Nigeria - Demographic and Health Survey - 2004

Publication date: 2004

Nigeria Demographic and Health Survey 2003 Nigeria Demographic and Health Survey 2003 National Population Commission Federal Republic of Nigeria ORC Macro Calverton, Maryland, USA April 2004 National Population Commission ORC Macro U.S. Agency for International Development This report summarizes the findings of the 2003 Nigeria Demographic and Health Survey (2003 NDHS), which was conducted by the National Population Commission of the Federal Republic of Nigeria. ORC Macro provided technical assistance. Funding was provided by the U.S. Agency for international development (USAID). This publication was made possible through support provided by the U.S. Agency for International Development under the terms of Contract No. HRN-C-00-97-00019-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. Additional information about the 2003 NDHS may be obtained from the headquarters of the National Population Commission, Plot 2031, Olusegun Obasanjo Way, Zone 7 Wuse, PMB 0281, Abuja, Nigeria; Telephone: (234) 09 523- 9173, Fax: (234) 09 523-1024. Additional information about the DHS project may be obtained from ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705; Telephone: 301-572-0200, Fax: 301-572-0999, Internet: www.measuredhs.com. Recommended citation: National Population Commission (NPC) [Nigeria] and ORC Macro. 2004. Nigeria Demographic and Health Survey 2003. Calverton, Maryland: National Population Commission and ORC Macro. Contents | iii CONTENTS Page Tables and Figures . ix Message from the Vice President . xv Message from the Chairman . xvii Preface . xix Acknowledgments . xxi Summary of Findings . xxiii Map of Nigeria . xviii CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy of Nigeria .1 1.2 Population and Basic Demographic Indicators .3 1.3 Population and Health Policies and Programmes .4 1.4 Education .7 1.5 Organization and Objectives of the 2003 Nigeria Demographic and Health Survey.7 1.6 Response Rates.10 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age, Sex, and Residence .11 2.2 Household Composition .12 2.3 Educational Attainment.13 2.4 Household Characteristics .19 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3.1 Characteristics of Survey Respondents .23 3.2 Educational Attainment by Background Characteristics .23 3.3 Access to Mass Media .28 3.4 Employment .30 3.5 Measures of Women’s Empowerment.37 CHAPTER 4 FERTILITY 4.1 Current Fertility .51 4.2 Fertility Differentials.53 4.3 Fertility Trends.54 iv | Contents 4.4 Children Ever Born and Living .55 4.5 Birth Intervals .56 4.6 Age at First Birth .58 4.7 Teenage Pregnancy and Motherhood .59 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods .61 5.2 Ever Use of Contraception .64 5.3 Current Use of Contraception.66 5.4 Number of Children at First Use of Contraception .70 5.5 Knowledge of Fertile Period.70 5.6 Source of Contraception.71 5.7 Informed Choice .72 5.8 Future Use of Contraception.73 5.9 Exposure to Family Planning Messages.75 5.10 Contact of Nonusers with Family Planning Providers.78 5.11 Discussion of Family Planning with Husband .79 5.12 Attitudes Toward Family Planning.80 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .83 6.2 Polygyny.84 6.3 Age at First Marriage .86 6.4 Age at First Sexual Intercourse .87 6.5 Recent Sexual Activity.89 6.6 Postpartum Amenorrhoea, Abstinence, and Insuseptibility .92 6.7 Menopause .93 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children.95 7.2 Desire to Limit Childbearing .96 7.3 Need for Family Planning .98 7.4 Ideal Number of Children. 101 7.5 Ideal Number of Children by Background Characteristics. 102 7.6 Wanted and Unwanted Fertility. 104 7.7 Wanted Fertility Rates. 105 7.8 Ideal Number of Children and Unmet Need by Women’s Status . 105 CHAPTER 8 8.1 Data Quality Assessment. 107 8.2 Levels . 108 Contents | v 8.3 Comparison of Infant Mortality Rates with Previous Demographic and Health Surveys . 108 8.4 Socioeconomic Differentials in Childhood Mortality . 110 8.5 Demographic Differentials in Childhood Mortality . 111 8.6 Mortality Differentials by Women’s Status. 112 8.7 High-Risk Fertility Behaviour. 113 CHAPTER 9 MATERNAL AND CHILD HEALTH 9.1 Antenatal Care. 115 9.1.1 Number and Timing of ANC Visits . 115 9.1.2 Components of ANC . 118 9.1.3 Tetanus Toxoid. 119 9.2 Place of Delivery . 121 9.2.1 Assistance during Delivery . 122 9.2.2 Delivery Characteristics . 123 9.3 Postnatal Care . 125 9.4 Reproductive Health Care by Women’s Status. 126 9.5 Vaccination of Children . 128 9.5.1 Vaccination by Background Characteristics . 129 9.5.2 Vaccination in the First Year of Life. 130 9.6 Acute Respiratory Infection and Fever. 131 9.7 Household Hygiene. 133 9.7.1 Presence of Materials for Washing Hands . 133 9.7.2 Disposal of Children’s Stools. 134 9.8 Diarrhoea . 134 9.8.1 Knowledge of ORS Packets. 136 9.8.2 Diarrhoea Treatment . 136 9.8.3 Feeding Practices During Diarrhoea. 137 9.9 Children Health Care by Women’s Status . 138 9.10 Perceived Problems in Accessing Health Care. 139 9.11 Use of Smoking Tobacco . 141 CHAPTER 10 MALARIA 10.1 Mosquito Nets . 143 10.2 Antimalarial Drug Use During Pregnancy . 146 10.3 Treatment of Children with Fever or Convulsions. 148 vi | Contents CHAPTER 11 INFANT FEEDING AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS 11.1 Breastfeeding. 151 11.1.1 Age Pattern of Breastfeeding. 153 11.1.2 Duration and Frequency of Breastfeeding. 154 11.2 Types of Food Consumed by Children . 156 11.3 Micronutrient Supplementation . 159 11.3.1 Use of Iodized Salt in Households . 159 11.3.2 Micronutrient Status of Young Children . 160 11.3.3 Micronutrient Intake Among Women . 162 11.4 Nutritional Status of Children. 163 11.5 Nutritional Status of Women . 166 CHAPTER 12 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 12.1 Knowledge of Ways to Avoid HIV/AIDS . 169 12.2 Beliefs about AIDS. 172 12.3 Stigma and Discrimination . 174 12.4 Knowledge of Mother-to-Child Transmission. 177 12.5 HIV Testing and Counselling . 178 12.6 Sexual Negotiation, Attitudes, and Communication . 179 12.7 High-Risk Sex and Condom Use . 182 12.8 Sexual Behaviour among Young People . 186 12.9 Sexually Transmitted Infections. 193 12.10 Orphanhood . 197 CHAPTER 13 FEMALE CIRCUMCISION 13.1 Knowledge and Prevalence of Female Circumcision. 201 13.2 Flesh Removal and Infibulation . 201 13.3 Age at Circumcision. 202 13.4 Circumcision of Daughters. 203 13.5 Attitudes toward Female Circumcision. 205 13.6 Reasons for Supporting Female Circumcision. 207 13.7 Reasons for Not Supporting Female Circumcision . 208 REFERENCES . 209 APPENDIX A SAMPLE DESIGN . 211 Contents | vii APPENDIX B SAMPLING ERRORS . 217 APPENDIX C DATA QUALITY TABLES. 231 APPENDIX D 2003 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY PERSONNEL . 237 APPENDIX E QUESTIONNAIRES . 243 APPENDIX F WORLD SUMMIT FOR CHILDREN INDICATORS . 333 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators. 3 Table 1.2 Results of the household and individual interviews . 10 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 11 Table 2.2 Household composition. 13 Table 2.3 Educational attainment of household population . 14 Table 2.4 School attendance ratios. 17 Table 2.5 Grade repetition and dropout rates. 18 Table 2.6 Household characteristics . 20 Table 2.7 Household durable goods. 21 Figure 2.1 Population pyramid . 12 Figure 2.2 Age-specific attendance rates. 15 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS Table 3.1 Background characteristics of respondents . 24 Table 3.2 Educational attainment by background characteristics. 25 Table 3.3 Literacy. 27 Table 3.4.1 Exposure to mass media: women. 29 Table 3.4.2 Exposure to mass media: men . 30 Table 3.5.1 Employment status: women. 31 Table 3.5.2 Employment status: men . 32 Table 3.6.1 Occupation: women. 34 Table 3.6.2 Occupation: men . 35 Table 3.7.1 Type of employment: women. 36 Table 3.7.2 Type of employment: men . 36 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures. 38 Table 3.9 Women’s control over earnings . 39 Table 3.10 Women’s participation in decisionmaking . 40 Table 3.11.1 Women’s participation in decisionmaking by background characteristics: women . 41 Table 3.11.2 Women’s participation in decisionmaking by background characteristics: men . 43 Table 3.12.1 Women’s attitude toward wife beating . 45 Table 3.12.2 Men’s attitude toward wife beating. 46 Table 3.13.1 Women’s attitutde toward refusing sex with husband . 48 x | Tables and figures Table 3.13.2 Men’s attitude toward wife refusing sex with husband . 49 Figure 3.1 Employment status of women and men . 33 Figure 3.2 Type of earnings of employed women and men . 37 Figure 3.3 Number of decisions in which women participate in the final say . 43 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 51 Table 4.2 Fertility by background characteristics. 53 Table 4.3 Trends in age-specific fertility rates . 54 Table 4.4 Children ever born and living. 56 Table 4.5 Birth intervals. 57 Table 4.6 Age at first birth . 58 Table 4.7 Median age at first birth by background characteristics. 59 Table 4.8 Teenage pregnancy and motherhood . 60 Figure 4.1 Age-specific fertility rates, by residence. 52 Figure 4.2 Total fertility rate by region . 54 Figure 4.3 Trends in total fertility rates. 55 CHAPTER 5 FAMILY PLANNING Table 5.1.1 Knowledge of contraceptive methods: women . 62 Table 5.1.2 Knowledge of contraceptive methods: men . 63 Table 5.2 Knowledge of contraceptive methods by background characteristics. 64 Table 5.3.1 Ever use of contraception: women. 65 Table 5.3.2 Ever use of contraception: men . 66 Table 5.4 Current use of contraception . 67 Table 5.5 Current use of contraception by background characteristics . 68 Table 5.6 Current use of contraception by women’s status . 69 Table 5.7 Number of children at first use of contraception . 70 Table 5.8 Knowledge of fertile period. 71 Table 5.9 Source of contraception. 71 Table 5.10 Informed choice . 73 Table 5.11 Future use of contraception . 74 Table 5.12 Reasons for not intending to use contraception. 74 Table 5.13 Preferred method of contraception for future use . 75 Table 5.14.1 Exposure to family planning messages: women . 76 Table 5.14.2 Exposure to family planning messages: men. 77 Table 5.15 Contact of nonusers with family planning providers . 79 Table 5.16 Discussion of family planning with husband. 80 Table 5.17 Attitudes of couples toward family planning. 81 Figure 5.1 Current use of any contraceptive method among currently married women age 15-49, by background characteristics . 68 Figure 5.2 Source of family planning methods among current users of modern methods . 72 Figure 5.3 Percentage of women and men exposed to family planning messages. 78 Tables and Figures | xi CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status. 83 Table 6.2 Polygyny. 85 Table 6.3 Age at first marriage . 86 Table 6.4 Median age at first marriage. 87 Table 6.5 Age at first sexual intercourse. 88 Table 6.6 Median age at first intercourse . 89 Table 6.7.1 Recent sexual activity: women. 90 Table 6.7.2 Recent sexual activity: men . 91 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility . 92 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 93 Table 6.10 Menopause . 93 Figure 6.1 Percentage of married men with two or more wives, by region . 85 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children. 96 Table 7.2 Desire to limit childbearing by background characteristics . 97 Table 7.3 Need for family planning among currently married women. 99 Table 7.4 Need for family planning among all women and among women who are not currently married . 100 Table 7.5 Ideal number of children . 102 Table 7.6 Mean ideal number of children by background characteristics . 103 Table 7.7 Fertility planning status . 104 Table 7.8 Wanted fertility rates . 105 Table 7.9 Ideal number of children and unmet need for family planning by women’s status . 106 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates. 108 Table 8.2 Comparison of infant mortality rates from the 2003 NDHS and the 1990 NDHS . 109 Table 8.3 Early childhood mortality rates by background characteristics . 110 Table 8.4 Early childhood mortality rates by demographic characteristics . 111 Table 8.5 Early childhood mortality by women’s status indicators . 112 Table 8.6 High-risk fertility behaviour. 114 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care . 116 Table 9.2 Number of antenatal care visits and timing of first visit . 117 Table 9.3 Antenatal care content. 119 Table 9.4 Tetanus toxoid injections . 120 Table 9.5 Place of delivery . 121 Table 9.6 Assistance during delivery . 123 Table 9.7 Delivery characteristics . 124 Table 9.8 Postnatal care by background characteristics. 126 Table 9.9 Reproductive health care by women’s status. 127 Table 9.10 Vaccinations by source of information . 128 Table 9.11 Vaccinations by background characteristics. 130 xii | Tables and figures Table 9.12 Vaccinations in first year of life. 131 Table 9.13 Prevalence and treatment of symptoms of ARI and fever.132 Table 9.14 Hand-washing materials in the household.133 Table 9.15 Disposal of child’s stools .134 Table 9.16 Prevalence of diarrhoea .135 Table 9.17 Knowledge of ORS packets .136 Table 9.18 Diarrhoea treatment .137 Table 9.19 Feeding practices during diarrhoea .138 Table 9.20 Child health care by women’s status .139 Table 9.21 Problems in accessing health care .140 Table 9.22 Use of smoking tobacco.142 Figure 9.1 Number of antenatal care visits .117 Figure 9.2 Problems in accessing health care .141 CHAPTER 10 MALARIA Table 10.1 Ownership of mosquito nets. 144 Table 10.2 Use of mosquito nets by children. 145 Table 10.3 Use of mosquito nets by pregnant women . 146 Table 10.4 Use of intermittent preventive treatment (IPT) by pregnant women. 147 Table 10.5 Use of specific drugs for intermittent preventive treatment. 148 Table 10.6 Prevalence and prompt treatment of fever/convulsions . 149 Table 10.7 Type and timing of antimalarial drugs . 150 CHAPTER 11 INFANT FEEDING AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS Table 11.1 Initial breastfeeding .152 Table 11.2 Breastfeeding status by child’s age .154 Table 11.3 Median duration and frequency of breastfeeding.155 Table 11.4 Foods consumed by children in the day or night preceding the interview .157 Table 11.5 Frequency of foods consumed by children in the day or night preceding the interview .158 Table 11.6 Frequency of foods consumed by children in preceding seven days .159 Table 11.7 Iodization of household salt .160 Table 11.8 Micronutrient intake among children .161 Table 11.9 Micronutrient intake among mothers .163 Table 11.10 Nutritional status of children.165 Table 11.11 Nutritional status of women by background characteristics.167 Figure 11.1 Median duration of breastfeeding by background characteristics. 156 Figure 11.2 Prevalence of stunting among children under five years by region and mother’s education. 164 CHAPTER 12 AIDS/HIV/STI-RELATED KNOWLEDGE AND BEHAVIOUR Table 12.1 Knowledge of aIDS . 170 Table 12.2 Knowledge of HIV prevention methods . 171 Table 12.3.1 Beliefs about AIDS: women . 173 Table 12.3.1 Beliefs about AIDS: men. 174 Table 12.4.1 Accepting attitudes towards those living with HIV: women . 175 Table 12.4.2 Accepting attitudes towards those living with HIV: men . 176 Tables and Figures | xiii Table 12.5 Knowledge of prevention of mother-to-child transmission of HIV. 177 Table 12.6 Population who had an HIV test and received test results . 178 Table 12.7 Pregnant women counselled about HIV. 179 Table 12.8 Attitudes toward negotiating safer sex with husband . 180 Table 12.9 Men’s attitude toward condoms . 181 Table 12.10 Discussion of HIV/AIDS with partner . 182 Table 12.11 High-risk sex and condom use at last high-risk sex: women and men age 15-49 . 183 Table 12.12 High-risk sex and condom use at last high-risk sex among young women and men by background characteristics. 184 Table 12.13 Paid sex in past year . 186 Table 12.14 Age at first sex among young women and men . 187 Table 12.15 Knowledge of a source for condoms among young women and men . 188 Table 12.16 Condom use at first sex among young women and men . 189 Table 12.17 Prevalence of premarital sex in the past year and use of a condom during premaritl sex among young women and men. 190 Table 12.18 Age mixing in sexual relationships. 191 Table 12.19 Multiple sex partnerships among young women and men. 192 Table 12.20.1 Knowledge of symptoms of STIs: women. 194 Table 12.20.2 Knowledge of symptoms of STIs: men. 195 Table 12.21 Self-reporting of sexually transmitted infection (STI) and STI symptoms . 196 Table 12.22 Women and men seeking treatment for STIs. 197 Table 12.23 Orphanhood and children’s living arrangements . 198 Table 12.24 Schooling of children 10-14 by orphanhood and living arrangements . 199 Figure 12.1 High-risk sex among cohabiting and noncohabiting young women and men. 185 Figure 12.2 Abstinence, being faithful, and using condoms among young women and men. 193 CHAPTER 13 FEMALE CIRCUMCISION Table 13.1 Knowledge and prevalence of female circumcison. 202 Table 13.2 Age at circumcision . 203 Table 13.3 Daughter’s circumcision experience and type of circumcision. 204 Table 13.4 Aspects of daughter’s circumcision. 205 Table 13.5.1 Attitutdes toward female circumcision: women. 206 Table 13.5.2 Attitutdes toward female circumcision: men . 207 Table 13.6 Perceived benefits of undergoing female circumcision . 208 Table 13.7 Reasons for not supporting female circumcision. 208 APPENDIX A SAMPLE DESIGN Table A.1 Allocation of the sample . 212 Table A.2 Sample implementation: women . 214 Table A.5 Sample implementation: men. 215 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 220 Table B.2 Sampling errors for national sample . 221 Table B.3 Sampling errors for urban sample. 222 Table B.4 Sampling errors for rural sample. 223 xiv | Tables and figures Table B.5 Sampling errors for North Central sample . 224 Table B.6 Sampling errors for North East sample. 225 Table B.7 Sampling errors for North West sample. 226 Table B.8 Sampling errors for South East sample. 227 Table B.9 Sampling errors for South South sample. 228 Table B.10 Sampling errors for South West sample. 229 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 231 Table C.2.1 Age distribution of eligible and interviewed women. 232 Table C.2.2 Age distribution of eligible and interviewed men . 232 Table C.3 Completeness of reporting . 233 Table C.4 Births by calendar years . 233 Table C.5 Reporting of age at death in days . 234 Table C.6 Reporting of age at death in months . 235 Message from the Vice President | xv MESSAGE FROM THE VICE PRESIDENT In the past, demographic data required for meaningful development planning was scarce and scanty. The present administration, in its efforts to ensure the production of adequate, reliable and timely demographic data, will continue to support the conduct of surveys and population censuses periodically. The implementation of the 2003 Nigeria Demographic and Health Survey (2003 NDHS) further shows the renewed effort of government to alleviate poverty and to resolve related health problems with the goal of overall improvement in the quality of life in Nigeria. Nigeria’s commitment to population and reproductive health issues is of paramount concern to the government, and efforts will continue to be strengthened so as to ensure that the set objectives are achieved and realized. Information provided in this report should be fully utilized by all at the three tiers of government to ensure success in the health sector. I commend USAID for the generous support provided for the study and urge the National Population Commission to continue its effort to generate additional demographic data required for meaningful planning and development. His Excellency Atiku Abubakar (Turakin Adamawa) Vice President Federal Republic of Nigeria Abuja Message from the Chairman | xvii MESSAGE FROM THE CHAIRMAN I am delighted to present the final report of the 2003 Nigeria Demographic and Health Survey (2003 NDHS). The 2003 NDHS is the latest in the periodic Demographic and Health Survey (DHS) series, which started in Nigeria at the national level in 1990. The surveys are designed to measure levels, patterns, and trends of demographic and health indicators. This report, which is a sequel to the prelimi- nary report that was produced in October of last year, is more detailed and comprehensive. The success of the 2003 NDHS was made possible by the support and collaboration of a number of organizations and individuals. In this connection, I wish to acknowledge the assistance of the United States Agency for International Development (USAID/Nigeria), which provided the funding for the sur- vey. I also wish to express appreciation to ORC Macro for its technical assistance in all the stages of the survey. The National Population Commission remains grateful to other development partners, especially the Department for International Development (DFID), United Nations Population Fund (UNFPA), and UNICEF for their supportive roles. Finally, I wish to commend the report of the 2003 NDHS to policymakers, programme administrators and researchers. The text and the tables have been presented in a user-friendly manner and I hope end-users will avail themselves of this vital information. Chief S. D. Makama (Ubandoman Pyem) Chairman National Population Commission Abuja Preface | xix PREFACE The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the third national Demo- graphic and Health Survey (DHS) in a series under the worldwide Demographic and Health Surveys pro- gramme. The first Nigeria DHS survey was conducted in 1990. Funding for the 2003 NDHS survey was provided by the U.S. Agency for International Development (USAID/Nigeria), while technical assistance was provided by ORC Macro. The United Nations Population Fund (UNFPA) and United Nations Chil- dren’s Fund (UNICEF) also provided logistical support. Fieldwork for the survey took place between March and September 2003 in selected clusters nationwide. The major objective of the 2003 NDHS, which is a follow-up to the 1999 NDHS, is to obtain and provide information on fertility, fertility preferences, use and knowledge of family planning methods, ma- ternal and childhood health, maternal and childhood mortality, breastfeeding practices, nutrition, knowl- edge of HIV/AIDS, and other health issues. Compared with the 1999 NDHS, the 2003 NDHS has a wider scope. For example, unlike the 1999 survey, the 2003 survey includes a module on malaria and another on testing for salt. In addition, the 2003 data are geo-referenced to allow for more detailed geo- graphical analysis. Other innovations of the 2003 NDHS include the concurrent processing of data even as fieldwork was ongoing. This innovation served a dual purpose by facilitating field checks for errors and hastening the process of data entry and analysis. As may be expected, the findings of the 2003 NDHS are more comprehensive than findings for the two previous DHS surveys conducted in the country. Indeed, the production of the survey report within nine months after the completion of fieldwork is unprecedented, making the findings the most timely and up to date. The enforcement of standards and consistency and a response rate of more than 90 percent also make the findings very reliable. In addition to presenting national estimates, the report provides estimates of key indicators of fer- tility, mortality, and health for rural and urban areas in Nigeria and for the six geo-political zones. Over- all, the report provides information on a number of key topics to guide planners, policymakers, pro- gramme managers and researchers in the planning, implementation, monitoring, and evaluation of popula- tion and health programmes in Nigeria. Highlights of the 2003 NDHS indicate on the one hand a national total fertility rate of 5.7, and on the other hand, a national infant mortality rate of 100 deaths per 1,000 live births and an under-five mor- tality rate of 203 deaths per 1,000 live births. The gap between knowledge and use of family planning methods is still wide. Knowledge of HIV/AIDS remains high. The unprecedented success of the 2003 NDHS was made possible by the contributions of a num- ber of organizations and individuals. I wish to acknowledge the support of USAID/Nigeria for funding the survey. Similarly, I appreciate ORC Macro’s technical support in the design and implementation of the survey. The personal commitment of the ORC Macro Country Manager, Ms. Holly Newby, and her colleagues is particularly remarkable and is very much appreciated. I also acknowledge and appreciate the logistics support provided by other development partners, especially the UNFPA, DFID, and UNICEF. The 2003 NDHS witnessed the support and collaboration of other stakeholders such as the Federal Ministry of Health. Their contributions are very much appreciated. xx | Preface As the National Population Commission continues with its efforts to ensure the availability and dissemination of up to date and reliable demographic and health data, it is hoped that end users will make use of the available information for programme evaluation and for socio-economic planning. Dr. A. O. Akinsanya Director-General National Population Commission Acknowledgments | xxi ACKNOWLEDGMENTS In the recent past, adequate, timely and reliable data in Nigeria have been scarce and very limited for planning and socio-economic development. The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the latest in the series of DHS surveys conducted in Nigeria and provides indicators for the strategic management and monitoring of socio-economic activities including health programmes. The 2003 NDHS was designed to provide data to monitor the population and health situation in Nigeria. Specifically, the 2003 NDHS collected information on fertility levels and preferences, awareness and use of family planning methods, maternal and child health, breastfeeding practices, nutritional status of mothers and young children, childhood mortality, use of bed nets, female genital cutting, marriage, sexual activity, and awareness and behaviour regarding AIDS and other sexually transmitted infections. On behalf of the Commission, I gratefully acknowledge the support of the United States Agency for International Development (USAID/Nigeria) in providing funds to cover the cost of the 2003 NDHS. The technical support provided by ORC Macro played a key role during the implementation period. Wor- thy of mention is Ms. Holly Newby, the ORC Macro Country Manager who worked tirelessly during the period. Her efforts are greatly appreciated. Mr. Albert Themme and Ms. Elizabeth Britton handled data processing of the NDHS marvelously and in record time. Their efforts deserve our appreciation and grati- tude. I wish to commend the efforts of Dr. Alfredo Aliaga, the Sampling Specialist at ORC Macro, who provided technical support during the sample selection exercise. Other ORC Macro officials, such as Ms. Anne Cross, Dr. Fern Greenwell and Ms. Arlinda Zhuzhuni, deserve our deep appreciation for their con- tributions at different stages of the 2003 NDHS implementation. In the area of logistics, we acknowledge with gratitude the support of United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and Department for International Develop- ment (DFID). The Chairman of the Commission and his team of Federal Commissioners greatly assisted during the implementation period by providing excellent leadership and advocacy support. The unflinching sup- port and technical assistance provided by the Director-General and all Directors is hereby acknowledged. The U.N. Chief Technical Adviser, Prof. G.B. Fosu, took pains in providing technical support, including the review of the report, and his efforts are highly appreciated. During the implementation period of the survey, the core team—also referred to as Zonal Coordinators—worked tirelessly and their efforts are hereby acknowledged. The survey could not have been conducted in such a timely and successful fashion without the commitment of the entire field staff of the 2003 NDHS. The entire data processing staff is also commended for their important role in the timely processing of the data. A number of organizations rendered immense support during the implementation stage including the Federal Ministry of Health, the National Action Committee on AIDS, and the National Programme on Immunization. Some members of academia in various Nigerian universities served as resource persons during the report writing exercise. Their useful contributions and commitment are commendable and hereby acknowledged. xxii | Acknowledgments Finally, our special gratitude goes to all the households, men, and women who were selected and who responded very well during the survey; without their participation and support, this project would have been a failure. Our appreciation goes to the entire people of Nigeria for their understanding and for making possible an enabling environment conducive to the conduct of this very important survey. Samuel A. Ogunlade Project Director National Population Commission Summary of Findings | xxiii SUMMARY OF FINDINGS The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the third national Demographic and Health Survey conducted in Nigeria. The 2003 NDHS is based on a nation- ally representative sample of over 7,000 house- holds. All women age 15-49 in these households and all men age 15-59 in a subsample of one- third of the households were individually inter- viewed. The survey provides up-to-date infor- mation on the population and health situation in Nigeria. Specifically, the 2003 NDHS collected information on fertility levels and preferences, awareness and use of family planning methods, maternal and child health, breastfeeding prac- tices, nutritional status of women and young children, childhood mortality, use of bed nets, female genital cutting, marriage, sexual activity, and awareness and behaviour regarding AIDS and other sexually transmitted infections in Ni- geria. The National Population Commission con- ducted the survey, which was in the field from March to August 2003. ORC Macro, though the MEASURE DHS+ project, provided technical support. The U.S. Agency for International De- velopment (USAID)/Nigeria funded the survey. Other development partners, including the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and Department for International Development (DFID), also provided support for the survey. FERTILITY Fertility Levels, Trends, and Preferences. The total fertility rate (TFR) in Nigeria is 5.7. This means that at current fertility levels, the av- erage Nigerian woman who is at the beginning of her childbearing years will give birth to 5.7 children by the end of her lifetime. Compared with previous national surveys, the 2003 survey shows a modest decline in fertility over the last two decades: from a TFR of 6.3 in the 1981-82 National Fertility Survey (NFS) to 6.0 in the 1990 NDHS to 5.7 in the 2003 NDHS. How- ever, the 2003 NDHS rate of 5.7 is significantly higher than the 1999 NDHS rate of 5.2. Analysis has shown that the 1999 survey underestimated the true levels of fertility in Nigeria. On average, rural women will have one more child than urban women (6.1 and 4.9, respectively). Fertility varies considerably by region of residence, with lower rates in the south and higher rates in the north. Fertility also has a strong negative correlation with a woman’s educational attainment. Most Nigerians, irrespective of their number of living children, want large families. The ideal num- ber of children is 6.7 for all women and 7.3 for cur- rently married women. Nigerian men want even more children than women. The ideal number of children for all men is 8.6 and for currently married men is 10.6. Clearly, one reason for the slow decline in Nigerian fertility is the desire for large families. Birth Intervals. A 36-month interval between deliveries is best for mother and child; longer birth intervals also contribute to reduction in overall lev- els of fertility. The median birth interval in Nigeria is 31 months, which is close to the optimal interval. The median interval is lowest among mothers age 15-19 (26 months) and highest among mothers age 40-49 (39 months). While there is no difference in birth intervals between urban and rural women, birth intervals do vary considerably by region of resi- dence. Women in the South West have the longest median birth interval (37 months) and women in the South East have the shortest median birth interval (27 months), a difference of almost one year. Initiation of Sexual Behaviour and Child- bearing at Young Ages. One-third of women age 25-49 reported that they had had sexual intercourse by age 15. By age 20, more than three-quarters of women, and by age 25, nine in ten women have had sexual intercourse. One-quarter of teenage women has given birth or is pregnant. Early childbearing is more of a rural phenomenon, with 30 percent of ru- ral women age 15-19 having begun childbearing compared with 17 percent of urban women in the same age group. Overall, median age at first birth is increasing. Whereas median age at first birth is less than 19 years among women over age 35, it is 20.3 years among women age 25-29. xxiv | Summary of Findings FAMILY PLANNING Knowledge of Family Planning Methods. About eight in ten women and nine in ten men know at least one modern method of family planning. The pill, injectables, and the male condom are the most widely known modern methods among both women and men. Mass media is an important source of information on family planning. Radio is the most frequent source of family planning messages: 40 percent of women and 56 percent of men say they heard a radio message about family planning during the months preceding the survey. However, more than half of women (56 percent) and 41 percent men were not exposed to family plan- ning messages from a mass media source. Current Use. A total of 13 percent of cur- rently married women are using a method of family planning, including 8 percent who are us- ing a modern method. The most common mod- ern methods are the pill, injectables, and the male condom (2 percent each). Urban women are more than twice as likely as rural women to use a method of contraception (20 percent versus 9 percent). Contraceptive use varies significantly by region. For example, one-third of married women in the South West use a method of con- traception compared with just 4 percent of women in the North East and 5 percent of women in the North West. Source of Family Planning Methods. Fifty-eight percent of users get their contracep- tive methods from private health care providers, more than twice as many as get them from the public sector (23 percent). The private sector is the most common source for the pill (74 percent) and male condoms (59 percent). Provision of in- jectables for current users is shared equally by the private sector and the public sector (48 per- cent each). Unmet Need for Family Planning. While most women want large families, there is a mi- nority who want to limit their family size or wait a period of time before having their next birth but are not using contraception. Seventeen per- cent of currently married women are in these two categories and have an unmet need for fam- ily planning. Information on contacts of nonusers with fam- ily planning providers is important for determining whether family planning initiatives are effective or not. During the year preceding the survey, 4 percent of nonusers reported that they were visited by a fam- ily planning service provider at home; 6 percent of nonusers visited a health facility and discussed fam- ily planning with a provider; and 24 percent of non- users who visited a health facility did not discuss family planning. This is an indication of missed op- portunities for increasing family planning accep- tance and use. CHILD HEALTH Mortality. The 2003 NDHS survey estimates infant mortality to be 100 per 1,000 live births for the 1999-2003 period. This infant mortality rate is significantly higher than the estimates from both the 1990 and 1999 NDHS surveys; the earlier surveys underestimated mortality levels in certain regions of the country, which in turn biased downward the na- tional estimates. Thus, the higher rate from the 2003 NDHS is more likely due to better data quality than an actual increase in mortality risk overall. The rural infant mortality rate (121 per 1,000) is considerably higher than the urban rate (81 per 1,000), due in large part to the difference in neonatal mortality rates. As in other countries, low maternal education, a low position on the household wealth index, and shorter birth intervals are strongly associ- ated with increased mortality risk. The under-five mortality rate for the 1999-2003 period was 201 per 1,000. Vaccinations. Only 13 percent of Nigerian children age 12-23 months can be considered fully vaccinated, that is, have received BCG, measles, and three doses each of DPT and polio vaccine (exclud- ing the polio vaccine given at birth). This is the low- est vaccination rate among African countries in which DHS surveys have been conducted since 1998. Less than half of children have received each of the recommended vaccinations, with the excep- tion of polio 1 (67 percent) and polio 2 (52 percent). More than three times as many urban children as ru- ral children are fully vaccinated (25 percent and 7 percent, respectively). WHO guidelines are that children should complete the schedule of recom- mended vaccinations by 12 months of age. In Nige- ria, however, only 11 percent of children age 12–23 Summary of Findings | xxv months received all of the recommended vacci- nations before their first birthday. Childhood Illness. In the two weeks pre- ceding the survey, 10 percent of children experi- enced symptoms of acute respiratory infection (ARI), and 31 percent had a fever. Among chil- dren who experienced symptoms of ARI or fe- ver, almost one-third (31 percent) sought treat- ment from a health facility or health care pro- vider. Approximately one-fifth of children had di- arrhoea in the two weeks preceding the survey. Twenty-two percent of mothers reported that their children with diarrhoea were taken to a health provider. Overall, 40 percent received oral rehydration salts (ORS), recommended home fluids (RHF), or increased fluids. Less than one-fifth of children (18 percent) were given a solution made from ORS, despite the fact that 65 percent of mothers say they know about ORS packets. Although 20 percent of mothers said they gave their sick child more liq- uids than usual to drink, 38 percent of mothers said they curtailed fluid intake. NUTRITION Breastfeeding. Breastfeeding is almost uni- versal in Nigeria, with 97 percent of children born in the five years preceding the survey hav- ing been breastfed. However, just one-third of children were given breast milk within one hour of birth (32 percent), and less than two-thirds were given breast milk within 24 hours of birth (63 percent). Overall, the median duration of any breastfeeding is 18.6 months, while the median duration of exclusive breastfeeding is only half a month. Complementary Feeding. At age 6-9 months, the recommended age for introducing complementary foods, three-quarters of breast- feeding infants received solid or semisolid foods during the day or night preceding the interview; 56 percent received food made from grains, 25 percent received meat, fish, shellfish, poultry or eggs, and 24 percent received fruits or vegeta- bles. Fruits and vegetables rich in vitamin A were consumed by 20 percent of breastfeeding infants age 6-9 months. Nutritional Status of Children. Overall, 38 percent children are stunted (short for their age), 9 percent of children are wasted or thin (low weight- for-height), and 29 percent of children are under- weight (low weight-for-age). Generally, children who live in rural areas or in the north and children of uneducated mothers are significantly more likely to be undernourished than other children. The children in the North West are particularly disadvantaged— one-third are severely stunted, which reflects exten- sive long-term malnutrition in the region. Nutritional Status of Women. The mean body mass index (BMI) of Nigerian women is 22.3, which falls well within the internationally accepted normal range (between 18.5 and 24.9). Almost two-thirds of women (64 percent) have BMIs falling in the normal range; 15 percent are thin, including 2 percent who are severely thin. The youngest women are the most likely of all the population subgroups to be thin; one-quarter of women age 15-19 have a BMI of less than 18.5. One-fifth of Nigerian women weigh more than they should: 15 percent are overweight and 6 percent are obese. The likelihood of being over- weight or obese increases with age. WOMEN’S HEALTH Maternal Care. Almost two-thirds of mothers in Nigeria (63 percent) received some antenatal care (ANC) for their most recent live birth in the five years preceding the survey. While one-fifth of moth- ers (21 percent) received ANC from a doctor, almost four in ten women received care from nurses or midwives (37 percent). Almost half of women (47 percent) made the minimum number of four recom- mended visits, but most of the women who received antenatal care did not get care within the first three months of pregnancy. In terms of content of care, slightly more than half of women who received antenatal care said that they were informed of potential pregnancy compli- cations (55 percent). Fifty-eight percent of women received iron tablets; almost two-thirds had a urine or blood sample taken; and 81 percent had their blood pressure measured. Almost half (47 percent) received no tetanus toxoid injections during their most recent birth. The majority of births in Nigeria occur at home (66 percent). Only one-third of live births during the five years preceding the survey occured in a health xxvi | Summary of Findings facility. Slightly more than one-third of births are attended by a doctor, nurse, or midwife. A smaller proportion of women receive postnatal care, which is crucial for monitoring and treating complications in the first two days after deliv- ery. Only 23 percent of women who gave birth outside a health facility received postnatal care within two days of the birth of their last child. More than seven in ten women who delivered outside a health facility received no postnatal care at all. Across all maternal care indicators, rural women are disadvantaged compared with urban women, and there are marked regional differ- ences among women. Overall, women in the south, particularly the South East and South West, received better care than women in the north, especially women in the North East and North West. Female Circumcision. Almost one-fifth of Nigerian women are circumcised, but the data suggest that the practice is declining. The oldest women are more than twice as likely as the youngest women to have been circumcised (28 percent versus 13 percent). Prevalence is highest among the Yoruba (61 percent) and Igbo (45 percent), who traditionally reside in the South West and South East. Half of the circumcised respondents could not identify the type of proce- dure performed. Among those women who could identify the type of procedure, the most common type of circumcision involved cutting and removal of flesh (44 percent of all circum- cised women). Four percent of women reported that their vaginas were sewn closed during cir- cumcision. Among the 53 percent of Nigerian women who had heard of female circumcision, two- thirds (66 percent) believe that female circumci- sion should be discontinued, while 21 percent want the practice to continue. Continuation of female circumcision finds greater support among southerners than northerners and among those who are circumcised than the uncircumcised. Even so, less than half of circumcised women want the practice to be continued (42 percent). Among men who had heard of the practice, simi- lar to women, almost two-thirds are against con- tinuation of female circumcision, while about one-fifth of this group were in favour if it. Perceived Constraints to Use of Health Care. Survey respondents were asked to identify barriers to accessing health care services for themselves. Almost half of women cite at least one barrier to care. The most commonly cited problem is getting money for treatment (30 percent), followed by dis- tance to health facility, and having to take transport (24 percent each). One in ten women say that getting permission to go is a problem. WOMEN’S CHARACTERISTICS AND STATUS While the majority of Nigerian women have had some education, 42 percent have never attended school. This is almost twice the proportion of men who have never attended school (22 percent). Slightly over half of women report being cur- rently employed (56 percent). Eighty-four percent of working women earn cash only or cash in addition to in-kind earnings. Almost three-quarters of women who receive cash earnings report that they alone de- cide how their earnings are used. An additional 16 percent say that they decide jointly with their hus- band or someone else. Only 10 percent of women report that someone else decides how their earnings will be used. The 2003 NDHS collected information on women’s participation in different types of decisions in the household. Almost half (46 percent) of cur- rently married women reported that they did not have a final say (either alone or jointly) in any speci- fied decision. Among married women, household decisionmaking is highly dominated by husbands. To assess attitudes toward wife beating, re- spondents were asked whether a husband would be justified in beating his wife for specific reasons. A majority of both women and men (approximately six in ten) believe there are occasions when a man is justified in beating his wife. For example, approxi- mately half of women believe that a husband is justi- fied in hitting his wife if she goes out without telling him or if she neglects the children. These were also the most common justifications cited by men (50 percent and 47 percent, respectively). MALARIA CONTROL PROGRAM INDICATORS Nets. Although malaria is a major public health concern in Nigeria, only 12 percent of households report owning at least one mosquito net. Even fewer, Summary of Findings | xxvii 2 percent of households, own an insecticide treated net (ITN). Rural households are almost three times as likely as urban households to own at least one mosquito net. Overall, 6 percent of children under age five sleep under a mosquito net, including 1 percent of children who sleep under an ITN. Five percent of pregnant women slept under a mosquito net the night before the survey, one-fifth of them under an ITN. Use of Antimalarials. Overall, 20 percent of women reported that they took an antimalarial for prevention of malaria during their last preg- nancy in the five years preceding the survey. Another 17 percent reported that they took an unknown drug, and 4 percent took paracetamol or herbs to prevent malaria. Only 1 percent re- ceived intermittent preventative treatment (IPT)—or preventive treatment with sulfadox- ine-pyrimethamine (Fansidar/SP) during an an- tenatal care visit. Among pregnant women who took an antimalarial, more than half (58 percent) used Daraprim, which has been found to be inef- fective as a chemoprophylaxis during preg- nancy. Additionally, 39 percent used chloro- quine, which was the chemoprophylactic drug of choice until the introduction of IPT in Nigeria in 2001. Among children who were sick with fe- ver/convulsions, one-third took antimalarial drugs, the majority receiving the drugs the same day as the onset of the fever/convulsions or the following day. HIV/AIDS AND OTHER STIS Knowledge. Almost all men (97 percent) and a majority of women (86 percent) reported that they had heard of AIDS. Considerably fewer know how to prevent transmission of the AIDS virus; men are better informed than women. Sixty-three percent of men and 45 per- cent of women reported knowing that condom use protects against HIV/AIDS. More respon- dents (six in ten women and eight in ten men) reported knowing that limiting the number of sexual partners is a way to avoid HIV/AIDS. Less than half of the population knows that mother to child trans- mission of HIV is possible through breastfeeding. Few people (less than one in ten) know that a woman living with HIV can take drugs during preg- nancy to reduce the risk of transmission. HIV Testing and Counselling. Six percent of women and 14 percent of men have been tested for HIV and received the results of their test. During the 12 months preceding the survey, only 3 percent of women and 6 percent of men were tested and re- ceived their test results. About one-quarter of women received counselling or information about HIV/AIDS during an antenatal care visit. High-risk Sex. A much higher percentage of men than women report having had sex with a non- marital, noncohabiting partner at some time during the year preceding the survey (39 percent of men versus 14 percent of women). Less than half of men (47 percent) and less than one-quarter of women (23 percent) reported using a condom the last time they had sex with a nonmarital, noncohabiting partner. Fifteen percent of men who are currently married or cohabiting reported having high-risk sex in the past 12 months. Sexually Transmitted Infections. Five percent of both women and men reported having a sexually transmitted infection (STI) or an associated symp- tom during the 12 months preceding the survey. The never-married population of both women and men are most at risk. Eight percent of never-married women and 7 percent of never-married men reported having an STI or STI symptom. Of these, 68 percent of women and 83 percent of men sought treatment for their STI or STI symptom; however, not every- one went to a health professional. Orphanhood. Nationwide, fewer than 1 per- cent of children have lost both parents; 6 percent of children under age 15 have lost at least one parent. Burkina� Faso Niger Cameroon CAR Chad DRCGabon Equatorial� Guinea Benin Togo NORTH EAST NORTH WEST NORTH CENTRAL SOUTH� WEST SOUTH� SOUTH SOUTH� EAST Yobe Kaduna Kano Jigawa Katsina Sokoto Zamfara Kebbi Niger F.C.T. Bauchi Gombe Plateau Nasarawa BenueKogi Kwara Oyo Ogun Ondo Edo Delta Enugu Anambra Cross� River AbiaAbia EbonyiEbonyi Imo Akwa� Ibom Osun Ekiti Borno Adamawa Taraba Gulf of Guinea Lagos Bayelsa Rivers NIGERIA xxviii | Map of Nigeria Introduction | 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY OF NIGERIA History The evolution of Nigeria from the mid-1800s until it attained independence in 1960 is largely the story of the transformational impact of the British on the people and culture of the Niger-Benue area. The British were in the Niger-Benue area to pursue interests that were largely economic and strategic. In the process of seeking to realize those interests, a sociopolitical aggregation—known today as Nigeria— emerged. Nigeria came into existence as a nation-state in 1914 through the amalgamation of the North and South protectorates. Before then, there were various separate cultural, ethnic, and linguistic groups, such as the Oyo, Benin, Nupe, Jukun, Kanem-Bornu, and Hausa-Fulani empires. These peoples lived in king- doms and emirates with traditional but sophisticated systems of government. There were also other rela- tively small but strong—and indeed resistant—ethnic groups (e.g., Ibo, Ibibio, and Tiv). The British established a crown colony type of government after the amalgamation. The affairs of the colonial administration were conducted by the British until 1942, when a few Nigerians became in- volved in the administration of the country. In the early 1950s, Nigeria achieved partial self-government with a legislature in which the majority of the members were elected into an executive council; most were Nigerians. Nigeria became a federation of three regions in 1954 and remained so until its independence in October 1960, with the Lagos area as the Federal Capital Territory. Three years later, on October 1, 1963, Nigeria became a republic. Nigeria has since had different administrative structures. Within the bounda- ries of Nigeria are many social groups with distinct cultural traits, which are reflected in the diverse be- haviour of the people. There are about 374 identifiable ethnic groups, but the Igbo, Hausa, and Yoruba are the major groups. Presently, Nigeria is made up of 36 states and a Federal Capital Territory (FCT), which are grouped into six geopolitical regions: North Central, North East, North West, South East, South South, and South West. There are also 774 constitutionally recognized Local Government Areas (LGAs) in the country. Geography Nigeria lies between 4º16' and 13º53' north latitude and between 2º40' and 14º41' east longitude. The country is in the West African subregion and borders Niger in the north, Chad in the northeast, Cam- eroon in the east, and Benin in the west. To the south, Nigeria is bordered by approximately 800 kilome- tres of the Atlantic Ocean, stretching from Badagry in the west to the Rio del Rey in the east. With a total land area of 923,768 square kilometres, the country is the fourth largest in Africa. Nigeria is diverse climatically and topographically and exhibits a great variety of relief features, encom- passing uplands of 600 to 1,300 metres on the North Central and the east highlands and lowlands of less than 20 metres in the coastal areas. The lowlands extend from the Sokoto plains to the Borno plains in the North, the coastal lowlands of Western Nigeria, and the Cross River basin in the east. The highland in- cludes the Jos Plateau and the Adamawa highlands in the North, extending to the Obudu Plateau and 2 | Introduction Oban Hills in the South East. Other topographic features include the Niger-Benue Trough and Chad Ba- sin. Nigeria has a tropical climate with wet and dry seasons associated with the movement of the Intertropical Convergence Zone north and south of the equator. The dry season occurs from October to March with a spell of coolness and dry, dusty harmattan wind felt mostly in the north in December and January. The wet season occurs from April to September. The temperature oscillates between 25° and 40°C, while rainfall ranges from 2,650 millimetres in the southeast to less than 600 millimetres in some parts of the north, mainly on the fringes of the Sahara Desert. The vegetation that results from these cli- matic differences consists of mangrove swamp forest in the Niger Delta and Sahel grassland in the north. Within a wide range of climatic, vegetation, and soil conditions, Nigeria possesses potential for a wide range of agricultural production. Economy Nigeria’s economic history and development have been closely tied to its agricultural sector. Be- fore the discovery of oil, the country depended almost entirely on agriculture for food and on agro- industrial raw materials for foreign exchange earnings through commodity trade. Agriculture also pro- vided gainful employment to over 75 percent of the country’s labour force and satisfactory livelihood to over 90 percent of the population at the time of the country’s independence. Over the years, the dominant role of agriculture in the economy, especially in terms of the country’s foreign exchange earnings, gave way to petroleum. Since 1980, oil production has accounted for more than two-thirds of the gross domes- tic product (GDP) and more than 80 percent of total government revenue. To date, the government has largely controlled vast industrial and commercial enterprises; however, there is now a vigorous drive to privatization. There are also large, multinational companies, as well as organized small-scale enterprises. Since the onset of the new democratic administration in 1999, economic policies have become more favourable to investment. Consequently, there has been an improvement in the performance of the domestic economy. Nigeria’s GDP was estimated at 2.7 percent in 1999, 2.8 percent in 2000, and 3.8 per- cent in 2001. The aggregate index of agricultural production was 3.9 percent in 2001, compared with 3.7 percent in 1999. The average industrial capacity utilization was 35.5 percent in 2001, representing an in- crease of 4.5 percent over the 1999 figure of 31 percent (Central Bank of Nigeria, 2002). Before the ad- vent of the civilian administration in 1999, Nigeria had a large public sector, comprising over 550 public enterprises in most sectors of the economy and dominating activities in power, telecommunication, petro- leum, and steel sectors. The public enterprise sector accounts for an estimated 50 percent of the total GDP, 57 percent of investments, and two thirds of formal sector employment. Like other developing countries, the civilian administration in Nigeria has recognized the impor- tance of privatization in the restructuring of its economy. The country embarked on a broader economic reform and liberalization programme designed to restore macroeconomic stability, achieve faster sustain- able growth, raise living standards, and reduce poverty. The reform programme was also aimed at pro- moting greater private sector participation in economic activity, and it included the maintenance of sound macroeconomic policies, as well as deregulation, with emphasis on power, telecommunications, and downstream petroleum sectors. It is too early to determine the impact of privatization and liberalization on the Nigerian economy. However, it is believed that these economic policy reforms, combined with investments in human resources and physical infrastructure, as well as the establishment of macroeco- nomic stability and good governance, are essential to achieve a high rate of self-sustaining, long-term economic growth. Introduction | 3 1.2 POPULATION AND BASIC DEMOGRAPHIC INDICATORS In Nigeria, population has always been a contentious issue. Censuses conducted in Nigeria have been controversial and have on occasion given rise to impassioned concerns from sections of the popula- tion. To a large extent, this has been because population figures are used by the federal government as one factor in the allocation of funds. They are also used to determine representation in the Houses of Assem- bly and both chambers of the National Assembly. The first attempt at a population census in Nigeria was in 1866. Subsequent censuses before 1952, such as 1911 and 1922, were restricted to some sections of the country. The 1952-53 enumeration was the first nationwide census. The first postindependence census conducted in 1962 was cancelled be- cause of alleged irregularities in its conduct. Another census conducted in 1963 was officially accepted (Table 1.1). The 1973 exercise was declared unacceptable and was cancelled. Thereafter, no attempt was made at conducting a census until 1991. The total population of Nigeria as reported in the 1991 census was 88,992,220. Using a growth rate of 2.83 percent per annum, the National Population Commission (NPC) estimates the current popula- tion of Nigeria to be about 126 million. This makes Nigeria the most populous nation in Africa and the tenth most populous in the world. The spatial distribution of the population within the country 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 square kilometre in parts of Akwa Ibom, Imo, Anambra, and Enugu State, as well as around Kano, Katsina, and Sokoto States. However, the average population density of the country in 1991 was 96 persons per square kilometre. The most densely populated states are Lagos, Anambra, Imo, and Akwa Ibom. Except for Lagos, all states with high population densities are located in the South East 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. The population of Nigeria is predominantly rural; approximately one-third live in urban areas. The states with the largest proportion of urban population are Lagos (94 percent), Oyo (69 percent), and Anambra (62 percent). The least urbanized states, with an urban population under 15 percent, include Sokoto (14 percent), Kebbi (12 percent), Akwa Ibom (12 percent) Taraba (10 percent), and Jigawa (7 per- cent) (NPC, 1998). Table 1.1 Basic demographic indicators Demographic indicators from various sources, Nigeria 1963-1999 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Census NFS NDHS Census NDHS Indicators 1963 1981-1982 1990 1991 19991 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Population (millions) 55.7 84.7 u 88.9 u Density (pop./sq.km) 60 92 u 96 u Percent urban 19 23 24 36.3 u Crude birth rate (CBR) 66 46 39 44.6 38 Crude death rate (CDR) 27 16 u 14 u Total fertility rate (TFR) u 6.3 6 5.9 5.2 Infant mortality rate (IMR) u 85 87 93 78 Life expectancy at birth 36 48 u 53.2 u –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– u = Unknown (not available) 1 Reported rates. See 1999 NDHS final report for information on data quality. Sources: National Population Commission; Federal Office of Statistics 4 | Introduction The effort to generate reliable demographic data has included the conduct of numerous sample surveys. These include the 1965-66 Rural Demographic Sample Survey and the 1980 National Demo- graphic Sample Survey (NDSS) conducted by the Federal Office of Statistics and the National Population Bureau, respectively. The 1981-1982 Nigeria Fertility Survey (NFS) was the first nationally representative survey on fertility, family planning, contraceptive use, and related topics. The first Nigeria Demographic and Health Survey (NDHS) followed in 1990. In addition to the topics covered by the NFS, the 1990 NDHS also col- lected information on issues related to maternal and child health. In 1994, the first sentinel survey was conducted to serve as a baseline study to monitor the various projects designed to achieve the objectives of the National Population Policy. In 1999, another NDHS was conducted. This was followed by a senti- nel survey conducted in 2000. 1.3 POPULATION AND HEALTH POLICIES AND PROGRAMMES Population Policies and Programmes On February 4, 1988, the Federal Government of Nigeria approved the National Policy on Popu- lation for Development in response to the pattern of population growth rate and its adverse effect on na- tional development. Since that time, emerging issues highlighted by the 1991 National Population Cen- sus, the 1994 International Conference on Population and Development, the 1999 AIDS/HIV Summit in Abuja, and other fora resulted in a revision of the National Population Policy, which was signed by the President and Commander-in-Chief of the armed forces of the Federal Republic of Nigeria, Chief Oluse- gun Obasanjo (GCFR), on January 14, 2004.1 The policy recognizes that population factors, social and economic development, and environmental issues are irrevocably entwined and are all critical to the achievement of sustainable development in Nigeria. The overall goal of the 2004 National Policy on Population for Sustainable Development is the improvement of the quality of life and the standards of living of the people of Nigeria. The specific goals are the following: • Achievement of sustained economic growth, poverty eradication, protection and preservation of the environment, and provision of quality social services • Achievement of a balance between the rate of population growth, available resources, and the social and economic development of the country • Progress towards a complete demographic transition to reasonable birth rates and low death rates. • Improvement in the reproductive health of all Nigerians at every stage of the life cycle • Acceleration of a strong and immediate response to curb the spread of HIV/AIDS and other related infectious diseases • Progress in achieving balanced and integrated urban and rural development. To achieve these goals, the 2004 population policy sets out the following objectives: 1 Although the policy has been approved by the government, some changes are still expected. Introduction | 5 • Increase understanding and awareness of the interrelationships between population factors, social and economic development, and the environment, and their mutual importance to the long-term sustainable development of Nigeria • Expand access and coverage and improve the quality of reproductive and sexual health care services • Strengthen and expand a comprehensive family planning and fertility management pro- gramme that ensures that all couples/individuals who want them have uninterrupted access to a reasonable range of contraceptive methods at affordable prices, and is also adequately re- sponsive to the needs of infertile and subfertile couples • Strengthen and improve safe motherhood programmes to reduce maternal mortality and mor- bidity and enhance the health of women • Reduce infant and child mortality and improve the health and nutritional status of Nigerian children through expanded access to high-quality promotive, preventive, and curative health care services • Promote Behavioural Change Communication (BCC) programmes to increase reproductive and sexual health knowledge, awareness, and behavioural change among Nigerians • Empower women to participate actively and fully in all aspects of Nigeria’s development and effectively address gender issues • Enhance the involvement of men in reproductive health programmes and health care • Increase the integration of adolescents and young people into development efforts and effec- tively address their reproductive health and related needs • Increase and intensify coverage of population and family life education programmes • Accelerate the integration of reproductive health and family planning concerns into sectoral programmes and activities • Use effective advocacy to promote and accelerate attitudinal change towards population and reproductive health issues among public and private sector leaders • Reduce and eventually eliminate harmful social and cultural practices that adversely affect the reproductive health of the population through the promotion of behavioural change and appropriate legislation • Strengthen the national response to HIV/AIDS to rapidly control the spread of the epidemic and mitigate its social and economic impacts • Encourage the integration of population groups with special needs, including nomads, refu- gees and displaced persons, the elderly, persons with disabilities, and remote rural dwellers into the development process • Accelerate progress towards integrated urban and rural development and balanced population distribution 6 | Introduction • Increase enrolment and retention of children, especially girls, in basic education and raise lit- eracy levels among Nigerians • Accelerate the integration of population factors into development planning at national, state and local government levels • Improve the population, social, and economic database; promote and support population and development research; and help leadership groups recognize the important contribution that planning and data utilization make to the good governance of Nigeria • Improve systems for monitoring and evaluating the implementation of the population policy and for reviewing the policy at periodic intervals. The Government of Nigeria has set the goal of a 2-percent population growth rate by 2015 or be- yond in its National Economic Policy. The targets for reduction in the total fertility rate and increases in modern contraceptive prevalence indicated below are consistent with this goal. The following key targets have been set to guide policy, programme planning, and implementation: • Achieve a reduction of the national population growth rate to 2 percent or lower by the year 2015 • Achieve a reduction in the total fertility rate of at least 0.6 children every five years • Increase the modern contraceptive prevalence rate by at least 2 percentage points per year • Reduce the infant mortality rate to 35 deaths per 1,000 live births by 2015 • Reduce the child mortality rate to 45 deaths per 1,000 live births by 2015 • Reduce the maternal mortality ratio to 125 deaths per 100,000 live births by 2010 and to 75 per 100,000 live births by 2015 • Achieve sustainable universal basic education as soon as possible prior to 2015 • Eliminate the gap between men and women in enrolment in secondary, tertiary, vocational and technical education and training by 2015 • Eliminate illiteracy by 2020 • Achieve a 25 percent reduction in the adult prevalence of HIV every five years. Health Policies and Programmes The Federal Government has several programmes and policies aimed at improving health care de- livery services. The fourth National Development Plan (1981-1985) established a government commit- ment to provide adequate and effective primary health care that is promotive, protective, preventive, re- storative, and rehabilitative to the entire population by the year 2000. A national health policy was conse- quently 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 functional referral system. It defines the roles and responsibilities of the three tiers of government, as well as of civil society and nongovernmental organiza- tions (NGOs). Introduction | 7 In general, the provision of health services is the responsibility of federal, state, and local gov- ernments as well as religious organizations and individuals. The services are organized in a three-tier health care system: 1) Primary health care, which is largely the responsibility of local governments, with the sup- port of the State Ministry of Health 2) Secondary health care, which provides specialized services to patients referred from the pri- mary health care level and is the responsibility of the state government 3) Tertiary health care, which provides highly specialized 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; immunization 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 centers should include maternal and child health care, including family planning services. The health sector is characterized by wide regional disparities in status, service delivery, and re- source availability. More health services are located in the southern states than in the north. The health sector has deteriorated despite Nigeria’s high number of medical personnel per capita. The current priori- ties in the health sector are in the area of childhood immunization and prevention of HIV/AIDS. 1.4 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 both in the public and private sectors. The 1976 National Policy on Universal Primary Education gives every child the right to tuition-free primary education. Later, the 6-3-3-4 system was introduced, estab- lishing six years of primary education, followed by three years of junior secondary and three years of sen- ior secondary education; the last segment of four years is for university or polytechnic education. Subse- quently, the National Literacy Programme for Adults was launched, followed by the establishment of no- madic education to address the needs of children of migrant cattle herders and fishermen in the riverine areas. In October 1999, Universal Basic Education (UBE) was launched, making it compulsory for every child to be educated free of tuition up to the junior secondary school level in an effort to meet Nigeria’s manpower requirement for national development. 1.5 ORGANIZATION AND OBJECTIVES OF THE 2003 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the latest in a series of nationally representative population and health surveys conducted in Nigeria. The 2003 NDHS was con- ducted by the National Population Commission (NPC); all activities were coordinated by a 12-member committee. The survey was funded by USAID/Nigeria, while ORC Macro provided technical support through MEASURE DHS+, a project sponsored by the U.S Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. Other development partners, including the Department for International Develop- ment (DFID), the United Nations Population Fund (UNFPA), and the United Nations Children’s Fund (UNICEF), also provided support for the survey. 8 | Introduction The 2003 NDHS was designed to provide estimates for key indicators such as fertility, contracep- tive use, infant and child mortality, immunization levels, use of family planning, maternal and child health, breastfeeding practices, nutritional status of mothers and young children, use of mosquito nets, female genital cutting, marriage, sexual activity, and awareness and behaviour regarding AIDS and other sexually transmitted infections in Nigeria. Sample Design The sample for the 2003 NDHS was designed to provide estimates of population and health indi- cators (including fertility and mortality rates) for Nigeria as a whole, urban and rural areas, and six major subdivisions. A representative probability sample of 7,864 households was selected for the 2003 NDHS sam- ple. The sample was selected in two stages. In the first stage, 365 clusters were selected from a list of enumeration areas developed from the 1991 population census. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected for par- ticipation in the survey. All women age 15-49 who were either permanent residents of the households in the 2003 NDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in a subsample of one-third of all households selected for the survey, all men age 15-59 were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. Questionnaires Three questionnaires were used for the 2003 NDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content of these questionnaires was based on the model questionnaires developed by the MEASURE DHS+ programme for use in countries with low levels of contraceptive use. The questionnaires were adapted during a technical workshop organized by the National Popula- tion Commission to reflect relevant issues in population and health in Nigeria. The workshop was at- tended by experts from the government, NGOs, and international donors. The adapted questionnaires were translated from English into the three major languages (Hausa, Igbo, and Yoruba) and pretested dur- ing November 2002. The Household Questionnaire was used to list all usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito nets. Additionally, the Household Question- naire was used to record height and weight measurements of women age 15-49 and children under the age of 6. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: • Background characteristics (e.g., education, residential history, media exposure) • Birth history and childhood mortality Introduction | 9 • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care • Breastfeeding and child feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Awareness and behaviour regarding AIDS and other sexually transmitted infections • Female genital cutting. The Men’s Questionnaire was administered to all men age 15-59 living in every third household in the 2003 NDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a reproductive history or questions on maternal and child health or nutrition. Training of Field Staff Over 100 people were recruited by the NPC to serve as supervisors, field editors, male and female interviewers, quality control personnel, and reserve interviewers. Efforts were made to recruit high- calibre personnel who came from all of the 36 states and the FCT to ensure appropriate linguistic and cul- tural diversity. They all participated in the main interviewer training, which was conducted from February 17 to March 8, 2003. The training was conducted in English and included lectures, presentations by out- side experts, practical demonstrations, and practice interviewing in small groups. The practice interviews were conducted in the languages that the questionnaires were translated into: English, Hausa, Igbo, and Yoruba. Practice in certain less common dialects was also accomplished by translating directly from the English questionnaires. All of the field staff participated in three days of field practice. Finally, a series of special lectures was held specifically for the group comprising supervisors, field editors, quality control personnel, and field coordinators. Fieldwork Fieldwork for the 2003 NDHS took place over a five-month period, from March to August 2003. Twelve interviewing teams carried out data collection. Each team consisted of one team supervisor, one field editor, four female interviewers, one male interviewer, and one driver. Special care was taken to monitor the quality of data collection. First, the field editor was responsible for reviewing all question- naires for quality and consistency before the team’s departure from the cluster. The field editor and su- pervisor would also sit in on interviews periodically. Twelve staff assigned from the NPC coordinated fieldwork activities and visited the teams at regular intervals to monitor the work. In addition, quality con- trol personnel independently reinterviewed selected households after the departure of the teams. These checks were performed periodically through the duration of the fieldwork. ORC Macro also participated in field supervision. Data Processing The processing of the 2003 NDHS results began shortly after the fieldwork commenced. Com- pleted questionnaires were returned periodically from the field to NPC headquarters in Abuja, where they were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included two supervisors, a questionnaire administrator (who ensured that the ex- pected numbers of questionnaires from all clusters were received), three office editors, 12 data entry op- erators, and a secondary editor. The concurrent processing of the data was an advantage since the NPC was able to advise field teams of problems detected during the data entry. In particular, tables were gener- 10 | Introduction ated to check various data quality parameters. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in September 2003. 1.6 RESPONSE RATES Table 1.2 shows household and individual response rates for the 2003 NDHS. A total of 7,864 households were selected for the sample, of which 7,327 were found. The shortfall is largely due to struc- tures that were found to be vacant. Of the 7,327 existing households, 7,225 were successfully interviewed, yielding a household response rate of 99 percent. In these households, 7,985 women were identified as eligible for the individual interview. Interviews were completed with 95 percent of them. Of the 2,572 eligible men identified, 91 percent were successfully interviewed. There is little difference between urban and rural response rates. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, accord- ing to residence, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Result Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household interviews Households selected 3,163 4,701 7,864 Households occupied 2,979 4,348 7,327 Households interviewed 2,931 4,294 7,225 Household response rate 98.4 98.8 98.6 Interviews with women Number of eligible women 3,181 4,804 7,985 Number of eligible women interviewed 3,057 4,563 7,620 Eligible woman response rate 96.1 95.0 95.4 Interviews with men Number of eligible men 1,073 1,499 2,572 Number of eligible men interviewed 986 1,360 2,346 Eligible man response rate 91.9 90.7 91.2 Household Population and Housing Characteristics | 11 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter presents a descriptive summary of some demographic and socioeconomic character- istics of the population in the sampled households. Also examined are environmental conditions such as housing facilities and physical features of the dwelling units in which the population lives. All usual residents of each sampled household, plus all visitors who slept in that household the night before the interview, were listed using the household questionnaire. Some basic information was collected for each person, including age, sex, marital status, and education. In addition, information was collected on whether each person is a usual resident of the household or a visitor, and whether the person slept in the household the night prior to the survey interview. This allows the analysis of either de jure (usual residents) or de facto (those who are physically present there at the time of the survey) populations. 2.1 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE Table 2.1 shows the distribution of the de facto household population in the 2003 Nigeria Demo- graphic and Health Survey (2003 NDHS) by five-year age groups, according to sex and urban-rural resi- dence. The 2003 NDHS households constitute a population of 35,173 persons. The population age struc- ture indicates the history of the population of Nigeria and also its future course (Figure 2.1). About 50 percent of the population is female, and 50 percent is male. 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, which reflects the young age structure of the Nigerian population and is an indication of a population with high fertility. Forty-four percent of the population is below 15 years of age and 4 percent is age 65 or older. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and resi- dence, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Rural Total ––––––––––––––––––––––– –––––––––––––––––––––– ––––––––––––––––––––––– Age Male Female Total Male Female Total Male Female Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <5 14.8 15.2 15.0 18.2 16.7 17.4 17.0 16.2 16.6 5-9 14.4 13.1 13.7 15.7 14.9 15.3 15.2 14.3 14.8 10-14 12.4 13.4 12.9 12.2 11.8 12.0 12.3 12.3 12.3 15-19 10.8 10.4 10.6 9.5 10.3 9.9 9.9 10.3 10.1 20-24 9.6 9.4 9.5 7.8 8.9 8.4 8.4 9.1 8.8 25-29 7.7 8.8 8.3 6.4 8.1 7.3 6.8 8.4 7.6 30-34 6.3 5.7 6.0 5.7 5.9 5.8 5.9 5.8 5.9 35-39 4.4 5.7 5.1 4.7 4.5 4.6 4.6 4.9 4.7 40-44 4.4 4.1 4.2 4.0 4.2 4.1 4.1 4.2 4.2 45-49 4.1 3.5 3.8 3.2 3.2 3.2 3.5 3.3 3.4 50-54 3.0 3.5 3.3 3.2 3.8 3.5 3.1 3.7 3.4 55-59 2.2 2.1 2.1 2.1 2.4 2.2 2.1 2.3 2.2 60-64 2.1 1.7 1.9 2.5 2.0 2.3 2.4 1.9 2.1 65-69 1.5 1.1 1.3 1.6 1.1 1.4 1.6 1.1 1.4 70-74 1.0 0.8 0.9 1.5 1.0 1.3 1.3 1.0 1.1 75-79 0.4 0.4 0.4 0.6 0.4 0.5 0.5 0.4 0.5 80 + 0.8 0.9 0.8 1.0 0.9 0.9 0.9 0.9 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,017 5,870 11,887 11,441 11,844 23,286 17,459 17,714 35,173 12 | Household Population and Housing Characteristics 2.2 HOUSEHOLD COMPOSITION Information about the composition of households by sex of the head of the household and size of the household is presented in Table 2.2. The data show that households in Nigeria are predominantly headed by men (83 percent) and less than one in five (17 percent) are headed by women. Female-headed households are more common in urban areas (19 percent) than in rural areas (15 percent). There is signifi- cant variation by region: the proportion of households headed by a female ranges from a low of 7 percent in the North East to a high of 28 percent in the South South. The average household size in Nigeria is 5.0 persons. The household size is slightly higher in ru- ral areas than in urban areas (5.1 versus 4.7 persons). It is also higher in the north than the south. Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 NDHS 2003 Age Male Percent Female Household Population and Housing Characteristics | 13 2.3 EDUCATIONAL ATTAINMENT Educational attainment is perhaps the most important characteristic of household members. Many phenomena such as reproductive behaviour, use of contraception, children’s health, and proper hygienic habits are related to the education of household members. Table 2.3 shows the classification of the house- hold members by educational attainment, according to age group, residence, and geopolitical region for each sex. Although the majority of the household population age 6 and older has some education, 46 per- cent of females and 31 percent of males have never attended school. With the exception of the youngest age group, some of whom will begin to attend school in the future, the proportion with no education increases with age. For example, the proportion of women who have never attended any formal schooling increases from 27 percent among those age 10-14 to 89 percent among those age 65 and above. For men, the proportion increases from 18 percent of those age 10-14 to 70 percent of those age 65 and older. Approximately one-quarter of women and one-third of men have attended at least some secondary schooling, however, the median number of years of schooling is 0.2 for females and 3.6 for males. Educational attainment is higher in urban areas than in rural areas. The proportion of the popula- tion that has achieved any education varies among Nigeria’s geopolitical regions. The North West and North East have the highest proportion of persons with no education—seven in ten women and half of men—while the South East has the lowest percentage who have never been to school among females (18 percent) and South South among males (9 percent). Table 2.2 Household composition Percent distribution of households by sex of head of household and household size, according to residence, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Region ––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––– North North North South South South Characteristic Urban Rural Central East West East South West Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex of head of household Male 81.0 84.8 84.3 93.5 92.1 73.5 71.8 76.8 83.4 Female 19.0 15.2 15.7 6.5 7.9 26.5 28.2 23.2 16.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of usual members 0 0.1 0.2 0.3 0.0 0.2 0.4 0.1 0.1 0.2 1 14.9 9.8 10.7 9.1 7.1 16.8 15.1 15.9 11.7 2 12.7 11.5 10.2 9.2 11.1 15.4 13.0 14.8 12.0 3 14.0 14.2 12.3 10.8 15.8 13.8 12.4 18.9 14.1 4 12.8 13.4 13.9 12.8 14.0 11.5 12.9 13.1 13.2 5 12.2 12.0 10.9 11.0 13.3 11.6 10.7 14.0 12.1 6 10.4 11.0 11.1 11.8 9.9 12.2 10.5 10.2 10.8 7 8.4 8.4 9.8 8.8 8.6 9.2 8.6 5.2 8.4 8 4.5 5.5 5.9 6.7 5.6 3.4 5.6 2.5 5.1 9+ 10.0 14.0 14.9 19.9 14.4 5.7 11.0 5.3 12.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 2,598 4,627 1,040 1,185 1,911 690 1,315 1,083 7,225 Mean size 4.7 5.1 5.4 5.9 5.2 4.1 4.7 4.0 5.0 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure members, i.e., usual residents. 14 | Household Population and Housing Characteristics Table 2.3 Educational attainment of household population Percent distribution of the de facto female and male household populations age six and over by highest level of education at- tended or completed, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended or completed ––––––––––––––––––––––––––––––––––––––––––––––––––– More Median Some than Don’t number Background No Some Completed secon- Completed secon- know/ of characteristic education primary primary1 dary secondary2 dary missing Total Number years ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– FEMALE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 45.9 51.6 0.0 0.0 0.0 0.0 2.4 100.0 2,041 0.0 10-14 26.8 53.2 4.6 14.0 0.1 0.0 1.3 100.0 2,176 2.3 15-19 30.2 11.2 10.1 39.6 7.3 0.9 0.8 100.0 1,832 5.6 20-24 33.9 5.6 11.9 17.3 23.3 7.1 0.9 100.0 1,609 5.8 25-29 39.7 5.5 14.6 13.0 18.6 8.0 0.6 100.0 1,481 5.3 30-34 47.5 7.4 15.5 13.4 9.1 6.3 0.8 100.0 1,031 2.1 35-39 49.8 7.3 14.9 15.0 3.9 8.7 0.4 100.0 867 0.0 40-44 60.4 8.9 12.4 10.0 2.4 5.5 0.5 100.0 736 0.0 45-49 68.0 11.5 8.7 3.6 1.1 4.4 2.7 100.0 584 0.0 50-54 76.3 6.2 8.1 4.6 0.8 2.9 1.1 100.0 653 0.0 55-59 80.9 6.2 5.1 2.4 0.3 2.1 3.0 100.0 404 0.0 60-64 85.5 6.8 1.5 3.7 0.1 1.0 1.5 100.0 341 0.0 65+ 88.7 3.5 2.5 1.0 0.3 1.0 3.1 100.0 594 0.0 Residence Urban 31.9 21.3 9.6 18.6 10.8 6.8 1.0 100.0 4,839 3.9 Rural 53.4 20.4 7.9 10.7 4.4 1.7 1.4 100.0 9,521 0.0 Region North Central 40.9 27.2 9.7 13.4 5.3 2.5 1.1 100.0 2,248 0.9 North East 68.0 17.1 4.3 5.7 2.7 1.5 0.7 100.0 2,593 0.0 North West 72.2 13.6 4.2 4.1 2.5 1.5 2.0 100.0 3,823 0.0 South East 17.8 25.1 12.1 20.6 16.2 5.6 2.6 100.0 1,314 5.4 South South 20.6 27.5 12.5 23.6 9.4 5.4 0.9 100.0 2,559 5.1 South West 23.2 19.9 13.6 24.3 11.4 7.1 0.5 100.0 1,823 5.4 Total 46.1 20.7 8.5 13.4 6.6 3.4 1.3 100.0 14,360 0.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MALE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 41.1 56.1 0.0 0.0 0.0 0.0 2.8 100.0 2,175 0.0 10-14 18.2 62.1 3.1 15.4 0.1 0.0 1.2 100.0 2,144 2.7 15-19 15.4 15.6 8.9 51.2 7.4 0.8 0.9 100.0 1,736 6.7 20-24 16.2 6.4 13.2 27.9 24.7 10.0 1.5 100.0 1,473 8.7 25-29 20.6 4.3 16.7 15.5 27.4 14.2 1.3 100.0 1,195 8.6 30-34 23.7 5.9 14.4 19.3 18.1 17.5 1.0 100.0 1,029 8.3 35-39 27.2 7.0 15.8 18.3 12.9 17.7 1.0 100.0 796 6.4 40-44 35.7 8.9 15.7 15.5 6.1 17.6 0.5 100.0 724 5.5 45-49 38.7 12.1 15.9 12.6 4.2 15.9 0.6 100.0 613 5.3 50-54 47.0 14.1 16.0 10.0 2.8 8.1 2.1 100.0 550 1.5 55-59 52.8 14.3 12.2 6.8 2.9 9.3 1.8 100.0 372 0.0 60-64 66.0 9.3 11.1 6.6 1.1 4.0 1.8 100.0 411 0.0 65+ 70.4 9.9 6.9 5.7 1.2 3.8 2.1 100.0 760 0.0 Residence Urban 19.9 24.0 9.3 21.5 12.3 11.9 1.1 100.0 4,971 5.6 Rural 36.3 25.2 9.6 15.9 6.7 4.6 1.6 100.0 9,028 2.0 Region North Central 21.9 29.5 9.1 21.1 10.1 7.5 0.7 100.0 2,222 4.9 North East 50.2 22.9 4.6 11.8 4.9 4.9 0.8 100.0 2,626 0.0 North West 50.0 23.1 6.2 9.3 5.0 4.4 2.1 100.0 3,670 0.0 South East 14.0 23.6 16.0 20.2 11.5 10.8 4.0 100.0 1,124 5.6 South South 8.7 28.1 14.1 25.8 13.0 9.2 1.1 100.0 2,557 5.8 South West 13.9 21.0 13.4 27.7 12.5 10.7 0.8 100.0 1,800 5.9 Total 30.5 24.8 9.5 17.9 8.7 7.2 1.4 100.0 13,999 3.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Totals include 10 women and 20 men with missing information on age. 1 Completed 6 years at the primary level 2 Completed 6 years at the secondary level Household Population and Housing Characteristics | 15 School Attendance Rates Table 2.4 provides net attendance ratios (NAR) and gross attendance ratios (GAR) by sex, resi- dence, geopolitical region, and household economic status according to school level. The NAR for pri- mary school is the percentage of the primary school-age (6-11 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (12-17 years) popu- lation that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students of any age, expressed as the percentage of the official primary school age population. The GAR for secondary school is the total number of sec- ondary school students up to age 24, expressed as the percentage of the official secondary school age population. If there are significant numbers of over-age and under-age students at a given level of school- ing, the GAR can exceed 100 percent. Children are considered to be attending school currently if they attended at any point during the current school year. Table 2.4 shows that 60 percent of primary school age children in Nigeria are attending primary school. The NAR is higher in urban areas than in rural areas (70 and 56 percent, respectively), as is the GAR (100 and 82 percent, respectively). There is significant variation by region: the NARs in the North East and North West are just over half the ratios in the three southern regions. At the secondary school level, the NAR is 35 percent and the GAR is 61 percent. Regional disparities at the secondary school level are even more pronounced than at the primary school level: the NAR, for example, ranges from a low of 15 percent in the North West, to a high of 61 percent in the South West. The Gender Parity Index (GPI) represents the ratio of the GAR for females to the GAR for males. It is presented for both the primary and secondary school levels and offers a summary measure to the ex- tent to which there are gender differences in attendance rates. A GPI of less than 1 indicates that a smaller proportion of females than males attends school. The GPI for primary school is 0.86 and for secondary school is 0.77. Although there is little urban-rural differential at the primary school level, there is signifi- cant difference at the secondary school level. Once again, regional differentials are significant; the data indicate that girls residing in the North West and North East are particularly disadvantaged. Gender dis- parities by age in school attendance at any level are shown in Figure 2.2. Figure 2.2 Age-Specific Attendance Rates 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female NDHS 2003 16 | Household Population and Housing Characteristics Table 2.4 also shows school attendance ratios and GPIs by wealth quintile, an indicator of the economic status of households. The wealth index is a recently developed measure that has been tested in a number of countries in relation to inequities in household income, use of health services, and health out- comes (Rutstein, 2004; Rutstein et al., 2000). It is an indicator of the level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The wealth index was constructed using house- hold asset data and principal components analysis. Asset information was collected in the 2003 NDHS Household Questionnaire and covers information on household ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics such as source of drinking water, type of sanitation facilities, and type of material used in flooring. Each asset was assigned a weight (factor score) generated through principal component analysis, and the resulting asset scores were standardized in relation to a standard normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest) The data in Table 2.4 show that there is a high correlation between economic status of the house- hold and school attendance. For example, the NAR at the primary school level is 40 percent for the poor- est households and 83 percent for the most advantaged households. The data indicate that unless there is an effective policy on free education, many young Nigerians will continue to be denied educational op- portunities. Household Population and Housing Characteristics | 17 Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Net attendance ratio1 Gross attendance ratio2 Gender Background –––––––––––––––––––––––––– ––––––––––––––––––––––––– parity characteristic Male Female Total Male Female Total index3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– PRIMARY SCHOOL ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 71.0 68.0 69.5 105.5 93.8 99.8 0.89 Rural 60.2 51.1 55.7 89.4 75.3 82.4 0.84 Region North Central 71.4 68.9 70.2 109.1 110.0 109.5 1.01 North East 49.5 39.1 44.4 71.1 51.8 61.6 0.73 North West 49.0 34.2 41.7 77.6 48.6 63.3 0.63 South East 82.4 78.3 80.2 124.5 117.0 120.4 0.94 South South 83.2 81.1 82.2 124.5 114.4 119.5 0.92 South West 81.2 84.6 82.8 104.6 114.9 109.4 1.10 Wealth quintile Lowest 45.0 35.7 40.4 71.5 57.1 64.4 0.80 Second 55.6 42.2 48.9 88.5 63.4 75.9 0.72 Middle 64.9 56.6 60.9 97.2 83.7 90.7 0.86 Fourth 75.4 72.7 74.1 111.8 106.0 109.0 0.95 Highest 82.9 82.8 82.9 108.4 103.8 106.0 0.96 Total 63.7 56.5 60.1 94.6 81.2 88.0 0.86 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SECONDARY SCHOOL ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 47.2 45.3 46.3 75.6 67.2 71.6 0.89 Rural 31.7 25.9 28.7 65.0 45.9 55.3 0.71 Region North Central 42.7 32.6 37.7 90.7 55.6 73.3 0.61 North East 22.9 14.9 19.1 41.6 23.1 32.9 0.55 North West 19.8 9.5 14.7 41.0 14.6 27.8 0.36 South East 44.9 51.4 48.5 84.7 93.7 89.8 1.11 South South 51.6 51.5 51.5 90.9 90.8 90.9 1.00 South West 62.2 59.9 61.0 94.1 80.2 87.0 0.85 Wealth quintile Lowest 17.5 12.0 14.6 40.9 23.8 32.1 0.58 Second 24.8 16.2 20.9 50.1 31.3 41.5 0.63 Middle 37.3 26.7 32.0 71.2 49.8 60.4 0.70 Fourth 43.5 40.1 41.8 84.5 63.1 73.9 0.75 Highest 62.6 64.9 63.8 95.0 94.2 94.6 0.99 Total 37.5 32.6 35.1 69.0 53.3 61.2 0.77 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 The NAR for primary school is the percentage of the primary-school-age (6-11 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (12-17 years) popula- tion that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the offi- cial primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over- age and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school GAR for females to the GAR for males. The Gender Parity Index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. 18 | Household Population and Housing Characteristics Dropout and Repetition Rates By asking about the grade or class that children were attending during the previous school year, it is possible to calculate dropout rates and repetition rates. These rates describe the flow of students through the school system. Repetition and dropout rates approach zero where students nearly always pro- gress to the next grade at the end of the school year. Repetition and dropout rates often vary across grades, indicating points in the school system where students are not regularly promoted to the next grade or they decide to drop out of school. Although an automatic promotion policy does not operate officially in Nigeria, very few primary school students repeat grades. Table 2.5 indicates that apart from first grade, which 4 percent are repeat- ing, the rates for grades 2 to 6 are all below 3 percent. Dropout rates are also low (less than 2 percent) from grades 1 through 5. At the sixth grade, the dropout rate is 17 percent. The reason for the high drop- out rate at grade 6 is probably because many of the pupils who attend primary school are unable to move Table 2.5 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– School grade Background ––––––––––––––––––––––––––––––––––––––––––––––––––––– characteristic 1 2 3 4 5 6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– REPETITION RATE1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 3.8 2.8 1.7 1.6 2.9 2.4 Female 4.0 1.8 3.5 1.9 1.8 1.9 Residence Urban 4.5 0.9 1.7 2.3 4.4 2.9 Rural 3.5 3.2 3.0 1.4 1.2 1.5 Region North Central 2.4 1.1 2.2 0.0 2.1 0.0 North East 1.1 0.7 1.1 0.0 0.0 4.0 North West 6.1 4.2 5.6 1.3 5.7 (5.9) South East 0.8 6.9 2.0 1.3 2.0 3.1 South South 6.6 0.0 1.6 2.2 1.1 1.1 South West 2.4 3.3 0.9 5.1 3.5 2.2 Total 3.9 2.4 2.5 1.7 2.4 2.1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– DROPOUT RATE2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 0.0 0.4 0.8 0.0 2.0 15.8 Female 0.1 0.3 0.9 3.3 0.1 17.9 Residence Urban 0.0 0.2 0.6 0.3 0.3 7.0 Rural 0.1 0.4 1.1 2.1 1.6 23.7 Region North Central 0.0 0.3 1.0 1.1 0.0 24.9 North East 0.0 0.4 0.3 0.0 0.0 14.2 North West 0.0 0.6 0.4 0.0 2.3 (26.8) South East 0.0 0.4 0.0 0.7 0.6 4.0 South South 0.2 0.0 2.5 4.3 2.5 21.3 South West 0.0 0.0 0.0 0.0 0.0 3.4 Total 0.0 0.3 0.9 1.4 1.1 16.9 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. Household Population and Housing Characteristics | 19 to the next educational level (i.e., secondary school). There is great variation by residence and region. For example, rural children are more than three times as likely as urban children to drop out of school at grade 6. 2.4 HOUSEHOLD CHARACTERISTICS The 2003 NDHS gathered information on housing characteristics such as source of water, elec- tricity, cooking fuel, type of toilet facilities, number of sleeping rooms in the house, and housing material. Table 2.6 presents this information by urban–rural residence and region. These characteristics are corre- lated with health and are also an indication of socioeconomic status. About half of households in Nigeria have electricity. Electricity is much more common in urban areas than in rural areas (85 and 34 percent, respectively). Indeed, urban dwellers are more advantaged overall in terms of household characteristics than rural dwellers. Nonetheless, living conditions across the entire country are mixed, with a majority of Nigerians having no access to potable water and using tradi- tional pit toilets. The source of water and availability of sanitary facilities are important determinants of the health status of household members. Sources of water expected to be relatively free of disease are piped water and water drawn from protected wells and deep boreholes. Other sources, like unprotected wells and sur- face water (rivers, streams, ponds, and lakes), are more likely to carry disease-causing agents. The table shows that 42 percent of Nigerian households have access to clean water sources (17 percent from piped water, 24 percent from a protected well, and 1 percent from spring water). Sources of drinking water differ considerably by place of residence. Thirty-three percent of urban households obtain water from pipes into dwelling/yard/plot or from public taps, compared with just 9 per- cent of rural households. It is notable that in rural areas, approximately one-fifth obtain drinking water from open public wells and 27 percent from a river or stream. A majority of Nigerians (56 percent) have access to water within 15 minutes. About two-thirds of urban households obtain water within 15 minutes, compared with about half of rural households. The median time to the source of drinking water is 5 min- utes for the urban households and 10 minutes for the rural households. The lack of availability of sanitary facilities poses a serious public health problem. Only 15 per- cent of households have a flush toilet, while the majority (57 percent) use traditional pit toilets, and one- quarter have no facility. There are differences in the type of toilet facilities by both residence and region. Urban households are more than four times as likely to have a modern flush toilet as rural areas (29 and 7 percent, respectively). Households in the North West and North East are the least likely to have a flush toilet. The type of material used for flooring is an indicator of the economic situation of households and therefore the potential exposure of household members to disease-causing agents. Forty-two percent of households live in dwellings with cement floors and 31 percent in dwellings with earth or sand floors. There are substantial differences in the flooring materials by urban-rural residence. Almost half of rural households have a floor made of earth, sand, or dung, compared with 10 percent of urban households. Firewood and straw is the most common fuel used for cooking, reported by two-thirds of house- holds. An additional 27 percent use kerosene. Rural households are twice as likely as urban households to use firewood or straw (84 and 41 percent, respectively). 20 | Household Population and Housing Characteristics Table 2.6 Household characteristics Percent distribution of households by household characteristics, according to residence and region, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Region ––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household North North North South South South characteristic Urban Rural Central East West East South West Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Electricity Yes 84.9 33.8 47.2 30.9 42.0 70.2 57.9 79.9 52.2 No 15.0 66.0 52.6 68.9 57.8 29.4 42.1 20.0 47.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Source of drinking water Piped into dwelling/yard/plot 14.4 2.3 7.8 4.6 10.2 8.3 3.2 4.6 6.6 Public tap 18.5 6.2 8.1 9.7 11.8 11.8 4.6 18.8 10.6 Open well in dwelling/yard/plot 9.4 14.2 12.6 15.1 22.9 1.8 3.3 9.2 12.5 Open public well 6.7 21.2 9.4 30.8 25.0 1.5 5.2 12.7 16.0 Protected well in dwelling/ yard/plot 6.7 3.7 5.5 1.8 3.3 10.8 7.0 3.5 4.8 Protected public well 24.4 16.3 11.5 5.3 12.1 33.1 35.8 25.6 19.2 Spring 0.6 1.3 1.5 0.2 0.5 4.8 0.5 1.2 1.1 River/stream 6.7 26.9 34.9 17.3 10.4 10.6 33.0 13.5 19.6 Pond/lake/dam 0.8 1.7 2.0 1.9 0.4 1.3 1.3 2.1 1.4 Rainwater 0.5 2.1 0.1 0.0 0.0 6.7 4.2 0.5 1.5 Tanker truck 5.9 1.9 5.9 4.4 0.6 7.3 1.4 4.2 3.3 Other 5.2 2.0 0.6 8.9 2.9 1.8 0.5 4.1 3.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Time to water source Percentage <15 minutes 64.9 51.4 51.1 58.2 62.1 59.4 45.8 59.4 56.3 Median time to source 4.6 9.9 10.0 9.4 6.5 4.9 14.8 9.2 9.4 Sanitation facility Flush toilet 28.7 6.7 9.6 4.5 4.5 41.3 21.2 23.4 14.6 Traditional pit toilet 55.6 56.9 50.1 74.6 74.3 39.8 42.3 39.1 56.5 Ventilated improved pit (vip) latrine 5.5 1.9 1.9 0.5 1.6 0.9 8.5 5.5 3.2 Bush/field 9.7 31.6 38.0 20.1 19.2 17.6 19.7 30.7 23.7 River 0.3 2.7 0.4 0.3 0.3 0.1 8.2 1.2 1.9 Other 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand 9.9 43.6 28.3 57.3 41.8 12.8 21.7 11.8 31.4 Dung 0.4 3.6 1.4 4.5 4.2 0.2 1.1 1.2 2.4 Cement 47.4 39.6 48.5 31.5 45.4 53.1 35.9 44.4 42.4 Carpet 39.0 12.1 20.8 6.2 7.4 27.8 38.4 40.9 21.8 Other 2.0 0.8 0.8 0.1 1.1 1.3 2.7 1.3 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 0.5 0.1 0.5 0.4 0.2 0.1 0.1 0.4 0.3 Kerosene 53.4 12.1 16.1 4.8 10.3 51.0 36.2 64.2 26.9 Firewood, straw 41.1 84.4 79.5 92.6 83.8 45.0 61.1 30.7 68.8 Dung 0.1 0.8 0.5 0.1 1.5 0.0 0.1 0.0 0.5 Other 4.7 2.5 3.4 2.0 3.6 3.7 2.5 4.7 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Persons per sleeping room 2.9 3.6 4.0 3.7 3.3 3.0 3.6 2.2 3.3 Number of households 2,598 4,627 1,040 1,185 1,911 690 1,315 1,083 7,225 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Percentages may not add to 100 due to missing cases. Household Population and Housing Characteristics | 21 Crowded conditions may affect health as well as the quality of life. The number of persons per sleeping room in the household is used as a measure of household room density. On average, there are 3.3 persons per sleeping room in Nigeria. Rural households have more people per sleeping room than urban households (3.6 and 2.9 percent, respectively). Household Durable Goods The availability of durable consumer goods is an indicator of a household’s socioeconomic status. Moreover, particular goods have specific advantages. For example, having access to a radio or a televi- sion exposes household members to innovative ideas, a refrigerator prolongs the wholesomeness of foods, and a means of transport allows greater access to services away from the local area. Table 2.7 shows the availability of selected consumer goods by residence. Nationally, almost three-fourths of households own a radio, and almost one-third own a television. Fewer households own a refrigerator—just 18 percent. In each case, urban households are much more likely than rural households to own these goods. Indeed, urban households are more likely than rural households to own each of the items except for bicycles, work animals, and boats, which are more commonly owned in rural areas. Rural households are also disadvantaged in terms of communications. Less than 2 percent of the rural house- holds have telephones or cell phones, compared with 12 percent of urban households. The data presented in this chapter vividly portray the level of poverty in Nigeria. Less than half of Nigerians have access to potable water and just one-third of rural households have electricity. There is a need for vigorous policies to improve access to the basic necessities of life. Furthermore, the data on edu- cation illustrate the need for better schooling of the population, especially females. Table 2.7 Household durable goods Percentage of households possessing various durable consumer goods, by residence and region, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Region ––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– North North North South South South Durable consumer goods Urban Rural Central East West East South West Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Radio 85.3 65.8 75.0 60.8 72.5 87.7 69.4 79.1 72.8 Television 58.6 15.4 23.6 14.0 19.9 52.9 37.3 54.4 31.0 Telephone/cell phone 11.8 1.9 1.6 1.1 2.3 14.0 6.5 12.8 5.5 Refrigerator 36.1 7.9 13.6 9.2 8.9 35.4 24.8 28.8 18.0 Gas cooker 7.5 2.1 2.7 1.1 1.7 12.2 6.3 4.9 4.0 Iron 57.3 16.8 24.6 13.2 20.6 51.4 40.7 52.5 31.3 Fan 69.2 19.6 32.9 17.9 23.1 58.3 47.0 63.6 37.4 Bicycle 17.9 41.0 36.5 44.9 40.8 24.7 33.2 5.8 32.7 Motorcycle/scooter 17.5 13.8 23.3 13.9 14.9 14.2 14.4 10.4 15.1 Car/truck 17.8 4.9 8.4 6.3 4.9 21.3 9.7 15.0 9.6 Donkey/horse/camel 1.5 8.0 0.8 4.8 18.0 0.1 0.0 0.0 5.7 Canoe/boat/ship 1.2 7.1 3.9 1.2 7.5 0.1 12.2 0.2 5.0 None of the above 7.0 19.9 14.7 22.6 14.3 7.8 15.4 14.0 15.2 Number of households 2,598 4,627 1,040 1,185 1,911 690 1,315 1,083 7,225 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of individual female and male respondents. This information is essential for the interpretation of the findings presented later in the report and can provide an approximate indication of the representativeness of the survey. The chapter begins by describing basic background characteristics, including age, marital status, residence, education, religion, ethnicity, and economic status of respondents’ households. The chapter also includes more detailed information on education, employment, and indictors of women’s status. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 shows the distribution of women age 15-49 and men age 15-59 by background charac- teristics. The proportions of women and men decline with increasing age, which reflects the young age structure of the Nigerian population. A little more than two-thirds (68 percent) of all women are currently married, and an additional 2 percent are in informal unions (“living together”). One-quarter of women age 15-49 have never been mar- ried, while negligible proportions of women are divorced or separated (3 percent) or widowed (2 percent). Slightly more than half of men are currently married or living together, 45 percent have never been mar- ried, 2 percent are divorced or separated, and 1 percent widowed. With regard to residence, the majority of women and men live in rural areas (approximately two- thirds). Sixty percent of women and 58 percent of men are from the north, while 40 percent of women and 42 percent of men are from the south. The majority of respondents have had some education, however, 42 percent of women and 22 percent of men have never attended school. One-fifth of women and one-quarter of men have attained primary education only, while 37 percent of women and 53 percent of men have attended secondary school or higher. The table also shows that half of all respondents are Muslims, approximately one in seven re- spondents are Catholics, an additional one in seven are Protestants, and one in five say that they follow another Christian church. A negligible proportion belongs to other religions. The ethnic composition of the sample indicates that the Hausa, Igbo, and Yoruba are the major ethnic groups in Nigeria. However, other ethnic groups constitute almost half of the total sample, under- scoring the multiplicity of ethnic groups in Nigeria. 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Table 3.2 provides an overview of the relationship between respondents’ level of education and other background characteristics. The data show that younger respondents are more likely than older re- spondents to have some education. For example, more than twice as many of the oldest women than the youngest women report that they have no education (68 and 29 percent, respectively). Characteristics of Respondents and Women’s Status 23 24 | Characte Table 3.1 Background characteristics of respondents Percent distribution of women and men by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of women Number of men ––––––––––––––––––––– ––––––––––––––––––––– Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 22.5 1,716 1,749 19.3 453 453 20-24 19.6 1,494 1,464 18.2 426 441 25-29 18.1 1,382 1,356 14.0 328 336 30-34 12.4 941 940 12.8 299 280 35-39 10.7 816 798 9.4 220 203 40-44 9.0 688 695 8.8 208 206 45-49 7.7 583 618 6.8 159 167 50-54 na na na 5.7 133 134 55-59 na na na 5.1 120 126 Marital status Never married 25.3 1,926 2,087 44.7 1,048 1,090 Married 68.0 5,182 4,991 50.8 1,191 1,141 Living together 2.0 154 166 2.3 54 55 Divorced/separated 2.9 219 209 1.8 42 47 Widowed 1.8 139 167 0.5 11 13 Residence Urban 34.5 2,629 3,057 37.2 872 986 Rural 65.5 4,991 4,563 62.8 1,474 1,360 Region North Central 14.7 1,121 1,256 14.9 348 416 North East 17.9 1,368 1,413 17.9 421 423 North West 27.5 2,095 1,791 25.7 602 547 South East 9.7 737 1,081 8.8 207 265 South South 17.6 1,342 938 19.0 445 313 South West 12.6 958 1,141 13.7 322 382 Education No education 41.6 3,171 3,005 21.6 507 493 Primary 21.4 1,628 1,666 25.7 603 604 Secondary 31.1 2,370 2,462 40.9 960 966 Higher 5.9 451 487 11.8 276 283 Religion Catholic 13.1 998 1,161 14.3 335 373 Protestant 15.2 1,162 1,300 14.7 345 373 Other Christian 19.6 1,494 1,423 19.5 457 436 Muslim 50.7 3,862 3,601 50.2 1,177 1,125 Other 1.4 104 135 1.3 32 39 Ethnic group Fulani 6.1 463 484 5.9 139 132 Hausa 27.0 2,055 1,735 25.0 586 542 Igbo 13.6 1,037 1,390 13.4 315 382 Kanuri 3.0 232 187 2.5 59 47 Tiv 2.2 170 201 2.2 52 66 Yoruba 11.4 865 1,042 12.0 281 340 Other 36.7 2,797 2,581 38.9 914 837 Wealth quintile Lowest 18.6 1,414 1,479 18.0 423 423 Second 18.9 1,439 1,399 17.8 418 393 Middle 19.9 1,513 1,510 18.6 436 445 Fourth 20.0 1,526 1,544 21.6 507 527 Highest 22.7 1,728 1,688 24.0 563 558 Total 100.0 7,620 7,620 100.0 2,346 2,346 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of education attended, whether or not that level was com- pleted. The ethnic groups are the six largest in the sample and are listed in alphabetical order. na = Not applicable ristics of Respondents and Women’s Status Table 3.2 Educational attainment by background characteristics Percent distribution of women and men by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended or completed ––––––––––––––––––––––––––––––––––––––––––––––––––– Median Com- Some Com- More than Number years Background No Some pleted secon- pleted secon- of of characteristic education primary primary1 dary secondary2 dary Total respondents schooling ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 29.2 11.1 9.9 39.6 8.9 1.4 100.0 1,716 5.8 20-24 33.9 6.6 11.2 17.9 23.0 7.4 100.0 1,494 5.8 25-29 37.8 6.2 14.7 13.4 19.6 8.3 100.0 1,382 5.4 30-34 45.9 8.5 15.3 14.2 9.0 7.2 100.0 941 3.0 35-39 49.9 9.4 15.0 14.2 3.7 7.8 100.0 816 0.0 40-44 58.7 9.9 13.9 9.3 2.5 5.7 100.0 688 0.0 45-49 68.0 13.5 8.4 3.5 1.3 5.2 100.0 583 0.0 Residence Urban 24.9 7.6 12.0 24.3 19.1 12.1 100.0 2,629 7.7 Rural 50.4 9.6 12.7 16.5 8.1 2.7 100.0 4,991 0.0 Region North Central 35.9 12.9 17.1 20.5 9.4 4.2 100.0 1,121 5.1 North East 67.8 8.9 7.6 8.3 5.0 2.4 100.0 1,368 0.0 North West 75.0 5.7 6.1 6.1 4.8 2.2 100.0 2,095 0.0 South East 7.7 10.5 14.3 27.9 27.6 12.1 100.0 737 9.2 South South 8.1 12.5 17.8 34.5 17.5 9.7 100.0 1,342 7.6 South West 10.8 5.0 19.0 33.9 20.3 11.0 100.0 958 8.9 Wealth quintile Lowest 68.7 10.8 10.1 8.7 1.7 0.1 100.0 1,414 0.0 Second 63.3 10.2 11.3 11.5 2.7 1.0 100.0 1,439 0.0 Middle 49.2 10.7 13.4 18.7 6.4 1.6 100.0 1,513 0.9 Fourth 29.2 10.3 15.9 24.2 16.3 4.1 100.0 1,526 5.7 Highest 5.8 3.4 11.5 30.4 28.8 20.1 100.0 1,728 10.9 Total 41.6 8.9 12.5 19.2 11.9 5.9 100.0 7,620 5.0 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 10.4 18.2 6.9 56.3 7.8 0.5 100.0 453 7.0 20-24 12.4 7.6 12.1 30.0 27.6 10.3 100.0 426 8.9 25-29 15.6 7.1 18.0 18.0 22.8 18.5 100.0 328 8.4 30-34 15.3 8.0 18.5 24.4 16.9 17.0 100.0 299 8.3 35-39 23.9 12.2 18.2 17.7 11.7 16.4 100.0 220 6.2 40-44 34.9 9.5 13.3 19.0 4.9 18.4 100.0 208 5.7 45-49 39.7 19.3 9.9 12.4 3.2 15.5 100.0 159 4.8 50-54 44.3 17.0 16.1 8.6 6.6 7.4 100.0 133 2.3 55-59 52.8 12.9 19.9 4.9 1.2 8.2 100.0 120 0.0 Residence Urban 11.2 9.7 13.3 29.7 17.6 18.5 100.0 872 9.1 Rural 27.8 13.1 14.2 25.2 12.0 7.8 100.0 1,474 5.7 Region North Central 13.4 10.0 13.4 36.4 13.8 12.9 100.0 348 6.9 North East 41.9 12.2 10.2 17.6 7.8 10.2 100.0 421 4.7 North West 41.5 16.7 9.7 16.7 6.7 8.9 100.0 602 3.3 South East 2.5 8.4 17.7 33.4 20.7 17.3 100.0 207 9.2 South South 3.0 12.7 18.7 31.7 22.4 11.4 100.0 445 8.6 South West 4.8 5.2 17.9 36.8 20.5 14.9 100.0 322 10.1 Wealth quintile Lowest 42.6 17.8 14.6 16.5 7.9 0.6 100.0 423 2.8 Second 36.2 14.2 13.9 24.1 7.3 4.2 100.0 418 5.1 Middle 24.7 14.4 12.9 28.2 11.7 8.0 100.0 436 5.8 Fourth 11.0 12.6 16.3 29.4 17.0 13.7 100.0 507 8.0 Highest 2.2 2.8 11.8 33.4 22.8 27.0 100.0 563 11.0 Total 21.6 11.8 13.9 26.9 14.1 11.8 100.0 2,346 6.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Characteristics of Respondents and Women’s Status 25 Table 3.2 also shows that the level of education varies by residence. Women in rural areas are disadvantaged and far less likely to be educated than their urban counterparts. One-half of rural women have not attended school, which is twice the proportion of urban women (50 and 25 percent, respec- tively). The urban-rural difference is more pronounced at the level of secondary school or higher. For ex- ample, only 11 percent of women in rural areas have completed secondary school or gone on to post- secondary study, compared with 31 percent of women in urban areas. Among male respondents, those in urban areas also have higher levels of educational attainment. Only 11 percent of urban males compared with 28 percent of their rural counterparts have no formal education. While 36 percent of urban males have completed secondary or higher levels of education, only 20 percent of their rural counterparts have done so. Among both male and female respondents, the level of educational attainment is higher in the south relative to the north. For example, women in the North West are 10 times as likely as women in the South East and South West to say that they have no education. Educational attainment increases as the economic status of the household increases. For example, 69 percent of the women in the poorest households have no formal education compared with just 6 per- cent of women in the most advantaged households. Half of women in the highest wealth quintile have completed secondary or higher levels of education, compared with just 2 percent of women in the lowest quintile. The pattern of men’s educational attainment by economic status is similar. Literacy The ability to read is an important personal asset allowing women and men increased opportuni- ties in life. Knowing the distribution of the literate population can help programme planners know how best to reach women and men with their messages. In the 2003 NDHS, literacy was established by a re- spondent’s ability to read all or part of a simple sentence in any of the major language groups of Nigeria. The test on literacy was only applied to respondents who had less than secondary education, and those with secondary or higher are assumed to be literate. Table 3.3 shows that almost half (48 percent) of women are literate. The level of literacy is much higher for younger women than older women, ranging from a high of 61 percent for women age 15-19 to a low of 22 percent for women age 45-49. Urban women have a higher level of literacy than rural women (68 and 38 percent, respectively). Literacy levels also vary widely among the regions. Patterns of men’s literacy are similar to women’s, although a greater proportion of men are literate (73 percent compared with 48 percent). 26 | Characteristics of Respondents and Women’s Status Table 3.3 Literacy Percent distribution of women and men by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No schooling or primary school –––––––––––––––––––––––––––––––––––––––––––– Secondary Can read Can read Cannot No card Number Background school or whole part of read with required of Percent characteristic higher sentence sentence at all language Missing Total respondents literate1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 49.8 5.4 6.1 37.7 0.8 0.2 100.0 1,716 61.3 20-24 48.3 3.6 4.5 42.4 0.7 0.5 100.0 1,494 56.4 25-29 41.3 5.4 5.2 46.9 1.0 0.2 100.0 1,382 51.9 30-34 30.4 5.2 5.7 58.3 0.3 0.1 100.0 941 41.3 35-39 25.7 7.8 6.4 58.9 1.2 0.1 100.0 816 39.8 40-44 17.5 6.2 7.4 67.8 0.5 0.5 100.0 688 31.1 45-49 10.0 7.9 4.5 75.8 1.2 0.6 100.0 583 22.4 Residence Urban 55.6 6.1 5.9 31.6 0.7 0.2 100.0 2,629 67.5 Rural 27.3 5.2 5.5 60.8 0.9 0.4 100.0 4,991 38.0 Region North Central 34.1 4.9 4.4 55.2 1.1 0.3 100.0 1,121 43.4 North East 15.7 4.2 5.7 72.9 1.3 0.2 100.0 1,368 25.6 North West 13.1 3.1 4.7 78.6 0.1 0.5 100.0 2,095 20.9 South East 67.5 10.6 7.5 14.1 0.1 0.2 100.0 737 85.6 South South 61.7 7.3 6.0 22.6 1.9 0.6 100.0 1,342 75.0 South West 65.2 7.1 6.8 20.5 0.4 0.0 100.0 958 79.1 Total 37.0 5.5 5.6 50.7 0.8 0.3 100.0 7,620 48.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 64.6 4.4 10.2 18.6 2.3 0.0 100.0 453 79.2 20-24 67.9 6.0 6.4 15.0 4.7 0.0 100.0 426 80.3 25-29 59.4 11.0 8.6 16.8 4.3 0.0 100.0 328 78.9 30-34 58.3 8.7 8.7 20.7 3.7 0.0 100.0 299 75.6 35-39 45.7 12.8 11.8 23.7 5.9 0.0 100.0 220 70.4 40-44 42.3 12.0 10.3 27.3 8.1 0.0 100.0 208 64.6 45-49 31.1 14.7 14.2 30.1 9.7 0.2 100.0 159 60.0 50-54 22.6 15.4 17.2 37.9 6.9 0.0 100.0 133 55.2 55-59 14.3 20.5 12.4 42.1 10.7 0.0 100.0 120 47.2 Residence Urban 65.8 11.3 9.7 9.3 3.9 0.0 100.0 872 86.8 Rural 45.0 8.8 10.2 30.0 6.0 0.0 100.0 1,474 64.0 Region North Central 63.1 6.9 5.2 24.6 0.2 0.0 100.0 348 75.2 North East 35.7 13.9 10.4 37.8 2.2 0.0 100.0 421 59.9 North West 32.2 8.0 15.5 27.2 17.1 0.0 100.0 602 55.7 South East 71.4 5.7 15.8 7.0 0.0 0.2 100.0 207 92.9 South South 65.6 6.7 8.2 18.1 1.4 0.0 100.0 445 80.5 South West 72.1 17.4 3.5 5.9 1.1 0.0 100.0 322 93.0 Total 52.7 9.7 10.0 22.3 5.2 0.0 100.0 2,346 72.5 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Refers to respondents who attended secondary school or higher and respondents who can read a whole sentence or part of a sentence Characteristics of Respondents and Women’s Status 27 3.3 ACCESS TO MASS MEDIA The 2003 NDHS collected information on the exposure of respondents to common print and elec- tronic media. Respondents were asked how often they read a newspaper, listen to the radio, or watch tele- vision. These data are important because they provide an indication of the extent to which Nigerians are regularly exposed to the mass media, which are often used to disseminate messages on family planning and other health topics. Tables 3.4.1 and 3.4.2 show that slightly more than one-third of both women and men are not ex- posed to any media. However, a majority of all respondents listen to the radio at least once a week, and more than one-third watch television at least once a week. About one in ten respondents reads a newspa- per weekly. As expected, women and men living in urban areas are much more likely to be exposed to mass media. The proportion of women who are exposed to any media at least once a week declines with age. Urban respondents are more likely than rural respondents to be exposed to all three types of media. Among the regions, exposure to all three types of media is highest among those who live in the south compared with their northern counterparts. There is a positive relationship between the level of education and exposure to mass media. Similarly, wealth quintile is positively related to exposure to mass media. For instance, whereas 65 percent of women in the lowest quintile have no weekly exposure to any media source, just 6 percent of those in the highest quintile have no exposure. The corresponding figures for the male respondents are 59 and 13 percent, respectively. 28 | Characteristics of Respondents and Women’s Status Table 3.4.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure ––––––––––––––––––––––––––––––––– Reads a Watches Listens to No newspaper television the radio exposure at least at least at least All three to Number Background once once once specified specified of characteristic a week a week a week media media women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 12.2 41.3 58.4 10.3 34.4 1,716 20-24 17.7 40.9 65.0 14.7 28.9 1,494 25-29 12.8 39.4 61.5 10.3 30.8 1,382 30-34 10.6 31.2 57.7 9.5 38.3 941 35-39 9.8 33.2 59.7 7.7 37.5 816 40-44 7.6 24.8 51.7 6.1 45.0 688 45-49 6.2 23.8 51.1 5.3 45.4 583 Residence Urban 21.1 63.1 73.0 18.6 18.4 2,629 Rural 7.3 21.6 51.8 5.5 44.2 4,991 Region North Central 7.7 28.0 44.7 6.4 48.6 1,121 North East 4.8 15.9 34.1 3.0 61.0 1,368 North West 6.7 23.8 70.9 5.6 27.1 2,095 South East 25.9 50.9 69.4 21.4 24.2 737 South South 19.2 53.9 59.2 16.1 30.9 1,342 South West 18.5 63.5 78.3 16.5 15.6 958 Education No education 0.1 12.0 47.2 0.1 50.2 3,171 Primary 3.7 32.0 54.5 2.7 39.2 1,628 Secondary 24.8 62.0 72.9 20.5 18.3 2,370 Higher 59.0 81.2 88.0 51.3 5.6 451 Wealth quintile Lowest 1.0 3.6 33.5 0.4 64.8 1,414 Second 3.2 8.0 45.0 2.1 53.0 1,439 Middle 5.2 17.8 57.7 2.9 39.7 1,513 Fourth 13.4 52.6 70.6 10.4 19.8 1,526 Highest 33.2 86.8 83.1 30.3 6.2 1,728 Total 12.1 35.9 59.2 10.0 35.3 7,620 Characteristics of Respondents and Women’s Status 29 Table 3.4.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure ––––––––––––––––––––––––––––––––– Reads a Watches Listens to No newspaper television the radio exposure at least at least at least All three to Number Background once once once specified specified of characteristic a week a week a week media media men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 10.6 39.6 61.4 6.9 32.0 453 20-24 12.8 37.7 60.9 8.9 33.8 426 25-29 14.6 35.8 57.7 12.2 37.9 328 30-34 11.7 42.3 63.1 10.5 33.0 299 3.4 EM Li cially if it puts them ficult. The difficulty a arms, fam- ily busines yment, and hence not rvey asked women se ge of em- ployment e currently working an itional in- formation ntinuously throughou ings. Men were also a 30 | Characteristics of R 35-39 6.1 29.6 51.7 5.7 45.7 220 40-44 13.3 32.9 53.4 12.2 39.8 208 45-49 13.3 37.1 56.8 9.2 37.4 159 50-54 6.0 41.4 58.3 5.2 33.1 133 55-59 10.4 30.0 51.9 8.7 42.6 120 Residence Urban 19.8 59.0 72.1 15.4 20.3 872 Rural 6.5 24.0 50.3 5.2 45.6 1,474 Region North Central 8.4 34.8 50.0 6.6 44.2 348 North East 3.1 13.5 31.8 1.8 65.6 421 North West 7.7 27.5 70.4 5.9 26.8 602 South East 22.3 46.6 72.5 19.3 25.0 207 South South 14.3 51.4 53.6 11.4 35.1 445 South West 21.5 61.7 77.5 16.7 15.8 322 Education No education 4.9 16.3 48.9 4.0 48.5 507 Primary 9.1 32.1 54.1 6.9 39.6 603 Secondary 14.0 45.1 63.7 10.4 30.7 960 Higher 19.7 57.6 67.0 17.4 25.3 276 Wealth quintile Lowest 2.1 11.0 38.6 1.5 59.4 423 Second 3.8 13.0 43.2 1.7 53.1 418 Middle 6.1 23.2 56.7 4.3 39.5 436 Fourth 14.8 50.6 64.2 11.4 26.5 507 Highest 25.2 72.7 80.7 21.3 12.5 563 Total 11.4 37.0 58.4 9.0 36.2 2,346 PLOYMENT ke education, employment can also be a source of empowerment for women, espe in control of income. The measurement of women’s employment, however, is dif rises largely because some of the work that women do, especially work on family f ses, or in the informal sector, is often not perceived by women themselves as emplo reported as such. To avoid underestimating women’s employment, the NDHS su veral questions to probe for their employment status and to ensure complete covera in any sector, formal or informal. Employed women are those who say that they ar d those who worked at any time during the 12 months preceding to the survey. Add was also obtained on the type of work women were doing, whether they worked co t the year, whom they worked for, and the form in which they received their earn sked about employment. espondents and Women’s Status Tables 3.5.1 and 3.5.2 show the percent distribution of women and men by employment status, according to background characteristics. Fifty-six percent of women reported being currently employed and additio omen (42 percent) di currently employed, y. Figure 3.1 shows nal 2 percent worked during the 12 months prior to the survey. About two in five w d not work at all in the 12 months preceding the survey. Seventy percent of men are while an additional 3 percent were employed in the 12 months preceding the surve the distribution of women and men by current employment status. Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months Not preceding the survey employed –––––––––––––––––– in the 12 Not months Number Background Currently currently preceding of characteristic employed employed the survey Missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 24.8 2.0 73.1 0.1 100.0 1,716 20-24 47.0 2.8 50.1 0.1 100.0 1,494 25-29 63.4 2.0 34.7 0.0 100.0 1,382 30-34 70.7 2.4 26.9 0.1 100.0 941 35-39 78.2 1.8 20.0 0.0 100.0 816 40-44 75.4 1.5 23.0 0.0 100.0 688 45-49 77.4 2.5 20.1 0.0 100.0 583 Marital status Never married 30.6 2.4 67.0 0.0 100.0 1,926 Married or living together 64.4 2.1 33.4 0.1 100.0 5,336 Divorced/separated/widowed 70.7 1.7 27.6 0.0 100.0 358 Number of living children 0 34.4 2.8 62.8 0.0 100.0 2,499 1-2 57.3 1.7 40.8 0.1 100.0 2,009 3-4 69.0 1.9 29.0 0.1 100.0 1,526 5+ 76.5 2.0 21.5 0.0 100.0 1,586 Residence Urban 57.8 2.2 40.0 0.0 100.0 2,629 Rural 55.3 2.2 42.5 0.1 100.0 4,991 Region North Central 63.2 1.8 35.0 0.0 100.0 1,121 North East 50.0 4.7 45.1 0.2 100.0 1,368 North West 51.5 1.4 47.1 0.0 100.0 2,095 South East 57.0 1.9 41.0 0.0 100.0 737 South South 55.0 1.8 43.2 0.0 100.0 1,342 South West 67.8 1.5 30.8 0.0 100.0 958 Education No education 56.4 2.2 41.2 0.1 100.0 3,171 Primary 65.9 2.1 32.0 0.0 100.0 1,628 Secondary 48.0 2.1 49.9 0.0 100.0 2,370 Higher 61.7 2.0 36.3 0.0 100.0 451 Total 56.1 2.2 41.6 0.1 100.0 7,620 Characteristics of Respondents and Women’s Status 31 Ta s for both men and w p. Women who are di by those who are m to be em- ployed (31 yed, com- pared with children a woman ha en are the least likely g children are employ 32 | Characteristics of R bles 3.5.1 and 3.5.2 show that current employment increases with age of respondent omen, although the percentage of men employed declines among the oldest age grou vorced, separated, or widowed are most likely to be employed (71 percent), followed arried or living together (64 percent), while never-married women are the least likely percent). Also, 94 percent of men who are currently or formerly married are emplo 40 percent of never-married men. Table 3.5.1 shows that as the number of living s increases, the proportion who work also increases. Women with no living childr to be employed (34 percent). Similarly, twice as many men with one or more livin ed than men with no children. Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months Not preceding the survey employed –––––––––––––––––– in the 12 Not months Number Background Currently currently preceding of characteristic employed employed the survey Missing Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 25.4 2.6 68.3 3.7 100.0 453 20-24 49.6 6.6 43.4 0.5 100.0 426 25-29 73.4 4.3 21.8 0.5 100.0 328 30-34 90.6 2.5 6.9 0.0 100.0 299 35-39 95.1 2.4 1.6 0.9 100.0 220 40-44 96.9 1.9 1.2 0.0 100.0 208 45-49 97.0 0.9 2.1 0.0 100.0 159 50-54 96.6 0.0 3.4 0.0 100.0 133 55-59 88.4 0.0 11.4 0.2 100.0 120 Marital status Never married 39.9 4.6 53.6 1.9 100.0 1,048 Married or living together 94.0 1.9 4.0 0.2 100.0 1,245 Divorced/separated/widowed 93.8 1.8 4.4 0.0 100.0 53 Number of living children 0 46.0 4.2 48.1 1.7 100.0 1,168 1-2 90.7 3.0 6.3 0.0 100.0 379 3-4 93.4 2.4 3.5 0.6 100.0 316 5+ 95.5 1.0 3.4 0.1 100.0 482 Residence Urban 64.8 2.8 31.6 0.8 100.0 872 Rural 72.7 3.2 22.9 1.1 100.0 1,474 Region North Central 61.8 2.0 36.0 0.2 100.0 348 North East 84.9 3.6 11.1 0.5 100.0 421 North West 80.6 4.5 13.6 1.3 100.0 602 South East 67.9 3.2 28.0 0.9 100.0 207 South South 51.8 2.9 42.8 2.4 100.0 445 South West 64.4 1.2 34.5 0.0 100.0 322 Education No education 96.3 1.2 2.1 0.4 100.0 507 Primary 80.2 2.1 16.8 0.9 100.0 603 Secondary 51.1 4.1 43.3 1.5 100.0 960 Higher 63.3 5.1 31.2 0.4 100.0 276 Total 69.8 3.1 26.2 1.0 100.0 2,346 espondents and Women’s Status Figure 3.1 Employment Status of Women and Men Women Men Currently employed 56% Not currently employed 2% Not employed in the 12 months preceding the survey 42% Not employed in the 12 months preceding the survey 26% Currently employed 70% Not currently employed 3% NDHS 2003Note: Totals May not add to 100 because of missing cases. The percentage of men currently employed is significantly higher in rural areas than in urban ar- eas (73 and 65 percent, respectively). Women’s employment does not vary greatly by urban-rural resi- dence. There is significant difference, however, in levels of employment by region of residence. For ex- ample, employment among women ranges from a low of 50 percent in the North East to a high of 68 per- cent in the South West. Among men, employment ranges from a low of 52 percent in the South South to a high of 85 percent in the North East. There is no uniform pattern of employment status by level of educa- tion. Occupation Respondents who are currently employed or worked within the year before the survey were asked to state their occupation. Table 3.6.1 shows that the sales and services sector employs more than half (56 percent) of work- ing women. In addition, 21 percent of working women are in agriculture, 10 percent work at skilled man- ual jobs, and 8 percent are engaged in professional, technical, and managerial work. Negligible propor- tions of working women are engaged in unskilled manual labour (3 percent), clerical jobs (2 percent), or domestic service (1 percent). Table 3.6.2 shows that the highest proportion of men work in agriculture (38 percent), followed by skilled manual occupations (21 percent) and sales and services (19 percent). Twice as many men as women are employed in the professional, technical, or managerial sector (16 and 8 per- cent, respectively). The majority of women are employed in sales and services regardless of urban-rural residence. Urban women, however, are more likely than rural women to be employed in either the skilled manual or professional sectors, while rural women are more likely to be in agriculture. More than half of rural men work in agriculture; eight in ten urban men are working in the professional, sales and services, or skilled manual sectors. There is considerable variation by geopolitical region. For example, men in the north are more likely to be in agriculture compared with those in the south. In general, southern women and men are more likely to be in professional/technical/managerial occupations than their northern counterparts, perhaps reflecting differential levels of education. Characteristics of Respondents and Women’s Status 33 Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to back- round characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Number Background technical/ and Skilled skilled Domestic Agri- of characteristic managerial Clerical services manual manual service culture Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 2.5 1.7 53.3 9.6 5.5 4.6 22.8 100.0 459 20-24 7.3 2.1 53.8 13.9 3.8 1.5 17.5 100.0 744 25-29 7.7 1.8 57.3 14.6 2.0 0.5 16.1 100.0 903 30-34 7.8 1.7 56.6 11.2 2.1 1.1 19.6 100.0 688 35-39 9.9 2.0 60.7 6.5 2.0 1.1 17.8 100.0 653 40-44 11.2 1.3 54.4 3.0 1.7 1.3 26.7 100.0 530 45-49 9.0 0.5 55.4 2.0 1.8 0.3 30.9 100.0 466 Marital status Never married 11.8 4.8 44.2 13.0 5.6 3.3 17.2 100.0 635 Married or living together 7.2 1.0 58.7 9.2 2.2 1.0 20.7 100.0 3,548 Divorced/separated/ widowed 10.0 2.7 49.5 6.4 1.4 2.0 28.0 100.0 259 Number of living children 0 9.8 3.7 49.7 12.2 4.9 3.1 16.6 100.0 930 1-2 8.0 1.3 54.8 13.8 2.4 1.0 18.7 100.0 1,186 3-4 6.5 1.0 61.4 8.0 1.9 0.9 20.4 100.0 1,082 5+ 8.0 1.1 57.6 4.9 1.8 0.8 25.6 100.0 1,245 Residence Urban 13.2 3.4 58.0 13.3 3.5 1.6 7.0 100.0 1,576 Rural 5.1 0.7 55.1 7.5 2.1 1.2 28.1 100.0 2,867 Region North Central 7.0 0.6 45.2 6.5 2.2 1.8 36.7 100.0 728 North East 4.6 1.2 63.5 11.4 1.1 2.0 16.2 100.0 749 North West 3.3 0.4 68.3 12.9 4.3 1.4 9.4 100.0 1,107 South East 15.2 3.7 45.1 8.1 2.1 0.3 25.5 100.0 434 South South 12.0 2.9 42.8 8.1 3.3 0.7 30.0 100.0 761 South West 11.5 2.7 61.9 7.8 1.7 1.6 12.7 100.0 663 Education No education 0.7 0.1 64.3 8.6 2.4 1.6 22.4 100.0 1,860 Primary 3.3 0.8 53.7 8.3 2.4 1.2 30.1 100.0 1,108 Secondary 11.3 3.5 54.2 12.6 3.6 1.2 13.6 100.0 1,188 Higher 59.9 8.0 20.1 8.0 1.4 1.1 1.6 100.0 287 Total 8.0 1.7 56.1 9.5 2.6 1.4 20.6 100.0 4,443 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Percentages may not add to 100 due to missing cases (no more than 0.3 percent of cases in any category). 34 | Characteristics of Respondents and Women’s Status Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Number Background technical/ and Skilled skilled Domestic Agri- of characteristic managerial Clerical services manual manual service culture Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.0 0.0 12.1 29.9 7.7 0.3 50.0 100.0 127 20-24 5.0 0.5 22.9 26.7 11.4 0.0 33.4 100.0 239 Earn d the cont al or nona nflu- ence 25-29 13.3 1.5 26.7 22.3 3.2 0.9 32.0 100.0 255 30-34 18.6 0.7 20.9 22.3 5.0 0.2 32.4 100.0 279 35-39 25.2 0.0 20.5 12.9 5.1 0.0 36.3 100.0 215 40-44 23.3 3.4 15.0 18.0 2.8 0.0 37.4 100.0 205 45-49 23.5 2.4 8.8 23.1 3.0 0.0 39.2 100.0 156 50-54 15.4 2.7 13.9 16.5 4.0 0.0 47.4 100.0 128 55-59 14.5 0.4 12.7 12.0 3.5 0.0 56.9 100.0 106 Marital status Never married 9.5 0.9 21.2 29.1 7.7 0.6 31.0 100.0 466 Married or living together 18.4 1.4 17.4 17.4 4.2 0.0 41.1 100.0 1,193 Divorced/separated/ widowed 14.5 0.0 19.9 23.3 7.1 0.0 35.2 100.0 50 Number of living children 0 12.6 0.7 22.5 24.8 7.8 0.5 31.1 100.0 586 1-2 14.5 1.0 21.4 20.0 6.4 0.1 36.6 100.0 355 3-4 19.0 2.2 15.0 21.1 3.3 0.0 39.3 100.0 303 5+ 19.1 1.4 13.5 16.2 2.4 0.0 47.5 100.0 465 Residence Urban 23.3 2.0 26.5 32.0 6.3 0.5 9.4 100.0 590 Rural 12.0 0.9 14.3 14.9 4.7 0.0 53.3 100.0 1,120 Region North Central 17.3 1.2 14.1 21.2 3.8 0.2 42.1 100.0 222 North East 15.9 1.0 19.0 18.4 2.8 0.0 43.0 100.0 372 North West 8.3 0.5 17.5 13.1 7.9 0.0 52.7 100.0 513 South East 22.4 0.3 30.4 25.2 10.2 0.0 11.5 100.0 147 South South 21.1 4.3 18.6 23.7 1.6 1.1 29.5 100.0 244 South West 22.4 0.7 16.0 36.9 5.3 0.0 18.7 100.0 211 Education No education 3.8 0.0 11.8 13.8 3.0 0.0 67.6 100.0 494 Primary 6.7 1.3 16.5 31.8 4.1 0.0 39.7 100.0 496 Secondary 13.3 2.5 29.7 23.4 8.9 0.6 21.7 100.0 530 Higher 79.0 1.0 9.9 3.1 3.8 0.0 3.3 100.0 189 Total 15.9 1.3 18.5 20.8 5.2 0.2 38.1 100.0 1,709 ings, Employers, and Continuity of Employment Table 3.7.1 presents information on women’s employment status, the form of earnings, an inuity of employment. The table takes into account whether women are involved in agricultur gricultural occupations, since all of the employment variables shown in the table are strongly i d by the sector in which a woman is employed. Characteristics of Respondents and Women’s Status 35 Table 3.7.1 Type of employment: women Percent distribution of women employed in the 12 months pre- ceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Agri- Nonagri- Employment cultural cultural characteristic work work Total –––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 24.5 88.5 75.3 Cash and in-kind 21.6 5.7 9.0 In-kind only 8.8 0.7 2.4 Not paid 45.0 4.4 12.8 Missing 0.2 0.7 0.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 25.6 8.5 12.0 Employed by nonfamily member 2.0 15.1 12.4 Self-employed 72.4 75.7 75.0 Missing 0.0 0.8 0.6 Total 100.0 100.0 100.0 Continuity of employment All year 38.3 77.0 69.0 Seasonal 59.3 14.3 23.6 Occasional 2.1 7.9 6.7 Missing 0.3 0.8 0.7 Total 100.0 100.0 100.0 Number of women 916 3,525 4,443 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 2 women with missing information on type of employment who are not shown separately Table 3.7.2 Type of employment: men Percent distribution of men employed in the 12 months preced- ing the survey by type of earnings, according to type of employ- ment (agricultural or nonagricultural), Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Agri- Nonagri- Employment cultural cultural characteristic work work Total –––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 18.6 84.9 59.6 Cash and in-kind 19.5 6.2 11.3 In-kind only 8.6 1.7 4.3 Not paid 53.3 4.7 23.3 Missing 0.0 2.5 1.5 Total 100.0 100.0 100.0 Number of men 652 1,057 1,709 The data show that almost half of women employed in agricultural work are not paid (45 percent). A majority of women in this sector report that they are self-employed (72 percent) and that they work seasonally (59 percent). Among women employed in nonagricultural work, most earn cash only (89 percent), say that they are self-employed (76 percent) and work all year (77 percent). Information was also collected on men’s earnings (Table 3.7.2 and Figure 3.2). Similar to women, the majority of men in agriculture (53 percent) state that they are not paid for their work, while 85 percent of those in nonagricul- tural jobs state they earn cash only. 36 | Characteristics of Respondents and Women’s Status Figure 3.2 Type of Earnings of Employed Women and Men Women Men Cash only 75% Not paid 13% Cash and in-kind 9% Not paid 23% Cash only 60% In-kind only 2% Cash and in-kind 11% In-kind only 4% NDHS 2003Note: Total may not add to 100 because of missing cases. 3.5 MEASURES OF WOMEN’S EMPOWERMENT Decision on Use of Earnings As means of assessing women’s autonomy, respondents in the 2003 NDHS who had received cash earnings for work in the 12 months before the survey were asked who mainly decides how these earnings will be used. This information allows the assessment of women’s control over their own earn- ings. In addition, they were asked about the proportion of household expenditures supported by their earn- ings. This information not only allows an evaluation of the relative importance of women’s earnings in the household economy, but has implications for the empowerment of women. It is expected that em- ployment and earnings are more likely to empower women if their earnings are important for meeting the needs of their households. Table 3.8 shows women’s degree of control over the use of their earnings and the extent to which the earnings of women meet household expenditures by background characteristics. Almost three-quarters of women who receive cash earnings report that they alone decide how their earnings are used, and an additional 16 percent say that they decide jointly with their husband or someone else. Only 10 percent of women report that someone else decides how their earnings will be used. Women age 15-19 are more likely than older women to report that someone else decides how their earnings are to be used. Almost all women who are divorced, separated, or widowed say that they alone are responsible for deciding how to use their earnings. Among currently married women, seven out of ten report that they alone decide how their earnings are used, while one-fifth say that such decisions are made jointly with their husbands or someone else. More than three-quarters of never-married women make independent decisions on how to use their earnings. The data suggest that the proportion of women who make joint decisions with their husbands or someone else increases with parity. More urban women than rural women report that they alone decide how to spend their earnings, although the difference is not great (78 and 71 percent, respectively). Among the geopolitical regions, women in North West and South West are most likely to decide on how to use their earnings relative to women i other regions. Surprisingly, there is no difference by level of education. n Characteristics of Respondents and Women’s Status 37 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person who decides Proportion of household how earnings are used expenditures met by earnings ––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––– Someone Almost Less Half Number Background Self else none/ than or of characteristic only Jointly1 only2 Missing Total none half more All Missing Total women 38 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 62.8 14.7 22.1 0.4 100.0 41.2 31.2 23.3 2.7 1.6 100.0 330 20-24 77.7 10.4 11.9 0.0 100.0 32.9 31.9 28.6 6.4 0.2 100.0 591 25-29 74.1 17.1 8.5 0.3 100.0 27.5 36.1 28.8 7.6 0.0 100.0 801 30-34 75.1 16.2 8.6 0.1 100.0 19.4 33.7 38.2 8.6 0.1 100.0 605 35-39 72.5 18.2 9.3 0.0 100.0 17.8 38.1 36.8 7.3 0.0 100.0 589 40-44 69.8 21.5 8.7 0.0 100.0 13.9 26.5 42.9 16.3 0.4 100.0 441 45-49 77.0 17.8 5.1 0.1 100.0 15.9 32.2 37.7 13.8 0.4 100.0 388 Marital status Never married 78.0 7.2 14.8 0.0 100.0 33.8 22.5 31.9 11.5 0.3 100.0 462 Married or living together 71.0 19.0 9.9 0.1 100.0 23.1 36.7 34.2 5.8 0.3 100.0 3,062 Divorced/separated/ widowed 97.4 0.4 2.1 0.2 100.0 14.3 11.1 30.0 44.2 0.4 100.0 220 Number of living children 0 73.8 11.2 14.8 0.2 100.0 37.9 26.0 28.1 7.8 0.2 100.0 704 1-2 75.0 15.4 9.6 0.0 100.0 23.6 34.8 32.7 8.2 0.6 100.0 1,015 3-4 75.2 16.4 8.0 0.3 100.0 22.0 36.0 32.9 9.0 0.1 100.0 966 5+ 69.9 20.9 9.2 0.0 100.0 16.7 34.7 38.9 9.6 0.1 100.0 1,059 Residence Urban 77.8 14.2 8.0 0.0 100.0 22.2 31.9 35.5 10.4 0.0 100.0 1,414 Rural 70.7 17.8 11.3 0.2 100.0 24.9 34.4 32.6 7.8 0.4 100.0 2,331 Region North Central 64.9 14.9 19.8 0.5 100.0 23.6 31.2 39.1 6.1 0.0 100.0 515 North East 71.0 18.8 10.1 0.1 100.0 43.7 31.2 22.0 2.9 0.3 100.0 656 North West 80.6 14.0 5.3 0.1 100.0 25.6 44.4 26.7 2.7 0.7 100.0 1,053 South East 74.5 18.4 7.1 0.1 100.0 17.9 38.3 33.8 9.8 0.3 100.0 296 South South 63.5 23.3 13.2 0.0 100.0 8.3 23.0 43.6 25.0 0.0 100.0 617 South West 80.2 11.6 8.2 0.0 100.0 18.8 26.9 43.4 11.0 0.0 100.0 607 Education No education 74.9 16.2 8.6 0.3 100.0 29.9 37.1 27.4 5.1 0.5 100.0 1,612 Primary 71.1 17.3 11.6 0.0 100.0 18.0 31.5 38.1 12.3 0.1 100.0 886 Secondary 72.6 15.8 11.6 0.0 100.0 21.2 31.6 37.1 9.9 0.1 100.0 972 Higher 74.6 17.0 8.4 0.0 100.0 17.5 24.1 44.0 14.4 0.0 100.0 274 Total 73.4 16.4 10.1 0.1 100.0 23.9 33.4 33.7 8.7 0.3 100.0 3,744 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 With husband or someone else 2 Includes husband Table 3.8 also shows the proportion of household expenditures met by earnings. More than half of women who receive cash earnings say that less than half or none of their household expenditures are met by their earnings. One-third of the women say their earnings contribute to half or more of their household expenditures. Only 9 percent of the women say that their earnings meet all household expendi- tures. Younger women are more likely to contribute nothing or almost nothing, while older women are more likely to meet all household expenditures. Divorced, separated, and widowed women are more | Characteristics of Respondents and Women’s Status likely to meet all household expenditures with their earnings, compared with never married or currently married women. Table 3.9 shows the relationship between women’s control over earnings and their contribution to household expenditures based on marital status. Seventy-one percent of women who are currently married or living together with their partner, decide by themselves how their earnings are used, while almost one- fifth decide jointly with their husband or partner. One in ten women says that her husband alone decides. Eighty-four percent of unmarried women report that they alone decide how their earnings are used, while 11 percent report that someone else only makes the decision. The greater a woman’s contribution to household expenditures, the more likely she is to decide jointly with her husband how earnings are used. It is notable that one in ten women who contribute at least half of the money used for household expendi- tures say that their husband alone decides how their money is used. In addition to information on women’s education, employment status, and earnings control, the 2003 NDHS also obtained information from both women and men on other measures of women’s em- powerment and status. Specifically, questions were asked on women’s participation in household deci- sionmaking, on acceptance of wife-beating, and on opinions about when a wife should be able to refuse to have sex with her husband. These data provide insights into women’s control over their environment and their attitudes toward gender roles; both factors are relevant to understanding women’s health behaviours and outcomes. Table 3.9 Women’s control over earnings Percent distribution of women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to marital status, and the proportion of household expenditures met by earnings, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married1 ––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––– Jointly Jointly Jointly Some- Contribution with with Hus- Someone Number with one Number to household Self hus- someone band else of Self someone else of expenditures only band else only only Total women only else only Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Almost none/none 84.3 8.5 0.5 5.7 0.6 100.0 708 83.2 4.2 12.6 100.0 188 Less than half 73.2 16.0 1.2 9.1 0.4 100.0 1,122 77.8 6.0 16.3 100.0 129 Half or more 63.2 23.5 0.6 11.5 1.1 100.0 1,047 83.7 6.5 9.7 100.0 213 All 49.4 39.7 0.3 10.4 0.3 100.0 177 92.6 2.2 5.2 100.0 150 Total 71.0 18.2 0.8 9.2 0.7 100.0 3,062 84.2 5.0 10.7 100.0 682 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Totals include 8 currently married women and 2 unmarried women with missing information on contribution to household expen- ditures. Percentages for currently married women may not add to 100 due to missing cases (no more than 0.3 percent of cases in any category). 1 Never-married, divorced, separated, or widowed women Household Decisionmaking To assess women’s decisionmaking autonomy, information was collected on women’s participa- tion in seven different types of decisions: the respondent’s own health care, making large household pur- chases, making household purchases for daily needs, visits to family or friends, what food should be cooked each day, and children’s health care and education. The ability of women to make decisions that affect the circumstances of their own lives is an essential aspect of empowerment. Table 3.10 shows the percent distribution of women according to who in the household usually has the final say on each one of the different types of decisions. Characteristics of Respondents and Women’s Status 39 Among married women, decisionmaking is highly dominated by husbands. For each specified de- cision, the majority of women state that their husband has the final say. At least two-thirds of women state that their husband alone makes decisions regarding the children’s health care and education, large household purchases, and even the respondent’s own health care. Women are most likely to have a final say in what food to cook each day—46 percent state that they alone or jointly decide what to cook— followed by visits to friends and relatives (38 percent), and daily household purchases (33 percent). Among unmarried women, the majority also report that, when applicable, someone else has the final say in each of the specified decisions. Table 3.10 Women’s participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to current marital status and type of deci- sion, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married 1 ––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––– Decision Decision Jointly Jointly Some- not Jointly Some- not with with Hus- one made/not Number with one made/not Number Self hus- someone band else appli- of Self someone else appli- of Decision only band else only only cable Total women only else only cable Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Own health care 12.8 10.3 0.1 73.4 3.1 0.1 100.0 5,336 22.5 4.7 67.0 5.7 100.0 2,284 Large household purchases 7.1 12.4 0.1 77.5 2.6 0.2 100.0 5,336 16.4 5.4 65.2 13.0 100.0 2,284 Daily household purchases 19.0 13.9 0.2 64.5 2.4 0.0 100.0 5,336 18.4 5.3 64.0 12.1 100.0 2,284 Visits to family or relatives 17.7 20.4 0.2 59.7 1.7 0.2 100.0 5,336 23.1 6.1 62.1 8.6 100.0 2,284 What food to cook each day 33.5 11.7 0.8 51.0 2.9 0.0 100.0 5,336 19.8 6.0 62.8 11.3 100.0 2,284 Children's health care 9.3 17.3 0.3 66.8 2.1 4.1 100.0 5,336 13.8 4.3 36.2 45.6 100.0 2,284 Children's education 4.8 16.5 0.3 67.7 2.0 8.6 100.0 5,336 13.3 4.6 35.3 46.7 100.0 2,284 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Never-married, divorced, separated, or widowed women Table 3.11.1 and Figure 3.3 show how participation in decisionmaking varies by background characteristics. Women are considered to participate in a decision if they alone or jointly with a husband or someone else have the final say in that decision. The results indicate that just 14 percent of women par- ticipate in all of the five specified decisions, while 46 percent of women report that they do not participate in any of the decisions. The table shows that women’s involvement in all the specified decisions increases with age, from a low of 5 percent among women age 15-19 to a high of 31 percent among women age 45- 49. Divorced, separated, or widowed women are much more likely to be involved in all types of decisions than currently married women and never-married women (56, 13, and 11 percent, respectively). Women who have no living children, no education, those living in rural areas and in the north, and those who are not employed are the least likely to participate in all the specified decisions. 40 | Characteristics of Respondents and Women’s Status Table 3.11.1 Women’s participation in decisionmaking by background characteristics: women Percentage of women who say that they alone or jointly have the final say in specific decisions, by background charac- teristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Alone or jointly has final say in: ––––––––––––––––––––––––––––––––––––––––––––––– Making What None Own Making daily Visits to food All of the Number Background health large pur- family or to cook specified specified of characteristic care purchases chases relatives each day decisions decisions women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 9.7 6.3 8.3 16.1 15.5 4.6 73.8 1,716 20-24 19.7 13.3 21.0 27.1 31.2 8.8 53.4 1,494 25-29 25.2 20.6 35.8 39.6 45.5 13.7 37.7 1,382 30-34 29.9 25.9 38.6 45.4 50.6 19.0 34.3 941 35-39 33.1 31.2 44.1 47.4 55.2 22.6 32.3 816 40-44 34.6 32.9 46.9 46.3 54.3 22.8 33.2 688 45-49 45.8 39.3 52.5 59.4 65.0 30.8 22.9 583 Marital status Never married 20.1 14.2 16.4 21.2 18.2 10.8 68.8 1,926 Married or living together 23.3 19.6 33.0 38.3 46.0 13.0 40.0 5,336 Divorced/separated/ widowed 65.7 62.8 63.6 72.1 66.3 56.0 20.6 358 Number of living children 0 17.2 12.7 16.3 22.8 21.2 9.0 65.6 2,499 1-2 25.0 19.9 31.2 36.4 43.5 14.7 41.8 2,009 3-4 27.5 23.1 37.2 42.8 49.0 16.1 36.8 1,526 5+ 32.4 30.1 44.2 47.7 56.1 21.1 31.1 1,586 Residence Urban 30.3 24.4 36.3 40.3 44.6 17.9 41.1 2,629 Rural 21.4 18.1 27.0 33.0 37.4 12.6 49.1 4,991 Region North Central 21.3 12.7 26.1 23.2 39.5 8.8 50.6 1,121 North East 12.4 11.4 15.3 39.8 38.8 6.8 46.9 1,368 North West 13.1 11.7 16.8 28.0 26.4 8.4 57.5 2,095 South East 48.9 42.9 59.0 57.1 57.6 34.9 30.9 737 South South 32.7 31.2 44.4 36.7 47.6 21.4 41.2 1,342 South West 39.8 28.0 43.8 42.3 47.2 19.7 35.4 958 Education No education 17.5 14.6 20.7 32.7 34.8 10.2 50.5 3,171 Primary 30.1 28.4 41.8 40.7 49.7 19.7 39.1 1,628 Secondary 26.1 19.9 31.2 32.4 37.1 14.2 49.4 2,370 Higher 44.7 33.3 50.1 53.5 55.4 26.8 28.0 451 Employment Not employed 12.4 8.6 12.3 21.3 22.2 6.2 66.5 3,326 Employed for cash 35.4 30.6 44.8 48.1 53.7 22.0 30.0 3,630 Employed, not for cash 25.5 22.9 41.9 37.3 54.3 15.4 34.8 622 Total 24.5 20.3 30.2 35.5 39.9 14.4 46.4 7,620 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 42 cases with missing information on employment. Characteristics of Respondents and Women’s Status 41 46 16 13 6 5 14 None 1 2 3 4 5 Number of decisions 0 10 20 30 40 50 60 Percent of women Figure 3.3 Number of Decisions in Which Women Participate in the Final Say NDHS 2003 The 2003 NDHS also sought men’s opinions concerning women’s participation in decisionmak- ing in five specified areas. Table 3.11.2 shows that only 5 percent of men said a wife should participate in all decisions either alone or jointly, while 42 percent said that she should not participate in any decision. Among the five specified decisions, men were most likely to think that women should participate in the decision on how many children to have (44 percent), followed by visits to family or relatives and how to spend her money (31 and 26 percent, respectively). More rural men (46 percent) disapprove of wives’ participation in any of the specified decisions than urban men (36 percent). There is significant variation by region with the South West, South East, and North Central having lower proportions of men who believe wives should not participate in any decisions. The data indicate that men with higher education are more likely to support their wives participation in all specified decisions than men with no education (11 and 2 percent, respectively). 42 | Characteristics of Respondents and Women’s Status Table 3.11.2 Women’s participation in decisionmaking by background characteristics: men Percentage of men who say that the wife alone or jointly should have the final say in specific decisions, by background character- istics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife alone or jointly should have final say in: –––––––––––––––––––––––––––––––––––––––––––––––––––– What to None Making Making Visits to do with How many All of the Number Background large daily family or the money children specified specified of characteristic purchases purchases relatives she earns to have decisions decisions men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 13.8 51.5 32.8 52.5 42.7 8.1 23.8 453 20-24 16.7 48.0 34.8 59.8 53.3 8.9 19.4 426 25-29 14.5 52.9 32.0 43.3 43.7 5.4 25.0 328 30-34 21.1 49.8 36.6 58.3 54.9 11.4 23.7 299 35-39 13.5 40.9 30.7 59.6 45.3 8.7 21.7 220 40-44 21.0 42.6 31.7 58.9 47.5 7.5 21.9 208 45-49 13.2 44.4 33.9 53.7 45.0 5.7 25.5 159 50-54 11.4 50.9 33.8 60.1 45.2 5.4 18.9 133 55-59 10.8 38.9 34.1 54.4 38.8 3.8 25.1 120 Marital status Never married 16.1 57.2 37.8 57.2 50.0 9.2 17.5 1,048 Married or living together 15.6 40.7 30.0 52.8 44.4 6.6 27.2 1,245 Divorced/separated/ widowed 7.1 33.7 26.9 70.5 51.1 6.6 19.9 53 Number of living children 0 17.5 53.6 37.1 56.5 49.0 9.7 19.3 1,168 1-2 13.1 40.0 31.6 56.0 49.8 5.5 25.1 379 3-4 15.1 43.3 30.5 52.7 43.1 6.2 27.5 316 5+ 13.5 43.5 28.1 52.8 43.0 5.8 25.9 482 Residence Urban 18.0 50.5 38.9 65.0 51.8 9.0 14.9 872 Rural 14.2 46.4 30.2 49.3 44.3 7.0 27.4 1,474 Region North Central 20.3 75.1 46.4 63.2 52.3 10.6 11.8 348 North East 1.9 15.2 12.2 32.2 36.0 0.5 51.1 421 North West 5.2 12.3 16.8 58.2 42.8 0.5 32.5 602 South East 39.0 62.3 56.7 55.3 57.4 13.2 10.1 207 South South 17.3 83.9 37.5 49.3 45.4 10.6 10.9 445 South West 30.6 68.8 57.8 78.7 59.6 20.3 3.6 322 Education No education 4.8 17.4 15.8 44.7 33.6 1.5 43.1 507 Primary 14.6 46.1 31.5 51.4 41.7 7.2 27.1 603 Secondary 18.8 61.9 40.3 58.9 53.7 9.1 12.8 960 Higher 26.7 58.9 46.3 69.5 60.7 16.0 10.2 276 Employment Not employed 18.8 61.5 37.0 57.1 48.5 11.0 15.0 703 Employed for cash 17.4 52.0 39.5 61.0 52.7 8.3 16.6 1,179 Employed, not for cash 5.1 16.9 11.3 36.3 29.6 1.5 50.8 450 Missing 48.1 15.3 51.2 71.9 60.2 0.0 24.5 14 Total 15.6 47.9 33.4 55.1 47.1 7.8 22.7 2,346 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 14 cases with missing information on employment. Characteristics of Respondents and Women’s Status 43 Women’s Agreement with Reasons for Wife Beating The 2003 NDHS gathered information on women’s attitudes toward wife beating, a proxy for women’s perception of their status. Women who believe that a husband is justified in hitting or beating his wife for any reason at all may also believe themselves to be of low status both absolutely and relative to men. Such perceptions by women could act as a barrier to accessing health care for themselves and their children, could affect their attitude toward contraceptive use, and could impact their general well- being. Women were asked whether a husband is justified in beating his wife under a series of circum- stances. Possible reasons that justified a man beating his wife included her burning the food, her not hav- ing the food prepared on time, her arguing with him, her going out without telling him, her neglecting the children, and her refusing sexual relations. The results are summarized in Table 3.12.1. Approximately two-thirds (65 percent) of women believe that a husband is justified in beating his wife for at least one of the specified reasons. More than half of women believe that a husband is justified in beating his wife if she goes out without telling him, and about half agree that she should be beaten if she neglects the children. Slightly smaller percentages agree if a woman argues with her husband (44 per- cent) or refuses to have sex with her husband (38 percent). Approximately one-third feel that a husband is justified in beating his wife if the food is not cooked on time or if she burns the food. There is little variation in these beliefs by age. Women who are married, have at least one child, or who reside in rural areas are the most likely to agree with at least one of these reasons. There are large variations by geopolitical region. Almost all women in the North East agree with at least one reason for wife-beating (90 percent), compared with less than one-third of women in the South East (31 percent). Differences are also notable by level of education. Agreement with at least one reason ranges from a high of 78 percent among women with no education to a low of 31 percent among women with higher educa- tion. Women who participate in more household decisions are less likely to feel that wife beating is justi- fied for any reason. Table 3.12.2 presents the percentage of men who agree that a husband is justified in beating his wife for specific reasons by background characteristics. Sixty-one percent of men agree with at least one specified reason for wife beating, a proportion similar to women (65 percent). The most prevalent reasons given for wife beating include, going out without telling the husband (50 percent), neglecting the children (47 percent), arguing with the husband (40 percent), and refusing to have sex with him (34 percent). Men who are divorced, separated, or widowed are more likely than currently married or never married men to agree with at least one specified reason for wife beating (75 percent compared with 63 percent and 59 percent). Men in rural areas are more likely to agree with at least one specified reason for wife beating than those in urban areas (66 and 54 percent, respectively). Similar to women, men’s beliefs vary greatly by region. Men who have no education and who are employed but do not earn cash are also more likely to agree with at least one specified reason. The table shows that men who support women’s participation in decisionmaking are less likely to agree with any of the reasons justifying wife beating. 44 | Characteristics of Respondents and Women’s Status Table 3.12.1 Women’s attitude toward wife beating Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Husband is justified in hitting or beating his wife if she: Percentage –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– who agree Goes out Refuses with at Burns Doesn’t without Neglects to have least one Number Background the cook food Argues telling the sex specified of characteristic food on time with him him children with him reason women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 29.6 33.8 42.5 51.1 49.3 33.3 63.4 1,716 20-24 29.6 32.1 43.4 51.6 48.0 36.1 63.0 1,494 25-29 27.6 31.0 40.1 51.5 47.8 36.6 63.3 1,382 30-34 30.7 32.2 42.6 53.9 51.4 37.3 67.5 941 35-39 33.0 36.6 45.6 54.1 48.2 40.5 65.7 816 40-44 33.1 33.3 45.5 56.1 51.0 43.8 66.2 688 45-49 38.4 38.1 51.0 56.4 53.8 44.9 66.6 583 Marital status Never married 21.0 25.9 32.4 35.3 40.5 20.8 51.4 1,926 Married or living together 34.3 36.0 47.3 59.2 52.7 43.4 69.4 5,336 Divorced/separated/widowed 30.4 34.2 46.3 51.3 48.6 39.6 62.2 358 Number of living children 0 24.2 27.9 36.8 42.1 43.2 27.6 56.4 2,499 1-2 34.0 36.1 47.2 58.6 52.7 41.2 68.7 2,009 3-4 32.3 35.3 45.3 57.9 51.6 42.1 68.0 1,526 5+ 35.3 36.5 47.5 57.5 53.0 44.2 68.7 1,586 Residence Urban 22.7 24.9 35.4 42.2 41.1 28.1 56.6 2,629 Rural 35.0 37.8 47.8 58.4 53.8 42.5 68.7 4,991 Region North Central 27.4 31.8 34.0 39.7 44.2 28.8 52.9 1,121 North East 65.7 67.5 80.3 83.2 81.4 73.5 90.2 1,368 North West 29.8 28.9 41.4 71.8 49.4 47.7 75.3 2,095 South East 8.8 13.2 16.4 17.4 20.9 9.3 31.3 737 South South 25.9 30.5 39.8 43.5 46.8 26.1 62.0 1,342 South West 10.5 15.6 32.7 23.4 35.6 12.0 46.9 958 Education No education 42.7 43.1 55.8 71.1 60.6 54.2 77.9 3,171 Primary 30.3 33.9 43.6 51.0 49.9 35.5 64.3 1,628 Secondary 19.6 24.5 32.6 36.5 39.8 21.9 53.1 2,370 Higher 7.0 8.9 14.1 15.7 19.5 10.0 30.6 451 Employment Not employed 31.4 33.6 43.4 54.7 49.8 39.1 65.0 3,326 Employed for cash 29.4 31.9 43.2 51.3 48.4 36.6 63.3 3,630 Employed, not for cash 33.4 39.1 44.3 50.7 52.5 33.1 68.3 622 Number of decisions in which woman has final say1 0 32.7 35.3 44.9 57.2 49.9 39.3 67.5 3,534 1-2 35.2 37.3 48.7 58.6 57.4 42.8 70.2 2,160 3-4 23.1 27.4 38.3 40.7 43.7 31.4 58.8 825 5 21.5 23.6 32.4 36.3 36.5 26.3 48.1 1,100 Total 30.7 33.3 43.5 52.8 49.4 37.5 64.5 7,620 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 42 cases with missing information on employment. 1 Either by herself or jointly with others Characteristics of Respondents and Women’s Status 45 46 | Chara - Table 3.12.2 Men’s attitude toward wife beating Percentage of men who agree that a husband is justified in hitting or beating his wife for specific reasons, according to back ground characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Husband is justified in hitting or beating his wife if she: Percentage ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– who agree Goes out Refuses with at Burns Doesn’t Argues without Neglects to have least one Number Background the cook food with telling the sex specified of characteristic food on time him him children with him reason men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 21.9 23.3 35.4 50.0 43.6 31.9 60.1 453 20-24 17.7 21.7 40.9 49.2 47.9 33.8 59.4 426 25-29 14.9 15.9 42.1 45.5 46.9 31.4 60.2 328 30-34 10.2 12.0 39.6 51.3 47.4 31.1 62.5 299 35-39 13.8 12.5 45.1 54.5 48.9 36.1 68.8 220 40-44 13.3 14.3 37.4 49.0 44.6 31.5 58.0 208 45-49 12.9 16.2 43.0 50.8 47.4 38.9 61.5 159 50-54 13.3 14.8 49.8 53.4 50.5 44.4 69.2 133 55-59 10.3 11.7 30.6 48.3 41.6 29.7 55.1 120 Marital status Never married 17.4 19.9 37.2 46.3 44.1 29.3 58.7 1,048 Married or living together 13.6 14.4 41.9 52.8 47.8 36.7 62.8 1,245 Divorced/separated/widowed 19.5 27.8 52.0 51.9 62.4 41.7 75.2 53 Number of living children 0 17.3 19.4 38.0 47.3 44.3 29.7 59.0 1,168 1-2 13.3 14.3 39.3 52.5 46.0 35.8 61.7 379 3-4 13.2 14.3 43.0 50.0 47.5 35.4 64.8 316 5+ 14.3 15.9 43.6 53.9 51.5 39.6 64.2 482 Residence Urban 8.9 10.7 29.8 38.9 36.9 24.4 53.7 872 Rural 19.3 21.0 46.1 56.3 52.1 38.9 65.8 1,474 Region North Central 13.8 21.5 33.2 37.1 42.4 22.4 50.7 348 North East 30.2 28.9 74.9 74.5 74.7 69.3 82.0 421 North West 14.0 14.6 35.2 66.3 45.1 43.9 70.8 602 South East 9.0 9.0 15.0 28.3 25.3 4.2 36.6 207 South South 12.9 13.7 40.8 45.6 45.0 25.6 60.5 445 South West 8.4 11.9 26.0 20.4 32.2 9.1 44.8 322 Education No education 21.1 20.8 49.9 65.4 55.5 51.8 73.5 507 Primary 15.2 18.6 41.2 51.6 46.7 31.7 61.0 603 Secondary 14.8 17.3 35.9 42.4 41.8 26.7 56.0 960 Higher 8.0 6.9 34.0 43.6 45.6 27.6 57.8 276 Employment Not employed 16.6 19.2 34.1 43.9 44.8 28.1 57.8 703 Employed for cash 11.4 13.0 41.8 48.6 46.2 31.4 59.9 1,179 Employed, not for cash 24.2 24.9 45.7 62.9 51.1 48.1 71.0 450 Number of decisions in which woman should have final say1 0 28.9 25.8 50.8 60.9 55.4 47.4 69.3 533 1-2 15.5 18.2 38.5 53.9 45.9 35.0 62.4 979 3-4 7.9 12.3 35.7 38.0 40.3 24.0 54.2 652 5 3.3 3.6 32.3 38.5 45.4 18.7 56.9 182 cteristics of Respondents and Women’s Status Total 15.5 17.2 40.0 49.9 46.5 33.5 61.3 2,346 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 14 cases with missing information on employment. 1 Either by herself or jointly with others Women’s Attitude Toward Refusing Sex with Husband The extent of control women have over when and with whom they have sex has important impli- cations for demographic and health outcomes. The 2003 NDHS asked respondents if a woman would be justified in refusing sex with her husband in each of the following four situations: if she knows husband has a sexually transmitted infection; if she knows her husband has sex with women other than herself (or his wives); if she has recently given birth; and if she is tired or not in the mood. Table 3.13.1 shows that a majority of women agree with each specified reason for refusing to have sex. Women are most likely to agree that a woman can refuse to have sex with her husband if she knows he has a sexually transmitted infection (84 percent), although more than two-thirds believe that a woman can refuse sex if she has recently given birth or if she knows her husband has sex with other women. Less than half of women (44 percent) agree with all of the specified reasons for refusing sex and 12 percent agree with none of the specified reasons. Although there is little difference by urban-rural residence in the reasons women agree justify re- fusing to have sex with their husbands, there are substantial variations by region. Interestingly, never- married women are twice as likely as currently or formerly married women to agree that there is no rea- son for refusing sex with a husband. Table 3.13.2 shows that male respondents are more likely to agree with each specified reason. Approximately half of men agree with all reasons. Characteristics of Respondents and Women’s Status 47 48 | Chara - Table 3.13.1 Women’s attitude toward refusing sex with husband Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, accord ing to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife is justified in refusing sex with her husband if she: –––––––––––––––––––––––––––––––––––––––––––– Knows Percentage Percentage Knows husband who agree who agree husband has has sex Is tired with all with none a sexually with women Has or not of the of the Number Background transmitted other than recently in the specified specified of characteristic infection wife/wives given birth mood reasons reasons women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 73.5 61.4 60.1 50.7 40.8 21.2 1,716 20-24 84.1 70.1 71.3 56.7 44.5 11.2 1,494 25-29 88.3 69.7 74.3 57.7 45.3 7.4 1,382 30-34 87.2 72.0 72.2 54.7 45.1 7.8 941 35-39 86.8 70.5 68.5 54.9 44.4 9.7 816 40-44 86.0 70.3 69.0 53.9 44.0 11.4 688 45-49 85.8 68.3 72.1 54.2 44.6 11.5 583 Marital status Never married 75.3 61.1 65.4 59.8 45.4 20.3 1,926 Married or living together 86.0 70.5 69.6 52.7 43.4 9.5 5,336 Divorced/separated/ widowed 89.1 72.6 78.3 55.6 42.5 9.7 358 Number of living children 0 77.2 62.5 64.5 55.1 42.4 18.1 2,499 1-2 87.4 72.4 72.9 56.9 46.1 8.2 2,009 3-4 85.7 68.4 69.8 51.1 41.4 9.8 1,526 5+ 86.1 71.8 70.2 54.4 45.8 10.4 1,586 Residence Urban 86.3 68.4 71.2 58.5 44.7 10.1 2,629 Rural 82.0 68.1 67.8 52.6 43.4 13.3 4,991 Region North Central 77.1 62.4 68.4 58.2 49.2 19.5 1,121 North East 90.1 78.0 73.3 55.0 49.1 7.6 1,368 North West 83.6 71.4 58.0 35.2 32.1 11.5 2,095 South East 71.5 54.3 58.6 52.1 40.5 24.7 737 South South 86.2 66.9 81.2 67.9 47.0 7.2 1,342 South West 86.3 66.8 78.2 75.6 54.2 9.3 958 Education No education 83.1 69.4 65.9 44.6 38.8 12.2 3,171 Primary 81.5 66.9 68.4 59.4 48.1 14.8 1,628 Secondary 83.3 66.9 71.7 63.0 47.4 11.9 2,370 Higher 93.9 71.9 77.8 64.1 45.7 4.4 451 Employment Not employed 79.3 62.7 62.5 48.3 38.1 16.2 3,326 Employed for cash 87.3 73.2 73.8 59.0 47.8 8.8 3,630 Employed, not for cash 85.2 69.5 75.9 64.5 52.9 10.9 622 Number of decisions in which woman has final say1 0 80.0 65.5 65.4 52.0 42.8 15.7 3,534 1-2 87.9 73.3 69.8 53.5 42.8 7.1 2,160 3-4 88.1 66.4 75.0 60.8 43.7 7.3 825 5 82.5 68.6 74.4 60.7 49.3 14.9 1,100 Number of reasons wife beating is justified 0 74.4 58.1 61.0 51.3 40.1 22.3 2,704 1-2 89.4 65.8 69.1 48.1 37.4 6.7 1,563 3-4 89.2 74.0 74.4 57.4 43.3 5.5 1,250 5-6 87.2 79.6 75.9 62.1 53.8 7.4 2,104 Total 83.5 68.2 69.0 54.6 43.9 12.2 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 42 cases with missing information on employment. 1 Either by herself or jointly with others cteristics of Respondents and Women’s Status Table 3.13.2 Men’s attitude toward wife refusing sex with husband Percentage of men who believe that a wife is justified in refusing to have sex with her husband for specific reasons, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife is justified in refusing sex with her husband if she: –––––––––––––––––––––––––––––––––––––––––––– Knows Percentage Percentage Knows husband who agree who agree husband has has sex Is tired with all with none a sexually with women Has or not of the of the Number Background transmitted other than recently in the specified specified of characteristic infection wife/wives given birth mood reasons reasons men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 80.9 62.8 73.5 51.5 39.7 14.9 453 20-24 90.8 69.8 79.8 61.4 49.2 7.2 426 25-29 93.5 74.4 85.3 65.8 53.2 3.5 328 30-34 97.4 82.2 87.4 75.1 62.2 0.5 299 35-39 96.1 79.6 86.3 66.4 52.1 1.2 220 40-44 92.9 74.8 84.0 58.2 43.9 1.6 208 45-49 96.0 79.4 86.1 64.3 50.6 1.0 159 50-54 91.6 76.3 82.3 70.4 51.1 4.0 133 55-59 91.9 67.2 84.2 60.9 45.1 3.0 120 Marital status Never married 86.9 68.4 78.9 60.5 48.5 9.9 1,048 Married or living together 94.8 77.2 84.3 64.8 50.8 1.8 1,245 Divorced/separated/widowed 94.1 60.0 94.3 58.0 33.1 2.5 53 Number of living children 0 88.1 69.2 80.4 61.2 48.6 8.9 1,168 1-2 94.8 72.7 84.3 63.6 49.6 2.3 379 3-4 95.0 79.8 85.5 60.6 49.1 1.4 316 5+ 93.6 77.6 82.3 67.1 51.3 2.2 482 Residence Urban 93.2 70.0 82.0 64.8 48.8 4.9 872 Rural 90.1 74.7 82.2 61.5 49.7 5.8 1,474 Region North Central 93.4 84.2 93.1 79.6 70.4 3.0 348 North East 96.3 74.0 83.5 55.6 40.0 1.4 421 North West 93.1 70.7 69.9 42.6 32.1 3.5 602 South East 94.1 77.1 84.8 76.3 61.7 5.1 207 South South 78.9 66.8 78.4 59.3 50.1 16.2 445 South West 94.1 69.2 94.7 87.4 62.3 2.3 322 Education No education 92.2 74.4 76.6 50.8 37.5 2.9 507 Primary 88.5 71.4 78.6 59.9 46.3 7.3 603 Secondary 91.6 71.6 84.9 67.1 53.4 6.1 960 Higher 94.3 78.1 90.0 75.6 63.8 3.8 276 Employment Not employed 84.3 68.5 77.0 61.8 50.2 12.2 703 Employed for cash 95.2 74.0 88.2 68.1 52.2 1.8 1,179 Employed, not for cash 91.7 76.5 74.1 49.9 40.2 4.6 450 Number of decisions in which woman has final say1 0 85.3 73.2 71.9 52.1 41.2 10.8 533 1-2 92.5 69.2 80.4 57.0 41.7 3.5 979 3-4 93.8 75.9 90.4 73.6 60.3 3.9 652 5 93.1 81.4 91.4 85.4 75.6 5.8 182 Number of reasons wife beating is justified 0 91.1 69.3 80.4 61.3 49.5 6.7 1,353 1-2 92.5 76.2 86.1 64.0 47.8 2.7 469 3-4 89.6 79.4 85.0 68.3 50.6 5.1 304 5-6 91.7 79.1 79.8 61.2 50.3 4.1 220 Total 91.2 72.9 82.1 62.7 49.4 5.5 2,346 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 14 cases with missing information on employment. 1 Either by herself or jointly with others Characteristics of Respondents and Women’s Status 49 Fertility | 51 Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––– Residence –––––––––––––– Age group Urban Rural Total ––––––––––––––––––––––––––––––––––––––– 15-19 88 146 126 20-24 186 252 229 25-29 258 282 274 30-34 222 257 244 35-39 156 174 168 40-44 51 81 72 45-49 12 22 18 TFR 4.9 6.1 5.7 GFR 164 204 190 CBR 36.3 44.5 41.7 ––––––––––––––––––––––––––––––––––––––– Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by number of women age 15-44) expressed per 1,000 women CBR: Crude birth rate expressed per 1,000 population FERTILITY 4 This chapter looks at a number of fertility indicators, including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate child- bearing. Data on fertility were collected in the 2003 NDHS in several ways. First, each woman was asked a series of questions on the number of sons and daughters who were living with her, the number living elsewhere, and the number who had died. Next, a complete history of all of the women’s births was ob- tained, including the month and year each child was born; the name and sex; if deceased, the age at death; and if alive, the current age and whether the child was living with the mother. The information from those questions was used to calculate measures of current and completed fertility, i.e., the number of children ever born. 4.1 CURRENT FERTILITY Measures of current fertility presented in this chapter include age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). These rates are generally presented for the three-year period preceding the survey. The three- year period was chosen as a compromise among three criteria: to get the most current information, to reduce sampling error, and to avoid problems noted in the 1999 NDHS of the displacement of births from five to six years before the survey. ASFRs are useful in understanding the age pattern of fertility. Table 4.1 shows that Nigerian women experience their prime reproductive years during their twenties and early thirties. At every age, rural women bear more children than urban women. The rural ASFRs rise sharply from age 15-19 years to age 20-24, peak at age 25-29 and then decline. On the other hand, the urban ASFRs assume a more gradual pattern, an indication both of delayed marriage and some deliberate attempt to postpone or terminate births by urban women. Figure 4.1 shows that whereas the urban ASFR pattern depicts a narrow peak at age 25-29, the rural ASFR depicts a broad peak that extends from age 20-24 to 30-34. The total fertility rate is a useful measure for examining the overall level of fertility. It is interpreted as the number of children the average woman would bear in her lifetime if she experienced the currently-observed age-specific fertility rates throughout her reproductive years. According to the results of the 2003 NDHS, the total fertility rate for Nigeria is 5.7. As expected, the TFR for rural women is significantly higher than that of urban women. On average, rural women will give birth to one more child during their reproductive years than urban women (6.1 and 4.9, respectively). 52 | Fertility The TFR of 5.7 computed in the 2003 NDHS is significantly higher than the 1999 NDHS rate of 5.2. This confirms the analysis in the Data Quality Chapter of the 1999 NDHS final report that detailed evidence of an underreporting of births during the five years preceding the survey. Indeed, the results of that analysis indicated that the TFR was closer to 6.0 (NPC, 2000). On the other hand, there is no evi- dence of omission or transference of births in the 2003 NDHS (see Table C.4). The crude birth rate in Nigeria is 42 births per 1,000 population. As with the TFR, there is a clear differential in this rate by residence: 45 births per 1,000 in rural areas versus 36 births per 1,000 in urban areas. The GFR of 190 indicates that 1,000 women age 15-44 would have 190 live births per year and also indicates a significant urban-rural difference. Higher rural than urban fertility has been explained with respect to the underlying socioeconomic differences and the changing proximate determinants of fertility, especially delayed marriage and higher use of modern contraceptives in urban areas (Isiugo Abanihe, 1996). 4.2 FERTILITY DIFFERENTIALS Table 4.2 shows total fertility rates, the percentage of women who are currently pregnant, and the mean number of children ever born (CEB) to women age 40-49, by residence, region, education, and wealth quintile. The large urban-rural differentials in fertility have already been noted. Region of residence also shows considerable variation in fertility. Table 4.2 shows a pattern of lower rates in the south and higher rates in the north. The TFR is lowest in the South West and South East (4.1), followed closely by the South South (4.6). The North Central shows a rate corresponding to the national average of 5.7. The rates for the North West and North East are significantly higher at 6.7 and 7.0, respectively (Figure 4.2). Figure 4.1 Age-Specific Fertility Rates, by Residence + + + + + + + * * * * * * *& & & & & & & 15-19 20-24 25-29 30-34 35-39 40-44 45-49 0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 Births per 1,000 women Urban Rural Total& * + NDHS 2003 Fertility | 53 Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, per- centage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background char- acteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––– Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant1 age 40-49 ––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 4.9 9.4 6.2 Rural 6.1 12.4 7.1 Region North Central 5.7 9.4 7.4 North East 7.0 14.2 7.4 North West 6.7 16.2 6.7 South East 4.1 6.8 6.6 South South 4.6 9.0 6.9 South West 4.1 6.0 5.5 Education No education 6.7 14.8 7.1 Primary 6.3 11.0 7.1 Secondary 4.7 8.1 5.5 Higher 2.8 6.2 4.3 Wealth quintile Lowest 6.5 12.8 7.2 Second 6.3 13.8 7.2 Middle 5.7 13.2 6.7 Fourth 5.9 10.2 7.0 Highest 4.2 7.8 5.5 Total 5.7 11.4 6.8 ––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Rate for women age 15-49 years Fertility is also strongly correlated with education and wealth quintile. The higher a woman’s educational attainment and the more economically advantaged her household, the lower her fertility. There is a monotonic decline in fertility with educational attainment. Eleven percent of the women inter- viewed reported that they were pregnant at the time of the interview. Variations in this proportion follow the same general patterns as the TFRs. Table 4.2 also shows the mean number of live births for women age 40-49. This figure is an indi- cator of completed fertility or cumulative fertility of women approaching the end of their childbearing years. A comparison of the TFR (5.7) and cumulative fertility (6.8) gives an indication of fertility over time. The data indicate fertility decline among women in all groups, with the exception of women in the North West region. 54 | Fertility 4.3 FERTILITY TRENDS One method of understanding fertility trends is to examine the ASFRs over time. Because women age 50 and older were not interviewed in the survey, the rates are successively truncated as the number of years before the survey increases. The ASFR data shown in Table 4.3 indicate that over the last 20 years there has been a steady decline in fertility among women of all ages in Nigeria. As has been alluded to previously, the declining fertility observed here can be interpreted in light of rising age at marriage and increasing contraceptive use. 5.7 5.7 7.0 6.7 4.1 4.6 4.1 Nigeria North Central North East North West South East South South South West 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 Births per woman Figure 4.2 Total Fertility Rates by Region NDHS 2003 Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Mother’s age –––––––––––––––––––––––––––––––––– at birth 0-4 5-9 10-14 15-19 ––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 126 147 167 197 20-24 246 265 285 307 25-29 272 315 305 312 30-34 237 254 270 [282] 35-39 171 173 [200] - 40-44 69 [89] - - 45-49 [25] - - - ––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Fertility | 55 Figure 4.3 presents the trend in the TFR over the years from different Nigerian data sets. Overall, these data indicate a modest decline in fertility at the national level over the years, from a TFR of 6.3 in the 1981-82 National Fertility Survey (NFS) to 5.7 in the 2003 NDHS. 4.4 CHILDREN EVER BORN AND LIVING Table 4.4 shows all women and currently married women by number of children ever born. Data on the number of children ever born reflect the accumulation of births over the past 30 years and therefore have limited relevance to current fertility levels, particularly when the country has experienced a decline in fertility. Approximately seven in ten women reported having given birth. As expected, currently married women have had more births than all women in all age groups; 90 percent of married women report that they have given birth. The reason is undoubtedly that currently married women are more consistently ex- posed to the risk of pregnancy. The percentage of women in their forties who have never had children provides an indicator of the level of primary infertility—the proportion of women who are unable to bear children at all. Since voluntary childlessness is rare in Nigeria, it is likely that married women with no births are unable to bear children. The 2003 NDHS results suggest that primary infertility is low: less than 3 percent of married women age 45-49 report that they have had no children. It should be noted that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more (secondary infertility). The mean number of children ever born (CEB) for all women is 3.1 and for currently married women is 4.1. As expected the mean CEB increases with age. Comparing the CEB column with that of the mean number of living children reveals substantial experience of child loss among Nigerian women. 6.3 6.0 5.9 5.7 1981-1982 NFS 1990 NDHS 1991 PES 2003 NDHS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 Figure 4.3 Trends in Total Fertility Rates 56 | Fertility 4.5 BIRTH INTERVALS A birth interval is defined as the length of time between two successive live births. 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 the previous birth are at in- creased risk of dying at an early age. Table 4.5 presents the percent distribution of non-first births in the five years preceding the sur- vey, by number of months since preceding birth. The median birth interval in Nigeria is 31 months. The median number of months since preceding birth increases significantly with age, from a low of 26 among mothers age 15-19 to a high of 39 among mothers age 40-49. Studies have shown that the death of a preceding birth should lead to a shorter birth interval com- pared with when a child survives. Indeed, the table indicates that the death of a preceding birth shortens the birth interval by about six months. According to the 2003 NDHS data, living in a rural or an urban area does not make any differ- ence in birth intervals in Nigeria. There is a ten-month difference between women in the South West, who have the longest birth interval, and those in the South East, who have the shortest birth interval (37 months and 27 months, respectively). Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mean Mean Number of children ever born Number number number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– of of children of living Age 0 1 2 3 4 5 6 7 8 9 10+ Total women ever born children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 79.0 16.7 3.2 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,716 0.26 0.22 20-24 41.6 24.0 17.6 10.6 4.9 1.1 0.2 0.0 0.0 0.0 0.0 100.0 1,494 1.18 0.97 25-29 16.8 13.5 16.0 17.6 17.0 10.7 5.2 2.1 0.5 0.2 0.2 100.0 1,382 2.74 2.23 30-34 8.0 6.6 9.8 11.5 14.9 15.7 12.8 11.2 5.8 2.4 1.2 100.0 941 4.35 3.41 35-39 2.5 4.1 5.6 8.8 12.2 10.2 12.4 12.4 12.2 9.8 9.8 100.0 816 5.93 4.54 40-44 5.5 3.3 3.7 4.2 6.7 10.9 11.8 12.0 11.1 11.9 18.9 100.0 688 6.62 4.91 45-49 3.3 3.4 4.3 2.6 8.8 9.9 10.4 9.2 11.1 10.9 26.1 100.0 583 7.03 5.05 Total 31.0 12.7 9.6 8.4 8.5 6.9 5.8 4.9 4.0 3.3 4.9 100.0 7,620 3.09 2.38 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 44.8 41.9 10.0 3.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 545 0.72 0.61 20-24 13.5 32.3 27.4 16.6 8.0 1.8 0.4 0.0 0.0 0.0 0.0 100.0 911 1.80 1.48 25-29 7.1 12.9 17.8 20.2 19.4 12.8 6.1 2.6 0.6 0.2 0.3 100.0 1,146 3.15 2.56 30-34 3.9 6.3 9.2 11.9 15.5 16.8 13.8 12.2 6.4 2.7 1.4 100.0 848 4.63 3.63 35-39 1.5 3.3 5.7 8.6 12.7 10.5 12.1 12.2 12.6 10.4 10.3 100.0 763 6.07 4.63 40-44 5.1 2.8 3.5 3.7 6.9 11.1 12.0 11.3 10.8 12.6 20.2 100.0 619 6.76 5.00 45-49 2.5 2.7 4.2 2.6 8.6 10.3 9.9 9.2 11.4 11.3 27.1 100.0 504 7.17 5.13 Total 10.1 14.6 12.6 11.3 11.4 9.5 7.6 6.4 5.3 4.5 6.7 100.0 5,336 4.12 3.17 Fertility | 57 Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median Number number of Number of months since preceding birth of months since Background ––––––––––––––––––––––––––––––––––––––––––––––––– non-first preceding characteristic 7-17 18-23 24-35 36-47 48+ Total births birth ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 21.1 22.8 44.1 9.5 2.6 100.0 91 26.1 20-29 10.4 17.8 43.9 18.1 9.8 100.0 2,302 29.1 30-39 7.9 12.7 37.2 20.8 21.4 100.0 1,979 33.3 40-49 8.0 9.0 28.8 19.1 35.0 100.0 564 38.7 Birth order 2-3 9.5 15.6 42.0 18.0 14.9 100.0 1,904 30.5 4-6 8.4 14.7 40.5 19.4 17.0 100.0 1,837 31.3 7+ 10.6 13.8 34.0 20.6 21.0 100.0 1,195 32.4 Sex of preceding birth Male 10.1 15.5 39.7 18.5 16.2 100.0 2,468 30.7 Female 8.6 14.2 39.2 19.8 18.2 100.0 2,468 31.9 Survival of preceding birth Living 5.8 13.9 41.5 20.0 18.8 100.0 3,900 32.3 Dead 22.7 18.5 31.7 16.0 11.1 100.0 1,036 26.4 Residence Urban 7.8 14.9 38.1 19.4 19.8 100.0 1,383 31.7 Rural 10.0 14.8 40.0 19.0 16.2 100.0 3,554 31.1 Region North Central 7.4 12.9 37.9 20.4 21.4 100.0 704 33.2 North East 11.0 17.1 42.2 19.1 10.6 100.0 1,220 29.4 North West 9.3 15.2 39.7 20.1 15.7 100.0 1,757 31.3 South East 11.5 23.2 35.5 14.5 15.2 100.0 282 27.2 South South 10.2 10.5 40.9 15.5 23.0 100.0 591 30.9 South West 5.2 9.8 33.8 21.4 29.9 100.0 383 36.5 Education No education 10.2 15.3 38.9 19.5 16.0 100.0 2,678 31.1 Primary 8.5 13.3 38.9 19.5 19.9 100.0 1,212 32.0 Secondary 8.8 14.7 42.6 18.0 15.9 100.0 888 30.6 Higher 5.9 19.4 36.0 15.8 22.9 100.0 158 32.2 Wealth quintile Lowest 9.8 16.2 38.9 19.4 15.7 100.0 1,163 30.8 Second 11.2 14.0 39.1 19.5 16.3 100.0 1,131 31.1 Middle 10.2 14.3 38.3 21.2 15.9 100.0 991 31.6 Fourth 6.8 13.8 42.7 18.3 18.4 100.0 902 31.2 Highest 7.9 15.8 38.7 16.6 21.0 100.0 749 31.4 Total 9.4 14.8 39.5 19.1 17.2 100.0 4,936 31.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 58 | Fertility 4.6 AGE AT FIRST BIRTH The age at which childbearing begins influences the number of children a woman bears through- out her reproductive period in the absence of any active control. Table 4.6 shows the percent distribution of women by age at first birth, according to age at the time of the survey. For women age 25 and older, the median age at first birth is presented in the last column of the table. The data indicate that the age at first birth in Nigeria is increasing. For example, the median age at first birth is 20.3 years for women age 25-29, whereas it is less than 19 years among women 35 years and older. Also the percentage of women who gave birth before age 15 and 18 generally shows some postponement of first births by younger cohorts of mothers. For example, only 3 percent of women 15-19 had given birth by age 15 compared with at least 15 percent of those age 30 or older. Table 4.7 shows the median age at first birth among women age 25-49 by background character- istics. Women in urban areas initiate childbearing almost 2 years later than their counterparts in rural ar- eas. Among the six geopolitical regions, childbearing is started several years later in South East and South West than in the North East and North West. Median age at first birth increases steadily with edu- cational attainment from 18 among women with no education to 25 among women with higher educa- tion—a five-year difference. There is also a positive correlation by wealth quintile. Table 4.6 Age at first birth Percentage of women who gave birth by specific exact ages, and median age at first birth, by current age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Median Percentage who gave birth by exact age: who have Number age at ––––––––––––––––––––––––––––––––––––––––––––––––––– never of first Current age 15 18 20 22 25 given birth women birth ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 3.4 na na na na 79.0 1,716 a 20-24 6.6 28.0 45.7 na na 41.6 1,494 a 25-29 8.3 31.5 47.4 61.9 77.0 16.8 1,382 20.3 30-34 15.1 39.2 57.5 70.9 82.2 8.0 941 19.2 35-39 15.6 46.6 61.6 74.3 86.3 2.5 816 18.4 40-44 16.2 43.1 59.1 71.2 82.1 5.5 688 18.8 45-49 15.0 46.7 62.0 73.6 83.7 3.3 583 18.5 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Fertility | 59 4.7 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 them- selves and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of educational attainment and accessibility to job opportunities may be curtailed. Table 4.8 shows the percentage of women age 15-19 who are mothers or pregnant with their first child by background characteristics. One in five teenage women in Nigeria is a mother and another 4 per- cent are pregnant with their first child. Thus, 25 percent of teenage women have begun childbearing. As expected, the percentage who have begun childbearing increases with age from 8 percent of women age 15 to 40 percent of women age 19. Clearly, early childbearing is more of a rural phenomenon, with 30 percent of rural women age 15-19 having begun childbearing compared with 17 percent of urban women. Adolescent fertility is low- est in the South West and South East, high in the South South and North Central, and highest in the North East and North West. This pattern follows the educational attainment gradient among the regions, with regions having the lowest levels of schooling among adolescents also having the highest levels of child- bearing among them. Table 4.7 Median age at first birth by background characteristics Median age at first birth among women age 20-49, by current age and background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Women Background –––––––––––––––––––––––––––––––––––––––––––––––––––––––– age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban a 22.1 20.2 18.9 20.0 18.8 a 20.4 Rural 19.6 19.3 18.8 18.3 18.4 18.1 19.0 18.7 Region North Central a 20.4 19.8 18.9 18.9 18.9 20.0 19.7 North East 18.3 18.1 17.3 18.0 17.2 18.2 18.0 17.8 North West 18.0 18.3 17.5 16.9 18.1 17.8 17.9 17.8 South East a a 22.5 22.0 20.8 19.5 a 22.7 South South a 22.2 20.2 17.9 18.4 17.2 a 19.8 South West a 23.7 22.4 21.4 21.0 20.5 a 22.1 Education No education 17.7 18.0 17.4 17.4 17.7 18.3 17.7 17.8 Primary 19.2 19.5 19.0 18.6 19.1 17.6 19.0 18.9 Secondary a 22.9 21.7 21.2 21.3 23.4 a 22.3 Higher a a 26.1 22.7 23.3 20.4 a 24.9 Wealth quintile Lowest 18.4 17.7 18.5 17.6 17.1 18.8 18.0 17.9 Second 19.0 18.5 17.5 18.0 18.5 17.9 18.4 18.2 Middle 19.4 18.8 18.4 18.1 19.0 17.8 18.7 18.5 Fourth a 21.2 19.7 17.3 19.2 18.6 19.9 19.5 Highest a 24.4 22.1 21.9 20.5 19.6 a 22.5 Total a 20.3 19.2 18.4 18.8 18.5 19.6 19.3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– a Omitted because less than 50 percent of the women had a birth before the beginning of the age group 60 | Fertility Table 4.8 shows that whereas more than half of women age 15-19 who have no formal education have begun childbearing (54 percent), 9 percent of those with secondary education have done so. Thus, initiation of childbearing is delayed among those who stay in school. The wealth index shows that as the socioeconomic status of households increases, the likelihood of teenage childbearing decreases. That is, women living in less advantaged households are more likely to initiate childbearing before age 20 than those living in relatively more advantaged households. Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who are: Percentage ––––––––––––––––––––– who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15 3.8 3.7 7.5 391 16 9.4 4.6 13.9 273 17 26.9 4.2 31.1 324 18 29.2 5.0 34.2 429 19 35.8 3.7 39.5 299 Residence Urban 13.6 3.1 16.7 580 Rural 24.8 4.8 29.6 1,136 Region North Central 13.8 2.6 16.4 242 North East 38.1 6.3 44.4 294 North West 36.9 8.3 45.2 420 South East 5.3 0.8 6.2 180 South South 11.3 3.0 14.3 362 South West 4.1 0.6 4.7 218 Education No education 44.5 9.5 53.9 501 Primary 20.5 3.0 23.5 360 Secondary 7.6 1.8 9.4 831 Higher * * * 23 Wealth quintile Lowest 27.4 4.8 32.2 270 Second 30.2 5.4 35.6 299 Middle 22.8 5.6 28.4 375 Fourth 18.0 4.7 22.8 404 Highest 10.1 1.0 11.2 367 Total 21.0 4.3 25.2 1,716 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. FAMILY PLANNING 5 This chapter presents the 2003 NDHS results on contraceptive knowledge, use, sources, and atti- tudes. Although the focus is on women of reproductive age (15-49 years), some results from the men’s survey will also be presented since men play an important role in the realization of reproductive goals. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Knowledge of contraceptive methods is a key variable in any discussion of fertility regulation and in the evaluation of family planning programmes. Acquiring knowledge about fertility control is an im- portant step toward gaining access to and then using a suitable contraceptive method in a timely and ef- fective manner. Information on knowledge of contraception was collected by asking respondents a series of questions combining spontaneous recall and prompting. First, respondents were asked to name the ways or methods by which couples could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked whether the respondent recognized it. Using this approach, information was collected for 12 modern family planning methods: female and male sterilization, the pill, the IUD, injectables, implants, male and female condoms, the dia- phragm, foam or jelly, the lactational amenorrhoea method (LAM), and emergency contraception. Infor- mation was also collected on two traditional methods: periodic abstinence (safe period or rhythm method) and withdrawal. Other traditional or “folk” methods mentioned by the respondents, such as herbs or amu- lets, were also recorded. Table 5.1.1 shows the level of knowledge of contraceptive methods among all women, currently married women, sexually active and inactive unmarried women, and for women who have never had any sexual experience, by specific method. The 2003 NDHS finds that 79 percent of all women age 15-49 know at least one method of family planning and 77 percent know a modern method. Knowledge of any modern method is higher among sexually active unmarried women (91 percent) than currently married women (76 percent) and unmarried women who never had sex (66 percent). Modern methods are more widely known than traditional methods (77 percent versus 43 percent). The most widely known modern contraceptive methods among all women are the pill (60 percent), the male condom (59 percent), in- jectables (57 percent), and female sterilization (37 percent). The diaphragm and foam/jelly are the least widely known (each reported by 9 percent of women), along with implants (10 percent) and male sterili- zation (11 percent). The mean number of methods known is a rough indicator of the breadth of knowledge of family planning methods. On average all women and currently married women know four methods each, while sexually active unmarried women know six methods. Knowledge of contraception among men is higher than among women. Knowledge of any method or any modern method for all men is almost universal, with 9 out of every 10 men knowing at least one method (Table 5.1.2). The most well known modern method is the male condom (87 percent), followed by the pill (57 percent). The mean number of methods known by all men is five, while currently married men and sexually active unmarried men know an average of close to six. Family Planning | 61 62 | Family Planning Table 5.1.1 Knowledge of contraceptive methods: women Percentage of all women, currently married women, sexually active unmarried women, sexually inactive unmarried women, and women with no sexual experience who know any contraceptive method, by specific method, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Unmarried women who ever had sex –––––––––––––––––– Unmarried Currently Not women All married Sexually sexually who never Contraceptive method women women active1 active2 had sex ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Any method 78.5 78.4 91.2 89.4 66.2 Any modern method 76.7 76.2 91.2 88.3 65.6 Female sterilization 37.2 39.6 44.0 42.5 19.2 Male sterilization 10.6 10.3 19.4 13.2 6.9 Pill 60.4 63.0 72.0 63.4 41.1 IUD 27.1 29.2 33.4 32.1 11.0 Injectables 57.1 61.0 69.1 59.7 32.2 Implants 10.4 10.4 18.6 13.7 5.4 Male condom 59.2 54.3 87.2 78.5 59.1 Female condom 12.7 11.5 23.6 20.4 9.0 Diaphragm 8.8 8.6 13.8 11.5 5.7 Foam/jelly 8.7 7.9 16.5 13.2 6.2 Lactational amenorrhoea method (LAM) 19.5 21.1 22.0 23.8 7.9 Emergency contraception 15.7 13.7 37.4 27.5 9.5 Any traditional method 42.8 43.1 67.3 57.2 22.2 Periodic abstinence 28.0 25.7 55.7 44.9 17.4 Withdrawal 25.6 23.6 58.7 40.0 13.8 Other method 16.2 18.9 19.0 13.5 4.2 Mean number of methods known 4.0 4.0 5.9 5.0 2.5 Number of women 7,620 5,336 362 833 1,090 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Had sexual intercourse in the month preceding the survey 2 Did not have sexual intercourse in the month preceding the survey Table 5.1.2 Knowledge of contraceptive methods: men Percentage of all men, currently married men, sexually active unmarried men, sexually inac- tive unmarried men, and men with no sexual experience who know any contraceptive method, by specific method, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Unmarried men who ever had sex –––––––––––––––––– Unmarried Currently Not men who All married Sexually sexually never Contraceptive method men men active1 active2 had sex ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Any method 90.2 90.0 99.9 95.0 83.8 Any modern method 89.5 88.9 99.6 94.6 83.8 Female sterilization 37.9 44.7 39.1 32.2 25.5 Male sterilization 20.7 24.7 17.9 18.0 14.6 Pill 57.3 63.2 69.8 54.6 40.5 IUD 25.0 32.3 14.0 14.1 19.3 Injectables 52.9 60.1 60.3 46.5 37.3 Implants 16.9 20.9 8.2 10.9 15.0 Male condom 86.8 85.4 99.1 93.6 81.1 Female condom 19.5 22.5 21.5 24.0 9.7 Diaphragm 10.3 11.9 12.4 12.2 5.1 Foam/jelly 14.5 18.3 17.1 12.6 6.0 Lactational amenorrhoea method (LAM) 18.5 25.9 14.8 10.5 7.9 Emergency contraception 27.9 30.1 44.0 29.9 15.0 Any traditional method 59.2 68.9 76.5 60.4 29.6 Periodic abstinence 43.8 53.6 51.6 43.9 18.6 Withdrawal 49.4 57.9 65.9 50.6 23.2 Other method 10.2 13.8 14.0 5.0 3.3 Mean number of methods known 4.9 5.7 5.5 4.6 3.2 Number of men 2,346 1,245 230 312 559 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Had sexual intercourse in the month preceding the survey 2 Did not have sexual intercourse in the month preceding the survey Knowledge of Contraceptive Methods by Background Characteristics Table 5.2 shows that knowledge of at least one contraceptive method and at least one modern method is almost universal in urban areas among currently married women and men. Knowledge is lower in rural areas. Knowledge of any family planning method among married women ranges from a low of 64 percent in the North East to a high of 97 percent in the South West. The same pattern is evident regarding knowledge of any modern method, from a low of 61 percent in the North East to a high of 97 percent in the South West. Men’s knowledge varies similarly by region, although differentials are not as great. Women age 25-39 and women with secondary or higher education are more likely to know a method than the oldest and youngest women and those with no education. Family Planning | 63 Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and men who know at least one contraceptive method and who know at least one modern method, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––– ––––––––––––––––––––––––––– Knows Knows any Knows Knows any Background any modern any modern characteristic method method1 Number method method1 Number –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 64.9 61.6 545 * * 5 20-24 76.8 74.2 911 84.8 82.8 60 25-29 85.9 83.4 1,146 93.2 92.6 142 30-34 80.6 78.1 848 93.7 93.7 243 5.2 EV Th hich is de- fined as th spondents who said t ethod. Ta d sexually active unm age. Tw percent of sexually a each cate- gory used among all women (1 the most c 64 | Family Planning 35-39 83.2 82.3 763 96.5 96.5 204 40-44 75.7 72.8 619 89.3 88.2 197 45-49 71.6 70.6 504 86.1 83.8 155 50-54 na na na 81.9 80.7 124 55-59 na na na 85.0 81.4 116 Residence Urban 91.0 90.7 1,633 95.6 95.2 401 Rural 72.9 69.8 3,703 87.3 85.9 844 Region North Central 77.4 75.9 754 93.2 92.7 174 North East 63.5 60.8 1,122 73.2 72.2 283 North West 75.1 71.8 1,880 95.2 93.2 372 South East 87.1 84.5 368 97.2 97.0 99 South South 94.2 93.3 664 91.2 90.2 172 South West 97.0 96.5 548 99.1 98.7 145 Education No education 66.5 63.3 2,877 75.9 72.8 399 Primary 87.0 85.2 1,175 92.8 92.5 366 Secondary 96.8 95.9 1,046 99.3 99.3 325 Higher 99.8 99.8 238 100.0 100.0 155 Total 78.4 76.2 5,336 90.0 88.9 1,245 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been sup- pressed. na = Not applicable 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhoea method (LAM), and emergency contraception ER USE OF CONTRACEPTION e 2003 NDHS collected data on the level of ever use of family planning methods, w e use of a contraceptive method at any time during a woman’s reproductive years. Re hat they had heard of a contraceptive method were asked if they had ever used that m ble 5.3.1 shows the percent distribution of all women, currently married women, an arried women who have ever used any contraceptive method by specific method and enty-nine percent of all women, 31 percent of currently married women, and 65 ctive unmarried women reported having used a method. The majority of women in a modern method. The male condom is the most common modern method ever used 0 percent) and sexually active married women (46 percent). The pill and the male condom are ommon modern methods ever used among currently married women (8 percent each). Table 5.3.1 Ever use of contraception: women Percentage of all women, currently married women, and sexually active unmarried women who have ever used any contraceptive method, by specific method and age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––– Female Emer- Any Any Any steri- In- Male Female gency tradi- Periodic Other Number meth- modern liza- ject- Im- con- con- Dia- Foam/ contra- tional absti- With- meth- of Age od method tion Pill IUD ables plants dom dom phragm jelly LAM ception method nence drawal od women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 11.2 9.2 0.0 2.2 0.0 1.3 0.0 6.5 0.1 0.0 0.0 0.6 2.0 5.4 3.3 2.9 1.0 1,716 20-24 30.3 22.8 0.0 6.5 0.3 3.5 0.1 14.8 0.2 0.1 0.4 2.2 4.2 17.5 10.0 9.5 3.5 1,494 25-29 39.2 30.0 0.1 10.1 1.6 5.1 0.0 15.5 0.2 0.1 0.5 6.1 3.9 21.9 12.5 12.0 5.1 1,382 30-34 36.7 28.2 0.0 10.0 1.6 8.9 0.0 9.6 0.1 0.4 0.6 6.5 2.3 17.1 9.6 8.4 4.3 941 35-39 39.8 30.6 0.6 11.7 3.1 10.0 0.1 8.2 0.1 0.2 0.4 7.1 3.6 18.9 12.7 10.0 4.3 816 40-44 31.8 24.6 0.2 10.6 3.8 9.4 0.4 6.0 0.0 0.1 0.3 5.1 0.7 15.9 9.7 7.6 4.8 688 45-49 28.8 22.5 0.7 9.1 5.0 6.9 0.1 4.4 0.0 0.3 0.9 4.4 1.0 12.4 7.7 4.8 2.7 583 Total 29.4 22.7 0.2 7.7 1.6 5.5 0.1 10.1 0.1 0.1 0.4 4.0 2.8 15.1 9.0 7.8 3.5 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 9.2 7.9 0.0 2.9 0.0 1.5 0.0 3.1 0.0 0.0 0.0 1.5 1.0 2.8 1.6 1.8 0.3 545 20-24 24.3 16.8 0.0 5.4 0.5 3.6 0.0 7.8 0.1 0.0 0.3 3.0 1.3 13.1 6.8 5.2 3.2 911 25-29 37.4 27.6 0.1 9.2 1.9 5.2 0.0 12.9 0.3 0.2 0.6 6.6 2.3 20.0 11.7 9.7 4.8 1,146 30-34 35.9 26.8 0.0 9.2 1.6 8.9 0.0 7.9 0.1 0.5 0.6 7.2 1.9 17.1 9.6 7.9 4.5 848 35-39 39.8 30.4 0.7 11.9 3.1 10.1 0.1 7.5 0.1 0.2 0.4 7.5 3.8 18.4 12.1 9.6 4.5 763 40-44 31.5 24.3 0.3 10.0 3.8 9.6 0.4 5.4 0.0 0.1 0.3 5.3 0.5 14.9 8.7 8.0 4.8 619 45-49 27.1 21.4 0.6 9.2 4.0 6.9 0.1 4.6 0.0 0.3 1.1 3.9 0.9 11.3 6.6 4.7 2.3 504 Total 30.7 23.1 0.2 8.4 2.0 6.5 0.1 7.8 0.1 0.2 0.5 5.3 1.8 15.0 8.7 7.2 3.7 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED WOMEN1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Total 64.9 57.0 0.3 18.4 1.5 10.2 0.3 45.7 0.0 0.0 0.4 1.6 13.8 41.8 24.9 30.6 8.6 362 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– LAM = Lactational amenorrhoea method 1 Women who had sexual intercourse in the month preceding the survey Among currently married women, ever use of a method is highest among women age 35-39 (40 percent). Married women younger than 25 are the least likely to have ever used a method of contracep- tion. Experience using LAM is reported by 5 percent of currently married women. LAM is one of the four most common modern methods of contraception used by currently married women in the prime reproduc- tive years of 25-39. Periodic abstinence is the most commonly used traditional method across all age groups of married women. Men were also asked about ever use of methods that require men’s active participation to use, specifically male sterilization, male condom, periodic abstinence, and withdrawal. Approximately one- third of married men and three-fourths of sexually active unmarried men have ever used a method (Table 5.3.2). The male condom is the most common method, with 23 percent of currently married men and 69 percent of sexually active unmarried men reporting ever use. Use of periodic abstinence and withdrawal is also common. This is of particularly concern regarding sexually active unmarried men because periodic abstinence and withdrawal do not prevent transmission of sexually transmitted infections. Family Planning | 65 Table 5.3.2 Ever use of contraception: men Percentage of all men, currently married men, and sexually active unmarried men who have ever used any contraceptive method, by specific method and age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––– Any Male Any Periodic Any modern sterili- Male traditional absti- With- Other Number Age method method zation condom method nence drawal method of men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 12.1 9.8 0.0 9.8 4.7 1.8 3.8 0.0 453 20-24 34.5 30.2 0.4 30.0 13.5 7.5 8.9 0.6 426 25-29 48.2 42.0 0.2 42.0 33.5 23.1 24.9 1.6 328 30-34 50.7 35.2 0.3 34.9 38.6 25.0 25.9 2.7 299 35-39 36.7 24.7 0.0 24.7 24.6 17.1 18.1 2.1 220 40-44 34.8 27.0 0.0 27.0 28.3 19.0 17.8 0.9 208 45-49 37.5 21.0 1.2 21.0 32.9 21.1 21.3 1.7 159 50-54 29.2 13.2 0.0 13.2 24.6 18.9 12.5 4.3 133 55-59 25.4 10.9 0.0 10.9 20.3 14.5 12.8 0.7 120 Total 33.8 25.2 0.2 25.1 22.4 14.7 15.2 1.3 2,346 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 * * * * * * * * 5 20-24 21.2 14.9 0.0 14.9 11.2 5.0 7.8 2.5 60 25-29 33.8 27.4 0.0 27.4 27.2 20.0 18.0 0.7 142 30-34 48.2 31.6 0.4 31.2 36.8 25.0 22.6 3.0 243 35-39 36.1 24.0 0.0 24.0 23.4 16.7 16.7 2.2 204 40-44 34.5 27.6 0.0 27.6 27.6 18.6 17.1 0.9 197 45-49 37.1 20.8 1.3 20.8 32.3 20.2 21.1 1.7 155 50-54 29.4 12.6 0.0 12.6 26.1 20.0 13.3 4.6 124 55-59 24.9 11.3 0.0 11.3 19.6 13.5 13.3 0.8 116 Total 35.6 23.2 0.2 23.1 27.5 18.9 17.5 2.0 1,245 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED MEN1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Total 76.1 69.4 0.3 69.4 40.8 22.6 34.3 2.7 230 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Male respondents were not asked about methods that are female controlled, such as the pill or the IUD. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Men who had sexual intercourse in the month preceding the survey 5.3 CURRENT USE OF CONTRACEPTION The data on the current use of family planning are among the most important information col- lected in the 2003 NDHS, because they provide insight into one of the principal determinants of fertility among women, and they serve as a key measure for assessing the success of the national family planning programme. This section focuses on contraceptive use among currently married women since they are the most likely to be regularly exposed to the risk of pregnancy. Table 5.4 shows the percent distribution of women by current use of specific family planning methods according to age. The 2003 NDHS results indicate that while 13 percent of currently married women are using a method of family planning, only 8 percent are using a modern method. These data in- dicate that there has been no significant change in levels of contraceptive use since 1999 (15 percent ver- sus 16 percent). 66 | Family Planning Table 5.4 Current use of contraception Percent distribution of all women, currently married women, and sexually active unmarried women by contraceptive method currently used, according to age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––– Female Emer- Any Any Any steri- In- Male gency tradi- Periodic Other Not Number meth- modern liza- ject- con- contra- tional absti- With- meth- currently of Age od method tion Pill IUD ables dom LAM ception method nence drawal od using Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 6.6 4.7 0.0 1.1 0.0 0.4 2.6 0.4 0.1 1.9 0.9 0.7 0.3 93.4 100.0 1,716 20-24 15.7 10.9 0.0 2.7 0.2 1.1 6.0 0.8 0.1 4.8 2.4 1.2 1.3 84.3 100.0 1,494 25-29 18.1 11.7 0.1 3.0 0.5 1.4 5.0 1.6 0.1 6.4 2.9 1.8 1.7 81.9 100.0 1,382 30-34 14.2 10.3 0.0 1.9 0.8 2.5 2.6 2.0 0.2 3.9 2.0 1.1 0.8 85.8 100.0 941 35-39 16.4 11.2 0.6 2.3 1.6 3.2 2.1 1.0 0.2 5.2 2.5 1.9 0.8 83.6 100.0 816 40-44 14.6 8.6 0.2 1.6 1.3 3.0 1.7 0.7 0.1 6.1 4.0 1.2 0.9 85.4 100.0 688 45-49 7.9 4.9 0.7 0.9 1.0 1.5 0.8 0.0 0.0 3.0 0.9 1.4 0.7 92.1 100.0 583 Total 13.3 8.9 0.2 2.0 0.6 1.6 3.4 1.0 0.1 4.4 2.1 1.3 0.9 86.7 100.0 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 4.3 3.8 0.0 1.7 0.0 0.4 0.3 1.4 0.0 0.5 0.0 0.3 0.2 95.7 100.0 545 20-24 9.4 6.6 0.0 1.4 0.2 1.1 2.2 1.4 0.1 2.9 1.0 0.5 1.3 90.6 100.0 911 25-29 16.1 10.0 0.1 2.3 0.6 1.5 3.4 1.9 0.0 6.1 2.9 1.8 1.5 83.9 100.0 1,146 30-34 13.6 9.5 0.0 1.8 0.7 2.4 1.9 2.2 0.3 4.1 2.1 1.2 0.9 86.4 100.0 848 35-39 16.3 10.9 0.7 2.4 1.6 3.3 1.5 1.0 0.2 5.5 2.7 1.9 0.9 83.7 100.0 763 40-44 15.1 8.8 0.3 1.6 1.2 3.4 1.8 0.7 0.0 6.3 4.1 1.3 0.9 84.9 100.0 619 45-49 8.9 5.4 0.6 1.0 1.1 1.8 0.8 0.0 0.0 3.5 1.1 1.6 0.8 91.1 100.0 504 Total 12.6 8.2 0.2 1.8 0.7 2.0 1.9 1.4 0.1 4.3 2.1 1.3 1.0 87.4 100.0 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– SEXUALLY ACTIVE UNMARRIED WOMEN1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Total 49.9 38.6 0.3 9.5 1.0 3.4 23.8 0.0 0.7 11.3 4.0 4.2 3.1 50.1 100.0 362 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhoea method 1 Women who had sexual intercourse in the month preceding the survey The most commonly used methods among currently married women are injectables, male con- doms, pill, and periodic abstinence, all in the range of 2 percent. The use of modern contraceptive meth- ods varies by age. Current use of any modern method is 4 percent among currently married women age 15-19, rising to 11 percent among women age 35-39, and then dropping to 5 percent among the oldest women. Most of the women who are sterilized are age 35 or older. LAM is the most common method among the age group 25-34. The male condom is favoured among sexually active unmarried women (24 percent). Current Use of Contraception by Background Characteristics Table 5.5 and Figure 5.1 show that there is substantial variation in the current use of contracep- tive methods according to background characteristics. Contraceptive use varies with residence, region, level of education, number of living children, and economic status of the household. Married women in urban areas are twice as likely to use a family planning method as their rural counterparts (20 percent ver- sus 9 percent). The same pattern is evident for current use of any modern method (14 percent urban and 6 percent rural). Contraceptive use varies significantly by region. For example, one-third of married women in the South West use contraception—the majority using a modern method—compared with just 4 percent of women in the North East. Family Planning | 67 Table 5.5 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––– Female Emer- Any Any Any steri- In- Male gency tradi- Periodic Other Not Number Background meth- modern liza- ject- con- contra- tional absti- With- meth- currently of characteristic od method tion Pill IUD ables dom LAM ception method nence drawal od using Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 20.2 13.9 0.3 3.3 1.9 2.3 4.0 1.7 0.3 6.3 2.9 2.8 0.6 79.8 100.0 1,633 Rural 9.2 5.7 0.1 1.1 0.2 1.8 1.0 1.2 0.0 3.5 1.7 0.6 1.2 90.8 100.0 3,703 Region North Central 13.3 10.3 0.8 2.2 0.1 4.1 1.5 1.2 0.0 3.0 1.9 0.6 0.4 86.7 100.0 754 North East 4.2 3.0 0.0 0.7 0.2 0.9 0.2 0.9 0.0 1.2 0.6 0.2 0.4 95.8 100.0 1,122 North West 4.9 3.3 0.1 0.6 0.1 0.8 0.1 1.7 0.0 1.6 0.2 0.0 1.4 95.1 100.0 1,880 South East 22.5 13.0 0.1 1.5 0.7 0.6 8.9 0.8 0.0 9.5 3.3 5.0 1.2 77.5 100.0 368 South South 25.4 13.8 0.4 4.0 0.7 4.7 2.4 1.5 0.0 11.6 7.3 2.9 1.5 74.6 100.0 664 South West 32.7 23.1 0.0 5.2 4.9 2.9 7.4 1.7 1.0 9.7 4.4 4.1 1.1 67.3 100.0 548 Education No education 4.0 2.3 0.1 0.3 0.2 0.7 0.2 0.8 0.0 1.7 0.4 0.2 1.0 96.0 100.0 2,877 Primary 16.7 11.2 0.4 3.0 1.1 2.7 1.9 1.6 0.2 5.5 2.8 1.6 1.1 83.3 100.0 1,175 Secondary 26.1 18.3 0.3 4.0 1.3 4.0 5.8 2.5 0.3 7.8 4.4 2.5 0.9 73.9 100.0 1,046 Higher 36.9 21.7 0.5 4.2 2.8 4.8 6.7 2.0 0.0 15.2 7.8 7.0 0.5 63.1 100.0 238 Number of living children 0 1.7 1.4 0.0 0.6 0.1 0.0 0.6 0.0 0.0 0.2 0.1 0.0 0.2 98.3 100.0 656 1-2 11.5 7.4 0.0 1.6 0.4 0.9 2.9 1.5 0.1 4.1 2.3 0.7 1.1 88.5 100.0 1,751 3-4 14.2 9.6 0.2 2.8 1.0 1.7 1.6 1.9 0.3 4.6 1.8 1.8 1.0 85.8 100.0 1,449 5+ 17.1 11.0 0.5 1.6 1.2 4.4 1.7 1.4 0.0 6.2 2.9 1.9 1.3 82.9 100.0 1,480 Wealth quintile Lowest 6.9 3.6 0.1 0.9 0.1 1.5 0.7 0.4 0.0 3.3 1.3 0.1 1.9 93.1 100.0 1,150 Second 5.6 2.9 0.1 0.4 0.3 1.2 0.4 0.4 0.0 2.8 1.4 0.6 0.8 94.4 100.0 1,142 Middle 9.1 6.7 0.2 1.7 0.3 2.1 0.3 1.9 0.0 2.4 1.4 0.3 0.7 90.9 100.0 1,086 Fourth 13.5 9.2 0.3 2.8 1.0 1.0 1.7 2.3 0.1 4.3 2.7 1.3 0.3 86.5 100.0 957 Highest 30.0 20.5 0.5 3.7 2.3 4.1 7.3 2.1 0.4 9.4 4.0 4.2 1.2 70.0 100.0 1,002 Total 12.6 8.2 0.2 1.8 0.7 2.0 1.9 1.4 0.1 4.3 2.1 1.3 1.0 87.4 100.0 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhoea method 20 9 13 4 5 23 25 33 4 17 26 37 RESIDENCE Urban Rural REGION North Central North East North West South East South South South West EDUCATION No education Primary Secondary Higher 0 10 20 30 40 Births per woman Figure 5.1 Current Use of Any Contraceptive Method among Currently Married Women Age 15-49, by Background Characteristics NDHS 2003 68 | Family Planning Current use of family planning is positively correlated with educational attainment. Use of any modern method increases from 2 percent among currently married women with no education to 22 per- cent among women with higher education. Interestingly, use of any traditional method also increases with the level of education, from slightly less than 2 percent of currently married women with no education to 15 percent of women with higher education. As expected, there is a direct relationship between the number of living children and use of fam- ily planning. The 2003 NDHS indicates that use of any contraceptive method increases with the number of living children. Only 2 percent of currently married women with no children use contraception, com- pared to 17 percent with five or more children. The wealth index measures the economic status of the household (Chapter 2). Data from the 2003 NDHS show that currently married women in households in the highest (most economically advantaged) quintile of the wealth index are more than four times as likely to use a method of contraception as those in the lowest (least advantaged) quintile (30 percent versus 7 percent). A woman’s desire and ability to control her fertility and her choice of contraceptive method are in part affected by her empowerment status and self-image. A woman who feels that she is unable to control her life may be less likely to feel she can make and carry out decisions about her fertility. Table 5.6 shows the distribution of currently married women by contraceptive use, according to selected indicators of women’s status (described in Chapter 2). Table 5.6 Current use of contraception by women’s status Percent distribution of currently married women by contraceptive method currently used, according to indicators of women’s status, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––– Female Emer- Any Women’s Any Any steri- In- Male gency tradi- Periodic Other Not Number status meth- modern liza- ject- con- contra- tional absti- With- meth- currently of indicator od method tion Pill IUD ables dom LAM ception method nence drawal od using Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say1 0 6.1 4.3 0.1 0.8 0.6 1.2 0.9 0.6 0.0 1.8 0.9 0.3 0.7 93.9 100.0 2,136 1-2 12.4 8.5 0.3 1.8 0.3 2.0 1.4 2.5 0.2 3.9 1.9 0.9 1.1 87.6 100.0 1,799 3-4 23.4 14.1 0.7 2.4 1.4 3.0 4.8 1.8 0.0 9.3 3.4 4.6 1.3 76.6 100.0 709 5 22.0 13.8 0.0 4.2 1.8 3.3 3.6 0.5 0.3 8.2 4.9 1.8 1.5 78.0 100.0 692 Number of reasons to refuse sex with husband 0 5.2 3.3 0.1 0.8 0.3 0.8 0.3 0.1 0.0 1.9 0.4 0.2 1.3 94.8 100.0 506 1-2 11.7 7.7 0.0 1.4 0.8 1.4 1.3 2.6 0.1 4.0 1.2 1.7 1.1 88.3 100.0 1,409 3-4 14.1 9.2 0.3 2.1 0.8 2.4 2.5 1.1 0.1 4.9 2.7 1.2 0.9 85.9 100.0 3,422 Number of reasons wife beating is justified 0 19.4 12.2 0.2 2.3 1.0 2.9 3.9 1.4 0.2 7.2 3.2 2.4 1.6 80.6 100.0 1,632 1-2 15.1 10.2 0.1 1.6 1.0 2.6 1.8 3.1 0.1 4.8 2.8 1.2 0.8 84.9 100.0 1,135 3-4 10.2 6.8 0.2 2.0 0.9 1.8 1.1 0.8 0.0 3.4 1.3 0.7 1.3 89.8 100.0 878 5-6 5.6 3.8 0.3 1.3 0.3 0.8 0.6 0.5 0.1 1.8 0.9 0.4 0.5 94.4 100.0 1,691 Total 12.6 8.2 0.2 1.8 0.7 2.0 1.9 1.4 0.1 4.3 2.1 1.3 1.0 87.4 100.0 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhoea method 1 Either by herself or jointly with others Family Planning | 69 The data indicate that, in Nigeria, there is a correlation between women’s status and their ability to use a contraceptive method, including their ability to negotiate the use of male condoms or to discuss periodic abstinence with their partners. The strong positive relationship between empowerment and con- traceptive use is observed for all three indicators of women’s status. 5.4 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION Family planning may be used by couples to either space births or limit family size. Contraception is used to space births when there is an intention to delay a possible pregnancy. When couples have al- ready had the number of children they want, family planning is used as a means to limit family size (i.e., to stop having children). method of fam tracep- tive m current age. O nal 25 percen en. For examp ey be- gan h ounger wome adopt- ing fa 5.5 when ductiv such a provid of all cycle. fertile implic 70 | Family Plann The 2003 NDHS asked women how many children they had at the time they first used a ily planning. Table 5.7 shows the percent distribution of women who have ever used a con ethod by the number of living children at the time of first use of contraception, according to verall, 40 percent of women began using contraception before they gave birth and an additio t began after having one child. Early use of family planning increases among younger wom le, the data show that 80 percent of the youngest women started contraceptive use before th aving children, compared with 10 percent of the oldest women. The pattern suggests that y n are increasingly adopting family planning to delay or space births, while older women are mily planning to limit births. Table 5.7 Number of children at first use of contraception Percent distribution of women who have ever used contraception by number of living children at the time of first use of contraception, according to current age, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children at time of first use of contraception Number –––––––––––––––––––––––––––––––––––––––––––––– of Current age 0 1 2 3 4+ Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 79.8 14.0 0.4 0.7 0.0 5.1 100.0 192 20-24 67.1 25.1 5.9 1.3 0.0 0.6 100.0 452 25-29 42.2 32.1 13.5 6.5 5.0 0.6 100.0 542 30-34 25.4 26.6 17.4 12.8 17.7 0.2 100.0 346 35-39 19.9 19.4 15.4 8.7 35.8 0.8 100.0 324 40-44 16.3 21.0 13.0 9.2 39.3 1.2 100.0 219 45-49 10.1 23.4 9.1 9.2 48.1 0.0 100.0 168 Total 39.7 24.7 11.4 6.7 16.6 1.0 100.0 2,243 KNOWLEDGE OF FERTILE PERIOD The successful use of natural family planning methods depends largely on an understanding of during the menstrual cycle a woman is most likely to conceive. An elementary knowledge of repro- e physiology thus provides background for the successful practice of coitus-associated methods s withdrawal. Such knowledge is especially critical for the practice of periodic abstinence. The 2003 NDHS asked respondents about their knowledge of a woman’s fertile period. Table 5.8 es the results for all women users and nonusers of periodic abstinence. Only one-fifth (20 percent) respondents reported the correct timing of the fertile period, that is halfway through her menstrual Even among users of periodic abstinence, less than one in three knows the correct timing of the period. It is clear that knowledge of the fertile period is minimal among women, which has major ations regarding use of periodic abstinence as an effective means of pregnancy prevention. ing Table 5.8 Knowledge of fertile period Percent distribution of women by knowledge of the fertile period during the ovula- tory cycle, according to current use/nonuse of periodic abstinence, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Users Nonusers of of periodic periodic All Perceived fertile period abstinence abstinence women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Just before her period begins 3.1 3.2 3.2 During her period 1.4 1.2 1.2 Right after her period has ended 50.2 33.0 33.4 Halfway between two periods 28.8 19.8 20.0 Other 0.0 0.2 0.1 No specific time 5.4 10.8 10.7 Don't know 9.6 31.3 30.9 Missing 1.5 0.4 0.4 Total 100.0 100.0 100.0 Number of women 163 7,457 7,620 5.6 SOURCE OF CONTRACEPTION In the 2003 NDHS, information was collected from current users of family planning methods on where they most recently obtained their method of contraception. Such information is important to family planning programme managers for strategic planning purposes. Table 5.9 shows the percent distribution of current users by source. Table 5.9 Source of contraception Percent distribution of current users of modern contraceptive methods by most recent source of method, according to specific method, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Inject- Male Source Pill IUD ables condoms Total1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Public sector 18.6 (65.5) 48.4 4.1 22.8 Government hospital 10.9 (47.0) 22.9 3.1 13.1 Governm 6.5 Family pla 2.4 Commun 0.8 Other pu 0.1 Private me 57.7 Private ho 7.5 Pharmacy 48.8 Private do 1.0 Private co 0.1 Other pri 0.2 Other sou 14.3 Shop 2.5 Friends/re 11.8 Other 0.3 Missing 4.9 Total 100.0 Number o 597 ––––––––– –––––––– Note: Tab Figures in parenthese 1 Total inc female con ent health center 4.9 (12.9) 19.0 0.4 nning clinic 1.3 (5.6) 6.0 0.5 ity health worker 1.5 (0.0) 0.5 0.0 blic 0.0 (0.0) 0.0 0.1 dical sector 74.0 (32.5) 48.0 59.2 spital or clinic 2.3 (30.3) 17.9 0.6 71.6 (0.0) 25.1 58.3 ctor 0.0 (0.0) 4.3 0.3 mmunity health worker 0.0 (0.0) 0.6 0.0 vate medical 0.0 (2.1) 0.0 0.0 rce 5.5 (0.0) 1.0 29.1 1.9 (0.0) 0.0 4.7 latives 3.6 (0.0) 1.0 24.5 0.2 (0.0) 0.6 0.3 1.7 (2.1) 1.9 7.2 100.0 (100.0) 100.0 100.0 f women 152 45 121 260 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– le excludes lactational amenorrhoea method (LAM) and emergency contraception. s are based on 25-49 unweighted cases. ludes 12 sterilized women, 1 implant user, 2 diaphragm users, 1 foam/jelly user, and 4 users of doms. Family Planning | 71 According to the findings of the 2003 NDHS, the private sector was the most frequently reported source of contraceptive supply (Figure 5.2), providing contraception to two and a half times as many women as the public sector (58 percent versus 23 percent). A private hospital or clinic was the most fre- quently reported private sector source (49 percent), while a government hospital was the most frequently reported in the public sector (13 percent). This pattern is different from that observed in the 1999 NDHS, which indicated that women accessed family planning methods from both sectors equally. Access to specific methods varies greatly by source. The public sector is the most common source of IUDs (66 percent), and the private sector is the most common source for the pill (74 percent) and male condom (59 percent). Provision of injectables for current users is equally shared by the public sector and the private sector (48 percent each). Figure 5.2 Source of Family Planning Methods among Current Users of Modern Methods NDHS 2003 Private medical sector 58% Public sector 23% Other source 14% Missing 5% 5.7 INFORMED CHOICE Informed choice is an important aspect of the delivery of family planning services. It is required that all family planning providers inform method users of the potential side effects and what they should do if they encounter such side effects. This information is to assist the user in coping with side effects and thus decrease discontinuations of temporary methods. Contraceptive users should also be informed of the choices they have with respect to other methods. Table 5.10 shows that less than half of users were given information about each of the three is- sues considered to be essential parts of informed choice. Forty-two percent were informed about potential side effects of their method, 39 percent were told what to do if they experience any of the side effects, and 42 percent were given information about other family planning method options. There are significant dif- ferentials by background characteristics. Family planning providers in the public sector are twice as likely to inform contraceptive users about method side effects or problems, what to do if they experience side effects, and other contraceptive options as their counterparts in the private sector. Women in urban areas have significantly more access to information than their rural counterparts. 72 | Family Planning Table 5.10 Informed choice Among current users of modern contraceptive methods who adopted the current method in the five years preceding the survey, percentage who were informed about the side effects of the method used, percentage who were informed what to do if side effects were experienced, and percentage who were informed of other methods that could be used for contraception, by method, initial source of method, and background character- istics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Informed Informed Informed of about side effects what to do other methods Method, source, and or problems of if experienced that could 5.8 FUTURE U Intention ily plan- ning, that is, the e re. Cur- rently married wo out their intention to use fa background characteristic method used1 side effects1 be used2 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Method Pill 36.5 32.0 41.7 IUD (53.6) (50.4) (58.9) Injectables 45.5 44.7 56.8 Initial source of method3 Public sector 64.5 60.3 69.5 Private medical sector 36.1 34.8 46.6 Residence Urban 49.6 47.2 47.1 Rural 35.7 31.6 37.0 Region North Central 38.1 33.8 43.0 North East (41.8) (37.0) (35.4) North West (61.7) (59.1) 28.0 South East (25.9) (22.0) (21.2) South South 35.4 31.2 44.2 South West (51.5) (50.5) 53.5 Education No education (36.5) (30.3) 25.2 Primary 45.7 40.6 45.0 Secondary 41.5 39.1 43.6 Higher 45.4 46.2 51.7 Wealth quintile Lowest (36.1) (37.9) (45.7) Second (33.8) (26.7) (36.6) Middle 37.2 32.2 39.0 Fourth 34.0 28.6 33.0 Highest 53.3 51.7 48.9 Total 42.4 39.1 41.7 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Among users of female sterilization, pill, IUD, injectables, and implants 2 Among users of female sterilization, pill, IUD, injectables, implants, female condom, diaphragm, foam or jelly, and lactational amenorrhoea method (LAM) 3 Source at start of current episode of use SE OF CONTRACEPTION to use contraception is an important indicator of the changing demand for fam xtent to which nonusers of contraception plan to use family planning in the futu men who were not using contraceptives at the time of the survey were asked ab mily planning in the future. The results of this inquiry are shown in Table 5.11. Family Planning | 73 Table 5.11 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Nigeria 2003 –––––––––––––––––––––––––––––––––– –––––––– Intention 0 –––––––––––––––––––––––––––––––––– Intends to use 21.3 Unsure 9.9 Does not intend to use 68.7 Missing 0.1 Total 100.0 1 Number of women 480 –––––––––––––––––––––––––––––––––– 1 Includes current pregnancy A little more than one-quarter (27 per- cent) of currently married women intend to use family planning in the future, compared with two-thirds (64 percent) who do not intend to use a method. Intention to use increases with the number of living children; for example, 29 percent of women with four or more children intend to use a contraceptive method in the future compared with 21 percent of women with no children. Reasons for Not Intending to Use Contraception The reasons given by respondents who do not intend to use a contraceptive method in the future are important to the family planning programme since they identify areas for poten- tial interventions. Table 5.12 presents the distribution of currently married nonusers who do not intend to use family planning in the future by the main reason for not intending to use. Half of nonusers gave a fertility-related reason for not planning to use contraception. In particular, 36 percent cited desire for as many children as possible as the main reason. This reason is more prominent among younger women (45 percent) than older women (28 percent). One- quarter of all nonusers cited opposition to use as the reason for not intending to use. Opposition cent), the opposition of her husband or partner (4 related reasons, which include health concerns a nonusers. Nine percent cited lack of knowledge as 74 | Family Planning –––––––––––––––––––––––––––––––––––––––– Number of living children1 ––––––––––––––––––––––––––––– 1 2 3 4+ Total –––––––––––––––––––––––––––––––––––––––– 26.2 28.4 27.2 29.1 27.4 11.1 9.1 7.4 6.9 8.4 62.4 62.1 65.3 63.3 63.8 0.3 0.4 0.1 0.7 0.4 00.0 100.0 100.0 100.0 100.0 815 757 680 1,932 4,664 –––––––––––––––––––––––––––––––––––––––– Table 5.12 Reasons for not intending to use contraception Percent distribution of currently married women 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, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age –––––––––––––––– Reason 15-29 30-49 Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Fertility-related reasons 47.1 54.8 51.3 Infrequent sex/no sex 1.0 6.0 3.7 Menopausal/had hysterectomy 0.2 6.3 3.5 Subfecund/infecund 0.5 14.2 8.0 Wants as many children as possible 45.4 28.3 36.1 Opposition to use 29.0 23.8 26.2 Respondent opposed 16.0 11.8 13.7 Husband/partner opposed 4.0 3.8 3.9 Others opposed 0.0 0.1 0.1 Religious prohibition 8.9 8.0 8.5 Lack of knowledge 9.5 7.7 8.5 Knows no method 8.0 6.6 7.3 Knows no source 1.5 1.0 1.2 Method-related reasons 9.1 10.2 9.7 Health concerns 2.9 3.2 3.1 Fear of side effects 5.4 5.6 5.5 Lack of access/too far 0.0 0.2 0.2 Costs too much 0.2 0.1 0.1 Inconvenient to use 0.3 0.2 0.2 Interferes with body's normal processes 0.3 0.8 0.6 Other 1.0 1.0 1.0 Don’t know 4.1 2.5 3.2 Missing 0.2 0.0 0.1 Total 100.0 100.0 100.0 Number of women 1,357 1,619 2,976 to use includes respondent’s own opposition (14 per- percent), and religious prohibition (9 percent). Method- nd fear of side effects, are cited by only 10 percent of their reason for not intending to use in the future. Preferred Method of Contraception for Future Use Future demand for specific methods of family planning was assessed by asking current nonusers which method they intend to use in the future. Table 5.13 shows that among currently married nonusers who intend to use in the future, the preferred method is injectables (28 percent), followed by the pill (23 percent), and periodic abstinence (6 percent). One-fifth of women are unsure which method they would prefer to use. There is little difference by age. Table 5.13 Preferred method of 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, according to age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age –––––––––––––––– Method 15-29 30-49 Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Female sterilization 0.3 2.9 1.4 Pill 22.5 22.8 22.6 IUD 2.1 3.1 2.6 Injectables 27.6 27.9 27.7 5.9 Exposure to Electronic m s, and leaflets), and traditional folk m tential sources of information about sages on a par- ticular type of media of communica- tion for various targe rint, and tradi- tional folk media on e 2003 NDHS were asked if they h , read a family planning message in through traditional fo 5.14.1 and 5.14.2. Implants 0.6 2.0 1.2 Male condom 6.1 3.5 5.0 Female condom 0.0 0.1 0.0 Diaphragm 0.0 0.8 0.3 Foam/jelly 0.0 0.7 0.3 Lactational amenorrhoea method (LAM) 1.9 2.8 2.3 Periodic abstinence 6.4 6.3 6.3 Withdrawal 1.6 1.5 1.5 Other 10.3 7.1 8.9 Unsure 20.6 18.5 19.7 Total 100.0 100.0 100.0 Number of women 718 559 1,278 Family Planning Messages edia (radio and television), print media (newspaper, magazines, poster edia (town criers and mobile public announcements) are the major po family planning in Nigeria. Information about public exposure to mes allows policymakers to ensure the use of the most effective means t groups in the population. To assess the effectiveness of electronic, p the dissemination of family planning information, respondents in th ad heard or seen family planning messages on the radio or television a newspaper, magazine, poster, or leaflet, or heard a family planning message lk media during the months preceding the survey. The results are shown in Tables Family Planning | 75 Table 5.14.1 Exposure to family planning messages: women Percentage of women who heard or saw a family planning message on the radio, television, newspaper/ magazine, posters/leaflets/brochures, town crier/mobile public announcement, in the months preceding the survey, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Exposed to family planning messages on: –––––––––––––––––––––––––––––––––––––––––––––––––––––– Town crier/ None mobile of the Posters/ public specified Number Background Newspaper/ leaflets/ announce- media of characteristic Radio Television magazine brochures ment sources women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 0 and 56 pe status. Telev 2 per- cent o mes- sage i 2 per- cent v proxi- matel ement (Figur 76 | Family Plann 15-19 30.4 16.2 9.2 11.4 7.1 65.5 1,716 20-24 41.7 24.0 15.1 17.3 8.0 53.7 1,494 25-29 47.4 25.4 14.4 17.0 9.7 49.4 1,382 30-34 44.0 22.8 13.0 15.8 8.4 53.6 941 35-39 43.7 24.5 13.7 17.5 9.1 51.9 816 40-44 38.6 18.0 9.0 10.5 7.1 59.9 688 45-49 39.8 18.3 8.6 11.6 8.7 58.4 583 Residence Urban 54.7 39.6 20.3 23.3 10.9 40.2 2,629 Rural 32.6 11.8 7.9 10.2 6.9 64.8 4,991 Region North Central 26.3 14.4 9.7 14.4 7.7 69.7 1,121 North East 20.8 7.6 5.7 9.7 3.9 76.6 1,368 North West 39.3 10.8 4.6 5.4 2.7 60.4 2,095 South East 53.6 27.5 18.4 14.9 10.2 41.4 737 South South 49.1 36.2 23.1 28.1 20.9 44.7 1,342 South West 63.8 47.1 20.9 23.8 8.0 30.1 958 Education No education 27.1 6.0 2.3 4.3 2.7 72.1 3,171 Primary 38.3 18.2 8.2 12.2 9.6 58.6 1,628 Secondary 53.0 36.1 21.6 24.1 11.9 40.9 2,370 Higher 72.6 64.6 46.5 48.0 23.0 17.4 451 Wealth quintile Lowest 21.5 4.0 3.2 4.2 3.7 77.6 1,414 Second 26.5 6.4 3.9 6.1 4.2 71.6 1,439 Middle 36.4 11.7 8.1 11.0 7.8 61.2 1,513 Fourth 48.1 26.1 12.6 16.7 9.0 48.0 1,526 Highest 63.4 52.7 29.6 32.0 15.2 29.1 1,728 Total 40.2 21.4 12.2 14.7 8.3 56.3 7,620 Radio is the most common source of family planning messages for both women and men (4 rcent, respectively). This is true regardless of age, residence, region, education, or economic ision is the next most common source among all respondents, with 21 percent of women and 3 f men having seen a message. Men are more likely than women to have read a family planning n a newspaper or magazine (22 percent versus 12 percent) or on a poster or in a brochure (3 ersus 15 percent). In part, this reflects higher levels of literacy among men. Additionally, ap y one in ten respondents has heard a message from a town crier or a mobile public announc e 5.3). ing Table 5.14.2 Exposure to family planning messages: men Percentage of men who heard or saw a family planning message on the radio, television, newspaper/magazine, posters/leaflets/brochures, town crier/mobile public announcement, in the months preceding the survey, by back- ground characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Exposed to family planning messages on: –––––––––––––––––––––––––––––––––––––––––––––––––––––– Town crier/ None mobile of the Posters/ public specified Number sages from re by backg er on the w plan- ning m Background Newspaper/ leaflets/ announce- media of characteristic Radio Television magazine brochures ment sources men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 45.2 26.9 12.6 23.8 7.9 51.5 453 20-24 55.8 36.8 24.0 34.9 13.4 40.6 426 25-29 63.3 38.6 28.4 40.6 14.8 32.6 328 30-34 64.2 37.1 28.2 35.7 12.1 33.8 299 35-39 53.6 28.7 23.1 29.1 10.4 43.2 220 40-44 55.5 28.5 21.8 30.1 14.3 43.7 208 45-49 61.0 33.0 22.7 38.1 11.5 38.8 159 50-54 53.8 27.9 21.4 35.3 7.4 42.8 133 55-59 57.3 18.0 14.4 19.5 4.6 41.9 120 Residence Urban 66.2 47.3 29.1 40.8 15.2 30.1 872 Rural 49.9 22.9 17.7 27.0 8.9 47.9 1,474 Region North Central 54.2 32.2 24.7 39.2 21.6 40.5 348 North East 49.3 24.1 14.6 33.9 6.7 48.4 421 North West 49.3 16.9 8.9 18.8 4.4 48.8 602 South East 43.1 28.2 22.1 22.7 14.5 55.5 207 South South 61.3 40.3 35.8 44.2 7.1 35.1 445 South West 80.0 61.1 33.7 36.5 22.3 18.4 322 Education No education 37.8 7.2 2.4 11.6 3.0 61.3 507 Primary 52.3 22.4 10.7 24.8 6.6 46.4 603 Secondary 63.2 42.6 28.0 38.7 13.5 33.4 960 Higher 71.9 61.4 61.4 63.2 28.4 20.9 276 Wealth quintile Lowest 36.4 11.0 8.5 16.6 5.0 61.3 423 Second 49.0 15.4 11.2 23.3 6.6 50.7 418 Middle 55.7 22.8 16.1 26.1 8.1 41.5 436 Fourth 64.7 43.8 27.2 43.7 12.9 31.8 507 Highest 68.1 56.5 39.7 44.6 20.3 27.8 563 Total 55.9 32.0 21.9 32.1 11.2 41.3 2,346 More than half of women and 41 percent of men were not exposed to family planning mes any source during the months preceding the survey. There are significant differences in exposu round characteristics: those respondents residing in rural areas, in the north, in households low ealth index, and those with less education are the least likely to have been exposed to family essages. Family Planning | 77 Figure 5.3 Percentage of Women and Men Exposed to Family Planning Messages 40 21 12 15 8 5656 32 22 32 11 41 Radio Television Newspaper magazine Posters/leaflets/ brochurs Town crier/ mobile public announcement No media sources 0 10 20 30 40 50 60 Percent Women Men NDHS 2003 5.10 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Information on contacts of nonusers with family planning providers is important for determining whether family planning initiatives are effective or not. Contact could be through a home visit by a health worker or a visit to a health facility. The 2003 NDHS asked women who are not using contraception whether in the 12 months preceding the survey 1) they were visited by a community health worker who discussed family planning, and 2) whether they visited a health facility, and if so, whether anyone dis- cussed family planning. Table 5.15 shows that few women who are nonusers had contacts with health workers who dis- cussed family planning. Only 4 percent of nonusers reported that they were visited by a family planning service provider at home, and 6 percent of nonusers visited a health facility and discussed family planning with a provider. Across all age groups, residence, region, education, and economic status, the percentage of nonusers who visited a health facility but did not discuss family planning is significantly higher than the percentage of nonusers who visited a health facility and discussed family planning. This is an indica- tion of missed opportunities for increasing family planning acceptance and use. Educational attainment and a higher score on the wealth index are correlated with greater expo- sure to family planning providers. Three percent of women with no education versus 14 percent of women with higher education discussed family planning on a visit to a health facility. Similarly, 3 percent of women in households in the two lowest quintiles of the wealth index versus 10 percent of those in households in the two highest quintiles discussed family planning at a health facility. The proportion of nonusers who did not discuss family planning with a fieldworker or health facility staff is very high across all background characteristics. The high proportion of nonusers of family planning represents a large pool of potential users that could be targeted for family planning counselling. 78 | Family Planning Table 5.15 Contact of nonusers with family planning providers Percentage of women who are not using contraception who were visited by a community health extension worker (CHEW) who discussed family planning, percentage who visited a health facility and discussed family planning,, and percentage who visited a health facility but did not discuss family planning, in the 12 months preceding the survey, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women who Women who Women who Did not discuss were visited visited visited family planning by a CHEW health facility health facility with CHEW Background who discussed and discussed didn’t discuss or at a Number of characteristic family planning family planning family planning health facility women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.4 1.6 15.4 97.4 1,603 20-24 3.7 5.3 27.3 92.5 1,260 25-29 4.0 9.7 31.2 88.7 1,132 30-34 4.7 10.8 29.4 87.1 808 35-39 4.9 6.4 28.3 90.3 682 40-44 5.1 6.3 23.2 90.9 587 45-49 3.1 4.6 18.7 94.3 537 5. on fo is thu of co or cu a- tio es fam od by to ag s. Residence Urban 4.4 8.9 29.6 89.0 2,121 Rural 3.1 4.6 21.9 93.7 4,488 Region North Central 2.9 5.9 24.2 92.4 984 North East 3.0 4.5 22.9 94.4 1,314 North West 1.5 2.3 28.0 96.9 1,994 South East 4.4 2.4 30.0 94.3 590 South South 7.1 10.8 17.0 85.4 1,020 South West 5.0 15.4 23.0 82.2 707 Education No education 1.5 2.6 21.8 96.4 3,042 Primary 4.2 8.6 25.9 89.5 1,403 Secondary 5.3 8.4 25.5 88.9 1,872 Higher 9.4 13.6 36.2 82.0 290 Wealth quintile Lowest 1.6 2.8 18.4 96.2 1,313 Second 2.3 2.8 19.9 95.7 1,343 Middle 3.5 4.7 24.0 93.5 1,379 Fourth 5.2 10.2 28.0 87.5 1,310 Highest 5.0 9.8 32.0 87.5 1,263 Total 3.5 6.0 24.4 92.2 6,608 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CHEW =Community health extension worker 11 DISCUSSION OF FAMILY PLANNING WITH HUSBAND Although discussion between a husband and wife about contraceptive use is not a preconditi r adoption of contraception, its absence may be an impediment to use. Interspousal communication s an important intermediate step along the path to eventual adoption, and especially continuation, ntraceptive use. Lack of discussion may reflect a lack of personal interest, hostility to the subject, stomary reticence in talking about sex-related matters. To gain insight about interspousal communic n on family planning, currently married women in the 2003 NDHS were asked the number of tim ily planning was discussed with their husbands in the 12 months preceding the survey. Table 5.16 presents information on currently married women who know a contraceptive meth the number of times they discussed family planning with their husbands in the past year, according e. Almost two-thirds of women reported that they never discussed family planning with their husband Family Planning | 79 Table 5.16 Discussion of family planning with husband Percent distribution of currently married women who know a contraceptive method by the number of times they discussed family planning with their husband in the past year, accord- ing to current age, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of times family planning was discussed with husband ––––––––––––––––––––––––––––––––––––– Number Once or Three of Age Never twice or more Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 80.0 16.1 3.8 0.1 100.0 353 20-24 67.8 22.6 9.7 0.0 100.0 700 25-29 58.8 27.5 13.5 0.3 100.0 985 30-34 62.4 23.0 14.5 0.0 100.0 684 35-39 63.0 24.5 12.2 0.3 100.0 634 40-44 62.3 20.6 16.7 0.4 100.0 469 45-49 68.8 21.5 8.4 1.3 100.0 361 Total 64.6 23.2 11.9 0.3 100.0 4,186 Women age 15-19 were the least likely to have had a discussion about family planning. It is notable, however, that 12 percent of women discussed family planning at least three times. In particular, women in their prime childbearing years were the most likely to have had multiple discussions about family plan- ning with their husbands. 5.12 ATTITUDES TOWARD FAMILY PLANNING When couples have a positive attitude toward family planning, they are more likely to adopt a family planning method. In the 2003 NDHS, married women were asked whether they approved of family planning and what they perceived as their husband’s attitude toward family planning. This information is useful in the development of family planning policies because it indicates the extent to which further edu- cation and publicity are needed to gain general acceptance of family planning. If there is widespread dis- approval of contraception, this can be a major barrier to adoption of contraceptive methods. Table 5 a family plan- ning method ap is 33 percent of all respondents er, one-third of women who ap nterviewed who disapprove of f amily planning. Educat rcent of women with higher edu ning. This com- pares with just o higher among urban than rura There i lar, approval in the south tends South West say that both they en in the South East. More than husbands disap- prove. 80 | Family Planning .17 shows that more than half (55 percent) of married women who know prove of family planning. Almost two-thirds of those who approve, which , reported that their husband also approves of family planning. Howev prove say that their husband disapproves. Among the 39 percent of those i amily planning, almost all reported that their husband also disapproves of f ion plays a significant role in approval of family planning. Sixty-one pe cation reported that both they and their husband approve of family plan 16 percent of women with no education. Approval of family planning is als l residents. s significant regional variation in approval of family planning. In particu to be higher than in the north. For example, 61 percent of women in the and their husbands approve of family planning, as do 51 percent of wom half of women in the North West, however, say that both they and their Table 5.17 Attitudes of couples toward family planning Percent distribution of currently married women who know of a method of family planning, by approval of family planning and perception of their husband’s attitude toward family planning, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Woman approves Woman disapproves of family planning of family planning –––––––––––––––––––––––––– –––––––––––––––––––––––––– Hus- Hus- Hus- Hus- band band’s band Husband band’s Woman Number Background Husband disap- attitude ap- disap- attitude is un- of characteristic approves proves unknown proves proves unknown sure1 Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 14.9 6.2 13.3 1.6 46.1 7.1 10.8 100.0 353 20-24 29.9 12.3 10.2 2.9 31.4 6.4 6.9 100.0 700 25-29 42.1 10.6 9.0 2.0 26.5 4.3 5.7 100.0 985 30-34 33.4 11.5 12.2 1.9 29.4 4.8 6.9 100.0 684 Total 33.3 10.8 10.5 1.9 31.1 5.8 6.6 100.0 4,186 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Includes missing 35-39 35.9 11.7 9.5 0.5 30.6 5.8 5.8 100.0 634 40-44 33.6 10.6 9.5 3.1 30.7 6.0 6.4 100.0 469 45-49 28.2 10.7 11.7 1.6 33.2 8.8 5.9 100.0 361 Residence Urban 40.6 10.4 9.3 1.8 28.1 4.1 5.7 100.0 1,487 Rural 29.2 11.0 11.1 2.0 32.8 6.7 7.1 100.0 2,699 Region North Central 40.6 11.0 15.8 1.8 16.6 6.3 8.1 100.0 584 North East 18.0 11.4 11.9 2.8 38.7 9.3 7.9 100.0 713 North West 17.4 7.5 8.1 1.8 51.6 6.6 7.0 100.0 1,412 South East 50.7 9.1 6.2 2.9 22.4 3.5 5.2 100.0 321 South South 47.4 17.8 9.5 2.1 13.8 3.8 5.5 100.0 625 South West 60.6 11.5 12.8 0.7 8.2 1.8 4.5 100.0 531 Education No education 15.6 9.8 11.5 1.9 44.7 8.2 8.3 100.0 1,914 Primary 38.6 12.2 11.8 1.7 24.2 5.5 6.0 100.0 1,022 Secondary 54.8 10.9 8.0 2.6 17.1 2.3 4.4 100.0 1,012 Higher 61.2 13.2 6.5 0.9 11.5 1.5 5.1 100.0 237 Family Planning | 81 Other Proximate Determinants of Fertility | 83 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6 This chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhoea, abstinence from sexual relations, and menopause. Generally, marriage is a primary indication of the exposure of women to the risk of pregnancy and, therefore, is important for the understanding of fertility. Populations in which age at first marriage is low tend to have early childbearing and high fertility. For this reason, it is important to examine trends in age at marriage. Data on age at first sexual intercourse, which is a more direct measure of the beginning of exposure to pregnancy and the level of exposure, are also presented in this chapter. Durations of postpartum amenorrhoea, postpartum abstinence, and menopause are additional measures of other proximate determinants of fertility that, like marriage and sexual intercourse, influence exposure to the risk of pregnancy. 6.1 CURRENT MARITAL STATUS Table 6.1 presents the percent distribution of women and men by marital status at the time of the survey. In this table, the term “married,” refers to legal or formal unions, while “living together” refers to informal unions. Widowed, divorced, and separated make up the remainder of the “ever-married” or “ever-in-union” category. In other tables and text, the term “currently married” refers to both formal and informal unions. Table 6.1 Current marital status Percent distribution of women and men by current marital status, according to age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Marital status –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Never Living Age married Married together Divorced Separated Widowed Total Number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 66.7 30.9 0.8 1.1 0.3 0.1 100.0 1,716 20-24 36.1 59.2 1.8 1.4 1.1 0.4 100.0 1,494 25-29 12.2 80.3 2.6 2.3 1.9 0.6 100.0 1,382 30-34 5.1 86.7 3.4 1.6 1.6 1.6 100.0 941 35-39 1.7 91.3 2.2 1.4 0.6 2.8 100.0 816 40-44 0.7 87.6 2.4 2.2 1.5 5.6 100.0 688 45-49 0.9 84.7 1.7 3.1 1.6 8.1 100.0 583 Total 25.3 68.0 2.0 1.7 1.2 1.8 100.0 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 98.9 1.1 0.0 0.0 0.0 0.0 100.0 453 20-24 84.7 13.3 0.6 0.3 1.1 0.0 100.0 426 25-29 54.0 41.9 1.5 1.8 0.8 0.0 100.0 328 30-34 14.5 75.4 5.8 1.5 2.0 0.9 100.0 299 35-39 4.9 89.6 3.3 1.6 0.5 0.2 100.0 220 40-44 3.6 89.1 5.6 1.1 0.6 0.0 100.0 208 45-49 0.2 93.5 4.0 0.4 0.1 1.8 100.0 159 50-54 0.2 92.2 1.2 3.2 2.0 1.2 100.0 133 55-59 0.0 94.5 1.7 0.9 0.0 2.8 100.0 120 Total 44.7 50.8 2.3 1.0 0.8 0.5 100.0 2,346 84 | Other Proximate Determinants of Fertility In general, marriage and cohabitation are considered to be primary factors of exposure to the risk of pregnancy. Table 6.1 indicates that in Nigeria 25 percent of women age 15-49 have never married, while 68 percent are married, 2 percent are living together, and 5 percent are separated, divorced, or wid- owed. It is of interest to note that among adolescents age 15-19, more than 30 percent are married or liv- ing together. As expected, the percentage married increases with age. Widowhood also increases with age, from less than 1 percent below age 30 to 8 percent among women age 45-49. The proportion of men who have never married is considerably higher (45 percent) than that of women (25 percent). About half of men are formally married, 2 percent are living together, and 2 percent are either divorced, separated, or widowed. A significant proportion of men marry when they are age 25 or older, unlike women who tend to marry at younger ages. In addition, the proportion of widowers does not increase significantly with age among men, possibly because of higher rates of remarriage among men. 6.2 POLYGYNY Polygyny (having more than one spouse) has implications for the frequency of exposure to sexual activity and fertility. Measurement of polygyny is derived from responses of currently married women to the following questions, “Does your husband (partner) have any other wives apart from yourself,” and if so, “How many other wives does he have?” Similarly, currently married men were asked, “How many wives do you have?” Table 6.2 presents the proportion of currently married women who are in polygynous unions by background characteristics. The data show that 36 percent of married women in Nigeria are in polygynous unions. Twenty-seven percent report that they have only one cowife, while 9 percent say they have two or more cowives. The percentage of women in polygynous unions tends to increase with age, from 27 per- cent of women age 15-19 to 45 percent of those age 40-44. Further, polygyny is more prevalent in rural than in urban areas, and more common among women with lower levels of education. There is marked regional variation in polygyny. Polygyny is more prevalent in the northern parts of Nigeria and ranges from a low of 10 percent in the South East to a high of 44 percent in the North East. Approximately one- fifth of men are in polygynous unions, which is less than the proportion of women (36 percent) (Figure 6.1). Other Proximate Determinants of Fertility | 85 Table 6.2 Polygyny Percent distribution of currently married women age 15-49 by number of cowives and percent distribution of currently married men age 15-59 by number of wives, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––– Number of cowives Number of wives Background –––––––––––––––––––––––––––––– ––––––––––––––––––––– characteristic 0 1 2+ Missing Total Number 1 2+ Missing Total Number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 72.3 22.9 4.0 0.8 100.0 545 * * * * 5 20-24 72.7 22.2 3.9 1.2 100.0 911 98.0 2.0 0.0 100.0 60 25-29 67.1 25.5 7.1 0.3 100.0 1,146 93.3 6.7 0.0 100.0 142 30-34 58.2 31.5 10.1 0.2 100.0 848 84.5 15.5 0.0 100.0 243 35-39 58.2 28.7 11.8 1.3 100.0 763 74.2 24.7 1.2 100.0 204 40-44 54.2 30.6 14.3 0.8 100.0 619 71.6 28.2 0.3 100.0 197 45-49 57.9 24.0 17.8 0.3 100.0 504 69.0 31.0 0.0 100.0 155 50-54 na na na na na na 68.6 30.9 0.5 100.0 124 55-59 na na na na na na 67.1 32.5 0.4 100.0 116 Residence Urban 69.6 21.8 8.1 0.4 100.0 1,633 81.9 17.8 0.3 100.0 401 Rural 60.9 28.6 9.7 0.8 100.0 3,703 75.1 24.6 0.3 100.0 844 Region North Central 60.9 24.8 13.9 0.3 100.0 754 77.1 22.9 0.0 100.0 174 North East 55.8 34.3 9.8 0.0 100.0 1,122 70.4 29.6 0.0 100.0 283 North West 58.7 32.5 7.7 1.1 100.0 1,880 75.2 24.0 0.8 100.0 372 South East 88.1 4.4 6.0 1.6 100.0 368 91.8 8.2 0.0 100.0 99 South South 73.8 17.4 7.6 1.2 100.0 664 77.5 22.5 0.0 100.0 172 South West 70.7 18.4 11.0 0.0 100.0 548 86.2 13.1 0.7 100.0 145 Education No education 55.2 33.8 10.4 0.6 100.0 2,877 69.9 29.9 0.2 100.0 399 Primary 62.9 25.2 11.1 0.7 100.0 1,175 77.5 22.4 0.1 100.0 366 Secondary 82.7 11.2 5.1 1.0 100.0 1,046 85.2 14.1 0.7 100.0 325 Higher 82.9 13.1 4.0 0.0 100.0 238 79.3 20.4 0.3 100.0 155 Total 63.5 26.5 9.2 0.7 100.0 5,336 77.3 22.4 0.3 100.0 1,245 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 23 30 24 8 23 13 North Central North East North West South East South South South West 0 10 20 30 40 Figure 6.1 Percentage of Married Men with Two or More Wives, by Region NDHS 2003 REGION 86 | Other Proximate Determinants of Fertility 6.3 AGE AT FIRST MARRIAGE Marriage is universal in Nigeria, as revealed by the results of the 1991 Census (NPC, 1998). The age at which a woman first gets married influences the length of time she is exposed to the risk of preg- nancy during her childbearing years. The proportion of women who are married by specific exact ages and median age at first marriage are shown in Table 6.3. Three-fifths of women age 30-49 at the time of the survey were married by age 18, while eight in ten were married by age 22. The median age at first marriage is 16.6 years for women 25-49, and has increased from 15.5 years among women 45-49 to 19.1 among women age 20-24. This implies that younger women are marrying at later ages than women did in the past. Table 6.3 also shows that men marry at significantly older ages than women. The median age at first marriage for men is over 23 years in all age groups. Less than half of men age 25-29 have married, compared with almost 90 percent of women. Unlike women, there are no significant differentials in men’s median age at first marriage between the younger and the older cohorts. Table 6.3 Age at first marriage Percentage of women and men who were first married by specific exact ages and median age at first marriage, according to current age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Median first married by exact age: Percentage age at ––––––––––––––––––––––––––––––––––––––––––– never first Current age 15 18 20 22 25 married Number marriage ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 16.1 na na na na 66.7 1,716 a 20-24 18.8 43.3 55.5 na na 36.1 1,494 19.1 25-29 25.5 47.0 58.4 70.2 82.1 12.2 1,382 18.5 30-34 34.4 61.3 71.3 79.0 85.5 5.1 941 16.5 35-39 38.0 63.7 74.8 82.6 90.4 1.7 816 16.0 40-44 41.8 65.1 77.6 85.2 90.6 0.7 688 15.7 45-49 43.5 70.6 79.2 85.3 90.8 0.9 583 15.5 20-49 30.6 55.1 66.3 na na 13.2 5,904 17.2 25-49 34.6 59.1 69.9 78.7 86.8 5.5 4,410 16.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 0.7 na na na na 98.9 453 a 20-24 0.4 4.1 8.2 na na 84.7 426 a 25-29 1.4 4.8 13.1 23.3 36.7 54.0 328 a 30-34 1.7 7.6 14.0 22.0 43.5 14.5 299 26.4 35-39 3.4 13.7 22.8 30.9 44.6 4.9 220 26.1 40-44 1.6 7.1 19.1 32.0 50.5 3.6 208 24.9 45-49 1.1 7.9 17.1 30.7 53.1 0.2 159 24.2 50-54 6.1 15.0 27.7 40.7 58.4 0.2 133 23.6 55-59 1.1 9.7 16.3 22.8 37.9 0.0 120 26.5 20-59 1.7 7.7 15.5 na na 31.7 1,983 a 25-59 2.1 8.7 17.6 27.8 45.1 16.3 1,466 a ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a Omitted because less than 50 percent of the respondents were married for the first time before reaching the beginning of the age group Other Proximate Determinants of Fertility | 87 Table 6.4 shows the median age at first marriage among women age 20-49 and men age 25-59 by current age and background characteristics. Among women, the median age at first marriage is consis- tently lower in rural areas than in urban areas. However, in both rural and urban areas, younger women are marrying at later ages. For example, the median age at first marriage for urban women age 45-49 is 16.5 as opposed to 21.1 years among women age 25-29. Similarly, in rural areas, the median age at first marriage among the oldest women is 15.2 versus 17.8 years among women in their early twenties. Across regions, there is evidence of increasing median age at first marriage between the oldest and youngest cohorts. The region with the lowest median age at first marriage, the North West, shows an increase from 14.1 years among women age 45-49 to 15.5 years among women age 20-24. There are sub- stantial differentials in age at first marriage by wealth quintile: women from more advantaged households tend to marry later than those from less advantaged households. 6.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is used as a proxy for the onset of a woman’s exposure to the risk of preg- nancy. However, some women start sexual activity before marriage, therefore the age at which they begin sexual intercourse signifies the beginning of their exposure to the risk of pregnancy, instead of their age at first marriage. Table 6.5 presents the percentage of women and men who had first sexual intercourse by specific ages and the median age at first sexual intercourse. Table 6.4 Median age at first marriage Median age at first marriage among women 20-49 and among men age 25-59, by current age and background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age: women Women Women Men Background –––––––––––––––––––––––––––––––––––––––––––––––– age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban a 21.1 18.6 17.5 17.5 16.5 19.6 18.9 a Rural 17.8 17.0 15.8 15.5 15.3 15.2 16.3 15.9 24.9 Region North Central 19.6 18.9 17.8 16.5 16.5 16.5 18.2 17.7 a North East 16.3 15.9 14.7 15.0 14.7 14.7 15.3 15.0 23.1 North West 15.5 15.1 14.8 14.5 14.0 14.1 14.8 14.6 24.0 South East a 23.8 22.5 20.7 19.6 17.3 a 21.8 a South South a 21.4 20.2 16.8 17.5 16.2 a 19.2 a South West a 22.7 21.5 21.3 20.1 19.7 a 21.3 a Education No education 15.4 15.1 14.7 14.7 14.5 15.0 14.9 14.8 22.5 Primary 18.1 17.9 17.3 16.8 17.7 16.4 17.5 17.3 a Secondary a 22.1 20.4 20.2 20.4 (22.7) a 21.2 a Higher a a 26.7 24.3 21.8 (20.8) a 24.8 a Wealth quintile Lowest 16.3 15.4 15.2 14.5 14.7 15.2 15.3 15.0 23.4 Second 16.7 15.9 14.8 15.3 14.9 14.5 15.4 15.1 23.3 Middle 17.9 16.5 15.8 15.8 15.4 15.6 16.4 15.9 24.9 Fourth 19.6 19.8 17.7 15.4 16.3 15.6 17.9 17.4 a Highest a 23.2 22.0 20.8 20.1 19.8 a 21.8 a All women 19.1 18.5 16.5 16.0 15.7 15.5 17.2 16.6 na All men na a 26.4 26.1 24.9 24.2 na na a ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable a Omitted because less than 50 percent were married for the first time before the beginning of the age group 88 | Other Proximate Determinants of Fertility One-third of women age 25-49 report that they had sexual intercourse by age 15. By age 20, more than three-quarters of women, and by age 25, almost all women (nine in ten), have had sexual intercourse. The median age at first sexual intercourse is lower among the older women than among the younger women. For the oldest women (age 45-49), the median age at first intercourse is 15.5 years and for younger women (age 20-24), the median age at first intercourse is 17.6 years. As with marriage, the age at which the majority of men have had sexual intercourse is higher than for women. For example, at age 20, two-fifths of men have had sexual intercourse, compared with three- quarters of women. However, whereas median age at first intercourse has increased among women, it has decreased among men. Median age at first intercourse has declined from 25.2 years among men age 55-59 to 20.4 years among men age 25-29. Table 6.6 presents the median age at first sexual intercourse for different cohorts by background characteristics. Rural women have their first sexual intercourse at younger ages than their urban counter- parts. Among the regions, age at first sex is lowest in the North East and North West (15 years or less), and highest in the South West and South East (approximately 19 years). For women, the median age at first sexual intercourse increases with level of educational attainment. Women with no education start Table 6.5 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 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who had first Percentage Median sexual intercourse by exact age: who never age at ––––––––––––––––––––––––––––––––––––––––––– had first Current age 15 18 20 22 25 intercourse Number intercourse –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 20.3 na na na na 48.9 1,716 a 20-24 21.2 54.1 73.9 na na 13.6 1,494 17.6 25-29 26.7 55.1 72.2 84.6 91.3 2.7 1,382 17.3 30-34 34.2 63.5 77.7 84.9 89.0 0.7 941 16.1 35-39 36.6 65.4 77.1 84.4 88.3 0.3 816 15.9 40-44 42.0 66.5 77.7 83.2 86.8 0.3 688 15.6 45-49 42.7 70.7 79.5 85.7 89.1 0.0 583 15.5 20-49 31.2 60.5 75.5 na na 4.3 5,904 16.7 25-49 34.6 62.7 76.1 84.6 89.3 1.1 4,410 16.2 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 7.9 na na na na 75.2 453 a 20-24 5.1 22.3 47.4 na na 37.9 426 a 25-29 7.5 22.7 44.4 66.9 81.3 14.3 328 20.4 30-34 7.2 25.0 47.2 62.1 81.6 2.6 299 20.3 35-39 6.2 25.1 38.1 56.9 73.7 0.6 220 20.8 40-44 4.4 22.7 38.8 57.2 70.5 0.4 208 20.8 45-49 2.4 16.6 31.7 50.9 69.8 0.0 159 21.8 50-54 5.6 16.4 35.7 53.1 76.7 0.2 133 21.3 55-59 1.7 14.8 22.7 39.7 48.4 0.0 120 25.2 20-59 5.5 21.8 41.1 na na 11.5 1,893 a 25-59 5.6 21.6 39.3 57.8 74.3 3.9 1,466 20.8 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a Omitted because less than 50 percent had intercourse for the first time before reaching the beginning of the age group Other Proximate Determinants of Fertility | 89 sexual activity as early as 15 years of age, while women with secondary or higher education have their first sexual intercourse after age 18. Among the younger cohorts, median age at first intercourse increases with level of education. Table 6.6 presents the same information for men. Rural and urban men have their first sexual ex- perience at almost the same ages. Educational differentials are also small. Median age at first intercourse among men does vary by region, ranging from a low of 18.9 years in North Central to 23.5 years in the North West. 6.5 RECENT SEXUAL ACTIVITY In the absence of contraception, the probability of pregnancy is related to the regularity of sexual intercourse. The information on recent intercourse is important for the refinement of the measurement of exposure to pregnancy. Table 6.7.1 presents the distribution of women by timing of the last sexual intercourse, according to background characteristics. In the four weeks preceding the survey, 56 percent of women age 15-49 were sexually active, while 19 percent were sexually active in the last 12 months, and 7 percent had not had sex for more than one year. Among all women, 14 percent have never had sexual intercourse. The proportion of women who were sexually active in the four weeks preceding the survey increases with age up to a maximum of 70 percent of women age 35-39; at older ages the percentage declines. Not surprisingly, there is great variation in the percentage of women who were sexually active in the last four weeks by marital status. It is notable that among currently married women, the proportion of women who had recent intercourse remains relatively stable at all marital durations. Table 6.6 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 and among men age 25-59, by current age and background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age: women Women Women Men Background ––––––––––––––––––––––––––––––––––––––––––––––– age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 18.7 18.7 17.9 16.7 17.3 16.0 18.2 17.8 21.5 Rural 16.9 16.4 15.6 15.6 15.2 15.2 15.9 15.7 20.6 Region North Central 18.0 18.3 17.0 16.9 16.7 16.1 17.6 17.3 18.9 North East 16.1 15.9 14.9 14.8 14.8 14.7 15.3 15.0 21.1 North West 15.8 15.2 14.9 14.7 14.3 14.3 14.9 14.7 23.5 South East a 18.9 18.9 19.0 19.8 16.9 19.1 18.8 20.7 South South 18.0 18.1 16.9 16.8 16.2 15.8 17.4 17.0 20.5 South West 19.1 19.9 19.1 18.8 19.6 19.2 19.3 19.4 20.4 Education No education 15.5 15.2 14.8 14.8 14.6 15.1 15.0 14.9 21.5 Primary 16.9 16.9 16.3 16.8 17.1 16.1 16.7 16.7 20.8 Secondary 18.8 18.7 18.8 18.5 19.8 20.4 18.8 18.8 20.4 Higher a 20.6 19.8 18.6 20.3 19.2 a 20.1 20.9 All women 17.6 17.3 16.1 15.9 15.6 15.5 16.7 16.2 na All men na 20.4 20.3 20.8 20.8 21.8 na na 20.8 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable a Omitted because less than 50 percent were married for the first time before the beginning of the age group 90 | Other Proximate Determinants of Fertility Table 6.7.1 Recent sexual activity: women Percent distribution of women by timing of last sexual intercourse, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Timing of last sexual intercourse –––––––––––––––––––––––––––– Within One or Never had Number Background the last Within more sexual of characteristic 4 weeks 1 year1 years ago Missing intercourse Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age 15-19 33.5 13.9 2.4 1.3 48.9 100.0 1,716 20-24 55.3 20.9 6.2 4.0 13.6 100.0 1,494 25-29 63.7 22.8 5.2 5.6 2.7 100.0 1,382 30-34 67.4 19.6 6.0 6.2 0.7 100.0 941 35-39 70.1 18.1 7.2 4.4 0.3 100.0 816 40-44 66.9 18.9 11.4 2.5 0.3 100.0 688 45-49 59.5 17.1 21.1 2.2 0.0 100.0 583 Marital status Never married 15.1 19.5 7.5 1.4 56.5 100.0 1,926 Married or living together 73.7 17.7 4.3 4.3 0.0 100.0 5,336 Divorced/separated/widowed 19.7 30.0 41.5 8.4 0.4 100.0 358 Marital duration2 Married only once 0-4 years 77.5 15.7 2.2 4.6 0.1 100.0 1,149 5-9 years 72.3 20.8 2.0 4.9 0.0 100.0 880 10-14 years 71.0 17.8 5.4 5.7 0.0 100.0 704 15-19 years 74.7 16.3 4.6 4.5 0.0 100.0 552 20-24 years 73.9 19.1 5.1 2.0 0.0 100.0 538 25+ years 70.9 17.6 9.0 2.4 0.0 100.0 580 Married more than once 73.6 17.4 4.6 4.4 0.0 100.0 933 Residence Urban 51.8 20.1 7.6 3.1 17.4 100.0 2,629 Rural 58.8 18.0 6.5 4.1 12.7 100.0 4,991 Region North Central 41.6 25.0 11.1 4.5 17.8 100.0 1,121 North East 63.4 16.0 5.0 5.8 9.8 100.0 1,368 North West 77.8 11.2 2.5 2.5 6.0 100.0 2,095 South East 42.2 22.2 8.7 3.3 23.7 100.0 737 South South 50.8 20.9 7.7 3.4 17.2 100.0 1,342 South West 35.4 26.2 11.5 3.3 23.5 100.0 958 Education No education 71.0 15.0 6.3 4.5 3.2 100.0 3,171 Primary 51.3 21.1 8.7 4.3 14.6 100.0 1,628 Secondary 41.6 20.7 5.9 2.7 29.0 100.0 2,370 Higher 49.5 26.0 8.7 2.1 13.8 100.0 451 Current contraceptive method Pill 79.1 13.8 4.1 3.1 0.0 100.0 152 IUD (78.4) (21.6) (0.0) (0.0) (0.0) (100.0) 45 Condom 62.4 34.7 2.0 0.9 0.0 100.0 260 Periodic abstinence 58.2 35.4 3.4 2.9 0.0 100.0 163 Other method 72.6 22.9 2.9 1.5 0.0 100.0 392 No method 54.5 17.5 7.5 4.0 16.5 100.0 6,608 Total 56.4 18.7 6.8 3.7 14.3 100.0 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-29 unweighted cases. 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married Other Proximate Determinants of Fertility | 91 Rural women are more likely to be sexually active (59 percent) than urban women (52 percent). Among the six regions, the North West has the highest proportion of sexually active women (78 percent), followed by the North East (63 percent). The South West has the lowest proportion of sexually active women (35 percent), followed by the South East and North Central (42 percent each). Women with no education are more likely to be sexually active than women with some education, as are women who are using a contraceptive method. Table 6.7.2 shows that almost half the men interviewed were sexually active in the four weeks preceding the survey. Another one-fifth had sexual intercourse in the past year, while 7 percent had not had sex in more than a year. Twenty-four percent of men had never had sex. The percentage sexually Table 6.7.2 Recent sexual activity: men Percent distribution of men by timing of last sexual intercourse, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Timing of last sexual intercourse ––––––––––––––––––––––––––– Within One or Never had Number Background the last Within more sexual of characteristic 4 weeks 1 year1 years ago Missing intercourse Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age 15-19 11.1 7.1 6.5 0.0 75.2 100.0 453 20-24 29.3 21.7 11.1 0.0 37.9 100.0 426 25-29 53.0 24.6 7.9 0.2 14.3 100.0 328 30-34 62.8 26.9 7.4 0.3 2.6 100.0 299 35-39 69.3 25.4 3.8 0.9 0.6 100.0 220 40-44 75.6 16.2 4.0 3.9 0.4 100.0 208 45-49 72.8 22.0 4.6 0.6 0.0 100.0 159 50-54 72.6 22.0 4.6 0.6 0.2 100.0 133 55-59 67.0 22.0 8.6 2.5 0.0 100.0 120 Marital status Never married 20.5 15.2 11.0 0.0 53.3 100.0 1,048 Married or living together 73.0 23.0 2.7 1.3 0.0 100.0 1,245 Divorced/separated/widowed 27.8 39.3 32.9 0.0 0.0 100.0 53 Marital duration2 Married only once 0-4 years 72.0 23.8 3.9 0.3 0.0 100.0 268 5-9 years 67.3 29.6 3.1 0.0 0.0 100.0 178 10-14 years 71.2 20.6 3.4 4.9 0.0 100.0 145 15-19 years 79.9 18.7 0.5 0.9 0.0 100.0 142 20-24 years 79.4 18.1 1.7 0.8 0.0 100.0 131 25+ years 68.5 25.0 4.3 2.3 0.0 100.0 163 Married more than once 75.4 22.2 1.2 1.2 0.0 100.0 218 Residence Urban 43.0 20.1 7.8 1.0 28.0 100.0 872 Rural 51.8 19.7 6.6 0.5 21.3 100.0 1,474 Region North Central 42.4 28.5 8.4 0.0 20.7 100.0 348 North East 60.1 17.4 4.0 1.6 16.9 100.0 421 North West 55.2 9.1 2.9 0.5 32.3 100.0 602 South East 30.1 26.6 16.8 3.2 23.2 100.0 207 South South 47.8 20.9 7.2 0.0 24.1 100.0 445 South West 40.5 27.9 11.1 0.0 20.4 100.0 322 Education No education 66.8 13.2 4.1 1.1 14.8 100.0 507 Primary 46.3 25.1 7.0 0.4 21.2 100.0 603 Secondary 39.2 18.4 9.0 0.2 33.2 100.0 960 Higher 52.5 25.7 5.8 2.3 13.7 100.0 276 Total 48.6 19.9 7.1 0.7 23.8 100.0 2,346 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married 92 | Other Proximate Determinants of Fertility Table 6.8 Postpartum amenorrhoea, abstinence, and insuscep- tibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrhoeic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of births for which the mother is: ––––––––––––––––––––––––––– Number Months Amenor- Insuscep- of since birth rhoeic Abstaining tible births ––––––––––––––––––––––––––––––––––––––––––––––––––––––– < 2 91.7 85.1 97.2 189 2-3 81.6 52.5 88.0 241 4-5 69.4 33.0 77.4 272 6-7 63.5 33.4 70.4 249 8-9 65.2 29.2 72.5 244 10-11 52.4 23.7 60.7 216 12-13 52.9 13.9 56.5 238 14-15 51.2 19.3 59.0 204 16-17 33.4 14.7 41.3 216 18-19 24.9 11.4 31.1 143 20-21 18.6 5.5 21.0 153 22-23 16.1 18.3 29.9 143 24-25 6.2 4.3 10.0 273 26-27 4.6 2.7 6.8 230 28-29 3.2 3.4 6.7 167 30-31 2.1 3.9 6.0 198 32-33 1.0 3.2 4.2 175 34-35 2.2 4.3 5.4 184 Total 38.1 21.0 43.8 3,734 Median 13.2 3.0 15.1 na Mean 13.1 7.6 15.1 na ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Estimates are based on status at the time of the survey. na = Not applicable active increases with age from 11 percent of men age 15-19 to 76 percent of men age 40-44; thereafter, the percentage decrease slightly. The table shows that men in union are the most likely to be sexually ac- tive (73 percent). Men’s patterns of sexual activity by residence and region are similar to those of women. As with women, recent sexual activity varies with educational attainment. Approximately 67 percent of men with no education were sexually active in the four weeks preceding the survey, compared with 39 percent of men with some secondary education. 6.6 POSTPARTUM AMENORRHOEA, ABSTINENCE, AND INSUSEPTIBILITY Postpartum amenorrhoea refers to the interval between childbirth and the return of menstruation. This is the period during which a woman becomes temporarily infecund following childbirth. A number of studies have established a direct relationship between the length and intensity of breastfeeding and the duration of postpartum amenorrhoea. Postpartum abstinence refers to the period of voluntary sexual inac- tivity after childbirth. Women are considered insusceptible if they are not exposed to the risk of pregnancy, either because they are amenor- rhoeic or are abstaining from sexual intercourse following a birth. Women who gave birth during the three years preceding the survey were asked about the duration of amenorrhoea and the duration of sexual abstinence following childbirth. Table 6.8 shows the percentage of births in the three years preceding the survey for which mothers are postpartum amenor- rhoeic, abstaining, and insusceptible by number of months since birth. Mean and median dura- tions are also shown. In Nigeria, women are amenorrhoeic for approximately 13 months after giving birth. The median duration of post- partum abstinence is lower—just 3 months. Eighty-five percent of women abstain from sex during the first two months following child- birth. The proportion abstaining decreases with increasing months after delivery, particularly during the first year after birth. A comparison of the data with those from the 1999 NDHS indicates that there has been no change in the duration of postpartum insusceptibility. Table 6.9 shows the median duration of postpartum amenorrhoea, abstinence, and insusceptibility by background characteristics. The median duration of postpartum amenorrhoea, abstinence, and insusceptibility are 13 months, 3 months, and 15 months, respectively. Urban women in Nigeria have a shorter duration of amenorrhoea and postpartum insusceptibility than rural women, but have longer postpartum abstinence. There are also substantial dif- ferentials by region and mother’s education. Other Proximate Determinants of Fertility | 93 Table 6.10 Menopause Percentage of women age 30-49 who are menopausal by age, Nigeria 2003 –––––––––––––––––––––––––––––––– Number Percentage of Age menopausal1 women –––––––––––––––––––––––––––––––– 30-34 0.6 941 35-39 1.5 816 40-41 5.9 381 42-43 12.7 247 44-45 28.9 280 46-47 36.3 142 48-49 52.4 221 Total 10.6 3,028 –––––––––––––––––––––––––––––––– 1 Percentage of all women who are not pregnant and not postpartum amenor- rhoeic whose last menstrual period oc- curred six or more months preceding the survey 6.7 MENOPAUSE The lack of a menstrual period in the preceding six months among women who are neither pregnant nor postpartum amenor- rhoeic is taken as evidence of menopause. Table 6.10 shows the proportion of women who are menopausal. The proportion of women who are menopausal increases steadily after age 30. More than half of women age 48-49 report that they are menopausal. Table 6.9 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum absti- nence, and postpartum insusceptibility following births in the three years pre- ceding the survey, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Postpartum: –––––––––––––––––––––––––– Number Background Amenor- Insuscep- of characteristic rhoea Abstinence tibility births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age 15-29 13.0 2.8 14.6 2,307 30-49 13.6 3.4 15.9 1,427 Residence Urban 10.6 3.5 12.6 1,110 Rural 14.1 2.7 16.3 2,624 Region North Central 13.0 16.5 19.2 540 North East 15.8 2.3 16.3 857 North West 15.4 1.9 15.5 1,282 South East 10.8 4.3 13.2 244 South South 7.2 3.9 9.5 491 South West 10.6 5.5 12.1 320 Mother's education No education 15.8 2.3 17.0 1,855 Primary 12.7 5.7 14.1 883 Secondary 7.3 3.5 8.7 866 Higher 5.6 4.7 6.2 129 Total 13.2 3.0 15.1 3,734 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Medians are based on status at the time of the survey. Fertility Preferences | 95 FERTILITY PREFERENCES 7 This chapter addresses three questions that allow an assessment of the need for contraception. Does the respondent want more children? If so, how long would she prefer to wait before the next child? If she could start afresh, how many children in all would she want? This chapter also examines the occur- rence of unwanted or mistimed pregnancies and analyzes the effect that prevention of such pregnancies would have on the fertility rates. Because the underlying rationale of most family planning programmes is to give couples the freedom and ability to bear the number of children they want and to achieve the spac- ing of births they prefer, these are key issues for programme planners. Interpretation of data on fertility preferences has always been the subject of controversy. Survey questions have been criticized on the grounds that answers are misleading because 1) they reflect un- formed, ephemeral views, which are held with weak intensity and little conviction; and 2) they do not take into account the effect of social pressures or the attitudes of other family members, particularly the husband, who may exert a major influence on reproductive decisions. The first objection has greater force in noncontracepting societies where the idea of conscious reproductive choice may still be alien; prefer- ence data from these settings should be interpreted with caution. In societies with moderate to high levels of use, greater interpretive weight can be attached to the findings. The second objection is correct in prin- ciple. In practice, however, its importance is doubtful; for instance, the evidence from surveys in which both husbands and wives are interviewed suggests that there is no radical difference between the views of the two sexes. The inclusion of women who are currently pregnant complicates the measurement of views on fu- ture childbearing. For these women, the question on desire for more children is rephrased to refer to de- sire for another child after the one that they are expecting. To take into account the way in which the pref- erence variable is defined for pregnant women, the results are classified by number of living children, including the current pregnancy as equivalent to a living child. 7.1 DESIRE FOR MORE CHILDREN Information on fertility preferences among currently married women is presented in Table 7.1. The table shows the potential need for contraceptive services for spacing as well as for limiting births. Until recently, concern for providing appropriate contraceptive methods to couples who wish to have no more children has overshadowed contraception for child spacing purposes. The interest in spacing has been reinforced by recent evidence that 1) short birth intervals are harmful to the welfare of children and mothers; 2) large numbers of couples wish to postpone childbearing by using contraception; and 3) there is a potential demand for contraception for spacing births in some countries where demand for limiting family size has not yet emerged. Table 7.1 shows that the desire for more children is related to the number of living children women already have. Virtually all currently married women with no children want to have a child, eight in ten express the desire to have a child soon. As the number of living children increases, the desire to have children decreases. The percentage of women who want to space the birth of their next child (have another later) first rises with parity, up to parity two, then declines steadily with the rise in the number of living children. This pattern was also observed in the 1999 NDHS (NPC, 2000:88). However, it is striking that almost three-quarters of women with four living children (73 percent) want to have another child. It is equally significant that 18 percent of all women want no more children. The desire to stop childbearing begins to appear when couples have had at least three living children. While only 2 percent 96 | Fertility Preferences of childless women want no children, half of women who have had six or more children say they want to stop childbearing. Irrespective of the number of living children, more than half of women (52 percent) either want to delay having another child or stop childbearing altogether. These women are potential contraceptive users for spacing or for limitation of fertility. 7.2 DESIRE TO LIMIT CHILDBEARING Table 7.2 presents the percentage of currently married women who want no more children by number of living children and background characteristics. This table provides information about varia- tions in the potential demand for fertility control. The data show that the desire to limit childbearing is higher in urban than rural areas (22 and 17 percent, respectively) and varies with the number of living children. In urban areas, for example, one- third of women with four living children desire no more children. This compares with just 15 percent of women living in rural areas. There are no significant urban-rural differences in the desire to limit child- bearing once women have had six or more children. At that parity, about half of women in both urban and rural areas want no more children. There are large regional variations in the desire to limit childbearing. In general, the desire to limit childbearing is lowest in the North West (7 percent) and highest in the South East and South South regions (32 percent each). In the South West, even at parity four, half of all currently married women want no more children. In all the southern regions, the majority desire no more children once they have had five children. At parity six and above, eight in every ten women in the southern regions do not want any more children. In contrast, in the North West and North East, the majority of women do not wish to limit childbearing, irrespective of the number of living children they already have. This is especially true of women in the North West; in that region, just two out of every ten women with six or more children say that they want no more children. Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women by desire for children, according to number of living children, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Desire for children 0 1 2 3 4 5 6+ Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Have another soon2 79.2 47.1 42.1 36.8 32.4 23.2 14.8 37.1 Have another later3 10.5 43.8 46.2 42.6 36.7 29.5 19.1 33.8 Have another, undecided when 2.3 5.1 4.4 6.3 3.5 3.8 3.6 4.3 Undecided 0.9 0.5 0.7 2.7 3.5 3.7 3.9 2.3 Want no more 1.8 0.6 4.4 8.2 20.5 34.4 50.3 18.1 Sterilized4 0.0 0.0 0.0 0.1 0.3 0.0 0.8 0.2 Declared infecund 5.1 2.4 2.2 3.2 3.0 4.4 7.1 3.9 Missing 0.3 0.5 0.0 0.1 0.0 1.0 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 491 902 871 776 701 608 986 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization Fertility Preferences | 97 In addition to regional differences, the desire to limit childbearing varies by education. Almost twice as many women with higher education as women with no education want to limit childbearing (29 percent versus 15 percent). The desire to limit childbearing increases with household economic status. For example, one in six women in households in the lowest wealth quintile wants to limit childbearing, com- pared with one in four women in households in the highest quintile. Among women residing in urban areas and in the south and in the North Central region, among those with some education, and among those in the highest wealth quintile, parity five appears to be the threshold value at which a significant proportion begin to want no more children. Table 7.2 Desire to limit childbearing by background characteristics Percentage of currently married women who want no more children, by number of living children and background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 Background ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– All characteristic 0 1 2 3 4 5 6+ women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 0.0 0.0 5.1 12.5 34.1 46.0 49.4 21.8 Rural 2.5 0.9 4.1 6.5 15.2 29.2 51.8 16.7 Region North Central 0.0 0.0 7.2 7.3 31.8 46.6 61.9 24.1 North East 3.5 0.2 4.5 8.1 16.0 23.3 44.8 16.3 North West 2.2 0.9 1.3 3.0 8.2 10.4 20.7 6.5 South East (0.0) 0.0 4.6 10.0 27.7 55.6 83.5 31.6 South South (0.0) 0.0 3.7 12.3 16.7 53.8 80.6 31.6 South West (0.0) 1.6 11.0 21.4 52.0 62.3 80.9 29.9 Education No education 2.8 0.8 4.1 7.7 15.4 22.8 40.5 15.0 Primary 0.0 0.0 4.8 8.9 19.1 44.1 65.4 25.8 Secondary 0.0 0.8 3.7 7.7 23.5 53.0 68.2 16.4 Higher (0.0) (0.0) (9.1) (14.3) (76.2) (49.9) (81.0) 29.3 Wealth quintile Lowest 2.8 1.5 2.7 6.7 13.5 17.7 48.3 15.5 Second 1.2 0.2 5.9 7.0 12.5 27.8 49.6 16.1 Middle 3.7 0.3 3.2 5.1 15.6 38.8 46.3 17.3 Fourth 0.0 0.0 4.9 10.0 25.1 35.3 45.2 18.4 Highest 0.0 0.9 5.1 13.4 39.5 56.1 76.7 24.8 Total 1.8 0.6 4.4 8.3 20.8 34.4 51.0 18.3 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes current pregnancy 98 | Fertility Preferences 7.3 NEED FOR FAMILY PLANNING This section discusses the extent of need and potential demand for family planning services in Nigeria. Unmet need for family planning refers to fecund women who either wish to postpone the next birth (spacers) or who wish to stop childbearing altogether (limiters), but are not using a contraceptive method. Pregnant women are considered to have unmet need for spacing or limiting if their pregnancy was mistimed or unwanted, respectively. Similarly, amenorrhoeic women are classified as having unmet need if their last birth was mistimed or unwanted. Women who are currently using a family planning method are said to have a met need for family planning method. The total demand for family planning comprises those who fall in the met need and the unmet need categories. Table 7.3 presents estimates for unmet need, met need, and total demand for family planning among currently married Nigerian women by background characteristics. The total demand for family planning among currently married women is 30 percent, and 43 percent of that demand is satisfied. The demand for spacing purposes is twice as high as the demand for limiting purposes (20 and 10 percent, respectively). Overall, less than one-fifth of currently married women have an unmet need for family planning (17 percent). Twelve percent have unmet need for spacing and 5 percent for limiting. Unmet need does not vary much by age except for women age 45-49, who have the lowest unmet need. It is notable that up to age 34, virtually all unmet need for family planning is for spacing purposes. After age 35, most unmet need is for limiting childbearing. Total unmet need for family planning is high- est in the South South region, where one-fourth of currently married women have unmet need for family planning, and lowest in the North West (11 percent). There are no rural-urban differentials nor does un- met need vary substantially by wealth quintile. However, it should be noted that among women in house- holds in the lowest wealth quintile, only 32 percent of demand for family planning is satisfied, compared with 62 percent among women in households in the highest wealth quintile. No doubt, women in more economically advantaged households have the means to satisfy their family planning needs, unlike women in poorer households. Table 7.4 shows the need for family planning among all women and women who are not cur- rently married. As expected, unmet need for family planning is higher among currently married women (17 percent) and lower among all women (14 percent) and women who are not currently married (6 per- cent). Fertility Preferences | 99 Table 7.3 Need for family planning among currently married women Percentage of currently married women with unmet need for family planning, and with met need for family planning, and the total demand for family planning, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Met need for Unmet need for family planning Total demand for family planning1 (currently using)2 family planning3 Percentage –––––––––––––––––––– ––––––––––––––––––––– –––––––––––––––––––– of Number Background For For For For For For demand of characteristic spacing limiting Total spacing limiting Total spacing limiting Total satisfied women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 13.9 0.6 14.6 4.1 0.2 4.3 18.0 0.9 18.9 22.9 545 20-24 16.1 0.3 16.4 9.3 0.2 9.4 25.4 0.4 25.8 36.5 911 25-29 16.0 1.1 17.1 15.3 0.8 16.1 31.2 1.9 33.2 48.5 1,146 30-34 13.9 5.3 19.1 8.8 4.8 13.6 22.7 10.0 32.7 41.5 848 35-39 8.1 10.1 18.1 5.2 11.1 16.3 13.3 21.2 34.5 47.4 763 40-44 5.3 14.1 19.3 2.5 12.7 15.1 7.7 26.7 34.4 43.9 619 45-49 2.4 9.0 11.4 1.2 7.6 8.9 3.6 16.7 20.3 43.7 504 Residence Urban 11.7 5.5 17.3 12.1 8.2 20.2 23.8 13.7 37.5 54.0 1,633 Rural 11.8 4.9 16.7 6.0 3.3 9.2 17.8 8.2 26.0 35.5 3,703 Region North Central 15.2 6.6 21.8 7.0 6.4 13.3 22.2 12.9 35.1 37.9 754 North East 13.1 5.0 18.1 2.8 1.4 4.2 15.9 6.4 22.3 19.0 1,122 North West 9.9 1.2 11.1 4.6 0.4 4.9 14.5 1.5 16.1 30.8 1,880 South East 9.0 10.0 18.9 12.3 10.2 22.5 21.2 20.2 41.4 54.3 368 South South 13.0 11.5 24.5 14.7 10.7 25.4 27.7 22.3 49.9 50.9 664 South West 11.3 5.9 17.2 19.1 13.6 32.7 30.4 19.5 49.9 65.6 548 Education No education 10.1 3.9 14.1 2.5 1.4 4.0 12.7 5.4 18.0 22.1 2,877 Primary 13.4 7.6 21.0 8.3 8.4 16.7 21.7 16.0 37.7 44.4 1,175 Secondary 15.8 4.9 20.7 18.1 8.0 26.1 33.9 12.9 46.8 55.8 1,046 Higher 6.6 8.1 14.7 24.1 12.8 36.9 30.7 20.9 51.7 71.5 238 Wealth quintile Lowest 11.3 3.6 14.9 3.8 3.1 6.9 15.1 6.8 21.8 31.8 1,150 Second 10.6 5.0 15.6 4.1 1.6 5.6 14.7 6.5 21.2 26.6 1,142 Middle 12.5 4.2 16.7 5.4 3.7 9.1 17.9 7.9 25.8 35.2 1,086 Fourth 13.0 6.9 19.9 8.8 4.7 13.5 21.8 11.6 33.4 40.3 957 Highest 11.9 6.2 18.0 18.4 11.6 30.0 30.3 17.8 48.0 62.4 1,002 Total 11.8 5.1 16.9 7.8 4.8 12.6 19.6 9.9 29.5 42.7 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women who are not using family planning and whose last birth was mistimed, and fecund 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 included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who became pregnant while using a method (these women are in need of better contraception). 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 chil- dren. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrhoeic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in the total demand for contraception (since they would have been using had their method not failed). 100 | Fertility Preferences Table 7.4 Need for family planning among all women and among women who are not currently married Percentage of all women and women who are not currently married with unmet need for family planning, and with met need for family planning, and the total demand for family planning, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Met need for Unmet need for family planning Total demand for Percentage family planning1 (currently using)2 family planning3 of –––––––––––––––––––– ––––––––––––––––––––– –––––––––––––––––––– demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fied women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 7.7 0.2 7.9 6.3 0.3 6.6 14.0 0.5 14.5 45.4 1,716 20-24 12.7 0.3 13.0 15.4 0.3 15.7 28.0 0.6 28.6 54.8 1,494 25-29 14.4 1.0 15.4 17.0 1.1 18.1 31.4 2.1 33.5 54.1 1,382 30-34 13.9 4.9 18.8 9.4 4.8 14.2 23.3 9.7 33.0 43.0 941 35-39 7.6 9.5 17.1 5.8 10.6 16.4 13.4 20.1 33.5 48.9 816 40-44 4.7 12.8 17.5 2.5 12.1 14.6 7.3 24.9 32.1 45.6 688 45-49 2.4 8.0 10.3 1.1 6.8 7.9 3.5 14.8 18.3 43.4 583 Residence Urban 8.9 3.5 12.5 13.7 5.6 19.3 22.7 9.1 31.8 60.8 2,629 Rural 10.5 3.7 14.2 7.4 2.6 10.1 18.0 6.4 24.3 41.4 4,991 Region North Central 12.3 4.6 16.8 7.2 5.0 12.2 19.5 9.6 29.0 42.0 1,121 North East 12.0 4.1 16.1 2.8 1.2 4.0 14.7 5.3 20.0 19.7 1,368 North West 9.0 1.1 10.0 4.2 0.6 4.8 13.2 1.6 14.9 32.5 2,095 South East 7.7 5.0 12.7 14.8 5.2 20.0 22.5 10.2 32.7 61.1 737 South South 10.7 6.0 16.8 18.0 6.0 24.0 28.8 12.0 40.7 58.8 1,342 South West 7.2 3.4 10.5 18.3 8.0 26.2 25.4 11.3 36.8 71.4 958 Education No education 9.8 3.6 13.4 2.5 1.6 4.0 12.2 5.2 17.4 23.2 3,171 Primary 11.2 5.6 16.8 7.5 6.3 13.8 18.8 11.8 30.6 45.2 1,628 Secondary 10.3 2.4 12.6 17.0 4.0 21.0 27.3 6.4 33.6 62.4 2,370 Higher 5.1 4.3 9.4 28.6 7.1 35.7 33.7 11.4 45.1 79.1 451 Total 10.0 3.7 13.6 9.6 3.7 13.3 19.6 7.3 26.9 49.3 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN WHO ARE NOT CURRENTLY MARRIED ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 4.8 0.0 4.8 7.4 0.3 7.6 12.2 0.3 12.4 61.3 1,171 20-24 7.3 0.4 7.6 24.9 0.6 25.5 32.2 0.9 33.1 77.0 583 25-29 6.6 0.3 6.8 25.6 2.3 28.0 32.2 2.6 34.8 80.4 236 30-34 14.2 1.4 15.7 14.4 5.3 19.7 28.6 6.7 35.3 55.7 93 35-39 0.9 1.8 2.7 13.8 3.3 17.1 14.7 5.1 19.8 86.4 53 40-44 0.0 1.1 1.1 3.1 7.1 10.2 3.1 8.2 11.3 90.2 69 45-49 2.3 1.3 3.6 0.5 1.5 2.1 2.8 2.9 5.7 36.5 79 Residence Urban 4.3 0.2 4.6 16.5 1.4 17.9 20.8 1.6 22.4 79.6 996 Rural 6.7 0.3 7.1 11.7 0.9 12.6 18.4 1.2 19.6 64.0 1,288 Region North Central 6.3 0.4 6.7 7.7 2.2 9.9 13.9 2.7 16.6 59.6 366 North East 6.8 0.3 7.1 2.6 0.0 2.6 9.4 0.3 9.7 27.0 245 North West 0.5 0.0 0.5 1.1 2.6 3.7 1.6 2.6 4.2 88.0 215 South East 6.5 0.0 6.5 17.3 0.2 17.5 23.8 0.2 24.0 72.8 369 South South 8.6 0.7 9.2 21.3 1.3 22.6 29.8 1.9 31.8 71.0 678 South West 1.7 0.0 1.7 17.1 0.4 17.5 18.8 0.4 19.2 91.2 411 Education No education 6.2 0.2 6.4 1.5 3.2 4.7 7.7 3.4 11.1 42.3 293 Primary 5.6 0.3 5.9 5.6 0.7 6.3 11.2 1.0 12.2 51.6 454 Secondary 6.0 0.4 6.3 16.2 0.8 17.0 22.1 1.2 23.3 72.9 1,324 Higher 3.4 0.0 3.4 33.5 0.7 34.2 37.0 0.7 37.7 90.8 213 Total 5.7 0.3 6.0 13.8 1.1 14.9 19.5 1.4 20.9 71.3 2,284 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women who are not using family planning and whose last birth was mistimed, and fecund 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 included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who be- came pregnant while using a method (these women are in need of better contraception). 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. 3 Nonusers who are pregnant or amenorrhoeic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in the total demand for contraception (since they would have been using had their method not failed). Fertility Preferences | 101 7.4 IDEAL NUMBER OF CHILDREN This section discusses responses of women to inquiries about what they consider to be the ideal number of children. Respondents who had no children were asked how many children they would like to have if they could choose the number of children to have in their whole life. Those who had living chil- dren were asked about the number of children they would choose if they could start their childbearing again. Responses provide an indicator of future fertility, while the information supplied by the latter group also provides a measure of unwanted fertility. Table 7.5 shows the distribution of respondents by ideal number of children and mean ideal num- ber of children according to actual number of living children for all women and for all men. One in every nine women gave a non-numeric response1 to the question on ideal number of children. In general, Nige- rian women, irrespective of their number of living children, consider a large number of children ideal. The ideal number of children is 6.7 for all women and 7.3 for currently married women. Almost two-thirds of all women consider five or more children to be ideal. Only 6 percent of women think three or less children is ideal. Among all women, the mean ideal number of children increases with the number of living chil- dren, from 5.4 for those without any children to 8.6 among those with six or more children. Clearly, Nige- rian women consider a large family to be desirable. Nigerian men, on average, want even more children than Nigerian women. Indeed, men’s mean ideal number of children is about two children more than that of women (8.6 versus 6.7). Currently mar- ried men report a mean ideal number of children that is three children more than the ideal of currently married women (10.6 versus 7.3). These findings are similar to those from the 1999 NDHS (NPC, 2000:95). 1 Non-numeric responses include “it is up to God,” “any number,” and “don’t know.” 102 | Fertility Preferences 7.5 IDEAL NUMBER OF CHILDREN BY BACKGROUND CHARACTERISTICS Among both women and men, there are significant variations in mean ideal number of children by background characteristics (Table 7.6). The older the respondent, the more children they consider ideal; this is true across most background characteristics. However, even the youngest women (age 15- 19), think the ideal family size is about six children (5.8). Rural women want one more child than urban women (7.0 versus 6.0). Women in the North West have the largest ideal number of children (8.6), fol- lowed by those in the North East (7.8). Women in the south, on the other hand, want fewer children than women in the north. The number is lowest in the South West (4.8). Table 7.5 Ideal number of children Percent distribution of all women and all men by ideal number of children and mean ideal number of children for all women and for all men and for currently married women and for currently married men, according to number of living children, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of living children1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Ideal number of children 0 1 2 3 4 5 6+ Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 0.2 0.1 0.0 0.2 0.2 0.1 0.1 0.1 2 2.5 2.2 1.6 0.5 0.6 1.7 0.4 1.6 3 7.6 6.2 3.9 2.1 0.7 2.0 1.4 4.4 4 30.2 21.2 16.6 12.7 11.8 5.7 6.3 18.2 5 18.1 15.6 17.4 14.7 9.6 11.5 5.9 14.2 6+ 34.5 44.9 51.2 57.7 65.6 63.6 68.2 50.7 Non-numeric responses 6.8 9.7 9.4 12.2 11.4 15.5 17.7 10.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,319 1,109 936 818 737 646 1,055 7,620 Mean ideal number of children for:2 All women 5.4 6.3 6.6 7.0 7.5 7.6 8.6 6.7 Number 2,161 1,001 849 718 653 546 868 6,795 Currently married women 6.9 6.6 6.7 7.0 7.5 7.7 8.6 7.3 Number 431 805 786 678 621 510 806 4,638 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 1.5 0.0 0.0 0.0 0.0 0.0 0.2 0.8 1 0.0 0.1 0.7 0.0 0.0 0.0 0.0 0.1 2 2.0 0.3 1.3 0.0 0.0 0.0 0.4 1.2 3 5.7 11.2 5.1 7.1 1.6 2.7 1.1 4.8 4 21.0 18.3 14.3 15.6 30.8 17.3 7.2 17.3 5 20.9 14.2 16.1 19.5 9.0 7.2 6.9 15.8 6+ 39.4 37.6 39.9 45.0 41.9 56.7 58.1 44.6 Non-numeric responses 9.5 18.3 22.6 12.9 16.7 16.1 26.1 15.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 1,139 168 161 145 117 102 513 2,346 Mean ideal number of children for:2 All men 6.7 7.3 8.3 9.6 9.3 10.2 13.4 8.6 Number 1,031 138 124 126 98 85 379 1,982 Currently married men 6.7 8.0 8.5 9.7 9.4 10.3 13.5 10.6 Number 80 105 116 122 95 83 371 972 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Includes current pregnancy 2 Means are calculated excluding respondents giving non-numeric responses. Fertility Preferences | 103 The ideal number of children declines as level of education and wealth quintile increase. For ex- ample, the mean ideal number of children is 4.9 among women with higher education, compared with 8.3 for women with no education. Similarly, women in households in the lowest wealth quintile want 7.6 children, compared with the 5.1 children for women living in households in the highest wealth quintile, a difference of 2.5 children. These findings are similar to those of the 1999 NDHS (NPC, 2000:97), which showed that ideal family size has a strong negative correlation with level of education. Table 7.6 also presents the findings for men. As observed earlier, men, irrespective of background characteristics, want more children than women. Similar to women, the ideal family size among urban men is lower than among rural men (6.6 and 9.8, respectively). However, the differential for men between urban and rural ideal number of children (3.2 children) is larger than the differential for women (1 child). The magnitude of regional differences is also more pronounced for men than for women. Men in the North West want almost three times as many children as men in the South West (12.8 versus 4.8). Similar to women, the mean ideal number of children is lowest in the South West and South East and highest in the North West and North East. Men’s ideal number of children decreases as level of education and wealth quintile increase. For example, men without education want twice as many children as men with higher education (14.4 versus 6.5). In fact, men without education have the largest ideal family size among all the subgroups in the sample. Table 7.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women by current age and mean ideal number of children for all men, accord- ing to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age: women Background ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 women men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 5.5 5.6 5.7 6.4 6.6 7.0 7.1 6.0 6.6 Rural 6.0 6.6 7.0 7.4 8.1 8.0 8.1 7.0 9.8 Region North Central 5.2 6.0 6.1 6.4 7.1 6.9 7.6 6.2 8.0 North East 7.0 6.9 7.9 8.0 8.9 9.1 8.8 7.8 12.5 North West 7.4 8.2 8.5 9.3 9.6 9.1 9.4 8.6 12.8 South East 5.2 5.0 5.0 5.3 5.6 5.8 6.3 5.3 5.3 South South 5.0 5.1 5.3 5.7 5.9 7.0 6.9 5.5 6.7 South West 4.4 4.4 4.4 4.8 5.2 5.4 6.3 4.8 4.8 Education No education 7.5 7.8 8.4 8.7 9.1 8.7 8.6 8.3 14.4 Primary 5.9 6.5 6.5 6.6 7.2 7.1 6.8 6.6 9.0 Secondary 5.0 5.1 5.1 5.5 5.5 5.8 5.0 5.2 6.8 Higher (5.0) 5.1 4.6 4.8 4.8 (5.6) (5.3) 4.9 6.5 Wealth quintile Lowest 6.4 6.7 8.0 8.1 8.6 8.4 8.8 7.6 11.4 Second 6.3 7.0 7.4 7.8 8.5 8.3 8.4 7.4 11.6 Middle 6.3 6.9 7.0 7.4 8.0 8.6 7.7 7.1 9.6 Fourth 5.8 6.0 6.3 7.2 7.9 7.3 7.8 6.5 7.4 Highest 4.7 5.1 5.0 5.3 5.6 5.6 5.8 5.1 5.0 All women 5.8 6.2 6.5 7.1 7.5 7.7 7.8 6.7 na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 104 | Fertility Preferences 7.6 WANTED AND UNWANTED FERTILITY In the 2003 NDHS, women were asked a series of questions for each child born in the preceding five years (and for any current pregnancy) to determine whether the particular pregnancy was planned, unplanned but wanted at a later time, or unwanted. These questions form a potentially powerful indicator of the degree to which couples successfully control childbearing. In addition, the data can be used to gauge the effect of the prevention of unwanted births on fertility. The questions are demanding. The respondent is required to recall accurately her wishes at one or more points in the past five years and to report them honestly. The danger of rationalization is present and a previously unwanted pregnancy may well become a cherished child. Despite these potential problems, results from previous surveys have proved plausible. Respondents are clearly willing to report unwanted conceptions, although some after-the-fact rationalization probably occurs; the result is probably an under- estimate of unwanted fertility. In DHS surveys, these retrospective questions are asked independently of the questions on the de- sire for more children and total desired family size and have not been cross-edited at the data processing stage. Table 7.7 shows the percent distribution of births in the five years preceding the survey by plan- ning status of birth, according to birth order and mother’s age at birth. Although more than eight in ten births were wanted at the time, one out of every six births was either not wanted at all or was wanted later (mistimed). There is no clear pattern in the percentage of births not wanted by birth order. Table 7.7 Fertility planning status Percent distribution of births in the five years preceding the survey (including current pregnancies), by fertility planning status, according to birth order and mother’s age at birth, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Planning status of birth Birth order –––––––––––––––––––––––––––– Number and mother's Wanted Wanted Wanted of age at birth then later no more Missing Total births –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth order 1 83.0 8.4 7.8 0.9 100.0 1,430 2 88.3 8.0 2.7 1.0 100.0 1,169 3 88.8 8.9 1.5 0.7 100.0 1,005 4+ 83.0 10.6 5.6 0.7 100.0 3,483 Mother's age at birth <20 82.4 9.4 7.1 1.1 100.0 1,235 20-24 85.4 10.9 3.1 0.5 100.0 1,916 25-29 88.4 8.8 1.8 1.0 100.0 1,776 30-34 84.1 9.8 5.6 0.6 100.0 1,100 35-39 81.7 7.5 10.1 0.7 100.0 770 40-44 76.0 9.8 12.3 1.8 100.0 246 45-49 81.9 7.5 10.6 0.0 100.0 43 Total 84.7 9.5 5.0 0.8 100.0 7,087 Fertility Preferences | 105 Table 7.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––– Total wanted Total Background fertility fertility characteristic rate rate –––––––––––––––––––––––––––––––––––––– Residence Urban 4.6 4.9 Rural 5.7 6.1 Region North Central 5.2 5.7 North East 6.7 7.0 North West 6.6 6.7 South East 3.5 4.1 South South 3.9 4.6 South West 3.9 4.1 Education No education 6.5 6.7 Primary 5.7 6.3 Secondary 4.3 4.7 Higher 2.6 2.8 Wealth quintile Lowest 6.1 6.5 Second 5.9 6.3 Middle 5.4 5.7 Fourth 5.6 5.9 Highest 3.8 4.2 Total 5.3 5.7 –––––––––––––––––––––––––––––––––––––– Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. 7.7 WANTED FERTILITY RATES Table 7.8 presents total wanted fertility rates and total fertility rates for the three years preceding the survey by background characteristics. Wanted fertility rates are calcu- lated in the same manner as the conventional age-specific fertility rates presented in Chapter 4, except that births classified as unwanted are omitted from the numerator. The remainder is cumulated to form a total wanted fertility rate, which is analogous to the conventional TFR. A comparison of the two rates suggests the potential effect of the elimination of unwanted births. The total wanted fertility rate is 5.3, which is 0.4 births less than the total fertility rate of 5.7. This difference implies a low level of unwanted births in Nigeria. However, there are some differences between wanted TFRs and actual TFRs across subgroups. For example, the difference between the two rates is lowest in the North West (0.1 child) and largest in the South South region (0.7 child). 7.8 IDEAL NUMBER OF CHILDREN AND UNMET NEED BY WOMEN’S STATUS Table 7.9 shows women’s ideal family size and their unmet need for family planning by the three indicators of women empowerment—number of decisions in which the respondent participates, number of reasons for which a woman can refuse to have sexual relations with her husband, and number of reasons for which the respondent feels a husband is justified in beating his wife (see Chapter 3). The data indicate that the higher the status of women, the lower the ideal number of children. This is true regardless of indicator of women’s status. However, the relationship between women’s status indicators and unmet need for family planning is unclear. 106 | Fertility Preferences Table 7.9 Ideal number of children and unmet need for family planning by women’s status Mean ideal number of children and unmet need for family planning, by women's status indicators, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Unmet need for family planning 2 Mean ideal ––––––––––––––––––––––––––––– Number number of For For of Women’s status indicator children1 Number spacing limiting Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say3 0 8.1 1,791 11.8 2.6 14.4 2,136 1-2 7.3 1,564 12.6 5.0 17.6 1,799 3-4 6.1 643 13.3 8.6 21.9 709 5 6.3 640 8.1 9.7 17.8 692 Number of reasons to refuse sex with husband 0 8.0 420 12.6 4.0 16.6 506 1-2 7.9 1,171 10.4 4.4 14.8 1,409 3-4 7.0 3,046 12.2 5.6 17.8 3,422 Number of reasons wife beating is justified 0 6.4 1,493 11.5 5.5 16.9 1,632 1-2 7.5 998 9.6 5.2 14.8 1,135 3-4 7.3 761 16.1 4.4 20.5 878 5-6 8.1 1,386 11.4 5.1 16.4 1,691 Total 7.3 4,638 11.8 5.1 16.9 5,336 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Totals are calculated excluding the women giving non-numeric responses. 2 See Table 7.3 for definition of unmet need for family planning. 3 Either by herself or jointly with others Infant and Child Mortality | 107 INFANT AND CHILD MORTALITY 8 One important objective of the 2003 Nigeria Demographic and Health Survey (2003 NDHS) was to measure levels and trends of mortality among children, because infant and child mortality rates are ba- sic indicators of a country’s socioeconomic situation and quality of life. Estimates of childhood mortality are based on information from the birth history section of the questionnaire administered to women. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the mother, the number who live elsewhere, and the number who have died). For each of these births, information was collected on sex, month and year of birth, survivor- ship status, and current age or, if the child had died, age at death. This information is used to directly es- timate the following five mortality rates: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality: the probability of dying before the first birthday Child mortality: the probability of dying between the first and fifth birthdays Under-five mortality: the probability of dying between birth and the fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. 8.1 DATA QUALITY ASSESSMENT The reliability of mortality estimates depends on the sampling variability of the estimates and on nonsampling errors. Sampling variability and sampling errors are discussed in Appendix B. Nonsampling errors depend on the completeness with which child deaths are reported and the accuracy of the reported date of birth and age at death. Omission of births and deaths affects mortality estimates, displacement of dates impacts mortality trends, and misreporting of age at death may distort the age pattern of mortality. Typically, the most serious source of nonsampling errors in a survey that collects retrospective in- formation on births and deaths arises from an underreporting of births and deaths of children who are not alive at the time of the survey. Mothers may be reluctant to talk about their dead children because of feel- ings associated with any death or because the culture in which they live may discourage discussing the dead. Even if a respondent is willing to discuss a dead child, she may be likely to forget events that hap- pened in the more distant past, particularly if a child was alive only for a short time. 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: 74 percent for the period 0-4 years preceding the survey. Furthermore, it appears that early infant deaths for births that occurred longer before the survey have not been severely underreported; 72 percent of all neonatal deaths in the 20 years preceding the survey were early neonatal deaths (Appendix Table C.5). Another issue affecting childhood mortality estimates is the quality of reporting of age at death. If age at death is misreported, estimates may be biased, especially if the net effect of age misreporting re- sults in transference of deaths from one age bracket to another. To minimize 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 de- termine a more precise age at death in terms of months. Despite the emphasis during interviewer training and fieldwork monitoring on probing for accurate age at death, Appendix Table C.6 shows that the num- 108 | Infant and Child Mortality ber of reported deaths at age 12 months or one year of age is several times that reported for ages 11 and 13 months. It is likely, then, that some of these deaths actually occurred before one year of age but are not included in the infant mortality rate. Of course, the excess deaths reported at 12 months and one year of age have no effect on estimates of overall under-five mortality rates. Despite evidence of heaping at age of death, it should be noted that the age at death data collected in the 2003 NDHS are far superior to those collected in the 1999 NDHS and are substantially better than those in the 1990 NDHS, both in terms of heaping of age at death and completeness of reporting of age at death. Furthermore, the majority of deaths recorded at one year of age occurred in the North East and North West (data not shown), where lack of recordkeeping and uncertainty regarding dates of events makes this type of data collection extremely difficult. 8.2 LEVELS Table 8.1 shows early childhood mortality rates based on data from the 2003 NDHS. For the five years immediately preceding the survey (1999-2003), the infant mortality rate was 100 deaths per 1,000 live births. The estimates of neonatal mortality and postneonatal mortality were 48 and 52 deaths per 1,000 births, respectively. The estimate of child mortality (age 1 to age 4) was higher: 112 deaths per 1,000 children surviving to 12 months of age. The overall under-five mortality rate for the period was 201 deaths per 1,000 births. 8.3 COMPARISON OF INFANT MORTALITY RATES WITH PREVIOUS DEMOGRAPHIC AND HEALTH SURVEYS The 2003 NDHS Compared with the 1999 NDHS The infant mortality estimate from the 2003 NDHS (100 per 1,000) is significantly higher than those from the 1990 NDHS (87 per 1,000) and the 1999 NDHS (75 per 1,000). In the case of the latter survey, there is evidence of omission of births and deaths from the period preceding the survey (National Population Commission, 2000). The conclusion of the data quality assessment in the 1999 NDHS report is that the reported rates significantly underestimated the true mortality levels in the country. The very substantial difference between the 1999 and 2003 surveys confirms the underreporting of events in the 1999 NDHS. Thus, this chapter will include no further discussion of the 1999 results. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Approximate Neonatal Postneonatal Infant Child Under-five Years preceding calendar mortality mortality1 mortality mortality mortality the survey period (NN) (PNN) (1q0) (4q1) (5q0) ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0-4 1999-2003 48 52 100 112 201 5-9 1994-1998 59 61 120 132 236 10-14 1989-1993 55 58 113 136 234 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Computed as the difference between the infant and the neonatal mortality rates Infant and Child Mortality | 109 Table 8.2 Comparison of infant mortality rates from the 2003 NDHS and the 1990 NDHS Infant mortality rates (per 1,000 live births) for the period 10-14 years preceding the 2003 NDHS and the period 0-4 years preced- ing the 1990 NDHS, by region –––––––––––––––––––––––––– Infant Region/ mortality survey rate –––––––––––––––––––––––––– Northeast 2003 NDHS 129 1990 NDHS 83 Northwest 2003 NDHS 136 1990 NDHS 110 Southeast 2003 NDHS 74 1990 NDHS 78 Southwest 2003 NDHS 81 1990 NDHS 75 Total 2003 NDHS 113 1990 NDHS 87 –––––––––––––––––––––––––– Note: For this comparison, the regions of analysis are the four regions used in the 1990 NDHS. The 2003 NDHS Compared with the 1990 NDHS The 1990 NDHS infant mortality rate of 87 per 1,000 is significantly lower than the 2003 NDHS rate of 100 per 1,000, which would indicate a worsening of health conditions in the country during the 1990s. In comparing the results of the two surveys, however, it is necessary to consider that the difference between the rates may not indicate an increase in infant mortality, but rather reflect an underestimate dur- ing the previous survey. The 2003 NDHS results for the period 10-14 years preceding the survey, which would correspond to approximately the 1989-1993 calendar years, produce an infant mortality rate of 113 per 1,000, while the 1990 NDHS estimate for approximately the same time period (1986-1990) was 87 per 1,000. The 26- point difference is substantial, and it is unlikely that sampling variability is responsible for the much higher rate of the 2003 survey. Table 8.2 shows a comparison between the infant mortality rates from the 2003 NDHS and the 1990 NDHS, according to the four regions of analysis used in the 1990 survey.1 The rates are shown for approximately the same time period, which is the 10-14 years preceding the 2003 NDHS (1989-1993) and the 0-4 years preceding the 1990 NDHS (1986-1990). For clarity, this section examines only infant mortality rates for comparable time periods. A more detailed analysis would include neonatal, postneonatal, and child mortality. The comparison of infant mortality rates suggests that the 1990 survey underestimated mortality in certain regions. Table 8.2 shows that while the estimates for infant mortality in the Southeast and Southwest are statistically identical, there are discrepancies between the Northeast and Northwest rates. In the case of the Northwest, the rate calculated from the 2003 data is 136 per 1,000 compared with the 1990 estimate of 110 per 1,000, a 26-point difference. The difference between rates in the Northeast region is even greater: the rate from the 2003 survey is 129 per 1,000, compared with the 1990 survey rate of 83 per 1,000, a 46-point difference. Mortality estimates from the two surveys for the Northeast and Northwest are substantially different. Greater credibility should be placed in the 2003 estimates for two reasons. First, studies have shown that respondents typically underreport infant and child deaths. Thus, it is likely that the interviewers working in the Northeast during the 2003 NDHS were better able to obtain complete information regarding respondents’ dead children. Second, in the case of the Northeast, the in- fant morality rates in the 1990 survey were as low as rates in the southern regions, even though women in the Northeast were comparatively disadvantaged in terms of various maternal care indicators such as antenatal and delivery care. Although a thorough investigation of the discrepancies between the two sets of estimates is beyond the scope of this report, evidence points to a serious underestimate of mortality in the Northeast and Northwest regions during the 1990 NDHS. This, in turn, would have biased 1 There are slight differences in the definitions of the regions because of changes in state boundaries that occurred after the 1990 survey. For example, the creation of Kwara and Kogi states affects the dividing line between the Northeast and Northwest regions. However, any impact this has on the results of the comparative analysis should be negligible. 110 | Infant and Child Mortality downward the infant mortality rate for the entire country, because the high-fertility respondents of the north contributed more than half of the births in Nigeria in the sample. The greater contribution to the un- derestimate is attributable to respondents in the Northeast. In conclusion, this preliminary analysis indi- cates that the 1990 survey estimate of 87 per 1,000 for the 1986-1990 period was an underestimate. Thus, it is not possible to conclude that the difference between the 1990 rate (87 per 1,000) and the 2003 rate (100 per 1,000) is due to an increase in mortality risks during the intervening years. Clearly, poor data quality in the previous survey contributes to the difference. 8.4 SOCIOECONOMIC DIFFERENTIALS IN CHILDHOOD MORTALITY Table 8.3 shows the 2003 NDHS infant and child mortality rates by socioeconomic variables. The estimated mortality rates are for the 10-year period preceding the survey. A 10-year period is used to calculate the rates for population subgroups to reduce sampling variability. As is the case in most countries, mortality rates in infancy and early childhood are higher in rural than in urban areas. In terms of infant mortality, rural rates (121 per 1,000) exceed urban rates (81 per 1,000) by a factor of about 1.5. Much of this difference arises from the neonatal rates. In the case of child mortality, rural rates (139 per 1,000) exceed urban rates (78 per 1,000) by a factor of about 1.8. In- fant and child mortality rates also vary according to region. For example, the North East, North West, and South South have the highest infant mortality rates, followed by North Central. In these regions, infant mortality is estimated as exceeding 100 per 1,000. Infant mortality in the South East and South West, Table 8.3 Early childhood mortality rates by background characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the ten-year period preceding the survey, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Neonatal Postneonatal Infant Child Under-five Background mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0) –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 37 44 81 78 153 Rural 60 61 121 139 243 Region North Central 53 49 103 70 165 North East 61 65 125 154 260 North West 55 59 114 176 269 South East 34 32 66 40 103 South South 53 68 120 63 176 South West 39 30 69 47 113 Mother's education No education 60 64 124 166 269 Primary 53 58 111 85 186 Secondary 37 35 71 45 113 Higher (39) (22) (61) (20) (80) Wealth quintile Lowest 59 74 133 143 257 Second 70 70 140 178 293 Middle 56 54 110 118 215 Fourth 48 39 87 101 179 Highest 23 30 52 29 79 Total 53 56 109 121 217 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 250 to 499 exposed persons. 1 Computed as the difference between the infant and the neonatal mortality rates Infant and Child Mortality | 111 however, is estimated at less than 70 per 1,000. Regional differentials in infant mortality are consistent with regional differentials in basic indicators of maternal care, such as antenatal care visits and content, as well as delivery assistance (see Chapter 9). As expected, mortality levels decline as mother’s education increases. Between education cate- gories, the differentials are greater for postneonatal mortality and, especially, child mortality than for neonatal mortality. The mortality risk of children is also associated with the economic status of the house- hold. The under-five mortality rate in households in the lowest and second quintiles of the wealth index is more than three times that in households in the highest quintile. 8.5 DEMOGRAPHIC DIFFERENTIALS IN CHILDHOOD MORTALITY Table 8.4 shows the relationship between early childhood mortality and demographic variables. As was the case with the socioeconomic differentials, the rates are shown for the 10-year period preced- ing the survey. Table 8.4 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the ten-year period preceding the survey, by demographic characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Neonatal Postneonatal Infant Child Under-five Demographic mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0) ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex of child Male 60 56 116 120 222 Female 46 56 102 122 212 Mother's age at birth <20 58 65 123 143 248 20-29 48 52 100 114 203 30-39 55 57 113 112 212 40-49 (95) (50) (145) (188) (306) Birth order 1 59 47 106 105 200 2-3 40 54 94 105 189 4-6 51 58 109 128 223 7+ 73 65 137 152 269 Previous birth interval2 <2 79 81 160 174 307 2 years 49 62 111 134 230 3 years 32 31 63 75 134 4+ years 30 31 61 59 116 Birth size3 Small/very small 67 72 139 na na Average or larger 42 43 86 na na Medical maternity care3 No antenatal or delivery care 63 67 130 na na Either antenatal or delivery care 37 37 74 na na Both antenatal and delivery care 31 34 65 na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 250 to 499 exposed persons. na =Not applicable 1 Computed as the difference between the infant and the neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period preceding the survey 112 | Infant and Child Mortality As expected, mortality rates are generally higher for boys than for girls. There are significant dif- ferences in mortality risks associated with mother’s age and birth order. The largest differentials are in the neonatal period. Shorter birth intervals are associated with higher childhood mortality, both during and after infancy. In terms of the length of the preceding birth interval, mortality rates are markedly lower for intervals of at least two years than for shorter birth intervals. There is a further decrease in the risk of death after a three-year birth interval. In terms of under-five mortality, births following an interval of at least three years are at less than half the risk of death as births occurring within two years of a preceding birth. Studies have shown that a child’s weight at birth is an important indicator of his or her survival chances. Since relatively few mothers had information on their child’s exact weight at birth, they were asked instead whether their child was very large, larger than average, average, smaller than average, or small at birth. This has been found to be a good proxy for children’s weight. Children reported to be small or very small have substantially higher mortality rates. Children whose mothers did not receive antenatal or delivery care also have higher mortality rates. 8.6 MORTALITY DIFFERENTIALS BY WOMEN’S STATUS The ability to access information, make decisions, and act effectively in their own interest, or in the interest of those who depend on them, are essential aspects of the empowerment of women. It follows that if women, the primary caretakers of children, are empowered, the health and survival of their infants will be enhanced. Table 8.5 presents mortality rates by three indicators of women’s status: participation in household decisionmaking, attitude toward refusing to have sex with their husband, and attitude toward wife-beating. For all three indicators, there is an association between increasing women’s status and de- creasing levels of mortality. Table 8.5 Early childhood mortality by women’s status indicators Neonatal, postneonatal, infant, child and under-five mortality rates for the ten-year period preceding the survey, by women’s status indicators, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Neonatal Postneonatal Infant Child Under-five Indicator of mortality mortality1 mortality mortality mortality women’s status (NN) (PNN) (1q0) (4q1) (5q0) –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say2 0 57 55 112 154 249 1-2 56 61 116 123 225 3-4 40 53 94 59 147 5 48 50 97 92 181 Number of reasons to refuse sex with husband 0 54 51 105 150 239 1-2 62 56 118 123 227 3-4 49 57 106 116 210 Number of reasons wife beating is justified 0 47 42 89 78 160 1-2 56 52 108 112 208 3-4 46 70 115 120 221 5-6 62 63 125 167 271 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Computed as the difference between the infant and the neonatal mortality rates 2 Either by herself or jointly with others Infant and Child Mortality | 113 8.7 HIGH-RISK FERTILITY BEHAVIOUR Previous research has shown a strong relationship between the fertility patterns of women and the mortality risks of their children. Typically, mortality risks are greater for children who are born to moth- ers who are too young or too old, who are born after a short birth interval, or who have a high birth order. 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 older than 34 years of age. A “short birth interval” is defined as a birth occurring within 24 months of the previous birth, and a child is of “high birth order” if the mother has already given birth to three or more children. Table 8.6 shows the distribution of children born in the five years preceding the survey by risk category. While first births to women age 18-34 are considered an unavoidable risk, they are included in the analysis and are shown as a separate risk category. Column 1 shows that in the five-year period before the survey, 41 percent of births were in a single high-risk category and 24 percent were in a multiple high- risk category. Only one-fifth of births were not in any high-risk category. Column 2 shows risk ratios for births in various high-risk categories relative to births not having any high-risk characteristics. The risk ratio for children in any avoidable high-risk category (1.4) was about 40 percent higher than for children not in any high-risk category. The last column in Table 8.6 looks to the future and addresses the question of how many cur- rently married women have the potential for having a high-risk birth. The results were obtained by simu- lating the risk category into which a birth to a currently married woman would fall if she were to become pregnant at the time of the survey. For example, a woman who was 37 years old at the time of the survey and had three previous births, the last of which occurred three years earlier, would be classified in the multiple high-risk category for being too old (35 or older) and at risk of having a high-order birth (more than three previous births). Twenty-seven percent of currently married women would fall in this category. Overall, eight in ten married women have the potential to give birth to a child with an elevated risk of mortality. Almost half of all married women (48 percent) have the potential to give birth to children in the multiple high-risk categories. 114 | Infant and Child Mortality Table 8.6 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 risk ratio, and the percent distribution of currently married women by cate- gory of risk if they were to conceive a child at the time of the survey, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Births in the 5 years Percentage preceding the survey of –––––––––––––––––––– currently Percentage Risk married Risk category of births ratio women1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Not in any high-risk category 21.2 1.00 13.3a Unavoidable risk category First order births between ages 18 and 34 years 13.7 1.22 6.4 Single high-risk category Mother's age <18 7.9 1.76 2.9 Mother's age >34 0.7 1.18 3.8 Birth interval <24 months 6.7 1.10 10.0 Birth order >3 25.8 1.16 15.3 Subtotal 41.2 1.26 32.0 Multiple high-risk category Age <18 & birth interval <24 months2 1.0 1.30 1.1 Age >34 & birth interval <24 months 0.0 1.61 0.1 Age >34 & birth order >3 11.4 1.25 27.0 Age >34 & birth interval <24 months & birth order >3 2.1 2.60 5.6 Birth interval <24 months & birth order >3 9.3 2.13 14.6 Subtotal 23.9 1.72 48.3 In any avoidable high-risk category 65.1 1.43 80.3 Total 100.0 na 100.0 Number of births 6,219 na 5,336 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead of births not in any high-risk category. na =Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the combined categories age<18 and birth order>3 a Includes sterilized women Maternal and Child Health | 115 MATERNAL AND CHILD HEALTH 9 The state of maternal and child health is one indicator of a society’s level of development, as well as an indicator of the performance of the health care delivery system. This chapter presents findings on several important aspects of reproductive and child health such as antenatal and delivery care, postnatal care, characteristics of the neonate, vaccinations, and common childhood illnesses and their treatment. 9.1 ANTENATAL CARE This section provides information on issues relating to antenatal care (ANC) services. ANC from a trained provider is important in monitoring pregnancy and helping to reduce the risks for the mother and child during this period. Table 9.1 shows the percent distribution of women who had a live birth in the five years preceding the survey by antenatal care provider for the most recent birth, according to back- ground characteristics. The data show that six in ten mothers received antenatal care from a trained medi- cal professional. The most common antenatal care providers are nurses or midwives (37 percent). More than one-third of mothers (37 percent) did not receive any antenatal care. Almost half of teenage mothers did not receive antenatal care, compared with approximately one- third of mothers age 20 and older. The type of antenatal care provider also varies by the age at which women give birth. Teenage mothers are also less likely to receive ANC from a doctor. The receipt of ANC also varies by birth order, with births at higher parities less likely to receive ANC, particularly from a trained provider. There are clear differences in ANC by residence; women residing in urban areas and in the south are much more likely to receive ANC than their rural and northern-dwelling counterparts. This difference is likely to be due to the concentration of hospitals and health care facilities in urban and southern areas. It is striking that rural women are three times less likely to receive antenatal care than urban women. Forty- seven percent of mothers in the North East and 59 percent of mothers in the North West did not receive ANC, whereas in other regions the proportion of women not receiving ANC ranges from 1 to 25 percent. There is a positive relationship between ANC and educational attainment. For example, three- fifths of mothers with no education did not receive any ANC from a trained provider. In contrast, doctors provide ANC to 70 percent of mothers with higher education. There is also a positive relationship between the household wealth index and type of ANC pro- vider. Whereas six in ten women in households in the two lowest quintiles did not receive ANC from a health professional, only 2 in 100 women in the most advantaged households were without care. 9.1.1 Number and Timing of ANC Visits Antenatal care can be more effective in preventing adverse pregnancy outcomes when it is sought early in the pregnancy and continues through to delivery. Table 9.2 shows number of antenatal care visits and timing of the first visit by residence. At least four antenatal visits are recommended during pregnancy to ensure proper care. Less than half of mothers made four or more ANC visits (Figure 9.1). There is a relationship between residence and number of visits. Seventy-one percent of urban women make four or more visits to an antenatal care provider compared with only 38 percent of rural women. 116 | Maternal and Child Health Table 9.1 Antenatal care Percent distribution of women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Antenatal care provider ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Nurse/ Community midwife/ health Traditional Number Background auxiliary extension birth No of characteristic Doctor midwife worker attendant Other one Missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 12.4 34.0 3.5 2.2 0.2 47.7 0.0 100.0 719 20-34 24.0 36.7 1.9 2.4 0.3 34.7 0.1 100.0 2,514 35-49 20.8 39.9 1.4 3.2 0.4 33.9 0.4 100.0 678 Birth order 1 24.9 36.6 2.5 2.9 0.2 32.9 0.1 100.0 803 2-3 26.4 34.2 2.0 2.6 0.3 34.3 0.1 100.0 1,102 4-5 21.1 39.2 1.4 2.2 0.3 35.8 0.1 100.0 874 6+ 13.9 37.4 2.5 2.3 0.5 43.2 0.2 100.0 1,132 Residence Urban 38.5 44.2 0.3 1.5 0.1 15.0 0.2 100.0 1,144 Rural 14.2 33.6 2.8 2.9 0.4 46.0 0.1 100.0 2,766 Region North Central 23.8 50.0 0.5 0.0 0.1 25.3 0.2 100.0 575 North East 10.9 36.4 5.3 0.2 0.1 47.1 0.0 100.0 862 North West 5.4 31.5 1.9 1.6 0.6 59.0 0.0 100.0 1,341 South East 50.8 45.4 0.2 0.9 0.8 0.8 1.2 100.0 222 South South 38.8 33.3 0.7 10.0 0.3 16.8 0.0 100.0 544 South West 56.0 35.9 0.8 5.0 0.0 2.3 0.1 100.0 367 Education No education 8.2 27.7 2.8 1.2 0.4 59.6 0.0 100.0 1,989 Primary 22.3 49.7 1.9 5.4 0.2 20.3 0.2 100.0 918 Secondary 42.3 45.2 1.1 2.9 0.2 8.1 0.2 100.0 862 Higher 70.2 27.9 0.0 0.0 0.0 1.7 0.2 100.0 143 Wealth quintile Lowest 7.6 26.4 3.2 2.9 0.2 59.7 0.1 100.0 852 Second 9.2 28.1 2.1 2.2 0.3 58.1 0.1 100.0 846 Middle 15.4 41.1 3.3 2.0 1.0 37.2 0.1 100.0 808 Fourth 25.5 51.6 1.1 3.6 0.1 18.0 0.2 100.0 735 Highest 56.5 39.3 0.4 1.8 0.1 1.8 0.1 100.0 670 Total 21.3 36.7 2.1 2.5 0.3 36.9 0.1 100.0 3,911 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one source of ANC was mentioned, only the provider with the highest qualification is considered in this tabulation. Maternal and Child Health | 117 Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent birth, and by the timing of the first visit, according to residence, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Number and timing –––––––––––––––– of ANC visits Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of ANC visits None 15.0 46.0 36.9 1 2.8 2.5 2.6 2-3 8.4 12.1 11.0 4+ 71.1 37.6 47.4 Don't know/missing 2.7 1.8 2.1 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 15.0 46.0 36.9 <4 23.4 13.9 16.7 4-5 38.1 22.0 26.7 6-7 20.4 15.0 16.6 8+ 2.3 2.1 2.1 Don't know/missing 0.8 1.0 1.0 Total 100.0 100.0 100.0 Median months pregnant at first visit (for those with ANC) 4.9 5.1 5.0 Number of women 1,144 2,766 3,911 Figure 9.1 Number of Antenatal Care Visits NDHS 2003 No antenatal care visits 37% 1 antenatal care visit 3% 4+ antenatal care visits 47% 2-3 antenatal care visits 11% Note: Total does not add to 100 due to missing cases. 118 | Maternal and Child Health Among women who receive antenatal care, 17 percent make their first ANC visit during the first three months of pregnancy. Although the proportions of urban and rural mothers who received antenatal care for the most recent births in the last five years differ substantially, among those who received antena- tal care the proportion of women who benefit from ANC during the first trimester differs only slightly by residence. Slightly more than one-quarter of both urban and rural women who received antenatal care made their first visit during the first trimester. This result is also confirmed by the median number of months pregnant at first visit: 4.9 for urban mothers and 5.1 for rural mothers. 9.1.2 Components of ANC The content of antenatal care is important in judging its quality. Certain items of care have been selected and included in the questionnaire to indicate the level of the care received. Pregnancy complica- tions are an important source of maternal and child mortality and morbidity, and thus information on the signs of complications and tests for complications should be routinely included in all antenatal care. Moreover, in Nigeria, neonatal tetanus, malaria, and maternal anemia are major causes of neonatal mor- tality. In the 2003 Nigeria Demographic and Health Survey (2003 NDHS), respondents were asked whether they had received each of the following services at least once during antenatal care: weight measured, height measured, blood pressure measured, and urine and blood samples taken. Information on iron supplements and antimalarial drugs was collected and reported for the most recent birth in the five years preceding the survey, whether or not the mother saw anyone for antenatal care. Table 9.3 shows the percent distribution of women who received antenatal care by the content of care and receipt of iron tablets or syrup and antimalarial drugs, according to background characteristics. More than half of all women were informed of signs of pregnancy complications, and about the same pro- portion had their height measured. More than eight in ten women had their weight measured and blood pressure taken, and almost two-thirds had urine and blood samples taken. For each component of ANC, older women were more likely than younger women to report that they had received services. Urban-rural residence is an important determinant of the likelihood of receiving all of the speci- fied components of ANC, with urban women receiving more components of care than rural woman. Once again, northern mothers appear to receive lower quality ANC than mothers in the south. There is a positive correlation between both level of education and wealth quintile and the content of antenatal care women receive. Mothers with higher education and women in households higher on the wealth index receive more services than those with less education and those living in households lower on the wealth index. Iron is a vital component of hemoglobin, which carries oxygen to the body tissues. To sustain life, mothers need iron. Almost six in ten mothers received iron supplements, while less than one in four mothers received antimalarial drugs during pregnancy. The likelihood of a mother receiving iron supple- mentation or an antimalarial varies by background characteristics in a pattern similar to that of antenatal care services. Maternal and Child Health | 119 9.1.3 Tetanus Toxoid Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, a major cause of infant deaths. 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 the current pregnancy. Table 9.3 Antenatal care content Percentage of women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth, by content of antenatal care, and percentage of women with a live birth in the five years preceding the survey who received iron tablets or syrup or antimalarial drugs for the most recent birth, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among women who received antenatal care ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Informed of signs of Received Receive pregnancy Blood Urine Blood Number iron anti- Number Background compli- Weight Height pressure sample sample of tablets malarial of characteristic cations measured measured measured taken taken women or syrup drugs women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 45.8 78.1 48.0 71.4 53.5 50.2 376 49.2 30.4 719 20-34 56.2 83.7 57.2 81.8 65.7 66.6 1,640 60.0 40.7 2,514 35-49 58.7 83.8 61.0 83.9 68.6 72.4 446 59.2 39.5 678 Birth order 1 53.9 82.1 54.7 79.4 66.3 63.3 538 60.4 43.0 803 2-3 55.1 83.9 58.8 82.4 67.0 68.9 723 60.5 37.6 1,102 4-5 58.5 85.1 58.8 81.2 63.8 66.3 561 60.5 40.3 874 6+ 52.9 80.3 53.4 79.1 60.4 61.5 641 51.6 35.0 1,132 Residence Urban 66.2 91.6 64.3 90.6 81.4 81.3 970 78.4 55.3 1,144 Rural 47.8 77.2 51.4 74.1 53.4 54.6 1,492 49.4 31.6 2,766 Region North Central 47.3 90.8 63.0 92.6 74.7 75.3 429 58.7 39.4 575 North East 44.3 84.4 63.4 77.8 50.1 52.0 456 54.4 31.5 862 North West 48.1 80.2 46.8 64.1 54.1 42.2 549 40.6 25.3 1,341 South East 66.0 83.4 56.3 89.4 76.1 85.9 218 93.7 63.1 222 South South 60.0 68.8 49.0 76.6 63.4 69.9 452 69.4 56.7 544 South West 75.6 92.8 64.4 94.9 80.2 86.1 358 89.2 60.2 367 Education No education 42.0 77.7 52.0 72.2 50.5 48.2 802 39.0 23.9 1,989 Primary 52.8 79.8 52.2 78.5 60.3 65.5 730 68.7 44.6 918 Secondary 65.9 88.3 61.1 88.2 77.5 77.3 790 84.4 59.7 862 Higher 80.4 97.4 78.4 96.8 91.4 91.8 140 91.2 76.7 143 Wealth quintile Lowest 39.0 70.3 46.4 68.5 36.9 45.5 343 36.4 24.9 852 Second 41.3 72.2 52.3 69.5 49.7 47.2 354 37.0 28.0 846 Middle 48.2 78.0 52.7 74.3 56.4 54.2 507 57.8 32.1 808 Fourth 59.5 86.9 58.8 87.0 72.5 74.4 602 75.0 48.1 735 Highest 72.0 95.1 64.9 92.0 85.4 85.0 657 92.9 66.6 670 Total 55.0 82.8 56.5 80.6 64.4 65.1 2,462 57.9 38.6 3,911 120 | Maternal and Child Health Table 9.4 shows the distribution of women who received tetanus toxoid injections during preg- nancy according to background characteristics. Eleven percent of mothers received one dose and 40 percent received two or more doses of teta- nus toxoid. However, almost half of respondents did not receive any tetanus toxoid injection during their pregnancy. This nonreceipt was more prevalent among teenage mothers, rural residents, mothers in the North West, those with no education, and those living in households in the lowest wealth quintile, with at least six in ten of these mothers not receiving tetanus toxoid injections. The proportion of mothers who received two or more tetanus toxoid injections increases with age at birth, level of education, and wealth quintile. The percentage of urban women who received full tetanus coverage is almost twice that of rural women. At the regional level, there is a great disparity between mothers in the north and those in the south. In the north, only 20 to 45 percent of mothers received two or more injections, compared with 62 to 77 percent in the southern regions. Table 9.4 Tetanus toxoid injections Percent distribution of women who had a live birth in the five years preceding the survey by number of tetanus toxoid injections received during pregnancy for the most recent birth, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Two Don’t Number Background No One or more know/ of characteristic injections injection injections missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 61.6 9.4 27.1 1.9 100.0 719 20-34 44.2 10.7 43.0 2.1 100.0 2,514 35-49 43.5 10.9 43.8 1.8 100.0 678 Birth order 1 46.2 12.1 39.9 1.8 100.0 803 2-3 44.8 9.9 42.1 3.2 100.0 1,102 4-5 45.5 9.0 44.3 1.2 100.0 874 6+ 51.8 11.2 35.5 1.5 100.0 1,132 Residence Urban 24.7 12.7 60.7 2.0 100.0 1,144 Rural 56.6 9.6 31.8 2.0 100.0 2,766 Region North Central 33.4 17.2 45.4 3.9 100.0 575 North East 56.2 12.3 30.8 0.7 100.0 862 North West 72.6 6.1 20.1 1.2 100.0 1,341 South East 7.3 12.3 77.4 2.9 100.0 222 South South 27.0 9.5 61.5 2.0 100.0 544 South West 9.3 12.5 74.0 4.3 100.0 367 Education No education 70.4 8.3 20.4 1.0 100.0 1,989 Primary 32.8 10.8 52.6 3.8 100.0 918 Secondary 16.3 15.5 66.0 2.1 100.0 862 Higher 4.6 10.2 82.1 3.1 100.0 143 Wealth quintile Lowest 69.9 9.5 19.1 1.4 100.0 852 Second 68.6 7.2 22.7 1.6 100.0 846 Middle 49.9 11.2 36.9 2.0 100.0 808 Fourth 27.4 13.8 55.7 3.1 100.0 735 Highest 10.1 11.7 76.4 1.9 100.0 670 Total 47.3 10.5 40.2 2.0 100.0 3,911 Maternal and Child Health | 121 9.2 PLACE OF DELIVERY Proper medical attention and hygienic conditions during delivery can reduce the risk of complica- tion and infections that can cause serious illness or the death of the mother, her baby, or both. The 2003 NDHS collected information on the place of delivery and the type of assistance received, for all births during the five years preceding the survey. Table 9.5 shows the percent distribution of live births by place of delivery, according to background characteristics. Table 9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to background character- istics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Place of delivery –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number Background Any Public Private of characteristic facility1 sector sector Home Other Missing Total births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 21.6 15.4 6.2 76.5 0.7 1.2 100.0 1,121 20-34 35.8 18.9 16.9 63.4 0.3 0.5 100.0 4,206 35-49 31.3 18.5 12.8 67.6 0.2 1.0 100.0 892 Birth order 1 43.4 24.4 19.0 55.3 0.6 0.7 100.0 1,278 2-3 34.7 17.9 16.8 64.1 0.6 0.6 100.0 1,908 4-5 32.4 18.6 13.8 66.7 0.2 0.6 100.0 1,365 6+ 22.0 13.4 8.6 77.2 0.1 0.8 100.0 1,667 Residence Urban 54.2 28.5 25.6 44.8 0.5 0.5 100.0 1,795 Rural 23.8 14.0 9.8 75.1 0.3 0.7 100.0 4,424 Region North Central 45.4 27.0 18.4 54.6 0.0 0.0 100.0 897 North East 17.1 14.5 2.6 82.2 0.0 0.6 100.0 1,472 North West 10.4 8.8 1.6 88.6 0.0 1.0 100.0 2,161 South East 84.1 19.9 64.1 13.2 0.3 2.5 100.0 371 South South 53.2 29.5 23.7 45.0 1.6 0.3 100.0 789 South West 77.6 33.7 43.9 20.8 1.5 0.1 100.0 529 Mother's education No education 10.3 7.1 3.2 88.8 0.2 0.6 100.0 3,224 Primary 40.5 22.7 17.9 58.0 0.4 1.1 100.0 1,465 Secondary 69.2 35.4 33.7 30.0 0.5 0.4 100.0 1,316 Higher 88.1 48.6 39.5 10.5 1.2 0.2 100.0 215 Antenatal care visits2 None 3.7 2.7 1.0 95.6 0.6 0.1 100.0 1,444 1-3 27.8 16.1 11.7 72.2 0.0 0.0 100.0 532 4+ 59.2 33.0 26.2 40.2 0.5 0.1 100.0 1,855 Don't know/missing 57.7 20.3 37.4 35.2 0.0 7.1 100.0 81 Wealth quintile Lowest 11.5 7.5 4.0 87.1 0.5 0.9 100.0 1,394 Second 16.1 10.5 5.6 82.8 0.0 1.1 100.0 1,379 Middle 24.9 15.6 9.3 74.5 0.4 0.2 100.0 1,255 Fourth 43.8 28.1 15.7 55.2 0.1 0.9 100.0 1,157 Highest 79.7 34.9 44.8 19.2 0.8 0.2 100.0 1,033 Total 32.6 18.2 14.4 66.4 0.4 0.7 100.0 6,219 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Sum of percentage delivered at a public sector facility and percentage delivered at a private sector facility 2 Includes only the most recent birth in the five years preceding the survey 122 | Maternal and Child Health Two-thirds of births in Nigeria are delivered at home; this means the majority of births occur without quality delivery services. Only one-third of deliveries occur in a health facility: 18 percent in the public sector and 14 percent in the private sector. Urban women are more than twice as likely as rural women to deliver in a health facility. There are significant regional differentials in place of delivery. Births in health facilities range from a low of 10 percent in the North West to a high of 84 percent in the South East. Educational attainment, number of antenatal care visits, and household economic status are all positively correlated with the likelihood of delivering in a facility. However, birth order is positively correlated with the likelihood of delivering at home. 9.2.1 Assistance during Delivery The level of assistance received by a woman during delivery can reduce maternal and child deaths and related complications, which is one of the goals of the global Safe Motherhood Initiative. Ma- ternal complications may arise during puerperium as a result of trauma sustained during labour, disorders of the circulatory system, or psychological disorders. The presence of a trained assistant during delivery, therefore, becomes imperative. Table 9.6 shows the percent distribution of live births by assistance pro- vided during delivery, according to background characteristics. Slightly more than one-third of births in Nigeria are attended by doctors, nurses, or midwives. One-fifth of births receive the assistance of a traditional birth attendant. One in every four births is as- sisted by a relative or some other untrained person, while 17 percent are unassisted. Differentials in deliv- ery assistance are similar to those described previously in this chapter. Maternal and Child Health | 123 9.2.2 Delivery Characteristics Caesarean section (C-section) may be performed as a result of adverse conditions developing dur- ing labour as well as a decision reached before labour. In both cases, it tends to reduce the risks of deliv- ery for mother and child. Table 9.7 shows that C-sections are rare in Nigeria: less than 2 percent of births are delivered by this procedure. Women with higher education are the most likely to have had a C-section; among these women, 14 percent of births are delivered by C-section. Caesarean section occurs more frequently in the South East (9 percent of births) than in other regions. Table 9.6 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, accord- ing to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person providing assistance during delivery –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Nurse/ Community midwife/ health Traditional Don’t Number Background auxiliary extension birth Relative/ know/ of characteristic Doctor midwife worker attendant other No one missing Total births –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 5.1 19.1 1.9 25.3 33.6 13.9 1.1 100.0 1,121 20-34 7.1 30.7 0.9 19.3 24.0 17.3 0.7 100.0 4,206 35-49 5.7 30.6 1.0 19.4 23.1 19.1 1.2 100.0 892 Birth order 1 10.7 34.4 1.9 18.8 25.8 7.5 0.9 100.0 1,278 2-3 7.1 30.2 0.6 20.8 26.2 14.3 0.8 100.0 1,908 4-5 6.0 29.3 0.7 18.9 25.7 18.9 0.6 100.0 1,365 6+ 3.2 21.7 1.3 22.3 24.8 25.6 1.1 100.0 1,667 Residence Urban 14.1 44.4 0.3 11.6 17.9 10.6 1.0 100.0 1,795 Rural 3.5 22.2 1.4 23.9 28.7 19.4 0.8 100.0 4,424 Region North Central 9.6 39.0 1.5 6.1 34.7 9.0 0.1 100.0 897 North East 2.4 17.4 2.2 25.4 31.7 19.8 1.0 100.0 1,472 North West 0.8 11.5 0.7 24.3 31.0 30.5 1.2 100.0 2,161 South East 20.2 67.3 0.2 3.0 6.2 0.4 2.8 100.0 371 South South 8.6 47.0 0.2 32.2 9.8 1.8 0.3 100.0 789 South West 23.9 57.0 0.7 9.0 8.4 0.9 0.1 100.0 529 Mother's education No education 2.0 10.7 1.2 26.3 32.1 26.8 1.0 100.0 3,224 Primary 5.3 38.6 1.1 19.6 24.3 10.2 0.9 100.0 1,465 Secondary 13.8 57.9 0.9 9.8 13.9 2.9 0.7 100.0 1,316 Higher 38.9 50.0 0.0 2.2 8.3 0.4 0.2 100.0 215 Wealth quintile Lowest 1.8 9.8 1.4 31.6 34.3 20.3 0.8 100.0 1,394 Second 1.5 16.2 1.3 25.4 31.1 23.3 1.2 100.0 1,379 Middle 3.8 22.5 1.3 21.7 29.5 20.6 0.6 100.0 1,255 Fourth 6.6 43.6 1.0 13.8 20.5 13.2 1.5 100.0 1,157 Highest 23.1 61.2 0.2 4.3 7.5 3.5 0.2 100.0 1,033 Total 6.6 28.6 1.1 20.4 25.6 16.9 0.9 100.0 6,219 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is consid- ered in this tabulation. 124 | Maternal and Child Health Birth weight is a major determinant of infant and child health and mortality. Birth weight of less than 2.5 kilograms is considered low. For all births during the five-year period preceding the survey, mothers were asked about their perception of the child’s size at birth. They were then asked to report the actual weight in kilograms if the child had been weighed after delivery. It is not surprising that with the majority of deliveries occurring at home, the vast majority of newborns were not weighed at birth (73 percent). Birth weight was reported for one in seven births in the preceding five years. The same propor- tion of mothers said that their newborns were weighed but they did not remember the weight. Among births for which the birth weight was known, one in ten was classified as low birth weight (i.e., the infant weighed less than 2.5 kg at birth). Table 9.7 Delivery characteristics Percentage of live births in the five years preceding the survey delivered by caesarian section, and percent distribution by birth weight and by mother's estimate of baby's size at birth, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth weight Size of child at birth Delivery ––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––– by Less 2.5 kg Don’t Smaller Average Don't Number Background caesarean Not than or know/ Very than or know/ of characteristic section weighed 2.5 kg more missing Total small average larger missing Total births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mother's age at birth <20 1.3 84.2 0.4 5.2 10.3 100.0 8.3 8.2 81.8 1.7 100.0 1,121 20-34 1.8 70.1 1.5 13.8 14.6 100.0 6.2 8.5 84.2 1.1 100.0 4,206 35-49 1.9 70.2 1.5 11.9 16.4 100.0 5.1 6.3 86.9 1.7 100.0 892 Birth order 1 3.6 68.1 1.6 15.1 15.2 100.0 6.9 8.3 83.3 1.4 100.0 1,278 2-3 1.3 70.1 1.2 14.9 13.8 100.0 5.7 7.7 85.3 1.3 100.0 1,908 4-5 1.6 72.9 1.0 11.9 14.2 100.0 6.2 8.4 84.3 1.1 100.0 1,365 6+ 0.8 79.0 1.4 6.3 13.4 100.0 7.0 8.2 83.5 1.3 100.0 1,667 Residence Urban 3.5 50.3 2.5 26.6 20.5 100.0 5.0 6.8 87.2 1.0 100.0 1,795 Rural 1.0 81.8 0.8 6.0 11.5 100.0 7.0 8.6 82.9 1.4 100.0 4,424 Region North Central 0.9 63.7 2.2 7.9 26.2 100.0 6.4 9.9 83.5 0.2 100.0 897 North East 1.1 87.2 0.4 4.2 8.2 100.0 8.7 10.1 78.7 2.5 100.0 1,472 North West 0.5 90.3 0.3 2.6 6.8 100.0 6.8 6.0 86.2 1.0 100.0 2,161 South East 8.6 30.9 5.6 47.9 15.6 100.0 3.6 10.3 82.5 3.6 100.0 371 South South 2.5 55.1 1.4 23.8 19.7 100.0 5.2 6.9 87.4 0.5 100.0 789 South West 3.9 31.2 2.8 35.8 30.2 100.0 2.3 8.3 88.5 0.9 100.0 529 Mother's education No education 0.4 90.7 0.4 1.7 7.2 100.0 8.3 8.9 81.0 1.7 100.0 3,224 Primary 1.3 67.7 1.3 9.9 21.1 100.0 4.9 7.5 86.5 1.0 100.0 1,465 Secondary 3.4 43.3 3.2 30.2 23.2 100.0 3.9 7.4 88.0 0.7 100.0 1,316 Higher 13.9 15.9 3.2 68.3 12.7 100.0 4.0 3.9 91.6 0.5 100.0 215 Wealth quintile Lowest 0.5 91.4 0.1 1.9 6.6 100.0 9.3 10.5 78.2 2.0 100.0 1,394 Second 0.7 88.7 0.2 2.1 8.9 100.0 7.5 8.4 82.6 1.5 100.0 1,379 Middle 1.0 80.5 1.1 5.6 12.9 100.0 5.6 6.8 86.4 1.2 100.0 1,255 Fourth 1.6 63.0 1.5 12.3 23.2 100.0 5.2 6.4 87.2 1.2 100.0 1,157 Highest 5.8 27.5 4.2 46.1 22.2 100.0 3.4 8.0 88.2 0.4 100.0 1,033 Total 1.7 72.7 1.3 12.0 14.1 100.0 6.4 8.1 84.2 1.3 100.0 6,219 Maternal and Child Health | 125 The percentage of children not weighed varies by background characteristics. Weighing at birth is less prevalent among teenage mothers, higher parity births, births in rural areas, and those in the North East and North West. The likelihood of being weighed at birth is also low among mothers with no educa- tion and those living in households in the lowest wealth quintile. According to mothers’ estimates of their newborns’ size, more than eight in ten (84 percent) were of average or larger size. However, almost one in six births was reported as either very small or smaller than average. 9.3 POSTNATAL CARE Postnatal care is important both for the mother and the child to treat complications arising from the delivery, as well as to provide the mother with important information on how to care for herself and her child. The postnatal period is defined as the time between the delivery of the placenta and 42 days (6 weeks) following the delivery. The timing of postnatal care is important. The first two days after delivery are critical, since most maternal and neonatal deaths occur during this period. Table 9.8 measures postna- tal care for births that occurred outside a health facility in the five years preceding the survey. If a woman had more than one live birth outside a health facility, only the most recent birth is considered. In Nigeria, less than one-fourth of women who gave birth outside a health facility receive postna- tal care within two days of birth (23 percent). An additional 3 percent have a checkup within the first week after birth. However, more than seven out of ten women who deliver outside a health facility re- ceive no postnatal care. There are significant differentials by residence, region, education, and economic index. 126 | Maternal and Child Health 9.4 REPRODUCTIVE HEALTH CARE BY WOMEN’S STATUS Table 9.9 shows women’s use of antenatal, delivery, and postnatal care services by three indica- tors of women’s status (empowerment) defined in Chapter 3. In societies where health care is widespread, women’s status and age may not affect their access to reproductive health services; in other societies, however, increased empowerment of women is likely to be associated with increased ability to seek out and use health services to better meet their reproductive health needs, including the need for safe mother- hood. Table 9.8 Postnatal care by background characteristics Percent distribution of women whose last live birth in the five years preceding the survey occurred outside a health facility, by timing of postnatal care, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Timing of first postnatal checkup –––––––––––––––––––––––––––––––––––––– Within Did not 2 days 3-6 days 7-41 days Don't receive Number Background of after after know/ postnatal of characteristic delivery delivery delivery missing checkup1 Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 23.9 2.1 2.7 0.3 71.0 100.0 546 20-34 23.9 2.9 2.2 0.6 70.5 100.0 1,570 35-49 20.1 1.6 3.4 0.7 74.2 100.0 449 Birth order 1 25.0 2.0 2.5 0.4 70.1 100.0 454 2-3 23.6 3.1 3.0 0.5 69.8 100.0 691 4-5 25.1 2.0 2.5 0.5 69.8 100.0 561 6+ 20.7 2.5 2.1 0.7 74.0 100.0 860 Residence Urban 31.3 4.4 3.5 0.4 60.4 100.0 498 Rural 21.3 2.0 2.2 0.6 73.9 100.0 2,068 Region North Central 13.8 1.7 4.3 0.2 80.1 100.0 303 North East 31.5 1.7 1.9 0.8 64.0 100.0 701 North West 18.6 1.5 1.3 0.5 78.1 100.0 1,194 South East 17.2 2.3 3.1 1.4 76.0 100.0 37 South South 32.9 7.7 3.4 0.7 55.4 100.0 251 South West 26.9 10.7 15.0 0.0 47.4 100.0 81 Education No education 21.0 1.5 2.0 0.6 74.9 100.0 1,766 Primary 25.5 4.2 3.1 0.4 66.8 100.0 519 Secondary 32.7 5.6 3.0 0.6 58.1 100.0 265 Higher * * * * * * 15 Wealth quintile Lowest 18.9 1.0 1.7 0.6 77.8 100.0 740 Second 19.0 2.1 1.5 1.3 76.1 100.0 692 Middle 24.9 3.1 2.4 0.0 69.7 100.0 589 Fourth 29.8 3.7 3.7 0.0 62.8 100.0 412 Highest 41.5 6.6 8.8 0.4 42.7 100.0 133 Total 23.2 2.5 2.5 0.6 71.3 100.0 2,566 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes women who received the first postnatal checkup after 41 days Maternal and Child Health | 127 The first women’s status indicator in Table 9.9 is positively related to women’s empowerment and reflects the degree of decisionmaking control women are able to exercise in areas that affect their lives and environments. The second indicator reflects women’s perception of sexual roles and women’s rights over their bodies, and relates positively to women’s sense of self and empowerment. The final indi- cator, which reflects women’s perception of gender roles, is negatively related to women’s level of em- powerment. A higher value for this indicator (the number of reasons a woman believes wife beating is justified) is interpreted as indicating lower empowerment. Table 9.9 shows that decisionmaking ability and perceptions regarding the justification of wife beating are strongly correlated with reproductive health care. The more empowered a woman, the more likely she is to receive reproductive health services. The pattern is less clear regarding the relationship between reproductive health care and reasons to refuse sex with the husband, although women who agree with at least three specified reasons are more likely to receive services than women agreeing with fewer reasons. Table 9.9 Reproductive health care by women’s status Percentage of women with a live birth in the five years preceding the survey who received antenatal and postnatal care from a health professional for the most recent birth, and percentage of births in the five years preceding the survey for which mothers received professional delivery care, by women’s status indicators, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage Percentage of of women of women births for which who received who received mothers received antenatal care postnatal delivery care from a doctor, care within from a doctor, nurse/midwife, or first two days Number nurse/midwife, or Number Women’s status indicator auxiliary midwife of delivery1 of women auxiliary midwife of births ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say2 0 50.2 35.4 1,616 24.0 2,585 1-2 60.4 54.8 1,328 34.7 2,152 3-4 77.4 66.3 478 59.1 756 5 75.5 66.3 489 60.6 726 Number of reasons to refuse sex with husband 0 53.3 44.6 359 33.7 557 1-2 54.3 45.0 1,037 27.3 1,677 3-4 63.5 52.2 2,515 40.3 3,985 Number of reasons wife beating is justified 0 72.3 61.5 1,188 54.1 1,821 1-2 63.3 49.5 836 36.2 1,327 3-4 57.0 48.1 667 31.5 1,095 5-6 47.7 38.9 1,220 22.4 1,977 Total 60.1 49.6 3,911 36.2 6,219 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Includes mothers who delivered in a health facility 2 Either by herself or jointly with others 128 | Maternal and Child Health 9.5 VACCINATION OF CHILDREN Vaccination of children is an important part of current preventive measures designed to improve child health and reduce morbidity and mortality. According to the World Health Organization (WHO), to be considered fully vaccinated, a child should receive a dose of BCG vaccine against tuberculosis at birth or soon after; three doses of DPT for the prevention of diphtheria, pertussis (whooping cough), and teta- nus; at least three doses of polio vaccine; and a vaccination against measles. The DPT and polio vaccina- tions should be given at approximately 4, 8, and 12 weeks of age; there is also a dose of polio vaccine that should be given at birth. Measles vaccine should be given at or soon after the child reaches nine months. WHO further recommends that children receive the complete schedule of vaccinations before 12 months of age and that the vaccinations be recorded on a health card given to the parents or caretaker. Information on vaccination status was collected from vaccination cards shown to the interviewer and from mothers’ verbal reports if no card was available. If the cards were available, the interviewers copied vaccination dates directly onto the questionnaire. If a vaccination card was presented but a vac- cine had not been recorded on the card as having been given, the mother was asked to recall whether that particular vaccine had been given. The mother was then asked whether the child had received other vac- cinations that were not recorded on the card, and if so, they too were noted on the questionnaire. If the mother was not able to provide a card for the child, she was asked to recall whether the child had received BCG, polio, DPT (including the number of doses for each), and measles vaccinations. The information collected covered all children under age five, although most data presented here are restricted to children age 12-23 months to better reflect children who have reached the age by which they should be fully vac- cinated. Information on vaccination coverage among children age 12-23 months is shown in Table 9.10 by source of information used to determine coverage (i.e., vaccination record or mother’s report). Health cards were presented for just one-fifth (21 percent) of children age 12-23 months. The third row of the table shows the proportion of children who were immunized at any age up to the time of the survey, while the last row shows the proportion who were vaccinated by age 12 months, the age at which vaccination coverage should be complete. Table 9.10 Vaccinations by source of information Percentage of children 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children who received: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– DPT Polio1 No Number –––––––––––––––– ––––––––––––––––––––––– vacci- of Source of information BCG 1 2 3 0 1 2 3 Measles All2 nations children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Vaccinated at any time before the survey Vaccination card 20.2 18.0 14.0 10.4 14.6 17.8 14.4 10.7 13.5 8.3 0.1 213 Mother's report 28.1 24.6 17.7 11.0 13.1 49.4 37.9 18.7 22.4 4.7 26.5 786 Either source 48.3 42.6 31.7 21.4 27.8 67.2 52.3 29.4 35.9 12.9 26.5 999 Vaccinated by 12 months of age3 46.9 38.7 30.1 20.1 27.1 63.7 50.6 26.8 31.4 11.3 30.6 999 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 3 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. Maternal and Child Health | 129 According to information from both the vaccination records and mothers’ recall, only 13 percent of Nigerian children age 12-23 months can be considered fully immunized, the lowest vaccination rate among the African countries in which DHS surveys have been conducted since 1998. Less than half of children have received each of the vaccinations, with the exception of Polio 1 (67 percent) and Polio 2 (52 percent). Although 43 percent of children receive DPT 1, the proportion who go on to receive the third dose falls off to 21 percent; the dropout rate1 is thus 50 percent, slightly lower than the dropout rate of 56 percent for polio. WHO recommends that children receive the complete schedule of recommended vaccinations by 12 months of age. In Nigeria, however, only 11 percent of children age 12-23 months received all of the recommended vaccinations before their first birthday. 9.5.1 Vaccination by Background Characteristics Table 9.11 presents vaccination coverage levels among children age 12-23 months by background characteristics, to provide an indication of the success of the vaccination programme in reaching all sub- groups of the population. The data show that the percentage of female children age 12-23 months who are fully immunized is almost twice that of their male counterparts (17 versus 9 percent). There are variations in percentage of children who received specific vaccinations by urban-rural residence, region, level of education, and wealth quintile. More than three times as many urban children as rural children are fully immunized (7 and 25 percent, respectively). In general, a higher proportion of children in the southern regions were vaccinated compared with those in the north. In the northern regions, vaccination coverage ranges from 4 to 12 percent, whereas in the southern regions the lowest vaccination rate is 21 percent and the highest in 45 percent. The differentials by wealth quintile are almost as large. While less than 4 percent of children living in households in the two lowest quintiles are fully vaccinated, 40 percent of children in households in the highest quintile have received all recommended vaccinations. 1 Dropout rate = (Dise 1 – Dose 3) * 100/Dose 1 130 | Maternal and Child Health 9.5.2 Vaccination in the First Year of Life Table 9.12 shows the percentage of children age 12-59 months who received specific vaccina- tions during the first year of life, according to age cohort. There has been little change in vaccination cov- erage over time. However, the data indicate that the children age 24-35 months at the time of the survey were the most likely of all the cohorts to have received at least one vaccination by 12 months of age. For example, whereas 24 percent of these children received no vaccination during the first year of life, 31 percent of the youngest children age 12-23 months at the time of the survey received no vaccinations, in- dicating a slight decrease in vaccination rates. In particular, the data indicate a decline in vaccination rates for all three doses of polio. Table 9.11 Vaccinations by background characteristics Percentage of children 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and percentage with a vaccination card, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children who received: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage DPT Polio 1 No with a Number Background ––––––––––––––– ––––––––––––––––––––––– vacci- vaccina- of characteristic BCG 1 2 3 0 1 2 3 Measles All2 nations tion card children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 46.5 41.4 30.4 19.1 28.2 65.8 50.8 26.5 33.8 9.1 27.7 20.2 512 Female 50.2 44.0 33.1 23.8 27.3 68.6 53.9 32.5 38.1 17.0 25.3 22.5 486 Birth order 1 59.6 51.5 39.8 29.0 37.3 68.7 54.4 32.1 43.5 17.8 19.2 33.1 188 2-3 48.0 44.5 32.5 22.3 27.0 66.0 53.8 29.2 33.8 13.4 29.8 20.6 332 4-5 52.8 42.7 34.9 24.1 30.2 71.3 54.6 32.1 39.3 14.4 22.7 21.7 220 6+ 36.8 33.8 22.3 12.3 19.8 64.2 46.8 25.7 30.2 7.6 30.8 13.2 259 Residence Urban 70.1 63.5 51.3 40.2 40.2 75.3 64.4 42.0 52.1 25.1 16.7 35.6 312 Rural 38.4 33.1 22.9 12.8 22.1 63.5 46.8 23.7 28.5 7.4 31.0 14.8 687 Region North Central 63.4 54.1 33.0 23.8 36.2 70.0 52.6 36.8 44.6 12.4 20.7 22.9 149 North East 31.1 23.8 14.0 9.1 18.7 61.6 41.7 24.8 22.5 6.0 30.5 17.1 219 North West 27.5 20.9 13.2 5.8 12.0 54.4 39.9 16.4 15.6 3.7 40.5 9.6 356 South East 83.4 83.2 66.3 58.5 39.6 80.7 68.1 57.4 64.1 44.6 15.3 43.1 74 South South 76.1 74.3 63.3 32.5 47.8 86.0 77.2 40.0 66.9 20.8 6.5 37.9 120 South West 85.0 83.7 80.2 67.8 65.4 93.0 83.1 44.8 73.1 32.5 5.1 36.4 81 Mother’s education No education 22.7 19.4 9.8 5.6 12.8 54.7 38.9 18.7 15.6 3.8 41.1 7.3 484 Primary 57.7 48.5 37.6 20.5 26.7 77.7 58.5 34.2 42.5 13.0 18.6 26.1 247 Secondary 84.1 77.8 68.4 54.0 52.5 80.4 70.9 46.8 66.2 32.4 8.4 41.5 230 Higher (97.0) (88.4) (52.1) (29.4) (76.1) (78.1) (69.9) (30.8) (68.1) (11.3) (2.4) (46.2) 38 Wealth quintile Lowest 22.8 21.9 15.3 7.1 12.6 61.5 43.9 20.0 15.9 3.4 36.1 11.5 206 Second 30.2 27.1 17.5 7.7 16.6 61.6 41.3 23.6 22.9 3.9 34.8 13.3 202 Middle 42.8 33.8 20.8 13.3 19.0 61.0 47.0 25.1 32.0 8.9 31.8 16.1 219 Fourth 59.6 48.5 35.3 22.2 37.0 67.3 57.2 26.3 41.9 11.0 22.9 25.9 185 Highest 91.4 86.9 74.6 60.6 57.7 86.7 74.7 54.4 70.7 39.9 4.3 42.3 187 Total 48.3 42.6 31.7 21.4 27.8 67.2 52.3 29.4 35.9 12.9 26.5 21.3 999 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) Maternal and Child Health | 131 9.6 ACUTE RESPIRATORY INFECTION AND FEVER Acute respiratory infection (ARI) is a common cause of illness and death during infancy and childhood. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths caused by ARI. In the 2003 NDHS, the prevalence of ARI was estimated by asking mothers whether their chil- dren under age five had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. These symptoms are consistent with ARI. It should be noted that the morbidity data collected are subjective in the sense that they are based on a mother’s perception of illness without validation by medical personnel. Table 9.13 shows that in the two weeks preceding the survey, 10 percent of children experienced symptoms of ARI and 31 percent had a fever. Prevalence peaks at age 6-11 months and then declines among older children. Children of more educated mothers and those living in more economically advan- taged households are the least likely to experience these illnesses. There is significant regional variation in prevalence of fever and ARI symptoms. Among children who experienced symptoms of ARI or fever, treatment was sought from a health facility or health care provider for almost one-third (31 percent). The likelihood of seeking treatment in- creases as the education of the mother and the economic index of the household increases. The proportion of children ill with fever and/or who had symptoms of ARI for whom treatment was sought ranges from a low of 20 percent in the North East to a high of 53 percent in the South West. Table 9.12 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by 12 months of age, and percentage with a vaccination card, by current age of child, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children who received: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage DPT Polio 1 No with a Number Current age ––––––––––––––––– –––––––––––––––––––––––––– vacci- vaccina- of in months BCG 1 2 3 0 1 2 3 Measles All2 nations tion card children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 12-23 46.9 38.7 30.1 20.1 27.1 63.7 50.6 26.8 31.4 11.3 30.6 21.3 999 24-35 51.4 41.8 31.5 22.9 23.4 70.8 58.5 34.8 28.6 10.3 23.9 17.2 1,050 36-47 40.5 32.8 27.1 19.8 16.3 61.4 55.8 36.2 26.6 10.3 35.8 10.1 1,067 48-59 41.4 36.3 29.0 18.1 18.2 65.8 60.1 34.6 32.0 8.7 30.0 8.5 899 12-59 46.0 38.0 30.0 20.8 21.4 66.2 56.9 33.5 30.4 10.6 29.3 14.4 4,014 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Information was obtained from the vaccination card or if there was no written record, from the mother. For children whose infor- mation was based on the mother’s report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccinations. 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 132 | Maternal and Child Health Table 9.13 Prevalence and treatment of symptoms of ARI and fever Percentage of children under five years of age who had a cough accompanied by short, rapid breathing (symptoms of ARI), and percentage of children who had fever in the two weeks preceding the survey, and percentage of children with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among children with symptoms of ARI and/or fever, percentage Percentage for whom of children Percentage treatment was with of children Number sought from a Number Background symptoms with of health facility/ of characteristic of ARI fever children provider1 children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 12.6 24.3 663 24.4 196 6-11 16.3 41.2 668 34.3 303 12-23 11.8 39.5 999 34.8 429 24-35 9.9 33.4 1,050 35.8 376 36-47 7.8 26.4 1,067 29.7 316 48-59 5.9 21.7 899 21.4 210 Sex Male 10.5 31.0 2,717 32.1 935 Female 10.1 31.1 2,628 30.6 896 Residence Urban 7.8 27.0 1,620 40.0 484 Rural 11.4 32.8 3,726 28.3 1,347 Region North Central 6.7 23.9 781 49.5 201 North East 16.2 37.4 1,225 19.5 514 North West 8.8 35.7 1,818 33.4 682 South East 6.3 22.9 347 36.6 89 South South 12.2 29.5 684 25.1 243 South West 6.8 17.2 489 52.6 102 Mother’s education No education 11.0 35.7 2,675 22.0 1,022 Primary 11.3 28.3 1,259 39.5 409 Secondary 8.4 24.2 1,215 46.4 343 Higher 5.4 27.6 197 51.7 57 Wealth quintile Lowest 11.0 32.8 1,162 18.9 419 Second 12.4 35.0 1,116 21.5 432 Middle 12.1 34.0 1,071 30.1 391 Fourth 9.2 30.5 1,024 44.5 348 Highest 6.2 21.7 972 54.2 240 Total 10.3 31.0 5,345 31.4 1,831 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ARI = Acute respiratory infection 1 Excludes pharmacy, shop, and traditional practitioner Maternal and Child Health | 133 9.7 HOUSEHOLD HYGIENE 9.7.1 Presence of Materials for Washing Hands The connection between hand-washing and diarrhoea is well established. Increasing the fre- quency of hand-washing substantially decreases the occurrence of diarrhoea in young children. The prox- imity of the materials necessary for washing hands, such as running water, soap or cleanser, and a basin, may lead to more frequent hand-washing. Table 9.14 shows that less than half of households in the coun- try have access to the three specified materials to wash hands (43 percent). The presence of these materi- als is higher in urban than rural areas (50 versus 40 percent). Prevalence by region ranges from a high of seven in ten households in the South South and South East to a low of three in ten households in the North West. It should be noted that a quarter of households do not have any hand-washing materials. Table 9.14 Hand-washing materials in the household Percentage of households with hand-washing materials in dwelling,, yard, or plot, by background character- istics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Hand-washing materials ––––––––––––––––––––––––––––––––– Soap, ash, All three No or other hand- hand- Number Background Water/ cleansing washing washing of characteristic tap agent Basin materials materials households ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 64.3 66.7 66.1 49.8 22.0 2,598 Rural 63.4 55.0 53.5 39.8 27.3 4,627 Region North Central 55.3 51.4 56.2 36.8 32.6 1,040 North East 73.3 50.2 50.1 35.3 19.6 1,185 North West 56.9 55.4 36.3 29.0 31.0 1,911 South East 72.3 77.8 87.0 67.5 12.5 690 South South 76.8 81.2 88.8 68.6 9.6 1,315 South West 52.4 44.6 50.9 38.0 42.2 1,083 Source of drinking water Piped 67.6 65.8 61.9 50.0 22.5 1,249 Protected well 68.2 71.1 71.0 56.1 18.8 1,737 Open well 60.4 47.4 40.3 30.8 32.8 2,058 Surface 58.6 52.9 60.0 38.0 27.9 1,597 Other 68.0 68.7 68.0 50.3 18.2 579 Time to get water In dwelling/yard/plot 69.1 65.3 62.2 51.5 23.1 2,046 <5 minutes 63.1 64.8 55.0 38.8 21.6 319 5 to 9 minutes 64.9 62.8 63.7 47.0 22.8 866 10 to 29 minutes 59.3 54.1 53.5 38.1 29.5 1,780 30 to 59 minutes 58.9 51.3 50.9 35.7 29.3 1,142 60+ minutes 65.6 59.6 61.6 43.3 21.7 1,011 Total 63.8 59.2 58.0 43.4 25.4 7,225 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 5 cases with data missing on source of water and 60 cases with data missing on time to get water. 134 | Maternal and Child Health 9.7.2 Disposal of Children’s Stools The proper disposal of children’s faeces is extremely important in preventing the spread of dis- ease. If faeces are left uncontained, disease may be spread by direct contact or through animal contact. Table 9.15 presents information on the disposal of faecal matter of children under age five, by back- ground characteristics. Two-thirds of children’s stools are usually contained. Children’s stools are more likely to be contained in urban than rural areas (83 and 61 percent, respectively). There is a positive rela- tionship between mothers’ education and children’s stool containment. 9.8 DIARRHOEA Dehydration from diarrhoea is a major cause of death among young children in Nigeria. In the 2003 NDHS, mothers were asked whether any of their children under five years of age had diarrhoea at any time during the two-week period prior to the survey. If any child had diarrhoea, the mother was asked about feeding practices during the diarrhoeal episode and about what actions were taken to treat the diar- rhoea. Table 9.16 shows percentage of children less than five years with diarrhoea in the preceding two weeks before the survey, by background characteristics. Nearly one-fifth of children had diarrhoea in the two weeks preceding the survey. Table 9.15 Disposal of child’s stools Percent distribution of mothers whose youngest child under five years is living with her by way in which child's faecal matter is disposed of, according to background characteristics and type of toilet facilities in household, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Stools contained ––––––––––––––––––––––– Child Stools uncontained Uses diapers always Thrown ––––––––––––––––––––––––– ––––––––––––––– uses into Buried Thrown Thrown Dis- Number Background toilet/ toilet/ in outside outside Rinsed pos- Wash- of characteristic latrine latrine yard dwelling yard away able able Other Missing Total mothers –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 9.2 72.3 1.1 4.0 5.3 3.2 1.1 1.4 0.5 1.8 100.0 1,068 Rural 5.2 52.5 3.5 15.4 16.8 2.6 0.4 1.5 0.4 1.8 100.0 2,532 Region North Central 7.8 37.0 1.5 19.1 22.5 2.9 1.7 6.8 0.5 0.3 100.0 531 North East 3.4 69.2 0.9 8.2 15.2 1.2 0.5 0.5 0.1 0.8 100.0 793 North West 4.1 69.5 3.5 9.1 8.6 1.2 0.0 0.0 0.2 3.8 100.0 1,251 South East 15.3 54.7 1.0 10.6 7.3 6.3 1.4 1.1 0.8 1.4 100.0 209 South South 6.7 40.6 7.9 22.3 10.6 6.5 0.8 1.9 1.6 1.0 100.0 473 South West 13.9 52.5 0.3 7.4 20.3 4.4 0.3 0.3 0.0 0.6 100.0 343 Mother’s education No education 4.6 59.7 3.3 12.6 14.8 1.7 0.0 0.8 0.3 2.3 100.0 1,833 Primary 4.8 52.5 2.7 16.1 18.4 2.9 0.1 2.0 0.4 0.1 100.0 836 Secondary 10.2 61.4 2.2 8.0 7.0 5.1 1.4 1.6 0.9 2.1 100.0 798 Higher 18.8 59.2 0.0 2.3 1.9 2.2 5.8 5.9 0.0 3.9 100.0 134 Toilet facilities None 2.5 9.3 5.3 33.5 41.2 3.5 0.4 1.9 0.5 1.9 100.0 828 Pit latrine 6.0 76.2 2.0 5.2 5.8 1.4 0.2 1.3 0.2 1.7 100.0 2,238 Improved pit latrine 2.9 72.1 1.1 6.8 2.0 8.4 1.6 0.0 5.0 0.0 100.0 87 Flush toilet 18.7 62.6 0.9 4.2 0.8 6.1 2.7 1.7 0.5 1.8 100.0 398 Other (0.0) (12.5) (14.3) (34.3) (14.1) (17.8) (0.0) (0.0) (1.4) (5.5) (100.0) 48 Total 6.4 58.4 2.8 12.0 13.4 2.8 0.6 1.4 0.4 1.8 100.0 3,601 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes one case with data missing on toilet facilities. Maternal and Child Health | 135 Table 9.16 Prevalence of diarrhoea Percentage of children under five years with diarrhoea in the two weeks preceding the survey, by background char- acteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––– Diarrhoea in the two weeks Number Background preceding of characteristic the survey children –––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 12.8 663 6-11 26.6 668 12-23 27.2 999 24-35 22.8 1,050 36-47 14.4 1,067 48-59 8.8 899 Sex Male 19.3 2,717 Female 18.3 2,628 Residence Urban 14.5 1,620 Rural 20.7 3,726 Region North Central 14.9 781 North East 35.1 1,225 North West 18.9 1,818 South East 8.6 347 South South 8.0 684 South West 6.4 489 Mother's education No education 24.0 2,675 Primary 17.2 1,259 Secondary 11.2 1,215 Higher 6.4 197 Hand-washing materials in household Water/tap 19.8 3,478 Soap/ash/other cleansing agent 18.2 3,157 Basin 16.3 2,951 All three hand-washing materials 15.9 2,193 None 16.9 1,288 Source of drinking water Piped 17.3 801 Protected well 12.6 1,107 Open well 23.9 1,921 Surface 17.2 1,112 Other 19.2 402 Wealth quintile Lowest 21.7 1,162 Second 23.6 1,116 Middle 19.6 1,071 Fourth 18.9 1,024 Highest 9.0 972 Total 18.8 5,345 –––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 2 cases with data missing on source of drinking water. 136 | Maternal and Child Health Table 9.17 Knowledge of ORS packets Percentage of mothers with births in the five years preceding the survey who know about oral rehydra- tion salts (ORS) packets for treatment of diarrhoea in children, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––– Percentage of mothers who know Number Background about ORS of characteristic packets mothers –––––––––––––––––––––––––––––––––––––––––– Age 15-19 54.1 356 20-24 62.5 850 25-29 67.1 1,055 30-34 68.7 713 35-49 65.6 936 Residence Urban 75.5 1,144 Rural 60.5 2,766 Region North Central 57.0 575 North East 67.7 862 North West 79.7 1,341 South East 36.7 222 South South 38.6 544 South West 72.5 367 Education No education 65.2 1,989 Primary 60.3 918 Secondary 67.1 862 Higher 76.1 143 Wealth quintile Lowest 50.0 852 Second 58.4 846 Middle 70.0 808 Fourth 73.9 735 Highest 75.7 670 Total 64.9 3,911 –––––––––––––––––––––––––––––––––––––––––– ORS = Oral rehydration salts Children age 6-11 and 12-23 months have the highest prevalence of diarrhoea (27 percent each). Rural children are more likely than urban children to have diarrhoea. The likelihood of children in the North East having diarrhoea is more than five times that of children in the South West (35 versus 6 per- cent). Incidence of diarrhoea is inversely related to educational attainment. There is little variation by the economic status of the household, with the exception of children in households in the highest wealth quin- tile, who are the least likely to have had diarrhoea. 9.8.1 Knowledge of ORS Packets A simple and effective response to dehydration associated with diarrhoea is a prompt increase in the child’s fluid intake through food and oral rehydration therapy (ORT). ORT may include the use of a solution prepared from commercially produced packets of oral rehydration salts (ORS) or a homemade mixture usually prepared from sugar, salt, and water. Table 9.17 shows the proportion of women with children under five years of age who know about ORS packets. Two-thirds of mothers (65 percent) know about ORS packets. There is significant variation by back- ground characteristics. The most striking variation is observed at the regional level: knowledge ranges from a low of 37 percent in the South East to a high of 80 percent in the North West. 9.8.2 Diarrhoea Treatment Mothers of children who had diarrhoea in the two weeks preceding the survey were asked what was done to manage or treat the illness. The results are shown in Table 9.18. Twenty-two percent of mothers reported their children with diarrhoea were taken to a health facility. Less than one-fifth of children (18 percent) were given a solution made from ORS. Twenty-nine percent, however, received either ORS or recommended home fluids (RHF), which are either cereal-based liquids or a mixture of sugar, salt, and water. Forty percent received ORS, RHF, or increased fluids. Other treatments were also common. In particular, half of all children received a pill or syrup, and 15 percent received some other home treatment. One in five children with diarrhoea were given no treatment at all. The small number of children in the sample who had diarrhoea in the two weeks before the survey makes comparisons by region or mother’s education difficult. There is a significant differential, however, by residence, with urban children more likely than rural children to have gone to a health facility. For exam- ple, 30 percent of urban children were taken to a health care facility compared with just 19 percent of ru- ral children. There is generally a positive correlation between treatment of diarrhoea and the economic status of the household. Maternal and Child Health | 137 9.8.3 Feeding Practices During Diarrhoea Mothers are encouraged to continue feeding their children normally when the children suffer from diarrhoea and to increase the amount of fluids children are given. These practices help to reduce the likelihood the child will become dehydrated and also minimize the adverse consequences of diarrhoea on the child’s nutritional status. Table 9.18 Diarrhoea treatment Percentage of children under five years of age who had diarrhoea in the two weeks preceding the survey taken for treatment to a health provider, percentage who received oral rehydration therapy (ORT), and percentage given other treatments, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Oral rehydration therapy Other treatments Percent- ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––– Number age ORS, RHF of taken to Either In- or in- Pill Intra- Home No children Background a health ORS ORS creased creased or Injec- venous remedy/ treat- with characteristic provider1 packets RHF or RHF fluids fluids syrup tion solution other Missing ment diarrhoea –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 20.1 14.4 12.2 22.4 9.5 27.2 35.4 1.1 0.0 21.1 1.1 27.6 85 6-11 27.4 20.6 14.8 31.5 16.5 39.2 45.8 0.4 0.0 11.2 0.0 27.4 178 12-23 18.8 17.2 18.3 28.6 26.8 43.5 47.8 2.4 0.2 13.1 0.5 23.3 272 24-35 27.8 25.0 22.2 38.1 20.2 46.6 64.5 3.7 0.2 10.0 0.5 12.7 239 36-47 10.3 8.6 11.3 17.9 19.8 31.6 48.6 1.0 0.0 20.5 2.3 15.7 153 48-59 21.3 18.9 20.9 31.0 21.1 42.4 48.2 2.0 0.0 21.1 2.3 11.6 79 Sex Male 23.9 19.8 16.5 30.1 18.8 40.2 52.9 1.8 0.1 13.9 1.1 19.1 524 Female 18.8 16.5 18.0 28.7 22.2 40.2 48.0 2.2 0.1 15.1 0.7 20.5 482 Residence Urban 30.3 22.9 17.1 34.3 25.1 49.0 58.9 4.5 0.0 7.2 0.5 17.5 235 Rural 18.8 16.8 17.2 27.9 19.0 37.5 48.0 1.3 0.1 16.7 1.0 20.5 771 Region North Central 39.7 22.3 27.3 47.0 36.0 59.9 46.4 3.6 0.5 20.7 0.0 11.4 116 North East 7.6 13.8 8.9 19.7 13.9 29.0 48.9 0.2 0.0 13.9 0.6 26.3 430 North West 29.8 20.5 20.0 30.5 18.0 41.8 53.1 3.1 0.0 15.2 1.9 16.8 343 South East (24.9) (17.4) (25.3) (33.7) (15.3) (39.4) (63.8) (12.1) (1.6) (5.0) (0.0) (11.4) 30 South South (26.8) (27.7) (29.9) (49.1) (31.1) (56.9) (43.0) (0.0) (0.0) (7.3) (0.0) (19.0) 55 South West (38.9) (23.3) (33.4) (46.6) (65.1) (74.3) (60.1) (2.4) (0.0) (13.3) (0.0) (3.4) 31 Mother's education No education 16.6 13.2 15.0 22.5 17.3 33.9 47.1 1.4 0.1 16.8 0.8 22.7 641 Primary 24.7 22.4 18.2 35.0 23.8 45.3 54.3 2.2 0.0 10.9 0.0 17.5 216 Secondary 35.3 31.1 24.4 48.0 25.9 57.7 60.0 3.9 0.4 8.9 2.6 11.7 137 Higher * * * * * * * * * * * * 13 Wealth quintile Lowest 10.3 12.6 8.6 17.2 17.9 29.5 45.8 1.4 0.0 15.3 0.7 27.2 252 Second 13.1 14.8 15.7 24.1 15.2 31.2 45.4 0.9 0.0 16.7 0.9 24.4 263 Middle 22.5 18.5 28.0 38.4 22.4 48.1 50.4 2.4 0.2 20.3 0.0 14.5 210 Fourth 39.2 21.1 16.8 33.8 23.2 48.6 59.5 1.2 0.3 4.7 2.5 16.3 194 Highest 36.8 37.7 21.7 49.3 32.6 60.8 60.2 7.9 0.0 13.3 0.0 5.0 87 Total 21.5 18.2 17.2 29.4 20.4 40.2 50.5 2.0 0.1 14.5 0.9 19.8 1,006 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Oral rehydration therapy (ORT) includes solution prepared from oral rehydration salts (ORS) packets, recommended home fluids (RHF), or increased fluids. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. 1 Excludes pharmacy, shop and traditional practitioner 138 | Maternal and Child Health Table 9.19 Feeding practices during diarrhoea Percent distribution of children un- der five years who had diarrhoea in the two weeks preceding the survey by amount of liquids and food of- fered compared with normal prac- tice, Nigeria 2003 ––––––––––––––––––––––––––––––– Liquid/food offered Percent ––––––––––––––––––––––––––––––– Amount of liquids offered Same as usual 40.8 More 20.4 Somewhat less 21.6 Much less 15.5 None 1.1 Don't know/missing 0.6 Total 100.0 Amount of food offered Same as usual 36.9 More 8.2 Somewhat less 25.8 Much less 16.1 None 5.2 Never gave food 7.6 Don't know/missing 0.3 Total 100.0 Number of children 1,006 Table 9.19 presents data on feeding practices when a child has diarrhoea. Just one-fifth of chil- dren are given more fluids than usual, as recommended. The most common practice is to give the same amount of fluids as usual (41 percent). However, a significant proportion of children are offered less fluid than usual: 22 percent are offered somewhat less and 16 percent are offered much less. Regarding intake of foods when children are sick with diarrhoea, 37 percent of children are of- fered the same amount of food, and 8 percent are offered more food than usual. Almost half of children with diarrhoea are offered somewhat less or much less food than usual, or no food at all. 9.9 CHILDREN HEALTH CARE BY WOMEN’S STATUS Status and self-respect can be major determinants of a mother’s ability to obtain adequate health care for her children. Table 9.20 shows utilization of child health care services by the mother’s level of empowerment, as measured by the three indicators of women’s status defined in Chapter 3. The data indicate that decisionmaking ability has a generally positive relationship with children’s access to health care. The more empowered a woman, the more likely her child is to receive services. Jus- tification of wife-beating exhibits a strong negative correlation with access to child health services. There is no clear pattern, however, in the relationship between child’s health care and reasons to refuse sex with husband. Maternal and Child Health | 139 9.10 PERCEIVED PROBLEMS IN ACCESSING HEALTH CARE The 2003 NDHS included a series of questions aimed at obtaining information on the problems women perceive as barriers to accessing health care for themselves. This information is particularly im- portant in understanding and addressing the barriers women may face in seeking care in general. To ob- tain this information, all respondents were asked whether each of the following factors would be a big problem or not for them in obtaining medical advice or treatment when they are sick: knowing where to go, getting permission to go, getting money for treatment, distance to the health facility, availability of transport, not wanting to go alone, and concern that there may not be a female provider. Almost half of women cite at least one problem in accessing health care (Table 9.21). The most commonly cited problem is getting money for treatment (30 percent), followed by distance to health facil- ity and having to take transport (24 percent each). Less than one in five women reported the other three problems: concern that there may not be a female provider (17 percent), not wanting to go alone (14 per- cent), and knowing where to go for treatment (14 percent). One in ten women say that getting permission to go is a problem (Figure 9.2). Table 9.20 Child health care by women’s status Percentage of children age 12-23 months fully vaccinated, and percentage of children under five years who were ill with a fever, symptoms of ARI and/or diarrhoea, in the two weeks preceding the survey taken to a health provider for treatment, by women's status indicators, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage of Percentage of of children children with fever children with 12-23 months Number and/or symptons Number diarrhoea Number fully of of ARI taken to of taken to a of Women’s status indicator vaccinated1 children a health provider2 children health provider2 children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say3 0 7.9 408 28.9 801 21.8 490 1-2 13.2 362 32.5 630 19.6 357 3-4 24.7 104 35.9 192 22.0 91 5 18.6 125 33.6 206 28.4 68 Number of reasons to refuse sex with husband 0 10.4 87 34.3 136 29.3 74 1-2 9.8 263 30.4 473 24.2 258 3-4 14.5 649 31.5 1,221 19.5 674 Number of reasons wife beating is justified 0 23.8 323 42.1 433 30.0 178 1-2 9.8 198 33.5 398 33.2 228 3-4 9.1 181 28.9 324 18.1 184 5-6 5.5 297 24.5 676 12.8 415 Total 12.9 999 31.4 1,831 21.5 1,006 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Those who have received BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 2 Excludes pharmacy, shops, and traditional practitioner 3 Either by herself or jointly with others 140 | Maternal and Child Health Table 9.21 Problems in accessing health care Percentage of women who reported they have big problems in accessing health care for themselves when they are sick, by type of prob- lem and background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Problems in accessing health care ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Concern Knowing Getting Not there may Any where permission Getting Distance Having wanting not be a of the Number Background to go for to go for money for to health to take to go female specified of characteristic treatment treatment treatment facility transport alone provider problems women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 15.3 11.9 29.5 23.9 23.0 18.3 19.2 48.8 1,716 20-29 13.2 9.6 28.7 23.0 22.4 13.4 16.5 44.8 2,876 30-39 13.5 9.5 30.7 25.0 24.7 12.3 17.5 45.7 1,757 40-49 13.1 8.3 35.2 27.3 26.5 13.4 15.5 49.0 1,271 Number of living children 0 12.6 8.8 29.8 22.4 21.4 15.3 16.0 44.7 2,499 1-2 15.1 11.3 28.2 24.7 23.9 14.5 18.0 46.2 2,009 3-4 15.5 10.2 30.7 25.2 25.1 13.6 18.1 48.6 1,526 5+ 12.1 9.5 34.0 26.5 26.1 13.0 17.1 47.9 1,586 Marital status Never married 9.6 7.7 31.6 19.5 19.2 12.2 10.2 41.5 1,926 Married or living together 15.3 11.0 29.4 26.0 25.4 15.2 20.0 48.1 5,336 Divorced, separated, widowed 12.7 4.7 40.2 26.2 24.0 11.7 12.6 51.7 358 Residence Urban 5.1 4.0 16.9 9.5 8.5 6.0 7.8 25.6 2,629 Rural 18.3 13.0 37.6 32.2 31.8 18.6 22.1 57.6 4,991 Region North Central 5.2 4.7 32.7 18.6 18.7 7.2 6.0 39.5 1,121 North East 20.6 15.5 29.1 25.7 26.5 18.9 19.8 50.2 1,368 North West 20.1 15.5 27.1 29.4 29.0 20.6 33.5 54.3 2,095 South East 10.4 4.5 35.1 21.8 14.8 3.7 4.0 43.4 737 South South 13.8 8.8 47.1 34.8 35.3 19.4 16.5 60.4 1,342 South West 2.5 1.3 10.1 5.6 5.0 2.8 2.0 15.7 958 Education No education 22.4 16.9 34.1 32.0 31.8 20.8 28.3 58.6 3,171 Primary 10.7 6.6 37.1 25.9 25.5 13.1 12.3 48.8 1,628 Secondary 6.5 4.5 24.6 16.1 14.8 8.2 8.5 34.3 2,370 Higher 1.7 0.3 11.4 9.0 8.1 4.1 2.8 18.5 451 Employment Not employed 16.1 11.9 31.2 24.6 24.7 17.5 19.9 48.4 3,177 Working for cash 11.5 8.5 26.4 22.2 21.1 11.2 15.2 42.3 3,744 Working, not for cash 13.8 7.9 49.1 35.1 34.6 14.9 14.2 60.4 673 Wealth quintile Lowest 29.7 19.3 48.9 47.8 48.9 27.8 28.7 75.1 1,414 Second 19.6 15.1 39.4 33.6 33.4 20.1 26.4 62.2 1,439 Middle 12.9 10.7 32.2 23.2 21.8 14.3 18.1 47.5 1,513 Fourth 6.1 4.6 22.8 13.5 12.3 8.0 10.1 33.7 1,526 Highest 3.1 1.7 13.1 8.2 7.0 3.8 5.4 20.8 1,728 Total 13.7 9.9 30.4 24.4 23.8 14.3 17.2 46.6 7,620 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 26 cases with missing information on education. Maternal and Child Health | 141 Getting money for treatment was the problem most commonly reported by women of all back- grounds. The likelihood of citing at least one problem varies by background characteristics. In particular, there is a strong negative correlation between both level of education and wealth quintile and citing at least one problem accessing health care. Furthermore, there are large differentials by residence and re- gion. For example, rural women are more than twice as likely to report at least one of the specified prob- lems as urban women. 9.11 USE OF SMOKING TOBACCO Tobacco smoking during pregnancy increases the risk of having babies with small or low birth weight. Its use at other times adversely affects women’s health status and may also adversely affect chil- dren’s health, particularly in terms of respiratory illness. Table 9.22 shows that smoking is not common among Nigerian women. Ninety-nine percent of women report that they do not use any kind of smoking tobacco, and there is no significant variation by background characteristics. 14 10 30 24 24 14 17 47 Knowing where to go for treatment Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern there may not be a female provider Any of the specified problems 0 10 20 30 40 50 Percent Figure 9.2 Problems in Accessing Health Care NDHS 2003 142 | Maternal and Child Health Table 9.22 Use of smoking tobacco Percentage of women who smoke cigarettes or tobacco, by background characteristics and maternity status, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Uses tobacco ––––––––––––––––––––––––––––––– Does Number Background Other not use of characteristic Cigarettes Pipe tobacco tobacco women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.3 0.0 0.0 99.6 1,716 20-34 0.3 0.0 0.1 99.4 3,817 35-49 0.9 0.3 1.4 97.3 2,087 Residence Urban 0.3 0.0 0.4 99.3 2,629 Rural 0.6 0.1 0.5 98.7 4,991 Region North Central 0.2 0.1 0.4 99.3 1,121 North East 0.9 0.2 0.0 98.8 1,368 North West 1.1 0.1 0.3 98.4 2,095 South East 0.0 0.1 2.1 97.7 737 South South 0.0 0.0 0.3 99.7 1,342 South West 0.1 0.0 0.5 99.3 958 Education No education 0.8 0.2 0.8 98.0 3,171 Primary 0.4 0.1 0.3 99.2 1,628 Secondary 0.2 0.0 0.1 99.7 2,370 Higher 0.0 0.0 0.5 99.5 451 Maternity status Pregnant 0.4 0.0 0.2 99.2 868 Breastfeeding (not pregnant) 0.5 0.0 0.3 99.0 1,985 Neither 0.5 0.1 0.6 98.8 4,767 Total 0.5 0.1 0.5 98.9 7,620 Malaria | 143 MALARIA 10 Malaria is a major public health concern in Nigeria. According to recent estimates, half of the Ni- gerian population has at least one episode of malaria annually, and the majority of outpatient visits can be attributed to malaria (FMOH, 2001). Plasmodium falciparum, transmitted by the anopheles mosquito, is responsible for the majority of malaria deaths in Nigeria, and the groups most at risk are children under five years of age and pregnant women. Pregnant women are vulnerable because their natural immunity is reduced; thus, they are four times more likely to suffer from complications of malaria than nonpregnant women. Malaria is a cause of pregnancy loss, stillbirth, low birth weight, and neonatal mortality (Jamison et al., 1993). Individuals with sickle cell and other low immune groups are also at higher risk. Malaria negatively impacts the social and economic development of communities in Nigeria. It is responsible for school absenteeism and low productivity at workplaces and on farms. The Federal Gov- ernment policy on malaria control in Nigeria focuses on the following main interventions: 1) management of cases, 2) prevention of malaria with insecticide-treated nets (ITN), and 3) use of intermittent preventive treatment (IPT) during pregnancy. Health promotion monitoring and evaluation are cross-cutting activi- ties. 10.1 MOSQUITO NETS Ownership of Mosquito Nets All households in the 2003 Nigeria Demographic and Health Survey (NDHS) were asked whether they own a mosquito net, and if so, how many. Table 10.1 shows the percentage of households with at least one, and more than one, mosquito net (treated or untreated), and the percentage of households that have at least one, and more than one ITN, by background characteristics. Table 10.1 shows that ownership of mosquito nets is not widespread in Nigeria. Only 12 percent of households report that they own at least one net. Two percent of households report that they own an ITN. Prevalence of mosquito net ownership varies greatly by residence and region. Rural households are three times as likely as urban households to own at least one mosquito net. Furthermore, ownership ranges from less than 1 percent in the South West to 22 percent in the North East. It is notable that the least advantaged household (in terms of the wealth index) have the highest levels of mosquito net owner- ship. Whereas 23 percent of the households in the lowest quintile own at least one net, only 3 percent of households in the highest quintile report ownership. Use of Mosquito Nets In the 2003 Nigeria NDHS, respondents to the Household Questionnaire were asked about the use of mosquito nets by household members during the previous night. The use of mosquito nets by children under five and pregnant women is of special interest for public health purposes. Since the prevalence of malaria-carrying mosquitoes varies seasonally, with a peak during and immediately following periods of rainfall, use of mosquito nets may be expected to follow a similar sea- sonal pattern. The 2003 NDHS fieldwork was conducted from March to August, which is the rainy season in most areas of Nigeria. Thus, the data collection coincided with the period when mosquito nets are most likely to be used. 144 | Malaria Tables 10.2 and 10.3 show the percentages of children under five years of age, all women age 15-49, and pregnant women who slept under a mosquito net the night before the survey and the percent- age who slept under an ITN, by background characteristics. Six percent of children under five slept under a mosquito net including 1 percent of children who slept under an ITN. Approximately twice as many rural as urban children slept under a mosquito net (7 and 4 percent, respectively). There are marked dif- ferences by region; for example, whereas 9 percent of children in the South South and in the North Cen- tral slept under a net the night preceding the survey, no children in the South West were reported to have slept under a net. Six percent of all women and 5 percent of pregnant women slept under a mosquito net the night before the survey, approximately one-fourth of them under an ITN (Table 10.3). Similar to children, women in rural areas are several times more likely than their urban counterparts to have slept under a net. There are also significant differences by region. Table 10.1 Ownership of mosquito nets Percentage of households with at least one and more than one mosquito net (treated or untreated), and percentage of household that have at least one and more than one insecticide treated net (ITN), by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of households that have: –––––––––––––––––––––––––––––––––––––––––––––––––– Bckground At least More than At least More than Number of characteristic one net one net one ITN1 one ITN1 households ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 5.4 2.7 1.0 0.4 2,598 Rural 15.5 8.7 2.9 1.5 4,627 Region North Central 14.9 9.6 3.9 2.7 1,040 North East 22.1 12.3 1.3 0.8 1,185 North West 13.3 7.8 3.1 1.5 1,911 South East 5.8 2.1 2.4 0.8 690 South South 10.5 4.9 2.0 0.7 1,315 South West 0.5 0.1 0.3 0.0 1,083 Wealth quintile Lowest 23.0 13.9 4.5 3.1 1,413 Second 15.5 8.9 1.3 0.3 1,347 Middle 10.8 5.2 2.4 1.0 1,408 Fourth 8.0 4.1 2.1 1.0 1,446 Highest 3.3 1.6 1.0 0.3 1,611 Total 11.8 6.6 2.2 1.1 7,225 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 An insecticide treated net (ITN) is a permanent net that does not require any treatment, a pretreated net obtained in the past six months, or a net that has been soaked with insecticide in the past six months. Malaria | 145 Table 10.2 Use of mosquito nets by children Percentage of children under five years who slept under a mos- quito net the night before the survey and percentage who slept under an insecticide treated net (ITN), by background characteris- tics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children who slept under a mosquito net the night before the survey ––––––––––––––––– Number Background Any of characteristic net ITN1 children –––––––––––––––––––––––––––––––––––––––––––––––––––– Age <1 6.7 1.3 1,412 1 6.9 1.5 1,078 2 5.2 0.9 1,171 3 6.5 1.4 1,192 4 4.1 0.7 1,008 Sex Male 6.3 1.1 2,986 Female 5.6 1.2 2,875 Residence Urban 3.6 0.6 1,787 Rural 7.0 1.4 4,074 Region North Central 8.9 2.7 854 North East 6.8 0.4 1,349 North West 5.0 1.7 1,965 South East 4.4 1.3 365 South South 8.6 0.5 774 South West 0.0 0.0 554 Total 5.9 1.2 5,861 –––––––––––––––––––––––––––––––––––––––––––––––––––– 1 An insecticide treated net (ITN) is a permanent net that does not require any treatment, a pretreated net obtained in the past six months, or a net that has been soaked with insecticide in the past six months. 146 | Malaria 10.2 ANTIMALARIAL DRUG USE DURING PREGNANCY Pregnant women who carry the malaria parasite may be at risk of serious problems that jeopard- ize their own health, that compromise the health of the foetus, and that increase the likelihood of adverse pregnancy outcomes such as stillbirth, spontaneous abortion, and low birth weight. As a protective meas- ure, in 2001 the Federal Ministry of Health recommended that pregnant women receive IPT using two doses of sulfadoxine-pyrimethamine (SP) during the second and early in the third trimester of pregnancy. In reference to the pregnancy leading to their last live birth, women in the 2003 NDHS were asked whether any antimalarials were taken during the pregnancy and which drug(s) was taken. Table 10.4 presents the percentage of women who had a birth in the last five years preceding the survey who took an antimalarial or other drug during the most recent pregnancy for prevention, and the percentage who received IPT as part of their antenatal care, by background characteristics. Twenty percent of women report that they took an antimalarial during their last pregnancy. An- other 17 percent report that they took an unknown drug, and 4 percent took paracetamol or herbs to pre- vent malaria. Only 1 percent received IPT during an antenatal care visit. Among women who took an antimalarial for prevention during pregnancy, there are significant differentials by background characteristics. Urban women are more than twice as likely as rural women to have taken an antimalarial. By region, prevalence ranges from a low of 8 percent in the North East to a high of 32 percent in the South East. Table 10.3 Use of mosquito nets by pregnant women Percentage of all women and pregnant women age 15-49 who slept under a mosquito net (treated or untreated) the night before the survey, and the percentage who slept under an insecticide treated net (ITN), by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of Percentage of women who pregnant women slept under a who slept under mosquito net a mosquito net the night before the night before the survey the survey Number –––––––––––––– Number –––––––––––––– of Background Any of Any pregnant characteristic net ITN1 women net ITN1 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 2.6 0.5 2,801 3.2 0.4 254 Rural 7.1 1.8 5,340 6.2 1.6 629 Region North Central 8.2 2.6 1,207 9.2 1.6 108 North East 8.4 0.5 1,468 8.4 1.7 197 North West 5.0 2.1 2,235 4.0 1.1 352 South East 2.9 1.4 774 2.0 1.5 51 South South 6.6 1.0 1,434 5.0 1.5 115 South West 0.3 0.1 1,023 0.0 0.0 60 Total 5.6 1.4 8,141 5.4 1.3 883 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 An insecticide treated net (ITN) is a permanent net that does not require any treatment, a pretreated net obtained in the past six months, or a net that has been soaked with insecticide in the past six months. Malaria | 147 Table 10.5 shows the different antimalarial drugs that were taken by the 20 percent of pregnant women who reported preventive use of antimalarials. More than half (58 percent) of these women used Daraprim/Metaprim, which has been found to be ineffective as a chemoprophylaxis during pregnancy (FMOH, 2001). Additionally, 39 percent used chloroquine, which was the chemoprophylactic drug of choice until the introduction of IPT in 2001. Although it is only two years since the introduction of the new IPT recommendation, it is worthy of note that 12 percent of the women who took an antimalarial for prevention used SP/Fansidar. Other antimalarials, Halfan and Amodiaquine, were used by 2 and 1 percent of women, respectively. A larger percentage of urban women than rural women used each of the drugs with the exception of chloroquine. More than 4 in 10 women in all regions use Daraprim/Metaprim. Use of Daraprim/Metaprim is highest in the North West, North East, and South South (74, 63, and 51 percent, respectively). Table 10.4 Use of intermittent preventive treatment (IPT) by pregnant women For the last birth in the five years preceding the survey, percentage for which the mother took antimalarial drugs for prevention during the pregnancy and percentage for which the mother got intermittent preventive treatment (IPT) during an antenatal visit, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who: –––––––––––––––––––––––––––––––––––––––––––––––––– Took anti- Took malarial for Took Paracetamol Number prevention unknown or herbs Received of Bckground during last drug during during last IPT1 during pregnant characteristic pregnancy last pregnancy pregnancy ANC visit women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 34.0 19.3 5.7 2.0 1,144 Rural 14.8 15.7 3.4 0.6 2,766 Region North Central 17.1 19.2 5.3 0.7 575 North East 7.9 19.8 5.1 0.9 862 North West 21.4 4.0 0.8 1.2 1,341 South East 31.9 32.9 2.6 0.2 222 South South 29.2 30.4 3.6 1.3 544 South West 31.4 22.2 13.3 1.1 367 Total 20.4 16.7 4.1 1.0 3,911 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Intermittent preventive treatment is preventive treatment with sulfadoxine-pyrimethamine (SP/Fansidar) during an antenatal visit. 148 | Malaria 10.3 TREATMENT OF CHILDREN WITH FEVER OR CONVULSIONS Since the major manifestations of malaria are fever and convulsions or fits, mothers were asked whether their children under age five had had a fever, convulsions, or fit in the two weeks preceding the survey. If reported, the mother was asked if the child was given any drugs. Table 10.6 shows that 32 percent of children under age five had a fever and/or convulsions in the two weeks preceding the survey. Among those sick with fever/convulsions, one-third took antimalarial drugs, and one-quarter received the drugs the same day as the onset of the fever/convulsions or the fol- lowing day. There are striking differences in both morbidity and treatment by region. Children in the North East and North West were the most likely to have been ill during the two weeks preceding the sur- vey (39 and 36 percent, respectively), while children in the South West were the least likely (18 percent). Although children in the South West were least likely to be sick, they were most likely to have received an antimalarial in response to their symptoms. Forty-three percent of sick children in the South West took an antimalarial compared with 27 percent in the North East, one of the regions with the highest levels of morbidity, and just 15 percent in the South East. Table 10.5 Use of specific drugs for Intermittent Preventive Treatment (IPT) For mothers who took antimalarial drugs for prevention during the last pregnancy leading to a live birth in the five years preceding the survey, percentage who took a specific drug, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number Percentage of women who took: of women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– who took Bckground Daraprim/ antimalarial characteristic SP/Fansidar Chloroquine Halfan Metaprim Amodiaquine drug –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 14.1 31.6 3.1 63.5 1.2 390 Rural 9.1 46.4 1.4 51.7 0.4 408 Region North Central 6.8 55.1 1.8 40.1 0.0 99 North East 17.7 25.5 0.0 63.1 0.0 68 North West 15.3 26.1 2.6 74.1 0.8 286 South East 13.3 36.6 8.1 41.9 0.5 71 South South 6.7 46.6 1.8 51.4 0.9 159 South West 8.3 58.0 0.0 45.6 2.1 115 Total 11.6 39.2 2.2 57.5 0.8 798 Malaria | 149 Table 10.7 presents the percentage of children under five who took antimalarial drugs for fever and/or convulsions in the two weeks preceding the survey, by background characteristics. Ninety-seven percent took the first line drug, chloroquine, 1 percent took the second line drug, Fansidar/SP, and 4 per- cent took other antimalarials. The data show that children of all age groups received the antimalarials, indicating that equal care is given to children of all ages under five. Almost three-quarters of children re- ceived the antimalarial the same day as the onset of symptoms or the next day. Promptness of treatment varies significantly by region. Table 10.6 Prevalence and prompt treatment of fever/convulsions Percentage of children under age five with fever and/or convulsions in the two weeks preceding the survey, and among children with fever and/or convulsions, percentage who took antimalarial drugs and who took the drugs the same/next day, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among children with fever and/or convulsions, percentage who: –––––––––––––––––––––––– Number Percentage Took of of children Number Took antimalarial children Bckground with fever/ of antimalarial drugs same/ with fever/ characteristic convulsions children drugs next day convulsions ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age <1 33.4 1,331 29.3 19.5 445 1 40.0 999 36.3 23.8 399 2 34.0 1,050 41.7 32.3 356 3 27.4 1,067 32.3 25.3 292 4 21.9 899 27.1 23.2 196 Sex Male 31.6 2,717 32.5 22.9 858 Female 31.6 2,628 35.2 26.4 832 Residence Urban 27.8 1,620 38.5 30.1 450 Rural 33.3 3,726 32.2 22.7 1,239 Region North Central 24.2 781 32.2 23.6 189 North East 38.5 1,225 27.0 17.9 471 North West 36.0 1,818 39.6 31.7 654 South East 23.6 347 14.8 13.6 82 South South 30.0 684 36.2 18.8 206 South West 18.0 489 43.2 34.6 88 Total 31.6 5,345 33.9 24.6 1,689 150 | Malaria Table 10.7 Type and timing of antimalarial drugs Among children under age five who took antimalarial drugs for fever and/or convulsions in the two weeks preceding the survey, percentage who took first-line drug, second-line drug, or other antimalarial drugs and percentage who took each type of drug the same/next day afer developing fever and/or convulsions, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who took: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number Other of children First-line Second-line antimalarial who took Background First-line drug same/ Second- drug same/ Other drug same/ antimalarial characteristic drug next day line drug next day antimalarial next day drugs ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in years <1 98.4 66.0 0.4 0.0 1.6 0.5 130 1 95.7 63.2 2.0 0.0 5.8 3.3 145 2 96.7 75.2 1.5 1.0 5.9 3.1 149 3 98.7 77.0 1.0 1.0 1.3 1.3 95 4 94.7 81.2 1.0 0.0 4.3 4.3 53 Sex Male 97.2 68.8 1.2 0.0 3.1 2.0 279 Female 96.8 73.0 1.3 0.8 4.8 2.8 293 Residence Urban 97.8 76.5 1.5 0.4 3.9 3.2 173 Rural 96.6 68.5 1.1 0.4 4.0 2.0 399 Region North Central 94.3 68.5 1.3 1.3 4.5 3.5 61 North East 96.4 63.1 0.4 0.0 4.0 3.0 127 North West 99.4 79.2 0.7 0.7 3.5 2.2 259 South East (91.7) (83.3) (0.0) (0.0) (8.3) (8.3) 12 South South 92.9 50.6 4.8 0.0 5.7 1.2 75 South West (96.7) (80.2) (1.3) (0.0) (1.9) (0.0) 38 Total 97.0 70.9 1.2 0.4 4.0 2.4 572 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: According to national policy, chloroquine is the first-line drug and SP/Fansidar is the second-line drug. Figures in parentheses are based on 25-49 unweighted cases. Infant Feeding and Children’s and Women’s Nutritional Status | 151 INFANT FEEDING AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS 11 Nutritional deficiencies have been found to contribute to the high rates of disability, morbidity, and mortality in Nigeria, especially among infants and young children (NPC and UNICEF, 2001). Thus, the importance of adequate nutrition for women and children cannot be overemphasized and remains a great concern in the country. The 2003 Nigeria Demographic and Health Survey (NDHS) collected data on various factors re- lated to the nutrition of women and children. This chapter examines infant feeding practices, including duration of breastfeeding, use of a feeding bottle with a nipple, introduction of complementary foods, and the intake of micronutrients, such as vitamin A, iron supplements, and iodized salt. The nutritional status of all children under age five and all women age 15-49 is analyzed using anthropometric indices (height and weight measures). 11.1 BREASTFEEDING Initiation of breastfeeding at birth is crucial for the health of both child and mother. Suckling at the breast immediately after birth aids the expulsion of the placenta and reduces the risk of postpartum haemorrhage in the mother, helps maintain the body temperature of the baby, and encourages bonding between the mother and child, which enhances their physical and psychological well-being. Breast milk, a good source of nutrients and natural immunity for infants, is sufficient for new- borns; they need not be given anything else to eat or drink besides breast milk. Giving the newborn the first breast milk, which contains colostrum, and exclusive breastfeeding during the first six months of a child’s life are recommended because they protect the infant from disease agents as well as provide all required nutrients. Table 11.1 shows the percentage of children who were ever breastfed, and among children ever breastfed, the proportion who started breastfeeding within one hour and within one day of birth, and those who received a prelacteal feed. Breastfeeding is almost universal in Nigeria, with 97 percent of children born in the five years preceding the survey having been breastfed. However, just one-third of children were given breast milk within one hour of birth (32 percent), and less than two-thirds were given breast milk within 24 hours of birth (63 percent), indicating a delay in the initiation of breastfeeding. Initiation of breastfeeding in the first hour and in the first 24 hours after birth varies by back- ground characteristics. Women who delivered in a health facility and those assisted at delivery by health professionals are more likely to initiate breastfeeding early (within 1 hour or within 24 hours of delivery). There is considerable variation by region, ranging from a low of 13 percent of women in the South West initiating breastfeeding within one hour of giving birth to a high of 58 percent of women in the South East. Only about half of women in the North West and North East start breastfeeding within the first day (48 and 55 percent, respectively), compared with more than seven in ten women in other regions. Fur- thermore, women with the least education and women in households that are in the lowest quintile of the wealth index initiate breastfeeding later than those with at least some education and those living in house- holds that are ranked higher on the wealth index. 152 | Infant Feeding and Children’s and Women’s Nutritional Status Table 11.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and among children ever breastfed, the percentage who started breastfeeding within one hour and within one day of birth, and percentage who received a prelacteal feed, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Among all children: Among children ever breastfed, percentage who: ––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––– Started Started Number of Percentage Number breastfeeding breastfeeding Received a children Background ever of within 1 hour within 1 day prelacteal ever characteristic breastfed children of birth of birth1 feed2 breastfed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 97.0 3,186 30.9 61.2 69.7 3,090 Female 97.7 3,033 32.9 64.4 67.2 2,965 Residence Urban 97.6 1,795 34.7 73.6 63.5 1,752 Rural 97.3 4,424 30.8 58.4 70.5 4,303 Region North Central 97.9 897 46.6 83.5 39.8 878 North East 96.3 1,472 25.9 54.6 83.2 1,418 North West 98.1 2,161 27.1 48.3 78.7 2,121 South East 97.1 371 57.5 81.9 53.6 360 South South 96.8 789 40.3 77.9 49.0 763 South West 97.4 529 12.7 73.4 74.2 515 Mother's education No education 97.9 3,224 27.0 50.7 78.4 3,156 Primary 96.7 1,465 35.9 72.2 63.4 1,417 Secondary 97.0 1,316 35.9 78.0 54.4 1,277 Higher 95.8 215 53.9 88.5 39.6 206 Assistance at delivery Health professional3 96.9 2,253 40.0 79.7 55.8 2,182 Traditional birth attendant 97.8 1,268 29.9 49.8 77.5 1,240 Other 97.4 1,593 26.0 57.4 74.7 1,552 No one 97.6 1,051 27.0 52.5 77.5 1,027 Place of delivery Health facility 97.1 2,025 40.3 80.9 55.2 1,967 At home 97.4 4,129 28.1 54.3 75.9 4,024 Other (100.0) 22 (29.1) (80.0) (38.3) 22 Wealth quintile Lowest 97.7 1,394 22.4 46.8 77.8 1,363 Second 96.7 1,379 30.6 54.6 72.9 1,334 Middle 96.7 1,255 36.8 65.5 67.2 1,214 Fourth 97.7 1,157 35.4 75.8 64.4 1,131 Highest 98.2 1,033 36.5 77.2 56.2 1,014 Total 97.4 6,219 31.9 62.8 68.5 6,055 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on all births in the past five years whether the children were living or dead at the time of inter- view. Total includes 54 and 43 children with data missing on assistance at delivery and place of delivery, respectively. Figures in parentheses are based on 25-49 unweighted cases. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life before the mother started breast- feeding regularly 3 Doctor, nurse/midwife, or auxiliary midwife, or CHEW Infant Feeding and Children’s and Women’s Nutritional Status | 153 The practice of giving something other than breast milk in the first three days of life (prelacteal feeding) is discouraged because it limits the frequency of suckling by the infant and exposes the baby to infections. Prelacteal feeding is widely practiced in Nigeria. Approximately seven in ten newborns re- ceive a prelacteal feed. There are differences in prelacteal feeding practices by region, level of education, place of delivery, assistance at delivery, and wealth quintile. The practice is more common among women with little or no education and those living in households in the lowest wealth quintile than among women with higher education and those in households in the highest wealth quintile. In addition, women who received delivery assistance from a health professional and those who delivered in a health facility are less likely to give prelacteal feeds than those who delivered at home or without the assistance of a trained medical professional. These differentials may be due in part to the Baby-Friendly Hospital Initiative, which promotes exclusive breastfeeding and policies that support breastfeeding in hospitals. 11.1.1 Age Pattern of Breastfeeding UNICEF and WHO recommend that children be exclusively breastfed (receive only breast milk) during the first six months of life and that children be given solid and/or semisolid complementary food starting at age six months (WHO and UNICEF, 1998). Children require adequate complementary foods to follow normal growth patterns. Lack of complementary foods (given at the appropriate age) may lead to malnutrition, frequent illness, and even death. However, even after complementary foods have been in- troduced, UNICEF recommends that breastfeeding continue for at least the first two years of the child’s life (NPC and UNICEF, 2001). Table 11.2 shows the percent distribution of youngest children under age three living with the mother, by breastfeeding status, according to age. In Nigeria, exclusive breastfeeding of infants is not practiced in compliance with the WHO/UNICEF recommendations. The data show that only 17 percent of infants below six months are exclusively breastfed. Indeed, just one-quarter of infants under two months of age are exclusively breastfed. Among children 4-5 months of age, fewer than one in ten is ex- clusively breastfed. This is a result of early supplementation of breast milk with plain water. Almost half (48 percent) of newborns under two months of age receive plain water as well as breast milk. An addi- tional 19 percent receive other milk or liquids. Complementary feeding also starts early. Among children age 4-5 months, more than one-third (36 percent) receive complementary food in addition to breast milk (Table 11.2). Although complemen- tary feeding is introduced early in Nigeria, not all children are in compliance with UNICEF’s recommen- dation of introducing semisolid and/or solid complementary food at six months of age. One in four chil- dren age 6-9 months is either exclusively breastfed or receives breast milk and plain water only. Regard- ing the duration of any breastfeeding, two-thirds of children age 20-23 months have discontinued breast- feeding. The use of a bottle with a nipple regardless of the content (formula or other liquid) requires atten- tion in terms of hygiene and handling. Because of inadequate and insufficient cleaning and ease of con- tamination after cleaning, the nipple may house disease-causing agents. Bottle-feeding is common in Ni- geria, even among children who should be exclusively breastfed; 23 percent of children under two months and one-quarter of children age 2-3 months drink from a bottle with a nipple. 154 | Infant Feeding and Children’s and Women’s Nutritional Status 11.1.2 Duration and Frequency of Breastfeeding Table 11.3 shows the median duration of any breastfeeding, exclusive breastfeeding, and pre- dominant breastfeeding among children born in the three years preceding the survey. The percentages of breastfeeding children under six months who were breastfed at least six times in the 24 hours preceding the survey and mean number of daytime and nighttime feeds, by background characteristics, are also pre- sented. At the national level, the median duration of any breastfeeding among children born in the three years preceding the survey is 18.6 months (Figure 11.1). The median duration of exclusive breastfeeding is half a month, while the median duration of predominant feeding is 4.6 months (Table 11.3). Predomi- nate breastfeeding refers to either exclusive breastfeeding or receiving plain water, water-based liquids, and/or juice in addition to breast milk. Table 11.2 Breastfeeding status by child’s age Percent distribution of youngest children under three years living with the mother by breastfeeding status and percentage of children under three years using a bottle with a nipple, according to age in months, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Breastfeeding and consuming: –––––––––––––––––––––––––––––––– Exclu- Water- Using Number Not sively Plain based Comple- Number a bottle of breast- breast- water liquids/ Other mentary of with a living Age in months feeding fed only juice milk foods Total children nipple1 children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <2 4.0 26.2 47.5 8.9 8.6 4.7 100.0 182 22.5 183 2-3 0.9 19.3 49.2 6.5 14.1 10.0 100.0 230 25.1 231 4-5 0.6 8.7 38.1 9.9 7.1 35.6 100.0 247 17.6 250 6-7 1.3 3.9 26.5 4.4 7.3 56.6 100.0 230 14.4 239 8-9 1.2 1.6 17.8 1.6 6.9 70.8 100.0 231 16.3 240 10-11 4.5 2.6 10.1 2.3 0.2 80.4 100.0 184 14.7 189 12-15 10.1 3.8 3.9 0.6 1.3 80.2 100.0 387 10.4 403 16-19 33.7 2.1 2.3 1.6 0.4 59.9 100.0 313 6.3 323 20-23 65.9 0.9 0.4 0.9 0.0 31.9 100.0 248 8.3 272 24-27 90.9 0.3 0.0 0.0 0.0 8.8 100.0 361 12.6 441 28-31 90.5 0.0 0.3 0.0 0.0 9.1 100.0 210 5.0 303 32-35 94.8 0.0 0.5 0.0 0.0 4.7 100.0 154 3.2 305 <6 1.7 17.2 44.6 8.4 10.0 18.1 100.0 659 21.6 663 6-9 1.3 2.8 22.1 3.0 7.1 63.7 100.0 460 15.3 478 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children classified as breastfeeding and consum- ing plain water only consume no supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding, and consuming plain water, water-based liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and water-based liquids and who do not receive complementary foods are classified in the water-based liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years Infant Feeding and Children’s and Women’s Nutritional Status | 155 There is little variation in exclusive breastfeeding: women of all backgrounds exclusively breast- feed for a median of less than one month, with the exception of women with higher education who exclu- sively breastfeed for 2.5 months. The median duration of any breastfeeding varies by region, education, and household economic status. The results of the 2003 NDHS confirm the findings of the 1999 NDHS, which followed a similar pattern. Table 11.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by background charac- teristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median duration (months) of breastfeeding1 Breastfeeding children under six months2 ––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––– Predo- Percentage Mean Mean Any Exclusive minant Number breastfed 6+ number number Number Background breast- breast- breast- of times in last of day night of characteristic feeding feeding feeding3 children 24 hours feeds feeds children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 18.6 0.5 4.7 1,947 96.5 7.8 6.0 326 Female 18.6 0.5 4.4 1,867 98.2 7.5 5.6 306 Residence Urban 17.2 0.5 3.8 1,137 96.7 8.0 6.5 179 Rural 19.2 0.5 4.8 2,677 97.5 7.5 5.5 453 Region North Central 19.0 0.7 3.8 553 97.6 7.8 5.3 85 North East 20.5 0.4 6.6 875 99.2 7.7 6.0 143 North West 19.9 0.4 5.4 1,310 96.5 7.8 4.9 220 South East 13.3 0.4 0.5 245 97.7 6.8 7.8 33 South South 15.8 0.6 2.9 503 97.8 7.7 6.6 82 South West 15.9 0.7 3.4 328 94.5 7.4 6.7 68 Mother's education No education 20.0 0.4 5.5 1,893 97.7 8.0 5.6 315 Primary 18.4 0.5 3.7 901 97.6 7.7 6.3 145 Secondary 16.9 0.6 3.3 887 95.9 6.8 5.8 157 Higher 15.7 2.5 4.7 134 100.0 8.6 5.2 15 Wealth quintile Lowest 20.2 0.5 5.4 811 96.0 8.4 5.7 135 Second 20.0 0.4 4.9 831 97.0 7.5 5.5 133 Middle 19.1 0.5 3.6 758 96.8 7.3 5.2 105 Fourth 18.4 0.7 4.4 736 99.5 7.7 5.9 135 Highest 14.3 0.5 3.7 679 96.9 7.3 6.4 123 Total 18.6 0.5 4.6 3,815 97.3 7.7 5.8 632 Mean for all children 18.2 2.0 6.3 na na na na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Median and mean durations are based on current status. na = Not applicable 1 It is assumed that non-last-born children or last-born child not living with the mother are not currently breastfeeding. 2 Excludes children who do not have a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, water-based liquids, and/or juice only (excludes other milk) 156 | Infant Feeding and Children’s and Women’s Nutritional Status Mothers were asked about the frequency of breastfeeding among children under six months of age in the preceding 24 hours. Table 11.3 shows that almost all children under six months of age are breastfed at least six times per day in Nigeria, which meets the international recommendation (NPC and UNICEF, 2001). The mean number of feeds is eight in the daytime and six at night. 11.2 TYPES OF FOOD CONSUMED BY CHILDREN Table 11.4 shows the percentage of youngest children under three years of age living with the mother who consumed specific foods during the day or night preceding interview. The table shows that 13 percent of breastfeeding infants under six months of age consume infant formula, 11 percent consume milk or other dairy products, and 18 percent consume other liquids. Breastfeeding children under six months also commonly eat food made from grains (15 percent). At age 6-9 months, when complementary foods should be introduced, three-quarters of breastfeeding infants receive solid or semisolid foods; 56 percent receive food made from grains; 25 percent receive meat, fish, shellfish, poultry, or eggs; and 24 percent receive fruits or vegetables. Fruits and vegetables rich in vitamin A are consumed by one-fifth of breastfeeding infants 6-9 months old. At almost one year of age (10-11 months), a higher proportion of breastfeeding children receive these complementary foods. By 20-23 months of age, three in ten breastfeeding children receive other milk products, nine in ten eat foods made from grains, six in ten receive fruits and vegetables, and the same proportion gets eggs and animal products. Less than half receive food with oil or butter added. 18.6 18.6 17.2 19.2 19 20.5 19.9 13.3 15.8 15.9 20 18.4 16.9 15.7 18.6 SEX Male Female RESIDENCE Urban Rural REGION North Central North East North West South East South South South West MOTHER'S EDUCATION No education Primary Secondary Higher Total 0 5 10 15 20 25 30 Figure 11.1 Median Duration of Breastfeeding by Background Characteristics NDHS 2003 .0 .0 Infant Feeding and Children’s and Women’s Nutritional Status | 157 As previously shown in Table 11.2, few children under age 16 months are not breastfed in Nige- ria. Table 11.4 shows that among those who are not breastfed by age 20-23 months, the proportion receiv- ing milk products is almost the same as among children who are breastfeeding and receiving other milk products. There are only slight differences between breastfeeding and nonbreastfeeding children receiving food made from grains, but the proportion of children receiving other complementary foods is higher among the latter group of children. Table 11.5 presents the frequency of consumption of specific foods by children less than three years of age in the day or night preceding the interview. Among breastfeeding children age 6-9 months, who should be receiving complementary foods, grains are consumed slightly more than once a day. All other foods are consumed less than once a day. Beginning at age two, grains are received twice a day, as are fruits and vegetables. The frequency of foods consumed by nonbreastfeeding children is similar to that of breastfeeding children. Table 11.4 Foods consumed by children in the day or night preceding the interview Percentage of children under three years of age living with the mother who consumed specific foods in the day or night preced- ing the interview, by breastfeeding status and age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Solid/semisolid foods ––––––––––––––––––––––––––––––––––––––––––– Any Food Meat/ Food Fruits and solid Other Food made Food fish/ made vegetables or milk/ made Fruits/ from made shellfish/ with rich in semi- Number Child’s age Infant cheese/ Other from vege- roots/ from poultry/ oil/fat/ vitamin solid of in months formula yogurt liquids1 grains tables2 tubers legumes eggs butter A3 food children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– BREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <2 5.5 7.2 11.9 4.2 2.0 1.7 1.3 0.3 1.8 2.0 11.6 175 2-3 14.6 7.3 14.5 8.9 2.0 0.8 0.9 1.2 1.9 2.0 15.2 227 4-5 15.7 16.5 25.1 27.1 15.1 6.5 6.3 10.3 7.3 13.5 50.2 246 6-7 11.3 15.6 25.5 49.6 17.6 8.5 13.4 16.6 18.7 14.2 69.1 227 8-9 14.1 21.7 25.5 61.5 30.8 10.4 14.1 32.8 27.3 26.0 83.0 228 10-11 12.3 26.4 30.6 78.3 41.3 26.9 27.5 47.0 33.0 39.4 89.3 176 12-15 10.6 30.8 36.1 83.6 57.6 26.7 29.3 55.2 45.0 52.9 96.4 348 16-19 6.0 26.5 36.5 81.4 64.2 27.2 32.5 58.2 42.6 56.6 96.2 208 20-23 8.5 30.3 36.7 89.3 59.6 26.9 30.1 56.6 45.6 53.6 98.8 85 24-35 16.0 30.5 47.1 89.5 73.1 35.0 31.3 55.3 37.6 73.1 98.9 61 <6 12.6 10.7 17.8 14.5 6.9 3.2 3.1 4.4 3.9 6.3 27.5 648 6-9 12.7 18.7 25.5 55.6 24.2 9.5 13.8 24.7 23.1 20.1 76.1 455 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– NONBREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 16-19 11.0 37.4 57.3 83.7 78.2 37.7 35.6 79.4 40.1 72.0 99.5 105 20-23 3.7 32.5 40.5 86.5 74.8 46.2 39.6 73.0 50.3 66.9 99.6 163 24-35 9.5 40.1 51.6 88.2 75.8 40.7 36.6 71.3 57.0 71.7 99.6 664 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status and food consumed refer to a 24-hour recall period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitamin A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A 158 | Infant Feeding and Children’s and Women’s Nutritional Status Table 11.6 shows the average number of days specific foods were consumed by youngest chil- dren under age three in the seven days preceding the survey. Among breastfeeding children, less than age six months, plain water is consumed about six days a week. Food from grains is given one day a week. All other types of food or drink were given less than one day a week. Breastfeeding children age 6-9 months drank plain water daily in the week preceding the interview. They consumed food made from grains almost four days a week. Meat, fish, shellfish, poultry or eggs were consumed less than two days a week, as were foods made with oil, fat, or butter. The mean number of days that various nutritious foods are consumed by children who are no longer breastfeeding should be higher than for children who are breastfeeding. Among children 16 months and older, most semisolid or solid foods and fruits and vegetables rich in vitamin A are consumed with greater frequency among nonbreastfeeding than breastfeeding children. Table 11.5 Frequency of foods consumed by children in the day or night preceding the interview Mean number of times specific foods were consumed in the day or night preceding the interview by youngest children under three years of age living with the mother, according to breastfeeding status and age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Solid/semisolid foods –––––––––––––––––––––––––––––––––––––––––––––––––––––– Food Meat/ Food Fruits and Other Food made Food fish/ made vegetables milk/ made Fruits/ from made shellfish/ with rich in Number Child’s age Infant cheese/ Other from vege- roots/ from poultry oil/fat/ vitamin of in months formula yogurt liquids1 grains tables2 tubers legumes eggs butter A3 children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– BREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <2 0.1 0.2 0.2 0.1 0.1 0.0 0.0 0.0 0.0 0.0 175 2-3 0.4 0.1 0.2 0.2 0.1 0.0 0.0 0.0 0.0 0.1 227 4-5 0.3 0.3 0.5 0.6 0.5 0.1 0.1 0.2 0.2 0.4 246 6-7 0.3 0.3 0.5 1.0 0.4 0.1 0.2 0.2 0.3 0.3 227 8-9 0.3 0.4 0.6 1.2 0.7 0.1 0.2 0.5 0.5 0.5 228 10-11 0.3 0.5 0.6 1.7 1.0 0.4 0.3 0.8 0.6 0.8 176 12-15 0.2 0.6 0.8 1.7 1.4 0.4 0.4 0.9 0.7 1.1 348 16-19 0.1 0.5 0.8 1.8 1.6 0.4 0.4 1.0 0.7 1.1 208 20-23 0.2 0.6 0.7 2.0 1.3 0.4 0.4 0.8 0.7 1.0 85 24-35 0.3 0.4 0.7 2.1 2.3 0.4 0.4 0.7 0.6 1.8 61 <6 0.3 0.2 0.3 0.3 0.2 0.1 0.0 0.1 0.1 0.2 648 6-9 0.3 0.4 0.5 1.1 0.6 0.1 0.2 0.4 0.4 0.4 455 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– NONBREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 16-19 0.2 0.7 1.3 1.6 2.0 0.7 0.4 1.5 0.8 1.5 105 20-23 0.1 0.5 0.9 1.9 2.1 0.7 0.5 1.3 1.1 1.5 163 24-35 0.2 0.7 1.1 1.9 2.1 0.5 0.4 1.2 1.0 1.6 664 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status and food consumed refer to a 24-hour recall period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitamin A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papa- yas, and other locally grown fruits and vegetables that are rich in vitamin A Infant Feeding and Children’s and Women’s Nutritional Status | 159 11.3 MICRONUTRIENT SUPPLEMENTATION Micronutrients are necessary for normal body function and play a vital role in ensuring good health. Children can receive micronutrients from foods, food fortification, and direct supplementation. Deficiency of these elements contributes to childhood morbidity and mortality. The 2003 NDHS collected various data useful for assessing the intake of micronutrients by women and young children. 11.3.1 Use of Iodized Salt in Households Disorders induced by dietary iodine deficiency constitute a major global nutrition concern. A lack of sufficient iodine can lead to goiter, hypothyroidism, impaired mental and physical development, and diminished school performance. Iodine deficiency in the feotus leads to increased rates of abortion, still- births, congenital anomalies, cretinism, psychomotor defects, and neonatal mortality. Iodine deficiency can be avoided by using salt that has been fortified with iodine (iodized salt). Fortified salt, which con- tains 15 parts per million of iodine, prevents iodine deficiency. Table 11.6 Frequency of foods consumed by children in preceding seven days Mean number of days specific foods were consumed in the seven days preceding the interview by youngest children under three years of age living with the mother, according to breastfeeding status and age, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Solid/semisolid foods ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Fruit and vegetables rich in vitamin A ––––––––––––––––––––––––– Fruits Pumpkin/ Mango/ and red or papaya/ vege- Food yellow other Food tables Meat/ made yams or local Liquids Food made not Food fish/ with squash/ Green fruits –––––––––––––––––––––––––––––––––––––––– made from rich in made shellfish/ oil/ carrots/ leafy rich in Number Child’s age Plain Infant Other Fruit Herbal Other from roots/ vitamin form Cheese/ poultry/ fat/ red sweet vege- vitamin of in months water formula milk juice tea liquids grains tubers A legumes yogurt eggs butter potatoes tables A children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– BREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <2 5.0 0.4 0.5 0.1 0.8 0.1 0.3 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.0 0.0 175 2-3 5.7 1.0 0.4 0.0 0.6 0.2 0.6 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 227 4-5 6.4 1.0 0.8 0.2 0.9 0.6 1.9 0.3 0.2 0.3 0.2 0.5 0.4 0.3 0.4 0.3 246 6-7 6.7 0.8 0.7 0.3 0.7 0.6 3.2 0.4 0.4 0.6 0.2 1.0 1.1 0.2 0.6 0.3 227 8-9 6.8 0.9 0.8 0.5 0.8 1.0 4.1 0.6 0.8 1.1 0.4 1.7 1.6 0.4 0.9 0.6 228 10-11 6.8 0.8 1.1 0.4 0.9 1.0 5.3 1.3 1.1 1.3 0.6 2.7 2.1 0.7 1.7 0.8 176 12-15 6.8 0.5 0.7 0.6 0.7 1.4 5.6 1.3 1.2 1.4 1.0 3.0 2.6 1.1 1.5 1.4 348 16-19 6.8 0.3 0.8 0.5 0.8 1.7 5.6 1.4 1.5 1.6 1.0 3.3 2.7 1.2 1.9 1.7 208 20-23 6.8 0.6 0.7 0.6 0.8 1.4 6.0 1.3 1.1 1.7 0.9 2.8 2.7 0.7 2.0 1.2 85 24-35 6.8 0.7 0.9 0.6 0.9 1.9 6.6 1.3 1.3 1.3 1.1 3.1 2.4 0.8 2.6 2.1 61 <6 5.8 0.8 0.6 0.1 0.8 0.3 1.0 0.1 0.1 0.1 0.1 0.2 0.2 0.2 0.2 0.1 648 6-9 6.8 0.9 0.8 0.4 0.8 0.8 3.7 0.5 0.6 0.8 0.3 1.4 1.4 0.3 0.7 0.5 455 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– NONBREASTFEEDING CHILDREN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 16-19 6.4 0.9 1.7 0.8 0.9 2.7 5.2 2.2 2.1 1.8 0.9 4.9 2.3 1.8 2.4 1.7 105 20-23 6.7 0.2 1.1 1.0 0.7 1.9 5.4 2.3 1.9 2.2 0.6 4.4 3.0 1.5 2.4 1.9 163 24-35 6.6 0.5 1.3 0.9 0.7 2.5 5.9 2.1 2.0 1.8 1.2 4.1 3.5 1.4 2.7 2.1 664 Total 6.6 0.5 1.3 0.9 0.7 2.4 5.6 2.1 2.0 1.9 1.0 4.2 3.3 1.5 2.6 2.0 997 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Breastfeeding status refers to a 24-hour recall period (yesterday and last night). 160 | Infant Feeding and Children’s and Women’s Nutritional Status The survey undertook a rapid test, using a test kit supplied by UNICEF, to assess whether the household was using iodized salt for cooking. The data presented in Table 11.7 are based on the 94 per- cent of households where salt was tested. Almost all households in Nigeria use adequately iodized salt (97 percent). The region with the lowest prevalence of adequately iodized salt is North Central (93 per- cent). 11.3.2 Micronutrient Status of Young Children Vitamin A is a micronutrient that is essential for the proper development of children’s immune and visual systems. It is present in certain fruits and vegetables, such as pumpkin, red or yellow yams or squash, carrots, green leafy vegetables, mango, and paw-paw. Women in Nigeria should receive vitamin A supplements after childbirth. This enhances the micronutrient status of the mothers and their breast- feeding children and, consequently, the survival status of the child. Table 11.8 shows the percentage of the youngest children under three years of age who consumed fruits and vegetables rich in vitamin A in the seven days preceding the survey. The data show that 43 per- cent of children ate such foods. The consumption of fruits and vegetables rich in vitamin A varies consid- erably by the age of the child and breastfeeding status. Although children under six months are recom- mended to receive no complementary foods, 6 percent received fruits and vegetables rich in vitamin A. The proportion increases from 21 percent among children age 6-9 months to 72 percent among children age 24-35 months. Nonbreastfeeding children are more than twice as likely to consume fruits and vegeta- bles rich in vitamin A as breastfeeding children. This is expected since nonbreastfeeding children are older and should receive more complementary foods than the younger breastfeeding children. The con- sumption of fruits and vegetables rich in vitamin A is lowest in North Central (29 percent) and highest in South East (56 percent). Table 11.7 Iodization of household salt Percent distribution of households by level of iodine in salt (parts per million), according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Level of iodine in household salt: Percentage Percentage –––––––––––––––––––––––––––––––––– Number of of house- of Background None Inadequate Adequate households holds households Number of characteristic (0 ppm) (<15 ppm) (15+ ppm) Total tested tested with no salt households ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 0.9 0.6 98.5 100.0 2,398 92.3 5.3 2,598 Rural 2.2 1.2 96.7 100.0 4,354 94.1 2.9 4,627 Region North Central 5.7 1.6 92.7 100.0 966 92.9 4.4 1,040 North East 0.9 0.3 98.8 100.0 1,095 92.4 5.2 1,185 North West 0.7 1.1 98.2 100.0 1,758 92.0 3.1 1,911 South East 2.6 0.4 97.0 100.0 640 92.6 3.3 690 South South 1.0 1.0 98.0 100.0 1,261 95.9 3.4 1,315 South West 0.9 1.1 98.0 100.0 1,032 95.3 3.4 1,083 Total 1.7 1.0 97.3 100.0 6,752 93.5 3.8 7,225 Infant Feeding and Children’s and Women’s Nutritional Status | 161 Table 11.8 Micronutrient intake among children Percentage of youngest children under age three living with the mother who consumed fruits and vegetables rich in vitamin A in the seven days preceding the survey, and percent- age of children age 6-59 months who received vitamin A supplements in the six months preceding the survey, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Children under age three living with the mother Children age 6-59 months –––––––––––––––––––––– ––––––––––––––––––––– Percentage who Percentage consumed who fruits and Number received Number Background vegetables rich of vitamin A of characteristic in vitamin A1 children supplements children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 6.4 659 na na 6-9 20.8 460 30.8 478 10-11 40.1 184 32.6 189 12-23 58.7 949 31.2 999 24-35 71.8 724 40.0 1,050 36-47 na na 31.2 1,067 48-59 na na 34.1 899 Sex Male 40.7 1,497 34.3 2,370 Female 46.0 1,480 33.2 2,312 Birth order 1 43.0 597 36.5 939 2-3 41.2 907 36.2 1,471 4-5 44.7 675 37.7 1,046 6+ 44.7 798 25.3 1,226 Breastfeeding status Breastfeeding 30.0 1,980 27.8 1,397 Not breastfeeding 70.3 980 36.5 3,229 Missing * 16 23.7 55 Residence Urban 49.4 907 48.9 1,438 Rural 40.7 2,070 27.0 3,244 Region North Central 29.2 437 32.4 693 North East 43.3 671 25.1 1,075 North West 44.7 1,046 15.2 1,584 South East 55.6 175 60.4 312 South South 50.5 378 55.8 597 South West 42.8 269 76.4 421 Mother's education No education 41.3 1,501 16.8 2,340 Primary 41.8 685 40.4 1,106 Secondary 47.6 690 58.8 1,053 Higher 53.7 101 65.6 182 Mother's age at birth <20 44.2 540 24.0 816 20-24 43.6 720 35.4 1,310 25-29 42.0 799 39.6 1,185 30-34 42.1 470 32.2 712 35-49 45.6 448 33.5 660 Wealth quintile Lowest 40.5 644 22.6 1,013 Second 42.6 630 18.4 977 Middle 46.3 599 24.5 959 Fourth 40.2 568 43.6 887 Highest 47.7 536 64.9 847 Total 43.3 2,977 33.7 4,682 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Information on vitamin A supplements is based on mother’s recall. An asterisk indi- cates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A 162 | Infant Feeding and Children’s and Women’s Nutritional Status Table 11.8 also shows that one-third of children age 6-59 months received vitamin A supplements in the six months preceding the survey. Children residing in urban areas and in the south are much more likely to receive vitamin A supplementation than those in rural areas and in the north. There is a positive relationship between mother’s education and supplementation. Vitamin A supplementation ranges from a low of 17 percent for children of women with no education to a high of 66 percent for children of the most educated mothers. Less than one-quarter of children living in households in the three lowest wealth quintiles receive vitamin A supplementation, compared with 44 percent of children in the fourth quintile and 65 percent of children in the highest quintile. 11.3.3 Micronutrient Intake Among Women A mother’s nutritional status during pregnancy is important both for the child’s intrauterine de- velopment and for protection against maternal morbidity and mortality. Table 11.9 shows that only one- fifth of women who gave birth in the five years preceding the survey received a vitamin A dose within two months of giving birth. There is variation in postpartum vitamin A supplementation by age at birth, residence, region, level of education, and wealth quintile. Supplementation is higher among women over 20 years of age than among younger women and much higher among women in the south than in the north. Urban women are more than twice as likely as rural women to have received a postpartum vitamin A dose. Furthermore, there is a positive relationship between education and household economic status and postpartum vitamin A supplementation. Night blindness is an indicator of severe vitamin A deficiency, and pregnant women are espe- cially prone to suffer from it. Table 11.9 shows that 8 percent of women with a recent birth reported that they experienced night blindness. After adjusting for women who also reported vision problems during the day, an estimated 2 percent of women suffered from night blindness. The small percentages make it difficult to examine variation among subgroups of Nigeria’s population. Anaemia usually results from a nutritional deficiency of iron, folate, vitamin B12, or some other nutrients. Anaemia may have detrimental effects on the health of women and children and may become an underlying cause of maternal mortality and perinatal mortality. Anaemia also results in an increased risk of premature delivery and low birth weight. Early detection of anaemia can help to prevent complica- tions related to pregnancy and delivery, as well as child-development problems. Anaemia is a serious concern for young children because it can result in impaired cognitive performance, behavioural and mo- tor development, coordination, language development, and scholastic achievement, as well as increased morbidity from infectious diseases. It is recommended that iron tablets be taken daily for at least three months during pregnancy. Thus, information on the prevalence of iron supplementation can be useful for the development of health-intervention programs, such as iron-fortification programs, designed to prevent anaemia. The 2003 NDHS asked women who had a recent birth whether they received or purchased any iron tablets during the last pregnancy. If so, the woman was asked to report the number of days that the tablets were actually taken during that pregnancy. Table 11.9 shows that one-fifth of women (21 percent) reported taking iron supplements for at least 90 days during the pregnancy, which is the recommended supplementation. Forty percent of women received no iron at all. There is significant variation by background characteristics. Almost half of women in rural areas did not receive any iron supplementation, which is more than twice the proportion in urban areas. Preg- nant women living in the South West are the most likely subgroup to have taken iron for at least 90 days (63 percent). This compares with just 10 percent of women in the North West. Iron supplementation is positively correlated with education and household economic status. Infant Feeding and Children’s and Women’s Nutritional Status | 163 11.4 Nutritional Status of Children Malnutrition places children at increased risk of morbidity and mortality and has also been shown to be related to impaired mental development. Anthropometry provides one of the most important indica- tors of children’s nutritional status. Height and weight measurements were obtained for all children born in the five years preceding the 2003 NDHS. The height and weight data are used to compute the follow- ing three summary indices of nutritional status: height-for-age, weight-for-height, and weight-for-age. The indices are expressed as standardized scores (Z-scores) or standard deviation units from the median for the international reference population recommended by WHO. Children who fall more than two stan- Table 11.9 Micronutrient intake among mothers Among women who gave birth in the five years preceding the survey, percentage who received a vitamin A dose in the two months after delivery, percentage who had night blindness during pregnancy, and percent distribution by whether iron tab- lets or syrup were taken during pregnancy for specific numbers of days, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Suffered Received night blindnes Number of days took iron vitamin A during pregnancy tablets or syrup during pregnancy dose ––––––––––––––––– –––––––––––––––––––––––––––––––––––––––– Number Background post- Don't know/ of characteristic partum1 Reported Adjusted2 None <60 60-89 90+ missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 11.1 7.3 2.7 48.5 25.4 5.1 13.6 7.4 100.0 719 20-24 18.4 7.5 3.1 40.5 23.9 6.6 20.9 8.1 100.0 921 25-29 24.2 7.1 1.5 34.7 25.7 6.2 24.1 9.3 100.0 965 30-34 20.3 8.9 1.4 37.5 25.4 4.8 23.3 9.0 100.0 628 35-49 23.2 8.0 2.1 38.8 25.6 3.4 23.5 8.7 100.0 678 Number of children ever born 1 19.4 5.6 1.1 37.5 26.9 6.0 20.9 8.7 100.0 803 2-3 21.1 7.2 2.4 36.6 25.6 6.5 24.4 6.8 100.0 1,102 4-5 23.4 8.9 2.7 37.5 25.3 5.6 22.4 9.1 100.0 874 6+ 15.4 8.5 2.4 46.1 23.5 3.7 17.3 9.5 100.0 1,132 Residence Urban 33.0 5.6 0.9 19.7 28.1 6.2 35.2 10.7 100.0 1,144 Rural 14.1 8.5 2.7 48.1 24.0 5.0 15.4 7.6 100.0 2,766 Region North Central 18.5 5.6 0.1 29.8 23.8 6.5 17.1 22.8 100.0 575 North East 11.5 11.1 3.8 45.2 25.0 6.7 20.6 2.6 100.0 862 North West 6.5 4.9 2.4 58.8 23.2 3.4 9.5 5.0 100.0 1,341 South East 51.7 5.3 0.3 4.0 39.4 5.3 30.9 20.4 100.0 222 South South 33.6 11.0 1.9 29.7 34.1 5.6 22.9 7.8 100.0 544 South West 48.0 9.3 2.3 9.4 13.1 7.4 63.4 6.7 100.0 367 Education No education 8.1 7.4 2.8 58.8 20.8 3.8 10.3 6.4 100.0 1,989 Primary 25.5 9.0 1.5 27.5 29.1 6.8 25.7 10.9 100.0 918 Secondary 34.7 7.5 2.0 14.0 29.5 7.1 38.1 11.3 100.0 862 Higher 51.1 3.8 0.0 8.3 36.0 8.0 42.2 5.5 100.0 143 Wealth quintile Lowest 10.3 15.5 5.5 61.0 21.0 3.2 8.1 6.7 100.0 852 Second 10.4 5.4 1.6 61.1 19.3 3.2 11.2 5.2 100.0 846 Middle 13.7 5.8 1.2 39.4 28.5 6.7 15.2 10.3 100.0 808 Fourth 24.2 5.0 1.1 21.8 30.3 6.8 29.0 12.1 100.0 735 Highest 45.2 5.6 1.0 6.0 28.4 7.8 49.1 8.8 100.0 670 Total 19.6 7.7 2.2 39.8 25.2 5.4 21.2 8.5 100.0 3,911 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: For women with two or more live births in the five-year period, data refer to the most recent birth. 1 In the first two months after delivery 2 Women who reported night blindness but did not report difficulty with vision during the day 164 | Infant Feeding and Children’s and Women’s Nutritional Status dard deviations below the reference median (-2 SD) are regarded as undernourished, while those who fall more than three standard deviations below the reference median (-3 SD) are considered severely under- nourished. Table 11.10 shows the nutritional status of children under five years of age, by background characteristics. Children whose height-for-age is below -2 SD from the median of the reference population are considered stunted or short for their age. Stunting is the outcome of failure to receive adequate nutrition over an extended period and is also affected by recurrent or chronic illness. Almost two in five children are short for their age; half of these undernourished children are severely stunted. Children whose weight-for-height is below -2 SD from the median of the reference population are considered wasted (or thin). Wasting represents the failure to receive adequate nutrition in the period im- mediately before the survey and typically is the result of a recent episode of illness, especially diarrhoea, or a rapid deterioration in the food supply. Almost one in ten children is wasted. Children whose weight-for-age is below -2 SD from the median of the reference population are considered underweight. The measure reflects the effects of both acute and chronic malnutrition. Twenty- nine percent of all children are underweight; almost one in three of these children is severely under- weight. Nutritional status varies substantially by background characteristics. The impact of weaning can be seen in younger children, whose nutritional status deteriorates after six months of age, when children are being weaned. Rural children and children of younger or less educated mothers are disadvantaged in terms of nutritional status. Children living in the North West stand out as being particularly disadvantaged in terms of nutritional status (Figure 11.2). 31 43 55 18 21 25 50 37 22 7 REGION North Central North East North West South East South South South West MOTHER'S EDUCATION No education Primary Secondary Higher 0 10 20 30 40 50 60 70 Percentage of children stunted Figure 11.2 Prevalence of Stunting among Children under Five Years by Region and Mother’s Education NDHS 2003 Infant Feeding and Children’s and Women’s Nutritional Status | 165 Table 11.10 Nutritional status of children Percentage of children under five years classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Height-for-age Weight-for-height Weight-for-age (stunted) (wasted) (underweight) –––––––––––––––––––––––––– –––––––––––––––––––––––––– –––––––––––––––––––––––––– Percent- Percent- Percent- Percent- Percent- Percent- age age Mean age age Mean age age Mean Number Background below below z-score below below z-score below below z-score of characteristic -3 SD -2 SD1 -SD -3 SD -2 SD1 -SD -3 SD -2 SD1 -SD children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age in months <6 2.7 7.4 -0.0 2.9 7.9 0.1 0.5 6.6 0.2 527 6-9 9.3 24.7 -0.9 3.5 14.2 -0.5 6.8 20.4 -1.1 425 10-11 17.1 36.2 -1.4 1.6 9.8 -0.3 10.9 31.7 -1.4 179 12-23 24.9 49.4 -2.0 4.0 15.0 -0.7 15.6 41.4 -1.8 889 24-35 21.7 43.3 -1.6 1.5 5.9 -0.4 11.3 34.8 -1.3 972 36-47 21.7 43.9 -1.7 1.7 8.0 -0.3 8.0 26.6 -1.3 985 48-59 23.6 41.3 -1.7 0.7 6.4 -0.3 5.8 27.9 -1.3 812 Sex Male 20.3 40.8 -1.5 2.2 9.3 -0.4 9.3 29.2 -1.2 2,390 Female 18.2 35.9 -1.4 2.2 9.2 -0.4 8.4 28.1 -1.2 2,399 Birth order2 1 16.3 36.9 -1.4 2.2 9.3 -0.4 8.2 28.5 -1.2 885 2-3 18.9 36.1 -1.4 1.9 9.6 -0.3 9.3 28.5 -1.2 1,392 4-5 20.2 35.7 -1.4 2.0 8.0 -0.4 9.1 28.1 -1.2 1,009 6+ 22.0 45.0 -1.7 2.6 10.0 -0.4 9.4 29.9 -1.3 1,143 Birth interval in months2 First birth3 16.3 36.8 -1.4 2.2 9.4 -0.4 8.2 28.6 -1.2 888 <24 27.1 44.5 -1.8 2.1 9.1 -0.4 12.1 33.0 -1.4 808 24-47 19.1 38.8 -1.5 2.1 8.7 -0.4 8.8 29.1 -1.2 2,092 48+ 15.7 32.1 -1.2 2.4 11.0 -0.3 7.2 22.7 -1.0 641 Size at birth2 Very small 27.7 50.4 -1.9 2.6 15.0 -0.6 16.6 42.2 -1.6 243 Small 21.4 42.2 -1.6 2.4 12.3 -0.7 13.8 37.9 -1.6 353 Average or larger 18.9 37.4 -1.4 2.2 8.6 -0.3 8.1 27.1 -1.2 3,801 Residence Urban 12.9 28.8 -1.1 1.6 8.3 -0.4 6.8 22.2 -1.0 1,553 Rural 22.3 42.9 -1.6 2.5 9.7 -0.4 9.9 31.8 -1.3 3,236 Region North Central 11.3 31.4 -1.1 1.2 5.5 -0.4 4.9 19.6 -1.0 758 North East 21.6 43.0 -1.6 1.2 7.9 -0.4 9.5 33.1 -1.4 1,089 North West 34.4 55.3 -2.2 3.8 12.5 -0.3 14.7 42.9 -1.6 1,452 South East 5.3 19.7 -0.5 0.7 4.9 0.0 2.1 8.5 -0.3 338 South South 6.3 20.9 -0.7 2.5 11.1 -0.5 6.4 18.0 -0.9 643 South West 8.6 24.6 -1.0 2.1 8.6 -0.4 4.7 19.1 -1.0 510 Mother's education4 No education 28.7 50.0 -2.0 2.2 10.2 -0.4 11.7 37.6 -1.5 2,172 Primary 15.9 36.6 -1.4 2.6 9.4 -0.4 8.6 26.1 -1.2 1,105 Secondary 7.3 22.4 -0.8 2.3 6.9 -0.3 5.3 16.9 -0.8 1,068 Higher 2.3 7.1 -0.3 0.6 10.3 -0.3 2.1 8.9 -0.5 194 Mother's age4 15-19 18.0 40.8 -1.5 4.1 12.0 -0.4 10.6 31.2 -1.3 294 20-24 23.9 41.8 -1.7 2.2 8.5 -0.4 11.3 34.5 -1.4 913 25-29 18.4 36.7 -1.4 2.6 9.1 -0.3 8.8 27.9 -1.1 1,389 30-34 19.7 37.7 -1.4 1.8 9.6 -0.4 8.8 29.2 -1.2 903 35-49 17.0 37.5 -1.4 1.9 9.0 -0.4 7.1 23.5 -1.2 1,039 Mother’s status Mother interviewed 19.5 38.5 -1.5 2.2 9.3 -0.4 9.0 28.8 -1.2 4,429 Mother not interviewed but in household 16.4 34.8 -1.4 5.9 8.4 -0.3 8.3 26.4 -1.1 110 Mother not interviewed and not in the household5 16.1 38.1 -1.2 0.8 8.1 -0.4 6.4 27.2 -1.1 247 Wealth quintile Lowest 26.4 48.8 -1.8 2.4 10.4 -0.4 10.8 34.8 -1.4 977 Second 26.0 47.7 -1.9 2.8 11.2 -0.4 12.0 37.5 -1.5 971 Middle 22.5 44.2 -1.6 2.6 8.1 -0.3 10.3 30.7 -1.3 954 Fourth 15.8 32.5 -1.3 1.6 8.2 -0.4 7.8 26.6 -1.2 934 Highest 5.2 17.9 -0.6 1.6 8.2 -0.3 3.4 13.4 -0.7 952 Total 19.2 38.3 -1.5 2.2 9.2 -0.4 8.9 28.7 -1.2 4,789 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on children who stayed in the household the night before the interview. Each of the indices is expressed in standard deviation (SD) units 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 reference population (-3 SD and -2 SD) are considered malnourished. Table is based on children with valid dates of birth (month and year) and valid measurements (height and weight). Total includes 25 cases with missing information on size at birth. 1 Includes children who are below -3 SD 2 Excludes children whose mothers were not interviewed 3 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 4 For women who were not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers were not listed in the household schedule. 5 Includes children whose mothers are dead 166 | Infant Feeding and Children’s and Women’s Nutritional Status 11.5 NUTRITIONAL STATUS OF WOMEN The 2003 NDHS collected anthropometric data from all women age 15-49. Women’s nutritional status is important both as an indicator of overall health and as a predictor of pregnancy outcome for both mother and child. Two indices of women’s nutritional status—height and body mass index (BMI)—are presented in Table 11.11. Maternal height is a measure of past nutritional status and reflects in part the cumulative effect of social and economic outcomes on access to nutritional foods during childhood and adolescence. It can be used to predict the risks associated with difficult deliveries since small stature is often associated with small pelvis size and a greater likelihood of obstructed labor. Short stature is also correlated with low birth weight in infants, high risk of stillbirths, and high rates of miscarriage. The height below which a woman is considered to be at nutritional risk is in the range of 140 to 150 centimeters. The mean height of Nigerian women is 158 centimeters, and varies little by background characteristics. However, short stat- ure is more prevalent among teenagers, with 5 percent of women age 15-19 below 145 centimeters tall. The BMI, which incorporates both height and weight and provides a better measure of thinness and obesity than weight alone, is defined as weight in kilograms divided by the square of the height in meters (kg/m2). For the BMI, a cutoff of 18.5 has been recommended for indicating chronic energy defi- ciency among nonpregnant women. To avoid bias in the measurement of women’s nutritional status, pregnant women and women who had given birth in the two months preceding the survey were excluded from the calculation of weight and body mass measures. Table 11.11 shows that the mean BMI of Nige- rian women (22.3) falls well within the internationally accepted normal range. Almost two-thirds of women (64 percent) have BMIs in the normal range, 15 percent are thin, and 2 percent are severely thin. The youngest women are the most likely subgroup to be thin; one-quarter of women age 15-19 have a BMI of less than 18.5. There is significant regional variation, with the prevalence of thinness ranging from 7 percent in the North Central to 23 percent in the North East. The BMI is also used to evaluate the proportion of women who are overweight or obese. A cutoff point of 25.0 has been recommended for defining overweight, while 30.0 is the cutoff point for defining obesity. According to the 2003 NDHS, one-fifth of Nigerian women weigh more than they should: 15 percent are overweight, and 6 percent are obese. There is a strong relationship between age and high BMI. For example, only 7 percent of women age 15-19 are overweight or obese, compared with one-third (34 percent) of women age 45-49. There are marked variations by residence, education, and household eco- nomic status. Infant Feeding and Children’s and Women’s Nutritional Status | 167 Table 11.11 Nutritional status of women by background characteristics Among women age 15-49, mean height, percentage under 145 cm, mean body mass index (BMI), and percentage with specific BMI levels, by back- ground characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Height Body mass index BMI 1 (kg/m2) –––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Normal Thin Overweight/obese –––––––– ––––––––––––––––––––––––––––––––––– –––––––––––––––––––––– Percent- 17.0- 16.0- ≥25.0 25.0- 30.0 Mean age Number 18.5- 18.4 16.9 <16.0 (over- 29.9 or Number Background height below of Mean 24.9 <18.5 (mildly (moderately (severely) weight/ (over- higher of characteristic in cm 145 cm women BMI (normal) (thin) thin) thin) thin) obese) weight) (obese) women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 155.8 4.5 1,641 20.5 69.0 24.5 17.5 4.0 3.0 6.5 5.5 0.9 1,504 20-24 158.4 1.1 1,461 21.8 71.2 14.4 10.2 3.1 1.2 14.3 11.3 3.1 1,201 25-29 159.0 0.9 1,347 22.6 65.0 11.9 8.7 2.4 0.8 23.1 17.6 5.5 1,080 30-34 158.9 1.5 924 23.2 62.7 10.4 7.4 1.9 1.2 26.9 18.2 8.6 746 35-39 159.0 1.0 795 23.7 55.0 12.7 10.0 1.3 1.4 32.3 21.8 10.5 664 40-44 158.8 0.7 667 23.5 56.2 13.1 9.0 3.4 0.7 30.7 20.9 9.8 620 45-49 157.8 2.3 559 23.8 57.4 9.2 4.5 2.7 2.0 33.5 22.2 11.3 546 Residence Urban 159.0 1.3 2,544 23.2 59.2 13.1 9.1 2.4 1.6 27.7 18.1 9.6 2,258 Rural 157.6 2.2 4,850 21.8 67.1 16.3 11.6 3.1 1.6 16.6 13.0 3.6 4,105 Region North Central 157.8 1.5 1,086 23.1 70.3 6.6 5.3 1.0 0.3 23.1 16.9 6.2 944 North East 158.2 1.6 1,320 21.4 62.9 23.0 16.1 4.3 2.7 14.1 10.4 3.7 1,095 North West 157.2 2.5 2,022 21.5 65.3 19.7 12.9 4.3 2.5 15.0 10.7 4.2 1,630 South East 158.8 2.9 707 23.6 57.9 8.2 6.2 1.4 0.5 33.9 25.5 8.4 648 South South 158.3 1.3 1,308 22.9 64.2 11.1 8.7 1.6 0.8 24.7 16.8 8.0 1,173 South West 159.1 1.6 950 22.3 62.5 16.7 11.9 3.1 1.7 20.8 15.0 5.9 872 Education No education 157.5 2.1 3,052 21.6 65.4 19.8 13.5 4.2 2.1 14.8 11.2 3.5 2,503 Primary 157.3 2.5 1,606 22.6 64.8 12.8 9.4 1.9 1.4 22.4 16.4 6.0 1,385 Secondary 158.7 1.7 2,312 22.5 64.6 13.1 9.6 2.2 1.2 22.3 16.1 6.2 2,080 Higher 161.1 0.0 425 25.0 53.7 4.9 2.9 0.8 1.2 41.4 24.7 16.7 394 Wealth quintile Lowest 157.2 3.6 1,364 21.1 67.8 21.5 14.6 4.1 2.8 10.7 8.6 2.1 1,141 Second 157.4 1.3 1,386 21.3 70.0 18.2 12.8 3.6 1.8 11.8 9.0 2.8 1,155 Middle 157.4 2.1 1,464 22.0 66.7 16.0 11.2 3.4 1.3 17.4 12.7 4.6 1,238 Fourth 158.1 1.6 1,492 22.5 65.2 13.1 9.8 1.8 1.5 21.7 15.9 5.8 1,300 Highest 159.7 1.1 1,688 24.0 54.7 9.2 6.5 1.8 0.9 36.1 24.5 11.6 1,528 Total 158.0 1.9 7,394 22.3 64.3 15.2 10.7 2.9 1.6 20.5 14.8 5.8 6,362 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Excludes pregnant women and women with a birth in the preceding 2 months HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 12 Acquired immunodeficiency syndrome (AIDS) is one of the world’s most serious public health concerns, and it poses an enormous challenge to most countries, especially developing countries such as Nigeria. The first case of human immunodeficiency virus (HIV) infection in Nigeria was recorded in 1986, and since then, rates of infection have been increasing. Estimates of HIV prevalence have increased from 1.8 percent in 1991 to 4.5 percent in 1996, and the 2001 National HIV/Syphilis Sentinel Survey estimated a national HIV seroprevalence rate of 5.8 per- cent (FMOH, 2001). Regional prevalence rates varied significantly, from a high of 7.7 percent in the South South to a low of 3.3 percent in the North West. The greatest concern is the projected mortality due to AIDS over the next few years and its socio- economic consequences. Projections of annual deaths caused by AIDS have increased in Nigeria from less than 50,000 in 1999 to about 350,000 by 2003-2004. The number of Nigerian children orphaned as a result of parental AIDS deaths is projected to be near 2 million in 2003-2004. AIDS deaths have eco- nomic, health, and social consequences for everyone in the country. The magnitude of the problem has renewed the vigour of the Federal Government of Nigeria to review the national HIV/AIDS policy. The future course of the Nigerian AIDS epidemic will depend on the efforts of individuals, de- velopment partners, local and international nongovernmental organizations (NGOs), religious groups, and traditional institutions to curb the pandemic. A three-year HIV/AIDS Emergency Action Plan (HEAP) was initiated by the Federal Government of Nigeria (FGN) in 2001. The FGN has created the National Action Committee on AIDS (NACA) to do extensive work in collaboration with international develop- ment partners and local and international NGOs to mitigate the effects of HIV/AIDS. Strategies employ a multisectoral approach, working at national, state, and local government levels. Data obtained from the 2003 Nigeria Demographic and Health Survey (NDHS) provide an in- valuable resource for witnessing levels and trends of important factors related to HIV/AIDS. These data are intended to inform policy makers and programme planners in their strategies for programme planning and evaluation. This chapter presents information about knowledge, attitudes, and practices related to prevention and control of HIV/AIDS and care of people living with the virus. 12.1 KNOWLEDGE OF WAYS TO AVOID HIV/AIDS Table 12.1 shows that awareness of AIDS in Nigeria is higher among men than women, with 97 percent of men and 86 percent of women reporting that they have “heard of AIDS.” There is little varia- tion in knowledge among men by background characteristics; however, there are significant differences among women. The lowest level of AIDS awareness is among women living in households ranked lowest on the wealth index (70 percent). Knowledge of AIDS among women ranges from a low of 76 percent in the North East to a high of 96 percent in the South East. Awareness of AIDS is universal for men and women with higher education (100 percent). Two aspects of AIDS-related behaviour that AIDS prevention programmes focus their messages on are the use of condoms and limiting the number of sexual partners or staying faithful to one partner. These are considered programmatically important ways to prevent HIV transmission. To ascertain whether programmes have effectively communicated these messages, interviewers asked respondents HIV/AIDS and Other Sexually Transmitted Infections | 169 Table 12.1 Knowledge of AIDS Percentage of women and men who have heard of AIDS, by background charac- teristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––– –––––––––––––––––––– Has Has heard Number heard Number Background of of of of characteristic AIDS respondents AIDS respondents ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 82.8 1,716 92.9 453 about these behavi could be avoided, they were asked ho estions were asked about ways to avoi spondents were al- lowed to give all of . Next, women and men were asked sp n) whether limiting their sexual activity lts are presented in Table 12.2. 170 | HIV/AIDS and Other Sexually 20-24 87.4 1,494 97.8 426 25-29 89.7 1,382 98.2 328 30-39 87.9 1,757 99.0 519 40-49 84.0 1,271 97.4 367 15-24 84.9 3,210 95.3 880 Marital status Never married 88.4 1,926 95.7 1,048 Ever had sex 94.5 838 98.9 489 Never had sex 83.6 1,087 93.0 559 Married/living together 85.4 5,336 98.4 1,006 Divorced/separated/ widowed 88.1 358 (96.4) 40 Residence Urban 94.7 2,629 99.0 792 Rural 81.9 4,991 95.9 1,301 Region North Central 84.5 1,121 97.1 313 North East 75.7 1,368 97.3 377 North West 86.6 2,095 99.3 529 South East 95.5 737 99.3 192 South South 90.3 1,342 92.1 385 South West 90.3 958 97.7 296 Education No education 77.9 3,171 95.9 385 Primary 86.6 1,628 92.8 519 Secondary 94.8 2,370 99.0 932 Higher 100.0 451 100.0 257 Wealth quintile Lowest 69.6 1,414 92.3 362 Second 79.9 1,439 95.8 360 Middle 88.5 1,513 99.1 392 Fourth 92.8 1,526 97.2 452 Highest 97.7 1,728 99.5 527 Total 86.3 7,620 97.0 2,093 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. ours as ways of avoiding AIDS. If respondents reported that AIDS w “a person could avoid getting the HIV virus.” Two types of qu d getting infected. First, an open-ended question was asked, and re the ways to avoid HIV/AIDS that they know of without prompting ecific questions on whether condom use and (in a separate questio to just one partner can reduce their chances of getting AIDS. Resu Transmitted Infections Table 12.2 Knowledge of HIV prevention methods Percentage of women and men who, in response to a prompted question, say that people can reduce the risk of getting the AIDS virus by using condoms and by having sex with just one partner who is not infected and who has no other partners, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Knowledge of HIV prevention by: Knowledge of HIV prevention by: ––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Using Using condoms condoms Limiting and limiting Limiting and limiting sex to one sex to one Number sex to one sex to one Number Background Using uninfected uninfected of Using uninfected uninfected of characteristic condoms partner partner1 women condoms partner partner1 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 38.6 53.3 36.5 1,716 58.2 64.8 52.0 453 20-24 47.8 63.0 44.9 1,494 67.8 80.6 65.1 426 25-29 51.3 64.4 49.3 1,382 69.2 86.7 65.4 328 30-39 46.6 61.4 44.1 1,757 67.2 87.3 64.0 519 40-49 39.1 58.0 37.1 1,271 54.1 82.8 52.1 367 15-24 42.9 57.8 40.4 3,210 62.8 72.4 58.4 880 Marital status Never married 47.9 63.0 45.6 1,926 65.9 75.6 61.3 1,048 Ever had sex 59.7 72.9 57.2 838 77.7 84.7 74.1 489 Never had sex 38.7 55.4 36.7 1,087 55.5 67.7 50.1 559 Married/living together 43.3 58.7 41.1 5,336 60.3 84.6 57.7 1,006 Divorced/separated/ widowed 46.8 60.4 43.7 358 (74.8) (87.5) (72.5) 40 Residence Urban 57.5 73.0 54.5 2,629 70.6 83.1 65.3 792 Rural 37.8 53.0 35.9 4,991 59.0 78.4 56.4 1,301 Region North Central 34.7 55.6 33.8 1,121 68.1 83.8 66.6 313 North East 34.7 50.6 34.0 1,368 47.5 80.2 45.7 377 North West 48.8 59.8 44.7 2,095 69.8 83.1 62.0 529 South East 43.6 77.3 42.2 737 79.4 85.1 75.5 192 South South 48.8 58.0 47.1 1,342 50.4 68.2 49.8 385 South West 56.3 67.4 52.4 958 73.5 83.4 69.0 296 Education No education 33.0 48.0 30.8 3,171 44.9 73.0 41.9 385 Primary 43.3 56.1 40.8 1,628 54.2 74.8 52.2 519 Secondary 55.6 72.5 53.4 2,370 71.4 82.4 66.7 932 Higher 73.7 91.1 70.5 451 80.5 93.8 76.4 257 Wealth quintile Lowest 25.0 37.1 23.6 1,414 42.1 66.5 40.4 362 Second 31.1 46.5 29.1 1,439 57.5 79.0 54.7 360 Middle 47.5 61.9 45.2 1,513 68.4 86.5 65.3 392 Fourth 53.4 67.9 50.3 1,526 64.4 82.2 61.8 452 Highest 61.8 80.7 59.2 1,728 77.4 84.0 70.6 527 Total 44.6 59.9 42.3 7,620 63.4 80.2 59.8 2,093 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Knowledge Indicator 1 "Knowledge of HIV prevention methods" HIV/AIDS and Other Sexually Transmitted Infections | 171 Knowledge of prevention of AIDS is not quite as widespread as knowledge of the disease itself. Limiting the number of sexual partners is acknowledged by more Nigerians of all backgrounds as a means to avoid AIDS, compared with use of condoms. Forty-five percent of women and 63 percent of men re- port knowledge of condom use for HIV/AIDS protection. On the other hand, six in ten women and eight in ten men report knowing that limiting the number of sexual partners is a way to avoid HIV/AIDS. More men than women know about condom use and limiting partners as ways to avoid AIDS, al- though patterns of knowledge by background characteristics are similar for both women and men. The youngest women and men (age 15-19) are somewhat less likely than older women and men to know these specific ways to avoid transmission of HIV. This is important because sexual debut often occurs before age 20. Variation by education is particularly striking among both women and men. Knowledge of con- dom use to avoid AIDS ranges from a low of 33 percent among women with no education to a high of 74 percent among those with higher education. Knowledge among men increases steadily with education as well, from a low of 45 percent among men with no education to a high of 81 percent among men with higher education. 12.2 BELIEFS ABOUT AIDS The 2003 NDHS also inquired about common misconceptions regarding AIDS and HIV trans- mission. Respondents were asked whether they think it is possible for a healthy-looking person to have the AIDS virus; results are presented in Tables 12.3.1 and 12.3.2 by background characteristics. The tables also present the percentage of the population who know that the common misconceptions regarding transmission of AIDS are not true, in particular, that a person cannot get AIDS from mosquito bites, from witchcraft or other supernatural means, or from sharing food with a person who has AIDS. The tables also show the percentage of the population who know both that it is possible for a healthy-looking person to have AIDS and that the two most common misconceptions regarding transmission (AIDS can be trans- mitted via mosquito bites or by supernatural means) are not true. Once again, levels of knowledge are higher among men than among women, and the greatest variability in knowledge is seen by level of education. Overall, about half of women (53 percent) and nearly three-quarters of men (73 percent) know that a healthy-looking person can have AIDS. There are greater gaps in knowledge regarding modes of transmission than knowledge of whether or not a healthy- looking person can have the AIDS virus. For each of the misconceptions regarding transmission of AIDS, approximately four in ten women know that it is not really a mode of transmission; the percentages for men are slightly higher. Respondents who know that a healthy-looking person can have the AIDS virus and who also reject the two most common misconceptions regarding transmission of the AIDS virus are in the minority: 21 percent of women and 28 percent of men. There is room for growth in educating the population about the modes of transmission of the AIDS virus. The lowest levels of knowledge are among persons with no education or primary education. 172 | HIV/AIDS and Other Sexually Transmitted Infections Table 12.3.1 Beliefs about AIDS: women Percentage of women who, in response to a prompted question, correctly reject local misconceptions about AIDS transmission or preven- tion, and who know that a healthy-looking person can have the AIDS virus, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who know that: Percentage –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– who reject two A person most common AIDS cannot be cannot become misconceptions A healthy- transmitted by infected by and say that a looking person AIDS cannot be witchcraft or other sharing food healthy-looking Number Background can have the transmitted by supernatural with someone person can have of characteristic AIDS virus mosquito bites means with AIDS the AIDS virus1 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 46.3 32.1 36.0 40.5 17.0 1,716 20-24 59.4 41.9 42.3 50.6 24.8 1,494 25-29 59.0 40.3 43.8 49.6 22.7 1,382 30-39 53.0 36.8 41.2 43.8 20.7 1,757 40-49 50.6 33.6 36.7 40.8 19.1 1,271 15-24 52.4 36.7 38.9 45.2 20.6 3,210 Marital status Never married 58.8 41.2 43.4 51.8 23.7 1,926 Ever had sex 69.2 45.8 46.9 59.5 28.0 838 Never had sex 50.7 37.7 40.7 45.9 20.4 1,087 Married/living together 51.4 35.5 39.3 42.3 19.9 5,336 Divorced/separated/ widowed 54.3 33.1 32.2 46.6 17.6 358 Residence Urban 68.6 49.8 51.1 59.0 29.9 2,629 Rural 45.4 30.0 34.1 37.5 15.9 4,991 Region North Central 43.3 26.3 29.8 35.6 11.9 1,121 North East 45.4 25.5 35.2 35.0 16.6 1,368 North West 52.3 43.2 42.5 48.0 23.7 2,095 South East 67.1 52.7 57.4 64.8 33.5 737 South South 53.6 31.3 30.3 42.2 14.3 1,342 South West 68.4 47.3 53.3 52.0 29.9 958 Education No education 40.4 28.1 31.8 32.7 14.9 3,171 Primary 48.4 30.5 35.0 36.0 15.8 1,628 Secondary 66.9 45.7 48.7 59.4 25.7 2,370 Higher 92.2 75.1 69.5 87.2 54.3 451 Wealth quintile Lowest 33.0 19.1 21.0 23.3 9.7 1,414 Second 41.4 25.3 30.4 31.2 14.2 1,439 Middle 51.8 34.5 41.3 42.2 18.0 1,513 Fourth 57.6 43.3 44.1 52.8 22.5 1,526 Highest 77.8 57.4 58.6 69.5 36.2 1,728 Total 53.4 36.9 40.0 44.9 20.8 7,620 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The two most common local misconceptions involve transmission by mosquito bites and by witchcraft or other supernatural means. 1 Corresponds to UNAIDS Knowledge Indicator 2 "No incorrect beliefs about AIDS" HIV/AIDS and Other Sexually Transmitted Infections | 173 Table 12.3.2 Beliefs about AIDS: men Percentage of men who, in response to a prompted question, correctly reject local misconceptions about AIDS transmission or prevention, and who know that a healthy-looking person can have the AIDS virus, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who know that: Percentage –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– who reject two A person most common AIDS cannot be cannot become misconceptions A healthy- transmitted by infected by and say that a looking person AIDS cannot be witchcraft or other sharing food healthy-looking Number Background can have the transmitted by supernatural with someone person can have of characteristic AIDS virus mosquito bites means with AIDS the AIDS virus1 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 55.8 32.9 47.9 45.2 17.3 453 174 | 20-24 74.2 44.4 55.7 64.1 29.1 426 25-29 82.6 49.4 58.6 67.7 33.2 328 30-39 81.9 53.5 54.8 65.0 35.1 519 40-49 72.6 42.7 53.9 53.6 25.3 367 15-24 64.7 38.5 51.7 54.4 23.0 880 Marital status Never married 69.7 43.7 54.9 61.0 27.6 1,048 Ever had sex 79.8 52.0 59.5 70.5 34.0 489 Never had sex 60.9 36.5 50.8 52.7 21.9 559 Married/living together 76.5 45.1 53.3 56.4 28.5 1,006 Divorced/separated/ widowed (80.5) (55.5) (45.4) (68.3) (27.2) 40 Residence Urban 82.1 55.0 59.0 68.4 37.5 792 Rural 67.8 38.3 50.8 53.2 22.2 1,301 Region North Central 67.9 35.7 47.0 53.1 18.2 313 North East 69.5 47.5 44.5 51.4 20.0 377 North West 77.5 38.9 59.3 56.5 25.2 529 South East 82.3 42.6 47.4 73.9 28.5 192 South South 64.4 46.5 52.8 60.3 33.1 385 South West 81.3 59.6 69.3 67.8 46.6 296 Education No education 59.2 30.4 45.7 44.5 14.8 385 Primary 67.1 38.0 43.5 46.2 19.6 519 Secondary 77.7 46.9 56.9 64.9 29.9 932 Higher 89.8 71.1 76.5 84.8 58.0 257 Wealth quintile Lowest 55.9 26.5 40.0 36.8 11.7 362 Second 67.2 34.7 45.5 47.8 18.8 360 Middle 72.3 39.9 58.0 61.1 23.2 392 Fourth 80.0 54.8 56.7 64.7 34.1 452 Highest 83.9 58.7 63.8 75.3 43.9 527 Total 73.2 44.6 53.9 59.0 28.0 2,093 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The two most common local misconceptions involve transmission by mosquito bites and by witchcraft or other supernatural means. Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Knowledge Indicator 2 "No incorrect beliefs about AIDS" 12.3 STIGMA AND DISCRIMINATION Knowledge and beliefs about AIDS affect how people treat others whom they know to be living with HIV. To ascertain the level to which people are accepting of others who are living with HIV, the 2003 NDHS asked several questions regarding behavioural treatment of persons with AIDS. Results are presented in Tables 12.4.1 and 12.4.2, which excludes the 14 percent of women and 3 percent of men who reported that they have never heard of an illness called AIDS. Respondents were asked whether or not they would be willing to take on the care of a relative with HIV in their own household. Overall, four in ten respondents reported that they would be willing to care for a sick relative in their own household. Only one-quarter of respondents in the South West reported that they would do so. HIV/AIDS and Other Sexually Transmitted Infections Table 12.4.1 Accepting attitudes towards those living with HIV: women Percentage of women expressing accepting attitudes toward people with HIV, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Would buy Believe Believe Are fresh HIV-positive HIV-positive Percentage Number willing to care vegetables female teacher status of a family expressing of women for a family from should be member does accepting who have Background member with shopkeeper allowed to not need to attitudes on all heard of characteristic HIV at home with AIDS keep teaching remain a secret four measures1 HIV/AIDS –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 41.8 19.3 23.6 54.2 2.1 1,420 20-24 45.8 21.8 24.7 56.7 3.0 1,305 25-29 41.4 21.2 25.3 63.0 4.4 1,240 30-39 45.5 19.1 22.0 64.5 3.6 1,545 40-49 44.6 15.8 18.5 67.1 3.4 1,067 15-24 43.7 20.5 24.2 55.4 2.5 2,725 Marital status Never married 47.3 26.3 27.4 55.3 4.5 1,702 Ever had sex 51.0 31.6 32.3 56.1 6.1 793 Never had sex 44.0 21.8 23.2 54.6 3.2 909 Married/living together 42.3 17.3 21.6 62.7 2.7 4,559 Divorced/separated/ widowed 47.1 15.5 19.3 64.1 4.5 316 Residence Urban 46.1 26.1 27.7 59.0 4.1 2,490 Rural 42.5 15.6 20.1 62.0 2.8 4,087 Region North Central 47.5 18.5 16.9 58.5 2.9 947 North East 51.0 12.7 20.3 68.3 3.6 1,036 North West 47.5 18.7 25.9 55.5 2.6 1,813 South East 59.8 26.7 29.2 49.8 2.7 704 South South 32.5 22.2 23.7 68.1 5.2 1,212 South West 26.4 21.2 20.6 64.6 2.5 865 Education No education 43.7 12.1 18.7 61.9 2.1 2,470 Primary 38.8 16.1 18.2 64.4 2.2 1,410 Secondary 44.5 25.8 27.3 58.2 4.3 2,246 Higher 57.3 40.4 39.9 57.1 8.4 451 Wealth quintile Lowest 37.1 10.6 14.2 62.7 1.1 984 Second 44.0 12.2 19.4 63.9 3.2 1,150 Middle 42.6 15.3 22.6 66.9 2.5 1,339 Fourth 45.3 22.2 23.2 61.1 3.6 1,415 Highest 47.3 30.9 30.6 52.7 4.9 1,689 Total 43.8 19.6 23.0 60.9 3.3 6,577 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Corresponds to UNAIDS Stigma and Discrimination Indicator 1 "Accepting attitudes towards those living with HIV" To assess personal attitudes towards others known to be living with AIDS, the 2003 NDHS asked respondents whether they would be willing to purchase fresh vegetables from a seller who has the AIDS virus, whether they believe a female teacher who has the AIDS virus should be permitted to continue teaching, and whether or not they would want the status of a family member with the AIDS virus to re- main a secret. These results are also presented in Tables 12.4.1 and 12.4.2. Only 20 percent of women and 28 percent of men say that they would purchase fresh vegetables from a person with the AIDS virus. Only 23 percent of women and 27 percent of men believe that a female teacher with the AIDS virus should be allowed to continue teaching in school. A majority of respondents (61 percent of women and 70 percent of men), however, say that they believe that the HIV-positive status of a family member does not need to remain a secret. HIV/AIDS and Other Sexually Transmitted Infections | 175 Table 12.4.2 Accepting attitudes towards those living with HIV: men Percentage of men expressing accepting attitudes toward people with HIV, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Believe Would buy Believe HIV-positive Percentage Are fresh HIV-positive status of a expressing Number willing to care vegetables female teacher family member accepting of men for a family from should be does not need attitudes who have Background member with shopkeeper allowed to to remain a on all four heard of characteristic HIV at home with AIDS keep teaching secret measures1 HIV/AIDS 176 | HIV –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 34.8 19.3 15.5 59.4 3.1 421 20-24 39.8 30.4 27.5 73.3 5.9 417 25-29 43.4 36.3 32.0 72.0 7.8 322 30-39 44.4 29.6 33.2 74.2 9.1 514 40-49 36.7 26.6 25.4 71.8 6.6 357 15-24 37.3 24.8 21.5 66.3 4.5 838 Marital status Never married 39.6 29.1 24.7 66.6 6.2 1,003 Ever had sex 45.1 35.4 28.8 74.5 9.3 484 Never had sex 34.6 23.2 20.9 59.3 3.3 519 Married/living together 40.2 27.0 29.0 73.4 7.0 990 Divorced/separated/ widowed (42.3) (32.2) (24.0) (81.6) (4.9 ) 38 Residence Urban 35.1 34.2 32.3 68.0 7.1 784 Rural 43.0 24.3 23.4 71.6 6.2 1,247 Region North Central 56.6 21.3 20.0 73.0 5.7 304 North East 31.4 31.7 25.0 72.3 6.3 367 North West 42.1 27.9 31.5 63.6 5.0 525 South East 36.0 24.3 33.7 58.8 4.6 191 South South 46.9 33.0 29.2 69.6 13.9 355 South West 23.3 28.0 20.3 84.6 2.8 289 Education No education 35.1 18.6 22.0 67.2 2.8 369 Primary 36.3 22.0 20.5 71.7 4.4 482 Secondary 40.6 26.9 26.9 71.2 6.3 923 Higher 51.4 58.1 45.0 68.1 16.8 257 Wealth quintile Lowest 36.4 13.3 16.4 67.9 1.2 334 Second 40.6 25.5 22.8 74.8 5.9 345 Middle 48.6 28.8 26.8 73.4 7.3 388 Fourth 32.6 30.5 24.4 70.2 6.6 439 Highest 41.4 36.9 38.1 66.2 9.8 524 Total 39.9 28.2 26.8 70.2 6.6 2,031 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Stigma and Discrimination Indicator 1 "Accepting attitudes towards those living with HIV” The percentage of the population expressing the most accepting attitudes towards persons living with the AIDS virus is presented in the last percentage column of the table. This is the percentage of re- spondents who reported in the affirmative for all four behaviours presented in the table: they would care for an HIV-positive family member in their own home, they would buy fresh vegetables from a shop- keeper with AIDS, they would allow an HIV-positive teacher to continue teaching, and they would not keep the HIV-positive status of a family member a secret. Only 3 percent of women and 7 percent of men report acceptance on all four indicators. /AIDS and Other Sexually Transmitted Infections - 12.4 KNOWLEDGE OF MOTHER-TO-CHILD TRANSMISSION AIDS education programmes include not only informing the population on how to avoid becom- ing infected with HIV, but also informing them what people living with the illness can do to prevent its transmission to other people. Table 12.5 shows the percentage of respondents who know that HIV can be transmitted from a mother to her child via breastfeeding. Overall, about half of the population know that mother-to-child transmission of HIV is possible through breastfeeding. This knowledge increases with increasing education. Few people (less than one in ten) know that a woman living with HIV can take drugs during pregnancy to reduce the risk of transmission. Table 12.5 Knowledge of prevention of mother-to-child transmission of HIV Percentage of women and men who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother to child trans mission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––– HIV can be HIV can be transmitted by transmitted by Risk of breastfeeding Risk of breastfeeding MTCT can be and risk of MTCT can be and risk of reduced by MTCT can be reduced by MTCT can be mother reduced by mother reduced by HIV can be taking drugs mother taking Number HIV can be taking drugs mother taking Number Background transmitted by during drugs during of transmitted by during drugs during of characteristic breastfeeding pregnancy pregnancy1 women breastfeeding pregnancy pregnancy1 men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 40.8 5.2 4.5 1,716 44.6 3.7 3.2 453 20-24 48.9 7.0 5.9 1,494 62.3 6.2 5.5 426 25-29 50.8 7.7 6.6 1,382 65.0 6.1 3.9 328 30-39 45.5 5.6 4.4 1,757 60.3 10.4 8.3 519 40-49 44.7 5.4 4.7 1,271 50.9 10.7 9.6 367 15-24 44.6 6.1 5.1 3,210 53.2 4.9 4.3 880 Marital status Never married 53.1 6.3 5.1 1,926 55.0 5.9 4.7 1,048 Ever had sex 62.8 7.4 5.6 838 64.9 6.3 5.1 489 Never had sex 45.7 5.4 4.7 1,087 46.4 5.7 4.3 559 Married/living together 43.4 6.0 5.2 5,336 57.7 9.2 7.8 1,006 Divorced/separated/ widowed 45.1 7.1 5.1 358 (57.5) (4.3) (4.3) 40 Residence Urban 57.1 8.2 6.7 2,629 57.4 8.4 7.4 792 Rural 40.1 5.0 4.4 4,991 55.8 6.9 5.4 1,301 Region North Central 48.3 7.7 7.4 1,121 70.2 8.5 7.9 313 North East 34.6 5.3 4.5 1,368 50.5 10.5 8.4 377 North West 33.0 7.3 6.0 2,095 56.5 7.9 6.5 529 South East 64.2 6.9 4.8 737 58.8 8.8 5.4 192 South South 58.8 5.5 4.5 1,342 60.9 2.9 2.9 385 South West 55.8 3.3 2.8 958 41.7 6.9 5.6 296 Education No education 28.9 4.1 3.6 3,171 42.4 4.7 4.3 385 Primary 45.2 4.7 4.2 1,628 45.7 5.1 3.4 519 Secondary 63.5 7.6 6.3 2,370 64.4 5.7 5.0 932 Higher 76.3 18.0 13.4 451 69.6 23.0 18.8 257 Wealth quintile Lowest 26.6 2.2 1.7 1,414 41.5 4.7 4.6 362 Second 34.0 3.4 3.1 1,439 51.8 6.4 6.4 360 Middle 45.4 6.1 5.2 1,513 62.3 8.8 5.5 392 Fourth 52.0 7.0 6.0 1,526 58.9 5.9 4.9 452 Highest 66.9 10.9 8.9 1,728 63.2 10.4 8.5 527 Total 45.9 6.1 5.2 7,620 56.4 7.5 6.2 2,093 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Knowledge Indicator 5 "Knowledge of prevention of mother to child transmission of HIV" HIV/AIDS and Other Sexually Transmitted Infections | 177 12.5 HIV TESTING AND COUNSELLING The 2003 NDHS asked all respondents who have heard of AIDS whether or not they have ever been tested for the illness, how long ago they were tested, and whether they received the test results the most recent time they were tested. Table 12.6 shows that 6 percent of women and 14 percent of men have ever been tested and received the results of their HIV test. Only 3 percent of women and 6 percent of men have been tested and received results during the 12 months preceding the survey. The likelihood of hav- ing been tested and receiving the results has a strong positive correlation with education and the wealth index. The vast majority of the population (approximately eight in ten) have never been tested for HIV. Table 12.6 Population who had an HIV test and received test results Percent distribution of women and men by HIV testing status, and percentage of women and men who were tested for HIV and received test results in the past 12 months, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage who were who were tested and tested and Ever tested received Ever tested received –––––––––––––– Don’t results Number –––––––––––––– Don’t results Number Background Received No Never know/ in past of Received No Never know/ in past of characteristic results results tested missing Total 12 months women results results tested missing Total 12 months men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 2.5 0.4 80.0 17.2 100.0 1.7 1,716 3.2 1.1 88.6 7.1 100.0 1.3 453 20-24 6.9 0.5 79.9 12.7 100.0 3.3 1,494 10.5 0.8 86.5 2.2 100.0 7.5 426 25-29 11.4 1.1 77.0 10.5 100.0 5.3 1,382 12.5 0.5 85.2 1.8 100.0 7.1 328 30-39 6.9 0.9 79.9 12.3 100.0 3.2 1,757 22.0 0.6 76.3 1.2 100.0 8.1 519 40-49 5.0 0.4 78.6 16.0 100.0 1.8 1,271 19.1 1.5 76.9 2.6 100.0 5.6 367 15-24 4.5 0.4 79.9 15.1 100.0 2.5 3,210 6.7 0.9 87.6 4.7 100.0 4.3 880 Marital status Never married 6.7 0.5 81.1 11.6 100.0 3.8 1,926 9.2 0.9 85.6 4.4 100.0 5.2 1,048 Ever had sex 12.8 0.9 80.9 5.5 100.0 7.3 838 17.0 1.0 80.8 1.3 100.0 10.0 489 Never had sex 2.1 0.3 81.3 16.4 100.0 1.0 1,087 2.3 0.8 89.9 7.0 100.0 1.0 559 Married/living together 6.1 0.7 78.5 14.7 100.0 2.6 5,336 18.1 0.9 79.4 1.6 100.0 6.4 1,006 Divorced/separated/ widowed 8.6 0.6 79.0 11.9 100.0 4.9 358 (16.3) (0.0 ) (80.1) (3.6) (100.0) (9.2) 40 Residence Urban 11.8 0.7 82.1 5.4 100.0 5.3 2,629 16.3 0.8 81.7 1.2 100.0 7.5 792 Rural 3.6 0.6 77.6 18.2 100.0 1.8 4,991 11.9 0.9 83.0 4.1 100.0 4.9 1,301 Region North Central 5.3 0.5 78.7 15.5 100.0 3.2 1,121 18.9 1.0 77.1 2.9 100.0 9.6 313 North East 1.3 0.1 74.3 24.3 100.0 0.7 1,368 12.6 1.8 82.8 2.7 100.0 6.0 377 North West 1.1 0.1 85.0 13.8 100.0 0.4 2,095 4.2 0.8 94.2 0.7 100.0 1.2 529 South East 22.9 0.2 72.4 4.5 100.0 9.3 737 25.4 0.4 73.5 0.7 100.0 11.5 192 South South 9.3 1.6 79.4 9.7 100.0 5.3 1,342 13.8 0.2 78.0 7.9 100.0 5.7 385 South West 9.8 1.7 78.7 9.7 100.0 4.0 958 17.8 0.7 78.8 2.7 100.0 6.6 296 Education No education 0.8 0.2 76.7 22.2 100.0 0.3 3,171 2.0 1.0 93.0 4.1 100.0 1.1 385 Primary 3.7 1.0 81.7 13.6 100.0 2.0 1,628 11.2 1.1 80.5 7.2 100.0 4.6 519 Secondary 12.2 0.7 81.8 5.2 100.0 5.5 2,370 14.6 0.8 83.7 1.0 100.0 6.1 932 Higher 25.0 2.2 72.8 0.0 100.0 12.7 451 32.3 0.8 66.5 0.4 100.0 15.0 257 Wealth quintile Lowest 1.2 0.1 68.2 30.6 100.0 0.4 1,414 6.1 1.5 84.7 7.7 100.0 2.9 362 Second 1.6 0.7 77.6 20.1 100.0 1.0 1,439 5.9 0.6 89.3 4.2 100.0 2.3 360 Middle 2.3 0.6 85.5 11.5 100.0 1.3 1,513 9.2 1.7 88.1 0.9 100.0 3.7 392 Fourth 6.5 0.7 85.6 7.2 100.0 2.5 1,526 15.7 0.0 81.4 2.8 100.0 6.7 452 Highest 18.2 1.1 78.2 2.5 100.0 8.9 1,728 25.3 0.8 73.2 0.7 100.0 11.4 527 Total 6.4 0.7 79.2 13.8 100.0 3.0 7,620 13.6 0.9 82.5 3.0 100.0 5.9 2,093 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 15-49 unweighted cases. 178 | HIV/AIDS and Other Sexually Transmitted Infections An appropriate opportunity for educating women about HIV/AIDS arises when they go for an antenatal visit during pregnancy. Table 12.7 shows the percentage of women who received any information or counselling regarding AIDS during an antenatal visit, among women who gave birth during the two years preceding the survey. Overall, almost one-quarter of women received counselling about HIV/AIDS during an antenatal care visit. A majority of women in the South East and South West (about six in ten) received AIDS counselling. Among women in other regions, those who re- ceived any information were in the minority, espe- cially in the North East and North West, where less than two in ten women received counselling about HIV/AIDS regarding AIDS. The percentage of women who received information or counseling during an antenatal care visit rises steadily with increasing education and increasing wealth quin- tile. Table 12.7 Pregnant women counselled about HIV Among women who gave birth in the two years preceding the survey, percentage who were counselled about HIV during antenatal care visit for the most recent birth, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––– Number of Counselled women who about HIV gave birth Background during in the past characteristic antenatal visit 2 years ––––––––––––––––––––––––––––––––––––––––––––––––– Age 12.6 SEXUAL NEGOTIATION, ATTITUDES, AND COMMUNICATION In an effort to assess the ability of women to negotiate safer sex with a spouse who has a sex- ually transmitted infection (STI), all respondents were asked two attitudinal questions. They were asked whether a wife is justified in refusing to have sex with her husband if she knows her hus- band has an STI and whether such a wife is justified in asking that her husband use a condom. Overall, about nine in ten Nigerians report that a woman may either refuse to have sex with her husband or ask him to wear a condom if she knows he has an STI (Table 12.8). More men than women report that a woman is justified in either behaviour, although both men and women are more likely to report that a woman may refuse to have sex than to propose using a condom. While there is no particular pattern in attitudes by education, the percen - pose condom use increases with increasing the educa believe a woman can propose condom use are in South women. 15-19 11.9 271 20-24 19.7 589 25-29 29.4 709 30-39 28.2 721 40-49 22.0 157 15-24 17.2 860 Marital status Never married 23.3 71 Married/living together 24.4 2,321 Divorced/separated/ widowed 22.6 55 Residence Urban 44.4 701 Rural 16.2 1,746 Region North Central 22.8 361 North East 14.9 554 North West 11.4 863 South East 58.8 137 South South 38.1 308 South West 59.9 223 Education No education 8.4 1,239 Primary 28.4 588 Secondary 49.5 542 Higher 71.3 78 Wealth quintile Lowest 8.7 530 Second 11.1 538 Middle 18.9 487 Fourth 32.0 477 Highest 58.9 414 Total 24.3 2,447 tage of people who believe that a woman can pro tion. Regions in which people are the least likely to South among men and in the North Central among HIV/AIDS and Other Sexually Transmitted Infections | 179 Table 12.8 Attitudes toward negotiating safer sex with husband Percentage of women and men who believe that, if a husband has an STI, his wife can either refuse to have sex with him or propose condom use, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Woman is justified to: Woman is justified to: –––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Refuse Refuse w . T p c - c - t w 180 | HIV/A sex or sex or Propose propose Number Propose propose Number Background Refuse condom condom of Refuse condom condom of characteristic sex use use1 women sex use use1 men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 73.5 64.3 81.1 1,716 80.9 70.3 87.0 453 20-24 84.1 76.5 90.9 1,494 90.8 84.8 96.0 426 25-29 88.3 79.7 93.2 1,382 93.5 85.0 97.1 328 30-39 87.0 74.4 90.8 1,757 96.9 84.9 98.4 519 40-49 85.9 70.4 91.0 1,271 94.2 78.3 95.9 367 15-24 78.5 70.0 85.6 3,210 85.7 77.3 91.4 880 Marital status Never married 75.3 69.7 84.1 1,926 86.9 78.7 91.9 1,048 Ever had sex 87.2 82.2 95.3 838 90.4 87.2 96.6 489 Never had sex 66.2 60.1 75.5 1,087 83.9 71.2 87.8 559 Married/living together 86.0 73.9 90.8 5,336 95.5 82.3 97.7 1,006 Divorced/separated/ widowed 89.1 74.4 90.7 358 (95.4) (87.3) (97.8) 40 Residence Urban 86.3 80.4 92.4 2,629 93.5 86.1 97.1 792 Rural 82.0 68.9 87.3 4,991 89.8 77.2 93.4 1,301 Region North Central 77.1 55.2 80.6 1,121 93.5 84.7 98.2 313 North East 90.1 74.0 92.2 1,368 96.7 79.2 98.6 377 North West 83.6 76.6 89.5 2,095 93.6 85.4 96.8 529 South East 71.5 70.8 85.8 737 94.1 91.7 99.3 192 South South 86.2 79.0 92.2 1,342 77.1 64.1 81.0 385 South West 86.3 76.6 91.8 958 94.0 83.6 97.8 296 Education No education 83.1 66.6 87.2 3,171 92.4 69.8 94.7 385 Primary 81.5 71.3 86.9 1,628 88.4 78.3 91.7 519 Secondary 83.3 79.4 91.4 2,370 91.5 83.2 95.5 932 Higher 93.9 88.3 97.7 451 93.8 91.7 98.6 257 Wealth quintile Lowest 81.2 62.1 85.6 1,414 88.7 69.8 90.8 362 Second 82.0 66.9 87.1 1,439 91.5 72.3 94.2 360 Middle 81.4 71.8 86.6 1,513 93.4 85.4 97.3 392 Fourth 86.4 78.7 91.5 1,526 88.2 81.4 92.2 452 Highest 85.7 82.4 93.7 1,728 93.6 89.4 98.3 527 Total 83.5 72.8 89.1 7,620 91.2 80.6 94.8 2,093 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Sexual Negotiation Indicator 1 "Women's ability to negotiate safer sex with husband" Men’s attitudes towards condoms directly affect their inclination to use them. Men were asked hether they agree with a series of statements regarding condoms; results are presented in Table 12.9 hirty percent of men agreed with the statement that condoms are inconvenient to use, and thirty-seven ercent agreed with the statement that condoms reduce sexual pleasure. Most men know that condoms annot be reused, although one-quarter agreed with the statement that condoms break easily. Thirty per ent of men agreed with the statement that a woman has no right to tell a man to use a condom. Sixty hree percent of men agree with the statement that a condom protects against disease. These questions ere asked regardless of whether or not the respondent had ever used a condom. IDS and Other Sexually Transmitted Infections Table 12.9 Men’s attitude toward condoms Percentage of men who agree with specific statements about condoms, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of men who agree with the following statements: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– A Condoms condom A A woman diminish is very A condom has no right a man’s incon- condom protects to tell a man Condoms Condoms Number Background sexual venient can be against to use a break are of characteristic pleasure to use reused disease condom easily expensive men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.5 16.4 5.8 46.4 23.9 16.1 6.9 453 20-24 38.1 30.0 9.8 68.1 37.1 23.3 10.9 426 25-29 47.6 38.5 9.4 74.4 33.4 31.8 16.9 328 30-39 42.8 36.1 8.6 69.9 28.5 30.2 10.1 519 40-49 37.2 27.7 7.9 58.5 26.2 20.4 6.7 367 Residence Urban 36.0 26.3 7.1 67.8 26.3 24.3 7.7 792 Rural 38.3 31.4 9.0 60.4 31.6 24.3 11.4 1,301 Region North Central 32.9 24.2 6.6 68.7 15.0 20.2 7.7 313 North East 42.5 32.3 3.1 59.4 25.5 19.6 5.0 377 North West 52.1 53.3 23.1 76.0 72.8 39.0 18.9 529 South East 34.2 19.9 1.4 51.5 10.0 27.4 19.1 192 South South 27.8 15.6 3.2 50.7 11.7 17.9 4.2 385 South West 24.2 13.2 1.1 63.1 9.2 14.6 4.9 296 Education No education 36.6 36.0 14.7 52.5 44.2 22.1 12.8 385 Primary 36.2 30.6 8.1 59.8 33.2 24.0 9.8 519 Secondary 35.9 25.6 6.3 64.8 24.1 23.9 8.5 932 Higher 46.8 31.6 6.0 79.9 20.6 29.6 11.7 257 Condom use Used at last sex 47.5 27.3 5.4 96.5 20.2 26.2 13.6 253 Ever used (not at last sex) 65.8 41.3 6.5 93.0 19.6 39.0 11.5 310 Never used 30.0 27.5 9.1 51.6 33.2 21.0 9.1 1,530 Marital status Never married 32.5 24.2 6.4 59.4 26.3 20.4 9.0 1,048 Ever had sex 46.9 31.0 7.2 76.6 21.2 25.4 12.0 489 Never had sex 19.9 18.2 5.7 44.3 30.7 16.0 6.4 559 Married or living together 42.3 35.1 10.1 66.4 33.4 28.3 11.2 1,006 Divorced/separated/ widowed (44.3) (27.2) (11.3) (81.4 ) (20.1) (25.3) (6.5) 40 Wealth quintile Lowest 33.5 29.1 13.7 49.7 33.5 24.4 14.0 362 Second 39.8 33.0 11.1 59.7 38.7 26.2 11.4 360 Middle 43.9 38.6 8.1 70.9 41.1 26.4 11.8 392 Fourth 33.6 27.6 5.6 63.3 25.9 19.9 5.2 452 Highest 37.0 22.2 5.0 68.8 15.3 25.2 9.2 527 Total 37.4 29.5 8.3 63.2 29.6 24.3 10.0 2,093 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on fewer than 25-49 unweighted cases. HIV/AIDS and Other Sexually Transmitted Infections | 181 In addition to asking about attitudes, the 2003 NDHS also directly asked respondents whether or not they have ever discussed ways to prevent getting the virus that causes AIDS with their partners. Table 12.10 presents these data for women and men who are currently married or living with a partner. Nation- ally, 36 percent of married women and 58 percent of married men say that they have discussed prevention of AIDS with their partners. In all regions, percentages reporting AIDS prevention discussion with their partners are higher among men than among women. Although discussion of AIDS with partners is far from universal, Nigerians are accepting of 182 communication regarding AIDS. Nine in ten Nigerians report that discussion of AIDS in the media and other venues is acceptable (data not shown). This is true for women and men and across educational and regional characteristics. People overwhelmingly approve (over 90 percent) discussion of AIDS in the newspaper, on the radio, on television, in churches, in mosques, at home, and in schools. Table 12.10 Discussion of HIV/AIDS with partner Percent distribution of women and men who are currently married or living with a partner by whether they ever discussed HIV/AIDS prevention with their husband/partner, according to background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––– Ever Never Has not Ever Never Has not discussed discussed Don’t heard Number discussed discussed Don’t heard Number Background HIV/AIDS HIV/AIDS know/ of of HIV/AIDS HIV/AIDS know/ of of characteristic prevention prevention missing AIDS Total women prevention prevention missing AIDS Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.6 55.9 0.4 20.1 100.0 545 * * * * * 5 20-24 36.6 47.2 0.3 15.8 100.0 911 52.3 44.3 0.0 3.4 100.0 60 25-29 43.1 44.9 0.5 11.5 100.0 1,146 50.7 48.5 0.0 0.8 100.0 142 30-39 36.9 50.4 0.3 12.4 100.0 1,611 61.4 37.4 0.2 1.1 100.0 447 40-49 34.2 48.5 0.6 16.7 100.0 1,123 57.0 40.7 0.2 2.2 100.0 352 Residence Urban 50.2 44.9 0.8 4.1 100.0 1,633 68.1 31.6 0.2 0.0 100.0 327 Rural 30.1 50.6 0.3 19.1 100.0 3,703 52.5 45.1 0.1 2.4 100.0 679 Region North Central 38.6 43.2 0.0 18.2 100.0 754 60.2 35.2 0.0 4.6 100.0 139 North East 23.7 52.2 0.1 24.1 100.0 1,122 45.0 53.2 0.1 1.7 100.0 241 North West 26.0 59.4 0.9 13.7 100.0 1,880 52.8 46.8 0.2 0.2 100.0 305 South East 61.9 34.6 0.6 2.8 100.0 368 72.9 26.5 0.6 0.0 100.0 85 South South 51.7 39.0 0.1 9.2 100.0 664 63.2 32.5 0.0 4.2 100.0 115 South West 58.1 34.9 0.5 6.5 100.0 548 75.4 24.6 0.0 0.0 100.0 121 Education No education 21.1 56.7 0.5 21.8 100.0 2,877 41.5 55.5 0.0 3.1 100.0 284 Primary 42.4 47.1 0.6 9.9 100.0 1,175 55.3 41.9 0.2 2.5 100.0 286 Secondary 61.5 35.4 0.2 2.9 100.0 1,046 69.9 29.8 0.3 0.0 100.0 300 Higher 78.6 21.4 0.0 0.0 100.0 238 68.7 31.3 0.0 0.0 100.0 136 Total 36.2 48.8 0.4 14.5 100.0 5,336 57.6 40.7 0.1 1.6 100.0 1,006 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 12.7 HIGH-RISK SEX AND CONDOM USE Engaging in sexual intercourse with someone other than a spouse or a partner with whom one is living is considered high-risk sexual activity in terms of transmitting an STI. If a person does have sex with a nonmarital, noncohabiting partner, the risk of contracting HIV can be reduced by using condoms. Table 12.11 shows the percentage of women and men who had sex with a partner other than with whom they are married or living, among all women and men who reported having sex at some time in the 12 months preceding the survey. Those who had engaged in sex with a nonmarital, noncohabiting partner were then asked whether they used a condom the last time they engaged in sex with such a partner. | HIV/AIDS and Other Sexually Transmitted Infections Table 12.11 High-risk sex and condom use at last high-risk sex: women and men age 15-49 Among women and men reporting sexual activity in the past 12 months, percentage who had sex with a nonmarital, noncohabiting part- ner (high-risk sex) in the past 12 months, and among these women and men, percentage who say they used a condom the last time they had sex with a nonmarital, noncohabiting partner, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––– Number Number Percentage Number of women Percentage Number of men engaging of women Percentage who had engaging of men Percentage who had in high- sexually who used high-risk in high- sexually who used high-risk risk sex active in condom at sex in risk sex active in condom at sex in Background in the past the past last high- past in the past the past last high- past characteristic 12 months1 12 months risk sex2 12 months 12 months1 12 months risk sex2 12 months ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 34.6 819 22.0 283 94.1 83 32.8 78 20-24 25.8 1,167 26.0 301 72.4 218 53.0 158 25-29 10.6 1,243 29.3 131 55.7 254 43.8 141 30-39 4.8 1,579 14.9 76 23.3 477 48.0 111 40-49 4.0 1,045 (8.3) 42 14.4 341 56.9 49 15-24 29.4 1,987 24.0 585 78.4 301 46.3 236 Marital status Never married 99.5 672 25.8 669 99.5 374 45.9 372 Married/living together 1.3 4,989 6.2 64 14.6 970 50.7 141 Divorced/separated/ widowed 52.1 193 17.5 101 (81.9) 29 (40.4) 23 Residence Urban 19.1 1,939 30.4 371 46.3 479 59.4 222 Rural 11.8 3,915 17.5 463 35.3 894 38.2 316 Region North Central 15.3 755 23.8 115 52.9 216 43.0 114 North East 4.3 1,122 5.7 48 31.3 286 35.2 90 North West 1.7 1,898 (24.3) 31 6.5 317 (29.6) 21 South East 30.3 486 21.9 147 44.5 105 75.6 47 South South 36.9 988 19.6 364 60.4 247 37.8 149 South West 21.1 605 40.9 128 58.0 201 63.0 116 Education No education 2.4 2,795 4.2 67 10.6 293 (23.0) 31 Primary 11.6 1,209 10.9 140 32.0 354 33.3 113 Secondary 34.1 1,504 25.5 513 56.6 527 48.6 299 Higher 32.9 346 39.4 114 47.5 198 66.0 94 Wealth quintile Lowest 8.0 1,151 11.9 92 33.6 247 18.7 83 Second 8.4 1,176 11.6 99 23.0 244 34.7 56 Middle 11.4 1,145 14.3 130 32.6 269 47.4 88 Fourth 19.4 1,120 24.2 218 55.4 256 48.3 142 Highest 23.4 1,262 34.0 296 47.2 357 63.6 168 Total 14.2 5,855 23.2 834 39.1 1,373 46.9 537 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Sexual Behaviour Indicator 1 "High-risk sex in the last year" 2 Corresponds to UNAIDS Sexual Behaviour Indicator 2 "Condom use at last high-risk sex" A larger proportion of men than women reported having had high-risk sex at some time in the past 12 months (39 percent of men versus 14 percent of women). Less than half of all men (47 percent) and less than one-quarter (23 percent) of women reported using a condom the last time they had sex with a nonmarital, noncohabiting partner. Fifteen percent of men who are currently married or cohabiting re- port having had sex with a nonmarital, noncohabiting partner in the past 12 months. The percentage of respondents who have had sex with a nonmarital, noncohabiting partner increases with increasing educa- tion for both women and men, as does the percentage who used a condom the last time they had sex with such a partner. HIV/AIDS and Other Sexually Transmitted Infections | 183 The prevalence of high-risk sex among sexually active young people is presented in Table 12.12, along with condom use at last high-risk sex. Overall, 29 percent of women and 78 percent of men age 15- 24 engaged in high-risk sex in the 12 months preceding the survey. Among young people who had high- risk sex, approximately one-quarter of women and slightly less than half of men used a condom at last high-risk sex. The percentage of young women engaging in high-risk sex increases steadily with increas- 184 | H ing education, as does reported use of condoms. There is an insufficient number of cases of men to allow for analysis by education. Table 12.12 High-risk sex and condom use at last high-risk sex among young women and men by background characteristics Among women and men age 15-24 reporting sexual activity in the past 12 months, percentage who had sexual relations with a nonmarital, noncohabiting partner (high-risk sex) in the past 12 months, and among these young women and men, percentage who say they used a con- dom the last time they had sex with a nonmarital, noncohabiting partner, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Number Number Percentage Number of women Percentage Number of men engaging of women Percentage 15-24 who engaging of men Percentage 15-24 who in high- sexually used had high- in high- sexually used had high- risk sex active in condom at risk sex in risk sex active in condom at risk sex Background in the past the past last high- the past in the past the past last high- in the past characteristic 12 months 12 months risk sex1 12 months 12 months 12 months risk sex1 12 months –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 34.6 819 22.0 283 94.1 83 32.8 78 20-24 25.8 1,167 26.0 301 72.4 218 53.0 158 Marital status Never married 99.7 533 25.3 532 99.2 232 46.5 231 Ever married 3.7 1,454 (11.4) 53 7.4 68 * 5 Residence Urban 40.7 588 33.5 239 85.9 115 61.7 99 Rural 24.7 1,399 17.4 345 73.7 186 35.2 137 Region North Central 35.1 252 20.5 88 91.7 59 41.0 54 North East 8.1 389 (5.8) 31 (70.9) 46 (25.6) 32 North West 2.0 674 * 13 (19.5) 49 * 9 South East 70.0 153 24.6 107 (98.8) 22 (71.6) 22 South South 70.6 364 19.3 257 94.5 70 39.3 66 South West 56.7 154 47.6 88 93.7 55 66.3 52 Education No education 3.4 874 * 30 (16.4) 24 * 4 Primary 25.4 353 11.9 90 59.4 62 (28.5) 37 Secondary 59.8 687 25.1 411 89.8 192 45.8 173 Higher 75.4 73 44.1 55 * 23 * 22 Wealth quintile Lowest 16.9 384 14.0 65 64.9 68 (22.8 ) 44 Second 20.4 376 12.6 77 68.7 46 (29.2) 32 Middle 21.8 439 12.6 96 60.3 45 (47.9) 27 Fourth 36.1 422 24.0 152 93.9 69 47.5 65 Highest 53.3 366 37.5 195 93.7 72 67.7 68 Total 29.4 1,987 24.0 585 78.4 301 46.3 236 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 5 "Young people using a condom at last high-risk sex" IV/AIDS and Other Sexually Transmitted Infections Substantial regional variation exists among young women who are sexually active. Most young women in the South East and the South South (seven in ten) who are sexually active have sex with non- cohabiting partners. Only 19 to 25 percent of these women used a condom the last time they had sex. Women in the North East and the North West who have been sexually active with a noncohabiting partner are in a small minority. Figure 12.1 shows the distribution of young people age 15-24 with regard to sex- ual activity with cohabiting and noncohabiting partners. Nationally, most young women who are sexually active have a partner with whom they are living, while most young men who are sexually active are not living with their partners. On the other hand, young men who are sexually active are a smaller population than young women who are sexually active. Figure 12.1 High-Risk Sex among Cohabiting and Noncohabiting Young Women and Men 15-19 20-24 15-24 15-19 20-24 15-24 0 20 40 60 80 100 Never had sex Sex, not in past year Sex with cohabiting partner only & condom Sex with cohabiting partner only & no condom Sex with noncohabiting partner & condom Sex with noncohabiting partner & no condom NDHS 2003 WOMEN MEN Table 12.13 shows that 3 percent of men report having had sex with a prostitute in the 12 months preceding the survey. Approximately half (48 percent) of the men who had sex with a prostitute used a condom (data not shown). HIV/AIDS and Other Sexually Transmitted Infections | 185 Table 12.13 Paid sex in past year Percentage of men reporting sex with a prostitute in the past 12 months, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––– Percentage reporting sex with prostitute Background in past Number characteristic 12 months1 of men –––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.8 453 20-24 3.9 426 25-29 3.3 328 30-39 3.0 519 12.8 SEXUAL BEHAVIOUR Promoting change i grammes. Those who are no thought to be accepting of pr on young women and men ag One of the strategies age at which they become se had sex by exact ages 15 an before the age of 15, and hal 186 | HIV/AIDS and Other Sexually Transmitted 40-49 2.5 367 15-24 2.8 880 Marital status Never married 2.7 1,048 Married/living together 2.4 1,006 Divorced/separated/ widowed (17.9) 40 Residence Urban 1.8 792 Rural 3.5 1,301 Region North Central 0.7 313 North East 6.3 377 North West 1.8 529 South East 2.5 192 South South 3.8 385 South West 1.7 296 Education No education 2.9 385 Primary 3.2 519 Secondary 3.0 932 Higher 1.6 257 Wealth quintile Lowest 6.5 362 Second 2.5 360 Middle 1.9 392 Fourth 2.2 452 Highest 2.0 527 Total 2.9 2,093 –––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 un- weighted cases. 1 Corresponds to UNAIDS Sexual Behaviour Indicator 3 "Commercial sex in the last year" AMONG YOUNG PEOPLE n sexual behaviour is a key feature of many HIV/AIDS prevention pro- t yet sexually active or those who have recently made their sexual debut are ogrammes focusing on behaviour change. Thus, the next several tables focus e 15-24 and the sexual behaviours that affect their risk of exposure to HIV. for reducing the risk of contracting an STI is for young persons to delay the xually active. Table 12.14 shows the percentage of young people who have d 18, by background characteristics. One-fifth of women age 15-19 had sex f of women age 20-24 had sex by the time they were age 18. Proportions of Infections Table 12.14 Age at first sex among young women and men Percentage of women and men age 15-24 who have had sex by exact age 15 and 18, by background characteris- tics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––– –––––––––––––––––––––––––––– Percent who had sex Number Percent who had sex Number by exact age of by exact age of Background –––––––––––––– women ––––––––––––––– men characteristic 15 18 age 15-24 15 18 age 15-24 men who ) of ever-mar es is not nearl men and wom in- creasing ong women w T Table 12 source, o to know ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-17 21.5 na 988 5.3 na 237 18-19 18.6 52.2 728 10.8 28.8 216 15-19 20.3 na 1,716 7.9 na 453 20-22 20.3 53.5 1,061 5.9 23.8 298 23-24 23.3 55.6 433 3.0 18.8 128 20-24 21.2 54.1 1,494 5.1 22.3 426 Marital status Never married 6.4 na 1,685 6.4 na 809 Ever married 36.5 na 1,525 8.3 na 70 Residence Urban 10.7 na 1,093 5.3 na 351 Rural 25.8 na 2,117 7.3 na 529 Region North Central 16.8 na 486 12.2 na 143 North East 31.0 na 543 3.6 na 118 North West 36.1 na 815 3.1 na 224 South East 4.3 na 332 7.5 na 82 South South 14.0 na 630 9.2 na 186 South West 4.3 na 405 4.1 na 127 Education No education 41.5 na 1,008 4.0 na 100 Primary 21.3 na 626 5.4 na 198 Secondary 7.7 na 1,442 7.8 na 536 Higher 0.3 na 134 1.6 na 46 Wealth quintile Lowest 35.2 na 537 9.4 na 166 Second 29.3 na 542 2.8 na 148 Middle 21.9 na 695 6.9 na 150 Fourth 17.1 na 707 7.8 na 224 Highest 6.0 na 729 5.1 na 192 Total 20.7 na 3,210 6.5 na 880 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Percentage who had sex by exact age 18 are not analyzed by background characteristics because respon- dents age 15-17 have not yet lived to age 18 and thus cannot contribute to the denominator. na = Not applicable initiated sexual activity by these ages are significantly lower. Over one-third (37 percent ried women age 15-24 first had sex before the age of 15. Initiation into sex at such young ag y as common among the never-married. Among the never-married, just 6 percent of both en had sex by age 15. The percentage of women who had sex before age 15 declines with education, from 42 percent among women with no education, to less than 1 percent am ith higher education. he 2003 NDHS asked respondents whether or not they know of a place to obtain condoms. .15 presents statistics on whether or not young women and men age 15-24 know of at least one ther than their family or friends. Overall, young women are less than half as likely as young men of a source for condoms, although there is a great deal of variation by background characteristics. HIV/AIDS and Other Sexually Transmitted Infections | 187 Knowledge of a s men. Very few y climbs to nearly t gional variation i know of a source young women, ran Table 12.15 Knowledge of a source for condoms among young women and men Percentage of women and men age 15-24 who know at least one source for male con- doms, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––– –––––––––––––––––––––– Know a Number Know a Number Background source for of women source for of men characteristic male condoms age 15-24 male condoms age 15-24 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 19.0 1,716 49.9 453 20-24 29.8 1,494 66.9 426 15-24 24.0 3,210 58.1 880 Marital status Never married 33.4 1,685 59.6 809 Ever had sex 52.8 646 80.0 307 Never had sex 21.3 1,039 47.1 502 Ever married 13.7 1,525 41.6 70 Residence Urban 35.2 1,093 67.0 351 Rural 18.3 2,117 52.2 529 Region North Central 21.2 486 56.2 143 The perce Table 12.16, amon of men age 15-24 one-fifth reported the last time they likely to have use 188 | HIV/AIDS and Other Sexual ource for condoms increases greatly with increasing education among both women and oung women with no education report knowing a source (4 percent), but this figure wo-thirds of young women with higher education knowing of a source (64 percent). Re- s also significant. Twice as many young men in the South West as in the North West (84 and 42 percent, respectively). Regional variation is even more dramatic among ging from 6 percent in the North West to 51 percent in the South West. North East 10.5 543 52.9 118 North West 6.2 815 42.0 224 South East 33.9 332 77.9 82 South South 38.1 630 55.7 186 South West 51.3 405 84.4 127 Education No education 3.5 1,008 17.5 100 Primary 14.8 626 37.9 198 Secondary 38.7 1,442 71.1 536 Higher 64.0 134 81.7 46 Wealth quintile Lowest 6.7 537 35.1 166 Second 11.8 542 45.5 148 Middle 16.1 695 59.6 150 Fourth 30.0 707 61.8 224 Highest 47.5 729 82.5 192 Total 24.0 3,210 58.1 880 ntage of young people who used a condom the first time they had sex is presented in g those who have ever had sexual intercourse. Only 6 percent of women and 17 percent reported using a condom the first time they had sex. Among young, never-married men, using a condom the first time they had sex, even though almost half reported doing so had sex (see Table 12.17). Young women and men with higher education are the most d a condom the first time they had sex, as are women and men in the South West. ly Transmitted Infections Table 12.16 Condom use at first sex among young women and men Among women and men age 15-24 who have ever had sex, percentage who used a con- dom the first time they ever had sex, by background characteristics Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––– ––––––––––––––––––––– Number of Number women age of men age Used a 15-24 who Used a 15-24 who Background condom have ever condom have ever characteristic at first sex1 had sex at first sex1 had sex –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 6.5 877 10.6 112 20-24 6.4 1,291 19.6 265 Marital status Never married 17.6 646 20.2 307 Ever married 1.7 1,523 2.8 70 Residence Table 12. 12 months preced Three out of ten women and 29 pe course, and one-q young persons as twice as likely to Urban 12.1 654 27.3 139 Rural 4.0 1,514 10.9 239 Region North Central 7.1 301 12.4 74 North East 0.5 411 8.2 56 North West 0.6 690 6.4 56 South East 16.9 169 27.5 36 South South 8.0 407 11.5 89 South West 26.5 191 39.9 66 Education No education 0.3 909 (0.0) 32 Primary 3.0 400 8.7 78 Secondary 11.8 775 17.0 242 Higher 39.3 85 (62.1) 26 Wealth quintile Lowest 2.0 417 7.7 84 Second 1.5 405 8.3 52 Middle 2.4 474 10.5 61 Fourth 6.8 451 18.3 87 Highest 19.8 421 33.0 94 Total 6.4 2,169 16.9 378 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 6 "Condom use at first sex" 17 presents the percentage of never-married young women and men who had sex in the ing the survey, as well as the percentage who used a condom the last time they had sex. never-married respondents age 15-24 had sex in the past 12 months (32 percent of rcent of men). About half of the men reported using a condom during last sexual inter- uarter of the women reported doing so. There are no urban-rural differences among to whether or not they have had premarital sex, but urban women and men are about have used a condom the last time they had sex. HIV/AIDS and Other Sexually Transmitted Infections | 189 Table 12.17 Prevalence of premarital sex in the past year and use of a condom during premarital sex among young women and men Among never-married women and men age 15-24, percentage who had sex in the past 12 months, and, among those who had premarital sex in the past 12 months, percentage who used a condom at last sex, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Never-married women Never-married men ––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Number Number Number of women Number of men of never- 15-24 of never- 15-24 Had sex married Used sexually active Had sex married Used sexually active Background in past women condom in the past in past men condom in the past characteristic 12 months1 15-24 at last sex2 12 months 12 months1 15-24 at last sex2 12 months –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.3 1,145 23.0 267 17.4 448 32.8 78 20-24 49.4 540 27.0 267 42.8 361 53.7 154 Residence Urban 31.1 708 35.9 220 29.4 332 63.6 98 Rural 32.0 977 17.4 313 28.2 477 34.3 135 Region North Central 29.0 282 21.2 82 38.7 138 41.5 53 190 | North East 15.0 162 (6.6) 24 29.6 103 (27.2) 30 North West 5.4 136 * 7 4.9 184 * 9 South East 37.1 282 24.1 104 26.8 82 (71.6) 22 South South 46.8 497 19.2 233 36.6 182 39.0 67 South West 25.3 326 50.5 83 42.3 121 65.8 51 Education No education 16.9 119 * 20 2.9 78 * 2 Primary 24.3 329 11.1 80 20.8 171 (24.2) 35 Secondary 33.9 1,124 25.7 381 33.5 515 46.6 172 Higher 46.0 113 46.4 52 48.9 46 * 22 Wealth quintile Lowest 28.9 188 14.1 54 30.6 142 (23.0) 43 Second 31.7 221 13.8 70 23.9 134 (29.2) 32 Middle 26.5 325 10.8 86 20.1 132 (46.5) 26 Fourth 33.8 405 24.5 137 28.8 217 47.4 62 Highest 34.1 545 39.4 186 36.8 186 69.2 68 Total 31.6 1,685 25.0 533 28.7 809 46.7 232 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. 1 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 2 "Young people having premarital sex" 2 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 3 "Young people using a condom during premarital sex" Age-mixing in sexual relationships is a major factor in the spread of HIV/AIDS. If a younger, un- infected partner has sex with an older, infected partner, this can introduce the virus into a younger, unin- fected cohort. Table 12.18 shows the percentage of teenage women who had a partner ten or more years their senior. One in five women age 15-17 who have had high-risk sexual intercourse did so with some- one ten or more years their senior. HIV/AIDS and Other Sexually Transmitted Infections Table 12.18 Age mixing in sexual relationships Among women age 15-19 who had nonmarital sex in the past 12 months, percentage who had nonmarital sex with a man 10 or more years older than themselves, by background character- istics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––– Number of Percentage women age who had 15-19 who had nonmarital nonmarital sex with sex in Background a man 10+ the past characteristic years older1 12 months ––––––––––––––––––––––––––––––––––––––––––––––– Age Those who are sexu partners with whom they en age 15-24 who have had sex people with multiple partne have had sex with more tha 7 percent of women in the S partner. 15-17 21.3 122 18-19 4.2 161 Marital status Never married 10.3 265 Ever married * 18 Residence Urban 14.7 110 Rural 9.6 173 Region North Central (25.5) 45 North East * 13 North West * 5 South East 12.8 55 South South 8.7 133 South West (4.2) 33 Education No education * 14 Primary (12.2) 48 Secondary 12.2 211 Higher * 11 Wealth quintile Lowest (10.1) 29 Second (3.3) 42 Middle (10.8) 46 Fourth 19.0 79 Highest 9.8 86 Total 11.6 283 ––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 un- weighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been sup- pressed. 1 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 7 “Age-mixing in sexual relationships” (among the last three partners in the past 12 months) ally active can reduce their risk of exposure to HIV by limiting the number of gage in sexual contact. Table 12.19 shows the percentage of women and men with more than one partner in the past 12 months. The percentage of young rs is fairly low. Overall, 2 percent of women and 8 percent of men age 15-24 n one person in the past 12 months. Differentials by region are more marked: outh South and 16 percent of men in the North East have had more than one HIV/AIDS and Other Sexually Transmitted Infections | 191 Table 12.19 Multiple sex partnerships among young women and men Among women and men age 15-24, percentage who have had sex with more than one partner in the past 12 months, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––– ––––––––––––––––––––– Percentage Percentage who had Number who had Number 2+ partners of 2+ partners of Background in the past women in the past men characteristic 12 months1 age 15-24 12 months1 age 15-24 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.9 1,716 4.9 453 20-24 3.8 1,494 12.2 426 Marital status Never married 2.9 1,685 8.8 809 Ever married 1.5 1,525 4.4 70 Residence Urban 2.5 1,093 7.2 351 Rural 2.1 2,117 9.3 529 Figure 12 in the past 12 mon with more than o percent of women sex, but they had reported that they months. 192 | HIV/AIDS and Other Sexua Region North Central 1.1 486 9.0 143 North East 1.2 543 15.8 118 North West 0.6 815 1.8 224 South East 1.5 332 6.7 82 South South 7.2 630 9.9 186 South West 1.1 405 11.6 127 Education No education 0.9 1,008 1.3 100 Primary 1.7 626 5.3 198 Secondary 3.0 1,442 10.7 536 Higher 6.7 134 11.1 46 Wealth quintile Lowest 1.9 537 9.5 166 Second 1.5 542 10.3 148 Middle 2.0 695 6.4 150 Fourth 2.9 707 6.5 224 Highest 2.6 729 9.8 192 Total 2.2 3,210 8.4 880 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Corresponds to UNAIDS Young People's Sexual Behaviour Indicator 4 "Young people having multiple partners in last year" .2 shows the distribution of young people age 15-24 by the number of partners they had ths and by whether or not they used a condom. Seven percent of men age 20-24 had sex ne partner and did not use a condom the last time they had sex; this is true for only 3 age 20-24. Two-thirds of women age 20-24 did not use a condom the last time they had sex with only one partner in the past 12 months. Nearly 40 percent of men age 20-24 had never had sex, and an additional 11 percent had had sex, but not in the past 12 lly Transmitted Infections Figure 12.2 Abstinence, Being Faithful, and Using Condoms Among Young Women and Men 15-19 20-24 15-24 15-19 20-24 15-24 0 20 40 60 80 100 Never had sex Sex, not in past year Sex with 1 partner only & condom Sex with 1 partner only & no condom Sex with >1 partner & condom Sex with >1 partner & no condom NDHS 2003 WOMEN MEN 12.9 SEXUALLY TRANSMITTED INFECTIONS It is important for people experiencing symptoms of STIs to be able to recognize them and seek appropriate treatment. People who do not know the symptoms may fail to recognize that they need treat- ment and, consequently, may not seek help. All 2003 NDHS respondents were asked whether they had ever heard about infections other than HIV that can be transmitted through sexual contact. Those who had heard of an STI were then asked to state what symptoms a man or a woman with an STI (other than HIV) might have. Table 12.20.1 shows that 55 percent of women have never heard of STIs. One-fifth of all women could identify a symptom a man might have, and one-fifth could identify a symptom a woman might have. Knowledge of STIs among men is higher. Most men have heard of an STI (71 percent), although not all who have heard of STIs could identify a symptom a man or woman with an STI might experience. Thirty-five percent of all men could identify a symptom a man might experience, and 18 percent could identify a symptom a woman might experience (Table 12.20.2). Knowledge of symptoms rises with in- creasing education and increasing household economic status (higher wealth quintiles) among both women and men. All 2003 NDHS respondents who had ever had sex were asked whether they had an STI in the past 12 months. They were also asked whether they had experienced any abnormal genital discharge or a genital sore or ulcer in the past 12 months. These data are likely to underestimate the true prevalence of STIs for a number of reasons. For example, if symptoms are not obvious or prolonged, they may not be recognized as an STI. Furthermore, even if a respondent knows that she or he has an STI, the respondent may be reluctant to report it, because of embarrassment or presumed stigma associated with such infec- tions. HIV/AIDS and Other Sexually Transmitted Infections | 193 Table 12.20.1 Knowledge of symptoms of STIs: women Percentage of women with knowledge of symptoms associated with sexually transmitted infections (STIs) in a man and in a woman, by background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Knowledge of symptoms Knowledge of symptoms of STIs in a man of STIs in a woman –––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––– Two Two No No One or more No One or more knowl- symptoms symptom symptoms symptoms symptom symptoms Number Background edge men- men- men- men- men- men- of characteristic of STIs tioned tioned tioned Missing tioned tioned tioned Missing women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 194 | HIV/A 15-19 70.8 13.1 7.3 8.7 0.0 14.9 5.8 8.5 0.0 1,716 20-24 53.4 18.0 11.1 17.5 0.1 19.6 8.9 18.1 0.1 1,494 25-29 46.1 16.3 12.4 25.1 0.1 15.9 11.7 26.2 0.1 1,382 30-39 51.6 14.0 12.5 21.9 0.0 13.8 12.0 22.6 0.0 1,757 40-49 51.5 13.0 11.6 23.9 0.0 14.4 9.0 25.2 0.0 1,271 Marital status Never married 52.1 19.5 12.5 15.9 0.0 22.2 9.5 16.1 0.0 1,926 Ever had sex 32.2 27.9 17.3 22.6 0.0 31.5 12.5 23.7 0.0 838 Never had sex 67.4 13.0 8.8 10.8 0.0 15.0 7.3 10.3 0.0 1,087 Married or living together 57.2 13.1 10.1 19.7 0.0 13.3 9.2 20.3 0.0 5,336 Divorced/separated/ widowed 44.1 16.3 14.6 25.0 0.0 14.9 12.2 28.8 0.0 358 Residence Urban 45.8 17.4 13.6 23.1 0.0 18.8 12.1 23.3 0.0 2,629 Rural 60.3 13.5 9.5 16.8 0.0 14.0 8.0 17.7 0.0 4,991 Region North Central 55.4 16.6 9.3 18.6 0.0 17.8 8.3 18.4 0.0 1,121 North East 71.1 6.9 3.9 18.1 0.0 5.9 3.7 19.2 0.0 1,368 North West 71.4 6.5 6.6 15.4 0.1 6.1 5.7 16.8 0.1 2,095 South East 38.0 28.7 13.4 19.8 0.0 25.8 12.0 24.2 0.0 737 South South 35.0 22.8 19.2 23.0 0.0 27.7 12.9 24.5 0.0 1,342 South West 39.0 20.5 18.5 22.1 0.0 23.4 20.1 17.5 0.0 958 Education No education 74.3 7.1 5.5 13.0 0.1 6.7 5.1 13.8 0.1 3,171 Primary 53.4 16.6 11.1 18.9 0.0 16.6 10.3 19.7 0.0 1,628 Secondary 39.9 22.2 16.1 21.8 0.0 25.2 13.0 21.9 0.0 2,370 Higher 8.4 23.7 21.2 46.7 0.0 25.1 18.0 48.4 0.0 451 Wealth quintile Lowest 69.4 9.7 8.2 12.7 0.0 8.9 7.6 14.1 0.0 1,414 Second 66.2 12.1 6.3 15.3 0.1 12.2 6.1 15.4 0.1 1,439 Middle 62.6 12.4 8.5 16.4 0.0 13.8 6.9 16.7 0.0 1,513 Fourth 51.6 14.7 12.7 21.1 0.0 15.3 11.0 22.1 0.0 1,526 Highest 31.5 23.6 17.3 27.6 0.0 26.0 14.4 28.1 0.0 1,728 Total 55.3 14.8 10.9 19.0 0.0 15.7 9.4 19.6 0.0 7,620 IDS and Other Sexually Transmitted Infections Table 12.20.2 Knowledge of symptoms of STIs: men Percentage of men with knowledge of symptoms associated with sexually transmitted infections (STIs) in a man and in a woman, by background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Knowledge of symptoms Knowledge of symptoms of STIs in a man of STIs in a woman –––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––– Two Two No No One or more No One or more nths prec two STI re- port t of neve knowl- symptoms symptom symptoms symptoms symptom symptoms Number Background edge men- men- men- men- men- men- of characteristic of STIs tioned tioned tioned tioned tioned tioned men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 54.2 16.2 16.4 13.2 29.8 9.2 6.8 453 20-24 32.5 19.5 17.2 30.8 42.9 7.5 17.1 426 25-29 19.4 17.9 23.7 39.0 52.5 10.5 17.6 328 30-39 17.1 14.3 18.9 49.6 43.3 13.9 25.8 519 40-49 17.9 18.2 18.9 44.9 47.2 11.3 23.5 367 Marital status Never married 35.8 18.0 17.9 28.2 41.0 9.1 14.1 1,048 Ever had sex 15.8 18.9 22.1 43.3 51.3 12.5 20.4 489 Never had sex 53.3 17.3 14.3 15.0 31.9 6.1 8.6 559 Married or living together 22.2 16.3 19.6 42.0 43.6 11.9 22.4 1,006 Divorced/separated/ widowed (10.0) (10.0) (20.7) (59.4) (50.9) (17.0) (22.1) 40 Residence Urban 26.5 18.0 21.0 34.4 46.7 11.1 15.6 792 Rural 30.1 16.4 17.4 36.0 39.8 10.3 19.8 1,301 Region North Central 21.9 12.3 20.0 45.7 41.5 12.1 24.5 313 North East 41.6 6.2 16.1 36.0 24.9 10.3 23.2 377 North West 38.2 16.9 19.1 25.8 37.7 9.3 14.8 529 South East 14.2 21.5 17.2 47.1 45.7 3.9 36.2 192 South South 24.0 25.6 13.7 36.7 56.2 9.9 9.9 385 South West 18.3 21.9 28.0 31.8 54.1 17.0 10.5 296 Education No education 45.6 15.0 15.5 23.9 34.4 8.9 11.0 385 Primary 32.9 14.7 18.7 33.7 37.4 11.6 18.1 519 Secondary 24.8 18.2 19.9 37.1 45.9 9.8 19.4 932 Higher 9.4 20.6 19.9 50.2 51.7 13.9 25.0 257 Wealth quintile Lowest 40.3 16.5 16.8 26.3 38.0 9.3 12.4 362 Second 37.5 14.6 16.8 31.1 33.7 13.4 15.3 360 Middle 30.6 13.2 22.1 34.1 41.8 9.2 18.4 392 Fourth 27.5 15.1 16.3 41.1 40.9 9.5 22.1 452 Highest 14.6 23.6 21.1 40.8 53.2 11.5 20.8 527 Total 28.8 17.0 18.8 35.4 42.4 10.6 18.2 2,093 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses based on 25-49 unweighted cases. Overall, 1 percent of women and 3 percent of men reported having had an STI in the 12 mo eding the survey (Table 12.21). The percentage who reported having either an STI or one of the symptoms is slightly higher: 5 percent of both women and men. Never-married women and men ed higher levels than the national average. Eight percent of never-married women and 7 percen r-married men report having had an STI or symptom. HIV/AIDS and Other Sexually Transmitted Infections | 195 Table 12.21 Self-reporting of sexually transmitted infection (STI) and STI symptoms Among women and men who ever had sex, percentage self-reporting an STI and/or symptoms of an STI in the past 12 months, by background char- acteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Percentage Percentage Percentage with STI/ Number Percentage with STI/ with Percentage discharge/ of with Percentage discharge/ Number Percentage abnormal with genital women Percentage abnormal with genital of men Background with genital genital sore/ who ever with genital genital sore/ who ever characteristic an STI discharge sore/ulcer ulcer had sex an STI discharge sore/ulcer ulcer had sex 196 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.1 2.4 2.1 3.9 877 4.8 5.1 0.0 5.6 112 20-24 1.5 4.3 4.2 7.0 1,291 2.8 3.2 1.1 3.5 265 25-29 1.7 3.1 3.3 5.5 1,344 6.6 7.4 3.9 9.5 281 30-39 0.9 2.2 2.6 3.6 1,748 3.0 2.2 0.6 4.2 510 40-49 0.8 1.4 1.9 2.7 1,269 0.8 0.9 0.0 1.5 366 Marital status Never married 2.8 4.6 4.0 8.3 838 5.8 5.8 2.4 7.1 489 Married/living together 0.8 2.3 2.7 4.0 5,335 2.0 1.9 0.5 3.2 1,006 Divorced/separated/ widowed 1.0 3.1 3.1 4.5 357 (3.4) (4.7) (1.3) (4.7) 40 Residence Urban 0.6 2.1 1.9 3.5 2,172 4.2 2.5 0.7 5.0 548 Rural 1.3 2.9 3.3 5.1 4,358 2.7 3.6 1.4 4.2 987 Region North Central 1.3 4.8 4.5 6.5 921 2.2 1.8 1.0 3.8 241 North East 0.2 1.9 1.9 2.8 1,234 4.7 4.5 1.0 4.8 306 North West 0.3 1.6 2.5 3.5 1,969 1.3 4.7 0.7 4.9 334 South East 4.3 2.4 3.8 6.7 562 7.7 1.2 1.3 8.5 145 South South 1.9 4.0 3.7 6.7 1,111 4.3 4.5 2.4 4.9 278 South West 0.4 2.1 1.6 3.0 733 0.9 0.4 0.3 1.2 230 Education No education 0.5 2.1 2.4 3.4 3,070 2.6 4.1 1.3 4.3 310 Primary 0.8 1.9 3.4 4.2 1,390 2.4 3.3 2.1 4.4 392 Secondary 2.1 4.1 3.6 6.8 1,682 4.4 3.4 0.8 5.5 614 Higher 1.8 3.8 2.0 4.9 388 2.2 1.1 0.0 2.2 219 Wealth quintile Lowest 0.4 2.5 3.0 4.1 1,292 3.7 4.6 1.7 4.8 279 Second 0.7 2.4 2.8 4.0 1,297 1.9 3.4 0.8 3.7 257 Middle 0.8 3.0 3.1 4.5 1,278 2.5 4.2 1.4 4.6 291 Fourth 1.3 1.7 2.3 4.2 1,259 3.8 2.7 1.7 5.0 293 Highest 2.0 3.5 3.1 5.9 1,404 3.8 1.8 0.3 4.4 415 Total 1.0 2.7 2.9 4.5 6,530 3.2 3.2 1.1 4.5 1,535 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. Treatment and prevention behaviours of those who have experienced STIs are important factors in controlling the spread of STIs. Respondents who reported having an STI or abnormal genital discharge, genital sores, or ulcers in the past 12 months were asked whether they sought treatment. The results are presented in Table 12.22. Two out of three women did seek treatment, as did four out offive men; how- ever, not everyone approached a health professional. Only 40 percent of women and 30 percent of men with an STI or symptom sought assistance from a clinic, hospital, or health professional. | HIV/AIDS and Other Sexually Transmitted Infections Table 12.22 Women and men seeking treatment for STIs Percentage of women and men reporting an STI or symptoms of an STI in the past 12 months who sought care, by source of advice or treatment, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Source of advice or treatment Women Men –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Clinic/hospital/health professional1 40.4 30.6 Traditional healer 15.3 43.2 Advice or medicine from shop/pharmacy 31.3 54.7 Advice from friends/relatives 22.3 42.0 Advice or treatment from any source 67.6 82.7 No advice or treatment 32.4 17.3 Number with STI and/or symptoms of STI 297 69 –––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Symptoms of an STI are an abnormal genital discharge, a genital sore, or a genital ulcer. 1 Corresponds to UNAIDS STI Service Indicator 4 "Men and women seeking treatment for STIs" 12.10 ORPHANHOOD Repercussions of HIV infection are not limited to the persons directly infected with the virus. Children of infected parents will eventually become orphans in need of new caretakers. When a house- hold takes in a child who has been orphaned, there are more people over whom the resources of the household have to be spread. Table 12.23 presents data on the prevalence of orphanhood in Nigeria. Overall, fewer than 1 percent of children have lost both parents; however, 6 percent of children under age 15 have lost at least one parent. Eleven percent of children in the South East have lost one or both par- ents—the highest prevalence in the country. Nationwide, 11 percent of children under age 15 are living with neither their mother nor their father; prevalence climbs to 18 percent among children age 10-14. HIV/AIDS and Other Sexually Transmitted Infections | 197 Percent distribution of de jure children under age 15 by survival status of parents and children's living arrangements, according to background characteris- tics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Missing Not informa- Mother, living Living Both Both tion on father with Living Living with Number Background parents Mother Father parents father/ or both either with with both of characteristic dead dead dead alive mother Total dead1 parent mother father parents Total children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 0-1 0.0 0.1 0.5 99.1 0.4 100.0 0.6 1.1 12.2 1.0 85.6 100.0 2,479 2-4 0.2 0.7 1.5 96.9 0.7 100.0 2.5 6.8 10.5 3.0 79.7 100.0 3,421 5-9 0.6 2.3 3.7 92.5 1.0 100.0 6.6 12.0 9.0 6.8 72.2 100.0 5,262 10-14 1.2 3.9 6.7 85.8 2.4 100.0 11.8 18.3 11.2 9.7 60.8 100.0 4,415 0-14 0.6 2.0 3.6 92.6 1.2 100.0 6.2 10.9 10.5 5.9 72.7 100.0 15,577 Sex Male 0.7 2.3 3.6 92.3 1.2 100.0 6.6 10.4 10.4 6.8 72.4 100.0 7,928 Female 0.5 1.8 3.6 92.9 1.2 100.0 5.8 11.4 10.5 4.9 73.1 100.0 7,649 Residence Urban 0.6 2.2 4.3 92.3 0.7 100.0 7.1 13.3 12.5 6.0 68.2 100.0 4,981 Rural 0.6 2.0 3.3 92.7 1.5 100.0 5.8 9.8 9.5 5.8 74.9 100.0 10,596 Region North Central 0.5 1.8 4.8 91.9 1.1 100.0 7.1 11.1 12.8 5.6 70.4 100.0 2,432 North East 0.6 1.7 2.5 94.4 0.7 100.0 4.8 9.8 5.9 7.4 77.0 100.0 3,330 North West 0.6 1.5 2.1 94.7 1.1 100.0 4.2 7.5 5.8 4.7 82.0 100.0 4,803 South East 1.2 2.4 7.1 88.2 1.1 100.0 10.7 15.0 14.5 2.6 67.9 100.0 1,100 South South 0.7 3.8 5.1 88.1 2.3 100.0 9.6 16.1 18.1 7.9 57.9 100.0 2,375 South West 0.3 1.5 3.9 93.3 1.0 100.0 5.7 12.8 16.4 5.9 64.9 100.0 1,537 Wealth quintile Lowest 0.6 2.1 2.8 93.1 1.4 100.0 5.5 8.8 8.0 4.8 78.4 100.0 3,338 Second 0.7 1.6 2.6 93.9 1.2 100.0 5.0 11.5 8.6 5.7 74.2 100.0 3,301 Middle 0.5 2.0 5.2 91.0 1.3 100.0 7.7 10.7 13.1 6.9 69.4 100.0 3,146 Fourth 0.8 1.6 4.7 91.8 1.1 100.0 7.1 11.8 13.1 5.4 69.7 100.0 3,066 Highest 0.3 2.9 2.6 93.2 1.0 100.0 5.8 12.3 9.8 6.7 71.3 100.0 2,727 Total 0.6 2.0 3.6 92.6 1.2 100.0 6.2 10.9 10.5 5.9 72.7 100.0 15,577 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Corresponds to UNAIDS Indicator 14.4 “Prevalence of orphanhood—mother, father, or both dead” Table 12.23 Orphanhood and children’s living arrangements Table 12.24 presents data on school attendance among children age 10-14. Nearly three-quarters of children age 10-14 whose parents are both alive and who are living with at least one of their parents are currently attending school (73 percent). This varies regionally, from just over half of the children in the North East and North West attending school, to over 90 percent in the three south regions. Children with one parent who has died, be it a mother or father, are no worse off with regard to school attendance. There are too few children who have lost both parents to provide a reliable estimate of children age 10-14 attending school. The estimate presented in the table is based on very few cases and should be used with caution. 198 | HIV/AIDS and Other Sexually Transmitted Infections Table 12.24 Schooling of children 10-14 by orphanhood and living arrangements Percentage of dejure children age 10-14 who are currently attending school, by orphanhood, living arrangements, and background characteristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Both parents alive ––––––––––––––––––––––––––––––– Living with at Not living with Both Mother, father, least one parent either parent Mother dead Father dead parents dead or both dead ––––––––––––––– –––––––––––––– ––––––––––––––– –––––––––––––– –––––––––––––– ––––––––––––––– Percent Percent Percent Percent Percent Percent Background attending attending attending attending attending attending characteristic school Number school Number school Number school Number school Number school Number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age Male 78.6 1,647 80.9 254 80.3 98 81.1 135 (52.8) 31 76.5 265 Female 68.0 1,584 74.3 305 80.8 72 81.9 162 * 23 76.9 257 Residence Urban 84.1 1,096 80.4 236 88.6 66 88.5 109 * 15 85.1 190 Rural 67.9 2,135 75.0 322 75.4 104 77.5 189 (44.2) 39 72.0 332 Region North Central 88.5 531 81.0 80 * 16 88.1 63 * 8 87.1 88 North East 51.3 630 44.7 102 (43.3) 37 47.4 35 * 9 38.4 81 North West 54.3 942 59.7 93 (70.1) 37 65.7 41 * 15 59.0 93 South East 92.5 234 87.8 80 * 13 97.0 49 * 5 96.0 67 South South 94.9 544 95.5 127 (99.0) 55 84.6 72 * 13 88.8 140 South West 95.5 351 97.1 78 * 12 93.3 39 * 4 92.4 54 Wealth quintile Lowest 50.8 672 66.8 76 (55.7) 32 65.8 50 * 11 56.9 93 Second 63.4 677 57.6 109 * 26 70.3 43 * 13 65.0 82 Middle 71.1 654 68.2 91 (68.4) 29 82.5 80 * 11 75.0 120 Fourth 90.4 645 87.5 121 (90.4) 33 88.2 86 * 15 87.9 134 Highest 94.8 585 93.0 162 (98.9) 50 97.9 39 * 3 93.3 92 Total 73.4 3,231 77.3 558 80.5 170 81.5 298 (49.5) 54 76.7 522 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. There are too few cases of “double orphans” to calculate the UNAIDS Indicator for ratio of orphans to non-orphans who are in school. HIV/AIDS and Other Sexually Transmitted Infections | 199 Female Circumcision | 201 FEMALE CIRCUMCISION 13 Female genital cutting (FGC), also known as female circumcision in Nigeria, is a common prac- tice in many societies in the northern half of sub-Saharan Africa. Nearly universal in a few countries, it is practiced by various groups in at least 25 African countries, in Yemen, and in immigrant African popula- tions in Europe and North America. In a few societies, the procedure is routinely carried out when a girl is a few weeks or a few months old (e.g. Eritrea, Yemen), while in most others, it occurs later in childhood or adolescence. In the case of the latter, FGC is typically part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife. The 2003 Nigeria Demographic and Health Survey (2003 NDHS) collected data on the practice of female circumcision in Nigeria from all women age 15-49. The 1999 NDHS collected data on female circumcision only from currently married women. In this chapter, topics discussed include knowledge, prevalence, and type; age at circumcision; person who performed the circumcision; and attitudes towards the practice. 13.1 KNOWLEDGE AND PREVALENCE OF FEMALE CIRCUMCISION Table 13.1 presents data on women’s knowledge of female circumcision. About half (53 percent) of Nigerian women age 15-49 have heard of the practice. There are marked variations in knowledge of female circumcision by residence, region, education, and ethnicity. About two-thirds of urban respondents have heard of female circumcision, compared with less than half of women in rural areas (69 versus 45 percent). In general, women in the south are more than twice as likely as women in the north to have heard of the practice. These variations by region and residence are a reflection of ethnic differentials. The Igbo and Yoruba, who are primarily resident in the South East and South West, respectively, have greater knowledge of female circumcision than the ethnic groups primarily resident in the north. Table 13.1 also shows the prevalence of female circumcision by background characteristics, which follows the same patterns as knowledge of circumcision. The proportion of women who were cir- cumcised at the time of the survey was greatest in the southern regions, among the Yoruba and Igbo, and among urban residents. The high prevalence of female circumcision among the Yoruba (61 percent) and Igbo (45 percent) helps to explain regional and urban-rural differentials, since the Yoruba and Igbo tradi- tionally reside in the South West and South East, which are more urban than the north. More than twice as many of the oldest women as the youngest women are circumcised (28 versus 13 percent), suggesting that there has been a decline in the practice. Caldwell et al. (2000) have reported a decline in the prevalence of female circumcision among the Yoruba. 13.2 FLESH REMOVAL AND INFIBULATION Questions directed at determining the type of female circumcision were asked of women who re- ported they had been circumcised. Table 13.1 indicates that the type of circumcision could not be deter- mined for half of the women. However, among those women who could identify the type of procedure, circumcision that involved cutting and removal of flesh is most commonly reported (44 percent). Four percent of women reported that their vagina was sewn closed (infibulation) during their circumcision, which is the most radical procedure. It is worth noting that among the Yoruba, who have the largest pro- portion of women circumcised, less than 1 percent of women are infibulated. Infibulation is most preva- lent in the South South region (8 percent). 202 | Female Circumcision 13.3 AGE AT CIRCUMCISION The percent distribution of women by age at circumcision is presented in Table 13.2. Female cir- cumcision in Nigeria occurs mostly in infancy (i.e., before the first birthday). Three-quarters of the women who underwent circumcision were circumcised by age one. Twenty-one percent, however, were circumcised at age five or older. There are marked variations in the proportions of women circumcised in infancy by residence and ethnicity. For instance, almost nine in ten Igbo and Yoruba were circumcised during infancy compared with less than half of those in other ethnic groups (45 percent). Infibulation, the most severe form of circumcision, is more likely to be carried out on women cir- cumcised at a later age than on the very young. The table shows that 37 percent of those cut before the age of one had been infibulated, while 49 percent of those circumcised after the age of four were infibu- lated. It should be noted that the total number of respondents infibulated was 57. Table 13.1 Knowledge and prevalence of female circumcision Percentage of women who have heard of female circumcision, percentage of women circumcised, and the percent distribution of circumcised women by type of circumcision, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage Type of circumcision of women of ––––––––––––––––––––––––––––––––––––– who heard women Number Cut, Cut, Number Background of female circum- of no flesh flesh Sewn Not of characteristic circumcision cised women removed removed closed determined Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 43.1 12.9 1,716 2.2 37.8 5.1 55.0 100.0 221 20-24 52.8 17.0 1,494 1.8 43.1 2.9 52.2 100.0 253 25-29 57.5 20.8 1,382 1.8 40.2 2.2 55.8 100.0 288 30-34 55.0 19.4 941 1.1 43.6 7.6 47.7 100.0 183 35-39 60.8 22.2 816 2.4 44.3 4.9 48.4 100.0 181 40-44 53.6 22.2 688 1.2 49.0 1.9 47.9 100.0 153 45-49 59.6 28.4 583 3.9 51.0 3.6 41.6 100.0 165 Residence Urban 68.7 28.3 2,629 1.5 37.6 4.0 56.9 100.0 744 Rural 45.0 14.0 4,991 2.5 49.6 3.9 44.0 100.0 701 Region North Central 36.0 9.6 1,121 1.2 64.6 2.5 31.7 100.0 107 North East 40.1 1.3 1,368 * * * * * 18 North West 25.1 0.4 2,095 * * * * * 9 South East 87.7 40.8 737 0.3 12.2 2.7 84.8 100.0 300 South South 82.5 34.7 1,342 3.0 66.0 7.5 23.5 100.0 466 South West 85.7 56.9 958 2.2 36.3 1.3 60.3 100.0 545 Ethnic group Fulani 19.4 0.6 463 * * * * * 3 Hausa 28.5 0.4 2,055 * * * * * 8 Igbo 86.5 45.1 1,037 1.3 28.3 3.1 67.3 100.0 467 Kanuri 58.5 0.5 232 * * * * * 1 Tiv 27.9 0.9 170 * * * * * 1 Yoruba 88.2 60.7 865 2.1 38.3 0.9 58.7 100.0 525 Other 54.8 15.7 2,797 2.5 66.1 7.8 23.6 100.0 439 Total 53.2 19.0 7,620 2.0 43.5 3.9 50.6 100.0 1,445 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 1 case with data missing on circumcision. An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. Female Circumcision | 203 13.4 CIRCUMCISION OF DAUGHTERS Women interviewed in the 2003 NDHS who had living daughters were asked if any of their daughters had been circumcised, and if not, whether they intended to have a daughter circumcised. Table 13.3 shows that, of women who have at least one daughter, 10 percent had circumcised a daughter, and an additional 3 percent intend to have a daughter circumcised. The proportion of women who have at least one circumcised daughter increases with age. Prevalence varies by residence and ethnicity, with women residing in urban areas, those in the south, and Yorubas and Igbos being the most likely to have circum- cised daughters or intend to have their daughters circumcised. Table 13.2 Age at circumcision Percent distribution of circumcised women by age at circumcision, according to background charac- teristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at circumcision in years –––––––––––––––––––––––––––––––––––– Don’t Number Background know/ of characteristic <1 1-4 5+ missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 78.4 1.7 14.2 5.7 100.0 221 20-24 77.2 1.1 18.7 3.1 100.0 253 25-29 79.5 0.2 17.7 2.5 100.0 288 30-34 64.3 0.3 27.4 8.1 100.0 183 35-39 71.6 3.3 24.4 0.7 100.0 181 40-44 72.4 1.5 24.3 1.8 100.0 153 45-49 73.5 0.6 21.1 4.8 100.0 165 Residence Urban 79.2 0.9 16.8 3.1 100.0 744 Rural 69.6 1.5 24.4 4.5 100.0 701 Region North Central 51.6 1.7 42.1 4.6 100.0 107 North East * * * * * 18 North West * * * * * 9 South East 94.1 0.1 4.9 0.9 100.0 300 South South 55.2 2.1 38.0 4.7 100.0 466 South West 86.4 0.7 9.1 3.8 100.0 545 Ethnic group Igbo 88.9 0.3 9.4 1.4 100.0 467 Yoruba 87.4 1.2 7.1 4.4 100.0 525 Other 45.0 2.0 47.4 5.5 100.0 453 Type of circumcision Cut, no flesh removed (69.7) (0.0) (30.3) (0.0) (100.0) 29 Cut, flesh removed 60.6 1.9 35.2 2.3 100.0 628 Sewn closed 37.4 5.0 49.2 8.4 100.0 57 Not determined 89.6 0.3 5.2 4.8 100.0 732 Total 74.6 1.2 20.5 3.8 100.0 1,445 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 204 | Female Circumcision Table 13.3 shows the percent distribution of most recently circumcised daughters by type of cir- cumcision. The results show that circumcision involving the cutting and removal of flesh is the most common in Nigeria, accounting for two-thirds of all circumcisions. Five percent of circumcised daughters had no flesh removed, and 4 percent were infibulated. Table 13.3 Daughter’s circumcision experience and type of circumcision Among women with at least one living daughter, percentage with at least one circumcised daughter, percentage who intend to have their daughter circumcised, and percent distribution by type of circumcision among most recently circumcised daughters, according to background characteristics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage Percentage Among circumcised daughters, of women of women Number type of circumcision with at who intend of women –––––––––––––––––––––––––––––––––––––– least one to have with at Cut, Cut, Number Background daughter daughter least one no flesh flesh Sewn Not of characteristic circumcised circumcised daughter removed removed closed determined Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.5 5.0 183 * * * * * 1 20-24 4.4 3.9 538 (1.5) (63.7) (2.5) (32.3) (100.0) 23 25-29 6.9 2.3 898 12.6 54.1 5.4 27.9 100.0 62 30-34 6.4 4.4 715 4.1 71.5 2.0 22.5 100.0 45 35-39 11.3 3.5 707 3.7 69.1 4.0 23.2 100.0 80 40-44 12.9 2.7 582 2.4 77.0 3.7 16.9 100.0 75 45-49 23.8 1.4 506 4.3 64.6 3.1 28.0 100.0 120 Residence Urban 15.0 3.1 1,294 2.9 68.0 3.4 25.7 100.0 194 Rural 7.5 3.2 2,834 6.7 65.9 3.7 23.7 100.0 213 Region North Central 6.6 3.3 606 1.1 59.8 0.0 39.1 100.0 40 North East 0.2 0.4 856 * * * * * 2 North West 0.9 0.9 1,320 * * * * * 12 South East 25.7 4.9 324 7.3 42.1 9.5 41.1 100.0 83 South South 17.2 10.6 621 1.7 81.0 6.1 11.2 100.0 107 South West 40.8 3.0 401 5.2 73.0 0.0 21.9 100.0 164 Education No education 5.6 1.6 2,158 7.4 58.1 3.9 30.6 100.0 121 Primary 14.8 4.2 1,000 0.6 73.7 3.2 22.6 100.0 148 Secondary 14.9 5.7 786 8.6 65.1 4.3 22.0 100.0 117 Higher 11.8 4.4 185 (0.0) (79.8) (0.0) (20.2) (100.0) 22 Ethnic group Igbo 25.8 4.5 447 5.3 52.5 9.5 32.7 100.0 115 Yoruba 46.3 2.6 371 4.9 70.6 0.0 24.5 100.0 172 Other 3.6 3.0 3,311 4.5 75.5 2.9 17.1 100.0 120 Wealth quintile Lowest 6.8 3.1 903 6.7 71.5 3.1 18.7 100.0 61 Second 6.2 2.6 874 1.9 72.0 3.4 22.7 100.0 54 Middle 8.2 1.9 822 5.1 64.9 7.7 22.2 100.0 67 Fourth 11.1 4.0 770 6.1 68.9 3.0 22.0 100.0 85 Highest 18.4 4.2 759 4.4 62.7 2.1 30.8 100.0 140 Total 9.9 3.1 4,129 4.9 66.9 3.6 24.6 100.0 407 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 26-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Female Circumcision | 205 Table 13.4 Aspects of daughter’s cir- cumcision Percent distribution of most recently circumcised daughter by the age of the daughter at the time she was cir- cumcised, and the person performing the circumcision, Nigeria 2003 –––––––––––––––––––––––––––––– Aspects Percent –––––––––––––––––––––––––––––––– Age of daughter when she was circumcised (in years) 0 85.0 1-4 4.1 5-6 1.8 7-8 2.0 9-10 0.5 11-12 0.9 13+ 3.9 Don’t know/missing 1.8 Person who performed the circumcision Traditional circumciser 60.6 Traditional birth attendant 10.0 Other traditional 1.0 Doctor 2.0 Nurse/midwife 24.3 Other health professional 0.4 Don’t know/missing 1.8 Total 100.0 Number 407 Table 13.4 indicates that almost all of the most recently circumcised daughters (85 percent) were circumcised before their first birthday, and 4 percent were circumcised between ages 1-4 years. Tradi- tional circumcisers carried out 61 percent of the circumcisions. Circumcision is also commonly performed by nurses and midwives (24 percent) and traditional birth attendants (10 percent). 13.5 ATTITUDES TOWARD FEMALE CIRCUMCISION Women and men who had heard of female circumcision were asked if they thought the practice should be continued or discontinued. Table 13.5.1 indicates that among the Nigerian women who had heard of female circumcision, two-thirds believe that the practice should be discontinued, while 21 per- cent believe the practice should be continued. Approximately one in ten of this group of women ex- pressed conditional approval or was unsure of her opinion. Continuation of female circumcision finds greater support among southerners than northerners and among those who are circumcised than those un- circumcised. Even so, less than half of circumcised women want the practice to be continued. Women were also asked about their perception of men’s attitudes toward female circumcision. Half of women believe that men want the practice discontinued. Nonetheless, one-fifth believe that men want female cir- cumcision to continue. 206 | Female Circumcision Men who had heard of female circumcision were asked the same attitude questions. Table 13.5.2 shows that among men who had heard of the practice, almost two-thirds are against continuation of female circumcision, while about one-fifth favour continuation. Similar to women, men residing in urban areas and those in the south are the most likely to support the continuation of the practice. Once again, differentials by residence are largely due to ethnicity. Almost half of men believe women want the prac- tice discontinued, while only 14 percent believe that women want female circumcision to continue. Table 13.5.1 Attitudes toward female circumcison: women Percent distribution of all women who have heard of female circumcision by opinion on whether female circumcision should be continued and by opinion on whether men think female circumcision should be continued, according to background character- istics, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Believes men think that Attitude toward female circumcision female circumcision should be: ––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––– Should Should be be Depends/ Depends/ Number Background con- discon- don’t Con- Discon- don’t of characteristic tinued tinued know Missing Total tinued tinued know Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.4 60.0 15.2 1.4 100.0 20.8 42.7 35.5 1.0 100.0 739 20-24 21.3 66.2 10.6 1.9 100.0 19.9 49.1 29.0 2.0 100.0 789 25-29 17.0 70.1 12.2 0.7 100.0 14.9 51.5 32.8 0.7 100.0 794 30-34 15.8 73.7 9.9 0.5 100.0 15.8 53.1 30.6 0.5 100.0 518 35-39 24.9 66.7 8.4 0.0 100.0 21.1 51.2 27.7 0.0 100.0 496 40-44 20.0 64.9 14.8 0.4 100.0 18.6 51.5 29.6 0.3 100.0 369 45-49 24.9 62.9 11.2 1.0 100.0 19.5 49.4 30.1 1.0 100.0 347 Residence Urban 22.5 64.7 11.9 0.9 100.0 18.7 49.4 31.0 0.9 100.0 1,805 Rural 19.4 67.9 11.8 1.0 100.0 18.5 49.4 31.2 0.9 100.0 2,248 Region North Central 13.2 64.2 19.1 3.6 100.0 12.1 42.0 42.3 3.6 100.0 403 North East 7.3 78.6 13.5 0.6 100.0 5.9 55.5 37.9 0.7 100.0 548 North West 13.5 70.5 13.1 2.9 100.0 11.5 55.7 30.7 2.1 100.0 527 South East 23.9 67.4 8.6 0.0 100.0 20.4 56.8 22.8 0.0 100.0 646 South South 18.9 73.7 7.2 0.2 100.0 20.0 52.6 26.9 0.5 100.0 1,107 South West 38.3 46.3 15.1 0.3 100.0 31.3 34.9 33.6 0.3 100.0 821 Education No education 19.1 64.7 14.7 1.6 100.0 15.5 47.8 35.2 1.5 100.0 1,023 Primary 23.1 64.5 11.6 0.9 100.0 18.9 47.8 32.2 1.0 100.0 949 Secondary 23.2 65.4 10.9 0.6 100.0 22.6 48.9 28.1 0.5 100.0 1,666 Higher 10.4 79.7 9.1 0.8 100.0 9.2 59.3 30.6 0.9 100.0 415 Circumcision status Not circumcised 9.3 76.3 12.9 1.4 100.0 8.3 57.1 33.3 1.3 100.0 2,607 Circumcised 41.5 48.6 9.8 0.1 100.0 37.0 35.7 27.1 0.2 100.0 1,445 Total 20.8 66.4 11.8 0.9 100.0 18.6 49.4 31.1 0.9 100.0 4,052 Female Circumcision | 207 13.6 REASONS FOR SUPPORTING FEMALE CIRCUMCISION In the 2003 NDHS, women and men who said they thought female circumcision should continue were asked about the benefits the girls themselves get if they undergo this procedure. Chastity before marriage is the reason most commonly cited by both women and men in Nigeria. More than one-third of the women (36 percent) and 45 percent of men cited the need to prevent premarital sex as their reason for supporting female circumcision (Table 13.6). Maintaining virginity before marriage has been given as a benefit of female circumcision in other African countries as well, but except for Niger, it has always been the third or fourth most frequently given reason (Yoder et al., 2004). An additional 35 percent of women and 30 percent of men said that a circumcised female would have better marriage prospects. Whereas almost one-quarter of men cite greater sexual pleasure for men as a perceived benefit, this is the least commonly cited reason among women (5 percent). One-quarter of women and one-fifth of men support female circumcision due to a belief that it aids safe delivery. This misconception will require adequate public education to correct. Table 13.5.2 Attitudes toward female circumcision: men Percent distribution of all men who have heard of female circumcision by opinion on whether female circumcision should be continued and by opinion on whether women think female circumcision should be continued, according to background charac- teristics, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Believes women think that Attitude toward female circumcision female circumcision should be: ––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––– Should Should be be Depends/ Depends/ Number Background con- discon- don’t Con- Discon- don’t of characteristic tinued tinued know Missing Total tinued tinued know Missing Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 20.2 54.0 25.0 0.8 100.0 17.1 40.2 42.0 0.8 100.0 127 20-24 19.0 62.1 18.4 0.5 100.0 15.8 50.1 33.0 1.0 100.0 223 25-29 22.6 59.9 17.6 0.0 100.0 16.1 46.5 37.4 0.0 100.0 211 30-34 17.0 67.4 15.6 0.0 100.0 8.9 58.9 32.1 0.0 100.0 229 35-39 22.1 61.3 16.6 0.0 100.0 15.4 54.9 29.7 0.0 100.0 163 40-44 10.2 75.8 14.0 0.0 100.0 8.0 55.9 36.1 0.0 100.0 166 45-49 24.8 62.6 12.6 0.0 100.0 15.2 49.2 35.6 0.0 100.0 117 50-54 19.8 57.7 22.5 0.0 100.0 16.7 53.5 29.9 0.0 100.0 103 55-59 21.4 66.3 12.3 0.0 100.0 15.3 45.8 38.9 0.0 100.0 89 Residence Urban 23.1 59.8 17.0 0.2 100.0 13.0 49.9 37.0 0.2 100.0 586 Rural 16.7 65.9 17.3 0.1 100.0 14.5 52.2 33.0 0.3 100.0 840 Region North Central 17.4 75.6 6.9 0.0 100.0 12.6 68.1 19.3 0.0 100.0 154 North East 8.7 73.7 17.3 0.3 100.0 9.4 50.8 39.1 0.7 100.0 307 North West 14.5 64.3 21.2 0.0 100.0 11.7 53.6 34.7 0.0 100.0 276 South East 28.4 45.5 26.2 0.0 100.0 12.2 42.4 45.4 0.0 100.0 156 South South 24.1 64.1 11.4 0.4 100.0 20.4 51.6 27.6 0.4 100.0 279 South West 27.8 52.7 19.5 0.0 100.0 16.4 44.0 39.6 0.0 100.0 254 Education No education 15.2 63.7 21.0 0.0 100.0 15.2 46.5 38.3 0.0 100.0 280 Primary 24.6 57.6 17.8 0.0 100.0 17.4 44.8 37.8 0.0 100.0 362 Secondary 20.1 61.2 18.4 0.4 100.0 12.8 51.4 35.2 0.6 100.0 549 Higher 14.4 77.0 8.6 0.0 100.0 9.7 66.3 24.0 0.0 100.0 235 Total 19.3 63.4 17.1 0.1 100.0 13.9 51.2 34.6 0.2 100.0 1,426 208 | Female Circumcision 13.7 REASONS FOR NOT SUPPORTING FEMALE CIRCUMCISION Women and men who said they thought female circumcision should be discontinued were asked about the benefits the girls themselves get if they do not become circumcised. Table 13.7 shows that sex- ual gratification was cited as a benefit by the majority of the women and men who do not support the con- tinuation of female circumcision. One-third of the women cited more sexual pleasure for the woman and an additional one-fourth cited more sexual pleasure for the men. Among men, however, 48 percent cited more sexual pleasure for the man, and an additional 34 percent cited increased sexual pleasure for the woman. Religion is the reason least frequently cited by both women and men for not supporting female circumcision, suggesting that female circumcision is not perceived as a religious practice. It has been ob- served that female circumcision is a cultural rather than a religious practice (Toubia, 1995; Caldwell et al., 2000). Table 13.6 Perceived benefits of undergoing female circumcision Among women and men who say they think female circumcision should be continued, percentage who cite specific reasons, according to urban-rural residence, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––– –––––––––––––––––––––––––– Residence Residence ––––––––––––––– ––––––––––––––– Reason Urban Rural Total Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Reason for supporting female circumcision Cleanliness/hygiene 5.1 8.4 6.8 5.5 14.4 10.0 Social acceptance 34.0 21.9 27.7 9.1 22.7 16.0 Better marriage prospects 26.8 42.0 34.6 28.3 31.9 30.1 Preserve virginity/prevent premarital sex 49.0 23.4 35.8 48.3 41.8 45.0 More sexual pleasure for the man 7.1 3.5 5.3 24.7 21.7 23.2 Religious approval 10.4 12.2 11.3 11.2 6.2 8.7 Helps delivery 24.6 25.8 25.2 20.2 20.9 20.5 Other 9.6 21.3 15.7 15.7 5.9 10.7 Number 407 436 843 135 141 276 Table 13.7 Reasons for not supporting female circumcision Among women and men who say they think female circumcision should be discontinued, percentage who cite specific reasons, according to urban-rural residence, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––– –––––––––––––––––––––––––– Residence Residence ––––––––––––––– ––––––––––––––– Reason Urban Rural Total Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Reason for not supporting female circumcision Fewer medical problems 33.0 34.2 33.7 25.8 35.6 31.8 Avoiding pain 18.8 21.7 20.5 27.2 22.3 24.2 More sexual pleasure for her 38.9 32.5 35.3 41.9 28.8 33.9 More sexual pleasure for the man 25.1 24.0 24.5 53.0 45.0 48.1 Follows religion 2.3 3.1 2.8 3.6 5.1 4.5 Number 1,168 1,525 2,693 350 554 904 References | 209 REFERENCES Caldwell, John J., I.O. Orubuloye and Pat Caldwell, 2000. Female genital cutting: Conditions of decline, Social Science and Medicine 19: 233-254. Central Bank of Nigeria. 2002. Annual report and statement of account for the year ended 31st Dec, 2001. Abuja, Nigeria: Central Bank of Nigeria. Federal Office of Statistics [Nigeria] and IRD/Macro International Inc. 1992. Nigeria Demographic and Health Survey 1990. Columbia, Maryland: Federal Office of Statistics and IRD/Macro International Inc. Federal Ministry of Health (FMOH) [Nigeria]. 2001. Strategic Plan for Rolling Back Malaria in Nigeria 2001-2005. Abuja, Nigeria: Federal Ministry of Health. Gwatkin, D.R., S. Rutstein, K. Johnson, R.P. Pande, and A. Wagstaff. 2000. Socio-economic differences in health, nutrition and poverty. HNP/Poverty Thematic Group of the World Bank. Washington, D.C.: The World Bank. Isiugo, Abanihe. 1996. Fertility in Nigeria. Occasional Paper of the Department of Sociology, University of Ibadan. Ibadan, Nigeria: University of Ibadan. Jamison, D., W.H. Mosley, A. Measham, and J.L. Bobadilla. 1993. Disease control priorities in develop- ing countries. New York: Oxford University Press. National AIDS/STDs Control Programme, Department of Public Health, Federal Ministry of Health. 2001. A Technical Report on The 2001 National HIV/Syphilis Sentinel Survey among Pregnant Women attending Ante-natal Clinics in Nigeria. Abuja, Nigeria: Federal Ministry of Health. National Population Commission (NPC) [Nigeria]. 1998. 1991 Population Census of the Federal Repub- lic of Nigeria: Analytical Report at the National Level. Lagos, Nigeria: National Population Commission. National Population Commission (NPC) [Nigeria]. 2000. Nigeria Demographic and Health Survey 1999. Calverton, Maryland: National Population Commission and ORC/Macro. National Population Commission (NPC) [Nigeria] 2004. National Policy on Population for Sustainable Development. Abuja: Nigeria: National Population Commission (Forthcoming). National Population Commission (NPC) [Nigeria] and UNICEF, 2001. Children’s and Women’s Rights in Nigeria: A Wake-up Call. Situation Assessment and Analysis 2001. Abuja: Nigeria: National Population Commission and UNICEF. Rutstein, S. 1999. Wealth versus expenditure: Comparison between the DHS wealth index and household expenditures in four departments of Guatemala. Calverton, Maryland, USA: ORC Macro (Unpublished). Rutstein, S., K. Johnson, and D. Gwatkin. 2000. Powerty, health inequality, and its health and demo- graphic effects. Paper presented at the 2000 Annual Meeting of the Population Association of America, Los Angeles, California. 210 | References Toubia, Nahid, 1995. Female Genital Mutilation: A Call for Global Action. New York: Research Action Information Network for Bodily Integrity for Women (RAINBO). World Health Organisation (WHO) and UNICEF, 1998. Complementary feeding of young children in de- veloping countries: A review of current scientific knowledge. WHO, Geneva. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting in Demographic and Health Surveys: A Critical and Comparative Inquiry. Calverton, Maryland: ORC Macro (Forthcoming). Appendix A | 211 SAMPLE DESIGN APPENDIX A A.1 INTRODUCTION The principal objective of the 2003 NDHS is to provide current and reliable data on fertility and family planning behaviour, child mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge and attitudes towards HIV/AIDS. A related objective is to provide as many of these key indicators as possible for urban and rural areas separately, as well as for each of Ni- geria’s six geopolitical zones (see Table A.1). The population covered by the 2003 NDHS is defined as the universe of all women age 15-49 and all men age 15-59 in Nigeria. A probability sample of households was selected and all women age 15-49 identified in the households were eligible to be interviewed. In addition, in a subsample of one-third of the households selected for the survey, all men age 15-59 were eligible to be interviewed. A.2 SAMPLE FRAME The sample frame for this survey was the list of enumeration areas (EAs) developed for the 1991 Population Census. Administratively, at the time the survey was planned, Nigeria was divided into 36 states and the Federal Capital Territory (FCT) of Abuja. Each state was subdivided into local government area (LGA) units and each LGA was divided into localities. In addition to these administrative units, for implementation of the 1991 Population Census, each locality was subdivided into enumeration areas (EAs). The list of approximately 212,080 EAs, with household and population information (from the 1991census) for each EA, was evaluated as a potential sampling frame for the 2003 NDHS. The EAs are grouped by states, by LGAs within a state, and by localities within an LGA, stratified separately by urban and rural areas. Any locality with less than 20,000 population constitutes a rural area. Also available from the 1991 census were maps showing the location of the EAs. These maps needed to be updated in the field before the final household selection. After a careful evaluation, the EA list was used as the sample frame. A.3 SAMPLE ALLOCATION The primary sampling unit (PSU), or cluster, for the 2003 NDHS is defined as one or more EAs from the 1991 census frame. A minimum requirement of 50 households per cluster was imposed on the design; in the case of less than 50 households, a contiguous EA was added. The number of clusters in each state was not allocated in proportion to the state’s population because of the need to obtain estimates for each of the six zones. Since Nigeria is a country where the majority of the population resides in rural areas, the number of clusters allocated to the urban areas in five out of the six zones was increased in or- der to obtain reasonable urban estimates. The target of the 2003 NDHS sample was to obtain completed interviews with about 8,250 women. Based on the level of nonresponse found in the 1999 Nigeria DHS survey, a target of 7,935 households was set. When the sample was implemented, three clusters could not be visited because of communal clashes, so 7,864 households were selected, in which all women age 15-49 were eligible to be interviewed. To obtain estimates of fertility and child mortality with a reasonable level of precision, a minimum of 1,200 completed interviews with women was desired in each zone. In each state, the number of households was not distributed proportionally between urban and rural areas. Also, in six designated states, a minimum of 350 completed interviews were targeted to provide selected indicators. 212 | Appendix A A.4 SAMPLE SELECTION The 2003 NDHS sample was selected using a stratified, two-stage cluster design. A total of 365 clusters were selected, 165 in urban and 200 in rural areas. Table A.1 shows the distribution of clusters selected for the 2003 NDHS. Once the number of households was allocated to each state by urban and rural areas, the numbers of clusters was calculated based on an average sample take of 20 completed Table A.1 Allocation of the sample Number of expected women’s interviews and number of clusters covered, by state, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Expected number Number of of women’s interviews clusters selected Region/ –––––––––––––––––––––––––– –––––––––––––––––––––––––– state Urban Rural Total Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– North Central 530 755 1,285 26 30 56 Plateau 54 147 201 3 6 9 Benue 89 261 350 4 10 14 Nasarawa 30 86 116 1 3 4 Kogi 126 87 213 6 3 9 Kwara 134 15 149 7 1 8 Niger 84 140 224 4 6 10 FCT 13 18 32 1 1 2 North East 500 811 1,311 25 32 57 Taraba 32 121 153 2 5 7 Adamawa 80 134 214 4 5 9 Gombe 44 106 151 2 4 6 Borno 185 67 253 9 3 12 Bauchi 90 310 400 5 12 17 Yobe 68 72 140 3 3 6 North West 500 1,233 1,733 27 49 76 Jigawa 14 186 200 1 7 8 Kano 252 150 402 13 6 19 Kebbi 22 124 146 1 5 6 Kaduna 93 307 400 5 12 17 Katsina 53 214 267 3 9 12 Zamfara 33 115 149 2 5 7 Sokoto 33 137 170 2 5 7 South East 500 747 1,247 25 30 55 Ebonyi 104 63 167 5 3 8 Anambra 140 210 350 7 8 15 Enugu 151 89 240 8 4 12 Abia 86 123 209 4 5 9 Imo 19 262 281 1 10 11 South South 500 774 1,274 25 31 56 Bayelsa 6 90 97 0 4 4 Cross River 59 113 172 3 5 8 Akwa Ibom 23 201 223 1 8 9 Rivers 127 223 350 6 9 15 Delta 118 119 237 7 4 11 Edo 167 28 195 8 1 9 South West 750 650 1,400 40 25 65 Lagos 363 76 439 20 1 21 Oyo 138 144 281 7 6 13 Osun 57 124 180 3 5 8 Ogun 75 117 192 4 5 9 Ekiti 54 72 125 3 3 6 Ondo 64 118 182 3 5 8 Total 3,280 4,970 8,250 165 200 365 Appendix A | 213 women’s interviews (in 19 selected households) in urban areas, and 25 completed interviews (in 24 se- lected households) in rural areas. In each urban or rural area in a given state, clusters were selected sys- tematically with equal probability. The selection was done using the following formula: P1i = (a / A ) where a: is the number of clusters to be selected in the given combination of residence area and state, A: is the total number of clusters in the given combination of residence area and state. In each selected cluster, a complete household listing operation was carried out and households were selected to achieve a fixed sample take per cluster. Since the 2003 NDHS sample is unbalanced (disproportional) by urban-rural residence and state, it requires sampling weights to provide estimates at every domain of study. In a given state, if c is the fixed number of households selected out of the total households (Li)— found in the 2003 listing process—for the ith cluster, then the household probability in the selected ith clus- ter can be expressed as P2i = ( c / Li ) The final household overall probability in the ith cluster could be calculated as fi = P1i * P2i and the sampling design weight for the ith cluster is given as 1/ fi = 1 / (P1i * P2i ) A.5 SAMPLE FOR MALE SURVEY In every third household selected, all men age 15-59 listed in the household were eligible to be in- terviewed. Based on data from the 1999 NDHS, this was expected to produce a total of about 2,800 suc- cessfully completed male interviews in the 2003 NDHS. A.6 RESPONSE RATES Tables A.2 and A.3 present information on the results of the household and individual interviews. Household interviews were completed for 99 percent of the occupied households. A total of 7,985 eligible women were found in these households, and 95 percent of them were successfully interviewed. The over- all response rate for women was 94 percent. A total of 2,572 eligible men from every third household were identified for the individual interviews; 91 percent were successfully interviewed. The overall re- sponse rate for men was 90 percent. The principal reason for nonresponse among eligible women and men was the failure to find them at home despite repeated visits to the household. The refusal rate was low. There was no difference by urban-rural residence in overall response rates for eligible women and men. By region, the overall response rates for eligible women varied little, with the exception of South South, which had the lowest response rate for women (88 percent). The lowest overall response rate for men was in the South South and South East (83 percent each). 214 | Appendix A Table A.2 Sample implementation: women Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women, and overall response rates, according to urban-rural residence and region, Nigeria 2003 Residence Region Result Urban Rural North Central North East North West South East South South South West Total Selected households Completed (C) 92.7 91.3 95.4 95.9 93.3 86.6 87.1 91.9 91.9 Household present but no com- petent respondent at home (HP) 0.5 0.6 0.4 0.2 0.7 0.3 0.9 0.8 0.6 Refused (R) 0.9 0.3 0.2 0.2 0.4 1.0 0.9 0.4 0.5 Dwelling not found (DNF) 0.1 0.2 0.1 0.0 0.1 0.0 0.7 0.3 0.2 Household absent (HA) 3.3 3.9 1.7 2.0 3.6 4.6 6.3 4.0 3.7 Dwelling vacant/address not a dwelling (DV) 2.3 3.1 2.0 1.4 1.7 6.7 3.2 2.3 2.8 Dwelling destroyed (DD) 0.1 0.2 0.2 0.2 0.2 0.3 0.3 0.1 0.2 Other (O) 0.1 0.3 0.0 0.0 0.1 0.6 0.4 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of sampled households 3,163 4,701 1,214 1,242 1,689 1,195 1,159 1,365 7,864 Household response rate (HRR)1 98.4 98.8 99.2 99.5 98.8 98.6 97.1 98.4 98.6 Eligible women Completed (EWC) 96.1 95.0 95.8 94.7 97.2 95.3 90.4 97.8 95.4 Not at home (EWNH) 1.8 2.5 2.3 2.3 1.3 2.2 5.4 0.9 2.3 Postponed (EWP) 0.0 0.1 0.0 0.1 0.1 0.0 0.1 0.0 0.1 Refused (EWR) 0.9 0.8 0.6 1.3 0.2 1.2 1.4 0.7 0.8 Partly completed (EWPC) 0.3 0.1 0.1 0.3 0.1 0.1 0.3 0.3 0.2 Incapacitated (EWI) 0.6 0.7 0.7 0.8 0.6 0.7 0.6 0.3 0.6 Other (EWO) 0.3 0.9 0.5 0.5 0.6 0.4 1.8 0.1 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 3,181 4,804 1,311 1,492 1,843 1,134 1,038 1,167 7,985 Eligible women response rate (EWRR)2 96.1 95.0 95.8 94.7 97.2 95.3 90.4 97.8 95.4 Overall response rate (ORR)3 94.6 93.8 95.1 94.2 96.0 94.0 87.8 96.2 94.1 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ——————————— C + HP + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: 100 * EWC ————————————————————————— EWC + EWNH + EWP + EWR + EWPC + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100 Appendix A | 215 Table A.3 Sample implementation: men Percent distribution of households and eligible men by results of the household and individual interviews, and household, eligible men, and overall response rates, according to urban-rural residence and region Nigeria 2003 Residence Region Result Urban Rural North Central North East North West South East South South South West Total Selected households Completed (C) 92.7 91.3 96.5 97.0 92.8 85.9 85.8 92.3 91.9 Household present but no com- petent respondent at home (HP) 0.5 0.6 0.5 0.2 0.9 0.5 0.8 0.2 0.5 Refused (R) 1.1 0.3 0.0 0.2 0.0 1.5 1.1 0.9 0.6 Dwelling not found (DNF) 0.1 0.1 0.0 0.0 0.0 0.0 0.5 0.2 0.1 Household absent (HA) 3.4 4.0 1.3 1.7 3.8 4.1 6.9 4.7 3.7 Dwelling vacant/address not a dwelling (DV) 1.9 3.1 1.3 0.7 2.3 6.9 3.7 1.1 2.6 Dwelling destroyed (DD) 0.1 0.4 0.5 0.0 0.2 0.3 0.8 0.0 0.3 Other (O) 0.2 0.3 0.0 0.0 0.0 0.8 0.5 0.5 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of sampled households 1,003 1,566 396 406 554 391 379 443 2,569 Household response rate (HRR)1 98.2 99.0 99.5 99.5 99.0 97.7 97.3 98.6 98.7 Eligible men Completed (EMC) 91.9 90.7 97.2 88.9 93.3 84.9 85.8 94.3 91.2 Not at home (EMNH) 3.7 5.3 1.6 2.9 3.9 7.1 10.7 3.5 4.6 Postponed (EMP) 0.0 0.1 0.0 0.0 0.2 0.0 0.0 0.0 0.0 Refused (EMR) 1.2 0.5 0.0 1.5 0.9 2.2 0.3 0.0 0.8 Partly completed (EMPC) 0.4 0.3 0.5 0.0 0.3 1.3 0.0 0.0 0.3 Incapacitated (EMI) 0.9 0.5 0.7 1.3 0.2 1.3 0.5 0.2 0.7 Other (EMO) 1.9 2.7 0.0 5.5 1.2 3.2 2.7 2.0 2.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 1,073 1,499 428 476 586 312 365 405 2,572 Eligible men response rate (EMRR)2 91.9 90.7 97.2 88.9 93.3 84.9 85.8 94.3 91.2 Overall response rate (ORR)3 90.2 89.8 96.7 88.4 92.4 83.0 83.4 93.0 90.0 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ————————— C + HP + R + DNF 2 Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: 100 * EMC ————————————————————————— EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EMRR/100 Appendix B | 217 ESTIMATES OF SAMPLING ERRORS APPENDIX B 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 col- lection and data processing, such as failure to locate and interview the correct household, misunderstand- ing of the questions on the part of either the interviewer or the respondent, and data entry errors. Al- though numerous efforts were made during the implementation of the 2003 Nigeria Demographic and Health Survey (NDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents se- lected in the 2003 NDHS is only one of many samples that could have been selected from the same popu- lation, 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 cal- culate 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 possi- ble 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 2003 NDHS sam- ple is the result of a multi-stage stratified design, and, consequently, it was necessary to use more com- plex formulae. The computer software used to calculate sampling errors for the 2003 NDHS is the ISSA Sampling Error Module. This module used the Taylor linearization 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 linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: ∑ ∑ = =− ⎥⎥⎦ ⎤ ⎢⎢⎣ ⎡ ⎟⎟⎠ ⎞ ⎜⎜⎝ ⎛ − − == H h h h m i hi h h m z z m m x frvarrSE h 1 2 1 2 1 2 2 1)()( in which hihihi rxyz −= , and hhh rxyz −= where h represents the stratum which varies from 1 to H, 218 | Appendix B mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and f 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 sev- eral replications of the parent sample, and calculates standard errors for these estimates using simple for- mulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo- independent replications are thus created. In the 2003 NDHS, there were 362 non-empty clusters. Hence, 361 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )= = − − = ∑ in which )()1( ii rkkrr −−= where r is the estimate computed from the full sample of 362 clusters, r(i) is the estimate computed from the reduced sample of 361 clusters (ith cluster excluded), and k 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 DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the in- crease 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 2003 NDHS are calculated for selected variables considered to be of pri- mary interest for woman’s survey and for man’s surveys, respectively. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the 6 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.10 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 stan- dard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to women aged 40-49) can be interpreted as follows: the overall average from the national sample is 6.808 and its standard error is 0.134. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 6.808±2×0.134. There is a high probability (95 percent) that the true average number of children ever born to all women aged 40 to 49 is between 6.540 and 7.077. Sampling errors are analyzed for the national woman sample and for two separate groups of esti- mates: (1) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 1.1 percent and 32.7 percent with an average of 6.36 percent; the highest relative standard errors are for estimates of very low values (e.g., currently using Appendix B | 219 female sterilization). If estimates of very low values (less than 10 percent) were removed, then the aver- age drops to 4.2 percent. 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, 2.5 percent. However, for the mortality rates, the average relative standard error is much higher, 6.04 percent. There are differentials in the relative standard error for the estimates of sub-populations. For ex- ample, for the variable want no more children, the relative standard errors as a percent of the estimated mean for the whole country, and for the urban areas are 4.9 percent and 6.1 percent, respectively. For the total sample, the value of the design effect (DEFT), averaged over all variables, is 1.78 which means that, due to multi-stage clustering of the sample, the average standard error is increased by a factor of 1.78 over that in an equivalent simple random sample. 220 | Appendix B Table B.1 List of selected variables for sampling errors, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion All women Literate Proportion All women No education Proportion All women Secondary education or higher Proportion All women Net attendance ratio for primary school Ratio Children 6-11 years Never married Proportion All women Currently married/in union Proportion All women Married before age 20 Proportion All women age 20-49 Currently pregnant Proportion All women Children ever born Mean All women Children surviving Mean All women Children ever born to women age 40-49 Mean Women age 40-49 Total fertility rate (3 years) Proportion All women Knows any contraceptive method Proportion Currently married women Ever using any contraceptive method Proportion Currently married women Currently using any contraceptive method Proportion Currently married women Currently using a modern method Proportion Currently married women Currently using pill Proportion Currently married women Currently using IUD Proportion Currently married women Currently using condom Proportion Currently married women Currently using female sterilization Proportion Currently married women Currently using periodic abstinence Proportion Currently married women Obtained method from public sector source Proportion Current users of modern methods Wanting no more children Proportion Currently married women Wanting to delay birth at least 2 years Proportion Currently married women Ideal family size Mean All women Neonatal mortality (0-4 years) Rate Children exposed to the risk of mortality Postneonatal mortality (0-4 years) Rate Children exposed to the risk of mortality Infant mortality rate (0-4 years) Rate Children exposed to the risk of mortality Infant mortality rate (5-9 years) Rate Children exposed to the risk of mortality Infant mortality rate (10-14 years) Rate Children exposed to the risk of mortality Child mortality (0-4 years) Rate Children exposed to the risk of mortality Under-five mortality (0-4 years) Rate Children exposed to the risk of mortality Mothers received tetanus injection for last birth Proportion Women with at least one live birth in five years before the survey Mothers received medical assistance at delivery Proportion Births in past 5 years1 Had diarrhoea in two weeks before survey Proportion Children age 0-59 months Treated with oral rehydration salts (ORS) Proportion Children with diarrhoea in two weeks before the survey Taken to a health provider Proportion Children with diarrhoea in two weeks before the survey Vaccination card seen Proportion Children age 12-23 months Receiving vaccinations: Proportion Children age 12-23 months BCG DPT (3 doses) Polio (3 doses) Measles Fully immunized Height-for-age (below -2SD) Proportion Children age 0-59 months Weight-for-height (below -2SD) Proportion Children age 0-59 months Weight-for-age (below -2SD) Proportion Children age 0-59 months BMI <18.5 Proportion All women Circumcised Proportion All women Has heard of HIV/AIDS Proportion All women Knows about condoms Proportion All women Knows about limiting partners Proportion All women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion All men Literate Proportion All men No education Proportion All men Secondary education or higher Proportion All men Never married Proportion All men Currently married/in union Proportion All men Knows any contraceptive method Proportion All men Ideal family size Mean All men Has heard of HIV/AIDS Proportion All men age 15-49 Knows about condoms Proportion All men age 15-49 Knows about limiting partners Proportion All men age 15-49 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Births occurring 1-59 months before interview Appendix B | 221 Table B.2 Sampling errors for national sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.345 0.018 7620 7620 3.325 0.052 0.309 0.381 Literate 0.482 0.017 7620 7620 3.017 0.036 0.447 0.516 No education 0.416 0.017 7620 7620 2.970 0.040 0.383 0.450 Secondary education or higher 0.370 0.016 7620 7620 2.861 0.043 0.339 0.402 Net attendance ratio for primary school 0.601 0.016 5896 6111 2.044 0.027 0.568 0.634 Never married 0.253 0.010 7620 7620 2.002 0.039 0.233 0.273 Currently married/in union 0.700 0.011 7620 7620 2.014 0.015 0.679 0.721 Married before age 20 0.663 0.012 5871 5904 2.019 0.019 0.638 0.688 Currently pregnant 0.114 0.005 7620 7620 1.385 0.044 0.104 0.124 Children ever born 3.094 0.056 7620 7620 1.517 0.018 2.983 3.206 Children surviving 2.381 0.038 7620 7620 1.346 0.016 2.306 2.457 Children ever born to women age 40-49 6.808 0.134 1313 1271 1.508 0.020 6.540 7.077 Total fertility rate (3 years) 5.655 0.142 na 21194 1.696 0.025 5.372 5.939 Knows any contraceptive method 0.784 0.011 5157 5336 1.976 0.014 0.762 0.807 Ever using contraceptive method 0.307 0.013 5157 5336 2.076 0.043 0.281 0.334 Currently using any contraceptive method 0.126 0.007 5157 5336 1.451 0.053 0.112 0.139 Currently using a modern method 0.082 0.005 5157 5336 1.184 0.055 0.073 0.092 Currently using pill 0.018 0.002 5157 5336 1.247 0.128 0.013 0.023 Currently using IUD 0.007 0.001 5157 5336 1.023 0.165 0.005 0.010 Currently using condom 0.019 0.003 5157 5336 1.495 0.148 0.014 0.025 Currently using female sterilization 0.002 0.001 5157 5336 1.056 0.327 0.001 0.003 Currently using periodic abstinence 0.021 0.003 5157 5336 1.544 0.147 0.015 0.027 Obtained method from public sector source 0.228 0.022 616 597 1.287 0.095 0.185 0.272 Wanting no more children 0.183 0.009 5157 5336 1.658 0.049 0.165 0.201 Wanting to delay birth at least 2 years 0.338 0.010 5157 5336 1.569 0.031 0.318 0.359 Ideal family size 6.668 0.088 6783 6795 2.324 0.013 6.491 6.844 Neonatal mortality (0-4 years) 48.370 3.527 6101 6310 1.191 0.073 41.317 55.423 Postneonatal mortality (0-4 years) 51.587 4.234 6135 6343 1.430 0.082 43.119 60.054 Infant mortality (0-4 years) 99.956 6.202 6135 6343 1.481 0.062 87.552 112.360 Infant mortality (5-9 years) 119.858 5.482 5442 5574 1.123 0.046 108.894 130.822 Infant Mortality (10-14 years) 113.346 6.144 4436 4515 1.141 0.054 101.058 125.634 Child mortality (0-4 years) 111.693 6.819 6309 6530 1.404 0.061 98.056 125.331 Under-five mortality (0-4 years) 200.485 8.942 6343 6563 1.554 0.045 182.601 218.370 Mothers received tetanus injection for last birth 0.508 0.018 3775 3911 2.284 0.036 0.471 0.544 Mothers received medical assistance at delivery 0.362 0.019 6029 6219 2.464 0.053 0.324 0.401 Had diarrhoea in two weeks before survey 0.188 0.011 5186 5345 1.869 0.056 0.167 0.209 Treated with oral rehydration salts (ORS) 0.182 0.016 929 1006 1.173 0.086 0.151 0.213 Taken to a health provider 0.215 0.027 929 1006 1.916 0.128 0.160 0.270 Vaccination card seen 0.213 0.019 1015 999 1.407 0.087 0.176 0.250 Received BCG 0.483 0.025 1015 999 1.564 0.052 0.433 0.533 Received DPT (3 doses) 0.214 0.022 1015 999 1.696 0.104 0.169 0.258 Received polio (3 doses) 0.294 0.023 1015 999 1.576 0.078 0.249 0.340 Received measles 0.359 0.025 1015 999 1.636 0.070 0.309 0.409 Fully immunized 0.129 0.017 1015 999 1.629 0.135 0.094 0.164 Height-for-age (below -2SD) 0.383 0.011 4610 4789 1.501 0.030 0.360 0.406 Weight-for-height (below -2SD) 0.092 0.006 4610 4789 1.326 0.062 0.081 0.104 Weight-for-age (below -2SD) 0.287 0.013 4610 4789 1.774 0.044 0.262 0.312 BMI <18.5 0.152 0.008 6426 6362 1.736 0.051 0.136 0.167 Circumcised 0.190 0.014 7620 7620 3.012 0.071 0.163 0.217 Has heard of HIV/AIDS 0.863 0.010 7620 7620 2.488 0.011 0.844 0.883 Knows about condoms 0.446 0.011 7620 7620 1.938 0.025 0.424 0.468 Knows about limiting partners 0.599 0.013 7620 7620 2.241 0.021 0.574 0.624 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.372 0.021 2346 2346 2.078 0.056 0.330 0.413 Literate 0.725 0.014 2346 2346 1.486 0.019 0.697 0.752 No education 0.216 0.014 2346 2346 1.598 0.063 0.189 0.243 Secondary education or higher 0.527 0.019 2346 2346 1.801 0.035 0.490 0.564 Never married 0.447 0.017 2346 2346 1.628 0.037 0.413 0.480 Currently married/in union 0.531 0.017 2346 2346 1.606 0.031 0.498 0.564 Knows any contraceptive method 0.902 0.011 2346 2346 1.843 0.013 0.879 0.924 Ideal family size 8.590 0.291 1992 1982 1.624 0.034 8.008 9.171 Has heard of HIV/AIDS 0.970 0.005 2086 2093 1.457 0.006 0.960 0.981 Knows about condoms 0.634 0.019 2086 2093 1.824 0.030 0.595 0.672 Knows about limiting partners 0.802 0.013 2086 2093 1.520 0.017 0.775 0.828 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 222 | Appendix B Table B.3 Sampling errors for urban sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 3057 2629 na 0.000 1.000 1.000 Literate 0.675 0.023 3057 2629 2.679 0.034 0.630 0.721 No education 0.249 0.021 3057 2629 2.718 0.085 0.206 0.291 Secondary education or higher 0.556 0.025 3057 2629 2.795 0.045 0.505 0.606 Net attendance ratio for primary school 0.695 0.019 2241 1956 1.549 0.028 0.657 0.734 Never married 0.321 0.015 3057 2629 1.759 0.046 0.291 0.351 Currently married/in union 0.621 0.017 3057 2629 1.974 0.028 0.587 0.656 Married before age 20 0.524 0.019 2368 2049 1.861 0.036 0.485 0.562 Currently pregnant 0.094 0.006 3057 2629 1.212 0.068 0.081 0.107 Children ever born 2.658 0.077 3057 2629 1.419 0.029 2.504 2.812 Children surviving 2.185 0.056 3057 2629 1.283 0.026 2.073 2.297 Children ever born to women age 40-49 6.248 0.176 507 418 1.327 0.028 5.896 6.599 Total fertility rate (3 years) 4.861 0.202 na 7369 1.651 0.042 4.456 5.266 Knows any contraceptive method 0.910 0.010 1870 1633 1.561 0.011 0.890 0.931 Ever using contraceptive method 0.449 0.023 1870 1633 2.017 0.052 0.402 0.495 Currently using any contraceptive method 0.202 0.014 1870 1633 1.501 0.069 0.174 0.230 Currently using a modern method 0.139 0.010 1870 1633 1.265 0.073 0.119 0.160 Currently using pill 0.033 0.005 1870 1633 1.228 0.153 0.023 0.043 Currently using IUD 0.019 0.004 1870 1633 1.161 0.192 0.012 0.026 Currently using condom 0.040 0.008 1870 1633 1.678 0.190 0.025 0.055 Currently using female sterilization 0.003 0.001 1870 1633 0.970 0.392 0.001 0.006 Currently using periodic abstinence 0.029 0.005 1870 1633 1.169 0.155 0.020 0.039 Obtained method from public sector source 0.207 0.027 354 322 1.262 0.131 0.153 0.262 Wanting no more children 0.218 0.013 1870 1633 1.389 0.061 0.192 0.245 Wanting to delay birth at least 2 years 0.323 0.017 1870 1633 1.604 0.054 0.288 0.357 Ideal family size 6.023 0.148 2746 2409 2.699 0.025 5.727 6.320 Neonatal mortality (10 years) 36.679 4.256 4017 3393 1.305 0.116 28.167 45.191 Postneonatal mortality (10 years) 44.109 4.752 4023 3397 1.352 0.108 34.605 53.612 Infant mortality (10 years) 80.788 7.678 4023 3397 1.576 0.095 65.432 96.144 Child mortality (10 years) 78.464 7.803 4073 3437 1.383 0.099 62.859 94.069 Under five mortality (10 years) 152.913 11.956 4079 3441 1.770 0.078 129.000 176.826 Mothers received tetanus injection for last birth 0.734 0.026 1350 1144 2.176 0.036 0.681 0.787 Mothers received medical assistance at delivery 0.588 0.035 2118 1795 2.529 0.060 0.518 0.658 Had diarrhoea in two weeks before survey 0.145 0.020 1902 1620 2.226 0.137 0.105 0.185 Treated with oral rehydration salts (ORS) 0.229 0.027 281 235 0.968 0.119 0.174 0.283 Taken to a health provider 0.303 0.089 281 235 2.798 0.293 0.125 0.481 Vaccination card seen 0.356 0.032 395 312 1.266 0.090 0.292 0.421 Received BCG 0.701 0.043 395 312 1.760 0.062 0.614 0.788 Received DPT (3 doses) 0.402 0.036 395 312 1.377 0.089 0.331 0.474 Received polio (3 doses) 0.420 0.047 395 312 1.801 0.112 0.326 0.514 Received measles 0.521 0.047 395 312 1.749 0.089 0.428 0.614 Fully immunized 0.251 0.035 395 312 1.527 0.140 0.181 0.322 Height-for-age (below -2SD) 0.288 0.020 1748 1553 1.665 0.068 0.249 0.327 Weight-for-height (below -2SD) 0.083 0.009 1748 1553 1.379 0.111 0.064 0.101 Weight-for-age (below -2SD) 0.222 0.022 1748 1553 2.020 0.100 0.178 0.267 BMI <18.5 0.131 0.010 2642 2258 1.552 0.078 0.111 0.152 Circumcised 0.283 0.017 3057 2629 2.085 0.060 0.249 0.317 Has heard of HIV/AIDS 0.947 0.005 3057 2629 1.269 0.005 0.937 0.957 Knows about condoms 0.575 0.014 3057 2629 1.546 0.024 0.548 0.603 Knows about limiting partners 0.730 0.014 3057 2629 1.740 0.019 0.702 0.758 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 986 872 na 0.000 1.000 1.000 Literate 0.868 0.012 986 872 1.145 0.014 0.843 0.893 No education 0.112 0.013 986 872 1.319 0.118 0.085 0.139 Secondary education or higher 0.658 0.027 986 872 1.766 0.041 0.604 0.711 Never married 0.510 0.024 986 872 1.526 0.048 0.461 0.558 Currently married/in union 0.460 0.024 986 872 1.515 0.052 0.412 0.508 Knows any contraceptive method 0.949 0.010 986 872 1.443 0.011 0.929 0.969 Ideal family size 6.567 0.301 817 729 1.557 0.046 5.964 7.170 Has heard of HIV/AIDS 0.990 0.004 887 792 1.118 0.004 0.982 0.997 Knows about condoms 0.706 0.022 887 792 1.420 0.031 0.663 0.750 Knows about limiting partners 0.831 0.017 887 792 1.352 0.020 0.797 0.865 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 223 Table B.4 Sampling errors for rural sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 4563 4991 na na 0.000 0.000 Literate 0.380 0.022 4563 4991 3.096 0.059 0.335 0.424 No education 0.504 0.022 4563 4991 2.986 0.044 0.460 0.548 Secondary education or higher 0.273 0.018 4563 4991 2.690 0.065 0.237 0.308 Net attendance ratio for primary school 0.557 0.023 3655 4155 2.184 0.040 0.512 0.602 Never married 0.217 0.013 4563 4991 2.092 0.059 0.191 0.242 Currently married/in union 0.742 0.013 4563 4991 1.966 0.017 0.716 0.767 Married before age 20 0.737 0.015 3503 3855 2.026 0.020 0.706 0.767 Currently pregnant 0.124 0.007 4563 4991 1.426 0.056 0.110 0.138 Children ever born 3.324 0.073 4563 4991 1.501 0.022 3.177 3.470 Children surviving 2.485 0.050 4563 4991 1.367 0.020 2.386 2.584 Children ever born to women age 40-49 7.083 0.176 806 853 1.513 0.025 6.731 7.435 Total fertility rate (3 years) 6.075 0.182 na 13887 1.670 0.030 5.710 6.439 Knows any contraceptive method 0.729 0.015 3287 3703 1.894 0.020 0.700 0.758 Ever using contraceptive method 0.245 0.015 3287 3703 2.058 0.063 0.214 0.276 Currently using any contraceptive method 0.092 0.007 3287 3703 1.457 0.080 0.077 0.107 Currently using a modern method 0.057 0.005 3287 3703 1.166 0.082 0.048 0.067 Currently using pill 0.011 0.002 3287 3703 1.342 0.218 0.006 0.016 Currently using IUD 0.002 0.001 3287 3703 0.952 0.351 0.001 0.004 Currently using condom 0.010 0.002 3287 3703 1.159 0.197 0.006 0.015 Currently using female sterilization 0.001 0.001 3287 3703 1.149 0.522 0.000 0.003 Currently using periodic abstinence 0.017 0.004 3287 3703 1.765 0.234 0.009 0.025 Obtained method from public sector source 0.253 0.036 262 275 1.323 0.141 0.181 0.324 Wanting no more children 0.167 0.011 3287 3703 1.727 0.067 0.145 0.190 Wanting to delay birth at least 2 years 0.345 0.013 3287 3703 1.548 0.037 0.320 0.371 Ideal family size 7.021 0.108 4037 4387 2.139 0.015 6.805 7.237 Neonatal mortality (10 years) 59.979 3.944 7499 8463 1.205 0.066 52.091 67.866 Postneonatal mortality (10 years) 60.758 4.105 7520 8487 1.350 0.068 52.549 68.967 Infant mortality (10 years) 120.736 5.790 7520 8487 1.324 0.048 109.157 132.316 Child mortality (10 years) 138.678 8.578 7672 8674 1.704 0.062 121.521 155.835 Under five mortality (10 years) 242.671 9.006 7693 8699 1.496 0.037 224.659 260.683 Mothers received tetanus injection for last birth 0.414 0.022 2425 2766 2.200 0.052 0.371 0.457 Mothers received medical assistance at delivery 0.271 0.020 3911 4424 2.288 0.075 0.230 0.311 Had diarrhoea in two weeks before survey 0.207 0.012 3284 3726 1.686 0.059 0.182 0.231 Treated with oral rehydration salts (ORS) 0.168 0.018 648 771 1.179 0.107 0.132 0.204 Taken to a health provider 0.188 0.020 648 771 1.240 0.106 0.148 0.227 Vaccination card seen 0.148 0.020 620 687 1.386 0.137 0.107 0.188 Received BCG 0.384 0.030 620 687 1.517 0.078 0.324 0.444 Received DPT (3 doses) 0.128 0.027 620 687 1.950 0.209 0.075 0.181 Received polio (3 doses) 0.237 0.024 620 687 1.376 0.100 0.190 0.285 Received measles 0.285 0.028 620 687 1.555 0.100 0.228 0.342 Fully immunized 0.074 0.018 620 687 1.742 0.247 0.037 0.110 Height-for-age (below -2SD) 0.429 0.014 2862 3236 1.445 0.033 0.401 0.457 Weight-for-height (below -2SD) 0.097 0.007 2862 3236 1.275 0.073 0.083 0.111 Weight-for-age (below -2SD) 0.318 0.015 2862 3236 1.621 0.047 0.288 0.347 BMI <18.5 0.163 0.011 3784 4105 1.804 0.067 0.141 0.184 Circumcised 0.140 0.019 4563 4991 3.613 0.132 0.103 0.178 Has heard of HIV/AIDS 0.819 0.015 4563 4991 2.593 0.018 0.789 0.848 Knows about condoms 0.378 0.015 4563 4991 2.109 0.040 0.348 0.409 Knows about limiting partners 0.530 0.018 4563 4991 2.404 0.034 0.494 0.565 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 1360 1474 na na 0.000 0.000 Literate 0.640 0.020 1360 1474 1.515 0.031 0.600 0.679 No education 0.278 0.020 1360 1474 1.622 0.071 0.238 0.317 Secondary education or higher 0.450 0.025 1360 1474 1.870 0.056 0.399 0.500 Never married 0.410 0.023 1360 1474 1.709 0.056 0.364 0.455 Currently married/in union 0.573 0.023 1360 1474 1.690 0.040 0.527 0.618 Knows any contraceptive method 0.874 0.017 1360 1474 1.881 0.019 0.840 0.908 Ideal family size 9.767 0.414 1175 1253 1.591 0.042 8.940 10.594 Has heard of HIV/AIDS 0.959 0.008 1199 1301 1.455 0.009 0.942 0.975 Knows about condoms 0.590 0.029 1199 1301 2.007 0.048 0.533 0.647 Knows about limiting partners 0.784 0.019 1199 1301 1.591 0.024 0.746 0.822 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 224 | Appendix B Table B.5 Sampling errors for North Central sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.251 0.030 1256 1121 2.484 0.121 0.190 0.312 Literate 0.434 0.040 1256 1121 2.879 0.093 0.353 0.515 No education 0.359 0.034 1256 1121 2.537 0.096 0.291 0.428 Secondary education or higher 0.341 0.031 1256 1121 2.349 0.092 0.278 0.404 Net attendance ratio for primary school 0.702 0.033 1067 978 1.951 0.046 0.637 0.767 Never married 0.280 0.027 1256 1121 2.154 0.098 0.225 0.334 Currently married/in union 0.673 0.025 1256 1121 1.874 0.037 0.623 0.723 Married before age 20 0.635 0.023 996 879 1.503 0.036 0.590 0.681 Currently pregnant 0.094 0.012 1256 1121 1.466 0.128 0.070 0.119 Children ever born 2.976 0.111 1256 1121 1.264 0.037 2.754 3.198 Children surviving 2.404 0.077 1256 1121 1.111 0.032 2.250 2.559 Children ever born to women age 40-49 7.354 0.338 202 169 1.690 0.046 6.677 8.030 Total fertility rate (3 years) 5.704 0.335 na 3146 1.445 0.059 5.035 6.374 Knows any contraceptive method 0.774 0.032 848 754 2.198 0.041 0.711 0.837 Ever using contraceptive method 0.324 0.032 848 754 1.958 0.097 0.261 0.387 Currently using any contraceptive method 0.133 0.015 848 754 1.276 0.112 0.103 0.163 Currently using a modern method 0.103 0.012 848 754 1.133 0.115 0.080 0.127 Currently using pill 0.022 0.005 848 754 1.062 0.245 0.011 0.032 Currently using IUD 0.001 0.001 848 754 0.747 0.713 0.000 0.003 Currently using condom 0.015 0.005 848 754 1.121 0.316 0.005 0.024 Currently using female sterilization 0.008 0.003 848 754 0.955 0.371 0.002 0.014 Currently using periodic abstinence 0.019 0.007 848 754 1.429 0.349 0.006 0.033 Obtained method from public sector source 0.330 0.068 121 97 1.588 0.206 0.194 0.467 Wanting no more children 0.241 0.020 848 754 1.392 0.085 0.200 0.282 Wanting to delay birth at least 2 years 0.358 0.019 848 754 1.168 0.054 0.320 0.397 Ideal family size 6.194 0.197 1184 1060 2.273 0.032 5.800 6.589 Neonatal mortality (10 years) 53.260 8.562 1898 1680 1.398 0.161 36.136 70.384 Postneonatal mortality (10 years) 49.379 7.317 1899 1680 1.332 0.148 34.745 64.013 Infant mortality (10 years) 102.638 10.125 1899 1680 1.235 0.099 82.389 122.887 Child mortality (10 years) 69.698 10.853 1916 1699 1.500 0.156 47.992 91.403 Under five mortality (10 years) 165.18 13.746 1917 1699 1.335 0.083 137.691 192.674 Mothers received tetanus injection for last birth 0.626 0.037 645 575 1.967 0.060 0.551 0.701 Mothers received medical assistance at delivery 0.501 0.033 1015 897 1.648 0.066 0.435 0.567 Had diarrhoea in two weeks before survey 0.149 0.022 895 781 1.712 0.145 0.106 0.192 Treated with oral rehydration salts (ORS) 0.223 0.059 138 116 1.432 0.262 0.106 0.340 Taken to a health provider 0.397 0.039 138 116 0.846 0.098 0.319 0.476 Vaccination card seen 0.229 0.046 181 149 1.384 0.199 0.138 0.321 Received BCG 0.634 0.057 181 149 1.485 0.090 0.520 0.748 Received DPT (3 doses) 0.238 0.048 181 149 1.366 0.200 0.143 0.334 Received polio (3 doses) 0.368 0.049 181 149 1.288 0.134 0.269 0.467 Received measles 0.446 0.067 181 149 1.675 0.150 0.312 0.580 Fully immunized 0.124 0.033 181 149 1.274 0.264 0.059 0.189 Height-for-age (below -2SD) 0.314 0.027 850 758 1.625 0.087 0.260 0.369 Weight-for-height (below -2SD) 0.055 0.009 850 758 1.130 0.163 0.037 0.073 Weight-for-age (below -2SD) 0.196 0.021 850 758 1.481 0.108 0.154 0.238 BMI <18.5 0.066 0.009 1069 944 1.229 0.142 0.047 0.085 Circumcised 0.096 0.035 1256 1121 4.165 0.361 0.027 0.165 Has heard of HIV/AIDS 0.845 0.037 1256 1121 3.611 0.044 0.771 0.919 Knows about condoms 0.347 0.027 1256 1121 1.985 0.077 0.293 0.400 Knows about limiting partners 0.556 0.041 1256 1121 2.946 0.074 0.474 0.639 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.278 0.041 416 348 1.853 0.147 0.197 0.360 Literate 0.752 0.032 416 348 1.496 0.042 0.689 0.816 No education 0.134 0.027 416 348 1.600 0.199 0.081 0.188 Secondary education or higher 0.631 0.037 416 348 1.553 0.058 0.558 0.705 Never married 0.495 0.042 416 348 1.693 0.084 0.412 0.579 Currently married/in union 0.499 0.041 416 348 1.682 0.083 0.417 0.582 Knows any contraceptive method 0.930 0.018 416 348 1.418 0.019 0.895 0.966 Ideal family size 8.042 0.498 407 339 1.342 0.062 7.045 9.039 Has heard of HIV/AIDS 0.971 0.010 374 313 1.125 0.010 0.951 0.990 Knows about condoms 0.681 0.029 374 313 1.205 0.043 0.623 0.739 Knows about limiting partners 0.838 0.024 374 313 1.273 0.029 0.789 0.886 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 225 Table B.6 Sampling errors for North East sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.275 0.025 1413 1368 2.094 0.090 0.225 0.325 Literate 0.256 0.030 1413 1368 2.590 0.118 0.196 0.316 No education 0.678 0.032 1413 1368 2.552 0.047 0.615 0.742 Secondary education or higher 0.157 0.021 1413 1368 2.201 0.136 0.114 0.199 Net attendance ratio for primary school 0.444 0.040 1301 1278 2.018 0.089 0.365 0.523 Never married 0.124 0.017 1413 1368 1.949 0.138 0.090 0.158 Currently married/in union 0.821 0.020 1413 1368 1.941 0.024 0.781 0.860 Married before age 20 0.855 0.016 1108 1074 1.477 0.018 0.823 0.886 Currently pregnant 0.142 0.013 1413 1368 1.379 0.090 0.117 0.168 Children ever born 3.927 0.125 1413 1368 1.368 0.032 3.677 4.178 Children surviving 2.859 0.108 1413 1368 1.616 0.038 2.644 3.075 Children ever born to women age 40-49 7.412 0.364 247 241 1.587 0.049 6.683 8.140 Total fertility rate (3 years) 7.027 0.299 na 3808 1.985 0.043 6.428 7.626 Knows any contraceptive method 0.635 0.022 1133 1122 1.535 0.035 0.591 0.679 Ever using contraceptive method 0.123 0.013 1133 1122 1.307 0.104 0.098 0.149 Currently using any contraceptive method 0.042 0.006 1133 1122 1.038 0.147 0.030 0.055 Currently using a modern method 0.030 0.004 1133 1122 0.851 0.143 0.022 0.039 Currently using pill 0.007 0.003 1133 1122 1.246 0.434 0.001 0.014 Currently using IUD 0.002 0.001 1133 1122 1.100 0.757 0.000 0.005 Currently using condom 0.002 0.001 1133 1122 1.014 0.654 0.000 0.005 Currently using female sterilization 0.000 0.000 1133 1122 0.551 1.018 0.000 0.001 Currently using periodic abstinence 0.006 0.003 1133 1122 1.316 0.486 0.000 0.013 Obtained method from public sector source 0.535 0.107 32 29 1.189 0.199 0.322 0.748 Wanting no more children 0.163 0.020 1133 1122 1.794 0.121 0.123 0.202 Wanting to delay birth at least 2 years 0.344 0.024 1133 1122 1.692 0.069 0.296 0.391 Ideal family size 7.817 0.178 1107 1060 1.651 0.023 7.462 8.173 Neonatal mortality (10 years) 60.637 7.661 2842 2802 1.417 0.126 45.316 75.959 Postneonatal mortality (10 years) 64.856 5.691 2850 2809 1.108 0.088 53.474 76.238 Infant mortality (10 years) 125.493 8.204 2850 2809 1.201 0.065 109.086 141.900 Child mortality (10 years) 153.707 10.692 2915 2884 1.274 0.070 132.322 175.092 Under five mortality (10 years) 259.911 11.454 2923 2891 1.177 0.044 237.002 282.820 Mothers received tetanus injection for last birth 0.431 0.036 867 862 2.178 0.084 0.358 0.503 Mothers received medical assistance at delivery 0.220 0.027 1487 1472 2.100 0.123 0.166 0.275 Had diarrhoea in two weeks before survey 0.351 0.018 1239 1225 1.331 0.052 0.314 0.387 Treated with oral rehydration salts (ORS) 0.138 0.020 403 430 1.162 0.148 0.097 0.179 Taken to a health provider 0.076 0.017 403 430 1.298 0.228 0.041 0.111 Vaccination card seen 0.171 0.037 236 219 1.435 0.219 0.096 0.246 Received BCG 0.311 0.048 236 219 1.525 0.154 0.215 0.407 Received DPT (3 doses) 0.091 0.026 236 219 1.361 0.287 0.039 0.143 Received polio (3 doses) 0.248 0.044 236 219 1.521 0.178 0.160 0.336 Received measles 0.225 0.035 236 219 1.242 0.155 0.156 0.295 Fully immunized 0.060 0.018 236 219 1.171 0.310 0.023 0.096 Height-for-age (below -2SD) 0.430 0.022 1099 1089 1.375 0.052 0.386 0.475 Weight-for-height (below -2SD) 0.079 0.011 1099 1089 1.298 0.133 0.058 0.100 Weight-for-age (below -2SD) 0.331 0.023 1099 1089 1.449 0.069 0.285 0.376 BMI <18.5 0.230 0.021 1120 1095 1.687 0.092 0.188 0.273 Circumcised 0.013 0.003 1413 1368 1.069 0.250 0.006 0.019 Has heard of HIV/AIDS 0.757 0.018 1413 1368 1.547 0.023 0.722 0.793 Knows about condoms 0.347 0.032 1413 1368 2.496 0.091 0.284 0.410 Knows about limiting partners 0.506 0.021 1413 1368 1.557 0.041 0.465 0.548 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.286 0.031 423 421 1.426 0.110 0.223 0.349 Literate 0.599 0.031 423 421 1.284 0.051 0.538 0.661 No education 0.419 0.041 423 421 1.727 0.099 0.336 0.502 Secondary education or higher 0.357 0.044 423 421 1.902 0.124 0.268 0.446 Never married 0.300 0.048 423 421 2.147 0.160 0.204 0.395 Currently married/in union 0.672 0.048 423 421 2.116 0.072 0.575 0.769 Knows any contraceptive method 0.780 0.042 423 421 2.103 0.054 0.695 0.865 Ideal family size 12.484 1.173 297 284 1.831 0.094 10.138 14.830 Has heard of HIV/AIDS 0.973 0.008 376 377 0.954 0.008 0.957 0.989 Knows about condoms 0.475 0.055 376 377 2.131 0.116 0.365 0.585 Knows about limiting partners 0.802 0.026 376 377 1.254 0.032 0.750 0.853 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 226 | Appendix B Table B.7 Sampling errors for North West sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.278 0.029 1791 2095 2.699 0.103 0.221 0.335 Literate 0.209 0.017 1791 2095 1.779 0.082 0.175 0.243 No education 0.750 0.017 1791 2095 1.645 0.022 0.717 0.784 Secondary education or higher 0.131 0.011 1791 2095 1.370 0.083 0.109 0.153 Net attendance ratio for primary school 0.417 0.034 1459 1834 2.131 0.082 0.349 0.485 Never married 0.069 0.008 1791 2095 1.375 0.119 0.053 0.086 Currently married/in union 0.897 0.011 1791 2095 1.494 0.012 0.876 0.919 Married before age 20 0.908 0.009 1406 1675 1.180 0.010 0.889 0.926 Currently pregnant 0.162 0.009 1791 2095 1.028 0.055 0.144 0.180 Children ever born 3.778 0.096 1791 2095 1.235 0.025 3.586 3.970 Children surviving 2.699 0.066 1791 2095 1.178 0.024 2.567 2.830 Children ever born to women age 40-49 6.734 0.238 315 372 1.152 0.035 6.258 7.209 Total fertility rate (3 years) 6.687 0.254 na 5907 1.471 0.038 6.179 7.196 Knows any contraceptive method 0.751 0.020 1556 1880 1.812 0.026 0.711 0.791 Ever using contraceptive method 0.151 0.011 1556 1880 1.156 0.069 0.130 0.172 Currently using any contraceptive method 0.049 0.007 1556 1880 1.224 0.136 0.036 0.063 Currently using a modern method 0.033 0.005 1556 1880 1.048 0.144 0.024 0.043 Currently using pill 0.006 0.002 1556 1880 1.228 0.405 0.001 0.011 Currently using IUD 0.001 0.001 1556 1880 0.775 0.594 0.000 0.002 Currently using condom 0.001 0.000 1556 1880 0.733 0.732 0.000 0.002 Currently using female sterilization 0.001 0.001 1556 1880 1.039 1.007 0.000 0.002 Currently using periodic abstinence 0.002 0.002 1556 1880 1.467 0.752 0.000 0.006 Obtained method from public sector source 0.477 0.102 40 38 1.276 0.214 0.272 0.681 Wanting no more children 0.065 0.009 1556 1880 1.436 0.138 0.047 0.083 Wanting to delay birth at least 2 years 0.360 0.020 1556 1880 1.635 0.055 0.321 0.400 Ideal family size 8.563 0.106 1522 1793 1.283 0.012 8.351 8.776 Neonatal mortality (10 years) 55.259 4.247 3462 4150 0.990 0.077 46.765 63.753 Postneonatal mortality (10 years) 58.608 6.380 3472 4162 1.410 0.109 45.849 71.367 Infant mortality (10 years) 113.867 8.167 3472 4162 1.250 0.072 97.533 130.201 Child mortality (10 years) 175.610 12.271 3569 4280 1.437 0.070 151.068 200.152 Under five mortality (10 years) 269.481 13.639 3579 4292 1.471 0.051 242.203 296.758 Mothers received tetanus injection for last birth 0.262 0.022 1125 1341 1.698 0.084 0.218 0.306 Mothers received medical assistance at delivery 0.130 0.016 1821 2161 1.623 0.120 0.099 0.162 Had diarrhoea in two weeks before survey 0.189 0.019 1529 1818 1.775 0.099 0.152 0.226 Treated with oral rehydration salts (ORS) 0.205 0.025 265 343 0.962 0.121 0.155 0.255 Taken to a health provider 0.298 0.062 265 343 2.069 0.210 0.173 0.423 Vaccination card seen 0.096 0.015 311 356 0.874 0.154 0.066 0.126 Received BCG 0.275 0.029 311 356 1.131 0.106 0.217 0.333 Received DPT (3 doses) 0.058 0.013 311 356 0.990 0.230 0.031 0.084 Received polio (3 doses) 0.164 0.025 311 356 1.179 0.153 0.113 0.214 Received measles 0.156 0.027 311 356 1.282 0.171 0.103 0.210 Fully immunized 0.037 0.012 311 356 1.094 0.319 0.013 0.061 Height-for-age (below -2SD) 0.553 0.022 1188 1452 1.419 0.039 0.510 0.596 Weight-for-height (below -2SD) 0.125 0.013 1188 1452 1.287 0.100 0.100 0.150 Weight-for-age (below -2SD) 0.429 0.023 1188 1452 1.555 0.054 0.382 0.475 BMI <18.5 0.197 0.016 1404 1630 1.499 0.081 0.166 0.229 Circumcised 0.004 0.002 1791 2095 1.122 0.399 0.001 0.008 Has heard of HIV/AIDS 0.866 0.019 1791 2095 2.316 0.022 0.828 0.903 Knows about condoms 0.488 0.018 1791 2095 1.499 0.036 0.452 0.523 Knows about limiting partners 0.598 0.022 1791 2095 1.910 0.037 0.554 0.642 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.350 0.038 547 602 1.860 0.108 0.274 0.426 Literate 0.557 0.027 547 602 1.282 0.049 0.503 0.612 No education 0.415 0.030 547 602 1.429 0.073 0.354 0.475 Secondary education or higher 0.322 0.029 547 602 1.437 0.089 0.264 0.379 Never married 0.355 0.031 547 602 1.535 0.088 0.293 0.418 Currently married/in union 0.618 0.032 547 602 1.515 0.051 0.555 0.681 Knows any contraceptive method 0.940 0.013 547 602 1.313 0.014 0.913 0.967 Ideal family size 12.755 0.703 362 417 1.388 0.055 11.349 14.160 Has heard of HIV/AIDS 0.993 0.003 477 529 0.887 0.003 0.986 1.000 Knows about condoms 0.698 0.036 477 529 1.699 0.051 0.627 0.770 Knows about limiting partners 0.831 0.025 477 529 1.456 0.030 0.781 0.881 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 227 Table B.8 Sampling errors for South East sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.404 0.103 1081 737 6.890 0.255 0.198 0.610 Literate 0.856 0.021 1081 737 2.009 0.025 0.813 0.899 No education 0.077 0.015 1081 737 1.850 0.194 0.047 0.107 Secondary education or higher 0.675 0.039 1081 737 2.758 0.058 0.596 0.754 Net attendance ratio for primary school 0.802 0.037 670 437 2.251 0.046 0.729 0.875 Never married 0.462 0.023 1081 737 1.485 0.049 0.417 0.507 Currently married/in union 0.499 0.025 1081 737 1.666 0.051 0.449 0.550 Married before age 20 0.345 0.027 803 557 1.606 0.078 0.291 0.398 Currently pregnant 0.068 0.005 1081 737 0.706 0.080 0.057 0.079 Children ever born 2.241 0.075 1081 737 0.820 0.034 2.090 2.392 Children surviving 1.934 0.074 1081 737 0.962 0.038 1.786 2.082 Children ever born to women age 40-49 6.572 0.503 219 128 2.562 0.077 5.566 7.579 Total fertility rate (3 years) 4.106 0.368 na 2108 1.771 0.090 3.371 4.841 Knows any contraceptive method 0.871 0.031 509 368 2.073 0.035 0.810 0.933 Ever using contraceptive method 0.559 0.057 509 368 2.574 0.101 0.445 0.672 Currently using any contraceptive method 0.225 0.028 509 368 1.493 0.123 0.169 0.280 Currently using a modern method 0.130 0.019 509 368 1.305 0.150 0.091 0.169 Currently using pill 0.015 0.007 509 368 1.361 0.496 0.000 0.029 Currently using IUD 0.007 0.004 509 368 1.067 0.550 0.000 0.015 Currently using condom 0.089 0.020 509 368 1.551 0.221 0.050 0.128 Currently using female sterilization 0.001 0.001 509 368 0.635 0.763 0.000 0.003 Currently using periodic abstinence 0.033 0.011 509 368 1.379 0.333 0.011 0.054 Obtained method from public sector source 0.174 0.049 90 78 1.220 0.282 0.076 0.272 Wanting no more children 0.316 0.032 509 368 1.545 0.101 0.252 0.379 Wanting to delay birth at least 2 years 0.223 0.034 509 368 1.825 0.151 0.156 0.291 Ideal family size 5.314 0.154 999 693 2.812 0.029 5.005 5.623 Neonatal mortality (10 years) 33.975 13.372 1086 706 2.042 0.394 7.231 60.719 Postneonatal mortality (10 years) 31.652 10.193 1088 707 1.704 0.322 11.266 52.037 Infant mortality (10 years) 65.626 21.848 1088 707 2.375 0.333 21.931 109.321 Child mortality (10 years) 39.771 10.797 1096 710 1.652 0.271 18.176 61.365 Under five mortality (10 years) 102.787 28.906 1098 711 2.660 0.281 44.975 160.599 Mothers received tetanus injection for last birth 0.897 0.035 329 222 2.061 0.039 0.828 0.967 Mothers received medical assistance at delivery 0.876 0.043 524 371 2.310 0.049 0.791 0.962 Had diarrhoea in two weeks before survey 0.086 0.026 466 347 2.073 0.301 0.034 0.139 Treated with oral rehydration salts (ORS) 0.174 0.064 45 30 1.124 0.370 0.045 0.302 Taken to a health provider 0.249 0.108 45 30 1.670 0.433 0.034 0.464 Vaccination card seen 0.431 0.081 91 74 1.697 0.188 0.269 0.592 Received BCG 0.834 0.050 91 74 1.402 0.060 0.733 0.934 Received DPT (3 doses) 0.585 0.067 91 74 1.407 0.114 0.452 0.719 Received polio (3 doses) 0.574 0.105 91 74 2.208 0.183 0.364 0.784 Received measles 0.641 0.097 91 74 2.109 0.152 0.447 0.836 Fully immunized 0.446 0.068 91 74 1.429 0.153 0.309 0.582 Height-for-age (below -2SD) 0.197 0.015 439 338 0.811 0.074 0.168 0.226 Weight-for-height (below -2SD) 0.049 0.013 439 338 1.299 0.254 0.024 0.074 Weight-for-age (below -2SD) 0.085 0.029 439 338 2.170 0.343 0.027 0.143 BMI <18.5 0.082 0.021 985 648 2.418 0.263 0.039 0.124 Circumcised 0.408 0.030 1081 737 2.021 0.074 0.347 0.468 Has heard of HIV/AIDS 0.955 0.013 1081 737 2.121 0.014 0.928 0.982 Knows about condoms 0.436 0.024 1081 737 1.619 0.056 0.387 0.485 Knows about limiting partners 0.773 0.027 1081 737 2.085 0.034 0.720 0.826 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.462 0.113 265 207 3.682 0.244 0.236 0.688 Literate 0.929 0.024 265 207 1.503 0.026 0.881 0.976 No education 0.025 0.011 265 207 1.105 0.422 0.004 0.047 Secondary education or higher 0.714 0.058 265 207 2.103 0.082 0.597 0.831 Never married 0.517 0.050 265 207 1.618 0.096 0.418 0.617 Currently married/in union 0.478 0.050 265 207 1.637 0.105 0.378 0.579 Knows any contraceptive method 0.955 0.020 265 207 1.561 0.021 0.915 0.995 Ideal family size 5.309 0.288 259 205 1.751 0.054 4.733 5.885 Has heard of HIV/AIDS 0.993 0.005 233 192 0.967 0.005 0.982 1.000 Knows about condoms 0.794 0.050 233 192 1.898 0.063 0.694 0.895 Knows about limiting partners 0.851 0.017 233 192 0.723 0.020 0.818 0.885 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 228 | Appendix B Table B.9 Sampling errors for South South sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.291 0.055 938 1342 3.733 0.190 0.180 0.402 Literate 0.750 0.031 938 1342 2.216 0.042 0.687 0.813 No education 0.081 0.022 938 1342 2.418 0.267 0.038 0.124 Secondary education or higher 0.617 0.039 938 1342 2.433 0.063 0.539 0.694 Net attendance ratio for primary school 0.822 0.023 704 969 1.538 0.029 0.775 0.868 Never married 0.431 0.024 938 1342 1.453 0.055 0.384 0.478 Currently married/in union 0.495 0.024 938 1342 1.447 0.048 0.447 0.542 Married before age 20 0.481 0.029 693 980 1.520 0.060 0.424 0.539 Currently pregnant 0.090 0.013 938 1342 1.438 0.149 0.063 0.117 Children ever born 2.513 0.164 938 1342 1.634 0.065 2.184 2.841 Children surviving 2.064 0.113 938 1342 1.395 0.055 1.838 2.290 Children ever born to women age 40-49 6.894 0.315 153 214 1.466 0.046 6.264 7.524 Total fertility rate (3 years) 4.630 0.274 na 3698 1.084 0.059 4.083 5.178 Knows any contraceptive method 0.942 0.020 467 664 1.822 0.021 0.902 0.981 Ever using contraceptive method 0.613 0.031 467 664 1.380 0.051 0.551 0.675 Currently using any contraceptive method 0.254 0.028 467 664 1.381 0.110 0.199 0.310 Currently using a modern method 0.138 0.021 467 664 1.294 0.150 0.097 0.179 Currently using pill 0.040 0.012 467 664 1.330 0.300 0.016 0.065 Currently using IUD 0.007 0.006 467 664 1.391 0.747 0.000 0.018 Currently using condom 0.024 0.008 467 664 1.142 0.336 0.008 0.040 Currently using female sterilization 0.004 0.004 467 664 1.169 0.824 0.000 0.011 Currently using periodic abstinence 0.073 0.017 467 664 1.397 0.231 0.039 0.106 Obtained method from public sector source 0.126 0.027 141 186 0.967 0.215 0.072 0.180 Wanting no more children 0.316 0.022 467 664 1.027 0.070 0.272 0.360 Wanting to delay birth at least 2 years 0.304 0.030 467 664 1.429 0.100 0.243 0.365 Ideal family size 5.538 0.152 901 1290 2.068 0.027 5.234 5.841 Neonatal mortality (10 years) 52.656 10.561 1072 1542 1.156 0.201 31.534 73.778 Postneonatal mortality (10 years) 67.568 9.922 1075 1548 1.256 0.147 47.725 87.412 Infant mortality (10 years) 120.224 18.027 1075 1548 1.580 0.150 84.170 156.279 Child mortality (10 years) 63.423 5.753 1084 1556 0.761 0.091 51.917 74.928 Under five mortality (10 years) 176.022 17.272 1087 1562 1.373 0.098 141.479 210.566 Mothers received tetanus injection for last birth 0.710 0.043 380 544 1.859 0.061 0.623 0.797 Mothers received medical assistance at delivery 0.559 0.058 560 789 2.185 0.104 0.442 0.676 Had diarrhoea in two weeks before survey 0.080 0.016 484 684 1.215 0.201 0.048 0.113 Treated with oral rehydration salts (ORS) 0.277 0.072 37 55 0.909 0.261 0.132 0.421 Taken to a health provider 0.268 0.071 37 55 0.973 0.267 0.125 0.410 Vaccination card seen 0.379 0.077 92 120 1.418 0.202 0.226 0.532 Received BCG 0.761 0.059 92 120 1.268 0.078 0.643 0.880 Received DPT (3 doses) 0.325 0.084 92 120 1.624 0.257 0.158 0.492 Received polio (3 doses) 0.400 0.069 92 120 1.281 0.173 0.262 0.538 Received measles 0.669 0.071 92 120 1.353 0.107 0.526 0.811 Fully immunized 0.208 0.054 92 120 1.224 0.262 0.099 0.317 Height-for-age (below -2SD) 0.209 0.023 464 643 1.259 0.112 0.163 0.256 Weight-for-height (below -2SD) 0.111 0.020 464 643 1.315 0.182 0.071 0.152 Weight-for-age (below -2SD) 0.180 0.027 464 643 1.426 0.149 0.127 0.234 BMI <18.5 0.111 0.013 811 1173 1.201 0.119 0.084 0.137 Circumcised 0.347 0.049 938 1342 3.169 0.142 0.248 0.446 Has heard of HIV/AIDS 0.903 0.023 938 1342 2.408 0.026 0.857 0.950 Knows about condoms 0.488 0.029 938 1342 1.784 0.060 0.430 0.546 Knows about limiting partners 0.580 0.031 938 1342 1.933 0.054 0.518 0.643 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.264 0.057 313 445 2.282 0.216 0.150 0.377 Literate 0.805 0.033 313 445 1.478 0.041 0.738 0.871 No education 0.030 0.011 313 445 1.130 0.363 0.008 0.052 Secondary education or higher 0.656 0.047 313 445 1.735 0.071 0.563 0.749 Never married 0.600 0.033 313 445 1.189 0.055 0.534 0.666 Currently married/in union 0.386 0.032 313 445 1.168 0.083 0.322 0.450 Knows any contraceptive method 0.861 0.032 313 445 1.635 0.037 0.797 0.925 Ideal family size 6.692 0.411 305 432 1.366 0.061 5.871 7.514 Has heard of HIV/AIDS 0.921 0.023 276 385 1.394 0.025 0.875 0.966 Knows about condoms 0.504 0.054 276 385 1.781 0.107 0.397 0.611 Knows about limiting partners 0.682 0.047 276 385 1.657 0.068 0.589 0.775 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 229 Table B.10 Errors for biomarkers in South West sample, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.732 0.035 1141 958 2.668 0.048 0.662 0.802 Literate 0.791 0.017 1141 958 1.419 0.022 0.757 0.825 No education 0.108 0.013 1141 958 1.381 0.117 0.083 0.134 Secondary education or higher 0.652 0.025 1141 958 1.766 0.038 0.602 0.702 Net attendance ratio for primary school 0.828 0.017 695 615 1.120 0.021 0.793 0.862 Never married 0.396 0.015 1141 958 1.050 0.038 0.366 0.427 Currently married/in union 0.571 0.018 1141 958 1.236 0.032 0.535 0.608 Married before age 20 0.342 0.022 865 740 1.351 0.064 0.298 0.385 Currently pregnant 0.060 0.009 1141 958 1.252 0.146 0.043 0.078 Children ever born 2.019 0.076 1141 958 1.073 0.038 1.868 2.171 Children surviving 1.768 0.062 1141 958 1.023 0.035 1.643 1.892 Children ever born to women age 40-49 5.459 0.190 177 147 1.118 0.035 5.079 5.840 Total fertility rate (3 years) 4.122 0.234 na 2631 1.318 0.057 3.654 4.591 Knows any contraceptive method 0.970 0.009 644 548 1.406 0.010 0.951 0.989 Ever using contraceptive method 0.657 0.018 644 548 0.981 0.028 0.620 0.694 Currently using any contraceptive method 0.327 0.023 644 548 1.238 0.070 0.282 0.373 Currently using a modern method 0.231 0.021 644 548 1.263 0.091 0.189 0.273 Currently using pill 0.052 0.012 644 548 1.371 0.231 0.028 0.076 Currently using IUD 0.049 0.009 644 548 1.047 0.182 0.031 0.067 Currently using condom 0.074 0.011 644 548 1.054 0.147 0.052 0.096 Currently using female sterilization 0.000 0.000 644 548 na na 0.000 0.000 Currently using periodic abstinence 0.044 0.009 644 548 1.139 0.208 0.026 0.063 Obtained method from public sector source 0.199 0.038 192 170 1.302 0.189 0.124 0.275 Wanting no more children 0.299 0.020 644 548 1.097 0.066 0.259 0.338 Wanting to delay birth at least 2 years 0.343 0.023 644 548 1.215 0.066 0.297 0.388 Ideal family size 4.757 0.066 1070 901 1.337 0.014 4.626 4.889 Neonatal mortality (10 years) 39.077 7.515 1156 976 1.122 0.192 24.048 54.107 Postneonatal mortality (10 years) 30.112 5.561 1159 979 1.060 0.185 18.991 41.234 Infant mortality (10 years) 69.190 9.048 1159 979 1.092 0.131 51.094 87.285 Child mortality (10 years) 46.690 9.827 1165 983 1.339 0.210 27.037 66.344 Under five mortality (10 years) 112.650 14.172 1168 985 1.297 0.126 84.305 140.994 Mothers received tetanus injection for last birth 0.864 0.022 429 367 1.353 0.026 0.820 0.909 Mothers received medical assistance at delivery 0.816 0.019 622 529 0.982 0.023 0.778 0.853 Had diarrhoea in two weeks before survey 0.064 0.012 573 489 1.185 0.193 0.039 0.089 Treated with oral rehydration salts (ORS) 0.233 0.070 41 31 0.944 0.302 0.092 0.374 Taken to a health provider 0.389 0.094 41 31 1.127 0.242 0.201 0.577 Vaccination card seen 0.364 0.056 104 81 1.124 0.155 0.251 0.476 Received BCG 0.850 0.046 104 81 1.173 0.054 0.759 0.942 Received DPT (3 doses) 0.678 0.055 104 81 1.095 0.080 0.569 0.788 Received polio (3 doses) 0.448 0.064 104 81 1.226 0.142 0.321 0.575 Received measles 0.731 0.048 104 81 1.007 0.066 0.635 0.828 Fully immunized 0.325 0.060 104 81 1.226 0.184 0.205 0.444 Height-for-age (below -2SD) 0.246 0.016 570 510 0.793 0.064 0.214 0.277 Weight-for-height (below -2SD) 0.086 0.012 570 510 0.996 0.138 0.062 0.110 Weight-for-age (below -2SD) 0.191 0.021 570 510 1.177 0.109 0.149 0.233 BMI <18.5 0.167 0.020 1037 872 1.760 0.122 0.126 0.207 Circumcised 0.569 0.025 1141 958 1.715 0.044 0.518 0.619 Has heard of HIV/AIDS 0.903 0.013 1141 958 1.507 0.015 0.876 0.929 Knows about condoms 0.563 0.025 1141 958 1.674 0.044 0.514 0.613 Knows about limiting partners 0.674 0.019 1141 958 1.394 0.029 0.636 0.713 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.717 0.043 382 322 1.867 0.060 0.631 0.803 Literate 0.930 0.014 382 322 1.057 0.015 0.903 0.958 No education 0.048 0.013 382 322 1.149 0.263 0.023 0.073 Secondary education or higher 0.721 0.024 382 322 1.060 0.034 0.672 0.770 Never married 0.501 0.039 382 322 1.526 0.078 0.423 0.579 Currently married/in union 0.451 0.036 382 322 1.407 0.080 0.379 0.522 Knows any contraceptive method 0.980 0.009 382 322 1.238 0.009 0.962 0.998 Ideal family size 4.766 0.163 362 305 1.568 0.034 4.439 5.092 Has heard of HIV/AIDS 0.977 0.009 350 296 1.091 0.009 0.959 0.994 Knows about condoms 0.735 0.028 350 296 1.175 0.038 0.679 0.790 Knows about limiting partners 0.834 0.023 350 296 1.149 0.027 0.789 0.880 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 231 DATA QUALITY TABLES APPENDIX C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Male Female Male Female –––––––––––––––––– ––––––––––––––––– ––––––––––––––––– –––––––––––––––––– Age Number Percentage Number Percentage Age Number Percentage Number Percentage –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 703 4.0 678 3.8 37 101 0.6 121 0.7 1 553 3.2 516 2.9 38 107 0.6 186 1.0 2 568 3.3 592 3.3 39 68 0.4 88 0.5 3 626 3.6 583 3.3 40 400 2.3 391 2.2 4 523 3.0 498 2.8 41 61 0.4 62 0.4 5 486 2.8 487 2.7 42 134 0.8 143 0.8 6 554 3.2 553 3.1 43 80 0.5 84 0.5 7 594 3.4 536 3.0 44 49 0.3 56 0.3 8 593 3.4 520 2.9 45 294 1.7 240 1.4 9 433 2.5 431 2.4 46 71 0.4 72 0.4 10 546 3.1 544 3.1 47 89 0.5 63 0.4 11 334 1.9 369 2.1 48 109 0.6 133 0.8 12 480 2.8 523 3.0 49 50 0.3 76 0.4 13 453 2.6 428 2.4 50 310 1.8 208 1.2 14 331 1.9 312 1.8 51 23 0.1 103 0.6 15 433 2.5 414 2.3 52 99 0.6 170 1.0 16 287 1.6 305 1.7 53 62 0.4 92 0.5 17 335 1.9 342 1.9 54 56 0.3 80 0.5 18 421 2.4 476 2.7 55 144 0.8 192 1.1 19 260 1.5 295 1.7 56 59 0.3 68 0.4 20 526 3.0 634 3.6 57 45 0.3 45 0.3 21 198 1.1 210 1.2 58 83 0.5 68 0.4 22 320 1.8 334 1.9 59 41 0.2 30 0.2 23 242 1.4 247 1.4 60 229 1.3 218 1.2 24 188 1.1 183 1.0 61 24 0.1 021 0.1 25 453 2.6 588 3.3 62 78 0.4 41 0.2 26 176 1.0 240 1.4 63 40 0.2 34 0.2 27 211 1.2 211 1.2 64 40 0.2 26 0.1 28 237 1.4 294 1.7 65 163 0.9 113 0.6 29 118 0.7 149 0.8 66 18 0.1 13 0.1 30 497 2.8 513 2.9 67 36 0.2 17 0.1 31 102 0.6 110 0.6 68 48 0.3 39 0.2 32 174 1.0 171 1.0 69 13 0.1 16 0.1 33 128 0.7 139 0.8 70+ 482 2.8 396 2.2 34 128 0.7 99 0.6 Don’t know/ 35 408 2.3 359 2.0 missing 20 0.1 10 0.1 36 111 0.6 114 0.6 Total 17,459 100.0 17,714 100.0 232 | Appendix C Table C.2.1 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were inter- viewed (weighted), by five-year age groups, Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household Interviewed women Percentage population age 15-49 of eligible Age of women –––––––––––––––––––– women group age 10-54 Number Percent interviewed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 10-14 2,176 na na na 15-19 1,832 1,730 22.4 94.4 20-24 1,609 1,540 19.9 95.7 25-29 1,481 1,416 18.3 95.6 30-34 1,031 979 12.6 94.9 25-39 867 825 10.7 95.1 40-44 736 701 9.1 95.2 45-49 584 549 7.1 94.0 50-54 653 na na na 15-49 8,141 7,740 100.0 95.1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Table C.2.2 Age distribution of eligible and interviewed men De facto household population of men aged 10-64, interviewed men aged 15-59 and percent of eligible men who were interviewed (weighted), Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household Interviewed men Percentage population age 15-59 of eligible Age of men –––––––––––––––––––– men group age 10-64 Number Percent interviewed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 10-14 741 na na na 15-19 517 457 19.4 88.5 20-24 474 431 18.3 91.0 25-29 346 326 13.8 94.2 30-34 305 291 12.3 95.5 25-39 239 221 9.4 92.7 40-44 233 210 8.9 89.9 45-49 188 173 7.3 92.1 50-54 164 135 5.7 82.4 55-59 125 117 4.9 93.0 60-64 134 na na na 15-59 2,591 2,362 100.0 91.2 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of men and interviewed men are household weights. Age is based on the household schedule. na = Not applicable Appendix C | 233 Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio, by calendar year and survival status of chil- dren (weighted), Nigeria 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage with Number of births complete birth date 1 Sex ratio at birth2 Calendar year ratio3 ––––––––––––––––––––––– ––––––––––––––––––––––– –––––––––––––––––––––– –––––––––––––––––––––– Year Living Dead Total Living Dead Total Living Dead Total Living Dead Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 2003 604 37 641 99.6 100.0 99.6 119.2 89.2 117.2 na na na 2002 1,257 148 1,405 97.4 89.1 96.5 93.0 127.3 96.1 na na na 2001 1,011 144 1,155 97.5 86.1 96.1 104.1 143.2 108.3 85.7 77.8 84.6 2000 1,101 222 1,323 95.1 85.3 93.5 107.1 96.4 105.2 110.2 123.6 112.3 1999 987 215 1,202 94.2 89.2 93.3 103.2 125.3 106.8 98.5 93.6 97.6 1998 904 238 1,142 95.8 90.3 94.6 111.6 113.6 112.0 98.5 95.2 97.8 1997 848 285 1,133 93.9 77.4 89.8 88.2 88.5 88.3 92.4 117.5 97.6 1996 933 247 1,180 90.7 87.2 89.9 99.3 118.3 103.0 108.8 82.9 102.1 1995 866 310 1,177 90.1 81.5 87.8 108.0 106.1 107.5 99.3 128.7 105.7 1994 811 236 1,047 92.3 76.9 88.8 103.3 110.7 104.9 97.7 86.5 94.9 1999-2003 4,960 767 5,726 96.6 88.0 95.4 103.3 117.4 105.1 na na na 1994-1998 4,362 1,316 5,678 92.5 82.5 90.2 101.8 106.2 102.8 na na na 1989-1993 3,353 1,152 4,505 91.4 80.5 88.6 101.0 100.5 100.8 na na na 1984-1988 2,600 972 3,573 90.7 79.9 87.7 102.5 125.5 108.3 na na na < 1984 2,871 1,225 4,096 89.4 81.9 87.1 110.5 138.6 118.1 na na na All 18,147 5,431 23,578 92.7 82.2 90.3 103.5 116.4 106.3 na na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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-1+Bx+1)]*100, where Bx is the number births in calendar year x Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Nige- ria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage with Number missing of Subject Reference group information cases –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth date Births in the 15 years preceding the survey Month only 8.19 16,330 Month and year 0.26 16,330 Age at death Deceased children born in the 15 years preceding the survey 0.97 3,359 Age/date at first union1 Ever-married women age 15-49 0.77 5,694 Respondent's education All women age 15-49 0.14 7,620 Diarrhoea in last 2 weeks Living children age 0-59 months 2.18 5,345 Anthropometry Living children age 0-59 months (from the Height household questionnaire) 6.54 5,842 Weight 6.15 5,842 Height or weight 6.54 5,842 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Both year and age missing 234 | Appendix C Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods preceding the survey (weighted), Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Age at ––––––––––––––––––––––––––––––––––– Total death (days) 0-4 5-9 10-14 15-19 0-19 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <1 49 71 45 36 200 1 78 82 51 34 245 2 21 26 17 13 77 3 26 26 19 14 85 4 15 11 9 10 45 5 10 13 23 18 63 6 16 12 9 4 41 7 6 13 16 10 45 8 6 8 4 1 19 9 5 8 6 7 26 10 2 3 4 8 17 11 2 7 1 0 10 12 8 6 4 1 18 13 0 0 2 0 2 14 19 9 12 12 51 15 5 10 0 4 19 16 0 7 1 1 10 17 0 0 1 2 3 18 7 1 1 0 9 20 2 4 6 1 12 21 12 10 6 5 33 22 0 0 1 0 1 23 0 0 0 1 1 24 1 1 1 0 3 25 0 0 2 0 2 26 0 1 1 0 2 27 0 2 0 0 2 28 0 2 0 0 3 29 1 4 0 0 4 30 0 6 2 2 10 31+ 4 10 5 2 22 Total 0-30 289 342 245 182 1,057 Percent early neonatal1 74.1 70.4 70.9 70.4 71.5 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 0-6 days/0-30 days Appendix C | 235 Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five-year periods preceding the survey, Nigeria 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Age at ––––––––––––––––––––––––––––––––––– Total death (months) 0-4 5-9 10-14 15-19 0-19 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <1a 289 342 245 182 1,057 1 29 38 31 12 109 2 24 41 16 19 101 3 31 36 26 36 129 4 12 30 22 15 80 5 34 35 16 11 96 6 15 15 36 13 79 7 28 36 29 25 117 8 28 31 16 24 99 9 28 27 22 14 90 10 25 21 22 16 83 11 14 37 12 18 81 12 26 37 28 35 126 13 18 13 21 21 73 14 14 22 14 8 58 15 7 16 12 13 48 16 15 8 8 2 33 17 8 15 24 7 54 18 22 19 24 23 87 19 3 20 11 1 35 20 4 9 7 6 26 21 5 3 1 1 11 22 1 13 1 3 18 23 5 13 7 5 30 24+ 9 9 16 9 43 Missing 0 0 0 1 1 1 year 49 75 47 56 227 Total 0-11 555 689 493 385 2,121 Percent neonatal1 52.1 49.6 49.6 47.4 49.8 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– a Includes deaths under one month reported in days 1 Under one month/under one year Appendix D | 1 2003 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY PERSONNEL Appendix D 2003 NDHS Implementation Committee Mr. Wetcos Mutihir Mr. Samuel A. Ogunlade Mr. Joshua A. Adekunle Mr. Mudasiru A. Thomas Dr. Ismaila L. Sulaiman Mr. Emmanuel E. Attah Dr. Helen N. Avong Mr. Bolaji B. Akinsulie Mrs. Adenike O. Ogunlewe Mr. Chidi B. Arukwe Mrs. Patience U. Mbagwu Mr. Inuwa B. Jalingo Director Research and Planning Project Director Deputy Director Data Analysis Deputy Director Surveys Deputy Director Census Deputy Director Planning Assistant Director Research Chief Research Officer Assistant Chief Research Officer Assistant Chief Population Statistician Assistant Chief Population Statistician Project Coordinator ORC Macro Staff Ms. Holly Newby Ms. Anne R. Cross Dr. Alfredo Aliaga Mr. Albert Themme Ms. Elizabeth Britton Dr. K. Fern Greenwell Ms. Arlinda Zhuzhuni Ms. Laurie Liskin Dr. Sidney Moore Ms. Kaye Mitchell Ms. Katherine Senzee Dr. Kia Reinis Country Manager Regional Coordinator Sampling Specialist Data Processing Specialist Data Processing Monitoring Training and Fieldwork Monitoring Fieldwork Monitoring Communications Advisor Editor Document Production Cover Design Report Writing Report Writing Staff Mr. J. A. Adekunle, National Population Commission Mrs. A. O. Ogunlewe, National Population Commission Mr. S. A. Ogunlade, National Population Commission Mr. C. B. Arukwe, National Population Commission Mr. E. E. Attah, National Population Commission Mr. A. D. Fasiku, National Population Commission Dr. I. L. Sulaiman, National Population Commission Mrs. P. U. Mbagwu, National Population Commission Dr. H. N. Avong, National Population Commission Mr. I. B. Jalingo, National Population Commission Mr. B. B. Akinsulie, National Population Commission Dr. C.T. Oluwadare, State University Ado-Ekiti Dr. Pam Ishaya, University of Jos Prof. Uche Isiugo-Abanihe, University of Ibadan Prof. A.A. Adewuyi, Obafemi Awolowo University, Ile-Ife Prof. J.G. Ottong, University of Calabar Dr. M.E. Mosanya, Federal Ministry of Health Mr. G.E. Asuquo, The Policy Project Dr. G.E.N. Osubor, BASICS II Secretarial Staff A. A. Akeju I. Onuorah J. Oladapo F. O. Oladele F. Akpan Translators S. M. Suleiman (Hausa) I. Mohammed (Hausa) C. Okeke (Igbo) A. Tijani (Yoruba) 2 | Appendix D Pretest Field Staff S. A. Ogunlade, Monitoring/Coordination Igbo Language Group P. U. Mbagwu N. L. Ezenwa J. E. Okwudarue S. M. O. Unogu A. B. Afegbua Hausa Language Group H. N. Avong I. B. Jalingo S. Abubakar J. Tauhid F. Akilu B. Ibrahim Yoruba Language Group A. A. Owolabi E. E. Idoko F. A. Ajetunmobi F. O. Alao A. B. Sadiku English Language Group M. A. Thomas E. O. Oyetunji B. B. Akinsulie A. O. Ogunlewe E. O. Olanipekun Survey Field Staff General Monitoring/Coordination W. Mutihir S. A. Ogunlade North Central Region Supervisors S. A. Bamidele B. D. Chirwa Editors F. B. Akilu J. Ojabeh Interviewers S. Adama A. Shaibu I. A. Bello A. E. Tsaku H. Moshood F. Yakubu P. O. Onoja K. T. Tiamiyu Trainers/Zonal Coordinators J. A.Adekunle C. B. Arukwe Reserve Interviewer H. Kpojime Quality Control Interviewer P. Uza Drivers M. Audu M. Olajide Mapping and Listing Supervisors C. Okereke M. A. Adigun Listers P. Yohana T. S. Kywuta O. Y.Ohieky A. Ndaali G. S. Faturashe I. Odenigbo Mappers P. Panzi, A. T. Ojo P. O. Ogbogo A. Ogbo S. Abubakar A. M. Mohammed S. A Yahaya Appendix D | 3 North East Region Supervisors T. Jibrin A. Sa’ad Editors H. Bulama M. Jonathan Interviewers G. L. Musa B. D. Bajo G. G. Gula S. Kwarau B. Mustapha A. Esthon T. Jonatan E. Reuben A. B. Kowa U. G. Abubakar Trainer/Zonal Coordinator I. B. Jalingo Reserve Interviewer I. Mohammed Quality Control Interviewer A. Baraza Drivers S. Bello I. Audu T. Akpan Mapping and Listing Supervisors H. S. Ibrahim J. S. Ejiko Listers S. A. Yurma N. F. Wonakpalukai M. Yahaya H. I. Ibrahim Y. Hamidu S. Z. Chara O. S. Apeji Mappers S. Bello T. B. Hudu C. I. Mishikir J. Maigari B. Umar M.D. Iyawa North West Region Supervisors I. M. K. Gusau N. B. Ungogo Editors H. Yusuf H. Akande Interviewers H. Ibrahim A. Mahmoud M. Ibrahim Z. Muhammed A. Muhammed L. I. Argungu L. Bala B. Garba M. Aliyu S. Audu S. Umar Reserve Interviewer A. Mani Quality Control Interviewer U. T. Lamar Drivers A. Isah A. Farouk I. Ihejirika Supervisors J. Ezeoke W. Ittah Trainers/Zonal Coordinators I.L. Sulaiman H. N. Avong Listers A. S. D. Maiyama A. Y. Isa T. A. Suleiman I. A. Dogo U. A. Madawaki T. O. Osifo D. Ibrahim Mappers Y. Kachala H. Gulumbe J. Musa F. B. Kaita L. U. Tsoho M. Mohammed G. D. Akpan A. Usman C. C. Okeke 4 | Appendix D South East Region Supervisors A. A. Okafor O. Ezekiel Editors G. Anih J. C. Nwaogazi Interviewers M. Nnajieze N. Ndu U. Okonkwo L. Iroanya N. Ezeali M. R. Nnaji G. Okochi V. Nwakwe L. Onuegbu S. U. Anyanwu Trainers/Zonal Coordinators M. A. Thomas P. U. Mbagwu Reserve Interviewer C. Ubani Quality Control Interviewer J. I. Anikwe Drivers M. Anukwa A. M. Vincent Mapping and Listing Supervisors M. Chike L. O. Akinsibo Listers E. A. Ugwueje P. A. Eke G. Anya B. C. Mweke M. Nnajieze Mappers F. N. Jiakponnan S. U. Anyanwu S. Ebele J. O. Ulasi E. Aki South South Region Supervisors E. Esara A. Ineife Editors M. Okon P. Isiguzo Interviewers B. Nwineh N. B. Adams J. Atibi V. U. Nath-George I. E. Uffort R. Igoni E. Iko L. Ikem P. Madojemu C. Olaye Trainer/Zonal Coordinator E. E. Attah Reserve Interviewer J. Isibor Quality Control Interviewer S. J. Igoh Drivers T. Nkamanse G. Evbadoloyi Mapping and Listing Supervisors B. Ojesekhoba A.J.U. Ekpenyoung Listers J. Amah F. O. Oladele E. E. Bassey S. J Olaoye J. O. Omoruyi E. Miegbemo D. Tadafe Mappers J.B. Ogunmola A. Ama-Ebi O. O. Ofem E. A. Edem S. I. Ekeoba U. I. Akpakpa P.O. Lotobi Appendix D | 5 South West Region Supervisors F. A. David S. Aduloju Editors M. Agboola T. M.Adeboye Interviewers V. O. Ojo I. A. Olasode E. F. Adeola R. Olumeyan N. Shotade A .Akinrinmade B. Odusanya J. Ogunleye K. Oteju A. O. Fadele Trainers/Zonal Coordinators B. B. Akinsulie A. O. Ogunlewe Reserve Interviewer P. E.Okiei Quality Control Interviewer F. Ajetunmobi Drivers T. Alidu A. Kumuyi S. Aghahowa I. Adegbola Mapping and Listing Supervisors L. O. Anifowose O. K. Bakare Listers A. M. Orogade R. O. Adebola O.E. Ayeni R. A. Kuye A. George H. O. Kolade Mappers D. S. Opaleke O. S. Adeleye D.S. Ogunsola O.T. Obafemi E. A. Adejobi S. O. Adu Data Processing Staff Data Processing Supervisors A. Fatilewa G. O. Ibe Demographer A. A. Owolabi Questionnaire Administrator E. F. Elias Office Editors H. A. Aminu O. T. Ojogun F. O. Oladele Data Processing Operators A. A. Adamu H. O. Amakwe A. A. Akeju E. P. Umoffia J. A. Okoisor B. T. Esan A. Telimoye O. P. C. Essien V. Mordi E. Obua E. Nwandu C. Egbu Appendix E | 243 QUESTIONNAIRES APPENDIX E 244 | Appendix E NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 2003 HOUSEHOLD QUESTIONNAIRE NATIONAL POPULATION COMMISSION IDENTIFICATION STATE NAME LOCAL GOVT. AREA LOCALITY NAME ENUMERATION AREA URBAN /RURAL (URBAN = 1, RURAL = 2) CLUSTER NUMBER……………………………………………………………………………………………… BUILDING NUMBER……………………………………………………………………………………………… HOUSEHOLD NAME/NUMBER MEN’S INTERVIEW (YES=1, NO=2) . LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE (LARGE TOWN = 1, MEDIUM TOWN = 2, SMALL TOWN = 3, VILLAGE = 4) INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* ňņņŎņņʼn DAY ŇųųŇųųŇ ŌņņŐņņō MONTH ŇųųŇųųŇ ňņņŎņņŐņņŐņņō YEAR ŇųųŇ ŇųųŇųųŇ ŊņņŏņņŐņņŐņņō NAME ŇųųŇųųŇ ŊņņŐņņō RESULT ŇųųŇ Ŋņņŋ NEXT VISIT: DATE TIME TOTAL NO. OF VISITS TOTAL PERSONS IN HOUSEHOLD TOTAL ELIGIBLE WOMEN TOTAL ELIGIBLE MEN *RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 OTHER (SPECIFY) LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE HAUSA YORUBA IGBO ENGLISH OTHER LANGUAGE OF INTERVIEW 1 2 3 4 6 NATIVE LANGUAGE OF RESPONDENT 1 2 3 4 6 TRANSLATOR YES NO USED? 1 2 SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME NAME DATE ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ DATE ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ENGLISH 245Appendix E | HOUSEHOLD SCHEDULE Now we would like some information about the people who usually live in your household or who are staying with you now. LINE NO. USUAL RESIDENTS AND VISITORS RELATIONSHIP TO HEAD OF HOUSEHOLD SEX RESIDENCE AGE ELIGIBILITY Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household?* Is (NAME) male or female? Does (NAME) usually live here? Did (NAME) stay here last night? How old is (NAME) as of last birthday? CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 CIRCLE LINE NUMBER OF ALL MEN AGE 15-59 CIRCLE LINE NUMBER OF ALL CHILDREN UNDER AGE 6 (1) (2) (3) (4) (5) (6) (7) (8) (8A) (9) M F YES NO YES NO IN YEARS 01 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 01 01 01 02 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 02 02 02 03 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 03 03 03 04 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 04 04 04 05 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 05 05 05 06 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 06 06 06 07 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 07 07 07 08 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 08 08 08 09 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 09 09 09 10 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 10 10 10 * CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 02 = WIFE OR HUSBAND 03 = SON OR DAUGHTER 04 = SON-IN-LAW OR DAUGHTER-IN-LAW 05 = GRANDCHILD 06 = PARENT 07 = PARENT-IN-LAW 08 = BROTHER OR SISTER 09 – BROTHER OR SISTER-IN-LAW 10 = OTHER RELATIVE 11 = ADOPTED/FOSTER/ STEPCHILD 12 = NOT RELATED 98 = DON’T KNOW 246 | Appendix E LINE NO. PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD** EDUCATION IF ALIVE IF AGE 5 YEARS OR OLDER IF AGE 5-24 YEARS Is (NAME)’s natural mother alive? Does (NAME)’s natural mother live in this house- hold? IF YES: What is her name? RECORD MOTHER’S LINE NUMBER Is (NAME)’s natural father alive? IF ALIVE Does (NAME)’s natural father live in this house- hold? IF YES: What is his name? RECORD FATHER’S LINE NUMBER Can (NAME) read & write in any language with under- standing? Has (NAME) ever attended school? What is the highest level of school (NAME) has attended?*** What is the highest class/year (NAME) completed at that level?*** Is (NAME) currently attending school? During the current school year, did (NAME) attend school at any time? During the current school year, what level and class/year [is/was] (NAME) attending?*** During the previous school year, did (NAME) attend school at any time? During that school year, what level and class/year did (NAME) attend?*** (10) (11) (12) (13) (13A) (14) (15) (16) (17) (18) (19) (20) YES NO DK YES NO DK YES NO YES NO LEVEL CLASS/ YEAR YES NO YES NO LEVEL CLASS/ YEAR YES NO LEVEL CLASS/ YEAR 01 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 02 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 03 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 04 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 05 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 06 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 07 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 08 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 09 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 10 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE ** CODES FOR Q.10 THROUGH Q.13 THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. IN Q.11 AND Q.13, RECORD ‘00’ IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE. ***CODES FOR Qs. 15, 18 AND 20 EDUCATION LEVEL: 0 = PRE-PRIMARY/KINDERGARTEN 1 = PRIMARY 2 = SECONDARY 3 = HIGHER 8 = DON’T KNOW EDUCATION CLASS: 00 = LESS THAN 1 YEAR COMPLETED 98 = DON‘T KNOW FOR "HIGHER", TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL. 247Appendix E | LINE NO. USUAL RESIDENTS AND VISITORS RELATIONSHIP TO HEAD OF HOUSEHOLD SEX RESIDENCE AGE ELIGIBILITY Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household?* Is (NAME) male or female? Does (NAME) usually live here? Did (NAME) stay here last night? How old is (NAME) as of last birthday? CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 CIRCLE LINE NUMBER OF ALL MEN AGE 15-59 CIRCLE LINE NUMBER OF ALL CHILDRE N UNDER AGE 6 (1) (2) (3) (4) (5) (6) (7) (8) (8A) (9) M F YES NO YES NO IN YEARS 11 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 11 11 11 12 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 12 12 12 13 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 13 13 13 14 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 14 14 14 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 15 15 15 16 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 16 16 16 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 17 17 17 18 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 18 18 18 19 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 19 19 19 20 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 20 20 20 21 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 21 21 21 22 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 22 22 22 23 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 23 23 23 * CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 02 = WIFE OR HUSBAND 03 = SON OR DAUGHTER 04 = SON-IN-LAW OR DAUGHTER-IN-LAW 05 = GRANDCHILD 06 = PARENT 07 = PARENT-IN-LAW 08 = BROTHER OR SISTER 09 = BROTHER OR SISTER-IN- LAW 10 = OTHER RELATIVE 11 = ADOPTED/FOSTER/ STEPCHILD 12 = NOT RELATED 98 = DON’T KNOW ** Q.10 THROUGH Q.13 THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. IN Q.11 AND Q.13, RECORD ‘00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE. ***CODES FOR Qs. 15, 18 AND 20 EDUCATION LEVEL: 0 = PRE-PRIMARY/KINDERGARTEN 1 = PRIMARY 2 = SECONDARY 3 = HIGHER 8 = DON’T KNOW EDUCATION CLASS: 00 = LESS THAN 1 YEAR COMPLETED 98 = DON’T KNOW 248 | Appendix E LINE NO. PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD** EDUCATION IF ALIVE IF AGE 5 YEARS OR OLDER IF AGE 5-24 YEARS Is (NAME)’s natural mother alive? Does (NAME)’s natural mother live in this house- hold? IF YES: What is her name? RECORD MOTHER’S LINE NUMBER Is (NAME)’s natural father alive? IF ALIVE Does (NAME)’s natural father live in this house- hold? IF YES: What is his name? RECORD FATHER’ S LINE NUMBER Can (NAME) read & write in any language with under- standing? Has (NAME) ever attended school? What is the highest level of school (NAME) has attended?*** What is the highest class/year (NAME) completed at that level?*** Is (NAME) currently attending school? During the current school year, did (NAME) attend school at any time? During the current school year, what level and class/year [is/was] (NAME) attending?*** During the previous school year, did (NAME) attend school at any time? During that school year, what level and class/year did (NAME) attend?*** (10) (11) (12) (13) (13A) (14) (15) (16) (17) (18) (19) (20) YES NO DK YES NO DK YES NO YES NO LEVEL CLASS/ YEAR YES NO YES NO LEVEL CLASS/ YEAR YES NO LEVEL CLASS/ YEAR 11 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 12 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 13 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 14 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 15 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 16 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 17 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 18 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 19 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 20 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 21 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 22 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE 23 1 2 8 Ŋņņņņō ź skip to (12) 1 2 8 Ŋņņņņō ź skip to (13A) 1 2 1 2 NEXT ŋ LINE 1 2 Ŋ� GO TO 18 1 2 GO TO ŋ 19 1 2 NEXT ŋ LINE TICK HERE IF CONTINUATION QUESTIONNNAIRE USED ňņņʼn Ŋņņŋ Just to make sure that I have a complete listing: 1) Are there any other persons such as small children or infants that we have not listed? YES ňņņʼn Ŋņņŏņņ� ENTER EACH IN TABLE NO ňņņʼn Ŋņņŋ 2) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here? YES ňņņʼn Ŋņņŏņņ� ENTER EACH IN TABLE NO ňņņʼn Ŋņņŋ 3) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed? YES ňņņʼn Ŋņņŏņņ� ENTER EACH IN TABLE NO ňņņʼn Ŋņņŋ 249Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 21 What is the main source of drinking water for members of your household? PIPED WATER PIPED INTO DWELLING…………………………….11 PIPED INTO YARD/PLOT………………………….12 PUBLIC TAP………………………………………….13 WATER FROM OPEN WELL OPEN WELL IN DWELLING……………………….21 OPEN WELL IN YARD/PLOT……………………….22 OPEN PUBLIC WELL……………………………….23 WATER FROM COVERED WELL OR BOREHOLE PROTECTED WELL/BOREHOLE IN DWELLING…………………………………………31 PROTECTED WELL/BOREHOLE IN YARD/PLOT…………………………………….32 PROTECTED PUBLIC WELL/BOREHOLE……….33 SURFACE WATER SPRING………………………………………………. .41 RIVER/STREAM………………………………………42 POND/LAKE………………………………………….43 DAM…………………………………………………….44 RAINWATER…………………………………………….51 TANKER TRUCK……………………………………….61 BOTTLED WATER………………………………………71 OTHER ___________________________ 96 (SPECIFY) ņņ� 23 ņņ� 23 ņņ� 23 ņņ� 23 ņņ� 23 ņņ� 23 ņņ� 23 ņņ� 23 22 How long does it take you to go there, get water, and come back? MINUTES………………………… ON PREMISES…………………………………….….996 23 What kind of toilet facilities does your household have? FLUSH TOILET…………………………………………11 PIT TOILET/LATRINE TRADITIONAL PIT TOILET……………………….21 VENTILATED IMPROVED PIT (VIP) LATRINE………………………………….22 NO FACILITY BUSH/FIELD………………………………………….31 RIVER…………………………………………………32 OTHER _________________________________ 96 (SPECIFY) ņņņ�25 ņņņ�25 24 Do you share these facilities with other households? YES……………………………………………………….1 NO…………………………………………………………2 25 Does your household have: Electricity? A radio? A television? A telephone/Cellular phone? A refrigerator? A gas cooker? An electric iron? An electric fan? YES NO ELECTRICITY……………………………….1 2 RADIO…………………………………………1 2 TELEVISION…………………………………1 2 TELEPHONE/CELLULAR PHONE.………1 2 REFRIGERATOR……………………………1 2 GAS COOKER……………………………….1 2 IRON………………………………………….1 2 FAN……………………………………………1 2 26 What does your household mainly use for cooking? PROBE TO DETERMINE EXACT TYPE ELECTRICITY………………………………………….01 LPG/NATURAL GAS………………………………….02 BIOGAS…………………………………………………03 KEROSENE…………………………………………….04 COAL, LIGNITE……………………………………….05 CHARCOAL…………………………………………….06 FIREWOOD, STRAW………………………………….07 DUNG………………………………………………….08 OTHER __________________________________ 96 (SPECIFY) 26A How many rooms in total are in your household, including rooms for sleeping and all other rooms? NUMBER OF ROOMS (TOTAL) . 26B How many rooms are used for sleeping in your household? NUMBER OF ROOMS (SLEEPING) . 250 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 27 MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION. NATURAL FLOOR EARTH/SAND……………………………………….11 DUNG……………………………………………….12 RUDIMENTARY FLOOR WOOD PLANKS…………………………………….21 PALM/BAMBOO…………………………………….22 FINISHED FLOOR PARQUET OR POLISHED WOOD……………….31 VINYL OR ASPHALT STRIPS…………………….32 CERAMIC TILES……………………………………33 CEMENT…………………………………………….34 CARPET…………………………………………….35 OTHER __________________________________ 96 (SPECIFY) 28 Does any member of your household own: A bicycle? A motorcycle or motor scooter? A car or truck? A donkey or horse or camel? A canoe or boat or ship? YES NO BICYCLE……… ………………………. 1 2 MOTORCYCLE/SCOOTER …………… 1 2 CAR/TRUCK……………………………. 1 2 DONKEY/HORSE/CAMEL……………. 1 2 CANOE/BOAT/SHIP……………………. 1 2 29A Does your household own any mosquito nets that can be used to protect against mosquitoes while sleeping? I am talking about nets people sleep under. YES……………………………………………………….1 NO…………………………………………………………2 ņņ�30G 29B How many mosquito nets does your household own? ňņņʼn NUMBER OF NETS.ŇųųŇ Ŋņņŋ 30A ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. ASK OR RECORD APPROPRIATE ANSWER FOR THE FOLLOWING QUESTIONS. IF UNABLE TO OBSERVE THE NETS, CIRCLE APPROPRIATE CODE AND ASK QUESTIONS. NET 1 SEEN.1 NOT SEEN.2 NET 2 SEEN . 1 NOT SEEN . 2 NET 3 SEEN.1 NOT SEEN.2 30B How long ago did your household obtain the mosquito net? MONTHS MORE THAN 3 YRS AGO . 96 MONTHS MORE THAN 3 YRS AGO . 96 MONTHS MORE THAN 3 YRS AGO .96 30C OBSERVE OR ASK THE BRAND OF MOSQUITO NET(S) IN THE HOUSEHOLD. PERMANENT NET1 .1 (SKIP TO 30F) ņŋ PRETREATED NET2 .2 NET WITH KIT….3 UNTREATED NET .4 OTHER .6 DON'T KNOW/ UNSURE .8 PERMANENT NET1. 1 (SKIP TO 30F) ņŋ PRETREATED NET2. 2 NET WITH KIT…3 UNTREATED NET . 4 OTHER. 6 DON'T KNOW/ UNSURE . 8 PERMANENT NET1 .1 (SKIP TO 30F) ņŋ PRETREATED NET2 .2 NET WITH KIT…3 UNTREATED NET.4 OTHER .6 DON'T KNOW/ UNSURE.8 30D Since you got the mosquito net, was it ever soaked or dipped in a liquid to repel mosquitoes or bugs? YES .1 NO .2 (SKIP TO 30F) ņō NOT SURE .8 YES . 1 NO. 2 (SKIP TO 30F) ņō NOT SURE. 8 YES.1 NO .2 (SKIP TO 30F) ņō NOT SURE .8 1 ‘Permanent’ is a pretreated net that does not require any further treatment 2 ‘Pretreated’ net that requires additional treatments every 6-12 months 251Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 30E How long ago was the net last soaked or dipped? IF LESS THAN 1 MONTH, RECORD ‘00'. MONTHS MORE THAN 3 YRS AGO . 96 MONTHS MORE THAN 3 YRS AGO . 96 MONTHS MORE THAN 3 YRS AGO .96 30F Who slept under this mosquito net last night? RECORD RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. NET 1 LINE NO NAME___________ LINE NO NAME___________ LINE NO NAME___________ NET 2 LINE NO NAME__________ LINE NO NAME__________ LINE NO NAME__________ NET 3 LINE NO NAME__________ LINE NO NAME__________ LINE NO NAME__________ 30G Does your household do anything else to protect themselves against mosquito? YES . 1 NO . 2 ņņ�33 30H What does your household do? COIL . A SPRAY (INSECTICIDE) ………………….B WIRE GAUZE …………………………….C OTHER_________________________ X (SPECIFY) 33 Where do you usually wash your hands? IN DWELLING/YARD/PLOT. 1 SOMEWHERE ELSE . 2 NOWHERE. 3 ņʼn ņŏ� 35 34 Where you wash your hands, do you have the following: Water/tap? Soap, ash or other cleansing agent? Basin? YES NO WATER/TAP?. 1 2 SOAP, ASH OR OTHER CLEANSING AGENT? . 1 2 BASIN?. 1 2 35 ASK RESPONDENT FOR A TEASPOONFUL OF SALT. TEST SALT FOR IODINE. RECORD PPM (PARTS PER MILLION). 0 PPM (NO IODINE). 1 7 PPM. 2 15 PPM. 3 30 PPM. 4 NO SALT IN HH. 5 SALT NOT TESTED ________________ 6 (SPECIFY REASON) There will be an education survey done at a later point in time. Your household may or may not be asked to participate in the survey. If your household is included in the survey someone will return to your house and ask additional questions about education. 252 | Appendix E HEIGHT AND WEIGHT CHECK COLUMNS (8) AND (9): RECORD THE LINE NUMBER, NAME AND AGE OF ALL WOMEN AGE 15-49 AND ALL CHILDREN UNDER AGE 6. WOMEN 15-49 WEIGHT AND HEIGHT MEASUREMENT OF WOMEN 15-49 LINE NO. FROM COL.(8) NAME FROM COL.(2) AGE FROM COL.(7) What is (NAME)’s date of birth? WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) MEASURED LYING DOWN OR STANDING UP RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER (36) (37) (38) (39) (40) (41) (42) (43) YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņʼn ŇųųŇ Ŋņņŋ CHILDREN UNDER AGE 6 WEIGHT AND HEIGHT MEASUREMENT OF CHILDREN BORN IN 1998 OR LATER LINE NO. FROM COL.(9) NAME FROM COL.(2) AGE FROM COL.(7) What is (NAME)’s date of birth?* WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) MEASURED LYING DOWN OR STANDING UP RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER DAY MONTH YEAR LYING STAND. ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼnňņņŎņņʼnňņņŎņņŎņņŎņņʼn ŇųųŇųųŇŇųųŇųųŇŇųųŇųųŇųųŇųųŇ ŊņņŏņņŋŊņņŏņņŋŊņņŏņņŏņņŏņņŋ ňņņŎņņŎņņʼn ňņņʼn Ňų0ŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ ňņņŎņņŎņņʼn ňņņʼn ŇųųŇųųŇųųŇ ŇųųŇ Ŋņņŏņņŏņņŋ.Ŋņņŋ 1 2 ňņņʼn ŇųųŇ Ŋņņŋ TICK HERE IF CONTINUATION QUESTIONNAIRE USED ňņņʼn Ŋņņŋ * FOR CHILDREN NOT INCLUDED IN ANY BIRTH HISTORY, ASK DAY, MONTH AND YEAR. FOR ALL OTHER CHILDREN, COPY MONTH AND YEAR FROM 215 IN MOTHER’S BIRTH HISTORY AND ASK DAY. 253Appendix E | �� 254 | Appendix E NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 2003 INDIVIDUAL WOMAN’S QUESTIONNAIRE NATIONAL POPULATION COMMISSION IDENTIFICATION STATE NAME LOCAL GOVT. AREA LOCALITY NAME ENUMERATION AREA URBAN /RURAL (URBAN = 1, RURAL = 2) . CLUSTER NUMBER. BUILDING NUMBER. HOUSEHOLD NAME/NUMBER LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE. (LARGE TOWN = 1, MEDIUM TOWN = 2, SMALL TOWN = 3, VILLAGE = 4) NAME AND LINE NUMBER OF WOMAN INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* ňņņŎņņʼn DAY ŇųųŇųųŇ ŌņņŐņņō MONTH ŇųųŇųųŇ ňņņŎņņŐņņŐņņō YEAR ŇųųŇ ŇųųŇųųŇ ŊņņŏņņŐņņŐņņō NAME ŇųųŇųųŇ ŊņņŐņņō RESULT ŇųųŇ Ŋņņŋ NEXT VISIT: DATE TIME TOTAL NO. OF VISITS ňņņʼn ŇųųŇ Ŋņņŋ *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER __________________________ (SPECIFY) HAUSA YORUBA IGBO ENGLISH OTHER LANGUAGE OF INTERVIEW 1 2 3 4 6 NATIVE LANGUAGE OF RESPONDENT 1 2 3 4 6 TRANSLATOR YES NO USED? 1 2 SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME NAME DATE ňņņŎņņʼn Ňų ŇųųŇ Ŋņņŏņņŋ DATE ňņņŎņņʼn Ňų Ň ųŇ Ŋņņŏņņŋ ňņņŎņņʼn Ňų Ň ųŇ Ŋņņŏņņŋ ňņņŎņņʼn Ňų Ň ųŇ Ŋņņŏņņŋ 255Appendix E | SECTION 1. RESPONDENT’S BACKGROUND INTRODUCTION AND CONSENT INFORMED CONSENT GREETINGS. My name is and I am working with the National Population Commission. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. We won’t take too much of your time. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. We hope that you will participate in this survey since your views are important. At this time, do you want to ask me anything about the survey? May I begin the interview now? Signature of interviewer: Date: RESPONDENT AGREES TO BE INTERVIEWED.…1 Ň " RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . 2 ņņ�END NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME (START OF INTERVIEW). ňņņŎņņʼn HOUR.Ňų Ňų Ň ŌņņŐņņō MINUTES .ŇųųŇų Ň Ŋņņŏņņŋ 102 First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village? CITY .1 TOWN.2 VILLAGE.3 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD ‘00' YEARS. ňņņŎņņʼn YEARS .Ňų ŇųųŇ Ŋņņŏņņŋ ALWAYS.95 VISITOR .96 ņʼn ņŏ�105 104 Just before you moved here, did you live in a city, in a town, or in a village? CITY .1 TOWN.2 VILLAGE.3 105 In what month and year were you born? ňņņŎņņʼn MONTH .Ň ųŇ ųŇ Ŋņņŏņņŋ DON’T KNOW MONTH .98 ňņņŎņņŎņņŎņņʼn YEAR .ŇųųŇųųŇųųŇ ųŇ Ŋņņŏņņŏņņŏņņŋ DON’T KNOW YEAR.9998 106 How old were you as at last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. ňņņŎņņʼn AGE IN COMPLETED YEARS.Ňų Ň ųŇ Ŋņņŏņņŋ 107 Have you ever attended school? YES .1 NO .2 ņ�111 108 What is the highest level of school you attended: primary, secondary, or higher? PRIMARY .1 SECONDARY.2 HIGHER.3 109 What is the highest (class/form/year) you completed at that level? ňņņŎņņʼnCLASS.Ňų Ň ųŇ Ŋņņŏņņŋ 110 CHECK 108: PRIMARY ňņņʼn SECONDARY ňņņʼn Ōņņŋ OR HIGHER Ŋņņŏņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņ " ņņ�114 256 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 111 Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me? CANNOT READ AT ALL .1 ABLE TO READ ONLY PARTS OF SENTENCE.2 ABLE TO READ WHOLE SENTENCE.3 NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) 112 Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)? YES .1 NO .2 113 CHECK 111: CODE ‘2', ‘3' ňņņʼn CODE ’1' ňņņʼn OR ’4' Ōņņŋ CIRCLED Ŋņņŏņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņ CIRCLED " ņ�115 114 Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 115 Do you listen to the radio almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 116 Do you watch television almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 117 What is your religion? CATHOLIC .1 PROTESTANT .2 OTHER CHRISTIAN.3 ISLAM.4 TRADITIONALIST .5 OTHER 6 (SPECIFY) 118 What is your ethnic group? ____________________ 257Appendix E | SECTION 2: REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Now I would like to ask about all the births you have had during your life. Have you ever given birth? YES .1 NO .2 ņņ�206 202 Do you have any sons or daughters to whom you have given birth who are now living with you? YES .1 NO .2 ņņ�204 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD ‘00’. ňņņŎņņʼn SONS AT HOME.ŇųųŇųųŇ ŌņņŐņņō DAUGHTERS AT HOME.ŇųųŇųųŇ Ŋņņŏņņŋ 204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? YES .1 NO .2 ņņ�206 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD ‘00’. ňņņŎņņʼn SONS ELSEWHERE.ŇųųŇųųŇ ŌņņŐņņō DAUGHTERS ELSEWHERE.ŇųųŇųųŇ Ŋņņŏņņŋ 206 Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive? YES .1 NO .2 ņņ�208 207 How many boys have died? And how many girls have died? IF NONE, RECORD ‘00’. ňņņŎņņʼn BOYS DEAD .ŇųųŇųųŇ ŌņņŐņņō GIRLS DEAD.ŇųųŇųųŇ Ŋņņŏņņŋ 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD ‘00’. ňņņŎņņʼn TOTAL.ŇųųŇųųŇ Ŋņņŏņņŋ 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct? ňņņʼn ňņņʼn PROBE AND YES Ōņņŋ NO Ŋņņŏņņ� CORRECT Ň 201-208 AS " NECESSARY. 210 CHECK 208: ONE OR MORE ňņņʼn NO BIRTHS ňņņʼn BIRTHS Ōņņŋ Ŋņņŏņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņ " ņņ�226 258 | Appendix E 211 Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 212 213 214 215 216 217 IF ALIVE: 218 IF ALIVE 219 IF ALIVE: 220 IF DEAD: 221 What name was given to your (first/next) baby? (NAME) Were any of these births twins? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00’ IF CHILD NOT LISTED IN HOUSEHOLD) How old was (NAME) when he/she died? 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. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)? 01 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " (NEXT BIRTH) ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ 02 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 03 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 04 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 05 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 06 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 07 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 259Appendix E | 212 213 214 215 216 217 IF ALIVE: 218 IF ALIVE 219 IF ALIVE: 220 IF DEAD: 221 What name was given to your next baby? (NAME) Were any of these births twins? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00' IF CHILD NOT LISTED IN HOUSEHOLD) How old was (NAME) when he/she died? 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. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)? 08 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE IN YEARS ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ YES. 1 NO . 2 LINE NUMBER ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ Ň " 221 ňņņŎņņʼn DAYS . 1 ŇųųŇųųŇ ŌņņŐņņō MONTHS. 2 ŇųųŇųųŇ ŌņņŐņņō YEARS. 3 ŇųųŇųųŇ Ŋņņŏņņŋ YES . 1 NO . 2 09 SING.1 MULT.2 BOY. 1 GIRL . 2 ňņņŎņņʼn MONTHŇųųŇųųŇ Ŋņņŏņņŋ YEAR ňņņŎņņŎņņŎņņʼn ŇųųŇųųŇųųŇųųŇ Ŋņņŏņņŏņņŏņņŋ YES.1 NO.2 Ň " 220 AGE