South Africa - Demographic and Health Survey - 2002

Publication date: 2002

i CONTENTS Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Key Findings of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii Map of South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii CHAPTER 1 INTRODUCTION 1.1 History, Society and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Geography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Demographic Data and Population Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Health Policy Goals, Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Objectives and Organisation of the 1998 South Africa Demographic and Health Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Distribution of Household Population by Age and Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 School Attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.5 Grants and Pensions Received by the Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.6 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.7 Water and Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.8 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.9 Characteristics of Women Aged 15-49 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.10 Child Care for Working Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 CHAPTER 3 FERTILITY 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.2 Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.3 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.4 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.5 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 3.6 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3.7 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 CHAPTER 4 CONTRACEPTION AND FERTILITY PREFERENCES 4.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.3 Source of Contraceptive Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.4 Age at First Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.5 Current Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.6 Number of Children at First Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.7 Knowledge of Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.8 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . 53 4.9 Timing of Sterilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 ii 4.10 Source of Contraceptive Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.11 Quality of Contraceptive Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.12 Breaks in Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.13 Intention to Use among Non-Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.14 Reason for Non-use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.15 Preferred Contraceptive Method for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.16 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . . . . . . . . . . . 60 4.17 Acceptability of Media Messages on Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 4.18 Exposure to Family Planning Messages in the Print Media . . . . . . . . . . . . . . . . . . . . . . . . 62 4.19 Discussion of Family Planning with Husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.20 Attitudes of Couples Toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.21 Perceptions About the Legality of Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 4.22 Fertility Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.23 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 4.24 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.25 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 CHAPTER 5 SEXUAL BEHAVIOUR, HIV/AIDS AND THE MISTREATMENT OF WOMEN 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 5.2 AIDS Knowledge and Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 5.3 Sources of Knowledge about HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 5.4 Perception of the Risk of Getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 5.5 Opinions About Reporting HIV/AIDS Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 5.6 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 5.7 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 5.8 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 5.9 Relationship with Last Sexual Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 5.10 Condom Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 5.11 Treatment of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 CHAPTER 6 INFANT AND CHILD MORTALITY 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 6.2 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 6.3 Socio-economic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 6.4 Demographic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 6.5 Environmental Factors and Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 6.6 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 CHAPTER 7 MATERNAL AND CHILD HEALTH 7.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 7.2 Tetanus Toxoid Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 7.3 Assistance and Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 7.4 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 7.5 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 7.6 Stress Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 7.7 Immunisation Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 7.8 Differentials in Vaccination Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 7.9 Prevalence of Diarrhoeal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 7.10 Treatment of Diarrhoeal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 7.11 Prevalence of Acute Respiratory Infection (ARI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 iii 7.12 Serious Accidents and Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 CHAPTER 8 INFANT AND CHILD FEEDING PRACTICES 8.1 Initiation of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 8.2 Duration of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 8.3 Frequency of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 8.4 Weaning Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 8.5 Termination of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 CHAPTER 9 ADOLESCENT HEALTH 9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 9.2 Sexual Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 9.3 Contraception and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 9.4 Incidence of Intentional and Unintentional Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 9.5 Patterns of Exposure to Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 9.6 Alcohol Use/Misuse by Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 9.7 Anthropometry of Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 9.8 Abnormalities in Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 9.9 Chronic Obstructive Pulmonary Disease and Asthma in Adolescents . . . . . . . . . . . . . . . 163 CHAPTER 10 MORTALITY AND MORBIDITY IN ADULTS 10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 10.2 Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 10.3 Chronic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 10.4 Reported Cancer Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 10.5 Self-Reported Prevalence and Incidence of Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . 176 10.6 Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 10.7 Occupational Health: Disease and Injury in Working Adults . . . . . . . . . . . . . . . . . . . . . 181 10.8 Prevalence of Symptoms of Sexually Transmitted Diseases among Men . . . . . . . . . . . . 189 CHAPTER 11 UTILISATION OF HEALTH SERVICES AND CHRONIC MEDICATION 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 11.2 Health Services Attended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 11.3 Satisfaction with Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 11.4 Access to Medical Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 11.5 Self-Reported Chronic Disease Drugs Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 11.6 Payment for Prescribed Medication for Chronic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 197 11.7 Patterns of Prescribed Medication for Common Chronic Diseases . . . . . . . . . . . . . . . . . . 198 11.8 Chronic Disease Drug Utilisation Patterns between Private and Public Sector Patients. . 204 11.9 Patients’ Knowledge of their Chronic Disease Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 CHAPTER 12 HYPERTENSION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA IN ADULTS 12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 12.2 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 12.3 Mean Blood Pressure, Pulse Rates and Pulse Pressure of Adults . . . . . . . . . . . . . . . . . . 207 12.4 Prevalence of Hypertension and Treatment Status of Hypertensive Participants . . . . . 210 12.5 Hypertension Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 12.6 Patient’s Reported Frequency of BP Measurements and Knowledge of their iv Measured BPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 12.7 Comparison of BP Control Between Public and Private Health Care Services . . . . . . . . 218 12.8 Chronic Obstructive Pulmonary Disease and Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 12.9 Self-Reporting of Respiratory Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 12.10 Reporting of Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 12.11 Associations of Respiratory Symptoms and Abnormal PEFR with Risk Factors Measured in the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 12.12 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 CHAPTER 13 ADULT HEALTH RISK PROFILES 13.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 13.2 Prevalence of Tobacco Use among Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 13.3 Perceptions about Tobacco Use and Tobacco Cessation Patterns in Adults . . . . . . . . 233 13.4 Exposure to Environmental Tobacco Smoke and Dust or Fumes in the Work Place . . 235 13.5 Patterns of Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 13.6 Risky Drinking and Alcohol Dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 13.7 Perceptions of Own Body Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 13.8 Weight, Height, and Mid-Upper Arm Circumference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 13.9 Body Mass Index (BMI) and Prevalence of Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 13.10 Waist and Hip Circumference and Waist/Hip Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 CHAPTER 14 ORAL HEALTH AND ORAL CARE IN ADULTS 14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 14.2 Perceptions of Oral Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 14.3 Utilisation of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 14.4 Loss of Natural Teeth and Use of Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 14.5 Oral Health Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 14.6 Knowledge about Fluoride in Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 14.7 Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 CHAPTER 15 IMPLICATIONS OF FINDINGS 15.1 Major Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 15.2 Population Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 15.3 Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 15.4 Youth and Adolescent Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 15.5 Maternal and Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 15.6 HIV/AIDS and STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 15.7 Adult Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 15.8 Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 15.9 Use of Chronic Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 15.10 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 APPENDIX D ESTABLISHING REFERENCE AND PREDICTIVE VALUES FOR PEAK EXPIRATORY FLOW RATE (PEFR) FOR THE v SADHS SAMPLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 APPENDIX E PERSONS INVOLVED IN THE 1998 SOUTH AFRICA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . 334 APPENDIX F QUESTIONNAIRES List of Tables Table 1.1 Sample results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table 2.1 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Table 2.2 Comparison of broad age structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.5 Educational level of the female and male household population . . . . . . . . . . . . . . 12 Table 2.6 School attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.7 Grants and pensions, employment status, recent injuries . . . . . . . . . . . . . . . . . . . 14 Table 2.8 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.9 Fetching water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.10 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.11 Age distribution of women 1996 and 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.12 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.13 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.14 Reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.15 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.16 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.17 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2.18 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 2.19 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 2.20 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 2.21 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 2.22 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 2.23 Decision on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 2.24 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 3.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.3 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.4 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 3.5 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 3.6 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 3.7 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . . . 42 Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.2 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.3 Contraceptive method first used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.4 First source of contraceptive information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.5 Age at first use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 vi Table 4.6 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 4.7 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . 51 Table 4.8 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 4.9 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . 53 Table 4.10 Median duration of postpartum insusceptibility by background characteristics . . . . 54 Table 4.11 Timing of sterilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 4.12 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.13 Quality of family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 4.14 Breaks in contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 4.15 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 4.16 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 4.17 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . . 62 Table 4.18 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 4.19 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 4.20 Wives’ perceptions of couple’s attitude toward family planning . . . . . . . . . . . . . . 65 Table 4.21 Perception of legality of abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 4.22 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 4.23 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 4.24 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . . . 69 Table 4.25 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 4.26 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 4.27 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . 73 Table 4.28 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 4.29 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 5.1 Knowledge of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 5.2 Knowledge of ways to avoid AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 5.3 Perception of risks of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 5.4 Beliefs about reporting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 5.5 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 5.6 Median age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 5.7 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 5.8 Number of sexual partners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 5.9 Relationship with last person with whom had sexual intercourse . . . . . . . . . . . . . 87 Table 5.10 Use of condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 5.11 Mistreatment of women in last 12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 5.12 Mistreatment of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 5.13 Service use and needs for abused women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 5.14 Sexual abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 5.15 Child sexual abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 6.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 6.2 Infant and child mortality by socio-economic characteristics . . . . . . . . . . . . . . . . 102 Table 6.3 Adjusted infant and under-five mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Table 6.4 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . 104 Table 6.5 Infant and child mortality by environmental factors . . . . . . . . . . . . . . . . . . . . . . 105 Table 6.6 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 vii Table 7.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 7.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . 110 Table 7.3 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 7.4 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 7.5 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 7.6 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . 117 Table 7.7 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 7.8 Stress incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Table 7.9 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 7.10 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Table 7.11 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Table 7.12 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Table 7.13 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Table 7.14 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . 130 Table 7.15 Injury rates for children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table 8.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table 8.2 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 8.3 Median duration and frequency of breastfeeding by background variables . . . . . . 137 Table 8.4 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . 139 Table 9.1 Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table 9.2 Adolescent injury rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table 9.3 Tobacco use by adolescent men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table 9.4 Tobacco use by adolescent women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table 9.5 Risky drinking and alcohol dependency among adolescents . . . . . . . . . . . . . . . . . 151 Table 9.6 Anthropometric measurements for adolescent men . . . . . . . . . . . . . . . . . . . . . . . 153 Table 9.7 Anthropometric measurements for adolescent women . . . . . . . . . . . . . . . . . . . . 154 Table 9.8 Body mass index (BMI) of adolescent men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Table 9.9 Body mass index (BMI) of adolescent women . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Table 9.10 Waists and hip circumference of adolescent men . . . . . . . . . . . . . . . . . . . . . . . . 158 Table 9.11 Waists and hip circumference of adolescent women . . . . . . . . . . . . . . . . . . . . . . 159 Table 9.12 Blood pressure and pulse rate in adolescent men . . . . . . . . . . . . . . . . . . . . . . . . 161 Table 9.13 Blood pressure and pulse rate in adolescent women . . . . . . . . . . . . . . . . . . . . . . 162 Table 9.14 Lung disease in adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 Table 10.1 Adult mortality rates by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table 10.2 Family history of chronic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Table 10.3 Chronic disease prevalence among men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table 10.4 Chronic disease prevalence among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Table 10.5 Chronic disease incidence among men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table 10.6 Chronic disease incidence among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Table 10.7 Cancer pattern in adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Table 10.8 Comparative cancer incidence rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Table 10.9 Prevalence and incidence of TB among adults . . . . . . . . . . . . . . . . . . . . . . . . 177 Table 10.10 Comparative TB incidence rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Table 10.11 Injury rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Table 10.12 Work-related illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 viii Table 10.13 Incidence of health problems and injuries related to work . . . . . . . . . . . . . . . . . . 183 Table 10.14 Incidence of health problems or injuries aggravated by work . . . . . . . . . . . . . . . 185 Table 10.15 Incidence of health problems or injury related to or aggravated by work . . . . . . . 186 Table 10.16 Type of work-related health problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Table 10.17 Type of work-related injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Table 10.18 Symptoms of sexually transmitted diseases in men . . . . . . . . . . . . . . . . . . . . . . . 190 Table 11.1 Health services attended, by age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Table 11.2 Health services attended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Table 11.3 Satisfaction with health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Table 11.4 Reasons for dissatisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Table 11.5 Access to medical aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Table 11.6 Medication for chronic conditions for men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Table 11.7 Medication for chronic conditions for women . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Table 11.8 Payment for medication for chronic conditions . . . . . . . . . . . . . . . . . . . . . . . . . 198 Table 11.9 Use of prescribed medication for eight common chronic conditions . . . . . . . . . . . 199 Table 11.10 Prescribed medication for eight common chronic conditions . . . . . . . . . . . . . . . . 200 Table 11.11 Public and private sector provision of medication for chronic conditions . . . . . . . 203 Table 11.12 Knowledge about prescribed medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Table 12.1 Mean blood pressure - men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Table 12.2 Mean blood pressure - women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Table 12.3 Hypertension prevalence and treatment status of men . . . . . . . . . . . . . . . . . . . . 212 Table 12.4 Hypertension prevalence and treatment status of women . . . . . . . . . . . . . . . . . . 213 Table 12.5 Hypertension risk factors - men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Table 12.6 Hypertension risk factors - women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Table 12.7 Public vs private sector source of hypertension medication . . . . . . . . . . . . . . . . . 219 Table 12.8 Symptoms of lung disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Table 12.9 Lung disease and risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Table 13.1 Tobacco use men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Table 13.2 Tobacco use women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Table 13.3 Perceptions about tobacco on health and tobacco cessation patterns of adults . . . 234 Table 13.4 Environmental tobacco smoke (ETS) and fume or dust exposure among men . . . . 236 Table 13.5 Environmental tobacco smoke (ETS) and fume or dust exposure among women . 237 Table 13.6 Risky drinking and alcohol dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Table 13.7 Adult self perceptions of weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Table 13.8 Anthropometry of adult men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Table 13.9 Anthropometry of adult women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Table 13.10 Body mass index (BMI) of men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Table 13.11 Body mass index (BMI) of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Table 13.12 Waist and hip circumference of adult men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Table 13.13 Waist and hip circumference of adult women . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Table 14.1 Dental problems among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Table 14.2 Utilisation of Health services among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 Table 14.3 Tooth loss and use of dentures among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Table 14.4 Toothbrush ownership and oral rinsing among adults . . . . . . . . . . . . . . . . . . . . . . 258 ix Table 14.5 Knowledge about fluoride among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Table 14.6 Oral health policy for South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Table 15.1 Draft National Oral Health Policy for South Africa . . . . . . . . . . . . . . . . . . . . . . 275 x List of Figures Figure 2.1 Age and sex structure, SADHS 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 2.2 Access to electricity, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Figure 2.3 Marital status of women, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure 3.1 Total fertility rate by education level, South Africa 1998 . . . . . . . . . . . . . . . . . . . 35 Figure 3.2 Fertility rate by province, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Figure 3.3 Total fertility rate by population group, 1910-90 . . . . . . . . . . . . . . . . . . . . . . . . . 36 Figure 3.4 Age-specific fertility rates for Africans, South Africa 1988 and 1998 . . . . . . . . . . 37 Figure 4.1 Current use of contraception by type, South Africa 1998 . . . . . . . . . . . . . . . . . . . 52 Figure 5.1 Proportion of women reporting sexual abuse in childhood by age, South Africa 1998 98 Figure 6.1 Childhood mortality 1978 - 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Figure 7.1 Antenatal care by type of provider, South Africa 1998 . . . . . . . . . . . . . . . . . . . . 110 Figure 7.2 Distribution of births by place of delivery South Africa 1998 . . . . . . . . . . . . . . . . 114 Figure 8.1 Percentage of infants exclusively breastfed, South Africa 1998 . . . . . . . . . . . . . . 135 Figure 9.1 Injury rate by age group in the month preceding the survey . . . . . . . . . . . . . . . . . 144 Figure 10.1 Age specific death rates for men for the periods 0-2 years, 3-6 years and 7-9 years preceding the survey, South Africa 1998 . . . . . . . . . . . . 167 Figure 10.2 Age specific death rates for women for the periods 0-2 years, 3-6 years and 7-9 years preceding the survey, South Africa 1998 . . . . . . . . . . . . 167 Figure 10.3 Types of injury, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Figure 10.4 Annual unintentional and intentional injury rates per province, South Africa 1998 . 180 Figure 10.5 Self-reported incidence of work-related diseases and injuries, South Africa 1998 . 189 Figure 12.1 Prevalence of hypertension in men, South Africa 1998 . . . . . . . . . . . . . . . . . . . . 214 Figure 12.2 Prevalence of hypertension in women, South Africa 1998 . . . . . . . . . . . . . . . . . 214 Figure 13.1 The prevalence of smoking by population group and sex, South Africa 1998 . . . . 230 Figure 13.2 The prevalence of smoking, living with smokers, and working with smokers in dusty environment, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Figure 13.3 The prevalence of measured overweight and perceived overweight by population group and sex, South Africa 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 xi PREFACE The 1998 South Africa Demographic and Health Survey (SADHS) is the first study of its kind to be conducted in South Africa and heralds a new era of reliable and relevant information in South Africa. The SADHS, a nation-wide survey has collected information on key maternal and child health indicators, and in a first for international demographic and health surveys, the South African survey contains data on the health and disease patterns in adults. Plans to conduct the South Africa Demographic and Health Survey go as far back as 1995, when the Department of Health National Health Information Systems of South Africa (NHIS/SA) committee, recognised serious gaps in information required for health service planning and monitoring. Fieldwork was conducted between late January and September 1998, during which time 12,247 households were visited, 17,500 people throughout nine provinces were interviewed and 175 interviewers were trained to interview in 11 languages. The information from this benchmark survey will be used to evaluate health programmes of the department, describe health status and will be instrumental in identifying new directions for the national and provincial health programmes in South Africa. The survey findings serve as an important tool for programmes to assess progress and highlight some of the challenges facing the health sector in continuing to improve the health status of all South Africa, now and into the new millennium. I would like to extend my sincere gratitude to all who have made the completion of the 1998 South Africa Demographic and Health Survey possible. I am deeply indebted to the staff of the National and Provincial Departments of Health for their hard work. Thanks also go to the Medical Research Council, Macro-International and USAID for their technical advice and support, and the Centre for Health Systems Research and Development, University of the Orange Free State for conducting the field work. Very special thanks go to the families and individuals who participated for sharing information about themselves and giving their invaluable time without which this study would not have been possible. Finally, I would like to invite all to make use of the data in search of strategies and plans for the improvement of the health of all South Africans Dr M E Tshabalala-Msimang Minister of Health xii ACKNOWLEDGMENTS Many people have participated in the completion of the 1998 South Africa Demographic and Health Survey (SADHS) with great dedication and commitment. The Department of Health primarily funded the 1998 SADHS with contributions from Macro-International and USAID. Contributions in human resources, technical expertise and commitment to excellence have come from a great many organisations and individuals in the completion of the SADHS final report. First and foremost I would like to extend thanks to the National Department of Health, Health Systems Research, Research Co-ordination and Epidemiology Directorate for co-ordinating this enormous and complex project under the leadership of Dr Lindiwe Makubalo. A special vote of thanks goes to the Medical Research Council for their major role in almost all aspects of the Survey. In particular, we are deeply indebted and grateful to Dr Debbie Bradshaw for her technical support and to Ms Nolwazi Mbananga for co-ordinating the fieldwork. Thanks also go to the Provincial Health Departments for their logistical and technical support throughout the survey. I would also like to thank colleagues in the National Information Systems Committee (NHIS/SA) for their commitment to and work on the survey. I would like to express my sincere appreciation to the Centre for Health Systems Research and Development at the University of Free State in partnership with King Finance for implementing the fieldwork. Thanks also go to the Human Sciences Research Council for their assistance in the planning phase of this initiative. For the drawing of the sample, I would like to thank Statistics South Africa. Technical assistance during the survey was also provided by Measure DHS+ (formerly Macro- International Inc.). We extend thanks for the support provided by the Measure DHS+ team in the completion of the survey. Many thanks to all the dedicated researchers and policy and programme managers who participated in the writing of this report. Thanks also to Ms Lusanda Mahlasela for co-ordinating and working on the finalisation and editing of this report and to Ms Elize de Kock for her tremendous work in consolidating comments and editing. To all who have contributed to the 1998 SADHS – thank you. This is a substantial achievement. South Africa, for the first time has an understanding of the nation*s health status. We have a clearer idea of the challenges which face us and the directions we need to take in order to improve the health of South Africans. Dr Ayanda Ntsaluba Director General Department of Health xiii KEY FINDINGS OF THE SURVEY Mortality rates Infant mortality rate: 45 per 1,000 live births Under-5 mortality rate: 59 per 1,000 live births Child mortality rate: 15 per 1,000 live births Maternal mortality ratio: 150 per 100,000 births *Immunisation coverage in children aged 12-23 months (%) Total: 63 Urban: 67 Non-urban: 60 Male: 65 Female: 62 Percent of children 12-23 months with Road-to-Health card: 75 Exclusive breastfeeding (% of infants) 0-3 months: 10 4-6 months: 1 Awareness of HIV/AIDS (% of women 15-49): 97 Perceptions about AIDS (% of women 15-49) People can protect themselves from HIV/AIDS by using condoms True: 87 False: 7 People can protect themselves from HIV/AIDS by avoiding public toilets True: 24 False: 65 Condom use (% of sexually active women 15-49) Ever used condom: 22 Used condom at last sex: 8 Prevalence of STD symptoms (% of men 15+) Total: 12 Urban: 9 Non-urban: 17 Fertility rate Total: 2.9 children per woman Urban: 2.29 children per woman Non-urban: 3.92 children per woman ** Modern contraceptive prevalence (%): 61 Urban: 66 Rural: 53 Treatment of women (%) Ever abused by partner: 13 Abused when pregnant: 4 Ever raped: 4 Antenatal care from doctor/nurse (% of births): 94 Assistance during delivery (% of births in last 5 years) Doctor: 30 Nurse/midwife: 54 Smoking rate (% of adults age 15+) Men: 42 Women: 11 Adolescents age 15-19: 10 Alcohol rates (% of men and women age 15+) Ever drank alcohol: Men:58; Women: 26 Drink alcohol now: Men:45; Women:17 Dependent on alcohol: Men:28; Women:10 Prevalence of hypertension (% of adults age 15+) Men: 13; Women: 16 Percentage of hypertensives who were controlled Men:26; Women: 38 Prevalence of airways limitation (Asthma) (% of adults age 15+) Men: 7; Women: 9 Prevalence of chronic bronchitis (% of adults age 15+) Men: 2; Women: 3 Abnormal peak flow (% of adults age 15+) Men: 4; Women: 4 Overweight (% of adults age 15+) Men: 29; Women: 55 Obesity (% of adults age 15+) Men: 9; Women: 29 Injury rates (per 100,000) Intentional: Men:381 Women: 175 Unintentional: Men: 1,373 Women: 631 Access to medical aid (% of adults age 15+)) Urban: 24 Non-Urban: 16 Total: 17 Health service utilisation (% of adults age 15+) Public sector: 19 Private sector: 13 Chemist: 7 Traditional Healer:3 Faith Healer: 2 Dentist: 3 Tooth loss and dentures (% of adults age 15+) Lost any teeth: Men :59; Women: 64 Lost all teeth: Men: 7; Women: 9 Wear dentures: Men: 10; Women: 9 Perception about the benefits of fluoridation: (% of adults age 15+) Fluoride is beneficial: Men 52; Women: 51 * Childhood immunisation coverage is the percentage of children aged 12-23 months who have received BCG, three doses of DPT and polio, and measles vaccines. ** Contraceptive prevalence refers to the percentage of all sexually active women aged 15-49 who are using a modern c o n t r a c e p t i v e m e t h o d . xiv WESTERN CAPE NORTHERN CAPE EASTERN CAPE NORTH WEST NORTHERN PROVINCE FREE STATE MPUMALANGA KWAZULU NATAL GAUTENG WESTERN CAPE NORTHERN CAPE EASTERN CAPE NORTH WEST NORTHERN PROVINCE FREE STATE MPUMALANGA KWAZULU NATAL GAUTENG REPUBLIC OF SOUTH AFRICA 1 CHAPTER 1 INTRODUCTION 1.1 History, Society, and the Economy The People of South Africa The people of South Africa have diverse origins. Ancestors of the Khoisan flourished in Southern Africa for thousands of years as hunter-gatherers. Around 300-500 AD, Bantu-speaking people moved southwards from West Africa bringing Iron Age settlements to Southern Africa. Nguni-speaking people lived in the eastern part and the Sotho-speaking people lived in the northern part. During the 15th century, European explorers came to South Africa. The Dutch East India Trading Company later established an outpost in the Cape to make provisions for the passing sea trade. The British also settled in the Cape. As the settlers moved inland, a series of wars followed leading to the conquest of the Xhosa and later the Zulu peoples and a dispossession of the land. In 1713, the great smallpox epidemic, imported by the settlers, decimated the Khoikhoi who had little resistance to this foreign disease. The discovery of diamonds in 1867 and gold in 1871 changed the socio-political and economic path of South Africa forever. The mining interests fostered the development of the rail system, electricity, urban concentrations, commercial farming and manufacturing interests in the interior. Control of the riches led to the South African War in 1899. A bitter guerrilla war between the British and the Boers ensued until 1902 when a treaty was signed with the Boers agreeing to come under the sovereignty of Britain. Sugar plantations in Natal recruited labourers from India when local people were not attracted to the difficult and unrewarding conditions. Indentured labourers were brought from Calcutta and given the option of a passage to India or a small grant of land at the end of the contract. ‘Passenger’ Indians also came to South Africa as merchants. Apartheid and political changes The Act of Union brought the four colonies under British rule in 1910 but Africans were generally excluded from this process. It was only in the former Cape Colony that the vote was based on wealth and not on race. However, only men were allowed to vote. In 1913, the Natives’ Land Act divided South Africa into ‘white’ and ‘black’ areas, forming the cornerstone of Apartheid. The rights of African people were systematically stripped while the political power of the Afrikaners grew. In 1948, a majority of whites voted for Afrikaner nationalism and a series of restrictive laws were introduced to benefit the white minority and ensure inferior amenities for Africans, Asians and Coloureds. In 1950 the Population Registration Act classified people according to race and the Group Areas Act defined where people could or could not live. In a final consolidation of Apartheid, the non-urban ‘black’ areas were patched together into ‘homelands’ to create separate ‘nation states’ for the different ethnic groups. Negotiations between the government and anti-Apartheid groups started in 1990. These culminated in the first national election which ushered in a full democracy in South Africa on the 27 April 1994. Today South Africa is a republic with 9 provinces under a semi-federal system. The administrative capital is Pretoria, the legislative capital is Cape Town and the judicial capital is Bloemfontein. 1Although people are no longer registered according to a Population Registration Act, it is necessary to collect some statistical data according to self-reported categorisation into these population groups in order to monitor the progress in reducing these social and economic inequalities. In this report, the terms African and Asian are used instead of Black and Indian, however it is recognised that Asian is a broader category, not only including people of Indian descent. 2 Population groups The groups identified by the Population Registration Act were White, Indian, Black and Coloured. While Coloured was often explained as being mixed descent, it included people of Khoisan, Malaysian, Griqua, Indian and Chinese origin. Classification of the population into racial groups under Apartheid had profound economic and social impacts.1 Culture and religion The rich heritage of South Africa has resulted in enormous cultural diversity. The new constitution underscores the rights of all to foster their own religion and culture. There are 11 official languages although English is widely used in business and public official activities. The largest organised religion is Christianity. Others include Hinduism, Islam and Judaism. In addition, many people have a ‘traditionalist’ belief system. Gender The position of women in South Africa is intertwined with class and race. The most disadvantaged group in South Africa are the non-urban African women. The social status previously accorded to African women has been undermined as men became migrant labourers. The system of ‘customary law’, entrenched by the colonialists, ensured that African women held minor status. Since 1994, a strong government policy of gender equality has emerged. The international Convention for the Elimination of All Forms of Discrimination Against Women (CEDAW) was signed without reservation in 1995. A wide range of initiatives include mechanisms to promote women’s rights and monitor the impact of government spending on women’s lives. The Gender Commission has been set up in terms of the Constitution, as an independent body to promote gender equity in society. The President’s Office has established an Office of the Status of Women to ensure that gender issues are incorporated in policy and programmes. Economy South Africa is a middle-income country with modern infrastructure and relatively well developed financial, legal, communication, energy and transport systems. It has the largest economy in Africa. However, South Africa has one of the most skewed distributions of income in the world. In 1994 the Government of National Unity entered office with the blueprint for Reconstruction and Development Programme (RDP) which has been supplemented by Growth, Employment and Redistribution (GEAR). Economic growth has been at a level of about 2 percent per annum since 1994, but has been unable to address the high levels of poverty and unemployment. 1.2 Geography South Africa is situated at the southern tip of the continent of Africa. Covering 1.2 million sq. km, most of the country lies in the sub-tropical region. A large part of the country is on a plateau that rises 1000 m above sea level. Mostly semi-arid, water is scarce except along the east coast. With the exception of the South Cape, which experiences a Mediterranean climate, rainfall generally occurs in summer but is unreliable. Long periods of drought are often experienced and encroaching desert is an 3 issue in the western part of the country. Irrigation schemes have been set up to support agriculture and industry. One tenth of the land is arable. The main seaports are Durban and Cape Town. These and 5 others serve the mining and industrial hinterland together with a well-developed rail and road transport system. Airports are found in all the provinces and there is an extensive highway system. South Africa encompasses Swaziland and Lesotho, two land-locked countries that are economically dependent on South Africa. Mozambique, Zimbabwe, Botswana and Namibia neighbour South Africa and have a long and varied history of violations and dependence. A new era of co-operation has begun with the new government of South Africa. 1.3 Demographic Data and Population Policies During the Apartheid era, demographic data were fragmented and incomplete. While statistics for whites, coloureds and Asians were of reasonable quality, the data for Africans were not adequate. The 1996 census collected information for the whole population and introduced questions for direct and indirect estimation of birth and death rates. Regarding vital statistics, much attention has been given to improving registration of births and deaths. However, it remains a challenge to produce accurate and timely mortality rates. In response to a growing concern about the rate of growth of the African population, a national family planning programme was set up in 1974 to provide clinic-based contraceptive services. During the 1980s the government established a Population Development Programme (PDP) which undertook an advocacy role with an aim to reduce fertility. In addition to supporting the provision of contraception, the PDP paid attention to selected aspects of socio-economic and community development within the Apartheid framework. South Africa endorsed the United Nations Programme of Action that was adopted at the International Conference on Population Development (ICPD) held in Cairo, 1994. In 1998 a new national population policy was developed within a framework of multi-sectoral and sustainable development (Department of Welfare, 1998). 1.4 Health Policy Goals, Priorities and Programmes When the Government of National Unity took office in 1994, there was huge fragmentation and gross inequalities in health status, health infrastructure and health services. Since then, there has been an intensive programme of legislative and policy development to reform the health service. Priority programmes have been outlined in the White Paper for the Transformation of the Health System in South Africa (Department of Health, 1997). Amongst the priorities are HIV/AIDS, tuberculosis, maternal health, child health and nutrition. Other priorities include the improvement of access to public health facilities and health care, increasing access to medicines, provision of free primary health care for pregnant women and children under the age of six, improvement of childhood nutrition, management of communicable diseases, provision of services in previously neglected areas such as mental health and maintenance of public health infrastructure. Regarding reproductive health, the current health policy focuses on providing adequate information and facilities to empower people to make informed choices about sexual relations, pregnancy and childbearing. The Choice on Termination of Pregnancy Act (Act 92 of 1996) and the Sterilisation Act (Act 44 of 1998) were thus introduced in 1996 and 1998 respectively. Other areas of extensive legislative changes include the Medical Schemes Act (Act 131 of 1998) for better management of medical schemes and the Medical Dental and the Supplementary Health Services Professions Amendment Act (Act 1 of 1998). The Department of Health continues to support legislation that limits the use of tobacco (Tobacco Control Amendments Act, 1999). 4 1.5 Objectives and Organisation of the 1998 South Africa Demographic and Health Survey The aim of the 1998 South Africa Demographic and Health Survey (SADHS) was to collect data as part of the National Health Information System of South Africa (NHIS/SA). The survey results are intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving health services in the country. A variety of demographic and health indicators were collected in order to achieve the following general objectives: (i) To contribute to the information base for health and population development programme management through accurate and timely data on a range of demographic and health indicators. (ii) To provide baseline data for monitoring programmes and future planning. (iii) To build research and research management capacity in large-scale national demographic and health surveys. The primary objective of the SADHS is to provide up-to-date information on: • basic demographic rates, particularly fertility and childhood mortality levels, • awareness and use of contraceptive methods, • breastfeeding practices, • maternal and child health, • awareness of HIV/AIDS, • chronic health conditions among adults, • lifestyles that affect the health status of adults, and • anthropometric indicators. Organisation The SADHS was a joint effort between various organisations. The Department of Health provided the funds and played an active role in the management of the survey. The Medical Research Council (MRC) co-ordinated the survey, provided technical input and undertook the processing and analysis of the data. MACRO International, funded by USAID, provided technical support in questionnaire design, sample design, field staff training, data processing and analysis. USAID provided additional funds for the sample in the Eastern Cape to be increased from the size in the original survey design. The University of Orange Free State’s Centre for Health Systems Research and Development in partnership with King Finance Corporation implemented the fieldwork. The Human Sciences Research Council (HSRC) made technical input on the design and quality control of the survey. Statistics South Africa (SSA) provided sampling details in each of the nine provinces. Sample design and implementation The sample for the SADHS was designed to be a nationally representative probability sample of approximately 12,000 completed interviews with women between the ages of 15 and 49. The country was stratified into the nine provinces and each province was further stratified into urban and non-urban areas. In addition the Eastern Cape was stratified into five health regions, with each health region stratified into urban and non-urban areas (See Appendix A for full details). The sampling frame for the SADHS was the list of approximately 86,000 enumeration areas (EAs) created by the Central Statistical Services, now Statistics South Africa (SSA), for the 1996 census. Within each stratum a two-stage sample was selected. The Primary Sampling Units (PSUs) corresponded to the EAs and were selected with probability proportional to size (pps), the size being the number of census visiting 2Interviewers were instructed to include any second household residing on a selected plot, this rule resulted in more than the expected number of 12,540 households selected. 5 points in the EA. This led to a total of 972 PSUs being selected for the SADHS (690 in urban areas and 282 in non-urban areas). In urban enumeration areas ten households were selected, while in non- urban EAs 20 households were selected. This resulted in a total of 12,860 households being selected throughout the country2. Every second household was selected for the adult health survey. In this second household, in addition to interviewing all women aged 15-49, interviewers also interviewed all adults aged 15 and over. It was expected that the sample would yield interviews with approximately 12,000 women aged 15-49 and 13,500 adults. The final sample results are shown in Table 1.1. Questionnaires The survey utilised three questionnaires: a Household Questionnaire, a Woman’s Questionnaire and an Adult Health Questionnaire. The contents of the first two were adapted from the DHS Model Questionnaires to meet the needs of the national and provincial Departments of Health. The Adult Health Questionnaire was developed to obtain information regarding the health of adults. Indicators listed in the preliminary Year 2000 Goals, Objectives and Indicators document were included where a household survey was the appropriate mechanism for collecting the information. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Basic information was collected on the characteristics of each person listed, including his/her age, sex, education and relationship to the head of the household. Information was collected about social grants, work status and injuries experienced in the last month. An important purpose of the Household Questionnaire was to identify women and adults who were eligible for interview. In addition, information was collected about the dwelling itself, such as the source of water, type of toilet facilities, material used to construct the house and ownership of various consumer goods. The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: Background characteristics (age, education, race, etc.) Pregnancy history Knowledge and use of contraceptive methods Antenatal and delivery care Breastfeeding and weaning practices Child health and immunisation Marriage and recent sexual activity Fertility preferences Violence against women Knowledge of HIV/AIDS Maternal mortality Husband’s background and respondent’s work In every second household, all men and women aged 15 and above were eligible to be interviewed with the Adult Health Questionnaire. The respondents were asked questions on: Recent utilisation of health services, Family medical history, Clinical conditions, Dental health, Occupational health, Medications taken, 6 Habits and lifestyles, Anthropometric measurements, and, Blood pressure and lung function test. Pilot Study Pilot studies were carried out in November 1996 in non-urban and urban areas. The questionnaires were adapted and finalised on the basis of the results of the pilot study. The instructions and questions in the questionnaires were translated and produced in all official languages in South Africa (English, Afrikaans, isiXhosa, isiZulu, Sesotho, Setswana, Sepedi, SiSwati, TshiVenda, Xitsonga and isiNdebele). Training and Fieldwork The training of field workers was conducted by personnel from the MRC, HSRC, Free State University (Centre for Health Systems Research and Development) and Macro International. Training consisted of plenary sessions on more general issues like contraceptive methods conducted for the whole group in one venue and more specific discussions by section for each of the nine provinces in separate venues. There was also intensive training in adult anthropometric measurements, taking blood pressure and measuring lung capacity. Some 175 candidates were recruited for field work. Each province had 1 or 2 managers who were responsible, under the supervision of 2 part-time regional managers, for the fieldwork operation in that province. Each province had 3 teams of female interviewers who were selected on the basis of education, maturity, field experience and language spoken. The Eastern Cape had 7 teams and KwaZulu-Natal had 5 teams as they had larger sample sizes. Team leaders supervised the teams and ensured the work flow. Each province had 2 centrally based editors who screened all the questionnaires before they were submitted to the office for processing. Fieldwork commenced in late January 1998 and was completed in September 1998. Immediately before the fieldwork, information about the survey was released through the national media including TV, radio and newspapers. A community liaison strategy was developed in each province using local media to precede work in the different areas. Quality control In the course of the fieldwork, quality control measures were instituted at three levels. First, field team leaders and editors were trained to identify the enumerator areas included in the sample and guide interviewers in the selection of dwellings for interviews. Secondly, approximately 10 percent of the sample were re-visited in the months of the interview to ensure that the appropriate dwellings were selected and interviewed. Thirdly, a team consisting of staff from the HSRC carried out independent quality control visits to check questionnaires for errors, quality of identification and interviews at the enumerator area and dwelling levels. Data processing The questionnaires were processed at the Medical Research Council offices in Cape Town. Office editors checked the clusters for completeness and open-ended questions were coded. The completeness and consistency of the information was checked before the data were entered onto the computer using ISSA (Integrated System for Survey Analysis). A small proportion of the questionnaires were returned to the field to complete missing information. 7 Table 1.1 Sample results Number of households, number of interviews and response rates, South Africa 1998 ____________________________________________________ Result Number Percent ____________________________________________________ Households selected Households occupied Households absent for extended period Dwelling vacant/destroyed Households occupied Households interviewed Households not interviewed Eligible women Women interviewed Women not interviewed Eligible adults Adults interviewed Adults not interviewed 12,860 100.0 12,638 98.3 76 0.6 146 1.1 12,638 100.0 12,247 96.9 391 3.1 12,327 100.0 11,735 95.2 592 4.8 14,928 100.0 13,827 92.6 1,101 7.4 Response rate Of the total 972 PSUs that were selected, fieldwork was not implemented in three PSUs due to concerns about the safety of the interviewers and the questionnaires for another three PSUs were lost in transit. The data file contains information for a total of 966 PSUs. A total of 12,860 households was selected for the sample and 12,247 were successfully interviewed. The shortfall is primarily due to refusals and to dwellings that were vacant or in which the inhabitants had left for an extended period at the time they were visited by interviewing teams. Of the 12,638 households occupied 97 percent were successfully interviewed. In these households, 12,327 women were identified as eligible for the individual women’s interview (15-49) and interviews were completed with 11,735 or 95 percent of them. In the one half of the households that were selected for inclusion in the adult health survey 14,928 eligible adults age 15 and over were identified of which 13,827 or 93 percent were interviewed. The principal reason for non- response among eligible women and men was the failure to find them at home despite repeated visits to the household. The refusal rate was about 2 percent. 1The household was defined as a person or a group of related or unrelated persons who live together in the same dwelling and share meals. 8 Table 2.1 Household population by age, residence and sex Percent distribution of the de-facto household population by five-year age group, according to sex and residence, South Africa 1998___________________________________________________________________________________________________ Urban Non-urban Total_______________________ ______________________ _____________________ Age group Male Female Total Male Female Total Male Female Total___________________________________________________________________________________________________ 0-4 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 + Missing/Don't know Total Number 9.6 8.9 9.2 13.6 11.6 12.6 11.4 10.2 10.8 11.5 10.0 10.7 16.8 14.6 15.7 13.9 12.1 13.0 12.1 11.5 11.8 18.4 15.8 17.0 14.9 13.5 14.2 10.6 8.6 9.5 12.4 8.8 10.4 11.4 8.7 10.0 9.3 8.7 9.0 7.6 7.4 7.5 8.5 8.1 8.3 8.1 8.1 8.1 4.9 6.0 5.5 6.7 7.1 6.9 7.2 7.8 7.5 3.7 5.0 4.4 5.6 6.5 6.1 7.0 7.4 7.2 4.0 5.0 4.5 5.6 6.3 6.0 5.6 5.9 5.8 3.9 3.9 3.9 4.8 5.0 4.9 5.0 4.4 4.7 2.5 2.9 2.7 3.8 3.8 3.8 4.1 5.6 4.9 2.4 4.3 3.4 3.4 5.0 4.2 3.2 3.7 3.5 2.2 3.4 2.9 2.8 3.6 3.2 2.3 3.2 2.8 2.3 3.6 3.0 2.3 3.4 2.9 2.0 2.3 2.2 2.2 2.8 2.5 2.1 2.6 2.3 1.0 1.6 1.3 1.4 2.0 1.7 1.1 1.8 1.5 0.8 1.1 1.0 1.0 1.3 1.2 0.9 1.2 1.0 0.5 1.0 0.8 0.7 1.2 1.0 0.6 1.1 0.9 0.2 0.1 0.2 0.2 0.1 0.2 0.2 0.1 0.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 13,314 14,930 28,254 10,901 12,712 23,640 24,215 27,643 51,894 ___________________________________________________________________________________________________ 1 Total includes 36 persons for whom sex is missing CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Distribution of Household Population by Age and Sex The 1998 SADHS collected information on the demographic and social characteristics of all usual residents and visitors who spent the night preceding the interviews at the selected residence.1 The distribution of the SADHS household population is shown in Table 2.1 by five-year age groups, according to sex and urban/non-urban residence. Fifty-three percent of the household population are females, while males constitute nearly 47 percent of the population. Thirty-eight percent of the population are 15 years while nearly 6 percent are over 65 years. The median age of the SADHS population is 21.2 years (also see Table 2.2). The non-urban population is younger than the urban population. Besides relatively higher fertility in the past, this could be due to parents in urban areas sending young children to non-urban areas for care. 9 Figure 2.1 The age-sex distribution of the SADHS household population is shown graphically in Figure 2.1. The population pyramid has a relatively broad base that is typical of a “young” population. The inward tapering of the younger categories is visible and indicates a reduction in fertility (see Chapter 3). To examine the age structure further, the age structure of the SADHS population was compared to the 1996 census population (excluding the institutional population (see Table 2.2). Differences that exist between these structures, suggest the general difficulties of enumerating hard-to-reach individuals, such as mobile young adults. Table 2.2 Comparison of broad age structures Age structure of the SADHS compared with the 1996 age structure. Broad age groups Comparative surveys (%) SADHS, 1998 Population census, 1996a Less than 15 15-64 65+ Missing/Don’t know Total Median age 37.9 56.3 5.7 0.2 100.0 21.2 33.9 60.2 4.7 1.2 100.0 Sources: (a) Stats SA, 1998 10 Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children, according to residence, South Africa 1998 _________________________________________________ Characteristic Urban Non-urban Total _________________________________________________ Household headship Male Female Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size Percent with foster children 1 63.8 50.0 58.1 36.2 50.0 41.9 12.9 10.7 12.0 17.4 12.1 15.2 17.9 13.8 16.2 18.4 14.9 16.9 13.4 13.9 13.6 7.9 12.2 9.7 5.0 8.3 6.4 2.9 5.2 3.9 4.2 8.8 6.1 100.0 100.0 100.0 3.9 4.7 4.2 16.6 34.3 23.9 _________________________________________________ Note: Table is based on de jure members; i.e., usual residents. 1 Foster children are children under age 15 living in households with neither their mother nor their father present. 2.2 Household Composition Table 2.3 shows that a large proportion (42 percent) of South African households are headed by women. In non-urban areas, half of all households have females as de facto heads. This phenomenon is partly explained by the absence of males due to their involvement in migrant labour. In urban areas the proportion of households headed by females is somewhat lower at 36 percent. The average household size is 4.2; non-urban households on average are larger (4.7) than urban households (3.9). Twenty-four percent of households have foster children (individuals under 15 years of age who have no natural parents in the household). In urban areas the proportion of households with foster children is 17 percent, while it is double that in non-urban areas (34 percent). Detailed information on fosterhood and orphanhood of children under 15 years of age is presented in Table 2.4. Only about one-third of children live with both parents. Even amongst children under age two years, two-thirds live in households with either only one or no parent present. Nearly 35 percent of all children under 15 live with only their mother present, while 3 percent live with their fathers only. Twenty-five percent of children live in households with neither parent present. Possible explanations for this high rate of fosterhood include the cultural norms of young unmarried mothers sending children back to their mothers (grandmothers) for care and also general marital instability and the widespread system of labour migration. 11 Table 2.4 Fosterhood and orphanhood Percentage distribution of de jure children under age 15 by survival of parents and child's living arrangements, according to child's age, sex, residence, and province, South Africa 1998________________________________________________________________________________________________________ Living Living with mother with father but not father but not mother Not living with either parent Missing Living ____________ _____________ ________________________ infor- with Father Mother mation Number Background both Father Father Mother Mother Both only only Both on father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children____________________________________________________________________________________________________ Age <2 3-5 6-9 10-14 Sex Male Female Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 33.3 45.4 2.4 1.7 0.1 12.1 0.4 0.5 0.2 3.8 100.0 3,269 34.1 33.7 3.8 1.9 0.2 19.5 0.8 2.0 0.4 3.6 100.0 3,529 32.9 27.4 5.0 2.6 0.3 23.1 1.0 2.7 0.6 4.4 100.0 5,539 32.0 21.9 6.6 3.1 0.7 23.0 1.4 3.9 1.3 6.1 100.0 7,366 33.0 29.3 4.9 2.8 0.4 20.1 1.0 2.9 0.8 4.8 100.0 9,748 32.6 29.7 5.0 2.3 0.4 21.0 1.0 2.4 0.7 4.8 100.0 9,923 42.0 25.1 4.9 2.6 0.6 15.1 1.1 2.3 0.8 5.5 100.0 8,993 25.1 33.1 5.0 2.4 0.2 25.2 1.0 2.9 0.8 4.2 100.0 10,710 51.8 22.8 4.8 2.0 1.3 9.0 0.7 1.3 0.8 5.4 100.0 1,518 22.0 28.7 5.6 2.5 0.4 31.5 1.1 3.9 1.1 3.3 100.0 3,534 39.3 29.3 4.1 2.0 0.4 17.0 1.3 2.6 0.5 3.4 100.0 374 39.0 23.6 5.2 1.9 0.7 22.1 1.3 2.1 0.7 3.3 100.0 1,146 30.6 28.6 5.5 4.0 0.3 20.6 1.4 3.0 1.0 5.1 100.0 4,457 35.4 28.1 4.5 1.9 0.2 21.0 0.6 1.6 1.0 5.8 100.0 1,540 45.6 24.7 4.4 2.2 0.3 12.3 0.9 2.1 0.3 7.2 100.0 2,899 30.5 31.9 2.6 2.3 0.6 24.8 1.4 2.0 0.8 3.3 100.0 1,388 23.0 42.2 5.3 1.6 0.0 19.4 0.6 2.9 0.5 4.4 100.0 2,849 32.8 29.5 5.0 2.5 0.4 20.6 1.0 2.7 0.8 4.8 100.0 19,703 ____________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. 2.3 Educational Level of Household Members The educational level of the household population six years and older is shown in Table 2.5. The information contained in the table reflects the highest level of education completed, according to age, urban/non-urban residence and province. In addition, the table provides the median years of education completed according to these background characteristics. Educational levels are slightly higher for males than females. Only 11 percent of men have never been to school, compared to 14 percent of women. Only a small percentage of the younger generation (ages 10-19) have no schooling at all. Urban residents are generally better educated than non-urban residents. Gauteng and the Western Cape – the two most developed provinces in the country - have conspicuously lower proportions of respondents with no educational qualifications (only 5 percent). A relatively large proportion of the household members have only attained some form of primary school education: 41 percent of females and 44 percent of males. Nearly 45 percent of males have attained a secondary education qualification, a level only marginally higher than that of females (44 percent). Only about 5 percent of both females and males have completed some form of tertiary education. The drop-out rates in primary and secondary schools are relatively high. The median years of schooling is only six years. Of note is the steady increase in the median years of schooling from older to younger age cohorts. For example, compared to those aged 55-59, the median years of schooling of the age cohort 20-24 years had approximately doubled to 10 years. 12 Table 2.5 Educational level of the female and male household population Percentage distribution of the de facto female and male household population age six and over by highest level of education completed, and median number of years of schooling, according to selected background characteristics, South Africa 1998___________________________________________________________________________________________________________ Level of education Number Median _________________________________________________________________________________________ of number of Background No Sub A- Std 4- Std 6- Don’t know/ women/ years of characteristics education Std 3 Std 5 Std 9 Std 10 Higher missing Total men schooling ____________________________________________________________________________________________________________ FEMALE ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 23.1 75 .5 0 .1 0 .0 0 .0 0 .0 1 .3 100 .0 2,764 0 .9 1 .2 51 .1 32 .6 14 .9 0 .0 0 .0 0 .2 100 .0 3,724 4 .9 1 .3 5 .1 14 .9 67 .4 7 .8 3 .3 0 .2 100 .0 2,397 8 .7 2 .0 5 .6 9 .0 45 .1 28 .9 9 .1 0 .3 100 .0 2,243 10 .3 4 .1 10 .4 10 .6 38 .0 25 .3 11 .2 0 .4 100 .0 1,966 9 .8 7 .5 13 .2 15 .4 36 .1 17 .7 9 .0 1 .1 100 .0 1,790 8 .6 11 .3 13 .2 15 .1 35 .9 15 .0 8 .4 1 .1 100 .0 1,747 7 .9 13 .7 18 .6 17 .0 32 .5 10 .7 6 .8 0 .7 100 .0 1,374 7 .0 18 .3 18 .8 15 .5 31 .3 7 .0 7 .8 1 .2 100 .0 1,039 6 .6 22 .2 18 .4 18 .0 28 .2 6 .6 4 .9 1 .7 100 .0 1,392 6 .0 28 .6 19 .5 13 .8 25 .4 6 .7 4 .6 1 .4 100 .0 988 5 .2 36 .3 20 .1 13 .1 21 .8 3 .9 2 .2 2 .5 100 .0 932 3 .7 44 .7 19 .3 10 .3 17 .7 3 .3 3 .0 1 .6 100 .0 1,853 2 .0 7 .5 21 .0 14 .4 34 .6 14 .0 7 .4 1 .1 100 .0 13,334 7 .6 21 .3 32 .5 15 .5 23 .4 4 .8 1 .7 0 .8 100 .0 10,913 4 .4 5 .6 20 .4 16 .4 36 .0 12 .2 6 .4 3 .0 100 .0 2,288 7 .5 15 .0 30 .3 17 .6 27 .2 5 .9 3 .8 0 .2 100 .0 3,846 5 .6 15 .4 26 .0 18 .6 27 .3 9 .1 3 .3 0 .3 100 .0 506 6 .1 13 .4 27 .4 16 .6 29 .8 8 .3 4 .2 0 .3 100 .0 1,538 6 .1 16 .5 29 .7 14 .3 25 .6 9 .2 3 .8 0 .8 100 .0 5,127 5 .5 16 .2 26 .4 15 .1 28 .6 8 .2 4 .6 0 .9 100 .0 1,955 6 .0 4 .8 19 .2 12 .7 36 .8 17 .5 7 .9 1 .0 100 .0 4,499 8 .3 18 .2 27 .6 14 .6 26 .4 8 .6 3 .8 0 .8 100 .0 1,587 5 .5 22 .7 28 .6 13 .2 25 .7 5 .0 3 .5 1 .2 100 .0 2,900 4 .7 13 .7 26 .2 14 .9 29 .5 9 .8 4 .8 1 .0 100 .0 24,247 6 .4 __________________________________________________________________________________________________________ MALE ____________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 27.4 71.6 0.1 0.0 0.0 0.0 0.9 100.0 2,747 0.7 2.1 61.0 26.2 10.2 0.0 0.0 0.5 100.0 3,618 4.3 1.2 10.6 19.0 61.0 6.5 1.3 0.4 100.0 2,765 8.1 2.4 7.8 10.0 43.7 26.8 8.8 0.6 100.0 2,062 10.0 3.7 10.4 11.1 37.8 25.2 11.1 0.7 100.0 1,613 9.8 4.7 11.9 11.8 36.9 22.8 10.7 1.2 100.0 1,364 9.3 5.8 13.7 16.0 34.3 17.8 10.3 2.1 100.0 1,361 8.7 9.6 18.4 15.3 34.2 12.2 10.1 0.3 100.0 1,170 7.5 10.3 19.5 13.5 32.3 13.4 9.0 1.9 100.0 928 7.4 15.6 16.2 13.4 31.5 10.8 9.1 3.4 100.0 812 7.2 21.5 21.3 13.3 25.2 8.5 8.2 2.0 100.0 667 6.2 32.1 17.5 11.2 24.1 7.3 5.7 2.1 100.0 556 4.8 38.5 20.3 9.0 17.6 5.9 5.6 3.1 100.0 1,127 3.1 6.0 23.0 13.2 33.2 15.0 8.1 1.5 100.0 11,761 7.7 16.5 37.8 15.0 23.1 4.9 1.8 0.9 100.0 9,080 4.4 5.2 23.7 15.2 33.7 11.7 6.9 3.6 100.0 2,204 7.4 13.8 36.3 16.3 23.8 6.0 3.6 0.2 100.0 3,170 5.0 14.0 27.5 16.4 28.4 9.5 4.0 0.2 100.0 436 6.1 10.0 30.4 13.8 29.8 9.1 6.4 0.5 100.0 1,396 6.5 12.5 30.9 13.3 26.6 11.3 4.3 1.2 100.0 4,351 6.0 13.7 29.6 14.4 29.5 8.1 3.6 1.0 100.0 1,755 5.9 4.8 22.0 11.5 33.5 17.9 9.1 1.3 100.0 3,945 8.3 14.5 31.0 13.8 27.1 9.8 2.6 1.2 100.0 1,370 5.6 12.8 34.7 14.9 27.0 5.4 4.0 1.2 100.0 2,214 5.3 10.6 29.5 14.0 28.8 10.6 5.3 1.2 100.0 20,841 6.4 ___________________________________________________________________________________________________________ Note: Total includes 38 women and 51 men for whom age is missing 13 Table 2.6 School attendance Percentage of the de facto household population age 6-24 years in school, by age, sex, and residence, South Africa 1998 __________________________________________________________________________________________________________ Male Female Total _________________________ _________________________ ________________________ Age Urban Non-urban Total Urban Non-urban Total Urban Non-urban Total __________________________________________________________________________________________________________ 6-10 11-15 6-15 16-20 21-24 91.0 84.9 87.6 91.5 87.9 89.5 91.3 86.4 88.6 94.9 93.4 94.1 95.6 94.0 94.8 95.2 93.7 94.4 93.0 89.1 90.9 93.6 91.0 92.2 93.3 90.0 91.5 71.2 77.0 74.0 67.1 70.2 68.5 69.3 73.9 71.4 23.9 34.2 27.8 26.2 27.8 26.9 25.1 30.6 27.3 2.4 School Attendance School attendance ratios by age group, sex and residence for the population aged 6-24 are presented in Table 2.6. The school attendance ratio is the number of persons in a specific age group who are in school per hundred persons in that particular age group. Nearly 92 percent of children aged 6-15 are in school, with urban attendance higher than non-urban (93 versus 90 percent). In this age group, slightly more girls than boys are in school (92 versus 91 percent). Attendance rates among age group 11-15 are higher than for the 6-10 age group. 2.5 Grants and Pensions Received by the Households Table 2.7 shows the prevalence of grants made to members of the household. Grants are defined as alimony, compensation for injuries, and state pensions. Less than 2 percent of the population below 25 years receive grants. The proportion receiving some kind of grant increases rapidly after age 50. In the case of women, 66 percent of those 60-64 receive a grant, while the proportion rises to 81 percent of those age 65 and older. For the males, the percentages are 28 and 66, respectively. 14 Table 2.7 Grants and pensions, employment status, recent injuries Percent distribution of the de-facto male and female household population, by whether receiving a government grant or pension, whether currently working, and whether injured in the 30 days preceding the survey, South Africa 1998 ___________________________________________________________________________________________________________ Receiving grant/pension Working Injured in last month ________________________ ________________________ ________________________ Background Don’t know/ Don’t know/ Don’t know/ characteristic Yes No missing Yes No missing Yes No missing Total Number ____________________________________________________________________________________________________________ FEMALE ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 1.6 97.4 1.0 0.0 0.0 0.0 0.3 97.3 2.4 100.0 2, 764 1.8 97.4 0.8 1.0 92.5 6.4 0.5 98.1 1.4 100.0 3, 724 1.5 98.2 0.3 4.9 92.3 2.8 0.7 98.4 1.0 100.0 2, 397 1.2 98.7 0.1 16.9 80.9 2.2 0.5 99.1 0.4 100.0 2, 243 1.4 98.2 0.3 31.1 67.0 1.8 0.6 98.3 1.1 100.0 1, 966 3.2 96.4 0.4 37.8 60.2 2.1 0.6 98.8 0.6 100.0 1, 790 2.9 96.4 0.8 41.8 56.1 2.0 1.1 98.0 0.9 100.0 1, 747 4.5 95.1 0.5 42.6 55.7 1.7 1.2 98.2 0.6 100.0 1, 374 5.9 93.5 0.6 40.0 57.4 2.6 0.9 98.1 1.0 100.0 1, 039 8.9 90.6 0.4 35.7 62.0 2.4 1.1 97.7 1.2 100.0 1, 392 18.4 81.1 0.5 26.0 72.9 1.2 1.2 98.1 0.7 100.0 988 65.9 34.0 0.1 8.8 87.4 3.9 1.1 97.8 1.2 100.0 932 80.9 18.6 0.5 3.2 93.2 3.6 1.4 97.8 0.9 100.0 1, 853 10.9 88.5 0.6 25.2 63.2 2.4 0.9 97.8 1.3 100.0 13, 334 12.9 86.6 0.6 10.1 72.6 3.2 0.5 98.5 1.0 100.0 10, 913 11.8 87.8 0.4 33.3 55.1 3.0 0.9 98.7 0.4 100.0 2, 288 15.4 84.4 0.2 10.7 74.7 1.1 0.6 99.1 0.4 100.0 3, 846 20.0 79.7 0.3 20.6 67.9 1.0 0.6 98.8 0.6 100.0 506 12.8 87.1 0.1 24.1 65.7 0.1 0.4 99.6 0.1 100.0 1, 538 12.5 86.9 0.6 15.3 68.9 3.6 0.5 96.9 2.7 100.0 5, 127 11.6 88.0 0.4 16.0 68.1 3.4 0.7 98.5 0.8 100.0 1, 955 7.7 91.5 0.8 26.8 62.1 2.7 1.6 97.0 1.4 100.0 4, 499 9.6 90.1 0.3 15.4 68.8 3.3 0.4 98.8 0.7 100.0 1, 587 11.6 87.2 1.3 9.1 72.6 4.3 0.6 98.7 0.7 100.0 2, 900 11.8 87.6 0.6 18.4 67.4 2.8 0.8 98.1 1.1 100.0 24, 247 __________________________________________________________________________________________________________ MALE ____________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 1.2 97.8 1.0 0.0 0.0 0.0 0.7 97.4 1.9 100.0 2,747 1.9 97.2 0.9 0.7 92.0 7.3 0.8 98.0 1.3 100.0 3,618 1.8 97.5 0.7 6.1 90.1 3.8 1.1 97.9 1.0 100.0 2,765 1.2 98.4 0.3 29.1 68.7 2.2 1.2 98.1 0.7 100.0 2,062 2.7 96.9 0.4 54.4 44.3 1.3 1.6 97.6 0.8 100.0 1,613 2.8 97.0 0.2 64.6 34.0 1.4 1.8 97.7 0.5 100.0 1,364 3.0 96.6 0.4 67.2 30.3 2.5 2.5 97.1 0.4 100.0 1,361 4.8 94.7 0.5 63.6 33.8 2.6 2.5 97.4 0.1 100.0 1,170 5.9 93.9 0.2 63.7 35.0 1.2 2.6 97.0 0.5 100.0 928 9.4 90.3 0.3 61.1 37.7 1.2 3.6 95.8 0.5 100.0 812 10.2 89.6 0.2 49.5 48.8 1.7 1.8 97.7 0.5 100.0 667 28.0 71.9 0.1 33.7 64.7 1.6 1.1 98.5 0.4 100.0 556 66.1 33.5 0.4 10.8 85.0 4.3 1.7 97.7 0.6 100.0 1,127 6.8 92.7 0.5 36.3 50.4 2.6 1.9 97.2 1.0 100.0 11,761 7.3 92.1 0.6 18.5 61.4 3.5 1.0 98.2 0.8 100.0 9,080 8.3 91.3 0.3 45.7 41.8 3.7 2.8 96.7 0.5 100.0 2,204 9.2 90.6 0.2 15.9 67.1 1.1 1.2 98.5 0.3 100.0 3,170 15.9 83.8 0.3 36.4 51.2 0.8 1.4 98.1 0.5 100.0 436 7.3 92.6 0.1 30.5 56.0 0.2 0.7 99.2 0.1 100.0 1,396 7.0 92.3 0.7 26.3 56.1 4.3 1.2 96.9 1.9 100.0 4,351 6.0 93.3 0.7 28.2 56.1 3.3 0.8 98.0 1.2 100.0 1,755 4.1 95.1 0.8 38.8 47.7 2.5 2.2 96.8 1.0 100.0 3,945 6.9 92.8 0.4 27.5 54.0 3.6 1.6 97.6 0.7 100.0 1,370 6.5 92.3 1.2 13.7 63.8 4.7 0.8 98.8 0.4 100.0 2,214 7.0 92.4 0.6 28.5 55.2 3.0 1.5 97.6 0.9 100.0 20, 841 __________________________________________________________________________________________________________ Note: Total includes 38 women and 51 men for whom age is missing 15 2.6 Housing Characteristics Type of housing The housing characteristics of the households included in the SADHS sample are shown in Table 2.8. These environmental characteristics have important implications for exposure to disease and also reflect at the same time household economic status. Fifty-one percent of all homes have plaster as the main wall finish. In urban areas where many shack settlements are located, 16 percent of the homes have plastic, cardboard or corrugated iron as the main wall material. In non-urban areas, mud and plaster are the most commonly used wall materials. The SADHS collected information on the number of rooms used for sleeping as a measure of overcrowding. The mean number of persons per room used for sleeping is 2.1. This average is slightly higher for non-urban areas (2.3 persons per room) than urban areas (2.0). Respondents in just over half (52 percent) of all households say they never go hungry. while almost one-third say they sometimes go hungry and 11 percent report that their households often experience hunger. Hunger is more of a problem in non-urban than urban households. Fifty-six percent of non-urban households experience hunger sometimes or often compared to only 33 percent of urban households. 16 Table 2.8 Housing characteristics Percent distribution of households by housing character- istics, according to residence, South Africa 1998 _______________________________________________ Residence _________________ Characteristic Urban Non-urban Total _______________________________________________ Electricity Yes No Missing/Don't know Total Fuel used for cooking1 Electricity Gas Paraffin Wood Coal Animal dung Other Source of drinking water Piped into residence Piped water in site/yard Public tap Borehole/well Dam/river/stream/spring Rain-water tank Water carrier/tanker Bottled water Other Missing Total Time to water source <15 minutes Sanitation facility Own flush toilet Shared flush toilet Traditional pit toilet Vent. improved pit latrine No facility Other Missing/Don’t know Total 84.2 37.1 64.9 15.4 62.3 34.6 0.4 0.7 0.5 100.0 100.0 100.0 73.1 22.6 52.4 8.4 6.0 7.4 29.0 39.5 33.3 4.9 55.6 25.7 8.9 8.5 8.7 0.1 2.1 0.9 0.8 0.1 0.5 59.0 10.0 38.9 27.6 16.5 23.0 11.3 31.3 19.5 0.2 7.0 3.0 0.2 28.5 11.8 0.0 1.6 0.7 0.3 1.8 1.0 0.1 0.2 0.1 0.6 2.5 1.4 1.0 1.0 1.0 100.0 100.0 100.0 95.4 55.2 79.0 73.1 6.9 46.0 6.5 0.7 4.1 8.0 3.1 6.0 9.5 62.5 31.2 2.0 25.6 11.6 0.4 0.4 0.4 0.6 0.7 0.7 100.0 100.0 100.0 Table 2.8 Housing characteristics.continued _______________________________________________ Residence _________________ Characteristic Urban Non-urban Total_______________________________________________ Main floor material Mud. sand. dung Wood planks Cement Vinyl Carpet Ceramic tile Parquet/polish wood Other Missing/Don’t know Total Main wall material Plastic/Cardboard Mud Mud and cement Corrugated iron/zinc Prefab Bare brick/Cement block Plaster/Finished Other Missing Total Frequency of household hunger Often Sometimes Seldom Never Missing Total Persons per sleeping room 1-2 3-4 5-6 7+ Missing /Don’t Know Total Mean Total 4.8 32.1 16.0 1.7 0.7 1.3 24.0 46.1 33.1 24.1 10.6 18.5 29.4 8.1 20.7 11.5 0.9 7.2 3.2 0.6 2.1 0.6 0.1 0.4 0.8 0.7 0.8 100.0 100.0 100.0 4.6 0.6 3.0 2.3 31.5 14.3 4.1 15.8 8.9 11.4 3.2 8.0 0.5 0.2 0.4 10.3 14.3 12.0 64.1 31.6 50.8 1.3 0.8 1.1 1.3 2.0 1.6 100.0 100.0 100.0 8.2 14.7 10.8 24.4 41.7 31.5 4.6 4.2 4.5 61.2 37.9 51.6 1.6 1.5 1.6 100.0 100.0 100.0 78.5 70.9 75.4 16.2 20.5 18.0 3.3 5.4 4.2 1.0 1.8 1.3 0.9 1.5 1.1 100.0 100.0 100.0 2.0 2.3 2.1 7,227 5,020 12,247 _______________________________________________ 1 May add to more than 100. since multiple answers were allowed. Almost two in three South African households have access to electricity. There is a significant difference in access to electricity between urban and non-urban areas in the country. Only 37 percent of non-urban households have electricity, compared to 84 percent of urban households (see Figure 2.2). 17 0 25 50 75 100 Percent TOTAL RURAL URBAN Electricity No electricity Figure 2.2 Access to electricity, South Africa 1998 Just over half (52 percent) of all South African households use electricity as the main source of energy for cooking, while one-third use paraffin and one-quarter use wood (see Table 2.9). Nearly three-quarters (73 percent) of urban households use electricity as source of energy for cooking and 29 percent use paraffin. Fifty-six percent of non-urban households use wood as their main source of energy for cooking. 2.7 Water and Sanitation Thirty-nine percent of all households have piped water in the residence and 23 percent have piped water in the yard or on the site. For urban households, piped water in the residence is the main source of drinking water (59 percent). Only 10 percent of non-urban residents get their drinking water from piped water in their residences. Public taps are the main source of drinking water for 31 percent of non-urban households. The overwhelming majority of urban households are within 15 minutes of a source of drinking water, compared to 55 percent of non- urban households. A large proportion of households in non-urban areas do not have access to potable water in their dwellings or on their stands. Hence it has to be fetched, sometimes from a distant source, a task usually undertaken by women or younger children. Table 2.9 shows the percentage of households that fetch their drinking water and, of these, a breakdown by the person(s) who fetched water the day before the survey and the average time it takes to fetch the water and return. From the table it is clear that many households have no choice but to fetch water. Three provinces have markedly high proportions of households that have to fetch water, namely the Northern Province (62 percent), the Eastern Cape (59 percent) and KwaZulu-Natal (54 percent). The findings indicate that it is mainly women who are burdened with the task of fetching water. For example, in the Eastern Cape, among the households that fetch their drinking water, 76 percent said water was fetched by 18 women, compared to only 14 percent who said water was fetched by men. This burden is exacerbated by the amount of time it takes to fetch water. The Eastern Cape and KwaZulu-Natal have the largest proportion (40 percent or more) of households that spend 30 minutes or longer to fetch water. Eighty-seven percent of South African households have toilet facilities. The majority of urban households (80 percent) have flush toilets. Most non-urban households (66 percent) have pit latrines. About one-quarter of non- urban households do not have toilet facilities (see Table 2.10). Table 2.9 Fetching water Percentage of households that fetch drinking water, persons who fetched water the day before the interview and percent distribution of households by time taken to collect water, according to background characteristics, South Africa 1998 Among those households, percentage who said water was fetched yesterday by: Time taken to collect water Characteristic % house- holds that fetched water Woman Man Girl Boy <15 min 15-29 min 30+ min Number Residence Urban 12.4 65.8 27.1 12.8 8.0 70.6 17.0 12.4 892 Non-urban 69.3 68.0 17.3 20.2 10.2 39.0 23.5 37.5 3,476 Province Western Cape 3.8 (39.9) (52.3) (2.7) (5.1) (64.7) (22.6) (12.7) 47 Eastern Cape 59.3 75.7 13.9 23.5 7.7 35.9 23.7 40.4 1,096 Northern Cape 10.1 46.5 42.6 8.2 11.8 72.9 8.6 18.5 27 Free State 11.3 62.3 27.4 13.4 6.5 71.6 22.7 5.6 183 KwaZulu-Natal 54.3 65.7 17.0 24.0 12.8 33.4 24.5 42.1 1,314 North West 41.0 55.8 43.4 11.0 11.9 61.6 22.4 15.9 405 Gauteng 11.5 72.3 21.3 7.6 5.3 84.5 9.6 5.9 294 Mpumalanga 32.8 62.7 29.8 21.8 11.2 58.6 17.1 24.3 242 Northern 62.1 68.9 14.1 12.5 8.4 43.8 22.7 33.5 760 Total 35.8 67.6 19.3 18.7 9.8 45.5 22.1 32.4 4,368 Note: Parenthesis indicate that a figure is based on 25-49 respondents. 19 Table 2.10 Household durable goods Percentage of households possessing selected durable consumer goods, by residence, South Africa 1998 ____________________________________________________ Durable goods Urban Non-urban Total ____________________________________________________ Radio 84.5 73.5 80.0 Television 73.2 35.0 57.6 Telephone 43.3 6.1 28.0 Refrigerator 68.5 24.4 50.4 Bicycle 19.3 13.4 16.9 Personal computer 9.7 1.5 6.3 Washing machine 32.4 5.2 21.3 Motorcycle 2.2 1.3 1.8 Private car 34.3 11.8 25.1 Donkey/horse 0.3 5.3 2.4 Sheep/cattle 0.9 23.1 10.0 None of the above 8.0 16.7 11.6 Number of households 7,227 5,020 12,247 Table 2.11 Age distribution of women 1996 and 1998 Percentage distribution of women of reproductive age, South Africa, 1996 and 1998.__________________________________________________ . 1996 1998 Age group Census* SADHS __________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 19.5 19.2 18.9 17.7 16.9 15.8 14.7 14.1 12.5 13.9 10.1 11.0 7.1 8.3 100 100 ___________________________________________________ * Source: Statistics South Africa, 1998. 2.8 Household Durable Goods The presence of durable consumer goods is a measure of household socio-economic status. Table 2.10 shows the percent distribution of households by durable consumer goods owned, such as radios, television sets, telephones, and automobiles. A radio is available in 80 percent of households, a telephone in 28 percent, and an automobile in 25 percent. About 12 percent of the households do not have any of the durable consumer goods asked about in the survey. Ownership of durable goods differs by place of residence. Seventy-three percent of urban households have a television set, compared to 35 percent of non-urban households. Similarly, 69 percent of urban households have a refrigerator and 43 percent have a telephone, compared to 24 and 6 percent respectively of non-urban households. Overall, 8 percent of urban and 17 percent of non- urban households have none of the listed durable goods. 2.9 Characteristics of Women Aged 15-49 Years Age distribution A total of 11,735 women aged 15 to 49 were interviewed in the SADHS. They completed both a Woman's and Adult Health Questionnaire. In Table 2.11 below, their age distribution is compared with the age distribution of the women in reproductive ages in the 1996 Census. The two age schedules are fairly comparable. Also, no significant differences are apparent between the household population and individual respondents as a group in terms of age, residence, province and population group. The distributions of respondents to the women's questionnaire according to selected characteristics are presented in Table 2.11. 20 Table 2.12 Background characteristics of respondents Percent distribution of women aged 15-49 by selected background characteristics, South Africa 1998 ______________________________________________________ Number of women __________________ Background Weighted Un- characteristic percent Weighted weighted ______________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Marital status Never married Married Living together Widowed Divorced Not living together Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Missing Total 19.2 2,249 2,373 17.7 2,075 2,086 15.8 1,857 1,811 14.1 1,654 1,616 13.9 1,636 1,628 11.0 1,294 1,255 8.3 970 966 60.5 7,095 6,518 39.5 4,640 5,217 10.2 1,193 919 13.3 1,566 2,756 2.2 253 1,041 6.5 763 936 20.1 2,364 1,826 7.7 909 931 21.7 2,552 1,057 7.0 819 1,131 11.2 1,316 1,138 48.3 5,665 5,811 33.7 3,957 3,956 9.5 1,119 992 2.4 285 296 2.2 256 234 3.9 452 446 6.8 804 810 11.0 1,291 1,359 13.8 1,625 1,775 44.2 5,181 5,175 16.4 1,922 1,754 7.8 912 862 77.9 9,147 8,993 41.5 4,873 4,274 36.4 4,274 4,719 10.2 1,201 1,533 7.8 916 755 3.5 406 393 0.6 66 61 100.0 11,735 11,735 21 Table 2.13 Level of education Percent distribution of women aged 15-49 by the highest level of education completed and population group, according to selected background characteristics, South Africa 1998 __________________________________________________________________________________________________ Highest level of education completed Population group ________________________________________ _________________________________ Background No Sub A- Std 4- Std 6- characteristic education Std 3 Std 5 Std 9 Std 10 Higher African Coloured White Asian Total Number ___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Total 0.9 5.1 14.9 68.6 7.9 2.7 80.1 9.2 7.2 3.0 100.0 2,249 1.7 5.7 8.5 46.3 28.0 9.8 84.1 8.7 3.7 2.9 100.0 2,075 4.3 10.2 11.0 39.2 24.3 11.0 78.6 11.4 6.7 2.8 100.0 1,857 7.7 12.6 15.0 38.0 17.4 9.2 76.0 10.6 8.7 4.0 100.0 1,654 12.1 13.9 15.7 35.7 14.5 8.2 75.6 11.5 8.7 3.7 100.0 1,636 13.2 18.4 18.1 33.7 10.1 6.5 74.0 10.3 10.9 4.3 100.0 1,294 18.1 20.1 17.3 31.2 5.7 7.5 70.9 10.5 13.0 4.8 100.0 970 3.3 7.0 12.0 46.4 20.6 10.7 68.7 13.9 11.2 5.6 100.0 7,095 12.2 17.1 16.7 40.7 10.0 3.3 92.1 4.6 2.6 0.2 100.0 4,640 2.0 8.6 14.4 46.7 18.3 10.0 24.6 63.0 10.8 0.6 100.0 1,193 5.1 12.5 18.5 45.8 11.3 6.8 85.4 8.8 4.8 0.5 100.0 1,566 8.5 13.5 19.1 40.2 13.6 5.1 29.0 59.4 11.4 0.0 100.0 253 4.6 11.2 16.0 46.8 14.8 6.7 86.4 2.9 10.5 0.2 100.0 763 10.5 14.5 12.8 38.8 16.8 6.5 81.3 1.2 3.8 13.0 100.0 2,364 7.9 10.5 15.4 42.6 15.3 8.3 91.2 3.3 4.2 0.8 100.0 909 2.9 6.5 10.5 47.2 23.1 9.8 76.7 3.0 17.9 2.0 100.0 2,552 10.3 13.6 13.7 41.2 14.4 6.7 96.2 0.4 2.2 0.7 100.0 819 12.5 11.9 12.9 45.8 10.3 6.6 97.9 0.0 0.0 1.4 100.0 1,316 6.8 11.0 13.8 44.2 16.4 7.8 77.9 10.2 7.8 3.5 100.0 11,735 Educational level of women aged 15-49 years Twenty-four percent of women aged 15-49 have completed Standard 10 or have a higher qualification (Table 2.13). A clear cohort effect is observable in the educational attainment of women. The proportion of women who have received no education increases with age. Conversely, the proportion of women with a given educational level increases in each younger age category. A good example is the category Standard 6-9. Although the age group 15-19 cannot be considered due to the fact that they may not yet have completed their schooling (age censoring), 46 percent of the women in the age group 20-24 are found in this category. This proportion declines with age and in the age group 45-49 only 31 percent have attained this level. Regarding women who have completed Standard 10, the linear relationship between age and educational attainment remains constant. Considering the relatively low educational level of the majority of women in South Africa it is of interest to note the reasons that respondents provided for stopping schooling (Table 2.14). Two reasons predominate: “falling pregnant” is reported by 17 percent of women who failed to complete their primary education and 10 percent of women who failed to complete their secondary education. Socio-economic conditions and poverty are reported by 20 percent of women who did not complete primary education. 22 Table 2.14 Reasons for leaving school Percent distribution of women aged 15-24 who had ever attended school by reason for leaving school, according to highest level of education completed, South Africa 1998 _________________________________________________________________________________ Highest level of education _____________________________________________ Reason stopped Primary Primary Secondary Secondary attending school incomplete complete incomplete complete Higher Total _________________________________________________________________________________ Currently attending 38.2 61.0 71.3 28.7 47.5 58.3 Got pregnant 17.2 12.3 10.4 5.4 2.4 9.8 Got married 4.3 3.8 2.0 1.3 0.0 2.1 Take care of children 0.9 1.8 0.8 0.7 0.2 0.8 Family need help 1.2 0.1 0.3 0.8 0.0 0.5 Could not pay school fees 17.4 8.1 4.3 20.8 5.1 8.8 Need to earn money 2.6 2.7 2.1 11.6 2.1 3.9 Graduated. enough 0.1 0.3 0.3 21.5 35.5 6.2 Did not pass exams 0.6 0.5 0.9 1.5 0.0 0.9 Did not like school 4.3 3.1 2.1 0.2 0.5 2.0 School not accessible 1.1 0.0 0.2 0.2 0.0 0.3 Other 9.4 5.7 3.3 4.5 2.6 4.3 Missing 2.7 0.7 1.9 2.6 4.2 2.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 396 349 2 503 759 264 4,271 Marital status The age distribution of women according to their marital status is shown in Table 2.15. Forty-eight percent of women of reproductive age have never married or are not currently living in a union. In the age group 25- 29, 47 percent of women have not yet married, while almost 12 percent of women aged 45-49 have never been married. Figure 2.3 shows women included in the sample by marital status. Only one-third of women aged 15-49 are currently married. The proportion married increases steadily with age. Between ages 35 and 49 the proportion married stabilises at just below 60 percent. Approximately 10 percent of all women are cohabiting with a man and 6 percent of the respondents are either divorced or separated. Table 2.15 Current marital status Percent distribution of women by current marital status, according to age, South Africa 1998 Age groups Current marital status Total Never married Married Living together Widowed Divorced Separated Total Number 15-19 20-24 25-29 30-34 35-39 40-44 45-49 95.9 75.4 46.5 28.9 18.5 14.6 11.5 1.2 11.9 34.2 49.3 58.0 55.4 58.8 2.0 10.5 14.3 11.7 10.1 11.5 8.5 0.0 0.1 0.8 2.1 3.6 6.4 9.7 0.0 0.3 1.0 2.9 3.7 4.9 6.1 0.9 1.8 3.2 5.2 6.2 7.3 5.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,249 2,075 1,857 1,654 1,636 1,294 970 Total 48.3 33.7 9.5 2.4 2.2 3.9 100.0 11,735 23 Table 2.16 Polygyny Percentage of currently married women in a polygynous union, by age and selected background characteristics, South Africa 1998_________________________________________________________________________ Age group ____________________________________________ Background All characteristic 20-24 25-29 30-34 35-39 40-44 45-49 women_________________________________________________________________________ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 6.7 10.7 11.9 8.5 8.4 8.7 9.6 12.5 10.5 19.8 15.8 24.0 18.3 16.8 (7.6) 8.0 6.3 4.1 2.7 1.9 5.1 4.9 4.2 3.5 5.5 4.9 4.9 4.6 (4.5) 7.3 8.8 9.5 9.3 5.5 7.8 14.3) 5.0 5.9 9.0 3.0 (10.7) 7.3 13.0 9.2 22.4 14.8 28.8 17.5 17.9 (7.2) 10.8 15.9 10.8 13.8 (14.6) 12.7 (6.8) 13.5 16.5 9.9 9.7 11.4 11.9 12.3) 14.1 23.8 21.1 27.9 20.7 20.7 11.4 14.8 20.8 19.0 28.0 19.1 18.9 * (23.1) 25.3 29.1 32.1 18.9 26.3 (17.3) 15.2 27.9 17.1 16.2 20.4 19.1 11.2 7.8 11.5 15.0 18.8 11.2 13.1 10.4 13.1 14.8 6.9 8.1 9.5 10.9 3.2 5.9 9.2 3.3 7.2 (0.0) 5.8 * 1.3 1.8 2.6 4.3 (1.7) 2.2 10.7 12.9 20.1 14.8 19.3 17.5 16.3 7.8 14.3 18.4 12.4 12.1 14.6 14.0 13.0 11.5 21.9 17.2 27.8 20.0 18.5 (2.6) 7.7 5.3 3.3 4.0 1.4 4.5 * 2.9 0.8 1.2 0.7 2.3 1.7 * (0.0) 0.0 5.6 (6.8) (2.5) 3.1 9.5 10.6 14.9 11.3 14.1 12.4 12.5 _________________________________________________________________________ Note: There were too few cases (73) of married women in the 15-19 age group to show separately. Parentheses indicate that a figure is based on 25-49 respondents. An asterisk indicates a figure is based on fewer than 25 respondents and has been suppressed. Figure 2.3 Marital status of women, South Africa 1998 Never married 48% Married 34% Widowed 2% Separated 4% Living together 10% Divorced 2% 24 Table 2.17 Age at first marriage Percentage of women aged 15-49 years and who were first married by exact ages and median age at first marriage, by current age, South Africa 1998 ____________________________________________________________________________________________ Percentage Median Percentage who were first married by exact age: who had Number age at_________________________________________ never of first Current age 15 18 20 22 25 married women marriage____________________________________________________________________________________________ 15-19 0.4 NA NA NA NA 95.9 2,249 a 20-24 1.1 7.9 14.2 NA NA 75.4 2,075 a 25-29 2.5 11.0 20.2 30.9 44.1 46.5 1,857 a 30-34 2.9 14.2 26.9 36.7 51.5 28.9 1,654 24.7 35-39 5.0 16.9 29.5 43.0 57.2 18.5 1,636 23.3 40-44 3.1 15.1 30.3 44.9 59.9 14.6 1,294 23.1 45-49 2.8 13.2 30.0 46.7 61.9 11.5 970 22.6 Median for women 20-49 2.8 12.7 24.0 35.3 47.4 37.0 9,486 b Median for women 25-49 3.3 14.0 26.8 39.4 53.7 26.2 7,411 24.2 ____________________________________________________________________________________________ NA = Not applicablea Less than 50 percent of respondents in age group x to x+4 were married by age xb Not calculated due to censoring Polygyny The prevalence of polygynous unions in South Africa was measured in the SADHS by asking currently married females the question: “Besides yourself, how many other wives does your husband have?” Thirteen percent of currently married women in South Africa reported that they are in a polygynous union (Table 2.16). Among African women, where polygynous unions most often occur, no discernible trend according to age is apparent from the data. However, between the ages of 30 and 49, between one-sixth and one-fifth of women are married to a man with more than one wife. Age at first marriage The median age at first marriage has increased from 22.6 years among women 45-49 to 24.7 among women in the age group 30-34 (see Table 2.17). From the data it appears that early marriage is becoming progressively rare. The proportion of women married by the exact age of 20 declined from 30 percent among women in the age group 45-49 to 14 percent among women aged 20-24 years. Overall, about one-quarter of South African women marry by age 20. Table 2.18 shows the median age at first marriage for women aged 25-49 by selected background characteristics. The median age at first marriage for all women is 24 years. There are some striking differentials in the median age at first marriage by certain background characteristics such as province and educational level. Whereas the median age at first marriage is about 23 years in Mpumalanga, it is nearly 25 years in the Western Cape. Age at first marriage exhibits a positive relationship with the educational level of respondents. The median age at first marriage among those with no education is approximately 21 years, while it is nearly 25 years for those with a Std 6-Std 9 qualification. 25 26 Table 2.18 Median age at first marriage Median age at first marriage among women aged 25-49 years, by current age and selected background characteristics, South Africa 1998 _______________________________________________________________________________ Current age Women Background ___________________________________________ aged characteristic 25-29 30-34 35-39 40-44 45-49 25-49 ________________________________________________________________________________ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total a 25.8 24.3 23.6 22.9 24.8 a 22.4 21.7 21.6 21.8 22.9 a 25.4 22.7 22.5 23.8 24.5 a 24.7 23.4 22.7 22.8 24.2 a 27.0 25.0 24.5 23.7 a 24.0 22.5 21.3 21.8 21.5 22.3 a 25.7 24.9 24.4 23.8 a a 27.3 25.7 23.2 22.4 a 24.8 25.2 24.8 24.3 22.4 24.4 a 23.6 21.0 21.7 21.7 23.2 23.3 21.4 19.4 19.4 20.7 20.6 24.9 19.9 20.3 22.0 21.7 21.4 23.7 23.9 21.9 21.8 21.4 22.3 a 23.1 23.2 23.1 24.6 23.8 a 25.4 24.7 23.9 22.7 24.6 a 26.2 24.4 21.7 22.2 a a 25.5 23.9 23.6 24.4 a a 25.3 24.2 23.8 22.8 24.9 a 27.5 26.4 25.4 23.7 a a 22.6 21.7 21.6 21.8 22.9 a 25.2 24.1 23.4 25.7 a 22.0 22.0 21.1 21.2 21.2 21.4 21.8 20.6 20.4 20.3 21.7 21.0 a 24.7 23.3 23.1 22.6 24.2 ________________________________________________________________________________ Note: Medians are not shown for women 20-24 because less than 50 percent of women had married by age 20.a Less than 50 percent of respondents in age group x to x+4 were first married by age x Exposure to mass media Table 2.19 provides information pertaining to the exposure of women to different types of mass media by age, residence, province, educational level and population group. Approximately 42 percent of the women read a newspaper at least once a week, 64 percent watch television once a week, while 72 percent listen to the radio every day. In urban areas a higher proportion watch television (79 percent) and listen to the radio (77 percent). In total, about 14 percent of the SADHS respondents are not exposed to mass media on a regular basis. African women in non-urban areas and those without any education or a low level of education have little exposure to a conventional mass media campaign. 27 Table 2.19 Access to mass media Percentage of women aged 15-49 who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background characteristics, South Africa 1998_________________________________________________________________________________ Mass media____________________________________ No Read Watch Listen to All Number Background mass newspaper television radio three of characteristic media weekly weekly daily media women_________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 13.5 41.9 64.6 70.6 30.1 2,249 14.5 42.7 62.4 71.3 29.4 2,075 12.3 44.1 63.3 72.6 29.8 1,857 12.0 42.0 66.5 75.0 31.6 1,654 14.2 42.9 64.7 71.7 30.5 1,636 13.0 39.2 65.0 71.6 29.2 1,294 16.1 36.4 63.4 69.1 28.3 970 6.9 54.4 79.4 76.6 41.4 7,095 23.7 22.5 41.1 64.4 12.4 4,640 4.1 64.7 87.7 71.5 46.9 1,193 25.4 26.6 44.0 67.3 19.4 1,566 11.1 54.9 73.4 63.2 36.1 253 7.5 38.1 77.1 81.5 31.4 763 17.5 38.3 53.2 68.2 24.8 2,364 11.0 50.4 74.3 73.8 37.1 909 7.3 54.5 78.0 76.8 41.7 2,552 12.7 28.5 66.1 70.8 20.1 819 19.2 22.7 43.0 69.5 12.8 1,316 32.9 3.8 29.4 60.1 2.2 804 26.2 12.3 39.1 59.8 5.4 1,291 19.9 22.0 51.6 64.4 12.8 1,625 11.1 44.7 69.0 72.7 31.4 5,181 4.1 66.9 80.9 82.6 51.5 1,922 1.1 82.9 90.9 84.6 66.2 912 16.4 32.7 57.3 71.3 22.9 9,147 8.9 43.7 73.8 77.8 33.8 4,873 25.0 20.1 38.5 64.0 10.4 4,274 5.4 64.8 84.7 65.0 43.9 1,201 0.2 86.7 94.0 83.1 68.4 916 1.0 78.6 93.1 78.2 61.1 406 13.5 41.8 64.2 71.8 30.0 11,735 Employment and occupational status The SADHS collected information from women regarding their employment status. The findings are shown in Table 2.20 by the usual background characteristics. Overall, 67 percent of women were not employed at the time of the survey, 28 percent were employed all year, 2 percent were employed seasonally and another 2 percent were employed occasionally. The proportions of unemployed women aged 15-19 (93 percent) and 20-24 (81 percent) are higher than the proportion of unemployed women aged 25 years and older. This is in part due to the fact that many of the younger respondents are still at school or furthering their education. Unemployment among women is higher in the non-urban than urban areas. Thirty-one percent of urban women and only 17 percent of non-urban women work all year. The province with the smallest proportion of unemployed women during the previous 12 months preceding the survey is the Western Cape (42 percent). The provinces with the highest unemployment rates for women are the Northern Province (78 percent) and Eastern Cape (74 percent). Educational level is related to employment status. A high percentage of women with no education are not employed (71 percent), compared to 52 percent of women with a Standard 10 certificate. Similarly, regular 28 Table 2.20 Employment Percent distribution of women aged 15-49 by employment status and continuity of employment, according to selected background characteristics, South Africa 1998 ___________________________________________________________________________________________________ Not currently employed Currently employed _________________ ___________________________________________ Did not work Worked All year in last in ________________ Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Missing Total women ___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 89.2 3.7 2.7 1.4 0.9 1.6 0.5 100.0 2,249 75.3 5.5 13.9 1.6 2.2 1.0 0.6 100.0 2,075 59.0 5.4 27.6 3.1 2.6 1.8 0.5 100.0 1,857 50.6 5.9 34.4 3.8 2.9 1.7 0.7 100.0 1,654 46.8 4.7 39.5 4.7 2.4 1.8 0.2 100.0 1,636 47.0 2.8 39.5 5.3 1.6 2.9 0.8 100.0 1,294 49.6 2.3 37.6 4.4 2.4 3.2 0.5 100.0 970 55.6 4.9 30.8 4.2 2.0 2.0 0.5 100.0 7,095 73.5 3.9 16.6 1.6 2.2 1.6 0.5 100.0 4,640 41.8 6.6 38.2 6.4 3.5 3.1 0.5 100.0 1,193 74.1 3.0 18.0 2.4 1.1 0.9 0.3 100.0 1,566 63.5 2.5 27.9 2.9 1.7 1.2 0.3 100.0 253 56.6 4.4 32.7 3.0 1.9 1.2 0.2 100.0 763 65.1 4.4 21.6 2.4 2.8 2.9 0.8 100.0 2,364 66.9 5.8 21.9 2.9 1.5 0.6 0.4 100.0 909 54.5 6.3 30.5 4.4 1.9 2.0 0.5 100.0 2,552 66.7 2.8 24.1 1.9 2.3 1.1 1.0 100.0 819 77.5 1.9 16.0 1.4 1.5 1.2 0.5 100.0 1,316 70.5 4.4 19.6 2.4 1.9 0.7 0.6 100.0 804 62.7 5.2 22.3 3.4 3.2 2.5 0.7 100.0 1,291 65.4 4.1 23.3 2.3 3.0 1.6 0.4 100.0 1,625 69.2 4.1 19.5 3.0 1.4 2.1 0.6 100.0 5,181 52.0 5.4 34.5 3.9 2.5 1.3 0.3 100.0 1,922 36.4 5.0 49.9 4.6 1.9 1.6 0.6 100.0 912 68.3 3.8 21.3 2.4 2.0 1.6 0.6 100.0 9,147 61.6 4.1 26.7 3.3 2.1 1.5 0.6 100.0 4,873 76.0 3.4 15.2 1.3 1.9 1.6 0.5 100.0 4,274 45.8 7.1 36.4 6.0 2.4 1.8 0.5 100.0 1,201 32.5 8.5 46.0 6.3 2.2 4.5 0.0 100.0 916 54.5 5.0 32.1 4.5 1.6 2.0 0.2 100.0 406 62.7 4.5 25.2 3.2 2.1 1.8 0.5 100.0 11,735 full-time employment increases and seasonal employment decreases with an increase in the level of education. More African women (68 percent) are unemployed than women of other population groups (coloureds, 46 percent; whites, 33 percent; and Asians 55 percent). 29 Table 2.21 Employer and form of earnings Percent distribution of currently employed women aged 15-49 by employer and form of earnings, according to selected background characteristics, South Africa 1998___________________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative_______________ ________________ _________________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 24.3 0.0 68.1 0.0 4.2 2.8 0.6 100.0 149 10.1 0.6 83.4 0.9 3.3 1.2 0.6 100.0 390 14.4 0.0 82.9 0.7 1.4 0.3 0.3 100.0 653 18.4 0.3 75.4 1.3 3.5 0.4 0.8 100.0 711 16.6 0.7 76.3 1.0 3.4 1.1 0.8 100.0 792 18.3 0.9 76.9 1.3 1.5 0.9 0.3 100.0 640 17.7 0.7 76.0 1.2 2.5 1.7 0.2 100.0 461 14.6 0.2 80.4 1.0 2.5 0.9 0.4 100.0 2,771 22.1 1.3 70.4 1.2 3.1 1.1 0.8 100.0 1,024 8.1 0.0 87.2 0.2 2.8 0.4 1.2 100.0 614 15.2 0.3 79.5 2.9 1.6 0.2 0.2 100.0 354 4.5 1.1 90.4 1.7 1.1 0.9 0.3 100.0 85 10.4 0.3 84.6 0.3 3.0 0.5 0.8 100.0 297 22.9 0.4 71.1 0.4 3.2 1.5 0.4 100.0 704 11.4 1.2 79.7 2.9 4.1 0.4 0.4 100.0 245 20.3 0.0 75.3 0.7 2.4 1.2 0.0 100.0 987 24.9 0.0 70.0 1.9 2.0 0.0 1.2 100.0 243 15.7 3.9 73.4 1.3 2.6 2.2 0.9 100.0 266 16.9 0.0 80.0 1.6 0.6 0.0 0.9 100.0 198 24.5 1.1 70.3 0.3 2.8 0.3 0.8 100.0 408 16.6 0.2 78.1 0.9 2.6 1.4 0.2 100.0 490 18.7 0.6 75.9 0.9 2.4 0.9 0.6 100.0 1,354 13.5 0.5 80.2 1.3 2.8 1.4 0.4 100.0 815 10.1 0.2 83.2 1.5 3.8 0.7 0.5 100.0 530 19.1 0.7 75.4 1.4 2.3 0.6 0.5 100.0 2,505 16.5 0.2 79.2 1.4 1.9 0.4 0.4 100.0 1,644 24.2 1.5 68.2 1.4 3.0 1.0 0.7 100.0 861 4.9 0.0 91.4 0.1 2.0 0.2 1.3 100.0 565 18.6 0.3 72.3 0.4 5.2 3.1 0.0 100.0 541 14.4 0.6 81.6 0.4 2.3 0.6 0.0 100.0 163 16.6 0.5 77.7 1.0 2.7 0.9 0.5 100.0 3,795 Place of employment and form of earnings In Table 2.21 details are provided of the place of employment and the type of earnings of employed respondents. Seventeen percent of employed women are self-employed, while the vast majority of working women (79 percent) are employed by non-relatives and about 4 percent work for relatives. All but a small fraction of working women earn cash; 97 percent are paid in cash while less than 3 percent are either unpaid or paid in kind. KwaZulu-Natal (23 percent) and Mpumalanga (25 percent) have a larger proportion of women who are self-employed. A large proportion of women in all nine provinces are employed by non- relatives and earn cash. The distribution of employed women by employer and form of earnings varies little by level of education. Compared to other groups, a smaller proportion of coloured women (5 percent) are self-employed. 30 Table 2.22 Occupation Percent distribution of currently employed women aged 15-49 by occupation, according to selected background characteristics, South Africa 1998 _____________________________________________________________________________________________ Prof./ Middle Foreman Number Background tech./ white & skilled Skilled Unskilled of characteristic manag. collar artisan manual manual Other Missing Total women _____________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 2.3 21.9 6.5 22.2 37.0 9.3 0.7 100.0 149 10.1 23.9 4.9 16.2 36.1 7.8 1.0 100.0 390 14.8 22.8 6.7 10.3 41.3 3.7 0.3 100.0 653 16.9 17.0 5.6 13.9 40.8 4.9 0.9 100.0 711 16.3 16.1 5.3 12.9 43.8 4.9 0.9 100.0 792 14.6 12.1 7.5 11.8 48.6 4.6 0.7 100.0 640 14.1 13.1 5.0 8.2 56.3 3.0 0.2 100.0 461 16.3 20.7 6.7 14.2 36.3 5.3 0.5 100.0 2,771 9.3 8.5 3.9 8.1 65.2 3.9 1.1 100.0 1,024 10.3 20.6 6.9 18.5 38.6 4.7 0.4 100.0 614 20.5 11.8 7.4 13.9 40.5 5.5 0.4 100.0 354 13.2 19.3 4.2 10.4 45.7 4.8 2.3 100.0 85 14.1 16.8 6.4 10.0 46.5 5.7 0.5 100.0 297 15.1 13.8 4.4 13.6 50.1 2.7 0.1 100.0 704 16.8 15.5 4.4 8.4 48.0 6.0 0.8 100.0 245 14.3 23.4 6.5 12.2 37.9 5.4 0.2 100.0 987 10.9 10.6 5.3 6.8 58.4 5.0 2.9 100.0 243 16.4 12.4 5.6 8.6 48.7 6.1 2.2 100.0 266 1.0 1.2 0.0 5.0 88.6 1.9 2.3 100.0 198 1.1 1.1 2.2 8.2 84.6 2.3 0.6 100.0 408 0.8 2.7 4.2 13.0 76.0 2.7 0.7 100.0 490 4.1 15.8 9.3 17.2 47.1 5.6 0.9 100.0 1,354 17.1 40.0 7.0 12.7 15.9 7.0 0.4 100.0 815 64.5 18.9 2.4 6.7 2.3 5.0 0.2 100.0 530 12.4 10.2 6.0 10.0 56.3 4.2 0.8 100.0 2,505 13.6 12.1 6.9 11.6 50.7 4.4 0.6 100.0 1,644 10.1 6.5 4.2 7.1 67.0 3.8 1.2 100.0 861 11.5 19.6 4.9 20.0 38.7 4.7 0.6 100.0 565 27.0 41.9 5.9 13.4 3.4 8.4 0.1 100.0 541 13.6 40.5 9.1 21.4 10.8 3.9 0.7 100.0 163 14.4 17.4 5.9 12.6 44.1 4.9 0.7 100.0 3,795 Occupation The distribution of employed women by occupation is presented in Table 2.22. Forty-four percent of the women are engaged in unskilled occupations, while 14 percent occupy professional, technical and management jobs and 17 percent occupy the middle white collar jobs. The majority of African non-urban women hold unskilled jobs (67 percent) compared to 51 percent of African urban women. 31 Educational level is clearly associated with type of occupation: women with no education or with primary education only are primarily engaged in unskilled occupations, while professional, technical and management jobs are occupied by women with a higher level of education. White women (27 percent) have a higher proportion of professionals than the other population groups. Younger women are less involved in unskilled manual occupations than older women. There is a clear correlation between education level and occupation. Women with higher education are more likely to be in a professional/technical/management occupation (65 percent), while women with no education are more likely to be in unskilled occupations (89 percent). Decision on use of earnings Information on who decides how to use the cash earned by employed women may point to the status of women. Two-thirds (67 percent) make the decision themselves (Table 2.23). Twenty-one percent of women who earn cash make decisions jointly with their husbands/partners, while the partners of 3 percent of the women make the decisions about spending their earnings. There is little difference by age in decision making regarding earnings, except that fewer younger respondents (those between the ages of 15 and 24) make joint decisions with a partner on the use of earnings, mainly because fewer are married. More urban women (23 percent) than non-urban women (18 percent) decide jointly with their partners on spending. Fewer women in KwaZulu-Natal (14 percent) than women in other provinces make joint decisions with their husbands on spending their earnings. In Gauteng and Northern Cape (29 percent and 31 percent) of women make decisions jointly with their partners. The partners of 6 percent of women earning cash in the Eastern Cape decide on how their earnings should be spent. White women generally involve their husbands/partners to a larger extent in decision making about their earnings (36 percent) than is the case among African women (18 percent), Asian women (20 percent) and coloured women (23 percent). The majority of non-urban African women (72 percent) make such decisions on their own, largely due to the fact that either they are not married or their husbands/partners work away from home and return only on occasion. 32 Table 2.23 Decision on use of earnings Percent distribution of women aged 15-49 receiving cash earnings by person who decides on use of earnings, according to selected background characteristics, South Africa 1998___________________________________________________________________________________________________ Person who decides how earnings are used ___________________________________________ Jointly Jointly with with Number Background Self Husband/ husband/ Someone someone of characteristic only partner partner else else Missing Total women___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Marital status Currently married Not married Total 83.6 0.0 1.5 8.2 6.1 0.7 100.0 144 76.1 2.4 7.4 5.7 3.5 4.8 100.0 377 66.8 0.8 22.4 1.8 4.1 4.1 100.0 645 64.7 3.5 22.7 1.0 3.8 4.4 100.0 692 62.2 4.3 24.0 0.6 5.3 3.6 100.0 765 63.6 2.5 28.4 0.4 2.1 2.9 100.0 619 68.4 4.0 21.2 0.0 2.8 3.5 100.0 445 65.8 2.6 22.5 1.4 3.7 3.9 100.0 2,704 69.1 3.4 18.1 2.2 4.1 3.1 100.0 984 65.0 2.3 21.2 5.0 3.9 2.6 100.0 605 63.8 5.9 21.3 0.8 5.9 2.3 100.0 341 61.3 1.8 31.0 0.9 1.5 3.5 100.0 82 69.4 2.0 21.3 0.5 6.7 0.0 100.0 292 77.5 3.3 13.8 1.2 1.3 2.8 100.0 686 66.3 1.7 19.0 0.4 5.4 7.1 100.0 233 59.3 2.0 28.5 1.1 3.7 5.4 100.0 968 74.5 1.8 17.2 1.2 3.7 1.6 100.0 236 65.5 5.3 17.0 0.5 4.3 7.5 100.0 243 69.5 2.2 20.9 0.5 4.3 2.6 100.0 193 68.6 3.5 21.3 0.3 3.9 2.4 100.0 400 69.1 3.0 18.1 1.0 5.0 3.8 100.0 478 68.8 3.2 19.4 2.3 3.3 2.9 100.0 1,315 63.9 2.1 22.5 2.1 3.7 5.7 100.0 787 61.0 2.6 27.5 1.0 4.0 4.0 100.0 514 69.1 2.9 18.0 0.8 4.3 4.8 100.0 2,428 67.7 2.6 19.3 0.6 4.3 5.5 100.0 1,606 72.1 3.6 15.5 1.1 4.3 3.4 100.0 823 62.2 2.4 23.1 5.9 5.2 1.2 100.0 557 58.4 2.2 35.6 1.2 1.3 1.3 100.0 520 70.2 4.6 20.4 0.6 0.6 3.6 100.0 161 90.6 0.0 0.2 3.4 2.1 3.8 100.0 1,760 44.9 5.4 40.6 0.0 5.4 3.6 100.0 1,927 66.7 2.8 21.3 1.6 3.8 3.7 100.0 3,688 2.10 Child Care for Working Mothers Table 2.24 presents the percent distribution of employed women by whether they have a child under the age of six years according to the women's background characteristics. The table also provides details on who cares for such children while their mothers are at work. Thirty-one percent of employed women have a child/children under the age of six. A higher proportion of non-urban than urban employed women have a child under the age of six (41 percent compared to 27 percent). There is no significant difference between the level of education and whether the working woman has a child under the age of six. Women with a higher level of education are more likely to hire help and use child care institutions for their children. The role of the husband or partner and other male children in looking after such a child when the mother is working is minimal. This holds for all sub-groups of women. 33 T ab le 2 .2 4 C hi ld c ar e w hi le w or ki ng Pe rc en t d is tr ib ut io n of c ur re nt ly e m pl oy ed w om en a ge d 15 -4 9 by w he th er th ey h av e a ch ild u nd er s ix y ea rs o f a ge d at h om e, a nd th e pe rc en t d is tr ib ut io n of e m pl oy ed m ot he rs w ho h av e a ch ild u nd er s ix b y pe rs on w ho c ar es fo r c hi ld w hi le m ot he r i s at w or k, a cc or di ng to s el ec te d ba ck gr ou nd c ha ra ct er is tic s, S ou th A fr ic a 19 98 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ O ne o r C hi ld 's ca re ta ke r w hi le m ot he r i s at w or k N o ch ild m or e __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ N ot N um be r un de r ch ild re n R e- N ei gh - C hi ld O th er O th er w or ke d of B ac kg ro un d si x un de r s ix sp on d- H us ba nd / O th er bo ur / H ir ed is in fe m al e m al e si nc e em pl oy ed ch ar ac te ri st ic at h om e at h om e en t pa rt ne r re la tiv e Fr ie nd he lp sc ho ol ch ild ch ild bi rt h1 O th er M is si ng T ot al w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ R es id en ce U rb an N on -u rb an Pr ov in ce W es te rn C ap e E as te rn C ap e N or th er n C ap e F re e St at e K w aZ ul u- N at al N or th W es t G au te ng M pu m al an ga N or th er n E du ca tio n N o ed uc at io n S ub A - St d 3 S td 4 - St d 5 S td 6 - St d 9 S td 1 0 H ig he r Po pu la tio n gr ou p A fr ic an A fr . u rb an A fr . n on -u rb an C ol ou re d W hi te A si an Em pl oy m en t s ta tu s A ll ye ar , f ul l w ee k A ll ye ar , p ar t w ee k S ea so na l O cc as io na l T ot al 72 .7 27 .3 12 .9 1 .2 17 .5 4 .1 1 1. 4 36 .4 2 .7 0 .0 0 .3 6 .7 7 .7 10 0. 0 2, 77 1 59 .2 40 .8 22 .2 3 .6 21 .3 8 .1 5 .4 14 .8 5 .6 0 .6 1 .2 9 .3 7 .9 10 0. 0 1, 02 4 69 .2 30 .8 9 .3 2 .6 18 .5 8 .9 3 .4 38 .0 0 .7 0 .0 0 .7 11 .2 8 .2 10 0. 0 6 14 65 .9 34 .1 22 .2 2 .5 22 .5 3 .5 1 7. 6 14 .5 2 .6 0 .0 0 .4 4 .9 9 .8 10 0. 0 3 54 69 .3 30 .7 13 .3 1 .8 39 .6 5 .6 9 .1 20 .3 3 .7 1 .9 0 .0 2 .8 3 .8 10 0. 0 8 5 73 .1 26 .9 8 .2 1 .1 18 .8 6 .5 7 .1 35 .5 2 .1 0 .0 1 .1 11 .3 8 .3 10 0. 0 2 97 70 .1 29 .9 14 .8 4 .9 20 .2 7 .6 1 1. 1 20 .1 4 .7 1 .0 1 .0 10 .0 5 .1 10 0. 0 7 04 65 .7 34 .3 9 .2 1 .1 22 .7 5 .8 1 0. 9 20 .3 9 .3 0 .0 2 .3 5 .7 12 .6 10 0. 0 2 45 73 .6 26 .4 16 .5 0 .0 11 .9 1 .8 1 0. 1 45 .0 2 .8 0 .0 0 .0 6 .4 6 .4 10 0. 0 9 87 62 .3 37 .7 28 .5 2 .6 23 .4 7 .1 5 .4 19 .3 2 .8 0 .0 0 .7 2 .1 8 .0 10 0. 0 2 43 58 .3 41 .7 25 .2 1 .1 17 .7 4 .2 8 .3 17 .5 8 .4 0 .0 0 .0 7 .2 9 .4 10 0. 0 2 66 67 .4 32 .6 23 .6 4 .0 14 .1 9 .5 1 .1 18 .8 5 .7 3 .6 0 .0 4 .5 15 .2 10 0. 0 1 98 70 .1 29 .9 26 .0 3 .7 19 .5 9 .5 1 .5 14 .0 8 .4 0 .2 1 .7 9 .5 5 .1 10 0. 0 4 08 69 .0 31 .0 27 .6 2 .0 20 .2 7 .7 1 .1 22 .9 4 .9 0 .0 1 .4 6 .2 6 .7 10 0. 0 4 90 70 .4 29 .6 15 .9 1 .6 20 .5 4 .5 6 .2 30 .9 4 .3 0 .0 0 .8 7 .6 8 .1 10 0. 0 1, 35 4 67 .9 32 .1 10 .3 2 .7 19 .6 5 .3 1 1. 9 35 .9 1 .2 0 .0 0 .0 7 .6 6 .2 10 0. 0 8 15 67 .4 32 .6 6 .2 0 .3 14 .1 1 .8 2 8. 2 31 .9 1 .4 0 .0 0 .0 8 .9 9 .2 10 0. 0 5 30 67 .6 32 .4 19 .8 2 .1 18 .0 6 .0 7 .5 26 .1 5 .0 0 .3 0 .9 5 .9 8 .4 10 0. 0 2, 50 5 72 .3 27 .7 17 .1 0 .9 14 .5 3 .9 1 0. 0 36 .4 4 .0 0 .1 0 .5 4 .1 8 .5 10 0. 0 1, 64 4 58 .7 41 .3 23 .4 3 .6 22 .5 8 .6 4 .4 12 .8 6 .2 0 .6 1 .4 8 .2 8 .3 10 0. 0 8 61 64 .0 36 .0 7 .9 2 .3 24 .7 6 .8 6 .0 34 .8 1 .8 0 .1 0 .0 10 .7 5 .8 10 0. 0 5 65 78 .9 21 .1 9 .9 1 .2 12 .6 0 .2 2 2. 8 36 .0 0 .0 0 .0 0 .0 12 .7 6 .7 10 0. 0 5 41 75 .2 24 .8 4 .7 0 .0 25 .9 4 .7 2 3. 3 30 .2 0 .0 0 .0 0 .0 9 .4 4 .1 10 0. 0 1 63 69 .6 30 .4 15 .5 1 .4 17 .2 6 .1 1 0. 1 31 .6 2 .2 0 .3 0 .3 7 .7 8 .4 10 0. 0 2, 95 3 68 .1 31 .9 16 .6 2 .3 24 .8 2 .6 1 3. 1 25 .4 5 .1 0 .2 0 .5 7 .3 2 .1 10 0. 0 3 73 63 .4 36 .6 19 .1 3 .5 23 .3 2 .3 1 .0 23 .7 13 .1 0 .0 4 .8 4 .0 3 .9 10 0. 0 2 44 71 .4 28 .6 23 .7 9 .0 27 .4 7 .0 3 .1 3 .7 10 .3 0 .0 0 .0 12 .8 3 .0 10 0. 0 2 14 69 .1 30 .9 16 .2 2 .0 18 .9 5 .5 9 .3 28 .7 3 .7 0 .2 0 .6 7 .6 7 .7 10 0. 0 3, 79 5 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 1 R es po nd en t i s cu rr en tly e m pl oy ed b ut h as n ot w or ke d si nc e la st b ir th . 33 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-non-urban residence, South Africa 1998_____________________________________________________ Residence______________ Age group Urban Non-urban Total_____________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women 15-49 TFR women 15-44 General fertility rate Crude birth rate 56 99 76 113 178 139 123 174 143 88 149 109 53 111 74 18 50 29 1 24 9 2.25 3.92 2.90 2.25 3.80 2.85 79 133 100 19.2 25.4 21.9 _________________________________________ Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Total fertility rate expressed per woman. General fertility rate (births divided by number of women 15-49), expressed per 1,000 women. Crude birth rate expressed per 1,000 population. CHAPTER 3 FERTILITY 3.1 Introduction In the SADHS, data were collected on current and completed fertility. Utilising the birth histories of women interviewed during the survey, this chapter provides direct estimates of current levels, trends and differentials in fertility. During the interviews the women were requested to provide information on the total number of sons and daughters they had given birth to that were still living with them, the number living elsewhere and the number who had died. Interviewers obtained a birth history for each woman, including details on each live birth separately, according to the month and year of birth, sex and survival status. In the case of children who had died, their age at death was also recorded. The fertility indicators reported here are based on the answers provided by women aged 15-49 years regarding their reproductive histories. 3.2 Fertility Levels The total fertility rate (TFR) and age-specific fertility rates (ASFRs) are a common measure of recent fertility. The TFR is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through these years bearing children at the prevailing age-specific rates. Table 3.1 shows the age-specific and other aggregate fertility measures calculated from the 1998 SADHS data for the three-year period prior to the survey (roughly 1995- early 1998). The TFR for South Africa, derived from the survey data was 2.9. Using data from the 1996 population census, indirect methods yielded a slightly higher TFR level of 3.3 for 1996, two years before the SADHS. (Udjo, 1999). Another study utilising indirect methods and the same Census data, estimated the TFR at 3.1 (Dorrington et al., 1999). Fertility in urban areas (TFR=2.3) is substantially lower than in rural areas (TFR=3.9). This lower fertility in urban areas is apparent at all ages. Peak childbearing occurs between the ages of 20 and 34. Rural women continue to bear children at later ages than urban women. The derived crude birth rate is only 22 births per 1 000 population. 34 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, South Africa 1998_____________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49_____________________________________________________ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Total 2.3 2.7 3.2 3.9 4.7 4.7 2.3 3.2 3.0 3.5 3.4 4.0 2.7 3.6 3.6 2.2 3.6 3.6 3.3 4.3 4.0 2.4 3.2 3.7 2.3 2.2 3.2 3.1 4.6 4.5 3.9 4.6 4.9 4.5 3.3 4.9 3.9 4.8 4.4 3.5 4.0 4.1 2.7 3.0 3.2 2.2 3.5 2.4 1.9 3.8 2.5 3.1 3.7 4.1 2.4 2.8 3.5 4.0 4.7 4.9 2.5 3.5 3.2 1.9 2.5 2.5 2.9 3.5 3.7 _____________________________________________________ Note: The number of Asian women interviewed was too small to provide a reliable measure of the total fertility rate. 1 Women age 15-49 years 3.3 Fertility Differentials Differentials in fertility are shown in Table 3.2. The SADHS data indicate a strong negative linear association between education and fertility. Whereas women with no education had a TFR of 4.5, those who have completed Standard 10 have 2.2 children on average (see Figure 3.1). The Northern Province has the highest TFR (3.9), while Free State has the lowest (2.2) (see Figure 3.2). The TFR for African women is 3.1, for coloured women 2.5 and 1.9 for white women. Unfortunately, despite attempts to design the sample so as to over sample Asian households, the sample of Asian women was too small to allow a reliable estimate of the TFR. Table 3.2 also allows for the assessment of differential trends in fertility over time. The mean number of children ever born to women aged 40-49 is a measure of past fertility. By comparing current (total) fertility with past (completed) fertility, it is clear that substantial declines in fertility occurred among all sub-groups of the population. For instance, among urban African women there was a decline from 3.5 to 2.4. 35 Less than 4 percent of women reported they were pregnant at the time of the survey. Although this under- estimates the proportion of pregnant women, as many women in the early stages of pregnancy would not have known that they were pregnant, the differentials in pregnancy status closely follow the differentials in current fertility. 36 3.4 Fertility Trends Adequate historical demographic statistics are only available for certain sections of the population. For the white population, birth statistics are available from 1910 and for the Indian and coloured population from about the 1940s. For the African population incomplete birth registration statistics created a vacuum in our knowledge of demographic trends. Fertility rates for the African population were calculated with the aid of census statistics by Sadie (1970). In addition, the Human Sciences Research Council (HSRC) conducted a number of small-scale surveys from the 1960s to the 1980s, the results of which were used to estimate fertility levels (Mostert and Malherbe, 1974; Lötter and van Tonder, 1976; Van Tonder, 1985). Probably the most comprehensive source of information on fertility patterns before the 1998 SADHS was a large DHS-type survey conducted in 1987-1989 (Mostert, 1990). This collection of vital statistics, analytical work and surveys provide reasonably accurate pointers to historical fertility trends (see Figure 3.3) for different population groups. The data in Figure 3.3 show that fertility among whites started to decline during the 19th century and then remained at a level of between 3 and 4 for more than six decades before declining below 3 towards the late 1960s. Thereafter the decline continued to below the replacement level. In 1990 the TFR was 1.7. The fertility of the Asian segment of the population started its decline in the 1950s, largely due to increasing age at marriage and the use of contraception. By 1990, the fertility of this population (TFR of 2.3) was nearing the replacement level. The fertility of the coloured population gradually increased in the two decades before the 1960s. Thereafter, the introduction of modern contraception heralded a decline which continues to the present. The fertility of the African population was at a high level during the middle of this century (a TFR of nearly 7). After 1960, African fertility started to decline, slowly at first, but subsequently gained momentum. By the mid-1980s, African fertility was about 4.5, and by 1990 it had declined to an estimated level of around 4.0. 37 Table 3.3 Trends in fertility Age-specific fertility rates for four-year periods preceding the survey, South Africa 1998 __________________________________________________________________ Age group 0-3 4-7 8-11 12-15 16-19 __________________________________________________________________ 15-19 78 93 90 116 104 20-24 136 156 170 196 190 25-29 138 159 162 183 183 30-34 108 134 128 153 [143] 35-39 72 89 99 [122] - 40-44 30 42 [57] - - 45-49 10 [12] - - - __________________________________________________________________ Note: Age-specific fertility rates per 1,000 women. Estimates enclosed in brackets are truncated. Source: DHS-type survey 1987-1989 and SADHS 1998 The fertility of the white population in South Africa mirrors fertility trends in the more developed world, where the transition from high to low fertility has been completed. The Asian and the coloured population have almost completed their fertility transition. The most interesting fertility transition taking place in South Africa at present is that of the African population. Besides the fact that Africans constitute the majority of the South African population, and therefore determine overall fertility levels, their fertility behaviour may also predict the path of future fertility trends in other African countries. Therefore it is useful to examine trends in African fertility by comparing the results of the 1998 SADHS with a large- scale DHS-type survey conducted in the period 1987-1989 (Mostert 1990). In both surveys similar methodologies were utilised. The age-specific fertility rates (ASFRs) for the three years preceding the surveys are shown in Figure 3.4. Whereas the calculated total fertility rate for the African population was 4.6 in the first survey, it was 3.1 in 1998. Fertility trends can also be examined by looking at rates reported for previous times in the birth histories of women interviewed in the SADHS. Such rates were calculated for four-year periods prior to the survey and are presented in Table 3.3. They also show a decline in fertility over the past 12-15 years, although a much gradual one than implied by comparing external data sources. 38 3.5 Children Ever Born and Living The distribution of women by the number of children ever born to them is shown in Table 3.4 for all women and currently married women. In addition, the table gives the mean number of children ever born to women in each five-year age group as well as the mean number of living children. It is clear that most women have had at least one birth by age 35. Women in their late thirties have given birth to an average of 3.2 children. The results also show that 5 percent of women in the age group 45-49 have never given birth, while a quarter of women in this age group have given birth to 6 children or more. In the age group 45-49 the mean number of children ever born is 4.0; of whom 3.6 were still living. Differences in the findings for currently married women compared to all women are mainly found among the younger women. For example, nearly 80 percent of married women aged 20-24 have given birth, compared to 60 percent of all women in the same age category. Nearly 4 percent of currently married women aged 40 and older have never given birth, which can be regarded as a rough measure of primary infertility in the population, since voluntary childnessness is uncommon in most African societies. 39 Table 3.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born and mean number ever born and living children, by age of woman, South Africa 1998 Number of children ever born (CEB) Number of women Mean no. of CEB Mean no. of living children Age group 0 1 2 3 4 5 6 7 8 9 10+ Total ALL WOMEN 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 86.8 41.7 18.4 6.8 4.9 4.7 5.2 29.5 12.6 40.8 33.2 1 8.3 11.6 11.0 9.9 21.1 0.4 14.4 29.3 31.2 22.7 19.8 14.7 18.2 0.1 2.9 12.7 21.0 21.5 19.7 15.7 12.0 0.0 0.2 4.4 13.9 16.2 15.1 17.2 8.0 0.0 0.0 1.4 4.7 10.7 12.5 12.5 4.8 0.0 0.0 0.5 2.5 6.9 9.2 9.6 3.2 0.0 0.0 0.0 1.1 3.2 4.0 5.9 1.5 0.0 0.0 0.0 0.2 1.5 1.8 3.7 0.7 0.0 0.0 0.0 0.2 0.5 0.9 1.8 0.3 0.0 0.0 0.0 0.0 0.4 1.4 3.6 0.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,249 2,075 1,857 1,654 1,636 1,294 970 11,735 0.14 0.79 1.58 2.49 3.23 3.52 4.03 1.94 0.13 0.74 1.50 2.34 2.99 3.18 3.57 1.79 CURRENTLY MARRIED WOMEN 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 63.4 20.4 11.6 3.7 3.5 3.6 4.1 7.5 33.0 43.4 25.6 12.5 8.0 8.8 6.8 15.6 2.1 27.6 34.9 31.3 22.7 19.3 14.5 25.1 1.6 7.9 18.2 23.2 21.8 19.7 14.5 18.6 0.0 0.7 6.2 17.6 17.7 15.7 18.3 13.6 0.0 0.0 2.5 5.8 11.9 13.2 14.5 8.3 0.0 0.0 1.0 3.8 7.5 10.0 9.8 5.5 0.0 0.0 0.0 1.7 3.9 4.5 6.4 2.8 0.0 0.0 0.1 0.3 2.0 2.2 4.3 1.4 0.0 0.0 0.0 0.3 0.5 1.1 2.2 0.6 0.0 0.0 0.1 0.0 0.5 1.8 4.6 1.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 73 465 900 1,008 1,114 865 652 5,077 0.42 1.25 1.94 2.83 3.47 3.74 4.34 2.98 0.40 1.17 1.83 2.66 3.25 3.37 3.89 2.75 40 3.6 Birth Intervals The birth interval is a notable factor in the survival of infants. A baby born soon after a previous child is at an increased risk of poor health. As a general rule, births with an interval of less than 24 months are classified as high-risk births. Table 3.5 presents the percent distribution of births in the five years before the survey by interval since the previous birth, according to selected background characteristics. Fourteen percent of second and higher order births take place within 24 months of the previous birth. More than 20 percent of births to women with a tertiary qualification take place less than 24 months after the previous birth, a higher proportion than found in any other educational category. Among white women short intervals are even more common, as 30 percent of births take place within 24 months of the previous birth. Table 3.5 shows that 53 percent of second and third births occurred at an interval of more than 48 months. This suggests that many South African women have an early first birth, many while still teenagers, but postpone the birth of a second child for a considerable period of time. The median birth interval was 47 months, a very long interval when compared to other sub-Saharan countries. Urban women have substantially longer birth intervals than rural women (54 months as opposed to 43 months). A significant difference in birth interval was also found when comparing the survival status of the previous baby. Where the previous baby has died, the interval is 17 months less than when the previous sibling survived. 41 Table 3.5 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to selected background characteristics, South Africa 1998. Characteristic Number of months since previous birth Total Median no. of months since previous birth Number of births7 - 17 18 - 23 24 - 35 36 - 47 48+ Age of mother 15-19 20-29 30-39 40+ Birth order 2-3 4-6 7+ Sex of previous baby Male Female Survival of previous baby Living Dead Residence Urban Rural Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A-Std 3 Std 4-Std 5 Std 6-Std 9 Std 10 Higher Population group African African urban African rural Coloured White Asian Total * 7.3 4.0 5.7 4.8 6.4 8.3 5.9 5.3 4.4 22.9 4.3 6.7 4.1 7.9 4.2 3.8 7.6 3.7 2.9 5.4 5.8 6.6 4.9 4.9 5.3 5.0 11.1 5.3 3.0 6.8 2.9 13.6 8.1 5.6 * 11.0 6.6 4.7 7.9 8.4 9.3 8.3 7.9 7.8 13.2 6.8 9.3 6.6 10.6 4.2 4.0 9.0 6.4 7.4 8.5 8.5 6.8 8.5 7.8 8.9 6.5 9.2 8.0 5.9 9.4 5.7 16.6 9.2 8.1 * 22.4 17.5 15.3 17.2 20.4 31.7 18.2 20.6 19.2 21.2 15.3 22.8 11.3 24.1 13.5 17.2 19.7 17.3 14.2 18.7 26.7 23.0 23.6 17.3 19.2 14.6 14.7 20.1 15.6 23.2 11.0 20.6 16.4 19.3 * 20.7 16.8 15.6 17.2 18.4 24.8 18.4 17.9 18.6 10.8 17.1 19.0 16.9 17.6 17.4 16.5 18.8 16.9 17.5 19.2 19.8 21.4 20.6 16.3 17.5 14.0 22.6 17.9 15.6 19.4 15.7 21.6 32.8 18.2 * 38.6 55.1 58.8 52.9 46.5 25.9 49.3 48.3 49.9 31.8 56.5 42.1 61.0 39.8 60.8 58.5 45.0 55.7 58.0 48.2 39.1 42.1 42.4 53.6 49.1 59.9 42.4 48.8 59.9 41.2 64.7 27.6 33.5 48.8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 28.4 40.7 53.0 60.5 49.7 45.6 36.1 47.1 47.0 47.9 30.6 53.7 42.9 58.5 40.3 53.9 54.9 45.0 52.4 53.7 46.7 41.5 43.5 42.2 51.2 47.0 58.3 41.3 47.1 55.9 42.4 58.2 35.4 39.1 47.1 15 1,312 1,586 416 1,997 1,082 251 1,745 1,585 3,122 208 1,557 1,773 251 519 64 169 749 212 614 247 504 404 561 594 1,239 372 159 2,795 1,130 1,665 290 149 71 3,330 Note: An asterisk indicates a figure is based on fewer than 25 respondents and has been suppressed. 3.7 Age at First Birth Table 3.6 shows the percent distribution of women by the age at the birth of their first child and the median age at first birth. The median age at first birth was approximately 21 years for most age cohorts. Forty-eight percent of women in the age group 30-34 interviewed by the SADHS had given birth before turning 20. However, there are indications that this trend is changing. For instance, 40 percent of respondents aged 20-24 and 25-29 had given birth before reaching age 20, eight percentage points lower than that of the older cohort of women. Teenage childbearing is discussed further in Chapter 9. 42 Table 3.7 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age and selected background characteristics, South Africa 1998_______________________________________________________________________________ Current age Women Background ____________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49_______________________________________________________________________________ Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Education No education Sub A - Std 3 Std 4 - Std 5 Std 6 - Std 9 Std 10 Higher Population group African Afr. urban Afr. non-urban Coloured White Asian Total 21.9 20.9 21.2 21.3 21.0 21.3 20.0 19.5 20.0 20.6 21.0 20.1 23.4 21.4 21.9 21.2 21.9 21.8 20.8 20.5 20.9 21.5 21.9 21.1 20.7 20.5 20.8 21.9 20.0 20.8 21.0 20.1 20.5 21.4 20.6 20.7 20.6 20.5 20.7 21.1 22.2 20.9 20.8 20.1 21.3 20.9 19.7 20.7 21.7 20.2 21.3 21.0 20.6 21.0 19.7 19.0 20.0 19.3 19.2 19.5 19.6 19.2 19.3 20.2 20.8 19.7 19.5 18.6 19.8 20.3 20.3 19.8 19.5 18.9 19.8 20.2 20.8 19.8 19.0 19.3 19.9 20.2 20.0 19.7 20.5 20.1 20.5 20.9 20.6 20.5 23.2 22.1 22.6 23.2 24.2 22.7 a 25.8 24.5 24.9 24.8 24.9 20.6 19.8 20.3 20.6 20.5 20.3 21.2 20.1 20.6 20.8 19.9 20.6 19.9 19.4 19.9 20.5 21.1 20.0 22.0 21.0 21.5 20.8 20.5 21.2 24.4 24.7 24.0 23.5 22.8 23.8 24.2 21.7 20.9 22.2 22.6 22.3 20.9 20.2 20.7 21.0 21.0 20.8_______________________________________________________________________________ Note: The medians for cohorts 15-19 and 20-24 could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. a = Omitted because less than 50 percent in the age group had given birth by age 20 Table 3.6 Age at first birth Percent distribution of women 15-49 years by age at first birth, according to current age, South Africa 1998 Current age Women with no births Age at first birth Total Number of women Median age at first birth<15 15-17 18-19 20-21 22-24 25+ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 86.8 41.7 18.4 6.8 4.9 4.7 5.2 0.6 1.6 2.9 3.6 2.8 3.1 2.7 8.8 18.7 16.9 21.0 19.0 15.2 15.3 3.8 19.8 20.6 23.4 20.6 21.2 23.2 NA 13.2 17.8 16.6 18.7 20.9 16.8 NA 5.0 15.6 14.3 19.1 17.6 19.3 NA NA 7.8 14.3 14.9 17.2 17.4 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,249 2,075 1,857 1,654 1,636 1,294 970 a a 20.9 20.2 20.7 21.0 21.0 Note: NA = Not applicable. a = Half or more of women in these age groups had not given birth before entering the age group, making the calculation of a median age at birth unfeasible. Table 3.7 shows the median age at first birth for the age cohorts 25-29 to 45-49 by selected background characteristics. No median age at first birth is provided for the age group 15-24 since a substantial proportion of women in this age cohort had not yet given birth at the time of the survey. The results show that median age at first birth is higher for women in urban areas than for women in rural areas. Similarly, age at first birth increases with higher levels of education. For example, in the age cohort 30-34, women without any formal education have their first birth around age 19, compared with age 26 for women with secondary or higher education. There is considerable regional variation in age at first birth. Age at first birth is lowest in Mpumalanga (19.5) and highest in the Western Cape (21.8 years). Age at first birth also varies by population group. Whites have the highest age at first birth (23.8), followed by Asians (22.3) and coloureds (21.2). African women recorded the lowest age at first birth (20.3 years). 43 CHAPTER 4 CONTRACEPTION AND FERTILITY PREFERENCES 4.1 Knowledge of Contraceptive Methods Knowledge of contraceptive methods has been recognised as a key factor in the uptake of contraceptives and lack of information is an important reason for unmet need. Women who know about a range of contraceptive methods are more likely to use a method. Women interviewed in the SADHS were asked if they had heard about methods a couple could use to avoid or delay pregnancy. Respondents were asked to name any methods they had heard of. If the respondent did not mention a particular method, that method was described and she was asked if she had heard of it. Respondents were then asked to mention any other additional methods that the interviewer did not describe. Table 4.1 shows the percentage of all women, of currently married women, of sexually active unmarried women and of women who have no sexual experience who know of contraceptive methods. Almost all women (97 percent) have heard of at least one modern method. Knowledge is equally high in both the married and the sexually active unmarried groups. Although lower than the other groups, women with no sexual experience still exhibit significant knowledge of at least one modern method (86 percent). Among all groups of women, the two best-known methods are the injection (94 percent) and the pill (93 percent). The majority of women (89 percent) also know of the male condom. The female condom which is available on a limited basis in South Africa was mentioned by a very small number of women. Over three-quarters of married and sexually active women have heard of the IUD, however less than half of those without sexual experience know of this method (40 percent). This may be due to the fact that the group with no sexual experience is younger than the married and sexually active unmarried, and the IUD is generally used by women who have had children. The use of this method has decreased over time and it is no longer available in some clinics, as trained staff are required to fit the device. Vaginal methods such as the diaphragm, foam, and jelly, were the least known of the modern methods. The diaphragm had previously been available in the public and private services but has now been discontinued from both services. Just over two-thirds (68 percent) of all women have heard of female sterilisation, compared to only a third who know of male sterilisation. Married women are more likely to know of these permanent methods than women in the other groups. Emergency contraceptive pills were mentioned by very few women in the unprompted “other” section. This low level of spontaneous reporting of this method may be due to both limited knowledge of the method as well as the fact that some women do not think of this as a usual method of contraception. Traditional methods of family planning are less widely known than modern methods, with 42 percent of all women having heard of a traditional method. Withdrawal was mentioned by almost a third (31 percent) of women. Natural methods such as periodic abstinence (the rhythm method) are known by a quarter of all respondents (25 percent). A wide variety of other methods were described by women, including tying a rope or string around the waist. A number of post-coital methods were mentioned including drinking water, coke or milk and burying menses. One of the interesting points about many of the traditional methods is that they are often only used post-coitally rather than on a regular basis of any sort. 44 Table 4.1 Knowledge of contraceptive methods Percentage of all women, of currently married women of sexually active unmarried women, and of those with no sexual experience who know specific contraceptive methods, South Africa 1998_____________________________________________________________ Sexually Currently active No Contraceptive All married unmarried sexual method women women women experience_____________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilisation Male sterilisation Any traditional method Periodic abstinence Withdrawal Herbs Other Number of respondents Mean number of methods 96.7 98.1 99.2 85.5 96.5 98.0 99.2 85.5 93.2 95.4 96.4 79.4 71.4 79.5 76.9 39.8 94.4 96.7 98.2 78.0 16.4 21.1 12.8 15.6 88.7 89.1 94.3 77.1 67.9 77.8 66.4 44.5 35.3 44.1 29.8 30.3 41.8 50.0 45.0 22.5 25.3 30.9 26.7 14.5 30.5 39.3 32.0 14.0 12.4 14.2 13.4 6.1 4.8 5.4 6.1 4.0 11,735 5,077 2,074 1,545 5.4 5.9 5.5 4.0 4.2 Ever Use of Contraception Respondents were asked if they had ever used anything to delay or avoid pregnancy. Table 4.2 shows the percentage of women who have ever used a method of family planning, according to method used and age. Over 80 percent of married women between the ages of 20 and 44 have used a method of contraception. This figure falls slightly in the oldest age group (45-49) where three quarters (75 percent) have ever used a method. The lowest use was recorded in the youngest married group where two thirds (66 percent) have ever used a method. Injectables are by far the most commonly cited method for all women, followed by the pill. The male condom has been used by less than one-fifth of all women (18 percent). Women between the ages of 20 and 34 are more likely to have ever used a condom than those aged 35 and over. Table 4.3 shows what methods women used when they first started using contraception. There are major differences by population group in the contraceptive method first used. Two-thirds of white and Asian women used the pill as their first method (65 and 68 percent, respectively) and only a very small number used the injection. In contrast, almost two-thirds of African and coloured women (65 and 64 percent respectively) used injectables as their first method. Looking at changes over time, an increasing proportion of women are using the injection as their first contraceptive method. Three-quarters of women aged 15-19 years used the injection as their first method, compared to less than half of those aged between 35-39 and a third of the 45-49 age group. It can also be seen that the opposite effect has occurred with the pill with a much lower proportion of the youngest group using the method compared to the older group. The IUD is generally recommended for parous women and so naturally has been used by a higher number of women in the older age groups. Use of the condom as a first method is highest in the youngest age group. 45 Table 4.2 Ever use of contraception Percentage of all women and of currently married women who have ever used a contraceptive method, by method and age, South Africa 1998________________________________________________________________________________________________________________ Modern method Traditional method________________________________________________________________ ____________________ Any Diaph., Female Male Any Periodic Number Any modern Inject- foam, Con- sterili- sterili- trad. absti- With- of Age method method Pill IUD ables jelly dom sation sation method nence drawal Other women________________________________________________________________________________________________________________ ALL WOMEN________________________________________________________________________________________________________________ 15-19 38.9 38.0 9.6 0.2 31.1 0.1 9.5 0.0 0.0 4.1 1.8 2.7 0.5 2,249 20-24 80.3 79.3 30.1 1.5 66.9 0.3 24.0 0.4 0.1 9.9 4.9 6.6 2.1 2,075 25-29 86.9 85.9 44.4 4.6 73.0 0.5 23.8 2.8 0.8 12.5 7.1 8.1 1.7 1,857 30-34 87.9 86.9 48.6 11.3 68.7 0.7 23.0 8.4 1.6 12.4 3.7 10.5 2.8 1,654 35-39 86.8 85.6 51.6 15.2 62.1 1.1 16.4 17.0 2.7 11.5 4.7 8.9 3.0 1,636 40-44 81.6 80.2 51.5 20.6 54.3 1.7 13.2 24.3 2.8 9.3 3.8 7.2 3.1 1,294 45-49 73.5 71.7 44.8 17.4 40.2 2.2 11.7 23.6 2.6 11.1 3.0 9.9 2.7 970 Total 75.0 73.9 37.6 8.5 57.0 0.8 17.8 8.7 1.3 9.8 4.2 7.3 2.1 11,735 ________________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN________________________________________________________________________________________________________________ 15-19 66.4 63.6 18.5 0.0 51.2 1.6 26.6 0.0 0.0 13.2 3.5 9.8 1.6 73 20-24 84.4 83.5 40.8 3.4 70.3 0.2 26.7 1.1 0.6 13.4 5.8 10.7 1.5 465 25-29 87.6 86.5 47.3 5.1 70.4 0.3 25.1 4.7 1.4 15.3 7.8 11.1 1.7 900 30-34 88.8 87.4 50.5 10.8 65.7 1.2 22.1 10.2 2.7 14.6 4.1 12.3 3.2 1,008 35-39 86.6 85.5 53.9 16.7 58.8 1.1 17.3 20.2 3.6 12.5 4.9 9.9 2.9 1,114 40-44 82.6 80.9 53.9 21.4 50.1 2.0 12.8 29.5 4.0 11.1 4.0 8.6 3.3 865 45-49 75.4 72.9 45.8 19.1 38.4 3.1 12.2 26.3 3.5 13.1 3.8 11.8 2.9 652 Total 84.6 83.2 49.3 13.1 59.1 1.3 19.2 15.8 2.8 13.4 5.0 10.7 2.7 5,077 Table 4.3 Contraceptive method first used Percent distribution of women who have ever used contraception by method first used, South Africa 1998 ___________________________________________________________________________________________________________________ Diaph., Sterilisation Periodic Background Injec- foam, ______________ absti- With- Other characteristic Pill IUD tions jelly Condom Female Male nence drawal methods Missing Total Number _________________________________________________________________________________________________________________ Age 15-19 12.6 0.2 74.4 0.0 9.3 0.0 0.0 1.1 1.5 0.3 0.5 100.0 875 20-24 17.3 0.8 73.3 0.1 6.1 0.0 0.1 0.9 0.6 0.6 0.3 100.0 1,666 25-29 24.5 2.2 66.3 0.0 3.3 0.1 0.0 1.0 1.3 0.6 0.7 100.0 1,614 30-34 29.2 5.3 56.5 0.0 3.7 1.2 0.0 0.8 2.4 0.8 0.1 100.0 1,453 35-39 37.1 7.9 45.6 0.3 2.6 2.4 0.0 0.6 1.8 1.1 0.5 100.0 1,420 40-44 43.4 6.5 39.7 0.7 1.2 4.2 0.0 0.9 2.7 0.5 0.1 100.0 1,055 45-49 46.1 6.4 32.4 0.5 3.1 5.1 0.0 0.7 4.4 0.8 0.5 100.0 713 Residence Urban 31.3 5.3 54.1 0.3 5.0 1.4 0.0 0.8 1.0 0.4 0.4 100.0 5,673 Non-urban 24.2 1.7 63.8 0.0 2.5 1.8 0.0 1.1 3.4 1.1 0.3 100.0 3,122 Province Western Cape 29.7 1.0 60.6 0.0 4.9 1.9 0.0 0.4 0.1 0.6 0.8 100.0 964 Eastern Cape 28.7 1.8 65.1 0.0 1.3 1.6 0.0 0.6 0.6 0.2 0.2 100.0 1,119 Northern Cape 26.2 2.0 67.6 0.0 1.1 2.5 0.1 0.0 0.1 0.1 0.1 100.0 191 Free State 24.6 3.6 66.1 0.0 2.7 0.8 0.0 0.7 1.1 0.4 0.1 100.0 612 KwaZulu-Natal 29.6 2.4 53.9 0.1 5.7 2.1 0.0 1.1 3.6 1.4 0.1 100.0 1,604 North West 26.3 4.0 64.6 0.0 2.8 1.2 0.0 0.3 0.3 0.2 0.4 100.0 718 Gauteng 32.6 8.8 47.4 0.6 5.4 0.9 0.0 1.1 2.3 0.6 0.3 100.0 2,113 Mpumalanga 22.3 4.1 63.8 0.1 2.8 2.3 0.1 1.7 1.5 0.6 0.5 100.0 634 Northern 27.5 2.3 57.1 0.1 4.4 1.6 0.0 1.2 3.7 0.9 1.0 100.0 841 Population group African 23.4 4.3 64.5 0.2 2.5 1.4 0.0 1.0 1.7 0.7 0.4 100.0 6,823 Coloured 27.5 1.6 63.9 0.0 3.0 1.9 0.1 0.4 0.6 0.7 0.3 100.0 905 White 65.3 5.3 5.0 0.8 15.6 1.8 0.0 0.8 5.1 0.3 0.0 100.0 735 Asian 67.7 3.5 6.7 0.0 16.8 1.7 0.0 0.3 1.7 1.2 0.3 100.0 284 Total 28.8 4.0 57.5 0.2 4.1 1.5 0.0 0.9 1.9 0.7 0.4 100.0 8,796 _____________________________________________________________________________________________________________________ Note: includes 49 women not stated as to population group. 46 4.3 Source of Contraceptive Information Women who had ever used a contraceptive method were asked where they got their initial information on contraceptive use. Overall, the most important sources of first information are nurses, mothers, and friends. Increasingly, younger women are getting contraceptive information from their mothers (Table 4.4). Over a third of women (39 percent) in the youngest age group received information from their mothers and for this age group this is the most common source of information. Looking at the oldest age group, only 10 percent cited their mothers as the first source of contraceptive information. These older women mainly got their contraceptive information from a nurse (50 percent) or a doctor (17 percent). This is probably because the mothers of the older women were unlikely to have used a method of contraception and so were not in a position to give information. The proportion who obtained information from pamphlets and radio/TV is low across all age groups. Looking at differences across population groups, it can be seen that overall few Asian (7 percent) and coloured (11 percent) women received contraceptive advice from their mothers, compared to almost a fifth (19 percent) of African women and almost a third of white women. Table 4.4 First source of contraceptive information Among women who have ever used a contraceptive method, percentage who first got information about methods from various sources, South Africa 1998 ______________________________________________________________________________________________________________ Background Other Poster, Radio, characteristic Mother Sister Father relative Friend Teacher Nurse Doctor leaflet TV Other Number _______________________________________________________________________________________________________________ Age 15-19 39.4 11.5 0.3 7.7 17.2 8.6 20.3 3.2 0.9 1.4 5.6 875 20-24 23.7 10.1 0.1 4.7 17.8 6.7 38.7 2.9 1.5 1.8 6.4 1,666 25-29 18.6 9.2 0.6 4.6 14.9 7.1 45.0 3.2 1.9 1.6 6.1 1,614 30-34 17.3 8.5 0.2 3.8 15.7 5.0 46.6 6.2 1.8 0.5 6.6 1,453 35-39 12.3 5.7 0.1 3.6 13.7 2.8 51.3 8.2 1.3 2.2 7.8 1,420 40-44 10.8 4.3 0.2 4.2 11.4 2.8 53.4 11.1 2.5 1.4 8.1 1,055 45-49 10.2 5.2 0.1 3.0 11.5 2.6 49.9 17.2 2.6 1.6 7.0 713 Residence Urban 21.2 8.1 0.3 4.3 13.9 6.5 42.1 8.0 2.6 1.5 6.3 5,674 Non-urban 14.5 7.9 0.2 4.8 16.8 3.1 47.7 3.8 0.3 1.5 7.5 3,122 Province Western Cape 15.4 4.1 0.5 2.7 4.6 5.6 54.1 10.6 2.1 0.5 3.9 964 Eastern Cape 20.6 8.8 0.1 3.0 10.2 3.7 48.0 4.0 0.6 0.6 4.6 1,119 Northern Cape 18.2 5.8 0.1 4.0 7.2 6.7 57.9 9.8 2.6 0.6 2.6 191 Free State 26.9 9.6 0.1 2.0 8.7 6.4 45.3 11.3 1.0 1.2 7.6 612 KwaZulu-Natal 7.8 7.3 0.2 3.4 15.6 3.3 53.4 5.0 0.8 1.4 7.7 1,604 North West 35.8 10.7 0.7 6.7 15.3 7.1 32.1 3.0 0.4 1.4 10.0 718 Gauteng 22.2 8.1 0.1 6.3 18.4 8.0 35.7 8.8 4.2 2.2 5.4 2,113 Mpumalanga 21.3 9.8 0.1 4.9 24.1 4.7 40.8 4.3 0.9 1.9 11.5 634 Northern 10.4 8.2 0.3 5.2 21.9 1.5 39.1 3.0 0.5 2.5 8.6 841 Population group African 19.1 9.4 0.2 5.0 16.1 4.9 44.7 3.0 0.7 1.5 6.6 6,823 Coloured 10.8 2.3 0.3 2.2 5.2 5.5 65.0 7.6 2.0 0.7 3.2 905 White 31.0 3.4 0.4 2.7 17.2 7.7 12.5 34.2 9.5 2.6 8.9 735 Asian 7.3 3.7 0.3 2.2 12.5 6.6 43.1 16.0 4.6 2.7 15.7 284 Total 18.8 8.0 0.2 4.4 14.9 5.3 44.1 6.5 1.7 1.5 6.8 8,796 ______________________________________________________________________________________________________________ Note: includes 49 women not stated as to population group. 47 Table 4.5 Age at first use Among women who have ever used a contraceptive method, the median age at first use, the percentage who used before age 19 and, among those, the percentage who got information or advice from a parent or guardian, South Africa 1998 _______________________________________________________________________ Those who used Among all ever users before age 19 _________________________ _________________ Median First Number Percentage Number age used of women who got who used Background at first before who ever help from before characteristic use age 19 used parents age 19 _______________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Non-urban Province Western Cape Eastern Cape Northern Cape Free State KwaZulu-Natal North West Gauteng Mpumalanga Northern Population group African Coloured White Asian Total 16.5 NA 875 40.5 849 18.8 55.0 1,666 30.7 913 19.7 42.0 1,614 27.3 675 20.4 34.0 1,453 23.7 500 21.6 26.0 1,420 22.7 368 22.0 21.0 1,055 18.1 224 24.0 13.0 713 21.1 90 19.7 43.0 5,674 31.9 2,440 20.3 38.0 3,122 24.7 1,179 20.0 38.0 964 26.9 369 19.7 44.0 1,119 35.0 492 20.7 30.0 191 26.8 57 20.2 40.0 612 43.9 247 20.5 34.0 1,604 12.6 309 19.7 43.0 718 47.8 539 19.4 46.0 2,113 30.3 980 19.0 50.0 634 29.9 315 20.4 37.0 841 21.6 310 19.6 44.0 6,823 30.1 3,012 20.7 33.0 905 19.2 294 20.3 32.0 735 40.7 232 21.3 24.0 284 9.8 68 19.9 41.0 8,796 29.6 3,618 ______________________________________________________________________ NA = Not applicable 4.4 Age at First Use Age at first contraceptive use has dropped considerably, from 24 years among women 45-49 to 19 years among women 20-24 at the time of the survey (Table 4.5). This may reflect a number of factors, including an increase in acceptability of using a method at a younger age, the trend to delay childbearing, and a drop in the age at first sexual intercourse. There are no real differences in age at first use among ethnic groups, provinces and urban and non-urban women. The proportion of women who were given advice and information on how to use contraception by parents has changed over the years, with 41 percent of the youngest age group reporting parental or guardian support, compared with just over a fifth (21 percent) in the oldest age group. 48 4.5 Current Contraceptive Use Contraceptive use is an important reproductive health indicator and can inform on the level of unmet need for contraception. The contraceptive prevalence rate (CPR) is usually defined as the percentage of currently married women who are currently using a method of contraception. Given the relatively high level of contraceptive use among unmarried women in South Africa, the data on contraceptive use in Table 4.6 are presented for all women, currently married women and all sexually active women. Over half of all women are using a method of contraception, almost all of which are modern methods (Table 4.6 and Figure 4.1). By far the most widely used method is the injection (27 percent), followed by the pill and female sterilisation (9 percent each). Both the IUD, condom and male sterilisation are used by less than two percent of all women. Few women (less than 1 percent) use traditional methods of contraception. Looking at method use by age, injection is more popular at the younger ages, while sterilisation is the more popular method after the age of 35 years, with almost one in four women over the age of 40 having being sterilised. As expected, contraceptive use is higher among currently married women (56 percent) than all women and is highest among women who were sexually active in the four weeks before the survey (62 percent). The highest prevalence is recorded in the 20-24 age group where 69 percent of all sexually active women are using a method of contraception. Rates drop to 57 percent in the 40-44 age group and to 46 percent among those 45 and over. Some women are much more likely to use contraception than others. Table 4.7 shows current contraceptive use by background characteristics for all women - whether married or unmarried -who were sexually active in the four weeks preceding the interview. There is a large difference in current contraceptive use between urban and non-urban women with two-thirds (67 percent) of women in the urban areas using a method, compared to 54 percent in non-urban areas. The proportion of women using injectables is slightly higher in the non-urban areas (33 percent) than in the urban areas (28 percent). These differences can be partly explained by the fact that some non-urban areas rely on mobile clinics, which often supply injections in favour of pills. Use of the pill and female and male sterilisation is more common in urban areas, which may reflect differences in service availability or cultural acceptability. Provincial differences in contraceptive prevalence are large. KwaZulu-Natal, Northern and Mpumalanga Provinces record the lowest rates, with levels of contraceptive prevalence below 60 percent. The lowest recorded prevalence is in Northern Province where only 55 percent of sexually active women are using a method of contraception. At 74 percent, Western Cape Province records the highest prevalence of all the provinces. This could be attributed to historically better health services and to the different demographic profile of the Western Cape compared to the rest of the country. There are also differences in the specific methods used. The proportion of women using injectables is highest in the North West, Eastern Cape and Free State. Twenty-four percent of sexually active women in the Western Cape have been sterilised, compared to only 4 percent of women in Northern Province. Education plays a major role in contraceptive use with only a third (35 percent) of those who have not attended school using a method, compared to over three-quarters (79 percent) who attained a minimum of Standard 9. There are also strong differences between ethnic groups, with white and Asian women reporting highest method use (76 and 80 percent, respectively), compared to 59 percent of African women and 69 percent of coloured women. There are also differences in use between urban and non-urban African women with contraceptive prevalence higher in the urban areas. The injection is the most popular method among African women (35 percent), followed by the pill (12 percent) and female sterilisation (8 percent). 49 Coloured women are also high users of injectables with over a quarter (27 percent) using this method. In contrast, Asian women have the highest levels of use of the pill and female sterilisation (34 and 32 percent, respectively) and only a very small proportion use the injection (4 percent). Similarly, among white women, the pill and sterilisation are the most popular methods (20 and 27 percent, respectively). White women also report the highest levels of use of male sterilisation (15 percent); far lower proportions of coloured and Asian women and no African women reported that their partners had been sterilised. Contraceptive use increases with number of living children up to three children, and declines thereafter. 52 Table 4.8 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, South Africa 1998____________________________________________________________________________________________________ Never used Number of living children at time of first use of contraception Median contra- Number number Current age ception of of children 0 1 2 3 4+ Missing Total women at first use1____________________________________________________________________________________________________ 15-19 29.4 52.0 18.6 0.0 0.0 0.0 0.0 100.0 93 0.0 20-24 15.5 37.6 38.6 6.5 1.5 0.3 0.0 100.0 511 0.1 25-29 11.8 38.4 37.5 6.7 3.6 1.4 0.6 100.0 994 0.1 30-34 11.3 31.6 38.6 9.1 3.7 5.2 0.4 100.0 1,176 0.3 35-39 12.8 28.0 32.2 11.1 7.4 7.7 0.8 100.0 1,333 0.5 40-44 17.8 21.7 32.7 12.5 6.5 8.8 0.0 100.0 1,105 0.6 45-49 24.7 18.0 20.4 13.4 9.4 13.5 0.6 100.0 859 0.9 Total 15.4 29.0 33.1 10.0 5.6 6.5 0.4 100.0 6,070 0.4____________________________________________________________________________________________________ 1 Among ever-married women who have ever used contraception _____________________________________________________ 4.6 Number of Children at First Use Table 4.8 shows how first use of contraception has changed over the years. In the youngest group of 15-19 years, over half (52 percent) used a method before their first child, compared to only 18 percent of women 45-49. Each five-year age group shows the trend towards starting to use a method earlier in their reproductive lives and reflects either a move towards delaying childbearing or the earlier onset of sexual activity. 53 4.7 Knowledge of Fertile Period An elementary knowledge of reproductive physiology provides a useful background for successful practice of coitus-related methods such as the calendar method, the Billings method, and other types of periodic abstinence. In the SADHS, women were asked when during a woman’s monthly cycle, she has the greatest chance of becoming pregnant. Over a third of women (38 percent) reported that they did not know when this time was. Only 11 percent gave the correct answer by stating that the greatest risk was in the middle of the cycle. Twenty percent thought the most likely time to conceive is just before a woman’s period begins and 23 percent said it is right after the period has ended. Five percent said that women are most likely to conceive during their menstrual periods. 4.8 Postpartum Amenorrhoea, Abstinence and Insusceptibility Table 4.9 shows that about half of women in South Africa remain amenorrhoeic for at least two months following a birth. Thirty-five percent of women remain amenorrhoeic for at least one year following a birth while 28 percent abstains from sexual relations for this duration. On average, women are amenorrhoeic for ten months and abstain from sexual relations for 10 months following a birth. The median duration of post- partum sexual abstinence is 4.9 months. Forty percent of women remain insusceptible to the risk of pregnancy for at least 16 months after a birth. Thereafter, women become increasingly susceptible although the loss of insusceptibility is not dramatic in subsequent months after a birth. The loss of insusceptibility does not necessarily increase with increase in months since a birth. The lower and upper bounds of percentages insusceptible are 20.1 for 28-29 months and 31.8 for 22-23 months following a birth. Table 4.10 presents the median duration of postpartum insusceptibility by background characteristics. The median duration of amenorrhoea is 2.4 months while the median duration of post partum sexual abstinence is 4.9 months following a birth. Uneducated women and those in Northern Province have remarkably higher duration of amenorrhoea than others. Similarly, the duration of post partum sexual abstinence is highest in Northern Province. Table 4.9 Postpartum Amenorrhoea, abstinence and insusceptibility Percentage of births whose mothers are postpartum amenorrheic, abstaining and insusceptible, by number of months since birth and median and mean durations, South Africa 1998 _______________________________________________________________________________________ Postpartum _______________________________________________________________________________________ Amenorrhoeic Abstaining Insusceptible Number of births Months since birth <2 57.7 88.7 90.8 123 2-3 51.6 68.0 80.1 195 4-5 43.2 46.9 65.8 204 6-7 42.1 40.6 62.0 173 8-9 37.7 36.8 59.6 184 10-11 36.8 28.6 51.7 162 12-13 35.3 27.6 48.6 165 14-15 30.9 26.3 48.1 167 16-17 24.8 21.1 40.0 176 18-19 16.6 12.9 27.6 177 20-21 22.2 13.1 31.8 151 22-23 13.5 17.3 27.1 181 24-25 18.5 9.8 27.0 190 26-27 15.4 14.0 25.1 175 28-29 9.9 11.6 20.1 161 30-31 13.6 9.1 20.3 147 32-33 19.8 17.0 29.3 144 34-35 14.0 19.6 28.7 163 Total 28.0 28.1 43.6 3,037 Median 2.4 4.9 12.2 - Mean 10.5 10.5 16.0 - Prev/Incidence Mean 10.0 10.0 15.5 - 54 Table 4.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea and postpartum insusceptibility by selected background characteristics, South Africa 1998 _______________________________________________________________________________________ Postpartum ___________________________________________________________________ Amenorrhoeic Abstaining Insusceptible Number of births Respondent’s age <30 2.4 5.3 14.4 1, 869 30+ 2.4 4.5 10.8 1, 169 Residence Urban 0.7 3.8 10.7 1, 472 Non-urban 6.3 5.8 14.0 1, 565 Province Western Cape 4.9 5.2 9.1 255 Eastern Cape 5.3 6.2 11.6 453 Northern Cape 0.8 3.7 14.0 60 Free State 2.4 7.1 16.6 153 KwaZulu-Natal 3.4 2.9 8.9 676 North West 1.4 5.8 13.9 211 Gauteng 0.5 2.5 6.5 559 Mpumalanga 3.7 4.5 7.1 228 Northern Province 8.9 11.9 17.7 441 Education No education 12.5 4.6 15.3 261 SubA-Std3 0.6 5.4 13.4 386 Std4-Std5 2.1 4.5 15.9 457 Std6-Std9 3.6 5.5 11.1 1, 267 Std 10 0.6 4.2 9.3 479 Higher 0.7 3.4 8.4 189 Population group African 2.4 5.2 13.3 2, 540 Afr. urban 0.6 4.1 11.8 1, 075 Afr. non-urban 6.4 5.8 14.1 1, 466 Coloured 0.7 5.5 10.3 284 White 3.4 2.2 4.8 132 Asian 2.1 0.4 2.5 62 Total 2.4 4.9 12.2 3, 037 4.9 Timing of Sterilisation Almost one-quarter of women over the age of 40 in South Africa have been sterilised. The median age at which women have the procedure done has increased slightly from 32 to 34 years over the past decade or so (Table 4.11). This increase may reflect the move towards women starting their families later. 55 Table 4.11 Timing of sterilisation Percent distribution of sterilised women by age at the time of sterilisation, according to the number of years since the operation, South Africa 1998 ______________________________________________________________________________________________ Age at time of sterilisation Number Years since ________________________________________________ of Median operation <25 25-29 30-34 35-39 40-44 45-49 Total women age1_____________________________________________________________________________________________ <2 6.0 20.3 23.8 28.7 16.3 4.8 100.0 195 33.8 2-3 0.9 17.7 31.0 28.3 16.9 5.2 100.0 170 33.8 4-5 6.8 15.0 36.3 30.7 11.2 0.0 100.0 151 33.6 6-7 0.6 19.0 40.0 33.3 7.1 0.0 100.0 130 33.0 8-9 10.4 25.1 38.7 23.4 2.5 0.0 100.0 114 32.0 10+ 9.0 36.8 39.6 14.6 0.0 0.0 100.0 259 a Total 5.9 23.6 34.6 25.3 8.8 1.8 100.0 1,020 32.6____________________________________________________________________________________________ 1 Median age was calculated only for women less than 40 years of age to avoid problems of censoring.a Not calculated due to censoring 4.10 Source of Contraceptive Method In the SADHS, women who reported using a modern method of contraception at the time of the survey were asked where they obtained their method the last time. Table 4.12 shows that the majority of users (84 percent) obtain their contraceptives from the public sector. Government hospitals are the most common public source (38 percent), followed by day hospital/clinics (20 percent) and family planning clinics (20 percent). Mobile clinics are used by six percent of modern method users. A tiny fraction of women reported obtaining their method from a community health worker, which might refer to the community-based distribution programme that is available as a pilot project at limited sites in six provinces. Fourteen percent of women use the private medical sector to get their contraceptives. Half of the private sector users (7 percent) go to a private doctor or gynaecologist, while five percent use a private hospital and two percent a pharmacy. Although the private sector is used by a smaller proportion of women, it is the source of supply for almost half (46 percent) of IUD users and a quarter of pill users (25 percent). Half of male sterilisations (48 percent) are also performed in the private sector. Public sector sources supplied almost all (93 percent) of injectable users and over three-quarters (77 percent) of condom users. 56 Table 4.12 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, South Africa 1998______________________________________________________________________________________ Female Male All Inject- Con- sterili- sterili- modern Source of supply Pill IUD ables dom sation sation methods______________________________________________________________________________________ Public 73.2 53.1 93.0 77.1 76.4 30.9 83.6 Government hospital 24.1 22.1 32.9 26.1 72.0 26.9 37.5 Day hospital/clinic 18.2 10.0 27.3 17.1 4.3 4.0 20.3 Family planning clinic 24.9 19.3 24.2 26.3 0.2 0.0 19.6 Mobile clinic 5.9 1.7 8.5 7.0 0.0 0.0 6.1 Community health worker 0.2 0.0 0.1 0.0 0.0 0.0 0.1 Other public 0.0 0.0 0.0 0.6 0.0 0.0 0.0 Private medical 24.8 46.3 6.3 7.4 22.2 48.1 14.4 Private hospital/clinic 1.4 5.9 0.6 0.0 21.4 47.1 5.4 Pharmacy 7.3 0.8 0.5 7.4 0.0 0.0 2.0 Private doctor/gynecologist 16.1 37.9 5.1 0.0 0.8 1.0 7.0 Other private 0.0 1.7 0.0 0.0 0.0 0.0 0.0 Other private 1.5 0.0 0.2 13.3 0.0 0.0 0.9 Shop 0.0 0.0 0.0 6.2 0.0 0.0 0.2 Friend/relative 0.2 0.0 0.0 1.8 0.0 0.0 0.1 Other 1.3 0.0 0.2 5.4 0.0 0.0 0.6 Missing 0.5 0.7 0.5 2.2 1.4 20.9 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,096 143 3,199 224 1,020 108 5,790 4.11 Quality of Contraceptive Services Information on the perceived quality of care for women accessing family planning services was collected in the SADHS. Specifically, women using modern methods other than sterilisation were asked if they agreed with each of four statements about the family planning service they used: (1) the staff shout and scold; (2) the staff do not explain much about the family planning method; (3) the staff ignore problems which you report; and (4) the staff are unfriendly. Overall, about one in 6 or 7 users agreed with each statement (Table 4.13). In the public services, family planning clinics were rated as giving the poorest quality in all areas that were assessed by the survey. A fifth of family planning clinic users feel that staff shout or scold (21 percent), do not explain much about their method to them (21 percent) or are unfriendly (20 percent). These figures are slightly lower for those who use government hospitals and day hospitals/clinics. Staff at mobile clinics were rated overall as the least unfriendly (14 percent) and least likely to scold and shout (15 percent), among government-sector users. Quality is also an issue for private sector family planning users. Pharmacies were seen as providing the least quality service of all private and public outlets with a quarter (25 percent) of users regarding them as unfriendly. Seventeen percent of women who go to private doctors or gynaecologists reported that staff shout or scold and one fifth (20 percent) reported that staff did not explain the method to them. Private hospitals and clinics appear to provide the best service with only small numbers reporting poor quality. 57 Table 4.13 Quality of family planning services Percentage of current users of modern contraceptive methods who agree with statements about the family planning service they use, according to source of service, South Africa 1998____________________________________________________________________ Does not explain Number Shout much Ignore Are of and about the problems un- current Source of method scold method I report friendly users____________________________________________________________________ Public 17.9 16.4 14.1 17.0 4,839 Government hospital 16.6 15.9 13.9 16.4 2,170 Day hospital/clinic 18.8 13.3 12.1 16.0 1,173 Family planning clinic 20.6 20.7 17.1 20.2 1,136 Mobile clinic 14.7 16.8 12.7 13.9 354 Private 12.6 15.1 11.6 13.6 834 Private hospital/clinic 3.3 4.3 2.5 3.8 313 Pharmacy 21.6 26.3 23.6 24.7 115 Private doctor/gynecologist 17.4 20.4 15.3 18.1 403 Total 16.8 15.9 13.4 16.1 5,790 ___________________________________________________________________ Note: Total includes some users of other private sources 4.12 Breaks in Contraceptive Use All women who reported that they were currently using a modern method other than sterilisation were asked if they had a break in their contraceptive use for any reason in the last year (Table 4.14). If a break was reported women were asked to specify the reason for this break. In total, 22 percent of women had taken a break from using contraception in the last year. This was highest in the 25-29 age group where one quarter (25 percent) had stopped their method. Women over the age of forty were least likely to have taken a break and this may be because women in this age group are more likely to have completed their families. It may also be that women in this age group are highly motivated not to fall pregnant. Provincial differences can also be seen, with almost one-third of users in Mpumalanga having taken a break, compared to much lower figures in the other provinces. Being pregnant was the main reason for the break in use in all age groups. Other reasons included health reasons, sexual inact

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