Tajikistan - Demographic and Health Survey - 2018

Publication date: 2018

Tajikistan 2017 D em ographic and H ealth S urvey Demographic and Health Survey Tajikistan 2017 REPUBLIC OF TAJIKISTAN TAJIKISTAN Demographic and Health Survey 2017 Statistical Agency under the President of the Republic of Tajikistan Dushanbe, Republic of Tajikistan Ministry of Health and Social Protection of Population of the Republic of Tajikistan Dushanbe, Republic of Tajikistan The DHS Program ICF Rockville, Maryland, USA November 2018 The 2017 Tajikistan Demographic and Health Survey (TjDHS) was implemented by the Statistical Agency under the President of the Republic of Tajikistan from August 8 to November 11, 2017. The funding for the 2017 TjDHS was provided by the United States Agency for International Development (USAID). Additional funding for the survey was provided by the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). ICF provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2017 TjDHS may be obtained from the Statistical Agency under the President of the Republic of Tajikistan: 17 Bokhtar Street, Dushanbe, Republic of Tajikistan; telephone: 992-372-23-02-45; fax: 992-372-21-43-75; email: stat@tojikiston.com. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1-301-407-6500; fax: +1-301-407-6501; email: info@DHSprogram.com; internet: www.DHSprogram.com. Cover photo: “Hauz-e Sangin Mosque, Istaravshan, Tajikistan.” © 2015 Robert Wilson. Used under Creative Commons (CC BY-ND 2.0) license. Available at https://flic.kr/p/rR2Ndn. Recommended citation: Statistical Agency under the President of the Republic of Tajikistan, Ministry of Health and Social Protection of Population of the Republic of Tajikistan, and ICF. 2018. Tajikistan Demographic and Health Survey 2017. Dushanbe, Republic of Tajikistan, and Rockville, Maryland, USA: Statistical Agency under the President of the Republic of Tajikistan (SA), Ministry of Health and Social Protection of Population of the Republic of Tajikistan (MOHSP), and ICF. Contents • iii CONTENTS TABLES AND FIGURES . vii ACKNOWLEDGMENTS . xiii ACRONYMS AND ABBREVIATIONS . xv READING AND UNDERSTANDING TABLES FROM THE 2017 TAJIKISTAN DEMOGRAPHIC AND HEALTH SURVEY (TjDHS) . xvii SUSTAINABLE DEVELOPMENT GOAL INDICATORS . xxv MAP OF TAJIKISTAN . xxviii 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 1 1.3 Questionnaires . 2 1.4 Anthropometry, Anemia Testing, and Blood Pressure Measurement . 3 1.5 Pretest . 3 1.6 Training of Field Staff . 4 1.7 Fieldwork . 5 1.8 Data Processing . 5 1.9 Response Rates . 5 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 2.1 Drinking Water Sources and Treatment . 7 2.2 Sanitation . 8 2.3 Exposure to Smoke inside the Home and Other Household Characteristics . 9 2.3.1 Exposure to Smoke inside the Home . 9 2.3.2 Other Housing Characteristics . 9 2.3.3 Household Possessions . 9 2.4 Household Wealth . 9 2.5 Handwashing . 10 2.6 Household Population and Composition . 10 2.7 Children’s Living Arrangements and Orphanhood . 11 2.8 Birth Registration . 11 2.9 Education . 12 2.9.1 Educational Attainment . 12 2.9.2 School Attendance . 12 2.10 Child Discipline . 13 3 CHARACTERISTICS OF RESPONDENTS . 29 3.1 Basic Characteristics of Survey Respondents . 29 3.2 Education and Literacy . 29 3.3 Mass Media Exposure and Internet Usage . 31 3.4 Employment . 32 3.5 Occupation . 32 3.6 Type of Employment . 33 3.7 Employment Abroad . 34 3.8 History of Diabetes . 34 3.9 History of High Blood Pressure . 35 3.10 High Blood Pressure . 36 3.11 Tobacco Use . 38 iv • Contents 4 MARRIAGE AND SEXUAL ACTIVITY . 51 4.1 Marital Status . 51 4.2 Polygyny . 52 4.3 Age at First Marriage . 52 4.4 Age at First Sexual Intercourse . 52 4.5 Recent Sexual Activity . 53 5 FERTILITY . 59 5.1 Current Fertility . 59 5.2 Children Ever Born and Living . 61 5.3 Birth Intervals . 61 5.4 Insusceptibility to Pregnancy . 61 5.5 Age at First Birth . 62 5.6 Teenage Childbearing . 63 6 FERTILITY PREFERENCES . 71 6.1 Desire for Another Child . 71 6.2 Ideal Family Size . 72 6.3 Fertility Planning Status . 73 6.4 Wanted Fertility Rates . 74 7 FAMILY PLANNING . 79 7.1 Contraceptive Knowledge and Use . 79 7.2 Knowledge of the Fertile Period . 81 7.3 Source of Modern Contraceptive Methods . 81 7.4 Informed Choice . 82 7.5 Discontinuation of Contraceptives . 82 7.6 Demand for Family Planning . 83 7.7 Decision Making about Family Planning . 85 7.8 Future Use of Contraception . 85 7.9 Exposure to Family Planning Messages in the Media . 85 7.10 Contact of Nonusers with Family Planning Providers . 85 8 ABORTION . 97 8.1 Pregnancies Ending in Induced Abortion . 97 8.2 Lifetime Experience with Induced Abortion . 98 8.3 Rates of Induced Abortion . 98 8.4 Use of Contraception before Abortion . 99 8.5 Reasons for Abortion . 99 9 INFANT AND CHILD MORTALITY . 107 9.1 Infant and Child Mortality . 108 9.2 Sociodemographic and Biodemographic Risk Factors . 108 9.3 Perinatal Mortality . 110 9.4 High-risk Fertility Behavior . 111 9.5 Registration of Child Deaths . 112 10 MATERNAL HEALTH CARE . 117 10.1 Antenatal Care Coverage and Content . 118 10.1.1 Skilled Providers . 118 10.1.2 Timing and Number of ANC Visits . 119 10.2 Components of ANC Visits . 119 Contents • v 10.3 Delivery Services . 119 10.3.1 Institutional Deliveries . 120 10.3.2 Skilled Assistance during Delivery . 121 10.3.3 Delivery by Cesarean . 121 10.4 Postnatal Care . 122 10.4.1 Postnatal Health Check for Mothers . 122 10.4.2 Postnatal Health Check for Newborns . 123 10.5 Knowledge of Danger Signs . 123 10.6 Problems in Accessing Health Care . 124 11 CHILD HEALTH . 139 11.1 Birth Weight . 139 11.2 Vaccination of Children . 140 11.2.1 Vaccination Card Ownership and Availability . 140 11.2.2 Vaccination Coverage . 140 11.3 Symptoms of Acute Respiratory Infection . 142 11.4 Fever . 143 11.5 Diarrheal Disease . 143 11.5.1 Prevalence of Diarrhea and Treatment or Advice Seeking . 143 11.5.2 Feeding Practices . 144 11.5.3 Treatment of Diarrhea . 144 11.5.4 Knowledge of ORS Packets (Rehydron) . 145 11.6 Treatment of Childhood Illness . 145 11.7 Disposal of Children’s Stools . 145 11.8 Knowledge of Danger Signs and Symptoms of Childhood Illness . 146 12 NUTRITION OF CHILDREN AND WOMEN . 159 12.1 Nutritional Status of Children . 159 12.1.1 Measurement of Nutritional Status among Young Children . 159 12.1.2 Data Collection . 161 12.1.3 Levels of Child Malnutrition . 161 12.2 Infant and Young Child Feeding Practices . 162 12.2.1 Breastfeeding . 162 12.2.2 Complementary Feeding . 164 12.2.3 Minimum Acceptable Diet . 165 12.3 Anemia Prevalence in Children . 166 12.4 Presence of Iodized Salt in Households . 167 12.5 Micronutrient Intake and Supplementation among Children . 168 12.6 Nutritional Status of Women . 169 12.7 Anemia Prevalence in Women . 170 12.8 Dietary Diversity in Women . 172 12.9 Micronutrient Supplementation and Deworming during Pregnancy . 173 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 189 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 189 13.2 Knowledge about Mother-to-Child Transmission . 191 13.3 Discriminatory Attitudes towards People Living with HIV . 191 13.4 Multiple Sexual Partners . 192 13.5 Coverage of HIV Testing Services . 192 13.5.1 Awareness of HIV Testing Services and Experience with HIV Testing . 193 13.5.2 HIV Testing of Pregnant Women . 193 13.5.3 Knowledge and Use of HIV Self-test Kits . 194 13.6 Self-reporting of Sexually Transmitted Infections . 194 vi • Contents 13.7 HIV/AIDS-related Knowledge and Behavior among Young Women . 195 13.7.1 Knowledge . 195 13.7.2 First Sex . 195 13.7.3 Coverage of HIV Testing Services . 196 14 DOMESTIC VIOLENCE . 207 14.1 Measurement of Violence . 208 14.2 Experience of Physical Violence . 208 14.2.1 Perpetrators of Physical Violence . 209 14.3 Experience of Sexual Violence . 209 14.3.1 Prevalence of Sexual Violence . 209 14.3.2 Perpetrators of Sexual Violence . 210 14.4 Experience of Different Forms of Violence . 210 14.5 Marital Control by Spouse . 210 14.6 Forms of Spousal Violence . 211 14.6.1 Prevalence of Spousal Violence . 211 14.6.2 Injuries due to Spousal Violence . 214 14.6.3 Violence Initiated by Women against Their Husbands . 214 14.7 Help Seeking among Those Who Have Experienced Violence . 215 15 WOMEN’S EMPOWERMENT . 231 15.1 Married Women’s Employment . 232 15.2 Control over Women’s Earnings . 232 15.3 Control over Husband’s Earnings . 233 15.4 Women’s Ownership of a House . 234 15.5 Bank Accounts and Mobile Phones . 235 15.6 Participation in Decision Making . 235 15.7 Attitudes toward Wife Beating . 236 15.8 Negotiating Sexual Relations . 237 REFERENCES . 251 APPENDIX A SAMPLE DESIGN . 253 A.1 Introduction . 253 A.2 Sample Frame . 253 A.3 Sample Design and Implementation . 254 A.4 Sample Probabilities and Sampling Weights . 255 A.5 Survey Implementation. 257 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 259 APPENDIX C DATA QUALITY TABLES . 271 APPENDIX D SURVEY PERSONNEL . 275 APPENDIX E QUESTIONNAIRES . 279 Household . 281 Women . 299 Biomarker . 387 Fieldworker . 397 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 6 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 Table 2.1 Household drinking water . 16 Table 2.2 Household sanitation facilities . 17 Table 2.3 Household characteristics . 18 Table 2.4 Household possessions . 19 Table 2.5 Wealth quintiles . 20 Table 2.6 Handwashing . 20 Table 2.7 Household population by age, sex, and residence . 21 Table 2.8 Household composition . 21 Table 2.9 Children’s living arrangements and orphanhood . 22 Table 2.10 Birth registration of children under age 5 . 23 Table 2.11.1 Educational attainment of the female household population . 24 Table 2.11.2 Educational attainment of the male household population . 25 Table 2.12 School attendance ratios . 26 Table 2.13 Child discipline . 27 Table 2.14 Attitudes toward physical punishment . 28 Figure 2.1 Household drinking water by residence . 8 Figure 2.2 Household toilet facilities by residence . 8 Figure 2.3 Household wealth by residence . 10 Figure 2.4 Population pyramid . 11 3 CHARACTERISTICS OF RESPONDENTS . 29 Table 3.1 Background characteristics of respondents . 39 Table 3.2 Educational attainment . 40 Table 3.3 Literacy . 40 Table 3.4 Exposure to mass media . 41 Table 3.5 Internet usage . 42 Table 3.6 Employment status . 43 Table 3.7 Occupation . 44 Table 3.8 Type of employment . 45 Table 3.9 Respondent’s and partner’s employment abroad . 46 Table 3.10 History of diabetes . 47 Table 3.11 Blood pressure measured and medication prescribed and taken . 48 Table 3.12 Blood pressure status . 49 Table 3.13 Controlled hypertension . 50 Figure 3.1 Education of survey respondents . 29 Figure 3.2 Secondary education by region . 30 Figure 3.3 Exposure to mass media . 31 Figure 3.4 Employment status by education . 32 Figure 3.5 Occupation . 33 Figure 3.6 Hypertension by age . 37 Figure 3.7 Hypertension by Body Mass Index (BMI) . 37 Figure 3.8 Awareness of hypertension . 38 4 MARRIAGE AND SEXUAL ACTIVITY . 51 Table 4.1 Current marital status . 54 Table 4.2 Number of women’s co-wives . 54 viii • Tables and Figures Table 4.3 Age at first marriage . 55 Table 4.4 Median age at first marriage by background characteristics . 55 Table 4.5 Age at first sexual intercourse . 56 Table 4.6 Median age at first sexual intercourse by background characteristics . 56 Table 4.7 Recent sexual activity . 57 Figure 4.1 Marital status . 51 Figure 4.2 Women’s median age at marriage by region . 52 Figure 4.3 Median age at first sex and first marriage . 53 5 FERTILITY . 59 Table 5.1 Current fertility . 64 Table 5.2 Trends in age-specific and total fertility rates . 64 Table 5.3 Fertility by background characteristics . 65 Table 5.4 Children ever born and living . 65 Table 5.5 Birth intervals . 66 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 67 Table 5.7 Median duration of postpartum amenorrhea, abstinence, and insusceptibility . 68 Table 5.8 Menopause . 69 Table 5.9 Age at first birth . 69 Table 5.10 Median age at first birth . 70 Table 5.11 Teenage pregnancy and motherhood . 70 Figure 5.1 Age-specific fertility rates . 60 Figure 5.2 Trends in fertility by residence . 60 Figure 5.3 Fertility by region . 60 Figure 5.4 Birth intervals . 61 Figure 5.5 Median age at first birth by residence . 63 Figure 5.6 Teenage pregnancy and motherhood by woman’s age . 63 6 FERTILITY PREFERENCES . 71 Table 6.1 Fertility preferences according to number of living children . 76 Table 6.2 Desire to limit childbearing . 76 Table 6.3 Ideal number of children by number of living children . 77 Table 6.4 Mean ideal number of children according to background characteristics . 77 Table 6.5 Fertility planning status . 78 Table 6.6 Wanted fertility rates . 78 Figure 6.1 Desire to limit childbearing by number of living children . 72 Figure 6.2 Ideal family size . 73 Figure 6.3 Ideal family size by number of living children . 73 Figure 6.4 Fertility planning status . 74 Figure 6.5 Trends in wanted and actual fertility . 74 7 FAMILY PLANNING . 79 Table 7.1 Knowledge of contraceptive methods . 87 Table 7.2 Current use of contraception by age . 87 Table 7.3 Current use of contraception according to background characteristics . 88 Table 7.4 Knowledge of fertile period . 88 Table 7.5 Source of modern contraceptive methods . 89 Table 7.6 Informed choice . 90 Table 7.7 Twelve-month contraceptive discontinuation rates . 90 Table 7.8 Reasons for discontinuation . 91 Table 7.9.1 Need and demand for family planning among currently married women . 91 Table 7.9.2 Need and demand for family planning for all women . 92 Tables and Figures • ix Table 7.10 Decision making about family planning . 93 Table 7.11 Future use of contraception . 93 Table 7.12 Exposure to family planning messages . 94 Table 7.13 Contact of nonusers with family planning providers . 95 Figure 7.1 Contraceptive use . 80 Figure 7.2 Trends in contraceptive use . 80 Figure 7.3 Modern contraceptive use by region . 81 Figure 7.4 Use of modern methods by education . 81 Figure 7.5 Source of modern contraceptive methods . 82 Figure 7.6 Contraceptive discontinuation rates . 83 Figure 7.7 Demand for family planning . 84 Figure 7.8 Trends in demand for family planning . 84 Figure 7.9 Unmet need by region . 84 8 ABORTION . 97 Table 8.1 Pregnancy outcome by background characteristics . 101 Table 8.2 Lifetime experience with induced abortion . 102 Table 8.3 Induced abortion rates . 103 Table 8.4 Trends in age-specific and total abortion rates . 103 Table 8.5 Induced abortion by background characteristics . 104 Table 8.6 Use of contraception before pregnancy . 104 Table 8.7 Reason for abortion . 105 Figure 8.1 Pregnancy outcome . 97 Figure 8.2 Induced abortion by pregnancy order . 98 Figure 8.3 Age-specific abortion rates . 99 Figure 8.4 Reason for abortion . 99 9 INFANT AND CHILD MORTALITY . 107 Table 9.1 Early childhood mortality rates . 113 Table 9.2 Five-year early childhood mortality rates according to background characteristics . 113 Table 9.3 Ten-year early childhood mortality rates according to additional characteristics . 114 Table 9.4 Perinatal mortality . 115 Table 9.5 High-risk fertility behavior . 116 Figure 9.1 Trends in early childhood mortality rates . 108 Figure 9.2 Under-5 mortality by region . 109 Figure 9.3 Under-5 mortality by household wealth . 109 Figure 9.4 Childhood mortality by previous birth interval . 110 Figure 9.5 Death registration . 112 10 MATERNAL HEALTH CARE . 117 Table 10.1 Antenatal care . 125 Table 10.2 Number of antenatal care visits and timing of first visit . 126 Table 10.3 Components of antenatal care . 127 Table 10.4 Place of delivery . 128 Table 10.5 Assistance during delivery . 129 Table 10.6 Cesarean section . 130 Table 10.7 Duration of stay in health facility after birth . 130 Table 10.8 Timing of first postnatal check for the mother . 131 Table 10.9 Type of provider of first postnatal check for the mother . 132 Table 10.10 Timing of first postnatal check for the newborn . 133 Table 10.11 Type of provider of first postnatal check for the newborn . 134 Table 10.12 Content of postnatal care for newborns . 135 x • Tables and Figures Table 10.13 Knowledge of danger signs and complications during pregnancy and delivery . 136 Table 10.14 Problems in accessing health care . 137 Figure 10.1 Trends in antenatal care coverage . 118 Figure 10.2 Trends in place of birth . 120 Figure 10.3 Health facility births by region . 120 Figure 10.4 Assistance during delivery . 121 11 CHILD HEALTH . 139 Table 11.1 Child’s size and weight at birth . 147 Table 11.2 Possession and observation of vaccination cards, according to background characteristics . 148 Table 11.3 Vaccinations by source of information . 149 Table 11.4 Vaccinations by background characteristics . 150 Table 11.5 Prevalence and treatment of fever . 151 Table 11.6 Prevalence and treatment of diarrhea . 152 Table 11.7 Feeding practices during diarrhea . 153 Table 11.8 Oral rehydration therapy, zinc, and other treatments for diarrhea . 154 Table 11.9 Knowledge of ORS packets . 155 Table 11.10 Source of advice or treatment for children with diarrhea . 156 Table 11.11 Disposal of children’s stools . 157 Table 11.12 Knowledge of danger signs and symptoms of childhood illnesses . 158 Figure 11.1 Childhood vaccinations . 141 Figure 11.2 Vaccination coverage by residence . 142 Figure 11.3 Basic vaccinations by region . 142 Figure 11.4 Diarrhea prevalence by age . 143 Figure 11.5 Feeding practices during diarrhea . 144 Figure 11.6 Treatment of diarrhea . 144 Figure 11.7 Prevalence and treatment of childhood illness . 145 12 NUTRITION OF CHILDREN AND WOMEN . 159 Table 12.1 Nutritional status of children . 174 Table 12.2 Initial breastfeeding . 175 Table 12.3 Breastfeeding status according to age . 176 Table 12.4 Median duration of breastfeeding . 177 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 178 Table 12.6 Minimum acceptable diet . 179 Table 12.7 Prevalence of anemia in children . 180 Table 12.8 Presence of iodized salt in household . 181 Table 12.9 Micronutrient intake among children . 182 Table 12.10 Therapeutic and supplemental foods . 183 Table 12.11 Nutritional status of women . 184 Table 12.12 Prevalence of anemia in women . 185 Table 12.13 Foods and liquids consumed by women in the day or night preceding the interview . 186 Table 12.14 Micronutrient intake among mothers . 188 Figure 12.1 Trends in nutritional status of children . 161 Figure 12.3 Infant and young child feeding indicators on breastfeeding status . 163 Figure 12.4 IYCF indicators on minimum acceptable diet . 166 Figure 12.5 Childhood anemia status by residence . 167 Figure 12.6 Anemia in children by region . 167 Figure 12.7 Trends in women’s nutritional status . 170 Figure 12.8 Anemia in women by region . 171 Tables and Figures • xi 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 189 Table 13.1 Knowledge of HIV or AIDS . 197 Table 13.2 Knowledge of HIV prevention methods . 198 Table 13.3 Comprehensive knowledge about HIV . 199 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 199 Table 13.5 Discriminatory attitudes towards people living with HIV . 200 Table 13.6 Coverage of prior HIV testing . 201 Table 13.7 Pregnant women counseled and tested for HIV . 202 Table 13.8 Knowledge and coverage of self-testing for HIV . 203 Table 13.9 Self-reported prevalence of sexually transmitted infections (STIs) . 204 Table 13.10 Women seeking treatment for STIs . 205 Table 13.11 Comprehensive knowledge about HIV among young women . 205 Table 13.12 Age at first sexual intercourse among young women . 206 Table 13.13 Recent HIV tests among young women . 206 Figure 13.1 Knowledge of HIV prevention among women by region . 190 Figure 13.2 Trends in knowledge of HIV . 191 Figure 13.3 Knowledge of mother-to-child transmission (MTCT) . 191 Figure 13.4 Discriminatory attitudes among women by region . 192 Figure 13.5 HIV testing . 193 Figure 13.6 Pregnant women counseled and tested for HIV . 194 14 DOMESTIC VIOLENCE . 207 Table 14.1 Experience of physical violence . 216 Table 14.2 Persons committing physical violence . 217 Table 14.3 Experience of sexual violence . 218 Table 14.4 Age at first experience of sexual violence . 219 Table 14.5 Persons committing sexual violence . 219 Table 14.6 Experience of different forms of violence . 219 Table 14.7 Experience of violence during pregnancy . 220 Table 14.8 Marital control exercised by husbands . 221 Table 14.9 Forms of spousal violence . 222 Table 14.10 Spousal violence by background characteristics . 223 Table 14.11 Spousal violence by husband’s characteristics and empowerment indicators . 224 Table 14.12 Violence by any husband in the last 12 months . 225 Table 14.13 Experience of spousal violence by duration of marriage . 225 Table 14.14 Injuries to women due to spousal violence . 226 Table 14.15 Violence by women against their husband by women’s background characteristics . 227 Table 14.16 Violence by women against their husband by husband’s characteristics and empowerment indicators . 228 Table 14.17 Help seeking to stop violence . 229 Table 14.18 Sources for help to stop the violence . 230 Figure 14.1 Women’s experience of physical violence by marital status. 209 Figure 14.2 Experience of different forms of violence . 210 Figure 14.3 Marital controlling behaviors by fear of husband . 211 Figure 14.4 Forms of spousal violence . 212 Figure 14.5 Spousal violence by region . 212 Figure 14.6 Spousal violence by husband’s alcohol consumption . 213 15 WOMEN’S EMPOWERMENT . 231 Table 15.1 Employment and cash earnings of currently married women . 239 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 239 Table 15.2.2 Control over men’s cash earnings . 240 xii • Tables and Figures Table 15.3 Women’s control over their own earnings and over those of their husbands . 240 Table 15.4 Ownership of assets . 241 Table 15.5 Ownership of title or deed for house . 242 Table 15.6 Ownership and use of bank accounts and mobile phones . 243 Table 15.7 Participation in decision making . 243 Table 15.8 Women’s participation in decision making by background characteristics . 244 Table 15.9 Attitude toward wife beating . 245 Table 15.10 Attitudes toward negotiating safer sexual relations with husband . 246 Table 15.11 Ability to negotiate sexual relations with husband . 247 Table 15.12 Indicators of women’s empowerment . 247 Table 15.13 Current use of contraception by women’s empowerment . 248 Table 15.14 Ideal number of children and unmet need for family planning by women’s empowerment . 248 Table 15.15 Reproductive health care by women’s empowerment . 249 Figure 15.1 Employment by age . 232 Figure 15.2 Control over women’s earnings: Person who decides how the wife’s cash earnings are used . 233 Figure 15.3 Ownership of assets . 234 Figure 15.4 Women’s participation in decision making . 236 Figure 15.5 Attitudes towards wife beating . 236 APPENDIX A SAMPLE DESIGN . 253 Table A.1 Households . 254 Table A.2 Enumeration areas . 254 Table A.3 Sample allocation of clusters and households . 255 Table A.4 Sample allocation of completed interviews with women . 255 Table A.5 Sample implementation . 257 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 259 Table B.1 List of selected variables for sampling errors, Tajikistan DHS 2017 . 261 Table B.2 Sampling errors: Total sample, Tajikistan DHS 2017 . 262 Table B.3 Sampling errors: Urban sample, Tajikistan DHS 2017 . 263 Table B.4 Sampling errors: Rural sample, Tajikistan DHS 2017 . 264 Table B.5 Sampling errors: Dushanbe sample, Tajikistan DHS 2017 . 265 Table B.6 Sampling errors: GBAO sample, Tajikistan DHS 2017 . 266 Table B.7 Sampling errors: Sughd sample, Tajikistan DHS 2017 . 267 Table B.8 Sampling errors: DRS sample, Tajikistan DHS 2017 . 268 Table B.9 Sampling errors: Khatlon sample, Tajikistan DHS 2017 . 269 Table B.10 Sampling errors: Feed the Future districts (FTF), Tajikistan DHS 2017 . 270 APPENDIX C DATA QUALITY TABLES . 271 Table C.1 Household age distribution . 271 Table C.2 Age distribution of eligible and interviewed women . 271 Table C.3 Completeness of reporting . 272 Table C.4 Births by calendar years . 272 Table C.5 Reporting of age at death in days . 273 Table C.6 Reporting of age at death in months. 273 Table C.7 Height and weight data completeness and quality for children . 274 Acknowledgments • xiii ACKNOWLEDGMENTS he Statistical Agency under the President of the Republic of Tajikistan is pleased to present the results of the 2017 Tajikistan Demographic and Health Survey (TjDHS). This survey was funded by the United States Agency for International Development (USAID). Additional funding was provided by the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA) in Tajikistan. The 2017 TjDHS is the second DHS survey to be undertaken in the country. The Statistical Agency wishes to express its appreciation to the following organizations:  Ministry of Health and Social Protection of Population of the Republic of Tajikistan.  The Demographic and Health Surveys (DHS) Program/ICF for technical support, training of fieldwork staff, consultations, recommendations, and analysis of the data collected.  The 2017 TjDHS Steering Committee for their technical assistance and timely support in implementation of this work. The Statistical Agency, in particular, expresses appreciation to the following staff and consultants at The DHS Program/ICF for their technical support during all stages of survey design and implementation: Gulnara Semenov, regional coordinator; Jeremy Taglieri, 2017 TjDHS country manager; Guillermo Rojas, data processing director; Mahmoud Elkasabi, senior sampling specialist; Alexander Izmukhambetov, data processing specialist; and Ikhtier Kholmatov, data processing consultant. We also wish to acknowledge the employees of the statistical system of the Republic of Tajikistan for their active participation in and contribution to this work. Over 200 staff members from the Statistical Agency under the President of the Republic of Tajikistan, working in regional, city, and rayon branches of the agency as well as in the State Leading Information Centre, participated in the survey. We hereby extend our gratitude to the government of Tajikistan and to the representatives of local authorities for their support and assistance during the survey process. Above all, we appreciate the co-operation of all the survey respondents who have made the 2017 TjDHS a success. This report was prepared as a joint effort of the Statistical Agency under the President of the Republic of Tajikistan and The DHS Program/ICF staff. Mrs. Hasanzoda Gulnora Kenja Director, Statistical Agency under the President of the Republic of Tajikistan, and National Coordinator, 2017 TjDHS T Acronyms and Abbreviations • xv ACRONYMS AND ABBREVIATIONS AIDS acquired immunodeficiency syndrome ANC antenatal care ARI acute respiratory infection ART antiretroviral therapy BCG Bacille Calmette-Guérin BFHI Baby Friendly Hospital Initiative BMI body mass index CAPI computer-assisted personal interview CSPro Census and Survey Processing System DHS Demographic and Health Survey DPT diphtheria, pertussis, and tetanus DRS Districts of Republican Subordination EA enumeration area FTF Feed the Future GAR gross attendance ratio GBAO Gorno-Badakhshan Autonomous Oblast GFR general fertility rate GPI gender parity index HepB hepatitis B Hib haemophilus influenzae type B HIV human immunodeficiency virus ISCO International Standard Classification of Occupations IFSS internet file streaming system IUD intrauterine device IYCF infant and young child feeding LAM lactational amenorrhea method LPG liquid petroleum gas MDD-W Minimum Dietary Diversity for Women MOHSP Ministry of Health and Social Protection of Population MR measles and rubella MTCT mother-to-child transmission NAR net attendance ratio NN neonatal mortality ORS oral rehydration salts ORT oral rehydration therapy xvi • Acronyms and Abbreviations PNN postneonatal mortality PSU primary sampling unit RHF recommended homemade fluids SA Statistical Agency SD standard deviation STI sexually transmitted infection TAR total abortion rate TBA traditional birth attendant TFR total fertility rate TjDHS Tajikistan Demographic and Health Survey UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency VIP ventilated improved pit WHO World Health Organization Reading and Understanding Tables from the 2017 TjDHS • xvii READING AND UNDERSTANDING TABLES FROM THE 2017 TAJIKISTAN DEMOGRAPHIC AND HEALTH SURVEY (TjDHS) he new format of the 2017 TjDHS final report is based on approximately 185 tables of data. They are located for quick reference at the end of each chapter and through links in the text (electronic version). Additionally, this more reader-friendly version features about 80 figures that clearly highlight trends, subnational patterns, and background characteristics. Large colorful maps display breakdowns for regions in Tajikistan. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, TjDHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of TjDHS tables, the presentation of background characteristics, and a brief summary of sampling and understanding denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting TjDHS tables. T xviii • Reading and Understanding Tables from the 2017 TjDHS Example 1: Exposure to Mass Media A Question Asked of All Survey Respondents Table 3.4 Exposure to mass media Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Tajikistan DHS 2017 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 29.4 90.8 14.5 9.5 6.7 1,911 20-24 17.9 87.6 14.0 8.5 11.1 2,031 25-29 13.2 85.0 12.1 6.3 13.6 1,921 30-34 15.3 83.1 12.0 6.1 16.2 1,551 35-39 16.5 86.2 13.7 7.5 12.3 1,240 40-44 22.2 86.9 17.6 10.8 11.8 1,068 45-49 21.7 85.9 15.1 9.1 12.7 996 Residence Urban 30.0 90.0 21.6 15.2 8.2 2,694 Rural 15.7 85.5 11.3 5.7 13.1 8,024 Region Dushanbe 38.7 87.2 33.4 26.7 9.9 955 GBAO 41.2 86.3 6.0 5.0 8.8 209 Sughd 23.1 88.4 17.9 11.2 10.8 3,292 DRS 15.8 87.0 9.2 4.0 12.1 2,342 Khatlon 12.4 84.9 9.0 3.6 13.2 3,920 FTF districts 10.1 79.8 9.9 3.4 17.9 2,096 Education None/primary 6.5 72.3 8.1 3.3 27.0 619 General basic 12.4 83.9 9.6 3.9 14.8 3,615 General secondary 15.5 88.3 12.9 6.8 10.5 4,624 Professional primary/ middle 34.5 90.1 18.6 12.7 6.9 860 Higher 57.3 95.3 33.4 28.2 2.3 1,000 Wealth quintile Lowest 10.0 79.1 6.1 2.1 19.8 2,113 Second 13.5 87.1 10.2 4.6 11.8 2,101 Middle 17.3 86.6 14.2 7.2 11.6 2,109 Fourth 20.7 89.8 15.1 9.0 9.1 2,155 Highest 34.3 90.4 23.2 17.0 7.4 2,240 Total 19.3 86.7 13.9 8.1 11.9 10,718 Step 1: Read the title and subtitle—highlighted in orange in Example 1. They tell you the topic and the specific population group being described. In this case, the table is about women’s exposure to mass media. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green. They describe how the information is categorized. In this table, the first three columns of data show different types of data that women access at least once a week. The fourth column shows women who access all three types of media, while the fifth column is women who do not access any of the three media at least once a week. The last column lists the number of women interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to mass media by age, urban-rural residence, region, FTF districts, educational level, and wealth quintile. Most of the tables in the TjDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in pink. These percentages represent the totals of all women age 15-49 and their exposure to mass media on a weekly basis. In this case, 19.3%* of women read the newspaper at least once a week, 86.7% watch television weekly, and 13.9% listen to the radio weekly. 1 2 3 4 5 Reading and Understanding Tables from the 2017 TjDHS • xix Step 5: To find out what percentage of women with more higher education access all three media weekly, draw two imaginary lines, as shown on the table. This shows that 28.2% of women age 15-49 with higher education access all three types of media weekly. Step 6: By looking at patterns by background characteristics, we can see how exposure to media varies across Tajikistan. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help program planners and policy makers determine how to most effectively reach their target populations. * For the purpose of this document data are presented exactly as they appear in the table including decimal places. However, the text in the remainder of this report rounds data to the nearest whole percentage point. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of women in Tajikistan do not access any of the three media at least once a week? b) What age group of women are most likely to read a newspaper weekly? c) Compare women in urban areas and women in rural areas—which group is more likely to listen to the radio weekly? d) By region, what are the lowest and highest percentages (range) of women who access all three media at least once a week? e) Is there a clear pattern in exposure to television on a weekly basis by education level? f) Is there a clear pattern in exposure to radio on a weekly basis by wealth quintile? Answers: a) 11.9% b) Women age 15-19: 29.4% of women in this age group read a newspaper at least once a week. c) Women in urban areas, 21.6% listen to the radio weekly, compared to 11.3% of women in rural areas. d) 3.6% of women in Khatlon access all three media at least once a week, compared to 26.7% in Dushanbe. e) Watching television on a weekly basis increases with a woman’s level of education; 72.3% of women with no or primary education watch television weekly, compared to 95.3% of women with higher education. f) Listening to the radio on a weekly basis increases as household wealth increases; 6.1% of women in the lowest wealth quintile listen to the radio weekly, compared to 23.2% of women in the highest wealth quintile. xx • Reading and Understanding Tables from the 2017 TjDHS Example 2: Prevalence and Treatment of Fever A Question Asked of a Subgroup of Survey Respondents Table 11.5 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the 2 weeks preceding the survey and among children with fever in the 2 weeks before the survey, the percentage for whom advice or treatment was sought, and percentage who received antibiotics as treatment, by background characteristics, Tajikistan DHS 2017 Among children under age 5: Among children under age 5 with fever: Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought1 Percentage for whom treatment was sought same or next day Percentage who took antibiotic drugs Number of children with fever Age in months <6 8.7 590 51.9 36.8 57.5 51 6-11 16.2 614 44.7 28.1 66.7 99 12-23 12.7 1,394 53.1 37.9 72.9 178 24-35 8.0 1,269 43.4 30.0 54.2 102 36-47 7.2 1,294 30.5 16.3 63.0 93 48-59 5.7 1,135 29.6 19.9 41.2 65 Sex Male 9.6 3,178 44.1 30.5 63.8 305 Female 9.1 3,118 43.4 28.2 60.5 283 Residence Urban 9.0 1,328 54.3 37.5 62.9 119 Rural 9.4 4,968 41.1 27.3 62.0 469 Region Dushanbe 6.7 407 44.2 29.2 44.1 27 GBAO 16.5 102 29.9 6.4 31.2 17 Sughd 4.0 1,803 49.0 33.6 50.7 72 DRS 9.6 1,496 44.1 29.6 56.5 143 Khatlon 13.2 2,488 43.1 29.6 70.3 328 FTF districts 6.3 1,386 57.1 37.6 64.6 88 Mother’s education None/primary 10.5 524 (40.9) (24.0) (54.9) 55 General basic 10.1 2,321 44.8 29.9 64.0 233 General secondary 9.1 2,482 43.0 30.7 63.7 225 Professional primary/middle 6.5 462 (52.8) (27.1) (69.7) 30 Higher 8.7 507 39.4 28.5 48.8 44 Wealth quintile Lowest 12.5 1,165 38.6 24.0 62.9 146 Second 10.5 1,281 44.3 29.8 57.9 135 Middle 8.4 1,395 32.1 23.3 62.7 117 Fourth 7.8 1,383 57.8 38.2 69.4 107 Highest 7.8 1,072 50.1 35.2 57.9 83 Total 9.3 6,296 43.7 29.4 62.2 588 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes advice or treatment from public and private health sector, pharmacy, shop, and market. Excludes advice or treatment from a traditional practitioner. Step 1: Read the title and subtitle. In this case, the table is about two separate groups: all children under 5 (a) and children under 5 with fever in the two weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under 5 (a), and then isolate the columns that refer only to children under 5 with fever in the two weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under 5 had fever in the two weeks before the survey? It’s 9.3%. Now look at the second panel. How many children under 5 had fever in the two weeks before the survey? It’s 588 children or 9.3% of the 6,296 (with rounding). The second panel is a subset of the first panel. Step 4: Only 9.3% of children under 5 had fever in the two weeks before the survey. Once these children are divided into the background characteristic categories, there may be too few cases for the percentages to be reliable. 1 2 3 4 a b 3 Reading and Understanding Tables from the 2017 TjDHS • xxi  What percentage of children under 5 with fever in the two weeks before the survey whose mothers have no education or primary education took antibiotic drugs? 54.9%. This percentage is in parentheses because there are between 25 and 49 children under 5 with fever in the two weeks before the survey (unweighted) in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 3.) Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. xxii • Reading and Understanding Tables from the 2017 TjDHS Example 3: Understanding Sampling Weights in TjDHS Tables A sample is a group of people who have been selected for a survey. In the TjDHS, the sample is designed to represent the national population age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a minimum sample size per area. For the 2017 TjDHS, the survey sample is representative at the national and regional levels, and for urban and rural areas. To generate statistics that are representative of the country as a whole and the five regions, the number of women surveyed in each region should contribute to the size of the total (national) sample in proportion to size of the region. However, if some regions have small populations, then a sample allocated in proportion to each region’s population may not include sufficient women from each region for analysis. To solve this problem, regions with small populations are oversampled. For example, let’s say that you have enough money to interview 10,718 women and want to produce results that are representative of Tajikistan as a whole and its regions (as in Table 3.1). However, the total population of Tajikistan is not evenly distributed among the regions: some regions, such as Khatlon, are heavily populated while others, such as GBAO are not. Thus, GBAO must be oversampled. A sampling statistician determines how many women should be interviewed in each region in order to get reliable statistics. The blue column (1) in the table at the right shows the actual number of women interviewed in each region. Within the regions, the number of women interviewed ranges from 973 in GBAO to 3,217 in Khatlon. The number of interviews is sufficient to get reliable results in each region. With this distribution of interviews, some regions are overrepresented and some regions are underrepresented. For example, the population in Khatlon is about 37% of the population in Tajikistan, while GBAO’s population contributes only 2% of the population in Tajikistan. But as the blue column shows, the number of women interviewed in Khatlon accounts for only about 30% of the total sample of women interviewed (3,217/10,718), while the number of women interviewed in GBAO accounts for about 9% of the total sample of women interviewed (973/10,718). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of Tajikistan, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small region, like GBAO, should only contribute a small amount to the national total. Women from a large region, like Khatlon, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each region so that each region’s contribution to the total is proportional to the actual population of the region. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at region level. The total national sample size of 10,718 women has not changed after weighting, but the distribution of the women in the regions has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the green column (3) to the actual population distribution of Tajikistan, you would see that women in each region are contributing to the total sample with the same weight that they contribute to the population of the country. The weighted number of women in the survey now accurately represents the proportion of women who live in GBAO and the proportion of women who live in Khatlon. Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Tajikistan DHS 2017 Background characteristic Weighted percent Weighted number Unweighted number Region Dushanbe 8.9 955 1,814 GBAO 2.0 209 973 Sughd 30.7 3,292 2,235 DRS 21.8 2,342 2,479 Khatlon 36.6 3,920 3,217 Total 100.0 10,718 10,718 1 2 3 Reading and Understanding Tables from the 2017 TjDHS • xxiii With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national and region levels. In general, only the weighted numbers are shown in each of the TjDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Sustainable Development Goal Indicators • xxv SUSTAINABLE DEVELOPMENT GOAL INDICATORS Sustainable Development Goal Indicators, Tajikistan DHS 2017 Sex Total TjDHS table number Indicator Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 17.8 17.2 17.5 12.1 2.2.2 Prevalence of malnutrition among children under 5 years of age 9.6 8.2 8.9 na a) Prevalence of wasting among children under 5 years of age 6.1 5.0 5.6 12.1 b) Prevalence of overweight among children under 5 years of age 3.5 3.2 3.3 12.1 3. Good health and well-being 3.1.2 Proportion of births attended by skilled health personnel na na 94.8 10.5 3.2.1 Under-five mortality rate1 40 26 33 9.2 3.2.2 Neonatal mortality rate1 16 10 13 9.2 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods na 52.2 na 7.9.2 3.7.2 Adolescent birth rates per 1,000 women a) Girls aged 10-14 years2 na 0 na na b) Women aged 15-19 years3 na 54 na 5.1 3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15 years and older4 na 0.5 na na 3.b.1 Proportion of the target population covered by all vaccines included in their national program a)Coverage of DPT containing vaccine (3rd dose)5 86.5 87.4 87.0 11.4 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months6,7 na 24.1 na 14.9 a) Physical violence na 18.7 na 14.9 b) Sexual violence na 1.4 na 14.9 c) Psychological violence na 13.3 na 14.9 5.3.1 Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 a) before age 15 na 0.1 na 4.3 b) before age 18 na 8.7 na 4.3 5.6.1 Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care8 na 27.2 na na 5.b.1 Proportion of individuals who own a mobile telephone9 na 53.7 na 15.6 Residence Total TjDHS table number Indicator Urban Rural 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity 99.2 99.3 99.3 2.3 7.1.2 Proportion of population with primary reliance on clean fuels and technology10 97.0 75.2 80.5 2.3 Sex Total TjDHS table number Indicator Male Female 8. Decent work and economic growth 8.10.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money-service provider11 na 1.1 na 15.6 16. Peace, justice, and strong institutions 16.2.1 Percentage of children aged 1-17 years who experienced any physical punishment and/or psychological aggression by caregivers in the past month12 70.5 67.4 69.0 2.13 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 95.9 95.7 95.8 2.10 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet13 na 12.4 na 3.5 na = Not applicable 1 Expressed in terms of deaths per 1,000 live births for the 5-year period preceding the survey 2 Equivalent to the age-specific fertility rate for girls age 10-14 for the 3-year period preceding the survey, expressed in terms of births per 1,000 girls age 10-14 3 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 4 Data are not age-standardized and are available for women age 15-49 only. 5 The percentage of children age 12-23 months who received three doses of DPT-HepB-Hib vaccine 6 Data are available for women age 15-49 who have ever been in union only. xxvi • Sustainable Development Goal Indicators 7 In the DHS, psychological violence is termed emotional violence. 8 Data are available for currently married women who are not pregnant only. 9 Data are available for women age 15-49 only. 10 Measured as the percentage of the population using clean fuel for cooking. 11 Data are available for women age 15-49 who have and use an account at bank or other financial institution; information on use of a mobile- money-service provider is not available 12 Data are available for children age 1-14 only. 13 Data are available for women age 15-49 who have used the internet in the past 12 months. xxviii • Map of Tajikistan Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2017 Tajikistan Demographic and Health Survey (TjDHS) is the second Demographic and Health Survey conducted in Tajikistan. It was implemented by the Statistical Agency under the President of the Republic of Tajikistan (SA) in collaboration with the Ministry of Health and Social Protection of Population (MOHSP). Data collection took place from August 8 until November 11, 2017. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. The United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF) in Tajikistan provided additional funds for the survey. 1.1 SURVEY OBJECTIVES The primary objective of the 2017 TjDHS is to provide current and reliable information on population and health issues. Specifically, the TjDHS collected information on fertility and contraceptive use, maternal and child health and nutrition, childhood mortality, domestic violence against women, child discipline, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking and high blood pressure. The 2017 TjDHS follows the 2012 TjDHS survey and provides updated estimates of key demographic and health indicators. The information collected through the TjDHS is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population. 1.2 SAMPLE DESIGN The sampling frame used for the 2017 TjDHS is the 2010 Tajikistan Population and Housing Census conducted by the SA. Administratively, Tajikistan is divided into five regions: Dushanbe, Districts of Republican Subordination (DRS), Sughd, Khatlon, and Gorno-Badakhshan Autonomous Oblast (GBAO). Each region is subdivided into urban and rural areas. The country is divided into districts distributed over the country’s regions. Each district is further divided into census divisions, which are subdivided into instruction areas. Each instruction area is divided into urban enumeration areas (EAs) or rural villages. The sampling frame of the 2017 TjDHS is a list of EAs and natural villages covering all urban and rural areas of the country, with the primary sampling units (PSUs) being EAs in urban areas and natural villages in rural areas. An EA is a geographical area, usually a city block, consisting of the minimum number of households required for efficient counting; each EA serves as a counting unit for the population census. The sample was designed to yield representative results for the urban and rural areas separately, and for each of the four administrative regions and Dushanbe. In addition, as in the previous TjDHS survey, the sample was designed to allow certain indicators to be presented for the 12 districts in Khatlon covered under the Feed the Future program (FTF); these 12 districts have been combined as a single FTF domain. The sampling frame excluded institutional populations such as persons in hotels, barracks, and prisons. The 2017 TjDHS followed a stratified two-stage sample design. The first stage involved selecting sample PSUs (clusters) with a probability proportional to their size within each sampling stratum. A total of 366 clusters were selected, 166 in urban areas and 200 in rural areas. The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected clusters, and a fixed number of 22 households was selected from each T 2 • Introduction and Survey Methodology cluster with an equal probability systematic selection process, for a total sample of just over 8,000 households. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. Hemoglobin testing was performed in each household among eligible women age 15-49 who consented to being tested. With the parent’s or guardian’s consent, children age 6-59 months were also tested for anemia in each household. Height and weight information was collected from eligible women age 15-49 and children age 0-59 months in all households. In addition, one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.3 QUESTIONNAIRES Three questionnaires were used in the 2017 TjDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Biomarker Questionnaire. These questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Tajikistan. In addition, information about the fieldworkers for the survey was collected through a self-administered Fieldworker Questionnaire. Suggestions were solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all questionnaires were finalized in English, they were translated into Russian and Tajik. The Household Questionnaire listed all members of and visitors to selected households. Basic demographic information was collected on each person listed, including age, sex, marital status, education, and relationship to head of household. For children under age 18, the survival status of parents was determined. The data on age and sex of household members and visitors were used to identify women who were eligible for individual interviews. The Household Questionnaire also collected information on child discipline about one randomly selected child age 1-14 per household, as well as characteristics of the household’s dwelling unit, such as source of water; type of toilet facilities; materials used for flooring, external walls, and roofing; and ownership of various durable goods. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics:  Background characteristics (including age, education, and media exposure)  Pregnancy history, reasons for abortion, and child mortality  Contraception  Antenatal, delivery, and postnatal care  Vaccinations and childhood illnesses  Maternal and child health and nutrition  Marriage and sexual activity  Fertility preferences  Women’s work and husbands’ background characteristics  Knowledge, awareness, and behaviors regarding HIV/AIDS and other sexually transmitted infections (STIs)  Knowledge, attitudes, and behaviors related to other health issues (e.g., injections, smoking, childhood illnesses, and pregnancy and childbirth)  History of high blood pressure and blood pressure measurement  Domestic violence In addition, the Biomarker Questionnaire was used to record the results of the anthropometry measurements and hemoglobin testing, and was signed and dated by the health investigator. The purpose of the Fieldworker Questionnaire was to collect basic background information on the people who collected data in the field, this included the Team Supervisor, Interviewer, and Biomarker Technician. Introduction and Survey Methodology • 3 This self-administered questionnaire was created to serve as a tool in conducting analyses of data quality. The questionnaire was distributed and collected by the SA after the final selection of fieldworkers and before the fieldworkers entered the field. No personal identifiers were attached to the Tajikistan DHS fieldworkers’ data file. The 2017 TjDHS survey methodology and instruments were approved by the Institutional Review Board of ICF. The protocol for anemia testing was reviewed and approved by MOHSP and the Institutional Review Board of ICF. 1.4 ANTHROPOMETRY, ANEMIA TESTING, AND BLOOD PRESSURE MEASUREMENT The 2017 TjDHS incorporated three biomarkers: anthropometry, anemia testing, and blood pressure measurement. Data related to the coverage of the anthropometric measures and the result of the anemia testing were recorded in the Biomarker Questionnaire, and blood pressure measurement data were recorded in the Woman’s Questionnaire. All households in which anthropometry, anemia testing, or both were conducted received a brochure explaining the causes and prevention of anemia. Anthropometry: In all households, height and weight measurements were recorded for children age 0-59 months and women age 15-49. Weight measurements were obtained using lightweight, electronic SECA 878 scales with a digital screen and the mother and child function. Height measurements were carried out with measuring boards made by Shorr Productions. Children younger than age 24 months were measured while lying down (recumbent) on the board, while standing height was measured for older children. Hemoglobin testing: In all households, blood specimens were collected from all eligible children age 6-59 months and women age 15-49 who consented to testing for anemia. A consent statement was read to all eligible respondents or to the parent or adult responsible for children and young women age 15-17. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick for young children with small fingers) and collected in a microcuvette. Hemoglobin analysis was carried out on-site using a battery-operated portable HemoCue 201+ analyzer, which produces a result in less than 1 minute. Results were given verbally and in writing. Parents of children with a hemoglobin level below 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their hemoglobin level was below 7 g/dl and 9 g/dl, respectively. Blood pressure: During the woman’s interview, three blood pressure measurements were taken from consenting women age 15-49 using the Life Source blood pressure monitor UA-767F or a similar digital oscillometric device with automatic upper-arm inflation and automatic pressure release. Measurements were taken at intervals of 10 minutes or more. Systolic and diastolic blood pressure values are expressed in millimeters of mercury (mmHg). The average of the second and third measurements was used to classify the respondent with respect to hypertension, according to internationally recommended categories (WHO 1999). The information explaining the respondent’s averaged blood pressure measurement result and a corresponding referral for advice were read aloud and then provided to the respondent in writing via the Blood Pressure Reporting Form. 1.5 PRETEST Eleven women participated in a training to pretest the TjDHS survey questionnaires over a 4-week period from May 10 through June 5, 2017. The classroom training focused on questionnaire content as well as how to take blood pressure measurements, how to test household salt for the presence of iodine, and how to report results back to the respondents. Participants were instructed on using the computer-assisted personal interviewing (CAPI) system, an electronic data capture system programmed on tablet computers that the participants used to 4 • Introduction and Survey Methodology implement the survey. The DHS Program staff led training in Russian, with support from SA personnel in Tajik. The biomarker classroom training of the health investigators (three women and three men), all physicians, was led by The DHS Program staff. The training included classroom instruction on the anthropometry measurements, anemia testing, appropriate procedures for obtaining informed consent, recording of biomarker information in the Biomarker Questionnaire, and reporting of test results back to the respondents and referrals. The training was divided into three sessions that followed the DHS biomarker curriculum: classroom training on anthropometry and anemia testing, in-class standardization of the tests and outdoor practice sessions, and field practice with interviewers. As part of the pretest field work, interviewers and health investigators conducted household and women’s interviews and collected biomarkers in both rural and urban areas. At the end of each day, both during and after the pretest fieldwork, debriefing sessions were held, and questionnaires were modified based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF Seventy-nine people (75 women and 4 men) participated in the 4-week main training course in Dushanbe on interviewing, which consisted of lectures, demonstrations, and practice interviews. Eighteen health investigators (12 women and 6 men) attended a parallel training course on conducting biomarker tests. The main fieldwork training was conducted from July 10 until August 4, 2017. The training was led by master trainers recruited through SA regional offices who had participated in a 3-day training of trainers session conducted a few days earlier. The DHS Program staff, with assistance from the two senior TjDHS staff hired by SA, supported the training. The interviewer training was conducted in Tajik, and sessions discussed the concepts, procedures, and methodology of conducting the survey. In addition, senior subject specialists from the MOHSP attended the sessions to provide background on topics such as family planning and reproductive health, HIV/AIDS and other STIs, childhood immunization, and child health and nutrition. A guest speaker from the Committee on Women’s and Family Affairs under the Government of Tajikistan was also invited to deliver a lecture on gender-based violence in Tajikistan. Participants were guided through the questionnaires. All participants received training on how to test household salt for iodine and how to take adult blood pressure measurements using a digital blood pressure measuring device with automatic upper-arm inflation and automatic pressure release. Once training on use of paper questionnaires concluded, The DHS Program data processing staff and an ICF consultant conducted a weeklong training on computer-assisted personal interviewing (CAPI). From July 24 through July 29, 2017, participants learned about features of the data collection system, different scenarios and technical issues typically encountered during fieldwork, and ways to resolve issues. The biomarker classroom portion of the training commenced on July 24 and continued through August 5, 2017. This training was led by The DHS Program staff with assistance from the two health investigators who excelled during the pretest in both the classroom training and the field practice. Biomarker training included classroom instruction that focused on anthropometry measurements, anemia testing, appropriate procedures for obtaining informed consent, recording biomarker information in the Biomarker Questionnaire, and reporting test results back to the respondents with referrals as needed. The training was divided into three sections in accord with the DHS biomarker curriculum: classroom training in anthropometry and anemia testing, in-class standardization of the tests and outdoor practice sessions, and field practice with interviewers. All supervisors received hands-on training on how to measure height/length and weight of eligible children and adults. Although the team health investigator is responsible for measuring height/length and weight, it was necessary to train supervisors to assist the health investigators during the measurement of the children. Introduction and Survey Methodology • 5 Throughout the training, participants were evaluated through in-class exercises, quizzes, and observations made during field practice. At the end of the training, the teams were formed by selecting supervisors, interviewers, and health investigators. The supervisors received additional training in data quality control procedures, fieldwork coordination, and management. On July 21, all supervisors participated in a half-day practice held in a children’s polyclinic in Dushanbe. In the polyclinic, after the supervisors received parental consent, they copied immunization records from the MOHSP form 63 and children’s health cards directly to the tablet computers. The trainees were taken for field practice twice in unsampled areas outside Dushanbe, where they had an opportunity to implement the survey in a real world situation. Field practice took place over 2 days and each interviewer visited a minimum of two households per day. During the field practice, a total of 169 women’s interviews and 124 household interviews were completed. To practice biomarker collection, approximately 127 women were measured and 123 were tested for anemia. Among children, 136 were measured and 102 were tested for anemia. Consent was obtained from all individuals. 1.7 FIELDWORK Data collection was carried out by 14 field teams, each consisting of one female team supervisor, four female interviewers, and one health investigator. Fieldwork started in most regions by August 8, 2017, and ended on November 11, 2017. Fieldwork monitoring was an integral part of the survey. Senior TjDHS technical staff from SA, including the biomarker quality control field supervisor and IT specialists, visited teams regularly to review the work and monitor data quality. The DHS Program representatives also visited teams to monitor data collection and to observe the anemia testing and height and weight measurements of women and children under age 5. During field visits, staff provided teams they visited (supervisor, interviewers, and health investigator) with critical feedback to improve their performance. In addition, they used the TjDHS field-check tables based on data from the completed clusters to illustrate problems specific to each team visited. 1.8 DATA PROCESSING All electronic data files were transferred via a secure internet file streaming system (IFSS) to the SA central office in Dushanbe, where they were stored on a password-protected computer. The data processing operation included secondary editing, which required resolution of computer-identified inconsistencies and coding of open-ended questions. The data were processed by two IT specialists and one secondary editor who took part in the main fieldwork training; they were supervised remotely by The DHS Program staff. Data editing was accomplished using CSPro software. During the fieldwork, field-check tables were generated to check various data quality parameters, and specific feedback was given to the teams to improve performance. Secondary editing and data processing were initiated in August 2017 and completed in February 2018. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2017 TjDHS. All 8,064 households in the selected housing units were eligible for the survey, of which 7,915 were occupied. Of the occupied households, 7,843 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 10,799 women age 15-49 were identified for subsequent individual interviews; interviews were completed with 10,718 women, yielding a response rate of 99%, which is the same response rate achieved in the 2012 survey. 6 • Introduction and Survey Methodology Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Tajikistan DHS 2017 Residence Total Result Urban Rural Household interviews Households selected 3,654 4,410 8,064 Households occupied 3,559 4,356 7,915 Households interviewed 3,517 4,326 7,843 Household response rate1 98.8 99.3 99.1 Interviews with women age 15-49 Number of eligible women 4,243 6,556 10,799 Number of eligible women interviewed 4,212 6,506 10,718 Eligible women response rate2 99.3 99.2 99.2 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 7 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings  Drinking water: 80% of households have access to an improved drinking water source.  Sanitation: 97% of households have an improved toilet facility that is not shared with other households.  Indoor smoke: 16% of households use solid fuels for cooking, and 8% are exposed to tobacco smoke inside the home on a daily basis.  Household population and composition: 38% of the population is under age 15. The average household size is six persons. Twenty-one percent of households are headed by women.  Birth registration: 96% of the births of children under age 5 are registered, an increase from 88% in 2012.  Educational attainment: A large majority of women (80%) and men (79%) have at least some secondary education. Men are more likely than women to have post- secondary education (25% versus 13%).  Child discipline: 69% of children age 1-14 were subjected to violent disciplinary methods in the month before the survey. nformation obtained in the 2017 Tajikistan DHS on the socioeconomic characteristics of the household population provides context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on source of drinking water, sanitation, exposure to smoke inside the home, wealth, hand washing, household population composition, family living arrangements, birth registration, educational attainment, school attendance, and child discipline. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, and rainwater. Households that use bottled water for drinking are classified as using an improved source only if their water source for cooking and handwashing comes from an improved source. Sample: Households I 8 • Housing Characteristics and Household Population Improved sources of water protect against outside contamination so that water is more likely to be safe to drink. In Tajikistan, 80% of households have access to an improved source of drinking water (Table 2.1 and Figure 2.1). The most common improved source is water piped into a dwelling, yard, or plot (51%), and the most frequently cited unimproved source is surface water, that is, water from rivers, lakes, ponds, or similar sources (12%). Almost all households boil the water used for drinking (92%). Rural households obtain water from unimproved sources much more often than urban households (28% versus 3%). Almost all urban households (96%) have access to drinking water on their premises compared with 65% of rural households. Trends: Access to improved water sources increased from 78% in 2012 to 80% in 2017. The proportion of households with access to water on the premises rose from 53% in 2012 to 75% in 2017. More households treated drinking water appropriately in 2017 (93%) than in 2012 (85%). 2.2 SANITATION Improved toilet facilities Include any unshared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; pit latrines with slabs; and composting toilets Sample: Households Use of improved toilet facilities, which are unshared facilities that prevent household members from coming into contact with human waste, helps to reduce the spread of communicable diseases. Overall, 97% of households have an improved sanitation facility that is not shared with other households (Table 2.2). Use of unimproved toilet facilities is not common, just 1% in rural areas and less than 1% in urban areas (Figure 2.2). Only a few households share improved toilet facilities (4% in urban areas and 2% in rural areas). Trends: Households using improved toilet facilities increased from 93% in 2012 to 97% in 2017. Figure 2.1 Household drinking water by residence Figure 2.2 Household toilet facilities by residence 53 90 37 14 3 19 9 3 12 4 1 5 20 3 28 Total Urban Rural Percent distribution of households by source of drinking water Unimproved source Other improved source Tube well or borehole Public tap/ standpipe Piped water into dwelling/yard/plot/ neighbor’s yard 97 96 97 3 4 2 1 <1 1 Total Urban Rural Percent distribution of households by type of toilet facilities Unimproved facility Shared facility Improved facility Housing Characteristics and Household Population • 9 2.3 EXPOSURE TO SMOKE INSIDE THE HOME AND OTHER HOUSEHOLD CHARACTERISTICS 2.3.1 Exposure to Smoke inside the Home Exposure to smoke in the home, either from cooking with solid fuels or use of tobacco products, has potentially harmful health effects. Eighty-four percent of households use clean fuels (electricity or gas) for cooking (Table 2.3), an increase from 71% in 2012. Cooking with solid fuels is much more common among rural than urban households (23% versus 2%). In most rural households, cooking takes place in a separate building (86%) or outdoors (5%), which may limit exposure to pollutants in households that burn solid fuels for cooking. Exposure to tobacco smoke is not common inside homes in Tajikistan. The majority of households (84%) report that no one ever smokes tobacco products in the home, and only 8% say smoking takes place on a daily basis. 2.3.2 Other Housing Characteristics The 2017 TjDHS collected data on access to electricity; flooring, roof, and wall material; and the number of rooms used for sleeping (Table 2.3). Virtually all households (99%) have access to electricity. Most dwellings have some type of solid flooring, with wood being the most common material (50%). Earth or sand floors are more common in rural than in urban areas (29% versus 5%). Rural dwellings are also much more likely to have dirt walls than urban dwellings (48% versus 10%). 2.3.3 Household Possessions The survey included questions about household ownership of common durable goods, means of transport, agricultural land, farm animals, and possession of a bank account (Table 2.4). Rates of possession of household effects vary. For example, almost all households have a television (98%) and mobile phone (96%), 69% own a refrigerator, but only 21% possess a computer. Very few households have a bank account (2%). Urban households are more likely than rural households to possess common household effects. For example, 90% of urban households own a refrigerator compared with 60% of rural households. On the other hand, as expected, rural households have a higher ownership rate of agricultural land1 than urban households (63% versus 11%). Rural households are more likely than urban households to own a car or truck (42% versus 35%) and a bicycle (42% versus 25%). 2.4 HOUSEHOLD WEALTH Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, and housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by their score, and then dividing the distribution into five equal categories, each with 20% of the population. Sample: Households 1 According to the Land Code of the Republic of Tajikistan, land in the Republic of Tajikistan is exclusively owned by the State (GOT 2008). However, upon appropriate State registration, a land plot can be given for perpetual use to natural persons and legal entities of the Republic of Tajikistan (Land Code, Articles 11-15). Land suitable for agricultural needs can be allocated to natural persons and legal entities for agricultural production (Articles 65-71). 10 • Housing Characteristics and Household Population Table 2.5 presents data on wealth quintiles according to residence and region. Wealth is clearly concentrated in urban areas. Ninety percent of the de jure household population is in the two highest wealth quintiles in urban areas, while 52% falls into the two lowest quintiles in rural areas (Figure 2.3). The concentration of wealth differs markedly by region. Ninety-five percent of the household population in Dushanbe is in the highest quintile. In contrast, 71% of the household population in GBAO is in the two lowest quintiles. 2.5 HANDWASHING Handwashing is one of the most effective ways to prevent germs from spreading. Interviewers were able to observe the place most often used for washing hands in the case of 95% of surveyed households (Table 2.6). Seventy-six percent of households had water and soap available in the place for handwashing. Only 4% of the households had no water, no soap, and no other cleansing agent available in the place for handwashing. Patterns by background characteristics  Urban households had soap and water at the place for handwashing more often than rural households (90% versus 70%).  Among regions, households in GBAO were least likely to have soap and water available (49%).  The availability of soap and water at the handwashing place increased with wealth, from 56% in the lowest quintile to 93% in the highest quintile. 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors). De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview. How data are calculated All tables are based on the de facto population, unless specified otherwise. Figure 2.3 Household wealth by residence 2 262 26 6 25 21 20 69 4 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 11 A total of 44,360 persons (20,729 males and 23,631 females) spent the night before the interview in the 7,843 households surveyed in the 2017 TjDHS. The age structure of the de facto household population shows the effects of past demographic trends in Tajikistan, particularly the country’s moderately high fertility. More than half (55%) of the population is under age 25, and 38% are younger than 15. Four percent of the population is age 65 and older (Table 2.7 and Figure 2.4). The average household is 6 persons (Table 2.8). Households are larger on average in rural areas (6.5 persons) than urban areas (4.8 persons). Men head the majority of households, with only 21% headed by women. Trends: The average household size declined from 6.3 persons in 2012 to 6 persons in 2017. 2.7 CHILDREN’S LIVING ARRANGEMENTS AND ORPHANHOOD Orphan A child with one or both parents who are dead. Sample: Children under age 18 In general, most children under age 18 live with their biological parents. Only 2% do not. Three percent of children under age 18 are orphans, with most having lost their father (2%). Orphanhood increases with the child’s age, from 1% among children age 0-4 to 7% among children age 15-17 (Table 2.9). Trends: The percentage of children under age 18 not living with a biological parent and the percentage orphaned did not change between 2012 and 2017. 2.8 BIRTH REGISTRATION Registered birth Child has a birth certificate or child does not have a birth certificate, but his/her birth is registered with the civil authorities. Sample: De jure children under age 5 The registration of a child’s birth is critical in ensuring a child will have access to the rights and benefits of citizenship. The vast majority of children under age 5 (96%) are registered with the civil authorities, and most young children (91%) have a birth certificate as proof of the registration (Table 2.10). Trends: Ninety-six percent of the births of children under age 5 were registered, an increase from the level in 2012 (88%). Figure 2.4 Population pyramid 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 2610 12 • Housing Characteristics and Household Population 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Half of the population has completed fewer than the median number of years of schooling, and half of the population has completed more than the median number of years of schooling. Sample: De facto household population age 6 and older Eighty percent of the female population and 79% of the male population age 6 and older have at least some secondary education. Males are more likely than females to have post-secondary education (25% versus 13%). Only 7% of women and men never attended school (Tables 2.11.1 and 2.11.2). Trends: Educational levels are increasing. The median number of years of schooling among women was 8.9 in 2017 compared with 8.6 years in 2012. Among men, the median number of years of schooling was 9.5 in 2017 compared with 9.3 years in 2012. Patterns by background characteristics  Urban women (52%) and men (61%) are more likely than rural women (45%) and men (53%) to have a secondary or higher education.  The percentage of women with a secondary or higher education is lowest in DRS (34%). Men are least likely to have a secondary or higher education in Khatlon (51%) and DRS (52%). GBAO has highest percentage of both women (69%) and men (67%) with a secondary education or higher education.  Only 37% of women and 45% of men in the lowest quintile have at least a secondary education compared with 56% of women and 63% of men in the highest wealth quintile. 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary2 or secondary3 school. Sample: Children age 7-10 for primary school NAR and children age 11-17 for secondary school NAR Gross attendance ratio (GAR) The total number of children attending primary school divided by the official primary school age population and the total number of children attending secondary school divided by the official secondary school age population. Sample: Children age 7-10 for primary school GAR and children age 11-17 for secondary school GAR Gender Parity Index (GPI) The ratio of female to male students attending primary school and the ratio of female to male students attending secondary school. The index reflects the magnitude of the gender gap. Sample: Primary school students and secondary school students 2 Grades 1-4 3 Grades 5-11 Housing Characteristics and Household Population • 13 Net Attendance The results in Table 2.12 show that school attendance is high but not universal among the school-age population in Tajikistan. The primary school NAR indicates that 83% of children age 7-10 who should be attending the primary level are doing so. The secondary school NAR shows that 87% of children age 11-17 who should be attending the secondary level are doing so. The NAR for primary school is virtually the same for girls and boys (83%), while the secondary school NAR is slightly higher among boys (89%) than girls (85%). Patterns by background characteristics  The NAR for primary school is almost the same in urban and rural areas (84% versus 83%). There also is little difference by residence in the secondary school NAR (86% in urban areas and 87% in rural areas).  The lowest primary school NAR is in Sughd (78%) while the secondary school NAR is lowest in DRS (85%). GBAO has the highest NARs (88% for primary school and 96% for secondary school). Other Measures of School Attendance Table 2.12 presents information on two additional school attendance measures, the gross attendance rate (GAR) and the gender parity index (GPI). A comparison of primary school GAR and NAR indicates that the proportion of primary school students who are underage or overage at the primary level is 12%. A comparison of the secondary school GAR and NAR indicates that the proportion of secondary school students who are outside of the official school age for the level is 8%. A GPI of 1 is evidence of equality between in school participation ratios for girls and boys. The primary school GPI is 0.99, indicating that boys have only a very slight advantage over girls in primary school attendance. The secondary level GPI is 0.97, showing that boys have a greater but still comparatively small advantage over girls in secondary school attendance. 2.10 CHILD DISCIPLINE Nonviolent disciplinary approaches Includes one or more:  Taking away privileges, forbidding something the child liked, or not allowing the child to leave the house  Explaining that the child’s behavior was wrong  Giving the child something else to do Sample: De jure children age 1-14 Psychological aggression Includes one or both:  Shouting, yelling, or screaming at the child  Calling the child dumb, lazy, or a similar term Sample: De jure children age 1-14 14 • Housing Characteristics and Household Population Physical punishment Includes one or more:  Shaking the child  Spanking, hitting, or slapping the child on the bottom with a bare hand  Hitting the child on the bottom or other part of the body with a belt, hairbrush, stick, or other similar hard object  Hitting or slapping the child on the face, head, or ears  Hitting the child on the hand, arm, or leg  Beating the child up, that is hitting the child over and over as hard as one can Sample: De jure children age 1-14 Severe physical punishment Includes one or both:  Hitting or slapping the child on the face, head, or ears  Beating the child up, that is hitting the child over and over as hard as one can Sample: De jure children age 1-14 The manner in which parents and caretakers discipline children can have long-term consequences for their physical and psychological development and well-being. To identify the types of child disciplinary methods used in Tajikistan, questions on child discipline were asked about one randomly-selected child age 1-14 in each household.4 In the 2017 TjDHS, the respondent to the Household Questionnaire (the household head or other knowledgeable adult household member) was asked a series of separate questions about practices used to discipline the child during the month before the survey. Overall, 69% of children age 1-14 experienced some type of violent discipline in the month before the survey (Table 2.13). Only 24% of children experienced only nonviolent discipline. Children were most likely to experience psychological aggression (65%). Some type of physical punishment was administered in the case of almost half (48%) of the children, and 12% of children experienced severe physical discipline. Overall, only 15% of those responding to questions about child discipline believe that in order to bring up, raise, or educate a child properly, the child needs physical punishment (Table 2.14). Patterns by background characteristics  The percentage experiencing violent disciplinary methods increases with the age of the child, peaking at 75% among children age 5-9.  Boys (51%) are slightly more likely to experience physical punishment than girls (45%).  Use of a violent disciplinary method was somewhat more common in rural households (70%) than in urban households (66%). GBAO (81%) had the highest reported use of violent disciplinary methods and Sughd had the lowest (60%).  The percentage of respondents who believe that physical punishment is needed to bring up, raise, or educate a child properly is lower among better educated and wealthier respondents as well as among those under age 25 compared with those respondents who are less educated, poorest, and older. 4 If several children age 1-14 were listed in the household schedule, only one child per household was randomly selected for administration of the questions on child discipline. If one child age 1-14 was listed in the household schedule, the questions on child discipline were administered about this child. If none of the children listed in the household schedule were age 1-14, the questions on child discipline were not administered. Housing Characteristics and Household Population • 15 Respondents in Khatlon (24%) are four times more likely than respondents in Sughd (6%) to believe in physical punishment. LIST OF TABLES For more information on household population and housing characteristics, see the following tables:  Table 2.1 Household drinking water  Table 2.2 Household sanitation facilities  Table 2.3 Household characteristics  Table 2.4 Household possessions  Table 2.5 Wealth quintiles  Table 2.6 Handwashing  Table 2.7 Household population by age, sex, and residence  Table 2.8 Household composition  Table 2.9 Children's living arrangements and orphanhood  Table 2.10 Birth registration of children under age 5  Table 2.11.1 Educational attainment of the female household population  Table 2.11.2 Educational attainment of the male household population  Table 2.12 School attendance ratios  Table 2.13 Child discipline  Table 2.14 Attitudes toward physical punishment 16 • Housing Characteristics and Household Population Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, by time to obtain drinking water and by person who usually collects drinking water; percentage of households and de jure population using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Tajikistan DHS 2017 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 96.7 72.3 79.7 96.5 71.9 77.9 Piped into dwelling/yard/plot 88.5 34.4 50.9 87.2 35.4 48.2 Piped to neighbor 1.4 2.7 2.3 1.3 2.5 2.2 Public tap/standpipe 3.1 18.5 13.8 3.2 17.5 14.0 Tube well or borehole 2.7 12.2 9.3 3.7 12.3 10.2 Protected dug well 0.2 3.0 2.1 0.2 2.7 2.1 Protected spring 0.4 1.5 1.2 0.6 1.4 1.2 Rain water 0.1 0.1 0.1 0.1 0.1 0.1 Bottled water, improved source for cooking/handwashing1 0.3 0.0 0.1 0.3 0.0 0.1 Unimproved source 3.3 27.7 20.3 3.5 28.1 22.1 Unprotected dug well 0.1 0.5 0.4 0.2 0.4 0.4 Unprotected spring 0.4 2.4 1.8 0.5 2.0 1.6 Tanker truck/cart with small tank 2.3 7.7 6.0 2.1 7.2 5.9 Surface water 0.5 17.2 12.1 0.6 18.4 14.0 Bottled water, unimproved source for cooking/ hand- washing1 0.0 0.1 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises2 96.4 65.3 74.8 95.9 67.3 74.3 Less than 30 minutes 2.6 25.2 18.3 3.0 23.2 18.2 30 minutes or longer 0.6 8.5 6.1 0.6 8.5 6.6 Don’t know/missing 0.4 1.0 0.8 0.5 1.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult male 15+ 0.4 5.1 3.7 0.4 4.3 3.3 Adult female 15+ 2.3 23.5 17.1 2.7 22.2 17.4 Male child under age 15 0.2 1.7 1.2 0.2 1.7 1.3 Female child under age 15 0.5 2.7 2.1 0.6 3.0 2.4 Other 0.2 1.6 1.2 0.2 1.6 1.2 Water on premises 96.4 65.3 74.8 95.9 67.3 74.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking3 Boiled 92.7 91.7 92.0 92.7 91.8 92.0 Bleach/chlorine added 0.5 0.5 0.5 0.5 0.4 0.4 Strained through cloth 0.4 0.4 0.4 0.4 0.5 0.5 Ceramic, sand or other filter 5.0 1.8 2.7 4.6 2.0 2.7 Solar disinfection 0.3 0.2 0.2 0.3 0.2 0.2 Let it stand and settle 6.4 10.5 9.2 6.5 10.5 9.5 No treatment 5.3 7.8 7.0 5.7 7.5 7.0 Percentage using an appropriate treatment method4 94.2 91.8 92.5 93.9 92.0 92.5 Number of households/population 2,390 5,453 7,843 11,538 35,456 46,994 1 Households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and handwashing. 2 Includes water piped to a neighbor 3 Respondents may report multiple treatment methods, so the sum of treatments may exceed 100%. 4 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 17 Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities and percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, according to residence, Tajikistan DHS 2017 Type and location of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved sanitation 95.7 96.8 96.5 96.0 97.3 97.0 Flush/pour flush to piped sewer system 57.4 0.5 17.9 49.4 0.5 12.5 Flush/pour flush to septic tank 0.3 0.2 0.2 0.3 0.2 0.2 Flush/pour flush to pit latrine 3.5 2.0 2.5 4.3 2.0 2.5 Ventilated improved pit (VIP) latrine 3.9 9.2 7.6 5.0 10.0 8.8 Pit latrine with slab 30.4 84.7 68.2 36.8 84.5 72.8 Composting toilet 0.1 0.2 0.1 0.2 0.2 0.2 Unimproved sanitation 4.3 3.2 3.5 4.0 2.7 3.0 Shared facility1 4.0 2.0 2.6 3.7 1.7 2.2 Flush/pour flush to piped sewer system 1.3 0.0 0.4 1.0 0.0 0.2 Flush/pour flush to pit latrine 0.1 0.0 0.0 0.1 0.0 0.0 Ventilated improved pit (VIP) latrine 0.4 0.2 0.3 0.4 0.3 0.3 Pit latrine with slab 2.2 1.8 1.9 2.2 1.4 1.6 Unimproved facility 0.3 1.2 0.9 0.3 1.0 0.8 Flush/pour flush not to sewer/septic tank/pit latrine 0.1 0.1 0.1 0.1 0.1 0.1 Pit latrine without slab/open pit 0.1 0.5 0.4 0.1 0.4 0.3 Bucket 0.1 0.6 0.4 0.0 0.5 0.4 Hanging toilet/hanging latrine 0.0 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 2,390 5,453 7,843 11,538 35,456 46,994 Location of toilet facility In own dwelling 53.8 4.7 19.7 45.0 5.0 14.8 In own yard/plot 43.2 94.4 78.8 52.1 94.3 83.9 Elsewhere 3.0 0.9 1.6 2.9 0.7 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population with a toilet/latrine facility 2,390 5,453 7,843 11,538 35,456 46,994 1 Facilities that would be considered improved if they were not shared by two or more households 18 • Housing Characteristics and Household Population Table 2.3 Household characteristics Percent distribution of households and de jure population by housing characteristics, percentage using solid fuel for cooking, percentage using clean fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Tajikistan DHS 2017 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 99.1 99.2 99.2 99.2 99.3 99.3 No 0.9 0.8 0.8 0.8 0.7 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand 4.5 29.2 21.7 5.6 29.0 23.3 Wood planks 42.6 23.9 29.6 41.8 22.7 27.4 Parquet or polished wood 24.5 19.2 20.8 23.7 19.2 20.3 Vinyl or linoleum 10.8 4.9 6.7 10.9 5.0 6.5 Ceramic tiles 0.3 0.2 0.3 0.3 0.2 0.2 Cement 9.0 16.8 14.4 9.5 18.3 16.1 Carpet 8.3 5.8 6.6 8.1 5.5 6.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Roof material No roof 0.4 1.5 1.2 0.3 1.1 0.9 Thatch 0.5 2.0 1.5 0.3 1.6 1.3 Sod 0.1 0.1 0.1 0.1 0.1 0.1 Wood planks 0.1 0.3 0.2 0.1 0.2 0.2 Cardboard 0.1 0.0 0.0 0.1 0.0 0.0 Metal 20.0 13.9 15.8 20.1 12.7 14.5 Wood 0.1 0.3 0.3 0.1 0.3 0.3 Schiefer/cement fiber 54.7 81.2 73.1 58.6 83.4 77.3 Ceramic tiles 0.7 0.1 0.3 0.7 0.1 0.2 Cement 10.7 0.4 3.5 9.2 0.4 2.5 Roofing shingles soft 1.7 0.1 0.6 1.3 0.1 0.4 Taule (ruberoid) 10.9 0.1 3.4 9.1 0.1 2.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Wall material No walls 0.0 0.0 0.0 0.0 0.0 0.0 Trunks 0.0 0.3 0.2 0.0 0.3 0.2 Dirt 10.0 48.0 36.4 11.6 49.6 40.3 Stone with mud 1.7 4.9 3.9 2.0 4.5 3.9 Uncovered adobe 0.3 3.3 2.4 0.3 2.8 2.2 Plywood 0.2 0.0 0.1 0.1 0.0 0.0 Cardboard 0.0 0.1 0.1 0.0 0.1 0.1 Reused wood 0.2 0.0 0.1 0.1 0.0 0.1 Cement/monolit 30.8 1.7 10.6 27.0 1.6 7.8 Stone with lime/cement 3.2 2.8 2.9 3.1 2.2 2.4 Bricks 40.3 23.1 28.3 40.7 22.2 26.7 Cement blocks 8.4 1.7 3.7 7.7 1.5 3.1 Covered adobe 4.9 13.9 11.2 7.2 15.1 13.2 Wood planks 0.1 0.1 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 21.2 12.7 15.3 11.6 7.5 8.5 Two 45.1 43.3 43.8 41.9 36.2 37.6 Three or more 33.7 44.0 40.9 46.5 56.3 53.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 54.2 8.7 22.6 45.8 7.4 16.8 In a separate building 44.0 86.1 73.3 52.2 87.9 79.1 Outdoors 1.7 5.1 4.1 2.0 4.7 4.0 Other 0.0 0.1 0.1 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 63.9 39.5 46.9 60.0 39.0 44.2 LPG/natural gas/biogas 34.2 37.7 36.6 37.0 36.1 36.4 Coal/lignite 0.0 0.1 0.0 0.0 0.1 0.1 Charcoal 0.1 0.2 0.1 0.0 0.2 0.2 Wood 1.1 13.7 9.9 1.8 15.0 11.7 Straw/shrubs/grass 0.5 5.8 4.2 0.8 6.3 5.0 Agricultural crop 0.1 0.3 0.2 0.2 0.4 0.3 Animal dung 0.1 2.7 2.0 0.1 2.8 2.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Continued… Housing Characteristics and Household Population • 19 Table 2.3—Continued Households Population Housing characteristic Urban Rural Total Urban Rural Total Percentage using solid fuel for cooking1 1.9 22.8 16.4 3.0 24.8 19.5 Percentage using clean fuel for cooking2 98.1 77.1 83.5 97.0 75.2 80.5 Frequency of smoking in the home Daily 8.2 7.5 7.7 8.9 8.3 8.5 Weekly 5.3 5.8 5.6 5.5 5.7 5.7 Monthly 0.8 0.6 0.7 0.8 0.6 0.6 Less than once a month 2.0 2.0 2.0 2.1 2.1 2.1 Never 83.6 84.1 84.0 82.7 83.3 83.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population 2,390 5,453 7,843 11,538 35,456 46,994 LPG = Liquefied petroleum gas 1 Includes coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung 2 Includes electricity and LPG/natural gas/biogas Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, livestock/farm animals, watch, and bank account, according to residence, Tajikistan DHS 2017 Residence Total Possession Urban Rural Household effects Radio 21.3 16.7 18.1 Television 98.6 97.8 98.0 Mobile phone 96.0 96.4 96.3 Non-mobile telephone 14.6 2.7 6.3 Computer 35.6 14.8 21.1 Refrigerator 90.4 60.3 69.4 Washing machine 64.4 27.9 39.0 Vacuum cleaner 59.7 24.0 34.9 Camera 25.2 13.9 17.3 Table/hon-tohta 69.5 49.3 55.5 Chair 44.4 17.5 25.7 Couch 62.3 46.1 51.0 Bed 52.2 52.8 52.6 Buffet/curio cabinet/wall unit 67.1 64.0 65.0 Air conditioner 41.8 12.1 21.1 DVD player 71.8 75.6 74.5 Satellite antenna/dish 61.0 55.8 57.4 Freezer 34.7 15.3 21.2 Electric fan 39.2 43.2 42.0 Sewing machine 55.6 69.8 65.4 Stove 38.5 76.6 65.0 Mini-generator 6.3 10.2 9.1 Fuel or wood stock 38.1 89.4 73.8 Carpet 97.1 94.7 95.4 Internet 38.4 21.5 26.7 Means of transport Bicycle 24.6 42.0 36.7 Animal drawn cart 12.6 34.2 27.6 Motorcycle/scooter 1.2 2.1 1.9 Car/truck 34.9 41.5 39.5 Boat with a motor 0.3 0.2 0.2 Tractor 0.4 2.7 2.0 Combine-harvester 0.2 0.2 0.2 Any agricultural equipment 2.3 3.4 3.1 Ownership of agricultural land 11.1 62.9 47.2 Ownership of farm animals1 11.4 71.2 53.0 Watch 56.9 49.4 51.7 Bank account 2.8 1.4 1.8 Number of households 2,390 5,453 7,843 1 Cows, bulls, other cattle, horses, donkeys, goats, sheep, chickens or other poultry, pigs, rabbits, animals for fur, and beehives 20 • Housing Characteristics and Household Population Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence, region and Feed the Future (FTF) districts, Tajikistan DHS 2017 Residence/ region/ FTF districts Wealth quintile Total Number of persons Gini Coefficient Lowest Second Middle Fourth Highest Residence Urban 2.3 1.9 6.3 20.9 68.6 100.0 11,538 0.22 Rural 25.7 25.9 24.5 19.7 4.2 100.0 35,456 0.17 Region Dushanbe 0.0 0.0 0.1 4.7 95.2 100.0 3,933 0.26 GBAO 53.5 17.8 10.4 6.3 12.0 100.0 987 0.35 Sughd 16.4 15.5 21.4 27.8 18.9 100.0 14,055 0.18 DRS 21.0 22.8 24.8 21.2 10.2 100.0 10,580 0.26 Khatlon 24.9 26.5 21.0 17.2 10.4 100.0 17,438 0.26 FTF districts 21.7 28.1 23.4 18.8 8.0 100.0 9,363 0.23 Total 20.0 20.0 20.0 20.0 20.0 100.0 46,994 0.22 Table 2.6 Handwashing Percentage of households in which the place most often used for washing hands was observed to be fixed or mobile and total percentage of households in which the place for handwashing was observed; and among households in which the place for handwashing was observed, percent distribution by availability of water, soap, and other cleansing agents, according to background characteristics, Tajikistan DHS 2017 Percentage of households in which place for washing hands was observed: Number of households Among households in which place for handwashing was observed, percentage with: Number of households in which a place for hand- washing was observed Background characteristic And place for hand- washing was a fixed place And place for hand- washing was mobile Total Soap and water1 Water and cleansing agent other than soap only2 Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Total Residence Urban 94.6 3.1 97.7 2,390 90.0 0.2 7.0 1.6 0.0 1.1 100.0 2,336 Rural 82.5 11.3 93.8 5,453 70.1 0.9 16.7 6.2 0.4 5.7 100.0 5,115 Region Dushanbe 96.4 0.9 97.3 882 93.7 0.1 4.8 0.7 0.0 0.8 100.0 858 GBAO 59.9 39.9 99.8 204 48.8 0.0 51.0 0.1 0.0 0.1 100.0 203 Sughd 88.6 10.0 98.6 2,648 67.8 0.2 15.8 7.9 0.6 7.7 100.0 2,612 DRS 83.0 9.3 92.3 1,654 70.1 2.2 16.8 6.5 0.2 4.2 100.0 1,527 Khatlon 84.1 7.6 91.7 2,456 86.3 0.5 9.1 2.1 0.1 1.9 100.0 2,252 FTF districts 80.3 8.2 88.6 1,313 91.6 0.5 3.7 2.0 0.2 2.1 100.0 1,163 Wealth quintile Lowest 77.3 12.0 89.3 1,579 55.8 1.8 24.4 5.8 1.0 11.2 100.0 1,410 Second 83.5 9.4 92.9 1,394 71.1 0.9 16.3 6.6 0.0 5.1 100.0 1,295 Middle 84.0 12.5 96.5 1,380 73.2 0.6 15.3 7.3 0.3 3.2 100.0 1,331 Fourth 87.6 10.0 97.6 1,451 81.3 0.4 11.5 4.3 0.1 2.4 100.0 1,417 Highest 95.4 2.6 98.0 2,038 92.9 0.1 4.8 1.6 0.0 0.6 100.0 1,998 Total 86.2 8.8 95.0 7,843 76.4 0.7 13.7 4.8 0.3 4.2 100.0 7,451 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand 3 Includes households with soap only as well as those with soap and another cleansing agent Housing Characteristics and Household Population • 21 Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by various age groups, and percentage of the de facto household population age 10-19, according to sex and residence, Tajikistan DHS 2017 Urban Rural Male Female Total Age Male Female Total Male Female Total <5 14.0 11.7 12.8 17.3 15.0 16.1 16.5 14.2 15.3 5-9 12.9 11.6 12.2 14.4 12.2 13.2 14.0 12.0 12.9 10-14 10.4 9.7 10.0 10.7 8.9 9.7 10.6 9.1 9.8 15-19 10.7 8.4 9.5 9.8 8.8 9.3 10.0 8.7 9.3 20-24 7.6 8.4 8.0 6.3 9.4 8.0 6.6 9.2 8.0 25-29 7.8 8.7 8.3 7.1 8.7 7.9 7.3 8.7 8.0 30-34 6.7 7.1 6.9 5.9 7.0 6.5 6.1 7.0 6.6 35-39 5.3 5.5 5.4 4.4 5.6 5.0 4.6 5.6 5.1 40-44 4.4 5.5 5.0 4.0 4.6 4.3 4.1 4.8 4.5 45-49 4.3 5.4 4.8 4.2 4.2 4.2 4.2 4.5 4.4 50-54 4.9 6.0 5.5 3.8 4.9 4.4 4.1 5.2 4.7 55-59 4.2 5.0 4.6 4.5 4.2 4.3 4.5 4.4 4.4 60-64 3.3 3.2 3.2 2.8 2.7 2.7 2.9 2.8 2.8 65-69 1.7 1.9 1.8 1.8 1.6 1.7 1.8 1.7 1.7 70-74 0.7 0.6 0.6 1.0 0.8 0.9 0.9 0.7 0.8 75-79 0.7 0.9 0.8 0.9 0.8 0.8 0.9 0.8 0.8 80+ 0.5 0.6 0.5 1.1 0.8 0.9 0.9 0.7 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency age groups 0-14 37.3 33.0 35.0 42.4 36.0 39.0 41.1 35.3 38.0 15-64 59.1 63.1 61.2 52.8 60.0 56.6 54.4 60.8 57.8 65+ 3.6 3.9 3.8 4.8 3.9 4.3 4.5 3.9 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Child and adult populations 0-17 43.9 37.9 40.7 49.5 41.2 45.1 48.1 40.4 44.0 18+ 56.1 62.1 59.3 50.5 58.8 54.9 51.9 59.6 56.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Adolescents 10-19 21.1 18.1 19.5 20.6 17.6 19.0 20.7 17.7 19.1 Number of persons 5,256 5,880 11,136 15,473 17,751 33,224 20,729 23,631 44,360 Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of households, and percentage of households with orphans and foster children under age 18, according to residence, Tajikistan DHS 2017 Residence Total Characteristic Urban Rural Household headship Male 68.3 83.9 79.1 Female 31.7 16.1 20.9 Total 100.0 100.0 100.0 Number of usual members 0 0.1 0.0 0.0 1 7.4 0.9 2.9 2 11.7 3.8 6.2 3 12.7 7.2 8.9 4 16.1 10.2 12.0 5 17.9 17.9 17.9 6 13.4 19.5 17.7 7 8.3 13.7 12.0 8 4.4 8.5 7.3 9+ 8.1 18.3 15.2 Total 100.0 100.0 100.0 Mean size of households 4.8 6.5 6.0 Percentage of households with orphans and foster children under 18 years of age Double orphans 0.2 0.3 0.2 Single orphans1 4.0 4.4 4.3 Foster children2 3.7 4.0 3.9 Orphans and/or foster children 7.3 7.8 7.7 Number of households 2,390 5,453 7,843 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes children with one dead parent and an unknown survival status of the other parent. 2 Foster children are those under age 18 living in households with neither their mother nor their father present, and the mother and/or the father are alive. 22 • Housing Characteristics and Household Population Table 2.9 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, percentage of children not living with a biological parent, and percentage of children with one or both parents dead, according to background characteristics, Tajikistan DHS 2017 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Missing informa- tion on father/ mother Percent- age not living with a bio- logical parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Age 0-4 87.9 9.7 0.8 0.3 0.1 1.1 0.0 0.0 0.0 0.1 1.2 0.9 6,682 <2 89.4 9.6 0.4 0.1 0.0 0.4 0.0 0.0 0.0 0.0 0.4 0.4 2,694 2-4 86.8 9.8 1.0 0.4 0.1 1.6 0.1 0.1 0.0 0.1 1.7 1.3 3,988 5-9 84.4 9.6 1.7 1.0 0.3 2.6 0.0 0.1 0.1 0.1 2.8 2.3 5,736 10-14 84.6 7.5 2.8 1.4 0.8 2.4 0.1 0.3 0.1 0.1 2.8 4.0 4,381 15-17 81.5 7.9 4.4 1.3 1.4 2.3 0.3 0.3 0.6 0.2 3.5 7.1 2,715 Sex Male 85.7 8.6 2.1 0.8 0.4 1.9 0.0 0.2 0.1 0.1 2.2 2.9 9,991 Female 84.7 9.3 1.9 0.9 0.6 2.1 0.1 0.1 0.1 0.1 2.5 2.8 9,523 Residence Urban 81.7 11.1 2.6 0.8 0.7 2.5 0.0 0.2 0.1 0.3 2.9 3.6 4,506 Rural 86.3 8.3 1.8 0.9 0.4 1.8 0.1 0.1 0.1 0.0 2.2 2.6 15,008 Region Dushanbe 80.2 13.5 3.0 0.4 0.9 1.4 0.1 0.1 0.1 0.3 1.6 4.2 1,518 GBAO 75.5 9.6 2.7 3.0 0.5 7.9 0.3 0.1 0.2 0.2 8.4 3.7 359 Sughd 76.5 17.4 1.2 0.9 0.4 3.1 0.1 0.1 0.1 0.1 3.4 1.9 5,586 DRS 90.9 3.6 1.9 0.9 0.5 1.8 0.0 0.2 0.1 0.0 2.2 2.8 4,497 Khatlon 89.8 4.9 2.4 0.8 0.5 1.1 0.1 0.2 0.2 0.1 1.5 3.3 7,554 FTF districts 90.3 4.8 2.3 0.7 0.3 1.1 0.1 0.2 0.2 0.1 1.6 3.2 4,162 Wealth quintile Lowest 87.6 6.1 3.0 1.2 0.6 1.2 0.2 0.0 0.2 0.1 1.5 3.9 4,216 Second 85.5 9.1 2.2 1.0 0.5 1.2 0.1 0.2 0.0 0.1 1.6 3.0 4,030 Middle 87.9 7.9 0.8 0.5 0.2 2.0 0.1 0.2 0.1 0.1 2.5 1.6 3,912 Fourth 83.9 9.7 1.3 0.9 0.3 3.5 0.0 0.2 0.1 0.1 3.8 1.8 3,756 Highest 80.7 12.4 2.7 0.7 0.9 2.1 0.0 0.2 0.1 0.3 2.5 3.9 3,600 Total <15 85.9 9.1 1.6 0.8 0.4 1.9 0.1 0.1 0.0 0.1 2.2 2.2 16,799 Total <18 85.2 8.9 2.0 0.9 0.5 2.0 0.1 0.2 0.1 0.1 2.3 2.9 19,514 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent. Housing Characteristics and Household Population • 23 Table 2.10 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Tajikistan DHS 2017 Percentage of children whose births are registered and who: Total percentage of children whose births are registered Number of children Background characteristic Had a birth certificate Did not have birth certificate Age <2 85.6 7.5 93.1 2,694 0 78.2 11.5 89.6 1,238 1 91.9 4.1 96.0 1,456 2-4 95.2 2.4 97.7 3,988 2 95.1 2.5 97.5 1,369 3 94.5 3.0 97.5 1,420 4 96.4 1.7 98.1 1,199 Sex Male 91.4 4.5 95.9 3,369 Female 91.3 4.4 95.7 3,313 Residence Urban 93.1 3.6 96.7 1,390 Rural 90.9 4.7 95.6 5,292 Region Dushanbe 93.5 4.5 97.9 427 GBAO 94.5 2.7 97.3 114 Sughd 97.7 1.6 99.3 1,927 DRS 85.6 5.4 91.0 1,570 Khatlon 89.7 6.0 95.7 2,643 FTF districts 90.5 5.0 95.6 1,489 Wealth quintile Lowest 86.4 7.5 93.9 1,234 Second 91.9 2.6 94.5 1,377 Middle 91.3 5.0 96.3 1,488 Fourth 93.6 3.1 96.7 1,456 Highest 93.3 4.3 97.6 1,127 Total 91.4 4.5 95.8 6,682 24 • Housing Characteristics and Household Population Table 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Tajikistan DHS 2017 Background characteristic No education Some primary Completed primary1 Some secondary2 Completed secondary3 Profes- sional primary Profes- sional middle Higher Total Number of women Median years completed Age4 6-9 41.5 57.6 0.7 0.2 0.0 0.0 0.0 0.0 100.0 2,262 0.2 10-14 1.2 14.6 17.6 66.4 0.1 0.0 0.0 0.0 100.0 2,142 4.8 15-19 1.9 0.7 0.4 55.1 32.2 0.7 4.1 4.7 100.0 2,048 9.3 20-24 1.6 1.4 1.8 31.1 40.7 1.5 9.8 12.0 100.0 2,170 10.3 25-29 4.2 2.2 2.9 37.6 35.9 2.0 5.0 10.0 100.0 2,053 10.1 30-34 3.3 3.5 4.7 40.7 31.4 0.8 5.8 9.8 100.0 1,656 9.0 35-39 0.8 1.9 1.2 43.9 36.6 1.8 5.1 8.7 100.0 1,318 9.4 40-44 0.8 0.6 0.5 23.4 54.6 2.6 6.4 11.1 100.0 1,139 9.8 45-49 1.1 1.4 0.4 9.1 65.1 4.3 9.3 9.2 100.0 1,062 9.6 50-54 0.7 1.5 0.4 15.8 64.6 2.9 5.6 8.4 100.0 1,223 9.5 55-59 2.0 2.5 0.9 16.2 62.0 2.1 5.7 8.7 100.0 1,034 9.5 60-64 2.1 2.0 1.6 28.4 48.1 1.5 7.2 9.1 100.0 658 9.4 65+ 9.1 6.2 8.1 42.0 21.5 1.8 3.4 7.5 100.0 931 7.4 Residence Urban 5.7 10.0 3.2 29.0 28.7 2.2 6.3 15.0 100.0 5,067 9.3 Rural 7.2 9.7 3.7 34.8 34.8 1.2 4.3 4.3 100.0 14,632 8.8 Region Dushanbe 5.1 11.8 2.6 28.7 25.1 1.3 4.3 21.1 100.0 1,748 9.3 GBAO 3.3 8.3 2.3 17.6 39.3 4.8 6.5 18.0 100.0 428 9.9 Sughd 5.8 8.4 2.7 26.8 38.6 2.2 6.9 8.5 100.0 6,141 9.4 DRS 7.1 10.2 4.3 44.2 26.3 1.3 3.2 3.3 100.0 4,362 8.4 Khatlon 8.1 10.3 4.3 34.3 34.5 0.7 3.9 4.0 100.0 7,018 8.6 FTF districts 9.3 11.7 4.8 34.6 32.4 0.7 3.5 3.0 100.0 3,750 8.4 Wealth quintile Lowest 8.3 11.2 4.3 39.0 32.4 0.8 2.2 1.8 100.0 3,941 8.3 Second 7.9 9.9 4.2 37.4 33.7 1.0 3.1 2.8 100.0 3,846 8.6 Middle 6.6 8.6 3.4 33.9 37.1 1.5 4.8 4.1 100.0 3,810 9.0 Fourth 5.9 9.5 3.2 30.5 34.4 1.9 6.7 7.7 100.0 3,959 9.2 Highest 5.3 9.8 2.8 26.2 28.9 1.9 7.0 18.1 100.0 4,141 9.5 Total 6.8 9.8 3.6 33.3 33.2 1.4 4.8 7.0 100.0 19,698 8.9 Note: Total includes women with missing or unknown information on educational attainment. 1 Completed Grade 4 at the primary level 2 Attended or completed the general basic level (Grades 5-9) or attended but did not complete the general secondary level (Grades 10-11) 3 Completed Grade 11 at the secondary level or completed Grade 10 at the secondary level and has a general education school diploma (“attestat” as in older Soviet educational system terminology) 4 Total includes one woman with missing or unknown information on age. Housing Characteristics and Household Population • 25 Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Tajikistan DHS 2017 Background characteristic No education Some primary Completed primary1 Some secondary2 Completed secondary3 Profes- sional primary Profes- sional middle Higher Total Number of men Median years completed Age4 6-9 42.0 56.9 0.9 0.2 0.0 0.0 0.0 0.0 100.0 2,350 0.2 10-14 0.5 16.6 20.3 62.5 0.1 0.0 0.0 0.0 100.0 2,208 4.7 15-19 0.5 1.1 0.0 56.9 29.4 1.9 2.2 8.0 100.0 2,081 9.3 20-24 0.8 0.9 0.6 14.6 37.5 2.9 4.6 38.0 100.0 1,372 10.9 25-29 1.4 1.4 1.2 20.0 39.1 3.3 4.7 28.9 100.0 1,507 10.7 30-34 1.7 2.5 1.0 21.7 41.9 2.6 2.7 25.9 100.0 1,259 10.5 35-39 0.6 1.2 1.0 17.6 48.5 3.7 4.1 23.3 100.0 962 10.5 40-44 1.3 0.2 0.3 9.0 51.4 10.3 6.3 21.2 100.0 851 10.4 45-49 0.6 0.6 0.3 5.3 48.4 14.7 8.8 21.3 100.0 870 10.0 50-54 0.5 0.6 0.3 6.0 49.8 13.0 7.9 21.8 100.0 850 9.9 55-59 0.1 1.1 0.7 5.8 45.2 12.6 11.0 23.5 100.0 923 10.0 60-64 0.1 2.1 0.5 9.8 42.4 11.4 11.7 22.1 100.0 601 9.9 65+ 3.1 2.7 3.5 24.3 31.1 7.2 6.6 21.3 100.0 927 9.6 Residence Urban 5.8 10.5 3.1 20.1 24.8 3.3 4.1 28.3 100.0 4,398 9.9 Rural 7.0 11.3 3.5 25.4 31.2 5.1 4.1 12.4 100.0 12,364 9.3 Region Dushanbe 5.3 12.1 2.9 16.9 20.9 1.1 2.9 37.8 100.0 1,626 10.3 GBAO 4.7 9.6 2.4 16.1 27.8 10.0 6.6 22.7 100.0 395 10.3 Sughd 6.1 9.8 3.3 23.3 31.5 6.2 4.8 15.1 100.0 5,091 9.5 DRS 6.4 11.7 3.4 26.9 29.4 4.4 4.1 13.8 100.0 3,805 9.3 Khatlon 7.9 11.8 3.7 25.3 30.5 4.0 3.6 13.3 100.0 5,844 9.3 FTF districts 8.8 13.6 4.3 28.8 30.0 2.3 2.8 9.2 100.0 2,976 8.9 Wealth quintile Lowest 8.4 12.6 4.0 29.8 30.3 4.7 2.9 7.3 100.0 3,388 8.8 Second 6.8 10.8 3.4 27.5 32.8 5.0 4.3 9.5 100.0 3,248 9.3 Middle 7.0 11.0 3.4 24.3 32.3 5.5 5.1 11.4 100.0 3,275 9.4 Fourth 6.2 10.5 3.0 20.6 29.6 5.7 4.4 19.9 100.0 3,253 9.8 Highest 5.2 10.7 3.0 18.2 23.3 2.5 3.9 33.2 100.0 3,597 10.2 Total 6.7 11.1 3.4 24.0 29.5 4.6 4.1 16.5 100.0 16,762 9.5 Note: Total includes men with missing or unknown information on educational attainment. 1 Completed Grade 4 at the primary level 2 Attended or completed the general basic level (Grades 5-9) or attended but did not complete the general secondary level (Grades 10-11) 3 Completed Grade 11 at the secondary level or completed Grade 10 at the secondary level and has a general education school diploma (“attestat” as in older Soviet educational system terminology) 4 Total includes two men with missing or unknown information on age. 26 • Housing Characteristics and Household Population Table 2.12 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Tajikistan DHS 2017 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 85.4 83.4 84.4 0.98 98.9 95.3 97.1 0.96 Rural 82.4 83.1 82.8 1.01 93.9 94.0 93.9 1.00 Region Dushanbe 88.6 86.4 87.5 0.97 101.2 93.3 97.3 0.92 GBAO 91.0 85.6 88.4 0.94 104.2 100.8 102.6 0.97 Sughd 78.8 78.0 78.4 0.99 94.1 93.4 93.8 0.99 DRS 87.6 85.4 86.5 0.98 98.3 95.0 96.7 0.97 Khatlon 82.1 85.3 83.6 1.04 91.9 94.5 93.1 1.03 FTF districts 85.2 85.4 85.3 1.00 98.0 96.2 97.1 0.98 Wealth quintile Lowest 82.3 82.8 82.5 1.01 92.2 94.9 93.5 1.03 Second 80.0 81.4 80.7 1.02 92.9 92.6 92.8 1.00 Middle 83.1 82.5 82.8 0.99 98.2 91.8 95.3 0.93 Fourth 84.6 85.5 85.0 1.01 94.4 96.4 95.4 1.02 Highest 85.9 83.9 84.9 0.98 97.9 95.7 96.8 0.98 Total 83.1 83.2 83.2 1.00 95.0 94.3 94.7 0.99 SECONDARY SCHOOL Residence Urban 87.6 84.6 86.1 0.97 95.5 92.0 93.8 0.96 Rural 88.9 85.5 87.3 0.96 96.5 93.9 95.3 0.97 Region Dushanbe 87.1 84.3 85.7 0.97 94.3 91.6 93.0 0.97 GBAO 96.1 95.2 95.7 0.99 104.1 104.5 104.3 1.00 Sughd 85.7 85.8 85.8 1.00 94.4 94.1 94.2 1.00 DRS 88.1 82.0 85.1 0.93 93.0 88.4 90.8 0.95 Khatlon 90.7 86.6 88.8 0.95 99.3 96.0 97.7 0.97 FTF districts 89.8 84.0 87.1 0.93 97.9 96.1 97.1 0.98 Wealth quintile Lowest 87.9 84.5 86.3 0.96 93.8 91.8 92.9 0.98 Second 91.4 84.9 88.4 0.93 99.2 94.4 97.0 0.95 Middle 85.9 85.5 85.8 1.00 96.1 94.0 95.1 0.98 Fourth 88.8 88.8 88.8 1.00 95.7 96.7 96.2 1.01 Highest 88.3 83.4 85.9 0.94 96.5 91.2 93.8 0.95 Total 88.6 85.3 87.0 0.96 96.2 93.4 94.9 0.97 1 The NAR for primary school is the percentage of the primary school age (7-10 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (11-17 years) population that is attending secondary school. By definition the NAR cannot exceed 100%. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100%. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Housing Characteristics and Household Population • 27 Table 2.13 Child discipline Percentage of de jure children age 1-14 by child discipline methods experienced during the month before the survey, Tajikistan DHS 2017 Percentage of children age 1-14 years who experienced: Number of children age 1-14 Background characteristic Non-violent discipline only1 Any psychological aggression2 Physical punishment Any violent discipline method5 Any3 Severe4 Age 1-2 33.1 51.2 39.8 9.6 56.2 1,066 3-4 25.3 63.9 50.8 13.1 67.6 980 5-9 19.4 71.4 54.5 14.0 74.9 2,135 10-14 22.1 67.3 43.1 11.0 70.5 1,594 Child’s sex Male 22.8 66.6 51.1 13.3 70.3 2,920 Female 24.6 63.9 44.8 11.1 67.6 2,855 Residence Urban 28.0 61.5 46.2 10.5 65.5 1,354 Rural 22.3 66.4 48.6 12.7 70.0 4,421 Region Dushanbe 23.2 64.8 51.9 15.5 69.8 452 GBAO 16.1 76.0 64.6 12.7 81.2 109 Sughd 32.1 58.6 36.0 5.9 59.8 1,674 DRS 18.5 68.5 46.3 9.4 72.3 1,328 Khatlon 20.9 67.9 56.5 18.0 73.1 2,212 FTF districts 23.5 66.0 45.7 12.2 69.0 1,249 Education of household head6 None/primary 18.4 66.9 52.9 15.2 70.2 298 General basic 25.3 64.1 46.4 10.4 67.8 840 General secondary 23.2 65.7 47.6 12.8 69.8 2,699 Professional primary/ middle 23.0 66.5 50.3 10.7 68.9 834 Higher 25.6 63.7 47.2 12.4 67.6 1,103 Wealth quintile Lowest 19.5 70.5 55.3 17.4 74.2 1,259 Second 21.8 67.8 48.2 12.2 71.0 1,178 Middle 21.5 64.5 48.3 11.6 68.9 1,155 Fourth 29.6 60.5 42.0 9.2 64.2 1,112 Highest 26.8 61.9 45.3 10.0 65.6 1,071 Total 23.7 65.3 48.0 12.2 69.0 5,775 1 Only non-violent discipline: (1) providing an affirmative response to one or both of the following: took away child’s privileges, forbade something the child liked, or did not allow the child to leave the house or explained why some behavior was wrong, or gave the child something else to do; and (2) a negative response to all of the following: shook the child; shouted, yelled, or screamed at the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; called the child dumb, lazy, or similar name; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; or beat the child over and over as hard as possible. 2 Psychological aggression: providing an affirmative answer to one or both of the following: shouted, yelled, or screamed at the child or called the child dumb, lazy, or similar name. 3 Any physical punishment: providing an affirmative response to any of the following: shook the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; or beat the child over and over as hard as possible. 4 Severe physical punishment: providing an affirmative response to one or both of the following: hit or slapped the child on the face, head, or ears; or beat the child over and over as hard as possible. 5 Any violent discipline method: providing an affirmative response to any of the following: shook the child; shouted, yelled, or screamed at the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; called the child dumb, lazy, or similar name; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; or beat the child over and over as hard as possible. 6 Total includes one child with missing information on household head education. 28 • Housing Characteristics and Household Population Table 2.14 Attitudes toward physical punishment Percentage of respondents to the child discipline module who believe that physical punishment is needed to bring up, raise, or educate a child properly, Tajikistan DHS 2017 Background characteristic Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module1 Respondent’s age <25 10.5 324 25-39 14.9 2,762 40-59 16.3 1,983 60+ 13.9 705 Respondent’s sex Male 14.5 769 Female 15.1 5,006 Respondent's relationship to selected child2 Mother 14.8 3,021 Father 14.1 415 Other 15.4 2,339 Residence Urban 14.6 1,354 Rural 15.1 4,421 Region Dushanbe 17.7 452 GBAO 12.9 109 Sughd 5.5 1,674 DRS 10.7 1,328 Khatlon 24.3 2,212 FTF districts 20.6 1,249 Respondent's education None/primary 15.9 333 General basic 15.7 1,729 General secondary 15.7 2,692 Professional primary/middle 11.2 475 Higher 12.3 546 Wealth quintile Lowest 20.2 1,259 Second 14.8 1,178 Middle 14.0 1,155 Fourth 12.8 1,112 Highest 12.6 1,071 Total 15.0 5,775 Note: Table is based on Table CP.6: Attitudes toward physical punishment, UNICEF MICS 5 Child Discipline Module Tabulation plan. 1 The denominator of the table is respondents to the Household Questionnaire living in households where a child age 1-14 was randomly selected for the child discipline module. 2 The respondent's relationship to any child age 1-14 is established using information from the Household schedule. Characteristics of Respondents • 29 CHARACTERISTICS OF RESPONDENTS 3 Key Findings  Age: More than half of the women interviewed in the 2017 TjDHS are below age 30.  Education and literacy: 56% of women have completed secondary schooling. Ninety-five percent of women are literate.  Exposure to mass media: 12% of women have used the internet in the past 12 months. Television is the most commonly accessed form of media among women (87%).  Employment and occupation: One in four women are currently employed. One in three employed women work in agriculture.  Diabetes and hypertension: One in 10 women are hypertensive, and 2% have been told by a health care provider that they have high blood sugar or diabetes. his chapter presents information on the demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS The 2017 TjDHS interviewed 10,718 women age 15-49 (Table 3.1). More than half of women (55%) are below age 30, with adolescents (those age 15-19) constituting 18% of women in Tajikistan. Nearly three- quarters of women (72%) are currently married or living together with a partner as though married, while 22% of women have never been married. Six percent of women are divorced, separated, or widowed. Three-quarters of respondents live in rural areas. Over two-thirds live in either Khatlon (37%) or Sughd (31%), and 22% live in DRS. Dushanbe is home to 9% of the TjDHS respondents, and 2% live in GBAO. 3.2 EDUCATION AND LITERACY Educational attainment is high in Tajikistan. The majority of women age 15-49 (94%) have some secondary-level education or higher. Relatively few respondents never went to school (2%) or attended school only at the primary level (4%) (Table 3.2). Over half of women in Tajikistan (56%) have completed a secondary or higher education (Figure 3.1). Eight percent of women have some professional primary or middle education, and 9% have a higher education. Women have completed a median of 9.8 years of schooling. T Figure 3.1 Education of survey respondents 2 2 2 38 39 8 9 No education Some primary Primary com- pleted Some sec- ondary Sec- ondary com- pleted Profes- sional primary/ middle Higher Percent distribution of women age 15-49 by highest level of schooling attended or completed 30 • Characteristics of Respondents Literacy Respondents who had attended higher than secondary school were assumed to be literate. All other respondents, shown a typed sentence to read aloud, were considered literate if they could read all or part of the sentence. Sample: Women age 15-49 The literacy rate is high (95%) among women in Tajikistan (Table 3.3). Five percent of women cannot read at all. Trends: The median number of years of schooling completed by women age 15-49 has increased only slightly since the 2012 TjDHS, from 9.4 years to 9.8 years; however, there has been a larger increase among women age 15-24, from 8.9 years to 10.0 years. The proportion of women age 15-49 with a higher education has increased somewhat over the past 5 years, from 6% to 9%. The proportion of women with no education has not changed (2% in both 2012 and 2017). Patterns by background characteristics  Urban women are notably more likely than rural women to have attended or completed schooling at the higher education level (19% versus 6%) (Table 3.2).  Women in DRS are least likely to have completed secondary school or higher (39%) compared with GBAO where they are most likely (84%) (Figure 3.2).  Women in GBAO and Dushanbe have a clear educational advantage over the rest of the country: 28% of women in GBAO and 27% in Dushanbe have some university education, as compared with 4% and 5% of women in DRS and Khatlon, respectively.  Women in GBAO have completed a median of 1.9 more years of schooling than women from DRS (10.7 years versus 8.8 years).  The median number of years of schooling exceeds the national average among women age 20-24 (10.3 years) and falls far below the average among women age 30-34 (9.0 years).  Women from the wealthiest households have completed a median of 1 more year of schooling than women from the poorest households (10.4 years versus 9.2 years).  Women age 25-29 and age 30-34 and women in Khatlon are relatively less likely to be literate (91% each) than women in other age groups and regions (95%-99%).  The literacy rate increases with increasing wealth, from 89% among women in the lowest wealth quintile to 98% among women in the highest quintile. Figure 3.2 Secondary education by region Note: Secondary education includes completed secondary, professional primary/middle, and higher education Characteristics of Respondents • 31 3.3 MASS MEDIA EXPOSURE AND INTERNET USAGE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered regularly exposed to that form of media. Sample: Women age 15-49 Data on women’s exposure to media are useful for understanding which women are likely to be reached by media campaigns disseminating family planning, health, and other information. Television is the form of media most commonly accessed at least weekly (87%) among women age 15-49 in Tajikistan. Women have considerably less regular exposure to the other two forms of media: 19% read a newspaper at least once a week, while 14% listen to the radio at least once a week (Table 3.4 and Figure 3.3). Twelve percent of women have no access to any of the three forms of media at least once a week. Internet usage The internet is a global network through which information is shared. Internet use includes accessing web pages, email, and social media. Sample: Women age 15-49 Twelve percent of women age 15-49 report having used the internet in the past 12 months. Among those who had used the internet in the past 12 months, less than half used it on a daily basis during the past month (46%), while over one-third (36%) used it at least once a week (Table 3.5). Trends: Weekly television exposure increased slightly from 84% in 2012 to 87% in 2017, while weekly exposure to newspapers and radio declined in the same time period (from 30% to 19% and from 26% to 14%, respectively). Although the proportion of women with no weekly media access declined slightly from 15% to 12%, the proportion with weekly access to all three mass media fell from 17% to 8%. These changes in levels of exposure to various media may relate at least in part to the rapid growth in computer ownership among Tajikistani households over the last 5 years, from 12% in 2012 to 21% in 2017 (see Chapter 2, Table 2.4). In addition, increased access to the internet (from 4% in 2012 to 27% in 2017), which accompanied computer ownership, may have affected usage of traditional mass media (Table 2.4). Patterns by background characteristics  Women age 15-19 are more likely to read a newspaper at least once a week (29%) than women in older age groups (13%-22%) and less likely to access none of the three media at least once a week (7% versus 11%-16%).  Rural women are more likely than their urban counterparts (13% versus 8%) to have no weekly exposure to any of the three media.  There is more variation in exposure to newspapers and radio than in exposure to television. Across regions, weekly television exposure ranges from 85% to 88%, while weekly newspaper access ranges from 12% to 41% and weekly radio access ranges from 6% to 33%. Figure 3.3 Exposure to mass media 19 87 14 8 12 Reads news- paper Watches television Listens to radio All three media None of these media Percentage of women age 15-49 who are exposed to media on a weekly basis 32 • Characteristics of Respondents  Exposure to newspapers and radio increases sharply with increasing education and wealth; exposure to television also rises with increasing education and wealth but less markedly.  Urban women are notably more likely than rural women to have used the internet in the past 12 months (26% versus 8%).  The percentage of women using the internet in the past 12 months is lowest among those in Khatlon (3%) and highest among those in Dushanbe (35%).  Internet use increases with increasing education and wealth. 3.4 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey. Sample: Women age 15-49 One in four women age 15-49 in Tajikistan are currently employed (Table 3.6). Trends: Current employment among women has decreased very slightly since 2012, from 27% to 25%. Patterns by background characteristics  The percentage of women employed at the time of the survey increases steadily with age, from 11% among those age 15-19 to 40% among those age 45-49.  Women who are currently married or who were previously married are more likely to be employed than those who have never been married. Half of women who are divorced, separated, or widowed (51%) are currently working, as compared with one-quarter of married women (24%) and 19% of never- married women.  Employment status varies widely by region. The current employment rate is highest in Sughd (31%) and lowest in DRS (14%) and ranges from 24% to 30% in other regions of Tajikistan.  The current employment rate generally increases with increasing education. Women with a higher education are three times more likely to be currently employed as women with no education or only a primary education (54% versus 18%) (Figure 3.4). 3.5 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, and agriculture. Sample: Women age 15-49 who were currently employed or had worked in the 12 months before the survey Figure 3.4 Employment status by education 18 16 22 45 54 No educa- tion/ primary General basic General secondary Profes- sional primary/ middle Higher Percentage of women age 15-49 who are currently employed Characteristics of Respondents • 33 Women who were employed in the 12 months preceding the survey were most likely to work in agriculture (33%); 30% were employed in professional, technical, or managerial positions, while 13% worked in sales and services, 13% in skilled manual labor, 11% in unskilled manual labor, and 1% in clerical jobs (Table 3.7 and Figure 3.5). Trends: Involvement in agricultural work has tripled among women in the past 5 years, from 10% in 2012 to 33% in 2017. In contrast, involvement in unskilled manual labor has decreased, from 45% to 11%. It is important to note that the classification of occupations in the 2017 TjDHS was based on the 2012 version of the International Standard Classification of Occupations (ISCO-08), as recommended by the International Labour Organization, while the 2012 TjDHS classification was based on the ISCO-88. As a result, due to significant changes in the classification structure1, trends in occupations between the 2012 and 2017 TjDHS surveys should be interpreted with caution. Patterns by background characteristics  Among women who were employed in the 12 months preceding the survey, women age 15-19 are more likely to have worked in agriculture (64%) than women in older age groups (25%-38%) and less likely to have worked in professional/technical/managerial occupations (3% versus 28%-37%).  Urban women, women from GBAO and Dushanbe, women with a professional or higher education, and women in the highest wealth quintile are most likely to be employed in professional, technical, or managerial occupations.  One-quarter or more of employed women in urban areas, in Dushanbe, and in the highest wealth quintile work in sales and services.  As expected, women in rural areas are much more likely to work in agricultural occupations than women in urban areas (44% versus 2%). Agricultural employment is also far more common among women in Khatlon (51%) and Sughd (30%) than among women in other regions (13% or less).  Approximately half of employed women who have a general basic education or less (52%-53%) and are in the lowest two wealth quintiles (49%-54%) are working in agriculture, as compared with 2% of women who have a higher education and are in the highest wealth quintile. 3.6 TYPE OF EMPLOYMENT Among women who were employed in the 12 months preceding the survey, three-quarters (75%) are paid in cash only and 9% are paid in cash and in-kind. Around 1 in 7 women are not paid (13%), and 3% receive only in-kind payments. Over half of women are employed by a non-relative (56%), one-quarter work for a family member, and 19% are self-employed (Table 3.8). Trends: The percentage of employed women who were paid in cash only increased from 53% in 2012 to 75% in 2017. The percentage of women engaged in agriculture who received cash only has also increased since 2012, from 5% to 47%. Similarly, the percentage of women engaged in nonagricultural work for cash 1 “The new occupation classification brought significant changes in the division of employment between occupations within individual sectors. The main issue here was reclassification of one occupational group to another” (Cedefop 2014). Figure 3.5 Occupation 30 1 13 13 11 33 Professional/ technical/managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Percentage of women age 15-49 employed in the 12 months before the survey by occupation 34 • Characteristics of Respondents only has increased from 59% to 89%. The proportion of women who are not paid or who are paid in-kind has decreased since 2012. Patterns by background characteristics  As expected, women who work in nonagricultural jobs are far more likely to be paid in cash for the work they do. Nearly 3 in 10 women employed in agriculture are not paid at all for their work (27%).  Women who work in agriculture are equally likely to be employed by family members and by non- family members (46% each). Women in nonagricultural jobs are more likely to be employed by a non- family member (60%) than to work for a relative (15%) or to be self-employed (25%).  Women’s employment in agricultural jobs is more often seasonal than year-round (89% versus 8%). Women in nonagricultural jobs are much more likely to be employed throughout the year (80%). 3.7 EMPLOYMENT ABROAD Tajikistan is a country that experiences a large outflux of citizens for the purpose of labor migration. Migrants contribute to the economies of both their country and their host country. According to data from the Statistical Agency under the President of the Republic of Tajikistan, labor migration decreased substantially between 2013 and 2016, from 793,449 to 435,457 independent labor migrants working abroad (SA 2016b). In 2016, personal received remittances were equivalent to 27% of Tajikistan’s gross domestic product (GDP), a decline from 42% in 2012 (World Bank 2018). The majority of Tajikistani labor migrants are men. Only 3% of women reported that they were working abroad at some point in the 3 years preceding the survey for 3 or more months at a time; conversely, 39% of currently married women reported that their spouse was working abroad during the 3 years preceding the survey for 3 or more months at a time (Table 3.9). Patterns by background characteristics  The proportion of women whose partners worked abroad generally decreases with age.  In general, urban women, those with a higher education, and those from the wealthiest households are less likely than rural, less educated, and less wealthy women to report that their husband was employed abroad.  By region, women in Sughd (42%), DRS (41%), and Khatlon (38%) were most likely to have spouses who worked abroad, while women in GBAO (20%) were least likely. 3.8 HISTORY OF DIABETES With rapid urbanization, sedentary lifestyles, and increasing rates of obesity, the prevalence of diabetes has increased over the years both worldwide and in Tajikistan. Diabetes mellitus is a group of diseases that are characterized by elevated blood glucose levels due to defects in insulin secretion or insulin action (ADA 2004, ADA 2014). As a result, blood glucose levels remain abnormally high over a prolonged period of time. If left untreated, diabetes can cause many complications, including heart attack, stroke, kidney failure, loss of vision, leg amputation, nerve damage, and premature death. The diagnosis of diabetes is usually made when classic diabetes signs and symptoms are associated with abnormal blood glucose (Pippitt et al. 2016). Blood glucose levels are determined through tests conducted in the laboratory by a health provider or self-tests administered at home. Seventeen percent of women age 15-49 in Tajikistan report having ever had their blood sugar measured by a health care provider, and 2% report having ever been told that they have high blood sugar or diabetes (Table 3.10). Characteristics of Respondents • 35 Patterns by background characteristics  The percentage of women who report having their blood sugar measured increases with age, from 5% among those age 15-19 to 31% among those age 45-49.  The likelihood of women having their blood sugar measured for diabetes by a health care provider increases with increasing body mass index2 (BMI), from 10% among women who are classified as thin to 29% among women who are obese.  Women who are urban, more educated, and wealthier are more likely to report having their blood sugar measured.  The proportion of women with their blood sugar measured ranges from 11% among those in Sughd to 39%-40% among those in GBAO and Dushanbe.  In general, women age 40-44 and age 45-49 (4%-6%), those who are obese (5%), and those living in GBAO (5%) are slightly more likely than other women (1%-3%) to have ever been told by a health provider that they have high blood glucose or diabetes. 3.9 HISTORY OF HIGH BLOOD PRESSURE Noncommunicable diseases are the main causes of death in Tajikistan, accounting for 64% of all deaths in 2015 (WHO 2017). Cardiovascular diseases, including heart attacks and strokes, accounted for 48% of all deaths registered in the country that same year (SA 2016a). High blood pressure or hypertension is among the major risk factors for cardiovascular disease. The 2017 TjDHS Woman’s Questionnaire included questions to determine if respondents’ blood pressure had ever been measured by a doctor or other health care provider and if they had been ever diagnosed as hypertensive. Table 3.11 summarizes the results of the questions relating to hypertension. Sixty-two percent of women age 15-49 report ever having had their blood pressure measured by a doctor or other health care provider, and 6% report ever having been told by a doctor or other health provider that their blood pressure was high. Among women who have ever been informed that they have high blood pressure or hypertension, 78% had been informed in the 12 months preceding the survey, 73% were prescribed medication to control their blood pressure, and 51% were taking medication to control their blood pressure at the time of the survey. Trends: The proportion of women age 15-49 who report ever having been told by a doctor or other health provider that their blood pressure was high decreased from 12% in 2012 to 6% in 2017. Patterns by background characteristics  The percentage of women who ever had their blood pressure measured by a health care provider generally increases with age, body mass index (BMI), education, and wealth.  The percentage of women who have had their blood pressure measured is lowest among those who live in Khatlon (49%).  As expected, the percentage of women who have ever been told they have high blood pressure or hypertension by a health provider increases directly with age, from 1% among those age 15-19 to 19% among those age 45-49. 2 The 2017 TjDHS obtained data on the height and weight of women age 15-49. This information was used to calculate each woman’s body mass index (BMI), a commonly used measure of nutritional status obtained by dividing weight in kilograms by height in meters squared (kg/m2). More information on BMI levels among TjDHS respondents is presented in Chapter 12. 36 • Characteristics of Respondents  Also as expected, obesity is strongly related to high blood pressure. The percentage of women who have been told they have high blood pressure is much higher among those classified as obese (17%) than among those classified as normal weight (4%) or thin (3%).  The percentage of women who have been told they have high blood pressure is similar among those in urban and rural areas and ranges from 4% in Dushanbe to 8% in DRS.  Among women who have ever been told they have high blood pressure or hypertension, there are regional variations in the proportions who have been prescribed medication (from 57% in GBAO to 84% in Dushanbe) and the proportions who are currently taking medication (from 32% in GBAO to 59% in Dushanbe). 3.10 HIGH BLOOD PRESSURE The 2017 TjDHS Woman’s Questionnaire included questions to determine if respondents were taking medication to control blood pressure. Respondents were also asked if their blood pressure could be measured as part of the survey. Hypertension Three measurements of systolic and diastolic blood pressure (measured in millimeters of mercury [mmHg]) were taken during the survey interview, with an interval of at least 10 minutes between measurements, using a digital oscillometric blood pressure measuring device with automatic upper-arm inflation and automatic pressure release. The average* of the second and third measurements was used to classify individuals with respect to hypertension. Respondents were classified as having hypertension if they had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or had a normal average blood pressure reading but were taking antihypertensive medication. Elevated blood pressure was classified as mild, moderate, or severe according to the cut-off points recommended by the World Health Organization (WHO 1999). These measurements in a survey situation do not constitute a medical diagnosis of disease; rather, they are used only as a statistical description of the survey population. Blood pressure category Systolic (mmHg) Diastolic (mmHg) Optimal <120 AND <80 Normal 120-129 OR 80-84 High normal 130-139 OR 85-89 Level of hypertension Grade 1, mildly elevated 140-159 OR 90-99 Grade 2, moderately elevated 160-179 OR 100-109 Grade 3, severely elevated 180+ OR 110+ Note: Respondents whose blood pressure fell into two different categories based on their average systolic and average diastolic levels were classified according to the highest blood pressure category in which they fell on either of the two measures. * If the third blood pressure measurement was missing, the second measurement was considered the average. If the second and third measurements were missing, the first measurement was considered the average. Sample: Women age 15-49 with valid blood pressure measurements Ninety-nine percent of women had valid blood pressure measurements taken as part of the survey (data not shown). Ten percent of women age 15-49 were classified as hypertensive: 2% with hypertension controlled by medication, 7% with Grade 1 hypertension, 1% with Grade 2 hypertension, and less than 1% with Characteristics of Respondents • 37 Grade 3 hypertension or severely elevated blood pressure (Table 3.12). An additional 9% of women had high-normal blood pressure. It should be noted that the blood pressure measurements taken in the survey are not intended to provide a medical diagnosis of the disease; therefore, the term hypertension as used here should be regarded as a statistical description of the survey population as opposed to a clinical diagnosis. Controlled hypertension Controlled hypertension is defined as having a systolic blood pressure level below 140 mmHg and a diastolic blood pressure level below 90 mmHg and currently taking antihypertensive medication to control blood pressure. Sample: Women age 15-49 with hypertension Among the 10% of women with high blood pressure, only 17% have controlled hypertension (Table 3.13). Patterns by background characteristics  The 2017 TjDHS results corroborate other epidemiological studies showing that hypertension is positively associated with age (Figure 3.6). The prevalence of hypertension is seven times higher among women age 45- 49 (28%) than among women age 20-24 (4%).  Significant differences in the prevalence of hypertension are found among women according to their body mass index (BMI). As expected, hypertension levels are higher among overweight/obese women than among those of normal weight (Figure 3.7). The rate of hypertension among obese women (BMI of 30 or above) is 28%, as compared with 2% among women who are thin (BMI below 18.5) and 6% among women of normal weight (BMI between 18.5 and 24.9).  Differentials in hypertension rates by urban- rural residence are negligible. However, by region, the prevalence of hypertension ranges from 7% among women in Dushanbe to 12% among women in DRS.  As expected, although not universal, controlled hypertension is higher among women diagnosed with high blood pressure by a health provider (42%) than the national average of 17% (Table 3.13). Figure 3.6 Hypertension by age Figure 3.7 Hypertension by Body Mass Index (BMI) 4 4 6 8 16 19 28 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group Percentage of women with hypertension* * A systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above or taking antihypertensive medication. The term hypertension as used in this figure is not meant to represent a clinical diagnosis of the disease; rather, it provides a statistical description of the survey population at the time of the survey. 2 6 12 28 10 Thin (BMI <18.5) Normal (BMI 18.5-24.9) Overweight (BMI 25.0-29.9) Obese (BMI ≥30.0) All women Percentage of women age 15-49 with hypertension* Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). * A systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above or taking antihypertensive medication. The term hypertension as used in this figure is not meant to represent a clinical diagnosis of the disease; rather, it provides a statistical description of the survey population at the time of the survey. 38 • Characteristics of Respondents  Similarly, only half of women currently on antihypertensive medication have effectively achieved controlled hypertension. Figure 3.8 shows the level of awareness and treatment status of hypertensive women. Four in 10 women with high blood pressure reported that they are aware of their condition (40%); 17% are being treated and have brought their blood pressure under control, and 15% are being treated but still have elevated blood pressure. Eight percent of hypertensive women are aware that they have elevated blood pressure but are not being treated, and 60% are unaware of their condition. Although the overall rate of hypertension among adult women in Tajikistan is relatively low, hypertension is a serious health problem among women age 45 and older and those who are obese. A first step toward bringing hypertension under control is awareness by individuals of their condition and its implications in terms of premature disability and death. Many Tajikistani women may suffer from hypertension but do not know it; hypertension is often termed the ‘silent killer’ because of the lack of warning signs or symptoms. Educating the population about the adverse effects of hypertension and promoting blood pressure screening, particularly among older individuals, should be an important focus of health programs. 3.11 TOBACCO USE The 2017 TjDHS included questions designed to assess the prevalence of tobacco use among women age 15-49. Tobacco use is rare among women in Tajikistan; only 0.5% reported that they regularly use tobacco (data not shown). LIST OF TABLES For more information on the characteristics of survey respondents, see the following tables:  Table 3.1 Background characteristics of respondents  Table 3.2 Educational attainment  Table 3.3 Literacy  Table 3.4 Exposure to mass media  Table 3.5 Internet usage  Table 3.6 Employment status  Table 3.7 Occupation  Table 3.8 Type of employment  Table 3.9 Respondent’s and partner’s employment abroad  Table 3.10 History of diabetes  Table 3.11 Blood pressure measured and medication prescribed and taken  Table 3.12 Blood pressure status  Table 3.13 Controlled hypertension Figure 3.8 Awareness of hypertension Unaware 60% Aware, treated, controlled 17% Aware, treated, not controlled 15% Aware, not treated 8% Awareness of hypertension and treatment status among women age 15-49 with hypertension Characteristics of Respondents • 39 Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Tajikistan DHS 2017 Background characteristic Weighted percent Weighted number Unweighted number Age 15-19 17.8 1,911 1,898 20-24 19.0 2,031 1,952 25-29 17.9 1,921 1,893 30-34 14.5 1,551 1,548 35-39 11.6 1,240 1,251 40-44 10.0 1,068 1,130 45-49 9.3 996 1,046 Marital status Never married 22.3 2,388 2,514 Married 71.9 7,709 7,499 Living together 0.4 38 46 Divorced/separated 3.9 416 471 Widowed 1.6 167 188 Residence Urban 25.1 2,694 4,212 Rural 74.9 8,024 6,506 Region Dushanbe 8.9 955 1,814 GBAO 2.0 209 973 Sughd 30.7 3,292 2,235 DRS 21.8 2,342 2,479 Khatlon 36.6 3,920 3,217 FTF districts 19.6 2,096 1,578 Education None/primary 5.8 619 601 General basic 33.7 3,615 3,468 General secondary 43.1 4,624 4,364 Professional primary/ middle 8.0 860 911 Higher 9.3 1,000 1,374 Wealth quintile Lowest 19.7 2,113 1,978 Second 19.6 2,101 1,693 Middle 19.7 2,109 1,753 Fourth 20.1 2,155 1,934 Highest 20.9 2,240 3,360 Total 100.0 10,718 10,718 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 40 • Characteristics of Respondents Table 3.2 Educational attainment Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Tajikistan DHS 2017 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary2 Completed secondary3 Profes- sional primary Profes- sional middle Higher Age 15-24 1.7 1.3 1.2 44.9 34.5 1.0 6.9 8.5 100.0 10.0 3,942 15-19 1.5 0.9 0.4 58.9 29.0 0.7 4.0 4.7 100.0 9.3 1,911 20-24 1.8 1.7 1.9 31.8 39.7 1.4 9.7 12.1 100.0 10.3 2,031 25-29 3.9 2.3 2.8 38.3 35.6 1.9 5.2 10.1 100.0 10.1 1,921 30-34 3.2 3.6 4.7 42.7 29.3 0.9 5.5 10.0 100.0 9.0 1,551 35-39 0.8 1.9 1.3 46.1 34.3 1.7 4.9 8.9 100.0 9.4 1,240 40-44 0.8 0.6 0.6 24.3 54.0 2.4 6.5 10.8 100.0 9.8 1,068 45-49 1.2 1.7 0.4 10.1 64.2 4.5 8.9 9.1 100.0 9.6 996 Residence Urban 1.0 2.6 1.3 32.0 33.5 2.2 7.9 19.4 100.0 10.2 2,694 Rural 2.4 1.6 2.0 40.3 40.3 1.5 5.8 5.9 100.0 9.6 8,024 Region Dushanbe 0.9 4.6 0.7 30.4 29.5 1.1 6.2 26.5 100.0 10.3 955 GBAO 0.4 0.5 0.3 15.1 42.0 4.8 8.9 28.1 100.0 10.7 209 Sughd 0.7 0.4 0.3 30.2 45.5 3.0 8.5 11.5 100.0 10.1 3,292 DRS 2.7 1.6 2.5 54.4 28.0 1.6 4.9 4.3 100.0 8.8 2,342 Khatlon 3.2 2.6 3.2 38.5 41.2 0.7 5.3 5.3 100.0 9.7 3,920 FTF districts 4.5 3.7 3.9 40.2 38.6 0.8 4.4 3.9 100.0 9.4 2,096 Wealth quintile Lowest 3.4 2.0 3.1 45.3 39.3 1.2 3.1 2.7 100.0 9.2 2,113 Second 2.3 2.0 2.0 45.1 38.7 1.1 4.5 4.3 100.0 9.3 2,101 Middle 2.7 1.1 1.7 39.0 41.9 2.0 6.0 5.5 100.0 9.8 2,109 Fourth 1.2 1.6 1.6 34.3 40.3 2.2 9.0 10.0 100.0 10.0 2,155 Highest 0.9 2.6 1.0 28.3 33.2 2.0 8.8 23.3 100.0 10.4 2,240 Total 2.1 1.9 1.9 38.2 38.6 1.7 6.3 9.3 100.0 9.8 10,718 1 Completed Grade 4 at the primary level 2 Attended or completed the general basic level (Grades 5-9) and attended but did not complete the general secondary level (Grades 10-11) 3 Completed Grade 11 at the secondary level or completed Grade 10 at the secondary level and has a general education school diploma (“attestat” as in older Soviet educational system terminology) Table 3.3 Literacy Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Tajikistan DHS 2017 Higher than secondary schooling No schooling, primary or secondary school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 16.5 68.3 11.6 3.6 0.0 0.0 100.0 96.4 3,942 15-19 9.4 78.1 8.9 3.6 0.0 0.0 100.0 96.4 1,911 20-24 23.2 59.1 14.1 3.6 0.1 0.0 100.0 96.3 2,031 25-29 17.1 57.4 16.6 8.8 0.1 0.0 100.0 91.1 1,921 30-34 16.5 53.5 20.6 9.5 0.0 0.1 100.0 90.5 1,551 35-39 15.5 63.6 15.6 5.3 0.0 0.0 100.0 94.7 1,240 40-44 19.6 64.2 13.5 2.4 0.2 0.0 100.0 97.4 1,068 45-49 22.5 60.8 13.3 3.1 0.0 0.3 100.0 96.6 996 Residence Urban 29.4 58.2 10.0 2.3 0.0 0.0 100.0 97.6 2,694 Rural 13.3 64.0 16.2 6.4 0.1 0.1 100.0 93.4 8,024 Region Dushanbe 33.9 56.0 8.9 1.1 0.0 0.1 100.0 98.8 955 GBAO 41.7 48.7 7.2 2.4 0.0 0.0 100.0 97.6 209 Sughd 23.0 66.6 7.9 2.4 0.1 0.0 100.0 97.4 3,292 DRS 10.9 69.6 14.3 5.1 0.0 0.2 100.0 94.8 2,342 Khatlon 11.2 57.3 22.2 9.3 0.0 0.0 100.0 90.6 3,920 FTF districts 9.1 50.3 27.8 12.8 0.0 0.0 100.0 87.2 2,096 Wealth quintile Lowest 6.9 60.7 21.8 10.4 0.1 0.1 100.0 89.4 2,113 Second 10.0 63.9 19.6 6.4 0.0 0.1 100.0 93.5 2,101 Middle 13.6 66.3 14.6 5.5 0.1 0.0 100.0 94.4 2,109 Fourth 21.1 66.5 9.1 3.3 0.1 0.0 100.0 96.6 2,155 Highest 34.1 55.6 8.4 1.8 0.0 0.1 100.0 98.2 2,240 Total 17.4 62.5 14.6 5.4 0.0 0.1 100.0 94.5 10,718 1 Refers to women who attended schooling higher than the secondary level and women who can read a whole sentence or part of a sentence Characteristics of Respondents • 41 Table 3.4 Exposure to mass media Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Tajikistan DHS 2017 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all 3 media at least once a week Accesses none of the 3 media at least once a week Number of women Age 15-19 29.4 90.8 14.5 9.5 6.7 1,911 20-24 17.9 87.6 14.0 8.5 11.1 2,031 25-29 13.2 85.0 12.1 6.3 13.6 1,921 30-34 15.3 83.1 12.0 6.1 16.2 1,551 35-39 16.5 86.2 13.7 7.5 12.3 1,240 40-44 22.2 86.9 17.6 10.8 11.8 1,068 45-49 21.7 85.9 15.1 9.1 12.7 996 Residence Urban 30.0 90.0 21.6 15.2 8.2 2,694 Rural 15.7 85.5 11.3 5.7 13.1 8,024 Region Dushanbe 38.7 87.2 33.4 26.7 9.9 955 GBAO 41.2 86.3 6.0 5.0 8.8 209 Sughd 23.1 88.4 17.9 11.2 10.8 3,292 DRS 15.8 87.0 9.2 4.0 12.1 2,342 Khatlon 12.4 84.9 9.0 3.6 13.2 3,920 FTF districts 10.1 79.8 9.9 3.4 17.9 2,096 Education None/primary 6.5 72.3 8.1 3.3 27.0 619 General basic 12.4 83.9 9.6 3.9 14.8 3,615 General secondary 15.5 88.3 12.9 6.8 10.5 4,624 Professional primary/ middle 34.5 90.1 18.6 12.7 6.9 860 Higher 57.3 95.3 33.4 28.2 2.3 1,000 Wealth quintile Lowest 10.0 79.1 6.1 2.1 19.8 2,113 Second 13.5 87.1 10.2 4.6 11.8 2,101 Middle 17.3 86.6 14.2 7.2 11.6 2,109 Fourth 20.7 89.8 15.1 9.0 9.1 2,155 Highest 34.3 90.4 23.2 17.0 7.4 2,240 Total 19.3 86.7 13.9 8.1 11.9 10,718 42 • Characteristics of Respondents Table 3.5 Internet usage Percentage of women age 15-49 who have ever used the internet, and percentage who have used the internet in the past 12 months; and among women who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Tajikistan DHS 2017 Ever used the internet Used the internet in the past 12 months Number of women Among respondents who have used the internet in the past 12 months, percentage who, in the past month, used the internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Total Number of women Age 15-19 11.2 10.8 1,911 43.9 37.6 16.0 2.4 100.0 206 20-24 16.3 15.1 2,031 55.1 34.2 9.9 0.8 100.0 307 25-29 15.4 14.1 1,921 47.2 35.6 14.5 2.8 100.0 271 30-34 14.9 13.0 1,551 44.0 36.5 16.3 3.1 100.0 202 35-39 12.7 11.0 1,240 37.7 33.9 24.3 4.0 100.0 136 40-44 12.8 11.1 1,068 43.8 34.5 19.4 2.3 100.0 119 45-49 11.4 8.9 996 35.2 39.8 25.0 0.0 100.0 89 Residence Urban 28.8 26.3 2,694 50.2 35.1 13.9 0.8 100.0 709 Rural 8.8 7.7 8,024 41.0 36.5 18.6 3.8 100.0 620 Region Dushanbe 39.6 34.9 955 46.0 35.5 18.3 0.1 100.0 333 GBAO 32.4 30.4 209 33.0 41.7 25.3 0.0 100.0 64 Sughd 22.3 19.9 3,292 45.8 34.7 15.9 3.6 100.0 654 DRS 6.9 6.3 2,342 57.4 31.3 9.4 2.0 100.0 148 Khatlon 3.6 3.3 3,920 39.8 43.6 14.5 2.1 100.0 131 FTF districts 3.9 3.6 2,096 32.0 46.2 19.2 2.6 100.0 75 Education None/primary 4.2 3.7 619 (56.4) (28.3) (11.5) (3.8) 100.0 23 General basic 5.5 5.1 3,615 43.4 35.0 19.7 1.9 100.0 184 General secondary 10.5 9.1 4,624 44.5 34.3 18.5 2.6 100.0 422 Professional primary/ middle 29.3 26.3 860 38.4 39.4 20.6 1.6 100.0 226 Higher 52.0 47.5 1,000 51.3 35.9 10.6 2.2 100.0 475 Wealth quintile Lowest 2.2 1.8 2,113 24.2 22.1 51.4 2.3 100.0 38 Second 4.9 4.0 2,101 37.0 34.6 26.9 1.5 100.0 85 Middle 8.4 7.5 2,109 31.2 46.6 18.5 3.7 100.0 157 Fourth 16.3 14.5 2,155 46.7 35.3 15.8 2.1 100.0 313 Highest 35.9 32.9 2,240 50.9 34.4 12.7 2.0 100.0 736 Total 13.8 12.4 10,718 45.9 35.7 16.1 2.2 100.0 1,329 Note: Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Respondents • 43 Table 3.6 Employment status Percent distribution of women age 15-49 by employment status, according to background characteristics, Tajikistan DHS 2017 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 11.1 0.3 88.6 100.0 1,911 20-24 15.8 0.6 83.6 100.0 2,031 25-29 22.2 1.3 76.4 100.0 1,921 30-34 29.3 1.1 69.7 100.0 1,551 35-39 34.9 1.2 63.9 100.0 1,240 40-44 35.9 1.4 62.6 100.0 1,068 45-49 40.0 1.4 58.6 100.0 996 Marital status Never married 19.3 0.6 80.1 100.0 2,388 Married or living together 24.2 1.0 74.8 100.0 7,747 Divorced/separated/ widowed 51.0 1.6 47.5 100.0 583 Number of living children 0 19.4 0.7 79.9 100.0 3,215 1-2 24.4 1.3 74.3 100.0 3,216 3-4 29.4 1.0 69.6 100.0 3,428 5+ 24.9 0.7 74.4 100.0 859 Residence Urban 25.9 1.2 72.9 100.0 2,694 Rural 24.1 0.9 75.0 100.0 8,024 Region Dushanbe 24.2 1.2 74.5 100.0 955 GBAO 29.5 2.9 67.5 100.0 209 Sughd 31.0 1.6 67.4 100.0 3,292 DRS 13.9 0.6 85.5 100.0 2,342 Khatlon 25.2 0.5 74.3 100.0 3,920 FTF districts 27.2 0.7 72.1 100.0 2,096 Education None/primary 17.8 0.8 81.4 100.0 619 General basic 15.9 0.6 83.5 100.0 3,615 General secondary 22.0 1.1 77.0 100.0 4,624 Professional primary/ middle 45.3 2.1 52.6 100.0 860 Higher 53.7 1.1 45.1 100.0 1,000 Wealth quintile Lowest 22.6 0.8 76.6 100.0 2,113 Second 24.4 0.5 75.1 100.0 2,101 Middle 23.3 0.9 75.8 100.0 2,109 Fourth 24.8 1.3 73.9 100.0 2,155 Highest 27.3 1.3 71.4 100.0 2,240 Total 24.5 1.0 74.5 100.0 10,718 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 44 • Characteristics of Respondents Table 3.7 Occupation Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Tajikistan DHS 2017 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Total Number of women Age 15-19 3.7 1.0 4.5 19.0 8.1 63.8 100.0 218 20-24 37.1 1.2 7.7 19.6 4.8 29.6 100.0 333 25-29 34.3 1.8 10.4 13.8 8.4 31.2 100.0 452 30-34 27.9 0.8 11.3 12.5 9.3 38.2 100.0 471 35-39 29.2 0.6 18.2 10.1 14.9 27.1 100.0 448 40-44 35.1 0.8 16.0 8.7 14.1 25.3 100.0 399 45-49 33.2 0.7 15.3 8.7 16.3 25.8 100.0 412 Marital status Never married 21.6 1.7 6.2 17.7 9.8 43.2 100.0 474 Married or living together 32.4 0.8 12.4 11.7 10.5 32.2 100.0 1,953 Divorced/separated/widowed 29.7 1.2 23.7 10.0 17.8 17.6 100.0 306 Number of living children 0 26.1 1.2 7.5 17.1 8.9 39.3 100.0 645 1-2 39.7 1.8 14.4 11.2 11.3 21.6 100.0 828 3-4 27.4 0.4 14.8 11.9 11.4 34.1 100.0 1,041 5+ 20.1 0.0 10.7 7.5 16.3 45.4 100.0 220 Residence Urban 42.3 2.5 26.0 15.4 12.0 1.8 100.0 729 Rural 25.8 0.4 7.7 11.5 10.9 43.6 100.0 2,004 Region Dushanbe 44.8 3.9 26.8 9.2 14.9 0.5 100.0 243 GBAO 63.8 1.9 8.6 4.6 16.1 4.9 100.0 68 Sughd 31.7 0.5 13.7 13.5 10.1 30.4 100.0 1,074 DRS 32.4 1.1 11.6 22.0 19.5 13.4 100.0 340 Khatlon 22.2 0.6 8.6 9.8 8.2 50.6 100.0 1,008 FTF districts 18.2 0.2 7.8 5.8 4.9 63.0 100.0 586 Education None/primary 9.4 0.8 10.7 10.8 15.7 52.7 100.0 115 General basic 1.2 0.2 12.5 16.3 17.4 52.4 100.0 596 General secondary 3.6 0.3 17.1 18.1 15.4 45.4 100.0 1,066 Professional primary/middle 74.1 1.3 9.8 5.9 3.7 5.3 100.0 408 Higher 85.3 2.8 6.5 3.1 0.7 1.5 100.0 548 Wealth quintile Lowest 16.7 0.0 6.9 8.6 18.6 49.3 100.0 495 Second 22.8 0.0 4.0 10.0 9.7 53.5 100.0 523 Middle 26.3 0.4 8.7 14.5 8.7 41.3 100.0 511 Fourth 33.4 1.1 15.1 17.2 8.8 24.5 100.0 562 Highest 47.1 2.8 25.0 12.2 10.6 2.3 100.0 641 Total 30.2 1.0 12.6 12.6 11.2 32.5 100.0 2,733 Characteristics of Respondents • 45 Table 3.8 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Tajikistan DHS 2017 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 47.3 88.7 75.2 Cash and in-kind 18.7 4.9 9.4 In-kind only 7.5 0.5 2.8 Not paid 26.6 5.9 12.7 Total 100.0 100.0 100.0 Type of employer Employed by family member 45.9 15.1 25.1 Employed by non-family member 46.2 60.4 55.7 Self-employed 7.9 24.6 19.2 Total 100.0 100.0 100.0 Continuity of employment All year 7.9 80.0 56.6 Seasonal 89.3 11.9 37.1 Occasional 2.7 8.0 6.4 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 887 1,843 2,733 Note: Total includes women with missing information on type of employment who are not shown separately. 46 • Characteristics of Respondents Table 3.9 Respondent’s and partner’s employment abroad Percentage of women age 15-49 who worked abroad during the 3 years before the survey for 3 or more months at a time, and percentage of currently married women age 15-49 who said that their husband worked abroad during the 3 years before the survey for 3 or more months at a time, by background characteristics, Tajikistan DHS 2017 All women Currently married or living together Background characteristic Worked abroad1 Number of women Partner worked abroad1 Number of women Age 15-19 1.0 1,911 36.9 240 20-24 3.2 2,031 44.6 1,557 25-29 3.8 1,921 41.1 1,688 30-34 4.4 1,551 41.2 1,374 35-39 4.6 1,240 37.4 1,089 40-44 5.0 1,068 30.6 953 45-49 2.7 996 28.6 847 Marital status Never married 1.2 2,388 na na Married or living together 4.1 7,747 38.5 7,747 Divorced/separated/ widowed 3.5 583 na na Residence Urban 3.9 2,694 28.7 1,803 Rural 3.2 8,024 41.5 5,944 Region Dushanbe 3.3 955 21.8 585 GBAO 7.3 209 20.2 144 Sughd 3.7 3,292 42.2 2,533 DRS 3.2 2,342 41.4 1,709 Khatlon 3.1 3,920 37.9 2,776 FTF districts 3.8 2,096 50.2 1,548 Education None/primary 3.9 619 42.9 468 General basic 3.0 3,615 40.4 2,532 General secondary 2.9 4,624 37.2 3,442 Professional primary/ middle 5.5 860 41.3 626 Higher 4.8 1,000 32.9 680 Wealth quintile Lowest 2.0 2,113 35.9 1,469 Second 2.3 2,101 42.1 1,508 Middle 3.2 2,109 44.3 1,606 Fourth 4.4 2,155 40.3 1,668 Highest 5.0 2,240 29.3 1,496 Total 3.4 10,718 38.5 7,747 na = Not applicable 1 Employment abroad refers to working abroad during the 3 years before the survey for 3 or more months at a time. Characteristics of Respondents • 47 Table 3.10 History of diabetes Percentage of women age 15-49 who have ever had their blood sugar measured by a doctor or other health care provider and who have been told by a health care provider that they have high blood sugar or diabetes, according to background characteristics, Tajikistan DHS 2017 Background characteristic Ever had blood sugar measured by doctor or health care provider Ever told have high blood sugar or diabetes by doctor or health care provider Number of women Age 15-19 5.2 0.9 1,911 20-24 14.4 1.3 2,031 25-29 17.3 1.7 1,921 30-34 18.0 1.1 1,551 35-39 21.7 2.7 1,240 40-44 26.7 3.9 1,068 45-49 30.5 5.8 996 Currently pregnant Pregnant 21.8 1.6 795 Not currently pregnant 17.0 2.2 9,923 Nutritional status: Body Mass Index (BMI)1 Thin (BMI <18.5) 10.4 1.1 747 Normal (BMI 18.5-24.9) 14.5 1.4 5,969 Overweight (BMI 25.0-29.9) 19.8 2.3 2,609 Obese (BMI ≥30.0) 28.5 5.3 1,394 Residence Urban 24.4 2.6 2,694 Rural 15.0 2.0 8,024 Region Dushanbe 39.7 2.7 955 GBAO 38.8 4.6 209 Sughd 11.3 1.2 3,292 DRS 18.8 2.4 2,342 Khatlon 15.0 2.5 3,920 FTF districts 13.2 2.7 2,096 Education None/primary 17.4 1.8 619 General basic 14.8 1.4 3,615 General secondary 16.7 2.5 4,624 Professional primary/middle 21.4 2.9 860 Higher 26.0 2.3 1,000 Wealth quintile Lowest 13.4 1.8 2,113 Second 14.6 1.5 2,101 Middle 14.9 2.2 2,109 Fourth 16.2 2.5 2,155 Highest 27.0 2.6 2,240 Total 17.3 2.1 10,718 1 The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 48 • Characteristics of Respondents Table 3.11 Blood pressure measured and medication prescribed and taken Percentage of women age 15-49 who have ever had their blood pressure measured by a doctor or other health care provider and who have been told by a health care provider that they have high blood pressure or hypertension, and among women who have been told they have high blood pressure or hypertension, percentage told in the past 12 months they have high blood pressure or hypertension, percentage prescribed medication to control blood pressure, and percentage taking medication to control blood pressure, according to background characteristics, Tajikistan DHS 2017 Ever had blood pressure measured by doctor or health care provider Ever told have high blood pressure or hypertension by doctor or health care provider Number of women Among women who have been told by a doctor or health care provider they have high blood pressure or hypertension, percentage who were: Background characteristic Told in the past 12 months have high blood pressure or hypertension Prescribed medication to control blood pressure Taking medication to control blood pressure Number of women Age 15-19 26.7 1.2 1,911 * * * 23 20-24 63.3 3.1 2,031 54.4 39.5 29.9 63 25-29 68.5 4.1 1,921 65.7 60.9 40.1 80 30-34 68.8 5.3 1,551 66.0 65.5 39.7 82 35-39 74.0 9.0 1,240 78.9 74.9 48.7 111 40-44 73.4 11.1 1,068 90.8 78.9 53.2 118 45-49 74.1 19.0 996 90.6 87.4 67.3 189 Currently pregnant Pregnant 74.9 4.3 795 (60.9) (61.4) (34.4) 34 Not currently pregnant 60.7 6.4 9,923 79.3 73.6 51.9 632 Nutritional status: Body Mass Index (BMI)1 Thin (BMI <18.5) 47.5 2.5 747 * * * 19 Normal (BMI 18.5-24.9) 57.7 3.7 5,969 70.4 63.1 43.8 218 Overweight (BMI 25.0-29.9) 68.8 7.5 2,609 81.1 73.0 45.7 195 Obese (BMI ≥30.0) 73.5 16.8 1,394 85.1 84.5 63.8 234 Residence Urban 64.5 5.6 2,694 80.9 79.5 57.2 150 Rural 60.8 6.4 8,024 77.6 71.1 49.2 516 Region Dushanbe 59.5 4.4 955 79.5 84.3 58.6 42 GBAO 69.3 6.8 209 64.1 56.6 32.0 14 Sughd 77.3 5.0 3,292 82.1 75.1 51.5 164 DRS 61.3 7.7 2,342 73.3 64.5 42.2 181 Khatlon 49.1 6.7 3,920 79.9 76.6 56.5 264 FTF districts 37.8 5.8 2,096 78.0 76.0 54.2 122 Education None/primary 57.1 7.2 619 (74.1) (66.3) (43.5) 44 General basic 55.6 4.9 3,615 71.1 66.2 47.1 178 General secondary 62.7 7.5 4,624 81.6 75.9 53.8 345 Professional primary/middle 75.3 6.4 860 79.4 79.1 56.9 55 Higher 70.8 4.4 1,000 84.1 77.3 45.3 44 Wealth quintile Lowest 56.3 6.6 2,113 76.4 66.2 45.8 140 Second 58.7 6.3 2,101 75.6 64.6 39.4 133 Middle 61.8 5.3 2,109 79.2 82.0 56.0 112 Fourth 67.0 7.3 2,155 78.9 70.9 57.4 157 Highest 64.6 5.6 2,240 81.8 84.3 56.8 124 Total 61.7 6.2 10,718 78.3 73.0 51.0 666 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). Characteristics of Respondents • 49 Table 3.12 Blood pressure status Among women age 15-49, percent distribution of blood pressure values, percentage having normal blood pressure and taking antihypertensive medication, and prevalence of hypertension, according to background characteristics, Tajikistan DHS 2017 Classification of blood pressure1 Blood pres- sure less than 140/90 mmHg and currently taking anti- hypertensive medication Prevalence of hypertension2 Number of women3 Background characteristic Optimal SBP <120 and DBP <80 mmHg Normal SBP 120-129 and DBP 80-84 mmHg High normal SBP 130-139 and DBP 85-89 mmHg Mildly elevated (Grade 1) SBP 140-159 or DBP 90-99 mmHg Moderately elevated (Grade 2) SBP 160-179 or DBP 100-109 mmHg Severely elevated (Grade 3) SBP 180+ or DBP 110+ mmHg Total Age 15-19 73.7 16.9 6.2 3.0 0.1 0.0 100.0 0.5 3.7 1,895 20-24 71.1 19.6 6.4 2.9 0.1 0.0 100.0 0.9 3.8 2,026 25-29 69.9 20.2 5.7 3.7 0.3 0.1 100.0 1.6 5.7 1,917 30-34 62.8 21.4 9.1 5.5 1.0 0.2 100.0 1.3 8.1 1,543 35-39 49.7 24.2 12.9 11.1 1.5 0.6 100.0 2.5 15.7 1,236 40-44 41.3 25.8 16.4 12.7 2.7 1.1 100.0 2.1 18.6 1,060 45-49 33.7 27.9 15.2 15.3 5.8 2.2 100.0 4.7 27.9 996 Currently pregnant Pregnant 73.5 18.2 6.0 2.3 0.0 0.0 100.0 1.5 3.9 795 Not pregnant or not sure 60.2 21.7 9.5 6.9 1.3 0.5 100.0 1.7 10.3 9,878 Previously diagnosed with high blood pressure by a health provider4 Ever diagnosed 26.2 20.4 16.6 23.3 10.0 3.5 100.0 26.9 63.7 663 Diagnosed in the last 12 months 21.6 21.2 16.3 25.0 11.5 4.4 100.0 31.2 72.1 520 Not diagnosed in the last 12 months 43.0 17.5 17.7 17.4 4.3 0.0 100.0 11.4 33.2 144 Never diagnosed 63.5 21.5 8.7 5.4 0.6 0.2 100.0 0.0 6.3 10,010 Currently taking antihypertensive medication Yes 18.9 19.2 14.7 28.4 14.0 4.8 100.0 52.8 100.0 338 No 62.6 21.5 9.0 5.8 0.8 0.3 100.0 0.0 6.9 10,335 Nutritional status: Body Mass Index (BMI)5 Thin (BMI <18.5) 79.2 15.1 3.8 1.6 0.2 0.0 100.0 0.6 2.4 744 Normal (BMI 18.5- 24.9) 69.8 18.9 6.8 4.0 0.4 0.1 100.0 1.2 5.7 5,941 Overweight (BMI 25.0-29.9) 51.6 26.3 12.3 7.7 1.5 0.6 100.0 1.7 11.5 2,598 Obese (BMI ≥30.0) 32.9 26.1 16.7 17.7 4.8 1.8 100.0 4.1 28.4 1,390 Residence Urban 63.9 20.1 8.8 5.9 1.0 0.3 100.0 1.6 8.8 2,675 Rural 60.3 21.8 9.3 6.7 1.3 0.5 100.0 1.7 10.2 7,998 Region Dushanbe 72.3 13.9 8.6 4.7 0.5 0.0 100.0 1.6 6.9 939 GBAO 54.3 24.4 11.1 7.4 2.5 0.3 100.0 0.7 10.8 209 Sughd 55.7 25.6 9.9 6.7 1.6 0.5 100.0 0.7 9.5 3,290 DRS 62.8 18.5 9.0 7.7 1.5 0.6 100.0 1.8 11.6 2,317 Khatlon 62.6 21.2 8.9 6.1 0.8 0.4 100.0 2.5 9.8 3,918 FTF districts 60.7 22.9 7.7 6.9 1.1 0.7 100.0 1.9 10.5 2,094 Education None/primary 61.8 20.2 9.2 6.9 1.0 0.8 100.0 2.2 10.9 617 General basic 64.6 20.1 8.3 5.9 0.8 0.3 100.0 1.4 8.4 3,596 General secondary 59.4 21.8 9.8 7.0 1.5 0.6 100.0 2.0 11.0 4,610 Professional primary/ middle 58.1 22.7 9.6 7.5 1.9 0.2 100.0 1.3 10.9 858 Higher 59.5 23.8 9.8 5.5 1.0 0.4 100.0 0.9 7.9 992 Wealth quintile Lowest 58.6 20.6 10.9 7.6 1.8 0.4 100.0 1.3 11.1 2,107 Second 61.1 22.4 8.3 6.8 0.7 0.7 100.0 1.3 9.5 2,088 Middle 62.0 21.8 8.9 5.9 1.0 0.4 100.0 1.7 9.1 2,104 Fourth 60.4 21.7 9.5 6.4 1.5 0.4 100.0 2.4 10.8 2,152 Highest 63.8 20.5 8.6 6.0 0.9 0.3 100.0 1.5 8.7 2,223 Total 61.2 21.4 9.2 6.5 1.2 0.4 100.0 1.7 9.8 10,673 1 The average of the second and third measurements is used to classify individuals with respect to hypertension. If the third blood pressure measurement was missing, the second measurement was considered the average. If the second and third blood pressure measurements were missing, the first measurement was considered the average. When a respondent’s average systolic blood pressure (SBP) and average diastolic blood pressure (DBP) fell into different categories, the higher category was applied. 2 A woman was classified as having hypertension if she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control her blood pressure. The term hypertension as used in this table is not meant to represent a clinical diagnosis of the disease; rather, it provides a statistical description of the survey population at the time of the survey. 3 Includes pregnant women 4 Hypertension excludes respondents with blood pressure values less than 140/90 mmHg who were ever told they have high blood pressure or hypertension by a doctor or health care provider and who do not take antihypertensive medications. 5 The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 50 • Characteristics of Respondents Table 3.13 Controlled hypertension Prevalence of controlled hypertension among women age 15-49 with hypertension, according to background characteristics, Tajikistan DHS 2017 Background characteristic Prevalence of controlled hypertension1 Number of women with hypertension2,3 Age 15-19 14.6 69 20-24 23.6 77 25-29 27.4 109 30-34 16.0 125 35-39 16.1 194 40-44 11.3 197 45-49 16.7 278 Currently pregnant Pregnant (38.6) 31 Not pregnant or not sure 16.3 1,020 Previously diagnosed with high blood pressure by a health provider4 Ever diagnosed 42.2 422 Diagnosed in the last 12 months 43.2 375 Not diagnosed in the last 12 months 34.4 48 Never diagnosed 0.0 628 Currently taking antihypertensive medication Yes 52.8 338 No 0.0 713 Nutritional status: Body Mass Index (BMI)5 Thin (BMI <18.5) * 18 Normal (BMI 18.5-24.9) 21.4 338 Overweight (BMI 25.0-29.9) 15.1 299 Obese (BMI ≥30.0) 14.3 395 Residence Urban 18.1 236 Rural 16.7 814 Region Dushanbe 24.0 65 GBAO 6.2 23 Sughd 7.1 313 DRS 15.9 268 Khatlon 25.3 382 FTF districts 17.7 220 Education None/primary 20.5 67 General basic 16.7 303 General secondary 18.4 508 Professional primary/middle 12.1 94 Higher 11.9 78 Wealth quintile Lowest 11.7 235 Second 14.0 198 Middle 19.1 190 Fourth 22.6 233 Highest 17.6 194 Total 17.0 1,050 Note: The average of the second and third measurements is used to classify individuals with respect to hypertension. If the third blood pressure measurement was missing, the second measurement was considered the average. If the second and third blood pressure measurements were missing, the first measurement was considered the average. When a respondent’s average systolic and average diastolic blood pressure fell into different categories, the higher category was applied. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Controlled hypertension is defined as having a systolic blood pressure level below 140 mmHg and having a diastolic blood pressure level below 90 mmHg and currently taking antihypertensive medication to control blood pressure among all women age 15-49 with hypertension. 2 A woman was classified as having hypertension if she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control her blood pressure. The term hypertension as used in this table is not meant to represent a clinical diagnosis of the disease; rather, it provides a statistical description of the survey population at the time of the survey 3 Includes pregnant women. 4 Hypertension excludes respondents with blood pressure values less than 140/90 mmHg who were ever told they have high blood pressure or hypertension by a doctor or health care provider and who do not take antihypertensive medications. 5 The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). Marriage and Sexual Activity • 51 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings  Current marital status: 72% of women age 15-49 are currently in a union; 6% are divorced, separated, or widowed; and 22% have not yet married.  Age at first marriage: Less than 1% of women age 25- 49 had married by age 15, and only 13% had married by age 18. The median age at first marriage was the same in 2017 as in 2012 (20.2 years).  Sexual initiation: The median ages at first sexual intercourse and first marriage are identical among women age 25-49 (20.2 years), reflecting the fact that very few women report engaging in sexual activity before marriage. arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have other profound consequences for women’s lives. 4.1 MARITAL STATUS Currently married Women who report being married or living together with a partner as though married at the time of the survey. Sample: Women age 15-49 In Tajikistan, 72% of women age 15-49 are currently married. Reflecting the traditional character of Tajik society, virtually all of these women are in formal unions; less than 1% report they are living together with a partner. Around one-fifth of women (22%) have never been married, 4% are divorced or separated, and 2% are widowed (Table 4.1 and Figure 4.1). Most Tajik women marry at least once during their lifetime. The proportion who have never been married decreases rapidly with age, from 87% among women age 15-19 to 20% among women age 20-24. Only 2% of women age 40-49 have never married. Women age 45-49 are most likely to be divorced or separated (7%) or widowed (6%). M Figure 4.1 Marital status Never married 22% Married or living together 72% Divorced/ separated 4% Widowed 2% Percent distribution of women age 15-49 52 • Marriage and Sexual Activity Trends: The percentage of women age 15-49 who were currently married increased from 67% in 2012 to 72% in 2017. Most of that change was due to increases in the proportions of women age 20-24 (68% in 2012 versus 77% in 2017) and age 25-29 (83% in 2012 versus 88% in 2017) who were currently married. 4.2 POLYGYNY Polygyny Women who report that their husband or partner has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 Polygynous unions are not common in Tajikistan. Overall, 3% of women report that their husband (or partner) has other wives (Table 4.2). Almost all women in polygynous unions report their husband has only one other wife. The proportion of polygynous unions increases with age, from less than 1% among women age 15-24 to 5% among women age 40-44. Women in Khatlon (5%), women with no education or only a primary education (4%), and women in the lowest wealth quintile (4%) are most likely to report that they have co- wives. 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women age 25-49 Table 4.3 shows that less than 1% of women age 25-49 had married by age 15, and only 13% had married by age 18. The pace of marriage was quite rapid after age 18, with 47% of women age 25-49 marrying by age 20 and 86% marrying by age 25. The median age at first marriage among women age 25-49 was 20.2 years. Trends: The median age at which women age 25-49 first married was the same in 2017 as in 2012 (20.2 years). Patterns by background characteristics  The median age at first marriage among women age 25-49 was only slightly higher in urban than in rural areas (20.5 years versus 20.1 years) (Table 4.4).  GBAO has the highest median age at marriage (23.1 years), followed by Dushanbe (20.8 years) (Figure 4.2). 4.4 AGE AT FIRST SEXUAL INTERCOURSE Median age at first sexual intercourse Age by which half of respondents have had sexual intercourse. Sample: Women age 25-49 Figure 4.2 Women’s median age at marriage by region 20.8 23.1 20.0 20.1 20.3 Dushanbe GBAO Sughd DRS Khatlon Median age at first marriage among women age 25-49 Marriage and Sexual Activity • 53 Tajikistan is a traditional society. In such settings, women are unlikely to engage in or admit to engaging in sexual intercourse before marriage. Thus, it is not surprising that the findings with respect to age at first intercourse among women age 25-49 (Tables 4.5 and 4.6) closely parallel the information the women reported with regard to the age at which they first married. The median age at first intercourse among women age 25-49 is in fact identical to the median age at which these women first married (20.2 years) (Figure 4.3). 4.5 RECENT SEXUAL ACTIVITY Sexual activity exposes women to the risk of pregnancy if no contraceptive method is being used. Table 4.7 shows that 78% of women age 15-49 have ever had sexual intercourse, and 47% had sex during the 4 weeks before the survey. Marital status is closely related to sexual activity. Most currently married women (92%) had sex within the year before the survey, and 65% had sex within the 4 weeks before the survey. The opposite pattern is observed among women who were divorced, separated, or widowed, 90% of whom had not had sex during the year before the survey. Only 2% of never-married women had ever had sex, and most of those women reported they last had sex 1 or more years before the survey. LIST OF TABLES For more information on marriage and sexual activity, see the following tables:  Table 4.1 Current marital status  Table 4.2 Number of women’s co-wives  Table 4.3 Age at first marriage  Table 4.4 Median age at first marriage by background characteristics  Table 4.5 Age at first sexual intercourse  Table 4.6 Median age at first sexual intercourse by background characteristics  Table 4.7 Recent sexual activity Figure 4.3 Median age at first sex and first marriage 20.2 20.2 Median age at first sex Median age at first marriage Median age in years among women age 25-49 54 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Tajikistan DHS 2017 Age Marital status Total Percentage currently in union Number of women Never married Married Living together Divorced Separated Widowed 15-19 87.0 12.5 0.1 0.4 0.0 0.0 100.0 12.6 1,911 20-24 20.4 76.3 0.3 2.5 0.0 0.4 100.0 76.6 2,031 25-29 6.4 87.4 0.5 4.7 0.0 1.0 100.0 87.9 1,921 30-34 5.2 88.2 0.4 4.8 0.3 1.2 100.0 88.6 1,551 35-39 4.8 87.3 0.5 5.0 0.0 2.5 100.0 87.8 1,240 40-44 2.4 88.7 0.6 5.4 0.2 2.8 100.0 89.3 1,068 45-49 2.2 84.6 0.4 6.6 0.0 6.1 100.0 85.0 996 Total 22.3 71.9 0.4 3.8 0.1 1.6 100.0 72.3 10,718 Table 4.2 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, and percentage of currently married women with one or more co-wives, according to background characteristics, Tajikistan DHS 2017 Background characteristic Number of co-wives Total Percentage with one or more co- wives1 Number of women 0 1 2+ Don’t know Age 15-19 99.2 0.6 0.0 0.2 100.0 0.6 240 20-24 97.1 0.8 0.0 2.1 100.0 0.8 1,557 25-29 96.5 1.3 0.0 2.2 100.0 1.3 1,688 30-34 93.9 2.3 0.3 3.5 100.0 2.6 1,374 35-39 92.2 4.0 0.4 3.4 100.0 4.4 1,089 40-44 91.9 4.2 0.5 3.4 100.0 4.8 953 45-49 92.9 3.5 0.0 3.6 100.0 3.5 847 Residence Urban 94.0 2.9 0.1 3.1 100.0 2.9 1,803 Rural 94.9 2.2 0.2 2.7 100.0 2.4 5,944 Region Dushanbe 95.0 2.0 0.1 2.9 100.0 2.1 585 GBAO 99.2 0.4 0.0 0.4 100.0 0.4 144 Sughd 97.3 0.4 0.0 2.3 100.0 0.4 2,533 DRS 94.8 2.2 0.3 2.7 100.0 2.5 1,709 Khatlon 91.9 4.4 0.2 3.5 100.0 4.6 2,776 FTF districts 91.7 2.7 0.3 5.3 100.0 3.0 1,548 Education None/primary 91.4 3.6 0.6 4.4 100.0 4.2 468 General basic 94.2 2.9 0.3 2.6 100.0 3.2 2,532 General secondary 95.2 1.7 0.0 3.0 100.0 1.7 3,442 Professional primary/ middle 95.5 2.4 0.2 1.9 100.0 2.6 626 Higher 95.1 2.6 0.3 2.0 100.0 2.9 680 Wealth quintile Lowest 92.7 3.9 0.3 3.1 100.0 4.3 1,469 Second 94.8 2.2 0.3 2.8 100.0 2.4 1,508 Middle 95.5 1.7 0.1 2.7 100.0 1.8 1,606 Fourth 95.8 1.4 0.1 2.7 100.0 1.5 1,668 Highest 94.4 2.8 0.0 2.8 100.0 2.8 1,496 Total 94.7 2.4 0.2 2.8 100.0 2.5 7,747 1 Excludes women who responded “don’t know” when asked if their husband has other wives Marriage and Sexual Activity • 55 Table 4.3 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Tajikistan DHS 2017 Percentage first married by exact age: Percentage never married Number of women Median age at first marriage Current age 15 18 20 22 25 15-19 0.0 na na na na 87.0 1,911 a 20-24 0.1 8.7 56.0 na na 20.4 2,031 19.7 25-29 0.2 10.0 45.1 73.1 89.5 6.4 1,921 20.3 30-34 0.3 10.3 36.0 63.5 83.1 5.2 1,551 20.9 35-39 0.7 19.6 48.5 67.5 80.8 4.8 1,240 20.1 40-44 0.2 22.0 61.4 77.4 88.0 2.4 1,068 19.3 45-49 0.0 7.4 49.8 78.7 90.0 2.2 996 20.0 20-49 0.3 12.3 49.0 na na 8.2 8,807 a 25-49 0.3 13.3 46.9 71.4 86.3 4.6 6,776 20.2 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50% of the women began living with their spouse or partner for the first time before reaching the beginning of the age group Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 25-49, according to background characteristics, Tajikistan DHS 2017 Background characteristic Women age 25-49 Residence Urban 20.5 Rural 20.1 Region Dushanbe 20.8 GBAO 23.1 Sughd 20.0 DRS 20.1 Khatlon 20.3 FTF districts 20.2 Education None/primary 20.9 General basic 19.9 General secondary 19.9 Professional primary/middle 20.9 Higher 22.0 Wealth quintile Lowest 20.5 Second 20.2 Middle 20.1 Fourth 20.0 Highest 20.4 Total 20.2 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner. 56 • Marriage and Sexual Activity Table 4.5 Age at first sexual intercourse Percentage of women age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Tajikistan DHS 2017 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number of women Median age at first intercourse Current age 15 18 20 22 25 15-19 0.1 na na na na 87.0 1,911 a 20-24 0.1 7.6 54.9 na na 20.1 2,031 19.8 25-29 0.3 8.8 45.5 72.8 89.3 6.1 1,921 20.3 30-34 0.2 8.5 38.8 65.0 84.2 4.6 1,551 20.8 35-39 0.7 17.7 49.9 68.1 82.2 4.1 1,240 20.0 40-44 0.2 16.0 61.7 79.4 89.6 1.8 1,068 19.4 45-49 0.0 4.8 48.7 78.7 91.0 1.4 996 20.1 20-49 0.2 10.1 49.4 na na 7.7 8,807 a 25-49 0.3 10.9 47.8 72.1 87.1 4.0 6,776 20.2 15-24 0.1 na na na na 52.5 3,942 a na = Not applicable due to censoring a = Omitted because less than 50% of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 25-49, according to background characteristics, Tajikistan DHS 2017 Background characteristic Women age 25-49 Residence Urban 20.4 Rural 20.1 Region Dushanbe 20.5 GBAO 23.1 Sughd 20.0 DRS 20.0 Khatlon 20.2 FTF districts 20.0 Education None/primary 20.6 General basic 19.8 General secondary 19.9 Professional primary/middle 21.0 Higher 21.9 Wealth quintile Lowest 20.5 Second 20.2 Middle 20.0 Fourth 19.9 Highest 20.3 Total 20.2 Marriage and Sexual Activity • 57 Table 4.7 Recent sexual activity Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Tajikistan DHS 2017 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Age 15-19 9.5 3.3 0.2 87.0 100.0 1,911 20-24 46.8 25.7 7.5 20.1 100.0 2,031 25-29 55.8 26.2 11.9 6.1 100.0 1,921 30-34 56.8 24.8 13.8 4.6 100.0 1,551 35-39 59.3 20.8 15.8 4.1 100.0 1,240 40-44 64.3 19.0 14.9 1.8 100.0 1,068 45-49 57.9 19.9 20.8 1.4 100.0 996 Marital status Never married 0.0 0.1 1.9 98.0 100.0 2,388 Married or living together 65.4 26.8 7.7 0.1 100.0 7,747 Divorced/separated/ widowed 2.0 8.2 89.7 0.0 100.0 583 Marital duration2 0-4 years 62.9 31.1 5.7 0.2 100.0 1,926 5-9 years 61.4 30.2 8.5 0.0 100.0 1,794 10-14 years 66.7 24.7 8.5 0.0 100.0 1,160 15-19 years 67.8 23.3 8.9 0.0 100.0 814 20-24 years 71.6 21.3 7.0 0.0 100.0 853 25+ years 67.5 24.2 8.4 0.0 100.0 828 Married more than once 70.0 21.9 8.0 0.0 100.0 372 Husband’s/partner’s residence3 Resident 72.6 21.8 5.5 0.1 100.0 6,886 Nonresident 8.0 66.8 25.1 0.0 100.0 861 Residence Urban 50.1 11.7 14.0 24.2 100.0 2,694 Rural 46.5 22.6 9.8 21.1 100.0 8,024 Region Dushanbe 47.5 7.4 15.8 29.3 100.0 955 GBAO 49.6 14.5 9.5 26.5 100.0 209 Sughd 48.6 24.3 8.0 19.1 100.0 3,292 DRS 48.6 20.8 9.5 21.1 100.0 2,342 Khatlon 45.5 18.9 12.9 22.6 100.0 3,920 FTF districts 42.6 23.6 13.5 20.4 100.0 2,096 Education None/primary 46.9 22.8 13.9 16.5 100.0 619 General basic 45.0 19.9 10.5 24.6 100.0 3,615 General secondary 48.7 20.9 9.9 20.6 100.0 4,624 Professional primary/ middle 47.3 19.7 14.7 18.3 100.0 860 Higher 50.6 13.6 11.1 24.6 100.0 1,000 Wealth quintile Lowest 43.5 20.6 11.4 24.4 100.0 2,113 Second 45.0 21.1 11.9 22.0 100.0 2,101 Middle 47.1 25.0 8.3 19.6 100.0 2,109 Fourth 51.5 20.7 9.1 18.7 100.0 2,155 Highest 49.7 12.3 13.3 24.6 100.0 2,240 Total 47.4 19.9 10.8 21.9 100.0 10,718 Note: Total includes women with missing information on timing of last sexual intercourse. 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 3 Resident husband/partner resides with the respondent; a nonresident husband/partner lives elsewhere. Fertility • 59 FERTILITY 5 Key Findings  Total fertility rate: The total fertility rate for the 3 years preceding the 2017 TjDHS was 3.8 births per woman. The rate at the time of the 2012 TjDHS was also 3.8 births, highlighting the stability of fertility behavior in Tajikistan.  Birth interval: The median birth interval is 28.8 months, with 36% of births occurring less than 24 months after the preceding birth.  Postpartum insusceptibility: The median duration of postpartum insusceptibility (that is, the period of time after giving birth that a woman is not at risk of pregnancy) is 6.8 months.  Age at first birth: The median age at first birth among women age 25-49 is 21.9 years.  Teenage childbearing: 7% of women age 15-19 have begun childbearing; 3% have already given birth, and 4% are pregnant with their first child. he number of children that a woman bears depends on many factors, including the age she begins childbearing, how long she waits between births, and her fecundity. Postponing first births and extending the interval between births have played a role in reducing fertility levels in many countries. These factors also have positive health consequences. In contrast, short birth intervals (of less than 24 months) can lead to harmful outcomes for both newborns and their mothers, such as preterm birth, low birth weight, and death. Childbearing at a very young age is associated with an increased risk of complications during pregnancy and childbirth and higher rates of neonatal mortality. This chapter describes the current level of fertility in Tajikistan and some of its proximate determinants. It presents information on the total fertility rate, birth intervals, insusceptibility to pregnancy (due to postpartum amenorrhea, postpartum abstinence, or menopause), age at first birth, and teenage childbearing. 5.1 CURRENT FERTILITY Total fertility rate The average number of children a woman would have by the end of her childbearing years if she bore children at the current age-specific fertility rates. Age-specific fertility rates are calculated for the 3 years before the survey, based on detailed birth histories provided by women. Sample: Women age 15-49 The total fertility rate (TFR) in Tajikistan is 3.8 births per woman (Table 5.1). The pace of childbearing increases rapidly with age, rising from a rate of 54 births per 1,000 women in the 15-19 age group to a peak of 303 births per 1,000 women in the 20-24 age group. At most ages, age-specific fertility rates are T 60 • Fertility higher among rural than urban women (Figure 5.1), with the gap especially marked among women age 20-24. Overall, the TFR is 4.0 births per woman in rural areas, as compared with 3.0 births in urban areas. Trends: The TFR remained stable at 3.8 births per woman between the 2012 and 2017 TjDHS surveys (Table 5.2). The TFR in rural areas increased slightly between the two surveys, from 3.9 births in 2012 to 4.0 births in 2017, while the TFR in urban areas dropped from 3.3 births to 3.0 births (Figure 5.2). Patterns by background characteristics  By region, the TFR is highest in Khatlon (4.1 births per woman) and DRS (4.0 births per woman) and lowest in Dushanbe (2.7 births per woman) (Figure 5.3).  The TFR generally declines with increasing education, from 3.9 to 4.0 births among women with a general secondary education or less to 2.8 births among women with a higher education (Table 5.3).  The TFR in the highest wealth quintile is 3.0 births per woman, which is considerably lower than the rates in the other quintiles (3.8 to 4.1 births). Figure 5.3 Fertility by region Total fertility rate for the 3 years before the survey Figure 5.1 Age-specific fertility rates Figure 5.2 Trends in fertility by residence 0 50 100 150 200 250 300 350 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group Births per 1,000 women Urban Rural Total 3.8 3.3 3.93.8 3.0 4.0 Total Urban Rural TFR for the 3 years before each survey 2012 TjDHS 2017 TjDHS Fertility • 61 5.2 CHILDREN EVER BORN AND LIVING The 2017 TjDHS collected information on the total number of children ever born to women age 15-49 and the number of their children who were still alive. Table 5.4 shows that, on average, women age 15-49 have had 2.11 children, of whom 2.0 survived to the time of the survey. The mean number of children ever born increases with age, peaking at 3.9 among women age 45-49. Only 1% of currently married women age 45-49 have never given birth, suggesting that primary infertility (the inability to bear a child) is low in Tajikistan. 5.3 BIRTH INTERVALS Median birth interval Number of months since the preceding birth by which half of children are born. Sample: Non-first births in the 5 years before the survey Short birth intervals, particularly intervals less than 24 months, are associated with increased health risks for both mothers and newborns. In Tajikistan, more than one in three (36%) non-first births occur within 24 months of a previous birth, with 17% taking place less than 18 months after a preceding birth (Figure 5.4). The median birth interval is 28.8 months (Table 5.5). Trends: The median birth interval in 2017 is 2 months shorter than in 2012 (28.8 months versus 30.8 months). Patterns by background characteristics  The median birth interval increases markedly with the

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