Namibia - Demographic and Health Survey - 2008

Publication date: 2008

Namibia N am ibia 2006-07 Demographic and Health Survey 2006-07 D em ographic and H ealth Survey Namibia Demographic and Health Survey 2006-07 Ministry of Health and Social Services Windhoek, Namibia Macro International Inc. Calverton, Maryland USA August 2008 The Global Fund – To Fight AIDS, Tuberculosis, and Malaria The report presents the findings from the 2006-07 Namibia Demographic and Health Survey (NDHS) conducted by the Ministry of Health and Social Services (MoHSS). Macro International Inc. provided technical assistance through the MEASURE DHS project, which is funded by the United States Agency for International Development (USAID). Most of the funds for the local costs of the survey were provided by the Government of Namibia, with assistance from the Global Fund, UNICEF, and DFID through a SADC project. Additional support was provided by UNFPA and the World Health Organization. USAID funding was provided under contract number GPO-C-00-03-00002-00. The views expressed in this report are those of the authors and do not necessarily reflect the views of the United States Agency for International Development or the United States Government or the Government of Namibia. The 2006-07 NDHS is part of the worldwide Demographic and Health Surveys program, which is designed to assist developing countries to collect data on fertility, family planning, maternal and child health, nutrition, and HIV/AIDS. Additional information about the survey may be obtained from the Ministry of Health and Social Services (MoHSS), Private Bag 13198, Windhoek, Namibia, Telephone: (264-61) 203-2544/5; Fax: (264-61) 272-286; Email: doccentre@mhss.gov.na; Internet: www.healthnet.org.na. Additional information about the DHS programme may be obtained by contacting MEASURE DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200; Fax: 301-572-0999; Email: reports@macrointernational.com; Internet: http://www.measuredhs.com. Suggested citation: Ministry of Health and Social Services (MoHSS) [Namibia] and Macro International Inc. 2008. Namibia Demographic and Health Survey 2006-07. Windhoek, Namibia and Calverton, Maryland, USA: MoHSS and Macro International Inc. Contents | iii CONTENTS Page TABLES AND FIGURES . ix FOREWORD . xvii PREFACE. xix SUMMARY OF FINDINGS . xxi MAP OF NAMIBIA . xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy.1 1.1.1 Geography.1 1.1.2 History.1 1.1.3 Economy .1 1.2 Population .2 1.3 Health Services and Programmes .3 1.4 Survey Objectives and Implementation .4 1.4.1 Organisation .4 1.4.2 Questionnaires .4 1.4.3 Pilot Survey .5 1.4.4 Advocacy and Publicity.5 1.4.5 Training for Fieldworkers .5 1.4.6 Household Listing .6 1.4.7 Data Collection.6 1.4.8 Data Processing .6 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Population by Age and Sex.7 2.2 Household Composition .8 2.3 Education of the Household Population .9 2.3.1 Educational Attainment.10 2.3.2 School Attendance Rates .12 2.3.3 Grade Repetition and Dropout Rates .14 2.4 Household Environment .16 2.4.1 Drinking Water.16 2.4.2 Household Sanitation Facilities .18 2.4.3 Housing Characteristics.19 2.5 Household Possessions.21 2.6 Wealth Index .22 2.7 Birth Registration.23 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents.25 iv │ Contents 3.2 Educational Attainment by Background Characteristics.27 3.3 Literacy .29 3.4 Access to Mass Media .31 3.5 Employment .33 3.6 Occupation.36 3.7 Earnings and Type of Employment .39 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Current Fertility.41 4.2 Fertility Differentials by Background Characteristics.43 4.3 Fertility Trends .44 4.4 Children Ever Born and Living.46 4.5 Birth Intervals.47 4.6 Age at First Birth.49 4.7 Teenage Pregnancy and Motherhood.50 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.53 5.2 Ever Use of Contraception .55 5.3 Current Use of Contraceptive Methods .57 5.4 Differentials in Contraceptive Use by Background Characteristics.59 5.5 Number of Children at First Use of Contraception.61 5.6 Knowledge of the Fertile Period .62 5.7 Timing of Sterilization .63 5.8 Source of Contraception .63 5.9 Cost of Contraception .64 5.10 Informed Choice.65 5.11 Future Use of Contraception .67 5.12 Reasons for Not Intending To Use .67 5.13 Preferred Method for Future Use .68 5.14 Exposure to Family Planning Messages .69 5.15 Contact of Nonusers with Family Planning Providers .70 5.16 Husband/Partner’s Knowledge of Women’s Contraceptive Use .72 5.17 Men's Attitude Towards Contraception.73 5.18 Men's Attitude Towards Childbearing .74 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .75 6.2 Polygyny .76 6.3 Age at First Marriage .77 6.4 Age at First Sexual Intercourse.79 6.5 Recent Sexual Intercourse .81 6.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility.84 6.7 Menopause.86 Contents | v CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children .87 7.2 Desire to Limit Childbearing.89 7.3 Unmet Need for Family Planning .92 7.4 Ideal Number of Children .94 7.5 Mean Ideal Number of Children by Background Characteristics .95 7.6 Fertility Planning Status .95 7.7 Wanted Fertility Rates .96 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality.99 8.3 Socioeconomic Differentials in Infant and Child Mortality . 101 8.4 Demographic Differentials in Infant and Child Mortality. 102 8.5 Differentials in Infant and Child Mortality by Women’s Status . 103 8.6 Perinatal Mortality. 104 8.7 High-Risk Fertility Behaviour . 106 CHAPTER 9 ADULT AND MATERNAL MORTALITY 9.1 Data. 109 9.2 Direct Estimates of Adult Mortality . 110 9.3 Estimates of Maternal Mortality . 112 CHAPTER 10 MATERNAL HEALTH 10.1 Antenatal Care . 115 10.2 Place of Antenatal Care. 117 10.3 Number and Timing of ANC Visits. 118 10.4 Components of Antenatal Care . 119 10.5 Tetanus Toxoid Injections . 121 10.6 Place of Delivery. 122 10.7 Assistance During Delivery . 123 10.8 Postnatal Care. 125 10.9 Problems in Accessing Health Care . 127 10.10 Participation of Men in Family Health Care . 129 10.11 Payment for Delivery . 131 CHAPTER 11 CHILD HEALTH 11.1 Child’s Size at Birth . 133 11.2 Vaccination Coverage . 135 11.3 Trends in Vaccination Coverage . 137 11.4 Acute Respiratory Infection . 137 11.5 Fever. 138 11.6 Prevalence of Diarrhoea. 140 11.7 Diarrhoea Treatment. 141 11.8 Feeding Practices . 142 11.9 Knowledge of ORS Packets . 144 vi │ Contents 11.10 Disposal of Children’s Stools . 145 CHAPTER 12 NUTRITION OF CHILDREN AND WOMEN 12.1 Nutritional Status of Children . 147 12.2 Initiation of Breastfeeding. 151 12.3 Breastfeeding Status by Age. 153 12.4 Duration and Frequency of Breastfeeding . 155 12.5 Types of Supplemental Foods. 156 12.6 Micronutrient Intake among Children. 159 12.7 Nutritional Status of Women. 162 12.8 Foods Consumed by Mothers. 163 12.9 Micronutrient Intake among Mothers . 165 CHAPTER 13 MALARIA AND OTHER HEALTH ISSUES 13.1 Ownership of Mosquito Nets . 167 13.2 Use of Mosquito Nets by Children . 168 13.3 Use of Mosquito Nets by Pregnant Women. 169 13.4 Malaria Prophylaxis in Pregnancy . 170 13.5 Malaria Diagnosis and Treatment . 172 13.6 Treatment of Fever. 173 13.7 Knowledge and Signs of Malaria. 175 13.8 Knowledge of Causes of Malaria. 176 13.9 Action Taken in Case of Malaria. 178 13.10 Action Taken to Prevent Malaria . 180 13.11 Health Insurance Coverage . 182 13.12 Knowledge and Attitudes Concerning Tuberculosis . 185 13.13 Use of Tobacco. 187 CHAPTER 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 14.1 Knowledge of HIV/AIDS Transmission and Prevention Methods . 192 14.1.1 Knowledge of AIDS. 192 14.1.2 Knowledge of HIV Prevention. 193 14.2 Comprehensive Knowledge about HIV/AIDS. 195 14.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 197 14.4 Accepting Attitudes towards People Living with AIDS. 199 14.5 Attitudes towards Negotiating Safer Sex. 202 14.6 Attitudes towards Condom Education for Youth and Beliefs about Abstinence and Faithfulness . 203 14.7 Higher-Risk Sex. 205 14.7.1 Multiple Partners and Condom Use . 205 14.7.2 Transactional Sex. 209 14.8 Coverage of HIV Counselling and Testing. 210 14.8.1 HIV Testing and Counselling for Pregnant Women. 212 14.8.2 Male Circumcision. 214 14.8.3 Self-Reporting of Sexually Transmitted Infections (STI) . 215 14.8.4 Prevalence of Medical Injections. 217 14.9 HIV Knowledge and Sexual Behaviour among Youth. 220 Contents | vii 14.9.1 Comprehensive HIV/AIDS Knowledge and Source of Condoms among Youth . 220 14.9.2 Age at First Sex . 222 14.9.3 Condom Use at First Sex. 223 14.9.4 Abstinence and Premarital Sex. 225 14.9.5 Higher-Risk Sex and Condom Use among Young Adults . 226 14.9.6 Cross-generational Sexual Partners. 229 14.9.7 Drunkenness during Sex among Young Adults . 230 14.9.8 Voluntary HIV Counselling and Testing among Young Adults . 232 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Form of Earnings. 233 15.2 Women’s Control over Their Own Earnings and the Relative Magnitude of Women’s Earnings. 235 15.3 Control over Husband’s Earnings . 237 15.4 Women’s Participation in Decision-Making. 239 15.5 Attitudes towards Wife Beating . 243 15.6 Attitudes towards Refusing Sex with Husband . 246 15.7 Women’s Empowerment Indicators . 251 15.8 Current Use of Contraception by Women’s Empowerment Status. 252 15.9 Ideal Family Size and Unmet Need by Women’s Status . 253 15.10 Women’s Status and Reproductive Health Care . 253 CHAPTER 16 ORPHANS AND VULNERABLE CHILDREN 16.1 Orphans and Vulnerable Children. 255 16.1.1 Children’s Living Arrangements and Orphanhood. 255 16.1.2 Orphaned and Vulnerable Children. 256 16.2 Social and Economic Situation of Orphaned and Vulnerable Children . 258 16.2.1 School Attendance. 259 16.2.2 Basic Material Needs . 260 16.2.3 Orphans Living with Siblings . 261 16.2.4 Nutritional Status . 261 16.2.5 Sex before Age 15 . 262 16.3 Care and Support for OVCs . 263 16.3.1 Succession Planning. 263 16.3.2 Widows Dispossessed of Property. 265 16.3.3 External Support for Households with OVCs . 265 CHAPTER 17 ACCESS TO HEALTH CARE 17.1 Proximity to Government Health Facilities . 269 17.2 Type of Transport to Government Health Facilities. 270 17.3 Type of Transport to Government Hospitals . 271 17.4 Time to Government Health Facilities . 271 REFERENCES . 273 viii │ Contents APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 277 A.1 Sample Design . 277 A.2 Sample Implementation . 279 APPENDIX B ESTIMATES OF SAMPLING ERRORS. 281 APPENDIX C DATA QUALITY TABLES . 301 APPENDIX D PERSONS INVOLVED IN THE 2006-07 NAMIBIA DEMOGRAPHIC AND HEALTH SURVEY. 305 APPENDIX E QUESTIONNAIRES . 311 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators,, Namibia 1991 and 2001. 2 Table 1.2 Results of the household and individual interviews. 6 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence. 7 Table 2.2 Household composition. 9 Table 2.3.1 Educational attainment of the female household population . 10 Table 2.3.2 Educational attainment of the male household population . 11 Table 2.4 School attendance ratios . 13 Table 2.5 Grade repetition and dropout rates. 15 Table 2.6 Household drinking water. 17 Table 2.7 Household drinking water by region . 18 Table 2.8 Household sanitation facilities. 18 Table 2.9 Household sanitation by region. 19 Table 2.10 Housing characteristics. 20 Table 2.11 Household durable goods . 21 Table 2.12 Wealth quintiles. 23 Table 2.13 Birth registration of children under age five . 24 Figure 2.1 Population Pyramid . 8 Figure 2.2 Age-Specific School Attendance Rates. 14 Figure 2.5 Percentage of Households Owning Various Durable Goods . 22 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .26 Table 3.2.1 Educational attainment: Women.27 Table 3.2.2 Educational attainment: Men .28 Table 3.3.1 Literacy: Women .29 Table 3.3.2 Literacy: Men .30 Table 3.4.1 Exposure to mass media: Women.31 Table 3.4.2 Exposure to mass media: Men .32 Table 3.5.1 Employment status: Women .34 Table 3.5.2 Employment status: Men.35 Table 3.6.1 Occupation: Women.37 Table 3.6.2 Occupation: Men .38 Table 3.7 Type of employment: Women.39 Figure 3.1 Women’s Employment Status in the Past 12 Months.36 x | Tables and Figures CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility .42 Table 4.2 Current fertility by region .43 Table 4.3 Fertility by background characteristics .44 Table 4.4 Trends in age-specific fertility rates.45 Table 4.5 Trends in age-specific and total fertility rates .45 Table 4.6 Children ever born and living.46 Table 4.7 Birth intervals.48 Table 4.8 Age at first birth .49 Table 4.9 Median age at first birth .50 Table 4.10 Teenage pregnancy and motherhood.51 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence.42 Figure 4.2 Total Fertility Rates for Selected Countries .43 Figure 4.3 Trends in Age-specific Fertility Rates, Namibia 1992-2007.45 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .54 Table 5.2 Knowledge of contraceptive methods by background characteristics .55 Table 5.3.1 Ever use of contraception: Women .56 Table 5.3.2 Ever use of contraception: Men .57 Table 5.4 Current use of contraception by age .58 Table 5.5 Trends in contraceptive use .59 Table 5.6 Current use of contraception among sexually active women by background characteristics .60 Table 5.7 Current use of contraception among all women by background characteristics .61 Table 5.8 Number of children at first use of contraception .62 Table 5.9 Knowledge of fertile period.62 Table 5.10 Timing of sterilization.63 Table 5.11 Source of modern contraception methods .64 Table 5.12 Cost of modern contraceptive methods.65 Table 5.13 Informed choice .66 Table 5.14 Future use of contraception .67 Table 5.15 Reason for not intending to use contraception in the future .68 Table 5.16 Preferred method of contraception for future use.69 Table 5.17 Exposure to family planning messages .70 Table 5.18 Contact of nonusers with family planning providers .71 Table 5.19 Husband/partner's knowledge of women's use of contraception .72 Table 5.20 Male attitudes about the use of contraception.73 Table 5.21 Male attitudes about childbearing .74 Figure 5.1 Trends in Contraceptive Use among All Women Age 15-49, Namibia 1992-2006-07 .59 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .75 Tables and Figures | xi Table 6.2 Number of women's co-wives and men’s wives.77 Table 6.3 Age at first marriage .78 Table 6.4 Median age at first marriage: Women .79 Table 6.5 Age at first sexual intercourse .80 Table 6.6 Median age at first intercourse .81 Table 6.7.1 Recent sexual activity: Women .82 Table 6.7.2 Recent sexual activity: Men .83 Table 6.8 Postpartum amenorrhoea, abstinence and insusceptibility.84 Table 6.9 Median duration of amenorrhoea, postpartum abstinence and postpartum insusceptibility.85 Table 6.10 Menopause.86 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children: all women.87 Table 7.2 Fertility preferences by number of living children: currently married women and men .89 Table 7.3 Desire to limit childbearing: All women and men.90 Table 7.4 Desire to limit childbearing: Currently married women and men .91 Table 7.5 Unmet need and the demand for family planning among all women .92 Table 7.6 Ideal number of children .94 Table 7.7 Mean ideal number of children.95 Table 7.8 Fertility planning status.96 Table 7.9 Wanted fertility rates.97 Figure 7.1 Fertility Preferences of Women Age 15-49.88 Figure 7.2 Desire to Limit Childbearing Among Women 15-49 and Men 15-49, by Number of Living Children.91 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 100 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 102 Table 8.3 Early childhood mortality rates by demographic characteristics. 103 Table 8.4 Early childhood mortality rates by women's status . 104 Table 8.5 Perinatal mortality. 105 Table 8.6 High-risk fertility behaviour . 107 Figure 8.1 Trends in Infant and Childhood Mortality, Namibia 1992 to 2006-07 . 100 CHAPTER 9 ADULT AND MATERNAL MORTALITY Table 9.1 Data on siblings . 110 Table 9.2 Adult mortality rates. 111 Table 9.3 Direct estimates of maternal mortality . 113 Figure 9.1 Adult Mortality Rates in Namibia by Age and Sex 1998-2007 . 111 Figure 9.2 Female Mortality Rates in Namibia by Age, 2000 NDHS and 2006-07 NDHS . 112 xii | Tables and Figures Figure 9.3 Male Mortality Rates in Namibia by Age, 2000 NDHS and 2006-07 NDHS . 112 CHAPTER 10 MATERNAL HEALTH Table 10.1 Antenatal care provider. 116 Table 10.2 Place of antenatal care. 118 Table 10.3 Number of antenatal care visits and timing of first visit . 119 Table 10.4 Components of antenatal care . 120 Table 10.5 Tetanus toxoid injections . 121 Table 10.6 Place of delivery . 122 Table 10.7 Assistance during delivery . 124 Table 10.8 Timing of first postnatal check-up . 125 Table 10.9 Postnatal care provider . 126 Table 10.10 Problems accessing health care . 128 Table 10.11 Participation of men in antenatal care visit . 129 Table 10.12 Knowledge about diarrhoea treatment . 130 Table 10.13 Payment for delivery . 131 CHAPTER 11 CHILD HEALTH Table 11.1 Child's weight and size at birth. 134 Table 11.2 Vaccinations by source of information. 135 Table 11.3 Vaccinations by background characteristics . 136 Table 11.4 Vaccinations in first year of life. 137 Table 11.5 Prevalence of symptoms of ARI . 138 Table 11.6 Prevalence and treatment of fever. 139 Table 11.7 Prevalence of diarrhoea . 140 Table 11.8 Diarrhoea treatment . 141 Table 11.9.1 Feeding practices during diarrhoea: liquids . 143 Table 11.9.2 Feeding practices during diarrhoea: solid food . 144 Table 11.10 Knowledge of ORS packets or pre-packaged liquids. 145 Table 11.11 Disposal of children's stools. 146 CHAPTER 12 NUTRITION OF CHILDREN AND WOMEN Table 12.1 Nutritional status of children . 149 Table 12.2 Initial breastfeeding. 152 Table 12.3 Breastfeeding status by age . 154 Table 12.4 Median duration and frequency of breastfeeding . 156 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 157 Table 12.6 Infant and young child feeding (IYCF) practices . 158 Table 12.7 Micronutrient intake among children . 161 Table 12.8 Nutritional status of women . 163 Table 12.9 Foods consumed by mothers in the day or night preceding the interview. 164 Table 12.10 Micronutrient intake among mothers . 166 Figure 12.1 Nutritional Status of Children by Age . 151 Tables and Figures | xiii Figure 12.2 Infant Feeding Practices by Age. 154 Figure 12.3 Infant and Young Child Feeding Practices 2000 NDHS and 2006-07 NDHS . 155 Figure 12.4 Infant and Young Child Feeding Practices . 159 CHAPTER 13 MALARIA AND OTHER HEALTH ISSUES Table 13.1 Ownership of mosquito nets . 168 Table 13.2 Use of mosquito nets by children. 169 Table 13.3 Use of mosquito nets by pregnant women . 170 Table 13.4 Prophylactic use of anti-malarial drugs and use of intermittent preventive treatment (IPT) by women during pregnancy . 171 Table 13.5 Prevalence of fever and treatment with anti-malarial drugs. 173 Table 13.6 Anti-malarial drugs received by children . 174 Table 13.7.1 Knowledge of signs of malaria: Women . 175 Table 13.7.2 Knowledge of signs of malaria: Men. 176 Table 13.8.1 Knowledge of causes of malaria: Women. 177 Table 13.8.2 Knowledge of causes of malaria: Men . 178 Table 13.9.1 Action taken in case of malaria: Women. 179 Table 13.9.2 Action taken in case of malaria: Men . 180 Table 13.10.1 Action taken to prevent malaria: Women. 181 Table 13.10.2 Action taken to prevent malaria: Men . 182 Table 13.11.1 Health insurance coverage: Women . 183 Table 13.11.2 Health insurance coverage: Men. 184 Table 13.12.1 Knowledge and attitude concerning tuberculosis: Women . 186 Table 13.12.2 Knowledge and attitude concerning tuberculosis: Men . 187 Table 13.13.1 Use of tobacco: Women. 188 Table 13.13.2 Use of tobacco: Men . 189 CHAPTER 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 14.1 Knowledge of AIDS. 193 Table 14.2 Knowledge of HIV prevention methods. 194 Table 14.3.1 Comprehensive knowledge about AIDS: Women . 196 Table 14.3.2 Comprehensive knowledge about AIDS: Men. 197 Table 14.5.1 Accepting attitudes towards people living with HIV/AIDS: Women . 200 Table 14.5.2 Accepting attitudes towards people living with HIV/AIDS: Men. 201 Table 14.6 Attitudes towards negotiating safer sexual relations with husband. 202 Table 14.7 Adult support of education about condom use to prevent AIDS . 204 Table 14.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women . 206 Table 14.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men. 208 Table 14.9 Payment for sexual intercourse among men . 209 Table 14.10.1 Coverage of prior HIV testing: Women . 211 Table 14.10.2 Coverage of prior HIV testing: Men. 212 Table 14.11 Pregnant women counselled and tested for HIV. 213 Table 14.12 Male circumcision. 215 Table 14.13 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms. 216 xiv | Tables and Figures Table 14.14 Prevalence of medical injections . 218 Table 14.15 Comprehensive knowledge about AIDS and of a source of condoms among youth . 221 Table 14.16 Age at first sexual intercourse among youth. 222 Table 14.17 Condom use at first sexual intercourse among youth. 224 Table 14.18 Premarital sexual intercourse and condom use among youth . 225 Table 14.19.1 Higher-risk sexual intercourse and condom use among youth: Women . 227 Table 14.19.2 Higher-risk sexual intercourse and condom use among youth: Men. 228 Table 14.20 Age-mixing in sexual relationships among women age 15-19 . 230 Table 14.21 Drunkenness during sexual intercourse among youth. 231 Table 14.22 Recent HIV tests among youth . 232 Figure 14.1 HIV Prevalence by Year of Survey . 191 Figure 14.2 Perceptions and Beliefs about Abstinence and Faithfulness . 205 Figure 14.3 Women and Men Seeking Treatment for STIs . 217 Figure 14.4 Type of Facility Where Last Medical Injection Was Received . 219 Figure 14.5 Percentage of Men and Women Whose Last Injection Was Given with a Syringe and Needle Taken From a New, Unopened Package, by Type of Facility Where Last Injection Was Received . 220 Figure 14.6 Trends in Age at First Sexual Intercourse, Namibia 2000 and 2006-07. 223 Figure 14.7 Abstinence, Being Faithful, and Condom Use (ABC) among Young Women and Men . 229 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings: All women and men . 234 Table 15.2 Employment and cash earnings: Currently married women and men . 235 Table 15.3 Control over women's cash earnings and relative magnitude of women's earnings: Women. 236 Table 15.4 Control over men's cash earnings . 238 Table 15.5 Women's perceptions of who controls earnings and the relative size of earnings . 239 Table 15.6 Women's participation in decision-making . 240 Table 15.7 Women's participation in decision-making according to men . 240 Table 15.8.1 Women's participation in decision-making by background characteristics. 241 Table 15.8.2 Men's attitude towards wives' participation in decision-making. 243 Table 15.9.1 Attitudes towards wife beating: Women. 244 Table 15.9.2 Attitudes towards wife beating: Men . 246 Table 15.10.1 Attitudes towards refusing sexual intercourse with husband: Women. 247 Table 15.10.2 Attitudes towards refusing sexual intercourse with husband: Men . 249 Table 15.11 Men's attitudes towards a husband's rights when his wife refuses to have sexual intercourse. 250 Table 15.12 Indicators of women's empowerment. 251 Table 15.13 Current use of contraception by women's status. 252 Table 15.14 Women's empowerment and ideal number of children and unmet need for family planning . 253 Table 15.15 Reproductive health care and women's empowerment . 254 Figure 15.1 Number of Decisions in Which Women Participate . 242 Tables and Figures | xv CHAPTER 16 ORPHANS AND VULNERABLE CHILDREN Table 16.1 Children's living arrangements and orphanhood. 256 Table 16.2 Orphans and vulnerable children (OVC) . 257 Table 16.3 School attendance by survivorship of parents and by OVC status . 259 Table 16.4 Possession of basic material needs by orphans and vulnerable children. 260 Table 16.5 Orphans not living with siblings. 261 Table 16.6 Underweight orphans and vulnerable children. 262 Table 16.7 Sexual intercourse before age 15 among orphans and vulnerable children . 263 Table 16.8 Succession planning. 264 Table 16.9 Widows dispossessed of property. 265 Table 16.10 External support for very sick persons. 266 Table 16.11 External support for orphans and vulnerable children. 267 Figure 16.1 OVC Population, Namibia 2006-07. 258 CHAPTER 17 ACCESS TO HEALTH CARE Table 17.1 Nearest government health facility . 269 Table 17.2 Means of transport to government health facility . 270 Table 17.3 Means of transport to government hospital. 271 Table 17.4 Time to reach government health facility and means of transport . 272 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample allocation by region . 278 Table A.2 Sample implementation: Women . 279 Table A.2 Sample implementation: Women . 280 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 274 Table B.2 Sampling errors for National sample. 285 Table B.3 Sampling errors for Urban sample . 286 Table B.4 Sampling errors for Rural sample. 287 Table B.5 Sampling errors for Caprivi sample. 288 Table B.6 Sampling errors for Erongo sample . 289 Table B.7 Sampling errors for Hardap sample . 290 Table B.8 Sampling errors for Karas sample. 291 Table B.9 Sampling errors for Kavango sample. 292 Table B.10 Sampling errors for Khomas sample. 293 Table B.11 Sampling errors for Kunene sample . 294 Table B.12 Sampling errors for Ohangwena sample . 295 Table B.13 Sampling errors for Omaheke sample . 296 Table B.14 Sampling errors for Omusati sample. 297 Table B.15 Sampling errors for Oshana sample . 298 Table B.16 Sampling errors for Oshikoto sample. 299 Table B.17 Sampling errors for Otjozondjupa sample . 300 xvi | Tables and Figures APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 301 Table C.2.1 Age distribution of eligible and interviewed women . 302 Table C.2.2 Age distribution of eligible and interviewed men. 302 Table C.3 Completeness of reporting . 303 Table C.4 Births by calendar years . 303 Table C.5 Reporting of age at death in days . 304 Table C.6 Reporting of age at death in months. 304 Foreword | xvii FOREWORD This report presents the results of the 2006-07 Namibia Demographic and Health Survey (NDHS) that was carried out from November 2006 through March 2007. The survey is the latest in a series of periodic surveys that are conducted in collaboration with various stakeholders led by the Ministry of Health and Social Services. The main objective of this survey was to measure levels, patterns, and trends in demographic and health indicators in Namibia. Specifically, the 2006-07 NDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs). In addition, it collected information on the use of mosquito nets, women’s empowerment and demographic and health outcomes as well as information on orphans and vulnerable children care and support. This survey was designed to produce estimates at the regional level for most indicators. The tables, figures, and text are related to the most important indicators consistent with the objectives of the survey. They are targeted for use by policymakers, planners, and researchers, especially in the health sector. I believe that the 2006-07 NDHS report will be widely read and utilized by communities, health and social workers, the relevant line ministries and civil society organisations, regional councils, local authorities as well as our development partners, with the vision of improving the health status of all Namibians at large. One of the key result areas in the third National Development Plan (NDP 3) is the Quality of Life. This key result area has three goals: 1) Affordable and Quality Health Care, 2) Reduce Spread of HIV/AIDS and its effects, and 3) the Eradication of Extreme Poverty and Hunger. In order for the Ministry of Health and Social Services and other stakeholders responsible for the implementation of programmes to realize the goals under this key result area, I urge them all to make use of the 2006-07 NDHS report to assist in the programming of health interventions. Together we can make a difference! DR RICHARD NCHABI KAMWI (MP) MINISTER FOR HEALTH AND SOCIAL SERVICES Preface | xix PREFACE The 2006-07 Namibia Demographic and Health Survey (NDHS) marks yet another milestone in the history of the Ministry of Health and Social Services. It provides a comprehensive source of information on health and demographic indicators at a point in time when the Ministry evaluates its implemented programmes and interventions over the five years period. The 2006-07 NDHS has been a large-scale research project. Twenty-eight field teams interviewed about 9,200 households, 9,800 women and 3,900 men age 15-49. The interviews were conducted between November 2006 and March 2007. The survey covered about 500 primary sampling units in all regions. This report presents findings of the 2006-07 NDHS. The 2006-07 NDHS is the third survey of its kind to be undertaken in Namibia, others being in 1992 and 2000. The 2006-07 NDHS differed in three aspects from the 2000 NDHS survey: it included a module on malaria indicators, women’s empowerment, and orphans and vulnerable children. The MoHSS would like to acknowledge organizations that contributed to the successful completion of the 2006-07 NDHS. The Ministry is grateful for the financial, technical and other assistance provided by the United States Agency for International Development (USAID), the Global Fund, the Chinese Government, and the United Nations Children’s Fund (UNICEF). Furthermore, the Ministry appreciates technical support from the United Nations Population Fund (UNFPA), World Health Organization (WHO), Macro International Inc., National Planning Commission Secretariat and others. Sincere thanks are also extended to members of the 2006-07 NDHS Steering Committee and stakeholders who contributed to the successful completion of the survey. The Ministry acknowledges the valuable support in raising awareness about the survey and generating cooperation from communities that was provided by all regional councillors, governors, various town and city councils; and the Namibia Agricultural Union and local farmers associations. Special thanks go to the staff who participated in various aspects of the survey and the respondents, who generously gave their time to provide the information that forms the basis of this report. Finally, I would like to express my sincere gratitude to the overall 2006-07 NDHS project coordinating team at the Directorate of Policy, Planning and Human Resource Development for their tireless work during the survey and for ensuring that the project was completed successfully. KAHIJORO KAHUURE PERMANENT SECRETARY Summary of Findings | xxi SUMMARY OF FINDINGS The 2006-07 Namibia Demographic and Health Survey (NDHS) is a nationally representative survey of 9,804 women age 15-49 and 3,915 men age 15-49. The 2006-07 NDHS is the third com- prehensive survey conducted in Namibia as part of the Demographic and Health Surveys (DHS) programme. The data are intended to provide programme managers and policymakers with detailed information on levels and trends in fer- tility; nuptiality; sexual activity; fertility prefer- ences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality, adult and maternal mortal- ity; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexu- ally transmitted infections. The 2006-07 NDHS is the first NDHS survey to collect information on malaria prevention and treatment. HOUSEHOLD CHARACTERISTICS The 2006-07 NDHS collected information on the availability of various amenities in the surveyed households. The survey found that almost 90 percent of households have access to an im- proved water source. Nationally, one in three households has an im- proved, unshared toilet facility. There are large disparities by residence, with 60 percent of households in urban areas having sanitary toilets, compared with only 14 percent of rural house- holds. FERTILITY The survey results show that Namibia has ex- perienced a decline in fertility of almost two births over the past 15 years, with the fertility rate falling from 5.4 births per woman in 1990- 1992 to 3.6 births in 2005-07. On average, rural women have 1.5 children more than urban wom- en (4.3 and 2.8, respectively). The low level of fertility among urban women is also reflected in the lower fertility among women in the urban region of Khomas, where women on average are having 2.6 children compared with 2.8 to 5.1 children in the other regions. Fertility differen- tials by education and wealth are substantial. Women with no formal education have an aver- age of more than six children (6.3), while women with completed secondary education have less than three children (2.8). Similarly, women in the lowest wealth quintile have an average of five children (5.1), while women in the highest wealth quintile have between two and three chil- dren (2.4). Despite the decline in fertility, unplanned preg- nancies are common in Namibia. Overall, two in three births are either unwanted (41 percent) or mistimed, i.e., wanted later (22 percent). If all unwanted births were avoided, women would have an average of 2.7 children, compared with the actual average of 3.6 children. While marriage and cohabitation are generally considered primary indicators of exposure to the risk of pregnancy, many women in Namibia bear children outside of a stable union. Visiting rela- tionships are common and many women have children in the context of such unions. The me- dian age at first marriage in Namibia is relatively high, 28.2 years among women age 30-49. Urban women marry more than one year later than rural women (29.1 and 27.4 years, respectively). The median age at first marriage for women age 30- 49 with no education is 24.3 years compared with 27.9 years for women with more than sec- ondary education. Typically, men and women in Namibia begin sexual activity before marriage. Among the pop- ulation age 25-49, the median age at first sexual intercourse is 19.3 years for women and 18.2 years for men. The 2006-07 NDHS indicates that about 6 per- cent of currently married women are in a poly- gynous union (i.e., they have one or more co- wives). Three percent of men reported having two or more wives. This is a decline from the 2000 NDHS, in which 12 percent of women were in a polygynous union and 4 percent of men had more than two wives. Older women, women who live in rural areas, women with no education, and xxii * Summary of Findings women in the lowest wealth quintiles are more likely than other women to have co-wives. The prevalence of polygyny varies across regions. Hardap and Karas have the lowest level (less than 2 percent) and Kunene has the highest levels (17 percent). FAMILY PLANNING Knowledge of family planning in Namibia has been nearly universal since 1992. In the 2006-07 NDHS, 98 percent of all women reported know- ing about a contraceptive method. Male con- doms, injectables, and the pill are the most wide- ly known methods. Ninety-three percent of sexually active women and men age 15-49 have used a family planning method at least once in their lifetime. Two in three of these women are currently using any contraceptive method and 66 percent use a mod- ern method. The most popular methods are in- jectables and male condoms, used by 24 percent and 23 percent, respectively, of sexually active women. Nine percent of sexually active women use the pill and 8 percent have been sterilized. Government-sponsored facilities remain the chief providers of contraceptive methods in Namibia. The distribution of sources of modern methods for current users shows that three in four users obtained their method from the public sector. While the participation of the private medical sector in family planning service delivery has remained the same (10 percent), use of retail out- lets has increased fourfold since 2000 (3 percent to 13 percent). Unmet need for family planning has declined from 5 percent in 2000 to 3 percent in 2006-07. If all women with an unmet need for family planning were to use a contraceptive method, the contraceptive prevalence rate in Namibia would increase from 47 to 50 percent. CHILD HEALTH Data from the 2006-07 NDHS indicate that the under-five mortality rate in Namibia is 69 deaths per 1,000 live births (based on the five-year pe- riod preceding the survey). This means that one in every fourteen children born in Namibia dies before attaining his or her fifth birthday. The in- fant mortality rate is 46 deaths per 1,000 live births. About half of these infant deaths take place in the neonatal period, that is, during the first month of life. Child mortality is consistently lower in urban areas than in rural areas. There is substantial var- iation in mortality rates across regions. Under- five and infant mortality rates are highest in Ohangwena and Caprivi and lowest in Kunene. Children whose mothers have more than secon- dary education have much lower mortality than children whose mothers have less education. Si- milarly, children whose mothers are in the high- est wealth quintile have much lower mortality than children whose mothers are in the lowest quintile. Children are considered fully vaccinated when they receive one dose of BCG vaccine, three doses each of DPT and polio vaccines, and one dose of measles vaccine. Overall, 69 percent of children age 12-23 months have received all vac- cinations. Ninety-five percent of children have received the BCG vaccination, and 84 percent have been vaccinated against measles. Coverage for the first dose of DPT and polio is relatively high (95 percent each). However, only 83 percent of children received the third dose of DPT and 79 percent received the third dose of polio. Com- parison of the 2006-07 NDHS results with those of the earlier surveys shows that vaccination coverage in Namibia has increased from 65 per- cent in 1992 to the current rate of 69 percent. Four percent of children under age five experi- enced symptoms of acute respiratory infection (ARI) in the two weeks before the survey, and 17 percent of children under five were reported to have had fever—a major manifestation of ma- laria—during the same time period. More than half of the children (56 percent) were taken to a health facility or provider of treatment. Ten per- cent of children with fever received antimalarial drugs, while 15 percent received antibiotics. At the time of the survey, diarrhoea was a less prevalent problem among young children than fever; 12 percent of children under age five had diarrhoea at some time in the two weeks before the survey. Two-thirds of children with diarrhoea were taken to a health provider. Seven in ten children with diarrhoea were treated with some type of oral rehydration therapy (ORT): 63 per- cent were treated with solution prepared from a Summary of Findings | xxiii packet of oral rehydration salts (ORS), 21 per- cent were given recommended salt-sugar solution (SSS) prepared at home, and 16 percent were given increased fluids. Seventeen percent of children with diarrhoea did not receive any treatment at all. MATERNAL HEALTH In Namibia, almost all women who had a live birth in the five years preceding the survey re- ceived antenatal care from health professionals (95 percent): 16 percent from a doctor and 79 percent from a nurse or midwife. Only 4 percent of mothers did not receive any antenatal care. Tetanus toxoid injections are given during preg- nancy to prevent neonatal tetanus. Nearly six in ten women (57 percent) with a live birth in the five years before the survey had sufficient teta- nus toxoid coverage to ensure that their last (most recent) birth was protected against neona- tal tetanus; one in three women received two or more injections. The majority of births in the five years before the survey were delivered in a health facility (81 percent). This figure is higher than that reported in the 2000 NDHS (75 percent) and the 1992 NDHS (67 percent). Seventy-six percent of births took place in public health facilities and 5 per- cent occurred in private health facilities. Nine- teen percent of births were assisted by a doctor, 63 percent by a nurse or midwife, 7 percent by a trained traditional birth attendant, and 11 percent by a relative or other person. Thirteen percent of births were delivered by a caesarean section. Overall, 78 percent of mothers received a postna- tal checkup for the most recent birth in the past five years, with 34 percent having the checkup within the critical 48 hours after delivery. Adult mortality rates derived from the 2006-07 NDHS data are higher for males than females (10.4 and 8.3 deaths per 1,000 population, re- spectively). A comparison of the 2006-07 NDHS and the 2000 NDHS rates indicates that there has been a substantial increase in adult mortality in Namibia. The rate for females almost doubled between the two surveys and the rate for males is 65 percent higher than it was in 2000. The maternal mortality ratio during the 10-year period before the survey is estimated at 449 ma- ternal deaths per 100,000 live births. This figure should be viewed with caution because the num- ber of female deaths occurring during pregnancy, at delivery, or within two months of delivery is small (86). As a result, the maternal mortality estimates are subject to larger sampling errors than the adult mortality estimates; the 95 percent confidence intervals indicate that the maternal mortality ratio varies from about 390 to 560. BREASTFEEDING AND NUTRITION Breastfeeding is common in Namibia, with 94 percent of children breastfed at some point dur- ing childhood. The median breastfeeding dura- tion in Namibia is 16.8 months. Exclusive breast- feeding, on the other hand, is relatively short, with a median duration of less than one month. About one-quarter of babies are exclusively breastfed throughout the first six months of life. By age 6-9 months, 72 percent of children are receiving complementary foods. Two in three children age 18-23 months have been weaned. Bottle-feeding is common; 38 percent of babies less than six months of age are fed with a bottle. The proportion bottle-fed peaks at 50 percent among children age 6-8 months. Overall, 29 percent of children are stunted (short for their age), 8 percent are wasted (thin for their height), and 17 percent are underweight (thin for their age). All of the indices indicate that malnu- trition increases with age, prevalence peaking at age 12-23 months and declining as children ap- proach their fifth birthday. For example, stunting affects 38 percent of children age 18-23 months; 14 percent are severely stunted. Nine to 10 per- cent of children age 12-23 months are wasted; the highest rate of severe acute malnutrition is found among children age 18-23 months (3 per- cent). More than half of women (56 percent) have a body mass index (BMI) in the normal range (BMI 18.5-24.9). In Namibia, overweight and obesity are more common than underweight. A total of 28 percent of women are overweight or obese (BMI ≥25.0), including 12 percent classi- fied as obese (BMI ≥30.0). At the other extreme, 16 percent are considered thin (BMI <18.5), in- cluding 6 percent who are moderately or severely thin (BMI <17). xxiv * Summary of Findings MALARIA One in four households interviewed in the survey has at least one mosquito net, and most of these households have a net that has been treated at some time with an insecticide (20 percent). Al- most all of the households owning an ever- treated net have at least one net meeting one of the insecticide-treated net (ITN) criteria, i.e., it was a factory-treated net that did not require re- treatment, a pre-treated net obtained within the past year, or a net soaked in insecticide at some time during the past year. Eleven percent of children under age five slept under an ever-treated net the night before the survey, almost all of which were ITNs. Nine per- cent of pregnant women slept under an ITN. Among women who had their last birth in the two years before the survey, 30 percent took an antimalarial drug during their pregnancy. Twen- ty-eight percent of all pregnant women took at least one dose of SP/Fansidar during their preg- nancy. Eleven percent reported taking two or more doses of SP/Fansidar. The majority of women who took SP/Fansidar were given the drug during an antenatal care visit, and thus are considered to have received intermittent preven- tive treatment (IPT). HIV/AIDS AND STIS Knowledge of HIV and AIDS is universal in Namibia; 99 percent of women age 15-49 and 99 percent of men age 15-49 have heard of AIDS. However, among both women and men, only two in three have what can be considered comprehen- sive knowledge about the modes of HIV trans- mission and prevention. Comprehensive knowl- edge means, a) knowing that use of condoms and having just one uninfected, faithful partner can reduce the chances of getting HIV, b) knowing that a healthy-looking person can have HIV, and c) rejecting the two most common local miscon- ceptions about HIV transmission or prevention. Most women and men know that HIV can be transmitted by breastfeeding, and about three- quarters know that the risk of mother-to-child transmission can be reduced by taking drugs dur- ing pregnancy. Given that most HIV infections in Namibia are contracted through heterosexual contact, infor- mation about higher-risk sex (i.e., sexual inter- course with a non-marital, non-cohabiting part- ner) is important for planning HIV-prevention programmes. The 2006-07 NDHS measured higher-risk sex in the past 12 months. Overall, 49 percent of wom- en and 60 percent of men engaged in higher-risk sex in the year before the survey. About half of these women and two-thirds of the men reported using a condom consistently with their last high- er-risk partner. Among the adult population age 15-49, more than half of women and one in three men have been tested for HIV and received the results at some point in time. ORPHANS AND VULNERABLE CHILDREN One-quarter of Namibian children under age 18 in the households sampled for the 2006-07 NDHS live with both parents, while one in three does not live with either parent. Seventeen per- cent of children under age 18 are orphaned, that is, one or both parents is dead. A comparison of the results from the 2000 NDHS and 2006-07 NDHS for this age group indicates that there has been a dramatic increase in orphanhood in Na- mibia. The proportion of children orphaned, i.e., with one or both parents dead, more than doubled between the two surveys, from 11 percent to 17 percent. The proportion of paternal orphans, i.e., those whose fathers have died, increased from 7 percent to 13 percent, while the proportion of maternal orphans increased from 4 percent to 7 percent between two surveys. The proportion of children under age 18 with both parents dead tripled, from 1 percent in 2000 to 3 percent in 2006-07. Overall, 14 percent of children under age 18 are considered vulnerable, i.e., they live in a house- hold in which at least one adult has been chroni- cally ill during the past year or at least one parent living in the household or elsewhere has suffered from a chronic illness. In total, three in ten chil- dren are either orphaned and/or vulnerable. Summary of Findings | xxv ACCESS TO HEALTH FACILITIES Households interviewed in the 2006-07 NDHS were asked to name the nearest government health facility, the mode of transport they would use to visit the facility, and how long it takes to get to the facility using the transport of choice. The same questions were asked about the gov- ernment hospital. Rural households are more likely to be nearest to a clinic than urban households, and urban house- holds are more likely to be nearest to a govern- ment hospital than rural households. Two in three households access to the nearest government health facility by foot. Urban house- holds are more likely to use a car or motorcycle while rural households are more likely to use public transport. There are substantial regional differences in mode of transport to health facili- ties. About three in ten households in Hardap, Karas, Khomas, Kunene, Omaheke, and Otjo- zondjupa use car or motorcycle, while in Kavango more than nine in ten households walk to health facilities. The type of transport used to access the nearest government hospital is different from the type of transport used to access the nearest government health facility. Because of the greater distance, on average, to hospitals, fewer households (17 percent) reported that they would walk to the nearest government hospital, and two in three said they would use public transport. One in five households is within 15 minutes of a government health facility and three in five are within one hour of a facility. On the other hand, 10 percent of households are more than 3 hours from the nearest government health facility. Overall, it takes on average 74 minutes to reach the nearest facility and 99 minutes to reach a government hospital. Six in ten households in both urban and rural areas indicated that they would walk to the nearest government health facility. xxvi | Map of Namibia Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY AND ECONOMY 1.1.1 Geography Namibia is situated in South-Western Africa and covers approximately 824,000 square kilo- metres. It is bordered by the Atlantic Ocean in the west, Botswana and Zimbabwe in the east, South Africa in the south, and Angola and Zambia in the north. The Namib Desert, the oldest desert in the world, stretches along the whole west coast of the country, while the Kalahari Desert runs along the southeastern border with Botswana. Namibia’s name is derived from the Namib Desert, a unique geological feature renowned for the pristine and haunting quality of its landscape. The Namibian climate varies from arid and semi-arid to subtropical with temperatures between 5°C and 20°C. Fog sometimes occurs along the temperate desert coast. The central, southern, and coastal areas constitute some of the most arid landscapes south of the Sahara. The hottest months of the year are January and February, with average daytime temperatures varying between 9°C and 30°C. During the winter months, May to September, temperatures can fluctuate between -6°C and 10°C at night to 20°C in the day. Frost occurs over large areas of the country during winter, but in general, winter days are clear, cloudless and sunny. Overall, Namibia is a summer rainfall area with limited showers beginning in October and continuing until April. 1.1.2 History On March 21, 1990 Namibia achieved its independence after a century of colonial rule, first by Germany and then by South Africa, following the successful implementation of United Nations Resolution 435. With a constitution based on Roman-Dutch law, the country has a multi-party system and holds general elections every five years. A bicameral legislature consists of the National Council (two members chosen from each regional council) and the National Assembly. Administratively, the country is divided into 13 regions, namely: Caprivi, Kavango, Kunene, Ohangwena, Omusati, Oshana, and Oshikoto regions in the north; Omaheke, Otjozondjupa, Erongo, and Khomas regions in the central areas; and the Hardap and Karas regions in the south. 1.1.3 Economy The positive global economic performance between 2002 and 2006 had a favourable impact on the Namibian economy mainly through high commodity prices and strong demand from the rest of the world. In real terms, the economy recorded a growth rate of 6 percent in 2004, above the 4.4 percent projected earlier. On average, the economy grew by 4.6 percent between 2001 and 2004, just above the target rate of 4.3 percent set in National Development Plan 2 (NDP2). Taking into account the prospects of the world economy and that of Namibia’s main trading partners, the outlook for the Namibian economy for the coming years points to moderate economic performance with a projected average annual growth rate of 3.7 percent (Ministry of Finance, 2007). 2 | Introduction The economy of Namibia, which was formerly based on natural resources, is slowly becoming more diversified. This change is partly a result of the increased processing of minerals such as diamonds, zinc, copper, and marble. In addition, tourism sector has been expanding very rapidly in the past decade, e.g., preliminary amounts indicate that travel and tourism’s contribution to GDP increased by 9.3 percent (real growth) in 2007 alone. Agricultural growth has a disproportionate effect on reducing poverty because 70 percent of the poor in developing countries, including Namibia, live in rural areas. Namibia, along with its developing-country partners, has long championed the reduction of trade barriers for agricultural products as one of the most important actions to reduce poverty (Gaomab, 2007). The manufacturing sector in Namibia remains small, with fish and meat processing being the largest individual sub-sectors. Beverages, other food products, metal and pre-cast concrete products, furniture, paints, detergents, and leather goods are also produced. Namibia is ranked as a middle-income country but has one of the most skewed incomes per capita in the world. The disparities in per capita income among the population are as a result of lopsided development, which characterised the Namibian economy in the past. The country also has a high unemployment rate, which is estimated at 37 percent (Ministry of Labour and Social Welfare, 2004). 1.2 POPULATION According to the 2001 Population and Housing Census, the Namibian population consists of 1,830,330 people, of which 942,572 are female and 887,721 are male (Table 1.1). The country has a relatively young population, with 43 percent under 15 years of age and less than 4 percent over age 65. Despite rapid urbanisation, Namibia is still mainly rural, with one in three living in urban areas. Overall, the population density is low (2 persons per square kilometre). Regional population densities vary substantially, with almost two-thirds of the population living in the four northern regions and less than one-tenth living in the south. Despite its small population, Namibia has a rich diversity of ethnic groups, including Afrikaners, Basters, Caprivians, Coloureds, Damaras, Germans, Hereros, Kavangos, Namas, Owambos, Sans, and Tswanas. Table 1.1 Basic demographic indicators,, Namibia 1991 and 2001 Indicator 1991 Census 2001 Census Population 1,409,920 1,830,330 Intercensal growth rate (percent) 3.1 2.6 Density (population/km2) 1.7 2.1 Percent urban 28 33 Life expectancy at birth (years) Male 59 48 Female 63 50 Source: http://www.npc.gov.na/census/census_indicators English is the official language but there are more than 11 indigenous languages in Namibia. People commonly speak two or three languages and more than 50 percent of the population speaks Oshiwambo. Introduction | 3 1.3 HEALTH SERVICES AND PROGRAMMES The Ministry of Health and Social Services has adopted a primary health care (PHC) approach for the delivery of health services to the Namibian population. The PHC programmes established were to reflect the eight elements of PHC: • Promotion of proper nutrition and adequate supply of safe water; • Maternal and child care, including family spacing; • Immunisation against the major infectious diseases; • Basic housing and basic sanitation; • Prevention and control of locally endemic diseases; • Education and training in the prevention and control of prevailing community health problems; • Appropriate treatment for common diseases and injuries; and • Community participation in health and social matters. To implement the PHC strategy, programmes have been organised into functional directorates at the national and regional level. These include the following: • Primary Health Care, • Special Programmes, • Developmental Social Welfare Services, • Tertiary Health Care and Clinical Support Services, • Policy, Planning and Human Resource Development, • Human Resource Management and General Services, • Finance and Logistics, and • 13 Regional Directorates (MOHSS, 2007). Secondary and tertiary curative (care) services are maintained and strengthened to provide an integral national system of referral support for PHC services. The three intermediate/referral hospitals are Oshakati Hospital in Oshana Region, Rundu Hospital in Kavango Region, and Katutura Hospital in Khomas Region. Windhoek Central Hospital serves as the overall national referral hospital. As part of the health sector reform, restructuring has meant that authority is decentralised to the 13 Regional Management Teams (RMT) and their respective districts at the operational level. The 13 regional directorates oversee service delivery in 34 health districts. The role of the district is to ensure efficient and effective implementation of the regionally directed programmes and projects. Public health services are provided through 30 public district hospitals, 44 health centres, and 265 clinics. Three intermediate hospitals and one national referral hospital provide support to the district hospitals. Because of the vastness of the country, the sparse distribution of the population, and lack of access to permanent health facilities in some communities, outreach (mobile clinic) services are provided at about 1,150 outreach points across the country. As PHC includes diverse interventions, intersectoral collaboration has been recognised as an important aspect in health and social care delivery. Many partners in health and social care play a major role in this sector. Although the government is the main service provider, private and mission facilities continue to make important contributions, the latter is being totally subsidised by the government. The private sector is mainly urban, providing health care through medium-sized hospitals, as well as through private pharmacies, doctors’ surgeries, and nursing homes. 4 | Introduction 1.4 SURVEY OBJECTIVES AND IMPLEMENTATION The 2006-07 Namibia Demographic and Health Survey is designed to: • Determine key demographic rates, particularly fertility, under-five mortality, and adult mortality rates; • Investigate the direct and indirect factors that determine the level and trends of fertility; • Measure the level of contraceptive knowledge and practice among women and men by method; • Determine immunisation coverage and prevalence and treatment of diarrhoea and acute respiratory diseases among children under five; identify infant and young child feeding practices and assess the nutritional status of children age 6–59 months and women age 15–49 years; • Assess knowledge and attitudes of women and men regarding sexually transmitted infections and HIV/AIDS, and evaluate patterns of recent behaviour regarding condom use; • Identify behaviours that protect or predispose people to HIV infection and examine social, economic, and cultural determinants of HIV; • Determine the proportion of households with orphans and vulnerable children (OVCs); and • Determine the proportion of households with sick people taken care of at household level. The 2006-07 NDHS is part of the worldwide Demographic and Health Surveys (DHS) programme funded by the United States Agency for International Development (USAID). DHS surveys are designed to collect data on fertility, family planning, and maternal and child health; assist countries in conducting periodic surveys to monitor changes in population, health, and nutrition; and provide an international database that can be used by researchers investigating topics related to population, health, and nutrition. 1.4.1 Organisation The 2006-07 NDHS was conducted by the Ministry of Health and Social Services (MOHSS). Macro International Inc. of Calverton, Maryland provided technical assistance through the MEASURE DHS project of USAID. Most of the funds for local costs of the survey were provided by the Government of Namibia, with assistance from the Global Fund, UNICEF, and DFID, through a SADC project. USAID provided additional funds for the implementation of the survey and technical assistance provided by Macro International. 1.4.2 Questionnaires The 2006-07 NDHS used three questionnaires: the Household Questionnaire, the Women’s Questionnaire (women age 15-49), and the Men’s Questionnaire (men age 15-49). These field instruments were based on the model questionnaires developed for the DHS programme—and adapted to the situation and needs of Namibia—as well as the questionnaires used in the 2000 NDHS. The survey instruments included the expanded HIV/AIDS module developed to assist countries in obtaining UNAIDS core Monitoring & Evaluation indicators. During the adaptation of the questionnaires, input was sought from a variety of organisations that will be using the data. The completed questionnaires were translated from English into six local languages, namely Afrikaans, Damara/Nama, Oshiwambo, Otjiherero, Rukwangali, and Silozi. The main purpose of the Household Questionnaire was to collect information on demographic and socio-economic characteristics of the population and information about respondents’ dwellings. In addition, the Household Questionnaire was used to identify women and men eligible for the individual interview. The Household Questionnaire listed all persons who spent the night preceding Introduction | 5 the interview in the household, including usual household members and visitors. The Household Questionnaire also recorded the height and weight of women and children under 6 years of age. The Women’s Questionnaire was used to collect information on the following topics: ● Background characteristics (age, education, religion, etc.), ● Reproductive history (to arrive at fertility and childhood mortality rates), ● Knowledge and use of family planning methods, ● Antenatal and delivery care, ● Infant feeding practices including patterns of breastfeeding, ● Vaccinations, ● Episodes of childhood illness and responses to illness, with a focus on treatment of fevers in the past two weeks, ● Marriage and sexual activity, ● Fertility preferences, ● Husband’s background and the woman’s work status, ● Adult mortality, including maternal mortality, and ● HIV/AIDS-related knowledge, attitudes, and behaviour. Men were asked about their participation in the health care of their family and their attitudes on gender roles. Eligible men age 15-49 in selected households were interviewed using the Men’s Questionnaire. In addition to the questionnaires, other technical documents were prepared by MOHSS in collaboration with Macro International, including interviewers' and supervisors' training manuals; and interviewer and supervisor assignment sheets for fieldwork control. 1.4.3 Pilot Survey The survey instruments were piloted in Hardap, Omaheke, and Otjozondjupa regions from 16 September to 23 September 2006. In each region, the pilot survey was conducted by two teams that included six interviewers and one supervisor. The questionnaires were pretested in both urban and rural clusters. About 150 women and 150 men were interviewed during the pilot survey and the results of the pilot survey were used to modify the survey instruments as necessary. 1.4.4 Advocacy and Publicity A publicity campaign was implemented between September 5 and 23, 2006 to sensitize the communities about the survey and its objectives. The campaign was carried out by two teams that visited all 13 regions. Information about the survey was announced in the print media and on television, including the official launch of the survey by the MOHSS. T-shirts and leaflets were also prepared for this purpose. 1.4.5 Training for Fieldworkers A training programme was conducted for all NDHS field staff from 10 October 2006 to 10 November 2006. Approximately 230 persons representing all the major language groups in Namibia were trained. The trainers were from MOHSS, Macro International, and the Central Bureau of Statistics (CBS). The topics included sampling and use of the global positioning system. The training consisted of classroom lectures, mock interviews, and practical interviews in the field. Based on the performance during training, 170 persons were recruited to work as supervisors, field editors, enumerators, and data entry personnel. Among this group, about 100 were trained to 6 | Introduction carry out household listing. Because there was a break for Christmas and New Year’s Day, refresher training was conducted from 12 January to 3 February 2007. 1.4.6 Household Listing Prior to the main survey, a complete list of households in the selected primary sampling units (PSUs) was carried out. This provided a sampling frame from which 20 households in each PSU were selected for the survey. The listing exercise was carried out by CBS and assisted by MOHSS. 1.4.7 Data Collection The 2006-07 NDHS data were collected by 28 teams, each consisting of a team supervisor, a field editor, three female interviewers, one male interviewer, and a driver. The majority of team supervisors and editors were MOHSS staff. The assignment of field took into consideration the person’s proficiency in the major languages spoken in Namibia. Quality assurance was maintained by national and regional supervisors through close supervision and monitoring during fieldwork. The questionnaires were edited by the field editors in the field and verified by the team supervisor before being transported to the MOHSS central office. National and regional supervisors ensured quality control through editing of questionnaires and observation of interviewers. Common mistakes were communicated and discussed with all team members. 1.4.8 Data Processing Data entry commenced on 10 December 2006 and ended the third week of May 2007. CSPro—a Windows-based integrated Census and the Survey Processing package that combines and replaces the ISSA and IMPS packages, which was developed by the MEASURE DHS+ project in collaboration with the U.S. Census Bureau—was used for entry, editing, and tabulation of the NDHS data. Prior to data entry, a practical training was provided by Macro International to all data entry staff including the data manager, data entry supervisors, secondary data editors and data entry clerks. The data entry software was installed on 19 computers with one computer used as the central command or server unit for the data administrator. Data processing was performed by a team of 21 data entry operators, 2 data entry supervisors, 3 administrators/coders, and 3 secondary editors. Table 1.2 presents information on the number of households selected and interviewed and the number of eligible women and of eligible men identified and interviewed. A total of 9,970 households were selected for the sample, of which 9,410 were found and eligible for inter- view. Of the eligible households, 9,200 were suc- cessfully interviewed yielding a response rate of 98 percent. In the interviewed households, 10,352 women age 15-49 were identified as eligible for the women’s questionnaire. Interviews were com- pleted for 9,804 (95 percent) of these women. Of the 4,446 men age 15-49 identified as eligible for the men’s questionnaire, 3,915 (88 percent) were successfully interviewed. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Namibia 2006-07 Residence Result Urban Rural Total Household interviews Households selected 4,250 5,720 9,970 Households occupied 4,020 5,390 9,410 Households interviewed 3,893 5,307 9,200 Household response rate1 96.8 98.5 97.8 Interviews with women age 15-49 Number of eligible women 4,742 5,610 10,352 Number of eligible women interviewed 4,405 5,399 9,804 Eligible women response rate2 92.9 96.2 94.7 Interviews with men age 15-49 Number of eligible men 1,995 2,451 4,446 Number of eligible men interviewed 1,673 2,242 3,915 Eligible men response rate2 83.9 91.5 88.1 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Housing Characteristics | 7 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 The purpose of this chapter is to provide a descriptive summary of some demographic and socio-economic characteristics of the population in the households sampled in the 2006-07 Namibia Demographic and Health Survey (NDHS). For the purpose of the 2006-07 NDHS, a household was defined as a person or a group of persons, related or unrelated, who live together and share a common source of food. The Household Questionnaire (see Appendix E) collected basic demographic and socio-economic information (e.g., age, sex, education attainment, and current school attendance) on all usual residents and visitors who spent the night preceding the interview in the household. This method of data collection allows analysis of results for either the de jure (usual residents) or de facto (those who were present at the time of the survey) populations. The Household Questionnaire also collected information on housing facilities (e.g., source of water supply and sanitation facilities) and household possessions. The information presented in this chapter is intended to facilitate interpretation of the key demographic, socio-economic, and health indices presented later in the report. It is also intended to assist in the assessment of the representativeness of the survey sample. 2.1 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification. The distribution of the de facto household population in the 2006-07 NDHS is shown in Table 2.1 by five-year age groups, according to sex and residence. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Namibia 2006-07 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 11.0 10.8 10.9 16.0 13.8 14.8 13.9 12.6 13.2 5-9 11.2 10.2 10.7 14.9 13.1 14.0 13.4 11.9 12.6 10-14 10.8 10.2 10.5 15.7 14.3 14.9 13.7 12.6 13.1 15-19 9.2 10.9 10.1 12.3 11.0 11.6 11.0 11.0 11.0 20-24 10.7 11.6 11.2 8.5 7.9 8.2 9.4 9.4 9.4 25-29 11.4 11.1 11.2 6.1 6.0 6.0 8.3 8.1 8.2 30-34 9.9 9.7 9.8 5.1 5.3 5.2 7.1 7.1 7.1 35-39 6.8 6.4 6.6 3.9 4.6 4.3 5.1 5.3 5.2 40-44 6.0 5.4 5.7 3.2 4.2 3.7 4.4 4.7 4.5 45-49 3.8 3.9 3.9 2.6 3.2 2.9 3.1 3.5 3.3 50-54 3.4 3.1 3.3 2.5 3.4 2.9 2.9 3.3 3.1 55-59 2.6 2.0 2.3 1.9 2.7 2.3 2.2 2.4 2.3 60-64 1.2 1.6 1.4 1.8 2.4 2.1 1.5 2.1 1.8 65-69 0.9 1.1 1.0 1.6 2.1 1.9 1.3 1.7 1.5 70-74 0.4 0.8 0.6 1.3 1.6 1.5 0.9 1.3 1.1 75-79 0.3 0.4 0.4 1.1 1.6 1.4 0.8 1.1 1.0 80 + 0.2 0.7 0.5 1.5 2.6 2.1 1.0 1.8 1.4 Don't know/missing 0.1 0.1 0.1 0.1 0.2 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 8,126 8,773 16,900 11,498 12,916 24,414 19,624 21,688 41,314 | Household Population and Housing Characteristics 8 In Table 2.1, younger age groups (those under age 35) represent a higher proportion of the population than older age groups, reflecting a distribution pattern similar to that seen in the 1992 and 2000 NDHS surveys. The proportion of the population age 0-5 has declined steadily from 16 percent in 1992 to 14 percent in 2000 and 13 percent in 2006-07. Another indicator of declining fertility is the decline in the proportion of the population under age 15, from 43 percent in 2000 to 39 percent in 2006-07 (see discussion in Chapter 4). Table 2.1 shows that 53 percent of the population are females and 47 percent are males. The excess of females over males has been observed since the 1992 NDHS survey. This is true in urban and rural areas. 2.2 HOUSEHOLD COMPOSITION Information on key aspects of the composition of households, including the sex of the head of the household and the size of the household, is presented in Table 2.2. These characteristics are important because they are associated with the welfare of the household. Female-headed households are, for example, typically poorer than male-headed households. Economic resources are often more limited in larger households. Moreover, where the size of the household is large, crowding can lead to health problems. In general, household size has a negative correlation with the socio-economic status. While this is generally the case, it has also been found that sometimes there are significant benefits in having other members in a household. The 2006-07 NDHS data indicate that 56 percent of households are headed by men, a decline of three percentage points from 2000 compared with a decline of ten percentage points between 1992 and 2000. In contrast, female-headed households increased from 31 percent in 1992 to 44 percent in 2006-07. Rural households are more likely than urban households to be headed by women (47 percent compared with 40 percent). There are marked differences in size between rural and urban households. In rural areas, 13 percent of households have nine or more members compared with only 6 percent in urban areas. Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 NDHS 2006-07 Male Percent Female Age Household Population and Housing Characteristics | 9 Table 2.2 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 18, according to residence, Namibia 2006-07 Residence Characteristic Urban Rural Total Household headship Male 59.9 52.6 56.0 Female 40.1 47.4 44.0 Total 100.0 100.0 100.0 Number of usual members 0 0.5 0.3 0.4 1 16.2 12.8 14.4 2 16.1 12.3 14.1 3 16.1 13.4 14.7 4 17.7 13.3 15.3 5 10.6 11.5 11.1 6 7.7 10.1 9.0 7 5.6 7.2 6.4 8 3.8 5.9 5.0 9+ 5.7 13.2 9.7 Total 100.0 100.0 100.0 Mean size of households 4.0 4.9 4.5 Percentage of households with orphans and foster children under age 18 Foster children1 19.9 46.1 33.9 Double orphans 2.5 5.5 4.1 Single orphans 10.7 25.0 18.4 Foster and/or orphan children 23.5 51.0 38.3 Number of households 4,260 4,940 9,200 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. The average household size in Namibia declined from 5.1 in 2000 to 4.5 persons at the time of the 2006-07 NDHS. The mean household size in rural areas is larger than in urban areas (4.9 compared with 4.0, respectively). Overall, 38 percent of households have orphans and fostered children. Orphans and fostered children are more likely to be found in rural households than in urban households (51 percent and 24 percent, respectively). 2.3 EDUCATION OF THE HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and status an individual enjoys in society. Studies have consistently shown that educational attainment has a strong effect on health behaviours and attitudes (Gwatkin et al., 2000). Results from the 2006-07 NDHS can be used to look at educational attainment among household members and school attendance, repetition, and drop-out rates among youth. For the purposes of this analysis, the official age for entry into the primary level is age 6. The official primary level of schooling consists of 7 years (grades 1 to 7). The number of years assumed for completion of secondary school is five years. | Household Population and Housing Characteristics 10 2.3.1 Educational Attainment Tables 2.3.1 and 2.3.2 present data on the educational attainment of household members age six and over by sex. Overall, 15 percent of the female population and 16 percent of the male population have no education. These proportions are lower than those reported in the 2000 NDHS; 21 percent for females and 22 percent for males. There is a negative relationship between age and educational attainment, older persons are less likely than younger persons to have received education. Women and men living in rural areas are more likely than those in urban areas to have no education. For example, 19 percent of women living in rural areas have no education compared with 8 percent of those in urban areas. Table 2.3.1 Educational attainment of the female household population Percent distribution of the de facto female household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Namibia 2006-07 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 37.9 60.8 0.2 0.0 0.0 0.0 1.0 100.0 2,073 0.3 10-14 3.1 78.5 10.4 7.1 0.1 0.0 0.6 100.0 2,740 4.1 15-19 2.8 15.9 12.5 62.2 5.1 0.8 0.8 100.0 2,382 8.1 20-24 4.5 11.4 5.5 54.0 16.9 6.6 1.0 100.0 2,041 8.9 25-29 5.5 13.1 6.6 45.4 20.1 7.7 1.6 100.0 1,748 9.0 30-34 7.4 18.3 5.7 39.0 17.2 11.0 1.5 100.0 1,533 8.8 35-39 9.8 24.7 7.3 33.0 14.6 8.9 1.7 100.0 1,150 8.1 40-44 11.5 26.4 8.3 32.8 9.4 9.7 1.9 100.0 1,016 7.3 45-49 17.5 30.5 5.9 23.7 8.7 12.8 0.9 100.0 755 6.3 50-54 21.2 38.0 7.2 20.6 5.3 6.4 1.4 100.0 711 4.6 55-59 24.1 43.0 6.7 12.4 3.8 6.3 3.8 100.0 525 3.6 60-64 34.1 36.3 7.0 10.2 4.1 3.0 5.4 100.0 449 2.2 65+ 49.7 32.6 2.6 5.6 3.5 1.4 4.6 100.0 1,291 0.0 Residence Urban 8.3 23.8 5.8 35.8 16.0 8.5 1.9 100.0 7,653 8.3 Rural 19.1 42.5 7.7 24.6 2.9 2.0 1.3 100.0 10,792 4.4 Region Caprivi 16.0 37.6 7.1 34.2 1.7 2.9 0.6 100.0 922 5.4 Erongo 7.9 21.7 7.4 36.9 16.3 6.1 3.7 100.0 1,137 8.2 Hardap 13.0 36.6 7.8 30.3 8.2 2.7 1.4 100.0 612 5.9 Karas 6.4 31.4 11.1 33.2 12.6 4.4 0.9 100.0 603 7.1 Kavango 21.7 45.9 6.1 19.7 2.0 1.6 2.9 100.0 1,939 3.4 Khomas 6.2 19.0 4.7 35.5 20.6 12.8 1.3 100.0 3,363 9.1 Kunene 38.3 27.7 5.2 17.4 5.8 1.9 3.8 100.0 528 2.3 Ohangwena 18.0 44.1 8.8 22.3 2.5 1.8 2.5 100.0 2,250 4.2 Omaheke 26.4 31.0 6.5 25.4 5.5 3.6 1.6 100.0 726 4.3 Omusati 13.8 42.2 7.6 29.5 3.7 2.3 0.8 100.0 2,154 5.2 Oshana 9.9 37.1 6.8 34.2 8.1 3.4 0.5 100.0 1,554 6.4 Oshikoto 14.3 41.9 7.3 29.0 4.1 2.8 0.5 100.0 1,695 5.1 Otjozondjupa 22.3 32.2 6.1 27.0 8.1 3.9 0.3 100.0 962 5.1 Wealth quintile Lowest 24.6 48.2 6.9 18.0 0.6 0.1 1.7 100.0 3,759 3.1 Second 19.5 44.3 7.7 24.5 1.8 0.5 1.7 100.0 3,691 4.2 Middle 16.5 36.6 8.3 31.5 4.0 1.9 1.3 100.0 3,474 5.4 Fourth 8.2 27.5 7.1 40.6 11.0 4.2 1.4 100.0 3,644 7.7 Highest 4.4 17.8 4.5 31.9 23.4 16.2 1.7 100.0 3,878 9.6 Total 14.6 34.7 6.9 29.2 8.3 4.7 1.6 100.0 18,445 6.0 Note: Total includes 27 unweighted women with information missing on age. 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level Household Population and Housing Characteristics | 11 Observation of education level across regions show that women and men in Kavango, Kunene, Omaheke, Otjozondjupa, and regions are the least likely to have gone to school. On the other hand, women and men in Caprivi, Erongo, Karas, and Khomas regions have the highest levels of education. Table 2.3.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Namibia 2006-07 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 38.0 60.3 0.1 0.1 0.0 0.0 1.4 100.0 2,173 0.3 10-14 4.8 82.9 6.3 5.4 0.2 0.0 0.4 100.0 2,683 3.7 15-19 5.0 28.5 13.5 48.7 3.6 0.3 0.5 100.0 2,156 7.2 20-24 7.8 17.8 6.4 46.7 14.6 5.5 1.3 100.0 1,853 8.5 25-29 9.4 18.9 5.8 37.0 18.8 8.1 2.1 100.0 1,621 8.7 30-34 10.6 18.4 4.9 34.6 19.4 10.2 1.9 100.0 1,395 8.7 35-39 12.7 23.6 5.9 28.1 18.7 10.4 0.7 100.0 1,002 8.1 40-44 14.8 25.6 5.0 25.7 15.0 12.1 1.8 100.0 856 7.6 45-49 22.7 27.5 5.4 20.9 8.5 13.0 1.9 100.0 610 5.8 50-54 20.6 31.3 7.6 19.9 8.6 10.1 1.9 100.0 561 5.5 55-59 24.2 33.1 5.9 15.7 7.3 12.8 1.1 100.0 427 4.6 60-64 36.2 36.0 5.6 9.2 5.2 4.8 3.0 100.0 296 2.3 65+ 42.5 35.1 2.7 8.7 4.7 2.1 4.3 100.0 783 0.9 37.9 25.5 0.0 0.0 0.0 0.0 36.7 100.0 20 0.0 Residence Urban 9.7 28.5 5.0 30.6 15.7 8.8 1.7 100.0 7,081 7.9 Rural 20.1 46.5 6.7 20.1 3.4 2.0 1.2 100.0 9,357 3.6 Region Caprivi 8.3 45.1 6.3 31.9 3.4 4.6 0.4 100.0 803 5.5 Erongo 10.4 25.0 6.9 33.0 16.3 6.1 2.3 100.0 1,303 8.1 Hardap 15.1 37.1 7.3 26.9 9.5 2.8 1.2 100.0 557 5.5 Karas 10.2 30.9 7.5 31.5 15.1 4.1 0.7 100.0 638 7.1 Kavango 18.4 44.4 6.2 24.2 2.5 2.0 2.2 100.0 1,622 3.8 Khomas 8.2 25.2 4.3 29.9 18.9 12.0 1.5 100.0 3,287 8.5 Kunene 41.7 28.5 3.8 15.4 4.7 1.7 4.1 100.0 452 0.9 Ohangwena 21.5 50.9 6.8 15.0 2.1 1.3 2.5 100.0 1,725 2.8 Omaheke 26.4 33.0 4.5 24.6 7.5 3.1 0.9 100.0 804 4.0 Omusati 13.8 51.5 7.0 22.3 2.9 1.9 0.7 100.0 1,610 4.2 Oshana 10.8 46.2 7.5 24.4 6.3 4.0 0.9 100.0 1,181 5.2 Oshikoto 17.4 50.0 6.3 18.0 4.6 3.2 0.6 100.0 1,477 3.7 Otjozondjupa 27.3 34.9 5.0 20.3 7.3 4.7 0.4 100.0 978 3.8 Wealth quintile Lowest 22.8 53.5 5.8 15.1 0.9 0.2 1.7 100.0 2,971 2.7 Second 20.9 49.0 7.2 18.6 2.0 0.9 1.3 100.0 3,032 3.4 Middle 18.5 40.2 7.1 27.1 4.2 1.7 1.2 100.0 3,453 4.6 Fourth 11.9 32.5 6.1 32.5 11.5 4.0 1.5 100.0 3,562 6.8 Highest 5.6 21.8 3.8 27.6 23.0 16.9 1.4 100.0 3,420 9.5 Total 15.6 38.7 6.0 24.6 8.7 4.9 1.4 100.0 16,438 5.2 Note: Total includes 20 unweighted men with information missing on age. 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level | Household Population and Housing Characteristics 12 2.3.2 School Attendance Rates Table 2.4 presents the net attendance ratios (NAR) and gross attendance ratios (GAR) for primary and secondary schools by household residence and regions for the school year that started in 2005. The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students, of any age, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, of any age, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over- age and under-age students at a given level of schooling, the GAR can exceed 100 percent. Youth are considered to be attending school if they attended formal academic school at any point during the given school year. The gender parity index (GPI) assesses sex-related differences in school attendance rates and is calculated by dividing the GAR for females by the GAR for males. A GPI of one indicates parity or equality between the rates of participation for males and females. A GPI of less than one indicates a gender disparity in favour of males, i.e., a higher proportion of males than females attends that level of schooling. A GPI greater than one indicates a gender disparity in favour of females. Table 2.4 indicates that the NAR for primary school is 91, which means that 91 percent of children who should be attending primary school are doing so. This is higher by 5 percentage points than the level in 2000. The corresponding figures for secondary school are much lower at 47 percent and 43 percent, respectively. There is no discrimination between male and female children in attending primary school; the NAR is 91 for both boys and girls. Net attendance ratios for primary school are higher in urban than in rural areas, and are 95 percent or higher in Caprivi, Karas, Omusati, Oshana, and Oshikoto. The GAR figures (ratios of 136 for males and 130 for females) indicate that there are children in primary school who are not primary-school age. As expected, the NAR levels are higher for the children in wealthier households. Secondary school attendance is higher for females (NAR of 53) than for males (NAR of 40). Erongo and Khomas regions have the highest NARs at the secondary level (64 percent and 61 percent, respectively), while Kunene has the lowest (25 percent). The GAR shows that there are many secondary school students who are not secondary-school age. The GPI for secondary school is 1.32, indicating that more females attend secondary school than their male counterparts. Oshikoto and Oshana regions have the highest GPI (1.50 and 1.59, respectively), while Kavango region has the lowest (0.92). Household Population and Housing Characteristics | 13 Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the gender parity index (GPI), according to background characteristics, Namibia 2006-07 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 91.5 91.9 91.7 1.00 123.0 120.6 121.8 0.98 Rural 90.0 91.0 90.5 1.01 143.3 135.3 139.3 0.94 Region Caprivi 95.0 95.9 95.4 1.01 125.8 125.9 125.8 1.00 Erongo 93.3 93.3 93.3 1.00 114.9 118.7 116.8 1.03 Hardap 90.9 95.9 93.4 1.05 123.2 127.4 125.3 1.03 Karas 96.4 97.0 96.7 1.01 119.6 122.4 120.9 1.02 Kavango 86.8 86.8 86.8 1.00 143.7 134.0 138.6 0.93 Khomas 91.7 92.5 92.1 1.01 124.5 119.5 122.2 0.96 Kunene 57.9 54.8 56.2 0.95 79.9 72.3 75.8 0.90 Ohangwena 88.8 93.9 91.3 1.06 145.1 148.9 146.9 1.03 Omaheke 86.5 81.5 83.9 0.94 130.1 108.0 118.7 0.83 Omusati 96.5 95.4 95.9 0.99 156.2 144.1 150.0 0.92 Oshana 95.4 95.1 95.2 1.00 152.5 132.1 141.8 0.87 Oshikoto 93.2 95.9 94.5 1.03 148.6 135.3 142.0 0.91 Otjozondjupa 82.0 82.3 82.1 1.00 109.1 122.7 115.4 1.12 Wealth quintile Lowest 87.8 87.7 87.8 1.00 141.7 133.9 137.8 0.94 Second 90.0 92.2 91.1 1.03 145.6 134.8 140.0 0.93 Middle 89.5 91.5 90.5 1.02 141.4 135.1 138.4 0.96 Fourth 92.1 93.6 92.8 1.02 128.4 124.7 126.6 0.97 Highest 94.7 92.9 93.8 0.98 119.5 118.8 119.1 0.99 Total 90.5 91.3 90.9 1.01 136.3 130.3 133.3 0.96 SECONDARY SCHOOL Residence Urban 52.6 62.7 58.1 1.19 67.3 78.3 73.3 1.16 Rural 33.8 47.0 40.3 1.39 46.1 58.3 52.2 1.26 Region Caprivi 49.6 53.8 51.9 1.08 65.7 65.9 65.8 1.00 Erongo 63.1 64.4 63.8 1.02 77.2 79.3 78.3 1.03 Hardap 43.6 50.1 47.0 1.15 48.3 56.0 52.3 1.16 Karas 51.6 61.2 56.5 1.19 53.8 68.9 61.5 1.28 Kavango 31.5 29.1 30.3 0.92 48.0 39.9 44.0 0.83 Khomas 50.7 69.5 60.6 1.37 64.8 87.3 76.6 1.35 Kunene 21.6 28.5 25.1 1.32 29.7 32.2 31.0 1.09 Ohangwena 30.2 51.2 41.4 1.70 44.0 65.9 55.7 1.50 Omaheke 37.8 49.7 43.1 1.31 46.7 55.0 50.4 1.18 Omusati 41.4 51.1 46.3 1.23 56.9 65.0 61.0 1.14 Oshana 40.0 59.9 50.3 1.50 58.0 75.8 67.2 1.31 Oshikoto 37.1 59.0 47.8 1.59 47.4 70.9 58.9 1.50 Otjozondjupa 36.4 41.8 39.2 1.15 41.4 49.1 45.3 1.18 Wealth quintile Lowest 23.5 35.0 29.3 1.49 34.4 44.1 39.3 1.28 Second 34.1 48.6 41.3 1.43 48.2 60.5 54.3 1.26 Middle 39.4 50.4 44.9 1.28 53.4 63.3 58.3 1.19 Fourth 46.9 60.3 53.8 1.29 60.5 76.0 68.5 1.26 Highest 64.9 73.2 69.5 1.13 78.2 89.2 84.3 1.14 Total 40.0 52.8 46.5 1.32 53.1 65.7 59.6 1.24 1 The NAR for primary school is the percentage of the primary-school-age (7-13 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (14-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary- school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school 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. | Household Population and Housing Characteristics 14 Figure 2.2 shows age-specific school attendance rates (i.e., percentage of a given age cohort attending school), for the de jure household population age 5-24. 2.3.3 Grade Repetition and Dropout Rates Repetition and dropout rates presented in Table 2.5 describe the flow of pupils through the educational system in Namibia at the primary level. The repetition rates show the percentage of pupils who attended a particular grade during the school year who attended the same grade during the following school year. Dropout rates show the percentage of pupils in a grade during the school year who no longer attended school the following year. Table 2.5 shows high repetition rates for students in grade 1 regardless of sex or residence. The national repetition average for grade 1 is 12 percent, and may be attributable to the lack of pre- primary schooling. The repetition rate declines with increasing grades. At grade 5 there is a significant increase in repetition rates for both sexes, in urban and rural areas, and in almost all regions. A possible explanation for this is that pupils in grades 1-4 are not required to write examinations; examinations are only given from grade 5 onward. At the regional level, repetition rates in grade 1 are highest in Kunene (33 percent), Omaheke (27 percent) and Caprivi (18 percent) regions. Otjozondjupa (4 percent), Oshana (6 percent), and Oshikoto (8 percent) regions have the lowest rates. Pupils from the higher wealth quintiles have the lowest repetition rates for all grades. Dropout rates by sex and residence are relatively the same. The rates are highest in grades 5 and 7 at about 4 percent. Dropout rates are negatively associated with wealth; pupils in the lowest wealth quintile have the highest dropout rates. Table 2.5 also reveals Kunene region as having the highest dropout rate compared to other regions. This requires further investigation to understand the contributing factors. Figure 2.2 Age-Specific School Attendance Rates 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 10 20 30 40 50 60 70 80 90 100 Percent Female Male NDHS 2006-07Note: Figure shows percentage of the de jure household population age 5-24 years attending school. Household Population and Housing Characteristics | 15 Table 2.5 Grade repetition and dropout rates Repetition and dropout rates for the de facto household population age 5-24 who attended primary school in the previous school year by school grade and background characteristics, Namibia 2006-07 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE1 Sex Male 12.4 6.7 8.5 5.5 10.3 5.1 7.6 Female 11.7 5.4 4.0 5.1 10.4 4.7 7.1 Residence Urban 11.1 7.4 7.5 3.9 8.9 2.2 2.3 Rural 12.5 5.6 5.7 6.0 11.1 6.1 9.6 Region Caprivi 18.3 13.6 18.0 17.5 16.8 9.1 14.7 Erongo 16.2 10.6 7.0 1.9 14.1 3.7 7.2 Hardap 10.8 2.8 13.9 3.4 6.1 2.9 5.2 Karas 9.7 1.3 1.2 1.7 12.7 0.0 1.7 Kavango 9.5 6.3 7.2 7.5 17.8 8.3 6.6 Khomas 10.0 11.4 6.4 4.7 8.6 0.0 0.3 Kunene 32.7 6.6 10.8 4.9 3.4 8.8 0.0 Ohangwena 14.6 7.5 7.6 6.9 9.6 5.2 11.9 Omaheke 27.4 17.4 4.2 9.0 26.8 8.2 16.7 Omusati 9.8 2.4 2.6 6.6 7.5 9.4 13.2 Oshana 6.1 0.9 8.8 3.1 5.5 1.4 1.2 Oshikoto 8.4 1.3 2.4 1.0 5.2 4.0 4.5 Otjozondjupa 4.2 2.6 0.0 0.0 6.2 0.0 0.0 Wealth quintile Lowest 13.0 7.8 5.7 6.3 11.4 4.3 13.4 Second 13.9 4.8 8.8 6.5 9.9 7.5 8.6 Middle 13.0 5.2 4.5 5.5 12.7 7.0 7.7 Fourth 11.2 1.0 4.7 2.1 7.4 2.3 4.2 Highest 7.8 11.4 7.5 5.1 9.5 1.2 0.0 Total 12.0 6.1 6.3 5.3 10.4 4.9 7.3 DROPOUT RATE2 Sex Male 1.1 1.5 1.0 1.4 4.1 2.2 4.3 Female 1.8 0.4 0.9 1.1 3.9 2.2 3.3 Residence Urban 0.9 0.4 0.6 1.7 3.9 1.2 3.5 Rural 1.7 1.2 1.1 1.1 4.0 2.6 3.9 Region Caprivi 0.6 0.0 1.5 0.0 4.8 6.5 5.4 Erongo 0.0 0.0 0.0 0.0 7.4 0.0 0.0 Hardap 1.5 0.0 0.9 0.8 3.1 0.0 4.3 Karas 0.0 0.0 0.0 0.0 0.0 2.1 3.3 Kavango 2.8 1.9 0.0 2.5 4.3 5.4 7.2 Khomas 0.0 0.0 0.0 1.7 3.2 0.0 4.2 Kunene 12.5 11.7 0.9 5.8 0.0 18.7 9.7 Ohangwena 2.6 0.7 2.0 2.0 6.6 1.2 3.8 Omaheke 2.6 0.0 4.5 4.3 2.4 0.9 9.5 Omusati 0.0 0.0 1.1 0.2 3.0 2.6 1.8 Oshana 0.0 0.0 0.0 0.6 4.0 2.1 2.8 Oshikoto 0.0 2.9 0.7 0.6 2.9 1.4 0.9 Otjozondjupa 3.1 0.0 1.0 1.4 1.8 0.0 12.9 Wealth quintile Lowest 2.2 2.1 1.4 2.1 5.2 4.6 6.1 Second 1.0 0.6 1.2 0.9 3.9 2.1 1.9 Middle 2.6 1.3 1.4 1.0 4.7 1.3 5.1 Fourth 0.6 0.0 0.2 0.5 5.0 1.8 5.0 Highest 0.0 0.0 0.0 1.6 0.4 0.3 0.7 Total 1.4 1.0 0.9 1.3 4.0 2.2 3.8 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. | Household Population and Housing Characteristics 16 2.4 HOUSEHOLD ENVIRONMENT The physical characteristics of the dwelling in which a household lives are important determinants of the health status of household members, especially children. They can also be used as indicators of the socio-economic status of households. The 2006-07 NDHS respondents were asked a number of questions about their household environment, including questions on the source of drinking water, type of sanitation facility, type of flooring, walls, and roof, and number of rooms used for sleeping. The results are presented for households and for the de jure population. 2.4.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals that Namibia, along with other nations worldwide, has adopted (United Nations General Assembly, 2001). Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2005). The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.7. They include a piped source within the dwelling or plot, public tap, tube well or borehole, protected well or spring and rainwater.1 Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, if it must be fetched from source that is not immediately accessible to the household, it may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is the fact that burden of going for water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water. Table 2.6 shows that overall, 88 percent of households in Namibia have access to an improved source of drinking water. Urban households are more likely than rural households to have an improved water source (97 percent compared with 80 percent, respectively). Approximately three- quarters of all households have access to piped water while 11 percent have access to improved sources such as tube well/borehole and protected dug well. Overall, there has been an improvement in access to safe drinking water since 2000, from 79 percent to 88 percent. Twelve percent of the population obtain their drinking water from a non-improved source; this includes 20 percent of the rural population in the rural areas and less than 1 percent of the urban population. Generally, the quality of water available to households in Namibia is safe; about 90 percent of households do not treat the water before drinking. Water treatment differs by urban and rural residence. Rural households are much more likely than urban households to treat the drinking water (16 percent and 6 percent, respectively). Overall, drinking water is available on the premises in 81 percent of households in urban areas and 32 percent in rural areas. In households where water has to be fetched, drinking water is most often collected by adult females (25 percent). The amount of time spent by households to obtain water varies; 39 percent of households in rural areas take less than 30 minutes to obtain water, compared with 17 percent in urban areas. 1 The categorization into improved and non-improved follows that proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO and UNICEF, 2004). Household Population and Housing Characteristics | 17 Table 2.6 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage of households and the de jure population that treat drinking water, according to residence, Namibia 2006-07 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 97.0 80.4 88.1 96.6 79.3 86.4 Piped water into dwelling/yard/plot 79.5 25.6 50.6 80.7 23.1 46.8 Public tap/standpipe 17.3 31.8 25.1 15.8 32.8 25.8 Tube well or borehole 0.0 16.8 9.0 0.0 16.2 9.6 Protected dug well 0.0 4.1 2.2 0.0 4.8 2.8 Protected spring 0.1 0.4 0.2 0.1 0.4 0.3 Rainwater 0.0 1.7 0.9 0.0 2.0 1.2 Non-improved source 0.4 18.3 10.0 0.5 19.7 11.8 Unprotected dug well 0.1 5.3 2.9 0.1 5.7 3.4 Unprotected spring 0.0 0.6 0.4 0.0 0.8 0.5 Tanker truck/cart with small tank 0.1 1.3 0.7 0.1 1.0 0.7 Surface water 0.1 11.1 6.0 0.2 12.2 7.3 Bottled water, improved source for cooking/washing1 0.9 0.0 0.4 0.7 0.0 0.3 Bottled water, non-improved source for cooking/washing1 0.0 0.0 0.0 0.1 0.0 0.0 Other 1.7 1.3 1.5 2.2 1.0 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 97.9 80.4 88.5 97.3 79.3 86.7 Time to obtain drinking water (round trip) Water on premises 81.1 32.3 54.9 82.1 29.7 51.3 Less than 30 minutes 16.5 38.9 28.5 15.1 38.5 28.9 30 minutes or longer 1.9 27.1 15.5 2.0 30.1 18.5 Don't know/missing 0.5 1.7 1.1 0.7 1.7 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 10.2 37.4 24.8 10.0 39.5 27.4 Adult male 15+ 6.0 13.6 10.1 4.4 9.3 7.3 Female child under age 15 0.6 6.7 3.9 1.0 8.8 5.6 Male child under age 15 0.3 2.6 1.5 0.5 3.1 2.0 Other 1.8 7.3 4.7 2.0 9.4 6.4 Water on premises 81.1 32.3 54.9 82.1 29.7 51.3 Missing 0.1 0.1 0.1 0.0 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 12.6 4.1 8.1 12.5 4.3 7.7 Bleach/chlorine 0.2 0.2 0.2 0.1 0.1 0.1 Strained through cloth 0.0 0.3 0.2 0.0 0.3 0.2 Ceramic, sand or other filter 2.6 0.2 1.3 1.7 0.2 0.8 Solar disinfection 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.7 0.7 0.7 0.8 0.5 0.6 No treatment 83.7 94.3 89.4 84.6 94.4 90.4 Percentage using an appropriate treatment method 3 15.3 4.8 9.6 14.3 4.8 8.7 Number 4,260 4,940 9,200 16,964 24,283 41,247 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering and solar disinfecting. | Household Population and Housing Characteristics 18 Regional access to improved sources of drinking water is presented in Table 2.7, which shows that access ranges from 65 percent in Omusati region to 99 percent in Khomas region. Table 2.7 Household drinking water by region Percent distribution of households and de jure population by source of drinking water, according to region, Namibia 2006-07 Households Population Region Improved source Non- improved source Other Total Number Improved source Non- improved source Other Total Number Caprivi 85.9 12.9 1.2 100.0 514 86.8 12.1 1.1 100.0 2,145 Erongo 94.9 2.4 2.6 100.0 837 95.7 2.0 2.3 100.0 2,754 Hardap 94.7 4.1 1.2 100.0 328 95.9 3.3 0.9 100.0 1,333 Karas 93.9 5.6 0.5 100.0 382 94.3 5.3 0.5 100.0 1,449 Kavango 69.1 27.1 3.8 100.0 750 70.2 26.2 3.6 100.0 4,422 Khomas 98.5 0.3 1.3 100.0 1,950 97.5 0.3 2.2 100.0 7,631 Kunene 77.6 14.8 7.6 100.0 305 72.0 20.3 7.7 100.0 1,327 Ohangwena 86.9 13.1 0.0 100.0 829 86.8 13.2 0.0 100.0 4,733 Omaheke 96.1 1.9 2.0 100.0 426 96.9 1.9 1.3 100.0 1,897 Omusati 65.2 34.6 0.1 100.0 855 62.1 37.8 0.1 100.0 4,368 Oshana 97.0 2.6 0.4 100.0 663 96.7 3.1 0.2 100.0 3,054 Oshikoto 85.2 14.3 0.5 100.0 745 85.4 14.4 0.2 100.0 3,757 Otjozondjupa 96.6 1.4 2.0 100.0 615 97.0 1.4 1.6 100.0 2,377 Total 88.5 10.0 1.5 100.0 9,200 86.7 11.8 1.5 100.0 41,247 2.4.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is another of the Millennium Development Goals. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2004). Table 2.8 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Namibia 2006-07 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 57.9 14.1 34.4 61.4 13.3 32.9 Flush/pour flush to piped sewer system 55.0 7.4 29.4 57.8 5.5 27.0 Flush/pour flush to septic tank 0.2 0.3 0.3 0.3 0.2 0.2 Flush/pour flush to pit latrine 0.7 0.4 0.6 0.9 0.4 0.6 Ventilated improved pit (VIP) latrine 1.6 4.3 3.0 1.8 5.1 3.7 Pit latrine with slab 0.2 1.5 0.9 0.2 1.8 1.1 Composting toilet 0.2 0.2 0.2 0.4 0.3 0.3 Non-improved facility 42.1 86.0 65.6 38.7 86.8 67.2 Any facility shared with other households 23.0 3.6 12.6 18.1 2.3 8.8 Flush/pour flush not to sewer/septic tank/ pit latrine 1.9 0.3 1.0 2.0 0.3 1.0 Pit latrine without slab/open pit 1.4 2.7 2.1 1.5 2.9 2.4 Bucket 0.7 1.1 0.9 0.8 1.1 1.0 Hanging toilet/hanging latrine 0.1 0.3 0.2 0.2 0.3 0.3 No facility/bush/field 14.7 77.8 48.6 15.7 79.7 53.4 Other 0.1 0.1 0.1 0.3 0.1 0.2 Missing 0.2 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,260 4,940 9,200 16,964 24,283 41,247 Household Population and Housing Characteristics | 19 Table 2.8 shows that overall, 34 percent of the households have access to improved sanitation facilities. Improved sanitation is biased towards urban households, where 58 percent have improved sanitation facilities compared with 14 percent of rural households. Conversely, households in rural areas are more likely than those in urban areas to have non-improved facilities (86 percent and 42 percent, respectively). Seventy-eight percent of households in rural areas have no toilet facilities. There was no significant change in the proportion of households without toilet facilities compared with the 2000 NDHS. The regional overview presented in Table 2.9 shows that 62 percent of households in Khomas, 53 percent in Erongo, and 52 percent in Karas regions have improved sanitation facility. In contrast, less than 10 percent of households in Caprivi and Ohangwena have improved facilities. Table 2.9 Household sanitation by region Percent distribution of households and de jure population by type of toilet facility (improved/non-improved), according to region, Namibia 2006-07 Households Population Region Improved, not shared facility Non- improved facility Other/ missing Total Number Improved, not shared facility Non- improved facility Other/ missing Total Number Caprivi 8.2 91.8 0.0 100.0 514 9.2 90.8 0.0 100.0 2,145 Erongo 52.9 46.7 0.4 100.0 837 56.7 43.1 0.2 100.0 2,754 Hardap 46.8 52.9 0.3 100.0 328 51.8 47.9 0.3 100.0 1,333 Karas 52.1 47.6 0.3 100.0 382 58.7 41.1 0.2 100.0 1,449 Kavango 11.6 88.3 0.1 100.0 750 11.5 88.4 0.1 100.0 4,422 Khomas 62.0 37.7 0.3 100.0 1,950 67.2 32.0 0.8 100.0 7,631 Kunene 21.7 78.1 0.2 100.0 305 18.5 81.4 0.1 100.0 1,327 Ohangwena 5.4 94.4 0.2 100.0 829 5.3 94.6 0.0 100.0 4,733 Omaheke 22.7 77.3 0.0 100.0 426 22.3 77.7 0.0 100.0 1,897 Omusati 14.3 85.4 0.3 100.0 855 14.8 84.9 0.4 100.0 4,368 Oshana 29.6 70.4 0.0 100.0 663 30.2 69.8 0.0 100.0 3,054 Oshikoto 31.9 68.0 0.1 100.0 745 30.0 69.9 0.1 100.0 3,757 Otjozondjupa 42.8 57.1 0.1 100.0 615 44.9 54.9 0.2 100.0 2,377 Total 34.4 65.4 0.2 100.0 9,200 33.0 66.7 0.3 100.0 41,247 2.4.3 Housing Characteristics Table 2.10 presents information on the characteristics of the dwellings in which the sampled households live. These characteristics reflect the household’s socio-economic situation and may influence environmental conditions. For example, the use of biomass fuels and exposure to indoor pollution may have a direct bearing on the health and welfare of household members. Table 2.10 shows that 44 percent of households and 39 percent of the population have electricity. Use of electricity is more prevalent in urban than in rural areas (78 percent compared with 15 percent, respectively). The percentage of households that have electricity increased by seven percentage points from 37 percent in the 2000 NDHS. The commonly used flooring materials are earth or sand (41 percent), cement (27 percent), and ceramic tiles (16 percent). There was a decrease in the proportion of households living in homes with earth or sand floors from 49 percent in the 2000 NDHS to 41 percent in the 2006-07 NDHS. Over the same period, the use of cement flooring rose slightly from 25 percent to 27 percent. Table 2.10 shows that more than 70 percent of households have two or more rooms used for sleeping, indicating that overcrowding is not significant. | Household Population and Housing Characteristics 20 Table 2.10 Housing characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Namibia 2006-07 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 77.6 14.6 43.7 78.2 11.6 39.0 No 22.4 85.2 56.1 21.8 88.2 60.9 Missing 0.0 0.2 0.1 0.0 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 13.4 64.9 41.1 14.1 69.0 46.4 Dung 0.9 5.9 3.6 1.1 6.0 4.0 Wood/planks 0.7 0.1 0.4 0.8 0.0 0.3 Palm/bamboo 0.0 0.0 0.0 0.0 0.0 0.0 Parquet or polished wood 1.0 0.3 0.6 0.9 0.3 0.5 Vinyl or asphalt strips 5.2 1.1 3.0 4.8 0.7 2.3 Ceramic tiles 32.5 2.2 16.3 32.5 1.7 14.3 Cement 32.9 22.7 27.4 34.8 19.5 25.8 Carpet 12.4 1.1 6.3 10.3 0.7 4.7 Other 0.7 1.7 1.2 0.8 2.0 1.5 Missing 0.2 0.0 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 30.0 28.0 28.9 18.7 17.7 18.1 Two 31.6 23.5 27.3 33.3 19.0 24.9 Three or more 37.7 47.4 42.9 47.4 62.1 56.1 Missing 0.7 1.1 0.9 0.6 1.2 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 81.4 44.9 61.8 77.8 47.8 60.2 In a separate building 5.4 15.6 10.9 6.9 15.6 12.0 Outdoors 12.7 39.0 26.8 14.9 36.1 27.4 Other 0.1 0.0 0.1 0.2 0.1 0.1 Missing 0.4 0.4 0.4 0.2 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 67.1 5.9 34.2 65.6 3.9 29.3 LPG/natural gas/biogas 11.5 3.5 7.2 10.4 2.3 5.7 Kerosene 0.4 0.1 0.3 0.2 0.0 0.1 Coal/lignite 0.0 0.1 0.0 0.0 0.1 0.0 Charcoal 0.1 0.9 0.6 0.1 0.9 0.6 Wood 15.5 88.8 54.9 19.7 92.0 62.3 Agricultural crop 0.0 0.0 0.0 0.0 0.1 0.0 Animal dung 0.0 0.4 0.2 0.0 0.5 0.3 No food cooked in household 0.3 0.1 0.2 0.1 0.0 0.0 Other 5.0 0.1 2.4 3.8 0.1 1.6 Missing 0.1 0.0 0.1 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking 1 15.6 90.3 55.7 19.8 93.6 63.3 Number of households/ population 4,260 4,940 9,200 16,964 24,283 41,247 Number of households/ population using solid fuel 665 4,461 5,126 3,362 22,733 26,095 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung Household Population and Housing Characteristics | 21 The majority of households cook in the house (62 percent). Urban households are more likely than rural households to cook in the house (81 percent and 45 percent, respectively). The predominant type of cooking fuel in Namibia is wood, used by 55 percent of households. There has been an increase in the use of electricity for cooking, from 26 percent in 2000 to 34 percent in 2006-07. Wood is much more common in rural areas than in urban areas (89 percent and 16 percent, respectively). The proportion of rural households that use wood for cooking has increased slightly from 86 percent in 2000. Overall, 90 percent of rural households and 16 percent of urban households use solid fuel for cooking. Almost all households in Namibia (97 percent) cook on an open fire or use a stove with no chimney or hood (data not shown). 2.5 HOUSEHOLD POSSESSIONS The availability of durable consumer goods is a positive indicator of a household’s socio- economic status. Moreover, particular goods have specific benefits. For instance, having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport allows greater access to services away from the local area. Table 2.11 shows the availability of selected consumer goods by residence. Table 2.11 Household durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land and livestock/farm animals, by residence, Namibia 2006-07 Households Population Household possession Urban Rural Total Urban Rural Total Household effects Radio 82.0 69.7 75.4 83.9 71.9 76.8 Television 65.6 12.3 37.0 69.4 11.5 35.3 Mobile telephone 77.9 30.5 52.4 79.3 33.3 52.3 Non-mobile telephone 33.3 12.9 22.3 34.1 14.2 22.4 Refrigerator 68.9 14.8 39.9 71.9 13.5 37.5 Means of transport Bicycle 16.9 13.7 15.2 19.0 15.4 16.9 Animal drawn cart 0.9 11.9 6.8 1.1 13.3 8.3 Motorcycle/scooter 2.9 1.2 2.0 2.7 1.2 1.8 Car/truck 37.2 14.9 25.2 37.7 16.2 25.0 Boat with a motor 0.7 0.2 0.4 0.6 0.1 0.3 Ownership of agricultural land 7.6 41.5 25.8 9.2 46.1 30.9 Ownership of farm animals1 13.7 69.7 43.8 15.3 78.0 52.2 Number 4,260 4,940 9,200 16,964 24,283 41,247 1 Cattle, cows, bulls, horses, donkeys, mules, goats, sheep, or chickens The upward trend in possession of durable goods seen in the 2000 NDHS continues with the 2006-07 NDHS. Table 2.11 shows that 75 percent of households in Namibia have a radio, compared with 71 percent in 2000. Mobile telephones and television sets are available in 52 percent and 37 percent of households, respectively. The most commonly owned means of transportation are car/truck (25 percent) and bicycle (15 percent). Possession of durable goods varies between urban and rural households. Televisions, telephones, and refrigerators are much more common in urban households than in rural households. For example, 66 percent of urban households have a television set compared with 12 percent of rural households. On the other hand, rural households are much more likely than urban households to own agricultural land (42 percent compared with 8 percent, respectively) and own farm animals (70 percent compared with 14 percent, respectively). | Household Population and Housing Characteristics 22 2.6 WEALTH INDEX The 2006-07 NDHS incorporates the concept of the wealth index for the first time to enrich the analysis of different components of the survey. The wealth index is used throughout the report as a proxy for the standard of living of the household. It is based on household ownership of consumer goods; dwelling characteristics; type of drinking water source; toilet facilities; and other character- istics related to the household’s socio-economic status. To construct the index, each of these assets was assigned a weight (factor score) generated through principal component analysis and the resulting asset scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset and the scores were summed for each household. Individuals were ranked according to the total score of the household in which they reside. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed on the basis of data from the entire country sample, and this index is used in all the tabulations presented in this report. Table 2.12 shows the distribution of the de jure household population by wealth quintile, according to residence and region. The distribution indicates the degree to which wealth is evenly (or unevenly) distributed in the country. Table 2.12 shows that Erongo, Karas, and Khomas regions have a very large proportion of their population in the two highest wealth quintiles, with almost no representation in the lowest quintile. In contrast, Caprivi, Kavango, Ohangwena, and Omusati regions have the highest proportion of population in the lowest quintile and only a small proportion in the highest quintile. Figure 2.5 Percentage of Households Owning Various Durable Goods 75 37 52 22 40 15 7 2 25 0 26 44 Radio Television Mobile telephone Non-mobile telephone Refrigerator Bicycle Animal-drawn cart Motorcycle/scooter Car/truck Boat with a motor Ownership of agricultural land Ownership of farm animals 0 20 40 60 80 100 NDHS 2006-07 Household Population and Housing Characteristics | 23 Table 2.12 Wealth quintiles Percent distribution of de jure population by wealth quintile, according to residence and region, Namibia 2006-07 Wealth quintile Residence/region Lowest Second Middle Fourth Highest Total Number of population Residence Urban 1.4 3.6 14.8 34.3 45.9 100.0 16,964 Rural 33.0 31.5 23.6 10.0 1.9 100.0 24,283 Region Caprivi 48.8 21.2 17.3 7.7 5.0 100.0 2,145 Erongo 0.0 2.7 12.8 36.8 47.6 100.0 2,754 Hardap 0.2 10.1 26.3 38.8 24.6 100.0 1,333 Karas 0.4 6.5 21.1 35.6 36.4 100.0 1,449 Kavango 46.3 19.1 21.0 10.5 3.0 100.0 4,422 Khomas 0.0 0.7 10.7 29.2 59.4 100.0 7,631 Kunene 25.5 22.2 29.2 17.5 5.6 100.0 1,327 Ohangwena 37.7 41.7 15.7 3.7 1.1 100.0 4,733 Omaheke 1.7 18.6 51.7 22.8 5.1 100.0 1,897 Omusati 32.9 38.7 20.3 6.5 1.6 100.0 4,368 Oshana 12.4 29.9 28.9 19.6 9.3 100.0 3,054 Oshikoto 29.2 27.0 14.7 20.4 8.7 100.0 3,757 Otjozondjupa 2.7 15.0 28.9 35.9 17.6 100.0 2,377 Total 20.0 20.0 20.0 20.0 20.0 100.0 41,247 2.7 BIRTH REGISTRATION The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration (or later) as proof that the birth has been registered. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; United Nations General Assembly, 2002). In the 2006-07 NDHS, mothers of children under five were asked if their child’s birth had been registered and whether they had a birth certificate for the child. A child’s birth was considered to have been registered if the mother could produce a birth certificate or reported that the birth was registered. Not all children who are registered have a birth certificate because some certificates may have been lost or were never issued. However, all children with a certificate have been registered. Table 2.13 shows that 67 percent of births in the past five years in Namibia were registered, a slight decline from 71 percent in the 2000 NDHS. Only 7 percent of children whose birth was registered did not have a birth certificate. As in the 2000 NDHS, birth registration is more common in urban areas (83 percent) than in rural areas (59 percent). Coverage of birth registration varies widely across regions, ranging from 46 percent in Kavango to 96 percent in Karas. In Erongo, Hardap, Karas, and Khomas regions, at least four in five births are registered. There is a positive relationship between birth registration and wealth quintile; births in households in the higher wealth quintiles are more likely to be registered. | Household Population and Housing Characteristics 24 Table 2.13 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background charac- teristics, Namibia 2006-07 Percentage of children whose births are registered Background characteristic Had birth certificate Did not have birth certificate Total registered Number of children Age <2 49.0 8.6 57.6 2,236 2-4 68.3 5.4 73.7 3,224 Sex Male 58.9 6.8 65.7 2,734 Female 62.0 6.6 68.5 2,726 Residence Urban 77.2 5.3 82.5 1,828 Rural 52.0 7.4 59.3 3,633 Region Caprivi 55.0 6.4 61.5 314 Erongo 85.3 3.2 88.5 267 Hardap 82.5 3.0 85.5 157 Karas 86.7 9.3 96.1 156 Kavango 26.1 20.1 46.3 664 Khomas 81.2 2.7 84.0 763 Kunene 51.6 4.3 55.9 246 Ohangwena 53.6 2.1 55.7 699 Omaheke 68.1 5.9 74.0 367 Omusati 60.8 7.3 68.1 535 Oshana 63.4 10.8 74.2 360 Oshikoto 55.9 5.4 61.3 535 Otjozondjupa 59.4 2.1 61.5 397 Wealth quintile Lowest 36.9 9.4 46.2 1,265 Second 53.2 7.9 61.1 1,252 Middle 60.3 7.3 67.5 1,211 Fourth 77.7 4.3 82.0 935 Highest 89.0 2.5 91.5 797 Total 60.4 6.7 67.1 5,461 Characteristics of Respondents | 25 CHARACTERISTICS OF RESPONDENTS 3 This chapter provides a profile of men and women age 15-49 who were interviewed in the 2006-07 NDHS. Information is presented on a number of basic characteristics including: age, religion, marital status, residence, education, literacy, and media access. The chapter also explores adult employment status, occupation, and earnings. An analysis of these variables provides the socio- economic context within which demographic and reproductive health issues are examined. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The background characteristics of the 9,804 women age 15-49 and the 3,915 men age 15-49 interviewed in the 2006-07 NDHS are shown in Table 3.1. This table is important because it provides the background for interpreting findings presented later in the report. Twenty-three percent of women and men fall into the 15-19 age group while 19 percent of women and men fall into the 20-24 age group. Smaller proportions of women and men are found in the older age groups. Nine and 10 percent of women and men fall in the 40-44 age group, and 7 percent of women and 6 percent of men are in the 45-49 age group. The Namibian population is predominantly Christian, with 77 percent of women and 70 percent of men being Protestant and a smaller proportion being Roman Catholic (21 percent of women and 26 percent of men). The most widely spoken language is Oshiwambo (48 percent), followed by Damara/Nama (13 percent), Afrikaans (10 percent), and Herero (9 percent). The majority of respondents have never been married (58 percent of women and 65 percent of men). Thirty-five percent of women and 31 percent of men are married or living together. The distribution of women and men by residence is almost equal, with 49 percent of women and 50 percent of men residing urban areas. By region, Khomas has the highest percentage (weighted) of female and male respondents (23 percent and 25 percent, respectively), whereas Kunene has the lowest (3 percent for women and 2 percent for men). The proportion of women age 15-49 with less than primary education is lower than that of men. Conversely, the proportion of women with secondary education is higher than that of men (69 percent and 63 percent, respectively). Place of residence is another characteristic that determines access to services and exposure to information pertaining to reproductive health and other aspects of life. Half of the respondents reside in rural areas, compared with 23 percent of women and 25 percent of men who live in Khomas region, where the capital city, Windhoek, is located. The majority of Namibians have some formal schooling. Only 7 percent of women and 9 percent of men have never gone to school. The level of education has improved since the 2000 NDHS, in which the proportion of women age 15-49 and men age 15-59 who had never attended school was 10 and 13 percent, respectively. 26 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Namibia 2006-07 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 22.9 2,246 2,205 23.3 910 909 20-24 18.9 1,855 1,876 19.2 750 743 25-29 16.6 1,623 1,562 17.9 702 678 30-34 14.5 1,417 1,423 15.0 586 563 35-39 10.7 1,045 1,074 10.2 400 419 40-44 9.5 928 951 8.5 331 351 45-49 7.0 689 713 6.0 235 252 Religion Roman Catholic 20.9 2,053 2,171 26.3 1,028 1,152 Protestant 77.0 7,547 7,446 70.3 2,754 2,647 No religion 1.4 142 133 2.4 94 90 Other 0.4 35 34 0.6 24 11 Missing 0.3 26 20 0.4 15 15 Language Afrikaans 9.7 954 904 9.5 373 386 Damara/nama 13.4 1,310 1,480 12.8 502 571 English 1.5 145 99 1.7 65 48 Herero 9.2 903 795 10.1 394 366 Kwangali 5.2 514 583 5.1 199 235 Silozi 1.7 166 191 1.9 75 74 Oshiwambo 47.5 4,662 4,476 47.4 1,855 1,747 San 0.7 67 102 0.8 32 43 Other 11.1 1,083 1,174 10.7 420 445 Marital status Never married 57.9 5,673 5,545 65.0 2,545 2,507 Married 19.9 1,949 2,003 18.1 708 699 Living together 15.3 1,501 1,572 12.7 498 530 Divorced/separated 4.3 426 412 3.9 151 160 Widowed 2.6 252 269 0.3 12 18 Missing 0.0 3 3 0.0 1 1 Residence Urban 48.7 4,772 4,405 50.1 1,962 1,673 Rural 51.3 5,032 5,399 49.9 1,953 2,242 Region Caprivi 4.8 474 656 4.8 189 242 Erongo 7.0 688 611 9.2 362 351 Hardap 3.2 315 550 3.4 132 231 Karas 3.2 318 493 4.0 157 267 Kavango 9.5 934 996 8.4 331 365 Khomas 22.6 2,218 996 25.1 984 485 Kunene 2.6 259 433 2.3 92 162 Ohangwena 10.6 1,043 996 7.8 306 260 Omaheke 3.8 373 490 4.8 188 223 Omusati 9.9 975 954 8.2 320 292 Oshana 8.4 819 1,018 6.9 270 350 Oshikoto 8.5 837 901 8.2 322 361 Otjozondjupa 5.6 550 710 6.7 262 326 Education No education/preschool 6.6 651 775 9.2 360 406 Incomplete primary 17.3 1,699 1,833 21.9 856 931 Complete primary 7.5 736 783 6.4 252 258 Incomplete secondary 48.5 4,751 4,712 41.0 1,604 1,585 Complete secondary 13.1 1,286 1,142 13.7 538 503 More than secondary 7.0 682 559 7.8 305 232 Wealth quintile Lowest 16.5 1,621 1,599 14.3 560 561 Second 17.0 1,668 1,751 15.5 607 635 Middle 19.2 1,885 2,223 22.3 875 1,082 Fourth 23.4 2,292 2,450 24.6 963 989 Highest 23.8 2,338 1,781 23.3 911 648 Total 15-49 100.0 9,804 9,804 100.0 3,915 3,915 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Respondents | 27 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Tables 3.2.1 and 3.2.2 present an overview of the relationship between the respondent’s level of education and other background characteristics. Overall, the level of education in Namibia is high. Tables 3.2.1 and 3.2.2 show the percent distributions of women and men by highest level of education attained according to age, urban-rural residence, region, and wealth quintile. The results indicate that 7 percent of women and 9 percent of men have no formal education. The proportion of women and men with no education increases with age from 2 percent for women and 3 percent for men age 15-19 to 16 percent for women and 19 percent for men age 45-49. Children in urban areas are more likely to be educated than those in rural areas. For instance, 13 percent of women in rural areas have no education compared with 5 percent in urban areas. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median number of years completed, according to background characteristics, Namibia 2006-07 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of women Age 15-24 2.9 12.1 8.2 61.2 12.1 3.5 100.0 8.5 4,101 15-19 2.0 13.0 10.5 66.7 7.0 0.8 100.0 8.3 2,246 20-24 4.1 11.1 5.4 54.6 18.2 6.6 100.0 8.9 1,855 25-29 5.9 13.1 5.5 48.8 18.7 8.0 100.0 9.0 1,623 30-34 7.8 16.6 6.5 42.3 15.8 11.0 100.0 8.7 1,417 35-39 10.6 24.4 7.9 36.9 12.1 8.0 100.0 7.9 1,045 40-44 11.0 26.1 9.5 33.8 9.0 10.6 100.0 7.4 928 45-49 16.1 36.9 7.1 21.6 7.7 10.5 100.0 5.3 689 Residence Urban 3.7 10.2 5.0 49.9 20.4 10.8 100.0 9.3 4,772 Rural 9.4 24.1 9.9 47.1 6.2 3.3 100.0 7.6 5,032 Region Caprivi 5.5 20.4 8.5 58.9 2.2 4.4 100.0 8.2 474 Erongo 3.1 10.5 7.4 48.6 23.6 6.7 100.0 9.3 688 Hardap 6.1 16.9 9.3 51.2 12.7 3.8 100.0 8.2 315 Karas 1.4 10.7 10.1 51.7 20.2 5.9 100.0 8.9 318 Kavango 15.7 29.8 9.5 37.1 4.7 3.2 100.0 6.5 934 Khomas 2.0 7.9 3.4 47.8 23.3 15.6 100.0 9.8 2,218 Kunene 28.1 19.9 7.9 30.6 9.1 4.5 100.0 6.3 259 Ohangwena 6.6 25.0 12.5 47.2 6.1 2.6 100.0 7.5 1,043 Omaheke 17.7 14.9 8.3 45.5 8.4 5.1 100.0 7.9 373 Omusati 2.9 18.9 7.9 56.5 9.2 4.5 100.0 8.4 975 Oshana 2.5 14.5 6.6 57.8 12.9 5.7 100.0 8.7 819 Oshikoto 6.8 23.9 7.6 48.6 8.5 4.6 100.0 8.1 837 Otjozondjupa 13.6 21.5 7.5 42.1 11.5 3.7 100.0 7.7 550 Wealth quintile Lowest 14.2 34.1 10.9 37.8 2.9 0.1 100.0 6.1 1,621 Second 9.6 25.4 10.1 49.5 4.4 1.0 100.0 7.4 1,668 Middle 9.3 18.9 9.5 52.9 6.8 2.5 100.0 8.1 1,885 Fourth 3.0 12.4 6.3 56.6 15.8 5.9 100.0 8.9 2,292 Highest 0.7 3.5 2.8 43.6 28.9 20.5 100.0 10.9 2,338 Total 6.6 17.3 7.5 48.5 13.1 7.0 100.0 8.5 9,804 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level 28 | Characteristics of Respondents Tables 3.2.1 and 3.2.2 also show that women are slightly more likely to be educated and reach higher levels of education than men. The median number of years of schooling for women is 8.5, compared with 7.2 years for men. The proportion of men and women with no education is higher in Kunene, Omaheke, and Otjozondjupa than in other regions. Overall, the results show that there is improvement in education compared with the 2000 NDHS. Higher wealth status is associated with higher levels of educational attainment. Fourteen percent of women in the lowest wealth quintile have no education compared with less than 1 percent of women in the highest wealth quintile. Among men, 15 percent in the lowest quintile have no education compared with 2 percent in the highest quintile. Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median number of years completed, according to background characteristics, Namibia 2006-07 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of men Age 15-24 5.1 19.9 8.5 51.7 11.7 3.1 100.0 7.2 1,661 15-19 3.2 23.4 12.3 53.2 7.8 0.1 100.0 6.8 910 20-24 7.4 15.7 3.9 49.8 16.4 6.7 100.0 7.8 750 25-29 10.1 16.8 5.1 39.3 17.9 10.8 100.0 7.8 702 30-34 11.1 19.3 4.2 33.2 18.7 13.5 100.0 7.6 586 35-39 11.4 25.4 4.1 34.1 15.1 9.8 100.0 7.2 400 40-44 14.7 33.4 6.5 27.3 9.6 8.5 100.0 6.1 331 45-49 18.9 34.5 5.4 20.8 6.9 13.5 100.0 5.0 235 Residence Urban 5.3 13.6 4.5 45.4 19.8 11.4 100.0 8.2 1,962 Rural 13.1 30.2 8.4 36.6 7.6 4.1 100.0 6.3 1,953 Region Caprivi 6.3 27.4 4.3 50.0 4.4 7.6 100.0 7.0 189 Erongo 5.7 19.9 4.6 44.8 19.7 5.3 100.0 7.7 362 Hardap 9.7 21.6 6.8 41.9 17.2 2.9 100.0 7.0 132 Karas 2.0 9.8 7.7 53.2 22.9 4.3 100.0 8.0 157 Kavango 7.7 24.8 9.1 48.9 6.1 3.4 100.0 6.8 331 Khomas 5.6 10.4 5.1 44.2 18.8 16.0 100.0 8.4 984 Kunene 31.9 22.5 6.2 25.5 10.8 3.0 100.0 4.2 92 Ohangwena 11.3 34.5 11.4 32.5 6.9 3.3 100.0 6.2 306 Omaheke 26.3 18.2 5.0 25.6 18.2 6.8 100.0 6.3 188 Omusati 5.1 33.8 7.7 41.7 8.8 2.9 100.0 6.6 320 Oshana 5.1 20.8 5.6 46.5 15.6 6.5 100.0 7.5 270 Oshikoto 11.9 35.1 9.5 29.7 6.9 6.9 100.0 6.2 322 Otjozondjupa 18.7 25.5 2.3 32.9 14.0 6.7 100.0 6.6 262 Wealth quintile Lowest 15.4 40.8 9.1 30.7 3.4 0.6 100.0 5.3 560 Second 12.0 32.1 9.3 39.0 5.5 2.1 100.0 6.3 607 Middle 13.9 24.7 6.7 43.0 8.4 3.3 100.0 6.7 875 Fourth 6.6 17.2 6.4 46.7 16.8 6.3 100.0 7.6 963 Highest 1.8 5.6 2.7 40.6 27.4 21.9 100.0 9.8 911 Total 15-49 9.2 21.9 6.4 41.0 13.7 7.8 100.0 7.2 3,915 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level Characteristics of Respondents | 29 3.3 LITERACY The ability to read and write is an important personal asset, allowing individuals to increase their opportunities in life. Knowing the distribution of the literate population can help programme managers reach women and men with messages. The 2006-07 NDHS assessed the ability to read among women and men who had never been to school or who had attended only the primary level by asking respondents to read a simple, short sentence.1 Tables 3.3.1 and 3.3.2 show the percent distribution of women and men by level of schooling attended and level of literacy, and the percentage literate according to background characteristics. 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, Namibia 2006-07 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percent- age literate1 Number Age 15-19 74.6 16.0 4.3 4.1 0.5 0.0 0.5 100.0 94.9 2,246 20-24 79.4 8.4 4.7 6.5 0.6 0.1 0.3 100.0 92.5 1,855 25-29 75.6 10.8 5.1 7.3 0.6 0.0 0.5 100.0 91.5 1,623 30-34 69.1 16.1 5.9 7.9 0.5 0.1 0.3 100.0 91.1 1,417 35-39 57.0 22.9 9.1 9.6 1.2 0.1 0.2 100.0 89.0 1,045 40-44 53.4 22.6 11.2 11.0 1.1 0.4 0.4 100.0 87.2 928 45-49 39.9 27.6 12.8 16.3 1.1 0.5 1.9 100.0 80.2 689 Residence Urban 81.1 10.3 3.8 3.9 0.3 0.1 0.6 100.0 95.1 4,772 Rural 56.6 21.3 9.1 11.4 1.1 0.1 0.4 100.0 86.9 5,032 Region Caprivi 65.5 11.5 11.2 11.0 0.0 0.3 0.5 100.0 88.3 474 Erongo 78.9 14.6 2.2 3.5 0.3 0.2 0.3 100.0 95.8 688 Hardap 67.7 18.3 5.1 8.9 0.0 0.0 0.1 100.0 91.0 315 Karas 77.8 13.0 5.7 3.5 0.0 0.0 0.0 100.0 96.5 318 Kavango 45.1 15.6 15.8 19.9 2.9 0.4 0.3 100.0 76.5 934 Khomas 86.7 7.9 2.1 2.1 0.3 0.1 0.8 100.0 96.7 2,218 Kunene 44.1 13.4 10.6 29.2 2.2 0.3 0.2 100.0 68.1 259 Ohangwena 55.9 30.0 7.1 6.2 0.1 0.0 0.8 100.0 92.9 1,043 Omaheke 59.1 13.0 5.7 20.6 0.9 0.1 0.6 100.0 77.8 373 Omusati 70.3 20.3 5.3 3.3 0.1 0.1 0.6 100.0 95.8 975 Oshana 76.4 15.6 4.1 3.3 0.0 0.0 0.6 100.0 96.1 819 Oshikoto 61.7 20.7 9.2 6.2 2.0 0.0 0.3 100.0 91.6 837 Otjozondjupa 57.4 16.4 10.1 15.0 1.0 0.0 0.1 100.0 83.9 550 Wealth quintile Lowest 40.7 25.0 13.1 18.4 2.1 0.1 0.7 100.0 78.8 1,621 Second 54.9 24.5 9.0 10.2 0.7 0.2 0.4 100.0 88.4 1,668 Middle 62.2 18.2 8.0 10.3 0.8 0.1 0.3 100.0 88.4 1,885 Fourth 78.3 12.6 4.5 3.4 0.3 0.2 0.7 100.0 95.4 2,292 Highest 93.0 4.9 1.0 0.8 0.1 0.0 0.3 100.0 98.8 2,338 Total 68.5 15.9 6.5 7.7 0.7 0.1 0.5 100.0 90.9 9,804 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 1 These sentences include the following: The child is reading a book, The rains came late this year, Parents must care for their children, and Farming is hard work 30 | Characteristics of Respondents Twenty-seven percent of women age 45-49 had no education but could read a whole sentence. Ohangwena region has the highest proportion of women who could read a whole sentence but had no schooling (30 percent). On the other hand, 23 percent respondents of men age 45-49 had no schooling but could read a whole sentence. One-fifth of women and men in rural areas were able to read a sentence, with women exceeding men by 1 percent. Literacy rates in Namibia are high. Overall, 91 percent of women and 89 percent of men are literate. In general, literacy decreases as age increases for both women and men. The percentage literate is higher for women than for men in all age groups. Women and men in urban areas have higher literacy rates (95 percent each) than their rural counterparts (87 percent for women and 82 percent for men). Literacy rates for women are 95 percent or higher in Erongo, Karas, Omusati, and Oshana regions. For men, the highest literacy rate is in Khomas (97 percent). As with educational attainment, literacy shows a direct association with wealth status. 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, Namibia 2006-07 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percent- age literate1 Number Age 15-19 61.1 20.5 10.0 7.4 0.7 0.0 0.4 100.0 91.5 910 20-24 72.9 10.0 7.7 7.4 1.4 0.1 0.5 100.0 90.6 750 25-29 68.0 10.5 9.5 10.6 1.2 0.1 0.1 100.0 88.0 702 30-34 65.4 12.8 11.9 8.7 0.7 0.1 0.5 100.0 90.1 586 35-39 59.0 14.9 12.9 12.6 0.6 0.0 0.0 100.0 86.8 400 40-44 45.4 23.4 14.4 15.4 1.1 0.0 0.3 100.0 83.2 331 45-49 41.2 23.0 15.9 17.9 0.9 0.3 0.8 100.0 80.1 235 Residence Urban 76.6 10.4 8.1 4.0 0.4 0.0 0.3 100.0 95.2 1,962 Rural 48.3 20.3 13.4 16.0 1.5 0.1 0.3 100.0 82.0 1,953 Region Caprivi 62.0 10.9 8.8 18.1 0.0 0.0 0.3 100.0 81.7 189 Erongo 69.8 19.5 5.0 4.3 1.1 0.0 0.3 100.0 94.3 362 Hardap 62.0 10.8 10.1 12.9 1.3 0.0 2.9 100.0 82.9 132 Karas 80.4 10.3 5.5 3.8 0.0 0.0 0.0 100.0 96.2 157 Kavango 58.3 12.1 14.4 11.6 2.8 0.2 0.5 100.0 84.9 331 Khomas 79.0 7.7 10.1 2.9 0.1 0.0 0.1 100.0 96.9 984 Kunene 39.3 8.4 19.3 25.3 6.4 1.4 0.0 100.0 67.0 92 Ohangwena 42.8 25.0 19.2 13.0 0.0 0.0 0.0 100.0 87.0 306 Omaheke 50.6 9.0 7.1 33.0 0.4 0.0 0.0 100.0 66.6 188 Omusati 53.4 24.8 14.3 7.2 0.0 0.3 0.0 100.0 92.5 320 Oshana 68.5 14.8 10.8 4.5 0.0 0.0 1.4 100.0 94.1 270 Oshikoto 43.5 29.8 9.4 12.6 4.7 0.0 0.0 100.0 82.7 322 Otjozondjupa 53.6 17.7 8.6 19.5 0.0 0.0 0.6 100.0 79.9 262 Wealth quintile Lowest 34.7 21.6 20.4 20.8 2.2 0.1 0.0 100.0 76.8 560 Second 46.6 22.6 14.1 14.0 2.0 0.3 0.4 100.0 83.3 607 Middle 54.7 18.0 12.2 13.5 0.9 0.1 0.5 100.0 85.0 875 Fourth 69.8 14.2 9.7 5.3 0.5 0.0 0.6 100.0 93.7 963 Highest 89.9 5.3 2.4 2.4 0.0 0.0 0.1 100.0 97.6 911 Total 15-49 62.5 15.3 10.8 10.0 1.0 0.1 0.3 100.0 88.6 3,915 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 | 31 3.4 ACCESS TO MASS MEDIA Information access is essential in increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behaviour. It is important to know which subgroups are likely to be reached by the media for purposes of planning programmes intended to inform people about health and family planning. In the 2006-07 NDHS, exposure to the media was assessed by asking how often a respondent reads a newspaper, watches television, or listens to a radio. Tables 3.4.1 and 3.4.2 show the percentage of women and men exposed to different types of media by age, urban-rural residence, region, level of education, and wealth quintile. 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, Namibia 2006-07 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 49.8 43.9 80.3 27.8 12.2 2,246 20-24 53.6 48.1 82.6 33.3 10.1 1,855 25-29 50.5 47.6 80.4 30.6 10.3 1,623 30-34 49.2 44.8 81.3 32.2 12.4 1,417 35-39 45.9 41.4 80.9 27.5 13.0 1,045 40-44 45.9 40.9 78.7 27.9 13.3 928 45-49 38.9 40.9 78.3 25.6 14.1 689 Residence Urban 67.7 74.0 85.2 52.0 4.8 4,772 Rural 31.3 16.9 76.3 8.6 18.5 5,032 Region Caprivi 32.8 34.9 74.9 17.4 19.7 474 Erongo 71.3 72.0 86.0 50.1 2.6 688 Hardap 54.9 56.1 81.4 34.7 7.3 315 Karas 49.2 57.1 81.0 33.0 8.7 318 Kavango 26.5 27.4 69.2 12.3 24.9 934 Khomas 74.3 80.3 85.1 59.5 3.5 2,218 Kunene 33.0 35.8 79.1 20.3 15.7 259 Ohangwena 34.6 13.9 73.1 7.7 21.3 1,043 Omaheke 30.3 27.4 84.7 13.9 11.9 373 Omusati 37.7 20.0 78.8 12.4 15.0 975 Oshana 53.7 32.8 87.9 25.6 8.1 819 Oshikoto 40.5 28.3 81.4 19.7 13.3 837 Otjozondjupa 41.3 51.3 83.7 29.2 10.2 550 Education No education/preschool 3.6 13.1 63.7 1.4 33.7 651 Incomplete primary 21.6 20.3 72.0 7.8 22.8 1,699 Complete primary 34.3 27.5 80.6 15.1 14.7 736 Incomplete secondary 53.8 46.8 83.7 30.3 8.2 4,751 Complete secondary 79.3 74.4 85.5 58.2 2.9 1,286 More than secondary 85.8 83.1 88.3 70.1 3.0 682 Wealth quintile Lowest 20.9 5.7 62.6 2.5 32.9 1,621 Second 29.4 9.6 77.3 4.5 17.6 1,668 Middle 33.9 20.3 82.6 8.7 12.1 1,885 Fourth 61.2 66.7 86.5 41.0 3.6 2,292 Highest 82.6 94.8 88.4 72.6 1.0 2,338 Total 49.0 44.7 80.7 29.8 11.8 9,804 32 | Characteristics of Respondents Radio is the most widely accessed mass media, with 81 percent of women and 83 percent of men listening to the radio at least once a week. Newspaper reading and television watching at least once a week by men is almost equal (52 percent and 51 percent, respectively), while for women the corresponding percentages are 49 percent for newspapers and 45 percent for television. Only 11 percent of women and 11 percent of men are not exposed to any of these media on a weekly basis. 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, Namibia 2006-07 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 47.2 50.1 79.1 31.8 13.7 910 20-24 52.1 52.5 82.8 35.1 9.4 750 25-29 53.8 53.0 85.4 38.1 8.9 702 30-34 57.8 51.9 84.1 39.3 8.1 586 35-39 51.4 54.8 86.3 36.9 9.4 400 40-44 48.9 47.8 84.6 35.6 12.0 331 45-49 49.9 46.9 85.6 36.8 11.6 235 Residence Urban 72.2 77.1 88.8 56.2 2.7 1,962 Rural 31.0 25.7 77.7 15.4 18.3 1,953 Region Caprivi 21.2 24.7 68.1 10.6 26.4 189 Erongo 64.8 68.2 92.5 48.7 2.2 362 Hardap 59.6 62.5 88.0 42.6 5.9 132 Karas 67.1 68.4 89.7 53.8 4.7 157 Kavango 32.3 38.8 73.8 20.6 19.5 331 Khomas 72.7 77.7 87.1 54.9 2.1 984 Kunene 30.8 38.8 69.7 22.5 24.2 92 Ohangwena 22.3 20.6 52.5 9.6 38.7 306 Omaheke 28.9 27.7 87.8 15.9 11.0 188 Omusati 45.1 26.0 90.5 17.9 5.1 320 Oshana 76.9 67.0 95.3 59.5 2.7 270 Oshikoto 35.9 26.9 83.3 20.3 13.3 322 Otjozondjupa 46.8 51.8 89.2 35.7 9.1 262 Education No education/preschool 5.2 20.5 69.9 1.7 28.1 360 Incomplete primary 24.7 29.9 75.7 12.3 19.3 856 Complete primary 37.0 43.8 84.9 23.4 10.6 252 Incomplete secondary 61.7 56.9 86.2 41.8 6.5 1,604 Complete secondary 83.1 75.9 91.6 63.7 0.6 538 More than secondary 86.1 83.0 89.2 71.8 2.9 305 Wealth quintile Lowest 15.9 11.4 60.7 4.1 35.3 560 Second 30.9 21.3 78.8 13.3 15.8 607 Middle 42.7 32.7 85.1 20.5 9.8 875 Fourth 66.3 71.0 92.3 49.2 2.7 963 Highest 80.5 93.4 88.8 70.8 0.5 911 Total 15-49 51.7 51.4 83.3 35.8 10.5 3,915 There are only small differences in access to mass media by age. Urban residents are much more likely than rural residents to read newspapers, watch television, and listen to the radio. Fifty percent or more of women in Erongo and Khomas regions and men in Khomas and Oshana regions have access to all three media on a weekly basis. On the other hand, exposure to mass media is less than 10 percent for women and men in Ohangwena. There is a direct relationship between level of education and media exposure. Characteristics of Respondents | 33 Media exposure among women and men is also affected by wealth status. Eight in ten women (83 percent) in the highest wealth quintile read a newspaper at least once a week, compared with 21 percent of women in the lowest wealth quintile. Similarly, 81 percent of men in the highest wealth quintile read a newspaper at least once a week, compared with 16 percent of men in the lowest wealth quintile. The majority of women and men in the highest wealth quintile (73 percent of women and 71 percent of men) have access to all three mass media compared with 3 percent of women and 4 percent of men in the lowest wealth quintile. 3.5 EMPLOYMENT Male and female respondents age 15-49 were asked whether they were employed at the time of the survey and if not, whether they were employed in the 12 months preceding the survey. Measuring employment is difficult because some work, especially work on family farms, in family businesses, or in the informal sector, may not be perceived as employment and hence, not reported as such. To avoid underestimating a respondent’s employment, the 2006-07 NDHS asked women and men several questions to probe for their employment status and to ensure complete coverage of employment in both the formal and informal sectors. Respondents were asked a number of questions to elicit their current employment status and continuity of employment in the 12 months prior to the survey. Employed individuals are those who say that they are currently working (i.e., worked in the past 7 days) and those who worked at any time during the 12 months preceding the survey. Tables 3.5.1 and 3.5.2 show the percent distribution of 2006-07 NDHS respondents according to current and recent employment. The data show that 44 percent of women and 62 percent of men were employed at the time of the survey, while an additional 9 percent of women and 6 percent of men were employed at some time during the 12 months before the survey (Figure 3.1). The proportion currently employed is considerably lower among younger respondents, especially those age 15-19, probably because many are still in school. Single women and men are also less likely to be working than those who are married or formerly married. For example, 38 percent of women who have never married were employed, compared with 54 percent of women who are married or living together. Women and men with no children are less likely to be working than those who have children. The proportion working is higher among women and men in urban areas than those in rural areas. By region, employment among women ranges from 28 percent in Ohangwena to 63 percent in Erongo. For men, the corresponding percentages are 16 percent in Ohangwena and 83 percent in Erongo. The survey data show a direct relationship between level of education and current employ- ment among women. While three in ten women with no education are currently employed, 80 percent of women with more than secondary education are employed. Conversely, unemployment decreases as women’s level of education increases. Eighteen percent of currently employed men have more than secondary education while 43 percent of unemployed men have not completed primary education. 34 | Characteristics of Respondents Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Namibia 2006-07 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 15.7 9.9 74.2 0.2 100.0 2,246 20-24 38.9 9.2 51.9 0.0 100.0 1,855 25-29 54.2 8.5 37.3 0.0 100.0 1,623 30-34 60.8 8.0 31.1 0.1 100.0 1,417 35-39 59.0 8.0 33.0 0.0 100.0 1,045 40-44 59.8 8.4 31.8 0.0 100.0 928 45-49 53.7 9.7 36.5 0.1 100.0 689 Marital status Never married 37.8 9.5 52.6 0.1 100.0 5,673 Married or living together 53.5 7.6 38.9 0.0 100.0 3,451 Divorced/separated/widowed 53.8 10.6 35.5 0.1 100.0 678 Number of living children 0 30.3 9.3 60.4 0.1 100.0 3,419 1-2 52.8 7.8 39.3 0.0 100.0 3,620 3-4 55.6 8.8 35.6 0.0 100.0 1,789 5+ 42.6 12.0 45.4 0.1 100.0 976 Residence Urban 55.2 5.6 39.2 0.0 100.0 4,772 Rural 34.2 12.1 53.6 0.1 100.0 5,032 Region Caprivi 40.3 17.7 41.8 0.2 100.0 474 Erongo 63.4 7.0 29.7 0.0 100.0 688 Hardap 39.4 9.0 51.6 0.0 100.0 315 Karas 51.5 7.4 41.1 0.0 100.0 318 Kavango 34.5 1.3 64.1 0.1 100.0 934 Khomas 56.5 3.2 40.2 0.0 100.0 2,218 Kunene 34.4 23.7 41.9 0.0 100.0 259 Ohangwena 27.6 4.9 67.1 0.4 100.0 1,043 Omaheke 36.4 3.8 59.9 0.0 100.0 373 Omusati 39.9 19.0 41.0 0.0 100.0 975 Oshana 48.4 20.0 31.5 0.0 100.0 819 Oshikoto 42.8 13.3 43.9 0.0 100.0 837 Otjozondjupa 37.8 3.3 58.9 0.0 100.0 550 Education No education/preschool 30.1 13.2 56.6 0.1 100.0 651 Incomplete primary 37.8 11.3 50.8 0.1 100.0 1,699 Complete primary 37.7 8.7 53.5 0.0 100.0 736 Incomplete secondary 39.6 9.0 51.3 0.1 100.0 4,751 Complete secondary 63.6 7.0 29.3 0.0 100.0 1,286 More than secondary 79.7 1.9 18.4 0.0 100.0 682 Wealth quintile Lowest 29.9 15.2 54.8 0.0 100.0 1,621 Second 29.4 13.4 57.1 0.2 100.0 1,668 Middle 38.4 8.9 52.6 0.1 100.0 1,885 Fourth 56.7 5.7 37.7 0.0 100.0 2,292 Highest 58.1 4.6 37.3 0.0 100.0 2,338 Total 44.4 8.9 46.6 0.1 100.0 9,804 Note: Total includes three unweighted women with information missing on marital status. 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents | 35 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Namibia 2006-07 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 28.7 5.7 65.6 0.0 100.0 910 20-24 57.4 8.9 33.5 0.1 100.0 750 25-29 72.6 6.7 20.7 0.0 100.0 702 30-34 78.7 5.7 15.6 0.0 100.0 586 35-39 82.1 5.2 12.7 0.0 100.0 400 40-44 80.1 4.7 15.3 0.0 100.0 331 45-49 79.2 6.3 14.5 0.0 100.0 235 Marital status Never married 50.2 6.8 42.9 0.0 100.0 2,545 Married or living together 85.8 4.3 9.9 0.0 100.0 1,205 Divorced/separated/widowed 79.2 15.2 5.6 0.0 100.0 163 Number of living children 0 47.6 6.2 46.2 0.1 100.0 2,096 1-2 78.5 5.7 15.8 0.0 100.0 967 3-4 77.5 9.5 13.0 0.0 100.0 481 5+ 84.6 5.3 10.1 0.0 100.0 370 Residence Urban 69.4 7.6 23.1 0.0 100.0 1,962 Rural 55.4 5.2 39.3 0.1 100.0 1,953 Region Caprivi 64.6 3.0 32.4 0.0 100.0 189 Erongo 83.2 7.0 9.9 0.0 100.0 362 Hardap 64.6 13.3 22.2 0.0 100.0 132 Karas 65.0 9.9 25.1 0.0 100.0 157 Kavango 51.5 6.0 42.5 0.0 100.0 331 Khomas 69.6 9.1 21.3 0.0 100.0 984 Kunene 81.8 2.0 16.3 0.0 100.0 92 Ohangwena 15.8 5.1 78.7 0.4 100.0 306 Omaheke 75.9 3.9 20.2 0.0 100.0 188 Omusati 54.1 6.1 39.8 0.0 100.0 320 Oshana 53.9 3.9 42.2 0.0 100.0 270 Oshikoto 65.1 3.3 31.6 0.0 100.0 322 Otjozondjupa 69.7 4.4 25.9 0.0 100.0 262 Education No education/preschool 76.8 1.9 21.0 0.3 100.0 360 Incomplete primary 62.6 6.3 31.1 0.0 100.0 856 Complete primary 51.0 6.0 43.0 0.0 100.0 252 Incomplete secondary 55.2 7.2 37.7 0.0 100.0 1,604 Complete secondary 70.2 7.2 22.6 0.0 100.0 538 More than secondary 78.4 7.0 14.6 0.0 100.0 305 Wealth quintile Lowest 48.7 4.1 47.3 0.0 100.0 560 Second 52.5 4.8 42.5 0.2 100.0 607 Middle 64.7 5.6 29.7 0.0 100.0 875 Fourth 67.4 9.0 23.6 0.0 100.0 963 Highest 70.0 6.8 23.2 0.0 100.0 911 Total 15-49 62.4 6.4 31.2 0.0 100.0 3,915 Note: Total includes one unweighted men with information missing on marital status. 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 36 | Characteristics of Respondents 3.6 OCCUPATION Respondents who were currently employed were asked to state their occupation; and the results are presented in Tables 3.6.1 and 3.6.2. Nationally, sales and services employ the largest pro- portion of women (44 percent). For men, the largest proportion work as skilled labour (27 percent). Agricultural jobs absorb 17 percent of women and 27 percent of men. For women and men, residence determines the type of work they do. People who live in urban areas are more likely to be employed in professional, clerical, sales, and services, while agriculture is the predominant occupation of people living in rural areas. Urban women are most often employed in sales and services (48 percent). The most common occupations of urban men are skilled manual labour (36 percent) and sales and services (22 percent). In rural areas, more than 33 percent of women and 56 percent of men are employed in agriculture. Variations by region show that almost half of women in Caprivi are employed in agricultural occupations while 50 percent or more women in Erongo, Hardap, Omaheke, and Oshana are in sales and services jobs. Tables 3.6.1 and 3.6.2 show that men and women with more than secondary education are more likely to be employed in professional, technical, or managerial occupations. NDHS 2006-07 Figure 3.1 Women’s Employment Status in the Past 12 Months Currently employed 44% Not employed in past 12 months 47% Not currently employed, but was in past 12 months 9% Characteristics of Respondents | 37 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, Namibia 2006-07 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 1.5 6.7 35.8 0.8 1.0 24.4 29.9 100.0 575 20-24 8.5 10.1 49.6 4.5 2.6 16.2 8.6 100.0 892 25-29 14.0 10.5 46.6 6.9 1.9 12.9 7.2 100.0 1,018 30-34 14.8 10.7 44.6 7.0 2.5 14.6 5.8 100.0 975 35-39 16.1 10.7 45.4 4.3 1.0 16.8 5.9 100.0 700 40-44 22.7 6.4 41.1 4.9 2.3 16.9 5.7 100.0 633 45-49 23.2 6.2 41.4 3.5 1.5 20.1 4.0 100.0 437 Marital status Never married 9.8 9.6 45.5 5.3 2.0 15.5 12.2 100.0 2,684 Married or living together 19.1 9.1 41.8 4.4 1.6 17.7 6.2 100.0 2,108 Divorced/separated/widowed 13.9 7.4 49.0 5.1 2.7 17.9 4.0 100.0 436 Number of living children 0 13.2 9.8 38.4 4.3 1.4 13.9 18.9 100.0 1,352 1-2 14.9 11.2 46.4 6.0 2.2 13.4 5.9 100.0 2,195 3-4 15.9 8.4 46.8 4.0 2.2 17.3 5.4 100.0 1,152 5+ 7.4 1.2 45.2 4.2 1.7 35.3 4.9 100.0 533 Residence Urban 17.5 14.0 48.4 5.9 2.4 2.8 9.1 100.0 2,901 Rural 9.5 3.3 39.2 3.8 1.3 33.8 9.0 100.0 2,330 Region Caprivi 5.6 2.8 34.8 0.8 1.0 48.4 6.6 100.0 275 Erongo 14.1 10.5 50.0 6.7 5.4 6.1 7.2 100.0 484 Hardap 12.2 8.9 62.3 5.2 1.7 4.9 4.7 100.0 153 Karas 15.9 17.4 43.9 4.2 4.4 8.2 6.1 100.0 187 Kavango 11.2 3.9 41.2 3.7 0.9 35.9 3.3 100.0 335 Khomas 20.7 17.0 44.0 6.9 2.0 0.8 8.4 100.0 1,326 Kunene 10.9 6.5 44.4 1.7 2.5 27.6 6.4 100.0 151 Ohangwena 11.1 2.7 46.1 9.2 2.2 17.4 11.3 100.0 339 Omaheke 20.3 13.0 49.5 5.6 1.8 3.8 6.1 100.0 150 Omusati 10.4 3.5 37.0 2.2 0.1 39.7 7.0 100.0 575 Oshana 10.6 5.3 49.9 2.8 1.4 9.1 21.0 100.0 561 Oshikoto 10.4 6.4 33.1 4.5 0.9 32.4 12.3 100.0 469 Otjozondjupa 14.3 9.1 59.2 5.5 2.1 6.9 2.9 100.0 226 Education No education/preschool 0.7 0.5 47.7 3.2 2.1 40.8 5.1 100.0 282 Incomplete primary 0.8 0.8 51.6 4.4 1.9 35.2 5.3 100.0 834 Complete primary 1.3 1.5 58.6 5.7 1.7 21.2 10.0 100.0 342 Incomplete secondary 6.5 7.4 52.2 5.5 2.6 14.9 10.9 100.0 2,308 Complete secondary 19.9 26.1 34.1 6.2 1.0 4.7 8.0 100.0 909 More than secondary 69.5 11.2 6.5 1.5 0.6 0.4 10.3 100.0 556 Wealth quintile Lowest 1.4 0.5 26.3 2.8 0.5 58.8 9.7 100.0 732 Second 5.0 1.2 45.7 4.3 1.4 33.0 9.4 100.0 713 Middle 8.1 3.9 56.6 6.8 2.3 13.5 8.8 100.0 892 Fourth 12.1 9.7 57.3 5.6 3.2 3.9 8.1 100.0 1,428 Highest 29.9 20.3 32.3 4.5 1.4 1.9 9.7 100.0 1,466 Total 13.9 9.2 44.3 4.9 1.9 16.6 9.1 100.0 5,231 Note: Total includes two unweighted women with information missing on marital status. 38 | 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, Namibia 2006-07 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 3.9 2.7 9.3 14.5 4.2 46.7 18.8 100.0 314 20-24 6.9 2.5 17.1 25.4 6.0 30.4 11.8 100.0 498 25-29 11.3 2.2 17.0 29.5 7.6 22.4 10.1 100.0 556 30-34 13.2 2.1 16.9 32.4 3.5 21.9 10.0 100.0 494 35-39 10.9 2.6 23.0 27.2 5.0 22.2 9.1 100.0 349 40-44 14.4 1.3 16.6 28.0 4.7 23.5 11.6 100.0 281 45-49 12.7 0.7 13.4 26.6 3.9 28.4 14.3 100.0 201 Marital status Never married 7.7 2.2 15.0 26.1 5.5 31.1 12.4 100.0 1,452 Married or living together 14.4 2.3 18.5 26.8 5.1 21.7 11.2 100.0 1,086 Divorced/separated/widowed 6.9 0.0 17.5 33.7 3.3 29.1 9.6 100.0 154 Number of living children 0 7.6 2.3 15.1 21.9 6.3 33.3 13.5 100.0 1,128 1-2 11.9 1.5 16.8 32.6 4.8 22.5 9.9 100.0 815 3-4 12.8 3.7 16.0 26.0 5.1 24.7 11.8 100.0 418 5+ 12.9 1.0 21.7 30.5 2.9 20.8 10.2 100.0 333 Residence Urban 14.1 3.0 22.2 35.8 5.9 4.4 14.5 100.0 1,510 Rural 5.5 1.0 9.4 15.4 4.4 56.2 8.1 100.0 1,184 Region Caprivi 8.0 0.4 11.7 15.4 4.5 52.4 7.6 100.0 128 Erongo 9.2 2.5 15.7 41.2 9.7 7.7 14.0 100.0 326 Hardap 6.0 0.6 14.0 38.4 7.5 25.0 8.6 100.0 103 Karas 11.9 2.6 18.5 28.2 10.0 21.9 6.9 100.0 118 Kavango 8.8 1.9 27.5 11.7 1.3 37.0 11.8 100.0 190 Khomas 16.3 3.2 18.6 36.4 5.7 3.8 15.8 100.0 775 Kunene 6.1 0.0 9.2 10.3 11.0 57.4 6.0 100.0 77 Ohangwena 19.6 2.4 23.1 23.4 0.5 15.0 15.8 100.0 64 Omaheke 4.7 0.5 10.9 13.2 0.6 63.3 6.9 100.0 150 Omusati 4.9 0.6 6.6 16.6 2.0 63.7 5.6 100.0 192 Oshana 12.2 3.5 26.5 22.4 1.6 25.9 7.8 100.0 156 Oshikoto 7.1 1.3 11.5 21.4 0.0 42.2 16.4 100.0 221 Otjozondjupa 3.6 2.4 15.1 17.9 10.9 42.6 7.5 100.0 194 Education No education/preschool 1.5 1.1 8.5 27.5 5.5 52.6 3.4 100.0 283 Incomplete primary 0.9 0.5 15.5 27.3 5.4 43.2 7.1 100.0 590 Complete primary 2.6 0.0 10.9 33.6 5.5 35.7 11.8 100.0 144 Incomplete secondary 5.7 2.3 20.2 31.1 6.3 21.8 12.6 100.0 1,000 Complete secondary 18.0 4.9 22.3 21.5 4.5 10.5 18.3 100.0 416 More than secondary 51.4 3.0 7.8 13.5 1.6 5.5 17.3 100.0 261 Wealth quintile Lowest 2.5 0.0 8.4 11.7 1.4 68.0 8.0 100.0 295 Second 3.6 0.3 10.6 15.5 4.7 56.6 8.8 100.0 348 Middle 5.2 0.8 18.8 29.2 4.3 35.2 6.5 100.0 615 Fourth 8.5 2.6 21.1 36.2 7.5 12.5 11.6 100.0 736 Highest 23.5 4.6 16.3 27.0 5.5 3.6 19.5 100.0 700 Total 15-49 10.4 2.1 16.6 26.8 5.2 27.2 11.7 100.0 2,693 Note: Total includes one unweighted man with information missing on marital status. Characteristics of Respondents | 39 3.7 EARNINGS AND TYPE OF EMPLOYMENT Table 3.7 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural). Four in five women employed in agricultural work are not paid for their work, while 83 percent of women employed in non-agricultural work are given their earnings as cash only. More than half of women employed in agricultural work are employed by a family member. Thirty-one percent of women in agricultural work and 22 percent of women in non- agricultural work are self-employed. Differentials by continuity of employment show that 70 percent of women in agricultural work are seasonally employed, whereas 77 percent of women in non- agricultural work are employed all year. 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 non-agricultural), Namibia 2006-07 Employment characteristic Agricultural work Non-agricultural work Missing Total Type of earnings Cash only 16.4 83.3 44.2 68.6 Cash and in-kind 1.5 3.3 1.5 2.8 In-kind only 1.3 1.7 3.2 1.8 Not paid 80.7 11.4 47.7 26.3 Missing 0.1 0.2 3.4 0.5 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 52.7 11.3 14.7 18.5 Employed by non-family member 16.2 66.1 40.2 55.5 Self-employed 31.1 22.4 41.7 25.6 Missing 0.0 0.2 3.4 0.4 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 26.8 76.8 72.0 68.1 Seasonal 70.1 14.0 17.0 23.6 Occasional 3.1 9.0 7.3 7.9 Missing 0.0 0.2 3.7 0.5 Total 100.0 100.0 100.0 100.0 Number of women employed during the past 12 months 870 3,887 474 5,231 Women age 15-49 are employed in two major areas: namely agricultural work and non- agricultural work. Overall, 69 percent of women receive cash only, while 26 percent are not paid. Most women (81 percent) in agricultural work are not paid. Fifty-six percent of women are employed by non-family members, 19 percent by family members, and 26 percent are self-employed. Sixty-six percent of women employed in non-agricultural work are employed by non-family members, 22 percent are self-employed, and 11 percent are employed by family members. With regard to continuity of employment, 68 percent of employed women work all year, 24 percent are seasonal workers, and 8 percent are considered occasional workers. Seventy-seven percent of women employed in non-agricultural work are employed all year, 14 percent are seasonal workers, and 9 percent are considered occasional workers. The majority of women employed in agriculture are seasonal workers, while 27 percent work all year. Fertility | 41 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4 This chapter looks at a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women begin childbearing. Information on current and cumulative fertility is essential in monitoring population growth. The data on birth intervals are important because short intervals are strongly associated with childhood mortality. The age at which childbearing begins can also have a major impact on the health and well-being of both the mother and the child. Data on fertility were collected in several ways. Each woman was asked about all of the births she had had in her lifetime. To ensure completeness of the responses, the duration, the month and year of termination, and the result of the pregnancy were recorded for each pregnancy. In addition, questions were asked separately about sons and daughters who live with the mother, those who live elsewhere, and those who have died. Subsequently, a list of all births was recorded along with name, age if still alive, and age at death if dead. Finally, information was collected on whether the women were pregnant at the time of the survey. 4.1 CURRENT FERTILITY Measures of current fertility presented in this chapter include age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). These rates are generally presented for the three-year period preceding the survey, a period covering portions of calendar years 2005 through 2007. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of ASFRs are calculated by identifying live births that occurred in the period 1-36 months prior to the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman- years lived in each of the specified five-year age groups in the period 1-36 months prior to the survey. The total fertility rate is a common measure of current fertility and is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. The general fertility rate is the number of live births occurring during a specified period per 1,000 women age 15-44. The crude birth rate is the number of births per 1,000 population during a specified period. Current estimates of fertility levels are presented in Table 4.1 and Figure 4.1 by urban-rural residence. The TFR in Namibia for the period 2005 to 2007 is 3.6 births per woman, 0.6 births lower than that recorded in the 2000 NDHS (4.2 births per woman). On average, rural women have 1.5 more children than urban women (4.3 compared with 2.8 children per woman). The difference in fertility rates between urban and rural women can be attributed to better education and greater access to family planning information and services in urban areas (see Chapters 3 and 5). The age pattern of fertility indicates that childbearing in Namibia begins early. According to the cumulative age-specific fertility rates shown in Table 4.1, fertility peaks in the age group 20-24 (204 births per thousand women in rural and 136 births per thousand women in urban areas). Age- specific fertility rates are higher in rural areas than in urban areas for all age groups. 42 | Fertility Table 4.1 Current fertility Age-specific and total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Namibia 2006-07 Residence Age group Urban Rural Total 15-19 58 92 78 20-24 136 204 169 25-29 133 192 159 30-34 116 180 145 35-39 87 133 110 40-44 27 58 44 45-49 9 8 8 TFR 2.8 4.3 3.6 GFR 100 143 122 CBR 28.8 29.6 29.2 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 CBR: Crude birth rate expressed per 1,000 population + + + + + + + & & & & & & &) ) ) ) ) ) ) 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 50 100 150 200 250 Births per 1,000 women Urban Rural Total) & + NDHS 2006-07 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence Fertility | 43 Compared with other countries in south-eastern Africa that have participated in the DHS programme, fertility in Namibia is slightly higher than that in Lesotho and slightly lower than that in Zimbabwe and Swaziland (Figure 4.2). 4.2 FERTILITY DIFFERENTIALS BY BACKGROUND CHARACTERISTICS Fertility is known to vary by residence, educational background, and other background characteristics of a woman. Table 4.2 shows that the TFR varies between regions, ranging from 2.6 children per woman in Khomas to 5.1 children per woman in Omaheke. Teenage fertility is high in Kavango (140 births per 1,000 women), Omaheke (137 per 1,000), Caprivi (121 per 1,000), and Otjozondjupa (120 per 1,000), while Khomas, Omusati, and Oshana have the lowest rates (42, 49, and 49 births per 1,000 women, respectively). Table 4.2 Current fertility by region Age-specific and total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Namibia 2006-07 Region Age group Caprivi Erongo Hardap Karas Kavango Khomas Kunene Ohang- wena Omaheke Omusati Oshana Oshikoto Otjozond- jupa Total 15-19 121 76 103 112 140 42 112 70 137 49 49 63 120 78 20-24 157 136 163 119 213 132 194 203 214 196 147 175 212 169 25-29 159 145 134 198 184 122 222 185 235 167 131 201 172 159 30-34 143 141 153 122 151 101 195 230 227 138 142 148 144 145 35-39 61 57 75 68 180 98 107 117 145 119 90 111 179 110 40-44 67 9 14 15 82 27 100 39 44 55 38 70 55 44 45-49 11 0 9 0 33 0 0 8 10 8 0 23 8 8 TFR 3.6 2.8 3.3 3.2 4.9 2.6 4.7 4.3 5.1 3.7 3.0 4.0 4.5 3.6 GFR 129 101 116 110 166 94 163 138 167 118 99 126 152 122 CBR 30.8 24.8 26.6 23.6 36.7 28.2 33.6 29.7 31.5 26.4 26.5 27.9 33.6 29.2 6.7 6 5.9 5.7 5.5 4.9 3.8 3.8 3.6 3.5 Uganda 2006 Malawi 2004 Zambia 2001-02 Tanzania 2004 Mozambique 2003 Kenya 2003 Zimbabwe 2005-06 Swaziland 2006-07 Namibia 2006-07 Lesotho 2004 0 1 2 3 4 5 6 7 8 Births per woman Figure 4.2 Total Fertility Rates for Selected Countries NDHS 2006-07 6.0 44 | Fertility Table 4.3 shows several fertility measurements, namely the total fertility rate, mean number of births to women age 40-49, and the percentage of women who are currently pregnant. The mean number of births to women age 40-49 is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period. If fertility remained stable over time and the reported data on both children ever born and births during the three years preceding the survey are reasonably accurate, the total fertility rate (TFR) and the mean number of children ever born (CEB) tend to be similar. When fertility levels are falling, the TFR will be substantially lower than the mean number of children ever born among women age 40-49. The percentage pregnant provides a useful additional measure of current fertility, although it is recognized that it may not capture some pregnancies that are in an early stage. Table 4.3 shows the decline in fertility by background characteristics. The current TFR is 0.8 children lower than the mean number of children among women age 40-49 (3.6 births per woman and 4.4 children, respectively). Educational attainment is closely linked to a woman’s fertility; the TFR for women with no formal education (6.3) and women with a primary education (4.0-4.7) is four or more children per woman, while that for women with at least some secondary education is three or fewer children per woman (2.1-3.2). A comparison of current (total) fertility with past (completed) fertility shows that there have been substantial and roughly equivalent declines in both urban and rural areas and within all regional and education categories. Table 4.3 indicates that 5 percent of women were pregnant at the time of the survey. This is likely to be an underestimate because women in the early stages of pregnancy may be unaware or unsure that they are pregnant while some may not report that they are pregnant. Kunene has the highest pregnancy rate (10 percent). Differentials in pregnancy status parallel differentials in current fertility; the proportion of women who are currently pregnant declines as the level of education increases and wealth status rises. 4.3 FERTILITY TRENDS Table 4.4 uses information from the retrospective birth histories obtained from the 2006-07 NDHS respondents to examine trends in age-specific fertility rates for successive five-year periods Table 4.3 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Namibia 2006-07 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 2.8 4.6 3.7 Rural 4.3 6.1 4.9 Region Caprivi 3.6 7.2 4.7 Erongo 2.8 5.3 3.8 Hardap 3.3 7.0 4.2 Karas 3.2 4.0 3.8 Kavango 4.9 6.2 5.0 Khomas 2.6 4.0 3.5 Kunene 4.7 10.2 5.6 Ohangwena 4.3 5.1 5.4 Omaheke 5.1 7.4 4.7 Omusati 3.7 4.8 4.2 Oshana 3.0 4.1 4.5 Oshikoto 4.0 5.6 5.1 Otjozondjupa 4.5 7.3 4.6 Education No education/preschool 6.3 7.2 5.5 Incomplete primary 4.7 6.5 5.4 Complete primary 4.0 5.9 4.9 Incomplete secondary 3.2 5.0 3.7 Complete secondary 2.8 4.6 2.8 More than secondary 2.1 4.6 2.7 Wealth quintile Lowest 5.1 6.9 5.5 Second 4.3 5.6 4.9 Middle 4.1 6.4 4.7 Fourth 2.8 5.1 4.2 Highest 2.4 3.6 3.1 Total 3.6 5.4 4.4 Note: Total fertility rates are for the period 1-36 months prior to interview. Fertility | 45 before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because birth histories were not collected for women over age 50, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years or more prior to the survey because women in that age group would have been age 50 or over at the time of the survey. Table 4.4 shows that fertility rates for all age groups have decreased over time. For example, the fertility rate for women age 15-19 was 88 births per 1,000 women in 1988-1992 compared with 74 births per 1,000 women in 2003-2007. Another way to examine fertility trends is to compare current estimates with earlier surveys. Table 4.5 and Figure 4.3 show the age-specific fertility rates and TFRs from the 1992, 2000, and 2006-07 NDHS surveys. The data show that fertility declined from 5.4 children per woman in the early 1990s to 3.6 children per woman in 2005-07. Across age groups, the sharpest decline is seen among women age 25-29, from 241 in 1990-92 to 159 children per woman in 2005-07. Table 4.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Namibia 2006-07 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 74 82 87 88 20-24 165 161 179 193 25-29 159 174 200 218 30-34 143 167 191 [194] 35-39 108 125 [137] 40-44 45 [85] 45-49 [9] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. Table 4.5 Trends in age-specific and total fertility rates Age-specific and total fertility rates (TFR) for the three-year period preceding several surveys, Namibia 1992-2007 Mother’s age at birth NDHS 1992 (1990-92) NDHS 2000 (1998-2000) NDHS 2006-07 (2006-07) 15-19 109 88 78 20-24 207 166 169 25-29 241 176 159 30-34 208 160 145 35-39 166 137 110 40-44 105 71 44 45-49 37 38 8 TFR 5.4 4.2 3.6 Note: Age-specific fertility rates are per 1,000 women. 109 207 241 208 166 105 37 88 166 176 160 137 71 38 78 169 159 145 110 44 8 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 50 100 150 200 250 300 Births per 1,000 women NDHS 1992 NDHS 2000 NDHS 2006-07 Figure 4.3 Trends in Age-specific Fertility Rates, Namibia 1992-2007 46 | Fertility 4.4 CHILDREN EVER BORN AND LIVING Table 4.6 presents the distribution of all women and currently married women by number of children ever born, according to five-year age groups. The table also shows the mean number of children ever born. Data on the number of children ever born reflect the accumulation of births to women over their entire reproductive years and therefore have limited reference to current fertility levels, particularly when a country has experienced a decline in fertility. However, the information on children ever born is useful for observing how average family size varies across age groups and for observing the level of primary infertility. Table 4.6 shows that 87 percent of women age 15-19 have never given birth. However, this proportion declines rapidly to 5 percent or less for women age 35 and over. Namibian women have an average of 4.75 children by the end of their reproductive years, which is 1.15 children more than the TFR. This discrepancy is largely attributable to the fertility decline between the 1992 and 2000 NDHS surveys. As expected, both the mean number of children ever born and the mean number of children surviving rise with increasing age of women. The last two columns in Table 4.6 compare these two variables, and reveal the level of child loss among Namibian women. By the end of their reproductive years (age 45-49), women in Namibia have given birth to an average of 1.91 children, with 1.76 surviving. This means that 92 percent of children ever born have survived. The same pattern is replicated for currently married women, except that the mean number of children ever born is higher for currently married women (3.15 children) than for all women (1.91 children). The difference is due to the lower levels of fertility among women in the “all women” category. Table 4.6 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, Namibia 2006-07 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 87.4 11.0 1.4 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,246 0.15 0.14 20-24 42.0 37.1 16.4 3.7 0.7 0.1 0.0 0.0 0.0 0.0 0.0 100.0 1,855 0.84 0.80 25-29 20.6 27.8 29.3 14.9 5.2 1.9 0.2 0.0 0.0 0.0 0.0 100.0 1,623 1.63 1.54 30-34 9.5 20.3 24.8 21.7 11.7 6.9 3.3 1.4 0.3 0.0 0.0 100.0 1,417 2.49 2.32 35-39 4.9 12.1 18.6 20.8 17.6 10.5 7.7 4.9 2.0 0.7 0.3 100.0 1,045 3.41 3.20 40-44 4.4 6.1 15.1 16.8 19.1 12.6 10.5 6.8 4.3 2.3 2.0 100.0 928 4.12 3.75 45-49 3.6 6.2 12.0 13.6 15.0 12.5 12.3 9.3 5.0 6.0 4.7 100.0 689 4.75 4.19 Total 33.9 19.4 16.1 11.1 7.4 4.5 3.2 2.0 1.0 0.7 0.6 100.0 9,804 1.91 1.76 CURRENTLY MARRIED WOMEN 15-19 38.7 48.2 11.2 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 118 0.76 0.72 20-24 14.2 40.2 34.4 8.2 2.5 0.5 0.0 0.0 0.0 0.0 0.0 100.0 398 1.46 1.37 25-29 8.8 23.8 34.4 20.7 9.2 2.5 0.6 0.0 0.0 0.0 0.0 100.0 625 2.08 1.96 30-34 4.2 15.2 26.5 24.1 14.1 8.3 5.2 1.9 0.6 0.0 0.0 100.0 751 2.87 2.69 35-39 2.5 9.1 15.7 21.6 19.5 11.6 9.0 6.5 3.2 0.7 0.5 100.0 612 3.79 3.56 40-44 3.0 4.2 14.4 17.5 17.4 13.0 11.1 8.7 5.3 2.5 2.8 100.0 522 4.42 4.06 45-49 2.0 4.9 12.9 14.1 13.8 12.1 11.7 8.3 6.1 7.9 6.1 100.0 424 5.01 4.40 Total 6.6 16.8 22.9 18.2 12.8 7.8 6.0 3.9 2.3 1.5 1.3 100.0 3,451 3.15 2.91 Fertility | 47 Voluntary childlessness is uncommon in Namibia and currently married women with no children are likely to be those who are sterile or unable to bear children. The level of childlessness among married women at the end of their reproductive years can be used as an indicator of the level of primary sterility. In Namibia, primary sterility among all women age 45-49 is around 4 percent. 4.5 BIRTH INTERVALS A birth interval is defined as the length of time between two live births. The study of birth intervals is important in understanding the health status of young children. Research has shown that short birth intervals are closely associated with poor health of children, especially during infancy. Children born too close to a previous birth, especially if the interval between the births is less than two years, are at increased risk of health problems and dying at an early age. Longer birth intervals, on the other hand, contribute to the improved health status of both mother and child. The study of birth intervals is done using two measures, namely median birth interval and proportion of non-first births that occur with an interval of 24 months or more after the previous birth. Table 4.7 presents the distribution of second and higher-order births in the five years preceding the survey by the number of months since the previous birth, according to background characteristics. The table also includes the median number of months since the preceding birth. Table 4.7 shows that the overall median birth interval for Namibia is 42.3 months. In the five years preceding the survey 13 percent of children were born within 24 months after a preceding birth, 26 percent were born 2 to 3 years after their older sibling, and 42 percent were born 4 years or more after a preceding birth. The shortest birth intervals are observed among children born to women age 15-19 (24.7 months) and children whose preceding sibling died (30.4 months). Birth intervals are longest for children born to women with higher than secondary education (47.6 months). The median birth interval is 10 months longer in urban areas than in rural areas. In all regions, the median birth interval is longer than 36 months. The medians range from 36.5 months in Omaheke to 52.1 months in Erongo. A large proportion (44 percent) of children of younger women (15-19) are born less than 24 months after the preceding birth, indicating that birth intervals among younger women are very short, increasing the health risks to both children and mothers. 48 | Fertility Table 4.7 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Namibia 2006-07 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Number of non-first births Median number of months since preceding birth Age 15-19 22.8 21.3 24.1 25.1 4.3 2.3 100.0 42 24.7 20-29 6.2 11.0 29.7 21.1 12.2 19.9 100.0 1,355 37.2 30-39 4.3 6.4 23.7 17.6 13.7 34.2 100.0 1,562 46.8 40-49 2.8 5.8 20.9 19.9 11.3 39.2 100.0 412 48.5 Birth order 2-3 5.1 8.2 23.6 18.5 12.3 32.3 100.0 2,040 44.4 4-6 4.6 8.2 28.6 19.8 14.3 24.7 100.0 1,043 40.7 7+ 7.3 9.8 30.8 24.9 9.8 17.3 100.0 288 36.8 Sex of preceding birth Male 5.7 9.0 23.9 20.8 12.5 28.1 100.0 1,705 42.6 Female 4.6 7.7 27.7 18.0 12.8 29.2 100.0 1,667 42.0 Survival of preceding birth Living 4.4 7.7 25.8 20.0 12.9 29.4 100.0 3,152 43.1 Dead 15.7 17.9 25.9 11.6 10.3 18.7 100.0 219 30.4 Residence Urban 5.7 6.3 19.9 17.3 14.4 36.5 100.0 1,338 48.6 Rural 4.7 9.7 29.6 20.8 11.6 23.5 100.0 2,034 38.8 Region Caprivi 3.5 6.1 21.0 21.8 14.0 33.7 100.0 180 46.6 Erongo 4.2 6.3 14.7 17.6 17.6 39.6 100.0 197 52.1 Hardap 7.2 12.6 21.6 14.6 11.3 32.8 100.0 98 40.0 Karas 7.4 4.3 20.6 18.4 16.1 33.4 100.0 98 47.7 Kavango 1.0 5.2 25.9 20.4 17.8 29.7 100.0 398 46.5 Khomas 8.6 6.3 18.8 17.5 13.8 35.0 100.0 586 47.5 Kunene 4.8 15.4 28.2 23.3 9.3 19.2 100.0 140 36.8 Ohangwena 5.3 9.7 31.4 25.3 9.6 18.7 100.0 400 36.9 Omaheke 8.2 13.6 27.4 13.7 10.7 26.4 100.0 163 36.5 Omusati 2.7 7.8 29.7 19.9 11.5 28.4 100.0 295 41.7 Oshana 2.6 10.0 34.2 20.8 10.0 22.4 100.0 231 37.1 Oshikoto 4.1 8.5 31.7 20.9 9.3 25.5 100.0 336 39.3 Otjozondjupa 8.1 10.9 25.8 12.7 13.0 29.6 100.0 250 40.3 Education No education/preschool 6.2 10.2 29.2 20.8 14.3 19.3 100.0 478 38.3 Incomplete primary 3.7 7.2 28.8 23.9 12.8 23.5 100.0 836 40.6 Complete primary 3.9 9.0 28.9 13.6 13.0 31.6 100.0 265 42.9 Incomplete secondary 5.0 8.1 24.1 17.6 11.4 33.7 100.0 1,313 45.0 Complete secondary 7.5 8.8 23.9 16.1 13.8 29.9 100.0 309 43.3 More than secondary 7.2 8.4 12.6 22.4 14.7 34.7 100.0 171 47.6 Wealth quintile Lowest 3.1 9.6 32.0 23.1 11.4 20.7 100.0 790 38.6 Second 5.6 8.8 29.0 20.8 12.0 23.8 100.0 683 39.2 Middle 6.1 9.0 25.6 18.8 13.7 26.9 100.0 764 41.3 Fourth 4.5 8.6 22.8 16.4 12.7 35.0 100.0 661 46.4 Highest 7.2 4.2 15.1 16.5 14.0 43.1 100.0 474 53.0 Total 5.1 8.3 25.8 19.4 12.7 28.7 100.0 3,372 42.3 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. Fertility | 49 4.6 AGE AT FIRST BIRTH The age at which childbearing commences is an important determinant of the overall level of fertility as well as the health and welfare of the mother and the child. In some societies, postponement of first births because of increasing age at first marriage has contributed to overall fertility decline. Table 4.8 shows the percentage of women who gave birth by specific ages, according to age at the time of the survey. Table 4.8 shows trends in the median age at first birth across age cohorts. The measures are presented for women age 25-49 to ensure that half of the women have already had a birth. Almost one-fifth of women age 25-49 have given birth before reaching age 18, while 57 percent have had a birth by age 20. The median age at first birth is about 21 years across all age cohorts, indicating virtually no change in the age at first birth. The median age at first birth for age group (25-49) is 21.4 years, which is similar to that recorded in the 2000 NDHS (21.1 years). Table 4.8 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, Namibia 2006-07 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 1.4 na na na na 87.4 2,246 a 20-24 2.3 17.0 35.1 na na 42.0 1,855 a 25-29 1.5 17.7 36.1 54.5 70.9 20.6 1,623 21.4 30-34 1.9 16.2 36.6 52.5 71.8 9.5 1,417 21.6 35-39 1.7 17.1 38.9 57.0 76.3 4.9 1,045 21.2 40-44 2.5 18.8 36.8 52.8 71.9 4.4 928 21.6 45-49 4.9 17.5 41.9 59.4 79.1 3.6 689 21.0 20-49 2.2 17.3 37.0 na na 18.1 7,558 21.5 25-49 2.2 17.4 37.6 54.8 73.3 10.3 5,703 21.4 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 4.9 shows that the median age at first birth is almost the same in urban and rural areas (21.8 and 21.0 years, respectively). Among regions, the highest median age at first birth for women 25-49 is 22.5 years or higher in Khomas, Omusati, and Oshana. Women in Kunene began child- bearing three years earlier than women in Omusati (19.5 years). Median age at first birth increases with the woman’s education and household wealth status. Women who completed secondary school began childbearing at 24.2 years compared with 19.9 years for women with no education. Women in the poorest households had their first child at 20.4 years compared with 23.1 years for women in the wealthiest households. 50 | Fertility Table 4.9 Median age at first birth Median age at first birth among women age 25-49, according to background characteristics, Namibia 2006-07 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women 25-49 Residence Urban 22.3 22.1 21.5 21.3 20.9 21.8 Rural 20.8 20.9 21.0 21.8 21.0 21.0 Region Caprivi 19.8 19.5 22.0 19.6 19.5 19.9 Erongo 22.4 21.0 21.6 21.6 20.1 21.3 Hardap 20.3 21.4 20.7 20.0 20.5 20.6 Karas 21.3 22.6 21.4 21.3 19.3 21.4 Kavango 19.8 19.3 19.5 20.2 20.9 19.7 Khomas 23.5 22.8 20.9 21.1 21.9 22.5 Kunene 20.3 19.2 19.2 18.9 19.2 19.5 Ohangwena 20.9 22.4 21.8 21.9 21.5 21.7 Omaheke 20.1 20.8 20.0 20.7 19.9 20.3 Omusati 22.0 22.4 22.0 24.6 24.3 22.9 Oshana 22.4 21.6 22.6 23.5 21.6 22.5 Oshikoto 20.8 20.5 22.1 23.1 21.0 21.3 Otjozondjupa 20.9 20.2 19.7 19.2 20.1 20.2 Education No education/preschool 19.9 19.7 19.7 20.3 19.9 19.9 Incomplete primary 19.0 19.1 19.5 20.0 20.0 19.5 Complete primary 19.4 20.3 19.6 20.8 20.8 20.1 Incomplete secondary 21.4 21.9 22.1 21.7 21.0 21.6 Complete secondary 24.1 25.0 24.1 24.0 22.4 24.2 More than secondary a 27.0 26.2 26.8 25.6 a Wealth quintile Lowest 20.2 19.9 20.3 21.0 21.2 20.4 Second 20.7 21.6 20.9 22.1 21.2 21.1 Middle 20.8 20.8 21.0 21.6 20.3 20.9 Fourth 21.7 21.2 20.7 20.9 19.8 21.0 Highest 24.7 24.1 22.9 22.4 21.8 23.1 Total 21.4 21.6 21.2 21.6 21.0 21.4 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 4.7 TEENAGE PREGNANCY AND MOTHERHOOD Teenage pregnancy is a major health concern because of its association with higher morbidity and mortality for both the mother and child. Childbearing during the teenage years frequently has adverse social consequences, particularly for female educational attainment because women who become mothers in their teens are more likely to curtail their education. Using information from the 2006-07 NDHS, Table 4.10 shows the percentage of women age 15-19 who are mothers or who are pregnant with their first child. Overall, 15 percent of teenagers in Namibia have started childbearing; 13 percent have had a live birth and 3 percent are pregnant with their first child. Childbearing among teenagers increases rapidly between the ages of 17 and 19—from 14 percent among women age 17, to 35 percent among women age 19. Rural teenagers are more likely than urban teenagers to have started childbearing (18 percent and 12 percent, respectively). Fertility | 51 Across regions, there appears to be two patterns of childbearing among teenagers. There are regions with high teenage pregnancy rates (27 percent or higher), such as Omaheke (27 percent), Otjozondjupa (27 percent), Caprivi (30 percent), Kunene (31 percent), and Kavango (34 percent). On the other hand, teenage pregnancy is 10 percent or less in Khomas, Ohangwena, Omusati, and Oshana regions. The childbearing rates among teenagers in the remaining regions are between 13 percent (Karas) and 19 percent (Hardap). Teenage pregnancy rates have a negative association with education and wealth status. Fifty- eight percent of teenagers with no education have started childbearing, more than twice the rate for teenagers who have incomplete primary school (25 percent), and almost ten times higher than the rate for those who completed secondary school (6 percent). Teenagers from the poorest households are nearly five times as likely to have been pregnant as those from the richest households (22 percent compared with 5 percent). Table 4.10 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, Namibia 2006-07 Percentage who: Background characteristic Have had a live birth Are pregnant with first child Percentage who have begun childbearing Number of women Age 15 2.0 0.8 2.7 401 16 3.5 2.1 5.5 508 17 11.5 2.3 13.9 456 18 17.0 4.5 21.6 466 19 30.4 4.2 34.6 415 Residence Urban 9.5 2.3 11.8 908 Rural 14.7 3.2 17.9 1,338 Region Caprivi 22.0 7.7 29.7 103 Erongo 11.5 3.1 14.6 118 Hardap 15.5 3.7 19.2 68 Karas 12.1 1.1 13.2 52 Kavango 27.9 6.0 34.0 239 Khomas 5.5 0.8 6.3 401 Kunene 25.4 5.1 30.5 52 Ohangwena 9.1 0.9 10.0 346 Omaheke 25.5 1.7 27.1 85 Omusati 6.8 2.5 9.3 261 Oshana 6.6 2.7 9.3 198 Oshikoto 11.3 2.3 13.6 228 Otjozondjupa 20.1 6.4 26.5 94 Education No education/preschool 45.3 12.7 58.0 45 Incomplete primary 22.8 2.3 25.1 291 Complete primary 20.0 2.2 22.3 235 Incomplete secondary 9.5 2.9 12.4 1,498 Complete secondary 4.6 1.6 6.1 157 More than secondary 0.0 0.0 0.0 19 Wealth quintile Lowest 18.3 4.2 22.4 445 Second 12.3 2.5 14.8 474 Middle 17.8 3.1 20.9 423 Fourth 12.6 2.9 15.5 419 Highest 3.4 1.4 4.8 485 Total 12.6 2.8 15.4 2,246 Family Planning | 53 FAMILY PLANNING 5 This chapter presents results from the 2006-07 NDHS regarding aspects of contraceptive knowledge, attitudes, and behaviour. Although the focus is on women, some results from male respondents are discussed because men play an important role in achieving family planning goals. To get an indication of interspousal communication and agreement on knowledge and attitudes of couples regarding family planning, the study compares the responses of men, where possible, with responses of their wives in the same household. Where feasible, comparisons are also made with findings from previous survey rounds to highlight trends in important indicators. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS One major objective of the 2006-07 NDHS was to assess the level of knowledge of contraceptive methods among women and men. Individuals who have adequate information about the available methods of contraception are better able to develop a rational approach to planning their families. Information on respondents’ knowledge of contraception was collected in the survey by asking female and male respondents to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked whether the respondent had heard of it. In Table 5.1, contraceptive methods are grouped into two types, modern and traditional. Modern methods include female and male sterilization, the pill, the intrauterine device (IUD), injectables, implants, male condom, female condom, lactational amenorrhoea (LAM), and emergency contraception. Traditional methods include the rhythm method (periodic abstinence) and withdrawal. Provision was also made in the questionnaire to record any other methods, including folk methods, named spontaneously by the respondent. Specific contraceptive methods asked about were the same as those in the 2000 NDHS (MoHSS, 2003), except that in the 2006-07 NDHS, the diaphragm, foam, and jelly were not explicitly asked about, while implants were. Table 5.1 shows the level of knowledge of specific contraceptive methods among all women and men, among married women and men, and among unmarried but sexually active women and men. The 2006-07 NDHS finds that knowledge of contraception is practically universal; 98 percent of all women and men know at least one contraceptive method. Knowledge of modern contraception among the sexually active respondents is also high, regardless of sex or marital status. Knowledge of traditional methods is considerably lower for both women and men regardless of marital status with men showing somewhat higher levels of knowledge of these traditional methods. The most widely known modern methods of contraception among all women are male condom (95 percent), injectables (93 percent), the pill (90 percent), and female condom (83 percent). The least commonly cited modern methods by all women are implants (19 percent), emergency contraception (21 percent), and male sterilization (32 percent). In general, married women and sexually active unmarried women show similar levels of knowledge of both modern and traditional contraceptive methods, except that married women seem somewhat more aware of longer-term methods, such as sterilization, the IUD, and implants. Compared with married women, sexually active unmarried women were slightly more likely to have heard of male and female condoms, emergency contraception, and the withdrawal method. Among sexually active unmarried women, the male condom is also the most widely known contraceptive method (98 percent). In general, for both men and women there have been only slight increases in knowledge of contraceptive methods since the 2000 NDHS. Among all women, the major exceptions are that knowledge of the female condom increased from 66 percent in 2000 to 83 percent in 2006-07 and knowledge of the IUD decreased from 52 percent in 2000 to 46 percent in 2006-07. 54 | Family Planning Among sexually active unmarried women, while there is an increase in the level of knowledge of male and female condoms from the level in 2000, knowledge of some modern contraceptive methods in the 2006-07 NDHS is lower than that in the 2000 NDHS. For example, knowledge of the IUD declined from 60 percent to 49 percent, knowledge of female sterilization declined from 69 percent to 62 percent, and knowledge of male sterilization declined from 38 percent to 33 percent. Table 5.1 also shows that virtually all sexually active men know at least one modern method of fertility regulation. Among all men, most widely known modern methods of contraception are the male condom (98 percent), female condom (82 percent), injectables (80 percent), and the pill (78 percent). Among men, the least commonly mentioned modern contraceptive methods are emergency contraception (25 percent), implants (26 percent), and male sterilization (42 percent). Compared with the 2000 NDHS, all men are currently less likely to have heard of female sterilization (58 percent in the 2000 NDHS and to 54 percent currently), the pill (83 percent and 78 percent), and injectables (86 percent and 80 percent). Over the same period, all men were somewhat more likely to have heard of male sterilization (38 percent in the 2000 NDHS and 42 percent currently), the IUD (35 percent and 40 percent), and female condom (74 percent and 82 percent). Table 5.2 presents knowledge of family planning methods across subgroups of women and men. The table shows that knowledge of at least one modern method of family planning is universal (98 percent or more) among all subgroups of currently married women in Namibia, except among the youngest age group (96 percent). Married men are as knowledgeable about modern family planning methods as married women. There is little variation between respondents in different regions with all showing near universal knowledge of at least one contraceptive method. The only exception is married men in Ohangwena, who are least likely to know a modern method of fertility regulation (79 percent). For both married women and men, limited education is associated with having somewhat lower levels of knowledge of contraception. Similarly, being in the lowest wealth quintile is associated with somewhat lower levels of contraceptive knowledge. Table 5.1 Knowledge of contraceptive methods Percentage of all respondents, currently married respondents, and sexually active unmarried respondents age 15-49 who know any contraceptive method, by specific method, Namibia 2006-07 Women Men Method All women Currently married women Sexually active unmarried woman1 All men Currently married men Sexually active unmarried men1 Any method 98.3 99.1 99.5 98.0 99.0 100.0 Any modern method 98.3 99.0 99.4 98.0 99.0 100.0 Female sterilization 58.7 67.5 61.5 54.4 61.6 59.9 Male sterilization 31.5 35.1 32.7 41.6 45.3 45.1 Pill 89.7 91.9 92.4 77.7 85.4 82.4 IUD 45.5 50.9 48.6 40.0 43.8 42.3 Injectables 92.5 95.7 95.4 79.9 87.6 85.9 Implants 18.8 21.9 17.6 26.1 30.6 26.9 Male condom 94.6 93.9 97.9 97.6 98.3 99.8 Female condom 83.0 81.1 89.2 82.3 85.6 85.7 Emergency contraception 20.7 23.2 25.6 25.4 24.6 29.2 Any traditional method 47.3 50.2 53.3 56.4 61.4 60.0 Rhythm 33.8 35.8 36.4 36.4 41.7 38.2 Withdrawal 32.9 36.1 40.0 47.0 48.4 50.9 Folk method 5.4 7.0 4.1 5.8 6.9 6.3 Mean number of methods known by respondents 15-49 6.1 6.4 6.4 6.1 6.6 6.5 Number of respondents 9,804 3,451 1,343 3,915 1,205 733 1 Had last sexual intercourse within 30 days preceding the survey Family Planning | 55 Table 5.2 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, Namibia 2006-07 Women Men Background characteristic Heard of any method Heard of any modern method1 Number Heard of any method Heard of any modern method1 Number Age 15-19 95.5 95.5 118 * * 3 20-24 99.5 99.5 398 98.2 98.2 76 25-29 99.1 99.1 625 99.5 99.5 199 30-34 99.3 99.2 751 99.4 99.4 260 35-39 99.1 99.0 612 99.2 99.2 248 40-44 99.8 99.7 522 98.5 98.5 242 45-49 98.1 98.0 424 98.6 98.6 178 Residence Urban 99.5 99.4 1,731 100.0 100.0 714 Rural 98.6 98.5 1,719 97.6 97.6 491 Region Caprivi 98.8 98.8 200 100.0 100.0 82 Erongo 99.9 99.9 327 100.0 100.0 163 Hardap 100.0 100.0 131 98.7 98.7 45 Karas 99.7 99.7 139 99.2 99.2 48 Kavango 98.4 97.9 477 100.0 100.0 125 Khomas 99.6 99.6 749 100.0 100.0 332 Kunene 97.6 97.6 141 99.6 99.6 43 Ohangwena 97.7 97.7 218 78.8 78.8 38 Omaheke 99.2 99.2 150 100.0 100.0 53 Omusati 97.8 97.8 195 (97.5) (97.5) 47 Oshana 99.6 99.6 197 100.0 100.0 53 Oshikoto 99.4 99.4 246 100.0 100.0 73 Otjozondjupa 99.0 98.9 278 98.6 98.6 104 Education No education/preschool 95.2 94.9 408 95.2 95.2 159 Incomplete primary 99.1 99.0 805 98.9 98.9 284 Complete primary 99.7 99.7 242 99.0 99.0 56 Incomplete secondary 99.7 99.6 1,226 99.9 99.9 381 Complete secondary 99.9 99.9 435 100.0 100.0 168 More than secondary 99.8 99.8 334 100.0 100.0 156 Wealth quintile Lowest 97.4 97.2 590 94.1 94.1 154 Second 98.9 98.8 502 99.0 99.0 134 Middle 98.6 98.6 698 99.7 99.7 246 Fourth 99.8 99.7 798 99.8 99.8 311 Highest 99.9 99.9 863 100.0 100.0 360 Total 15-49 99.1 99.0 3,451 99.0 99.0 1,205 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 cases and has been suppressed. 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhoea method (LAM), and emergency contraception 5.2 EVER USE OF CONTRACEPTION All women interviewed in the 2006-07 NDHS who said they had heard of a method of family planning were asked whether they had ever used that method. Men were only asked about ever use of male methods, i.e., male sterilization, male condom, rhythm method, and withdrawal. Table 5.3.1 shows the percentage of all women, currently married women, and sexually active unmarried women who have ever used specific methods of family planning, by age, while Table 5.3.2 shows comparable information for men. 56 | Family Planning Overall, 72 percent of all women reported using a method at some time and 71 percent have ever used a modern method (Table 5.3.1). This is an increase from 2000, when 63 percent of all women reported having using a contraceptive method. Among currently married women, 86 percent have used a method in the past and 84 percent have used a modern method at some time. The most common ever used modern methods among currently married women are injectables (57 percent), male condoms (43 percent), and the pill (37 percent). Among women who are unmarried but sexually active, 93 percent have used a family planning method at some time, and the most commonly used methods are condoms (81 percent), injectables (50 percent), and the pill (25 percent). Table 5.3.1 Ever use of contraception: Women Percentage of all women, currently married women, and sexually active unmarried women age 15-49 who have ever used any contraceptive method by method, according to age, Namibia 2006-07 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Male con- dom Female con- dom Emer- gency contra- ception Any tradi- tional method Rhythm With- drawal Folk method Number of women ALL WOMEN 15-19 36.3 35.2 0.1 0.0 3.6 0.0 14.4 0.0 29.4 2.8 0.6 5.4

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