.0 36.8 1,250 States/Regions Kachin 7.7 13.3 2.9 3.4 4.6 0.7 67.4 100.0 27.3 56 Kayah 49.7 6.3 2.7 3.5 2.7 0.0 35.1 100.0 62.2 12 Kayin 10.5 11.9 2.3 2.9 1.3 0.0 71.2 100.0 27.5 66 Chin 0.6 1.1 0.6 2.9 4.0 0.0 90.7 100.0 5.2 24 Sagaing 10.3 19.4 5.5 23.9 6.6 0.8 33.5 100.0 59.1 172 Tanintharyi 4.6 10.0 5.9 5.1 1.7 0.0 72.6 100.0 25.6 48 Bago 1.7 11.9 20.7 10.4 3.8 0.0 51.5 100.0 44.7 135 Magway 20.7 4.9 4.1 5.5 2.1 0.0 62.7 100.0 35.2 119 Mandalay 8.3 5.6 4.6 6.1 2.8 0.0 72.6 100.0 24.7 183 Mon 12.5 32.2 2.1 0.8 1.0 0.8 50.6 100.0 47.6 59 Rakhine 12.9 12.0 10.9 6.7 4.1 4.3 49.1 100.0 42.5 121 Yangon 2.7 15.8 2.6 6.8 1.3 0.0 70.8 100.0 27.9 193 Shan 9.7 10.5 4.3 2.1 3.6 0.0 69.8 100.0 26.5 232 Ayeyarwady 16.3 12.2 7.1 5.7 3.3 0.0 55.4 100.0 41.3 217 Nay Pyi Taw 48.3 7.4 3.7 2.0 1.3 0.0 37.2 100.0 61.5 32 Mother’s education No education 7.3 10.7 5.0 6.2 3.2 0.9 66.8 100.0 29.2 264 Primary 11.8 13.9 5.8 8.8 3.3 0.7 55.8 100.0 40.3 730 Secondary 10.2 10.4 6.4 5.7 3.5 0.1 63.7 100.0 32.7 532 More than secondary 14.6 13.1 9.5 6.3 2.0 0.0 54.6 100.0 43.5 143 Wealth quintile Lowest 9.5 11.3 6.2 7.0 3.2 1.1 61.8 100.0 34.0 444 Second 10.8 10.4 5.5 7.9 4.7 0.6 60.1 100.0 34.6 367 Middle 12.2 12.7 8.2 9.5 4.0 0.1 53.3 100.0 42.5 286 Fourth 12.6 12.7 5.7 7.2 2.3 0.0 59.5 100.0 38.2 303 Highest 9.7 15.2 5.5 3.9 1.5 0.0 64.3 100.0 34.2 270 Total 10.8 12.2 6.2 7.2 3.2 0.4 59.9 100.0 36.4 1,669 1 Includes newborns who received a checkup after the first week 138 • Maternal Health Care Table 9.10 Type of provider of first postnatal checkup for the newborn Percent distribution of last births in the 2 years preceding the survey by type of provider of the newborn’s first postnatal health check during the two days after the last live birth, according to background characteristics, Myanmar DHS 2015- 16 Type of health provider of newborn’s first postnatal checkup No postnatal checkup in the first 2 days after birth Background characteristic Doctor/ nurse/ midwife/LHV Auxiliary midwife Community health worker Traditional birth attendant Total Number of births Mother’s age at birth <20 23.7 1.7 1.5 6.8 66.3 100.0 125 20-34 27.8 2.1 0.1 7.1 62.9 100.0 1,226 35-49 28.1 2.0 0.0 4.6 65.3 100.0 318 Birth order 1 34.9 1.5 0.5 3.8 59.4 100.0 612 2-3 24.3 2.3 0.0 6.5 66.9 100.0 719 4-5 23.1 2.7 0.0 11.8 62.4 100.0 226 6+ 18.2 1.7 0.0 12.3 67.8 100.0 113 Place of delivery Health facility 36.9 0.4 0.2 0.0 62.5 100.0 755 Elsewhere 19.9 3.3 0.2 12.0 64.5 100.0 914 Residence Urban 32.0 0.7 0.5 2.0 64.8 100.0 419 Rural 26.1 2.5 0.1 8.1 63.2 100.0 1,250 States/Regions Kachin 19.3 3.9 0.0 4.1 72.7 100.0 56 Kayah 53.3 4.8 0.0 4.1 37.8 100.0 12 Kayin 21.5 2.1 0.0 3.9 72.5 100.0 66 Chin 5.2 0.0 0.0 0.0 94.8 100.0 24 Sagaing 43.4 5.8 0.0 9.9 40.9 100.0 172 Tanintharyi 19.4 2.6 0.0 3.5 74.4 100.0 48 Bago 29.3 4.4 1.1 10.0 55.3 100.0 135 Magway 32.1 1.0 0.0 2.1 64.8 100.0 119 Mandalay 21.9 1.9 0.0 0.9 75.3 100.0 183 Mon 42.7 1.7 0.0 3.1 52.4 100.0 59 Rakhine 25.6 1.4 0.0 15.5 57.5 100.0 121 Yangon 20.4 0.0 1.0 6.5 72.1 100.0 193 Shan 19.3 0.7 0.0 6.6 73.5 100.0 232 Ayeyarwady 31.1 1.5 0.0 8.6 58.7 100.0 217 Nay Pyi Taw 56.5 1.2 0.0 3.8 38.5 100.0 32 Mother’s education No education 14.9 2.6 0.0 11.6 70.8 100.0 264 Primary 28.6 2.2 0.5 8.9 59.7 100.0 730 Secondary 28.5 1.6 0.0 2.6 67.3 100.0 532 More than secondary 42.2 1.2 0.0 0.0 56.5 100.0 143 Wealth quintile Lowest 20.2 2.6 0.0 11.1 66.0 100.0 444 Second 24.2 1.3 0.4 8.7 65.4 100.0 367 Middle 32.0 3.1 0.0 7.4 57.5 100.0 286 Fourth 33.1 2.1 0.6 2.4 61.8 100.0 303 Highest 33.4 0.7 0.0 0.2 65.8 100.0 270 Total 27.6 2.0 0.2 6.6 63.6 100.0 1,669 LHV = lady health visitor Maternal Health Care • 139 Table 9.11 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Myanmar DHS 2015-16 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone At least one problem accessing health care Number of women Age 15-19 5.1 30.3 24.2 39.3 52.0 1,810 20-34 4.3 33.3 23.2 32.0 49.2 5,771 35-49 4.0 36.0 23.3 28.1 47.7 5,305 Number of living children 0 4.2 28.7 20.8 32.9 47.2 5,331 1-2 3.0 33.0 22.0 28.7 46.7 4,510 3-4 5.3 43.3 27.8 31.7 54.6 2,279 5+ 9.3 48.7 36.6 36.4 58.3 765 Marital status Never married 4.1 28.5 20.1 33.3 47.1 4,278 Married 4.3 35.8 25.1 30.6 49.5 7,759 Divorced/separated/ widowed 5.5 45.3 24.6 29.9 54.1 848 Employed last 12 months Not employed 3.6 32.6 21.0 30.6 47.8 3,518 Employed for cash 4.1 34.4 23.3 30.7 48.8 8,606 Employed not for cash 9.8 36.3 35.7 43.3 56.6 762 Residence Urban 1.8 26.5 11.6 22.8 39.9 3,768 Rural 5.4 37.1 28.2 35.0 52.8 9,117 States/Regions Kachin 8.0 44.5 29.8 35.3 59.5 374 Kayah 1.6 46.4 23.3 31.0 55.1 65 Kayin 1.1 43.3 31.6 37.9 56.9 303 Chin 19.8 59.9 52.1 53.1 72.2 102 Sagaing 2.8 22.7 12.0 13.3 29.8 1,410 Tanintharyi 2.9 36.5 19.1 19.1 49.1 283 Bago 3.3 27.3 17.1 23.4 38.4 1,244 Magway 3.2 31.2 20.4 39.0 52.9 1,081 Mandalay 5.0 28.3 18.6 25.0 42.8 1,541 Mon 0.6 18.3 11.6 25.0 35.6 463 Rakhine 6.3 41.7 29.7 31.6 53.6 777 Yangon 1.5 35.7 19.6 26.3 48.7 1,927 Shan 9.4 37.2 33.6 43.1 56.1 1,368 Ayeyarwady 5.0 45.4 35.1 48.0 65.3 1,650 Nay Pyi Taw 2.3 34.4 30.4 46.5 59.3 300 Education1 No education 10.4 51.1 40.2 43.9 62.8 1,606 Primary 5.2 41.0 27.4 33.5 54.4 5,305 Secondary 2.2 26.3 17.2 29.1 44.5 4,646 More than secondary 0.7 12.4 8.4 16.6 26.5 1,325 Wealth quintile Lowest 9.0 58.9 43.3 47.1 70.5 2,274 Second 5.8 44.7 31.4 37.2 59.3 2,408 Middle 3.9 33.4 23.7 31.8 49.7 2,633 Fourth 2.4 24.4 14.6 25.1 40.4 2,702 Highest 1.5 14.9 8.8 19.7 30.7 2,868 Total 4.3 34.0 23.4 31.4 49.0 12,885 1 Total includes three women with missing information on education Child Health • 141 CHILD HEALTH 10 Key Findings  Vaccination: Fifty-five percent of children age 12-23 months had received all basic vaccinations at the time of the survey.  Symptoms of acute respiratory infection (ARI): Three percent of children under age 5 had symptoms of ARI in the 2 weeks before the survey. Fifty-eight percent of these children were taken to a health facility or provider for advice or treatment.  Fever: Sixteen percent of children under age 5 had a fever in the 2 weeks before the survey, and 57% of these children were taken to a health facility or provider for advice or treatment.  Diarrhea: Ten percent of children under age 5 had diarrhea in the 2 weeks before the survey. Fifty-four percent of these children were taken to a health facility or provider for advice or treatment, and 68% received oral rehydration therapy (ORT) or increased fluids. Fourteen percent of children with diarrhea went untreated. nformation on child health and survival can help policymakers assess the efficacy of current strategies, formulate appropriate interventions to prevent deaths from newborn and childhood illnesses, and improve the health of children in Myanmar. This chapter presents information on birth weight and vaccination status for young children. It also looks at the prevalence of, and treatment practices for, three common childhood illnesses: symptoms of acute respiratory infection (ARI), fever, and diarrhea. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal disease, information is also provided on the disposal of children’s fecal matter. 10.1 BIRTH WEIGHT Low birth weight Percentage of births with a reported birth weight below 2.5 kilograms regardless of gestational age. Sample: Live births in the 5 years before the survey that have a reported birth weight, from either a written record or the mother’s report Information on low birth weight is very important because low birth weight is the leading cause of deaths in neonates according to a study on causes of under-5 mortality in Myanmar carried out by the Ministry of Health and Sports (MoHS) in 2014 (MoHS 2014a). It is not only an indirect indicator of maternal nutrition but also a predictive indicator of potential neonatal death and of malnutrition if the child survives. I 142 • Child Health Only 45% of live births in the 5 years preceding the survey had a reported birth weight. Among infants with a reported birth weight, 8% had a low birth weight (less than 2.5 kg) (Table 10.1). Table 10.1 also includes information on a mother’s estimate of her infant’s size at birth. Although the mother’s estimate of size is subjective, it can be a useful proxy for the child’s weight. Two percent of births are reported as very small, 11% as smaller than average, and 83% as average or larger than average. Patterns by background characteristics  The percentage of births with low birth weights decreases with increasing mother’s age at birth, from 10% among births to mothers who were less than age 20 at childbirth to 8% for mothers age 20-34 and 6% for mothers age 35-49.  Babies born to mothers with no education are more likely to have a low birth weight than babies born to mothers with a secondary education; however, it is difficult to draw conclusions since birth weights are available for only 16% of births among women with no education.  Although very few women in Myanmar use tobacco (see Chapter 3), one-quarter of babies born to these women are reported to be either very small or smaller than average at birth, as compared with only 13% of babies born to women who do not smoke. 10.2 VACCINATION OF CHILDREN All basic vaccinations coverage Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report). To have received all basic vaccinations, a child must receive at least:  one dose of BCG vaccine, which protects against tuberculosis  three doses of DPT/pentavalent, which protects against diphtheria, pertussis (whooping cough), tetanus, hepatitis B, and Haemophilus influenzae type b  three doses of polio vaccine  first dose of measles/measles rubella vaccine Sample: Living children age 12-23 months Immunization is the most cost-effective and efficient way to control and eliminate the vaccine-preventable diseases that largely contribute to childhood morbidity and mortality. In Myanmar, the Expanded Program of Immunization (EPI) was initiated in 1978 with BCG and DPT vaccines for children and tetanus toxoid vaccines for pregnant mothers. The oral polio vaccine (OPV) and measles vaccine were introduced in 1987. In 2003, the stand-alone or monovalent hepatitis B (HepB) vaccine was introduced. Since November 2012, DPT and hepatitis B have been combined with Haemophilus influenzae type b vaccine as the pentavalent vaccine. A second dose of measles vaccine was introduced partially in 2008 and made available nationwide in 2012. The combined measles and rubella (MR) vaccine was introduced in 2015 to replace the first dose of measles vaccine. All of these basic vaccinations are recommended to be given in the first year of a child’s life. Pneumococcal conjugate vaccine (PCV) was introduced in 2016, so it was not included in the MDHS questionnaire. The 2015-16 MDHS collected information on the coverage of basic vaccinations among all children born in the 5 years preceding the survey. In the MDHS, information on vaccination coverage was obtained in two ways—from vaccination cards and from mothers’ verbal reports. For all children born since January 2010, mothers were asked to show the interviewer the vaccination cards in which vaccination dates are recorded. If there was no card, or if the mother was unable to show the card to the interviewer, the child’s vaccination information was based on the mother’s recall. The mother was asked to recall whether the child had received BCG, polio, DPT/pentavalent, hepatitis B, and measles/measles rubella vaccines. If she Child Health • 143 indicated that the child had received the polio, DPT/pentavalent, hepatitis B, or measles/measles rubella vaccines, she was asked about the number of doses that the child received. Vaccination coverage should be interpreted carefully because mothers’ recall may not be accurate. Vaccination cards were available for only 45% of children age 12-23 months. The survey results showed that 55% of children age 12-23 months received all basic vaccinations at any time before the survey. Eight percent of children age 12-23 months had not received any vaccinations. Forty-five percent of children age 12-23 months received all of the basic vaccinations before their first birthday (Table 10.2). Regarding specific vaccinations, 88% of children age 12-23 months received the BCG vaccine, and 77% were vaccinated against measles (Table 10.3). Vaccination coverage for the first doses of pentavalent and oral polio vaccine was high (87% and 90%, respectively). However, the percentage of children who received the third doses of the pentavalent and oral polio vaccines decreased to 62% and 67%, respectively. The differences between the percentages of children receiving the first and third doses were 25 percentage points for pentavalent and 23 percentage points for polio (Figure 10.1). Trends: Table 10.4 indicates that the percentage of children age 12-59 months at the time of the survey who received all basic vaccinations by age 12 months increased from 46% among children age 48-59 months to 56% among children age 24-35 months and then decreased to 45% among those age 12-23 months. The main reason for the recent decrease is a drop-off in coverage for the measles vaccine during the transition period from the measles to the MR vaccine. However, the percentage of children who received no vaccinations decreased from 17% among those age 48-59 months to 10% among those age 12- 23 months (Table 10.4). Patterns by background characteristics  Basic vaccination coverage differs slightly by sex of the child; males are more likely to receive all basic vaccinations than females (58% and 51%, respectively) (Table 10.3).  Immunization coverage for all antigens is lowest for sixth- and higher-order births.  There is a marked difference in vaccination coverage by residence, especially for the third dose of pentavalent (75% in urban areas and 58% in rural areas). Figure 10.1 Childhood vaccinations 88 87 77 62 90 82 67 77 55 8 BCG 1 2 3 1 2 3 Measles All basic None Percentage of children age 12-23 months vaccinated at any time before the survey PolioDPT/pentavalent 144 • Child Health  The percentage of children age 12-23 months who received all basic vaccinations varies across the country, ranging from a low of 34% in Ayeyarwady Region to a high of 81% in Mandalay Region (Figure 10.2).  Vaccination coverage improves substantially with increasing mother’s education. For instance, 80% of children whose mothers have more than a secondary education are fully vaccinated, as compared with only 41% of children whose mothers have no education.  Children living in households in the highest wealth quintile (77%) are much more likely to be fully vaccinated than those living in households in the lower two quintiles (41%). 10.3 SYMPTOMS OF ACUTE RESPIRATORY INFECTION Acute respiratory infection (ARI) is one of the most common childhood illnesses and is the third leading cause of death, following preterm and birth asphyxia, among children under age 5 in Myanmar according to a study of causes of under-5 mortality carried out by the MoHS in 2014 (MoHS 2014a). To address this major cause of morbidity and mortality in children under age 5, facility-based integrated management of neonatal and childhood illnesses (F-IMNCI), IMNCI (training in early newborn care and neonatal resuscitation for basic health staff), and community case management (CCM) are being implemented in Myanmar. F-IMNCI is a care package that trains health care providers to manage newborn and childhood illnesses at the hospital level (inpatient care), providing an important care link for sick neonates and children reaching these facilities from the primary health care level and the community. IMNCI is a complementary care package designed to train primary health care staff and basic health staff in managing newborns in outpatient care. Community case management of ARI/pneumonia and diarrhea is implemented by trained and supervised health volunteers in townships that basic health staff cannot reach easily. National guidelines have been developed for implementation of F-IMNCI, IMNCI, and CCM. Treatment of ARI symptoms Children with ARI symptoms for whom advice or treatment was sought from a health facility or provider. ARI symptoms consist of cough accompanied by (1) short, rapid breathing that is chest-related and/or (2) difficult breathing that is chest-related. Sample: Children under age 5 with symptoms of ARI in the 2 weeks before the survey Mothers reported that 3% of children under age 5 had symptoms of ARI in the 2 weeks preceding the survey. Fifty-eight percent of children with symptoms of ARI were taken to a health facility or provider for advice or treatment, and 43% received an antibiotic (Table 10.5). Figure 10.2 Vaccination coverage by states and regions Child Health • 145 Patterns by background characteristics  The prevalence of ARI symptoms among children under age 5 was found to be highest among those age 12-23 months (5%). Seventy-one percent of these children were taken to a health facility or provider to seek advice or treatment.  Among children under age 5 with ARI symptoms, boys were more likely to be taken to a health facility or provider than girls (65% and 48%, respectively).  The prevalence of ARI symptoms was highest among children in Chin State (16%), followed by children in Rakhine State (8%).  Children are more likely to be taken to a health facility or provider to seek advice or treatment for ARI symptoms if their mother has a higher level of education. For example, 55% of children whose mothers had a primary education and 63% of children whose mothers had a secondary education were taken to a health facility or provider. 10.4 FEVER Fever is the most common symptom of childhood illness in Myanmar. It can result from mild illnesses such as the common cold or more severe diseases such as malaria, dengue hemorrhagic fever, and Japanese encephalitis. Treatment of fever Children with fever for whom advice or treatment was sought from a health facility or provider. Sample: Children under age 5 with a fever in the 2 weeks before the survey Sixteen percent of children under age 5 had a fever in the 2 weeks preceding the survey. Fifty-seven percent of these children were taken to a health facility or provider for advice or treatment, and 32% received antibiotics (Table 10.6). Patterns by background characteristics  The prevalence of fever increases from 10% among children less than age 6 months to 22% among those age 6-11 months.  The percentage of children with a fever in the 2 weeks preceding the survey was highest in Chin State (32%) and lowest in Sagaing Region (7%).  The percentage of children with a fever who are taken to a health facility or provider increases substantially with increasing household wealth, from 47% of children living in households in the lowest quintile to 74% of children living in households in the highest quintile. 10.5 DIARRHEAL DISEASE 10.5.1 Prevalence of Diarrhea Diarrhea is a common childhood illness and, according to the earlier-mentioned MoHS study on causes of under-5 mortality (MoHS 2014a), is the fourth-leading cause of death among children under age 5 in Myanmar. Nationwide implementation of F-IMNCI, IMNCI, and CCM (as described in Section 10.3) is being carried out to address this major cause of morbidity and mortality in children. National F-IMNCI, IMNCI, and CCM guidelines have been developed by the MoHS and are being used by health care providers across the country (MoHS 2014b). 146 • Child Health The MDHS results showed that 10% of children under age 5 had diarrhea in the 2 weeks preceding the survey (Table 10.7). Patterns by background characteristics  The prevalence of diarrhea is highest among children age 12-23 months, followed by those who are age 6-11 months (Figure 10.3).  The prevalence of diarrhea is highest in Chin State (24%), followed by Kachin State (20%).  There are slight differences in diarrhea prevalence by household wealth. For example, the prevalence of diarrhea is 12% and 13%, respectively, among children in households in the lowest and second-lowest wealth quintiles, as compared with 7% among children in households in the highest wealth quintile. 10.5.2 Treatment of Diarrhea The F-IMNCI, IMNCI, and CCM guidelines incorporate treatment protocols for management of diarrhea. One treatment is oral rehydration therapy (ORT), which includes giving low-osmolarity oral rehydration salt (ORS) packets or a recommended homemade fluid. Supplementation with zinc sulphate (ZnSO4) tablets is also included in the national guidelines for treatment of diarrhea in children under age 5 (MoHS 2014b). Oral rehydration therapy Children with diarrhea are given a fluid made from a special packet of oral rehydration salts (ORS) or government-recommended homemade fluids (RHF). Sample: Children under age 5 with diarrhea in the 2 weeks before the survey As mentioned above, 10% of children under age 5 had diarrhea in the 2 weeks before the survey (Table 10.7). Fifty-four percent of these children were taken to a health facility or provider for advice or treatment, and 68% received oral rehydration therapy (ORT) or increased fluids (Table 10.8, Figure 10.4). Patterns by background characteristics  Among children under age 5 suffering from diarrhea, boys (74%) are more likely than girls (61%) to be given ORT or increased fluids as a treatment.  The percentage of children with diarrhea for whom advice or treatment is sought from a health facility or provider is higher in rural areas (55%) than urban areas (49%). However, the percentage of children who are given ORT or increased fluids as a treatment for diarrhea is higher in urban (77%) than rural (66%) areas. Figure 10.3 Diarrhea prevalence by age Figure 10.4 Treatment of diarrhea 6 14 17 12 8 5 10 <6 6-11 12-23 24-35 36-47 48-59 Total Percentage of children under age 5 who had diarrhea in the 2 weeks before the survey Age in months 14 33 26 68 22 63 5 62 54 No treatment Home remedy/other Antibiotics ORT or increased fluids Increased fluids ORS or RHF Recommended home fluids Fluid from ORS packet Taken to a health provider Percentage of children under age 5 with diarrhea in the 2 weeks before the survey Child Health • 147  The proportion of children with diarrhea for whom advice or treatment is sought from a health facility or provider is much higher among those whose mothers have a secondary education (62%) than among those whose mothers have no education (36%). 10.5.3 Feeding Practices Appropriate feeding practices Children with diarrhea are given more liquids than usual and as much food or more than usual. Sample: Children under age 5 with diarrhea in the 2 weeks before the survey To reduce dehydration and minimize the effects of diarrhea on nutritional status, mothers are encouraged to continue normal feeding of children with diarrhea and to increase the amount of fluids given. Twenty-two percent of children who had diarrhea in the 2 weeks preceding the survey were given increased fluids, while 7% were given more than the usual amount of food, 47% were given the same amount as usual, and 30% were given somewhat less food (Figure 10.5). Overall, 56% of children under age 5 who had diarrhea in the 2-week period preceding the survey were given increased fluids and/or ORT as well as continued feeding (Table 10.9). Patterns by background characteristics  Younger children are less likely to be given continued feeding along with ORT and/or increased fluids than older children. For example, 44% of children age 6-11 months, 57% of children age 12-23 months, and more than 62% of children age 24-59 months are given continued feeding along with ORT and/or increased fluids.  There are considerable differences in feeding practices during a diarrheal episode by sex of the child. Sixty-two percent of male children under age 5 with diarrhea were given continued feeding along with ORT and/or increased fluids, as compared with 49% of female children.  Children in urban areas are more likely than those in rural areas to receive continued feeding along with ORT and/or increased fluids when they have diarrhea (63% and 54%, respectively).  The percentage of children with diarrhea who receive continued feeding along with ORT and/or increased fluids varies according to mother’s education. For instance, 51% of children whose mothers have no education were given continued feeding along with ORT and/or increased fluids during their diarrheal episode in the 2 weeks preceding the survey, as compared with 61% of children whose mothers have a secondary education. 10.5.4 Knowledge of ORS Packets This section includes information about the proportion of women age 15-49 with a live birth in the 5 years preceding the survey who know about ORS packets for treatment of diarrhea. The MDHS results show that knowledge of ORS packets for treatment of diarrhea is nearly universal among women in Myanmar according to all background characteristics other than educational level. Women with no education are less likely to know about ORS packets (78%) than women at higher educational levels (>98%) (data not shown). Figure 10.5 Feeding practices during diarrhea 7 22 47 56 38 21 4 2 4Food given Liquids given Percentage of children under age 5 with diarrhea in the 2 weeks before the survey More Same Less None Never gave (compared to usual) (compared to usual) 148 • Child Health Treatment of Childhood Illness In summary, during the 2 weeks before the survey, fever was the most common illness reported among children under age 5 (16%). Children with ARI symptoms (58%) and fever (57%) are slightly more likely to be taken for advice or treatment than children with diarrhea (54%) (Figure 10.6). 10.6 KNOWLEDGE REGARDING TREATMENT OF CHILDHOOD ILLNESSES Early care seeking for a sick child is an important first step in reducing childhood mortality, and knowledge of the symptoms of the illness influences early care seeking. In order to investigate this issue, women interviewed in the MDHS were asked what types of symptoms of childhood illnesses would cause them to take a child to a health facility right away. Fever was the most common symptom that would prompt medical treatment, reported by 59% of all women age 15-49 (Table 10.10). Although dengue hemorrhagic fever occurs in Myanmar, awareness of the warning signs of the disease among women is very low. Only 6% of women reported signs of dengue as a symptom that would prompt medical treatment. 10.7 DISPOSAL OF CHILDREN’S STOOLS Safe disposal of children’s stools The child’s last stools were put or rinsed into a toilet or latrine or buried, or the child used a toilet or latrine. Sample: Youngest children under age 5 living with their mother Proper disposal of children’s feces is important to prevent the spread of disease. Sixty-two percent of children under age 5 living with their mothers had their last stool disposed of safely (Table 10.11). Patterns by background characteristics  Children living in urban areas (74%) are much more likely than those living in rural areas (59%) to have their stools disposed of safely.  Safe disposal of children’s stools increases with increasing mother’s education. Forty-nine percent of children whose mothers have no education have their stools disposed of safely, as compared with 78% of children whose mothers have more than a secondary education.  The percentage of children whose stools are disposed of safely varies by household wealth. Children in households in the highest wealth quintile are more likely to have their stools disposed of safely than children in the lowest wealth quintile (76% versus 50%).  The percentage of children whose stools are disposed of safely ranges from a low of 27% in Rakhine State to a high of 76% in Yangon Region. Figure 10.6 Prevalence and treatment of childhood illnesses 3 16 10 58 57 54 ARI Fever Diarrhea ARI Fever Diarrhea Percentage of children under age 5 with symptoms in the 2 weeks before the survey Among those with illness, percentage for whom advice or treatment was sought from a health facility or provider Child Health • 149 LIST OF TABLES For more information on low birth weight, vaccinations, childhood illness, and disposal of children’s stools, see the following tables:  Table 10.1 Child’s size and weight at birth  Table 10.2 Vaccinations by source of information  Table 10.3 Vaccinations by background characteristics  Table 10.4 Vaccinations in first year of life  Table 10.5 Prevalence and treatment of symptoms of ARI  Table 10.6 Prevalence and treatment of fever  Table 10.7 Prevalence of diarrhea  Table 10.8 Diarrhea treatment  Table 10.9 Feeding practices during diarrhea  Table 10.10 Symptoms of childhood illness that prompt treatment  Table 10.11 Disposal of children’s stools 150 • Child Health Table 10.1 Child’s size and weight at birth Percent distribution of live births in the 5 years preceding the survey by mother’s estimate of baby’s size at birth, percentage of live births in the 5 years preceding the survey that have a reported birth weight, and among live births in the 5 years preceding the survey with a reported birth weight, percentage less than 2.5 kg, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percent distribution of all live births by size of child at birth Percentage of all births that have a reported birth weight1 Number of births Births with a reported birth weight1 Very small Smaller than average Average or larger Don’t know/ missing Total Percentage less than 2.5 kg Number of births Mother’s age at birth <20 1.7 9.9 84.5 3.9 100.0 36.6 345 10.4 126 20-34 1.7 10.6 83.9 3.8 100.0 46.3 3,153 8.3 1,461 35-49 1.3 14.0 80.7 3.9 100.0 45.4 789 6.3 358 Birth order 1 1.6 11.9 83.9 2.7 100.0 59.5 1,509 8.5 898 2-3 1.5 10.1 84.2 4.1 100.0 44.4 1,789 8.4 794 4-5 2.1 11.0 81.1 5.8 100.0 28.0 635 5.3 178 6+ 1.5 13.7 81.2 3.6 100.0 21.3 352 7.4 75 Mother’s smoking status Smokes cigarettes/tobacco 2.0 23.4 70.1 4.5 100.0 12.8 92 * 12 Does not smoke 1.6 10.9 83.7 3.8 100.0 46.1 4,194 8.0 1,934 Residence Urban 1.0 9.0 88.3 1.7 100.0 77.9 953 7.5 742 Rural 1.8 11.8 82.0 4.4 100.0 36.1 3,333 8.5 1,204 States/Regions Kachin 0.7 15.7 77.9 5.6 100.0 34.3 168 5.9 58 Kayah 0.8 8.0 90.4 0.8 100.0 44.5 32 7.8 14 Kayin 3.6 22.0 70.7 3.7 100.0 47.1 147 8.7 69 Chin 0.0 15.5 84.5 0.0 100.0 28.9 65 11.6 19 Sagaing 1.8 9.9 81.9 6.4 100.0 43.8 474 9.1 208 Tanintharyi 0.0 5.9 85.0 9.1 100.0 45.6 133 3.3 60 Bago 2.3 10.0 86.9 0.8 100.0 46.8 373 7.7 175 Magway 0.7 8.7 84.9 5.7 100.0 32.0 310 4.9 99 Mandalay 1.2 17.5 81.0 0.4 100.0 57.9 431 8.0 250 Mon 0.4 13.0 78.4 8.2 100.0 56.4 144 6.3 81 Rakhine 5.5 19.5 73.4 1.6 100.0 12.6 303 (20.0) 38 Yangon 1.0 4.1 90.5 4.4 100.0 79.0 435 5.2 344 Shan 1.6 9.6 83.8 5.0 100.0 37.3 607 9.2 226 Ayeyarwady 1.1 9.3 88.0 1.7 100.0 46.8 567 11.4 265 Nay Pyi Taw 0.8 7.4 83.3 8.5 100.0 39.8 96 10.6 38 Mother’s education No education 2.4 14.2 77.6 5.8 100.0 15.8 789 14.2 125 Primary 1.4 10.6 84.2 3.9 100.0 38.5 1,963 7.7 756 Secondary 1.8 10.3 84.8 3.1 100.0 64.7 1,212 7.4 784 More than secondary 0.4 10.8 87.5 1.3 100.0 87.2 322 8.6 281 Wealth quintile Lowest 2.2 12.1 81.3 4.5 100.0 23.9 1,277 6.0 305 Second 1.6 10.9 82.6 4.9 100.0 35.1 965 7.7 338 Middle 1.8 11.6 80.9 5.8 100.0 45.2 721 11.5 326 Fourth 1.2 9.2 87.5 2.1 100.0 64.5 716 7.7 462 Highest 0.7 11.6 87.1 0.6 100.0 84.7 608 7.8 515 Total 1.6 11.2 83.4 3.8 100.0 45.4 4,286 8.1 1,945 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Based on either a written record or the mother’s recall Child Health • 151 Table 10.2 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated by age 12 months, Myanmar DHS 2015-16 BCG Pentavalent1 Polio Measles All basic vacci- nations2 No vacci- nations Number of children Source of information 1 2 3 1 2 3 Vaccinated at any time before survey Vaccination card 44.1 44.8 42.8 40.6 44.8 42.8 40.9 38.7 36.4 0.0 383 Mother’s report 43.7 42.0 34.4 21.7 45.5 38.7 26.1 38.3 18.4 7.9 469 Either source 87.8 86.9 77.3 62.3 90.3 81.5 67.0 77.1 54.8 7.9 852 Vaccinated by age 12 months3 86.6 85.5 76.9 60.2 88.8 81.1 64.9 61.2 45.0 9.5 852 1 Pentavalent is DPT-HepB-Hib. 2 BCG, first dose of measles, and three doses each of pentavalent and polio vaccine 3 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination. Table 10.3 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and percentage with a vaccination card, by background characteristics, Myanmar DHS 2015-16 Background characteristic BCG Pentavalent1 Polio Measles All basic vaccina- tions2 No vaccina- tions Percentage with a vaccination card seen Number of children 1 2 3 1 2 3 Sex Male 89.1 88.1 79.5 63.5 92.0 82.9 68.7 79.4 57.9 6.8 44.6 475 Female 86.1 85.2 74.4 60.7 88.2 79.8 64.9 74.1 50.9 9.3 45.4 377 Birth order 1 86.5 85.5 77.1 61.3 90.3 80.5 64.9 77.1 53.6 8.9 41.7 318 2-3 89.1 88.7 79.9 65.6 91.7 83.4 69.9 78.6 57.8 6.1 50.9 373 4-5 91.7 90.0 75.5 59.9 90.8 85.0 70.1 76.5 52.7 7.0 35.4 107 6+ 78.6 76.3 63.4 49.8 79.9 67.2 53.9 67.8 45.3 16.3 41.7 53 Residence Urban 91.8 91.0 85.0 75.2 93.3 88.3 76.0 81.7 67.5 5.0 55.3 220 Rural 86.4 85.4 74.5 57.8 89.3 79.1 63.9 75.5 50.4 8.9 41.3 631 States/Regions Kachin 91.2 98.4 84.1 73.6 96.8 85.7 70.4 81.9 59.4 1.6 55.3 26 Kayah 100.0 100.0 97.0 84.8 100.0 98.5 84.8 95.6 80.3 0.0 47.0 6 Kayin 88.4 86.9 78.8 70.9 90.0 83.7 72.5 82.6 65.0 6.9 65.8 28 Chin 92.7 91.5 82.8 64.7 93.9 90.3 69.9 73.0 53.0 4.9 15.7 11 Sagaing 86.5 86.5 82.0 71.5 86.5 82.0 71.5 76.9 66.4 13.5 58.9 79 Tanintharyi 98.1 98.1 81.6 61.8 92.5 85.0 67.3 84.9 52.4 1.9 44.4 22 Bago 94.5 83.4 75.3 56.3 88.2 80.0 59.0 77.6 46.7 3.9 44.1 75 Magway (97.8) (93.3) (86.6) (61.8) (100.0) (93.3) (68.2) (91.0) (58.2) (0.0) (43.0) 55 Mandalay 93.4 93.4 91.2 88.2 93.4 93.4 90.1 86.5 81.3 6.6 59.9 89 Mon (95.4) (95.4) (88.6) (68.7) (97.7) (90.8) (75.3) (84.4) (64.4) (2.3) (46.1) 26 Rakhine 88.1 90.6 78.7 48.3 95.6 90.2 72.2 73.4 41.0 4.4 13.3 66 Yangon 96.4 96.4 88.0 76.0 98.1 90.0 78.0 79.7 67.4 1.9 66.8 99 Shan 76.1 74.7 64.8 53.9 78.5 67.4 52.7 63.7 45.7 18.7 36.4 127 Ayeyarwady 74.5 76.7 58.5 40.8 86.5 66.0 51.6 70.6 33.8 11.9 33.6 125 Nay Pyi Taw (97.7) (91.0) (77.6) (59.9) (90.8) (81.7) (59.6) (85.8) (49.4) (2.3) (25.1) 18 Mother’s education No education 71.6 70.1 59.8 43.7 74.1 65.0 51.5 60.7 41.0 23.2 27.6 124 Primary 89.2 88.3 76.7 60.4 92.9 81.9 66.3 79.6 53.6 4.8 44.4 391 Secondary 91.0 90.1 81.7 68.0 92.5 84.7 69.2 77.1 56.4 6.4 50.4 266 More than secondary 96.0 96.0 93.7 83.7 96.0 96.0 90.0 91.3 79.6 4.0 58.0 71 Wealth quintile Lowest 86.1 81.9 68.5 49.1 87.4 74.4 56.4 75.1 41.2 8.3 31.5 240 Second 77.1 81.1 66.8 49.4 83.2 70.5 54.6 61.0 40.5 15.9 40.7 187 Middle 86.4 81.7 77.0 67.3 89.3 80.1 70.7 80.1 64.2 8.6 46.5 135 Fourth 95.7 97.8 89.1 74.0 97.8 93.7 78.9 83.5 64.9 1.9 51.6 147 Highest 97.8 96.3 93.7 84.4 97.8 96.7 85.4 92.0 77.1 2.2 64.6 144 Total 87.8 86.9 77.3 62.3 90.3 81.5 67.0 77.1 54.8 7.9 44.9 852 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Pentavalent is DPT-HepB-Hib. 2 BCG, first dose of measles, and three doses each of pentavalent and polio vaccine 152 • Child Health Table 10.4 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by age 12 months, and percentage with a vaccination card, by current age of child, Myanmar DHS 2015-16 Age in months BCG Pentavalent1 Polio Measles All basic vaccina- tions2 No vaccina- tions Percentag e with a vaccination card seen Number of children 1 2 3 1 2 3 12-23 86.6 85.5 76.9 60.2 88.8 81.1 64.9 61.2 45.0 9.5 44.9 852 24-35 87.6 86.2 78.8 64.5 89.5 83.5 68.5 74.3 55.5 8.9 39.4 782 36-47 87.0 83.9 75.6 62.9 88.9 82.9 67.4 71.6 52.3 9.5 28.1 866 48-59 79.5 76.4 69.2 57.9 82.0 76.4 66.9 65.8 46.3 16.6 22.8 792 Total 85.6 83.6 75.6 61.6 87.8 81.5 67.1 68.2 49.9 10.6 33.9 3,292 Note: Information was obtained from the vaccination card or, if there was no written record, from the mother. For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccinations. 1 Pentavalent is DPT-HepB-Hib. 2 BCG, first dose of measles, and three doses each of pentavalent and polio vaccine Child Health • 153 Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey, and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Myanmar DHS 2015-16 Among children under age 5: Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 2.0 404 * * 8 6-11 1.6 403 * * 7 12-23 4.7 852 71.1 54.2 40 24-35 3.9 782 66.2 38.3 30 36-47 3.4 866 (47.2) (30.1) 29 48-59 2.1 792 (44.4) (45.1) 17 Sex Male 3.8 2,131 64.8 44.5 81 Female 2.6 1,968 47.6 41.5 51 Mother’s smoking status Smokes cigarettes/tobacco 5.4 85 * * 5 Does not smoke 3.2 4,014 58.2 44.7 127 Cooking fuel3 Electricity or gas 2.5 728 (77.4) (54.7) 18 Charcoal 4.0 593 (63.0) (55.3) 24 Wood/straw4 3.2 2,758 53.5 37.3 88 Animal dung * 13 * * 1 No food cooked in household * 5 * * 0 Residence Urban 3.0 925 (76.6) (53.8) 28 Rural 3.2 3,174 53.2 40.5 103 States/Regions Kachin 7.5 162 (34.2) (25.1) 12 Kayah 7.6 31 (61.1) (71.4) 2 Kayin 5.3 140 * * 7 Chin 15.6 60 40.4 47.2 9 Sagaing 0.3 456 * * 1 Tanintharyi 5.9 125 * * 7 Bago 2.2 360 * * 8 Magway 4.8 299 * * 14 Mandalay 2.0 411 * * 8 Mon 2.2 140 * * 3 Rakhine 8.3 294 (79.1) (69.1) 24 Yangon 0.4 423 * * 2 Shan 1.7 564 * * 10 Ayeyarwady 3.7 542 * * 20 Nay Pyi Taw 1.9 92 * * 2 Mother’s education No education 3.3 730 (45.3) (40.4) 24 Primary 3.3 1,879 55.3 45.2 62 Secondary 3.1 1,175 63.0 41.8 37 More than secondary 2.7 314 * * 8 Wealth quintile Lowest 4.1 1,211 45.3 38.0 50 Second 3.5 906 62.1 54.7 32 Middle 2.9 691 (58.8) (20.1) 20 Fourth 2.7 699 (71.4) (57.1) 19 Highest 1.9 593 * * 11 Total 3.2 4,099 58.2 43.3 131 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI include cough accompanied by short, rapid breathing that is chest-related and/or by difficult breathing that is chest-related. 2 Excludes pharmacy, shop, market, and traditional practitioner 3 Total includes two children from households using other source of cooking fuel. 4 Includes grass, shrubs, and crop residues 154 • Child Health Table 10.6 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the 2 weeks preceding the survey, and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Myanmar DHS 2015-16 Among children under age 5: Among children under age 5 with fever: Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antimalarial drugs Percentage who took antibiotic drugs Number of children Age in months <6 10.3 404 46.2 0.0 18.7 42 6-11 22.3 403 63.9 1.4 29.6 90 12-23 21.2 852 52.8 1.9 29.6 180 24-35 18.0 782 63.3 0.1 35.0 141 36-47 13.5 866 53.8 0.2 27.6 117 48-59 11.0 792 56.5 0.3 43.7 87 Sex Male 15.5 2,131 57.5 1.2 31.9 330 Female 16.6 1,968 56.1 0.5 31.3 327 Residence Urban 16.4 925 59.1 0.0 33.8 151 Rural 15.9 3,174 56.1 1.1 30.9 505 States/Regions Kachin 21.8 162 56.9 0.0 25.5 35 Kayah 22.0 31 70.6 0.0 54.3 7 Kayin 18.0 140 64.2 0.0 24.7 25 Chin 32.2 60 36.5 4.2 40.1 19 Sagaing 6.6 456 * * * 30 Tanintharyi 20.9 125 55.7 0.0 38.7 26 Bago 16.3 360 (56.0) (2.5) (32.3) 59 Magway 18.2 299 (53.4) (2.3) (24.4) 54 Mandalay 11.1 411 (57.9) (0.0) (26.6) 46 Mon 9.1 140 * * * 13 Rakhine 24.1 294 48.9 0.0 57.8 71 Yangon 8.2 423 * * * 35 Shan 14.1 564 (55.1) (0.0) (41.3) 80 Ayeyarwady 26.1 542 57.4 1.3 17.0 142 Nay Pyi Taw 16.7 92 (38.2) (0.0) (20.3) 15 Mother’s education No education 15.6 730 53.2 0.2 36.1 114 Primary 16.7 1,879 52.6 1.2 26.3 313 Secondary 16.0 1,175 60.7 0.8 32.9 188 More than secondary 13.1 314 (81.5) (0.0) (53.4) 41 Wealth quintile Lowest 18.0 1,211 46.5 0.3 27.7 218 Second 19.3 906 59.0 1.9 26.1 175 Middle 13.0 691 51.4 0.0 27.9 90 Fourth 13.6 699 67.0 1.5 44.0 95 Highest 13.4 593 74.4 0.0 43.4 80 Total 16.0 4,099 56.8 0.8 31.6 657 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes pharmacy, shop, market, and traditional practitioner Child Health • 155 Table 10.7 Prevalence of diarrhea Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey, by background characteristics, Myanmar DHS 2015- 16 Diarrhea in the 2 weeks preceding the survey Number of children Background characteristic All diarrhea Diarrhea with blood Age in months <6 6.2 0.1 404 6-11 13.8 0.2 403 12-23 17.1 1.0 852 24-35 11.6 0.5 782 36-47 8.0 0.5 866 48-59 5.3 0.4 792 Sex Male 10.5 0.3 2,131 Female 10.3 0.8 1,968 Source of drinking water1 Improved 9.9 0.5 3,287 Not improved 12.6 0.6 812 Toilet facility2 Improved, not shared 10.4 0.6 1,711 Shared3 9.1 0.3 384 Not improved 10.7 0.5 2,004 Residence Urban 8.4 0.4 925 Rural 11.0 0.6 3,174 States/Regions Kachin 20.0 0.8 162 Kayah 10.6 0.3 31 Kayin 16.5 0.6 140 Chin 24.4 3.7 60 Sagaing 6.1 0.3 456 Tanintharyi 7.9 0.0 125 Bago 7.0 0.4 360 Magway 8.4 0.8 299 Mandalay 8.7 0.0 411 Mon 7.5 0.0 140 Rakhine 13.9 0.9 294 Yangon 4.8 0.4 423 Shan 10.2 0.2 564 Ayeyarwady 17.2 0.9 542 Nay Pyi Taw 8.6 1.3 92 Mother’s education No education 10.7 0.9 730 Primary 10.5 0.5 1,879 Secondary 11.4 0.3 1,175 More than secondary 6.1 0.6 314 Wealth quintile Lowest 12.2 0.7 1,211 Second 12.6 0.8 906 Middle 9.7 0.3 691 Fourth 7.9 0.2 699 Highest 7.3 0.3 593 Total 10.4 0.5 4,099 1 See Table 2.1 for definition of categories. 2 See Table 2.2 for definition of categories. 3 Facilities that would be considered improved if they were not shared by two or more households 15 6 • C hi ld H ea lth Ta bl e 10 .8 D ia rr h ea t re at m en t A m on g ch ild re n un de r ag e 5 w ho h ad d ia rr he a in t he 2 w ee ks p re ce di ng t he s ur ve y, t he p er ce nt ag e fo r w ho m a dv ic e or t re at m en t w as s ou gh t fr om a h ea lth f ac ili ty o r pr ov id er , th e pe rc en ta ge g iv en o ra l r eh yd ra tio n th er ap y (O R T ), th e pe rc en ta ge g iv en in cr ea se d flu id s, th e pe rc en ta ge g iv en O R T o r i nc re as ed fl ui ds , a nd th e pe rc en ta ge g iv en o th er tr ea tm en ts , b y ba ck gr ou nd c ha ra ct er is tic s, M ya nm ar D H S 2 01 5- 16 P er ce nt ag e of ch ild re n w ith di ar rh ea fo r w ho m ad vi ce o r tre at m en t w as so ug ht fr om a he al th fa ci lit y or pr ov id er 1 O ra l r eh yd ra tio n th er ap y (O R T ) O th er tr ea tm en ts B ac kg ro un d ch ar ac te ris tic Fl ui d fr om O R S p ac ke t R ec om - m en de d ho m e flu id s (R H F ) E ith er O R S or R H F In cr ea se d flu id s O R T o r in cr ea se d flu id s A nt ib io tic dr ug s A nt im ot ili ty dr ug s Zi nc s up pl e- m en ts H om e re m ed y/ ot he r M is si ng N o tr ea tm en t N um be r of ch ild re n w ith di ar rh ea A ge in m o nt hs <6 (5 4. 4) (1 7. 8) (1 .1 ) (1 8. 3) (1 3. 8) (2 7. 4) (1 5. 9) (1 8. 8) (0 .6 ) (4 8. 4) (1 .3 ) (2 0. 7) 25 6- 11 59 .0 55 .3 4. 0 59 .3 11 .2 60 .8 35 .4 12 .1 10 .9 28 .1 0. 0 18 .9 56 12 -2 3 52 .9 61 .2 4. 4 61 .4 26 .0 67 .5 27 .3 15 .3 10 .0 29 .7 0. 0 14 .4 14 5 24 -3 5 55 .6 68 .8 4. 3 69 .7 20 .2 72 .5 18 .9 22 .3 8. 4 29 .2 0. 0 13 .3 90 36 -4 7 53 .4 68 .0 6. 9 70 .2 20 .7 74 .0 34 .3 20 .7 10 .1 31 .2 0. 0 12 .0 69 48 -5 9 45 .6 74 .2 5. 1 74 .2 30 .7 79 .5 12 .2 6. 5 1. 7 49 .2 0. 0 8. 8 42 S ex M al e 56 .1 68 .1 5. 5 68 .6 23 .7 73 .6 27 .9 15 .2 6. 3 29 .9 0. 0 12 .3 22 5 Fe m al e 51 .1 54 .9 3. 6 56 .8 19 .5 60 .8 22 .9 18 .2 10 .8 35 .7 0. 2 16 .2 20 3 T yp e of d ia rr he a2 N on -b lo od y 52 .6 61 .3 3. 6 62 .2 20 .9 66 .9 25 .3 16 .1 8. 1 32 .2 0. 1 14 .9 40 5 B lo od y (7 3. 6) (7 0. 3) (2 3. 1) (7 7. 8) (3 4. 3) (7 9. 8) (3 1. 7) (2 5. 9) (1 5. 2) (3 8. 0) (0 .0 ) (0 .0 ) 21 R es id en ce U rb an 48 .7 67 .1 7. 5 71 .7 29 .2 77 .0 30 .9 9. 4 14 .9 37 .4 0. 4 5. 0 77 R ur al 54 .8 60 .7 4. 0 61 .1 20 .1 65 .5 24 .4 18 .2 7. 0 31 .6 0. 0 16 .2 35 0 M ot h er ’s e d uc at io n N o ed uc at io n 36 .1 54 .3 0. 7 54 .3 22 .7 60 .2 18 .2 7. 5 5. 0 23 .5 0. 4 26 .3 78 P rim ar y 53 .0 60 .9 7. 1 63 .3 22 .2 66 .5 20 .1 17 .4 7. 3 36 .9 0. 0 12 .0 19 7 S ec on da ry 62 .3 67 .7 3. 2 67 .9 20 .1 72 .7 33 .7 20 .5 7. 6 32 .6 0. 0 11 .3 13 4 M or e th an s ec on da ry * * * * * * * * * * * * 19 W ea lt h q ui nt ile Lo w es t 49 .6 62 .5 6. 3 65 .5 19 .0 68 .8 19 .5 17 .4 6. 3 31 .6 0. 0 14 .2 14 8 S ec on d 54 .1 61 .2 4. 9 61 .6 28 .4 65 .9 23 .9 16 .7 6. 8 35 .2 0. 0 15 .4 11 4 M id dl e 49 .1 56 .6 1. 0 56 .8 21 .9 61 .5 18 .5 17 .5 0. 7 31 .9 0. 5 23 .4 67 Fo ur th 64 .5 66 .8 2. 4 66 .8 14 .4 70 .7 43 .9 18 .0 20 .1 33 .0 0. 0 3. 6 55 H ig he st (6 0. 7) (6 3. 1) (6 .5 ) (6 3. 1) (2 2. 7) (7 3. 0) (3 8. 5) (1 0. 4) (1 7. 1) (3 0. 3) (0 .0 ) (1 0. 2) 43 T ot al 53 .7 61 .9 4. 6 63 .0 21 .7 67 .6 25 .5 16 .6 8. 4 32 .6 0. 1 14 .2 42 7 N ot e: O R T in cl ud es fl ui d pr ep ar ed fr om o ra l r eh yd ra tio n sa lt (O R S ) pa ck et s an d re co m m en de d ho m e flu id s (R H F) . Fi gu re s in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. D at a by s ta te s an d re gi on s ar e no t s ho w n du e to v er y fe w c as es . 1 E xc lu de s ph ar m ac y, s ho p, m ar ke t, an d tr ad iti on al p ra ct iti on er 2 T ot al in cl ud es o ne c hi ld w ith m is si ng in fo rm at io n on ty pe o f d ia rr he a. C hi ld H ea lth • 1 57 Ta bl e 10 .9 F ee di ng p ra ct ic es d ur in g d ia rr he a P er ce nt d is tr ib ut io n of c hi ld re n un de r ag e 5 w ho h ad d ia rr he a in th e 2 w ee ks p re ce di ng th e su rv ey b y am ou nt o f l iq ui ds a nd fo od o ffe re d co m pa re d w ith n or m al p ra ct ic e, th e pe rc en ta ge o f c hi ld re n gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g du rin g th e di ar rh ea e pi so de , an d th e pe rc en ta ge o f ch ild re n w ho c on tin ue d fe ed in g an d w er e gi ve n O R T a nd /o r in cr ea se d flu id s du rin g th e ep is od e of d ia rr he a, b y ba ck gr ou nd ch ar ac te ris tic s, M ya nm ar D H S 2 01 5- 16 A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T a nd /o r in cr ea se d flu id s1 N um be r of ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic M or e S am e as u su al S om e- w ha t le ss M uc h le ss N on e D on ’t kn ow / m is si ng T ot al M or e S am e as u su al S om e– w ha t le ss M uc h le ss N on e N ev er ga ve fo od D on ’t kn ow / m is si ng T ot al A ge in m o nt hs <6 (1 3. 8) (8 0. 7) (4 .9 ) (0 .5 ) (0 .0 ) (0 .0 ) 10 0. 0 (1 .7 ) (4 5. 2) (6 .2 ) (0 .0 ) (1 8. 3) (2 8. 7) (0 .0 ) 10 0. 0 (1 .7 ) (1 2. 5) 25 6- 11 11 .2 61 .5 14 .4 7. 4 2. 6 3. 0 10 0. 0 4. 7 56 .3 10 .1 8. 7 4. 6 8. 6 7. 0 10 0. 0 8. 5 43 .7 56 12 -2 3 26 .0 51 .8 15 .4 3. 2 3. 6 0. 0 10 0. 0 8. 8 44 .4 33 .3 7. 9 4. 1 1. 4 0. 0 10 0. 0 20 .3 56 .8 14 5 24 -3 5 20 .2 59 .9 18 .1 1. 8 0. 0 0. 0 10 0. 0 3. 6 49 .2 36 .9 5. 4 3. 1 1. 8 0. 0 10 0. 0 16 .3 62 .4 90 36 -4 7 20 .7 55 .1 19 .6 3. 7 0. 9 0. 0 10 0. 0 13 .0 49 .1 27 .1 9. 2 1. 5 0. 0 0. 0 10 0. 0 19 .3 63 .7 69 48 -5 9 30 .7 36 .2 31 .4 1. 7 0. 0 0. 0 10 0. 0 3. 8 32 .5 50 .1 9. 7 3. 9 0. 0 0. 0 10 0. 0 27 .1 67 .6 42 S ex M al e 23 .7 54 .9 15 .7 3. 2 1. 7 0. 7 10 0. 0 9. 2 45 .6 30 .2 7. 4 3. 6 3. 4 0. 7 10 0. 0 20 .0 61 .8 22 5 Fe m al e 19 .5 56 .2 19 .4 3. 2 1. 8 0. 0 10 0. 0 4. 5 47 .8 30 .0 7. 4 5. 2 4. 0 1. 1 10 0. 0 14 .4 49 .3 20 3 T yp e of d ia rr he a2 N on -b lo od y 20 .9 56 .8 16 .7 3. 4 1. 8 0. 4 10 0. 0 7. 0 47 .3 29 .5 7. 0 4. 5 3. 9 1. 0 10 0. 0 16 .6 55 .4 40 5 B lo od y (3 4. 3) (3 2. 3) (3 2. 8) (0 .6 ) (0 .0 ) (0 .0 ) 10 0. 0 (6 .8 ) (3 6. 0) (4 2. 3) (1 2. 1) (2 .9 ) (0 .0 ) (0 .0 ) 10 0. 0 (3 1. 7) (6 6. 4) 21 R es id en ce U rb an 29 .2 58 .3 10 .9 0. 8 0. 9 0. 0 10 0. 0 3. 8 48 .6 26 .8 5. 9 8. 2 3. 9 2. 9 10 0. 0 24 .8 62 .5 77 R ur al 20 .1 54 .9 18 .9 3. 8 1. 9 0. 5 10 0. 0 7. 6 46 .2 30 .8 7. 7 3. 5 3. 6 0. 5 10 0. 0 15 .7 54 .4 35 0 M ot h er ’s e d uc at io n N o ed uc at io n 22 .7 52 .2 20 .7 2. 3 0. 0 2. 1 10 0. 0 6. 2 54 .2 27 .0 5. 1 3. 1 2. 3 2. 1 10 0. 0 18 .7 51 .0 78 P rim ar y 22 .2 58 .6 14 .5 2. 5 2. 3 0. 0 10 0. 0 6. 8 42 .8 31 .4 9. 0 5. 1 3. 7 1. 1 10 0. 0 17 .1 52 .9 19 7 S ec on da ry 20 .1 53 .8 19 .0 5. 3 1. 7 0. 0 10 0. 0 6. 7 49 .2 29 .2 6. 8 3. 2 4. 9 0. 0 10 0. 0 15 .9 61 .3 13 4 M or e th an s ec on da ry * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 19 W ea lt h q ui nt ile Lo w es t 19 .0 55 .6 19 .7 3. 2 1. 4 1. 1 10 0. 0 7. 7 41 .2 31 .3 10 .2 2. 2 4. 9 2. 6 10 0. 0 14 .0 54 .4 14 8 S ec on d 28 .4 47 .6 19 .1 3. 2 1. 7 0. 0 10 0. 0 7. 2 49 .4 30 .3 4. 4 6. 7 2. 1 0. 0 10 0. 0 23 .1 55 .5 11 4 M id dl e 21 .9 57 .9 13 .7 5. 4 1. 1 0. 0 10 0. 0 5. 3 45 .1 33 .9 8. 4 5. 4 2. 0 0. 0 10 0. 0 17 .5 48 .6 67 Fo ur th 14 .4 65 .6 13 .7 3. 2 3. 1 0. 0 10 0. 0 10 .2 53 .3 19 .3 5. 6 4. 4 7. 2 0. 0 10 0. 0 10 .0 60 .8 55 H ig he st (2 2. 7) (5 9. 3) (1 6. 0) (0 .0 ) (2 .0 ) (0 .0 ) 10 0. 0 (2 .4 ) (5 1. 9) (3 3. 6) (6 .2 ) (4 .3 ) (1 .6 ) (0 .0 ) 10 0. 0 (2 2. 7) (6 6. 4) 43 T ot al 21 .7 55 .5 17 .5 3. 2 1. 7 0. 4 10 0. 0 6. 9 46 .6 30 .1 7. 4 4. 4 3. 7 0. 9 10 0. 0 17 .3 55 .8 42 7 N ot e: It is r ec om m en de d th at c hi ld re n be g iv en m or e liq ui ds to d rin k du rin g di ar rh ea a nd th at fo od n ot b e re du ce d. F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. D at a by s ta te s an d re gi on s ar e no t s ho w n du e to v er y fe w c as es . 1 C on tin ue d fe ed in g in cl ud es c hi ld re n w ho w er e gi ve n m or e, th e sa m e as u su al , o r so m ew ha t l es s fo od d ur in g th e di ar rh ea e pi so de . 2 T ot al in cl ud es o ne c hi ld w ith m is si ng in fo rm at io n on ty pe o f d ia rr he a. 158 • Child Health Table 10.10 Symptoms of childhood illness that prompt treatment Percent distribution of women age 15-49 who reported six major symptoms of childhood illness that would prompt them to take their child to a health facility immediately, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Fever Becomes sicker Diarrhea Develops rashes Difficult breathing Signs of dengue1 Number of respon- dents Age 15-19 52.5 41.8 29.7 10.7 5.6 4.5 1,810 20-24 55.8 41.1 35.1 10.5 6.5 5.0 1,867 25-34 62.3 42.3 35.4 11.9 7.6 6.0 3,904 35-49 59.7 42.7 36.0 14.3 6.0 7.1 5,305 Residence Urban 64.1 37.2 35.2 17.7 7.8 4.2 3,768 Rural 56.7 44.3 34.7 10.4 6.0 6.9 9,117 States/Regions Kachin 54.9 45.3 19.1 6.2 5.1 1.1 374 Kayah 49.6 40.7 38.7 3.3 4.3 1.6 65 Kayin 59.7 44.8 33.0 4.5 4.7 1.3 303 Chin 26.6 64.1 29.4 1.2 3.2 0.2 102 Sagaing 50.7 44.7 19.3 14.2 3.0 0.1 1,410 Tanintharyi 66.9 39.1 59.1 19.1 5.6 2.8 283 Bago 56.7 41.6 36.4 8.7 9.8 18.2 1,244 Magway 50.6 31.5 46.5 14.3 9.1 13.7 1,081 Mandalay 61.1 42.4 34.2 11.6 6.4 15.4 1,541 Mon 47.8 73.8 32.8 8.9 5.8 5.1 463 Rakhine 66.2 65.7 49.5 4.8 6.7 2.1 777 Yangon 69.4 26.4 49.0 25.5 8.5 0.3 1,927 Shan 54.9 49.7 15.5 2.6 3.5 0.2 1,368 Ayeyarwady 62.1 37.3 31.8 13.7 6.1 4.3 1,650 Nay Pyi Taw 65.8 47.1 40.5 15.4 11.4 11.3 300 Education2 No education 55.6 49.4 27.9 5.4 4.1 2.2 1,606 Primary 58.3 41.7 35.3 11.1 6.5 6.9 5,305 Secondary 58.8 41.7 35.5 14.5 6.7 6.4 4,646 More than secondary 65.6 37.8 39.0 20.0 8.9 6.2 1,325 Wealth quintile Lowest 56.1 46.8 34.3 6.5 5.6 4.1 2,274 Second 56.6 42.0 35.8 10.7 6.4 5.6 2,408 Middle 57.3 42.4 36.2 12.1 6.0 7.5 2,633 Fourth 60.1 42.5 32.7 13.1 7.4 7.4 2,702 Highest 63.4 38.5 35.0 18.7 6.9 5.5 2,868 Total 58.9 42.3 34.8 12.5 6.5 6.1 12,885 1 Symptoms of dengue include sudden high fever, severe headaches, pain behind the eyes, severe muscle and joint pain, fatigue, nausea, vomiting, and skin rash. 2 Total includes three women with missing information on education. Child Health • 159 Table 10.11 Disposal of children’s stools Percent distribution of youngest children under age 5 living with their mother by the manner of disposal of the child’s last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Left in the open Other Age in months <6 2.6 25.0 1.4 56.1 9.0 5.0 0.9 100.0 29.0 399 6-11 2.9 35.2 4.2 37.4 8.7 10.7 0.9 100.0 42.3 399 12-23 5.1 45.8 2.6 20.6 10.4 15.0 0.5 100.0 53.6 823 24-35 20.1 45.6 4.1 7.6 7.4 14.9 0.3 100.0 69.8 681 36-47 45.6 32.1 2.6 3.7 3.7 12.2 0.1 100.0 80.3 671 48-59 60.0 23.3 1.4 2.6 2.3 10.1 0.3 100.0 84.7 525 Toilet facility2 Improved, not shared 26.2 40.1 2.3 16.3 8.4 6.6 0.2 100.0 68.6 1,489 Shared3 23.6 41.3 1.9 15.2 6.4 11.6 0.1 100.0 66.7 346 Not improved 21.1 31.6 3.4 20.3 5.8 17.1 0.8 100.0 56.1 1,663 Residence Urban 28.8 44.9 0.5 14.7 8.2 2.8 0.2 100.0 74.2 822 Rural 21.9 33.5 3.5 19.1 6.6 14.9 0.5 100.0 58.8 2,676 States/Regions Kachin 39.8 21.0 3.7 8.7 10.0 16.9 0.0 100.0 64.4 130 Kayah 21.7 44.8 3.0 12.6 3.4 14.1 0.4 100.0 69.5 23 Kayin 17.8 27.1 4.0 18.8 8.1 18.9 5.3 100.0 48.9 110 Chin 28.7 20.0 2.0 26.9 4.7 17.7 0.0 100.0 50.7 40 Sagaing 37.8 21.5 4.7 16.8 12.3 6.9 0.0 100.0 64.1 390 Tanintharyi 16.5 33.4 1.2 18.1 3.1 27.7 0.0 100.0 51.1 100 Bago 27.4 37.7 4.0 14.3 1.8 14.8 0.0 100.0 69.1 324 Magway 20.3 52.8 1.5 14.5 6.1 4.9 0.0 100.0 74.6 266 Mandalay 7.6 42.9 1.8 18.8 16.1 12.9 0.0 100.0 52.3 374 Mon 20.6 32.5 4.4 20.4 7.5 14.0 0.5 100.0 57.5 119 Rakhine 6.3 17.1 3.1 24.3 6.1 40.2 2.8 100.0 26.6 236 Yangon 35.8 40.5 0.0 13.3 9.5 0.9 0.0 100.0 76.3 378 Shan 21.1 37.3 2.2 24.3 4.8 10.3 0.0 100.0 60.6 447 Ayeyarwady 22.7 47.9 3.5 19.3 0.8 5.6 0.3 100.0 74.0 481 Nay Pyi Taw 25.3 25.8 4.9 18.1 1.9 22.4 1.5 100.0 56.0 80 Mother’s education No education 18.2 28.0 3.2 20.3 6.8 21.9 1.6 100.0 49.4 565 Primary 23.2 34.4 3.5 18.3 6.6 13.7 0.3 100.0 61.0 1,593 Secondary 25.8 39.3 2.2 17.8 7.4 7.5 0.1 100.0 67.2 1,045 More than secondary 27.2 50.5 0.3 13.9 7.2 0.9 0.0 100.0 78.0 295 Wealth quintile Lowest 15.7 30.6 3.5 20.0 5.7 23.4 1.1 100.0 49.8 954 Second 22.1 34.6 4.4 19.0 5.5 13.8 0.6 100.0 61.2 760 Middle 27.1 35.7 2.7 19.3 6.9 8.1 0.1 100.0 65.5 611 Fourth 28.3 38.5 1.7 18.0 6.9 6.5 0.1 100.0 68.5 625 Highest 29.5 45.9 0.5 12.0 11.3 0.8 0.0 100.0 75.9 547 Total 23.5 36.2 2.8 18.1 7.0 12.1 0.4 100.0 62.4 3,498 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine, or if it was buried. 2 See Table 2.2 for definition of categories. 3 Facilities that would be considered improved if they were not shared by two or more households Nutrition of Children and Women • 161 NUTRITION OF CHILDREN AND WOMEN 11 Key Findings  Nutritional status of children: Twenty-nine percent of children under age 5 are stunted (short for their age), 7% are wasted (thin for their height), 19% are underweight (thin for their age), and 1% are overweight (heavy for their height).  Breastfeeding: Almost all children (98%) are breastfed at some point in their life. Half of infants under age 6 months are exclusively breastfed (51%).  Minimum acceptable diet: The feeding practices of only 16% of children age 6-23 months meet the minimum acceptable dietary standards.  Anemia: Almost three in five children age 6-59 months are anemic (58%), and 47% of women age 15-49 are anemic.  Salt iodization: Eighty-two percent of households use iodized salt for cooking.  Obesity: Twenty-five percent of women age 15-49 are overweight or obese; 6% are obese. his chapter focuses on the nutritional status of children and women. It describes the nutritional status of children under age 5 and infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods. Also covered are the diversity of foods fed and the frequency of feeding as well as micronutrient status, supplementation, and fortification. Relevant aspects of the nutritional status of women age 15-49 are addressed. 11.1 NUTRITIONAL STATUS OF CHILDREN The anthropometric data on height and weight collected in the 2015-16 MDHS permit the measurement and evaluation of the nutritional status of young children in Myanmar. This evaluation allows identification of subgroups of the child population that are at increased risk of faltered growth, disease, impaired mental development, and death. 11.1.1 Measurement of Nutritional Status among Young Children The 2015-16 MDHS collected data on the nutritional status of children by measuring the height and weight of children under age 5 in all sampled households, regardless of whether their mother was interviewed in the survey. Weight measurements were obtained using lightweight SECA mother-infant scales with a digital screen, designed and manufactured under the guidance of UNICEF. Height measurements were carried out using a Shorr Productions measuring board. Children younger than age 24 months were measured lying down on the board (recumbent length), and standing height was measured for older children. Mid-upper-arm circumference (MUAC) was measured for children age 0-59 months using standard tapes supplied by UNICEF that were calibrated with the new WHO Child Growth Standards. T 162 • Nutrition of Children and Women Children’s height/length, weight, and age data were used to calculate three indices: height-for-age, weight- for-height, and weight-for-age. Each of these indices provides different information about growth and body composition for assessing nutritional status. As indicated in the box below, stunting, or low height-for-age, is a sign of chronic undernutrition that reflects failure to receive adequate nutrition over a long period. Stunting can also be affected by recurrent and chronic illness. Wasting, or low weight-for-height, is a measure of acute undernutrition and represents the failure to receive adequate nutrition in the period immediately before the survey. Wasting may result from inadequate food intake or from a recent episode of illness causing weight loss. The opposite of wasting is overweight (high weight-for-height), a measure of overnutrition. Weight-for-age is a composite index of weight-for-height and height-for-age. Thus, it includes both acute (wasting) and chronic (stunting) undernutrition and is an indicator of overall undernutrition. Stunting, or height-for-age Height-for-age is a measure of linear growth retardation and cumulative growth deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age (stunted), or chronically undernourished. Children whose Z-score is below minus three standard deviations (-3 SD) from the median are considered severely stunted. Sample: Children under age 5 Wasting, or weight-for-height The weight-for-height index measures body mass in relation to body height or length and describes current nutritional status. Children whose weight-for- height Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered thin (wasted), or acutely undernourished. Children whose Z-score is below minus three standard deviations (-3 SD) from the median are considered severely wasted. Sample: Children under age 5 Underweight, or weight-for-age Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic undernutrition. Children whose weight-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are classified as underweight. Children whose Z-score is below minus three standard deviations (-3 SD) from the median are considered severely underweight. Sample: Children under age 5 Overweight in children Children whose weight-for-height Z-score is more than two standard deviations (+2 SD) above the median of the reference population are considered overweight. Sample: Children under age 5 The means of the Z-scores for height-for-age, weight-for-height, and weight-for-age are also calculated as summary statistics representing the nutritional status of children in a population. These mean scores describe the nutritional status of the entire population of children without the use of a cutoff point. A mean Z-score of less than 0 (i.e., a negative mean value for stunting, wasting, or underweight) suggests a downward shift in the entire sample population’s nutritional status relative to the reference population. The farther away mean Z-scores are from 0, the higher the prevalence of undernutrition. Nutrition of Children and Women • 163 11.1.2 Data Collection A total of 4,594 children under age 5 were present in the MDHS sample households at the time of the survey, and complete and credible anthropometric (height and weight) data were collected for 4,100 of these children (89%). 11.1.3 Levels of Child Malnutrition According to the 2015-16 MDHS, 29% of children under age 5 are stunted and 8% are severely stunted, indicating chronic undernourishment. Seven percent are wasted and 1% are severely wasted, indicating acute undernutrition. Nineteen percent of children under age 5 are underweight, and 4% are severely underweight. Only 1% of children under age 5 are overweight (Table 11.1, Figure 11.1). These figures imply that there has been some recent improvement in child undernutrition; the results of the 2009-10 Multiple Indicators Cluster Survey (MICS) showed that 35% of children under age 5 in Myanmar were stunted. Similarly, 8% were wasted and 23% were underweight (MNPED and MOH 2011). Patterns by background characteristics  Stunting becomes more prominent as children grow older, with the peak prevalence of moderate and severe stunting at age 24-35 months.  Children in rural areas are more likely to be stunted (32%) than those in urban areas (20%).  The proportions of children who are stunted and underweight both decline with increasing mother’s education and increasing household wealth (Table 11.1, Figure 11.2). Figure 11.1 Nutritional status of children Figure 11.2 Stunting in children by mother’s education 21 6 15 8 1 4 29 7 19 1 Stunting Wasting Underweight Overweight Percentage of children under age 5 classified as malnourished Severe Moderate 39 32 23 17 No education Primary Secondary More than secondary Percentage of children under age 5 who are stunted 164 • Nutrition of Children and Women  Stunting among children is highest in Chin State, at 41%, with 13% severely stunted (Figure 11.3).  Overall, the nutritional status of children in Rakhine State is the worst in the country, with 38% of children stunted (18% severely stunted), 14% wasted, and 34% underweight. For information on results regarding mid-upper-arm circumference, see Table 11.2. 11.2 INFANT AND YOUNG CHILD FEEDING PRACTICES Appropriate infant and young child feeding (IYCF) practices include exclusive breastfeeding in the first 6 months of life, continued breastfeeding through age 2, introduction of solid and semisolid foods at age 6 months, and gradual increases in the amount and texture of food given and frequency of feeding as the child gets older. It is also important for young children to receive a diverse diet (i.e., foods from different food groups to address growing micronutrient needs) (WHO 2008). 11.2.1 Breastfeeding Initiation of Breastfeeding Early initiation of breastfeeding is important for both the mother and the child. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also encourages bonding between the mother and her newborn, facilitating the production of regular breast milk. Thus, it is recommended that children be put to the breast immediately or within 1 hour after birth and that prelacteal feeding (i.e., feeding newborns anything other than breast milk before breast milk is regularly given) be discouraged. Early breastfeeding Initiation of breastfeeding within 1 hour of birth. Sample: Last-born children who were born in the 2 years before the survey The Ministry of Health and Sports (MoHS) encourages facility delivery and supports the Baby Friendly Hospital Initiative (MoHS 2015a), in which early initiation of breastfeeding and rooming-in practices to increase bonding and protect newborns from harmful external environments are promoted. The MDHS results showed that 98% of last-born children in the 2 years before the survey had ever been breastfed; however, 20% received prelacteal feeding (Table 11.3). Myanmar complies with the National Strategy on Infant and Young Child Feeding (IYCF) (2011-2016), which encourages mothers to breastfeed exclusively until the child is age 6 months without any water, other fluids, or food (MoHS 2011). Patterns by background characteristics  Newborns delivered at a health facility are more likely to be given prelacteal feeding (23%) than those delivered at home (18%). Figure 11.3 Stunting in children by states and regions Percentage of children under age 5 who are stunted Nutrition of Children and Women • 165  Children in Rakhine State are least likely to be breastfed within 1 hour of birth (37%); that state also has the highest percentage of children receiving prelacteal feeding, contrary to recommendations.  Newborns in the highest wealth quintile are more likely to receive prelacteal feeding (23%) than newborns in the other wealth quintiles. 11.2.2 Exclusive Breastfeeding Breast milk contains all of the nutrients needed by children in the first 6 months of life and is an uncontaminated nutritional source. It is recommended that children be exclusively breastfed in the first 6 months of their life; that is, they should be given nothing but breast milk. Complementing breast milk before age 6 months is unnecessary and is discouraged because the likelihood of contamination and the resulting risk of diarrheal disease are high. Early initiation of complementary feeding also reduces breast milk output because the production and release of breast milk is modulated by the frequency and intensity of suckling. Table 11.4 and Figure 11.4 show breastfeeding practices according to the child’s age group. Only half of infants under age 6 months are exclusively breastfed (51%). Conversely, many children in this age group are given plain water (19%) and complementary foods (21%) in addition to breast milk. The 2009-10 MICS indicated that only 24% of children under age 6 months in Myanmar were exclusively breastfed (MNPED and MOH 2011). Figure 11.5 shows that among children under age 24 months, 12% are being fed using bottles with nipples, which is contrary to the Breast Milk Substitute Order of Myanmar launched in 2014 (MoHS 2014c). Overall, 71% of children under age 24 months are receiving age-appropriate breastfeeding, and 75% of children age 6-8 months are being given complementary foods. Although breastfeeding durations are fairly long—88% of children are still breastfeeding at age 1 and 64% continue breastfeeding until their second birthday—the exclusive breastfeeding interval is still too short, with only half of children under age 6 months being exclusively breastfed. Figure 11.4 Breastfeeding practices by age 0 20 40 60 80 100 <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 age in months Percentage of children under age 2 Breastfeeding and receiving complementary foods Not breastfeeding Exclusive breastfeeding 166 • Nutrition of Children and Women Figure 11.5 IYCF breastfeeding indicators 11.2.3 Median Duration of Breastfeeding The median duration of breastfeeding in Myanmar is 23.7 months; that is, half of children are breastfed until age 23.7 months. The median duration of exclusive breastfeeding is 2.3 months, and the median duration of predominant breastfeeding (the period in which a child receives only water or other non-milk liquids in addition to breast milk) is 4.6 months (Table 11.5). Patterns by background characteristics  Children in rural areas have a longer median duration of breastfeeding than those in urban areas (25.1 months and 21.4 months, respectively).  The median duration of breastfeeding declines as mother’s education and household wealth increase. 11.2.4 Complementary Feeding After the first 6 months, breast milk is no longer sufficient to meet the nutritional needs of the infant; therefore, complementary foods should be added to the child’s diet. The transition from exclusive breastfeeding to family foods is referred to as complementary feeding. This is the most critical period for children, as during this transition they are most vulnerable to becoming undernourished. Complementary feeding should be timely; that is, all infants should start receiving foods in addition to breast milk from 6 months onwards. Appropriate complementary feeding should include feeding children a variety of foods to ensure that requirements for nutrients are met. Fruits and vegetables rich in vitamin A should be consumed daily. Eating a range of fruits and vegetables, in addition to those rich in vitamin A, is also important. Studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs for certain micronutrients. Therefore, it has been recommended that meat, poultry, fish, or eggs be part of the child’s daily diet as well or eaten as often as possible (WHO 1998). In the 2015-16 MDHS, women who had at least one child living with them who was born in 2013 or later were asked questions about the types of liquids and foods the child had consumed during the day or night 12 71 75 64 88 72 38 51 Bottle feeding (0-23 months) Age-appropriate breastfeeding** (0-23 months) Introduction of solid, semisolid or soft foods (6-8 months) Continued breastfeeding at 2 years Continued breastfeeding at 1 year Predominant breastfeeding* (0-5 months) Exclusive breastfeeding at age 4-5 months Exclusive breastfeeding under age 6 months * Predominant breastfeeding includes exclusive breastfeeding, breastfeeding plus water, and breastfeeding plus non-milk liquids/juice **Age appropriate breastfeeding = Children age 0-5 months who are exclusively breastfed + children age 6-23 months who receive breast milk and complementary foods Nutrition of Children and Women • 167 before the interview. Mothers who had more than one child born in 2013 or a later year were asked questions about the youngest child living with them. Table 11.6 indicates the types of foods and liquids received by children during the day and night before the interview by their age and breastfeeding status. Overall, food made from grains was the most commonly consumed item, followed by meat, fish, and poultry and vitamin A-rich fruits and vegetables. Patterns by background characteristics  Ninety-two percent of breastfeeding children age 6-23 months receive complementary foods, as compared with 97% of nonbreastfeeding children in the same age group.  Thirty-eight percent of breastfeeding children age 6-23 months consumed fruits and vegetables rich in vitamin A in the 24 hours before the survey, compared with 45% of nonbreastfeeding children of the same age.  Thirty percent of breastfeeding children and 39% of nonbreastfeeding children age 6-23 months consumed eggs during the 24 hours before the survey.  Forty-two percent of breastfeeding children and 59% of nonbreastfeeding children age 6-23 months consumed meat, fish, and/or poultry in the 24 hours before the survey. 11.2.5 Minimum Acceptable Diet Infant and young children should be fed a minimum acceptable diet to ensure appropriate growth and development. Without adequate dietary diversity and meal frequency, infants and young children are vulnerable to undernutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. The WHO minimum acceptable diet recommendation, which is a combination of dietary diversity and minimum meal frequency, is different for breastfed and nonbreastfed children. The composite indicator of a minimum acceptable diet for all children age 6-23 months is defined in the box below. Dietary diversity is a proxy for adequate micronutrient density of foods. Minimum dietary diversity means feeding the child food from at least four food groups. The cut-off of four food groups is associated with better-quality diets for both breastfed and nonbreastfed children. Consumption of food from at least four groups means that the child has a high likelihood of consuming at least one animal source of food and at least one fruit or vegetable in addition to a staple food (grains, roots, or tubers) (WHO 2008). The four groups should come from a list of seven food groups: grains, roots, and tubers; legumes and nuts; dairy products (milk, yogurt, cheese); flesh foods (meat, fish, poultry, and liver/organ meat); eggs; vitamin A- rich fruits and vegetables; and other fruits and vegetables. Minimum meal frequency is a proxy for a child’s energy requirements. For infants and young children, the indicator is based on how much energy the child needs and, if the child is breastfed, the amount of energy needs not met by breast milk. Breastfed children are considered to be fed with a minimum meal frequency if they receive solid, semisolid, or soft foods at least twice a day (for infants age 6-8 months) or at least three times a day (for children age 9-23 months). Nonbreastfed children age 6-23 months are considered to be fed with a minimum meal frequency if they receive solid, semisolid, or soft foods at least four times a day. 168 • Nutrition of Children and Women Minimum acceptable diet Proportion of children age 6-23 months who receive a minimum acceptable diet (apart from breast milk). This composite indicator is calculated from the following two fractions: Breastfed children age 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day Breastfed children age 6-23 months and Nonbreastfed children age 6-23 months who received at least two milk feedings and had at least the minimum dietary diversity (not including milk feeds) and the minimum meal frequency during the previous day Nonbreastfed children age 6-23 months According to the MDHS results, the feeding practices of only 16% of children in Myanmar age 6-23 months meet the minimum standards with respect to all three IYCF practices (i.e., breastfeeding status, number of food groups, and times they were fed during the day or night before the survey) (Table 11.7). Twenty-five percent of children had an adequately diverse diet—that is, they had been given foods from the appropriate number of food groups—and 58% had been fed the minimum number of times appropriate for their age (Figure 11.6). Patterns by background characteristics  Breastfed children are much less likely to receive the minimum number of food groups than nonbreastfed children (22% and 42%, respectively).  Children in urban areas (21%) are more likely to be fed according to the three recommended IYCF practices than those in rural areas (14%).  Children whose mothers have more education and those who are from the higher wealth quintiles are more likely to be fed according to the three recommended IYCF practices than those whose mothers have less education and those from the lower wealth quintiles. 11.3 ANEMIA PREVALENCE IN CHILDREN Anemia prevalence Any anemia is defined as a blood hemoglobin level below 11.0 g/dl in children. In the DHS, severe anemia is defined as below 7.0 g/dl; moderate anemia is defined as 7.0-9.9 g/dl. Sample: Children age 6-59 months Figure 11.6 IYCF indicators on minimum acceptable diet 22 58 17 42 54 11 25 58 16 Minimum dietary diversity (IYCF Indicator 5) Minimum meal frequency (IYCF Indicator 6) Minimum acceptable diet (IYCF Indicator 7) Percentage of children age 6-23 months Breastfed Nonbreastfed All children 6-23 months Nutrition of Children and Women • 169 Anemia is a condition that is marked by low levels of hemoglobin in the blood. Iron is a key component of hemoglobin, and iron deficiency is estimated to be responsible for half of all anemia globally. Other causes of anemia include malaria, hookworm and other helminths, other nutritional deficiencies, chronic infections, and genetic conditions. Anemia is a serious concern for children because it can impair cognitive development, stunt growth, and increase morbidity from infectious diseases. As part of the MDHS, hemoglobin testing was carried out among children age 6-59 months. Overall, 58% of children had anemia, with 31% having mild anemia, 26% having moderate anemia, and only 1% having severe anemia (Table 11.8, Figure 11.7). Patterns by background characteristics  The prevalence of anemia declines with the child’s age, ranging from a high of 81% among children age 6-8 months to a low of 41% among children age 48-59 months.  Children from Sagaing Region have the highest prevalence of anemia (71%), followed by those from Yangon Region (66%) and Tanintharyi Region, Ayeyarwady Region, and Rakhine State (62% each); those from Shan State have the lowest prevalence (40%) (Figure 11.8). 11.4 MICRONUTRIENT INTAKE AND SUPPLEMENTATION AMONG CHILDREN Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Micronutrients are available in foods and can also be provided through direct supplementation. Breastfeeding children benefit from supplements given to their mother. The information collected on food consumption among the youngest children under age 2 is useful in assessing the extent to which children are consuming food groups rich in two key micronutrients—vitamin A and iron—in their daily diet. Iron deficiency is one of the primary causes of anemia, which has serious health consequences for both women and children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage and is the leading cause of childhood blindness. VAD also increases the severity of infections such as measles and diarrheal disease in children and slows recovery from illness. VAD is common in dry environments where fresh fruits and vegetables are not readily available. In addition to questions on food consumption, the 2015-16 MDHS included Figure 11.7 Childhood anemia status by residence Figure 11.8 Anemia prevalence in children by states and regions Percentage of children age 6-59 months with any anemia 36 30 31 23 27 26 0.3 1 1 59 58 58 Urban Rural Total Percentage of children age 6-59 months Moderate Mild Severe 170 • Nutrition of Children and Women questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the 6 months before the survey. Seventy percent of children age 6-23 months consumed foods rich in vitamin A in the 24 hours before the interview, and 59% consumed foods rich in iron. Among children age 6-59 months, only half (54%) received vitamin A supplementation in the 6 months before the survey, and less than half (43%) received deworming medication (albendazole) during that period (Table 11.9). Patterns by background characteristics  Among children age 6-23 months, the percentage who consumed foods rich in vitamin A and foods rich in iron in the 24 hours before the interview increases with increasing age. Similarly, among children age 6-59 months, older children are more likely to be given deworming medication than younger children.  Nonbreastfed children are more likely than breastfed children to have consumed foods rich in vitamin A and foods rich in iron in the 24 hours before the survey.  There are strong differences in micronutrient intake by state/region. For example, the proportion of children age 6-59 months who received a vitamin A supplement in the 6 months before the survey varies from 44% in Kayin State to 82% in Kayah State. 11.5 PRESENCE OF IODIZED SALT IN HOUSEHOLDS Iodine is an essential micronutrient, and iodized salt prevents goiter and other thyroid-related health problems among children and adults. In line with food and drug regulations, household salt should be fortified with iodine to at least 15 parts per million. The 2015-16 MDHS tested for the presence of iodine in household salt; overall, salt was tested in 98% of households (Table 11.10). The aim of the Health Management Information System (HMIS) is for at least 90% of households to use qualified iodized salt for cooking (MoHS, 2012). However, the MDHS results showed that only 82% of households in which salt was tested had iodized salt. It should be noted that household salt was tested for the presence or absence of iodine only; the iodine content in the salt was not measured. Patterns by background characteristics  Over 90% of households in Kachin State, Kayah State, Bago Region, Mandalay Region, Yangon Region, and Nay Pyi Taw used iodized salt.  Households in the coastal areas—Tanintharyi Region (32%), Ayeyarwady Region (52%), Rakhine State (60%), and Mon State (79%)—are less likely to use iodized salt. 11.6 NUTRITIONAL STATUS OF WOMEN The 2015-16 MDHS collected anthropometric data on height and weight for 98% of the women age 15-49 interviewed in the survey. These data were used to calculate several measures of nutritional status, specifically maternal height and body mass index (BMI). Information on BMI is presented in Table 11.11. Nutrition of Children and Women • 171 Body mass index (BMI) BMI is calculated by dividing weight in kilograms by height in meters squared (kg/m2). A BMI of less than 18.5 indicates that respondents are too thin for their height (that is, they have a chronic energy deficiency). At the other end of the BMI scale, women are considered overweight if their BMI falls between 25.0 and 29.9 and obese if their BMI is greater than or equal to 30.0. Sample: Women age 15-49 who are not pregnant and who have not had a birth in the 2 months before the survey Among women age 15-49, 6% are of short stature (below 145 cm). The mean BMI for women age 15-49 is 22.5. Sixteen percent of women are thin (BMI below 18.5), while 60% have a normal BMI (between 18.5 and 24.9); 25% are overweight or obese, and 6% are obese (Table 11.11). Patterns by background characteristics  Chin State has the highest proportion of women (14%) who are of short stature (under 145 cm).  The proportion of women who are overweight or obese is higher in urban areas (33%) than in rural areas (21%). Conversely, women in rural areas are more likely to be thin or of normal BMI than women in urban areas.  Yangon Region has the highest percentage of women classified as overweight (26%) and obese (8%).  The proportion of women who are overweight or obese tends to rise with increasing education and wealth. 11.7 ANEMIA PREVALENCE IN WOMEN Anemia prevalence Any anemia is defined as a blood hemoglobin level below 11.0 g/dl in pregnant women and below 12.0 g/dl in nonpregnant women. The cut-offs are adjusted for altitude for enumeration areas above 1,000 meters and for cigarette smoking. Sample: Women age 15-49 Anemia among women age 15-49 was measured using capillary blood collected from a finger prick. Hemoglobin was successfully measured for almost all of the women interviewed. Nearly half of women (47%) are anemic (Table 11.12). Thirty-eight percent are classified as mildly anemic, 8% as moderately anemic, and 1% as severely anemic (Figure 11.9). Patterns by background characteristics  Pregnant women are more likely to be anemic (57%) than those who are lactating (48%) or those who are neither pregnant nor lactating (46%) (Figure 11.9).  Anemia is slightly more prevalent among women who have had six or more births and among women who are using IUDs.  Women in Rakhine State and Tanintharyi Region (55% each) are most likely to be anemic. Figure 11.9 Anemia in women 29 40 38 28 8 8 0.4 0.3 0.6 57 48 46 Pregnant Breastfeeding Neither Percentage of women age 15-49 Moderate Mild Severe Any 172 • Nutrition of Children and Women 11.8 MICRONUTRIENT INTAKE AMONG MOTHERS The 2015-16 MDHS included questions to ascertain whether mothers had received vitamin A supplements after birth and whether they had taken iron supplements or deworming medication during pregnancy. The MoHS provides vitamin A supplements to postpartum women (200,000 IU) within 42 days of their delivery, provides iron supplements (180 tablets during pregnancy) and deworming tablets (one tablet after the first trimester) to pregnant women, and offers education on eating iron-rich foods and avoiding parasites to prevent anemia. Only 35% of women age 15-49 who gave birth in the 5 years before the survey received vitamin A supplementation during the first 2 months after delivery. Almost 60% of women took iron supplements for at least 90 days during their pregnancy. Only 55% of women took deworming tablets during the pregnancy of their last birth (Table 11.13). Eighty-one percent of women who delivered their last child in the 5 years before the survey lived in households with iodized salt. Patterns by background characteristics  Women in urban areas were more likely than those in rural areas to have received postpartum vitamin A supplements (43% versus 33%), to have taken iron supplements during pregnancy for at least 90 days (76% versus 54%), to have taken deworming tablets during pregnancy (60% versus 54%), and to live in households with iodized salt (93% versus 77%).  Women with more education and those from the highest wealth quintile are more likely to have received a postpartum vitamin A supplement and iron tablets during pregnancy than less educated and less wealthy women. LIST OF TABLES For more information on nutrition of children and women, see the following tables:  Table 11.1 Nutritional status of children  Table 11.2 Mid-upper-arm circumference among children  Table 11.3 Initial breastfeeding  Table 11.4 Breastfeeding status by age  Table 11.5 Median duration of breastfeeding  Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview  Table 11.7 Infant and young child feeding (IYCF) practices  Table 11.8 Prevalence of anemia in children  Table 11.9 Micronutrient intake among children  Table 11.10 Presence of iodized salt in household  Table 11.11 Nutritional status of women  Table 11.12 Prevalence of anemia in women  Table 11.13 Micronutrient intake among mothers N ut rit io n of C hi ld re n an d W om en • 1 73 Ta bl e 11 .1 N ut ri tio na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r ag e 5 cl as si fie d as m al no ur is he d ac co rd in g to th re e an th ro po m et ric in di ce s of n ut rit io na l s ta tu s: h ei gh t- fo r- ag e, w ei gh t-f or -h ei gh t, an d w ei gh t- fo r- ag e, b y ba ck gr ou nd c ha ra ct er is tic s, M ya nm ar D H S 2 01 5- 16 H ei gh t-f or -a ge 1 W ei gh t-f or -h ei gh t W ei gh t-f or -a ge B ac kg ro un d ch ar ac te ris tic P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 M ea n Z- sc or e (S D ) N um be r o f ch ild re n P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 P er ce nt ag e ab ov e +2 S D M ea n Z- sc or e (S D ) N um be r o f ch ild re n P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 P er ce nt ag e ab ov e +2 S D M ea n Z- sc or e (S D ) N um be r o f ch ild re n A ge in m on th s <6 2. 7 6. 6 -0 .3 33 8 4. 5 12 .9 3. 0 -0 .4 34 0 2. 9 9. 8 1. 6 -0 .5 34 1 6- 8 5. 7 14 .5 -0 .5 20 5 0. 3 4. 9 2. 7 -0 .3 20 2 5. 0 15 .5 2. 0 -0 .6 20 5 9- 11 2. 7 15 .3 -0 .8 19 1 0. 4 8. 7 2. 9 -0 .6 19 2 1. 1 10 .8 1. 3 -0 .8 19 2 12 -1 7 4. 2 16 .1 -1 .0 44 5 2. 5 10 .1 1. 3 -0 .6 44 4 3. 6 16 .0 0. 8 -0 .9 45 0 18 -2 3 10 .8 31 .4 -1 .6 39 1 1. 6 5. 8 1. 4 -0 .5 38 6 4. 2 17 .6 1. 1 -1 .1 39 1 24 -3 5 12 .1 40 .6 -1 .7 77 8 1. 1 5. 7 0. 6 -0 .5 78 0 4. 3 21 .6 0. 0 -1 .3 78 1 36 -4 7 10 .3 35 .9 -1 .6 90 5 0. 5 5. 4 0. 6 -0 .5 89 6 3. 2 21 .0 0. 2 -1 .3 90 3 48 -5 9 7. 4 32 .9 -1 .6 83 7 0. 9 6. 6 1. 3 -0 .6 83 5 4. 2 22 .9 0. 6 -1 .4 83 7 S ex M al e 8. 9 31 .0 -1 .4 2, 11 6 1. 5 7. 7 1. 6 -0 .5 2, 09 9 3. 7 19 .9 0. 6 -1 .1 2, 11 7 Fe m al e 7. 6 27 .2 -1 .3 1, 97 4 1. 2 6. 3 1. 0 -0 .5 1, 97 7 3. 8 17 .9 0. 8 -1 .1 1, 98 3 B ir th in te rv al in m on th s3 Fi rs t b irt h4 5. 6 25 .0 -1 .2 1, 31 9 2. 0 8. 0 1. 4 -0 .6 1, 31 3 3. 1 17 .2 1. 3 -1 .0 1, 32 6 <2 4 16 .7 42 .1 -1 .7 30 0 0. 9 6. 1 1. 9 -0 .5 30 0 7. 3 25 .8 0. 0 -1 .3 30 0 24 -4 7 11 .5 36 .0 -1 .5 85 2 1. 2 7. 2 1. 3 -0 .5 84 6 4. 6 22 .3 0. 4 -1 .3 85 3 48 + 6. 3 25 .2 -1 .3 1, 28 0 1. 0 6. 9 1. 0 -0 .5 1, 27 9 2. 7 17 .7 0. 2 -1 .1 1, 28 2 S iz e at b ir th 3 V er y sm al l 5. 9 32 .8 -1 .5 53 (0 .0 ) (1 5. 7) (0 .2 ) (- 1. 1) 52 (0 .9 ) (3 4. 9) (0 .0 ) (- 1. 7) 52 S m al l 16 .5 42 .1 -1 .7 41 3 1. 6 7. 3 1. 9 -0 .7 41 2 10 .3 35 .4 1. 6 -1 .5 41 5 A ve ra ge o r l ar ge r 6. 9 26 .7 -1 .3 3, 13 5 1. 4 6. 8 1. 2 -0 .5 3, 12 5 2. 7 16 .5 0. 6 -1 .1 3, 14 5 D on ’t kn ow 9. 2 37 .3 -1 .5 14 9 1. 4 13 .3 1. 1 -0 .7 14 9 5. 6 24 .2 0. 0 -1 .4 14 9 M ot he r’ s in te rv ie w s ta tu s In te rv ie w ed 8. 1 28 .9 -1 .3 3, 75 1 1. 4 7. 3 1. 3 -0 .5 3, 73 9 3. 7 19 .2 0. 6 -1 .1 3, 76 2 N ot in te rv ie w ed b ut in ho us eh ol d 14 .6 40 .5 -1 .4 78 0. 0 4. 9 2. 2 -0 .2 78 4. 7 15 .0 0. 0 -0 .9 78 N ot in te rv ie w ed a nd n ot in th e ho us eh ol d5 8. 7 29 .0 -1 .4 26 1 1. 1 3. 7 1. 5 -0 .4 25 9 4. 2 16 .2 1. 4 -1 .1 26 0 M ot he r’ s nu tr iti on al s ta tu s6 Th in (B M I < 1 8. 5) 8. 5 34 .9 -1 .5 43 9 0. 7 10 .4 1. 0 -0 .8 43 7 4. 7 28 .5 0. 4 -1 .4 44 2 N or m al (B M I 1 8. 5- 24 .9 ) 8. 8 28 .8 -1 .4 2, 15 8 1. 5 6. 7 0. 9 -0 .6 2, 15 5 3. 6 19 .8 0. 5 -1 .2 2, 16 8 O ve rw ei gh t/o be se (B M I ≥ 2 5) 4. 3 23 .3 -1 .2 87 0 0. 9 5. 7 2. 1 -0 .4 86 6 1. 8 11 .2 1. 2 -0 .9 87 0 R es id en ce U rb an 4. 7 20 .0 -1 .0 87 6 2. 0 8. 9 2. 1 -0 .6 87 4 2. 5 15 .1 0. 9 -0 .9 88 1 R ur al 9. 2 31 .6 -1 .4 3, 21 3 1. 2 6. 5 1. 1 -0 .5 3, 20 2 4. 0 20 .0 0. 6 -1 .2 3, 21 9 (C on tin ue d… ) 17 4 • N ut rit io n of C hi ld re n an d W om en Ta bl e 11 .1 — C o n ti n u e d H ei gh t-f or -a ge 1 W ei gh t-f or -h ei gh t W ei gh t-f or -a ge B ac kg ro un d ch ar ac te ris tic P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 M ea n Z- sc or e (S D ) N um be r o f ch ild re n P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 P er ce nt ag e ab ov e +2 S D M ea n Z- sc or e (S D ) N um be r o f ch ild re n P er ce nt ag e be lo w -3 S D P er ce nt ag e be lo w -2 S D 2 P er ce nt ag e ab ov e +2 S D M ea n Z- sc or e (S D ) N um be r o f ch ild re n S ta te s/ R eg io ns K ac hi n 10 .6 36 .1 -1 .5 15 4 0. 6 4. 0 1. 5 -0 .2 15 4 4. 3 17 .3 0. 0 -1 .0 15 4 K ay ah 12 .2 39 .7 -1 .6 30 0. 6 2. 6 2. 8 -0 .1 30 2. 6 17 .9 0. 3 -1 .0 30 K ay in 6. 1 25 .4 -1 .2 17 7 1. 8 5. 9 2. 6 -0 .3 17 7 2. 9 15 .2 1. 4 -0 .9 17 8 C hi n 12 .8 41 .0 -1 .5 61 0. 5 3. 3 2. 6 -0 .1 59 4. 3 16 .7 2. 0 -1 .0 60 S ag ai ng 6. 4 26 .7 -1 .3 47 4 0. 9 6. 0 1. 5 -0 .5 47 4 3. 1 13 .4 0. 3 -1 .1 47 4 Ta ni nt ha ry i 4. 7 25 .6 -1 .1 14 8 2. 4 10 .3 1. 6 -0 .7 14 8 3. 6 19 .6 0. 3 -1 .1 14 8 B ag o 4. 3 23 .0 -1 .2 40 6 2. 2 6. 1 0. 3 -0 .7 40 7 3. 4 17 .6 0. 0 -1 .2 40 7 M ag w ay 10 .1 25 .9 -1 .4 29 9 1. 3 6. 2 0. 9 -0 .6 29 5 3. 3 21 .8 0. 4 -1 .1 29 9 M an da la y 6. 7 26 .1 -1 .3 42 4 0. 6 7. 1 1. 6 -0 .5 42 0 2. 4 18 .0 0. 8 -1 .1 42 4 M on 6. 1 28 .1 -1 .2 16 8 0. 7 6. 8 0. 0 -0 .6 16 8 2. 4 18 .8 0. 4 -1 .1 16 8 R ak hi ne 17 .8 37 .5 -1 .7 26 9 3. 7 13 .9 0. 2 -0 .9 26 9 11 .3 34 .3 0. 0 -1 .6 26 9 Y an go n 5. 0 20 .3 -0 .8 43 3 2. 2 12 .6 3. 5 -0 .7 43 0 3. 6 15 .3 2. 1 -1 .0 43 6 S ha n 12 .3 36 .5 -1 .6 43 3 1. 4 4. 7 0. 8 -0 .2 43 5 3. 4 15 .5 0. 4 -1 .1 43 8 A ye ya rw ad y 9. 1 37 .2 -1 .7 52 2 0. 0 3. 9 0. 9 -0 .6 51 6 3. 1 24 .6 1. 1 -1 .3 52 1 N ay P yi T aw 5. 6 22 .0 -1 .2 93 0. 0 6. 6 0. 0 -0 .6 92 2. 8 16 .3 0. 0 -1 .1 92 M ot he r’ s ed uc at io n7 N o ed uc at io n 15 .0 39 .3 -1 .7 64 5 1. 3 7. 6 0. 4 -0 .5 64 5 6. 2 25 .5 0. 0 -1 .4 64 8 P rim ar y 8. 7 31 .5 -1 .4 1, 81 3 1. 3 7. 0 1. 0 -0 .5 1, 80 8 4. 0 19 .8 0. 6 -1 .2 1, 81 8 S ec on da ry 4. 6 22 .5 -1 .1 1, 08 1 1. 2 7. 0 2. 0 -0 .5 1, 07 4 2. 4 15 .2 1. 1 -1 .0 1, 08 5 M or e th an s ec on da ry 3. 8 16 .9 -1 .0 28 9 2. 7 9. 0 2. 6 -0 .6 28 9 1. 2 15 .4 0. 6 -1 .0 28 9 W ea lth q ui nt ile Lo w es t 12 .2 38 .0 -1 .6 1, 17 9 1. 3 7. 8 0. 7 -0 .5 1, 16 9 5. 4 24 .5 0. 5 -1 .3 1, 17 6 S ec on d 8. 7 31 .9 -1 .5 91 6 1. 3 5. 7 1. 2 -0 .5 91 3 4. 4 18 .8 0. 1 -1 .2 91 9 M id dl e 8. 6 29 .1 -1 .3 73 5 0. 9 7. 7 1. 3 -0 .6 73 0 3. 8 18 .4 0. 6 -1 .1 73 6 Fo ur th 4. 9 21 .1 -1 .2 70 1 1. 1 5. 1 2. 0 -0 .5 70 3 2. 0 15 .6 1. 3 -1 .0 70 6 H ig he st 2. 9 16 .0 -0 .9 55 7 2. 3 9. 0 1. 9 -0 .5 56 1 1. 2 12 .4 1. 4 -0 .8 56 3 To ta l 8. 2 29 .2 -1 .3 4, 08 9 1. 3 7. 0 1. 3 -0 .5 4, 07 6 3. 7 18 .9 0. 7 -1 .1 4, 10 0 N ot e: T ab le is b as ed o n ch ild re n w ho s ta ye d in t he h ou se ho ld o n th e ni gh t be fo re t he in te rv ie w . E ac h of t he in di ce s is e xp re ss ed in s ta nd ar d de vi at io n un its ( S D ) fro m t he m ed ia n of t he W H O C hi ld G ro w th S ta nd ar ds ad op te d in 2 00 6. T ab le is b as ed o n ch ild re n w ith v al id d at es o f b irt h (m on th a nd y ea r) a nd v al id m ea su re m en t o f b ot h he ig ht a nd w ei gh t. Fi gu re s in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 1 R ec um be nt le ng th is m ea su re d fo r c hi ld re n un de r a ge 2 ; s ta nd in g he ig ht is m ea su re d fo r a ll ot he r c hi ld re n. 2 In cl ud es c hi ld re n w ho a re b el ow - 3 st an da rd d ev ia tio ns (S D ) f ro m th e W H O C hi ld G ro w th S ta nd ar ds p op ul at io n m ed ia n 3 E xc lu de s ch ild re n w ho se m ot he rs w er e no t i nt er vi ew ed 4 Fi rs t-b or n tw in s (tr ip le ts , e tc .) ar e co un te d as fi rs t b irt hs b ec au se th ey d o no t h av e a pr ev io us b irt h in te rv al . 5 In cl ud es c hi ld re n w ho se m ot he rs a re d ec ea se d 6 E xc lu de s ch ild re n w ho se m ot he rs w er e no t w ei gh ed a nd m ea su re d, c hi ld re n w ho se m ot he rs w er e no t in te rv ie w ed , an d ch ild re n w ho se m ot he rs a re p re gn an t or g av e bi rth w ith in t he p re ce di ng 2 m on th s. M ot he r’s nu tri tio na l s ta tu s in te rm s of B M I ( bo dy m as s in de x) is p re se nt ed in T ab le 1 1. 11 . 7 Fo r w om en w ho a re n ot i nt er vi ew ed , in fo rm at io n is t ak en f ro m t he H ou se ho ld Q ue st io nn ai re . E xc lu de s ch ild re n w ho se m ot he rs a re n ot l is te d in t he H ou se ho ld Q ue st io nn ai re . To ta l in cl ud es 2 c hi ld re n w ith m is si ng in fo rm at io n on m ot he r’s e du ca tio n. Nutrition of Children and Women • 175 Table 11.2 Mid-upper-arm circumference among children Percentage of children age 3-59 months by MUAC-for-age, by background characteristics, Myanmar DHS 2015-16 Background characteristic MUAC-for-age Percentage below -3 SD Percentage below -2 SD1 Mean Z- score (SD) Number of children Age in months 3-6 0.4 1.4 0.4 254 6-11 0.6 1.8 0.0 330 12-23 0.8 3.2 -0.1 837 24-35 0.5 4.4 -0.4 781 36-47 0.1 4.5 -0.5 899 48-59 0.2 4.2 -0.7 834 Sex Male 0.4 3.4 -0.3 2,037 Female 0.5 4.0 -0.4 1,898 Birth interval in months2 First birth3 0.7 2.7 -0.3 1,255 <24 0.6 6.6 -0.5 297 24-47 0.4 4.9 -0.4 812 48+ 0.1 2.8 -0.3 1,220 Size at birth2 Very small (0.0) (8.2) (0.8) 49 Small 1.1 6.6 -0.6 388 Average or larger 0.4 3.1 -0.3 2,997 Don’t know 0.0 3.8 -0.6 149 Mother’s interview status Interviewed 0.4 3.6 -0.3 3,583 Not interviewed but in household 0.0 9.4 -0.6 94 Not interviewed and not in the household4 0.6 3.6 -0.3 258 Mother’s nutritional status5 Thin (BMI < 18.5) 0.8 5.6 -0.6 429 Normal (BMI 18.5-24.9) 0.4 3.5 -0.3 2,102 Overweight/obese (BMI ≥ 25) 0.2 2.4 -0.2 840 Residence Urban 0.2 2.7 -0.2 844 Rural 0.5 4.0 -0.4 3,091 States/Regions Kachin 0.0 3.8 -0.4 149 Kayah 0.6 2.5 -0.0 30 Kayin 0.0 2.0 -0.1 174 Chin 1.0 4.5 -0.4 57 Sagaing 1.0 3.5 -0.4 461 Tanintharyi 0.3 2.3 -0.5 144 Bago 0.4 2.3 -0.3 397 Magway 0.4 2.7 -0.0 282 Mandalay 0.0 2.2 -0.4 397 Mon 0.0 3.4 -0.3 160 Rakhine 1.7 13.0 -0.9 248 Yangon 0.5 3.8 -0.4 425 Shan 0.0 5.5 -0.3 401 Ayeyarwady 0.4 1.9 -0.3 520 Nay Pyi Taw 0.0 2.1 -0.5 91 Mother’s education6 No education 0.6 8.3 -0.6 616 Primary 0.2 3.0 -0.3 1,742 Secondary 0.7 2.4 -0.2 1,039 More than secondary 0.1 2.6 -0.2 274 (Continued…) 176 • Nutrition of Children and Women Table 11.2 — Continued Background characteristic MUAC-for-age Percentage below -3 SD Percentage below -2 SD1 Mean Z- score (SD) Number of children Wealth quintile Lowest 0.5 4.2 -0.4 1,146 Second 0.4 3.1 -0.3 879 Middle 0.4 4.4 -0.3 701 Fourth 0.0 3.6 -0.3 673 Highest 0.7 3.0 -0.2 536 Total 0.4 3.7 -0.3 3,935 Note: Table is based on children who stayed in the household on the night before the interview. The measure is expressed in standard deviation units (SD) from the median of the WHO Child Growth Standards adopted in 2006. Table is based on children with valid dates of birth (month and year) and valid measurement of mid-upper-arm circumference. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes children who are below -3 standard deviations (SD) from the WHO Child Growth Standards population median 2 Excludes children whose mothers were not interviewed 3 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval 4 Includes children whose mothers are deceased 5 Excludes children whose mothers were not weighed and measured, children whose mothers were not interviewed, and children whose mothers are pregnant or gave birth within the preceding 2 months. Mother’s nutritional status in terms of BMI (body mass index) is presented in Table 11.11. 6 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. Total includes 6 children with missing information on mother’s education. Nutrition of Children and Women • 177 Table 11.3 Initial breastfeeding Among last-born children who were born in the 2 years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within 1 hour and within 1 day of birth, and among last-born children born in the 2 years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Myanmar DHS 2015-16 Among last-born children born in the past 2 years: Among last-born children born in the past 2 years who were ever breastfed: Background characteristic Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last-born children Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 97.7 64.4 82.6 899 22.4 878 Female 98.6 69.5 86.0 771 18.2 760 Assistance at delivery Health personnel3 98.1 69.2 86.5 1,189 19.5 1,167 Traditional birth attendant 98.2 60.7 77.8 407 20.7 400 Other 97.0 65.6 81.7 62 31.3 60 No one * * * 11 * 11 Place of delivery Health facility 97.9 65.0 83.8 756 23.1 740 At home 98.2 68.2 84.6 908 18.2 892 Other * * * 6 * 6 Residence Urban 97.6 69.8 88.3 419 19.0 409 Rural 98.2 65.8 82.8 1,250 20.9 1,228 States/Regions Kachin 95.9 64.3 75.3 56 23.9 54 Kayah 99.3 71.9 84.6 12 31.3 12 Kayin 96.6 75.9 87.8 66 22.3 64 Chin 98.3 70.4 87.9 24 24.3 24 Sagaing 99.2 63.3 79.6 172 26.9 170 Tanintharyi 99.1 62.5 84.3 48 36.5 47 Bago 97.9 63.4 84.2 135 18.3 132 Magway 99.3 77.1 87.5 119 13.1 118 Mandalay 98.2 70.9 87.4 183 14.2 180 Mon 98.0 61.7 84.6 59 23.1 57 Rakhine 97.3 37.0 70.7 121 37.1 118 Yangon 98.3 83.6 94.5 193 7.6 189 Shan 98.6 70.0 88.2 232 24.0 229 Ayeyarwady 97.0 59.1 77.0 217 18.4 211 Nay Pyi Taw 98.4 74.6 91.3 32 14.2 31 Mother’s education No education 99.2 66.3 83.9 264 25.5 262 Primary 98.6 67.3 84.2 730 18.4 720 Secondary 97.2 66.8 83.8 532 20.2 517 More than secondary 96.7 64.8 85.7 143 22.5 139 Wealth quintile Lowest 98.9 65.7 82.6 444 19.8 439 Second 97.9 63.1 81.1 367 20.9 359 Middle 98.6 68.9 84.8 286 19.0 283 Fourth 96.9 67.5 86.7 303 20.0 293 Highest 97.7 70.4 87.5 270 22.9 264 Total 98.1 66.8 84.2 1,669 20.4 1,637 Note: Table is based on last-born children born in the 2 years preceding the survey regardless of whether the children are living or dead at the time of the interview. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes children who started breastfeeding within 1 hour of birth 2 Children given something other than breast milk during the first 3 days of life 3 Doctor, nurse/midwife/lady health visitor, or auxiliary midwife 178 • Nutrition of Children and Women Table 11.4 Breastfeeding status by age Percent distribution of youngest children under age 2 who are living with their mother by breastfeeding status and the percentage currently breastfeeding, and the percentage of all children under age 2 using a bottle with a nipple, according to age in months, Myanmar DHS 2015-16 Breastfeeding status Total Percentage currently breast- feeding Number of youngest children under age 2 living with their mother Percentage using a bottle with a nipple Number of all children under age 2 Age in months Not breast- feeding Exclusively breastfed Breast- feeding and consuming plain water only Breast- feeding and consuming non-milk liquids1 Breast- feeding and consuming other milk Breast- feeding and consuming compleme ntary foods 0-1 0.0 70.7 16.0 0.1 4.4 8.8 100.0 100.0 91 8.4 94 2-3 2.8 52.7 24.2 1.1 7.0 12.2 100.0 97.2 155 9.6 155 4-5 1.9 38.2 14.1 5.3 3.5 36.9 100.0 98.1 153 4.9 155 6-8 3.9 5.2 11.6 1.0 6.0 72.4 100.0 96.1 201 13.9 201 9-11 2.1 2.5 1.9 0.2 0.4 92.9 100.0 97.9 198 10.1 202 12-17 12.9 0.5 2.0 0.8 0.3 83.6 100.0 87.1 454 13.9 468 18-23 32.1 0.0 0.4 0.5 1.4 65.5 100.0 67.9 369 13.4 383 0-3 1.8 59.3 21.1 0.8 6.0 11.0 100.0 98.2 246 9.2 249 0-5 1.8 51.2 18.5 2.5 5.1 20.9 100.0 98.2 399 7.5 404 6-9 3.1 5.0 8.7 0.8 4.5 77.9 100.0 96.9 283 12.4 283 12-15 12.1 0.6 2.0 0.6 0.4 84.4 100.0 87.9 340 15.0 347 12-23 21.5 0.3 1.3 0.6 0.8 75.5 100.0 78.5 823 13.7 852 20-23 36.2 0.1 0.6 0.1 0.0 63.1 100.0 63.8 237 13.6 250 Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Non-milk liquids include juice, juice drinks, clear broth, or other liquids. Table 11.5 Median duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the 3 years preceding the survey, by background characteristics, Myanmar DHS 2015-16 Median duration (months) of breastfeeding among children born in the past 3 years1 Background characteristic Any breastfeeding Exclusive breastfeeding Predominant breastfeeding2 Sex Male 24.7 1.7 4.5 Female 22.7 3.4 4.8 Residence Urban 21.4 (2.3) 4.6 Rural 25.1 2.3 4.7 Mother’s education No education 25.2 * 4.5 Primary 25.1 (2.1) 4.3 Secondary 23.3 2.6 4.6 More than secondary (20.1) (4.1) (6.1) Wealth quintile Lowest 27.0 2.5 4.7 Second 25.1 (1.1) 3.5 Middle 25.2 2.7 4.4 Fourth 21.1 * 4.7 Highest 20.7 3.7 5.4 Total 23.7 2.3 4.6 Mean for all children 24.2 3.8 5.5 Note: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 It is assumed that non-last-born children and last-born children not currently living with their mother are not currently breastfeeding. 2 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only Nutrition of Children and Women • 179 Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under age 2 who are living with their mother by type of foods consumed in the day or night preceding the interview, according to breastfeeding status and age, Myanmar DHS 2015-16 Liquids Solid or semi-solid foods Any solid or semi- solid food Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Food made from grains3 Fruits and vege- tables rich in vitamin A4 Other fruits and vege- tables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry Eggs Cheese, yogurt, other milk products Number of children BREASTFEEDING CHILDREN 0-1 3.9 3.3 0.1 0.0 6.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 8.8 91 2-3 6.1 3.7 3.3 2.0 9.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 12.6 150 4-5 5.5 5.0 7.6 7.6 25.3 3.7 1.3 0.6 2.3 1.8 3.4 1.5 37.6 150 6-8 6.2 8.5 15.5 12.1 49.8 19.5 4.7 1.4 13.2 16.6 14.5 1.0 75.3 193 9-11 3.1 9.3 38.6 3.6 65.3 36.3 16.5 9.4 15.4 34.7 29.5 3.0 94.9 194 12-17 2.8 8.6 54.2 3.5 71.7 38.2 14.5 15.8 27.4 49.5 33.4 7.2 96.0 395 18-23 4.5 12.7 63.7 2.5 69.2 54.2 19.4 16.1 24.3 53.9 37.3 4.8 96.5 251 6-23 3.9 9.7 46.3 4.9 65.8 38.2 14.2 12.0 21.7 41.6 30.1 4.6 92.0 1,033 Total 4.3 8.2 34.8 4.6 51.8 28.1 10.5 8.7 16.0 30.4 22.2 3.5 72.6 1,424 NONBREASTFEEDING CHILDREN <12 * * * * * * * * * * * * * 19 12-17 6.5 32.3 52.2 3.6 78.2 40.6 20.1 22.7 22.4 50.0 38.2 3.6 93.4 59 18-23 13.7 21.0 72.8 5.3 73.4 51.7 27.8 21.3 35.0 66.3 43.0 4.1 99.8 119 6-23 11.8 26.7 62.9 6.1 72.3 45.0 23.6 20.4 28.9 58.5 39.0 3.7 96.5 189 Total 13.4 26.6 60.8 5.9 69.6 43.3 22.8 19.6 27.8 56.3 37.5 3.6 93.9 197 Note: Breastfeeding status and food consumed refer to a “24-hour” period (yesterday and last night). An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Other milk includes fresh, tinned, and powdered animal milk. 2 Does not include plain water. Includes juice, juice drinks, clear broth, or other non-milk liquids. 3 Includes fortified baby food 4 Includes pumpkin, carrots, squash, sweet potatoes, dark green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A 18 0 • N ut rit io n of C hi ld re n an d W om en Ta bl e 11 .7 I nf an t a nd y ou ng c hi ld fe ed in g (IY C F) p ra ct ic es P er ce nt ag e of y ou ng es t c hi ld re n ag e 6- 23 m on th s liv in g w ith th ei r m ot he r w ho a re fe d ac co rd in g to th re e IY C F fe ed in g pr ac tic es b as ed o n br ea st fe ed in g st at us , n um be r of fo od g ro up s, a nd ti m es th ey a re fe d du rin g th e da y or n ig ht p re ce di ng th e su rv ey , b y ba ck gr ou nd c ha ra ct er is tic s, M ya nm ar D H S 2 01 5- 16 A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no nb re as tfe d ch ild re n 6- 23 m on th s, p er ce nt ag e fe d: A m on g al l c hi ld re n 6- 23 m on th s, p er ce nt ag e fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r o f br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r o f no n- br ea st fe d ch ild re n 6- 23 m on th s B re as t- m ilk , m ilk , or m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r o f al l c hi ld re n 6- 23 m on th s A ge in m on th s 6- 8 8. 1 61 .7 7. 3 19 3 * * * * 8 99 .1 7. 8 62 .0 7. 0 20 1 9- 11 17 .8 47 .7 13 .1 19 4 * * * * 4 99 .2 17 .5 48 .0 12 .8 19 8 12 -1 7 26 .3 55 .7 19 .7 39 5 38 .1 38 .3 51 .4 15 .8 59 92 .0 27 .8 55 .1 19 .2 45 4 18 -2 3 27 .4 67 .7 22 .1 25 1 22 .9 48 .6 54 .1 9. 6 11 9 75 .2 34 .2 63 .3 18 .1 36 9 S ex M al e 24 .3 57 .3 17 .7 54 4 30 .0 44 .6 53 .6 9. 2 11 4 87 .9 27 .8 56 .7 16 .2 65 8 Fe m al e 18 .5 59 .3 15 .7 48 9 31 .9 39 .0 54 .7 13 .5 75 90 .9 21 .2 58 .7 15 .4 56 4 R es id en ce U rb an 28 .1 53 .9 21 .9 24 8 32 .8 57 .0 49 .6 16 .2 62 86 .6 33 .9 53 .0 20 .8 31 0 R ur al 19 .5 59 .6 15 .1 78 4 29 .8 35 .3 56 .2 8. 3 12 8 90 .2 21 .7 59 .1 14 .2 91 2 S ta te s/ R eg io ns K ac hi n 36 .1 41 .5 20 .2 27 * * * * 10 80 .1 37 .5 39 .3 18 .0 37 K ay ah 17 .3 78 .2 15 .2 8 * * * * 2 88 .0 21 .6 74 .1 14 .6 10 K ay in 13 .2 35 .9 5. 3 40 * * * * 7 92 .2 17 .8 37 .8 6. 4 47 C hi n 11 .2 59 .9 6. 3 14 * * * * 2 89 .6 11 .8 55 .4 6. 4 16 S ag ai ng 8. 8 59 .8 6. 3 11 2 * * * * 7 95 .4 9. 5 58 .6 6. 0 11 9 Ta ni nt ha ry i 18 .7 62 .8 14 .4 29 * * * * 5 90 .8 19 .1 62 .6 13 .2 34 B ag o 26 .9 59 .8 20 .1 92 * * * * 13 92 .7 28 .8 60 .8 20 .3 10 5 M ag w ay 31 .8 78 .5 25 .5 79 * * * * 4 97 .0 32 .3 78 .1 24 .2 83 M an da la y 42 .6 85 .7 36 .9 10 7 * * * * 26 83 .2 46 .8 80 .6 32 .3 13 3 M on 9. 3 57 .8 5. 6 33 * * * * 5 93 .9 14 .1 60 .5 6. 3 38 R ak hi ne 12 .7 31 .4 6. 1 76 * * * * 10 94 .2 17 .0 34 .5 7. 2 86 Y an go n 12 .9 42 .2 11 .2 12 9 * * * * 14 91 .4 14 .1 40 .5 11 .3 14 3 S ha n 24 .2 69 .6 21 .2 11 8 (3 1. 2) (4 3. 5) (5 1. 5) (9 .2 ) 62 76 .4 30 .8 63 .4 17 .1 18 0 A ye ya rw ad y 18 .6 48 .9 13 .8 14 7 * * * * 21 92 .0 20 .5 51 .9 12 .9 16 8 N ay P yi T aw 39 .2 74 .7 36 .0 21 * * * * 1 96 .8 41 .1 73 .0 36 .6 22 M ot he r’ s ed uc at io n N o ed uc at io n 13 .3 52 .5 9. 6 15 4 (3 1. 7) (2 3. 8) (5 7. 1) (1 0. 9) 30 88 .8 15 .0 53 .2 9. 8 18 5 P rim ar y 18 .3 59 .5 14 .7 47 0 30 .1 39 .9 49 .5 6. 9 77 90 .1 21 .4 58 .1 13 .6 54 7 S ec on da ry 24 .9 59 .0 20 .3 32 9 32 .8 43 .1 52 .7 13 .7 63 89 .2 27 .8 58 .0 19 .2 39 2 M or e th an se co nd ar y 42 .6 58 .9 28 .0 80 * * * * 19 85 .7 49 .8 61 .5 26 .1 99 (C on tin ue d… ) N ut rit io n of C hi ld re n an d W om en • 1 81 Ta bl e 11 .7 — (C o n ti n u e d ) A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no nb re as tfe d ch ild re n 6- 23 m on th s, p er ce nt ag e fe d: A m on g al l c hi ld re n 6- 23 m on th s, p er ce nt ag e fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r o f br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r o f no n- br ea st fe d ch ild re n 6- 23 m on th s B re as t- m ilk , m ilk , or m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r o f al l c hi ld re n 6- 23 m on th s W ea lth q ui nt ile Lo w es t 17 .7 54 .5 11 .8 28 9 (3 0. 5) (2 4. 7) (5 1. 8) (3 .2 ) 38 91 .8 18 .5 54 .1 10 .8 32 7 S ec on d 14 .7 53 .5 13 .3 23 7 (3 2. 4) (4 2. 8) (6 2. 5) (1 5. 1) 34 91 .5 18 .3 54 .6 13 .6 27 1 M id dl e 22 .6 65 .4 17 .1 18 8 (1 8. 3) (2 3. 8) (3 7. 6) (3 .0 ) 23 91 .2 22 .7 62 .4 15 .6 21 1 Fo ur th 27 .3 62 .5 24 .6 17 1 25 .3 48 .7 47 .9 6. 2 45 84 .5 31 .7 59 .5 20 .8 21 5 H ig he st 32 .0 59 .3 22 .4 14 9 (4 0. 5) (5 8. 7) (6 3. 2) (2 1. 9) 49 85 .2 38 .7 60 .2 22 .3 19 8 To ta l 21 .5 58 .2 16 .8 1, 03 3 30 .8 42 .4 54 .1 10 .9 18 9 89 .3 24 .8 57 .6 15 .9 1, 22 2 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 Fo od g ro up s: a . i nf an t f or m ul a, m ilk o th er th an b re as t m ilk , c he es e or y og ur t o r ot he r m ilk p ro du ct s; b . f oo ds m ad e fro m g ra in s, r oo ts , a nd tu be rs , i nc lu di ng p or rid ge a nd fo rti fie d ba by fo od fr om gr ai ns ; c . v ita m in A -r ic h fru its a nd v eg et ab le s (a nd re d pa lm o il) ; d . o th er fr ui ts a nd v eg et ab le s; e . e gg s; f. m ea t, po ul try , f is h, a nd s he llf is h (a nd o rg an m ea ts ); g. le gu m es a nd n ut s 2 Fo r b re as tfe d ch ild re n, m in im um m ea l f re qu en cy is re ce iv in g so lid o r s em is ol id fo od a t l ea st tw ic e a da y fo r i nf an ts a ge 6 -8 m on th s an d at le as t t hr ee ti m es a d ay fo r c hi ld re n ag e 9- 23 m on th s. 3 In cl ud es tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a, fr es h, ti nn ed , a nd p ow de re d an im al m ilk , a nd y og ur t 4 Fo r n on br ea st fe d ch ild re n ag e 6- 23 m on th s, m in im um m ea l f re qu en cy is re ce iv in g so lid o r s em is ol id fo od o r m ilk fe ed s at le as t f ou r t im es a d ay . 5 N on br ea st fe d ch ild re n ag e 6- 23 m on th s ar e co ns id er ed to b e fe d w ith a m in im um s ta nd ar d of th re e in fa nt a nd y ou ng c hi ld fe ed in g pr ac tic es if th ey r ec ei ve o th er m ilk o r m ilk p ro du ct s at le as t t w ic e a da y, re ce iv e th e m in im um m ea l f re qu en cy , a nd re ce iv e so lid o r se m is ol id fo od s fro m a t l ea st fo ur fo od g ro up s no t i nc lu di ng th e m ilk o r m ilk p ro du ct s fo od g ro up . 6 B re as tfe ed in g, o r n ot b re as tfe ed in g an d re ce iv in g tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a, fr es h, ti nn ed , a nd p ow de re d an im al m ilk , a nd y og ur t 7 C hi ld re n ar e fe d th e m in im um re co m m en de d nu m be r o f t im es p er d ay a cc or di ng to th ei r a ge a nd b re as tfe ed in g st at us a s de sc rib ed in fo ot no te s 2 an d 4. 182 • Nutrition of Children and Women Table 11.8 Prevalence of anemia in children Percentage of children age 6-59 months classified as having anemia, by background characteristics, Myanmar DHS 2015-16 Anemia status by hemoglobin level Background characteristic Any anemia (<11.0 g/dl) Mild anemia (10.0-10.9 g/dl) Moderate anemia (7.0-9.9 g/dl) Severe anemia (<7.0 g/dl) Number of children age 6-59 months Age in months 6-8 81.0 37.2 43.8 0.0 136 9-11 74.8 33.7 40.3 0.8 163 12-17 77.7 31.6 45.3 0.7 387 18-23 73.3 34.6 37.9 0.8 345 24-35 58.8 31.7 25.9 1.2 723 36-47 50.2 31.9 17.8 0.6 833 48-59 40.8 26.2 14.5 0.1 789 Sex Male 57.7 29.3 27.6 0.7 1,738 Female 57.9 32.9 24.5 0.5 1,638 Mother’s interview status Interviewed 59.3 31.7 26.9 0.6 3,071 Not interviewed but in household 50.4 32.4 17.5 0.5 64 Not interviewed and not in the household1 40.9 22.0 17.9 1.0 241 Residence Urban 58.7 35.5 22.9 0.3 699 Rural 57.5 29.9 26.9 0.7 2,676 States/Regions Kachin 47.8 24.4 22.5 0.9 141 Kayah 45.6 25.0 20.6 0.0 25 Kayin 46.7 26.9 19.0 0.8 162 Chin 42.3 23.6 17.6 1.1 53 Sagaing 70.5 31.7 38.4 0.5 312 Tanintharyi 61.6 35.9 24.8 0.9 134 Bago 54.0 31.5 22.1 0.4 374 Magway 59.5 22.5 35.4 1.5 254 Mandalay 57.8 36.7 21.1 0.0 327 Mon 54.8 25.3 27.8 1.6 142 Rakhine 61.5 31.6 29.6 0.3 236 Yangon 66.3 42.3 24.0 0.0 384 Shan 40.3 27.1 12.6 0.6 275 Ayeyarwady 61.9 29.7 31.4 0.8 474 Nay Pyi Taw 57.7 26.0 29.8 2.0 81 Mother’s education2 No education 53.4 30.6 22.0 0.8 491 Primary 60.7 30.3 29.8 0.6 1,546 Secondary 58.0 34.6 22.9 0.5 880 More than secondary 65.2 33.3 31.6 0.2 217 Wealth quintile Lowest 58.8 29.7 28.2 0.9 1,020 Second 58.9 31.1 27.3 0.5 782 Middle 58.6 31.0 26.9 0.7 608 Fourth 52.9 30.6 22.0 0.3 558 Highest 58.6 35.2 22.9 0.5 408 Total 57.8 31.1 26.1 0.6 3,376 Note: Table is based on children who stayed in the household on the night before the interview and who were tested for anemia. Prevalence of anemia, based on hemoglobin levels, is adjusted for altitude using formulas in CDC 1998. Hemoglobin is in grams per deciliter (g/dl). 1 Includes children whose mothers are deceased 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. Nutrition of Children and Women • 183 Table 11.9 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the 6 months preceding the survey, who were given iron supplements in the past 7 days, and who were given deworming medication in the 6 months preceding the survey, and among all children age 6-59 months who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Myanmar DHS 2015-16 Background characteristic Among youngest children age 6-23 months living with their mother: Among all children age 6-59 months: Among children age 6-59 months living in households tested for iodized salt Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in past 6 months Percentage given iron supplements in past 7 days Percentage given deworming medication in past 6 months3 Number of children Percentage living in households with iodized salt4 Number of children Age in months 6-8 31.7 25.3 201 34.2 9.8 6.4 201 76.7 196 9-11 63.2 49.7 198 44.3 2.8 15.2 202 81.6 201 12-17 76.3 65.5 454 49.9 10.4 22.2 468 78.0 463 18-23 85.1 72.6 369 60.1 7.7 32.3 383 81.8 383 24-35 na na na 57.0 8.5 46.4 782 77.3 773 36-47 na na na 53.3 6.5 54.4 866 80.9 856 48-59 na na na 60.6 9.3 59.0 792 82.3 783 Sex Male 69.7 59.1 658 52.7 7.6 41.9 1,916 80.7 1,899 Female 69.3 57.8 564 56.1 8.6 43.3 1,779 79.2 1,755 Breastfeeding status Breastfeeding 67.5 55.9 1,033 51.6 9.2 29.2 1,506 78.6 1,485 Not breastfeeding 80.4 72.8 189 56.3 7.3 51.7 2,189 81.0 2,169 Mother’s age at birth 15-19 46.3 37.0 45 52.7 3.3 40.8 73 82.2 73 20-29 72.7 62.2 600 46.9 6.5 37.7 1,574 79.5 1,560 30-39 68.8 58.3 492 59.2 9.6 45.4 1,641 81.3 1,618 40-49 63.7 45.4 85 64.3 8.9 50.0 406 76.3 402 Residence Urban 79.0 69.0 310 53.3 8.4 36.9 821 92.8 815 Rural 66.3 54.9 912 54.7 8.0 44.2 2,874 76.3 2,839 States/Regions Kachin 75.4 62.5 37 61.3 6.7 54.7 146 93.2 146 Kayah 61.1 55.0 10 81.8 1.2 57.4 29 99.4 29 Kayin 56.7 50.6 47 43.7 12.4 42.5 125 71.5 122 Chin 52.3 49.8 16 53.9 0.6 49.5 53 88.0 53 Sagaing 67.3 57.9 119 73.0 7.6 47.6 409 85.1 409 Tanintharyi 65.6 57.8 34 52.0 1.1 43.7 112 34.1 111 Bago 69.7 59.3 105 55.6 9.6 45.3 331 92.4 324 Magway 73.1 62.7 83 51.3 30.0 47.0 267 90.6 262 Mandalay 77.6 67.4 133 59.5 7.2 46.6 364 90.9 362 Mon 60.5 51.2 38 70.3 1.5 52.7 119 75.6 114 Rakhine 68.8 54.3 86 56.0 5.6 48.4 258 55.6 255 Yangon 78.2 67.6 143 48.2 5.6 30.3 381 97.1 381 Shan 64.4 46.2 180 44.6 3.6 27.7 515 85.5 513 Ayeyarwady 67.8 59.4 168 44.8 9.0 45.0 504 52.5 491 Nay Pyi Taw 76.6 71.4 22 62.2 2.1 44.0 84 94.2 83 Mother’s education No education 58.8 45.2 185 43.9 6.6 36.2 660 67.8 653 Primary 66.3 54.1 547 56.5 8.1 44.6 1,718 78.0 1,695 Secondary 74.8 66.8 392 56.9 7.4 43.8 1,048 87.8 1,039 More than secondary 87.0 75.1 99 56.5 14.2 40.4 270 92.0 267 Wealth quintile Lowest 62.1 51.3 327 49.3 8.1 43.3 1,107 64.4 1,087 Second 67.9 57.9 271 53.4 7.1 42.5 824 81.4 816 Middle 63.2 51.1 211 55.8 8.8 43.2 624 85.3 618 Fourth 77.3 66.9 215 63.4 8.4 43.5 621 88.5 620 Highest 82.3 70.1 198 54.3 8.6 39.2 518 94.0 513 Total 69.5 58.5 1,222 54.4 8.1 42.6 3,695 80.0 3,654 Note: Information on vitamin A is based on both mother’s recall and the immunization card (where available). Information on iron supplements and deworming medication is based on the mother’s recall. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat (and organ meat), fish, poultry, and eggs 3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 4 Excludes children in households in which salt was not tested 184 • Nutrition of Children and Women Table 11.10 Presence of iodized salt in household Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the household, and among households with salt tested, the percentage with iodized salt, according to background characteristics, Myanmar DHS 2015-16 Among all households, the percentage: Among households with tested salt: Background characteristic With salt tested With no salt in the household Number of households Percentage with iodized salt Number of households Residence Urban 98.0 2.0 3,315 92.1 3,248 Rural 98.5 1.5 9,185 78.5 9,044 States/Regions Kachin 98.7 1.3 365 91.3 360 Kayah 99.4 0.6 65 99.2 64 Kayin 98.3 1.7 335 73.3 329 Chin 99.5 0.5 105 89.5 105 Sagaing 99.7 0.3 1,295 87.2 1,291 Tanintharyi 96.2 3.8 306 31.9 294 Bago 97.2 2.8 1,269 90.8 1,233 Magway 98.5 1.5 1,062 89.1 1,045 Mandalay 98.9 1.1 1,461 94.2 1,444 Mon 95.2 4.8 466 79.2 444 Rakhine 98.6 1.4 695 59.6 686 Yangon 99.7 0.3 1,730 97.1 1,724 Shan 98.7 1.3 1,339 87.4 1,322 Ayeyarwady 97.2 2.8 1,705 52.2 1,657 Nay Pyi Taw 97.0 3.0 303 94.1 294 Wealth quintile Lowest 97.0 3.0 2,583 66.3 2,505 Second 98.1 1.9 2,593 80.0 2,544 Middle 99.3 0.7 2,503 84.7 2,485 Fourth 99.1 0.9 2,424 87.2 2,402 Highest 98.2 1.8 2,397 93.2 2,355 Total 98.3 1.7 12,500 82.1 12,291 N ut rit io n of C hi ld re n an d W om en • 1 85 Ta bl e 11 .1 1 N ut ri tio na l s ta tu s of w om en A m on g w om en a ge 1 5- 49 , th e pe rc en ta ge w ith h ei gh t un de r 14 5 cm , m ea n bo dy m as s in de x (B M I), a nd t he p er ce nt ag e w ith s pe ci fic B M I le ve ls , by b ac kg ro un d ch ar ac te ris tic s, M ya nm ar D H S 20 15 -1 6 H ei gh t B od y m as s in de x1 B ac kg ro un d ch ar ac te ris tic P er ce nt -a ge be lo w 1 45 c m N um be r o f w om en M ea n bo dy m as s in de x (B M I) 18 .5 -2 4. 9 (to ta l n or m al ) <1 8. 5 (t ot al th in ) 17 .0 -1 8. 4 (m ild ly th in ) <1 7 (m od er at el y an d se ve re ly th in ) ≥2 5. 0 (t ot al ov er w ei gh t o r ob es e) 25 .0 -2 9. 9 (o ve rw ei gh t) ≥3 0. 0 (o be se ) N um be r o f w om en A ge 15 -1 9 6. 9 2, 05 0 22 .7 60 .1 14 .4 9. 5 4. 8 25 .6 19 .8 5. 8 1, 96 5 20 -2 9 6. 1 3, 67 5 22 .4 61 .2 15 .2 10 .3 4. 9 23 .6 18 .8 4. 8 3, 51 7 30 -3 9 6. 2 3, 71 6 22 .5 59 .4 16 .0 10 .6 5. 4 24 .6 18 .9 5. 7 3, 56 5 40 -4 9 6. 7 3, 19 4 22 .6 58 .4 16 .1 11 .1 4. 9 25 .5 19 .5 6. 0 3, 05 0 R es id en ce U rb an 4. 6 3, 63 9 23 .5 54 .3 12 .6 8. 7 4. 0 33 .1 23 .9 9. 2 3, 52 1 R ur al 7. 2 8, 99 9 22 .1 62 .0 16 .7 11 .2 5. 5 21 .3 17 .2 4. 1 8, 57 9 S ta te s/ R eg io ns K ac hi n 8. 6 36 4 23 .2 61 .9 10 .1 7. 3 2. 8 28 .0 20 .8 7. 2 33 9 K ay ah 6. 3 64 22 .5 70 .3 9. 3 6. 9 2. 4 20 .4 15 .4 5. 0 60 K ay in 8. 2 29 7 22 .8 59 .7 13 .5 9. 2 4. 3 26 .7 20 .2 6. 6 27 8 C hi n 14 .3 10 0 21 .8 76 .5 9. 4 7. 0 2. 4 14 .1 12 .9 1. 2 92 S ag ai ng 5. 2 1, 40 3 22 .9 57 .9 13 .4 9. 4 4. 0 28 .7 22 .1 6. 6 1, 35 5 Ta ni nt ha ry i 5. 1 28 1 22 .7 56 .7 16 .2 10 .5 5. 7 27 .1 21 .6 5. 5 26 6 B ag o 5. 4 1, 24 1 22 .0 54 .8 22 .2 14 .5 7. 7 23 .0 18 .6 4. 4 1, 20 1 M ag w ay 7. 4 1, 07 8 21 .8 62 .8 18 .5 11 .7 6. 7 18 .7 16 .3 2. 4 1, 03 7 M an da la y 6. 0 1, 52 3 22 .3 60 .3 17 .7 12 .6 5. 1 22 .0 16 .4 5. 6 1, 46 9 M on 7. 4 45 9 22 .9 57 .1 14 .7 9. 3 5. 4 28 .2 20 .4 7. 8 43 6 R ak hi ne 7. 4 74 8 21 .3 66 .6 20 .0 16 .1 3. 9 13 .4 11 .8 1. 6 70 2 Y an go n 3. 0 1, 88 3 23 .5 54 .5 11 .9 7. 8 4. 1 33 .5 25 .5 8. 0 1, 83 0 S ha n 9. 3 1, 29 1 23 .0 67 .2 8. 1 6. 2 2. 0 24 .6 18 .2 6. 4 1, 22 9 A ye ya rw ad y 7. 8 1, 61 3 22 .1 58 .9 18 .4 11 .0 7. 4 22 .7 17 .9 4. 8 1, 52 0 N ay P yi T aw 6. 3 29 4 22 .3 61 .8 16 .2 11 .4 4. 8 22 .1 16 .3 5. 8 28 6 E du ca tio n2 N o ed uc at io n 11 .3 1, 57 8 22 .2 63 .4 15 .3 11 .2 4. 1 21 .2 17 .4 3. 8 1, 50 0 P rim ar y 7. 4 5, 22 7 22 .7 59 .8 13 .8 9. 7 4. 1 26 .4 20 .7 5. 6 4, 99 3 S ec on da ry 4. 6 4, 55 1 22 .3 59 .4 18 .0 11 .5 6. 5 22 .6 17 .1 5. 5 4, 37 1 M or e th an s ec on da ry 2. 9 1, 27 8 23 .0 56 .6 13 .7 9. 3 4. 5 29 .6 22 .2 7. 5 1, 23 3 W ea lth q ui nt ile Lo w es t 9. 3 2, 23 3 21 .3 65 .0 20 .6 13 .7 6. 9 14 .5 11 .8 2. 6 2, 07 7 S ec on d 8. 3 2, 37 8 22 .0 64 .4 15 .6 10 .1 5. 5 20 .0 16 .5 3. 5 2, 26 2 M id dl e 6. 6 2, 61 0 22 .5 60 .6 16 .4 12 .0 4. 4 23 .0 17 .8 5. 2 2, 51 9 Fo ur th 4. 9 2, 63 8 22 .9 57 .8 13 .8 9. 2 4. 7 28 .4 22 .3 6. 1 2, 55 2 H ig he st 3. 7 2, 77 9 23 .6 53 .0 12 .4 8. 1 4. 3 34 .6 25 .3 9. 3 2, 68 9 To ta l 6. 4 12 ,6 37 22 .5 59 .8 15 .5 10 .5 5. 0 24 .7 19 .2 5. 5 12 ,1 00 N ot e: T he b od y m as s in de x (B M I) is e xp re ss ed a s th e ra tio o f w ei gh t i n ki lo gr am s to th e sq ua re o f h ei gh t i n m et er s (k g/ m 2 ) . 1 E xc lu de s pr eg na nt w om en a nd w om en w ith a b irt h in th e pr ec ed in g 2 m on th s 2 To ta l i nc lu de s th re e w om en w ith m is si ng in fo rm at io n on e du ca tio n. 186 • Nutrition of Children and Women Table 11.12 Prevalence of anemia in women Percentage of women age 15-49 with anemia, by background characteristics, Myanmar DHS 2015-16 Background characteristic Anemia status by hemoglobin level Any Mild Moderate Severe Number of women Not pregnant <12.0 g/dl 10.0-11.9 g/dl 7.0-9.9 g/dl <7.0 g/dl Pregnant < 11.0 g/dl) 10.0-10.9 g/dl) 7.0-9.9 g/dl) < 7.0 g/dl) Age 15-19 45.4 36.7 8.3 0.4 2,032 20-29 47.1 37.7 8.7 0.6 3,626 30-39 46.5 38.1 7.9 0.5 3,674 40-49 46.6 37.5 8.6 0.5 3,155 Number of children ever born 0 48.8 40.2 8.1 0.5 5,099 1 42.8 35.2 7.4 0.2 2,032 2-3 43.4 34.2 8.5 0.7 3,432 4-5 48.7 39.7 8.4 0.6 1,287 6+ 52.7 38.9 12.7 1.1 638 Maternity status Pregnant 56.9 28.9 27.7 0.4 449 Breastfeeding 47.8 40.0 7.5 0.3 1,807 Neither 45.8 37.6 7.7 0.6 10,233 Using IUD Yes 52.3 39.0 11.1 2.3 215 No 46.4 37.6 8.3 0.5 12,274 Smoking status Smokes cigarettes/tobacco 45.1 31.6 12.5 1.0 470 Does not smoke 46.6 37.8 8.2 0.5 12,019 Residence Urban 46.5 38.6 7.5 0.4 3,554 Rural 46.6 37.2 8.7 0.6 8,935 States/Regions Kachin 36.6 30.6 5.7 0.3 363 Kayah 30.9 23.3 6.7 0.9 63 Kayin 44.1 35.8 7.4 0.9 295 Chin 38.5 29.5 8.7 0.2 100 Sagaing 51.0 40.6 9.5 0.9 1,376 Tanintharyi 54.5 45.9 8.5 0.1 280 Bago 47.6 40.3 7.1 0.2 1,239 Magway 52.2 37.4 13.7 1.2 1,062 Mandalay 43.6 33.5 9.7 0.3 1,496 Mon 39.0 32.7 6.1 0.1 449 Rakhine 55.4 41.1 14.1 0.2 740 Yangon 53.5 46.1 6.9 0.5 1,861 Shan 34.9 28.9 5.9 0.1 1,275 Ayeyarwady 43.0 35.8 6.2 1.0 1,598 Nay Pyi Taw 43.1 35.0 8.0 0.1 290 Education1 No education 45.0 35.0 9.5 0.5 1,556 Primary 47.3 37.5 9.2 0.6 5,188 Secondary 46.0 38.2 7.3 0.6 4,487 More than secondary 47.2 39.4 7.4 0.4 1,254 Wealth quintile Lowest 47.5 37.1 9.7 0.7 2,223 Second 47.6 37.0 9.9 0.7 2,368 Middle 47.4 39.2 7.5 0.7 2,590 Fourth 44.4 36.4 7.7 0.2 2,599 Highest 46.0 38.3 7.3 0.4 2,709 Total 46.5 37.6 8.4 0.5 12,489 Note: Prevalence is adjusted for altitude and for smoking status, if known, using formulas in CDC 1998. 1 Total includes three women with missing information on education. N ut rit io n of C hi ld re n an d W om en • 1 87 Ta bl e 11 .1 3 M ic ro nu tr ie nt in ta ke a m on g m ot he rs A m on g w om en a ge 1 5- 49 w ith a c hi ld b or n in th e pa st 5 y ea rs , t he p er ce nt ag e w ho r ec ei ve d a vi ta m in A d os e in th e fir st 2 m on th s af te r th e bi rth o f t he ir la st c hi ld , t he p er ce nt d is tri bu tio n by n um be r of d ay s th ey to ok ir on ta bl et s or s yr up d ur in g th e pr eg na nc y of th ei r la st c hi ld , a nd th e pe rc en ta ge w ho to ok d ew or m in g m ed ic at io n du rin g th e pr eg na nc y of th ei r la st c hi ld , a nd am on g w om en a ge 1 5- 49 w ith a c hi ld b or n in t he p as t 5 ye ar s an d w ho li ve in h ou se ho ld s th at w er e te st ed f or io di ze d sa lt, t he p er ce nt ag e w ho li ve in h ou se ho ld s w ith io di ze d sa lt, b y ba ck gr ou nd c ha ra ct er is tic s, M ya nm ar D H S 2 01 5- 16 B ac kg ro un d ch ar ac te ris tic P er ce nt ag e w ho re ce iv ed vi ta m in A do se p os t- pa rtu m 1 N um be r o f d ay s w om en to ok ir on ta bl et s or s yr up d ur in g pr eg na nc y of la st bi rth P er ce nt ag e of w om en w ho to ok de w or m in g m ed ic at io n du rin g pr eg na nc y of la st bi rth N um be r o f w om en A m on g w om en w ith a c hi ld b or n in th e la st 5 y ea rs w ho li ve in h ou se ho ld s th at w er e te st ed fo r i od iz ed s al t N on e <6 0 60 -8 9 90 + D on ’t kn ow / m is si ng To ta l P er ce nt ag e liv in g in h ou se ho ld s w ith io di ze d sa lt2 N um be r o f w om en A ge 15 -1 9 36 .6 10 .2 17 .6 6. 6 64 .2 1. 4 10 0. 0 59 .1 61 2 84 .2 60 1 20 -2 9 36 .0 13 .4 15 .6 10 .9 58 .5 1. 6 10 0. 0 55 .1 1, 02 9 79 .1 1, 02 3 30 -3 9 35 .2 12 .7 19 .3 9. 8 56 .4 1. 8 10 0. 0 55 .6 1, 04 4 81 .2 1, 03 4 40 -4 9 33 .4 12 .3 16 .5 8. 0 60 .3 2. 9 10 0. 0 52 .8 89 6 80 .2 88 4 R es id en ce U rb an 42 .8 5. 2 9. 4 7. 8 75 .9 1. 7 10 0. 0 59 .8 83 8 92 .6 83 3 R ur al 32 .9 14 .5 19 .6 9. 5 54 .2 2. 0 10 0. 0 54 .0 2, 74 4 77 .2 2, 71 1 S ta te s/ R eg io ns K ac hi n 30 .1 6. 7 19 .3 7. 2 48 .4 18 .5 10 0. 0 59 .0 13 3 92 .9 13 3 K ay ah 39 .9 7. 5 6. 9 4. 7 80 .2 0. 7 10 0. 0 63 .3 24 99 .6 23 K ay in 20 .4 16 .6 12 .2 8. 2 59 .3 3. 6 10 0. 0 51 .7 11 3 71 .8 11 1 C hi n 27 .8 25 .6 20 .0 11 .2 42 .4 0. 7 10 0. 0 46 .9 43 88 .2 43 S ag ai ng 41 .7 9. 9 18 .6 8. 7 61 .8 1. 1 10 0. 0 58 .6 39 8 83 .4 39 8 Ta ni nt ha ry i 25 .2 11 .2 13 .5 10 .5 64 .5 0. 4 10 0. 0 63 .0 10 2 34 .9 10 0 B ag o 35 .7 5. 9 24 .3 11 .4 56 .0 2. 4 10 0. 0 60 .7 32 9 92 .2 32 3 M ag w ay 30 .1 11 .7 16 .8 8. 6 61 .2 1. 6 10 0. 0 52 .1 27 4 90 .5 27 2 M an da la y 42 .3 11 .6 16 .9 5. 8 64 .4 1. 2 10 0. 0 43 .8 38 3 92 .3 38 1 M on 40 .8 7. 8 13 .8 8. 2 69 .7 0. 5 10 0. 0 65 .3 12 1 77 .6 11 7 R ak hi ne 31 .9 22 .7 22 .2 11 .9 41 .7 1. 4 10 0. 0 48 .6 23 8 59 .1 23 5 Y an go n 43 .5 3. 0 3. 2 7. 0 85 .3 1. 5 10 0. 0 66 .8 38 7 97 .5 38 7 S ha n 31 .1 28 .9 12 .3 12 .1 46 .4 0. 4 10 0. 0 39 .0 45 9 86 .6 45 7 A ye ya rw ad y 31 .7 8. 2 26 .8 8. 9 54 .9 1. 1 10 0. 0 65 .8 49 7 53 .7 48 2 N ay P yi T aw 35 .7 8. 9 21 .9 10 .1 56 .3 2. 7 10 0. 0 52 .5 83 93 .2 81 E du ca tio n N o ed uc at io n 23 .2 36 .0 20 .2 9. 0 33 .3 1. 5 10 0. 0 39 .5 58 7 69 .7 57 9 P rim ar y 35 .6 10 .5 20 .0 9. 6 57 .7 2. 2 10 0. 0 58 .4 1, 62 9 79 .2 1, 60 9 S ec on da ry 38 .7 4. 9 14 .6 8. 8 70 .1 1. 6 10 0. 0 59 .7 1, 06 9 86 .2 1, 06 0 M or e th an s ec on da ry 44 .1 2. 7 6. 2 7. 5 80 .9 2. 7 10 0. 0 54 .0 29 8 92 .4 29 6 W ea lth q ui nt ile Lo w es t 29 .3 21 .1 22 .8 9. 7 44 .9 1. 5 10 0. 0 52 .6 98 1 65 .1 96 1 S ec on d 29 .9 15 .2 19 .2 8. 6 54 .2 2. 7 10 0. 0 52 .6 78 7 82 .0 78 1 M id dl e 38 .8 9. 6 19 .4 7. 7 61 .2 2. 1 10 0. 0 59 .8 62 4 85 .5 61 9 Fo ur th 39 .1 4. 7 12 .6 11 .6 69 .6 1. 5 10 0. 0 59 .7 63 8 87 .6 63 6 H ig he st 44 .7 4. 7 7. 4 7. 5 78 .4 2. 0 10 0. 0 53 .9 55 2 93 .7 54 7 To ta l 35 .2 12 .3 17 .3 9. 1 59 .3 2. 0 10 0. 0 55 .3 3, 58 3 80 .8 3, 54 4 1 In th e fir st 2 m on th s af te r d el iv er y of la st b irt h 2 E xc lu de s w om en in h ou se ho ld s w he re s al t w as n ot te st ed Malaria • 189 MALARIA 12 Key Findings  Ownership of nets: Although 97% of households possess a mosquito net, only 27% own at least one insecticide-treated net (ITN).  Access to an ITN: Only 21% of the household population has access to an ITN (if each ITN in the household were used by up to two people).  Use of an ITN: Sixteen percent of the household population, 19% of children under age 5, and 18% of pregnant women slept under an ITN the night before the survey.  Treatment-seeking source: The majority (57%) of children under age 5 with a recent fever, a symptom of malaria in endemic areas, received advice or treatment from a public sector source. alaria is a major public health problem in Myanmar, with more than two-thirds of the country’s population living in areas of malaria risk. The peak period for malaria transmission is the monsoon and post-monsoon season that falls from June to December. The fieldwork for the 2015-16 MDHS was carried out in the low-transmission season from December to April/May. The malaria-endemic areas in Myanmar have been classified as high risk (Kachin State, Kayah State, Kayin State, Chin State, Sagaing Region, Rakhine State, Shan State, and Tanintharyi Region), moderate risk (Mon State), and low risk (Yangon Region, Mandalay Region, Magway Region, Bago Region, Ayeyarwady Region, and Nay Pyi Taw) via village-based micro-stratification and annual parasite incidence (API). The latest updated classification was carried out in the first and second quarters of 2015. The national malaria control program and other agencies such as the Myanmar Medical Association, the Myanmar Council of Churches, the Myanmar Red Cross Society, Population Services International, Save the Children, and the University Research Company-Control and Prevention of Malaria Project distribute insecticide-treated nets (ITNs) in most of the malaria-endemic areas. This chapter presents data that are useful in assessing how well malaria control strategies are being implemented, including the availability and use of mosquito nets, the prophylactic and therapeutic use of antimalarial drugs, diagnostic testing of children with fever, and prevalence of anemia among children under age 5. M 190 • Malaria 12.1 OWNERSHIP OF INSECTICIDE-TREATED NETS Ownership of insecticide-treated nets Households that have at least one insecticide-treated net (ITN). An ITN is defined as (1) a factory-treated net that does not require any further treatment (long-lasting insecticidal net, or LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. Sample: Households Full household ITN coverage Percentage of households with at least one ITN for every two people. Sample: Households Distribution of ITNs to households in malaria-endemic areas is one of the central malaria control interventions supported by the government in Myanmar. Almost all households (97%) in Myanmar possess at least one mosquito net (treated or untreated), but only 27% possess at least one ITN (Table 12.1). On average, each household has 2.7 mosquito nets of any type and 0.6 ITNs. Three in four households had at least one net for every two persons who stayed in the household the night before the survey. Fourteen percent of households had at least one ITN for every two people who stayed in the household the night preceding the survey, which indicates that all members of those households had access to an ITN. In other words, only 14% of households owned enough ITNs to cover all household members (Table 12.1, Figure 12.1). To offer maximum protection, ITN distribution needs to expand to reach the 73% of households that do not currently own any ITNs and to provide enough ITNs for the 13% of households that own at least one ITN but have an insufficient supply for the number of household members (Figure 12.1). Figure 12.1 Household ownership of ITNs No ITN 73%At least 1 ITN, but not enough for all HH members 13% At least 1 ITN for every 2 people in the HH 14% Percent distribution of households Malaria • 191 Patterns by background characteristics  Rural households are more likely to own an ITN than urban households (31% and 15%, respectively).  Households in the highest wealth quintile are less likely to possess an ITN than those in the other quintiles (Figure 12.2).  The percentage of households with at least one ITN varies greatly according to state and region; ownership is highest in Kayah State (85%) and lowest in Yangon Region (6%).  The proportion of households owning at least one ITN for every two residents also varies by state and region. In the high-risk areas, coverage is highest in Kayah State (59%), Chin State (52%), and Tanintharyi Region (47%) and lowest in Kayin State (13%) (Table 12.1).  More than four in five mosquito nets (82%) were purchased by households. Sixteen percent of nets were distributed by the government or nongovernmental organizations (NGOs). ITNs are most often distributed by the government or NGOs (75%) (Table 12.2). 12.2 HOUSEHOLD ACCESS TO AND USE OF ITNS Access to an ITN Percentage of the population that could sleep under an ITN if each ITN in the household were used by up to two people. Sample: De facto household population Use of ITNs Percentage of the population that slept under an ITN the night before the survey. Sample: De facto household population Access to an ITN is measured by the proportion of the population that could sleep under an ITN if each ITN in the household were used by up to two people. Comparing ITN access and ITN use indicators can help programs identify if there is a behavioral gap in which available ITNs are not being used. If the difference between these indicators is substantial, the ITN program may need to focus on behavior change and how to identify the main drivers or barriers to ITN use to design appropriate interventions. This analysis helps ITN programs determine whether they need to achieve higher ITN coverage, promote ITN use, or both. Overall, 21% of the household population had access to an ITN; in other words 21% of those who stayed in the household the night before the survey could have slept under an ITN if each net were used by a maximum of two people (Table 12.3). Figure 12.2 ITN ownership by household wealth 35 32 27 23 17 Lowest Second Middle Fourth Highest Percentage of households with at least one ITN Poorest Wealthiest 192 • Malaria Overall, 16% of the population slept under an ITN the night before the survey (Table 12.4, Figure 12.3). However, in households that owned at least one ITN, 55% of members slept under an ITN. Overall, 58% of ITNs were used the night before the survey (Table 12.5). Patterns by background characteristics  Access to an ITN and use of an ITN by the household population are twice as high in rural areas as in urban areas. Twenty-five percent of rural residents have access to an ITN, as compared with 12% of urban residents, while 18% of rural residents and only 9% of urban residents used an ITN the night before survey (Figure 12.3).  There are wide regional variations in access to an ITN, ranging from a high of 73% in Kayah State to a low of 4% in Yangon Region and Nay Pyi Taw (Figure 12.4).  Similarly, use of an ITN varies by state and region; 42% of the household population in Tanintharyi Region and 40% each in Kayah State, Chin State, and Rakhine State used an ITN the night before the survey, as compared with only 3% of the household population in Nay Pyi Taw and 4% in Yangon Region. 12.3 USE OF ITNS BY CHILDREN AND PREGNANT WOMEN One of the key malaria control strategies is encouraging vulnerable populations such as children under age 5 and pregnant women to sleep under an ITN. Use of mosquito nets by pregnant women is an important strategy to prevent malaria morbidity and to reduce the negative effects of malaria on pregnancy and pregnancy outcomes. Figure 12.3 Access to and use of ITNs by residence Figure 12.4 Access to ITNs by states and regions Percent of the household population that could sleep under an ITN if each ITN in the household were used by up to 2 people 21 12 25 16 9 18 Total Urban Rural Percentage of the household population with access to an ITN and who slept under an ITN the night before the survey Access to an ITN Slept under an ITN Malaria • 193 Although 82% of children under age 5 and 84% of pregnant women slept under any net the night before the survey, only 19% of children and 18% of pregnant women slept under an ITN (Table 12.6, Table 12.7, Figure 12.5). In households with at least one ITN, 56% of children under age 5 and 62% of pregnant women slept under an ITN the night before the survey (Table 12.6 and Table 12.7). Patterns by background characteristics  Children in rural households are more likely to sleep under an ITN than children in urban households (22% versus 8%) (Table 12.6). Similarly, pregnant women in rural areas are more likely than those in urban areas to sleep under an ITN (21% versus 10%) (Table 12.7).  More than two in five children under age 5 slept under an ITN in the high-risk areas of Tanintharyi Region (47%), Rakhine State (46%), Kayah State (45%), and Chin State (42%) (Table 12.6).  The proportions of children under age 5 and pregnant women sleeping under an ITN are larger in households in the lowest wealth quintile than in households in the highest quintile. 12.4 CASE MANAGEMENT OF MALARIA IN CHILDREN Care seeking for children under age 5 with a fever Percentage of children under age 5 with a fever in the 2 weeks before the survey for whom advice or treatment was sought from a health provider, a health facility, or a pharmacy. Sample: Children under age 5 with a fever in the 2 weeks before the survey Diagnosis of malaria in children under age 5 with a fever Percentage of children under age 5 with a fever in the 2 weeks before the survey who had blood taken from a finger or heel for testing. This is a proxy measure of diagnostic testing for malaria. Sample: Children under age 5 with a fever in the 2 weeks before the survey Artemisinin-based combination therapy (ACT) for children under age 5 with a fever Among children under age 5 with a fever in the 2 weeks before the survey who took any antimalarial drugs, the percentage who received artemisinin-based combination therapy (ACT). Sample: Children under age 5 with a fever in the 2 weeks before the survey Prompt and effective treatment for malaria is crucial to prevent the disease from becoming severe and complicated. The first line of treatment for Plasmodium falciparum malaria in Myanmar is artemisinin- based combination therapy (ACT), common forms of which include artemether-lumefantrine, atesunate- mefloquine, and dihydroartemisinin-piperaquine. Evidence of artemisinin resistance in Myanmar gave rise to the Myanmar Artemisinin Resistance Containment (MARC) project, which sought to address the issue of artemisinin-resistant parasites (WHO 2013). Overall, 16% of children under age 5 had a fever in the 2 weeks before the survey. Advice or treatment was sought for 65% of these children with recent fever, and 3% had blood taken from a finger or heel, presumably for diagnostic testing (Table 12.8). Figure 12.5 Use of ITNs 16 18 19 Household population Pregnant women Children under age 5 Percentage who slept under an ITN the night before the survey 194 • Malaria Among children under age 5 with recent fever for whom advice or treatment was sought, 57% received advice or treatment from any public sector source, while 31% received advice or treatment from any private source (Table 12.9). Government sub-centers and government hospitals are the primary sources in the government sector, with private hospitals and clinics playing an important role in the private sector. Nine percent of children received advice or treatment from a shop. Only 1% of children received antimalarial drugs for treatment of fever in the 2 weeks preceding the survey (data not shown). 12.5 PREVALENCE OF LOW HEMOGLOBIN IN CHILDREN Prevalence of low hemoglobin in children Percentage of children age 6-59 months who had a blood hemoglobin measurement below 8 grams per deciliter (g/dl). The cut-off of 8 g/dl is often used to classify malaria-related anemia. This is a different cut-off than that used to classify severe anemia in Chapter 11 (7 g/dl). Sample: Children age 6-59 months Anemia is one of the complications of malaria infection, especially in children. Other causes of anemia are nutritional deficiencies, helminth infestation, damage to bone marrow through heavy metals or other toxins, and genetically acquired diseases such as sickle cell anemia. The prevalence of anemia in Myanmar has been discussed earlier (Chapter 11) in relation to nutritional deficiency. This section addresses anemia in relation to malaria. Although anemia is not specific to malaria, trends in anemia prevalence can reflect malaria morbidity, and they respond to changes in the coverage of malaria interventions (Korenromp 2004). Malaria interventions have been associated with a 60% reduction in the risk of anemia using a cut- off of 8 g/dl (Roll Back Malaria Partnership 2003). Table 12.10 shows that 3% of children age 6-59 months have hemoglobin levels below 8.0 g/dl. Nine percent of children age 9-11 months and 10% of those age 12-17 months have hemoglobin levels below 8.0 g/dl, as compared with only 2% of children age 6-8 months and 36-47 months and 1% of those age 48-59 months (Figure 12.6). The proportion of children with hemoglobin levels below 8.0 g/dl is highest in Mon State (7%) and lowest in Shan State, Kayin State, Chin State, Mandalay Region, and Yangon Region (2% each). There is little variation in the proportion of children with hemoglobin levels below 8.0 g/dl by residence, household wealth, or mother’s educational level. Figure 12.6 Low hemoglobin by age 2 9 10 4 4 2 1 3 6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total Percentage of children age 6-59 months with hemoglobin lower than 8.0 g/dl Age in months Malaria • 195 LIST OF TABLES For more information on malaria, see the following tables:  Table 12.1 Household possession of mosquito nets  Table 12.2 Source of mosquito nets  Table 12.3 Access to an insecticide-treated net (ITN)  Table 12.4 Use of mosquito nets by persons in the household  Table 12.5 Use of existing ITNs  Table 12.6 Use of mosquito nets by children  Table 12.7 Use of mosquito nets by pregnant women  Table 12.8 Prevalence, diagnosis, and prompt treatment of children with fever  Table 12.9 Source of advice or treatment for children with fever  Table 12.10 Hemoglobin <8.0 g/dl in children 19 6 • M al ar ia Ta bl e 12 .1 H o us eh ol d po ss es si o n o f m o sq ui to n et s P er ce nt ag e of h ou se ho ld s w ith a t le as t on e m os qu ito n et ( tr ea te d or u nt re at ed ), i ns ec tic id e- tr ea te d ne t (IT N ), a nd l on g- la st in g in se ct ic id al n et ( LL IN ); a ve ra ge n um be r of n et s, I T N s, a nd L LI N s pe r ho us eh ol d; a nd p er ce nt ag e of h ou se ho ld s w ith a t l ea st o ne n et , I T N , a nd L LI N p er tw o pe rs on s w ho s ta ye d in th e ho us eh ol d la st n ig ht , b y ba ck gr ou nd c ha ra ct er is tic s, M ya nm ar D H S 2 01 5- 16 B ac kg ro un d ch ar ac te ris tic P er ce nt ag e of h ou se ho ld s w ith a t l ea st o ne m os qu ito n et A ve ra ge n um be r of n et s pe r ho us eh ol d N um be r of ho us eh ol ds P er ce nt ag e of h ou se ho ld s w ith a t l ea st o ne n et fo r ev er y tw o pe rs on s w ho s ta ye d in th e ho us eh ol d la st n ig ht 1 N um be r of ho us eh ol ds w ith a t l ea st on e pe rs on w ho s ta ye d in th e ho us eh ol d la st n ig ht A ny m os qu ito ne t In se ct ic id e- tre at ed m os qu ito n et (IT N )2 Lo ng - l as tin g in se ct ic id al n et (L LI N ) A ny m os qu ito ne t In se ct ic id e- tre at ed m os qu ito n et (IT N )2 Lo ng - l as tin g in se ct ic id al n et (L LI N ) A ny m os qu ito ne t In se ct ic id e- tre at ed m os qu ito n et (IT N )2 Lo ng - l as tin g in se ct ic id al n et (L LI N ) R es id en ce U rb an 98 .3 14 .7 11 .2 2. 9 0. 3 0. 2 3, 31 5 81 .7 8. 3 5. 9 3, 30 2 R ur al 96 .7 31 .1 28 .6 2. 6 0. 6 0. 6 9, 18 5 73 .8 16 .2 15 .1 9, 10 9 S ta te s/ R eg io ns K ac hi n 99 .0 44 .0 42 .5 2. 9 1. 0 1. 0 36 5 77 .8 26 .8 25 .9 36 0 K ay ah 99 .3 85 .2 84 .1 2. 9 2. 2 2. 1 65 78 .2 58 .6 57 .6 65 K ay in 87 .9 35 .5 34 .5 1. 7 0. 6 0. 6 33 5 44 .4 12 .5 12 .2 33 3 C hi n 97 .0 80 .2 77 .7 2. 8 2. 1 2. 0 10 5 70 .7 51 .9 50 .0 10 5 S ag ai ng 99 .8 31 .9 27 .3 3. 3 0. 8 0. 7 1, 29 5 85 .3 18 .7 16 .6 1, 29 1 T an in th ar yi 96 .9 77 .5 76 .6 2. 9 1. 8 1. 8 30 6 76 .0 47 .4 46 .5 30 3 B ag o 99 .2 13 .4 12 .2 3. 1 0. 2 0. 2 1, 26 9 86 .3 3. 8 3. 0 1, 24 9 M ag w ay 97 .7 27 .1 24 .7 2. 4 0. 5 0. 4 1, 06 2 76 .2 13 .3 12 .3 1, 05 7 M an da la y 98 .8 10 .1 7. 9 2. 3 0. 2 0. 2 1, 46 1 70 .6 5. 1 3. 9 1, 45 8 M on 99 .0 64 .2 61 .9 3. 1 1. 5 1. 5 46 6 83 .3 41 .0 40 .0 45 8 R ak hi ne 96 .1 67 .0 65 .1 2. 6 1. 5 1. 4 69 5 65 .6 35 .5 34 .4 69 2 Y an go n 99 .7 5. 7 2. 8 2. 8 0. 1 0. 0 1, 73 0 84 .6 3. 0 1. 0 1, 73 0 S ha n 85 .2 38 .6 34 .9 2. 1 0. 8 0. 7 1, 33 9 55 .8 20 .4 18 .4 1, 33 3 A ye ya rw ad y 99 .8 15 .9 11 .6 2. 8 0. 3 0. 2 1, 70 5 81 .6 6. 4 4. 9 1, 67 9 N ay P yi T aw 98 .7 7. 5 5. 1 2. 4 0. 1 0. 1 30 3 71 .5 2. 8 1. 5 30 0 W ea lt h q ui nt ile Lo w es t 94 .3 34 .8 32 .1 2. 0 0. 7 0. 6 2, 58 3 61 .3 16 .4 15 .7 2, 53 5 S ec on d 96 .8 31 .5 29 .4 2. 4 0. 6 0. 6 2, 59 3 72 .6 17 .1 16 .2 2, 57 5 M id dl e 98 .6 26 .8 24 .4 2. 7 0. 6 0. 5 2, 50 3 78 .2 13 .9 12 .7 2, 49 3 Fo ur th 98 .8 23 .3 20 .3 3. 0 0. 5 0. 4 2, 42 4 82 .7 13 .2 11 .5 2, 41 7 H ig he st 97 .4 16 .6 12 .6 3. 3 0. 4 0. 3 2, 39 7 85 .7 9. 6 6. 8 2, 39 2 T ot al 97 .2 26 .8 24 .0 2. 7 0. 6 0. 5 12 ,5 00 75 .9 14 .1 12 .7 12 ,4 11 1 D e fa ct o ho us eh ol d m em be rs 2 A n in se ct ic id e- tr ea te d ne t ( IT N ) is ( 1) a fa ct or y- tr ea te d ne t t ha t d oe s no t r eq ui re a ny fu rth er tr ea tm en t ( LL IN ) or ( 2) a p re tr ea te d ne t o bt ai ne d w ith in th e pa st 1 2 m on th s or ( 3) a n et th at h as b ee n so ak ed w ith in se ct ic id e w ith in th e pa st 1 2 m on th s. Malaria • 197 Table 12.2 Source of mosquito nets Percent distribution of mosquito nets by source of net, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Government/ NGO distribution ANC visit Purchased Other Not sure/missing Total Number of mosquito nets Type of net ITN1 74.9 0.6 23.5 0.9 0.1 100.0 7,827 Other2 1.2 0.1 96.7 1.9 0.2 100.0 31,190 Residence Urban 4.1 0.1 93.5 2.1 0.2 100.0 12,817 Rural 21.8 0.2 76.4 1.5 0.1 100.0 26,199 States/Regions Kachin 30.2 0.1 68.2 1.5 0.0 100.0 1,177 Kayah 72.7 0.1 26.8 0.4 0.0 100.0 206 Kayin 30.1 0.4 66.8 2.7 0.1 100.0 585 Chin 75.0 0.0 24.0 1.1 0.0 100.0 307 Sagaing 20.0 0.5 78.2 1.3 0.0 100.0 5,160 Tanintharyi 58.3 0.0 41.3 0.4 0.0 100.0 901 Bago 4.7 0.0 93.4 1.8 0.0 100.0 4,413 Magway 14.3 0.1 83.6 1.9 0.0 100.0 2,970 Mandalay 2.5 0.0 94.8 2.4 0.2 100.0 4,075 Mon 44.0 0.2 52.9 2.8 0.1 100.0 1,581 Rakhine 42.8 1.4 54.0 1.8 0.1 100.0 2,210 Yangon 1.0 0.0 97.8 0.9 0.2 100.0 6,213 Shan 29.0 0.0 70.3 0.7 0.1 100.0 3,253 Ayeyarwady 7.4 0.1 90.3 2.1 0.1 100.0 5,156 Nay Pyi Taw 2.0 0.1 93.4 4.1 0.4 100.0 811 Wealth quintile Lowest 33.0 0.3 63.9 2.9 0.1 100.0 5,028 Second 24.9 0.4 73.6 1.0 0.0 100.0 6,217 Middle 17.0 0.2 81.6 1.1 0.0 100.0 7,786 Fourth 12.8 0.2 85.5 1.3 0.1 100.0 9,157 Highest 4.9 0.0 92.7 2.1 0.2 100.0 10,828 Total 16.0 0.2 82.0 1.7 0.1 100.0 39,017 ANC = Antenatal care 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. 2 Any net that is not an ITN Table 12.3 Access to an insecticide-treated net (ITN) Percent distribution of the de facto household population by number of ITNs the household owns, according to number of persons who stayed in the household the night before the survey, Myanmar DHS 2015-16 Number of persons who stayed in the household the night before the survey Number of ITNs 1 2 3 4 5 6 7 8+ Total 0 77.7 78.1 76.0 73.6 70.0 66.2 70.3 67.2 71.5 1 14.5 11.0 10.6 11.3 10.3 8.8 6.7 7.4 9.8 2 5.0 7.0 8.1 8.6 10.3 12.0 7.8 7.0 8.9 3 1.1 2.5 3.3 4.1 5.8 7.8 9.1 10.0 5.9 4 1.2 1.0 1.4 1.3 2.0 3.4 3.7 4.0 2.3 5 0.2 0.2 0.5 0.7 1.2 1.2 1.7 2.3 1.1 6 0.3 0.0 0.1 0.3 0.2 0.4 0.4 1.2 0.4 7 0.0 0.1 0.0 0.0 0.2 0.1 0.1 0.2 0.1 8+ 0.0 0.0 0.0 0.0 0.0 0.2 0.2 0.7 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 748 3,814 7,432 11,010 9,747 7,237 4,572 6,570 51,130 Percentage with access to an ITN1 22.3 21.9 20.5 20.8 21.8 23.9 20.3 19.0 21.2 1 Percentage of the de facto household population who could sleep under an ITN if each ITN in the household were used by up to two people 198 • Malaria Table 12.4 Use of mosquito nets by persons in the household Percentage of the de facto household population who slept the night before the survey under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), and under a long-lasting insecticidal net (LLIN), and among the de facto household population in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Myanmar DHS 2015-16 Household population Household population in households with at least one ITN1 Background characteristic Percentage who slept under any mosquito net last night Percentage who slept under an ITN1 last night Percentage who slept under an LLIN last night Number of persons Percentage who slept under an ITN1 last night Number of persons Age2 <5 81.6 18.6 16.6 4,595 56.3 1,516 5-14 81.5 18.1 16.0 10,442 54.7 3,458 15-34 83.2 14.7 12.8 14,736 53.5 4,043 35-49 88.3 15.0 12.4 9,987 56.9 2,625 50+ 86.8 14.0 12.3 11,366 54.1 2,934 Sex Male 83.0 15.6 13.5 23,547 54.0 6,790 Female 85.8 15.7 13.7 27,583 55.5 7,789 Residence Urban 90.0 9.2 6.6 13,962 58.8 2,187 Rural 82.5 18.0 16.2 37,168 54.1 12,392 States/Regions Kachin 82.9 25.3 24.2 1,554 57.8 680 Kayah 59.4 40.3 38.7 281 46.8 242 Kayin 68.2 22.2 21.6 1,473 61.3 533 Chin 57.3 40.4 38.2 480 49.7 390 Sagaing 91.9 19.5 16.0 5,610 55.6 1,968 Tanintharyi 72.2 41.9 40.6 1,296 52.9 1,028 Bago 90.1 5.3 4.3 4,860 34.9 742 Magway 87.1 15.5 13.4 4,015 56.1 1,111 Mandalay 87.1 6.9 5.0 5,857 64.2 629 Mon 79.9 36.4 33.7 1,912 55.5 1,254 Rakhine 72.1 39.5 38.0 3,167 58.8 2,128 Yangon 96.3 3.7 1.5 6,968 61.9 420 Shan 62.9 21.6 19.6 5,752 55.0 2,256 Ayeyarwady 95.1 8.2 6.0 6,718 50.0 1,109 Nay Pyi Taw 74.9 3.3 2.0 1,186 44.0 90 Wealth quintile Lowest 77.0 22.6 20.9 10,032 58.7 3,858 Second 82.1 18.5 17.3 10,127 55.0 3,412 Middle 86.8 14.9 12.9 10,215 52.2 2,908 Fourth 88.1 11.9 9.8 10,363 48.8 2,530 Highest 88.4 10.6 7.5 10,394 58.7 1,870 Total 84.5 15.6 13.6 51,130 54.8 14,579 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. 2 Total includes three persons with missing information on age. Malaria • 199 Table 12.5 Use of existing ITNs Percentage of insecticide-treated nets (ITNs) that were used by anyone the night before the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage of existing ITNs1 used last night Number of ITNs1 Residence Urban 67.7 1,101 Rural 56.6 5,893 States/Regions Kachin 59.9 364 Kayah 39.7 140 Kayin 80.9 194 Chin 38.5 224 Sagaing 55.1 995 Tanintharyi 49.1 556 Bago 49.4 243 Magway 63.2 535 Mandalay 68.1 316 Mon 50.7 712 Rakhine 58.2 1,014 Yangon 76.2 183 Shan 63.8 1,030 Ayeyarwady 65.6 457 Nay Pyi Taw 66.4 32 Wealth quintile Lowest 59.3 1,720 Second 55.6 1,651 Middle 56.3 1,396 Fourth 55.5 1,252 Highest 67.6 975 Total 58.3 6,994 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. 200 • Malaria Table 12.6 Use of mosquito nets by children Percentage of children under age 5 who, the night before the survey, slept under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), and under a long-lasting insecticidal net (LLIN), and among children under age 5 in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Myanmar DHS 2015-16 Children under age 5 in all households Children under age 5 in households with at least one ITN1 Background characteristic Percentage who slept under any mosquito net last night Percentage who slept under an ITN1 last night Percentage who slept under an LLIN last night Number of children Percentage who slept under an ITN1 last night Number of children Age in months <12 81.0 17.8 16.4 865 54.5 282 12-23 83.4 19.9 18.2 925 62.1 297 24-35 80.8 18.4 16.4 888 56.3 290 36-47 79.9 16.8 14.5 991 51.4 324 48-59 83.1 20.1 17.9 926 57.5 323 Sex Male 81.8 18.8 16.9 2,387 56.7 790 Female 81.5 18.4 16.4 2,208 55.9 726 Residence Urban 87.1 8.3 6.9 1,025 53.7 158 Rural 80.1 21.5 19.4 3,570 56.6 1,357 States/Regions Kachin 82.5 25.7 25.0 171 54.4 81 Kayah 64.7 44.5 43.2 33 52.5 28 Kayin 69.1 25.3 24.5 188 66.7 71 Chin 59.8 42.2 40.4 63 49.9 53 Sagaing 93.2 25.1 21.1 497 58.2 215 Tanintharyi 71.5 46.7 45.4 153 55.2 129 Bago 86.8 3.9 3.0 423 23.9 68 Magway 89.6 15.3 13.4 323 58.8 84 Mandalay 87.8 7.2 5.9 445 (67.8) 47 Mon 82.1 43.4 42.1 183 63.4 125 Rakhine 69.9 46.0 44.2 308 63.9 222 Yangon 91.5 2.8 1.3 473 * 32 Shan 62.4 21.3 19.0 656 53.3 262 Ayeyarwady 89.9 8.3 5.6 581 (52.8) 91 Nay Pyi Taw 73.0 4.6 3.5 98 * 6 Wealth quintile Lowest 72.9 23.8 21.9 1,328 59.2 535 Second 81.9 21.4 20.1 995 57.2 373 Middle 85.6 18.2 15.7 792 54.1 266 Fourth 87.7 13.8 11.0 801 51.5 215 Highest 86.6 10.1 8.9 680 54.4 126 Total 81.6 18.6 16.6 4,595 56.3 1,516 Note: Table is based on children who stayed in the household the night before the interview. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. Malaria • 201 Table 12.7 Use of mosquito nets by pregnant women Percentage of pregnant women age 15-49 who, the night before the survey, slept under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), and under a long-lasting insecticidal net (LLIN), and among pregnant women age 15-49 in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Myanmar DHS 2015-16 Among pregnant women age 15-49 in all households Among pregnant women age 15-49 in households with at least one ITN1 Background characteristic Percentage who slept under any mosquito net last night Percentage who slept under an ITN1 last night Percentage who slept under an LLIN last night Number of women Percentage who slept under an ITN1 last night Number of women Residence Urban 95.2 10.4 6.7 105 * 15 Rural 81.1 20.7 19.6 367 60.5 125 Education No education 59.8 23.4 23.4 63 (56.3) 26 Primary 84.8 19.4 18.5 207 61.6 65 Secondary 89.2 19.3 15.5 160 65.6 47 More than secondary (99.4) (2.3) (2.3) 41 * 2 Wealth quintile Lowest 74.1 20.7 19.1 141 62.6 47 Second 86.6 24.6 24.6 95 60.5 39 Middle 89.0 23.1 22.9 78 71.3 25 Fourth 86.5 12.2 8.5 76 (46.2) 20 Highest 92.2 8.5 5.1 82 * 10 Total 84.2 18.4 16.7 472 61.9 140 Note: Table is based on women who stayed in the household the night before the interview. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Because of the small number of cases, estimates for states and regions are not shown separately. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. 202 • Malaria Table 12.8 Prevalence, diagnosis, and prompt treatment of children with fever Percentage of children under age 5 with a fever in the 2 weeks preceding the survey, and among children under age 5 with a fever, the percentage for whom advice or treatment was sought and the percentage who had blood taken from a finger or heel, by background characteristics, Myanmar DHS 2015-16 Children under age 5 Children under age 5 with fever Background characteristic Percentage with fever in the 2 weeks preceding the survey Number of children Percentage for whom advice or treatment was sought1 Percentage who had blood taken from a finger or heel for testing Number of children Age in months <12 16.3 807 63.9 1.8 131 12-23 21.2 852 62.7 3.5 180 24-35 18.0 782 69.6 3.9 141 36-47 13.5 866 63.5 3.0 117 48-59 11.0 792 65.8 2.2 87 Sex Male 15.5 2,131 64.2 3.2 330 Female 16.6 1,968 65.7 2.8 327 Residence Urban 16.4 925 64.6 0.1 151 Rural 15.9 3,174 65.1 3.9 505 States/Regions Kachin 21.8 162 64.9 2.3 35 Kayah 22.0 31 74.2 7.4 7 Kayin 18.0 140 72.6 1.8 25 Chin 32.2 60 40.7 17.0 19 Sagaing 6.6 456 * * 30 Tanintharyi 20.9 125 76.3 6.4 26 Bago 16.3 360 (61.0) (0.0) 59 Magway 18.2 299 (54.9) (2.3) 54 Mandalay 11.1 411 (65.3) (0.0) 46 Mon 9.1 140 * * 13 Rakhine 24.1 294 78.9 11.5 71 Yangon 8.2 423 * * 35 Shan 14.1 564 (57.2) (0.0) 80 Ayeyarwady 26.1 542 63.4 0.0 142 Nay Pyi Taw 16.7 92 (61.4) (2.6) 15 Mother's education No education 15.6 730 64.5 6.8 114 Primary 16.7 1,879 62.5 2.3 313 Secondary 16.0 1,175 65.4 2.4 188 More than secondary 13.1 314 (82.5) (0.3) 41 Wealth quintile Lowest 18.0 1,211 60.6 5.3 218 Second 19.3 906 64.3 1.6 175 Middle 13.0 691 57.7 1.9 90 Fourth 13.6 699 74.0 3.5 95 Highest 13.4 593 75.8 0.5 80 Total 16.0 4,099 65.0 3.0 657 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes advice or treatment from a traditional practitioner Malaria • 203 Table 12.9 Source of advice or treatment for children with fever Percentage of children under age 5 with a fever in the 2 weeks preceding the survey for whom advice or treatment was sought from specific sources, and among children under age 5 with a fever in the 2 weeks preceding the survey for whom advice or treatment was sought, the percentage for whom advice or treatment was sought from specific sources, by background characteristics, Myanmar DHS 2015-16 Percentage for whom advice or treatment was sought from each source: Background characteristic Among children with fever Among children with fever for whom advice or treatment was sought Any public sector source 38.4 56.7 Government hospital 12.2 18.0 Government rural health center 9.2 13.6 Government health post (sub center) 14.5 21.4 Fieldworker 3.1 4.6 Other 0.4 0.6 Any private sector source 21.2 31.3 Private hospital/clinic 15.9 23.4 Pharmacy 2.2 3.2 Private doctor 3.2 4.8 Other 0.1 0.1 Any other source 8.7 12.9 Shop 5.8 8.5 Traditional practitioner 1.0 1.4 Market 0.3 0.4 Other 1.8 2.7 Number of children 657 445 204 • Malaria Table 12.10 Hemoglobin <8.0 g/dl in children Percentage of children age 6-59 months with hemoglobin lower than 8.0 g/dl, by background characteristics, Myanmar DHS 2015-16 Background characteristic Hemoglobin <8.0 g/dl Number of children Age in months 6-8 2.3 136 9-11 8.7 163 12-17 9.6 387 18-23 4.3 345 24-35 3.5 723 36-47 1.6 833 48-59 0.8 789 Sex Male 3.9 1,738 Female 2.8 1,638 Mother's interview status Interviewed 3.4 3,071 Not interviewed but in household 2.9 64 Not interviewed and not in the household1 3.0 241 Residence Urban 3.9 699 Rural 3.2 2,676 States/Regions Kachin 3.8 141 Kayah 4.1 25 Kayin 2.4 162 Chin 2.4 53 Sagaing 3.2 312 Tanintharyi 3.8 134 Bago 2.9 374 Magway 5.0 254 Mandalay 1.9 327 Mon 6.8 142 Rakhine 3.4 236 Yangon 2.2 384 Shan 1.8 275 Ayeyarwady 4.9 474 Nay Pyi Taw 4.7 81 Mother's education2 No education 3.7 491 Primary 3.5 1,546 Secondary 3.0 880 More than secondary 4.1 217 Wealth quintile Lowest 3.1 1,020 Second 4.8 782 Middle 3.2 608 Fourth 1.8 558 Highest 3.7 408 Total 3.4 3,376 Note: Table is based on children who stayed in the household the night before the interview. Hemoglobin levels are adjusted for altitude using CDC formulas (CDC 1998). Hemoglobin is measured in grams per deciliter (g/dl). 1 Includes children whose mothers are deceased 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. Total includes 2 children with missing information on mother’s education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 205 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13 Key Findings  Knowledge of HIV prevention methods: Twenty percent of women and 22% of men have “comprehensive knowledge” about the modes of HIV transmission and prevention.  Knowledge of prevention of mother-to-child transmission of HIV: Sixty-seven percent of women and 61% of men know that HIV can be transmitted by breastfeeding. Among women and men, 59% and 55%, respectively, know that the risk of mother-to-child transmission is reduced by a mother taking special drugs during pregnancy.  Attitudes towards people living with HIV/AIDS: Eighty percent of women and 72% of men are willing to care for a family member with HIV/AIDS. Seventy-five percent of women and 79% of men would not want to keep it a secret if a family member became infected with HIV.  HIV tests: Sixty-four percent of women and 63% of men age 15-49 know where to get an HIV test. Eighteen percent of women and 21% of men have ever been tested for HIV and received the results of their last test. his chapter presents information on the current status of HIV knowledge, attitudes, and testing coverage in the general population and the young population. Although the prevalence of HIV is very low in Myanmar, estimated at 0.54% in the adult population age 15 and above, sentinel sero- surveillance indicates that it is higher in high-risk groups such as men who have sex with men, people who inject drugs, and female sex workers (MoHS 2015b). The National AIDS Program in Myanmar will benefit from the information derived from this survey and can develop strategic plans for preventive measures through health education, increasing HIV awareness, and testing for HIV. Similarly, this information will allow an assessment of Myanmar’s commitment towards the UNAIDS 90-90-90 target (UNAIDS 2016). 13.1 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHODS Most women and men age 15-49 (92% each) are aware of HIV (Table 13.1). Overall, 59% of women and 71% of men know that using condoms is a way to prevent HIV transmission (Table 13.2). Seventy percent of women and 75% of men recognize that the risk of getting HIV can be reduced by limiting sexual intercourse to one uninfected partner. Fifty-four percent of women and 62% of men are aware of both of these prevention methods (Figure 13.1). T 206 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Patterns by background characteristics  Across all age groups, men are more likely than women to know that HIV can be prevented by using condoms and limiting sexual intercourse to one uninfected partner; the difference is most prominent in the 20-24 age group (65% and 52%, respectively).  Women and men with no education (22% and 32%, respectively) are less likely to know about the two prevention methods than those who have more than a secondary education (84% and 85%, respectively).  Among the states and regions, women living in Chin State have the least knowledge of the two prevention methods (27%), followed by women in Shan State (30%) and Rakhine State (32%) (Figure 13.2). Comprehensive knowledge of HIV Knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV. Sample: Women and men age 15-49 Comprehensive knowledge of HIV is a composite measure and indicates that a person knows that both condom use and limiting sexual intercourse to one uninfected partner can prevent HIV, knows that a healthy-looking person can have HIV, and rejects the two most common local misconceptions about the transmission of HIV, which in Myanmar are that HIV can be transmitted through mosquito bites and that a person can become infected with HIV by sharing food with someone who has AIDS. One in five women and 22% of men age 15-49 have comprehensive knowledge about HIV (Table 13.3.1 and Table 13.3.2). Patterns by background characteristics  Women and men living in rural areas (13% and 16%, respectively) are less likely than those living in urban areas (36% and 38%, respectively) to have comprehensive knowledge of HIV.  There are variations in comprehensive knowledge of HIV among women by region/state. For instance, only 8% of women in Rakhine State and 10% of women in Chin State have comprehensive knowledge, as compared with 33% in Yangon Region. Figure 13.1 Knowledge of HIV prevention methods by residence Figure 13.2 Knowledge of HIV prevention methods by states and regions Percentage of women age 15-49 who knows HIV prevention methods 66 77 49 5654 62 Women Men Urban Rural Percentage of women and men age 15-49 who know that HIV can be prevented by using condoms and limiting sex to one uninfected partner HIV/AIDS-related Knowledge, Attitudes, and Behavior • 207  Comprehensive knowledge of HIV rises with increasing education and wealth among both women and men. The difference is particularly striking with respect to education: 3% or less of women and men with no education have comprehensive knowledge, compared with 62% of women and men with more than a secondary education. 13.2 KNOWLEDGE ABOUT MOTHER-TO-CHILD TRANSMISSION Increasing the level of general knowledge about transmission of HIV from mother to child and reducing the risk of transmission using antiretroviral drugs are critical in reducing mother-to-child transmission (MTCT) of HIV. To assess MTCT knowledge, respondents were asked whether HIV can be transmitted from mother to child through breastfeeding and whether a mother with HIV can reduce the risk of transmission to her baby by taking certain drugs during pregnancy. Improving knowledge regarding MTCT can help prevent mother-to-child transmission. Women are more aware than men that HIV can be transmitted through breastfeeding (67% versus 61%) and that the risk of MTCT can be reduced by taking special drugs (59% versus 55%) (Table 13.4, Figure 13.3). Overall, half of women and 45% of men age 15-49 know that HIV can be transmitted by breastfeeding and that the risk of MTCT can be reduced by the mother taking special drugs during pregnancy (Table 13.4). Patterns by background characteristics  Knowledge regarding MTCT varies by states and regions among both women and men. Only 29% of women and 20% of men living in Shan State are aware of MTCT, as compared with 65% of women in Sagaing Region and 62% of men in Tanintharyi Region.  Women and men with no education are least likely to be aware of MTCT (32% and 31%, respectively). 13.3 HIV/AIDS ATTITUDES 13.3.1 Attitudes toward People Living with HIV/AIDS Widespread stigma and discrimination in a population can adversely affect both people’s willingness to be tested and their adherence to antiretroviral therapy (ART). Thus, reduction of stigma and discrimination in a population is an important indicator of the success of programs targeting HIV/AIDS prevention and control. Figure 13.3 Knowledge of mother-to- child transmission (MTCT) of HIV 71 61 67 59 67 56 61 55 During pregnancy During delivery By breastfeeding Know that the risk of MTCT can be reduced by mother taking special drugs Percentage of women and men age 15-49 Women Men Know that HIV can be transmitted from mother to child: 208 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Accepting attitudes about HIV Women and men are asked four questions to assess the level of stigma associated with HIV/AIDS. Respondents who indicate that (1) they are willing to care for a family member with AIDS in their home, (2) they would buy fresh vegetables from a shopkeeper who has HIV, (3) a female teacher who has HIV but is not sick should be allowed to continue teaching, and (4) they would not want to keep secret that a family member was infected with HIV are considered to have accepting attitudes. Sample: Women and men age 15-49 Table 13.5.1 and Table 13.5.2 present information on attitudes towards people living with HIV/AIDS. The majority of women (80%) and men (72%) are willing to take care of family members with AIDS and do not want to keep it a secret (75% and 79%, respectively). Thirty-five percent of women and 36% of men report that they would buy fresh vegetables from a shopkeeper who is HIV positive, and approximately half of women and men say that an HIV-positive but healthy teacher should be allowed to continue teaching (53% and 49%, respectively). Overall, however, the proportions of women and men with accepting attitudes in all four situations are very low (20% and 19%, respectively). Patterns by background characteristics  Rural women and men (16% and 15%, respectively) are less likely than urban women and men (30% and 27%, respectively) to have accepting attitudes towards people living with HIV/AIDS.  Women and men with no education (9% and (6%, respectively) are less likely to have accepting attitudes than women and men with more than a secondary education (38% and 43%, respectively) (Figure 13.4). 13.3.2 Attitudes toward Negotiating Safer Sexual Relations with Husbands Knowledge about HIV transmission and ways to prevent it is of little use if people feel powerless to negotiate safer sex practices with their partners. To assess attitudes toward negotiating safer sexual relations with husbands, women and men were asked whether they thought that a wife is justified in refusing to have sexual intercourse with her husband if she knows he has sex with other women or asking that he use a condom if she knows he has a sexually transmitted infection (STI). Eighty-one percent of women and 68% of men believe that a woman is justified in refusing sexual intercourse if her husband has another sexual partner (Table 13.6). Similarly, three in four women (75%) and about four in five men (82%) believe that a woman is justified in asking her husband to use a condom if she knows that he has an STI. Patterns by background characteristics  Women and men living in urban areas are more likely to have positive attitudes toward negotiating for safer sexual relations with husbands than those in rural areas. For instance, 79% of men in urban areas believe that a woman is justified in refusing sexual intercourse if her husband has another sexual partner, as compared with 64% of men in rural areas. Figure 13.4 Discriminatory attitudes towards people living with HIV by education 9 14 23 38 6 11 24 43 No education Primary Secondary More than secondary Women Men Percentage of women and men age 15-49 who express accepting attitudes on all four indicators HIV/AIDS-related Knowledge, Attitudes, and Behavior • 209  Attitudes toward negotiating safer sexual relations with husbands vary by education. For instance, 49% of women with no education believe that a woman is justified in asking her husband to use a condom if she knows that he has an STI, compared with 94% of women with more than a secondary education. 13.3.3 Attitudes toward Condom Education for Young People Women and men age 18-49 were asked if children age 12-14 should be educated on using condoms to avoid HIV. Forty percent of women and 46% of men agreed that children age 12-14 should be taught about condoms (Table 13.7). Patterns by background characteristics  Urban women and men (51% and 54%, respectively) are more likely than rural women and men (36% and 43%, respectively) to support teaching children age 12-14 about condoms.  Only 21% of women in Shan State and 30% of men in Kayin State agree that children age 12-14 should be taught about using a condom. On the other hand, 54% of women in Yangon Region and 62% of men in Magway Region support condom education.  Women and men with no education are less likely to support educating children age 12-14 on condom use than those with more education. For instance, only 21% of women and 29% of men with no education support teaching children about condoms, as compared with 62% of women and men with more than a secondary education. 13.4 PAID SEX The act of paying for sex introduces an uneven negotiating ground for safer sexual intercourse. Table 13.8 shows the percentage of men age 15-49 who had ever paid for sexual intercourse, the percentage who had paid for sexual intercourse in the past 12 months, and the percentage reporting that a condom was used the last time they paid for sexual intercourse. Overall, 2% of men had ever paid for sexual intercourse, and 1% reported having paid for sexual intercourse in the 12 months preceding the survey. Among those who had paid for sexual intercourse in the 12 months preceding the survey, 77% reported using a condom during their last such intercourse. 13.5 COVERAGE OF HIV TESTING SERVICES Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk and increase safer sex practices so that they can remain disease free. Among those who are living with HIV, knowledge of their status allows them to take action to protect their sexual partners, to access care, and to receive treatment. 13.5.1 Awareness of HIV Testing Services and Experience with HIV Testing To assess awareness and coverage of HIV testing services, respondents were asked whether they had ever been tested for HIV. If they said that they had, they were asked whether they had received the results of their last test and where they had been tested. If they had never been tested, they were asked whether they knew a place where they could go to be tested. 210 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.9.1 shows coverage of prior HIV testing among women. Sixty-four percent of women in Myanmar know a place to get an HIV test. Eighteen percent of women had ever been tested for HIV and received their test results (Figure 13.5). Information on coverage of HIV testing among men is presented in Table 13.9.2. Sixty-three percent of men know where to get an HIV test. About one in five men (21%) reported having ever been tested for HIV and receiving their results. Two percent of women and men who had been tested for HIV did not receive their test results. Patterns by background characteristics  Married women are more likely than unmarried women to have been tested for HIV and to have received their test results (24% and 7%, respectively). Also, unmarried men are more likely to have been tested and to have received their results than unmarried women (15% versus 7%) (Table 13.9.1 and Table 13.9.2).  Women and men in urban areas (28% and 37%, respectively) are more likely to have been tested for HIV and to have received their results than those in rural areas (13% and 14%, respectively).  Women and men in Rakhine State are least likely to ever have been tested for HIV and to have received their test results (8% and 10%, respectively).  Women and men at higher educational levels are more likely than those with no education to have been tested for HIV and to have received their results. For example, only 9% of women and men with no education had been tested and received their results, as compared with 37% of women and 55% of men with more than a secondary education (Figure 13.6). Figure 13.5 HIV testing Figure 13.6 HIV testing by education 18 5 21 5 Ever tested for HIV and received the result Tested in 12 months before the survey and received the result Women Men Percentage of women and men age 15-49 9 9 14 14 20 24 37 55 Women Men Percentage of women and men age 15-49 who have ever been tested for HIV and received results of the most recent test No education Primary complete Secondary More than secondary HIV/AIDS-related Knowledge, Attitudes, and Behavior • 211  Only 5% of women and men were tested for HIV in the 12 months preceding the survey and received the results of their last test (Table 13.9.1 and Table 13.9.2). There are variations by state/region in the proportions of women who had been test and received results in the past 12 months, ranging from a low of 3% in Sagaing Region, Rakhine State, and Nay Pyi Taw to a high of 8% in Kayah State and Kayin State (Figure 13.7). 13.5.2 HIV Testing of Pregnant Women In efforts to prevent MTCT, it is vital to screen pregnant women for HIV, which entails initial testing and education about HIV. Through mandatory testing in pregnancy, HIV can be diagnosed and managed early. Thirty-four percent of women who gave birth during the 2 years preceding the survey received counseling on HIV during an antenatal care (ANC) visit (Table 13.10). Twenty-three percent of women reported that they received counseling on HIV during ANC and that they were tested for HIV and received the results of their test. Patterns by background characteristics  Women living in urban areas are more likely to receive the recommended screening services (counseling on HIV, HIV testing, and receipt of results) than rural women (39% versus 17%).  Women in Rakhine State (7%) are least likely to receive the recommended screening services.  There are wide variations by education in HIV services received by women during pregnancy. Only 7% of women with no education received the recommended services, as compared with 37% of women with more than a secondary education. 13.6 MALE CIRCUMCISION In Myanmar, 4% of men age 15-49 are circumcised. Men living in urban areas are more likely to be circumcised than those living in rural areas (7% versus 3%) (Table 13.11). 13.7 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections (STIs) and symptoms Respondents who had ever had sex were asked whether they had an STI or symptoms of an STI (a bad-smelling, abnormal discharge from the vagina/penis or a genital sore or ulcer) in the 12 months before the survey. Sample: Women and men age 15-49 Sexually transmitted diseases are associated with HIV, and people with an STI are 2-9 times more likely to contract HIV than those without an STI. Overall, 8% of women and 7% of men reported that they had experienced symptoms of an STI in the 12 months preceding the survey (Table 13.12). Figure 13.7 Recent HIV testing (or ever tested) by states and regions Percentage of women age 15-49 who were tested for HIV in the year before the survey and received results 212 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Sixty percent of women and 84% of men with an STI or STI symptoms did not receive advice or treatment from a health care provider (Figure 13.8). Lack of such advice or treatment can increase disease progression or the risk of STI transmission to partners. 13.8 INJECTIONS Injection overuse in a health care setting can contribute to the transmission of blood-borne pathogens because it amplifies the effects of unsafe practices such as reuse of injection equipment. Respondents were asked whether they had received any injections from a health worker in the 12 months before the survey and, if so, whether their last injection was administered with a syringe from a new, unopened package. It should be noted that self-administered medical injections (e.g., insulin injections for diabetes) were not included in the calculations. Fifty-five percent of women and 47% of men age 15-49 reported that they received a medical injection in the 12 months preceding the survey (Table 13.13). On average, both women and men received two injections in the 12 months before the survey. It is universal in Myanmar for health providers to use syringes and needles from a new, unopened package. 13.9 HIV/AIDS-RELATED KNOWLEDGE AND BEHAVIOR AMONG YOUNG PEOPLE This section addresses HIV/AIDS-related knowledge among young people age 15-24 and also assesses the extent to which young people are engaged in behaviors that may place them at risk of contracting HIV. 13.9.1 Knowledge Knowledge of how HIV is transmitted is crucial in enabling people to avoid HIV infection, and this is especially true for young people, who are often at greater risk because they may have shorter relationships with more partners or engage in other risky behaviors. Sixteen percent of young women and 18% of young men have comprehensive knowledge of HIV/AIDS (defined as knowing that both condom use and limiting sexual intercourse to one uninfected partner are HIV prevention methods, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission) (Table 13.14). Young men are more likely to know about sources of condoms than young women (42% and 23%, respectively). Patterns by background characteristics  Young women and men living in urban areas (28% and 30%, respectively) are more likely to have comprehensive knowledge about HIV than those living in rural areas (11% and 13%, respectively).  Comprehensive knowledge of HIV is associated with education. Forty-seven percent of young women and men with more than a secondary education have comprehensive knowledge, as compared with only 1% of young women and men with no education. Figure 13.8 STI advice or treatment seeking-behavior 32 4 4 60 14 1 2 84 Sought advice or treatment from a clinic/hospital/ private doctor/other health professional Sought advice or medicine from a shop/pharmacy Sought advice or treatment from any other source No advice or treatment Percentage of women and men age 15-49 reporting an STI or symptoms of an STI Women Men HIV/AIDS-related Knowledge, Attitudes, and Behavior • 213 13.9.2 First Sex Young people who initiate sex at an early age are typically at higher risk of becoming pregnant or contracting an STI than young people who initiate sex later. Consistent condom use can reduce such risks. In Myanmar, young women are more likely than young men to have sexual intercourse before age 18 (14% and 6%, respectively) (Table 13.15). Patterns by background characteristics  Thirty-five percent of ever-married young women had sexual intercourse before age 18, as compared with only 16% of ever-married young men.  Young women and men with no education (38% and 14%, respectively) were more likely than those with a secondary education (10% and 5%, respectively) to initiate sex before age 18. 13.9.3 Coverage of HIV Testing Services Seeking an HIV test may be more difficult for young people than adults because many young people lack experience in accessing health services for themselves and because there are often barriers to young people obtaining services. Table 13.16 presents information on HIV testing among young people age 15-24 who had sexual intercourse in the past 12 months. Eight percent of young women and 6% of young men had been tested for HIV in the 12 months preceding the survey and had received the results of their last test. Patterns by background characteristics  By age group, 11% of young women age 23-24 had been tested for HIV in the past 12 months and received their results, as compared with only 3% of young women age 15-17.  Seven percent of young women and 2% of young men living in rural areas had been tested for HIV in the past 12 months and received the results of their test, compared with 14% of young women and 17% of young men living in urban areas. LIST OF TABLES For more information on HIV/AIDS-related knowledge, attitudes, and behavior, see the following tables:  Table 13.1 Knowledge of AIDS  Table 13.2 Knowledge of HIV prevention methods  Table 13.3.1 Comprehensive knowledge about HIV: Women  Table 13.3.2 Comprehensive knowledge about HIV: Men  Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV  Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women  Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men  Table 13.6 Attitudes toward negotiating safer sexual relations with husband  Table 13.7 Adult support of education about condom use to prevent AIDS  Table 13.8 Payment for sexual intercourse and condom use at last paid sexual intercourse  Table 13.9.1 Coverage of prior HIV testing: Women  Table 13.9.2 Coverage of prior HIV testing: Men  Table 13.10 Pregnant women counseled and tested for HIV  Table 13.11 Male circumcision  Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms  Table 13.13 Prevalence of medical injections  Table 13.14 Comprehensive knowledge about AIDS and a source of condoms among young people  Table 13.15 Age at first sexual intercourse among young people  Table 13.16 Recent HIV tests among young people 214 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.1 Knowledge of AIDS Percentage of women and men age 15-49 who have heard of AIDS, by background characteristics, Myanmar DHS 2015-16 Women Men Background characteristic Has heard of AIDS Number of respondents Has heard of AIDS Number of respondents Age 15-24 89.9 3,677 89.9 1,423 15-19 88.5 1,810 89.0 731 20-24 91.2 1,867 90.8 692 25-29 92.5 1,867 93.4 677 30-39 92.6 3,990 93.5 1,377 40-49 91.6 3,351 92.0 1,259 Marital status1 Never married 92.2 4,278 91.3 1,644 Ever had sex * 11 96.9 178 Never had sex 92.2 4,267 90.6 1,466 Married 91.5 7,759 92.5 2,957 Divorced/separated/wi dowed 89.1 848 88.6 135 Residence Urban 98.1 3,768 97.7 1,350 Rural 88.9 9,117 89.7 3,387 States/Regions Kachin 95.6 374 96.7 161 Kayah 95.0 65 93.7 23 Kayin 88.1 303 88.3 115 Chin 75.6 102 89.3 39 Sagaing 96.3 1,410 93.4 514 Tanintharyi 97.0 283 97.4 103 Bago 95.0 1,244 99.5 454 Magway 97.8 1,081 96.7 320 Mandalay 94.4 1,541 96.1 601 Mon 96.9 463 97.2 162 Rakhine 72.5 777 81.1 222 Yangon 98.4 1,927 98.9 703 Shan 70.3 1,368 67.7 542 Ayeyarwady 94.3 1,650 93.2 653 Nay Pyi Taw 94.3 300 93.8 126 Education2 No education 65.3 1,606 68.4 575 Primary 91.8 5,305 91.2 1,684 Secondary 98.0 4,646 97.7 2,139 More than secondary 100.0 1,325 100.0 339 Wealth quintile Lowest 78.8 2,274 84.2 890 Second 89.1 2,408 88.8 916 Middle 93.5 2,633 94.1 979 Fourth 95.4 2,702 94.2 986 Highest 98.4 2,868 97.9 966 Total 91.6 12,885 92.0 4,737 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes two men with missing information on marital status. 2 Total includes three women with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 215 Table 13.2 Knowledge of HIV prevention methods Percentage of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting HIV by using condoms every time they have sexual intercourse and by having one sex partner who is not infected and has no other partners, by background characteristics, Myanmar DHS 2015-16 Percentage of women who say HIV can be prevented by Percentage of men who say HIV can be prevented by Background characteristic Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of women Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of men Age 15-24 54.2 65.7 48.2 3,677 68.2 68.8 58.8 1,423 15-19 49.8 62.9 44.3 1,810 62.5 64.7 53.0 731 20-24 58.5 68.4 52.0 1,867 74.3 73.2 64.9 692 25-29 62.5 73.6 56.9 1,867 74.9 76.9 66.1 677 30-39 64.4 74.2 59.2 3,990 72.3 77.6 64.4 1,377 40-49 57.5 69.0 52.0 3,351 68.8 76.8 61.8 1,259 Residence Urban 72.3 78.5 66.0 3,768 84.9 85.3 77.0 1,350 Rural 54.1 66.9 48.8 9,117 64.8 70.4 56.4 3,387 States/Regions Kachin 70.1 74.8 61.6 374 77.6 78.7 67.1 161 Kayah 68.2 77.4 62.5 65 69.6 74.3 60.5 23 Kayin 56.7 71.8 52.4 303 56.4 24.6 15.7 115 Chin 41.5 38.7 27.2 102 60.7 50.2 37.6 39 Sagaing 69.1 86.4 67.0 1,410 76.4 70.4 62.8 514 Tanintharyi 61.7 78.7 59.5 283 79.6 88.1 76.7 103 Bago 64.1 80.2 60.8 1,244 70.5 86.2 66.5 454 Magway 59.7 70.3 50.4 1,081 80.1 79.7 70.6 320 Mandalay 57.5 70.8 49.5 1,541 69.3 81.3 63.5 601 Mon 60.0 70.2 53.3 463 79.7 79.8 70.6 162 Rakhine 37.8 45.1 31.5 777 70.3 74.4 67.6 222 Yangon 63.5 69.4 56.8 1,927 84.0 86.4 78.1 703 Shan 35.2 40.3 29.6 1,368 52.5 52.6 43.6 542 Ayeyarwady 73.3 84.3 70.0 1,650 60.6 72.2 54.0 653 Nay Pyi Taw 58.3 76.3 52.8 300 70.1 78.9 64.6 126 Education3 No education 27.3 35.8 22.0 1,606 40.7 45.4 31.9 575 Primary 52.6 67.3 47.2 5,305 61.4 69.7 53.3 1,684 Secondary 69.7 79.8 64.0 4,646 82.3 83.6 73.8 2,139 More than secondary 89.8 90.8 83.5 1,325 91.7 92.5 85.1 339 Wealth quintile Lowest 45.2 55.9 39.2 2,274 54.8 61.8 46.8 890 Second 50.8 65.0 46.3 2,408 58.6 66.5 51.0 916 Middle 57.2 71.0 51.6 2,633 70.4 78.8 63.5 979 Fourth 64.0 74.9 58.7 2,702 79.4 78.3 69.2 986 Highest 75.6 81.3 69.3 2,868 87.3 86.3 78.9 966 Total 59.4 70.3 53.8 12,885 70.5 74.7 62.3 4,737 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners 3 Total includes three women with missing information on education. 216 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.3.1 Comprehensive knowledge about HIV: Women Percentage of women age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, and the percentage with comprehensive knowledge about HIV, according to background characteristics, Myanmar DHS 2015-16 Percentage of respondents who say that: Percentage who say that a healthy-looking person can have HIV and who reject the two most common local misconceptions1 Percentage with comprehensive knowledge about HIV2 Background characteristic A healthy- looking person can have HIV HIV cannot be transmitted by mosquito bites HIV cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has HIV Number of respondents Age 15-24 60.2 34.6 68.3 53.8 21.1 16.2 3,677 15-19 59.6 33.5 66.8 49.6 18.6 13.4 1,810 20-24 60.9 35.7 69.6 57.9 23.4 18.9 1,867 25-29 61.8 41.9 71.5 63.1 27.9 23.7 1,867 30-39 58.9 40.7 71.4 59.8 26.3 22.1 3,990 40-49 55.3 36.5 65.7 55.2 23.1 18.7 3,351 Marital status Never married 62.6 41.3 73.4 61.9 27.4 21.4 4,278 Ever had sex * * * * * * 11 Never had sex 62.6 41.3 73.4 61.9 27.4 21.4 4,267 Married 57.2 36.4 67.1 55.5 22.8 19.1 7,759 Divorced/separated/ widowed 53.6 36.0 64.8 52.0 20.9 17.1 848 Residence Urban 73.7 57.0 86.3 78.9 43.2 36.0 3,768 Rural 52.6 30.2 61.9 48.5 16.3 13.0 9,117 States/Regions Kachin 72.8 44.1 71.7 70.0 33.2 27.0 374 Kayah 69.4 48.1 63.9 63.4 33.1 27.7 65 Kayin 50.7 33.2 52.8 52.0 20.7 17.9 303 Chin 50.8 31.3 47.9 48.7 18.0 9.8 102 Sagaing 74.0 31.5 71.6 54.5 22.4 19.3 1,410 Tanintharyi 52.0 46.0 78.7 69.0 25.7 22.5 283 Bago 60.6 37.3 73.6 55.5 22.2 18.7 1,244 Magway 57.6 33.3 65.8 53.1 20.1 15.6 1,081 Mandalay 66.5 34.5 73.1 61.5 25.0 18.3 1,541 Mon 61.5 49.1 79.6 69.0 34.1 26.9 463 Rakhine 26.7 28.6 48.2 34.7 10.8 7.6 777 Yangon 70.8 53.5 84.1 73.2 40.4 33.3 1,927 Shan 35.5 29.0 50.9 42.7 15.4 11.5 1,368 Ayeyarwady 57.8 39.9 70.4 58.9 19.9 18.5 1,650 Nay Pyi Taw 53.9 36.1 57.6 50.4 22.0 18.2 300 Education3 No education 26.8 14.3 31.1 22.3 3.5 2.3 1,606 Primary 52.8 26.9 61.1 45.8 12.7 9.6 5,305 Secondary 68.4 46.7 83.0 71.6 31.2 25.4 4,646 More than secondary 87.6 81.0 97.6 96.0 70.4 61.9 1,325 Wealth quintile Lowest 39.2 21.8 46.4 31.4 6.7 4.9 2,274 Second 48.5 25.6 59.3 44.5 12.0 9.7 2,408 Middle 58.3 32.1 69.0 54.7 18.2 14.4 2,633 Fourth 66.1 43.0 77.3 67.3 29.6 24.2 2,702 Highest 76.3 62.2 87.5 82.0 48.7 40.6 2,868 Total 58.7 38.0 69.0 57.4 24.2 19.7 12,885 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Two most common local misconceptions: that HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. 3 Total includes three women with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 217 Table 13.3.2 Comprehensive knowledge about HIV: Men Percentage of men age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, and the percentage with comprehensive knowledge about HIV, according to background characteristics, Myanmar DHS 2015-16 Percentage of respondents who say that: Percentage who say that a healthy-looking person can have HIV and who reject the two most common local misconceptions1 Percentage with comprehensiv e knowledge about HIV2 Background characteristic A healthy- looking person can have HIV HIV cannot be transmitted by mosquito bites HIV cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has HIV Number of respondents Age 15-24 54.2 37.4 70.4 49.6 21.0 17.8 1,423 15-19 50.1 36.5 67.9 43.4 17.3 14.3 731 20-24 58.6 38.3 73.2 56.2 24.9 21.5 692 25-29 63.3 44.8 78.3 62.9 32.7 26.6 677 30-39 60.1 40.9 73.5 59.8 29.0 24.3 1,377 40-49 57.8 38.3 70.2 53.7 26.2 22.7 1,259 Marital status3 Never married 56.2 42.5 73.4 55.8 26.5 21.5 1,644 Ever had sex 75.2 58.8 86.2 73.2 45.5 36.7 178 Never had sex 53.9 40.6 71.8 53.7 24.2 19.7 1,466 Married 59.6 38.1 72.3 55.6 26.4 22.9 2,957 Divorced/separated/widowed 50.7 38.7 62.4 50.6 24.3 17.4 135 Residence Urban 70.8 59.4 86.5 75.1 45.1 38.1 1,350 Rural 53.1 31.8 66.8 47.8 18.9 16.0 3,387 States/Regions Kachin 74.7 48.6 82.3 64.1 37.2 31.9 161 Kayah 43.3 39.7 59.8 57.2 19.7 18.2 23 Kayin 51.4 32.7 64.0 56.4 20.1 5.3 115 Chin 55.5 39.1 56.6 57.9 23.4 14.4 39 Sagaing 61.3 40.8 72.4 50.7 26.0 22.2 514 Tanintharyi 50.9 40.7 79.1 64.4 23.7 23.3 103 Bago 68.8 38.4 81.3 52.9 25.2 21.8 454 Magway 69.2 36.7 77.6 58.1 28.3 24.9 320 Mandalay 68.7 36.2 78.9 60.7 26.3 22.8 601 Mon 58.9 53.2 75.5 64.4 30.1 26.6 162 Rakhine 44.2 43.8 69.4 45.8 24.7 23.2 222 Yangon 72.9 61.1 85.5 71.8 46.3 39.7 703 Shan 30.1 26.2 52.7 40.6 13.1 10.0 542 Ayeyarwady 44.2 27.6 59.9 49.1 15.8 12.5 653 Nay Pyi Taw 57.5 35.7 70.5 47.4 23.2 19.4 126 Education No education 30.8 12.0 40.7 24.8 3.9 3.1 575 Primary 49.9 25.7 62.0 41.5 13.8 11.2 1,684 Secondary 67.5 51.6 85.2 68.5 35.1 29.9 2,139 More than secondary 86.6 81.2 96.8 95.8 72.1 61.9 339 Wealth quintile Lowest 39.8 19.3 52.9 32.7 7.8 6.3 890 Second 52.7 26.4 60.5 41.9 15.1 12.8 916 Middle 60.7 40.8 75.0 53.5 24.2 20.4 979 Fourth 62.9 44.6 80.2 65.4 31.7 27.5 986 Highest 73.0 64.9 91.0 81.7 50.9 42.5 966 Total 58.2 39.7 72.4 55.6 26.4 22.3 4,737 1 Two most common local misconceptions: that HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. 3 Total includes three men with missing information on marital status. 218 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV Percentage of women and men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Myanmar DHS 2015-16 Women Men Percentage who know that: Percentage who know that: Background characteristic HIV can be transmitted by breastfeeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of women HIV can be transmitted by breastfeeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of men Age 15-24 63.5 56.8 48.2 3,677 54.5 50.0 40.2 1,423 15-19 61.3 55.2 46.6 1,810 53.5 47.7 39.1 731 20-24 65.8 58.3 49.7 1,867 55.6 52.5 41.4 692 25-29 67.4 62.6 54.7 1,867 59.4 58.7 44.9 677 30-39 69.9 60.9 53.2 3,990 64.7 56.0 46.8 1,377 40-49 67.7 57.3 50.7 3,351 63.7 57.0 46.7 1,259 Marital status1 Never married 62.0 56.6 46.8 4,278 55.5 52.1 41.3 1,644 Ever had sex * * * 11 61.1 56.1 41.3 178 Never had sex 62.1 56.5 46.8 4,267 54.8 51.6 41.3 1,466 Married 70.3 60.4 53.8 7,759 63.7 56.8 46.5 2,957 Divorced/separated/ widowed 64.2 58.8 51.8 848 55.6 46.9 41.8 135 Currently pregnant Pregnant 67.4 62.2 53.7 466 na na na na Not pregnant or not sure 67.1 58.9 51.2 12,419 na na na na Residence Urban 67.3 63.9 53.1 3,768 58.3 60.2 43.7 1,350 Rural 67.1 57.0 50.6 9,117 61.6 52.7 44.8 3,387 States/Regions Kachin 68.8 71.2 57.2 374 60.6 67.2 47.1 161 Kayah 71.2 62.2 51.9 65 49.1 38.5 27.1 23 Kayin 68.1 48.2 42.8 303 57.5 35.1 30.7 115 Chin 58.3 38.2 32.7 102 62.5 52.0 40.1 39 Sagaing 78.5 74.1 65.4 1,410 70.8 58.0 49.6 514 Tanintharyi 71.9 63.2 54.7 283 76.6 71.3 61.9 103 Bago 73.1 63.5 55.5 1,244 73.5 62.7 53.7 454 Magway 67.2 57.9 49.8 1,081 67.3 62.1 52.1 320 Mandalay 74.8 65.5 56.7 1,541 63.6 60.2 49.7 601 Mon 63.9 54.5 45.5 463 61.7 48.1 36.7 162 Rakhine 53.1 42.0 36.7 777 59.4 46.2 40.7 222 Yangon 61.9 59.8 51.5 1,927 55.5 67.1 47.4 703 Shan 42.9 33.6 28.9 1,368 34.7 25.5 20.3 542 Ayeyarwady 77.9 65.8 59.1 1,650 61.9 52.0 45.2 653 Nay Pyi Taw 70.7 63.0 54.8 300 66.7 59.0 48.0 126 Education2 No education 43.5 36.2 32.3 1,606 42.1 34.1 31.0 575 Primary 70.1 59.2 53.7 5,305 62.2 54.1 46.7 1,684 Secondary 71.4 64.6 54.9 4,646 64.3 60.2 46.8 2,139 More than secondary 69.2 66.7 52.6 1,325 61.0 60.1 42.4 339 Wealth quintile Lowest 61.3 48.9 45.4 2,274 59.8 48.7 45.0 890 Second 67.5 58.3 52.8 2,408 61.2 51.7 44.2 916 Middle 70.0 59.5 52.4 2,633 65.2 56.8 47.8 979 Fourth 68.5 62.2 52.9 2,702 59.7 57.3 44.5 986 Highest 67.6 64.2 52.4 2,868 57.0 59.0 41.1 966 Total 67.1 59.0 51.3 12,885 60.6 54.9 44.5 4,737 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Total includes two men with missing information on marital status. 2 Total includes three women with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 219 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Myanmar DHS 2015-16 Percentage of women who: Percentage expressing accepting attitudes on all four indicators Number of women who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent's home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 81.2 31.5 54.7 68.1 17.3 3,305 15-19 80.4 27.6 52.8 65.1 14.9 1,603 20-24 82.0 35.1 56.5 71.0 19.6 1,702 25-29 80.5 40.6 57.3 73.5 21.9 1,727 30-39 79.8 36.2 53.7 77.8 21.1 3,696 40-49 78.6 34.4 48.7 80.9 20.7 3,069 Marital status Never married 84.4 38.2 58.0 70.5 21.8 3,945 Ever had sex * * * * * 10 Never had sex 84.4 38.2 58.1 70.5 21.8 3,935 Married 77.4 32.9 50.4 77.6 18.5 7,096 Divorced/separated/w idowed 81.3 38.9 53.7 78.2 25.4 756 Residence Urban 87.0 48.5 69.9 70.5 29.5 3,695 Rural 76.8 28.9 45.5 77.4 15.8 8,102 States/Regions Kachin 82.1 49.0 60.5 74.9 25.9 358 Kayah 76.7 44.5 61.6 83.0 26.7 61 Kayin 76.6 30.6 49.7 80.7 16.3 267 Chin 74.8 39.7 54.6 59.4 18.7 77 Sagaing 82.1 27.9 48.3 78.3 16.9 1,358 Tanintharyi 80.4 47.6 56.3 67.9 24.7 275 Bago 74.4 32.1 48.7 82.4 17.4 1,182 Magway 82.7 29.6 43.4 74.0 13.6 1,056 Mandalay 78.6 27.4 48.1 77.2 14.3 1,454 Mon 85.6 49.9 59.5 69.8 29.1 448 Rakhine 63.1 19.8 36.9 66.9 11.4 563 Yangon 88.7 47.2 69.2 76.9 31.5 1,897 Shan 78.4 36.1 51.1 63.2 20.0 961 Ayeyarwady 79.8 36.6 57.7 76.0 20.4 1,556 Nay Pyi Taw 66.0 26.4 42.9 82.0 14.2 283 Education1 No education 70.7 22.6 31.6 72.6 9.4 1,049 Primary 75.3 26.8 44.4 79.9 14.3 4,868 Secondary 83.9 38.4 59.1 73.0 23.2 4,552 More than secondary 91.1 63.6 82.1 68.3 38.4 1,325 Wealth quintile Lowest 68.4 22.7 40.8 77.5 10.6 1,791 Second 74.7 26.5 42.6 78.1 14.6 2,146 Middle 80.2 30.5 47.6 78.0 17.7 2,463 Fourth 83.7 38.5 57.9 74.6 22.6 2,576 Highest 87.9 50.3 69.6 69.9 29.8 2,820 Total 80.0 35.1 53.2 75.3 20.0 11,797 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes three women with missing information on education. 220 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men Among men age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Myanmar DHS 2015-16 Percentage of men who: Percentage expressing accepting attitudes on all four indicators Background characteristic Are willing to care for a family member with AIDS in the respondent's home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Number of men who have heard of AIDS Age 15-24 71.1 31.6 46.7 71.3 14.9 1,279 15-19 68.9 25.0 44.5 69.7 11.1 651 20-24 73.5 38.4 48.9 72.9 18.9 628 25-29 76.0 45.4 58.1 79.0 26.5 632 30-39 71.7 37.8 51.0 79.8 19.9 1,288 40-49 69.8 31.8 45.1 86.4 18.1 1,159 Marital status1 Never married 74.5 36.8 50.7 72.6 18.1 1,501 Ever had sex 85.4 53.6 55.6 65.2 22.9 172 Never had sex 73.1 34.6 50.1 73.6 17.4 1,329 Married 70.0 34.9 48.7 82.2 19.4 2,736 Divorced/separated/ widowed 73.4 32.2 39.3 82.6 16.4 119 Residence Urban 75.4 51.4 65.6 73.5 26.9 1,320 Rural 70.0 28.6 42.1 81.3 15.4 3,039 States/Regions Kachin 88.1 49.8 62.7 82.5 27.9 156 Kayah 70.7 38.4 43.5 74.4 20.3 21 Kayin 90.4 40.5 59.9 61.8 19.4 101 Chin 76.0 37.3 52.6 59.9 15.7 35 Sagaing 76.3 30.1 57.2 75.5 18.6 480 Tanintharyi 81.7 47.8 56.6 80.4 26.7 100 Bago 66.6 28.5 44.7 86.5 16.3 452 Magway 80.0 30.5 34.9 85.9 16.9 309 Mandalay 77.5 34.6 46.9 81.3 18.7 578 Mon 77.9 35.7 50.2 76.3 20.0 157 Rakhine 75.8 36.3 51.7 68.1 19.9 180 Yangon 63.6 54.0 60.7 81.2 27.8 695 Shan 73.8 28.0 44.5 74.5 14.4 367 Ayeyarwady 59.3 25.7 39.4 76.4 11.6 609 Nay Pyi Taw 63.8 30.0 41.4 82.6 14.4 118 Education No education 69.7 15.7 31.1 79.5 6.4 394 Primary 64.9 24.5 36.5 82.0 10.6 1,535 Secondary 75.0 41.4 57.0 76.9 23.5 2,091 More than secondary 84.0 72.0 79.5 77.1 42.9 339 Wealth quintile Lowest 60.9 21.3 35.4 79.0 9.2 750 Second 67.5 25.2 36.9 82.9 12.8 813 Middle 73.8 33.3 45.7 82.7 18.6 922 Fourth 73.0 38.3 55.2 77.5 19.3 928 Highest 80.2 55.1 68.2 73.2 31.7 946 Total 71.7 35.5 49.2 78.9 18.9 4,358 1 Total includes two men with missing information on marital status. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 221 Table 13.6 Attitudes toward negotiating safer sexual relations with husband Percentage of women and men age 15-49 who believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sexual intercourse with other women, and percentage who believe that a woman is justified in asking that they use a condom if she knows that her husband has a sexually transmitted infection (STI), by background characteristics, Myanmar DHS 2015-16 Women Men Woman is justified in: Woman is justified in: Background characteristic Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Number of women Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Number of men Age 15-24 77.1 68.4 3,677 66.2 77.4 1,423 15-19 73.0 62.5 1,810 65.6 73.1 731 20-24 81.0 74.1 1,867 66.9 82.0 692 25-29 83.2 78.8 1,867 71.6 87.5 677 30-39 82.1 79.6 3,990 68.1 84.1 1,377 40-49 80.8 75.8 3,351 67.9 82.1 1,259 Marital status1 Never married 76.0 69.1 4,278 65.1 78.7 1,644 Ever had sex * * 11 74.5 91.0 178 Never had sex 76.0 69.1 4,267 64.0 77.2 1,466 Married 82.9 78.8 7,759 69.8 84.4 2,957 Divorced/separated/ widowed 80.4 74.0 848 63.3 72.3 135 Residence Urban 84.4 84.0 3,768 79.2 90.9 1,350 Rural 78.9 71.7 9,117 63.5 78.5 3,387 States/Regions Kachin 74.9 86.2 374 69.2 90.5 161 Kayah 77.3 78.7 65 54.7 84.3 23 Kayin 83.1 77.2 303 70.0 75.8 115 Chin 70.6 65.6 102 49.3 69.7 39 Sagaing 90.6 88.8 1,410 58.2 81.2 514 Tanintharyi 80.1 74.5 283 62.7 82.8 103 Bago 78.2 75.2 1,244 75.0 81.3 454 Magway 79.9 80.3 1,081 67.0 91.8 320 Mandalay 85.3 72.3 1,541 74.0 84.9 601 Mon 81.8 74.7 463 66.9 80.0 162 Rakhine 77.9 61.4 777 64.8 82.9 222 Yangon 81.0 78.1 1,927 88.3 93.0 703 Shan 60.6 52.2 1,368 57.3 67.9 542 Ayeyarwady 87.1 85.5 1,650 57.1 76.2 653 Nay Pyi Taw 83.7 65.9 300 60.9 79.0 126 Education2 No education 65.0 49.1 1,606 50.6 60.6 575 Primary 79.9 73.5 5,305 61.0 78.2 1,684 Secondary 84.0 81.1 4,646 75.3 88.5 2,139 More than secondary 89.3 94.1 1,325 85.3 97.0 339 Wealth quintile Lowest 74.5 62.8 2,274 54.9 69.3 890 Second 79.2 71.6 2,408 59.8 74.4 916 Middle 81.2 75.8 2,633 69.7 84.3 979 Fourth 82.4 78.8 2,702 73.2 88.0 986 Highest 83.8 84.5 2,868 80.7 92.8 966 Total 80.5 75.3 12,885 68.0 82.1 4,737 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes two men with missing information on marital status. 2 Total includes three women with missing information on education. 222 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.7 Adult support of education about condom use to prevent AIDS Percentage of women and men age 18-49 who agree that children age 12-14 should be taught about using a condom to avoid AIDS, by background characteristics, Myanmar DHS 2015-16 Women Men Background characteristic Percentage who agree Number Percentage who agree Number Age 18-24 39.2 2,581 40.9 971 18-19 35.6 714 32.9 279 20-24 40.5 1,867 44.2 692 25-29 44.4 1,867 51.8 677 30-39 39.9 3,990 47.8 1,377 40-49 39.6 3,351 44.3 1,259 Marital status Never married 43.6 3,256 44.5 1,199 Married 39.0 7,692 46.8 2,952 Divorced/separated/w idowed 40.5 841 36.5 133 Residence Urban 51.4 3,420 54.0 1,219 Rural 35.8 8,370 42.6 3,066 States/Regions Kachin 39.7 341 54.4 150 Kayah 42.6 59 41.7 20 Kayin 39.3 275 30.1 104 Chin 41.9 91 52.3 34 Sagaing 45.7 1,313 56.5 455 Tanintharyi 30.7 258 43.3 89 Bago 42.5 1,122 45.6 407 Magway 49.1 1,004 61.7 288 Mandalay 37.8 1,444 38.1 544 Mon 29.3 423 54.3 141 Rakhine 27.2 705 54.0 191 Yangon 53.9 1,739 48.6 640 Shan 21.3 1,213 31.6 508 Ayeyarwady 41.8 1,524 42.2 600 Nay Pyi Taw 39.4 279 48.2 112 Education1 No education 20.7 1,543 28.8 545 Primary 36.2 5,059 40.4 1,592 Secondary 46.5 3,875 52.9 1,816 More than secondary 61.6 1,309 61.7 332 Wealth quintile Lowest 29.3 2,073 36.1 801 Second 34.5 2,201 40.3 836 Middle 40.3 2,401 46.0 878 Fourth 43.0 2,476 48.8 882 Highest 51.5 2,639 56.8 889 Total 18-49 40.4 11,789 45.9 4,285 1 Total includes three women with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 223 Table 13.8 Payment for sexual intercourse and condom use at last paid sexual intercourse Percentage of men age 15-49 who ever paid for sexual intercourse and percentage reporting payment for sexual intercourse in the past 12 months, and among them, the percentage reporting that a condom was used the last time they paid for sexual intercourse, according to background characteristics, Myanmar DHS 2015-16 Among all men: Among men who paid for sex in the past 12 months: Background characteristic Percentage who ever paid for sexual intercourse Percentage who paid for sexual intercourse in the past 12 months Number of men Percentage reporting condom use at last paid sexual intercourse Number of men Age 15-24 1.8 1.7 1,423 (70.8) 24 15-19 0.4 0.4 731 * 3 20-24 3.3 3.0 692 * 21 25-29 3.1 2.4 677 * 16 30-39 2.3 1.4 1,377 * 19 40-49 1.1 0.5 1,259 * 6 Marital status Never married 2.7 2.3 1,646 (78.1) 38 Married 1.6 0.8 2,957 (74.2) 25 Divorced/separated/ widowed 1.8 1.8 135 * 2 Residence Urban 2.7 2.1 1,350 (80.2) 29 Rural 1.7 1.1 3,387 (75.2) 36 Education No education 1.1 0.6 575 * 3 Primary 1.7 1.0 1,684 * 17 Secondary 2.3 1.7 2,139 (89.7) 37 More than secondary 2.6 2.2 339 * 7 Wealth quintile Lowest 1.2 0.5 890 * 5 Second 2.2 1.6 916 * 14 Middle 1.2 0.8 979 * 7 Fourth 2.5 1.7 986 * 17 Highest 2.7 2.2 966 * 21 Total 2.0 1.4 4,737 77.4 65 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 224 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.9.1 Coverage of prior HIV testing: Women Percentage of women age 15-49 who know where to get an HIV test, percent distribution of women age 15-49 by testing status and by whether they received the results of the last test, the percentage of women ever tested, and the percentage of women age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage who know where to get an HIV test Percent distribution of women by testing status and by whether they received the results of the last test Total Percentage ever tested Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of women Ever tested and received results Ever tested, did not receive results Never tested1 Age 15-24 60.5 9.2 1.2 89.6 100.0 10.4 3.5 3,677 15-19 56.1 3.0 0.4 96.7 100.0 3.3 0.9 1,810 20-24 64.8 15.2 2.0 82.8 100.0 17.2 6.0 1,867 25-29 67.8 25.7 2.8 71.4 100.0 28.6 8.1 1,867 30-39 67.8 24.6 2.5 73.0 100.0 27.0 6.2 3,990 40-49 61.5 14.3 1.1 84.7 100.0 15.3 2.9 3,351 Marital status Never married 62.7 6.6 0.5 93.0 100.0 7.0 1.9 4,278 Ever had sex * * * * 100.0 * * 11 Never had sex 62.7 6.5 0.5 93.0 100.0 7.0 1.9 4,267 Married 65.2 24.0 2.6 73.4 100.0 26.6 6.6 7,759 Divorced/separated/ widowed 61.0 15.3 1.4 83.3 100.0 16.7 3.6 848 Residence Urban 79.7 28.0 1.7 70.3 100.0 29.7 7.6 3,768 Rural 57.6 13.4 1.8 84.8 100.0 15.2 3.7 9,117 States/Regions Kachin 80.7 33.3 5.5 61.2 100.0 38.8 6.9 374 Kayah 73.8 26.1 7.5 66.4 100.0 33.6 7.8 65 Kayin 59.7 26.0 3.9 70.1 100.0 29.9 7.5 303 Chin 53.0 15.2 2.5 82.3 100.0 17.7 5.3 102 Sagaing 71.5 11.1 1.7 87.2 100.0 12.8 2.9 1,410 Tanintharyi 71.2 19.4 1.5 79.1 100.0 20.9 4.2 283 Bago 68.2 15.6 1.5 82.8 100.0 17.2 4.1 1,244 Magway 60.0 13.5 2.3 84.2 100.0 15.8 4.1 1,081 Mandalay 63.8 24.6 1.3 74.1 100.0 25.9 6.2 1,541 Mon 69.3 22.8 4.1 73.1 100.0 26.9 6.5 463 Rakhine 43.2 7.6 0.8 91.6 100.0 8.4 2.6 777 Yangon 76.4 22.4 1.0 76.6 100.0 23.4 6.1 1,927 Shan 43.4 18.5 1.7 79.8 100.0 20.2 4.7 1,368 Ayeyarwady 66.3 13.0 1.5 85.4 100.0 14.6 4.7 1,650 Nay Pyi Taw 55.9 14.9 2.0 83.1 100.0 16.9 2.6 300 Education2 No education 31.5 8.7 0.8 90.5 100.0 9.5 2.5 1,606 Primary 57.5 13.9 2.1 84.0 100.0 16.0 4.0 5,305 Secondary 74.4 19.5 1.7 78.8 100.0 21.2 5.1 4,646 More than secondary 93.6 37.4 1.9 60.7 100.0 39.3 10.2 1,325 Wealth quintile Lowest 44.4 9.2 2.2 88.6 100.0 11.4 3.0 2,274 Second 55.9 12.8 1.7 85.5 100.0 14.5 3.5 2,408 Middle 62.5 14.0 1.4 84.5 100.0 15.5 4.1 2,633 Fourth 71.2 19.7 2.2 78.1 100.0 21.9 5.5 2,702 Highest 81.4 29.9 1.5 68.6 100.0 31.4 7.4 2,868 Total 64.1 17.7 1.8 80.5 100.0 19.5 4.8 12,885 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes “don't know/missing” 2 Total includes three women with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 225 Table 13.9.2 Coverage of prior HIV testing: Men Percentage of men age 15-49 who know where to get an HIV test, percent distribution of men age 15-49 by testing status and by whether they received the results of the last test, the percentage of men ever tested, and the percentage of men age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage who know where to get an HIV test Percent distribution of men by testing status and by whether they received the results of the last test Total Percentage ever tested Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of men Ever tested and received results Ever tested, did not receive results Never tested1 Age 15-24 56.1 10.5 1.8 87.8 100.0 12.2 4.1 1,423 15-19 49.1 6.1 1.1 92.8 100.0 7.2 2.0 731 20-24 63.6 15.1 2.5 82.4 100.0 17.6 6.3 692 25-29 69.7 22.8 2.0 75.2 100.0 24.8 8.5 677 30-39 65.1 26.9 2.6 70.5 100.0 29.5 6.3 1,377 40-49 63.2 24.0 2.0 73.9 100.0 26.1 3.5 1,259 Marital status2 Never married 59.1 14.5 1.5 84.0 100.0 16.0 4.2 1,644 Ever had sex 77.5 37.4 1.4 61.2 100.0 38.8 10.4 178 Never had sex 56.9 11.8 1.5 86.8 100.0 13.2 3.4 1,466 Married 64.4 23.8 2.5 73.7 100.0 26.3 5.8 2,957 Divorced/separated/ widowed 64.6 26.0 1.5 72.6 100.0 27.4 5.8 135 Residence Urban 81.0 36.7 1.8 61.5 100.0 38.5 10.0 1,350 Rural 55.2 14.2 2.2 83.6 100.0 16.4 3.3 3,387 States/Regions Kachin 63.8 22.3 2.6 75.0 100.0 25.0 3.7 161 Kayah 57.2 24.9 2.3 72.8 100.0 27.2 5.3 23 Kayin 40.0 15.4 2.3 82.3 100.0 17.7 4.1 115 Chin 48.8 13.4 2.4 84.2 100.0 15.8 3.3 39 Sagaing 62.3 18.2 2.1 79.7 100.0 20.3 3.7 514 Tanintharyi 76.2 24.2 2.3 73.5 100.0 26.5 7.1 103 Bago 82.0 21.3 7.9 70.8 100.0 29.2 5.9 454 Magway 60.7 21.7 1.1 77.2 100.0 22.8 4.6 320 Mandalay 66.5 25.6 1.1 73.2 100.0 26.8 6.0 601 Mon 58.4 19.9 3.7 76.5 100.0 23.5 5.6 162 Rakhine 52.0 10.1 0.3 89.6 100.0 10.4 2.5 222 Yangon 81.7 31.0 1.8 67.3 100.0 32.7 7.6 703 Shan 41.5 14.6 1.3 84.1 100.0 15.9 5.0 542 Ayeyarwady 50.6 15.4 0.6 84.0 100.0 16.0 4.1 653 Nay Pyi Taw 61.6 16.6 1.8 81.7 100.0 18.3 6.3 126 Education No education 32.9 9.3 2.1 88.6 100.0 11.4 1.9 575 Primary 51.9 13.6 2.2 84.3 100.0 15.7 4.1 1,684 Secondary 73.9 23.7 2.1 74.2 100.0 25.8 5.8 2,139 More than secondary 94.5 55.1 2.2 42.7 100.0 57.3 13.0 339 Wealth quintile Lowest 44.5 8.6 1.9 89.5 100.0 10.5 2.4 890 Second 48.6 13.9 1.9 84.2 100.0 15.8 3.1 916 Middle 62.0 14.7 2.5 82.7 100.0 17.3 3.1 979 Fourth 70.9 22.2 2.1 75.7 100.0 24.3 6.7 986 Highest 84.5 42.5 2.0 55.5 100.0 44.5 10.4 966 Total 62.6 20.6 2.1 77.3 100.0 22.7 5.2 4,737 1 Includes “don't know/missing” 2 Total includes two men with missing information on marital status. 226 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.10 Pregnant women counseled and tested for HIV Among all women age 15-49 who gave birth in the 2 years preceding the survey, the percentage who received HIV pretest counseling, the percentage who received an HIV test during antenatal care for their most recent birth by whether they received their results and post-test counseling, and the percentage who received an HIV test during ANC or labor for their most recent birth by whether they received their test results, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage who received counseling on HIV during antenatal care1 Percentage who were tested for HIV during antenatal care and who: Percentage who received counseling on HIV and an HIV test during ANC, and the results Percentage who had an HIV test during ANC or labor and who:2 Number of women who gave birth in the past 2 years3 Received results and received post-test counseling Received results and did not receive post- test counseling Did not receive results Received results Did not receive results Age 15-24 24.8 14.8 14.3 3.6 15.2 29.3 4.3 434 15-19 18.9 5.1 9.1 5.0 3.6 14.2 5.0 70 20-24 25.9 16.6 15.3 3.3 17.4 32.2 4.2 364 25-29 36.5 24.7 15.7 3.5 25.3 42.1 4.0 473 30-39 39.2 26.1 15.6 5.7 27.2 43.9 6.2 651 40-49 32.7 20.3 10.4 4.7 17.3 30.7 6.2 111 Marital status Married 34.3 22.6 14.9 4.4 22.9 38.9 5.1 1,622 Divorced/separated/ widowed 33.3 15.8 15.6 5.3 22.8 34.0 5.3 48 Residence Urban 48.6 40.9 22.1 3.6 39.2 63.7 4.1 419 Rural 29.4 16.2 12.6 4.7 17.4 30.4 5.4 1,250 States/Regions Kachin 33.7 21.6 34.1 9.8 25.9 56.5 9.8 56 Kayah 39.1 38.2 14.7 20.3 28.7 54.3 21.1 12 Kayin 34.7 21.6 24.1 7.7 27.6 46.4 7.7 66 Chin 28.5 6.4 11.0 4.7 11.9 17.4 4.7 24 Sagaing 30.2 12.2 13.3 3.3 17.1 27.1 6.4 172 Tanintharyi 19.2 16.3 19.9 4.2 13.8 37.0 4.2 48 Bago 40.2 27.5 17.6 1.5 29.5 48.1 1.5 135 Magway 38.7 15.9 19.2 8.5 18.3 37.2 8.5 119 Mandalay 39.0 25.9 26.0 2.1 30.1 55.6 3.9 183 Mon 35.2 29.7 24.0 11.6 26.3 53.7 12.6 59 Rakhine 12.5 11.1 2.1 2.4 7.2 14.0 3.0 121 Yangon 56.6 46.1 11.2 4.4 43.3 58.0 4.4 193 Shan 18.2 14.0 10.3 2.2 14.0 24.3 2.2 232 Ayeyarwady 39.4 23.7 7.3 5.0 20.0 32.7 5.0 217 Nay Pyi Taw 39.2 16.2 17.0 8.5 20.2 33.1 9.7 32 Education No education 11.9 7.4 6.2 1.8 6.6 13.8 2.5 264 Primary 35.0 18.8 11.8 6.0 21.8 32.0 6.8 730 Secondary 41.8 29.2 18.5 4.2 28.8 49.6 4.9 532 More than secondary 43.7 42.9 33.9 2.1 36.5 78.8 2.2 143 Wealth quintile Lowest 24.1 11.9 6.0 4.6 12.5 18.9 4.7 444 Second 32.3 18.4 13.9 5.1 20.0 34.7 5.6 367 Middle 35.4 19.1 17.8 3.9 21.1 39.6 4.5 286 Fourth 41.7 31.8 14.2 5.2 32.5 46.0 7.3 303 Highest 44.0 38.0 28.9 3.1 35.0 68.0 3.1 270 Total 34.2 22.4 14.9 4.5 22.9 38.7 5.1 1,669 1 In this context, "pretest counseling" means that someone talked with the respondent about all three of the following topics: (1) babies getting the AIDS virus from their mother, (2) preventing the virus, and (3) getting tested for the virus. 2 Women were asked whether they received an HIV test during labor only if they were not tested for HIV during ANC. 3 Denominator for percentages includes women who did not receive antenatal care for their last birth in the past 2 years. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 227 Table 13.11 Male circumcision Percent distribution of men age 15-49 who report having been circumcised, by background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage of men circumcised1 Number of men Age 15-24 4.1 1,423 15-19 3.9 731 20-24 4.2 692 25-29 3.9 677 30-39 4.3 1,377 40-49 3.1 1,259 Residence Urban 6.8 1,350 Rural 2.7 3,387 Total 3.9 4,737 228 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms Among women and men age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Myanmar DHS 2015-16 Percentage of women who reported having in the past 12 months: Percentage of men who reported having in the past 12 months: Background characteristic STI Bad- smelling/ abnormal genital discharge Genital sore or ulcer STI/ genital discharge/ sore or ulcer Number of women who ever had sexual intercourse STI Bad- smelling/ abnormal discharge from penis Genital sore or ulcer STI/ abnormal discharge from penis/ sore or ulcer Number of men who ever had sexual intercourse Age 15-24 0.0 7.8 1.7 8.9 1,146 0.0 6.4 1.5 7.3 358 15-19 0.0 7.5 1.0 8.5 245 0.0 5.8 3.0 8.8 55 20-24 0.0 7.9 1.9 9.0 901 0.0 6.5 1.2 7.0 303 25-29 0.1 7.7 0.5 7.9 1,359 0.0 5.8 0.8 6.0 508 30-39 0.2 7.5 1.2 8.2 3,233 0.4 5.5 1.8 6.8 1,219 40-49 0.1 7.0 0.8 7.5 2,878 0.5 5.8 1.4 6.5 1,181 Marital status Never married * * * * 11 1.2 15.9 5.1 20.2 178 Married 0.1 7.3 0.9 7.9 7,757 0.3 5.3 1.3 6.0 2,955 Divorced/separated/ widowed 0.1 8.1 1.7 8.5 848 0.3 2.9 0.9 3.2 134 Male circumcision Circumcised na na na na na 1.9 10.4 2.4 11.1 123 Not circumcised na na na na na 0.3 5.6 1.4 6.5 3,134 Don’t know na na na na na * * * * 8 Residence Urban 0.2 9.0 1.1 9.6 2,290 0.7 7.1 1.7 8.2 888 Rural 0.1 6.8 0.9 7.4 6,326 0.2 5.3 1.4 6.0 2,378 States/Regions Kachin 0.8 8.4 0.9 9.0 269 0.4 6.4 2.6 7.8 112 Kayah 0.2 17.5 1.7 18.7 44 0.0 1.2 0.0 1.2 15 Kayin 0.0 2.0 0.8 2.7 224 0.0 2.4 0.8 2.8 75 Chin 0.6 19.9 4.0 20.6 74 0.0 10.9 5.3 15.2 28 Sagaing 0.0 4.7 0.9 5.2 917 0.0 2.5 2.6 4.0 341 Tanintharyi 0.0 1.3 0.4 1.3 191 0.0 7.9 2.0 9.3 64 Bago 0.1 6.1 0.9 6.4 846 0.4 2.5 0.7 3.1 338 Magway 0.1 6.3 1.2 7.0 705 0.0 11.9 0.5 11.9 230 Mandalay 0.1 5.2 0.6 5.6 936 0.0 7.1 1.7 7.5 405 Mon 0.4 8.0 1.4 9.2 300 0.0 12.7 1.6 13.8 96 Rakhine 0.0 11.2 2.6 12.3 537 0.5 4.4 2.7 5.0 155 Yangon 0.0 6.9 0.5 7.2 1,160 1.1 3.7 0.0 3.7 458 Shan 0.2 9.4 1.2 10.4 1,006 0.5 5.5 1.8 6.8 411 Ayeyarwady 0.4 10.7 0.9 11.3 1,190 0.0 8.1 1.6 9.1 445 Nay Pyi Taw 0.0 4.8 0.8 5.5 216 0.3 4.8 2.6 6.9 92 Education1 No education 0.0 5.9 0.6 6.1 1,368 0.0 3.5 0.9 4.5 461 Primary 0.1 6.9 0.9 7.4 4,059 0.2 6.5 1.1 7.0 1,343 Secondary 0.3 8.5 1.6 9.4 2,521 0.6 6.0 2.1 7.0 1,251 More than secondary 0.2 9.5 0.3 10.0 665 0.0 4.8 1.6 6.5 210 Wealth quintile Lowest 0.1 7.9 1.4 8.5 1,808 0.0 6.2 0.8 6.4 666 Second 0.1 6.9 1.1 7.5 1,758 0.3 5.6 1.6 7.0 661 Middle 0.0 7.0 1.0 7.4 1,726 0.1 5.0 1.6 6.1 656 Fourth 0.3 6.5 0.5 6.9 1,675 0.5 5.7 1.4 5.9 651 Highest 0.2 8.8 1.0 9.6 1,650 0.6 6.4 2.0 7.8 632 Total 0.1 7.4 1.0 8.0 8,616 0.3 5.8 1.5 6.6 3,266 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Total includes three women with missing information on education. H IV /A ID S -r el at ed K no w le dg e, A tti tu de s, a nd B eh av io r • 2 29 Ta bl e 13 .1 3 P re va le n ce o f m ed ic al in je ct io ns P er ce nt ag e of w om en a nd m en a ge 1 5- 49 w ho r ec ei ve d at le as t o ne m ed ic al in je ct io n in th e la st 1 2 m on th s, th e av er ag e nu m be r of m ed ic al in je ct io ns p er p er so n in th e la st 1 2 m on th s, a nd a m on g th os e w ho r ec ei ve d a m ed ic al i nj ec tio n, t he p er ce nt ag e of la st m ed ic al i nj ec tio ns f or w hi ch t he s yr in ge a nd n ee dl e w er e ta ke n fro m a n ew , un op en ed p ac ka ge , by b ac kg ro un d ch ar ac te ris tic s, M ya nm ar D H S 2 01 5- 16 W om en M en B ac kg ro un d ch ar ac te ris tic P er ce nt ag e w ho r ec ei ve d a m ed ic al in je ct io n in th e la st 1 2 m on th s A ve ra ge nu m be r o f m ed ic al in je ct io ns p er pe rs on in th e la st 1 2 m on th s N um be r of re sp on de nt s Fo r l as t in je ct io n, sy rin ge a nd ne ed le ta ke n fro m a n ew , un op en ed pa ck ag e N um be r of re sp on de nt s re ce iv in g m ed ic al in je ct io ns in th e la st 1 2 m on th s P er ce nt ag e w ho re ce iv ed a m ed ic al in je ct io n in th e la st 1 2 m on th s A ve ra ge nu m be r o f m ed ic al in je ct io ns p er pe rs on in th e la st 1 2 m on th s N um be r of re sp on de nt s Fo r l as t in je ct io n, sy rin ge a nd ne ed le ta ke n fro m a n ew , un op en ed pa ck ag e N um be r of re sp on de nt s re ce iv in g m ed ic al in je ct io ns in th e la st 1 2 m on th s A ge 15 -2 4 47 .8 1. 8 3, 67 7 98 .9 1, 75 6 42 .1 1. 7 1, 42 3 96 .5 59 9 15 -1 9 42 .6 1. 5 1, 81 0 98 .9 77 0 42 .9 1. 4 73 1 94 .6 31 4 20 -2 4 52 .8 2. 0 1, 86 7 98 .9 98 6 41 .2 1. 9 69 2 98 .6 28 5 25 -2 9 60 .5 2. 6 1, 86 7 99 .4 1, 12 9 45 .5 1. 5 67 7 98 .9 30 8 30 -3 9 57 .7 2. 6 3, 99 0 99 .1 2, 30 1 46 .8 1. 8 1, 37 7 98 .5 64 4 40 -4 9 57 .4 2. 8 3, 35 1 98 .8 1, 92 2 54 .4 3. 2 1, 25 9 99 .4 68 5 M ar ita l s ta tu s1 N ev er m ar rie d 45 .9 1. 7 4, 27 8 99 .2 1, 96 2 42 .5 1. 5 1, 64 4 96 .8 69 8 E ve r ha d se x * * 11 * 5 48 .3 2. 4 17 8 99 .0 86 N ev er h ad s ex 45 .9 1. 7 4, 26 7 99 .2 1, 95 7 41 .8 1. 4 1, 46 6 96 .5 61 2 M ar rie d 60 .9 2. 8 7, 75 9 99 .0 4, 72 6 49 .9 2. 4 2, 95 7 98 .9 1, 47 4 D iv or ce d/ se pa ra te d/ w id ow ed 49 .5 2. 3 84 8 98 .5 42 0 47 .4 2. 1 13 5 10 0. 0 64 R es id en ce U rb an 53 .0 2. 2 3, 76 8 99 .4 1, 99 8 46 .1 1. 8 1, 35 0 99 .0 62 3 R ur al 56 .0 2. 5 9, 11 7 98 .9 5, 11 0 47 .6 2. 2 3, 38 7 98 .0 1, 61 3 S ta te s/ R eg io ns K ac hi n 54 .4 2. 1 37 4 98 .1 20 4 38 .2 1. 6 16 1 98 .6 62 K ay ah 57 .6 2. 4 65 98 .9 37 41 .6 1. 9 23 99 .1 9 K ay in 50 .4 2. 3 30 3 98 .3 15 3 32 .6 1. 4 11 5 98 .9 37 C hi n 26 .9 1. 3 10 2 10 0. 0 27 26 .4 2. 0 39 10 0. 0 10 S ag ai ng 59 .0 2. 4 1, 41 0 99 .4 83 2 49 .7 1. 9 51 4 98 .0 25 6 T an in th ar yi 52 .1 2. 4 28 3 99 .4 14 8 42 .9 1. 9 10 3 99 .0 44 B ag o 63 .6 2. 9 1, 24 4 99 .1 79 1 55 .3 2. 4 45 4 99 .4 25 1 M ag w ay 58 .1 2. 7 1, 08 1 99 .0 62 8 50 .7 2. 3 32 0 97 .8 16 2 M an da la y 67 .0 3. 1 1, 54 1 99 .8 1, 03 3 53 .8 2. 4 60 1 95 .8 32 3 M on 55 .7 2. 2 46 3 97 .8 25 8 50 .6 3. 3 16 2 97 .9 82 R ak hi ne 45 .9 2. 1 77 7 95 .2 35 7 35 .1 1. 6 22 2 96 .8 78 Y an go n 43 .3 1. 3 1, 92 7 99 .6 83 3 41 .2 1. 4 70 3 10 0. 0 29 0 S ha n 50 .2 2. 6 1, 36 8 98 .5 68 6 44 .3 3. 1 54 2 97 .5 24 0 A ye ya rw ad y 57 .5 2. 6 1, 65 0 99 .7 94 8 52 .1 1. 9 65 3 99 .4 34 0 N ay P yi T aw 57 .9 2. 4 30 0 98 .7 17 3 40 .7 1. 3 12 6 99 .2 51 (C on tin ue d… ) 23 0 • H IV /A ID S -r el at ed K no w le dg e, A tti tu de s, a nd B eh av io r Ta bl e 13 .1 3 — C o n ti n u e d W om en M en B ac kg ro un d ch ar ac te ris tic P er ce nt ag e w ho r ec ei ve d a m ed ic al in je ct io n in th e la st 1 2 m on th s A ve ra ge nu m be r o f m ed ic al in je ct io ns p er pe rs on in th e la st 1 2 m on th s N um be r of re sp on de nt s Fo r l as t in je ct io n, sy rin ge a nd ne ed le ta ke n fro m a n ew , un op en ed pa ck ag e N um be r of re sp on de nt s re ce iv in g m ed ic al in je ct io ns in th e la st 1 2 m on th s P er ce nt ag e w ho re ce iv ed a m ed ic al in je ct io n in th e la st 1 2 m on th s A ve ra ge nu m be r o f m ed ic al in je ct io ns p er pe rs on in th e la st 1 2 m on th s N um be r of re sp on de nt s Fo r l as t in je ct io n, sy rin ge a nd ne ed le ta ke n fro m a n ew , un op en ed pa ck ag e N um be r of re sp on de nt s re ce iv in g m ed ic al in je ct io ns in th e la st 1 2 m on th s E du ca ti o n2 N o ed uc at io n 48 .8 2. 3 1, 60 6 96 .9 78 3 44 .7 2. 2 57 5 95 .5 25 7 P rim ar y 57 .4 2. 6 5, 30 5 99 .1 3, 04 8 47 .8 2. 4 1, 68 4 98 .5 80 6 S ec on da ry 54 .7 2. 2 4, 64 6 99 .3 2, 54 2 47 .5 1. 9 2, 13 9 98 .7 1, 01 6 M or e th an s ec on da ry 55 .3 2. 2 1, 32 5 99 .9 73 4 46 .4 1. 8 33 9 99 .3 15 7 W ea lt h q ui nt ile Lo w es t 52 .1 2. 4 2, 27 4 97 .9 1, 18 4 44 .5 2. 3 89 0 98 .6 39 6 S ec on d 54 .1 2. 5 2, 40 8 98 .7 1, 30 2 44 .4 2. 0 91 6 96 .4 40 6 M id dl e 56 .4 2. 5 2, 63 3 99 .3 1, 48 5 48 .6 2. 1 97 9 97 .8 47 6 Fo ur th 55 .7 2. 3 2, 70 2 99 .4 1, 50 6 48 .7 2. 0 98 6 99 .3 48 0 H ig he st 56 .9 2. 5 2, 86 8 99 .5 1, 63 0 49 .4 2. 1 96 6 99 .1 47 7 T ot al 55 .2 2. 4 12 ,8 85 99 .0 7, 10 8 47 .2 2. 1 4, 73 7 98 .3 2, 23 6 N ot e: M ed ic al in je ct io ns a re th os e gi ve n by a d oc to r, nu rs e, p ha rm ac is t, de nt is t, or a ny o th er h ea lth w or ke r. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 T ot al in cl ud es tw o m en w ith m is si ng in fo rm at io n on m ar ita l s ta tu s. 2 T ot al in cl ud es th re e w om en w ith m is si ng in fo rm at io n on e du ca tio n. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 231 Table 13.14 Comprehensive knowledge about AIDS and a source of condoms among young people Percentage of young women and young men age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge about a source of condoms, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Women Men Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Age 15-19 13.4 16.7 1,810 14.3 31.6 731 15-17 12.2 14.6 1,096 11.0 27.0 452 18-19 15.2 19.9 714 19.7 39.1 279 20-24 18.9 28.5 1,867 21.5 53.5 692 20-22 16.1 24.0 1,133 19.4 56.2 426 23-24 23.2 35.5 734 25.0 49.1 266 Marital status Never married 18.1 20.8 2,533 17.8 40.0 1,143 Ever had sex * * 3 34.4 77.4 78 Never had sex 18.1 20.8 2,530 16.6 37.2 1,065 Ever married 12.0 26.9 1,144 18.1 51.6 280 Residence Urban 27.6 30.8 1,121 29.6 65.8 442 Rural 11.2 19.2 2,556 12.5 31.6 981 States/Regions Kachin 19.2 32.9 112 23.9 52.1 49 Kayah 25.1 47.6 19 15.5 36.4 7 Kayin 15.3 18.9 83 2.6 35.3 30 Chin 7.0 22.2 33 9.7 34.2 13 Sagaing 15.3 44.8 361 15.9 31.4 170 Tanintharyi 20.4 20.7 82 17.1 46.0 33 Bago 17.1 16.0 372 19.9 53.2 122 Magway 10.6 26.2 272 17.7 45.6 79 Mandalay 11.0 25.8 392 14.5 42.5 173 Mon 22.3 32.1 132 21.9 33.8 69 Rakhine 7.4 12.7 278 20.7 38.6 82 Yangon 28.1 18.1 582 35.7 64.0 226 Shan 8.4 12.9 449 5.7 27.9 155 Ayeyarwady 18.8 23.9 424 8.5 33.8 177 Nay Pyi Taw 17.7 14.2 84 16.2 32.2 38 Education3 No education 1.2 5.2 264 0.8 10.6 109 Primary 4.2 11.3 1,013 5.2 29.8 337 Secondary 19.3 24.7 2,084 22.0 47.3 894 More than secondary 47.0 60.7 314 46.8 80.3 83 Wealth quintile Lowest 4.6 12.5 662 5.7 25.0 247 Second 9.2 14.2 657 9.2 26.1 259 Middle 14.1 20.6 777 15.8 35.9 321 Fourth 21.1 28.4 796 23.0 52.4 305 Highest 28.8 34.6 785 32.6 67.7 291 Total 16.2 22.7 3,677 17.8 42.2 1,423 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about AIDS transmission or prevention. The components of comprehensive knowledge are presented in Tables 13.2, 13.3.1, and 13.3.2. 2 For this table, the following responses are not considered a source for condoms: friends, family members, and home. 3 Total includes one woman with missing information on education. 232 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.15 Age at first sexual intercourse among young people Percentage of young women and young men age 15-24 who had sexual intercourse before age 15 and percentage of young women and young men age 18-24 who had sexual intercourse before age 18, according to background characteristics, Myanmar DHS 2015-16 Women age 15-24 Women age 18-24 Men age 15-24 Men age 18-24 Background characteristic Percentage who had sexual intercourse before age 15 Number of respondents Percentage who had sexual intercourse before age 18 Number of respondents Percentage who had sexual intercourse before age 15 Number of respondents Percentage who had sexual intercourse before age 18 Number of respondents Age 15-19 0.9 1,810 na na 0.5 731 na na 15-17 0.7 1,096 na na 0.9 452 na na 18-19 1.2 714 15.3 714 0.0 279 6.0 279 20-24 1.3 1,867 14.0 1,867 0.0 692 5.6 692 20-22 1.4 1,133 14.1 1,133 0.0 426 4.3 426 23-24 1.2 734 13.8 734 0.1 266 7.8 266 Marital status Never married 0.0 2,533 0.0 1,511 0.2 1,143 1.6 697 Ever married 3.5 1,144 34.6 1,070 0.4 280 16.1 274 Knows condom source1 Yes 0.2 834 11.4 675 0.4 601 4.0 479 No 1.4 2,843 15.4 1,906 0.2 822 7.4 492 Residence Urban 0.5 1,121 10.1 772 0.5 442 4.6 311 Rural 1.4 2,556 16.2 1,809 0.2 981 6.2 660 Education2 No education 4.8 264 37.6 201 0.0 109 14.0 79 Primary 2.0 1,013 22.0 767 1.0 337 7.7 246 Secondary 0.3 2,084 9.5 1,313 0.1 894 4.5 571 More than secondary 0.1 314 0.7 298 0.0 83 0.0 76 Total 1.1 3,677 14.4 2,581 0.3 1,423 5.7 971 na = Not applicable 1 For this table, the following responses are not considered a source for condoms: friends, family members, and home. 2 Total includes one woman with missing information on education. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 233 Table 13.16 Recent HIV tests among young people Among young women and young men age 15-24 who have had sexual intercourse in the past 12 months, the percentage who were tested for HIV in the past 12 months and received the results of the last test, according to background characteristics, Myanmar DHS 2015-16 Women age 15-24 who have had sexual intercourse in the past 12 months: Men age 15-24 who have had sexual intercourse in the past 12 months: Background characteristic Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of women Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of men Age 15-19 2.4 223 (8.3) 49 15-17 3.1 63 * 10 18-19 2.1 160 (10.6) 39 20-24 9.9 823 5.6 271 20-22 8.7 454 6.4 134 23-24 11.3 369 4.9 137 Marital status Never married * 2 13.2 56 Ever married 8.3 1,045 4.6 265 Knows condom source1 Yes 12.2 291 9.8 183 No 6.8 756 1.1 137 Residence Urban 13.5 251 16.7 91 Rural 6.6 795 1.9 229 Education2 No education 2.3 120 * 30 Primary 6.6 397 4.6 106 Secondary 10.1 486 7.3 171 More than secondary (20.6) 42 * 14 Total 8.3 1,046 6.1 320 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For this table, the following responses are not considered a source for condoms: friends, family members, and home. 2 Total includes one woman with missing information on education. Adult and Maternal Mortality • 235 ADULT AND MATERNAL MORTALITY 14 Key Findings  Adult mortality: For women and men who have reached age 15, the probability of dying before age 50 is 7% and 16%, respectively.  Pregnancy-related mortality: The pregnancy-related mortality ratio was 227 maternal deaths per 100,000 live births for the 7 years period before the survey.  Lifetime risk of maternal death: The lifetime risk of maternal death indicates that 1 in 200 women in Myanmar will die from either pregnancy or childbearing. dult and maternal mortality indicators can be used to assess the health status of a population, especially in developing countries such as Myanmar. Estimation of mortality rates requires complete and accurate data on adult and maternal deaths. In the 2015-16 MDHS, data were collected on the survivorship of female respondents’ siblings to obtain an estimate of adult mortality. The inclusion of questions to determine if deaths of female siblings were maternity-related permits estimation of maternal mortality, a key indicator of maternal health and well-being and of the quality of maternal care. In keeping with the International Classification of Diseases (ICD-10) definition of maternal mortality, the 2015-16 MDHS results reflect pregnancy-related mortality, which accounts for deaths of women while pregnant, during delivery, or within 42 days of termination of pregnancy, irrespective of the cause of death (WHO 2011). In line with this, the maternal mortality module used in the DHS surveys measures only the timing of deaths and not the cause. Moreover, the data collected in the 2015-16 MDHS questionnaire are based on information about deaths during the 2 months following a birth rather than the recommended 42 days following a birth. This chapter includes results estimated from sibling history data collected in the sibling survival module (commonly referred to as the maternal mortality module) that is part of the Woman’s Questionnaire. In addition to adult mortality rates for 5-year age groups, the chapter includes a summary measure (35q15) that represents the probability of a person dying between exact ages 15 and 50—that is, between his or her 15th and 50th birthdays. 14.1 DATA To obtain a sibling history, each respondent was first asked to give the total number of her mother’s live births. The respondent was then asked to provide a list of all of the children born to her mother, starting with the first born. The respondent was further asked whether each of these siblings was still alive at the survey date. For living siblings, the current age was recorded. For deceased siblings, age at death and number of years since death were recorded. Interviewers were instructed that, when a respondent could not provide precise information on age at death or years since death, approximate but quantitative answers were acceptable. For sisters who died at age 12 or above, three questions were used to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died?” and, if not, “Did she die during childbirth?” and, if not, “Did she die within 2 months after the end of a pregnancy or childbirth?” Estimation of adult and maternal mortality by either direct or indirect means requires A 236 • Adult and Maternal Mortality reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number who have died, and (for maternal mortality) the number of sisters who died of maternity-related causes. Table 14.1 shows the number of siblings reported by respondents and the completeness of data on current age, age at death, and years since death. Overall, the sibling history data collected in the 2015-16 MDHS are fairly complete. There are very few siblings for whom survival status was not reported (0.1%), and among surviving siblings current age (used to estimate exposure to death) was reported for all. In the case of deceased siblings, both age at death and years since death (or year of death) were reported for all but seven deaths among the total of 9,853 reported unweighted deaths. Rather than excluding siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data.1 The sex ratio for enumerated siblings (the ratio of brothers to sisters multiplied by 100) is 103 (Appendix Table C.9). 14.2 DIRECT ESTIMATES OF ADULT MORTALITY Adult mortality rate The number of adult deaths per 1,000 population age 15-49. Adult mortality rates by 5-year age groups are calculated as follows: the number of deaths to a respondent’s siblings in each age group is divided by the number of person- years of exposure to the risk of dying in that age group during a specified period prior to the survey. The number of deaths is the number of siblings (brothers or sisters) reported as having died within the specified period. The person-years of exposure in each age group are calculated for both surviving and dead siblings based on their current age (living siblings) or age at death and years since death (dead siblings). Sample: Siblings (both living and dead) who were age 15-49 in the specified 7-year period preceding the survey by sex and 5-year age groups One way to assess the quality of the data used to estimate pregnancy-related mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if estimated rates of overall adult mortality are implausible, rates based on a subset of deaths (pregnancy-related deaths in particular) are unlikely to be free of serious problems. The reported ages at death and years since death of the respondents’ brothers and sisters are used to make direct estimates of adult mortality. Because of the differentials in exposure to the risk of dying, age- and sex-specific death rates are presented in this report. To ensure a sufficiently large number of adult deaths to generate a robust estimate, the rates are calculated for the 7-year period before the survey (roughly mid- 2009 to mid-2016). Nevertheless, age-specific mortality rates obtained in this manner are subject to considerable sampling variation. Use of this 7-year period was a compromise between the desire for the most recent data and the need to minimize sampling error. 1 The imputation procedure was based on the assumption that the reported birth ordering of siblings in the history was correct. The first step was to calculate birth dates for each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either age at death or years since death were reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of the ages at death for siblings for whom years since death were not reported but age at death was reported was used as a basis for imputing age at death. Adult and Maternal Mortality • 237 Table 14.2 and Figure 14.1 show direct estimates of age-specific mortality rates for women and men age 15-49 for the 7-year period before the survey. Overall, the level of adult mortality is more than twice as high among men (5.0 deaths per 1,000 population) than among women (2.1 deaths per 1,000 population). Mortality rates generally increase with age, but they increase more sharply for men than for women. Mortality rates are much higher for men than for women in all age groups other than the 20-24 age group, in which the mortality rates for men and women are similar (1.5 per 1,000 and 1.6 per 1,000, respectively). The probability of dying between exact ages 15 and 50 (35q15) is also much higher at 163, for men than for women at 72 (Table 14.3). Here, 35q15 is the probability of a 15-year-old man or woman dying before age 50, if they experience the age specific deaths rates in Table 14.2. 14.3 DIRECT ESTIMATES OF PREGNANCY-RELATED MORTALITY Pregnancy-related mortality rate The number of pregnancy-related deaths per 1,000 women age 15-49. Pregnancy-related mortality rates by 5-year age groups are calculated by dividing the number of pregnancy-related deaths to female siblings of respondents in each age group by the total person-years of exposure of the sisters to the risk of dying in that age group during the 7 years prior to the survey. The number of deaths is the number of sisters reported as having died during pregnancy or delivery or in the 2 months following delivery in the specified period by their age group at the time of death. The person-years of exposure in each age group are calculated for both surviving and dead sisters based on their reported current age (living sisters) or age at death and years since death (dead sisters). Sample: Sisters (both living and dead) age 15-49 in the specified period, by 5-year age groups Pregnancy-related mortality ratio The number of pregnancy-related deaths per 100,000 live births. The pregnancy-related mortality ratio is calculated by dividing the age-standardized pregnancy-related mortality rate for women age 15-49 for the specified period by the general fertility rate (GFR) for the same time period. Pregnancy-related deaths are a subset of all female deaths; they are defined as any deaths that occur during pregnancy or childbirth or within 2 months after the birth or termination of a pregnancy. Estimates of pregnancy-related mortality are therefore based solely on the timing of the death in relationship to the pregnancy. Two methods are generally used to estimate pregnancy-related mortality in developing countries: the indirect sisterhood method (Graham et al. 1989) and a direct variant of the sisterhood method (Rutenberg and Sullivan 1991; Stanton et al. 1997). Age-specific estimates of pregnancy-related mortality from reported survivorship of sisters are shown in Table 14.4 for the 7-year period before the survey. Table 14.4 shows that the pregnancy-related mortality rate among women age 15-49 is 0.16 deaths per 1,000 woman-years of exposure. By 5-year age groups, the pregnancy-related mortality rate is highest among women in the 30-34 age group (0.33), followed by those in the 40-44 age group (0.26). The overall percentage of female deaths due to pregnancy-related causes is 8%; this percentage varies by age and Figure 14.1 Adult mortality rates by age 0 1 2 3 4 5 6 7 8 9 10 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age in years Deaths per 1,000 population Women Men 238 • Adult and Maternal Mortality ranges from 0% among women age 45-49 to 14% among women age 30-34. However, this age-specific pattern should be interpreted with caution because of the very small number of events: only 22 maternal deaths among women of all reproductive ages. The estimated pregnancy-related mortality ratio (PRM) is 227 deaths per 100,000 live births during the 7- year period before the survey (with a 95% confidence interval of 131 to 323). In other words, for every 1,000 live births in Myanmar during the 7 years before the 2015-16 MDHS, approximately two women died during pregnancy, during childbirth, or within 2 months after childbirth. The lifetime risk of pregnancy-related death (0.005) indicates that of 1,000 women age 15, about five would die before age 50 during pregnancy, during childbirth, or within 2 months of childbirth. LIST OF TABLES For more information on adult and maternal mortality, see the following tables:  Table 14.1 Completeness of information on siblings  Table 14.2 Adult mortality rates  Table 14.3 Adult mortality probabilities  Table 14.4 Pregnancy-related mortality rates Adult and Maternal Mortality • 239 Table 14.1 Completeness of information on siblings Completeness of data on survival status of sisters and brothers reported by interviewed women, age of living siblings, and age at death (AD) and years since death (YSD) of dead siblings (unweighted), Myanmar DHS 2015-16 Sisters Brothers All siblings Number Percent Number Percent Number Percent All siblings 28,868 100.0 29,731 100.0 58,599 100.0 Living 24,747 85.7 23,927 80.5 48,674 83.1 Dead 4,095 14.2 5,758 19.4 9,853 16.8 Survival status unknown 26 0.1 46 0.2 72 0.1 Living siblings 24,747 100.0 23,927 100.0 48,674 100.0 Age reported 24,747 100.0 23,927 100.0 48,674 100.0 Dead siblings 4,095 100.0 5,758 100.0 9,853 100.0 AD and YSD reported 4,092 99.9 5,754 99.9 9,846 99.9 Missing only AD nc 0.0 2 0.0 2 0.0 Missing only YSD nc 0.0 1 0.0 1 0.0 Missing AD and YSD 3 0.1 1 0.0 4 0.0 nc = No cases Table 14.2 Adult mortality rates Direct estimates of female and male mortality rates for the 7 years preceding the survey, by 5-year age groups, Myanmar DHS 2015-16 Age Deaths Exposure years Mortality rates1 FEMALE 15-19 13 16,600 0.77 20-24 36 21,850 1.64 25-29 44 24,241 1.81 30-34 55 24,064 2.30 35-39 37 21,357 1.73 40-44 58 15,948 3.65 45-49 35 11,534 3.04 15-49 278 135,595 2.11a MALE 15-19 21 17,063 1.24 20-24 32 21,617 1.49 25-29 73 23,812 3.07 30-34 123 23,741 5.20 35-39 146 20,676 7.06 40-44 130 14,773 8.81 45-49 88 10,224 8.66 15-49 614 131,907 5.00a 1 Expressed per 1,000 population a Age-adjusted rate Table 14.3 Adult mortality probabilities The probability of dying between ages 15 and 50 for women and men for the 7 years preceding the survey, Myanmar DHS 2015-16 Female 35q151 Male 35q151 Survey 2015-16 MDHS 72 (CI: 61-83) 163 (CI: 144-182) CI = Confidence interval 1 The probability of dying between exact ages 15 and 50, expressed per 1,000 persons at age 15 240 • Adult and Maternal Mortality Table 14.4 Pregnancy-related mortality rates Direct estimates of pregnancy-related mortality rates for the 7 years preceding the survey, by 5-year age groups, Myanmar DHS 2015-16 Age Percentage of female deaths that are pregnancy- related Number of pregnancy- related deaths Exposure years Pregnancy- related mortality rate1 15-19 2.6 0 16,600 0.02 20-24 7.7 3 21,850 0.13 25-29 8.2 4 24,241 0.15 30-34 14.2 8 24,064 0.33 35-39 10.4 4 21,357 0.18 40-44 7.0 4 15,948 0.26 45-49 0.0 0 11,534 0.00 15-49 8.1 22 135,595 0.16a General fertility rate (GFR)2 69a Pregnancy-related mortality ratio (PRM)3 227 (CI: 131-323) Lifetime risk of maternal death4 0.005 CI = Confidence interval 1 Expressed per 1,000 woman-years of exposure 2 Expressed per 1,000 women age 15-49 3 Expressed per 100,000 live births; calculated as the age-adjusted pregnancy- related mortality rate times 100 divided by the age-adjusted general fertility rate 4 Calculated as 1-(1-PRM)TFR, where TFR represents the total fertility rate for the 7 years preceding the survey a Age-adjusted rate Women’s Empowerment • 241 WOMEN’S EMPOWERMENT 15 Key Findings  Employment and control over earnings: Almost all currently married men and nearly three-fourths of currently married women were employed in the 12 months preceding the survey. About 9 out of 10 women and men who worked earned cash only for their work.  Control over earnings: About half of currently married women (51%) with cash earnings decide independently on how their earnings will be used, while 41% decide jointly with their husband.  Ownership of assets: Fifty-four percent of women age 15-49 own a house and 48% own land alone or jointly with someone else. Similarly, 56% of men own a house and 49% own land alone or jointly.  Participation in decision making: About two-thirds of currently married women participate in three specified household decisions, while 5% do not have a say in any of these decisions.  Attitude towards wife beating: Fifty-one percent of women and 49% of men believe that a husband is justified in beating his wife in at least one of five specified situations.  Empowerment and health outcomes: Use of contraception and access to antenatal care, postnatal care, and delivery assistance from a health professional increase with increasing scores on women’s empowerment indices. omen’s empowerment has many different dimensions that can each be measured by separate indicators. This chapter explores women’s empowerment in terms of their employment and control over earnings, asset ownership, gender-related attitudes, and household decision making. In order to examine gender differentials, where possible, indicators for women are compared with those for men. In addition, women’s responses to specific questions on their participation in household decision making and attitudes towards wife beating are used to examine how selected demographic and health indicators vary by women’s empowerment. W 242 • Women’s Empowerment 15.1 MARRIED WOMEN’S AND MEN’S EMPLOYMENT Employment Respondents are considered to be employed if they have done any work other than their housework in the 12 months before the survey. Sample: Currently married women and men age 15-49 Cash employment Respondents are asked if they are paid for their labor in cash or in kind. Only those who receive payment in cash only or in cash and in kind are considered to earn cash for their employment. Sample: Currently married women and men age 15-49 employed in the 12 months before the survey Men are more likely to be employed than women in Myanmar. Almost all currently married men age 15-49 were employed in the 12 months preceding the survey, as compared with 71% of currently married women age 15-49 (Table 15.1). There is very little variation in employment by age among either women or men. Approximately 9 in 10 women and men are paid in cash only (87% and 88%, respectively). Four percent each of women and men receive in-kind earnings only for their work, and 7% each receive cash and in- kind payments. Three percent of women and 1% of men do not receive any payment for their work. 15.2 CONTROL OVER WOMEN’S EARNINGS Control over one’s own cash earnings Respondents are considered to have control over their own earnings if they participate in decisions alone or jointly with their husband about how their own earnings will be used. Sample: Currently married women age 15-49 who received cash earnings for employment during the 12 months before the survey Women gain direct access to economic resources when they are employed for cash. However, this access is meaningless unless women also control how their earnings are used. In Myanmar, more than half of currently married women age 15-49 who receive cash earnings decide by themselves on how their earnings are used, while 41% make such decisions jointly with their husbands. Only 6% reported that their husbands mainly decide on the use of their cash earnings. Most employed women earn less money than their husbands (59%), 24% earn the same as their husbands, and 15% earn more than their husbands (Table 15.2.1, Figure 15.1). Patterns by background characteristics  Urban women are more likely to be the main decision maker regarding the use of their earnings than rural women (56% versus 50%). Also, urban women are less likely than rural women to earn less than their husbands (53% versus 61%). Figure 15.1 Control over women’s earnings Mainly wife 51% Wife and husband jointly 41% Mainly husband 6% Other 2% Percent distribution of currently married women with cash earnings in the 12 months before the survey Women’s Empowerment • 243  Across the 15 different states and regions, the proportion of women who make independent decisions on using their cash earnings ranges from a low of 28% in Kayah State to a high of 80% in Mon State.  Women with more than a secondary education are more likely to make independent decisions on the use of their earnings than women with less education or no education (59% versus 50-51%). Also, they are much less likely than those at other educational levels to earn less than their husbands (44% versus 56-62%).  Although women’s control over their earnings does not vary consistently by household wealth, the likelihood of women earning less than their husband declines sharply with increasing wealth. 15.3 CONTROL OVER MEN’S EARNINGS Married men age 15-49 were asked about the primary decision maker regarding the use of their cash earnings. About half of men jointly decide with their wives and 26% say that their wives mainly decide how to spend their earnings. When women were similarly asked about decisions regarding the use of their husband’s earnings, 53% said that the decision was made jointly and 34% said that they primarily made the decision. Notably, women were much less likely than men (10% versus 23%) to say that the husband mainly decides about the use of his earnings (Table 15.2.2). Women’s role in decision making regarding the use of their own and their husbands’ earnings varies by their earnings relative to those of their husbands. Two-thirds or more of women who earn more than their husbands (67%) and whose husbands do not have cash earnings (69%) are the main decision makers about the use of their own earnings, as compared with half or less of women who earn the same as (41%) or less than (51%) their husbands. Similarly, women who earn more than their husbands are more likely than other women to be the main decision makers regarding the use of their husbands’ earnings (44% versus 29- 35%) (Table 15.3). 15.4 WOMEN’S AND MEN’S OWNERSHIP OF ASSETS Ownership of a house or land Respondents who own a house or land, whether alone or jointly with someone else. Sample: Women and men age 15-49 In Myanmar, there are no differences between women and men with respect to ownership of a house or land. More than half of women (54%) and men (56%) age 15-49 own a house alone or jointly with someone else, and almost half of women (48%) and men (49%) own land alone or jointly. However, men are more likely than women to own both a house and land alone (Table 15.4.1, Table 15.4.2, and Figure 15.2). Figure 15.2 Ownership of house and land 27 15 33 18 20 24 21 26 2 9 2 10 51 52 44 46 Men Women LAND Men Women HOUSE Percent distribution of women and men age 15-49 by ownership of house and land Alone Jointly Alone and jointly Do not own Own: 244 • Women’s Empowerment Patterns by background characteristics  Women living in rural areas are more likely to own a house and land alone or jointly than those living in urban areas. Three in five rural women own a house, as compared with two in five urban women. Fifty-three percent of rural women own land, compared with 37% of urban women (Table 15.4.1). Similar differentials by rural-urban residence are observed for men (Table 15.4.2).  Among women, sole or joint ownership of a house varies from a low of 33% in Kachin State to a high of 87% in Mandalay Region, and sole or joint ownership of land varies from 28% in Kachin State to 83% in Mandalay Region. Among men, ownership of both a house and land is also highest in Mandalay Region.  Ownership of a house and land declines sharply with increasing education among both women and men. 15.5 WOMEN’S PARTICIPATION IN DECISION MAKING Participation in household decisions Women are considered to participate in household decisions if they make decisions alone or jointly with their husband in the following areas: (1) the woman’s health care, (2) major household purchases, (3) visits to the woman’s family or relatives, and (4) the well-being of their children. Sample: Currently married women age 15-49 Participation in household decision making is an important aspect of women’s ability to have control over their own lives. Eighty-eight percent of currently married women participate in decisions about visits to their family or relatives, including 37% who make these decisions mainly alone; 83% participate in decisions regarding their own health care, including 40% who make these decisions mainly alone; and 74% participate in decisions about major household purchases, including 19% who make these decisions mainly alone (Table 15.5). Overall, 65% of currently married women participate in the three specified decisions (women’s own health care, making major household purchases, and visits to their family or relatives) alone or jointly with their husband (Table 15.6.1, Figure 15.3). Only 5% of women say that they do not participate in any of these decisions. Currently married women are also most likely to participate in decisions about the well-being of their children: 91% of women participate in these decisions, with 57% making them mainly alone and 34% making them jointly with their husband (Table 15.6.1). Currently married men were also asked about their participation in selected household decisions. Only 59% of men participate in decisions about the well-being of their children, and 72% participate in decisions about their own health care. With respect to the decisions that both women and men were asked about, the only one in which a higher proportion of men than women reported participating was the decision on major household purchases: 85% of men participated alone or jointly in this decision, as compared with 74% of women (Table 15.6.2). Figure 15.3 Women’s participation in decision making 83 74 88 65 5 Woman’s own health care Major household purchases Visits to family or relatives Participate in all 3 decisions Participate in none of these decisions Percentage of currently married women age 15-49 participating in specific decisions Women’s Empowerment • 245 Patterns by background characteristics  Currently married women who are employed for cash (67%) and those who are not employed (62%) are more likely to participate in the three selected decisions than women who are employed but do not earn cash (53%).  By state/region, currently married women in Rakhine State are least likely to participate in the three selected decisions (48%), while women in Tanintharyi Region (80%) and Kayin State (79%) are most likely to do so.  There are minimal differences in women’s participation in decision making by education or wealth. 15.6 ATTITUDES TOWARD WIFE BEATING Attitudes toward wife beating Respondents are asked if they agree that a husband is justified in hitting or beating his wife under each of the following five circumstances: she burns the food, she argues with him, she goes out without telling him, she neglects the children, and she refuses to have sex with him. If respondents answer “yes” in at least one circumstance, they are considered to have attitudes justifying wife beating. Sample: Women and men age 15-49 Another measure of women’s empowerment derives from the idea that gender equity is essential for empowerment. Attitudes in which the beating of wives by husbands is seen as justified are indicative of women’s lower status and can disempower women in their household and intimate relationships. In Myanmar, 42% of women agree that wife beating is justified if a wife neglects the children, and 22% agree that it is justified if the wife goes out without telling her husband. Smaller proportions of women agree that wife beating is justified if the wife burns the food (13%), refuses to have sexual intercourse with her husband (10%), or argues with her husband (10%). Overall, 51% of women agree that wife beating is justified for at least one of the five reasons (Table 15.7.1). Among men, the pattern of agreement with these five specified reasons for wife beating is similar to that observed for women (Table 15.7.2). Men are also most likely to agree that wife beating is justified if the wife neglects the children (40%) or goes out without telling her husband (17%) (Figure 15.4). In Myanmar, women and men were also asked if wife beating is justified if the wife refuses to use contraception and if she becomes involved in too much social activity. Ten percent each of women and men believe that a husband is justified in hitting or beating his wife if she refuses to use contraception. Fifteen percent of women and 21% of men believe that a husband is justified in hitting or beating his wife if she becomes involved in too much social activity. Patterns by background characteristics  Wife beating is more acceptable among rural women than urban women: 54% of women from rural areas agree that wife beating is justified in at least one of the five specified circumstances, as compared with 44% of women in urban areas (Table 15.7.1). There are, however, no urban-rural differentials in men’s acceptance of wife beating (Table 15.7.2). Figure 15.4 Attitudes toward wife beating 13 10 22 42 10 51 8 13 17 40 10 49 Burns the food Argues with him Goes out without telling him Neglects the children Refuses sexual intercourse Any of these reasons Percentage of women and men age 15-49 who agree that a husband is justified in beating his wife for specific reasons Women Men 246 • Women’s Empowerment  Agreement with wife beating varies greatly by state and region, ranging from 33% in Tanintharyi Region to 70% in Mandalay Region among women and from 14% in Kayah State to 69% in Rakhine State among men.  Women with more than a secondary education (33%) are much less likely to agree with wife beating than women with less education (52-55%). Among men, acceptance of wife beating does not vary consistently with education but is lowest among men with more than a secondary education (35%).  There are no clear patterns in acceptance of wife beating by wealth among either women or men; however, among women, those in the highest wealth quintile are less likely to agree with wife beating than those in the other wealth quintiles. 15.7 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES The two sets of empowerment indicators, namely women’s participation in household decisions and women’s attitudes toward wife beating, can be summarized in two separate indices. The first index shows the number of decisions (see Table 15.6.1 for the list of decisions) in which women participate alone or jointly with their husbands. This index ranges in value from 0 to 3 and is positively related to women’s empowerment. The second indicator, which ranges in value from 0 to 5, is the total number of reasons (see Table 15.7.1 for the list of reasons) for which the woman feels that a husband is justified in beating his wife. A lower score on this indicator is interpreted as reflecting a greater sense of entitlement and self- esteem and higher status for women. The data show that there is the expected positive relationship between the two empowerment indicators: the percentage of women who disagree with all of the five specified reasons given for wife beating increases from 44% among those who do not participate in any of the three specified decisions to 54% among those who participate in all three decisions, and the percentage of women who participate in all three of the specified decisions declines sharply with the number of reasons justifying wife beating, from 71% among women who do not agree with any reason to 48% among women who agree with all five reasons (Table 15.8). A woman’s ability to control her fertility and use a method of contraception is likely to be affected by her sense of empowerment and her own belief in her ability to control her sexual life and fertility. In Myanmar, women’s use of contraception is related to the two empowerment indicators. For example, 53% of women who participate in the three specified decisions use contraceptives, as compared with 45% of women who do not participate in any of the three decisions. Similarly, contraceptive use among women who do not agree with any reason for wife beating, at 52%, is much higher than contraceptive use among women who agree with all five reasons for wife beating, at 38% (Table 15.9). Unmet need for contraception declines slightly with increases in the number of decisions in which women participate (Table 15.10). Women’s use of maternal care also varies in the expected direction with both indicators of women’s empowerment. For example, 48% of women who participate in no decisions received delivery care for their most recent birth in the last 5 years, as compared with 66% of women who participate in all three decisions. Similarly, 65% of women who disagree with all five reasons for wife beating received delivery care for their most recent birth, compared with 51% of women who agree with all five reasons (Table 15.11). Child mortality is another demographic indicator that varies by women’s empowerment. For example, under-5 mortality declines from 77 per 1,000 live births in the 5 years preceding the survey among women who participate in 1-2 of the three decisions to 68 among women who participate in all three decisions. However, under-5 mortality declines from 79 per 1,000 live births among women who disagree with all five reasons for wife beating to 65 among women who agree with one or more reasons (Table 15.12). Women’s Empowerment • 247 LIST OF TABLES For more information on women’s empowerment and demographic and health outcomes, see the following tables:  Table 15.1 Employment and cash earnings of currently married women and men  Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings  Table 15.2.2 Control over men’s cash earnings  Table 15.3 Women’s control over their own earnings and over those of their husbands  Table 15.4.1 Ownership of assets: Women  Table 15.4.2 Ownership of assets; Men  Table 15.5 Participation in decision making  Table 15.6.1 Women’s participation in decision making by background characteristics  Table 15.6.2 Men’s participation in decision making by background characteristics  Table 15.7.1 Attitude toward wife beating: Women  Table 15.7.2 Attitude toward wife beating: Men  Table 15.8 Indicators of women’s empowerment  Table 15.9 Current use of contraception by women’s empowerment  Table 15.10 Ideal number of children and unmet need for family planning by women’s empowerment  Table 15.11 Reproductive health care by women’s empowerment  Table 15.12 Early childhood mortality rates by women’s status 248 • Women’s Empowerment Table 15.1 Employment and cash earnings of currently married women and men Percentage of currently married women and men age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently married women and men employed in the past 12 months by type of earnings, according to age, Myanmar DHS 2015-16 Among currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Age Percentage employed in past 12 months Number Cash only Cash and in-kind In-kind only Not paid Total Number WOMEN 15-19 69.1 227 84.1 3.6 2.7 9.7 100.0 157 20-24 64.9 834 84.6 4.8 2.9 7.8 100.0 541 25-29 67.5 1,258 87.2 5.0 3.8 4.0 100.0 849 30-34 71.5 1,505 86.7 8.0 2.6 2.7 100.0 1,077 35-39 73.5 1,482 89.0 5.3 4.1 1.6 100.0 1,090 40-44 72.2 1,283 86.4 8.1 3.9 1.6 100.0 926 45-49 72.6 1,169 85.6 7.8 5.6 1.0 100.0 849 Total 70.7 7,759 86.7 6.6 3.8 2.9 100.0 5,489 MEN 15-19 (99.5) 36 (90.2) (5.0) (0.0) (4.8) 100.0 36 20-24 99.3 228 86.7 6.2 6.0 1.1 100.0 226 25-29 99.7 447 88.4 5.9 3.8 1.9 100.0 446 30-34 99.3 549 88.8 5.4 4.7 1.1 100.0 545 35-39 99.0 587 88.8 8.1 2.3 0.8 100.0 581 40-44 99.0 593 87.1 7.3 4.8 0.8 100.0 587 45-49 99.1 516 85.3 8.2 4.6 1.9 100.0 511 Total 99.2 2,957 87.7 6.9 4.1 1.3 100.0 2,933 Note: Figures in parentheses are based on 25-49 unweighted cases. Women’s Empowerment • 249 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife’s cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Person who decides how the wife’s cash earnings are used: Total Wife’s cash earnings compared with husband’s cash earnings: Total Number of women Mainly wife Wife and husband jointly Mainly husband Other Missing More Less About the same Husband has no earnings Don’t know/ missing Age 15-19 41.7 35.7 5.6 16.0 1.1 100.0 19.0 63.1 11.3 0.9 5.7 100.0 138 20-24 51.9 34.5 5.0 8.3 0.2 100.0 14.0 66.1 18.5 0.4 1.1 100.0 484 25-29 51.1 41.2 4.2 3.3 0.2 100.0 13.0 64.3 21.4 0.9 0.5 100.0 783 30-34 49.9 40.8 6.7 2.6 0.0 100.0 16.3 62.3 20.4 0.8 0.2 100.0 1,020 35-39 51.7 43.0 4.3 1.0 0.0 100.0 16.3 56.8 26.0 0.8 0.2 100.0 1,028 40-44 52.8 39.2 7.6 0.2 0.1 100.0 16.6 53.2 28.1 1.5 0.6 100.0 874 45-49 52.0 41.8 5.6 0.4 0.2 100.0 13.6 51.5 31.2 2.8 0.8 100.0 793 Number of living children 0 48.1 38.7 3.8 9.0 0.4 100.0 16.9 58.5 22.6 1.0 1.0 100.0 626 1-2 50.9 41.5 5.1 2.4 0.1 100.0 14.7 59.8 24.0 0.7 0.8 100.0 2,692 3-4 51.7 40.9 6.8 0.6 0.0 100.0 15.0 58.0 24.9 1.9 0.2 100.0 1,385 5+ 56.9 35.1 8.0 0.0 0.0 100.0 17.5 53.7 26.3 2.3 0.2 100.0 417 Residence Urban 56.2 37.4 4.6 1.7 0.1 100.0 16.9 52.5 28.1 1.5 1.0 100.0 1,230 Rural 49.7 41.4 6.0 2.8 0.1 100.0 14.7 60.6 23.0 1.1 0.5 100.0 3,890 States/Regions Kachin 48.0 38.0 11.4 2.6 0.0 100.0 15.9 48.4 34.5 0.3 0.9 100.0 135 Kayah 28.1 61.5 7.8 2.6 0.0 100.0 10.5 49.5 37.7 1.0 1.3 100.0 27 Kayin 73.4 22.5 2.2 1.9 0.0 100.0 15.0 44.5 36.5 3.2 1.0 100.0 81 Chin 30.6 51.5 11.0 6.9 0.0 100.0 23.9 53.3 20.2 2.7 0.0 100.0 22 Sagaing 53.2 41.7 2.1 3.0 0.0 100.0 8.1 66.6 21.8 3.4 0.0 100.0 562 Tanintharyi 51.1 40.5 7.7 0.7 0.0 100.0 18.7 60.5 19.8 0.6 0.3 100.0 119 Bago 56.8 35.9 5.0 1.8 0.5 100.0 10.9 68.1 18.5 1.8 0.7 100.0 530 Magway 56.5 33.5 7.1 2.2 0.8 100.0 7.9 63.3 26.5 1.2 1.1 100.0 499 Mandalay 48.4 41.9 4.6 5.1 0.0 100.0 26.3 52.8 19.8 0.6 0.5 100.0 684 Mon 80.3 12.1 2.8 4.8 0.0 100.0 13.6 60.2 25.8 0.4 0.0 100.0 149 Rakhine 55.5 37.1 5.5 2.0 0.0 100.0 17.4 59.4 22.1 0.7 0.4 100.0 220 Yangon 35.4 58.8 5.1 0.6 0.0 100.0 12.4 59.6 27.6 0.3 0.0 100.0 510 Shan 48.9 41.3 7.6 2.2 0.0 100.0 13.6 52.3 31.3 1.0 1.8 100.0 695 Ayeyarwady 50.0 40.9 6.9 2.2 0.0 100.0 21.8 57.5 19.5 0.9 0.4 100.0 760 Nay Pyi Taw 54.1 39.0 4.8 2.1 0.0 100.0 10.7 53.5 34.7 0.6 0.6 100.0 129 Education1 No education 49.8 40.3 8.5 1.4 0.0 100.0 14.5 56.0 28.0 0.9 0.7 100.0 829 Primary 51.0 40.0 6.1 2.8 0.1 100.0 14.3 61.8 21.9 1.5 0.5 100.0 2,465 Secondary 50.2 42.1 4.3 3.0 0.4 100.0 15.6 59.3 23.4 1.2 0.6 100.0 1,394 More than secondary 58.5 38.0 2.0 1.5 0.0 100.0 21.7 44.0 33.1 0.4 0.9 100.0 428 Wealth quintile Lowest 55.6 35.2 7.0 2.2 0.0 100.0 17.0 65.2 16.7 0.6 0.5 100.0 1,047 Second 48.8 40.7 7.2 3.2 0.0 100.0 15.0 63.3 20.0 1.3 0.5 100.0 1,076 Middle 47.5 43.8 5.6 3.0 0.1 100.0 14.0 60.3 24.2 1.2 0.2 100.0 1,079 Fourth 50.3 42.8 4.3 2.3 0.4 100.0 13.9 53.6 29.9 1.6 1.0 100.0 972 Highest 54.3 39.8 3.9 1.9 0.1 100.0 16.5 49.4 31.6 1.4 1.1 100.0 946 Total 51.2 40.5 5.6 2.5 0.1 100.0 15.3 58.7 24.2 1.2 0.6 100.0 5,120 1 Total includes three women with missing information on education. 250 • Women’s Empowerment Table 15.2.2 Control over men’s cash earnings Percent distributions of currently married men age 15-49 who receive cash earnings for employment and of currently married women age 15- 49 whose husbands receive cash earnings for employment, by person who decides how husband’s cash earnings are used, according to background characteristics, Myanmar DHS 2015-16 Men Women Background characteristic Mainly wife Hus- band and wife jointly Mainly hus- band Other Total Number Mainly wife Hus- band and wife jointly Mainly hus- band Other Missing Total Number Age 15-19 (18.3) (54.9) (12.2) (14.6) 100.0 34 23.4 48.4 13.7 13.8 0.7 100.0 223 20-24 29.7 43.1 20.7 6.5 100.0 210 31.3 52.1 9.6 6.9 0.1 100.0 825 25-29 24.1 42.6 26.4 6.8 100.0 421 34.3 54.6 8.8 2.3 0.0 100.0 1,249 30-34 25.3 50.4 21.8 2.5 100.0 514 34.1 53.9 9.7 2.3 0.0 100.0 1,496 35-39 27.4 48.3 22.5 1.9 100.0 563 36.9 53.3 8.8 1.0 0.0 100.0 1,472 40-44 23.6 52.0 23.6 0.8 100.0 554 36.5 51.5 11.6 0.4 0.0 100.0 1,267 45-49 29.4 46.6 23.8 0.3 100.0 478 32.8 55.5 11.1 0.4 0.0 100.0 1,135 Number of living children 0 29.0 44.9 17.8 8.3 100.0 360 27.8 55.5 8.8 7.7 0.3 100.0 903 1-2 25.3 49.2 22.7 2.9 100.0 1,515 34.0 54.9 8.8 2.3 0.0 100.0 4,034 3-4 25.1 48.5 25.9 0.5 100.0 720 36.7 51.4 11.3 0.6 0.0 100.0 2,064 5+ 32.4 41.3 26.2 0.1 100.0 180 37.2 47.3 15.2 0.2 0.0 100.0 665 Residence Urban 28.2 43.6 25.6 2.6 100.0 748 34.8 54.4 9.7 1.1 0.1 100.0 2,001 Rural 25.4 49.6 22.2 2.8 100.0 2,027 34.1 53.0 10.1 2.7 0.0 100.0 5,666 States/Regions Kachin 24.2 44.5 29.2 2.1 100.0 83 36.1 48.1 12.9 2.8 0.2 100.0 237 Kayah 16.0 66.6 16.0 1.4 100.0 13 17.3 70.1 11.4 1.3 0.0 100.0 40 Kayin 60.7 28.0 10.8 0.6 100.0 59 61.0 30.5 7.9 0.6 0.0 100.0 195 Chin 19.3 52.9 25.4 2.4 100.0 11 19.9 61.8 15.0 3.4 0.0 100.0 64 Sagaing 18.3 50.6 28.5 2.7 100.0 294 41.8 48.4 6.7 3.1 0.0 100.0 803 Tanintharyi 22.1 61.4 15.7 0.8 100.0 54 33.5 54.3 11.9 0.2 0.0 100.0 173 Bago 14.2 64.1 17.4 4.4 100.0 302 34.8 55.5 7.0 2.3 0.3 100.0 761 Magway 22.6 45.0 29.2 3.2 100.0 204 34.3 53.4 9.8 2.5 0.0 100.0 636 Mandalay 29.8 42.7 22.3 5.3 100.0 343 35.5 51.3 8.3 4.9 0.0 100.0 834 Mon 37.3 40.6 19.5 2.6 100.0 76 61.0 31.1 5.6 2.3 0.0 100.0 278 Rakhine 15.6 45.1 38.0 1.3 100.0 126 30.9 47.1 19.9 2.2 0.0 100.0 448 Yangon 35.3 43.9 19.4 1.3 100.0 387 21.2 69.6 8.4 0.8 0.0 100.0 1,039 Shan 27.7 46.4 22.2 3.6 100.0 355 31.4 54.7 12.2 1.7 0.0 100.0 894 Ayeyarwady 26.9 49.6 22.1 1.4 100.0 402 31.5 54.3 12.3 1.9 0.0 100.0 1,072 Nay Pyi Taw 27.8 41.6 29.6 1.0 100.0 66 43.8 44.7 8.5 2.8 0.2 100.0 194 Education1 No education 33.1 45.4 18.5 3.0 100.0 392 33.6 51.1 13.7 1.6 0.0 100.0 1,180 Primary 29.3 46.3 22.1 2.3 100.0 1,188 36.3 51.0 10.0 2.7 0.0 100.0 3,606 Secondary 21.4 50.9 24.1 3.6 100.0 1,018 32.5 56.1 8.9 2.3 0.1 100.0 2,259 More than secondary 16.7 47.8 34.7 0.8 100.0 177 30.3 61.7 6.8 1.2 0.1 100.0 619 Wealth quintile Lowest 28.8 46.2 23.6 1.3 100.0 579 38.7 48.0 11.3 2.0 0.0 100.0 1,611 Second 29.1 47.4 21.9 1.6 100.0 563 35.6 51.9 10.2 2.2 0.0 100.0 1,565 Middle 22.2 54.1 20.4 3.2 100.0 562 31.9 55.2 10.1 2.8 0.0 100.0 1,536 Fourth 27.9 45.7 21.3 5.1 100.0 549 32.7 55.1 9.4 2.7 0.2 100.0 1,484 Highest 22.4 46.3 28.6 2.7 100.0 522 31.9 57.2 9.0 1.9 0.0 100.0 1,471 Total 26.2 48.0 23.1 2.8 100.0 2,775 34.3 53.4 10.0 2.3 0.0 100.0 7,667 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Total includes three women with missing information on education. Women’s Empowerment • 251 Table 15.3 Women’s control over their own earnings and over those of their husbands Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife’s cash earnings are used and percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband’s cash earnings are used, according to the relation between wife’s and husband’s cash earnings, Myanmar DHS 2015-16 Women’s earnings relative to husband’s earnings Person who decides how the wife’s cash earnings are used: Total Number Person who decides how the husband’s cash earnings are used: Total Number of women Mainly wife Wife and hus- band jointly Mainly hus- band Other Missing Mainly wife Wife and hus- band jointly Mainly hus- band Other More than husband 67.3 23.9 5.3 3.5 0.0 100.0 782 44.3 40.5 12.1 3.1 100.0 782 Less than husband 50.9 41.2 5.5 2.4 0.0 100.0 3,003 35.3 53.3 9.3 2.1 100.0 3,003 Same as husband 41.1 50.6 6.5 1.8 0.1 100.0 1,241 29.2 61.7 7.8 1.2 100.0 1,241 Husband has no cash earnings or did not work 69.0 22.7 0.5 7.8 0.0 100.0 61 na na na na na na Woman worked but has no cash earnings na na na na na na na 30.6 53.8 10.8 4.8 100.0 359 Woman did not work na na na na na na na 32.9 53.7 11.1 2.3 100.0 2,249 Total1 51.2 40.5 5.6 2.5 0.1 100.0 5,120 34.3 53.4 10.0 2.3 100.0 7,667 na = Not applicable 1 Includes cases where a woman does not know whether she earned more or less than her husband 252 • Women’s Empowerment Table 15.4.1 Ownership of assets: Women Percent distribution of women age 15-49 by ownership of housing and land, according to background characteristics, Myanmar DHS 2015-16 Percentage who own a house: Percentage who own land: Number of women Background characteristic Alone Jointly Alone and jointly Perc- entage who do not own a house Total Alone Jointly Alone and jointly Per- centage who do not own land Total Age 15-19 1.8 16.6 4.2 77.4 100.0 1.1 16.4 3.2 79.3 100.0 1,810 20-24 6.1 20.4 5.7 67.8 100.0 4.5 19.0 4.8 71.6 100.0 1,867 25-29 13.2 26.2 6.9 53.7 100.0 9.7 24.5 6.3 59.5 100.0 1,867 30-34 19.3 28.9 10.9 40.9 100.0 15.0 27.0 10.1 47.9 100.0 2,037 35-39 25.1 28.7 13.4 32.8 100.0 19.5 28.5 12.9 39.1 100.0 1,954 40-44 30.4 28.7 14.8 26.0 100.0 25.8 26.4 13.9 33.9 100.0 1,733 45-49 32.6 30.4 16.2 20.9 100.0 27.6 29.3 15.4 27.7 100.0 1,617 Residence Urban 13.5 20.7 5.8 60.0 100.0 11.1 19.9 5.5 63.6 100.0 3,768 Rural 20.0 27.7 12.0 40.3 100.0 15.9 26.3 11.0 46.8 100.0 9,117 States/Regions Kachin 17.7 9.4 6.1 66.8 100.0 16.9 4.8 5.9 72.4 100.0 374 Kayah 30.4 12.7 13.3 43.5 100.0 30.7 12.3 13.8 43.0 100.0 65 Kayin 29.6 17.2 6.1 47.0 100.0 29.5 16.6 4.9 49.0 100.0 303 Chin 4.2 14.2 26.1 55.5 100.0 3.9 14.5 25.5 56.1 100.0 102 Sagaing 4.8 2.5 35.4 57.3 100.0 4.5 2.4 35.2 57.8 100.0 1,410 Tanintharyi 5.2 35.2 1.5 58.0 100.0 4.9 30.3 0.8 63.9 100.0 283 Bago 23.6 11.1 9.7 55.6 100.0 19.3 8.8 9.8 62.1 100.0 1,244 Magway 29.4 29.6 11.3 29.7 100.0 14.7 30.2 3.5 51.6 100.0 1,081 Mandalay 22.1 63.8 0.9 13.3 100.0 18.7 63.6 0.8 17.0 100.0 1,541 Mon 11.1 28.2 10.8 49.9 100.0 10.4 24.9 10.5 54.2 100.0 463 Rakhine 6.0 16.4 19.0 58.7 100.0 5.6 15.8 18.2 60.4 100.0 777 Yangon 17.9 14.5 8.7 58.9 100.0 12.7 15.2 8.4 63.7 100.0 1,927 Shan 29.2 18.3 7.0 45.5 100.0 26.2 18.6 7.5 47.7 100.0 1,368 Ayeyarwady 12.8 44.1 0.1 43.0 100.0 10.3 38.6 0.1 51.0 100.0 1,650 Nay Pyi Taw 21.1 35.6 5.6 37.7 100.0 19.1 33.0 5.1 42.8 100.0 300 Education1 No education 29.4 23.8 15.3 31.5 100.0 24.2 22.0 14.4 39.4 100.0 1,606 Primary 21.3 29.2 12.4 37.0 100.0 16.4 27.6 11.3 44.7 100.0 5,305 Secondary 12.9 22.8 6.7 57.5 100.0 10.8 22.0 6.2 61.0 100.0 4,646 More than secondary 9.4 23.6 7.3 59.6 100.0 7.7 23.1 6.9 62.2 100.0 1,325 Wealth quintile Lowest 24.2 29.6 10.9 35.2 100.0 16.4 25.4 9.9 48.3 100.0 2,274 Second 20.8 28.0 11.4 39.8 100.0 16.4 26.1 10.3 47.2 100.0 2,408 Middle 17.6 26.2 12.1 44.1 100.0 14.4 25.7 10.4 49.4 100.0 2,633 Fourth 15.6 21.7 9.6 53.1 100.0 14.1 21.7 9.3 54.9 100.0 2,702 Highest 13.6 23.9 7.5 55.0 100.0 11.8 23.6 7.4 57.2 100.0 2,868 Total 18.1 25.7 10.2 46.0 100.0 14.5 24.4 9.4 51.7 100.0 12,885 1 Total includes three women with missing information on education. Women’s Empowerment • 253 Table 15.4.2 Ownership of assets; Men Percent distribution of men age 15-49 by ownership of housing and land, according to background characteristics, Myanmar DHS 2015- 16 Background characteristic Percentage who own a house: Total Percentage who own land: Total Number of men Alone Jointly Alone and jointly Per- centage who do not own a house Alone Jointly Alone and jointly Per- centage who do not own land Age 15-19 2.7 22.6 3.1 71.6 100.0 2.9 21.4 2.8 72.9 100.0 731 20-24 8.1 22.5 2.5 66.8 100.0 7.5 21.5 1.9 69.1 100.0 692 25-29 20.5 21.9 2.6 55.0 100.0 14.6 19.7 2.7 63.0 100.0 677 30-34 37.8 21.9 1.0 39.3 100.0 29.2 18.6 1.2 51.0 100.0 698 35-39 44.8 24.4 1.3 29.5 100.0 38.2 22.1 1.7 38.1 100.0 679 40-44 57.8 19.3 1.0 21.9 100.0 48.0 20.9 0.4 30.7 100.0 689 45-49 66.0 16.4 0.8 16.8 100.0 57.3 16.1 0.8 25.7 100.0 571 Residence Urban 20.8 20.9 2.5 55.8 100.0 18.2 19.3 2.4 60.1 100.0 1,350 Rural 37.7 21.7 1.5 39.2 100.0 30.9 20.5 1.4 47.2 100.0 3,387 States/Regions Kachin 30.7 28.8 4.1 36.4 100.0 31.2 27.0 4.4 37.4 100.0 161 Kayah 52.0 12.9 0.4 34.7 100.0 49.2 15.7 0.0 35.1 100.0 23 Kayin 30.7 13.1 2.9 53.4 100.0 29.9 11.1 2.3 56.7 100.0 115 Chin 47.3 7.1 0.0 45.6 100.0 52.2 5.8 0.0 42.0 100.0 39 Sagaing 35.3 9.2 0.8 54.8 100.0 32.1 10.1 0.5 57.3 100.0 514 Tanintharyi 6.6 40.9 1.2 51.3 100.0 8.2 34.3 1.7 55.8 100.0 103 Bago 35.9 6.1 0.0 58.0 100.0 25.6 4.9 0.0 69.4 100.0 454 Magway 44.2 3.9 0.0 51.9 100.0 41.4 4.2 0.0 54.4 100.0 320 Mandalay 35.0 50.4 1.1 13.5 100.0 31.8 50.9 1.4 15.9 100.0 601 Mon 16.1 28.9 0.4 54.6 100.0 17.8 29.1 0.4 52.7 100.0 162 Rakhine 21.2 32.5 0.3 46.0 100.0 15.9 28.1 0.6 55.4 100.0 222 Yangon 24.1 13.1 4.8 58.1 100.0 20.7 12.9 3.7 62.7 100.0 703 Shan 40.4 20.1 2.2 37.3 100.0 32.8 19.4 2.0 45.8 100.0 542 Ayeyarwady 35.6 25.1 2.5 36.8 100.0 21.4 18.7 2.5 57.3 100.0 653 Nay Pyi Taw 35.9 25.8 0.6 37.8 100.0 28.6 28.1 1.0 42.4 100.0 126 Education No education 50.0 14.5 1.4 34.1 100.0 40.2 14.9 1.2 43.7 100.0 575 Primary 43.2 20.9 1.2 34.7 100.0 34.7 19.1 1.3 44.9 100.0 1,684 Secondary 22.5 23.8 2.4 51.3 100.0 19.4 22.4 2.1 56.1 100.0 2,139 More than secondary 18.0 21.1 1.9 59.0 100.0 18.4 20.0 1.8 59.8 100.0 339 Wealth quintile Lowest 45.0 19.1 0.7 35.1 100.0 30.8 15.6 0.7 52.9 100.0 890 Second 41.3 18.9 2.6 37.3 100.0 34.2 17.9 2.4 45.5 100.0 916 Middle 31.2 23.8 2.2 42.9 100.0 28.1 23.6 1.6 46.7 100.0 979 Fourth 25.1 24.0 1.5 49.5 100.0 22.6 23.1 1.8 52.5 100.0 986 Highest 23.4 21.0 2.0 53.6 100.0 21.6 19.9 1.7 56.8 100.0 966 Total 32.9 21.4 1.8 43.9 100.0 27.3 20.1 1.7 50.9 100.0 4,737 Table 15.5 Participation in decision making Percent distribution of currently married women and currently married men age 15-49 by person who usually makes decisions about various issues, Myanmar DHS 2015-16 Decision Mainly wife Wife and husband jointly Mainly husband Someone else Other Missing Total Number WOMEN Own health care 40.1 43.4 14.1 2.1 0.4 0.0 100.0 7,759 Major household purchases 18.6 55.7 18.5 6.2 0.9 0.0 100.0 7,759 Visits to her family or relatives 36.8 50.9 9.5 2.3 0.5 0.0 100.0 7,759 Well-being of children 57.3 34.0 5.0 1.3 2.3 0.1 100.0 7,759 MEN Own health care 24.7 34.0 37.6 3.8 0.0 0.0 100.0 2,957 Major household purchases 9.4 48.3 36.7 5.6 0.0 0.0 100.0 2,957 Well-being of children 38.2 40.5 18.7 1.2 1.4 0.0 100.0 2,957 254 • Women’s Empowerment Table 15.6.1 Women’s participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Myanmar DHS 2015-16 Background characteristic Specific decisions All three decisions None of the three decisions Well-being of children Number of women Woman’s own health care Making major household purchases Visits to her family or relatives Age 15-19 69.7 54.4 81.1 46.7 11.4 73.2 227 20-24 76.1 62.1 81.9 53.4 9.5 85.4 834 25-29 84.2 72.9 85.8 63.8 5.6 91.6 1,258 30-34 85.7 75.4 87.6 67.4 4.9 92.3 1,505 35-39 84.3 77.0 89.9 68.1 4.0 93.7 1,482 40-44 84.7 79.5 89.5 69.6 4.1 92.4 1,283 45-49 85.0 78.1 90.3 67.8 3.7 93.1 1,169 Employment (last 12 months)1 Not employed 83.0 72.3 85.0 62.4 6.4 90.9 2,269 Employed for cash 84.0 76.1 89.1 67.4 4.4 91.8 5,120 Employed not for cash 78.1 62.1 84.4 52.9 8.4 87.4 369 Number of living children 0 74.2 63.6 82.0 53.3 9.7 74.6 916 1-2 85.4 74.8 88.7 66.6 4.3 93.7 4,061 3-4 84.3 77.3 88.7 67.6 4.7 94.2 2,098 5+ 81.1 76.9 85.8 66.2 6.2 90.6 684 Residence Urban 88.1 76.3 89.0 68.6 3.2 92.2 2,022 Rural 81.8 73.7 87.2 64.1 5.9 91.0 5,737 States/Regions Kachin 86.0 70.5 83.6 60.6 3.9 91.2 238 Kayah 92.9 72.5 88.4 66.8 2.0 90.0 40 Kayin 92.5 85.0 93.8 79.4 1.8 95.5 201 Chin 77.4 79.5 85.7 67.4 8.1 88.3 66 Sagaing 86.3 75.5 85.9 69.9 6.8 92.3 828 Tanintharyi 90.7 84.7 92.1 79.6 3.3 92.2 174 Bago 80.4 78.6 89.9 67.2 4.0 94.0 780 Magway 82.8 68.4 89.7 61.0 3.6 88.9 642 Mandalay 79.7 77.3 93.3 64.3 3.6 94.1 838 Mon 78.1 80.7 90.0 66.0 4.4 87.6 278 Rakhine 60.6 64.6 68.3 47.5 19.2 79.0 454 Yangon 94.4 79.4 91.5 73.8 1.3 96.7 1,042 Shan 88.5 69.7 92.2 64.2 3.2 92.4 901 Ayeyarwady 80.5 70.9 81.6 60.9 7.9 87.3 1,083 Nay Pyi Taw 77.7 68.9 84.3 56.2 5.7 90.8 195 Education2 No education 81.1 73.3 86.7 64.5 7.0 89.6 1,193 Primary 82.6 74.8 87.8 65.3 5.3 91.6 3,656 Secondary 84.0 73.5 87.5 64.3 4.9 91.3 2,285 More than secondary 90.5 76.6 89.4 69.4 2.0 92.6 621 Wealth quintile Lowest 77.9 72.0 82.9 60.3 8.0 87.7 1,622 Second 81.9 76.6 87.8 67.7 6.2 91.4 1,586 Middle 84.9 73.0 88.9 64.7 3.7 92.2 1,556 Fourth 84.4 75.8 89.4 66.8 4.9 93.0 1,509 Highest 88.4 74.5 89.8 67.0 2.9 92.4 1,487 Total 83.4 74.3 87.7 65.3 5.2 91.3 7,759 1 Total includes one woman with missing information on employment status in the last 12 months. 2 Total includes three women with missing information on education. Women’s Empowerment • 255 Table 15.6.2 Men’s participation in decision making by background characteristics Percentage of currently married men age 15-49 who usually make specific decisions either alone or jointly with their wife, by background characteristics, Myanmar DHS 2015-16 Background characteristic Specific decisions Both decisions Neither of the two decisions Well-being of children Number of men Man’s own health Making major household purchases Age 15-19 (63.2) (63.6) (51.7) (24.9) (62.8) 36 20-24 63.0 67.5 49.1 18.6 50.2 228 25-29 64.7 78.9 56.9 13.3 52.0 447 30-34 72.6 86.1 68.0 9.2 58.2 549 35-39 73.2 86.6 69.1 9.2 58.4 587 40-44 77.5 90.4 74.2 6.3 64.5 593 45-49 71.7 89.9 67.6 5.9 64.9 516 Employment (last 12 months) Not employed * * * * * 23 Employed for cash 71.5 85.4 66.4 9.4 59.7 2,775 Employed not for cash 70.8 79.2 61.5 11.4 51.8 159 Number of living children 0 63.6 75.3 53.0 14.1 57.1 381 1-2 72.5 84.6 67.5 10.4 57.6 1,605 3-4 73.8 89.2 69.3 6.4 63.5 773 5+ 69.6 90.1 66.9 7.3 59.1 197 Residence Urban 68.6 83.4 62.3 10.3 53.0 767 Rural 72.5 85.5 67.3 9.3 61.3 2,190 States/Regions Kachin 76.8 83.0 68.6 8.8 56.5 93 Kayah 81.9 90.0 76.7 4.8 39.2 15 Kayin 73.4 89.6 71.0 8.0 48.5 70 Chin 74.1 81.3 64.3 8.9 54.9 24 Sagaing 77.0 83.0 68.6 8.5 60.4 308 Tanintharyi 87.2 88.0 78.9 3.7 59.1 57 Bago 75.3 83.2 66.5 7.9 68.6 309 Magway 73.7 86.1 69.5 9.8 71.6 215 Mandalay 64.0 87.1 60.5 9.4 64.5 358 Mon 67.7 68.9 52.5 15.9 49.7 82 Rakhine 86.0 91.2 82.5 5.3 56.6 139 Yangon 61.6 88.1 58.1 8.5 41.9 413 Shan 74.6 84.5 71.8 12.7 53.8 371 Ayeyarwady 70.8 82.1 64.9 11.9 66.6 419 Nay Pyi Taw 60.9 88.7 58.0 8.4 66.6 81 Education No education 71.2 79.7 67.8 16.9 52.3 430 Primary 70.9 85.4 65.6 9.3 61.1 1,260 Secondary 71.6 86.0 65.5 7.9 59.6 1,085 More than secondary 76.0 87.8 68.6 4.8 59.6 181 Wealth quintile Lowest 70.3 85.2 66.3 10.8 60.0 627 Second 73.0 87.9 68.7 7.9 58.9 605 Middle 72.8 84.9 66.5 8.8 61.4 603 Fourth 69.8 81.7 63.2 11.6 58.6 590 Highest 71.7 85.0 65.4 8.8 56.6 531 Total 71.5 84.9 66.0 9.6 59.2 2,957 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 256 • Women’s Empowerment Table 15.7.1 Attitude toward wife beating: Women Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Myanmar DHS 2015-16 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Refuses to use contra- ception Involved in too much social activity Number Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 11.2 10.0 17.2 43.4 10.1 52.6 10.1 16.6 1,810 20-24 11.1 8.4 19.1 43.4 8.5 53.4 11.4 16.1 1,867 25-29 12.2 10.7 20.7 42.9 9.5 51.1 9.4 14.5 1,867 30-34 13.1 9.0 22.6 42.1 9.9 52.1 9.5 15.6 2,037 35-39 11.7 10.4 22.0 40.5 11.5 49.3 10.5 13.0 1,954 40-44 16.0 12.4 27.5 43.5 13.0 53.0 10.9 15.4 1,733 45-49 14.1 10.4 22.5 38.2 10.6 46.2 9.7 12.3 1,617 Employment (last 12 months)1 Not employed 11.1 9.6 18.7 39.4 10.2 47.7 11.0 15.3 3,517 Employed for cash 13.2 10.1 22.5 42.9 10.3 52.1 9.9 14.5 8,606 Employed not for cash 15.4 12.7 24.7 45.0 12.1 57.1 10.1 16.1 762 Number of living children 0 11.9 9.8 18.6 41.4 9.1 51.4 9.6 15.2 5,331 1-2 12.3 9.8 22.9 42.0 10.8 50.6 10.5 14.3 4,510 3-4 13.9 10.5 23.3 42.3 11.6 50.9 10.6 14.1 2,279 5+ 17.5 13.9 30.0 46.1 13.5 53.8 11.3 16.4 765 Marital status Never married 11.7 10.2 17.8 41.3 8.7 51.4 8.9 15.6 4,278 Married 13.2 10.1 23.9 42.1 11.0 50.7 10.4 14.4 7,759 Divorced/separated/ widowed 13.7 10.4 20.2 45.2 13.8 54.0 15.2 14.7 848 Residence Urban 9.1 7.3 14.9 35.4 7.4 44.0 7.6 13.8 3,768 Rural 14.2 11.3 24.4 44.8 11.7 54.1 11.3 15.2 9,117 States/Regions Kachin 13.4 9.7 23.3 51.4 9.5 59.7 12.8 14.8 374 Kayah 4.3 5.6 14.9 38.2 4.2 45.4 6.2 7.8 65 Kayin 5.8 8.8 15.2 33.4 6.3 40.5 8.4 8.0 303 Chin 10.6 22.7 32.0 43.9 15.1 55.3 8.7 20.4 102 Sagaing 17.4 11.5 27.9 59.0 10.8 67.8 9.8 13.4 1,410 Tanintharyi 5.4 2.7 11.2 27.6 3.8 32.7 3.4 9.7 283 Bago 14.4 6.3 24.1 36.8 6.6 48.0 9.7 15.3 1,244 Magway 9.2 6.4 16.0 38.5 8.1 45.5 4.8 10.6 1,081 Mandalay 18.6 17.3 40.1 58.9 18.3 69.6 16.2 18.9 1,541 Mon 8.2 6.0 11.4 35.3 6.7 42.4 8.4 13.7 463 Rakhine 12.5 17.1 27.5 50.3 23.4 60.0 22.6 25.8 777 Yangon 5.3 7.1 10.8 23.2 6.1 30.5 6.2 13.3 1,927 Shan 12.3 8.9 13.5 33.0 7.2 44.2 4.7 10.5 1,368 Ayeyarwady 16.1 10.2 20.2 44.7 11.2 54.5 12.9 14.9 1,650 Nay Pyi Taw 20.9 15.4 34.8 58.3 13.2 65.4 16.0 26.7 300 Education2 No education 16.0 14.4 26.3 41.8 14.2 52.1 13.0 15.5 1,606 Primary 16.3 11.5 25.6 45.2 12.4 54.7 11.6 15.7 5,305 Secondary 10.3 8.5 19.3 43.0 8.6 51.9 9.2 14.7 4,646 More than secondary 3.1 5.3 8.4 26.4 4.3 33.4 4.8 10.9 1,325 Wealth quintile Lowest 15.6 12.9 23.8 44.0 13.1 53.2 13.0 16.5 2,274 Second 15.5 11.2 25.3 44.1 12.5 54.2 12.1 15.8 2,408 Middle 13.1 11.1 24.1 45.5 11.0 54.1 10.5 14.6 2,633 Fourth 11.1 9.1 20.8 42.3 9.0 51.5 8.9 14.0 2,702 Highest 9.4 7.2 15.3 35.5 7.3 43.9 7.3 13.6 2,868 Total 12.7 10.1 21.6 42.0 10.4 51.2 10.2 14.8 12,885 1 Total includes one woman with missing information on employment status in the last 12 months. 2 Total includes three women with missing information on education. Women’s Empowerment • 257 Table 15.7.2 Attitude toward wife beating: Men Percentage of all men age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Myanmar DHS 2015-16 Background characteristic Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Refuses to use contra- ception Involved in too much social activity Number Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 10.3 15.6 20.0 47.3 16.3 57.1 15.6 24.9 731 20-24 9.3 13.5 18.2 45.0 12.7 54.5 11.3 25.6 692 25-29 6.1 10.7 11.8 38.4 10.0 46.6 8.0 19.7 677 30-34 7.2 13.4 16.5 41.1 7.7 51.4 8.9 19.0 698 35-39 7.0 9.3 15.9 34.9 7.3 43.7 8.5 21.5 679 40-44 9.1 13.7 14.3 33.3 8.2 41.3 7.8 15.0 689 45-49 7.0 16.7 19.2 37.1 7.4 47.1 7.2 20.5 571 Employment (last 12 months)1 Not employed 7.6 15.4 16.5 40.4 11.9 52.3 9.8 20.8 282 Employed for cash 7.9 12.7 16.3 39.6 9.7 48.4 9.4 20.7 4,123 Employed not for cash 10.1 18.1 19.8 41.1 12.7 53.4 13.3 24.2 332 Number of living children 0 9.4 13.3 17.2 43.0 13.4 52.9 12.0 22.2 2,077 1-2 6.1 12.4 13.8 37.1 7.0 44.9 7.8 20.5 1,669 3-4 9.0 14.6 19.8 38.8 8.7 49.9 8.5 20.5 792 5+ 7.2 13.6 18.8 31.2 6.4 38.8 7.0 13.9 200 Marital status Never married 9.8 14.2 18.1 44.9 15.3 55.4 12.7 22.8 1,646 Married 6.8 12.2 15.2 36.6 7.2 44.8 7.8 19.7 2,957 Divorced/separated/wido wed 13.1 24.1 26.8 45.5 10.3 61.3 17.0 25.1 135 Residence Urban 7.3 10.7 14.3 41.5 11.6 49.5 9.0 26.5 1,350 Rural 8.3 14.2 17.4 39.0 9.5 48.8 10.0 18.7 3,387 States/Regions Kachin 11.2 15.1 14.8 46.0 11.3 59.1 14.8 19.6 161 Kayah 1.1 3.1 4.7 8.5 0.8 14.2 2.3 0.0 23 Kayin 17.2 6.4 6.7 10.8 5.8 32.4 17.4 20.0 115 Chin 11.7 19.2 20.7 41.4 13.5 60.3 12.8 25.5 39 Sagaing 12.6 16.6 17.3 48.3 15.6 58.9 16.2 22.7 514 Tanintharyi 5.4 14.6 15.5 40.8 8.1 48.5 11.2 13.7 103 Bago 11.2 11.7 17.5 41.5 7.7 51.9 12.3 15.6 454 Magway 4.3 15.2 11.2 36.4 5.4 43.6 9.0 19.2 320 Mandalay 13.4 18.0 20.9 50.3 12.7 61.9 13.6 13.4 601 Mon 10.3 18.3 19.0 47.2 16.9 58.5 15.0 19.7 162 Rakhine 9.2 20.1 39.2 61.6 10.5 68.8 9.9 40.9 222 Yangon 2.9 7.3 18.1 48.1 12.1 53.1 4.5 37.2 703 Shan 3.2 16.7 10.5 25.8 8.5 34.5 4.4 20.9 542 Ayeyarwady 5.0 6.2 10.3 19.0 5.2 27.0 5.1 8.5 653 Nay Pyi Taw 12.8 14.9 22.0 52.1 11.4 61.7 12.1 25.4 126 Education No education 6.8 17.8 14.8 29.6 9.5 42.6 8.9 21.1 575 Primary 9.8 12.6 17.8 38.7 9.9 48.2 10.0 19.5 1,684 Secondary 7.8 13.6 17.2 44.4 11.1 53.5 10.5 22.6 2,139 More than secondary 3.5 6.0 9.1 32.6 5.5 34.9 4.8 17.4 339 Wealth quintile Lowest 8.9 13.6 17.9 34.1 9.9 44.1 10.0 16.9 890 Second 8.3 13.0 18.9 41.2 9.2 51.0 10.5 18.5 916 Middle 8.9 14.3 17.1 41.3 10.3 49.5 10.3 21.8 979 Fourth 8.1 13.1 15.5 41.6 10.7 52.3 9.4 23.5 986 Highest 6.1 12.2 13.5 40.0 10.1 47.6 8.4 23.5 966 Total 8.1 13.2 16.5 39.7 10.1 49.0 9.7 21.0 4,737 1 Total includes one man with missing information on employment status in the last 12 months. 258 • Women’s Empowerment Table 15.8 Indicators of women’s empowerment Percentage of currently married women age 15-49 who participate in all decision making and the percentage who disagree with all of the reasons justifying wife beating, by value on each of the indicators of women’s empowerment, Myanmar DHS 2015-16 Empowerment indicator Percentage who participate in all decision making Percentage who disagree with all of the reasons justifying wife beating Number of women Number of decisions in which women participate1 0 na 43.6 404 1-2 na 41.1 2,292 3 na 53.5 5,063 Number of reasons for which wife beating is justified2 0 70.8 na 3,825 1-2 60.8 na 2,908 3-4 58.8 na 874 5 48.4 na 152 na = Not applicable 1 See Table 15.6.1 for the list of decisions. Excludes decision on well-being of children. 2 See Table 15.7.1 for the list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. Table 15.9 Current use of contraception by women’s empowerment Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women’s status, Myanmar DHS 2015-16 Empowerment indicator Any method Any modern method Modern methods Any traditional method Not currently using Total Number of women Female sterili- zation Male sterili- zation Tempo- rary modern female methods1 Male condom Number of decisions in which women participate2 0 44.5 44.4 2.2 0.1 41.3 0.7 0.1 55.5 100.0 404 1-2 51.4 50.2 4.8 0.2 44.0 1.2 1.2 48.6 100.0 2,292 3 53.3 52.3 5.0 0.3 46.1 0.9 1.0 46.7 100.0 5,063 Number of reasons for which wife beating is justified3 0 51.9 50.8 5.0 0.2 44.4 1.2 1.1 48.1 100.0 3,825 1-2 54.6 53.7 4.8 0.4 47.6 0.9 0.9 45.4 100.0 2,908 3-4 48.2 47.4 4.4 0.1 42.3 0.7 0.8 51.8 100.0 874 5 38.1 38.1 0.8 0.0 37.3 0.0 0.0 61.9 100.0 152 Total 52.2 51.3 4.8 0.3 45.2 1.0 1.0 47.8 100.0 7,759 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUD, injectables, implants, female condom, emergency contraception, standard days method, lactational amenorrhea method, and other modern methods 2 See Table 15.6.1 for the list of decisions. Excludes decision on well-being of children. 3 See Table 15.7.1 for the list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. Women’s Empowerment • 259 Table 15.10 Ideal number of children and unmet need for family planning by women’s empowerment Mean ideal number of children for women age 15-49 and percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women’s empowerment, Myanmar DHS 2015-16 Empowerment indicator Mean ideal number of children1 Number of women Percentage of currently married women with an unmet need for family planning2 Number of women For spacing For limiting Total Number of decisions in which women participate3 0 3.0 381 8.1 11.0 19.1 404 1-2 2.9 2,179 5.0 11.4 16.5 2,292 3 2.9 4,860 4.4 11.5 15.9 5,063 Number of reasons for which wife beating is justified4 0 2.5 5,714 5.0 12.0 17.0 3,825 1-2 2.6 4,700 4.5 10.5 15.0 2,908 3-4 2.8 1,262 5.2 11.3 16.5 874 5 2.7 198 3.7 15.0 18.7 152 Total 2.5 11,874 4.8 11.4 16.2 7,759 1 Mean excludes women who gave non-numeric responses. 2 See Table 7.12.1 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 15.6.1 for the list of decisions. Excludes decision on well-being of children. 4 See Table 15.7.1 for the list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. Table 15.11 Reproductive health care by women’s empowerment Percentage of women age 15-49 with a live birth in the 5 years preceding the survey who received antenatal care, delivery assistance, and postnatal care from health personnel for the most recent birth, according to indicators of women’s empowerment, Myanmar DHS 2015-16 Empowerment indicator Percentage receiving antenatal care from a skilled provider1 Percentage receiving delivery care from a skilled provider1 Percentage with a postnatal checkup in the first 2 days after birth2 Number of women with a child born in the last 5 years Number of decisions in which women participate3 0 70.0 47.5 53.8 198 1-2 80.5 62.4 67.7 1,018 3 82.3 66.1 71.1 2,208 Number of reasons for which wife beating is justified4 0 81.2 65.1 70.7 1,761 1-2 81.3 63.9 68.9 1,390 3-4 78.6 56.5 62.5 363 5 65.6 50.7 65.1 69 Total 80.7 63.5 69.1 3,583 1 “Skilled provider” includes doctor, nurse, midwife, or lady health visitor. 2 Includes women who received a postnatal checkup from a doctor, nurse, midwife, lady health visitor, community health worker, or traditional birth attendant in the first 2 days after the birth. Includes women who gave birth in a health facility and those who did not give birth in a health facility. 3 Restricted to currently married women. See Table 15.6.1 for the list of decisions. Excludes decision on well-being of children. 4 See Table 15.7.1 for the list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. 260 • Women’s Empowerment Table 15.12 Early childhood mortality rates by women’s status Infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by indicators of women’s empowerment, Myanmar DHS 2015-16 Empowerment indicator Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Number of decisions in which women participate1 0 (74) (18) (91) 1-2 60 18 77 3 57 12 68 Number of reasons for which wife beating is justified2 0 65 15 79 1-2 51 14 65 3-4 52 13 65 Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. 1 Restricted to currently married women. See Table 15.6.1 for the list of decisions. Excludes decision on well-being of children. 2 See Table 15.7.1 for the list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. Domestic Violence • 261 DOMESTIC VIOLENCE 16 Key Findings  Experience of violence from anyone: Fifteen percent of women have experienced physical violence since age 15, and 3% have ever experienced sexual violence. Three percent of ever-pregnant women report having experienced physical violence during any pregnancy.  Marital control: Seventy-one percent of women have never experienced any marital control behaviors by their husbands, and 5% have experienced at least three types of marital control behaviors.  Spousal violence: Twenty-one percent of ever-married women have experienced spousal violence; the most common type of spousal violence is physical violence (15%), followed by emotional violence (14%). Only 3% of ever-married women have ever experienced spousal sexual violence.  Injuries due to spousal violence: Thirty-seven percent of ever-married women who have experienced spousal violence report suffering physical injuries, including 7% who have had serious injuries such as deep wounds, broken bones, and broken teeth.  Help seeking: Only 22% of women who have experienced physical or sexual violence committed by anyone have sought help to stop the violence, and 37% have never told anyone about the violence. omestic violence is a violation of basic human rights and has documented adverse health, demographic, and economic consequences for women, children, and societies. Women bear the brunt of domestic violence, including the associated health and psychological burdens. Furthermore, women may be socialized to accept, tolerate, or even rationalize domestic violence. The 2015-16 MDHS included a module of questions on women’s experience of domestic violence. The module was implemented in a subsample of half of the interviewed households (the same subsample selected for the male survey). In accordance with the World Health Organization’s guidelines on the ethical collection of information on domestic violence, only one eligible woman per household was randomly selected for the module, and the module was not implemented if privacy could not be obtained (WHO 2001). In total, 4,563 women received the domestic violence questions. Only 1% of women eligible for the domestic violence module could not be successfully interviewed with the module for privacy or other reasons. 16.1 MEASUREMENT OF VIOLENCE In the 2015-16 MDHS, information was obtained from never-married women on their experience of violence committed by anyone and from ever-married women on their experience of violence committed by their current and former husbands and by anyone else. Specifically, violence committed by the current D 262 • Domestic Violence husband (for currently married women) and by the most recent husband (for formerly married women) was measured by asking all ever-married women if their husband ever did the following to them: Physical spousal violence: push you, shake you, or throw something at you; slap you; twist your arm or pull your hair; punch you with his fist or with something that could hurt you; kick you, drag you, or beat you up; try to choke you or burn you on purpose; or threaten or attack you with a knife, gun, or any other weapon Sexual spousal violence: physically force you to have sexual intercourse with him even when you did not want to, physically force you to perform any other sexual acts you did not want to, or force you with threats or in any other way to perform sexual acts you did not want to Emotional spousal violence: say or do something to humiliate you in front of others, threaten to hurt or harm you or someone close to you, or insult you or make you feel bad about yourself In addition, information was obtained from all women (married and unmarried) about physical violence committed by anyone (other than a current or most recent husband) since they were age 15 by asking if anyone had hit, slapped, kicked, or done something else to hurt them physically. Similarly, information was gathered from all women about experiences of sexual violence committed by anyone (other than a current or most recent husband) at any time in their life, as a child or as an adult, by asking if they were forced in any way to have sexual intercourse or perform any other sexual acts when they did not want to. 16.2 EXPERIENCE OF PHYSICAL VIOLENCE FROM ANYONE Physical violence by anyone Percentage of women who have experienced any physical violence (committed by a husband or anyone else) since age 15 and in the 12 months preceding the survey. Sample: Women age 15-49 16.2.1 Prevalence of Physical Violence Fifteen percent of women age 15-49 have experienced physical violence since age 15, and 9% experienced physical violence during the 12 months preceding the survey. Two percent of women reported that they experienced physical violence often in the past 12 months (Table 16.1). Among women age 15-49 who have ever been pregnant, 3% have experienced physical violence from anyone during a pregnancy (Table 16.2). Domestic Violence • 263 Patterns by background characteristics  Divorced/separated/widowed women are more likely to have ever experienced physical violence (33%) than never-married women (9%) and married women (17%) (Figure 16.1).  The likelihood of experiencing physical violence increases with the number of living children. Twenty-eight percent of women with more than five children have experienced physical violence since age 15, as compared with 11% of women who have no living children.  By state and region, Tanintharyi Region and Rakhine State have the highest percentages of women who have ever experienced physical violence (30% and 27%, respectively). Rakhine State also has the highest percentage of ever-pregnant women who have experienced violence during pregnancy (8%).  Women with more than a secondary education are much less likely (6%) than women with a secondary education and those with no education to have experienced physical violence since age 15 (15% and 20%, respectively). Women with no education are six times as likely to have experienced violence during pregnancy as women with more than a secondary education (Figure 16.2).  Women’s likelihood of experiencing physical violence decreases with increasing wealth, from a low of 9% among those in the highest wealth quintile to a high of 23% among those in the lowest quintile. 16.2.2 Perpetrators of Physical Violence Among all women age 15-49 who had experienced physical violence since age 15, more than half (55%) reported their current husband and 19% reported a former husband as the perpetrator (Table 16.3). Sixty-seven percent of ever-married women reported their current husbands as perpetrators of physical violence, and 24% reported former husbands as perpetrators. Among never-married women, nearly all reported perpetrators were family members, including mothers or stepmothers, fathers or stepfathers, and other relatives. Only 1% of women reported that a current or former boyfriend perpetrated violence. Figure 16.1 Women’s experience of violence by marital status Figure 16.2 Violence during pregnancy by education 9 0 17 3 33 10 Percentage who have ever experienced physical violence since age 15 Percentage who have ever experienced sexual violence Never married Married Divorced/separated/widowed 6 4 3 1 3 No education Primary Secondary More than secondary Total Percentage among women age 15-49 who have ever been pregnant 264 • Domestic Violence 16.3 EXPERIENCE OF SEXUAL VIOLENCE Sexual violence Percentage of women who have experienced any sexual violence (committed by a husband or anyone else) ever and in the 12 months preceding the survey. Sample: Women age 15-49 16.3.1 Prevalence of Sexual Violence Three percent of women age 15-49 have ever experienced sexual violence, and 2% experienced sexual violence during the 12 months preceding the survey (Table 16.4). Less than 1% of women first experienced sexual violence before age 18 (data not shown). Patterns by background characteristics  As was the case for physical violence, divorced/separated/widowed women (10%) were more likely to have ever experienced sexual violence than married women (3%) and never-married women (<1%).  Women who have more than five children are more likely to have experienced sexual violence (6%) than women with fewer children (1% to 4%).  The percentage of women who have ever experienced sexual violence ranges from a high of 10% in Kayah State and 9% in Rakhine State to a low of 1% each in Yangon Region and Mandalay Region. Seven percent of women in Rakhine State and 6% of those in Kayah State reported having experienced sexual violence within the past 12 months.  Women’s likelihood of experiencing sexual violence declines with increasing education and wealth; 5% of women with no education and 4% of women in the lowest wealth quintile have ever experienced sexual violence, as compared with 1% each of women with more than a secondary education and women in the highest wealth quintile. 16.3.2 Perpetrators of Sexual Violence Among ever-married women age 15-49 who had experienced sexual violence, 56% reported their current husband and 43% reported a former husband as the perpetrator. One percent of ever-married women reported that strangers were the perpetrators of sexual violence (Table 16.5). The number of never-married women who reported sexual violence was too small to allow an analysis of perpetrators. 16.4 EXPERIENCE OF DIFFERENT FORMS OF VIOLENCE Physical violence and sexual violence may not occur in isolation; rather, women may experience a combination of different forms of violence. In Myanmar, 13% of women have experienced physical violence only, 1% have experienced sexual violence only, and 2% have experienced both physical and sexual violence. Overall, 16% of women age 15-49 have ever experienced physical or sexual violence. There are minimal variations in women’s experience of physical or sexual violence by age; however, women age 18-19 are more likely than those age 15-17 to have experienced such violence (19% versus 13%) (Table 16.6). Domestic Violence • 265 16.5 MARITAL CONTROL Marital control Percentage of women whose current husband (if currently married) or most recent husband (if formerly married) demonstrates at least one of the following controlling behaviors: is jealous or angry if she talks to other men, frequently accuses her of being unfaithful, does not permit her to meet her female friends, tries to limit her contact with her family, and insists on knowing where she is at all times. Sample: Ever-married women age 15-49 One in 20 ever-married women have husbands who have ever displayed at least three types of marital control behaviors. The most common marital control behavior is jealousy or anger if the woman talks to other men, reported by 23% of women. Eleven percent of women report that their husbands insist on knowing where they are at all times. Women less commonly reported that their husbands frequently accuse them of being unfaithful (7%), do not permit them to meet their female friends (6%), or try to limit their contact with their own family (4%) (Table 16.7). Patterns by background characteristics  Most marital control behaviors are more common in the youngest age group: 10% of women age 15- 19 report that their husbands demonstrate three or more marital control behaviors, as compared with 6% of women age 40-49.  A much higher proportion of divorced/separated/widowed women (16%) than currently married women (4%) report having experienced at least three marital control behaviors.  Women’s experience of marital control behaviors varies across states and regions. Ever-married women in Yangon Region are least likely to report that their husbands display at least three marital control behaviors (1%), while women in Kachin State (10%) are most likely to report such behaviors by their husbands.  Women’s experience of at least three marital control behaviors declines with increasing education. However, women with a secondary education are more likely than women in other education categories to report that their husbands are jealous or angry if they talk to other men (31%) and that their husbands insist on knowing where they are at all times (15%). 16.6 SPOUSAL VIOLENCE Spousal violence Percentage of women who have experienced any of the specified acts of physical, sexual, or emotional violence committed by their current husband (if currently married) or most recent husband (if formerly married), ever and in the 12 months preceding the survey. Sample: Ever-married women age 15-49 16.6.1 Prevalence of Spousal Violence More than one-fifth of ever-married women (21%) have experienced spousal physical, sexual, or emotional violence, and 15% experienced such violence in the 12 months preceding the survey (Table 16.8). Fifteen percent of women reported having ever experienced spousal physical violence, and 10% reported having experienced such violence in the past 12 months. Three percent reported that their husbands have 266 • Domestic Violence committed sexual violence, and 2% reported that they experienced sexual violence in the past 12 months. Spousal emotional violence was reported by 14% of women, and 10% reported such violence in the past 12 months. Of the acts of physical violence committed by husbands, women most commonly reported that their husband slapped them (11%) or pushed, shook, or threw something at them (10%). One percent of women reported that their husband tried to choke and burn them on purpose, and 2% reported that their husband had threatened or attacked them with knives, guns, or other weapons. Women reporting sexual violence mostly reported that their husband physically forced them to have sexual intercourse with him when they did not want to. Overall, 12% of women reported that their husband insulted them or made them feel bad about themselves. Women who were married more than once were also asked about spousal violence committed by any other husband. Seventeen percent of women have ever experienced spousal violence committed by any husband: 16% have experienced physical violence, and 4% have experienced sexual violence. During the 12 months preceding the survey, 11% of women experienced physical or sexual violence by any husband, current or previous (Table 16.8 and Table 16.11). Patterns by background characteristics  The prevalence of spousal violence (physical, sexual, or emotional) generally declines with women’s age, from a high of 28% among women age 15-19 to a low of 20% among women age 40-49 (Table 16.9).  Divorced/separated/widowed women report a much higher frequency of spousal violence (42%) than currently married women (19%). This differential is not surprising because spousal violence is one of the major reasons for marriage dissolution.  The prevalence of spousal violence is much higher among women with at least five children (32%) than among women with 0-4 children (19- 21%).  Spousal violence is most prevalent in Rakhine State (41%) and Tanintharyi Region (40%) and least prevalent in Yangon Region and Mandalay Region (12% each) (Figure 16.3).  Women’s education is inversely correlated with the likelihood of spousal violence. Women with no education are more likely to have ever experienced physical, sexual, or emotional violence (24%) than women with more than a secondary education (13%). The prevalence of spousal violence also declines with increasing household wealth. Figure 16.3 Spousal violence by states and regions Percentage of ever-married women age 15-49 who have ever experienced physical, sexual, or emotional violence committed by their husband Domestic Violence • 267 Patterns by husband’s characteristics and empowerment indicators  Husbands who have more than a secondary education (13%) are less likely to commit spousal violence than husbands with less education (20-22%) (Table 16.10). Notably, variations in spousal violence are somewhat greater by women’s own education than by the education of their husband.  Experience of spousal violence varies greatly with the level of husbands’ alcohol consumption. Nearly half of women whose husbands are often drunk have experienced spousal violence, as compared with 12% of women whose husbands do not drink alcohol (Figure 16.4).  The likelihood of experiencing spousal violence increases sharply with the number of marital control behaviors displayed by husbands: more than 70% of women whose husbands display three or more marital control behaviors have ever experienced spousal violence, compared with 13% of women whose husbands do not display any marital control behaviors.  Women who participate in household decision making and who do not agree with any reason for wife beating have a much lower prevalence of spousal violence than women who participate in no household decisions and women who agree with most reasons for wife beating (a difference of about 9 percentage points for each).  Intergenerational effects of spousal violence are evident in Myanmar. Women who report that their fathers beat their mothers are twice as likely (35%) to have themselves experienced spousal violence than women who report that their fathers did not beat their mothers (17%).  Women’s fear of their husband and spousal violence are correlated. Women who say that they are afraid of their husband most of the time are most likely to have ever experienced spousal violence (81%), followed by women who are only sometimes afraid of their husbands (34%). By contrast, only 14% of women who say that they are never afraid of their husband have experienced spousal violence. 16.6.2 Onset of Spousal Violence Table 16.12 shows when spousal violence first occurred in relation to the start of marriage among women married only once. Among currently married women age 15-49 who have been married only once, 5% first experienced spousal violence within the first 2 years of marriage and 12% by 10 years of marriage. 16.7 INJURIES DUE TO SPOUSAL VIOLENCE Injuries due to spousal violence Percentage of women who have the following types of injuries from spousal violence: cuts, bruises, or aches; eye injuries, sprains, dislocations, or burns; or deep wounds, broken bones, broken teeth, or any other serious injury. Sample: Ever-married women age 15-49 who have experienced physical or sexual violence committed by their current husband (if currently married) or their most recent husband (if formerly married) Figure 16.4 Spousal violence by husband’s alcohol consumption 12 27 23 49 Does not drink Drinks/never gets drunk Gets drunk sometimes Gets drunk very often Percentage of ever-married women who have ever experienced spousal (physical, sexual, or emotional) violence 268 • Domestic Violence Among ever-married women who have experienced any spousal physical or sexual violence, 37% have ever sustained an injury. The percentage who have been injured is slightly higher (39%) among women who experienced physical or sexual violence in the past 12 months (Table 16.13). Cuts, bruises, or aches are the most common types of injuries (31%) reported by women who have experienced spousal physical or sexual violence. Nonetheless, a significant proportion of women who have experienced spousal violence also report having eye injuries, sprains, dislocations, or burns (16%) and more serious injuries such as deep wounds, broken bones, and broken teeth (7%). 16.8 VIOLENCE INITIATED BY WOMEN AGAINST HUSBANDS In Myanmar, 8% of ever-married women have ever committed physical violence against their current or most recent husband when he was not already beating or physically hurting them. Six percent reported that they initiated violence within the past 12 months (Table 16.14 and Table 16.15). Patterns by background characteristics  Women who have themselves experienced spousal violence are much more likely than women who have not to have ever initiated violence against their husbands. Twenty-three percent of women who have experienced spousal violence also perpetrated such violence, as compared with 6% who have never experienced spousal violence.  By state and region, the proportion of women who have ever initiated violence against their husbands ranges from 2% in Yangon Region to 18-19% in Tanintharyi Region and Kayin State.  Women who do not participate in decision making are less likely to initiate violence (4%) than women who participate in decision making (9%).  Initiation of violence by women is more common among those who report that their father beat their mother (16%) than among those with no such history (7%). 16.9 RESPONSE TO VIOLENCE 16.9.1 Help-seeking Behavior to Stop the Violence In Myanmar, less than one-fourth (22%) of women age 15-49 who have experienced physical or sexual violence from anyone have ever sought help from anyone, and more than one-third (37%) have never sought help or told anyone about the violence (Table 16.16). Among women who have ever experienced sexual violence, 7 out of 10 have never sought help and never told anyone. Women who have faced both physical and sexual violence are more likely to seek help to stop the violence (28%) (Figure 16.5). Patterns by background characteristics  Help seeking is substantially lower among women age 15-19; only 8% in this age group have ever sought help to stop the violence, as compared with 22-29% in other age groups.  Help seeking in response to violence is less common among rural than urban women; 19% of rural women have ever sought help, compared with 32% of urban women. Figure 16.5 Help seeking by type of violence experienced 21 22 28 Physical only Sexual only Physical and sexual Percentage of women age 15-49 who have experienced physical or sexual violence and sought help Domestic Violence • 269  Women in Kayin State who have experienced violence are most likely to seek help (42%), whereas women in Rakhine State are least likely to do so (9%).  Women’s likelihood of seeking help increases with increasing education and is highest among those in the wealthiest households (32%). 16.9.2 Sources for Help Among women who have experienced physical or sexual violence and sought help, the most common source for help was their own family (53%). The second most common source was neighbors (27%). Only 1% of women sought help from the police. Three percent each sought help from a lawyer and a social work organization (Table 16.17). LIST OF TABLES For more information on domestic violence, see the following tables:  Table 16.1 Experience of physical violence  Table 16.2 Experience of violence during pregnancy  Table 16.3 Persons committing physical violence  Table 16.4 Experience of sexual violence  Table 16.5 Persons committing sexual violence  Table 16.6 Experience of different forms of violence  Table 16.7 Marital control exercised by husbands  Table 16.8 Forms of spousal violence  Table 16.9 Spousal violence by background characteristics  Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators  Table 16.11 Physical or sexual violence in the past 12 months by any husband  Table 16.12 Experience of spousal violence by duration of marriage  Table 16.13 Injuries to women due to spousal violence  Table 16.14 Women’s violence against their spouse by background characteristics  Table 16.15 Women’s violence against their spouse by husband’s characteristics and empowerment indicators  Table 16.16 Help seeking to stop violence  Table 16.17 Sources for help to stop the violence 270 • Domestic Violence Table 16.1 Experience of physical violence Percentage of women age 15-49 who have experienced physical violence since age 15 and percentage who experienced physical violence during the 12 months preceding the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage who have experienced physical violence since age 151 Percentage who experienced physical violence in the past 12 months Number of women Often Sometimes Often or sometimes2 Age 15-19 15.0 1.0 8.9 10.0 632 20-24 13.4 1.8 6.6 8.4 694 25-29 16.0 3.2 7.4 10.6 658 30-39 15.7 1.7 7.0 8.7 1,414 40-49 15.9 1.5 5.1 6.6 1,132 Marital status Never married 8.7 0.3 3.9 4.2 1,471 Married 17.0 2.2 8.0 10.3 2,750 Divorced/separated/ widowed 32.9 4.8 9.5 14.3 309 Number of living children 0 10.7 0.9 5.4 6.3 1,836 1-2 17.4 2.4 7.3 9.8 1,631 3-4 17.7 2.0 7.3 9.2 804 5+ 28.4 4.0 11.4 15.4 260 Employment Employed for cash 15.5 1.6 7.0 8.6 2,998 Employed not for cash 13.0 2.5 5.8 8.4 306 Not employed 15.6 2.2 6.5 8.7 1,227 Residence Urban 12.9 2.1 5.1 7.2 1,300 Rural 16.4 1.7 7.5 9.1 3,230 States/Regions Kachin 23.9 2.1 16.3 18.4 128 Kayah 12.4 0.8 5.2 5.9 24 Kayin 18.2 1.9 6.0 8.0 114 Chin 12.6 0.6 6.0 6.6 35 Sagaing 17.3 1.9 7.6 9.5 527 Tanintharyi 29.8 3.2 8.6 11.8 95 Bago 14.7 2.3 7.8 10.1 462 Magway 18.0 1.4 11.4 12.8 380 Mandalay 9.1 0.4 2.7 3.1 550 Mon 16.1 1.3 5.3 6.9 159 Rakhine 26.8 2.8 14.0 16.8 267 Yangon 8.4 1.3 2.7 3.9 664 Shan 10.0 1.2 4.9 6.1 444 Ayeyarwady 19.5 3.4 6.9 10.3 574 Nay Pyi Taw 20.7 1.8 8.8 10.6 108 Education3 No education 20.4 1.6 8.1 9.7 534 Primary 16.6 2.4 6.7 9.1 1,865 Secondary 14.7 1.7 7.4 9.1 1,693 More than secondary 6.4 0.0 3.1 3.1 435 Wealth quintile Lowest 22.6 2.7 11.7 14.4 825 Second 18.4 2.3 7.9 10.3 854 Middle 15.2 1.6 5.6 7.2 924 Fourth 12.7 1.0 6.4 7.4 915 Highest 9.4 1.5 3.3 4.8 1,012 Total 15.4 1.8 6.8 8.6 4,530 1 Includes violence in the past 12 months. For women who were married before age 15 and who reported physical violence by a spouse, the violence could have occurred before age 15. 2 Includes women for whom frequency in the past 12 months is not known 3 Total includes two women with missing information on education. Domestic Violence • 271 Table 16.2 Experience of 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, Myanmar DHS 2015-16 Background characteristic Percentage who experienced violence during pregnancy Number of women who have ever been pregnant Age 15-19 (2.4) 41 20-24 5.1 263 25-29 3.6 429 30-39 2.7 1,120 40-49 3.7 943 Marital status Never married * 0 Married 2.8 2,534 Divorced/separated/widowed 9.0 262 Number of living children 0 5.3 103 1-2 2.3 1,631 3-4 3.8 804 5+ 8.4 260 Residence Urban 3.3 723 Rural 3.4 2,074 States/Regions Kachin 5.9 89 Kayah 3.3 15 Kayin 5.6 85 Chin 4.5 24 Sagaing 3.0 308 Tanintharyi 4.0 58 Bago 2.5 287 Magway 4.6 234 Mandalay 2.4 308 Mon 2.6 93 Rakhine 7.5 172 Yangon 1.0 368 Shan 0.9 295 Ayeyarwady 5.4 391 Nay Pyi Taw 5.0 70 Education1 No education 5.5 434 Primary 3.6 1,370 Secondary 2.5 790 More than secondary 0.8 200 Wealth quintile Lowest 4.8 618 Second 4.5 594 Middle 3.9 543 Fourth 1.7 521 Highest 1.6 521 Total 3.4 2,797 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes two women with missing information on education. 272 • Domestic Violence Table 16.3 Persons committing physical violence Among women age 15-49 who have experienced physical violence since age 15, percentage who report specific persons who committed the violence, according to the respondent’s current marital status, Myanmar DHS 2015-16 Person Marital status Total Ever married Never married Current husband 66.8 na 54.5 Former husband 23.6 na 19.2 Father/stepfather 6.0 33.8 11.1 Mother/stepmother 3.3 43.6 10.7 Sister/brother 4.4 17.8 6.9 Current boyfriend/former boyfriend 1.1 0.7 1.0 Other relatives 12.4 16.1 13.1 Other 0.9 6.0 1.9 Number of women who have experienced physical violence since age 15 568 128 696 Note: Women can report more than one person who committed the violence. na = Not applicable Domestic Violence • 273 Table 16.4 Experience of sexual violence Percentage of women age 15-49 who have ever experienced sexual violence and percentage who experienced sexual violence in the 12 months preceding the survey, by background characteristics, Myanmar DHS 2015-16 Percentage who have experienced sexual violence: Background characteristic Ever1 Past 12 months Number of women Age 15-19 1.0 0.7 632 20-24 3.1 1.9 694 25-29 3.2 2.4 658 30-39 2.1 1.3 1,414 40-49 3.8 1.6 1,132 Marital status Never married 0.4 0.0 1,471 Married 3.1 2.1 2,750 Divorced/separated/ widowed 9.9 4.0 309 Employment Employed for cash 2.7 1.6 2,998 Employed not for cash 2.0 0.8 306 Not employed 2.9 1.6 1,227 Number of living children 0 1.0 0.5 1,836 1-2 3.5 2.3 1,631 3-4 3.9 1.7 804 5+ 6.2 3.2 260 Residence Urban 2.9 1.5 1,300 Rural 2.6 1.5 3,230 States/Regions Kachin 4.5 1.6 128 Kayah 9.7 5.6 24 Kayin 3.2 0.8 114 Chin 4.6 1.4 35 Sagaing 2.5 1.0 527 Tanintharyi 7.6 4.7 95 Bago 1.7 1.4 462 Magway 1.7 1.7 380 Mandalay 1.0 0.2 550 Mon 2.6 1.6 159 Rakhine 8.6 7.1 267 Yangon 0.6 0.2 664 Shan 3.5 2.3 444 Ayeyarwady 3.3 1.2 574 Nay Pyi Taw 2.6 1.1 108 Education2 No education 4.7 1.9 534 Primary 3.0 2.0 1,865 Secondary 2.1 1.2 1,693 More than secondary 0.9 0.3 435 Wealth quintile Lowest 3.9 2.5 825 Second 3.4 2.2 854 Middle 3.6 1.5 924 Fourth 1.9 1.2 915 Highest 0.9 0.5 1,012 Total 2.7 1.5 4,530 1 Includes violence in the past 12 months 2 Total includes two women with missing information on education. 274 • Domestic Violence Table 16.5 Persons committing sexual violence Among women age 15-49 who have experienced sexual violence, percentage who report specific persons who committed the violence, according to the respondent’s current marital status, Myanmar DHS 2015- 16 Marital status Person Ever married Never married Total Current husband 55.5 na 53.0 Former husband 42.6 na 40.7 Current/former boyfriend 5.4 * 6.3 Father/stepfather 2.3 * 2.2 Brother/stepbrother 0.0 * 0.1 Other relative 2.4 * 4.5 In-law 0.1 na 0.1 Own friend/acquaintance 2.3 * 2.3 Family friend 0.0 * 0.2 Employer/someone at work 1.6 * 1.5 Stranger 1.1 * 1.2 Missing 0.1 * 0.8 Number of women who have experienced sexual violence 116 6 122 Note: Women can report more than one person who committed the violence. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable Table 16.6 Experience of different forms of violence Percentage of women age 15-49 who have ever experienced different forms of violence, by current age, Myanmar DHS 2015-16 Age Physical violence only Sexual violence only Physical and sexual violence Physical or sexual violence Number of women 15-19 14.5 0.5 0.5 15.5 632 15-17 13.1 0.4 0.0 13.4 389 18-19 16.7 0.8 1.3 18.8 243 20-24 12.1 1.8 1.3 15.2 694 25-29 13.5 0.6 2.5 16.7 658 30-39 14.2 0.5 1.6 16.3 1,414 40-49 12.7 0.6 3.3 16.5 1,132 Total 13.4 0.7 1.9 16.1 4,530 Domestic Violence • 275 Table 16.7 Marital control exercised by husbands Percentage of ever-married women age 15-49 whose husbands have ever demonstrated specific types of controlling behaviors, by background characteristics, Myanmar DHS 2015-16 Percentage of women whose husband: Background characteristic Is jealous or angry if she talks to other men Frequently accuses her of being unfaithful Does not permit her to meet her female friends Tries to limit her contact with her family Insists on knowing where she is at all times Displays 3 or more of the specific behaviors Displays none of the specific behaviors Number of ever- married women Age 15-19 30.8 10.6 11.6 8.4 14.9 10.4 67.9 91 20-24 31.0 7.6 7.7 5.4 14.5 7.0 60.8 337 25-29 27.0 6.6 9.0 5.8 11.7 5.7 64.2 486 30-39 20.6 5.7 5.1 2.8 12.8 4.4 72.0 1,171 40-49 18.7 7.6 5.3 2.9 7.6 5.6 76.8 973 Marital status Married 21.2 5.7 5.0 2.5 10.8 4.3 72.2 2,750 Divorced/separated/ widowed 33.9 16.4 17.3 14.9 15.1 15.5 59.4 309 Number of living children 0 33.1 6.1 10.6 6.5 14.2 6.3 61.6 365 1-2 22.2 6.7 5.4 3.3 11.2 5.0 71.1 1,631 3-4 17.4 6.1 5.2 3.8 11.1 4.5 74.4 804 5+ 24.8 10.4 8.9 3.0 7.7 9.6 72.0 260 Employment Employed for cash 21.9 6.9 6.5 3.8 11.2 5.6 71.1 2,030 Employed not for cash 23.0 6.1 9.1 5.5 11.6 5.2 71.5 166 Not employed 23.8 6.8 5.2 3.3 11.1 5.1 70.5 863 Residence Urban 27.7 6.6 8.3 4.1 13.5 6.9 64.6 796 Rural 20.6 6.9 5.6 3.6 10.4 4.9 73.2 2,262 States/Regions Kachin 25.3 5.9 11.5 6.8 22.5 10.2 61.4 91 Kayah 32.3 12.6 12.4 4.8 24.4 7.9 52.4 15 Kayin 24.1 8.6 2.8 2.5 11.5 4.9 69.7 88 Chin 19.8 9.7 7.9 4.5 8.1 8.2 76.0 25 Sagaing 21.5 8.4 8.8 4.8 7.2 5.8 73.4 324 Tanintharyi 28.0 12.5 4.8 2.0 17.8 6.3 62.6 62 Bago 28.6 5.7 5.5 5.6 16.1 5.0 62.9 330 Magway 19.0 9.9 5.8 3.4 9.2 7.4 77.2 252 Mandalay 23.0 4.0 3.6 2.9 5.9 2.9 72.4 339 Mon 28.9 12.4 4.1 2.9 12.4 6.5 65.9 104 Rakhine 26.5 10.7 7.4 7.2 9.1 7.2 66.7 191 Yangon 16.2 2.4 3.4 0.0 7.4 1.4 79.0 414 Shan 21.7 5.6 5.0 2.9 14.2 5.3 71.5 325 Ayeyarwady 21.7 7.6 10.3 5.2 14.0 8.3 69.3 416 Nay Pyi Taw 21.2 6.9 8.1 4.1 12.7 4.6 70.7 79 Education1 No education 17.1 8.5 7.4 3.8 7.6 6.0 76.6 467 Primary 19.1 7.1 5.5 3.4 10.3 5.5 75.0 1,470 Secondary 31.1 6.8 7.3 5.1 14.9 6.1 61.3 897 More than secondary 21.4 1.4 4.3 0.9 9.6 1.5 70.8 222 Wealth quintile Lowest 20.6 8.8 6.6 2.9 10.3 6.3 72.9 674 Second 24.7 8.2 7.4 5.3 12.3 6.0 69.0 629 Middle 17.5 6.3 5.9 3.3 9.9 5.6 76.5 605 Fourth 25.5 6.0 5.1 4.2 10.2 4.7 68.2 576 Highest 24.4 4.4 6.2 3.2 13.5 4.4 67.7 575 Woman afraid of husband2 Afraid most of the time 60.1 29.8 30.0 33.5 27.0 33.9 32.5 111 Sometimes afraid 29.4 11.8 9.0 5.1 14.6 8.7 62.7 657 Never afraid 18.7 4.3 4.3 1.9 9.5 3.1 75.2 2,289 Total 22.5 6.8 6.3 3.8 11.2 5.4 70.9 3,059 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Total includes two women with missing information on education. 2 Total includes two women with missing information on whether they are afraid of their husband. 276 • Domestic Violence Table 16.8 Forms of spousal violence Percentage of ever-married women age 15-49 who have experienced various forms of violence ever or in the 12 months preceding the survey committed by their husband, Myanmar DHS 2015-16 In the past 12 months Type of violence Ever Often Sometimes Often or sometimes Physical violence Any physical violence 15.4 2.4 7.8 10.2 Pushed her, shook her, or threw something at her 9.6 1.5 5.0 6.5 Slapped her 11.0 1.3 5.8 7.0 Twisted her arm or pulled her hair 4.1 0.6 1.9 2.5 Punched her with his fist or with something that could hurt her 6.0 1.1 2.8 3.9 Kicked her, dragged her, or beat her up 3.6 0.6 1.7 2.3 Tried to choke her or burn her on purpose 0.8 0.2 0.4 0.6 Threatened her or attacked her with a knife, gun, or other weapon 1.6 0.2 0.9 1.1 Sexual violence Any sexual violence 3.0 0.6 1.6 2.2 Physically forced her to have sexual intercourse with him when she did not want to 2.9 0.5 1.5 2.1 Physically forced her to perform any other sexual acts she did not want to 1.0 0.3 0.4 0.7 Forced her with threats or in any other way to perform sexual acts she did not want to 0.5 0.1 0.2 0.2 Emotional violence Any emotional violence 13.5 3.9 6.3 10.2 Said or did something to humiliate her in front of others 6.2 1.6 2.6 4.3 Threatened to hurt or harm her or someone she cared about 3.5 0.9 1.7 2.6 Insulted her or made her feel bad about herself 11.6 3.4 5.5 8.9 Any form of physical and/or sexual violence 16.3 2.7 8.3 11.0 Any form of emotional and/or physical and/or sexual violence 20.9 5.1 9.9 15.0 Spousal violence committed by any husband Physical violence 16.3 na na 10.2 Sexual violence 3.5 na na 2.2 Physical and/or sexual violence 17.3 na na 11.0 Number of ever-married women 3,059 3,059 3,059 3,059 na = Not applicable Domestic Violence • 277 Table 16.9 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, by background characteristics, Myanmar DHS 2015-16 Background characteristic Emotional violence Physical violence Sexual violence Physical and sexual Physical and sexual and emotional Physical or sexual Physical or sexual or emotional Number of ever- married women Age 15-19 19.0 22.5 5.0 3.6 3.6 24.0 28.1 91 20-24 12.1 15.7 3.7 1.7 1.5 17.8 20.6 337 25-29 16.8 16.7 3.1 2.4 1.9 17.5 24.0 486 30-39 12.3 14.9 2.0 1.3 1.0 15.6 20.1 1,171 40-49 13.4 14.6 3.5 2.8 2.8 15.4 19.6 973 Marital status Married 10.9 13.7 2.3 1.5 1.2 14.5 18.5 2,750 Divorced/separated/ widowed 36.7 30.8 8.5 7.1 7.1 32.2 42.2 309 Number of living children 0 14.0 16.5 2.6 1.9 1.9 17.2 21.4 365 1-2 12.7 13.8 2.7 1.8 1.5 14.8 19.3 1,631 3-4 12.0 15.1 2.8 2.0 1.9 15.9 20.3 804 5+ 22.5 24.7 5.9 4.2 3.7 26.4 31.8 260 Employment Employed for cash 14.7 16.2 3.1 2.2 2.0 17.1 22.3 2,030 Employed not for cash 15.0 16.5 1.5 0.5 0.5 17.4 20.5 166 Not employed 10.4 13.4 3.0 2.1 1.7 14.3 17.4 863 Residence Urban 13.7 13.6 3.2 2.5 2.4 14.3 19.1 796 Rural 13.5 16.0 2.9 1.9 1.6 17.0 21.5 2,262 States/Regions Kachin 17.1 24.4 2.2 1.6 1.6 25.0 32.0 91 Kayah 25.3 12.7 10.9 5.0 5.0 18.5 28.8 15 Kayin 22.5 18.7 3.7 3.5 3.1 19.0 26.4 88 Chin 14.3 10.7 2.2 1.5 1.5 11.5 18.9 25 Sagaing 16.3 19.4 3.5 2.7 2.4 20.2 25.2 324 Tanintharyi 27.7 28.7 11.1 6.2 5.3 33.7 39.9 62 Bago 10.4 15.1 1.2 0.9 0.9 15.4 18.6 330 Magway 13.0 21.2 2.5 2.5 2.5 21.2 24.1 252 Mandalay 8.6 7.1 0.3 0.3 0.3 7.1 12.2 339 Mon 19.5 12.8 3.6 2.4 2.4 13.9 23.7 104 Rakhine 25.1 31.3 11.5 7.0 5.1 35.8 41.1 191 Yangon 6.2 9.3 0.9 0.6 0.6 9.7 11.7 414 Shan 12.9 7.7 3.1 1.6 1.6 9.2 15.4 325 Ayeyarwady 13.3 16.0 3.0 2.4 2.1 16.7 19.8 416 Nay Pyi Taw 16.6 20.4 1.4 0.4 0.4 21.5 27.8 79 Education1 No education 17.4 17.1 3.9 3.2 3.1 17.8 23.5 467 Primary 13.1 16.5 3.1 2.0 1.6 17.5 22.0 1,470 Secondary 13.5 14.9 2.8 1.9 1.8 15.9 19.5 897 More than secondary 8.6 6.8 1.0 0.3 0.3 7.5 13.3 222 Wealth quintile Lowest 16.9 21.7 3.7 2.4 2.2 23.1 28.5 674 Second 16.5 18.2 4.0 3.0 2.5 19.2 23.6 629 Middle 11.5 14.7 3.9 2.9 2.6 15.7 18.9 605 Fourth 11.1 11.3 1.7 1.1 1.0 11.9 16.4 576 Highest 10.9 9.9 1.2 0.7 0.7 10.4 15.3 575 Total 13.5 15.4 3.0 2.0 1.8 16.3 20.9 3,059 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Total includes two women with missing information on education. 278 • Domestic Violence Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators Percentage of ever-married women age15-49 who have ever experienced emotional, physical, or sexual violence committed by their husband, by husband’s characteristics and empowerment indicators, Myanmar DHS 2015-16 Background characteristic Emotional violence Physical violence Sexual violence Physical and sexual Physical and sexual and emotional Physical or sexual Physical or sexual or emotional Number of ever- married women Husband’s education1 No education 15.4 14.9 4.0 2.9 2.8 16.0 21.9 482 Primary 13.7 16.5 3.1 2.1 1.8 17.5 21.9 1,229 Secondary 13.3 15.3 3.0 2.0 1.8 16.2 20.4 1,101 More than secondary 10.5 8.9 0.1 0.0 0.0 9.0 12.8 177 Husband’s alcohol consumption Does not drink alcohol 6.7 9.4 1.7 1.0 0.9 10.1 12.2 1,627 Drinks alcohol but is never drunk 21.9 16.2 1.9 0.0 0.0 18.0 26.9 63 Is sometimes drunk 13.4 15.9 2.8 1.3 1.0 17.4 23.2 964 Is often drunk 39.8 38.3 8.6 8.0 7.8 38.9 49.1 404 Spousal education difference2 Husband has more education 14.4 16.2 3.4 2.4 1.9 17.3 22.0 1,232 Wife has more education 13.2 14.5 2.7 1.6 1.6 15.5 20.3 977 Both have equal education 11.4 14.8 2.0 1.4 1.4 15.4 18.8 549 Neither has any education 17.0 16.0 4.6 4.1 3.9 16.5 22.0 229 Spousal age difference3 Wife older 10.7 9.9 2.4 1.0 1.0 11.3 15.5 602 Wife is same age 12.5 15.1 1.4 1.4 1.4 15.1 20.8 320 Wife 1-4 years younger 11.4 14.5 2.1 1.1 0.9 15.5 19.5 1,014 Wife 5-9 years younger 9.4 14.6 3.0 2.2 1.9 15.5 18.1 546 Wife 10 or more years younger 10.9 15.5 2.9 2.7 1.6 15.7 18.9 268 Number of marital control behaviors displayed by husband4 0 6.4 9.1 1.0 0.5 0.3 9.6 12.6 2,170 1-2 22.9 23.5 4.4 2.8 2.4 25.1 33.2 723 3-4 65.2 62.3 21.4 18.1 17.1 65.6 74.8 133 5 (71.8) (66.7) (29.7) (25.5) (25.5) (70.9) (72.0) 33 Number of decisions in which women participate5 0 12.0 20.2 6.5 5.8 3.5 20.9 25.3 122 1-2 12.8 15.8 2.6 1.7 1.6 16.6 21.4 845 3 10.0 12.2 1.9 1.1 0.9 13.1 16.6 1,782 Number of reasons for which wife beating is justified6 0 11.8 13.1 2.3 1.6 1.6 13.7 17.8 1,493 1-2 16.2 18.0 3.7 2.6 2.2 19.0 24.0 1,151 3-4 11.5 16.0 3.3 1.8 1.6 17.6 22.3 342 5 16.4 19.7 3.2 2.4 2.4 20.5 26.8 73 Woman’s father beat her mother Yes 24.2 27.4 5.8 4.4 4.3 28.8 35.2 552 No 10.7 12.3 2.2 1.3 1.0 13.1 17.2 2,360 Don’t know 19.0 20.6 5.6 5.3 5.3 20.9 26.4 147 Woman afraid of husband7 Afraid most of the time 67.8 63.8 23.2 19.5 17.9 67.5 80.7 111 Sometimes afraid 22.4 27.2 4.9 3.2 2.7 28.8 34.4 657 Never afraid 8.4 9.7 1.4 0.9 0.8 10.3 14.1 2,289 Total 13.5 15.4 3.0 2.0 1.8 16.3 20.9 3,059 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. Figures in parentheses are based on 25-49 unweighted cases. 1 Total includes 69 women with missing information on husband’s education. 2 Total includes 69 women with missing information on husband’s education and two women with missing information on their education. 3 Includes only currently married women 4 According to the wife’s report. See Table 16.7 for list of behaviors. 5 According to the wife’s report. See Table 15.6.1 for list of decisions. Excludes decision on well-being of children. Includes only currently married women. 6 According to the wife’s report. See Table 15.7.1 for list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. 7 Total includes two women with missing information on whether they are afraid of their husband. Domestic Violence • 279 Table 16.11 Physical or sexual violence in the past 12 months by any husband Percentage of ever-married women who experienced physical or sexual violence by any husband in the past 12 months, by background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage of women who experienced physical or sexual violence in the past 12 months from any husband Number of ever- married women Age 15-19 21.8 91 20-24 14.0 337 25-29 13.3 486 30-39 10.8 1,171 40-49 8.2 973 Marital status Married 10.7 2,750 Divorced/separated/ widowed 14.1 309 Number of living children 0 14.5 365 1-2 10.0 1,631 3-4 9.8 804 5+ 16.9 260 Employment Employed for cash 11.4 2,030 Employed not for cash 13.4 166 Not employed 9.8 863 Residence Urban 8.9 796 Rural 11.8 2,262 States/Regions Kachin 22.5 91 Kayah 12.2 15 Kayin 9.9 88 Chin 8.0 25 Sagaing 13.2 324 Tanintharyi 17.3 62 Bago 11.2 330 Magway 14.7 252 Mandalay 3.2 339 Mon 9.3 104 Rakhine 26.5 191 Yangon 5.0 414 Shan 7.4 325 Ayeyarwady 11.9 416 Nay Pyi Taw 14.8 79 Education1 No education 10.8 467 Primary 11.8 1,470 Secondary 11.7 897 More than secondary 4.0 222 Wealth quintile Lowest 16.8 674 Second 12.9 629 Middle 10.0 605 Fourth 7.4 576 Highest 7.0 575 Woman afraid of husband2 Afraid most of the time 48.9 111 Sometimes afraid 19.1 657 Never afraid 6.9 2,289 Total 11.0 3,059 Note: Any husband includes all current, most recent, and former husbands. 1 Total includes two women with missing information on education. 2 Total includes two women with missing information on whether they are afraid of their husband. 280 • Domestic Violence Table 16.12 Experience of spousal violence by duration of marriage Among currently married women age 15-49 who have been married only once, the percentage who first experienced physical or sexual violence committed by their current husband by specific exact years since marriage, according to marital duration, Myanmar DHS 2015-16 Percentage who first experienced spousal physical or sexual violence by exact marital duration: Percentage who have not experienced spousal sexual or physical violence Number of currently married women who have been married only once Duration of marriage Before marriage 2 years 5 years 10 years Years since marriage <2 0.7 na na na 89.4 193 2-4 1.5 9.4 na na 86.7 325 5-9 0.5 4.8 12.0 na 85.7 533 10+ 0.2 4.1 9.5 11.6 85.4 1,551 Total 0.5 5.4 10.6 12.3 85.9 2,602 na = Not applicable Table 16.13 Injuries to women due to spousal violence Percentage of ever-married women age 15-49 who have experienced specific types of spousal violence by types of injuries resulting from the violence, according to the type of violence and whether they experienced the violence ever and in the 12 months preceding the survey, Myanmar DHS 2015-16 Type of violence Cuts, bruises, or aches Eye injuries, sprains, dislocations, or burns Deep wounds, broken bones, broken teeth, or any other serious injury Any of these injuries Number of ever-married women who have ever experienced any physical or sexual violence Experienced physical violence1 Ever2 32.7 16.5 7.5 38.3 471 Past 12 months 35.6 19.2 8.5 41.1 312 Experienced sexual violence Ever2 32.1 21.9 11.4 38.9 91 Past 12 months 31.3 18.3 13.5 32.7 66 Experienced physical or sexual violence1 Ever2 31.2 15.6 7.2 36.6 499 Past 12 months 33.5 17.7 8.0 38.7 337 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Excludes women who reported violence only in response to a direct question on violence during pregnancy 2 Includes in the past 12 months Domestic Violence • 281 Table 16.14 Women’s violence against their spouse by background characteristics Percentage of ever-married women age 15-49 who have committed physical violence against their current or most recent husband when he was not already beating or physically hurting them, ever and in the past 12 months, according to women’s own experience of spousal violence and background characteristics, Myanmar DHS 2015-16 Percentage who have committed physical violence against their husband Number of ever- married women Background characteristic Ever1 Past 12 months Woman’s experience of spousal physical violence Ever1 22.6 14.7 471 In the past 12 months 24.7 20.6 312 Never 5.8 4.2 2,587 Age 15-19 7.7 7.7 91 20-24 7.5 5.9 337 25-29 10.0 7.4 486 30-39 7.9 5.5 1,171 40-49 8.6 5.4 973 Marital status Married 8.3 6.2 2,750 Divorced/separated/widowed 9.0 3.1 309 Employment Employed for cash 8.5 5.8 2,030 Employed not for cash 7.0 4.5 166 Not employed 8.5 6.3 863 Number of living children 0 7.3 5.9 365 1-2 8.2 5.8 1,631 3-4 8.0 5.5 804 5+ 12.4 7.2 260 Residence Urban 7.8 5.6 796 Rural 8.6 5.9 2,262 States/Regions Kachin 11.7 11.4 91 Kayah 4.4 2.8 15 Kayin 19.3 13.3 88 Chin 4.6 3.9 25 Sagaing 10.1 6.4 324 Tanintharyi 18.0 7.6 62 Bago 5.7 2.0 330 Magway 8.2 6.6 252 Mandalay 5.7 3.8 339 Mon 9.7 6.2 104 Rakhine 15.3 11.7 191 Yangon 2.3 1.6 414 Shan 4.6 4.0 325 Ayeyarwady 12.6 9.4 416 Nay Pyi Taw 11.0 7.3 79 Education2 No education 7.8 5.3 467 Primary 8.2 5.4 1,470 Secondary 9.3 7.2 897 More than secondary 7.6 4.7 222 Wealth quintile Lowest 9.4 6.8 674 Second 9.4 6.8 629 Middle 9.1 5.7 605 Fourth 5.9 4.7 576 Highest 7.9 5.0 575 Total 8.4 5.9 3,059 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Includes in the past 12 months 2 Total includes two women with missing information on education. 282 • Domestic Violence Table 16.15 Women’s violence against their spouse by husband’s characteristics and empowerment indicators Percentage of ever-married women who have committed physical violence against their current or most recent husband when he was not already beating or physically hurting them, ever and in the past 12 months, according to their husband’s characteristics, Myanmar DHS 2015-16 Percentage who have committed physical violence against their husband Number of ever-married women Background characteristic Ever1 Past 12 months Husband’s education2 No education 6.1 3.8 482 Primary 8.8 6.1 1,229 Secondary 9.1 6.8 1,101 More than secondary 8.2 5.4 177 Husband’s alcohol consumption Does not drink alcohol 6.5 4.6 1,627 Drinks alcohol but is never drunk 10.4 7.5 63 Is sometimes drunk 8.4 5.9 964 Is often drunk 15.7 10.5 404 Spousal education difference3 Husband has more education 8.4 6.0 1,232 Wife has more education 8.9 6.8 977 Both have equal education 8.7 5.3 549 Neither has any education 6.1 2.9 229 Spousal age difference4 Wife older 9.5 7.6 602 Wife is same age 7.8 5.8 320 Wife 1-4 years younger 9.3 6.5 1,014 Wife 5-9 years younger 6.0 4.8 546 Wife 10 or more years younger 7.1 4.7 268 Number of marital control behaviors displayed by husband5 0 5.8 4.1 2,170 1-2 11.6 7.6 723 3-4 33.9 24.0 133 5 (10.0) (10.0) 33 Number of decisions in which woman participates6 0 4.0 2.5 122 1-2 8.5 6.2 845 3 8.5 6.4 1,782 Number of reasons for which wife beating is justified7 0 8.0 5.0 1,493 1-2 9.2 7.2 1,151 3-4 6.8 5.2 342 5 10.8 5.7 73 Woman’s father beat her mother Yes 15.6 11.9 552 No 6.7 4.6 2,360 Don’t know 9.1 3.2 147 Woman afraid of husband8 Afraid most of the time 10.6 5.6 111 Sometimes afraid 10.2 7.1 657 Never afraid 7.8 5.5 2,289 Total 8.4 5.9 3,059 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes in the past 12 months 2 Total includes 69 women with missing information on husband’s education. 3 Total includes 69 women with missing information on husband’s education and two women with missing information on their education. 4 Includes only currently married women 5 According to the wife’s report. See Table 16.7 for list of behaviors. 6 According to the wife’s report. See Table 15.6.1 for list of decisions. Excludes decision on well-being of children. Includes only currently married women. 7 According to the wife’s report. See Table 15.7.1 for list of reasons. Excludes the reasons refusal of contraception and involvement in social activities. 8 Total includes two women with missing information on whether they are afraid of their husband. Domestic Violence • 283 Table 16.16 Help seeking to stop violence Percent distribution of women age 15-49 who have ever experienced physical or sexual violence according to their help-seeking behavior, by type of violence and background characteristics, Myanmar DHS 2015-16 Background characteristic Sought help to stop violence Never sought help but told someone Never sought help, never told anyone Missing/ don’t know Total Number of women who have ever experienced any physical or sexual violence Type of violence Physical only 21.2 43.2 35.2 0.4 100.0 608 Sexual only 21.8 6.5 71.1 0.6 100.0 33 Physical and sexual 28.4 33.6 38.1 0.0 100.0 88 Age 15-19 7.8 50.2 41.8 0.2 100.0 98 20-24 26.7 36.9 34.8 1.7 100.0 105 25-29 28.9 37.3 33.8 0.0 100.0 110 30-39 23.0 35.7 41.3 0.0 100.0 230 40-49 22.1 44.6 33.0 0.3 100.0 186 Marital status Never married 12.5 41.7 45.6 0.2 100.0 131 Married 23.0 41.2 35.3 0.5 100.0 492 Divorced/separated/ widowed 29.8 34.7 35.6 0.0 100.0 106 Number of living children 0 15.8 42.5 41.1 0.5 100.0 202 1-2 25.7 38.6 35.4 0.3 100.0 301 3-4 22.5 43.2 33.9 0.4 100.0 149 5+ 24.1 35.8 40.1 0.0 100.0 78 Employment Employed for cash 22.9 39.8 36.9 0.3 100.0 488 Employed not for cash 22.1 31.6 45.9 0.5 100.0 42 Not employed 20.2 43.4 36.0 0.4 100.0 199 Residence Urban 32.1 29.6 37.8 0.5 100.0 178 Rural 18.9 43.8 37.0 0.3 100.0 552 States/Regions Kachin 18.6 47.0 34.4 0.0 100.0 32 Kayah 29.7 40.4 29.8 0.0 100.0 4 Kayin 41.9 28.5 29.6 0.0 100.0 21 Chin (25.6) (26.5) (44.1) (3.7) 100.0 5 Sagaing 22.8 54.3 22.8 0.0 100.0 94 Tanintharyi 17.1 37.8 45.1 0.0 100.0 32 Bago 20.9 48.1 30.9 0.0 100.0 70 Magway 22.6 41.7 34.8 0.8 100.0 69 Mandalay (26.8) (39.5) (33.7) (0.0) 100.0 51 Mon 21.9 41.7 33.2 3.2 100.0 27 Rakhine 9.3 41.0 49.7 0.0 100.0 80 Yangon (47.0) (23.5) (29.4) (0.0) 100.0 57 Shan (22.2) (43.2) (34.6) (0.0) 100.0 53 Ayeyarwady 15.5 30.2 53.5 0.8 100.0 112 Nay Pyi Taw 17.2 46.1 36.7 0.0 100.0 23 Education No education 14.2 42.2 43.7 0.0 100.0 112 Primary 22.9 40.3 36.6 0.2 100.0 329 Secondary 25.3 39.6 34.3 0.7 100.0 260 More than secondary (15.1) (39.9) (45.0) (0.0) 100.0 29 Wealth quintile Lowest 20.5 38.4 40.8 0.3 100.0 197 Second 23.9 37.2 38.8 0.1 100.0 164 Middle 17.7 46.8 34.9 0.6 100.0 148 Fourth 19.7 48.6 30.9 0.7 100.0 121 Highest 31.9 29.8 38.3 0.0 100.0 99 Total 22.1 40.3 37.2 0.3 100.0 730 Note: Figures in parentheses are based on 25-49 unweighted cases. 284 • Domestic Violence Table 16.17 Sources for help to stop the violence Percentage of women age 15-49 who have experienced physical or sexual violence and sought help by sources from which they sought help, according to the type of violence that women reported, Myanmar DHS 2015-16 Type of violence Source Physical only Sexual only Physical and sexual Total Own family 52.7 * (43.2) 53.0 Husband’s family 17.7 * (7.4) 15.3 Husband 0.5 * (0.0) 0.4 Boyfriend 0.0 * (0.0) 0.0 Friend 10.2 * (21.9) 11.9 Neighbor 26.0 * (40.3) 27.1 Religious leader 0.2 * (5.0) 1.0 Doctor/medical personnel 0.0 * (0.0) 0.0 Police 1.2 * (0.0) 0.9 Lawyer 0.0 * (0.0) 2.5 Social work organization 1.5 * (10.9) 2.9 Other 6.6 * (9.1) 6.7 Number of women who have experienced violence and sought help 129 7 25 161 Note: Women can report more than one source from which they sought help. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Early Child Development and Child Discipline • 285 EARLY CHILD DEVELOPMENT AND CHILD DISCIPLINE 17 Key Findings  Early childhood education: Twenty-three percent of children age 36-59 months have ever attended an early childhood education program, and 20% are currently attending such a program.  Early childhood learning: Fifty-four percent of children engaged with adult household members in four or more activities that promote learning and school readiness during the 3 days before the survey.  Learning materials: Only 5% of children under age 5 have three or more children’s books present in the household.  Child care arrangements: Thirteen percent of children were left alone or left in the care of another child younger than age 10 for more than 1 hour during the week preceding the survey.  Child discipline: Seventy-seven percent of children age 2-14 have experienced any violent discipline method. nformation obtained in the 2015-16 MDHS allows for an assessment of several key aspects of the welfare of Myanmar’s children. Questions were included on birth registration and living arrangements and the survival status of parents. A child’s access to education is critical, and the MDHS gathered information on both the level of preschool education among young children and children’s participation in primary and secondary school. This chapter provides key data on early childhood development and child discipline collected in the survey. These data will help the Myanmar government, civil society, communities, and other stakeholders design and implement programs and policies that help young children reach their full potential by supporting families and communities and increasing access to quality early childhood care and education. The data gathered on child discipline will help parents and caretakers implement effective disciplinary techniques that make for happy, healthy and well-behaved children. 17.1 EARLY CHILDHOOD EDUCATION Early childhood education programs are important in preparing children for school. In Myanmar, preschool services are offered for all children age 3 and age 4, including services providing activities to transition children to kindergarten and primary school. Social organizations, the Department of Social Welfare, voluntary welfare schools run by nongovernmental organizations, private schools, monasteries, and churches also provide day care and similar preschool and preprimary classes attached to basic education schools. The MDHS included questions designed to determine if children age 3-4 had ever attended or were currently attending an organized learning program. I 286 • Early Child Development and Child Discipline The MDHS data show that 23% of children age 36-59 months have ever attended an organized early childhood education program and that 20% are currently (in the last 7 days) attending such a program (Table 17.1). Patterns by background characteristics  The proportion of children who have ever attended early childhood education programs increases with age, from 15% among children age 36-47 months to 32% among children age 48-59 months.  Children living in urban areas are much more likely to attend an early childhood education program (33%) than children living in rural areas (21%).  Participation in early childhood education programs varies by state and region, from a high of 62% of children in Kayah State to a low of 13% of children in Rakhine State.  Considerable differences are observed by mothers’ education. Fourteen percent of children whose mothers have no education have ever attended early childhood education programs, as compared with 42% of children whose mothers have more than a secondary education (Figure 17.1).  Only 11% of children living in households in the lowest wealth quintile have ever attended early childhood education programs, compared with 42% of children living in households in the highest quintile. 17.2 CHILDHOOD LEARNING 17.2.1 Support for Learning It is recognized that a period of rapid brain development occurs in the first 3 to 4 years of life and that quality of home care is the major determinant of a child’s development during this period. In this context, adults spending “quality time” with children, the presence of children’s books in the home, opportunities for play to stimulate the imagination, and conditions of care are all important indicators of quality of home care. Children should be physically healthy, mentally alert, emotionally secure, socially competent, and ready to learn. Figure 17.1 Early childhood education by mother’s education 14 19 33 42 No education Primary Secondary More than secondary Percentage of de facto children age 36-59 months attending early childhood education programs Early Child Development and Child Discipline • 287 Support for early learning Percentage of children with whom any adult household member (age 15+) has (within the previous 3 days) engaged in four or more of the following activities to promote learning and school readiness: reading books or looking at picture books; telling stories; singing songs; taking the children outside the home, compound, or yard; playing with the children; and spending time with the children naming, counting, or drawing things. Sample: Children age 3-4 (36-59 months) Father’s and mother’s support for early learning Percentage of children with whom the natural father or natural mother has engaged in four or more support-for-early-learning activities to promote learning and school readiness. Sample: Children age 3-4 (36-59 months) Fifty-four percent of children age 36-59 months were engaged by adult household members in four or more activities that promote learning and school readiness during the last 3 days. However, fathers (6%) were much less likely than mothers (25%) to have engaged in four or more of these activities. The mean number of activities in which any adult household member engaged with children was 3.6. Thirteen percent of children were not living with their natural father (Table 17.2). Patterns by background characteristics  Children living in urban areas are much more likely to engage in four or more activities with adult household members than children living in rural areas (76% versus 49%).  There are substantial differences by education in mothers’ and fathers’ involvement in learning activities. Children whose mothers have no education and children whose fathers have no education are much less likely to engage in four or more activities with adult household members (31% each) than children whose mothers and fathers have more than a secondary education (83% each) (Figure 17.2).  Forty-three percent of children living in households in the lowest wealth quintile engaged in four or more activities with adult household members, as compared with 77% of children living in households in the highest quintile. 17.2.2 Children’s Books and Playthings Exposure to books in the early years not only provides children with a greater understanding of the nature of print but may also give them opportunities to see others reading (e.g., older siblings doing school work). The presence of books is also important for later school performance. Mothers of children under age 5 were asked about the number of children’s books or picture books they have. By stimulating the imagination, play also contributes to brain development. Mothers were asked what items children play with, including homemade toys, toys purchased from a shop, and other household objects or objects found around the home. Most children under age 5 in Myanmar do not have access to books in the household. Only 5% of children under age 5 have three or more children’s books in the household, and only 1% have 10 or more children’s Figure 17.2 Adult support for learning by parent’s education 31 51 71 83 31 52 66 83 No education Primary Secondary More than secondary Percentage of children age 36-59 months with whom adults engage in learning activities Mother’s education Father’s education 288 • Early Child Development and Child Discipline books. Fifty-nine percent of children under age 5 play with homemade toys (including dolls and cars). Overall, 72% of children play with two or more types of playthings, including homemade toys, toys purchased from a store, household objects (such as pots and bowls), and objects found outside the home (such as sticks, rocks, animals, shells, and leaves) (Table 17.3). Patterns by background characteristics  The percentage of children who play with two or more types of playthings increases with age. For example, 52% of children age 0-23 months have two or more types of playthings, as compared with 83% of children age 24-59 months.  Urban children under age 5 are more likely than rural children to have access to three or more children’s books (12% versus 2%).  The percentage of children who play with two or more types of playthings varies by state and region, from a high of 86% of children in Mandalay Region to a low of 53% of children in Chin State.  Mother’s and father’s education determines children’s access to books. For instance, children whose mothers have more than a secondary education are much more likely to have access to three or more children’s books than children whose mothers have no education (18% versus 1%).  Children living in households in the highest wealth quintile are much more likely to have three or more children’s books in the household than children living in households in the lowest quintile (15% versus 1%). 17.3 ADEQUATE CARE FOR YOUNG CHILDREN Leaving children alone or only in the presence of other young children is known to increase the risk of accidents, abuse, and neglect. In the 2015-16 MDHS, mothers were asked two questions to establish whether their youngest child under age 5 had been left alone during the week preceding the interview for 1 hour or more and whether the child was left in the care of other children under age 10 for 1 hour or more. Inadequate care Number of children under age 5 left alone or in the care of another child younger than age 10 for more than 1 hour at least once in the last week. Sample: De jure children under age 5 In Myanmar, 6% of children under age 5 were left alone and 10% were left in the care of another child younger than age 10 for more than 1 hour during the week before the survey. Overall, 13% of children were left alone or left in the care of another child younger than age 10 for more than 1 hour during the week (Table 17.4). Patterns by background characteristics  Children age 48-59 months were slightly more likely to be left alone or left in the care of another child younger than age 10 for more than 1 hour during the week before the survey (19%) than children age 36-47 months (16%).  A higher percentage of rural children (15%) than urban children (7%) were left alone or left in the care of another child younger than 10 years for more than one hour during the week.  The percentage of children left alone or left in the care of another child for more than 1 hour during the week before the survey varies by state and region, from a high of 28% in Chin State to a low of only 3% in Yangon Region. Early Child Development and Child Discipline • 289  There are sharp differences in the proportion of children left alone or left in the care of another child by mother’s educational level. This proportion was four times higher among children whose mothers had no education than among children whose mothers had more than a secondary education (19% versus 5%).  Similarly, 21% of children living in the poorest households were left alone or left in the care of another child for more than 1 hour during the week before the survey, as compared with 5% of children living in the wealthiest households. 17.4 CHILD DISCIPLINE Nonviolent disciplinary approaches Include one or more of the following:  taking away privileges, forbidding something the child likes, or not allowing the child to leave the house  explaining that the child’s behavior was wrong  giving the child something else to do Sample: De jure children age 2-14 Psychological aggression Includes one or both of the following:  shouting, yelling, or screaming at the child  calling the child dumb, lazy, or a similar term Sample: De jure children age 2-14 Physical punishment Includes one or more of the following:  shaking the child  spanking, hitting, or slapping the child on the bottom with a bare hand  hitting the child on the bottom or another part of the body with a belt, hairbrush, stick, or other similar hard object  hitting the child on the hand, arm, or leg Sample: De jure children age 2-14 Severe physical punishment Includes one or both of the following:  hitting or slapping the child on the face, head, or ears  beating the child up, that is, hitting the child over and over as hard as one can Sample: De jure children age 2-14 The manner in which parents and caretakers discipline children can have long-term consequences for their physical and psychological development and well-being. The 2015-16 MDHS household questionnaire included questions on how children in the household are usually disciplined. The respondent to the household questionnaire (the household head or another household member) was asked a series of separate questions about disciplinary practices that may have been used with the child during the month before the survey. 17.4.1 Prevalence of Disciplinary Approaches Table 17.5 shows the extent to which 11 different approaches were used to discipline children age 2-14 during the month before the survey. Both nonviolent and violent methods of child discipline were reported. 290 • Early Child Development and Child Discipline  The most common nonviolent disciplinary approach involved explaining that the child’s behavior was wrong, and this approach was used for 74% of children.  The most common form of psychological aggression involved shouting, yelling, or screaming, used for 72% of children.  The most common form of physical punishment was spanking, hitting, or slapping the child on the bottom with a bare hand, used for 28% of children.  The most common type of severe physical punishment involved hitting or slapping the child on the face, head, or ears, used for 10% of children. Overall, 15% of children age 2-14 experienced only nonviolent discipline, 74% experienced any type of psychological aggression, 43% experienced any type of physical punishment, and 12% experienced any type of severe physical punishment. Overall, 77% of children experienced any violent discipline method (Table 17.6). 17.4.2 Disciplinary Approaches by Background Characteristics Methods used for disciplining children do not vary substantially by age with the exception of physical punishment. Fifty-four percent of children age 2-4 experienced any physical punishment, as compared with 32% of children age 10-14. There are substantial differences in the use of severe physical punishment according to the educational level of the head of the household. Eleven percent of children in households where the household head has no education experienced severe physical punishment, compared with 7% of children in households where the household head has more than a secondary education. Children in households in the higher wealth quintiles are less likely than those in households in the lower wealth quintiles to experience any violent physical discipline methods. Children in households in the highest wealth quintile more often face only nonviolent discipline (19%) than those in the lowest quintile (11%) (Figure 17.3). LIST OF TABLES For more information on early child development and child discipline, see the following tables:  Table 17.1 Early childhood education  Table 17.2 Support for learning  Table 17.3 Learning materials  Table 17.4 Child care arrangements  Table 17.5 Child discipline  Table 17.6 Child discipline by background characteristics Figure 17.3 Child discipline by household wealth 11 13 17 17 19 81 80 77 73 74 Lowest Second Middle Fourth Highest Percentage of children age 2-14 by experience of child disciplining methods Only nonviolent discipline Any violent discipline method Poorest Wealthiest Early Child Development and Child Discipline • 291 Table 17.1 Early childhood education Percentage of de facto children age 36-59 months who ever attended an early childhood education program and among those who ever attended, the percentage currently attending, according to background characteristics, Myanmar DHS 2015-16 Background characteristic Percentage ever attending early childhood education1 Percentage currently (in last 7 days) attending early childhood education Number of children Age in months 36-47 14.8 12.2 812 48-59 31.9 27.8 778 Sex Male 21.6 19.0 815 Female 24.8 20.7 775 Residence Urban 32.7 30.1 324 Rural 20.7 17.2 1,267 States/Regions Kachin 36.5 34.8 69 Kayah 61.6 33.9 11 Kayin 17.2 13.4 45 Chin 28.6 24.9 23 Sagaing 30.8 24.4 195 Tanintharyi 18.4 12.2 46 Bago 19.8 17.2 161 Magway 19.2 18.2 128 Mandalay 25.0 21.7 153 Mon 29.2 18.5 51 Rakhine 13.0 11.4 104 Yangon 21.6 21.6 149 Shan 27.5 24.2 205 Ayeyarwady 15.9 14.1 211 Nay Pyi Taw 21.1 15.9 40 Mother’s education No education 13.5 11.3 315 Primary 19.3 15.7 771 Secondary 33.3 30.3 401 More than secondary 41.8 36.6 103 Wealth quintile Lowest 10.7 7.8 493 Second 19.5 17.4 379 Middle 25.3 21.4 253 Fourth 35.7 30.8 257 Highest 41.5 37.5 208 Total 23.2 19.9 1,591 1 Includes children currently attending early childhood education 292 • Early Child Development and Child Discipline Table 17.2 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 3 days, by background characteristics, Myanmar DHS 2015-16 Percentage of children age 36-59 months Mean number of activities Percentage of children not living with their natural father Number of children age 36-59 months Background characteristic With whom adult household members engaged in four or more activities With whom the father engaged in four or more activities With whom the mother engaged in four or more activities Any adult household member engaged with the child The father engaged with the child Age in months 36-47 55.7 5.9 25.7 3.8 0.8 13.3 812 48-59 53.0 6.1 25.1 3.5 0.8 13.6 778 Sex Male 53.4 6.6 23.0 3.6 0.9 13.8 815 Female 55.5 5.3 27.9 3.7 0.8 13.0 775 Residence Urban 76.2 9.0 42.6 4.6 1.1 14.6 324 Rural 48.8 5.2 21.0 3.4 0.7 13.2 1,267 States/Regions Kachin 63.4 6.6 28.2 4.2 0.6 18.5 69 Kayah 51.2 3.1 16.1 3.4 0.8 19.2 11 Kayin 37.2 1.6 14.6 2.9 0.2 16.3 45 Chin 49.1 2.2 33.5 3.4 0.5 12.7 23 Sagaing 34.8 3.4 13.8 2.6 0.6 14.6 195 Tanintharyi 40.4 5.3 21.7 2.9 0.5 14.2 46 Bago 51.7 2.9 25.2 3.7 0.8 11.9 161 Magway 68.5 7.9 29.4 4.2 0.7 14.4 128 Mandalay 57.1 13.1 26.9 3.7 1.3 7.6 153 Mon 40.0 4.7 15.1 3.1 0.5 23.6 51 Rakhine 53.3 3.6 17.9 3.7 0.8 23.0 104 Yangon 82.7 7.4 41.9 4.8 1.3 7.0 149 Shan 40.8 3.1 17.5 3.1 0.5 13.8 205 Ayeyarwady 69.5 8.7 37.3 4.4 1.1 11.9 211 Nay Pyi Taw 36.1 7.6 23.1 2.8 0.9 11.9 40 Mother’s education No education 31.2 1.5 6.7 2.5 0.5 13.2 315 Primary 51.4 6.7 23.6 3.6 0.9 11.5 771 Secondary 71.3 7.2 36.3 4.4 0.9 17.1 401 More than secondary 82.5 9.4 54.0 4.9 1.2 14.2 103 Father’s education No education 30.5 1.8 8.1 2.5 0.5 na 247 Primary 52.2 6.2 23.9 3.6 0.9 na 605 Secondary 66.2 8.6 32.2 4.2 1.0 na 450 More than secondary 83.1 15.4 49.5 5.0 1.6 na 75 Father not living in household 53.4 1.4 27.1 3.6 0.2 100.0 214 Wealth quintile Lowest 42.7 5.3 16.2 3.2 0.7 13.6 493 Second 51.3 5.2 21.9 3.5 0.8 11.1 379 Middle 56.9 4.3 26.4 3.7 0.8 13.4 253 Fourth 60.9 7.1 30.9 3.9 0.9 14.5 257 Highest 76.8 9.6 45.5 4.7 1.1 16.2 208 Total 54.4 6.0 25.4 3.6 0.8 13.4 1,591 na = Not applicable Early Child Development and Child Discipline • 293 Table 17.3 Learning materials Percentage of oldest children under age 5 by numbers of children’s books present in the household and by playthings that child plays with, by background characteristics, Myanmar DHS 2015-16 Household has for the child: Child plays with: Two or more types of playthings Number of oldest children under age 5 Background characteristic 3 or more children’s books 10 or more children’s books Homemade toys Toys from a shop/manuf actured toys Household objects/ objects found outside Age in months 0-23 1.7 0.1 42.4 56.8 46.9 51.7 1,211 24-59 6.0 1.1 67.9 80.5 84.8 82.9 2,271 Sex Male 4.2 0.9 56.6 73.4 68.6 70.6 1,797 Female 4.9 0.5 61.6 71.1 74.9 73.5 1,684 Residence Urban 11.8 2.7 58.3 83.0 67.8 76.3 816 Rural 2.3 0.1 59.3 69.0 72.8 70.7 2,666 States/Regions Kachin 5.6 1.3 50.7 77.1 70.9 73.0 129 Kayah 4.7 0.0 48.3 81.9 80.7 79.7 23 Kayin 3.9 1.1 60.7 62.2 72.8 65.8 109 Chin 3.4 0.3 46.8 47.3 76.4 52.7 40 Sagaing 6.3 0.9 69.8 78.2 76.3 79.2 390 Tanintharyi 1.6 0.0 28.5 69.5 75.1 63.8 99 Bago 4.3 1.1 62.5 74.4 74.5 75.3 321 Magway 3.0 0.0 65.6 71.9 71.5 75.7 266 Mandalay 7.9 0.4 81.7 85.0 82.9 85.9 374 Mon 3.8 0.0 21.9 66.0 64.4 53.6 118 Rakhine 2.6 0.6 65.3 57.8 68.9 65.8 234 Yangon 5.5 1.6 56.4 87.5 71.2 80.9 375 Shan 3.3 0.4 47.4 60.8 62.6 60.3 445 Ayeyarwady 3.6 0.8 55.2 67.6 67.3 66.6 478 Nay Pyi Taw 4.7 1.2 59.1 69.1 72.1 73.0 80 Mother’s education No education 0.5 0.0 52.4 52.9 72.0 59.5 561 Primary 1.8 0.1 60.7 73.1 73.3 73.3 1,589 Secondary 7.1 1.1 59.0 78.9 68.7 75.0 1,038 More than secondary 18.0 4.2 62.9 81.3 72.3 78.5 294 Father’s education No education 0.6 0.2 49.8 56.3 69.2 59.5 474 Primary 1.9 0.0 60.0 71.3 75.3 72.7 1,243 Secondary 5.2 0.6 62.5 80.4 69.8 77.4 1,105 More than secondary 24.3 5.4 59.1 79.2 69.7 75.7 174 Father not living in household 6.3 1.7 57.8 69.4 69.5 68.8 485 Wealth quintile Lowest 0.9 0.0 54.6 59.5 73.4 64.3 950 Second 1.8 0.1 58.1 67.7 71.8 68.8 760 Middle 1.9 0.0 61.6 76.4 71.9 75.2 607 Fourth 6.7 1.5 63.2 84.0 73.3 81.3 623 Highest 15.2 2.7 60.6 83.1 65.9 75.8 543 Total 4.5 0.7 59.1 72.3 71.6 72.0 3,481 294 • Early Child Development and Child Discipline Table 17.4 Child care arrangements Percentage of de jure children under age 5 left alone, percentage left in the care of another child younger than age 10 years for more than one hour, and percentage left alone or in the care of another child younger than 10 years for more than one hour during the week before the survey, by background characteristics, Myanmar DHS 2015-16 Background characteristic Left alone for more than 1 hour during the week Left in the care of another child younger than age 10 for more than 1 hour during the week Left alone or in the care of another child younger than age 10 for more than 1 hour during the week Number of children Age in months 36-47 8.6 11.8 16.4 812 48-59 9.4 14.9 19.0 778 Sex Male 6.5 10.0 13.6 1,797 Female 6.0 10.7 13.2 1,684 Residence Urban 4.3 5.0 7.3 816 Rural 6.9 12.0 15.3 2,666 States/Regions Kachin 9.4 12.2 17.3 129 Kayah 1.1 3.3 4.4 23 Kayin 4.7 6.1 7.5 109 Chin 14.1 14.1 27.5 40 Sagaing 2.5 3.9 5.0 390 Tanintharyi 5.4 16.3 17.5 99 Bago 5.7 13.4 15.6 321 Magway 5.1 21.2 22.8 266 Mandalay 2.2 3.7 4.1 374 Mon 5.9 9.9 12.2 118 Rakhine 8.2 21.8 25.6 234 Yangon 1.9 1.3 2.7 375 Shan 11.4 11.2 18.4 445 Ayeyarwady 10.9 12.2 17.5 478 Nay Pyi Taw 4.9 14.0 15.0 80 Mother’s education No education 10.7 14.2 18.8 561 Primary 7.0 13.2 16.2 1,589 Secondary 3.9 6.2 8.8 1,038 More than secondary 2.3 2.4 4.5 294 Wealth quintile Lowest 10.5 16.3 20.7 950 Second 7.0 13.1 16.7 760 Middle 4.7 8.1 10.7 607 Fourth 3.8 6.8 8.6 623 Highest 2.3 2.6 4.7 543 Total 6.3 10.3 13.4 3,481 Early Child Development and Child Discipline • 295 Table 17.5 Child discipline Percentage of de jure children age 2-14 reported as having been disciplined in specific manners during the month before the survey, Myanmar DHS 2015-16 Type of discipline Total Nonviolent disciplinary approaches Taking away privileges, forbidding something the child likes, or not allowing the child to leave the house 19.6 Explaining that the child’s behavior was wrong 73.5 Giving the child something else to do 52.5 Violent disciplinary approaches Psychological aggression Shouting, yelling, or screaming at the child 71.8 Calling the child dumb, lazy, or a similar term 22.4 Physical punishment Shaking the child 13.9 Hitting the child on the hand, arm, or leg 17.7 Spanking, hitting, or slapping the child on the bottom with a bare hand 28.4 Hitting the child on the bottom or another part of the body with a belt, hairbrush, stick, or other similar hard object 16.1 Severe physical punishment Hitting or slapping the child on the face, head, or ears 10.0 Beating up the child, that is, hitting the child over and over as hard as one can 3.0 Not disciplined with any of the approaches/missing 7.6 Number of children 7,395 296 • Early Child Development and Child Discipline Table 17.6 Child discipline by background characteristics Percentage of children age 2-14 by child disciplining methods experienced during the month before the survey, by background characteristics, Myanmar DHS 2015-16 Percentage of children age 2-14 who experienced: Number of children Background characteristic Only nonviolent discipline Any psychological aggression Any physical punishment Any severe physical punishment Any violent discipline method Age in years 2-4 12.6 75.8 53.6 12.6 80.0 1,627 5-9 12.8 77.7 48.3 14.5 81.1 2,758 10-14 18.7 69.5 32.1 8.7 72.0 3,010 Sex Male 13.7 76.8 46.9 13.4 79.9 3,749 Female 16.7 71.0 38.6 9.9 74.5 3,646 Residence Urban 18.0 73.3 42.3 11.8 76.0 1,688 Rural 14.4 74.1 43.1 11.6 77.6 5,654 States/Regions Kachin 14.2 76.0 47.3 11.9 79.1 230 Kayah 18.3 74.3 47.3 20.7 78.1 41 Kayin 16.5 70.6 42.9 11.8 75.2 246 Chin 17.1 69.9 48.1 21.4 74.6 69 Sagaing 13.2 72.2 37.6 9.9 75.6 819 Tanintharyi 22.0 67.9 47.1 14.5 73.3 206 Bago 15.7 76.4 43.6 11.1 79.2 693 Magway 15.1 76.5 41.9 8.6 79.6 598 Mandalay 16.4 71.7 41.9 12.1 74.5 814 Mon 17.6 69.2 42.6 11.5 72.2 301 Rakhine 14.6 74.0 43.6 13.6 79.1 451 Yangon 11.1 82.6 51.6 13.6 86.0 846 Shan 15.1 70.6 38.4 9.4 73.2 816 Ayeyarwady 16.1 74.1 43.2 13.3 76.8 1,034 Nay Pyi Taw 20.1 65.1 35.4 7.4 68.2 178 Education of the household head No education 12.2 75.1 43.7 11.1 78.5 1,918 Primary 14.7 74.0 44.1 13.0 77.6 3,231 Secondary 18.3 72.8 40.9 10.9 75.9 1,957 More than secondary 19.4 73.0 36.6 6.5 73.2 290 Parental survivorship1 Both alive 14.9 74.3 43.3 11.9 77.5 6,823 Father deceased 15.5 73.0 41.3 12.1 76.1 396 Mother deceased 27.9 61.0 27.7 3.9 63.2 117 Both deceased (16.5) (66.4) (28.5) (10.6) (71.9) 36 Wealth quintile Lowest 11.0 77.0 50.6 15.4 80.7 1,701 Second 13.4 77.0 46.5 12.0 80.4 1,610 Middle 16.7 72.7 40.7 9.4 76.5 1,460 Fourth 17.3 69.6 37.6 10.7 72.8 1,341 Highest 19.3 71.9 35.8 9.9 73.6 1,230 Total 15.2 74.0 42.8 11.7 77.2 7,395 Note: Nonviolent practices included one or more of the following: (1) taking away privileges, forbidding something the child likes, or not allowing the child to leave the house; (2) explaining that the child’s behavior was wrong; or (3) giving the child something else to do. Psychological aggression included one or both of the following: (1) shouting, yelling, or screaming at the child or (2) calling the child dumb, lazy, or a similar term. Physical punishment included one or more of the following: (1) shaking the child; (2) spanking, hitting, or slapping the child on the bottom with a bare hand; (3) hitting the child on the bottom or another part of the body with a belt, hairbrush, stick, or other similar hard object; (4) hitting or slapping the child on the face, head, or ears; (5) hitting the child on the hand, arm, or leg; and (6) beating the child up, that is, hitting the child over and over as hard as one can. Severe physical punishment included one or both of the following: (1) hitting or slapping the child on the face, head, or ears or (2) beating the child up, that is, hitting the child over and over as hard as one can. Figures in parentheses are based on 25-49 unweighted cases. 1 Total includes 23 children with missing information on parental survival status. References • 297 REFERENCES Bradley, S. E. K., T. N. Croft, J. D. Fishel, and C. F. Westoff. 2012. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International. Family Planning 2020. 2013. Family Planning Commitment 2020 - Government of Myanmar. http://ec2- 54-210-230-186.compute-1.amazonaws.com/wp-content/uploads/2016/10/Govt.-of-Myanmar-FP2020- Commitment-2013.pdf. Graham, W., W. Brass, and R. W. Snow. 1989. “Indirect Estimation of Maternal Mortality: The Sisterhood Method.” Stud Fam Plann 20(3): 125-135. doi:10.2307/1966567. Korenromp, E. L., J. Armstrong-Schellenberg, B. Williams, B. Nahlen, and R. W. Snow. 2004. “Impact of Malaria Control on Childhood Anemia in Africa – A Quantitative Review.” Trop Med Int Health 9(10): 1050-1065. Ministry of Health (MOH). 2012. 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Columbia, Maryland, USA: IRD/Macro International Inc. 298 • References Stanton, C., N. Abderrahim, and K. Hill. 1997. DHS Maternal Mortality Indicators: An Assessment of Data Quality and Implications for Data Use. DHS Analytical Reports No. 4. Calverton, Maryland, USA: Macro International Inc. United Nations Children’s Fund (UNICEF). 2006. Child Protection Information Sheets. New York: United Nations Children’s Fund. United Nations Program on HIV and AIDS (UNAIDS). 2016. Global Gains Made towards 90-90-90 Targets. www.unaids.org/en/resuources/presscentre/featurestories/2016/july/20160717_90-90-90. World Health Organization (WHO). 1998. Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva, Switzerland: World Health Organization. World Health Organization (WHO). 2001. Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence against Women. 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Geneva, Switzerland: WHO. http://www.who.int/maternal_child_adolescent/publications/WHO-MCA-PNC-2014-Briefer_A4.pdf. Appendix A • 299 SAMPLE DESIGN Appendix A A.1 INTRODUCTION he 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) is the first DHS survey to be conducted in Myanmar. A nationally representative sample of about 13,260 households was selected. All women age 15-49 who were usual residents of the selected households or who slept in the households the night before the survey were eligible for the survey. The survey resulted in about 16,800 interviews of women age 15-49. As for all DHS surveys, the main objectives of the 2015-16 MDHS survey were to provide up-to-date information on fertility and childhood mortality levels; fertility preferences; awareness, approval, and use of family planning methods; maternal and child health; knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections (STIs); and domestic violence. The survey was designed to produce representative estimates for the main demographic and health indictors for the country as a whole, for the urban areas and the rural areas separately, for each of the 14 states and regions, and for the Nay Pyi Taw Union Territory. Apart from the women’s survey, a men’s survey was also conducted at the same time in a subsample consisting of one household in every second household selected for the female survey. All men age 15-49 who were usual residents of the selected households or who slept in the households the night before the survey were eligible for the male survey. The survey collected information on their basic demographic and social status; on their knowledge and use of family planning methods; and on their knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections. The survey resulted in about 7,500 interviews of men age 15-49. Also in this subsample, one woman per household was selected randomly from all eligible women in the selected household to take the domestic violence questionnaire. In all of the selected households, parents or guardians of children age 6-59 months asked permission to collect a blood sample through a finger prick, also used to test for anemia. These children were also weighed and measured to obtain anthropometric indicators. Anemia testing and anthropometric measurements were also obtained for women age 15-49 in the sample households. A.2 SAMPLE FRAME The sampling frame used for 2015-16 MDHS is the cartographic frame of the Myanmar Population and Housing Census 2014 (MPHC 2014), provided by the Department of Population, the implementing institution of the MPHC 2014, of the Ministry of Immigration and Population of Myanmar. The sampling frame is a list of 76,990 primary sampling units (PSUs) covering the entire country. A PSU is either an enumeration area (EA) or a ward/village track for some of the non-enumerated or not completely enumerated areas during the census, mainly in Rakhine State. Each PSU has cartographic materials, which delineates its geographical locations, boundaries, main access point, and landmarks in or outside the PSU to identify the PSUs. Each PSU has identification information, administrative belongings, and a measure of size, which is the number of residential households enumerated during the population census if the PSU was an EA, or estimated during the census preparation work if the PSU was a ward/village track. Each PSU was also classified into one of the two types of residence, urban or rural. Institutional PSUs were excluded from this list, but the internally displaced population camps are included in the list. Myanmar is administratively divided into 14 states/regions and the Nay Pyi Taw Union Territory. These administrative units are further subdivided into districts and the districts are divided into townships. Table A.1 below shows the distribution of residential households by state/region and according to type of residence (urban and rural) summarized from the sampling frame. The shares vary from 14% for Yangon Region and Ayeyarwady Region to 0.5% for Kayah State. In Myanmar, 28% of the residential households T 300 • Appendix A live in urban areas. The urban percentage of the states/regions varies from 68% for Yangon Region to 13% for Ayeyarwady Region and Rakhine State. Table A.1 Distribution of residential households by state/region and type of residence Households Percentage State/region Urban Rural Total Urban State/region Kachin 91,907 174,945 266,852 34.4 2.5 Kayah 13,730 41,162 54,892 25.0 0.5 Kayin 63,951 237,614 301,565 21.2 2.8 Chin 19,022 71,475 90,497 21.0 0.8 Sagaing 179,736 909,647 1,089,383 16.5 10.1 Tanintharyi 63,170 207,729 270,899 23.3 2.5 Bago 234,228 891,334 1,125,562 20.8 10.4 Magway 128,363 777,702 906,065 14.2 8.4 Mandalay 406,173 898,061 1,304,234 31.1 12.1 Mon 111,929 303,825 415,754 26.9 3.8 Rakhine 74,120 493,336 567,456 13.1 5.2 Yangon 1,051,226 499,273 1,550,499 67.8 14.3 Shan 265,943 875,137 1,141,080 23.3 10.5 Ayeyarwady 198,294 1,286,144 1,484,438 13.4 13.7 Nay Pyi Taw 68,639 178,654 247,293 27.8 2.3 Myanmar 2,970,431 7,846,038 10,816,469 27.5 100.0 Source: Sampling frame of Myanmar Population and Household Census 2014, Myanmar Table A.2 below shows the distribution of population by states/regions and according to residence type, which is very close to the distribution of residential households. Table A.2 Distribution of residential household population by state/region and type of residence Household population Percentage State/region Urban Rural Total Urban Total Kachin 503,959 863,252 1,367,211 36.9 2.9 Kayah 66,767 206,052 272,819 24.5 0.6 Kayin 313,008 1,138,892 1,451,900 21.6 3.0 Chin 94,807 374,105 468,912 20.2 1.0 Sagaing 852,477 4,215,743 5,068,220 16.8 10.6 Tanintharyi 320,405 1,030,066 1,350,471 23.7 2.8 Bago 1,017,785 3,719,720 4,737,505 21.5 9.9 Magway 559,258 3,222,350 3,781,608 14.8 7.9 Mandalay 1,955,420 3,874,183 5,829,603 33.5 12.2 Mon 538,059 1,407,157 1,945,216 27.7 4.1 Rakhine 337,658 1,696,889 2,034,547 16.6 4.3 Yangon 4,848,157 2,091,491 6,939,648 69.9 14.5 Shan 1,266,090 4,222,479 5,488,569 23.1 11.5 Ayeyarwady 826,944 5,214,719 6,041,663 13.7 12.6 Nay Pyi Taw 319,033 751,896 1,070,929 29.8 2.2 Myanmar 13,819,827 34,028,994 47,848,821 28.9 100.0 Source: Sampling frame of Myanmar Population and Household Census 2014, Myanmar A master sample was created based on the above described census frame for responding and coordinating different household based surveys, which will be conducted in Myanmar for years to come, including the current 2015-16 MDHS. A master sample is a large, nationally representative sample of primary sampling units drawn from the entire census frame that can be used for sub-selecting multi-stage household based survey samples. A master sample is large enough for bearing and providing design flexibility for various household based surveys. Table A.3 below shows the sample allocation of the Myanmar 2014 master sample from which the MDHS 2015-16 sample clusters are selected. The master sample is a stratified sample selected with probability proportional to size (PPS). Stratification is achieved by separating each state/region into urban and rural areas, the urban and rural areas of each state/region forms each a sampling stratum. In total, 30 sampling strata were created. Samples were selected independently in each sampling stratum. Implicit stratification and proportional allocation were achieved at each of the lower administrative unit levels by sorting the sampling frame within the explicit stratum according to administrative unit in different levels before sample selection and by using a PPS selection procedure. Appendix A • 301 Table A.3 Master sample allocation of clusters by state/region and type of residence Full master sample Each of the four replicates State/region Urban Rural Total Urban Rural Total Kachin 80 96 176 20 24 44 Kayah 40 60 100 10 15 25 Kayin 52 136 188 13 34 47 Chin 40 64 104 10 16 26 Sagaing 76 280 356 19 70 89 Tanintharyi 56 124 180 14 31 45 Bago 100 264 364 25 66 91 Magway 60 264 324 15 66 81 Mandalay 160 232 392 40 58 98 Mon 80 140 220 20 35 55 Rakhine 44 216 260 11 54 65 Yangon 272 128 400 68 32 100 Shan 112 252 364 28 63 91 Ayeyarwady 72 328 400 18 82 100 Nay Pyi Taw 64 108 172 16 27 43 Myanmar 1,308 2,692 4,000 327 673 1000 Source: Sampling frame of Myanmar Population and Household Census 2014, Myanmar A.3 SAMPLE DESIGN AND IMPLEMENTATION The sample for 2015-16 MDHS was a stratified sample selected in two stages from the master sample. In the first stage, 442 clusters were selected with equal probability systematic sampling and with independent selection in each sampling stratum. Stratification was achieved by separating each state/region into urban and rural areas. The urban and rural areas of each state/region form a sampling stratum that follows exactly the master sample stratification. In total, 30 sampling strata were created. Implicit stratification and proportional allocation were achieved at each of the lower administrative unit levels by taking into account the sampling procedure used in the master sample selection. Table A.4 below shows the sample allocation of clusters and households. Among the 442 clusters, 123 were from urban areas and 319 were from rural areas. With a fixed number of 30 households to be selected per cluster, the total number of households selected was 13,260. Among them, 3,690 households were from urban areas, and 9,570 households were from rural areas. Table A.5 shows the sample allocation of a number of completed women interviews. With the large number of survey regions and the tight total sample size, the sample allocation features a power allocation with small adjustment in order to get at least 1,000 women interviews per state/region. The sample allocation is not far from an equal size allocation, which guarantees comparable survey precision across regions, with the largest sample size allocated to Yangon (about 1300 women 15-49) because it is the largest region and has a low fertility level. At the second stage, a fixed number of 30 households were selected from each selected cluster using equal probability systematic sampling. For the clusters that were completely enumerated in the population census, the census household listings were used as the base, which were updated by the MDHS listers and mappers, for selecting the sample households. For the clusters that were not enumerated or only partially enumerated in the census, an independent household listing operation was carried out to create a complete list of households residing in the cluster. Sample households were selected from the newly updated listing. The interviewers were asked to interview only the pre-selected households, no replacement was allowed for nonresponse households to prevent bias. The interviewers were asked to make at least three callbacks to reduce nonresponse The household listing operation consists of visiting each of the selected clusters; drawing a location map and a detailed sketch map; and recording on the household listing forms all residential households found in the cluster with the address and the name of the head of the households. Some of the selected EAs in the household listing operation were large. To minimize the task of household listing, the selected clusters with an estimated number of households greater than 300 were to be segmented. Only one segment was selected with probability proportional to the segment size. 302 • Appendix A Table A.4 Sample allocation of EAs and households by state/region and type of residence Allocation of clusters Allocation of households State/region Urban Rural Total Urban Rural Total Kachin 10 17 27 300 510 810 Kayah 7 20 27 210 600 810 Kayin 7 21 28 210 630 840 Chin 6 21 27 180 630 810 Sagaing 6 25 31 180 750 930 Tanintharyi 7 20 27 210 600 810 Bago 8 24 32 240 720 960 Magway 6 25 31 180 750 930 Mandalay 10 21 31 300 630 930 Mon 8 20 28 240 600 840 Rakhine 5 24 29 150 720 870 Yangon 21 12 33 630 360 990 Shan 8 23 31 240 690 930 Ayeyarwady 6 27 33 180 810 990 Nay Pyi Taw 8 19 27 240 570 810 Myanmar 123 319 442 3,690 9,570 13,260 The sample calculations were based on the survey results of the Multiple Indicator Cluster Survey (MICS) conducted in Myanmar in 2009-2010 (MICS 2009-2010): the average number of women 15-49 per household is 1.4 and 1.3 per urban household and rural household, respectively; women’s individual response rates were 98% and 97.4% in urban and rural areas, respectively; the average number of men 15- 49 per household is 1.2; men’s individual response rate was assumed to be 96%. The MICS 2009-2010 report showed a very high household response rate; 99.9% and 100% for the urban and rural areas, respectively. To be precocious, the MDHS assumed a household response rate of 98% for both urban and rural areas. Table A.5 Sample allocation of expected number of interviews by state/region and type of residence Expected number of interviews with women age 15-49 Expected number of interviews with men age 15-49 State/region Urban Rural Total Urban Rural Total Kachin 404 633 1,037 169 288 457 Kayah 282 744 1,026 119 339 458 Kayin 282 781 1,063 119 356 475 Chin 241 781 1,022 101 356 457 Sagaing 241 931 1,172 101 424 525 Tanintharyi 282 744 1,026 119 339 458 Bago 322 894 1,216 136 407 543 Magway 241 931 1,172 101 424 525 Mandalay 404 781 1,185 169 356 525 Mon 322 744 1,066 136 339 475 Rakhine 202 894 1,096 85 407 492 Yangon 847 447 1,294 356 203 559 Shan 322 856 1,178 136 389 525 Ayeyarwady 241 1,005 1,246 101 457 558 Nay Pyi Taw 322 708 1,030 136 321 457 Myanmar 4,955 11,874 16,829 2,084 5,405 7,489 * Male survey will be carried out in half of the households selected for the female survey. A.4 SAMPLE PROBABILITIES AND SAMPLING WEIGHTS Due to the nonproportional allocation of the sample to the different states/regions and the possible differences in response rates across states/regions, sampling weights are required for any analysis using 2015-16 MDHS data to ensure the actual representative of the survey results at the national level and state/region level. Since the 2015-16 MDHS sample is a two-stage stratified cluster sample, sampling weights were calculated based on sampling probabilities calculated separately for each sampling stage and for each cluster. The following notations were used where: P1hi: first-stage sampling probability of the ith EA in stratum h P2hi: second-stage sampling probability within the ith EA (household selection) Appendix A • 303 Let ah be the number of EAs selected in stratum h, Mhi the total population according to the sampling frame in the ith EA, and M hi the total population in the stratum h. The probability of selecting the ith EA in the 2015-16 MDHS sample is calculated as follows: M M a hi hih  Let hib be the proportion of households in the selected segment compared with the total number of households in the EA i in stratum h if the EA is segmented, otherwise 1hib . Then the probability of selecting EA i in the sample is: hi hi hih 1hi b M M a = P   Let hiL be the number of households listed in the census or in the household listing operation in the cluster i in stratum h, let hig be the number of households selected in the cluster. The second stage’s selection probability for each household in the cluster is calculated as follows: hi hi hi L g P 2 The overall selection probability of each household in cluster i of stratum h is therefore the product of the two-stage selection probabilities: hihihi PPP 21  The design weight for each household in cluster i of stratum h is the inverse of its overall selection probability: hihi PW /1 A spreadsheet containing all sampling parameters and selection probabilities was prepared to facilitate the calculation of the design weights. Design weights were adjusted for household nonresponse and also for individual nonresponse to get the sampling weights for female and male surveys, respectively. The differences of the household sampling weights and the individual sampling weights are introduced by individual nonresponse. Sampling weights for the domestic violence survey were calculated based on the number of eligible respondents in the households selected for the domestic violence module. The final sampling weights were normalized to give the total number of unweighted cases equal to the total number of weighted cases at national level, for both household weights and individual weights, respectively. The normalized weights are relative weights, which are valid for estimating means, proportions, and ratios, but not valid for estimating population totals and for pooled data. There are four sets of weights that were calculated:  One set for all households selected for the survey  One set for women’s individual survey  One set for households selected for the men’s survey  One set for the male individual survey  One set for the domestic violence survey 304 • Appendix A The number of weighted cases by using the normalized weight has no direct relation to the survey’s precision because it is relative; especially for oversampled areas, the number of weighted cases will be much smaller than the number of unweighted cases, which are directly related to survey precision. Sampling errors were calculated for selected indicators for the national sample, for the urban and rural areas separately, and for each of the 15 states and regions. A pp en di x A • 3 05 Ta bl e A .6 S am pl e im pl em en ta ti o n: W om en P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f th e ho us eh ol d an d in di vi du al in te rv ie w s, a nd h ou se ho ld , el ig ib le w om en a nd o ve ra ll w om en r es po ns e ra te s, a cc or di ng t o ur ba n- ru ra l re si de nc e an d re gi on ( un w ei gh te d) , M ya nm ar D H S 2 01 5- 16 R es ul t R es id en ce S ta te s/ R eg io ns T ot al U rb an R ur al K ac hi n K ay ah K ay in C hi n S ag ai ng T an in - th ar yi B ag o M ag - w ay M an - da la y M on R ak hi ne Y an go n S ha n A ye ya r- w ad y N ay P yi T aw S el ec te d ho u se ho ld s C om pl et ed ( C ) 92 .6 95 .1 93 .8 93 .0 94 .9 93 .0 98 .9 93 .6 96 .0 97 .2 94 .5 94 .2 94 .8 94 .8 89 .6 93 .0 94 .3 94 .4 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt a t h om e (H P ) 2. 6 1. 3 2. 9 2. 8 1. 3 1. 8 0. 0 0. 2 0. 8 1. 1 1. 1 1. 4 1. 1 1. 4 3. 0 1. 6 5. 3 1. 7 R ef us ed ( R ) 0. 6 0. 1 0. 4 0. 2 0. 0 0. 2 0. 0 0. 1 0. 1 0. 0 0. 4 0. 0 0. 0 0. 5 1. 7 0. 0 0. 1 0. 3 D w el lin g no t f ou nd ( D N F) 0. 2 0. 2 0. 0 0. 1 0. 0 0. 0 0. 0 0. 4 0. 0 0. 1 0. 6 0. 1 0. 1 0. 4 0. 3 0. 1 0. 1 0. 2 H ou se ho ld a bs en t ( H A ) 2. 0 1. 1 2. 5 1. 1 2. 7 0. 9 0. 6 3. 1 0. 5 1. 0 2. 4 1. 8 0. 9 1. 6 0. 7 0. 9 0. 1 1. 4 D w el lin g va ca nt /a dd re ss n ot a dw el lin g (D V ) 1. 1 0. 7 0. 1 0. 4 0. 0 2. 3 0. 4 0. 5 1. 0 0. 3 0. 5 0. 6 2. 2 0. 7 2. 0 1. 0 0. 0 0. 8 D w el lin g de st ro ye d (D D ) 0. 8 1. 3 0. 1 0. 9 1. 0 1. 7 0. 0 2. 0 1. 5 0. 3 0. 4 1. 8 0. 8 0. 5 2. 8 3. 2 0. 0 1. 1 O th er ( O ) 0. 1 0. 1 0. 2 1. 5 0. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed h ou se ho ld s 3, 67 2 9, 56 6 80 1 81 0 84 0 81 7 93 1 81 1 96 2 93 0 93 1 84 2 87 0 99 0 90 2 99 1 81 0 13 ,2 38 H ou se ho ld r es po ns e ra te ( H R R )1 96 .5 98 .3 96 .7 96 .7 98 .6 97 .8 10 0. 0 99 .2 99 .0 98 .8 97 .8 98 .4 98 .7 97 .6 94 .7 98 .2 94 .4 97 .8 E lig ib le w om en C om pl et ed ( E W C ) 93 .7 96 .7 94 .3 95 .0 97 .8 96 .8 97 .5 96 .4 97 .8 97 .4 96 .8 94 .8 93 .2 96 .5 89 .7 96 .3 95 .7 95 .8 N ot a t h om e (E W N H ) 3. 7 1. 9 2. 9 2. 3 1. 4 1. 5 1. 3 2. 6 1. 1 1. 3 2. 2 2. 5 4. 3 1. 5 7. 3 2. 2 2. 9 2. 5 P os tp on ed ( E W P ) 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. 0 0. 0 0. 0 0. 2 0. 0 0. 0 R ef us ed ( E W R ) 1. 5 0. 4 1. 3 1. 5 0. 1 0. 6 0. 7 0. 0 0. 1 0. 2 0. 4 1. 7 1. 3 1. 2 1. 7 0. 2 0. 3 0. 8 P ar tly c om pl et ed (E W P C ) 0. 2 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 1 0. 1 0. 2 0. 2 0. 0 0. 6 0. 1 In ca pa ci ta te d (E W I) 0. 8 0. 9 1. 5 1. 1 0. 7 1. 0 0. 4 0. 8 0. 9 1. 0 0. 6 0. 8 1. 0 0. 6 1. 0 1. 0 0. 5 0. 9 O th er ( E W O ) 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of w om en 4, 03 9 9, 41 5 85 3 79 7 76 8 77 5 1, 06 6 74 4 96 0 97 2 99 5 83 2 97 7 1, 10 4 86 7 95 4 79 0 13 ,4 54 E lig ib le w om en re sp on se r at e (E W R R )2 93 .7 96 .7 94 .3 95 .0 97 .8 96 .8 97 .5 96 .4 97 .8 97 .4 96 .8 94 .8 93 .2 96 .5 89 .7 96 .3 95 .7 95 .8 O ve ra ll w om en r es po ns e ra te (O R R )3 90 .4 95 .0 91 .1 91 .8 96 .5 94 .7 97 .5 95 .6 96 .9 96 .3 94 .6 93 .3 92 .0 94 .2 85 .0 94 .6 90 .4 93 .7 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C — — — — — — — — — — C + H P + P + R + D N F 2 T he e lig ib le w om en r es po ns e ra te (E W R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E W C ) 3 T he o ve ra ll w om en r es po ns e ra te ( O W R R ) i s ca lc ul at ed a s: O W R R = H R R * E W R R /1 00 30 6 • A pp en di x A Ta bl e A .7 S am pl e im pl em en ta ti o n: M en P er ce nt d is tr ib ut io n of h ou se ho ld s an d el ig ib le m en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le m en a nd o ve ra ll m en r es po ns e ra te s, a cc or di ng to u rb an -r ur al r es id en ce a nd re gi on ( un w ei gh te d) , M ya nm ar D H S 2 01 5- 16 R es id en ce S ta te s/ R eg io ns R es ul t U rb an R ur al K ac hi n K ay ah K ay in C hi n S ag ai ng T an in - th ar yi B ag o M ag - w ay M an - da la y M on R ak hi ne Y an go n S ha n A ye ya - rw ad y N ay P yi T aw T ot al S el ec te d ho u se ho ld s C om pl et ed ( C ) 92 .2 95 .0 93 .8 92 .1 95 .0 92 .9 99 .4 92 .3 95 .6 96 .1 93 .5 93 .3 95 .4 94 .3 90 .7 93 .5 93 .8 94 .2 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt a t h om e (H P ) 2. 4 1. 5 2. 5 3. 7 1. 2 1. 7 0. 0 0. 2 0. 8 1. 3 1. 3 1. 9 0. 9 1. 0 2. 2 1. 8 5. 9 1. 7 R ef us ed ( R ) 1. 0 0. 1 0. 7 0. 0 0. 0 0. 2 0. 0 0. 0 0. 2 0. 0 0. 9 0. 0 0. 0 1. 0 2. 2 0. 0 0. 0 0. 4 D w el lin g no t f ou nd ( D N F) 0. 3 0. 2 0. 0 0. 2 0. 0 0. 0 0. 0 0. 2 0. 0 0. 2 0. 9 0. 2 0. 0 0. 6 0. 2 0. 0 0. 2 0. 2 H ou se ho ld a bs en t ( H A ) 2. 1 1. 0 2. 7 1. 2 2. 4 0. 5 0. 4 3. 5 0. 6 1. 3 1. 9 1. 7 1. 1 2. 0 0. 4 0. 6 0. 0 1. 3 D w el lin g va ca nt /a dd re ss n ot a d w el lin g (D V ) 1. 1 0. 7 0. 0 0. 5 0. 0 2. 2 0. 2 1. 0 0. 8 0. 6 0. 9 0. 7 1. 8 0. 6 1. 3 1. 0 0. 0 0. 8 D w el lin g de st ro ye d (D D ) 0. 8 1. 4 0. 0 0. 5 1. 2 2. 4 0. 0 2. 7 1. 9 0. 4 0. 6 1. 9 0. 7 0. 4 2. 9 3. 0 0. 0 1. 3 O th er ( O ) 0. 2 0. 1 0. 2 1. 7 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed h ou se ho ld s 1, 83 8 4, 78 2 40 1 40 5 42 0 41 1 46 5 40 5 48 1 46 5 46 5 42 0 43 5 49 5 45 0 49 6 40 6 6, 62 0 H ou se ho ld r es po ns e ra te ( H R R )1 96 .2 98 .2 96 .7 95 .9 98 .8 97 .9 10 0. 0 99 .5 98 .9 98 .5 96 .9 97 .8 99 .0 97 .3 95 .1 98 .1 93 .8 97 .6 E lig ib le m en C om pl et ed ( E M C ) 87 .4 92 .2 87 .2 90 .1 95 .5 94 .6 96 .3 87 .1 92 .8 96 .0 91 .2 88 .5 88 .5 94 .6 78 .1 90 .8 89 .4 90 .8 N ot a t h om e (E M N H ) 9. 2 6. 2 10 .6 6. 5 2. 5 3. 2 2. 7 11 .2 5. 9 3. 3 6. 4 7. 6 9. 8 2. 6 17 .5 8. 0 9. 4 7. 1 R ef us ed ( E M R ) 1. 8 0. 3 0. 8 0. 3 0. 0 0. 6 0. 5 0. 0 0. 0 0. 3 1. 2 2. 3 0. 3 1. 4 1. 9 0. 2 0. 6 0. 7 P ar tly c om pl et ed (E M P C ) 0. 2 0. 1 0. 3 0. 0 0. 0 0. 0 0. 0 0. 3 0. 3 0. 0 0. 5 0. 3 0. 0 0. 2 0. 0 0. 0 0. 0 0. 1 In ca pa ci ta te d (E M I) 1. 3 1. 0 1. 1 2. 7 1. 6 1. 6 0. 5 0. 3 1. 1 0. 3 0. 7 1. 3 1. 0 1. 2 1. 9 0. 5 0. 6 1. 1 O th er ( E M O ) 0. 2 0. 2 0. 0 0. 3 0. 3 0. 0 0. 0 1. 0 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 5 0. 5 0. 0 0. 2 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of m en 1, 51 2 3, 70 6 37 6 29 3 31 4 31 3 40 9 28 6 37 3 30 3 40 8 30 4 29 5 42 7 36 6 40 1 35 0 5, 21 8 E lig ib le m en r es po ns e ra te (E M R R )2 87 .4 92 .2 87 .2 90 .1 95 .5 94 .6 96 .3 87 .1 92 .8 96 .0 91 .2 88 .5 88 .5 94 .6 78 .1 90 .8 89 .4 90 .8 O ve ra ll m en r es po ns e ra te (O R R )3 84 .0 90 .5 84 .3 86 .4 94 .4 92 .6 96 .3 86 .6 91 .8 94 .6 88 .3 86 .5 87 .6 92 .1 74 .3 89 .0 83 .9 88 .6 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C — — — — — — — — — — C + H P + P + R + D N F 2 T he e lig ib le m en r es po ns e ra te ( E M R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E M C ) 3 T he o ve ra ll m en re sp on se r at e (O M R R ) i s ca lc ul at ed a s: O M R R = H R R * E M R R /1 00 Appendix B • 307 ESTIMATES OF SAMPLING ERRORS Appendix B he estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2015-16 MDHS is only one of many samples that could have been selected from the same population, using the same design and expected 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 among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2015-16 MDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed by SAS programs developed by ICF. These programs use the Taylor linearization method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance:                     H h h h m i hi h h m z z m m x f rvarrSE h 1 2 1 2 2 2 1 1 )()( in which hihihi rxyz  , and hhh rxyz  where h represents the stratum, which varies from 1 to H, mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and fh is the sampling fraction of PSU in the hth stratum. T 308 • Appendix B The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulas. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the 2015-16 MDHS there were 441 non-empty clusters. Hence, 441 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )      in which )()1( ii rkkrr  where r is the estimate computed from the full sample of 441 clusters, r(i) is the estimate computed from the reduced sample of 440 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, the design effect (DEFT) for each estimate is also calculated. The design effect is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design, such as multistage and cluster selection. Relative standard errors and confidence limits for the estimates are also calculated. Sampling errors for the 2015-16 MDHS are calculated for selected variables considered to be of primary interest for the woman’s and the man’s surveys. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the 15 states/regions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 to B.19 present the value of the statistic (R), its standard error (SE), the number of unweighted (N-UNWE) and weighted (N-WEIG) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to child-bearing. The confidence interval (e.g., as calculated for children ever born to women over age 40) can be interpreted as follows: the overall average from the national sample is 3.028 and its standard error is 0.065. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, that is, 3.028±2×0.065. There is a high probability (95 percent) that the true average number of children ever born to all women over age 40 is between 2.898 and 3.158. For the total sample, the value of the design effect (DEFT), averaged over all variables for the women’s survey, is 1.517 which means that, due to multistage and clustering of the sample, the average standard error is increased by a factor of 1.517 over that in an equivalent simple random sample. Appendix B • 309 Table B.1 List of selected variables for sampling errors, Myanmar 2015-16 Variable Estimate Base population WOMEN Urban residence Proportion Ever-married women 15-49 Literacy Proportion Ever-married women 15-49 No education Proportion Ever-married women 15-49 Secondary education or higher Proportion Ever-married women 15-49 Never married/never in union Proportion All women 15-49 Currently married/in union Proportion All women 15-49 Married before age 20 Proportion All women 20-49 Had sexual intercourse before age 18 Proportion All women 20-49 Currently pregnant Proportion All women 15-49 Children ever born Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women age 40-49 Mean All women 40-49 Know any contraceptive method Proportion Currently married women 15-49 Know a modern method Proportion Currently married women 15-49 Currently using any method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using condoms Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using implants Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Used public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay next birth at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mothers received ANC for last birth from skilled provider Proportion Women with a live birth in last five years Mothers protected against tetanus for last birth Proportion Women with a live birth in last five years Births with skilled attendant at delivery Proportion Births occurring 1-59 months before survey Had diarrhea in the past 2 weeks Proportion Children under 5 Treated with ORS Proportion Children under 5 with diarrhea in past 2 weeks Sought medical treatment for diarrhea Proportion Children under 5 with diarrhea in past 2 weeks Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received Penvavalent vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all vaccinations Proportion Children 12-23 months Height-for-age (-2SD) Proportion Children under 5 who are measured Weight-for-height (-2SD) Proportion Children under 5 who are measured Weight-for-age (-2SD) Proportion Children under 5 who are measured Body Mass Index (BMI) <18.5 Proportion All women 15-49 who were measured Prevalence of anemia (children 6-59 months) Proportion All children 6-59 months who were tested Prevalence of anemia (women 15-49) Proportion All women 15-49 who were tested Had an HIV test and received results in past 12 months Proportion Ever-married women 15-49 Accepting attitudes towards people with HIV Proportion All women who have heard of HIV/AIDS Ever experienced any physical violence since age 15 Proportion Ever-married women 15-49 Ever experienced any sexual violence Proportion Ever-married women 15-49 Ever experienced any physical/sexual violence by husband Proportion Ever-married women 15-49 Ever experienced any physica/sexual violence in the past 12 months Proportion Ever-married women 15-49 Total fertility rate (3 years) Rate Women-years of exposure to childbearing Neonatal mortality rate¹ Rate Children exposed to the risk of mortality Postneonatal mortality rate¹ Rate Children exposed to the risk of mortality Infant mortality rate¹ Rate Children exposed to the risk of mortality Child mortality rate¹ Rate Children exposed to the risk of mortality Under-5 mortality rate¹ Rate Children exposed to the risk of mortality MEN Urban residence Proportion Ever-married men 15-49 Literacy Proportion Ever-married men 15-49 No education Proportion Ever-married men 15-49 Secondary education or higher Proportion Ever-married men 15-49 Never married/never in union Proportion All men 15-49 Currently married/in union Proportion All men 15-49 Had sexual intercourse before age 18 Proportion All men 20-49 Know any contraceptive method Proportion Currently married men 15-49 Know a modern method Proportion Currently married men 15-49 Want no more children Proportion Currently married men 15-49 Want to delay next birth at least 2 years Proportion Currently married men 15-49 Ideal number of children Mean All men 15-49 Had an HIV test and received results in past 12 months Proportion Ever-married men 15-49 Accepting attitudes towards people with HIV Proportion All men who have heard of HIV/AIDS 1 The mortality rates are calculated for 5 years and 10 years before the survey for the national sample and regional samples, respectively 310 • Appendix B Table B.2 Sampling errors: National sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.292 0.007 12885 12885 1.707 0.023 0.279 0.306 Literacy 0.883 0.006 12885 12885 1.949 0.006 0.872 0.894 No education 0.125 0.008 12885 12885 2.772 0.065 0.108 0.141 Secondary or higher education 0.463 0.011 12885 12885 2.397 0.023 0.442 0.485 Never married (never in union) 0.332 0.006 12885 12885 1.407 0.018 0.320 0.344 Currently married (in union) 0.602 0.006 12885 12885 1.385 0.010 0.590 0.614 Married before age 20 0.343 0.008 11050 11075 1.776 0.023 0.327 0.359 Had sexual intercourse before age 18 0.165 0.006 11050 11075 1.653 0.035 0.153 0.177 Currently pregnant 0.036 0.002 12885 12885 1.205 0.055 0.032 0.040 Children ever born 1.636 0.028 12885 12885 1.623 0.017 1.581 1.692 Children surviving 1.463 0.024 12885 12885 1.580 0.016 1.416 1.510 Children ever born to women age 40-49 3.028 0.065 3388 3351 1.618 0.021 2.898 3.158 Know any contraceptive method 0.985 0.003 7870 7759 1.914 0.003 0.980 0.990 Know a modern method 0.984 0.003 7870 7759 1.925 0.003 0.979 0.990 Currently using any method 0.522 0.008 7870 7759 1.455 0.016 0.506 0.539 Currently using a modern method 0.513 0.008 7870 7759 1.468 0.016 0.496 0.529 Currently using pill 0.138 0.006 7870 7759 1.425 0.040 0.127 0.149 Currently using IUD 0.028 0.003 7870 7759 1.691 0.112 0.022 0.035 Currently using condoms 0.010 0.002 7870 7759 1.405 0.157 0.007 0.013 Currently using injectables 0.276 0.007 7870 7759 1.364 0.025 0.262 0.290 Currently using implants 0.009 0.001 7870 7759 1.229 0.146 0.006 0.011 Currently using female sterilization 0.048 0.003 7870 7759 1.368 0.069 0.041 0.054 Using public sector source 0.542 0.012 3774 3996 1.524 0.023 0.517 0.566 Want no more children 0.605 0.007 7870 7759 1.233 0.011 0.592 0.619 Want to delay next birth at least 2 years 0.184 0.006 7870 7759 1.345 0.032 0.173 0.196 Ideal number of children 2.533 0.025 11723 11874 1.836 0.010 2.483 2.582 Mothers received antenatal care for last birth 0.807 0.015 3867 3583 2.293 0.019 0.777 0.837 Mothers protected against tetanus for last birth 0.719 0.013 3867 3583 1.760 0.018 0.693 0.745 Births with skilled attendant at delivery 0.602 0.019 4815 4286 2.246 0.032 0.564 0.640 Had diarrhea in the last 2 weeks 0.104 0.006 4597 4099 1.260 0.059 0.092 0.116 Treated with ORS 0.619 0.031 550 427 1.321 0.050 0.556 0.681 Sought medical treatment for diarrhea 0.537 0.030 550 427 1.237 0.057 0.477 0.598 Vaccination card seen 0.449 0.023 915 852 1.321 0.050 0.404 0.495 Received BCG vaccination 0.878 0.018 915 852 1.576 0.020 0.842 0.914 Received Pentavalent vaccination (3 doses) 0.623 0.023 915 852 1.404 0.038 0.576 0.670 Received polio vaccination (3 doses) 0.670 0.023 915 852 1.427 0.034 0.624 0.717 Received measles vaccination 0.771 0.021 915 852 1.456 0.027 0.729 0.813 Received all vaccinations 0.548 0.024 915 852 1.397 0.044 0.500 0.596 Height-for-age (-2SD) 0.292 0.010 4640 4089 1.312 0.033 0.272 0.311 Weight-for-height (-2SD) 0.070 0.005 4620 4076 1.248 0.072 0.060 0.080 Weight-for-age (-2SD) 0.189 0.008 4645 4100 1.272 0.043 0.173 0.206 Prevalence of anemia (children 6-59 months) 0.578 0.010 3926 3376 1.213 0.018 0.557 0.599 Prevalence of anemia (women 15-49) 0.465 0.007 12516 12489 1.642 0.016 0.451 0.480 Body Mass Index (BMI) < 18.5 0.155 0.005 12053 12100 1.376 0.029 0.146 0.164 Had an HIV test and received results in past 12 months 0.048 0.003 12885 12885 1.414 0.055 0.043 0.054 Accepting attitudes towards people with HIV 0.200 0.007 11742 11797 1.893 0.035 0.186 0.214 Ever experienced any physical violence since age 15 0.154 0.007 4530 4530 1.369 0.048 0.139 0.168 Ever experienced any sexual violence 0.027 0.003 4530 4530 1.339 0.120 0.020 0.033 Ever experienced any physical/sexual violence by any husband 0.173 0.009 3425 3059 1.388 0.052 0.155 0.191 Physical/sexual violence in the last 12 months by any husband 0.110 0.007 3425 3059 1.345 0.065 0.096 0.125 Total fertility rate (last 3 years) 2.279 0.068 37018 37015 1.469 0.030 2.143 2.415 Neonatal mortality (last 0-4 years) 24.546 2.956 4875 4340 1.081 0.120 18.633 30.459 Post-neonatal mortality (last 0-4 years) 15.772 2.869 4876 4348 1.326 0.182 10.034 21.510 Infant mortality (last 0-4 years) 40.318 4.144 4879 4344 1.191 0.103 32.030 48.605 Child mortality (last 0-4 years) 10.085 1.775 4816 4325 1.183 0.176 6.535 13.635 Under-5 mortality (last 0-4 years) 49.996 4.689 4897 4360 1.238 0.094 40.619 59.373 MEN Urban residence 0.285 0.009 4737 4737 1.343 0.031 0.267 0.303 Literacy 0.905 0.009 4737 4737 2.142 0.010 0.887 0.924 No education 0.121 0.009 4737 4737 1.887 0.074 0.103 0.139 Secondary or higher education 0.523 0.013 4737 4737 1.722 0.024 0.498 0.548 Never married (in union) 0.347 0.009 4737 4737 1.280 0.025 0.330 0.365 Currently married (in union) 0.624 0.009 4737 4737 1.271 0.014 0.606 0.642 Had first sexual intercourse before age 18 0.074 0.005 3969 4006 1.229 0.069 0.063 0.084 Knows any contraceptive method 0.969 0.006 2916 2957 1.768 0.006 0.958 0.981 Knows any modern contraceptive method 0.966 0.006 2916 2957 1.721 0.006 0.954 0.978 Want no more children 0.456 0.011 2916 2957 1.228 0.025 0.433 0.479 Want to delay birth at least 2 years 0.253 0.011 2916 2957 1.305 0.042 0.232 0.274 Ideal family size 2.808 0.046 4472 4477 1.852 0.016 2.716 2.901 Had HIV test and received results in past 12 months 0.052 0.004 4737 4737 1.387 0.086 0.043 0.061 Accepting attitudes towards people with HIV 0.189 0.007 4388 4358 1.243 0.039 0.174 0.204 Appendix B • 311 Table B.3 Sampling errors: Urban sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 1.000 0.000 3785 3768 na 0.000 1.000 1.000 Literacy 0.955 0.004 3785 3768 1.319 0.005 0.946 0.964 No education 0.051 0.010 3785 3768 2.694 0.189 0.032 0.071 Secondary or higher education 0.721 0.018 3785 3768 2.501 0.025 0.684 0.757 Never married (never in union) 0.393 0.012 3785 3768 1.473 0.030 0.370 0.417 Currently married (in union) 0.537 0.011 3785 3768 1.410 0.021 0.514 0.560 Married before age 20 0.245 0.015 3213 3178 1.975 0.061 0.215 0.275 Had sexual intercourse before age 18 0.110 0.010 3213 3178 1.725 0.087 0.091 0.129 Currently pregnant 0.028 0.003 3785 3768 1.218 0.116 0.022 0.035 Children ever born 1.214 0.039 3785 3768 1.538 0.032 1.136 1.292 Children surviving 1.140 0.036 3785 3768 1.558 0.032 1.067 1.213 Children ever born to women age 40-49 2.321 0.095 1018 988 1.596 0.041 2.132 2.510 Know any contraceptive method 0.998 0.001 2057 2022 1.169 0.001 0.996 1.000 Know a modern method 0.997 0.002 2057 2022 1.772 0.002 0.993 1.001 Currently using any method 0.596 0.014 2057 2022 1.295 0.024 0.568 0.624 Currently using a modern method 0.573 0.014 2057 2022 1.286 0.024 0.545 0.601 Currently using pill 0.181 0.011 2057 2022 1.315 0.062 0.159 0.203 Currently using IUD 0.043 0.007 2057 2022 1.520 0.159 0.029 0.056 Currently using condoms 0.021 0.004 2057 2022 1.405 0.210 0.012 0.030 Currently using injectables 0.214 0.014 2057 2022 1.602 0.068 0.185 0.243 Currently using implants 0.013 0.003 2057 2022 1.061 0.204 0.008 0.018 Currently using female sterilization 0.096 0.008 2057 2022 1.305 0.088 0.079 0.113 Using public sector source 0.344 0.020 1131 1168 1.399 0.057 0.305 0.384 Want no more children 0.640 0.015 2057 2022 1.380 0.023 0.611 0.670 Want to delay next birth at least 2 years 0.171 0.014 2057 2022 1.665 0.081 0.143 0.199 Ideal number of children 2.234 0.037 3484 3462 1.724 0.016 2.161 2.308 Mothers received antenatal care for last birth 0.944 0.013 881 838 1.594 0.013 0.919 0.969 Mothers protected against tetanus for last birth 0.805 0.018 881 838 1.359 0.023 0.768 0.842 Births with skilled attendant at delivery 0.878 0.024 1012 953 2.046 0.028 0.830 0.927 Had diarrhea in the last 2 weeks 0.084 0.011 980 925 1.207 0.132 0.062 0.106 Treated with ORS 0.671 0.056 91 77 1.068 0.083 0.560 0.783 Sought medical treatment for diarrhea 0.487 0.058 91 77 1.012 0.119 0.371 0.603 Vaccination card seen 0.553 0.038 209 220 1.134 0.069 0.477 0.628 Received BCG vaccination 0.918 0.027 209 220 1.399 0.029 0.864 0.972 Received DPT vaccination (3 doses) 0.752 0.034 209 220 1.165 0.045 0.684 0.820 Received polio vaccination (3 doses) 0.760 0.036 209 220 1.246 0.047 0.688 0.832 Received measles vaccination 0.817 0.035 209 220 1.320 0.043 0.747 0.887 Received all vaccinations 0.675 0.038 209 220 1.194 0.056 0.599 0.750 Height-for-age (-2SD) 0.200 0.016 950 876 1.141 0.078 0.169 0.231 Weight-for-height (-2SD) 0.089 0.013 948 874 1.303 0.142 0.064 0.114 Weight-for-age (-2SD) 0.151 0.015 953 881 1.253 0.101 0.120 0.181 Prevalence of anemia (children 6-59 months) 0.587 0.022 772 699 1.173 0.037 0.543 0.631 Prevalence of anemia (women 15-49) 0.465 0.016 3593 3554 1.889 0.034 0.433 0.496 Body Mass Index (BMI) < 18.5 0.126 0.007 3543 3521 1.218 0.054 0.113 0.140 Had an HIV test and received results in past 12 months 0.076 0.005 3785 3768 1.253 0.071 0.065 0.087 Accepting attitudes towards people with HIV 0.295 0.014 3702 3695 1.867 0.047 0.267 0.323 Ever experienced any physical violence since age 15 0.129 0.013 1208 1300 1.374 0.103 0.102 0.155 Ever experienced any sexual violence 0.029 0.008 1208 1300 1.615 0.270 0.013 0.045 Ever experienced any physical/sexual violence by any husband 0.152 0.018 832 796 1.452 0.119 0.116 0.188 Physical/sexual violence in the last 12 months by any husband 0.089 0.015 832 796 1.477 0.164 0.060 0.118 Total fertility rate (last 3 years) 1.914 0.108 10866 10808 1.486 0.056 1.698 2.130 Neonatal mortality (last 0-9 years) 17.892 3.736 2108 1951 0.986 0.209 10.419 25.364 Post-neonatal mortality (last 0-9 years) 18.828 4.406 2111 1958 1.281 0.234 10.015 27.640 Infant mortality (last 0-9 years) 36.719 5.708 2111 1956 1.183 0.155 25.303 48.136 Child mortality (last 0-9 years) 5.064 1.998 2096 1915 1.213 0.395 1.068 9.060 Under-five mortality (last 0-9 years) 41.597 6.132 2114 1960 1.180 0.147 29.334 53.861 MEN Urban residence 1.000 0.000 1321 1350 na 0.000 1.000 1.000 Literacy 0.961 0.011 1321 1350 2.016 0.011 0.939 0.982 No education 0.045 0.011 1321 1350 1.941 0.246 0.023 0.067 Secondary or higher education 0.754 0.021 1321 1350 1.807 0.028 0.711 0.797 Never married (in union) 0.403 0.015 1321 1350 1.117 0.037 0.373 0.433 Currently married (in union) 0.568 0.015 1321 1350 1.104 0.027 0.538 0.598 Had first sexual intercourse before age 18 0.065 0.009 1107 1130 1.220 0.139 0.047 0.083 Knows any contraceptive method 0.990 0.004 749 767 1.102 0.004 0.982 0.998 Knows any modern contraceptive method 0.990 0.004 749 767 1.102 0.004 0.982 0.998 Want no more children 0.477 0.027 749 767 1.467 0.056 0.424 0.531 Want to delay birth at least 2 years 0.257 0.021 749 767 1.304 0.081 0.215 0.299 Ideal family size 2.442 0.063 1259 1292 1.658 0.026 2.316 2.568 Had HIV test and received results in past 12 months 0.100 0.011 1321 1350 1.356 0.112 0.078 0.123 Accepting attitudes towards people with HIV 0.269 0.013 1296 1320 1.053 0.048 0.243 0.295 na=not applicable 312 • Appendix B Table B.4 Sampling errors: Rural sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.000 0.000 9100 9117 na na 0.000 0.000 Literacy 0.853 0.008 9100 9117 2.022 0.009 0.838 0.868 No education 0.155 0.011 9100 9117 2.786 0.068 0.134 0.176 Secondary or higher education 0.357 0.012 9100 9117 2.483 0.035 0.332 0.382 Never married (never in union) 0.307 0.007 9100 9117 1.403 0.022 0.293 0.320 Currently married (in union) 0.629 0.007 9100 9117 1.381 0.011 0.615 0.643 Married before age 20 0.383 0.009 7837 7897 1.715 0.025 0.364 0.402 Had sexual intercourse before age 18 0.187 0.007 7837 7897 1.638 0.039 0.173 0.202 Currently pregnant 0.039 0.002 9100 9117 1.198 0.062 0.034 0.044 Children ever born 1.811 0.035 9100 9117 1.647 0.020 1.740 1.882 Children surviving 1.597 0.029 9100 9117 1.587 0.018 1.538 1.656 Children ever born to women age 40-49 3.324 0.081 2370 2362 1.625 0.024 3.161 3.487 Know any contraceptive method 0.980 0.004 5813 5737 1.934 0.004 0.973 0.987 Know a modern method 0.980 0.004 5813 5737 1.932 0.004 0.973 0.987 Currently using any method 0.496 0.010 5813 5737 1.501 0.020 0.477 0.516 Currently using a modern method 0.491 0.010 5813 5737 1.519 0.020 0.471 0.511 Currently using pill 0.123 0.006 5813 5737 1.456 0.051 0.111 0.136 Currently using IUD 0.023 0.004 5813 5737 1.795 0.153 0.016 0.030 Currently using condoms 0.006 0.001 5813 5737 1.451 0.241 0.003 0.009 Currently using injectables 0.298 0.008 5813 5737 1.295 0.026 0.283 0.314 Currently using implants 0.007 0.001 5813 5737 1.324 0.201 0.004 0.010 Currently using female sterilization 0.031 0.003 5813 5737 1.422 0.104 0.024 0.037 Using public sector source 0.623 0.015 2643 2828 1.563 0.024 0.594 0.653 Want no more children 0.593 0.008 5813 5737 1.191 0.013 0.577 0.608 Want to delay next birth at least 2 years 0.189 0.006 5813 5737 1.230 0.033 0.176 0.202 Ideal number of children 2.655 0.032 8239 8413 1.874 0.012 2.592 2.718 Mothers received antenatal care for last birth 0.765 0.019 2986 2744 2.345 0.025 0.727 0.802 Mothers protected against tetanus for last birth 0.692 0.016 2986 2744 1.837 0.023 0.660 0.724 Births with skilled attendant at delivery 0.523 0.022 3803 3333 2.282 0.042 0.478 0.567 Had diarrhea in the last 2 weeks 0.110 0.007 3617 3174 1.272 0.065 0.096 0.125 Treated with ORS 0.607 0.036 459 350 1.368 0.059 0.535 0.679 Sought medical treatment for diarrhea 0.548 0.035 459 350 1.283 0.063 0.479 0.618 Vaccination card seen 0.413 0.027 706 631 1.368 0.065 0.360 0.467 Received BCG vaccination 0.864 0.022 706 631 1.610 0.026 0.820 0.908 Received DPT vaccination (3 doses) 0.578 0.029 706 631 1.452 0.050 0.521 0.635 Received polio vaccination (3 doses) 0.639 0.028 706 631 1.460 0.044 0.583 0.695 Received measles vaccination 0.755 0.025 706 631 1.489 0.034 0.704 0.806 Received all vaccinations 0.504 0.029 706 631 1.441 0.057 0.447 0.561 Height-for-age (-2SD) 0.316 0.011 3690 3213 1.321 0.035 0.294 0.339 Weight-for-height (-2SD) 0.065 0.006 3672 3202 1.240 0.085 0.054 0.076 Weight-for-age (-2SD) 0.200 0.009 3692 3219 1.277 0.047 0.181 0.219 Prevalence of anemia (children 6-59 months) 0.575 0.012 3154 2676 1.220 0.021 0.552 0.599 Prevalence of anemia (women 15-49) 0.466 0.008 8923 8935 1.533 0.017 0.449 0.482 Body Mass Index (BMI) < 18.5 0.167 0.006 8510 8579 1.421 0.034 0.156 0.179 Had an HIV test and received results in past 12 months 0.037 0.003 9100 9117 1.522 0.081 0.031 0.043 Accepting attitudes towards people with HIV 0.158 0.008 8040 8102 1.889 0.049 0.142 0.173 Ever experienced any physical violence since age 15 0.164 0.009 3322 3230 1.378 0.054 0.146 0.182 Ever experienced any sexual violence 0.026 0.003 3322 3230 1.171 0.124 0.020 0.033 Ever experienced any physical/sexual violence by any husband 0.180 0.010 2593 2262 1.374 0.058 0.159 0.201 Physical/sexual violence in the last 12 months by any husband 0.118 0.008 2593 2262 1.311 0.070 0.101 0.135 Total fertility rate (last 3 years) 2.427 0.084 26151 26207 1.467 0.035 2.259 2.595 Neonatal mortality (last 0-9 years) 35.796 2.746 7940 7083 1.093 0.077 30.304 41.288 Post-neonatal mortality (last 0-9 years) 28.633 3.225 7964 7103 1.460 0.113 22.182 35.083 Infant mortality (last 0-9 years) 64.428 4.201 7951 7090 1.257 0.065 56.027 72.830 Child mortality (last 0-9 years) 16.755 2.064 7995 7178 1.266 0.123 12.628 20.883 Under-five mortality (last 0-9 years) 80.104 5.081 7999 7125 1.357 0.063 69.943 90.266 MEN Urban residence 0.000 0.000 3416 3387 na na 0.000 0.000 Literacy 0.883 0.012 3416 3387 2.166 0.013 0.860 0.907 No education 0.152 0.012 3416 3387 1.892 0.077 0.129 0.175 Secondary or higher education 0.431 0.015 3416 3387 1.784 0.035 0.401 0.461 Never married (in union) 0.325 0.011 3416 3387 1.361 0.034 0.303 0.347 Currently married (in union) 0.647 0.011 3416 3387 1.351 0.017 0.624 0.669 Had first sexual intercourse before age 18 0.077 0.006 2862 2875 1.235 0.080 0.065 0.089 Knows any contraceptive method 0.962 0.007 2167 2190 1.818 0.008 0.947 0.977 Knows any modern contraceptive method 0.957 0.008 2167 2190 1.762 0.008 0.942 0.973 Want no more children 0.449 0.012 2167 2190 1.141 0.027 0.424 0.473 Want to delay birth at least 2 years 0.251 0.012 2167 2190 1.303 0.048 0.227 0.276 Ideal family size 2.957 0.059 3213 3185 1.909 0.020 2.838 3.076 Had HIV test and received results in past 12 months 0.033 0.004 3416 3387 1.372 0.127 0.025 0.041 Accepting attitudes towards people with HIV 0.154 0.009 3092 3039 1.374 0.058 0.136 0.172 na=not applicable Appendix B • 313 Table B.5 Sampling errors: Kachin sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.343 0.035 804 374 2.063 0.101 0.274 0.412 Literacy 0.907 0.013 804 374 1.226 0.014 0.882 0.932 No education 0.028 0.009 804 374 1.618 0.337 0.009 0.047 Secondary or higher education 0.585 0.033 804 374 1.923 0.057 0.518 0.652 Never married (never in union) 0.287 0.015 804 374 0.967 0.054 0.256 0.318 Currently married (in union) 0.636 0.021 804 374 1.250 0.033 0.593 0.678 Married before age 20 0.365 0.028 679 315 1.517 0.077 0.309 0.422 Had sexual intercourse before age 18 0.179 0.023 679 315 1.534 0.126 0.134 0.224 Currently pregnant 0.059 0.010 804 374 1.146 0.161 0.040 0.078 Children ever born 2.005 0.100 804 374 1.364 0.050 1.804 2.205 Children surviving 1.795 0.078 804 374 1.205 0.043 1.640 1.951 Children ever born to women age 40-49 3.535 0.223 224 102 1.504 0.063 3.088 3.981 Know any contraceptive method 0.993 0.005 505 238 1.325 0.005 0.983 1.003 Know a modern method 0.993 0.005 505 238 1.325 0.005 0.983 1.003 Currently using any method 0.435 0.033 505 238 1.486 0.075 0.370 0.501 Currently using a modern method 0.416 0.035 505 238 1.574 0.083 0.347 0.486 Currently using pill 0.150 0.023 505 238 1.458 0.155 0.103 0.196 Currently using IUD 0.009 0.004 505 238 0.864 0.415 0.001 0.016 Currently using condoms 0.030 0.008 505 238 1.032 0.261 0.014 0.046 Currently using injectables 0.171 0.029 505 238 1.705 0.168 0.114 0.228 Currently using implants 0.009 0.007 505 238 1.687 0.779 0.000 0.024 Currently using female sterilization 0.040 0.010 505 238 1.138 0.247 0.020 0.060 Using public sector source 0.498 0.053 194 99 1.458 0.106 0.393 0.603 Want no more children 0.578 0.022 505 238 0.997 0.038 0.534 0.622 Want to delay next birth at least 2 years 0.169 0.027 505 238 1.641 0.162 0.114 0.224 Ideal number of children 3.022 0.072 778 362 1.267 0.024 2.877 3.167 Mothers received antenatal care for last birth 0.800 0.055 277 133 2.280 0.068 0.691 0.909 Mothers protected against tetanus for last birth 0.802 0.041 277 133 1.703 0.051 0.720 0.883 Births with skilled attendant at delivery 0.637 0.058 353 168 2.028 0.092 0.520 0.754 Had diarrhea in the last 2 weeks 0.200 0.039 340 162 1.662 0.197 0.121 0.278 Treated with ORS 0.635 0.120 56 32 1.958 0.189 0.395 0.874 Sought medical treatment for diarrhea 0.522 0.105 56 32 1.591 0.201 0.312 0.731 Vaccination card seen 0.553 0.097 60 26 1.413 0.176 0.359 0.747 Received BCG vaccination 0.912 0.036 60 26 0.930 0.039 0.840 0.983 Received DPT vaccination (3 doses) 0.736 0.081 60 26 1.294 0.110 0.575 0.898 Received polio vaccination (3 doses) 0.704 0.091 60 26 1.421 0.130 0.521 0.886 Received measles vaccination 0.819 0.046 60 26 0.883 0.056 0.726 0.911 Received all vaccinations 0.594 0.083 60 26 1.223 0.140 0.428 0.761 Height-for-age (-2SD) 0.361 0.041 321 154 1.491 0.114 0.279 0.443 Weight-for-height (-2SD) 0.040 0.022 321 154 1.986 0.548 0.000 0.084 Weight-for-age (-2SD) 0.173 0.048 321 154 2.030 0.275 0.078 0.268 Prevalence of anemia (children 6-59 months) 0.478 0.030 296 141 1.031 0.063 0.418 0.538 Prevalence of anemia (women 15-49) 0.366 0.019 780 363 1.122 0.053 0.327 0.405 Body Mass Index (BMI) < 18.5 0.101 0.024 727 339 2.135 0.236 0.053 0.149 Had an HIV test and received results in past 12 months 0.069 0.011 804 374 1.276 0.165 0.046 0.092 Accepting attitudes towards people with HIV 0.259 0.021 772 358 1.319 0.080 0.218 0.301 Ever experienced any physical violence since age 15 0.239 0.034 272 128 1.304 0.142 0.171 0.307 Ever experienced any sexual violence 0.045 0.013 272 128 0.995 0.278 0.020 0.070 Ever experienced any physical/sexual violence by any husband 0.260 0.032 212 91 1.059 0.123 0.196 0.324 Physical/sexual violence in the last 12 months by any husband 0.225 0.038 212 91 1.317 0.169 0.149 0.300 Total fertility rate (last 3 years) 2.979 0.278 2293 1067 1.313 0.093 2.422 3.535 Neonatal mortality (last 0-9 years) 30.252 9.883 724 344 1.404 0.327 10.485 50.018 Post-neonatal mortality (last 0-9 years) 19.577 5.497 725 346 0.957 0.281 8.583 30.572 Infant mortality (last 0-9 years) 49.829 10.662 726 346 1.151 0.214 28.504 71.154 Child mortality (last 0-9 years) 11.672 4.431 731 349 0.970 0.380 2.811 20.534 Under-five mortality (last 0-9 years) 60.920 11.503 728 347 1.121 0.189 37.914 83.926 MEN Urban residence 0.315 0.045 328 161 1.733 0.142 0.226 0.405 Literacy 0.962 0.011 328 161 1.064 0.012 0.939 0.984 No education 0.067 0.016 328 161 1.164 0.241 0.035 0.099 Secondary or higher education 0.579 0.045 328 161 1.652 0.078 0.489 0.670 Never married (in union) 0.388 0.031 328 161 1.153 0.080 0.326 0.450 Currently married (in union) 0.580 0.031 328 161 1.131 0.053 0.518 0.641 Had first sexual intercourse before age 18 0.077 0.019 283 141 1.173 0.242 0.040 0.114 Knows any contraceptive method 0.977 0.010 186 93 0.932 0.010 0.957 0.998 Knows any modern contraceptive method 0.977 0.010 186 93 0.932 0.010 0.957 0.998 Want no more children 0.449 0.038 186 93 1.046 0.085 0.372 0.525 Want to delay birth at least 2 years 0.214 0.025 186 93 0.843 0.119 0.163 0.265 Ideal family size 3.395 0.160 312 154 1.735 0.047 3.075 3.716 Had HIV test and received results in past 12 months 0.037 0.010 328 161 0.941 0.266 0.017 0.056 Accepting attitudes towards people with HIV 0.279 0.025 320 156 1.003 0.090 0.229 0.330 314 • Appendix B Table B.6 Sampling errors: Kayah sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.273 0.016 757 65 0.957 0.057 0.242 0.304 Literacy 0.927 0.011 757 65 1.123 0.011 0.906 0.948 No education 0.147 0.029 757 65 2.260 0.199 0.089 0.205 Secondary or higher education 0.552 0.033 757 65 1.821 0.060 0.486 0.618 Never married (never in union) 0.314 0.020 757 65 1.168 0.063 0.274 0.353 Currently married (in union) 0.618 0.023 757 65 1.324 0.038 0.572 0.665 Married before age 20 0.324 0.026 651 56 1.422 0.081 0.272 0.376 Had sexual intercourse before age 18 0.147 0.020 651 56 1.435 0.136 0.107 0.187 Currently pregnant 0.048 0.009 757 65 1.188 0.192 0.030 0.067 Children ever born 2.079 0.137 757 65 1.569 0.066 1.805 2.353 Children surviving 1.911 0.117 757 65 1.494 0.061 1.677 2.145 Children ever born to women age 40-49 3.878 0.339 185 16 1.519 0.087 3.200 4.556 Know any contraceptive method 0.998 0.002 468 40 0.995 0.002 0.994 1.002 Know a modern method 0.998 0.002 468 40 0.995 0.002 0.994 1.002 Currently using any method 0.545 0.041 468 40 1.790 0.076 0.462 0.628 Currently using a modern method 0.506 0.046 468 40 1.981 0.091 0.414 0.598 Currently using pill 0.102 0.022 468 40 1.591 0.219 0.058 0.147 Currently using IUD 0.040 0.010 468 40 1.146 0.261 0.019 0.060 Currently using condoms 0.011 0.004 468 40 0.940 0.421 0.002 0.019 Currently using injectables 0.221 0.027 468 40 1.425 0.124 0.167 0.276 Currently using implants 0.007 0.004 468 40 0.969 0.551 0.000 0.014 Currently using female sterilization 0.102 0.023 468 40 1.633 0.224 0.056 0.148 Using public sector source 0.724 0.033 236 20 1.135 0.046 0.658 0.791 Want no more children 0.581 0.033 468 40 1.447 0.057 0.515 0.647 Want to delay next birth at least 2 years 0.208 0.022 468 40 1.144 0.103 0.165 0.251 Ideal number of children 3.246 0.139 609 52 2.172 0.043 2.968 3.524 Mothers received antenatal care for last birth 0.933 0.021 276 24 1.358 0.022 0.891 0.974 Mothers protected against tetanus for last birth 0.759 0.031 276 24 1.202 0.041 0.697 0.821 Births with skilled attendant at delivery 0.532 0.066 379 32 2.153 0.124 0.400 0.664 Had diarrhea in the last 2 weeks 0.106 0.014 369 31 0.878 0.135 0.077 0.134 Treated with ORS 0.765 0.067 39 3 0.897 0.087 0.631 0.898 Sought medical treatment for diarrhea 0.591 0.086 39 3 1.096 0.145 0.419 0.763 Vaccination card seen 0.470 0.083 66 6 1.340 0.176 0.305 0.636 Received BCG vaccination 1.000 0.000 66 6 na 0.000 1.000 1.000 Received DPT vaccination (3 doses) 0.848 0.042 66 6 0.937 0.049 0.765 0.931 Received polio vaccination (3 doses) 0.848 0.041 66 6 0.917 0.048 0.766 0.929 Received measles vaccination 0.956 0.030 66 6 1.190 0.032 0.895 1.016 Received all vaccinations 0.803 0.057 66 6 1.155 0.071 0.690 0.917 Height-for-age (-2SD) 0.397 0.031 353 30 1.130 0.078 0.335 0.459 Weight-for-height (-2SD) 0.026 0.008 349 30 0.901 0.298 0.010 0.041 Weight-for-age (-2SD) 0.179 0.022 353 30 1.002 0.126 0.134 0.224 Prevalence of anemia (children 6-59 months) 0.456 0.041 296 25 1.376 0.090 0.374 0.538 Prevalence of anemia (women 15-49) 0.309 0.022 738 63 1.295 0.071 0.264 0.353 Body Mass Index (BMI) < 18.5 0.093 0.012 707 60 1.063 0.125 0.070 0.116 Had an HIV test and received results in past 12 months 0.078 0.014 757 65 1.413 0.177 0.050 0.105 Accepting attitudes towards people with HIV 0.267 0.020 718 61 1.187 0.073 0.228 0.306 Ever experienced any physical violence since age 15 0.124 0.019 284 24 0.972 0.153 0.086 0.163 Ever experienced any sexual violence 0.097 0.018 284 24 1.021 0.185 0.061 0.133 Ever experienced any physical/sexual violence by any husband 0.189 0.023 215 15 0.852 0.120 0.144 0.235 Physical/sexual violence in the last 12 months by any husband 0.122 0.021 215 15 0.919 0.168 0.081 0.163 Total fertility rate (last 3 years) 3.299 0.338 2175 186 1.558 0.103 2.623 3.976 Neonatal mortality (last 0-9 years) 26.423 7.410 751 64 1.219 0.280 11.604 41.242 Post-neonatal mortality (last 0-9 years) 11.612 3.928 760 65 0.976 0.338 3.755 19.469 Infant mortality (last 0-9 years) 38.035 7.881 751 64 1.048 0.207 22.273 53.797 Child mortality (last 0-9 years) 12.674 4.174 758 65 0.991 0.329 4.325 21.022 Under-five mortality (last 0-9 years) 50.226 9.943 756 64 1.169 0.198 30.340 70.113 MEN Urban residence 0.234 0.033 264 23 1.247 0.139 0.169 0.299 Literacy 0.878 0.029 264 23 1.434 0.033 0.820 0.936 No education 0.111 0.030 264 23 1.552 0.271 0.051 0.171 Secondary or higher education 0.573 0.044 264 23 1.426 0.076 0.486 0.660 Never married (in union) 0.338 0.037 264 23 1.272 0.110 0.264 0.413 Currently married (in union) 0.658 0.037 264 23 1.279 0.057 0.583 0.733 Had first sexual intercourse before age 18 0.063 0.014 223 19 0.877 0.228 0.034 0.091 Knows any contraceptive method 0.983 0.010 173 15 0.993 0.010 0.963 1.003 Knows any modern contraceptive method 0.983 0.010 173 15 0.993 0.010 0.963 1.003 Want no more children 0.419 0.033 173 15 0.879 0.079 0.353 0.486 Want to delay birth at least 2 years 0.270 0.028 173 15 0.840 0.105 0.213 0.327 Ideal family size 3.472 0.204 240 21 1.996 0.059 3.063 3.881 Had HIV test and received results in past 12 months 0.053 0.018 264 23 1.330 0.348 0.016 0.090 Accepting attitudes towards people with HIV 0.203 0.024 247 21 0.931 0.117 0.156 0.251 na=not applicable Appendix B • 315 Table B.7 Sampling errors: Kayin sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.236 0.026 751 303 1.678 0.110 0.184 0.289 Literacy 0.935 0.009 751 303 1.031 0.010 0.916 0.953 No education 0.222 0.043 751 303 2.793 0.192 0.137 0.307 Secondary or higher education 0.409 0.042 751 303 2.349 0.103 0.324 0.493 Never married (never in union) 0.264 0.020 751 303 1.248 0.076 0.224 0.305 Currently married (in union) 0.663 0.022 751 303 1.258 0.033 0.620 0.706 Married before age 20 0.366 0.026 650 262 1.371 0.071 0.314 0.417 Had sexual intercourse before age 18 0.193 0.023 650 262 1.489 0.120 0.147 0.239 Currently pregnant 0.049 0.012 751 303 1.510 0.243 0.025 0.073 Children ever born 2.197 0.116 751 303 1.472 0.053 1.965 2.429 Children surviving 1.939 0.083 751 303 1.234 0.043 1.772 2.105 Children ever born to women age 40-49 3.676 0.189 210 85 1.210 0.051 3.298 4.054 Know any contraceptive method 0.980 0.008 494 201 1.279 0.008 0.964 0.996 Know a modern method 0.980 0.008 494 201 1.279 0.008 0.964 0.996 Currently using any method 0.405 0.030 494 201 1.370 0.075 0.344 0.465 Currently using a modern method 0.395 0.031 494 201 1.394 0.078 0.333 0.456 Currently using pill 0.147 0.021 494 201 1.322 0.144 0.104 0.189 Currently using IUD 0.018 0.006 494 201 1.044 0.344 0.006 0.031 Currently using condoms 0.013 0.005 494 201 1.022 0.404 0.002 0.023 Currently using injectables 0.139 0.017 494 201 1.083 0.122 0.105 0.172 Currently using implants 0.008 0.005 494 201 1.236 0.619 0.000 0.018 Currently using female sterilization 0.069 0.014 494 201 1.246 0.206 0.040 0.097 Using public sector source 0.394 0.040 202 81 1.154 0.101 0.314 0.473 Want no more children 0.552 0.020 494 201 0.909 0.037 0.511 0.593 Want to delay next birth at least 2 years 0.202 0.021 494 201 1.165 0.104 0.160 0.244 Ideal number of children 3.235 0.125 674 271 1.896 0.039 2.986 3.485 Mothers received antenatal care for last birth 0.717 0.071 273 113 2.615 0.099 0.575 0.859 Mothers protected against tetanus for last birth 0.673 0.062 273 113 2.184 0.092 0.550 0.797 Births with skilled attendant at delivery 0.496 0.076 351 147 2.499 0.154 0.344 0.648 Had diarrhea in the last 2 weeks 0.165 0.022 336 140 1.028 0.131 0.122 0.208 Treated with ORS 0.509 0.059 54 23 0.904 0.115 0.391 0.626 Sought medical treatment for diarrhea 0.476 0.085 54 23 1.256 0.178 0.306 0.646 Vaccination card seen 0.658 0.073 66 28 1.286 0.112 0.511 0.805 Received BCG vaccination 0.884 0.042 66 28 1.099 0.048 0.799 0.968 Received DPT vaccination (3 doses) 0.709 0.067 66 28 1.226 0.095 0.575 0.843 Received polio vaccination (3 doses) 0.725 0.060 66 28 1.124 0.083 0.604 0.846 Received measles vaccination 0.826 0.052 66 28 1.149 0.063 0.721 0.931 Received all vaccinations 0.650 0.070 66 28 1.213 0.107 0.511 0.789 Height-for-age (-2SD) 0.254 0.033 410 177 1.539 0.131 0.187 0.321 Weight-for-height (-2SD) 0.059 0.011 411 177 0.961 0.186 0.037 0.080 Weight-for-age (-2SD) 0.152 0.018 413 178 0.969 0.115 0.117 0.187 Prevalence of anemia (children 6-59 months) 0.467 0.019 373 162 0.743 0.041 0.429 0.504 Prevalence of anemia (women 15-49) 0.441 0.022 731 295 1.221 0.051 0.396 0.486 Body Mass Index (BMI) < 18.5 0.135 0.013 690 278 0.977 0.094 0.110 0.161 Had an HIV test and received results in past 12 months 0.075 0.011 751 303 1.173 0.151 0.052 0.097 Accepting attitudes towards people with HIV 0.163 0.014 665 267 0.972 0.085 0.136 0.191 Ever experienced any physical violence since age 15 0.182 0.033 297 114 1.486 0.183 0.116 0.249 Ever experienced any sexual violence 0.032 0.012 297 114 1.189 0.381 0.008 0.056 Ever experienced any physical/sexual violence by any husband 0.201 0.043 240 88 1.638 0.212 0.116 0.286 Physical/sexual violence in the last 12 months by any husband 0.099 0.024 240 88 1.219 0.237 0.052 0.147 Total fertility rate (last 3 years) 3.914 0.366 2154 868 1.445 0.094 3.182 4.646 Neonatal mortality (last 0-9 years) 33.028 9.538 734 306 1.248 0.289 13.952 52.103 Post-neonatal mortality (last 0-9 years) 32.489 14.276 738 308 1.935 0.439 3.936 61.041 Infant mortality (last 0-9 years) 65.516 14.164 735 307 1.371 0.216 37.189 93.844 Child mortality (last 0-9 years) 19.629 10.426 711 296 1.706 0.531 0.000 40.481 Under-five mortality (last 0-9 years) 83.860 22.326 741 310 1.734 0.266 39.207 128.513 MEN Urban residence 0.250 0.024 300 115 0.950 0.095 0.203 0.298 Literacy 0.721 0.039 300 115 1.508 0.054 0.642 0.799 No education 0.317 0.045 300 115 1.658 0.141 0.227 0.406 Secondary or higher education 0.422 0.048 300 115 1.675 0.114 0.326 0.518 Never married (in union) 0.366 0.030 300 115 1.064 0.081 0.307 0.426 Currently married (in union) 0.613 0.027 300 115 0.961 0.044 0.559 0.667 Had first sexual intercourse before age 18 0.093 0.020 254 97 1.070 0.210 0.054 0.132 Knows any contraceptive method 0.966 0.012 179 70 0.877 0.012 0.942 0.990 Knows any modern contraceptive method 0.966 0.012 179 70 0.877 0.012 0.942 0.990 Want no more children 0.445 0.037 179 70 0.998 0.084 0.371 0.519 Want to delay birth at least 2 years 0.323 0.032 179 70 0.907 0.098 0.260 0.387 Ideal family size 3.029 0.108 294 113 0.743 0.036 2.812 3.246 Had HIV test and received results in past 12 months 0.041 0.011 300 115 0.992 0.279 0.018 0.063 Accepting attitudes towards people with HIV 0.194 0.036 264 101 1.480 0.187 0.121 0.266 316 • Appendix B Table B.8 Sampling errors: Chin sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.253 0.016 750 102 0.988 0.062 0.221 0.284 Literacy 0.943 0.015 750 102 1.720 0.015 0.914 0.972 No education 0.139 0.028 750 102 2.224 0.203 0.083 0.195 Secondary or higher education 0.560 0.027 750 102 1.484 0.048 0.506 0.614 Never married (never in union) 0.271 0.019 750 102 1.160 0.069 0.234 0.309 Currently married (in union) 0.645 0.022 750 102 1.238 0.034 0.601 0.688 Married before age 20 0.363 0.027 621 85 1.406 0.075 0.308 0.417 Had sexual intercourse before age 18 0.161 0.020 621 85 1.352 0.124 0.121 0.201 Currently pregnant 0.066 0.008 750 102 0.930 0.128 0.049 0.083 Children ever born 2.704 0.117 750 102 1.146 0.043 2.470 2.938 Children surviving 2.337 0.097 750 102 1.104 0.041 2.144 2.530 Children ever born to women age 40-49 5.188 0.217 197 27 1.098 0.042 4.754 5.621 Know any contraceptive method 0.875 0.031 481 66 2.052 0.035 0.813 0.937 Know a modern method 0.867 0.034 481 66 2.167 0.039 0.799 0.934 Currently using any method 0.254 0.033 481 66 1.679 0.132 0.187 0.321 Currently using a modern method 0.252 0.033 481 66 1.677 0.132 0.185 0.318 Currently using pill 0.057 0.013 481 66 1.252 0.233 0.030 0.083 Currently using IUD 0.040 0.017 481 66 1.860 0.419 0.006 0.073 Currently using condoms 0.000 0.000 481 66 na na 0.000 0.000 Currently using injectables 0.048 0.013 481 66 1.339 0.273 0.022 0.074 Currently using implants 0.056 0.019 481 66 1.757 0.329 0.019 0.093 Currently using female sterilization 0.051 0.013 481 66 1.259 0.247 0.026 0.077 Using public sector source 0.595 0.070 123 17 1.570 0.118 0.454 0.735 Want no more children 0.502 0.027 481 66 1.179 0.054 0.448 0.555 Want to delay next birth at least 2 years 0.225 0.020 481 66 1.047 0.089 0.185 0.265 Ideal number of children 4.085 0.149 705 95 2.187 0.037 3.786 4.383 Mothers received antenatal care for last birth 0.735 0.060 315 43 2.395 0.081 0.615 0.855 Mothers protected against tetanus for last birth 0.691 0.065 315 43 2.494 0.094 0.561 0.822 Births with skilled attendant at delivery 0.356 0.041 479 65 1.555 0.116 0.273 0.438 Had diarrhea in the last 2 weeks 0.244 0.025 439 60 1.116 0.103 0.194 0.295 Treated with ORS 0.620 0.067 106 15 1.247 0.108 0.486 0.754 Sought medical treatment for diarrhea 0.412 0.082 106 15 1.545 0.200 0.247 0.576 Vaccination card seen 0.157 0.061 83 11 1.523 0.391 0.034 0.279 Received BCG vaccination 0.927 0.032 83 11 1.114 0.034 0.863 0.991 Received DPT vaccination (3 doses) 0.647 0.073 83 11 1.383 0.113 0.501 0.793 Received polio vaccination (3 doses) 0.699 0.065 83 11 1.287 0.093 0.569 0.830 Received measles vaccination 0.730 0.068 83 11 1.393 0.094 0.593 0.867 Received all vaccinations 0.530 0.084 83 11 1.523 0.158 0.362 0.698 Height-for-age (-2SD) 0.410 0.028 435 61 1.136 0.069 0.354 0.467 Weight-for-height (-2SD) 0.033 0.012 425 59 1.428 0.368 0.009 0.057 Weight-for-age (-2SD) 0.167 0.024 431 60 1.259 0.141 0.120 0.214 Prevalence of anemia (children 6-59 months) 0.423 0.041 378 53 1.619 0.097 0.340 0.505 Prevalence of anemia (women 15-49) 0.385 0.038 740 100 2.123 0.099 0.309 0.461 Body Mass Index (BMI) < 18.5 0.094 0.012 679 92 1.031 0.123 0.071 0.117 Had an HIV test and received results in past 12 months 0.053 0.013 750 102 1.643 0.255 0.026 0.080 Accepting attitudes towards people with HIV 0.187 0.019 566 77 1.187 0.104 0.148 0.226 Ever experienced any physical violence since age 15 0.126 0.024 264 35 1.164 0.189 0.078 0.173 Ever experienced any sexual violence 0.046 0.014 264 35 1.094 0.306 0.018 0.075 Ever experienced any physical/sexual violence by any husband 0.122 0.029 209 25 1.257 0.234 0.065 0.180 Physical/sexual violence in the last 12 months by any husband 0.080 0.020 209 25 1.079 0.254 0.039 0.121 Total fertility rate (last 3 years) 4.572 0.442 2131 289 1.372 0.097 3.688 5.456 Neonatal mortality (last 0-9 years) 44.374 6.771 969 132 0.971 0.153 30.832 57.916 Post-neonatal mortality (last 0-9 years) 30.687 7.727 966 132 1.226 0.252 15.234 46.140 Infant mortality (last 0-9 years) 75.061 10.003 971 133 1.031 0.133 55.055 95.066 Child mortality (last 0-9 years) 31.797 7.530 958 131 1.116 0.237 16.736 46.858 Under-five mortality (last 0-9 years) 104.471 13.337 980 134 1.156 0.128 77.797 131.144 MEN Urban residence 0.189 0.018 296 39 0.795 0.096 0.153 0.225 Literacy 0.852 0.025 296 39 1.204 0.029 0.802 0.902 No education 0.035 0.011 296 39 1.027 0.313 0.013 0.057 Secondary or higher education 0.658 0.026 296 39 0.954 0.040 0.605 0.711 Never married (in union) 0.376 0.029 296 39 1.042 0.078 0.317 0.434 Currently married (in union) 0.607 0.030 296 39 1.062 0.050 0.547 0.668 Had first sexual intercourse before age 18 0.121 0.021 238 31 1.015 0.178 0.078 0.164 Knows any contraceptive method 0.961 0.013 179 24 0.869 0.013 0.936 0.986 Knows any modern contraceptive method 0.950 0.016 179 24 0.959 0.017 0.918 0.981 Want no more children 0.425 0.039 179 24 1.060 0.092 0.346 0.503 Want to delay birth at least 2 years 0.337 0.036 179 24 1.009 0.106 0.265 0.408 Ideal family size 4.383 0.120 268 35 1.233 0.027 4.144 4.622 Had HIV test and received results in past 12 months 0.033 0.012 296 39 1.104 0.346 0.010 0.057 Accepting attitudes towards people with HIV 0.157 0.028 265 35 1.264 0.181 0.100 0.213 na=not applicable Appendix B • 317 Table B.9 Sampling errors: Sagaing sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.174 0.013 1039 1410 1.111 0.075 0.147 0.200 Literacy 0.857 0.017 1039 1410 1.576 0.020 0.823 0.891 No education 0.096 0.020 1039 1410 2.221 0.211 0.056 0.137 Secondary or higher education 0.431 0.027 1039 1410 1.728 0.062 0.377 0.484 Never married (never in union) 0.349 0.018 1039 1410 1.228 0.052 0.313 0.386 Currently married (in union) 0.587 0.018 1039 1410 1.196 0.031 0.551 0.624 Married before age 20 0.333 0.023 915 1245 1.466 0.069 0.288 0.379 Had sexual intercourse before age 18 0.161 0.017 915 1245 1.427 0.108 0.126 0.195 Currently pregnant 0.024 0.005 1039 1410 0.995 0.197 0.015 0.034 Children ever born 1.813 0.107 1039 1410 1.687 0.059 1.599 2.027 Children surviving 1.628 0.089 1039 1410 1.590 0.055 1.450 1.805 Children ever born to women age 40-49 3.323 0.205 289 394 1.494 0.062 2.913 3.733 Know any contraceptive method 0.986 0.008 606 828 1.636 0.008 0.971 1.002 Know a modern method 0.986 0.008 606 828 1.636 0.008 0.971 1.002 Currently using any method 0.512 0.031 606 828 1.542 0.061 0.449 0.575 Currently using a modern method 0.511 0.031 606 828 1.544 0.062 0.448 0.573 Currently using pill 0.094 0.016 606 828 1.389 0.176 0.061 0.127 Currently using IUD 0.022 0.006 606 828 0.968 0.261 0.011 0.034 Currently using condoms 0.005 0.003 606 828 0.994 0.562 0.000 0.011 Currently using injectables 0.314 0.028 606 828 1.467 0.088 0.258 0.369 Currently using implants 0.010 0.005 606 828 1.130 0.462 0.001 0.019 Currently using female sterilization 0.064 0.012 606 828 1.157 0.179 0.041 0.087 Using public sector source 0.667 0.039 312 424 1.468 0.059 0.588 0.745 Want no more children 0.595 0.020 606 828 0.990 0.033 0.556 0.635 Want to delay next birth at least 2 years 0.181 0.016 606 828 1.035 0.089 0.149 0.214 Ideal number of children 2.791 0.096 994 1348 2.036 0.034 2.599 2.983 Mothers received antenatal care for last birth 0.848 0.056 292 398 2.664 0.066 0.736 0.961 Mothers protected against tetanus for last birth 0.677 0.041 292 398 1.507 0.061 0.595 0.760 Births with skilled attendant at delivery 0.653 0.075 348 474 2.660 0.115 0.504 0.803 Had diarrhea in the last 2 weeks 0.061 0.016 334 456 1.160 0.260 0.029 0.093 Treated with ORS 0.644 0.163 20 28 1.496 0.253 0.318 0.970 Sought medical treatment for diarrhea 0.509 0.118 20 28 1.016 0.232 0.273 0.744 Vaccination card seen 0.589 0.073 58 79 1.068 0.124 0.442 0.735 Received BCG vaccination 0.865 0.047 58 79 0.960 0.055 0.770 0.959 Received DPT vaccination (3 doses) 0.715 0.070 58 79 1.083 0.098 0.576 0.855 Received polio vaccination (3 doses) 0.715 0.070 58 79 1.083 0.098 0.576 0.855 Received measles vaccination 0.769 0.074 58 79 1.253 0.096 0.622 0.916 Received all vaccinations 0.664 0.081 58 79 1.211 0.121 0.503 0.825 Height-for-age (-2SD) 0.267 0.026 335 474 1.072 0.099 0.214 0.320 Weight-for-height (-2SD) 0.060 0.017 335 474 1.255 0.277 0.027 0.093 Weight-for-age (-2SD) 0.134 0.015 335 474 0.793 0.111 0.105 0.164 Prevalence of anemia (children 6-59 months) 0.705 0.034 220 312 1.120 0.049 0.636 0.774 Prevalence of anemia (women 15-49) 0.510 0.024 1013 1376 1.531 0.047 0.462 0.558 Body Mass Index (BMI) < 18.5 0.134 0.011 999 1355 1.067 0.086 0.111 0.157 Had an HIV test and received results in past 12 months 0.029 0.005 1039 1410 1.004 0.180 0.019 0.040 Accepting attitudes towards people with HIV 0.169 0.015 1002 1358 1.305 0.091 0.138 0.200 Ever experienced any physical violence since age 15 0.173 0.024 362 527 1.207 0.139 0.125 0.222 Ever experienced any sexual violence 0.025 0.007 362 527 0.905 0.296 0.010 0.040 Ever experienced any physical/sexual violence by any husband 0.205 0.030 252 324 1.158 0.144 0.146 0.264 Physical/sexual violence in the last 12 months by any husband 0.132 0.028 252 324 1.321 0.215 0.075 0.188 Total fertility rate (last 3 years) 2.098 0.201 3005 4081 1.418 0.096 1.697 2.500 Neonatal mortality (last 0-9 years) 35.173 6.794 737 1006 0.830 0.193 21.585 48.762 Post-neonatal mortality (last 0-9 years) 17.304 8.110 745 1017 1.421 0.469 1.084 33.525 Infant mortality (last 0-9 years) 52.478 11.723 739 1009 1.257 0.223 29.032 75.924 Child mortality (last 0-9 years) 16.902 5.649 747 1021 1.128 0.334 5.603 28.200 Under-five mortality (last 0-9 years) 68.492 14.989 741 1012 1.452 0.219 38.514 98.471 MEN Urban residence 0.162 0.015 394 514 0.824 0.094 0.132 0.193 Literacy 0.958 0.014 394 514 1.384 0.015 0.930 0.986 No education 0.094 0.024 394 514 1.661 0.261 0.045 0.143 Secondary or higher education 0.540 0.035 394 514 1.398 0.065 0.469 0.610 Never married (in union) 0.357 0.029 394 514 1.201 0.081 0.299 0.415 Currently married (in union) 0.600 0.026 394 514 1.070 0.044 0.547 0.653 Had first sexual intercourse before age 18 0.066 0.016 323 423 1.129 0.237 0.035 0.097 Knows any contraceptive method 0.974 0.010 235 308 0.967 0.010 0.954 0.994 Knows any modern contraceptive method 0.970 0.011 235 308 0.950 0.011 0.949 0.991 Want no more children 0.482 0.028 235 308 0.863 0.058 0.425 0.538 Want to delay birth at least 2 years 0.254 0.027 235 308 0.948 0.106 0.200 0.308 Ideal family size 3.287 0.130 388 506 1.539 0.040 3.027 3.547 Had HIV test and received results in past 12 months 0.037 0.011 394 514 1.165 0.300 0.015 0.059 Accepting attitudes towards people with HIV 0.186 0.021 369 480 1.034 0.113 0.144 0.228 318 • Appendix B Table B.10 Sampling errors: Tanintharyi sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.244 0.019 717 283 1.156 0.076 0.207 0.281 Literacy 0.927 0.010 717 283 1.018 0.011 0.907 0.947 No education 0.045 0.012 717 283 1.493 0.258 0.022 0.068 Secondary or higher education 0.512 0.031 717 283 1.647 0.060 0.450 0.573 Never married (never in union) 0.326 0.029 717 283 1.672 0.090 0.267 0.385 Currently married (in union) 0.615 0.029 717 283 1.580 0.047 0.558 0.673 Married before age 20 0.356 0.027 611 242 1.371 0.075 0.302 0.409 Had sexual intercourse before age 18 0.158 0.019 611 242 1.275 0.119 0.120 0.195 Currently pregnant 0.039 0.007 717 283 0.999 0.184 0.025 0.054 Children ever born 2.013 0.130 717 283 1.511 0.064 1.754 2.273 Children surviving 1.797 0.098 717 283 1.330 0.055 1.601 1.993 Children ever born to women age 40-49 3.914 0.284 183 72 1.373 0.073 3.346 4.482 Know any contraceptive method 0.998 0.002 438 174 1.034 0.002 0.993 1.002 Know a modern method 0.998 0.002 438 174 1.034 0.002 0.993 1.002 Currently using any method 0.440 0.025 438 174 1.046 0.056 0.390 0.490 Currently using a modern method 0.433 0.025 438 174 1.058 0.058 0.383 0.483 Currently using pill 0.109 0.021 438 174 1.388 0.190 0.067 0.150 Currently using IUD 0.002 0.002 438 174 0.935 1.004 0.000 0.006 Currently using condoms 0.000 0.000 438 174 na na 0.000 0.000 Currently using injectables 0.208 0.021 438 174 1.066 0.099 0.167 0.250 Currently using implants 0.009 0.005 438 174 1.196 0.595 0.000 0.020 Currently using female sterilization 0.093 0.016 438 174 1.165 0.174 0.061 0.126 Using public sector source 0.555 0.052 193 76 1.444 0.094 0.451 0.658 Want no more children 0.488 0.024 438 174 1.016 0.050 0.440 0.537 Want to delay next birth at least 2 years 0.258 0.020 438 174 0.976 0.079 0.217 0.299 Ideal number of children 2.997 0.085 681 269 1.482 0.028 2.827 3.167 Mothers received antenatal care for last birth 0.806 0.062 253 102 2.502 0.077 0.681 0.931 Mothers protected against tetanus for last birth 0.689 0.043 253 102 1.463 0.062 0.604 0.774 Births with skilled attendant at delivery 0.653 0.081 329 133 2.383 0.125 0.490 0.815 Had diarrhea in the last 2 weeks 0.079 0.017 310 125 1.088 0.216 0.045 0.113 Treated with ORS 0.706 0.063 24 10 0.680 0.090 0.579 0.833 Sought medical treatment for diarrhea 0.619 0.125 24 10 1.202 0.202 0.369 0.870 Vaccination card seen 0.444 0.080 56 22 1.200 0.180 0.284 0.603 Received BCG vaccination 0.981 0.019 56 22 1.031 0.019 0.944 1.019 Received DPT vaccination (3 doses) 0.618 0.061 56 22 0.942 0.099 0.496 0.740 Received polio vaccination (3 doses) 0.673 0.061 56 22 0.972 0.091 0.551 0.795 Received measles vaccination 0.849 0.061 56 22 1.274 0.072 0.728 0.971 Received all vaccinations 0.524 0.087 56 22 1.303 0.166 0.350 0.698 Height-for-age (-2SD) 0.256 0.027 363 148 1.138 0.105 0.202 0.309 Weight-for-height (-2SD) 0.103 0.016 364 148 0.956 0.153 0.072 0.135 Weight-for-age (-2SD) 0.196 0.016 364 148 0.705 0.083 0.163 0.228 Prevalence of anemia (children 6-59 months) 0.616 0.031 329 134 1.117 0.050 0.555 0.678 Prevalence of anemia (women 15-49) 0.545 0.025 708 280 1.323 0.045 0.496 0.595 Body Mass Index (BMI) < 18.5 0.162 0.019 674 266 1.304 0.114 0.125 0.199 Had an HIV test and received results in past 12 months 0.042 0.010 717 283 1.295 0.231 0.023 0.061 Accepting attitudes towards people with HIV 0.247 0.022 695 275 1.318 0.087 0.204 0.290 Ever experienced any physical violence since age 15 0.298 0.033 248 95 1.129 0.110 0.232 0.364 Ever experienced any sexual violence 0.076 0.016 248 95 0.949 0.211 0.044 0.108 Ever experienced any physical/sexual violence by any husband 0.370 0.036 182 62 1.015 0.099 0.297 0.442 Physical/sexual violence in the last 12 months by any husband 0.173 0.025 182 62 0.893 0.145 0.123 0.224 Total fertility rate (last 3 years) 3.083 0.317 2065 817 1.496 0.103 2.450 3.716 Neonatal mortality (last 0-9 years) 20.287 6.557 644 259 1.047 0.323 7.172 33.401 Post-neonatal mortality (last 0-9 years) 35.546 14.475 647 261 1.752 0.407 6.597 64.496 Infant mortality (last 0-9 years) 55.833 16.830 646 260 1.596 0.301 22.174 89.492 Child mortality (last 0-9 years) 28.698 8.093 651 262 1.029 0.282 12.513 44.883 Under-five mortality (last 0-9 years) 82.929 21.814 649 261 1.645 0.263 39.301 126.557 MEN Urban residence 0.247 0.026 249 103 0.939 0.104 0.195 0.298 Literacy 0.888 0.024 249 103 1.221 0.028 0.839 0.937 No education 0.070 0.026 249 103 1.607 0.372 0.018 0.123 Secondary or higher education 0.548 0.045 249 103 1.435 0.083 0.457 0.639 Never married (in union) 0.407 0.033 249 103 1.063 0.081 0.341 0.474 Currently married (in union) 0.551 0.030 249 103 0.941 0.054 0.492 0.611 Had first sexual intercourse before age 18 0.036 0.014 201 83 1.060 0.388 0.008 0.064 Knows any contraceptive method 0.988 0.013 137 57 1.327 0.013 0.963 1.013 Knows any modern contraceptive method 0.988 0.013 137 57 1.327 0.013 0.963 1.013 Want no more children 0.348 0.042 137 57 1.022 0.120 0.265 0.432 Want to delay birth at least 2 years 0.343 0.045 137 57 1.097 0.130 0.253 0.432 Ideal family size 3.383 0.126 235 97 1.169 0.037 3.131 3.635 Had HIV test and received results in past 12 months 0.071 0.019 249 103 1.141 0.263 0.034 0.108 Accepting attitudes towards people with HIV 0.267 0.035 242 100 1.241 0.133 0.196 0.338 na=not applicable Appendix B • 319 Table B.11 Sampling errors: Bago sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.200 0.015 939 1244 1.173 0.077 0.170 0.231 Literacy 0.891 0.010 939 1244 0.946 0.011 0.872 0.911 No education 0.060 0.008 939 1244 1.092 0.141 0.043 0.077 Secondary or higher education 0.495 0.024 939 1244 1.492 0.049 0.446 0.544 Never married (never in union) 0.320 0.013 939 1244 0.842 0.040 0.294 0.345 Currently married (in union) 0.627 0.015 939 1244 0.939 0.024 0.597 0.657 Married before age 20 0.341 0.018 803 1063 1.073 0.053 0.305 0.377 Had sexual intercourse before age 18 0.175 0.009 803 1063 0.658 0.050 0.157 0.192 Currently pregnant 0.028 0.004 939 1244 0.833 0.160 0.019 0.037 Children ever born 1.497 0.106 939 1244 1.740 0.071 1.285 1.708 Children surviving 1.340 0.093 939 1244 1.735 0.069 1.155 1.525 Children ever born to women age 40-49 2.843 0.258 244 323 1.669 0.091 2.326 3.360 Know any contraceptive method 0.999 0.001 588 780 0.784 0.001 0.997 1.001 Know a modern method 0.999 0.001 588 780 0.784 0.001 0.997 1.001 Currently using any method 0.607 0.018 588 780 0.894 0.030 0.571 0.643 Currently using a modern method 0.601 0.018 588 780 0.869 0.029 0.566 0.636 Currently using pill 0.158 0.015 588 780 0.971 0.092 0.129 0.187 Currently using IUD 0.022 0.007 588 780 1.130 0.311 0.008 0.036 Currently using condoms 0.004 0.003 588 780 0.923 0.578 0.000 0.009 Currently using injectables 0.367 0.018 588 780 0.883 0.048 0.331 0.402 Currently using implants 0.010 0.004 588 780 0.950 0.394 0.002 0.017 Currently using female sterilization 0.035 0.008 588 780 1.009 0.220 0.019 0.050 Using public sector source 0.543 0.036 353 469 1.367 0.067 0.470 0.616 Want no more children 0.642 0.026 588 780 1.301 0.040 0.591 0.694 Want to delay next birth at least 2 years 0.170 0.017 588 780 1.107 0.101 0.136 0.205 Ideal number of children 2.342 0.092 854 1131 1.829 0.039 2.159 2.525 Mothers received antenatal care for last birth 0.795 0.026 248 329 1.027 0.033 0.742 0.848 Mothers protected against tetanus for last birth 0.726 0.031 248 329 1.100 0.043 0.664 0.788 Births with skilled attendant at delivery 0.629 0.054 280 373 1.732 0.086 0.521 0.738 Had diarrhea in the last 2 weeks 0.070 0.017 270 360 1.079 0.237 0.037 0.104 Treated with ORS 0.748 0.084 19 25 0.840 0.112 0.581 0.915 Sought medical treatment for diarrhea 0.544 0.081 19 25 0.706 0.148 0.383 0.705 Vaccination card seen 0.441 0.055 57 75 0.784 0.125 0.331 0.550 Received BCG vaccination 0.945 0.041 57 75 1.041 0.043 0.863 1.027 Received DPT vaccination (3 doses) 0.563 0.067 57 75 0.966 0.119 0.428 0.697 Received polio vaccination (3 doses) 0.590 0.065 57 75 0.943 0.110 0.460 0.720 Received measles vaccination 0.776 0.073 57 75 1.219 0.094 0.631 0.922 Received all vaccinations 0.467 0.063 57 75 0.897 0.135 0.341 0.593 Height-for-age (-2SD) 0.230 0.023 296 406 0.926 0.102 0.183 0.277 Weight-for-height (-2SD) 0.061 0.014 297 407 1.045 0.235 0.032 0.089 Weight-for-age (-2SD) 0.176 0.017 297 407 0.756 0.097 0.142 0.210 Prevalence of anemia (children 6-59 months) 0.540 0.021 272 374 0.702 0.040 0.497 0.583 Prevalence of anemia (women 15-49) 0.476 0.019 935 1239 1.172 0.040 0.438 0.514 Body Mass Index (BMI) < 18.5 0.222 0.019 907 1201 1.350 0.084 0.185 0.259 Had an HIV test and received results in past 12 months 0.041 0.007 939 1244 1.092 0.171 0.027 0.056 Accepting attitudes towards people with HIV 0.174 0.017 892 1182 1.362 0.099 0.139 0.209 Ever experienced any physical violence since age 15 0.147 0.024 340 462 1.252 0.164 0.099 0.195 Ever experienced any sexual violence 0.017 0.008 340 462 1.121 0.468 0.001 0.032 Ever experienced any physical/sexual violence by any husband 0.157 0.025 264 330 1.128 0.161 0.106 0.208 Physical/sexual violence in the last 12 months by any husband 0.112 0.022 264 330 1.132 0.197 0.068 0.156 Total fertility rate (last 3 years) 1.896 0.159 2674 3536 1.070 0.084 1.578 2.214 Neonatal mortality (last 0-9 years) 43.396 9.371 600 800 1.023 0.216 24.654 62.138 Post-neonatal mortality (last 0-9 years) 36.152 7.357 599 799 0.929 0.203 21.438 50.865 Infant mortality (last 0-9 years) 79.547 14.362 600 800 1.172 0.181 50.823 108.272 Child mortality (last 0-9 years) 4.087 2.508 610 814 0.995 0.614 0.000 9.102 Under-five mortality (last 0-9 years) 83.309 13.915 600 800 1.134 0.167 55.479 111.140 MEN Urban residence 0.197 0.028 346 454 1.288 0.140 0.142 0.253 Literacy 0.917 0.016 346 454 1.087 0.018 0.885 0.949 No education 0.082 0.013 346 454 0.870 0.157 0.056 0.107 Secondary or higher education 0.524 0.042 346 454 1.571 0.081 0.440 0.609 Never married (in union) 0.291 0.027 346 454 1.098 0.092 0.238 0.345 Currently married (in union) 0.681 0.029 346 454 1.140 0.042 0.624 0.738 Had first sexual intercourse before age 18 0.089 0.016 293 385 0.985 0.184 0.056 0.122 Knows any contraceptive method 0.997 0.003 236 309 0.793 0.003 0.992 1.003 Knows any modern contraceptive method 0.997 0.003 236 309 0.793 0.003 0.992 1.003 Want no more children 0.395 0.029 236 309 0.906 0.073 0.338 0.453 Want to delay birth at least 2 years 0.232 0.030 236 309 1.094 0.130 0.171 0.292 Ideal family size 2.771 0.127 323 423 1.586 0.046 2.518 3.024 Had HIV test and received results in past 12 months 0.059 0.013 346 454 1.032 0.221 0.033 0.086 Accepting attitudes towards people with HIV 0.163 0.024 344 452 1.183 0.145 0.116 0.210 320 • Appendix B Table B.12 Sampling errors: Magway sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.150 0.014 947 1081 1.238 0.096 0.121 0.179 Literacy 0.774 0.031 947 1081 2.303 0.041 0.711 0.837 No education 0.116 0.022 947 1081 2.139 0.192 0.071 0.161 Secondary or higher education 0.426 0.034 947 1081 2.129 0.080 0.358 0.495 Never married (never in union) 0.348 0.019 947 1081 1.248 0.056 0.309 0.387 Currently married (in union) 0.594 0.018 947 1081 1.146 0.031 0.557 0.631 Married before age 20 0.298 0.024 831 947 1.485 0.079 0.250 0.345 Had sexual intercourse before age 18 0.137 0.015 831 947 1.218 0.106 0.108 0.167 Currently pregnant 0.029 0.006 947 1081 1.042 0.195 0.018 0.041 Children ever born 1.564 0.067 947 1081 1.087 0.043 1.430 1.698 Children surviving 1.385 0.061 947 1081 1.123 0.044 1.264 1.507 Children ever born to women age 40-49 2.791 0.176 276 315 1.295 0.063 2.438 3.144 Know any contraceptive method 0.996 0.003 560 642 1.024 0.003 0.991 1.002 Know a modern method 0.994 0.004 560 642 1.329 0.004 0.986 1.003 Currently using any method 0.473 0.029 560 642 1.371 0.061 0.415 0.531 Currently using a modern method 0.454 0.030 560 642 1.418 0.066 0.394 0.514 Currently using pill 0.089 0.012 560 642 1.003 0.135 0.065 0.114 Currently using IUD 0.042 0.012 560 642 1.394 0.281 0.019 0.066 Currently using condoms 0.015 0.005 560 642 1.035 0.355 0.004 0.026 Currently using injectables 0.262 0.018 560 642 0.990 0.070 0.225 0.298 Currently using implants 0.016 0.006 560 642 1.129 0.369 0.004 0.029 Currently using female sterilization 0.026 0.008 560 642 1.175 0.303 0.010 0.042 Using public sector source 0.648 0.030 255 291 0.999 0.046 0.589 0.708 Want no more children 0.600 0.018 560 642 0.885 0.031 0.564 0.637 Want to delay next birth at least 2 years 0.218 0.016 560 642 0.941 0.075 0.185 0.251 Ideal number of children 2.654 0.066 881 1009 1.489 0.025 2.522 2.787 Mothers received antenatal care for last birth 0.825 0.038 238 274 1.554 0.046 0.748 0.901 Mothers protected against tetanus for last birth 0.665 0.038 238 274 1.243 0.057 0.589 0.741 Births with skilled attendant at delivery 0.684 0.058 270 310 1.918 0.085 0.568 0.800 Had diarrhea in the last 2 weeks 0.084 0.020 261 299 1.159 0.238 0.044 0.124 Treated with ORS 0.543 0.124 22 25 1.162 0.228 0.295 0.790 Sought medical treatment for diarrhea 0.688 0.110 22 25 1.108 0.159 0.469 0.908 Vaccination card seen 0.430 0.093 48 55 1.298 0.215 0.245 0.616 Received BCG vaccination 0.978 0.022 48 55 1.049 0.023 0.933 1.022 Received DPT vaccination (3 doses) 0.618 0.077 48 55 1.103 0.125 0.463 0.772 Received polio vaccination (3 doses) 0.682 0.085 48 55 1.265 0.125 0.512 0.852 Received measles vaccination 0.910 0.039 48 55 0.943 0.043 0.832 0.988 Received all vaccinations 0.582 0.087 48 55 1.222 0.149 0.408 0.756 Height-for-age (-2SD) 0.259 0.031 252 299 1.091 0.118 0.198 0.321 Weight-for-height (-2SD) 0.062 0.013 249 295 0.842 0.204 0.037 0.087 Weight-for-age (-2SD) 0.218 0.025 252 299 0.946 0.115 0.168 0.268 Prevalence of anemia (children 6-59 months) 0.595 0.041 214 254 1.205 0.068 0.513 0.676 Prevalence of anemia (women 15-49) 0.522 0.026 929 1062 1.571 0.049 0.471 0.574 Body Mass Index (BMI) < 18.5 0.185 0.018 909 1037 1.380 0.096 0.149 0.220 Had an HIV test and received results in past 12 months 0.041 0.008 947 1081 1.302 0.205 0.024 0.058 Accepting attitudes towards people with HIV 0.136 0.014 927 1056 1.251 0.104 0.108 0.164 Ever experienced any physical violence since age 15 0.180 0.026 328 380 1.231 0.145 0.128 0.233 Ever experienced any sexual violence 0.017 0.012 328 380 1.690 0.723 0.000 0.040 Ever experienced any physical/sexual violence by any husband 0.212 0.036 238 252 1.370 0.172 0.139 0.285 Physical/sexual violence in the last 12 months by any husband 0.147 0.027 238 252 1.178 0.184 0.093 0.201 Total fertility rate (last 3 years) 1.814 0.127 2748 3135 0.939 0.070 1.560 2.068 Neonatal mortality (last 0-9 years) 27.661 5.690 582 672 0.823 0.206 16.281 39.040 Post-neonatal mortality (last 0-9 years) 20.769 7.417 585 674 1.031 0.357 5.936 35.602 Infant mortality (last 0-9 years) 48.430 8.490 582 672 0.872 0.175 31.450 65.410 Child mortality (last 0-9 years) 7.413 3.388 588 678 0.934 0.457 0.637 14.188 Under-five mortality (last 0-9 years) 55.484 9.153 583 673 0.895 0.165 37.178 73.789 MEN Urban residence 0.145 0.016 291 320 0.755 0.108 0.113 0.176 Literacy 0.956 0.011 291 320 0.951 0.012 0.933 0.979 No education 0.102 0.026 291 320 1.448 0.253 0.050 0.154 Secondary or higher education 0.481 0.049 291 320 1.670 0.102 0.383 0.579 Never married (in union) 0.303 0.029 291 320 1.081 0.096 0.245 0.362 Currently married (in union) 0.674 0.029 291 320 1.066 0.044 0.615 0.733 Had first sexual intercourse before age 18 0.088 0.021 257 282 1.189 0.239 0.046 0.130 Knows any contraceptive method 0.961 0.018 195 215 1.309 0.019 0.925 0.998 Knows any modern contraceptive method 0.961 0.018 195 215 1.309 0.019 0.925 0.998 Want no more children 0.515 0.031 195 215 0.873 0.061 0.453 0.578 Want to delay birth at least 2 years 0.210 0.022 195 215 0.754 0.105 0.166 0.254 Ideal family size 2.752 0.103 261 286 1.225 0.038 2.546 2.959 Had HIV test and received results in past 12 months 0.046 0.012 291 320 0.985 0.262 0.022 0.071 Accepting attitudes towards people with HIV 0.169 0.024 282 309 1.094 0.145 0.120 0.218 Appendix B • 321 Table B.13 Sampling errors: Mandalay sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.292 0.020 963 1541 1.368 0.069 0.252 0.332 Literacy 0.872 0.018 963 1541 1.706 0.021 0.836 0.909 No education 0.107 0.020 963 1541 1.976 0.184 0.068 0.147 Secondary or higher education 0.459 0.037 963 1541 2.317 0.081 0.385 0.534 Never married (never in union) 0.394 0.019 963 1541 1.175 0.047 0.357 0.431 Currently married (in union) 0.544 0.017 963 1541 1.073 0.032 0.509 0.578 Married before age 20 0.258 0.022 845 1353 1.430 0.083 0.215 0.301 Had sexual intercourse before age 18 0.108 0.016 845 1353 1.516 0.150 0.075 0.140 Currently pregnant 0.029 0.007 963 1541 1.206 0.224 0.016 0.042 Children ever born 1.351 0.072 963 1541 1.263 0.053 1.207 1.494 Children surviving 1.211 0.060 963 1541 1.229 0.050 1.091 1.331 Children ever born to women age 40-49 2.651 0.200 249 399 1.364 0.076 2.251 3.052 Know any contraceptive method 0.996 0.003 525 838 0.983 0.003 0.991 1.001 Know a modern method 0.996 0.003 525 838 0.983 0.003 0.991 1.001 Currently using any method 0.557 0.025 525 838 1.166 0.045 0.506 0.608 Currently using a modern method 0.553 0.025 525 838 1.151 0.045 0.503 0.603 Currently using pill 0.118 0.014 525 838 0.973 0.116 0.091 0.146 Currently using IUD 0.040 0.009 525 838 1.070 0.229 0.022 0.058 Currently using condoms 0.011 0.006 525 838 1.334 0.554 0.000 0.023 Currently using injectables 0.321 0.020 525 838 1.003 0.064 0.280 0.362 Currently using implants 0.010 0.005 525 838 1.194 0.520 0.000 0.020 Currently using female sterilization 0.047 0.010 525 838 1.104 0.218 0.026 0.067 Using public sector source 0.585 0.041 292 466 1.420 0.070 0.503 0.667 Want no more children 0.566 0.022 525 838 1.021 0.039 0.522 0.610 Want to delay next birth at least 2 years 0.199 0.016 525 838 0.938 0.082 0.167 0.232 Ideal number of children 2.242 0.063 940 1508 1.366 0.028 2.116 2.367 Mothers received antenatal care for last birth 0.854 0.045 239 383 1.961 0.052 0.765 0.944 Mothers protected against tetanus for last birth 0.786 0.033 239 383 1.237 0.042 0.721 0.852 Births with skilled attendant at delivery 0.787 0.045 268 431 1.665 0.058 0.696 0.877 Had diarrhea in the last 2 weeks 0.087 0.017 255 411 0.976 0.198 0.052 0.121 Treated with ORS 0.591 0.103 24 36 0.988 0.174 0.385 0.797 Sought medical treatment for diarrhea 0.539 0.099 24 36 0.939 0.184 0.340 0.738 Vaccination card seen 0.599 0.064 56 89 0.969 0.107 0.471 0.727 Received BCG vaccination 0.934 0.043 56 89 1.300 0.046 0.847 1.021 Received DPT vaccination (3 doses) 0.882 0.048 56 89 1.114 0.055 0.786 0.979 Received polio vaccination (3 doses) 0.901 0.048 56 89 1.194 0.053 0.806 0.997 Received measles vaccination 0.865 0.056 56 89 1.209 0.064 0.754 0.976 Received all vaccinations 0.813 0.057 56 89 1.090 0.070 0.699 0.927 Height-for-age (-2SD) 0.261 0.034 254 424 1.236 0.129 0.194 0.328 Weight-for-height (-2SD) 0.071 0.020 252 420 1.237 0.282 0.031 0.111 Weight-for-age (-2SD) 0.180 0.026 254 424 1.088 0.147 0.127 0.233 Prevalence of anemia (children 6-59 months) 0.578 0.026 192 327 0.736 0.045 0.526 0.631 Prevalence of anemia (women 15-49) 0.436 0.023 931 1496 1.403 0.052 0.390 0.481 Body Mass Index (BMI) < 18.5 0.177 0.014 913 1469 1.102 0.078 0.149 0.205 Had an HIV test and received results in past 12 months 0.062 0.008 963 1541 0.983 0.123 0.047 0.077 Accepting attitudes towards people with HIV 0.143 0.014 912 1454 1.214 0.099 0.115 0.171 Ever experienced any physical violence since age 15 0.091 0.016 331 550 1.041 0.181 0.058 0.124 Ever experienced any sexual violence 0.010 0.004 331 550 0.765 0.412 0.002 0.019 Ever experienced any physical/sexual violence by any husband 0.082 0.019 235 339 1.073 0.235 0.043 0.120 Physical/sexual violence in the last 12 months by any husband 0.032 0.011 235 339 0.986 0.354 0.009 0.055 Total fertility rate (last 3 years) 2.009 0.162 2804 4486 1.139 0.080 1.685 2.332 Neonatal mortality (last 0-9 years) 32.180 8.670 559 905 0.929 0.269 14.840 49.519 Post-neonatal mortality (last 0-9 years) 26.503 6.294 552 894 0.841 0.237 13.914 39.091 Infant mortality (last 0-9 years) 58.683 10.557 559 905 0.791 0.180 37.568 79.798 Child mortality (last 0-9 years) 7.151 3.396 543 878 0.960 0.475 0.360 13.943 Under-five mortality (last 0-9 years) 65.414 11.653 561 908 0.768 0.178 42.108 88.721 MEN Urban residence 0.308 0.027 372 601 1.124 0.087 0.254 0.362 Literacy 0.969 0.007 372 601 0.796 0.007 0.955 0.984 No education 0.082 0.018 372 601 1.263 0.219 0.046 0.118 Secondary or higher education 0.563 0.045 372 601 1.737 0.080 0.473 0.652 Never married (in union) 0.377 0.028 372 601 1.124 0.075 0.320 0.433 Currently married (in union) 0.596 0.032 372 601 1.269 0.054 0.532 0.661 Had first sexual intercourse before age 18 0.057 0.013 309 499 1.011 0.235 0.030 0.084 Knows any contraceptive method 0.983 0.008 221 358 0.934 0.008 0.967 0.999 Knows any modern contraceptive method 0.974 0.012 221 358 1.110 0.012 0.950 0.998 Want no more children 0.421 0.031 221 358 0.935 0.074 0.359 0.484 Want to delay birth at least 2 years 0.233 0.029 221 358 1.034 0.127 0.174 0.291 Ideal family size 2.862 0.092 363 587 1.243 0.032 2.679 3.045 Had HIV test and received results in past 12 months 0.060 0.018 372 601 1.455 0.299 0.024 0.096 Accepting attitudes towards people with HIV 0.187 0.026 358 578 1.252 0.138 0.135 0.238 322 • Appendix B Table B.14 Sampling errors: Mon sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.308 0.019 789 463 1.157 0.062 0.270 0.346 Literacy 0.872 0.015 789 463 1.290 0.018 0.841 0.903 No education 0.092 0.016 789 463 1.543 0.173 0.060 0.124 Secondary or higher education 0.509 0.033 789 463 1.874 0.066 0.442 0.576 Never married (never in union) 0.350 0.025 789 463 1.443 0.070 0.301 0.399 Currently married (in union) 0.601 0.026 789 463 1.486 0.043 0.549 0.653 Married before age 20 0.325 0.033 675 397 1.831 0.102 0.258 0.391 Had sexual intercourse before age 18 0.133 0.024 675 397 1.859 0.184 0.084 0.181 Currently pregnant 0.037 0.007 789 463 1.051 0.190 0.023 0.052 Children ever born 1.791 0.107 789 463 1.450 0.060 1.577 2.005 Children surviving 1.630 0.090 789 463 1.372 0.055 1.450 1.811 Children ever born to women age 40-49 3.256 0.236 257 151 1.614 0.072 2.784 3.728 Know any contraceptive method 0.996 0.003 474 278 0.947 0.003 0.991 1.002 Know a modern method 0.996 0.003 474 278 0.947 0.003 0.991 1.002 Currently using any method 0.450 0.028 474 278 1.205 0.061 0.395 0.505 Currently using a modern method 0.446 0.027 474 278 1.169 0.060 0.393 0.500 Currently using pill 0.143 0.018 474 278 1.144 0.129 0.106 0.179 Currently using IUD 0.013 0.005 474 278 0.939 0.381 0.003 0.022 Currently using condoms 0.005 0.003 474 278 0.966 0.653 0.000 0.011 Currently using injectables 0.218 0.023 474 278 1.230 0.107 0.171 0.264 Currently using implants 0.011 0.004 474 278 0.921 0.410 0.002 0.019 Currently using female sterilization 0.058 0.011 474 278 1.002 0.185 0.037 0.080 Using public sector source 0.537 0.033 212 125 0.971 0.062 0.470 0.604 Want no more children 0.589 0.029 474 278 1.283 0.049 0.531 0.647 Want to delay next birth at least 2 years 0.162 0.017 474 278 1.025 0.107 0.127 0.197 Ideal number of children 2.707 0.098 617 363 1.637 0.036 2.510 2.904 Mothers received antenatal care for last birth 0.932 0.021 207 121 1.199 0.023 0.889 0.974 Mothers protected against tetanus for last birth 0.835 0.026 207 121 0.992 0.031 0.784 0.886 Births with skilled attendant at delivery 0.668 0.066 247 144 1.909 0.098 0.537 0.800 Had diarrhea in the last 2 weeks 0.075 0.016 239 140 0.962 0.215 0.043 0.107 Treated with ORS 0.655 0.130 18 10 1.156 0.199 0.395 0.916 Sought medical treatment for diarrhea 0.615 0.131 18 10 1.132 0.212 0.354 0.877 Vaccination card seen 0.461 0.103 44 26 1.369 0.223 0.255 0.666 Received BCG vaccination 0.954 0.032 44 26 0.999 0.033 0.891 1.017 Received DPT vaccination (3 doses) 0.687 0.091 44 26 1.298 0.132 0.505 0.868 Received polio vaccination (3 doses) 0.753 0.065 44 26 1.008 0.087 0.622 0.884 Received measles vaccination 0.844 0.055 44 26 1.002 0.065 0.734 0.953 Received all vaccinations 0.644 0.090 44 26 1.249 0.140 0.464 0.824 Height-for-age (-2SD) 0.281 0.042 285 168 1.436 0.148 0.198 0.364 Weight-for-height (-2SD) 0.068 0.016 286 168 1.066 0.229 0.037 0.099 Weight-for-age (-2SD) 0.188 0.032 286 168 1.307 0.170 0.124 0.252 Prevalence of anemia (children 6-59 months) 0.548 0.040 241 142 1.256 0.074 0.467 0.629 Prevalence of anemia (women 15-49) 0.390 0.026 767 449 1.467 0.066 0.339 0.442 Body Mass Index (BMI) < 18.5 0.147 0.015 743 436 1.167 0.103 0.116 0.177 Had an HIV test and received results in past 12 months 0.065 0.009 789 463 1.053 0.142 0.047 0.084 Accepting attitudes towards people with HIV 0.291 0.031 764 448 1.886 0.107 0.229 0.354 Ever experienced any physical violence since age 15 0.161 0.019 263 159 0.851 0.120 0.123 0.200 Ever experienced any sexual violence 0.026 0.010 263 159 0.993 0.375 0.006 0.046 Ever experienced any physical/sexual violence by any husband 0.155 0.025 190 104 0.967 0.164 0.104 0.206 Physical/sexual violence in the last 12 months by any husband 0.093 0.022 190 104 1.064 0.242 0.048 0.137 Total fertility rate (last 3 years) 2.333 0.273 2271 1333 1.484 0.117 1.788 2.878 Neonatal mortality (last 0-9 years) 26.179 7.762 529 309 0.842 0.297 10.654 41.703 Post-neonatal mortality (last 0-9 years) 11.213 3.820 528 308 0.797 0.341 3.573 18.853 Infant mortality (last 0-9 years) 37.392 9.295 530 309 0.892 0.249 18.802 55.982 Child mortality (last 0-9 years) 6.633 3.225 523 305 0.916 0.486 0.183 13.084 Under-five mortality (last 0-9 years) 43.777 11.622 530 309 1.026 0.265 20.532 67.022 MEN Urban residence 0.329 0.040 269 162 1.379 0.121 0.250 0.408 Literacy 0.903 0.021 269 162 1.162 0.023 0.861 0.945 No education 0.136 0.031 269 162 1.468 0.226 0.074 0.198 Secondary or higher education 0.528 0.044 269 162 1.448 0.084 0.440 0.617 Never married (in union) 0.484 0.035 269 162 1.146 0.072 0.414 0.554 Currently married (in union) 0.509 0.035 269 162 1.157 0.070 0.438 0.579 Had first sexual intercourse before age 18 0.071 0.021 209 126 1.201 0.302 0.028 0.114 Knows any contraceptive method 0.958 0.016 139 82 0.962 0.017 0.926 0.991 Knows any modern contraceptive method 0.951 0.018 139 82 0.963 0.019 0.916 0.987 Want no more children 0.354 0.037 139 82 0.909 0.105 0.280 0.428 Want to delay birth at least 2 years 0.304 0.042 139 82 1.081 0.139 0.220 0.389 Ideal family size 3.259 0.159 261 157 1.512 0.049 2.942 3.576 Had HIV test and received results in past 12 months 0.056 0.015 269 162 1.090 0.273 0.025 0.087 Accepting attitudes towards people with HIV 0.200 0.030 261 157 1.191 0.148 0.141 0.259 Appendix B • 323 Table B.15 Sampling errors: Rakhine sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.136 0.018 911 777 1.581 0.132 0.100 0.172 Literacy 0.921 0.014 911 777 1.565 0.015 0.893 0.949 No education 0.259 0.045 911 777 3.117 0.176 0.168 0.350 Secondary or higher education 0.308 0.039 911 777 2.563 0.128 0.229 0.387 Never married (never in union) 0.311 0.023 911 777 1.489 0.073 0.266 0.357 Currently married (in union) 0.585 0.025 911 777 1.546 0.043 0.534 0.635 Married before age 20 0.460 0.034 762 649 1.851 0.073 0.393 0.527 Had sexual intercourse before age 18 0.251 0.029 762 649 1.871 0.117 0.192 0.310 Currently pregnant 0.049 0.009 911 777 1.185 0.172 0.032 0.066 Children ever born 1.858 0.129 911 777 1.693 0.070 1.600 2.116 Children surviving 1.680 0.118 911 777 1.732 0.070 1.445 1.916 Children ever born to women age 40-49 3.823 0.303 197 168 1.497 0.079 3.218 4.429 Know any contraceptive method 0.937 0.022 535 454 2.090 0.023 0.893 0.981 Know a modern method 0.937 0.022 535 454 2.090 0.023 0.893 0.981 Currently using any method 0.371 0.034 535 454 1.619 0.091 0.303 0.439 Currently using a modern method 0.369 0.034 535 454 1.645 0.093 0.300 0.438 Currently using pill 0.132 0.025 535 454 1.706 0.190 0.082 0.182 Currently using IUD 0.000 0.000 535 454 na na 0.000 0.000 Currently using condoms 0.000 0.000 535 454 na na 0.000 0.000 Currently using injectables 0.229 0.027 535 454 1.483 0.118 0.175 0.283 Currently using implants 0.000 0.000 535 454 na na 0.000 0.000 Currently using female sterilization 0.008 0.005 535 454 1.134 0.531 0.000 0.017 Using public sector source 0.474 0.060 201 170 1.698 0.127 0.354 0.595 Want no more children 0.471 0.023 535 454 1.049 0.048 0.425 0.516 Want to delay next birth at least 2 years 0.261 0.018 535 454 0.970 0.071 0.224 0.298 Ideal number of children 3.086 0.115 741 633 1.732 0.037 2.856 3.317 Mothers received antenatal care for last birth 0.711 0.070 281 238 2.573 0.099 0.570 0.852 Mothers protected against tetanus for last birth 0.741 0.032 281 238 1.224 0.044 0.677 0.806 Births with skilled attendant at delivery 0.297 0.057 357 303 2.057 0.191 0.184 0.411 Had diarrhea in the last 2 weeks 0.139 0.021 346 294 1.072 0.153 0.096 0.181 Treated with ORS 0.619 0.092 50 41 1.264 0.149 0.434 0.804 Sought medical treatment for diarrhea 0.453 0.086 50 41 1.104 0.189 0.282 0.624 Vaccination card seen 0.133 0.045 79 66 1.161 0.337 0.043 0.223 Received BCG vaccination 0.881 0.031 79 66 0.853 0.036 0.819 0.944 Received DPT vaccination (3 doses) 0.483 0.063 79 66 1.101 0.129 0.358 0.609 Received polio vaccination (3 doses) 0.722 0.065 79 66 1.284 0.091 0.592 0.853 Received measles vaccination 0.734 0.055 79 66 1.090 0.075 0.624 0.843 Received all vaccinations 0.410 0.066 79 66 1.172 0.160 0.278 0.541 Height-for-age (-2SD) 0.375 0.038 318 269 1.339 0.102 0.299 0.452 Weight-for-height (-2SD) 0.139 0.028 317 269 1.314 0.202 0.083 0.195 Weight-for-age (-2SD) 0.343 0.057 317 269 1.985 0.167 0.229 0.458 Prevalence of anemia (children 6-59 months) 0.615 0.042 278 236 1.409 0.068 0.531 0.699 Prevalence of anemia (women 15-49) 0.554 0.029 866 740 1.687 0.051 0.497 0.611 Body Mass Index (BMI) < 18.5 0.200 0.017 821 702 1.207 0.084 0.167 0.234 Had an HIV test and received results in past 12 months 0.026 0.005 911 777 0.867 0.177 0.017 0.035 Accepting attitudes towards people with HIV 0.114 0.020 664 563 1.613 0.175 0.074 0.154 Ever experienced any physical violence since age 15 0.268 0.026 300 267 1.023 0.098 0.216 0.320 Ever experienced any sexual violence 0.086 0.016 300 267 1.002 0.189 0.054 0.119 Ever experienced any physical/sexual violence by any husband 0.372 0.033 235 191 1.049 0.089 0.306 0.438 Physical/sexual violence in the last 12 months by any husband 0.265 0.028 235 191 0.974 0.106 0.209 0.321 Total fertility rate (last 3 years) 2.674 0.270 2607 2223 1.528 0.101 2.133 3.215 Neonatal mortality (last 0-9 years) 31.916 6.945 758 643 0.917 0.218 18.026 45.807 Post-neonatal mortality (last 0-9 years) 14.755 4.055 751 638 0.834 0.275 6.646 22.865 Infant mortality (last 0-9 years) 46.672 9.121 758 643 1.032 0.195 28.429 64.915 Child mortality (last 0-9 years) 12.050 3.898 770 656 0.920 0.323 4.254 19.846 Under-five mortality (last 0-9 years) 58.159 10.540 761 646 1.054 0.181 37.079 79.240 MEN Urban residence 0.126 0.028 261 222 1.372 0.225 0.069 0.182 Literacy 0.782 0.067 261 222 2.570 0.085 0.649 0.915 No education 0.151 0.046 261 222 2.076 0.307 0.058 0.244 Secondary or higher education 0.478 0.049 261 222 1.570 0.102 0.380 0.575 Never married (in union) 0.340 0.036 261 222 1.213 0.105 0.268 0.411 Currently married (in union) 0.626 0.032 261 222 1.058 0.051 0.563 0.690 Had first sexual intercourse before age 18 0.069 0.016 210 178 0.924 0.235 0.036 0.101 Knows any contraceptive method 0.945 0.021 163 139 1.182 0.023 0.902 0.987 Knows any modern contraceptive method 0.945 0.021 163 139 1.182 0.023 0.902 0.987 Want no more children 0.336 0.041 163 139 1.107 0.122 0.254 0.418 Want to delay birth at least 2 years 0.395 0.036 163 139 0.946 0.092 0.322 0.467 Ideal family size 3.879 0.342 256 218 2.254 0.088 3.195 4.563 Had HIV test and received results in past 12 months 0.025 0.010 261 222 1.082 0.419 0.004 0.046 Accepting attitudes towards people with HIV 0.199 0.025 212 180 0.915 0.126 0.149 0.250 na=not applicable 324 • Appendix B Table B.16 Sampling errors: Yangon sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.713 0.016 1065 1927 1.185 0.023 0.681 0.746 Literacy 0.960 0.010 1065 1927 1.716 0.011 0.939 0.981 No education 0.047 0.011 1065 1927 1.746 0.241 0.024 0.070 Secondary or higher education 0.650 0.029 1065 1927 1.983 0.045 0.591 0.708 Never married (never in union) 0.398 0.017 1065 1927 1.139 0.043 0.364 0.432 Currently married (in union) 0.541 0.017 1065 1927 1.117 0.032 0.507 0.575 Married before age 20 0.261 0.025 892 1611 1.679 0.095 0.212 0.311 Had sexual intercourse before age 18 0.129 0.013 892 1611 1.123 0.098 0.104 0.154 Currently pregnant 0.026 0.005 1065 1927 1.004 0.190 0.016 0.035 Children ever born 1.205 0.064 1065 1927 1.334 0.053 1.077 1.332 Children surviving 1.122 0.057 1065 1927 1.304 0.051 1.007 1.237 Children ever born to women age 40-49 2.376 0.166 282 513 1.481 0.070 2.044 2.707 Know any contraceptive method 1.000 0.000 584 1042 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 584 1042 na 0.000 1.000 1.000 Currently using any method 0.627 0.022 584 1042 1.098 0.035 0.583 0.671 Currently using a modern method 0.602 0.022 584 1042 1.077 0.036 0.558 0.646 Currently using pill 0.213 0.019 584 1042 1.144 0.091 0.174 0.252 Currently using IUD 0.031 0.009 584 1042 1.176 0.270 0.014 0.048 Currently using condoms 0.012 0.004 584 1042 0.935 0.356 0.003 0.020 Currently using injectables 0.260 0.019 584 1042 1.056 0.074 0.222 0.299 Currently using implants 0.011 0.005 584 1042 1.041 0.402 0.002 0.021 Currently using female sterilization 0.074 0.011 584 1042 1.047 0.153 0.052 0.097 Using public sector source 0.356 0.033 357 629 1.318 0.094 0.289 0.423 Want no more children 0.649 0.022 584 1042 1.129 0.034 0.604 0.693 Want to delay next birth at least 2 years 0.163 0.024 584 1042 1.597 0.150 0.114 0.211 Ideal number of children 2.051 0.046 945 1709 1.208 0.022 1.960 2.142 Mothers received antenatal care for last birth 0.946 0.019 219 387 1.239 0.020 0.908 0.984 Mothers protected against tetanus for last birth 0.846 0.029 219 387 1.170 0.034 0.789 0.904 Births with skilled attendant at delivery 0.825 0.050 248 435 1.758 0.060 0.726 0.924 Had diarrhea in the last 2 weeks 0.048 0.015 240 423 1.063 0.303 0.019 0.078 Treated with ORS 0.671 0.114 12 20 0.820 0.170 0.443 0.898 Sought medical treatment for diarrhea 0.818 0.114 12 20 0.997 0.139 0.591 1.045 Vaccination card seen 0.668 0.074 55 99 1.171 0.111 0.519 0.816 Received BCG vaccination 0.964 0.024 55 99 0.960 0.025 0.916 1.012 Received DPT vaccination (3 doses) 0.760 0.090 55 99 1.564 0.118 0.580 0.940 Received polio vaccination (3 doses) 0.780 0.089 55 99 1.596 0.114 0.601 0.958 Received measles vaccination 0.797 0.063 55 99 1.170 0.079 0.670 0.923 Received all vaccinations 0.674 0.088 55 99 1.401 0.131 0.497 0.850 Height-for-age (-2SD) 0.203 0.028 240 433 1.068 0.139 0.147 0.260 Weight-for-height (-2SD) 0.126 0.022 239 430 0.994 0.171 0.083 0.169 Weight-for-age (-2SD) 0.153 0.024 242 436 1.015 0.158 0.105 0.201 Prevalence of anemia (children 6-59 months) 0.663 0.029 213 384 0.894 0.043 0.606 0.721 Prevalence of anemia (women 15-49) 0.535 0.024 1031 1861 1.530 0.045 0.487 0.583 Body Mass Index (BMI) < 18.5 0.119 0.011 1013 1830 1.112 0.095 0.097 0.142 Had an HIV test and received results in past 12 months 0.061 0.007 1065 1927 0.949 0.114 0.048 0.075 Accepting attitudes towards people with HIV 0.315 0.025 1048 1897 1.711 0.078 0.266 0.365 Ever experienced any physical violence since age 15 0.084 0.016 343 664 1.091 0.195 0.051 0.117 Ever experienced any sexual violence 0.006 0.003 343 664 0.781 0.557 0.000 0.012 Ever experienced any physical/sexual violence by any husband 0.100 0.020 241 414 1.009 0.196 0.061 0.139 Physical/sexual violence in the last 12 months by any husband 0.050 0.016 241 414 1.128 0.319 0.018 0.081 Total fertility rate (last 3 years) 1.768 0.173 3055 5522 1.280 0.098 1.423 2.113 Neonatal mortality (last 0-9 years) 20.791 8.974 521 907 1.222 0.432 2.844 38.738 Post-neonatal mortality (last 0-9 years) 18.372 7.679 524 912 1.244 0.418 3.014 33.730 Infant mortality (last 0-9 years) 39.163 10.449 523 911 1.125 0.267 18.265 60.061 Child mortality (last 0-9 years) 6.990 3.666 510 890 0.999 0.524 0.000 14.321 Under-five mortality (last 0-9 years) 45.879 10.302 523 911 1.045 0.225 25.275 66.483 MEN Urban residence 0.668 0.025 404 703 1.081 0.038 0.617 0.719 Literacy 0.981 0.006 404 703 0.895 0.006 0.969 0.993 No education 0.038 0.011 404 703 1.167 0.292 0.016 0.061 Secondary or higher education 0.713 0.026 404 703 1.153 0.036 0.661 0.765 Never married (in union) 0.388 0.023 404 703 0.942 0.059 0.342 0.434 Currently married (in union) 0.587 0.022 404 703 0.891 0.037 0.544 0.631 Had first sexual intercourse before age 18 0.067 0.012 343 597 0.880 0.177 0.044 0.091 Knows any contraceptive method 0.996 0.004 240 413 1.037 0.004 0.987 1.004 Knows any modern contraceptive method 0.996 0.004 240 413 1.037 0.004 0.987 1.004 Want no more children 0.494 0.043 240 413 1.333 0.087 0.407 0.580 Want to delay birth at least 2 years 0.310 0.033 240 413 1.088 0.105 0.245 0.375 Ideal family size 2.408 0.084 399 694 1.348 0.035 2.239 2.577 Had HIV test and received results in past 12 months 0.076 0.012 404 703 0.889 0.154 0.053 0.100 Accepting attitudes towards people with HIV 0.278 0.022 399 695 0.987 0.080 0.234 0.322 na=not applicable Appendix B • 325 Table B.17 Sampling errors: Shan sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.268 0.027 778 1368 1.715 0.102 0.213 0.322 Literacy 0.923 0.019 778 1368 1.994 0.021 0.885 0.962 No education 0.353 0.058 778 1368 3.345 0.163 0.238 0.469 Secondary or higher education 0.342 0.045 778 1368 2.647 0.132 0.251 0.432 Never married (never in union) 0.266 0.024 778 1368 1.515 0.090 0.218 0.314 Currently married (in union) 0.659 0.024 778 1368 1.393 0.036 0.611 0.706 Married before age 20 0.454 0.034 645 1134 1.751 0.076 0.385 0.523 Had sexual intercourse before age 18 0.230 0.033 645 1134 2.006 0.145 0.163 0.296 Currently pregnant 0.044 0.006 778 1368 0.868 0.145 0.031 0.057 Children ever born 1.877 0.115 778 1368 1.632 0.061 1.647 2.106 Children surviving 1.649 0.088 778 1368 1.516 0.054 1.472 1.826 Children ever born to women age 40-49 3.495 0.229 164 287 1.378 0.065 3.038 3.952 Know any contraceptive method 0.940 0.018 521 901 1.713 0.019 0.904 0.976 Know a modern method 0.938 0.018 521 901 1.732 0.020 0.901 0.974 Currently using any method 0.470 0.030 521 901 1.362 0.063 0.410 0.530 Currently using a modern method 0.461 0.032 521 901 1.440 0.068 0.398 0.524 Currently using pill 0.095 0.015 521 901 1.200 0.162 0.064 0.126 Currently using IUD 0.049 0.017 521 901 1.841 0.358 0.014 0.084 Currently using condoms 0.025 0.009 521 901 1.380 0.378 0.006 0.044 Currently using injectables 0.222 0.025 521 901 1.393 0.115 0.171 0.272 Currently using implants 0.004 0.002 521 901 0.934 0.674 0.000 0.009 Currently using female sterilization 0.065 0.015 521 901 1.354 0.225 0.036 0.095 Using public sector source 0.570 0.044 240 418 1.376 0.078 0.481 0.658 Want no more children 0.660 0.020 521 901 0.964 0.030 0.620 0.700 Want to delay next birth at least 2 years 0.147 0.014 521 901 0.891 0.094 0.120 0.175 Ideal number of children 2.622 0.106 698 1229 2.062 0.040 2.410 2.834 Mothers received antenatal care for last birth 0.681 0.068 266 459 2.361 0.100 0.545 0.818 Mothers protected against tetanus for last birth 0.579 0.063 266 459 2.079 0.110 0.452 0.706 Births with skilled attendant at delivery 0.467 0.070 351 607 2.176 0.149 0.328 0.607 Had diarrhea in the last 2 weeks 0.102 0.020 326 564 1.188 0.201 0.061 0.143 Treated with ORS 0.395 0.094 34 57 1.053 0.237 0.208 0.582 Sought medical treatment for diarrhea 0.343 0.091 34 57 1.081 0.265 0.162 0.525 Vaccination card seen 0.364 0.066 72 127 1.162 0.180 0.233 0.496 Received BCG vaccination 0.761 0.071 72 127 1.427 0.094 0.618 0.904 Received DPT vaccination (3 doses) 0.539 0.080 72 127 1.364 0.148 0.379 0.698 Received polio vaccination (3 doses) 0.527 0.079 72 127 1.342 0.149 0.370 0.685 Received measles vaccination 0.637 0.083 72 127 1.468 0.130 0.471 0.803 Received all vaccinations 0.457 0.073 72 127 1.248 0.159 0.312 0.603 Height-for-age (-2SD) 0.365 0.033 262 433 1.065 0.091 0.298 0.431 Weight-for-height (-2SD) 0.047 0.011 263 435 0.853 0.232 0.025 0.069 Weight-for-age (-2SD) 0.155 0.022 265 438 0.903 0.143 0.111 0.199 Prevalence of anemia (children 6-59 months) 0.403 0.039 166 275 1.042 0.097 0.325 0.481 Prevalence of anemia (women 15-49) 0.349 0.021 727 1275 1.163 0.059 0.308 0.390 Body Mass Index (BMI) < 18.5 0.081 0.014 701 1229 1.349 0.171 0.054 0.109 Had an HIV test and received results in past 12 months 0.047 0.014 778 1368 1.879 0.304 0.018 0.076 Accepting attitudes towards people with HIV 0.200 0.029 535 961 1.655 0.143 0.143 0.257 Ever experienced any physical violence since age 15 0.100 0.023 270 444 1.238 0.227 0.054 0.145 Ever experienced any sexual violence 0.035 0.018 270 444 1.589 0.512 0.000 0.070 Ever experienced any physical/sexual violence by any husband 0.104 0.034 216 325 1.634 0.328 0.036 0.172 Physical/sexual violence in the last 12 months by any husband 0.074 0.022 216 325 1.235 0.298 0.030 0.118 Total fertility rate (last 3 years) 2.976 0.279 2195 3857 1.263 0.094 2.418 3.534 Neonatal mortality (last 0-9 years) 31.104 7.529 692 1204 0.812 0.242 16.047 46.161 Post-neonatal mortality (last 0-9 years) 42.520 13.184 698 1214 1.386 0.310 16.152 68.888 Infant mortality (last 0-9 years) 73.624 14.558 693 1205 1.095 0.198 44.507 102.740 Child mortality (last 0-9 years) 26.910 8.163 703 1219 1.176 0.303 10.584 43.236 Under-five mortality (last 0-9 years) 98.553 19.048 699 1216 1.251 0.193 60.456 136.649 MEN Urban residence 0.251 0.034 286 542 1.316 0.135 0.183 0.318 Literacy 0.668 0.068 286 542 2.415 0.102 0.532 0.804 No education 0.354 0.061 286 542 2.144 0.173 0.232 0.476 Secondary or higher education 0.301 0.045 286 542 1.666 0.151 0.210 0.392 Never married (in union) 0.284 0.028 286 542 1.060 0.100 0.227 0.340 Currently married (in union) 0.685 0.031 286 542 1.111 0.045 0.624 0.746 Had first sexual intercourse before age 18 0.111 0.023 248 471 1.150 0.207 0.065 0.157 Knows any contraceptive method 0.889 0.039 198 371 1.745 0.044 0.810 0.968 Knows any modern contraceptive method 0.878 0.039 198 371 1.677 0.045 0.800 0.957 Want no more children 0.501 0.037 198 371 1.028 0.073 0.428 0.574 Want to delay birth at least 2 years 0.177 0.030 198 371 1.109 0.170 0.117 0.238 Ideal family size 2.779 0.144 243 463 1.426 0.052 2.491 3.066 Had HIV test and received results in past 12 months 0.050 0.018 286 542 1.408 0.366 0.013 0.086 Accepting attitudes towards people with HIV 0.144 0.023 191 367 0.921 0.163 0.097 0.190 326 • Appendix B Table B.18 Sampling errors: Ayeyarwady sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.161 0.010 919 1650 0.838 0.063 0.141 0.182 Literacy 0.816 0.020 919 1650 1.546 0.024 0.777 0.856 No education 0.087 0.016 919 1650 1.686 0.181 0.055 0.118 Secondary or higher education 0.408 0.035 919 1650 2.168 0.086 0.338 0.479 Never married (never in union) 0.279 0.018 919 1650 1.223 0.065 0.242 0.315 Currently married (in union) 0.656 0.020 919 1650 1.245 0.030 0.617 0.695 Married before age 20 0.398 0.026 810 1455 1.486 0.064 0.346 0.449 Had sexual intercourse before age 18 0.178 0.016 810 1455 1.182 0.089 0.146 0.209 Currently pregnant 0.054 0.008 919 1650 1.038 0.143 0.039 0.070 Children ever born 1.724 0.070 919 1650 1.123 0.041 1.583 1.864 Children surviving 1.505 0.061 919 1650 1.151 0.040 1.383 1.627 Children ever born to women age 40-49 2.923 0.169 234 423 1.118 0.058 2.586 3.260 Know any contraceptive method 1.000 0.000 601 1083 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 601 1083 na 0.000 1.000 1.000 Currently using any method 0.556 0.024 601 1083 1.162 0.042 0.508 0.603 Currently using a modern method 0.554 0.023 601 1083 1.149 0.042 0.507 0.600 Currently using pill 0.179 0.020 601 1083 1.257 0.110 0.140 0.218 Currently using IUD 0.027 0.009 601 1083 1.400 0.342 0.009 0.046 Currently using condoms 0.003 0.002 601 1083 0.964 0.714 0.000 0.007 Currently using injectables 0.310 0.019 601 1083 0.986 0.060 0.273 0.347 Currently using implants 0.006 0.003 601 1083 0.908 0.481 0.000 0.012 Currently using female sterilization 0.026 0.007 601 1083 1.149 0.288 0.011 0.041 Using public sector source 0.581 0.027 336 605 1.004 0.047 0.527 0.635 Want no more children 0.640 0.019 601 1083 0.973 0.030 0.602 0.679 Want to delay next birth at least 2 years 0.178 0.019 601 1083 1.233 0.108 0.140 0.217 Ideal number of children 2.412 0.073 901 1615 1.543 0.030 2.267 2.557 Mothers received antenatal care for last birth 0.783 0.034 275 497 1.378 0.044 0.715 0.852 Mothers protected against tetanus for last birth 0.710 0.036 275 497 1.303 0.050 0.639 0.782 Births with skilled attendant at delivery 0.500 0.042 314 567 1.368 0.083 0.417 0.584 Had diarrhea in the last 2 weeks 0.172 0.024 300 542 1.096 0.141 0.123 0.220 Treated with ORS 0.730 0.063 52 93 1.022 0.086 0.604 0.855 Sought medical treatment for diarrhea 0.612 0.071 52 93 1.031 0.117 0.469 0.755 Vaccination card seen 0.336 0.069 69 125 1.202 0.205 0.198 0.474 Received BCG vaccination 0.745 0.069 69 125 1.314 0.093 0.606 0.884 Received DPT vaccination (3 doses) 0.408 0.062 69 125 1.043 0.153 0.283 0.532 Received polio vaccination (3 doses) 0.516 0.059 69 125 0.969 0.115 0.398 0.635 Received measles vaccination 0.706 0.056 69 125 1.007 0.079 0.594 0.817 Received all vaccinations 0.338 0.061 69 125 1.055 0.179 0.217 0.459 Height-for-age (-2SD) 0.372 0.034 283 522 1.176 0.091 0.305 0.440 Weight-for-height (-2SD) 0.039 0.012 280 516 1.076 0.319 0.014 0.064 Weight-for-age (-2SD) 0.246 0.027 283 521 1.057 0.109 0.192 0.299 Prevalence of anemia (children 6-59 months) 0.619 0.038 255 474 1.226 0.062 0.543 0.696 Prevalence of anemia (women 15-49) 0.430 0.020 888 1598 1.198 0.046 0.390 0.470 Body Mass Index (BMI) < 18.5 0.184 0.013 848 1520 0.976 0.071 0.158 0.210 Had an HIV test and received results in past 12 months 0.047 0.008 919 1650 1.202 0.178 0.030 0.064 Accepting attitudes towards people with HIV 0.204 0.025 869 1556 1.857 0.125 0.153 0.255 Ever experienced any physical violence since age 15 0.195 0.030 340 574 1.414 0.156 0.134 0.256 Ever experienced any sexual violence 0.033 0.013 340 574 1.381 0.405 0.006 0.060 Ever experienced any physical/sexual violence by any husband 0.189 0.032 269 416 1.325 0.168 0.126 0.253 Physical/sexual violence in the last 12 months by any husband 0.119 0.026 269 416 1.331 0.221 0.066 0.172 Total fertility rate (last 3 years) 2.340 0.214 2644 4744 1.362 0.092 1.911 2.768 Neonatal mortality (last 0-9 years) 36.185 6.858 705 1270 0.930 0.190 22.470 49.900 Post-neonatal mortality (last 0-9 years) 29.410 7.141 710 1277 1.080 0.243 15.128 43.692 Infant mortality (last 0-9 years) 65.595 9.047 705 1270 0.960 0.138 47.501 83.689 Child mortality (last 0-9 years) 17.822 5.359 722 1304 1.057 0.301 7.105 28.540 Under-five mortality (last 0-9 years) 82.248 10.993 710 1279 0.995 0.134 60.263 104.234 MEN Urban residence 0.161 0.010 364 653 0.533 0.064 0.141 0.182 Literacy 0.944 0.021 364 653 1.721 0.022 0.902 0.985 No education 0.101 0.023 364 653 1.430 0.225 0.055 0.146 Secondary or higher education 0.470 0.039 364 653 1.494 0.083 0.392 0.548 Never married (in union) 0.332 0.030 364 653 1.226 0.091 0.271 0.393 Currently married (in union) 0.642 0.029 364 653 1.155 0.045 0.584 0.700 Had first sexual intercourse before age 18 0.056 0.013 316 567 1.042 0.242 0.029 0.083 Knows any contraceptive method 0.991 0.006 234 419 1.027 0.007 0.978 1.004 Knows any modern contraceptive method 0.991 0.006 234 419 1.027 0.007 0.978 1.004 Want no more children 0.492 0.035 234 419 1.076 0.072 0.422 0.563 Want to delay birth at least 2 years 0.236 0.039 234 419 1.398 0.165 0.158 0.313 Ideal family size 1.961 0.208 339 607 2.281 0.106 1.544 2.378 Had HIV test and received results in past 12 months 0.041 0.012 364 653 1.120 0.283 0.018 0.065 Accepting attitudes towards people with HIV 0.116 0.018 340 609 1.053 0.158 0.080 0.153 na=not applicable Appendix B • 327 Table B.19 Sampling errors: Nay Pyi Taw sample, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Urban residence 0.315 0.049 756 300 2.898 0.156 0.217 0.414 Literacy 0.868 0.014 756 300 1.136 0.016 0.840 0.896 No education 0.098 0.015 756 300 1.372 0.152 0.068 0.127 Secondary or higher education 0.444 0.029 756 300 1.620 0.066 0.385 0.502 Never married (never in union) 0.279 0.017 756 300 1.031 0.060 0.246 0.313 Currently married (in union) 0.649 0.018 756 300 1.046 0.028 0.613 0.685 Married before age 20 0.404 0.026 660 261 1.361 0.064 0.352 0.456 Had sexual intercourse before age 18 0.217 0.022 660 261 1.394 0.103 0.172 0.262 Currently pregnant 0.026 0.006 756 300 1.059 0.238 0.013 0.038 Children ever born 1.650 0.093 756 300 1.332 0.056 1.464 1.835 Children surviving 1.460 0.077 756 300 1.274 0.053 1.306 1.615 Children ever born to women age 40-49 3.093 0.161 197 76 0.947 0.052 2.772 3.414 Know any contraceptive method 0.992 0.004 490 195 0.909 0.004 0.984 0.999 Know a mordern method 0.992 0.004 490 195 0.909 0.004 0.984 0.999 Currently using any method 0.586 0.031 490 195 1.370 0.052 0.525 0.647 Currently using a modern method 0.547 0.030 490 195 1.317 0.054 0.488 0.606 Currently using pill 0.110 0.020 490 195 1.439 0.185 0.069 0.151 Currently using IUD 0.018 0.005 490 195 0.769 0.259 0.009 0.027 Currently using condoms 0.014 0.006 490 195 1.031 0.388 0.003 0.025 Currently using injectables 0.377 0.028 490 195 1.274 0.074 0.321 0.433 Currently using implants 0.002 0.002 490 195 0.904 1.005 0.000 0.005 Currently using female sterilization 0.020 0.006 490 195 0.969 0.303 0.008 0.033 Using public sector source 0.529 0.068 268 107 2.195 0.128 0.394 0.664 Want no more children 0.571 0.034 490 195 1.504 0.059 0.504 0.639 Want to delay next birth at least 2 years 0.171 0.021 490 195 1.209 0.121 0.129 0.212 Ideal number of children 2.530 0.061 705 281 1.158 0.024 2.409 2.651 Mothers received antenatal care for last birth 0.789 0.038 208 83 1.342 0.048 0.713 0.864 Mothers protected against tetanus for last birth 0.722 0.048 208 83 1.547 0.066 0.626 0.817 Births with skilled attendant at delivery 0.665 0.050 241 96 1.509 0.076 0.564 0.765 Had diarrhea in the last 2 weeks 0.086 0.021 232 92 1.183 0.250 0.043 0.129 Treated with ORS 0.692 0.098 20 8 0.950 0.141 0.496 0.887 Sought medical treatment for diarrhea 0.611 0.068 20 8 0.629 0.112 0.474 0.747 Vaccination card seen 0.251 0.077 46 18 1.207 0.308 0.097 0.406 Received BCG vaccination 0.977 0.019 46 18 0.866 0.020 0.939 1.015 Received DPT vaccination (3 doses) 0.599 0.073 46 18 1.008 0.122 0.453 0.745 Received polio vaccination (3 doses) 0.596 0.094 46 18 1.302 0.159 0.407 0.785 Received measles vaccination 0.858 0.045 46 18 0.873 0.052 0.768 0.948 Received all vaccinations 0.494 0.080 46 18 1.077 0.161 0.334 0.653 Height-for-age (-2SD) 0.220 0.030 233 93 1.081 0.135 0.161 0.280 Weight-for-height (-2SD) 0.066 0.015 232 92 0.911 0.227 0.036 0.096 Weight-for-age (-2SD) 0.163 0.020 232 92 0.824 0.125 0.122 0.203 Prevalence of anemia (children 6-59 months) 0.577 0.043 203 81 1.226 0.074 0.492 0.662 Prevalence of anemia (women 15-49) 0.431 0.026 732 290 1.436 0.061 0.378 0.483 Body Mass Index (BMI) < 18.5 0.162 0.021 722 286 1.505 0.128 0.120 0.203 Had an HIV test and received results in past 12 months 0.026 0.007 756 300 1.190 0.265 0.012 0.040 Accepting attitudes towards people with HIV 0.142 0.020 713 283 1.546 0.142 0.102 0.183 Ever experienced any physical violence since age 15 0.207 0.029 288 108 1.227 0.142 0.148 0.265 Ever experienced any sexual violence 0.026 0.008 288 108 0.892 0.321 0.009 0.043 Ever experienced any physical/sexual violence by any husband 0.218 0.036 227 79 1.304 0.164 0.147 0.290 Physical/sexual violence in the last 12 months by any husband 0.148 0.031 227 79 1.295 0.207 0.086 0.209 Total fertility rate (last 3 years) 2.022 0.290 2197 872 1.379 0.143 1.442 2.602 Neonatal mortality (last 0-9 years) 30.362 9.324 543 214 1.254 0.307 11.715 49.009 Post-neonatal mortality (last 0-9 years) 30.076 7.298 547 216 0.951 0.243 15.480 44.672 Infant mortality (last 0-9 years) 60.438 11.901 544 214 1.149 0.197 36.637 84.240 Child mortality (last 0-9 years) 19.796 5.306 566 224 0.828 0.268 9.185 30.407 Under-five mortality (last 0-9 years) 79.038 11.074 551 217 1.006 0.140 56.890 101.186 MEN Urban residence 0.288 0.040 313 126 1.551 0.138 0.208 0.368 Literacy 0.973 0.008 313 126 0.878 0.008 0.956 0.989 No education 0.074 0.021 313 126 1.433 0.287 0.032 0.117 Secondary or higher education 0.565 0.049 313 126 1.743 0.087 0.467 0.663 Never married (in union) 0.325 0.031 313 126 1.158 0.095 0.263 0.386 Currently married (in union) 0.645 0.032 313 126 1.176 0.049 0.581 0.709 Had first sexual intercourse before age 18 0.062 0.014 262 106 0.927 0.223 0.034 0.089 Knows any contraceptive method 0.963 0.013 201 81 1.014 0.014 0.936 0.990 Knows any modern contraceptive method 0.958 0.017 201 81 1.206 0.018 0.924 0.992 Want no more children 0.416 0.040 201 81 1.156 0.097 0.335 0.497 Want to delay birth at least 2 years 0.274 0.033 201 81 1.058 0.122 0.207 0.341 Ideal family size 2.981 0.106 290 116 1.192 0.036 2.768 3.194 Had HIV test and received results in past 12 months 0.063 0.021 313 126 1.511 0.330 0.022 0.105 Accepting attitudes towards people with HIV 0.144 0.025 294 118 1.202 0.171 0.095 0.194 328 • Appendix B Table B.20 Sampling errors for adult and maternal mortality rates, Myanmar 2015-16 Variable Value (R) Standard error (SE) Number of cases Design Effect (DEFT) Relative error (SE/R) Confidence limits Un- weighted (N) Weighted (WN) Lower (R-2SE) Upper (R+2SE) WOMEN Adult mortality rates 15-19 0.774 0.268 17557 16600 1.24 0.346 0.239 1.309 20-24 1.642 0.331 22606 21850 1.208 0.202 0.98 2.304 25-29 1.811 0.387 24592 24241 1.407 0.214 1.037 2.585 30-34 2.304 0.442 24359 24064 1.352 0.192 1.42 3.187 35-39 1.728 0.334 21883 21357 1.174 0.193 1.061 2.395 40-44 3.654 0.569 16444 15948 1.19 0.156 2.517 4.791 45-49 3.037 0.667 11647 11534 1.154 0.22 1.704 4.37 15-49 (age-adjusted) 2.108 0.167 139088 135595 1.228 0.079 1.774 2.442 Adult mortality probabilities 35q15 72 5.555 139088 135595 1.546 0.077 61 83 Maternal mortality rates 15-19 0.02 0.02 17557 16600 0.579 1.001 0 0.06 20-24 0.127 0.06 22606 21850 0.795 0.478 0.006 0.248 25-29 0.148 0.073 24592 24241 0.933 0.491 0.003 0.294 30-34 0.327 0.123 24359 24064 1.052 0.375 0.082 0.572 35-39 0.18 0.098 21883 21357 1.071 0.546 0 0.376 40-44 0.255 0.119 16444 15948 0.94 0.466 0.017 0.493 45-49 0 0 11647 11534 0 0 15-49 (age-adjusted) 0.156 0.033 139088 135595 0.979 0.214 0.089 0.223 Maternal mortality ratio (MMR) 227 47.923 139088 135595 0.979 0.211 131 323 MEN Adult mortality rates 15-19 1.239 0.315 18109 17063 1.108 0.254 0.609 1.87 20-24 1.487 0.306 22698 21617 1.17 0.206 0.875 2.099 25-29 3.067 0.427 24679 23812 1.179 0.139 2.213 3.921 30-34 5.197 0.565 24364 23741 1.172 0.109 4.068 6.327 35-39 7.061 0.751 20808 20676 1.241 0.106 5.558 8.563 40-44 8.811 1.033 15032 14773 1.308 0.117 6.746 10.877 45-49 8.656 1.279 10373 10224 1.339 0.148 6.097 11.214 15-49 (age-adjusted) 4.998 0.308 136063 131907 1.271 0.062 4.382 5.614 Adult mortality probabilities 35q15 163 9.407 136063 131907 1.474 0.058 144 182 * All rates are calculated for last 0-6 years before the survey. Appendix C • 329 DATA QUALITY TABLES Appendix C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Myanmar DHS 2015-16 Women Men Women Men Age Number Percent Number Percent Age Number Percent Number Percent 0 444 1.6 462 2.0 37 417 1.5 305 1.3 1 395 1.4 507 2.2 38 427 1.5 339 1.4 2 441 1.6 418 1.8 39 360 1.3 294 1.2 3 463 1.7 533 2.3 40 447 1.6 341 1.4 4 466 1.7 495 2.1 41 319 1.2 242 1.0 5 474 1.7 483 2.1 42 359 1.3 318 1.3 6 523 1.9 462 2.0 43 352 1.3 271 1.2 7 505 1.8 574 2.4 44 343 1.2 250 1.1 8 544 2.0 496 2.1 45 449 1.6 389 1.7 9 502 1.8 517 2.2 46 311 1.1 246 1.0 10 496 1.8 497 2.1 47 351 1.3 296 1.3 11 465 1.7 546 2.3 48 328 1.2 264 1.1 12 583 2.1 573 2.4 49 259 0.9 230 1.0 13 606 2.2 558 2.4 50 389 1.4 292 1.2 14 520 1.9 489 2.1 51 338 1.2 227 1.0 15 355 1.3 352 1.5 52 397 1.4 310 1.3 16 410 1.5 393 1.7 53 387 1.4 304 1.3 17 371 1.3 390 1.7 54 295 1.1 229 1.0 18 413 1.5 343 1.5 55 369 1.3 258 1.1 19 379 1.4 300 1.3 56 305 1.1 254 1.1 20 453 1.6 403 1.7 57 279 1.0 221 0.9 21 339 1.2 275 1.2 58 278 1.0 211 0.9 22 443 1.6 335 1.4 59 214 0.8 131 0.6 23 375 1.4 330 1.4 60 355 1.3 259 1.1 24 384 1.4 277 1.2 61 164 0.6 146 0.6 25 415 1.5 372 1.6 62 209 0.8 159 0.7 26 399 1.4 296 1.3 63 216 0.8 158 0.7 27 392 1.4 361 1.5 64 170 0.6 132 0.6 28 458 1.7 316 1.3 65 222 0.8 147 0.6 29 366 1.3 305 1.3 66 140 0.5 125 0.5 30 499 1.8 387 1.6 67 203 0.7 153 0.6 31 354 1.3 248 1.1 68 146 0.5 103 0.4 32 441 1.6 354 1.5 69 90 0.3 78 0.3 33 442 1.6 359 1.5 70+ 1,357 4.9 945 4.0 34 391 1.4 255 1.1 Don’t know 4 0.0 2 0.0 35 460 1.7 389 1.7 36 368 1.3 270 1.1 Total 27,583 100.0 23,547 100.0 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. 330 • Appendix C Table C.2.1 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49; and percent distribution and percentage of eligible women who were interviewed (weighted), by 5-year age groups, Myanmar DHS 2015- 16 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed Age group Number Percentage 10-14 2,670 na na na 15-19 1,928 1,822 13.9 94.5 20-24 1,994 1,904 14.6 95.5 25-29 2,031 1,911 14.6 94.1 30-34 2,127 2,056 15.7 96.7 35-39 2,031 1,971 15.1 97.0 40-44 1,820 1,750 13.4 96.2 45-49 1,698 1,652 12.6 97.3 50-54 1,806 na na na 15-49 13,629 13,066 100.0 95.9 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household questionnaire. na = Not applicable Table C.2.2 Age distribution of eligible and interviewed men De facto household population of men age 10-54, interviewed men age 15- 49 and percent of eligible men who were interviewed (weighted), by 5-year age groups, Myanmar DHS 2015-16 Household population of men age 10-54 Interviewed men age 15-49 Percentage of eligible men interviewed Age group Number Percentage 10-14 1,321 na na na 15-19 848 762 15.8 89.8 20-24 753 663 13.8 88.0 25-29 782 703 14.6 89.8 30-34 757 695 14.5 91.8 35-39 781 716 14.9 91.7 40-44 707 660 13.7 93.4 45-49 653 609 12.7 93.3 50-54 715 na na na 15-49 5,281 4,808 100.0 91.0 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of men and interviewed men are household weights. Age is based on the household questionnaire. na = Not applicable Appendix C • 331 Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Myanmar DHS 2015-16 Subject Reference group Percentage with information missing Number of cases Birth date Births in the 15 years preceding the survey Month Only 0.20 13,620 Month and Year 0.00 13,620 Age at Death Deceased children born in the 15 years preceding the survey 0.00 1,105 Age/date at first union1 Ever married women age 15-49 0.00 8,607 Ever married men age 15-49 0.06 3,091 Respondent’s education All women age 15-49 0.02 12,885 All married age 15-49 0.00 4,737 Diarrhea in last 2 weeks Living children 0-59 months 0.30 4,099 Anthropometry of children Living children age 0-59 months (from the Household Questionnaire) Height 10.23 4,594 Weight 8.31 4,594 Height or weight 10.27 4,594 Anthropometry of women Women age 15-49 (from the Household Questionnaire) Height 5.44 13,629 Weight 5.42 13,629 Height or weight 5.44 13,629 Anemia Living children age 6-59 months (from the Household Questionnaire) Children 18.80 4,157 Women 6.59 13,629 1 Both year and age missing Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living (L), dead (D), and total (T) children (weighted), Myanmar DHS 2015-16 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year L D T L D T L D T L D T 2016 110 3 113 100.0 100.0 100.0 71.3 16.3 69.0 na na na 2015 873 38 911 100.0 100.0 100.0 113.1 170.7 115.0 na na na 2014 834 29 863 100.0 100.0 100.0 129.7 213.0 131.8 100.9 78.6 99.9 2013 781 35 816 100.0 100.0 100.0 96.4 120.6 97.4 91.8 97.4 92.0 2012 866 43 910 100.0 100.0 100.0 109.8 198.0 112.8 111.0 106.3 110.7 2011 781 46 827 100.0 100.0 100.0 99.4 81.5 98.3 93.6 100.2 94.0 2010 802 49 852 100.0 100.0 100.0 99.1 108.8 99.6 95.0 72.4 93.3 2009 908 89 997 100.0 98.2 99.8 94.3 96.9 94.5 107.3 125.6 108.7 2008 890 93 983 100.0 100.0 100.0 97.1 160.6 101.8 104.4 102.1 104.2 2007 798 93 891 99.5 94.7 99.0 116.0 128.3 117.3 88.5 98.7 89.5 2012-2016 3,464 148 3,612 100.0 100.0 100.0 110.3 162.9 112.0 na na na 2007-2011 4,179 372 4,551 99.9 98.2 99.8 100.6 117.1 101.9 na na na 2002-2010 4,249 500 4,749 99.9 98.1 99.7 108.5 121.6 109.8 na na na 1997-2001 3,415 523 3,938 99.9 97.0 99.5 106.2 133.6 109.4 na na na <1997 3,545 688 4,233 99.9 97.5 99.5 102.7 122.5 105.7 na na na All 18,852 2,230 21,082 99.9 97.8 99.7 105.5 126.2 107.5 na na na NA = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x 332 • Appendix C Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for 5-year periods of birth preceding the survey (weighted), Myanmar DHS 2015-16 Age at death (days) Number of years preceding the survey Total 0-19 0-4 5-9 10-14 15-19 <1 39 69 40 68 216 1 19 34 29 28 110 2 12 13 12 6 43 3 4 22 32 18 77 4 2 8 3 4 18 5 3 6 9 10 27 6 3 4 3 3 12 7 2 5 16 11 34 8 2 1 2 3 8 9 1 1 2 3 7 10 6 5 5 6 21 11 0 1 1 3 5 12 1 0 1 0 2 14 2 2 4 2 10 15 2 1 3 0 6 16 0 0 0 2 2 17 1 0 3 1 5 18 2 2 2 0 6 19 0 0 2 2 3 20 1 2 6 2 11 21 0 1 0 1 2 22 0 2 0 2 4 23 0 0 0 0 0 24 0 0 0 1 1 25 1 0 2 1 5 26 0 0 0 0 0 27 0 1 1 1 3 28 2 0 0 2 4 30 0 0 0 0 0 Total 0-30 104 181 177 181 643 Percentage early neonatal1 78.2 86.5 71.9 76.1 78.2 1 0-6 days / 0-30 days Appendix C • 333 Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for 5-year periods of birth preceding the survey, Myanmar DHS 2015-16 Age at death (months) Number of years preceding the survey Total 0-19 0-4 5-9 10-14 15-19 <1 104 181 177 181 643 1 18 60 54 44 176 2 13 35 43 39 130 3 9 22 37 28 96 4 3 7 18 20 47 5 1 3 10 13 28 6 3 3 7 17 30 7 6 6 3 11 26 8 2 13 12 7 34 9 3 7 8 4 22 10 2 3 3 2 10 11 4 3 8 3 17 12 3 10 14 13 39 13 0 2 5 2 9 14 0 3 2 3 7 15 0 2 2 0 5 16 0 0 0 1 1 17 2 1 2 1 6 18 1 2 4 9 16 19 0 0 0 2 3 20 0 2 2 0 4 21 0 2 0 2 4 22 0 0 1 0 1 1 Year 0 3 2 2 8 Total 0-11 170 342 381 3