Nigeria - Demographic and Health Survey -2000

Publication date: 2000

Nigeria Demographic and Health Survey 1999 N ig eria D em o g rap h ic an d H ealth Su rvey 1 9 9 9 National Population Commission Nigeria Demographic and Health Survey 1999 National Population Commission Abuja, Nigeria December 2000 National Population Commission United Nations Population Fund U.S. Agency for International Development This report presents results from the 1999 Nigeria Demographic and Health Survey (NDHS) which was undertaken by the National Population Commission. Financial assistance for the survey was provided by the the United Nations Population Fund (UNFPA) and the U.S. Agency for International Development (USAID). ORC/Macro provided limited technical support in data processing, analysis, and report writing after the data were collected. Additional information about the NDHS may be obtained from the main office of the National Population Commission, Lukazlu Street, Wuse Zone 3, Private Mall Bag 0281, Abuja (09-523-0773 or 09- 523-1026). Recommended citation: National Population Commission [Nigeria]. 2000. Nigeria Demographic andHealth Survey 1999. Calverton, Maryland: National Population Commission and ORC/Macro. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xili Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvli Map of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 1.1 1.2 1.3 1.4 1.5 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography, History, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Health Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives, Organisation and Design of the NDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 2.1 2.2 2.3 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . 11 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Current Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 CHAPTER 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 FERT IL ITY REGULAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Current Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Number of Children at First Use of Family Planning Methods . . . . . . . . . . . . . . . . . . 57 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Conlr aceptive Effect of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 iii 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 Page Intention to Use Family Planning Among Non-Users . . . . . . . . . . . . . . . . . . . . . . . . . 61 Reasons For Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Exposure to Family Planning Messages in Electronic Media . . . . . . . . . . . . . . . . . . . 63 Acceptability of Media Messages on Family Planning . . . . . . . . . . . . . . . . . . . . . . . . 65 Exposure to Family Planning Messages through the Print Media . . . . . . . . . . . . . . . 65 Contact of Nonusers with FamilyPlanning Providers . . . . . . . . . . . . . . . . . . . . . . . . 67 Couples' Communication and Attitudes Towards Family Planning Use . . . . . . . . . . . 68 CHAPTER 5 5.1 5.2 5.3 5.5 5.6 5.7 5.8 5.9 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . 73 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Age at First Marr iage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . . . 83 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 CHAPTER 6 6.1 6.2 6.3 6.4 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Planning Status of Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 7.6 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels of Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Socioeconomic Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Demographic Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 8.6 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Childhood Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Acute Respiratory Infection and Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 iv CHAPTER9 9.1 9.2 9.3 Page MATERNAL AND CHILD NUTRITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Nutritional Status of Children Under Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 CHAPTER 10 10.1 10.2 10.3 10.4 FEMALE GENITAL CUTT ING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Prevalence of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Age at Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Person Who Performed Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Attitudes toward Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 CHAPTER 11 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 SEXUAL ACT IV ITY AND KNOWLEDGE OF SEXUALLY TRANSMITTED DISEASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Awareness and Knowledge of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Perceptions of the Risk of Getting HIWAIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Behaviour Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Knowledge of Condom Use to Protect against Disease . . . . . . . . . . . . . . . . . . . . . . 154 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Payment for Sexual Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Awareness of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Prevalence of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 CHAPTER 12 12.1 12,2 12.3 12.4 12.5 AVAILABIL ITY OF HEALTH AND FAMILY PLANNING SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Organisation of Health and Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . 161 Community Char acteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Distance and Time to Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Contraceptive Use by Distance to Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 CHAPTER 13 13.1 13.2 POLICY IMPLICATIONS OF DATA FROM THE NDHS . . . . . . . . . . . . . . . 169 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Assessing the Goals of the National Population Policy (NPP . . . . . . . . . . . . . . . . . . 169 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 V Page APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 APPENDIX C ANALYSIS OF DATA QUALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 APPENDIX D PERSONS INVOLVED IN THE 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 vi Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16.1 Table 2.16.2 Table 2.17 Table 2.18 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 4.1 Table 4.2 Table 4.3 Table 4.4.1 Table 4.4.2 Table 4.5.1 Table 4.5.2 Table 4.6.1 Table 4.6.2 Table 4.7 Table 4.8 Table 4.9 Table 4.10 TABLES Page Household population by age, sex, and residence . . . . . . . . . . . . . . . . . . . . . . 11 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Educational attainment of household population . . . . . . . . . . . . . . . . . . . . . . . 16 School attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Differential characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Educational attainment by background characteristics . . . . . . . . . . . . . . . . . . . 24 Reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Occupation: women . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Decision on use of earnings and contribution of earnings to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fertility trends by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . 42 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of contraceptive methods by background characteristics . . . . . . . . 46 Couples' knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . 47 Ever use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Current use of contraception by background characteristics: women . . . . . . . . 55 Current use of contraception by background characteristics: men . . . . . . . . . . 56 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . 57 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . 59 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . 60 vii Table4.11 T~4.12 Tab~4.13 T~4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8.1 Table 5.8.2 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 7.1 Table 7.2 T~7.3 Table 7.4 Table 8.1 Table 8.2 Table 8.3 Page Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . 63 Exposure to family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . 66 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Contact of non-users with family planning providers disseminating family planning information . . . . . . . . . . . . . . . . . . . . 68 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Spouse's perception of spouse's approval of family planning . . . . . . . . . . . . . 72 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Number of wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Median age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Postpartum amenorrhoea, abstinence, and insusceptibility. . . . . . . . . . . . . . . 84 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 87 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . 90 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . 91 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mean ideal number of children by background characteristics . . . . . . . . . . . . . 96 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Rates of early childhood mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Neonatal, postneonatal, infant, child, and under-five mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Neonatal, postneonatal, infant, child, and under-five mortality by biodemographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . 107 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 viii Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 11.1.1 Table 11.1.2 Table 11.2.1 Table 11.2.2 Table 11.3.1 Table 11.3.2 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8.1 Table 11.8.2 Table 11.9 Table 11.10.1 Table 11.10.2 Table 11.11 Table 11.12 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Page Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . 112 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 116 Prevalence and treatment of acute respiratory infection and fever . . . . . . . . . 117 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Breastfeeding status by child's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . 127 Foods received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . 128 Nutritional status of children by demographic characteristics . . . . . . . . . . . . 130 Nutritional status of children by background characteristics . . . . . . . . . . . . . 131 Nutritional status of women by background characteristics . . . . . . . . . . . . . . 133 Prevalence of female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Age at genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Attitudes toward female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Reasons for supporting female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . 139 Reasons for not supporting female genital cutting . . . . . . . . . . . . . . . . . . . . . 140 Genital cutting of daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Knowledge of HIV/AIDS and sources of HIV/AIDS information: women . 142 Knowledge of HIV/AIDS and sources of HIV/AIDS information: men . . . . . 143 Knowledge of ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . 144 Knowledge of ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . 145 HIV/AIDS-related knowledge: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 HIV/AIDS-related knowledge: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Perception of risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Perception of the risk of getting HIV/AIDS among couples . . . . . . . . . . . . . 151 Reasons for perception of smaU/no risk of getting HIV/AIDS . . . . . . . . . . . . 151 Reasons for perception of moderate/great risk of getting HIV/AIDS . . . . . . 151 HIV/AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 HIV/AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Knowledge of condom use to protect against HIV/AIDS and STIs . . . . . . . . 154 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Knowledge of sexually transmitted infectious . . . . . . . . . . . . . . . . . . . . . . . . 158 Distance to urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Main access route to rural communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Transportation to nearest town . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Distance to various services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 ix Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table A . I . I Table A. 1.2 'Iable B.1 Table B.2 'I able B.3 'I able B.4 ' lable B.5 Table B.6 "I able B.7 Table B.8 Table B.9 T~ble C.1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Page Distance to health facilities by type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Distance to health facility by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Distance to specific health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Contraceptive use and distance to family planning services . . . . . . . . . . . . . . 167 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . 190 Sampling errors: National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors: Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Sampling errors: Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors: Northeast region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Sampling errors: Northwest region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Sampling errors: Southeast region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors: Southwest region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Sampling errors: Central region sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 203 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Childhood mortality rates for the late 1980s . . . . . . . . . . . . . . . . . . . . . . . . . 211 Trends in childhood mortality by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 X FIGURES Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6 Figure 3.1 Figure 3.2 Figure 4. I Figure 4.2 Ngure4.3 N~re4 .4 Figure5.1 Ngure5.2 Ngure5.3 ngure6.1 ~gure6.2 Figure 6.3 Figure 8.1 Figure 8.2 Page Population Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Distribution of De Facto Household Population by Single Year of Age and Sex . . . . . . 13 Percentage of Males and Females Who Have No Education by Age Group . . . . . . . . . . 17 Percentage in School by Age and Urban-Rural Residence . . . . . . . . . . . . . . . . . . . . . . . 18 Percentage of Households with Specific Amenities, by Urban-Rural Residence . . . . . . . 20 Percentage of Women and Men with Access to Mass Media . . . . . . . . . . . . . . . . . . . . . 27 Total Fertility Rates by Selected Background Characteristics . . . . . . . . . . . . . . . . . . . . 37 Trends in Total Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Trends in Contraceptive Knowledge among Married Women 15-49, 1990 and 1999 . . . 48 Current Use of Contraceptive Methods among Currently Married Women, 1990 and 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Use of Family Planning Among Marrid Women, by Background Characteristics . . . . . . 57 Source of Family Planning Methods among Current Users of Modem Methods . . . . . . . 60 Percentage of Currently Married Women and Men in Polygynous Unions by Age . . . . . 75 Median Age at First Sexual Intercourse among Women Age 25-49 and Men Age 30-64 by Residence, Region, and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Postpartum Amenorrhoea, Abstinence, and Insusceptibility by Number of Months since Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Fe~lity Preferences of Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire to Limit Childbearing among Currently Married Women and Men, by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Trends in Unmet Need, Met Need, and Percentage of Demand for Family Planning that is Satisfied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Antenatal Care, Tetanus Vaccinations, Place of Delivery, and Delivery Assistance . . . 106 Vaccinafion Coverage among Children Age 12-23 Months . . . . . . . . . . . . . . . . . . . . . 115 xi Figure 10.1 Figure 10.2 Figure C.1 Figure C.2 Page Prevalence of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Provider of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Percent Distribution of Women 15-49 by Age Group, Nigeria 1990 and 1999 . . . . . . . 203 Births per Calendar Year, Nigeria DHS 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 xii FOREWORD The National Population Commission's programme of demographic data production is continuously developed in response to the requirements to provide veritable indicators to facilitate the execution of government policies and programmes such as: the 1988 Population Policy and the current Poverty Alleviation Programme of the Federal Government of Nigeria. It is in recognition of this statutory responsibility that the 1999 NDHS was conducted in all states of the Federation and the Federal Capital Territory. The main objectives of the NDHS are to collect and analyse information on reproductive health including family planning and infant and child mortality, as well as to measure the nutritional status of mothers and children. Compared with the 1990 NDHS, the current survey was expanded in scope to include questions on housing facilities and on awareness and behavionr with regard to the HIV/AIDS pandemic. The 1999 NDHS provides relevant details on these issues and updates the indicators derived from the 1990 survey. Coming at the beginning of the new civilian administration, they constitute benchmark data on which subsequent policy interventions in the social sectors will be evaluated in the future. I would like to acknowledge the assistance of the UNFPA and USAID for providing the funding and technical assistance for the data collection, processing, analysis and report preparation, and the various stakeholders who participated in the series of preparatory seminars and workshops prior to the survey and the preliminary report writing stage. Lastly, the individual and collective contributions of all the principal professional staff of the National Population Commission, the erstwhile Chairman, Lt. Col. Chris Ugokwe (rtd) and members of the Commission are highly commendable. It is my strong belief that this report wiU be of immense benefit to researchers and programme officers by filling the existing gaps in health and demographic statistics in the country, Dr Akintobi A. Kadejo Director-General August 2000 xiii ACKNOWLEDGMENTS Between July 1994 and September 2000, a great number of people participated in activities culminating in the implementation of the Nigeria Demographic and Health Survey (NDHS). These people spent time designing the survey, executing the field operations, processing and analysing the data and producing this report. We would like to mention Dr. Akintobi Kadejo, who in 1994 as the Director, Population Statistics Depa~nent of the National Population Commission (NPC) and more recently as Director-General of the Commission, provided technical guidance and moral support. Others include members of the erstwhile Board of the Commission and the Census Technical Group. Particular mention must be made of the core project team--Mr. Samuel Alaneme, Mr. Inuwa Jalingo, Mr. DoRm Atobasire, and Dr. Samuel Kahi--who, with the Survey Director, were involved in all stages of administration of the project. Successful implementation of a data-gathering exercise such as the NDHS in a country as vast as Nigeria depends on many institutions and individuals. Financial assistance for the project came from the United Nations Population Fund (UNFPA), while the U.S. Agency for International Development (USAID) financed the techncial support for data processing and report writing through their contract with Macro International Inc. The survey benefitted from the interest and experience of UNFPA, which included the project as one of the major activities in their 4 th Country Programme. The 1999 NDHS became the cornerstone of UNFPA sub-project NIR/P38-40 98-2001. The invaluable contributions of UNFPA Chief Technical Adviser, Dr. Gabriel Fosu, to the project are commendable. Dr. Bunmi Dosumu, a Senior Program Manager with USAID/Nigeria, facilitated the support received from both USAID and Macro International Inc. Her commitment to the success of the survey is exemplary. The technical assistance of Macro staff in data processing and report writing is gratefully acknowledged. Many of them took exceptional interest in the NDHS. In this regard, the role of Ms. Annie Cross, Ms. Elizabeth Britton, Ms. Jeanne Cushing, Dr. Jeremiah Sullivan, and Dr. Shea Rutstein deserve special mention. The survey also benefitted from the experience, intellectual guidance, and reviews of the draft report by Dr. Jacob Adetunji, a consultant for Macro International Inc. Many colleagues in the National Population Commission provided valuable inputs into this report. Comments on the first draft of the report received from Professors Tola Atinmo, Olukunle Adegbola, Chris Oyeka, F.A.Oyekanmi, Drs. A.B. Sulalman, A. O. Ketiku, A.A. Adeyemo, Uche Isiugo-Abanihe, Jude Edochie, and representatives of the World Health Organisation, Federal Office of Statistics, UNICEF, Family Health International, the National AIDS Control and Prevention Programme, the Planned Parenthood Federation of Nigeria, the Department of Community Development and Population Activities of the Federal Ministry of Health, and the Women's Health Organisation of Nigeria, among others, enriched the final report. The contributions of the Project Accountants--Mr. A. Ozoilo and Mrs. Endurance Emefiele,--and the secretariat staff--Mrs. Yemi Ohi, Mrs. Akpambang and other staff of the Census and Surveys Department--are gratefully acknowledged. The report uses data and ideas from past research studies on the theme of the survey, many of which are acknowledged in the references. Osamwonyi Osagie Project Director August 2000 XV EXECUTIVE SUMMARY The 1999 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey of 8,199 women age 15-49 and 3,082 men age 15-64, designed to provide information on levels and trends of fe~Jlity, family planning practice, maternal and child health, infant and child mortality, and maternal mortality, as well as awareness of HIV/AIDS and other sexually transmitted diseases (STDs) and female circumcision. Fieldwork for the survey took place between March and May 1999. Fertility The total fertility rate during the five years before the survey is 5.2 births per woman. This shows a drop from the level of 6.0 births per woman as reported in the 1990 NDHS and 5.4 from the 1994 Sentinel Survey. The total fertility rate may, however be higher due to evidence that some births were probably omitted in the data. Fertility is substantially higher in the Northeast and Northwest regions and lower in the Southeast, Southwest, and Central regions. Fertility rates are also lower for more educated women. Childbearing begins early in Nigeria, with about half of women 25 years and above becoming mothers before reaching the age of 20. The median age at first birth is 20. The level of teenage childbearing has declined somewhat, with the proportion of girls age 15-19 who have either given birth or are pregnant with their first child declining from 28 percent in 1990 to 22 percent in 1999. Teenage childbearing is higher in rural than urban areas and for those with no education than those with education. The data from the survey indicate that there is a strong desire for children and a preference for large families with 66 percent of married women and 71 percent of married men indicating a desire to have more children. Even among those with six or more children, 30 percent of married women and 55 percent of married men want to have more children. This indicates a decline for women from the 35 percent reported in the 1990 NDHS. Overall, women report a mean ideal number of children of 6.2, compared with 7.8 children for men. Despite the increasing level of contraceptive use, the 1999 NDHS data show that unplanned pregnancies are common, with almost one in five births reported to be unplanned. Most of these (16 percent of births) are mistimed (wanted later), while 3 percent were unwanted at all. Family Planning Knowledge about family planning methods is increasing in Nigeria, with about 65 percent of all women and 82 percent of all men having heard of at least one method of contraception. Among women, the pill is the best known method (53 percent) while among men, the condom is the best known method (70 percent). Radio is a main source of information about family planning, with 35 percent of women and 61 percent of men reporting that they heard a family planning message on the radio in the few months before interview. The proportions of women and men who have seen a television message are 23 and 40 percent, respectively. Only 17 percent of women had seen a family planning message in the print media. The contraceptive prevalence rate in Nigeria has also increased, with 15 percent of married women and 32 percent of married men now using some method of family planning. The use of modem methods is xvii lower at 9 percent for married women and 14 percent for men. Although traditional contraceptive methods are not actively promoted, their use is relatively high with about 6 percent of married women and 17 percent of married men reporting that they are using periodic abstinence or withdrawal. In 1990, only 6 percent of married women were using any method, with only 4 percent using a modern method. There are significant differentials in levels of family planning use. Urban women and men are much more likely to be using a method than rural respondents. Current use among married women is higher in the Southwest regions (26 percent), Southeast (24 percent), and Central (18 percent) regions than in the Northwest and Northeast (3 percent each). The largest differences occur by educational attainment. Only 6 percent of married women with no education are using a method of contraception, compared with 45 percent of those with more than secondary school. Users of modern contraception are almost as likely to obtain their methods from government as private sources. Forty-three percent of users obtain their methods from the public sector--mostly government hospitals and health centres--while 43 percent use private medical sources such as pharmacies and private hospitals and clinics; 8 percent get their methods from other private sources like friends, relatives, shops and non-governmental organisations. Maternal Health The results of the survey show that antenatal care is not uncommon in Nigeria, with mothers receiving antenatal check-ups from either a doctor, nurse or midwife for two out of three births in the three years preceding the survey. However, the content of antenatal care visits appears to be lacking in at least one respect: survey data indicate deficiencies in tetanus toxoid coverage during pregnancy. Mothers reported receiving the recommended two doses of tetanus toxoid for only 44 percent of births and one dose for I 1 percent of births. Almost 40 percent of births occurred without the benefit of a tetanus vaccination. In Nigeria, home deliveries are still very common, with almost three in five births delivered at home. Compared with 1990, the proportion of home deliveries has declined, with more births now taking place in health facilities. Increasing the proportion of births occurring in facilities is important since they can be attended by medically trained personnel which can result in fewer maternal deaths and delivery complications. Currently, 42 percent of births are attended by doctors, nurses or midwives. The 1999 NDHS data show that about one in four Nigerian women age 15-49 reported being circumcised. The practice of female genital cutting is more prevalent in the south and central parts of the country and is almost non-existent in the north. Child Health The 1999 NDHS data indicate a decline in childhood vaccination coverage, with the proportion of children fully immunised dropping from 30 percent of children age 12-23 months in 1990 to only 17 percent in 1999. Only a little over half of young children receive the BCG vaccine and the first doses of DPT and polio vaccines. Almost 40 percent of children have not received any vaccination. Diarrhoea and respiratory illness are common causes of childhood death. In the two weeks before the survey, 11 percent of children under three years of age were ill with acute respiratory infections (ARI) and 15 percent had diarrhoea. Half of children with ARI and 37,percent of those with diarrhoea were taken to a health facility for treatment. Of all the children with diarrhoea, 34 percent were given fluid prepared from packets of oral rehydralion salts (ORS) and 38 percent received a home-made sugar-salt solution. xviii The infant mortality rate for the five-year period before the survey (early 1994 to early 1999) is 75 per thousand live births. The under-five mortality is 140 deaths per 1,000 births, which means that one in seven children born in Nigeria dies before reaching his/her fifth birthday. However, both these figures are probably considerably higher in reality since an in-depth examination of the data from the birth histories reported by women in the NDHS shows evidence of omission of births and deaths. For this reason, the dramatic decline observed in childhood mortality between the 1990 and 1999 NDHS surveys needs to be viewed with considerably skepticism. Based on the reported birth history information, the infant mortality rate fell from 87 to 75 deaths per 1,000 births, while the under-five mortality rate dropped from 192 to 140. Problems with the overall levels of reported mortality are unlikely to severely affect differentials in childhood mortality. As expected, mother's level of education has a major effect on infant and child mortality. Whereas the lowest infant mortality rate was reported among children of mothers with post- secondary education (41 per thousand live births), the corresponding figure among infants of mothers with no schooling is 77 per thousand live births. Data were also collected in the NDHS on the availability of various health services. The data indicate that the vast majority of Nigerian households live within five kilometres of a health facility, with health centres being the closest, followed by clinics and hospitals. Breasffeeding and Nutrition Breastfeeding is widely practiced in Nigeria, with 96 percent of children being breastfed. The median duration of breastfeeding is 19 months. Although it is recommended that children be exclusively breastfed with no supplements for the first 4 to 6 months, only 20 percent of children 0-3 months are exclusively breasffed, as are 8 percent of children 4-6 months. Two-thirds of children 4-6 months are being given supplements in addition to breast milk. In the NDHS, interviewers weighed and measured children under three born to women who were interviewed. Unfortunately, data were either missing or implausible for more than half of these children. Of the half with plausible data, 46 percent of children under 3 are classified as stunted (low height-for-age), 12 percent are wasted (low weight-for-height) and 27 percent are underweight (low weight-for-age). The 1999 NDHS also collected information on the nutritional status of women who had a birth in the three years prior to the survey. Sixteen percent of these women are considered to be too thin, with a body mass index of less than 18.5. Women of short stature (height less than 145 cm) comprise 7 percent of the women measured. HIV/AIDS and Other Sexually Transmitted Diseases Survey data indicate that awareness of HIWAIDS is becoming more widespread. Three-quarters of women and 90 percent of men in Nigeria have heard of AIDS. The radio and relatives and friends are the most commonly cited sources of information about HIV/AIDS among both women and men. However, knowledge of ways to avoid HIV/AIDS is not so widespread. More than a quarter of women and 14 percent of men say they do not know of any way to avoid HIV/AIDS and 6 percent of women and 3 percent of men say there is no way to avoid it. Only 14 percent of women and 29 percent of men say that using condoms is a means of avoiding the disease. On the other hand, three in five men and women who have heard of AIDS know that ahealthy-looking person can be infected with the AIDS virus and over 80 percent know that AIDS is a fatal disease that cannot be cured. xix Two-thirds of Nigerian women and men believe that they have no chance of contracting HIV/AIDS, while almost all the rest believe their chances are small. Perhaps one reason is that many Nigerians say they have changed their sexual behavior to avoid getting AIDS. For example, 37 percent of women and 42 percent of men say they restrict themselves to only one pamler; one-fourth of the women say they asked their partners to remain faithful. Condoms are acknowledged by a large majority of respondents to be a way of preventing HIV/AIDS and other sexually-transmitted diseases. Men are almost twice as likely (38 percent) as women (20 percent) to have ever used condoms either for family planning or disease prevention. However, only 7 percent of women and 15 percent of men reported having used a condom the last time they had sexual intercourse. The most widely known sexually transmitted disease apart from AIDS is gonorrhoea. XX NIGERIA Northeast )guI Region xxii CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy Geography Nigeria lies on the west coast of Africa between 4 and 14 degrees north latitude and between 2 and 15 degrees east longitude. It occupies approximately 923,768 square kilometres of land, stretching from the Gulf of Guinea on the Atlantic coast in the south to the fringes of the Sahara Desert in the north. The territorial boundaries are defined by the Republics of Niger and Chad in the north, the Cameroon Republic on the east, and the Republic of Benin in the west. The Gulf of Guinea delimits the southern boundary. Nigeriais topographically characterised by two main land forms: lowlands andhighlands. Lowlands predominate in the Niger-Benue valley in the south, the Sokoto-Rimabasin in the northwest, and in the Chad basin in the northeast. Highlands are found mainly in the north and central areas, where they rise to a high at Jos Plateau; they are also found in the southeast, where they rise to a high at Obudu in Cross River State. As with land forms, two main wind systems define the climatic conditions in Nigeria. The southwest monsoon wind blows from the Atlantic Ocean towards the hinterland between bringing rainfall April and September. The northeast trade wind, which is hot, dry, and dust-laden, blows from the Sahara Desert between October and March, having a cooling effect on the entire country. The intensity of both of these winds diminishes inland. The mean temperature oscillates between 25 and 40 centigrade, while the rainfall ranges from 2,650 mm in the southeast to less than 600 mm in some parts of the north, mainly on the fringes of the Sahara Desert. The vegetation that results from these climatic differences consists of mangrove swamp forest in the Niger Delta and Sahel grassland in the. north. With a wide range of climatic, vegetational, and soil conditions, Nigeria possesses potential for a wide range of agricultural production. History Nigeria is a federal republic consisting of 36 states and a Federal Capital Territory. The states are subdivided into 774 administrative units of unequal size called Local Government Areas (LGAs). In some states, especially in the far north, these LGAs are grouped into emirates, districts, or traditional council areas. The 36 states are also grouped into six geopolitical zones that reflect ethnic identity in most cases. The history of the people of Nigeria goes back to antiquity. Evidence of art Iron Age culture was found in relics left behind by the peoples that lived in the Niger-Benue valley. These historical artifacts are known to have been made by the Nok culture. The growth of the Nigerian nation-state, however, can be traced to 1914 when the British colonial administration merged the North and South protectorates and the colony of Lagos into one administrative unit. Nigeria became an independent nation in 1960 and since then, has had different administrative structures. Within the boundaries of Nigeria are found many social groups with distinct but similar cultural traits, which are reflected in the diverse behaviour of the people. There are about 374 identifiable ethnic groups, but the Igbos, Hausas, and Yorubas are the major groups. Economy Nigeria is one of Africa's most endowed economies, with an abundance of both natural and human resources. Its citizens are noted for their high degree of resourcefulness and entrepreneurial skills. Ironically, the country's per capita income of U.S.$350 in 1999 is one of the lowest in the world. The economy is largely agricultural. Sectoral contributions to the gross domestic product may give a distorted picture ofreality since more than 50 percent ofthepopulationis engagedin agriculture. The structure and growth of the economy is therefore not easy to categorise. The main feature of the economy has always been that a high proportion of the national income is derived from the export of a wide range of mineral and agricultural products, with crude oil ctu~ently taking the lead. Since 1980, crude oil production has accounted for more than two-thirds of the gross domestic product and more than 80 percent of total government revenue. There exists vast industrial and commercial concerns that are largely dominated by state enterprises. There are also large, multinational companies, as well as poorly organised small-scale enterprises. All these economic features have combined to create a diverse private sector. The lack of a broad economic base and political instability have recently led to a large-scale 'brain drain' of skilled manpower. Inflation and unemployment are relatively high. The economy has fluctuated between growth and decline within the past two decades. Between 1980 and 1985, it registered negative growth of 3.4 percent per annum; however, between 1987 and 1995, it grew at 3.5 percent per annum. The main economic indicators in the years preceding the survey are less than satisfactory. In 1999, the growth of the gross domestic product was estimated at 2.7 percent, up from 2.4 percent achieved in 1998. However, it fell below the minimum 3.0 percent target for the year. The aggregate index of agricultural production increased by 3.7 percent in 1999, compared with 3.5 percent in 1998, while industrial production feU by 1.4 percent from the 1998 level The average industriai- capacity ntilisation in the same year stood at 31 percent, representing a marginal increase of 2 percent over the 1998 figure. Inflation was estimated at 8.0 percent in December 1999. The Central Bank recently reported that the country's balance of payments improved markedly in 1999 as a result of the rise in global oil prices; however, the performance of non-oil exports remained tmimpressive. Since the onset of democratic administration in 1999, economic policies have become more favourable to investment. Bold steps have been taken to privatise the government's equity in major manufacturing, oil, and service companies. 1.2 Population The total population of Nigeria as reported in the 1991 census was 88,992,220 (Table 1. I). Using a growth rate of 2.9 percent per annum, the National Population Commission (NPC) estimates the current population of Nigeria to be about 115 million. The spatial distribution of the population is uneven. Extensive areas in the Chad basin, the middle Niger valley, the grass plains, and the Niger delta, among others, are sparsely populated. In contrast, there are large areas of densely populated rural districts, which support more than 400 persons per ldlometre occur in parts of Akwa lbom, Imo, Anambra, and Enugu States, as well as around Kano, Katsina, and Sokoto States. However, the average population density of the country in 1991 was 96 persons per kilometre. The most densely populated states are Lagos, Anambra, Imo, and Akwa Ibom. Except for Lagos, all the states 2 Table 1.1 Demographic indicators Demographic indicators from various sources, Nigeria 1963-91 NFS 1981-82 Census and NDHS Census Indicator 1963 NDSS 1980 1990 1991 Population (millions) 55.7 84.7 U 88.9 Density (pop./sq. km) 60 92 U 96.0 Percentage urban 19 23 24 36.3 Crude birth rate (CBR) 66 46 39 44.6 a Crude death rate ((;DR) 27 16 U 14 Total fertility rata (TFR) U 6.3 6.0 5.9 a Infant mortality rate (IMP,) U 85 87 93 Life expectancy at birth 36 48 U 53.2 U = Unknown (not available) a From the post-enumeration survey Sources: National Population Commission, 1998; Federal Office of Statistics, 1990 with high population densities are located in the southeast of Nigeria. Kano State, with an average density of 281 persons per square kilometre is by far the most densely populated state in the north. Other states in the north with a population density of more than 100 persons per square kilometre are Katsina (140 per square kilometre) and Jigawa (127 per square kilometre). The population of Nigeria is predominantly rural, with about 36 percent living in urban areas. The states with a predominantly urban population are Lagos (94 percent), eye (69 percent), and Anambra (62 percent). The states with small urban populations are Jigawa (7 percent), Taraba (10 percent), Akwa Ibom (12 percent), Kebbi (12 percent) and Sokoto (14 percent). 1.3 Population and Health Policies and Programmes Population Policies and Programmes In the light of the perceived high population growth rate and its adverse effect on national development, the federal government adopted a National Policy on Population for Development, Unity, Progress and Self-Reliance (NPP) in 1998. The policy was designed to enable Nigeria to balance the rate of population growth with the available resources. The four main goals of the NPP are as follows: 1. To improve the living standards and the quality of life of the people . To promote their health and welfare, especially through preventing premature deaths and illness among the high-risk groups . To achieve lower population growth rates, through reduction of birth rates by voluntary fertility regulation methods that are compatible with the attainment of the economic and social goals of the nation . To achieve a more even distribution of the population between urban and rural areas (Federal Ministry of Health, 1988). 3 To achieve these goals and to promote national awareness of the adverse effects of rapid population growth, the following objectives were set out: a) Promote awareness among the citizens of population problems and the effects of rapid population growth on development. b) Provide everyone with information and education on the value of reasonable family size to both the individual family and the future of the nation in achieving self-reliance. c) Educate all young people about population matters, sexual relationships, fertility regulations, and family planning before they enter the ages of marriage and childbearing to encourage them to maintain responsible parenthood and reasonable family size to the best of their ability. d) Make family planning services readily available to all couples at an affordable cost at the earliest possible time to enable them to regulate their fertility. e) Provide fertility management programmes that will respond to the needs of sterile or sub- fertile couples to achieve reasonable self-fultillment. f) Improve demographic data collection and analysis on a regular basis and use such data for economic and social-development planning. g) Enhance integrated rural and urban development in order to improve the living conditions in the rural areas and to slow down the rate of rural-urban migration (Federal Ministry of Health, 1988). At the inception of the NPP, the government mobilised resources to implement the population programme. The Population Activities Fund Agency (PAFA) was established to manage a population activities fund with donor and government funds. PAFA was expected to mobilise more funds from other sources. The World Bank discontinued its involvement in 1996 after about three years of operation; therefore, the agency currently relies solely on government funding to promote population programmes in such areas as child and maternal health, advocacy, service delivery, and hospital services. Bilateral and international agencies that have supported the National Population Programme include the United Nations Population Fund (UNFPA), the U.S. Agency for International Development (USAID), and the World Bank. USAID has long been the main provider of contraceptives for the private sector. The British Depamnent for International Development has also continually supported the National Population Programme. The Planned Parenthood Federation of Nigeria (PPFN), an affiliate of the International Planned Parenthood Federation, is the doyen of population activities in the country. The MacArthur Foundation and the Ford Foundation, among others, support various non-governmental organisations. The population policy is widely commended internationally, but its implementation has been dogged by inconsistencies and other problems that are sometimes beyond its control. Chief among these problems are cultural norms that lead to high fertility and religious beliefs about family planning. The low status and level of education of women; poor quality of family planning service delivery; and lack of information, especially in rural areas, are also factors. Poor institutional mechanisms for coordination and implementation of the various population programmes, both private and public, have limited the achievements of the policy in its 12 years of existence. 4 Health Policies and Programmes The federal government has several programmes and policies ainfed at improving health delivery services. The fourth National Development Plan (1981-1985) established a government commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative, and rehabilitative to the entire population by the year 2000. A national health policy was consequently adopted in 1988. Its goal is to provide a formal framework for the direction of health management in Nigeria. The objective is to provide the population with access not only to primary health care but also to secondary and tertiary care, as needed, through a tractional referral system. It defines the roles and responsibilities of the three tiers of government, as well as of civil society and non-governmental organisations. In general, the provision of health services is the responsibility of federal, state, and local governments as well as religious organisations and individuals. The services are organised in a three-tier health care system: i) primary health care, which is largely the responsibility of local governments, with the support of the State Ministry of Health ii) secondary health care, which provides specialised services to patients referred from the primary health care level and is the responsibility of the state government ili) Tertiary health care, which provides highly specialised referral services to the primary and secondary levels of the health care delivery system and is in the domain of the federal and state governments. The national health policy regards primary health care as the framework to achieve improved health for the population. Primary health care services include health education; adequate nutrition; safe water and sanitation; reproductive health, including family planning; immunisalion against five major infectious diseases; provision of essential drugs; and disease control. The policy document requires that a comprehensive health care system delivered through the primary health centres should include maternal and child health care, including family planning services. The health sector is characterised by wide regional disparities in status, service delivery, and resource availability. More health services are located in the southern states to the disadvantage of the north. The health sector has deteriorated despite Nigeria's high number of medical personnel per capita. The current priorities in the health sector are in the area of childhood immunisation and prevention of HIV/AIDS. 1.4 Objectives, Organisation and Design of the NDHS Objectives The main objective of the 1999 Nigeria Demographic and Health Survey (NDHS) is to provide up-to-date information on real i ty and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programmes and strategies for improving health and family planning services in Nigeria. 5 Organisation The 1999 NDHS is a joint project between the National Population Commission (NPC), the United Nations Population Fund Activities (UNPFA) and the U.S. Agency for International Development (USA/D). The project was fimded by these three orgaulsations, while Macro International Inc., located in Maryland, provided limited technical support in data processing, analysis, and report writing after the data were collected. The NPC set up an NDHS committee to coordinate activities pertaining to the survey. Under the direction of the committee, the Census and Survey Depamnent of the commission conducted the survey. The committee organised seminars and workshops at which the commission's senior demographers gave inputs on the survey instrnments. The DHS Model Questionnaire (which had been sent from Macro International Inc. upon request) was adapted to Nigerian cultural conditions in a symposium held on 11 September 1998. After the workshop, other stakeholders were invited to a two-day workshop in Kaduna on 3 and 4 November 1998. The participants in the workshop included USA/D; UNFPA; Population Activities Fund Agency (PAFA); Family Health International (FHI); the Planned Parenthood Federation of Nigeria (PPFN); the Federal Ministry of Health (MOH); and academics from universities in Lagos, Ibadan, lle-Ife, Sokoto, and Nsukka. The participants expressed their interest in the survey and suggested that specific questions and modules be added to the questionnaire, such as AIDS/STD, a male questionnaire, and maternal mortality. The NDHS committee was responsible for the execution of the project. The project director was in charge of the day-to-day administration of the project with the assistance of the deputy project director. A project coordinator, whose responsibilities included coordinating the state activities, supervising logistics, and ensuring standards, was positioned at the headquarters in Lagos. The seven commission zonal directors acted as zonal coordinators for the survey in their respective zones, while state coordinators were assigned the administration of the survey at the state level. The actual interviews of households and individuals were conducted by teams of seven people, consisting of one supervisor, one field editor, one male interviewer, and four female interviewers. Altogether, there were 34 teams for the 36 states and the Federal Capital Territory. 1.5 Sample Design and Implementation The 1999 Nigeria Demographic and Health Survey (NDHS) was a nationally representative probability sample of women age 10-49 living in households. The sampling frame used for the survey was constructed from the enumeration areas (EAs) into which the country was delineated for the 1991 population census. Currently, the frame contains 212,079 EAs. The sample was stratified into rural and urban areas and was selected in two stages. It was designed to produce reliable estimates of most of the variables for the rural and urban segments of the country as well as each of five statistical regions, namely, the Northeast region, the Northwest region, the Central region, the Southeast region, and the Southwest region. Each of these five regions was treated as a sampling domain. The distribution of the states across these regions is shown fully in Appendix A. The regions used for this survey differ from the six geopolitical zones of the country and the seven administrative zones of the National Population Commission. The primary sampling unit was the EA. Altogether, 400 EAs were selected with equal probability. In all, 119 urban EAs and 281 rural EAs were selected. To ensure data quality, the selection of the EAs was done centrally by trained statisticians at the Liaison Office of the National Population Commission (NPC) in Lagos. The list of selected EAs was sent to the NPC offices in each state to identify the EAs, draw sketch maps, and conduct a listing of all households in each selected EA. NPC's comptrollers at the local govermnent offices thereafter cross-checked the work of the state officers to ensure no omission of any building within the EA. At the second sampling stage, one in every five households listed was selected for interview. The combination of equal probability selection at the first stage and a fixed sampling rate at the second stage yielded a roughly self-weighting sample design. However, while the returns from the rural stratum showed an appreciable level of self-weighting, the returns from the urban stratum showed a significant level of c leviation from self-weighting. The deviation in the urban stratum was due to underlisfing of dwellings in some EAs because of changes in EA boundaries over time. Therefore, in processing and estimating the population parameters, the sample returns were weighted by considering the selection probabilities of the primary sampling units, the expected and eventual field returns, and the differential response rate among the domains. The weights were standardised and entered with the individual data records. Thus, all the tables presented in this report are based on weighted data. In the selected households, all women age 10-49 were eligible for interview with the Women's Questionnaire. In every third household, men age 15-64 were eligible for interview with the Men's Questionnaire. Survey Questionnaires Four questionnaires were used for the main fieldwork: the Service Availability Questionnaire, the Household Questionnaire, the Women's Questionnaire, and the Men's Questionnaire. The Service Availability Questionnaire was implemented at an early stage of the fleldwork and was designed to assess the availability (or supply) of health and family planning services. It was administered at the community level (enumeration area) by interviewing knowledgeable informants in the selected community. All regular members and visitors in the selected household were listed on the Household Questionnaire. For each person listed, information was collected on name, sex, age, and education. The household questionnaire was used to identify both men and women who were eligible for the individual questionnaire and to collect data on housing characteristics. The Women's Questionnaire was administered to all women age 10-49 who were listed on the Household Questionnaire. The decision to interview women age 10-14 was influenced by pretest findings on teenage pregnancy, motherhood, and the age at commencement of sexual activities. Since most of the variables presented in this report are not relevant for the youngest women, the analysis has been restricted to women age 15-49. Women were asked questions on the following topics: Background characteristics (age, education, religion, etc.) Female genital cutting practices Fertility preferences Husband's background and respondent's work Knowledge of AIDS Maternal mortality Height and weight of respondents and their children under three. 7 The Men's Questionnaire was used to interview men age 15-64 living in every third household. It was similar to that for women except that it omitted the sections on antenatal and delivery care, breastfeeding, vaccinations, causes of death, female genital cutting, and height and weight. Training Two levels of training were organised. The first level was the training of trainers, which took place in Lagos between 16 and 20 November 1998. The trainees consisted of zonal and state directors of NPC and selected senior headquarters/liaison office staff who are well versed in survey methodology. Individuals who participated at some of the workshops organised at the planning stages of the survey acted as the facilitators during this level of training. The second stage of training took place for two weeks at the seven zonal headquarters of the i'qPC (namely, Kano, Yola, Port Harcourt, Enugu, Lagos, Ibadan, and Kaduna.) This level of training involved the training of interviewers, supervisors and field editors. Those trained at the first level of training facilitated at this level. Fieldwork Immediately after the training exercise, NDHS field personnel went to the field for data collection. The field staff consisted of 34 teams, each composed of one supervisor, one field editor, four female interviewers, one male interviewer, and a driver. Fieldwork was carried out in 400 EAs nationwide between 29 March 29 and 29 May 1999. The people involved in the f ieldwork and the complete description of the exercise are presented in Appendices D and A. Data Processing The personnel who took part in the processing of NDHS data consisted of 20 data entry operators, two supervisors, and six coders/editors, all of whom are staff of the NPC. Before data processing began, the data entry operators were trained intensively for two weeks by staff from Macro International Inc. (USA). Data were processed on microcomputers and printers that were provided by Macro International Inc., with funding from USAID. The computers were used to establish the nucleus of a demographic laboratory at the NPC. Data were processed using programmes written by Macro International Inc. with the Integrated System for Survey Analysis (ISSA), which was designed for processing DHS data. Response Rate The summary of results from the household and individual interviews is presented in Table 1.2. A total of 7,919 households were sampled, of which 7,736 were determined in the field to be valid households and 7,647 were successfully interviewed, giving a response rate of 99 percent. Of the 8,918 eligible women age 15-49 in these households, 8,199 were interviewed for a response rate of 92 percent. Every third household was selected for coverage with the Men's Questionnaire. Thus, 2,620 households were sampled, of which 2,571 were found and 2,550 were successfully interviewed. In these households, a total of 3,082 men age 15-64 were identified and 2,680 were interviewed for a response rate of 87 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Nigeria 1999 Resldenc~ Result Urban Rural Total FEMALE Household interviews Households sampled 2,600 5,319 7,919 Households found 2,524 5,212 7,736 Households interviewed 2,482 5,165 7,647 Household respo~e rate 983 99.1 98.8 Individual interviews: women Number of eligible women Number of eligible women interviewed Eligible woman response rate MALE 2,984 5,934 8,918 2,697 5,502 8,199 90.4 92.7 91.9 Household interviews Households sampled 849 1,771 2,620 Households found 834 1,737 2,571 Households interviewed 825 1,725 2,550 Household response rate 98.9 99.3 Individual interviews: men Number of eligibleman 1,056 Number of eligiblemen interviewed 882 Eligible man response rate 83.5 99.2 2,026 3,082 1,798 2,680 88.7 87.0 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on selected socioeconomic characteristics of the household population and the individual survey respondents. These characteristics include age, sex, education and place of residence. The chapter also considers the environmental conditions surrounding the households such as source of drinking water, availability of electricity, sanitation facilities, and housing materials. Examining the characteristics of respondents is useRll in understanding the factors that affect reproductive and contraceptive behaviour. Moreover, the patterns observed in some of these characteristics often provide a quick assessment of the data quality. 2.1 Characteristics of the Household Population The NDHS Household Questionnaire was used to collect data on the demographic and socioeconomic characteristics of all usual residents and any visitors who had spent the previous night in the sampled household. Age-Sex Composition The distribution of the NDHS household population is shown in Table 2.1 by age, sex, and residence. It shows that the proportion of persons in the younger age groups is substantially larger than the proportion in the older age groups for each sex in both urban and rural areas. This pattern is typical of a population with Table 2.1 Household population by age, sex, and residence Percent distribution of tile de facto household population by five-year age group, according to sex and urban-rural residence, Nigeria 1999 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 14.2 14.0 14.1 16.2 15.1 15.7 15.6 14.8 15.2 5-9 15.3 17.5 16.4 17.6 18.8 18.2 16.9 18.4 17.7 10-14 14.2 10.3 12.3 14.0 9.5 I1.8 14.1 9.7 11.9 15-19 11.1 10.5 10.8 9.6 10.2 9.9 10.1 10.3 10.2 20-24 7.6 9.8 8.7 6.2 8.2 7.2 6.6 8.7 7.6 25-29 6.5 8.9 7.7 6.8 8.2 7.5 6.7 8.4 7.6 30-34 6.1 7.2 6.7 5.3 6.3 5.8 5.5 6.6 6.1 35-39 6.1 5.9 6.0 4.6 5.3 5.0 5.0 5.5 5.3 40-44 5.3 4.2 4.7 4.1 3.8 3.9 4.4 3.9 4.2 45-49 3.9 3.0 3.4 3.3 3.3 3.3 3.4 3.2 3.3 50-54 3.3 3.3 3.3 2.9 3.9 3.4 3.0 3.7 3.4 55-59 1.8 1.2 1.5 2.1 2.0 2.0 2.0 1.8 1.9 60-64 1.4 1.5 1.5 2.2 2.1 2.1 2.0 1.9 1.9 65-69 1.3 0.8 1.1 1.8 1.1 1.5 1.7 1.1 1.4 70-74 0.8 0.9 0.9 1.7 1.0 1.3 1.5 0.9 1.2 75-79 0.4 0.3 0.3 0.6 0.4 0.5 0.5 0.4 0.4 80 + 0.5 0.6 0.6 0.9 0.6 0.8 0.8 0.6 0.7 Missing/Don't know 0.2 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 5,496 5,472 10,970 13,436 13,210 26,654 I8,932 18,683 37,624 Note: Total includes 10 people whose sex was not stated. 11 high fetXility. Although the proportion under age five is smaller than the proportion age 5-9--which is usually taken as evidence of a recent decline in fertility--at least some of this pattern is due to age misreporting of some ten-year-old girls as age 9 (see below). Overall, there are an equal number of males and females in the population. Figure 2.1 presents a graphic representation of the age and sex structure. The narrowing of the base of the pyramid may result from omission of recent births or displacement of births by age misreporting. Figure 2.1 Population Pyramid, Nigeria 1999 Age 80+ 75-79 70-74 65-69 60-64 55-50 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-0 0-4 I i iiiii i!iii!~i~iiiiiii!!iiii!!iiii~ii iiiiii!iiiii~ii~iiiiiiiiiii!iiiiiiii! ii¸ i iiii~iiiiiii!iii!ii!i!ii!iii~i!ii% ~i! ~ii!!!iiiiiii ~ i i~i !ilii 10 8 6 4 2 0 10 Percent L Female 1 2 4 6 8 NDHS1999 Figure 2.2 shows the distribution of the male and female household population by single year of age. Inspection of the figure reveals several irregularities. Noticeable heaping is observed at ages ending with the digits 0 and 5 and with even numbers, particularly the digits 2 and 8 at the middle and higher ages. The figure further reveals that except for age nine for females, ages ending in odd digits are generally underreported for both sexes. The unexpected heaping at age nine for women is almost certainly due to interviewers reporting younger ages for eligible respondents to lessen their work load, given that women age 10-49 were considered eligible. Age heaping is highly pronounced for age 20 and above among both males and females. It appears to be more pronounced at the younger ages in the rural areas than in the urban areas. Table 2.2 shows the distribution of the population by broad age groups. Children under age 15 account for 45 percent of Nigeria's population, whilethose age 15-64 account for 51 percent. The remaining 4 percent of the population are 64 years and older. Over the past two decades, there has been a very slight decline in the proportion under 15 and a slight increase in the older population. 12 5 4 3 2 1 0 Figure 2.2 Distribution of De Facto Household Population by Single Year of Age and Sex, Nigeria 1999 Percent I I I I I I I I 30 35 40 45 50 55 60 65 70+ Single Year of Age l~-Ma!e +Female I NDHS1999 The population has a low median age of 17.5 years (not shown). This means that half of the population is younger than 17.5 years and the other half is older than 17.5 years. The table also shows that the dependency ratio is 94; that is, there are 94 persons under 15 or over 64 for every 100 persons age 15-64 in Nigeria. In other words, besides taking care of himself/herself, the average Nigerian of working age is also expected to take care of approximately one other person. The decline in the dependency ratio since 1981-82 indicates a lessening of the economic burden of persons in the productive age range who support those of nonproductive ages. Table 2.2 Population by age from selected sources Percent distribution of the population by age group, selected sources, Nigeria 1963-1999 Sentinel Census NDSS NFS NDHS Census survey NDHS Age group 1963 1980 1981-82 1990 1991 1994 1999 <15 43.1 47.2 49.5 47.1 44.9 45.3 44.8 15-64 54.9 50.2 48.1 48.5 51.8 51.3 51.4 65+ 2.0 2.8 2.3 4.3 3.3 3.4 3.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency ratio 82 100 108 106 93 95 94 Sources: I963 Census, 1980 NDSS; 1981-82 NFS; 1990 NDHS; 1991 Census; 1994 Sentinel Survey (SS); 1999 NDHS 13 Household Composition Table 2.3 shows that households in Nigeria are predominantly headed by men (83 percent), with only 17 percent headed by women. The proportion of female-headed households is slightly higher in urban areas (19 percent) than in rural areas (16 percent). There are only small differences in the composition of urban and rural households by number of members. Thus, the mean household size in rural areas (5.1 persons) is only slightly higher than in urban areas (4.8). Fosterhood and Orphanhood Foster children are children under 15 years of age who are not living with either of their biological parents. To measure the prevalence of child fostering and orphanhood, four questions were asked in the NDHS Household Questionnaire on the survival status and residence of the parents of children less than 15 years of age. As shown in Table 2.3, 16 percent of households have foster children. Table 2.4 presents details regarding foster children and orphans under 15 years of age. The data show that almost three-quarters of children under 15 live with both their natural parents, while 8 percent live with their mothers but not their fathers, 4 percent live with only their fathers, and 9 percent live with neither parent (foster children). Information on parents is missing for 7 percent of children. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children in household, according to urban-rural residence, Nigeria 1999 Residence Chameteristlc Urba~ Rural Total Sex of head of household Male 81.4 83.8 83.0 Female 18.6 16.2 16.9 Total 100.0 100.0 100.0 Number of usual members 1 11.4 11.2 11.3 2 I1.9 11.0 11.3 3 13.7 12.8 13.1 4 14.6 13.8 14.1 5 15.2 12.9 13.6 6 10.8 10.5 10.6 7 7.7 9.2 8.8 8 5.0 5.4 5.3 9+ 9.7 12.8 11.8 Total 100.0 100.0 100.0 Mean size 4.8 5.1 5.0 Percentage witl~ foster children 16.2 16.0 16.1 Note: Table is based on de jure members; i.e., ~sual residents. Foster children are children under age 15 living in households with neither their mother nor their father present. The table also indicates a low level of orphanhood in Nigeria. Although 4 percent of children under 15 have lost their fathers and 3 percent have lost their mothers, less than one percent are orphans, having lost both parents. As expected, the percentage of children who are living with both their natural parents decreases with increasing age of the child. There are no major differences in fosterhood or orphanhood by sex of the child or by urban-rural residence. Most children below age 15 live with both parents in all regions of the country, but the proportion is highest in the two northern regions (81 percent) and lowest in the Southeast (58 percent). 14 i Table 2.4 Fosterhood and orphanhood Percent distribution of dejuro children under ago 15 by survival status of parents and child's living arrangements, according to background characteristics, Nigeria 1999 Living Living with mother with father but not father but not mother Not living with either parent Missing Living informa- with Father Mother tion on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children A•-• 81.6 8.5 1.1 3-5 77.6 5.5 1.4 6-9 70.8 5.6 2.3 10-14 62.1 5.8 3.5 S~-~ Male 72.8 6.3 2.2 Female 71.3 6.2 2.1 Residence Urban 71.3 7.5 1.7 Rural 72.4 5.7 2.3 Region Northeast 80.9 2.0 0.8 Northwest 81.2 2.7 1.0 Southeast 58.3 9.9 5.2 Southwest 68.8 8.6 1.9 Central 74.6 6.4 1.4 Total 72.1 6.2 2.1 1.1 0.2 1.6 0.I 0.0 0.2 5.7 100.0 3,270 2.1 1.0 5.1 0.2 0.3 0.8 6.0 i00.0 3,878 3.2 1.5 8.2 0.5 1.0 1.1 5.9 100.0 5,323 4.7 2.2 9.8 1.1 1.5 1.2 8.1 100.0 4,566 3.4 1.6 5.7 0.5 0.9 0.7 6.1 100.0 8,904 2.5 1.0 7.7 0.6 0.7 1.0 6.9 100.0 8,129 2.6 1.5 7.8 0.3 0.9 0.5 5.9 i00.0 4,750 3.1 1.3 6.2 0.6 0.7 1.0 6.7 I00.0 12,287 2.8 1.3 4.4 0.3 0.8 0.6 6.2 100.0 3,316 1.8 1.5 3.3 0.5 0.7 0.3 6.8 100.0 2,553 2.5 1.2 10.1 1.1 1.3 1.0 9.2 100.0 3,595 4.1 1.2 8.7 0.4 0.5 0.4 5.4 100.0 3,875 3.2 1.4 5.5 0.2 0.6 1.8 4.9 I00.0 3,697 3.0 1.3 6.7 0.5 0.8 0.9 6.5 100.0 17,037 Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., chlidren with both parents dead. Educational Level of Household Members The educational level of the population is often used as an indicator of the socioeconomic development of the country. Moreover, many phenomena, such as reproductive behaviour, use of contraception, infant and child mortality, morbidity, and proper hygienic habits are affected by education. Education in Nigeria has evolved over a long period of time, with a series of policy changes. As a result there have been increases in the enrolment of children and in the number of educational institutions bothin the public and private sectors. The 1976 National Policy on Universal Primary Education gives every child the right to free primary education. Later, the 6-3-3-4 system was introduced, establishing six years of primary education, followed by three years of junior secondary and three years of senior secondary education. The last segment of four years is for university or polytechnic education. Subsequently, the national literacy programme for adults was launched, followed by the establishment of nomadic education to address the needs of children of migrant cattle herders and fishing people in the riverine areas. In October 1999, Universal Basic Education (UBE) was launched, making it compulsory for every child to be educated free up to the junior secondary school level in an effort to meet the nation's manpower requirement for national development. Table 2.5 presents the distribution of the household population age six years and over by level of education, according to sex, age, place of residence, and region. The table shows that 26 percent of men and 38 percent of women have not received any formal education. Roughly one-third of the population has at least some primary school, but not more, while one-quarter of men and one-fifth of women reached secondary school. Seven percent of men and 4 percent of women have a higher education. 15 Table 2.5 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of education attained, according to selected background characteristics, Nigeria 1999 Level of education Number Median of number Background No Don't know/ women/ of years of characteristic education Primary Secondary Higher missing Total men schooling MALE Age 6-9 30.0 60.5 0.4 0.0 9.1 100.0 2,481 0.2 10-14 16.7 57.5 22.i 0.2 3.5 100.0 2,664 3.6 15-19 13.5 20.7 62.0 1.5 2.3 100.0 1,904 7.4 20-24 16.4 18.5 52.4 9.8 2.9 100.0 1,247 9.2 25-29 18.3 20.i 42.5 15.9 3.3 100.0 1,277 10.0 30-34 22.9 21.7 34.7 16.8 3.9 100.0 1,050 8.3 35-39 20.5 25.6 30.8 18.4 4.7 100.0 954 7.9 40-44 33.7 23.2 20.9 17.7 4.5 100.0 839 5.5 45-49 32.7 29.9 16.0 15.1 6.2 100.0 653 5.3 50-54 41.3 29.0 12.4 11.6 5.7 100.0 569 4.1 55-59 42.1 29.2 12.1 9.6 6.9 100.0 374 2.3 60-64 54.7 23.0 7A 3.9 11.0 100.0 373 0.0 65+ 65.7 17.0 3.9 3.3 10.1 100.0 847 0.0 R~idellce Urban 13.9 33.5 35.4 13.2 4.0 100.0 4,544 6.0 Rural 31.2 35.1 23.2 4.7 5.8 100.0 10,715 3.1 Region Northeazt 50.1 18.6 I6.2 4.5 I0.5 I00,0 2,586 0.0 Northwest 51.6 18.4 13.7 3.5 12.8 100.0 1,970 0.0 Southeast 9.I 50.1 31.6 6.8 2.3 100,0 3,402 5.3 Southwest 12.9 38.8 36.1 9.6 2.6 100,0 3,884 5.8 Central 25.1 35.9 27.2 9.1 2.7 100,0 3,417 4.8 Total 26.1 34.6 26.8 7.2 5.2 100.0 15,259 4.7 FEMALE Age 6-9 32.8 57.8 0.5 0.0 8.8 100.0 2,798 0.2 10-14 20.0 51.7 24.2 0.0 4.2 100.0 1,817 3.8 15-19 22.1 23.0 50.2 1.0 3.7 100.0 1,918 6.1 20-24 28.9 19.3 38.9 7.6 5.3 100~0 1,622 5.9 25-29 31.9 23.0 31.1 8.5 5.6 100.0 1,573 5.6 30-34 39.5 21.7 24.1 8.2 6.5 100,0 1,228 5.1 35-39 44.6 22.3 16.3 9.1 7.7 100.0 1,027 1.7 40-44 56.2 22.3 8.6 5.7 7.2 100.0 728 0.0 45-49 58.0 24.8 4.5 5.2 7.5 100,0 599 0.0 50-54 63.0 15.9 5.2 3.8 12.1 100,0 693 0.0 55-59 72.8 8.2 3.2 2.6 13.2 100.0 331 0.0 60-64 76.6 5.5 1.2 1.5 15.2 I00.0 356 0.0 65+ 83.6 2.8 0.5 1.3 I1.7 100,0 556 0.0 Residence Urban 25.4 32.0 29.9 8.1 4.6 100.0 4,529 5,1 Rural 43.3 29,8 16.7 2.1 8.1 100,0 10,745 0.1 Region Northeast 64.0 14.4 8.0 1.5 12.2 100,0 2,536 0.0 Northwest 64.6 11.5 5.8 0.6 17.6 100.0 1,935 0.0 Southeast 18.8 44.5 29.I 4.1 3.5 100.0 3,645 4.8 Southwest 22.8 36.5 30.4 6.5 3.7 100.0 3,789 5.3 Central 41.0 31.5 18.3 4.4 4.8 100.0 3,369 1.0 Total 38.0 30.5 20.6 3.9 7.1 100.0 15,273 1.7 Note: Total includes 26 men whose age is missing and 28 women whose age is missing 16 MeninNigeriahave adistinct educational advantage over women. Menreceiveroughiy three years more education than women, with a median number of years of schooling of 4.7 for males, compared with only 1.7 years for females. At every age group, there are smaller proportions of men than women with no education (Figure 2.3). Despite reductions over time in the propollion of men and women with no education (evidenced by the fact that younger people are less likely to be uneducated), the gender differential in educational attainment has narrowed little. The proportion of rural males and females with no education is almost double that of urban respondents. The Northwest region has the highest proportion of persons with no education (52 percent of men and 65 percent of women), while the Southeast region has the lowest percentage who have never been to school (9 percent of men and 19 percent of women). The Southwest region has the highest proportion who have attended higher educational institutions (10 percent of men and 7 percent of women). 100 80 60 40 i 20 Figure 2.3 Percentage of Males and Females Who Have No Education by Age Group, Nigeria 1999 Percent 0 6-9 101-14 151-19 20~24 25~29 30~34 35~39 40~44 451-49 50~54 55~59 50~54 65+ Age Group I~-Male -e-Female I NDHS 1999 School Attendance Rates Table 2.6 shows school attendance rates by age group, sex, and residence for the population age 6-24 years. A school enrolment rate is the percentage of children in a specific age group who are currently in school. 17 Table 2.6 School attendance Percent of the de facto household population 6-24 years of age currently in school, by age, sex, and ~esidence, Nigeria 1999 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 72.6 53.4 58.5 68.8 49.5 54.9 70.7 51.4 56.7 11-15 77.2 65.2 68.8 75.5 60.1 64.9 76.4 63.0 67.1 6-15 74.8 58.4 63.0 71.5 53.3 58.6 73.2 56.0 60.9 16-20 58.3 44.7 49.1 41.1 30.9 33.9 49.7 37.2 41.0 21-24 30.8 24.0 26.4 21.3 15.1 17.4 25.5 19.2 21.4 The table shows that 57 percent of children age 6-10 are in school. The percentage enrolled in school increases to 67 in the age group 11-15 years, after which it drops substantially. Only 41 percent of the population age 16-20 are attending school. Among those in their early twenties, only 21 percent are still in school. School attendance is substantially higher for urban than for rural residents (Figure 2.4). In the population as a whole, males are more likely than females to be enrolled in school in all age groups, with the differential being greatest for the 16-20 age group. Figure 2.4 Percentage in School by Age and Urban-Rural Residence, Nigeria 1999 Percent 80 60 40 20 6-15 16.20 21-24 AgeGroup I~Urban IZ3Rural I NDHSI999 18 2.2 Household Facilities In the Household Questionnaire, re- spondents were asked about certain charac- teristics of their households, including availa- bility of electricity, source of drinking water, time to water source, type of toilet facilities, I main floor materials, and persons per room. l These physical characteristics have an important bearing on exposure to disease for household members, particularly children. They are also useful indicators of the socioeconomic status of the household. Table 2.7 summarises this infor- mation by urban-rural residence. ! Overall, 45 percent of households in Nigeria have electricity (Figure 2.5). This represents an improvement over the 27 percent reported in the 1990 NDHS. Electricity is avail- able in four of every live urban households (84 percent), which is three times the proportion in rural areas (28 percent). Access to drinking water and adequate sanitation facilities are important determinants of health conditions. In Nigeria, one in four house- holds has piped water, either piped into their residence or plot or a public tap. More than 40 percent of households use water from a well or borehole, and 25 percent use surface water from a river, pond, or dam. Assuming that water from pipes, private wells, boreholes, and springs are tmcontaminated, slightly more than half of Nigerian households drink safe water. Sources used by households to obtain drinking water differ considerably by area of residence. Twenty-four percent of urban house- holds obtain water from pipes in their residence, yard, or plot, compared with only 4 percent of rural households. In urban areas, 26 percent of households obtain drinking water from public taps, versus 10 percent of rural households. Other sources of water for urban households are private wells and boreholes. In rural areas, one- third (32 percent) of households obtain drinking water from rivers and streams. Other major sources of water for rural dwellers are public wells and wells in the yard or plot. Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Nigeria 1999 Residence Characteristic Urban Rural Total Electricity Yes 84.3 27.9 44.9 No 14.9 70.9 54.0 Missing 0.8 1.2 1.1 Total 100.0 100.0 100.0 Source of drinking water Pipe in residence/yard/plot 24.0 3.7 9.8 Public tap 25.8 9.5 14.4 Well in residence/yard/plot 16.9 15.I 15.7 Public well 9.6 19.8 16.7 Bomhole I2.4 9.1 10.1 S~?ring 1.1 4.0 3.1 Rwer/stmam 3.2 32.2 23.4 Pond/lake 0.5 1.6 1.2 Darn 0.4 0.3 0.3 Rainwater 0.3 0.8 0.6 Tanker truck 1.6 1.1 1.3 Tanker vendor 2.0 1.2 1.4 Bottled water 0.4 0.1 0.2 Other 0.6 0.4 0.5 Missing 1.0 1.0 1.0 Total 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 74.2 48.5 56.3 Median time to source 0.3 14.1 9.4 Sanitation facility Own water closet 20.7 2.9 8.3 Shared flush toilet (W.C.) 9.9 1.4 3.9 Traditional pit toilet 46.4 56.7 53.6 Ventilated improved pit (VIP) latrine 8.8 5.2 6.3 Bucket toilet 0.3 0.1 0.1 No facility/bu stdfleld/river I2.3 32.1 26.1 Other 0.6 0.1 0.3 Missing 1.2 1.5 1.4 Total 100.0 100.0 100.0 Main floor material Earth/sand 9.8 44.8 34.2 Dung 1.5 4.6 3.7 Wood planks 0.1 0.2 0.2 Palm/bamboo 0.1 0.1 0.1 Vinyl or asphalt strips 0.0 0.2 0.1 Ceramic tiles 1.3 0.1 0.5 Cement 67.1 45.6 52.1 Terazol/Marble 2.0 0.5 0.9 Carpet 16.9 2.8 7.1 Missing 1.2 1.1 I.I Total 100.0 100.0 100.0 Persons per sleeping room 1-2 59.0 67.5 65.0 3-4 25.5 23.3 24.0 5-6 I0.4 5.2 6.8 7+ 3.4 2.0 2.4 Missing/Don't know 1.7 2.0 1.9 Mean 2.7 2.3 2.5 Total 100.0 100.0 100.0 Number of households 2,313 5,334 7,647 19 Figure 2.5 Percentage of Households with Specific Amenities, by Urban-Rural Residence, Nigeria 1999 Percent 100 80 6O 40 2O 0 Electricity piped Drinking Flush Toilet Water IB~Urban lllRural I~Total I NDHS 1999 Proximity to a water source encourages use of more water, which results in better hygiene. Slightly more than half of all Nigerian households are within 15 minutes of a source of water. About three-quarters of urban households (74 percent) are close (within 15 minutes) to a water source, compared with less than half of rural households. The median travel time to th~ source of drinking water is 14 minutes in rural areas, while it is only a fraction of a minute (0.3 minutes) in urban areas. NDHS data (Table 2.7) show that 8 percent of all households have their own water closet, while 4 percent share water closets, 54 percent have traditional pit toilets, and 26 percent have no toilet facility. The use of traditional pit toilets is more common in rural than in urban areas (57 percent versus 46 percent). Twelve percent of urban households have no toilet facility, which is much lower than the proportion in rural areas (32 percent). The most commonly used flooring materials are cement (52 percent) and earth/sand (34 percent). More than three-quarters of urban households and 90 percent of rural households use these two materials for flooring. The NDHS collected data on the total number of rooms that a household uses for sleeping. This information provides a measure of household room density. Table 2.7 shows that 65 percent of households have one or two persons per sleeping room and one-quarter have three to four persons per sleeping room. On average, there are 2.5 persons per sleeping room. 20 Household Durable Goods Besides providing information on the socioeconomic status of households, durable consumer goods have specific benefits for the households. Having access to a radio or tele- vision exposes household members to innovative ideas. A refrigerator prolongs the whole- someness of foods, and transportation allows greater access to many services outside the local area. Table 2.8 shows the availability of selected durable goods by urban-rural residence. Sixty-two percent of households own a radio, 31 percent have an electric fan, 26 percent have a television, 24 percent have an electric iron, and 24 percent have a bicycle. Few households have telephones (2 percent), private cars (8 percent), or gas cookers (5 percent). Table 2.8 Household durable ~oods Percentage of households possessing various durable consumer goods, by residence, Nigeria 1999 Residence Durable consumer goods Urban Rural Total Radio 77.6 55.3 62.1 Television 52.7 13.9 25.6 Telephone 5.3 0.2 1.8 Refrigerator 33.6 7.4 15.3 Bicycle 9.8 30.5 24.2 Motorcycle 13.9 13.3 13.5 Private car 14.9 4.5 7.7 Gas cooker 10.2 2.3 4.7 Electric iron 50.1 13.3 24.4 Electric fan 65.0 16.3 31.0 Donkey/hurse/camel 0.1 4.7 3.3 Canoe/boat/ship 0.2 4.3 3.1 None (radio through ear) 16.4 33.9 28.6 None of the above 13.4 30.2 25.1 Number of households 2,313 5,334 7,647 Ownership of all items inquired about is higher among urban than among rural households, except bicycles, work animals, and boats. For example, the proportion of urban households that own a private car (15 percent) is thrice the proportion of rural households (5 percent). Less than 1 percent of rural households have a telephone, compared with 1 in 20 urban households. Large urban-rural differentials are also observed in ownership of appliances that usually require electricity, such as televisions, refrigerators, irons, and fans. 2.3 Characteristics of Survey Respondents Background Characteristics Data concerning characteristics of the respondents are presented in Table 2.9. As expected, there are many more respondents in the younger age groups than at older ages. Seventy percent of women and 60 percent of men are in union (married or living together), while one-quarter of the women and more than one- third of the men have never married. The proportion divorced, widowed, or separated is generally low in Nigeria. About 70 percent of both maie and female respondents reside in rural areas, a decline from the level of 75 percent in the 1990 NDHS. About 30 percent of respondents are from the Northwest and Northeast regions, while about 48 percent are from the Southwest and Southeast regions. The remaining 22 percent reside in the Central region. 21 Table 2.9 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Nigeria 1999 Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted Alg5e- 19 21.6 1,775 1,774 19.1 511 513 20-24 18.5 1,521 1,528 11.9 319 315 25-29 18.5 1,516 1,521 13.6 366 361 30-34 13.9 1,137 1,142 13.0 348 348 35-39 12.I 992 983 10.3 275 278 40-44 8.5 696 689 8.9 239 240 45-49 6.9 568 562 7.4 197 197 50-54 7.6 205 209 55-64 8.2 220 219 Marital status Never married 26.0 2,130 2,118 36.9 988 988 Married 64.6 5,304 5,316 56.7 1,518 1,512 Living together 5.5 453 439 3.5 93 96 Widowed 1.6 134 132 0.7 18 18 Divorced 1.0 83 86 0.9 24 24 Not living together 1.2 102 108 1.4 38 42 Residence Urban 31.0 2,540 2,697 30.7 821 882 Rural 69.0 5,666 5,502 69.3 1,859 1,798 R~o'rt °~ beast 15.7 1,292 1,304 16.3 437 437 Northwest 13.2 1,087 1,162 13.3 356 337 Southeast 23.0 1,886 1,895 22.0 590 602 Southwest 25.4 2,080 2,002 26.0 696 698 Central 22.7 1,861 1,836 22.4 601 606 Education level attained No education 40.5 3,324 3,325 243 663 652 Primary 22.8 1,868 1,850 26.5 710 70g Secondary 30.5 2,506 2,503 36.8 986 988 Higher 6.2 508 521 12.0 32I 332 Religion Catholic 14.6 1,201 1,189 13.1 352 355 Protestant 19.0 1,559 1,558 20.3 543 553 Other Christian 20.4 1,672 1,657 19.1 513 521 Muslim 43.7 3,587 3,620 45.2 1,210 1,190 Traditionalist 1.6 132 120 1.9 52 50 Other 0.7 56 55 0.4 11 11 All women 100.0 8,206 8,199 100.0 2,680 2,680 Educational levels are low in Nigeria and women are at a distinct disadvantage compared with men. The proportion of women age 15-49 who have never been to school is 16 percentage points higher than that of men (41 versus 25 percent). The proportion of male respondents who have attended post-secondary schools (12 percent) is double that of female respondents (6 percent). As regards religion, slightly more than half of the respondents are Christian and slightly less than half are Muslim. Characteristics of Couples Since male respondents were selected from households in which women were also interviewed, it is possible to match married men with their wives to form a sample of couples. Table 2.10 presents information on 1,451 couples. 22 Table 2.10 Differential characteristics between spouses Percent distribution of couples by differences between spouses in age and level of education, Nigeria 1999 Number Percent/ of Characteristic Years couples Wife older 2.0 30 Husband older by: 0-4 years I3.9 201 5-9 years 31.7 460 10-14 years 25.9 375 15 years or more 26.5 385 Mean age difference (years) First wife 10.0 1,264 Second wife 17.5 187 All wives 10.9 1,45I Education (percent) Both husband and wife not educated 35.0 508 Wife educated, husband not 3.7 54 Husband educated, wife not 20.8 301 Both husband and wife educated 40.5 587 Total 100.0 1,451 In Nigeria, it is common for men to marry younger women. In the NDHS, only 2 percent of wives are older than their husbands. The mean age difference between husbands and their wives is 11 years. In polygynous unions, the mean age difference between the husband and his second wife is 18 years. The data also show that educated men are likely to marry educated women (41 percent), and that with no education marry women with no education (35 percent). It is rare for an educated woman to marry a man who is not educated, although 20 percent of educated husbands have wives who had no schooling. Educational Differentials Table 2.11 gives an overview of the relationship between the level of education and other background characteristics of respondents. Of particular importance are possible differences in the educational composition of women from different age groups, urban-rural residence, and regions. Older women and men are generally less educated than younger respondents. For example, 65 percent of women age 45-49 have no formal education, compared with only 26 percent of women age 15-19. The level of education also varies greatly according to residence. Women and men in urban areas are more likely to have obtained higher education than their rural counterparts. The urban-rural difference is more pronounced at the secondary and higher level. Only 3 percent of women and 8 percent of men in rural areas have a higher education, compared with 13 percent of women and 21 percent of men in urban areas. 23 Table 2.11 Educational attainment by background characteristics Percent distribution o f women and men by highest level of schooling attained, according to selected background characteristics, Nigeria 1999 Highest level of schooling attained Number of Background No edu- women/ cJaar vet~-istie e~tioa P r imly Se, condaty Higttex Total men WOMEN Age 15-19 25.7 22.1 51.3 0.9 I00.0 1,775 20-24 32.4 20.2 40.0 7.4 100.0 1,521 25-29 36.0 24.7 30.6 8.6 100.0 1,516 30-34 43.9 22.8 25.3 8.0 100.0 1,137 35-39 52.5 23.2 14.9 9.4 100.0 992 4044 63.1 23.4 8.2 5.3 100.0 696 452~9 64.9 ~.7 5.5 4.9 l f~.0 56g Residence Urban 24.9 21.0 41.5 12.5 100.0 2,540 Rural 47.5 23.5 25.6 3.3 100.0 5,666 Region Northeast 76.9 8.9 12.0 2.1 100.0 1,292 Northwest 82.3 8.1 8.3 1.2 I00.0 1,087 Southeast 11.0 36.2 46.2 6.7 100.0 1,886 Southwest 19.8 26.7 43.8 9.7 100.0 2,080 Central 43.9 23.0 25.6 7.5 100.0 1,86I All women 40.5 22.8 30.5 6.2 100.0 8,206 MEN Age 15-19 13.2 20.5 65.4 1.0 100.0 511 20-24 12.6 25.1 53.2 9.1 100.0 319 25-29 I5.6 28.7 38.2 17.5 I00.0 366 30-34 18.5 28.2 34.9 18.3 100.0 348 35-39 25.3 23.7 31.6 19A 100.0 275 40-44 36.2 26.4 19.4 18.1 100.0 239 45-49 36.0 34.9 16.0 13.1 100.0 197 50-54 42.9 32.I 15.2 9.8 100.0 205 55+ 53.9 27.0 11.4 7.7 100.0 220 Re~de~ce Urban 13.4 20.8 45.0 20.7 100.0 82I Rural 29.7 29.0 33.2 8.1 100.0 1,859 Region Northeast 49.5 I8.2 23.7 8.7 100.0 437 Northwest 58.6 21.4 12.6 7.3 100.0 356 Southeast 6.8 37.4 45.2 10.7 100.0 590 Southwest 10.0 25.8 50.0 14.1 100.0 696 Central 21.3 25.7 37.2 15.9 100.0 601 A11 raett 24.7 26,5 36,8 12,0 100.0 2,680 The Northwest region has the highest proportion of uneducated respondents (82 percent of women and 59 percent of men). In the Southeast region, only 11 percent of women and 7 percent of men had no schooling. The proportion of women who have a primary school education in the Southeast region is higher than in the other regions. 24 Reasons for Leaving School Knowledge of the reasons for leaving school can provide guidance for policies aimed at enhancing women's status. Women age 15-24 who had attended school but were not currently attending were asked in the NDHS why they stopped. Table 2.12 shows the percent distribution of women age 15-24 years by current enrolment status in school, that is, whether they are attending school and if not, their reasons for leaving school and level of education attained. Almost half (48 percent) of women age 15-24 who have attended school are still continuing their education. The major reason for leaving school is inability to pay school fees (15 percent). The next most frequently cited reason for stopping schooling is to get married (10 percent). This reason is most common among women who have completed primary school (19 percent). Among those who left higher education institutions, the major reasons for leaving are that they graduated, had enough education needed to earn money, and marriage. The proportion of those leaving school because they did not pass exams is highest amongst those who have completed secondary school (7 percent). It is interesting to note that the least common reason for leaving school is that the school is not accessible. Table 2.12 Reasons for leaving school Percent distribution of women age 15-24 who have ever attended school by current e~ollment status and reason for leaving school, according to highest level of education attended, Nigeria 1999 Highest level of education Reason stopped Primary Primary Secondary Secondary attending school incomplete complete incompIete complete Higher Total Still in school 45.1 11.9 71.0 22.4 67.5 48.0 Got pregnant 4.7 2.6 3.8 1.0 0.7 3.0 Got married 12.8 18.6 5.6 11.1 2.4 9.7 Take care of children 1.0 0.8 0.3 0.8 0.0 0.5 Family needed help 2.9 2.8 0.7 2.5 0.0 1.6 Could not pay school fees 18.6 34.4 8.9 10.2 1.5 14.9 Need to earn money 0,0 3.1 1.1 6,9 4.1 2.6 Graduated, enough 1.9 6.0 2.6 24.3 19.3 7.8 Did not pass exams 1.1 4.0 0.6 6,8 0,0 2.3 Did not like school 7.9 7.0 1.8 1.0 0.0 3.2 School not accessible 0.0 0.4 0.3 0.3 0.0 0.2 Other 2.6 3.7 1.2 7.5 0.0 2.9 Don' t know/misslng 1.4 4.6 2.2 5.3 4.5 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 211 488 1,126 393 129 2,347 Access to Mass Media NDHS respondents were asked if they usually read newspapers, listen to radio, or watch television at least once a week. This information is important because it provides an thdicalion of the level of exposure to the mass media, which are often used to disseminate information on family planning and public health. Table 2.13 and Figure 2.6 show the percentage of female and male respondents exposed to different types 25 Table2.13 Acee~ss tomassmedia Percentage of women and men who usually read a newspaper weekly, watch television weekly, and listen to the radio daily, by selected background characteristics, Nigeria 1999 Number No Reads a Watches Listens to All of news a ar television the radio three women/ Background mass ~Pk~ charaO.eristic media w weekly daily media men WOMEN Alg5e- 19 39.3 27.3 39.4 51.3 17.9 1,775 20-24 37.4 28.9 39.1 54.1 18.1 1,521 25-29 40.1 25.5 36.1 53.7 17.5 1,516 30-34 42.5 21.2 33.4 53.1 i6.5 1,137 35-39 45.8 19.0 31.9 49.4 14.3 992 40-44 49.4 13.2 28.5 43.7 10.3 696 45-49 51.5 11.1 24.3 45.3 8.3 568 Residence Urban 18.7 39.6 66.5 72.2 32.8 2,540 Rural 52.5 I5.7 20.9 41.9 8.4 5,666 Region Northeast 65.I 8.3 14.5 31.5 5.3 1,292 Northwest 57.9 5.6 10.4 40.4 3.0 1,087 Southeast 40.3 26.2 36.3 47.5 15.1 1,886 Southwest 19.7 38.3 58.4 73.2 29.6 2,080 Central 43.4 23.4 36.3 50.5 16.4 1,861 Education No education 66.8 0.2 10.3 31.1 0.1 3,324 Primary 41.1 12.0 33.7 52.1 6.7 1,868 Secondary 17.6 49.5 58.9 70.1 33.1 2,506 Higher 3.7 83.3 84.4 87.1 68.4 508 All women 42.0 23.1 35.0 51.2 15.9 8,206 MEN Alg.' e- I9 18.4 35.0 56.9 73.9 27.7 511 20-24 16.5 45.1 59.9 78.8 35.6 319 25-29 12.3 47.8 53.2 81.1 34.7 366 30-34 14.3 50.4 53.3 83.1 40.3 348 35-39 17.8 44.6 47.4 80.3 34.0 275 40-44 20.I 39.4 47.4 76.5 31.5 239 45-49 19.7 36.6 43.1 80.3 27.2 197 50-54 18.3 37.1 43.5 77.9 30.3 205 55+ 25.7 29.9 34.7 71.6 22.4 220 Residence Urban 6.3 63.1 82.9 89.2 57.5 821 Rural 22.6 31.5 36.3 73.2 20.6 1,859 Region Northeast 30.5 24.8 35.0 66.0 17.5 437 Northwest 32.5 13.3 22.3 65.8 8.7 356 Southeast 18.5 38.0 48.2 75.8 27.4 590 Southwest 6.1 66.9 75.9 90.5 58.6 696 Central 11.9 42.9 51.8 82.3 29.8 601 Education No education 40.2 2.5 18.1 57.0 1.4 663 Pdmarrv 17.2 30.4 41.1 79.4 19.5 710 Secondary 7.8 59.6 68.2 85.9 46.4 986 Higher 1.9 88.1 84.6 95.1 78.0 321 All men 17.6 41.2 50.6 78.1 31.9 2,680 26 Figure 2.6 Percentage of Women and Men with Access to Mass Media, Nigeria 1999 Newspaper Telsvision Radio All Three Media No Access 0 51 ~;~i~i~i~i~ii~i~i~i~iiiili~i~i~i~i~i~il i~iii~i~ili!i~ii!i~!i!i!] 78 i 42 20 40 60 80 100 Percent ]llWomen E~Men] NDHS1999 of mass media by age, residence, region, and level of education. In all, the proportion of men who have access to all three types of mass media is twice that of women (32 versus 16 percent). The table further shows that radio is the more commonly accessed medium, with 51 percent of women and 78 percent of men listening at least once a day. The next most widely used medium is television. Only 23 percent of women and 41 percent of men read a newspaper at least once a week. The proportion of women who have no access to any mass media is more than twice that of men (42 percent compared with 18 percent). Generally, exposure to mass media decreases with age and is higher in urban than in rural areas. Printed material and television are less commonly accessed by people in rural areas, perhaps in part because of their lower socioeconomic status. Exposure to all three media is substantially lower in the northern regions than in the other three regions. Less-educated respondents are also less likely to read newspapers, watch television, and listen to the radio than their better- educated peers. Women's Employment Status The NDHS collected information from women about their current employment status. The results are presented in Table 2.14. About half of women are not currently employed and about a third are employed on a full-time basis. The proportion not currently employed declines with age, while the proportions of those employed on a full-time and part-time basis increase with age. A slightly higher level of unemployment is observed among women in rural areas than in urban areas (54 versus 47 percent). The highest percentage of employed women is in the Southwest (67 percent) and the Southeast (56 percent). Unemployment is highest among women with no education (62 percent). 27 Table 2.14 Employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Nigeria 1999 Not currently employed Did not work Worked Currently employed in last in Number Background 12 last 12 All year All year Season- Occasion- of characteristic months months 5+ days <5 days ally ally Missing Total women Age 15-19 79.1 1.2 9.1 3.2 3.5 3.4 0.5 I00.0 1,775 20-26 62.2 1.5 24.5 3.7 6.1 1.6 0.4 I00.0 1,521 25-29 44.6 1.5 37.9 6.6 6.4 2.2 0.7 100.0 1,516 30-34 35.9 1.2 44.8 6.5 9.0 2.1 0.5 100.0 1,137 35-39 33.1 1.3 46.3 6.3 10.1 2.8 0.2 100.0 992 40-44 30.7 1.2 48.5 6.2 10.2 3.1 0.1 100.0 696 45-49 26.2 1.8 48.2 9.2 11.2 3.2 0.2 100.0 568 Residence Urban 45.4 1.2 42.5 2.9 4.7 2.6 0.5 100.0 2,540 Rural 52.5 1.4 28.4 6.5 8.2 2.5 0.4 100.0 5,666 Region Northeast 78.0 1.0 12.7 2.6 3.4 1.8 0.5 100.0 1,292 Northwest 78.4 1.1 10.4 3.6 4.1 2.4 0.0 100.0 1,087 Southeast 41.3 1.9 30.8 10.7 10.7 3.9 0.6 100.0 1,886 Southwest 29.9 2.0 55.3 4.1 5.6 2.6 0.5 100.0 2,080 Central 46.5 0.6 36.4 4.5 9.9 1.8 0.4 100.0 1,861 Education No education 60.8 1.2 24.1 4.3 7.0 2.3 0.4 100.0 3,324 Primary 32.8 1.7 42.4 9.9 9.9 2.9 0.1 100.0 1,868 Secondary 52.7 1.4 32.6 4.4 5.8 2.8 0.7 100.0 2,506 Higher 34.3 1.4 54.6 1.5 6.1 1.6 0.4 I00.0 508 All women 50.3 1.4 32.7 5.4 7.2 2.6 0.4 100.0 8,206 Women's Employers and Remuneration Table 2.15 shows the percent distribution of employed women by type of employer and form of earnings (remuneration), according to background characteristics. About 70 percent of women who work are self-employed, while 17 percent are employed by relatives and 13 percent are employed by non-relatives. In all cases, most (86 percent) employed women work for cash. Women in mral areas are tvdce as likely as those in urban areas to work for non-cash payments. The Northwest region has the highest proportion of self-employed women (78 percent), followed by the Southeast region (74 percent). The proportion of women who are employed by non-relatives increases with education. 28 Table 2.15 Employer and form of earnings Percent distribution of currently employed women by employer and type of earnings (cash, in kind, no payment), according to background characteristics, Nigeria 1999 Employed by Employed by Self-employed a nonrelative a relative Does Does Does Number Background Earn~ not eeee~n Eam~ not e~n Eam~ not e~n of characteristic cash cash cash cash cash cash Missing Total women Age 15-19 37.5 3.6 9.1 4.6 19.8 24.2 1,3 100.0 340 20-24 60.4 5.5 13.8 2.1 7.5 9.5 1,2 100.0 546 25-29 67.9 3.6 11.3 1.4 10.4 4.0 1,4 100.0 806 30-34 66,9 4.7 13,7 0,2 9,2 4,6 0,6 100,0 710 35-39 65.4 4.8 14.1 0.4 8.6 6.1 0.4 100.0 649 40-44 68.5 5.3 9.7 0.2 10.2 4.9 1,2 100.0 473 45-49 72.9 4.8 9.2 0.2 7.1 5.0 0,7 100.0 408 Residence Urban 64.5 2.8 20.2 1.4 6.6 3.5 1,0 100.0 1,342 Rural 64.1 5.5 7.7 1.0 11.7 9.1 1.0 100.0 2,590 Region Northeast 62.6 2.5 9.3 0.0 11.5 11.6 2,6 100.0 264 Northwest 76.6 1.6 6.5 0.0 11.5 2.1 1,5 100.0 223 Southeast 66.5 7.3 11.9 0.8 5.4 7.0 1,2 100.0 1,060 Southwest 66.5 2.3 13.0 1.7 12.0 3.9 0.7 100.0 1,406 Central 56.1 6.3 12.4 1.2 11.3 12.1 0,6 100.0 978 Education No education 67.8 5.6 2.2 0.2 13.7 9.5 0~9 100.0 1,250 Primary 73.2 5.0 3.9 1.7 9.1 6.3 0.8 100.0 1,223 Secondary 60.8 4.3 16.9 1.6 8.2 7.1 1,0 100.0 1,133 Higher 28.4 0.4 62.3 1.1 4.3 1.9 1,5 100.0 325 All women 64.2 4.6 11.9 1.1 9.9 7.2 1,0 100.0 3,931 1 Includes both women who receive only cash and those who receive cash and in-kind payment. 2 Includes both women who receive in-kind payment and those who receive no payment. Women's and Men's Occupations Tables 2.16.1 and 2.16.2 present information on the current occupation of employed women and men, respectively. Slightly more than one-fifth of working women are employed in agriculture. Of these, most work either on their own or on family-owned land. Many of those not employed in agriculture work in sales and services (56 percent). Almost 10 percent of employed women are in professional, technical, or managerial occupations, while 11 percent work in skilled and unskilled manual services. Generally, women are more likely to be engaged in non-agricultural than in agricultural employment (79 percent versus 21 percent). Women from the Southeast region are the most likely to be employed in agriculture (29 percent), while women from the Northwest region are the least likely (4 percent). As expected, women with higher education are less likely to be employed in agriculture (2 percent) and are more likely to be engaged in professional, technical, or managerial employment (63 percent). About three-fifths of women who have completed primary and secondary education are engaged in sales and services. 29 Table2.16.1 Occupation: women Percent distribution of currently employed women by type of work performed (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Nigeria 1999 Agricultural work Nonagricultural work ]?roLl Sales Manual labour Number Background Own Family Rented Other Tech./ and of charactetistie land land land land Man~g. sevc~ces Skilled Unskilled Other Missing Total women Age 15-19 3.4 17.8 2,1 1.2 4.3 57.6 9.8 0.0 1.2 2.7 I00.0 340 20-24 3.1 11.9 1.9 1.9 8.8 53.2 16.2 0.5 0.9 1.6 100.0 546 25-29 3.5 8.8 2,1 1.5 11.8 55.1 14.9 0.2 0.6 1.5 100.0 806 30-34 4.5 8.9 2.5 1.4 11.6 59.4 8.4 0.1 2.0 1.1 100.0 710 35-39 4.4 10.7 4,4 1.6 13.6 56.2 8.0 0.0 0.5 0.6 100.0 649 40-44 7.4 11.7 4.4 3.0 7.1 56.4 9.2 0.0 0.4 0.4 100.0 473 45-49 8.0 I3.6 4.5 4.0 6.4 55.9 6.4 0.0 0.5 0.8 100.0 408 Residence Urban 1.6 2.7 0,5 0.9 18.1 61.1 13.4 0.1 0.7 0.9 100.0 1,342 Rural 6.3 15.6 4,3 2.5 5.6 53.7 9.4 0.1 1.0 1.4 100.0 2,590 Region Northeast 2.6 11.8 0.0 1.I 9.6 54.2 15.6 0.0 1.8 3.4 I00.0 264 Northwest 0.4 2.6 0.0 0.7 6.9 70.3 12.0 1.3 2.4 3.4 100.0 223 Southeast 8.8 12.8 4,7 2.5 8.6 53.9 7.4 0.1 0.3 1.0 100.0 1,060 Southwest 1.9 7.0 4.5 2.1 10.7 61.5 10.7 0.1 0.9 0.5 100.0 1,406 Central 5.9 17.2 0.7 1.8 10.8 48.4 12.9 0.I 0.9 1.3 100.0 978 No education 7.5 17.7 4.8 2.6 0.4 55.5 8.6 0.1 1.2 1.5 100.0 1,250 Primary 4.9 11.6 3.4 2.4 1.3 62.9 12.1 0.1 0.7 0.6 100.0 1,223 Secondary 2.6 6.4 1,6 1.2 14.3 59.6 11.9 0.2 0.7 1.4 100.0 1,133 Higher 0.7 0.7 0,0 1.0 63.4 21.9 10.1 0.0 1.1 1.2 100.0 325 All women 4.7 I1.2 3,0 2.0 9.9 56.2 10.8 0.I 0.9 1.2 I00.0 3,931 Note: ProfJTechYManag. includes professional, technical, clerical, and managerial occupations. 30 About three-quarters (76 percent) of the men are currently working. Surprisingly, there is a higher level of unemployment among those who have completed secondary school (44 percent) than among those with no education (6 percent). One-third of all men are working in agricultural occupations, 14 percent are in sales and services, 14 percent are in manual work, and 12 percent are in professional, technical, or managerial employment. Table2.16.2 Occupation: men Percent distribution of type of work performed (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Nigeria 1999 Agricultural work Nonagricultural work Not currently ProLI Sales Manual labour Number Background era- Own Family Rented Other Tech./ and of characturistle ployed land land land land Manag. services Sldlled Unskilled Other Missing Total men Age 15-19 72.3 1.7 13.6 0.9 1A 1.0 3.8 4.1 0.4 0.5 0.4 100.0 511 20-24 44,4 6.7 12.0 2.6 L9 2.2 12.2 13.9 2,0 1.8 0.3 100.0 319 25-29 19.2 15.3 11.1 3.7 3.6 11.6 16.4 17.2 0.5 1.0 0.3 100.0 366 30-34 2,4 16.4 11.7 4.8 3.5 20.4 16.5 21,3 0.3 1.8 0.9 100.0 348 35-39 4.1 19.1 9.8 4.7 3.1 25.7 14.1 15.8 1.5 1A 0.8 100,0 275 40-44 0.8 29.3 6.6 6.9 3.6 20.6 15.0 14.8 0.9 1.0 0.4 100.0 239 45-49 2.1 25.9 6.6 3.0 3.6 I6.6 21.9 19.2 0.0 1.0 0.0 I00,0 197 50-54 3.0 20.7 10.3 8.0 7.9 13.3 19.I 15.7 0.0 0.5 1,5 100.0 205 55+ 6.7 34.0 7.3 4.0 7.8 12.8 I7.1 7.6 0.0 1.9 0.8 100.0 220 Residence Urban 31.2 3.7 2,3 1.8 1.5 18.9 18.2 19.7 0.6 1.7 0.6 100.0 821 Rural 20.0 21.7 14.2 4.8 4.5 9.6 11.8 11.1 0.7 1.0 0.6 100.0 1,859 Region Northeast 12.9 26.4 14.0 2.7 3.5 11.2 15.9 10.8 0.7 1.6 0.2 100.0 437 Northwest 6.9 40.6 21.8 0.9 2.4 7.9 9.8 7.3 0.9 0.6 0.9 100.0 356 Southeast 29.6 9.8 3,7 4.7 3.3 12.3 18.7 14.2 0.9 1.7 1.1 100,0 590 Southwest 32.5 4.3 9.3 6.9 3.1 13.2 12.5 16.8 0.7 0.3 0.4 100.0 696 Central 24.4 14.4 9.5 2.1 5.1 15.2 11.4 15.6 0.2 1.8 0.3 100.0 601 Edueatioll No education 5.5 40,0 18.2 5.4 7,1 2.3 8.8 11.2 0.5 0.7 0.3 100.0 663 Primary 12.6 14,9 15.1 5.3 4.1 7.4 16.7 21.8 0,6 0.7 0.7 100.0 710 Secondary 44.2 5.6 5.1 2.8 1.3 9.7 16.2 12.0 1.1 1.6 0.5 100.0 986 Higher 20.7 2.4 1,5 0.7 1.9 52.8 10.5 6.5 0.0 1.9 1.0 100.0 321 All men 23.4 16.2 10.5 3,8 3.6 12.4 13,8 13.7 0.7 1.2 0.6 100.0 2,680 Note: Pro~/Tech,/Manag. includes professional, technical, clerical, and managerial occupations, 31 Decision on Use of Earnings Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women. Table 2.17 shows that 70 percent of women who receive cash earnings decide for themselves how to spend their money, 12 percent dec'lde jointly with their husband or partner, while 11 percent report that their husband or partner alone decides how their earnings will be used. Table 2.17 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women receiv'mg cash earnings by person who decides how earnings are used, according to selected background characteristics, Nigeria 1999 Person who decides how earnings are used Jointly Jointly with Number Background Self with Someone someone of characteristic only Partner partner else else Missing Total women Age 15-19 65.3 4.6 4.1 14.6 7.3 4.1 100.0 226 20-24 74.2 9.6 8.8 2.7 2.1 2.5 100.0 447 25-29 67.9 12.7 I5.2 0.5 0.8 3.0 100.0 724 30-34 69.8 12.7 12.9 0.0 0.9 3.7 100.0 638 35-39 68.6 13.7 13.4 0.4 0.4 3.6 100.0 574 40-44 74.2 10.6 10.4 0.0 0.2 4.6 100.0 420 45-49 70.9 9.3 15.2 0.0 0.9 3.7 I00.0 365 Residence Urban 74.6 8.3 11.6 1.4 1.4 2.7 100.0 1,228 Rural 67.6 13.0 12.7 1.6 1.2 4.0 100.0 2,166 Region Northeast 79.3 3.7 9.7 0.9 0.4 5.8 100.0 220 Northwest 79.9 8.3 5.2 1.3 0.0 5.3 100.0 211 Southeast 59.4 15.5 17.7 1.4 2.0 3.9 100.0 894 Southwest 73.7 8.4 12.4 1.2 1.2 3.1 100.0 1,288 Central 71.1 I4.2 8.5 2.3 1.2 2.6 I00.0 781 Education No education 76.1 11.0 7.4 1.2 0.6 3.7 100.0 1,050 Primary 69.3 11.7 12.8 1.3 1.0 3.8 100.0 1,056 Secondary 67.3 10.6 14.5 2.3 2.5 2.8 100.0 977 Higher 61.3 12.8 20.0 1.1 0.6 4.2 100.0 3I 1 Marital status Not married 84.6 0.8 0.5 7.1 4.9 2.2 100.0 654 Currently married 66.7 13.8 15.1 0.2 0.4 3.8 100.0 2,740 Total 70.1 11.3 12.3 1.5 1.3 3.5 i00.0 3,394 Older, urban women with less than a secondary education and those not currently married are more likely to report that they make their own decisions on how to spend the money they earn. The greatest proportion of women who make their own decisions on spending their earnings is found in the Northwest region (80 percent) and the least in the Southeast region (59 percent). There is an inverse relationship between educational level and decision on use of women's cash income; the higher the level of education, the lower the proportion of women who make their own decision on how to spend their income. The most educated women have the highest proportion who decide on spending jointly with their husband or partner (20 percent) or allow their husband or partner to decide for them (13 percent). Married women have a considerably higher proportion who jointly decide with their husband or partner (15 percent) or allow their husband to decide for them (14 percent) on what to do with the cash they earn. 32 Child Care While Working Table 2.18 shows the percent distribution of employed women by whether or not they have a child under six years of age and for those who do, the percent distribution by type of childminder. Slightly more than half of employed women have a child under six years of age living with them. Four in 10 working mothers report that they care for their children under six themselves. Other caretakers include other relatives ( 13 percent), other female children ( 13 percent), and schools (5 percent). In urban areas, women frequently employ the services of their neighbours (6 percent) and servants or hired help (4 percent). Relatives other than the respondent's own children are an important source of child care for women who have a higher education (20 percent). These mothers are also more likely to place the child in school. More than half of women employed as occasional workers care for their children themselves (59 percent), while women who work full time engage the services of other relatives (13 percent). 33 t.o Table 2.18 Child care while working percent distribution of currently employed women by whether they have a child under six years of age at home, and the percent distribution of employed mothers who have a child under six by person who cares for child while mother is at work, according to selected background characteristics, Nigeria 1999 Child's caretaker while mother is at work One or No child more Not Number under children Re- Neigh- Child Other Other worked of Background six under six spend- Husband/ Other hot/ Hked is in female male sin c~ employed characteristic athome athome ent partner relative Friend help school child child birth Other Missing Total women Residence Urban 49.2 50.8 42.1 1.7 11.4 6.0 3,8 10.3 7.9 1.6 0.9 2.2 12.1 100.0 1,342 Rural 45.2 54.8 40.5 2.4 14.2 4.3 2,3 3.2 15.0 4.2 1.6 2.6 9.8 100.0 2,590 Region Northeast 32.0 68.0 61.8 2.8 4.8 1.0 4,0 3.4 10.1 1.1 0.0 0.0 11.0 100.0 264 Northwest 39.4 60.6 59.7 3.5 4.7 1.3 2,1 0.0 14.1 1.5 0.8 0.0 12.3 100.0 223 Southeast 51.i 48.9 17.8 3.5 19.1 4.8 5,4 . 6.4 22.1 8.3 3.7 4.2 4.7 100.0 1,060 Southwest 46.4 53.6 47.9 1.1 9.9 6.8 0,9 8.3 5.7 1.3 0.5 2.6 14.9 100.0 1,406 Central 47.4 52.6 42.1 1.9 17.8 4.2 2,6 2.6 13.9 2.6 0.7 2.1 9.6 100.0 978 Education No education 47.4 52.6 52.6 1.9 6.0 4.5 0.3 0.8 13.9 3.4 0.8 2.0 13.8 100.0 1,250 Primary 44.8 55.2 33.4 2.5 16.3 6.3 1.1 3.7 17.4 5.1 1.5 3.6 9.1 100.0 1,223 Secondary 44.8 55.2 43.1 2.2 16.4 3.4 4.6 7.1 8.5 1.9 1.8 1.7 9.4 100.0 1,133 Higher 56.1 43.9 14.2 1.5 19.8 5.6 I4,4 28.4 3.0 0.6 1.4 3.0 7.9 100.0 325 Work status For family member 47.4 52.6 34.3 0.3 8.8 6.8 2.4 3.0 18.6 4.2 0.9 2.6 18.1 100.0 673 For someone else 60.9 39.1 16.4 3.1 23.4 4.2 9,3 24.7 3.8 2.1 1.5 2.7 8.8 100.0 516 Self-employed 43.6 56.4 46.1 2.5 13.1 4.5 2,0 3.6 12.6 3.3 1.3 2.4 8.7 100.0 2,718 Missing 50.8 49.2 8.5 0.0 0.0 0.0 8.3 0.0 0.0 0.0 17.1 6.6 59.4 100.0 25 Occupation Agricultural 45.5 54.5 26.1 1.8 14.5 6.6 1,1 2.9 24.4 7.6 1.4 4.8 8.8 100.0 822 Nonagricultaral 46.5 53.5 45.0 2.3 13.0 4.4 3,2 6.3 9.5 2.2 1.4 1.8 10.7 100.0 3,028 Employment status All year, full week 45.8 54.2 43.3 1.8 12.7 4.9 3.I 6.2 10.1 3.2 1.0 2.3 11.3 100.0 2,678 All year, part week 45.9 54.1 31.8 2.5 17.1 4.5 1.7 4.5 22.9 3.6 2.2 1.8 7.3 100.0 437 Seasonal 45.8 54.2 33.2 3.4 I5.5 5.1 1.9 4.1 18.9 4.2 2.0 3.8 7.9 I00.0 585 Occasional 57.7 42.3 58.5 3.4 6.6 3.4 3.3 1.9 5.5 2.3 2.3 2.4 10.4 100.0 209 Total 46.6 53.4 41.0 2.2 13.3 4.8 2.8 5.5 12.7 3.3 1.3 2.5 10.6 100.0 3,931 ~ote: Total includes 82 women not stated as to occupation and 22 whose seasonality of employment is not stated. Respondent is currently employed but has not worked since last birth. CHAPTER 3 FERTILITY 3.1 Introduction Retrospective reproductive histories of women age 15-49 years were used to measure the fertility rates presented in this chapter. Each woman was asked to provide information on the number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. A summation of the total number of children dead and alive, at home and living elsewhere, and now deceased was used to determine the total number of children each woman had at the time of the interview. Each woman was then asked for a history of all her live births, including information such as name, month and year of birth, sex, and survival status. For children who had died, information on age at death was recorded. The age of each living child and whether or not the child resides with the mother were also determined. The above information is analysed in the following sections to provide fertility levels and trends; fertility differentials by residence, region, and education; information on the length of the interval between births; age at first birth; and the extent of childbearing among adolescents. A brief discussion of the quality of the NDHS fertility data appears in Appendix C. 3.2 Current Fertility Levels One of the most important indicators measured in the 1999 NDHS is the level of fertility currently prevailing in Nigeria. Table 3,1 presents the reportexl age-specific fertility rates for the five-year period preceding the survey per 1,000 women? The sum of the age-specific fertility rates (known as the total rea l i ty rate) is a useful means of summarising the level of fertility. It can be interpreted 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 represents the annual number of births in a population per 1,000 women age 15-44. The crude biffll rate is the annual number of births in a population per 1,000 people. Both these measures are calculated using the birth history data and the age and sex distribution of the household population. All rates are computed for the five-year period preceding the survey, which is roughly equivalent to the calendar years 1994-98. The total fertility rate indicates that if fertility rates were to remain constant at the level prevailing during the 1994-98 period, a Nigerian woman would bear 5.2 children in her lifetime. The age-specific rates indicate a pattern of late childbearing, with a peak at age group 25-29 and the rate at age group 30-34 being slightly higher than that of the 20-24 age group. The crude birth rate for the 1994-98 period was 38 per 1,000 persons, and the general fertility rate for the same period was 176 per 1,000 women. I Numerators of the age-specific fertility rates are calculated by summing the number of live births that occurred in the period 1-59 months preceding the survey (determinexl by the date of interview and the date of birth of the child) and classifying them by tile age (in five-year groups) of the mother at the time of birth (determined by the mother's date of birth). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-59 months preceding the survey. 35 An assessment of the fertility data in the 1999 NDHS indicates that there was probably some omission of births in thethree-year period immediately prior to the survey. Presumably, interviewers omitted recording some of these births to reduce their workload, since the lengthy health section applied to all births occurring since January 1996. Similar errors have not only been suspected in the 1990 NDHS (FOS, 1992:27), but also in DHS surveys in several other countries (IRD, 1990). The assessment suggests an underreporting of births in the 1999 survey on the order of 14 to 15 percent (see Appendix C). Thus, the true total fertility rate for the five years before the survey is probably closer to 5.9 or 6.0 than to the reported rate of 5.2. Despite the possibility that the level of fertility may have been underreported, there is no reason to believe that underreporfing would substantially alter the findings on differences in fertility across all subpopulafions. For example, it is clear that fertility is higher in rural than in urban areas. With a total fertility rate of 5.4, rural women are bearing almost one child more on average than urban women who have a total fertility rate of 4.5. In all age groups, fertility rates are higher in rural than in urban areas, although the difference is relatively larger among teenagers age 15-19. For example, the age- specific fertility rate for women age 15-19 is 75 in urban areas, compared with 126 in rural areas. Age-specific fertility rates among women age 35- 44 are almost one and a half times higher in rural areas than in urban areas. 3.3 Fertility Differentials Table 3.2 and Figure 3.1 show differentials in fertility by residence, region, and educational level. Fertility in the Northeast and Northwest is substantially--approximately two children--higher than in the other three regions. The northern regions also have the highest percentage of women who were pregnant at the time of the survey. Table 3.1 Currant fertility Age-specific and cumulative fertility rates and the crude birth rote for the five years preceding the survey, by urban-rural residence, Nigeria 1999 Residence Age group Urban Rural Total 15-19 75 126 111 20-24 192 233 220 25-29 231 243 239 30-34 21i 233 226 35-39 114 150 138 40-44 53 78 71 45-49 23 24 24 TFR women 15-49 4.50 5.44 5.15 TFR women 15-44 4.38 5.32 5.03 Genaral fertility rate 154 186 176 Crude birth rote 35.6 38.5 37.7 Note: Rates for age group 45-49 may be slightly biased due to truncation. Total feffdity rate expressed per woman. General fertility rate (births divided by number of women 15-49); exprezsed per 1,000 women. Crude birth rate expressed per 1,000 population. Table 3.2 Fertility by background characteristics Total fertility rate for the five years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Nigeria 1999 Mean number of children Total Percentage ever born Background fer til~ty currently to women characteristic rate pregnant age 40-49 Residence Urban 4.50 8.54 5.65 Rural 5.44 10.88 6.32 Region Northeast 6.79 13,51 6.37 Northwest 6.45 13.27 5.64 Southeast 4.64 7,93 6.92 Southwest 4.50 8.54 5.79 Central 4.49 10,08 5.81 Education No education 6.13 11.99 6.06 Primary 5.55 10,72 6.76 Secondary 4.91 7.59 5.70 Higher (2.43) 8,78 4.49 Total 5.15 10A6 6.12 ~wote: Figures in parentheses are based on 500-999 women. omen age 15-49 years 36 Total RESIDENCE U~an Rural REGION Northeast Northwest Southeast Southwest Central EDUCATION No education Primary Secondary Higher* Figure 3.1 Fertility Rates by Selected Background Characteristics, Nigeria 1999 ~ 5 . 4 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: : :; :::: ; ;: : ::~:: ::~:: : . =~.~.~ . ] 6.8 ,, ,,, ~ 6 . 1 ~ ~ ~ 4 ~ 5"6 ~ 2 . 4 1 2 3 4 5 6 Number of Chitdren 7 8 • Unreliable due to small number of women NDH$1999 The level of fertility is negatively associated with educational attainment. Women with no education are bearing children at a rate of more than six children over their lifetime, while women with a primary education have half a child less on average. The differential becomes more apparent at higher educational levels. There is a difference of more than one child between women with a secondary education and those with no education, while the difference between women with a higher education and those with a primary education is more than three children. The table also shows the mean number of children ever born to women age 40-49, which is a measure of completed fertility. This measure can be used to assess differentials in fertility trends over time for population subgroups. The data show a decline in fertility in urban areas, in most regions, and among most education subgroups. An overall comparison of past and present fertility suggests a recent decline of about one child per woman, from 6.1 to 5.2 children. 3.4 Ferti l ity T rends One way to examine fertility trends is to compare the results of the 1999 NDHS with those of other surveys. Figure 3.2 shows the 1999 NDHS results along with those from the 1981-82 Nigeria Fertility Survey (NFS), the 1990 NDHS, the 1991 Post Enumeration Survey (PES), and the baseline report of the 1994 Sentinel Survey. There appears to have been a decline in the total fertility rate in Nigeria from 6.3 in 1981-82 to 5.2 in 1999. The data suggest that on average a Nigerian woman has one child less in 1999 than she would have had in 1981-82. 37 Figure 3.2 Trends in Total Fertility Rates 1981/82 NFS 1990 NDHS 1991PES 1994 Sentinel Survey 1999 NDHS ~ 6 . 3 ::!ii:!ii:!i i !iiiii iiiiigiiiiiiii iiiiii iii iiiii!!iiiiiiii!iiii:!i ! SS : : : : :~: : . : : : : . < ::::::::::::::::::::::::::: : x : : : : : : : .x ~ ~ 5 . 4 ~ 5 . 2 0 1 2 3 4 5 Number of Children Note: Rates refer to the 5-year period preceding the suwey except the 1994 survey, which is based on the S-year period preceding the survey. Source: FOS 1992:25; NPC 1994:40; NPC 1998:226 6 However, the suspicion that recent births were underreported in the 1999 NDHS makes interpretation of trends in fertility more difficult. For example, Table 3.3 shows total fertility rates for the five-year periods prior to the 1990 and 1999 NDHS surveys by region. 2 As mentioned before, at the national level, there has evidently been a decline of about one child over the nine-year period. However, the substantial decline in fertility for the Central region (by 2.6 children) is implausibly steep, especially given the observed level of use of contraception (see Chapter 4). This implausible decline suggests very substantial underreporting of births in the Central region. It also seems unlikely that fertility in the Northeast region has increased by almost one child over the same time period. Table 3.3 Fertilitv trends by region Total fertility rates for the five-year period prior to the 1990 NDHS and the 1999 NDHS by region Percent Region 1990 NDHS 1999 NDHS change Northeast 5.9 6.8 +0.9 Northwest 7.0 6.5 -0.5 Southeast 5.8 4.6 -1.2 Southwest 5.9 4.5 -1.4 Central 7.1 4.5 -2.6 Nigeria 6.3 5.2 - 1.1 2 For this analysis, the data from the 1990 survey are re-daasified into the same five geographic regions used for the 1999 survey. The reclassification of the 21 states and F.C.T. Abuja that existed at the time of the 1990 survey is as follows: Northeast: Bauehi, Borne, Kano Northwest: Kaduna, Katsina, Sokoto Southeast: Anambra, Akwa Ibom, Cross River, Imo, Rivers Southwest: Bendel, Lagos, Ogtm, Ondo, eye Centrah Benue, F.C.T. Abuja, Gongola, Kwara, Niger, Plateau 38 Fertility trends can also be estimated on the basis of NDHS data alone. Table 3.4 shows age- specific fertility rates for five-year periods preceding the 1999 NDHS. As expected, the data show an extremely steep decline in rates for the most recent periods (5-9 to 0-4). How much of this decline is due to a true decline in childbearing and how much is due to omission of births is impossible to say. However, if, as mentioned above, the true fertility rate for the most recent period is about 5.9 or 6.0, then there most probably has been a moderate decline in fertility over the recent 5-10 years. 3.5 Children Ever Born The distribution of all women and currently married women by age and number of children ever Table 3.4 Age-specific fertility rates Age-speCific feztility rates for five-year periods preceding the survey, Nigeria 1999 Number of years preceding the survey Age group 0-4 5-9 10-14 15-19 15-19 111 139 133 159 20-24 220 262 261 257 25-29 239 279 280 301 30-34 226 262 246 [305] 35-39 138 198 [185] 40-44 71 [122] 45-49 [24] Note: Age-spec'ffic fertility rates pet 1,000 women. Esti- mates enclosed in brackets are truncated. born and living is presented in Table 3.5. The table also shows the mean number of children ever born to women in each five-year age group, an indicator of the momentum of childbearing. Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born and mean number of children ever born (CEB) and mean number of living children, according to five-year age groups, Nigeria 1999 Mean Mean num- number Number of children ever born Number ber of Age of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 81.6 12.9 4.6 0.7 0.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,775 0.25 0.22 20-24 44.3 23.2 16.4 10.9 3.7 1.0 0.3 0.2 0.0 0.0 0.0 100.0 1,521 1.12 0.98 25-29 18.4 13.9 19.4 19.4 13.4 10.1 3.3 1.5 0.3 0.1 0.1 100.0 1,516 2.51 2.18 30-34 8.7 7.1 10.9 16.0 17.7 15.2 10.8 6.8 4.5 1.4 0.9 100.0 1.137 3.94 3.40 35-39 3.5 3.5 7.4 8.9 17.3 16.4 12.4 11.1 8.9 4.2 6.4 100.0 992 5.24 4.47 40-44 4.2 2.0 4.3 8.2 11.1 13.3 12.9 14.1 12.9 7.1 9.9 100.0 696 5.95 5.10 45-49 3.0 2.7 5.7 7.7 9.4 10.6 12.7 11.9 12.3 8.5 15.6 100.0 568 6.33 5.15 Total 31.4 11.4 10.8 10.3 9.3 8.0 5.6 4.6 3.7 1.9 2.8 100.0 8,206 2.85 2.43 CURRENTLY b/~ARRIED WOMEN 15-19 38.3 41.8 16.9 2.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 100.0 472 0.85 0.74 20-24 15.2 34.3 25.1 17.1 5.7 1.6 0.6 0.4 0.0 0.0 0.0 100.0 934 1.73 1.52 25-29 7.2 14.9 21.9 22.1 15.8 11.8 3.9 1.8 0.4 0.2 0.2 100.0 1,272 2.89 2.52 30-34 4.1 6.8 11.3 17.4 18.3 16.4 11.5 7.1 4.8 1.6 0.8 100 .0 1,032 4.16 3.60 35-39 2.2 3.2 7.1 9.2 17.7 16.9 12.5 11.2 9.1 4.3 6.7 100.0 925 5.35 4.59 40-44 2.9 2.2 4.4 7.6 10.9 13.2 13.0 13.8 14.1 7.3 10.5 100.0 637 6.09 5.22 45-49 2.7 2.5 4.6 8.3 8.9 10.4 12.9 12.9 12.6 8.5 15.7 100.0 484 6.42 5.25 Total 8.8 14,5 14.3 14.0 12.5 10.9 7.5 6.2 5.0 2.5 3.7 100.0 5,757 3.81 3.27 39 The data show that 18 percent of all women age 15-19 years have given birth to at least one child, which is an indication of early childbearing. The high level of fertility in Nigeria is apparent in the rapid rise in the number of children born by age group of women. On average, women have given birth to one child by their early 20s, four children by their early 30s, and six children by their early 40s. In fact, one-third of women in their 40s have given birth to eight or more children. Figures for currently married women do not differ greatly from those for all women at older ages; however, at younger ages, the percentage of currently married women who have had children is much higher than the percentage among all women. The percentage of women age 45-49 who have never had children provides an indicator of primary infertility---the proportion of women who are unable to bear children. Voluntary childlessness is rare in Nigeria, and it is likely that married women with no births are unable to bear children. The data in Table 3.5 suggest that primary infertility is low, less than 3 percent. It should be noted that this estimate does not include women who may have had one or more children but who are unable to have more (secondary infertility). 3.6 Birth Intervals Information on birth intervals provides insight into birth spacing patterns, which affect fertility as well as infant and childhood mortality. Research has shown that children born too soon after a previous birth are at increased risk of dying at an early age. Table 3.6 shows the percent distribution of births in the five years before the survey by interval since previous birth, according to background characteristics. The data show that birth intervals are generally intermediate in length in Nigeria. More than one- quarter (26 percent) of non-first births occur less than 24 months after the previous birth, which is usually considered to place the child at higher risk of illness and death. More than one-third of births take place 24- 35 months after the previous birth, with 38 percent occurring at least 3 years after the previous birth. The median birth interval is 31 months for Nigerian women, seven months longer than the minimum of 24 months considered safe for mother and child. This is almost identical to the median birth interval of 30 months reported in the 1990 NDHS (FOS, 1992:31). As expected, younger women have shorter birth intervals than older women, presumably because they are more fecund and want to build their families. The median birth interval for women age 15-19 is 27 months, compared with 36 months for women over age 40. However, birth order, sex of previous birth, and place of residence do not seem to have much influence on birth intervals. A shorter median interval also prevails for children whose preceding sibling has died, compared with those whose prior sibling is alive. Among the factors that could be responsible for the shorter birth intervals are earlier resumption of intercourse, shortened or no breastfeeding, and nonuse of contraception. Birth interval length varies according to region. Women in the Southwest and Central regions have a median birth interval of 34 months, which is five months longer than that for women in the other three regions. Birth intervals do not show much variation by level of mother's education. 40 Table 3.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth and median length of birth interval, according to selected demographic and socioeconomic charactersfics, Nigeria 1999 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Median number of months Number since of previous Total births birth Age of mother 15-19 12.1 19.3 49.3 12.8 6.5 100.0 112 26.6 20-29 12.1 17.3 40.4 17.3 12.9 100.0 2,110 29.0 30-39 10.9 13.6 32.3 21.5 21.7 100.0 2,223 33.5 40 + 11.9 11.8 25.5 22.4 28.4 100.0 492 36.3 Birth order 2-3 9.5 15.1 38.0 19.5 17.8 100.0 2,061 31.1 4-6 12.1 I5.6 33.8 19.0 19.5 100.0 1,928 31.0 7+ 14.7 14.2 33.5 20.9 I6.8 100.0 948 31.2 Sex of prior birth Male 11.3 14.8 36.6 19.2 18.1 100.0 2,564 31.0 Female 11.8 15.5 34.3 20.0 18.4 100.0 2,374 31.3 Survival ofprlor birth Dead 28.3 20.4 28.3 12.0 11.0 100.0 708 24.5 Living 8.7 14.3 36.7 20.8 19,5 100.0 4,230 32.5 Residence Urban 10.5 13.5 34.9 19,8 21.3 100.0 1,322 32.7 Rural 11.9 15.7 35.7 19.5 17.2 100.0 3,616 30.6 Region Northeast 15.1 15.5 35.9 18.1 15.5 100.0 1,113 29.4 Northwest 13.5 17.4 35.6 17.4 16.0 100.0 882 28.9 Southeast 10.9 I8.4 37.5 18.3 14.9 I00.0 937 29.3 Southwest 8.2 11.7 34.9 21.2 24.0 100.0 1,009 34.2 Central 9,7 13.2 33.7 22.7 20.8 100.0 995 33.8 Education No education 13.2 15.5 33.6 19,3 18.4 100.0 2,560 31.3 Primary 10.2 15.3 37.2 20.0 17.3 100.0 1.238 30.8 Secondary 9.3 14.3 38.2 20.4 17.8 100.0 960 31.0 Higher 8,7 13.9 35,6 I6.5 25,3 100.0 180 32,5 Total 11.5 15.1 35.5 19.6 18,3 100.0 4,938 31.1 Note: First births are excluded. The interval for multiple births is the number of months since the end of the preceding pregnancy that ended in a live birth. 3.7 Age at First Birth The age at which childbearing starts is an important demographic indicator that usually reflects the age at first marriage, even though some births occur outside marital union. It also reflects the level of contraceptive use and the magnitude of adolescent fertility. These have major health and social implications for the society. Table 3.7 presents the distribution of women by age at first birth according to current age. Childbearing begins early in Nigeria, with about half of women 25 years and above becoming mothers before reaching the age of 20. The median age at first birth is 20. The data also show that there has been no significant change in the median age at first birth between older and younger women. 41 Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Nigeria 1999 Current age Women Median with Age at fast birth Number age at no of first births <15 15-17 I8-19 20-21 22-24 25+ Total women birth 15-19 81.6 6.5 9.5 2.4 NA NA NA 100.0 1,775 a 20-24 44.3 8.5 19.2 15.I 9.1 3.7 NA 100.0 1,521 a 25-29 18.4 11.2 18.6 16.7 15.1 14.3 5.8 100.0 1,516 20.4 30-34 8.7 14.6 19.0 15.2 14.6 I6.7 11.3 100.0 1,137 20.2 35-39 3.5 12.9 20.1 17.8 I4.4 12.4 18.9 100.0 992 19.9 40-44 4.2 14.7 24.3 15.5 14.3 12.5 14.6 100.0 696 19.4 45-49 3.0 10.7 22.4 14.5 16.3 13.7 19.3 100.0 568 20.2 •Th A = Not applicable e medians for cohorts 15-19 and 20-24 could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. D i f fe rent ia l s in med ian age at f irst b i r th are shown in Tab le 3.8. The most not iceab le d i f ferent ia ls occur w i th respect to reg ion, w i th women in the northern reg ions start ing to bear ch i ldren ear l ier than those in the Centra l , Southeast , and Southwest regions. Educated women, part icu lar ly those w i th a h igher educat ion, start bear ing ch i ld ren la ter than those wi th a pr imary and secondary educat ion. Table 3.8 Median age at fast birth by background characteristics Median age at first birth among women 25-49, by current age and selected background characteristics, Nigeria 1999 Current age Women Background age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 21.8 21.6 20.3 19.9 20.5 21.0 Rural 19.9 I9.6 19.7 19.2 20.1 19.7 Region Northeast 18.1 18.4 17.8 19.1 19.9 18.2 Northwest 18.4 18.4 19.0 18.5 18.4 18.6 Southeast 22.7 20.7 20.9 19.3 20.1 21.0 Southwest 22.0 21.6 20.8 20.3 20.7 21.1 Central 20.2 19.8 19.6 18.6 20.1 19.8 Education No education 18.4 18.5 18.5 18.7 19.7 18.7 Primary 19.9 19.7 19.7 19.0 20.5 19.8 Secondary 22.9 22.2 22.1 20.8 21.6 22.4 Higher a 25.4 24.2 23.7 23.9 a Total 20.4 20.2 19.9 19.4 20.2 20.1 Note: The medians for cohorts 15-19 and 20-24 could not be determined because half of the ~oman had not had a birth before reaching the lowest age of the age group. The medians could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. 42 3.8 Teenage Pregnancy and Motherhood Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic, and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement ofteenagemothersinthe areas of educational attainment and accessibility to job opportunities may be curtailed. Table 3.9 shows the percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics. Eighteen percent of teenage women in Nigeria are mothers, while another 4 percent are pregnant with their first child. In other words, 22 percent have begun childbearing. There has been a sharp decline in this percentage, from 28 percent of teenagers in 1990 to 22 percentin 1999 (FOS, 1992:34), suggest- ing a reduction in the incidence of teen- age pregnancy over the years. As expected, the proportion of women who have begun childbearing rises rapidly with age, from 11 percent of 15-year-old women to 34 percent of 19- year-old women (see Table 3.9). The table also shows significant residential, educational and regional differentials in teenage childbearing. The level of teen- age pregnancy and motherhood in rural areas (26 percent) is more than twice the level in urban areas (12 percent). More than 50 percent of teenagers in the North- east and Northwest regions have begun childbearing, compared with only 8 per- cent in the Southwest and the Southeast and 18 percent in the Central region. Education is strongly related to early childbearing. Girls with no educa- tion are far more likely to have begun childbearing than those with primary and Table 3.9 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their ftrst child, by selected background characteristics, Nigeria 1999 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 7.9 2.8 10.8 412 16 7.8 1.7 9.4 328 17 20.3 6.I 26.4 328 18 27.8 2.7 30.5 414 19 29.8 4.5 34.3 294 Residence Urban 9.5 2.5 12.1 532 Rural 22.3 3.9 26.1 1,243 Region Northeast 43.3 8.1 51.3 269 Northwest 47.1 7.6 54.7 200 Southeast 7.3 1.0 8.3 482 Southwest 6.1 1.9 7.9 449 Central 14.5 3.1 17.6 374 Education No education 50.1 7.6 57.7 456 Primary 16.2 4.4 20.6 392 Secondary 3.9 1.1 5.0 911 Higher * * * 16 Total 18.4 3.5 21.9 1,775 Note: An asterisk indicates a figure is based on fewer than 25 cases and ha~ been suppressed. especially those with some secondary education. Fifty-eight percent of teenage women with no education have begun childbearing, compared with only 21 percent of those with a primary education and 5 percent of those with some secondary education. 43 CHAPTER4 FERTILITY REGULATION 4.1 Knowledge of Contraceptive Methods Knowledge of contraceptive methods is an important variable in any discussion of fertility regulation and in the evaluation of family planning programmes. The practice of contraception depends on knowledge of methods and the places where they can be obtained. Information on knowledge of contraceptive methods was assessed through a series of questions combining spontaneous recall and prompting procedures. Women and men were first asked to name the ways or methods by which a couple could delay or avoid pregnancy. Interviewers then asked about specific methods not mentioned spontaneously by the respondent. In all, information was sought about eight modem methods--the pill, the intrauterine device (IUD), injectables, implants, barrier methods (diaphragm, foam, and jelly), condom, and female and male sterilisation--as well as two traditional methods--periodic abstinence (safe period or rhythm method), and withdrawal. Other methods mentioned by the respondent, such as herbs or breasffeeding, were also recorded. The ability to name or recognise the name of a family planning method is a nominal test of respondents' knowledge and not a measure of how much they might know about the method. Table 4.1 presents information on women's and men's knowledge of contraceptive methods. Two- thirds (65 percent) of women age 15-49 and 82 percent of men age 15-59 know of at least one contraceptive method. The proportions of currently married respondents who have heard of a contraceptive method Table 4.1 Knowledge of contraceptive methods Percentage of all women and men, of currently married women and men, and of sexually active unmarried women and men, and women with no sexual experience who know specific contraceptive methods, Nigeria 1999 Women Men Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men Any method 65.4 64.4 91.1 53.5 82.3 83.4 98.2 Any modern method 63.1 61.9 89.1 52.5 78.7 77.9 97.8 Pill 53.4 55.1 77.7 34.9 57.4 60.7 74.4 IUD 34.2 37.6 48.3 14.6 23.8 27.7 35.2 Injectables 49.2 51.8 67.8 28.2 51.0 56.2 61.8 Diaphragm/Foam/Jelly 14.3 15.1 23.6 6.5 17.1 18.0 26.9 Condom 48.1 44.6 84.9 43.8 70.1 66.8 95.6 Female sterilisation 27.9 29.3 34.4 18.1 36.0 40.8 37.5 Male sterilisalion 10.8 11.4 17.0 5.5 18.4 20.0 24.6 Implants 11.4 12.2 17.3 5.1 10.3 12.3 14.4 Any traditional method 40.2 40.4 66.8 24.9 61.7 68.7 82.4 Periodic abstinence 31.6 30.9 58.1 20.7 47.3 54.1 62.7 Withdrawal 26.1 26.6 45.0 13.3 50.0 54.9 75.1 Traditional charms 3.7 4.6 2.0 1.6 5.9 8.1 1.4 Traditional medications 0.9 1.0 1.0 0.3 5.5 6.9 9.2 Other methods 5.2 5.4 8.8 2.0 2.4 2.6 2.7 Number of respondents 8,206 5,757 367 1,324 2,680 1,612 228 Mean number of methods 3.2 3.3 4.9 1.9 4.0 4.3 5.2 45 are almost the same as among all women and men, being only slightly lower for women and slightly higher for men. However, knowledge of contraceptive methods is considerably higher among sexually active unmarried women and men than among married and total respondents. For example, 98 percent of sexually active unmarried men have heard of a contraceptive method. Knowledge of modern methods is higher than traditional methods for all groups. Among married women, the methods most frequently recognised are the pill (55 percent) and injectables (52 percent), followed by condoms (45 percent), IUD (38 percent), periodic abstinence (31 percent), female sterilisation (29 percent), and withdrawal (27 percent). Other methods such as male sterilisation, implants, diaphragms, foam, and jelly are less known (less than 20 percent). Among sexually active unmarried women and among men, the most commonly reported method is the condom, followed by the pill and injectables. In general, men are more likely than women to have heard of the male-oriented methods such as condoms, male 8terilisation, and withdrawal. Contraceptive knowledge varies considerably, as shown in Table 4.2. The proportions of women and men who know of any method increases with age and peaks at 30-34 years for women and 45-49 years among men. The same pattern is observed for women interviewed in the 1990 Nigeria Demographic and Health Survey. Table 4.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and men who know at least one method of contraception, by selected background characteristics, Nigeria 1999 Women Men Knows Knows Number Knows Knows Number Background any modem of any modem of characteristic method method women method method men Age 15-19 37.5 36.3 472 50.3 50.3 I2 20-24 60.8 58.8 934 71.3 63.0 46 25-29 68.2 66.0 1,272 79.3 76.9 202 30-34 70.9 68.3 1,032 85.9 83.0 284 35-39 68.0 66.1 925 86.4 81.2 248 40-44 64.4 6I .0 637 85.5 80.7 222 45-49 66.5 6I .7 484 89.0 81.4 191 50-54 NA NA NA 80.6 74.5 196 55-64 NA NA NA 80.0 70.0 210 Residence Urban 83.3 82.0 1,670 93.0 90.I 460 Rural 56.7 53.7 4,087 79.5 73.0 1,152 Region Northeast 35.4 34.6 1,137 61.4 57.2 307 Northwest 42.2 39.1 986 72.0 65.2 285 Southeast 81.6 79.0 946 93.4 88.4 303 Southwest 87.2 83.7 1,367 93.8 90.4 387 Central 70.0 67.7 1,321 92.1 83.9 330 Education No education 43.6 40.5 3,032 65.9 55.7 545 Primary 80.2 77.5 1,298 86.6 80.9 476 Secondary 92.9 91.9 1,123 95.7 94.6 373 Higher 99.0 97.8 303 98.7 98.2 217 Total 64.4 61.9 5,757 83.4 77.9 1,612 NA = Not applicable 46 Urban residents are much more l ikely than rural residents to have heard of contraceptive methods. For example, 83 percent of married urban women have heard of a method, compared with only 57 percent of rural women. Knowledge is also considerably higher among southerners than among those living in the north; the proport ion of married women who know of at least one method is more than twice as high in the Southeast and Southwest regions than in the Northeast and Northwest regions. As expected, educated women and men are much more likely to know about family planning methods than those with no education. Virtually all respondents with a higher education have heard of at least one method, compared with only 44 percent of uneducated women. Because both women and men in the same households were interviewed in the 1999 NDHS, it is possible to l ink married men with their wives and analyse data for married couples. Table 4.3 shows data comparing contraceptive knowledge of wives and husbands for the 1,451 couples that could be linked. The data show a rather low level of jo int knowledge of methods. Even for the best-known methods like the pill, condoms, and injectables, in only about one-third of couples do both the husband and wife know the method. When only one partner knows a method, it is more likely to be the husband than the wife who knows it, especially if it is a male-oriented method. The only method that wives are more likely than their husbands to know about is the IUD. Table 4.3 Couples' knowledge of contraceptlve methods Percent distribution of couples by knowledge of speCtfic contraceptive methods, Nigeria 1999 Husband Wife knows knows Both method, method, Neither Background know wife husband knows characteristic method doesn't doesn't method Total Any method 55.6 25.4 5.4 13.6 100.0 Any modern method 51.6 23.9 7.3 17.2 100.0 Pill 36.9 20.2 15.5 27.4 100.0 IUD 14.8 10.0 20.3 54.9 100.0 Injectables 33.5 21.4 15.9 29.2 100.0 Diaphragm/Foam/Jelly 4.4 12.5 8.8 74.3 100.0 Condom 36.3 26.3 5.7 31.7 100.0 Female sterilisation 15.4 25.0 13.1 46.4 I00.0 Male stedlisation 4.0 14.3 7.2 74.5 100.0 Implants 2.6 8.1 7.7 81.5 100.0 Any traditional method 28.1 33.4 5.6 32.9 100.0 Periodic abstinence 21.6 27.6 6.4 44.4 100.0 Withdrawal 18.4 33.7 6.6 41.4 100.0 Note: Table is based on 1,451 couples. Knowledge of contraceptive methods has increased dramatically in Nigeria over the past nine years. In 1990, only 44 percent of married women knew any method of contraception; by 1999, this proportion had grown to 64 percent (Figure 4.1). Knowledge of the pill, IUD, iujectables, and condom all increased by about 18 to 23 percentage points. 47 Figure 4.1 Trends in Contraceptive Knowledge among Married Women 15-49, 1990 and 1999 Any method Pil l njec ab es DiaphragnVfoanY]elly ~. 7.:;:~;:; Condom Female stedlisation Male sterillsatfon ~:7 .= 1 Periodic abstinence Withdrawal ~ . 1 Source: FOS 1992:37 44 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 52 ~q';t 15 ~: J~%- : , : :> : , 29 11 :::::::::::::::::::::::::::::::::::::::::::::::::: ~7 10 20 30 40 50 60 70 80 Percent 1~m1990 NDHS ~1999 NDHS I NDHS1999 4.2 Ever Use of Family Planning Methods Ever use of contraception is defined as the use of a contraceptive method at any time during a woman's reproductive years. In collecting this information, respondents were asked whether they ever used any of the methods that they indicated they know. Results showed that use lags considerably behind knowledge. Among all women, about a quarter (27 percent) have ever used a method and less than a fifth (17 percent) have used a modern method (Table 4.4.1). Ever use is slightly higher among married women than among all women (29 vs. 27 percent). Ever use of contraceptive methods among sexually active unmarried women (66 percent) is more than double that among those who are currently married. The percentage of married women who ever used a contraceptive method is highest among the 30-34 age group (36 percent) and lowest among the 15-19 age group (7 percent). For thelatter finding, the outcome is not unexpected since women in that age group are young and may want to start families. The most commonly used method is periodic abstinence (10 percent), even though more women know about the pill, IUD, condoms and injectables. The next most widely used methods among married women are the pill (9 percent), injectables (6 percent), and condoms (6 percent). Periodic abstinence is the most commonly ever-used method among married women in most age groups, although younger women also have used the pill and condoms, while older women have used the IUD and sometimes injectables. The level of ever use has increased significantly since 1990. In 1990, only 14 percent of married women reported having ever used a contraceptive method; by 1999, this proportion had doubled to 29 percent. 48 4~ ~o Table4.4.1 Ever use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who have ever used a contraceptive method, by method and age, Nigeria 1999 Modvra method Traditional method Any Tradi- Any Diaphragm/ Female tradi- periodic Tradi- tioaal Number Any modem Inject- Foa~/ sterili- Ira- tioral absti- With- tioaal medica- Other of Age method method Pill IUD ables Jelly Condom safioa plant method nence draw~l charms tions methods women ALL WOMEN 15-19 9.2 5.9 2.8 0.1 0.5 0.0 3.5 0.0 0.0 5.0 3.4 1.5 0.0 0.1 0.8 1,775 20-24 26.4 17.1 7.5 0.8 2.0 0.1 10.4 0.0 0.0 14.7 10.4 5.5 0.3 0.1 1.9 1,521 25-29 31.5 20.4 10.5 2.0 4.6 0.6 9.7 0.0 0.0 t7.4 11.7 6.5 0.4 0.2 2.2 1,516 30-34 37.3 25.7 13.4 5.4 8.9 1.0 8.8 0.2 0.5 19.9 13.3 7.6 0.7 0.4 1.6 1,137 35-39 35.6 24.6 12.2 7.3 7.9 0.8 6.6 0.8 0.3 18.0 11.3 7.1 0.8 0.3 2.4 992 40-44 31.7 20.8 9.5 7.8 7.7 0.3 3.3 0.1 0.4 16.0 9.7 3.5 1.6 0.4 2.9 696 45-49 30.9 17.7 6.6 7.3 6.6 0.9 2.3 0.9 0.2 18.5 12.1 4.6 1.3 0.2 2.5 568 Total 27.0 17.8 8.5 3.3 4.6 0.4 6.9 0.2 0.2 14.6 9.7 5.1 0.6 0.2 1.9 8,206 CURRENTLY MARRIED WOMEN 15-19 7.2 4.8 3.4 0.0 0.9 0.0 1.4 0.0 0.0 3.8 2.6 1.2 0.0 0.0 0.4 472 20-24 20.5 12.1 5.9 0.6 2.0 0.1 6.1 0.0 0.0 11.8 8.0 3.9 0.4 0.1 1.8 934 25-29 29.0 18.1 10.0 1.9 4.4 0.6 7.2 0.0 0.0 16.3 10.5 6.3 0.5 0.2 2.0 1,272 30-34 36.0 23.7 12.7 5.1 8.8 0.7 7.2 0.2 0.4 19.8 12.8 7.7 0.8 0.3 1.8 1,032 35-39 35.3 24.3 12.0 7.0 8.0 0.8 6.2 0.9 0.2 18.1 11.5 7.1 0.9 0.2 2.0 925 40-44 32.0 21.1 9.3 8.1 7.7 0.3 3.4 0.2 0.5 16.2 10.I 3.8 1.3 0.3 2.7 637 45-49 32.4 19.4 7.3 7.9 6.7 1.1 2.5 0.8 0.2 19.3 13.0 5.2 1.3 0.2 2.1 484 Total 28.7 18.5 9.3 4.1 5.7 0.5 5.6 0.3 0.2 15.7 10.2 5.5 0.7 0.2 1.9 5,757 UNMARRIED SEXUALLY ACITv'E WOMEN 15-I9 53.0 29.6 13.2 0.0 3.1 0.0 21.6 0.0 0.0 34.0 19.8 11.1 0.0 0.0 12.1 103 20-24 74.l 54.4 23.3 3.9 5.8 0.0 36.3 0.0 0.0 40.4 31.2 19.0 0.8 0.0 3.5 135 25+ 69.0 59.1 25.9 11.4 10.4 4.0 38.5 0.0 0.0 28.6 21.7 11.3 0.0 1.2 3.8 130 Total 66.4 49.1 21.4 5.5 6.7 1.4 33.0 0.0 0.0 34.4 24.6 14.1 0.3 0.4 6.0 367 L~ Table 4.4.2 Ever use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used a contraceptive method, by method and age, Nigeria 1999 Modern method Traditional method Any Tradi- Any Diaphragm/ Female Male tradi- periodic Tradi- tional Number Any modem Inject- Foam/ sterili- sterili- Ira- tional absti- With- tionaI medica- Other of Age method method Pill IUD ables Jelly Condom sation sation plant method nenee drawal charms tions methods men ALL MEN I5-19 13.9 10.9 1.7 0.0 0.2 0.0 10.1 0.0 0.0 0.2 6.0 2.9 4.0 0.0 0.0 0.6 511 20-24 36.4 30.1 2.5 0.3 0.6 1.2 29.4 0.0 0.0 0.0 19.1 12.I i l l 0.0 0.0 1.1 319 25-29 44.7 35.6 6.1 0.3 4.5 0.8 32.0 0.3 0.3 0.0 25.8 17.4 i5.8 0.6 0.3 0.6 366 30-34 50.1 31.1 5.9 0.7 5.1 0.0 26.7 0.0 0.0 0.0 34.1 26.4 19.2 0.6 0.5 0.6 348 35-39 45.1 29.1 7.9 2.4 5.5 0.2 24.3 0.4 0.0 0.2 33.8 27.7 16.5 0.6 0.4 1.9 275 40-44 47.6 26.1 9.0 0.7 9.1 0.4 18.5 1.3 0.0 0.0 35.2 27.1 18.1 1.3 0.9 0.4 239 45-49 48.0 23.0 8.2 1.0 5.2 1.5 17.9 1.0 0.5 0.0 39.4 33.1 17.2 1.5 0.5 1.0 197 50-54 52.6 28.9 6.9 2.7 6.5 1.8 20.5 2.4 0.3 0.0 40.9 37.4 16.4 0.0 1.7 0.8 205 55+ 46.3 16.3 7.1 2.9 2.6 0.5 11.3 0.9 0.5 0.0 38.9 33.8 9.0 2.7 4.6 0.9 220 Total 39.8 25.1 5.6 1.0 3.9 0.6 21.2 0.5 0.1 0.1 27.2 21.1 13.3 0.7 0.8 0.8 2,680 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * 12 20-24 (26.7) (18.1) (4.6) (0.0) (0.0) (0.0) (15.6) (0.0) (0.0) (0.0) (19.9) (15.3) (11.3) (0.0) (0.0) (0.0) 46 25-29 35.6 25.4 7.6 0.0 3.5 0.4 20.2 0.5 0.5 0.0 23.8 17.8 14.2 0.6 0.5 0.5 202 30-34 47.3 27.2 6.2 0.8 4.6 0.0 22.2 0.0 0.0 0.0 35.6 28.0 19.4 0.4 0.6 0.4 284 35-39 42.3 25.7 7.6 2.7 5.6 0.3 20.5 0.4 0.0 0.3 32.4 26.7 15.2 0.7 0.4 2.1 248 40-44 48.3 26.0 8.8 0.8 9.5 0.5 18.3 1.4 0.0 0.0 36,2 27.9 19.0 1.4 0.9 0.4 222 45-49 47.9 22.6 8.0 1.0 4.9 1.6 17.9 1.1 0.6 0.0 39.6 33.1 I7.2 1.6 0.0 1.0 191 50-54 53.0 29.8 7.3 2.9 6.8 1.9 21.0 2.5 0.3 0.0 41.2 37.4 17.1 0.0 1.8 0.9 196 55+ 46.1 15.7 7.0 3.0 2.7 0.5 i0.4 0.9 0.5 0.0 39.4 34.4 8.4 2.3 3.9 1.0 210 Total 45.1 24.5 7.3 1.5 5.2 0.6 18.7 0.9 0.2 0.1 34.8 28.7 15.8 0.9 1.1 0,9 1,612 UNMARRIED SEXUALLY AC£1NE MEN 15-19 (61.4) (52.4) (11.0) (0.0) (2.6) (0,0) (50.3) (0.0) (0.0) (0.0) (30.1) (16.4) (22.7) (0.0) (0.0) (2.6) 43 20-24 77.7 67.3 6.4 1.2 2.3 5.0 67.3 0.0 0.0 0.0 44.9 25.1 31.1 0.0 0.0 1.6 77 25+ 84.4 74.9 7.8 0.0 13.1 0.0 73.2 0.0 0.0 0.0 44.0 28.9 31.2 0.0 0.9 0.0 107 Total 77.8 68.0 7.9 0.4 7.4 1.7 66.8 0,0 0.0 0.0 41.6 25.2 29.6 0.0 0.4 1.0 228 Note: Figures in parentheses ~xe based on 25-49 cases. An asterisk indicates a figure is based on fewer than 25 cases and has been suppressed. As is the case for women, married men are somewhat more likely than all men to have used a contraceptive method (45 vs, 40 percent), whereas sexually active unmarried men are by far the most likely to have used a method (78 percent). As shown in Table 4.4.2, periodic abstinence is also the most commonly used method among married men (29 percent) as well as women. This method is followed by condoms (19 percent), withdrawal (16 percent), and then the pill (7 percent). 4.3 Current Use of Family Planning Methods Current use of family planning methods refers to the use of contraceptive methods at the time of the survey. Analysis of current use of family planning methods is conventionally based on women who are currently married, since they are the most likely to be regularly exposed to the risk of pregnancy. Only 15 percent of married women are currently using any method, while only 9 percent are using a modern method (Table 4.5.1). Although the percentage is low even for the sub-Saharan region, there has been an improvement since 1990, when only 6 percent of married women were reported to be using any method and only 4 percent were reported to be using a modern method (FOS, 1992: 42- -see Figure 4.2). The most commonly used method is periodic abstinence (rhythm method), which is used by 5 percent of married women. This method is followed by pills, injectables, and the IUD, which are used by 2 percent of married women each. Contraceptive use is highest among married women in their 30s and early 40s (about 20 percent) and lowest among the 15-19 age group (4 percent). This finding is expected since younger women are more likely than older women to want another child soon. While periodic abstinence is the most widely used method for all age groups, younger women are the next most likely to use either injectables or the pill, while older women are more likely to use IUDs. One-third of married men report that they are currently using a family planning method (Table 4.5.2). As among married women, married men report periodic abstinence as the major method (used by 15 percent). However, the next most commonly used method among men is condoms (6 percent). That use of periodic abstinence as reported by married men is considerably higher than as reported by married women has been found in other DHS surveys, and one theory is that men may mistake periodic abstinence for long-term abstinence. 51 L~ to Table 4.5.1 Current use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who are currently using a contraceptive method, by method and age, Nigeria 1999 Modem method Traditional method Any Any I)iaphr agm/ Female tradl- Periodic Iqot /qtmther Any modem Inject- Foam/ sterili- tioaal absti- With- Other currently of Age method method Pill IUD ables Jelly Condom sation Implant method neltee drawal methods using Total women ALL WOMEN 15-19 6.6 3.2 1.3 0.0 0.1 0.0 1.8 0.0 0.0 2.9 2.2 0.7 0.5 93.4 100.0 1,775 20-24 16.0 7.9 3.i 0.4 0.4 0.1 3.9 0.0 0.0 7.0 5.2 1.8 1.1 84.0 I00.0 1,521 25-29 17.2 8.8 2.8 1.1 2.0 0.2 2.7 0.0 0.0 7.3 5.7 1.5 1.2 82.8 I00.0 1,516 30-34 20.8 13.6 4.0 1.9 4.5 0.3 2.6 0.2 0.1 6.6 5.0 1.6 0.6 79.2 100.0 1,137 35-39 20.5 13.3 3.5 4.2 3.4 0.2 1.1 0.8 0.1 6.6 5.3 1.4 0.6 79.5 100.0 992 40-44 19.8 11.7 1.9 4.5 3.6 0.0 1.2 0.1 0.3 5.6 4.8 0.8 2.5 80.2 1130.0 696 45-49 I&9 8.7 1.7 3.5 1.8 0.2 0.7 0.9 0.0 5.2 4.7 0.5 0.9 85.1 100.0 568 Total 15.7 8.9 2.6 1.7 1.9 0.1 2.3 0.2 0.0 5.8 4.6 1.2 1.0 84.3 I00.0 8,206 CURRENTLY MARRIED WOMEN 15-19 4.2 1.2 1.0 0.0 0.0 0.0 0.2 0.0 0.0 2.5 2.0 0.5 0.4 95.8 100.0 472 20-24 8.2 2.6 1.1 0.1 0.2 0.1 1.0 0.0 0.0 4.7 3.5 1.2 0.9 91.8 100.0 934 25-29 13.9 6.7 2.2 0.9 1.9 0.2 1.6 0.0 0.0 6.1 4.6 1.5 t.1 86.1 100.0 1,272 30-34 20.1 I2.7 4.0 1.8 4.5 0.2 1.9 0.2 0.1 6.7 5.0 1.6 0.7 79.9 I00.0 1,032 35-39 20.7 13.3 3.6 3.7 3.6 0.2 1.2 0.9 0.1 7.1 5.7 1.5 0.3 79.3 100.0 925 40~14 20.5 12.1 2.1 4.8 3.6 0.0 1.2 0.2 0.3 5.9 5.1 0.8 2.4 79.5 100.0 637 45-49 16.5 9.4 1.9 4.I 1.8 0.2 0.6 0.8 0.0 6.2 5.5 0.6 0.9 83.5 160.0 484 Total 15.3 8.6 2.4 2.0 2.4 0.2 1.2 0.3 0.1 5.8 4.6 1.2 0.9 84.7 100.0 5,757 S ExzrALLY ACITqE UNMARRIED WOMEN" 15-19 46.6 23.0 6.9 0.0 1.0 0.0 15.I (tO 0.0 17.5 12.2 5.3 6.1 53.4 100.0 103 20-24 68.3 40.4 17.7 3.1 2.3 0.0 I7.3 0.0 0.0 25.1 19.2 5.9 2.8 31.7 I00.0 135 25+ 58.0 40.2 12.2 8.2 4.4 0.8 I4.6 0.0 0.0 14.2 11.7 2.5 3.6 42.0 100.0 130 Total 58.6 35.4 12.7 4.0 2.7 0.3 15.7 0.0 0.0 19.1 14.6 4.5 4.0 41.4 1O0.0 367 t~ Table 4.5.2 Current use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who are ettrrently using a contraceptive method, by method and age, Nigeria 1999 Modem method Traditional method Any Any modem inject- Age method method Pill IUD ables ALL MEN Any Diaphragm/ Female tradl- Peliodie Not Nura~r Foam/ sterili- tional abstl- With- Other currently of Jelly Cc~adom satloa method hence drawal methods using Total mesa 15-19 9.2 6.4 1.1 0.0 0.0 0.0 5.3 0.0 2.4 1.6 0.8 0.4 90.8 100.0 511 20-24 21.2 14.9 1.3 0.0 0.4 0.3 12.9 0.0 5.6 4.1 1.5 0.7 78.8 100.0 319 25-29 27.5 19.8 2.8 0.0 2.5 0.0 14.5 0.0 7.8 6.5 1.3 0.0 72.5 100.0 366 30-34 33.6 17.1 3.3 0.3 2.1 0.0 11.4 0.0 15.9 12.7 3.2 0.6 66.4 100.0 348 35-39 32.0 16.3 5.4 1.1 2.0 0.0 7.8 0.0 15.4 12.1 3.2 0.3 68.0 100.0 275 40-44 33.9 16.3 5.2 0.0 4.8 0.0 5.9 0.4 16.7 13.8 2.9 0.8 66.1 100.0 239 45-49 35.3 13.5 4.0 0.5 2.1 0.0 6.3 0.5 21.2 18.6 2.6 0.6 64.7 100.0 197 50-54 39.6 19.1 3.4 1.9 4.1 0.5 7.9 1.4 19.5 18.0 1.5 0.9 60.4 100.0 205 55+ 30.8 8.6 3.1 1.7 0.9 0.0 2.0 0.9 19.1 19.1 0.0 2.1 69.2 100.0 220 Total 26.9 14.2 3.0 0.5 1.8 0.1 8.6 0.2 11.9 10.1 1.8 0.7 73.1 100.0 2,680 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * * 12 20-24 (6.2) (2.0) (0.0) (0.0) (0.0) (0.0) (2.0) (0.0) (4.3) (4,3) (0.0) (0.0) (93.8) 100.0 46 25-29 24.4 14.5 3.6 0.0 2.6 0.0 8.3 0.0 9.9 8.4 1.5 0.0 75.6 100.0 202 30-34 31.6 14.2 3.7 0.4 1.7 0.0 8.3 0.0 17.0 13.0 4.0 0.4 68.4 100.0 284 35-39 29.8 14.3 4.9 1.2 2.0 0.0 6.2 0.0 15.2 11.6 3.6 0.3 70.2 100.0 248 40~ 35.2 16.3 5.1 0.0 4.9 0.0 5.9 0.4 18.0 14.8 3.2 0.9 64.8 100.0 222 45-49 35.9 13.9 4.2 0.5 2.2 0.0 6.5 0.5 21.4 18.7 2.7 0.6 64.1 1G0.0 191 50-54 41.3 20.0 3.6 2.0 4.2 0.5 8.2 1.4 20.4 18.8 1.6 1.0 58.7 100.0 196 55+ 31.4 8.5 3.3 1.7 1.0 0.0 1.6 0.9 20.1 20.1 0.0 2.9 68.6 100.0 210 Total 31.8 I4.1 3.9 0.8 2.5 0.1 6.4 0.4 16.9 14.5 2.4 1.7 68.2 100.0 1,612 SEXUALLY ACTIVE UNMARRIED MEN 15-19 (39.4) (27.7) (5.9) (0.0) (0.0) (0.0) (21.9) (0.0) (9.0) (9.0) (0.0) (2.6) (60.6) 100.0 43 20-24 50.3 38.6 4.2 0.0 1.6 i.I 31.7 0.0 11.7 6.9 4.8 0.0 49.7 100.0 77 25+ 57.4 47.4 4.0 0.0 5.9 0.0 37.4 0.0 10.0 9.1 1.0 0.0 42.6 100.0 107 Total 51.6 40.7 4.4 0.0 3.3 0.4 32~5 0.0 10.4 8.3 2.1 0.5 48.4 100.0 228 Note: Figures in parentheses ambased oa 25-49 cases. Anastefiskinthcates afigur~isbased on fewer thaa 25 cases andhasbeensuppressed. Figure 4.2 Current Use of Contraceptive Methods among Currently Married Women, 1990 and 1999 Percent Any Method Any Current Method II~INDHS 1990 I~NDHS 19991 NDHS1999 Contraceptiveuseis far from uniform across all sub-groups ofthepopulation. Tables4.6.1 and 4.6.2 show differentials in contraceptive use among married women and men, respectively. Among married women, use is almost twice as high in urban than in rural areas (23 versus 12 percent--see Figure 4.3). The proportion of married women using any method is about eight times higher in the two southern regions than in the two northern regions (24 to 26 percent versus 3 percent); it is intermediate in the Central region (18 percent). Women in the south are much more likely than those in the north to use traditional methods. The proportion of womenusing contraceptives also varies with educational level. Thehigher the level of education, the higher the proportion of women using a method. Contraceptive use rises from 6 percent for women with no education to 45 percent for women with a higher education. A similar pattern is observed with specific methods, whether modern or traditional. As expected, contraceptive use increases with the number of living children, from 3 percent of married women with no children to 21 percent of women with four or more children. Differentials in use among married men are similar to those for married women (Table 4.6.2). Use is higher among urban men, those in the south, men with more education, and those with more children. 54 Table4.6.1 Curmntuseofcontraceplionbybackgroundcharacturistics: women Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Nigeria 1999 Modem method Traditional method Any Any Diaphragm/ Female tradi- Periodic Background Any modem Inject- Foam/ sterili- tional absti- characteristic method method Pill IUD ables Jelly Condom sation Implant method nenee Not With- Other currently drawal methods using Residence Uth~m 23.4 15.7 5.5 4.0 3.0 0.4 2.5 0.2 0.2 6.4 Rural 12.0 5.6 1.2 1.2 2.1 0.1 0.7 0.3 0.0 5.6 Total N~bcr of womcIl Education No education 6.0 3.I 0.7 0.7 1.1 0.0 0.3 0.2 0.0 2.3 2.1 0.2 0.6 94.0 100.0 3,032 Primary 19.9 10.1 3.3 2.5 2.6 0.1 1.5 0.2 0.0 8.5 6.6 1.9 1.3 80.1 I00.0 1,298 Secondary 27.1 16.2 5.0 3.1 4.7 0.4 2.6 0.3 0.2 9.6 7.3 2.3 1.3 7Z9 100.0 1,123 Higher 44.8 28.0 6.6 8.7 5.8 1.0 4.6 0.7 0.7 15.9 10.6 5.3 1.0 55.2 100.0 303 No. of living children 0 3.3 1.3 0.7 0.0 0.1 0.0 0.5 0.0 0.0 1.9 1.2 0.8 0.0 96.7 100.0 585 1 8.0 3.5 1.5 0.2 0.4 0.3 1.1 0.0 0.0 3.9 2.9 1.0 0.6 92.0 100.0 944 2 14.3 7.8 2.8 1.2 1.1 0.0 2.3 0.2 0.2 5,9 4.9 0.9 0.0 85.7 100.0 931 3 I8.0 8.7 2.8 2.5 1.9 0.1 1.2 0.1 0.1 7.8 5.8 2.0 1.5 82.0 100.0 886 4+ 20.5 12.5 3.0 3.3 4.4 0.2 1.1 0.5 0.0 6.8 5.5 1.3 1.2 79.5 100.0 2,412 Total 15.3 8.6 2.4 2.0 2.4 0.2 1.2 0.3 0.1 5.8 4.6 1.2 0.9 84.7 100.0 5,757 Region Northeast 3.1 2.2 1A 0.1 0.7 0.0 0.1 0.0 0.0 0.7 0.5 0.3 0.1 96.9 100.0 1,137 Noithwest 3.2 2.5 1.I 0.2 0.9 0.0 0.1 0.I 0.0 0.2 0.1 0.1 0.6 96.8 100.0 986 Southeast 23.5 9.1 1.9 1.5 3.1 0.2 1.9 0.5 0,0 12.9 9,4 3.4 1,5 76.5 100,0 946 Southwest 26.2 15.5 4.2 5.2 2.6 0.3 2.9 0.2 0.2 9.I 7.1 1.9 1.6 73.8 100.0 1,367 Central 17.8 10.9 2.9 2.1 4.2 0.2 1.0 0.5 0.1 6.0 5.4 0.6 0.9 82.2 100.0 1,321 4.6 1.9 1.2 76.6 100.0 1,670 4.6 1.0 0.8 88.0 100.0 4,087 L/I OX Table 4.6.2 Current use of contraceptiou b 7 background characteristics: men Percent distribution of currently married men by contraceptive method currently used, according to selected background characteristics, Nigeria 1999 Modea-a method Traaition~l meXhod Any Tradi- Any Diaphragm/ Female tradi- Periodic Tradi- tioual Not Number Background Any modem Inject- Foam/ sterili- tional abstl- With- tional medl- Otlmr catrtentiy of characteristic method method Pill IUD ables J~lly Condom safion method neaee drawal ehmxns cations methods using Total men Residence Urban 39.3 24.4 8.4 1.3 2.7 0.2 11.5 0.2 14.6 11.8 2.8 0.2 0.2 0.0 60,7 100.0 460 Rural 28.9 10.0 2.1 0.6 2.4 0.0 4.4 0.5 17.9 15.6 2.2 03 0.4 0.2 71.1 160.0 1,152 Region Northeast 7.2 5.2 2.9 0.0 0.6 0.0 1.7 0.0 1.9 1.3 0.7 0.0 0.0 0.0 92,8 100.0 307 Northwest 3.0 1.5 0.3 0.0 0.9 0.0 ().3 0.0 0.0 0.i) 0.6 1.t 0.4 0.0 97,0 100.0 285 Southeast 53.3 14.3 2.6 1.0 4.0 0.0 4.9 1.8 38.6 34.7 4.0 0.0 0.0 0.3 46.7 100.0 303 Southwest 533 24.9 4.3 1.7 2.6 0.2 16.0 0.0 26.7 22.0 4.7 0.4 1.0 0.3 46,7 100.0 387 Central 34.9 20.5 8.7 0.9 4.3 0.0 6.3 0.3 l&2 12.2 1.9 0.0 0.3 0.0 65,1 100.0 330 Education No vducation 12.0 2.3 1.2 0.2 0.4 0.0 0.5 0.0 8.8 8.6 0.2 0.3 0.6 0.0 88,0 100.0 545 Primary 38.2 13.5 3.9 0.8 2.1 0.0 5.7 1.0 23.4 21.1 2.4 0.4 0.4 0.4 61,8 100.0 476 Secondary 40.2 21.6 5.3 0.8 3.2 0.0 12.1 0.2 18.0 14.1 4.0 0.3 0.2 0.0 59,8 100.0 373 Higher 53.4 32.4 8.4 2.2 7.5 0.4 13.4 0.5 21.0 15.8 5.2 0.0 0.0 0.0 46,6 100.0 217 No. of living children 0 14.3 9.4 0.8 0.0 0.8 0.0 7.8 0.0 4.9 4.9 0.0 0.0 0.0 0.0 85,7 100.0 145 1 26.0 10.9 3.2 0.6 0.6 0.0 6.4 0.0 15.1 10.8 4.3 0.0 0.0 0.0 74,0 100.0 181 2 31.4 13.2 3.2 1.0 1.5 0.0 Z4 0.0 18.2 13.5 4.7 0.0 0,0 0.0 68,6 1G0.0 198 3 34.3 16.5 4.1 0.0 3.5 0.0 8.9 0.0 16.9 14.3 2.7 0.4 0.5 0.0 65.7 100.0 223 4+ 35.5 15.2 4.7 1.1 3.2 0.I 5.4 0.8 19.0 17.2 1.8 0.5 0.6 0.2 64.5 100.0 865 Total 31.8 14.1 3.9 0.8 2.5 0.1 6.4 0.4 16.9 14.5 2.4 0.3 0.4 0.1 68.2 i00.0 1,612 Figure 4.3 Use of Family Planning Among Married Women, by Background Characteristics, Nigeria 1999 RESIDENCE Urban :.:.x.:-:-:.:.123 Rural 12 REGION Northeast Northwest Southeast Southwest Central EDUCATION NO ettucat/on i Primary [ Secondary ! Higher 0 10 20 30 40 50 Percent ImModarn Methods E3Tradhional Methods I 60 NDHS19gg 4.4 Number of Children at First Use of Family Planning Methods The NDHS included a question for all women who had ever used a method as to how many living children they had when they first used a method. Table 4.7 shows the distribution of ever-married women by the number of living children they had when they first used a method, according to f ive-year age group. These data enable the examination of both periodic and cohort changes in the timing of the initiation of contraceptive use during the family building process. Table 4.7 Number of children at first use of contraception Percent distribution of ever-marrled women by number of living children at the time of first use of contraception, according to current age, Nigeria 1999 Never used Number of living children at time of first use of contraception Number contra- of Current age ception 0 1 2 3 4+ Missing Total women 15-19 93.0 3.7 1.9 0.6 0.2 0.0 0.6 100.0 489 20-24 79.1 9.9 6.7 2.6 0.9 0.1 0.6 100.0 966 25-29 70.8 8.8 10.3 4.8 2.5 2.7 0.2 100.0 1,319 30-34 63.5 6.5 11.0 6.9 5£ 6.1 0.4 I00.0 1,079 35-39 64.2 5.5 7.6 5.5 4.5 12.1 0.6 100.0 974 40-44 68.0 4.5 5.2 3.5 3.5 14.8 0.6 100.0 687 45-49 68.8 4.5 8.6 2.6 1.4 13.5 0.7 100.0 562 Total 71.0 6.7 8.0 4.2 2.9 6.5 0.5 100.0 6,076 Overall, 19 percent of women initiated contraceptive use when they had fewer than three living children, with 7 percent initiating use before having the first child, 8 percent after having the first child, and 4 percent after having the second child. Younger cohorts of women have a tendency to initiate family planning use at lower parities than older cohorts. For example, while less than 16 percent of 57 women age 40 and older initiated family planning use before having three children, the proportion rises with younger cohorts, reaching 24 percent among women age 25-34 years. This pattern probably reflects the fact that young women are more likely to use family planning to space births, while older women are more likely to use family planning to l imit births. The trend toward initiating family planning use at lower parities can also be seen by comparing data from the 1990 and 1999 NDHS surveys. For example, in 1990, only 8 percent of women reported initiating contraceptive use when they had fewer than three children, compared with 19 percent in 1999. 4.5 Knowledge of the Fertile Period Table 4.8 presents the distribution of all women and those who have ever used per iodic abstinence in relation to their reported knowledge of the fertile period in the menstrual cycle. The most common response given by the women was "don't know" (45 percent). Only 14 percent of women correctly identified the middle of the menstrual cycle as the time a woman is most likely to get pregnant. When compared with the results from the 1990 NDHS (20 percent), the 1999 data show a decline. Knowledge of the fertile period is somewhat better among women who say they are using periodic Table 4.8 Knowledge of fertile period Percent distribution of users of periodic abstinence and of all women by knowledge of the fertile period during the ovulatory cycle, Nigeria 1999 Users of Perceived perloffxc All fertile period abstinence women During menstrtlal period 0.3 0.6 Right after period has ended 29.4 19.2 Halfway between periods 27.3 13.6 Just before period begins 3.0 2.1 At any time 13.5 18.7 Other 0.6 0.4 Don't know 25.2 44.6 Missing 0.7 0.8 Total 100.0 100.0 Number 375 8,206 abstinence as a method of family planning. However, even among these women, only 27 percent gave the correct answer ("halfway between periods" or "the middle of the cycle"), while 25 percent said they didn't know when a woman is most likely to get pregnant, and 14 percent said a woman can get pregnant any time. 4.6 Contraceptive Effect of Breastfeeding Breastfeeding is an important variable because of its effect on fecundity, spacing of births, and conception. It has been proved scientifically that exclusive hreastfeeding does prolong the period of postpartum infecundity. And for many years, women themselves in various cultures have recognised that prolonged breastfeeding lengthens the period of postpartum infecundity and birth intervals. Thus, hreastfeeding, if exclusively practised immediately after birth, can be an effective method of family planning. Table 4.9 presents the distribution of women by knowledge of the effects of breastfeeding on the risk of pregnancy by background characteristics. Half (51 percent) of the women believe that breastfeeding has no influence on the risk of pregnancy. However, 29 percent indicate that breastfeeding influences the risk of conception, with 5 percent saying that it increases the risk of pregnancy, 13 percent saying that it decreases the risk of pregnancy, and 10 percent saying it depends. Twenty percent of women do not know whether hreastfeeding increases or decreases the risk of pregnancy. Knowledge of the contraceptive effect of breastfeeding is higher in the Southeast (25 percent) and Southwest regions (18 percent) than in the other regions. The nigher the level of education, the more likely a woman will know that breastfeeding can decrease the risk of pregnancy. 58 Table 4.9 Perceived contraceptive effect of breastfeedlng Percent distribution of currently married women by perceived risk of pregnancy associated with breasffeeding and percentage of currently married women who previously relied and who currently rely on breastfeeding to avoid pregnancy and percentage who meet laetational amenorrhoeic method (LAM) criteria, according to selected background characteristics, Nigeria 1999 Perceived risk of pregnancy associated with breastfeeding Reliance on breastfeeding to avoid pregnancy Meet Number Background Un- In- De- Don't Previ- Cur- LAM of characteristic changed creased creased Depends know Missing Total ously rently criteria women Age 15-19 45.7 4.4 6.3 5.3 38.2 0.2 100.0 2.4 1.8' 7.9 472 20-24 53.7 5.8 10.3 8.0 21.7 0.5 100.0 6.5 3.3 6.1 934 25-29 50.7 5.2 12.7 11.2 19.5 0.8 100.0 8.0 4.0 5.1 1,272 30-34 53.7 4.5 14.1 10.3 17.1 0.2 I00.0 9.3 5.8 3.5 1,032 35-39 48.7 5.3 16.0 12.1 17.6 0.3 100.0 10.1 3.7 3.9 925 40-44 48.1 4.4 16.4 11.1 19.0 1.0 100.0 10.1 3.9 1.8 637 45-49 50.0 5.8 15.2 11.5 16.6 1.0 100.0 9.6 1.7 0.4 484 Residence Urban 49.1 5.1 15.9 10.4 18.8 0.7 100.0 9.3 4.0 3.5 1,670 Rural 51.3 5.1 12.0 10.1 21.0 0.5 100.0 7.8 3.7 4.6 4,087 Region Northeast 50.8 3.7 6.4 10.8 27.4 0.9 100.0 4.1 2.8 6.2 1,137 Northwest 62.6 5.0 9.9 4.7 17.5 0.2 100.0 6.9 3.9 5.1 986 Southeast 41.1 5.6 25.2 10.3 17.2 0.6 100.0 18.0 6.6 2.7 946 Southwest 46.8 7.5 18.0 12.3 14.7 0.7 100.0 8.3 4.0 3.4 1,367 Central 52.3 3.5 7.8 11.5 24.5 0.4 100.0 5.7 2.4 4.1 1,321 Education No education 53.7 4.3 8.7 8.9 23.7 0.7 100.0 5.5 2.9 4.5 3,032 Ptimary 47.6 5.3 15.8 11.8 19.1 0.5 100.0 11.4 5.2 4.2 1,298 Secondary 47.3 7.0 18.3 11.4 15.7 0.4 100.0 11.2 4.9 4.7 1,123 Higher 45.3 5.0 27.1 12.0 10.0 0.6 100.0 10.9 2.7 0.9 303 Tot~ 50.6 5.1 13.2 10.2 20.4 0.6 100.0 8.2 3.8 4.3 5,757 The last few columns in Table 4.9 show that 8 percent of women say they have used breastfeeding as a means to delay a pregnancy and 4 percent say they are currently doing so. Using data from other questions in the NDHS on duration since last birth and current breastfeeding status, 4 percent of respondents can be said to meet the criteria for using lactational amenorrhoea; that is, they are currently breastfeeding a child who is less than six months of age and they are not supplementing the breast milk with any other food or liquid. Curiously, although women in the Southeast region are by far the most likely to say they have used breastfeeding as a contraceptive and that they are currently doing so, they are the least likely to fit the criteria for effective use. 4.7 Sources of Family Planning Methods Information on sources of modern contraceptives is useful for family planning programme managers and implementors. In the 1999 NDHS, women who reported using a modern method of contraception at the t ime of the survey were asked where they most recently obtained the method. Table 4.10 and Figure 4.4 show that equal proportions of users obtain their methods from public sector (government) sources (43 percent) and private medical sources (43 percent). The main sources of contraceptives in the public sector are government hospitals (23 percent), health centres (12 percent), and public family planning clinics (7 percent). Among the private medical sources, pharmacies and patent medical stores account for the largest proportion (32 percent). Other private sources, such as shops and friends and relatives, account for 8 percent of current users. 59 Table 4.10 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Nigeria 1999 An Inject- modern 1 Source of supply Pill IUD ables Condom methods Public sector 29.1 74.4 68.6 12.9 42.9 Government hospital 16.0 48.3 28.0 3.8 23.0 Government health centre 4.7 19.1 26.0 5.9 12.2 Family planning clinic 6.8 6.3 12.1 2.5 6.5 Moblie clinic 0.0 0.0 0.6 0.6 0.3 Community health worker 1.0 0.7 1.2 0.0 0.7 Other public 0.5 0.0 0.6 0.0 0.3 Private medical sector 53.1 19.5 27.0 62.7 42.9 Private hospitaYclinic 4.3 17.4 I4.4 5.6 10.0 Pharmacy/patent reed. store 47.4 1.5 9.3 56.5 31.5 Private doctor 0.0 0.6 2.5 0.6 0.8 Private mobile clinic 0.5 0.0 0.0 0.0 0.2 Private community health worker 0.0 0.0 0.7 0.0 0.2 Other private medical 0.9 0.0 0.0 0.0 0.3 Other private 11.8 1.6 1.9 15.4 8.4 Shop 2.3 0.0 0.7 4.8 2.1 Church 0.4 0.0 0.6 0.0 0.4 Friends/relatives 5.6 0.0 0.7 9.4 4.2 Nongovemment organizatinn 0.0 0.8 0.0 0.0 0.2 Other 3.5 0.8 0.0 1.1 1.5 DoJa't know/missing 6.0 4.5 2.5 9.1 5.8 Total 100.0 100.0 100.0 100.0 100.0 Number of women 216 137 159 186 728 Note: Totals include 10 users of diaphragm/foam/jelly, 16 users of female sterilisation, ] and 4 users of implants. Figure 4.4 Source of Family Planning Methods among Current Users of Modern Methods, Nigeria 1999 Private medical 43% Other 8% know/Missing 7% NDHS1999 60 Overall, public sector sources supply three-quarters of IUD users and more than two-thirds of injectable users. Users of pills and condoms, however, on the other hand, are more l ikely to go to private medical sources, especially pharmacies. 4.8 Intention to Use Family Planning Among Non-Users An important indicator of the changing demand for family planning is the extent to which non- users of contraception plan to use family planning in the future. Women and men who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. The results are presented in Table 4.11. Among both women and men, 23 percent of currently married non-users say they intend to use family planning in the future, with slightly more than half saying they intend to use in the next 12 months. Sixty percent of married women and 57 percent of married men say they do not intend to use family planning, while 15 percent of women and men are unsure as to whether they will use or not. Among women, the intent to use in the next 12 months increases somewhat with the number of l iving children. Table 4.11 Future use of contraception Percent distribution of currently married women and men who are not using a contraceptive method by intention to use a method in the future, according to number of living children (women), Nigeria 1999 Future use of contracoptlon Number of living children 1 0 1 2 3 4+ women men Intend to use in next 12 months 2.9 10.8 14.4 14.8 16.3 13.7 11.8 Intend to use later 10,2 11.8 10.2 8.3 5.7 8.3 10.1 Unsure as to 6ruing 0,6 0.8 0.9 0.3 0.8 0.7 0.9 Unsure as to intention 19,8 17.5 16.4 15.7 12.9 15.3 14.8 Do not intend to use 65.5 57.6 56.7 59.1 62.2 60.3 56.8 Don't know/Missing 0.9 1.5 1.4 1.8 2.3 1.8 5.7 Total 100,0 100,0 100.0 100.0 I00.0 100.0 100,0 Number of woman/men 395 880 802 747 2,051 4,875 1,098 1 Includes current pregnancy 4.9 Reasons For Nonuse To better inform programmes aimed at contraceptive education and encouragement of use, the NDHS included questions about why respondents do not intend to use family planning in the future. The main reasons for not using family planning given by currently married nonusers who do not intend to use a contraceptive method in the future are presented in Table 4.12. The important reasons given by women are a desire for more children, opposition to family planning, lack of knowledge about methods, and religious prohibitions about using. Younger women are more likely to say that they want more children, while a larger proportion of older women say they do not intend to use because they are menopausal or they have had a hysterectomy. 61 Table 4.12 Reasons for not intending to use contraception Percent distribution of currently married women and men who are not using a contraceptive method and who do not intend to use in the future, by main reason for not intending to use, according to age (women), Nigeria 1999 Age Reason for not intending Total Total to use contraception <30 30-49 women men Not married 0.1 0.1 0.1 0.2 Infrequent sex 0.5 3.7 2.2 1.8 Menopausal, hysterectomy 0.1 9.2 5.1 4.8 Subfecund, infe~und 0.7 2.4 1.7 2.5 Wants more children 34.1 22.8 27.9 37.5 Respondent opposed 15.1 16.4 15.8 I3.1 Spouse opposed 8.3 5.9 7.0 0.2 Others opposed 0.1 0.2 0.1 0.3 Religious prohibitlon 11.5 10.4 10.9 21.8 Knows no method 15.6 14.3 14.8 9.0 Knows no source 3.0 2.8 2.9 2.6 Health concerns 1.3 1.5 1.4 0.4 Fear side effects 4.5 3.8 4.1 1.9 Lack of access 0.1 0.1 0.1 0.2 Costs too much 0.0 0.1 0.1 0.0 Inconvenient to use 0.1 0.5 0.3 0.0 Interferes with body processes 0.5 1.6 1.1 0.2 Up to woman to use 0.0 0.0 0.0 0.2 Other 2.2 2.9 2.6 2.4 Don't know 1.6 1.1 1.3 0.7 Missing 0.7 0.1 0.4 0.2 Total 100.0 100.0 100.0 100.0 Number of women/man 1,333 1,604 2,937 624 The men that were interviewed gave such reasons as wanting more children (38 percent), religious restrictions (22 percent), and opposition to use (13 percent). It is also interesting to note reasons that are not commonly cited. For example, very few respondents say they do not intend to use because of health concerns or fear of side effects. Similarly, lack of access and excessive costs do not seem to be barriers to use. 4.10 Preferred Method of Contraception for Future Use Future demand for specific methods was assessed by asking nonusers who said they intended to use family planning in the future which method they preferred to use. Table 4.13 presents information on the preferred method of currently married women who are not using a contraceptive method but who intend to use one in the future. The largest share of these women (27 percent) say they intend to use injectables, while 19 percent say they would prefer to use the pill, and 10 percent say they intend to use periodic abstinence. Women who intend to use family planning in the next 12 months have method preferences similar to women who intend to use later. 62 Table 4.13 Preferred method o f contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, Nigeria I999 Timing of intended use In next After 12 12 Preferred method months months Total Pill 17.9 22.0 19.2 IUD 9.4 7.6 8.6 Injectables 27.2 28.3 27.2 Diaphragm/foam/jelly 0.3 0.0 0.2 Condom 6.7 3.8 5.8 Female sterilisatlon 1.8 3.7 2.5 Implants 0.9 1.0 0.9 Periodic abstinence 10.2 10.2 10.4 Withdrawal 3.2 2.7 2.9 Folk method 5.0 4.5 5.1 Other 1.1 0.5 0.8 Don't know 0.7 0.0 0.4 Missing 15.5 15.6 15.9 Total 100.0 100.0 100.0 Nttmber of women 667 404 1,105 Note: Total includes 34 women unsure of the timing. 4.11 Exposure to Family Planning Messages in Electronic Media Television and radio are major sources of information about family planning. To assess the effectiveness of such media and the dissemination of family planning information, women and men interviewed in the 1999 NDHS were asked if they had heard a family planning message on the radio or television in the few months prior to the interview. Table 4.14 shows that more men than women are exposed to radio and television messages. For example, 35 percent of women say they heard a family planning message on the radio, compared with 61 percent of men. Similarly, the proportions of women and men who have seen a television message are 23 and 40 percent, respectively. Consequently, more than 60 percent of women do not receive family planning messages through either media. Urban residents are much more likely than rural residents to be exposed to family planning messages on radio and television. Similarly, women and men living in the Southeast, Southwest, and Central regions are more likely to receive a message than those in the Northeast and Northwest regions. As expected, a greater proportion of those with more education say they have heard a family planning message. 63 Table 4.14 Exposure to family plannine messages on radio and television Peteant distribution of women and men by whether or not they have heard a radio or television message about family planning in the few months prior to the interview, according to selected background characteristics, Nigeria 1999 Heard family plann'mg message on radio/television Number Tele- of Background Radio vision women/ characteristic Both only only Neither Missing Total men WOMEN Alg5e- 19 14.9 11.0 3.3 70.3 0.6 I00.0 1,775 20-24 20.6 16.3 2.5 59.7 0.9 100.0 1,521 25-29 24.5 15.0 2.2 57.7 0.6 100.0 1,516 30-34 25.1 16.1 1.9 56.4 0.4 100.0 1,137 35-39 22.5 17.4 1.1 58.8 0.1 100.0 992 40-44 16.7 12.7 2.2 67.6 0.8 100.0 696 45-49 17.8 15.9 1.0 65.0 0.4 100.0 568 Residence Urban 40.9 11.8 4.8 42.0 0.5 100.0 2,540 Rural 11.2 16.0 1.1 71.1 0.6 100.0 5,666 Region Northeast 3.9 8.8 0.5 86.3 0.4 100.0 1,292 Northwest 7.4 16.8 0.2 74.4 1.2 100.0 1,087 Southeast 20.4 16.3 1.3 61.2 0.8 100.0 1,886 Southwest 39.4 17.2 4.8 38.0 0.5 100.0 2,080 Central 18.2 13.0 2.6 66.0 0.1 100.0 1,861 Education No education 4.9 12.4 0.6 81.4 0.6 100.0 3,324 primary 18.6 17.8 2.2 61.0 0.4 100.0 1,868 Secondary 34.0 16.2 3.6 45.5 0.7 100.0 2,506 Higher 61.3 10.9 6.1 21.5 0.2 I00.0 508 Total 20.4 14.7 2.2 62.1 0.6 100.0 8,206 MEN Alga- 19 32.0 15.2 4.5 47.4 0.9 100.0 511 20-24 43.7 21.4 4.2 29.3 1.4 100.0 319 25-29 40.2 25.6 2.6 30.7 0.9 100.0 366 30-34 40.9 27.3 0.3 29.9 1.6 100.0 348 35-39 43.4 20.3 1.9 34.0 0.4 100.0 275 40-44 39.7 24.5 1.5 33.9 0.4 100.0 239 45-49 33.5 23.5 0.5 40.9 1.6 100.0 197 50-54 35.4 25.5 1.0 37.5 0.6 100.0 205 55+ 31.9 30.0 1.0 36.7 0.4 100.0 220 Residence Urban 63.3 11.9 3.6 19.9 1.3 100.0 821 Rural 26,7 27,8 1.7 43,l 0.8 100.0 1,859 Region Northeast 25.3 22.2 1.2 50.2 1.1 100.0 437 Northwest 15.6 19.5 0.6 63.7 0.6 100.0 356 Southeast 39.1 23.6 1.5 33.4 2.4 100.0 590 Southwest 56.0 18.0 4.4 21.5 0.1 I00.0 696 Central 38,2 30,4 2.3 28,6 0,6 100.0 601 Education No education 13.3 24.9 0.2 61.0 0.7 100.0 663 primary 33.1 28.8 1.7 35.4 0.9 100.0 710 Secondary 47.3 20.3 3.9 27.3 1.3 100.0 986 Higher 70.2 13.9 2.8 12.6 0.6 100.0 321 Total 37.9 22.9 2.3 36.0 1.0 100.0 2,680 64 4.12 Acceptability of Media Messages on Family Planning To determine the level of acceptance of the dissemination of family planning through electronic media, men and women were asked during the 1999 NDHS whether it was acceptable to disseminate information on family planning methods on television and radio. Table 4.15 shows that a majority of women and men find family planning messages to be acceptable. Men are slightly more likely than women to say that such messages are either acceptable or unacceptable and are less likely to be unsure of their views. There is higher acceptability of dissemination through electronic media among urban than among turn/respondents. The proportion of respondents who accept family planning messages through electronic media is highest in the Southwest region and lowest in the Northwest region. Respondents with higher levels of education are generally more accepting of family planning messages through electronic media than their less-educated counterparts. 4.13 Exposure to Family Planning Messages through the Print Media Femalerespondents were asked if they had received any message about family planning through the print media (newspaper, magazine article, poster, leaflet, brochure) in the few months prior to the interview. Table 4.16 shows that only 17 percent of women reported seeing any message about family planning in a print media source, with 13 percent seeing a poster, 10 percent seeing a newspaper or magazine, and 5 percent seeing a leaflet or brochure. Women in urban areas are more likely to have seen a message in print than women in rural areas (27 versus 12 percent). When data are analysed regionally, exposure to messages in print is higher among women in the south than among those in the north. The proportion of women exposed to family planning messages in any print medium increases directly with education, from 4 percent among those with no education to 63 percent of those with higher than secondary education. 65 Table 4.15 Acceptability of media messages on family planning Percent distribution of women and men by acceptability of messages about family planning on radio or television, by selected background characteristics, Nigeria 1999 Acceptability of message Number Not of Background accept- Accept- women/ characteristic able able Unsure Missing Total men WOMEN AIg5e- 19 19.5 50.3 29.7 0.6 100.0 1,775 20-24 19.4 57.2 23.1 0.3 I00.0 1,521 25-29 I9.9 58.3 21.2 0.6 100.0 1,516 30-34 18.4 57.9 23.3 0.4 100.0 1,137 35-39 21.1 55.6 22.8 0.5 100.0 992 40-44 23.6 52.6 23.0 0.7 100.0 696 45-49 24.1 49.3 25.7 0.9 100.0 568 Residence Urban 15.6 70.0 13.8 0.5 100.0 2,540 Rural 22.4 48.1 29.0 0.5 100.0 5,666 Region Northeast 33.8 27.0 37.3 1.9 100.0 1,292 Northwest 38.1 20.9 40.8 0.3 100.0 1,087 Southeast 13.0 68.8 18.0 0.2 100.0 1,886 Southwest 14.7 74.2 I0.6 0.5 100.0 2,080 Central 14.0 58.3 27.6 0.2 I00.0 1,861 Education No education 30.0 29.4 39.7 0.9 100.0 3,324 Primary 17.2 63.0 19.6 0.2 100.0 1,868 Secondary 12.5 75.1 I2.1 0.4 100.0 2,506 Higher 6.0 91.6 2.2 0.2 100.0 508 Total 20.3 54.9 24.3 0.5 100.0 8,206 MEN Alg5e- 19 18.1 59.3 22.1 0.4 100.0 511 20-24 20.5 67.1 11.4 1.0 100.0 319 25-29 24.0 62.9 12.1 0.9 100.0 366 30-34 20.0 69.2 10.5 0.3 100.0 348 35-39 27.0 62.5 9.1 1.4 100.0 275 40-44 27.6 58.6 13.5 0.4 100.0 239 45-49 26.3 58.2 13.9 1.6 100.0 197 50-54 26.7 59.0 13.6 0.6 100.0 205 55-59 31.I 54.5 13.5 0.9 100.0 220 Residence Urban 15.2 72.3 11.4 1.1 I00.0 821 Rural 27.2 57.1 15.0 0.7 100.0 1,859 Region Northeast 33.6 38.6 26.5 1.3 100.0 437 Northwest 55.4 26.6 17.6 0.4 100.0 356 Southeast 20.8 63.4 I4.3 1.5 100.0 590 Southwest 11.4 85.0 3.4 0.1 100.0 696 Central 14.0 71.1 14.2 0.7 100.0 601 Education No education 42.0 34.1 23.3 0.6 100.0 663 Primary 22.9 63.2 12.7 1.2 100.0 710 Secondary 15.0 72.3 11.7 0.9 100.0 986 Higher 12.9 83.3 3.7 0.0 100.0 321 Total 23.5 61.8 13.9 0.8 ~100.0 2,680 66 Table 4.16 Family planning messages in print Percentage of all women who have received a message about family planning from the print media in the few months prior to the interview, by type of print media and selected background characteristics, Nigeria 1999 Any News- Number Background print paper/ Leaflet/ of characteristic media magazine Poster brochure women Age 15-19 11.9 7.2 8.8 2.6 1,775 20-24 18.6 11.6 13.8 5.1 1,521 25-29 20.7 12.3 16.2 5.0 1,516 30-34 21.4 13.0 17.7 6.9 1,137 35-39 16.8 10.1 13.7 4.7 992 40-44 11.8 6.2 9.4 4.0 696 45-49 12.1 4.8 10.7 3.8 568 Residence Urban 27.4 18.9 20.6 7.9 2,540 Rural 11.9 5.9 9.7 3.0 5,666 Region Northeast 3.3 1.7 2.3 1.0 1,292 Northwest 5.3 2.1 4.6 0.5 1,087 Southeast 20.6 12.2 15.5 6.8 1,886 Southwest 25.7 16.6 19.9 7.7 2,080 Central 18.6 10.2 15.6 3.5 1,861 Education No education 3.8 0.5 3.6 0.4 3,324 Primary 13.2 4.2 11.1 2.3 1,868 Secondary 26.9 17.8 20.0 7.8 2,506 Higher 62.5 53.4 48.4 24.0 508 Total 16.7 9.9 13.1 4.5 8,206 4.14 Contact of Nonusers with Family Planning Providers Family planning providers in government and nongovernmental organisations are expected to visit women and men of reproductive age who are nonusers to discuss options and to motivate them to adopt a method of family planning by discussing the advantages or benefits of using family planning methods. To assess the frequency of the visits, respondents were asked whether they were visited by a family planning provider or discussed family planning with health facility staff in the 12 months prior to interview. Table 4.17 shows that less than 4 percent of nonusers reported that they were visited by a family planning service provider at home, while 8 percent attended a health facility in the 12 months preceding the survey and discussed family planning with a staff member. There are few differentials in these levels except that women in the Southwest region and those with a higher education are more likely to have discussed family planning during a visit to a health facility. Although this pattern of contact with family planning providers could be evidence that facility staff use routine health visits as opportunities to discuss family planning with clients, it could also be that these women specifically visited a health facility to obtain family planning services. 67 Table 4.17 Contact of non-users with family planning providers disseminating family planning information Percent distr~butinn of women who do not use contraception hy whether they were visited by a family planning service provider or spoke with a health facility (HF) staff member about family planning methods (FP) during the 12 months prior to interview, according to selected background characteristics, Nigeria 1999 Visited by FP provider Not visited by a FP provider Ne'xther visited by Attended Attended Did not Attended Attended Did not FP provider HF and HF but attend HF and HF but attend nor Number Background discussed did not t health dis sad did not I health discussec~ of characteristic FP l discuss FP facility ~ discuss FP facility Missing FP at ~ Total women Age 15-19 0.2 0.2 1.1 1.6 10.5 86.3 0.2 96.7 100.0 1,659 20-24 1.3 1.2 1.7 7.1 16.1 72.2 0.4 88.3 100.0 1,277 25-29 2.1 0.3 1.8 9.7 15.7 69.9 0.5 85.6 100.0 1,255 30-34 2.5 0.6 2.1 9.0 i4.3 71.2 0.2 85.6 I00.0 900 35-39 2.3 0.7 2.0 7.8 12.9 74.1 0.3 87.0 100.0 788 40-44 1.3 0.2 1.7 5.4 12.6 78.0 0.7 90.6 100.0 559 45-49 0.9 0.6 2.3 2.6 13.6 79.8 0.2 93.4 100.0 484 Residence Urban 2.0 0.7 1.7 9.2 15.9 70.0 0.4 86.0 100.0 1,993 Rural 1.2 0.5 1.7 4.8 12.7 78.8 0.3 91.4 100.0 4,928 Region Northeast 0.4 0.1 0.4 2.6 15.8 80.2 0.5 96.0 100.0 1,253 Northwest 1.0 1.6 1.2 3.2 13.3 79.6 0.3 92.9 100.0 1,048 Southeast 1,2 0,3 2,1 6,0 13.7 76.1 0.6 89,8 100,0 1,489 Southwest 2.8 0.7 3.1 10.3 12.7 70.2 0.2 83.0 100.0 1,591 Central 1.4 0.3 1.3 6.8 12.9 77.0 0.2 90.0 100.0 1.540 Education No education 0.7 0.4 1.1 3.1 11.6 87,.7 0.4 94.3 100.0 3,17,3 Primary 1.7 0.5 2.3 8.5 15.3 71.5 0.3 86.8 100.0 1,551 Secondary 1.9 0.7 2.2 8.2 14.9 71.8 0.3 86.7 100.0 1,973 Higher 5.4 1.1 2.0 I1.9 17.6 61.3 0.8 78.9 100.0 275 Total 1.4 0.6 1.7 6.1 13.6 76.2 0.3 89.9 100.0 6,922 I Spoke with health facility staffabout family planning methods Was not visited by a family pl~tuning worker and either did not attend a health facilityin preceding 12 months or attended facility but did not speak with a staff member about family planning methods The level of missed opportunities to motivate nonusers to adopt family planning methods was very high. Nine in ten respondents did not have any contact with family planning providers. This proportion of nonusers is very significant. To reach these women, a more vigorous outreach programme is needed. 4.15 Couples' Communication and Attitudes Towards Family Planning Use While husband-wife communication about family planning and agreement to use contraception is not necessary for adoption of certain methods, its absence may be a serious impediment to use. Interspousal communication is therefore an important intermediate step along the path to eventual adoption and sustained use of contraception. Lack of discussion may reflect a lack of personal interest, hostility to the subject, or a customary reticence in talking about sex-related matters. To gain insight about spousal communication on family planning, currently married respondents in the 1999 NDHS were asked how often they had talked to their spouses about family planning in the year prior to the survey. Data for currently married women are sllown in Table 4.18. 68 Table 4.18 Discussion of fumilv elannin~ with husband Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with their husband in the past year, according to current age, Nigeria 1999 Number of times family planning was discussed with husband Number Once or More of Age Never twice often Missing Total women 15-19 70.7 20.8 6.4 2.1 I00.0 177 20-24 58.5 29.4 10.9 1.2 100.0 568 25-29 53.0 27.3 19.1 0.6 100.0 868 30-34 43.7 30.8 24.8 0.7 100.0 730 35-39 47.1 29.4 23.1 0.3 100.0 621 40-44 51,3 28.3 20.2 0.3 100.0 410 45-49 59,3 29.1 11.3 0.3 100.0 318 Total 52.2 28.6 18.5 0.7 100.0 3,692 More than half of women say that they have not talked to their husbands about family planning at all in the past year, while 29 percent have discussed it once or twice and 19 percent have discussed it more often. Teenaged women are the least likely to have discussed family planning with their husbands. When couples have a positive attitude towards family planning, use of effective contraceptive methods will be facilitated. Attitudinal data were collected by asking women and men if they approved of couples' using family planning. Married respondents were asked whether they thought their spouses approved of family planning. This information is useful inthe formulation of family planning policies since it shows the extent to which further education or publicity is needed to increase acceptance of family planning. If there is widespread disapproval of family planing, this might act as a barrier to the adoption of contraceptives. Table 4.19 shows the percent distribution of currently married, nonsterilised women who know of a contraceptive method by their attitude towards family planning and their husband's attitude. The data show that 57 percent of married women who know of contraceptive methods approve of family planning, while 21 percent say they disapprove and 20 percent are unsure of their attitudes. Moreover, 44 percent of married women say their husbands approve. Overall, 40 percent of women report that both they and their husbands approve of family planing, while 5 percent say they both disapprove. In the case where there is disagreement between couples, the table shows that it is more common for the wife to report that she approves and her husband disapproves (7 percent) than the husband approves and she disapproves (2 percent). Approval of family planning is higher among urban than among rural residents and higher among respondents in their 30s than among those that are older or younger. It is also higher among women in the Southeast, Southwest, and Central regions than in the Northeast and Northwest regions. Finally, a higher proportion of married women with more than secondary schooling approve of family planning. 69 Table 4.19 Attitudes of couples toward family planning Percent distrlbufion o f currently marr'ied, nonsteril ised women who know of a contraceptive method by wife's attitude toward family p lanning and wife's perception of her husband's att itude toward family planning, according to selected background characteristics, Nigeria 1999 Woman approves Woman disapproves Husband Husband's Husband's Both Rcspon- Number Background Both dis- attitud~ Husband attitude dis- dent Wifo Husband of characterisfio approw approves unknown approves unknown approve unsure Missing Total approves approves women Age 15-19 18.1 2.8 11.6 3.3 17.6 7.4 36.5 2.8 100,0 32.5 22.9 177 20-24 34.0 8.1 10.6 1.3 I6.0 4,8 22.7 2.4 100.0 53.1 37.6 568 25-29 41.6 6.4 9.0 1.8 13,4 4.9 20.1 2,7 I00.0 57.3 45.6 868 30-34 49.1 8.0 6.8 1.3 12,3 4.1 16.1 2,3 I00.0 64.2 52.7 730 35-39 44.1 6.8 11.1 1.3 16.0 3.0 15.8 2.0 100.0 61.9 47.2 621 40-44 39.3 7.0 10.4 2,7 15.1 4,3 18.4 2.8 100,0 56.7 44.7 410 45-49 35.2 6.9 10.I 2.3 16.6 5,2 22.2 1.5 100.0 52.9 38.9 318 Residence Urban 48.3 6.8 10.0 2,0 13.4 3.4 14.5 1,6 100.0 65.3 52,2 1,389 Rural 35.7 7.0 9.3 1.7 15.5 5.1 23.0 2.8 100.0 52,2 39.5 2,303 Reg~oll Non, beast 15,7 5.2 2.9 2.8 28.4 12.1 29.7 3.2 100.0 23.8 20.3 402 Northwest 17.3 2,6 6.3 2.5 21.6 4.3 41.4 3.9 I00.0 26.2 22.8 415 Southeast 43.0 9,7 13.4 1.9 11.8 3.1 15.1 2,1 100.0 66.6 47,2 766 Southwest 51.6 7.4 10.4 1.7 13.3 3.3 10.1 2.2 100,0 69.7 55.0 1,189 Central 45.0 6.9 9.6 1,0 9.8 3.9 22.1 1.7 100,0 61.5 48.1 919 Education No education 21.9 4.5 9,0 1.8 20.2 7.5 32.1 2.9 I00.0 35.6 25.4 1,315 Primary 41.7 8.9 I0.5 1.9 14.5 3.8 16.3 2.5 100.0 61.1 46,3 1,039 Secondary 53.4 7,9 10.6 1.1 10.6 2.5 11.8 1.9 100.0 72,4 56.6 1,040 Higher 72.0 7.9 4.9 3.5 5.6 0.0 5.1 1.1 100.6 85.1 77.4 29g Total 40.4 7.0 9.5 1.8 14.7 4,5 19.8 2.4 100.0 57.1 44.3 3,692 Table 4.20 shows the percent distribution of couples by approval of family planning according to the age difference between spouses and level of education. Overall, in 27 percent of couples, both the wife and husband reported that they approve of family planning, while for 14 percent, both partners disapprove. When one spouse disapproves, it is equally likely to be the wife or the husband who disapproves; in 9 percent of couples, the wife approves and the husband does not, while in another 9 percent, the husband approves and the wife does not. It appears that the likelihood that both husband and wife disapprove of family planning increases with the number of years the husband is older than his wife. Furthermore, when both spouses are educated, they are more likely to approve of family planning. When there is a discrepancy in education between spouses, couples in which the wife has more education than her husband are more likely to jointly approve of family planning than couples in which the husband has more education than his wife. 70 Table 4.20 Attitudes of couples toward family planning Percent fftstribution of couples by approval of family planning, according to age difference between spouses and level of education, Nigeria 1999 Approval of family planning Wife Husband Age/education approves, approves, Porcent of Number difference Both Both dis- husband wife dis- couples in of between spouses approve approve disapproves approves Missing Total agreement couples Age Husband younger (16.7) (7.1) (3.5) (3.9) (68.8) 100.0 (23.8) 30 Husband 0-4 years oldes 38.8 10.4 14.5 5.9 30.4 100.0 49.1 201 Husband 5-9 years older 32.9 11.0 8.1 8.5 39.5 100.0 44.0 460 Husband 10-14 years older 22.8 16.0 6.6 10.8 43.8 100.0 38.8 375 Husband 15 years + older 17.5 16.1 9.2 8.0 49.2 100.0 33.6 385 Education Husband/wife no education 5.3 21.3 5.7 6.0 61.7 100.0 26.5 508 Wife educated, husband not 23.6 9.3 13.6 10.5 43.1 100.0 32.9 54 Husband educated, gcffe not 15.2 17.3 8.3 9.7 49.5 100.0 32.5 301 Husband and wife educated 51.4 5.2 11.3 9.8 22.2 100.0 56.6 587 Total 26.7 13.5 8.8 8.5 42.5 100.0 40.2 1,451 Note: Figures in parentheses are based on 25-49 cases. Because both men and women interviewed in the NDHS were asked whether they approved of family planning and, if married, whether they thought their spouse approved of family planning, it is possible to examine the extent to which husbands and wives report accurately on their spouse' s attitude. Table 4.21 shows the percent distribution of couples by husband's and wife's attitude toward family planning, according to their spouse's perception of their attitude. The data indicate that when husbands and wives report that their spouse approves of family planning, they are more often right than wrong. For example, in 73 percent of cases in which wives reported that their husband approved of family planning, the husbands also said they approved. Similarly, in 61 percent of the couples in which the husband said his wife approved of family planning, she also said she approved. However, when husbands and wives report that their spouse disapproves of family planning, in one-quarter to one-third of cases, the opposite is true; that is, the spouse actually approves of family planning. Caution should be used in drawing the conclusion from these data that there is a considerable lack of communication between spouses about attitudes towards family planning. It is l ikely that at least some respondents report more favourable attitudes towards family planning than they in fact hold, perhaps in an attempt to please the interviewer or to appear more sophisticated. 71 Table 4.21 Spouse' s perception of spouse's approval of family plannln~ Percent distribution of couples by husband's and wife's actual attitude towards family planning, according to their spouse's perception of their attitude, Nigeria 1999 Perception Spouse's actual attitude Number Disap- of ~.pproves approves Unsure Total couples Wife's perception of husband's attitude Approves 73.1 Disapproves 33.7 Don't know 34.2 21.7 5,2 100.0 447 49.2 17.1 100.0 443 50.0 15.7 100.0 560 All wives 46.1 41.0 12.9 100.0 1,451 Husband's perception of wife's attitude Approves 61.0 Disapproves 23.6 Don't know 24.9 18.7 20.3 100.0 568 32.1 44.3 100.0 472 31.8 43.3 100.0 411 All husbands 38.6 26.8 34.6 100.0 1,45i 72 CHAPTER5 OTHER PROXIMATE DETERMINANTS OF FERTILITY 5.1 Introduction Fertility differentials among population subgroups and changes in fertility over time can be traced to one or more of the proximate determinants of fertility, i.e., the variables that influence exposure to the risk of conception and childbearing. These factors together determine the pace or frequency of reproduction, which in turn affects the level of fertility. One of the most important proximate determinants of fertility is contraceptive use, which was discussed in the previous chapter; this chapter pertains to other determinants. 5.2 Current Marital Status For this analysis, marriage refers to both formal and informal unions. Formal marriage refers to those in which a civil or legal ceremony has been performed. Informal union (cohabitation) refers to a situation in which a man and a woman live together without having performed any civil or religious ceremony. Table 5.1 shows the percent distribution of respondents by current marital status, according to age. About one-quarter of Nigerian women of childbearing age have never married, while 70 percent are either formally married or living together, and 4 percent are widowed, divorced, or separated. The proportion of Table 5.1 Current marital status Percent distribution of women and men by current marital status, according to age, Nigeria 1999 Marital status Never Living Not living Age married Married together Widowed Divorced together WOMEN Number of women/ Total men 15-19 72.5 24.4 2.2 0.1 0.6 0.2 100.0 1,775 20-24 36.5 57.6 3.8 0.3 1.0 0.8 100.0 1,521 25-29 13.0 78.0 5.9 0.4 0.7 2.0 100.0 1,516 30-34 5.1 84.7 6.0 1.4 1.5 1.2 100.0 1,137 35-39 1.9 84.9 8.3 1.7 1.5 1.7 100.0 992 40-44 1.3 82.7 8.9 4.6 0.7 1.8 100.0 696 45-49 1.1 75.6 9.6 9.8 1.5 2.5 I00.0 568 All ages 26.0 64.6 5.5 1.6 1.0 1.2 100.0 8,206 MEN 15-19 97.0 2.2 0.2 0.0 0.2 0.5 100,0 511 20-24 82.8 14.2 0.3 0.3 0.9 1.5 100.0 319 25-29 42.0 52.0 3.2 0.3 0.3 2.2 100.0 366 30-34 15.2 78.0 3.6 0.3 1.8 1.1 100.0 348 35-39 5.2 85.5 4.6 0~0 1.7 3.0 100.0 275 40-44 2.6 86.6 6.5 0.5 2.2 1.7 100.0 239 45-49 0.0 90.3 6.5 2.1 0.5 0.5 100.0 197 50-54 0.4 90.0 5.8 2.8 0.0 1.0 100.0 205 55-64 0.0 89.0 6.4 1.8 0.9 1.8 100.0 220 All ages 36.9 56.7 3.5 0.7 0.9 1.4 100.0 2,680 73 women who have never married declines sharply as age increases; 73 percent of teenagers age 15-19 have never married, compared with oniy 1 percent of women age 45-49 years. Thus, vh'tually all Nigerian women eventually marry. This universality of marriage has been found in earlier surveys, such as the 1990 NDHS and the 1995 Sentinel Survey. It is interesting to note that informal unions increase with age. Only 2 percent of teenaged women live in cohabitational unions, compared with 10 percent of women age 45-49. Table 5.1 also reveals that the proportion of women currently married increases with age up to 40-44 and declines thereafter. The proportion widowed increases with age, reaching a peak of 10 percent at age 45-49 years. The proportions divorced and not living together (separated) show no clear pattern with age. Thus, marital disruption in Nigeria seems to be due more to widowhood than to divorce or separation. The present data do not provide information on time spent in between marriages, but it seems that women quickly remarry after divorce. The second panel of Table 5.1 shows that 37 percent of men have never been married, while 60 percent are currently married or living together and 3 percent are divorced, widowed, or not living together. At almost every age group, a higher proportion of men than women has never married. For example, at age 15-19 years, 97 percent of men have never married whereas 73 percent of women have never married. 5.3 Polygyny Previous national surveys have shown that polygyny is widespread in Nigeria. The prevalence of the practice was measured in the 1999 NDHS by asking married women whether their husband or partner has any other wife or partner, and if so, how many. Married men were asked how many wives or partners they have. The accuracy of the information supplied by women depends largely on the extent of knowledge of whether their husbands have other wives (Oyekanmi, 1999). The proportions of currently married women and men in polygynous unions by age and selected background characteristics are presented in Table 5.2. Slightly more than one-third (36 percent) of aU female respondents and one-quarter (26 percent) of all male respondents are in polygynous unions. For women, this level of polygyny represents a slight decline from the 41 percent found in the 1990 NDHS. Generally, older persons are more likely to be in polygynous unions (Figure 5.1). Interestingly, there are more teenagers (15-19 years) in polygynous unions (30 percent) than those age 20-24 years (27 percent). From age 20-24 to 40-44 years, the proportion of women in polygynous unions increases progressively from 27 to 46 percent. The proportion of men currently in polygynous unions increases from 12 percent among those age 20-24 years to 34 percent among those age 45-49. Among women, polygynous marriage is more common in rural than in urban areas (38 versus 31 percent), while for men there appears to be no difference (26 percent). Regional variations in polygyny exist and differ considerably for women and men. Among women, polygyny is more common in the Northeast (41 percent), the Northwest (40 percent), and the Central (40 percent) regions and is lowest in the Southeast region (20percent). Among men, polygynyis most commonintheSouthwest region(41 percent), followed by the Northwest and Northeast regions, with 25 and 24 percent, respectively. The Southeast region has the lowest proportion of both women and men in polygynous unions. The figures portray a strong inverse relationship between education and polygyny. For example, the proportion of married women in polygynous unions decreases from 46 percent among women with no education to 17 percent among those with higher education. This pattern is similar to what was observed for women in the 1990 NDHS. Similarly, the proportion of married men in polygynous unions decreases from 32 percent for those with no education to 19 percent for those with a higher education. 74 ! Table 5.2 Polygyny Percentage of currently married women and men in a polygynous union by age and selected background characteristics, Nigeria 1999 Current age Background All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 women men Residence Urban 39.9 17,2 22.4 31.5 34.2 42.8 48.0 30.9 25.8 Rural 28.2 30.0 33,8 40,6 43.7 47.9 43.6 37.7 26.3 Region Northeast Northwest Southeast Southwest Central Education No education Primary Secondary Higher All women AU men 31.6 34.5 34.4 47.4 54.9 49.6 45.9 41.0 24.1 31.1 33.3 40.9 45,6 49.1 53.5 34.6 40.3 24.5 28.5 10.0 17.7 16,3 23.4 21.9 31.1 20.2 14.5 13.5 17.6 27.7 36.6 35.8 47.9 48.8 34.6 41.3 32.7 27.0 33.2 40.3 44.3 55.9 60.4 39.9 22.4 34.3 38.1 42.3 49.5 52.4 53.3 52.7 46.1 32.3 22.0 22.5 28.1 36.3 30.4 38.2 33.6 30.3 24.6 15.2 9.7 19.0 21.4 25.6 30.9 30.5 19.0 23.4 * 9.4 10.9 17.9 21.1 20.0 16.0 16.6 18.8 30.2 26.5 30.6 37,5 40.7 46.3 44.9 35.7 NA a * (11.5) I2.0 18.4 21.8 31.4 33.6 NA 26.2 NA = Not applicable Note: Figures in parentheses are based on 25-49 cases, while an asterisk indicates a figure is based on fewer than 25 ~nweighted cases and has been suppressed. Includes men 50-64 Figure 5.1 Percentage of Currently Married Women and Men in Polygynous Unions by Age Percent 50 40 30 20 10 0 15-19 20-24 25-29 30-34 35-39 Age ImWomen C~Men I 40-44 45-49 NDHS 1999 75 Table 5.3 presents the proportions of currently married women by number of co-wives and proportion of currently married men by number of wives, according to selected background characteristics. Of the 36 percent of women in polygynous unions, roughly the same proportion report having one co-wife as report having two or more co-wives. However, among men, most of those in polygynous marriages report having only two wives; only 4 percent of married men have three or more wives. There are few differences in the number of co-wives and wives by background characteristics, except that the proportion of women with two or more co-wives increases with age. Also, polygynously married women in the Northeast and Northwest regions are more likely than those in the Southwest and Central regions to report having only one co-wife. Table 5.3 Number of wives Percent distribution of currently married women by number of co-wives and percent distribution of currently married men by number of wives, according to background characteristics, Nigeria 1999 Women Men Number of co-wives Don't Number Number of wives Don't Number Background know/ of know/ o[ characteristic 0 1 2+ Missing Total women 1 2 3+ missing TotaI men Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Residence Urban Rural Region Northeast Northwest Southeast Southwest Central Education No education Primary Secondary Higher 69.8 14.3 11.5 4.3 100.0 472 * * * * 100.0 12 73.5 12.9 11.0 2.6 100,0 934 (88.5) (9.4) (0.0) (2.1) 100.0 46 69.4 14.8 13.3 2.4 100.0 1,272 88.0 5.7 0.5 5.9 100.0 202 62.5 15.6 i8.9 3.0 100.0 1,032 81.6 11.4 2.6 4.4 100.0 284 59.3 16.3 21.0 3.5 I00.0 925 78.2 14.6 2.0 5.1 100.0 248 53.7 20.3 23.1 2.8 100.0 637 68.6 18.7 5.7 6.9 100.0 222 55.1 15.5 25.7 3.6 100.0 484 66.4 22.0 4.8 6.7 100.0 191 NA NA NA NA NA NA 67.7 21.5 4.7 6.1 100.0 196 NA NA NA NA NA NA 58.2 26.3 8.7 6.8 100.0 210 69.1 12.3 15.7 2.8 100.0 1,670 74.2 10.7 4.0 I1.1 100.0 460 62.3 16.8 17.7 3.1 100.0 4,087 73.7 18.8 3.9 3.7 100.0 1,152 59.0 24.0 14.3 2.6 100.0 1,137 75.9 20.4 3.7 0.0 100.0 307 59.7 20.2 17.2 2.9 100.0 986 75.5 22.8 1.4 0.3 100.0 285 79.8 8.8 6.5 4.9 100.0 946 85.5 9.7 1.7 3.2 100.0 303 65.4 11.7 20.0 2.9 100.0 1,367 58.7 13.4 7.1 20.8 100.0 387 60.1 13.4 24.2 2.3 100.0 1,321 77.6 17.1 4.5 0.8 100.0 330 53.9 21.3 21.8 3.0 100.0 3,032 67.7 24.3 5.6 2.4 100.0 545 69.7 11.4 15.9 3.0 100.0 1,298 75.4 14.0 4.0 6.7 100.0 476 81.0 7.0 9.2 2.7 100.0 1,123 76.6 11.8 2.7 8.9 100.0 373 83.4 7.0 5.5 4.0 100.0 303 81.2 10.2 1.5 7.1 100.0 217 Total 64.3 15.5 17.2 3.0 100.0 5,757 73.8 16.5 3.9 5.8 100.0 1,612 NA = Not applicable Note: Figures in parentheses are based on 25-49 cases, while an asterisk refers to a figure based on fewer than 25 unweighted cases that has been suppressed. 5.5 Age at First Marriage In Nigeria, most childbearing takes place within marriage, which is why questions on age at first marriage, duration of marriage, and stability of marriage are important. In societies with little pre-marital sexual activity and low contraceptive use, age at first marriage is concomitant with the initiation of sustained exposure of women to conception. 76 Table 5.4 presents the proportion of women and men ever married by exact ages and median age at first marriage according to current age. The table shows that for women, the median age at first marriage is about 18 years. This age is slightly higher than the median age of 17 years in 1990 and the age of 16.5 from the 1991 census (NDHS, 1992; NPC, 1998). That age at marriage is increasing is also reflected in the data in Table 5.4, which show that the median age at first marriage is higher among women in their 20s than among those in their 30s and 40s. For example, among women age 20-24, the median age at marriage is almost 20. Men marry considerably later than women. The median age at first marriage is 26, compared with 18 for women. The data show little evidence of any trend towards earlier or later marriage. Table 5.4 Ageat first marrlage Percentage of women and men who were first married by specific exact ages and median age at first marriage, according to current age, Nigeria 1999 WOMEN Percentage Percentage who were fttst married by exact age: who have Number never of Current age 15 18 20 22 25 married women Median age at ftrst marriage 15-19 13.8 NA NA NA NA 72.5 1,775 a 20-24 19.8 39.6 52.7 NA NA 36.5 1,521 19.6 25-29 22.6 45.3 58.0 69.3 81.0 13.0 1,516 18.6 30-34 27.0 52.0 64.9 76.3 86.3 5.1 1,137 17.7 35-39 27.1 52.9 66.6 77.8 86.1 1.9 992 17.6 40-44 30.7 56.1 70.3 84.1 91.9 1.3 696 17.2 45-49 22.5 49.2 64.2 77.9 86.6 1.1 568 18.1 Women 20-49 24.3 47.8 61.2 72.1 80.3 13.1 6,431 18.3 Women 25-49 25.7 50.4 63.8 75.7 85.4 5.9 4,9I 1 17.9 MEN Percentage Percentage who were ftrst married by exact age: who have Number never of Current age 20 22 25 28 30 married men Median age at fkst marriage 25-29 15.5 24.8 45.5 NA NA 42.0 366 a 30-34 16.7 26.7 45.8 63.3 76.7 15.2 348 25.6 35-39 16.0 27.5 45.3 63.8 75,3 5.2 275 25.7 40-44 19.5 31.8 50.9 66.0 74.8 2.6 239 24.8 45-49 15.8 29.3 39.4 60.5 73.0 0.0 197 26,3 50-54 14.8 30.8 46.1 56.4 66.4 0.4 205 25.8 55-64 13.6 24.0 37.8 55.3 63.1 0.0 220 26.9 Men 30-64 16.2 28.2 44.5 61.3 72.2 5.0 1,484 25.9 ~qA = Not applicable Omitted because less than 50 percent of respondents in the age group x to x+5 have married by age x Table 5.5 shows the variations in median age at marriage by background characteristics. Urban women marry approximately two years later than rural women; the median age at first marriage for women age 25-49 years is 19 for urban women and 17 for rural women. Regional variations indicate that for women age 25-49 years, the median age at first marriage varies from 15 in the Northeast and Northwest regions to 20 in the Southeast and Southwest regions. These findings confirm those from the 1990 NDHS that also showed about a five-year difference in median age at marriage for women in the north and south (FOS, 1992:61). Median age at marriage increases with higher educational attainment. Among women with no 77 Table 5.5 Median age at first marriage Median age at fwst marriage among women age 20-49 yeats and men age 30-64, by current age and selected background characteristics, Nigeria 1999 Cuffent age Women Women Men Background ago age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 30-64 Residence Urban a 20.6 19.7 18.6 18.2 18.9 19.9 19.4 27.4 Rural I8.6 17.8 16.8 I6.9 16.7 17.7 17.5 17.3 25.2 Region Northeast 15.5 14.9 15.1 15.1 14.6 15.4 15.1 15.0 24.0 Northwest 15.1 14.9 I4.5 14.6 14.4 14.1 14.7 14.6 22.2 Southeast a 22.2 20.1 20.2 18.5 18.4 a 20.2 28.2 Southwest a 21.1 20.6 20.0 19.3 19.2 a 20.2 27.8 Central 19.6 18.7 17.9 17.4 17.0 18.2 18.2 17.9 25.8 Education No education 15.1 15.2 15.3 15.5 15.8 I7.2 15.5 15.6 23.7 Primary 19.3 18.6 18.1 18.5 17.8 18.4 18.5 18.3 26.4 Secondary a 21.8 20.8 21.1 20.3 20.5 a 21.2 26.2 Higher a a 24.2 23.7 23.0 22.7 a 24.5 29.1 All women 19.6 18.6 17.7 17.6 17.2 18.1 18.3 17.9 NA All men a a 25.6 25.7 24.8 26.3 NA NA 25.9 ~qA = Not applicable Omitted because less than 50 percent of the respondents in that age group married before entering the age group education, the median age at first marriage is about 16 years, while it is close to 25 years among those with schooling beyond secondary. Men's age at first marriage also varies by place of residence, region and education. For example, median age at first marriage is 27 among urban men and 25 among rural men. As for women, men in the south tend to marry later than those in the north. The median age at first marriage is about 28 in the Southeast and Southwest regions, while it is only 22 in the Northwest region. With respect to education, median age at first marriage increases from 24 for men with no education to 29 for those with more than a secondary education. 5.6 Age at First Sexual Intercourse In most Nigerian societies, it is a cultural expectation that age at first marriage can be used as a proxy for the onset of exposure of a woman to regular sexual intercourse, while men are generally expected to be exposed to intercourse before marriage. In fact, since some women engage in sexual intercourse before marriage, the age at which they start sexual intercourse marks the beginning of their exposure to the risk of reproduction. Table 5.6 shows the proportions of women and men who have had sexual intercourse by specified exact ages and the median age at first sexual intercourse by current age. About half of the women reported having had sexual intercourse by age 18; about one-quarter said they had had sex before age 15. In general, men are exposed to sexual intercourse later than women. The median age at first sexual intercourse among men is 20, compared with 18 for women. These results imply that there has been a steep trend towards later age at sexual debut among women. The 1990 NDHS showed a median age at first intercourse of 16, compared with 18 in 1999. Although it is possible that women are delaying entry into sexual activity, the fact that the median age at first sex appears 78 Table 5.6 Age at first sexual intercourse Percentage of women and men who had first sexual intercourse by specified exact ages and median age at first inter- course, according to current age, Nigeria 1999 Current age 15 18 20 22 WOMEN Percentage who had first Percentage Number Median sexual intercourse by exact age: never of age at having women/ first 25 intercourse men intercourse 15-19 16.2 NA NA NA NA 56.9 1,775 a 20-24 20.7 49.4 67.0 NA NA 15.9 1,521 a 25-29 24.0 49.1 64.3 76.1 82.2 4.0 1,516 18.1 30-34 26.4 53.7 68.5 77.0 83.6 1.1 1,137 17.3 35-39 25.9 51.9 65.3 74.9 79.0 0.5 992 17.7 40-44 28.4 51.7 66.5 74.6 78.3 0.4 696 17.7 45-49 22.2 48.7 65.7 75.6 80.5 0.0 568 18.1 20-49 24.3 50.6 66.2 75.6 80.2 5.0 6,431 17.9 25-49 25.4 51.0 66.0 75.8 81.1 1.7 4,911 17.8 MEN 15-19 8.3 NA NA NA NA 73.2 511 a 20-24 11.2 36.3 54.0 NA NA 35.8 319 19.6 25-29 9.2 33.8 51.0 66.5 81.7 12.0 366 19.8 30-34 7.9 33.0 51.7 65.2 78.6 2.1 348 19.8 35-39 5.5 26.4 52.5 69.0 82.7 0.8 275 19.8 40-44 3.6 20.2 47.4 66.6 79.5 0.5 239 20.2 45-49 5.1 22.0 44.2 63.9 74.6 0.0 197 20.4 50-54 4.5 21.3 38.0 58.9 71.8 0.0 205 20.9 55+ 2.8 19.8 34.0 59.2 73.4 0.0 220 20.9 25-64 6.0 26.5 46.7 64.7 78.2 3.0 1,850 20.3 NA = Not applicable Omitted because less than 50 percent of respondents in the age group x to x + 5 have had intercourse by age x to have also risen by two years among women who are currently in their 30s and 40s makes this hypothesis unlikely. A more likely explanation is that since the questions concerning age at first sex changed between the two surveys, the apparent trend is due to errors in reporting in one of the surveys. Table 5.7 shows the median age at first sexual intercourse for women and men according to selected background characteristics (Figure 5.2). For rural women, age at first sexual intercourse is lower thart for urban women across all age groups. Among women age 20-49 years, the median age at first sexual intercourse for rural women is 17, compared with 19 for urban women. Women in the Northeast and Northwest regions first have sexual intercourse at about age 15. Women in the southern part of the country engage in sexual intercourse about three to four years later than their northern counterparts. There has not been any appreciable change in the pattern over time. Age at first sexual intercourse increases with education. Women with no education initiate sexual activity at the age of 16 years, compared with age 21 among those with more than a secondary school education. Among men, there are fewer differences in the age at wl~ich sexual activity is initiated. For example, the median age at first sexual intercourse is about the same for urban and rural men. Furthermore, median age at first intercourse does not seem to vary with increasing education among males as it does among females. However, there are differentials by region and they are different from those observed for women. 79 Table 5.7 Median age at first sexual intercourse Median age at ftrst sexual intercourse among women age 20-49 years and men age 30-64, by current age and selected background eharacteristies, Nigeria 1999 Current age Women Women Men Background age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 30-64 Residence Urban 19.0 19.3 18.6 18.7 18.5 19.1 18.9 18.8 20.1 Rural 17.4 17.3 16.5 16.7 17.1 17.7 17.2 17.1 20.3 Region Northeast 15.8 15.2 15.3 15.1 15.1 15.7 15.3 15.2 22.2 Northwest 15.2 15.1 14.7 I5.0 14.5 14.6 15.0 14.9 20.8 Southeast 19.3 18.8 18.4 19.8 19.3 18.4 I8.9 18.8 19.2 Southwest 18.9 19.8 19.1 18.9 18.9 19.3 19.1 19.2 20.2 Central 18.6 18.5 18.2 18.2 17.6 18.2 18.3 I8.2 19.8 Education No education 15.2 I5.4 15.4 15.6 16.2 17.4 15.6 15.7 20.5 Primary 17.9 17.8 17.7 18.5 18.3 18.3 18.0 18.1 20.1 Secondary 19.4 19.7 19.2 19.8 19.3 19.9 19.5 19.6 20.1 Higher a 20.8 20.2 20.4 20.8 22.9 a 20.7 20.2 Aii women 18.1 18.1 17.3 17.7 17.7 18.1 17.9 17.8 NA All men a 19.8 19.8 19.8 20.2 20.4 NA NA 20.3 ~qA = Not applicabie Omitted because less than 50 percent of respondents in that age group had intercourse before entering the age group Figure 5.2 Median Age at First Sexual Intercourse among Women Age 25-49 and Men Age 30-64 by Residence, Region, and Education NIGERIA . Urban I . . . . . . . . . . . . . . . . . . . . . . . . RESIDENCE Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REGION Northwest IIIIIIIIIIIIII Northeast . . . . . . . . . Southeast ii iiii~iiiii~ii ii~iii iiiiii~i iii~i~i~i iiiii~Ii~ i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i~i iii i ~ . Southwest . [. ' . Centre. [ . !!J!!.J!.[[ . . . . . . . . . . . . . . . . EDUCATION I 0 5 10 15 20 25 MedianAge I IWomen DMen I NDHS lg99 80 Contrary to the findings for women, the median age at first sexual intercourse among men is lowest in the Southeast (19 years), Central (20 years), and Southwest (20 years) regions and highest in the Northeast region (22 years). 5.7 Recent Sexual Activity The frequency of sexual activity directly affects a woman's chance of becoming pregnant. Information on recent sexual activity can be used to further refine measures of exposure to pregnancy. Women and men interviewed in the NDHS were asked how long ago their last sexual activity took place. Those who had sexual intercourse at least once within the four weeks prior to the survey were considered sexually active, while women who had not were further classified depending on whether they had recently given birth--a common reason for abstaining. Tables 5.8.1 and 5.8.2 show the distribution of women and men by recent sexual activity. Slightly less than half of all women can be considered sexually active, while 12 percent have not resumed sex after a recent birth, 24 percent have had sex but not in the four weeks before the survey, and 16 percent have never had sex. The percentage of women who are sexually active increases with age to a peak at age group 35-39 (61 percent), after which it drops to 38 percent at age group 45-49. Women who are not in marital unions are far less likely to be sexually active than women in unions; only 15 percent of women who had never married were sexually active in the month prior to the survey, with 62 percent never having had sex at all. The proportion of sexually active women is higher in rural (50 percent) than in urban (45 percent) areas. A greater proportion of women are sexually active in the northern regions (72 percent in the Northwest and 68 percent in the Northeast) than in the southern regions (38 percent in the Southeast and the Southwest). Women in the Central region (44 percent) fall in between. More than one in four women in the southern regions is currently abstaining for reasons other than a recent birth. This proportion is more than twice that of women in the northern regions. Women with a secondary education are the least likely to be sexually active (37 percent), while those with no education are the most likely (61 percent). Those with no education or with only a primary education are more likely to practice postpartum abstinence than those with a secondary or higher education. As expected, the proportion of women who are sexually active is higher among those using some form of contraceptive method than among nonusers. Thehighest proportion of sexually active women is among IUD users (71 percent), while the lowest proportion is found among those using periodic abstinence. Slighily more than half (51 percent) of all men are sexually active, while 29 percent have had sex but are not currently active, and the remaining 20 percent have never had sex (Table 5.8.2). Sexual activity of men increases with age from 10 percent of men age 15-19 years to 71 percent of men age 45-49 years, after which it declines to 61 percent of men age 55 and above. As expected, sexual activity is higher among men in polygynous unions (77 percent) than among those in monogamous unions (69 percent). One in five men who have never married are sexually active, as are 40 percent of men who are widowed, divorced, or separated (formerly married). 81 Table 5.8.1 Recent sexual activity: women Percent distribution ef women by sexual activity in the four weeks preceding the survey, and among those not sexually active, the duration of abstinence and whether postpartum or not postpartum abstaining, according to selected background characteristics, Nigeria 1999 Not sexually active in last four weeks Background Sexually Postpartum Net postpartum Missing/ Never chamctaristic/ active abstaining abstaining Does had Number contraceptive in last not inter- of method 4 weeks 0-1 years 2+ years 0-1 years 2+ years know cearse Total women Current age 15-19 24.6 5.6 0.2 10.0 1.1 1.6 56.9 100.0 1,775 20-24 49.2 13.5 0.5 16.7 2.0 2.0 15.9 100.0 1,521 25-29 60.6 13.7 0.8 15.1 2.4 3.4 4.0 100.0 1,516 30-34 58.2 17.7 0.8 15.8 2.9 3.4 1.1 100.0 1,I37 35-39 61.2 12.4 1.7 16.4 5.1 2.8 0.5 100.0 992 40-44 55.4 7.6 0.8 23.0 10.2 2.5 0.4 100.0 696 45-49 38.0 3.2 0.5 26.6 27.8 3.8 0.0 100.0 568 Marriage duration (years) Nevar marrled 14.5 1.6 0.0 17.1 3.4 1.3 62.1 100.0 2,130 0-4 62.7 21.4 0.5 11.4 0.8 2.5 0.8 100.0 1,193 5-9 64.2 17.4 0.7 12.8 1.1 3.8 0.1 100.0 1,260 10-14 65.0 14.5 1.3 13.5 2.6 3.1 0.0 100.0 1,056 15-19 61.2 13.0 1.2 16.6 5.4 2.6 0.0 100.0 963 20-24 56.1 11.1 1.2 19.2 8.2 4.0 0.1 100.0 778 25-29 52.4 6.1 0.9 24.6 14.7 1.3 0.0 100.0 553 30+ 39.7 1.I 1.0 24.3 29.0 5.0 0.0 100.0 275 Residence Urban 44.6 9.4 0.5 18.0 5.4 2.6 19.5 100.0 2,540 Rural 50.2 I1.8 0.8 15.1 4.7 2.6 14.8 100.0 5,666 Region Northeast 67.7 8.9 0.5 9.4 1.6 3.3 8.7 100.0 1,292 Northwest 71.9 9.0 0.3 10.3 1.7 1.7 5.0 100.0 1,087 Seutheast 38.0 8.5 0.7 18.2 7.6 2.5 24.5 100.0 1,886 Southwest 37.6 12.8 0.6 21.0 6.3 2.4 19.4 100.0 2,080 Central 44.0 14.5 1.2 16.2 4.7 3.1 16.3 100.0 1,861 Education No education 61.3 11.9 0.8 13.7 6.1 2.9 3.3 100.0 3,324 Primary 39.5 15.3 1.2 18.4 5.7 3.5 16.4 100.0 1,868 Secondary 36.5 8.6 0.3 16.0 2.6 1.9 34.0 100.0 2,506 Higher 56.4 2.5 0.2 22.2 5.0 1.3 12.4 100.0 508 Current contraceptive method No method 45.8 11.8 0.7 14.3 5.3 2.9 19.2 100.0 6,922 Pill 66.9 2.6 0.5 27.2 1.9 0.0 0.9 I00.0 216 IUD 71.2 1.4 0.0 21.8 3.2 2.3 0.0 100.0 137 Periodic abstinence 52.6 16.0 1.4 23.6 3.8 1.6 0.9 100.0 375 Other 66.7 4.3 0.2 26.5 1.0 1.1 0.2 100.0 540 Total 48.4 11.1 0.7 16.0 4.9 2.6 16.3 100.0 8,206 82 Table5.8.2 Recentsexual activity: men Percent distribution of men by sexual activity in the four weeks preceding the survey, according to salected background characteristics, Nigeria 1999 Not Sexually sexually Never active active had Number Background in last in last inter- of characteristic 4 weeks 4 weeks course Total men Alg5e- 19 10.3 16.5 73.2 100.0 511 20-24 33.5 30.7 35.8 100.0 319 25-29 57.2 30.8 12.0 100.0 366 30-34 67.3 30,5 2.1 100.0 348 35-39 69.0 30,2 0.8 100.0 275 40-44 63.9 35,5 0.5 100.0 239 45-49 70.7 29.3 0.0 I00.0 197 50-54 69.9 30.1 0.0 100,0 205 55+ 60.7 39,3 0.0 100.0 220 Marital status Never marrled 19.8 25,2 55.0 100.0 988 In polygynous union 76.9 23.1 0.0 100.0 328 In monogamous union 68.7 31.3 0.0 100.0 1,283 Formerly married 39.7 60.3 0.0 100.0 81 Residence Urban 47.1 31.5 21.4 100.0 821 Rural 52,5 27.8 19.8 100.0 1,859 Education No education 61.8 26,9 11.2 100.0 663 Primary 48.8 35,6 15.7 100.0 710 Secondary 40.3 26,0 33.7 100.0 986 Higher 64.9 2%2 7.9 100.0 321 Total 50.8 28,9 20.3 100.0 2,680 5.8 Postpartum Amenorrhoea, Abstinence, and Insusceptibility Studies have shown that for a few weeks or months after the birth of a child, a woman does not ovulate and therefore is not susceptible to pregnancy. This period is known as postpartum amenorrhoea, which may be six weeks or longer, depending on whether and how frequently a woman breastfeeds. Thus, besides contraceptive use and cultural norms that may dictate sexual abstinence after childbirth, exposure to pregnancy is influenced by breasffeeding practices. The proportion of women who gave birth in the three years before the survey and who were still amenorrhoeic, abstaining, and insusceptible to the risk of conception are presented in Table 5.9. The data are grouped in intervals of two months to reduce fluctuations in the figures. As expected, the proportion of women who are amenorrhoeic declines as the number of months since birth increases. For example, 85 percent of women who delivered less than two months before the survey are soil anaenorrhoeic, compared with less than I0 percent of women who delivered two years before the survey. The median duration of postpartum amenorrhoea is 13 months. Postpartum abstinence is common in Nigeria. Almost 90 percent of women who delivered two months before the survey are abstaining from sexual relations. The proportion drops quite rapidly to about 8 percent at 24-25 months after birth. Consequently, the median duration of postpartum abstinence is only six months. 83 Table 5.9 Postpartum amanorrhoea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amano~rhoeic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Nigeria I999 Percentage of births for which the mother is: Number Months Amenor- Insus- of since birth rhoeic Abstaining ceptible births <2 85.4 88.7 94.0 187 2-3 80.1 71.9 89.6 192 4-5 76.4 54.5 83.7 221 6-7 62.6 49.3 75.0 199 8-9 57.7 41.1 66.7 195 I0-11 55.9 43.9 68.9 168 12-13 50.8 32.3 61.3 324 14-15 47.9 27.9 54.7 301 16-17 31.5 22.4 40.2 191 18-19 25.0 22.0 35.7 149 20-21 16,0 18,7 27.8 i48 22-23 13.7 9.4 20.9 146 24-25 9.1 7.7 13.5 223 26-27 7.2 8.4 13.3 271 28-29 2.6 3.2 5.1 151 30-31 1.7 5.1 5.9 121 32-33 1.2 3.6 4.8 140 34-35 3.9 5.0 6.8 155 Total 37.8 30.0 45.7 3,481 Median 12.8 6.2 15.5 Mean I2.9 10.6 15.6 Prevalence/Incidence mean 13.4 10.7 16.2 Because of either amenorrhoea or abstinence, 94 percent of women are considered insusceptible to the risk of pregnancy within the first two months after birth (Figure 5.3). qlais figure drops to 14 percent of women who delivered two years before the survey. The median duration of postpartum insusceptibility to pregnancy is about 16 months. Because breastfeeding and postpartum abstinence practices vary considerably among different groups of women, Table 5.10 shows the median duration of postpartum amenorrhoea, abstinence, and insusceptibility by background characteristics. As mentioned above, the median duration of postpartum amenorrhoea is 13 months, sexual abstinence is 6 months, and insusceptibility is 16 months. Older women, rural women, women who live in the northern regions, and women with less education generally have shorter durations of amenorrhoea after a birth than other women, presumably because they breastfeed their babies for shorter periods of time. Postparttun abstinence shows less variation by background characteristics, although it is interesting to note that women in the southern part of the country tend to abstain after a birth for longer periods than women in the northern parts of the country (12-13 months versus 2-4 months). These regional differences in amenorrhoea and abstinence tend to offset each other so that there is little difference in the median durations of postpartum insusceptibility by region. A major differential in the length of insusceptibility to pregnancy is education level; less-educated women remain insusceptible to pregnancy for considerably longer after a birth than women with a higher education (18 versus 7 months). 84 100 Figure 5.3 Postpartum Amenorrhoea, Abstinence, and Insusceptibility by Number of Months since Birth Percent 80 60 40 20 0 I I I I I I I I I ~ I I I I I I <2 2 -3 4 -5 6 -7 8 -9 10-1112-1314-1516-1718-1920-2122-2324-2526-2728-2930-3132"3334"3S Months since Birth [-B-Amenorrhoea ,,~Abstinence "--Insusceptiblity I NDHS 1999 Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amanorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Nigeria 1999 Median duration of postpartum: Number Background Amenor- Absti- Insuscep- of characteristic rhoea nance tibility births Age <30 10.3 6.0 14.7 2,073 30+ 14.2 6.4 16.3 1,407 Residence Urban 10.1 7.1 12.4 967 Rural 14.3 6.0 16.7 2,514 Region Northeast 15.9 2.4 16.1 774 Northwest 16.7 3.7 17.2 620 Southeast 7.3 6.1 12.9 631 Southwest 11.4 12.0 13.8 760 Central 13.4 13.2 17.9 695 Education No education 16.g 5.2 18.0 1,685 Primary 11.7 10.0 15.6 854 Secondary 8.7 6.6 12.2 807 Higher 2.5 2.9 6.9 135 Total 12.8 6.2 15.5 3,481 Note: Medians are based on current status. 85 5.9 Termination of Exposure to Pregnancy Age also affects the risk of pregnancy. With increasing age, the proportion of women at risk of conceiving reduces as infertility sets in. Data on menopause are presented in Table 5.11. For this survey, a woman is considered menopausal if she is not pregnant or amenorrhoeic and either declares herself menopausal or did not have a menstrual period for six or more months before the survey. For all women age 30-49 years, 11 percent have reached menopause. As expected, the proportion of menopausal women rises with age, from 2 percent among women age 30-34 years to 55 percent among those age 48-49 years. Table 5.11 Menopause Prevalence of women age 30-49 who are menopausal, Nigeria 1999 Percentage Number meno- of Age pausal I women 30-34 2.4 1,137 35-39 4.5 992 40-41 14.7 433 42-43 11.7 190 44-45 26.5 313 46-47 29.6 149 48-49 55.3 180 Women 30-49 11.3 3,394 1 Percentage of all women (numerator) who are not pregnant and not postpartum amenorrhoeic whose last menstrual period occurred six or more months preceding the survey (excludes other women who report that they are menopausal) (denominator). 86 CHAPTER6 FERT IL ITY PREFERENCES This chapter deals with fertility preferences of both women and men, their desire to have more children, the length of time they want to walt before having another child, their ideal family size and their attitudes towards family planning. This chapter is aimed at assessing the direction of future fertility and the need for family planning in Nigeria. The measurement of fertility preferences, particularly attitudes towards family planning, has always been difficult due to certain limitations. This difficulty may be partly because inquiries into fertility desires tend to elicit responses from people about issues on which they may not have thought or on which they have no firm conviction. 6.1 Desire for More Children Table 6.1 shows the percent distribution of currently married women and men by desire for children according to the number of children they already have. Two-thirds of women and 71 percent of men indicate a desire for more children. Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women and men by desire for more children, according to number Nigeria 1999 of l iving children, Number of living children I Desire for children 0 1 2 3 4 5 6+ Total WOMEN Have another sooi~, 2 73.0 43.2 36.5 29.8 26.5 22.1 13.3 31.9 Have another laterO 3.7 37.8 39.8 39.4 28.5 22.6 13,5 28.4 Have another, undecided when 3.8 7.2 7.7 5.7 5.8 5.0 3.3 5.7 Undecided 5.3 4.5 5.8 7.6 9.1 11.7 9.9 7.7 Want no more 2.2 1.0 4.9 10.9 22.6 32.2 52.0 19.3 Sterilised 0.0 0.0 0.2 0.1 0.0 0.3 1.0 0.3 Declared infecund 5.7 2.3 2.1 3.2 4.0 4.1 4.7 3.5 Missing 6.4 4.0 3.0 3.3 3.4 2.1 2.3 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 414 956 935 907 839 660 1,046 5,757 MEN Have another soo~ 49.8 50.4 35.4 32.3 37.1 29.3 31.3 36.1 Have another later ° 29.8 38.9 42.7 35.2 24.5 2%5 18.0 28.4 Have another, undecided when 8.3 6.9 9.8 5.5 3.9 5.6 6.0 6.5 Undecided 5.2 2.2 2.1 9.6 5.8 5.8 6.7 5.7 Want no more 2.1 0.6 6.4 13.6 21.8 27.9 31.1 18.3 S terilised 0.0 0.0 0,0 0.0 0.0 0.0 1.2 0.4 Declared infecund 3.3 1.0 2.2 2.4 5.6 3.9 5.3 3.7 Missing 1.5 0.0 1.5 1.4 1.4 0.0 0.4 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 145 181 198 223 168 157 540 1,612 Includes current pregnancy Wants next birth within two years Wants to delay next birth for two or more years 87 More than one in four women (28 percent) indicate that they want to wait two or more years before having another child (Figure 6.1 ). These women are potential contraceptive users for child spacing. About one-third of women want another child soon, while 6 percent want more children but are unsure of the timing, and 8 percent are undecided whether they want another child or not. One in five women want no more children. Figure 6.1 Fertility Preferences of Currently Married Women 15-49, Nigeria 1999 Want child soon (<2 years) 32% Dedar Wanl child laler (2+ years) 28% Undecided B% Note: 'Want no more" includes sterilised women. Wanls child, unsure timing 6% NDHS 199g As expected, the proportion of women who want to stop childbearing rises with the number of living children (Figure 6.2), ranging tt'om a low of 2 percent for childless women to a high of 52 percent for women with six or more children. Conversely, the desire to have a child soon declines with increasing number e l children. While 73 percent of childless women want to have a child within the next two years, only 13 percent of those with six or more children want another soon. For those who want another child later, the pattern rises and then falls. The desire to have another child later increases markedly from 4 percent for those with no living child to 38 percent for those with one child and 40 percent tot those with two children. The percentages drop among women with higher parity to as low as 14 percent among those with six or more children. Data from the male respondents show that 36 percent want to have another child soon, while 28 percent want to have another child later, and 7 percent of the men want more children but are unsure of the timing. Moreover, 6 percent of men are undecided about whether or not they want another child and 18 percent say they want no more children. As with women, the proportion of men who want no more children generally rises with the number of living children they already have. 88 Figure 6.2 Desire to Limit Childbearing among Currently Married Women and Men, by Number of Living Children, Nigeria 1999 Percent 60 50 40 30 20 10 0 0 1 2 3 4 5 6+ Number of Living Children Ill,Women E~Men I Note: Desire to limit childbearingincludes respondents who stated that they did not want any more children and those who have been sterilised. NDHS 1999 On a general note, about half of women and men want either to space their children (have another later) or to stop childbearing altogether (want no more). This high proportion of "spacers" and "limiters" indicates a considerable interest in controlling fertility and thus a potential demand for family planning services. Desire to limit childbearing among currently married women and men by number of living children is presented in Figure 6.2. The figure shows that women have a stronger desire to limit fertility than men, especially after four children. Compared with data from the 1990 NDHS, there has been little change in the desire for more children. Perhaps most significant is that the proportion of married women who want no more children increased from 15 percent in 1990 to 19 percent in 1999, while the proportion who want another child later declined somewhat (from 33 to 28 percent). This implies a shift from interest in spacing children to increased desire to limit fertility. The proportion who are undecided about their fertility desire declined from 14 percent in 1990 to 8 percent in 1999. Table 6.2 presents data on fertility preference by age of currently married women. It shows that the desire to have another child soon decreases as age increases, from 43 percent of women age 15-19 years to 12 percent of those age 45-49 years. The desire to have another child later also generally decreases as age increases, declining from 47 percent of those age 20-24 years to 3 percent of those 45-49. Conversely, the proportion of women who want no more children increases with age, from a low of 1 percent of women age 15-19 years to a high of 59 percent of those age 45-49 years. Similarly, the proportion of women who declare themselves/nfectmd (unable to bear children) increases froml percent for the youngest age group (15-19 years) to 16 percent for the oldest age group (45-49 years). The general pattern indicates that the greatest need for family planning services among older women is for limiting births, while among younger women, the need is for methods to space births. 89 Table 6.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Nigeria 1999 Current age Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon~ 43,2 35.5 38.3 34.2 28.6 21.0 12.3 31.9 Have another later z 35,7 46.7 40.0 30.2 15.6 8.0 2.9 28.4 Have another/undeclded when 8,0 7.6 6.5 6.0 5.3 2.4 1.6 5.7 Undecided 5,2 5.1 5.8 10.3 11.7 9.7 4.3 7.7 Want no more 0,9 1.2 4.9 14.4 30.9 48.9 59.2 19.3 Sterilised 0,0 0.0 0.0 0.2 0.9 0.2 0.8 0.3 Declared infecund 1,8 0.5 1.2 1.8 4.4 6.2 15.9 3.5 Missing 5.3 3.4 3.3 2.8 2.6 3.8 3.0 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 472 934 1,272 1,032 925 637 484 5,757 J Wants next birth within two years 2 Wants to delay next birth for two or more years Data on the desire for future childbearing among couples is presented in Table 6.3, according to the number of living children. To a large extent, couples have similar desires for having more children. Of the 856 couples for which both wife and husband were interviewed, 57 percent agree on having more children, 10 percent agree on having no more children, and 11 percent disagree about their desires for more children. For 5 percent of couples, either the wife or the husband is in_fecund (cannot have more children) and for 17 percent of couples, either the wife or the husband is undecided about whether she or he wants more children. The proportion of couples in which the husband wants more children and the wife does not (6 percent) is almost the same as the proportion in which the wife wants more children and the husband does not (5 percent)--a finding that refutes the general notion that men are more pronatalist than women. Table 6.3 Desire for more children among monogamous couples Percent distribution of monogamous couple.s by desire fox more children, aacoMing to numbe~ of li~ing children reported, Nigeria 1999 Husband Wife Both One Number of Both more/ more/ want Husband/ or both Number living children want wife husband no wife undecided/ of reported more no more no more more infecund missing Total couples Same number 0 76.4 0,0 0.0 0.0 3.9 19.8 100.0 81 1-3 75.7 3,1 2.1 2.7 2.4 14.0 100.0 290 4-6 43.7 9,9 7.0 19.0 2.6 17.8 100.0 157 7-9 7.6 14.8 7.0 45.5 12.8 12.3 100.0 57 10+ * * * * * * 100.0 2 Different number Husband > wife 48.8 5.6 6.2 8.4 8.9 22.1 100.0 207 Wife > husband 55.1 7,7 12.0 7.4 5.0 12.8 100.0 63 Total 57.2 5,9 4.8 10.0 5.0 I7.1 100.0 856 Note: An asterisk indicates that a figure is based on fewer titan 25 cases and has been suppressed. 90 Agreement among couples about future childbearing desires is higher among couples with fewer children, while the proportion of couples who disagree on their desired fertility rise with increase in family size. For example, three-quarters of couples with three or less children agree that they want more children. Among couples with seven to nine children, more than half agree on future childbearing preferences, with the majority not wanting any more children. Table 6.4 presents the percent distribution of currently married women and men who want no more children by number of living children and selected background characteristics. The table indicates that the desire to stop having children is higher among urban women (25 percent) than among rural women (18 percent). The difference between urban and rural women is more pronounced among respondents who have had three or more children. Table 6.4 Desire to limit childbearing by background characteristics Percentage of currently married women and men who want no more children by number of living children and selected background characteristics. Nigeria 1999 Background characteristic Number of living children 1 0 1 2 3 4 5 6+ Total WOMEN Residence Urban 1.7 0.3 7.7 17.7 34.7 42.6 60.0 24.5 Rural 2.3 1.2 4.1 7.8 17.1 28.1 50.7 17.5 Region Northeast 2.7 1.9 3.7 5.1 5.8 8.6 20.2 6.9 Northwest 3.4 0.5 2.6 4.7 7.5 17.7 26.1 7.4 Southeast 2.0 0.0 4.3 5.6 23.1 38.9 70.0 30.4 Southwest 2.4 1.0 8.7 20.3 42.0 57.3 73.6 31.2 Central 0.0 1.I 5.3 11.9 23.8 28.3 51.9 19.6 Education No education 2.9 1.5 5.1 10.4 15.3 23.1 43.1 16.4 Pximary 1,7 0.0 1,9 9,6 24,5 38,2 65,6 25,7 Secondary 1.4 0.8 4.5 8.8 31.5 44.0 63.9 17.0 Higher 0.0 0.0 20.1 27.4 58.3 66.5 86.4 34.6 Total 2.2 1.0 5.1 I1.0 22.6 32,5 53.0 19.6 MEN Residence Urban 2.3 2.0 13.2 23.5 35.5 45.1 40.0 25.7 Rural 2.1 0.0 2.5 8.5 16.0 21.6 29.9 16.0 Region Northeast 4.9 0.0 6.1 16.0 12.5 17.1 8.4 8.8 Northwest 2.7 0.0 0.0 0.0 8.2 3.6 8.0 3.9 Southeast 0.0 0.0 5.1 20.2 33.3 37.8 59.3 33.7 Southwest 0.0 2.3 12.0 24.8 36.4 44.9 46.1 29.7 Central 0.0 0.0 6.3 0.0 16.3 26.8 26.6 14.4 Education No education 2,5 0,0 9,9 2,8 9,2 13.1 16.1 10.4 Primary 2.5 0.0 1.5 13.7 23.9 40.3 48.6 24.6 Secondary 2.7 1.7 3.3 12.0 23.5 27.4 38.2 17.6 Higher 0.0 0.0 19.0 33.6 44.3 48.4 41.0 28.9 Total 2.1 0.6 6.4 I3.6 21.8 27.9 32.3 18.8 ~ote: Women and men who have been stetilised are considered to want no more children. Includes current pregnancy 91 The proportion of women who want no more children declines rapidly from the south to the north as shown by the fact that about 30 percent of women in the southern regions want no more children, compared with 20 percent of women in the Central region and only 7 percent of women in the northern regions. The proportion of women who want no more children is highest among those with more than a secondary education (35 percent) and lowest among those with no education (16 percent). However, there is no consistent pattern for those with primary and secondary levels of education. Tile data for men show patterns similar to women. The desire to have no more children is higher in the urban than in the rural areas, with the difference more pronounced among men with three or more living children. Regional variations show that the proportion who want no more children is highest for the Southeast region (34 percent), followed by the Southwest region (30 percent), the Central region (14 percent), the Northeast region (9 percent), and the Northwest region (4 percent). For educational differences, the proportion of men who want no more children is highest among those with a higher education (29 percent) and lowest among those with no education (10 percent). 6.2 Need for Family Planning Services One of the concerns of family planning programs is to estimate the number of women or couples who are in need of services as well as the potential demand for services. The concept of unmet need for family planning has evolved to define this indicator. Fecund women who say either they do not want any more children or that they want to walt two or more years before having another child, but are not using contraception, are considered to have an unmet need for family planningJ Women who are using family planning methods are said to have a met need for family planning. Women with unmet and met need constitute the total demand for family planning. Table 6.5 presents data on unmet need, met need, and total demand for family planning, according to whether the need is for spacing or limiting births. The data indicate that almost one in every five married women (18 percent) can be said to have an unmet need for family planning, 13 percent for spacing purposes and 5 percent for limiting births. Unmet need is rather uniform across various groups of women, although it is somewhat higher among women age 20-24, women in the Northwest region, and those with a primary education only. As expected, tmmet need for spacing methods is higher among younger women, while unmet need for limiting purposes is higher among older women. There are large differences in unmet need and total demand for family planning services in the regions. Married women in the Northwest and the Southeast have the greatest unmet need (24 and 21 percent, respectively), while those in the Northeast show the lowest unmet need (I 2 percent). Almost all the unmet need in Northwest is for spacing purposes. With respect to total demand for family planning, it is considerably higher among women in the south than in the north. Total demand for family planning comprises 44 percent of married women in the Southeast, 42 percent in the Southwest, and 34 percent in Central region, while it is only 28 percent in the Northwest and 15 percent in the Northeast. Combining unmet need with the proportion of women who are currently using contraception (met need) gives a total demand for family planning of 33 percent of married women. Therefore, if all women who say they want to space or limit thetr children were to use a contraceptive method, the contraceptive prevalence rate would increase from 15 to 33 percent of married women. 1 For an exact description of the calculation, see footnote 1, Table 6.4. 92 Table 6.5 Need for family planning Percentage of curmnily married women, unmarried women, and all women with unmet need for fami/y plannlng and with met need for family planning, and the total demand for family planning,by selected background characteristics (currently married women), Nigeria 1999 Met need for Unmet need for family planning z Total demand for Percentage family plarmlng I (currently using) family planning of demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fled women Respondent's age 15-19 14.0 0.8 14.8 4.2 0.0 4.2 18.2 0.8 19.0 21.9 472 20-24 2904 0.3 22.7 8.1 0.1 8.2 30.5 0.4 30.9 26.5 934 25-29 15.9 1.2 17.0 12.4 1.6 13.9 28.2 2.7 30.9 45.0 1,272 30-34 13.7 4.2 17.9 14.9 5.2 20.1 28.6 9.4 38.0 52.8 1,032 35-39 9.0 9.1 18.1 8.5 12.2 20.7 17.5 21.3 38.9 53.3 925 40-44 4.8 10.7 15.4 4.2 16.3 20.5 9.0 26.9 35.9 57.0 637 45-49 2.3 9.6 11.9 2.7 13.8 16.5 5.0 23.4 28.4 58.0 484 Residence Urban 10.9 5.6 16.6 13.5 9.9 23.4 24.4 15.5 40.0 58.5 1,670 Rural 13.7 4.2 17.9 7.3 4.7 12.0 21.0 8.9 29.9 40.2 4,087 Region Northeast 10.2 2.1 12.2 2.3 0.7 3.1 12.5 2.8 15.3 20.0 1,137 Northwest 21.9 2.4 24.4 2.4 0.8 3.2 24.3 3.3 27.6 11.7 986 Southeast 14.0 6.8 20.9 13.1 10.4 23.5 27.1 17.2 44.4 53.0 946 Southw~t 9.2 6.6 15.7 14.7 11.5 26.2 23.9 18.1 41.9 62.5 1,367 Central 11.6 4.7 16.3 11.3 6.5 17.8 22.9 11.2 34.I 52.2 1,321 Edueatiun No education 12.0 3.6 15.6 3.1 2.9 6.0 15.1 6.6 21.7 27.8 3,032 Primary 14.7 7.0 21.7 I0.8 9.1 19.9 25.5 16.2 41.6 47.9 1,298 Secondary 15.5 4.1 19.5 19.3 7.8 27.1 34.8 11.9 46.7 58.1 1,123 Higher 5.2 5.5 10.7 24.1 20.7 44.8 29.3 26.2 55.5 80.7 303 Total women currently married Total women not currently married AU women 12.9 4.6 17.5 9.1 6.2 15.3 22.0 10.8 32.8 46.7 5,757 3.4 0.2 3.6 15.6 0.8 16.4 19.0 1.0 20.0 82.1 2,449 10.1 3.3 13.3 11.0 4.6 15.7 21.1 7.9 29.0 54.0 8,206 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also includedin unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last clftld was unwanted, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here, Currently, 47 percent of the demand for family planning is being met (see Table 6.5, next-to-last column), which means that about half of the need of those who want family planning is unfulfilled. There has been a reduction in the level of unmet need since 1990 when 21 percent of married women had an unmet need for family planning (FOS, 1992:72). The reduction is due to the increase in contraceptive use (met need), which rose from 6 to 15 percent of married women. Consequently, the percentage of demand that was satisfied in 1999 (47 percent) is a remarkable improvement over the 23 percent in the 1990 NDHS. 93 Figure 6.3 shows a comparison of unmet need, met need, and total demand for family planning as well as the demand satisfied among currently married women for 1990 and 1999. This figure indicates the significant improvement in met need, the percentage of demand satisfied, and the consequent decline in unmet need. Figure 6.3 Trends in Unmet Need, Met Need, and Percentage of Demand for Family Planning that is Satisfied 60 50 40 30 20 10 0 Percenlage of currently married women 21 18 Unmet need ,71 23 ::;::~!~ ~ ~::~::~ .$j:+:.:~ ~,: :+: Met need Percentage of demand satisfied [~1990NDHS D1999NDHS I NDHS 1999 6.3 Ideal Family Size Data on ideal family size norms were obtained from responses to two major questions. Respondents who had no children were asked how many children they would like to have if they could choose exactly the number of children to have in their whole life. Those who had living children were asked how many children they would like to have if they could go back to the time when they did not have any children and could choose exactly the number of children to have in their whole life. These questions on ideal family size aim at two things: first, among respondents who have not started childbearing, the data provide an idea of the total number of children they will have in the future (to the extent that they are able to realise their fertility desires), and second, among older, higher parity respondents, these data provide a measure of the level of unwanted fertility. It should be noted that some respondents, especially those for whom feV.ility control is an unfamiliar concept, may have had difficulty answering this hypothetical question. The data in Table 6.6 indicate that 18 percent of women and 22 percent of men gave non-numeric responses such as "it is up to God," "any number," or "don't know." Those who gave numeric responses generally want rather large families. More than 40 percent of women want six or more children, while about one-third of women say their ideal number of children is four or five. Less than 3 percent of women want two or fewer children, the level necessary for long-term population stabilisation. Assuming that women who already have many children may find it difficult to admit that they may have ideally wanted fewer, it is useful to examine the ideal family sizes cited by women of lower parities. Yet, even among women with three or fewer children, only a small fraction (less than 4 percent) say they want two or fewer children. It is clear that the two-child norm is still far from being accepted in Nigeria. 94 Table 6.6 Ideal and actual number of children Percent distribution of all women and men by ideal number of children and meau ideal number of children for all women and men and for currently married women and men, according to number of living children, Nigeria 1999 Meal number of children Number of living children t 0 1 2 3 4 5 6+ Total WOMEN 0 1.6 0.5 0.1 1 0.0 1.9 0.1 2 2.7 1.2 3.3 3 8.5 5.2 3.9 4 28.9 20.9 19.8 5 16.6 i3.0 16.4 6+ 29.0 38.9 40.2 Non-numeric response 12.5 18.3 16.2 Total 100.0 100.0 100.0 Number of women 2,492 1,072 1,006 Mean idea1 number for: 2 All women 5.2 6.1 6.2 Number of women 2,180 876 843 Currently married women 6.6 6.2 6.2 Number of women 325 780 783 0.2 0.2 0.2 0.3 0.7 0.0 0.0 0.0 0.2 0.3 0.6 0.4 0.7 0.5 1.6 6.3 1.3 2.2 0.8 4.9 16.4 18.0 4.0 5.3 18.8 15.5 11.1 18.5 5.9 14.1 42.4 48.3 53.4 62.5 41.9 18.5 20.8 21.1 24.5 17.7 100.0 100.0 100.0 100.0 100.0 947 882 697 1,110 8,206 6.2 6.6 7.1 7.8 6.2 772 698 550 838 6,756 6.2 6.5 7.1 7.8 6.7 733 662 521 788 4,593 MEN 0 0.5 0.0 1 0.3 0.5 2 3.0 1.5 3 9.1 I1.0 4 20.6 17.2 5 18.7 13.3 6+ 33.9 35.7 Non-numeric response 13.9 20.8 Total 100.0 100.0 Number of men 1,145 197 Mean ideal number for: 2 All men 6.1 7.0 Number of men 985 156 Mean ideal number for: 2 Currently married men 8.6 7.2 Number of men 118 140 Monogamous men 9.0 7.3 Number of men 101 121 Polygynous men 6.0 7.1 Number of men 16 19 0.0 0.0 0.0 0.7 0.0 0.3 0.5 0.0 0.0 0.0 0.0 0.2 2.4 0.4 0.0 0.5 0.0 1.6 5.5 6.4 1.1 3.9 1.5 6.3 16.3 9.7 12.8 4.9 3.6 14.1 18.0 11.1 9.6 15.8 3.6 13.7 40.5 52.4 47.5 44.9 52.4 41.5 16.9 20.0 29.0 29.3 38.9 22.3 100.0 100.0 100.0 100.0 100.0 100.0 215 234 174 163 552 2,680 6.6 8.6 8.8 8.3 12.6 7.8 179 187 123 115 337 2,083 6.6 8.6 8.9 8.3 12.6 9.3 163 177 119 111 328 1,156 6.6 8.8 8.8 7.8 11.2 8.7 144 150 92 82 192 881 6.3 7.9 9.2 9.9 14.5 11.3 19 28 28 29 136 274 1 Includes current pregnancy 2 Means are calculated excluding women and men giving non-nume• responses. This desire for large families is reflected in the mean ideal family size which is 6.2 children among women and 7.8 among men. The mean ideal number of children increases with the number of living children, from 5.2 children for childless women to 7.8 children for women with six or more children. Similarly, the percentage of women who want to have six or more children, for example, is 29 percent among childless women and rises steadily with parity to 63 percent for those who already have six or more children. 95 This correlation may be explained in several ways. First, to the extent that they are able to implement their preferences, respondents who want larger families will tend to actually have them. Second, men and women may adjust their preferences upward through rationalisatlon as the actual number of living children increases. Finally, respondents with larger families, being older on average than those with smaller families, may have larger ideal family sizes because of attitudes they acquired 20 to 30 years ago. The ideal family size is slightly higher for married women than for all women. The differences are much larger among men, for whom the mean ideal number of children is 9.3 among married men, compared with only 7.8 among all men. For each level of parity, the mean ideal number of children reported by men is higher than that reported by women. For example, women with six or more living children gave a mean ideal number of children of 7.8 whereas men with six or more living children gave a mean of 12.6 children. Compared with the figures from the 1990 NDHS in which women reported a mean ideal number of children of 5.8, there has been a rise in the ideal number, although comparisons are made more difficult by the fact that 60 percent of women in the 1990 survey gave non-numeric responses. The 1988 population policy advised a fertility goal of an average of four children per woman. Hence, in both the 1990 and 1999 NDHS, respondents reported an ideal number of children that was about 50 percent higher than the policy target. Table 6.7 presents the mean ideal number of children by age and selected background characteristics for women and men. Ideal family size increases progressively with age, from 5.6 for women age 15-19 years to 7.0 for women age 45-49 years. Among the male respondents, mean ideal number of children is 6.1 among men age 15-19 years and 9.9 among those age 45-49 years. Table 6.7 Mean ideal number of children by background characteristics Mean ideal number of children for all respondents, by age and selected background characteristics, Nigeria 1999 Current age Background All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 women men Residence Urban 4.9 5.0 5.1 5.4 5.8 6.3 6.0 5.3 6.1 Rural 5.9 6.1 6.3 6.9 7.4 7.4 7.4 6.5 8.6 Region Northeast 7.3 7.8 7.5 9.0 9.6 9.3 8.4 8.2 10.6 Northwest 8.0 7.6 8.3 8.3 9.2 7.9 8.0 8.2 13.4 Southeast 5.5 5.3 5.5 5.9 6.6 6.9 7.I 5.8 6.6 Southwest 4.6 4.6 4.9 5.1 5.5 6.2 6.4 5.1 5.5 Central 5.1 5.1 5.7 6.1 6.5 7.1 6.9 5.8 7.3 Education No education 7.7 7.8 7.7 7.8 8.1 7.4 7.5 7.7 12.5 Primary 5.5 5.6 5.8 6.0 6.4 7.1 6.6 6.0 7.7 Secondary 4.9 4.8 5.1 5.4 5.8 6.4 5.9 5.1 6.0 Higher 3.4 4.3 4.2 4.6 4.5 4.6 5.1 4.4 6.2 All women 5.6 5.7 6.0 6.4 6.9 7.1 7.0 6.2 NA All men 6.1 6.4 6.8 7.2 8.0 10.1 9.9 NA 7.8 NA = Not applicable 96 Rural women and men are more likely to want larger families than urban women and men. For women, this is Irne at every age group, and rural respondents want about one child more than their urban counterparts. The northern and southern regions differ by about three children in mean ideal number of children. Although the women in the Northeast and Northwest regions reported a mean of 8.2 children, those in the Southeast and Central regions reported a mean of 5.8 children and women in the Southwest region reported a mean of 5.1 children. Ideal family size shows a strong negative correlation with women's level of education, declining from 7.7 children among women with no education to 4.4 children for women with a higher education. Moreover, this correlation is true at all ages. For men, the mean ideal number of children declines from 12.5 for those with no education to 6.2 children among those with a nigher education. 6.4 Planning Status of Births The NDHS collected information on births in the three years preceding the survey and arty current pregnancy as to whether the pregnancy was planned (wanted then), unplanned (wanted later), or not wanted at all (wanted no more). The purpose of these questions was to assess how successfully couples control their fertility. The validity of the responses depends to a large extent on how honestly the questions are answered and how well the respondents remember their desires for pregnancies at the time. Mistimed and unwanted pregnancies at the time of conception may turn out to be wanted children after birth, which makes assessment of unplanned births more difficult. Table 6.8 shows the percent distribution of births in the three years preceding the survey by fertility planning status, according to birth order and mother's age at birth. More than three-quarters of births were wanted at the time of conception, while 16 percent were mistimed and 3 percent were not wanted at the time they were conceived. As expected, the percentage of births that were not wanted increases with birth order (from less than 1 percent of first births to 6 percent of fourth or nigher order births). Unwantedness also Table 6.8 Fertility planning status Percent distribution of births (including current pregnancy) in the three years preceding the survey by fertility planning status, according to birth order and mother s age at birth, Nigeria 1999 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age at birth then later wanted Missing Total births Birth order 1 79.5 16.9 0.6 3.0 100.0 900 2 82.7 14.2 0.6 2.5 100.0 756 3 82.9 13.8 1.0 2.3 100.0 695 4+ 73.6 16.6 5.9 4~0 100.0 2,030 Age at birth <19 77.7 18.5 0.8 3.1 100.0 714 20-24 79.8 17.1 0.6 2.5 100.0 1,147 25-29 80.6 14.4 1.4 3.5 100.0 1,170 30-34 77.4 15.1 4.8 2.7 100.0 757 35-39 70.3 14.5 9.8 5.4 100.0 441 40-44 70.8 9.6 14.8 4.8 I00.0 124 45-49 44.9 17.6 34.0 3.5 100.0 27 Total 77.8 15.8 3.1 3.3 100.0 4,381 97 increases with the mother's age at the time of birth. For example, less than 1 percent of births to women age 24 and below were unwanted, compared with 34 percent of births to women age 45-49 years. This pattern may be caused by the fact that a lower proportion of older women than younger women are using contraception and the fact that older women are more likely to have achieved their desired family size and therefore consider an additional pregnancy unwanted. The percentage of births considered mistimed (wanted later) shows little difference with birth order and the age of mother at the time of the birth. Compared with data from the 1990 NDHS, there has been an increase in the proportion of mistimed births. In 1990, only 8 percent of births were wanted later, compared with 16 percent of births in the 1999 survey. The proportion of unwanted births barely changed over the same period, rising from 2 to 3 percent of all births. Table 6.9 presents the total wanted fertility rate and total fertility rates for the three years preceding the survey by selected background characteristics. The total wanted fertility rate is calculated in the same manner as Table 6.9 Wanted fertility rates Total wanted fertility rates and total fertility rates for the five years preceding the survey, by selected background characteristics, Nigeria 1999 Total wanted Total Background fertility fertility characteristic rates rates Residence Urban 4.2 4.5 Rural 5.1 5.4 Regio:n Northeast 6.4 6.8 Northwest 6.0 6.5 Southeast 4.2 4.6 Southwest 4.2 4.5 Central 4.2 4.5 Mother's education No education 5.8 6.i Primary 5.1 5.6 Secondary 4.4 4.9 Higher (2.3) (2.4) Total 4.8 5.2 Note: Figures in parentheses are based on 25-49 children. Rates are calculated based on women age 15-49 in the period 1-59 months preceding the survey, be total fertility rates are those presented in Table 3.2. the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as births that exceed the number considered ideal by the respondent. This rate expresses, in theory, what the level of fertility would have been if in the three years preceding the survey, all unwanted births were eliminated. A comparison of the two rates should suggest the potential effect of the elimination of unwanted births. The total wanted fertility rate is 4.8 children per woman, which is 0.4 less than the actual total fertility rate (TFR) of 5.2 (see Table 3.1). The difference implies a low prevalence of unwanted births in Nigeria. There is a decline in both the wanted and actual fertility rates since 1990, when rates were 5.8 and 6.0, respectively. Differences between the wanted TFRs and actual TFRs are fairly uniform across all groups of women, with the former being generally 0.2 to 0.4 less than the latter. 98 CHAPTER 7 INFANT AND CHILD MORTAL ITY 7.1 Introduction Rates of infant and child mortality reflect a country's level of socioeconomic development and quality of life. This chapter examines the mortality of children under five in Nigeria. Information on trends and differentials in neonatal, postneonatal, and infant and child mortality, as well as information on patterns of fertility associated with high mortality risk, is provided. Mortality estimates are disaggregated by sex, socioeconomic and demographic characteristics, region, and other factors in order to identify segments of the population requiring special attention. This information is useful for monitoring and evaluating population and health programmes and policies. For example, the 1988 National Policy on Population (NPP) alms to reduce the infant mortality rate to 30 per 1,000 live births by the year 2000. Data from the 1999 NDHS present an opportunity to assess whether this goal was met. Moreover, infant and child mortality rates are inputs for population projections. In this report, mortality in early childhood is measured using the following five rates: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality (lq0): the probability of dying before the first birthday Child mortality (4ql): the probability of dying between the first and fifth birthday Under-five mortality (5q0): the probability of dying between birth andthe fifth birthday. All rates are expressed as deaths per 1,000 live births, except child mortality, which is expressed as deaths per 1,000 children surviving to the first birthday. Childhood mortality rates are derived from the birth history section of the Womn's Questionnaire. During the survey, respondents were asked questions about their childbearing experience, i.e., their total number of sons and daughters who live in the household, who live elsewhere, or who have died. Then for each live birth, information on name, date of birth, sex, and survivorship status was recorded for any living child; information about his/her age (in completed years) and whether the child resided with his/her mother was obtained. For all children who had died, the respondent was asked their age at death. 7.2 Assessment of Data Quality The reliability of early childhood mortality rates from birth history depends on the accuracy of reporting by respondents. In cultural settthgs, such as in Nigeria, where there is reluctance to speak about the dead, many mothers may omit dead children. Therefore, special skills are required to elicit accurate information from respondents about their deceased children. An examination of the birth history data in the 1999 NDHS (see Appendix C) shows evidence of omission of births and deaths, especially in the three years preceding the date of interview. Such omissions may result from interviewers displacing births to avoid the 99 numerous health questions that were to be asked about live births since January 1996. The conclusion of an in-depth assessment of the mortality data is that the reported rates are underestimates (see Appendix C.4). Nevertheless, the reported results are presented here in the belief that they may provide some useful insight into infant and child mortality conditions in Nigeria. 7.3 Levels of Childhood Mortality Table 7.1 shows neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey. The infant mortality rate (IMR) for the most recent period, 0-4 years before the survey, is 75 per 1,000 live births. The IMR for 1985-89 (10-14 years before the survey) is 77 per 1,000 live births. This rute is lower than the 87 per 1,0001ive births reported for the period 1986-90 obtained from the 1990 NDHS and probably reflects the underreporting of mortality for the 1999 survey (see Appendix C.4). The neonatal mortality rate is 37 per 1,000 live births and the postneonatal mortality rate is almost identical (38). Under-five mortality in Nigeria is 140 per 1,000 live births, a high level of mortality even by African standards. Under-five mortality for the 10-14 years before the survey (1985-89) is 142 per 1,000, which is low relative to the 1990 NDHS estimate of 192 per 1,000 for the same period. Table 7.1 Rates of early childhood mortality Neonatal, postneonatal, infant, child, and under-five mortality by five-year periods preceding the survey, Nigeria 1999 Years Neonatal Postneonatal Infant Child tinder-five preceding mortality mortality mortality mortality mortality survey (NN) (PNN) (~q0) (4ql) (sqo) 0-4 36.9 38.3 75.2 70.3 140.2 5-9 33.0 33.1 66.2 63.9 125.8 10-14 35.8 41.3 77.0 70.8 142.3 Note: See Appendix C for discussion of the quality of data. 7.4 Socioeconomic Differentials The risk of early childhood death is higher in some subgroups of the population than in others. Table 7.2 shows the socioeconomic differentials in infant and child mortality in the 10 years before the 1999 NDHS. Urban areas have substantially lower childhood mortality rates than rural areas. It appears that a relatively larger proportion of infant deaths in urban areas occurs in the first month of life, while a slightly higher proportion of rural infant deaths occurs after the first month of life. Infant and child mortality rates also vary according to mothers' region of residence. Under-five mortality in the ten years before the survey was highest in the Northwest (188 per 1,000 live births) and Notheast regions (175) and lowest in the Central region (84). The extent to which these differentials are real or due to differential underreporting of deaths is unclear. 100 Table 7.2 Neonatal, postneonatal, infant, child, and under-five mortality by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality for the ten-year period preceffmg the survey, by socioeconomic characteristics, Nigeria 1999 Post- Neonatal neonatal Infant Child Under-five Socioeconomic mortality rao~ality mortality mortality mortality characteristic (NN) (PNN) (lqo) (4ql) ~qo) Residence Urban 36.2 23.1 59.3 51.6 107.8 Rural 34.6 40.4 75.0 73.4 142.9 Region Northeast 44.5 34.9 79.4 104.1 175.2 Northwest 25.1 57.5 82.6 115.1 188.2 Southeast 37.3 37.1 74.3 65.6 135.0 Southwest 42.6 27.3 69.9 33.9 101.5 Central 23.8 26.9 50.7 35.5 84.4 Mother's education No education Primary Secondary Higher Medical maternity care 1 No antenatal or delivery care 46.4 65.0 I 11.5 NA NA Either antenatal or delivery care 31.9 32.0 63.9 NA NA Both antenatal and delivery care 31.6 22.6 54.3 NA NA Total 35.0 35.8 70.8 67.4 133.4 NA= Not applicable 1 Based on births in the five years preceding the survey 35.4 41.5 76.9 86.6 156.8 36.1 35.1 71.2 54.5 121.8 34.5 24.5 59.0 39.3 95.9 25.3 15.2 40.5 13.0 53.0 Mother's level of education is strongly related to levels of infant and child mortality. Educated mothers normally have better access to resources needed for improved child survival. In the 1999 NDHS, large differentials in childhood mortality rates by mother's education are observed. Mortality among infants was lowest among children of mothers with a pos-secondary education (41 per 1,000 live births) and highest among infants of mothers with no schooling (77 per 1,000 live births). Similarly, under-five mortality rates were highest among children of mothers with no schooling (157 per 1,000 live births) and lowest among those whose mothers had a postsecondary education (53 per 1,000 live births). These rates indicat that mothers with no education are almost three times as likely to have an infant die in the first year of life as those with a postsecondary education. Table 7.2 also shows the relationship between antenatal care and delivery assistance by a trained medical person on one hand and infant mortality on the other. In general, infants whose mother received no medical maternity care were about twice as likely to die as those whose mothers received the basic medical care. 7.5 Demographic Differentials The risk of infant death is influenced by biodemographic factors such as birth intervals, mother's age at birth, and birth order. Table 7.3 presents the relationship between infant and child mortality and various biodemographic variables. As is commonly observed, the 1999 NDHS data show that male infants 101 have higher risk of death than females. Infants of older mothers (40-49) are about twice as likely to die as infants of younger mothers (<40 years). Similarly, higher order births have elevated risks of dying in infancy. Seventh and higher births are twice as likely to die as infants as second and third births. The 1999 NDHS also shows that short birth intervals (under two years) are associated with higher infant deaths. Infants born within two years of a preceding birth were twice as likely to die as those born after three years of a preceding birth. The level of under-five mortality also decreases as the spacing between births increases. Table 7.3 Neonatal~ postneonatal, infant~ child~ and under-five mortailty by biodemographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality for the ten-year period preceding the survey, by selected biodemogmphic characteristics, Nigeria 1999 Post- Neonatal neonatal Infant Child Under-five Biodemographie mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lq0) (4ql) (~qo) Sex of child Male 38.3 35.0 73.2 65.9 134.4 Female 31.6 36.6 68.2 69.0 132.5 Age of mother at birth < 20 36.0 37.9 74.0 91.6 158.8 20-29 33.9 31.1 65.0 60.7 121.7 30-39 32.0 39.1 71.1 61.4 128.1 40-49 76.2 77.8 154.1 94.6 234.1 ~irth order 1 39.0 26.9 65.9 61.3 123.1 2-3 25.8 29.3 55.1 58.8 110.7 4-6 32.9 37.3 70.2 73.8 138.8 7+ 55.0 59.8 114.8 85.4 190.4 Previous birth interval <2 years 51.5 52.0 I03.6 78.7 174.I 2-3 years 25.7 33.5 59.2 70.6 125.6 4 or more years 24.3 26.2 50.5 44.4 92.7 Size at birth 1 Small or very small 49.9 38.9 88.7 NA NA Average or larger 28.1 31.8 59.9 NA NA NA = Not applicable l Based on births in the five years preceding the survey 7.6 High-Risk Fertility Behaviour Certain patterns of reproductive behaviour are associated with negative maternal and child health. They include motherhood at specific young or old ages, short spacing between births, and high parity. In this analysis, a mother is classified as "too young" if she is less than 18 years of age and "too old" if she is over 34 years of age. A "short birth interval" is defined as a birth occurring less than 24 months after a previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more children (i.e., if the child is of birth order four or higher). First births, although often at increased risk, are not placed in a high-risk category since they are not considered an avoidable risk. The distribution of women and children according to fertility behaviour that exposes them to an elevated risk of dying is shown in Table 7.4. The data show that 64 percent of children born in the five years 102 preceding the survey have an elevated risk of dying. Out of this proportion, 40 percent are in the single high- r isk category, and 24 percent are in the multiple high-risk category. Among children who fall in the single high-risk category, children born to adolescent mothers younger than 18 years are particularly at h igh risk of dying, almost twice (1.9) the r isk of those not in any high-risk category. Another category of h igh risk is being born within abirth interval of less than 24 months (risk is 1.5). As expected, higher parity is also associated with an increased risk of dying. In the multiple high-risk categoy, a combination of older age at motherhood, a short birth interval, and high parity contributes to the highest r isk of mortality. Children in this category are almost four (3.6) t imes as likely to die as those who are not in any risk category. Children of older mothers born too close to a preceding birth are more than three (3.3) t imes as likely to die as those not in any risk category. Another important multiple risk category is children born with a birth interval of less than 24 months and a parity of 4 or higher; they have a mortality r isk of 2.4. Thus, children who are in the multiple r isk category were usually 2 to 4 t imes as likely to die as those not in any high-risk category. The good news is that the percentage of births in these multiple high-risk categories is low. Table 7.4 High-risk fertility behaviour Percent distribution of children born in the five years preceding the survey by category of elevated risk of dying, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of dying, by category of increased risk, Nigeria 1999 Births in 5 years preceding the survey Percentage of currently Percentage married a Risk category of births Risk ratio women Not In any high-rlsk category 22.8 1.00 15.8 b Unavoidable risk category (First births) 13.5 1.05 6.3 Single high-risk category Mother's age <18 8.0 1.91 2.8 Mother's age >34 1.0 0.67 3.8 Birth interval <24 months 6.9 1.48 8.8 Birth order >3 24.3 1.39 17.3 Subtotal 40.2 1.49 32.6 Multiple high-risk category c Age <18 & birth interval <24 months 1.2 0.80 Age >34 & birth interval <24 months 0.1 3.26 Age >34 & birth order >3 9.1 1.71 Age >34 & birth interval <24 months & birth order >3 2.6 3.63 Birth interval <24 months & birth order >3 10.4 2.37 Subtotal 23.5 2.18 In any high-risk category 63.7 1.74 Total 100.0 Number of births 6,190 0.8 0.2 27.1 5.4 11.8 45.3 77.9 100.0 5,808 Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk ~ategory to the pmportion dead of births not in any high-risk category. Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 ~nlnonths ago, and latest birth of order 3 or higher. eludes stefilised women C . . . Includes the combined categories Age <18 and b~rth order >3. 103 CHAPTER 8 MATERNAL AND CHILD HEALTH This chapter presents findings on antenatal care, delivery care, childhood wtccinations, and selected childhood illnesses. Childhood illnesses are associated with a number of risk factors, including inadequate antenatal care, lack of or inadequate vaccination, high birth order, and malnutrition. Irrespective of changes in the social role of women throughout the ages and the countless variations of that role in different cultures, women's status largely depends on the biological facts that women are the bearersofchildrenandthatthecareofchildrenisusuallytheresponsibilityofwomen. The state ofmaternal and child health reflects the society' s level of development. 8.1 Antenatal Care Antenatal Care Coverage Table 8.1 shows the percent distribution of live births in the three years preceding the survey by antenatal care provider, according to maternal age, birth order, residence, region, and mother's education. It shows that for almost two-thfrds of births (64 percent), mothers receive antenatal care either from a doctor, nurse, midwife, or auxiliary midwife. For less than one-third (30 percent) of births, mothers receive no antenatal care. Traditional birth attendants provide a very small proportion of antenatal care (4 percent of births) (Figure 8.1). Differences in antenatal care coverage by mother's age at birth and birth order are not large, although teenaged mothers are particularly unlikely to obtain antenatal care. Pregnant women in rural areas are less likely than those in urban areas to receive antenatal care from a doctor or nurse or midwife (56 versus 84 percent). This differential could be because of lack of access to antenatal care providers, economic constraints, and/or lack of awareness of the importance of antenatal care. There are also differences in the sources of antenatal care for births in urban and rural areas. Forty percent of urban women receive antenatal care from a doctor, compared with only 19 percent of rural women. The difference is probably because of the higher concentration of hospitals and doctors in urban areas. Antenatal care coverage is considerably higher in the southern part of the country than in the north. The proportion of births for which women receive antenatal care from either a doctor or a nurse or ntidwife ranges from 89 percent in Southwest region to 28 percent in the Northwest region. Moreover, births to women in the south are much more likely than births in the north to receive antenatal care from a doctor--39 percentand 51 percent in the Southeast and Southwest regions, respectively, compared with 5 percent and 7 percent in the Northeast and Northwest regions, respectively. Antenatal care coverage from doctors in the Central region is intermediate. Moe than half the births in the two northern regions do not benefit from any antenatal care at all; in the Northwest region, mothers did not receive any antenatal care for two-thirds of the births. There is a positive association between mother's education and source of antenatal care. As the mother's level of education increases, so does the likelihood that she will receive antenatal care from a doctor during pregnancy--8 percent of mothers with no education receive antenatal care from a doctor, compared with 67 percent of women with a higher (postsecendary) education. Likewise, women with no education have 105 Table 8.1 Antenatal care Percent distribution of births in the three years preceding the survey by source of antenatal care during pregnancy, according to selected background characteristics, Nigeria 1999 Antenatal care provider I Traditional Number Background Nurse/2 birth of characteristic Doctor Midwife attendant No one Missing Total births Mother's age at birth < 20 13.1 33.8 4.6 45.4 3.1 100.0 615 20-34 28.0 39.8 3.8 26.1 2.4 100.0 2,468 35+ 22.5 40.8 3.4 28.4 4.8 100.0 464 Birth order 1 26.3 38.8 4.3 28.3 2.3 100.0 739 2-3 28.5 38.5 3.6 27.3 2.2 100.0 1,159 4-5 23.5 37.0 4.5 32.0 3.0 100.0 832 6+ 19.1 41.4 3.2 32.2 4.2 100.0 818 Residence Urban 40.i 43.4 3.0 10.3 3.2 100.0 984 Rural 18.8 37.1 4.2 37.2 2.7 100.0 2,563 Region Northeast 4.5 35.8 1.5 54.1 4.1 100.0 788 Northwest 6.9 21.4 4.0 65.1 2.6 100.0 629 Southeast 39.0 42.5 8.3 7.7 2.4 100.0 649 Southwest 50.9 38.3 4.6 3.5 2.7 100.0 777 Central 21.1 55.1 1.4 20.2 2.3 100.0 704 Mother's education No education 7.9 30.7 3.6 54.4 3.3 100.0 1,714 Primary 29.7 51.9 5.4 10.6 2.5 100.0 868 Secondary 47.3 43.9 3.3 3.4 2.1 100.0 827 Higher 66.5 27.7 0.6 0.8 4.5 100.0 138 Total 24.7 38.9 3.9 29.7 2.9 100.0 3,547 1 If the respondent mentioned more than one provider, only the most qualified provider is considered. 2 Includes auxiliary midwives Figure 8.1 Antenatal Care, Tetanus Vaccinations, Place of Delivery, and Delivery Assistance, Nigeria 1999 ANTENATAL CARE Doctor L ~ Nurse/Midwife TBA ~4 No one TETANUS VACCINATION None 2+ k;;;.;'.'.;i;:!' PLACE OF DELIVERY Health facility At home DELIVERY ASSISTANC.,E Doctor " " " 8 Nurse/Midwife Relative/Friend I'H.H.H. NO one t////////,./~ . . 2 5 • • - :~39 !i.ii;ii.i!i!i.ii!~:.~.1 . 44 37 ~//i//~///////((/((///////////////~ ~4 ,z/////////////////,/A21 ,.,~.,.,. ,.,.,,-.,A 11 10 20 30 40 50 Percent 58 60 70 Note: Percentages are based on births in the three years preceding the survey. TBA = Traditional birth attendant NDHS 1999 106 the highest percentage (55 percent) who do not receive any antenatal care at all, compared with women with a secondary or higher education (4 percent and 1 percent, respectively). Number and Timing of Antenatal Visits The number and timing of antenatal care visits can be factors in their effectiveness in preventing adverse pregnancy outcomes. Table 8.2 shows the percent distribution of live births by the number of antenatal care visits and the stage of pregnancy during which the first visit occurred. For almost half of all births (47 percent), mothers made four or more antenatal care visits. This level of contact with antenatal care providers constitutes 81 percent of all births that receive antenatal care, which implies that women who use antenatal clinics are aware of the importance of regular attendance. The median number of antenatal care visits is six. Almost half of all pregnant women get antenatal care before the end of the second Irimester (less than six months). The median duration of pregnancy at the time of the first antenatal care visit is 5.1 months. This figure means that half of all pregnant women have their first antenatal visit after five months or do not get any care at all. This timing of the first antenatal visit is considered late if mothers are to receive the maximum benefits of antenatal care. Table 8.2 Number of antenatal care visits and stage of pregnancy Percent distribution of live births in the last three years by number of antenatal care (ANC) visits, and by the stage of pregnancy at the time of the first visit, Nigeria 1999 Number of visits and Percentage stage of pregnancy of births Number of ANC visits None 29.7 1 1.7 2-3 visits 8.9 4+ visits 47.3 Don't know/missing 12.4 Total 100.0 Median 5.8 Number of months pregnant at time of first ANC visit No antenatal care 29.7 Less than 6 months 48.1 6-7 months 15.4 8+ months 1,9 Don't know/missing 4,9 Total 100.0 Median 5.1 Total 3,547 Tetanus Toxoid Vaccination Tetanus toxoid injections are given during pregnancy for the prevention of neonatal tetanus, one of the principal causes of death among infants in many developing countries. A pregnant woman is expected to receive two doses of the toxoid for full protection. On the other hand, if a woman has been fully vaccinated during a previous pregnancy, she may only require one dose for a current pregnancy. Five doses are considered to provide lifetime protection. In order to estimate the extent of tetanus toxoid coverage during pregnancy, the NDHS collected data for each birth in the three years before the survey on whether the mother had received tetanus toxoid vaccinations during pregnancy and, if so, the number of injections. These results are presented in Table 8.3. The data may underestimate the actual extent of protection from tetanus, since women were asked about vaccination during specific pregnancies. Women who had received prior vaccinations may not have received additional injections because they were considered unnecessary. The data indicate that for more than 44 percent of all births, mothers received two or more doses of tetanus toxoid during pregnancy, while for 11 percent, they had received one dose. Almost 40 percent of births occurred without the benefit of any tetanus toxoid vaccination. Tetanus toxoid coverage is nigher among older than among younger women; well over half of teenage mothers received no injections at all during pregnancy. There is little difference in tetanus toxoid coverage by birth order, which is somewhat surprising since one would expect coverage might diminish with birth order, given that many women would have already received the recommended complete vaccinations in prior pregnancies. Tetanus toxoid vaccination coverage is higher in urban than in rural areas. 107 Table 8.3 Tetanus toxoid vaccinations Percent distdbutlon of births in the three years preceding the sttrwy by number of tetanus toxoid injections mother received during pregnancy, according to selected background characteristics, Nigeria 1999 Number of tetanus toxald injections Two Don't Number Background No One doses know/ of characteristic injection dose or more Missing Total births Mother's age at birth < 20 57.3 7.6 30.5 4.6 100.0 615 20-34 34.8 11.6 47.9 5.8 I00.0 2,468 35+ 34.8 13.8 43.3 8.0 100.0 464 Birth order 1 40.3 10.4 43.9 5.4 100.0 739 2-3 34.6 12.8 47.0 5.7 100.0 1,159 4-5 40.9 10.2 43.2 5.6 100.0 832 6+ 40.8 10.6 41.8 6.9 100.0 818 Residence Urban 19.3 14.1 59.6 7.0 100.0 984 Rural 46.1 10.0 38.4 5.5 100.0 2,563 Region Northeast 64.1 7.2 24.1 4.7 100.0 788 Northwest 69.2 5.2 21.0 4.6 100.0 629 Southeast 20.6 10.3 61.8 7.3 100.0 649 Southwest 13.3 14.6 63.9 8.1 100.0 777 Central 27.7 17.9 49.8 4.6 I00.0 704 Mother's education No education 62.8 8.0 24.1 5.2 100.0 1,714 Primary 23.6 15.I 53.9 7.4 100.0 868 Secondary 10.1 13.4 70.6 5.9 100.0 827 Higher 5.8 12.6 76.4 5.2 100.0 138 Total 38.7 11.2 44.3 5.9 100.0 3,547 Mothers in the Southeast and Southwest regions are thrice as likely to have received two or more doses of tetanus toxoid during pregnancy (62 percent and 64 percent, respectively) than are mothers in the Northeast and Northwest regions (24 percent and 21 percent, respectively). Two-thirds of births in the northern part of the country are at risk of tetanus infection because the mothers did not receive any tetanus toxo'ld vaccination during pregnancy. In contrast, 28 percent of mothers in the Central region did not receive any tetanus toxoid vaccination. Women with no education have the lowest tetanus toxoid vaccination coverage. Almost two-thirds of pregnant women with no education do not receive a tetanus toxoid vaccination; the percentage falls to 24 percent among those with a primary education, I 0 percent among those with a secondary education, and only 6 percent among those with a higher education. Conversely, the proportion of women who received two or more doses of tetanus toxoid during pregnancy increases from 24 percent among women with no education to 76 percent among women with a higher education. Educated women may have a greater understanding of the advantages of vaccination and greater access to modern medical care. They may also be more willing to utilise the available services. 8.2 Delivery Care Delivery is a potentially hazardous process. Indeed, most maternal mortality occurs during delivery. Therefore, the place of delivery and the type of assistance women receive during delivery are important components of reproductive health care and are crucial to efforts to promote safe motherhood. 108 Place of Delivery The place of delivery is an important indicator of service coverage. Table 8.4 shows the distribution of births by place of delivery, according to maternal background characteristics. In all, 58 percent of births in Nigeria occur at home, while 37 percent occur in health facilities. Compared with 1990, there has been an increase in the proportion of births occuring in health facilities, from 31 to 37 percent (FOS, 1992: 89). Table 8.4 Place of delivery Percent distribution of births in the three years preceding the survey by place of delivery, according to selected background characteristics, Nigeria 1999 Place of delivery Don~ Number Background Health At know/ of characteristic facility home Missing Total births Mother's age at birth < 20 22.2 74.4 3.4 100.0 615 20-34 41.3 54.5 4.2 100.0 2,468 35+ 36.2 57,3 6.5 100.0 464 Birth order 1 43.6 52.4 4.0 100.0 739 2-3 40.7 55.6 3.8 100.0 1,159 4-5 35.0 60.6 4.4 100.0 832 6+ 29.2 65.2 5,6 100.0 818 Residence Urban 52,5 42.2 5.4 100.0 984 Rural 31.5 64.5 4.0 100.0 2,563 Region Northeast 11.7 84.7 3.6 100.0 788 Northwest 6.4 91.0 2.6 I00.0 629 Southeast 54.9 39.4 5.7 100.0 649 Southwest 67.2 25.5 7.3 100.0 777 Central 44.3 53.2 2.5 100.0 704 Mother's education No education 13.4 82.9 3.7 100.0 1,714 Primary 48.0 47.1 5.0 100.0 868 Secondary 67,9 27.0 5.1 100.0 827 Higher 83.9 11.4 4.7 100.0 138 Arttenatal care visits None 2.5 96.9 0.6 100.0 1,054 1-3 visits 34.3 64,0 1.7 100.0 375 4 or more visits 59,7 38,0 2.3 100.0 1,677 Total 37.3 58.3 4,4 100.0 3,547 Note: Total includes 441 births for which data on antenatal visits are missing. There was no dear-cut association between place of delivery and maternal age. Use of health facilities for delivery decreases with increasing birth order; sixth or higher births are least likely to occur in a health facility. Women in urban areas are more likely to deliver in a health facility than women in rural areas. There are marked differences by region regarding place of delivery. Home deliveries are most common in the north, where almost nine in ten births occur at home, in contrast to one in three births in the south and one in two in the Central region, q'he percentage of births that occur in a health facility increases with education, from only 13 percent of births to women with no education to 84 percent among those with 109 a higher education. Women who have contact with health professionals during pregnancy are much more likely to deliver at a health facility than women who have no such contact. Women who make four or more antenatal care visits deliver 60 percent of their babies in a health facility, compared with 3 percent of women who make no antenatal care visits. Assistance During Delivery Another important aspect of maternal health care is care during delivery. Attendance by a medically trained person during labour and delivery can reduce maternal deaths, one goal of the global Safe Motherhood Initiative. Table 8.5 shows the distribution of births by type of assistance during delivery, according to selected maternal background characteristics. Table 8.5 Assistance during delivery Percent distribution of births in the three years preceding the survey by type of assistance during delivery, according to selected background chamcteristles, Nigeria 1999 Attendant assisting during delivery Traditional Don~ Number Background Nurse/ birth Relative/ No know/ of characteristic Doctor Midwife I attendant Other one Missing Total births Mother's age at birth < 20 3.3 20.5 28.8 32.6 12.4 2.4 I00.0 615 20-34 9.1 36.9 19.1 21.7 10.9 2.3 I00.0 2,468 35+ 7.3 34.1 18.7 22.3 13.0 4.6 100.0 464 Birth order 1 10.0 36.5 21.2 23.9 6.4 1.9 100.0 739 2-3 9.2 35.1 20.3 22.6 11.0 1.8 100.0 1,159 4-5 7.8 32.1 18.9 26.5 11.8 3.0 100.0 832 6+ 4.2 30.8 22.6 22.1 16.3 3.9 100.0 818 Residence Urban 14.0 43.9 15.5 14.2 9.6 2.8 100.0 984 Rural 5.5 29.8 22.7 27.3 12.1 2.6 100.0 2,563 ~.egioEL Northeast Northwest Southeast Southwest Central Mother's education No education Primary Secondary Higher Antenatal care visits 1.3 11.4 29.0 31.6 23.2 3.6 100.0 788 1.6 6.5 38.7 25.5 25.5 2.3 100.0 629 93 55A 18.I 12.5 2.3 1,8 100,0 649 17.7 55.5 10.6 10.5 2.4 3.2 100.0 777 8.1 38.9 9.0 38.1 4.1 1.9 100.0 704 2.1 12.8 29.6 33.3 19.1 3.1 I00.0 1,714 8.4 47.3 14.8 20.8 6.3 2.3 I00.0 868 15.0 59.2 11.1 9.8 2.7 2.1 100.0 827 33.4 54.7 4.4 5.2 0.8 1.6 100.0 138 None 0.5 2.7 34.8 37.9 24.0 0.0 100.0 1,054 1-3 visits 5.9 33.8 19.4 31.2 9.7 0.0 I00.0 375 4 or more visits 12.5 52.7 13.3 15.I 6.1 0.3 I00.0 1,677 Don~t know/Missing 9.3 35.4 16.2 15.9 3.1 20.0 100.0 441 Total 7.9 33.7 20.7 23.7 11.4 2.6 100.0 3,547 l Includes auxiliary midwives 110 Forty-two percent of births in Nigeria are attended by medically trained personnel, mostly nurses or midwives; only 8 percent of births are attended by doctors. One in five births is assisted by a traditional birth attendant, while almost one in four is assisted by a relative or friend. Eleven percent of births are delivered without any assistance at all. Women over the age of 20 years are almost twice as likely as women under 20 to be assisted at delivery by medically trained personnel. Since deliveries to young women are especially risky, the low coverage for teenaged mothers is a particularly important finding. The proportion of births assisted by medically-trained personnel decreases at higher birth orders, from 47 percent of first births to only 35 percent of sixth and higher births Women in urban areas (58 percent) were more likely to be assisted at birth by medically trained personnel than rural women (35 percent). Births to women in the south are most likely to be attended by medically trained personnel (65 to 73 percent), followed by births to women in the Central region (47 percent). Only about 10 percent of births to women in the north are assisted by doctors, nurses, or midwives. One-quarter of births inthe north are delivered without assistance, in sharp contrast with only 4 percent of births in the Central region and 2 percent of bilths in the south. A significant proportion of deliveries in the Central region (38 percent) and in the north (26 to 32 percent) are assisted by relatives and friends. As expected, better-educated women tend to benefit from better assistance at delivery. Only 15 percent of births to uneducated women are assisted by medically-trained personnel, in contrast with 56 percent among births to women with a primary education, 74 percent among births to those with secondary education, and 88 percent among births to those with a higher education. Women who make no antenatal visits are much less likely to receive medically gained assistance than those who had antenatal care. It is interesting to note that although doctors provide antenatal care for 25 percent of births (Table 8.1), they assist only 8 percent of deliveries (Table 8.5). Similarly, nurses and midwives provide antenatal care to 39 percent of births but assist 34 percent during delivery. On the other hand, tradirionai birth attendants assist with five rimes as many births as they provide antenatal care for. One possible reason for these discrepancies might be economi causes (i.e., antenatal care is available at a nominal fee but delivery fees are often unaffordable). Another reason might be inability to get to a health facility at the onset of labour, especially when labour occurs at night. It should be noted, however, that delivery in health facilities in Nigeria is usually conducted by nurses or midwives (even when a doctor is available), except where there are complications. Characteristics of Delivery Access to caesarean sections can save the lives of women who cannot deliver normally. Women interviewed in the NDHS were asked whether they had a caesarean secrion for any birth that occurred in the three years preceding the survey. The results in Table 8.6 show that only 4 percent of bilths in Nigeria-- I in 27 are delivered by caesarean section. The percentage of births delivered by caesarean section increases slightly with age. It is also higher in urban than in rural areas, which presumably reflects better access to higher quality care. There is variation among the regions with regard to the percentage of deliveries by caesarean section, ranging from a low of less than 1 percent in the Noitheast region to a high of 7 percent in the Southwest region. The percentage of deliveries by caesarean section increases with mother's education. Low birth weight is associated with morbidity and mortality during infancy (Faveau et al., 1990). Mothers of babies born in the three years prior to the survey were asked whether their children were weighed at birth and if so, how much they weighed. If the information was available on a health card or birth record, 111 Table 8.6 Delivery characteristics: caesarean section T birth weight and size Among births in the three years preceding the survey, the percentage of deliveries by caesarean section, and the percent distribution by birth weight and by the mother's esthnate of baby's size at birth, according to selected background characteristics, Nigeria 1999 Birth weight Size of child at birth Delivery Less 2.5 kg Birth Smaller Average Number Background by than or weight not Very than or Don't of charaetaristie C-section <2.5 kg more provided Total small average larger know Total births Mother's age at birth <20 1.7 1.1 4.6 94.3 100.0 7.0 9.9 78.7 4.4 100.0 615 20-34 4.1 1.1 15.7 83.2 100.0 6.6 7.1 82.6 3.8 100.0 2,468 35+ 4.5 2.1 10.4 87.5 100.0 6.8 9.3 76.4 7.5 100.0 464 Birth order 1 4.0 1.8 15.7 82.5 100.0 7.1 9.7 79.8 3.3 100.0 739 2-3 3.3 1.2 15.3 83.5 100.0 6.1 6.6 83.1 4.1 100.0 1,159 4-5 4.2 0.6 12.9 86.5 100.0 7.5 7.2 80.7 4.7 100.0 832 6+ 3.5 1.3 7.9 90.8 100.0 6.4 8.5 79.7 5.4 100.0 818 Residence Urban 5.2 2.3 21.9 75.8 100.0 5.7 6.8 82.3 5.2 100.0 984 Rural 3.1 0.8 9.7 89.5 100.0 7.1 8.2 80.6 4.1 I00.0 2,563 Region Northeast 0.6 0.8 3.4 95.8 100.0 7.4 7.7 80.6 4.2 100.0 788 Northwest 2.1 0.3 2.9 96.8 100.0 9.4 11.8 75.1 3.7 100.0 629 Southeast 4.6 1.8 19.1 79.1 100.0 5.5 6.6 84.8 3.1 100.0 649 Southwest 7.2 1.7 23.0 75.3 100.0 7.3 6.6 81.8 4.3 100.0 777 Central 4.0 1.4 16.6 81.9 100.0 3.9 7.0 82.7 6.4 100.0 704 Mother's education No education 1.7 0.4 2.6 97.0 100.0 8.1 9.2 77.5 5.2 100.0 1,714 Primary 3.9 0.6 11.0 88.4 100.0 5.1 6.3 84.3 4.3 100.0 868 Secondary 6.6 2.9 29.3 67.7 100.0 5.5 7.1 84.1 3.3 100.0 827 Higher 10.6 5.2 59.6 35.2 100.0 6.6 4.6 87.2 1.6 100.0 138 Total 3.7 1.2 13.1 85.7 100.0 6.7 7.8 81.1 4.4 100.0 3,547 that information was noted on the questionnaire. In addition, mothers were asked for their subjective perception of the baby's size at birth (e.g., very large, larger than average, average, etc.). Unfortunately, more than 85 percent of respondents did not know the birth weight of their babies, either because delivery was outside a health facility or because they did not remember. As long as delivery at home is prevalent and most babies are not weighed at birth, this lack of adequate data on birth weight will persist. Similar problems are found in other DHS surveys in Africa (e.g., Tanzania and Kenya). Of those for whom birth weight information is available, 8 percent weighed less than 2.5 kg and the remaining 92 percent were reported to weigh more than 2.5 kg. Although not as accurate or useful as the actual birth weight, it is notable that almost the same proportion of births (7 percent) were reported by the mother to be "very small" at birth. 8.3 Maternal Mortality In an attempt to obtain an estimate of the level of maternal mortality in Nigeria, the 1999 NDHS included the DHS maternal mortality module, which asks questions about the survivorship of all l ive births 112 of the respondent's mother (i.e., the respondent's brothers and sisters). The "sisterhood" methodology is a means of enlarging the effective sample size without having to interview any additional respondents (Graham et al., 1989). The DHS approach to estimating maternal and adult mortality maximises use of the available data, using information on the age of surviving siblings, the age at death of siblings who died, and the number of years since the sibling died. Data can therefore be aggregated to determine the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in defined calendar periods. Rates of maternal mortality are obtained by dividing maternal deaths by person-years of exposure (Rutenberg and Sullivan, 1991). Each respondent interviewed was first asked to give the total number of her/his mother's live births. Then the respondent was asked to provide a list of all of the children born to her/his mother, starting with the firstborn. The respondent was also asked whether each of these siblings was still alive at the survey date. For living siblings, current age was collected; for deceased siblings, age at death and year of death or years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on siblings age at death or number of years since death, approximate quantitative answers were acceptable. For sisters who died at age 10 or older, in order to determine whether the death was maternity- related, the respondent was asked: "Was [NAME OF SISTER] pregnant when she died?" and if not, "Did she die during childbirth?" If death was neither during pregnancy nor childbirth, one more question was asked: "Did she die within two months after the end of a pregnancy or childbirth?" Unfortunately, it appears that many interviewers did not understand how to/~11 in the maternal mortality section of the questionnaire. Many questionnaires contained sibling histories that were not in proper order and/or that erroneously listed information for the respondent as well as her siblings. More damaging to the analysis was the fact that much of the information about siblings was missing. Among respondents' sisters who had died, 68 percent were missing information on the number of years since death, which is necessary for calculating maternal deaths occuring in a particular time period. For most other DHS surveys in Africa, the comparable figure is less than 2 percent missing (Stanton et al., 1997:16). Although it is sometimes possible to impute a value for the number of years since death if siblings are listed in the correct birth order, the ages of other siblings are given and the age at death of the deceased sibling is given, imputation was impossible for 24 percent of female sibling deaths because both the age at death and the years since death were missing. Without knowing age at death, it is impossible to know whether a sister died of maternal causes. Another indicator of questionable data is the fact that the sex ratio of siblings was reported as 110.4. This ratio is higher than the expected level of about 102 to 105 and could indicate underreporting of female births and/or overreporting of male births by respondents. Finally, the data on the average number of siblings by age of respondents imply that fertility has been increasing over time. A more plausible explanation is that older respondents omitted reporting some of their siblings. The magnitude of the problems with the data render any analysis suspect. The maternal mortality ratio was estimated to be 289 per 100,000 live births by the direct method applicable to the seven-year period prior to the survey (approximately 1993-99). The estimate is low, especially given that the period covered in this estimate was a time when Nigeria had very poor performance on most development indices. As such, it would be unusual to have improvement in maternal mortality rates during a period when development indices show deterioration. Maternal mortality ratios from other sub-Saharan countries range from 393 (Zimbabwe) to 1,451 (Central African Republic) deaths per 100,000 births (Stanton et al., 1997:31). Somewhat more plausible is the fact that the survey showed that maternal deaths represent approximately 23 percent of all deaths to women age 15-49 years. 113 8.4 Childhood Vaccination Childhood vaccination remains an important strategy for the reduction of morbidity and mortality from common vaccine-preventable diseases. In Nigeria, such diseases include tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles. High vaccination coverage is generally associated with low levels of disease in the population. Thus, high vaccination coverage is a crucial goal in all child survival programmes in Nigeria. Guidelines from the World Health Organisation (WHO) recommend that all children receive a BCG vaccination against tuberculosis; three doses of DPT vaccine for the prevention of diphtheria, pertussis (whooping cough), and tetanus; three doses of polio vaccine; and a vaccination against measles. WHO recommends that children receive all of these vaccines before their first birthday and that the vaccinations be recorded on a health card given to the parents. In the NDHS, mothers were asked to show the interviewer the health cards of all children born in the three years before the survey. The interviewer copied from the card the date each vaccine was received. If a child never received a health card or if the mother was unable to show the card to the interviewer, the mother was asked to recall whether the child had received BCG, polio, DPT (including the number of doses for polio and DPT), and measles vaccinations. Mothers were able to produce health cards for only 20 percent of children age 12-23 months, which represents a decline from the level of 35 percent obtained in the 1990 NDHS (FOS, 1992:95). Vaccination Coverage Information on vaccination coverage is presented in Table 8.7, according to the source of information used to determine coverage, i.e., the vaccination card or mother's report. Data are presented for children age 12-23 months, thereby including ouly those children who have reached the age by which they should be fully vaccinated. The first indicator shows the proportion of these children who had been vaccinated at any age up to the time of the survey. These results are presented according to the source of the information used to determine coverage, i.e., vaccination record or mother's report. The second indicator shows the proportion of children who had been vaccinated by age 12 months, the age at which vaccination coverage should be complete. Table 8.7 Vaccinations b v source of information Percentage of children 12-23 months who have received specific vaccines at any time before the survey, by source of information, and the percentage vaccinated by 12 months of age, Nigeria 1999 Source of information Percentage of children who received: DPT Polio Number of BCG DPT1 DPT2 DPT3 Polio0 Poliol Polio2 Polio3 Measles All I None children Vaccinated at any time before the survey Vaccination card 18.7 16.4 13.8 10.6 15.7 17.5 15.2 10.0 13.1 7.7 0.2 226 Mother's report 35.1 31.0 25.5 15.7 10.5 39.2 29.2 14.8 27.4 9.13 38.0 935 Either source 53.8 47.4 39.3 26.3 26.1 56.8 44.4 24.8 40.5 16.8 38.2 1,161 Vaccinated by 12 months of age 52.0 45.7 37.6 24.8 25.7 54.3 41.3 23,0 32.1 I4.3 39.1 1,161 l Children who are fully vaccinated (i.e., those who have received BCG, measles and three doses of DPT and polio (excluding ~For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of llfe was assumed to be the same as for children with a written record of vaccination. 114 According to information from either the vaccination records or mothers' recall, only 17 percent of Nigerian children 12-23 months can be considered fully immunised. A/thoughthe level of coverage for BCG and the first doses of DPT and polio are close to or exceed 50 percent, the proportion who go on to receive the second and third doses of these two vaccines falls off sharply, to only about 25 percent for the third doses of the DPT and polio vaccines (Figure 8.2). Forty-one percent of children age 12-23 months have received the measles vaccine. Thirty-eightpercentofNigerianchildrenhavereceivednovaccinations atall. Ofthose children who do receive vaccinations, most receive them by the recommended age of 12 months. The 1999 NDHS documented a significant worsening of vaccination coverage compared with the 1990 NDHS. The percentage of children 12-23 months who are fully vaccinated declined from 30 percent in 1990 to 17 percent in 1999. Although there has been a deeline for all types of vaccines, the deline is greater for DPT and polio than it is for BCG and measles. The reason for the decline probably lies in the great shortage of all vaccines in Nigeria during the period 1996-1998. Figure 8.2 Vaccination Coverage among Children Age 12-23 Months, Nigeria 1999 Percent vaccinated 8o 60 40 20 0 BOG 1 2 3+ Polio 57 i:?~: ::5:: ::;::: x ~. : :55 3+ MeasCes All DPT Note: Based on health card information and mother's report None NDHS 1999 Differentials in Vaccination Coverage As seen in Table 8.8, there are no large differences in vaccination status by the sex or birth order of the child. However, children in urban areas are almost three times more likely to be fully vaccinated than children in rural areas. Similarly, 75 percent of children in urban areas receive BCG vaccination, compared with 46 percent of children in rural areas. This strong urban-rural differential could be because of differences in awareness of the importance of vaccination and in the access to health services. Coverage for all vaccines is highest in the south, followed by the Central region, and is lowest in the north. Although more than one-quarter of children in the south and 20 percent of children in the Central region are fully vaccinated, only about 6 percent of children in the north have been fully vaccinated. 115 Table 8.8 Vaccinations by background characteristics I Pareantage of ehildran 3.2-23 months who had xeceived specific vaccines by the thne of the survey (according to the vaccination card or the mother's report), and the percentage with a vaccination card, according to background characteristics, Nigeria 1999 Pex- Pexeeatage of children who received: centage ~i~h a DPT Polio vacei- Number Background nation of chaxae~'zristio BCG DPT1 DPT2 DPT3 Polio0 Poliol Polio2 Polio3 Measles All I None card children Child's sex Male 53.8 48.1 40.1 25.3 26.0 57.2 44.4 24.1 40.1 16.1 38.8 18.7 610 Female 53.9 46.6 38.4 27.3 26.3 56.2 44.5 25.5 40.8 3.7.4 37,6 20.3 551 Birth order 1 52.9 43.0 37.1 25.1 25.7 52.6 43.0 23.7 40.6 16.5 41.3 I9.6 220 2-3 56.8 51.2 43.0 29.3 25.9 58.3 47.1 27.7 43.8 i9.6 37.1 21.7 408 4-5 54.6 47.6 38.4 29.2 29.2 54.1 43.0 25.7 39.1 18.4 39.5 18.6 280 6+ 48.9 44.9 36.3 19.3 23.6 60.8 42.8 20.0 36.4 10.6 35.9 16.9 252 Residence Urban 75.0 70.4 60.1 44.7 41.7 75.7 64.9 41.8 61.5 31.7 19.6 28.1 310 Rural 46.1 39.0 31.7 19.6 20.5 49.8 36.9 18.5 32.8 11.3 45.0 16.3 g50 Region Northeast 26.0 26.6 19.6 12.1 9.7 35.9 23.7 11.I 19.7 7.5 60.9 7.2 241 Northwest 21.6 20.1 16.2 9.2 8.0 30.3 20.0 10.2 19.9 4.3 67.3 8.2 245 Southeast 73.3 66.8 59.7 40.7 29.5 78.1 63.2 36.7 54.3 24.9 17.6 27.7 194 Southwest 83.7 72.2 61.3 40.8 49.7 78.2 69.4 41.3 64.8 28.6 13.8 32.5 256 Central 67.9 54.6 42.9 31.2 33.8 65.1 48.6 26.3 45.3 19.6 27.7 23.0 224 Mother's education No education 29.9 2A.3 18.2 11.1 12,8,. 36.2 23.0 10.5 20.7 6.3 59.8 8.1 581 Primary 67.7 59.5 49.3 32.4 33.8 67.2 55.7 30.1 49.5 18.1 23.7 27.3 285 Secondary 86.8 80.9 69.5 48.4 44.2 86.7 73.9 44.5 67.5 33.0 9.8 34.0 249 Higher (90.8) (82.9) (80.5) (60.5) (50.5) (89.5) (85.0) (65.9) (87.2) (52.9) (9.2) (35.5) 46 Total 53.8 47.4 39.3 26.3 26.1 56.8 44.4 24.8 40.5 16.8 38.2 19.5 1,161 Note: Figures in parentheses are based on 25-49 (unweighted) children. 1 Children who are fully vaccinated (i.e., those who have received BCG, measles and three doses of DPT and polio (excluding polio 0)). Complete coverage increases with increasing maternal education. Oniy 6 percent of children whose mothers have no education are fully vaccinated, in contrast with 53 percent of those whose mothers have higher than a secondary education. Sixty percent of children born to women with no education have no vaccinations at all. 8.5 Acute Respiratory Infection and Fever Acute respiratory infection (ARI) is a major cause of morbidity and mortality among children in Nigeria. Common symptoms associated with severerespiratoryinfectioninchide fever, cough, and difficult or rapid breathing. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths from respiratory infections. The prevalence of ARI was estimated by asking mothers interviewed in the NDHS if their children under age three had experienced coughing accompanied by short, rapid breathing, in the two weeks preceding the survey. Mothers whose children had experienced these symptoms were asked what they had done to treat the illness. It bears mentioning that reports of disease prevalence are inherently 116 imprecise, since they are based on a mother's subjective assessment. Information on the prevalence and treatment of ARI is presented in Table 8.9. The data indicate that 11 percent of children under three were ill with a cough and rapid breathing in the two weeks preceding the survey. Less than 50 percent of these children were taken to a health facility for treatment. Prevalence of ARI varies with the age of the child; it is lower for children under six months, who also have the lowest rate of health facility use for this illness. There are no large differentials by sex or birth order in the prevalence or treatment of ARI. There is no urban-rural differential in the prevalence of ARI, but affected children in urban areas are more likely to be taken to a health facility (65 versus 45 percent), Although there was minimal variation in the prevalence of AR/across regions, there are differences in the Table 8.9 Prevalence and treatment of acute respiratory infection and fever Percentage of children under three years who were ill with a cough accompanied by short, rapid breathing or a fever during the two weeks preceding the survey, by selected background characteristics, Nigeria i999 Peseantage Percentage of children of childrcn taken to with cough Percentage a health Number Background and rapid of children facility or of characteristic breathing with fever provider 1 children Child's age < 6 months 7.5 21.7 39.5 574 6-11 months 13.0 35.7 55.3 534 12-23 months 13.1 34.4 48.7 1,161 24-35 months 10.5 27.1 51.8 937 Child's sex Male 11.8 31.8 48.8 1,632 Female 10.8 28.6 50.7 1,574 Birth order 1 13.2 28.9 47.6 675 2-3 10.0 27.7 44.9 1,071 4-5 11.5 31.1 51.8 754 6+ 11.4 34.3 56.2 706 Residence Urban 10.3 26.5 64.8 896 Rural 11.7 31.6 44.5 2,310 Region Northeast 12.9 34.4 33.4 684 Northwest 10.8 32.9 45.5 572 Southeast 11.7 39.7 46.0 586 Southwest 9.3 22.8 68.6 714 Central 12.0 23.0 58.7 649 Mother's education No education 11.5 29.9 39.5 1,522 Primary 11.1 34.4 56.0 780 Secondary 11.0 27.6 58.5 775 Higher 13.1 23.8 78.2 130 Total 11.3 30.2 49.7 3,206 l Includes health centre, hospital, clinic, and private doctor 117 treatment of ARI. Only one-third of children with ARI in the Northeast region are taken to a health facility, compared with almost 70 percent of ill children in the Southwest region. Similarly, there are no differentials in the prevalence of ARI by maternal education. However, children of more-educated mothers are more likely to be taken to a health facility than children of less-educated mothers (ranging from 40 percent among mothers with no education to 78 percent among those with a higher education). Malariais endemic throughout Nigeria. Sincethe major manifestation ofmalariais fever, mothers were asked whether their children under age 3 had a fever in the two weeks preceding the survey. Thirty percent of children under three years of age were reported to have had fever in the two weeks prior to the survey (Table 8.9). There are few major differentials in the prevalence of fever. It is slightly lower among children under six months of age and slightly higher in rural than in urban areas. There are some regional differentials with the Southeast region having higher figures than the other regions. Surprisingly, the Southwest region has unexpectedly low figures when compared with other regions. The reason for this difference is uncertain; however, it should be noted that fever can be associated with many diseases and the relative prevalence of these diseases at any point in time may differ between regions. 8.6 Diarrhoea Dehydration caused by diarrhoea is a major cause of illness and death among young children in Nigeria. The mainstay of treatment for diarrhoea is oral rehydration therapy (ORT), either as a solution prepared from commercially available packets of oral rehydratlon salts (ORS), or as a homemade sugar-salt solution, or as some other homemade rehydration fluids. Prevalence of Diarrhoea Table 8.10 presents the prevalence of diarrhoea in children under three years of age. Fifteen percent of children had experienced diarrhoea in the two weeks preceding the survey. The prevalence of bloody diarrhoea (symptomatic of dysentery) was 2 percent. Diarrhoea prevalence is low (8 percent) among children under six months, most of whom are still being breasffed, and highest (18 to 19 percent) among children aged 6-23 months, many of whom are being weaned and are beginning to eat mushy and solid foods. Among regions, diarthoeaprevalence is highest in the Northeast region (22 percent) and lowest in the Southwest region (7 percent). Diarrhoea prevalence is associated with maternal education. Children whose mothers have no education had a diarrhoea prevalence of 18 percent, which falls to 14 percent among those with primary education, 12 percent of those with secondary education and 11 percent among those with a higher education. Table 8.I 0 Prevalence of diarrhoea Percentage of children under three years of ago with diarrhoea and diarrhoea with blood during the two weeks preceding the survey, by selected background characteristics, Nigeria 1999 Diarrhoea in the preceding 2 weeks Diarrhoea Number Background All with of characteristic diarrhoea blood children Child's age < 6 months 8.2 1.2 574 6-11 months 18.8 1.5 534 12-23 months 18.3 3.1 1,I61 24-35 months 13.8 2.8 937 Child's sex Male 15.1 2.8 1,632 Female 15.4 2.0 1,574 Birth order 1 14.7 2.4 675 2-3 14.6 2.5 1,071 4-5 16.7 2.3 754 6+ 15.1 2.4 706 Residence Urban 13.9 2.0 896 Rural 15.8 2.6 2,310 Region Northeast 22.3 3.9 684 Northwest 17.9 2.2 572 Southeast 15.0 3.3 586 Southwest 7.1 0.7 714 Central I4.6 2.1 649 Mother's education No education 18.0 2.9 1,522 Primary 13.8 2.7 780 Secondary 12.2 1.5 775 Higher 10.7 0.0 130 Total 15.3 2.4 3,206 118 Treatment of Diarrhoea Table 8.11 presents data concerning treatment of recent episodes of diarrhoea among children under three years as reported by the mother. Thirty-seven percent of all children who had a recent episode of diarrhoea were taken to a health facility or a medical care provider for treatment. Children 6-11 months old, urban children, children in the Southwest and Central regions, and children of more educated women were more likely to be taken to a health facility. Table 8.11 Treatment ofdiarthoea Among clffldren under three years who had diarrhoea in the two weeks preceding the survey, the percentage taken for treatment to a health facility or provider, the percentage who received oral rehydtation therapy (ORT) (either solution prepared from ORS packets, homemade sugar-salt eelution (SSS), or increased fluids), the percentage who received no OPT and the percentage given other treatments, according to seiected background characteristics, Nigeria 1999 Percentage Oral rehydration therapy Other treatments taken to Did a health Either In, not Home No Number Background facility or ORS ORS or creaged received /nice- remedy/ treat- of characteristic provider I packet SSS SSS fluids OPT tlon Other ment Missing children Child's age < 6 months 25.9 23.1 28.3 3%8 46.8 38.7 2.1 89.2 4.8 0.0 47 6-11 months 46.4 40.1 42.6 57.5 52.4 25.5 8.9 90.2 5.8 0.0 101 12-23 months 33.4 34.9 38.9 51.7 53.3 24.4 8.1 92.9 2.8 0.4 212 24-35 months 41.1 32.7 37.6 50.3 56.9 25.2 11.2 95.0 2.3 0.0 129 Child's sex Male 37.2 30.9 38.2 47.7 55.1 27.1 10.3 93.3 3.5 0.4 246 Female 37.6 37.7 38.4 54.8 51.8 25.3 6.7 91.7 3.4 0.0 243 Birth order 1 41.4 31.9 40.3 53.9 43.6 27.5 10.8 93.7 2.0 0.0 99 2-3 33.3 35.7 38.2 52.7 56.8 24.2 5.9 93.8 2.5 0.6 157 4-5 36.9 28.9 37.2 44.9 52.6 30.1 9.9 88.4 6.2 0.0 126 6+ 40.4 40.8 38.1 54.0 58.6 23.3 8.5 94.5 3.0 0.0 107 Residence Urban 50.9 43.0 43.5 60.8 63.6 18.1 11.4 92.3 2.3 0.0 124 Rural 32.8 31.3 36.6 48.0 50.0 29.0 7.5 92.6 3.9 0.3 365 Rogiollt Northeast 32.1 24.0 22.6 35.3 62.1 27.8 2.8 89.7 6.5 0.0 153 Northwest 24.4 16.2 26.1 33.1 54.4 35.0 1.8 91.4 3.7 0.9 102 Southeast 36.8 38.4 57.3 70.4 47.8 21.9 6.2 96.5 0.0 0.0 88 Southwest 53.2 59.4 57.2 77.4 46.8 14.3 22.1 95.7 2.2 0.0 51 Central 51.9 52.9 49.0 64.3 47.2 24.8 19.8 93.0 2.4 0.0 95 Mother's education No education 29.4 23.4 28.7 37.1 55.4 31.6 8.7 90.3 5.6 0.3 273 Primary 45.0 44.6 42.0 61.0 47.5 23.9 7.8 95.5 0.9 0.0 108 Secondary 47.3 51.5 56.7 76.4 51.2 15.5 5.8 94.7 0.9 0.0 94 Higher 70.0 51.9 74.4 82.2 74.5 10.4 29.4 100.0 0.0 0.0 14 Total 37.4 34.3 38.3 51.2 53.4 26.2 8.5 92.5 3.5 0.2 489 ORS -- Oral rehydration salts 1 Includes health centre, hospital, clinic, and private doctor 119 Thirty-four percent of children with diarrhoea were given a fluid prepared from ORS packets, and 38 percent received a homemade sugar-salt solution. In all, 51 percent were given either ORS or a homemade solution. Mothers reported giving 53 percent of ill children an increased amount of fluid than before the onset of the diarrhoea. However, 26 percent of children were given neither ORS nor a homemade solution nor increased fluids, placing this group at a greater risk of dehydration and death. Nine percent of children who had diarrhoea were given an injection. It should be noted that 93 percent of all children who had diarrhoea were given a home remedy. Only 4 percent of the children did not receive any treatment for the diarrhoeal episode. Rural children and those in the Northwest region are more likely than other children not to receive any kind of oral rehydration therapy. Simfiarly, children whose mothers are less educated are less likely to be given oral rehydration solutions when they have diarrhoea. When asked about specific eating and drinking regimens for children with diarrhoea, the data in Table 8.12 shows that children with diarrhoea were given less to drink in 23 percent of cases, the same amount to drink in 18 percent, and more to drink in 53 percent of cases. About one-half (54 percent) gave children with diarrhoea less to eat, while 19 percent gave the same amount to eat and only 23 percent gave more to eat. Table 8.12 Feeding practices during diarrhoea Percent distribution of children under three years who had diarrhoea in the past two weeks by amount of fluids and solid foods given compared with normal practice, Nigeria 1999 Percentage Feeding practice of children Amount of fluids given Same 18.4 Increased 53.4 Decreased 23.4 Don't know/misslng 4.8 Amount of solid foods given Same 19.2 Increased 23.0 Decreased 53.9 Don't know/m~ss~ng 3.9 Total 100.0 Number 489 Knowledge of Diarrhoea Treatment Besides asking mothers of children with diarrhoea what they actually do to treat their children, the NDHS also asked women interviewed whether they had heard of ORS and whether children with diarrhoea should be given more or less to drink and eat than usual. On being asked "Have you ever heard of a special product called ORS you can get for the treatment of diarrhoea?" 58 percent of women with a birth during the three years before the survey said they had heard of ORS (Table8.13). Kn°wledge°fpacketsis higher am°rig °lder w°men'urbanw°men'th°seinthes°uth ' and those with more education. Table 8.13 also shows that almost half of women with children under three believe that children with diarrhoea should be given increased fluids, while 31 percent believe the child should get less fluids. On the other hand, 25 percent of women believe that a child with diarrhoea should receive more to eat, while 52 percent believe that the child should have less to eat. These figures are short of the recommendation for increased fluids during a diarrhoeal episode and increased food intake both during and after a diarrhoeal episode. Urban women, women in the north, and women who are better educated are more likely to say that children with diarrhoea should receive more to drink and eat than usual. 120 Table 8.13 Knowledge of diarrhoea eare Percentage of women who had a birth in the three years praceding the survey who know about ORS packets for treatment of diarrhoea and the percent distribution by opinion on appropriate feeding practices during diarrhoea, according to selected background characteristics, Nigeria I999 Perceived appropriate feeding practices during diarrhoea compared with usual feeding practices Know I21quids Solid foods about ORS packets for Don't Don't Number Background treatment of know/ know/ of characteristic diarrhoea Less Same More Missing Total Less Same More Missing Total women Age 15-19 40.3 34.8 11.9 35.6 17,7 100.0 46.0 12.7 23.2 18.2 100.0 285 20-24 54.2 30.9 13.0 45.3 10.8 100.0 50.7 16.7 22.6 10.0 100.0 704 25-29 58,4 31.7 10.8 49.6 7.9 100.0 51.3 14.4 26.7 7.5 100.0 854 30-34 67.2 29.7 10.4 52.9 6.9 100.0 53,2 15.2 24.8 6.9 100.0 641 35+ 58.2 29.3 9.1 54.3 7.4 100.0 53.8 15.1 23.9 7.2 100.0 621 Residence Urban 68.9 24.3 7,9 58.5 9.3 100.0 55.3 13.3 22.1 9.3 100.0 868 Rural 53.2 33.5 I2.2 45.3 9.1 100.0 50.1 15.7 25.4 8.7 100.0 2,237 Region Northeast 50.3 20.3 8.4 62.9 8.3 100.0 55.9 7.8 27.5 8.8 100.0 690 Northwest 35.2 26.9 13.4 48.3 11.4 I00.0 42.8 17.6 27.5 12.2 100.0 556 Southeast 66.0 40.9 9.2 39.7 10.2 100.0 41.3 20.5 29.1 9.1 100.0 532 Southwest 65.7 34.7 7.4 50.2 7.7 100.0 61.9 13,1 18.4 6.5 100.0 686 Central 69.0 33.5 17.0 40.9 8.7 100.0 51.9 18.3 21.3 8.4 100.0 641 Education No education 44.9 28.7 12.0 48.6 10.7 100.0 51.8 12.6 24.9 10.7 100.0 1,522 Primary 65.4 36,8 9.5 45.8 7.9 100.0 52.3 17.2 22.8 7.6 100.0 761 Secondary 73.1 31.8 10.6 50.4 7.3 100.0 51.9 17.3 24.2 6.6 100.0 702 Higher 77.1 17.5 9.4 65.2 7.9 100.0 41.8 19.1 32.5 6.6 100.0 119 Total 57.6 30.9 11.0 49.0 9.1 100.0 51.5 15.1 24.5 8.9 100.0 3,104 ORS = Oral rehydration salts 121 CHAPTER 9 MATERNAL AND CHILD NUTRITION Adequate nutrition, especially for women and children, remains an important concern in Nigeria. The 1999 NDHS collected data on several areas related to nutrition of women and children. Specifically, this chapter examines infant feeding practices (including breastfeeding and complementary feeding) and nutritional status (based on height and weight measurements) of children age 0-35 months. Data on women's nutritional status (body mass index and height) are also presented. 9.1 Breastfeeding and Supplementation Infant feeding practices determine the nutritional status of children and in turn, their health status. It is generally recommended that children be exclusively breastfed with no supplements for the first four to six months of life, after which appropriate and adequate complementary foods should be given in addition to breast milk (WHO/UNICEF, 1990). The amount of health benefit derived from breastfeeding is influenced by the age of the baby at initiation of breastfeeding, the duration and intensity of breastfeeding, and the age at which the child starts to receive supplementary foods and other liquids. By the age of six months, children require complementary foods in order to follow normal growth patterns. When children do not receive adequate complementary foods by the middle of the first year and/or when they experience frequent illnesses such as diarrhoea, malnutrition may result, thereby increasing the risk of serious illness and death. Prevalence and Initiation of Breastfeeding Breast milk contains all nutrients needed by children in the first few months of life. It also provides some immunity to disease through the mother's antibodies, particularly the colostrum which is the first breast milk produced. To encourage early initiation of breastfeeding, women are educated about the benefits of exclusive breastfeeding and are urged to put their babies to breast soon after birth. NDHS data confirm that breastfeeding is widely practiced in Nigeria. Table 9.1 shows that 96 percent of children are breasffed. This figure is similar to the 1990 NDHS figure of 97 percent (FOS, 1992:108). Table 9.1 also shows that 38 percent of newborns are put to the breast within one hour of birth and 66 percent within one day of birth. These percentages are a slight increase over the figures from the 1990 NDHS, which showed that 33 percent of children were put to the breast within one hour and 50 percent within one day of birth. The timing of breastfeeding initiation differs between urban and rural respondents, with urban children breasffed earlier than rural cNldren. For example, 43 percent of urban children are put to the breast within one hour of birth, compared with 36 percent of rural children. Similarly, 74 percent of urban children are breastfed within one day of birth, compared with 63 percent of rural children. This situation differs from the 1990 NDHS, which found either no difference or a slight advantage for rural children. The change may be partly because of the Baby Friendly Hospital Initiative (BFHI), which promotes exclusive breastfeeding and policies that support breast.feeding in hospitals, most of which are in urban areas. Also, health education about breasffeeding is being increasingly delivered through the print and electronic media which are more 123 Table 9.1 Initinl breasffeeding Percentage of children born in the five years preceding the survey who were ever breasffed, and who started breasffeeffmg within one hour and within one day ef birth, by background characteristles, Nigeria 1999 Percentage who started breast feeding: Percentage Within Within Number Background ever 1 hour 1 day of characteristic breast fed of birth of birth I children Sex Male 95.8 38.4 65.7 1,807 Female 96.7 38.0 65.5 1,741 Residence Urban 96.4 43.0 73.5 984 Rural 96.2 36.3 62.6 2,563 Region Northeast 94.8 24.5 44.4 788 Northwest 95.4 51.4 66.4 629 Southeast 97.6 42.7 75.3 649 Southwest 97.4 26.7 69.0 777 Central 96.1 50.2 75.5 704 Education No education 95.4 37.7 57.6 1,714 Primary 96.5 37.8 71.3 868 Secondary 97.7 38.8 74.0 827 Higher 96.2 42.8 77.8 138 Asslstanee at delivery Medically trained 97.3 39.7 77.5 1,474 Traditional midwife 95.9 38.8 59.7 734 Other or none 95.0 38.8 59.6 1,246 Place of delivery Health facility 97.3 41.1 78.0 1,323 At home 95.4 38.2 60.4 2,068 Total 96.2 38.2 65.6 3,547 Note: Total includes 93 children for whom assistance at delivery information is missing and 156 for whom place of delivery information is missing. l Includes children who started breast feeding within one hour of bk'th. accessible to urban residents. These may account for the observed increase in early initiation of breastfeeding by urban residents. The proportion of babies put to the breast within one hour of birth shows considerable regional variation, the lowest being 25 percent in the Northeast region and the highest 51 percent in the Northwest region. Surprisingly, there were no differentials in the proportion of babies put to breast within one hour by the type of personnel who assisted at delivery nor by place of delivery, although children born in health facilities and assisted at delivery by medically trained personnel are more likely to be breasfed within the first day of life. Timing of Introduction of Complementary Foods The timing of introduction of complementary foods in addition to breast milk has important implications for the child and the mother. Early supplementation, especially under unhygienic conditions, 124 can result in infection with foreign organisms and lower immunity to disease, The timing of the introduction of food supplemenls also has an impact on the length of the mother's postpartum amenorrhoea. Early initiation of supplementation results in earlier resumption of the mother's menstrual periods, since supplementation reduces infants' dependence on breast milk and the frequency of suckling. Mothers were asked about the current breastfeeding status of their most recent birth under age three and, i f the child was being breasffed, whether various types of liquid or solid foods had been given to the child "yesterday" or "last night." Children who are exclusively breastfed are defined as receiving breast milk only, while ful l breastfeeding is defined as receiving breast milk and plain water only. The results shown in Table 9,2 indicate that babies are breasffed for a relatively long time; even among children 12-13 months old, 86 percent are still receiving breast milk. However, the data indicate that supplementation of breast milk with other liquids and foods begins early in Nigeria. Among newborns less than two months of age, most are either exclusively breasffed (25 percent) or fully breasffed (48 percent); however, one-quarter of these very young babies are already receiving complementary foods or liquids. Among those age 2-3 months, 40 percent are being given supplements. Table 9.2 Breasffeeding status by child's age Percent distribution of living children under three years of age by breasffeeding status, according to child's age in months, Nigeria 1999 Breasffeeding and: Not Plain Number Child's age breast- Exclusively water Supple- of ha months feeding breasffed only ments Total children <1 3.0 25.3 48.2 23.5 100.0 176 2-3 4.7 14.2 40.2 40.8 100.0 185 4-5 6.6 7.7 24.2 61.5 100.0 201 6-7 2.6 8.7 14.5 74.2 100.0 187 8-9 6.7 9.2 13.2 70.8 100.0 183 10-11 7.1 4.4 7.1 81.4 100.0 151 12-13 13.7 7.4 5.8 73.1 100.0 301 14-15 16.6 5.8 6.6 71.0 100.0 273 16-17 34.4 3.8 2.9 59.0 100.0 165 18-19 44.2 4.7 2.3 48.9 100.0 127 20-21 61.1 4.4 2.3 32.2 100.0 120 22-23 68.2 3.3 0.0 28.4 100.0 120 24-25 81.0 3.6 0.6 14.9 100.0 175 26-27 87.1 0.5 1.0 11.4 100.0 200 28-29 89.8 4.5 2.2 3.5 100.0 91 30-31 94.1 2.9 0.0 3.0 100.0 69 32-33 94.8 0.0 0.0 5.2 100.0 77 34-35 89.7 3.8 0.0 6.5 100.0 78 <3 months 3.9 19.6 44.1 32.4 100.0 361 4-6 months 5.7 8.2 21.0 65.1 100.0 285 7-9 months 5.0 8.8 14.0 72.2 100.0 286 Note: Breasffeeffmg status refers to last 24 hours. Children chssified as breastfeeding and plain water only receive no supplements. 125 Among older children, it is the lack of complementary feeding that is a problem. Among children age 12-13 months--when supplements other than breast milk are generally considered necessary for adequate nutrition--the data show that 13 percent of children are being given only breast milk or breast milk and water. The data imply that there has been a remarkable improvement since 1990 in the proportion of very young babies who are exclusively breastfed (from less than 2 percent to 25 percent of children under two months old and from 1 to 14 percent of children age 2-3 months old). However, it is likely that the difference is caused by changes in the series of questions used to determine child feeding practices. Data on the median duration and frequency of breastfeeding are presented in Table 9.3. The estimates of mean and median duration of breastfeeding are based on current status data, that is, the proportion of children born in the three years before the survey who were being breastfed at the time of the survey, as opposed to retrospective data on the length of breastfeeding of older children who are no longer breastfed. The prevalence/incidence mean is also provided for possible comparison with other data sources. The median duration of any breastfeeding is 19 months, a month short of the period documented in the 1990 NDHS. The median duration of exclusive breasffeeding is less than a month, while for full breastfeeding (breast milk plus plain water), it is a little more than two months. The median duration of breasffeeding differs across background characteristics. For example, the median duration of breastfeeding is longer in rural areas (19 months) than in urban areas (17 months). Breastfeeding duration is longest in the Northwest region (22 months) and shortest in the Southeast region (16 months). It is also longer among women with no education (22 months) than among women with a primary education ( 18 months), a secondary ( 16 months), or a higher education ( 15 months). It is also longer for women who had no assistance at delivery (21 months) than for women who had medical assistance at delivery (17 months). Overall, 86 percent of children under six months of age were breastfed six or more times in the 24 hours preceding the survey. The proportion is lower among children whose mothers have more than secondary school than among those whose mothers are less educated. This difference may be because many women with a higher education work outside the home in jobs to which they cannot take the'tr young infants. 126 Table 9.3 Median duration and frequency of breasffeeding Median durations of any bmasffeeding, exclusive breasffecding, and predominant breasffecding among youngest children under three years, and the percentage of children under six months who were breesffed six or more times in the 24 hours preceding the survey, according to background characteristics, Nigeria I999 Median duration (months) of breasffe~ding among children under three years Children under six months Percentage Any Exclusive Predominant Number bressffed Number Background breast- breast- breast-~ of 6+ times in of characteristic feeding feeding feeding children last 24 hours children Sex of child Ma/e 18.2 0.5 3.0 1,579 85.6 256 Female 18.9 0.5 2.1 1,525 85.8 305 Residence Urban 17.0 0.6 2.0 868 85.2 141 Rural 19. I 0.5 2.6 2,237 85.9 421 Region Northeast 21.1 0.4 3.3 690 91.0 129 Northwest 22.2 0.5 4.4 556 94.8 91 Southeast 15.5 0.5 1.6 532 81.9 91 Southwest 17.1 0.6 1.4 686 79.0 128 Central 18.0 0.6 2.9 641 83.1 122 Mother's education No education 21.5 0.4 2.8 1,522 92.1 274 Primary 18.0 0.5 2.1 761 77.7 136 Secondary 16.2 0.6 2.5 702 83.5 134 Higher 15.1 0.5 0.5 119 64.5 17 Assistance at delivery Medically trained 17.2 0.6 2.3 1,282 81.1 244 Traditional midwife 20.3 0.4 3.3 653 92.7 116 Other or none 20.5 0.4 2.5 1,127 87.6 199 Missing 0.9 0.4 0.4 42 51 ;0 2 Ail children 18.5 0.5 2.4 3,104 85.7 561 Mean 1 for all children 18.9 2.8 5.8 96.4 NA NA P/I s 21.3 2.3 6.0 NA NA NA ~A = Not applicable 2 Median and mean based on current status s Either exclusively breasffed or received only plain water, water-based liquids, and/or juice. Prevalence-incldence mean Types of Complementary Foods As mentioned above, the timing and type of weaning foods given to children can have a profound effect on their health and nutritional status. In the survey, mothers of children under three were asked what foods and liquids their youngest child had received in the 24 hours preceding the survey. The data were only collected for children who were still being breastfed. The data in Table 9.4 show that supplementation is started too early in Nigeria. Only about one-fifth of breasffed children age 0-3 months receive nothing besides breast milk. At that age, 10 percent are already being fed with cereal and 20 percent with other liquids. Common complementary foods at 4-6 months included cereal (44 percent); other liquids (38 percent); meat, fish, and eggs (16 percent); milk (13 percent); and roots and tubers (11 percent). 127 Table 9.4 Foods received by children in preceding 24 hours Percentage of breasffecding children under three years of age who received spec'LfiC foods in the 24 hours preceding the interview, by child's age, Nigeria 1999 Percentage of children who rey.eived specific foods in preceding 24 hours Solid/semlsolid foods Meat/ Grains/ Tubers/ Using Breast fish/ bread/ roots/ bottle Number Child's age milk Infant Other Other poultry/ cereal/ plan- with a of in months only formula milk liquids eggs porridge tains Other nipple children <2 26.1 5.3 7.5 12.6 1.2 5.3 1.8 4.8 18.4 171 2-3 14.9 11.8 8.7 26.4 4.7 14.3 0.7 6.3 21.8 176 4-5 8.3 7.1 14.5 37.9 12.4 38.5 6.4 13.4 15.4 187 6-7 8.9 10.4 11.8 43.7 29.1 53.6 20.0 30.8 18.6 182 8-9 9.9 9.7 15.7 49.5 34.8 57.9 30.4 37.6 15.0 171 10-11 4.7 10.8 16.1 58.2 45.5 65.8 32.7 45.3 13.3 140 12-13 8.6 5.7 15.0 51.2 43.9 64.2 32.9 44.5 16.7 260 14-15 7.0 4.8 18.6 49.3 44.2 66.2 22.3 44.0 10.2 228 16-17 5.7 4.2 15.6 50.3 48.7 67.9 36.0 54.9 8.5 109 I8-23 9.8 2.7 13.7 47.6 48.3 65.1 35.5 51.3 6.8 156 24-29 16.7 0.0 14.1 49.3 41.0 58.1 17.7 44.0 2.5 68 30-35 30.9 0.0 13.1 39.6 36.6 62.7 20.1 37.0 13.2 16 <4 months 20A 8.6 g.1 19.6 3.0 9.9 1.2 5.5 20.1 347 4-6 months 8.7 7.8 13.2 37.6 15.5 43.9 10.5 18.3 16.5 268 7-9 months 9.3 10.3 14.7 49.5 34.6 55.5 26.7 35.5 16.2 272 Total 10.8 6.9 13.8 42.9 31.5 50.3 21.3 33.3 14.3 1,863 Note: Breasffeeding status refers to last 24 hours. Percentages may sum to more than 100 percent because child may have received more than one type of supplement. The category of tubers and roots also includes plantains and unripe bananas. Data are based on the youngest child only. Use of infant formula is quite low, with only 9 percent of breastfeeding children under four months being given infant formula and 8 percent of those age 4-6 months. These figures for use of infant formula are considerably lower than the figures from the 1990 NDHS. Use of bottles with nipples is more common, being used to feed up to 20 percent of breastfeeding children age 0-3 months and 17 percent of those age 4-6 months. 9.2 Nutritional Status of Children Under Three Nutritional status is an important determinant of child health and survival. Undernutrition in childhood is often initiated by inadequate food intake, recurrent infections, and/or inadequate maternal care. Besides questions about breastfeeding and weaning foods, tile 1999 NDHS included an anthropometric component, in which all children under three and their mothers were both weighed and measured. Each interviewing team carried a scale, a measuring board, and a measuring tape. The scales were bathroom-type scales purchased in Nigeria. Young children were placed in a basket and then put on the scale. The boards were made by gluing a tailor's measuring tape to a flat board; they were used to measure children younger than 24 months by laying them down on the board (recumbent length). Older children and mothers were measured standing (height) against a wall, using the measuring tape. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. In any large population, there is variation in height and weight; this variation approximates a normal distribution. 128 Use of a standard reference population as a point of comparison facilitates the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. One of the most commonly used reference populations, and the one used in this report, is the U.S. National Center for Health Statistics (NCHS) standard, which is recommended for use by the World Health Organisation~ Three standard indices of physical growth that describe the nutritional status of children are presented: Height-for-age (stunting) Weight-for-height (wasting) Weight-for-age (underweight) Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Height-for-age is a measure of linear growth. A child who is below minus two standard deviations (-2 SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. If the child is below minus three standard deviations (-3 SD) from the reference median, then the child is considered to be severely stunted. A child between -2 SD and -3 SD is considered to be moderately stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and may also be caused by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year-old child could look like a well-fed two- year-old. Weight-for-heig~at measures body mass in relation to body length and describes current nutritional status. A child who is below minus two standard deviations (-2 SD) from the reference median for weight- for-height is considered to be too thin for his/her height, or wasted, a condition reflecting acute malnutrition. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or recent episodes of illness causing loss of weight and the onset of malnutrition. As with stunting, wasting is considered severe if the child is more than three standard deviations below the reference mean. Severe wasting is closely/inked to an elevated risk of mortality. Prevalence of wasting may vary considerably by season; therefore, it is useful to keep in mind that this survey was implemented in April and May. Weight-for-age is a composite index of height-for-age and weight-for-height and thus does not distinguish between acute malnutrition (wasting) and chronic malnutrition (stunting). A child can be underweight for his/her age because he/she is stunted, wasted, or both. Weight-for-age is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for- age is below minus two standard deviations from the median of the reference population are classified as underweight. In the reference population, only 2.3 percent of children fall below minus two standard deviations (-2 SD) for each of these three indices. In the survey, all surviving children born since January 1996 were eligible for height and weight measurement. Of the 3,206 children eligible for measurement, 92 percent were weighed and measured. Unfortunately, of the children who were both weighed and measured, 42 percent were considered to have implausibly low or high values for height-for-age or weight-for-height. An additional 4 percent were missing age in exact months. The following analysis focuses on the 1,473 children under 36 months for whom complete and plausible anthropometric data were collected. Table 9.5 shows the percentage of children who 129 Table 9.5 Nutritional status of children by demographic characteristics Percentage of children under three classified as malnourished according to three anthropometric indices of nutrition status: height-for-age, w6lght-for-height, and weight-for-age, by selected demographic characladstlcs, Nigeria 1999 Height-for-age Weight-for-heigin Weight-for-ago Per- Per- Per- Per- Per- Per- cantage centege Mean centege centege Mean cantego centege Mean Number Demographic below below Z-score below below Z-scorn below below Z-scorn of characteristic -3 SD -2 SD 1 (SD) -3 SD -2 SD 1 (SD) -3 SD -2 SD 1 (SD) children Child's age <6 months 7.1 21.4 -0.6 5.2 13.6 0.4 4.3 11.5 -0.I 243 6-11 months 18.8 39.0 -1.3 5.0 13.5 0.4 12.7 27.2 -0.7 290 12-23 months 31.4 54.9 -2.0 6.6 15.5 0.1 13.1 31.5 -1.2 526 24-35 months 33.7 52.1 -2.0 2.5 7.0 0.2 9.9 31.1 -1.0 415 Sex Male 27.0 48.4 -1.8 4.4 11.6 0.2 10.6 29.2 -I.0 748 Female 24.1 42.4 -1.5 5.4 13.3 0.3 10.7 25.3 -0.7 725 Birth order 1 23.8 44.9 -1.6 7.3 13.5 0.1 10.1 25.9 -1.0 297 2-3 25.6 43.3 -1.6 3.7 10.9 0.3 7.3 24.9 -0.8 529 4-5 25.1 45.2 -1.7 5.0 14.3 0.3 12.4 29.4 -0.9 343 6 + 27.7 50.1 -1.7 4.6 I 1.8 0.2 15.3 30.4 -0.9 305 Birth interval Frost birth 23.6 44.5 -1.6 7.8 13.9 0.I 10.5 26.0 -1.0 304 <24 months 28.7 47,5 -1.7 3.4 10.7 0.5 9.5 26.4 -0.7 207 24-47 months 26.0 45.6 -I.6 4.7 11.5 0.3 10.3 27.7 -0.9 711 48 months 24.1 44.7 -1.5 3.1 14.6 0.2 13.0 28.4 -0.9 251 A/I c'fffldran 25.6 45.5 -1.6 4.9 I2.4 0,3 10.7 27.3 -0.9 1,473 Note: Table omits a large proportion of children for whom anthropomotfic date are not available (see text). Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below the median of the International Reference Population (-3 SD and -2 SD) are shown according to demographic characteristics. 1 Includes children who are below -3 standard deviations from the International Reference Population median are classified as malnourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child's age and selected background characteristics. It is impossible to know whether the 45 percent of children included in the analysis are representative of all children under three or whether the information is biased because of the omission of such a large proportion of eligible children. Just under half of children under three in Nigeria were recorded as being short for their age or stunted, while about one-quarter are severely stunted (<-3 SD). The figures are high and suggest chronic food insecurity and/or repeated illnesses. Stunting is evident even among children under age six months (21 percent). The prevalence of stunting generally increases as children get older, up to a high of 55 percent among one-year-old children. Prevalence of stunting varies little by sex of the child, birth order or the length of the preceding birth interval. As shown in Table 9.6, rural children are slightly more likely to be stunted than urban children (47 versus 42 percent). The two northern regions and the Central region have higher prevalences of stunting than the southern regions. Children of women with no education have a higher prevalence of stunting than children of women with any education (56 percent compared with 38-40 percent). 130 ?2able 9.6 Nutritional status of children by background characteristics Percentage of children under three classified as malnourished according to three anthropometrie indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by selected background characteristics, Nigeria 1999 Height-for-age Weight-for-height Weight-for-age Per- Per- Per- Per- Per- Per- centage eentage Mean centage centage Mean centage centage Mean Number Background below below Z-score below below Z-score below below Z-score of characteristic -3 SD -2 SD 1 (SD) -3 SD -2 SD 1 (SD) -3 SD -2 SD t (SD) children Residence Urban 22.8 41.6 -1.5 3.4 11.4 0.2 8.7 26.7 -0.8 417 Rural 26.7 47.0 -1.7 5.5 12.8 0.3 11.5 27.5 -0.9 1,056 Region Northeast 35.9 55.2 -2.I 7.9 16.3 0.I 19.4 38.0 -I.3 302 Northwest 35.9 57.0 -2.0 11.6 22.9 -0.2 24.3 45.2 -1.5 108 Southeast 18.3 35.3 -1.3 2.8 8.0 0.5 5.0 18.3 -0.4 368 Southwest 19.4 38.9 -1.2 4.2 12.4 0.1 6.5 25.1 -0.8 404 Central 28.8 53.1 -2.0 2.9 10.0 0.6 9.5 23.9 -0.9 291 Education No education 34.4 56.2 -2.0 6.4 15.0 0.2 17.8 36.3 -1.2 547 Primary 22.6 39.7 -1.5 5.0 12.6 0.2 6.8 23.9 -0.8 414 Secondary 17.9 38.8 -1.3 3.4 9.2 0.4 5.8 19.5 -0.6 446 Higher 22.5 37.6 -1.4 1.7 11.3 0.3 9.3 25.5 -0.7 65 All childran 25.6 45.5 -1.6 4.9 12.4 0.3 10.7 27.3 -0.9 1,473 Note: Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO international Reference Population. The percentage of children who are more than three or more than two standard deviations below (i.e., away in the negative direction) the median of the International Reference Population (-3 SD and -2 SD) are shown according to demographic characteristics. 1/ncludes chi/dran who are be/nw -3 standard deviations from the International Reference Population median Twelve percent of children under three are underweight for their height or are wasted; 5 percent are severely wasted (<-3 SD). The prevalence of wasting varies little with background characteristics, except that it is lower among children age 12-23 months. Another exception is regional differences. The two northern regions have a higher prevalence of wasting than the other three regions. Caution is necessary when interpreting regional differences, since the proportion of children with implausible anthropometric data was highest in the Northwest region (69 percent). Twenty-seven percent of children are considered to be underweight (low weight-for-age), and 11 percent are classified as severely underweight. As with stunting, children under six months are least likely to be underweight, probably due to the positive effects of breastfeeding. After six months of age, the proportion of children who are underweight rises to about one-third of children age 12-35 months. The likelihood of being underweight varies little by any of the other characteristics examined except that it is higher among children in the northern regions than in the southern or Central regions. Trends in Nutritional Status of Children Trends in child nutrition in Nigeria can be observed by comparing data from the 1990 NDHS with that obtained in the present survey (1999 NDHS). The two surveys used similar sampling strategies and data processing and analysis methods. However, the 1990 survey covered children under five, while the 1999 survey focused on children under three; therefore, it was necessary to retabulate data from the 1990 NDHS 131 to restrict the data to the younger children. Also, the two surveys used different measuring equipment. Any interpretation of trends is based on the assumption that the results from the 45 percent of children with adequate data in the 1999 NDHS are representative of all children under three. The data indicate that stunting and wasting seem to have increased (from 36 to 46 percent of children under age three for stunting and from 11 to 12 percent of children for wasting). However, the proportion of children who are underweight seems to have decreased from 35 to 27 percent. It should be noted that two other surveys exist but their data are not again directly comparable. The 1993 UNICEF survey had anthropometric data but they are not based on a nationally representative sample, rather on "focus" states that were purposively sampled. The National Micronutrient Survey (NMS 1993) was based on a nationally representative sample but covered a different age range: 6-71 months. 9.3 Nutritional Status of Mothers All mothers of children born since January 1996 were also eligible to be weighed and measured. The objective was to determine the nturitional status of women of reproductive age. However, since weighing and measuring all women would add considerably to the length and cost of the fleldwork, it was decided to limit the anthropometric section to women with young children who would be measured anyway. 1 The information was used to construct the following indicators of mothers' nutritional status: • Meanheight (in centimetres) • Body mass index (BMI). Women who were pregnant at the time of the survey and those who had delivered a baby within the two months before the interview were excluded from the tables on weight and body mass index. Thus, the data on height are available for 2,494 or 80 percent of the eligible women, while data on weight are available for 2,219 or 87 percent of the nonpregnant, nonpostpartum women, and BMIs are available for 2,046 or 80 percent of the women. Height is used to identify mothers at nutritional r ise Height of women can be used to predict the risk of difficulty in delivering children, given the association between height and size of the pelvis. Also, the risk of giving birth to low-weight newborns is higher among women of small stature. Although the cut- off point at which the mother can be considered at risk varies between populations, a value of 145 centimetres is used. Indices of body mass are used to assess thinness or obesity. The most commonly used index is the body mass index or BMI (also referred to as the Quetelet index), which is defined as weight in kilograms divided by the square of the height in metres (kg/m2). The main advantage of the BMI is that it does not require a reference table from a well-nourished population. For the BMI, a cut-off point of 18.5 has been recommended for defining thinness, or acute malnutrition. Obesity has not been defined clearly in terms of the scale, although a BMI or 25.0 or above is usually considered obese. The mean height of mothers of young chilflren in Nigeria is 159 cm (Table 9.7). Seven percent of mothers are shorter than the cut-off point of 145 cm. The mean BMI is 22.8, with 16 percent of mothers failing below the cut-off of 18.5. 1 Interviewers were instructed to weigh and measure all women who had had a birth since January 1996, regardless of whether or not the child was living. 132 The prevalence of short stature (height less than 145 cm) falls somewhat with increasing age. There is also considerable regional variation, ranging from 4 percent of mothers in the Central region to 11 percent in the Northwest region. Mothers with no education have nearly twice the prevalence of short stature than mothers with some education. The prevalence of a BMI less than 18.5 decreases with increasing age, from 19 percent among mothers 15-19 years te l2 percent among those 35-49 years. It also varies with region, being considerably higher in the two northern regions and in the Southwest region than in the Central and Southeast regions. There was a lower prevalence with increasing education. Since this is the first nationally representative data on the nutritional status of mothers in Nigeria, there is no way to assess trends over time. The data should provide a good baseline with which other studies can be compared in the future. Table 9.7 Nutritional status of- women by background cb~:actea'isdcs Among women who gave birth in the three years preceding the survey, mean height and percentage under 145 cm, mean body mass index (BMI), percentage whose BMI is below 18.5, mean DHS Z-score, and percentage wasted, by se/ected background charactei'islics, Nigeria 1999 Background characterlstie Height Body mass index 1 Mean Per- body Per- Per- Mean contage Number mass centage Number Mean centage Number height below of index below of DHS below of in cm 145 era women (kg/m 2) 18.5 women Z-score -2 SD women Age 15-19 155.5 10.5 226 22.9 18.6 192 -0.5 8.3 176 20-24 157.4 8.1 556 22.5 17.5 443 -0.3 6.0 425 25-29 159.0 6.6 708 22.7 17.3 555 -0.6 13.2 540 30-34 160.6 4.4 520 23.0 15.5 447 -0.6 13,1 430 35-49 160.3 5.2 484 23.1 12.3 418 -0.8 14,5 402 Residence Urban 160.3 5.6 660 23.0 14.8 535 -0.5 10.5 522 Rural 158.4 6.9 1,834 22.7 16.5 1,520 -0.6 11.8 1,450 Region Northeast 159.1 7.4 586 22.3 25.0 486 -0.8 18.4 465 Northwest 158.7 10.7 387 23.2 18.0 342 -0.6 12.3 313 Southeast 157.3 6.4 461 23.9 6.5 351 -0.3 5.1 341 Southwest 161.1 5.1 544 22,0 19.9 442 -0,7 13,5 432 Central 158.0 4.1 515 23.0 8.4 434 -0.4 6.2 422 Education No education 158.4 8,6 1,207 22.5 19,7 1,022 -0,7 15,1 965 Primary 158.2 5.1 630 22.6 13.7 514 -0.6 9.4 503 Secondary 160.1 4.2 568 23.4 11.7 454 -0.3 6.7 440 Higher 163.8 4.1 90 24.6 7.9 66 -0.1 4.9 65 Total 158.9 6.5 2.494 22.8 16.1 2.055 -0.6 11.4 1.972 Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in metres (kg/m 2). The D HS Z-scorn is based on a study of e/ire mothers in DH8 surveys and indicates the number of standard deviation units (SD) from the median of the DHS de facto reference population. The percentage of mothers who are more than two standard deviations below the median of the DHS reference popuhatlon (-2 SD) are considered wasted. 1 Excludes pregnant women and women with a birth in the preceding two months 133 CHAPTER10 FEMALE GENITAL CUTTING Although the practice of female genital cutting (female circumcision) has become an important issue in international discourse, nationally representative data on its prevalence are rare. For the first time in Nigeria, the 1999 NDHS collected information on this practice. Women were asked if they were circumcised, and if so, what type of circumcision they had, who performed the circumcision and at what age. Those who had daughters were asked the same series of questions about their eldest daughter. All women were asked their opinions on whether the practice should be continued or discontinued. In this chapter, data on the prevalence, types, age at circumcision anti persons performing female circumcision in the country are presented. Respondents' opinions on confirmation of the practice and reasons for or against the practice are also presented. 10.I Prevalence of Female Genital Cutting The data show that circumcision is common, with one in four Nigerian women age 15-49 reporting that they were circumcised (Table 10.1 ). Among those circumcised, by/:at the most common procedure was .Table 10.I Prevalence of female ~enital cultln g Percent distribution of women 15-49 by whether they have been circumcised and, among those circumcised, percent disttlbutiot by type of circumcision, according to background characteristics, Nigeria 1999 Number Type of circumcision of Not Number eircum- Background Circum- circum- " of Clitoti- lnfibu- cised characteristic cised cised Missing Total women dectomy Excision lation Missing Total women Age 15-19 8.8 38.6 52.5 100.0 1,775 82.0 5.1 7.8 5.1 100.0 157 20-24 19.6 65.2 I5.2 100.0 1,521 81.4 7.8 3.4 7.4 100.0 298 25-29 26.4 69.0 4.6 100.0 1,516 81.2 8.3 2.9 7.7 100.0 400 30-34 31.3 67.4 1.3 100.0 1,I37 82.1 6.5 3.2 8.2 100.0 356 35-39 31.0 67.9 1.2 100.0 992 81.0 6.7 5.7 6.5 100.0 307 40-44 37.9 60.9 1.2 100.0 696 81.3 6.6 4.7 7.4 100.0 264 45-49 48.3 51.3 0.4 100.0 568 86.9 4.7 0.8 7.6 100.0 274 Residence Urban 30.0 51.5 18.6 100.0 2,540 77.8 6.9 4.1 11.2 100.0 761 Rural 22.9 63.0 14.1 100.0 5,666 84.8 6.6 3.6 5.0 100.0 1,295 Region Northeast 1.9 91.1 7.0 100.0 1,292 (13.7) (20.6) (49.9) (15.8) 100.0 25 Northwest 2.6 92.4 4.9 100.0 1,087 (69.1) (14.7) (13.3) (2.9) 100.0 28 Southeast 36.5 39.1 24.4 100.0 1,886 75.0 11.7 3.7 9.6 100.0 689 Southwest 48.4 32.5 19.1 100.0 2,080 84.2 4.6 3.3 7.9 100.0 1,008 Central 16.4 69.1 14.5 100.0 1,861 98.6 0.7 0.7 0.0 100.0 306 Education No education 15.6 81.1 3.3 100.0 3,324 85.1 5.2 5.2 4.6 100.0 518 Primary 36.1 48.0 16.0 100.0 1,868 83.0 8.0 1.9 7.1 100.0 674 Secondary 27.6 40.3 32.1 100.0 2,506 79.9 6.7 4.6 8.8 100.0 692 Higher 33.8 54.7 11.5 100.0 508 79.6 6.5 3.6 10.3 100.0 172 Total 25.1 59.5 15.5 100.0 8,206 82.2 6.7 3.8 7.3 100.0 2,056 Note: The proportion with missing information is high due to an error in the questionnaires that resulted in women who had never had sexual intercourse skipping these questions. Figures in parentheses are based on 25-49 unweighted cases. 135 the least invasive form of clitoridectomy (82 percent) (Figure 10.1). Only a small proportion of circumcised women reported excision (removal of the labia) or infibulation (sewing together of the labia). The prevalence of female genital cutting generally increases with age. Although almost half of women age 45-49 are circumcised, the proportion is one-quarter or less among women under age 30.1 There is a slight differential by urban-rural residence in female genital cutting, with a larger proportion of urban than rural women being circuancised. This difference may be a reflection of the pattern of settlement in the Southwest region, where the largest proportion of circumcised women lives (48 percent). The prevalence of the practice is lowest in the Northeast region (2 percent) and the Northwest region (3 percent). Female genital cutting is more common among better-educated women, which may again be a reflection of its being more prevalent in the Southwest and Southeast regions tiaan in the northern regions. Although very few women in the north have been circumcised, they are more likely to report having had excision or infibulation than women in the south. Figure 10.1 Prevalence of Female Genital Cutting, Nigeria 1999 m2~ Circumcised Not circumcised m Data missing AMONG THOSE CIRCUMCISED: Clitoridectomy Excision ~ 7 Infibulation ~4 Other/Missing ~7 0 ::;i;::~:: i:: ##iiii::i~::~ii::ii~:#::i~i# i:,iii iii i iiiiiiiiiiiiii:,i ::iii:ii 182 20 40 60 80 1 O0 Percent NDHS 1999 1 Because of an error in the questionnaire, women who had never had sexual intercourse were skipped on the questions on female circumcision. Since these women are more likely to be younger, this affects the analysis of age patterns. 136 10.2 Age at Circumcision In Nigeria, female genital cutting is commonly performed in infancy; as shown in Table 10.2, 42 percent of circumcised women were circumcised before attaining one year of age. This pattern cuts across residence and educational levels. However, the few women in the north who are circumcised reported having the operation at older ages than those in the south. This pattern is also reflected in the type of circumcision, with c/itoridectomy and excision generally being performed at younger ages than lnfibulation. Table 10.2 Age at genital cutting Percent distribution of circumcised women by age at circumcision, according to background characteristics, Nigeria 1999 Age at ~rcumcislon Don't Number Background know/ of characteristic 0 1-4 5+ Missing Total women Residence Urban 43.1 7.9 17.6 31.4 100.0 761 Rural 40.7 7.8 26.6 24.8 100.0 1,295 Region Northeast (7.8) (20.9) (51.1) (20.2) 100.0 25 Northwest (16.2) (12.6) (39.6) (31.6) 100.0 28 Southeast 49.1 2.7 28.4 I9.9 100.0 689 Southwest 40.6 10.7 16.2 32.5 100.0 1,008 Central 33.1 8.6 31.7 26.6 100.0 306 Educatlon No education 34.5 10.7 26.8 28.0 100.0 518 Primary 44.1 6.4 22.7 26.9 100.0 674 Secondary 42.4 6.4 22.5 28.8 100.0 692 Higher 50.1 10.5 18.8 20.6 100.0 172 Type of circumcision Clitoridectomy 41.4 8.7 23.3 26.7 100.0 1,690 Excision 44.0 2.9 37.0 16.1 100.0 I39 Infibulation 20.4 9.5 37.3 32.8 100.0 77 Other/Missing/ Don't know 52.5 2.1 4.1 41.3 100.0 150 Total 41.6 7.8 23.3 27.3 100.0 2,056 Note: Figures in parentheses are based on 25-49 unweighted cases. 10.3 Person Who Performed Circumcision The risks of complications and infection associated with female genital cutting may be a function of the environmental conditions under which the operation is performed and the cleanliness of the instruments. Questions on the person who performed circumcision were asked to indirectly gauge exposure to these risks. About 70 percent of circumcisions were performed either by traditional birth attendants (36 percent) or by circumcision practitioners (37 percent) (Figure 10.2). Only 13 percent were performed by trained modern medical personnel. This pattern holds in all regions and across all educational levels. 137 Figure 10.2 Provider of Female Genital Cutting, Nigeria 1999 Oth~ . . . . Doctor 2% Nurse/Midwife Circumcisiol practitioner 37% Traditional birth attendant 36% NDHS 1999 10.4 Attitudes toward Female Genital Cutting In response to the question "Do you think female circumcision should be continued or should it be discontinued?" only 15 percent of all women are of the opinion that the practice should be continued, while almost half believe that the practice should be discontinued and more than one-fifth said they do not know how they feel (Table 10.3). As might be expected, the pattern of favourable attitudes towards female genital cutting tends to mirror the pattern of the practice itself. Consequently, urban women and women in the south are more likely than others to favour continuation of the practice, as are those who have been circumcised. The one exception is educational attainment. Although educated women are more likely than uneducated women to be circumcised, almost three-quarters of those with more than secondary school say they think the practice should be discontinued. 138 Table 10.3 Attitudes toward female eenital cuttin~ Percent distribution of all women by opinion on whether female genital cutting ~ould bo continued according to background characteristics and circumcision status, Nigeria 1999 Attitude toward female genital cutting Should Should Number Background be con- be dis- Don't of characteristic tinuad continued know Missing Total women Residence Urban 16.7 48.7 16.6 18.0 100.0 2,540 Rural 14.8 46.2 24.9 14.0 I00.0 5,666 Region Northeast 1.8 63.2 27.9 7.0 100.0 1,292 Northwest 3.6 48.3 43.5 4.6 100.0 1,087 Southeast 19.4 43.7 12.8 24.1 100.0 1,886 Southwest 31.4 38.6 I1.4 18.6 I00.0 2,080 Central 9.8 47.7 28.0 14.5 100.0 1,861 Education No education 11.8 49.3 35.6 3.3 100.0 3,324 Primary 23.1 44.8 16.4 15.7 100.0 1,868 Secondary 15.3 40.7 12.3 31.7 100.0 2,506 Higher 10.7 71.3 7.1 10.9 100.0 508 Circumcision status Circumcised 54.4 37.0 8.6 0.1 100.0 2,056 Not circumcised 2.8 63.2 33.8 0.2 100.0 4,879 Total 15.4 47.0 22.3 15.3 100.0 8,206 Note: The proportion with missing information is high due to an error in the questionnaires that resulted in women who had never had sexual intercourse skipping these questions. Respondents who want the practice of female genital cutting to continue advanced several reasons for their opinion; the major ones are that circumcision is a good tradition/custom and that it will preserve virginity and prevent immorality (Table 10.4). Very few women cite religion as a reason for favouring the practice, nor do many women say that circumcision provides greater pleasure for husbands. Similarly, only 5-7 percent of women say that female circumcision should be continued because of cleanliness or because it will enhance a girl's marriage prospects. As to why the practice should be discontinued, many respondents believe that it is a bad tradition, while some say that it is against religion (Table 10.5). Other reasons given for advocating a discontinuation of the practice include medical complications arising from the practice, painfifl personal experience, the indignity of the practice, and inhibition of sexual satisfaction. Table 10.4 Reasons for sunnurtine female genital cutting Among women who say they think female fftrcmnclsinn should be continued, percentage who cite specific reasons, Nigeria 1999 Percentage Reason of women Good tradition 35.4 Custom and traffltion 50.2 Religious demand 2.0 Cleanliness 5.3 Better marriage prospects 6.7 Greater pleasure of husband 2.6 Preserve virginity/ Prevent immorality 14.3 Other 5.6 Does not know 1.9 Number of women 1,263 Note: Multiple responses accepted 139 Women who had daughters were asked if their ddest daughter was circumcised and, if not, whether they planned to have her circumcised. The results in Table 10.6 show that only one in five daughters have been circumcised, with another 4 percent planned to be circumcised. Almost three-quarters of women with daughters say they do not plan to have the daughter circumcised. The pattern of responses generally follows that of circumcision among the women themselves; namely, the daughters of women in urban areas, in the Southwest and Southeast regions, and those whose mothers are circumcised are most likely to be circumcised. There is a clear relationship with age, with daughters of older women much more likely to be circumcised than daughters of younger women. / Table 10.5 Reasons for not supporting female eanital euttine Among women who say they think female circumcision should be discontinued, percentage who cite specific reasons, Nigeria 1999 Percentage Reason of women Bad tradition 60.6 Against religion 22.4 Medical complications 22.3 Painful personal experience 10.4 Against dignity of women I 0.1 Prevents sexual satisfaction 6.5 Other 3.2 Does not know 2.8 Number of women 3,857 Note: Multiple responses accepted Table 10.6 Genital cutfin~ ofdauehtars Percent distribution of women with daughters by whether the oldest daughter is circumcised or circumcision is planned, according to background characteristics and circumcision status, Nigeria 1999 Status of eldest daughter Do not Daughter Plan to plan Number Background ckcum- circum- circum- of characteristic cised cise cision Missing Total women Age 15-19 3.9 3.8 89.1 3.1 100.0 157 20-24 8.2 6.4 82.5 2.9 100.0 546 25-29 13.7 4.5 79.4 2.4 100.0 951 30-34 19.4 3.9 74.4 2.4 100.0 895 35-39 21.0 3.3 74.7 0.9 100.0 858 40-44 28.3 3.2 67.2 1.3 100.0 614 4549 41.9 2.6 54.8 0.7 100.0 482 Residence Urban 24.5 3.7 70.5 1.2 100.0 1,316 Rural 18.4 4.1 75.4 2.1 100.0 3,187 Region Northeast 1.6 0.6 95.3 2.4 100.0 785 Northwest 2.2 0.3 93.3 4.2 100.0 681 Southeast 30.6 8.1 60.6 0.7 100.0 861 Southwest 43.9 5.5 49.7 0.9 100.0 1,126 Central 11.9 3.8 82.4 1.9 100.0 1,050 Education No education 14.6 2.0 81.0 2.4 100.0 2,352 Primary 29.2 6.3 63.0 1.5 100.0 1,111 Secondary 24.4 6.9 67.4 1.3 100.0 815 Higher I9.4 2.3 77.9 0.5 100.0 225 Circumcision status Circumcised 59.9 10.9 28.3 0.8 100.0 1,416 Not cimumcised 1.9 0.7 95.4 2.0 100.0 3,064 Total 20.2 4.0 73.9 1.9 100.0 4,503 140 CHAPTER 11 SEXUAL ACTIVITY AND KNOWLEDGE OF SEXUALLY TRANSMITTED DISEASES 11.1 Introduction Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are becoming an important public health concern in Nigeria. However, there are no reliable nationally representative data on sexual practices nor on knowledge and beliefs about HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, several questions were included in the 1999 NDHS to ascertain the level of awareness about these health problems. Knowledge of means of avoiding AIDS can help prevent its spread. Both women and men were asked about their sexual practices, including giving or receiving gifts in exchange for sex. They were also asked whether they had ever heard of AIDS and, if so, where they had learned the most about AIDS. They were then asked whether they knew of anything a person could do to avoid getting AIDS. Finally, respondents were asked whether they thought it was possible for a healthy- looking person to have the AIDS virus and whether they thought that people with AIDS almost never, sometimes, or almost always died from the disease. 11.2 Awareness and Knowledge of H1V/AIDS The future course of what has now become a pandemic depends to a large extent on the level of HIV/AIDS awareness and knowledge among the general public. Tables 11.1.1 and 11.1.2 present the percentage of women and men, respectively, who have heard of HIV/AIDS by source of information, according to background characteristics. The table shows that 74 percent of women and 90 percent of men have heard of HIV/AIDS. The radio and relatives and friends are the most commonly cited sources of information about HIV/AIDS among both women and men. The radio was cited by 46 percent of women and 72 percent of men; relatives and friends were cited by 42 percent of women and 52 percent of men. Television is also an important source of H/V/AIDS information (24 percent of women and 40 percent of men). Men are more likely than women to Cite every source of information about HIV/AIDS except health workers, which were cited by 17 percent of women and 14 percent of men. The percentage of respondents who have heard of HIV/AIDS is surprisingly constant over the age groups, being only slightly lower among women in their 40s and men age 15-19. The percentage of women and men who have heard of HIV/AIDS is higher for those never married than for those who are currently or were formerly in union, especially among women. Knowledge of AIDS is higher in urban than in rural areas. It is also highest in the Southeast and Southwest regions and lowest in the Northwest region. The percentage of women and men who know of AIDS increases with level of education. As might be expected, radio, television, and newspapers are more important sources of AIDS information for urban than for rural respondents. Those sources are also more likely to be cited by more-educaWxl respondents. Women and men were asked what a person can do to avoid getting HIV/AIDS. Tables 11.2.1 and 11.2.2 show the percentage of women and men respectively, who cite various ways to avoid HIV/AIDS and the percentage who have been misinformed, according to background characteristics. The tables are based on respondents who have heard of AIDS. 141 t~ Table 11.1.1 Knowledge of HIV/AIDS and sources of HIV/AIDS infomaation: women Percentage of women who have heard of I-IIV/AIDS and among women who have heard of HIV/AIDS percentage who rexeived information about HIV/AIDS from specific sources, by background characteristics, Nigeria 1999 Source of HIV/AIDS infoanation Has Coal- Friend/ Number Background heard of News- Pamph- Health Mosque/ alunity Rela- Work- Other of characteristic HIV/AIDS Radio 'IV paper let worker church School meeting five place source women Age 15-19 74.2 39.9 21.3 8.4 3.7 6.8 4.6 21.0 2.4 41.2 1.1 1.9 1,775 20-24 76.6 48.1 28.0 12.6 5.9 15.6 6.4 12.0 4.0 43.3 2.9 1.9 1,521 25-29 75.4 48.8 27.5 11.6 4.9 23.8 6.1 4.8 5.6 39.5 3.9 1.7 1,516 30-39 75.0 49.3 26.1 8.6 4.8 22.6 6.5 3.0 6.0 42.1 4.0 1.7 2,129 4049 69.8 40.3 17.2 4.8 2.6 13.8 7.1 1.0 6.9 41.2 3.7 2.3 1,265 Marital status Currently maa'ied 69.6 43.7 21.i 6.6 3.8 19.6 5.4 2.0 5.4 38.8 2.7 1g 5,757 Fomaedy married 80.6 42.3 19.1 5.4 2.5 14.1 4.5 3.6 6.9 57.7 5.3 4.2 319 Never married 86.4 51.0 33.6 17.0 6.7 9.5 8.2 27.0 3.3 46.3 3.7 2.8 2,130 Residence Urban 87.6 61.3 49.7 17.4 7.4 22.9 6.1 10.7 4.1 43.5 5.1 0.8 2,540 Rural 68.5 38.5 12.9 5.6 3.1 14.0 6.1 7.6 5.3 40.7 2.2 2.4 5,666 Region Northeast 49.8 27.8 10.7 3.6 1.3 12.4 1.8 2.4 1.7 28.6 1.0 0.1 1,292 Northwest 47.4 31.7 7.8 1.6 1.1 7.1 2.9 1.2 2.1 32.7 0.4 0.1 1,087 Southeast 90.6 55.9 25.8 13.3 6.3 16.1 10.2 16.2 7.5 53.3 3.7 5.9 1,886 Southwest 84.9 57.7 42.2 12.5 5.0 19.3 4.1 8.3 3.2 38.8 3.7 1.0 2,080 Central 79.0 42.0 21.9 9.9 6.2 23.3 9.0 9.8 8.1 46.8 4.7 1.1 1,861 Education No education 49,5 23.7 4.8 0.3 1.1 10.1 3.2 0,2 4.6 32.2 0,8 0.6 3,324 Primary 85.7 49.9 19.1 2.6 2.7 18.6 7.5 3.2 5.9 52.1 2,8 3.4 1,868 Secondary 94.1 63.5 42.9 17.1 6.2 20.0 7.8 20.2 4.3 46.1 3.5 2.3 2,506 Higher 98.5 84.6 79.4 53.5 24.5 37.2 11.8 26.1 6.1 40.8 16.2 2.4 508 Total 74.4 45.6 24.3 9.3 4.5 16.8 6.1 8.6 4.9 41.5 3.1 1.9 8,206 Table 11.1.2 Knowledge of HIV/AIDS and so~ of HIAV/AIDS information: men Percentage of men who have heard of HIVAIDS and among men who heard of HIV/AIDS percentage who received infomaation about HIV/AIDS from specific sources, by background characteristics, Nigeria 1999 Source of HIVIAIDS in fomaatlon Has Corn- Friend/ Number Background heard of News- Pamph- Health Mosque/ munity Rela- Work- Other of characteristic HrV/AIDS Radio TV paper let worker church School meeting tive place source men Age 15-19 85.0 59.9 35.6 18.3 10.6 8.5 8.0 27.1 1.6 44.2 3.0 1.4 511 20-24 93.8 76.1 47.2 26.7 17.2 14.8 7.6 15.6 2.5 55.1 5.9 2.0 319 25-29 90.4 76.0 45.0 30.5 16.7 13.0 7.7 9.5 4.7 57.4 15.4 2.3 366 30-39 91.3 79.7 44.2 32.0 17.5 17.8 8.3 3.6 4.2 55.9 16.3 1.9 623 4049 89.3 72.1 36.5 25.2 14.5 15.7 9.9 3.3 7.0 51.5 17.0 1.9 436 50-64 88.4 69.5 31.7 19.0 12.2 15.7 9.8 2.6 7.7 46.5 10.1 2.5 425 Marital status Currently macded 88.9 73.6 36.9 24.2 13.8 15.8 8.8 3.0 5.9 52.9 14.1 2.0 1,612 Formerly married 88.5 67.1 39.5 24.9 18.6 18.8 8.7 6.2 6.0 57.0 16.4 1.2 81 Never married 90.5 70.1 44.5 27.3 15.9 11.6 8.2 22.1 2.3 49.0 6.9 2.0 988 Residence Urban 95.3 79.8 68.7 41.5 22.1 18.5 8.7 14.2 4.9 48.8 15.9 1.7 821 Rural 86.9 68.7 27.0 18.2 11.5 12.5 8.5 8.3 4.4 52.8 9.6 2.1 1,859 Region Northeast 76.9 61.3 28,0 I6,8 10.0 8,7 3.7 3,7 1.7 56,1 5,3 0,7 437 Northwest 76.6 58.7 17.0 9.6 8.5 14.5 7.2 5.1 3.5 64.8 12.7 1.5 356 Southeast 96.1 79.6 42.1 25.9 14.5 8.8 10.9 12.4 7.9 57.9 15.2 3.2 590 Southwest 96.5 78.3 59.5 34.5 17.2 16.1 9.6 13.6 5.7 36.8 11.7 1.5 696 Central 91.7 73.5 36.8 29.8 19.1 21.7 9.6 11.5 2.8 51.3 11.6 2.6 601 Education No educatinn 73.2 52.2 11.2 2.0 4.0 8.8 4.6 1.0 3.5 51.1 5.6 1.0 663 Primary 91.7 74.0 28.9 13.9 9.1 t0.1 8.9 t.8 6.3 53.9 10.9 2.4 710 Secondary 95.8 78.9 54.1 34.7 16.6 14.5 9.4 19.0 3.8 49.4 11.3 1.4 986 Higher 98.8 88.2 79.2 70.2 43.5 34.8 13.5 20.0 5.5 54.3 25.9 5.0 321 Total 89.5 72.1 39.8 25.4 14.7 14.3 8.6 10.1 4.6 51.6 11.5 2.0 2,680 Table 11.2.1 Knowledge of ways to avoid HIV/AIDS: women Among women who have heard of H[V/AIDS, percentage who know of specific ways to avoid HIV/AIDS and percentage with raisin fomaatlon about HIV/AIDS, by background characteristics, Nigeria 1999 Ways to avoid HtV/AIDS E/lbqlfe clean Avoid instxu- Percentage No Avoid sex Ensure Easure merits Avoid Tradi- with wayto Abstain One sexwith with safe safe for contami- Avoid tional Dce.m't anymi.~ Number Background avoid from Use sex prosti- homo- trans- injee- circtma- nated Avoid mosquito healer/ know infor- of characteristic HIV/AIDS sex condoms partner totes sexuals fusions tions eision objects kissing bite Other any way marion t women Ag~ 15-19 5.9 25.5 11.6 38.2 12.3 1.8 13.4 17.6 8.4 1.7 2.7 0.6 2.4 30.1 5.3 1,318 20-24 5.3 14.3 18.4 50.4 16.0 4.1 I8.8 "23.9 10.5 1.6 1.8 0.4 3.0 24.4 4.7 1,164 25-29 7.2 10.8 17.3 55.6 18.7 2.5 I8.9 25.2 11.4 1.3 1.6 0.2 2.8 24.2 4.5 1,144 30-39 5.3 11.5 14.1 58.0 17.0 3.7 20.5 2A.7 11.1 0.9 1.6 0.6 2.6 24.1 4.3 1,597 40-49 6.1 13.7 6.2 57.9 16.6 2.3 14.0 20.0 9.1 1.8 0.8 0.0 1.7 25.6 2.6 882 Marital status Currently married 6.2 8.9 12.0 56.9 18.9 3.2 17.3 21.7 9.8 1.3 1.2 0.3 2.2 25.9 3.4 4,007 Formerly married 5.1 i7.0 11.1 45.2 10.8 2.8 13.5 19.0 7.7 0.6 0.0 0.4 4.6 27.3 5.1 257 Never married 5.4 28.7 18.2 41.7 10.5 2.5 18.3 24.4 11.3 1.8 3.3 0.6 3.1 24.9 6.4 1,841 Residence Urban 5.0 15.7 19.4 55.3 19.0 4.8 24.5 28.1 13.1 1.0 2.6 0.5 2.1 23.8 4.8 2,226 Rural 6A 15.0 10.6 49.8 14.3 1.9 13.3 19.2 8.5 1.6 1.3 0.3 2.8 26.8 4.1 3,880 Region Northea~ 4.6 2.9 7.0 41.0 39.6 4.7 20.3 24.8 9.1 0.6 0.4 0.1 0.5 33.3 1.0 644 Northwest 3.9 4.7 8.4 54.8 25.0 4.5 21.5 25.8 13.4 0.0 1.3 0.0 0.8 23.7 2.1 515 Southeast 4.6 28.2 13.0 48.9 7.3 1.6 15.3 23.0 9.1 2.8 1.5 0A 4.8 22.6 6.2 1,710 Southwest 5.4 11.I 17.7 55.5 12.3 2.8 17.2 19.8 I0.3 1.1 3.0 0.4 2.7 25.8 5.7 1,767 Central 9.3 14.1 15.1 54.4 17.2 3.3 17.4 22.6 10.6 1.0 1.4 0.6 1.3 26.5 2.9 1,470 Education No education 7.7 6.7 4.0 47.1 22.6 2.4 9.6 13.6 4.8 0.5 0.4 0.1 0.9 34.5 1.4 1,645 Prima~ 5.4 14.7 8.5 52.6 13.I 2.0 I i .0 16.4 7.7 0.7 0.9 0.1 3.1 27.3 4.0 1,601 Secondary 5.5 20.0 i8.3 50.3 12.6 2.6 20.6 26.1 12.1 2.2 2.8 0.6 2.9 22.2 5.9 2,358 Higher 3.4 22.6 41.6 71.7 20.1 9.2 48.5 53.0 26.8 2.9 4.0 1.6 4.3 7.6 8.2 501 Total 5.9 15.2 13.8 51.8 16.0 2.9 17.4 22A 10.2 1.4 1.8 0.4 2.6 25.7 4.4 6,105 I Includes mosquito bites, kissing, or seeking care from a traditionai healer or spiritual aid. Table 11.2,2 Knowledge of ways to avoid HI'V/AIDS: men Among men who have heard of HIV/AIDS, percentage who know of specific ways to avoid HIV/AIDS and percentage with misinformation about HIV/AIDS, by background characteristics, Nigeria I999 Ways to avoid HIV/AIDS ~]lSqllTe clean Avoid inst~u= percentage No Avoid sex Ensure Ensure merits Tradi- with way to Abstain One sex with with safe safe for Avoid tional Doesn't any ntis- Number Background avoid from Use sex prosti- home- trans- injec- ckcun~ Avoid mosquito healerl know infor- of characteristic HIV/AIDS sex condor~ partner tares sexuals fusions tions cision kissing bite Other any way marion I men Ag~ 15-19 3.2 32.3 29.7 25,6 29.3 5,7 14.8 17.1 13.7 2.0 1.1 6.0 24.6 8.4 435 20-24 2.4 27.8 38.6 37.3 35.0 6.5 18.2 23.9 18.9 2.0 1.3 5.8 13,4 8.9 299 25-29 3.0 21.7 37.4 45,9 45.7 9.9 23.5 34.5 21.2 3.2 1.6 5.4 10.0 9.9 331 30-39 2.6 22.6 30.4 50.8 50.1 10.8 254 27.8 22,3 3.1 1,5 6.8 9.3 9.6 569 4049 1.8 23.7 23.5 50.2 47.9 8.3 22.0 24,7 i9.2 2.6 1.3 7,7 9.8 10.8 389 50-64 1.7 22.9 19.3 46.5 46.6 8.1 17.1 20.9 13.5 1.7 0,6 3.6 17.5 5.3 376 Marital status Otrre~tlyrrta~ed 2.4 19.4 22.4 48.9 48.9 8.7 20,4 25.0 18.5 2.4 1,3 6.2 12.2 8.9 1,433 Formerly married 1,4 41.6 51.8 41,2 46.2 18.7 31.5 37,1 24.4 2.5 1.7 4.2 11.7 6.8 71 Never ~ed 2.7 32.9 38.8 33.9 33.2 7.0 19.6 23.3 17.5 2.5 1.I 5.8 17.2 8.9 894 Residence Urban 1.4 23.1 39,8 45.5 38.1 10.4 26.0 29.7 21,4 3.5 1A 4.7 13.0 8.8 783 Rural 3,0 26.0 24A 41.9 45.3 74 17.8 22.3 I6.8 2.0 12 6,6 14.6 8.9 1,616 Region Northeast 2.6 19.2 17.2 29.1 63.7 15,5 20.8 25.0 26.5 3,7 4.6 7.5 14.9 12.1 336 Northwest 0,8 6,6 10.1 35.4 78.6 15.3 20.0 36.2 27,0 1.5 0.7 7.3 11.4 9.2 273 Southeast 3,7 43.0 29.6 42.5 21.9 2.3 164 20.3 10.8 0.5 0.0 8.8 17.3 9.3 567 Southwest 3.9 19.8 37.1 38.2 30.8 2.0 22.5 25.2 14.5 3.0 0.6 4,5 16.4 7.9 671 Central 0.2 25.8 36.9 62.0 49.1 14,6 22.2 22,9 21.3 3.6 1.5 3.5 8.7 7.5 551 Edt l~on No education 2.6 14.9 9.9 35.5 58.1 11.7 11.6 18.3 15.5 1.3 1.3 5.8 18.1 7.1 485 Primary 3.1 25.1 18,3 41.2 36A 4.1 9.9 14.9 11.0 1,2 0.6 6.0 17.1 7.4 652 Secondary 2.6 27.4 38.0 40.7 37.0 6.3 21.2 25,3 18.8 2.5 1.2 5.9 13.9 9.0 945 Higher 0.6 33.6 56.3 65.8 50.9 18.0 53.6 53,1 35.9 6.7 2.6 6.4 2.1 14.1 317 Total 2.5 25.1 29,4 43.1 42.9 8.4 20.5 24.7 18.3 2.5 1.2 6,0 14.1 8.9 2,399 l Includes mosquito bites, kissing, or seeking care from a traditional healer or spiritual aid. Six percent of women and 3 percent of men say that there is no way to avoid HIV/AIDS, while about a quarter (26 percent) of women and 14 percent of men say that they do not know any way to avoid getting HIV/AIDS. Urban respondents are less likely than rural respondents to report that there is no way to avoid getting HIV/AIDS. Similarly the tendency to report that there is no way to avoid getting HIV/AIDS declines with increase in the level of education. Among both women and men, the most common way to avoid HI'q/AIDS mentioned is to keep to one sexual partner, cited by 52 percent of women and 43 percent of men. The same is true for almost all subgroups, particularly among urban and better-educated respondents. Although avoiding sex with prostitutes is the next most frequently reported way to avoid HIV/AIDS among by men (43 percent), among women, ensuring the use of sterilised needles for injections is the next most frequently reported (22 percent). Men cite use of condoms as the third most common way to avoid AIDS. Condom use as a way to avoid AIDS is more likely to be cited by urban and more educated respondents than their rural and less-educated counterparts. Tables 11.3.1 and 11.3.2 present the distribution of women and men who know about AIDS according to their opinions on various HIV/AIDS-related issues, by background characteristics. Three in five women and men know that a healthy-looking person can be infected with the AIDS virus. Women and men who live in urban areas and those who have more formal education are more likely to be aware that healthy- looking people can be carrying HIV. There is widespread understanding that AIDS is a fatal disease that cannot be cured. More than 85 percent of women and men report that AIDS is almost always fatal, while 85 percent of women and 74 percent of men know that the disease cannot be cured. More than half of women and 47 percent of men know that the AIDS virus can be transmitted from mother to child. Urban residents, those who live in the south, and those with more education are more likely to be aware of mother-to-child transmission of the virus. As a means of gauging the personal impact of HIV/AIDS, respondents were asked if they personally know someone who has AIDS or who has died of AIDS. Overall, slightly less than a third of respondents (32 percent of women and men) reported that they know someone who has AIDS or who has died of AIDS. Respondents who live in the Northwest and Central Regions and those with more education are more likely to know someone with AIDS. 146 "--3 Table 11.3.1 HIV/AIDS-related knowledge: women Percent distribution of women who have heard of AIDS by responses to questions on various HIV/AIDS-related issues, according to background characteristics, Nigeria 1999 Can a healthy- Can the AIDS Knows looking person virus be transmitted someone have the AIDS virus? Is AIDS a fatal disease7 Can AIDS be cured7 from mother to child? with AIDS or who Number Background Don't Almost Some- Almost Don't Don't Don't died of of characteristic Yes No know never times always know Yes No know Yes No know Total AIDS women Age 15-19 54.9 20.3 24.8 0.8 6.1 20-2/1 65.2 15.3 19.1 0.4 6.0 25-29 65.4 14.8 19.7 0.9 6.5 30-39 61.1 14.7 23.8 0.6 5.5 4049 57.1 15.4 27.4 0.6 5.9 Marital status Currently married 59.9 15.6 24.3 0.7 6.1 Formerly married 55.5 16.1 28.0 0.7 6.8 Never married 63.4 17.4 19.1 0.6 5.4 Residence Urban 67.1 13.2 19.5 0.8 6.8 Rural 57.1 17.9 24.8 0.6 5.5 Region Northeast 56.8 9.4 33.8 0.6 8.9 Northwest 31.3 26.8 41.5 0.9 5.8 Southeast 64.3 I6.4 19.2 0.8 4.2 Southwest 68.5 14.3 17.0 0.4 7.0 Central 59.4 17.5 22.9 0.9 5.4 Education No education 43.9 17.2 38.6 0.6 6.8 Primary 59.3 17.8 22.7 0.7 5.4 Secondary 67.7 16.0 16.2 0.8 5.8 Higher 88.6 8.0 3.4 0.4 6.0 Total 60.8 16.2 22.9 0.7 6.0 86.1 6.9 6.1 83.4 9.4 49.7 14.9 35.2 100.0 32.3 1,318 87.1 5.8 5.4 85.4 8.2 56.4 12.8 30.0 100.0 31.8 1,164 87.3 5.2 4.7 86.6 7.3 57.5 13.1 28.7 100.0 33.4 1,144 85.9 7.7 4.9 83.6 10.2 56.3 12.5 30.7 100.0 33.1 1,597 85.9 7.4 2.5 86.6 9.8 50.8 12.8 36.0 100.0 30.0 882 85.6 7.2 4.6 84.3 9.6 53.3 13.0 33.1 100.0 32.1 4,007 84.5 7.2 3.8 85.8 10.1 46.8 15.4 36.7 100.0 31.1 257 88.5 5.5 5.5 86.2 7.6 57.5 13.4 28.6 100.0 32.8 1,841 86.2 6.1 5.7 83.8 9.2 62.1 9.3 28.3 100.0 28.6 2,226 86.6 7.0 4.4 85.5 9.0 49.9 15.5 34.0 100.0 34.4 3,880 79.4 11.0 9.8 70.6 17.9 33.9 17.7 48.0 100.0 25.7 644 79.5 13.7 5.0 80.8 13.0 35.1 14.1 49.7 100.0 47.2 515 90.3 4.5 4.8 85.6 8.5 60.9 13.0 25.6 100.0 35.5 1,710 88.9 3.4 4.6 88.8 5.4 61.7 11.6 26.2 100.0 18.3 1,767 84.5 8.7 3.1 87.1 8.9 53.5 13.2 32.9 100.0 43.0 1,470 80.0 12.2 3.7 80.1 14.7 35.3 15.6 48.4 100.0 29.3 1,645 86.7 6.9 4.1 85.1 9.7 53.4 14.2 31.8 100.0 32.1 1,601 89.5 3.9 5.8 87.6 5.5 62.2 12.3 25.1 100.0 32.9 2,358 92.5 I.i 6.9 87.4 4.9 82.6 6.7 10.3 100.0 39.8 501 86.4 6.7 4.9 84.9 9.0 54.3 13.2 31.9 100.0 32.3 6,105 oo Table 11.3.2 HW/AIDS-relatedknowledge: men Percent distribution of men who have heard of AIDS by responses to questions on various HIV/AIDS-related issues, according to background characteristics, Nigeria 1999 Can a healthy- Can the AIDS Knows looking person vires be transmitted someone have the AIDS vires? Is AIDS a fatal disease? Can AIDS be cured? from mother to child? with AIDS or who Number Background Don't Almost Some- Almost Don't Don't Don't died of of characteristic Yes No know never times always know Yes No know Yes No know Total AIDS men Age 15-19 51.6 16.9 31.1 0.8 10.9 79.4 7.9 7.8 73.8 18.1 42.0 11.2 45.9 100.0 24.3 435 20-24 66.0 11.4 22.5 0.4 8.4 85.9 5.3 8.3 77.3 14.4 47.2 13.5 36.9 100.0 31.7 299 25-29 69.8 11.7 17.9 0.3 7.0 84.5 6.6 9.4 74.1 15.2 51.4 10.4 36.6 100.0 37.5 33I 30-39 67.8 10.6 21.6 0.0 5.7 90.2 4.1 8.7 75.4 15.6 52.3 9.7 36.4 100.0 34.3 569 4049 58.9 14.1 26.2 0.4 4.7 89.0 5.0 6.8 74.4 17.8 47.6 5.8 43.7 100.0 32.6 389 504;4 50.0 I2.9 36.0 0.0 6.7 81.7 10.2 6.7 71.4 21.1 37.0 10.3 49.7 100.0 30.6 376 Marital status Currently married 59.3 12.6 27.4 0.2 6.0 86.4 6.6 7.6 75.0 16.7 45.9 9.0 42.8 100.0 32.8 1,433 Formerly married 63.2 18.5 18.3 0.0 5.9 88.2 5.9 9.6 55.6 34.8 34.8 13.6 50.8 100.0 33.6 71 Never married 62.7 13.0 24.1 0.5 9.1 83.6 6.2 8.4 74.9 16.2 48.4 11.2 38.7 100.0 29.9 894 Residence Urban 68.4 II.1 19.9 0.6 6.6 85.2 6.7 10.4 71.9 I7.2 54.5 8.2 35.4 100.0 31.3 783 Rural 56.9 13.8 28.9 0.1 7.5 85.5 6.3 6.7 75.5 17.0 42.6 10.9 44.4 100.0 32.0 1,616 Region No,beast 48.6 13.8 37.0 0.4 9.8 79.2 9.7 10.2 72.9 16.4 24.8 10.6 61.2 100.0 36.9 336 Northwest 39.9 16.7 43.4 0.0 3.2 87.6 8.9 4.7 81.9 13.0 37.2 4.3 57.3 100.0 39.4 273 Southeast 62.3 10.8 25.8 0.6 4.2 88.4 5.7 10.3 69.7 18.0 51.3 13.5 31.7 100.0 27.9 567 Southwest 64.0 19.0 16.6 0.3 9.0 83.8 5.9 9.4 80.7 9.8 55.6 13.5 29.1 100.0 16.7 671 Central 72.7 5.3 22.0 0.0 8.3 87.0 4.5 3.9 68.6 27.4 48.3 4.6 46.8 100.0 47.1 551 Education No education 37.7 14.8 47.1 0.5 7.4 81.1 10.3 6.8 69.7 22.8 24.6 7.9 65.5 100.0 27.9 485 Primary 52.2 16.2 31.1 0.0 7.4 83.7 8.1 5.5 73.7 19.8 39.5 10.7 47.6 100.0 31.4 652 Secondary 68.3 12.3 18.9 0.4 7.8 85.9 5.0 8.5 77.1 13.9 51.2 12.1 34.6 100.0 29.1 945 Higher 90.7 5.0 3.9 0.4 4.3 93.8 1.2 13.1 74.6 I2.0 80.4 5.6 12.6 100.0 46.2 317 Total 60.7 12.9 25.9 0.3 7.2 85.4 6.4 7.9 ~ 74.4 17.1 46.5 10.0 41.5 100.0 31.7 2,399 11.3 Perceptions of the Risk of Getting HIV/AIDS Women and men who had heard of AIDS were asked what they perceived to be their personal risk of contracting HIV/AIDS. They were asked to classify their risk as small, moderate, great, or no risk at all. Table 11.4 presents the distribution of respondents who know about AIDS by perception of risk according to background characteristics. The data reveal that about two-thirds of women and men believe they have no risk at all of getting AIDS. One-quarter of women and 30 percent of men say their chance is small, while only 5 percent of women and 3 percent of men say that they have a moderate chance of getting AIDS and very few think that their chance of getting AIDS is great (3 percent of women and 2 percent of men). Differences in the perceptions of HIV/AIDS risks between subgroups are small; however, the proportion of respondents who consider themselves at no risk of getting AIDS is somewhat higher among the youngest respondents (age 15-19), as well as among those in the Southwest region. It is possible to use the fact that women and men were interviewed separately to link data on currently ma~ied men and their wives living in the same household. Such linking of data allows for a close assessment of couples as units of study. Table 11.5 presents the percent distribution of couples who know about HIV/AIDS by husbands' and wives' perceptionoftheriskofgetting HIV/AIDS. Thetable shows that among couples who have heard of AIDS, 44 percent share the view that they are at no risk of contracting HIV/AIDS. Similarly, in 8 percent of couples, both believe their chance of getting HIV/AIDS is small. Among couples who have differing viewpoints, there is a slight tendency for wives to perceive a somewhat greater risk of becoming infected than their husbands. For example, in 18 percent of couples, the husband says he has no risk at all, but the wife says she feels she has a small chance of becoming infected. This compares with 16 percent of couples in which the wife reports no risk but the husband reports a small risk. Table 11.6 shows the reasons respondents give for perceiving their risk of contracting AIDS as small or nil. Nineteen percent of women and 21 percent of men state that the'tr risk is low or nil because they are abstaining from sex altogether. Women (65 percent) are more likely than men (59 percent) to report that sticking to one pauper or limiting their number of partners is the reason for their low risk, while men (17 percent) are more likely than women (7 percent) to report that condom use is the reason for their low risk of contracting the AIDS virus. Similarly, respondents who said they felt they had a moderate or great risk of getting HIV/AIDS were asked the reasons for their perception. Table 11.7 shows the reasons respondents give for perceiving their risk of contracting AIDS as moderate or great. About 40 percent of women and men believe that they are at moderate or great risk because they have multiple sexual partners. Slightly more than one-quarter of women and men report that they are at moderate or great risk because they do not use condoms. Seventeen percent of women, compared with 8 percent of men, believe they are at moderate or great risk because their spouse has other sexual partners, while one in five men reports that having sex with prostitutes is the reason for believing he is at risk of getting AIDS. The same proportion of women report prostitutes as the source of risk, presumably because their partner frequents prostitutes. Finally, blood transfusions and injections are considered the source of HIV risk for a sizeable proportion of women and men in Nigeria. 149 Table 11.4 Perception of risk of getting I/IV/AIDS Percent distribution of women and of men who have heard of HIVIAIDS by their perception of the risk of getting HI'V/AIDS according to background characteristics, Nigeria 1999 Chances of getting tlIV/AIDS: women Chances of getting HIV/AIDS: men Number Number Background No risk Has Don't of No risk Don~ of characteristic at all Small Moderate Great AIDS know Total women at all Small Moderate Great know Total of men Age 15-19 69.2 24.3 3.7 2.3 0.2 0.5 100.0 1,318 71.6 24.3 2.2 1.3 0.6 100.0 435 20-24 62.6 27.7 4.5 4.2 0.6 0.5 100.0 1,164 61.5 32.7 2.8 2.5 0.4 100.0 299 25-29 63.5 25.1 6.8 3.7 0.7 0.3 100.0 1,144 61.7 33.0 3.5 0.9 0.9 100.0 331 30-39 64.5 26.2 4.8 3.I 0.5 0.8 100.0 1,597 60.7 34.0 3.0 1.5 0.8 100.0 569 40-49 68.5 23.6 4.4 2.9 0.2 0.3 100.0 882 62.6 31.0 3.3 2.0 1.1 100.0 389 50-64 NA NA NA NA NA NA NA NA 68.0 26.6 2.7 1.8 0.9 100.0 376 Marital status Oarrenfly married 64.6 25.4 5.3 3.5 0.6 0.6 100.0 4,007 64.4 29.8 3.1 1.8 0.9 100.0 1,433 Formerly martied 64.4 25.2 7.2 2.4 0.4 0.4 t00.0 257 54.1 39.6 3.5 2.9 0.0 100.0 71 Never married 67.8 25.7 3.3 2.8 0.2 0.3 100.0 1,841 65.1 30.4 2.5 1.3 0.7 100.0 894 Residence Urban 69.4 21.8 4.4 3.1 0.8 0.4 100.0 2,226 64.3 29.6 3.5 2.0 0.6 100.0 783 Rural 63.3 27.6 5.0 3.3 0.2 0.6 100.0 3,880 64.4 30.6 2.6 1.5 0.9 100.0 1,616 Region Northeast 68.3 22.0 7.3 1.0 0.3 1.1 100.0 644 51.4 41.9 3.5 2.3 0.9 100.0 336 Northwest 48.5 42.3 7.8 0.8 0.2 0.3 100.0 515 67.0 28.1 4.1 0.3 0.4 100.0 273 Southeast 61.3 30.1 3.3 4.7 0.1 0.4 100.0 1,710 64.1 31.5 1.6 0.7 2.1 100.0 567 Southwest 76.9 17.7 3.4 1.5 0.1 0.5 100.0 1,767 71.2 21.2 4.1 3.2 0.3 100.0 671 Central 61.4 25.1 6.2 5.3 1.5 0.5 100.0 1,470 62.9 34.2 1.8 0.9 0.2 100.0 551 Education No education 62.4 26.6 6.9 3.0 0.4 0.7 100.0 1,645 63.9 31.9 2.4 1.0 0.9 100.0 485 Primary 66.2 25.9 3.8 3.2 0.3 0.6 100.0 1,601 65.1 28.6 2.6 2.5 1.1 100.0 652 Secondary 67.1 24.7 4.0 3.4 0.5 0.3 100.0 2,358 66.0 28.6 3.3 1.4 0.7 100.0 945 Higher 66.4 24.5 4.9 3.3 0.7 0.2 100.0 501 58.6 36.5 3.0 1.6 0.3 100.0 317 Total 65.5 25.5 4.8 3.2 0.4 0.5 100.0 6,105 64.4 30.3 2.9 1.6 0.8 100.0 2,399 NA = Not applicable Table 11.5 Perception of the risk of getting HIV/AIDS among couples Percent distribution of couples who know about AIDS by husband's and wife's perceptions of the risk of getting HIV/AIDS, Nigeria 1999 Chances of getting HIV/A1DS: husband Chances of getting No risk Don't HI'V/AIDS: wife at all Small Moderate Great know Total No risk at all 44.3 15.8 1.7 1.4 0.3 63.4 Small 17.6 8.2 1.2 0.4 0.2 27.7 Moderate 1.9 3.1 0.2 0.1 0.0 5.3 Great 1.2 1.2 0.0 0.0 0.1 2.5 Has AIDS 0.2 0.4 0.0 0.0 0.0 0.7 Donlknow 0.3 0.0 0.1 0.0 0.0 0.4 Total 65.6 28.7 3.1 1.9 0.6 100.0 Table 11.6 Reasons for perception of small/no risk of getting HIV/AIDS Percentage of women and men who think they have a small or no risk of getting HIV/AIDS, by reasons for that perception of risk and marital status, Nigeria 1999 Has only one Ensure partner/ Spouse No safe Number limits has no Avoids homo- blood No of : Marital Abstains Uses sexual other prosti- sexual trans- injec- women/ !status from sex condom partners partners tutes contact fusion tions Other men WOMEN Never in union 45.2 11.1 42.9 NA 7.3 2.0 15.1 24.0 6.2 1,720 Currentiy in union 4.7 4.9 76.4 NA 13.7 2.9 16.1 23.6 6.7 3,605 Formerly in union 38.4 5.8 45.9 NA 9.4 2.0 14.7 20.5 8.7 231 Total 18.7 6.8 64.8 0.0 11.5 2.6 15.7 23.6 6.6 5,556 MEN Never in union 44.4 25.2 35.4 2.6 18.0 5.0 16.5 20.7 7.1 854 Currentiy in union 5.5 11.5 74.1 11.7 35.3 5.7 18.1 20.0 5.0 1,350 Formerly in union 32.9 31.0 45.7 11.7 36.6 I2.8 24.0 30.3 3.6 67 Total 21.0 17.3 58.7 8.3 28.8 5.6 17.7 20.6 5.8 2,271 NA = Not applicable (no code for the category) Table 11.7 Reasons for perception of moderate/great risk of getting HIV/AIDS Percentage of women and men who think they have a moderate or great risk of getting HIV/AIDS, by reasons for that perception of risk and marital status, Nigeria 1999 Has Spouse Has sex Had Number Doesn't many has with Homo- blood Had of use sex other prosti- sexual trans- injec- women/ Respondents condoms partners partner(s) tutus contact fusion tinns Other men Women 26.2 38.9 17.0 20.2 8.2 23.8 17.3 9.9 491 Men 27.0 43.9 8.3 21.3 1.6 13.7 28.0 18.9 109 Note: Response categories printed on the Woman's Questionnaire were incorrect; however, interviewers were instructed to write in the women's answers, which were subsequently assigned to the above categories. 151 11.4 Behav iour Change NDHS respondents who had heard of H1WAIDS were asked whether or not they had changed their behaviour since they learned of the disease. If they responded positively, they were asked what they did. Tables 11.8.1 and 11.8.2 present the percentage of women and men respectively, who report specific changes in behaviour to avoid HIV/AIDS, according to background characteristics. The tables show that 26 percent of women and 15 percent of men say they have not changed their behaviour since hearing about HIV/AIDS. Women in the Northeast and Southwest regions and men in the Southeast region are less likely to have changed their behaviour than other women and men. Less-educated women are less likely to have changed thdr behaviour since hearing about HIV/AIDS than more-educated women; men differ little by education in their behavioural response to the disease. Table 11.8.1 H IV /A IDS prevention behavinur: women Percentage of women who have heard of H1V/AIDS who report spee'tfic changes in beha,6our in order to avoid HIV/AIDS, according to background characteristics, Nigeria 1999 Change in sexual behaviour to avoid HIV/AIDS Change innon- sexual No Asked No Ensure behaviour change Began Restricted spouse homo- safe Other toavcfld Number Background in sexual Kept Stopped using to one Fewer to be sexual injec- sexual H1V/ of characteristic behaviour virginity sex condoms partner partners faithful contact tions behaviour AIDS women ~ge 15-19 24.1 36.7 4.8 3.8 21.9 2.9 I2.5 0.5 10.2 0.7 30,3 1,318 20-24 20.2 11.0 4.6 8.6 41.9 5.4 24.2 1.1 14.3 0.3 24.8 1,164 25-29 26.7 3.3 3.5 5.6 41.0 4.7 30.0 0.5 13.5 0.5 31.3 1,144 30-39 27.0 0.9 3.8 5.2 40.9 4.7 33.2 0.6 14.3 0.6 32.3 1,597 40-49 30.5 0.3 8.4 1.5 37.0 3.7 29.1 1.0 13.2 0.6 33.9 882 Marital status Currently in union 28.3 0.4 2.3 3.8 41.3 4.6 33.0 0.8 12.5 0.5 33.1 4,007 Formerly in union 27.2 0.4 26.8 3.8 26.1 3.5 17.1 0.2 14.7 0.4 31.5 257 Never married 19.2 35.4 7.1 8.0 27.4 3.7 11.6 0.7 14.1 0.7 24.7 1,841 Residence UrhaJi 25.3 12.5 4.3 7.1 37.1 4.0 26.8 1.1 13.9 0.4 29.3 2,226 Rural 25.7 10.0 5.0 3.9 36.1 4.4 25.3 0.5 12.6 0.6 31.2 3,880 Northeast 51.7 5.0 1.4 2.5 19.0 4.2 19.3 0.8 13.1 1.0 55.7 644 Northwest 15.8 6.1 2.2 3.9 43.3 5.6 26.7 1.4 15.7 0.8 18.1 515 Southeast 18.4 17.0 9.4 4.1 34.9 2.7 20.0 0.2 15.0 0.8 27.0 1,710 Southwest 32.3 10.6 2.3 5.7 38.3 4.9 23.7 1.1 11.1 0.3 35.5 1,767 Central 17.7 8.6 4.8 7.0 41.2 5.0 37,8 0.7 12.5 0.3 21.8 1,470 Education No education 31.9 1.7 4.3 2.4 33.3 4.4 30.4 0.8 8.9 1.0 36.0 1,645 Primary 27.6 7.4 6.0 3.1 37.5 4.3 23.8 0.4 10.8 0.3 32.4 1,601 Secoadary 21.1 20.8 4.4 6.4 36.2 3.8 22.5 0.7 14.6 0.3 26.7 2,358 Higher 18.7 6.0 4.4 13.7 45.2 6.1 33.0 1.7 27.1 0.4 24.0 501 Tolal 25.5 I0.9 4.8 5.1 36.5 4.3 25.8 0.7 13.1 0.5 30.5 6,105 152 Table 11.8.2 HI'V/AIDS prevention behaviour: men Percentage of Men who have heard of HIVIAIDS who report specific changes in behaviour in order to avoid HW/AIDS, according to background chatacterlstics, Nigeria 1999 Change in sexual behaviour to avoid HIV/AIDS Change i n l iOn- No Asked No Avoid Ensure sexual change Began Restricted spouse homo- sex with safe Other behaviour Background in sexual Kept Stopped using to one Fewer to be sexual prosti- injec- sexual to avoid characteristic behaviour virginity sex condoms partner partners faithful contact tutes tions behaviour H1V/AIDS Nttmber of Men Age 15-19 17.9 51.2 8.4 9.6 12.0 6.3 3.6 4.3 10.7 12.1 2.1 2.7 435 20-24 15.0 24.1 6.9 21.9 31.6 12.7 6.8 2.3 14.1 15.3 1.9 0.7 299 25-29 10.5 7.6 4.7 21.8 48.3 17.3 11.3 3.0 23.8 17.9 1.5 1.3 331 30-39 11.0 0.8 2.3 18.1 54.7 16.1 16.2 6.0 32.2 20.5 2.5 0.2 569 40-49 18.0 0.2 2.0 9.0 55.1 12.5 13.7 3.5 27.5 14.5 3.2 1.1 389 50-64 17.8 0.5 6.0 9.0 47.4 15.0 18.4 4.2 23.4 14.6 2.1 0.8 376 Marital status Currently in union 14.3 0.2 2.0 I0.7 55.1 13.7 15.7 4.0 28.6 16.6 2.2 0.7 1,433 Formerly in union 14.3 0.0 18.8 28.8 31.9 24.7 13.9 i 1.5 28.5 20.7 7.6 0.0 71 Never married 15.8 36.3 8.2 19.8 22.1 11.7 5.9 3.9 13.0 14.9 2.0 1.8 894 1.4 1.0 Residence Urban 12.7 15.1 5.7 21.5 41 .g 13.4 12.7 4.6 19.5 19.5 2.5 Rural 15.9 12.9 4.4 11.3 42.2 13.3 11.7 3.9 24.3 14.4 2.1 783 1,616 Total 14.9 13.6 4.8 14.7 42.i 13.3 12.0 4.2 22.8 16.1 2.3 1.1 2,399 Education No education 14.5 6.0 3.7 2.1 39.5 11.9 14.2 5.7 41.5 14.4 3.2 0.7 485 Primary i7. I 9.1 5.9 10.2 45.8 14.1 I0.I 2.8 15.4 8.6 2.0 0.8 652 Secondary 14.3 23.1 5.1 19.0 37.3 11.9 10.2 3.1 17.5 16.6 1.9 1.6 945 Higher 12.6 6.2 3.6 30.0 53.0 18.0 18.0 7.7 24.9 32.3 2.6 1.0 317 Region Northeast I4.2 14.6 3.4 3.5 35.5 5.4 10.9 3.8 41 .g 2I .3 2.0 1.2 336 Northwest 7.1 11.4 1.1 1.4 36.9 6.6 12.2 3.2 47.2 23.1 5.2 0.0 273 Southeast 24.5 11.9 5.7 I0.0 41.9 16.0 5A 0.5 3.5 4.8 2.2 1.1 567 Southwest 13.5 14.4 5.7 22.4 43.7 10.9 11.4 0.9 15.6 18.0 1.9 1.7 671 CenRal 10.8 i5.0 5.7 23.4 47.0 21.6 20.2 12.6 27.5 I8.6 1.5 0.9 551 The most common change in behaviour among both women and men was to restrict sex to one partner (37 percent of women and 42 percent of men). Among women, the next most common response was to ask their partner to be faithful; one-quarter of women gave this answer. Among men, the next most common response was to avoid having sex with prostitutes (23 percent). Only 5 percent of women and 15 percent of men say they began using condoms, while 5 percent of women and men say they stopped having sex. A sizeable proportion of respondents said they responded to the risk of HIV/AIDS by keeping their virginity (I 1 percent of women and 14 percent of men). Expectedly, younger and never-married women and men are more likely than older, ever-married respondents to say they kept their virginity to avoid the risk of contracting HIV/AIDS. 11.5 Knowledge of Condom Use to Protect against Disease Condoms are the only proven barrier method for reducing the risk of all sexually transmitted infections, including HIV. Thus they can be used for dual protection against unintended pregnancy and sexually transmitted diseases. Because of the important role condom use plays in preventing HIV transmission, respondents were asked whether they had heard of using Table 11.9 Knowledge of condom use to protect against HIV/AIDS and 8TIs Among women and men who have heard of HIV/A1DS and who have ever had sexual intercourse, percentage who know condoms are used to prevent HIV/AIDS and STIs, by background characteristics, Nigeria I999 Women Men Percentage Percentage knowing knowing condoms condoms can prevent Number can prevent Ntunber Background ttW/AIDS of HIV/A1DS of characteristic and STIs women and gTIs men Age 15-19 65.0 511 93.3 130 20-24 75.4 960 91.0 195 25-29 74.8 1,089 87.2 293 30-39 71.9 1,581 84.9 562 40-49 57.7 879 77.9 388 50-64 NA NA 70.7 376 Marital status Currently in union 66.8 4,004 77.8 1,433 Formerly in union 66.5 257 80.5 71 Nevar married 88.1 759 97.3 438 Residence Urban 81.7 1,799 93.3 620 Rural 63.5 3,221 77.1 1,322 Region Northeast 36.4 584 64.3 266 Northwest 54.3 487 52.8 238 Southeast 77.5 1,303 89.2 460 Southwest 84.0 1,432 92.0 538 Central 68.0 1,215 89.9 441 Education No education 42.3 1,609 52.8 444 Primary 71.4 1,383 81.7 564 Secondary 89.2 1,587 95.9 643 Higher 97.8 440 98.2 291 Total 70.0 5,020 82.3 1,943 NA = Not applicable condoms to avoid getting AIDS or other sexually transmitted diseases. Table 11.9 presents the percentage of respondents who answered affirmatively, according to background characteristics. Data are restricted to those who have heard of HIV/AIDS and who have ever had sexual intercourse. Seventy percent of women and 82 percent of men know of the disease prevention capabilities of condoms. Knowledge about condoms is more widespread among urban respondents than among their rural counterparts. The percentage of respondents who know that condoms can be used to prevent sexually transmitted diseases increases with level of education. Knowledge about condoms is more widespread among the never-married than among the currently and formerly married respondents. The data also indicate a significant difference between knowledge of condoms among men and women. For example, it is notable that among young people age 15-19 years who have ever had sex and who have heard of AIDS, knowledge of the disease prevention capabilities of condoms is nigh, especially for men (65 percent for women and 93 percent for men). 154 11.6 Use of Condoms As shown in Tables 11.10.1 and 11.10.2, 12 percent of women and 31 percent of men who have heard of HIV/AIDS and who have had sex in the 12 months before to the survey report that they have ever used a condom for family planning purposes. Similarly, 15 percent of women and 32 percent of men have used condoms to prevent getting sexually transmitted diseases. Twenty percent of women and 38 percent of men have ever used condoms for either family planning or disease prevention reasons. However, only 7 percent of women and 15 percent of men had used a condom the last time they had had sex. Among both women and men, condom use peaks at age 20-24 years and decreases thereafter, regardless of whether condoms were used for family planning or disease prevention reasons or whether they were used during the last sexual intercourse. Condom use is considerably higher among those who have never married than among those who were formerly married and those who are currently married. It is also higher in urban than in rural areas and rises steeply with education of respondent. , , , , , , , Table 11.10.1 Use of condoms: women Among women who have heard of HIV/AIDS and who have had sexual intercourse in the 12 months preceding the survey, percentage who ever used a condom for family phnning or to avoid ST/s and percentage who used a condom during hst sexual intercourse, according to background characteristics, Nigeria I999 Ever used condom Used a condom For To during Number Background family avoid last sexual of characteristic planning STI8 Either intercourse women Age 15-19 12.7 18.3 21.8 10.3 460 20-24 16.7 21.9 27.3 9.5 859 25-29 13.3 16.3 23.5 5.7 987 30-39 10.9 12.7 18.9 5.9 1,390 40-49 4.9 5.5 8.8 2.3 633 Marital status Current/y in union 8.3 10.0 15.6 3.4 3,568 Formerly in union 14.6 22.9 27.7 12.3 120 Never married 31.4 40.5 45.8 22.8 642 Residence Urban 15.6 19.1 26.3 8.3 1,569 Rural 9.8 12.5 I7.1 5.5 2,760 Education No education 2.1 5.0 6.2 1.6 1,353 Primary 8.5 10.6 15.0 4.2 1,145 Secondary 17.4 21.5 29.9 10.3 1,428 Higher 35.2 36.9 50.2 I6.1 403 Total 11.9 14.9 20.4 6.5 4,329 STI = Sexually transmitted infection 155 Table 11.10.2 Use of condoms: men Among men who have heard of Ill'V/AIDS and who have had sexual intercourse in the 12 months preceding the survey, percentage who ever used a condom fol" family planning or to avoid STIs and percentage who used a condom during last sexual intercourse, according to background characteristics, Nigeria 1999 Ever used condom Used a condom For To during Number Background family avoid last sexual of characteristic planning STDs Either intercourse men Age 15-19 42.5 47.8 51.8 26.5 108 20-24 50.4 52.3 57.8 38.3 175 25-29 40.4 40.8 46.7 21.3 267 30-39 29.9 34.2 39.9 10.8 503 40-49 22.1 20.2 25.8 6.3 347 50-54 19.4 17.7 24.1 8.5 330 Marital status Currently in union 21.9 22.3 28.1 6.8 1,302 Formerly in union 55.0 52.1 59.0 32.9 48 Never married 58.2 62.5 67.6 40.0 381 Residence Urban 47.4 47.6 55.6 22.6 548 Rural 23.1 24.7 29.3 11.2 1,182 Education No education 5.8 7.0 9.1 2.7 388 Primary 22.4 23.1 29.0 10.3 495 Secondary 43.7 46.2 52.4 22.0 576 Higher 54.5 53.7 63.0 25.4 271 Total 30.8 32.0 37.7 14.8 1,730 STI = Sexually transmitted infection 11.7 Payment for Sexual Relations Among respondents who have ever had sexual intercourse, Table 11.11 shows the percentage of women and men who gave or received money, gifts, or favours in return for sex in the past 12 months according to marital status and background characteristics. Overall, 6 percent of women and 11 percent of men report having such an exchange. Unmarried respondents (both women and men) are much more likely than married respondents to have exchanged goods or favours for sex. For example, less than 2 percent of currently married women say they received money, gifts, or favours in return for sex during the previous year, compared with 24 percent ofunmarried women. Similarly, 7 percent of currently marriedmen gaveor received money, gifts, or favours for sex during the previous 12 months, comapred with 24 percent of unmarried men. Urban unmarried women and men are less likely to give or receive money, gifts, or favours than their rural counterparts. 156 Table 11.11 Paymant for sexualrelations Among women and men who have ever had sexual intercourse, the percentage who gave or received money, gifts, or favours in return for sex in the last 12 months, by marital status and background characteristics, Nigeria I999 Women Men Currently Not currently Currently Not cturently married married Total marded marded Total Backgroulld characteristic Percent Number Percent Number Percent Number Percent Number Percent Number percent Number Age 15-19 1.1 464 32.0 301 13.3 765 * 12 28.4 125 27.3 137 20-24 2.1 934 25.8 344 8.5 1,278 4.6 46 20.I 159 16.6 205 25-29 1.8 1,272 26.1 183 4.9 1,455 9.0 202 20.9 120 13.4 322 30-39 2.0 1,955 22.5 157 3.5 2,112 8.8 532 32.5 82 11.9 613 4049 1.3 1,122 4.9 140 1.7 1,262 6.4 413 24.0 22 7.3 435 50-54 NA NA NA NA NA NA 5.1 406 11.0 19 5.4 425 Residence Urban 1.9 1,668 14.1 377 4.1 2,044 8.3 460 22.0 186 12.3 646 Rural 1.7 4,079 29.6 749 6.1 4,828 6.7 1,152 25.1 339 10.9 1,491 Education No education 0.8 3,024 10.0 188 1.3 3,213 3.7 545 21.3 43 5.0 588 Primary 2.7 1,298 24.6 263 6.4 1,561 7.0 476 27.0 123 11.1 599 Secondary 3.2 1,122 30.6 531 12.0 1,653 8.7 373 24.0 281 15.2 654 Higher 2.9 303 20.3 142 8A 445 13.9 217 20.9 79 15.8 295 Total 1.8 5,747 24.4 1,125 5.5 6,872 7.2 1,612 24.0 525 11.3 2,137 Note: An asterisk indicates that the figure is based on less than 25 uaweighted ~ and has been suppressed. NA = Not applicable 11.8 Awareness o f Sexua l ly T ransmi t ted D iseases All respondents were asked whether they had heard about diseases that can be transmitted through sexual intercourse and, if so, which specificfliseases they knew. Table 11.12 presents the percentage of women and men who have heard of s~J f i c sexually transmitted infections by various background characteristics. Knowledge of sexually transmitted infections is nearly universal among men, with only 9 percent not having heard of at least one such disease. Knowledge of sexually transmitted infections is much lower among women, one-third of whom do not know of any such disease. The most widely known sexually lransmitted disease reported by women is AIDS (62 percent), while gonorrhoea (83 percent) is the most widely known for the men? Although gonorrhoea is the next most widely known sexually transmitted infection among women (43 percent), AIDS is next among men (78 percent). Far fewer women and men mentioned syphilis or genital warts as being sexually transmitted diseases. 1 The proportion of respondents who have heard of HIV/AIDS is based on spontaneous mention of the disease. It differs from the data presented in Table 11.1, which is based on responses to a specific question on whether the respondent had ever heard of AIDS ("prompted knowledge"). 157 Oo Tableau 11.12 Knowledge of sexually ~rensmitted infections Percentage of women and men who have heard of specific sexually transmitted infections (STI), by background characteristics, Nigeria 1999 Won'en Men No Number No Number Background Gonor- I/IV/ Genital knowledge of Gonor- HIV/ Genital ~aowledge of characteristic Syphilis rhoea AIDS warts Other of STIs women Syphilis rhoea AIDS warts Other of STIs men Age 15-19 6.5 32.0 58.9 1.1 1.4 37.5 1,775 15.6 61.4 69.2 1.3 1.1 19.4 511 20-24 14.4 47.5 65.6 2.2 1.1 30.8 1,521 26.6 87.4 84.5 4.2 1.6 4.3 319 25-29 16.6 48.4 63.9 2.7 1.5 30.5 1,516 37.9 89.4 84.0 7.1 3.1 6.2 366 30-39 14.3 46.6 62.9 2.5 1.4 32.4 2,129 41.5 89.1 82.4 7.4 2.3 5.6 623 40-49 9.1 40.6 57.1 2.6 1.2 36.4 1,265 35.2 87.6 78.9 7.7 5.3 5.6 436 50-64 NA NA NA NA NA NA NA 28.5 85.3 72.0 7.9 4.7 8.5 425 Marital status Currently in union 11.0 41.1 57.9 1.9 1.1 37.3 5,757 33.3 87.1 78.1 7.5 3.7 7.0 1,612 Formerly in union 17.5 52.5 65.3 4.8 2.5 25.8 319 42.4 91.5 69.4 14.6 2.6 6.2 81 Never married 14.9 46.9 72.0 2.5 1.7 24.2 2,130 26.8 75.1 78.9 2.8 1.7 11.4 988 Sexually active 27.1 68.4 81.6 4.6 3.2 13.1 807 41.7 93.3 89.4 4.4 2.3 0.9 445 Sexually inactive 7.5 33.8 66.1 1.2 0.7 30.9 1,323 14.7 60.2 70.2 1.5 1.2 20.1 543 Residence Urban 17.4 55.3 75.8 3.1 0.9 20.2 2,540 36.9 87.5 86.2 6.7 3.2 4.4 821 Rural 10.0 37.5 55.6 1.7 1.5 39.4 5,666 28.7 80.7 74.5 5.6 2.8 10.5 1,859 Region Northeast 7.9 16.2 34.0 0.5 0.0 63.5 1,292 43.0 73.3 66.2 7.7 1.1 20.1 437 Northwest 6.8 26.9 41.5 1.9 0.2 56.4 1,087 25.2 82.2 73.4 11.6 0.6 13.4 356 Southeast 19.8 53.6 72.5 3.4 4.0 19.7 1,886 42.1 84.2 75.7 4.0 5.1 5.3 590 Southwest 11.2 51.8 71.7 2.3 1.2 22.7 2,080 19.6 85.6 85.5 1.0 4.2 3.7 696 Central 11.9 50.5 71.2 2.1 0.4 25.1 1,861 29.0 85.6 83.4 9.0 2.1 6.5 601 Education No education 3.6 22.1 38.5 0.6 0.4 57.0 3,324 22.8 74.7 59.9 8.3 3.1 18.1 663 primary 9.6 47.4 69.1 1.7 2.0 24.3 1,868 23.9 83.6 76.1 3.5 3.6 7.8 710 Secondary 16.2 59.1 80.9 2.3 1.7 15.1 2,506 29.2 82.8 86.2 3.7 2.2 5.4 986 Higher 59.0 84.8 93.8 13.3 3.1 3.1 508 71.1 97.8 95.4 13.4 3.4 0.9 321 Total 12.3 43.0 61.8 2.2 1.3 33.5 8,206 31.2 82.8 78.1 6.0 2.9 8.6 2,680 NA = Not applicable Both women and men are less likely to be informed about sexually transmitted diseases if they are younger (15-19 years) or older (50-64 years), if they are currently in union, and if they have never had sex. Knowledge of sexually transmitted diseases is higher among urban than among rural respondents. The percentage of women and men who cannot name any sexually transmitted infection is considerably higher in the north than in the south, being highest in the Northeast region and lowest in the Southeast region for women and the Southwest region for men. Knowledge of sexually transmitted diseases is positively associated with increase in level of education. 11.9 Prevalence of Sexually Transmitted Diseases Respondents were asked whether they had had any sexually transmitted disease in the previous 12 months and if so, which one and what action (if any) was taken in response to the most recent episode. Less than 1 percent of women and only 4 percent of men reported having any such disease in the 12 months before the survey (data not shown). These figures are likely to be underestimates of the true prevalence of sexually transmitted infections for two reasons. First, many sexually transmitted diseases may go unrecognised because they produce no obvious symptoms, no health care was sought, or the problem was misdiagnosed or misunderstood by the respondent when diagnosed. Second, many women and men fail to report a recent sexually transmitted disease because of the social stigma. Because of the small numbers of respondents who reported having had sexually transmitted infections, detailed analysis is impossible. However, gonorrhoea accounted for more infections than any of the other diseases. Most of the respondents (84 percent of women and 82 percent of men) who had a sexually transmitted disease in the previous year reported that they sought treatment for it. Women were more likely than men to inform their partners of the disease (67 versus 49 percent). Among infected men, 31 percent reported that they avoided sex, 30 percent said they took some kind of medicine, and 3 percent reported using condoms to prevent spreading the infection to their partners. One- third of women and men took no measures to protect their partners, although sometimes this was because their partners were already infected (data not shown). 159 CHAPTER 12 AVAILABILITY OF HEALTH AND FAMILY PLANNING SERVICES 12.1 Introduction Use of family planning and health services is determined by supply as well as demand. The 1999 NDHS fielded a Service Availability Questionnaire (reproduced in Appendix E) to provide a picture of the health care service environment that prevails in Nigeria. This is important because inaccessibility to and lack of availability of health and family planning services are some of the reasons for the low contraceptive prevalence rate, high maternal and infant mortality rates and high incidence of sexually transmitted diseases including HIV/AIDS. The questionnaire on service availability solicits information on the services that are available and nearest to a majority of the people in the community. It was administered at the community level (enumeration area) by interviewing knowledgeable informants in the selected community. It included the state and local government area identifiers, community characteristics such as the size of the sampled community (large town, other town or village), general services such as post office and bank, as well as health and family planning service providers. Respondents were asked to identify the nearest of each of the following types of facilities that offer health and family planning services: private doctors; pharmacies/patent medicine stores; health centres/posts; clinics/hospitals; family planning clinics; and malmml and child health centres. 12.2 Organisation of Health and Family Planning Services The objective of the national health policy is to "achieve health for all Nigerians based on the national philosophy of social justice and equity" (Ransome Kuti et al., 1989; FOS 1990). The emphasis in health care delivery for the entire country is on the provision and expansion of primary health care. The prevention of premature deaths and illnesses among high-risk mothers and children is an essential aspect of the health delivery system. States of the Federation are free to determine how to achieve this goal, hence there are diverse policy implementation strategies for health and family planning services in the country. There is active involvement of both the private and public sectors in the establishment of appropriate structures to coordinate and facilitate the interaction of the three tiers of government for successful policy implementation. Nigeria has three levels of administration in its health care provision system federai, state and local government area (LGA). Policies and guidelines on health and family planning matters are set at the federal level by the Federal Government while policies for service provision are determined at the state level. The actual implementation and provision of care is handled at the LGA level. The organisatJon of stationary health facilities is structure.d on a three-iler system. The primary level consists of health centres/clinics (as well as outreach services) provided by LGAs that provide maternal and child health care, preventive care, and basic curative care. The secondary level, which is based at the state level, is largely composed of district hospitals that provide curative and some preventive services. The tertiary level encompasses teaching hospitals, which are under the control of the Federal Government. Some communities---especially in large towns and cities--are well served by the three types of facilities. However, general success in making health and family planning services easily accessible and available in Nigeria is 161 still limited. More than a decade after adoption of the national health policy, the time required to obtain such services and the cost of providing family planning services to a large population of reproductive age, is of great concern to the government. 12.3 Community Characteristics As shown in Table 12.1, most households in Nigeria are located in or near urban areas and overall, 47 percent are within 15 kilometres of a town. In the Southwest region, which is more urbanised than other regions, 75 percent of households are located within 15 kilometres of a town. Looking at rural households, about one in four is within 15 kilometres of a town. Table 12.1 Distance to urban areas Percent distribution of households by distance to nearest town, according to region and urban-ruralresidence, Nigeria 1999 Reginn Residence Distal.ace to North- North- South- South- nearest town (kin) east west east west Central Urban Rural Total <15 45.6 40.4 32.8 75.0 31.5 100.0 23.6 46.7 15-29 14.6 22.1 22.5 9.8 14.1 0.0 23.1 16.1 30+ 18.6 28.2 24.4 7.1 30.1 0.0 29.6 20.6 Don't know/missing 21.3 9.3 20.4 8.1 24.3 0.0 23.7 16.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 1,211 1,075 1.814 2,002 1,546 2,313 5,334 7,647 Table 12.2 presents data on the main access route between rural communities and towns. All- weather roads are the primary means of access to cities and towns in Nigeria (46 percent), although one-third of rural communities are accessible by seasonal roads only. Distance from the nearest town makes little difference in the type of access road to the rural community. Table 12.2 Main access route to rural communities Percent distribution of rtucal households by main access route to nearest town, according to distance to town, Nigeria 1999 Main access route to town All Don't Number Distance to weather Seasonal River/ know/ of urban area (kin) road road rail Path Missing Total households <15 55.7 40.0 0.0 4.3 0.0 100.0 1,257 15-29 53.8 42.8 1.9 1.4 0.0 100.0 1,235 30+ 55.7 41.5 0.6 2.1 0.0 100.0 1,578 Don't know/missing 14.7 6.0 0.0 0.0 79.4 100.0 1,264 Total 45.5 33.1 0.6 2.0 18.8 100.0 5,334 As shown in Table 12.3, the vast majority of rural households use motorised transportation to get to towns (72 percent). Other means of transportaion include cycling (4 percent) and walking (4 percent), Walking is more common for households located within 15 kilometres of a town (10 percent) than for those more distant (1-3 percent). 162 Table 12.3 Transportation tonearest town Percent distribution of rural households by most commonly used type of transportation to nearest town, according to distance to town, Nigeria 1999 Type of transportation to nearest town Don~t Number Distance to know/ of nearest town (kin) Motorized Anhnal WaUdng Cycling Other Missing Total households <15 81.4 1.4 9.8 6.9 0.6 0.0 100.0 1,257 15-29 92.1 0.0 1.4 4.6 1.9 0.0 I00.0 1,235 30+ 93.7 1.0 2.6 2.6 0.0 0.0 100.0 1,578 Don't know/missing 17.5 0.0 1.4 1.9 0.0 79.2 100.0 1,264 Total 72.4 0.6 3.7 3.9 0.6 18.8 100.0 5,334 Table 12.4 shows the distance of Nigerian households from various services. Primary schools are very common in Nigeria. Four out of five households lives with/n one kilometre of a primary school and all but a fraction live within 10 kilometres of a primary school. Secondary schools are somewhat less common, with only about half of households living within one kilometre of a secondary school. Two-thirds of households are within less than 10 kilometres of a post office, while almost 90 percent are within 10 kilometres of a local market. Cinemas are less common, since only 37 percent of households are within 10 kilometres of a movie theatre and there is no known cinema in areas where 17 percent of households live. Three in five households live within 10 kilometres of a bank, while 85 percent of households are within 10 kilometres of public transportation. Almost four in five household (78 percent) are within 10 kilometres of some kind of health facility. Distance to health services is explored in greater detail in the remainder of this chapter. Table 12.4 Distance to various services Percent distribution of households by distance (kilometres) to various services, Nigeria 1999 Services Health Distance to Primary Secondary Post Local centre/ Public service (km) school school office market Cinema Bank hospital transport <1 81.1 53.3 36.4 61.7 21.7 36.9 52.3 67.3 1-4 13.0 18.6 16.4 17.2 8.1 16.3 18.0 10.4 5-9 3.1 9.9 13.5 8.1 7.6 7.7 7.2 7.3 10-14 0.7 6.0 5.8 5.0 4.6 5.8 5.8 2.1 15-29 0.5 4.7 12.5 3.8 14.4 12.5 8.0 4.9 30+ 0.2 3.4 9.8 1.3 26.9 13.9 4.7 2.6 Don't know/missing 0.1 0.7 1.4 0.1 10.5 2.2 1.0 1.9 Total 98.6 96.6 95.7 97.1 93.7 95.2 97.0 96.6 Number of households 7,647 7,647 7,647 7,647 7,647 7,647 7,647 7,647 12.4 Distance and Time to Health Services Table 12.5 shows the distribution of households by distance to nearest health facilities (kilometres) (top panel) and time (bottom panel) to nearest health facilities (minutes). As expected, health centres and clinics are the closest health care facilities, with 68 percent of households residing within 10 kilometres of a health centre and 54 percent within I0 kilometres of a clinic. Hospitals are more distant; however, almost 163 half (45 percent) of households are within 10 kilometres of a hospital. When any of these three types of health care facilities are taken into account, 81 percent of households are within I0 ldlometres of one of the three. Looking at the private sector, half of households are within 10 kilometres of a private doctor and two- thirds are within 10 kilometres of a pharmacy. In terms of time taken to reach health facilities, 59 percent of households are within 30 minutes of a health centre or a pharmacy, while 48 percent are within 30 minutes of a clinic, 42 percent are within 30 minutes of a hospital, and 45 percent are within 30 minutes of a private doctor. The median number of minutes required to reach facilities should be viewed with caution, since many respondents round the time to the nearest 5, 10 or 15 minutes. However, the median time to facilities follows the same general pattern as distance to facilities, with pharmacies and health centres being closer than hospitals. Table 12.5 Distance to health facilities by type Percent distribution of households by distance (kilometres) and time (minutes) to nearest health facility, private doctor, or pharmacy, according to type, Nigeria 1999 Distance and time Health facility Any of the Health three Private centre Clinic Hospital facilities doctor pharmacy DISTANCE (KILOMETRES) <1 38.1 34.7 17.7 53.0 30.6 43.5 1-4 22.5 15.5 I7.0 19.9 15.4 16.5 5-9 7.1 3.4 10.2 8.4 4.5 5.7 10-14 6.9 1.9 8.3 3.9 3.9 3.8 15-29 5.1 3.7 15.1 3.2 6.5 3.0 30+ 2.4 2.4 13.3 1.8 3.9 3.2 Don't know/missing 1.0 1.0 0.6 0.4 0.8 0.8 No facility 17.0 37.3 17.9 9.4 34.4 23.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 7,647 7,647 7,647 7,647 7,647 7,647 TIME (MrNLrrES) <15 38.1 34.1 23.7 52.0 29.4 44.3 15-29 20.8 13.9 18.3 18.2 15.4 14.5 30-59 10.4 7.2 17.7 7.9 I0.8 7.7 60-119 9.3 5.1 10.8 8.5 6.3 6.6 120+ 4.2 1.5 10.9 3.6 3.1 2.9 Don~t know/Missing 0.2 0.7 0.8 0.4 0.6 0.6 No facility 17.0 37.3 17.9 9.4 34.4 23.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 7,647 7,647 7,647 7,647 7,647 7,647 Median time 15.3 10.8 25.6 10.6 15.5 10.6 Table 12.6 presents data on distance to the closest health facility (health centre, clinic, or hospital) by region. The data indicate that households in the southern part of the country are generally closer to health facilities than those in the other regions, although the Central region has the highest proportion of households within 1 kilometre of a facility. The proportion of households residing within 10 kilometres of a health centre, clinic, or hospital is 88 percent in the Southwest region and 87 in the Southeast region, compared with 82 percent in the Central region, 73 in the Northeast region, and 67 percent in the Northwest region. 164 Table 12.6 Distance to health facility by region Percent distribution of households by distance (ldlometres) and thne acccording to region, Nigeria 1999 (minutes) to nearest facility, Re#on DistaJace and North- North- South- South- time east west east west Central Total DISTANCE (KILOMETRES) <1 51.2 45.2 35.7 58.4 73.3 53.0 1-4 15.2 12.9 37.4 22.5 4.5 19.9 5-9 6.5 9.0 13.8 7.5 4.4 8.4 10-14 3.8 8.0 4.3 2.1 3.1 3.9 15-29 2.1 7.0 4.6 3.1 0.0 3.2 30+ 0.0 5.5 0.0 2.6 1.5 1.8 Don't know/missing 0.0 1.4 0.0 0.7 0.0 0.4 No facility 21.2 I1.0 4.3 3.1 13.2 9.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 1,211 1,075 1,814 2,002 1,546 7,647 TIME (MINIrmS) <15 47.6 51.3 29.0 65.2 65.8 52.0 15-29 17.9 12.4 25.3 19.4 12.5 18.2 30-59 8.4 10.5 11.7 6.1 3.7 7.9 60-119 3.8 12.1 21.0 4.8 0.0 8.5 120+ 1.1 1.3 8.6 0.7 4.9 3.6 Don't know/Misslng 0.0 1.4 0.0 0.7 0.0 0.4 No facility 21.2 11.0 4.3 3.1 13.2 9.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 1,211 1,075 1,814 2,002 1,546 7,647 Median time 10.6 10.6 20.6 8.0 10.2 10.6 The distribution of households by the amount of time required to reach the nearest health facility generally follows the distribution for distance. One exception is that households in the Southeast region appear to require the longest amount of time to reach a facility. Since respondents were asked to report time to reach the nearest facility using the most conunon means of transport to get there, it is possible that more people in the Southeast region walk or use a slower means of transport, compared with people in communities located further from the nearest facility. Table 12.7 shows the distribution of households by distance and time to the nearest facility providing specific kinds of services, namely, delivery care, childhood immunisations and family planning services. There appears to be little difference in distance or time to specific services. In other words, it seems that the nearest facility usually provides all three of these services. This no doubt reflects a policy of integration of services so that people do not need to go to one facility for family planning and another for child inununisations. 165 Table 12.7 Distance to specific health services Percent distribution of households by distance (kilometres) and time (minutes) to nearest facility providing specific services, Nigeria 1999 Health service Child Family Distance and Delivery immuffx- planning time care sations service Total DISTANCE (KILOMETRES) <1 48.4 51.9 52.5 53.0 1-4 19.4 17.4 16.4 19.9 5-9 8.3 7.4 6.5 8.4 10-14 3.8 6.1 3.3 3.9 15-29 4.9 3.3 4.8 3.2 30+ 3.4 3.7 3.1 1.8 Don't know/missing 0.0 0.2 0.2 0.4 No facility 11.8 10.0 13.3 9.4 Total I00.0 100.0 100.0 100.0 Number of households 7,647 7,647 7,647 7,647 TIME (M~rtYrEs) <15 47.9 50.8 52.3 52.0 15-29 18.0 17.4 12.9 I8.2 30-59 8.5 8.5 I0.3 7.9 60-119 9.0 8.4 5.9 8.5 120+ 4.8 4.8 5.2 3.6 Don't know/Missing 0.0 0.0 0.0 0.4 No facility 11.8 10.0 13.3 9.4 Total 100.0 100.0 I00.0 100.0 Number of households 7,647 7,647 7,647 7,647 Median time 10.8 10.7 10.5 10.6 12.5 Contraceptive Use by Distance to Services Family planning programme managers often debate whether physical availability of services affects the level of use. Table 12.8 shows the distribution of married women by whether they are using a modern method, a traditional method, or no method, according to distance to the nearest facility providing family planning services. It is apparent that the level of use of modern methods is highest among women who live closest to family planning services, dropping from 12 percent among women who live within 1 kilometre of a family planning service to 3 percent among those living 15 kilometres or more from a source of family planning. From this analysis it is not possible to say whether the availability of services causes contraceptive prevalence rates to be higher among women living closer to facilities providing family planning services or higher rates among those women are a function of an urban lifestyle or some other factor. That use of traditional methods of family planning is also generally higher among women who live closer to a source of family planning services indicates that factors other than proximity to services have an affect, since traditional methods such as periodic abstinence, withdrawal, and herbs, do not require health facilities. 166 Table 12.8 Contraceptive use and distance to faroilv l)lannin~ services Percent distribution of currently manied women by contraceptive use, according to distance (kiloroetres) to nearest facility providing family planning (PP) services, Nigeria 1999 Contraceptive method currently used Not using Number Distance to Modem Traditional FP of FP services method method method Total women <1 12.4 7.9 79.7 100.0 2,954 1-4 6.7 9.4 83.9 100.0 809 5-14 4.4 5.6 90.0 100.0 613 15+ 2.6 3.9 93.4 100.0 502 Don't know/misslng 10.0 10.0 80.0 100.0 10 No fac'dity 3.2 2.7 94.0 100.0 920 Total 8.5 6.7 84.8 100.0 5,808 167 CHAPTER 13 POLICY IMPLICATIONS OF THE NDHS DATA 13.1 Introduction Policy formulation and implementation are often data-driven. Data enrich the goals and objectives of policies, the targets to be achieved and strategies for achieving such targets. Policies are often revised to respond to problems raised by data. The generation of a new set of data therefore has policy implications that may take either of two directions: The data might call for the introduction of a new policy with a set of goals and objectives that would address issues raised. • The data might require changing strategies and setting new targets. The 1999 Nigeria Demographic and Health Survey generated a large amount of data on the social and health status of the population. These include data on fertility, childhood mortality, reproductive health, child health, nutrition, family planning, HIV/AIDS and other sexually transmitted diseases, female circumcision, etc. Being the first such data to be generated in recent times, the NDHS data have potentially extensive implications for policy. Basically, the demographic, health and social issues raised by the NDHS data are not substantially different from issues that had been of central concern to past population intervention programmes. The problems of high fertility, lack of adequate maternal and child health care, early marriage, low nutritional status, low usage of contraceptive methods had been well articulated in the past and these concerns had led to the adoption of the National Policy on Population and Development by the Federal Government in 1988. As stated in Chapter 1, the four main goals of the policy are to improve the standard of living of people in part by preventing premature death and illness, as well as to reduce fertility by increasing contraceptive use and to achieve a more even urban-rural distribution of the population. A number of policy objectives that would achieve these goals were set. It is useful to review the goals and objectives of the National Population Policy in light of the NDHS data. 13.2 Assessing the Goals of the National Population Policy (NPP) NDHS data indicate some progress in achieving the goals of the NPP. Although the levels of childhood mortality measured in the NDHS are most probably underestimates, thus artifically amplifying the decline in mortality, there has almost certainly been at least a modest decline in childhood mortality over the past decade. NDHS data do not shed much light on what might be contributing to the decline. According to survey findings, there has been no improvement in the nutritional status of children as measured by height and weight. More distressing is that the proportion of one-year-old children vaccinated against the major childhood diseases has declined from 30 percent in 1990 to a shockingly low 17 percent in 1999. In addition, survey data do not show large declines in the percentage of children under five who were ill with fever, respiratory infections, or diarrhoea, although it appears that children are increasing likely to be taken to a health facility when ill and those with diarrhoea are now more likely to be treated with oral rehydration therapy. In short, there is much room for further action. 169 With regard to the NPP's fertility-related goals, survey data show evidence of a gradual decline in the total fertility rate from about 6.0 in thelate 1980s to about 5.2 in the mid-1990s. Given the NPP's focus oa reducing adolescent fertility, it is particularly encouraging that the decline in fertility has been steeper than average for women 15-19. Nevertheless, NDHS data indicate that challenges still remain. For example, the NPP posited to reduce pregnancies to women below 18 years and above 35 years by 50 percent by 1995 and 90 percent by the year 2000. Again, NDHS data show some progress, with the proportion of 20- to 24- year-old women who gave birth to a child before age 18 declining from 35 percent in 1990 to 28 percent in 1999. However, this is still a relatively high level. Moreover, NDHS data show that 30 percent of 18-year- olds and 26 percent of 17-year-olds have either given birth or are pregnant with their first child, indicating that teenage pregnancy rates are still high. The NPP also hoped to reduce the proportion of women who get married before the age of 18 years by 50 percent in 1995 and by 80 percent by the year 2000. Once again, it appears that there has been progress, albeit modest. The proportion of women age 20-24 who have married by age 18 has declined from 52 percent in 1990 to 40 percent in 1999. Over the same period, the median age at marriage among these women has increased by about two years, from 17.8 to 19.6. Still, it is doubtful that the NPP targets have been met. Other areas of improvement include knowledge and use of contraceptive methods. The proportion of married women who have heard of contraceptive methods has increased dramatically since 1990 and is now higher for every method mentioned, perhaps as a result of more widespread exposure to family planning messages on the radio and television. Contraceptive use has increased from only 6 percent of married women to 16 percent in 1999. Despite these areas of progress, change has been modest and gradual. Consequently, by and large, the targets of the National Population Policy remain unmet. In addition, health problems that were not envisaged to be of great concern in the NPP have assumed dangerous proportions. These include the increasing prevalence of HIV/AIDs and the continuing practice of female genital cutting which was not specifically addressed in the NPP but which data from NDHS indicate is not uncommon. The non-attainment of targets set by the NPP and the emergence of new problems call for policy review not in terms of setting new goals and objectives but in terms of designing new strategies to realise the goals of the NPP. What should be the main thrust of the review of the NPP as reflected by the NDHS ? What new goals and objectives should be set? What new strategies should be adopted? In the light of the NDHS data, the goals and objectives of the NPP are still relevant. What is therefore required is a more aggressive implementation of the policy in addition to devising strategies that would make its targets more feasible and attainable. The policy implications of the NDHS can be divided into specific and general policies. While the specific policies seek to directly redress the demographic and health problems raised by the NDHS data, the general policies seek to effect major changes that would create a conducive atmosphere for solving demographical and health problems raised by the NDHS data. The contents of the policy implications are outlined below: Specific Policy Implications of the NDHS Data These are strategies that would help to achieve the targets set out in the NPP: i) Provision of adequate health care facilities in the urban and rural areas and at a cost affordable to the majority of Nigerians. These facilities would help reduce mortality 170 particularly among infants and mothers by reducing the burden of childhood diseases as well as ensuring adequate antenatal, postnatal and emergency obstetrical care. The introduction of the National Health Insurance scheme should also be pursued vigorously. ii) Facilitate access to family planning services. Though the NDHS data show noticeable improvement in contraceptive knowledge, use of methods is still low. Efforts should concentrate in the Northwest, where tmmet need is higher and knowledge of methods lower, iii) More aggressive promotion of Family Life Education and propagation of the values of small family size. NDHS data show that Nigerian couples still want many children. About 66 percent of women and 71 percent of men desire more children. The mean ideal family size is 6.2 children for women and 7.8 for men. iv) Integration of traditional birth attendants and health practitioners into the modern health care system. The traditional sector meets a large proportion of the health need of the populace particularly in the rural areas and are also agents of questionable health practices. A substantial proportion of female circumcisions are carried out by birth attendants. Proper orientation of the traditional health sectors on the principles of modern health care would help to reduce the incidence of harmful health practices. v) Appropriate and feasible incentives and legislation for fertility regulation should be put in place. vi) In view of the increasing prevalence of HIV/AIDS cases, there is need to step up the AIDS awareness campaign, particularly among those in rural areas where awareness is low. vii) The proposed bill in the National Assembly to legislate against female circumcision should be pursued with vigor to its enactment. General Policy Implications of the NDHS Data In addition to the specific strategies outlined above, there is the need for government to embark on social and economic programmes that would solve on a more sustainable basis the demographic and health problems observed in the NDHS data. Survey findings show that socio-economic indicators such as educational attainment are strongly correlated with most of the indicators measured. For example, fertility preferences, knowledge and use of contraceptives, prevalence of female circumcision and other health problems are strongly related to education levels, rural-urban residence, and to a larger extent, the economic and occupational status of respondents. Government should therefore implement wide ranging socio- economic programmes such as: i) Universal, free and compulsory education that would bring schooling to the doorstep of all Nigerians. The Universal Basic Education (UBE) is a step in the right direction. ii) A poverty alleviation programme that would increase the living standard of the people and their purchasing power. iii) A coordinated rural development programme. This would ensure the provision of basic facilities such as water, electricity, health facilities, schools etc. iv) Adoption of the gender factor as an integral part of the development process. Women should be empowered and their social and economic conditions should be improved. 171 REFERENCES Adalemo, I.A. and J.M. Baba (eds.). 1993. Nigeria: Giant in the tropics. Vol. 1, Heritage Edition, Gabume Press. Adamu, A. 2000. Representatives criticize female circumcision. The Guardian Newspaper, April 28, 2000, p. 2. Adegbola, O. (ed.). 1995. The Nigerian National Population Programme: Retrospect & prospects. Lagos, Nigeria: Population Activities Fund Agency (PAFA). Bankole, A. and C.F. Westoff. 1995. Child-bearing attitudes and intentions. DHS Comparative Studies No. 17. Calverton, Maryland: Macro International Inc. Bicego, George and Omar B. Ahmad. 1996. Infant and child mortality. DHS Comparative Studies No. 20. Calverton, Maryland: Macro International Inc. Bongaarts, J. 1978. 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Federal Ministry of Health [Nigeria] (FMH). 1988. National health policy for and strategy to achieve health for all Nigerians. Lagos, Nigeria: Federal Ministry of Health. Federal Office of Statistics [Nigeria] (FOS). 1992. Nigeria Demographic and Health Survey, 1990. Columbia, Maryland: Federal Office of Statistics and Macro International Inc. Federal Republic of Nigeria. 1975. Fourth National Development Plan, 1981-1984. Lagos, Nigeria: Federal Ministry of Information. Federal Republic of Nigeria. 1997. Report of the Vision 2010 Committee: Main report. Abuja, Nigeria: Federal Republic of Nigeria. Ghana Statistical Service (GSS) and Macro International Inc. (MI). 1999. Ghana Demographic and Health Survey 1998. Calverton, Maryland: Ghana Statistical Service and Macro International Inc. 173 Ilori, F.A. 1982. Sex differentials in attitude towards family sizein Nigeria: Implications for family planning. In H. Chojnaka et.al. (eds.) Population and economic development in Nigeria in the 1980s, New York, New York. 209-240. Institute for Resource Development (IRD). 1990. An assessment of DHS-ldata quality. DHS Methodological Reports No.1. Columbia, Maryland: IRDfMacro Systems Inc. Kalu, S.I. 1988. Household structure and fertility in Nigeria. Unpublished thesis submitted for the Master of Philosophy in Population Studies of the University of Legon, Ghana. Love and Life. 1999. Female circumcision and sex: How it affects women's sex life. Journal on Sex Education and Life Experience No. 12, 25-26. Macro International Inc. 1994. Fertility trends and determinants in six African countries. DHS Regional Analysis Workshop for Anglophone Africa. Calverton, Maryland: Macro International Inc. National Council for Population and Development (NCPD) [Kenya], Central Bureau of Statistics (CBS) and Macro International Inc. (MI). 1999. Kenya Demographic andHealth Survey 1998. 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Columbia, Maryland: Macro International Inc. World Bank. 1994, Nigeria social sectors' strategy: Review report (#11781). 175 APPENDIX A SAMPLE DESIGN APPENDIX A SAMPLE DESIGN A.1 Preamble The 1999 National Demographic Sample survey was designed as probability sampling of eligible respondents within all regular households in the entire country. The sampling frame used for selecting the Primary Sampling Units (PSUs) was the Enumeration Areas (EAs) into which the country was delineated for the 1991 National Population Census. The frame contains 212,079 EAs that are mutually exclusive and collectively exhaustive of the territorial land area of Nigeria. The survey was aimed at producing an unbiased nationally represented data and statistics. It was also structured to produce mainly regional (domain) and rural-urban (strata) estimates. Nevertheless, estimates for the administrative divisions (states) will be obtained for variables that yield adequate data at that level of division. The 36 states and Federal Capital Territory (FCT) of the country were grouped into five Survey Statistical regions as shown below: CENTRAL Plateau Benue Nasarawa Taraba Adamawa Kogi Kwara Niger FCT NORTHEAST Jigawa Gombe Kano Borno Banchi Yobe NORTHWEST Kebbi Kaduna katsina Zamfara ' Sokoto SOUTHEAST Ebonyi Anambra Bayelsa Cross-River Akwa-Ibom Enugu Rivers Abia Inao SOUTHWEST Lagos Oyo Osun Delta Ogun Edo Eldti Ondo The 212,079 EAs were classified into one of the two strata --(i) rural and (ii) urban, where urban EA (U) is defined as an EA within a locality having population of 20,000 and above, while, rural EA (R) is an EA within a locality with population less than 20,000 persons. A.2 Sample Allocation Procedure The DHS was designed to give every eligible woman (aged between 10-49 years) nationwide an equal probability of being selected. Consideration was initially given to updating and segmentation of the existing EAs into standard units (clusters) of almost equal population/households, from where a fixed "sample-take" of households ought to be drawn. But after considering the technicalities involved, time and cost under the stringent budget for the survey and judging from the balance of advantage of not segmenting, a decision was taken not to undertake the segmentation exercise. As the primary objective of the survey is to obtain rates rather than 179 absolute yield, an unbiased spread of the selected clusters (EAs) was seen more as a priority rather than cluster size which is known not to vary considerably within a strata of state. A proportional allocation of the eligible women (to be sampled) was assigned for each state using the projected population from the 1991 census as an auxiliary information. In determining the number of PSUs (EAs), that will yield the allocated number of eligible women for a state and stratum, an even distribution of the target population among the EAs within a stratum of a state was assumed. By targeting 10,000 eligible women age 15-49 (or 12,504 aged 10-49) and allowing for 10 percent nonresponse, a field return of 9,000 eligible women (aged 15-49) was expected. Tim target population represented 0.0003707 of the projected eligible women. Targeting this same proportion of eligible women existing in the rural and urban strata of a state, the expected number of EAs to yield the target after a second stage sampling was obtained. A.3 Sample Selection A two stage sampling procedure was adopted to sample eligible women. A sub-sample of selected households for eligible women interview was selected (at third stage) for the canvassing of the men questionnaire. A.3,1 First Stage Sampling (Sampling of EAs) After arranging the EAs in each stratum of a state in their geographic order, the PSUs allocated to the stratum in the state were selected by systematic sampling procedure. Selection was therefore independent both within stratum and between states. The selection probability of all PSUs within a stratum in a state are equal. Thus, Y.P~ = NnkC ~ =1 i=1 where P~ = probability of selecting the i th PSU in the h th stratum of the K th state. Nhk = Total number of EAs in the h th stratum of state k h=lor2 k = 1,2 . 37. i= l ,2 . Chk = the constant selection probability from the h 'h stratum of the K th state. A.3.2 Household Listing and Quality Control The primary sampling units which serve as clusters for enumeration were selected centrally by a trained statistician at the National Population Commission's Liaison Office in Lagos. The selected EAs were sent to the local governments for the NPC's resident technical staff to re-identify the EA boundaries and obtain a sketch map of the EA, indicating all buildings within the EA. The NPC Comptroller of the local government who is a very senior staff thereafter cross checked the work of the technical staff to ensure no omission of any building within the EA or inclusion of a building outside the boundaries of the EA. After approval of the building numbering and listing, the technical staff who did not serve as interviewers in the EA identified and listed all households within the EA in the Household Listing Form - NDHS-07. The Comptroller again was supposed to spot check the listed households by re-listing all households in one of five residential buildings listed by the technical staff. 180 The following quality control procedure was adopted: i) ii) iii) If no error was found in the re-listing (sample), then the listing was accepted for enumeration, if 2 or more percent error was found then, the entire EA was re-listed if errors were found but less than 2 percent, a second independent sample was drawn, the cumulative errors were found, if 2 or more percent error was obtained (from the two samples), the entire households in the EA will be re-listed, otherwise correction was to be made on the Household Listing Form (NDHS-07). (Note that in an EA, where there are less than 10 residential buildings the comptroller is expected to quality check one of every five households listed in the EA). A.3.3 Second Stage Sampling (Household and Eligible Women Sampling) After the spot/quality check as described in 1.3.2 above, one in every five households listed was selected by adopting the systematic sampling procedure. The number of secondary sampling units (SSUs)--households selected (i.e. sample size) for the EAs is variable, i.e. where n i l . T ni = the number of secondary sampling units (households) selected for the canvassing of eligible women and household questionnaires in the i th PSU. T = total household in the i 'h PSU. Hence, Pr (SSUi;~AO = 0.20 where, SSUIj = the jth household in the i th PSU. All eligible women (EWu) within the selected sample units are included in the sample. That is, Pr (EWIj\SUij) = 1. Whereas for the eligible men's (EMij) interview, a sub-sample (n~), one in every three SSUs selected for women's questionnaire is systematically selected. Therefore Pr (E~j~A~) = 0.667. A.4 Weighting Field Returns The field returns from the designed sampling procedure as described above have to be weighted because the field returns for the sampling domains did not reflect entirely a self weighting sample of the population in the domains. Though the population used as auxiliary information to estimate the number of eligible women to be sampled from each state (under a self weighting sample) is a projection-- i.e "an estimate," it is reliable. However, the inability to strictly adhere to and implement the recommended quality control procedures (A.3.2) and the small number of PSUs relative to the variability that exists within the PSUs account for the field returns deviating from the self-weighting sample envisaged during the sample design. 181 It should be noted that while the returns from the rural stratum show an appreciable level of self weighting, the returns from the urban stratmn showed a significant level of deviation from self weighting. The deviation from the urban stratum was due to under-listing of dwellings in some PSUs due to changes in physical features at the EAs boundaries over time. Therefore in processing and estimating the population parameters, the sample returns were weighted by taking into consideration the selection probabilities of the primary sampling units, the expected and eventual field returns and the differential in response rate among the domains. The weights were standardized and entered with the individual data records. Fortunately, the clusters (EAs) were evenly spread over the geographical area of the domain and the under-listing or otherwise of dwelling was not systematic, it was rather random within the domain, hence, bias of a differential in variable values between the listed and the unlisteal dwellings does not arise. 182 TableA.l.1 Sample implementation: women Percent distribution of households and eligible women in the NDHS sample by results of the household and individual interviews and household, eligible women, and overallresponse rates, according to region and urban-rural residence, Nigeria 1999 Region Residence North- North- South- South- Result east west east west Central Urban Rural Total Selected hol~seholds Completed (C) 99.2 99.4 94.5 96.5 95.2 95.5 97.1 96.6 Household present but no competent respondent at home (HP) 0.0 0.1 1.0 0.6 1.8 1.0 0.7 0.8 Refused (JR) 0.1 0.2 0.5 0.6 0.1 0.7 0.2 0.3 Household absent (HA) 0.4 0.3 1.5 1.3 2.6 2.0 1.0 1.3 Dwelling vacant/address not a dwelling (DV) 0.2 0.0 0.5 0.0 0.2 0.3 0.2 0.2 Other (O) 0.2 0.I 2.0 0.9 0.1 0.6 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Numberofhouseholds 1,206 1,129 1,921 2,023 1,640 2,600 5,319 7,919 Household response rate (HRR) 1 99.9 99.7 98.4 98.7 98.1 98.3 99.1 98.8 Eligible women Completed (EWC) 96.8 97.7 94.3 93.8 94.5 94.0 95.6 95.1 Not at home (EWNH) 2.7 1.6 4.0 4.9 4.5 4.5 3.5 3.8 Postponed (EWP) 0.0 0.0 0.0 0.1 0.1 0.I 0.0 0.0 Refused (EWR) 0.1 0.1 0.8 0.7 0.3 0.8 0.3 0.5 Partly completed (EWPC) 0.1 0.0 0.2 0.0 0.3 0.2 0.1 0.1 Incapacitated (EWI) 0.2 0.0 0.4 0.2 0.3 0.2 0.3 0.2 Other (EWe) 0.1 0.5 0.2 0.3 0.0 0.3 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,641 1,396 2,461 2,522 2,297 3,424 6,893 10,317 Eligible woman response rate (EWRR) 2 96.8 97.7 94.3 93.8 94.5 94.0 95.6 95.1 Overall response rate (eRR) 3 96.8 97.4 92.8 92.6 92.7 92.4 94.8 94.0 Note: The household response rateis calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, and dwelling not found. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, pattlally completed, incapacitated and "other." The overall response rate is the product of the household and woman response rates. Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C +HP+R+ HA+ DV+O 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNH + EWP + EWR + EWPC + EWI + Ewe 3 The overall response rate (eRR) is calculated as: eRR = HRR* EWRR 183 Table A.1.2 Sample implementation: men Percent distribution of households and eligible men in the NDHS sample by results of the household and individual interviews, and household, eligible men, and overall response rates, according to region and urban-rural residence, Nigeria 1999 Region Residence North- North- South- South- Result east west east west Central Urban Rural Total Selected hottseholds Completed (C) 98.7 99.7 95.6 97.5 96.5 97.2 97.4 97.3 Household present but no competent respondent at home (HP) 0.0 0.3 1.1 0.4 1.1 0.9 0.5 0.6 Refused (R) 0.0 0.0 0.2 0.3 0.2 0.1 0.2 0.2 Household absent (HA) 0.8 0.0 0.8 1.0 2.0 1.2 0.9 1.0 DweRing vacant/address not a dwelling (DV) 0.5 0.0 0.6 0.1 0.2 0.2 0.3 0.3 Other (O) 0.0 0.0 1.7 0.6 0.0 0.4 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 399 377 636 667 541 849 1,771 2,620 Household response rate (EIRR) 1 100.0 99.7 98.7 99.2 98.7 98.9 99.3 99.2 Eligible men Completed (EMC) 92.6 91.3 94.2 92.9 91.4 89.9 94.0 92.6 Not at home (EMNH) 4.4 6.8 4.1 6.0 8.6 8.4 4.8 6.0 Postponed (EMP) 0.0 0.0 0.2 0.0 0.0 0.1 0.0 0.0 Refused (EMR) 0.4 0.8 0.6 0.5 0.0 0.6 0.4 0.4 Partly completed (EMPC) 0.6 0.0 0.5 0.1 0.0 0.2 0.3 0.2 Incapacitated (EMI) 0.8 0.0 0.0 0.1 0.0 0.2 0.2 0.2 Other (EMO) 1.1 1.1 0.5 0.3 0.0 0.6 0.4 0.5 Total. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 472 369 639 751 663 981 1,913 2,894 Eligible man response rate (EMRR) 2 92.6 9/.3 94.2 92.9 91.4 89.9 94.0 92.6 Overall response rate (ORR) s 92.6 91.1 93.0 92.2 90.2 88.9 93.3 91.8 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The eligible man response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and man response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C+HP+R+HA+DV+O 2 Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: EMC EMC + EMNH + EMP + EIVlP, + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = HRR* EMRR 184 APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX B ESTIMATES OF SAMPLING ERRORS The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the NDHS to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the NDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the NDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the NDHS is the ISSA Sampling Error Module. This module used the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearisation method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below with the standard error being the square root of the variance: _ 1 - f~ l mh Far(r) X 2 h=l [ mh-1 °h 2 / zh i=l m h in which Zhi = Yhi - r. Xhi , and z h = Yh - r. X h 187 where h mh Yhi xhi f represents the stratum which varies from I to H, is the total number of enumeration areas (EAs) selected in the h th stratum, is the sum of the values of variable y in the ith EA in the h th stratum, is the sum of the number of cases in the i th EA in the h th stratum, and is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the NDHS, there were 399 non-empty clusters. Hence, 399 replications were created. The variance of a rate r is calculated as follows: SE2(R) = var ( r ) = 1 k E( r i - r ) 2 k(k-1) i=l in which r i = k r - (k -1 ) r (o where r ro) k is the estimate computed from the full sample of 399 clusters, is the estimate computed from the reduced sample of 398 clusters (ith cluster excluded), and is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEbT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the NDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for the five regions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 to B.9 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R_+2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant since there is no known unweighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to women aged 15-49) can be interpreted as follows: the overall average from the national sample is 2.848 and its standard error is .04. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.848-+2x.04. There is a high probability (95 percent) that the true average number of children ever bona to all women aged 15 to 49 is between 2.771 and 2.925. 188 Sampling errors are analysed for the national sample and for two separate groups of estimates: ( 1 ) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 0 percent and 50.7 percent with an average of 6.6 percent; the highest relative standard errors are for estimates of very low values (e.g., currently using implants among currently married women who were currently using a contraceptive method). If estimates of very low values (less than 10 percent) were removed, then the average drops considerably. So in general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small, 2.2 percent. However, for the mortality rates, the average relative standard errors are somewhat higher, e.g., 4.8 percent for under-five mortality. There are differentials in the relative standard error for the estimates of sub-populations. For example, for the variable with secondary education or higher, the relative standard errors as a percent of the estimated mean for the whole country, for the rural areas, and for the Northeast region are 3. I percent, 4.4 percent, and 17.5 percent, respectively. For the total sample, the value of the design effect (DEFT) averaged over all variables is 1.46, which means that due to multi-stage clustering of the sample variance is increased by a factor of 1.46 over that in an equivalent simple random sample. 189 Table B.1 List of selected variables for sampling errors) Nigeria 1999 Variable Estimate Base population Urban Proportion No education Proportion With secondary education or higher Proportion Never manied Proportion Currently married/in union Proportion Married before age 20 Proportion Sex before age 18 Proportion Children ever born Mean Children ever born to women over 40 Mean Children surviving Mean Knowing any contraceptive method Proportion Knowing any modem contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modem method Proportion Currently using pill Proportion Currently using IIJD Proportion Currently using injectabhis Proportion Currently using implants Proportion Currently using condom Proportion Currently using female sterilisation Proportion Currently using periodic abstinence Proportion Currently using withdrawal Proportion Using public sector source Proportion Want no more ehildren/sterilised Proportion Want to delay at least 2 years Proportion Ideal number of children Mean Mothers received tetanus injection Proportion Mothers received medical care at birth Proportion Had diarrhoea in the last 2 weeks Proportion Treated with ORS packets Proportion Having health card, seen Proportion Received BCG vaccination Proportion Received DPT vaccination (3 doses) Proportion Received polio vaccination (3 doses) Proportion Received measles vaccination Proportion Fully immunised Proportion Weight-for-height (below -2 SD) Proportion Height-for-age (below -2 SD) Proportion Weight-for-age (below -2 SD) Proportion Total fertility rate (5 years) Rate Neonatal mortality rate Rate Postneonatal mortality rate Rate Infant mortality rate Rate Child mortality rate Rate Under-five mortality rate Rate All women 15-49 All women 15-49 All women 15-49 All women 15-49 All women 15-49 All women I5-49 All women 15-49 All women 15-49 All women 40-49 All women I5-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currentiy married women 15-49 Currently married women 15-49 Current users of modem method Currently married women 15-49 Currently married women 15-49 All women 15-49 Births in lest 3 years Births in last 3 years Children under 3 Children under 3 with diarrhoea in last 2 weeks Children 12.23 months Children 12.23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12.23 months Children under 3 Children under 3 Cffddien under 3 Woman-years of exposure to child-bearing Number of births Number of births Number of births Number of births Number of births 190 Table B.2 Sampling errors: National sample T Nigeria 1999 Value Variable (R) Number of cases Standard Un- Design Relative Confidence limits error weighted Weighted effect error (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban No education With secondary education or higher Never married Currently married/in union Married before age 20 Sex before age 18 Children ever born Children ever born to women over 40 Children surviving Knowing any contraceptive method Knowing any modern contraceptive method Ever used any contraceptive method Currently using any method Currently using a modern method Currently using pill Currently using 1UD Currently using injectables Currently using implants Currently using condom Currently using female stenilisation Currently using periodic abstinence Currently using withdrawal Using public sector source Want no more children/sterilised Want to delay at least 2 years Ideal number of children Mothers received tetanus injection Mothers received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Having health card, seen Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Weight-for-helght (below -2 SD) Height-for-age (below -2 SD) Weight-for-age (below -2 SD) Total fertility rate (5 years) Neonatal mortality rate (0-4 years) Postneonatal mortality rate (0-4 years) Infant mortality rate (0-4 years) Child mortality rate (0-4 years) Under-five mortality rate (0-4 years) 0.310 0.015 8199 8206 3.009 0.050 0.279 0.340 0.405 0.014 8199 8206 2.528 0.034 0.378 0.432 0.367 0.011 8199 8206 2.128 0.031 0.345 0.390 0.260 0.006 8199 8206 1.333 0.025 0.247 0.272 0.702 0.007 8199 8206 1.414 0.010 0.687 0.716 0.612 0.010 6425 6431 1.568 0.016 0.593 0.631 0.506 0.009 6425 6431 1.474 0.018 0.488 0.525 2.848 0.039 8199 8206 1.205 0.014 2.771 2.925 6.121 0.101 1251 1265 1.234 0.016 5.920 6.323 2.433 0.032 8199 8206 1.187 0.013 2.369 2.497 0.644 0.014 5755 5757 2.231 0.022 0.616 0.672 0.619 0.014 5755 5757 2.257 0.023 0.590 0.648 0.287 0.010 5755 5757 1.707 0.035 0,267 0.308 0.153 0.007 5755 5757 1.483 0.046 0.139 0.167 0.086 0.006 5755 5757 1.620 0.070 0.074 0.098 0.024 0.003 5755 5757 1.283 0.107 0.019 0.029 0.020 0.002 5755 5757 1.162 0.107 0.016 0.024 0.024 0.003 5755 5757 1.396 0.118 0.018 0.029 0.001 0.000 5755 5757 0.980 0.507 0.000 0.001 0.012 0.001 5755 5757 1.014 0.119 0.010 0.015 0.003 0.001 5755 5757 0.970 0.247 0.001 0.004 0,046 0.003 5755 5757 1.135 0.068 0.040 0.052 0.012 0.002 5755 5757 1.204 0.142 0.009 0,016 0.429 0.023 720 728 1.239 0.053 0,383 0.475 0.193 0.008 5755 5757 1.500 0.040 0.177 0.208 0.284 0.008 5755 5757 1.286 0.027 0,269 0.299 6.165 0.068 6753 6756 1.894 0.011 6.030 6.300 0.554 0,016 3549 3547 1.782 0.029 0.522 0.587 0.416 0.016 3549 3547 1.736 0.038 0.384 0.447 0.153 0.007 3208 3206 1.064 0.045 0.139 0,166 0.343 0.026 491 489 1.182 0.076 0,291 0.395 0.195 0.015 1166 1161 1.274 0.077 0.165 0.225 0.538 0.022 1166 1161 1.455 0.040 0.495 0.581 0.263 0.018 1166 1161 1.375 0.069 0.227 0.299 0.248 0.017 1166 1161 1,304 0.068 0.214 0.281 0.405 0.020 1166 1161 1.377 0.050 0.364 0.445 0.168 0.014 1166 1161 1.232 0.083 0.140 0.195 0.124 0.008 1456 1473 0.970 0,067 0.107 0.141 0.455 0,015 1456 1473 1.139 0.033 0.424 0.485 0.273 0.014 1456 1473 1.147 0.050 0.246 0.300 5.146 0.112 NA 36250 1.525 0,022 4.922 5.369 36.923 2.974 6979 6479 1,140 0.081 30.975 42.872 38.093 2.853 6503 6503 1.089 0.075 32.388 43.798 75.016 4,295 6507 6507 1.160 0.057 66.426 83.606 70.321 4.454 6614 6612 1.211 0.063 61.414 79.229 140.062 6.654 6646 6644 1.323 0.048 126.754 153.370 NA=Notapplicable 191 Table B.3 Sampling errors: Urban sample, Nigeria 1999 Value Variable (R) Numberofc~es Standard Un- Design Relative Confidence limits error weighted Weighted effect error (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban 1,000 No education 0,249 With secondary education or higher 0.541 Never married 0.306 Currently married/in union 0.657 Married before age 20 0.503 Sex before age 18 0.398 Children ever born 2,528 Children ever born to women over 40 5,653 Children sutwP4ng 2,236 Knowing any contraceptive method 0.833 Knowing any modern contraceptive method 0.820 Ever used arty contraceptive method 0,427 Currently using any method 0.234 Currently using a modern method 0.157 Currently using pill 0.055 Currently using IUD 0.040 Currently using inje~tables 0.1)30 Currently using implants 0.002 Currently using condom 0.025 Currently using female sterilisation 0.002 Currently using periodic abstinence 0,046 Currently using withdrawal 0.019 Using public sector source 0.401 Want no more childrerdsterilised 0.243 Want to delay at least 2 years 0.262 Ideal number of children 5.325 Mothers received teCanu~ injection 0.737 Mothers received medical care at birth 0.579 Had diarrhoea in the last 2 weeks 0,139 Treated with ORS packets 0.430 Having health card, seen 0.281 Received BCG vaccination 0.750 Received DPT vaccination (3 doses) 0.447 Received polio vaccination (3 doses) 0.418 Reeei';ed measles vaccir~at'xon 0.615 Fully immunised 0.317 Weight-for-height (below -2 SD) 0,114 Height-for-age (below -2 SD) 0.416 Welght-for-age (below -2 SD) 0.267 Total fertility rate (5 years) 4:'497 Neonatal mortality rate (0-9 years) 36,174 Posmeonatal mortality rate (0-9 years) 23.128 Infant mortality rate (0-9 years) 59,302 Child mortality rate (0-9 years) 51.576 Under-five moaality rate (0-9 years) 107.820 0.000 2697 2540 NA 0.000 1.000 1.000 0.022 2697 2540 2.627 0,088 0.205 0,292 0.020 2697 2540 2.072 0.037 0,501 0.58I 0.010 2697 2540 1.122 0.033 0,286 0.325 0,01i 2697 2540 1.159 0.016 0.636 0.679 0,016 2131 2008 1.467 0.032 0.471 0.535 0.015 2131 2008 1,411 0,038 0.368 0.428 0.061 2697 2540 1.I83 0,024 2.406 2,649 0.188 393 380 1.477 0,033 5.277 6.030 0.050 2697 2540 1.104 0.022 2,137 2.336 0,023 1769 1670 2.622 0.028 0.787 0.880 0.024 1769 1670 2.664 0.030 0.772 0.869 0.021 1769 1670 1.799 0.050 0.385 0.469 0.017 1769 1670 1,640 0.071 0.201 0.267 0.013 1769 1670 1.539 0.085 0.130 0,184 0.007 1769 1670 1.318 0,131 0.040 0,069 0.005 I769 1670 1.142 0.134 0,029 0.050 0.005 1769 1670 1.255 0.169 0.020 0.040 0,001 1769 1670 1.010 0,507 0.000 0.005 0.003 1769 1670 0.932 0.138 0.018 0.032 0.001 1769 1670 1.031 0.582 0.000 0.004 0.005 I769 1670 1,088 0.119 0.035 0.056 0.004 1769 1670 1.325 0.227 0.010 0.028 0.035 365 356 1.349 0.086 0.332 0.471 0,016 1769 1670 1.611 0.068 0.211 0.276 0,015 1769 1670 1.398 0.056 0.233 0.291 0.092 2252 211I 1,853 0.017 5,141 5.508 0.024 1039 984 1.596 0,032 0.690 0.784 0.035 I039 984 2.047 0,060 0,509 0,649 0.013 948 896 1.155 0.097 0,112 0.166 0.064 134 124 1.419 0.149 0.302 0.558 0.029 332 310 1.181 0.104 0.223 0.340 0.036 332 310 1.524 0.049 0.677 0.823 0.036 332 310 1,279 0,080 0.375 0,519 0,031 332 310 1.124 0,075 0.356 0,481 0.037 332 310 1.348 0.060 0.542 0.689 0,029 332 310 1.112 0,093 0,258 0.376 0.015 431 417 0.982 0.131 0,084 0.144 0.026 431 417 1.092 0.063 0.364 0.469 0.024 431 417 1.123 0.090 0.219 0.315 0.199 NA 11249 1.698 0.044 4.099 4.895 4.493 1847 1738 1.121 0.124 27,188 45.161 2.767 1850 1741 0.936 0.120 17.593 28.662 5.509 1852 1743 1.175 0.093 48.285 70.320 6.432 1877 1767 1,117 0.125 38.712 64.441 9,445 1884 1774 1.277 0,088 88.931 126,709 NA = Not applicable 192 Table B.4 Sampling errors: Rural sample~ Nigeria 1999 Variable Number of cases Standard Un- Design Relative Confidence limits Value error weighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban No education With secondary education or higher Never married Currently married/in tWlon Married before age 20 Sex before age 18 Children ever born Children ever born to women over 40 Children surviving Knowing any contraceptive method Knowing any modem contraceptive method Ever used any contraceptive method Currently using any method Currently using a modern method Currently using pill Currently using IUD Currently using injectables Currently using implants Currently using condom Currently using female sterilisatlon Currently using periodic abstinence Currantly using withdrawal Using public sector source Want no more ehildren/aterilised Want to delay at least 2 years Ideal number of children Mothers received tetanus injection Mothers received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Having health card, seen Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Weight-for-height (below -2 SD) Height-for-age (below -2 SD) Weight-for-age (below -2 SD) Total fertility rate (5 years) Neonatal mortality rate (0-9 years) Postneonatal mortality rate (0-9 years) Infant mortality rate (0-9 years) Child mortality rate (0-9 years) Under-five mortality rate (0-9 years) 0.000 0.000 5502 5666 NA NA 0.000 0.000 0.475 0.017 5502 5666 2.467 0.035 0.442 0,508 0.290 0.013 5502 5666 2.086 0.044 0.264 0.315 0.239 0.008 5502 5666 1.424 0.034 0.223 0.255 0.721 0.009 5502 5666 1.519 0.013 0.703 0.740 0.661 0.011 4294 4423 1.588 0.017 0.638 0.684 0.556 0.011 4294 4423 1.477 0.020 0.533 0.578 2.991 0.048 5502 5666 1.201 0.016 2.895 3.088 6.322 0.117 858 885 1.139 0.019 6.088 6.556 2.521 0.041 5502 5666 1.207 0.016 2.440 2.603 0.567 0.016 3986 4087 2.101 0.029 0.534 0.600 0.537 0.017 3986 4087 2.142 0.032 0.503 0.571 0,230 0.011 3986 4087 1.626 0.047 0.208 0.252 0.120 0.007 3986 4087 1.331 0.057 0.107 0.134 0.056 0.006 3986 4087 1.656 0,107 0.044 0.068 0.012 0.002 3986 4087 1.104 0.159 0.008 0.016 0,012 0.002 3986 4087 1.184 0.169 0.008 0.016 0.021 0.003 3986 4087 1.468 0.158 0.014 0.028 0.000 0.000 3986 4087 NA NA 0.000 0.000 0.007 0.001 3986 4087 1.111 0.206 0.004 0.010 0.003 0.001 3986 4087 0.947 0.272 0.001 0.005 0.046 0.004 3986 4087 1.150 0.083 0.038 0.054 0.010 0.002 3986 4087 1.090 0.174 0.006 0.013 0.456 0.030 355 372 1.136 0.066 0.396 0.516 0.172 0.009 3986 4087 1.482 0.051 0.154 0.190 0.293 0.009 3986 4087 1.255 0.031 0.275 0.311 6.547 0.083 4501 4645 1.815 0.013 6.380 6,714 0.484 0.021 2510 2563 1.892 0.043 0.442 0.526 0.353 0.018 2510 2563 1.651 0.050 0.318 0.388 0.158 0.008 2260 2310 1.023 0.051 0.142 0.174 0.313 0.027 357 365 1.091 0.087 0.259 0.367 0.I63 0.017 834 850 1.338 0.106 0.128 0.198 0.461 0.026 834 850 1.475 0.056 0.409 0.513 0.196 0.020 834 850 1.417 0.101 0.156 0.235 0.185 0.019 834 850 1.401 0.103 0.147 0.224 0.328 0.023 834 850 1.408 0 .071 0.281 0.374 0.113 0.015 834 850 1.313 0.129 0.084 0.142 0.128 0.010 1025 1056 0.961 0.079 0.108 0.148 0.470 0.018 1025 1056 1.136 0.039 0.433 0.506 0.275 0.016 1025 1056 1.148 0.059 0.242 0.307 5.436 0.133 NA 25002 1.439 0.024 5.171 5.701 34.568 2.540 4632 4741 1.145 0.073 29.488 39.648 40.327 2.917 4653 4762 1.082 0.072 34.493 46.161 74.895 4.335 4655 4764 1.151 0.058 66.225 83.566 73.429 4.731 4737 4845 1.215 0.064 63.967 82.892 14Z825 7,021 4762 4870 1.319 0,049 128.783 156,866 NA=Notapplicable 193 Table B.5 Sampling errors: Northeast region sample~ Nigeria 1999 Variable Number of cases Standard Un- Design Relative Confidence limits Value error weighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban 0.290 0.039 1304 1292 3,127 0.136 0.211 0.368 No education 0,769 0.033 1304 1292 2,822 0.043 0,703 0.835 With secondary education or higher 0.I42 0.025 1304 1292 2,569 0.175 0.092 0.191 Never married 0.096 0.014 1304 1292 1.669 0.142 0.068 0.123 Currently married/in union 0.880 0.015 1304 1292 1,686 0.017 0.850 0.911 Married before age 20 0.851 0.018 1034 1023 1,596 0.021 0.816 0.887 Sex before age 18 0.700 0.021 1034 1023 1,494 0.030 0.658 0.743 Children ever born 3.375 0.080 1304 1292 0,972 0.024 3.215 3.534 Children ever born to women over 40 6.370 0.322 164 163 1,245 0.050 5.727 7.014 Children surviving 2.733 0.061 I304 1292 0,926 0.022 2.611 2.856 Knowing any contraceptive method 0.354 0.029 1145 1137 2,082 0.083 0.295 0.413 Knowing any modern contraceptive method 0.346 0,030 1145 1137 2,105 0.086 0.286 0.405 Ever used any contraceptive method 0.070 0.013 1145 i i37 1,663 0.I80 0.045 0.095 Currently using any method 0.031 0.007 1145 1137 1,371 0.228 0,017 0.044 Currently using a modem method 0,022 0.006 1145 1137 1,308 0.255 0.011 0.034 Currentiy using pill 0.014 0.005 1145 1137 1,516 0.377 0.003 0.024 Currentiy using IUD 0,001 0.001 1145 1137 1,041 1.044 0.000 0.003 Currently using injectables 0.007 0.003 1145 1137 1,202 0.430 0.001 0.013 Currently using implants 0.000 0.000 1145 1137 NA NA 0.000 0.000 Currently using condom 0.001 0,001 1145 1137 1.04I 1.044 0.000 0.003 Currently using female stedlisation 0.000 0.000 1145 1137 NA NA 0.000 0.000 Currently using periodic abstinence 0.005 0.002 1145 1137 1.178 0,502 0.000 0.010 Curtenily using wlthdrawal 0.003 0.002 1145 1137 1.643 0.959 0.000 0.007 Using public sector source 0.357 0.060 29 29 0.663 0.168 0.236 0.477 Want no more children/sterliised 0.069 0.012 1145 1137 1.651 0.180 0.044 0.094 Want to delay at least 2 years 0.292 0.023 1145 I137 1.685 0.078 0.247 0.338 Ideal number of children 8.179 0.311 733 715 1.946 0.038 7.557 8.800 Mothers received tetanus injection 0,313 0.032 789 788 1.793 0,104 0.248 0.378 Mothers received medical care at birth 0.127 0.024 789 788 1.848 0.189 0.079 0.175 Had diarrhoea in the last 2 weeks 0.223 0.017 685 684 1.038 0.075 0.I 90 0.257 Treated with ORS packets 0,240 0.049 153 153 1.379 0.203 0.142 0.337 Having health card, seen 0.072 0.018 242 241 1.084 0.249 0.036 0.108 Received BCG vaccination 0.260 0.031 242 241 1,109 0.120 0.197 0.322 Received DPT vaccination (3 doses) 0.121 0.027 242 24I 1.273 0.221 0.067 0.174 Received polio vaccination (3 doses) 0.111 0.024 242 241 1.198 0.218 0.062 0.159 Received measles vaccination 0.197 0.033 242 241 1.306 0,170 0.130 0.264 FuUy immunised 0.075 0.025 242 241 1.501 0,338 0.024 0.126 Weight-for-height (below -2 SD) 0.163 0.022 302 302 1,039 0.137 0.119 0,208 Height-for-age (below -2 SD) 0.552 0.031 302 302 1.069 0.056 0,490 0.613 Weight-for-age (below -2 SD) 0.380 0.036 302 302 1.306 0.096 0.307 0.453 Total fertility rate (5 years) 6.785 0.232 NA 5745 1.081 0.034 6.322 7.249 Neonatal mortality rate (0-9 years) 44.518 6.023 1422 1417 1.058 0.135 32.473 56,564 Posmeonatal mortality rate (0-9 years) 34.869 3.875 1427 1422 0.969 0.111 27.120 42.619 Infant mortality rate (0-9 years) 79.388 7,597 1428 1423 1,004 0.096 64.194 94.582 Child mortality rate (0-9 years) 104.102 11,085 1467 1461 1.164 0.106 81.931 126.272 Under-five mortality rate (0-9 years) 175.225 14.172 1474 1468 1,152 0.081 146.881 203.570 NA = Not applicable 194 Table B.6 Sampling errors: Northwest region sample, Nigeria 1999 Standard Value error Variable (R) (SE) Number of cases Un- Design Relative Confldencellmits weighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban No education With secondary education or higher Never married Currently married/in union Married before age 20 Sex before age 18 Children ever born Children ever born to women over 40 Children surviving Knowing any contraceptive method Knowing any modem contraceptive method Ever used arty contraceptive method Currently using any method Currently using a modem method Currently using pill Currently using IUD Currently using injectables Currently using implants Currently using condom Currently using female sterillsafion Currendy using periodic abstinence Currently using withdrawal Using pubfic sector source Want no more children/sterilised Want to delay at least 2 years Ideal number of children Mothers received tetanus injection Mothers received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Having health card, seen Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Weight-for-height (below -2 SD) Height-for-age (below -2 SD) Weight-for-age (below -2 SD) Total fertility rate (5 years) Neonatal mortality rate (0-9 years) Posmeonatal mortality rate (0-9 years) Infant mortality rate (0-9 years) Child mortality rate (0-9 years) Under-five mortality rate (0-9 years) 0,164 0.020 1162 1087 1,888 0.125 0,123 0,205 0.823 0.025 1162 1087 2.196 0.030 0.774 0.872 0,096 0.019 1162 1087 2.223 0.200 0.057 0.134 0,063 0.012 1162 1087 1,630 0,184 0.040 0.087 0,907 0.015 1162 1087 1.742 0.016 0.878 0.937 0,885 0,014 948 887 1,352 0,016 0.857 0.913 0.792 0.018 948 887 1.375 0.023 0.756 0.828 3.191 0.091 1162 1087 1.083 0,029 3.008 3.373 5.640 0,341 151 141 1.174 0,060 4.959 6.322 2.515 0,062 1162 1087 0.956 0.025 2,390 2,640 0.422 0,036 1052 986 2.332 0.084 0.351 0.493 0.391 0,036 1052 986 Z421 0.093 0.318 0.464 0.077 0,011 1052 986 1.330 0.142 0.055 0.099 0.032 0.007 1052 986 1.370 0.231 0.017 0.047 0,025 0,006 I052 986 1.302 0.252 0,012 0.037 0.011 0.004 1052 986 1.198 0,349 0.003 0.019 0.002 0.001 1052 986 0.558 0.346 0.001 0.004 0.009 0,004 1052 986 1.196 0.377 0.002 0.017 0.000 0,000 1052 986 NA NA 0.000 0,000 0.001 0.001 1052 986 0,953 1.014 0.000 0.003 0.001 0,001 1052 986 1,031 1,004 0.000 0.003 0.001 0,001 1052 986 0.933 1,006 0.000 0.002 0.001 0,001 1052 986 0.967 0.981 0.000 0.003 0.585 0.097 33 30 1.111 0,165 0.392 0.779 0.073 0.010 1052 986 1,192 0,131 0.054 0.093 0.320 0.014 1052 986 0,953 0,043 0.292 0,347 8.158 0.149 921 860 1.352 0.018 7,860 8.457 0.261 0,036 669 629 1.972 0.136 0.190 0.333 0.080 0.017 669 629 1.584 0,217 0.045 0,115 0.179 0,017 608 572 1.074 0.093 0,145 0.212 0,162 0.034 109 102 0.949 0.206 0,095 0.229 0.082 0.021 259 245 1.237 0,256 0.040 0,124 0.216 0,038 259 245 1.478 0.174 0.141 0.292 0.092 0,026 259 245 1.466 0.284 0.040 0,145 0.102 0.026 259 245 1.405 0.258 0.049 0.154 0.199 0.032 259 245 1.302 0.162 0.135 0.264 0.043 0.014 259 245 1.078 0.315 0.016 0.070 0,229 0.039 116 108 1.007 0.172 0.150 0.308 0.570 0.047 116 108 0.976 0,082 0,477 0.664 0.452 0.044 116 108 0.925 0.097 0.365 0.540 6.452 0.291 NA 4911 1.083 0.045 5.870 7.034 25,122 4.550 1860 1184 1.301 0,181 16.023 34.222 57,500 8.201 1270 1194 1.269 0.143 41,098 73.902 82.622 10.344 1270 1199 1.286 0.125 61,935 103,309 115.094 12.063 1297 1219 1,311 0.105 90.967 139.220 I88,207 18.152 1307 1229 1.573 0,096 151.902 224.511 NA = Not applicable 195 Table B.7 Sampling errors: Southeast region sample~ Nigeria 19~ Variable Number of cases Standard Un- Design Relative Confidence limits Value error weighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban 0.185 0.025 1895 1886 No education 0.110 0.013 1895 1886 With secondary education or higher 0.529 0.017 1895 1886 Never married 0.425 0.012 1895 1886 Currently married/in union 0.501 0.013 1895 1886 Married before age 20 0.434 0.013 1407 1404 Sex before age 18 0,410 0.018 1407 1404 Children ever born 2.685 0.101 1895 1886 Children ever born to women over 40 6.918 0.189 300 300 Children surviving 2.291 0.083 1895 1886 Knowing any contraceptive method 0.816 0.015 943 946 Knowing any modem contraceptive method 0.790 0.017 943 946 Ever used any contraceptive method 0.455 0.020 943 946 Currently using any method 0.235 0.014 943 946 Currently using a modem method 0.091 0.010 943 946 Currently using pill 0.019 0.005 943 946 Currently using 1UD 0.015 0.004 943 946 CutTenfly using injectables 0.031 0.006 943 946 Currently using implants 0.000 0.000 943 946 Currently using condom 0.019 0.005 943 946 Currently using female sterilisation 0.005 0.002 943 946 Currently using periodic abstinence 0.094 0.007 943 946 Currently using withdrawal 0,034 0.007 943 946 Using public sector source 0,450 0.040 188 187 Want no more childrerdsterilised 0.299 0.025 943 946 Want to delay at least 2 years 0,265 0.018 943 946 Ideal number o f clfridren 5,834 0.106 1722 1712 Mothers received tetanus injection 0.722 0.022 651 649 Mothers received medical care at birth 0.654 0.033 651 649 Had diarrhoea in the last 2 weeks 0.150 0.016 588 586 Treated with ORS packets 0.384 0.057 85 88 Having health card. seen 0,277 0.035 197 194 Received BCG vaccination 0,733 0.036 197 194 Received DPT vaccination (3 doses) 0,407 0.039 197 194 Received polio vaccination (3 doses) 0.367 0.040 197 194 Received measles vaccination 0,543 0.037 197 194 Fully immunised 0,249 0.038 I97 194 Weight-for-height (below -2 SD) 0,080 0,013 366 368 Height-for-age (below -2 SD) 0.353 0.024 366 368 Weight-for-age (below -2 SD) 0.183 0.023 366 368 Total fertility rate (5 years) 4.640 0.196 NA 8115 Neonatal mortality rate (0-9 years) 37.255 4.178 1181 1185 Postneonatal mortaFrty rate (0-9 years) 37,073 4.306 1185 1189 Infant mortality rate (0-9 years) 74,328 6.718 1187 1191 Child mortality rate (0-9 years) 65,596 5.185 1208 1212 Under-five mortality rate (0-9 years) 135.048 8.277 1216 1220 2,765 0.133 0.136 0.234 1.788 0.117 0.084 0.135 1,453 0.032 0.495 0.562 1.092 0.029 0.400 0,450 1,114 0.026 0.476 0.527 0.985 0,030 0.408 0.460 1.369 0.044 0,374 0.446 1.377 0.038 2.483 2.887 1.202 0.027 6.540 7.296 1.326 0.036 2.126 2.457 1.157 0.018 0.786 0.845 1.244 0.021 0,757 0.823 1.254 0.045 0.414 0.495 0.981 0.058 0,208 0.262 1.051 0.108 0.072 0.111 1.192 0.278 0.009 0.030 0.925 0,246 0.007 0.022 1,049 0.191 0.019 0.043 NA NA 0.000 0.000 1.139 0.266 0.009 0.029 0.965 0.433 0.001 0,010 0.765 0.077 0.080 0.I09 1.221 0,211 0,020 0.049 1.112 0.090 0,370 0.531 1.644 0.082 0.250 0.348 1,280 0.069 0.228 0.302 1.923 0.018 5.621 6.047 1.119 0,031 0.677 0.766 1.575 0.050 0.589 0.719 1.069 0.109 0.118 0.183 1.078 0.149 0.270 0.498 1.075 0.125 0.208 0.346 1.097 0.049 0,662 0.804 1.075 0.096 0.328 0.485 1.122 0.109 0.287 0.446 1.034 0.068 0.469 0.618 1.166 0.151 0.174 0.325 0.908 0.160 0.054 0.106 0.918 0.067 0.305 0.400 1.088 0.124 0.137 0.228 1.246 0.042 4.248 5.031 1.042 0.112 28.898 45.611 1.048 0.116 28.462 45.685 1,143 0.090 60,892 87.764 0.855 0.079 55,226 75.966 1.038 0.061 118.494 151,602 NA=Notapplicable 196 Table B.8 Sampling errors: Southwest region sample, Nigeria 1999 Variable Number of cases Standard Un- Design Relative Confidenceiimits Value error weighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban 0.524 0.029 2002 2080 2.594 0.055 0.466 0.582 No education 0.198 0.013 2002 2080 1.504 0.068 0.171 0.225 With secondary education or higher 0.535 0.019 2002 2080 1.743 0.036 0.496 0.574 Never married 0.315 0,010 2002 2080 0.941 0.031 0.296 0.335 Currently married/in union 0.657 0.011 2002 2080 1.022 0.017 0.635 0.679 Married before age 20 0.445 0.017 1571 1631 1.335 0.038 0.412 0.479 Sex before age 18 0.349 0.015 1571 1631 1.256 0.043 0.319 0.379 Children ever born 2.585 0.065 2002 2080 1.093 0.025 2.455 2,716 Children ever born to women over 40 5.793 0.I93 368 383 1.451 0.033 5.408 6.178 Children surviving 2.314 0.062 2002 2080 1.163 0.027 2.190 2.438 Knowing any contraceptive method 0.872 0.012 1318 1367 1.293 0.014 0.849 0.896 Knowing any modem contraceptive method 0.837 0.013 1318 1367 1.255 0.015 0.812 0.863 Ever used any eoutraceptive method 0.476 0.018 1318 1367 1.318 0.038 0.440 0.512 Currently using any method 0,262 0.016 1318 1367 1.298 0.060 0.231 0.293 Currantly using a modern method 0.155 0.013 1318 1367 1.276 0.082 0.130 0.181 Currently using pill 0.042 0.005 1318 1367 0,996 0.132 0.031 0.053 Currently using 1UD 0.052 0.006 1318 1367 1.027 0,12I 0.039 0.064 Currently using injectables 0.026 0.005 1318 1367 1.194 0,202 0.015 0.036 Currently using implants 0,002 0.001 1318 1367 0.988 0.575 0.000 0.005 Currently using condom 0.029 0.004 1318 1367 0.824 0.132 0.021 0.036 Currently using female sterilisation 0.002 0.001 I318 1367 1.002 0,582 0.000 0,005 Currently using periodic abstinence 0.071 0.009 1318 1367 1.218 0.121 0.054 0.089 Currently using withdrawal 0.019 0.004 1318 1367 1.i67 0.228 0.011 0.028 Using public sector source 0.344 0.035 282 292 1.223 0.101 0.275 0.413 Want no more childran/sterilised 0.310 0.014 1318 1367 1.119 0.046 0.282 0.339 Want to delay at least 2 years 0.293 0.014 1318 I367 1.100 0.047 0.265 0.321 Ideal number of children 5.111 0.069 1794 I867 1.497 0.013 4.973 5.248 Mothers received tetanus injection 0.785 0,018 745 777 1.123 0.023 0.749 0,822 Mothers received medical care at birth 0.732 0.024 745 777 1.352 0.033 0.684 0.780 Had diarrhoea in the last 2 weeks 0.071 0.013 685 714 1.219 0.177 0,046 0.097 Treated with ORS packets 0.594 0.085 49 51 1.141 0.143 0.424 0,763 Having health card, seen 0.325 0.037 246 256 1.219 0.114 0.251 0.399 Received BCG vaccination 0.837 0.025 246 256 1,053 0.030 0.788 0.887 Received DPT vaccination (3 doses) 0.408 0.037 246 256 1.158 0.091 0.334 0.481 Received poiio vaccination (3 doses) 0.413 0.035 246 256 1.099 0.085 0.343 0.483 Received measles vaccination 0.648 0.040 246 256 1.309 0.062 0.567 0.729 Fully immunised 0.286 0.029 246 256 0.993 0.102 0.228 0.345 Weight-for-helght (below -2 SD) 0.124 0.015 389 404 0.916 0.123 0.093 0.155 Height-for-age (below -2 SD) 0.389 0.033 389 404 1.325 0.085 0.323 0.455 Weight-for-age (below -2 SD) 0.251 0.026 389 404 1.153 0.102 0.199 0.302 Total fertility rate (5 years) 4.501 0.184 NA 9166 1.296 0.041 4.132 4.869 Neonatal mortality rate (0-9 years) 42.628 4.873 1318 1373 1.140 0.114 32.881 52.375 Postneonatal mortality rate (0-9 years) 27,289 4.508 1320 1375 1.023 0.165 I8.272 36.305 Infant mortality rate (0-9 years) 69,917 7.762 1320 1375 1.197 0.111 54.392 85,442 Child mortality rate (0-9 years) 33.939 4.398 1334 1389 1.194 0.I30 25.143 42.735 Under-five mortality rate (0-9 years) 101.483 9.784 1336 1391 1.325 0.096 81.914 121.052 NA = Not applicable 197 Table B.9 Sampling errors: Central region sample~ Nigeria 1999 Numberofc~es Standard Un- Design Relative Confidence limits Value error weighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban 0.295 0.038 1836 1861 3.581 0.129 0.219 0.372 No education 0.439 0.029 1836 1861 2.462 0.065 0.382 0.496 With secondary education or higher 0.331 0.025 1836 1861 2.245 0.074 0.282 0.381 Never married 0.258 0.011 1836 1861 1.103 0.044 0.235 0.280 Currently married/in union 0.710 0.011 1836 1861 1.060 0.016 0.688 0.732 Married before age 20 0.634 0.021 i465 1486 1.677 0.033 0.592 0.676 Sex before age 18 0.466 0.018 1465 1486 1.369 0.038 0.430 0.502 Children ever born 2.741 0.069 1836 1861 1.086 0.025 2.604 2.878 Children ever born to women over 40 5.811 0.177 268 277 1.085 0.031 5.456 6.166 Children surviving 2.453 0.060 1836 1861 1.072 0.025 2.333 2.574 Knowing any contraceptive method 0.700 0.025 1297 1321 1.996 0.036 0.650 0.751 Knowing any modem contraceptive method 0.677 0.026 1297 1321 2.018 0.039 0.624 0.729 Ever used any contraceptive method 0.316 0.021 1297 1321 1.630 0.067 0.274 0.358 Currently using any method 0.178 0.016 1297 1321 1.542 0.092 0.145 0.211 Currently using a modern method 0.109 0.017 1297 1321 2.010 0.160 0.074 0.144 Currently using pill 0.029 0.007 1297 1321 1.508 0.244 0.015 0.043 Currently using IUD 0.021 0.005 1297 1321 1.267 0.239 0.011 0.031 Currently using injectables 0.042 0.009 1297 I321 1.578 0.210 0.024 0.059 Currently using implants 0.001 0.001 1297 1321 0.823 1.005 0.000 0.002 Currently using condom 0.010 0.003 1297 1321 0.982 0.278 0.004 0.015 Currently using female sterilisation 0.005 0.002 1297 1321 0.906 0.363 0.001 0.008 Currently using periodic abstinence 0.054 0.007 1297 1321 1.190 0.138 0.039 0.069 Currently using withdrawal 0.006 0.002 1297 1321 1.096 0.379 0.002 0.011 Using public sector source 0.526 0.047 188 190 1.298 0.090 0.431 0.621 Want no more childrerdstedlised 0.191 0.016 1297 1321 1.445 0.083 0.160 0.223 Want to delay at least 2 years 0.255 0.015 1297 1321 1.223 0.058 0.225 0.284 Ideal number of children 5.779 0.111 I583 1602 1.762 0.019 5.558 6.00I Mothers received tetanus injection 0.677 0.032 695 704 1.692 0.047 0.613 0.741 Mothers received medical cam at birth 0.470 0.028 695 704 1.374 0.060 0.413 0.526 Had dlarrhoea in the last 2 weeks 0.146 0.014 642 649 0.986 0.095 0.119 0.174 Treated with ORS packets 0.529 0.051 95 95 0.979 0.096 0.427 0.631 Having health card, seen 0.230 0.034 222 224 1.196 0.148 0.162 0.298 Received BCG vaccination 0.679 0.041 222 224 1.291 0.060 0.597 0.760 Received DPT vaccination (3 doses) 0.312 0.049 222 224 1.558 0.157 0.214 0.411 Received polio vaccination (3 doses) 0.263 0.041 222 224 1.357 0.155 0.182 0.344 Received measles vaccination 0.453 0.043 222 224 1.273 0.095 0.367 0.539 Fully immunised 0.196 0.035 222 224 1.287 0.178 0.127 0.266 Weight-for-height (below -2 SD) 0.100 0.018 283 291 0.992 0.174 0.065 0.135 Height-for-age (below -2 SD) 0.531 0.038 283 291 1.253 0.071 0.456 0.606 Weight-for-age (below -2 SD) 0.239 0.027 283 291 1.047 0.112 0.185 0.292 Total feg&Frty rate (5 years) 4.492 0.190 NA 8314 1.584 0.042 4.112 4.871 Neonatal mortality rate (0-9 years) 23.815 3.850 1298 1320 1.095 0.162 16.115 31.515 Postneonatal mortality rate (0-9 years) 26.478 4.170 NA NA NA 0.157 18.139 34.818 Infant mortality rate (0-9 years) 50.293 6.437 I302 1324 1.176 0.128 37.420 63.166 Child mortality rate (0-9 years) 35.511 5.052 1308 1330 1.100 0.142 25.407 45.615 Under-five mortality rate (0-9 years) 84.018 9.037 I313 1336 1.230 0.108 65.943 102.093 NA = Not applicable 198 APPENDIX C ANALYSIS OF DATA QUALITY APPENDIX C ANALYSIS OF DATA QUALITY This Appendix provides an assessment of the quality of the 1999 Nigeria Demographic and Health Survey data. For this purpose, information on the age and sex distribution of the household members is assessed, as are data concerning the extent of missing values, data on fertility levels and trends, and the reporting of childhood mortality. C.1 Age and Sex Distribution Table C.1 presents the distribution of the household population in single years of age according to sex. As was mentioned in Chapter 2, the data show a high level of"heaping" on ages ending in "0" and "5", particularly among women. For example, the number of men and women reported as being age 30 is more than 6 times the nurnber reported as being age 31 (see Figure 2.2 in Chapter 2). Such heaping is common in developing countries where many people do not know their ages. Also, ages of household members were often reported by another member who may not know the ages of all people listed and may have rounded ages up or down. Somewhat more disconcerting than the high level of heaping is the large number of women reported as being age 9 (877 versus 372 age 10). This is almost certainly due to the fact that women age 10-49 were eligible for individual interviews, which often require making call-backs to the household if the girl is not at home. A likely explanation is that some interviewers intentionally displaced women age 10, 11, 12, etc. to younger ages so as to avoid having to do the extra interviewing This explanation gains credence from the fact that the number of 10-year-old boys is considerably higher than the number of 10-year-old girls and the number of boys age 9 is considerably lower than the number of girls age 9.1 The fact that for all ages between I0 and 14, there are many more men than women implies that some young girls may have been omitted from the household roster altogether in order to reduce the interviewer's workload. Although this distorts the age distribution, especially for young women (see Figure 2.1 in Chapter 2), it probably does not affect many of the indicators covered in this report, since women under age 15 are unlikely to have borne a child or to be using contraception. In fact, the very nature of the questions asked may have contributed to the incentive for interviewers to reduce the number of girls age I 0-14, since it is sometimes awkward to ask girls about their sexual behaviour, fertility, and contraceptive use. Table C.2 shows the age distribution of the population listed in the household and of women interviewed individually. Not only is the proportion of women age 10-14 listed in the household low, but also the percentage of these women who were successfully interviewed is low (88 percent). Figure C. 1 shows the age distribution of womenrespondents from the 1990 and 1999 NDHS surveys. On the whole, the 1999 survey has a better age distribution, especially for age group 15-19. It seems that interviewing 10- to 14-year-old girls may have "protected" the 15- to 19-year-olds from age transference. There is still approximately the same number of women in the 20-24 and 25-29 age groups, which is likely due to age mistatement. i The age range for eligibility for interviewing with the Men's Questionnaire was 15-64 and only men living in every third household were eligible. 201 Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Nigeria 1999 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent 0 549 2.9 544 2.9 38 I76 0.9 194 1.0 1 570 3.0 549 2.9 39 94 0.5 108 0.6 2 528 2.8 496 2.7 40 533 2.8 435 2.3 3 575 3.0 534 2.9 41 68 0.4 41 0.2 4 731 3.9 639 3.4 42 126 0.7 125 0.7 5 718 3.8 647 3.5 43 65 0.3 68 0.4 6 657 3.5 619 3.3 44 46 0.2 59 0,3 7 668 3.5 654 3.5 45 356 1.9 264 1.4 8 617 3.3 647 3.5 46 58 0.3 75 0.4 9 538 2,8 877 4.7 47 78 0.4 73 0.4 10 699 3,7 372 2.0 48 90 0.5 107 0.6 11 392 2.1 257 1.4 49 71 0.4 80 0.4 12 605 3.2 429 2.3 50 356 1.9 358 1.9 13 480 2.5 382 2.0 51 34 0.2 75 0.4 14 487 2.6 376 2.0 52 84 0.4 136 0.7 15 502 2.6 463 2.5 53 54 0.3 68 0.4 16 336 1.8 336 1.8 54 42 0.2 55 0.3 17 362 1.9 353 1.9 55 198 1.0 180 1.0 18 439 2.3 458 2.5 56 52 0.3 57 0.3 19 266 1.4 307 1.6 57 46 0.2 27 0.1 20 448 2.4 638 3.4 58 49 0.3 44 0.2 21 179 0.9 231 1.2 59 29 0.2 23 0.1 22 245 1.3 300 1.6 60 244 1.3 264 1.4 23 201 1.1 234 1.3 61 17 0.1 18 0.I 24 175 0.9 218 1.2 62 53 0.3 40 0.2 25 508 2.7 636 3.4 63 36 0.2 21 0.1 26 180 1.0 265 1.3 64 24 0.I 14 0.1 27 212 1.1 239 1.3 65 160 0.8 116 0.6 28 238 1.3 303 1.6 66 46 0.2 I3 0.I 29 I39 0.7 150 0.8 67 49 0.3 22 0.1 30 567 3.0 656 3.5 68 38 0.2 32 0.2 31 87 0.5 109 0.6 69 23 0.1 14 0.1 32 181 1.0 222 1.2 70+ 531 2.8 358 1.9 33 117 0.6 124 0.7 Don't know/ 34 98 0.5 118 0.6 Missing 26 0.1 28 0.1 35 477 2,5 462 2.5 36 109 0.6 153 0.8 Total 18,932 100.0 18,683 I00.0 37 98 0.5 109 0.6 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. 202 Table C.2 Age distribution of eligible and interviewed women Percent distribution of the de facto household population of women age 5-54, and of interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted) by five-year age groups, Nigeria 1999 Percentage Household Interviewed of eligible population women women interviewed Age Number Percent Number Percent (weighted) 5-9 3,445 NA NA NA NA 10-14 1,817 17.3 1,605 16.4 88.3 15-19 1,918 18.2 1,769 18.1 92.3 20-24 1,622 15.4 1,533 15.6 94.5 25-29 1,573 15.0 1,50I 15.3 95.4 30-34 1,228 11.7 1,171 12.0 95.3 35-39 1,027 9.8 959 9.8 93.4 40-44 728 6.9 691 7.1 94.9 45-49 599 5.7 570 5.8 95.2 50-54 693 NA NA NA NA 10-49 10,513 NA 9,800 NA 93.2 Note: The de facto population includes all residents and nonresidents who slept in the household the night before interview. NA = Not applicable Figure 0.1 Percent Distribution of Women 15-49 by Age Group, Nigeria 1990 and 1999 25 r 20 ~ -_ . . . . . . .5 . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-18 20-24 25-29 30"34 35-39 49-44 Age I"v'1990 4"19991 45-49 203 C.2 Completeness of Reporting Table C.3 presents data on the percentage of cases with missing values for certain key indicators. For example, for all births recorded in the birth history section of the Women's Questionnaires as having occurred in the 15 years prior to the survey, 16 percent were missing a month of birth, while 1 percent were missing both month and year. Most variables have moderate levels of missing values. An exception is the variable concerning children's size at birth, which was missing for the vast majority of births in the three years preceding the survey. Although height and weight information was missing for only 8 percent of children under five, the anthropometric data were deemed to be implausible for a much larger proportion (42 percent) of children under three (not shown). TableC.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Nigeria 1999 Percentage Number missing of Subject Reference group information cases Birth date Births in last 15 years Month only 16.0 16,910 Month and year 1.4 16,910 Age at death Deaths to births in last 15 years 3.9 2,212 Age/date at first union 1 Ever-married women 4.5 6,129 Respondent's education All women 0.3 9,810 Child's size at birth Births in last 59 months 57.5 1,193 Anthropometry z Children under ago 3 Height missing 7.6 3,208 Weight missing 7.5 3,208 Height or weight missing 8.1 3,208 Diarrhoea in last 2 weeks Children under 3 years 2.7 3,208 1 Both year and age missing 2 Child not measured C.3 Fertility Data An important measure of data quality is the completeness and accuracy of information on births. Table C.4 shows births by calendar year and survival status for the 1999 NDHS. Figure C.2 shows the same data graphically, as well as a smoothed average number of b'n~hs by year. The data show an unexpected drop in the number of births recorded for 1996 (1,122) and 1997 (1,150), relative to 1995 (1,430) and 1994 (1,361). This is no doubt due to either birth transference (i.e., interviewers deliberately misrecording dates of birth in order to avoid having to ask the questions in the lengthy health section which are aimed at births occurring since January 1996) or birth omission (also to avoid asking the questions in the health section). Birth transference across a cut-off date results in a characteristic spike in births in the year or two prior to the cut-off and a deep trough just after the cut-off date. The data from the 1999 NDHS do not show the spike, but rather only a trough in births for 1996 and 1997, a pattern that is more consistent with omission of births. 204 to 0 L~ Table C.4 Births by calendar years Distribution of births by Western calendar years for l iving (L), dead (D), and all (T) children, according to reporting completeness, sex ratio at birth, and ratio of births by calendar year, Nigeria 1999 Percentage with Number of births complete birth date t Sex ratio at birth S Calendar ratio 3 Male Female Year L D T L D T L D T L D T L D T L D T 99 415 25 440 98.9 91.6 98.5 89.3 84,7 89.0 NA NA NA 196 11 207 219 13 233 98 1,322 114 1,436 94.0 77.1 92.7 101.1 85.7 99.8 185.3 139.5 180.6 665 52 717 658 61 719 97 1,012 138 1,150 89.7 77.6 88.2 117.2 124,0 118.0 87.5 113.0 89.9 546 76 622 466 62 528 96 992 131 1,122 89.8 70.3 87.5 102.5 123,2 104.7 88.5 77.5 87.0 502 72 574 490 59 548 95 1,230 199 1,430 87.6 64.3 84.3 107.5 94,4 105.6 113.5 126.5 115.1 637 97 734 593 103 695 94 1,176 185 1,361 83.9 75.8 82.8 122.3 79,6 115.4 98.5 98.8 98.6 647 82 729 529 103 632 93 1,158 174 1,332 83.5 77.3 82.7 105.0 130,9 108.1 99.3 96.4 98.9 593 99 692 565 75 640 92 1,155 177 1,332 85.8 68.4 83.5 100.8 149.2 106.1 107.1 110.6 107.6 580 106 686 575 71 646 91 999 146 1,145 82.8 64.0 80.4 102.3 118.3 104.2 92.3 84.6 91.3 505 79 584 494 67 560 90 1,008 168 1,176 85.1 60.8 81.6 89.9 110.9 92.7 NA NA NA 477 88 565 531 80 610 95-99 4,971 607 5,578 91.1 72.2 89.0 105.0 104.0 104.8 NA NA NA 2,546 309 2,855 2,426 297 2,723 90-94 5,496 849 6,345 84.2 69.6 82.3 I04.1 114.7 105.4 NA NA NA 2,802 454 3,256 2,693 396 3,089 85-89 3,899 703 4,601 83.1 67.5 80.7 116.7 113,7 116.3 NA NA NA 2,100 374 2,474 1,799 329 2,128 80-84 2,901 582 3,484 82.9 62.8 79.6 116.9 114,0 116.4 NA NA NA 1,564 310 1,874 1,338 272 1,610 <80 2,701 665 3,366 81.0 63.4 77.5 115.2 129,8 118.0 NA NA NA 1,446 376 1,822 1,255 289 1,544 All 19,968 3,406 23,375 85.1 67.3 82.5 110.0 115.1 110.7 NA NA NA 10,458 1,823 12,281 9,510 1,583 11,094 NA = Not applicable 1 Both year and month of birth given 2 (Bm/Bf). 100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx t+Bx+l)].100, where B x is the number of births in calendar year x Figure C.2 also shows the estimated nmnber of births for 1996 through 1999. The estimation was by artificially increasing the number of births each year to extend the smoothed line. 2 Comparing the total number of estimated births for these years with the reported number (after inflating the partial-year 1999 figure to a full 12-month period) gives about 22 percent more estimated births than recorded births. For the five-year period before the survey (the period for which fertility rates were calculated in this report), the difference between the estimated number and the reported number is about 17 percent. Adjusting the reported total fertility rate of 5.2 for the five years before the survey by this amount would give an adjusted rate of 6.0. Figure C.2 Births per Calendar Year, Nigeria DHS 1999 Number of births 1500 1000 S00 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 I-S-Births ~Smoothed -~-Estirnated I Another way to assess fertility data is to compare results from two survey for the same time period. A comparison between the total fertility rate for the five-year period prior to 1990 (1986-1990) based on the 1990 and 1999 NDHS data gives approximately the same values--5.9 and 6.0, respectively. This test indicates that the 1990 survey probably gave approximately correct values of the total fertility rate for the period immediately preceding the survey and that the 1999 survey does not under-represent births for the more distant past. A final comparison can be made using a model developed by Bongaarts (1978). Using data on the factors that determine the level of fertility, like contraceptive use, age at marriage, etc., along with a hypothetical level of "natural" fertility, it is possible to calculate an implied level of fertility. Application of the model to data from the 1990 NDHS gives an implied level of fertility that is very close to the actual reported level. For the 1999 NDHS, however, the difference between the implied and actual level of fertility is 16 percent--6.0 compared with 5.2. While the Bongaarts model is not applicable in all situations, 2 Since the increase in the smoothed number of births between 1992 and 1993 was 51, 50 births were added to the number of births in 1995 to get the estimated number of births in 1996, to which were added 40 births to get the estimated number of births in 1997, to which were added 30 births to get the estimated number for 1998, to which were added 20 to get the estimated number for 1999. 206 particularly those in which women have a set goal for the number of children, it is likely to be applicable to Nigeria where contraception is used mostly before the first birth and for spacing. In conclusion, there is a shortfall in the number of recent births reported in the 1999 NDHS. This shortfall results in an underestimate of current fertility of about 16-17 percent. A more likely estimate of the total fertility rate for the 5-year period preceding the survey is 6.0 births per woman. C.4 Data on Childhood Mortality A comparison of the under-five mortality estimates for 5-year time periods immediately preceding the 1990 and 1999 NDHSs indicates a substantial mortality decline, from 190 deaths per 1,000 births to 140 per 1,000. The implied rapid mortality decline over a 9-year period could be interpreted as an indication that health conditions are improving in Nigeria. Such an interpretation is valid only if the mortality data collected in the 1999 NDHS are reliable. Structure of the Survey Instruments One perspective from which to assess the data quality is to consider whether the structure of the 1999 survey instruments could have encouraged underreporting of events. In this regard, two sections of the Women's Quesfionnairerequirecomment--Reproduction(Section2) and Health(Section4). Alll ivebirths are to be recorded in the birth history of the Reproduction Section, including information such as: name, month and year of biffh, sex and survival status. The Health Section includes a substantial number of questions that are asked about each birth occurring in January 1996 or later. The Reproduction and Health Sections of the 1999 Women's Questionnaire are quite similar to those of the 1990 NDHS with the exception of the addition of a cause of death module asked of mothers for all deceased children born since January 1996. The added burden of these new questions could create motivation for underreporting of events in the 1999 survey. While the cause of death module consists of about 25 questions, because of skips in the questionnaire, only 10 or 15 questions are asked about any deceased child. Nevertheless, respondents might underreport deceased children in order to avoid discussing those painful events. This is possible especially in rural areas where the content of the questionnaire will be quickly known throughout a village. It is also possible that interviewers would purposely fail to record the births of deceased children in the birth history so as to avoid having to ask the unpleasant questions in the Health Section. Internal Data Consistency in the 1999 NDHS Another means of assessing data quality is to apply standard tests of the internal data consistency to detect data defects (i.e., misreporting of dates of birth and ages at death). Shortfall in Births As discussed above (C.3 Fertility Data), there appears to be a shortfall in the number of births reported as occurring in the few years prior to the survey. At issue here is whether or not the shortfall affects infant mortality estimates. Mortality rates in this report are estimated for five-year time periods preceding the survey, the first of which approximately covers the period March 1994 -March 1999. Thus, to the extent that the biff-h shortfall in 1996 and 1997 is dueto transfer of events to 1995 and 1994, but not to earlier years, it will have little or no impact on the estimation of mortality. On the other hand, to the extent the birth dearth is due to omission that is selective for the survivorship status of a child rather than to birth transference, this would tend to negatively bias mortality estimates. 207 Misreporting of Age at Death Misreporting of age at death cart result in overestimatiort or underestimation of mortality rates for specific ages. In particular, if late infant deaths are reported as deaths at age one as a result of rounding to the nearest year, this would result in underestimates of infant mortality and overestimates of mortality at age one. The occurrence of such rounding can be avoided (and detected if it occurs) by requiring that age of death be recorded in terms of months of age. To minimise the error in reporting of age at death, interviewers were instructed to record the age at death in days for deaths under one month and in months for deaths under two years. They also were asked to probe for deaths reported at one year to ensure that they actually occurred at 12 months. Table C.5 shows the distribution of deaths under one month old by the age at death in days. There is evidence of some heaping on 7 days and to a lesser extent, on 14 days. When selective omission of childhood deaths occurs, it is usually most severe for deaths in early infancy. However, the proportion of neonatal deaths occurring in the first week of life is high, 70 percent for the period 0-4 years before the survey. The fact that the proportion declines the further back in time is an indication that early neonatal deaths occurring longer before the survey may have been omitted. Table C.6 shows the distribution of deceased children by reported age at death in months. In these distributions, rounding up late infant deaths to age one would be evident as a shortage of deaths at months 9, 10 and 11 and a peak of deaths at 12 months of age. Table C.6 does indicate a greater number of deaths at 12 months of age than in months of late infancy but, to the extent that this is due to misreportJng of age, the problem is not severe. 208 Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-yeas periods preceding the survey (unweighted), Nigeria 1999 Number of years preceding the survey Age at death Total (in days) 0-4 5-9 10-14 15-19 0-19 <1 46 52 29 15 142 1 45 28 31 20 124 2 11 9 9 5 34 3 15 15 12 12 54 4 16 6 6 5 33 5 15 10 10 7 42 6 5 12 5 7 29 7 17 20 12 10 59 8 11 4 4 10 29 9 11 7 3 3 24 10 4 8 3 2 17 I1 2 1 0 2 5 12 2 2 0 0 4 13 0 1 1 1 3 14 3 9 7 8 27 15 2 1 0 4 7 16 0 2 2 0 4 17 0 0 0 1 1 18 1 1 1 0 3 19 1 1 1 0 3 20 4 0 1 4 9 21 3 3 3 1 10 22 0 0 0 1 1 23 0 I 0 0 1 24 0 2 1 1 4 25 1 0 1 0 2 27 0 1 0 0 1 28 0 1 1 1 3 29 0 1 0 0 1 30 2 0 1 0 4 31+ 1 5 4 0 10 Missing 0 0 3 0 3 Total0-301 217 198 145 122 682 Percentearly neonatal ~ 70.4 66.5 70.7 58.5 67.2 l Includes cases for which age at death (in exact days) is not known 2 (0-6 days/0-30 days) * 100 209 Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods preceding the survey (unweighted), Nigeria 1999 Number of years preceding the survey Age at death Total (in months) 0-4 5-9 10-14 15-19 0-19 <1 a 218 198 148 125 689 1 24 27 2I 13 85 2 27 29 22 18 97 3 25 26 i9 15 85 4 15 6 11 8 40 5 19 6 11 12 47 6 19 27 11 13 70 7 16 26 20 14 76 8 20 lg 13 13 63 9 18 17 18 6 60 10 8 13 i5 5 40 11 10 5 7 4 26 12 16 14 16 12 58 13 3 3 4 3 13 14 6 9 1 2 19 15 4 5 7 2 18 16 4 3 5 4 16 17 4 5 1 2 13 18 8 12 6 6 32 19 1 0 4 1 6 20 3 5 3 1 12 21 1 0 1 0 2 23 2 1 0 0 3 24+ 2 5 5 4 16 Missing 3 3 1 0 7 1 year 68 82 49 47 246 Tot~0-11 b 418 398 315 246 1,377 Percentneonat~ e 52.2 49.7 47.0 50.7 50.0 a Includes deaths under 1 month reported in days b W ' ' ' e lncludes c~ses fur hich age at death (m exact months) is not known (under 1 month/under 1 year) * 100 A more important problem with the age at death data is the substantial number of deaths that are reported at one year of age (i.e., deaths that should have been reported in month of age). Indeed, for the period immediately prior to the survey, more deaths are reported at age one (68) than in terms of months 12- 23 (52). This is unfortunate because it is not possible to determine if these deaths are the result of rounding of age at death to the nearest year or if these events occurred at one year of age. It should be noted that the field supervisors had instructions to check questionnaires for this error. The routine practice by interviewers of recording deaths at one year of age (rather than in terms of months) indicates that little or no attention was paid to this editing rule by the supervisors of interviewing teams. Inconsistency of Mortality Levels and Health Status by Region It is reasonable to assume that differentials in mortality levels would correspond with differentials in child health indicators. However, the rankings of the regions in terms of mortality levels and health 210 indicators are not consistent. For example, under-five mortality in the Southeast (149) and Southwest (102) Regions is higher than in Central Region (91)--thlly 50 percent higher in the case of Southeast. However, both Southeast and Southwest rank higher than the Central Region for health indicators like antenatal care coverage (82 percent in Southeast and 89 percent in Southwest vs.76 percent in Central) and delivery in a health facility (55 percent of births in Southeast, 67 percent in Southwest, and 44 percent in Central). Tetanus toxoid coverage for pregnant women, the percentage of births assisted by health professionals and the percentage of children fully immtmised are all higher in Southeast and Southwest than in Central Region. Comparison with External Data The most straightforward procedure for evaluating the quality of the mortality estimates from the 1999 NDHS is by comparison with estimates from an external source such as the 1990 NDHS. The 1990 NDHS is a particularly appropriate reference because the data collection and estimation methodology is similar to that of the 1999 NDHS (i.e., direct calculation of mortality rates is possible in both surveys). On the assumption that respondents do not overreport deceased children in surveys, the mortality rates from the 1990 NDHS are considered minimum estimates. Table C.7 shows mortality estimates from the 1990 and 1999 NDHS for the latter part of the decade of the 1980s. For this comparison, respondents to the 1999 survey were required to recall events over a longer retrospective period than were respondents to the 1990 survey so that estimates from 1999 survey are more susceptible to respondent recall error. The estimates from the 1999 survey are consistently lower than those from the 1990 survey---by 11 percent for infant mortality, 39 percent for child mortality and 26 percent for under-five mortality. Table C.7 Childhood mortality rates for the late 1980s Childhood mortality rates for the late 1980s as estimated from the 1990 and 1999 NDHSs, according to region Po~t- Country/ Time Neonatal neonatal Infant Child Under-five Region Source period mortality mortality mortality mortality mortality Northeast 1990 NDHS 1995-90 30.0 35,6 65.6 163.9 218.9 1999 NDHS 1994-99 49.6 46,7 96.3 96.9 183.9 % difference 65 31 47 -41 -16 Northwest 1990 NDHS 1985-90 50.0 65,9 115.8 208.5 300.2 1999 NDHS 1994-99 25.6 68,9 94.5 151.9 232.1 % difference -49 5 - 18 - 27 - 23 Southeast 1990 NDHS 1985-90 37.1 43.7 80.8 75.9 150.6 1999 NDHS 1994-99 38.1 41.7 79.8 45.2 121.4 % difference 3 -5 - 1 -40 - 19 Southwest 1990 NDHS 1985-90 41.7 32,9 74.7 88.4 156.4 1999 NDHS 1994-99 42.3 44.3 86.7 47.0 129.8 % difference 1 35 16 -47 - 17 Central 1990 NDHS 1985-90 39.9 46.5 96.5 71.2 160.8 1999 NDHS 1994-99 25.6 27,7 53.4 53.7 104.2 % difference -36 -40 -45 -25 -35 Nigeria 1990 NDHS 1985-90 42.2 45.2 87.4 115.5 192.8 1999 NDHS 1994-99 36.4 41.2 77.6 70.7 142.8 % difference -14 -9 -11 -39 -26 211 Table C.7 also shows mortality estimates by region, s Disaggregation of the estimates in this manner can be useful in revealing specific areas in which data defects exist. The sampling variance associated with regional estimates for 5-year time periods is large but it was decided to show 5-year rather than ten-year rates so that the analysis of this note would be organised in a consistent fashion. In Northeast, Northwest, Southeast and Southwest Regions, under-five mortality estimates from the 1999 survey are lower than those from the 1990 survey by 16-23 percent. In Central Region the under-rive estimate is lower by 35 percent. There is no doubt that the 1999 survey underestimates mortality at the national and regional levels for the time period 1984-89. In addition, underestimation appears to have occurred in all regions but is most pronounced in Central Region. Of course, underestimation of mortality for the 1984-89 time period does not necessarily imply underestimation of mortality for more recent time periods. Table C.8 shows the differences in mortality estimates for the five-year periods immediately prior to the 1990 and 1999 surveys (i.e., for 1985-90 in the case of the 1990 NDHS and for 1994-99 in the case of the 1999 NDHS). The implied trends indicate substantial mortality declines over a nine-year per iod--a 14 percent decline for infant mortality, 39 percent for child mortality and 27 percent for under-rive Table C.8 Trends in childhood mortality by region Childhood mortality rates for the five years before the 1990 and 1999 NDHS, according to region Post- Country/ Time Neonatal neonatal Infant Child Under-flve Region Source period mortality mortality mortality mortality mortality Northeast 1990 NDHS 1985-90 30.0 35.6 65.6 163.9 218.9 1999 NDHS 1994-99 50.9 36.7 87.6 114.4 I92.0 % difference 70 3 34 -30 - 12 Northwest 1990 blDHS 1985-90 50.0 65.9 115.8 208.5 300.2 1999 NDHS 1994-99 22.7 55.4 78.2 101.1 171.3 % difference -55 -16 -32 -52 -43 Southeast 1990 NDHS 1985-90 37.1 43.7 80.8 75.9 150.6 1999 NDHS 1994-99 38.4 42.7 81.1 74.3 149.4 % difference 4 -2 0 -2 - 1 Southwest I990 NDHS 1985-90 41.7 32.9 74.7 88.4 156.4 1999 NDHS 1994-99 39.8 32.8 72.7 31.7 102.1 % difference -5 0 -3 -64 -35 Central 1990 NDHS 1985-90 39.9 46.5 96.5 71.2 160.8 1999 NDHS 1994-99 29.9 26.1 56.0 36.9 90.8 % difference -25 -44 -42 -48 -44 Nigeria 1990 NDHS 1995-90 42.2 45.2 87.4 115.5 192.8 I999 NDH8 1994-99 38.8 38.2 75.1 70.3 140.1 % difference -8 -15 -14 -39 -27 3 For this armlysis the data from the 1990 survey are presented for the five regions of Nigeria existing at the time of the 1999 survey. The 21 states and F.C.T. Abuja that existed at the time of the 1990 survey map unambiguously into the five regions existing at the time of the 1999 survey. That mapping is as follows: Northeast: Bauchi. Bomo, Kano Northwest: Kaduna, Katsina, Sokoto Southeast: Anambra, Akwa Ibom, Cross River, Imo, Rivers Southwest: Bendel, Lagos, Ogun, Ondo, Oyo Central: Benue, F.C.T. Abuja, Gongola, Kwara, Niger, Plateau 212 mortality.4 Mortality declines of this magnitude are rare but not without precedent in high-mortality African countries. Declines of a similar magnitude (on the order of 30 percent) and structure (concentrated between exact ages 1 to 5) have occurred over ten-year periods in Ghana, Cameroon, Senegal and Rwanda (Bicego and Ahmad, 1996). However, substantial mortality declines are usually accompanied by improvements in socioeconomic or health conditions. For example, substantial improvements occurred in the percentage of children who were fully immunised in Ghana and Senegal. Not only is there no such improvement in Nigeria, but the percentage of children fully immunised actually declined in Nigeria from 30 to 17 percent, hardly the kind of change in health care that is associated with a mortality decline. Table C.8 also shows implied mortality trends by region. The Southeast Region is distinctive in that little change exists between the estimates for the 1990 and the 1999 surveys. The remaining four regions show mortality declines; the Northwest and Central Regions standing out with declines in under-five mortality in excess of40percent. The Northwest Regionindicates a substantial declineinneonatal mo~l i ty (55 percent) which strains credibility. As a result, the level of neonatal mortality in Northwest (23) appears to be inconsistent with the observed postneonatal rate (55) and is the lowest of all the regions. Indirect Mortality Estimates R might be thought that any problems that exist in the 1999 mortality data could be overcome by using indirect mortality estimation techniques. The earlier analysis suggests that the primary problem with the 1999 data is underreporting of infant and child deaths, which results in the appearance of a substantial decline in mortality between the 1990 and 1999 surveys (a 27 percent decline in the case of under-five mortality). However, the indirect techniques cannot in any way compensate for underreporting of events. This will be demonstrated by comparing indirect estimates calculated from the 1990 and 1999 surveys. Table C.9 shows indirect estimates of infant and under five mortality from the two surveys. Two points are worth noting. First, the declines in mortality between surveys, as measured by either infant or under-five mortality are of the same order of magnitude as is the case with the direct under-five mortality estimates (20-30 percent over a nine-year period). Thus, the appearance of a substantial intersurvey decline in mortality is unmitigated when mortality rates are calculated by indirect techniques for both surveys. The second point is that the indirect estimates of infant mortality are much greater than the corresponding direct estimates. For example, the direct rate from the 1999 survey (75 per 1,000) is 22 percent less than the indirect estimate, based on women 20-24 (95 per 1,000). This is due to modeling error resulting when the indirect procedure is used for Nigeria, a country in which the assumptions of the model are not fully met. Thus, the indirect infant mortality estimate from the 1999 survey cannot be compared to the direct estimate from the 1990 survey. 4 The trend of the mortality estimates from the 1999 survey between 1985-90 and 1994-99 is essentially flat. 213 Table C.9 Indirect mortality estimates Indirect estimates of infant and under-five mortality, 1990 and 1999 EDHS Proportion of Children Deceased by Age 1990 NDHS 1999 NDHS Children Children Age group ever Chi Idren Proportion ever Children Proportion of women born surviving dead born surviving dead 15-19 0.311 0.262 .158 0.250 0.220 .120 20-24 1.443 1.187 .177 1.120 0.980 .125 25-29 2.966 2.441 .177 2.510 2.180 .I31 30-34 4.578 3.772 .176 3.940 3.400 .137 35-39 5.529 4.338 .215 5.240 4.470 .147 Indirect Mortality Estimates Infant mortality rate (per 1,000 births) Under-five mortality per 1,000 births Age group 1990 1999 Percent 1990 1999 Percent of women NDHS NDHS change NDHS NDHS change 20-24 131 95 -27 221 156 -29 25-29 115 90 -23 192 145 -24 30-34 106 86 -19 175 139 -21 35-39 118 85 -28 197 139 -29 Note: Estimates are based on the UN North Model Life Tables. Summary Any assessment of the quality of survey-based data will find internal and external inconsistencies. Sampling variability can contribute to such findings especially when considering data at the regional as opposed to the national level. So, a data quality assessment often requires a judgement as to whether the degree of the inconsistency indicates acceptable departures from expected patterns or severe data problems. There are a number of problems with the data of the 1999 NDHS. There is clear evidence of underreporting of events for the time period 1984-89. The magnitude of the mortality decline implied by the estimates from the 1990 and 1999 surveys ranks among the largest observed in high-mortality African countries. Yet, the health indicators for Nigeria indicate a deterioration of immunisation coverage for children over the last decade. The neonatal mortality rate for the Northeast Region is unrealistically low and inconsistent with the postneonatal mortality rate. Both the mortality and the fertility data for the Central Region appear particularly flawed. The weight of evidence indicates that the mortality rates based on the data are most probably underestimates. Moreover, the nature and scope of the data defects leading to this conclusion suggest that the possibility of repairing these data so that they would form the basis for reliable mortality estimates for Nigeria is not good. This review is useful because of the implications for future surveys that attempt to estimate mortality in the Nigerian setting. It is not the purpose here to specify the design parameters that are necessary to ensure that reliable data are collected. Such design features are well known and it should be a high priority of the next survey to put them in place. 214 APPENDIX D PERSONS INVOLVED IN THE 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY APPENDIX D PERSONS INVOLVED IN THE 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 1999 NDHS IMPLEMENTATION COMMITTEE Prof. R. IL Udo Mr. B. I. Gwahi Dr. A. A. Kadejo Mr. Osamwonyi Osagie Mr. S, O, Alaneme Prof. G.B. Fosu Mr, A. A. Akinkunle Mr. C. C. Ucheudu Dr. S. I. Kalu Mr. A. Ozoilo Mr. I. B. Jalingo Chairman Member Member Project Director Deputy I)'trector (Surveys) UNFPA/CTA Assistant Director (ITD) Assistant Director (Cartography) Head, Data Analysis Unit Project Accountant Project Coordinator/Secretary MACRO INTERNATIONAL STAFF Ms Anne R. Cross Dr. Alfredo P. Aliaga Ms. Jeanne Cushing Ms. Elizabeth Britton Dr. Jacob Adetunji Dr. Jeremiah Sullivan Dr, Shea Rutstein Dr, Sidney Moore Ms. Kaye Mitchell Mr. Darrin Helsel Regional Coordinator Sampling Specialist Data Processing Specialist Data Processing Specialist Consultant (Report Writing) Analyst Analyst Editor Report Production Specialist Dissemination Specialist REPORT WRITING STAFF Mr, O. Osagie Prof. G. B, Fosu Mr. S.O. Ogunlade Mr. J.D. Zubema Mr. D. Chiso Dr. I.L Suliaman Mr. F, O. Alao Mr. O.E. Adonri Mr. O. Osifo Mr. B. B. Akinsulie Mrs.D. S, Saidu Mrs. O.A. Ogunlewe Mr. A. B. Sadiku Mr. A.A Atobasire Mr. M.K. Usman Mr. I,B. Jalingo Mr. O.R. Ologun Mrs. E.E. Idoko Mr. C.B. Arttkwe Mrs. A, O. Oshideko Mrs. E.A.Olanipekun Mr. A.A Olaoye Mr. J. Nwazulum Mr. J. O. Ajayi Mr. O. M. Makinwa Mrs. F, Ajetunmobi Mr. S,O. Alaneme 217 Dr. J. Adettmji Dr. A. B. Sulaiman Prof, C. Oyeka Prof. F.A.D. Oyekanmi Mrs. D. Aken'ova Prof. T. Atinmo Dr. Uche Isiugi Abanihe Dr. A.A. Adeyemo Dr. A .O. Ketiku Resource Persons Mrs. Olugbemi A.O Dr, Bunmi Dosumu Dr.S. Arms Kolo Dr. J .K Bamigbose Mr, Adeosun Mr. J. Edochie Prof. O. Adegbola Mrs. Julie victor Ahuchogu Dr. L. Idoko Secretarial Staff Yemi Oni (Mrs.) G. A. Akpambang (Mrs) A. A. Akeju (Miss) A. O. Awoyemi DATA PROCESSING STAFF Programmers J. Atula E. Iheanacho (Mrs) N. Giwa C. Ulor E. A. Ojo O. Odofin A. Adenowo A. I. Tisor N. Nwanekwu P. O. Mbaegbu F. Adeyemi A. Yohanna Data Entry Operators Y. O. Raji N. Babayemi B. A. Gbaniro A.O. Agtmbiade S.M. Ojigwe H. Opara E.M . O jos ipe K.B. Ajayi-Bembe P. Umehea M. O. Araba CODING STAFF Supervisors O. S. Apeji O.R. Ologtm Coders F. O. Oladele E.N. Ugorji E. N. Onyia J.I. Agekamhe L. N. Onyeji (Mrs) J.K. Uwadia 218 CONTROLSTAFF Supervisors M. A. Okuneye A.A. Atobasire Assistants S. A. Osunola S.O. Lateef F IELD STAFF ZONE 1 Zonal Coordinator Dr. I, L. Sulaiman State Coordinators Manu Adamu Datti Aminu Danbatta Ibrahim Baffa Alhaji Ja'afar Abubakar Yusuf Badawi Mirnga Trainers M. M. Adamu Ibrahim Baffa A. Mahmoud (Mrs.) C.C. Uchendu A. J. Andero A.D. Fasiku Supervisors Sani M. Kura Mustapha Kassim Ubaie Abdullahi Mrs. F. B. Kaita Haruna I. lbrahim Halima Inuwa Raliya M. Sambo Zainab A. Mohammed Lami Bala Mohammed A. Bello Hajara L. Dadi Hadiza. A. Jega Amina Mani Halima L. Dambasau Abba Ado Yola Mary Wetle Fatima Adamu Field Editors Alh, Ibrahim Ririwan Mohd. Sada Bichi Ismaila Musa Yusuf Hussaim Samaila A. Aji Interviewers Laiyanatu Hamisu Sahnunu Umaru Binta Abubakar Zalifa Muhammed Hussaina Musa Amina Tttkur U. A. Mairiga Salma Ibrahim Mwada Kofur Aishatu Yusuf Fati Zanna Musa I. Mshelia 219 Drivers Danladi Yusuf Ahmed Faruk Muhammed Yaskaru Sale Abdu Mul~ar Mustapha ZONE 2 Zonal Coordinator J. D. Zubema State Coordinators S. V, Tsakma I. B. Gwani I. B. Gwani H. S. Ibrahim I, B, Jalingo Musa Chindo Umar Abubakar Sa'ad Trainers Aga, J. H. O. Onimole Supervisors L. G. Dalmat Gar Sani Ali Hamza Abubakar Audu H. Maigoro Field Editors Nicodemus Daniel Rashid M, Haruna Ibrahim Usman S, Mafindi U. Hussaiai Interviewers Bazza Mohammed Late Haniel Talatu Reuben Elsen Garkida Lami Musa Wonokpalukai N. Umaru Joy Simon Waziri Mary Akula Borne Ibrahim M. Sariga Sadiq A. Yusuf Dauda Solomi Yakubu Deborah Yahaya Hauwa Bello Halima Hinna Abubakar M. Aminu O. Lydia Bajo Benedicta Zubairu Halimatu Hassan Hadiza Ibrahim S. Mohammed Drivers Audu Bitrus Ibrahim Adamu Abubakar Ladan Yakubu Ahmadu ZONE 3 Zonal Coordinator Emma E. Attah State Coordinators I. O. Alilionwu R. A, Haniday Eze T. Ihuoma Ntuk A, Nsudoh C. N. Ugban C.S. Bokolo 220 Trainers S. I. Kalu (P.hd) B. Agali O. E. Adonri T.E. Offiong G. N. Arukwe (Mrs.) A.A. Atobasire Supervisors John C. Nwaogazi Richard A. Halliday Eze T. Ihuoma Ntuk Nsudoh C. N. Ngban Field Editors Odinma Okoro Cromwell Bokolo Lawrence Ofonye Okon Mfon Nkanu Edu Interviewers Jiakponna F. N, Torty Mabierei Kanu G. C. Ekeneme D. A. Elendi Chbuihe N. Benibor (Mrs)Tarinabo L. Okardi Ekanem C. W. Wokoma Isiguzo, Priscillia Aprioku, Innocent M. Eke, Pauline A. Emecheta Ben. Nma Ugwuegbu, Anne U. Ibemere Carol C. S. U. Anyanwu Okon Margaret Usudoh Ekere Essien Uduak Alcpan Afflong Essien Mbuk Umo A. Edim Ukpong E. Ika Anne Ude Edikang Peter Bassey Ewa Drivers Anaba Peter Uwanakwa Young Louis Edet Cashimer Onu Umoh Okon ZONE 4 Zonal Coordinator C. C. Mezue State Coordinators O. O. Oni C. Udebunu N. O. Nweze A.A. Okafor J. A. Aga Nweke V. A. Dibia Trainers Okafor, A.A. M.K. Usman C. B. Arukwe A.A. Ugochukwu E.A.Olanipek-un (Mrs) O.S. Apeji 221 Supervisors Amadasun, Isaac O. Okechukwu L. O. Nweke I. L Okpala S. O. Chinwuko O.A. Ogashi, S. O. Field Editors Seidu, A.K. Odo,E. I. Chuku, S.N. Obiozor, M. A. Ujah Francis T. Ogholaja, O. Joseph Interviewers Alagbada, G. O. Omoragbon, A. Sandra Nwaobi Patricia Uhuegho Eubu Rita Ekeoba, S. I. Elibe, C. E. Nweke, I. N. Nnaji-Eze, M. Nwobodo, N. Ani, O. C. Etuka, R. N. Mbala, E. Iwotor, J. E. M. 0. Nwokolka Onigbo, C. A. Akalugo, A. U. Maduagwuna, C. B. lbekwe Chinedu Onwusogbulu, Edith Olasi, J. O. J. Ogagbolo, Jane Atema Eunice A. Ogbogo Linda Adikwu Martha Bello Jibril Nwaogwugwu A. Anthonia Esiekpe O. Florence Ejakpofo Esther Adams Mary Tadate Dan Drivers Eubadmoyi; G. Nnah, K. Imeta, I. Okeke C. Y. Henry Igbakua Sani Felix ZONE 5 Zonal Coordinator B, I, Okuboyejo State Coordinators K. O. Sonowo M.A. Fadipe V. A. Owoyemi J.O. Olanipekun (PhD) Trainers O. Osagie B. Fadipe I. O. Alilionwu Winifred Ittah Ojogun Osifo J. Nwazulum 222 Supervisors Tai K. Oyekan M.E. Adeneye S. A. Ogunleye Omolewa Samson Field Editors Adeyanju, S.A. Obafemi, O. T. Ajayi, D.O. Adu, Sunday O. Interviewers Jatto, M. O. Mbonu Leticia Apantaku, O. O. Adeola, E. F. Ariyo, F. O. Shotade, A. O. Ogunrinde, C. O. Lawrence, B. Ojo, H. K. O. Ayo George Ogundare, O. O. Sokunbi, A. S. Akinsanya, O. A. Ayoola, A. O. Fatoye, I. Ola Ipinlaye, Y. R. Akinduro, R. I. Olagbaye, G. J. Ojo, M. O. Ogunkuade, M. O. Drivers Okuronmu Kayode Oseni, Sorungbe, S.A. Kumuyi, S. A~ ZONE 6 Zonal Coordinator S. A. Ogunlade State Coordinators S. A. Mahmud K.O. Lawal P. M. Salifu J.O. Babatunde Trainers S. O. Ogunlade A. Ogunlewe J. A. Ogunshina H.M. Mbene S. O. Alaneme Supervisors Aminu, Adebola Akanmu, M. O. Abolaji, J.O. Adeyemo, I. G. Field Editors Babaita, I.I. Sangodapo, M. O. Maliki, Babatunde Olaaipekun, S. O. 223 Interviewers Olaogun, F. A. Usman, R. A. Oyerinde, S. F. Adewara, Janet ANNa, O. O. Adeboye, T. M. Afolabi, F. A. Oni, Adebanke Adetona, I. A. Folortmsho, T. K. Obaje, S. F. Ogungbuyi, O. A. Opaluwa, R. A. Yusuf, Sarah Alabi, D. O. Durodola, T. L. Oladosu, M. I. Afolabi, C. M. Olasode, A. I. Oladeji, Z. O. Ajibade, Atanda Drisu, James Drivers Adebayo, Stile Adebayo Johnson ZONE 7 Zonal Coordinator Wetkos Mutihir State Coordinators Mansa Musa Adamu Abdullahi Alhaji Ladan Alfa Mohammed Aliyu G. Khalilu Shuaibu Kasim S.G. Gouler Hajiya A. Mahmud Michael Akok Trainers Shaibu, K. Sulaiman, I. (P.hd) Akinkunle, A.A. Akinsulie, B.B. Adekanmbi, T.O. Winful, O. (Mrs) Makinwa, O. M. Supervisors Pius B. Dung Bagudo Ango Umaru Bello Saleh Abubakar Abdullahi Muhammad Isiaka Waz'tri E. K. Field Editors Abubakar D. Saidu Kangiwa Ahmed Sule Bala Salihu Garba Salisu Musa Ibrahim Sani Oni Idowu David 224 Interviewers Priscilla Yohanna Asabe Chindo Abigail Suleiman Nanra Adamu Abdu Muhammed Omonusi Funke Usman Alkali Halima Isiyaku Luba Hasihmu Kebbi Nurja Gulumbe A. Haruna Ijusur V. Rabi Umar B. Amina Abashiya Amina Nwagwu N. Juliet Sanusi Yusuf Ismaila Bashirat Mayana Usman Nana Usman Bileiss Hajiyn Mohammed Larai Danladi M. Jakuwa Yahana Aisha Ibrahim Husainah Yusuf S. A. Halima Akande Hasiya S. Abdullahi Haruna Mary Aliyu Zainab Mohammed Sarah Audu Yosi Jatau Ukpo, O. Musa Paul Watkut Usman Kasim M. Awooh Drivers Aliyu Moh'd A. Bahago Ibrahim 225 APPENDIX E QUESTIONNAIRES FEDERAL REPUBLIC OF NIGERIA NATIONAL POPULATION COMMISSION 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY SERVICE AVAILABILITY QUESTIONNAIRE NDHS 01 IDENTIFICATION STATE NAME LOCAL GOVT. AREA LOCALITY NAME ENUMERATION AREA *URBAN/RURAL **LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE . DAY DATE OF VISIT MONTH yEAR INTERVIEWER'S NAME NAME ILESULT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RESULT RESULT CODES: 1 2 COMPLETED UNABLE TO COMPLETE SPECIFY, REASON BELOW (S~ECI~) SUPERVISOR NAME DATE OFFICE EDITOR NAME t DATE * Urban = 1, Rural = 2 FIELDEDITOR NAME DATE KEYED BY NAME DATE ** (LargvTown= l , Mediurn Town = 2, Small Town f 3, Villagv = 4) *** The questionnaire solicits information on the services available and neate~ ~o the majority of the people in to community. 229 SFL-'r ION 1h. COMMUNITY CHARACTERISTICS NO. E 102 QUESTIONS AND FILTERS Type of Locality irt which the EAis Located What is the name of the nearest urban centre? CODING CATEGORIES SKIP LARGE TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MEDIUM TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SMALL TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 V ILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 103 How far is it in kilometers te the nearest urban centre? KM. TO NEAREST URBAN CENTRE . . . . . . . 104 What are the most commonly used lype~ oftransportefion to go the nearest urban centre? (CIRCLE ALL APPLICABLE) 105 106 What is the main access route to this (COMMUNITY) Whet are the major economic aetivitie~ of the (COMMUNITY) inhabitants? Is then telephone service in the (COMMUNITY) Are the following things in the (COMMUNITY)? MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X (SPECIFY) ALL WEATHER ROAD . . . . . . . . . . . . . . . . . . . . . I SEASONAL ROAD . . . . . . . . . . . . . . . . . . . . . . . . . 2 OTHER (RIVER/RAILWAY) . . . . . . . . . . . . . . . . . 3 : PATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER X (SPECIFY) AGRICULTURE . . . . . . . . . . . . . . . . . . . . . . . . . . . A LIVESTOCK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B FISHING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C IRADINGfMARKETING . . . . . . . . . . . . . . . . . . . D MANUFACTURING . . . . . . . . . . . . . . . . . . . . . . . ~ MINING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OOTTAGE INDUSTRY . . . . . . . . . . . . . . . . . . . . G OTHER X (SPECIFY) ~(ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 KILOMETERS 107 Is there a pr ima~ School here? Is there a Secendary School here? Is there a Post Office here? Is there a Local Market hero? iPKIMARY . . . . . . . . . . . . . . . . . . . . . . . . . I SECONDARY SCHOOL . . . . . . . . . . . . . IFOST OFFICE . . . . . . . . . . . . . . . . . . . . . LOCAL MARKET . . . . . . . . . . . . . . . . . . rs there a Cinema here? C INEMA . . . . . . . . . . . . . . . . . . . . . . . . . . IS there a Bank hare? BANK . . . . . . . . . . . . . . . . . . . . . . . . . . . . Is there a Health Centre/Hospital here? Is there atransportation hero? I f in Locality write "00". I fnoL write distance in ldlometres, i f you do not know miw "98". f fmore than 95 kms write "95" HEALTH CENTRE/HOSPiTAL . . . . . . . PUBLIC TRANSPORTATION . . . . . . . . 230 109 109a SECTION IC: HEALTH AND FAMILY PLATO PROORAM IN THE COMMUNITY Does a communiiy based family planning health Ptogcam cover this 20MMUNITY)? ~kre the following methods* avaitable from the community based distribution ~¢atr¢? a: Pill? b: Condom? Vaginals? 110 Does a family planning servlee provider (Nurse) visit this Community? llOa How oRen do cs tho family planning service prox;Mer (Nurso) visit ltfis community? llOb Doc~ a family planning scrvi~ provider (Nurse) mako available family planning courtsollktg? ll0v Are the followlng mcdhods available from the family sc~icc provider (Nurse)? Pill? ll0d Condom? Vaginals? How many family planning service provider (Nurse) in this Communlty? 111 Is the Community visited regularly by a mobile family planning ¢linio? I l i a How o l in does tho mobilo fan~ly planning clinic visit this Community? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -~II0 PILL: YES . I l'~ O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CONDOM: YES . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VAGINALS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- -~111 NO. Of TIMES ~ PER (MONTH) . . . . 1 (YEAR) . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PILL: YES . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CONDOM: YES . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VAGINAL& YES . i NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 TOTAL ~O. OFPPPROVIDERS(WORKERS) . ~ ' ~O. OF GOVERNMENT WORKERS . NO. OF NON-GOVT. WORKERS . YES . 1 NO . 2- -,I12 ~O.OfTIMES ~I P~(MONTH) . . . . 1 L- I I (YEAR) . 2 231 11 lb Are the fol lowing methods avai lable f rom the mobile fami ly planning cl ime)? a: P i l l? Female Steri l ization? b: IUD? c: d: Injectables? PILL: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [UD: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 FEMALE STERIL IZATION: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [NJECTABLES: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 112 Have there been any fami ly p lanning eampai~as in the (COMMUNITY) in th~ YES I last year? . ,xlO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . 112a What specifically was this campaign promoting? (C IRCLE ALL APPL ICABLE) 2H ILD SPACING A • BENEFITS OF B IRTH CONTROL . . . . . . . . . . . B . USE OF FAMILY PLANNING . . . . . . . . . . . . . . . C BREAST FEEDING . . . . . . . . . . . D SPECIFY (METHOD(S) PROMOTION E WHEILE METHODS ARE AVA/LABLE F OTHER X (SPECIFY) -~113 232 NO. 113 114 114a l14b 115 l l5a 116 [16a 116b 117 [17a QUESTIONS W'hero do most women givo birth CODING CATEGORIES AT HOME. . I .AT HEALTH CENTRE/HOSPITAL . . . . . . . . . . . 2 , SKIp Is them a traditional bhfrl attendant available to women here who regularly YES .1 ~ssists during delivery? .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , Does the traditional birth attendant provide fron supplements? YES . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [~as the tra~ilonal birth attendant had any special training from the YES . . . . . . . . 1 gov~a'nment or Mirfistty of Health or other organizafiott? NO . . . . 2 DON'T KNOW 8 [s the Community covered hy a trained midwife? YES . . . . . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Does the trained midwife provide iron supplements? YES . . . . . . . . . . . . . . . I • NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , Is *he Community covered by a Health worker? YES . . . . . I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .--* 117 Does the health worker provide? a: Basle medleation e.g for fever ere? ib: ORT InsPection or OR8 paokcLs? o: Vitamin A oapsules? d: Gro,C~h Monitoring and promotion e: Iron tablets? fi Iodized Oil eapsules]injeetiora? g: Antenatal care? h: Immunizations? fi Family planning services? ~tow often does the health worker visit? Have there been any health campai~s in the (COMMUNITY)? BASIC MEDICATIONS: YES . . . 1 NO . . . . . . 2 ORT/ORS: YES . . I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . V ITAMIN P~ YES . . . . 1 NO . . . . . 2 GROWTH MONITORING AND PROMOTION: YES 1 NO. . . 2 IRON TABLETS: YES .1 NO . . . . . . . . . 2 IODIZED OIL: YES l NO . . . . . . . . . . . . . . . . . . . . 2 ANTENATAL CARE: YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 IMMUNIZATIONS: YES . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 FAMILY PLANNING? YES . . . . 1 • NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , NO. Of TIMES H I PER (MONTH) . . . . 1 f I f (YEAR) 2 - ,115 I what was the health campai~a promoting? CIRCLE ALL APPLICABLE) YES . . . . . . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.-- ,201 BENEF ITS OFHREAST-FEEDING . . A IMMUNIZATION . . B .D IARRF IOEADISEASECONTROL . . . . . . . . . . C . AIDS D .DRUG ABUSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . E . GROWTH MONITORING AND PROMOTION P VITAMIN A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O . IODINE DEFICIENCY . . . . . . . . . . . . . . . . . . . . . H . SANITATION I OTHER X (SPECIFY) 233 SECTION 2: FACILITY IDENTIFICATION SECTION #- What is the name oftke nearest doctor with a private olinic to tMs community? B. What is ~e name ofthe nearest phmmacy/patem medi#me store (PMS) to this community? C. What is 1he name ofthe nearest health cet~e providing geaeral health services to ~s ~um~? D. What is the name ofthe nearest clinio providing general health servlces to this community? E. What is the name of the nearest hospital providing generld he.Mill services 1o this corarnunity? 234 A: PRIVATE DOCTOR NO. A201 A202 A203 A204 A205 A206 A207 A208 A209 A21"0 QUESTIONS NAME OF PRIVATE DOCTOR How far is the Doctor (in Pan) from here? VqRITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '95~ What is the most common type oftrampost to the Doctor's clinic? Flow long does it take to gct from hero to (pRIVATE DOCTOR'8, NAME) asing most common type oftramport CODING CATEGORIES PRIVATE DOCTOR'S NAME NOT APPLICABLE . 000 KILOMETERS ~[OTORIZED (E.O. BUS) I CYCLING 2 ANIMAL 3 WALKING . . . . . 4 OTHER 6 (SPECIFY) Does this private doctor provide antenatal care? delivery care? child immunization? family planning servioe~? Nho is the ne.arcet doetor with a private practice who provide family danning services to this community? HOURS YES MINUTES . . . . . . . . . ANTENATAL CARE? I DELIVERY CARE? I CHILD IMMUNIZATION? . I FAMILY PLANNING? I I PRIVATE DOCTORS'S NAME SKIP TO -,B201 NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . . . . . 000. NO DK 2 8 2 8 2 8 2 S - - ,A210 --~A210 FIow far is the private Doctor's clinic (in kms) from here? 'WRITE 1N '~00" IF LESS THAN 1 KILOMETER, IF I TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 K/LOMETERS OR MORE, WRITE IN "95".) What is the most common type of tramport to the Doctor's practice? ~Iow long does it lake to get from here to (PRIVATE DOCTOR'8, NAME) asing most common type of transport? ~ow many ptactiffmg private Doctors are there within 30 kilometers? .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98.-,A210 KILOMETERS MOTORIZED (E.G. BUS) I ~YCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL 3 ,WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 , OTHER 6 (SPECIFY) [-IOLrRS . . . . . . . . . . . . MINUTES NO. OF PRIVATE DOCTORS WITHIN 30 KM . . . . I ~?:}1 :! I 235 B: PHARMACY/PATENT MEDICINE STORES NO. ]8201 B202 B203 B204 B205 B206 ]3207 QUESTIONS CODING CATEGORIES SKIP TO NAME OF PHARMACY PATENT MEDICINE STORES PHARMACY/PATENT MEDICINE STORES NAME • NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . . . . 000 -.-~C201 Is fl~t a government pharmacy/patent me~lidme ~tores or is it operated by a GOVRIINMENT. I private organisafion? How far is the doctor (in kin) from here7 (WRITE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '95') What is the most common type oflransport to the pharmacy/patent medicine stores? ,PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . KILOMETERS MOTORIZED (E.G. BUS) I ~YCLINO . . . . . 2 ANIMAL 3 ~VALKING . . . . . . . . . . . . . . . . . . . . . . 4 DTHER 6 (SPECIFY) MINUTES . How long does R take to get from here to (PHAILMACY/P ATENT MEDICINE STORES) ufmg most commontyp¢ of Wamport7 Do~ thls pharmacy/patent medicine steres sell family planning supplie~? .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - . - ,B212 NO 2 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . PHARMACY/PATENT MEDICINE STORES NAME NOT APPLICABLE . . . . . . . . 000- - ,B212 • DON'T KNOW . . . . . . . . . . , . . . . . . . . . . . . . . . . . 98-.-,B212 6OVEIhNMENT . . . . 1 .PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . KILOMETERS . . . . . ~ .MOTORIZED (E.G. BUS) . . . . . . . . . . . . . . . . . . . . . 1 . 0YCLINO . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . 3 ,WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 , W]tat is the name of the nearest pharmacy/patient medidno store~ which sells family planning supplies to t~ community? B2OS Is that a government pharmacy/pate~ medidme stores or is it operated by ~rivate Orgaaizafion? B209 ~tow far is it doctor (in kin) from hem7 WRITE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE 1N '95') B210 What is the most common type of Lanspost to the pharmacy/patent me.divine stores? B211 How long does it take to get from hero Io (PHARMACY/PATENT MEDICINE STORES) using most common type oftranspost? B212 How many pharmade.4pateat medicine stems in total are flmro within 30 kilomclcrs7 * Patent medicine store => PMS OTHER 6 (SPECIFY) HOURS MINUTES . . . . . NO. OF PHARMACIES/PMS WITHIN 30 KM I~+'~l~'~:l 236 C: HEALTH CENTKE~OST NO. C201 QUESTIONS NAME OF HEALTH CENTRE/POST C202 C203 C204 (2205 {2206 C207 C208 {3209 C210 C211 {2212 C213 Is that a govmuncnt health create/post or is it operated by privato organiz~on? How far is it (in kms) from her~7 (WRITE IN 'Off IF LESS THAN l KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '98') What is the most common type of transport to the health een~e/post? How long does it take to get from hea~ to (HEALTH CENTRE/POST) usingmost eommonlype oftransport? Does this health ¢¢rdm/post aulenatal care? dellvcry care7 grov~h monitoring and promotion? chitd immunization? family planning serviee~? What is the name o f t~ nearest health ¢erdav]post providing family planning service to this coramunlty7 Is that a government health centre/post or is R operated by private Organization7 flow far is it (in lans) from hero? ,%VILITE 1N 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCI~ IN KMS. [F 95 KILOMETERS OR MORE, WRITE IN '955 What is the most common typo of transport to th~ health centre/post? ~ow long does it ~ak¢ to ge~ from h~xe to (HEALTH CENTRE~OST) admg most common ~ypo c f transport ? 'Does th~s health cenl~'v./post antenatal cam? delive~J cam? growth monitoring wad promotion? child immunization? family plamaln~ sexviee~? FIow many health ¢en~ee/posts in total are them within 30 ldlomc4er~? CODING CATEGOPJ.ES [SKIP TO HEALTH CENTRE/POST NAME NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . . . . 000. -*D201 GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I KILOMETERS . . . . . . . . . . . . . . . . . . . . . . . MOTORIZED (E.G. BUg) . . . . . . . . . . . . . . . . . . . . . I CYCLING . . . . . . . . . . . . . . . . . . . ANIMAL . . . . . . . . . . . . . . . . . . . . WALKING . . . . . . . . . . . . . . . . . . DTHER (SPECIFy) flOURS . . . . . . . . ~IINUTES . . . . . . ANTENATAL CARE? . . . . . . . . . . 1 DELIVERY CARE? . . . . . . . . . . . . 1 GROWTH MONITORING AND PROMOTION . . . . . . . . . . . . . . . . . 1 CHILD IMMUNIZATION? . . . . . . 1 FAMILY PLANNING . . . . . . . . . . 1 I HEALTHCENTREfPOST NAME GOVERNMENT PRIVATE . . . . . KILOMETERS ., . 2 . 3 . 4 6 i i YES NO DK 2 $ 2 8 2 S 2 S 2 S ,C213 I . . . . . . . . . . . . . . I MOTOI~D (E.G. BUS) . . . . . . . . . . . . . . . . . . . . . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) Ho g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M ES . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO DK ANTENATAL CARE? . . . . . . . . . . 1 DELIVERy CARE? . . . . . . . . . . . . 1 GROWTH MONITORING AND PROMOTION . . . . . . . . . . . . . . . . . 1 CHILD IMMUNIZATION? . . . . . . 1 FAMILY PLANNING . . . . . . . . . . 1 2 8 2 8 2 8 2 8 2 8 NO. OF HEALTH CENTRES/POSTS WITHIN 30 ~ . . . . . . . . . . . . . . . . . . 237 D: CLINIC NO. I)201 NAME OF CLINIC QUESTIONS D202 :Is that a governmcaxt dinio or is it operated by a pdvato otgamzafion? D203 ~I~ far is it (i~ kn~) from here? ~VRITE IN '00' IF LESS THAN ! KILOMETER. 1F ! TO 94 KILOMETERS, WRITE DISTANCE IN KIVIS. IF 95 KILOMETERS OR MORE, WRITE IN '95~ I)204 ~Nhat is the most common type of transport to tho dinio? I)205 How long doe~ it ~ak¢ to get from he~o to (CLINIC NAME) udlng most commonlyp¢ ofh'anspor~? D206 Doe~ this clinic provide?. anteaatM cam? delivery care? growth monitoring and promotion? child immunization? family planning servic¢~? 1)207 What is the name of the nearest clinic providing family planning service to this community? D208 I s~ a government dinlc or is it operated by private Organization? D209 How far is it (in kms) from her~? (WRITE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN ICMS. IF 95 KILOMETERS OR MORE, WRITE IN '953 I)210 What i~ the most oommon typo oftra~port ~ the clinic? 1)211 How long does it Lake to get from hero to (CLINIC NAME) udng most common type of~ansport? D212 Does this clinic provldo?. antenatal cam? deliver/taro? growth monitoring and promotion? child immunization? fanfily planning s~rvlo~? I)213 How many clinics in total am them within 30 kilometers? 238 CODING CATEGORIES SKIP TO CLINIC NAME . . NOT APPIJCABLE . . . . . . . . . . . . . . . . . . . . . . . 000-.-,E201 9OVERNMENT . . . . . . . . I .pRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . KILOMETERS . . . . . ~ MOTORIZED (E.G. BUS) 1 • ~YCLINO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . ANIMAL . . . 3 ~]AI2K1NG .4 OTHER 6 (SPECIFY) ~IOURS MINIrI~S ~ YES NO DK ANTENATAL CARE? . . . . . . . . . . 1 2 8 DELIVERy CARE? . . . . . . . . . . . . 1 2 S 3ROWTH MONITORING AND PROMOTION . . . . . . . . . . . . . . . . . 1 2 8 CHILD IMMUNIZATION? . . . . . . I 2 8 FAMILY PLANNING 1 2 $ L - - ,D213 CLINIC NAME GOVERNMENT I .PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . KILOMETERS . MOTORIZED (E.G. BUS) 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL 3 .WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . OTHER 6 (SPECIFY) HOURS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MINUTES YES NO DK ANTENATAL CARE? . . . . . . . . . . I 2 8 DELIVERY CARE? . . . . . . I 2 8 GROWTH MONITORING AND PROMOTION 1 2 8 CHILD IMMUNIZATION? . . . . . . 1 2 8 .FAMILY PLANNING . . . . . . . . . . 1 2 8 . NO. OF CLINICS WITHIN 30 KM . . . . . . . ~ E: HOSPITAL NO. E201 NAME OF HOSPITAL QUESTIONS HOSPITAL NAME CODING CATEGOKIES E202 E203 E204 E205 E206 E207 E208 E~09 E210 E211 B212 Is that a government hospital or is it operated by a private Organization? How far is it (in kms) from here? WRITE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. tF 95 KILOMETERS OR MORE, WRITE IN '953 What is the most common type of~ansport 1o the hospital? .NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . . . . 000-.-~214 GOVERNMENT 1 , PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , How long does it take to get from he~e to (HOSPITAL NAME) using most commonWpe oftramport? Does'this hospital provide? an~natat care? delivery care? gcow~h monitoring and promotion? child ~f ion? family planning seawices? What is the name of the nearest hospital providing family plamling service to this community? Is that a government hoslYltal or is it operated by a private Organization? How far is it (in kms) from here? WRITE IN '00'IFLESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KivIs, IF 95 KILOMETERS OR MORE, WRITE IN '95') What is the most common ~ype of transport to the hospltal? How long does it take to get from here to (HOSPITAL NAME) wing mest common g~pe of transport? Does this hospital provide? antenatal care? delivery care7 growth monitoring and promotion? child immunization7 family planning services? E213 How many hospitals in total ate thee within 30 kilometers? KILOMETERS ~OTORIZED (E.G. BUS) I CYCLING . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . 4 9THER 6 (SPECIFY) ROURS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~INUTES YES NO DE: ANTENATAL CARE? . . . . . . . . . . 1 2 8 DELIVERY CARE? . . . . . . . . . . . . 1 2 8 GROWTH MONITORING AND PROMOTION . . . . . . . . . . . . . 1 2 8 CHILD IMMUNIZATION7 . . . . . . 1 2 8 FAMILY PLANNING . . . . . . . . . . 1 2 8 I _ _ HOSPITAL NAME GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . KILOMETERS . MOTORIZED (E.G. BUS) 1 CYCLING 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) HOURS . . . . . . . . . . . . MINUTES ~ , YES NO DK 2 g 2 8 2 : l 2 2 81 ANTENATAL CARE7 . . . . . . . . . . 1 DELIVERY CARE? . . . . . . . . . . . . 1 GROW2TI MONITORING AND PROMOTION . . . . . . . . . . . . . . . . . 1 CHILD IMMUNIZATION? . . . . . . 1 FAMILY PLANNING . . . . . . . . . . 1 NO. OF HOSPITALS WiTH ,o . . . . ,E213 239 CONTRACEPTIVE METHOD AND HEALTH SERVICES IDENTIFICATION NO. 214 215 216 217 218 QUESTIONS What is t11o n~me of the nearest place whcce biflh control (child-spacing) ,ill can be oblained? How far is it (in kms) from hero? WRITE IN '00 IF LESS THAN 1 KILOMETEIL IF 1 TO 94 RILOMETERS, WRITE IN DISTANCE IN KIVIS. IF 95 KILOMETERS OR MORE, WRITE IN '95' What is file n~me of%be nearest plaoo or provider to this community where condom~/femidom can be obtained How far is it (in kms) from here7 WRITE IN '00' IF LESS THAN ] KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN ICMS. IF 95 KILOMETERS OR MORE, WP, I2~ IN '95') What is the name of the nearest place to this comm~mlty where family planning injection can be obtained? CODING CATEGORIES NEAREST PILL PROVIDER NAME NAME KILOMETERS . NEAREST CONDOM/FEMIDOM PROVIDER NAME KILOMETERS . . . . . . . . NEAREST INJECTION PROVIDER NAME 219 [Iow far is it (in ~ns) from hero7 WRITE IN '00' IF LESS THAN 1 RILOMETER. IF 1 TO 94 KILOMETERS . . . . . . . . . . . . . . . . . . . . . . . KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '9Y) 220 What is the nmne oflhe nearest faoillty or provider lo this community NEAREST IUD PROVIDER NAME where 1UDs can be inserted? KILOMETERS . . . . . . . . . . . . . . . . . . . . . . . 221 222 222A 223 223A 224 225 226 227 228 NEAREST STERILIZATION PROVIDER NAME How far is it (in kms) from hero? WRITE IN '00' IF LESS THAN 1 KILOMETEP~ IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN F2¢IS. iF 95 KILOMETERS OR MORE, WRITE IN '95~ What is the name of the nearest facility or provider 1O 1his community ~vhero female sterilizalion can be oblamed? What is tbe mmav of~ae nearest faoility or provider 1O this community NEAREST STEKILIZATION PROVIDER NAME ¢~hcro male sterilization can be obtained? [Iow far is the female sterilization (in Pans) from heco? ¢¢KITE IN 'S0' IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS . . . . . . . . . KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '959 ~Iow far is 1he male slerilizafion (in Kms) from here? ¢¢RITE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS . . . . . . . . . KILOMETERS, WRITE DISTANCE IN KMS. iF 95 KILOMETERS OR MORE, WRITE IN '959 What is name ofthe nearest phce 1O this community where immunizations NEAREST IMMUNIZATION PROVIDER ~or children can be oblained? [~ow far is it (in l~ms) from here? ~VR1TE IN 'Off IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS KILOMETERS, WRITE DISTANCE IN KMS. iF 95 KILOMETERS OR MORE, WRITE IN '953 ~lhal is the name of the nearest place to "dtis community where oral NEAKEST ORS PLACE NAME rehydration solution (ORS) packet~ can be obtained? How far is it (in kms) from here? ~VKITE 1N '00' IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS . . . . . . . . . KILOMETERS, WRITE DISTANCE 1N KMS. [F 95 KILOMETE1LS OR MORE, WRITE IN '95') If child is sick with cough (re~piralory disease), what is the name of the NEAREST RESP. DISEASE TREATMENT PLACE a ~ place where treatment san be obtained gKIF TO 240 NO. I SKIP TO 229 QUF~TIONS How far is it (in kms) from here? WRITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 94 KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETER8 OR MORE, WRITE IN '959 CODING CATEGORIES KILOMETERS . . . . . . . . . . . . . . . . . . . . . . . 230 What is the name of the nearest place to this communiW where axat enatal NEAREST ANTENATAL PROVIDER NAME care can be oblaitted 231 How far is it (in kms) from here? WKITE IN '00' IF LESS THAN I KILOMETER. IF 1 TO 94 KILOMETERS KILOMETERS, WRITE DISTANCE IN KMS. IF 95 KILOMETERS OR MORE, WRITE IN '953 232 If a woman has a complication in deliver/, what is the name ofthe nearest NrEAREST DELIVER PLACE NAME ,l~e she can be treated? 233 How far is R (in kms) from here? WRITE IN "00' IF LESS THAN 1 KILOMETEI2. IF I TO 94 KILOMETERS KILOMETERS, WRITE DISTANCE IN KMS. IF 95 K1LOMETFA~ OR MORE, WRITE IN '959 234. COMMUNITY INFORMANT(S) NAME POSITION/TITLE/OCCUPATION I. 2. 3. 4. 235. TOTAL NUMBER OF INFORMANT(S) IN TIlE COMMUNITY . . . . . . . . . . . . . . . 241 FEDERAL REPUBLIC OF NIGERIA NATIONAL POPULATION COMMISSION 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE NDHS02 IDENTIFICATION STATE NAME . . . . . . . . . . . . LOCAL GO~P. AREA LOCALITY NAME . . . . ENUMERATION AREA *URBAN/RURAL BUILDING NUMBER HOUSEHOLD NAME/NUMBER **LARGE TOWN/MEDIU2~ TOWN/SMALL TOWN/VILLAGE . . . . . . . . . . . . . . . . . . INTERVIEWER'S VISITS ' DATE INTERVIEWER'S NAME RESULT NEXT VISIT: DATE TIME RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF V/SIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 4 POSTPONED 5 REFUSED 6 DWELLING VACANT 7 DWELLING DESTROYED 8 OTHER (SPECIFY) FINAL VISIT DAY ~'.'~ MONTH i~>~ YEAR ~ ":::~ . NAME ~ i~ RESULT '~ ~i'~ VIs~sTOTALNO" OF TOTALIN HOUSEHOLD WOMENTOTALELIOIBLE MENTOTAL ELIGIBLE [ ] LINENO. OF RESPONDENTS TOHOUSEHOLD SCHEDULE SUPERVISOR DATE FIELD EDITOR NAME NAME OFFICE EDITOR KEYED BY * (Urban = 1, Rural = 2) ** (Large Town = 1, Medium Town = 2, Small Town = 3, Village = 4) 243 lq'ow w~ would h~c to have some infom~afion about the L]R~ USUAL RESIDE24T8 A~) RELATIONSHIP TO NO. vISnDRS HEAD OF HOUSEHOLD* HOUSEHOLD SCHEDULE RESIDENCE SEX AGE ]K[~JCATION Ple~e g~ve me the n~es o f ~ae ~h~t ~ the ~at~onsb~ DC~ Did ~on~ who ~sua~y livein yot~ 3f (t'~AME) ~o ~e he~ ~AME) NAME) male or ho~ehold md guess of ~he 3f the household? tautly b~e stay h~e female? housd~old v,:ho stayed hece h~t ~? last n~ht? ~t , s~g with ~l~ he~d of tl~ hou~ehdd. (i) (2) (3) (4) (5) (6) yF~ NO ~'~,~ ~qO M 01 ~ I 2 1 2 02 ~ l 2 1 2 03 ~ I 2 2 04 ~ I 2 1 2 05 ~ I 2 1 2 06 ~ 1 2 2 07 ~ I 2 IF AGE 6 YEARS OR OLDI~ Is(NAME) ~Iow old i~ C~a (NAME) H~ ~t bi~d~y ~tyl~g'a~e ewr t~t w~h to s~d? (*9 (8) (9) INySAR~ YF~ NO YES NO [] [] [] [] PARENTAL SURVIVORSF~PAND RE3E)ENCE FOR PERSONS LESS "FrIAN 15 YEARS OLD'** ELIGIBILITY IFA~ED SCHOOL WI~B the h~est levd Is of~hcol (NAME) (t~d¢~ articled? s~llin school? what ~ ~h i~gm& 0~or ~ge (NA~) oompleted at l~O~n th~deve~** 25 Ye~s (NAME)'s na~r~d motheg aUv¢~ IFALIVE Is a'~EE)'S IFALIVE 2IRCLE Do~ (NAME)'S m~rat motker household? ~YES: Wh~bb= n~me? RECORD MOTHEr" S CIRCLE nabral f~%er r~INE alive? ~ OF ~LL OF ~,LL Does / /O i~ MI~ ~qAb~)'s ~ED 10-49 AGED mter~ ~ 15/o4 ?/ein~is lov~aold? ~t b his ~me7 ~ECORD YAT~R'3 iLINE (lo) (11) (12) (D) (14) (15) 06) 07) ~ NO ~NO DK YE3 NO DE 12 ~ 1 2 ~ o2 02 21 2 . ~ 1 2 ~ 03 03 212 ~ 1 2 ~ 04 04 21 2 ~ 1 2 ~ o5 o5 212 ~ i 2 ~ 06 o~ 2 2 s ~ i 2 ~ 07 o7 244 L~'~ NO. 08 09 10 11 12 13 14 USUAL RESIDENTS AND P.~LATiONSI-H P 70 VISITOR8 HEAD OF HOUSEHOLD" alCK HERE IF CONTINUAT/ON S I~US~D RESIDENCE SEX AGE EDUCATION I E] Tick if Household has more ~han 14 persons p ~ SDP.VIVORBH]P AND RES]DI~'ICB FOR PERSON8 LESS 31-1AN 15 YEARS OLD*** 2 ELIGIBILITY O8 0~ CO CO 10 10 11 11 12 12 13 13 14 [ 14 Jmt to m#~ an¢ t l~ I lmve a eomple~ i i~a~ l) Are lhe~ ~y oth=p~tzom suda as m~r t eba2dx~ o~in f~ that w~ hnvv not ~d? 2) In additie~, m~ th~ m~y oiler Feople v&o may not be mmnber* of Your fmm2Y, mda ~ ~ ~ ~ ~ ~& ~° ~ Y ~ ~ 3) Ate f ix~ may gue*ts er tmaporaty -d~itom stayivg h*~ or mtyoxte e£~ "~ao slept h~o lint ~t ~ ~© not ~ ~ ? [~] • EiffI~KEACHINTABLB YB8 ~ • ~EACHINTABLE YE~ ~ . ENTEREACHINTABLE No IX3 No U-3 ~oU--] *CODES FOI~ Q.3 RELAIIONSl~P TO HEAD OF HOUSEHOI/X 01 = I'a~AD 02 ffi WIFE ORHUS~ 03 ffi SON OR DAUGHTEK 04 = SON-IN-LAW OP. DAUGHTI~-IN-LAW 0 5 = G ~ 06=P~ 07 - pARE1WJT-B~/-LAW 08 = B K ~ OR SIffrER 09 =BROTHER OR $IS'lXR-~I-LAW 10 = O'IHE~ RELATIVB 11 = ADOP'IED/FO,WIE R/S'I'EP ~ D 12 = NOTRELATED 98 ffi DON'TKNOW ** CODES FOR Q.10 EI)UCATJON LEVEL: 1 = PRIMARY 2 = SECONDAP, Y 3 = I~GFIER 8 = DON'TKNOW EDUCAq~ON GRADE £0 = LESS THAN l YEAK COMPLETED O1 = 1 YF~AP. COMPLBTED 0'2 = 2 ~EAP.8 COMP~ 0B = 3 YEAI~ COMPLEI~D 04 = 4 ~T.A~S O3~L~[ '~D 05 = 5 YF2~RS COI~t~L~ 06 = 6 YEARS COI~LI~I~D ~=DO~TKNOW *** Q.12 THP.OUGH Q.15: "llx¢~ qu¢*fiom r~%r to the ~ ia~i=l imx*~ of the d~.d. Roeotd 00 if pattat not nmmber ofho~s~old. 245 NO. IS QUEST IONS AND FILTERS What is the main souroe of drinking wetc~ for members of your hausohold? CODING CATFA3ORIES SKIP PIPED WATER PIPED INTO P~ESIDENCE/YARDLPLOT . 11-- -, 20 PUBLIC TAP . 12 WELL WATER WELL INRES IDENCF JYARD/PLOT 21-- -, 20 pUBLIC WELL 22 SURFACE WATER SPRING . . . . . . . . . . . . . . . . . . . . . . . . . 31 ~STKEAM . . . . . . . . . . 32 POND/LAKE . . . . . . . . . . . . . 33 DAM 34 .RA INWATER . . . . . . . . . . . . . . . . . . . . . . . . 41 - - - , 20 TANKER (TRUCK) 51- - -* 20 TANKER VENDOR . . . . . . . . . . . 52 - - - , 20 BOTTLED WATER . . . . . . . . . . . . . . . . . . . 61 71 BOREHOLE OTHER 96- - -b 20 (SPECIFY) 19 How long doe~ i t take you to go fl~ro, get wetcr, and corns back? MINUTES ON PREMISES . . . . . . . . . . . . . . . . . . . . . . . 996 20 Whal k ind o f toi let faci l i ty does your household have? 21 22 Does your household have: Electricity? Aradio? Atolevls ion? Atelcphone? A r~ig~retor? A Gas Cooker? An E le~ic Iron? An Electric Fan? How many rooms are in your household? How many rooms are used for s leeping in your household? FLUSH TOILET (W.C) OWN WATER CLOSET 11 SHAILED FLUSH TOILET (W.C) . . . . . 12 PIT TOILET/LA.TR1NE TRADIT IONAL PIT TOILET 21 VENTILATED IMPROVED PIT (NIP) LATRINE 22 BUCKET TOILET 23 .NO FACIL ITY/BUSH/F IELDfRIVER . . . . . 31 OTHER 96 (SPECIFY) YES NO ELECTRIC ITY . . . . . . . . . . . . . i 2 RADIO I 2 TELEVIS ION . . . . 1 2 1 TELEPHONE . . . . . . . . . . . . . . l 2 .REFRIGERATOR . . . . . . . . . . 1 2 , GAS COOKER I 2 ELECTRIC IRON . . . . . . . . . . . I 2 . ELECTRIC FAN . . . . . . . . . . . . i 2 ROOMS . 22H 246 NO. 23 24 25 26 27 28 QUEST IONS AND FILTERS MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION. Doe* any member of your household own: A bicycle? A motorcycle? A car? A Donkey/Horse/Camel? A Canoe/BoaffSkip ? What type o f salt is usual ly used for cooking in your household? (ASK TO SE~ SALT PACKAGE). How do you holdlhJs accommodation? if you rent it or if it is rent-free, who owns this aeeormnodation? MAIN MATERIAL USED FOR OUTER WALLS RSCORI) OBSERVATION CODING CATEGORIES NATITRAL FLOOR EARTH/SAND . . . . . . 11 DUNO . . . . . . . . . . . . 12 RUDIMENTARY FLOOR WOOD PLANI~'*S . . . . . . . . . . . . . " . . . . . . 21 PALM/BAMBOO 22 F INISHED FLOOR PARQUET OR POL ISHED WOOD . . . 31 V INYL OR ASPHALT STRIPS . . . . . . . 32 CERAMIC TILES . . 33 CEMENT . . . . . . . . . . . . 34 TERRAZZO/MARBLE . . . . . . . . . . . . . . 35 CARPET . . . . . . . . . . . . . . . . . . . . . . . . . . 36 OTHER 96 (SPECIFY) YES NO B ICYCLE I 2 MOTORCYCLE . I 2 CAR . 1 2 DONKEY/HORSE/CAMEL . . . I 2 CANOEdBOAT/SHfp . . . . . . . . . 1 2 LOCAL SALT . . . . . . . . . . . . . . . . . . . . . . . . . 01 PACKAGED SALT ( IODIZED) 02 PACKAGED SALT (NOT IODIZED) . . . . . 03 SALT FOR ANIMALS . . . . . . . 04 LOOSE SALT . . . . . . . . 05 OTHER 96 (SPECIFY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 l OWNER OCCUPIER . . . . . . . . . . . . . . . . . . . 02 IOT OWNER, BUT RENT FREE . . . . . . . . 03 HOUSED BY EMPLOYER . . . . . . . . . . . . . . 04 OTHER 96 (SPECIPO 'RIVATE IND1VIDUAI . . 0 I PUBLIC OWNERSHIP . . . . . . . . . . 02 EMPLOYER 03 PRIVATE MORTGAGE COMPANY . . . . . 04 OTHER 96 (SPECIFY) CEMENT BLOCKS . 01 CONCP,~TE . 02 • BAKED BRICKS . 03 . UNBAKED BRICK, MUD OR EARTH . 04 TERRAZ~OReIARBLE/HEWN STONE . 05 PLANK/WOOD/BAMBOO MATERIAL. . . 06 THATCH/MAT/LEAVES/STRAW . 07 CORRUOATED IRON SHEETS/ZINC . 08 OTHER 96 (SPECIFY) SKIP 247 NO. QUESTIONS AND HLTERS 29 MAIN MATERIAL USED FOR ROOF RECORD OBSERVATION 30 31 32 MAIN SOURCE OF LIGHT TYPE OF KITCHEN FACILITY TYPE OF BATHING FACILITY CODINO CATEGORIES EARTH/MUD THATCH/MAT/LEAVES HARD CONCRETE (CEMENT) 01 CORRUOATED METAL SHEET/ASBESTOS TILES 02 • WOODEN TILES/PLANKS . . . . . . . . . . . . . 03 O4 05 OTHER 96 (SPECIFY) ELECTRICITY . . . . . . . . . . . . . 01 PRESSURE LAMp 02 KEROSINE LAMPS WITH GLASS SHADES . . . . . . . . . . . 03 KEROSINE/OIL LAMPS WITHOUT GLASS SHADES . . . . . . . . . . . . 04 OTHER 96 (SFECn~) SEPARATE ROOM IN THE BUILDING FOR EXCLUSIVE USE OF HOUSEHOLD 01 SEPARATE ROOM IN THE BUILDING FOR USE OF THIS AND OTHER HOUSEHOLDS 02 • ENCLOSURE WITHOUT ROOF . . . . . . . . . 03 OPEN SPACE WITHIN/AROUND BUILDIN@~ OTHER 96 (SFECISY) SEPARATE ROOM IN THE BUILDING FOR EXCLUSIVE USE OF HOUSEHOLD 01 SEPARATE ROOM IN THE BUILDING FOR ALL OCCUPANTS 02 ENCLOSURE IN THE BUILDING BUT W1THOUT ROOF . . . . . . . . . . . . . . . . . . . . . 03 PUBLIC BATHROOM/STREAM/ E-IVER 04 OTHER 96 (SPECIFY) SKIP 248 FEDERAL REPUBLIC OF NIGERIA NDHSOS NATIONAL POPULATION COMMISSION 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY INDIVIDUAL QUESTIONNAIRE FOR WOMEN IDENTIFICATION STATE NAME . LOCAL GOXrf. AREA LOCAL ITY NAME ENUMERATION AREA *URBAN/RURAL . **LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE BUILDING NUMBER HOUSEHOLD NAME/NUMBER . NAME AND LINE NUMBER OF WOMAN IN HOUSEHOLD SCHEDULE . D INTERVIEWER'S VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER'S NAME RESULT NEXT VISIT: DATE TIME RESULT CODES: DAY MONTH yEAR NAME RESULT OF VISITS TOTAL NO. IZI . 1 COMPLETED 5 PARTLY COMPLETED 2 NOT AT HOME 6 i~CAPACITATED 3 POSTPONED 7 DWELLING DESTROYED 4 REFUSED 8 OTHER (SPECIFY) NAME DATE SUPERVISOR ~ NAMEDATE FIELD EDITOR * (Urban= 1, Rural=2) ** (Larg* Town= 1, Medium Town-~2, Small Town-~3, Village=4) OFFICE EDITOR KEYED BY 249 NO. I01 102 SECTION 1. RESPONDENT'S BACKGROUND 110 QUESTIONS AND FILTERS RECORD THE TIME. (START OF INTERVIEW) First I would llke to ask somo questions about you and your household. For most afthe time until you were 10 years old, did you livo in a largo town, medium town, small town or in the village? CODING CATEGOKIES MINUTES . . . . . . . . . . . . . . . . . . . . . . . LARGETOWN . . . . . . . . . . . . . . . . . . . . . . . . I MEDIUMTOWN . . . . . . . . . . . . . . . . . . . . . . . 2 SMALLTOWN . . . . . . . . . . . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 SKIP 103 ~Iow long have you been living eontinuoudy in (NAME OF CURRENT PLACE 7--'T--q OF RESIDENCE)? YEARS . . . . . . . . . . . . . . . . . . . . . . . . . ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 1"105 VISITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 1,105 104 rust before you moved here, dld you live in a large town, medium town, small LARGE ToWN . . . . . . . . . . . . . . . . . . . . . . . . 1 x)wr~ or in the village? MEDIUM TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 SMALL TOWN . . . . . . . . . . . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 105 [n what month and year were you bum? MONTH . . . . . . . . . . . . . . . . . . . . . . . . DON'T KNOW MO~ . . . . . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . . . . . . . . ~ DON'T KNOW YEAR . . . . . . . . . . . . . . . . 9998 106 ~Iow old were you at your last b'nthday? AOEINCO ,LE D ARS . . . . . 3OMPARE AND COR/LECT 105 AND/OR 106 1F INCONSISTENT. 107 Kate you ever ~ded school? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 : NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ,114 108 What is the highest level of school you attended: PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 primary, secondary, or higher? SECONDARY . . . . . . . . . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 109 ~aat is the hlghest (gradefforrtdyear) you emmplete6 a~ 1hal level? GRADE(YEAR) . . . . . . . . . . . . . . . . . . ~ l = AGE 24 AGE 25 OR BELOW ~ OR ABOVE [ -~ 111 112 2HECK 106: Are you cmremly at~ndi~g school? YES - - ~113 1 --,113 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 GOT PREGNANT . . . . . . . . . . . . . . . . . . . . . 01 COT MARRIED . . . . . . . . . . . . . . . . . . . . . . . 02 TO CARE FOR YOUNGER CHILDREN . 03 FAMILY NEEDED HELP ON FARM OR 1N BUSINESS . . . . . . . . . . . . . . . . . . . . . 04 COULD NOT PAY SCHOOL FEES . . . . . . . 05 NEEDED TO EARN MONEY . . . . . . . . . . . 06 GRADUATED/HAD ENOUGH SCHOOLING . . . . . . . . . . . . . . . . . . . . . . O? DID NOT pASS ENTRANCE EXAMS . . . . 08 DID NOT LIKE SCHOOL . . . . . . . . . . . . . . . 09 SCHOOL NOT ACCESSIBLE/ TOO FAR . . . . . . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . 98 What was the main reason you stopped attending school? 250 NO. QUEST IONS AND FILTERS CODING cATEGORIES SKIP 113 114 115 116 117 118 119 I IH . I 120 121 CBECK 108: pRIMARy SECONDARY ~] OR HIGHER [~ - - ,115 Can you read attd understand a later or newspaper easily, with diffteuEy, or not at all? EASILY . . . . . . 1 WITH DIFFICULTY 2 .NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . 3 , - ,116 Do you usuMly read a newspaper or mag~Jn~ at least oaee a week? YES . l .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , Do you usually listen to radio every day? YES 1 • NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Do you usually waleh te l~ lon at least once a week? YES . 1 ,NO . 2 . What is your religion? What is your ethnic group? CATHOLIC . i PROTESTANT. 2 OTHER CHRISTIAN . 3 ISLAM 4 TRADITIONALIST . . . . . . . . . . 5 OTHER 6 (SPECIFY) CHECK Q.4 IN THE HOUSEHOLD QUEST IONNAIRE THE WOMAN INTERVIEWED THE WOMAN INTERVIEWED IS NOT A USUAL ~ IS A USUAL RESIDENT ~_A RESIDENT L - I --~201 Now I would like to ask about the plae~ in which you usually live. WT~et is the name of the place in which you usually live? (NAME OF PLACE) LARGE TOWN 1 • MEDIUM TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 . SMALL TOWN . . . . . . . . . . . 3 VILLAGE 4 Is thai a large, medium, small tow~ or village? In which [STATE] is that located? 122 123 124 ~!ow I would like to ask about the household in which you usually llve. What is the main source of drinking water for members of your household? How Iong does it ~ake to go there, get water, and come back? ~TATE . . . . . . PIPED WATER PIPED INTO RESIDENCE/YARD/PLOT . . . . . . . 11--~125 POBLIC TAP . . . . . . . . . . . . . . . . . . . . . . 12 ~VELL WATER WELLINRESIDENCEfYARD/PLOT . 21--v125 PUBLIC WELL 22 SURFACE WATER SPRING . . . . . . . . . . . . . . . . 31 RIVER/STREAM . . . . . . . . . . . 32 • POND/LAKE . . . . . . . . . . . . . . . . . . . . . . 33 . DAM 34 RAINWATER 41 - -~ 125 .WATER TANKER (TRUCK) . ii . . . . . . . 51-.-,125 WATER VENDOR . 52 .BOTTLED WATER . 61-.-, 125 BOREHOLE . . 71 OTHER 96 (SPECIFY) MINUTES . ON PREMISES . . . . . . . . . 996 251 NO. 125 126 127 128 QUEST IONS AND FILTERS What kind of toilet facility does your household have7 Does your household have: E lear i c l ty? A Radio? A Television? A Telephone? A Refrigerator? A Gas Cooker? An E]~¢ Fan? An Electric I ron? Could you describe the main material of tha floor of your hame7 CODINO CATEGORIES FLUSH TOILET OWN FLUSH TOILET . . . . . . . . . . . . . . 11 SHARED FLUSH TOILET . . . . . . . . . . . 12 PIT TOILET/LATRINE TRADIT IONAL PIT TOILET /BUCKET 21 VENTILATED IMPROVED PIT (VIP) LATRINE . . . . 22 NO FACIL ITY /BUSH/F IELD/R IVERSIDE. 31 OTHER 96 (SFECWY) YES NO ELECTRICITY . I 2 RADIO 1 2 FELEVISION 1 2 FELEPHONE 1 2 .REFRIGERATOR . . . . . . . . . . . . . I 2 . ~AS COOKER I 2 ELECTI~C FAN . i 2 ELECTRIC IRON . . . . . . . . . . . . . . 1 2 NrATURAL FLOOR EARTH/SAND . . . . . . . . . . . . . . . . . . . . . 11 DUNG . . . . . . . . . . . . . . . . 12 RUDIMENTARY FLOOR WOOD FLANKS . . . . . . . . 21 PAL~AMBO0 22 FINISHED FLOOR PARQUET OR POL ISHED WOOD . . . 31 V INYL OR ASPHALT STRIPS 32 CERAMIC TILES 33 CEMENT 34 CAI~PET 35 9THER 96 (SPECIFY) Does aay member of your househoM own: A bicycle7 A motoreyvle? A car? A Donkey/Horse/Carnd? A Canoe/BoaffShip? YES NO BICYCLE 1 2 YIOTORCYCLE . . . . . . . . . . . . . . . i 2 2AR 1 2 . DONKEY/HORSE/CAMEL . . . . . 1 2 • CANOE/BOAT/SHIP . . . . . . . . . . . 1 2 SKIP 252 NO, w 201 202 2O3 204 205 m 206 207 208 I 209 SECTION 2. REPRODUCTION QUESTIONS AND FILTERS Now I would like to ask about allthe births you have had during your life. Have you ever given birth? Do you have any sons or daughters to whom you have given birth who at~ now living wi~ you? How raany sons live with you? And how many daughters live with you? IF NONE, RECORD '00'. Do you have my sons or daughtem to whom you havs given bit& who are alive but do not live with you? How many sons are alive but do not live wRh you? And how many daugh~rs are alive but do not live with you? 1F NONE, RECORD '00'. Have you ever given birth to a boy or glrl who was born alive but later d~ed? IF NO, PROBE: Any baby who crlcd or showed si~s of I~o but survived only a few houm or days? How many boys have died? And how nmay girls have died? IF NONE, RECORD '00'. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'. CHECK 208: Yusl~o make sure that I have this right: you have had m TOTAL - - daring your llfe. Is that correct? births • ~ PROBE AND YES NO [~ , CORRECT 201-208A8 NECESSARY. CODING CATEGORIES YES . I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8ONS ELSEWHERE . . . . . . . . . . . . . . ~ i DAUGHTERS ELSEWHERE . . . . . . . I :.~; '-~ !?:~ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BOYS DEAD . . . . . . . . . . . . . . . . . . . . I~ : I GIRL8 DEAD . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . CHECK 208: ONE OR MOR~ BIRTHS NO BIRTHS [--7 SKIP m -,206 -~204. -,206 -~208 253 211 212 Now I would like to record the names of all your births, wh~her stilt Miw or not, starting with the first ono you ~d. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 213 214 115 216 217 218 219 IF ALIVE: IF ALIVE: IF DEAD: Is (NAME) How old was (NAME) vchea living with he/she died? you? Whatnamewasgivcax Wereany Is I Inwhatmor~thmldy~ar Is Howoldwas toyour(fnsffnoxt) oftheso (NAME) nas(NAME)bom? (NAME) NAME)at baby? births a boy or still his/her last twins? a glrl? PROBE: alivo? birthday? What is his/her /ttthday? REC~P,D AGE DR: In wtmt season was IN le/sho born? COMPLETED YEARS. Ol 02 03 04 D5 (N~,,~) SING . 1 BOY. 1 MONTH . . . [~2q~[ YES . . 1 AOEIN L--.L--J yEARS MOLT 2 GIRL 2 YEAR NO. . . 2 219 S ING . 1 BOY. 1 MONTH . . . ~Ii:~?i!] YES . . 1 AGEIN YEARS MULT 2 GIRL 2 YEAR NO. . .2 219 YES ". NO . 2 NEXT BIRTH) YES . NO . 2 GO TO 220) S ING . 1 BOY. 1 MONTH . . . ]~,~i!~[ YES . . 1 AOEIN YES YEARS MULT 2 G IRL 2 YEAR NO. . .2 NO . . . . 2 OTO, 219 220) S ING . 1 BOY. 1 MONTH . . . [~:Y,:~[ YES . .1 AOEIN YEARS MULT 2 GIRL 2 YEAR NO. 2 219 SING- . 1 BOY, I MONTH . . . ~'~1:'=~:~1 YES . . 1 AGEIN YEARS ML~T 2 G IRL 2 YEAR NO . . . 2 219 IF '1 YR.', PROBE: How many months old was ~AMS)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS. 220 FROM YEAR OF B IRTH OF (NAME) SUBTRACT YEAR OF PR~NIOUS BIRTH. IS THE DIFFERENCE 2 OR MORE? 22I Were thee ~ b~u~l other lh between ~AME OF ~Pd~VIOU$ BIRTH) an( YE.~ONTHsDAYSI~~' . 32 ::,:~::l!:!:iii:':l: ~I~::':~ DAYS 1 ii~i~i ii~iiii~ YES . . . . . . . . 1 YES . . . . . MONTHS . . . . 2 ~i~i ii~i!ii~ NO . 2 NO . . . . . . ,l AYS 1 ,~<i YES . . . . . . . . 1 YES . . . . . MONTHS . . . . 2 ~ !:.~::~ NO . . . . . . . . . 2 NO . . . . . . YEARS . . . . . 3 (NEXT • -- --~. (BIRTH) . YES . . . NO . . . . 2 90TO • 22O) YES . . . NO . . . . 2 ~OTO 220) MONTHS 2 :: ~: NO . . . . . . 2 NO . . . . . . / YEARS 3 :::~:: (NEXT .] (BIRTH) DAYS . I ~ YES I YES 254 212 217 /F ALIVE: How old was (N .~E) at his/her last 'du~hday? RECORD AGE IN CO~LBTED YEARs. What name was giv¢~ to your (fi~/noxt) baby? (NAME) 06 ~7 ~8 09 I0 AGE IN YEARS ~AR rH OF ~CT *F *US AGE IN YEARS AGEIN YEARS AGEIN YEARS AGE IN YEARS ENCE2 RE7 . . . . . . 1 . . . . . . 2 .TZ~) 211 Now I would l iketo record ~he names of all your bhlhs, whether still allvo or not, star~_g with the fast one you ~. RECORD NAMES OF ALL THE BIRTHS IN 212. RECOP, D TWINS AND TPJPLETS ON SEPARATE LINES. . . . . . . i xr,l .TH) . . . . . . 1 xr,l TrY) xr,l TH) . . . . . . 1 .TH) 221 Wer~ thcr~ any other liv births betweea (NAME OF PREVIOUS BIRTH) and f~AME)? YES . . . . . NO . . . . . . YES . . . . . NO . . . . . . YES . . . . . NO . . . . . . YES . . . . . NO . . . . . . YES . . . . . NO . . . . . . 255 211 Now I would like to record the names of all your births, whether still alive or not, starting with I~ first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 212 What name was given to your (fusffn#xt) baby? (NAME) 11 12 13 14 15 H7 F ALIVE: tow old was NAME) at tL, Char tasl ~'thday? LECORD AGE N ~OIV~LETED ~ARS, AGEIN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AOE1N YEARS 21g IF ALIVE: is (NAME) living with you? YES . . . NO . . . . GO TO 220) 219 IF DEAD: How old was (NAME) when he/she died7 IF '1 YR.', PROBE: How many months old was (NAME)? RECORD DAYS'-IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS. DAYS . . . . . . . 1 ,~i~! ~iii~i MONTHS . . . . 2 ii~j~i ~iiii~i YEARS S !~!i ,~iii~il I 220 FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF pREVIOUS BIRTtt. IS THE DIFFERENCE 2 OR MORE? , .YES . . . . . . . . . .NO . . . . . . . . . 2 (NEXT ,1 (BroTH) 221 Wea~ thero my other lh Ymbs Between ~AME OF PREVIOUS BIRTH) an( ,~AME)~ YES . . . . . NO . . . . . . 256 222 IEROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- -.223 IS THE DIFFERENCE 2 YEARS OR MORE? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- - ,224 223 224 225 Have you had any live Ifnths since the birth of (NAME O17 LAST BIRTH)? COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS NUMBERS ARE ARE SAME CHECK: YES . I INO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DIFFERENT [~-- , (PROBE AND RECONCILE) FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH LIVING- CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 3ANUARY 1996. IF NONE, RECORD '0'. YES . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-.227 STILLBIRTHS . . . . . . . . . . . . . . . . . . . . . ~ MISCARRIAGE OR ABORTIONS . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 7 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8- 1~236 MONTHS . . . . . . . . . . . . . . . . . . . . . . . . . ~ 225A CHECK 219 AND ENTER THE NUMBER OF DEATHS SINCE IANUARY 1996; lie NONE, RECORD '0'. I 226A IIn addition to pre~mn¢ies which ended in live births) have you had any (other) pregnancy which ended in a stillbirth, miscarriage or an abortion? 226B How many pregnancies ended in stilltflrths7 IF NONE, ENTER "00" 226C How many pregnancies ended in ndscarriages or shoflions? IF NONE, ENTER "00" 227 Ave you pregnant now? 228 How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. 229 At the time you became pre~mnt did you want to become pregnant ~ did you want to wait arail later, or did you not want to have any more ehildrea at all? 236 When did your last menstrual period start? (DATE, IF GIVEN) 237 Between the first day of a woman's period and the first day of her next pined, are there certain times when she has a greater chance of becoming pre~ama than other fim¢~? 23g During which times of the monthly cycle doe~ a woman have the greatest chance of becoming pregnant? THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT WANTMORECHILDREN . . . . . . . . . . . . 3 DAYS AGO . . . . . . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . . . . . 2 ~'~ MONTHS AGO . 3 'YEARS AGO . 4 I ~ IN MENOPAUSE . 994 BEFORE LAST BIRTH . 995 NEVER MENSTRUATED ~. . 996 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8- DUR1NO HER PERIOD . . . . . . . . . . . . . . . . . . 01 RIGHT AFTERHERPERIODHASENDED . 02 IN THE MIDDLE OF THE CYCLE . . . . . . . . . 03 JUST BEFORE HER PER/OD BEGINS . . . . . 04 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . 98 257 SECTION 3. CONTRACEPTION NOW I would llke to talk about family plann~g, the various ways or methods ~at a couple can use to delay or avoid a pre~aancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLLVMN 302, READINO THE NAME AND DESCRIPTION OP EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE l OR 2 CIRCLED IN 301 OR 302, ASK 303. 301 Whish ways or methods have you heard shout? 302 Have you ever heard of 303 Have you ever used (METHOD)7 (METHOD)? SPONTANEOUS PROBED YES YES NO pILL Women can lake a pill every day. YES ] 1 2 3 - - • .NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 01 02 03 04 05 06 07 08 IUD Women can have a loop or ooil placed inside them by a doctor or a muse. 1 2 3 INJECTABLES Women can have an injection by a doctor or nurse which stops thean from becoming ¢~naut for several months. 1 2 3 IMPLANTS Women can have several small rods ,laced in their upper arm by a doctor or nurse which can prevent pregnancy for several years. 1 2 DIAPHRAGM, FOAM, JELLy Women can place a sponge, suppository, diaphragm, jelly, or ¢~emn inside themselves before intercourse. CONDOM Men can put a rubber sheath on their penis for sexual in~rcourso. 1 2 3 1 2 FEMALE STERILIZATION Women can have an olxa'ation to avoid having any more children. 1 2 3 MALE STERILIZATION Men can have an operation to avoid having any morn children. 1 2 3 YES 1 • .NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2, YES . . . . . . . . . . . . . . . 1 • .NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2. YES 1 3 NO .2 YES i • .NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . YES I 3 • ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Have you ever had an operation to -~ avoid havlng any more children? YES 1 NO . . . . . . . . 2 Have you ever had a parlner who h~ - - an operation to avoid hax;mg children? YES 1 NO 2 09 10 11 RBY~ PERIODIC ABSTINENCE Evca~ month that a woman is sexually active she can avoid having sexual intercourse on ~e days of the month she is most likely m get pregnam. 1 2 3 WITHDRAWAL Mett can be careful and pull out before climax. 1 2 3 Have you heard of any other ways or methods that women or men can use to avoid preg~aanoy? 1 3 YES 1 NO 2 YES 1 • LNO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , YES 1 (SPECIFY) NO 2 • YES I (SPECIFY) NO . . 2 258 y planning - the various ways or methods that a couple can use to delay or avoid a pregnanoy. CIRCLE CODE I IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUivIN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHODWITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303. NOT A SIN(~E I AT LEAST ONE "YES" ~--J "YES" [~ (NEVER USED) (EWR USED) • SKIP TO 309 / 305 Have you ever used anything or tried in any way to delay or avoid getting YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | iprngnaat7 ~0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~ -,331 307 i Vqhat have you used or done? COILR~CT 303 AND 304 (AND 302 IF NECESSARY). 309 ~ow I would like to ask you about the ftrst time that you did something or used a nethod to avoid getting prngnard. NUMBER OF CHILDREN . . . . . . . . . . . . . . . I-low many living children did you have at that time, if any? IF NONE, RECORD '00'. 310 ~Vhen you ftrst used family planning, did you want 1o have another child but at a inter time, or did you not want 1o have another child at all? ~VANTED CHILD LATER . . . . . . . . . . . . . . . . . . . . . 1 DID NOT WANT ANOTHER CHILD . . . . . . . . . . . . 2 3THER 96 (SPECIFY) CHECK 303: WOMAN NOT WOMAN STERILIZED ~ STERILIZED [--'] "314A 3HECK 227: NOT PREGNANT pREGNANT OR UlqSU]~ ~ [~ '332 313 Are you currently doing something or using any method to delay or avoid getting YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 314A 315 316 ~ Which ~thod are you using? CIRCLE '07' FOR FEMALE STEPJ LIZATION. ~ay I see the package of pills you are now using? RECORD NAME OF BRAND IF PACKAGE IS SEEN. Do you know tile brand name of the pills you are now using? RECORD NAME OF BRAND. ~LL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 [LID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 rNJECTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 DIAPHRAGM/FOAM/JELLY . . . . . . . . . . . . . . . . . . 05 2ONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . 07 VIALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . 08 PERIODIC ABSTINENCE . . . . . . . . . . . . . . . . . . . . 09 ~VITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3THER 96 (SPECIFY) PACKAGE SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I BRANDNAME . ~ PACKAGE NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . BRAND NAME DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . 98 ,326 ,318 -,323 1,326 --317 259 NO. 317 How much does one packet (cycl 0 of pills cost you? 318 Where did the sterilization take place? 319 320 321 323 326 QUESTIONS AND FILTERS CODING CATEGORIES COST (t~) . . . . . . . . . . . . . . . . . . . . . . ~ . FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9996- DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . 9998 - pUBLIC SECTOR GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . 11 IF SOURCE IS HOSPITAL, HEALTH CENTER, Ot~ CLINIC, WRITE OOVERNMENT HEALTH CENTER . . . . . . . . 12 THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF FAMLLY pLA I '~NO CLINIC . . . . . . . . . . . . . 13 SOURCE AND CIRCLE THE APPROPRIATE CODE. MOBILE CLINIC . . . . . . . . . . . . . . . . . . . . . . . . 14 (NAME OF PLACE) Do you regret filet (you/your husband) had the operation not to have any (more) chiidma? Why do you re~t the operation? In wh~ month and year was the sterilization performed? How do you determine which days of your monthly cycle not to have sexual relations? For how many months have you boon using (METHOD) continuously? IF LESS THAN 1 MONTH, RECORD 'Off SKIP ],326 OTHER PUBLIC 16 (SPECIFY) ?RIVATE MEDICAL SECTOR PRIVATE HOSpITAL/CLINIC . . . . . . . . . . . . . 21 PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . 23 MOBILE CLINIC . . . . . . . . . . . . . . . . . . . . . . . . 24 NON-GOVERNMENT ORGANISATION . . . . . . . . . . . . . . . . . . . . . . . . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) DTHER 96 (SPECIFY) DON T KNOW . 98 'ES . I [O . 2 -~321 i RESPONDENT WANTS ANOTHER CHILD . 01 HUSBAND WANTS ANOTHER CHILD . 02 ~IDE EFFECTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 FIEALTH REASONS ASSOCIATED WITH THE OPERATION . . . . . . . . . . . . . . . . . 04 ~[ARITAL STATUS HAS CHANGED . . . . . . . . . . 05 3PERATION FAILED . . . . . . . . . . . . . . . . . . . . . . . . 06 2HILD DIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07 FHER 96 (S~) IONTH . . . . . . . . . . . . . . . . . . . . . . . . 1+.327 EAR . . . . . . . . . . . . . . . . . . . . . . . . . I I 3ASED ON CALENDAR . . . . . . . . . . . . . . . . . . . . . 01 i 3ASED ON BODY TEMPERATURE . . . . . . . . . . . 02 BASED ON CERVICAL MUCUS (BILLINGS i METHOD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 BASED ON BODY TEMPERATURE AND i CERVICAL MUCUS . . . . . . . . . . . . . . . . . . . . . . 04 ! [ '~O SPECIFIC SYSTEM . . . . . . . . . . . . . . . . . . . . . . 05 DTHER 96 (SPECIFY) MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YEARS OR LONGER . 96 260 NO. 327 328 329 329A QUESTIONS AND FILTERS CHECK314: CIRCLE METHOD CODE: Where did you obtain (METHOD) the last time? IF SOURCE IS HOSPITAL, HEALTH CENTEE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) Do you know anoth~ place where you could have obfalaed (METHOD) the last time? CODING CATEGORIES SKIP ,NOT ASKED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00- - ,331 ~ES %10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . At the time of the ~il ization operation, did you know mother place where you ~ould have received the operation? pILL 01 ggD 02 INJECTABLF~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . 04 DIAPHRAGM/FOAM/JELLY . . . . . . . . . . . . . . . . . . 05 CONDOM/FEMIDOM . 06 .FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . 07- 1 MALE STERILIZATION 08 -/,329A .PERrODIC ABST INENCE . . . . . . . . . . . . . . . . . . . . 09 . 1 WITHDRAWAL . . . . . . . . . . . . l0 *332 . OTHER METHOD . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 PUBLIC SECTOR GOVERNMENT HOSPITAL . . . . . . . . . . . . . . . 11 GOVERNMENT HEALTH CENTER . . . . . . . . 12 l FAMILY PLANNING CLINIC 13 MOBILE CLINIC 1514 COMMUNITY HEALTH WORKER OTHER ~3HL[C 16 1 (SPECIFY) ?RIVATE MEDICAL SECTOR pRIVATE HOSPITAL]CLINIC . . . . . . 21 pHARMACY/PATENT MEDICINE STORE . . 22 PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . 23 MOBILE CLINIC . 24 COMMUNITY HEALTH WORKER 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) DTHER SOURCE SHOP . . . . . . . . . . . . . 31 CHURCH . . . . . . . . 32 • FRIEND/RELATIVE . . . . . . . . . . . . . . . . . . . . . 33 . NON-GOVEIhNMENT OROANISATION 34 OTHER 36 (SPECIFY) k'ES I -~330 ~O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -*334 1 2. ~.334 261 NO. 330 331 QUESTIONS AND FILTERS People select the place where they get fami ly planning service~ for various fe lons . What was the main reason you went to (NAME OF PLACE IN Q,32g or Q.318) instead of some othor place you know about? RECORD RESPONSE AND CIRCLE CODE. What is the main reason you are not us ing a method of oontracoption to avoid pregnancy? CODING CATECK)RIES ACCESS-RELATED REASONS CLOSER TO HOME . . . . . . . . . . . . I 1 CLOSER TO MARKET/WORK 12 AVAILABILITY OF TRANSPORT 13 gERVICE-RELATED REASONS STAFF MORE COMPETENT/FR IENDLY. . . 21 CLEANER FACIL ITY 22 • OFFERS MORE PRIVACY . . . . . . . . . . . . . . . . 23 . SHORTER WAIT INO T IME . . . . . . . . . . . . . . . 24 LONOER HRS. OF SERVICE . . . . . . . . . . . . . . 25 USE OTHER SERVICES AT THE FACIL ITY 26 i LOWER COST/CHEAPER . . . . . . . . . . . . . . . . . . . . 3J NANTED ANONYMITY . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 . NOT MARRIED . . . . . . . 11 FERT IL ITY -RELATE~ REASONS NOT HAVING SEX 21 INFREQUENT SEX . . 22 MENOPAUSAL/HYSTEP~ECTOMY . . . . . . . . 23 SUBFECUND/ INFECUND 24 POSTPARTUM/BREASTFEEDINO . . . . . . . . . 25 WANTS (MORE) CHILDREN . . . . . . . . . . . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . 31 HUSBAND OPPOSED . . . . . . . . . . . . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . . . . . . . . . . . . 33 REL IOIOUS PROHIB IT ION . . . . . 34 LACK OF KNOWLEDOE KNOWS NO METHOD . . . . . . . . . . . . . . . . . . . 41- KNOWS NO SOURCE . . . . . . . . . . . . . . . . . . . . 42- METHOD-RELATED KEASONS HEALTH CONCERNS . . . . . . . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . . . . . . . . . 52 LACK OF ACCESS/TOO FAR 53 COST TOO MUCH . . . . . . . . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . 55 INTERFERES WITH BODY'S NATURAL PROCESSES. . 56 OTHER 96 (SPECIFY) .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 . 332 Do you know o f a place where you can obtaln a method of fami ly p ianning? YES NO SKIP ,334 ~ 334 I :2 -~334 262 NO. 333 334 QUESTIONS AND FILTERS Where is ~mt? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) Were you visited by a family plamting service provider in the last 12 months? 335 Have you visited a health facility for any reason in the last 12 monlhs? 336 Did any staffmeanber at the health facility speak ~o you about family planning mo~hods? 337 338 339 Do you think flint breastfeeding can affect a woman's chance of becoming pre~? Do you flfink a woman's chance of becoming pro~aant is inked or decreased by breastfeeding7 CHECK210: ONE OR MORE NO BIRTH B THs D CODING CATEGORIES ~KIP PUBLIC SECTOR GOVERNMENT HOSPITAI- 11 GOVERNMENT HEALTH CENTER . 12 FAMILY PLANNING CI/NIC . 13 MOBILE CLINIC 14 COMMUNITY HEALTH WORKER . . . . . . . . 15 OTHER PUBUC 16 (SPECIFY) PP~VATE MEDICAL SECTOR pRIVATE HOSPITAI3CLINIC . . . . . . . . . . . . . 21, PHARIdACY/PMS 22 • PRIVATE DOCTOR . 23 . MOBILE CLINIC 24 COMMUNITY HEALTH WORKER . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER SOURCE SHOP . 31 CHURCH . 32 • FRIENDS/RELATIVES . . . . . . . . . . . . . . . . . . . 33 . NGO 34 OTHER 36 (SPECIFY) yES l .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . YES . . I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- . - ,337 YES I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . YES 1 NO . . . . . 2- - ,401 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 NCREASED . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - ,40 I .DECREASED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . DEPENDS 3 DON'T KNOW . :~ - - ,401 340 Have you ever relied on breasffee~ling as a melhod of avoiding pre~aancy? 341 CHECK 227 AND 31 h NOT PREGNANT OR UNSURE AND NOT STERILIZED 342 Are you currently relying on breasffeeding to avoid gstt~ng pre~mnt? EITHER PREGNANT OR STEPdLIZED YES l .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-.-,401 - - ,401 YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . 263 SECTION 4A. PREGNANCY AND BREASTFEEDrNG CHECK225: ONE OR MORE NO BIRTHS SINCE ~3 BIRTH SINCE [~] JAN. 1996 JAN. 1996 , (SKIP TO 465) ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. Now I would like to ask you some questions about the health of all your children bom in the last three years. LINE NUMBER FROM Q212 LAST BIRTH NEXT-TO-LAST BIRTH LINE NUMBER [ LINENUMBER SECOND-FROM-LAST BIRTH LINE NUMBER FROM Q212 NAME NAME NAME DQ216 p P ALI p AL:V P THEN 1 THEN (SKIP TO 407), I (SKIP TO 407), LATER 2 LATER . . . . 2 NO MORE . . . . . 3 NO MORE . . . . . . . . . 3 (SKIP TO 407), I (SKIP TO 407), At the time you became pregnant THEN 1 ~ith (NAME), did you watlt to - (SKIp TO 407)~- - become pregnant ~ did you LATER 2 ecant to wMt until later, or did you want no (morn) children at all? NO MOPE. 3 • (SKIP TO 407), - - - - J How much longer would you llke Lo have waited? When you were pregnant with (NAME), did you see anyone for ~ulenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? .MONTHS . . . . . . . . . . . . . . . 1 . ~:::~ ::::~:: .MONTHS . . . . . . . . . . . . . . 1 ::3~:: ::,~: IMONTHS . . . . . . . . . . . . . . . . I ::',:~,:~ i:::~ .YEARS . . . . . . . . . . . . . . . . . 2 :~:~ :~:~:~ .YEARS . . . . . . . . . . . . . . . . 2 ::~::: i::: .YEARS . . . . . . . . . . . . . . . . . . 2 ::::~ ~::~::~ DON'TKNOW . . . . . . . . . . . . . . . . . 998 DON'TKNOW . . . . . . . . . . . . . . . . . 998 DON'TKNOW . . . . . . . . . . . . . . . . . . 998 HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE B : AUXILIARy MIDWIFE . . . . . . . . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT . . . . . . . . . . . . D OTHER X: (SPECIFY) NO ONE Y - (SK IPT0410) , - - HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . A NURSE/MIDWIFE B AUXILIARY MIDWIFE. C OTHER PERSON TRADITIONAL BIRTH ATTENDANT D OTHER X HEALTH PROFESSIONAL DOCTOR . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . . . B AUXILIARy MIDWIFE . . . . . . . . . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT D OTHER X PROBE FOR THE TYPE OF (SPECIFY) (SPECIFY) PERSON AND RECORD NO ONE Y NO ONE Y ALL PERSONS SEEN. (SKIP TO 410), I (SKIP TO 410), How many months pre~aat wexe you whea you first received MONTHS [ ]MONTHS ~ MONTHS antenatal care? DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . . 98 How many times did y mtmmtal care during this NO. OF TIMES [ NO. OF TIMES [ NO. OFTIMES pregnanoy7 DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . . 98 Whenyouweropregnaulwith YES 1 YES i YES 1 (NAME) were you given art injeetioninthe armtopmvontthe NO 2 NO 2 NO . . . . . 2 baby from getting tetanus, that is, (SKIP TO 412)4 - - (SKIP TO 412), I (SKIP TO 412)4 ~onvulsiomaf~rbirth? DON'TKNOW . . . . . . . . . . . . . . . . . . . S DON'TKNOW . . . . . . . . . . . . . . . . . . . g DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 264 111 112 I13 I14 ;15 I16 CHECK 225: ONE ORMORE B IRTHS S INCE JAN. 1996 P NO BIRTH SINCE [~ JAN. 1996 • (SKIP TO 465) NAME LAST BIRTH NEXT-TO-LAST BIRTH NAME SECOND-FROM -LAST BIRTH NAME During this pre~aanoy, how many times did you get this injection? Where did you give Ifuth to Who assisted with the de l ive~ of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. Around the t ime of the b i~h o f (NAME), did you have any o f the followhig problems: Long labor, that is, did your regular contractions last more than 12 hours? Exe~sslve bleeding that was so much that you feared i t was l i fe threatening? A h igh fever wi th bad smel l ing vaginal discharge? Convulsions not caused by a fever? Was(NAME)dd iveradby eae~arianseotlon? When (NAME) was bor~ was he/she: very large, larger t i tan average, average, smaller than average, or very smal l? rIMES . ~ TI~S . . . . . . . . . . . . . . . ~ rIMES . . . . . . . . . . . . . . DON'TKNOW . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . 8 .DON'TKNOW . . . . . . . . . . . . . . . . . . . . . FIOME HOME HOME YOUR HOME 11 yOUR HOME 11 YOUR HOME . . " 1 ] OTHERHOME . . . . . . . . . . . . . . 12 . OTHERHOME . . . . . . . . . . . . . . 12 , OTHERHOME . . . . . . . . . . . . . . . 15. PUBLIC SECTOR GOVT. HOSPITAL . . . . . . . . . . 21 GOVT. HEALTH CENTER . .• 22 GOVT. HEALTH POST . . . . . . 23 OTHER PUBLIC 26 (SPECIFY) PRIVATE MEDICAL SECTOR pVT. HOSPITAUCLINIC . 31 OTHER PRIVATE MEDICAL 36 (SPECIFY) !OTHER 96 (SPECIFY) REALTH PROFESSIONAL DOCTOR NURSETM/DWIFE' B ALUGLIARY MIDWIFE . . . . . . . . C OTHER PERSON TRADIT IONAL B IRTH ATTENDANT D RELAT IVE~RIEND . . . . . . . . . . . E DTHER PUBLIC SECTOR GOVT. HOSPITAL .21 GOVT. HEALTH CENTER . . . 22 GOVT. HEALTHPOST ,23 OTHER PUBLIC 26 (SPECIFY) PRIVATE MEDICAL SECTOR pVT. HOSPITAL/CLINIC . 31 OTHER PRIVATE MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE B AUXIL IARY MIDWIFE . . . . . . . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT D RELAT1VE~RIEND . . . . . . . . . . E X OTHER X (SPECIFY) (SPECIFY) PUBLIC SECTOR GOVT. HOSP ITAL . . . . . . . . . . . 2; GOVT. HEALTH CENTER . . . . 2~ GOVT. HEALTH POST 2" OTHER pUBL IC 2( (SPECIFY) PR IVATE MEDICAL SECTOR pVT. HOSP ITAL /CL IN IC . 3] OTHER PRIVATE MEDICAL 3f (SPECIFY) OTHER 9( (SPECIFY) HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE . . . . t ALr.~ L IARY MIDWIFE . . . . . . . . . ( OTHER PERSON TRADIT IONAL B IRTH ATTENDANT l RELATIVE/FRIEND . OTHER (SPECIFY) .NO ONE . . . . . . . . . . . . . . . . . . . . . . . . Y .NO ONE . . . . . . . . . . . . . . . . . . . . . . . Y .NO ONE . . . . . . . . . . . . . . . . . . . . . . . . "~ YES NO YES NO YES NC LABOR ~ORE THAN 12 HOURS . . . . . . 1 EXCESSIVE BLEEDING . . . . . . 1 FEVER/BAD SMELL ING VAG. D ISCHARGE 1 CONVULSIONS . . . . . . . . . . . . . . 1 LABOR 2 MORE THAN 12 HOURS . . . . . . 1 2 2 EXCESSIVE BLEEDING . . . . . . 1 2 FEVER/BAD SMELL INO 2 VAO. D ISCHARGE 1 2 LABOR MORE THAN 12 HOURS . . . . . . . 1 EXCESSIVE BLEEDING 1 YES .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VERY LARGE 1 VERY LARGE . • 1 . LARGER THAN AVERAGE . . . . . . . 2 .LARGER THAN AVERAGE . . . . . . . 2 iAVERAOE , 3 %VERAOE 3 ~MALLER THAN AVERAGE . . . . . . 4 SMALLER THAN AVERAGE . . . . . . 4 VERY SMALL . . . . . . 5 VERY SMALL . . 5 DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 DON'T KNOW . . . . . . . . . . . . . . . . . . . S FEVER/BAD SMELL ING VAO. D ISCHARGE . 1 2 CONVULS IONS . . . . . . . . . . . . . . 1 2 , CONVULS IONS . . . . . . . . . . . . . . . 1 - 1 YES . . . . 1 YES NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VERY LARGE LARGER THAN AVERAGE . . . . . . . . . AVERAGE . . • SMALLER THAN AVERAGE . . . . . . . . VERY SMALL DON'T KNOW . . . . . . . . . . . . . . . . . . . . 265 401 3HECK 225: ONE OR MORE NO BIRTHS SINCE ~ BIRTH SINCE [~ JAN. 1996 • JAN. 1996 417 Was (NAME) weighed at birth? 418 419 How much did (NAME) weigh? RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE. LAST BIRTH Has your period returned sines the bit~ of (NAME)? • (SKIP TO 465) 420 Did your period retom between the bkth of(NAME) and your next pre~aancy? 421 NEXT-TO-LAST BIRTH SECOND-FROM -LAST BIRTH NAME NAME NAME For how many months afrer the birth of(NAME) did you not have a period? 422 CHECK 227: RESPONDENT PREGNANT? 423 Have you resumed sexual relations since the birth of(NAME)? 424 For how many months after the birth of (NAME) did you not have sexual t~latlons? YES 1 YES 1 YES . . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 419), ~ (SKIP TO 420), I (SKIP TO 420), ~RAMS FROM ORAMS PROM GRAMS FROM ~RAMS FROM G~S FROM GRAMS PROM CALL . . . . . . . . . RECALL . . . . . . . . . . ~DON'TKNOW . . . . . . . . . . . . . . . 99998 .DON'TKNOW . . . . . . . . . . . . . . 99998 .DON'TKNOW . . . . . . . . . . . . . . . . 99998 YES (SKIF TO 421), No ~ (SKIP TO 422), YES (S TO424), 1 YES . . . 1 no . . . . . . . . . . ._KIp 2 No 2 I (SKIP TO 424), MONTHS. ~ ~IONTHS ~ MONTHS DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . . 98 NOT D PREONANT PREG- - - OR UNSURE NANT • (~KIF TO 424), ~ I YES . I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I (SKIP TO 425), I MONTHS DON'T KNOW . . . . . . . . . . . . . . . . . . 98 425 Did you ever breastfeed (NAME)? YES 1 NO . . . . . . . . . . . . . . . . 2 (SKIP TO 427), I 425A Did you Feed (NAME) eolostmm FED COLOSTRUM . . . . . . . . . . 1 from the breast or wait until (SKIP TO 426). I eolostntm had passed? WAITED . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . 8 (SKIP TO 426), - - - - j 425B While you waited for colostrum to lass, what did you feed (NAME)? 426 How long afrer bhlh did you First put (NAME) to file breast? IF LESS THAN 1 HOUR, RECORD "00' HOURS. IF LESS THAN 24 HOURS, ILECORD HOURS. OTHERWISE, RECORD DAYS. PLAIN WATER SUGAR/GLUCOSE WATER BABY FORMULA . . . . . . . . . . . . . . . . FRESH MILK SOYAMILK . . . . . . . . . . . . . . . . . . . . . OTHER (SPECIFY) MONTHS DON'T KNOW . . . . . . . . . . . . . . . . . . 98 DON'T KNOW . . . . . . . . . . . . . . . . . . . 98 YES 1 YES 1 NO . . . . . . . . . . . . . . . . . . . . 2 NO . 2 (SKIP TO 427), I (SKIP TO 427), I i " 1 IMMEDIATELY . . . . . . . . . . 00O IMMEDIATELY . . . . . . . . . . . . . . . . 000 IMMEDIATELY . . . . . 0O0 HOURS . . . . . . . . . . . . . . . . . 1 :!:~-- ~ HOURS . . . . . . . . . . . . . . . . 1 :!~'-- ~ HOURS . . . . . . . . . . . . . . . . . . 1 DAYs . . . . . . . . . . . . . . . . . . 2 ~2 ~ DAYS . . . . . . . . . . . . . . . . 2 :~ ~ DAYS . . . . . . . . . . . . . . . . . . 2 ~5 266 401 427 428 429 430 431 CHECK 225: ONE OR MORE BIRTHS SINCE JAN. 1996 CHECK 404: CHILD ALIVE? Are you still breasffeeding NAME)? For how many months did you breasffeed (NAME)? Why did you stop breastfeedlag NAME)? P ALIVE NO BIRTH SINCE [-7 , (SKIP TO 465) JAB/. 1996 i ivB DE O V .:j ALI ? (SKIp TO 429) (SKIP TO 429), : • (SKIP TO 429),-- LAST BIRTH NEXT-TO-LAST BIRTH : SECOND-FROM -LAST BIRTH lAME NAME ~ NAME YES 1 YES 1 YES 1 (SKIp TO 43 IB)* I (SKIP TO 431B)4 I (SKIP TO 431B). J ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 MONTHS ~ MONTHS ~ MONTHS UNTILDIED . . . . . . . . . . . . . . . . . . . 95 UNTILDIED ,. 95 UNTILD1ED 95 (SKIp TO 43 IB)* I (SKIP TO 431B), I (SKIP TO 431B), • DON'T KNOW . . . . . . . . . . . . . . . . . . 9g ,DON'T KNOW . . . . . . . . . . . . . . . . . . 98 . DON'T KNOW . . . . . . . . . . . . . . . . . . . 98 MOTHERILL/WEAK . . . . . . . . . . . . 01 ~OTHERILL/WEAK 01 MOTHER1LIdWEAK 01 CHILD ILL/WEAK . . . . . . . . . . . . . . 02 I CHILD ILIdWEAK .02 CHILD ILL/WEAK 02 CHILD DIED . . . . . . . . . . . . . . . . . . . 03 ICHILD DIED .03 CHILD DIED . 03 NIPPLE/BREAST PROBLEM . . . . . 04 INIPPLE/BREAST PROBLEM . . . . . 04 . NIPPLE/BREAST PROBLEM . . . . . . 04 m NOT ENOUGH MILK . . . . . . . . . . . . 05 NOT ENOUGH MILK . . . . . . . . . . . . 05 NOT ENOUGH MILK . . . . . . . . . . . . . 05 MOTHER WORKING . . . . . . . . . . . . 06 MOTHER WORKING . . . . . . . . . . . . 06 MOTHER WORKING . . . . . . . . . . . . . 06 CHECK 404: CHILD ALIVE? CHILD REFUSED . . . . . . . . . . . . . . . 07 WEANING AGE/AGE TO STOP . . . 08 BECAME pREGNANT . . . . . . . . . . . 09 STARTED USING CONTRACEPTION . . . . . . . . . . 10 OTHER _96 (SPECIFY) ALIVE ~ DEAD CHILD REFUSED 07 CHILD REFUSED 07 ~VEANING AGE/AGE TO STOP . . . 08 WEANING AGE/AGE TO STOP . . . . 08 BECAME PREGNANT 09 BECAME pREGNANT 09 ~TARTED USING STARTED USING CONTRACEPTION . i0 CONTRACEPTION I0 OTHER 96 OTHER 96 (SPECIFY) (SPECIFY) DEAD p IVE p PESO p gKIP TO 43 IB) (SKIP TO 431B) ~SKIP TO 431 B) 431A Was (Name) ever given any water, .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or somahlag-dse ~o drink or eat NO NO . . . . . . . . . . . . . . . . . . . . ~ther tluta breasanilk)? 43 lB How many months old w~ (Name) when you started givlng the following on a regular basis? Formula or milk other than breaslmilk, such as soya milk? Water or other liquids? Arty soIid or mashy Food, such as ~ banana or mashed ~aka? 431C Have you over heard about exoludve brcastfeedlag? (SKIP TO 431C)~ AGE IN MONTHS AGE IN MONTHS (SKIp TO 431C)~ NOT GIVEN . . . . . . . . . . . . . . . . . . . . 96 AGE IN MONTHS NOT GIVEN . . . . . . . . . 96 NOT GIVEN . . . . . . . . . . . . . . . . . . . . 96 AGE IN MONTHS . . NOT GIVEN . . . . . . . . . . . . . . . . . . . . 96 NO. 2 (SKIP TO 431C)~ ] AGE IN MONTHS . I I ;~:: : I NOT GIVEN 96 NOT GIVEN 96 AGE IN MONTHS AOEINMONTHS ,OE IN MONTHS • NOT GIVEN . . . . . . . . . . . . . . . . . . . . 96 .NOT GIVEN . . . . . . . . . . . . . . . . . . . . 96 .NOT GIVEN . . . . . . . . . . . . . . . . . . . . . 96 iNO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (sKiPTO 267 NO BIRTH SINCE [~ YAN. 1996 • (SK/P TO 465) CHECK 225: ONE OR MORE BIRTHS SINCE IAN. 1996 431E 432 433 434 435 2HECK 404: CHILD ALIVE? How many times did you b~asffeed (NAME) last night between su~at and sunri~? IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER How many times did you breasffeed yeatexday during the daylight hou*'s? IF ANSWER IS NOT NI/MERIC PROBE FOR APPROXIMATE NUMBER. Did (NA/VIE) drink anything from a bottle with a nipple yesterday or last night? At any time yesterday or last night, was (NAME) given any of the following: Plain water? Sugar water7 /uice? Herbal tea? Baby formula? Tinned or powdered milk7 Fresh milk? Any other liqnid? Any food made from [WHEAT, MAIZE, RICE, SORGHUM or LOCAL ORAl'N] ~aeh aa [PORRIDGE, BREAD, or NOOBLES]? Any food made from [CASSAVA, PLANTAIN, YAMS, or LOCAL TUBER]? Eggs, fish or poult~? Meat? Any other solid or seml-soIid foods? (CO BACK TO 405 ~STILL • IN NEXT COLUMN 8REASTPEED- OR, IF NO MORE [NO, ELSE BIRTHS, GO TO GO TO 440) 440) (CO BACK TO 405 CSTILL • IN NEXT COLUMN BREASTFEED- OR, IF NO MORE [NO, ELSE BIRTHS, CO TO SO TO 440) 440) IvE p (CO BACK TO 405 (STILL * IN NEXT COLUMN BREABTFEED- OR, IF NO MORE ING, ELSE BIRTHS, CO TO 440) GO TO 440) 268 401 436 437 438 439 2HECK 225: ONE OR MORE NO BJRTHSSr~CE ~$3 HmT~SINCE ffAN. 1996 /AN. 1996 NAME LAST BIRTH ,- (SKIP TO 465) NEXT-TO-LAST BIRTH SECOND-FROM -LAST BIRTH NAME NAME CHECK 435: TYES" ? TO "NO£DK" ? ALL FOOD OR LIQUID GIVEN ONE ok YESTERDAY? MORE • (SKIP TO 438 ~side from breaslCeeding,) how may times did (NAME) eat ?esterday, including both meals md snacks? F~ NUMBER OF TIMES ]~ i~ I DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 IF 7 OR MORE TIMES, RECORD '7', =. D~ how many days during the la~ leven days was (NAME) given any >fthe following: Plain water? RECORD THE NUMBER OF DAYS. PLAIN WATER ::~:~ :: MILK . . . . . . . . . . ::~: FOOD MADE FROM . . . . . . . . . . . :::i:: . [GKAIN] ::~:~:: FOOD MADE FROM ::::~: [TUBER] ::~', I EC~S/FISH/I'OULTRY . . . . . . . . . : . MEAT ::.'.'."~ DTHER SOMD/SEMI- ~!~ SOLID FOODS ~, Any kind of nfilk (other titan breast OTHER LIQUIDS ~lk)7 Liquids other than plain water or milk? Food made from [WHEAT, MAIZE, KICE, gORGe, or LOCAL GRAIN]? Food made from [CASSAVA, PLANTAIN, YAMS, or LOCAL TUBER]? Eggs, fish, or poultry? Meat? Any other solid or semi-solid foods? IF DON'T KNOW, RECORD '8'. GO BACK TO 405 IN NEXT ONE oP . | MORE • (SKIP TO 438) NN 30 BACK TO 405 IN NEXT "yES . . . . NO/DK" TO ~ TOALL ONE oR ! MORE (SKIp TO 43~ GO BACK TO 405 1N NEXT COLUMN COLLrMN; OR, IF NO MORE BIRTHS, :COLUMN; OR, IF NO MORE BIRTHS, OR, IF NO MORE BIRTHS, GO TO 440. GO TO 440. GO TO 440. 269 144o 441 442 SECTION 4B. IMMUNIZATION AND HEALTH ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JAt~LIARy 1996 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS• BEGIN WITH THE LAST BIRTH• LAST BIRTH NEXT-TO-LAST BIRTH SECOND -FROM-LAST BIRTH LINE NUMBER FROM Q212 LINE NUMBER ~ LrNE NUMBER . . . . ~ ,INENUMBER FROM Q212 NAME NAME ~NAME ANDQ216 ALIVE ~ DEAD ~ ALIVE D DEAD ~ ALIVE ~ DEAD 443 444 445 446 Do you have a em'd whe~ YES, SEEN YES, SEEN YES, SEEN (NAME'S) vacchmfiom are ~At~n • (SKIP TO 445)4 - - . (SKIP TO 445) , - - - (SKIP TO 445)4 down? YES, NOTSEEN 2 YES, NOTSEEN . . . . . . . . . . . 2 YES, NOTSEEN • (SKIP TO 447)4 - - . (SKIP TO 447) ( - - - (SKIP TO 447)( IF YES: May I s~ it plemso? .NO CARD . . . . . . . . . . . . . . . . . . . . . . . . . 3, NO CARD . . . . . . . . . . . . . . . . . . . . . . . . 3 NO CARD . . . . . . . . . . . . . . . . . . . . . Did you ever have a vaocination YES YES YES card for (NAME)? (SKIP TO 447), '-4 (SKIP TO 447)4 - - (SKIP TO 447)4 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE'44* IN 'DA~ COLUMN IF CAP.D SHOWS THAT A VACCI~ATIONWASGIV£N, BLrf DAY MONTH ~ DAY MONTH YILn.R D&Y MONTH YEAR NO DATB IS RECORDED. I BeG Polio 0 I / Polio 1 / I I>2 IMlio 2 I I P3 Polio 3 I I DPT 1 ] i Dgr2 DPT3 I I Measl*~ I Has (NAME) reoeived any YES YES yES vaeoinationsthatarenotreeorded PROBE FOR VACCINATIONS ~-J ?ROBE FOR VACCINATIONS ~ (~ROBE FOR VACCINATIONS ,A on this card? AND WRITE '66' IN THE AND WRITE "66' IN THE AND WRITE '66' IN THE CORRESPONDING DAY COLUMN 1N ~ORRESPONDING DAY COLUMN IN CORRESPONDING DAY COLUMN E.ECORD'YES'ONLYIF 445) - - !445) - - IN445) E~BPONDENT MENTIONS • (SKIP TO 449)~- - (SKIP TO 449) ( - - " (SKIP TO 449)( BCO, POLIO 1-3, DFI" 1-3, NO . . . . . . 2NO . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . 2 AND/OR MEASLES (SKIp TO 449)( - - - - -q (SKIP TO 449) , - - (SKIP TO 449), VACCINE(S). DON'TKNOW 8 DON'TKNOW . . . . . . . . . . . . . . . 8 DON'TKNOW. 270 440 447 448 448A 448B 4480 448D 448E 448F 448G 448H 449 449A ENTEH THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996 IN THE TABLE. #.SK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WITH THE LAST BIRTH. Did (NAME) ever receive any vo~clna~ons ~ prevent him/her ~'om getting diseases? ?lease tell n~ i f (NAME) received my of the following vaccinations: A BCG vaccination again~ nbemulosis, that is, an injection in When was the first polio vaccine given, just after birth or latex? DPT vaeQinafion, that is, an inj ¢~doa usually given at the same time as polio drops? LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NAME ~AME NAME .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO . . 2 :NO , '. (SKIP TO 449),, (SKIP TO 449), DON TKNOW . . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 YES . . . . . . . YES NO . . . . . 2 3tO . . . 2 How ninny tiraes? 1 3IO . . . . . . . . 2 (SKIP TO 449), ] DON'T KNOW . . . . . . . . . . . . . . . . . S YES . 1 NO . . . . . . . . . 2 he lelt arra or shoulder that caused .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8. DON'T KNOW . . . . . . . . . . . . . . . . . 8 i sear? ?olin vaccine, that is, drops in the YES . . . . . YES YES 1 ~outh? NO 2 NO, 2 NO 2 (SKIP TO 448E), (SKIP TO 448t ) , (SKIP TO 448R), I DON'TKNOW . . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . 8 [Iow many tlme~? BERO.I ES ' BERO.I ES BRROET S JUST AFTER B IRTH. . . 1 JUST AFTER BIRTH . . . . . . . . . . . . . . . 1 JUST AFTER B IRTH. . 1 LATER 2 LATER . 2 LATER 2 • YES . YES . YES I NO . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. NO . 2 (SKIP TO 4480) , (SKIP TO 448G), (SKIP TO 448G), I DON'TKNOW. .• 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . 8 NUMBER OF TIMES . ~ NUMBER OF TIMES ~ NUMBER OF TIMES ~m injection to prevent measles? YES . . . . YES I No . . . . :: 2 YEs INO . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8. DON'TKNOW . . . . . . . . . . . . . . . . . 8 DEAD t~LIVE DEAD 2HECK216: ALIVE ~ GOBACK ~ ~ GOBACK CHILD ALIVE TOQ.443 • TOQ.443 , FOR NEXT BIRTH; FOR NEXT BIRTH; OR IF NO BIRTHS OR IF NO B IRTHS (SKIP TO 465) (SKIP TO 465) Has (NAME) been ill with a fever at any thne in the last 2 weeks? YES . NO. . DON T KNOW . . . . . . . •. YES 2 NO . . . . . . . . . . . . . . . . 8 DON'T KNOW Did you seek for medical advice or . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i YES ~,ahrtent for the fever? NO 2 ;NO . . . . . . . 450 ~Ias (NAME) been ill with a cough ~t anyt ime in the last 2 weeks? 451 When (NAME) was ill with a [cough, did hegshe breathe more Irapidly than usual with short, fast )reaths7 452 Did you seek advice or *reatment ~or the cough? 2 . . . . . . . . S . . . . . . . . 2 DEAD ~I,IVE ~ GO BACK TO QA43 • FORNEXT B~TH; [ ORIFNO BIRTHS (SKIP TO 465) YES 1 NO . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . 8 YES . 1 NO . . . . . . . . 2 DON TKNOW . . . . . . . . . . . . . . . . . . . . . 8 .DON TKNOW . . . . . . . . . . . . . . . . . . . . 8. DON TKNOW . . . . . . . . . . . . . . . . . 8 YES . . . . . . . [YES YES 1 NO . . . . . . 2 )IO . . .2 NO 2 (SKIP TO 454), (SKIP TO 454), (SKIp TO 454), [ DON T KNOW . . . . . . . . . . . . . . . . . . . . . g DON T KNOW . . . . . . . . . . . . . . . . . . . . 8, DON T KNOW . . . . . . . . . . . . . . . . . 8 YES . . . . YES YES 1 NO . . . . . 2 ~0 2 NO, 2 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . S DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . 8 YES . . . . iYES YES . 1 NO 2 I, NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454), [ (SKIP TO 454), (SKIP TO 454), 271 453 454 455 456 457 458 459 ENTER T I lE NAME, L INE NUMBER, AND SURVIVAL STATUS OF EACH B IRTH S INCE JANUARY 1996 IN T t tE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. Where did you seek advice or ~e~atmc, nt ? Auywhem else? RECORD ALL MENTIONED. LAST B IRTH NAME PUBL IC SECTOR GOVT. HOSP ITAL A GOVT. HEALTH CENTER . . . . . . . . B GOVT. HEALTH POST . . . . . . C MOBILE CL IN IC D COMM. HEALTH WORKER . E OTHER PUBLIC P (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC G NEXT-TO-LAST BIRTH NAME PUBLIC SECTOR GOVT. HOSP ITAL . . GOVT. HEALTH CENTER . . . . . . . GOVT. HEALTH POST MOBILE CLINIC . . . . . . . . . . . . . . . COMM. HEALTH WORKER . . . . . OTHER PUBLIC (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC. SECOND-FROM-LAST B IRTH NAME PUBL IC SECTOR $ OOVT. HOSP ITAL A E GOVT. HEALTH CENTER . . . . . B £ GOVT. HEALTH POST . . . . . . . . C E MOBILE CLINIC . D ]E COMM. HEALTH WORKER . . . E OTHER PUBL IC F (SPECIFY) PRIVATE MEDICAL SECTOR C PVT. HOSPITAL/CL INIC . . . . . . G • PHARMACY/PMS . . . . . . . . . . . . . . . H i PHARMACY/PMS . . . . . . . . . . . . . . H. PHARMACY/PMS . . . . . . . . . . . . . H PRIVATE DOCTOR II PRIVATE DOCTOR PRIVATE DOCTOR . I MOBILE CL IN IC . . . . . . . . . . . . . . . . . MOBILE CLINIC . . . . . . . . . . . . . . . . J MOBILE CL IN IC J COMM. HEALTH WORKER . . . . . . E COMM. HEALTH WORKER . . . . . E COMM. HEALTH WORKER . . . K OTHER PRIVATE MEDICAL OTHER PRIVATE MEDICAL OTHER PRIVATE MEDICAL I I L (SPECIFY) (SPECIFY) (SPECIFY) OTHER SOURCE OTHER SOURCE ! OTHER SOURCE SHOP M SHOP M SHOP . . . -- M TRAD. PRACTIT IONER . N TRAD. PRACTIT IONER . N TRAD. PRACTIT IONER . N SPIR ITUAL HEALER P SPIRITUAL HEALERS SPIRITUAL HEALERS P OTHER ~ OTHER ~ OTHER X (SPECIFY) (SPECIFY) (SPECIFY) Has (NAME) hsd diarshoea inth¢ .YES . YES YES I last 2 weeks? NO 2 NO NO 2 (SKIP TO 464) , (SKIP TO 464) , (SKIP TO 464) , t DON'T KNOW . . . . . . . . . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . . . . . . . 8 Was there any blood in the stools? YES . YES YES 1 NO . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . . . . . . . 8 On the worst day ofth¢ dla~rhoea, NUMBER OF BOWEL ~ NUMBER OF BOWEL ~ ~EROFBOWEL how many bowel movements did MOVEMENTS(STOOLING) ~fOVEMENTS(STOOLING) MOVEMENTS(STOOLING) . . . (NAME) have? DON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . 98 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . 98 Was he/she given the same amount . SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~AME SAME I offluidSodrinkasbeforethe MORE 2 ~£ORE . 2 MORE . 2 diarrhoea, or more, or less? LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 .LESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. LESS 3 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . S Was he/she given the same amount . SAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~AME SAME 1 of food to eat as before the d i~hoea , or more, or less? When (NAME) had diarrhoea, was he/she given any of the Following to drink: A fluid, made from a special packet cal led "ORT"? Th in watery gruel made f rom RICE OR OTHER LOCAL GRAIN, TUBER, PLANTAIN]? Soup? Home-made sugar-salt-water solution? M i lk or infaut Formula? Yoghurt-based drink? Water? Any other l iquid? MORE 2 MO1LE 2 MORE . . . . . . . . . . . . . . . . . . . . . . . . 2 LESS . . . . . . . . . . . . . . . . . . 3 LESS . . . . 3 LESS 3 DON'TKNOW . . . . . . . . . . . . . . . . . . . . . S DON'TKNOW . . . . . . . . . . . . . . . . . . . . 8 DON'TKNOW . . . . . . . . . . . . . . . . . S YES NO DK YES NO DK YES NO DK FLU ID FROM ORS PKT . . . . . . . 1 2 TH IN WATERY GRUEL 1 2 SOUP . . . . . . . . . . . . . . . l 2 SUG.-SALT-WAT. SOL . . . . . . . . 1 2 M ILK / INFANT FORM. 1 2 YOGHURT-BASED DR . . . . . . . . i 2 WATER . . . . . . . . . . . . . . . . . . . . . I 2 OTHER L IQUID . . . . . . . . . . . . . . 1 2 S FLUID FROM ORS PKT . . . . . 1 2 S rH INWATERYORUEL . . . . 1 2 S ~OUP . . . . . . . . . . . . . . . . . . . . . 1 2 8 ~UO.-SALT-WAT. SOL . . . . . . 1 2 8 MILK/ /NPANT FORM. 1 2 8 YOGHURT-BASED DR . . . . . . 1 2 8 WATER . . . . . . . . . . . . . . . . . . . 1 2 S FLUID FROM ORSPKT . . . 1 2 8 8 TH IN WATERYGRUEL . . 1 2 S S SOUP . . . . . . . . . . . . . . . . . . . 1 2 8 8 SUO.-SALT-WAT. SOL . . . . 1 2 S 8 MILK / INFANT FORM . . . . . 1 2 8 8 YOOHURT-BASEDDK. . . 1 2 8 WATER . . . . . . . . . . . . . . . . . 1 2 8 8 .OTHERL IQUID . . . . . . . . . . . . 1 2 v. OTHERL IQU1D . . . . . . . . . . 1 2 8 272 ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. 1 46O 461 462 463 Was anything (else) given to t~at the diarrhoea? What was giwn to treat the diarrhoea? Anything also7 RECORD ALL MENTIONED, Did you seek advice or treatm~mt for the diarrhoea? Whexe did you seek advlc¢ or treatment? Anywhere else? LAST BIRTH NEXT-TO-LAST BIRTH SECOND-PROM-LAST BIRTH NAME NAME NAME YES I YES . ] YES NO 2 NO . • NO 2 (SKIP TO 462)* - - - -~ (SKIP TO 462)* - - (SKIP TO 462)* • DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8. DON'T KNOW . . . . . . . . . . . . . . . . . . . . g, DON'T KNOW . . . . . . . . . . . . . . . . . S RECOMMENDED HOME FLUID . . . . A RECOMMENDED HOME FLUID. . . A RECOMMENDED HOME FLUID . A FABLET OR SYRUP . . . . . . . . . . . . . . . B TABLET OR SYRUP . . . . . . . . . . . . . . E TABLET OR SYRUP B iNJECTION . . . . . . . . . . . . . . . . . . . . . . C INJECTION ( INJECTION C ~I.V.) INTRAVENOUS D (LV.) INTRAVENOUS E (LV.) INTRAVENOUS . . . . . . . . . . D ~IOME REMEDIES/ HOME REMEDIES/ HOME REMEDIES/ HERBAL MEDICINES . . . . . E HERBAL MEDICINES . . . . . . . . . ~ HERBAL MEDICINES, E DTHER X OTHER ~ OTHER X (SPECIFY) (SPECIFY) (SPECIFY) !YES 1 YES YES 1 INO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO NO 2 • (SKIP TO 464)* - - • (SKIp TO 464)* - - . (SKIP TO 464)* ?DBLIC SECTOR pUBLIC SECTOR GOVT. HOSPITAL . . . . . . . . . . . . . . . A GOVT. HOSPITAL. A GOVT. HEALTH CENTER B GOVT. HEALTH CENTER . . . . . . . E GOVT. HEALTH POST . . . . . . . . . . . C. GOVT. HEALTH POST . . . . . . . . . . C, RECORD ALL MENTIONED. MOBILE CLINIC D COMM. HEALTH WORKER . . . . . . . E i OTHER PUBLIC F (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC G pHARMACY/PMS B pRIVATE DOCTOR . . . . . . . . . . . . . . . MOBILE CLINIC COMM. HEALTH WORKER . . . . . . E OTHER PKIVATE MEDICAL L (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . M TRAD. PRACTITIONER . . . . . . . . . . N SPIRITUAL HEALER P OTHER X (SPECIFY) 464 GO BACK TO 442 IN NEXT COLUMN; oR, IF NO MORE BIRTHS, GO TO 465. PUBLIC SECTOR GOVT. HOSPITAL . . . . . . . A GOVT. HEALTH CENTER . . . . . B GOVT. HEALTH POST. . C MOBILE CLINIC D COMM. HEALTH WORKER . . . E OTHER PUBLIC F MOBILE CLINIC . . . . . . . . . E COMM. HEALTH WORKER E OTHER PUBLIC (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC G PHARMACYLPMS B PRIVATE DOCTOR . . . . . . . . . . . . . . . . PRIVATE DOCTOR . . . . . . . . . . . . I MOBILE CLINIC . . . . . COMM, HEALTH WORKER E OTHER pRIVATE MEDICAL L (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . . . O PHARMACY/PM8 . H MOBILE CLINIC . . . . . . . . . . . . . . ff COMM. HEALTH WORKER . . . K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE SHOP M TRAD. PRACTIT IONER . N SPIRITUAL HEALER F (SPECIFY) OTHER SOURCE SHOP . . . . M TRAD. PRACTITIONER . . . . . . . N SPIRITUAL HEALER . . . . . . . . . P OTHER E OTHER X (SPECIFY) (SPECIFY) C,O BACK TO 442 IN NEXT COLUMN GO BACK TO 442 IN NEXT OR, COLUMN; OR, IF NO MORE BIRTHS, IF NO MORE BIRTHS, ~O TO 465. OO TO 465. 273 NO. 465 QUESTIONS AND HLTERS When a child has diarrhoea, should he/she be given less to drink fl~tn usual, about the same amount, or moro than usual? CODING CATEGORIES LESS TO DRINK. 1 ABOUT SAME AMOUNT TO DRINK . . . . . 2 MORE TO DRINK 3 .DON TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 466 When a child has dian~oea, should he/she be givenioss to eat than usual, LESS TO EAT 1 shout the same amount, or mor¢ than usual? ABOUT SAME AMOUNT TO EAT . . . . . . . . 2 MORE TO EAT 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 467 When a shild is alck with diarthoea, wlua si~as ofillness would tell you that he or she should be taken to a health facility or heal~ worker? RECORD ALL MENTIONED. When a child is sick with a cough, ~ signs of illness would tell you that he or she should be t, tken to a health facillty or health worker7 468 RECORD ALL MENTIONED. CHECK 459, ALL COLUMNS: NO CHILD ANY CHILD RECEIVED ORS ~ RECEIVED ORS 469 470 ~EPEATED WATERY STOOLS A ANY WATERY STOOLS . . . . . . . . . B REPEATED VOMITING . . . . . . . . . . . . . . . . . C ANY VOMITING . . . . . . . . . . . . . . . . . . . . . . . D BLOOD IN STOOLS . . . . . . . . . . . . . . . . . . . . E FEVER. . F MARKED THIRST . . . . . . . . . . . . . . . . . . . . . O NOT EATING/NOT DRINKING WELL . . . . H OET27NG SICKEP,/VERY SICK I NOT GETTING BETTER . . . . . . . . . . . . . . . . Y OTHER X (SPECIFY) .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . Z FAST BREATHING . . . . . . . . . . . . . . . . . . . . . A DIFFICULT BREATHING . . . . . . . . . . . . . . . B NOISY BREATHING C FEVER . . . D .UNABLE TO DR-rNK . . . . . . . . . . . . . . . . . . . E NOT EATING/NOT DIUNKING WELL . . . . F GETTING SICKER/VERY SICK . . . . . . . . . . O NOT GETTING BETTER . . . . . . H OTHER X (SPECIFY) DON T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . Z Have you ever heard of a special product called "ORT" you can get for YES . . the trea~anent of diarthoea? SKIP - - ,501 I ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , 274 SECTION 4C CAUSE OF DEATH OF CHILl)PEN BORN AND DYING IN THE PAST 3 YEARS ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH SINCE JANUARY 1996 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS WHO HAVE DIED. IF 2 OR MORE, BEGIN WITH THE LAST. LAST BIRTH NEXT-TO-LAST BIRTH SECOND -FROM-LAST BIRTH L ,, ERFROM0. I , E,, HER INE,, ER . . . . . . . . . . . . L E,, HSR FROM Q. 2 i2 AND Q216 NAME qAAffE NAME DEAD mw E DEAD ~ ALIW C OE~ ~ ALWE C (GO.NEXT (~OTON~XT , (GOTONE~ COLUMN; IF NO COLUMN; II ~ NO I COLUMN; IF NO MORE BIRTHS, MORE BIRTHS, Ii MORE BIRTHS, GO TO 501.) GO TO 501.) GO TO 50 I.) 474 I know it may be difficult to talk about the child(ren) you had who died, but %his information is very important in helping to plan heaEh programs to prevent other children from dying. I would liks to ask you some questions shout the events and symplnms your child(rer What do you think was the cause of (NAME's) death? During the illness that led to (NAME'S) death, did you seek advice or treatmmR anywhere or from anyone? IF YES: Whom did you see? Where did you go? RECORD ALL MENTIONED. LAST DECEASED CHILD Where did (NAME) die? PUBUC SECTOR GOVT. HOSPITAL . GOVT. HEALTH CENTER . GOVT. HEALTH POST . MOBILE CLINIC COMM. HEALTH WORKER . . . . OTHER PUBLIC (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . G PHARMACY/PMS H PRIVATE DOCTOR . . . . . . . . . . . . . MOBILE CLINIC . . . . . . . . COMM. HEALTH WORKER . ;. K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SHOP M I had during the time before he/she/they died. (We will ~ about one child at a time). NEXT-TO-LAST DECEASED CHILD SECOND -FROM-LAST DECEASE] CHILD PUBLIC SECTOR PUBLIC SECTOR A GOVT. HOSPITAL. A GOVT. HOSP ITAL . A B GOVT. HEALTH CENTER . B GOVT. HEALTH CENTER . B C. GOVT. HEALTHPOST . C. GOVT. HEALTHPOST C D MOBILE CLINIC . D E COMM. HEALTH WORKER . . . . E OTHER PUBLIC F F (SPECIFY) PRIVATE MEDICAL SECTOR O PYT. HOSPITAUCLINIC . G H PHA/h~ACY/PMS . . . . . H PRIVATE DOCTOR. MOBILE CLINIC . . . . . . . . . . . . . . K COMM. HEALTH WORKER . . . . K OTHER PRIVATE MEDICAL L L (SPECIFY) OTHER TRAD. PRACTIT IONER . N. TRAD. PRACTIT IONER . N. SPIRITUAL HEALER . P SPIRITUAL HEALER P D MOBILE CLINIC E COMM. HEALTH WORKER OTHER PUBLIC F (SPECIFY) pRIVATE MEDICAL SECTOR pVT. HOSPITALICLINIC PHARMACY/PMS PRIVATE DOCTOR . . . . . . . . MOBILE CLINIC COMM. HEALTH WORKER OTHER PRIVATE MEDICAL (SPECIFY) OTHER SHOP . . . . . . . . . . . . . . . . . . . . . . . . . M X OTHER X (SPECIFY) Z NONE Z 1 AT HOME . . . . . . . SHOP M TRAD. PRACTIT IONER . SP IR ITUALHEALER P DTHER X (SPECIFY) ~ONE IAT HOME . . . . . . . . . . . . . . . 1NAHEALTHFACILITY . . . . . . . . . . 2.1NAHEALTHFACILITY . . . . . . . . ONTHEWAYTO FACILITY . . . . . . . 30NTHEWAYTOPACIL1TY OTHER 4 OTHER (SPECIFY) (SPECIFY) OTHER (SPECIFY) NONE AT HOME . . . . IN A HEALTH FACILITY ON THE WAY TO FACILITy OTHER (SPECIFY) 275 489 490 FROM Q. 212 CHECK Q. 519: AGE AT DEATH Was (NAME) ham after a difficult labor/delivery? Was (NAME) malformed in any way? IF YES, SPECIFY Did (NAME) suckle or drink normally durlng the first two days of life? Did (NAME) havo a decrease in suckling or di~eulty raokllng during the days beforo death? Did (NAME) havo convulsions or spastm during the ilinegs that led to death? LAST DECEASED CHILD NAME LESS THAN 1 MONTH OR 1 MONTH OLDER [~ )SKIP TO 489 YES NO NEXT-TO-LAST-DECEASED CHILD >lAME LESS THAN 1 MONTH OR 1 MONTH OLDER [ '~ .SKIP TO 489 YES 2 >lO . . . . . . . . 2 SECOND-FROM-LAST DECEASED CHILD NAME LESS THAN 1 MONTH OR 1 MONTH OLDER [~ ,SKIP TO 489 YES NO .DOESNOTKNOW . . . . . . . . . . . . . . 8.DOESNOTKNOW . . . . . . . . . . . . . . . . YES YES DOESNOTKNOW .- . . . . . . . . . . . YES (SPECIFY) (SPECIFY) ~PECIFY) NO 2~NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO DOESNOTKNOW 8 DOES NOTKNOW. . DOES NOTKNOW . . . . . . . . . . . . YES :YES YES NO 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . DOES NOT KNOW . . . . . . . . . . . . . . 8 .DOES NOT KNOW . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . YES YES YES NO 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . DOESNOTKNOW . . . . . . . . . . . . . . S DOESNOTKNOW 8 DOESNOTKNOW . .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .NO ; . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . 8.DOES NOT KNOW . . . . . . . . . . . . . . . . S .DOES NOT KNOW . . . . . . . . . . . . . . Dutlng tho illne~s that led to death, did .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.YES . . . . . . . . (NAME) have a cough? NO 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 488) , - DON'T KNOW . . . . . . . . . . . . DAYS YES NO (SKIP TO 488), S DON'T KNOW . . . . . . . . . . . . . . . . . . . . g DAYS 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 488), (SKIP TO 488), . 8 DON'TKNOW . . . . . . For how many days did the cough las~? IF LESS THAN 1 DAY, WRITE "00" YES ~rO . . . . . . . . (SKIP TO 488), DON'T KNOW . . . . . . . . . DAYS YES >lO (SKIP TO 488), : :DON'T KNOW . . . . . . . . . . . . . . . . . . DAYS YES . . . . . . . . . . . 2 NO . . . . . . . . . . . . When (NAME) had the illness with the cough, did he/ske have diflloulty or rapid broaflalng? DON'T KNOW . . . . . . . . . . . For how many days did the difficult/rapid breathinglast? DAYS ~ DAYS IF LESS THAN 1 DAY, WRITE"00" 3R NEXT DECEASED CHILD; IF NO MORE DEATHS, GO TO 501 During the iline*s that led to doath, did YES I YES . . . . . . . . . . . . (NAME) have loeso or liquid stools, NO 2 NO that is, diarrhoea? (SKIP TO 493), (SKIP TO 493)* - - (SKIP TO 493), DON'T KNOW . . . . . . . . . . . . . . . . . . S .DON'T KNOW . . . . . . . . . . . . . . . . . . . . 8 .DON'T KNOW . . . . . . . . . . . . . . . . . . Was the episode of diarrhoea mild or MILD . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MILD MILD . . . . . . . . . . . . . . severe? SEVERE 2 SEVERE . . . . . . 2 SEVERE DOES NOT KNOW . . . . . . . . . . . . . . 8 .DOES NOT KNOW . . . . . . . . . . . . . . . . 8 .DOES NOT KNOW . 276 FROM Q. 212 LAST DECEASED CHILD NEXT-TO-LAST DECEASED CHILD SECOND-FROM-LAST DECEASED CHILD NAME NAME ~AME 491 For how long did the diarrhoea last? IF LESS THAN 1 DAY, WRITE '2)0" DAYS . . . . . . . . . . . . . . . . . . :~} WEEKS . . . . . . . . . . . . . . . . . :!~:~ MONTHS . . . . . . . . . . . . . . . 3 . DOES NOT KNOW . . . . . . . . . . . . 99 492 Was them any blood in tho stool7 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . 493 During tho i l lness that led to death, did YES . . . . . . . . . . . . . . . . . . . . . . . . . . . , 'NAME) have a cough? NO . (SKIP TO 497) , )ON'T KNOW . . . . . . . . . . . . . . . . . . . . I DON'T KNOW . . . . . . . . . . . . . . . . . . 494 495 496 497 497A 497B For how long did the cough la~? IF LESS THAN 1 DAY, WRITE '~0" ~¢hen (NAME) had the i l lness with the ~ough, did he/she ha~e dilllouR or rapid 3reathlng? Por how long did the dii~cuR/rapid breathing last? IF LESS THAN 1 DAY, WRITE"0 f f ' I~r lng the i l lness that led to death, did ,~NAME) have a fever? Was the fever o f (NAME) miM or ~OVer0? [tow long did tho fever la~?? IF LESS TITAN 1 DAY, WRITE "00" WEEKS . . . . . . . . . . . . . . . . . 2 WEEKS . 2 MONTHS . . . . . . . . . . . . . . . 3 MONTHS . . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 998 DOES NOT KNOW . 998 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )OES NOT KNOW . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . . . S YES . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 497) , - - (SKIP TO 497) . - - DON'T KNOW. . . . . . . . . . . . . . . . . .~ DAYS . . . . . . . . . . . . . . . . . . 1 i~i~ WEEK . 2 !~!~ MONTHS . . . . . . . . . . . . . . . 3 !iii~ DOES NOT KNOW . . . . . . . . . . . . 998 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . ] NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 497) ' - - DAYS . . . . . . . . . . . . . . . . . . . 1 WEEK . . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . . 3 )OES NOT KNOW . . . . . . . . . . . . . . 998 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 497) , - - DON'TKNOW. . . . . . . . . . . . . . . . .~ ~ DON'TKNOW . . . . WEEK . . . . . . . . . . . . . . . . . . 2 WEEK . . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 MONTI-18 . . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 998 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 498) , DON'T KNOW . . . . . . . . . . . . . . . . . . M ILD . . . . . . . . . . . . . . . . . . . . . . . . . . SEVER~ . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . 998 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 49S) , - - DON'T KNOW . . . . . . . . . . . . . . . . . . . . I [IL~ . . . . . . . . . . . . . . . . . . . . . . . . , . . . l SVERE . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,OES NOT KNOW . . . . . . . . . . . . . . . . 8 DAYS . . . . . . . . . . . . . . . . . . 1 [:~ ~ 4~1!~ ~ I WEEK . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 998 DAYS . . . . . . . . . . . WEEK . . . . . . . . . . . MONTHS . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . 1 :~:~i WEEK . . . . . . . . . . . . . . . . . . . ~!~ MONTHS . . . . . . . . . . . . . . . 3 "~'~' DOESNOTKNOW . . . . . . . . . . . . 99 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SIGP TO 497) , DON'T KNOW . . . . . . . . . . . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . ~:~::~:~ WEEK . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 99 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 498) , DON'T KNOW . . . . . . . . . . . . . . . . . . M ILD . . . . . . . . . . . . . . . . . . . . . . . . . . SEVERE . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . 498 Dur ingtho i l lness that ledto death, was yES . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . (NAME) unconscious? NO . NO . DOES NOT KNOW . . . . . . . . . . . . . . DOES NOT KNOW 277 498A 498B 498C 498D 498E 498F FROM Q. 212 During ~he illness that led ~ death, did (NAME) have convulsions? During the illness that led to death, did (NAME) have a skin rash all over his/her body and face? How long did the rash last?? IF LESS THAN 1 DAY, WRITE"00" During the illness that led to death, was there any discharge from tile eyes? During the illue*s that led to deatl~ was ! (NAME) v¢~/thin? How long was (NAIdE) vel~ thin? LAST DECEASED CHILD NAME YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 498E)4------q DOES NOT KNOW . . . . . . . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . 1 I~I i : : i I WEEK . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 DOES NOT KNOW . 992 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SK Ip TO 49~O) , - DOES NOT KNOW . . . . . . . . . . . . . . NEXT-TO-LAST DECEASED CHILD ~'AME ~rES f . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . . . ~ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : (SKIP TO 498E) , -~- - -q DOES NOT KNOW . . . . . . . . . . . . . . . . 8 DAYS . . . . . . . . . . . . . . . . . . . 1 ~:,:~:::: WEEK . . . . . . . . . . . . . . . . . . . 2 :::: :: ~IONTHS . . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . . . 99 SECOND-FROM-LAST DECEASED CHILD NAME YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 498E). DOES NOT KNOW . . . . . . . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . l ~::::~:: WEEK . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 99 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 498e) , - - - - - -q DOES NOT KNOW . 8 WEEK . . . . . . . . . . . . . . . . . . 2 WEEK . . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 MONTHS . . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 998 DOES NOT KNOW . . . . . . . . . . . . . . 998 498G Duringthei l lne~sthatledtodeath, did YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (NAME) have swelling of the feet or NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . legs? (SKIP TO 499)4 - - - - -q (SKIP TO 499)4 - - DOES NOT KNOW . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . . . . . : 77o7;:2:72';7: 2:oo : ~r~S . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 'O . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 4980) , DOES NOT KNOW . . . . . . . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . i ~::::>,:~:~ WEEK . . . . . . . . . . . . . . . . . . 2 ::::::! MONTHS . 3 DOES NOT KNOW . 99 ~ES . . . . . . . . . . . . . . . . . . . . . . . . . . . t%!O . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 499)4 DOES NOT KNOW . . . . . . . . . . . . . . DAYS . . . . . . . . . . . . . . . . . . 1 WEEK . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . 3 DAYS . . . . . . . . . . . . . . . . . . . 1 WEEK . . . . . . . . . . . . . . . . . . . 2 MONTHS . . . . . . . . . . . . . . . . 3 DAYS . . . . . . . . . . . . . . . . . . 1 ~i i : i l i l WEEK . . . . . . . . . . . . . . . . . . 2 !i!i!!i!i VIONTHS . . . . . . . . . . . . . . . 3 DOES NOT KNOW . . . . . . . . . . . . 998 : DOES NOT KNOW . . . . . . . . . . . . 99 DOES NOT KNOW . . . . . . . . . . . . . . 998 GO BACK TO 475 FOR NEXT DECEASED CHILD; 1F NO MORE DEATHS, GOTO 501 278 NO. 501 SECTION 5A. MARRIAGE QUESTIONS AND FILTERS PRESENCE OF OTHERS AT THIS pOINT. 502 Are you currently manned or living with a man? 503 504 CODING CATEGOPdES SKIP 506 YES NO .CH1LDRENUNDER IO . . . . . . . . . 1 21 HUSBAND/PARTNER 1 2 OTHER MALES 1 2 . OTHER FEMALES . . . . . . . . . . . . . 1 2 , Do you currently have a regular sexual partner, an ocvasional sexual partner, multiple sexual partner, or no sexual partner at all? Have you ever been married or lived with a man? ~¢hat is your marital status now: are you widowed, divorced, or separated? 507 Is your husband/partner livlng w'xth you now or is he shtylng elsewhere? 508 Doe* your husband/partner have any other wives/paxtnmz besides yoursolf? 509 Flow many other wire,partners does he have? 510 %re you the thst, second,., wife? 511 Flare you been married or Eyed with a man only once, or more than once? 512 !CHECK 511: MARRIED/LIVED WITH A MAN ONLY ONCE In what month and year did you start .lying with your huaband/pat~ner? MARILIED/LIVED WITH A MAN MORE THAN ONCE Now we will talk about your first husband/partner. In what month and year did you ztart living with him? YES, CURRENTLYMARRIED . . . . . . . . . . . 1 ~rqS07 YES, LIVING WITH AMAN . . . . . . . . . . . . . 2 NO, NOT IN UNION . . . . . . . . . . . . . . . . . . . . 3 REGULAR SEXUAL pARTNER . . . 1 • OCCASIONAL SEXUAL PARTNER . . . . . . . 2 . NO SEXUAL PARTNER 3 . MULTIPLE SEXIIAL I~ARTNER . . . . . . . . . . 4 . YES, FORMERLY MARRIED 1 YES, LIVED WITH A MAN . . . . . . . . . . . . . . 2 . -~511 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3".--'515 WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . . . . I- 7 DIVORCED . . . . . . . . . . . . . . . . . . . . . . . . . . . 2" ~,511 .SEPARATED . . . . . . . . . . . . . . . . . . . . . . . . . . 3". J LIVING WITH HER 1 ~TAYING ELSEWHERE . . . . . . . . . . . . . . . . 2 YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.--~511 NUMBER DONq~ KNOW . . . . . . . . . . . . . . . . . . . . . . . . 98--~511 RANK ~ ONCE 1 MORE THAN ONCE . . . . . . . . . . . . . . . . . . . . 2 : MONTH DON'T KNOW MONTH 98 YEAR DON'T KNOW YEAR . . . . . . . . 9998 513 FIow old were you when you started livin S with him? AGE [ ] 514A Before you got married, was your (first) husband related In you in any way7 yES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. - ,515 51413 What type of relationship was it? ~IRST COUSIN ON FATHER'S SIDE 1 FIRST COUSIN ON MOTHER'S SIDE . . . . . 2 SECOND COUSIN . . . . S UNCLE . . . . . . 4 OTHER BLOOD RELATIVE . . . . . . . . . . . . . 5 BROTHER-IN-LAW 6 OTHER NON-BLOOD RELATIVE . . . . . . . . 7 279 NO. QUESTIONS AND HLTERS 515 516 Now I need to ask you sorae que~tiom about sexual activity in order to gain a b~aer ~md~dlng of some family planning issue~. When was ~e last time you had sexual intercourse (if ever)7 CHECK 301 AND 302: KNOWS CONDOM ? The last time you had sex, was a condom used? I CODING CATEGORIES [ SKIP t NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000- - ,520 DAYS AGO . . . . . . . . . . . . . . . . . . . . I [~(~[:!~i~ WEEKS AGO . . . . . . . . . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . . . . . . . 3 ::~:~ ; YEARS AGO . . . . . . . . . . . . . . . . . . 4 ::~:~: BEFORE LAST BIRTH . . . . . . . . . . . . . . . . 996 DOES NOT KNOW CONDOM ? Some men use a condom, which means thnt they put a rubber sheath on their YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 petals for sexual ~ourse , The last NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 firae you had se~, was a condom used? DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 517 Do you know of a place where you can get condoms7 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - .519 518 Where is that? IF SOURCE IS HOSPITAI~ HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. PUBLIC SECTOR GOVERNMENT HOSPITAL . . . . . . . . . 11 GOVERNMENT HEALTH CENTER . 12 FAMILY PLANNING CLINIC . . . . . . . 13 MOBILE CLINIC . . . . . . . . . . . . . . . . . . 14 COMMUNITY HEALTH WORKBR . 15 OTHER PUBLIC 16 (SPECWY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . . 21 PHARMACY/PMS . . . . . . . . . . . . . . . . . 22 PRIVATE DOCTOR . . . . . . . . . . . . . . . . 23 MOBILE CLINIC . . . . . . . . . . . . . . . . . . 24 COMMUNITY HEALTH WORKER . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . 32 FRIENDS/RELATIVES . . . . . . . . . . . . . 33 NGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 (NAME OF PLACE) OTHER 36 (SPECIFY) 519 How old were you when you first had sexual irdereourse? AGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ FIRST TIME WHEN MARRIED . . . . . . . . . 96 280 SECTION 5B. CIRCGTV~CISION NO. QUEST IONS AND FILTERS CODING CATEGOPdES SKIP 520 Am you circurnsised? YES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ,524 521 What type of circumcision did you have? CLITOE/DECTOMY . . . . . . . . . . . . . . . . . . . 01 D~d you have clitorldeetomy, exelslo~, or inSbu~tion? EXCISION 02 INFIBULATrON . . . . . 03 OTHER 96 (SPECIFY) 522 i How old were you when you were fflreo.mcised? AGE IN COMPLETED YEARS [ ~ t IDOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 98 523 Who performed she circumcision7 524 CHECK 214, AND 217: HAS AT LEAST ONE r -n HAS NO LIVING LIVING DAUGHTER ~-3 DAUGHTER DOCTOR 01 TRAINED NURSE/MIDWIFE . . . . . . . . . . . 02 TRADITIONAL BIRTH ATTENDANT . . . 03 ~CIRCUMCISIONPRACTITIONER 04 OTHER 96 (SPECIFY) .DOES NOT KNOW . 9S. -- ,530 525 Has (NAME OF ELDEST DAUGHTER) been cricumeised? YES . 1- - ,527 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , 526 Do you plan~ have (NAME OF ELDEST DAUGHTER) ckeumelsed? YES . . . . . . . . . . . . . . . 1 - .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- fl~530 527 ~Iow old was she when she was circumcised? AGE IN COMPLETED YEARS . l~I(~ ~I .DOES NOT KNOW . 98 . 528 Who perfonmed ~ae circunl~slon? 529 Did anyone object ¢o your eldest daughtex being ffm~ltmcJsed? Anyone else? RECORD ALL PERsoNS MENTIONED. DOCTOR 01 TRAINED NURSE/MIDWIFE . . . . . . . . . . . 02 TRADITIONAL BIRTH ATTENDANT . . . 03 CIRCUMCISION pRACTITIONER . . . . . . . 04 OTHER 96 (SPECIFY) .DOES NOT KNOW . 98. NO ONE OBJECTED A RESPONDENT . B RESPONDENT'S HUSBAND C ILESPONDENT'S MOTHER . D RESPONDENT'S MOTHER- IN-LAW . E OTHER ILELATIVE OF RESPONDENT. , . F OTHER RELATIVE OF HUSBAND . G RESPONDENT'S FATHER- IN-LAW . H OTHER X (sPECmy) • DOES NOT KNOW . Y . 281 NO. QUEST IONS AND F ILTERS 530 Do you think female cireumeislon should be continued, or should k be Jiscontlnuexl? 531 532 533 534 What 9]pe of female elf cure , l ion do you think should be continued; :lltoridectomy, excision, or infibulaEon? Why do you think female c'trcumeision should be continued? Any other reasons? RECORD ALL REASONS MENTIONED Why do you think fmnale ~Ireumelsion should be discontinued? Any other re~sons? RECORD ALL PERSONS MENTIONED. CHECK 502: IN UNION CODING CATEGORIES SKIP CONTINUED I DISCONTIN I~D 2 - ,533 • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . g . - , 534 CL ITOKIDECTOMY . 01 ' EXCISION 02 ! INFIBULATION . . . . . . . . . . . . . . . 03 OTHER 96 (SPECIFY) GOOD TRADIT ION . A CUSTOM AND TRADIT ION. . . . , B REL IG IOUS DEMAND . C CLEANL INESS D BETTERMAR~AGEPROSPECTS , E ,534 GREATER PLEASURE OF HUSBAND . . . . F PRESERVATION OF V IRGINITy / PREVENTION OF IMMORALITY . . . . . . O OTHER X (SPECIFY) .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . Y . BAD TRADITION . . . . . . . . . . . . . . . . . . . . . . A AGAINST RELIGION . . . . . . . . . . . . . . . . . . . B MEDICAL COMPLICATIONS . . . . . . . . . . . . C PAINFUL PERSONAL EXPEILIENCE . . . . . D AGAINST DIGNITY OF WOMEN . . . . . . . . E pREVENTS SEXUAL SATISFACTION . . . . Y OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . Y NOT IN UNION - - ,536 535 Does ~/ou~ hushm~d/p~'tne~ thhak ferule " ' " sbeuld be e~x~nued or discontinued? CONTINUED . . . . 1 DISCONTINUED . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . 8 536 "Has there been any aetlvities against femalo elrcumeision in ~hls community? [YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . NO . 2 .DOESNOTKNOW . ; . S . 282 SECTION 6. FERTILITY PREFERENCES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 601 CHECK314: NEITHER HE OR SHE STERILIZED ~ STERILIZED [~ -- ~612 602 CHECK 227: NOT PREGNANT PREGNANT p p Now I have some questions about the Now I have some questions about the HAVE (A/ANOTHER) CHILD . . . . . . . . . . . . future, future. NO MORE/NONE . . . . . . . 2- 7 Would you like 1o have (a/another) After fue child you are expecting now, ~AYS SHE CAN'T GET PREGNANT . . . . . . 3- -[,606 child, or would you prefer not to have would you like to have another child, or UNDECIDED/DON'T KNOW . . . . . . . . . . . . 8- - ,604 any (more) dfil&en? would you prefer not Io have any morn ehiliken? 603 CHECK 227: NOT PREGNANT PREGNANT ORUNSURE ~ ~ YEARS 2 ____i~i! i~', SOON/NOW , 993 - 7 How long would you like to wait from After the child you are expe~hlg now, SAYS SHE CAN'T GET PREGNANT . . . . 994- A.606 now before the birth of (a/another) how long would you like to wait before AFTER MARRIAGE 995 child7 the birth of anoflmr child? OTHER 996 (SPECIFY) .DON'T KNOW . 998 604 CHECK 227: NOT PREGNANT PREGNANT OR UNSURE ~ [~ --,607 605 R'you become pre~aant in the next few weeks, would you be happy, Imhappy, or ~IAPPY would it not matter very much7 .UNHAPPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WOULD NOT MATTER . . . . . . . . . . . . . . . . . 3 606 CHECK 313: USING A~ETHOD? NOT NOT CURILENTLY CURILENTLY ASKED USING ~ USING [~ - - ,612 607 Do you fuink you will use a method to dday or avold preguaaey within the nexl .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- - ,609 12 months? ~lO 2 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 608 Do you think you will use a method lo dday or avoid preguanoy at any time in YES the ~e? NO 2- 7 . DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8- -[-610 283 NO. QUESTIONS AND FILTERS 609 610 Which method wouM you prefer to use? What is the main mason that you flfink you will never use a m~lhod? 611 Would you ever use a method i f you were nmriied? 612 CHECK216: HAS L IV ING CHILDREN ~] I f you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many wouldthat be? NO L IV ING CHILDREN ~] I f you could choose exactly the number of elfildren 1o have in your whole life, how mmly would that be? CODING CATEGORIES SKIP PILL . . . . . . . . 01 KID , . 02 INJECTABLES 03 IMPLANT8 04 DIAPHRAOMJFOAM/JELLY . . . . . . . . . . . . 05 CONDOM]FEMIDOM . . . . . . . 06 .FEMALE STERILIZATION . . . . . . . . . . . . . 07 . ~612 MALE STERILIZATION 08 .PERIODIC ABSTINENCE . . . . . . . . . . . . . . 09 . WITHDRAWAI 10 OTHER 96 (SPECIFY) .UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 . NOT CURRENTLY MARRIED 11 FERTILITY-RELATED REASONS INFREQUENT SEX . . . . . . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOMY . . . 23 SUBPECUND/INFECUND . . . . . . . . . . . 24 WANTS MORE CHILDREN 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . . . 31 HUSBAND OPPOSED . . . . . . . . . . . . . . . 32 OTHERS OPPOSED 33 RELIGIOUS PROHIBITION . . . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD 41 KNOWS NO SOURCE 42 *612 VIETHOD-RELATED REASONS HEALTH CONCERNS 51 PEAR OF SIDE EFFECTS . . . . . . . . . . . . 52 LACK OF ACCESS/TOO FAR . . . . . . . . 53 COST TOO MUCH 54 INCONVENIENT TO USE . . . . . . . . . . . 55 INTERFERES WITH BODY'S NORMAL PROCESSES 56 OTHER 96 (SPECIFY) .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . 98 . .YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . NO . . . . . . . . . 2 ,DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 , NUMBER OTHER 96- -~614 (SPECIFY) PROBE FOR A NUMERIC RESPONSE. 284 NO. 613 QUESTIONS AND FILTERS How many of these children would you like to he boys, how many would you llke Lo be girls attd for how many would it not matter? FOMBER )THER NUMBER OTHER NUMBER OTHER 614 Would you say that you approve or disapprove of eoupl~ using a method ~o APPROVE . . . . . . . tvoid getting pre~aant ? DISAPPROVE 615 Is it aeeaptable or not aeeaptable ~o you for itffommtion on farnily planning ~o be )roxClded: On the radio? On the television? 616 617 617B Ia the last few months, have you heard about fatal13, planning: On the radio? On the television? In a newspaper or magazine7 From a pester7 From leaflets or brochures? From town crier Any Other (SPECIF£) In the last few months, l~ve you heard about any message on Radio/T,V. on eondomuse7 I f Ye~, (Speolfy). 61g In the last few monlhs have you dlscussed the practice of family planding with :our frieads, neighbors, or relatives/Spouse7 619 With whom7 Anyone else? RECORD ALL MENTIONED. 620 CHECK 502: YES, YES, NO, CURRENTLY ~ LIVING [~ NOTIN V~ MARRIED WITH A MAN * UNION CODING CATEGORIES (SPECIFY) (SPECIFY) (SPECIFY) BOYS 96 GIRLS 96 EITHER 96 , , . 1 2 SKIP ,NO OPINION . . . . . . . . . . . . . . . . . . . . . . . . . . 3 , NOT ACCEPT- ACCEPT- ABLE ABLE DK RADIO . . . . . . . . . . . 1 2 8 • TELEVISION . . . . . 1 2 S . YES NO RADIO . 1 2 FELEVISION 1 2 .NEWSPAPER OR MAOAZ1NE . . . . . I 2 . POSTER 1 2 LEAFLETS OR BROCHURF~ . . . . . . 1 2 row~ C1LIER 1 2 OTHER X YES . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , ] YES 1 310 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2---)620 .ItUSBAND/PARTNER . . . . . . . . . . . . . . . . . . A . ~OTHER B FATHER . . , C ~ISTER(S) . D • BROTHER(S) . . . . . . . . . . . . . . . . . . . . . . . . . . E . DAUGHTE~ . . . . . . . . . . . . . . . . . . . . . . . . . . . F ~IOTHER-IN-LAW FRIENDS/NEIGHBORS . (SPECIFY) G .H X --~701 IOTHER 285 NO. QUESTIONS AND FILTERS 621 Spousea/paflners do not always agreo on ~verything. Now I want Io ask you about your husband's/partner's views on family plannin~ Do you thlnk that your husband/partner approve~ or disapproves of couples us'rag a method to avoid pregnancy? 622 How often have you lalked to your husband/partacr about family planning in "the past year? 623 Do you think your husband/parim~ wants the same number of children that you want, or does he want more or fewer than you want? CODING CATEGORIES SKIp APPROVES 1 DISAPPROVES 2 .DON'T KNOW . 8. NEVER 1 ONCE OR TWICE 2 MORE OFTEN . . . . . . . . . . . . . . . . . . . . . . . . . 3 SAME NUMBER 1 MORE CHILDREN . . . . . . . . . . . . . . . . . . . . . 2 FEWER CHILDREN 3 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 . 286 NO. 701 702 703 704 705 706 707 708 CHECK 502 AND 504: SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK QUESTIONS AND FILTERS CODING CATEGOPdES CURRENTLY FORMERLY MARPJED/ ~ MARPJED/ ~ NEVER LIVING WITH | LIVED WITH MARRIED AND v-- AMAN AMAN NEVER IN UNION | m SI~P ~703 )709 How old was your husband/partner on his last bhthday? Did your (last) husband/partner ever attend school? What was the highest level of school he attended: primary, secondary, or high~? What was the highest (grade/form/year) he completed at that levd? What (is/was) your (last) husband/parthcfs occupation? Tlmt is, what kind of work (does/did) he malnly do? AGE . YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - )706 PRIMARY . . . . . 1 SECONDARY 2 HIGHER 3 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8,-*-706 ) .DON TKNOW . . . . . . . . . . . . . . . . . . . . . . . . 98 , CHECK 706: WORKS (WORKED) IN AGRICULTURE DOES (DID) [~ NOT WORK 1N AGRICULTURE -- "709 (Does/d~d) your husband/pa~ner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land7 HIS LAND . . . . 1 • 2AMILY LAND . . . . . . . . . . . . . . . . . . . . . . . . 2 . RENTED LAND . . . . . . . . . . . . . . . 3 SOMEONE ELSE'S LAND . . . . . . . . . . . . . . . 4 709 Aside from your own housework, are you currently working? YES 1 -,712 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , 710 As Y°U kn°w" s°me w°men hk¢ uP j°bs f°r width they are paid in cash °r ldnd" Othe~s sell things, have a small business or work on the family farm or in the family busine.~. YES 1 -~712 Are you currently doing any oftheso things or any other work? .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . 711 Have you done any work in the last 12 months? YES 1 .NO . 2 .-,801A 712 What is your occupaEon, that is, what Idnd of work do you mainly do? 713 CHECK712: WORKS IN AGRICULTUR~ DOES NOT WORK IN AGP-/CULTORE - - .715 287 NO. QUESTIONS AND FILTERS 714 Do you work mainly on your own land or on family land, or do you rent land or work on someone else's land? 715 Do you do tlds work for a member of your fandly, for someone else, or am you self-employed? 716 Do you usually work throughout the year, or do you work seasonaEy, or only once in a whiLe? 717 During the last 12 months, how many months did you work? 718 During the last 12 months, how many days a week did you usually work (in the months that you worked) 7 719 During the last 12 months, approximalely how many days did you work? 720 Do you earn cash for your work? PROBE: Do you make money for working7 721 722 723 724 How much do you umally ~ for this work? PROBE: Is thls by the day, by the week, or by the month? CHECK 502: CURRENTLY MARRIED,L IV1N G WITH A MAN YES' ? Who mainly decides how the money ,ou earn will be used: you, yottr hvsband/panner, you and your husband/paflaer j oinfly, else? NO, NOT IN UNION ? Who mainly decides how the money you earn will be used: you, else, or you and som~no else jointly? Do you usually work at home or away from home? CHECK 217 AND 21 S: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS? YES ~ NO V-1 CODING CATEGORIES SKIP OWN LAND I FAMILY LAND . 2 RENTED LAND . . . . . . . 3 • SOMEONE BLSB 'S LAND . . . . . . . . . . . . . . . 4 FOR FAMILY MEMBER 1 FOR SOMEONE ELSE . 2 .SELF-EMPLOYED . . . . . . . . . . . . . . . . . . . . . 3 THROUGHOUT THE yEAR . . . . . . . . . . . . . 1. --, 71S SEASONALLYIPART OF THE YEAR 2 . ONCE IN A WHILE . . . . . . . . . . . . . . . . . . . . . 3,--,719 NUMBER OF MONTHS . . . . [ ] NUMBER OF DAYS ~. --~ 720 NUMBER OF DAYS YES .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.--~723 PERHOUR . . . . . . . . . . 1 ~:IZ~)' ~:~:~'i~'i~:~,? PER DAY . . . . . . . . . . . 2 ):~i '~:.:~:: :;~:~ i :i:i : : ~il eERWEEK . . . . . . . . . . 3 'L~ '.::i(~ :;:i~i;]?.i~:;:: ~ERMONTH . . . . . . . . 4 !::~i~i i~i~ ~!~:~ i~ii'~ ~ i . PERYEAR . . . . . . . . . . 5 OTHER 999996 (SPECIFY) , AESPONDENT DECIDES . . . . . . . . . . . . . . . . HUSBAND/PARTNER DECIDES . . . . . . . . . 2 IOINTLY WITH HUSBAND/PARTNER . . • 3 gOMEONE ELSE DECIDES. . 4 IOINTLY WITH SOMEONE ELSE . . . . . . . . 5 ROME . . . . . AWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ~SO1A 288 NO. 725 QUESTIONS AND HLTERS Who usual ly takes care of (NAME OF YOUNGEST CHILD AT HOME) whi le 'ou are working? CODING CATEC, OP/ES RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . O1 HUSBAND/PARTNER . . . . . . . . . . . . . . . . . 02 OLDER PEMALE CHILD . . . . . . . . . . . . . . . 03 OLDER MALE CHILD . . . . . . . . . . . . . . . . . 04 OTHER RELAT IVES . . . . . . . . . . . . . . . . . . 05 NE IOHBOURS . . . . . . . . . . . . . . . . . . . . . . . . 06 FRIENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07 SERVANTS/HIRED HELP . . . . . . . . . . . . . . 08 CHILD IS IN SCHOOL . . . . . . . . . . . . . . . . . 09 INST ITUT IONAL CHILD CARE . . . . . . . . . 10 HAS NOT WORKED SINCE LAST B IRTH . . . . . . . . . . . . . . . 95 OTHER 9 6 (SPECIFY) SKIp 289 SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES NO. 80 IA 8OlB 8OlC 801D 801E 801F 801O 8OlH 801I Q~ONS AND FILTERS Have you heard about diseases that can be transufitted through sexual i r~rcourse7 Which d iseas~ do you know7 RECORD ALL KESPONSES CHECK 515: HAS HAD SEXUAL INTERCOURSE CODING CATEGORIES YES NO SYPFIILIS . A GONOILRHEA . . . . . . B AIDS . . . . . . C GENITAL WARTS/CONDYLOMATA . . . . . . . . D OTHER W (SPECIFY) OTHER X (SPECIFY) • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z HAS NEVER HAD SEXUAL INTERCOURSE Dur ing the last twelve months, did you have any of these diseases? Which of the diseases did you have? RECORD ALL RESPONSES The last thne you had (DISEASE(S) FROM 801 E) did you seek advive or krea~? h the last 12 months, did you have a discharge from your virgina? In the last 12 months, did you have sore or u lcer In your private part? Where did you seek advice or treatment? ANY OTHER PLACE OR PERSON RECORD ALL MENTIONED SKIP I 2~ - ,801M - 'S01M YES NO ,DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 , SYPHILIS A GONORRHEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . H AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C GENITAL WARTS/CONDYLOMATA . . . . . . . . D OTHER W (SPECIFY) OTHER X (SPECIFY) .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z , YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , -~801 l YES 1 NO 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 YES . . 1 NO 2 .DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . ~UBLIC SECTOR GOVT. HOSP ITAL . . . . . . . . . . A HEALTH CENTER . . . . . . . . . . . . . . . . . . . . . . . B FP CLINIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C MOBILE CL IN IC . . . . . . . . . . . . . . . . . D DISPENSARY E OTHER PUBLIC SECTOR F MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . G PHARMACY/PMS . . H PR IVATE DOCTOR I MOBILE CLINIC J OTHER ME]) . PR IVATE SECTOR . . . . . . . . . K OTHER SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . L KELATIVES/FRIENDS M • TRADITIONAL HEALER . N OTHER X (SPECIFY) DOES NOT KNOW Z 1 2 -~801M -~801M 290 NO, 801 J 801K 801L QUF~TIONS AND FILTERS When you had (DISEASE(S) from 80 IE) did you inform your parth~r(s)? When you had (DISEASE(S) f rom 80 IE) did you do something not to infect your partner(s)? What did you do? RECORD ALL MENTIONED I CODING CATEGORIES SKIP YES 1 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ! YES . . . 1 N O . . . ] PARTNER ALREADy INFECTED . . . . . . . . . . . 3 1 ,80 IM NO SEXUAL INTERCOURSE . . . . . . . . . . . . . . . A USED CONDOMS B TOOK MEDIC INES . . . . . . . . . . . . . . . . . . . . . . . . C REFERI~ED pARTNER TO HEALTH WORKER D OTHER X (SPECIFY) 801M CHECK 801B: D ID NOT MENTION MENTIONED "A IDS" ~ "AIDS" [ -~ - - 802 801N 802 802B Have you ever heard of a disease cal led 'AIDS'? From which sources of information have you learned most about A IDS?? ANY OTHER SOURCES? RECORD ALL MENTIONED. How can a person get A IDS? ANy OTHER WAYS? RECORD ALL MENTIONED. YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , - ,811C RADIO . . . . . . . . . . . . . . . ~x T .V . , . B . NEWSPAPER/MAGAZINE . . . . . . . . . . . . . . . . . C , PAMPHLETS/POSTERS D HEALTH WORKERS E .MOSQUES/CHURCHES . . . . . . . . . . . . . . . . . . . . F . SCHOOLS/TEACHERS . . . . . . . . . O COMMUNITY MEET INGS . H . F ILIENDS/RELATIVES . . . . . . . . . . . . . . . . . . . . . . I . WORKPLACE ff OTHER X (SPECIFY) SEXUAL INTERCOURSE A SEXUAL INTERCOURSE WITH MULT IPLE PARTNERS . B SEX WITH PROSTITUTES . . . . . . . . . . . . . . . . . C NOT US ING CONDOM . . D HOMOSEXUAL CONTACT E BLOOD TRANSFUSION F INJECTIONS O .K ISSING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H . .MOSQUITO BITES . . . . . . . . . . . . . . . . . . . . . . . . . I . C IRCUMCISION 2" OTHER W (SPECIFY) OTHER X (SPECIFY) • DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z . 803 Is there anything a person can do to avoid getting H IV or the v i ras that causes YES . 1 A IDS? NO . 2 1 DON~T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ±~807 291 NO. 804 Q~TIONS AND FILTERS What can a person do? ANY OTHER WAYS7 RECORD ALL MENTIONED. 805 CHECK 804: DID NOT MENTION MENTION "SAFE SEX" r -~ SEX7' [-7 CODING CATEGORIES SAFE SEX . . . . . . . A ABSTAIN FROM SEX . . . . . . . . . . . . . . . . . . . . . . B USE CONDOMS C AVOID MULTIP I ,~ SEX pARTNeR8 . D AVOID SEX WITH PROSTITUTES E AVOID SEX WITH HOMOSEXUALS F ENSURE SAFE BLOOD TRANSFUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . O ENSURE INJECTIONS WITH STERILIZED NEEDLES . . . . . . H ENSURE CIRCUMCISION WITH CLEAN BLADES/KNIVES . . . . . . . . . . . . . . . . . . . . . . . . . . I AVOID KISSING . J AVOID MOSQUITO BITES K SEEK PROTECTION FROM TRADIT IONAL HEALER L OTHER W (SPECIFY) OTHER X (SPECIFY) • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z SKIp -- ,807 806 807 808 808A 808B 808C 808D What does "safe sox" mean to you7 R~CORD ALL MENTIONED Is it posslblo for a healthy-looking porson to hav¢ the AIDS virus? Do you think lhat persons wi~h AIDS almost never dio from lhe diseaso, somctime~ die, or almost always die from the diseaso? Can AIDS be cured? Can AIDS be transmit~d from mother to child? ABSTAIN FROM SEX . . . . B USE CONDOMS C HAVE ONLY ONE SEX PARTNER D AVOID SEX WITH PROSTITUTES E AVOID SEX WITH HOMOSEXUALS F OTHER X (SPECIFY) • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z YES 1 NO 2 .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . S ALMOST NEVER . . . . . . . . . . . . . . . 1 .SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ALMOST ALWAYS 3 .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 , YES 1 ' NO 2 ! .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 YES 11 2~ NO W ' ] ,808D .DOESNOTKNO . . . . . . . . . . . . . . . . . . . . . . . . 84 What can an infected prc~ant mother do to avoid infecting hot child with HIV? .TAKE MEDICATION LIKE AZT . . . . . . . . . . . . 1 ' DO NOT BKEASTFEED . . . . . . 2 vho has AIDS or h0s d/¢d of AIDS? Do you personally k~ OTHER 8 (SPECIFY) YES I NO . . . . . . DOES NOT KNOW 292 NO. 809 809B 809C 811A QUESTIONS AND FILTERS Do you think your chances of getting AIDS are small, moderato, great, or no risk at all? Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS? ANY OTHER REASONS? RECORD ALL MENTIONED. CODING CATEGORIES SKIP SMALL . . . 1 MODERATE . . . . . . . . . . . . 2 ~ILEAT . . . . . . . . 3- A~809C .NO RISK AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . 4 . .HAS AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-, - ,811A ABSTAIN FROM SEX . . . . . . . . . . . . . . . . . . . . . . B USE CONDOMS C 'AVOID MULTIPLE SEX PARTNERS D AVOID SEX WITH PROSTITUTES E i AVOID SEX WITH HOMOSEXUALS F • ENSURE SAFE BLOOD TRANSFUSION . . . . . O . i ENSURE INJECTION WITH ~ STERILIZED NEEDLE H AVOID KISSINO I . AVOID MOSQUITO BITES . . . . . . . . . . . . . . . . . J . SEEK PROTECTION FROM TRADITIONAL HEALER K OTHER W (SPECIFY) OTHER X (SPECIFY) .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z• DO NOT USE CONDOMS C MORE THAN ONE SEXUAL PARTNER . D SEX WITH PROSTITUTES E • SPOUSE HAS OTHER (PARTNER(S) . . . . . . . . F , HOMOSEXUAL CONTACT O HAD BLOOD TRANSFUSION H HAD INJECTIONS WITH UNSTERILISED NEEDLES I SEEK PROTECTION FROM TRADITIONAL HEALER . K OTHER W (SPECIFY) OTHER X (SPECIFY) DIDN'T START SEX A STOPPED ALL SEX B STARTED USINO CONDOMS C RESTRICTED SEX TO ONE pARTNER D REDUCED NUMBER OF PARTNERS . . . . . . . . E ~SIIC ADVICE SPOUSE/PARTNER TO BE FAITHFUL . F qO MORE HOMOSEXUAL CONTACTS . O ENSUR~ INJECTION WITH STERILIZED Why do you think that you have a (MODERATEJOILEAT CHANCE) of getting AIDS? ANY OTHER REASONS? RECORD ALL MENTIONED. Smeo you heard of AIDS, have you changed your behaviour to prevent getting AIDS? IF YES, WHAT DID YOU DO? RECORD ALL MENTIONED NEEDLES H OTHER W (SPECIFY) OTHER X (SPECIFY) NO BEHAVIOUR CHANGE Y 293 NO. 811B 811C 811D 811E 811F 81 IG QUESTIONS AND FILTERS ~las your knowledge of AIDS influenced or changed your deoisiom about having sex or your sexual bchav~our? IF YES, IN WHAT WAY? RECORD ALL MENTIONED CODING CATEGORIES D IDN'T START SEX . . . . A ~TOPPED ALL SEX . . . . . . . . B ~TARTED USYNO CONDOMS . . . . C RESTRICTED SEX TO ONE PARTNER . . . . . . D REDUCED NUMBER OF PARTNERS . . . . . . . . E [O MOPE HOMOSEXUAL CONTACTS . F ADVISED PARTNER TO BE FA ITHFUL . O DTHER W (SPECIFY) DTHER Y (SPECIFY) iNO BEHAVIOUR CHANGE . Z . SKIP Some people use a condom for sexual intercourse to avoid getting A IDS or other sexually ~xansmitted diseases? Have you ever heard of this? CHECK 515: HAS HAD SEXUAL r~ HAS NEVER HAD mTERCO~SE VA SEXU~ INTERCO~SE ~ -- .90' YES I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ,311F We may already have'calked about this. Have you ever used a condom for sex to YES I avoid gotthlg or transmitted diseases, such as AIDS? . NO . 2 . Have you glven or received money, gilts or favours in return for sex at any time 'YES 1 intha last 12 months? .NO . 2 . ~yes , was a condom used? YES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 294 SECTION 9. MATERNAL MORTALITY NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 901 Now I would like to ask you some questions about your brothers and sisters, :that is, all o f the children bomlo your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother #re birth to, including you? NUMBER OF BIRTHS TO [ ] i NATURAL MOTHER 902 CHECK 901: TWO OR MORE ONLY ONE BIRTH BIRTHS ~ (RESPONDENT ONLY) [~ - - '916 903 How many of these blabs did your mother have before you were born? 904 What was the name given to your oldest (next oldest) brother or sister? 905 Is (NAME) male or female? 906 Is (NAME) still alive? 907 How old is (NAME) 908 In what year did (NAME) die? 909 How many years ago did (NAME) die 910 How old was (NAME) when he/she died? 911 Was (NAME) pregnant when she died? 912 Did (NAME) die during childbirth? 913 Did (NAME) die vdthin two months alter the end of a pregnancy or ehildbisth? (i) (2) (3) (4) (5) MALE I MALE 1 MALE . . 1 MALE . . . . 1 MAI . . . . . . . . . . . . 1 FEMALE . . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . . 2 FEMALE . . . . . . . . . . 2 YES 1 YES 1 YES 1 YES 1 YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 NO . . 2 NO . . . . . . . . . . 2 NO 2 NO . . . . . . . . . . . . . . . 2 GO TO 908, I OO TO 908, I GO TO 908, I GO TO 908, I GO TO 908~ I DON'T KNOW . . . . . . . 8 DON'T KNOW . . . . . . . 8 DON'T KNOW . . . . . . . 8 DON'T KNOW . . . . . . . 8 DON'T KNOW . . . . . 8 GO TO [21" I GO TO [31" I GO TO [41, I GO TO [51" I GO TO [6], I GO TO [21 GO TO [31 GO TO [41 GO TO [5] OO TO [61 GO TO 910., I GOTO 910. q GOTO 910. I GO TO 910~ I GOTO 910. I DON'T KNOW . 98 DON'T KNOW . 98 DON'T KNOW . 98 DON'T KNOW . 98 DON'T KNOW . 98 IF MALE OR DIED IF MALE OR DIED IF MALE OR DIED IF MALE OR DIED IF MALE OR DIED BEFORE BEFORE BEFORE BEFORE BEFORE 10 YEARS OF AGE 10 yEARS OF AGE 10 YEARS OF AGE 10 YEARS OF AGE 10 "EARS OF AGE GO TO 12] GO TO [3] OO TO [41 GO TO [5] GO TO [6] YES 1 YES I YES 1 YES . . . . . . 1 YES . . . . . . . . . . . . . . 1 GOTO 914~ I GOTO 914" I GO TO 914~ I GO TO 914, I TO 914~ I NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 YES 1 YES 1 YES . . . . . . 1 YES 1 YES . . . . . . . . . . . . . . 1 GO TO 915'. I GO TO 915, I GOTO 915, I GO TO 9154 I GO TO 915~ I • NO . . . . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . 2 YES 1 YES i YES I YES . . . . . . 1 YES . . . . . . . . . . . . . . 1 NO .2 NO 2 NO 2 NO 2 NO . . . . . . . . . . . . . . . 2 GOTO 915, I GO TO 915- [ GO TO 915~ I OOTO915, I GO TO 915, I 295 YES 1 YES . 1 YES NO . . . . . . . 2 NO 2 NO 914 Was h~c death due complications o f pre~qaney or ehildbkth? 915 How many ehil&en did (NAME) give birth to during her lifetime? 904 What was the narae given to your olde~t (next oldest) brother or sister? GO TO [2 l (6) GO TO [31 (7) 1 YES , 2 NO Go TO [61 (10) 1 MALE 1 YES . . 2 NO GOTO [41 GOTO [51 (8) (9) 905 Is (NAME) male or MALE . . . . . . . . . . . . . 1 MALE . . . . 1 MALE. , 1 MALE female7 FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 906 Is (NAME) still YES 1 YES 1 YES I YES . . . . . . . . 1 YES alive7 NO 2 NO . . 2 NO . 2 qO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 GO TO 908~ / GO TO 908~ q GO TO 908q I GO TO 908, I GO TO 908~ DON'T KNOW . . . . . . g DON'T KNOW . . . . . . 8 DON'T KNOW . . . . . . 8 DON'T KNOW . . . . . . 8 DON'T KNOW . . . . . . • GO TO [71 ,~ GO TO [8], J GOTO [9], I GO TO [10]. I GOTO [11]., GO TO [71 GO TO [81 GO TO [91 GO TO [10] GO TO [11] 908 In what year did (NAME)die? 19 ~ 19 ~ 19 [ ] 19 ~ 19 GO TO 910~ J GOTO 910, J GO TO 910.q I GO TO 9104 I GO TO 9104 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 909 How many years 910 How old was (NAME) when he/she died? IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [7] YES 1 GO TO 914. J IF MALE OR DIED BEFORE 10 yEARS OF AGE GO TO [81 YES 1 GOTO 914, 1 IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [91 YES 1 GOTO 914~ I IF MALE OR DIED BEFORE 10 YEARS OF AGE Go TO [10I YES 1 GOTO 914~ I IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [ 1 l] YES GOTO 914, 911 Was (NAME) pregnant when she died7 NO . . . . . . . . . . . . . . . . 2 • NO . . . . . . . . . . . . . . . . 2 . ~O . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 912 Did (NAME) die YES , . 1 YES 1 YES 1 YES 1 YES durhlg childblrth7 GOTO 915~ l GO TO 915~ I GO TO 915~ I GOTO 9154 I GOTO915, • NO . . . . . . . . . . . . . . . . 2 • NO . . . . . . . . . . . . . . . . 2 .NO . . . . . . . . . . . . . . . . 2 ,NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 913 Did (NAME) die YES . . 1 YES . 1 YES . . . . . . . . . . . . . . . 1 YES . 1 YES . within two months afar theeadofapreg~uey NO . . . . . 2 NO . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . 2 or childbirth7 GO TO 9 1 5 ~ GOTO 915~ J GOTO 915~ q GOTO 915, I GOTO 9154 914 Was her death due YES . . 1 YES 1 YES 1 YES . . . . . . . . . . . . . . . 1 YES to eomplieat/ons o f pre~aney or NO . . 2 NO 2 NO . . . . . . . . . . . . . . . . 2 NO 2 NO 2 childbirth? 915 How many children 1o during her lifetime? GO TO [7] GO TO [8] GO TO [9] GO TO [10] GO TO [11] 296 904 What was the name (I i) (12) (13) (14) (15) given~o your oldest (n~xt oldest) brothe~ or sister? 905 Is (NAME) male or MALE . . 1 MALE . . . 1 MALE 1 MALE 1 MALE female7 • FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 906 Is (NAME) still alive? 907 How old is (NAME) 90$ In what year did (NAME) die? 909 How many years ago did (NAME) die 910 How old was (NAME) when he/she died? 9i I Was (NAME) pregaant when she died? 912 Did (NAME) die during childbi~h? 913 Did (NAME) die wlt~n two months after the end of a pregnancy or childbirth? YES 1 NO 2 GO TO 9084 I DON'T KNOW . . . . . . S GOTO [12], ) GO TO [12] 19 GOTO 910, I DON'T KNOW . . . . . 98 IF MALE OR DIED BEFORE i0 YEARS OF AGE GOTO 1121 YES 1 GOTO914, ) YES 1 NO. . 2 GO TO 908( DON'T KNOW . . . . . . 8 GO TO [13 I, I GO TO [IB] 19 GO TO 910. ) DON'T KNOW . 98 IF MALE OR DIED BEFORE I0 YEARS OF AGE OO TO [13] YES 1 GO TO 914,, I YES . . . . . . 1 NO 2 GO TO 908* I DON'T KNOW 8 OO TO [14], I GO TO [14] 19 GOTO 910, J DON'T KNOW . . . . . 98 IF MALE OR DIED BEFORE 10 YEAR8 OF AGE GO TO [141 YES . 1 GOTO914, I YES 1 NO 2 GO TO 908~ DON'T KNOW . 8 GOTO [15], I YES NO . 2 GO TO 908, DON'T KNOW . . . . . . 8 GO TO [16], GO TO [151 19 GO TO 910, DON'T KNOW . . . . . 98 IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [9161 YES 1 GOTO 914. 19 GOTO 910, I DON'T KNOW . 98 IF MALE OR DIED BEFORE I0 YEARS OF AGE GOTO [IS] YES 1 GO TO 914, I .NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 .NO . . . . . . . . . . . . . . . . 2 .NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 YES . 1 GOTO915, J .NO . . . . . . . . . . . . . . . . 2 , YES 1 YES . . 1 YES 1 YES . 1 GOTO 915, I GO TO915, J GO TO 915, I GO TO 915, NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 YES 1 NO . . . . . 2 GOTO 915, I YES NO . . . . . GOTO9154 YES NO GOTO915~ 914 Was her death due YES 1 YES . . . . YES to eompli~tions o f pregnancy or NO . . . . . 2 NO . . . . . . . . . 2 NO . . . . 2 ohildlfnth? 915 How many shildren did (NAME) give biah to during her lifetime? 1 YES 1 2 NO 2 I GOTO 915, I 1 YES I NO 2 e~, TO [14] OO TO [i31 GO TO [15] 1 YES 1 2 NO . . . . . . . . . . . . . . . . 2 I GO TO 915, - - I YES i NO . . . . . . . 2 GO TO [121 IF NO MORE BROTHERS OR SIST~IT& GO TO 916 HOUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 SECTION 10. HEIGHT AND WEIGHT CItECK 215: ONE OR MORE ~ NO BIRTHS SINCE ~ EIRTHS SINCE ~ , END JAN. 1996 * 3AN. 1996 IN 1002 (COLUMNS 2 AND 3) RECORD TItE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1996 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR TIlE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1996. IN 1006 AND 1009 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1996 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1996, GO TO NEXT PAGE). 10031002 ]LINE NO. FROM Q212NAME FROM Q212 FOR CHILDREN 1004 DATE OF BIRTH FROM Q215, AND ASK FOR DAY OF BIRTH 1005 BCG SCAR ON TOP OF LEFT SHOULDER 1006 HEIGHT (In ~nthnet~rs) 1007 WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP? WEIGHT (In kilogam 0 1008 1009 1010 1011 1002 1) RESPONDENT (NAME) yOUNGEST LIVING CHILD (NAME) 3) NEXT-TO-YOUNGEST LIVING CHILD ~AME) DAY . . . . . . . . . . . . . . . . . . . . MONTH . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . gCARSEEN . . . . . . . . . . . . . . . . . . . 1 NO SCAR . . . . . . . . . . . . . . . . . . . . . DATE WEIGHED AND MEASURED RESULT DAY . . . . . . . . . . . . . . . . . . MONTH . . . . . . . . . . . . . . YEAR . . . . . . . . . . ~ LYING . . . . . . . . . . . . . . . . . . . . . . . . 1 LYING . . . . . . . . . . . . . . . . . . . . . . . . ~TANDING . . . . . . . . . . . . . . . . . . . 2 $T,M-'NDING . . . . . . . . . . . . . . . . . . DAY . . . . . . . . . . . . . . . . . . . . : ~ONTH . I(EAR . . . . . . . . . . . DAY . . . . . . . . . . . . . . . . . . . . ~ONTH . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . MEASURED . . . . . . . . . . . . . . . . . . 1 ]MEASURED . . . . . . . . . . . . . . . . . . . 1 IMEASURED . . . . . . . . . . . . . . . . . . . NAME OF MEASURER: •ZHI LD SICK . . . . . . . . . . . . . . . . . . . NOT PRESENT . . . . . . . . . . . . . . . 3 CHILD NOT PRESENT . . . . . . . . . 2HILD REFUSED . . . . . . . . . . . . . . REFUSED . . . . . . . . . . . . . . . . . . . . 4 ~IOTHER REFUSED . . . . . . . . . . . . 3THER . . . . . . . . . . . . . . . . . . . . . . . OTHER . . . . . . . . . . . . . . . . . . . . . . 6 1____._! LINE NO. FROM Q212 CHILD SICK . . . . . . . . . . . . . . . . . . . CHILD NOT PRESENT . . . . . . . . . ~HILD REFUSED . . . . . . . . . . . . . . MOTHER REFUSED . . . . . . . . . . . . OTHER . . . . . . . . . . . . . . . . . . . . . . . (SPECIFY) (SPECIFY) (SPECIFY) NAME OF ASSISTANT: [ ] , 14) SL OO g- o- oUNGEST 298 1003 1004 1005 I006 1007 1008 1009 1010 1011 NAME FROM Q212 FOR CHILDREN DATE OF BIRTH FROM Q215, AND ASK FOR DAY OF BIRTH BCG SCAR ON TOP OF LEFT ~HOULDER ~IEIGHT (in e, ealm~rs) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP? WEIGHT (In kilogr'~s) DATE WEIGHED AND MEASURED RESULT NAME OF MEASURER: NAME OF ASSISTANT: 9 . . . . . . . . . . . . 1 . . . . . . . . . . . . 2 21 ~) 299 Commords about Respondent: INTERVIEWER'S OBSERVATIONS To be filled in aRor completing irderview CoRlmellts oil Spedtllc Questions: Any other Commenls: SUPBRVISOR'S OBSERVATIONS Name of Supervlsor: Date: EDITOR'S OBSERVATIONS Name of Editor: Date: 300 FEDERAL REPUBLIC OF NIGERIA NATIONAL POPULATION COMMISSION 1999 DEMOGRAPHIC AND HEALTH SURVEY INDIVIDUAL QUESTIONNAIRE FOR MEN NDHS04 IDENTIFICATION STATE NAME . . . . . . . . . . . LOCAL GOVT. AREA LOCALITY NAME . . . . ENUMERATION AREA *URBAN/RURAL . . . . . . . . . . **LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BUILDINO NUMBER . . . . . HOUSEHOLD NAMEAXrUM BER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAME AND LINE NUMBER OF MAN IN HOUSEHOLD SCHEDULE INTERVIEWER'S VISITS DATE INTERVIEWER'S NAME RESULT NEXT VISIT: DATE TIME i 1L~SULT CODES: 1. COMPLETED 2 NOT AT HOME 3. POSTPONED 4. REFUSED 3 5. PARTLY COMPLETED 6. INCAPACITATED 7. DWELLING DESTROYED 8 OTHER FINAL VISIT DAY MONTH i~ :i~ :'.i~ I YEAR ~i::: ::': ')~ i NAME RESULT TOTAL NO. OF VISITS (Sp~ify) NAME DATE SUPERVISOR FIELD EDITOR NAME DATE I * (Urban = 1, Rural ffi 2) ** (Large Townffi 1, Medium Towa-~2, Small Town=3, Villago-~l) Largo Towns arc ple~es with over 1 mJllloa population; Medium Towns are places ~Zch between 50,000 aad I million population; Small Towns aro pl~cesboth between 20,000 and 50,000 lmpul~tion while places with le~ than 20,000 are villages. 301 SECTION I. RESPONDENT'S BACKGROUND NO. QUESTIONS AND FILTERS 101 1LECORD THE TIME. (START OF INTERVIEW) 102 103 I04 105 106 107 108 109 110 111 112 113 114 First I would like to ~k some quesfiom about you and your household, For most of the time ur~l you were 12 years old, did you live in a large town, medinm towr~ small town, or in the village? How long have you been living cor~inuously in (NAME OF CURRENT PLACE OF RESIDENCE)? )'ust before you moved hero, did you Eve in a large town, medium town, small town, or inthe village? /n what month and year were you born? ~Iow old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. Have you ever attended school? What is the highest level of school you attended: primaw, secondary, or higher? What is the highest (grade/form/year) you completed at that level? CODING CATEGOFJES [ SKIP HOUR . ~ . M INUTES . i LARGE TOWN . . . . . . . . . . . . . . . . . . . . . . . . 1 MEDIUM TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 SMALL TOWN . . . . . . . . . . . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 YEARS . . . . . . . . . . . . . . . . . . . . . . . . . ~ ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . . . 95- 1 VISITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96- d~ 105 LARGE TOWN . . . . . . . . . . . . . . . . . . . . . . . . 1 MEDIUM TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 SMALL TOWN . . . . . . . . . . . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 MONTH . . . . . . . . . . . . . . . . . . . . . . . . ~ DON'T KNOW MONTH . . . . . . . . . . . . . . . . 98 yEAR . . . . . . . . . . . . . . . . . . . ~ DON'T KNOW YEAR . . . . . . . . . . . . . . . . . . 98 AGE IN COMPLETED YEARS . . . . . ~ i YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2~-~111 PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHECK 108: SECONDARY PRIMARY ~ OR HIGHER [~ SECONDARY . . . . . . . . . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 SPECIFY GRADE (YEAR) . . . . . . . . . . . . . . . . . . Fan you read and understand a letter or newspaper easily, wifla di~tculty, or not ~t al l? Do you usually read a newspapex or magazine at least once a we~k? - - ' i 12 Do you usually listen to radio eve W day? Do you usually walchlelevision at least onc~ a week? I 15 At 9 you currently working? 116 Have you done any work in the last 12 molfths? EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WITH DIFFICULTY . . . . . . . . . . . . . . . . . . . . NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 3 -~113 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~117 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - '124 302 NO. 117 118 119 120 QUESTIONS AND FILTERS What is your occupation, that is, what kind of work do you mainly do? 3HECK 117: WORK IN DOES NOT WORK AGRICULTURE ~ IN AGRICULTUP~E CODING CATEGORIES SKIP - - • 120 Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land? Do you do this work for a member of your family, for someone else, or are you self-employed? OWN LAND . . . . . . . . FAMILY LAND . . . . . 2 RENTED LAND . . . . . . . . . . . . . . . . . . . 3 • SOMEONE ELSE'S LAND . . . . . . . . . . . . . . . 4 FOR FAMILY MEMBER . . . . . . . . . . . . . . . . . FOR SOMEONE ELSE . 2 • SELF EMPLOYED . . . . . . . . . . . . . . . . . . . . . . 3 121 Do you usually work at this job throughout lira year, or do you work seasonally, PHROUOHOUT THE YEAR . . . . 1 - -* 123 or only once in a while7 SEASONALLY/PART OF THE YEAR . . . . . 2 • ONCE IN A WHILE . . . . . . . . . . . . . . . . . . . . . 3 122 During the laat 12 months, how many months did you work at thls job? NUMBER OF MONTttS . . . . . . . . . . . [ ] 123 How much do you earn for this work? PROBE: Is this by the hour, by the day. bythe week, by the month or bythc ye~? What is your religion7 What is your ethnic group7 124 125 .PEP.HOUR . . . . . . . . . . . ::ii i~i ~i, ,~::,, .PERDAY . . . . . . . . . . . 2 ,~i i~ :?d" OTHER 99996 (SPECIFY) CATHOLIC., I PROTESTANT 2 OTHER CHRISTIAN . . . . . . . . . 3 ISLAM., . 4 .TRADITIONALIST . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 (SPECIFY) 303 NO. m 201 SECTION 2. REPRODUCTION QUESTIONS AND FILTERS ~ow I would llke to ask about your children. I am inked only in the children ~tat are biologically youl,s. Have you over had children? 202 Do you have any sons or dauglaers who are now living with you? 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'. 204 Do you have any sons or daughters who are alive but do not live with you? 205 ~Iow many sons a~ alive but do not llve with you? ~md how many dau~ are alive but do not live with you7 IF NONE, RECORD '00'. 206 Have you ever given bh~h to a boy or glrl who was ham alive hat later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days? 207 How meaty hays have died? And how many girls have died? IF NONE, RECORD "00'. 209 CODING CATEGORIES SKIP Y~S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -,206 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -,204 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -,206 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -,208 BOYS DEAD . . . . . . . . . . . . . . . . . . . . GIRLS DEAD . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . CHECK 208: Just to make sure that I have this right: you have had in TOTAL children during your llfe. Is that correct? PROBEAND YES ~ NO ~-~ • CORRECT 201-208AS NECESSARY. 210A E 211 HAS NEVER HAD HAS HAD CHILDREN ~ CHILDREN [ -~ t and year was your last child born? MONTH . . . . . . . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . CHECK 201A, LAST CHILD: BORN SINCE BEFORE JANUARY 1996 ~ JANUARy 1996 ~ W h ~ ~ d , did youwant~ ha~otha child THEN _ _ 1 children at all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . 3 304 SECTION 3. CONTRACEPTION Now I wouM like to talk about family planning that is the various ways or methods that a couple can use to delay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CJECLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD W1TH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303. 301 Whioh ways or methods have you heard about? 302 Haveyoueverheard~ 303 Haveyouvverused (METHOD)? (METHOD)? SPONTANEOUS PROBED YES YES NO 01 1 2 02 IUD Womeax can have a loop or coil plaead inside them by a doctor or a nurse. 1 2 03 INJECTABLES Women can have an injection by a doctor or rmrso which stops them from becoming 1 2 pre~aant for several monlbs. 04 IMPLANTS Women can have several small rods daeed in their upper arm by a doctor or nurse which 1 2 can prevent pregtmnoy for several years. DIAPHRAOM, FOAM, JELLY Women can place a sponge, supposito~, diaphragm, jelly, or cream inside 1 2 themselves before inlereour so. 05 06 07 OS 09 PILL Women can take a pill every day. 10 11 YES 1 3 ~ • ~NO, DOES NOT KNOW . . . . . 2 . YES ,. 1 3 • NO, DOES NOT KNOW . . . . . 2 YES ,. 1 3 * .NO, DOES NOT KNOW . . . . . 2 . YES 1 3 - - NO, DOES NOT KNOW . . . . . 2 CONDOM Men oan pot a mbb~r sheath on thff~ penis for sexual inter~ou~e. 1 2 FEMALE STERILIZATION Women can have an operation to avoid having any more children. 1 2 MALE STER/L/ZATION Men can have an operation to avoid having any more shildrcn. 1 2 YES 1 3 - - • ~NO, DOES NOT KNOW . . . . . 2 . YES 1 3 - - .NO . . . . . . . . . . . . . . . . . . . . . . . 2 . [lave you ever had a parlner who 3 ~ I had operation to avoid having any I more children? YES • *' 1 KIO . . . . . . . . . . . . . . . . . . . . . . . 2 . Have you ever had a par~er who 3 - - had an operation to avoid having ~hildren? YES 1 NO 2 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she oan avoid hav'mg sexual intercourse on tbe days oftbe month she is most likely to get pre~ianL 1 2 WITHDRAWAL M~n can be careful and pull out before cllmag 1 2 Have you heard of any other ways or methods that women errata can useto avoid pregnanoy? YES 1 3 - - NO, DOES NOT KNOW . . . . . 2 YES 1 3 .NO . . . . . . . . . . . . . . . . . . . . . . . 2 . 3 m 304 (SPECIFY) (SPECIFY) CHECK303: NOT A SINCerE, I AT LEAST ONE "YES" ~ "YES" ~-q (NEVER USED) (EVER USED) • YES . . . . . . . . . . . . . . . . . . . . . . 1 ° NO 2 INO . . . . . . . . . . . . . . . . . . . . . . . 2 . • YES 1 • SKIp TO 307 305 NO. 305 306 307 308 309 QUESTIONS AND FILTERS Have you or any o f your wives/parSers ever used anything or tr ied in any way to delay or avoid getting pre~ant? What have you used or done7 CORRECT 303 AND 304 (AND 302 1F NECESSARY). Are you or your wife (wives) /pat~er (s) dffmg something or using a method to delay or avffld a pre~mncy? Which method are you using? What is the main reason you are not us ing a method o f ¢onlraeeptinn to avoid pregmaney? CODING CATEGORIES SKIp YES . 1 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - . -~309 YES . . . . . . . . . . . . . . . . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - . -~309 PILl 01 FUD 02 . rN JECTABLES . . . . . . . . . . . . . . . . . . . 03 . IMPLANTS 04 D IAPHRAGM/FOAM/ JELLy . . 05 ~401 CONDOM]FEMIDOM. 06 FEMALE STERIL IZATION . . . . . . . . 07 MALE STERIL IZATION 08 PERIODIC ABST INENCE 09 WITHDRAWAL . . . . . . l 0 OTHER 96 SPECIFy NOT MARRIED . . . . . . . . . . . . . . . . . . l l FERTIL ITY*RELATED REASONS NOT HAVING SEX 21 INFREQUENT SEX . . . . . . . . . . . . . 22 WIFE NENOPAUSAL/HYSTERECTOMY . 23 WIFESUBEECUND/rNFECUND , 24 POSTPARTUM/BREAST FEEDING 25 WANTS (MORE) CHILDREN . . . . 26 WIPE PREGNANT . . . . . . . . . . . . . . 27 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . 31 WIFE/PARTNER OPPOSED . . . . . . 32 OTHER8 OPPOSED . . . . . . . . . . . . . 33 RELIGIOUS PROHIB IT ION . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . 4] KNOWS NO SOURCE . . . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TOO EAR . . . . 53 COST TOO MUCH. . 54 INCONVENIENT TO USE . . . . . . . 55 INTERFERES WITH BODY'S NORMALPROCESSES 56 UPTO THE WOMANTOUSE 61 OTHER 96 SPECIFY DOES NOTKNOW . . . . 98 306 SECTION 4: MARRIAGE NO. 401 QUESTIONS AND FILTERS Are you currently married or living with a woman? CODING CATEGORIES YES, CURRENTLY MAILRIED . . . . . . . . . . . . . . . . YES, LIVING WITH A WOMAN . . . . . . . . . . . . . . . 2- NO, NOT IN UNION . . . . . . . . . . . . . . . . . . . . . . . . . 3 SKIP -~402A --,404 Howmanywif~wivesdo youhave? [0. OF WIVES . . . . . . . . . . . . . . . . . . . . . . . 402 Howmanywomenareyoulivingwithasifyouaremarried? 402A 403 NO. OF WOMEN . . . . . . . . . . . . . . . . . . . . . WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFEAVIVES. IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE 'Off. BEROF O SFI=ED STEOUALTHE BEEOF WIVES Do you currently have a regular sexual partner, an occasional sexual paflaer, multiple sexual partue~ or no sexual partner at all? REGULAR SEXErAL pARTNER . . . . . . . . . . . . . . . 1 OCCASIONAL SEXUAL PARTNER . . . . . . . . . . . . 2 NO SEXUAL PARTNER . . . . . . . . . . . . . . . . . . . . . . 3 MULTIPLE SEXUAL PARTNERS . . . . . . . . . . . . . 4 404 405 Have you ever beea married or lived with a woman? YES, FORMERLY MARRIED . . . . . . . . . . . . . . . . . 1 YES, LIVED WITH A WOMAN . . . . . . . . . . . . . . . 2 - - , 407 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 - ,410 406 What is your marital status now: a~ you widowed, divorced, or separated? WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I DIVORCED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SEPARATED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 407 Have you been marlSed or lived with a woman only one*, or more than one? ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MORE THAN ONCE . . . . . . . . . . . . . . . . . . . . . . . . . 2 408 MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW MONTH . . . . . . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ~ I~l:~l DOES NOT KNOW YEAR . . . . . . . . . . . . . . . . . . . 98 CHECK 407: MARRIED/LIVED WITH MARRIED/LIVED WITH ~ WOMAN MORE THAN A WOMAN ONLY ONCE ~-2 ONCE • - p M what month and year did you start living with ~our wife/womall? Now we will talk about your first vfife/woman you lived with. In what month and year did you start living with her? ,407 -~410 409 How old were you when you started living with her? AGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 Now I need tu ask you some queatiom about sexual activities in order to guin a NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000 -,509 better uaderslanding of some family plalming issues When was the last time you bad sexual intercourse (if ever)7 DAYS AGO . . . . . . . . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . . . . . . . . . . . 3 YEARS AGO . . . . . . . . . . . . . . . . . . . . . . 4 BEFORE LAST BIRTH . . . . . . . . . . . . . . . . . . . . . 996 307 NO. 411 QUESTIONS AND FILTERS CHECK 301 AND 302: KNOWS CONDOM rhe last time yOU had Sex, was a condom used? DOES NOT KNOW CONDOM ? Some men use a condom, which means that they put a tubber sheath on their penis for sexual haereourse. Tha last thne you had sex, was a condom used? CODING CATEGORIES YES . . . . . . . . 1 NO .2 sKIP 412 Do you know of a place where you can get condom? YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , -~414 413 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. CHECK 401: NO, NOT IN UNION ! Inthe last 12 mordhs, how many different persons have you had sex with? 414 PUBLIC SECTOR GOVERNMENT HOSPITAL . . . . . . . . . . . . . . 11 • GOVERNMENT HEALTH CENTER . . . . . . . 12 , FAMILY PLANNING CLINIC . . . 13 MOBILE CLINIC . 14 COMMUNITY HEALTH WORKER . . . . . . . 15 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . 21 PHARMACY/PMS 22 PRIVATE DOCTOR . . . . . . . . . . . . . . 23 MOBILE CLINIC 24 • COMMUNITY HEALTH WORKER . . . . . . . 25 , OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . 31 CHURCH 32 • FRIENDS/RELATIVES . . . . . . . . . . . . . . . . . . 33 , NGO . . . . . . . . . . . . 34 OTHER 36 (SPECIFY) NUMBER (NAME OF PLACE) CURRENTLY MAR~ED OR LIVING WITH A WOMAN lit the last 12 moaths, how many different persons have you had sex with other than your ~ife/wive~/wom~ you are living with) 415 How old were you when you first had sexual intercourse? AGE . • FIRST'TIME WHEN MARR/ED . . . . . . . . . . . . . . 96 , 308 NO. 7 502 CHECK 401: NOT IN UNION QUEST IONS AND FILTERS CURRENTLY MARRIED OR LIVING WITH A [~ WOMAN [-7 CODING CATEGORIES SKIP --~503 503 504 505 506 ZHECK503: 507 508 CHECK 404 KEGULAR OCCASIONAL MULTIPLE NO, SEPAL p SEXUAL SEXO PARTNER • PARTNER PARTNERS • pARTNER --~505A [s your wife (or one of your wives)/partnor pregnant now? ~qhaa she be*ame pregnat, did you want her to become pregnant then, did you want her to ~ait until later, or did you not want this pre~aaney at all? ~.) WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WlFE~ARTNER YF~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~- 7 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 8 - A*505A THEN . I 3 LATER . 2 [*50SB NOT AT ALL . 3 I gow I have some questions about the future, Would you like to have (a/m~other) child, or would you prefer not to have any (more) children? WIFE/PARTNER NOT WIFE/PARTNER (B) WIFE/PARTNER PP~EONANT ? qow I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have rely more children? SECTION 5: FERTILITY PREFERENCES HAXFE (A]ANOTHER) CHILD . . . . . . . 1 NO MORE/NONE . . . . . . . . . . . . . . . . . 2 SAYS WIFE CAN'T GET pREGNANT 3 SAYS HE CAN'T HAVE ONE ANY MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 UNDECIDED/DON'T KNOW . . . . . . . 8 MONTHS . . . . . . . . . . . . . . . . I PREGNANT OR PREGNANT YEARS UNs Now . . . . . . . . . . . . . . . . . . PARTNER SOON/NOW . . . . . . . . . . . . . . . . . . . . 993 • SAYS WIFE CAN'T FIow long would you llke ~o walt from now before the After the shild your wife/paxtner is GET PREGNANT . . . . . . . . . . . . . . . 994 firth of(a:anoth~r) ablld? expec~ how long would you Eke AFTER MARRIAGE . . . . . . . . . . . . . 995 to wait before the Wuth of anothea- abiM? OTHER 996 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . 998 ,507 CHECK 30g: USING A METHOD? NOT NOT CURRENTLY CURRaENTLY ASKED ~ USING ~ USING [ -7 - - .512 Doyouthii~youwilluseametEodtodelayoravoidpregmmoy wlthlnthenext 12mo~? [YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-- .510 i [ He . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i DOES NOT KNOW . . . . . . . . . . . . . . . . 8 509 Do you think you will use a method at any time in the future YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 3 DOES NOT KNOW . . . . . . . . . . . . . . . . S- d~-511 309 NO. 510 511 512 513 QUEST IONS AND FILTERS Which method would you prefer to use? What is ltho main reason that you think you will never use a method? CHECK204: HAS LIVING CHILDKEN NO LIVING CHILDREN If you could go bach to tbe time you did not have any If you could choose exactly the okildrea and could choose exactly tbe number of number of childien to have in your childrett to have in your whole lifo, how many would whole lifo, how many would that be2 thot be? How many of~heso children would you like to be boys, how many would you like to be girls and for how many would it not matter? CODING CATEGORIES PILL IUD [NJECTABLES . . . . . . . . . . . 03 IMPLANTS 04 DIAPHRAGM/FOAM/JELLY. 05 CONDOM/FEMIBOM 06 FEMALE STERILIZATION . . . . . . . . 07 MALE STERILIZATION 08 IpERIODIC ABSTINENCE. 09 WITHDRAWAL 10 OTHER 96 (SPECIFY) .UNSURE . . . . . . . . . . . . . . . . . . . . . . . 98. NOT MARRIED . . . . . . . . . . . . . . . . . . I 1 FERTILITY-RELATeD REASONS INFREQUENT SEX . . . . . . . . . . . . 22 WIFE MENOPAUSAL/HYSTERECTOMY. 23 WIFE SUBFECUND//NFECUND. 24 WANTS MORE CHILDREN . . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 WIFE OPPOSED . . . . . . . . . . . . . . 32 OTHERS OPPOSED 33 RELIGIOUS PROHIBITION . . . . . 34 LACK OF KNOWLEDGE • KNOWS NO METHOD . . . . . . . . . 41. KNOWS NO SOURCE, 42 METHOD-RELATED REASONS HEALTH CONCERNS 51 FEAR OF SIDE EFFECTS . . . . . . . 52 LACK OF ACCESS/TOO FAR . 53 COST TOO MUCH 54 INCONVENIENT TO USE . 55 INTERFERES WITH BODY'S NORMAL PROCESSES 56 UP TO THE WOMAN TO USE . . . :. 61 OTHER 96 (SPECIFY) .DON'T KNOW . . . . . . . . . . . . . . . . . . . 98. NUMBER OTHER 96- (SPECIFY) BOYS NUMBER ~ i OTHER 96 [ (SPECIFY) GIRLS NUMBER OTHER 96 ! (SPECIFY) EITHER OTHER 96 (SPECIFY) SKIP 01 02 ~512 -~514 310 NO. 514 515 516 517 517B 518 519 520 521 QUESTIONS AND FILTER8 Would you say that you approve or disapprove of couples using a method to avoid getting ~re@mant? Is it acceptable or not acceptable to you for information on family planning to be provided: On the radio ? On the television? In the last few months, have you heard about family planning: Onthe radio? On the television? In a newspaper? From a poster? From leaflets or brochures? From Town Crier? Any Other (SPECIFY) In the last few months, have you heard about any message on Radio/TV on condom use? Ifye% (Specify). In the last few months, have you discussed the practice of family planning with your spouse/partner, friends, neighbors, or relatives7 Withwhom? Anyone else? RECORD ALL MENTIONED• CHECK 401: CODINO CATEGORIES APPROVE DISAPPROVE . . . . 2 .NO OPINION . . . . . . . . . . . . . . . . . . . . . 3 NOT DOES ACCEPT- ACCEPT- NOT ABLE ABLE KNOW RADIO . . . . . . . . . . . 1 2 8 TELEVISION . . . . . 1 2 8 YES NO RADIO . . . . . . . . . . . . . . . . . . . . . 1 2 TELEVISION . . . . . . . . . . . . . . . 1 2 NEWSPAPER OR MAGAZINE 1 2 POSTER 1 2 LEAFLETS OR BROCHURES . 1 2 TOWN CRIER I 2 OTHER X YES 1 NO 2 YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- - ,520 WIFE/PARTNER . . . . . . . . . . . . . A MOTHER . . . . B FATHER C .SISTER(S) . . . . . . . . . . . . . . . . . . . . . . . . D BROTHER(S). E DAUGHTER. F ] dOTHER-IN-LAW . . . . . . . . . . . . . . . . O FRiENDS/NEIGHBORS H SON . . . . . . . . . I OTHER X l (SPECIFY) CURRENTLY LIVING WiTH NOT IN MARRIED ~ AWOMAN ~ UNION ~-~ Spouses/partners do not always agree on everything. Now I want ~o ask you about your wife's/the woman you live with's views on family planning, - - "601 Do you thiuk that your wlfe/the woman you live with approves or disapproves of couples using a method to avoid pre~aney? APPROVES . . . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVES 2 .DOE$ NOT KNOW . . . . . . . . . . . . . . . . 8 522 How ofleax have you talked to your wife/the woman you live with about family planning in NEVER 1 the past ye~? ONCE OR TWICE 2 I • MORE OFTEN . . . . . . . . . . . . . . . . . . . . 3 [ 523 Do you think your wife/the woman you live with wards the same number of children that SA/vlE NUMBER 1 [ you wahl or does she want more or fewer than you want? .MORE CH1LDREN . . . . . . . . . . . . . . . . 2 , FEWER CHILDREN 3 .DOES NOT KNOW . . . . . . . . . . . . . . . . 8, 524 Who decides on the number of children you want to have? HUSBAND ONLY . . . . . . . . . . . . . . . . . 1 WIFE ONLY. . 2 HUSBAND/WIFE . . . . . . . . . . . . . 3 MOTHER-IN-LAW 4 FATHER-IN-LAW 5 OTHER 6 (SPECIFY) SKIP 311 SECTION 6: AIDS AND OTHER SEXUALLY TRANSMITFED DISEASES NO. 601A 601B 501C 601D 601E 601F 601O 601H 601 1 QUESTIONS AND FILTERS Havo you heard about diseases that can be ~ansrditted through sexual intercourse? Which diseases do you know? P~ECORDALLRESPONSES CHECK 410 AND 410P: CODING CATEGORIES SKIP YES . . . 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .--,601~ SYPHILIS . . . A • GONORRHEA . . . . . . . . . . . . . . . . . . . . . . . . B , AIDS . . . . . . . . . . . . . . C GENITAL WARTS/CONDYLOMATA , . . D OTHER W (SPECIFY) OTHER X (SPECIFY) .DOES NOT KNOW . Z , - - ~601F YES 1 , NO 2 .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 8 . ,~601E SYPHILIS • GONORRHEA . . . . . . . . . . . . . . . . . . . . . . . . B . AIDS C GENITAL WARTS/CONDYLOMATA . . . D OTHER W (SPECIFY) OTHER X (SPECIFY) .DOES NOT KNOW . Z . YES I NO 2 , DOES NOT KNOW . 8 , YES . I HAS NEVER HAD HAS HAD SEXUAL SEXUAL INTERCOURSE ~S] INTERCOURSE V7 During the last twelve month% did you have any of these diseases? Which of the dlscas¢~ did you have? RECORD ALL RESPONSES Dtuing the last 12 months, did you have a discharge from your penis? During the last 12 months, did you have a son or ulcor or* your penis? ~HECK 601E, 601F AND 6010: HAD ONE OR MORE DISEASES NONE OF THE DISEASES V7 NO . 2 • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 8 . rhe last time you had (DISEASE FROM 601E/DISCHARGE/SORE) did you seek YES ulviee or treatment? NO 1 . . . . . . . . . . 9- ,60IN -~601JA 312 NO. 601J 501JA 601K 601L 601M QUESTIONS AND FILTERS Whore did you seek advice or treatmerd? Any other plac~ or person? RECORD ALL MENTIONED CHECK 410 AND 410F: HAS NEVER HAD HAS HAD SEXUAL SEXUAL INTERCOURSE ~ INTERCOURSE When you had (DISEASES FROM 601 E/DIS CHARGEJSOILE) did you h~orm /our paflner(s)? When you had (DISEASES FROM 601E/DISCHARGE/SORE) did you do iomahing not to infect your partner(s)? What did you do? RECORD ALL MENTIONED 601N CHECK 601B: DID NOT MENTION MENTIONED 'AIDS" ~ '/kIDS' Have you ever heard of a disease called AIDS7 From which sources of in forraation have you learned mc~ about AIDS7 601P 602 troy other sources? RECORD ALL MENTIONED [7 CODING CATEGORIES SKIP t~OBLIC SECTOR GOVT, HOSPITAL . . . . . . . . . . . . . . . . . . . . A .HEALTH CENTRE . . . . . . . . . . . . . . . . . . . . B ? CLINIC . . . . . C MOBILE CLINIC . . . . . . . . . . D DISPENSARY E OTHER PUBLIC SECTOR. F MEDICAL P/~VATE SECTOR pRIVATE HOSPITAL O PHARMACY/P.~LS . . . . . . . . . . . . . . . . . . . H PRIVATE DOCTOR I MOBILE CLINIC J OTHER MED. pRIVATE SECTOR K OTHER X (SPECIFY) SHOP . . . . . L RELATIVES/FRIEND M FRADITIONAL HEALER N NGO . . . . . P OTHER X (SPECIFY) • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . Z - - ,601N YES , 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . 1 ~IO . . . . . . . . . . . . . . 2 7 1 • PARTNER ALREADY INFECTED . . . . . . . 34 2, 60 IN .',TO SEXUAL INTERCOURSE . . . . . . . . . . . A USED CONDOMS B DOK MEDICINES . C REFER pARTNER TO HEALTH WORKER D OTHER X (SPECIF O -- '602 YES . . . . . . . . . . . . . . . I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , - .611C • RADIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A , tELEVISION . B ~IEWSPAPERS/MAQAZINES C PAMPHLETS~OSTERS . D HEALTH WORKERS E ,MOSQUES/CHURCHES . . . . . . . . . . . . . . . . F , ~CHOOLS/TEACHERS O 2OMMUNITY MEETINGS H FR IENDS/RELAT~ . . . . . . . I WORKPLACE . . . . . . . . . . . . . J OTHER X (SPECIFY) 313 NO. 502B 503 504 505 506 507 QUEST IONS AND FILTERS How can a person get AIDS? Any other ways? Record ALL MENTIONED Is there anything a person can do to avoid getting AIDS or tho virus that causes AIDS? What can a person do? Any other ways? RECORD ALL MENTIONED. CHECK 604: DID NOT MENTIONED MENTION "SAFE SEX" ~ "SAFE SEX" [ -~ What does "safe sex" meanto you? RECORD ALL MENTIONED Is i t possible for a healthy- looking person 1o have the AIDS "Ares? 508 Do you th ink that persons w i th AIDS almost never die from the disease, sometimes die, or almost a lways die f rom the disease? 50SA Can AIDS be cured? 608B Can A1DS b~ Iransmitted from mother ~o child? CODING CATEGORIES SKIP SEXUAL INTERCOURSE SKXUAL INTERCOURSE WITH MULT IPLE PARTNERS. , B SEX WITH PROSTITUTES . . . . . . . . . . . . . C NOT USE CONDOM. , D HOMOSEXUAL CONTACT E BLOOD TRANSFUSION F IN JECTIONS . . . . O K ISS ING . . . . . . . . H MOSQUITO BITES I SCARIF ICATION/CIRCUMCISION J OTHER W (SPECIFY) OTHER X (SPECIFY) .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . Z . yES 1 NO 2. • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 8 . .~ ,607 SAFE SEX ABSTAIN FROM SEX . . . . . . . . . . . . . . . . . . B USE CONDOMS . . . . . . . . C HAVE ONLY ONE SEX PARTNER D AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH HOMOSEXUALS . . . . F ENSURE SAFE BLOOD TRANSFUSION O ENSURE INJECTIONS WITH INFECTED NEEDLES H ENSURE CIRCUMCIS ION WITH . CLEAN BLADES/KNIVES . . . . . . . . . . . . . . I . AVOID K ISSING . . . . . . . . . . . . . . . . J AVOID MOSQUITO BITES . . . . . . K SEEK PROTECTION FROM TRADIT IONAL HEALER . . . . . . . . . . . L OTHER M (SPECIFY) OTHER X (SPECIFY) • DON~ KNOW . . . . . . . . . . . . . . . . . . . . . . . . Z . - - ~607 • ABSTAIN FROM SEX . . . . . . . . . . . . . . . . . . B . USE CONDOMS . . . . . . C AVOID MULT IPLE SEX PARTNER . . . . . D AVOID SEX WITH PROSTITUTES . . . . . . E AVOID SEX WITH HOMOSEXUALS . . . . F OTHER X (SPECIFY) • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . Z . YES . I NO. . 2 .DOESNOT KNOW . . . . . . . . . . . . . . . . . . . $ . ALMOST NEVER 1 .SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . . . 2 . ALMOST ALWAYS 3 DOES NOT KNOW 8 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO 2 • DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 8 . YES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW S 314 NO. 608C 608D 609 609B 609C 611A 6lIB QUESTIONS AND FILTERS Do you personally know someone who has AIDS orhas died of AIDS? What can an infected mother do to avoid transmitting AIDS to her unborn ehiM? Do you ~ your chances of getting AIDS a~ small, moderate, ~ceat, or no risk at art? Why do you think that you have (NO RISK/A SMALL CHANCE) of gelling AIDS? Any other reasons? RECORD ALL MENTIONED Why do you think that you have a (MODERATE/OKEAT) chanco of getting AIDS? Any other reasons? RECORD ALL MENTIONED Since you heard of AIDS, have you changed your b eha~;lour to prevent getting AIDS? IF YES, what did you do? Anything else? RECORD ALL MENTIONED Has your knowledge of AIDS influeaced or changed your deeisiom about ha,/mg sex or your sexual behaviour? IF YES, In what way? RECORD ALL MENTIONED CODING CATEGORIES gRIP YES I ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , .DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . S . TAKE MEDICATION LIKE AZT I SHOIKa) NOT BP, JEAST-FEED . 2 ,DOES NOT KNOW . . . . . . . . . . . . . . . . . . . . 8 , SMALL l MODERATE 2. GREAT 3 ~,609C .NO RISK AT ALL . 4. .HAS AIDS . 5.--,611A ABSTAIN FROM SEX . B USE CONDOMS . C HAVE ONLY ONE SEX pARTNER . D L IMITED NUMBER OF SEX PARTNERS . E AVOID SEX WITH PROSTITUTES . . . . . . F SPOUSEHASNOOTHERPARTNER . G -*611A NO HOMOSEXUAL CONTACT H ENSURE SAFE BLOOD TRANSFUSION . I ENSURE INJECTION WITH STERILIZED NEEDLES . J OTHER X (SPECIFY) DO NOT USE CONDOMS . C .MORE THAN ONE SEX PARTNER . . . . . D . SEX WITH PROSTITUTES E SPOUSE HAS OTHER PARTNER(S) . . . . . F HOMOSEXUAL CONTACT G HAD BLOOD TRANSFUSION . H HAD INJECTIONS I OTHER W (SPECIFY) OTHER X (SPECIFY) DIDN'T START SEX % STOPPED ALL SEX B .STARTED US ING CONDOMS . C . RESTRICTED SEX TO ONE PARTNER . D REDUCED NUMBER OF PARTNERS . E -* 611C AVOID SEX WITH PROSTITOT~S . F ASK SPOUSE TO BE FAITHFUL G NO MOKE HOMOSEXUAL CONTACTS H ENSURE INJECTIONS WITH STERILIZED NEEDLE . . OTHER X (SPECIFY) OTHER X (SPECIFY) NO BEHAVIOUR CHANGE . Y DIDN'T START SEX STOPPED ALL SEX . B STARTED US ING CONDOMS . . : . C RESTRICq'ED SEX TO ONE PARTNER . D REDUCED NUMBER OF PARTNERS . E AVOID SEX WITH PROSTITUTES . . . . . . F NO MORE HOMOSEXUAL CONTACTS G ASK SPOUSE TO BE FAITHFUL H OTHER X (SPECIFY) NO CHANGE IN SEXUAL BEHAVIOUR Y DOES NOT KNOW Z 315 NO. QUESTIONS AND FILTERS 511C Some people use a condom for soxual intercourse to avoid gating AIDS or other lexuallytransmitted infect/on. Have you ever heard of~his? 5liD CHECK 401 AND 401F: HAS NEVER HAD HAS HAD SEXUAL SEXUAL INTERCOURSE ~ INTERCOURSE H1E CODINGCATEGORIE$ SKIP YES . . . . . . . . . . . . . . . . . . . . . . 1 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.,--~611F --~701 We may already haveialkeA nbout this. Havo you over used a condom for soxto YES 1 ~void geding or transmRting disease, such as AIDS? .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . HIG blaveyouglvenorrec~ivedmoney, gigsorfavorsinrotumforsoxatanyfimeinthe YES 1 . fast 12 months? .NO . 2, H1H [f yes, was a condom use, d? YES . I NO . .2 316 NO, 701 702 703 SECTION 7: MATERNAL MORTALITY QUESTIONS AND FILTERS Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many chilikeal did your mother give birth to, including you? CHECKg01: TWO OR MORE r--m ONLY ONE BIRTH BIRTHS ~ (RESPONDENT ONLY) How marry of these births did your mother have before you were born? CODING CATEGORIES NUMBER OF BIRTHS TO NATURAL MOTHER NUMBER OF PRECEDINO BIRTH~ . . . . . . . . . . . . . . . . ] ~! ~l !SKIp ,716 317 704 What was the name (4) (5) given to your oldest (next oldest) brother or s/ster? 705 Is (NAME) male or MALE 1 MALE i female? FEMALE . . . . . . . . . . . 2 FEMALE . . . . . . . . . . 2 706 Is (NAME) suit alive? 707 How old is (NAME) (1) (2) (3) MALE 1 MALE . 1 MALE 1 FEMALE . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 YES 1 NO 2 GO TO 7084 I DK . 8 GO TO [2], i 708 In wlmt year did (NAME) die? 709 How many years ago did (NAME) dio 710 How old was (NAME) when he/she died? 711 Was (NAME) pre@maat when she died? 6o TO [21 GOTO710" I YES NO. GO TO 708~ DE •** GO TO [3]4 Go TO [31 GO TO710, I 1 YES . . . 1 2 NO 2 I GO TO 708, I 8 DK . . . . . . . . . . . . . . . . 8 1 GO TO [414 I [ ] GO TO [4] GO TO710, I YES i NO 2 GO TO 708, I DK 8 GO TO [5]', I Go TO [51 GO TO710., I YES . . . . . . . . 1 NO 2 GO TO 708. I DK . . 8 GO TO [6]. I GO TO [61 GOTO710, I • DK . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 , DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . 98 IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [21 YES 1 CrO TO 714" I IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [31 YES GO TO 714, IF MALE OR DIED BEFOtLE 10 YEARS OF AGE GO TO [41 1 YES . I I GO TO714~ I IF MALE OR DIED BEFORE I0 YEARS OF AGE GO TO [5] YES . . 1 GOTO 714t I IF MALE OR DIED BEFORE i0 YEARS OF AGE c,o TO [61 YES 1 GO TO714, I .NO . 2 .NO . 2 .NO . 2 .NO . 2 .NO . 2 . 712 Did [NAME) die YES 1 YES 1 YES . . . 1 YES 1 YES . 1 during childlfirth? GOTO7154 I GOTO 7154 } GOTO 715, I GOTO715~ I GO TO7154 I • NO . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 , 713 Did (NAME) die YES 1 YES 1 YES . . . . 1 YES . . 1 YES . . . . . 1 within two months after I theendof~pregnancy NO . . 2 NO . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . 2 NO 2 I or childbirth? GOTO715, I GOTO 715, t GOTO 7154- ] GO TO 715., I GOTO 715, I 714 Was her death duo YES 1 YES 1 YES . 1 YES 1 YES I to eomplicatior~s of pre~laneyorehildbirth? . NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 . 715 l low many children di0(NAME givob to during her lifetime? GO TO [2] GO TO [31 GO TO [4] GO TO ]'5] GO TO [6] I F NO MORE BROTHERS OR S ISTERS, GO TO 716 318 704 What was the name (6) (7) (8) given to your oldest (next oldest) brother or sister? 705 Is (NAME) ma le or MALE 1 MALE 1 MALE . . . . 1 re,hale? • FEMALE . . . . . . . . . 2 . FEMALE . . . . . . . . . . . 2 , FEMALE . . . . . . . . . . . 2 706 Is (NAME) sti l l al ive? YES 1 NO . . . . . . . . 2 GO TO 7084 I YES NO GO TO 7084 DK . . . . . . . . . . . . . . 8 DK GO TO [7], I GO TO [814 707 How old is GO TO [71 GO TO [81 708 Itt what year did (NAME) die? GO TO 710, l GOTO 710, I 1 YES 2 NO I GO TO 7084 8 DK I GO TO [9 ] , GO TO [91 GO TO 7104 t (9) (10) MALE 1 MALE 1 FEMALE . . . . . . . . . . . 2 . FEMALE . . . . . . . . . . 2 1 YES 1 YES 1 2 NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 . I GO TO 7084 I GO TO 7084 I 8 DK 8 DK . . . 8 I GO TO [1014 ) GOTO [11] , I GO TO [10l OO TO [111 GOTO 7104 r GO TO 710., I • DK . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . 98 , 709 How many years 710 How old was (NAME) wheal he/she died7 711 Was (NAME) pregnant wheat she died? IF MALE OR D IED BEFORE 10 YEARS OF AGE GO TO [71 YES . . . . . . . . . . . . . 1 GO TO 7144 I 1F MALE OR D IED BEFORE 10 yEARS OF AGE GO TO [81 YES 1 GOTO714, I IF MALE OR D IED BEFORE 10 yEARS OF AGE GO TO [91 YES . . . 1 GOTO 7144 I IF MALE OR D IED BEFORE 10 YEARS OF AGE GO TO [101 YES GO T( )714 . , IF MALE OR D IED BEFORE 10 YEA I~ OF AGE GOTO [11] 1 YES . . . l I GOTO7144 I NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 , 712 Did (NAME) die YES I YES . . . . . . 1 YES . i YES 1 YES 1 during ckildbirth? GOTO 715, f GO TO715, f GOTO 7154 f GO TO715.~ I GO TO7154 r • NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 , NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 . 713 Did (NAME) die YES . . . . . . . . . . . . . I YES 1 YES . . . . . 1 YES 1 YES l wi th in two months a t~r the end o fa pregrmaey NO . . . . . . . . . . . . . . 2 NO 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . 2 or ehildbir&7 GO TO 715, I GOTO7154 I GOTOT15, I GOTO715. , I GOTO7154 I 714 Was her death due YES 1 YES 1 YES 1 YES 1 YES , 1 to complications of pre~nanoy or childbirth7 NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 . 715 How many children to dur~ her lifO.irae? GO TO [7] GO TO [8] GO TO [9] OO TO [10] GO TO [111 I F NO MORE BROTHERS OR S ISTERS) GO TO 716 319 704 What was the name given to your oldest (next oldest] brother or sister? 705 Is (NAME) male or female? 706 Is (NAME) still alive? 707 How old is (NAME) 708 Itx what year did (NAME) die? 709 How many years ago did (NAME) die 710 How old was (NAME) when he/she died? 711 Was (NAME) pregnant when she died7 (11) (12) (13) (14) (15) MALE 1 MALE 1 MALE . . . . . . . . . . . . . 1 MALE 1 MALE 1 FEMALE . . . . . . . . . 2 : FEMALE . . . . . . . . . . . 2 , FEMALE . . . . . . . . . . . 2 FEMALE . . . . . . . . . . . 2 FEMALE . . . . . . . . . . 2 YES 1 YES l YES . I YES 1 YES . . . . . . . . . . . . . . 1 NO 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 GO TO 708* I GO TO 708, I GO TO 708* I GO TO 708'* I GO TO 708. I DK 8 DK 8 DK . . . . . . . . 8 DK 8 DK . . 8 GO TO [12], I GO TO [13]* I GO TO [14]* I GOTO [15], I GO TO [12] GO TO [131 GO TO [14] GO TO [15] 19 ~ 19 ~ 19 ~ 19 ~ 19 GO TO 710, I GO TO 710, I GO TO 710. I GO TO 710, I GO TO 710. I • DK . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 9g . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . . 98 . DK . . . . . . . . . . . . . . 98 IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [12] IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [13] YES GO TO 714, 1 YES . . . . . . . . . . . . . . . 1 I GOTO714* I 713 Did (NAME) die YES 1 yES 1 within two months after the end of a pregaaaey NO or childbirth? GO TO 715'. 714 Was her death due YES to complications o f prcgnanoy or childbirth? . NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 1F MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [141 YES 1 GO T0714. I IF MALE OR DIED BEFORE 10 YEARS OF AGE . _ 9o ._To_v 5] YES 1 YES I GOTO714, I GO TO 714~ I IF MALE OR DIED BEFORE 10 YEARS OF AGE GO TO [716] • NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 712 Did (NAME) die YES 1 YES 1 YES . . . . 1 YES 1 YES 1 durlng ehildl~u'th? GOTO715~ I GOTO715~ I GO TO715~ I GOTO715~ I GO T0715~ I • NO . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 YES 1 YES . . . . 1 YES 1 NO . . . . . . . . . . . . . . . . 2 NO ' . . . . 2 GOTO 715, I GOTOTI5 , I YES 1 YES 1 NO . . . . . . . . . . . . . . . . 2 . NO . . . . . . . . . . . . . . . 2 2 NO . . . . . . . . . . . . . . . . 2 I GOTO7154 I I YES . . . . . . . . . . . . . . . I Go TO 031 NO . . . . . . . . . 2 GOTO 715, GO TO [15] " HOUR ::!! :::~ MINUTES . 715 How many children did (NAME) give birth [ ~ 1 10 during her lifetime? Go TO I121 716 RECORD THE T/ME (END OF INTERVIEW) NO . . . . . . . . . . . . . . . . :2 Go TO [14] 320 Comments about Respondent: INTERVIEWER'S OBSERVATIONS To be filled in alter completing interview CoIlxmcttt~ ON Speeifio Quoations: Any other Comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Namo of Editor: Date: 321 Front Matter Title Page Citation Page Table of Contents List of Tables List of Figures Foreword Acknowledgments Executive Summary Map of Nigeria Chapter 01 - Introduction Chapter 02 - Characteristics of Households and Respondents Chapter 03 - Fertility Chapter 04 - Fertility Regulation Chapter 05 - Other Proximate Determinants of Fertility Chapter 06 - Fertility Preferences Chapter 07 - Infant and Child Mortality Chapter 08 - Maternal and Child Health Chapter 09 - Maternal and Child Nutrition Chapter 10 - Female Genital Cutting Chapter 11 - Sexual Activity and Knowledge of Sexually Transmitted Diseases Chapter 12 - Availability of Health and Family Planning Services Chapter 13 - Policy Implications of Data from The NDHS References Appendix A - Sample Design Appendix B - Estimates of Sampling Errors Appendix C - Analysis of Data Quality Appendix D - Persons Involved in The 1999 Nigeria Demographic and Health Survey Appendix E - Questionnaires Service Availability Questionnaire Household Questionnaire Individual Questionnaire for Women Individual Questionnaire for Men

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