South Africa - Demographic and Health Survey - 2007

Publication date: 2007

Copyright information Copyright © Department of Health, 2007. All materials in this report may be reproduced and copied for non-commercial purposes. Citation as to source, however, is required. ISBN: 978-1-920014-47-6 Suggested citation: Department of Health, Medical Research Council, OrcMacro. 2007. South Africa Demographic and Health Survey 2003. Pretoria: Department of Health. An electronic copy of this report is available at: www.doh.gov.za/ www.mrc.ac.za/bod/bod.htm Layout and formatting of text and tables: Elize de Kock PREFACE The 2003 South African Demographic and Health Survey (SADHS) is the second survey of its kind in South Africa. The findings of the survey enable us to track the changes in the health status of our population, identify risk factors, access and utilisation of key health services for the five year period since the 1998 survey. The results of the SADHS provide valuable information for addressing important areas such as antenatal care for mothers during pregnancy and assistance at the time of delivery, child health, infant feeding practices, and the prevalence and treatment of diarrhoeal disease among children. Information on adult health conditions, women’s reproductive intentions, fertility levels, knowledge about contraception and use thereof are also included in the findings. We are pleased to note that this survey has shown that there have been a number of areas where some advances have been made in health development. In the area of adult health the rate of smoking among men has dropped from 42 percent in 1998 to 35 percent in 2003 and for women from 11 percent to 10 percent. The proportion of women who reported that their last live birth occurred in a health facility increased to 89 percent from the 83 percent reported in the 1998 survey. A few other areas, such as the fact that less than 30 percent of children were reported to have received vitamin A supplement in the last 6 months, point us to areas that will require special attention in the current and coming strategic period. The successful completion of a project of this nature was dependant on the collaboration of a number of dedicated people and organisations. I would like to extend a special word of appreciation to collaborating Departments, Science Councils, the research teams and the communities whom so gracefully participated in the survey. i ACKNOWLEDGEMENTS I am pleased to present the results of South African Demographic and Health Survey (SADHS) that was initiated in 2003. Firstly I would like to acknowledge the ongoing support of the Members of Executive Councils (MECs) and Provincial Heads of Health Departments and all staff who participated so tirelessly in this DHS. I would also like to thank staff at the National Department of Health: Dr L Makubalo: Chief Director: Health Information, Evaluation and Research, Ms P Netshidzivani, Project Manager; Ms R du Plessis, Project co-ordinator and Mr P Sekwati. Thank you to Dr Debbie Bradshaw of the Medical Research Council for technical support throughout the project and Mr Johan van Zyl from the Human Sciences Research Council’s for the data processing and analysis. Other members of the co-ordination team who need special mention are: Mr N Ntuli, Ms M Ratsaka-Mothokoa and Ms L Mahlasela for their technical input in designing tools and piloting them; Ms C Molomo who was seconded from Statistics South Africa during the initial stages of the SADHS; and Mr B Kgweedi for administrative support for the project. Thanks to Dr Chimere-Dan from Africa Strategic Research Corporation for conducting the fieldwork. The Department would like to further acknowledge efforts of all members of the project management committee, in particular representatives from the Departments of Social Development and Statistics South Africa, University of the Witwatersrand (Reproductive Health Research Unit), Medical Research Council, University of Stellenbosch, ORC MACRO International, Maryland, USA for providing technical assistance to the project as part of its international Demographic and Health Surveys programme, and the United States Agency for International Development (USAID)/South Africa for technical assistance to the project. Finally we extend our gratitude to Department of National Treasury for additional support in ensuring the full funding of the Demographic and Health Survey. ii TABLE OF CONTENTS PREFACE . i ACKNOWLEDGEMENTS . ii TABLE OF CONTENTS . iii LIST OF TABLES . vii LIST OF FIGURES . xi ACRONYMS AND ABBREVIATIONS. xiii REPUBLIC OF SOUTH AFRICA PROVINCE MAP . xv KEY FINDINGS OF THE SURVEY . xvi SUMMARY . xix CHAPTER 1: INTRODUCTION 1.1 History, Society and the Economy.1 1.2 Geography.3 1.3 Demographic Data and Population Policies.3 1.4 Health Policy Goals, Priorities and Programmes .4 1.5 Objectives and Organisation of the 2003 South Africa Demographic and Health Survey .5 CHAPTER 2: CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Distribution of Household Population by Age and Sex .11 2.2 Household Composition.13 2.3 Educational Level of Household Members.15 2.4 School Attendance .18 2.5 Grants and Pensions, Injuries and Disabilities .18 2.6 Housing Characteristics .21 2.7 Water and Sanitation.22 2.8 Household Durable Goods .23 2.9 Characteristics of Men Aged 15-59 and Women Aged 15-49 Years.23 2.10 Characteristics of Adults Aged 15 Years or Older.41 2.11 Realization of Sample .41 CHAPTER 3: FERTILITY 3.1 Introduction.43 3.2 Fertility Levels .44 3.3 Fertility Differentials.45 3.4 Fertility Trends.47 3.5 Children Ever Born and Living.48 3.6 Birth Intervals .50 3.7 Age at First Birth.52 3.8 Conclusions.53 CHAPTER 4: CONTRACEPTION AND FERTILITY PREFERENCES 4.1 Introduction.54 4.2 Knowledge of Contraceptive Methods.54 4.3 Ever Use of Contraception .57 4.4 Current Use of Contraception .60 4.5 Current Use of Contraception by Background Characteristics .63 4.6 Current Use of Contraception by Woman’s Status .65 4.7 Number of Children at First Use.67 4.8 Knowledge of Fertile Period .68 4.9 Postpartum Amenorrhea, Abstinence and Insusceptibility .68 iii 4.10 Timing of Sterilisation .71 4.11 Source of Contraception.71 4.12 Fertility Preferences .72 4.13 Need for Family Planning Services.76 4.14 Ideal Number of Children .79 4.15 Fertility Planning.81 CHAPTER 5: SEXUAL BEHAVIOUR, HIV AND AIDS 5.1 Introduction.85 5.2 AIDS Knowledge and Awareness.85 5.3 Sources of Knowledge about HIV and AIDS .86 5.4 Perceptions of the Risk of Getting HIV/AIDS.89 5.5 Accepting Attitudes Towards those Living with HIV/AIDS .91 5.6 Knowledge of Prevention of Mother-to-Child Transmission of HIV .93 5.7 HIV Tests .94 5.8 Attitudes Towards Negotiating Safer Sex.96 5.9 Age at First Sexual Intercourse .98 5.10 Recent Sexual Activity.99 5.11 Self Reporting of Sexually-Transmitted Infections .101 5.12 Seeking Treatment for STIs .103 5.13 Higher Risk Sex and Condom Use.103 5.14 HIV Prevention during Antenatal Period.105 5.15 Number of Sexual Partners .107 5.16 Male Circumcision.110 CHAPTER 6: INFANT AND CHILD MORTALITY 6.1 Introduction.112 6.2 Levels and Trends in Infant and Child Mortality.113 6.3 Socio-economic Differentials in Childhood Mortality.115 6.4 Demographic Differentials in Childhood Mortality.116 6.5 High-Risk Fertility Behavior.117 6.6 Early Childhood Mortality and Women’s Status .119 CHAPTER 7: MATERNAL AND CHILD HEALTH 7.1 Introduction .120 7.2 Antenatal Care.120 7.3 Tetanus Toxoid .123 7.4 Assistance and Medical Care at Delivery .124 7.5 Characteristics of Delivery.127 7.6 Immunisation Coverage .128 7.7 Prevalence and Treatment of Diarrhoeal Disease .134 7.7.1 Prevalence .134 7.7.2 Knowledge and treatment of diarrhoea .135 7.8 Prevalence of Acute Respiratory Infections (ARI) and Fever .137 7.9 Injuries .139 CHAPTER 8: INFANT AND CHILD FEEDING PRACTICES 8.1 Introduction.142 8.2 Initiation of Breastfeeding.143 8.3 Duration of Breastfeeding .144 8.4 Vitamin A and Iron Supplementation .145 8.5 Vitamin A Supplementation amongst Children .146 8.6 Nutritional Status of Children .147 iv CHAPTER 9: ADOLESCENT HEALTH 9.1 Introduction.151 9.2 Sexual Behaviour .151 9.3 Contraception and Use of Condoms .163 9.4 Incidence of Intentional and Unintentional Injury .164 9.5 Patterns of Exposure to Tobacco.164 9.6 Alcohol Use/Misuse by Adolescents .167 9.7 Anthropometry of Adolescents .172 9.8 Blood Pressure in Adolescents.183 9.9 Chronic Respiratory Symptoms and Peak Flow Expiratory Rates in Adolescents .186 9.10 Dietary Intakes of Adolescents .188 9.11 Physical Activity in Adolescents .193 CHAPTER 10: MORTALITY AND MORBIDITY IN ADULTS 10.1 Introduction.197 10.2 Adult Mortality .197 10.3 Chronic Diseases.197 10.4 Self-reported Prevalence of Tuberculosis .204 10.5 Injury and Violence.205 10.6 Malaria .212 10.7 Self-reported Illness and Health Problems Caused by Work.214 CHAPTER 11: UTILIZATION OF HEALTH SERVICES AND CHRONIC MEDICATION 11.1 Introduction.217 11.2 Health Services Attended.217 11.3 Satisfaction with Health Services.220 11.4 Problems in Accessing Health Care Among Women .223 11.5 Access to Medical Aid .225 11.6 Self-Reported Chronic Disease Drugs Used .225 11.7 Payment for Prescribed Medication for Chronic Diseases .238 11.8 Patterns of Prescribed Medication for Common Chronic Diseases .230 11.9 Chronic Disease Drug Utilization in Private and Public Sectors .234 11.10 Patient Knowledge of their Chronic Disease Drugs.236 11.11 Discussion .236 CHAPTER 12: HYPERTENSION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA IN ADULTS 12.1 Introduction.237 12.2 Hypertension .237 12.3 Blood Pressure Data Quality.238 12.4 Mean Blood Pressure, Pulse Rates and Pulse Pressure of Adults .240 12.5 Prevalence of Hypertension and Treatment Status of Hypertensive Participants .242 12.6 Hypertension Risk Factors .245 12.7 Comparison of BP Control between Public and Private Health Care Services.248 12.8 Chronic Obstructive Pulmonary Diseases and Asthma.249 12.9 Self-reporting of respiratory diagnoses .249 12.10 Reporting of symptoms.252 12.11 Abnormal peak expiratory flow rates.255 12.12 Discussion .256 v CHAPTER 13: ADULT HEALTH RISK PROFILES 13.1 Introduction.258 13.2 Prevalence of Tobacco use Among Adults .258 13.3 Exposure to Environmental Tobacco Smoke and Dust/Fumes in the Work Place .264 13.4 Patterns of Alcohol Consumption .267 13.5 Risky Drinking and Alcohol Problems .271 13.6 Perceptions of Own Body Weight.273 13.7 Weight and Height .274 13.8 Body Mass Index (BMI) and Prevalence of Obesity .276 13.9 Waist and Hip Circumference and Waist/Hip Ratio (WHR) .280 13.10 Dietary Intake of Adult Men and Women.283 13.11 Physical Activity Levels of Adults .291 13.12 Discussion .297 CHAPTER 14: OLDER PERSONS 14.1 Introduction.298 14.2 Characteristics of the Older Population .299 14.3 Housing Characteristics and Household Durable Goods of Older Persons .304 14.4 Illness, Disability and Injuries among Older Persons .307 14.4.1 Self-reported Prevalence of Chronic Conditions .308 14.4.2 Symptoms of Chest Conditions.312 14.4.3 Disability.313 14.4.4 Injuries .314 14.4.5 Violence Against Older Persons .315 14.5 Health Service Utilization in Older Persons .316 14.5.1 Health Service Utilization and Satisfaction .316 14.5.2 Access to Medical Aid .318 14.5.3 Use of Medication for Chronic Conditions .318 14.6 Risk Factors for Chronic Diseases in Older Persons.322 14.7 Oral Health of Older Persons .328 14.8 Discussion .330 CHAPTER 15: ORAL HEALTH AND ORAL CARE IN ADULTS 15.1 Introduction.334 15.2 Perceptions of oral health problems.334 15.3 Utilisation of health services.336 15.4 Satisfaction with the services .338 15.5 Loss of natural teeth .339 15.6 Oral Health Practices .339 15.7 Discussion .340 15.8 Policy implications.341 15.9 Future Research.342 REFERENCES .343 APPENDIX A.354 APPENDIX B.363 APPENDIX C.391 APPENDIX D.402 APPENDIX E.407 APPENDIX F: QUESTIONNAIRES vi LIST OF TABLES Table 2.1 Household population by age, sex and residence .11 Table 2.2 Comparison of broad age structures .12 Table 2.3 Household composition .13 Table 2.4 Fosterhood and orphanhood .14 Table 2.5 Educational level of female and male household population .17 Table 2.6 School attendance .18 Table 2.7 Grants and pensions, recent injuries .19 Table 2.8 Disability prevalence .20 Table 2.9 Housing characteristics .21 Table 2.10 Household durable goods.23 Table 2.11 Age distribution of women and men.23 Table 2.12 Selected background characteristic of respondents .24 Table 2.13 Level of education .26 Table 2.14 Reasons for leaving school .27 Table 2.15 Literacy .28 Table 2.16 Current marital status.31 Table 2.17 Age at first marriage .32 Table 2.18 Median age at first marriage .32 Table 2.19 Polygyny .33 Table 2.20 Employment.34 Table 2.21 Occupation.36 Table 2.22 Decision on use of woman’s earnings .38 Table 2.23 Participation in decision making.40 Table 2.24 Background characteristic of adults.42 Table 3.1 Current fertility .44 Table 3.2 Fertility by background characteristic .46 Table 3.3 Bonferroni-adjusted correlation coefficients .47 Table 3.4 Trends in fertility .47 Table 3.5 Children ever born and living .49 Table 3.6 Birth intervals .51 Table 3.7 Age at first birth.52 Table 4.1 Knowledge of contraceptive methods .56 Table 4.2 Ever use of contraception .58 Table 4.3 Current use of contraception.61 Table 4.4 Current use of contraception by background characteristics .64 Table 4.5 Current use of contraception by women's status.66 Table 4.6 Number of children at first use of contraception .67 Table 4.7 Postpartum amenorrhea, abstinence and insusceptibility .68 Table 4.8 Median duration of postpartum insusceptibility by background characteristics .70 Table 4.9 Timing of sterilization .71 Table 4.10 Source of contraception .72 Table 4.11 Fertility preferences by number of living children .73 Table 4.12 Fertility preferences by age.75 Table 4.13 Desire to limit childbearing .76 Table 4.14 Need for family planning.77 Table 4.15 Ideal number of children.80 Table 4.16 Mean ideal number of children by background characteristics .81 Table 4.17 Fertility planning status .82 Table 4.18 Wanted fertility rates .83 vii Table 5.1 Knowledge of AIDS .86 Table 5.2 Knowledge of HIV prevention methods .88 Table 5.3 Beliefs about AIDS.90 Table 5.4 Accepting attitudes towards those living with HIV or AIDS .92 Table 5.5 Knowledge of prevention of mother to child transmission of HIV .93 Table 5.6 HIV tests and receiving results .95 Table 5.7 Attitudes toward negotiating safer sex with husband/boyfriend.97 Table 5.8 Age at first sexual intercourse .98 Table 5.9 Median age at first intercourse.99 Table 5.10 Recent sexual activity .100 Table 5.11 Self-reporting of sexually-transmitted infection (STI) and STI symptoms .102 Table 5.12 Women and men seeking treatment for STIs.103 Table 5.13 Higher risk sex and condom use at last higher risk sex in the last year.104 Table 5.14 Tested for HIV during antenatal visit .106 Table 5.15 Discussion of HIV/AIDS prevention and use family planning during antenatal visit .107 Table 5.16 Number of sexual partners.108 Table 5.17 Male circumcision .111 Table 6.1 Early childhood mortality rates.113 Table 6.2 Early childhood mortality rates by socioeconomic characteristics .115 Table 6.3 Early childhood mortality rates by demographic characteristics .116 Table 6.4 High-risk fertility behaviour .118 Table 6.5 Early childhood mortality rates by women's status.119 Table 7.1 Antenatal care .121 Table 7.2 Number of antenatal care visits and timing of first visit.122 Table 7.3 Components of antenatal care.123 Table 7.4 Tetanus toxoid injections .124 Table 7.5 Place of delivery .125 Table 7.6 Assistance during delivery.126 Table 7.7 Reproductive health care by women's status .127 Table 7.8 Delivery characteristic: caesarean section and birth weight, and size of child.128 Table 7.9 Vaccination by background characteristics .130 Table 7.10 Vaccinations by source of information .133 Table 7.11 Prevalence of diarrhoea .134 Table 7.12 Knowledge of diarrhoea care.135 Table 7.13 Treatment of diarrhoea.136 Table 7.14 Feeding practices during diarrhoea.137 Table 7.15 Prevalence and treatment of symptoms of ARI and fever .138 Table 8.1 Initial breastfeeding .143 Table 8.2 Breastfeeding status by age.144 Table 8.3 Vitamin A supplementation to postpartum mothers .146 Table 8.4 Micronutrient intake among children.147 Table 8.5 Nutritional status of children at birth .148 Table 8.6 Nutritional status of children .150 Table 9.1 Age at first sex among young women and men.152 Table 9.2 Young people having premarital sex in the last year and using a condom during premarital sex .154 Table 9.3 Multiple sex partnerships among young women and men.155 Table 9.4 Higher risk sex and condom use at last higher risk sex in the last year among young women and men .157 Table 9.5 Age-mixing in sexual relationships .158 Table 9.6 Sexual activity and condom use in last 12 months .159 Table 9.7 Condom use at first sex among young women and men .160 viii Table 9.8 Teenage pregnancy and motherhood .161 Table 9.9 HIV and AIDS awareness among youth.162 Table 9.10 Tobacco use by adolescent men.165 Table 9.11 Tobacco use by adolescent women.166 Table 9.12 Alcohol use among adolescent men.169 Table 9.13 Alcohol use among adolescent women.170 Table 9.14 Hazardous and harmful drinking among adolescents .173 Table 9.15 Anthropometric measurements for adolescent men.174 Table 9.16 Anthropometric measurements for adolescent women.175 Table 9.17 Body mass index (BMI) of adolescent men.178 Table 9.18 Body mass index (BMI) of adolescent women.179 Table 9.19 Waist and hip circumference of adolescent men .182 Table 9.20 Waist and hip circumference of adolescent women .183 Table 9.21 Blood pressure and pulse rate in adolescent men .184 Table 9.22 Blood pressure and pulse rate in adolescent women .185 Table 9.23 Lung disease in adolescents .187 Table 9.24 Dietary intake of adolescent men.189 Table 9.25 Dietary intake of adolescent women.190 Table 9.26 Physical activity of adolescent men and women .195 Table 10.1 Family history of chronic diseases.199 Table 10.2 Chronic disease prevalence among men .202 Table 10.3 Chronic disease prevalence among women .203 Table 10.4 Injury rates .206 Table 10.5 Violence in the last 12 months.210 Table 10.6 Place and result of attack .211 Table 10.7 Medical outcome of attack.212 Table 10.8 Work-caused illness.216 Table 10.9 Type of work-caused injuries .216 Table 11.1 Health services attended, by age and sex.218 Table 11.2 Health services attended .219 Table 11.3 Dissatisfaction with health services .221 Table 11.4 Reasons for dissatisfaction.223 Table 11.5 Problems in accessing health care .224 Table 11.6 Access to medical aid .225 Table 11.7 Medication for chronic conditions in men .226 Table 11.8 Medication for chronic conditions in women .227 Table 11.9 Payment for medication for chronic conditions.229 Table 11.10 Use of prescribed medication for eleven common chronic conditions .230 Table 11.11 Prescribed medication for eleven common chronic conditions .231 Table 11.12 Public and private sector provision of medication for chronic conditions .235 Table 11.13 Knowledge about prescribed medication.236 Table 12.1 Mean blood pressure – men .241 Table 12.2 Mean blood pressure – women .242 Table 12.3 Hypertension prevalence and treatment status of men .243 Table 12.4 Hypertension prevalence and treatment status of women.244 Table 12.5 Hypertension risk factors – men .246 Table 12.6 Hypertension risk factors – women .247 Table 12.7 Public versus private sector source of hypertension medication .248 Table 12.8 Symptoms of lung disease .251 Table 12.9 Lung disease and risk factors.251 ix Table 13.1 Tobacco use among men.260 Table 13.2 Tobacco use among women.261 Table 13.3 Environmental Tobacco Smoke (ETS) and fumes or dust exposure among men.265 Table 13.4 Environmental Tobacco Smoke (ETS) and fumes or dust exposure among women.266 Table 13.5 Patterns of drinking, risky drinking and symptoms of alcohol problems among men .269 Table 13.6 Patterns of drinking, risky drinking and symptoms of alcohol problems among women.270 Table 13.7 Hazardous and harmful drinking among adults .272 Table 13.8 Adults self perception of weight .274 Table 13.9 Anthropometry of adult men and women .275 Table 13.10 Body mass index (BMI) of adult men.276 Table 13.11 Body mass index (BMI) for adult women .277 Table 13.12 Waist and hip circumference of adult men .280 Table 13.13 Waist and hip circumference of adult women .281 Table 13.14 Dietary intake of adult men .285 Table 13.15 Dietary intake of adult women.286 Table 13.16 Eating fatty and salty foods .288 Table 13.17 Physical activity of adult men and women .293 Table 13.18 Physical activity domains of adult men .295 Table 13.19 Physical activity domains of adult women .296 Table 14.1 Comparison of broad age structures .300 Table 14.2 Residence of older population .301 Table 14.3 Level of education and population group of older persons.302 Table 14.4 Grants and pensions of older persons .304 Table 14.5 Housing characteristics of older persons .305 Table 14.6 Household durable goods of older persons.307 Table 14.7 Lung disease and reported disability of older persons.312 Table 14.8 Lung disease and reported disability of older persons by residence.313 Table 14.9 Injuries among older persons.314 Table 14.10 Health services attended by older persons .316 Table 14.11 Dissatisfaction with health service among older persons .317 Table 14.12 Access to medical aid among older persons .318 Table 14.13 Medication for chronic conditions for older persons .319 Table 14.14 Payment for medication for chronic conditions in older persons .320 Table 14.15 Use of prescribed medication for four common chronic conditions among older persons .321 Table 14.16 Risk factors for disease in older persons, comparing 2003 and 1998 SADHS.323 Table 14.17 Risk factors for disease in older persons by residence .324 Table 14.18 Oral health of older persons.329 Table 15.1 Oral health practices and problems among adults .335 Table 15.2 Care for oral health problem.337 Table 15.3 Reasons for dissatisfaction.338 x LIST OF FIGURES Figure 2.1 Household population age structure, SADHS 2003 .12 Figure 2.2 Proportion of children under 15 years who are maternal, paternal and dual orphans, SADHS 1998 and 2003.15 Figure 2.3 Proportion of adult men and women with Grade 12 or higher education, SADHS 1998 and 2003.16 Figure 2.4 Current marital status of women and men, South Africa 2003.30 Figure 3.1 Number of births reported by year of birth, SADHS 2003.43 Figure 3.2 Ratio of urban to non-urban fertility by age group, SADHS 1998 and 2003 .45 Figure 3.3 Fertility rates by quinquennial period before the survey for equivalent aged women based on retrospective histories, African South African women, SADHS 1998 and 2003 .48 Figure 3.4 Projected median intervals by cohort, parity and median date of child’s birth for African South African women, 1987-9, SADHS 1998 and 2003.52 Figure 4.1 Current use of contraception among sexually active women 15-49 years by method, South Africa 1998 and 2003 .60 Figure 4.2 Fertility preferences of women in union aged 15-49 years, SADHS 1998 and 2003.74 Figure 4.3 Percentage of demand for family planning satisfied, SADHS 1998 and 2003.78 Figure 4.4 Total fertility rate and its wanted and unwanted components, South Africa 2003 .84 Figure 6.1 Child mortality trends: HSRC 1988-1992, SADHS 1998 and SADHS 2003 .113 Figure 6.2 Infant mortality rate per 1000 live births from 1998 and 2003 SADHS by province.114 Figure 7.1 Proportion of children 12-23 months vaccinated, SADHS 1998 and 2003 .129 Figure 7.2 Proportion of children 12-23 months with health card, all vaccinations and none.132 Figure 7.3 Prevalence of acute respiratory infections and fever in preceding 2 weeks by age, SADHS 1998 and 2003.139 Figure 7.4 Serious injury rate in the last 30 days (per 100 000 population) by age group, SADHS 1998 and 2003.140 Figure 7.5 Serious injury rate in last 30 days (per 100 000) by cause and sex among children aged 5-14 years .141 Figure 9.1 Percentage of men and women who ever smoked cigarettes daily of occasionally.167 Figure 9.2 Mean weight of adolescent men and women, SADHS 1998 and 2003 .177 Figure 9.3 Prevalence of BMI in adolescent men and women.180 Figure 9.4 Prevalence of high waist circumference and high waist hip ratio (WHR) among adolescent women by population group .181 Figure 9.5 Nutrient intake (% of RDA) for adolescents, SADHS 2003.191 Figure 9.6 Nutrient intake (% of RDA) of African and White adolescents, SADHS 2003 .192 Figure 9.7 Fat scores for adolescents by population group.193 Figure 10.1 Family history of chronic disease among adults, SADHS 1998 and 2003 .198 Figure 10.2 Self-reported prevalence of chronic diseases among men, SADHS 1998 and 2003 .201 Figure 10.3 Self-reported prevalence of chronic diseases among women, SADHS 1998 and 2003 .201 Figure 10.4 Prevalence of TB by age and sex, SADHS 1998 and 2003 .205 Figure 10.5 All cause injury rate in last 30 days per 100 000 population, SADHS 2003.206 Figure 10.6 Map of malaria risk in South Africa in 2004 .213 Figure 11.1 Proportion of adults using public health facilities in last 30 days, SADHS 1998 and 2003.218 Figure 11.2 Health services attendance by facility, SADHS 1998 and 2003.220 Figure 11.3 Prevalence of dissatisfaction by facility, SADHS 1998 and 2003.222 xi Figure 12.1 Prevalence of hypertension according to medication status for men, SADHS 1998 and 2003.239 Figure 12.2 Prevalence of hypertension according to medication status for women, SADHS 1998 and 2003.239 Figure 12.3 Mean systolic and diastolic blood pressure by age and sex, SADHS 1998 and 2003 .240 Figure 12.4 Prevalence of airflow limitation by sex, SADHS 1998 and 2003 .253 Figure 12.5 Prevalence of chronic bronchitis by sex, SADHS 1998 and 2003.254 Figure 12.6 Prevalence of abnormal peak flow by sex, SADHS 1998 and 2003.256 Figure 13.1 Prevalence of smoking by population group and sex, SADHS 2003 .263 Figure 13.2 Prevalence of smoking, living with smokers, working with smokers and working in dusty environments by sex, SADHS 1998 and 2003.267 Figure 13.3 Distribution of BMI categories for adult men and women, SADHS 1998 and 2003 .278 Figure 13.4 Distribution of BMI categories by population group and sex, SADHS 1998 and 2003.279 Figure 13.5 Prevalence of central obesity (waist and WHR) in adult men and women, SADHS 2003.282 Figure 13.6 Nutrient intake (% of RDA) for adults, SADHS 2003 .287 Figure 13.7 Fat scores of adults, SADHS 2003 .289 Figure 13.8 Frequency of consuming fatty foods among adults 15+ years, SADHS 2003 .290 Figure 13.9 Salt use habits of adults by sex, SADHS 2003 .290 Figure 14.1 Urban/non-urban residence of the older household population: Census 2001 and SADHS 2003 .300 Figure 14.2 Self-reported prevalence of chronic disease among older persons, SADHS 1998 and 2003.309 Figure 14.3 Self-reported prevalence of chronic disease among older persons by area of residence, SADHS 2003 .311 Figure 14.4 Percentage of care-seekers 65 years or older who where dissatisfied with health care services.317 Figure 14.5 Percentage of older men and women who currently smoke daily and occasionally, and who use smokeless tobacco daily and occasionally.325 Figure 14.6 Percentage distribution of older men and women, by BMI categories and residence, 2003 .326 Figure 15.1 The risk factor approach to the promotion of oral health .341 xii ACRONYMS AND ABBREVIATIONS ACT Artemisinin combination therapy AIDS Acquired Immune Deficiency Syndrome ANC Antenatal care ANHMRC Australian National Health and Medical Research Council ARI Acute respiratory infections ART Anti-retroviral therapy ASRC Africa Strategic Research Corporation ASSA Actuarial Society of South Africa AsGISA Accelerated and shared Growth Initiative of South Africa ATC Anatomical therapeutic chemical classification AUDIT Alcohol Use Disorders Identification Test BP Blood pressure BMI Body mass index CAGE Cut down, Annoy, Guilt, Eye-opener (Alcohol dependence) CARe Centre for Actuarial Research CMR Child mortality rate CDAW Convention for the elimination of All Forms of Discrimination Against Women COPD Chronic obstructive pulmonary disease CSPro Census and Survey Processing System DALY Disability adjusted life year DDT Dichlorodiphenyltrichloroethane DHIS District Health Information System DoH Department of Health DPT Diptheria-pertussis-tetanus EAs Enumeration areas EC Emergency contraception EDL Essential drug list ETS Environmental tobacco smoke FFQ Food frequency questionnaire GEAR Growth, Employment and Redistribution GOLD Global Initiative for Chronic Obstructive Lung Disease GPAQ Global Physical Activity Questionnaire GPS Global positioning system HBV Hepatitus B HGOI Health Goals, Objective and Indicators HIV Human immunodeficiency virus HSRC Human Sciences Research Council HS Home solution ICPD International Conference on Population and Development IHD Ischaemic heart disease IMCI Integrated Management of Childhood Illnesses IMR Infant mortality rate IPAQ International Physical Activity Questionnaire IUD Intra-uterine device kg/m 2 Kilogram per metre squared Kg Kilogram m Metre METs Multiples of resting metabolic rate mmHg Millimeters of mercury MOS Measure of size MRC Medical Research Council MTCT Mother-to-child transmission NDoH National Department of Health N-Index Nutrition Index NHIS/SA National Health Information System of South Africa ORS Oral Rehydration Solution ORT Oral Rehydration Therapy PEFR Peak expiratory flow rate PHC Primary health care xiii PMTCT Prevention of mother-to-child transmission programme RDA Recommended dietary allowance RDP Reconstructive and development programme PPS Probability proportional to size SADC Southern African Development Community SADHS South African Demographic and Health Survey SD Standard deviation SE Standard error Stats SA Statistics South Africa STI Sexually transmitted infection TB Tuberculosis TBA Traditional birth attendant TFR Total fertility rate U-5MR Under-five mortality rate UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VCT Voluntary counseling and testing WHO World Health Organisation WHR Waist/hip ratio YRBS Youth Risk Behaviour Survey xiv REPUBLIC OF SOUTH AFRICA Provinces - xv KEY FINDINGS OF THE SURVEY Maternal and child health indicators 1998 2003 Infant and child mortality (preceding 5 years) Infant mortality rate per 1 000 live births 45 (37; 48) 43* (29; 57) Under-5 mortality rate per 1 000 live births 59 (51; 63) 58* (43; 73) Child mortality rate per 1 000 live births 15 (12; 19) 16* (10; 22) Fertility of women 15-49 yrs (preceding 3 years) Total fertility rate: children per woman 2.9 (2.7; 3.1) 2.1* (1.9; 2.3) Ideal number of children 2.9 (2.8; 2.9) 2.5* (2.4; 2.5) Percent women who want no more children 44 (42; 45) 61 (58; 64) Modern contraceptive-use prevalence rate: Sexually active women Percent currently using a modern method 61 (60; 63) 65 (63; 67) Attended antenatal care: % of births in last 5 years Mothers attended antenatal care during pregnancy 94 (93 – 95) 92 (90 – 93) Assistance during delivery: % of births in last 5 years Mothers received medical care at delivery 84 (82; 86) 91 (89; 93) Vaccination and supplementation in children 12-23 months old Percent of children with vaccination cards, seen 75 (71; 78) 71 (65; 77) Percent children fully immunized 63 (59; 68) 52 (45; 59) Percent children received Vitamin A supplementation 29 (24; 34) Exclusive breastfeeding: % of infants < 6 months 6.8 (4.1; 9.5) 8.3 (3.1; 13.4) 6-9 months 0.2 (0.0; 0.4) 0.4 (0.0; 1.2) Diarrhoea in children Child had diarrhoea in last two weeks 13.2 (12.0; 14.4) 7.9 (6.5; 9.4) * Data quality checks suggest that fertility and childhood mortality estimates are not reliable. See report text for details. xvi KEY FINDINGS OF THE SURVEY Sexual behaviour and HIV related indicators 1998 2003 Sexual activity: % of men 15-59 and women 15-49 yrs Had two or more sexual partners in last 12 months: Men (not in union) - 19 (16; 21) Had two or more sexual partners in last 12 months: Women (not in union) 3.9 (3.3; 4.5) 3.1 (2.4; 3.8) Had higher-risk sex in last 12 months: Men - 65 (62; 68) Had higher-risk sex in last 12 months: Women - 58 (56; 60) Had first sex before age 18: Men - 45 (43; 48) Had first sex before age 18: Women 46 (45; 48) 42 (40; 44) Abstinence among youth 15-24 yrs never in union Percent never had sex: Men 15-24 - 38 (34; 42) Percent never had sex: Women 15-24 40 (37; 42) 42 (39; 44) Condom use: % of sexually active men and women Condom use at last higher-risk sex: Men 15-59 - 69 (66; 72) Condom use at last higher-risk sex: Men 15-24 - 72 (66; 77) Condom use at last higher-risk sex: Women 15-49 - 46 (44; 49) Condom use at last higher-risk sex: Women 15-24 - 52 (48; 56) HIV: % of men 15-59 and women 15-49 yrs Had HIV test and received results in last 12 months: Women - 8.5 (7.5; 9.5) Ever had HIV test and received results: Men - 20 (18; 22) Accepting attitudes towards people with HIV: Women - 38 (37; 40) Never had HIV test : % men and women 15-24 yrs Never tested: Men 15-19 - 87 (83; 90) Never tested: Women 15-19 - 81 (79; 84) Never tested: Men 20-24 - 77 (72; 83) Never tested: Women 20-24 - 60 (56; 63) Knowledge and beliefs about HIV: % men and women 15-24 yrs Have heard of AIDS: Men 15-19 - 93 (91; 96) Have heard of AIDS: Women 15-19 95 (94; 96) 93 (91; 95) Have heard of AIDS: Men 20-24 - 94 (91; 97) Have heard of AIDS: Women 20-24 98 (97; 98) 93 (92; 95) Using condoms prevents HIV infection: Men 15-19 - 80 (76; 84) Using condoms prevents HIV infection: Women 15-19 79 (76; 81) 70 (67; 73) Using condoms prevents HIV infection: Men 20-24 - 87 (83; 90) Using condoms prevents HIV infection: Women 20-24 87 (85; 89) 72 (69; 75) A healthy-looking person can have the HI virus: Women 15-19 28 (26; 31) 76 (73; 79) A healthy-looking person can have the HI virus: Women 20-24 30 (28; 33) 77 (74; 80) A person cannot become infected by sharing food with HIV infected person: Women 15-19 67 (64; 69) 74 (71; 77) A person cannot become infected by sharing food with HIV infected person: Women 20-24 74 (71; 76) 75 (72; 78) Circumcision: % of men 15-59 yrs Percent circumcised - 45 (42; 48) xvii KEY FINDINGS OF THE SURVEY Adult health indicators 1998 2003 Smoking prevalence: % of adults 15+ and of adolescents 15-19 yrs Currently smoking: Adult men 42 (41; 44) 35 (33; 38) Currently smoking: Adolescent men 14 (12; 17) 16 (12; 20) Currently smoking: Adult women 11 (9; 12) 10 (9; 12) Currently smoking: Adolescent women 5.8 (3.6; 8.0) 5.4 (2.8; 8.0) Abstinence of alcohol intake: % of adults 15+ yrs and of adolescents 15-19 yrs Never consumed alcohol: Adult men 42 (40; 44) 52 (49; 54) Never consumed alcohol: Adolescent men 75 (71; 78) 68 (64; 73) Never consumed alcohol: Adult women 74 (73; 76) 78 (76; 81) Never consumed alcohol: Adolescent women 85 (82; 88) 83 (79; 87) Micro-nutrient intake: % of adults 15+ yrs Adequate micro nutrient intake: Adult men - 33 (30; 36) Adequate micro nutrient intake: Adult women - 35 (32; 38) Overweight and obesity: % of adults 15+ yrs Overweight: Adult men 20 (19; 22) 21 (19; 23) Overweight: Adult women 27 (26; 28) 28 (26; 29) Obesity: Adult men 6.9 (6.1; 7.8) 8.8 (7.2; 10.3) Obesity: Adult women 29 (28; 31) 27 (26; 29) Physical inactivity: % of adults 15+yrs Insufficiently active: Adult men - 76 (75; 79) Insufficiently active: Adult women - 86 (85; 87) Hypertension (blood pressure > 140/90 mmHg and/or medication): % of adults 15+ yrs Prevalence of hypertension: Adult men 13 (12; 14) 8.7* (7.0; 10.4) Prevalence of hypertension: Adult women 16 (15; 17) 14* (12; 15) Respiratory conditions: % of adults 15+ yrs Prevalence of symptoms of asthma: Adult men 6.7 (5.7; 7.6) 7.2 (6.1; 8.3) Prevalence of symptoms of asthma: Adult women 8.6 (7.8; 9.4) 8.1 (7.1; 9.0) Prevalence of symptoms associated with chronic bronchitis: Adult men 2.3 (1.8; 2.8) 2.3 (1.7; 3.0) Prevalence of symptoms associated with chronic bronchitis: Adult women 2.8 (2.3; 3.2) 2.0 (1.5; 2.4) Prevalence of abnormal peak flow: Adult men 4.0 (3.4; 4.7) 7.9 (6.7; 9.2) Prevalence of abnormal peak flow: Adult women 4.1 (3.5; 4.7) 10.9 (9.5; 12.3) Violence: % of adults 15+ yrs At least one physical attack in past 12 months: Adult men - 12.8 (10.5; 15.0) At least one physical attack in past 12 months: Adult women - 7.2 (5.7; 8.7) * Data quality checks suggest that prevalence of hypertension estimate is not reliable. See report text for details. xviii SUMMARY S.1 Characteristics of the survey The 2003 South African Demographic and Health Survey is the second national health survey to be conducted by the Department of Health, following the first in 1998. Compared with the first survey, the new survey has more extensive questions around sexual behaviour and for the first time included such questions to a sample of men. Anthropometric measurements were taken on children under five years, and the adult health module has been enhanced with questions relating to physical activity and micro-nutrient intake, important risk factors associated with chronic diseases. The 2003 SADHS has introduced a chapter reporting on the health, health service utilisation and living conditions of South Africa’s older population (60 years or older) and how they have changed since 1998. This has been introduced because this component of the population is growing at a much higher rate than the other age groups. The chapter on adolescent health in 1998 focussed on health risk-taking behaviours of people aged 15-19 years. The chapter has been extended in the 2003 SADHS to include indicators of sexual behaviour of youth aged 15-24 years. A total of 10 214 households were targeted for inclusion in the survey and 7 756 were interviewed, reflecting an 85 percent response rate. The survey comprised a household schedule to capture basic information about all the members of the household, comprehensive questionnaires to all women aged 15-49, as well as anthropometry of all children five years and younger. In every second household, interviews of all men 15-59 were conducted and in the alternate households, interviews and measurements of all adults 15 years and older were done including heights, weights, waist circumference, blood pressure and peak pulmonary flow. The overall response rate was 75 percent for women, 67 percent for men, 71 percent for adults, and 84 percent for children. This is slightly lower than the overall response rate for the 1998 SADHS, but varied substantially between provinces with a particularly low response rate in the Western Cape. Over the past decade, South Africa has initiated several activities to extend and improve the population-based health and demographic data in the country. The SADHS makes an important contribution towards these endeavours. The SADHS is a central element of monitoring coverage of government programmes and evaluating their outcomes on population health and forms a part of the national statistical system. S.2 Mortality and fertility Comparison with other data sources shows that both the estimates of the fertility rates and the child mortality rates are implausibly low, and there is no obvious way in which these estimates could be reliably adjusted to allow for the data inadequacies in a consistent manner. The data from KwaZulu- Natal consistently show up as being problematic which then leads to a distortion of the national estimates of many indicators. However, these inadequacies in the data are not confined to this province alone. Child mortality rates are a key health indicator, measuring not only mortality in children, but also the level of development and well-being of a community or country. While the overall level does not appear correct, the historical trend in this survey points to an increasing trend to an under-five mortality rate of 58 per 1 000 live births in 5 years preceding the survey. This highlights the importance and urgency to identify the determinants contributing to the increase in child mortality xix so that efforts can be directed towards reaching the Millennium Development Goal of reducing child mortality. S.3 Reproductive and sexual health Teenage pregnancy rates, sexual behaviour and contraception use are also key indicators in Demographic and Health Surveys. Careful interpretation of these results is needed as some of these indicators are affected by the low number of births reported, and by poor data from KwaZulu-Natal. In addition, the results are also influenced to some extent by the over-representation of urban areas and Africans. Teenage pregnancy Compared to the 1998 SADHS, teenage pregnancy and motherhood rates decreased. By the age of 19 years, 27 percent of women had begun childbearing in 2003 compared with 35 percent in the 1998 SADHS. Rates dropped particularly in non-urban areas: currently 14 percent compared with 21 percent in 1998. The figure in KwaZulu-Natal of 2 percent--compared with 17 percent in 1998— is implausible. Contraceptive use Modern contraceptive use is still high, and appears to have increased since the last survey. Sexually active women report a noticeable increase in the use of the male condom as a contraceptive. The proportion of women using this method has increased from 2 percent in the 1998 SADHS to 8 percent in 2003. A more than four-fold increase from 4 percent to 18 percent in the 15-19 age group indicates a particular improvement in acceptance, accessibility or availability of the method in younger people, pointing additionally to possible promising behaviour change regarding the risk of HIV-transmission. The female condom has gained some usage with 53 percent of all women 15-49 years knowing about the method and 3 percent reporting ever using it. Oral contraceptive use has decreased slightly while injectable contraceptive use has increased slightly from 30 percent to 33 percent, with young women preferring the 2-monthly, and older women the 3-monthly injectables. The shift to the two-monthly method has some cost implications in the public health sector in terms of product cost and increase in the number of client visits per year of use. There is an increase in the use of dual protection, but emergency contraceptive use is very low. It is also of concern that despite the relatively high levels of contraceptive prevalence, the proportion of women who have knowledge about the fertile period in their cycle is very low (12 percent) and has not improved since the last survey. Family planning visit programmes should use the opportunity to educate women about conception, fertility, pregnancy and the risks of HIV and other STIs. HIV and AIDS Knowledge of HIV and AIDS is almost universal in South Africa. However, it is disconcerting that the proportion of young women who have ever heard of AIDS has declined since 1998. Among women aged 20-24 years, an extremely high risk age category, the proportion of women who respond that they had heard of AIDS declined from 97 percent in 1998 to 93 percent in 2003. The survey included questions on beliefs about transmission of HIV and attitudes towards those infected with HIV as these can affect behaviour. The survey shows that there are reasonably good levels of awareness, but identifies some gaps in knowledge that need to be addressed in future awareness campaigns. Knowledge of condom use and having sex with an uninfected partner as HIV prevention methods are known by approximately three-quarters of men (76 percent) and slightly xx less women. Around three-quarters of women (77 percent) believe a healthy looking person can be infected with the HIV virus, a considerable increase compared to the 1998 survey where only 55 percent agreed that a healthy looking person could be infected. Although there has been an increase in understanding that infection is not possible through mosquito bites, it was only rejected by 57 percent of women. Knowledge that HIV can be transmitted from mother to child was known by less than half of men (48 percent) and slightly more women (57 percent). There is a willingness to care for family members with HIV and AIDS (85 percent among women), however at the same time only 60 percent of female respondents reported that they would not necessarily want the HIV positive status of a family member to remain a secret. This indicates that families are facing up to HIV, but have reservations about disclosing. Reasons for this need to be investigated. Voluntary counseling and testing (VCT) has been identified as an important strategy to reduce the spread of HIV. In 2003, 19 percent of women and 20 percent of men reported they had been tested for HIV and had received the results. Testing rates were in fact higher, but a proportion of men and women who had been tested had never received the test results. In 2003, HIV testing in the voluntary counseling and testing (VCT) and Prevention of Mother-to-Child Transmission (PMTCT) programmes was not yet universally available. While this may partly explain why the overall rates for testing observed in the survey were low, the results do indicate that there is a need to ensure that counseling and follow-up systems are adequate to ensure that those tested go on to receive their results. Fear of being found HIV positive may mean that people do not come back for results or deny that they received their results. This raises the need to address fear and stigmatisation as key components of the HIV related programmes. Discussion of HIV and AIDS prevention was reported by 80 percent of women during antenatal visits for the births in the 3 years preceding the survey. In the context of the extensive epidemic in South Africa and the risks of infecting the baby, this opportunity should always be utilized. Circumcision as a strategy to reduce transmission of STIs and HIV has received a great deal of interest internationally with increasing evidence that circumcision reduces the risk of STIs and HIV among men, including a trial conducted in South Africa (Auvert et al., 2006). In 2003 almost half of men (45 percent) reported being circumcised. The scope for introducing a programme to promote safe circumcision needs to be considered urgently. Such a programme must be accompanied by a strong awareness campaign to ensure that people understand that circumcision confers partial protection and must be used only in conjunction with other proven prevention measures such as abstinence, mutual monogamy, reduced number of sexual partners, and correct and consistent condom use. Sexual behaviour The median age of first intercourse appears to have remained fairly consistent across the age groups in women aged 20 to 44 ranging from 18.4 to 18.6 years. In the 25-29 age group the median age is 18.3 years; for the same age group in the 1998 survey the figure was 18.1. In 2003, 42 percent of women reported that they had sex before the age of 18 years compared with 46 percent in 1998, and indicating a slight increase in women delaying age of first intercourse which is important for prevention of STIs or HIV and teenage pregnancy. Reducing the number of sexual partners is an important HIV prevention strategy. In 2003, few women in a union (2 percent) and slightly more women not in a union (3 percent) report more than one partner in the last year. There has been little change since the 1998 survey, with a slight reduction in two or more partners among sexually active women not in a union. In 2003, men were also asked about how many partners they had had in the past year. In total, 7 percent of married and xxi cohabiting men report two or more partners in the last year. Among men who are not in a union, this figure rises to 19 percent and men aged 20-34 years who are not in a union report rates of around 25 percent. The proportion of men with two or more partners follows a U-shape with education, being highest among the unmarried men with no education and those with an education beyond matric. Educated men probably have greater employment opportunities and disposable incomes which may affect their behaviour. In contrast, this pattern is not seen among educated women. Prevention strategies need to ensure that men of all educational backgrounds are targeted. S.4 Maternal and child health Maternal health The survey reflects good coverage of antenatal care with women reporting such care for 92 percent of births in the preceding 5 years. Delivery in a health facility has increased to 89 percent compared to the 84 percent observed in the previous survey. Much of this increase has occurred in the non-urban areas with an increase from 74 percent in 1998 to 89 percent in 2003. In addition, efforts are needed to provide a post-natal check-up to women who did not deliver in a health facility. Amongst women who delivered their last baby outside of a health facility, 80 percent report receiving no post-natal check-up, and only 13 percent received a check-up within 2 days. Maternal mortality rates are very difficult to measure as extremely large surveys are required to obtain sufficient numbers of events through a household survey; even using the sibling methodology. This survey failed to measure the level of maternal mortality due to data quality concerns as more than half of the sibling death data had missing details. This is unfortunate as routine cause of death statistics also fail to measure this important indicator because maternal causes are often unrecorded on the death notification. The confidential enquiry of maternal deaths that occur in health facilities provides valuable information and ideally such data should be linked to vital statistics. However, this system fails to provide a reliable estimate of the maternal mortality ratio as deaths that occur outside of the facilities are under-represented. Given the lack of reliable data on the maternal mortality rate, it is important that the elements of the maternal health programme be monitored closely and suitable programme indicators such as access to health services be used. Child health Exclusive breastfeeding for the first six months of life and regular supplementation with Vitamin A are two effective interventions to improve child survival but the survey shows that the coverage of these two interventions is still sub-optimal. While the Prevention of Mother to Child Transmission form the backbone of the child health programmes, the Expanded Programme for Immunisation, the Integrated Management of Childhood Illnesses, the Integrated Nutrition Programme and, the results of the 2003 SADHS suggest that there is much scope, to improve the health programmes for child health. Only 8 percent of infants under six months are exclusively breastfed, and only 19 percent are fully breastfed (i.e., supplemented with water only)–indicating no change since 1998. Furthermore, a significant minority of babies (29 percent) is still being given pre-lacteal feeds and 39 percent are not initiating breastfeeding immediately after birth. Both of these behaviors have important negative impacts on child survival. Breastfeeding in the context of HIV infection is not straight-forward. The National Department of Health guidelines, adapted from WHO/UNICEF guidelines, indicate that women known to be HIV positive should avoid all breastfeeding if replacement feeding is acceptable, feasible, affordable, sustainable and safe. Otherwise exclusive breastfeeding for the first months of life is recommended, followed by early breastfeeding cessation as soon as feasible and conditions for safe xxii replacement feeding can be met. Breastfeeding should be actively promoted among women who are known to be HIV negative. The low rates of exclusive breastfeeding observed in both the 1998 and the 2003 SADHS show that there is an urgent need to strengthen programmes to promote and support breastfeeding. With respect to vitamin A supplementation, less than 40 percent of children are reported to have received such supplementation in the last six months. This intervention has been shown to reduce mortality by about 25 percent in children. The fortification of key cereals and foods will go a long way towards addressing the challenge of micronutrient deficiency in South Africa, but significant numbers of children remain vulnerable to micronutrient deficiencies and the vitamin A supplementation programme needs to be strengthened. Immunisation rates show a marked drop since 1998. This survey found that only 55 percent of 1- year old children were fully immunised compared to 63 percent in 1998. These results, however, do not tally with other data sources and need further investigation. Nonetheless, they do point to concerns about the child health programmes. The reported prevalence of diarrhoea and respiratory infections among children are generally unexpectedly lower than in 1998. The particularly low rates observed in KwaZulu-Natal raise questions about data quality. Nutritional status of children has been included for the first time into the SADHS. The results show that the proportion of children who are underweight is 12 percent, and the proportion stunted is 27 percent. The prevalence of undernutrition is slightly higher than the levels observed in earlier surveys such as the Vitamin A survey. S.5 Adult health A recent Lancet series acknowledges that developing countries with stressed health systems may be faced with a difficult task to address the escalating demands of chronic disease and their risk factors, but also argues that every country, regardless of the level of its resources, has the potential to make improvements in preventing and controlling chronic disease (Epping-Jordon et al., 2005). South Africa, like several other developing countries, has been highlighted as experiencing a unique demographic moment to focus on introducing policies that will reduce the future impact of chronic disease, and to minimise the rise in cardiovascular disease in particular (Leeder et al., 2004). Steps towards this have been initiated in South Africa, including the incorporation of an adult health module in the SADHS. The SADHS includes information on risk factors for chronic diseases, utilisation of health services, use of medication and selected adult health outcomes. The survey was designed to use hypertension and chronic respiratory disease as indicator conditions to monitor the programmes for managing and preventing chronic diseases. Risk factors for chronic diseases The data show that smoking has declined in men age 15 and above (42 percent in 1998 compared to 35 percent in 2003) but not in women (11 percent in 1998 compared to 10 percent in 2003). The overall decline in prevalence of smoking is supported by other data and may reflect government’s strong tobacco control initiatives. Disturbingly, the prevalence has not changed among young people. xxiii The survey also collected data on consumption of alcohol. Alcohol consumption is difficult to measure accurately in household surveys and these results should probably be considered a minimum level. Although large proportions of the population report no drinking, as in 1998, the drinking pattern shows high proportion of drinkers who drink excessively, particularly over weekends. Rates of alcohol use in the seven days before the survey are slightly lower than reported in 1998; in the case of men it was 30 percent in 2003 compared to 45 percent in 1998 and in the case of women it was 10 percent in 2003 compared to 17 percent in 1998. The proportion with signs of alcohol problems has gone down (28 percent to 21 percent for men, and 10 percent to 7 percent for women). However no change is evident in the younger adults. There is a clear need to encourage people who do drink alcohol, to consume moderate amounts in a regular pattern and not a risky pattern. Overweight and obesity has not changed since 1998 and remains particularly high for women. Fifty-five percent of women and 30 percent of men age 15 and above are overweight or obese. The prevalence of obesity among white women has declined slightly, and the extent of underweight among Indian women has declined slightly. There is considerable evidence of health problems associated with excess bodyweight. There is a need to promote healthier environments and lifestyles among all ages. Physical activity has been measured for the first time in the SADHS, and, compared to other countries, shows very high levels of inactivity. The survey found that 48 percent of men and 63 percent of women are inactive. The prevalence of inactivity is higher in the urban setting than in the non-urban. Urgent attention is needed to understand and change these behaviours and avoid the consequential burden of disease. Questions concerning the micro-nutrient intake of adults were introduced into this survey for the first time. The results show that there are marked variations according to particular nutrients. There is a generally low calcium intake which is reflected across all groups of adults. Vitamin A intake in adults is generally good, whereas intakes of Vitamin E, Folic acid, Magnesium, Thiamine and Zinc tend to be low. In terms of micro-nutrients, whites and urban Africans have the best quality diet. Food fortification can be expected to influence the micro-nutrient intake in the future and the questionnaire for the next SADHS will have to be adapted to capture the improved intake. The survey had limited information about dietary intake. However, it found that fat intake varied by population group, being lowest among whites and Indians. African women and coloured people eat salty foods the most often. Respiratory conditions and hypertension The data on respiratory conditions are difficult to interpret, and will require additional data to confirm morbidity trends: x The proportion of adults who reported that they have ever had TB has gone down. While TB registration data suggest that TB has increased, in keeping with the HIV and AIDS epidemic, it is not clear whether the prevalence has decreased due to increased mortality from TB. x Chronic bronchitis has declined markedly among older women, but there has been little change in the prevalence of smoking; yet abnormal peak flow has gone up significantly. A difference in the measurement procedures for peak flow may have reduced some errors in the previous survey and contributed to this apparent increase. x The lower prevalence of chronic respiratory disease with improved education is also striking. Detailed analysis of the 1998 data has shown that the protective effect of education was independent of other risk factors such as smoking, occupational exposure and past xxiv tuberculosis. If it is assumed that education level reflects the cumulative effect of one’s social position throughout life, the implication is that public health action to produce optimal lung health in adulthood is needed across the whole life course. Hypertension results in the 2003 SADHS are puzzling. Prevalence of hypertension based on medication remains the same as in 1998 for all ages and sex groups. The diastolic blood pressure is systematically too low for men and older women in this survey, resulting in much lower proportions of people with hypertension, yet investigation into changes in risk factors can offer no explanation. The survey does show that the lifestyle risk factors for hypertension (obesity, high salt and alcohol intake) are still very common in those persons with hypertension, and emphasizes the urgency to implement the planned national policy to promote a healthy lifestyle and the national guidelines for managing hypertension in primary health care facilities. In addition, consideration needs to be given to recent research that has shown benefit of lowering salt in commonly used foods in reducing blood pressure levels. Health service utilisation and satisfaction The proportion of adults who attended health services in the previous 30 days increased slightly between 1998 and 2003, but was higher for women than men. The most frequently attended health care facility type was public health services (20 percent) followed by the private health care services (15 percent). Generally the survey showed that adult patients are not happy with the services rendered, both in the private and public sector. Dissatisfaction with public hospitals and community health centres is highest in the provinces of Gauteng and Eastern Cape. It is more frequently expressed by people living in urban areas than those in non-urban areas. The major reason for dissatisfaction in the public sector hospitals and community health centres are long waiting times, staff attitudes, prescription medication not available and staff shortages. Long waiting times, staff attitude, and doctors and pharmacists being too expensive were the main reasons for dissatisfaction with private sector facilities and short consultations and cost were the most common reasons cited in the case of private doctors. Women aged 15-49 years living in non-urban areas experienced more problems with costs, distance and transport in reaching health services than those in urban settings. This was reported most frequently in Limpopo. Medical aid was available only to 14 percent of adults. Non-urban Africans and people with low levels of education had the least access to medical aid. Medical aid schemes expenditure on men's chronic drugs (23 percent) was higher than for women's drugs (12 percent). However, fewer men (7 percent) than women (12 percent) had regularly prescribed drugs for one of the following conditions: tuberculoses, asthma or chronic bronchitis, diabetes, hypertension, hyperlipidaemia, arthritis, osteoporosis, epilepsy or other atherosclerosis or stroke related conditions. Of the respondents who were taking drugs at the time of the survey, about two-thirds were taking two or more different drugs for their chronic conditions. Approximately a third of men and almost half of the women using chronic disease drugs received their drugs from the public sector facilities, and only about a quarter paid for their drugs by themselves. Patients who received their drugs from the public sector were more likely to report using two or more drugs than private sector patients, suggesting either that fewer drugs are used if the patient or their medical aid scheme has to pay for the drugs or that patients are forced to get public assistance if they require many drugs. Of the people taking chronic disease drugs, the most frequent condition being treated was hypertension (6.6 percent), followed by arthritis (2.3 percent), diabetes (1.7 percent) and asthma and xxv chronic bronchitis (1.5 percent). The rate of reported drug use for tuberculoses was low. Although patients would only take such medication for a 6-month period, the low rates are of concern as routine facility data sources show marked increase in tuberculosis cases, caseloads and mortality in the country. Estimated treatment of diabetes based on drugs identified during the survey, has remained the same between 1998 and 2003 despite the fact that increased prevalence of diabetes is predicted for the South African population. The rate of treatment of hyperlipidaemia remains extremely worrying as it is estimated that there are 5.7 million people in this country with an abnormal lipid profile. A marked reduction in the use of inhaled steroids, which is the first line treatment recommended for asthma and chronic bronchitis was reported in the survey. Utilization of drugs to treat hypertension was slightly higher in 2003 (7 percent) compared to 1998 (6 percent). The data collected on the levels of hypertension control in the 2003 data base were inadequate to establish if this emerging trend was indicative of better disease control mechanisms or not. Further analysis shows that in 2003 ACE inhibitors had replaced diuretics among men as the most frequently used anti hypertensive drug compared to 1998 and that use of methyldopa and reserpine had decreased dramatically among women. The increased use of ACE inhibitors, especially among men may be due to the increased availability of generic and cheaper ACE inhibitors. However, diuretics are still the recommended first line treatment. Finally, prescription of aspirin for patients after suffering a heart attack or stroke or for those having angina is known to reduce the chances of further attacks, however, the 2003 SADHS shows that prevalence of this prescription practice is still very low. The additional three conditions for which data were collected in 2003 are arthritis, osteoporosis and epilepsy. Arthritis drugs were taken more frequently by women (3 percent) than men (1 percent) and consisted almost exclusively of non-steroidal anti-inflammatory agents. For osteoporosis mostly calcium supplements were recorded. For epilepsy, hydantoin and carboxamide derivatives were mostly used. The findings about prescribed medications in the 2003 SADHS are similar to those in the 1998 SADHS. The public sector continues to be the main provider of chronic medicine, especially for the disadvantaged. Strengthening the public health system remains a critical prerequisite to achieve health for all in South Africa and in the management of chronic conditions. xxvi Violence and injuries Self-reported injury rates for adult men were similar in 2003 to those observed in 1998, but injury rates for women increased from about 800 per 100 000 population to about 1 100 per 100 000 population based on reported injuries in the preceding 30 days. The increase has occurred particularly among women living in the non-urban areas. Injury rates among men were generally higher than those among women especially in the 35-44 year age group for whom the rate reached nearly 3 000 injuries per 100 000 men. In this age group, the unintentional injury rate was four times higher among men than women. Questions about physical violence were included in the SADHS because the prevention of violence has become a national priority. The survey shows that 13 percent of men and 7 percent of women experienced a physical attack in the preceding 12 months. While the majority of men were attacked in a public road (53 percent), for women, the most attacks occurred at home (48 percent). Questions about rape and other forms of intimate partner violence were not repeated in the 2003 SADHS as they are not suitable for multi-faceted household questionnaire. Oral health The adult health questionnaire included questions on perceptions of oral health problems, utilisation of oral health services, satisfaction of services, loss of natural teeth and oral health practices. As the questions have been reviewed it is difficult to compare the results between the 1998 and 2003 surveys. However, this survey finds 16 percent of adults reporting oral problems (10 percent are related to teeth, and 4 percent to the gums). Twenty five percent and 28 percent of the respondents reported brushing and rinsing respectively, this was low, particularly in Free State. Overall, 65 percent reported visiting a dentist/dental therapist or oral hygienist at least once a year. The proportion of adults reporting satisfaction with the overall quality of a dentist visit was relatively high. The findings suggest that there is a need to strengthen the Department of Health’s programme that promotes healthy lifestyles and aims to reduce the common risk factors (such as sugar, alcohol and tobacco) that arise from environmental, economic, social and behavioural causes. This must be accompanied by the development of oral health systems that equitably improve oral health outcomes. S.6 Adolescent (15-19 years) and Youth (15-24 years) Health Monitoring the health related behaviours of young people and the extent to which they have adopted unhealthy lifestyles is extremely important in relation to the spread of HIV and other STIs on the one hand and the emergence of chronic diseases such as cardiovascular and respiratory conditions on the other. The 2003 SADHS shows that 12 percent of men and 6 percent of women aged 15-24 years had experienced their sexual debut by age 15. Although low proportions of young people are married, more than half of the unmarried young men and 49 percent of unmarried young women had sex in the last 12 months. There has been a significant shift towards the acceptance of condom use in relationships with 75 percent of men and 53 percent of women reporting that they used a condom at last sex. This represents a huge increase compared to the 1998 SADHS, which observed that 20 percent of unmarried women aged 15-24 years used a condom at last sex. In six of the nine provinces, the proportions of teenage women who have ever been pregnant are lower in the 2003 xxvii survey than in the 1998 survey. Overall, 27 percent of 19 year old women had begun childbearing compared to 35 percent found in the 1998 SADHS. Among sexually active women, 18 percent in the 15-19 age group and 15 percent in the 20-24 age group were currently using male condoms as their contraceptive method. In the 1998 SADHS only 4 percent of sexually active women (15-19) used condoms as a form of contraception. Use of oral contraceptives among sexually active women (15-19) has dropped from 9 percent in 1998 to 5 percent in 2003. Although the majority of young men and women (93 percent) have heard of AIDS, less know about HIV prevention methods. Just under 70 percent of young women and just over 70 percent of young men know that using condoms and limiting sex to one uninfected partner can reduce the chances of HIV infection. When questioned about the beliefs about AIDS, there was some uncertainty about mosquito bites with only around 60 percent agreeing with the statement that HIV cannot be transmitted by mosquito bites and around 75 percent agreeing that a person with HIV can look healthy. Only 50 percent of young women rejected both misconceptions about the transmission of HIV. Approximately half of young women and men are aware that HIV can be transmitted through breast-feeding. Few young people in the 15-19 age groups have had an HIV test and received the results, probably due to the high proportion that had not had sex in this age group. Although the testing rates increased in the 20-24 age group to 16 percent for women and 13 percent for men, there is clearly a need to find ways to encourage young people who are sexually active to be tested. The report includes the prevalence of risk factors for chronic diseases among adolescents aged 15- 19 years. It is essential to monitor this age group as it is during this period that life-long habits are initiated. Trends in these indicators serve as an early warning of future health impacts and can assist in directing the efforts to intervene with health promotion activities. Tobacco smoking in adolescents has increased slightly. Twenty percent of boys and 10 percent of girls have ever used tobacco products in the 2003 survey, compared to 17 and 9 percent respectively for boys and girls in the 1998 survey. The increase in this age group contrasts sharply with the general decrease observed across the other age groups of men, and highlights the public health importance of countering the consumer promotion efforts that target young people. As in the case of adult smokers, the proportion of smokers who use manufactured cigarettes in 2003 is lower than in 1998 and may indicate that the increase in prices and taxing of manufactured cigarettes has partially resulted in a move towards young smokers buying loose tobacco and rolling their own cigarettes. Twenty-eight percent of male adolescents and 14 percent of female adolescents (15-19 years old) acknowledge that they have consumed alcohol in the past 12 months, a finding which is comparable with the prevalence observed in 1998. This is substantially less than for adult men but only two percent less than for adult females, and may be indicative of a trend towards higher alcohol use by the younger generation. Despite these relatively low reported drinking rates, the data indicate high levels of risky drinking (especially over weekends) by both males and females who are current drinkers of alcohol, and interventions are especially needed to reduce high levels of drinking over weekends. The anthropometry of young people does not appear to have changed between 1998 and 2003. The mean weight, height and BMI of men and women in the two surveys are very similar. Both surveys show marked gender differences in anthropometric status. Underweight is a concern among young men with 29 percent having a BMI below 18.5 compared to 12 percent of young women. In xxviii contrast, young women have much higher levels of overweight and obesity than young men. In 2003, 24 percent of adolescent women are overweight or obese compared to 9 percent of adolescent men. Urban women are more prone to being overweight or obese than non-urban women and African urban women have the highest average BMI (24 kg/m 2 ) while African non-urban women have the lowest average BMI (22 kg/m 2 ). Young urban women have larger waist circumferences than their non-urban counterparts. Overall, 32 percent of adolescent men and 47 percent of women reported they were physically inactive. The gender difference in inactivity appears to increase with age and is higher for women older than 15 years old. The high levels of physical inactivity could in part explain patterns of overweight and obesity among adolescent men and women. The data highlight the need for interventions to increase opportunities for physical activity for adolescents and school leavers, with a view to increasing lifetime participation in physical activity, and with special recognition for vulnerable groups such as girls and young women. Micro-nutrient intake has been measured for the first time in the 2003 SADHS. There are no major differences in nutrient intake between age groups for young men and women, but there are large variations within the country. For all nutrients, African young people show a higher prevalence of deficiency than white youth. Calcium intake, however, is deficient in all population groups. Urban respondents have significantly better micronutrient scores, 21 in men and 20 in women compared with non-urban respondents (25 in men and 25 in women). The mean micronutrient scores are significantly better in Gauteng and in KwaZulu-Natal and poorest in Mpumalanga, the Northern Cape, and Limpopo. The introduction of food fortification in 2003 can be expected to improve the micro-nutrient intake in all areas. The indicators related to respiratory conditions and hypertension need to be interpreted carefully as a result of the small sample size and concerns about the quality of field work. However, the results do suggest that between 1998 and 2003 there may have been an increase in the prevalence of asthma related conditions among youth in urban areas. Chronic bronchitis is not a common condition in this age group. However, both surveys suggest that African women, particularly those living in non-urban areas experience a higher prevalence of this condition than other sub-groups, suggesting that this group of young women may have higher exposures to indoor air smoke. S.7 Health of Older Persons A new chapter on the health of older persons (defined as those age 60 years or older) has been introduced into the SADHS report. An ageing population is usually associated with growing health care needs, contributing to a rise in health care costs, making it very important to monitor the health and service utilization patterns of this age group. Living conditions of older persons have generally improved between 1998 and 2003. However, several findings highlight remaining barriers that prevent optimal health status, living conditions and health service delivery, particularly in the non-urban areas. About 40 percent of older persons have no education, with non-urban levels being double the urban levels, and extremely high levels of approximately 70 percent in older women in Limpopo and Mpumalanga. The low levels of education among older persons have several implications, including scope to fully participate in community life. Older persons’ level of education may also present particular challenges to effective health promotion and disease management. Health education materials developed for these purposes need to take the low levels of formal education into account when targeting the older population. xxix Access to piped water for drinking continues to be limited for non-urban (11 percent) and urban (64 percent) older persons. There has been limited improvement in terms of all types of sanitation facilities but no change in access to a flush toilet. Similar to 1998, 15 percent of urban and 95 percent of non-urban older persons had no access to a flush toilet in 2003. The limitations in access to piped water and sanitation facilities pose a number of challenges to older persons whose mobility and physical strength generally decline with increasing age. The urban/non-urban gap in access to electricity has been reduced since 1998, but nearly half of the non-urban older persons still have no access to electricity. Urban access to an own phone (51 percent) is considerably higher than non-urban access (6 percent). Between the two surveys, no improvement in access to a phone is shown in either urban or non-urban areas. Access to a phone can be useful in participating in various domains of societal life and so contribute to the maintenance of personal well-being. It can also be critical in sickness, emergency or loneliness. Having a radio or television facilitates access to information and some form of leisure or recreation. Given the large proportion of older persons without formal education, these media have an important purpose in disseminating visual and audio health information. Increased access to a phone, radio and television, and the promotion of reduced costs and rates for older persons may therefore indirectly promote health and well-being in the older population. The 2003 results indicate that, similar to 1998, high blood pressure is by far the most commonly reported chronic condition among older persons, with a large differential between men (24 percent) and women (44 percent). Arthritis presents in both men (14 percent) and women (18 percent) as the second-most commonly reported chronic condition. Chronic illness prevalence in the older population is generally considerably higher than in the total adult population, and co-morbidities are more prevalent in older persons than younger members of the adult population. This illustrates the need to ensure that health care services explicitly address and manage chronic conditions in older persons, and the need for chronic care services to plan and prioritize for increased numbers of older clients. It also points to the need for geriatric services to be strengthened. The data suggest that medical aid coverage over age 45 declines with increasing age, dropping from 18 percent among persons 35-44 years, to 13 percent among those •60 years, to 8 percent of those •80 years. This means that, at a time when a person is likely to have increasing medical expenses, access to medical aid is declining, and on the other hand, this implies that the state will have to bear increasing costs. Of people 60 years and older, about 5 percent report being physically attacked in the past 12 months. The protection of older persons is prominent in the recently-passed Older Persons Act, but the safety of older persons needs insistent attention and a strong political will at all levels of governance, spread over different sectors, as well as a community sensitive to the particular needs and vulnerabilities of the older population. S.8 Population policy Sustainable human development is now the central theme and organizing principle of South Africa’s population policy. This policy is implemented by integrating population factors into all policies, plans, programmes and strategies aimed at enhancing the quality of life of people, and promoting multi-sectoral interventions to address major national population concerns. The seven national strategies in the area of population and human development include: poverty reduction; environmental sustainability; health, mortality and fertility; gender, women, youth and children; education; employment; migration and urbanisation. The SADHS provides useful data to monitor trends in aspects of population policy, most noticeably around the intersection of health, mortality xxx and fertility with gender, women, youth and children. It also provides information regarding South Africa’s progress towards meeting the Millennium Development Goals. The current lack of reliable national estimates of key demographic indicators such as total fertility and child mortality requires urgent attention as these are crucial to monitor the progress of national population policies. Although the 2003 SADHS has not provided reliable estimates for some key indicators, some interesting trends can be discerned that indicate progress in the implementation of the population policy. There are indications of improvements in living conditions with higher proportions of people having access to electricity. Currently, three-quarters of South African households have access to electricity compared to less than two-thirds in the previous survey. Three-quarters of households use electricity as their main source of energy for cooking compared to just over half in 1998. However, the survey indicates that there are still high proportions of people without access to piped water and sanitation in the residence. This is particularly marked in non-urban areas where households are about five times less likely than urban households to have piped water in the dwelling, and about a quarter of non-urban households still rely on an open, outside water source for drinking water. A key indicator of poverty is the nutritional status of children, particularly child stunting. Historical data on child anthropometry are sparse, making it difficult to assess trends. However, the effects of undernutrition displayed by underweight and stunting of children do not show signs of improvement over the last decade. Recent research conducted in KwaZulu-Natal has demonstrated that access to the child grant reduced the extent of stunting among young children who receive it. In addition, the data from SADHS show that mother’s education is strongly associated with children’s nutritional status. These emphasise the importance of government programmes in reducing undernutrition. Orphans are known to be a particularly vulnerable group of any population. The survey shows that the proportion of orphans has grown. The proportion of children under 15 years who had lost both their parents increased from 0.8 to 2.4 percent while the proportion of children who had lost a father only, increased from 8 to 11 percent. Social security plays a vital role in the alleviation of poverty for children, women, older persons and people with disabilities and their families. The survey shows that social support grants are widely received. Government has committed itself to ensuring that this vital source of income for the most vulnerable sector of the community continues to contribute to development and a more equitable distribution of resources. The Government’s continued social grant support is reflected by the high proportion of older persons who receive a grant. This is commendable, but also reflects the magnitude of monetary poverty among the older population, and points to the enormous challenge to eradicate poverty in older age as envisaged in both the International Plan of Action on Ageing and the African Union Policy Framework and Plan of Action on Ageing. Decision making, an indicator of empowerment, shows interesting trends. Compared with 1998, there has been a polarisation in women’s decision making around use of earnings. While the proportion of women who make their own decision has remained fairly high (71 percent), the proportion who make these decision jointly with their partner has declined from 21 to 2 percent. The proportion whose partner makes these decisions increased from 3 to 13 percent. In a decision making index spanning health care, purchases, cooking and visiting, it was found that 43 percent of women have a say in all four domains while 18 percent have no say in any domain. In contrast only 2 percent of men reported that they were excluded from decision making in (finances, purchases, visiting, number of children). Gender relations are a fundamental issue to population policy. There xxxi is a need for further analysis of the trends in decision making and the influence that this has on population dynamics. S9. Study Limitations and Recommendations Comparison of the socio-demographic characteristics of the sample with the 2001 Population Census shows an over-representation of urban areas and the African population group, and an under-representation of whites and Indian females. It also highlights many anomalies in the ages of the sample respondents, indicating problems in the quality of the data of the 2003 survey. Careful analysis has therefore been required to distinguish the findings that can be considered more robust and can be used for decision making. This has involved considering the internal consistency in the data, and the extent to which the results are consistent with other studies. Some of the key demographic and adult health indicators show signs of data quality problems. In particular, the prevalence of hypertension, and the related indicators of quality of care are clearly problematic and difficult to interpret. In addition, the fertility levels and the child mortality estimates are not consistent with other data sources. The data problems appear to arise from poor fieldwork, suggesting that there was inadequate training, supervision and quality control during the implementation of the survey. It is imperative that the next SADHS is implemented with stronger quality control mechanisms in place. Moreover, consideration should be given to the frequency of future surveys. It is possible that the SADHS has become overloaded – with a complex implementation required in the field. Thus it may be appropriate to consider a more frequent survey with a rotation of modules as has been suggested by the WHO. xxxii 1 CHAPTER 1 INTRODUCTION 1.1 History, Society and the Economy Ten years of democracy At the time of this survey South Africa had enjoyed 10 years of democracy following the historic break from its past of racial discrimination and social disruption. The first decade of democracy has resulted in pervasive institutional transformation in line with the new democratic constitution. Efforts to deal with the legacy of Apartheid have been instituted in all sectors of society. Sound fiscal management has resulted in steady real economic growth for a record six straight years and the country’s economy is now seen as one of largest and most popular emerging economies of the world. However, the tight fiscal policies have not led to an increase in the number of jobs and the high rates of unemployment continue to create a major social and economic challenge. A range of government programmes have been introduced to redress the imbalances between the rich and the poor including access to free basic health services to pregnant women and children under six, education, shelter and clean water. Much has been achieved during the first ten years of democracy but there are many areas in which service delivery needs to be improved. Establishing efficient local government is critical in this regard. The People of South Africa The people of South Africa have diverse origins. For thousands of years, the ancestors of the Khoisan lived in the southern African region as hunter-gatherers. Bantu-speaking people moved from West Africa to southern Africa in about 300-500 AD, bringing the Iron Age to the region. European explorers came to South Africa during the 15 th century and an outpost was established in the Cape, providing fresh provisions to the passing sea trade. As European settlers in the Cape moved inland, a series of wars followed which lead to the invasion of the Xhosa and Zulu peoples and a dispossession of land. The great small-pox epidemic of 1713 decimated the Khoikoi who had little resistance to this disease that was imported by the settlers. South Africa’s economic and socio-political path was changed forever by the discovery of diamonds in 1867 and gold in 1871. The development of the rail system, electricity, urban concentrations, commercial farming and manufacturing interests followed from the interests in mining. Labourers were recruited in India when it became clear that local people were not interested to work under difficult and unrewarding conditions of the sugar plantations of Natal. Agreement was reached with labourers from Calcutta and given the option of a passage to India or a small donation of land at the end of the contract. In addition to indentured labourers, merchants, known as “passenger” Indians also came to South Africa. Currently, people of Indian descent account for just under 2 percent of the South African population. Apartheid and political changes Policies of racial separation go back as far as the Act of Union in 1910 which was negotiated without involving Africans. The “Native Land Act” of 1913, set aside only 7.3 percent of South African territory as reservations for Africans and barred them from buying land outside these areas. This act divided South Africa into “White” and “Black” areas forming the cornerstone of Apartheid. 2 The Black population was deprived of the right to vote or strike and they had no means of political influence. The political power of the Afrikaners grew and in 1948, Afrikaner nationalism was born and a series of restrictive laws were introduced to benefit the White minority. The Population Registration Act of 1950 classified people according to race and the Group Areas Act determined where people could or could not live. “Homelands” were formed out of non-urban “black” areas and created separate “nation states” for the different ethnic groups. A resistance movement spearheaded by South Africans living in exile culminated in a negotiated settlement which led to the first national election in South Africa on 27 April 1994. Today, South Africa is a democratic nation divided into 9 provinces under a semi-federal system. Pretoria is the administrative capital; Cape Town the legislative capital and Bloemfontein the judicial capital. Population groups The Population Registration Act identified groups as White, Indian, Black and Coloured. The Coloured group included people of Khoisan, Malaysian, Griqua, Indian and Chinese origin and was sometimes described as people of mixed decent. Classification of the population on the basis of race has had profound economic and social impacts under Apartheid. Although the Population Registration Act was repealed in 1991 and people are no longer registered by population group, it is necessary to collect selected statistical data according to self-reported classification of these population groups in order to monitor the progress that has been made in reducing the social and economic inequalities between population groups. In this report, African is used for African/Black. Culture and religion South Africa’s rich social heritage has resulted in huge cultural diversity. Under the new constitution, everyone has the right to foster their own religion and culture. South Africa is a religiously pluralistic society with Christianity as the majority religion. In addition to Christianity, Hinduism, Islam and Judaism, a “traditionalist” belief system is also practiced. There are 11 official languages, with English generally being used in business and public official activities. Gender The experiences of men and women in South African society differ significantly resulting in many gender based inequalities. Since the first democratically elected government came to power in 1994, gender equality has been placed higher on the development agenda through a range of government policies, and gender equality is guaranteed under the South African Constitution. Mechanisms to promote women’s rights and monitor the impact of government spending on women’s lives were among a wide range of initiatives that were initiated. In 1995, the government signed the international Convention for the elimination of All Forms of Discrimination Against Women (CDAW). The Gender Commission was set up as an independent body to promote gender equity in society. An Office of the Status of Women was established by the President’s Office to ensure that gender issues are incorporated in policy and programmes. While much has been achieved, gender inequalities are pervasive and rural African women remain the poorest and most disadvantaged people in South Africa. Economy South Africa is a middle income country with a modern infrastructure and has the largest economy in Africa. The formal sector is well developed and is based on mining, manufacturing, services, and agriculture. There is a growing informal economy. Economic growth has reached levels of about 4 percent per annum. However, there are high levels of unemployment and wealth inequalities. In 3 1996, the Growth, Employment and Redistribution (GEAR) policy was introduced and stressed the country’s commitment to open markets. This new policy extended the Reconstruction and Development Programme (RDP) that had focused on development and redistribution. In February 2006, plans to foster economic development through funding selected programmes were launched as the Accelerated and Shared Growth Initiative of South Africa (AsgiSA). These plans promise to create more jobs and address the Millennium Development Goal to halve poverty by 2014 (Bell 2006). 1.2 Geography South Africa, situated in the sub-tropical region at the southern tip of the African continent, covers 1.2 million sq. km. Most of the country is on a plateau that rises above the 1000 m sea level. Most parts of the country experience rainfall during the summer months but this is unreliable and water remains scarce excepting along the east coast. The country experiences long periods of drought and the western part has encroaching desert and semi-desert regions. One tenth of the land can be described as arable. Agriculture has been supported with irrigation schemes. The south western Cape has a Mediterranean climate with winter rainfall which supports the production of wheat, fruit and wine. Durban and Cape Town house the main seaports. The mining and industrial hinterland is served by these ports together with five other ports and a well-developed rail and road transport system. All nine provinces have an airport and an extensive highway system. Swaziland and Lesotho are two land-locked countries encompassed by South Africa. They are also economically dependent on South Africa. Mozambique, Zimbabwe, Botswana and Namibia are South Africa’s neighbours and share a long and diverse history of violation and dependence. A new period of cooperation within the region has emerged and the Southern African Development Community (SADC) was formed in 1992 to promote development and alleviate poverty in the region (IDASA, 2006). Member states are Angola, Botswana, Democratic Republic of Congo, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe. 1.3 Demographic Data and Population Policies The availability and quality of population data have improved enormously since 1994. The first census of 1996 and the 1998 South African Demographic and Health Survey (SADHS) laid an important foundation. The findings of these have been amplified by data from Census 2001, and the introduction of a number of new studies by Statistics South Africa, including the General Household Survey and the Labour Force Survey. Much has been done during this period to improve the quality of vital statistics data and there has been an increase in the registration of births and deaths. South Africa’s population policy was adopted by parliament in April 1998 and expresses South Africa’s commitment to the Programme of Action of the International Conference on Population and Development (ICPD) adopted in Cairo in 1994. The ICPD Programme of Action emphasises linkages between population trends and development objectives, and focuses on realizing the rights of individual women and men. A strong element of the ICPD approach is to empower women by providing them with more choices, through expanded access to education and health services, and by promoting skills, development and employment. Its inception represents a radical move away from previous programme intention to meet set demographic targets to a policy that prioritises individual human needs (Department of Social Development, 2006). 4 Sustainable human development is now the central theme and organizing principle of South Africa’s population policy. The needs of the present generation and improving their quality of life is to be done without destroying the environment or depleting non-renewable natural resources so as to avoid compromising the ability of future generations to meet their own needs. The policy forms an integral part of national strategies aimed at reducing past inequities and enhancing the quality of life of the population and is compatible with the Millennium Development Goals adopted by the United Nations in 2000. The objectives of the South African population policy are: • to promote the systematic integration of population factors into all policies, plans, programmes and strategies aimed at enhancing the quality of life of people, • to promote a coordinated, multi-sectoral, interdisciplinary and integrated approach in designing and implementing programmes and interventions that affect major national population concerns, and • to underpin the above two objectives with reliable and up-to-date information on population and human development, to inform policy-making and programme design, implementation, monitoring and evaluation. The policy outlines 7 national strategies in the area of population and human development including: • poverty reduction • environmental sustainability • health, mortality and fertility • gender, women, youth and children • education • employment • migration and urbanisation. The policy also outlines strategies for developing policy implementation capacity that include: • co-ordination and capacity building for integrating population and development planning, • advocacy and population information, education and communication (IEC), and • data collection and research. The policy has been evaluated twice since its inception, and results have shown that awareness of population issues have improved markedly and that population matters are increasingly integrated across government programmes. It is also evident that the greater availability of data is increasingly making it possible to base policy decisions on facts rather than guesswork or ideological preconceptions, as was the case ten years ago. The provision of reliable up to date data, at all levels, as well as the integration thereof into policies, plans, programmes and strategies, however, remains incomplete and a number of challenges remain, not least being the assessment of the impact of HIV and AIDS on the size and structure of the South African population. 1.4 Health Policy Goals, Priorities and Programmes The South African Government has made strides to address the fragmentation and gross inequalities in health infrastructure and health services since 1994. The Department of Health continuously aims to ensure that the health status of all the citizens of South Africa is improved. In this regard several pieces of legislation have been passed since 1994. The Health Act (Act No 63 of 1977) outlined the priority programmes that needed to be focussed on e.g. HIV and AIDS, tuberculosis, maternal 5 health, child health, nutrition, 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 and the management of communicable diseases. The Health Act has subsequently been replaced by the National Health Act, 2003 (Act No 61 of 2003) that provides a legal framework for the new health system that has been put in place since 1994. The mission of the national Department of Health is “to improve health status through prevention of illness and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.” In the five years between the first SADHS in 1998 and the second SADHS in 2003, the Department of Health continued with an extended programme of legislative and policy development to address health priorities. To ensure that services are rendered in previously neglected areas the Pharmacy Amendment Act (Act No. 1 of 2000) for instance makes provision for the performance of community service by persons registering for the first time as pharmacists. In an attempt to limit the use of tobacco, the Tobacco Products Control Amendment Act of 1999 (Act 12 of 1999) amongst others, prohibits the free distribution of tobacco products. In 2000, a comprehensive plan for HIV and AIDS was launched. This provided a framework for a multi-sectoral response and included several priority areas: (1) prevention, (2) treatment, care and support, (3) research, monitoring and surveillance and (4) human and legal rights. In 2003, an operational plan for comprehensive HIV and AIDS care, management and treatment was developed. The review of several acts was undertaken and the following amendment acts were passed: Medical Schemes Amendment Act (Act 62 of 2002), Medicines and Related Substances Amendment Act (Act 59 of 2002), Dental Technicians Amendment Act (Act 24 of 2004), Choice on Termination of Pregnancy Amendment Act (Act 38 of 2004) and the Sterilisation Amendment Act (Act 3 of 2005). Legislation that is currently being processed includes the following: Nursing Amendment Act 2004, Health Professions Amendment Act, 2004, South African Medical Research Council Amendment Act 2004, Pharmacy Amendment Act, 2003, Medicines and Related Substances Control Amendment Act 2004 and Tobacco Products Control Amendment Act 2004. The purpose of reviewing legislation is to ensure that all the legislation contributes to the promotion of health of all South Africans. A Strategic Framework for 2004-2009 has been adopted that includes to promote healthy lifestyles, to contribute towards human dignity by improving quality of care, to improve management of communicable diseases and non-communicable illnesses, to strengthen primary health care, Emergency Medical Services and hospital service delivery systems. Planning, budgeting and monitoring and evaluation are also included in the strategic framework. 1.5 Objectives and Organisation of the 2003 South Africa Demographic and Health Survey In 1995 the National Health Information System of South Africa (NHIS/SA) committee identified the need for improved health information for planning services and monitoring programmes. The first South African Demographic and Health Survey (SADHS) was planned and implemented in 1998. At the time of the survey it was agreed that the survey had to be conducted every five years to enable the Department of Health to monitor trends in health services. Information on a variety of demographic and health indicators were collected. The results of these surveys are intended to assist policy makers and programme managers in evaluating and designing 6 programmes and strategies for improving health services in the country. In addition to the aspects covered in the 1998 SADHS, information on the following additional aspects was included in the 2003 SADHS: x Information on children living in households where the biological mother is not staying in the household i.e. mother is dead, etc. x Child anthropometric data x Information on reproductive health and sexual behaviour of men x Information on malaria x Information on pensions/grants received by members of the household. The primary objective of the 2003 SADHS was to provide up-to-date information on: x Characteristics of households and respondents x Fertility x Contraception and fertility preferences x Sexual behaviour, HIV and AIDS x Infant and child mortality x Maternal and child health x Infant and child feeding x Adolescent health x Mortality and morbidity in adults x Utilisation of health services x Adult health: hypertension, chronic pulmonary disease and Asthma x Risk factors for chronic diseases x Oral health x Health of older persons Organisation of survey A project of the magnitude of the SADHS involves a large number of players. The Department of Health (DOH) commissioned, co-ordinated and funded the study together with the financial contribution from the Department of Social Development. The fieldwork was commissioned to a research company: Africa Strategic Research Cooperation and they appointed the fieldwork personnel who conducted the interviews. The Human Sciences Research Council (HSRC) provided technical input throughout the survey, and was responsible for quality control of the survey. They were also responsible for the capturing, processing and preliminary analysis of the data. The Medical Research Council (MRC) also provided technical input and did further analysis of the data and co-ordinated the compilation of the final report. ORCMACRO, funded by USAID, provided technical support in questionnaire design, sample design, field staff training, data processing and analysis. Statistics South Africa (Stats SA) provided the sampling frame and drew the sample of households for inclusion in the survey. Apart from USAID, representatives from each of the organisations mentioned in this paragraph served in a management committee responsible for the overall management of this study. Sample design and implementation The SADHS sample was designed to be a nationally representative probability sample of approximately 10 000 households. The country was stratified into the nine provinces and each province was further stratified into urban and non-urban areas. The sampling frame for the SADHS was provided by Statistics South Africa (Stats SA) based on the enumeration areas (EAs) list of 7 approximately 86 000 EAs created during the 2001 census. Since the Indian population constitutes a very small fraction of the South African population, the Census 2001 EAs were stratified into Indian and non-Indian. An EA was classified as Indian if the proportion of persons who classified themselves as Indian during Census 2001 enumeration in that EA was 80 percent or more, otherwise it was classified as Non-Indian. Within the Indian stratum, EAs were sorted descending by the proportion of persons classified as Indian. It should be noted that some provinces and non- urban areas have a very small proportion of the Indian population hence the Indian stratum could not be further stratified by province or urban/non-urban. A sample of 1 000 households was allocated to the stratum. Probability proportional to size (PPS) systematic sampling was used to sample EAs and the proportion of Indian persons in an EA was the measure of size. The non-Indian stratum was stratified explicitly by province and within province by the four geo types, i.e. urban formal, urban informal, rural formal and tribal. Each province was allocated a sample of 1 000 households and within province the sample was proportionally allocated to the secondary strata, i.e. geo type. For both the Indian and Non-Indian strata the sample take of households within an EA was sixteen households. The number of visited households in an EA as recorded in the Census 2001, 09 Books was used as the measure of size (MOS) in the Non-Indian stratum. The second stage of selection involved the systematic sampling of households/stands from the selected EAs. Funds were insufficient to allow implementation of a household listing operation in selected EAs. Fortunately, most of the country is covered by aerial photographs, which Statistics SA has used to create EA-specific photos. Using these photos, ASRC identified the global positioning system (GPS) coordinates of all the stands located within the boundaries of the selected EAs and selected 16 in each EA, for a total of 10 080 selected. The GPS coordinates provided a means of uniquely identifying the selected stand. As a result of the differing sample proportions, the SADHS sample is not self-weighting at the national level and weighting factors have been applied to the data in this report. A total of 630 Primary Sampling Units (PSUs) were selected for the 2003 SADHS (368 in urban areas and 262 in non-urban areas). This resulted in a total of 10 214 households being selected throughout the country 1 . Every second household was selected for the adult health survey. In this second household, in addition to interviewing all women aged 15-49, all adults aged 15 and over were eligible to be interviewed with the adult health questionnaire. In every alternate household selected for the survey, not interviewed with the adult health questionnaire, all men aged 15-59 years were also eligible to be interviewed. It was expected that the sample would yield interviews with approximately 10 000 households, 12 500 women aged 15-49, 5 000 adults and 5 000 men. The final sample results are shown in Table 1.1. Questionnaires The survey utilised five questionnaires: a Household Questionnaire, a Women’s Questionnaire, a Men’s Questionnaire, an Adult Health Questionnaire and an Additional Children Questionnaire. The contents of the first three questionnaires were based on the DHS Model Questionnaires. These model questionnaires were adapted for use in South Africa during a series of meetings with a Project Team that consisted of representatives from the National Department of Health, the Medical Research Council, the Human Sciences Research Council, Statistics South Africa, National Department of Social Development and ORCMacro. Draft questionnaires were circulated to other interested groups, e.g. such as academic institutions. The Additional Children and Men’s 1 Interviewers were instructed to include any second household residing on the selected stand. 8 Questionnaires were developed to address information needs identified by stakeholders, e.g. information on children who were not staying with their biological mothers. All questionnaires were developed in English and then translated in all 11 official languages in South Africa (English, Afrikaans, isiXhosa, isiZulu, Sesotho, Setswana, Sepedi, SiSwati, Tshivenda, Xitsonga and isiNdebele). 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 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, men and adults who were eligible for individual interviews. 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 Women’s Questionnaire was used to collect information from women aged 15-49 in all households. These women were asked questions on the following topics: x Background characteristics (age, education, race, residence, marital status, etc.) x Reproductive history x Knowledge and use of contraceptive methods x Antenatal, delivery, and postnatal care x Breastfeeding and weaning practices x Child health and immunisation x Marriage and recent sexual activity x Fertility preferences x Adult and maternal mortality x Knowledge of HIV and AIDS x 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: x Recent utilisation of health services, family medical history, x Clinical conditions x Dental health x Occupational health x Medications taken x Habits and lifestyles x Anthropometric measurements, and x Blood pressure and lung function test. In every second household in addition to the women, all men aged 15-59 were eligible to be interviewed. The Men’s Questionnaire collected similar information contained in the Woman's Questionnaire but was shorter because it did not contain questions on reproductive history, maternal and child health, nutrition, and maternal mortality. In households in which there was a child under six years of age whose biological mother was either not alive or did not live in the household, information about the child was collected from a guardian using the Additional Child’s Questionnaire. The level of child fostering is relatively high in South Africa and data on children’s health collected only from biological mothers might be incomplete. 9 The SADHS questionnaires were pre-tested (in two languages) in July 2003, using the “behind the glass” 2 technique. The questionnaires were then adapted to take into account the suggested changes for questions that were misunderstood or were not clear. Subsequently four teams of interviewers (one for each of four main language groups) were formed; the household, male, female and adult health questionnaires were tested in 4 identified areas. The lessons learnt from the two exercises were used to finalise the survey instruments. The questions 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 A tender for the implementation of the field work for the survey was issued by the National Department of Health. The contract for the field work was awarded to Africa Strategic Research Corporation (ASRC), a private firm based in Johannesburg. ASRC organised a 2-week training course from September 15-30, 2003 at a centre outside of Pretoria. The training of field workers was conducted by personnel from the MRC, the HSRC, National Department of Health and ORC Macro as well as staff and consultants appointed by ASRC. Training consisted of plenary sessions on more general issues like interviewing techniques, survey administration, and explaining the questionnaire and how to complete it, as well as smaller sessions to practice the anthropometric measurements and interviewing in local languages. The training included mock interviews between participants and two written tests. A practice session was arranged one Saturday to give trainees experience with interviewing actual households living around Pretoria and Johannesburg. ASRC was unable to recruit a sufficient number of interviewers of the required racial and gender groups for the first training. Consequently, a second training for an additional 49 trainees was arranged for October 6-11. In order to further balance the ethnic group and gender composition of the teams as well as to make up for attrition of field staff, some additional fieldworkers were trained in February 2004. 192 candidates were recruited for field work. The fieldworkers were organised into teams consisting of varying numbers of female and male interviewers and headed by a supervisor. Each province had 1 or 2 fieldwork supervisors and at least one editor who were responsible for the logistics and first round of checking of questionnaires. Each province had at least one team of interviewers consisting of different numbers of female and male members. This allowed for the teams to interview different members in households simultaneously, e.g. whilst the woman was interviewed by the female team member, the male team member interviewed the men. Due to political sensitivity and language problems teams were constructed in such a manner to be sensitive for the demographics of a specific area. This resulted in a team of white interviewers who where circulated between different provinces to do interviews in predominantly white areas. In each province there was a provincial manager who was an overall supervisor of the fieldwork operations. Staff from HSRC and the DoH conducted periodic quality control visits during fieldwork. Fieldwork commenced in mid-October 2003 and was completed in August 2004. 2 This refers to a process in which interviewers’ interview respondents using the questionnaires, being observed by a team of experts, from behind a one-way window. The experts are not visible to the interviewer/interviewee. Once the interview is finalised, it is discussed by the interviewer, respondent, and the team of experts to determine if any questions were not clear, etc. Changes to the questions are then suggested. Quality control In the course of the fieldwork quality control measures were instituted at three levels. Firstly, 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, 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. A team of staff members from the NDoH also carried out independent quality control visits to check questionnaires for errors, quality of identification and interviews at the enumerator area and dwelling levels. An independent consultant was appointed by the NDoH in January 2004 to assist ASRC with the implementation and fieldwork management after problems in this regard were identified. Data processing A preliminary round of data processing of the SADHS questionnaires was started in November 2003 so as to provide some feedback to field teams. The actual data processing did not start until January 2004, after a contract was arranged with the HSRC in Pretoria. Completed questionnaires were returned periodically from the field to ASRC, which in turn submitted them to HSRC, where they were entered and edited by data processing personnel specially trained for this task. Data were entered using programmes written in CSPro by ORC Macro. All data were entered twice (100 percent verification). The data processing of the survey was completed in October 2004. Response rate Of the total 630 PSUs that were selected, fieldwork was not implemented in nine PSUs. The data file contained information for a total of 621 PSUs. A total of 10 214 households were selected for the sample and 7 756 were successfully interviewed. The shortfall was 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 9 181 households occupied 85 percent were successfully interviewed. In these households, 7 966 women were identified as eligible for the individual women’s interview (15-49) and interviews were completed with 7 041 or 88 percent of them. In the one half of the households that were selected for inclusion in the adult health survey 9 614 eligible adults age 15 and over were identified of which 8 115 or 84 percent were interviewed. In the other half of the households that were selected for the men’s questionnaire to be completed 3 930 eligible men aged 15-59 were identified of which 3 118 or 79 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. Table 1.1 Response rates, South Africa 2003 Households Households selected 10 214 Households occupied 9 181 Households interviewed 7 756 Household response rate 84.5 Women’s interviews Number of eligible women 7 966 Number of women interviewed 7 041 Eligible women response rate 88.4 Men’s interviews Number of eligible men 3 930 Number of men interviewed 3 118 Eligible men response rate 79.3 Adults’ interviews Number of eligible adults 9 614 Number of adults interviewed 8 115 Eligible adult response rate 84.4 10 11 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Distribution of Household Population by Age and Sex The 2003 SADHS collected information on the demographic and social characteristics of the de jure residents (persons who usually live in the selected household), as well as the de facto residents (persons who do not usually live at the selected residence, but who have spent the night preceding the interview there). Table 2.1 indicates the distribution of the SADHS de facto household population by five-year age groups according to sex, and urban/non-urban residence. A third (33 percent) of the household population are younger than 15 years, 62 percent are 16-64 years, and 5.6 percent are 65 years or older. Non-urban households report higher proportions of younger (38 percent) and older persons (6.7 percent) than the urban households (29 and 4.8 percent, respectively). Fifty-four percent of the household population are females and 46 percent are males, showing some deviation from the 2001 Population Census proportions of 52 percent female and 48 percent male. Figure 2.1 shows the age-sex structure of the 2003 SADHS household population, reflecting a relatively young population with large youth cohorts as typically found in developing nations. However, the structure shows markedly erratic or rugged side edges, with a particularly heavy load of females in the cohorts 50-54 to 60-69 years, and a particular over-representation of males in the cohorts 60-64 to 70-74 years. Both male and female cohorts aged 10-14 years seem extraordinary large, while both male and female cohorts aged 0-4 years seem surprisingly small. While some of this can be explained by sampling variation, indications of age heaping are observed. Table 2.1 Household population by age, sex and residence Percentage distribution of the de facto household population by five-year age groups, according to age-sex and residence, South Africa 2003 Urban Non-urban Total Age group Male Female Total Male Female Total Male Female Total 0-4 8.4 7.7 8.0 8.9 7.0 7.9 8.6 7.5 8.0 5-9 10.5 8.9 9.6 14.2 11.8 12.9 11.9 10.0 10.9 10-14 11.8 11.3 11.6 19.2 15.4 17.1 14.6 12.9 13.7 15-19 10.1 9.7 9.9 12.4 10.8 11.5 11.0 10.1 10.5 20-24 10.2 9.5 9.9 7.8 8.0 7.9 9.3 9.0 9.1 25-29 8.0 7.6 7.8 6.3 6.6 6.5 7.4 7.2 7.3 30-34 7.9 7.6 7.8 4.1 5.1 4.7 6.5 6.7 6.6 35-39 7.4 8.0 7.7 4.3 5.9 5.2 6.3 7.2 6.8 40-44 6.7 6.7 6.7 3.9 4.2 4.1 5.6 5.8 5.7 45-49 5.2 5.6 5.4 3.8 4.0 3.9 4.7 5.0 4.8 50-54 3.9 5.2 4.6 2.8 5.6 4.3 3.5 5.4 4.5 55-59 3.0 3.4 3.2 2.8 4.1 3.5 2.9 3.7 3.3 60-64 2.4 3.3 2.9 3.7 3.9 3.8 2.9 3.5 3.3 65-69 2.1 2.1 2.1 2.6 2.9 2.7 2.3 2.4 2.3 70-74 1.3 1.3 1.3 1.7 2.2 2.0 1.4 1.7 1.6 75-79 0.4 0.8 0.6 1.0 1.1 1.0 0.6 0.9 0.8 80+ 0.6 1.0 0.8 0.6 1.3 1.0 0.6 1.1 0.9 Missing 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 8 590 9 741 18 333 5 060 6 075 11 140 13 651 15 816 29 473 Note: Total includes six persons for whom sex is missing. 12 Figure 2.1 Household population age structure, SADHS 2003 8 6 4 2 0 2 4 6 8 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 Percent Male Female The broad age structure of the 1998 SADHS and the 2003 SADHS are compared with the 1996 and 2001 censuses in Table 2.2. The population living in institutions are excluded from both census and SADHS counts. With respect to the broad age groups, there seems to be better consistency between the 2003 survey and the recent census, compared to the 1998 survey and the 1996 census. However, Figure 2.1 shows clearly how misleading aggregate figures can be, and one needs to keep in mind the inconsistencies between the 2001 census and the 2003 SADHS as seen in the difference in single five-year cohorts. The median age of the sample is 23.7 years, showing a substantial increase from 21.2 years in 1998 (Table 2.2). Further analysis is needed to get clarity whether this is a true effect of an ageing population, or whether the higher median is a consequence of the way individuals were selected into the sample, or possibly both. Table 2.2 Comparison of broad age structures Percentage distribution of population in broad age groups and median age from 1996 Census, 2001 Census, 1998 and 2003 surveys Comparative Surveys (%) Broad age groups SADHS 1998 Census 1996* SADHS 2003 Census 2001* Less than 15 37.9 33.9 32.4 32.0 15-64 56.3 60.2 62.0 63.0 65+ 5.7 4.7 5.6 5.0 Missing 0.2 1.2 0.0 0.0 Total 100.0 100.0 100.0 100.0 Median age 21.2 - 23.7 - * Source: Statistics South Africa. 13 2.2 Household Composition Similar to the situation in the 1998 survey, women head 42 percent of South African households (Table 2.3). In non-urban areas women head almost half of households, compared to 39 percent of households in the urban areas. This higher proportion in the non-urban areas may partly relate to the absence of males within the family due to labour migration to urban areas. However, urban areas also show a general trend towards women headed households. The average number of persons per household is 3.8, compared to 4.2 persons in the 1998 SADHS. The modal household size in non- urban areas is 4.0 persons per household, compared to an urban mode of 2.0 persons per household. In non-urban households, the average household size is 4.0 persons, noticeably smaller than 4.7 persons found in the 1998 SADHS. This decline between the two SADHS surveys is probably related to the increase in the number of houses that has been observed between the two censuses. Table 2.4 provides information about fosterhood and orphanhood of children under the age of 15. It can be seen that about one- third of children live with both parents while just over one-third live with their mother but not father, while only 2.3 percent live with their father and not mother. Just over 21 percent of children live in households with neither parent. This pattern is fairly similar to that observed in 1998, reflecting a high proportion of children living with adults other than their parents. One of the possible reasons for this high rate of fosterhood could relate to the practice among some mothers of sending their children to the children’s grandmother for care to enable the mothers to engage in the formal labour market. It may also relate to the increased numbers of deaths of young men and women over the past few years, as may be indicated by the finding that of those children living with neither parent, 0.8 percent in 1998 versus 2.4 percent in 2003 have lost both parents to death. However, this needs further analyses as the data also indicate that the proportion living with neither parent has declined somewhat since 1998 from 25 percent to 21 percent in 2003. Table 2.4 shows that 2.4 percent of children are dual orphans, with high levels shown in KwaZulu- Natal (4.9 percent), Gauteng (2.7 percent), and Free State (2.6 percent). Just less than 2 percent have lost their mother only, and 11.2 percent have lost their father only. Taking into account the dual orphans 4.3 percent are maternal orphans and 14 percent are paternal orphans. A relatively high proportion of children have missing information about the vital status of their parents (7.7 percent) and thus the proportion of children who are orphans may be higher as there is likely to be a bias towards orphanhood amongst those children with missing information. Similar percentages of orphans were found in the Statistics South Africa analysis of household survey and census data that they have collected. Anderson and Phillips (2006) found that in 2003, 4.4 - 4.5 percent of children under 15 years were maternal orphans and 11.6-12.8 percent were paternal orphans. Table 2.3 Household composition Percentage distribution of households by sex of head of household and household size, according to residence, South Africa 2003 Characteristic Urban Non-urban Total Household headship Male 61.2 51.3 57.6 Female 38.8 48.7 42.4 Number of usual members 0 0.4 0.3 0.3 1 11.4 11.6 11.5 2 20.4 15.4 18.6 3 19.3 17.5 18.7 4 19.4 20.6 19.8 5 12.0 13.3 12.5 6 7.9 9.9 8.6 7 3.9 4.9 4.2 8 2.2 2.9 2.4 9+ 3.3 3.6 3.4 Total 100.0 100.0 100.0 Number of households 4 952 2 804 7 756 Mean size 3.7 4.0 3.8 Percent with foster children 1 13.4 28.7 19.0 Note: This table is based on the de jure household members, i.e. the usual residents. 1 “Foster children” are children under the age of 15 years living in households with neither their biological mother or father present. 1 4 T a b le 2 .4 F o st e rh o o d a n d o rp h a n h o o d P e rc e n ta g e d is tr ib u tio n o f d e j u re c h ild re n u n d e r a g e 1 5 , b y su rv iv a l st a tu s o f p a re n ts a n d c h ild re n 's l iv in g a rr a n g e m e n ts , a cc o rd in g t o c h ild ’s a g e , se x, r e si d e n ce a n d p ro vi n ce , S o u th A fr ic a 2 0 0 3 L iv in g w ith m o th e r b u t n o t fa th e r L iv in g w ith f a th e r b u t n o t m o th e r N o t liv in g w ith e ith e r p a re n t B a ck g ro u n d c h a ra ct e ri st ic L iv in g w ith b o th p a re n ts F a th e r a liv e F a th e r d e a d M o th e r a liv e M o th e r d e a d B o th a liv e F a th e r o n ly a liv e M o th e r o n ly a liv e B o th d e a d M is si n g in fo rm a tio n o n fa th e r/ m o th e r T o ta l N u m b e r o f ch ild re n A g e < = 2 3 4 .0 4 4 .8 6 .3 0 .7 0 .1 6 .9 0 .6 0 .3 0 .3 6 .1 1 0 0 .0 1 3 7 9 3 -5 3 5 .8 3 2 .8 6 .0 1 .4 0 .2 1 3 .2 1 .1 1 .8 1 .3 6 .4 1 0 0 .0 1 4 5 1 6 -9 3 3 .5 2 5 .7 8 .6 2 .1 0 .6 1 5 .4 1 .2 3 .0 1 .7 8 .3 1 0 0 .0 2 7 1 5 1 0 -1 4 3 3 .1 2 0 .1 9 .0 1 .6 1 .2 1 6 .4 1 .5 4 .7 4 .0 8 .4 1 0 0 .0 4 0 3 7 S e x M a le 3 3 .6 2 6 .3 8 .4 1 .9 0 .7 1 4 .4 1 .3 3 .0 2 .2 8 .1 1 0 0 .0 4 7 8 1 F e m a le 3 3 .9 2 8 .1 7 .7 1 .3 0 .7 1 4 .2 1 .1 3 .3 2 .5 7 .3 1 0 0 .0 4 7 9 9 R e s id e n c e U rb a n 4 1 .4 2 5 .7 8 .6 1 .5 0 .3 1 0 .3 1 .1 2 .3 2 .4 6 .4 1 0 0 .0 4 7 8 1 N o n -u rb a n 2 4 .0 2 9 .0 7 .3 1 .7 1 .2 1 9 .4 1 .4 4 .2 2 .4 9 .4 1 0 0 .0 4 7 9 9 P ro v in c e W e st e rn C a p e 5 7 .9 2 2 .8 4 .9 0 .8 0 .1 7 .2 0 .5 1 .0 1 .9 3 .0 1 0 0 .0 1 0 1 1 E a st e rn C a p e 2 0 .3 2 5 .8 1 0 .1 1 .7 1 .3 1 9 .9 1 .4 5 .0 1 .5 1 3 .0 1 0 0 .0 1 4 3 9 N o rt h e rn C a p e 3 3 .0 2 9 .8 6 .5 2 .8 1 .2 1 6 .5 2 .3 3 .2 1 .8 3 .0 1 0 0 .0 1 7 9 F re e S ta te 2 8 .9 2 4 .9 6 .8 2 .2 0 .6 1 3 .7 2 .0 3 .5 2 .6 1 4 .9 1 0 0 .0 5 9 4 K w a Z u lu -N a ta l 3 5 .7 1 7 .9 8 .7 3 .0 2 .3 1 5 .4 1 .2 4 .0 4 .9 6 .9 1 0 0 .0 1 5 2 1 N o rt h W e st 1 9 .7 3 7 .1 6 .8 1 .5 0 .0 2 2 .6 1 .1 2 .6 1 .8 7 .0 1 0 0 .0 8 2 4 G a u te n g 4 8 .9 2 3 .7 1 0 .9 0 .7 0 .1 6 .2 1 .1 1 .5 2 .7 4 .2 1 0 0 .0 1 9 7 3 M p u m a la n g a 2 2 .9 3 9 .2 5 .6 1 .4 0 .4 1 8 .0 1 .9 4 .1 1 .7 4 .8 1 0 0 .0 7 1 2 L im p o p o 2 1 .9 3 6 .0 6 .0 1 .6 0 .1 1 7 .2 1 .0 3 .9 1 .1 1 1 .3 1 0 0 .0 1 3 2 8 T o ta l 3 3 .7 2 7 .2 8 .0 1 .6 0 .7 1 4 .3 1 .2 3 .2 2 .4 7 .7 1 0 0 .0 9 5 8 2 N o te : B y co n ve n tio n , fo st e r ch ild re n a re t h o se w h o a re n o t liv in g w ith e ith e r b io lo g ic a l p a re n t. T h is in cl u d e s o rp h a n s, i. e . ch ild re n w ith b o th p a re n ts d e a d . T o ta l i n cl u d e s tw o c h ild re n f o r w h o m s e x is m is si ng . 15 The high level of paternal orphans has been observed in other studies too, including the previous SADHS and the recent South African National HIV/AIDS Survey (Shisana et al., 2005). Compared to the 1998 SADHS, there has been a rapid growth (from 0.8 to 2.4 percent) in the percentage of dual orphans. Figure 2.2 shows that there has also been a consistent growth in all mentioned categories of orphans, a matter affecting the lives and well being of thousands of children, and requiring sustained policy attention and action. Anderson and Phillips (2006) show that the increase in the proportion of children who are orphans occurred among African children, and is particularly marked in KwaZulu-Natal. Figure 2.2 Proportion of children under 15 years who are maternal, paternal and dual orphans, SADHS 1998 and 2003 1.4 7.7 0.8 1.9 2.4 11.2 0 2 4 6 8 10 12 14 Maternal only Paternal only Dual P e rc e n t 1998 2003 2.3 Educational Level of Household Members Table 2.5 shows the highest education level of the household population six years and older, and the median number of years of education completed. Males’ education level is on average higher than females’ education level. About ten percent of males have never been to school, compared to 12 percent of females. A slight improvement is suggested compared to SADHS 1998, which showed that 11 percent of males and 14 percent of females had never been to school. Slightly more men (16 percent) than women (15 percent) completed Grade 12, and slightly more men (7 percent) than women (6 percent) have a tertiary qualification. SADHS 2003 shows that people who reside in urban areas have about three times the level of achieved tertiary qualifications compared to those living in non-urban areas. This may be a reflection of residential differences related to access to tertiary institutions, affordability, post-study employment opportunity, and possibly also reflects the higher proportions of older persons living in the non-urban areas, as well as the fact that older persons have considerably lower levels of education. Figure 2.3 shows the proportion of men and women who have Grade 12 or a higher qualification in the 2003 SADHS, compared with the 1998 SADHS. There has been a consistent increase in these proportions, indicating a cohort effect as the younger people get higher levels of education. However, in some categories, such as women 35-39 years, the increase from the early age group in the previous survey is greater than the cohort effect that is seen in other groups. It is not clear whether this increase is a result of adult learning, selective mortality, or bias in the samples. 16 Figure 2.3 Proportion of adult men and women with Grade 12 or higher education, SADHS 1998 and 2003 Women 11 38 37 27 23 18 15 12 11 6 6 15 45 48 42 35 24 8 11 1415 21 0 10 20 30 40 50 60 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ P e rc e n t 1998 2003 Men 14 45 49 49 36 32 28 23 19 14 14 8 36 36 34 28 22 22 20 17 13 12 0 10 20 30 40 50 60 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ P e rc e n t 1998 2003 17 Table 2.5 Educational level of male and female 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 2003 Level of Education Background characteristic No education Grades 1-5 Grades 6-7 Grades 8-11 Grade 12 Higher Unknown Total Number of males/ females Median number of years of schooling MALE Age 6-9 23.8 74.3 1.3 0.1 0.0 0.0 0.5 100.0 1 368 0.9 10-14 2.6 48.6 30.8 17.6 0.0 0.0 0.4 100.0 1 986 4.9 15-19 1.5 6.7 12.2 65.3 11.1 3.0 0.4 100.0 1 499 8.9 20-24 1.4 3.3 5.9 44.3 34.0 10.8 0.4 100.0 1 274 10.7 25-29 5.6 4.3 6.6 33.6 37.5 11.9 0.5 100.0 1 008 11.0 30-34 4.1 5.5 9.9 30.1 34.2 14.5 1.7 100.0 891 11.0 35-39 6.3 7.5 13.1 36.2 27.6 8.6 0.7 100.0 855 9.6 40-44 8.5 12.9 13.5 32.0 19.1 13.1 1.1 100.0 769 9.1 45-49 7.8 14.6 14.0 34.3 17.1 10.4 1.7 100.0 638 8.1 50-54 13.2 14.5 14.9 33.0 15.3 8.0 1.1 100.0 471 7.5 55-59 17.0 15.3 9.3 38.9 11.7 6.8 1.0 100.0 399 7.4 60-64 24.1 21.5 13.5 24.9 6.8 7.4 1.8 100.0 399 5.5 65+ 42.4 18.0 7.1 17.1 6.7 7.1 1.6 100.0 673 2.7 Residence Urban 7.5 18.6 11.2 33.2 19.6 9.1 0.9 100.0 7 709 8.5 Non-urban 13.6 30.4 15.3 27.5 10.1 2.6 0.6 100.0 4 520 5.7 Province Western Cape 5.6 20.6 13.8 35.3 17.1 6.5 1.1 100.0 1 321 7.9 Eastern Cape 11.9 33.7 14.3 25.0 9.0 4.5 1.7 100.0 1 490 5.5 Northern Cape 14.3 21.7 14.7 33.1 10.3 5.5 0.5 100.0 211 6.9 Free State 11.8 25.4 14.2 29.6 13.0 5.1 0.9 100.0 726 6.8 KwaZulu-Natal 6.9 18.4 11.1 33.4 23.7 6.4 0.1 100.0 2 609 9.0 North West 14.5 27.5 14.1 27.3 11.8 4.8 0.1 100.0 878 6.1 Gauteng 7.9 17.4 10.2 33.9 19.3 10.2 1.1 100.0 3 044 8.8 Mpumalanga 13.2 25.8 14.9 29.1 11.1 5.6 0.4 100.0 777 6.5 Limpopo 14.7 30.2 15.8 26.3 7.9 4.2 0.9 100.0 1 172 5.6 Total 9.7 23.0 12.7 31.1 16.1 6.7 0.8 100.0 12 229 7.5 FEMALE Age 6-9 23.9 75.0 1.0 0.0 0.0 0.0 0.2 100.0 1 361 1.0 10-14 1.8 40.7 37.5 19.8 0.1 0.0 0.2 100.0 2 039 5.4 15-19 1.5 2.5 9.0 72.1 13.0 1.9 0.0 100.0 1 604 9.3 20-24 2.3 2.8 4.0 45.4 34.3 11.1 0.0 100.0 1 416 10.7 25-29 3.0 3.2 7.1 39.0 35.5 12.3 0.0 100.0 1 143 10.9 30-34 6.2 6.3 9.4 35.8 29.9 12.3 0.2 100.0 1 056 10.3 35-39 5.9 8.6 13.7 35.8 25.5 9.7 0.8 100.0 1 143 9.4 40-44 11.8 11.3 16.8 35.2 15.3 8.8 0.7 100.0 913 7.9 45-49 11.3 15.0 15.8 36.2 13.9 7.1 0.7 100.0 784 7.6 50-54 22.4 18.4 13.2 28.7 9.6 5.1 2.6 100.0 848 6.2 55-59 25.5 17.7 14.4 25.6 7.7 6.2 3.0 100.0 580 5.8 60-64 33.8 18.4 11.9 23.6 6.5 4.9 1.0 100.0 560 4.4 65+ 46.8 16.7 11.9 15.1 4.4 3.7 1.4 100.0 963 1.3 Residence Urban 8.9 16.8 12.8 35.1 17.7 8.0 0.8 100.0 8 860 8.3 Non-urban 17.6 25.0 15.0 28.8 10.8 2.5 0.3 100.0 5 556 6.1 Province Western Cape 5.6 16.3 13.6 41.0 17.2 5.7 0.6 100.0 1 572 8.2 Eastern Cape 15.0 25.2 14.9 32.7 7.2 4.6 0.4 100.0 1 962 6.4 Northern Cape 15.1 21.3 16.0 32.0 10.2 4.8 0.7 100.0 256 6.7 Free State 12.2 24.6 15.9 29.6 12.0 5.6 0.2 100.0 908 6.7 KwaZulu-Natal 8.7 19.9 14.0 31.6 21.1 4.6 0.1 100.0 2 698 7.8 North West 15.3 25.0 16.5 28.0 11.5 3.7 0.1 100.0 1 131 6.2 Gauteng 9.4 13.4 11.3 34.1 20.5 9.7 1.6 100.0 3 294 9.1 Mpumalanga 18.3 23.5 12.0 30.3 10.7 5.0 0.1 100.0 921 6.5 Limpopo 20.6 22.0 13.9 30.1 8.6 4.3 0.5 100.0 1 673 6.1 Total 12.2 19.9 13.7 32.7 15.0 5.9 0.6 10.0 14 416 7.4 Note: Total includes one man and five women for whom age is missing. 18 2.4 School Attendance Table 2.6 presents school attendance by age group, sex, and residence for the population aged 6-24 years. There has been a decrease in the proportions of older children attending school compared with 1998 SADHS. Almost 90 percent of children aged 6-15 years are currently attending school, which is slightly lower than the 92 percent observed in SADHS 1998. School attendance in the age group 16-20 years has dropped from 71 percent in 1998 to 65 percent in 2003, and attendance in the age group 21-24 years has dropped from 27 to 20 percent. The percentage of children aged 6-10 years attending school in urban areas is slightly lower than the percentage in non-urban areas. Nearly 65 percent of the 16-20 year age group and 20 percent of the 21-24 year age group are attending school with slightly higher proportions of males than females, but similar proportions of urban and non-urban respondents in school. 2.5 Grants and Pensions, Injuries and Disabilities The percentage of males and females receiving a government grant or pension is indicated in Table 2.7. Grants are defined as alimony, compensation for injuries, and state pensions. The proportion of the girl population aged 6-9 years that receives a grant has increased significantly from 2 percent in 1998 to 27 percent in 2003. Increases of a similar magnitude are reported for boys of the same age group. These increases can be ascribed to the higher uptake of the Child Support Grant for children under the age of 9, with slight increases in the uptake in the age group 10-14 years. The proportion receiving some kind of grant increases rapidly after age 50. Of women aged 65 year or older, the proportion receiving a grant has increased from 81 percent in 1998 to 87 percent in 2003. Among men 65 years or older, the proportion has increased from 66 percent to 71 percent. The magnitude of increase between the 1998 and 2003 SADHS are hence much smaller in older persons than in young children. It is clear that a larger proportion of the population receives grants in non-urban areas. It is therefore not surprising to note that the largest proportional uptake of social grants or pensions take place in the more rural provinces, i.e. Eastern Cape, Northern Cape, North West and Limpopo. The injury data as included in Table 2.7 are described separately for children and adults in Chapters 7 and 10, respectively. Readers are referred to Sections 7.9 and 10.5 for a short discussion of the data. The percentage of male and female household members with reported sight, hearing, physical, intellectual or emotional disability is shown in Table 2.8. The proportion of the population with some kind of disability increases with age. The increase is particularly pronounced from age 55 where about one-tenth of the population indicated some kind of disability. This proportion increases to about 16 percent for the age group 80 years and over. The proportion is relatively stable across provinces and population groups, and compared to other education groups, only slightly higher for people with no education. Table 2.6 School attendance Percentage of the de facto household population aged 6-24 years in school, by age, sex and residence, South Africa 2003 Male Female Total Urban Non-urban Total Urban Non-urban Total Urban Non-urban Total Age 6-10 86.5 87.3 86.9 85.3 89.7 87.3 85.9 88.4 87.1 11-15 90.3 92.6 91.4 93.8 92.4 93.2 92.2 92.5 92.3 6-15 88.5 90.0 89.2 90.0 91.1 90.5 89.3 90.6 89.9 16-20 65.3 68.6 66.6 64.0 60.5 62.6 64.7 64.5 64.6 21-24 20.1 24.0 21.2 19.1 17.9 18.7 19.6 20.6 19.9 19 Table 2.7 Grants and pensions, and recent injuries Percentage distribution of the de facto male and female household population, by whether receiving a government grant or pension, and whether injured in the 30 days preceding the survey, South Africa 2003 Receiving grant/pension Had any injury Background characteristic Yes No Missing Yes No Missing Total Number of women/men MALE Age 6-9 26.3 71.6 2.1 1.6 97.2 1.2 100.0 1 368 10-14 2.6 96.0 1.4 1.8 97.2 1.1 100.0 1 986 15-19 1.4 96.9 1.7 0.9 98.0 1.1 100.0 1 499 20-24 1.4 97.6 1.0 1.3 97.9 0.9 100.0 1 274 25-29 3.5 95.8 0.8 1.5 98.3 0.2 100.0 1 008 30-34 3.6 95.5 0.9 2.1 97.5 0.4 100.0 891 35-39 3.0 96.3 0.6 3.9 95.9 0.2 100.0 855 40-44 5.3 93.4 1.3 2.7 96.3 1.0 100.0 769 45-49 4.9 94.4 0.7 2.2 97.1 0.6 100.0 638 50-54 10.7 89.1 0.1 0.7 99.2 0.1 100.0 471 55-59 14.1 84.5 1.4 3.4 95.4 1.2 100.0 399 60-64 33.7 65.1 1.2 1.5 97.3 1.3 100.0 399 65+ 70.7 29.2 0.1 2.1 97.4 0.5 100.0 673 Residence Urban 9.1 90.0 0.9 2.0 97.3 0.6 100.0 7 709 Non-urban 14.0 84.5 1.6 1.5 97.4 1.0 100.0 4 520 Province Western Cape 8.4 90.5 1.0 1.7 97.4 0.9 100.0 1 321 Eastern Cape 16.5 82.7 0.8 1.6 97.6 0.8 100.0 1 490 Northern Cape 16.7 82.0 1.3 2.0 97.5 0.5 100.0 211 Free State 14.1 84.4 1.5 1.9 97.6 0.5 100.0 726 KwaZulu-Natal 8.8 90.3 0.9 0.9 98.6 0.4 100.0 2 609 North West 14.1 85.2 0.7 1.4 98.2 0.4 100.0 878 Gauteng 7.2 91.5 1.4 2.9 95.7 1.4 100.0 3 044 Mpumalanga 11.0 87.8 1.2 1.5 98.2 0.3 100.0 777 Limpopo 15.3 82.8 1.9 2.2 97.3 0.5 100.0 1 172 Total 10.9 88.0 1.2 1.9 97.4 0.8 100.0 12 229 FEMALE Age 6-9 27.4 71.3 1.3 0.3 98.9 0.7 100.0 1 361 10-14 2.7 95.9 1.5 0.8 98.7 0.5 100.0 2 039 15-19 1.1 97.6 1.3 0.3 98.9 0.7 100.0 1 604 20-24 2.6 95.8 1.6 1.1 98.3 0.6 100.0 1 416 25-29 2.8 95.6 1.6 0.6 99.0 0.3 100.0 1 143 30-34 2.9 95.7 1.3 1.3 97.6 1.1 100.0 1 056 35-39 3.7 94.6 1.7 0.9 98.0 1.1 100.0 1 143 40-44 6.2 92.9 0.8 0.9 98.9 0.3 100.0 913 45-49 7.5 91.7 0.8 1.3 98.3 0.4 100.0 784 50-54 13.8 85.5 0.7 1.8 97.8 0.3 100.0 848 55-59 22.8 77.1 0.1 2.3 97.1 0.6 100.0 580 60-64 64.9 35.1 0.0 1.5 98.5 0.0 100.0 560 65+ 87.4 12.3 0.4 2.5 96.4 1.1 100.0 963 Residence Urban 13.0 85.9 1.2 1.1 98.3 0.6 100.0 8 860 Non-urban 18.2 80.7 1.2 1.1 98.3 0.7 100.0 5 556 Province Western Cape 11.6 86.8 1.6 1.1 97.7 1.2 100.0 1 572 Eastern Cape 22.8 76.7 0.5 1.0 98.8 0.3 100.0 1 962 Northern Cape 19.6 79.2 1.2 1.3 98.3 0.3 100.0 256 Free State 17.5 80.4 2.1 1.5 98.0 0.5 100.0 908 KwaZulu-Natal 13.6 85.7 0.7 0.9 98.8 0.3 100.0 2 698 North West 18.3 81.1 0.6 0.8 98.8 0.4 100.0 1 131 Gauteng 9.2 89.2 1.6 1.2 97.5 1.3 100.0 3 294 Mpumalanga 15.6 83.2 1.3 0.6 99.2 0.2 100.0 921 Limpopo 18.0 80.8 1.2 1.3 98.3 0.5 100.0 1 673 Total 15.0 83.9 1.2 1.1 98.3 0.6 100.0 14 416 Note: Total includes four men and five women for whom age is missing. 2 0 T a b le 2 .8 D is a b ili ty p re va le n ce P e rc e n ta g e o f m a le a n d f e m a le h o u se h o ld m e m b e rs w ith r e p o rt e d s ig h t, h e a ri n g , p h ys ic a l, in te lle ct u a l, o r e m o tio n a l d is a b ili ty , S o u th A fr ic a 2 0 0 3 M a le s F e m a le s B a ck g ro u n d ch a ra ct e ri st ic N o n e S ig h t H e a ri n g S p e e ch P h ys ic a l In te lle ct E m o tio n a l M is si n g T o ta l N u m b e r o f m e n N o n e S ig h t H e a ri n g S p e e ch P h ys ic a l In te lle ct E m o tio n a l M is si n g T o ta l N u m b e r o f w o m e n A g e 0 -4 9 7 .7 0 .3 0 .0 0 .0 0 .5 0 .0 0 .0 1 .4 1 0 0 .0 1 1 8 8 9 8 .4 0 .3 0 .2 0 .1 0 .1 0 .0 0 .0 0 .9 1 0 0 .0 1 2 0 2 5 -9 9 7 .2 0 .2 0 .2 0 .0 0 .9 0 .1 0 .2 1 .2 1 0 0 .0 1 6 3 7 9 8 .5 0 .3 0 .1 0 .1 0 .3 0 .0 0 .2 0 .6 1 0 0 .0 1 5 9 2 1 0 -1 4 9 8 .3 0 .3 0 .1 0 .0 0 .6 0 .1 0 .0 0 .7 1 0 0 .0 2 0 1 3 9 8 .3 0 .5 0 .0 0 .0 0 .7 0 .0 0 .0 0 .5 1 0 0 .0 2 0 6 6 1 5 -1 9 9 8 .2 0 .2 0 .0 0 .1 0 .5 0 .3 0 .1 0 .6 1 0 0 .0 1 5 1 7 9 8 .2 0 .4 0 .1 0 .0 0 .6 0 .1 0 .0 0 .6 1 0 0 .0 1 6 2 2 2 0 -2 4 9 7 .3 0 .6 0 .2 0 .0 0 .5 0 .8 0 .0 0 .7 1 0 0 .0 1 2 9 8 9 8 .0 0 .2 0 .3 0 .0 0 .4 0 .6 0 .1 0 .3 1 0 0 .0 1 4 4 0 2 5 -2 9 9 6 .0 0 .5 0 .4 0 .3 1 .9 0 .4 0 .2 0 .4 1 0 0 .0 1 0 2 4 9 6 .2 0 .2 0 .3 0 .2 1 .7 0 .5 0 .1 0 .8 1 0 0 .0 1 1 7 0 3 0 -3 4 9 6 .0 0 .5 0 .1 0 .3 1 .5 1 .1 0 .2 0 .3 1 0 0 .0 9 1 0 9 6 .8 0 .5 0 .1 0 .1 0 .9 0 .7 0 .1 0 .9 1 0 0 .0 1 0 7 0 3 5 -3 9 9 5 .2 0 .3 0 .1 0 .1 1 .7 1 .0 0 .1 1 .5 1 0 0 .0 8 7 8 9 5 .8 0 .6 0 .4 0 .1 1 .6 0 .5 0 .1 0 .8 1 0 0 .0 1 1 5 3 4 0 -4 4 9 5 .2 0 .7 0 .0 0 .0 2 .0 1 .0 0 .5 0 .5 1 0 0 .0 7 7 5 9 6 .0 0 .7 0 .2 0 .0 1 .7 0 .4 0 .5 0 .5 1 0 0 .0 9 2 5 4 5 -4 9 9 3 .8 0 .3 1 .1 0 .1 2 .9 0 .4 0 .3 1 .1 1 0 0 .0 6 4 9 9 5 .3 0 .9 0 .1 0 .2 1 .7 0 .8 0 .8 0 .3 1 0 0 .0 8 0 1 5 0 -5 4 9 6 .1 1 .1 0 .4 0 .2 1 .6 0 .0 0 .1 0 .4 1 0 0 .0 4 8 3 9 2 .2 0 .9 0 .6 0 .3 4 .0 1 .0 0 .3 0 .7 1 0 0 .0 8 6 0 5 5 -5 9 9 0 .1 1 .4 0 .4 0 .1 6 .5 0 .2 0 .5 0 .7 1 0 0 .0 4 0 8 9 3 .2 1 .4 0 .7 0 .0 4 .1 0 .1 0 .4 0 .0 1 0 0 .0 5 8 4 6 0 -6 4 9 0 .8 1 .4 0 .7 0 .2 5 .4 0 .7 0 .4 0 .6 1 0 0 .0 4 0 0 9 3 .8 1 .4 0 .3 0 .0 4 .0 0 .0 0 .0 0 .5 1 0 0 .0 5 6 7 6 5 -6 9 9 3 .1 0 .7 0 .3 0 .7 3 .5 0 .8 0 .3 0 .6 1 0 0 .0 3 1 1 9 3 .4 3 .5 0 .3 0 .0 1 .6 0 .0 0 .0 1 .1 1 0 0 .0 3 8 7 7 0 -7 4 9 0 .6 2 .2 0 .5 0 .0 2 .1 0 .0 0 .5 4 .2 1 0 0 .0 2 0 5 9 1 .8 2 .0 0 .7 0 .0 5 .0 0 .0 0 .0 0 .5 1 0 0 .0 2 6 6 7 5 -7 9 9 2 .8 1 .1 1 .6 0 .0 3 .9 0 .3 0 .0 0 .3 1 0 0 .0 8 9 8 8 .1 2 .6 4 .4 0 .0 4 .2 0 .0 0 .8 0 .0 1 0 0 .0 1 4 2 8 0 + 8 3 .6 2 .9 6 .1 0 .0 5 .7 0 .0 1 .2 0 .4 1 0 0 .0 8 1 8 4 .2 4 .7 1 .9 0 .0 6 .3 0 .0 1 .0 1 .9 1 0 0 .0 1 8 2 R e s id e n c e U rb a n 9 6 .5 0 .3 0 .2 0 .1 1 .4 0 .5 0 .1 0 .9 1 0 0 .0 8 7 5 6 9 6 .6 0 .5 0 .2 0 .0 1 .5 0 .3 0 .2 0 .8 1 0 0 .0 9 9 1 2 N o n -u rb a n 9 5 .7 0 .8 0 .4 0 .1 1 .7 0 .3 0 .3 0 .7 1 0 0 .0 5 1 1 0 9 6 .2 1 .0 0 .3 0 .1 1 .4 0 .3 0 .2 0 .4 1 0 0 .0 6 1 2 2 P ro v in c e W e st e rn C a p e 9 6 .5 0 .3 0 .3 0 .1 1 .2 0 .2 0 .1 1 .3 1 0 0 .0 1 5 8 4 9 6 .4 0 .4 0 .0 0 .1 1 .3 0 .1 0 .1 1 .5 1 0 0 .0 1 8 0 7 E a st e rn C a p e 9 6 .1 0 .1 0 .4 0 .0 1 .4 1 .0 0 .1 0 .9 1 0 0 .0 1 7 0 0 9 5 .4 0 .5 0 .5 0 .1 1 .4 1 .1 0 .3 0 .8 1 0 0 .0 2 1 4 5 N o rt h e rn C a p e 9 3 .2 1 .6 0 .5 0 .1 2 .9 0 .4 0 .2 1 .1 1 0 0 .0 2 4 8 9 3 .8 1 .1 0 .5 0 .1 2 .3 0 .6 0 .2 1 .4 1 0 0 .0 2 9 1 F re e S ta te 9 5 .5 0 .4 0 .2 0 .2 2 .1 0 .2 0 .7 0 .8 1 0 0 .0 8 3 8 9 5 .7 0 .4 0 .3 0 .1 2 .3 0 .1 0 .4 0 .6 1 0 0 .0 1 0 2 1 K w a Z u lu -N a ta l 9 8 .2 0 .0 0 .1 0 .0 1 .2 0 .1 0 .1 0 .2 1 0 0 .0 2 7 3 6 9 8 .2 0 .3 0 .0 0 .1 1 .0 0 .2 0 .0 0 .2 1 0 0 .0 2 8 0 0 N o rt h W e st 9 4 .6 1 .4 0 .5 0 .1 2 .1 0 .6 0 .1 0 .7 1 0 0 .0 1 0 2 3 9 4 .2 1 .7 0 .7 0 .2 2 .0 0 .6 0 .2 0 .4 1 0 0 .0 1 2 8 7 G a u te n g 9 6 .7 0 .3 0 .1 0 .0 1 .2 0 .3 0 .1 1 .3 1 0 0 .0 3 4 2 0 9 7 .6 0 .2 0 .2 0 .0 1 .0 0 .1 0 .1 0 .7 1 0 0 .0 3 7 2 4 M p u m a la n g a 9 6 .2 0 .5 0 .0 0 .4 1 .5 0 .7 0 .1 0 .6 1 0 0 .0 9 0 4 9 7 .7 1 .0 0 .1 0 .1 0 .6 0 .2 0 .1 0 .2 1 0 0 .0 1 0 4 9 L im p o p o 9 3 .0 2 .2 0 .6 0 .3 2 .2 0 .4 0 .5 0 .8 1 0 0 .0 1 4 1 4 9 4 .1 2 .1 0 .4 0 .1 2 .5 0 .2 0 .4 0 .3 1 0 0 .0 1 9 0 9 E d u c a ti o n N o e d u ca tio n 9 4 .0 0 .6 0 .5 0 .2 1 .9 0 .9 0 .3 1 .5 1 0 0 .0 2 6 3 0 9 4 .8 1 .1 0 .4 0 .2 1 .8 0 .6 0 .2 1 .0 1 0 0 .0 3 1 8 2 G ra d e s 1 -5 9 6 .5 0 .5 0 .2 0 .1 1 .8 0 .3 0 .2 0 .5 1 0 0 .0 2 8 5 9 9 6 .4 0 .8 0 .3 0 .0 1 .6 0 .4 0 .2 0 .3 1 0 0 .0 2 9 2 0 G ra d e s 6 -7 9 5 .4 0 .6 0 .3 0 .1 2 .1 0 .2 0 .3 1 .0 1 0 0 .0 1 5 7 7 9 5 .9 1 .1 0 .4 0 .0 1 .9 0 .1 0 .2 0 .5 1 0 0 .0 2 0 0 0 G ra d e s 8 -1 1 9 6 .9 0 .7 0 .2 0 .0 1 .2 0 .3 0 .1 0 .5 1 0 0 .0 3 8 4 6 9 7 .0 0 .5 0 .2 0 .1 1 .3 0 .3 0 .2 0 .5 1 0 0 .0 4 7 7 1 G ra d e 1 2 9 8 .4 0 .2 0 .0 0 .0 0 .7 0 .1 0 .0 0 .5 1 0 0 .0 2 0 1 1 9 7 .5 0 .3 0 .3 0 .1 1 .0 0 .2 0 .0 0 .6 1 0 0 .0 2 1 9 9 H ig h e r 9 7 .3 0 .1 0 .2 0 .1 0 .4 0 .7 0 .0 1 .2 1 0 0 .0 8 3 5 9 7 .9 0 .3 0 .0 0 .0 0 .5 0 .0 0 .0 1 .2 1 0 0 .0 8 6 9 U n kn o w n 8 3 .7 0 .0 0 .0 0 .7 8 .1 1 .2 0 .0 6 .4 1 0 0 .0 1 0 8 9 2 .8 2 .8 0 .0 0 .0 0 .0 0 .2 4 .1 0 .0 1 0 0 .0 9 3 P o p u la ti o n g ro u p A fr ic a n 9 6 .2 0 .6 0 .3 0 .1 1 .5 0 .4 0 .2 0 .8 1 0 0 .0 1 1 2 0 3 9 6 .5 0 .8 0 .3 0 .1 1 .4 0 .3 0 .2 0 .5 1 0 0 .0 1 3 2 1 6 A fr . u rb a n 9 6 .5 0 .4 0 .2 0 .1 1 .3 0 .5 0 .1 0 .9 1 0 0 .0 6 3 2 8 9 6 .7 0 .5 0 .2 0 .0 1 .4 0 .3 0 .2 0 .7 1 0 0 .0 7 3 5 2 A fr . n o n -u rb a n 9 5 .8 0 .8 0 .4 0 .1 1 .6 0 .3 0 .3 0 .7 1 0 0 .0 4 8 7 5 9 6 .2 1 .0 0 .3 0 .1 1 .4 0 .3 0 .2 0 .4 1 0 0 .0 5 8 6 5 C o lo u re d 9 6 .3 0 .4 0 .4 0 .0 1 .1 0 .3 0 .2 1 .3 1 0 0 .0 1 2 1 9 9 5 .6 0 .6 0 .1 0 .1 1 .6 0 .5 0 .1 1 .4 1 0 0 .0 1 3 8 7 I n d ia n 9 4 .5 0 .0 0 .1 0 .0 3 .1 0 .5 0 .0 1 .7 1 0 0 .0 3 0 3 9 4 .2 0 .1 0 .2 0 .1 4 .3 0 .1 0 .1 0 .9 1 0 0 .0 3 1 7 W h ite 9 7 .2 0 .1 0 .1 0 .0 1 .6 0 .2 0 .3 0 .5 1 0 0 .0 1 0 9 7 9 7 .1 0 .4 0 .6 0 .0 1 .1 0 .3 0 .1 0 .4 1 0 0 .0 1 0 7 4 O th e r/ m is si n g 8 9 .3 0 .0 0 .0 0 .0 7 .4 0 .0 0 .0 3 .3 1 0 0 .0 4 4 9 6 .8 0 .0 0 .0 0 .0 2 .9 0 .0 0 .0 0 .3 1 0 0 .0 4 1 T o ta l 0 .8 9 6 .2 0 .5 0 .3 0 .1 1 .5 0 .4 0 .2 1 0 0 .0 1 3 8 6 6 0 .6 9 6 .4 0 .7 0 .3 0 .1 1 .4 0 .3 0 .2 1 0 0 .0 1 6 0 3 4 N o te : T o ta l i n cl ud e s o n e m a n a n d s e ve n w o m e n f o r w h o m a g e is m is si n g . 21 2.6 Housing Characteristics Type of housing The household characteristics of the sample are shown in Table 2.9. Not only do these characteristics reflect the socio-economic status of the households but they also have environmental health implications. There are currently 77 percent of South African households with access to electricity. This is 12 percentage points more than the 1998 SADHS. It is also higher than the 2001 census (71 percent). Although there is still a significant difference in access to electricity between urban and non-urban households, the gap has narrowed when compared to the 1998 SADHS. In 1998, 84 percent of urban and 37 percent of non-urban households had access to electricity, compared now to 88 and 57 percent, respectively. Three-quarters (76 percent) of households use electricity as their main source of energy for cooking compared to 52 percent in 1998. The proportion of households using electricity for cooking has grown particularly in the non- urban areas where it has more than doubled to 57 percent compared to 23 percent in 1998. There has been a general drop in other fuels used for cooking in both non-urban and urban areas. Urban Non-urban Total Main wall material Plastic/cardboard 4.9 1.3 3.6 Mud 1.8 21.2 8.8 Mud and cement 7.7 19.5 11.9 Corrugated iron/zinc 10.9 4.0 8.4 Prefab 0.4 0.2 0.3 Bare brick or cement block 16.3 19.0 17.3 Plaster/finished 56.1 33.7 48.0 Other 0.5 0.3 0.4 Missing 1.5 0.9 1.3 Total 100.0 100.0 100.0 Persons per room 1-2 90.9 93.4 91.8 3-4 6.4 4.4 5.7 5-6 1.5 1.1 1.4 7+ 0.4 0.2 0.3 Missing 0.8 0.9 0.8 Total 100.0 100.0 100.0 Mean 1.3 1.2 1.2 Total 4 952 2 804 7 756 Table 2.9 Housing Characteristic Percentage distribution of households by housing characteristic, according to residence, South Africa, 2003 Residence Characteristic Urban Non-urban Total Electricity Yes 87.7 57.4 76.7 No 12.3 42.6 23.3 Total 100.0 100.0 100.0 Fuel used for cooking Electricity 87.2 56.8 76.2 LPG, natural gas 0.2 0.5 0.3 Biogas 0.0 0.0 0.0 Kerosene 3.7 11.4 6.5 Charcoal 0.5 0.5 0.5 Firewood, straw 0.1 0.4 0.2 Dung 0.1 0.0 0.0 Other 0.0 0.2 0.1 Missing 8.3 30.2 16.3 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 58.2 11.0 41.2 Piped into yard/plot 30.5 16.6 25.5 Public tap 9.5 36.5 19.3 Open well in dwelling 0.1 3.3 1.3 Protected well in dwelling 0.2 4.8 1.9 Spring 0.0 1.6 0.6 River, stream 0.1 17.6 6.4 Pond, lake 0.0 0.8 0.3 Pool/stagnant water 0.1 0.2 0.1 Dam 0.0 1.8 0.7 Rainwater 0.0 1.1 0.4 Tanker truck 0.7 3.4 1.7 Bottled water 0.0 0.7 0.3 Other 0.1 0.2 0.1 Missing 0.5 0.5 0.5 Total 100.0 100.0 100.0 Time to water source <15 minutes 95.7 51.0 79.6 Sanitation facility Flush toilet (connected to sewage) 74.8 5.5 49.7 Flush toilet (with septic tank) 6.3 1.5 4.6 Traditional pit toilet 14.7 70.0 34.7 Ventilated improved pit latrine 0.9 3.8 2.0 No facility, bush, field 2.3 18.5 8.1 Other 0.0 0.0 0.0 Missing 1.0 0.7 0.9 Total 100.0 100.0 100.0 Main floor material Earth, sand 8.1 28.1 15.3 Wood planks 1.3 0.3 0.9 Parquet, polished wood 4.3 2.3 3.6 Vinyl, linoleum 7.8 4.0 6.4 Ceramic tiles 22.8 3.9 15.9 Cement 31.1 53.5 39.2 Carpet 23.9 7.3 17.9 Other 0.0 0.0 0.0 Missing 0.7 0.7 0.7 Total 100.0 100.0 100.0 22 The main flooring material in South Africa is cement followed by ceramic tiles and earth/sand. Thirty nine percent of households have cement as the main flooring material compared to 33 percent in 1998. Households using ceramic tiles as main flooring material have more than doubled from 7 percent in 1998 to 16 percent in 2003. The increases occurred in both urban and non-urban areas. Other than cement and ceramic tiles, there has been little change compared to 1998. Forty-eight percent of South African households have plaster as the main wall material, compared to 51 percent in 1998. The proportion with mud walls decreased from 14 percent to 9 percent. Most households (92 percent) reported a population density of one to two people per room. This figure cannot be compared to the 1998 data in which an assessment was made of the number of persons per room that is used for sleeping. 2.7 Water and Sanitation Compared with access to electricity, there has been less change in access to piped water when compared to the 1998 SADHS. Two-thirds of households have access to piped water, 41 percent in the dwelling and a further 26 percent in the yard (Table 2.9). Given that the censuses show that there has been a growth in the number of households between 1996 and 2001, this would suggest that the actual number of households with access to piped water has grown. In addition, there has been a drop in dependence on dams, rivers, streams and springs (8 percent in 2003 compared with 12 percent in 1998). It is noticed that non-urban households still need time to catch up with their urban counterparts. Non-urban households are about five times less likely than urban households to have piped water in the dwelling, and about a quarter of non-urban households still rely on an open, outside water source for drinking water. Almost 80 percent of the households take less than 15 minutes to a water source, compared to 79 percent in the 1998 survey. Fifty-one percent of rural households take less than 15 minutes to a water source, compared to 55 percent in 1998, implying that in 2003 there were more rural households than in 1998 that take more than 15 minutes to a water source. The majority of urban households (75 percent) have flush toilets connected to sewage and a further 6 percent have flush toilets connected to a septic tank. In contrast, the majority of the non-urban households (70 percent) depend on traditional pit latrines. The profile with regard to sanitation has not changed much compared to the 1998 SADHS. Given that the number of households has grown, this likely indicates an increase in the number of households with access to sanitation. However, there are still 8 percent of households with no sanitation facility, which has dropped from 12 percent in 1998. The decrease is more marked in the non-urban areas where 19 percent have no toilet facility compared to 26 percent in 1998. Given the importance of clean, safe water and proper sanitation in health—in particular child and infant health—improvements from the previous survey are commendable, but non-urban households are in particular need of improvements. 23 2.8 Household Durable Goods Table 2.10 shows the distribution of durable goods among households. A radio is owned by 76.4 percent of households, and a television by 62.3 percent. Compared with 1998, there has been an increase in both urban and non-urban households owning a television. There has also been an increase from 50 to 59 percent of households owning a refrigerator. Households owning a computer have increased from 6 to 11 percent. The increase of computer ownership is mostly in urban households. Ownership of goods such as a refrigerator, a computer, a motor vehicle, as well as a telephone, sets the households in urban areas apart from those in non-urban areas. In contrast, the live-stock assets are mostly in non-urban areas. With regard to telephone access, 24 percent of South African households have their own telephone, and 27 percent have access to a public telephone nearby. Cell phones are owned by 55 percent of households. In the urban areas, 34 percent of households have their own phone and 63 percent have a cell phone. In contrast, in the non- urban areas, 6 percent have their own phone and 41 percent have a cell phone. About 40 percent of households have no access to a phone. 2.9 Characteristics of Men Aged 15-59 and Women Aged 15-49 Years Age distribution Table 2.11 presents the age distribution by five-year age groups of women aged 15-49 according to the 1996 and 2001 censuses and the 1998 and 2003 SADHS. Additionally, it reflects the age distribution of men aged 15-59 years according to the 2001 census and the 2003 SADHS. During the SADHS 2003, a total of 7 041 women aged 15-49 and 3 118 men aged 15-59 were interviewed. Table 2.11 shows consistency between the two censuses and surveys in terms of growth and decline of age cohorts within these age ranges. Table 2.10 Household durable goods Percentage of households possessing selected durable goods, by residence, South Africa 2003 Residence Household goods Urban Non- urban Total Durable goods Radio 80.3 69.4 76.4 Television 74.6 40.6 62.3 Refrigerator 71.2 37.1 58.9 Bicycle 15.6 14.8 15.3 Motorcycle/scooter 3.9 1.2 2.9 Car/truck 31.8 12.2 24.7 Computer 15.9 2.0 10.9 Donkey/Horse 0.3 4.1 1.7 Sheep/Cattle 1.1 22.4 8.8 Telephone 34.0 5.7 23.8 Cell phone 63.4 41.3 55.4 None of above 6.4 13.5 8.9 Phone access Own phone 34.0 5.7 23.8 At a neighbour nearby 3.0 5.4 3.9 At a public telephone nearby 23.2 33.8 27.0 Somewhere else nearby 1.1 13.5 5.6 No access 38.6 41.5 39.7 Number of households 4 952 2 804 7 756 Table 2.11 Age distribution of women and men Percentage distribution of women aged 15-49 years and men aged 15-59 years, South Africa, 1996, 1998, 2001 and 2003 WOMEN 15-49 MEN 15-59 1996 Census* 1998 SADHS 2001 Census* 2003 SADHS 2001 Census* 2003 SADHS Age group 15-19 19.5 19.2 20.0 19.8 18.9 19.3 20-24 18.9 17.7 17.3 17.6 16.2 16.9 25-29 16.9 15.8 16.1 14.4 14.6 13.3 30-34 14.7 14.1 13.8 13.0 12.3 11.2 35-39 12.5 13.9 13.0 14.1 11.1 10.9 40-44 10.1 11.0 10.9 11.5 9.5 10.4 45-49 7.1 8.3 8.9 9.5 7.4 7.2 50-54 NA NA NA NA 5.9 5.9 55-59 NA NA NA NA 4.2 5.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Note: NA = not applicable. *Source: Statistics South Africa. 24 Background characteristics The percent distribution, weighted and unweighted numbers of women aged 15-49 and men aged 15-59, and weighted proportions from the 2001 census, are presented in Table 2.12 by selected background characteristics. The proportions in each age group decline more rapidly in men than in women, with increasing age, probably due to higher mortality among males than females across the age groups. While there is general consistency in the comparability between the age distributions of the 2001 census and the 2003 survey regarding these age ranges, a rather large decline is seen in the 2003 survey in both men and women from the age group 20-24 to 25-29, as well as an unusually larger proportion of women 35-39 than those 30-34. Table 2.12 Selected background characteristics of respondents Percentage distribution of women aged 15-49 and men aged 15-59, by selected background characteristics, South Africa 2003 WOMEN 15-49 MEN 15-59 Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 19.8 1 395 1 450 19.3 603 649 20-24 17.6 1 242 1 227 16.8 527 517 25-29 14.4 1 015 1 019 13.3 416 397 30-34 13.0 918 901 11.2 348 334 35-39 14.1 991 972 10.9 340 338 40-44 11.5 812 782 10.4 323 292 45-49 9.5 668 690 7.2 224 233 50-54 - - - 5.9 184 197 55-59 - - - 5.0 155 161 Residence Urban 66.4 4 678 4 095 69.0 2 151 1 874 Non-urban 33.6 2 363 2 946 31.0 967 1 244 Province Western Cape 12.7 892 715 12.2 379 237 Eastern Cape 11.4 804 505 10.0 313 192 Northern Cape 1.8 125 777 1.9 59 374 Free State 6.3 443 796 6.4 199 361 KwaZulu-Natal 16.7 1 177 1 219 22.5 701 702 North West 7.4 523 749 6.9 216 330 Gauteng 26.3 1 854 722 26.1 815 346 Mpumalanga 6.4 451 776 6.7 208 346 Limpopo 11.0 772 782 7.3 228 230 Marital status Never married 54.3 3 821 3 701 55.7 1 738 1 704 Married 27.9 1 966 2 115 29.9 931 951 Living together 9.8 692 655 9.1 284 274 Widowed 2.5 175 167 1.0 32 38 Divorced 1.7 121 118 1.7 54 70 Not living together 3.8 266 285 2.0 62 66 Missing - - - 0.5 17 15 Education No education 4.3 302 337 4.5 141 170 Grades 1-5 6.2 438 497 7.3 227 252 Grades 6-7 10.2 721 790 10.2 316 349 Grades 8-11 46.7 3 285 3 263 43.8 1 367 1 358 Grade 12 23.9 1 683 1 555 25.2 787 699 Higher 8.7 609 598 9.0 279 290 Unknown 0.0 3 1 - 0 0 Population group African 82.8 5 831 5 234 81.5 2 540 2 327 African urban 61.5 3 586 2 553 63.5 1 613 1 188 African non-urban 38.5 2 246 2 681 36.5 927 1 139 Coloured 9.4 665 933 8.5 264 348 White 5.7 402 274 7.4 229 156 Indian 2.0 141 596 2.6 79 282 Other/missing 0.0 2 4 0.2 5 5 Total 100.0 7 041 7 041 100.0 3 118 3 118 25 Similar to the 2001 census, a sex difference is reflected in the urban proportions interviewed in the SADHS 2003, both datasets showing a higher proportion of men than women living in urban areas. However, considering the SADHS 2003 data on its own, an urban bias is reflected for both men and women. Provincial proportions, too, vary according to sex. While it is expected that the economically less developed provinces would house relatively more women than men, and vice versa, resulting from more male than female labour migration to economically more developed provinces with better employment prospects, the distribution for the Western Cape, KwaZulu-Natal in particular, Gauteng, and Mpumalanga diverge from the expected pattern. It is believed that provincial populations are experiencing considerable circular migration patterns and are therefore not static. However, it needs mentioning that the Western Cape and Gauteng had higher proportions of men and women in 2003 than reported in 2001, particularly higher for women in Gauteng. Whereas Table 2.12 reflects a considerable decrease of women from the time of the 2001 census to the 2003 survey in KwaZulu-Natal, it reflects a large increase of men in the same period, a situation seeming unusual and needing further investigation. Small sex differentials are generally observed regarding educational attainment, population group, and marital status, except for widowhood that is reported to be more than twice as high among women compared to men. However, when comparing the SADHS 2003 percentage distributions of these characteristics with those of the 2001 census, some larger differences are clear, including that the proportions of men and women married are lower in the SADHS 2003 than in the 2001 census; the percentage of men and women with no education are to a large extent lower in the 2003 SADHS than reported in the 2001 census; the percentage of men and women with primary school education are to some extent lower in 2003 than reported in the 2001 census, whereas the percentage of men and women with secondary school education are considerably higher in 2003 compared to 2001; in the 2003 SADHS, African men and women as a proportion of the total population, are considerably larger compared to the 2001 census, whereas the proportion of white men and women is noticeably smaller; and for both men and women, the urban/non-urban distribution of the African population group reflects a very large over-sample of urban Africans, and a large under-sample of non-urban Africans. Educational level Table 2.13 shows that about one-third of women and men have completed Grade 12 or higher, men having a slightly higher proportion than women. The women’s data reflect a considerable increase from the 1998 SADHS when it was reported that 24 percent had similar qualifications. Some caution needs to be exercised regarding this observed increase, as the reported 130 percent increase in the matriculated women of the most populous province, KwaZulu-Natal, (from 17 percent in 1998 to 39 percent in 2003) seems unlikely. Similar to the situation in the 1998 SADHS, the proportion of women with no education increases with age in the 2003 survey. The 2003 SADHS shows a similar but disrupted pattern for men. Similar proportions of men (4.5 percent) and women (4.3 percent) had received no education. The proportion of all women with no education dropped from 7 percent in 1998 to 4 percent in 2003, reflecting a sizeable decline. Again some caution is called for, taking into account that the proportion of women with no education in KwaZulu-Natal reflects a 400 percent decrease from 1998 (11 percent) to 2003 (2 percent). 2 6 T a b le 2 .1 3 L e ve l o f e d u ca tio n P e rc e n ta g e d is tr ib u tio n o f w o m e n a g e d 1 5 -4 9 y e a rs a n d m e n 1 5 -5 9 y e a rs b y th e h ig h e st l e ve l o f e du ca tio n c o m p le te d a n d p o p u la tio n g ro u p , a cc o rd in g t o s e le ct e d b ac kg ro u n d c h a ra ct e ri st ic s, S o u th A fr ic a 2 0 0 3 H ig h e st le ve l o f e d u ca tio n c o m p le te d P o p u la tio n g ro u p B a ck g ro u n d c h a ra ct e ri st ic N o e d u ca tio n G ra d e s 1 -5 G ra d e s 6 -7 G ra d e s 8 -1 1 G ra d e s 1 2 H ig h e r A fr ic a n C o lo u re d W h ite In d ia n O th e r T o ta l N u m b e r W O M E N 1 5 -4 9 A g e 1 5 -1 9 0 .6 2 .3 8 .6 7 3 .9 1 2 .8 1 .9 8 7 .0 8 .0 3 .5 1 .5 0 .0 1 0 0 .0 1 3 9 5 2 0 -2 4 1 .0 2 .4 4 .1 4 5 .8 3 4 .9 1 1 .5 8 5 .2 1 0 .1 3 .4 1 .3 0 .0 1 0 0 .0 1 2 4 2 2 5 -2 9 1 .9 3 .1 6 .8 3 9 .7 3 6 .5 1 2 .0 8 3 .1 9 .0 5 .8 2 .1 0 .1 1 0 0 .0 1 0 1 5 3 0 -3 4 4 .1 5 .9 8 .9 3 9 .4 3 0 .3 1 1 .5 8 0 .8 1 0 .0 7 .6 1 .6 0 .0 1 0 0 .0 9 1 8 3 5 -3 9 5 .9 9 .7 1 4 .7 3 6 .8 2 3 .6 9 .4 8 2 .8 8 .7 5 .4 3 .0 0 .1 1 0 0 .0 9 9 1 4 0 -4 4 1 1 .8 1 1 .0 1 7 .5 3 6 .0 1 4 .3 9 .4 7 7 .9 1 0 .4 9 .6 2 .0 0 .0 1 0 0 .0 8 1 2 4 5 -4 9 1 0 .6 1 5 .6 1 6 .8 3 9 .6 1 0 .9 6 .5 7 7 .9 1 1 .2 7 .6 3 .5 0 .0 1 0 0 .0 6 6 8 R e s id e n c e U rb a n 3 .7 4 .3 9 .1 4 6 .9 2 5 .3 1 0 .6 7 6 .7 1 2 .2 8 .1 3 .0 0 .0 1 0 0 .0 4 6 7 8 N o n -u rb a n 5 .5 1 0 .0 1 2 .4 4 6 .3 2 1 .1 4 .8 9 5 .0 4 .0 0 .9 0 .1 0 .0 1 0 0 .0 2 3 6 3 P ro v in c e W e st e rn C a p e 1 .7 6 .1 8 .6 5 4 .0 2 3 .0 6 .7 3 8 .5 5 3 .0 7 .2 1 .2 0 .1 1 0 0 .0 8 9 2 E a st e rn C a p e 3 .1 9 .7 1 2 .3 5 2 .5 1 4 .0 8 .4 9 4 .6 3 .2 1 .8 0 .4 0 .0 1 0 0 .0 8 0 4 N o rt h e rn C a p e 8 .5 7 .1 1 3 .7 4 8 .0 1 5 .3 7 .5 3 2 .2 6 0 .7 6 .3 0 .6 0 .3 1 0 0 .0 1 2 5 F re e S ta te 4 .4 8 .2 1 6 .6 4 4 .7 1 8 .9 7 .3 9 2 .7 3 .1 3 .8 0 .4 0 .0 1 0 0 .0 4 4 3 K w a Z u lu -N a ta l 2 .0 5 .6 7 .4 3 7 .9 3 9 .4 7 .7 8 2 .4 3 .9 5 .1 8 .7 0 .0 1 0 0 .0 1 1 7 7 N o rt h W e st 6 .9 9 .3 1 4 .7 4 2 .3 1 9 .7 7 .1 9 8 .1 0 .2 1 .7 0 .0 0 .0 1 0 0 .0 5 2 3 G a u te n g 5 .5 2 .3 8 .1 4 5 .9 2 6 .4 1 1 .7 8 6 .6 1 .4 1 0 .8 1 .2 0 .0 1 0 0 .0 1 8 5 4 M p u m a la n g a 5 .8 8 .5 1 0 .9 4 8 .3 1 8 .0 8 .5 9 5 .1 0 .9 3 .7 0 .2 0 .1 1 0 0 .0 4 5 1 L im p o p o 5 .7 8 .4 1 1 .9 5 0 .2 1 6 .3 7 .5 9 8 .3 0 .0 1 .7 0 .0 0 .0 1 0 0 .0 7 7 2 T o ta l 4 .3 6 .2 1 0 .2 4 6 .7 2 3 .9 8 .7 8 2 .8 9 .4 5 .7 2 .0 0 .0 1 0 0 .0 7 0 4 1 M E N 1 5 -5 9 A g e 1 5 -1 9 1 .2 4 .7 1 1 .2 6 9 .0 1 0 .9 3 .0 8 3 .8 8 .0 6 .2 2 .0 0 .0 1 0 0 .0 6 0 3 2 0 -2 4 1 .2 2 .5 4 .7 4 7 .3 3 3 .9 1 0 .5 8 7 .8 7 .2 3 .8 1 .2 0 .0 1 0 0 .0 5 2 7 2 5 -2 9 4 .8 3 .8 7 .4 3 1 .5 3 8 .8 1 3 .7 8 4 .8 5 .2 7 .8 2 .3 0 .0 1 0 0 .0 4 1 6 3 0 -3 4 2 .1 3 .6 1 0 .0 3 5 .0 3 6 .8 1 2 .6 8 3 .8 6 .9 6 .9 2 .4 0 .0 1 0 0 .0 3 4 8 3 5 -3 9 4 .8 7 .7 1 4 .0 3 7 .3 2 8 .3 8 .0 7 9 .1 1 2 .2 6 .1 2 .6 0 .0 1 0 0 .0 3 4 0 4 0 -4 4 8 .1 1 5 .7 1 0 .5 3 4 .2 2 1 .3 1 0 .3 7 5 .8 1 0 .9 9 .9 2 .2 1 .2 1 0 0 .0 3 2 3 4 5 -4 9 8 .3 1 2 .2 1 1 .7 3 8 .0 2 0 .0 9 .9 7 3 .6 1 3 .3 7 .8 5 .4 0 .0 1 0 0 .0 2 2 4 5 0 -5 4 1 2 .7 1 9 .6 1 7 .5 3 0 .8 1 3 .6 5 .9 7 5 .7 6 .9 1 2 .2 5 .3 0 .0 1 0 0 .0 1 8 4 5 5 -5 9 1 0 .8 1 1 .2 1 2 .6 4 5 .8 1 2 .2 7 .4 7 2 .0 8 .4 1 4 .9 3 .7 1 .1 1 0 0 .0 1 5 5 R e s id e n c e U rb a n 4 .0 5 .6 8 .9 4 3 .1 2 7 .8 1 0 .7 7 5 .0 1 0 .9 1 0 .2 3 .7 0 .3 1 0 0 .0 2 1 5 1 N o n -u rb a n 5 .8 1 1 .0 1 3 .0 4 5 .6 1 9 .6 5 .0 9 5 .8 3 .1 1 .0 0 .1 0 .0 1 0 0 .0 9 6 7 P ro v in c e E a st e rn C a p e 2 .1 9 .1 1 0 .1 4 6 .1 2 1 .7 1 1 .0 4 1 .6 4 6 .3 8 .6 2 .3 1 .3 1 0 0 .0 3 7 9 F re e S ta te 3 .9 9 .3 1 2 .7 4 6 .4 1 8 .7 8 .9 8 8 .5 2 .6 8 .9 0 .0 0 .0 1 0 0 .0 3 1 3 G a u te n g 7 .7 7 .3 1 3 .1 4 9 .3 1 4 .6 7 .9 3 7 .5 5 2 .5 9 .4 0 .3 0 .3 1 0 0 .0 5 9 K w a Z u lu -N a ta l 7 .5 1 2 .8 1 4 .8 3 9 .6 1 7 .0 8 .3 9 0 .7 2 .8 5 .3 1 .2 0 .0 1 0 0 .0 1 9 9 M p u m a la n g a 2 .1 4 .2 5 .1 4 2 .3 3 7 .2 9 .2 7 9 .8 3 .8 7 .9 8 .5 0 .0 1 0 0 .0 7 0 1 N o rt h e rn C a p e 9 .2 9 .2 1 3 .7 3 7 .2 2 1 .8 9 .0 1 0 0 .0 0 .0 0 .0 0 .0 0 .0 1 0 0 .0 2 1 6 L im p o p o 5 .6 4 .9 9 .1 4 4 .3 2 8 .0 8 .2 8 6 .9 1 .7 1 0 .4 1 .1 0 .0 1 0 0 .0 8 1 5 N o rt h w e st 5 .7 9 .3 1 5 .1 4 3 .3 1 7 .4 9 .3 9 5 .4 1 .7 2 .6 0 .0 0 .3 1 0 0 .0 2 0 8 W e st e rn C a p e 4 .4 1 1 .2 1 3 .4 4 8 .9 1 4 .2 8 .0 9 7 .0 0 .0 3 .1 0 .0 0 .0 1 0 0 .0 2 2 8 T o ta l 4 .5 7 .3 1 0 .1 4 3 .8 2 5 .2 8 .9 8 1 .5 8 .5 7 .4 2 .5 0 .2 1 0 0 .0 3 1 1 8 27 Given that only about one-third of women 15-49 and men 15-59 had completed their secondary school education, it is important to consider the reasons provided by respondents for leaving school. Table 2.14 presents such reasons for respondents aged 15-24 years who stopped attending school. As in 1998, two reasons predominate among women 15-24, viz financial reasons and falling pregnant. The proportion of all young women who left school due to pregnancy declined from 10 percent in 1998 to 7 percent in 2003, but the proportion who left school due to financial reasons, increased from 13 to 19 percent. “Could not pay school fees” is reported by one in three women (33 percent) who failed to complete their primary education, and by 10 percent who failed to complete their secondary education. Overall, 1.6 percent of young women indicate that getting married is the reason for not completing their education, down from 2.1 percent in 1998. Compared to 1998, more than double the proportion of women reported in 2003 that they left school because they needed to take care of younger children, and the situation seems to have worsened particularly among women with incomplete primary education among whom the proportion increased over three times from 1998 (0.9 percent) to 2003 (3.2 percent). It is interesting to note that “Did not like school” increased slightly overall from 2 percent in 1998 to 2.4 percent in 2003, but among women who failed to complete their primary school education, it almost tripled from 4.3 to 12.3 percent. Table 2.14 Reasons for leaving school Percentage distribution of men and women aged 15-24 years by school attendance and reason for leaving school, according to highest level of education completed, South Africa 2003 Highest level of education Reason stopped attending school No education Incomplete primary Complete primary Incomplete secondary Complete secondary Higher Total WOMEN 15-24 Currently attending 11.2 27.6 57.7 64.9 26.7 57.8 53.3 Got married 0.0 2.9 1.2 1.7 1.5 0.4 1.6 Care for younger children 0.0 3.2 1.7 2.4 0.7 0.9 1.9 Family needed help 0.0 0.5 0.0 0.1 0.0 0.0 0.1 Could not pay school fees 0.0 32.7 19.6 9.7 24.4 3.3 14.0 Needed to earn money 0.0 1.8 0.5 2.1 15.3 5.8 5.3 Graduated/had enough school 0.0 0.0 1.2 0.6 17.8 22.2 5.9 Did not pass entrance exam 0.0 1.6 0.1 1.8 0.7 0.0 1.3 Did not like school 0.0 12.3 2.2 2.8 0.3 0.0 2.4 School not accessible 0.0 0.1 0.0 0.1 0.5 0.0 0.2 Got pregnant 0.0 5.0 10.4 9.7 2.7 3.0 7.4 Other 0.0 11.2 2.2 3.0 2.6 0.5 3.0 Don’t know 0.0 1.2 1.7 0.9 1.7 1.1 1.1 Missing 88.8 0.0 1.6 0.3 5.1 5.0 2.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 21 111 122 1 599 612 169 2 637 MEN 15-24 Currently attending 0.0 59.4 56.0 69.7 24.8 67.5 57.6 Care for younger children 0.0 3.7 0.0 0.1 0.5 0.0 0.4 Family needed help 0.0 0.5 0.0 0.6 0.5 0.0 0.5 Could not pay school fees 0.0 17.8 14.6 11.8 23.1 4.8 14.1 Needed to earn money 0.0 9.0 10.7 7.4 14.8 4.0 9.0 Graduated/had enough school 0.0 0.0 0.0 0.2 17.9 16.6 5.1 Did not pass entrance exam 0.0 0.8 0.0 1.3 1.8 1.5 1.3 Did not like school 0.0 3.0 4.4 3.9 2.9 0.0 3.3 School not accessible 0.0 0.0 0.9 0.5 1.1 0.0 0.6 Other 0.0 0.7 8.4 2.4 2.4 0.6 2.5 Don’t know 0.0 0.2 1.7 0.3 1.9 0.0 0.7 Missing 100.0 4.9 3.3 2.0 8.3 4.9 4.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 13 70 64 665 244 73 1 130 Note: 3 women and 1 man with unknown highest level of education have been omitted. 2 8 T a b le 2 .1 5 L ite ra cy P e rc e n ta g e d is tr ib u tio n o f w o m e n a n d m e n b y le ve l o f sc h o o lin g a n d b y le ve l o f lit e ra cy , a n d p e rc e n t lit e ra te , a cc o rd in g t o s e le ct e d b a ck g ro u n d c h a ra ct e ri st ic s, S o u th A fr ic a 2 0 0 3 W O M E N 1 5 -4 9 M E N 1 5 -5 9 B a ck g ro u n d ch a ra ct e ri st ic P e rc e n ta g e w ith se co n d a ry sc h o o l o r h ig h e r C a n n o t re a d a t a ll A b le t o re a d o n ly p a rt s o f se n te n ce A b le t o re a d w h o le se n te n ce N o c a rd w ith re q u ir e d la n g u a g e M is si n g T o ta l N u m b e r P e rc e n ta g e w ith se co n d a ry sc h o o l o r h ig h e r C a n n o t re a d a t a ll A b le t o re a d o n ly p a rt s o f se n te n ce A b le t o re a d w h o le se n te n ce N o c a rd w ith re q u ir e d la n g u a g e M is si n g T o ta l N u m b e r A g e 1 5 -1 9 8 8 .5 0 .8 1 .0 9 7 .3 0 .0 0 .9 1 0 0 .0 1 3 9 5 8 2 .9 2 .4 2 .0 9 4 .8 0 .0 0 .8 1 0 0 .0 6 0 3 2 0 -2 4 9 2 .2 1 .7 1 .2 9 6 .7 0 .0 0 .4 1 0 0 .0 1 2 4 2 9 1 .7 1 .7 1 .5 9 6 .4 0 .1 0 .3 1 0 0 .0 5 2 7 2 5 -2 9 8 8 .3 2 .4 1 .4 9 5 .2 0 .0 1 .1 1 0 0 .0 1 0 1 5 8 4 .0 5 .2 2 .6 9 2 .0 0 .2 0 .0 1 0 0 .0 4 1 6 3 0 -3 4 8 1 .1 4 .4 2 .9 9 0 .8 0 .8 1 .1 1 0 0 .0 9 1 8 8 4 .3 2 .7 1 .1 9 4 .4 0 .2 1 .6 1 0 0 .0 3 4 8 3 5 -3 9 6 9 .7 7 .3 4 .7 8 5 .6 0 .2 2 .1 1 0 0 .0 9 9 1 7 3 .5 6 .2 5 .3 8 7 .3 0 .0 1 .3 1 0 0 .0 3 4 0 4 0 -4 4 5 9 .7 1 2 .9 6 .5 7 7 .8 0 .6 2 .2 1 0 0 .0 8 1 2 6 5 .8 1 1 .0 7 .0 8 1 .4 0 .0 0 .6 1 0 0 .0 3 2 3 4 5 -4 9 5 6 .9 1 4 .2 5 .3 7 6 .5 0 .3 3 .7 1 0 0 .0 6 6 8 6 7 .8 6 .7 4 .9 8 7 .4 0 .0 1 .0 1 0 0 .0 2 2 4 5 0 -5 4 - - - - - - - 5 0 .3 1 4 .7 1 4 .6 6 9 .5 0 .0 1 .1 1 0 0 .0 1 8 4 5 5 -5 9 - - - - - - - 6 5 .4 1 4 .3 9 .2 7 5 .6 0 .0 0 .9 1 0 0 .0 1 5 5 R e s id e n c e U rb a n 8 2 .8 3 .9 2 .0 9 2 .7 0 .1 1 .3 1 0 0 .0 4 6 7 8 8 1 .6 5 .1 3 .2 9 0 .9 0 .0 0 .8 1 0 0 .0 2 1 5 1 N o n -u rb a n 7 2 .1 7 .9 4 .7 8 5 .2 0 .4 1 .9 1 0 0 .0 2 3 6 3 7 0 .2 6 .8 6 .1 8 6 .3 0 .1 0 .6 1 0 0 .0 9 6 7 P ro v in c e W e st e rn C a p e 8 3 .6 2 .3 2 .4 9 4 .3 0 .0 1 .0 1 0 0 .0 8 9 2 7 8 .7 5 .7 2 .3 9 2 .1 0 .0 0 .0 1 0 0 .0 3 7 9 E a st e rn C a p e 7 4 .9 6 .0 2 .5 9 0 .5 0 .0 0 .9 1 0 0 .0 8 0 4 7 4 .1 4 .5 4 .5 9 0 .1 0 .0 0 .9 1 0 0 .0 3 1 3 N o rt h e rn C a p e 7 0 .8 9 .0 4 .3 8 6 .1 0 .0 0 .6 1 0 0 .0 1 2 5 7 1 .8 9 .5 3 .5 8 6 .3 0 .0 0 .8 1 0 0 .0 5 9 F re e S ta te 7 0 .9 6 .0 6 .1 8 5 .3 0 .5 2 .1 1 0 0 .0 4 4 3 6 4 .9 1 0 .0 7 .3 8 2 .4 0 .0 0 .3 1 0 0 .0 1 9 9 K w a Z u lu -N a ta l 8 5 .0 3 .7 3 .3 9 1 .1 0 .2 1 .7 1 0 0 .0 1 1 7 7 8 8 .6 1 .8 3 .0 9 4 .4 0 .0 0 .8 1 0 0 .0 7 0 1 N o rt h w e st 6 9 .1 8 .1 5 .0 8 5 .3 0 .5 1 .1 1 0 0 .0 5 2 3 6 7 .9 9 .6 5 .2 8 4 .9 0 .3 0 .0 1 0 0 .0 2 1 6 G a u te n g 8 3 .9 5 .0 1 .3 9 2 .2 0 .3 1 .1 1 0 0 .0 1 8 5 4 8 0 .5 6 .3 4 .1 8 8 .3 0 .0 1 .3 1 0 0 .0 8 1 5 M p u m a la n g a 7 4 .9 6 .5 3 .7 8 7 .8 0 .0 2 .0 1 0 0 .0 4 5 1 7 0 .0 9 .1 4 .7 8 4 .9 0 .3 1 .0 1 0 0 .0 2 0 8 L im p o p o 7 4 .0 7 .2 3 .0 8 6 .8 0 .3 2 .7 1 0 0 .0 7 7 2 7 1 .0 4 .7 5 .3 8 8 .5 0 .3 1 .1 1 0 0 .0 2 2 8 T o ta l 7 9 .2 5 .2 2 .9 9 0 .2 0 .2 1 .5 1 0 0 .0 7 0 4 1 7 8 .0 5 .6 4 .1 8 9 .4 0 .1 0 .8 1 0 0 .0 3 1 1 8 29 In the case of men, financial reasons were the main concern for stopping education. Almost one-quarter (23 percent) of men could not pay their school fees, or needed to earn money. It is interesting to note that “Got married” was not included as a potential reason in the men’s questionnaire. Fifty eight percent of men aged 15-24 years and 53 percent of women aged 15- 24 were still attending school at the time of interview. Literacy Table 2.15 presents literacy levels of women 15-49 and men 15-59. The adult population of South Africa is mostly able to read with about 90 percent being able to read a sentence presented during the interview. The proportions of adults who are able to read a complete sentence decreases with age to 70 percent of men 50-54 years, and 77 percent of women 45- 49 years. A higher proportion of adults in the non-urban areas are unable to read a complete sentence. Marital status Current marital status is reflected in Figure 2.4 and by age group in Table 2.16. About 55 percent of men and women in the respective age range report that they were never married. The proportion of women in the never married category has increased from 48.3 percent in the 1998 survey to 54.3 percent in 2003. Correspondingly, the proportion of women who report being married declined from 33.7 percent in 1998 to 27.9 percent in 2003, possibly pointing to a considerable change in female marriage patterns, or change in reporting on the subject over the five year period in between, or other influencing factors like those described below. These changes among women, when analysed by five-year age groups, are generally consistent between the surveys. Fifty six percent of men aged 15-59 years have never married with 29.9 percent who are currently married. Less than 2 percent of men and women, respectively, are divorced, but more than double the proportion of women (2.5 percent) compared to men (1 percent) are widowed. Budlender et al. (2004) highlight the challenges of collecting and interpreting statistical data regarding marital status in South Africa, resulting from the cultural and religious diversity in the forms of marriage, as well as the language issues around translation of questionnaires. They note that surveys and censuses reflect perceptions of marriage, and point out that the customary practice of lobola (bridewealth) could introduce complexity to the perceptions of marriage as such marriage takes place over an extended period of time. It is therefore possible that the two parties may perceive the timing of marriage differently. Budlender et al. (2004) furthermore highlight that changes in legislation in 1998 with the passing of the Recognition of Customary Marriage Act, giving new legal status to customary marriages, may affect perceptions differently from before. While this Act would improve the property rights of African women in particular, it is difficult to assess what impact it would have on reporting of marital status. Budlender et al. (2004) demonstrate gender differences in reporting of marriage, with more men reporting to be married than women. They also suggest that cohabitation is also likely to be reported differently by different people. It is important to keep these issues in mind when interpreting the findings. 30 Figure 2.4 Current marital status of women and men, South Africa 2003 Men 15-59 years Never married, 55.7Married, 29.9 Living together, 9.1 Widowed, 1.0 Not living together, 2.0 Divorced, 1.7 Women 15-49 years Never married, 54.3 Married, 27.9 Living together, 9.8 Widowed, 2.5 Not living together, 3.8 Divorced, 1.7 31 Age at first marriage In the 2003 SADHS, the median age at first marriage for women 25-49 has increased considerably to 27.0 years from 24.2 years in the 1998 SADHS (Table 2.17). Data presented by Budlender et al. (2004) suggest that in the late 1990’s the mean age at marriage for South Africans was around 25 years; higher than the ages reported for most other African countries. The observed extreme increase between the two SADHS surveys however, needs to be interpreted carefully. It can be noticed that the 1998 median age at first marriage ranged from 22.6 for women aged 45-49 to 24.7 for women 30-34, while the 2003 median ranges from 25.7 years to 27.0 for women of the same age groups—showing a full year’s difference between 1998’s highest and 2003’s lowest median age. This suggests either unusual dynamics in South African marriage patterns, or peculiarities in reporting such data. The constant decline from 1998 to 2003 in the proportion of women 15-49 who were first married by each of the indicated exact ages given in Table 2.17, suggest that women from all age groups are either waiting longer to marry (which may correlate in part to findings in other sections indicating that more women report to stay longer in school and enter the work force in larger numbers), or that issues of measurement of marital status mentioned by Budlender et al. (2004) influence the findings. For women aged 20-49 and 25-49, the proportion who had never married has increased considerably from the previous survey till the current, with 19 percent more and 30 percent more, respectively, who had never married. Further investigation into changes over time in the proportion of cohabiting, divorced, widowed or never-in-union women could shed light on contributing reasons for such dramatic change in these social patterns. Age at first marriage was not asked in the men’s questionnaire. Data on contraception are often reported only for men and women who are married. Given the late age of marriage in South Africa and the relatively high proportions of cohabitation, such statistics are not likely to be meaningful. For this reason, the data on fertility and contraception will generally be presented for people who are in union (married or cohabiting) or for people who are sexually active. Table 2.16 Current marital status Percent distribution of women 15-49 years and men 15-59 years, by current marital status by age, South Africa 2003 Age groups Never married Married Living together Widowed Divorced Not living together Missing Total Number WOMEN 15-49 15-19 95.6 1.3 2.3 0.0 0.0 0.8 0.0 100.0 1 395 20-24 79.4 8.3 10.8 0.0 0.2 1.3 0.0 100.0 1 242 25-29 55.4 25.3 13.4 0.7 0.6 4.7 0.0 100.0 1 015 30-34 36.8 40.1 14.6 1.7 2.1 4.7 0.0 100.0 918 35-39 31.0 47.1 9.7 4.0 2.7 5.4 0.0 100.0 991 40-44 21.7 49.9 12.4 5.5 4.3 6.2 0.0 100.0 812 45-49 17.7 52.0 8.6 10.3 4.7 6.7 0.0 100.0 668 Total 54.3 27.9 9.8 2.5 1.7 3.8 0.0 100.0 7 041 MEN 15-59 15-19 97.6 0.2 1.8 0.0 0.0 0.2 0.2 100.0 603 20-24 88.2 2.8 7.6 0.0 0.0 1.2 0.2 100.0 527 25-29 72.7 10.3 13.6 0.0 0.7 2.6 0.0 100.0 416 30-34 44.9 33.6 15.6 0.1 0.9 4.0 0.9 100.0 348 35-39 32.9 46.7 14.9 0.3 2.6 2.0 0.8 100.0 340 40-44 10.7 66.5 10.3 2.7 6.7 2.3 0.8 100.0 323 45-49 17.8 66.1 6.7 3.3 3.7 1.6 0.8 100.0 224 50-54 9.4 68.4 8.7 3.6 2.6 5.1 2.2 100.0 184 55-59 14.8 70.3 5.0 5.1 3.1 1.5 0.2 100.0 155 Total 55.7 29.9 9.1 1.0 1.7 2.0 0.5 100.0 3 118 32 The median age at first marriage differs by population group, being youngest for white and Indian women and oldest for African women (Table 2.18). The median age at first marriage for each of the population groups is 21.6, 22.9 and 28.5 years respectively. This population group pattern was also observed in the 1998 SADHS, albeit at slightly younger ages for African women. Women from North West and KwaZulu-Natal report the oldest ages at first marriage while Limpopo women report the youngest. Age at first marriage tends to increase with higher levels of education, but is very similar for urban and non-urban residence. Table 2.17 Age at first marriage Percentage of women aged 15-49 years who were first married by exact ages, and median age at first marriage, by current age, South Africa 2003 Percent who were first married by exact age Current age 15 18 20 22 25 Percentage who had never married Number of women Median age at first marriage 15-19 0.4 NA NA NA NA 95.6 1 395 a 20-24 0.8 5.6 12.6 NA NA 79.4 1 242 a 25-29 2.1 8.0 14.9 23.0 34.7 55.4 1 015 a 30-34 2.6 10.6 21.3 30.5 42.6 36.8 918 27.0 35-39 1.5 12.0 24.1 32.1 46.5 31.0 991 26.6 40-44 1.9 11.8 26.7 37.8 50.2 21.7 812 24.9 45-49 4.1 14.5 25.6 35.4 46.5 17.7 668 25.7 Median for women 20-49 2.0 9.9 20.0 NA NA 44.1 5 646 b Median for women 25-49 2.3 11.1 22.1 31.2 43.7 34.1 4 404 27.0 Note: NA = Not applicable a = less than 50 percent of respondents in age group x to x+4 were married by age x b = not calculated due to censoring Table 2.18 Median age at first marriage Median age at first marriage among women age 25-49, by current age and selected background characteristic, South Africa 2003 Current age Women aged Background characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban a 26.4 27.4 25.8 25.8 27.0 Non-urban a 32.4 24.3 23.0 25.3 26.9 Province Western Cape 27.0 24.7 24.4 24.0 26.7 25.1 Eastern Cape a a 27.8 25.2 25.2 26.9 Northern Cape 25.7 26.6 26.9 26.5 26.7 26.4 Free State 28.8 25.7 24.1 21.7 23.9 25.2 KwaZulu-Natal a a 33.7 23.6 26.7 32.0 North West a a 29.3 26.7 25.6 37.7 Gauteng a 26.4 27.7 27.4 26.4 27.5 Mpumalanga 27.7 28.5 21.2 26.2 25.9 25.8 Limpopo 26.6 24.1 21.6 22.1 19.2 23.0 Education No education a 28.6 23.9 26.7 21.5 25.1 Grades 1-5 27.4 24.1 23.7 26.9 24.4 25.0 Grades 6-7 28.0 26.6 24.2 22.7 26.9 24.8 Grades 8-11 a 26.6 25.4 25.6 25.4 26.5 Grade 12 a 27.8 28.6 24.6 27.4 29.7 Higher 27.4 27.5 26.7 25.8 27.3 27.0 Population group African a 28.2 28.1 26.1 25.8 28.5 African urban a 27.7 30.3 28.4 26.2 28.9 African non-urban a a 24.4 22.9 25.2 27.2 Coloured 28.2 24.1 25.0 24.2 27.5 25.8 White 23.3 22.1 21.5 20.6 21.5 21.6 Indian 23.2 23.1 23.2 21.1 23.7 22.9 Total a 27.0 26.6 24.9 25.7 27.0 Note: a = less than 50 percent of respondents in age group x to x + 4 were first married by age x. 33 Polygyny Table 2.19 shows the percentage of in-union men and women who currently are in a polygynous union by selected background characteristics. Approximately four percent of in-union women and men are in polygynous relationships. While considering the remarks of Budlender et al. (2004) elsewhere in this chapter, it is noted that the women’s proportion has declined drastically over the five-year period from 6.8 percent in 1998 to 3.9 percent in 2003. As in 1998, polygyny is more prominent among women in the non-urban areas. The non-urban proportion has declined more (10 percent in 1998 to 5 percent in 2003) than the urban proportion (4.4 percent to 3.5 percent). Polygyny generally increases with increasing age for both men and women. Among women, Limpopo and Mpumalanga, and among men, Northern Cape and KwaZulu-Natal are leading in the levels of polygyny. Polygyny is more common among Africans with 6 percent of non-urban African in-union men and 5 percent of non-urban African in- union women in polygynous marriages. A negative relationship between polygynous unions and educational level is generally shown for both women and men. For women, the only province that does not show a prominent decline since 1998 in this practice, is the Eastern Cape. A particularly large decline over the five years is seen in KwaZulu-Natal women, from 12 percent to 2 percent. Cultural and demographic change in a population usually occur at a slow pace. While the extreme decline observed in KwaZulu-Natal may reflect data problems, there are consistent indications across the background variables that polygyny is declining in South Africa. Employment Information was collected from women regarding their current employment status and their current employer. Table 2.20 shows the findings by the usual background characteristics. Overall, 36 percent of women were employed at the time of the survey, which is somewhat higher than the 32 percent employed at the time of the 1998 survey. These proportions are an average over the different age groups, which are lowered by the small proportions of employed women in the age groups 15-19 and 20-24, which in part is due to the fact that Table 2.19 Polygyny Percentage of women 15-49 and men 20-59 currently in a polygynous union, by age and selected background characteristics, South Africa 2003 Background characteristic Percentage polygyny Number of women Percentage polygyny Number of men Age 15-19 2.5 51 * 12 20-24 3.9 238 (0.0) 54 25-29 3.6 393 3.6 99 30-34 2.5 503 3.1 171 35-39 2.9 563 3.4 209 40-44 5.7 506 3.2 248 45-49 5.5 405 5.2 163 50-54 - - 8.5 142 55-59 - - 5.9 116 Residence Urban 3.5 1 852 3.7 899 Non-urban 5.0 806 5.8 316 Province Western Cape 1.7 404 3.5 106 Eastern Cape 4.0 236 2.4 207 Northern Cape 1.3 51 10.8 56 Free State 2.7 167 1.4 78 KwaZulu-Natal 2.1 387 9.1 78 North West 2.6 146 7.9 61 Gauteng 4.1 788 0.0 25 Mpumalanga 6.1 178 4.3 228 Limpopo 9.3 300 3.9 376 Education None - Grade 7 8.0 727 8.4 350 Grades 8-11 2.9 1 065 2.3 439 Grade 12+ 1.8 862 3.0 426 Population group African 4.8 1 976 5.0 879 African urban 4.4 1 234 4.4 582 African non-urban 5.4 742 6.2 297 Coloured 1.3 315 2.3 142 White 1.7 275 1.9 140 Indian 1.8 90 1.6 48 Total 3.9 2 658 4.3 1 215 34 many of the younger respondents are still attending school or are furthering their education at tertiary institutions. Generally, a positive relationship is seen between employment and age. The level of employment among urban women (42 percent) is considerably higher than among non-urban women (25 percent). The level of employment among Western Cape women (55 percent) is considerably higher than that of the remaining provinces, followed by Gauteng (41 percent), while the lowest levels are in Limpopo and the Eastern Cape where about a quarter of women are employed. No clear pattern overall shows up regarding women’s employment and their education. Considerably less African women (31 percent) are employed than women of other population groups of whom more than half are employed. Of the women who are currently employed, the majority (77 percent) are employed by a non-relative, 16 percent are self-employed, and a small proportion is employed by a relative. Compared to other provinces, self-employment is more prominent among women from Limpopo and the Eastern Cape, and compared to other population groups, this is more prominent among African women. Table 2.20 Employment Percentage distribution of currently employed women aged 15-49 by employer according to selected background characteristics, South Africa 2003 Currently employed Background characteristic Percentage women currently employed Number of women Self- employed Employed by a non- relative Employed by a relative Missing Total Number of women employed Age 15-19 6.2 1 395 10.5 72.9 13.7 3.0 100.0 86 20-24 22.6 1 242 10.5 79.0 9.2 1.3 100.0 281 25-29 39.4 1 015 17.7 75.9 5.0 1.3 100.0 400 30-34 47.6 918 16.4 77.9 4.5 1.2 100.0 437 35-39 50.9 991 15.1 79.3 4.6 1.0 100.0 504 40-44 56.0 812 16.4 75.9 6.8 0.8 100.0 455 45-49 53.3 668 18.8 75.2 4.3 1.6 100.0 356 Residence Urban 41.5 4 678 15.5 77.3 5.8 1.3 100.0 1 940 Non-urban 24.5 2 363 16.8 76.3 5.7 1.1 100.0 580 Province Western Cape 55.2 892 17.3 73.3 8.6 0.8 100.0 492 Eastern Cape 25.0 804 20.3 75.5 4.1 0.0 100.0 201 Northern Cape 36.1 125 8.3 88.6 2.3 0.8 100.0 45 Free State 33.6 443 17.5 75.4 5.1 2.0 100.0 149 KwaZulu-Natal 34.4 1 177 11.5 84.1 4.0 0.4 100.0 405 North West 29.8 523 19.0 77.2 3.5 0.4 100.0 156 Gauteng 40.5 1 854 14.2 77.0 6.6 2.2 100.0 751 Mpumalanga 31.7 451 10.3 85.2 3.3 1.2 100.0 143 Limpopo 23.2 772 25.7 65.8 6.5 2.1 100.0 179 Education No education 32.8 302 18.0 73.7 7.3 0.9 100.0 99 Grades 1-5 34.2 438 10.4 79.8 6.9 2.9 100.0 150 Grades 6-7 33.0 721 15.1 77.5 4.9 2.4 100.0 238 Grades 8-11 26.7 3 285 19.4 73.9 6.2 0.5 100.0 877 Grade 12 44.2 1 683 15.7 77.8 4.9 1.6 100.0 744 Higher 67.8 609 10.4 82.0 6.5 1.1 100.0 413 Population group African 30.9 5 831 17.4 76.3 4.8 1.6 100.0 1 804 Afr. urban 35.8 3 586 17.3 76.5 4.5 1.8 100.0 1 284 Afr. non-urban 23.2 2 246 17.7 75.6 5.6 1.2 100.0 520 Coloured 56.1 665 11.1 79.7 8.7 0.5 100.0 373 White 65.5 402 14.1 77.3 8.6 0.0 100.0 263 Indian 54.5 141 7.8 84.8 7.0 0.4 100.0 77 Total 35.8 7 041 15.8 77.1 5.8 1.3 100.0 2 520 35 Occupation Table 2.21 shows the percent distribution of employed women 15 to 49 years and employed men 15 to 59 years by occupation. There are about equally large proportions of women who work in professional/technical/management (19 percent), clerical (20 percent), household/ domestic (23 percent), and manual occupations (20 percent). Much smaller proportions are involved in sales, services and agricultural occupations. Among women with no education, the household/domestic field dominates, followed by agricultural and unskilled manual occupations. Among women with Grade 12 or higher, the largest proportions are in professional/technical/management and clerical jobs. It is noted that 13 percent of the women with Grade 12, and just over 1 percent with higher education, are working in the household/domestic field. Among African women, the household/domestic sector dominates; among coloured women, the clerical and household/domestic sectors; among white and Indian women, the clerical and professional/technical/management sectors. The 1998 and 2003 surveys’ occupation data do not allow much comparison, but an improvement in women’s occupational status is seen with the overall proportion engaged in professional/technical/management jobs having increased from 14 percent in 1998 to 19 percent in 2003. In non-urban areas this increase is even more prominent, from 9 percent in 1998 to 16 percent in 2003. Except for coloured women, the proportions of women holding such positions have increased for all population groups from the 1998 to the 2003 SADHS, with particularly steep increases among Indian and non-urban African women. The second part of Table 2.21 presents the distribution of men aged 15 to 59 years by occupation by selected background characteristics. Almost 45 percent of men are employed in manual occupations, the majority of these in skilled manual occupations. Almost one-fifth are in the professional/technical/management sector, and much smaller proportions are involved in the sales, agricultural and household/domestic fields. The great majority of men with a post-school qualification are in professional/technical/management and skilled manual posts. These posts dominate too among those with Grade 12, followed by posts in the clerical and services sectors. Men with no education are mainly employed in the agricultural and household/domestic sector, and a surprisingly high proportion of such men (35 percent) work as skilled manual workers. The largest urban/non-urban differences are seen among men in the professional/technical/management and agricultural fields. Among men of all population groups, the skilled manual field dominates, followed by the professional/technical/ management field. Among white and Indian men, these fields hold more or less equally large weight. Among African men, the proportions in the skilled manual field are about twice as common as the professional/technical/management field, and among coloured men, the skilled manual field are over three times more commonly reported as the professional/ technical/management field. Comparing the occupation data by gender, the findings show that similar proportions of men and women are employed in professional/technical/management occupations. Proportionally, moderately more men than women are employed in the agricultural and services fields; significantly more men than women are employed in skilled manual occupations; slightly more women than men are employed in unskilled manual posts; and significantly more women than men are employed in sales, clerical and household/domestic occupations. The largest gender differences are seen in the skilled manual and household/domestic occupations. 36 Table 2.21 Occupation Percentage distribution of women aged 15-49 and men aged 15-59 by occupation, by selected background characteristics, South Africa 2003 Background characteristic Prof/tech Manage- ment Clerical Sales Agriculture Household/ Domestic Services Skilled manual Unskilled manual Total Number of women WOMEN 15-49 Age 15-19 6.0 20.6 12.9 8.3 6.7 14.5 12.0 19.0 100.0 86 20-24 11.5 25.9 10.0 6.6 17.1 9.1 8.2 11.7 100.0 281 25-29 21.1 27.8 7.3 3.0 15.0 8.2 5.7 11.7 100.0 400 30-34 20.6 23.1 7.8 2.8 20.7 4.8 7.4 12.9 100.0 437 35-39 22.2 16.5 7.7 5.2 25.3 5.5 6.4 10.5 100.0 504 40-44 22.3 12.8 8.4 3.2 29.7 3.9 7.7 11.8 100.0 455 45-49 16.7 14.0 6.2 5.5 31.1 5.1 10.9 10.5 100.0 356 Residence Urban 20.1 21.3 8.7 1.6 22.1 6.5 8.5 11.1 100.0 1 940 Non-urban 16.4 13.9 5.8 13.6 25.7 5.1 5.2 14.1 100.0 580 Province Western Cape 13.2 18.7 10.1 7.2 23.3 8.6 10.4 8.3 100.0 492 Eastern Cape 23.7 18.0 5.9 1.4 23.7 6.9 7.7 12.9 100.0 201 Northern Cape 19.6 21.5 4.3 6.5 25.0 8.0 7.0 8.0 100.0 45 Free State 12.1 10.0 4.3 5.2 34.3 2.4 10.7 21.0 100.0 149 KwaZulu-Natal 26.8 26.5 7.2 3.4 18.2 2.6 7.2 8.1 100.0 405 North West 16.4 11.8 3.9 9.7 25.3 8.3 7.5 16.7 100.0 156 Gauteng 20.1 23.5 9.2 0.8 22.1 7.3 6.5 10.2 100.0 751 Mpumalanga 22.6 10.6 9.5 10.3 27.2 5.2 6.4 8.2 100.0 143 Limpopo 15.9 13.2 7.7 6.4 20.0 4.0 6.0 26.8 100.0 179 Education No education 4.1 3.7 6.4 18.5 44.0 0.7 8.1 14.6 100.0 99 Grades 1-5 4.2

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