Rwanda Demographic and Health Survey 2014-2015

Publication date: 2016

Rwanda Demographic and Health Survey 2014-15 ANNIVERSAR YCELE BRATING2005 2015 NIS R’S 10 YE ARS OF PO LIC Y S UPP ORT Republic of Rwanda Rwanda Demographic and Health Survey 2014-15 Final Report National Institute of Statistics of Rwanda Kigali, Rwanda Ministry of Finance and Economic Planning Kigali, Rwanda Ministry of Health Kigali, Rwanda The DHS Program ICF International Rockville, Maryland, USA March 2016 The Rwanda Demographic and Health Survey 2014-15 (2014-15 RDHS) was implemented by the National Institute of Statistics of Rwanda (NISR) from November 9, 2014, to April 8, 2015. The funding for the RDHS was provided by the government of Rwanda, the United States Agency for International Development (USAID), the One United Nations (One UN), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), World Vison International, the Swiss Agency for Development and Cooperation (SDC), and the Partners in Health (PIH). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2014-15 RDHS may be obtained from the National Institute of Statistics of Rwanda, 6139 Kigali, Rwanda; Telephone: +250 252 571035; Fax: +250 252 570705; Email: info@statistics.gov.rw; Website: www.statistics.gov.rw. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: info@DHSprogram.com; Website: www.DHSprogram.com. ISBN: 978-99977-43-09-1 Recommended citation: National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF International. 2015. Rwanda Demographic and Health Survey 2014-15. Rockville, Maryland, USA: NISR, MOH, and ICF International. Contents • iii CONTENTS TABLES AND FIGURES .ix FOREWORD . xix ACKNOWLEDGMENTS . xxi MAP OF RWANDA . xxii 1 INTRODUCTION . 1 1.1 Country Profile . 1 1.1.1 Geography . 1 1.1.2 Economy . 2 1.1.3 Population . 3 1.1.4 Population Policy . 4 1.1.5 Health Policy . 4 1.2 Objectives and Methodology of the Survey . 5 1.2.1 Objectives of the Survey . 6 1.2.2 Questionnaires . 7 1.2.3 Sample Design . 7 1.2.4 Sample Coverage . 8 1.2.5 Anthropometry Measurements, Anemia, Malaria, and HIV Testing . 9 1.3 Pretest . 11 1.4 Training of Field Staff . 11 1.5 Fieldwork . 12 1.6 Data Processing . 12 2 HOUSEHOLD CHARACTERISTICS . 13 2.1 Household Population by Age and Sex . 13 2.2 Household Composition . 15 2.3 Educational Attainment . 16 2.4 School Attendance . 18 2.5 Household Conditions . 20 2.5.1 Household Drinking Water . 20 2.5.2 Household Sanitation Facilities . 21 2.5.3 Household Hand Washing Places . 22 2.5.4 Household Characteristics . 23 2.5.5 Household Possession of Durable Goods . 25 2.5.6 Household Wealth . 26 2.6 Birth Registration . 27 2.7 Children’s Living Arrangements and Orphanhood . 28 2.8 School Attendance by Survivorship of Parents . 29 2.9 Health Insurance Coverage and Bank Accounts . 30 3 RESPONDENT CHARACTERISTICS . 35 3.1 Background Characteristics of Respondents . 35 3.2 Educational Attainment . 37 3.3 Literacy . 38 3.4 Exposure to Mass Media . 40 3.5 Employment . 43 3.6 Use of Tobacco . 48 4 PROXIMATE DETERMINANTS OF FERTILITY . 51 4.1 Marital Status . 51 4.2 Polygamy . 52 iv • Contents 4.3 Age at First Union . 54 4.4 Age at First Sexual Intercourse . 56 4.5 Recent Sexual Activity . 58 5 FERTILITY . 61 5.1 Fertility Levels and Differentials . 62 5.2 Fertility Trends . 65 5.3 Children Ever Born and Living . 67 5.4 Birth Intervals . 68 5.5 Exposure to the Risk of Pregnancy . 70 5.6 Menopause . 71 5.7 Age at First Birth . 72 5.8 Teenage Fertility . 73 6 FERTILITY PREFERENCES . 75 6.1 Desire for Children. 75 6.2 Ideal Number of Children . 78 6.3 Fertility Planning Status . 80 7 FAMILY PLANNING . 83 7.1 Knowledge of Contraceptive Methods . 83 7.2 Current Use of Contraceptive Methods . 85 7.2.1 Current Use of Contraception by Age . 85 7.2.2 Current Use of Contraception by Background Characteristics . 87 7.2.3 Trends in Current Use of Family Planning . 89 7.3 Timing of Sterilization . 89 7.4 Source of Supply . 89 7.5 Use of Social Marketing Brands of Pills and Condoms . 90 7.6 Informed Choice . 91 7.7 Contraceptive Discontinuation . 92 7.8 Reasons for Discontinuation of Contraceptive Use . 93 7.9 Knowledge of Fertile Period . 94 7.10 Need and Demand for Family Planning Services . 95 7.10.1 Need and Demand for Family Planning among Currently Married Women . 95 7.10.2 Need and Demand for Family Planning among All Women and Women Who Are Not Currently Married . 97 7.11 Future Use of Contraception . 98 7.12 Exposure to Family Planning Messages . 99 7.13 Contact of Nonusers with Family Planning Providers . 100 8 INFANT AND CHILD MORTALITY . 103 8.1 Assessment of Data Quality . 104 8.2 Levels and Trends in Childhood Mortality . 105 8.3 Socioeconomic Differentials in Childhood Mortality . 106 8.4 Demographic Differentials in Mortality . 107 8.5 Perinatal Mortality . 108 8.6 High-Risk Fertility Behavior. 110 9 MATERNAL HEALTH . 113 9.1 Antenatal Care . 113 9.1.1 Components of Antenatal Care . 115 9.1.2 Tetanus Vaccinations . 117 9.2 Delivery Care . 118 9.2.1 Place of Delivery . 118 9.2.2 Assistance during Delivery . 120 Contents • v 9.3 Postnatal Care . 122 9.3.1 Maternal Postnatal Care . 122 9.3.2 Newborn Postnatal Care . 124 9.4 Problems in Accessing Health Care . 126 10 CHILD HEALTH . 129 10.1 Child’s Size at Birth . 130 10.2 Vaccination of Children . 131 10.3 Trends in Vaccination Coverage . 133 10.4 Childhood Illnesses . 134 10.4.1 Acute Respiratory Infections . 134 10.4.2 Fever . 135 10.5 Diarrheal Disease . 137 10.5.1 Prevalence of Diarrhea. 137 10.5.2 Treatment of Diarrhea . 138 10.5.3 Feeding Practices during Diarrhea . 140 10.6 Knowledge of ORS Packets . 142 10.7 Stool Disposal . 142 11 NUTRITION OF CHILDREN AND ADULTS . 145 11.1 Nutritional Status of Children . 146 11.1.1 Measurement of Nutritional Status among Young Children . 146 11.1.2 Measures of Child Nutritional Status . 147 11.1.3 Trends in Children’s Nutritional Status . 150 11.2 Initiation of Breastfeeding . 151 11.3 Breastfeeding Status by Age . 152 11.4 Duration of Breastfeeding . 154 11.5 Types of Complementary Foods . 156 11.6 Infant and Young Child Feeding (IYCF) Practices . 157 11.7 Prevalence of Anemia in Children . 160 11.8 Micronutrient Intake among Children . 162 11.9 Iodization of Household Salt . 165 11.10 Nutritional Status of Women . 165 11.11 Prevalence of Anemia in Women . 167 11.12 Micronutrient Intake among Mothers . 169 11.13 Nutritional Status of Men . 170 12 MALARIA . 173 12.1 Mosquito Nets . 175 12.1.1 Ownership of Mosquito Nets . 175 12.1.2 Use of Mosquito Nets by Persons in the Household . 177 12.1.3 Use of Mosquito Nets by Children under Age 5 . 178 12.1.4 Use of Mosquito Nets by Pregnant Women . 179 12.2 Prevalence and Prompt Treatment of Fever . 180 12.3 Prevalence of Anemia and Malaria in Children and Women . 182 13 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 189 13.1 Knowledge of HIV and AIDS and of Transmission and Prevention Methods . 190 13.1.1 Awareness of AIDS . 190 13.1.2 HIV Prevention Methods . 190 13.1.3 Knowledge about Transmission . 192 13.1.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 195 13.2 Stigma Associated with AIDS and Attitudes Related to HIV and AIDS . 196 13.3 Attitudes toward Negotiating Safer Sex . 198 13.4 Attitudes toward Condom Education for Youth . 200 vi • Contents 13.5 Multiple and Concurrent Partnerships and Paying for Sex . 201 13.5.1 Multiple Sexual Partnerships . 201 13.5.2 Concurrent Sexual Partners . 204 13.5.3 Payment for Sex . 206 13.6 Prior Testing for HIV . 207 13.7 HIV Testing during Antenatal Care . 209 13.8 Reports of Recent Sexually Transmitted Infections . 211 13.9 Needle and Syringe Injection . 213 13.10 HIV- and AIDS-related Knowledge and Behavior among Youth . 214 13.10.1 Knowledge about HIV and AIDS and Sources for Condoms . 215 13.10.2 Age at First Sex and Condom Use at First Sexual Intercourse . 216 13.10.3 Premarital Sexual Activity . 217 13.10.4 Multiple Sexual Partnerships . 218 13.10.5 Age-mixing in Sexual Relationships . 218 13.10.6 Recent HIV Testing among Youth . 219 13.11 Male Circumcision . 220 14 HIV PREVALENCE . 225 14.1 Coverage Rates for HIV Testing among Adults . 226 14.2 HIV Prevalence among Adults . 228 14.2.1 HIV Prevalence by Age and Sex . 228 14.2.2 Trends in HIV Prevalence . 229 14.2.3 HIV Prevalence by Socioeconomic Characteristics . 230 14.2.4 HIV Prevalence by Demographic Characteristics. 231 14.2.5 HIV Prevalence by Sexual Risk Behavior . 233 14.3 HIV Prevalence among Youth . 234 14.3.1 Overall HIV Prevalence among Youth . 234 14.3.2 HIV Prevalence among Youth by Condom Use at Last Sex . 235 14.4 HIV Prevalence by Other Characteristics . 236 14.4.1 HIV Prevalence and STIs . 236 14.4.2 HIV Prevalence by Male Circumcision . 237 14.4.3 Prior HIV Testing by Current HIV Status . 238 14.5 HIV Prevalence among Cohabiting Couples . 239 14.6 HIV Prevalence among Children . 241 15 WOMEN’S STATUS AND DEMOGRAPHIC AND HEALTH OUTCOMES . 243 15.1 Women’s and Men’s Employment . 243 15.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings . 244 15.3 Women’s and Men’s Ownership of Selected Assets . 248 15.4 Women’s Participation in Decision-making . 250 15.5 Attitudes toward Wife Beating . 253 15.6 Women’s Empowerment Indicators . 256 15.7 Current Use of Contraception by Women’s Empowerment Status . 256 15.8 Ideal Family Size and Unmet Need by Women’s Status . 257 15.9 Women’s Status and Reproductive Health Care . 258 16 ADULT AND MATERNAL MORTALITY . 261 16.1 Data Quality Issues . 261 16.2 Adult Mortality . 263 16.3 Maternal Mortality . 263 17 DOMESTIC VIOLENCE . 267 17.1 Measurement of Violence . 267 17.1.1 Use of Valid Measures of Violence . 267 17.1.2 Ethical Considerations in the 2014-15 RDHS . 269 17.1.3 Subsample for the Violence Module . 269 17.2 Experience of Physical Violence . 269 17.3 Perpetrators of Physical Violence . 272 Contents • vii 17.4 Experience of Sexual Violence . 273 17.5 Perpetrators of Sexual Violence . 275 17.6 Age at First Experience of Sexual Violence . 275 17.7 Experience of Different Forms of Violence . 276 17.8 Violence during Pregnancy . 277 17.9 Marital Control by Spouse . 278 17.10 Forms of Spousal Violence . 281 17.11 Spousal Violence by Background Characteristics . 284 17.12 Violence by Spousal Characteristics and Empowerment Indicators . 286 17.13 Recent Spousal Violence . 289 17.14 Onset of Spousal Violence . 291 17.15 Physical Consequences of Spousal Violence . 291 17.16 Violence by Women and Men against Their Spouse . 293 17.17 Help-seeking Behavior by Those Who Experience Violence . 297 18 EARLY CHILDHOOD EDUCATION AND DEVELOPMENT . 301 18.1 Prevalence of Early Childhood Education . 301 18.2 Adult Involvement in Early Learning Activities . 302 18.3 Children’s Books and Playthings . 304 18.4 Adequate Care for Young Children . 305 18.5 Early Childhood Development . 306 REFERENCES . 309 APPENDIX A SAMPLE IMPLEMENTATION . 313 A.1 Introduction . 313 A.2 Sampling Frame . 313 A.3 Structure of the Sample and the Sampling Procedure . 316 A.4 Selection Probability and Sampling Weight . 318 A.5 Survey Results . 320 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 327 APPENDIX C DATA QUALITY TABLES . 349 APPENDIX D DISTRICT TABLES. 365 APPENDIX E SURVEY PERSONNEL . 471 APPENDIX F QUESTIONNAIRES . 477 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Results of the household and individual interviews . 9 2 HOUSEHOLD CHARACTERISTICS . 13 Table 2.1 Household population by age, sex, and residence . 14 Table 2.2 Household composition . 15 Table 2.3.1 Educational attainment of the female household population . 16 Table 2.3.2 Educational attainment of the male household population . 17 Table 2.4 School attendance ratios . 19 Table 2.5 Household drinking water . 21 Table 2.6 Household sanitation facilities . 22 Table 2.7 Hand washing . 23 Table 2.8 Household characteristics . 24 Table 2.9 Household possessions . 26 Table 2.10 Wealth quintiles . 27 Table 2.11 Birth registration of children under age 5 . 28 Table 2.12 Children’s living arrangements and orphanhood . 29 Table 2.13 School attendance by survivorship of parents . 30 Table 2.14 Household bank account and health insurance . 31 Table 2.15 Health insurance among adult women and men . 32 Figure 2.1 Population pyramid . 14 Figure 2.2 Age-specific attendance rates . 20 3 RESPONDENT CHARACTERISTICS . 35 Table 3.1 Background characteristics of respondents . 36 Table 3.2.1 Educational attainment: Women . 37 Table 3.2.2 Educational attainment: Men . 38 Table 3.3.1 Literacy: Women . 39 Table 3.3.2 Literacy: Men . 40 Table 3.4.1 Exposure to mass media: Women . 41 Table 3.4.2 Exposure to mass media: Men . 42 Table 3.5.1 Employment status: Women . 43 Table 3.5.2 Employment status: Men . 45 Table 3.6.1 Occupation: Women . 46 Table 3.6.2 Occupation: Men . 47 Table 3.7 Type of employment: Women . 48 Table 3.8.1 Use of tobacco: Women . 49 Table 3.8.2 Use of tobacco: Men . 50 4 PROXIMATE DETERMINANTS OF FERTILITY . 51 Table 4.1 Current marital status . 52 Table 4.2.1 Number of women’s co-wives . 53 Table 4.2.2 Number of men’s wives . 54 Table 4.3 Age at first marriage . 55 Table 4.4 Median age at first marriage by background characteristics . 56 Table 4.5 Age at first sexual intercourse . 57 Table 4.6 Median age at first sexual intercourse by background characteristics . 58 x • Tables and Figures Table 4.7.1 Recent sexual activity: Women . 59 Table 4.7.2 Recent sexual activity: Men . 60 5 FERTILITY . 61 Table 5.1 Current fertility . 63 Table 5.2 Fertility by background characteristics. 64 Table 5.3.1 Trends in age-specific fertility rates . 65 Table 5.3.2 Trends in fertility . 66 Table 5.4 Children ever born and living . 68 Table 5.5 Birth intervals . 69 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 70 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 71 Table 5.8 Menopause . 72 Table 5.9 Age at first birth . 72 Table 5.10 Median age at first birth . 73 Table 5.11 Teenage pregnancy and motherhood . 74 Figure 5.1 Age-specific fertility rates for five-year periods preceding the survey . 66 Figure 5.2 Trends in age-specific fertility rates, various sources . 67 6 FERTILITY PREFERENCES . 75 Table 6.1 Fertility preferences by number of living children . 76 Table 6.2.1 Desire to limit childbearing: Women . 77 Table 6.2.2 Desire to limit childbearing: Men . 78 Table 6.3 Ideal number of children by number of living children . 79 Table 6.4 Mean ideal number of children . 80 Table 6.5 Fertility planning status . 81 Table 6.6 Wanted fertility rates . 81 7 FAMILY PLANNING . 83 Table 7.1 Knowledge of contraceptive methods . 84 Table 7.2 Knowledge of contraceptive methods by background characteristics . 84 Table 7.3 Current use of contraception by age . 86 Table 7.4 Current use of contraception by background characteristics . 88 Table 7.5 Timing of sterilization . 89 Table 7.6 Source of modern contraception methods . 90 Table 7.7 Use of social marketing brand pills and condoms . 91 Table 7.8 Informed choice . 92 Table 7.9 Twelve-month contraceptive discontinuation rates . 93 Table 7.10 Reasons for discontinuation . 93 Table 7.11 Knowledge of fertile period . 94 Table 7.12.1 Need and demand for family planning among currently married women . 96 Table 7.12.2 Need and demand for family planning for all women and for women who are not currently married . 97 Table 7.13 Future use of contraception . 99 Table 7.14 Exposure to family planning messages . 100 Table 7.15 Contact of nonusers with family planning providers . 101 Figure 7.1 Trends in contraceptive use among currently married women . 89 Tables and Figures • xi 8 INFANT AND CHILD MORTALITY . 103 Table 8.1 Early childhood mortality rates . 105 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 106 Table 8.3 Early childhood mortality rates by demographic characteristics . 108 Table 8.4 Perinatal mortality . 109 Table 8.5 High-risk fertility behavior . 110 Figure 8.1 Trends in childhood mortality rates . 105 Figure 8.2 Under-5 mortality rates by socioeconomic characteristics . 107 Figure 8.3 Infant mortality rates by demographic characteristics . 108 9 MATERNAL HEALTH . 113 Table 9.1 Antenatal care . 114 Table 9.2 Number of antenatal care visits and timing of first visit. 115 Table 9.3 Components of antenatal care . 116 Table 9.4 Tetanus toxoid injections . 118 Table 9.5 Place of delivery . 119 Table 9.6 Assistance during delivery . 120 Table 9.7 Timing of first postnatal checkup . 123 Table 9.8 Type of provider of first postnatal checkup for the mother . 124 Table 9.9 Timing of first postnatal checkup for the newborn . 125 Table 9.10 Type of provider of first postnatal checkup for the newborn . 126 Table 9.11 Problems in accessing health care . 127 Figure 9.1 Trends in antenatal care and delivery, Rwanda 2005 to 2014-15 . 121 Figure 9.2 Births delivered by a skilled provider . 122 10 CHILD HEALTH . 129 Table 10.1 Child’s weight and size at birth . 130 Table 10.2 Vaccinations by source of information . 132 Table 10.3 Vaccinations by background characteristics . 132 Table 10.4 Vaccinations in first year of life . 133 Table 10.5 Prevalence and treatment of symptoms of ARI . 134 Table 10.6 Prevalence and treatment of fever . 136 Table 10.7 Prevalence of diarrhea . 137 Table 10.8 Diarrhea treatment . 139 Table 10.9 Feeding practices during diarrhea . 141 Table 10.10 Knowledge of ORS packets . 142 Table 10.11 Disposal of children’s stools . 143 Figure 10.1 Trends in vaccination coverage among children age 12-23 months . 133 11 NUTRITION OF CHILDREN AND ADULTS . 145 Table 11.1 Nutritional status of children . 149 Table 11.2 Initial breastfeeding . 152 Table 11.3 Breastfeeding status by age . 153 Table 11.4 Median duration of breastfeeding . 155 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 157 Table 11.6 Infant and young child feeding (IYCF) practices . 159 Table 11.7 Prevalence of anemia in children . 161 Table 11.8 Micronutrient intake among children . 164 Table 11.9 Presence of iodized salt in household . 165 Table 11.10 Nutritional status of women . 166 xii • Tables and Figures Table 11.11 Prevalence of anemia in women . 168 Table 11.12 Micronutrient intake among mothers . 170 Table 11.13 Nutritional status of men . 171 Figure 11.1 Nutritional status of children by age . 150 Figure 11.2 Trends in nutritional status of children under age 5 . 151 Figure 11.3 Infant feeding practices by age . 154 Figure 11.4 IYCF indicators on breastfeeding status . 156 Figure 11.5 Trends in the percentage of children age 6-23 months fed according to all three infant and young child feeding (IYCF) practices . 160 Figure 11.6 Trends in anemia status among children age 6-59 months . 162 Figure 11.7 Trends in nutritional status among women age 15-49 . 167 Figure 11.8 Trends in anemia status among women age 15-49 . 169 12 MALARIA . 173 Table 12.1 Household possession of mosquito nets . 176 Table 12.2 Access to an insecticide-treated net (ITN) . 177 Table 12.3 Use of mosquito nets by persons in the household . 178 Table 12.4 Use of existing ITNs . 178 Table 12.5 Use of mosquito nets by children . 179 Table 12.6 Use of mosquito nets by pregnant women . 180 Table 12.7 Prevalence, diagnosis, and prompt treatment of children with fever . 181 Table 12.8 Source of advice or treatment for children with fever . 182 Table 12.9 Type of antimalarial drugs taken by children who took antimalarial drugs . 182 Table 12.10 Hemoglobin <8.0 g/dl in children . 183 Table 12.11 Coverage of malaria testing among children . 184 Table 12.12 Prevalence of malaria in children . 185 Table 12.13 Coverage of malaria testing among women . 186 Table 12.14 Prevalence of malaria in women . 187 Figure 12.1 Percentage of de facto population with access to an ITN in the household. 176 13 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 189 Table 13.1 Knowledge of AIDS . 190 Table 13.2 Knowledge of HIV prevention methods . 191 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 193 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 194 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV. 196 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 197 Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 198 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 199 Table 13.7 Adult support of education about condom use to prevent AIDS . 200 Table 13.8.1 Multiple sexual partners: Women . 202 Table 13.8.2 Multiple sexual partners: Men . 203 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 205 Table 13.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 206 Table 13.11.1 Coverage of prior HIV testing: Women . 208 Table 13.11.2 Coverage of prior HIV testing: Men . 209 Table 13.12 Pregnant women counseled and tested for HIV . 210 Table 13.13 HIV testing for prenuptial purposes and as a couple . 211 Table 13.14 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 212 Table 13.15 Prevalence of medical injections . 214 Tables and Figures • xiii Table 13.16 Comprehensive knowledge about AIDS and of a source of condoms among youth . 215 Table 13.17 Age at first sexual intercourse among young people . 216 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 217 Table 13.19 Multiple sexual partners in the past 12 months among young people . 218 Table 13.20 Age-mixing in sexual relationships among women and men age 15-19 . 219 Table 13.21 Recent HIV tests among youth . 220 Table 13.22 Practice of circumcision . 221 Table 13.23 Place of circumcision . 222 Table 13.24 Age at circumcision . 223 Figure 13.1 Women and men seeking treatment for STIs . 213 14 HIV PREVALENCE . 225 Table 14.1 Coverage of HIV testing by residence and province . 227 Table 14.2 Coverage of HIV testing by selected background characteristics . 228 Table 14.3 HIV prevalence among adults . 229 Table 14.4 Trends in HIV prevalence by age . 230 Table 14.5 HIV prevalence by socioeconomic characteristics . 231 Table 14.6 HIV prevalence by demographic characteristics . 232 Table 14.7 HIV prevalence by sexual behavior . 233 Table 14.8 HIV prevalence among young people by background characteristics . 235 Table 14.9 HIV prevalence among young people by sexual behavior . 236 Table 14.10 HIV prevalence by other characteristics . 237 Table 14.11 HIV prevalence by male circumcision . 238 Table 14.12 Prior HIV testing by current HIV status . 239 Table 14.13 HIV prevalence among couples. 240 Table 14.14 HIV prevalence among children age 0-14 . 241 Figure 14.1 HIV prevalence by sex and age . 229 15 WOMEN’S STATUS AND DEMOGRAPHIC AND HEALTH OUTCOMES . 243 Table 15.1 Employment and cash earnings of currently married women and men . 244 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 245 Table 15.2.2 Control over men’s cash earnings . 247 Table 15.3 Women’s control over their own earnings and over those of their husbands . 248 Table 15.4.1 Ownership of assets: Women . 249 Table 15.4.2 Ownership of assets: Men . 250 Table 15.5 Participation in decision-making . 251 Table 15.6.1 Women’s participation in decision-making by background characteristics . 252 Table 15.6.2 Men’s participation in decision-making by background characteristics . 253 Table 15.7.1 Attitudes toward wife beating: Women . 254 Table 15.7.2 Attitudes toward wife beating: Men . 255 Table 15.8 Indicators of women’s empowerment . 256 Table 15.9 Current use of contraception by women’s empowerment . 257 Table 15.10 Ideal number of children and unmet need for family planning by women’s empowerment . 258 Table 15.11 Reproductive health care by women’s empowerment . 259 xiv • Tables and Figures 16 ADULT AND MATERNAL MORTALITY . 261 Table 16.1 Completeness of information on siblings . 262 Table 16.2 Sibship size and sex ratio of siblings . 262 Table 16.3 Adult mortality rates . 263 Table 16.4 Maternal mortality . 264 Figure 16.1 Maternal mortality ratios for the period 0-4 years prior to the 2000, 2005, 2010, and 2014-15 RDHS surveys . 265 17 DOMESTIC VIOLENCE . 267 Table 17.1.1 Experience of physical violence: Women . 270 Table 17.1.2 Experience of physical violence: Men . 271 Table 17.2.1 Persons committing physical violence: Women . 272 Table 17.2.2 Persons committing physical violence: Men . 272 Table 17.3.1 Experience of sexual violence: Women . 273 Table 17.3.2 Experience of sexual violence: Men . 274 Table 17.4.1 Persons committing sexual violence: Women . 275 Table 17.4.2 Persons committing sexual violence: Men . 275 Table 17.5.1 Age at first experience of sexual violence among women . 276 Table 17.5.2 Age at first experience of sexual violence: Men . 276 Table 17.6.1 Experience of different forms of violence: Women . 276 Table 17.6.2 Experience of different forms of violence: Men. 277 Table 17.7 Experience of violence during pregnancy . 278 Table 17.8.1 Marital control exercised by husbands . 279 Table 17.8.2 Marital control exercised by wives . 280 Table 17.9.1 Forms of spousal violence: Women . 282 Table 17.9.2 Forms of spousal violence: Men . 283 Table 17.10.1 Spousal violence by background characteristics: Women . 284 Table 17.10.2 Spousal violence by background characteristics: Men . 285 Table 17.11.1 Spousal violence by husband’s characteristics and empowerment indicators . 287 Table 17.11.2 Spousal violence by wife’s characteristics and empowerment indicators . 288 Table 17.12.1 Physical or sexual violence in the past 12 months by any husband/partner . 290 Table 17.12.2 Physical or sexual violence in the past 12 months by any wife/partner . 290 Table 17.13.1 Experience of spousal violence by duration of marriage: Women . 291 Table 17.13.2 Experience of spousal violence by duration of marriage: Men . 291 Table 17.14.1 Injuries due to spousal violence: Women . 292 Table 17.14.2 Injuries due to spousal violence: Men . 292 Table 17.15.1 Women’s violence against their spouse. 294 Table 17.15.2 Men’s violence against their spouse . 294 Table 17.16.1 Women’s violence against their spouse by spouse’s characteristics and empowerment indicators . 295 Table 17.16.2 Men’s violence against their spouse by spouse’s characteristics and empowerment indicators . 297 Table 17.17.1 Help seeking to stop violence: Women . 298 Table 17.17.2 Help seeking to stop violence: Men . 299 Table 17.18.1 Sources for help to stop the violence: Women . 300 Table 17.18.2 Sources for help to stop the violence: Men . 300 18 EARLY CHILDHOOD EDUCATION AND DEVELOPMENT . 301 Table 18.1 Early childhood education . 302 Table 18.2 Support for learning . 303 Table 18.3 Learning materials . 305 Tables and Figures • xv Table 18.4 Inadequate care . 306 Table 18.5 Early Child Development Index . 308 APPENDIX A SAMPLE IMPLEMENTATION . 313 Table A.1 Population by province and by district within province according to type of residence . 314 Table A.2 Distribution of residential households by province and by district within province according to type of residence . 315 Table A.3 Distribution of EAs and their average size in number of households by province and by district, according to type of residence . 316 Table A.4 Sample allocation of EAs and households by province and by district within province according to type of residence . 317 Table A.5 Sample allocation of expected number of interviews by province and by district within province according to type of residence . 318 Table A.6 Sample implementation: Women . 320 Table A.7 Sample implementation: Men . 321 Table A.8 Coverage of HIV testing by social and demographic characteristics: Women . 322 Table A.9 Coverage of HIV testing by social and demographic characteristics: Men . 323 Table A.10 Coverage of HIV testing by sexual behavior characteristics: Women . 324 Table A.11 Coverage of HIV testing by sexual behavior characteristics: Men . 325 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 327 Table B.1 List of selected variables for sampling errors, Rwanda 2014-15 . 329 Table B.2 Sampling errors: Total sample, Rwanda 2014-15 . 331 Table B.3 Sampling errors: Urban sample, Rwanda 2014-15 . 333 Table B.4 Sampling errors: Rural sample, Rwanda 2014-15 . 335 Table B.5 Sampling errors: Kigali City sample, Rwanda 2014-15 . 337 Table B.6 Sampling errors: South sample, Rwanda 2014-15 . 339 Table B.7 Sampling errors: West sample, Rwanda 2014-15 . 341 Table B.8 Sampling errors: North sample, Rwanda 2014-15 . 343 Table B.9 Sampling errors: East sample, Rwanda 2014-15 . 345 Table B.10 Sampling errors for adult and maternal mortality probability and rates in last 0-4 years, Rwanda 2014-15 . 347 APPENDIX C DATA QUALITY TABLES . 349 Table C.1 Household age distribution . 349 Table C.2.1 Age distribution of eligible and interviewed women . 350 Table C.2.2 Age distribution of eligible and interviewed men . 350 Table C.3 Completeness of reporting . 351 Table C.4 Births by calendar years . 351 Table C.5 Reporting of age at death in days . 352 Table C.6 Reporting of age at death in months . 353 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 354 Table C.8 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 355 Table C.9 Prevalence of anemia in children in 2005 . 356 Table C.10 Prevalence of anemia in women in 2005 . 357 Table C.11 Prevalence of anemia in children in 2007-08 . 358 Table C.12 Prevalence of anemia in women in 2007-08 . 359 Table C.13 Rotavirus and pneumococcal vaccinations by source of information . 360 Table C.14 Rotavirus and pneumococcal vaccinations by background characteristics . 360 Table C.15 Support for learning . 361 xvi • Tables and Figures Table C.16 Adult mortality rates . 362 Table C.17 Smoking . 363 APPENDIX D DISTRICT TABLES. 365 Table D2.3.1 Educational attainment of the female household population . 365 Table D2.3.2 Educational attainment of the male household population . 366 Table D2.4 School attendance ratios . 367 Table D2.7 Hand washing . 368 Table D2.11 Birth registration of children under age 5 . 369 Table D2.12 Children’s living arrangements and orphanhood . 370 Table D2.14 Household bank account and health insurance . 371 Table D2.15 Health insurance among adult women and men . 372 Table D3.1 Distribution of respondents by district . 373 Table D3.2.1 Educational attainment: Women . 374 Table D3.2.2 Educational attainment: Men . 375 Table D3.3.1 Literacy: Women . 376 Table D3.3.2 Literacy: Men . 377 Table D3.4.1 Exposure to mass media: Women . 378 Table D3.4.2 Exposure to mass media: Men . 379 Table D3.5.1 Employment status: Women . 380 Table D3.5.2 Employment status: Men . 381 Table D3.6.1 Occupation: Women . 382 Table D3.6.2 Occupation: Men . 383 Table D3.8.1 Use of tobacco: Women . 384 Table D3.8.2 Use of tobacco: Men . 385 Table D4.1 Current marital status . 386 Table D4.2.1 Number of women’s co-wives . 387 Table D4.2.2 Number of men’s wives . 388 Table D4.4 Median age at first marriage by background characteristics . 389 Table D4.6 Median age at first intercourse by background characteristics . 390 Table D4.7.1 Recent sexual activity: Women . 391 Table D4.7.2 Recent sexual activity: Men . 392 Table D5.2 Fertility by background characteristics . 393 Table D5.5 Birth intervals . 394 Table D5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 395 Table D5.10 Median age at first birth . 396 Table D5.11 Teenage pregnancy and motherhood . 397 Table D6.2.1 Desire to limit childbearing: Women . 398 Table D6.2.2 Desire to limit childbearing: Men . 399 Table D6.4 Mean ideal number of children . 400 Table D6.6 Wanted fertility rates . 401 Table D7.2 Knowledge of contraceptive methods by background characteristics . 402 Table D7.4 Current use of contraception by background characteristics . 403 Table D7.12.1 Need and demand for family planning among currently married women . 404 Table D7.12.2 Need and demand for family planning for all women . 405 Table D7.14 Exposure to family planning messages . 406 Table D7.15 Contact of nonusers with family planning providers . 407 Table D8.2 Early childhood mortality rates . 408 Table D9.1 Antenatal care . 409 Table D9.3 Components of antenatal care . 410 Tables and Figures • xvii Table D9.4 Tetanus toxoid injections . 411 Table D9.5 Place of delivery . 412 Table D9.6 Assistance during delivery . 413 Table D9.7 Timing of first postnatal checkup . 414 Table D9.8 Type of provider of first postnatal checkup for the mother . 415 Table D9.9 Timing of first postnatal checkup for the newborn . 416 Table D9.10 Type of provider of first postnatal checkup for the newborn . 417 Table D9.11 Problems in accessing health care . 418 Table D10.1 Child’s weight and size at birth . 419 Table D10.5 Prevalence of ARI . 420 Table D10.6 Prevalence of fever . 421 Table D10.7 Prevalence of diarrhea . 422 Table D10.10 Knowledge of ORS packets or pre-packaged liquids . 423 Table D10.11 Disposal of children’s stools . 424 Table D11.1 Nutritional status of children . 425 Table D11.2 Initial breastfeeding . 426 Table D11.4 Median duration of breastfeeding . 427 Table D11.7 Prevalence of anemia in children . 428 Table D11.8 Micronutrient intake among children . 429 Table D11.9 Presence of iodized salt in household . 430 Table D11.10 Nutritional status of women . 431 Table D11.11 Prevalence of anemia in women . 432 Table D11.12 Micronutrient intake among mothers . 433 Table D12.1 Household possession of mosquito nets . 434 Table D12.3 Use of mosquito nets by persons in the household . 435 Table D12.4 Use of existing ITNs . 436 Table D12.5 Use of mosquito nets by children. 437 Table D12.7 Prevalence, diagnosis, and prompt treatment of children with fever . 438 Table D12.10 Hemoglobin <8.0 g/dl in children . 439 Table D12.12 Prevalence of malaria in children . 440 Table D12.14 Prevalence of malaria in women . 441 Table D13.1 Knowledge of AIDS . 442 Table D13.2 Knowledge of HIV prevention methods . 443 Table D13.3.1 Comprehensive knowledge about AIDS: Women . 444 Table D13.3.2 Comprehensive knowledge about AIDS: Men . 445 Table D13.4 Knowledge of prevention of mother-to-child transmission of HIV . 446 Table D13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 447 Table D13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 448 Table D13.6 Attitudes toward negotiating safer sexual relations with husband . 449 Table D13.7 Adult support of education about condom use to prevent AIDS . 450 Table D13.8.1 Multiple sexual partners: Women . 451 Table D13.8.2 Multiple sexual partners: Men . 452 Table D13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 453 Table D13.10 Payment for sexual intercourse . 454 Table D13.11.1 Coverage of prior HIV testing: Women . 455 Table D13.11.2 Coverage of prior HIV testing: Men . 456 Table D13.12 Pregnant women counseled and tested for HIV . 457 Table D13.14 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 458 Table D13.15 Prevalence of medical injections . 459 Table D13.16 Comprehensive knowledge about AIDS and of a source of condoms among youth . 460 xviii • Tables and Figures Table D13.22 Practice of circumcision. 461 Table D14.5 HIV prevalence . 462 Table D14.8 HIV prevalence among young people . 463 Table D14.13 HIV prevalence among couples . 464 Table D15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 465 Table D15.2.2 Control over men’s cash earnings . 466 Table D15.6.1 Women’s participation in decision-making by background characteristics . 467 Table D15.7.1 Attitude toward wife beating: Women . 468 Table D15.7.2 Attitudes toward wife beating: Men . 469 Foreword • xix FOREWORD rom 2014 to 2015, with the aim of collecting data to monitor progress across Rwanda’s health programs and policies, the Government of Rwanda (GOR) conducted the most recent Rwanda Demographic and Health Survey (RDHS) through the Ministry of Health (MOH) and the National Institute of Statistics of Rwanda (NISR) with the members of the national steering committee to the DHS and the technical assistance of ICF International. As a member of the steering committee, ICF International provided technical assistance in implementing the 2014-15 RDHS. The RDHS was sponsored by the GOR, the United States’ Agency for International Development (USAID), One United Nations (ONE UN), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), World Vision International (WVI), Partners in Health (PIH), and the Suisse Development Cooperation (SDC). This most recent RDHS builds on the assessments and findings of the 1992, 2000, 2005, and 2010 RDHS surveys, as well as the 2007-08 Rwanda Interim Demographic and Health Survey (RIDHS). The main objective of the 2014-15 RDHS was to obtain current information on demographic and health indicators, including family planning; maternal mortality; infant and child mortality; nutrition status of mothers and children; prenatal care, delivery, and postnatal care; childhood diseases; and pediatric immunization. In addition, the survey was designed to measure indicators such as domestic violence, the prevalence of anemia and malaria among women and children, and the prevalence of HIV infection in Rwanda. For the first time, this 2014-15 RDHS also includes indicators to monitor HIV testing among children age 0-14 as well as domestic violence for males age 15-59. The 2014-15 RDHS targeted women age 15-49 and men age 15-59 from randomly selected households across the country. Information about children under 5 was also collected. RDHS data collection fieldwork was conducted from November 9, 2014, to April 8, 2015. The data entry, editing, and cleaning was completed by May 15, 2015, and the final survey report was completed in March 2016. Compared with the 2005 and 2010 RDHS, the 2014-15 survey shows promising results across multiple areas of health over the past 10 years. Such achievements include a decrease in maternal and infant mortality rates, an increase in prenatal care visits and utilization of delivery services, a steady decline in the total fertility rate, and relative stability in malaria and HIV prevalence. Compared with the 2010 RDHS, the 2014-15 survey also shows a slight increase in the utilization of modern contraceptives and higher immunization rates regarding coverage of children 12-23 months. Despite these improvements, the 2014-15 RDHS shows that there is still work to be done in the health sector, most notably in the area of pediatric and maternal nutrition, which remains a challenge in Rwanda. With this most recent data on nutrition across the country, Rwanda can now target health interventions and policies to tackle nutrition, with the hope of improving the nutritional status of the Rwandan people. The Ministry of Health and the National Institute of Statistics of Rwanda invite policy makers, program managers, and all users to play an important role in using the valuable data showcased in the 2014-15 RDHS to contribute to enhancing Rwandans’ quality of life. We hope that the RDHS datasets will be used efficiently and analyzed further by researchers so that the findings’ potential impact on the health sector can be maximized. F Acknowledgments • xxi ACKNOWLEDGMENTS he National Institute of Statistics of Rwanda (NISR) wishes to acknowledge the efforts of a number of organizations and individuals who contributed substantially to the success of the fifth Rwanda Demographic and Health Survey (2014-15 RDHS). First, we would like to acknowledge the financial assistance from the government of Rwanda (GOR), the United States Agency for International Development (USAID), One United Nations (ONE UN), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), World Vision International (WVI), Partners in Health (PIH), and the Suisse Development Cooperation (SDC). We express our gratitude to the Ministry of Health (MOH) for its close collaboration and to ICF International for its technical assistance throughout the survey. We gratefully acknowledge the support of the Steering Committee (SC) and Technical Advisory Committee (TAC) members, who contributed to the successful preparation and implementation of the survey. We wish to express great appreciation for the work carried out by the Technical Committee (TC) staff, namely coordinators, supervisors, cartographers, and data processors from NISR, MOH, and RBC Divisions, especially Malaria & OPD, HIV, Maternal and Child Health (MCH), and the National Reference Laboratory (NRL) that worked with dedication and enthusiasm to make the survey a success. We recognize the valuable support provided by NISR departments, especially administration, finance and procurement services; their interventions allowed this survey to run smoothly, safely, and in good conditions. We would like to express our special thanks to the Ministry of Local Government and to the local authorities as well as community health workers for their assistance and contribution to the smooth implementation of the survey. Special thanks goes to the team leaders, field and office editors, enumerators, drivers, and data entry staffs for their valuable time that made this survey possible. Finally, we are grateful to the survey respondents who generously gave their time to provide the information that forms the basis of this report. T xxii • Map of Rwanda Introduction • 1 INTRODUCTION 1 Key Findings • The 2014-15 Rwanda Demographic and Health Survey (RDHS) is a nationally representative survey of 12,699 households, 13,497 women age 15-49, and 6,217 men age 15-59. • The 2014-15 RDHS is the fifth standard DHS conducted in Rwanda as part of the worldwide DHS Program. • The primary purpose of the RDHS is to provide policymakers and planners with detailed information on fertility and family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; malaria; knowledge of HIV/AIDS and other sexually transmitted infections; and domestic violence, among others. • Anthropometry measurements and anemia and malaria testing were carried out among women and children in a subsample of 50 percent of households. HIV testing was carried out among adults in another 50 percent of households and children under age 15 in 15 percent of the households. 1.1 COUNTRY PROFILE 1.1.1 Geography wanda is located in central Africa, immediately south of the equator between latitude 1°4' and 2°51'S and longitude 28°63' and 30°54' E. It has a surface area of 26,338 square kilometers and is bordered by Uganda to the north, Tanzania to the east, the Democratic Republic of the Congo to the west, and Burundi to the south. Landlocked, Rwanda lies 1,200 kilometers from the Indian Ocean and 2,000 kilometers from the Atlantic Ocean. Rwanda forms part of the highlands of eastern and central Africa, with mountainous relief and an average elevation of 1,700 meters. However, there are three distinct geographical regions. Western and north-central Rwanda is made up of the mountains and foothills of the Congo-Nile Divide, the Virunga volcano range, and the northern highlands. This region is characterized by rugged mountains intercut by steep valleys, with elevations generally exceeding 2,000 meters. The divide itself rises to 3,000 meters at its highest point but is dwarfed by the volcano range, where the highest peak, Mount Karisimbi, reaches 4,507 meters. The Congo-Nile Divide slopes westward to Lake Kivu, which lies 1,460 meters above sea level in the Rift Valley trough. In Rwanda’s center, mountainous terrain gives way to the rolling hills that give the country its nickname, “Land of a Thousand Hills.” Here the average elevation varies between 1,500 and 2,000 meters. The area is also referred to as the central plateau (Randall Baker, 1970). Further east lies a vast region known as the “eastern plateaus,” where the hills level gradually into flat lowlands interspersed with a few hills and lake-filled valleys. The elevation of this region generally is below 1,500 meters. R 2 • Introduction Because of its elevation, Rwanda enjoys a temperate, sub-equatorial climate with average yearly temperatures around 18.5°C. The average annual rainfall is 1,250 millimeters, occurring over two rainy seasons of differing lengths that alternate with one long and one short dry season. The climate varies somewhat from region to region, depending on the altitude. The volcano range and northern highlands are generally cooler and wetter, with an average temperature of 16°C and an average rainfall above 1,300 millimeters per year. The maximum rainfall is 1,600 millimeters above the divide and the volcanic range. The hilly central region receives an average of 1,000 to 1,300 millimeters of rain per year, while rainfall on the eastern plateau, where the climate is relatively warmer and drier, generally falls below 1,000 millimeters and can be as low as 800 millimeters. Although Rwanda enjoys more or less constant temperatures, the climate is known to vary from year to year, with extreme variations in rainfall sometimes resulting in flooding or, more often, drought. These extremes have a profound impact on agricultural production. Rwanda has a dense network of rivers and streams, which drain into the Congo River on the western slope of the Congo-Nile Divide and into the Nile River in the rest of the country via the Akagera River, which receives all of the streams of this watershed. Water resources also include several lakes surrounded by wetlands. Deforestation caused mainly by land clearing for agricultural expansion has resulted in mostly anthropic vegetation, with only a few small areas of natural forestland (representing 7 percent of the country) remaining on the Congo-Nile Divide and the slopes of the volcanic range. Rwanda is divided into four geographically based provinces North, South, East, and West and the City of Kigali. The lower administrative areas consist of 30 districts, 416 sectors, 2,148 cells, and 14,837 villages. 1.1.2 Economy In Rwanda, regular efforts have been made to develop the service sector and to stimulate investment in the industrial sector. These efforts are now bearing positive results, as the service sector has contributed more to the economy than the agricultural sector in recent years. Rwanda’s economy has been growing steadily at about 8 percent per year since 2001, with gross domestic product (GDP) per capita more than tripling from $211 in 2001 to $719 in 2014. The rate of growth in food crop production was more than twice the population growth rate between 2007 and 2014. In fact, in fiscal year 2014-2015, GDP at current market prices was estimated to be Rwf 5,605 billion, up from Rwf 5,136 billion in 2013-2014. The service sector contributed 48 percent of GDP in 2014, and in this sector, the share of trade and transport represented 15 percent, and other services (e.g., information, communication, real estate activities, education, hotels and restaurants) represented 32 percent. The agriculture sector contributed 33 percent of GDP, with food crops representing 23 percent of this total. The industrial sector contributed 14 percent of GDP, with different types of manufacturing representing 5 percent, mining and quarrying representing 2 percent, and approximately 5 percent attributable to adjustment for taxes less subsidies on products. In fiscal year 2014-2015, estimates calculated at constant 2011 prices showed that GDP was 7.3 percent higher in real terms than in 2013-2014. In this period, the agriculture sector grew by 5 percent and contributed 1.6 percentage points to overall GDP growth. Activities in the industry sector grew by 7 percent and contributed 1 percentage point to GDP growth. The service sector increased by 8 percent and contributed 4 percentage points (NISR 2014-15). Introduction • 3 Although the agricultural sector appears to have been overtaken by the service sector, it remains the backbone of Rwanda’s economy and still employs many Rwandans. The Fourth Household Living Conditions Survey (EICV4) shows that the percentage of farmers whose main job is farming is 71 percent, with 61 percent of them independent famers and 10 percent wage farmers. However, the agricultural sector faces major problems, including production dominated by small farming operations of less than one hectare, rudimentary techniques, and a low rate of investment. Agrarian reforms are gradually being introduced to address these problems; in particular, over recent years, land consolidation and regionalization of crops have been a focus of agricultural policies, as has protection of land from erosion. The results of the EICV4 show that 85 percent of crop-producing households in Rwanda have at least one of their plots protected from erosion, and 13 percent have at least one of their plots irrigated. The EICV4 calculated an indicator of the incidence of poverty, which is the share of the population whose total consumption is below the poverty line (Rwf 159,375 in January 2014 prices), or the share of the population that cannot afford to buy a basic basket of goods (food and non-food).Thirty-nine percent of the population was identified as poor in 2013-2014, as compared with 45 percent in the Third Household Living Conditions Survey in 2010-2011. Finally, because of the failure of most development strategies that had been based on structural adjustment programs focused on growth measured in terms of per capita GDP, the overwhelming majority of development partners are recognizing the need to incorporate social factors into development strategies. Therefore, new initiatives are geared toward pro-poor economic growth and poverty reduction to revive the economies of developing nations. Rwanda has adopted this new orientation, and the economic development and poverty reduction strategies developed every five years through this framework serve as a guide for elaborating different plans as well as an instrument for monitoring and evaluating the development progress made. 1.1.3 Population The fourth population and housing census (RPHC4) in 2012 showed that the Rwandan population was 10,515,973 from which 5,451,105 (52 percent) of the country’s residents were female, and 5,064,867 (48 percent) were male. According to projections, Rwanda’s population would grow to 11,274,221 in 2015. The population increased from 4,831,527 in 1978 to 7,157,551 in 1991 and 8,128,553 in 2002 before reaching the 2012 total of 10,515,973. Thus, the population more than doubled between 1978 and 2012. The increase was essentially due to rapid population growth, which remains high despite the progressive decreases in the natural growth rate and the total fertility rate. In fact, according to census estimates, the natural growth rate was 2.6 percent between 2002 and 2012 and 3.1 percent between 1978 and 1991. The low natural growth rate of 1.2 percent between 1991 and 2002 is due to the high number of deaths caused by the genocide of 1994. Based on Rwanda Demographic and Health Surveys (RDHS) data, the total fertility rate is estimated to have declined from 6.1 in 2005 to 4.6 in 2010. Population density is high across the country and has increased steadily over the years, from 183 inhabitants per square kilometer in 1978 to 272 in 1991, 321 in 2002, and 415 in 2012. The population is largely rural: according to the RPHC4, almost 84 percent of the country’s residents live in rural areas. Among the total urban population, 49 percent live in City of Kigali, the capital of the country. Also, the population is essentially young, with 43.4 percent of all Rwandans under age 15 according to the RPHC4. 4 • Introduction The illiteracy rate in Rwanda declined between 2005 and 2010. Between the two RDHS surveys, the rate decreased from 29 percent to 23 percent among women age 15-49 and from 22 percent to 19 percent among men age 15-59. This means that 77 percent of women are considered literate, as compared with 80 percent of men. The educational level of Rwandans is still low. The 2010 RDHS results showed that 22 percent of women and 16 percent of men had no education, while 68 percent of women and 72 percent of men had attended primary school only. Nine percent of women and 11 percent of men had reached the secondary school level, while those with education beyond the secondary level made up only 1 percent of the female population and 2 percent of the male population. Although numerous religions are practiced in Rwanda, the 2012 census showed that Christianity is by far the dominant faith, practiced in some form by 93 percent of the population (44 percent are Catholic, 38 percent are Protestant, and 12 percent are Adventist). The number of Muslim adherents remained at 2 percent of the population from 2002 to 2012. Only 0.4 percent of the population profess to have no religion. Nearly all Rwandans speak the same language, Kinyarwanda, which is the country’s official first language, followed by English and French. Kiswahili, the third most common foreign language, is generally spoken in urban areas and in the provinces bordering other countries where this language is widely spoken, such as the Democratic Republic of the Congo and Tanzania. 1.1.4 Population Policy Out of concern for improving the country’s quality of life, the Rwandan government has developed strategies to ensure an acceptable balance between demographic growth and available resources, particularly since the 1980s. A family planning initiative developed in 1982 provided for training, improved access to family planning services, and, in particular, promotion of family planning through trained communicators known as Abakangurambaga (“Awakeners of the People”). A subsequent policy was adopted in 1990 aimed at curbing demographic growth and reducing fertility through family planning (ONAPO, 1990a, 1990b, and 199c). To create an environment favorable to behavioral change that would result in lower fertility rates, other elements were included in the plan, such as increased production, public health improvements, land use planning, training of communicators, promotion of education and school attendance, and employment and advancement of women. Following the 1994 genocide, population problems were seen in a new light, with an emphasis on both quality of life and population growth. A new national population policy was developed and issued to all development partners in 2003. This policy emphasizes quality of life by providing objectives and strategies to affect both demographic (fertility, mortality) and socioeconomic factors. The policy advocates slow population growth, managed sustainability of natural resources, food safety, access to primary and secondary education for all children(with a focus on technical and vocational instruction as well as information technology), good governance, equal opportunity, and participation in development by both men and women. 1.1.5 Health Policy Rwanda’s Health Sector Policy translates the Government’s overall vision of development in the health sector, as set out in Vision 2020 and the Economic Development and Poverty Reduction Strategy (EDPRS 2, 2013-2018). Since the adoption of the previous Health Sector Policy in 2005, much has changed in terms of national socio-economic development policy and more specifically in the health sector policy. The new Health Sector Policy thus takes into account new orientations in the national development agenda and changes in the socio-economic and epidemiologic situation of the Rwandan population and in the institutional environment of the country and specifically in the health sector. Introduction • 5 The health sector has a crucial role to play in the achievement of the national mid-term (EDPRS 2) goal of 11.5% economic growth rate. Continuous progress in the coverage and quality of promotive, preventive, curative and rehabilitative health interventions and in the health seeking behavior of the population ensure improvements in the health status and productivity of the Rwandan population. The health sector also has an influence on enabling environment for economic and social transformation as envisioned by the EDPRS 2. It aims to contribute among others, to a reduction in the fertility rate. Availability of high quality health services, as an important element of the service sector, contributes to the generation of collective wealth and is crucial to attracting investors and tourists. The overall objective of the health sector policy is to ensure universal accessibility (in geographical and financial terms) of equitable and affordable quality health services (preventative, curative, rehabilitative and promotional services) for all Rwandans. This objective will be attained through the full implementation of (1) the various programs, while strengthening (2) the various systems that will support them at (3) all levels of service delivery together with (4) the governance of the sector. To achieve the above objective health policy will require different directions such as: • Improve demand, access and quality of essential health services • Strengthen policies, resources and management mechanisms of health support systems to ensure optimal performance of the health programs • Strengthen policies, resources and management mechanisms of health services delivery systems • Strengthen the Health Sector Governance mechanisms The implementation of this policy would not be a reality without involving different stakeholders and existing structures ensure the involvement of all of them. • The Health Sector Working Group (HSWG comprises representatives of the MOH, development partners, and civil society. • Technical working groups (TWGs) are operational entities where technical and policy issues are discussed by staff of the MOH with representatives of development partners, NGOs, FBOs, and CSOs. TWGs operate under the authority of the HSWG. • The Single Project Implementation Unit (SPIU) aims at reducing the number of separate projects and the administrative burden of the MOH in managing and reporting on the various projects with off-budget resources. The 2015 Health Policy will help the Government of Rwanda to sustain the achievements made through previous policies and existing strategies. Health sector has contributed in achieving objectives of EDPRS I (2008-2012) and the Millennium Development Goals (MDGs). Ministry of Health through its implementing agency (RBC) and health facilities at different levels will continue to be an integral part of implementing strategies aiming to achieve Vision 2020 and Sustainable Development Goals (SDGs). 1.2 OBJECTIVES AND METHODOLOGY OF THE SURVEY The government of Rwanda planned the 2014-15 RDHS with the support of its development partners and institutions interested in population and health issues. The 2014-15 RDHS is the fifth survey of its kind, 6 • Introduction following standard DHS surveys conducted in 1992, 2000, 2005, and 2010. In addition in Rwanda interim RDHS was conducted in 2007-08. The 2014-15 RDHS was implemented by the National Institute of Statistics of Rwanda (NISR) in collaboration with the Ministry of Health (MOH) and the Rwanda Biomedical Center (RBC) under the guidance of a steering committee. The Demographic and Health Survey (DHS) Program of ICF International provided technical assistance through its contract with the United States Agency for International Development (USAID). Funding for the 2014-15 RDHS was provided by the Government of Rwanda and by development partners including USAID; United Nations agencies (One UN); the Global Fund to Fight AIDS, Tuberculosis, and Malaria; World Vision International; Partners in Health and Suisse Agency for Development and Cooperation. 1.2.1 Objectives of the Survey The main objectives of the 2014-15 RDHS were to: • Collect data at the national level to calculate essential demographic indicators, especially fertility and infant and child mortality, and analyze the direct and indirect factors that relate to levels and trends in fertility and child mortality • Measure levels of knowledge and use of contraceptive methods among women and men • Collect data on family health, including immunization practices; prevalence and treatment of diarrhea, acute upper respiratory infections, and fever among children under age 5; antenatal care visits; assistance at delivery; and postnatal care • Collect data on knowledge, prevention, and treatment of malaria, in particular the possession and use of treated mosquito nets among household members, especially children under age 5 and pregnant women • Collect data on feeding practices for children, including breastfeeding • Collect data on the knowledge and attitudes of women and men regarding sexually transmitted infections (STIs) and HIV and evaluate recent behavioral changes with respect to condom use • Collect data for estimation of adult mortality and maternal mortality at the national level • Take anthropometric measurements to evaluate the nutritional status of children, men, and women • Assess the prevalence of malaria infection among children under age 5 and pregnant women using rapid diagnostic tests and blood smears • Estimate the prevalence of HIV among children age 0-14 and adults of reproductive age • Estimate the prevalence of anemia among children age 6-59 months and adult women of reproductive age • Collect information on early childhood development • Collect information on domestic violence Introduction • 7 1.2.2 Questionnaires Three types of questionnaires were used in the 2014-15 RDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. They are based on questionnaires developed by the worldwide DHS Program and on questionnaires used during the 2010 RDHS. To reflect relevant issues in population and health in Rwanda, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations, and international donors. The questionnaires were translated from English into Kinyarwanda. The Household Questionnaire was used to list all of the usual members and visitors in the selected households as well as to identify women and men eligible for individual interviews. Basic information was collected on the characteristics of each person listed, including relationship to the head of the household, sex, residence status, age, and marital status along with survival status of children’s parents, education, birth registration, health insurance coverage, and tobacco use. The Household Questionnaire also collected information on the following: (1) dwelling characteristics; (2) possession of iodized salt; (3) possession and utilization of mosquito nets; (4) height and weight of women age 15-49, men age 15-59, and children age 0-5; (5) hemoglobin measurement of women and children; (6) blood collection from women and children for rapid and laboratory testing for malaria; and (7) blood collection from women, men, and children for laboratory testing for HIV. The Woman’s Questionnaire was administered to all women age 15-49 living in the sampled households. It was used to collect information on (1) background characteristics; (2) reproduction; (3) contraception; (4) pregnancy and postnatal care, including breastfeeding and feeding practices; (5) immunization, health, and nutrition of children(including early child development); (6) marriage and sexual activity; (7) fertility preferences; (8) husbands’ characteristics and women’s employment activity; (9) HIV/AIDS and other sexually transmitted infections; (10) other health issues; (11) adult and maternal mortality; and (12) domestic violence. The Man’s Questionnaire was administered to all men age 15-59 living in every second household in the sample. It was similar to the Woman’s Questionnaire but did not include questions on use of contraceptive methods or birth history; pregnancy and postnatal care; child immunization, health, and nutrition; or adult and maternal mortality. A detailed interviewers’ manual was also developed, as well as other instructional manuals including one focusing on biomarkers such as HIV, anemia, and anthropometric measurements. Instruction manuals were available and used during the pretest from August 25 to September 22, 2014; the training for the main survey from October 5 to November 2, 2014; and data collection from November 9 to April 8, 2015. 1.2.3 Sample Design The sampling frame used for the 2014-15 RDHS was the 2012 Rwanda Population and Housing Census (RPHC). The sampling frame consisted of a list of enumeration areas (EAs) covering the entire country, provided by the National Institute of Statistics of Rwanda, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as counting units for the census. The 2014-15 RDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas, five provinces, and each of Rwanda’s 30 districts (for some limited indicators). The first stage involved selecting sample points (clusters) consisting of 8 • Introduction EAs delineated for the 2012 RPHC. A total of 492 clusters were selected, 113 in urban areas and 379 in rural areas. The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected EAs from July 7 to September 6, 2014, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 12,792 households. However, during data collection, one of the households was found to actually be two households, which increased the total sample to 12,793. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level. All women age 15-49 who were either permanent residents of the household or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who either were permanent household residents or were visiting the night before the survey were eligible to be interviewed. In the subsample of households not selected for the male survey, anemia and malaria testing were performed among eligible women who consented to being tested. With the parent’s or guardian’s consent, children aged 6-59 months were tested for anemia and malaria in this subsample. Height and weight information was collected from eligible women, and children (age 0-5) in the same subsample. In the subsample of households selected for male survey, blood spot samples were collected for laboratory testing of HIV from eligible women and men who consented. Height and weight information was collected from eligible men. In one-third of the same subsample (or 15 percent of the entire sample), blood spot samples were collected for laboratory testing of children age 0-14 for HIV. The domestic violence module was implemented in the households selected for the male survey: The domestic violence module for men was implemented in 50 percent of the household selected for male survey and domestic violence for women was conducted in the remaining 50 percent of household selected for male survey (or 25 percent of the entire sample, each). 1.2.4 Sample Coverage All 492 enumeration areas selected for the sample were surveyed for the 2014-15 RDHS. A total of 12,793 households were selected, of which 12,717 were occupied at the time of the survey. Among these households, 12,699 completed the Household Questionnaire, yielding a response rate of 99.9 percent (Table 1.1). There was little variation in response rates by urban-rural residence. In the 12,699 households surveyed, 13,564 women age 15-49 were identified as being eligible for the individual interview; interviews were completed with 13,497 of these women, yielding a response rate of 99.5 percent. Male interviews were conducted in every second household. A total of 6,249 men age 15-59 were identified in this subsample of households. Of these men, 6,217 completed individual interviews, yielding a response rate of 99.5 percent. Response rates among men were slightly higher in rural areas, while rates among women were almost the same in rural and urban areas. Introduction • 9 Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Rwanda 2014-15 Residence Total Result Urban Rural Household interviews Households selected 2,939 9,854 12,793 Households occupied 2,911 9,806 12,717 Households interviewed 2,895 9,804 12,699 Household response rate1 99.5 100.0 99.9 Interviews with women age 15-49 Number of eligible women 3,446 10,118 13,564 Number of eligible women interviewed 3,427 10,070 13,497 Eligible women response rate2 99.4 99.5 99.5 Interviews with men age 15-59 Number of eligible men 1,619 4,630 6,249 Number of eligible men interviewed 1,607 4,610 6,217 Eligible men response rate2 99.3 99.6 99.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents 1.2.5 Anthropometry Measurements, Anemia, Malaria, and HIV Testing In the subsample of households not selected for the male survey, blood specimens were collected from women age 15-49 and children age 6-59 months for measurement of anemia in the field. Blood specimens were collected and tested for malaria in the field using a rapid diagnostic test (RDT) and blood smears were collected dried and stained and later tested in the laboratory using a microscope. Additionally, in the household selected for male survey; one-half of households, blood specimens for HIV testing were collected from all women age 15-49 and men age 15-59 who consented to the test. HIV testing among children age 0-14 was implemented in 15 percent of the households with the consent of the child’s parent or responsible guardian. Sterile, non-reusable, self-retractable lancets were used to collect blood specimens for anemia, malaria, and HIV testing. The protocol for blood specimen collection and HIV testing was reviewed and approved by the Rwanda National Ethics Committee, the Institutional Review Board of ICF International, and the Centers for Disease Control and Prevention (CDC) in Atlanta. Anthropometry In the all of the households not selected for the male survey, height and weight measurements were recorded for children age 0-5, women age 15-49, and men age 15-59. Height and weight information was collected from eligible men in half of households selected for male survey. Anemia testing Blood specimens for hemoglobin measurement were collected from women age 15-49 and from all children age 6-59 months for whom consent was obtained from their parents or the adult responsible for them. Consent was also obtained from parents or responsible adults for young unmarried women age 15-17. The consent statement explained the purpose of the test, the procedures to be followed, the confidentiality of the results, and the voluntary nature of the test. It also indicated that the results would be made available as soon as the test was completed. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Hemoglobin analysis was carried out on-site 10 • Introduction using a battery-operated portable HemoCue analyzer. Results were provided verbally and in writing. Parents of children with a hemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, non-pregnant women and pregnant women were referred for follow-up care if their hemoglobin levels were below 7 g/dl and 9 g/dl, respectively. Malaria testing Malaria diagnostic tests, including rapid diagnostic tests and tests using thick and thin blood smears, were conducted among eligible women and children. In the case of RDTs, a drop of blood was obtained by pricking the end of the finger, usually at the same time as anemia testing. RDT results were used to diagnose malaria and guide treatment of parasitic children during the survey. The parent or guardian of a child with a positive RDT result was provided with written results and the child was given artemisinin-based combination therapy (ACT) for treatment, according to the current malaria treatment guidelines. Women with a positive result were treated with ACT, while women with severe malaria were referred to the nearest health center for treatment. Thin and thick blood smears were also collected from eligible women (age 15-49) and children (age 6-59 months) who agreed to malaria testing. An informed consent statement was read to the eligible person or to the parent or adult responsible for a child or an unmarried young adult age 15-17. A slide with a thick and thin blood smears was prepared, stained for all eligible women and children. These samples were collected two or three times weekly by survey supervisors, transmitted, to NISR for verification and stored at Parasitology and Entomology Laboratory for microscopic examination of malaria parasites, then referred to the National Reference Laboratory/RBC (NRL) for quality assurance and quality control. The RBC Malaria and Other Parasitic Diseases Division were in charge of internal and external quality control of malaria testing. HIV testing Interviewers collected finger-prick dried blood spot (DBS) specimens for laboratory testing of HIV from women age 15-49 and men age 15-59 who consented to be tested. Also, DBS specimens were collected from children age 0-14 with the consent of their parent or another responsible guardian. The protocol for DBS collection and analysis was based on the anonymous linked protocol developed for the DHS Program. This protocol allows for merging of HIV test results with background characteristics and other data collected in the individual questionnaires after removal of all information that could potentially identify an individual. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If consent was given for HIV testing, four to five blood spots from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. A duplicate label was attached to the biomarker data collection form. A third copy of the barcode was affixed to the DBS transmittal sheet to track the blood samples from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field and transported to the NRL in Kigali. Upon arrival at the NRL, each blood sample was logged into the CSPro HIV Test Tracking System database and stored at -80˚C until tested. The HIV testing protocol stipulated that blood could be tested only after questionnaire data collection had been completed, data had been verified and cleaned, and all unique identifiers other than the anonymous barcode number had been removed from the data file. The testing algorithm calls for testing all samples on the first assay, the Vironostika® HIV Ag/Ab (Biomérieux) enzyme-linked immunoassay (ELISA I). A random 10 percent of samples deemed negative on Introduction • 11 the ELISA I are subjected to a second ELISA (ELISA II),the Murex HIV Ag/Ab combination (DiaSorin); the other 90 percent are recorded as negative. All samples deemed positive on the ELISA I are subjected to the ELISA II. Concordant positive and negative results on the ELISA I and ELISA II are recorded as positive and negative, respectively. If the results of the first and second tests are discordant, a third confirmatory test, the HIV 2.2 western blot (DiaSorin), is administered. The final result is recorded as positive if the western blot confirms it to be positive and negative if the western blot confirms it to be negative. If the western blot results are indeterminate, the sample is recorded as indeterminate. Polymerase chain reaction (PCR) was used in testing the specimens of children age 0-23 months. After HIV testing had been completed, the test results for the 2014-15 RDHS were entered into a spreadsheet with a barcode as the unique identifier. The barcode was used to link the HIV test results with the data from the individual interviews. All households, whether or not they were part of anthropometry, anemia, malaria, or HIV testing, were given a brochure explaining the causes and prevention of anemia, malaria, and HIV. Each respondent (whether providing consent or not) was given an informational brochure on HIV and a list of nearby sites providing HIV voluntary counseling and testing (VCT) services. Respondents who consented to HIV testing were given a voucher for transportation and a meal if they wished to receive free VCT services. 1.3 PRETEST A pretest was conducted from August 25 to September 22, 2014. Thirty-four individuals (17 women and 17 men) participated in the four-week pretest training and fieldwork practice for the 2014-15 RDHS. The majority of participants had worked in previous RDHS surveys. Training was conducted by representatives from the NISR, the MOH, the RBC Malaria and Other Parasitic Diseases Division, the RBC HIV division, and the RBC NRL, with technical assistance from ICF International. UNICEF provided training on the early childhood development module. Classroom instruction was provided during the first three weeks, and pretest fieldwork took place over five days in three rural villages and two urban villages. After the fieldwork, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.4 TRAINING OF FIELD STAFF The main training for the 2014-15 RDHS started on October 5, 2014, and ended on November 2, 2014. A total of 136 participants from across the country were invited to participate in the training. They were selected based on merit. Eighty-eight of the participants were female, and 48 were male. From October 6-25, the training focused on the questionnaires. These sessions were conducted by NISR trainers with support from ICF International. Class presentations by trainers were followed by mock interviews, group practice, and role playing among participants in the classroom. Guest speakers and experts (e.g., from the MOH, the RBC, and UNICEF) made brief presentation son the national health strategies related to nutrition, contraception, malaria, maternal and child health, the HIV voluntary counseling and testing component, and early childhood development before the questionnaire training session corresponding to each of these topics. This led to an understanding among fieldworkers that items included in the questionnaire would be useful in evaluating these health topics. All participants were trained on the questionnaires through October 26. From October 27-30, 34 participants identified as health technicians were separated and trained on biomarkers. Meanwhile, the remaining participants continued to be trained on the questionnaires. Training on biomarkers was provided by representatives from the NRL with support from ICF International. Health technicians learned how to 12 • Introduction withdrawal blood samples for HIV testing, how to prepare blood slides for malaria testing, and how to conduct anemia and rapid malaria testing. In addition, procedures for handling and packaging dried blood spots and slides were reviewed and demonstrated. Training on taking anthropometry measurements (weight and height) was also covered in detail. Training included PowerPoint presentations to illustrate procedures and emphasized practice among lab technicians in order to ensure accuracy. At the end of the main training, 17 teams were formed, each consisting of a team leader, a field editor, a health technician, a male interviewer, and three female interviewers. Team leaders received additional training on how to identify the selected households and different subsamples, data quality control procedures, and fieldwork coordination. Field editors received additional training on how to edit the questionnaires and on data quality control procedures. 1.5 FIELDWORK Data collection for the 2014-15 RDHS was carried out by 17 field teams from November 9, 2014, to April 8, 2015. Each team was provided a vehicle with a driver. All questionnaires and blood specimens were transferred to the NISR office every 3-4 days by 10 supervisors from the NISR and NRL/RBC who also coordinated and supervised fieldwork activities. ICF International provided technical assistance during the entire five months of data collection period. 1.6 DATA PROCESSING The processing of the 2014-15 RDHS data began as soon as questionnaires were received from the field. Completed questionnaires were returned to NISR headquarters. The numbers of questionnaires and blood samples (DBS and malaria slides) were verified by two receptionists. Questionnaires were then checked, and open-ended questions were coded by four editors who had been trained for this task and who had also attended the questionnaire training sessions for the field staff. Blood samples (DBS and malaria slides) with transmittal sheets were sent respectively to the RBC/NRL and Parasitological and Entomology Laboratory to be screened for HIV and tested for malaria. Questionnaire data were entered via the CSPro computer program by 17 data processing personnel who were specially trained to execute this activity. Data processing was coordinated by the NISR data processing officer. ICF International provided technical assistance during the entire data processing period. Processing the data concurrently with data collection allowed for regular monitoring of team performance and data quality. Field check tables were generated regularly during data processing to check various data quality parameters. As a result, feedback was given on a regular basis, encouraging teams to continue in areas of high quality and to correct areas of needed improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent double entry to minimize keying errors, and data editing were completed on April 26, 2015. Data cleaning and finalization were completed on May 15, 2015. Household Characteristics • 13 HOUSEHOLD CHARACTERISTICS 2 household is a person or a group of persons, related or unrelated, who live together and share common cooking and eating arrangements; it is often a domestic unit consisting of the members of a family who live together, with or without nonrelatives such as servants. This chapter summarizes demographic and socioeconomic characteristics of the people who live in the households in Rwanda that were sampled during the 2014-15 RDHS. The Household Questionnaire collected basic demographic and socioeconomic information (e.g., age, sex, educational attainment, and current school attendance) for all usual residents and visitors who slept in the household the night preceding the interview. This method of data collection allowed for analysis of the results for either the de jure population (usual residents) or the de facto population (persons in the household at the time of the survey). The Household Questionnaire also collected information on housing facilities, including dwelling characteristics, source of water supply, sanitation facilities, and household assets. The information in this chapter is intended to facilitate interpretation of key demographic, socioeconomic, and health indices presented later in the report. It will also assist in the assessment of the representativeness of the survey sample. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX Table 2.1 shows the distribution by age and sex of the household population surveyed, according to urban-rural residence. The household survey involved 53,844 respondents, of whom 44,780 (83 percent) lived in rural areas and 9,064 (17 percent) lived in urban areas. The distribution of the household population by age and sex is further depicted by the population pyramid in Figure 2.1. The pyramid is wide at the base, narrowing rapidly as it reaches the upper age limits, an indication of a population with high fertility. Although the base of the pyramid (age 0-4) remains large, it is narrower than the bars for the age group 5-9. This pattern reflects a recent decline in fertility. In addition, there A Key Findings • The mean size of a Rwandan household is 4.3 persons. • Thirty-one percent of households are headed by women. • Seventy-three percent of households use an improved source of drinking water. • More than four in 10 households (44 percent) use an appropriate method to treat drinking water, primarily boiling (38 percent). • Fifty-four percent of households have an improved, not shared sanitation facility. • Almost one in four households (23 percent) have electricity. • Three in five (60 percent) Rwandan households own a mobile phone. • Fifty-six percent of children under age 5 have had their births registered. • Nine percent of children under age 18 are orphan with one or both parent dead. • Almost three-quarters of Rwandan adults are covered by health insurance. 14 • Household Characteristics is a notable gender imbalance: there are 89 males for every 100 females in the total population. Further analysis reveals structural elements peculiar to the Rwandan population. First, both the male and female populations drop significantly from 10-14, to 15-19 and 30-34 to 35-39 age groups. The fall in the population at age 10-14 might relate to child mortality in previous years. The drop in the age 15-19 group can be directly attributed to the low birth rate during 1994-1999, while the fall observed in the 35-39 age group might be the effect of the genocide in 1994. The shape of the pyramid gradually evolves over time based on fertility, mortality, and international migration trends. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Rwanda 2014-15 Urban Rural Rwanda Age Male Female Total Male Female Total Male Female Total <5 14.6 13.8 14.2 15.9 13.9 14.9 15.7 13.9 14.8 5-9 13.8 12.0 12.9 16.7 14.6 15.6 16.2 14.2 15.1 10-14 11.6 10.4 11.0 14.8 13.0 13.8 14.2 12.5 13.3 15-19 9.4 12.1 10.8 10.6 9.2 9.9 10.4 9.7 10.0 20-24 10.9 11.9 11.4 7.2 8.1 7.6 7.8 8.7 8.3 25-29 10.5 10.7 10.6 6.9 7.5 7.2 7.5 8.1 7.8 30-34 9.5 9.0 9.3 6.9 7.3 7.1 7.4 7.6 7.5 35-39 5.7 6.1 5.9 4.4 5.4 4.9 4.6 5.5 5.1 40-44 4.4 4.2 4.3 3.5 4.5 4.0 3.7 4.4 4.1 45-49 3.0 2.7 2.8 3.0 3.6 3.3 3.0 3.4 3.2 50-54 2.2 1.9 2.1 2.9 3.3 3.1 2.7 3.1 2.9 55-59 1.3 1.7 1.5 2.4 3.0 2.7 2.2 2.8 2.5 60-64 1.1 1.1 1.1 1.7 2.2 2.0 1.6 2.0 1.8 65-69 0.7 0.6 0.7 1.1 1.3 1.2 1.0 1.2 1.1 70-74 0.4 0.8 0.6 0.8 1.3 1.1 0.8 1.2 1.0 75-79 0.3 0.5 0.4 0.5 0.8 0.6 0.4 0.7 0.6 80+ 0.3 0.6 0.4 0.8 1.0 0.9 0.7 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,430 4,634 9,064 20,985 23,793 44,780 25,415 28,427 53,844 Figure 2.1 Population pyramid 10 8 6 4 2 0 2 4 6 8 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Percent Male Female RDHS 2014-15 Age Household Characteristics • 15 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows that the mean size of a Rwandan household is 4.3 persons. It has decreased slightly from the mean household size of 4.6 found in the 2005 RDHS and the mean of 4.4 found in the 2010 RDHS. Mean household size varies somewhat by residence, with 4.1 members in urban areas and 4.3 in rural areas. In addition, Table 2.2 shows that 69 percent of Rwandan households are headed by men and 31 percent by women. By residence, female-headed households represent 32 percent of all households in rural areas and 27 percent in urban areas. After increasing significantly from 21 percent to 36 percent between 1992 and 2000, the percentage of female-headed households has dropped in ensuing years, from 34 percent in 2005 and 33 percent in 2010 to 31 percent in 2014-15. More than half of all households (53 percent) contain three to five people, 23 percent have six to eight people, and 3 percent have nine or more people. One-person households make up only 8 percent of all households. Table 2.2 also shows that 25 percent of households have foster and/or orphaned children; 20 percent have foster children, 11 percent have single orphans, and 2 percent have double orphans. No significant variation exists between rural and urban areas. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Rwanda 2014-15 Residence Total Characteristic Urban Rural Household headship Male 72.7 68.2 69.0 Female 27.3 31.8 31.0 Total 100.0 100.0 100.0 Number of usual members 1 12.4 7.3 8.2 2 14.3 11.9 12.3 3 16.6 18.8 18.5 4 17.8 19.6 19.3 5 13.9 15.9 15.6 6 9.9 12.6 12.1 7 7.3 7.4 7.4 8 3.7 3.7 3.7 9+ 4.2 2.7 3.0 Total 100.0 100.0 100.0 Mean size of households 4.1 4.3 4.3 Percentage of households with orphans and foster children under age 18 Foster children1 19.9 19.5 19.6 Double orphans 1.9 1.7 1.7 Single orphans2 9.8 11.1 10.9 Foster and/or orphan children 23.9 25.5 25.3 Number of households 2,188 10,511 12,699 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent 16 • Household Characteristics 2.3 EDUCATIONAL ATTAINMENT Tables 2.3.1 and 2.3.2 show the percent distribution of the female and male household populations according to highest level of education attained, by age, residence, province, and household wealth quintile. Educational attainment is important: it contributes to improved living conditions not only for the individual household but for society as a whole. Reproductive behavior, use of contraception, health habits, school attendance of household members, and habits relating to hygiene and nutrition are all influenced by educational attainment. The data in these two tables show that 19 percent of women and 13 percent of men have never attended school. A comparison of these proportions with those of the previous survey shows improvement: at the time of the 2010 survey, 22 percent of women and 16 percent of men had no education at all. The percentage of women and men who have completed only primary school is nearly identical (14 percent for women and 14 percent for men). As educational attainment increases, the percentage of both women and men in these categories decreases: only 3 percent of women and men have completed a secondary-level education, and 2 percent of women and 3 percent of men have attended any schooling beyond the secondary level. Table 2.3.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Rwanda 2014-15 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 22.6 77.3 0.0 0.0 0.0 0.0 0.1 100.0 3,279 0.2 10-14 1.7 89.1 2.0 7.2 0.0 0.0 0.0 100.0 3,567 2.7 15-19 1.4 42.0 16.3 39.2 1.1 0.1 0.0 100.0 2,756 5.3 20-24 4.8 41.6 14.6 25.3 11.2 2.4 0.0 100.0 2,466 5.2 25-29 10.7 52.6 16.7 6.7 7.9 5.4 0.0 100.0 2,292 3.9 30-34 16.4 50.0 20.6 5.1 3.8 4.1 0.0 100.0 2,147 3.7 35-39 17.5 36.9 33.4 6.5 3.3 2.4 0.1 100.0 1,575 4.5 40-44 24.2 32.0 35.1 3.5 2.2 2.9 0.0 100.0 1,257 4.1 45-49 35.6 26.7 31.6 3.7 0.6 1.8 0.0 100.0 980 2.7 50-54 46.4 31.8 16.7 2.7 1.5 0.9 0.2 100.0 869 0.6 55-59 50.1 30.7 16.8 0.5 1.6 0.3 0.1 100.0 790 0.0 60-64 61.2 26.2 9.7 2.0 0.7 0.2 0.0 100.0 577 0.0 65+ 75.1 20.7 3.0 0.8 0.1 0.0 0.3 100.0 1,153 0.0 Residence Urban 9.7 41.5 14.9 17.7 8.6 7.5 0.0 100.0 3,890 4.9 Rural 20.8 54.1 14.0 8.9 1.8 0.4 0.0 100.0 19,818 2.6 Province City of Kigali 9.8 41.4 16.8 16.0 8.7 7.2 0.1 100.0 2,562 4.9 South 19.1 53.5 15.0 9.1 2.2 1.1 0.1 100.0 5,867 2.8 West 21.0 53.5 11.7 10.1 2.7 1.0 0.0 100.0 5,386 2.6 North 19.4 50.8 15.4 11.4 2.2 0.8 0.0 100.0 3,971 3.0 East 20.7 54.6 13.5 8.8 1.7 0.7 0.0 100.0 5,923 2.5 Wealth quintile Lowest 30.2 57.1 8.5 3.8 0.4 0.0 0.0 100.0 4,806 1.3 Second 23.0 57.1 12.7 6.8 0.4 0.0 0.0 100.0 4,785 2.2 Middle 19.5 55.1 15.6 8.4 1.4 0.1 0.1 100.0 4,697 2.8 Fourth 14.3 51.3 17.7 13.5 2.7 0.5 0.0 100.0 4,720 3.5 Highest 7.8 39.3 16.3 19.5 9.7 7.4 0.0 100.0 4,701 5.2 Total 19.0 52.0 14.1 10.3 2.9 1.6 0.0 100.0 23,709 2.9 Note: Total includes one woman with age missing. 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school. 2 Completed 6th grade at the secondary level The percentage of women and men who have completed primary school or higher has increased since 2010, from 19 percent to 29 percent among women and from 22 percent to 30 percent among men. The figures for 2014-15 also show significant gains across generations. For example, among females, the proportion with Household Characteristics • 17 no education drops from 75 percent for women age 65 and over to 2 percent for girls between age 10 and age 14. The percentage among males in these age groups drops from 41 percent to 3 percent. In addition, the gap in educational attainment between the sexes has narrowed in the younger age groups. For example, among those age 25-29, only 37 percent of women have completed primary school or higher, as compared with 44 percent of men. However, among those age 20-24, the proportions are almost identical: 54 percent of women and 55 percent of men. The gender gap reverses among those age 15-19, with 57 percent of women and only 46 percent of men have completed primary school or higher. Table 2.3.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Rwanda 2014-15 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 23.7 76.2 0.0 0.0 0.0 0.0 0.1 100.0 3,316 0.1 10-14 2.9 90.2 1.5 5.4 0.0 0.0 0.1 100.0 3,619 2.4 15-19 2.2 51.4 12.1 33.4 0.9 0.0 0.0 100.0 2,639 4.8 20-24 4.3 40.3 15.4 24.5 10.8 4.6 0.0 100.0 1,990 5.3 25-29 8.2 48.1 17.5 8.5 9.3 8.2 0.1 100.0 1,912 4.5 30-34 14.1 46.9 22.9 5.6 4.5 6.0 0.0 100.0 1,879 4.2 35-39 15.9 33.0 36.2 5.8 3.6 5.5 0.0 100.0 1,175 5.0 40-44 16.0 34.5 33.6 7.5 3.6 4.5 0.3 100.0 933 4.9 45-49 22.8 28.9 36.2 5.4 2.6 4.0 0.0 100.0 767 4.7 50-54 27.9 37.1 25.4 3.4 3.3 2.5 0.4 100.0 698 2.9 55-59 28.0 40.1 24.6 2.9 2.3 2.1 0.0 100.0 570 2.9 60-64 33.0 41.2 18.3 3.7 1.8 2.1 0.0 100.0 402 2.4 65+ 40.5 40.0 14.0 2.8 1.3 1.1 0.3 100.0 739 1.6 Residence Urban 7.0 42.3 16.5 15.8 8.3 10.0 0.1 100.0 3,663 5.0 Rural 14.7 59.4 13.8 8.9 2.0 1.1 0.1 100.0 16,978 2.7 Province City of Kigali 7.1 42.2 18.8 13.7 8.3 9.7 0.2 100.0 2,415 5.0 South 14.6 58.8 13.7 8.7 2.1 1.8 0.2 100.0 4,986 2.6 West 15.1 56.9 12.7 10.3 3.2 1.8 0.1 100.0 4,651 2.9 North 12.8 57.7 15.6 9.5 2.6 1.8 0.0 100.0 3,384 3.0 East 13.9 59.1 13.4 10.0 2.1 1.4 0.0 100.0 5,205 2.8 Wealth quintile Lowest 23.9 64.2 7.4 4.2 0.3 0.0 0.0 100.0 3,613 1.3 Second 16.5 62.1 13.2 7.0 1.0 0.1 0.2 100.0 3,896 2.4 Middle 13.4 60.4 15.3 8.6 1.9 0.3 0.1 100.0 4,175 2.8 Fourth 9.7 57.1 17.4 11.5 2.8 1.4 0.1 100.0 4,372 3.4 Highest 5.8 40.9 16.9 17.5 8.8 10.1 0.0 100.0 4,585 5.2 Total 13.4 56.3 14.3 10.1 3.1 2.6 0.1 100.0 20,641 3.0 Note: Total includes two men with age missing. 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school. 2 Completed 6th grade at the secondary level By residence, the data show significant gaps in educational attainment. In rural areas, 21 percent of women and 15 percent of men have no education, as compared with 10 percent of women and 7 percent of men in urban areas. There are also variations among provinces. The City of Kigali has the lowest percentage of residents with no education (10 percent of women and 7 percent of men). Conversely, the West province has the highest proportion of women and men with no education (21 percent and 15 percent, respectively). As level of educational attainment increases, the gaps between the provinces widen: in the City of Kigali, 16 percent of women have completed secondary school or higher, as compared with 2 percent to 4 percent in other provinces; among men, 18 percent have completed secondary school or higher, compared with 4 percent to 5 percent in other provinces. Results by wealth quintile show that the proportions of both women and men with no education decrease as the household standard of living increases. Conversely, educational level increases with household wealth: 17 percent of women and 19 percent of men in the highest quintile have completed secondary school or higher, as compared with less than 1 percent of women and men in the lowest quintile. In 18 • Household Characteristics households in the highest wealth quintile, there is practically no gap in educational attainment between women and men up to the secondary level. 2.4 SCHOOL ATTENDANCE The level of school attendance of children is the primary indicator of a population’s access to education and, indirectly, its socioeconomic development. The 2014-15 RDHS asked questions concerning school attendance of all respondents between age 3 and age 24. Table 2.4 shows net attendance ratios (NARs) and gross attendance ratios (GARs) by sex and level of schooling, according to background characteristics. Net school attendance ratios measure school attendance among children who have reached the official school age. At the primary school level, the NAR is the percentage of the primary school age population (age 7-12 in Rwanda) that actually attends primary school. Table 2.4 shows that the primary-level NAR is 92 percent, which means that slightly more than 9 in 10 children in Rwanda between age 7 and 12 attend primary school. The ratio is the same in urban and rural areas (92 percent). In the provinces, the ratio ranges from a high of 93 percent in North to a low of 91 percent in South. Household wealth also affects the NAR, which is 86 percent among children in the lowest wealth quintile and 95 percent and 94 percent among children in the middle and fourth quintiles, respectively. The NAR is slightly higher for female children (92 percent) than for male children (91 percent). At the secondary level, where children are age 13-18, the NAR is much lower, at 29 percent; that is, only 29 percent of the official secondary school age population actually attends school. There are notable disparities between the sexes (32 percent for females versus 27 percent for males). The NAR is higher in urban areas than in rural areas (39 percent and 27 percent, respectively). By province, there is a gap between West, with an NAR of 33 percent, and the other provinces, whose NARs are between 25 percent (East) and 31 percent (City of Kigali). NARs clearly increase with increasing wealth, from 15 percent in the lowest quintile to 43 percent in the highest quintile. Table 2.4 also shows gross school attendance ratios. Unlike the NAR, the GAR measures school attendance among young people regardless of age. The GAR for primary school is the total number of students of any age attending primary school, expressed as a percentage of the official primary school age population (age 7-12). Unless there are significant numbers of overage and underage students at a given level of schooling, the GAR is always higher than the NAR and can, in some cases, exceed 100 percent. In Rwanda, the GAR at the primary level is 136 percent, which means that a significant proportion of children who do not fall into the official primary school age category are attending school at the primary level. These are likely to be children over age 12 or under age 7 who are attending primary school; in fact, a program exists to reintegrate children who drop out of primary school for any reason. In 2010, the GAR was higher for girls than for boys (146 percent versus 141 percent); in 2014-15, by contrast, the GAR was slightly higher for boys than girls (137 percent versus 135 percent). At the secondary level, the GAR is low (40 percent). The reason is either that official secondary school age children are still in primary school or that they have dropped out of secondary school or never attended at all. The ratio is different for girls (43 percent) and boys (37 percent), and it is higher in urban areas than in rural areas (54 percent versus 37 percent). In 2010, City of Kigali had by far the highest secondary school GAR. In 2014-15, however, West had the highest GAR (47 percent), followed by City of Kigali and North (42 percent each).East had the lowest GAR (34 percent). The GAR increases with increasing wealth, from 20 percent in the lowest quintile to 59 percent in the highest quintile. Household Characteristics • 19 Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling, and the gender parity index (GPI), according to background characteristics, Rwanda 2014-15 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 93.3 90.1 91.7 0.97 141.0 133.6 137.4 0.95 Rural 90.9 92.8 91.8 1.02 136.6 135.7 136.2 0.99 Province City of Kigali 91.8 91.9 91.8 1.00 142.3 139.9 141.2 0.98 South 90.4 90.7 90.6 1.00 135.2 134.2 134.7 0.99 West 91.1 92.8 92.0 1.02 139.3 132.7 135.9 0.95 North 91.3 94.2 92.7 1.03 136.1 136.8 136.5 1.01 East 91.8 92.6 92.2 1.01 136.5 136.7 136.6 1.00 Wealth quintile Lowest 84.5 86.6 85.5 1.02 122.3 122.9 122.6 1.00 Second 90.1 93.7 91.9 1.04 131.6 139.1 135.4 1.06 Middle 94.1 95.3 94.7 1.01 145.2 138.1 141.5 0.95 Fourth 94.1 94.7 94.4 1.01 148.2 139.4 143.8 0.94 Highest 93.5 91.6 92.6 0.98 138.9 137.9 138.4 0.99 Total 91.2 92.4 91.8 1.01 137.2 135.4 136.3 0.99 SECONDARY SCHOOL Residence Urban 40.2 38.7 39.4 0.96 57.7 50.7 53.9 0.88 Rural 24.1 29.9 26.9 1.24 33.7 40.8 37.2 1.21 Province City of Kigali 32.5 29.2 30.7 0.90 48.4 36.6 41.8 0.76 South 24.3 29.1 26.7 1.20 33.4 40.7 37.0 1.22 West 28.6 38.0 33.1 1.33 42.2 52.6 47.2 1.25 North 26.4 36.2 31.6 1.37 36.4 46.7 41.8 1.28 East 24.9 25.3 25.1 1.01 33.8 34.7 34.3 1.03 Wealth quintile Lowest 13.6 15.5 14.6 1.14 19.2 20.9 20.1 1.09 Second 20.5 23.2 21.9 1.14 27.0 29.3 28.2 1.08 Middle 22.7 29.6 26.0 1.30 33.5 39.9 36.6 1.19 Fourth 27.4 39.3 33.0 1.43 38.9 55.3 46.6 1.42 Highest 42.9 43.1 43.0 1.00 60.3 57.9 59.0 0.96 Total 26.5 31.5 29.0 1.19 37.4 42.6 40.0 1.14 1 The NAR for primary school is the percentage of the primary school age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. The table also includes a third school attendance indicator: the gender parity index (GPI), which is the ratio of the NAR/GAR for females to the NAR/GAR for males. The narrower the gap between the sexes, the closer the index is to 1. The NAR GPI for primary school is 1.01, and there are only minimal variations according to residence, province, or wealth quintile. This indicates an absence of disparity between the sexes. The NAR GPI for secondary school is 1.19; this indicates that boys are somewhat educationally disadvantaged at this level. The inequality is greater in rural areas, which have a GPI of 1.24 compared with 0.96 in urban areas. Figure 2.2 shows that the rate of school attendance, which is low at age 5, begins to increase at age 6 and reaches a high level between age 9 and age 12. This period corresponds to the primary school years for 20 • Household Characteristics children in classes three, four, five, and six in the normal primary cycle. After age 12, the age at the beginning of the secondary cycle, the curve declines steadily, reaching its lowest point at age 24. It should also be noted that the proportion of females who attend school is higher than the proportion of males at age 5, age 6, and age 8-15, while the situation generally reverses beginning at age 16. Figure 2.2 Age-specific attendance rates 2.5 HOUSEHOLD CONDITIONS The Household Questionnaire gathered information on certain household characteristics: access to electricity, source of drinking water, type of toilet facilities, and type of roofing and flooring materials. Information was also sought concerning ownership of various modern durable goods, including a radio, television, mobile phone, refrigerator, bicycle, motorcycle/scooter, and car/truck. Household characteristics and ownership of durable goods were used to evaluate the socioeconomic conditions of the household. 2.5.1 Household Drinking Water With respect to drinking water, Table 2.5 shows, at the national level, that 73 percent of households have access to an improved source of drinking water. Protected springs are the most common improved source of drinking water used by households (32 percent), followed by public taps/standpipes (27 percent). Only 10 percent of households have running water in their dwelling, yard, or plot. Overall, 27 percent of households use unimproved sources of water, which are considered unhealthy. For example, 14 percent of households use an unprotected spring as a water source, which increases household members’ risk of contracting diarrhea and other waterborne diseases. With respect to residence, it appears that urban households are more likely than rural households to use improved drinking water (91 percent versus 69 percent). In contrast, 31 percent of households in rural areas use unsafe drinking water, as compared with 9 percent of those in urban areas. In fact, 16 percent of rural households collect their water from an unprotected spring, 13 percent collect it from surface water, and 2 percent retrieve it from an unprotected well. Regarding the time spent in round-trip travel to obtain drinking water, Table 2.5 shows that slightly less than half of households (49 percent) spend 30 minutes or longer to get to the water source and return, and 41 percent spend fewer than 30 minutes. Only 11 percent of households have water on their premises. Fifty- 0 10 20 30 40 50 60 70 80 90 100 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age Male Female RDHS 2014-15Note: Figure shows percentage of the de jure household population age 5-24 years attending school Household Characteristics • 21 five percent of households in rural areas take 30 minutes or longer to obtain drinking water, as compared with 19 percent of households in urban areas. The proportions of households that spend less than 30 minutes to obtain drinking water vary slightly between rural areas (41 percent) and urban areas (38 percent). With respect to treatment of water prior to drinking, 44 percent of households use an appropriate treatment method prior to drinking, while the other 56 percent do not treat their water prior to drinking. Table 2.5 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Rwanda 2014-15 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 90.9 69.2 72.9 90.4 68.7 72.3 Piped into dwelling/yard/plot 42.1 2.7 9.5 43.6 2.8 9.6 Public tap/standpipe 39.3 24.8 27.3 37.7 24.2 26.5 Tube well or borehole 0.8 1.6 1.4 0.9 1.7 1.6 Protected well 0.5 2.3 2.0 0.5 2.2 1.9 Protected spring 7.8 37.0 32.0 7.4 37.0 32.0 Rain water 0.3 0.8 0.7 0.4 0.9 0.8 Non-improved source 8.9 30.8 27.0 9.5 31.2 27.6 Unprotected well 0.5 1.9 1.7 0.6 2.0 1.7 Unprotected spring 3.6 15.8 13.7 3.9 15.9 13.9 Tanker truck/cart with tank 0.0 0.1 0.1 0.0 0.1 0.1 Surface water 4.8 13.0 11.6 5.0 13.3 11.9 Other 0.1 0.0 0.0 0.1 0.0 0.0 Missing 0.0 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 43.2 3.7 10.5 44.5 3.9 10.7 Less than 30 minutes 37.7 41.3 40.7 36.0 40.7 39.9 30 minutes or longer 19.0 54.8 48.7 19.5 55.3 49.3 Don’t know/missing 0.0 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 62.4 33.2 38.3 64.9 33.5 38.7 Bleach/chlorine added 4.6 4.8 4.8 5.0 5.2 5.2 Strained through cloth 0.1 0.1 0.1 0.1 0.2 0.2 Ceramic, sand, or other filter 2.2 3.8 3.5 2.4 4.1 3.8 Solar disinfection 0.2 0.0 0.0 0.2 0.0 0.0 Let it stand 0.3 0.5 0.4 0.2 0.4 0.4 Other 0.4 0.1 0.1 0.4 0.1 0.1 No treatment 32.8 60.2 55.5 30.2 59.4 54.5 Percentage using an appropriate treatment method2 66.6 39.4 44.1 69.3 40.2 45.0 Number 2,188 10,511 12,699 9,033 45,052 54,085 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. The most common method to treat water prior to drinking is boiling (38 percent), followed by adding bleach/chlorine (5 percent) and using ceramic/sand or another filter (4 percent). Households in rural areas are more likely to drink untreated water (60 percent) than those in urban areas (33 percent). 2.5.2 Household Sanitation Facilities With respect to type of toilet facilities, Table 2.6 shows that 54 percent of households have access to an improved, unshared toilet facility (57 percent in rural areas and 42 percent in urban areas). Only 1 percent of households have toilets that flush to a piped sewer system, while 4 percent use a ventilated improved pit (VIP) latrine. However, almost half of households (48 percent) use unshared pit latrines with a slab. These 22 • Household Characteristics toilets are considerably more common in rural households than urban households (52 percent and 30 percent, respectively). Seventeen percent of Rwandan households use a toilet facility that would be considered improved except that it is shared with other households; most of these facilities are pit latrines with slabs (15 percent). Twenty-nine percent of households use an unimproved facility, with the majority (24 percent) using a pit latrine without a slab or an open pit. Twenty-seven percent of rural households and 11 percent of urban households use this type of facility. It should be noted that 4 percent of households in Rwanda have no sanitation facility at all (1 percent in urban areas and 4 percent in rural areas). It is interesting to note that rural households are more likely to have improved and not shared facilities. Although urban households have more improved facilities, they are mostly shared with other households. Table 2.6 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Rwanda 2014-15 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 5.7 0.2 1.1 6.6 0.2 1.3 Flush/pour flush to septic tank 1.3 0.0 0.2 1.5 0.0 0.3 Flush/pour flush to pit latrine 1.2 0.1 0.3 1.4 0.1 0.3 Ventilated improved pit (VIP) latrine 4.1 3.8 3.8 5.3 4.1 4.3 Pit latrine with slab 29.7 51.9 48.0 34.6 55.0 51.6 Composting toilet 0.2 0.6 0.6 0.1 0.6 0.5 Total 42.1 56.6 54.1 49.5 60.0 58.3 Shared facility1 Flush/pour flush to piped sewer system 0.7 0.0 0.1 0.6 0.0 0.1 Flush/pour flush to septic tank 0.0 0.0 0.0 0.0 0.0 0.0 Flush/pour flush to pit latrine 0.4 0.0 0.1 0.4 0.0 0.1 Ventilated improved pit (VIP) latrine 4.4 0.7 1.4 3.8 0.6 1.1 Pit latrine with slab 38.5 10.6 15.4 31.9 8.5 12.4 Composting toilet 0.2 0.1 0.1 0.1 0.1 0.1 Total 44.2 11.5 17.1 36.9 9.2 13.8 Non-improved facility Flush/pour flush not to sewer/septic tank/pit latrine 0.8 0.2 0.3 0.8 0.2 0.3 Pit latrine without slab/open pit 11.2 27.1 24.3 11.4 27.0 24.4 Bucket 0.0 0.0 0.0 0.0 0.0 0.0 No facility/bush/field 1.4 4.4 3.9 1.1 3.4 3.0 Other 0.2 0.1 0.1 0.3 0.1 0.1 Missing 0.0 0.1 0.1 0.0 0.1 0.1 Total 13.7 32.0 28.8 13.6 30.8 27.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,188 10,511 12,699 9,033 45,052 54,085 1 Facilities that would be considered improved if they were not shared by two or more households 2.5.3 Household Hand Washing Places Washing hands with water and soap before eating, while preparing food, and after leaving the toilet is a simple, inexpensive, and good practice that protects against many diseases. During the survey, the interviewers asked each household if there was a place used for hand washing, and, if so, they asked if they could observe the place to see if water and soap or some other cleansing agent was available. Table 2.7 shows that only 12 percent of households had a place for hand washing that was observed by an interviewer. Among households where there was a place for hand washing, over one third (37 percent) had water and soap. Nearly one in seven households had water only, and the same proportion had soap but no water. In urban areas, 20 percent of households had a place for hand washing, as compared with 10 percent of Household Characteristics • 23 households in rural areas. Among households where place for hand washing was observed sixty-seven percent had soap and water available in urban area compared with only 25 percent in rural area. A higher percentage of rural than urban households had no water, no soap, and no other cleansing agent available (39 percent versus 12 percent among household where a place for hand washing was observed). Among the provinces, households in North and East are least likely to have a place for hand washing (7 percent and 8 percent, respectively). In contrast, 13 percent of households in West, 14 percent in South, and 17 percent in City of Kigali have a place for hand washing. Among households where a place for hand washing was observed, households the highest percentage of household with soap and water is in City of Kigali 83 percent) while the lowest is in West (11 percent). The proportion of households with a place for hand washing increases with increasing wealth, from 9 percent among households in the lowest three quintiles to 20 percent of those in the highest quintile. Half of households in the lowest wealth quintile (50 percent) had no water, soap, or other cleansing agent available, as compared with only 9 percent of households in the highest quintile. Table 2.7 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, according to residence, province, and wealth quintile, Rwanda 2014-15 Percentage of house- holds where place for washing hands was observed Number of house- holds Among households where place for hand washing was observed, percentage with: Number of house- holds with place for hand washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 19.5 2,188 66.9 0.3 10.3 8.9 0.0 11.9 1.8 100.0 426 Rural 9.8 10,511 25.1 0.2 17.1 17.4 0.2 38.5 1.4 100.0 1,028 Province City of Kigali 16.8 1,496 83.3 0.0 6.9 1.2 0.0 5.8 2.8 100.0 251 South 13.8 3,103 25.2 0.5 21.8 4.3 0.3 46.3 1.6 100.0 427 West 13.1 2,789 11.1 0.3 5.5 49.9 0.0 32.9 0.3 100.0 367 North 7.0 2,090 24.8 0.0 27.0 7.3 0.9 37.9 2.1 100.0 147 East 8.1 3,221 57.1 0.0 18.7 0.9 0.0 22.0 1.4 100.0 262 Wealth quintile Lowest 9.0 2,920 9.3 0.0 18.1 21.3 0.0 50.3 1.0 100.0 262 Second 8.8 2,636 15.0 0.0 11.3 24.7 1.0 47.6 0.5 100.0 233 Middle 9.4 2,441 24.9 0.4 16.4 20.5 0.0 36.8 0.9 100.0 230 Fourth 10.4 2,290 34.2 0.4 19.9 13.0 0.0 31.7 0.8 100.0 238 Highest 20.4 2,412 70.4 0.2 12.4 5.3 0.0 8.9 2.8 100.0 492 Total 11.5 12,699 37.4 0.2 15.1 14.9 0.2 30.7 1.5 100.0 1,455 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 2.5.4 Household Characteristics The survey collected household information on access to electricity, type of housing materials, number of rooms used for sleeping, the place used for cooking, types of cooking fuel, and presence of tobacco smoking inside the house. These characteristics and others were used to evaluate the socioeconomic and living conditions of the household. Table 2.8 shows that only 23 percent of households in Rwanda have access to electricity. The situation has improved since 2010, when only 10 percent of households had electricity. The results show large 24 • Household Characteristics disparities between urban and rural areas. Only 12 percent of rural households have electricity, as compared with 73 percent of urban households. Table 2.8 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Rwanda 2014-15 Residence Total Housing characteristic Urban Rural Electricity Yes 72.9 12.4 22.8 No 27.1 87.5 77.1 Total 100.0 100.0 100.0 Roofing material Metal/iron sheets 89.7 57.6 63.1 Ceramic tiles 8.4 41.6 35.9 Other 1.9 0.8 1.0 Total 100.0 100.0 100.0 Flooring material Earth, sand 29.1 84.2 74.7 Dung 0.1 0.9 0.7 Ceramic tiles 4.7 0.6 1.3 Cement 65.7 14.1 23.0 Carpet 0.2 0.0 0.1 Other 0.2 0.1 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping One 32.1 26.4 27.4 Two 32.7 45.4 43.2 Three or more 34.8 28.0 29.2 Missing 0.3 0.1 0.2 Total 100.0 100.0 100.0 Place for cooking In the house 14.4 26.4 24.3 In a separate building 44.8 55.1 53.3 Outdoors 37.7 17.5 20.9 No food cooked in household 2.9 1.0 1.4 Missing 0.1 0.0 0.0 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.3 0.0 0.1 LPG/natural gas/biogas 1.5 0.1 0.3 Kerosene 0.6 0.0 0.1 Charcoal 65.5 4.8 15.3 Wood 26.1 76.7 68.0 Straw/shrubs/grass 2.9 16.7 14.4 Agricultural crop 0.0 0.6 0.5 No food cooked in household 2.9 1.0 1.4 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 94.6 98.9 98.1 Frequency of smoking in the home Daily 9.5 15.6 14.6 Weekly 2.4 4.0 3.7 Monthly 0.9 1.0 1.0 Less than monthly 0.4 0.4 0.4 Never 86.9 78.9 80.3 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number 2,188 10,511 12,699 LPG = Liquid petroleum gas 1 Includes charcoal, wood/straw/shrubs/grass, and agricultural crops Household Characteristics • 25 The type of material used for flooring is extremely important. Some materials propagate diseases causing germs and parasites. The large majority (75 percent) of floors in Rwandan houses are earth or sand. This proportion is higher in rural areas (84 percent) than in urban areas (29 percent). Twenty-three percent of households have cement floors. This type of flooring is more commonly observed in urban than in rural areas (66 percent versus 14 percent). The results indicate an improvement in flooring materials since 2010, when 81 percent of floors were earth/sand and 16 percent were cement. Table 2.8 shows that 43 percent of households have two rooms for sleeping (33 percent of urban households and 45 percent of rural households). It should be noted that, in 27 percent of households, all household members sleep in a single room. This proportion is higher in urban areas (32 percent) than in rural areas (26 percent). More than half (53 percent) of households cook their meals in a separate building, while 21 percent cook outdoors. Twenty-four percent of households cook in the same structure that is used for sleeping (14 percent of urban and 26 percent of rural households). Table 2.8 shows that 68 percent of households use wood as cooking fuel. More rural households than urban households use wood as cooking fuel (77 percent versus 26 percent). The second and third most common cooking fuels are charcoal (used by 15 percent of households) and straw/shrubs/grass (used by 14 percent of households). Sixty-six percent of households in urban areas use charcoal for cooking, as compared with only 5 percent of those in rural areas. Electricity is rarely used for cooking in Rwanda. Most households use a solid fuel for cooking (98 percent), with no significant difference between rural and urban areas. Fifteen percent of households report that someone smokes inside the house on a daily basis (16 percent in rural areas and 10 percent in urban areas).Four in five households (80 percent) report that no one smokes in the house. 2.5.5 Household Possession of Durable Goods To evaluate households’ socioeconomic level, the survey gathered information on possession of various household durable goods, the means of transportation used by household members, and ownership of agricultural land and livestock/farm animals. Table 2.9 shows that, overall, mobile telephones (60 percent) are the most frequently owned household good. More urban (86 percent) than rural (54 percent) households reported owning a mobile telephone. The proportion of households owning a mobile telephone has increased significantly since 2010, when only 40 percent of households owned a mobile telephone. The second most common household asset is a radio, owned by 55 percent of households. The proportion of households owning a radio is much higher in urban areas (67 percent) than in rural areas (52 percent). Ten percent of households own a television, twice as high as the proportion in 2010 (5 percent). There is a significant difference in television ownership between urban (39 percent) and rural (4 percent) households. Only 2 percent of households own a refrigerator (8 percent in urban areas and less than 1 percent in rural areas). Three percent of households own a computer, again with disparities between urban (14 percent) and rural (1 percent) areas. Bicycles are used as a means of transportation in 15 percent of households (16 percent of households in rural areas and 10 percent of households in urban areas). Only 1 percent of Rwandan households own a car or truck, while 2 percent own a motorcycle or scooter. Overall, 72 percent of households own agricultural land. The proportion varies significantly by urban- rural residence: 80 percent of rural households own agricultural land, as compared with 36 percent of urban 26 • Household Characteristics households. Fifty-three percent of households possess farm animals (58 percent of households in rural areas and 26 percent of households in urban areas). Table 2.9 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Rwanda 2014-15 Residence Total Possession Urban Rural Household effects Radio 67.1 51.9 54.5 Television 38.6 3.6 9.6 Mobile telephone 86.4 54.2 59.8 Non-mobile telephone 1.0 0.1 0.2 Refrigerator 8.4 0.2 1.6 Computer 13.9 1.0 3.2 Means of transport Bicycle 10.0 15.9 14.9 Animal-drawn cart 0.2 0.0 0.0 Motorcycle/scooter 4.4 1.3 1.8 Car/truck 5.9 0.2 1.2 Boat without a motor 0.0 0.2 0.2 Boat with a motor 0.0 0.0 0.0 Ownership of agricultural land 36.3 79.9 72.4 Ownership of farm animals1 26.4 58.1 52.6 Number 2,188 10,511 12,699 1 Cows, milk cows, bulls, goats, sheep, chickens, pigs, rabbits, or horses/donkeys/mules 2.5.6 Household Wealth Table 2.10 shows the percent distribution of the de jure population by wealth quintile and Gini coefficient. The wealth index was developed on the basis of de jure population data and was generated via a principal components analysis. Information on household goods was derived from responses to questions about ownership of certain durable goods (e.g., television, radio, car, mobile telephone) and questions about certain housing characteristics (access to electricity, source of drinking water, type of toilet facilities, type of flooring material, number of rooms used for sleeping, and type of cooking fuel). In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to both urban and rural areas is used to create wealth scores for households in both areas. Categorical variables to be used are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then analyzed using a principal components analysis to produce a common factor score for each household. In a second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning household scores to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. The results show that, in urban areas, 75 percent of the de jure population falls into the richest quintile, as compared with only 9 percent in rural areas. City of Kigali has the largest percentage of households in the highest wealth quintile (73 percent). Twenty-three percent of households in rural areas fall into the poorest quintile. Household Characteristics • 27 Table 2.10 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and province, Rwanda 2014-15 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 5.8 4.7 4.8 9.6 75.2 100.0 9,033 0.20 Rural 22.9 23.1 23.0 22.1 8.9 100.0 45,052 0.25 Province City of Kigali 5.3 4.9 6.0 10.9 72.9 100.0 6,023 0.25 South 25.7 20.9 19.3 20.6 13.6 100.0 13,132 0.22 West 25.6 24.0 20.6 17.1 12.7 100.0 12,398 0.21 North 19.3 22.4 23.0 22.3 13.0 100.0 8,858 0.16 East 16.4 20.7 24.3 24.6 14.1 100.0 13,674 0.26 Total 20.0 20.0 20.0 20.0 20.0 100.0 54,085 0.24 2.6 BIRTH REGISTRATION Registering a child’s birth with civil authorities establishes the child’s legal family ties and his or her right to a name and nationality prior to the age of majority. It confers on the child the right to be recognized by his or her parents and the right to state protection if his or her rights are abused by parents. It gives the child access to social assistance through the parents, including health insurance, and establishes family lineage. Registration is therefore an essential formality. Registration of a child with civil authorities, if performed correctly, also provides a reliable source of socio demographic statistics. For this reason, the survey asked, for all children age 0 to 4 in each household, whether the child had a birth certificate or whether the child’s birth had been registered with the civil authorities. Table 2.11 shows that 56 percent of children have been registered with the civil authorities. The percentage has dropped significantly since 2010, when 63 percent of births were registered. Only 3 percent of children under age 5 possess birth certificates. Children age 2-4 are more likely to be registered than those younger than age 2 (60 percent and 50 percent, respectively). There is no difference regarding to gender whether or not children are registered with the civil authorities. Children in the poorest households are less likely to be registered (43 percent) than children in households in the other wealth quintiles (53 to 66 percent). There is no discrepancy by urban/rural residence. Results by province show that children in North and City of Kigali are most likely to be registered with the civil authorities (67 percent and 59 percent, respectively). 28 • Household Characteristics Table 2.11 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Rwanda 2014-15 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Age <2 2.9 47.2 50.1 3,244 2-4 2.5 57.6 60.0 4,671 Sex Male 2.7 53.3 56.0 3,972 Female 2.6 53.4 55.9 3,942 Residence Urban 4.7 50.7 55.4 1,271 Rural 2.3 53.8 56.1 6,643 Province City of Kigali 2.6 56.8 59.4 900 South 2.4 47.6 50.0 1,808 West 3.3 51.7 55.0 1,902 North 4.3 62.7 66.9 1,149 East 1.5 53.1 54.6 2,156 Wealth quintile Lowest 1.0 42.2 43.3 1,916 Second 1.8 50.7 52.5 1,728 Middle 2.5 56.9 59.4 1,579 Fourth 2.5 63.9 66.4 1,383 Highest 6.6 57.6 64.2 1,310 Total 2.7 53.3 56.0 7,915 2.7 CHILDREN’S LIVING ARRANGEMENTS AND ORPHANHOOD Because the family is the primary safety net for children, any strategy aimed at protecting children must place a high priority on strengthening the family’s capacity to care for children. It is therefore essential to identify orphaned children and to determine whether those who have one or both parents alive are living with either or both surviving parents. Table 2.12 presents these two types of information for children under age 18, according to background characteristics. The data show that 63 percent of Rwandan children under age 18 live with both of their parents. This proportion declines steadily with age, from 74 percent among children under age 2 and 68 percent among those age 2 to 4 to 49 percent among those age 15 to 17. The results show practically no difference according to child’s sex. The proportion of children living with both of their parents is higher in rural areas (64 percent) than in urban areas (59 percent). The lowest proportion of children living with both parents is in the South province (59 percent), while the highest proportion is in the North and West provinces (66 percent each). Twenty-two percent of children under age 18 live with their mother only, whether their father is alive (17 percent) or deceased (5 percent); and 2 percent live with their father only. Twelve percent do not live with either parent. Overall, 9 percent of children under age 18 have lost one or both parents: 8 percent have lost their fathers, 3 percent have lost their mothers, and 1 percent have lost both parents. Because a parent’s risk of dying increases with time, the proportion of children who have lost their father and/or mother increases significantly with age, from 1 percent among those less than age 2 and 3 percent among those age 2 to 4 to 7 percent among those age 5 to 9. The proportion increases further among children age 10 to 14 (13 percent) and age 15 to 17 (23 percent). Household Characteristics • 29 Table 2.12 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Rwanda 2014-15 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biological parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Age 0-4 70.5 21.8 1.4 0.6 0.2 4.2 0.3 0.2 0.1 0.7 100.0 4.8 2.1 7,915 <2 73.7 23.6 0.8 0.1 0.0 0.9 0.2 0.0 0.0 0.5 100.0 1.2 1.1 3,244 2-4 68.3 20.6 1.8 1.0 0.3 6.5 0.3 0.3 0.2 0.8 100.0 7.2 2.8 4,671 5-9 66.6 15.8 3.9 1.7 0.7 8.3 0.8 0.9 0.5 0.7 100.0 10.5 6.8 8,189 10-14 57.9 14.5 7.6 2.4 1.0 11.4 1.1 2.2 1.2 0.7 100.0 15.9 13.2 7,224 15-17 48.8 11.5 12.0 1.4 1.2 13.6 2.0 4.6 3.4 1.4 100.0 23.6 23.4 3,361 Sex Male 63.6 17.0 5.0 1.8 0.7 7.9 0.9 1.4 1.0 0.8 100.0 11.1 9.1 13,363 Female 62.8 16.4 5.3 1.3 0.7 9.3 0.9 1.5 1.0 0.9 100.0 12.7 9.4 13,324 Residence Urban 59.1 19.1 4.3 2.6 0.8 8.8 0.9 2.2 1.2 0.9 100.0 13.1 9.5 3,996 Rural 63.9 16.3 5.3 1.3 0.7 8.5 0.9 1.4 0.9 0.8 100.0 11.7 9.2 22,692 Province City of Kigali 63.7 17.3 3.9 2.5 0.7 7.8 0.6 2.0 0.9 0.6 100.0 11.3 8.1 2,566 South 59.4 18.9 5.5 1.6 0.7 9.3 1.1 1.5 1.2 0.9 100.0 13.1 10.1 6,442 West 66.4 15.1 5.3 1.0 0.9 7.3 0.8 1.4 1.0 0.9 100.0 10.6 9.5 6,280 North 66.0 14.1 5.4 0.9 0.7 9.4 0.7 1.2 1.0 0.7 100.0 12.2 8.9 4,439 East 61.7 17.6 5.2 2.1 0.5 8.8 0.9 1.5 0.7 0.9 100.0 12.0 9.0 6,961 Wealth quintile Lowest 51.4 26.3 8.4 1.6 0.7 7.8 0.8 1.1 1.0 1.0 100.0 10.6 12.1 5,653 Second 63.4 16.6 5.7 1.3 0.5 8.3 1.0 1.2 1.1 0.9 100.0 11.6 9.5 5,486 Middle 69.3 13.2 5.1 1.2 0.7 7.2 0.6 1.2 0.8 0.8 100.0 9.8 8.4 5,379 Fourth 70.1 11.9 3.2 1.4 0.7 9.0 0.9 1.4 0.7 0.6 100.0 12.0 7.0 5,384 Highest 62.2 14.8 3.0 2.3 0.9 10.9 1.1 2.8 1.3 0.8 100.0 16.1 9.2 4,786 Total <15 65.3 17.5 4.2 1.5 0.6 7.9 0.7 1.0 0.6 0.7 100.0 10.2 7.2 23,327 Total <18 63.2 16.7 5.2 1.5 0.7 8.6 0.9 1.5 1.0 0.8 100.0 11.9 9.3 26,688 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent 2.8 SCHOOL ATTENDANCE BY SURVIVORSHIP OF PARENTS Access to education is considered an “essential service” and is included among the key components of national responses to guarantee orphans access to services on an equal basis with other children. To assess whether orphans are educationally disadvantaged in relation to other children, an indicator was devised to compare school attendance among orphans and non-orphans. The results are presented in Table 2.13 for children age 10 to 14, the age group in which school attendance is generally assumed for all children. The data show a clear relationship between parent survivorship and school attendance among children age 10 to 14. Although 95 percent of children whose parents are both alive and who are living with one of their parents attend school, only 83 percent of children who have lost both parents attend school. The ratio of school attendance for orphaned and non-orphaned children is less than 1 (0.88), indicating an educational disadvantage for orphans. 30 • Household Characteristics Table 2.13 School attendance by survivorship of parents For de jure children age 10-14, the percentage attending school by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Rwanda 2014-15 Percentage attending school by survivorship of parents Background characteristic Both parents deceased Number Both parents alive and living with at least one parent Number Ratio1 Sex Male 77.1 47 93.8 2,763 0.82 Female (90.5) 42 95.8 2,637 (0.95) Residence Urban * 12 97.8 750 * Rural 81.0 78 94.3 4,649 0.86 Province City of Kigali * 5 97.0 436 * South (79.0) 30 94.5 1,280 (0.84) West * 22 95.8 1,314 * North * 19 95.5 1,010 * East * 13 92.8 1,360 * Wealth quintile Lowest (87.0) 24 89.0 970 (0.98) Second (87.3) 26 92.7 1,000 (0.94) Middle * 12 95.3 1,190 * Fourth * 13 97.0 1,254 * Highest * 15 99.2 985 * Total 83.4 89 94.8 5,400 0.88 Note: Table is based only on children who usually live in the household. 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 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 2.9 HEALTH INSURANCE COVERAGE AND BANK ACCOUNTS Information on bank accounts and health insurance coverage was collected during the survey. The proportion of households in which at least one person has a bank account and health insurance coverage is shown in Table 2.14 by type of health insurance, urban-rural residence, province, and household wealth quintile. Forty-six percent of Rwandan households have at least one member with a bank account. This proportion is higher among households in urban areas (67 percent), City of Kigali (64 percent), and the highest wealth quintile (81 percent) than other households. Overall, 79 percent of Rwandan households have at least one member covered by health insurance. This proportion is similar to that found in the 2010 RDHS (78 percent). There is slight variation by residence (81 percent in urban areas and 78 percent in rural areas). There are considerable differences by province, with proportions varying from a low of 76 percent in South to a high of 84 percent in North. Households in the higher wealth quintiles are generally more likely to have at least one member insured than those in the lower wealth quintiles. With respect to type of health insurance coverage, nearly all households with at least one member insured are insured by Mutual Health Insurance (97 percent). Other types of coverage reported by households include La Rwandaise d’Assurance Maladie (RAMA; now the Rwanda Social Security Board, or RSSB) (6 percent), Military Medical Insurance (MMI) (1 percent), and private insurance (1 percent). These other types Household Characteristics • 31 of insurance are more commonly reported by households in urban areas, the City of Kigali, and the highest wealth quintile. Table 2.14 Household bank account and health insurance Percentage of households in which at least one member has a bank account and is covered by health insurance, and percentage of households with specific types of health insurance, according to residence, province, and wealth quintile, Rwanda 2014-15 Percentage of households with at least one member who has a bank account Percentage of households with at least one member covered by health insurance Number of households Type of insurance Residence/region Mutual/ community RAMA (RSSB) MMI Private/ commercial Other Number of households with at least one member covered by health insurance Residence Urban 66.5 81.4 2,188 93.1 14.1 2.5 4.2 1.5 1,780 Rural 41.8 78.2 10,511 97.9 3.7 0.5 0.2 0.1 8,218 Province City of Kigali 64.2 77.4 1,496 93.5 11.2 2.7 5.0 1.5 1,158 South 45.6 76.2 3,103 98.0 5.0 0.5 0.6 0.2 2,365 West 41.2 78.1 2,789 96.9 5.4 0.7 0.3 0.1 2,179 North 41.7 84.4 2,090 97.5 5.0 0.6 0.4 0.3 1,764 East 45.2 78.6 3,221 97.7 3.9 0.8 0.2 0.1 2,532 Wealth quintile Lowest 11.7 63.5 2,920 99.3 0.1 0.0 0.0 0.1 1,855 Second 32.4 75.0 2,636 99.5 0.5 0.1 0.0 0.0 1,978 Middle 48.0 82.4 2,441 98.6 1.8 0.4 0.1 0.1 2,010 Fourth 66.7 87.8 2,290 96.7 5.2 1.2 0.4 0.1 2,010 Highest 81.2 88.9 2,412 91.8 18.7 2.7 3.8 1.3 2,145 Total 46.1 78.7 12,699 97.1 5.5 0.9 0.9 0.3 9,998 Information about individual health insurance coverage is presented in Table 2.15 by type of insurance, according to selected background characteristics. Overall, 74 percent of women and 73 percent of men age 15-49 are insured. Women age 15-19 (72 percent) and 45-49 (71 percent) and men age 15-19 (70 percent) are slightly less likely to be insured than other women and men. According to marital status, currently married women (79 percent) and men (80 percent) are more likely to be insured than women and men in other categories, particularly those who are divorced or separated. Women and men in North have higher levels of coverage than those in the other provinces. There is no variation by urban-rural residence among men. However, urban women are more likely to have coverage than rural women (78 percent versus 73 percent). Among women, the proportion with insurance increases with increasing education; from 66 percent among those who have no education to 85 percent among those who have a secondary education or higher. The corresponding figures among men are 62 percent and 85 percent. Women and men in the higher wealth quintiles are more likely to have health insurance than those in the lower wealth quintiles. For example 85 percent of women in the highest quintile are covered by health insurance as compared to 57 percent of those in the lowest quintile. In terms of type of health insurance coverage, 94 percent of both women and men are insured by Mutual Health Insurance. Other types of coverage reported are RAMA, MMI, and private insurance. These other types of insurance are more commonly reported by women and men who are married, live in urban areas, reside in the City of Kigali, have a secondary education or higher, and are in the highest wealth quintile. 32 • Household Characteristics Table 2.15 Health insurance among adult women and men Percentage of women age 15-49 and men age 15-59 covered by health insurance, and percent distribution of respondents with specific types of health insurance, according to selected background characteristics, Rwanda 2014-15 Percentage of respondents covered by health insurance Number of respondents Type of insurance Background characteristic Mutual/ community RAMA (RSSB) MMI Private/co mmercial Other Don’t know/missing Total Number of respondents covered by health insurance WOMEN Age 15-19 71.5 2,768 96.2 3.0 0.1 0.3 0.2 0.2 100.0 1,980 20-24 75.5 2,457 97.3 1.8 0.2 0.3 0.1 0.3 100.0 1,856 25-29 76.0 2,300 92.9 5.0 1.2 0.6 0.3 0.1 100.0 1,749 30-34 74.0 2,151 90.9 6.0 1.6 0.9 0.4 0.2 100.0 1,592 35-39 74.0 1,575 91.2 6.0 1.2 1.3 0.2 0.1 100.0 1,165 40-44 75.3 1,269 93.5 5.2 0.4 0.6 0.3 0.0 100.0 956 45-49 71.0 977 95.4 3.0 0.7 0.6 0.4 0.0 100.0 694 Marital status Never married 74.0 5,100 95.9 3.1 0.1 0.5 0.3 0.2 100.0 3,775 Married 79.2 4,655 89.3 7.5 1.7 1.1 0.3 0.0 100.0 3,688 Living together 67.5 2,327 98.5 0.6 0.3 0.1 0.2 0.3 100.0 1,571 Divorced/separated 64.2 842 98.7 0.6 0.2 0.2 0.0 0.3 100.0 541 Widowed 73.0 572 97.4 2.2 0.4 0.0 0.0 0.0 100.0 418 Residence Urban 77.6 2,626 85.2 9.8 1.7 2.3 0.9 0.1 100.0 2,037 Rural 73.2 10,871 96.3 2.7 0.5 0.2 0.1 0.2 100.0 7,955 Province City of Kigali 73.9 1,799 87.5 7.3 1.7 2.6 0.8 0.1 100.0 1,329 South 70.9 3,214 94.4 3.9 0.6 0.6 0.3 0.3 100.0 2,280 West 71.5 2,965 94.4 4.5 0.7 0.3 0.1 0.1 100.0 2,120 North 80.7 2,211 95.5 3.4 0.5 0.2 0.3 0.1 100.0 1,783 East 75.0 3,308 96.1 2.9 0.7 0.2 0.0 0.2 100.0 2,480 Education No education 66.2 1,665 99.4 0.1 0.1 0.1 0.2 0.0 100.0 1,102 Primary 71.6 8,678 98.4 0.6 0.6 0.2 0.1 0.2 100.0 6,215 Secondary and higher 84.8 3,154 81.8 14.0 1.4 1.9 0.7 0.2 100.0 2,676 Wealth quintile Lowest 57.2 2,561 99.5 0.0 0.0 0.0 0.2 0.2 100.0 1,465 Second 67.7 2,631 99.5 0.2 0.1 0.0 0.0 0.2 100.0 1,782 Middle 75.8 2,597 98.3 1.3 0.2 0.0 0.0 0.2 100.0 1,968 Fourth 82.4 2,634 95.7 2.8 1.1 0.3 0.0 0.1 100.0 2,172 Highest 84.8 3,073 82.8 12.5 1.8 2.1 0.8 0.1 100.0 2,605 Total 15-49 74.0 13,497 94.1 4.2 0.7 0.6 0.2 0.2 100.0 9,992 Continued… Household Characteristics • 33 Table 2.15—Continued Percentage of respondents covered by health insurance Number of respondents Type of insurance Background characteristic Mutual/ community RAMA (RSSB) MMI Private/co mmercial Other Don’t know/missing Total Number of respondents covered by health insurance MEN Age 15-19 70.3 1,282 96.8 2.6 0.3 0.1 0.2 0.0 100.0 901 20-24 71.5 994 97.0 0.9 0.3 0.5 1.1 0.3 100.0 711 25-29 75.7 946 92.1 6.8 0.0 0.7 0.2 0.2 100.0 716 30-34 75.0 930 92.2 6.4 0.5 0.9 0.0 0.1 100.0 697 35-39 73.6 567 90.4 6.2 1.1 1.9 0.5 0.0 100.0 418 40-44 72.1 473 89.7 7.1 1.0 1.6 0.7 0.0 100.0 341 45-49 72.5 385 92.8 5.3 0.3 1.1 0.4 0.0 100.0 279 Marital status Never married 72.1 2,691 94.2 4.2 0.2 0.7 0.5 0.2 100.0 1,941 Married 80.1 1,833 91.0 6.8 0.7 1.2 0.3 0.1 100.0 1,469 Living together 63.4 959 98.4 0.8 0.5 0.2 0.2 0.0 100.0 608 Divorced/separated 42.1 79 93.1 3.8 0.0 3.1 0.0 0.0 100.0 33 Widowed 70.4 16 100.0 0.0 0.0 0.0 0.0 0.0 100.0 11 Residence Urban 73.1 1,169 84.6 9.0 1.4 3.1 1.7 0.1 100.0 855 Rural 72.8 4,408 96.1 3.4 0.1 0.2 0.0 0.1 100.0 3,208 Province City of Kigali 68.8 804 84.9 7.1 1.6 4.1 2.1 0.2 100.0 554 South 70.7 1,327 94.2 4.9 0.0 0.4 0.2 0.3 100.0 939 West 73.2 1,182 95.3 4.0 0.5 0.2 0.0 0.0 100.0 865 North 79.4 851 95.7 3.5 0.1 0.4 0.4 0.0 100.0 676 East 72.8 1,413 95.2 4.3 0.3 0.2 0.0 0.0 100.0 1,029 Education No education 61.9 496 99.6 0.0 0.0 0.0 0.4 0.0 100.0 307 Primary 69.7 3,636 99.2 0.3 0.1 0.2 0.2 0.1 100.0 2,534 Secondary and higher 84.5 1,445 80.8 14.6 1.2 2.3 0.9 0.2 100.0 1,222 Wealth quintile Lowest 53.5 819 99.5 0.0 0.0 0.0 0.3 0.2 100.0 438 Second 67.6 991 99.7 0.2 0.1 0.0 0.0 0.0 100.0 670 Middle 75.3 1,097 98.7 1.1 0.0 0.1 0.0 0.1 100.0 826 Fourth 78.5 1,234 95.9 3.4 0.1 0.4 0.0 0.1 100.0 969 Highest 80.8 1,436 82.6 12.5 1.2 2.4 1.3 0.1 100.0 1,159 Total 15-49 72.8 5,577 93.7 4.6 0.4 0.8 0.4 0.1 100.0 4,062 50-59 73.2 640 96.3 2.7 0.1 0.7 0.2 0.0 100.0 468 Total 15-59 72.9 6,217 94.0 4.4 0.4 0.8 0.4 0.1 100.0 4,531 Respondent Characteristics • 35 RESPONDENT CHARACTERISTICS 3 his chapter provides a sociodemographic profile of women age 15-49 and men age 15-59 who responded to the survey questions. The information that the women and men provided is important for understanding the behavior of the population with respect to contraception, sexually transmitted infections (STIs), HIV/AIDS, and fertility preferences. As with the Household Questionnaire, the individual questionnaire gathered information concerning the respondent’s age, place of residence, marital status, and educational attainment. In addition, the individual questionnaire collected data on literacy, exposure to mass media, employment and occupation, and on tobacco use. These characteristics are used to interpret findings elsewhere in the report. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Given the importance of age in analyzing demographic characteristics, special attention was paid to ensuring that this statistic was accurately recorded in the survey. Prior to recording any information, the interviewer asked respondents to gather all official documents with information about themselves and other members of the household. If no official documents were available, the interviewer confirmed the age provided by the respondent through reference to major life events (e.g., age at time of marriage, age of first child) or well-known national or regional events. Table 3.1 shows the distribution of women and men age 15-49 grouped by five-year age increments. The proportions in each age group decline with increasing age. Among women, the percentages range from a high of 21 percent for the 15-19 age group to a low of 7 percent for the 45-49 age group. The corresponding percentages among men are 23 percent and 7 percent. All women and men in the sample were asked their marital status. In the 2014-15 RDHS, all women and men were considered married if they were in a union with a partner, whether the union was formal (legally married) or informal (living together). According to this definition, Table 3.1 shows that nearly 2 in 5 women (38 percent) had never been married at the time of the survey, while slightly more than half of women were married (35 percent were legally married and 17 percent were living together with a man). In addition, 6 percent of women were divorced or separated, and 4 percent were widowed. Just under half (48 percent) of men age T Key Findings • Twelve percent of women and 9 percent of men age 15-49 have no education, while 23 percent and 26 percent, respectively, have at least some secondary education. • Eighty percent of women and 84 percent of men are literate. • Sixty-four percent of women and 81 percent of men age 15-49 are exposed to at least one source of mass media once a week. • Eighty-six percent of women and 87 percent of men were employed in the 12 months preceding the survey, with the majority (76 percent of women and 58 percent of men) employed in the agricultural sector. • Three in five working women are self-employed. • Only 2 percent of women and 10 percent of men age 15-49 use tobacco. products 36 • Respondent Characteristics 15-49 were single, while half were married (33 percent were legally married and 17 percent were living with a woman). One percent of men were separated or divorced, and less than 1 percent were widowed. The distribution of respondents by residence shows that the majority of women (81 percent) and men (79 percent) live in rural areas. Similarly, the distribution of respondents by province shows no significant disparities between women and men. The City of Kigali has the lowest proportion of respondents (13 percent of women and 14 percent of men), followed by North (16 percent of women and 15 percent of men). One-quarter of women and men live in East. Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Rwanda 2014-15 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 20.5 2,768 2,779 23.0 1,282 1,281 20-24 18.2 2,457 2,473 17.8 994 999 25-29 17.0 2,300 2,319 17.0 946 964 30-34 15.9 2,151 2,155 16.7 930 932 35-39 11.7 1,575 1,570 10.2 567 559 40-44 9.4 1,269 1,249 8.5 473 469 45-49 7.2 977 952 6.9 385 381 Religion Catholic 39.8 5,377 5,426 44.6 2,488 2,503 Protestant 45.1 6,084 5,971 38.3 2,135 2,107 Adventist 11.9 1,601 1,626 11.5 641 656 Muslim 2.0 267 303 3.0 168 180 Jehovah’s Witness 0.7 97 99 0.8 46 46 Traditional 0.0 5 3 0.0 0 0 Other 0.0 5 5 0.0 1 1 No religion 0.3 46 49 1.7 94 88 Missing 0.1 16 15 0.1 5 4 Marital status Never married 37.8 5,100 5,205 48.2 2,691 2,736 Married 34.5 4,655 4,611 32.9 1,833 1,817 Living together 17.2 2,327 2,279 17.2 959 937 Divorced/separated 6.2 842 838 1.4 79 80 Widowed 4.2 572 564 0.3 16 15 Residence Urban 19.5 2,626 3,427 21.0 1,169 1,507 Rural 80.5 10,871 10,070 79.0 4,408 4,078 Province City of Kigali 13.3 1,799 1,876 14.4 804 823 South 23.8 3,214 3,435 23.8 1,327 1,441 West 22.0 2,965 3,060 21.2 1,182 1,209 North 16.4 2,211 2,170 15.3 851 830 East 24.5 3,308 2,956 25.3 1,413 1,282 Education No education 12.3 1,665 1,600 8.9 496 487 Primary 64.3 8,678 8,509 65.2 3,636 3,565 Secondary and higher 23.4 3,154 3,388 25.9 1,445 1,533 Wealth quintile Lowest 19.0 2,561 2,523 14.7 819 807 Second 19.5 2,631 2,516 17.8 991 956 Middle 19.2 2,597 2,461 19.7 1,097 1,034 Fourth 19.5 2,634 2,523 22.1 1,234 1,188 Highest 22.8 3,073 3,474 25.7 1,436 1,600 Total 15-49 100.0 13,497 13,497 100.0 5,577 5,585 50-59 na na na na 640 632 Total 15-59 na na na na 6,217 6,217 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Respondent Characteristics • 37 The distribution of respondents by religion indicates that almost half of women are Protestant (45 percent), while 40 percent are Catholic. Among men, 45 percent are Catholic and 38 percent are Protestant. The Adventist faith is the next most common religion among both sexes (12 percent), followed by Muslim (2 percent of women and 3 percent of men). Table 3.1 also shows the distribution of women and men according to household wealth quintile. The development of the wealth index is explained in Chapter 2. Table 3.1 also provides data on educational attainment. Women are more likely than men to have no education (12 percent versus 9 percent) and less likely to have a secondary education or higher (23 percent versus 26 percent). However, the gap between women and men is not wide at the primary level. 3.2 EDUCATIONAL ATTAINMENT Tables 3.2.1 and 3.2.2 show the distributions of female and male respondents by highest level of education attained. The proportion of women who either attended some primary schooling or completed primary school only is almost equal to that of men (64 percent and 65 percent, respectively). At the secondary level or higher, the proportions are 23 percent among women and 26 percent among men. The proportions for both women and men drop significantly from the primary to secondary and the secondary to postsecondary levels. The data by age show that the proportions of women and men with no education have decreased significantly in the younger generation. Among men, the proportion with no education is 21 percent in the 45-49 age group but only 2 percent in the 15-24 age group. The corresponding proportions among women are 36 percent and 3 percent. The gap between women and men with no education has narrowed significantly: among women and men age 45 to 49, the gap is about 15 percentage points, while among those age 15-19 the gap is so small as to be insignificant. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Rwanda 2014-15 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 2.6 42.0 16.0 32.1 5.9 1.3 100.0 5.3 5,225 15-19 1.1 41.7 17.2 38.6 1.2 0.1 100.0 5.3 2,768 20-24 4.4 42.3 14.7 24.7 11.2 2.7 100.0 5.2 2,457 25-29 10.6 53.1 16.4 6.8 7.8 5.3 100.0 3.9 2,300 30-34 16.5 50.5 20.1 5.1 3.8 4.0 100.0 3.6 2,151 35-39 17.2 37.4 33.1 7.1 3.2 2.2 100.0 4.5 1,575 40-44 24.3 32.0 35.2 3.6 2.2 2.7 100.0 4.1 1,269 45-49 35.8 26.9 30.8 3.9 0.6 1.9 100.0 2.6 977 Residence Urban 5.3 29.7 19.1 23.8 11.6 10.6 100.0 5.9 2,626 Rural 14.0 45.8 22.2 13.9 3.2 0.8 100.0 4.2 10,871 Province City of Kigali 4.3 30.6 21.9 22.1 11.3 9.7 100.0 5.8 1,799 South 11.5 45.0 23.0 14.8 3.8 1.9 100.0 4.5 3,214 West 15.1 44.4 18.9 15.3 4.5 1.8 100.0 4.3 2,965 North 11.4 43.3 23.6 16.3 4.0 1.5 100.0 4.6 2,211 East 15.7 45.1 21.2 13.5 3.3 1.3 100.0 4.1 3,308 Wealth quintile Lowest 23.2 55.6 14.5 5.9 0.8 0.0 100.0 2.7 2,561 Second 15.6 52.2 20.4 11.0 0.7 0.1 100.0 3.8 2,631 Middle 13.2 46.4 24.3 13.5 2.4 0.1 100.0 4.3 2,597 Fourth 7.5 38.0 27.8 21.0 4.8 0.9 100.0 5.2 2,634 Highest 3.9 24.6 21.0 25.7 13.9 10.9 100.0 6.6 3,073 Total 12.3 42.7 21.6 15.8 4.9 2.7 100.0 4.6 13,497 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school. 2 Completed 6th grade at the secondary level 38 • Respondent Characteristics In the 15-24 age group, the median number of years of school completed for young women and young men is about the same. In addition, 40 percent of young women age 15-19 have attended or completed secondary school, as compared with 35 percent of young men. Educational attainment varies by residence. The proportion of women and men with no education is higher in rural areas (14 percent for women and 10 percent for men) than in urban areas (5 percent for women and 4 percent for men). Results by province show a wide gap between the city of Kigali and the rest of the country. In Kigali, only 4 percent of women and men age 15-49 have no education, while the proportions in the other provinces vary from 11 percent (North) to 16 percent (East) among women and from 9 percent (North) to 11 percent (West) among men. The data show a positive relationship between educational attainment and household wealth: the proportions of women and men with no education decrease as household wealth increases. Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Rwanda 2014-15 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 2.4 46.2 13.4 29.9 5.8 2.2 100.0 5.1 2,276 15-19 1.5 51.2 12.1 34.2 1.0 0.1 100.0 4.8 1,282 20-24 3.7 39.7 15.1 24.3 12.1 5.1 100.0 5.4 994 25-29 8.1 49.0 15.9 8.5 9.8 8.6 100.0 4.5 946 30-34 14.3 50.2 21.2 4.5 3.7 6.1 100.0 4.0 930 35-39 12.9 35.6 38.4 4.6 3.9 4.6 100.0 5.1 567 40-44 16.1 34.9 33.5 8.0 3.7 3.7 100.0 4.9 473 45-49 21.2 27.0 40.1 4.7 3.2 3.9 100.0 5.1 385 Residence Urban 4.2 30.2 19.2 20.9 12.2 13.3 100.0 5.9 1,169 Rural 10.1 47.6 21.8 14.5 3.8 2.1 100.0 4.4 4,408 Province City of Kigali 4.1 31.9 23.2 16.1 12.2 12.5 100.0 5.7 804 South 9.1 46.7 21.7 14.9 4.1 3.5 100.0 4.5 1,327 West 11.3 44.4 18.8 17.3 5.3 2.9 100.0 4.6 1,182 North 8.6 44.0 25.6 14.5 4.5 2.8 100.0 4.8 851 East 9.6 48.0 19.0 16.3 4.1 3.1 100.0 4.4 1,413 Wealth quintile Lowest 19.7 60.2 12.0 7.5 0.6 0.0 100.0 2.8 819 Second 12.1 54.3 21.8 10.3 1.4 0.1 100.0 3.9 991 Middle 8.7 48.3 24.5 14.4 3.5 0.6 100.0 4.5 1,097 Fourth 5.7 42.4 24.5 18.9 5.2 3.4 100.0 5.1 1,234 Highest 3.4 25.7 20.8 23.1 13.2 13.9 100.0 6.3 1,436 Total 15-49 8.9 44.0 21.2 15.9 5.6 4.5 100.0 4.8 5,577 50-59 28.1 39.4 25.5 3.1 2.1 1.8 100.0 2.7 640 Total 15-59 10.9 43.5 21.7 14.6 5.2 4.2 100.0 4.6 6,217 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school. 2 Completed 6th grade at the secondary level 3.3 LITERACY In this survey, literacy was established by asking respondents who reported not having attended school or having attended only primary school to read a sentence in any language of his/her choice (Kinyarwanda, French, English and Swahili) that was presented to them. Respondents were then classified into one of the following three levels: cannot read at all, can read part of a sentence, or can read a whole sentence. The test was Respondent Characteristics • 39 given only to women and men who had less than a secondary education; those with a secondary or postsecondary education (23 percent of women and 26 percent of men) were considered literate and not in need of testing. Tables 3.3.1 and 3.3.2 show that the proportion of women and men who cannot read at all has decreased from previous generations, especially among women. For women, this proportion drops from 39 percent in the 45-49 age group to 9 percent in the 15-19 age group. For men, the proportion decreases from 19 percent to 12 percent. The data show also that a higher proportion of women than men cannot read (20 percent of women and 16 percent of men). Eighty percent of women and 84 percent of men are considered literate; that is, they have attended secondary school or, if they have attended only primary school or not attended school, they are able to read all or part of a sentence. The level of literacy varies appreciably by residence. Literacy is higher in urban areas than in rural areas (91 percent versus 78 percent among women and 91 percent versus 82 percent among men). The results by province show a gap between the City of Kigali and the rest of the country: in Kigali, 92 percent of women and men are literate. In the other provinces, the proportion varies from 76 percent (East) to 80 percent (North and South) among women and from 81 percent (South and West) to 85 percent (North and East) among men. Results according to wealth show that literacy levels increase considerably from the poorest to the richest quintile (from 62 percent to 93 percent among women and from 68 percent to 93 percent among men). Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Rwanda 2014-15 Secondary school or higher No schooling or primary school Total Percent- age literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Age 15-24 39.3 43.7 5.9 10.8 0.0 0.0 0.2 100.0 88.9 5,225 15-19 40.0 44.9 5.8 9.2 0.0 0.0 0.1 100.0 90.7 2,768 20-24 38.6 42.4 6.0 12.7 0.0 0.0 0.3 100.0 86.9 2,457 25-29 19.8 50.9 8.8 20.3 0.1 0.0 0.1 100.0 79.5 2,300 30-34 12.9 53.5 8.5 25.0 0.0 0.0 0.1 100.0 74.9 2,151 35-39 12.4 57.8 8.7 21.0 0.0 0.0 0.1 100.0 78.9 1,575 40-44 8.5 56.0 7.3 27.9 0.0 0.3 0.0 100.0 71.8 1,269 45-49 6.4 44.4 9.3 39.3 0.0 0.5 0.1 100.0 60.1 977 Residence Urban 45.9 40.6 4.6 8.8 0.0 0.0 0.1 100.0 91.1 2,626 Rural 17.9 51.5 8.2 22.2 0.0 0.1 0.1 100.0 77.6 10,871 Province City of Kigali 43.2 44.9 4.1 7.7 0.0 0.0 0.1 100.0 92.1 1,799 South 20.4 53.4 6.1 19.9 0.0 0.1 0.0 100.0 79.9 3,214 West 21.7 48.4 7.8 22.0 0.0 0.0 0.1 100.0 77.9 2,965 North 21.8 47.4 10.7 19.6 0.2 0.2 0.2 100.0 79.9 2,211 East 18.0 50.0 8.3 23.5 0.0 0.1 0.2 100.0 76.3 3,308 Wealth quintile Lowest 6.8 45.2 10.4 37.4 0.1 0.1 0.1 100.0 62.4 2,561 Second 11.8 54.2 9.0 24.8 0.0 0.1 0.1 100.0 75.0 2,631 Middle 16.0 56.4 7.7 19.5 0.0 0.2 0.2 100.0 80.1 2,597 Fourth 26.7 53.6 7.4 12.0 0.0 0.1 0.1 100.0 87.7 2,634 Highest 50.5 39.1 3.6 6.7 0.0 0.0 0.1 100.0 93.2 3,073 Total 23.4 49.3 7.5 19.6 0.0 0.1 0.1 100.0 80.2 13,497 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 40 • Respondent Characteristics Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Rwanda 2014-15 Secondary school or higher No schooling or primary school Total Percent- age literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Age 15-24 38.0 42.1 7.6 12.0 0.0 0.0 0.3 100.0 87.7 2,276 15-19 35.2 44.0 8.3 12.1 0.0 0.0 0.3 100.0 87.6 1,282 20-24 41.5 39.7 6.6 11.9 0.0 0.0 0.2 100.0 87.8 994 25-29 27.0 48.3 8.3 16.4 0.0 0.0 0.0 100.0 83.6 946 30-34 14.3 54.7 9.4 21.5 0.0 0.0 0.1 100.0 78.4 930 35-39 13.1 62.7 7.2 16.6 0.1 0.0 0.3 100.0 83.0 567 40-44 15.5 59.5 7.8 17.2 0.0 0.0 0.0 100.0 82.8 473 45-49 11.7 60.9 8.2 19.0 0.0 0.2 0.0 100.0 80.8 385 Residence Urban 46.5 38.1 6.4 8.8 0.1 0.1 0.1 100.0 91.0 1,169 Rural 20.5 53.3 8.4 17.6 0.0 0.0 0.2 100.0 82.3 4,408 Province City of Kigali 40.8 44.7 6.8 7.1 0.1 0.1 0.3 100.0 92.4 804 South 22.5 49.8 8.2 19.4 0.0 0.0 0.1 100.0 80.5 1,327 West 25.5 45.4 10.1 18.9 0.0 0.0 0.2 100.0 80.9 1,182 North 21.8 54.5 8.4 15.1 0.0 0.0 0.1 100.0 84.8 851 East 23.5 54.9 6.5 15.0 0.0 0.0 0.1 100.0 84.9 1,413 Wealth quintile Lowest 8.1 44.9 14.6 32.3 0.0 0.0 0.0 100.0 67.7 819 Second 11.8 58.5 9.7 19.9 0.0 0.0 0.1 100.0 80.0 991 Middle 18.5 58.5 6.9 16.0 0.0 0.0 0.1 100.0 84.0 1,097 Fourth 27.5 54.2 6.6 11.5 0.0 0.0 0.2 100.0 88.3 1,234 Highest 50.1 37.5 5.1 6.9 0.0 0.1 0.2 100.0 92.7 1,436 Total 15-49 25.9 50.1 8.0 15.7 0.0 0.0 0.1 100.0 84.1 5,577 50-59 7.0 53.9 7.3 31.1 0.0 0.5 0.1 100.0 68.2 640 Total 15-59 24.0 50.5 8.0 17.3 0.0 0.1 0.1 100.0 82.4 6,217 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 EXPOSURE TO MASS MEDIA Data on the exposure of women and men to mass media are especially important to the development of education programs and the dissemination of all types of information, particularly information about health and family planning. Tables 3.4.1 and 3.4.2 present data on the exposure of women and men to mass media (print or broadcast). It should be stated at the outset that it is not necessary for a household to own a radio or television or to buy a newspaper to have access to these media, because many people listen to the radio or watch television at the homes of friends and neighbors. Respondent Characteristics • 41 Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Rwanda 2014-15 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 9.6 21.3 67.4 3.4 29.1 2,768 20-24 6.5 19.9 66.3 3.0 31.3 2,457 25-29 4.9 14.6 61.1 2.1 36.7 2,300 30-34 4.4 14.9 59.2 2.1 38.9 2,151 35-39 5.1 12.6 57.4 2.3 41.3 1,575 40-44 4.7 10.9 56.0 1.3 42.3 1,269 45-49 4.1 8.8 53.5 1.7 44.9 977 Residence Urban 10.4 51.0 76.9 7.6 17.8 2,626 Rural 5.0 7.5 57.9 1.2 40.6 10,871 Province City of Kigali 9.8 52.1 80.6 7.1 14.4 1,799 South 6.1 10.8 63.5 2.0 35.2 3,214 West 4.6 9.5 52.3 1.2 45.3 2,965 North 5.6 12.0 62.9 2.2 35.5 2,211 East 5.4 9.9 56.8 1.6 41.2 3,308 Education No education 0.3 3.0 40.9 0.0 58.3 1,665 Primary 3.6 10.8 58.5 0.6 39.5 8,678 Secondary and higher 15.6 37.1 81.1 8.8 15.2 3,154 Wealth quintile Lowest 2.8 3.4 28.5 0.4 69.4 2,561 Second 3.2 3.2 50.1 0.3 48.6 2,631 Middle 4.3 3.9 62.9 0.5 35.5 2,597 Fourth 6.5 8.7 78.0 1.2 21.1 2,634 Highest 12.2 53.9 83.7 8.8 11.3 3,073 Total 6.0 16.0 61.6 2.4 36.2 13,497 Tables 3.4.1 and 3.4.2 show that, at the national level, 36 percent of women and 20 percent of men are not exposed to any media, a moderate increase from the 2010 RDHS figures of 31 percent and 12 percent, respectively. Radio is the most common form of media exposure: 62 percent of women and 79 percent of men report listening to the radio at least once a week. Men watch television more frequently than women: 16 percent of women and 30 percent of men watch television at least once a week. Only 6 percent of women, as compared with 14 percent of men, report reading a newspaper at least once a week. The proportions of women and men who are exposed to all three media are very low (2 percent and 10 percent, respectively). The data by age show that younger women receive relatively more exposure to mass media than older women. The proportions of women who are not exposed to any media vary from 29 percent among those age 15-19 to 45 percent among those age 45-49. Among men, age differences are narrow and uneven. 42 • Respondent Characteristics Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Rwanda 2014-15 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 9.9 28.9 75.8 6.4 22.1 1,282 20-24 18.1 37.1 83.9 12.9 14.2 994 25-29 17.2 33.9 83.0 12.2 15.6 946 30-34 13.9 27.3 76.7 9.3 21.9 930 35-39 14.4 27.5 77.3 10.3 21.6 567 40-44 16.6 24.7 80.8 10.5 18.3 473 45-49 11.9 24.1 77.9 7.8 20.9 385 Residence Urban 32.1 61.7 88.4 26.5 8.9 1,169 Rural 9.7 21.7 76.9 5.5 21.8 4,408 Province City of Kigali 38.0 65.2 90.1 32.4 7.1 804 South 6.2 15.7 70.9 3.8 27.9 1,327 West 8.6 21.5 73.5 4.4 24.8 1,182 North 8.2 24.2 83.1 3.9 16.3 851 East 17.3 34.5 83.7 10.9 14.6 1,413 Education No education 0.0 12.9 62.2 0.0 36.8 496 Primary 8.9 24.8 77.5 5.7 21.2 3,636 Secondary and higher 33.4 49.3 89.8 23.8 7.9 1,445 Wealth quintile Lowest 3.9 14.9 55.4 1.9 43.0 819 Second 5.1 15.3 70.6 2.3 28.3 991 Middle 8.3 16.9 78.6 4.2 20.1 1,097 Fourth 15.3 28.1 87.8 9.1 10.9 1,234 Highest 30.8 60.8 92.3 24.6 5.4 1,436 Total 15-49 14.4 30.1 79.3 9.9 19.1 5,577 50-59 9.0 17.3 75.7 4.8 23.2 640 Total 15-59 13.9 28.8 79.0 9.3 19.5 6,217 Results by residence reveal significant differentials. In urban areas, 18 percent of women are not exposed to any media, as compared with 41 percent in rural areas. The differential is also wide among men: the proportion of men not exposed to any media varies from 9 percent in urban areas to 22 percent in rural areas. Results by province show significant differences between City of Kigali and other provinces: the percentage of women who are not exposed to any media is 14 percent in City of Kigali; while in other provinces this proportion varies from 35 percent (South) to 45 percent (West). Among men, the proportion is 7 percent in the city of Kigali, while it varies from 15 percent (East) to 28 percent (South) in other provinces. Educational attainment has a considerable correlation with level of media exposure. Among both women and men, those who have no education are least likely to be exposed to all three media. The results show that 58 percent of women with no education are not exposed to any media, as compared with 15 percent of women with a secondary education or higher. Among men, 37 percent of those with no education are not exposed to any media, compared with only 8 percent of those with a secondary education or higher. As in the case of educational attainment, there is a positive relationship between household wealth and media exposure. Women and men in the richest households have the highest levels of exposure to all three media: 9 percent of women and 25 percent of men. In contrast, less than 1 percent of women and 2 percent of men in the poorest households have access to all three media. Respondent Characteristics • 43 3.5 EMPLOYMENT The 2014-15 RDHS asked both women and men whether they were employed at the time of the survey. Respondents who reported having held a job, paid or unpaid, in any sector during the 12 months preceding the survey were considered employed. Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Rwanda 2014-15 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 52.5 9.2 38.0 0.2 100.0 2,768 20-24 73.1 9.5 17.4 0.0 100.0 2,457 25-29 85.3 7.4 7.3 0.0 100.0 2,300 30-34 87.6 7.1 5.3 0.0 100.0 2,151 35-39 88.8 7.2 4.0 0.0 100.0 1,575 40-44 88.9 6.9 4.2 0.0 100.0 1,269 45-49 88.0 7.6 4.4 0.0 100.0 977 Marital status Never married 62.3 8.9 28.6 0.1 100.0 5,100 Married or living together 86.7 7.5 5.8 0.0 100.0 6,982 Divorced/separated/widowed 88.2 7.6 4.2 0.0 100.0 1,415 Number of living children 0 60.8 8.9 30.1 0.1 100.0 4,754 1-2 84.8 8.0 7.2 0.0 100.0 4,007 3-4 88.4 7.6 4.1 0.0 100.0 2,894 5+ 88.7 6.6 4.8 0.0 100.0 1,842 Residence Urban 63.7 8.9 27.3 0.1 100.0 2,626 Rural 81.0 7.8 11.1 0.0 100.0 10,871 Province City of Kigali 64.9 10.3 24.8 0.0 100.0 1,799 South 81.8 7.0 11.1 0.1 100.0 3,214 West 76.9 4.6 18.5 0.0 100.0 2,965 North 80.2 8.9 10.9 0.0 100.0 2,211 East 79.6 10.3 10.0 0.0 100.0 3,308 Education No education 86.3 7.2 6.5 0.0 100.0 1,665 Primary 83.1 8.0 8.9 0.0 100.0 8,678 Secondary and higher 58.2 8.5 33.1 0.1 100.0 3,154 Wealth quintile Lowest 82.8 8.2 9.1 0.0 100.0 2,561 Second 84.0 6.5 9.5 0.0 100.0 2,631 Middle 81.1 8.5 10.4 0.0 100.0 2,597 Fourth 78.6 7.5 13.9 0.1 100.0 2,634 Highest 64.3 9.4 26.2 0.1 100.0 3,073 Total 77.7 8.0 14.2 0.0 100.0 13,497 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Table 3.5.1 shows that 78 percent of women were employed in the seven days before the survey, while 8 percent were not currently employed but had worked sometime in the previous 12 months and 14 percent had not been employed in the preceding 12 months. The percentage of women working at the time of the survey increases steadily with age, from 53 percent at age 15-19 to 73 percent at age 20-24, 85 percent at age 25-29, and 88-89 percent at age 30-49. Women who were separated, divorced, or widowed (88 percent) and married women (87 percent) were more likely to be employed at the time of the survey than women who had never been married (62 percent). Number of children is also related to a woman’s employment status. As number of children 44 • Respondent Characteristics increases, the proportion of women who work also increases, from 61 percent among those with no children to 89 percent for those with five children or more. Data by residence show that rural women were more likely to be working at the time of the survey (81 percent) than urban women (64 percent). The city of Kigali has the lowest percentage of women who are working (65 percent). In other provinces, the proportion of currently employed women ranges from 77 percent in West to 82 percent in South. Results by educational attainment show that women with no education (86 percent) are more likely to be employed than women with a primary education only (83 percent) and those with a secondary education or higher (58 percent). Finally, women in households in the two poorest wealth quintiles are more likely to be employed (83-84 percent) than women in the richest households (64 percent). Table 3.5.2 shows that 85 percent of men age 15-49 were employed in the seven days before the survey, while 2 percent were not currently employed but had worked sometime in the last 12 months and 13 percent had not been employed in the preceding 12 months As with women, the percentage of men working at the time of the survey increases with age, from 57 percent among those age 15-19 to 96-98 percent among those age 25 to 49. Currently married men are more likely to be working (98 percent) than separated, divorced, or widowed men (96 percent) and those who have never been married (71 percent). With respect to residence, men in rural areas (86 percent) were more likely to have been working at the time of the survey than men in urban areas (80 percent). By province, the data show that City of Kigali had the lowest proportion of men who were working at the time of the survey (82 percent); the highest proportions were reported in North and South (87 percent each). Men with no education (97 percent) were more likely to be employed than men with a primary education (91 percent) and men with a secondary education or higher (65 percent). Finally, similar to findings among women, the proportion of men who were working was lower in the richest households than in the poorest households (80 percent versus 90 percent). The proportion of men who were working at the time of the survey exceeded the proportion of women who were working in all categories of background characteristics. Since 2010, the proportion of women working at the time of the survey has increased from 73 percent to 78 percent, while the proportion among men has slightly decreased from 90 percent to 85 percent. As can be seen, in both 2010 and 2014-15, women were less likely than men to be working at the time of the survey. Respondent Characteristics • 45 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Rwanda 2014-15 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 56.8 1.7 41.0 0.5 100.0 1,282 20-24 80.7 2.2 16.9 0.2 100.0 994 25-29 96.1 1.2 2.7 0.0 100.0 946 30-34 97.2 1.3 1.5 0.0 100.0 930 35-39 98.3 1.1 0.6 0.0 100.0 567 40-44 98.1 1.5 0.3 0.0 100.0 473 45-49 97.2 2.2 0.6 0.0 100.0 385 Marital status Never married 70.7 1.9 27.0 0.3 100.0 2,691 Married or living together 98.3 1.3 0.4 0.0 100.0 2,792 Divorced/separated/widowed 95.5 2.4 2.2 0.0 100.0 94 Number of living children 0 71.7 1.9 26.2 0.3 100.0 2,760 1-2 97.7 1.2 1.2 0.0 100.0 1,288 3-4 98.3 1.6 0.1 0.0 100.0 912 5+ 98.2 1.5 0.3 0.0 100.0 617 Residence Urban 79.7 1.8 18.4 0.1 100.0 1,169 Rural 86.4 1.6 11.9 0.1 100.0 4,408 Province City of Kigali 81.8 1.2 16.9 0.0 100.0 804 South 86.6 1.0 11.9 0.5 100.0 1,327 West 83.6 2.2 14.2 0.0 100.0 1,182 North 86.9 1.1 12.0 0.0 100.0 851 East 85.2 2.2 12.5 0.1 100.0 1,413 Education No education 96.8 2.2 1.1 0.0 100.0 496 Primary 91.2 1.4 7.3 0.1 100.0 3,636 Secondary and higher 65.2 2.0 32.4 0.4 100.0 1,445 Wealth quintile Lowest 89.9 2.1 7.9 0.0 100.0 819 Second 90.9 0.7 8.2 0.2 100.0 991 Middle 85.6 2.9 11.4 0.2 100.0 1,097 Fourth 82.5 1.1 16.3 0.1 100.0 1,234 Highest 79.8 1.4 18.7 0.1 100.0 1,436 Total 15-49 85.0 1.6 13.3 0.1 100.0 5,577 50-59 95.7 1.7 2.6 0.0 100.0 640 Total 15-59 86.1 1.6 12.2 0.1 100.0 6,217 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Table 3.6.1 shows information on women’s occupations. The majority of women who were employed at the time of the survey or who had worked during the preceding 12 months were employed in agriculture (76 percent, as compared with 77 percent in 2010). In terms of other occupations, 11 percent of working women worked in sales and services, 4 percent worked in domestic services, 3 percent performed skilled manual labor and 2 percent performed unskilled manual labor. Only 3 percent reported working in a technical, professional, or managerial occupation. Results by age show that older women are more likely to work in agriculture than younger women (87 percent of those age 45-49 and 72 percent of those age 15-19). As expected, data by residence show that the proportion of women working in agriculture is higher in rural areas (87 percent) than in urban areas (23 percent). Also, this proportion is much lower in the city of Kigali (24 percent) than in other provinces, where the proportion of employed women working in agriculture varies from 80 percent (West) to 87 percent (East). With respect to educational attainment, 91 percent of women with no education and 81 percent of women with only a primary education work in agriculture, as compared with 45 percent of women with a 46 • Respondent Characteristics secondary education or higher. The proportion of employed women who work in agriculture also decreases with increasing wealth and is especially low among those in the highest quintile (28 percent). Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Rwanda 2014-15 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agri- culture Missing Total Number of women Age 15-19 0.4 0.1 8.7 1.4 3.3 13.0 71.7 1.3 100.0 1,709 20-24 2.0 0.7 14.0 3.4 2.2 5.8 71.3 0.5 100.0 2,028 25-29 4.3 1.0 13.7 3.7 2.5 2.7 72.0 0.2 100.0 2,133 30-34 3.8 0.5 11.8 2.8 1.7 1.5 77.8 0.2 100.0 2,037 35-39 4.0 0.2 11.1 2.9 1.4 1.2 79.2 0.0 100.0 1,511 40-44 3.2 0.4 10.5 1.7 1.3 0.6 82.2 0.2 100.0 1,215 45-49 2.0 0.1 6.1 2.2 1.4 0.9 87.3 0.0 100.0 934 Marital status Never married 2.7 0.8 12.0 3.6 3.0 10.3 66.4 1.1 100.0 3,634 Married or living together 3.3 0.3 11.2 2.4 1.5 0.8 80.5 0.1 100.0 6,579 Divorced/separated/widowed 1.4 0.3 10.6 2.2 2.2 2.5 80.8 0.0 100.0 1,355 Number of living children 0 3.1 1.0 11.6 3.7 3.0 10.2 66.3 1.1 100.0 3,318 1-2 3.7 0.4 12.9 2.9 1.8 2.3 75.8 0.1 100.0 3,720 3-4 2.6 0.2 10.3 2.3 1.7 0.9 81.9 0.0 100.0 2,776 5+ 1.2 0.1 9.4 1.1 1.4 0.7 86.1 0.0 100.0 1,754 Residence Urban 8.5 2.4 37.5 5.9 5.3 16.9 23.2 0.4 100.0 1,907 Rural 1.8 0.1 6.2 2.1 1.4 1.4 86.5 0.4 100.0 9,661 Province City of Kigali 6.7 2.2 34.9 7.3 6.0 18.8 23.7 0.2 100.0 1,353 South 2.9 0.3 7.9 2.6 1.1 2.6 82.2 0.4 100.0 2,853 West 2.4 0.4 11.4 1.5 2.0 2.1 79.7 0.4 100.0 2,416 North 2.3 0.2 8.7 2.3 1.9 1.5 82.5 0.7 100.0 1,971 East 1.9 0.1 5.7 2.0 1.3 1.7 86.9 0.2 100.0 2,975 Education No education 0.1 0.0 4.6 1.0 1.7 1.5 91.0 0.0 100.0 1,556 Primary 0.2 0.0 9.3 2.6 2.1 4.2 81.4 0.2 100.0 7,907 Secondary and higher 15.2 2.5 24.2 4.6 2.2 4.9 45.2 1.2 100.0 2,105 Wealth quintile Lowest 0.1 0.0 4.2 1.5 1.3 0.7 92.0 0.3 100.0 2,329 Second 0.1 0.0 5.7 1.4 1.4 1.0 90.1 0.3 100.0 2,381 Middle 1.0 0.0 5.4 2.4 1.9 0.6 88.5 0.1 100.0 2,327 Fourth 2.0 0.2 9.6 3.1 2.3 1.9 80.6 0.4 100.0 2,267 Highest 11.5 2.2 32.6 5.4 3.5 16.1 27.8 0.8 100.0 2,265 Total 2.9 0.5 11.4 2.7 2.1 4.0 76.1 0.4 100.0 11,568 Table 3.6.2 shows similar data for men’s occupations. As with women, the majority of men work in agriculture (58 percent, as compared with 60 percent in 2010). Twelve percent of working men perform skilled manual labor, 11 percent are employed in sales and services and 10 percent of perform unskilled manual labor. Only 5 percent reported working in a technical, professional, or managerial occupation. These proportions have remained similar since 2010. As is the case with women, results by age show that older men are somewhat more likely to work in agriculture than younger ones. Results by province show that 30 percent of men in City of Kigali work in skilled manual jobs, 22 percent work in sales and services, 15 percent work in the unskilled manual sector, and only 15 percent work in agriculture. In other provinces, agricultural occupations dominate. As expected, the proportion of men working in agriculture is higher in rural areas than in urban areas (69 percent versus 13 percent). Conversely, it appears that urban men are more likely than rural men to work in other occupations. In particular, urban men are significantly more likely than rural men to perform skilled manual labor (28 percent versus 8 percent) and to be employed in sales and services (23 percent versus 8 percent). The difference is not large for unskilled manual labor (15 percent in urban areas and 9 percent in rural areas). With respect to educational attainment, the results show that, as with women, the majority of men who have no Respondent Characteristics • 47 education work in agriculture (74 percent, as compared with 30 percent of those with a secondary education or higher). Among those with a secondary education or higher, 23 percent work in professional/ technical/managerial occupations. Results according to wealth show that a majority of men in the poorest households work in agriculture (77 percent). Only 21 percent of men in the richest quintile work in agriculture, and 23 percent are engaged in skilled manual labor. Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Rwanda 2014-15 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agri- culture Missing Total Number of men Age 15-19 0.8 0.0 7.9 7.4 15.6 7.5 60.4 0.4 100.0 751 20-24 3.4 0.5 13.9 9.9 14.3 4.9 53.0 0.1 100.0 824 25-29 9.1 0.3 12.9 13.6 11.7 2.0 50.4 0.0 100.0 921 30-34 6.0 0.4 11.8 14.7 7.4 1.2 58.4 0.0 100.0 916 35-39 4.8 0.2 9.3 14.1 7.3 1.0 63.2 0.0 100.0 564 40-44 6.0 0.6 11.4 11.9 4.2 0.6 65.3 0.0 100.0 472 45-49 5.1 0.4 8.6 15.4 2.9 0.3 67.3 0.0 100.0 383 Marital status Never married 5.7 0.4 12.3 10.3 13.8 5.8 51.5 0.2 100.0 1,955 Married or living together 4.8 0.3 10.4 13.5 7.2 0.7 63.0 0.0 100.0 2,781 Divorced/separated/widowed 2.2 0.0 10.4 15.3 16.3 0.8 55.0 0.0 100.0 92 Number of living children 0 5.9 0.4 11.4 10.5 13.6 5.6 52.4 0.2 100.0 2,030 1-2 6.4 0.6 11.9 14.0 9.9 0.8 56.4 0.0 100.0 1,273 3-4 3.3 0.2 12.0 12.1 6.0 0.9 65.6 0.0 100.0 911 5+ 2.6 0.0 7.8 14.7 4.3 0.4 70.2 0.0 100.0 615 Residence Urban 11.8 1.2 22.5 28.0 15.1 7.8 13.3 0.2 100.0 953 Rural 3.5 0.1 8.4 8.4 8.7 1.6 69.3 0.1 100.0 3,876 Province City of Kigali 10.2 1.2 22.0 30.0 14.6 7.3 14.7 0.0 100.0 668 South 4.3 0.1 7.6 7.9 7.2 2.7 69.9 0.4 100.0 1,163 West 4.5 0.2 9.4 10.9 10.8 1.7 62.5 0.0 100.0 1,014 North 3.5 0.5 8.8 10.0 12.2 1.2 63.9 0.0 100.0 749 East 4.6 0.1 11.7 9.3 8.3 2.4 63.8 0.0 100.0 1,235 Education No education 0.0 0.0 6.5 7.4 10.3 2.1 73.6 0.0 100.0 490 Primary 0.6 0.1 9.8 11.6 10.8 2.8 64.1 0.0 100.0 3,367 Secondary and higher 23.2 1.3 18.2 16.9 7.1 3.1 30.0 0.3 100.0 972 Wealth quintile Lowest 0.1 0.0 4.0 7.0 11.2 0.6 76.9 0.2 100.0 754 Second 0.4 0.1 6.3 9.1 10.6 0.3 73.1 0.0 100.0 908 Middle 1.0 0.0 8.9 9.0 9.1 1.2 70.9 0.0 100.0 970 Fourth 4.5 0.3 11.1 10.1 9.4 2.3 62.1 0.1 100.0 1,031 Highest 15.9 1.1 21.6 22.7 10.0 8.0 20.5 0.2 100.0 1,166 Total 15-49 5.1 0.3 11.2 12.3 10.0 2.8 58.2 0.1 100.0 4,829 50-59 3.1 0.6 5.0 8.6 3.1 0.5 79.1 0.0 100.0 623 Total 15-59 4.9 0.4 10.5 11.8 9.2 2.5 60.6 0.1 100.0 5,452 Table 3.7 shows the distribution of women employed during the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment. Overall, 44 percent of women in agricultural occupations were paid in cash and in-kind, 14 percent were paid in-kind only, 30 percent were not paid for their work, and only 13 percent were paid in cash only. Women in nonagricultural occupations were more likely to be paid in cash only (81 percent) than those working in agriculture (13 percent). Only 4 percent of women in nonagricultural occupations were not paid for their work. In the majority of cases, women are self-employed, regardless of their occupation (60 percent of women in agricultural occupations and 54 percent of those in nonagricultural occupations). Women who work in 48 • Respondent Characteristics agriculture are more likely to work for a family member than women in nonagricultural occupations (17 percent versus 4 percent). Slightly more than 2 in 5 women (42 percent) working in nonagricultural occupations are employed by a non-family member, while this proportion is about 22 percent among women working in agricultural occupations. Finally, 62 percent of employed women work all year, whereas about 3 in 10 work occasionally. Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Rwanda 2014-15 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 13.0 81.2 29.0 Cash and in-kind 43.6 13.4 36.4 In-kind only 13.5 1.0 10.5 Not paid 29.8 4.3 24.0 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Type of employer Employed by family member 17.3 4.3 14.4 Employed by non-family member 22.4 41.5 26.8 Self-employed 60.2 54.1 58.6 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Continuity of employment All year 60.9 66.9 62.2 Seasonal 8.2 5.1 7.5 Occasional 30.9 28.0 30.3 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 8,804 2,720 11,568 Note: Total includes 44 weighted women with missing information on type of employment who are not shown separately. 3.6 USE OF TOBACCO The consumption of tobacco has a negative impact on children’s health, because it affects not only the health of those who consume it but also the health of those in proximity to people who consume it. For this reason, the 2014-15 RDHS asked questions to determine the level of tobacco consumption among survey respondents. Table 3.8.1 shows the percentages of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to their background characteristics and maternity status. The results show that the vast majority of women in Rwanda do not use tobacco (98 percent). The proportion of women who smoke cigarettes or a pipe is very low, at less than 1 percent; however, 1 percent consume other tobacco products. Although the proportion of women who smoke tobacco is low, it appears that the oldest women age 45-49 (5 percent), those in South Province (3 percent), those with no education (4 percent) and those in the lowest wealth quintile (3 percent) are more likely to use other tobacco products. Respondent Characteristics • 49 Table 3.8.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Rwanda 2014-15 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Pipe Other tobacco Age 15-19 0.1 0.0 0.0 99.9 2,768 20-24 0.1 0.1 0.2 99.7 2,457 25-29 0.4 0.3 0.8 98.6 2,300 30-34 0.3 0.4 1.3 98.1 2,151 35-39 0.7 1.2 1.3 96.9 1,575 40-44 0.6 2.5 3.3 94.0 1,269 45-49 1.3 3.2 4.8 91.5 977 Maternity status Pregnant 0.2 0.2 1.2 98.6 984 Breastfeeding (not pregnant) 0.4 0.6 1.2 97.8 3,850 Neither 0.4 0.9 1.2 97.7 8,663 Residence Urban 0.6 0.1 0.4 98.9 2,626 Rural 0.3 0.9 1.4 97.5 10,871 Province City of Kigali 0.6 0.1 0.5 98.8 1,799 South 0.7 0.5 3.1 96.0 3,214 West 0.1 0.1 0.2 99.6 2,965 North 0.3 1.3 0.8 97.9 2,211 East 0.4 1.4 0.9 97.5 3,308 Education No education 0.7 2.3 3.8 93.7 1,665 Primary 0.4 0.7 1.1 97.9 8,678 Secondary and higher 0.3 0.0 0.0 99.6 3,154 Wealth quintile Lowest 0.5 1.6 3.1 95.1 2,561 Second 0.4 0.8 1.5 97.4 2,631 Middle 0.4 0.8 1.0 97.9 2,597 Fourth 0.3 0.6 0.4 98.9 2,634 Highest 0.3 0.1 0.1 99.5 3,073 Total 0.4 0.7 1.2 97.8 13,497 Table 3.8.2 shows the percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in the preceding 24 hours, according to background characteristics. The results show that 90 percent of men age 15-49 in Rwanda do not use tobacco. Nine percent of men reported smoking cigarettes and 2 percent reported smoking pipes, while approximately 1 percent reported consuming other tobacco products. The proportion of men who smoke cigarettes increases with increasing age, from 1 percent among those age 15-19 to 16 percent among those age 40-44, before declining slightly to 14 percent among those age 45-49. The proportion of men who smoke pipes follows a similar pattern (from 0 percent at age 15-19 to 9 percent at age 45-49). There are only minimal differences between urban and rural men in consumption of cigarettes or other tobacco products; about 9 percent in urban and rural areas smoke cigarettes. By province, men in South and East are more likely to smoke cigarettes (12 percent and 11 percent, respectively) than men in Kigali City and North (9 percent); men in West are least likely to smoke cigarettes (4 percent). As with women, men who have no education (18 percent) and those in the lowest wealth quintile (17 percent) are more likely to smoke cigarettes than their counterparts; they are also more likely to smoke pipes. 50 • Respondent Characteristics Table 3.8.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Rwanda 2014-15 Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Total Number of cigarette smokers Background characteristic Cigarettes Pipe Other tobacco 0 1-2 3-5 6-9 10+ Don’t know/ missing Age 15-19 1.2 0.0 0.2 98.7 1,282 * * * * * * 100.0 16 20-24 4.8 0.1 0.6 95.1 994 (5.8) (30.4) (41.0) (15.1) (5.5) (2.2) 100.0 47 25-29 11.8 0.9 1.0 87.8 946 3.3 28.9 42.6 12.6 7.5 5.2 100.0 112 30-34 12.5 2.5 1.3 86.2 930 3.5 28.3 44.1 7.0 15.9 1.3 100.0 116 35-39 15.4 2.9 0.4 83.8 567 4.0 25.7 51.2 9.5 7.2 2.4 100.0 88 40-44 16.0 6.3 1.0 80.3 473 8.2 31.0 37.0 3.4 16.6 3.8 100.0 76 45-49 14.2 9.0 0.8 80.4 385 8.7 27.2 43.8 12.8 5.4 2.2 100.0 55 Residence Urban 8.6 0.4 0.7 91.2 1,169 3.1 15.4 48.1 16.2 11.5 5.7 100.0 100 Rural 9.3 2.5 0.7 89.4 4,408 5.6 31.0 42.4 8.4 9.8 2.7 100.0 408 Province City of Kigali 8.7 0.8 0.8 90.7 804 4.2 15.8 50.6 13.5 13.8 2.2 100.0 70 South 12.2 2.9 1.0 86.3 1,327 8.3 41.3 34.6 5.6 7.0 3.3 100.0 162 West 4.4 0.4 0.3 95.3 1,182 4.3 26.0 41.7 7.8 11.4 8.9 100.0 51 North 8.7 2.5 0.4 90.4 851 1.7 22.9 53.7 8.4 8.8 4.6 100.0 74 East 10.7 3.0 0.8 87.6 1,413 4.0 22.5 45.6 14.5 12.2 1.1 100.0 152 Education No education 17.7 6.4 1.6 77.5 496 6.5 35.8 36.2 10.0 8.9 2.6 100.0 87 Primary 10.2 2.1 0.8 88.8 3,636 4.8 27.3 46.6 9.3 9.5 2.5 100.0 372 Secondary and higher 3.4 0.3 0.1 96.5 1,445 4.9 18.9 33.5 15.0 17.8 10.0 100.0 50 Wealth quintile Lowest 16.5 5.3 1.0 80.4 819 2.9 40.8 43.8 6.9 5.1 0.6 100.0 135 Second 10.2 3.2 0.8 88.2 991 5.2 23.2 47.0 13.0 7.3 4.3 100.0 101 Middle 9.8 1.7 1.0 89.2 1,097 8.2 30.3 37.1 3.5 14.8 6.2 100.0 108 Fourth 6.6 1.0 0.3 93.1 1,234 6.7 23.7 47.2 13.0 9.4 0.0 100.0 81 Highest 5.8 0.5 0.5 93.9 1,436 3.1 14.3 43.8 16.6 16.6 5.7 100.0 84 Total 15-49 9.1 2.0 0.7 89.8 5,577 5.1 28.0 43.5 10.0 10.2 3.2 100.0 509 50-59 19.1 16.0 3.8 69.5 640 13.1 31.8 36.0 10.3 7.0 1.7 100.0 123 Total 15-59 10.2 3.5 1.0 87.7 6,217 6.7 28.7 42.1 10.0 9.6 3.0 100.0 631 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figures is based on fewer than 25 unweighted cases. Among men who smoke cigarettes, 44 percent reported smoking from 3 to 5 cigarettes in the 24 hours preceding the survey, 28 percent smoked from 1 to 2 cigarettes, 10 percent smoked 6-9 cigarettes, and 10 percent smoked 10 or more cigarettes. Notably, 5 percent of men who reported that they smoke did not smoke a cigarette in the 24 hours before the interview. Proximate Determinants of Fertility • 51 PROXIMATE DETERMINANTS OF FERTILITY 4 Key Findings • The median age at first marriage among women age 25-49 is 22 years, • The median age at first marriage among men age 30-49 is 26 years. • Median age at first marriage among women has increased slightly since 2010, from 21 years to 22 years. • The percentage of never-married women (38 percent versus 39 percent in RDHS 2010) and men (48 percent versus 51 percent for RDHS 2010) has decreased slightly in the past five years. • Two percent of currently married men age 15-49 are in polygamous unions; 7 percent of currently married women have co-wives. • Only 2 percent of women and men age 30-49 reported having had sex before age 15. • Twelve percent of men reported that they had sex by age 18, as compared with 20 percent of women. his chapter addresses the key factors that define the risk of becoming pregnant. These factors include age at first marriage, age at first sexual intercourse, sexual activity, postpartum abstinence, and amenorrhea. 4.1 MARITAL STATUS In Rwanda, formal unions (married) or informal unions (living together) between men and women are the sole culturally permissible contexts for sexual activity. Marital status can therefore be considered the primary factor initiating exposure to the risk of pregnancy. In the data discussed in this section, the term married refers to men and women bound together legally, while living together refers to couples cohabiting in informal unions. People are considered never married if they have never been married or lived together with a partner. Ever-married people include those who are currently married as well as those who are living with a partner, widowed, separated, or divorced. Table 4.1 shows the distribution of women and men by marital status, according to age at the time of the survey. Of the 13,497 women interviewed, 52 percent were in a union. This proportion has remained relatively stable since the 2010 RDHS, when the figure was 50 percent. T 52 • Proximate Determinants of Fertility Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Rwanda 2014-15 Marital status Total Percentage of respondents currently in union Number of respondentsAge Never married Married Living together Divorced Separated Widowed WOMEN Age 15-19 96.2 0.1 2.9 0.2 0.6 0.0 100.0 3.1 2,768 20-24 58.8 11.3 24.7 1.3 3.7 0.3 100.0 35.9 2,457 25-29 24.0 39.7 28.9 2.5 4.2 0.8 100.0 68.6 2,300 30-34 11.4 58.7 20.0 3.6 4.0 2.2 100.0 78.7 2,151 35-39 7.1 62.5 16.3 4.6 4.0 5.6 100.0 78.7 1,575 40-44 4.1 55.7 15.0 5.3 5.9 14.2 100.0 70.6 1,269 45-49 3.5 52.1 10.0 6.7 3.8 23.8 100.0 62.1 977 Total 15-49 37.8 34.5 17.2 2.8 3.4 4.2 100.0 51.7 13,497 MEN Age 15-19 99.8 0.0 0.2 0.0 0.0 0.0 100.0 0.2 1,282 20-24 82.1 4.1 12.9 0.1 0.8 0.0 100.0 17.0 994 25-29 41.4 26.3 29.7 1.0 1.4 0.2 100.0 56.0 946 30-34 14.1 55.0 28.3 1.1 1.4 0.1 100.0 83.3 930 35-39 8.2 68.5 21.7 0.4 1.0 0.2 100.0 90.2 567 40-44 3.2 74.4 19.6 0.7 1.2 0.8 100.0 94.0 473 45-49 2.8 75.5 17.7 0.9 1.1 2.1 100.0 93.2 385 Total 15-49 48.2 32.9 17.2 0.5 0.9 0.3 100.0 50.1 5,577 50-59 1.9 73.9 16.6 2.2 2.5 2.9 100.0 90.5 640 Total 15-59 43.5 37.1 17.1 0.7 1.1 0.5 100.0 54.2 6,217 Thirty-five percent of women are in formal marriages, the same percentage as in 2010, while the proportion of women in informal unions has increased from 15 perc

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